Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

Pediatr Mar-Apr 07

28-03-07

17:22

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¶·È‰È·ÙÚÈ΋ ¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ™. ∞Ó‰ÚÔÓ›ÎÔ˘ ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ E. °·Ï·Ó¿Î˘ §. £ˆÌ·˝‰Ô˘ ª. ∫·Ó¿ÚÈÔ˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë A. K·ÙÙ¿Ì˘ ™. K›ÙÛÈÔ˘-∆˙¤ÏË ∞. ¶··‰ÔÔ‡ÏÔ˘ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ª. ∆ÛÔÏÈ¿

∆fiÌÔ˜ 70 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2007

¶ÂÚȯfiÌÂÓ· xi ∂¶π™∆√§∏ ∞¶√ ∆√¡ ¢π∂À£À¡∆∏ ™À¡∆∞•∏™ ∫. ™ÙÂÊ·Ó›‰Ë˜ ∂¶π∫∞πƒ√ £∂ª∞ 81 ∆Ô ÂÌ‚fiÏÈÔ HPV ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞ƒ£ƒA ™À¡∆∞•∏™ 83 Homocystinuria due to cystathionine ‚-synthase deficiency S. H. Mudd 85 Prevention of unintentional injury: relevance to paediatricians N. Spencer ∞¡∞™∫O¶∏™∂π™

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ º. ª·˘ÚÔÂȉ‹ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘

87 Creating a safer Europe for children A. J. Nicholson, D. Van Esso, I. Malcic, A. Biver 93 ∞ÛʷϤ˜ ·È¯Ó›‰È ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜: ÂÌfi‰È· Î·È ÚÔÔÙÈΤ˜ ¶. °ÚËÁÔÚ›Ô˘, ∞. ∆ÂÚ˙›‰Ë˜, ∂. ¶ÂÙÚ›‰Ô˘ ∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶ÈÂÚ›·˜ 1∞ 144 51 MÂÙ·ÌfiÚʈÛË TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889

ISSN 0377-2551

97 ∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ ∞. ∫·Ê¿ÙÔ˜, Ã. ÷Ù˙‹˜, ª. §ÈÓ·Ú‰¿Î˘, ¢. ∞ı·Ó·ÛfiÔ˘ÏÔ˜, Ã. §ÈÔÓ‹˜, ∂. ª·ÏˆÌÂÓ¿ÎË, ∞. ∫·ÓÈÛ¿Î˘, ∂. ™Ù·Ì·Ù¿ÎË Î·È ™˘ÓÂÚÁ·˙fiÌÂÓÔÈ ÂÚ¢ÓËÙ¤˜ 107 ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜, Û˘¯ÓfiÙËÙ· ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ Î·È ·˘ÙÔ·ÓÔÛ›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ∂. ∫·ÏÔ˘Ì¤ÓÔ˘, §. ¡ÙÔ‡ÓÙ·˜, ª. ∞Ï‚È˙¿ÎË, °. ª·ÛÙÔÚ¿ÎÔ˜, ∞. ª¿ÓÙ˙Ô˘, ∞. ∞ÓÙˆÓ›Ô˘, Ã. §·‰fiÔ˘ÏÔ˜, Ã. ªÂÁÁÚ¤ÏË, ¢. ÃÈÒÙ˘, π. ¶··ÛˆÙËÚ›Ô˘, ∞. ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË 115 ¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÛÙË ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ∂. ªÔ‡˙·, π. ∞ÓÙˆÓÈ¿‰Ô˘, ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘, ª. ∞Ó·ÁÓˆÛÙ¿ÎÔ˘, º. ∞Ó·ÙÔÏ›ÙÔ˘, ª. ªÔÚÔ˙›ÓË, °. ™·Ú·Ê›‰Ô˘, ª. •¿ÓıÔ˘

123 ∫·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Û ·È‰È¿ Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·: ¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ· ·ÔÙÂϤÛÌ·Ù· π. ¶··ÁÈ¿ÓÓ˘, °. ∫˘Ú‚·Û›Ï˘, π. ™ÔÊÈ·Ó›‰Ô˘, ∫. §¿ÛηÚË, ª. ∫È¿ÊÊ·, ™. ∞ÔÛÙÔÏÔÔ‡ÏÔ˘, ™. ƒ¿ÌÌÔ˜ 135 ÃÚ‹ÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ Î·È Û˘ÌÏËڈ̷ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ Û ·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ∞. ¶Ô˘ÚÙÛ›‰Ë˜, ¢. ¢ÔÁ¿Ó˘, ª. ª¿Î·, ª. µ·Ú‚Ô˘ÙÛ‹, ¢. ªÔ˘¯Ô‡ÙÛÔ˘, ¶. ÷Ù˙‹, ∂. ∫ÔÛÌ›‰Ë 141 H ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ ÚÒÙ˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÚÈÓ ÙËÓ ÂÊ˂›· ÛÙÔ ÓÔÌfi ∞ÙÙÈ΋˜ ∞. ∫·ÙÛ·Ê¿‰Ô˘, µ. ¶··Â˘·ÁÁ¤ÏÔ˘, °. ºÂÚÂÓÙ›ÓÔ˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™ 146 Homocystinuria due to cystathionine ‚-synthase deficiency: two sides to the same coin P. Augoustides-Savvopoulou, H. Ioannou, N. Kozeis, A. Karagiannidou, M. Athanasiou-Metaxa 152 ¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ª. £ÂÔ‰ˆÚ›‰Ô˘, µ. µ·ÛÈÏÔÔ‡ÏÔ˘, ∞. ∑ËÛÔ‡ÏË, °. ªÔÛÙÚÔ‡, µ. ™˘ÚÈÔÔ‡ÏÔ˘ 156 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞ - ¶fiÛ˜ ‰fiÛÂȘ ÙÔ˘ Ó¢ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È; - ∆ËÏÂʈÓÈ΋ (·È‰)È·ÙÚÈ΋ - ∫ÔÚÙÈÎÔÂȉ‹ Î·È Kawasaki - °Ú›Ë ÙˆÓ ÙËÓÒÓ, Í·Ó¿ Î·È Í·Ó¿ - ∂ԯȷ΋ ÁÚ›Ë: ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹ fi¯È;

∂. °·Ï·Ó¿Î˘ 158 ∫§π¡π∫√ ∫√Àπ∑

Ã. ∫ÒÛÙ·ÏÔ˜ 159 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ∂ÊË‚È΋ ÀÁ›· ¡. ¶··‰fiÔ˘ÏÔ˜ 163 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ ¡ÂÎÚÔÏÔÁ›·: R. J. Gorlin Ã. ™. ª·ÚÙÛfiη˜

Pediatr Mar-Apr 07

28-03-07

17:22

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Paediatriki Bimonthly Publication of the Greek Paediatric Society President A. Constantopoulos Editorial Board Editor-in-Chief C. Stefanidis Members S. Andronikou P. Augoustides-Savvopoulou A. Vazeou-Gerasimidi G. Varlamis ∂. Galanakis L. Thomaidou M. Kanariou ∂. Katsarou-Pectasides A. Kattamis S. Kitsiou-Tzeli ∞. Papadopoulou N. Papadopoulos A. Siamopoulou-Mavridou M. Tsolia Manuscript Editing Greek Editing F. Mavroidi English Editing S. Nakou

Volume 70 ñ Number 2 ñ March-April 2007

Contents xi LETTER FROM THE EDITOR-IN-CHIEF C. Stefanidis CURRENT ISSUE 81 HPV vaccination A. Constantopoulos EDITORIAL COMMENTARIES 83 Homocystinuria due to cystathionine ‚-synthase deficiency S. H. Mudd 85 Prevention of unintentional injury: relevance to paediatricians N. Spencer REVIEW ARTICLES 87 Creating a safer Europe for children A. J. Nicholson, D. Van Esso, I. Malcic, A. Biver 93 Safer play for children in playgrounds: barriers and prospects P. Grigoriou, A. Terzidis, E. Petridou ORIGINAL ARTICLES

Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 1∞ Pierias St. GR - 144 51, Metamorfossi 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

97 Atherogenic risk factors in preschool children in Crete A. Kafatos, C. Hatzis, M. Linardakis, D. Athanasopoulos, C. Lionis, E. Balomenaki, A. Kapnisakis, H. Stamataki and Collaborative researchers 107 Thyroid volume, prevalence of subclinical hypothyroidism and autoimmunity in children and adolescents I. Kaloumenou, L. Duntas, M. Alevizaki, G. Mastorakos, E. Mantzou, A. Antoniou, C. Ladopoulos, C. Mengreli, D. Chiotis, I. Papassotiriou, C. Dacou-Voutetakis 115 Neurodevelopmental outcome of very low birth weight neonates at preschool age H. Bouza, I. Antoniadou, H. Antonopoulou, M. Anagnostakou, F. Anatolitou, M. Morosini, J. Sarafidou, ª. Xanthou

123 Radiofrequency catheter ablation of accessory pathways in children: immediate and long-term results J. Papagiannis, G. Kirvassilis, I. Sofianidou, C. Laskari, M. Kiaffas, S. Apostolopoulou, S. Rammos 135 Use of alternative and complementary therapy by paediatric oncology patients in Greece A. Pourtsidis, D. Doganis, M. Baka, M. Varvoutsi, D. Bouhoutsou, P. Xatzi, H. Kosmidis 141 The epidemiology of chickenpox in schoolage children from the prefecture of Attica ∞. Katsafadou, V. Papaevangelou, G. Ferentinos, A. Constantopoulos CASE REPORTS 146 Homocystinuria due to cystathionine ‚-synthase deficiency: two sides to the same coin P. Augoustides-Savvopoulou, H. Ioannou, N. Kozeis, A. Karagiannidou, M. Athanasiou-Metaxa 152 Neurocysticercosis in childhood: a case report M. Theodoridou, V. Vasilopoulou, A. Zisouli, G. Mostrou, V. Syriopoulou 156 PAEDIATRIC NEWS IN BRIEF ∂. Galanakis 158 CLINICAL QUIZ

C. Costalos 159 NEWS FROM THE INTERNET Adolescent health websites N. Papadopoulos 163 LETTER TO THE EDITOR Obituary: R. J. Gorlin C. S. Bartsokas

Pediatr Mar-Apr 07

28-03-07

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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

™Ù¤ÏÏ· ∞Ó‰ÚÔÓ›ÎÔ˘, πˆ¿ÓÓÈÓ· ¡ÂÔÁÓÔÏÔÁ›·

Stella Andronikou, Ioannina Neonatology

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, £ÂÛÛ·ÏÔÓ›ÎË KÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·

Persefoni Avgoustides-Savvopoulou, 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

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, ∏Ú¿ÎÏÂÈÔ ∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·

Emmanuel Galanakis, Herakleion Ethics and Deontology

§ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘, ∞ı‹Ó· ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜

Loretta Thomaidou, Athens Developmental Pediatrics

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó· ∞ÓÔÛÔÏÔÁ›·

Maria Kanariou, Athens Immunology

∂˘ÛÙ·ı›· ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë, ∞ı‹Ó· ¡Â˘ÚÔÏÔÁ›·

Eustathia Katsarou-Pektasides, Athens Neurology

∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ı‹Ó· ∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·

Antonis Kattamis, Athens Haematology - √ncology

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞ı‹Ó· °ÂÓÂÙÈ΋

Sophia Kitsiou-Tzeli, Athens Genetics

∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, ∞ı‹Ó· °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ∏·ÙÔÏÔÁ›· - ¢È·ÙÚÔÊ‹

Alexandra Papadopoulou, Athens Gastroenterology - Hepatology - Nutrition

¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ı‹Ó· ∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶Ó¢ÌÔÓÔÏÔÁ›·

Nicos Papadopoulos, Athens Allergology - Pneumonology

∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡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

Peter Hoyer, Essen, Germany

Ellis D. Avner, Milwaukee, USA

Jan Janda, Prague, Czech Republic

Swati Bhave, New Delhi, India

Jan Kimpen, Ultrecht, Netherlands

Alberto Bissot, Panama, Panama

Craig B. Langman, Chicago, USA

David Branski, Jerusalem, Israel

John Manis, Boston, USA

Francesco Chiarelli, Chieti, Italy

Manuel Moya, Alicante, Spain

Chok-Wan Chan, Hong Kong, China

Hugh O'Brodovich, Toronto, Canada

Denis Daneman, Toronto, Canada

Ross Petty, Vancouver, 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

Nick J. Spencer, Coventry, UK

Margaret C. Fisher, Philadelphia, USA

Alfred Tenore, Udine, Italy

Raif Geha, Boston, USA

Alkis Togias, Bethesda, USA

Adenike Grange, Lagos, Nigeria

Eva Tsalikian, Iowa City, USA

Judith G. Hall, Vancouver, Canada

Catherine Weil-Olivier, Paris, France

Patricia Hamilton, London, UK

Max Zach Graz, Austria

Enver Hasanoglu, Ankara, Turkey

Johannes Zschocke, Heidelberg, Germany

Christer Holmberg, Helsinki, Finland

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Pediatr Mar-Apr 07

28-03-07

17:22

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∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏

EDITORIAL

∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ™·˜ ¢¯·ÚÈÛÙԇ̠ÁÈ· Ù· ÎÔϷ΢ÙÈο Û·˜ Û¯fiÏÈ· ÁÈ· ÙȘ ‚ÂÏÙÈÒÛÂȘ Ô˘ ¤ÁÈÓ·Ó ÙfiÛÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË fiÛÔ Î·È ÛÙÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. £· ı¤Ï·Ì ӷ Û·˜ ÂÓËÌÂÚÒÛÔ˘Ì fiÙÈ Ù· Ó¤· ̤ÏË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ Â›Ó·È Ë Î. ™Ù¤ÏÏ· ∞Ó‰ÚÔÓ›ÎÔ˘ (¡ÂÔÁÓÔÏÔÁ›·), Ô Î. ª·ÓÒÏ˘ °·Ï·Ó¿Î˘ (∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·), Ë Î. ™ÔÊ›· ∫›ÙÛÈÔ˘ (°ÂÓÂÙÈ΋) Î·È Ë Î. §ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘ (∞Ó·Ù˘ÍȷΤ˜ ¢È·Ù·Ú·¯¤˜). √È Û˘Ó¿‰ÂÏÊÔÈ ·˘ÙÔ› ¤¯Ô˘Ó Ì·ÎÚfi¯ÚÔÓË ›ڷ Î·È Â›Ì·È ‚¤‚·ÈÔ˜ fiÙÈ ı· Û˘Ì‚¿ÏÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÛÙËÓ ÂÎÏ‹ÚˆÛË ÙˆÓ ÛÙfi¯ˆÓ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. √ Î. ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜ Î·È Ë Î. ∂ϤÓË ∞ÓÙˆÓÔÔ‡ÏÔ˘ ·Ô¯ÒÚËÛ·Ó ·fi ÙË ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹. £· ı¤Ï·Ì ӷ ÙÔ˘˜ ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÁÈ· ÙËÓ Ô˘ÛÈ·ÛÙÈ΋ Û˘Ì‚ÔÏ‹ ÙÔ˘˜. ∞fi ÙËÓ ·Ú¯‹ ÙÔ˘ ¯ÚfiÓÔ˘ Ë ÂΉÔÙÈ΋ ‰ÈÂÚÁ·Û›· Á›ÓÂÙ·È ËÏÂÎÙÚÔÓÈο Ì ÛÙfi¯Ô ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ÎÚ›Û˘ ÙˆÓ ÂÚÁ·ÛÈÒÓ. °È· ÙË ‰È¢ÎfiÏ˘ÓÛ‹ Û·˜ ÌÔÚ›Ù ӷ ˘Ô‚¿ÏÏÂÙ ÙȘ ÂÚÁ·Û›Â˜ Û·˜ ËÏÂÎÙÚÔÓÈο. ¶ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ ÁÈ· ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ ı· ‚Ú›Ù ÛÙȘ “√‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜” ·˘ÙÔ‡ ÙÔ˘ Ù‡¯Ô˘˜. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÙËÚÂ›Ù·È Ë ¤ÎÙ·ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ηıÔÚ›˙ÂÙ·È ÛÙȘ Ô‰ËÁ›Â˜. £· ‹Ù·Ó ‰˘Ó·Ùfi Ó· ‰ËÌÔÛȇÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜ Û οı Ù‡¯Ô˜, ·Ó Ù· ΛÌÂÓ· ‹Ù·Ó Û˘ÓÙÔÌfiÙÂÚ·. ÕÏψÛÙ ÔÈ ÔÏ˘Û¤Ïȉ˜ ‰ËÌÔÛȇÛÂȘ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË ·Ó·ÁÓˆÛÈÌfiÙËÙ·. °È· Ó· ÂÍÔÈÎÔÓÔÌËı› ¯ÒÚÔ˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi ÔÈ “√‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜” ı· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÌfiÓÔ ÛÙÔ ÚÒÙÔ Ù‡¯Ô˜ οı ¯ÚfiÓÔ˘ Î·È ÛÙËÓ ÈÛÙÔÛÂÏ›‰· Ù˘ “¶·È‰È·ÙÚÈ΋˜”. ∞fi ·˘Ùfi ÙÔ Ù‡¯Ô˜ ÍÂÎÈÓ¿ÂÈ Ì›· Ó¤· ÛÂÈÚ¿ ¿ÚıÚˆÓ Ì ۯÔÏÈ·ÛÌfi ÚfiÛÊ·ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Ù· “™‡ÓÙÔÌ· ·È‰È·ÙÚÈο Ó¤·”. ∂Ï›˙Ô˘Ì fiÙÈ ı· Ù· ‚Ú›Ù ÂӉȷʤÚÔÓÙ·. ™Ù· ÂfiÌÂÓ· Ù‡¯Ë ı· ‰ËÌÔÛȇÔÓÙ·È ÌÂÙÂÎ·È‰Â˘ÙÈο ¿ÚıÚ· Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È ÂÚˆÙ‹ÛÂȘ ÔÏÏ·ÏÒÓ ··ÓÙ‹ÛˆÓ. ∆¤ÏÔ˜, fiÏÔÈ ÔÈ ·Ó·ÁÓÒÛÙ˜ ÌÔÚÔ‡Ó Ó· Ì·˜ ÛÙ›ÏÔ˘Ó ÂÚˆÙ‹Ì·Ù· Ô˘ ÙÔ˘˜ ··Û¯ÔÏÔ‡Ó ÛÙË Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ ÙÔ˘˜ Ú¿ÍË. ∆· ÂÚˆÙ‹Ì·Ù· ·˘Ù¿ ı· ·ÔÙÂϤÛÔ˘Ó Ù· ı¤Ì·Ù· ÁÈ· ÙË Ó¤· ÛÂÈÚ¿ ¿ÚıÚˆÓ: “ƒˆÙ‹ÛÙ ÙÔÓ ÂȉÈÎfi”. ªÂ ıÂÚÌÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Dear colleagues, Thank you for your kind comments on the improvements of the layout and the content of the journal.

We would like to inform you that the new members of the Editorial Board are Dr Stella Andronikou (Neonatology), Dr Manolis Galanakis (Medical Ethics), Dr Sophia Kitsiou (Genetics) and Dr Loretta Thomaidou (Developmental Pediatrics). These colleagues have long experience in their respective fields and we believe that they will contribute to the success of the journal. Dr Christos Kostalos and Dr Eleni Antonopoulou stepped down from the Editorial Board. We would like to thank them for their contribution.

The editorial process of the journal is handled electronically since the beginning of this year. All papers can now be submitted by e-mail. Detailed information about the submission of articles is included in the “Instructions to authors” of this issue. We would like to emphasize the importance of compliance to the suggested length of publications. We will be able to publish a larger number of papers if the manuscripts are shorter. In addition shorter papers are more reader friendly. To save space you will find the “Instructions to authors” only in the first issue of each year and at the web page of the journal.

A new section: “Paediatric news in brief” will start from this issue with comments on recent pediatric articles. We hope that you will find this section interesting. Educational articles will be included in the next issues with multiple choice answers. Finally we invite you to send us questions that arise from your every day practice. These questions will become the topics of the new section: “Ask the expert”.

Warm greetings Constantinos Stefanidis Editor-in-Chief

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Pediatr Mar-Apr 07

xii

28-03-07

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™ÂÏ›‰·12

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

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.

4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.

5. ∫ÏÈÓÈο ∫Ô˘›˙.

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

7. ∂›Î·ÈÚ· ı¤Ì·Ù·.

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

9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ.

10. ™‡ÓÙÔÌ· Ó¤·.

11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

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

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜ Î·È ¿ÚıÚ· Ì Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì Â›Î·ÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

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

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

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ.

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˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ. ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋. ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤ·/ˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙÔ˘˜. ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ñ ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

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

K›ÌÂÓÔ ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋

OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹

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

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË, Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË.

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

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

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ

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

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

Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562.

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

™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜, ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó: ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 40 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 20 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. ñ ÙȘ 10 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors/ Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus [List of Journals Indexed in Index Medicus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)]. ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

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. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂÚ·›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. 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

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

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. 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· ·ÔÛÙ¤ÏÏÂÙ·È Û ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹ Î·È Û ·Ú¯Â›· ˘„ËÏ‹˜ ·Ó¿Ï˘Û˘. ™Â ÂÚ›ÙˆÛË Ô˘ ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi, ÙÔ ˘ÏÈÎfi ı· ·ÔÛÙ¤ÏÏÂÙ·È Ù·¯˘‰ÚÔÌÈÎÒ˜ Î·È ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ ı· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÔÛÙ¤ÏÏÔÓÙ·È ÛÙËÓ ËÏÂÎÙÚÔÓÈ΋ ‰È‡ı˘ÓÛË Ù˘ ÂÙ·ÈÚ›·˜ (hps@ath.forthnet.gr). ™Â ͯˆÚÈÛÙfi Ì‹Ó˘Ì· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

“√È ÂÚ›ÔÏÔÈ Ù˘ ÂÈÚ‹Ó˘” Diana Marcela Cortes, 10 ¯ÚÔÓÒÓ, ∫ÔÏÔÌ‚›· ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“The patrol of the Peace”, Diana Marcela Cortes, 10 years old, Colombia Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, ̤ۈ e-mail Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word. ™Â ͯˆÚÈÛÙfi ·Ú¯Â›Ô ı· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÂÈÛÙÔÏ‹ fiÔ˘ ı· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

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

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ËÏÂÎÙÚÔÓÈο ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÙÔ ·Ú¯Â›Ô ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. ™ÂÏ›‰· Ù›ÙÏÔ˘ Ô˘ ÂÚȤ¯ÂÈ: ·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰. fiÓÔÌ·, ‰È‡ı˘ÓÛË, ËÏÂÎÙÚÔÓÈ΋ ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·.

2. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋ (200-250 ϤÍÂȘ), ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

3. §¤ÍÂȘ ÎÏÂȉȿ.

4. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ.

5. ∫›ÌÂÓÔ.

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

7. µÈ‚ÏÈÔÁÚ·Ê›·.

8. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

9. ∂ÈÎfiÓ˜ (Ë Î·ıÂÌ›· Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ.

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™À¡∆√ª√°ƒ∞ºπ∂™ o

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

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

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

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

ABBREVIATIONS

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

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

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

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Editorials (upon invitation by the Editorial Board).

Review articles.

Award-winning articles.

Original articles.

Clinical Quiz.

Round tables.

Current issues.

Issues of healthcare management and education.

Case reports.

News.

Brief reports.

Letters to the editor.

Abstracts.

Future congresses and events.

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 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.

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.

Units of measures of laboratory analyses Laboratory analyses should be expressed in the Système International (SI) units and in the metric (Conventional)

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system in parentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf 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.

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.

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 40 in original articles; ñ 20 in current issues and case reports; ñ 10 in brief reports and letters.

Doctoral dissertation: Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995.

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)].

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

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.

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.

πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

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.cancerpain.org/ Tables and Figures 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.) should be sent in high resolution electronic files. If this is not possible, material should be sent by post; in that case 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.

C. Manuscript Submission and Publication All manuscripts should be sent to the Greek Paediatric Society by e-mail (hps@ath.forthnet.gr). In a separate e-mail authors should state 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. In a separate file a cover letter should be submitted in Word format specifying in detail the modifications or objections to the reviewers’ suggestions.

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

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.

Before submitting your paper by e-mail, make sure the file contains: 1. The title 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, e-mail and telephone number;

“ªÔÓ·¯ÈÎfi §Ô˘ÏÔ‡‰È” Cheryl Desjardins, 15 ÂÙÒÓ, ∫·Ó·‰¿˜ ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“A single Flower”, Cheryl Desjardins, 15 years old, Canada Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

2. English and Greek abstracts (200-250 words), with the following structure: background, methods, results and conclusions.

3. Keywords.

4. List of abbreviations.

5. Text.

6. Acknowledgements and reference to funding, sponsorships or other financial sources.

7. References.

8. Tables (one per page).

9. Figures (one per page).

10. Figure titles.

˘·ÓÈԇϿÛÌ·ˆ· ‰ÂÓ ÌÂϤÙ˜ ‹ÛË ÙÔ˘ ÌËÙ¤Ú·˜ · ÌfiÓÔ Ó·Ì¤ÓÂÚ¤ÂÈ Ô ª∏∆∂™ ˜ Ô˘ ÂÁ¯fiÌÂ˙›ÏË Û : ∞˘Í‹. Ÿˆ˜ ¿ÓıËÌ· Ù· Û˘‰È·ÎÔÓËÏ›· ˜. ∞ÈÌÔÓÈ·. ¡Â%), ÂÊÂÚı› Í›·, ·ÁÓ‰ÚÔÌÔ Ù˜ ·ˆÛÈÓÔÂÙ·È Î˘Î‹˜ ÏÂÈProcef ÙˆÓ 12 ÛÂ Û˘È· ˘„ËÔ‰ËÁ›Â˜ 5 ∂Àƒø ¶∂. ¶√-

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81

∆Ô ÂÌ‚fiÏÈÔ HPV ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¢Âη¤ÓÙ ‰È·ÊÔÚÂÙÈÎÔ› ÈÔ› ÙˆÓ ·ÓıÚÒÈÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜. ∂Í ·˘ÙÒÓ, ÔÈ ÈÔ› 16 Î·È 18 ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 70% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·ÚΛÓÔ˘ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜. º˘ÛÈο, Ù· ÛÙÂϤ¯Ë ÙÔ˘ HPV Â›Ó·È ÂÚÈÛÛfiÙÂÚ· ·fi 200. √È Á˘Ó·›Î˜ Û ÔÛÔÛÙfi 70-80% ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ı· ÂÌÊ·Ó›ÛÔ˘Ó Ì›· Ïԛ̈ÍË ·fi HPV. ∆Ô test ¶··ÓÈÎÔÏ¿Ô˘, fiÙ·Ó ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ Á˘Ó·›Î˜, ‚ÔËı¿ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ηÚΛÓÔ˘. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Û ηϿ ÔÚÁ·ÓˆÌ¤Ó· ÚÔÁÚ¿ÌÌ·Ù· ÏËı˘ÛÌÈ·ÎÔ‡ ÂϤÁ¯Ô˘ Ì test ¶··ÓÈÎÔÏ¿Ô˘ ÌÂÈÒÓÂÙ·È Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜ ηٿ 70-75%. ∆¤ÙÔȘ ¯ÒÚ˜ Â›Ó·È ÔÈ ™Î·Ó‰ÈÓ·‚ÈΤ˜ ¯ÒÚ˜ (¶›Ó·Î·˜ 1). ŒÙÛÈ, ÛÙË ºÈÓÏ·Ó‰›·, ÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Î·È ÙË ™Ô˘Ë‰›· Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ test ¶··ÓÈÎÔÏ¿Ô˘, Ô˘ ÁÈÓfiÙ·Ó Û 85-95% ÙÔ˘ ÏËı˘ÛÌÔ‡, ÌÂÈÒıËÎÂ Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÙÚ·¯‹ÏÔ˘. ™ÙË ¯ÒÚ· Ì·˜ ‰˘ÛÙ˘¯Ò˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ‰Â‰Ô̤ӷ ˆ˜ ÚÔ˜ ÙÔ test ¶··ÓÈÎÔÏ¿Ô˘. ™‡Ìʈӷ Ì ÔÚÈṲ̂ÓÔ˘˜ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Û ÔÛÔÛÙfi οو ÙÔ˘ 20% ÙˆÓ Á˘Ó·ÈÎÒÓ, ÂÓÒ Î·Ù’ ¿ÏÏÔ˘˜ Û ÔÛÔÛÙfi οو ÙÔ˘ 10%. ¶ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛ ÙÔ ÂÌ‚fiÏÈÔ Gardasil

ÙÔ ÔÔ›Ô Â›Ó·È ÙÂÙÚ·‰‡Ó·ÌÔ (6,11,16 Î·È 18). ∏ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î¿Ï˘„Ë ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÁÈ· ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜ Î˘Ì·›ÓÂÙ·È ·fi 60-75%. ™˘ÓÂÒ˜ ÙÔ ÂÌ‚fiÏÈÔ ‰ÂÓ “ÍÂÚÈ˙ÒÓÂÈ” ÙÔÓ Î·ÚΛÓÔ, ·ÏÏ¿ ÙÔÓ ÂÏ·ÙÙÒÓÂÈ Û ›‰È· ÂÚ›Ô˘ ÔÛÔÛÙ¿ Ì ÙÔ test ¶··ÓÈÎÔÏ¿Ô˘. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ·ÁÁ›˙ÂÈ ÙÔ 100%. ∆Ô ÂÌ‚fiÏÈÔ ¤¯ÂÈ ¿ÚÂÈ ¿‰ÂÈ· ÁÈ· ÎÔÚ›ÙÛÈ· 9-25 ÂÙÒÓ ÛÙËÓ ∂˘ÚÒË Î·È ÙËÓ ∞ÌÂÚÈ΋, ÂÓÒ ÁÈ· ·ÁfiÚÈ· 9-15 ÂÙÒÓ ¤¯ÂÈ ¿ÚÂÈ ¿‰ÂÈ· ÌfiÓÔ ÛÙËÓ ∂˘ÚÒË. √ ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÛÙ· ÔÔ›· ‰ÔÎÈÌ¿ÛÙËΠÙÔ ÂÌ‚fiÏÈÔ ÚÔÙÔ‡ ¯ÔÚËÁËı› Ë ¿‰ÂÈ· ‹Ù·Ó 24.000 ÂÚ›Ô˘, ÂÓÒ ÙˆÓ ·ÁÔÚÈÒÓ ÌfiÓÔ 1.071. ∂›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ¯ÔÚËÁÂ›Ù·È ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÛÂÍÔ˘·ÏÈÎÒÓ Â·ÊÒÓ, ‰ÈfiÙÈ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ÌÔχÓÔÓÙ·È Ì ÙËÓ ÚÒÙË ÛÂÍÔ˘·ÏÈ΋ Â·Ê‹ Â›Ó·È ¿Ú· Ôχ ˘„ËÏfi. ¶·Ú¿ Ù·‡Ù· Û˘ÓÈÛÙ¿Ù·È Î·È Û ¿ÙÔÌ· Ì ÂÓÂÚÁfi ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹, ¯ˆÚ›˜ fï˜ Ó· ÁÓˆÚ›˙Ô˘Ì ·ÎÚÈ‚Ò˜ Û ÙÈ ÔÛÔÛÙfi ÚÔÛٷهÂÈ. ∆Ô ÂÌ‚fiÏÈÔ HPV ¯ÔÚËÁÂ›Ù·È ÂÓ‰ÔÌ˘˚ο Û ÙÚÂȘ ‰fiÛÂȘ (0, 2 Î·È 6 Ì‹Ó˜). ¢‡Ó·Ù·È Ó· ¯ÔÚËÁËı› Ù·˘Ùfi¯ÚÔÓ· Ì ÙÔ ÂÌ‚fiÏÈÔ Ù˘ Ë·Ù›Ùȉ·˜ µ, ·Ó Î·È Ù· ÂÚÈÛÙ·ÙÈο ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠηْ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ‹Ù·Ó Ôχ Ï›Á·, Î·È ‰ÂÓ ÂËÚ¿˙ÂÙ·È ·fi ÙË Ï‹„Ë ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ

AÏÏËÏÔÁÚ·Ê›·: ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ akonst@hol.gr ¶Úfi‰ÚÔ˜ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜

Correspondence: Andreas Constantopoulos akonst@hol.gr President of the Greek Paediatric Society

¶›Ó·Î·˜ 1. Test ¶··ÓÈÎÔÏ¿Ô˘ ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÒÚ˜ ÃÒÚ· ºÈÓÏ·Ó‰›·1 ∞ÁÁÏ›·1 ™Ô˘Ë‰›·1 µ¤ÏÁÈÔ2 √ÏÏ·Ó‰›·1 ¢·Ó›·1 °·ÏÏ›·1 πÙ·Ï›·1 °ÂÚÌ·Ó›·1 πÛ·Ó›·2

™‡ÛÙ·ÛË

% Ù·ÎÙÈÎfi screened

∏ÏÈÎÈ·Îfi ‡ÚÔ˜ (¤ÙË)

ªÂÛԉȿÛÙËÌ· (¤ÙË)

30-60 25-64 23-60 25-64 30-60 23-59 25-65 25-64 20-85 25-65

5 3-5 3 3 5 3 3 3 1 3

93 83 83 78 77 75 69 53-74 50 27

ñ ∆Ô ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ÂÍÂÙ¿˙ÔÓÙ·È Ù·ÎÙÈο ÛÙȘ ¯ÒÚ˜ ηٿ Ì‹ÎÔ˜ Ù˘ ∂˘ÚÒ˘ ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ· ñ ¢˘ÛÎÔÏ›· ÛÙËÓ Â›Ù¢ÍË ˘„ËÏ‹˜ Î¿Ï˘„˘ 1. Anttila A, Ronco G, Clifford G, Bray F, Hakama M, Arbyn M, et al. Cervical cancer screening programmes and policies in 18 European countries. Br J Cancer 2004;91:935-941.

2. van Ballegooijen M, van den Akker-van Marle E, Patnick J, Lynge E, Arbyn M, Anttila A, et al. Overview of important cervical cancer screening process values in European Union (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness. Eur J Cancer 2000;36:2177-2188.

3. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: cancer incidence. Mortality and prevalence worldwide.

IARC cancer base no. 5, version 2.0. Lyon (France): IARC Press; 2004. ¶·È‰È·ÙÚÈ΋ 2007;70:81-82

Pediatr Mar-Apr 07

28-03-07

17:23

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∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

Ê·Ú̿ΈÓ. ¶ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË Ì ٷ ¿ÏÏ· ÂÌ‚fiÏÈ· ̤¯ÚÈ Ó· Á›ÓÔ˘Ó ÔÈ ·Ó¿ÏÔÁ˜ ÌÂϤÙ˜. ¢ÂÓ Â›Ó·È ·Ó·Áη›Ô Ó· ÚÔËÁËı› test ¶··ÓÈÎÔÏ¿Ô˘ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·Ó Î·È ‰ÂÓ ÁÓˆÚ›˙Ô˘Ì ÙÈ ÌÔÚ› Ó· Û˘Ì‚Â› Û ¤Ó· ¿ÙÔÌÔ Ô˘ ¤¯ÂÈ ‹‰Ë ÌÔÏ˘Óı›. ∆Ô ÂÌ‚fiÏÈÔ ¤¯ÂÈ ¯ÔÚËÁËı› ηٿ Ï¿ıÔ˜ Î·È Û ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ÂÁ·ˆÓ ¯ˆÚ›˜ ·ÚÂÓ¤ÚÁÂȘ. ∞˘Ùfi ‚‚·›ˆ˜ ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ Ú¤ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Î·È ÔÈ ¤ÁÎ˘Â˜. √È ·ÚÂÓ¤ÚÁÂȘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ô˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ Ê‡ÏÏÔ Ô‰ËÁÈÒÓ ¯Ú‹ÛÙË Â›Ó·È ‹Ș: ÂÏ·ÊÚ¿ ÙÔÈ΋ ·ÓÙ›‰Ú·ÛË, Î·È ˘ÚÂÙfi˜ ̤¯ÚÈ 38,5oC. √È ·ÓÙȉڿÛÂȘ ·˘Ù¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÂÓÙfi˜ 5 ËÌÂÚÒÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘. °È· Ó· ÂÎÙÈÌËı› fï˜ ·Ó ¤Ó· ÂÌ‚fiÏÈÔ ¤¯ÂÈ ·ÚÂÓ¤ÚÁÂȘ, ı· Ú¤ÂÈ Ó· ¯ÔÚËÁËı› Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi Á˘Ó·ÈÎÒÓ. ¶ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ ¿‰ÂÈ·˜ ÛÙÔ Gardasil, ·˘Ùfi ‰ÔÎÈÌ¿ÛıËΠÌfiÓÔ Û 24.000 Á˘Ó·›Î˜ Î·È 1.071 ·ÁfiÚÈ·. ∞fi ÙË Ì¤¯ÚÈ ÙÒÚ· ¯ÔÚ‹ÁËÛË Ê·›ÓÂÙ·È Ó· ‰ËÏÒÓÔÓÙ·È ÔÚÈṲ̂ӷ ÂÚÈÛÙ·ÙÈο Ì ·ÚÂÓ¤ÚÁÂȘ Ù· ÔÔ›· ·Ó·Ï‡ÔÓÙ·È Î·È ÁÚ‹ÁÔÚ· ı· ÂÚÈÁÚ·Ê› ηٿ fiÛÔ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙÔ Gardasil. ∏ ‰È¿ÚÎÂÈ· ÚÔÛÙ·Û›·˜ Â›Ó·È 4,5-5 ¯ÚfiÓÈ· ̤¯ÚÈ ÛÙÈÁÌ‹˜ Î·È ¤¯ÂÈ ˘ÔÏÔÁÈÛı› fiÙÈ ı· ‰È·ÚΤÛÂÈ ÂÚ›Ô˘ 10,5 ¯ÚfiÓÈ·. √ ¯ÚfiÓÔ˜ ı· ‰Â›ÍÂÈ ·Ó ¯ÚÂÈ·Ûı› ·Ó·ÌÓËÛÙÈ΋ ‰fiÛË. º˘ÛÈο, Ô ·È‰›·ÙÚÔ˜ Â›Ó·È ÂΛÓÔ˜ Ô˘ ı· οÓÂÈ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, ‰ÈfiÙÈ ÁÓˆÚ›˙ÂÈ ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ηχÙÂÚ· ·fi fiϘ ÙȘ ¿ÏϘ È·ÙÚÈΤ˜ ÂȉÈÎfiÙËÙ˜. ¶Ú¤ÂÈ ˆÛÙfiÛÔ Ó· ÛËÌÂȈı› fiÙÈ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È Ôχ ˘„ËÏfi (185 :). ∞˜ ‰Ô‡Ì ÙÒÚ· ÙÈ Á›ÓÂÙ·È ‰ÈÂıÓÒ˜ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ̤ۈ ÏËÚÔÊÔÚÈÒÓ Ô˘ Û˘ÁÎÂ-

ÓÙÚÒÛ·Ì ·fi ÙȘ ¶·È‰È·ÙÚÈΤ˜ ÂÙ·ÈÚ›˜ ÙˆÓ ‰È·ÊfiÚˆÓ ¯ˆÚÒÓ. ∞fi ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ ÛÙȘ ∏¶∞ ÙÔ ÂÌ‚fiÏÈÔ Î˘ÎÏÔÊfiÚËÛ 6 Ì‹Ó˜ ÓˆÚ›ÙÂÚ· (πÔ‡ÓÈÔ˜ 2006) ·’ fi,ÙÈ ÛÙËÓ ∂˘ÚÒË, ·Ú¿ Ù·‡Ù·, ÌfiÏȘ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ Û˘ÓÈÛÙ¿Ù·È ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ Ó· Á›ÓÂÙ·È ·fi fiÔÈÔÓ ÙÔ ÂÈı˘Ì›. ∏ ∞˘ÛÙÚ›· Î·È Ë ∂ÛıÔÓ›· Â›Ó·È ÔÈ ‰‡Ô ÌÔÓ·‰ÈΤ˜ ¯ÒÚ˜ Ô˘ ÙÔ ¯ÔÚËÁÔ‡Ó Û˘ÛÙËÌ·ÙÈο, ¯ˆÚ›˜ fï˜ Ó· ηχÙÂÙ·È ·fi Ù· ·ÛÊ·ÏÈÛÙÈο Ù·Ì›·. ŸÏ· Ù· ·Ú·¿Óˆ ÛÙÔȯ›· ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ ·˘Ùfi ‰È·Ê¤ÚÂÈ ·fi Ù· ˘fiÏÔÈ·, ‰ÈfiÙÈ ‰ÂÓ Î·Ï‡ÙÂÈ 100% ÙÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜. ª¤¯ÚÈ Ó· ÏËÊıÔ‡Ó ÔÚÈÛÙÈΤ˜ ·ÔÊ¿ÛÂȘ ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· Ì·˙ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ÂÓË̤ڈÛË ÙˆÓ Á˘Ó·ÈÎÒÓ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂÙËÛ›ˆ˜ Û test ¶··ÓÈÎÔÏ¿Ô˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, ı· ϤÁ·Ì fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ·ÏÏ¿ ‰ÂÓ Ï‡ÓÂÈ ÔÚÈÛÙÈο ÙÔ Úfi‚ÏËÌ·. °È’ ·˘Ùfi ı· Ú¤ÂÈ Ó· ηıÈÂÚˆı› Û‡ÛÙËÌ· ÂÈÙ‹ÚËÛ˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ Ó¤ˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ı· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó, ÁÈ·Ù› ÙÔ ÂÌ‚fiÏÈÔ HPV ‰ÂÓ Î·Ï‡ÙÂÈ fiÏÔ˘˜ ÙÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜, ÂÔ̤ӈ˜ ÔÈ Á˘Ó·›Î˜ ·˘Ù¤˜ ı· ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÎÈÓ‰˘ÓÂ‡Ô˘Ó Ó· ·Ó·Ù‡ÍÔ˘Ó Î·ÚΛÓÔ ·fi ¿ÏÏÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜, ÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Î·Ï‡ÙÂÈ ÙÔ ÚÔÛÊÂÚfiÌÂÓÔ ÂÌ‚fiÏÈÔ. £· Ú¤ÂÈ Ó· Á›ÓÂÙ·È HPV-DNA test ÙÔ ÔÔ›Ô ı· Û˘Ó‰˘¿˙ÂÙ·È Ì ÙÔ test ¶··ÓÈÎÔÏ¿Ô˘ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ ÚÒÙÔ ÙÂÛÙ ı· Â›Ó·È ıÂÙÈÎfi. ∆¤ÏÔ˜, ·˜ ÛËÌÂȈı› fiÙÈ ÁÈ· οıÂ Ó¤Ô Ê¿ÚÌ·ÎÔ ‹ ÂÌ‚fiÏÈÔ ¯ÚÂÈ¿˙ÂÙ·È Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ.

¶›Ó·Î·˜ 2. ÃÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÒÚ˜ ÃÒÚ· ∂›Ó·È ÂÌ‚fiÏÈÔ ÚÔ˘Ù›Ó·˜ ∫·Ï‡ÙÂÙ·È ·fi Ù· ·ÛÊ·ÏÈÛÙÈο Ù·Ì›· ™Â ÔÈ· ËÏÈΛ· Á›ÓÂÙ·È ∫fiÛÙÔ˜ Û ¢ÚÒ ·Ó¿ ‰fiÛË ∞ÁÁÏ›· ∞˘ÛÙÚ›· µ¤ÏÁÈÔ °ÂÚÌ·Ó›· ¢·Ó›· ∂Ï‚ÂÙ›· ∂ÏÏ¿‰· ∂ÛıÔÓ›· ∏¶∞ πÛ·Ó›· πÙ·Ï›· ∫‡ÚÔ˜ §ÈıÔ˘·Ó›· √ÏÏ·Ó‰›· √˘ÁÁ·Ú›· ¶ÔÚÙÔÁ·Ï›· ™ÏÔ‚·Î›· ∆Ô˘ÚΛ· ∆Û¯›·

Ÿ¯È ¡·È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È ¡·È

Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È

Ÿ¯È Ÿ¯È Ÿ¯È ∞fi ÔÚÈṲ̂ӷ* Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È ™ÙËÓ ÔÏÈÙ›· Michigan ¢ÂÓ ¤¯ÂÈ Î˘ÎÏÔÊÔÚ‹ÛÂÈ ¢ÂÓ ¤¯ÂÈ Î˘ÎÏÔÊÔÚ‹ÛÂÈ Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È Ÿ¯È ¢ÂÓ ¤¯ÂÈ Î˘ÎÏÔÊÔÚ‹ÛÂÈ Ÿ¯È

9-15 (·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·) 11-12 ÎÔÚ›ÙÛÈ· -

150 220 (155) 125 155 155 150 185 100 112 ~150 100 160 130 ; 120 150 320

-

135

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Homocystinuria due to cystathionine ‚-synthase deficiency S. H. Mudd In this issue of Paediatriki Persephone Augoustides-Savvopoulou and coauthors describe two cases of cystathionine ‚-synthase (C‚S) deficiency with emphasis on the clinical and metabolic identification of such patients, and the fact that proper treatment can help avoid adverse effects of this genetic abnormality (1). This editorial attempts to clarify two nomenclatural issues that may make reading about this condition difficult for non-specialists, and to expand upon aspects covered only briefly in the article in question (1).

The name of the condition. Homocystinuria (i.e. excessive urinary homocystine) was found

by Nina Carson and coworkers in 1962 among mentally retarded Northern Irish children and independently (and virtually simultaneously) by Gerritsen and Waisman and by Barber and Spaeth in the United States (2). In 1964 deficient activity of C‚S, the enzyme that catalyzes the condensation of homocysteine with serine, forming cystathionine, was shown to be the underlying cause of the homocystinuria in Barber and Spaeth’s patient (2). For a few years thereafter “homocystinuria” was used as a definitive name of a specific genetic abnormality. However, in 1969 a patient with excessive urinary homocystine was shown to be unable to convert vitamin B12 to its coenzyme forms, methyl-B12 and adenosyl-B12, so that the methyl-B12-dependent methylation of homocysteine back to methionine did not occur normally (3). This defect in now termed cblC (cobalamin C) disorder to distinguish it from other inherited disorders of cobalamin metabolism. In 1972 a different homocystinuric patient was found to have yet another causative metabolic abnormality, severely deficient activity of 5,10-methylenetetra-hydrofolate reductase (MTHFR), the enzyme that forms methyltetrahydrofolate, a methyl donor for methylation of homocysteine (4). [These reactions are diagrammed in level (2) in Fig. 1 in citation (1)]. It thus became evident that “homocystinuria” is a metabolic abnormality with multiple causes, and that, to designate a specific disease with this abnormality, it is important to name the underlying deficiency. In contrast to the elevated methionine of C‚S deficiency, the two additional defects just discussed, as well as

Laboratory of Molecular Biology, National Institute of Mental Health

others discovered more recently affecting homocysteine remethylation (5), are characterized by low plasma methionine. A recent report indicates the brain damage of MTHFR deficiency is due to lack of methionine rather than to elevated homocysteine (6). Therefore, establishing the proper cause of a case of homocystinuria becomes especially important: dietary methionine restriction is often used beneficially in C‚S deficiency, but is contraindicated in a homocysteine remethylation defect.

Homocystine, homocysteine, and total homocysteine (tHcy). Homocystine is a disulfide with structure RS-SR (where R=-CH2CH2CH(NH2) COOH, formed in the body from homocysteine, the metabolically active sulfhydryl form, RSH. In plasma, homocystine greatly exceeds homocysteine, and even more homocysteine moieties occur as mixed disulfides bound to cysteine (RSSR’) or protein cysteine (RS-S-Protein) (7). Amino acid chromatography usually measures homocystine, but to measure the sum of the various forms in which homocysteine moieties occur, modern methods cleave disulfide bonds, assay the resulting homocysteine and term it “total homocysteine” (tHcy) (7).

The present situation. Based on the experience since 1962, and as described by Augoustides-Savvopoulou et al (1), C‚S deficiency is now known to occur in both B6-responsive and B6-non-responsive forms, ultimately dependent upon the specific mutation(s) in the alleles encoding C‚S (8). Untreated, B6-responsive individuals develop less severe clinical abnormalities or manifest them more slowly. For example, in a survey including data for 231 B6responsive patients and the same number of B6non-responders, the median IQ among responders was 78 versus 64 for non-responders; the chances of having been found to have dislocated optic lenses by age 10 years was 55% and 82% for responders and non-responders; of having a thromboembolic event by age 15 years, 12% and 27%; of having radiologically detectable spinal osteoporosis by age 15, 36% and 64%; and of not surviving to age 30, 4% and 23% (9). However, there may have been ascertainment bias for the patients included in that study, because, to be included, a patient had either to have some clinical

Correspondence: S. Harvey Mudd muddh@mail.nih.gov Building 35, Room 1B1006 35 Convent Drive Bethesda, MD 20892, USA

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manifestation, to be a family member of a diagnosed patient, or to have been detected by elevated blood methionine at newborn screening. More recent genetic screening of newborns in Denmark (10) or Norway (11), or of unrelated German control subjects (12) indicates the prevalence of homozygosity for the I278T C‚S mutation might be as high as 1:20,500, 1:104,000 and 1:17,800 live births, in those countries, respectively. Since homozygosity for I278T leads to B6-responsiveness, and because B6-responders are usually missed in newborn screening based upon elevated blood methionine concentrations (8), it remains possible that some of these patients may remain clinically normal throughout life, or that they may be diagnosed only later in life if they present with thromboembolic problems. As illustrated by the report of Augoustides-Savvopoulou et al (1), and supported now by a variety of further evidence, treatment of responders with pyridoxine and of non-responders by dietary methionine restriction, often with betaine in addition, is clearly beneficial (8,9,13).

Much progress has been made also for the homocystinurias due to remethylation defects. Particularly noteworthy are: The recent identification of the gene, MMACHC, mutations in which lead to cblC disorders (14). The discovery of further cobalamin disorders producing functional methionine synthase deficiency (cblE and cblG). The cloning of the gene for MTHFR and identification of several mutations in it leading to severely deficient activity of that enzyme.

The discovery of the common MTHFR polymorphism, C677T, that leads to formation of a thermolabile enzyme and, in individuals with serum folate toward the lower end of the reference range, to mild elevations of plasma tHcy. The current report that an Amish baby shown by genetic screening at birth to be homozygous for a severely inactivating MTHFR mutation and treated early with betaine to maintain methionine levels has been free of the irreversible mental and developmental problems that affect other individuals homozygous for the same mutation, but treated only at older ages (6).

The situation in Greece. It is of interest to the present author that, in-so-far as he is aware, the patients reported by Augoustides-Savvopoulou et al (1) are the first individuals with homocystinuria due to C‚S deficiency identified in Greece. On the current Jan Kraus C‚S website (http://www.uchsc.edu/sm/cbs), among the 559 alleles responsible for C‚S deficiency the ancestries of which are shown, none is listed as of Greek origin. Whether the Greek population is unusually free of inactivating C‚S mutations, or whether individuals with such mutations are present, Paediatriki 2007;70:83-84

awaiting ascertainment and treatment, may pose an intriguing question for the physicians of Greece.

References 1. Augoustides-Savvopoulou P, Ioannou H, Kozeis N, Karagiannidou A, Athanasiou-Metaxa M. Homocystinuria due to cystathionine b-synthase deficiency: two sides to the same coin. Paediatriki 2007;70:146-151.

2. Mudd SH, Finkelstein JD, Irreverre F, Laster L. Homocystinuria: an enzymatic defect. Science 1964;143:14431445.

3. Mudd SH, Levy HL, Abeles RH, Jennedy JP Jr. A derangement in B12 metabolism leading to homocystinemia, cystathioninemia and methylmalonic aciduria. Biochem Biophys Res Commun 1969;35:121-126.

4. Mudd SH, Uhlendorf BW, Freeman JM, Finkelstein JD, Shih VE. Homocystinuria associated with decreased methylenetetrahydrofolate reductase activity. Biochem Biophys Res Commun 1972;46:905-912.

5. Rosenblatt DS, Fenton WA. Inherited disorders of folate and cobalamin transport and metabolism. In: Scriver CR, Beaudet AL, Valle D, Sly WS, Childs B, Kinzler KW, editors.

The Metabolic and Molecular Bases of Inherited Disease, 8th ed. New York, N.Y.: McGraw-Hill; 2001. p. 3897-3933.

6. Strauss KA, Morton DH, Puffenberger EG, Hendrickson C, Robinson DL, Wagner C, et al. Prevention of brain disease from severe 5,10-methylenetetrahydrofolate reductase deficiency. Mol Genet Metab 2007; in press.

7. Mudd SH, Finkelstein JD, Refsum H, Ueland PM, Malinow MR, Lentz SR, et al. Homocysteine and its disulfide derivatives: a suggested consensus terminology. Arterioscler Thromb Vasc Biol 2000;20:1704-1706.

8. Mudd SH, Levy HL, Kraus JP. Disorders of transsulfuration. In: Scriver CR, Beaudet AL, Sly WS, Valle D, Childs B, Kinzler KW, editors. The Metabolic and Molecular Bases of Inherited Disease, 8th ed. New York: McGraw-Hill; 2001. p. 2007-2056.

9. Mudd SH, Skovby F, Levy HL, Pettigrew KD, Wilcken B, Pyeritz RE, et al. The natural history of homocystinuria due to cystathionine beta-synthase deficiency. Am J Hum Genet 1985;37:1-31.

10. Gaustadnes M, Ingerslev J, Rutiger N. Prevalence of congenital homocystinuria in Denmark. N Engl J Med 1999;340:1513.11.

11. Refsum H, Fredriksen A, Meyer K, Ueland PM, Kase BF. Birth prevalence of homocystinuria. J Pediatr 2004;144: 830-832.

12. Linnebank M, Homberger A, Junker R, Nowak-Goettl U, Harms E, Koch HG. High prevalence of the I278T mutation of the human cystathionine beta-synthase detected by a novel screening application. Thromb Haemost 2001;85: 986-988.

13. Yap S, Boers GH, Wilcken B, Wilcken DE, Brenton DP, Lee PJ, et al. Vascular outcome in patients with homocystinuria due to cystathionine beta-synthase deficiency treated chronically: a multicenter observational study. Arterioscler Thromb Vasc Biol 2001;21:2080-2085.

14. Lerner-Ellis JP, Tirone JC, Pawelek PD, Dore C, Atkinson JL, Watkins D, et al. Identification of the gene responsible for methylmalonic aciduria and homocystinuria, cblC type. Nat Genet 2006;38:93-100.

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Prevention of unintentional injury: relevance to paediatricians N. Spencer

Public health importance of unintentional injury As noted by Nicholson et al in this issue of the journal, unintentional injuries are the leading cause of death and disability in European children. Globally, it is estimated that by 2020 road traffic crashes will have moved from ninth to third in the world disease burden ranking, as measured in disability adjusted life years (1).

The costs in premature death and disability and the burden on health and social care services and families are huge. Yet injury prevention commands far less attention in most countries than smoking cessation. The tendency of doctors to focus on the consequences of injury rather than prevention contributes to the relatively low profile of this major public health issue.

Contributory factors European countries that have succeeded in providing a relatively safe environment for their children with resulting reduction in deaths and disability associated with unintentional injury, have done so as a result of a combination of legislation, enforcement and public education. Legislation, although necessary, is not sufficient to protect children. For example, Greece enacted legislation over 20 years ago related to seat belt wearing by children in cars and speed limits on urban roads but continues to have one of the highest road accident death rates in the EU (see Nicholson et al, Tables 2 and 3). This is likely to be due to limited enforcement and relatively poor acceptance of these measures by the population.

A key factor in relation to child pedestrian and cyclist injuries is exposure to traffic (2).

Children who are exposed to high volumes of traffic either as pedestrians or cyclists are at high risk. Poorer children are more likely to be exposed in this way as their parents are less likely to own cars (3).

Effectiveness of preventive interventions Nicholson et al’s reliance mainly on the results of individual studies as evidence of effectiveness of preventive interventions to reduce unintentional injury among children leads

them to slightly overstate the strength of the available evidence. Good randomised controlled trials in accident prevention are rare and the evidence base tends to be weak. However, there are now a series of Cochrane systematic reviews that report reasonably robust evidence for some preventive interventions.

For example, speed enforcement devices such as cameras are associated with a significant reduction in crashes (4) and helmets for cyclists significantly reduce head and facial injuries (5).

The Cochrane reviews highlight the need for more robust studies of injury prevention interventions.

Correspondence: Nicholas Spencer n.j.spencer@warwick.ac.uk University of Warwick Coventry, UK

Relevance to paediatricians Due to the heavy burden of death and disability resulting from unintentional injury, paediatricians are frequently faced with the consequences. Paediatricians, in common with other doctors, tend to focus on curative, clinical interventions at the individual level rather than preventive approaches at the population level. Clinical approaches to the consequences of unintentional injury can relieve suffering but cannot address the fundamental causes. Thus, for paediatricians to make a contribution to reducing the burden of unintentional injury, they need to focus on preventive interventions at the population level as well as clinical management of the consequences in individual children.

How might paediatricians contribute?

On matters concerning children, paediatricians have a powerful voice. We need to learn how to use this power to change public policy and public perceptions in relation to unintentional injury. The individual paediatrician can provide developmentally appropriate advice to parents and can participate in local groups promoting injury prevention strategies. Advocacy is probably most powerful when undertaken by national paediatric organisations that can communicate directly with policy makers and politicians. We, in Europe, can learn from our American colleagues in the American Academy of Pediatrics who have a long tradition of effective lobbying on a range of child health related issues. ¶·È‰È·ÙÚÈ΋ 2007;70:85-86

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Paediatricians also have a major potential role in promoting high quality, robust research to inform preventive strategies. Research of this nature is as important as drug trials.

References 1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997;349:1498-1504.

2. Sonkin B, Edwards P, Roberts I, Green J. Walking, cycling and transport safety: an analysis of child road deaths. J R Soc Med 2006;99:402-405.

Paediatriki 2007;70:85-86

3. Edwards P, Roberts I, Green J, Lutchmun S. Deaths from injury in children and employment status in family: analysis of trends in class specific death rates. BMJ 2006; 333:119.

4. Wilson C, Willis C, Hendrikz JK, Bellamy N. Speed enforcement detection devices for preventing road traffic injuries. Cochrane Database Syst Rev 2006;2:CD004607.

5. Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev 2000;2:CD001855.

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REVIEW ARTICLE

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Creating a safer Europe for children A.J. Nicholson, D. Van Esso, I. Malcic, A. Biver Abstract: Unintentional injuries are the leading cause of death and disability in European children with road-related injuries accounting for just under half of all deaths due to injury. There is a steep social gradient for all serious childhood injuries and children living in low- and middle-income European Union (EU) countries are 3.6 times more likely to die from injury than those in high-income countries.

Some EU countries (such as Sweden, the Netherlands and the United Kingdom) are among the safest places in the world and, if other EU countries were to match their performance, two thirds of lives lost per year due to injury could be saved. Legislation and enforcement to ensure safer environments (e.g. road and housing design and use of safety equipment) and reduction of risk behavior (e.g. speeding and driving under the influence of alcohol) are effective at a population level. Effective evidence-based interventions include reduction of speed limits, traffic calming measures, safer car fronts, correctly-fitted child passenger restraints, bicycle helmets, swimming pool fencing, personal flotation devices, smoke detectors, child-resistant lighters and child-resistant packaging for medicines and household chemicals.

Paediatricians across the EU should be aware of the extent of childhood injury deaths and assume a greater advocacy role to aid their prevention.

Accident Prevention Working Group of the European Academy of Paediatrics Correspondence: Alf Nicholson alf.nicholson@maile.hse.ie Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland

Key words: unintentional injury, road-related injuries, drowning, burns and scalds, falls, poisoning, choking and suffocation.

Background Injuries are the leading cause of death and disability for children in the European Union (EU). In the EU, for every death from injury, there are 30 hospital admissions and 300 emergency department attendances (1). It has been estimated that the overall socio-economic burden of all injuries in Europe is 400 billion Euros annually (i.e. almost 4 times the entire EU budget).

The leading causes of injury death for children (1-14 years old) in the EU include road-related (48%), drowning (11%), intentional injuries (11%), house fires (5%), high falls (5%), poisonings (2%) and miscellaneous (18%).

There has been improvement in all EU member states in the reduction of child injury deaths over the past 20 years (2-5).

Thus injuries are a neglected problem that has devastating effects on individuals and health budgets. Within the expanded EU, most of the burden of injuries falls on low and middle-income countries which have undergone great changes brought about by transition to market-style economies since the 1990’s. Children living in low and middle-income countries are 3.6 times more likely to die from injury than those in high income countries (Tables 1 and 2). High income countries have increased injury rates in socioeconomically deprived

groups and a widening gap between rich and poor. The increased mortality risk in deprived groups applies to most injury types including drowning, falls, poisoning, road-related and fire-related injuries.

Some countries in the EU, such as the Netherlands, United Kingdom and Sweden are among the safest places in the world and if all countries were to match their figures, two thirds of the lives lost every year due to injury could be saved. Countries with low rates of injury have invested in safety as a societal responsibility. Legislation and enforcement to ensure safer environments (e.g. road and housing design and the use of safety equipment) and reduce risk behaviors (e.g. speeding and driving under the influence of alcohol) are key changes at a population level (6-8). These measures have a synergistic effect when coupled with media and educational campaigns. There are differences that exist in countries throughout Europe as to how they adopt effective measures in reducing childhood deaths and serious injuries (Table 3).

Road-related injuries In the area of road safety, the EU has set a target to halve the number of deaths from road traffic injuries by 2010.

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be our first priority as these constitute 48% of all injury deaths in the EU. Road-related accidents include child injury deaths to pedestrians, bicyclists and motor vehicle passengers (9,10).

A pre-requisite for setting targets is good baseline data on road-related injuries and this requires either an injury surveillance system or some other means of providing complete and accurate information on the epidemiology of road-related injuries.

A great deal of intervention is being done in most EU countries but there is evidence that more lives could be saved on roads if the following strategies were implemented, enforced and taught to the public. a. The reduction of speed limits In the United Kingdom (11), introduction of 20 mph/hour speed limit zones has resulted in local reductions of 48% in child bicycle injuries and a 70% reduction in fatal road accidents involving pedestrians. Speed cameras or radar can catch drivers who are exceeding speed limits. Publicizing the presence of speed cameras or radar, further increases compliance with speed laws and substantially reduces road-related deaths.

b. Traffic calming Residential access roads should have speed limits of no more than 30 km/hour and design features that calm traffic and this has resulted in 60% reductions in road-related childhood injuries in 30 km/hour zones (Figure 1).

Pedestrians have twice the risk of injury where they are not segregated from motor vehicle traffic and studies in Denmark (12) have shown that segregated bicycle lanes alongside urban roads reduced deaths among cyclists by 35%. c. Safer car fronts for pedestrians and cyclists Engineers have known for some time how to modify car fronts so that they do less harm to cyclists and pedestrians and yet no EU country requires the fronts of cars to have a crashworthy design to minimize injury to pedestrians. If vehicles were required to pass performance tests for vehicle fronts, the annual number of deaths and injuries to pedestrians in the EU could fall by 20% (13-16,23). d. Child passenger restraints To protect occupants, a motor vehicle should be designed so that the passenger compartment maintains

Table 1. Injury deaths for children (0-14 years) in the EU Source: WHO 1996-2000 National Sources Average Malta* Sweden* United Kingdom* Italy* Netherlands* Finland Germany* Denmark* Luxembourg Austria Spain France* Ireland* Slovenia* Belgium* Greece* Hungary Czech Republic Portugal Poland* Slovakia Lithuania Estonia Latvia 0.00

2.19 3.79 4.21 4.57 4.73 5.00 5.34 5.40 5.96 6.33 6.49 6.66 6.70 7.36 7.44 7.87 8.09 8.47 8.95 9.16 10.53 21.01 22.60 23.51 5.00

10.00

15.00

Rates per 100,000 population *Some data is missing Paediatriki 2007;70:87-92

20.00

25.00

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Probability of death

1

straints optimally distribute any force of impact and thereby reduce sever injuries by 90%. Rear-facing child restraints should always be placed in the back seat as many vehicles have front airbags. Child passenger restraints are shown in Figure 2.

0.8 0.6 0.4 0.2 0 0

20

40 60 80 Impact speed (km/h)

100

Figure 1. Pedestrian fatality risk as a function of the impact speed of a car.

its integrity in a crash and there should be restraints so that occupants do not eject from the vehicle or tumble about inside it, injuring themselves and other occupants.

When used properly, child restraints or car seats have been shown to have an injury-reducing factor of 90-95% for rear-facing systems and 60% for forward-facing systems (17-19,23,24). For children 015 months (weight up to 13 kg), rear-facing child re-

e. Bicycle helmets Correctly fitted, bicycle helmets reduce the risk of head and brain injury by 63-88% (23).

Drowning Drowning is the second leading of death for children of the EU with more than 70% of the victims being boys and the most vulnerable being 1 to 4 years of age (21). Prompt resuscitation following immersion is critical to survival and the outcome for most children with immersion is determined by their status on arrival to the emergency department - medical and paediatric intensive care appear to have relatively little impact on outcome. Therefore prevention is the key to decreasing hospitalisations and deaths from drowning. Effective prevention strategies include swimming pool fencing (22). Other preventive strategies include personal flotation systems, swimming lessons, parental supervision and lifeguards.

Table 2. Road accident deaths for children (0-14 years) in the EU Source: WHO 1996-2000 National Sources Average Slovakia Malta* Sweden* United Kingdom* Czech Republic Finland Netherlands* Germany* Austria Italy* Hungary Denmark* France* Slovenia* Belgium* Luxembourg Spain Ireland* Poland* Greece* Portugal Lithuania Estonia Latvia

0.09

0.00

0.94 1.56 1.62 1.68 1.84 2.03 2.19 2.32 2.36 2.55 2.84 3.04 3.12 3.20 3.23 3.32 3.44 4.07 4.14 5.02 5.48 5.58 5.58 1.00

2.00

3.00

4.00

5.00

6.00

Rates per 100,000 population *Some data is missing ¶·È‰È·ÙÚÈ΋ 2007;70:87-92

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Burns and scalds Severe burn injuries require multiple hospitalisations and lengthy treatment and may result in permanent disability and disfigurement. Scalds and contact burns occur predominantly to under 2 year-olds. Age standardized mortality rates for children (1-14 years of age) dying through fires in the EU show that the lowest rate is in Italy (0.17 per 100,000) and the highest rate is in Ireland (0.91 per 100,000). Burn and scald injuries could be reduced in Europe, if the following preventive measures were implemented, enforced and promoted to the general public: Smoke detectors are an effective, reliable and inexpensive devices that provide an early warning and assist in reducing residential fire deaths by 71% (23,24).

Legislation requiring a safe pre-set temperature o (54 C) for all water heaters has proven to be a more effective method of reducing scald burns than education to encourage parents to turn down water heaters.

In the USA, fire deaths associated with cigarette lighters dropped by 43% with the adoption of childresistant designs (14).

A dramatic 75% reduction in burn unit admissions

due to sleepwear occurred following the introduction of the Flammable Fabrics Act of 1972 in the USA. Falls Falls resulting in severe or fatal injuries are usually due to second storey or higher windows.

Stair gates have been shown to assist in reducing falls downstairs. Absorbent surface material in playgrounds and appropriate height of play equipment for various ages provides an improvement in serious fall injuries. Window bars have shown a 35% decrease in deaths and a 31% decrease in reported falls.

Poisoning Children under 2 years of age are especially vulnerable and more than 90% of poisonings occur in the home environment (5). Many common household products can poison children including cleaning supplies, alcohol, pesticides, medicines and cosmetics (5).

Safe storage is an effective means of preventing poisoning with both medicinal and non-medicinal agents (6).

Educational strategies aimed at children and parents have been associated with increased knowledge

Table 3. Effective measures in reducing childhood deaths and serious injuries in Europe (Source: updated from Towner and Towner, 2004) Bicycle Child safety Seat belt Speed Child resistant Smoke Barrier Children Adoption of No sale of helmets seats/ wearing limits packaging detectors fencing, banned playground fireworks for children restraints by children roads pharmaceuticals in home domestic from riding/ standards to children in cars in urban swimming driving farm areas pools tractors Austria

1994

1994

1994

1996

Belgium Czech Republic 2000 Denmark Estonia France Germany Greece Hungary Iceland 1999 Ireland Italy Luxembourg Netherlands Norway Poland Portugal Spain 1999 Sweden Switzerland United Kingdom

1996 2000

2003 1992 1992 1999 2000 1990

1988

1997 1995 1992 1988 1981 1989

1975 2000

2003

1993 1977 2000 1981 1993 1989 2000 1992 1979 1997 1994 1974 1988 1981 1989

2003 1972 1952 1962

1988

1997

1990 1936 1959 1934

1998 1999

2000

2003 2003

1993 1994

2003* 1990 2002

1973

1994

1997

1999

2001 1999

2000 2000

2004

1984 1986

1974

1994

1976

1995

1997

1976 1998

1996

1997 1996 1998

1998

*: New homes only, : Indicates legislation enacted but year not known , YEAR: Indicates date legislation enacted if known, Blank: No legislation measure enacted Paediatriki 2007;70:87-92

1995

1988 1997

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Never put a rearward-facing seat in the front seat if there is a passenger airbag!

Rearward-facing baby seat (For babies up to 13 kg)

Forward-facing seat (Weight 9-18 kg)

Booster seat (Weight 15-25 kg)

Booster cushion (Weight 22-36 kg)

Figure 2. Car seats at different ages.

of poison prevention. The compulsory use of childresistant packaging for aspirin and paracetamol led to a dramatic fall in the number of children admitted to

hospital as a result of these medications in England, the Netherlands and USA (6).

Choking and suffocation Choking occurs most commonly on small attractive products, including balloons, coins, small toy parts, small food pieces and inedibles in food products. Legislative measures to be implemented include product bans (inedibles in foodstuffs, drawstrings on clothing); warning labels on products have reduced deaths in those countries where this legislation has been enforced (7).

Socioeconomic deprivation and childhood injury In England and Wales, the risk of children dying from fire was 16 times greater in the lowest socioeconomic group (SEG) compared to the highest (10,11), the risk of pedestrian injuries was 5 times higher in lower SEG and the overall risk of a childhood injury death was 3-4 times higher in children of parents in unskilled manual jobs than children whose parents were skilled non-manual workers (11). In Germany, poorer families were twice as likely to be involved in road traffic accidents (12).

Thus, there is a steep social gradient in relation to serious childhood injuries and deaths in most EU countries.

The impact of an expanding EU The childhood injury death rates for the new EU countries range from 10.8 per 100,000 in Hungary to 38.4 per 100,000 in Latvia. The only country that has a higher childhood injury death rate than the new EU countries is Portugal (17.8 per 100,000). Thus the childhood injury death rate in Latvia is 8 times that in Sweden. If the EU is committed to reducing disparities in living standards between its members, serious commitments will need to be made to ensure that childhood injury deaths will be reduced in candidate countries as a matter of urgent priority.

The role of government and legislation As of June 2001, only the UK and the Netherlands have specific targets or specific goals as part of a national health plan aimed at reducing childhood injury (12,13,15). It is clear that, before there can be an integrated approach to child safety across the EU, there needs to be one within each individual member state.

Legislation and its enforcement is one of the most effective ways to create a safer environment (13).

Whilst no EU member state has adopted all ten preventive policy measures that were conducted in recent research by Towner et al (12), Sweden and Spain do ¶·È‰È·ÙÚÈ΋ 2007;70:87-92

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A.J. Nicholson et al.

show commitment to using policy to influence the reduction of childhood injury by adopting most of the measures outlined in Table 3. The most common measures are related to motor vehicles and include child restraints, seat belt wearing and reduced speed limits.

The lowest adopted measures include bicycle helmets and smoke alarms in private residences. Even though Germany and the UK introduced mandatory child-resistant packaging for medicines 25 years ago, only 4 other countries use this proven safety measure. Even in situations where European directives exist, there is great variation in how EU member states enact these directives in their bodies of law. Many countries within the EU lack even a basic structure for enforcing regulations and standards for consumer products such as child care articles and toys. Coordination at national and European levels is quite deficient.

The role of EU regulations and standards The Treaty of Maastricht has extended significantly the authority of the European Commission with respect to the protection of the health and safety of European citizens. Standards play a key role in regulating safety in the EU as they provide technical specifications for existing framework legislation. European regulations and standards addressing child safety (e.g. childresistant packaging) are not implemented properly or are not providing the safety measures that are currently needed. New directives should be developed at EU level for pedestrian and bicycle protection through safer car fronts, all under 12 year olds should be protected by child restraint systems in cars, playground equipment should meet EU safety standards and European regulations should be developed for inedibles in food products, flammability of clothing, cords on children’s clothes, cigarette lighter that are child-proof and building code requirements for pool fencing, window ad balcony railings and amusement /riding devices.

Legislation of injury strategies and its enforcement is one of the most effective ways to create safer environments.

References 1. World Health Organization. Atlas of mortality in Europe.

Geneva; 1997.

2. Consumer Safety Institute. Deaths and injuries due to accidents and violence in the Netherlands 1998-1999. Amsterdam; 2000.

3. European Consumer Safety Association. Priorities for consumer safety in the European Union. Amsterdam; 2001.

Paediatriki 2007;70:87-92

4. British Medical Journal Publications. Injury Prevention.

London; 2001.

5. European Transport Safety Council. Priorities for EU motor vehicle safety design. Brussels; 2001.

6. Towner E, Dowswell T, Mackereth C, Jarvis S. What works in preventing unintentional injuries in children and young adolescents? NHS. Health Development Agency; 2001.

7. Harborview Injury Prevention and Research Center / Cochrane Collaboration / systematic review database.

University of Washington, Seattle. 2001.

8. EUROCAPP (European Evaluation of children’s and adolescent’s Accident Prevention Policies) study. Luxembourg; 1997.

9. Petridou E. Injuries from food products containing inedibles. Report to the European Parliament. Athens; 1997.

10. Proceedings on social inequalities and injury risk. Journal Injury Control and Safety Promotion 2001;8:129-210.

11. UNICEF: A league table of child deaths by injury in rich countries. Florence: Innocenti Report Card, No 2; 2001.

12. Breen J. Road safety advocacy. BMJ 2004;328:888-890.

13. European Association for the coordination of consumer representation in standardisation: update on standardisation work in the child safety field. Brussels; 2001.

14. Warda L, Tenenbein M, Moffatt ME. House fire injury prevention update. Part 1. A review of risk factors for fatal and non-fatal fire injury. Inj Prev 1999;5:145-150.

15. Plitponkarnpim A, Andersson R, Jansson B, Svanstrom L. Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition. Inj Prev 1999;5:98-103.

16. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.

17. Racioppi F, Eriksson S, Tingvall C, Villaveces A. Preventing road traffic injury: a public health perspective for Europe.

Copenhagen: WHO Regional Office for Europe; 2004.

18. Cubbin C, Smith GS. Socioeconomic inequalities in injuries: critical issues in design and analysis. Annu Rev Public Health 2002;23:349-375.

19. Towner E. Injury and inequalities: bridging the gap. Intl J Inj Contr Saf Promot 2005;12:79-84.

20. Roberts I, Mohan D, Abbasi K. War on the roads. BMJ 2002;324:1107-1108.

21. Risk assessment and target setting in EU transport programmes. Brussels: European Transport Safety Council; 2003.

22. Hobbs A. Safer car fronts for pedestrians and cyclists.

Brussels: European Transport Safety Council, February 2001. (Presentation to Commission hearing on pedestrian protection).

23. Thompson DC, Rivara FP, Thompson RS. Effectiveness of bicycle helmets in preventing head injuries. A case-control study. JAMA 1996;276:1968-1973.

24. Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC; Task Force on Community Preventive Services. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med 2001;21 (4 Suppl):31-47.

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93

∞ÛʷϤ˜ ·È¯Ó›‰È ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜: ÂÌfi‰È· Î·È ÚÔÔÙÈΤ˜ ¶. °ÚËÁÔÚ›Ô˘, ∞. ∆ÂÚ˙›‰Ë˜, ∂. ¶ÂÙÚ›‰Ô˘ ¶ÂÚ›ÏË„Ë: ∆· ·Ù˘¯‹Ì·Ù· ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜. ∫¿ı ¯ÚfiÓÔ ÂÚÈÛÛfiÙÂÚ· ·fi 200.000 ·È‰È¿ (ËÏÈΛ·˜ ≤14 ÂÙÒÓ) ÂÈÛΤÙÔÓÙ·È Ù· Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÏfiÁˆ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Û ·È‰È΋ ¯·Ú¿ ÛÙȘ ∏.¶.∞. ∏ ËÏÈÎȷ΋ ÔÌ¿‰· 5-9 ÂÙÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ. ∆· fiÚÁ·Ó· ·Ó·ÚÚ›¯ËÛ˘, Ë ÙÛÔ˘Ï‹ıÚ· Î·È ÔÈ ÎÔ‡ÓȘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ù· ϤÔÓ ˘‡ı˘Ó· fiÚÁ·Ó· ·fi ÏÂ˘Ú¿˜ ÂÍÔÏÈÛÌÔ‡. ∞Ó Î·È ·ÚÎÂÙ¿ Û˘¯ÓÔ›, ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ‰ÂÓ Ô‰ËÁÔ‡Ó Û˘Ó‹ıˆ˜ Û ·Ó·ËÚ›· ‹ ı¿Ó·ÙÔ. ∫˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Â›Ó·È Ë ·Á›‰Â˘ÛË Ù˘ ÎÂÊ·Ï‹˜ ÌÂ Û˘Ó¤ÂÈ· ÙÔÓ ÛÙÚ·ÁÁ·ÏÈÛÌfi Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÔÈ ÙÒÛÂȘ. ™Â ÌÂϤÙË ÁÈ· ÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, ˘ÔÏÔÁ›ÛıËΠfiÙÈ ÂÍ·ÈÙ›·˜ ·Ù˘¯‹Ì·ÙÔ˜ Ì ÎÔ‡ÓÈ· 70.000 ¿ÙÔÌ· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÛÙ· Â›ÁÔÓÙ· È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ οı ¯ÚfiÓÔ. ∏ ·Ó·ÌÊÈÛ‚‹ÙËÙË ·Í›· ÙÔ˘ ·È¯ÓȉÈÔ‡ Î·È Ù·˘Ùfi¯ÚÔÓ·, Ë ·Ó¿ÁÎË Ó· Á›ÓÂÙ·È Ë ‰È·‰Èηۛ· ·˘Ù‹ Û ·ÛʷϤ˜ ÂÚÈ‚¿ÏÏÔÓ, ηıÈÛÙ¿ ÙË Ï‹„Ë ÚÔÏËÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ··Ú·›ÙËÙË. √È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ·ÔÙÂÏÔ‡Ó ÌÈ· ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ ÚfiÏ˄˘. ∫ÂÓ¿ ÛÙË ÓÔÌÔıÂÛ›·, ·Î·Ù¿ÏÏËÏË ÙÔÔı¤ÙËÛË Î·È ·ÓÂ·Ú΋˜ Û˘ÓÙ‹ÚËÛË ÙÔ˘ ÂÍÔÏÈÛÌÔ‡, ¤ÏÏÂÈ„Ë Û˘ÌÌÂÙÔ¯‹˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi fiÏˆÓ ÙˆÓ ÂÌÏÂÎÔÌ¤ÓˆÓ fiˆ˜ ÙÔ˘ È·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡ Î·È ÙˆÓ ·È‰Ô„˘¯ÔÏfiÁˆÓ Î·È ÌÂÁ¿ÏÔ ÎfiÛÙÔ˜, ‰ËÌÈÔ˘ÚÁÔ‡Ó ‰˘Û¯¤ÚÂȘ ÛÙËÓ Ú¿ÍË. ¶ÂÚ·ÈÙ¤Úˆ ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ Ì ¤ÌÊ·ÛË ÛÙË Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ¤ÎıÂÛ˘ Î·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÚÔÏËÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ı· Û˘Ì‚¿ÏÂÈ Ô˘ÛÈ·ÛÙÈο ÛÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ·È¯ÓȉÈÔ‡ ÛÙËÓ ·È‰È΋ ¯·Ú¿.

EÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ∂ϤÓË ¶ÂÙÚ›‰Ô˘ epetrid@med.uoa.gr ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ª. ∞Û›·˜ 75, ∆.∫. 11527 ∞ı‹Ó·

§¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰Èο ·Ù˘¯‹Ì·Ù·, ·È‰È΋ ¯·Ú¿, ·È¯ÓȉfiÙÔÔ˜, ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜.

Safer play for children in playgrounds: barriers and prospects P. Grigoriou, A. Terzidis, E. Petridou Abstract: Among childhood injuries, those occurring in playgrounds have been recognized as a major problem. Each year in the United States, emergency departments treat more than 200,000 children aged 14 years and younger for playground-related injuries. Children aged 5 to 9 years have higher rates of emergency department visits for this reason than any other age group. Although common, most playground injuries are not serious enough to cause permanent disability or death. Fatalities are usually the result of asphyxiation secondary to strangulation. Swing accidents have been studied through the European Home and Leisure Accident Surveillance System, and it was concluded that 70,000 people are treated every year in emergency departments for swing-related injuries in the European Union. While playground-related injuries represent a substantial proportion of childhood injuries in most developed countries, prevention has always been a sensitive issue, as on the one hand, children must be allowed to test their skills, while on the other this process should take place in a safe environment. Standards are an essential tool for the prevention of playground injuries. The absence of appropriate legislation, inadequate maintenance of facilities, the lack of involvement of medical personnel, child psychologists, teachers and parents and the huge costs of safety measures complicate the implementation and enforcement of standards. Further epidemiological studies focusing on exposure data and the evaluation of prevention strategies will contribute substantially to safer play in playgrounds.

Laboratory of Hygiene and Epidemiology, Medical School, University of Athens Correspondence: Eleni Petridou epetrid@med.uoa.gr Laboratory of Hygiene and Epidemiology Medical School, University of Athens 75, Mikras Asias St., 11527, Athens

Key words: Playground injuries, playgrounds standards.

πÛÙÔÚÈ΋ ·Ó·‰ÚÔÌ‹ √ ¶Ï¿ÙˆÓ·˜ Î·È Ô ∞ÚÈÛÙÔÙ¤Ï˘ ›¯·Ó ‹‰Ë ÂÈÛËÌ¿ÓÂÈ ÙË ÛÔ˘‰·ÈfiÙËÙ· ÙÔ˘ ·È¯ÓȉÈÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÂÎ·›‰Â˘ÛË ÙÔ˘ ·È‰ÈÔ‡. ∆Ô ·È¯Ó›‰È ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Î·È ·Ú¿ÏÏËÏ·, ¤Ó· ̤ÛÔ ÚÔÂÙÔÈÌ·Û›·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ “·ÏËıÈÓÔ‡” ÎfiÛÌÔ˘.

√ fiÚÔ˜ “·È‰È΋ ¯·Ú¿” ·Ó·Ê¤ÚÂÙ·È Û ˘·›ıÚÈÔ˘˜ ¯ÒÚÔ˘˜ „˘¯·ÁˆÁ›·˜ Î·È ·È¯ÓȉÈÔ‡, Û˘Ó‹ıˆ˜ ‰ËÌfiÛÈ·˜ ¯Ú‹Û˘, fiˆ˜ ̤۷ Û ۯÔÏ›·, ¿Úη Î·È ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜, fiÔ˘ Ô ˘¿Ú¯ˆÓ ÂÍÔÏÈÛÌfi˜ ‰È¢ÎÔχÓÂÈ, ÏËÓ Ù˘ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋, ÎÔÈÓˆÓÈ΋ Î·È ‰È·ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË, ‰ËÏ·‰‹ Û˘Ì‚¿ÏÏÂÈ Ô˘ÛÈ·ÛÙÈο ÛÙËÓ ÔχÏ¢ÚË ·Ó¿Ù˘ÍË ¶·È‰È·ÙÚÈ΋ 2007;70:93-96

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¶. °ÚËÁÔÚ›Ô˘ Î·È Û˘Ó.

ÙˆÓ ·È‰ÈÒÓ. ™ÙȘ ̤Ú˜ Ì·˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·È‰ÈΤ˜ ¯·Ú¤˜ Î·È Û ¯ÒÚÔ˘˜ ÔÈÎÔÁÂÓÂȷ΋˜ ·Ó·„˘¯‹˜ (ÍÂÓԉԯ›·, ÂÛÙÈ·ÙfiÚÈ· Î.Ï.) ·ÏÏ¿ Î·È Ì¤Û· Û ¯ÒÚÔ˘˜ ηÙÔÈΛ·˜. √È ·È‰ÈΤ˜ ¯·Ú¤˜ ÛÙÔ¯Â‡Ô˘Ó ÛÙÔ Ó· ÂÈÙÚ¤„Ô˘Ó ÛÙ· ·È‰È¿ Ó· ‰ÔÎÈÌ¿ÛÔ˘Ó, ̤۷ Û ‡ÏÔÁ· ·ÛÊ·Ï‹ fiÚÈ·, ÙȘ ÈηÓfiÙËÙ¤˜ ÙÔ˘˜ Ó· ·ÏÏËÏÂȉÚÔ‡Ó Ì ÙÔÓ ÎfiÛÌÔ. ∏ ÚÒÙË ·È‰È΋ ¯·Ú¿ ÛÙË ª. µÚÂÙ·Ó›· ηٷÛ΢¿ÛÙËΠÙÔ 1877 ÛÙÔ Birmingham. ¶ÚˆÙÔfiÚÔ˜ ¯ÒÚ· ÛÙË ‰ËÌÈÔ˘ÚÁ›· ·È¯ÓȉfiÙÔˆÓ Ì ÂÍÔÏÈÛÌfi ıˆÚÂ›Ù·È Ë ¢·Ó›·, fiÔ˘ ÁÈ· ÚÒÙË ÊÔÚ¿ „ËÊ›ÛÙËÎ·Ó ÓfiÌÔÈ Ô˘ ·Ú›¯·Ó ‰È¢ÎÔχÓÛÂȘ ·È¯ÓȉÈÔ‡ ÂÓÙfi˜ ηÙÔÈÎÈÒÓ Î·È ·’ fiÔ˘ ÚÔ‹ÏıÂ Î·È Ë È‰¤· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·È‰È΋˜ ¯·Ú¿˜ “ÂÚÈ¤ÙÂÈ·˜”, ÌÈ·˜ ‰È·ÊÔÚÂÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÁÈ· ÙË ‰È·ÌfiÚʈÛË Ù˘ ·È‰È΋˜ ¯·Ú¿˜, fiˆ˜ ı· ‰Ô‡Ì ·Ú·Î¿Ùˆ. ™ÙȘ ∏.¶.∞. ÔÈ ÚÒÙ˜ ·È‰ÈΤ˜ ¯·Ú¤˜ ·Ó·Ù‡¯ıËÎ·Ó ÂÚ› Ù· Ù¤ÏË ÙÔ˘ 1800 Ì ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÊÈÏ·ÓıÚˆÈÎÒÓ ÔÚÁ·ÓÒÛÂˆÓ Î·È Ì ÙË ÏÔÁÈ΋ ¯ÒÚˆÓ ·È¯ÓȉÈÔ‡ ·ÛʷϤÛÙÂÚˆÓ ·fi ÙÔ˘˜ ‰ÚfiÌÔ˘˜, Ô˘ ̤¯ÚÈ ÙfiÙ ¤·È˙·Ó Ù· ·È‰È¿,. ™ÙËÓ ∂ÏÏ¿‰· ·È‰ÈΤ˜ ¯·Ú¤˜ ηٷÛ΢¿˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Û ۯÔÏ›·, ¿Úη, ÎÂÓÙÚÈο ÛËÌ›· ¯ˆÚÈÒÓ Î·È fiÏÂˆÓ Î·È ÁÂÓÈÎfiÙÂÚ· Û ¯ÒÚÔ˘˜ Ú·Û›ÓÔ˘ Î·È ‚Ú›ÛÎÔÓÙ·È Î¿Ùˆ ·fi ÙËÓ ÂÔÙ›· ÙˆÓ ‰‹ÌˆÓ (1). ŒÓ·˜ ‚·ÛÈÎfi˜ ‰È·¯ˆÚÈÛÌfi˜ Ô˘ ÌÔÚ› Ó· ÂÚÈÁÚ¿„ÂÈ Ù· ›‰Ë ÙˆÓ ˘·›ıÚÈˆÓ ¯ÒÚˆÓ ·È¯ÓȉÈÔ‡ Â›Ó·È ·˘Ùfi˜ Ô˘ ÙÔ˘˜ ‰È·ÎÚ›ÓÂÈ Û “·Ú·‰ÔÛÈ·ÎÔ‡˜” (traditional playgrounds) Î·È “ÂÚÈ¤ÙÂÈ·˜” (adventure playgrounds). √È “·Ú·‰ÔÛȷΤ˜” ·È‰ÈΤ˜ ¯·Ú¤˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÍÔÏÈṲ̂Ó˜ Ì ÎÔ‡ÓȘ, ÙÛÔ˘Ï‹ıÚ˜, ‰ÔÎÔ‡˜ ·Ó·ÚÚ›¯ËÛ˘, ̇ÏÔ˘˜ Î·È ÙÚ·Ì¿Ï˜ Î·È ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô ÙËÓ Î›ÓËÛË Î·È ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË ÙÔ˘ ·È‰ÈÔ‡. √È ·È‰ÈΤ˜ ¯·Ú¤˜ “ÂÚÈ¤ÙÂÈ·˜” ‚·Û›˙ÔÓÙ·È ÛÙË ÏÔÁÈ΋ fiÙÈ ÙÔ ·È¯Ó›‰È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÌÈ· ÈÔ ÔχÏ¢ÚË ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ ¤Ú·Ó Ù˘ ۈ̷ÙÈ΋˜. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ, ¿¯ÚËÛÙ· ·ÓÙÈΛÌÂÓ· fiˆ˜ Ï¿ÛÙȯ· ·˘ÙÔÎÈÓ‹ÙˆÓ, ‚·Ú¤ÏÈ· Î·È ·ÏÈ¿ Ô¯‹Ì·Ù· ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ËÁ‹ ÂÚÂı›ÛÌ·ÙÔ˜ ÁÈ· Â˘Ê¿ÓÙ·ÛÙÔ Î·È ‰ËÌÈÔ˘ÚÁÈÎfi ·È¯Ó›‰È Û ¤Ó· ηٿÏÏËÏ· ۯ‰ȷṲ̂ÓÔ fï˜ ÂÚÈ‚¿ÏÏÔÓ. ∆· ·È‰È¿ Â‰Ò ÌÔÚÔ‡Ó Ó· ‰È·ÌÔÚÊÒÛÔ˘Ó ÙÔÓ ·È¯ÓȉfiÙÔÔ fiˆ˜ ·˘Ù¿ ÓÔÌ›˙Ô˘Ó, Û˘Ó‹ıˆ˜ ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË ÂÓfi˜ ÂÓ‹ÏÈη. √È ÂÚÈÂÙÂÈÒ‰ÂȘ ·È‰ÈΤ˜ ¯·Ú¤˜, ·Ó Î·È ‚Ú‹Î·Ó ·‹¯ËÛË Û ÌÂÚÈο ÎÚ¿ÙË Ù˘ ∂˘ÚÒ˘ fiˆ˜ Ë ¢·Ó›·, Î·È Ë ∂Ï‚ÂÙ›·, ‰ÂÓ ¤Ù˘¯·Ó ·Ô‰Ô¯‹˜ ÛÙȘ ∏.¶.∞. ÏfiÁˆ ÙÔ˘ Êfi‚Ô˘ ·Ù˘¯ËÌ¿ÙˆÓ (2). ∂ÓÙÔ‡ÙÔȘ, ÛÙÔ Û‡Á¯ÚÔÓÔ ·ÛÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ Â›Ó·È ·Ó·Áη›Ô Ó· ‰È·ÌÔÚʈıÔ‡Ó Î·Ù¿ÏÏËÏÔÈ ·È¯ÓȉfiÙÔÔÈ, fiÔ˘ Ù· ·È‰È¿ ı· ÌÔÚÔ‡Ó Ó· ÂÈÚ·Ì·ÙÈÛÙÔ‡Ó Î·È Ó· ·Ó·Ù‡ÍÔ˘Ó ÙȘ ‰ÂÍÈfiÙËÙ¤˜ ÙÔ˘˜ ηıÒ˜ Î·È ÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ ÌÂٷ͇ ÙÔ˘˜.

Paediatriki 2007;70:93-96

∞Ù˘¯‹Ì·Ù· ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ - ¶ÂÚÈÁÚ·Ê‹ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ∆· ·Ù˘¯‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ¤Ó· Ú·ÁÌ·ÙÈο ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ·, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ (3). ¶·Ú’ fiÏ· ·˘Ù¿ Ë ÚfiÏË„‹ ÙÔ˘˜ ‰ÂÓ Â›Ó·È Â‡ÎÔÏË, ηıÒ˜ ¤Ú¯ÂÙ·È ·ÓÙÈ̤وË Ì ¤Ó· Ô˘ÛÈ·ÛÙÈÎfi ‰›ÏËÌÌ·, ÙËÓ ·Ó¿ÁÎË ·Ó¿Ù˘Í˘ ‰ÂÍÈÔÙ‹ÙˆÓ Î·È Â›Ù¢Í˘ ÙˆÓ ÛÙfi¯ˆÓ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ó·Ù‡¯ıËÎ·Ó ÔÈ ¯ÒÚÔÈ ·˘ÙÔ›, ·ÏÏ¿ Î·È ÙËÓ ·Ó¿ÁÎË Ë ‰È·‰Èηۛ· ·˘Ù‹ Ó· Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ̤۷ Û ¤Ó· ·ÛʷϤ˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÂÍÔÏÈÛÌfi. ∫¿ı ¯ÚfiÓÔ ÛÙȘ ∏.¶.∞. ÂÚÈÛÛfiÙÂÚ· ·fi 200.000 ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 14 ÂÙÒÓ ÂÈÛΤÙÔÓÙ·È Ù· Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÏfiÁˆ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙËÓ ÒÚ· ÙÔ˘ ·È¯ÓȉÈÔ‡ Û οÔÈ· ·È‰È΋ ¯·Ú¿ (4). ™Â ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi (ÂÚ›Ô˘ 45%) ÔÈ Î·ÎÒÛÂȘ Â›Ó·È ÛÔ‚·Ú¤˜ fiˆ˜ .¯. ηٿÁÌ·Ù·, ÂÛˆÙÂÚÈΤ˜ ηÎÒÛÂȘ, ‰È·Û›ÛÂȘ, ÂÍ·ÚıÚ‹Ì·Ù· Î·È ·ÎÚˆÙËÚÈ·ÛÌÔ› (4). ∆· ÎÔÚ›ÙÛÈ· Ê·›ÓÂÙ·È fiÙÈ ˘ÂÚ¤¯Ô˘Ó ÂÏ·ÊÚ¿ Û ·˘Ùfi ÙÔ Â›‰Ô˜ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ (4), ÂÓÒ ÛÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· 5-9 ÂÙÒÓ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ ÏfiÁˆ ·˘ÍË̤Ó˘ ¤ÎıÂÛ˘- Û˘ÁÎÚÈÙÈο Ì ÔÔÈ·‰‹ÔÙ ¿ÏÏË ËÏÈÎȷ΋ ÔÌ¿‰· (5). ∆· fiÚÁ·Ó· ·Ó·ÚÚ›¯ËÛ˘, Ë ÙÛÔ˘Ï‹ıÚ· Î·È ÔÈ ÎÔ‡ÓȘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ù· ϤÔÓ ˘‡ı˘Ó· fiÚÁ·Ó· ÚfiÎÏËÛ˘ ·Ù˘¯ËÌ¿ÙˆÓ ·fi ÏÂ˘Ú¿˜ ÂÍÔÏÈÛÌÔ‡. ∞Ó Î·È ·ÚÎÂÙ¿ Û˘¯ÓÔ›, ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ‰ÂÓ Ô‰ËÁÔ‡Ó Û˘Ó‹ıˆ˜ Û ÌfiÓÈÌË ‚Ï¿‚Ë ‹ ı¿Ó·ÙÔ. Œ¯ÂÈ ·Ó·ÎÔÈÓˆı› fiÙÈ Û ̛· ‰ÂηÂÙ›· (1990-2000) ÛÙË ¯ÒÚ· ·˘Ù‹ Û˘Ó¤‚ËÛ·Ó 147 ı¿Ó·ÙÔÈ ·È‰ÈÒÓ (15 ÂÚ›Ô˘ ·Ó¿ ¤ÙÔ˜). ∞fi ·˘ÙÔ‡˜, 82 ÔÊ›ÏÔÓÙ·Ó Û ·Á›‰Â˘ÛË Ù˘ ÎÂÊ·Ï‹˜ ‹ ·fi οÔÈÔ ÚÔ‡¯Ô ‹ Û οÔÈÔ fiÚÁ·ÓÔ ÌÂ Û˘Ó¤ÂÈ· ÙÔÓ ÛÙÚ·ÁÁ·ÏÈÛÌfi, Î·È 31 ÔÊ›ÏÔÓÙ·Ó Û ÙÒÛË. ∂›Û˘, Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ 70% ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ ÂÚÈÙÒÛÂˆÓ ¤Ï·‚ ¯ÒÚ· Û ·È‰ÈΤ˜ ¯·Ú¤˜ ȉȈÙÈ΋˜ ¯Ú‹Û˘ ̤۷ Û ηÙÔÈ˘, ÂÓÒ Û ·ÓÙ›ıÂÛË, ÙÔ 75% ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û˘Ì‚·›ÓÂÈ Û ·È‰ÈΤ˜ ¯·Ú¤˜ ‰ËÌfiÛÈÔ˘ ¯·Ú·ÎÙ‹Ú· (4), ÈÔ Û˘¯Ó¿ Û ۯÔÏ›· Î·È Û ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜ (5). ∞ÓÙ›ÛÙÔȯ· ÛÙÔÓ ∫·Ó·‰¿ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ 28.500 ·È‰È¿ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Î¿ı ¯ÚfiÓÔ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÂÍ·ÈÙ›·˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Û ·È‰È΋ ¯·Ú¿. À‡ı˘ÓÔ˜ Ì˯·ÓÈÛÌfi˜ ÛÙ· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›Ó·È Ë ÙÒÛË ·fi οÔÈÔ fiÚÁ·ÓÔ Î·È Û˘¯ÓfiÙÂÚË ‰È¿ÁÓˆÛË Ù· ηٿÁÌ·Ù·, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡Ó ÔÈ Î·ÎÒÛÂȘ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ (6). ™ÙÔÓ Â˘Úˆ·˚Îfi ¯ÒÚÔ, Ë Mulder Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ Ù˘ ÌÂϤÙËÛ·Ó Ù· ·Ù˘¯‹Ì·Ù· ÛÙȘ ÎÔ‡ÓȘ ÛÙ· Ï·›ÛÈ· ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ∂ÈÙ‹ÚËÛ˘ ∞Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ Û›ÙÈ Î·È Î·Ù¿ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ (European Home and Leisure

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·95

95

∞Ù˘¯‹Ì·Ù· ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜

Accident Surveillance System - EHLASS). ¢Â‰Ô̤ӷ ·fi 8 ¯ÒÚ˜ Â› Û˘ÓfiÏÔ˘ 5.000 ÂÚ›Ô˘ ·Ù˘¯ËÌ¿ÙˆÓ, Ô‰‹ÁËÛ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· ˆ˜ οı ¯ÚfiÓÔ ÛÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË 70.000 ¿ÙÔÌ· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÛÙ· Â›ÁÔÓÙ· È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÏfiÁˆ ·Ù˘¯‹Ì·ÙÔ˜ Ì ÎÔ‡ÓÈ· (7). ™ÙË ª. µÚÂÙ·Ó›· ¤¯ÂÈ ‰Âȯı› fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ·Ó¤Ú¯ÂÙ·È ÛÙ· 24.000 ·Ó¿ ÂÍ¿ÌËÓÔ, Û ∞ÁÁÏ›· Î·È √˘·Ï›· (8). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ∂ÏÏ¿‰·, ¤¯ÂÈ ˘ÔÏÔÁÈÛı› fiÙÈ Ë Â›ÙˆÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Â›Ó·È 11 ·Ó¿ 1.000 ·È‰È¿ ·Ó¿ ¤ÙÔ˜, Ì ‰ÈÏ¿ÛÈÔ Î›Ó‰˘ÓÔ Ó· Û˘Ì‚Â› ·Ù‡¯ËÌ· ÛÙȘ ‰ËÌfiÛȘ ·’ fi,ÙÈ ÛÙȘ ȉȈÙÈΤ˜ ·È‰ÈΤ˜ ¯·Ú¤˜ (9). ∂‰Ò ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Û‹ÌÂÚ· ÛÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË ¤¯Ô˘Ó ÙÂı› ÔÈ ‚¿ÛÂȘ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ‰ÈÎÙ‡Ô˘ ·fi ‚¿ÛÂȘ ‰Â‰ÔÌ¤ÓˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ ηχÙÂÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi 5.000.000 ÂÚÈÙÒÛÂȘ ·Ù˘¯‹Ì·ÙÔ˜ Î·È Û˘ÓÂÒ˜ ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛʤÚÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ·Ù˘¯‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù‹ ÙËÓ ÙfiÛÔ ÛËÌ·ÓÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ϤÁÂÙ·È ·È¯Ó›‰È (10). ¶ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ Î·È ·ÍÈÔÏfiÁËÛË √È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ‰È·ÚÎÒ˜ ÂÍÂÏ›ÛÛÔÓÙ·È Î·È ÙÚÔÔÔÈÔ‡ÓÙ·È, ·Ú¿ÏÏËÏ· Ì ÙȘ ÚÔÛ¿ıÂȘ Ô˘ Á›ÓÔÓÙ·È ÁÈ· ÙËÓ ÂÓ·ÚÌÔÓÈÛ‹ ÙÔ˘˜ Û ·ÁÎfiÛÌÈ· Îϛ̷η, ηıÒ˜ ÔÈΛÏÏÔ˘Ó Â˘Ú¤ˆ˜ ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÒÚ˜. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ fiÙ·Ó ‰ÂÓ ÙËÚÔ‡ÓÙ·È, Ù· ·È‰È¿ ÂÎÙ›ıÂÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ, ÂȉÈÎfiÙÂÚ· fiÙ·Ó Ë ÌË Û˘ÌÌfiÚʈÛË ¤¯ÂÈ Ó· οÓÂÈ Ì ·ÓÂ·ÚΤ˜ ‚¿ıÔ˜ ‹ ·Î·Ù¿ÏÏËÏË Â›ÛÙÚˆÛË ÙÔ˘ ‰¿ÊÔ˘˜ fiˆ˜ .¯. Ì ÙÛÈ̤ÓÙÔ, ¿ÛÊ·ÏÙÔ ‹ ¤ÙÚ˜ (3). ¶ÏËÓ ÙÔ˘ ·Î·Ù¿ÏÏËÏÔ˘ ‰¿ÊÔ˘˜, ÙÔ ‡„Ô˜ ÙÔ˘ ÂÍÔÏÈÛÌÔ‡ Â›Ó·È ¤Ó·˜ ¿ÏÏÔ˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÚԂϤÂÙ·È ·fi ÙȘ ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜. ∆Ô ÛÙÔÈ¯Â›Ô ·˘Ùfi ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ηıÒ˜ Û¯ÂÙ›˙ÂÙ·È Î˘Ú›ˆ˜ Ì ÙȘ ÙÒÛÂȘ, ÙÔ Û˘¯ÓfiÙÂÚÔ Â›‰Ô˜ ·Ù˘¯‹Ì·ÙÔ˜ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ¯ÒÚÔ˘˜, Œ¯ÂÈ ‰Âȯı› Ì¿ÏÈÛÙ· fiÙÈ Ë Û˘¯ÓfiÙËÙ· ·ÏÏ¿ Î·È Ë ‚·Ú‡ÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·˘Í¿ÓÂÙ·È fiÛÔ ·˘Í¿ÓÂÙ·È ÙÔ ‡„Ô˜ ÙˆÓ ÔÚÁ¿ÓˆÓ. ∆Ô fiÚÈÔ ÙÔ˘ 1,5 m Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·ÔÙÚÂÙÈÎfi, ·Ó Î·È ·˘Ùfi ÂÍ·ÚÙ¿Ù·È Î·È ·fi ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ·¢ı‡ÓÂÙ·È Ë ·È‰È΋ ¯·Ú¿ (3,11), fï˜ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· fiÛÔÓ ·ÊÔÚ¿ ÙÔ Ì¤ÁÈÛÙÔ ·ÛʷϤ˜ fiÚÈÔ. ÕÏÏ· ˙ËÙ‹Ì·Ù· Ô˘ ÚԂϤÔÓÙ·È ·fi ÙȘ Ô‰ËÁ›Â˜ ¤¯Ô˘Ó Ó· οÓÔ˘Ó Ì ÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ ÔÚÁ¿ÓˆÓ, fiˆ˜ .¯. ÙËÓ ÂÈÏÔÁ‹ ηٿÏÏËÏˆÓ ˘ÏÈÎÒÓ ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÙÔ˘˜ ‹ ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ··Ú·›ÙËÙˆÓ ·ÔÛÙ¿ÛÂˆÓ ÌÂٷ͇ ÙÔ˘˜. ª¤¯ÚÈ Î·È Û‹ÌÂÚ·, Ë ÂÊ·ÚÌÔÁ‹ ÚԉȷÁÚ·ÊÒÓ ·ÛÊ·Ï›·˜ ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ Û˘Ó·ÓÙ¿ ‰˘ÛÎÔϛ˜

Ì ·ÔÙ¤ÏÂÛÌ· Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ›Ù ӷ ÌËÓ ˘ÈÔıÂÙÔ‡ÓÙ·È, ›ÙÂ Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ Ó· Â›Ó·È ÂÏÏÈ‹˜. ™Â ÌÂϤÙË Û¯ÂÙÈο Ì ÙȘ Ù¿ÛÂȘ Î·È Ù· ›‰Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ·˘ÙÔ‡˜ ÛÙȘ ∏.¶.∞. ÛÙËÓ ÂÚ›Ô‰Ô 1992-1997 ‰ÂÓ ‰È·ÈÛÙÒıËΠԢÛÈ·ÛÙÈ΋ Ì›ˆÛ‹ ÙÔ˘˜ (5), Î·È ·˘Ùfi Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙ· ÂÍ‹˜: 1. ∏ ˘¢ı˘ÓfiÙËÙ· Û¯ÂÙÈο Ì ÙÔ˘˜ ¯ÒÚÔ˘˜ ·˘ÙÔ‡˜ ηٷӤÌÂÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ Ô˘ ‚Ú›ÛÎÔÓÙ·È ·˘ÙÔ› (‰‹ÌÔÈ, ȉÈÔÎً٘ Î.Ï.) Ì Èı·Ófi Â·ÎfiÏÔ˘ıÔ ÙȘ ‰˘Û¯¤ÚÂȘ Û˘ÓÂÚÁ·Û›·˜ Î·È Û˘ÓÙÔÓÈÛÌÔ‡, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ÙÔ ¤ÏÏÂÈÌÌ· Û¯ÂÙÈ΋˜ ÓÔÌÔıÂÙÈ΋˜ Ú‡ıÌÈÛ˘ ‰›ÓÂÈ ÙËÓ Â˘¯¤ÚÂÈ· ÛÙÔ˘˜ ηٷÛ΢·ÛÙ¤˜ Ó· ÏÂÈÙÔ˘ÚÁÔ‡Ó Ì ‚¿ÛË ÙÔ Î¤Ú‰Ô˜ Î·È ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌÔ‡˜.

2. ∏ ¤ÏÏÂÈ„Ë Î·Ù¿ÏÏËÏ˘ ÂÊ·ÚÌÔÁ‹˜ Î·È Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘ ÂÍÔÏÈÛÌÔ‡.

3. √ Ù¯ÓÈÎfi˜ ۯ‰ȷÛÌfi˜ ·fi ÙÔ˘˜ ηٷÛ΢·ÛÙ¤˜ Û˘¯Ó¿ ‰ÂÓ ÚÔ¸Ôı¤ÙÂÈ ÙË Û˘ÓÂÈÛÊÔÚ¿ Î·È ÙˆÓ ¿ÏÏˆÓ ÂÌÏÂÎfiÌÂÓˆÓ, fiˆ˜ ÙÔ˘ È·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡, ÙˆÓ ·È‰Ô„˘¯ÔÏfiÁˆÓ, ÙˆÓ ·È‰·ÁˆÁÒÓ, ÙˆÓ ÁÔÓ¤ˆÓ ·ÏÏ¿ Î·È ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·È‰ÈÒÓ. ÕÏψÛÙÂ Ë È‰¤· Ù˘ “ÂÚÈÂÙÂÈÒ‰Ô˘˜” ·È‰È΋˜ ¯·Ú¿˜ ‹Úı ÛÙÔÓ ÂÌÓ¢ÛÙ‹ Ù˘, ÙÔÓ ¢·Ófi ·Ú¯ÈÙ¤ÎÙÔÓ· Sorenson, ·Ú·ÙËÚÒÓÙ·˜ fiÙÈ Ù· ·È‰È¿ ¤·È˙·Ó ÈÔ Ôχ Ì ¿¯ÚËÛÙ· ÔÈÎÔ‰ÔÌÈο ˘ÏÈο ·Ú¿ Ì ÙÔ˘˜ ¯ÒÚÔ˘˜ ·È¯ÓȉÈÔ‡ Ô˘ ·˘Ùfi˜ ۯ‰›·˙ (1).

4. ™˘¯Ó¿ ‰ÂÓ Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ ÔÈ ‰È·ÊÔÚ¤˜ Û ÔÏÈÙÈÛÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο.

5. ∆Ô ÛËÌ·ÓÙÈÎfi ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ fï˜ Û ÌÈ· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË ·fi ÙË ª. µÚÂÙ·Ó›· Ô‰ËÁÂ›Ù·È ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÙË Ì›ˆÛË ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ‰ÂÓ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÎfiÛÙÔ˘˜ Ù¤ÙÔÈˆÓ ·ÚÂÌ‚¿ÛÂˆÓ (12).

6. ¢ÂÓ ˘¿Ú¯Ô˘Ó Â·Ú΋ ÛÙÔȯ›· ·fi ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜ ÁÈ·: ·) ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÚÔÏËÙÈÎÒÓ ·ÚÂÌ‚¿ÛˆÓ. √ MacKay Û ÌÈ· Û¯ÂÙÈ΋ ·Ó·ÛÎfiËÛË ‰È·›ÛÙˆÛ ÙËÓ ·ÚÔ˘Û›· ÂÓÓ¤· ÌfiÓÔ ÌÂÏÂÙÒÓ (‰‡Ô Û¯ÂÙÈÎÒÓ Ì ·Ú¤Ì‚·ÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›ÛÙÚˆÛË ÙÔ˘ ‰¿ÊÔ˘˜ Î·È ÂÙ¿ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÚÔÛ¿ıÂȘ Û Â›Â‰Ô ÂÎ·›‰Â˘Û˘) Ô˘ ‰ÂÓ ¤Ù˘¯Â ¢Ú›·˜ ÂÊ·ÚÌÔÁ‹˜ (3), ‚) ÙËÓ Î·Ù¿‰ÂÈÍË ÂȉÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ .¯. Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ‹ Ù· ‰È¿ÊÔÚ· ̤ÚË ÙÔ˘ ÛÒÌ·ÙÔ˜ (3) Î·È Á) ÙË Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ¤ÎıÂÛ˘. ∆· ÛÙÔȯ›· ·˘Ù¿ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙËÓ ÂÌ‚¿ı˘ÓÛË ÛÙÔ Úfi‚ÏËÌ·, ÙËÓ ÈÂÚ¿Ú¯ËÛË ÚÔÙÂÚ·ÈÔÙ‹ÙˆÓ Î·È ÙË Ï‹„Ë ¿ÌÂÛˆÓ Î·È ÔÚıÒÓ ÂÈÏÔÁÒÓ ·fi ÙÔ˘˜ ·ÚÌÔ‰›Ô˘˜ (3,11).

7. √È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ˘ÔηٷÛÙ‹ÛÔ˘Ó ÙÔÓ Ôχ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ù˘ Â·ÚÎÔ‡˜ Â›‚Ï„˘ ÙÔ˘ ·È‰ÈÔ‡. ¶·È‰È·ÙÚÈ΋ 2007;70:93-96

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·96

96

¶. °ÚËÁÔÚ›Ô˘ Î·È Û˘Ó.

¶ÚÔÔÙÈΤ˜ ªÂ ‰Â‰Ô̤ӷ ·fi ÙË ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙË ¯ÒÚ· Ì·˜, ˘ÔÏÔÁ›Û·Ì ÙËÓ ·Ó·ÏÔÁ›· ·˘ÙÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ·È‰ÈΤ˜ ¯·Ú¤˜ Û ·È‰È¿ ËÏÈΛ·˜ 3-12 ÂÙÒÓ (10). ∏ ·Ó·ÏÔÁ›· ‹Ù·Ó ÂÚ›Ô˘ 10%, Û˘ÁÎÚÈÙÈο ‰ÈÏ¿ÛÈ· ÙÔ˘ ¯ÚfiÓÔ˘ Ô˘ ÂÚÓ¿ ¤Ó· ·È‰› ÛÙËÓ ·È‰È΋ ¯·Ú¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. √ ‰ÈÏ¿ÛÈÔ˜ ΛӉ˘ÓÔ˜ ¤¯ÂÈ ˘ÔÏÔÁÈÛÙ› Ì ‚¿ÛË ÙËÓ ˘fiıÂÛË fiÙÈ ¤Ó· ·È‰› ÂÚÓ¿ ηٿ ̤ÛÔÓ fiÚÔ 1 ÒÚ· ÙËÓ Ë̤ڷ ÛÙËÓ ·È‰È΋ ¯·Ú¿ (~5% ‰ËÏ·‰‹, ηıÒ˜ Ë ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ÁÈ· Ù· ·È‰È¿ Â›Ó·È ·fi 7 .Ì. ¤ˆ˜ 9 Ì.Ì.). øÛÙfiÛÔ, ÙÔ ·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ·ÚÔ˘ÛÈ¿˙ÂÈ ÂӉ¯Ô̤ӈ˜ ˘ÂÚ‚ÔÏÈÎfi ÙÔÓ Î›Ó‰˘ÓÔ ·fi ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Û ·˘Ùfi ÙÔÓ ¯ÒÚÔ, ηıÒ˜ ¤Ó· ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ (.¯. Ì¿ıËÌ· ÛÙËÓ Ù¿ÍË ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘) ÂÓ¤¯ÂÈ ÌÈÎÚfi ΛӉ˘ÓÔ ·Ù˘¯‹Ì·ÙÔ˜. ∞˘Ùfi ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ ·È‰ÈΤ˜ ¯·Ú¤˜ Â›Ó·È Ú¿ÁÌ·ÙÈ ·ÛÊ·Ï›˜, ·ÓÙÈı¤Ùˆ˜, ¤¯Ô˘Ì ·Ó·ÎÔÈÓÒÛÂÈ fiÙÈ ÂÚ›Ô˘ 50% ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ı· ÌÔÚÔ‡Û ӷ ›¯Â ·ÔÊ¢¯ı› Ì ÙȘ ηٿÏÏËϘ ·ÚÂÌ‚¿ÛÂȘ ۯ‰ȷÛÌÔ‡ Î·È ÂÍÔÏÈÛÌÔ‡ (9). ∞Ó¿ÏÔÁ˜ ÂÎÙÈÌ‹ÛÂȘ ¤¯Ô˘Ó Á›ÓÂÈ Î·È ÁÈ· ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ¤Ú·Ó ·˘ÙÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ·È¯ÓȉfiÙÔÔ˘˜ Î·È Û˘ÓÔÏÈο ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ı· Ú¤ÂÈ Ó· ÂÛÙÈ·ÛÙ› Û fiϘ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙˆÓ ·È‰ÈÒÓ ·ÓÂÍ·Úًو˜ ÙfiÔ˘ ‹ ¯ÚfiÓÔ˘. ∂›Ó·È Â›Û˘ ÛËÌ·ÓÙÈÎfi Ó· ·ÓÙÈÏËÊıԇ̠fiÙÈ Ë ÚfiÎÏËÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÏÏËÏÂ›‰Ú·Û˘ ·ÙfiÌÔ˘, ¯ÚfiÓÔ˘ Î·È ÙfiÔ˘. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÂÓÂÚÁËÙÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Î·È ÂÈı˘ÌËÙ‹ Î·È ·Ó·Áη›·, ΛӉ˘ÓÔ˜ ı· ˘¿Ú¯ÂÈ. ∏ ÚÔÛ¿ıÂÈ· Ú¤ÂÈ Ó· ÂÛÙÈ·ÛÙ› ÛÙÔ Ó· ÂÏ·¯ÈÛÙÔÔÈËı› ·˘Ùfi˜, ¯ˆÚ›˜ Ó· ÂÚÈÔÚÈÛÙ› Ë ÂÏ¢ıÂÚ›· ÙÔ˘ ·È‰ÈÔ‡, Ë ‰È¿ıÂÛË ÁÈ· ÂÍÂÚ‡ÓËÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔÎÏ‹ÛÂˆÓ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ø˜ ÂÎ ÙÔ‡ÙÔ˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÚÔ·„Ô˘Ó ÙÚ›· Û˘ÌÂÚ¿ÛÌ·Ù·: 1. ∆Ô ·È¯Ó›‰È ÛÙÔ˘˜ ·È¯ÓȉfiÙÔÔ˘˜ ¤¯ÂÈ ÂÈÚfiÛıÂÙÔ Î›Ó‰˘ÓÔ Û ۯ¤ÛË Ì ¿ÏϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ˆÛÙfiÛÔ Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‰ÂÓ Â›Ó·È ··ÁÔÚ¢ÙÈÎfi˜.

2. ∆· ·Ù˘¯‹Ì·Ù· ÛÙÔ˘˜ ·È¯ÓȉfiÙÔÔ˘˜ ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó. ªÂ ‰Â‰Ô̤ÓË Ì¿ÏÈÛÙ· ÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·, Ë ÚfiÏË„Ë Ú¤ÂÈ Ó· ¤¯ÂÈ ÚˆÙ‡ÔÓÙ· ÚfiÏÔ.

3. ∂›Ó·È ·Ó·Áη›Ô Ó· ۯ‰ȷÛÙÔ‡Ó ÂÚÈÛÛfiÙÂÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ı· ηχ„Ô˘Ó Ù· ÛËÌÂÚÈÓ¿ ÎÂÓ¿ Û ۯ¤ÛË Ì ÙÔ ı¤Ì· ·˘Ùfi, ÒÛÙ ӷ ÏËÊıÔ‡Ó Ù· ηٿÏÏËÏ· ̤ÙÚ· ‚·ÛÈṲ̂ӷ Û ÂÈÛÙËÌÔÓÈΤ˜ ·ԉ›ÍÂȘ. ™˘ÛÙ¿ÛÂȘ √È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡Ó Î·È Ó· ÙÚÔÔÔÈÔ‡ÓÙ·È Ì ‚¿ÛË Ù· ÂÈPaediatriki 2007;70:93-96

‰ËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ. ∏ ÔÏÈÙ›· ˆÛÙfiÛÔ, Â›Ó·È ·˘Ù‹ Ô˘ ʤÚÂÈ ÙËÓ Â˘ı‡ÓË ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜. ∏ ÌÂÁ·Ï‡ÙÂÚË ¯ÚËÌ·ÙÔ‰fiÙËÛË Î·È Ë ı¤ÛÈÛË ÓÔÌÔıÂÛ›·˜, fiÔ˘ ˘¿Ú¯Ô˘Ó ·ÎfiÌË ÎÂÓ¿, ı· Û˘Ì‚¿ÏÔ˘Ó Ô˘ÛÈ·ÛÙÈο ÒÛÙ ӷ ÂÈÙ¢¯ı› ÙÔ ÂÈı˘ÌËÙfi ·ÔÙ¤ÏÂÛÌ·. ∆Ô ·È‰› ¤¯ÂÈ ‰Èη›ˆÌ· ÛÙÔ ·È¯Ó›‰È. ∆Ô ·È¯Ó›‰È ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ÚÔÛˆÈÎfiÙËÙ¿˜ ÙÔ˘. ™ÙȘ ̤Ú˜ Ì·˜ Î·È ÛÙȘ ÌÂÁ·ÏÔ˘fiÏÂȘ, ÔÈ ·È‰ÈΤ˜ ¯·Ú¤˜ Ù›ÓÔ˘Ó Ó· Á›ÓÔ˘Ó ÔÈ ÌÔÓ·‰ÈÎÔ› ¯ÒÚÔÈ ·È¯ÓȉÈÔ‡. £· Ú¤ÂÈ Ó· Â›Ó·È ÂÎÙfi˜ ·fi ¯ÒÚÔÈ „˘¯·ÁˆÁ›·˜ Î·È ¯ÒÚÔÈ ·ÛÊ·Ï›˜.

∂˘¯·ÚÈÛٛ˜ °È· ÙË Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙÔ ∫¤ÓÙÚÔ ŒÚ¢ӷ˜ Î·È ¶ÚfiÏ˄˘ ∞Ù˘¯ËÌ¿ÙˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ·ÎÔÏÔ˘ı› ÎÔÈÓfi ÚˆÙfiÎÔÏÏÔ Ì ÙȘ ¿ÏϘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, Ô˘ ÂÔÙ‡ÂÙ·È Î·È ÂÓ Ì¤ÚÂÈ ¯ÚËÌ·ÙÔ‰ÔÙÂ›Ù·È ·fi ÙË °ÂÓÈ΋ ¢È‡ı˘ÓÛË ¢ËÌfiÛÈ·˜ ÀÁ›·˜ Ù˘ ∫ÔÈÓfiÙËÙ·˜ Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ Î·È ∫ÔÈÓˆÓÈ΋˜ ∞ÏÏËÏÂÁÁ‡Ë˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∞˘ÁËÙ›‰Ô˘ ™ (ÂÈÌÂÏ‹ÙÚÈ·). ∆Ô ¶·È¯Ó›‰È. ™‡Á¯ÚÔÓ˜ ÂÚ¢ÓËÙÈΤ˜ Î·È ‰È‰·ÎÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ. 1Ë ¤Î‰ÔÛË, ∞ı‹Ó·: ∂ΉfiÛÂȘ ∆˘ˆı‹Ùˆ; 2001. Û. 67-370.

2. Krohe JR. Beyond playgrounds. The best advice you can give a kid may be: Go play in the street. Illinois Issues 1996;19-26. http://www.lib.niu.edu/ipo/1996/ii960619.html 3. MacKay M. Playground injuries: recent attempts to begin to address what we don’t know. Inj Prev 2003;9:194-196.

4. Tinsworth D, McDonald J. Special study: Injuries and deaths associated with children’s playground equipment.

United States Consumer Product Safety Commission.

Washington (DC), USA; 2001. Webpage: http://www.cpsc.gov/library/playgrnd.pdf 5. Phelan KJ, Khoury J, Kalkwarf HJ, Lanphear BP. Trends and patterns of playground injuries in United States children and adolescents. Ambul Pediatr 2001;1:227-233.

6. Preventing playground injuries. Injury Prevention Committee, Canadian Paediatric Society; Paediatrics & Child Health 2002;7(4): 255-256. Website: http://www.cps.ca/english/ statements/IP/IP02-01.htm 7. Mulder S, Barrow M, Bay-Neilsen H, Duval C. Swing accidents within the European region. Int J Consumer Safety 1995;2:175-189.

8. Sibert J, Stone D. Injury prevention in the UK - the European dimension. Inj Prev 1998;4 (Suppl): S34-S41.

9. Petridou E, Sibert J, Dedoukou X, Skalkidis I, Trichopoulos D. Injuries in public and private playgrounds: the relative contribution of structural, equipment and human factors. Acta Paediatr 2002;91:691-697.

10. Dessypris N, Petridou E, Skalkidis Y, Moustaki M, Koutselinis A, Trichopoulos D. Countrywide estimation of the burden of injuries in Greece: a limited resources approach.

J Cancer Epidemiol Prev 2002;7:123-129.

11. Norton C, Nixon J, Sibert JR. Playground injuries to children. Arch Dis Child 2004;89:103-108.

12. Ball D. Playgrounds: risks, benefits and choices. Contract research report. No 426/2002. Health and Safety Executive, UK; 2002.

Pediatr Mar-Apr 07

28-03-07

17:23

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™ÂÏ›‰·97

ORIGINAL ARTICLE

97

∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ ∞. ∫·Ê¿ÙÔ˜, Ã. ÷Ù˙‹˜, ª. §ÈÓ·Ú‰¿Î˘, ¢. ∞ı·Ó·ÛfiÔ˘ÏÔ˜, Ã. §ÈÔÓ‹˜, ∂. ª·ÏˆÌÂÓ¿ÎË, ∞. ∫·ÓÈÛ¿Î˘, ∂. ™Ù·Ì·Ù¿ÎË Î·È ™˘ÓÂÚÁ·˙fiÌÂÓÔÈ ÂÚ¢ÓËÙ¤˜* ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ∫Ú‹Ù˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 1189 ·È‰È¿ (591 ·ÁfiÚÈ·), ËÏÈΛ·˜ 4-7 ÂÙÒÓ. ŒÁÈÓ ̤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ۈ̷ÙÔÌÂÙÚÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ Î·È Ï‹„Ë ·›Ì·ÙÔ˜ ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·È ÙÔ˘ ۷ί¿ÚÔ˘. ∞ÔÙÂϤÛÌ·Ù·: ™‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ International Obesity Task Force (IOTF), 27,4% ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη (10,8% ·¯‡Û·Úη) Î·È 28,5% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (9% ·¯‡Û·Úη). ªÂ ·˘ÍË̤ӷ Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (>95Ë ÂηÙÔÛÙÈ·›· ı¤ÛË) ‚Ú¤ıËΠÙÔ 7,4% ÙˆÓ ·ÁÔÚÈÒÓ Î·È 7,9% ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ªÂ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË >200 mg/dl ‚Ú¤ıËΠÙÔ 14,4% ÙˆÓ ·È‰ÈÒÓ Î·È Ì LDL-C >130 mg/dl ÙÔ 13,8%. ªÂ ¤Ó·Ó ·Ú¿ÁÔÓÙ· ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ‚Ú¤ıËΠÙÔ 18,3% ÙˆÓ ·È‰ÈÒÓ, Ì ‰‡Ô ·Ú¿ÁÔÓÙ˜ ÙÔ 5,9% Î·È Ì ÙÚÂȘ ÙÔ 1,4%. ¶·È‰È¿ Ì ˘„ËÏ¿ Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (>100 mg/dl) ›¯·Ó Û ۇÁÎÚÈÛË Ì ÂΛӷ Ì ¯·ÌËÏ¿ Â›‰· (≤80 mg/dl), ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Ì¤ÛË ÙÈÌ‹ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ Î·È ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (p<0,05). ¶·È‰È¿ Ì ¯·ÌËÏ¿ Â›‰· HDL-C (<45 mg/dl) ›¯·Ó Û ۯ¤ÛË Ì ÂΛӷ Ì ˘„ËÏ¿ Â›‰· (≥60 mg/dl), ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÂÚ›ÌÂÙÚÔ Ì¤Û˘ Î·È ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (p<0,05). ∆· ·¯‡Û·Úη ·È‰È¿ ‚Ú¤ıËÎ·Ó ·ÎfiÌË Ó· ¤¯Ô˘Ó 2,87 ÊÔÚ¤˜ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· (p=0,041). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ·¯˘Û·ÚΛ·˜. ∏ ·ÚÔ˘Û›· ȉȷ›ÙÂÚ· Ù˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ ÛÙË ÓËȷ΋ ËÏÈΛ·, Ê·›ÓÂÙ·È Ó· Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· Ì ¿ÏÏÔ˘˜ ·ıËÚÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ˘ÂÚÏÈȉ·ÈÌ›·. ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË Û ÁÔÓ›˜, ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Î·È ·È‰È¿ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ·ÎfiÌË ËÏÈΛ· Â›Ó·È ¿ÌÂÛË ÂıÓÈ΋ ·Ó¿ÁÎË.

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ∆Ì‹Ì· π·ÙÚÈ΋˜, ∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜, ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ∞ÓÙÒÓ˘ ∫·Ê¿ÙÔ˜ kafatos@med.uoc.gr ¢È·ÛÙ·‡ÚˆÛË µÔ‡Ù˜™Ù·˘Ú¿ÎÈ· ∆.∫. 710 03, ∆.£. 2208, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

§¤ÍÂȘ ÎÏÂȉȿ: ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, ·ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ˘¤ÚÙ·ÛË, ·¯˘Û·ÚΛ·, ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ÂÚ›ÌÂÙÚÔ˜ ̤Û˘.

Atherogenic risk factors in preschool children in Crete A. Kafatos, C. Hatzis, M. Linardakis, D. Athanasopoulos, C. Lionis, E. Balomenaki, A. Kapnisakis, H. Stamataki and Collaborative researchers Abstract Background: The aim of the study was the investigation of atherogenic risk factors in preschool children of Crete.

Methods: The study population included 1189 children (591 boys), aged 4-7 years. All children were examined, for the following: anthropometric and blood pressure measurements. Blood was taken for serum lipoproteins and blood sugar.

Results: According to International Obesity Task Force (IOTF) criteria, 27.4% of the boys were classified as overweight or obese (obese 10.8%). The respective percentage for girls was 28.5% (obese 9%).

7.4% of the boys and 7.9% of the girls had blood pressure above the 95th percentile. Total cholesterol >200 mg/dl was found in 14.4% and LDL-C >130 mg/dl in 13.8% of the children. The percentage of children with one, two, and three metabolic syndrome risk factors was 18.3%, 5.9% and 1.4% respectively. Children with high serum triglycerides (>100 mg/dl) had significantly higher mean waist circumference (WC) and body mass index (BMI) compared to those with low triglycerides (≤80 mg/dl) (p<0.05). Similarly, children with lower HDL-C (<45 mg/dl) had significantly higher WC and BMI than children with higher HDL-C (≥60 mg/dl) (p<0.05). Moreover, obese children had significantly higher risk for hypetriglyceridemia as compared to non-obese children (Odds Ratio: 2.87, p=0.041).

Conclusions: These results of high prevalence of overweight and obesity in Cretan preschool children indicate the presence of this major public health problem in early ages. Levels of obesity and especially

University of Crete, Faculty of Medicine, Department of Social Medicine, Division of Preventive Medicine and Nutrition, Heraklion, Crete Correspondence: Antonis Kafatos kafatos@med.uoc.gr Voutes-Stavrakia Junction, 71 003, Po. Box: 2208, Herakleion, Crete

¶·È‰È·ÙÚÈ΋ 2007;70:97-106

Pediatr Mar-Apr 07

28-03-07

17:23

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∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

central obesity were strongly related to other atherogenic risk factors, namely dyslipidemia. Health and nutrition education addressed to parents, teachers and children should become an urgent national priority.

Key words: Preschool age, atherogenic risk factors, hypertension, obesity, body mass index, waist circumference.

™˘ÓÙÔÌÔÁڷʛ˜ ∂∂ ™∞¶ ¢∞¶ GLU TCHOL HDL-C

∂˘Úˆ·˚΋ ŒÓˆÛË ™˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ¢È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ™¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ √ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ TG ∆ÚÈÁÏ˘ÎÂÚ›‰È· TCHOL/HDL-C ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ¢ª™ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ª ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ¶π ¶ÂÚ›ÌÂÙÚÔ˜ ÈÛ¯›Ô˘ ¶ªπ ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÈÛ¯›Ô ¶ªª ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ Ì‹ÎÔ˜ ª™ ™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ OR Odds ratio IOTF International Obesity Task Force

∂ÈÛ·ÁˆÁ‹ √È Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔÈ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· Û ¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜ ̤Û˘ ËÏÈΛ·˜ Ù˘ ¯ÒÚ·˜ Ì·˜, Û¯ÂÙ›˙ÔÓÙ·È ÛÙÂÓ¿ Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·. ∏ ‚·ıÌÈ·›· ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙÔÓ ·Ú·‰ÔÛÈ·Îfi ÙÚfiÔ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ Ù·¯Â›· ·‡ÍËÛË ÙˆÓ ÚfiˆÚˆÓ ı·Ó¿ÙˆÓ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (1-4). ∏ ∂ÏÏ¿‰· Â›Ó·È ·fi ÙȘ ÚÒÙ˜ ¯ÒÚ˜ ÛÙËÓ ∂∂ ÛÂ Û˘¯ÓfiÙËÙ· ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ (5). ∏ ·ÚÔ˘Û›· ·˘ÍË̤ÓÔ˘ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ Û˘Ó˘¿Ú¯ÂÈ Û˘¯Ó¿ Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ ÔÈ ˘ÂÚÏÈȉ·È̛˜, Ë ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÙÔ ·˘ÍË̤ÓÔ Û¿Î¯·ÚÔ (GLU) ÓËÛÙ›·˜. ∂¿Ó Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Û˘Ó˘ÔÏÔÁÈÛÙ› ÙÔ ¿ÌÂÛÔ Î·È ¤ÌÌÂÛÔ Î¿ÓÈÛÌ·, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘˜ ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·ıËÚÔÛÎÏËÚ˘ÓÙÈ΋ ÂÂÍÂÚÁ·Û›·. ∏ Û˘Ó‡·ÚÍË 3 ‹ 4 ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍËPaediatriki 2007;70:97-106

ÛË Ù˘ ÈÓÒ‰Ô˘˜ Ͽη˜ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÚÙËÚÈÒÓ, Ô˘ ηٷϋÁÂÈ Û ·ıËڈ̷ÙÈ΋ Ͽη Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (6,7). À¤Ú‚·Ú· Î·È ·¯‡Û·Úη ·È‰È¿ [‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) >85Ë ÂηÙÔÛÙÈ·›· ı¤ÛË] ¤¯Ô˘Ó 24 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ·˘ÍË̤ÓË ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TCHOL) Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È Î¿Ùˆ ·fi ÙËÓ 85Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÙÔ˘ ¢ª™ (8). ∞ÎfiÌË, Ô ·ÓÙ›ÛÙÔȯԘ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙË ‰È·ÛÙÔÏÈ΋ ›ÂÛË (¢∞¶) Â›Ó·È 2,4 ÊÔÚ¤˜, 4,5 ÁÈ· ÙË Û˘ÛÙÔÏÈ΋ ›ÂÛË (™∞¶), 3 ÁÈ· ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË (LDL-C), 3,4 ÁÈ· ÙËÓ HDL ¯ÔÏËÛÙÂÚfiÏË (HDL-C), 7,1 ÁÈ· Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG) Î·È 12,6 ÁÈ· Ù· Â›‰· ÈÓÛÔ˘Ï›Ó˘ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· (8). ∂ÈϤÔÓ, Ë ¯Ú‹ÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ·È‰ÈÒÓ Ô˘ Â›Ó·È ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη ÌÔÚ› Ó· ÚԂϤ„ÂÈ ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ¤¯Ô˘Ó ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ıËÚÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (8). ∏ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜, ·ÎfiÌË Î·È ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, Û¯ÂÙ›˙ÂÙ·È Ì ˘ÂÚÏÈȉ·ÈÌ›· ÛÙȘ ÌÂÙ¤ÂÈÙ· ËÏÈ˘, ȉȷ›ÙÂÚ· Û ÂΛӷ Ù· ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙȘ ·ÓÒÙÂÚ˜ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÏÈÔÚˆÙÂ˚ÓÒÓ, Ì Â›Ù·ÛË Ù˘ ˘ÂÚÏÈȉ·ÈÌÈ΋˜ ÂÈÎfiÓ·˜ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ (9). ∏ Û¯¤ÛË ·˘Ù‹ Ê·›ÓÂÙ·È Ó· ·Ô‰›‰ÂÙ·È ÛÙËÓ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, fiÔ˘ Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ ÂÈÙ›ÓÂÙ·È Ë ˘ÂÚÏÈȉ·ÈÌ›· ‹ Ë ˘¤ÚÙ·ÛË Î·È Ë ·ÓÙÔ¯‹ ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ (10,40). ∏ ·Ú·¿Óˆ Û¯¤ÛË Ê·›ÓÂÙ·È, Â›Û˘, Ó· Á›ÓÂÙ·È ÛÙÂÓfiÙÂÚË Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜. ∞ÎfiÌË Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 2-3 ÂÙÒÓ, ÔÈ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓ Ù˘ ¡¤·˜ ÀfiÚ΢ ‚Ú¤ıËÎ·Ó Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ Â›‰· Ù˘ ÈÓÛÔ˘Ï›Ó˘ Î·È Ù· Â›‰· Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ (10). ∏ ÌÂÁ¿ÏË ÛËÌ·Û›· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Ê¿ÓËΠ·fi ÙË ÌÂϤÙË Bogalusa Heart Study ÛÙȘ ∏¶∞, fiÔ˘ ÔÈ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ ÔÚÔ‡ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÙËÓ ›‰È·

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∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

‰È·‰ÚÔÌ‹ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛË (11). ∂›Û˘, ‰È·ÈÛÙÒıËÎÂ Û˘ÛÛÒÚ¢ÛË Î·È Û˘Ó‡·ÚÍË ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ, Ì ÚÔ¤¯ÔÓÙ· ·Ú¿ÁÔÓÙ· ÙËÓ ·¯˘Û·ÚΛ·. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ÊÔÈÙÔ‡Ó ÛÙ· ÓËÈ·ÁˆÁ›· ¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË ‰ÈÂÍ‹¯ıË Û ÓËÈ·ÁˆÁ›· ¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ¡ÔÌÔ‡ ÷ÓÈÒÓ ∫Ú‹Ù˘ (÷ӛˆÓ, ∞ÎÚˆÙËÚ›Ô˘, ∂Ï¢ıÂÚ›Ô˘ µÂÓÈ˙¤ÏÔ˘, ™Ô‡‰·˜, £ÂÚ›ÛÔ˘ Î·È ¡¤·˜ ∫˘‰ˆÓ›·˜) Ô˘ ηχÙÔ˘Ó ÏËı˘ÛÌfi 81.719 ÌfiÓÈÌˆÓ Î·ÙÔ›ÎˆÓ Û ۇÓÔÏÔ 150.387 ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ (∂™À∂, ·ÔÁÚ·Ê‹ 2001). ∂Î·›‰Â˘ÛË ˘ÁÂÈÔÓÔÌÈÎÒÓ Ù˘ ÌÂϤÙ˘ ∆˘ ‰ÂÈÁÌ·ÙÔÏË„›·˜ ÚÔËÁ‹ıËΠÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ÙˆÓ ÂȉÈ΢fiÌÂÓˆÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ÷ӛˆÓ “O ÕÁÈÔ˜ °ÂÒÚÁÈÔ˜”, ÙÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡, ÙˆÓ ÂÈÛÎÂÙÚÈÒÓ ˘Á›·˜ Î·È ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÏÂÈÙÔ˘ÚÁÒÓ ÙÔ˘ K¤ÓÙÚÔ˘ I·ÙÚÔÎÔÈÓˆÓÈ΋˜ ŒÚ¢ӷ˜ (∫π∂) Î·È ÙÔ˘ ¢‹ÌÔ˘ ÷ӛˆÓ ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2004, ·fi ÙËÓ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ÁÈ· ÙËÓ ÂͤٷÛË fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ÙˆÓ ¤ÍÈ ‰‹ÌˆÓ. √È ˘ÁÂÈÔÓÔÌÈÎÔ› ·˘ÙÔ› ÂÎ·È‰Â‡ÙËÎ·Ó ÁÈ· ÙË Û˘ÏÏÔÁ‹ ÙˆÓ ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÙË Ï‹„Ë ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ (‚¿ÚÔ˜, Ì‹ÎÔ˜, ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜, ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ Î·È ÏÂοÓ˘), ÙË Ì¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ηıÒ˜ Î·È fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÌÔÏË„›· ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÏÈÔÚˆÙ½ÓÒÓ Î·È Ù˘ GLU. ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÎ·›‰Â˘Û˘, ÔÈ ÂÎ·È‰Â˘fiÌÂÓÔÈ ¯ˆÚ›ÛÙËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜ ·Ú¿ÏÏËÏ˘ ‰Ú¿Û˘ Ì ÁÚ·ÌÌ·ÙÂȷ΋ ˘ÔÛÙ‹ÚÈÍË Û ÙÔÈÎfi Â›Â‰Ô ·fi ÙÔ ∫π∂. ∏ οı ÔÌ¿‰· ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ‰‡Ô ·È‰È¿ÙÚÔ˘˜, Ì›· ÓÔÛËχÙÚÈ· Î·È ÂÈÛΤÙÚȘ ˘Á›·˜ ‹ Î·È ÎÔÈÓˆÓÈÎÔ‡˜ ÏÂÈÙÔ˘ÚÁÔ‡˜. ∂ÈÏÔÁ‹ ‰Â›ÁÌ·ÙÔ˜ ∏ ÌÂϤÙË ‰›Ô˘ ‰È‹ÚÎËÛ ٤ÛÛÂÚȘ Ì‹Ó˜ (ºÂ‚ÚÔ˘¿ÚÈÔ˜-ª¿ÈÔ˜ 2004), fiÔ˘ ¤ÁÈÓ ÏÂÙÔÌÂÚ‹˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÈ¤‰ˆÓ ˘Á›·˜, ıÚ¤„˘ Î·È ·Ó¿Ù˘Í˘ ·ÓÙÈÚÔÛˆ¢ÙÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ 1189 ÚÔÓË›ˆÓ Î·È ÓË›ˆÓ, ËÏÈΛ·˜ 4-7 ÂÙÒÓ (̤ÛË ËÏÈΛ· 5,3±0,6 ¤ÙË), fiÏˆÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ÙˆÓ ¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ. ∞fi Ù· 67 ÓËÈ·ÁˆÁ›· Ì 1761 ÂÁÁÂÁÚ·Ì̤ӷ ·È‰È¿, ‰¤¯ıËÎ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙÔ ÚfiÁÚ·ÌÌ· 1356 ·È‰È¿, Ì ڢıÌfi ·ÓÙ·fiÎÚÈÛ˘ 77% Î·È ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÔÚ›Ô˘ 70% Ô˘ ηıÔÚ›˙ÂÈ ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· (29). ∆ÂÏÈο, ·fi ·˘Ù¿ Û˘ÌÌÂÙ›¯·Ó 1189 ·È‰È¿ (591 ·ÁfiÚÈ· Î·È 598 ÎÔÚ›ÙÛÈ·) (ÙÂÏÈ΋ Û˘ÌÌÂÙÔ¯‹ 88%). ¶ÔÛÔÛÙfi 59% ÙˆÓ ·È‰ÈÒÓ ÚÔÂÚ¯fiÙ·Ó ·fi ·ÛÙÈ΋ ÂÚÈÔ¯‹, ÙÔ 35% ·fi ËÌÈ·ÛÙÈ΋ Î·È ÙÔ 6% ·fi ·ÁÚÔÙÈ΋. √È ÂÍÂÙ¿ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ·Ó ÛÙÔÓ ¯ÒÚÔ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ÙÔ˘˜, ηÙfiÈÓ ¤ÁÎÚÈÛ˘ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ¶·È‰Â›·˜ Î·È ÙÔ˘ ¶·È‰·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘, ÂÓÒ ÚÔËÁ‹ıËΠÏÂÙÔÌÂÚ‹˜ ÂÓË̤ڈÛË Î·È ÂÓ˘fiÁÚ·ÊË Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ. ™˘ÏÏÔÁ‹ ‰ÂÈÁÌ¿ÙˆÓ ·›Ì·ÙÔ˜ Î·È ·Ó·Ï˘ÙÈ΋ ̤ıÔ‰Ô˜ √È ·ÈÌÔÏË„›Â˜ ¤ÁÈÓ·Ó Û 603 ·È‰È¿ ÓËȷ΋˜ ËÏÈΛ·˜

¿Óˆ ÙˆÓ 5 ÂÙÒÓ (75%), Û ‡ÙÈ· ı¤ÛË ÌÂÙ¿ ·fi 12ˆÚË ÔÏÔÓ‡ÎÙÈ· ÓËÛÙ›·. ∞fi οı ·È‰› ÂÏ‹ÊıËÛ·Ó 3 ml ·›Ì·ÙÔ˜ Ì EDTA ÁÈ· ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È 5 ml ·›Ì·ÙÔ˜ Û ۈÏËÓ¿ÚÈ· ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡. ∏ GLU ÌÂÙÚ‹ıËΠ̠ÙËÓ ÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô GOD-PAP (12). ∏ ·ÎÚÈ‚‹˜ ÌÂıÔ‰ÔÏÔÁ›· ̤ÙÚËÛ˘ Ù˘ TCHOL, ÙˆÓ TG, Ù˘ HDL-C Î·È Ù˘ LDL-C ÂÚÈÁÚ¿ÊÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (13-15). ∆¤ÏÔ˜, ˘ÔÏÔÁ›ÛÙËÎÂ Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ TCHOL/HDL-C. ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ ™Â 1135 ·È‰È¿ (95%), ËÏÈΛ·˜ 4-7 ÂÙÒÓ, ÌÂÙÚ‹ıËΠÙÔ ‚¿ÚÔ˜, ÙÔ Ì‹ÎÔ˜, Ë ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (¶ª) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÈÛ¯›Ô˘ (¶π), ÂÓÒ ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ ‰Â›ÎÙ˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÈÛ¯›Ô (¶ªπ) Î·È ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ Ì‹ÎÔ˜ (¶ªª). ∞Ó·Ï˘ÙÈ΋ ÂÚÈÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ÌÂıfi‰ˆÓ ̤ÙÚËÛ˘ ·Ó·Ê¤ÚÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (15-17). √ ¢ª™ ˘ÔÏÔÁ›ÛÙËΠ·fi ÙË Û¯¤ÛË ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜ ÙÔ Ì‹ÎÔ˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2 ). ∆· fiÚÈ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ, ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·ıÔÚ›ÛÙËÎ·Ó ·fi ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ¢ª™, Ô˘ ·ÓÙÈÛÙÔȯ› Û fiÚÈ· ÂÓËÏ›ÎˆÓ ≤25 kg/m2 , 25,1 ¤ˆ˜ 30 kg/m2 Î·È ≥30 kg/m2 (18). ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜ ∏ ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËΠ۠1134 ·È‰È¿ (95%), ËÏÈΛ·˜ 4-7 ÂÙÒÓ, Û ηıÈÛÙ‹ ı¤ÛË Î·È ÌÂÙ¿ ·fi ·Ó¿·˘ÛË 5-10 ÏÂÙÒÓ. ∏ ̤ÙÚËÛË ¤ÁÈÓ Ì ˘‰Ú·ÚÁ˘ÚÈÎfi ÛÊ˘ÁÌÔÌ·ÓfiÌÂÙÚÔ, Ì Ï¿ÙÔ˜ ÂÚȯÂÈÚ›‰·˜ Ó· ηχÙÂÈ ÙÔ 50-75% ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘ ‰ÂÍÈÔ‡ ‚Ú·¯›ÔÓ·. O ÚÒÙÔ˜ Î·È ¤ÌÙÔ˜ ÙfiÓÔ˜ Korotkoff ·ÔÙ¤ÏÂÛ·Ó ·ÓÙÈÛÙÔ›¯ˆ˜, ÙË ™∞¶ Î·È ¢∞¶, Ô˘ ÌÂÙÚ‹ıËÎ·Ó ÙÚÂȘ ÊÔÚ¤˜ Ì ÌÂÛԉȿÛÙËÌ· 1-2 ÏÂÙÒÓ. ∞fi ÙȘ ÌÂÙÚ‹ÛÂȘ ·˘Ù¤˜ ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜ Ù˘ ‰Â‡ÙÂÚ˘ Î·È ÙÚ›Ù˘ ̤ÙÚËÛ˘ (ÚˆÙfiÎÔÏÏÔ MONICA) (15). ∆· ·˘ÍË̤ӷ Â›‰· Ù˘ ™∞¶ Î·È ¢∞¶ ηıÔÚ›ÛÙËÎ·Ó ·fi ÙËÓ Î·Ù¿ ËÏÈΛ·-ʇÏÔ 95Ë ÂηÙÔÛÙÈ·›· ı¤ÛË Ù˘ ηٷÓÔÌ‹˜ ÙˆÓ ·È‰ÈÒÓ (˘¤ÚÙ·ÛË ˆ˜ ™∞¶ ‹/Î·È ¢∞¶ >95Ë ÂηÙÔÛÙÈ·›· ı¤ÛË). ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ∆Ô ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ·ÔÙÂÏ› Û˘ÁΤÓÙÚˆÛË ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤ÓÙ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Â›Ó·È Ë ˘ÂÚÁÏ˘Î·ÈÌ›·, Ë ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, Ë ˘¤ÚÙ·ÛË, Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Î·È Ë ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË (20,30-35). øÛÙfiÛÔ, ‰ÂÓ ¤¯ÂÈ ‰È·Ù˘ˆı› ¤Ó·˜ ÎÔÈÓfi˜ ÔÚÈÛÌfi˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (ÁÈ· ÂÓ‹ÏÈΘ ‹ ·È‰È¿), Ì ·ÔÙ¤ÏÂÛÌ· ‰È¿ÊÔÚÔÈ ÊÔÚ›˜, ÔÚÁ·ÓÈÛÌÔ› ‹ ÂÈÛÙËÌÔÓÈο ȉڇ̷ٷ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ô ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ (31) ‹ ÙÔ National Cholesterol Education Program (NCEP ATP III) ÙˆÓ ∏¶∞ (32-34), Ó· ‰›ÓÔ˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÔÚÈÛÌÔ‡˜ Î·È ‚·Ú‡ÙËÙ· Û οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηÈ, Û˘ÓÂÒ˜, ‰È·ÊÔÚÂÙÈο ηٿ ÂÚ›ÙˆÛË fiÚÈ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÂÏ‹ÊıËÛ·Ó ˘’ fi„ÈÓ ÔÈ ·Ú·¿Óˆ ¤ÓÙ ·Ú¿ÁÔÓÙ˜. ∆· fiÚÈ¿ ÙÔ˘˜ ·ÓÙÈÛÙÔȯԇÓ: ÛÙËÓ ˘ÂÚÁÏ˘Î·ÈÌ›· ˆ˜ GLU ≥100 mg/dl (32), ÛÙËÓ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· ˆ˜ ¶ª ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ Î·Ù¿ ʇÏÔ-ËÏÈΛ· 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË, ÛÙËÓ ˘¤ÚÙ·ÛË ˆ˜ ™∞¶ ‹/Î·È ¢∞¶ ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ηٿ ʇÏÔ-ËÏÈΛ· 95˜ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ, ÛÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ˆ˜ TG ≥100 mg/dl Î·È ¯·ÌËÏ‹ HDL-C ¤ˆ˜ <10Ë Î·Ù¿ ʇÏÔ-ËÏÈΛ· ÂηÙÔÛÙÈ·›· ı¤ÛË. ¶·È‰È·ÙÚÈ΋ 2007;70:97-106

Pediatr Mar-Apr 07

28-03-07

17:23

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100

∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· SPSS ¤Î‰ÔÛË 13.0. ∞fi ÙÔ ‰Â›ÁÌ· ÌÂϤÙ˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÂÚÈÁÚ·ÊÈο ̤ÙÚ· ı¤Ûˆ˜ Î·È ‰È·ÛÔÚ¿˜ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ ÙˆÓ ·È‰ÈÒÓ Î·È ·ÊÔÚÔ‡Û·Ó ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ÙȘ ÏÈÔÚˆÙ½Ó˜, ÙË GLU ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·È ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË. °È· ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ·˘Ù¤˜ ˘ÔÏÔÁ›ÛÙËηÓ, Â›Û˘, ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÔÈ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Spearman. ªÂ ÙÔÓ ¤ÏÂÁ¯Ô χ2 (Chi-square test, Fisher exact test) ÂϤÁ¯ıËÎÂ Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ˆ˜ ÚÔ˜ Ù· Ê˘ÛÈÔÏÔÁÈο, ·˘ÍË̤ӷ Î·È ·ıÔÏÔÁÈο Â›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, Ù˘ GLU Î·È ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛˆÓ. ªÂ ÙË Ì¤ıÔ‰Ô Student t test ÂϤÁ¯ıËÎ·Ó ÌÂٷ͇ Ê‡ÏˆÓ Ù· Â›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ GLU Û ‰‡Ô ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜: 5,1-6,0 ÂÙÒÓ Î·È 6,1-7,0 ÂÙÒÓ. ∏ ̤ıÔ‰Ô˜ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (analysis of covariance) ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ‡·Ú͢ ÁÚ·ÌÌÈ΋˜ Ù¿Û˘ (linear trend) ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜ Î·È ÛÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ˆ˜ ÚÔ˜ Ù· Ê˘ÛÈÔÏÔÁÈο, ·˘ÍË̤ӷ Î·È ·ıÔÏÔÁÈο Â›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ GLU, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ·. ∏ ‡·ÚÍË ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÂϤÁ¯ıËΠ̠ÙÔÓ ¤ÏÂÁ¯Ô Levene (Levene’s test). °È· Ù· ·È‰È¿ Ì ·ıÔÏÔÁÈο Â›‰· GLU Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ, ÂÎÙÈÌ‹ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘Û˘ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (Logistic linear regression), ÔÈ ÏfiÁÔÈ Û˘ÌÏËڈ̷ÙÈÎÒÓ Èı·ÓÔÙ‹ÙˆÓ ‹ Û¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ (Odds ratio) Î·È Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘. ∏ ÂÎÙ›ÌËÛË ÔÚ›ÛÙËΠ۠ۯ¤ÛË Ì ÂΛӷ Ù· ·È‰È¿ Ô˘ ›¯·Ó ·ıÔÏÔÁÈο Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, ηıÒ˜ Î·È ¢ª™ Ô˘ ηıfiÚÈ˙ Â›‰· ·˘ÍË̤ÓÔ˘ ‚¿ÚÔ˘˜ (˘¤Ú‚·Ú·) Î·È ·¯˘Û·ÚΛ·˜. ø˜ ÌÂÙ·‚ÏËÙ‹ ÂϤÁ¯Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÈΛ·. ∆¤ÏÔ˜, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÂϤÁ¯Ô˘ Student ·ÏÔ‡ ‰Â›ÁÌ·ÙÔ˜ (One sample t test) ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ì ·Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ™Â fiϘ ÙȘ ·Ú·¿Óˆ ÌÂıfi‰Ô˘˜ ÔÚ›˙ÂÙ·È Î¿ı ÊÔÚ¿ ÙÔ ·Ô‰ÂÎÙfi Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ (p value) Ô˘ ·ÊÔÚ¿ ÛÙÔ 5%, 1% Î·È 1ò.

∞ÔÙÂϤÛÌ·Ù· √ ¶›Ó·Î·˜ 1 ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÁÚ·ÊÈΤ˜ ÙÈ̤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ GLU, ·Ó¿ ËÏÈΛ· Î·È Ê‡ÏÔ, ÙˆÓ ·È‰ÈÒÓ ÓËȷ΋˜ ËÏÈΛ·˜ (¿Óˆ ÙˆÓ 5 ÂÙÒÓ). ∆· ÎÔÚ›ÙÛÈ·, Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ıÂÚ¿ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ TCHOL, LDL-C, TCHOL/HDL-C (p>0,05), ÂÓÒ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ TG (p<0,05) ¤¯Ô˘Ó ÛÙȘ ËÏÈ˘ 5,1-6 ÂÙÒÓ. ∂›Û˘, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ GLU (p<0,05) Û fiϘ ÙȘ ËÏÈ˘. ∞fi ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ ·˘ÍË̤ӷ Â›‰· TCHOL ›¯Â ÙÔ 12,7% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 16,3% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05). ∞˘ÍË̤ӷ Â›‰· LDL-C ›¯Â, Â›Û˘, ÙÔ 11,1% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 16,7% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05). ™ÙÔÓ ¶›Ó·Î· 3 Ê·›ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÁÈ· οı ·ıËÚÔÁfiÓÔ ·Ú¿ÁÔÓÙ· ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘. ªÂ ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË ‚Ú¤ıËΠÙÔ 7,4% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 7,9% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05). À¤Ú‚·Ú· ‚Ú¤ıËÎ·Ó ÙÔ 16,6% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 19,5% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05), ÂÓÒ Ì ·¯˘Û·ÚΛ· ‚Ú¤ıËÎ·Ó ·ÓÙ›ÛÙÔȯ· ÙÔ 10,8% Î·È ÙÔ 9,0% (p>0,05). ∂›Û˘, ÔÛÔÛÙfi ÌfiÏȘ 1,3% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ ‚Ú¤ıËΠ̠·˘ÍË̤ӷ Â›‰· GLU ·›Ì·ÙÔ˜. ™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ªÂ ‰‡Ô ·Ú¿ÁÔÓÙ˜ ‚Ú¤ıËΠÙÔ 5,1% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 6,9% ÙˆÓ ÎÔÚÈÙÛÈÒÓ, ÂÓÒ Ì ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ (ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) ‚Ú¤ıËΠÌfiÓÔ ÙÔ 2,7% ÙˆÓ ·ÁÔÚÈÒÓ (p=0,026). ™ÙÔÓ ¶›Ó·Î· 5 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Î·Ù¿ ʇÏÔ ·ÏÔ› Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È GLU ·›Ì·ÙÔ˜ Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜ Î·È ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘. ∞˘ÍË̤ӷ Â›‰· GLU Û¯ÂÙ›˙ÔÓÙ·È ÛËÌ·ÓÙÈο

¶›Ó·Î·˜ 1. ∂›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Û·Î¯¿ÚÔ˘ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Û ·È‰È¿ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘ §ÈÔÚˆÙ½Ó˜ Î·È Û¿Î¯·ÚÔ

∏ÏÈΛ· (¤ÙË)

∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ·

™‡ÓÔÏÔ

ª¤ÛË ÙÈÌ‹ ± ∆˘È΋ ·fiÎÏÈÛË (¡) TCHOL (mg/dl) LDL-C (mg/dl) HDL-C (mg/dl) TG (mg/dl) TCHOL/HDL-C GLU (mg/dl)

5,1-6,0 6,1-7,0 5,1-6,0 6,1-7,0 5,1-6,0 6,1-7,0 5,1-6,0 6,1-7,0 5,1-6,0 6,1-7,0 5,1-6,0 6,1-7,0

169,3±28,5 (237) 168,3±25,5 (64) 102,1±25,8 100,4±21,4 57,3±11,4 57,5±11,0 50,4±18,8* 51,7±23,8 3,04±0,65 3,00±0,56 82,1±8,5** 80,9±7,5*

173,2±30,2 (244) 175,5±31,5 (48) 105,0±26,6 105,3±27,5 57,0±11,6 59,0±10,8 56,1±21,9 55,5±23,1 3,13±0,73 3,05±0,70 78,7±7,9 78,1±7,5

Student t test (Ô ¤ÏÂÁ¯Ô˜ ·ÊÔÚ¿ ÛÙ· ‰‡Ô ʇϷ Û οı ËÏÈÎȷ΋ ÔÌ¿‰· ͯˆÚÈÛÙ¿) * p <0,05, ** p <0,001 Paediatriki 2007;70:97-106

171,3±28,4 (481) 171,4±28,3 (112) 103,6±26,2 102,5±24,2 57,1±11,5 58,2±10,9 53,2±20,6 53,3±23,4 3,09±0,69 3,02±0,62 80,4±8,4 79,7±7,6

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·101

101

∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

¶›Ó·Î·˜ 2. º˘ÛÈÔÏÔÁÈο Î·È ·˘ÍË̤ӷ Â›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ·È‰ÈÒÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘ ∞ÁfiÚÈ· (¡=308)

§ÈÔÚˆÙ½Ó˜ ÔÚÔ‡ ·›Ì·ÙÔ˜

∫ÔÚ›ÙÛÈ· (¡=295)

™‡ÓÔÏÔ (¡=603)

¡ (%) TCHOL (mg/dl)

LDL-C (mg/dl)

HDL-C (mg/dl)

TG (mg/dl)

TCHOL / HDL-C

≤170 171-200 >200 ≤110 111-130 >130 <40 40-45 45-60 >60 ≤80 81-100 >100 ≤3,00 3,01-4,00 >4,00

169 (54,9) 100 (32,5) 39 (12,7) 205 (66,8) 68 (22,1) 34 (11,1) 13 (4,2) 30 (9,7) 161 (52,3) 104 (33,8) 284 (92,5) 13 (4,2) 10 (3,3) 164 (53,2) 124 (40,3) 20 (6,5)

142 (48,1) 105 (35,6) 48 (16,3) 180 (61,2) 65 (22,1) 49 (16,7) 15 (5,1) 27 (9,2) 141 (47,8) 112 (38,0) 265 (90,1) 14 (4,8) 15 (5,1) 152 (51,6) 114 (38,6) 29 (9,8)

311 (51,6) 205 (34,0) 87 (14,4) 385 (64,1) 133 (22,1) 83 (13,8) 28 (4,6) 57 (9,5) 302 (50,1) 216 (35,8) 549 (91,3) 27 (4,5) 25 (4,2) 316 (52,4) 238 (39,5) 49 (8,1)

ŒÏÂÁ¯Ô˜ χ2, p>0,05

(p<0,05) Ì ·˘ÍË̤ÓÔ ‚¿ÚÔ˜, Ì‹ÎÔ˜, ¶ª, ¢ª™, ¶ªπ Î·È ¶ªª. ¶·ÚfiÌÔÈ·, ·˘ÍË̤ӷ Â›‰· TG Û¯ÂÙ›˙ÔÓÙ·È ÛËÌ·ÓÙÈο (p<0,05) Ì ·˘ÍË̤ӷ Â›‰· ¶ª, ¢ª™ Î·È ¶ªª ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Ì ·˘ÍË̤ӷ Â›‰· ¶ªπ Û fiÏ· Ù· ·È‰È¿. ∆¤ÏÔ˜, ·ÚÓËÙÈ΋ Û¯¤ÛË ‰È·ÈÛÙÒÓÂÙ·È ÌÂٷ͇ HDL-C Î·È ¶ª, ·ÏÏ¿ Î·È ¢ª™ Î·È ¶ªª ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,05). ™ÙÔÓ ¶›Ó·Î· 6 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜ Î·È ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ ˆ˜ ÚÔ˜ Ù· Ê˘ÛÈÔÏÔÁÈο, ·˘ÍË̤ӷ Î·È ·ıÔÏÔÁÈο Â›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È GLU ·›Ì·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘. ∆· Â›‰· ÙÔ˘ GLU Û¯ÂÙ›˙ÔÓÙ·Ó ÛËÌ·ÓÙÈο Ì ÙË ™∞¶ (94,4, 96,3 Î·È 98,7 mmHg, p<0,05). ∆· Â›-

‰· ÙˆÓ TG Û¯ÂÙ›˙ÔÓÙ·Ó ÛËÌ·ÓÙÈο Ì ÙËÓ ¶ª (55,9, 57,5 Î·È 59,7 cm, p<0,05), ÙÔÓ ¢ª™ (16,6, 17,3 Î·È 17,9 kg/m2 , p<0,05) Î·È ÙËÓ ¶ªª (0,47, 0,49 Î·È 0,50, p<0,05). ∞ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Â›¯·Ó Ù· Â›‰· Ù˘ HDL-C Ì ÙËÓ ¶ª (57,7, 56,3 Î·È 55,5 cm, p<0,05), ÙÔÓ ¢ª™ (17,1, 16,7 Î·È 16,5 kg/m2 , p<0,05), ÙËÓ ¶ªπ (0,94, 0,89 Î·È 0,88, p<0,05) Î·È ÙËÓ ¶ªª (0,49, 0,48 Î·È 0,47, p<0,05). ™ÙÔÓ ¶›Ó·Î· 7 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ‰Â›ÎÙ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds ratio) ÙˆÓ ·È‰ÈÒÓ Ì ·ıÔÏÔÁÈο Â›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È GLU ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ٷ ·˘ÍË̤ӷ Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜, ÙËÓ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· Î·È Ù· Â›‰· ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ì ‚¿ÛË ÙÔÓ ¢ª™.

¶›Ó·Î·˜ 3. ™˘¯ÓfiÙËÙ· ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Û ·È‰È¿ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

À¤ÚÙ·ÛË* ÀÂÚ‚ÔÏÈÎfi µ¿ÚÔ˜** ¶·¯˘Û·ÚΛ·*** ÀÂÚÁÏ˘Î·ÈÌ›·#

∂ÍÂÙ·Ûı¤ÓÙ· ¡ (%) ∂ÍÂÙ·Ûı¤ÓÙ· ¡ (%) ∂ÍÂÙ·Ûı¤ÓÙ· ¡ (%) ∂ÍÂÙ·Ûı¤ÓÙ· ¡ (%)

∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ·

™‡ÓÔÏÔ

565 42 (7,4) 566 94 (16,6) 566 61 (10,8) 308 4 (1,3)

568 45 (7,9) 568 111 (19,5) 568 51 (9,0) 295 4 (1,4)

1133 87 (7,7) 1134 205 (18,1) 1134 112 (9,9) 603 8 (1,3)

* ™˘ÛÙÔÏÈ΋ ‹/Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË >95˘ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘ (ηٿ ʇÏÔ-ËÏÈΛ·) (p>0,05) ** ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û 25-30 kg/m2 (ÎÚÈÙ‹ÚÈ· IOTF). ªË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÔÛÔÛÙÔ‡ (p>0,05) Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ì ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û <25 kg/m2 *** ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û >30 kg/m2 (ÎÚÈÙ‹ÚÈ· IOTF). ªË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÔÛÔÛÙÔ‡ (p>0,05) Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ì ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û <25 kg/m2 # ™¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ ≥100 mg/dl (32) (p>0,05) ¶·È‰È·ÙÚÈ΋ 2007;70:97-106

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·102

102

∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

¶›Ó·Î·˜ 4. ™˘ÁΤÓÙÚˆÛË ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ·È‰È¿ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘ ∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ· ¡ (%)

™‡ÓÔÏÔ

224 (75,4) 50 (16,8) 15 (5,1) 8 (2,7)

203 (73,3) 55 (19,9) 19 (6,9) -

427 (74,4) 105 (18,3) 34 (5,9) 8 (1,4)

297

277

574

¶·Ú¿ÁÔÓÙ˜ 0 1 2 3 (ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) ™‡ÓÔÏÔ

ŒÏÂÁ¯Ô˜ χ2 (p=0,029) √È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·ÊÔÚÔ‡Ó ÛÂ: 1. ˘ÂÚÁÏ˘Î·ÈÌ›·: ۿί·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ ≥100 mg/dl 2. ˘¤ÚÙ·ÛË: Û˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË >95Ë ∂£ (ηٿ ʇÏÔ-ËÏÈΛ·) ‹ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË >95Ë ∂£ (ηٿ ʇÏÔ-ËÏÈΛ·) 3. ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·: ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ >90‹ ∂£ 4. ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·: ÙÚÈÁÏ˘ÎÂÚ›‰È· ≥100 mg/dl 5. ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË: <10Ë ∂£ (ηٿ ʇÏÔ-ËÏÈΛ·)

¶·È‰È¿ Ì ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· ‹ ¶ª ¿Óˆ ·fi ÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó 3,43 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ (95% ¢∂: 1,28-9,17, p=0,014) ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·. ¶·È‰È¿ Ì ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û Â›‰· ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 30 kg/m2, ¤¯Ô˘Ó 2,87 ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ (95% ¢∂: 1,05-7,85, p=0,041) ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·.

™˘˙‹ÙËÛË ∏ ÌÂϤÙË ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ 77% fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ 67 ÓËÈ·ÁˆÁ›ˆÓ Û ¤ÍÈ ‰‹ÌÔ˘˜ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ

¤‰ÂÈÍ Ôχ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜. ¶ÚÔ¤¯ÔÓÙ˜ ÛÂ Û˘¯ÓfiÙËÙ· ·ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ‹Ù·Ó ÙÔ ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ Î·È Ë ·¯˘Û·ÚΛ·. ∞ÎÔÏÔ˘ıÔ‡Ó ÔÈ ˘ÂÚÏÈȉ·È̛˜ ÛÙÔ 15% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Î·È Ë ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË ÛÙÔ 7,7%, ÂÓÒ Û ÂÙ¿ ·È‰È¿ - ·fi Ù· 603 ÛÙ· ÔÔ›· ¤ÁÈÓ ·ÈÌÔÏË„›· - ‚Ú¤ıËΠ·˘ÍË̤ÓË GLU ·›Ì·ÙÔ˜ (>100 mg/dl) ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›·. ™ÙÔ 6% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Û˘Ó˘‹Ú¯·Ó ‰‡Ô ·Ú¿ÁÔÓÙ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ÂÓÒ ÙÔ 1,4% (8 ·ÁfiÚÈ·) ›¯Â ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ÙÚÂȘ ·Ú¿ÁÔÓÙ˜). ∞˘Ù‹ Ë ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ·ÎfiÌË ËÏÈΛ·, ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο ·ÓËÛ˘¯ËÙÈÎfi ‡ÚËÌ· Î·È ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ·¯˘Û·ÚΛ·˜ Î·È fiÏˆÓ ÙˆÓ ¿ÏÏˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÙË Û˘Óԉ‡ԢÓ. ¶ÂÚÈÛÛfiÙÂÚÔ ·ÓËÛ˘¯ËÙÈÎfi Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ó·Ì¤ÓÂÙ·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Ì ÙËÓ ËÏÈΛ·, Ì ·ÔÎÔڇʈ̷ ÙËÓ ÂÊË‚È΋ ÂÚ›Ô‰Ô. ∞fi ÚfiÛÊ·ÙË ÌÂϤÙË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ·È‰È¿ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 3-17ó ÂÙÒÓ, Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, ‚Ú¤ıËΠfiÙÈ Ô ‰Â›ÎÙ˘ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ ηı›ÛÙ·Ù·È ¯ÂÈÚfiÙÂÚÔ˜ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ÛÙËÓ ÂÊË‚È΋. ¶·Ú¿ÏÏËÏ·, ·˘Í¿ÓÂÙ·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ·fi 2,7% ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Û 3,7% ÛÙËÓ ÂÊË‚È΋ (19). ¶·ÁÎÔÛÌ›ˆ˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÂÎÙÈÌ¿Ù·È Ó· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 4% Î·È 5% (20). ∆fiÛÔ Ë ‰È·¯ÚÔÓÈ΋ ·‡ÍËÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ

¶›Ó·Î·˜ 5. ™˘Û¯¤ÙÈÛË Û·Î¯¿ÚÔ˘ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ·È‰ÈÒÓ ·fi ÓËÈ·ÁˆÁ›· Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘ ™∞¶ (mmHg)

¢∞¶ (mmHg)

µ¿ÚÔ˜ (kg)

ª‹ÎÔ˜ (cm)

¶ª (cm)

¢ª™ (kg/m2)

¶ªπ

¶ªª

r (N)* GLU (mg/dl)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

0,162 (299)** 0,136 (279)**

0,050 (299) 0,075 (279)

0,257 (298)** 0,160 (298)** 0,236 (278)** 0,143 (278)**

0,272 (298)** 0,245 (278)**

0,249 (298)** 0,124 (298)** 0,219 (298)** 0,234 (278)** 0,162 (278)** 0,211 (278)**

TCHOL (mg/dl)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

-0,086 (299) 0,059 (279)

-0,124 (299)** 0,057 (279)

-0,098 (298) -0,029 (278)

-0,097 (298) -0,055 (278)

0,128 (298)** -0,055 (278)

-0,061 (298) -0,143 (298)** -0,080 (298) -0,003 (278) -0,075 (278) -0,016 (278)

TG (mg/dl)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

0,130 (298) 0,040 (278)

0,062 (298) 0,004 (278)

0,038 (297) 0,082 (277)

0,060 (297) -0,081 (277)

0,054 (297) 0,162 (277)**

0,017 (297) 0,129 (297)** 0,066 (297) 0,161 (277)** 0,180 (277)** 0,277 (277)**

HDL-C (mg/dl)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

-0,096 (299) 0,026 (279)

-0,072 (299) 0,021 (279)

-0,015 (298) -0,090 (278)

-0,065 (298) -0,012 (278)

-0,032 (298) 0,040 (298) -0,121 (298) 0,002 (298) -0,134 (278)** -0,117 (278) -0,172 (278)** -0,139 (278)**

LDL-C (mg/dl)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

-0,054 (298) 0,047 (278)

-0,090 (298) 0,075 (278)

-0,091 (297) 0,011 (277)

-0,074 (297) -0,028 (278)

-0,126 (297)** -0,076 (297) -0,140 (297)** -0,099 (297) -0,024 (277) 0,032 (277) -0,054 (277) 0,002 (277)

TCHOL/ HDL-C

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

0,013 (299) 0,031 (279)

-0,022 (299) 0,054 (279)

-0,044 (298) 0,059 (278)

0,004 (298) -0,028 (278)

-0,055 (298) 0,075 (278)

* r=Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ Spearman (N=·ÚÈıÌfi˜ ·È‰ÈÒÓ) ** p-value <0,05 Paediatriki 2007;70:97-106

-0,075 (298) 0,097 (278)

-0,012 (298) -0,058 (298) 0,091 (278) 0,102 (278)

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·103

103

∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

¶›Ó·Î·˜ 6. ∂›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Û ۯ¤ÛË Ì ÙÔ Û¿Î¯·ÚÔ Î·È ÙȘ ÏÈÔÚˆÙ½Ó˜ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ ·fi ÓËÈ·ÁˆÁ›· Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘ ™∞¶ (mmHg)

¢∞¶ (mmHg)

µ¿ÚÔ˜ (kg)

ª‹ÎÔ˜ (cm)

¡ GLU (mg/dl) TCHOL (mg/dl) TG (mg/dl) HDL-C (mg/dl) LDL-C (mg/dl)

*

≤50 ∂£ 50-90 ∂£ >90 ∂£ ≤170 171-200 >200 ≤80 81-100 >100 <45 45-60 ≥60 ≤110 111-130 >130

¶ª (cm)

¢ª™ (kg/m2)

¶ªπ

¶ªª

16,2±0,1 17,2±0,1 16,8±0,3 16,8±0,1 16,5±0,2 16,7±0,3 16,6±0,1** 17,3±0,5 17,9±0,5 17,1±0,3** 16,7±0,1 16,5±0,2 16,8±0,1 16,5±0,2 16,4±0,3

0,89±0,01 0,90±0,01 0,88±0,01 0,90±0,01** 0,88±0,01 0,87±0,01 0,89±0,01 0,90±0,02 0,91±0,02 0,94±0,01** 0,89±0,01 0,88±0,01 0,90±0,01 0,88±0,01 0,88±0,01

0,47±0,01 0,49±0,01 0,47±0,01 0,48±0,01 0,47±0,01 0,47±0,01 0,47±0,01** 0,49±0,01 0,50±0,01 0,49±0,01** 0,48±0,01 0,47±0,01 0,48±0,01 0,47±0,01 0,47±0,01

ª¤ÛË ÙÈÌ‹ ± ∆˘ÈÎfi ÛÊ¿ÏÌ·

295 233 50 306 192 80 530 24 22 70 301 207 374 125 77

**

94,4±0,5 96,3±0,6 98,7±1,3 95,7±0,5 95,7±0,6 94,5±1,0 95,4±0,4 98,3±1,8 96,7±1,9 96,2±1,8 95,6±0,5 95,3±0,6 95,8±0,5 95,6±0,8 94,4±1,0

60,9±0,5 61,8±0,5 63,2±1,1 61,5±0,5 61,9±0,6 60,3±0,9 61,4±0,3 62,3±1,6 62,3±1,7 62,3±1,6 61,1±0,5 61,6±0,6 61,5±0,4** 62,5±0,7 59,6±0,9

**

22,4±0,2 24,2±0,3 24,1±0,6 23,6±0,2 22,9±0,3 23,0±0,5 23,2±0,2 24,0±0,9 25,5±0,9 24,0±0,5 23,4±0,2 22,9±0,3 23,6±0,2** 22,8±0,4 22,5±0,5

117,1±0,3** 118,4±0,3 119,5±0,7 118,3±0,3 117,4±0,4 117,2±0,6 117,9±0,2 117,2±1,0 118,7±1,1 118,4±0,6 117,8±0,3 117,7±0,4 118,2±0,3** 117,3±0,5 116,3±0,6

54,8±0,4 57,6±0,4 56,4±0,9 56,7±0,4 55,4±0,5 55,4±0,7 55,9±0,3** 57,5±1,3 59,7±1,4 57,7±0,8** 56,3±0,4 55,3±0,4 56,6±0,3** 55,3±0,6 54,9±0,7

* ∂ηÙÔÛÙÈ·›· £¤ÛË (50‹ ∂£: ·ÁfiÚÈ· 82 / ÎÔÚ›ÙÛÈ· 79, 90‹ ∂£: ·ÁfiÚÈ· 91 / ÎÔÚ›ÙÛÈ· 88) ** p-value ≤0,05 ÁÈ· ÁÚ·ÌÌÈ΋ Ù¿ÛË (∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ANCOVA: ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈΛ·. ∏ ÂÙÂÚÔÁ¤ÓÂÈ· ÂϤÁ¯ıËΠ̠ÙÔÓ ¤ÏÂÁ¯Ô Levene)

·Ú·ÁfiÓÙˆÓ Î·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÛÙË ¯ÒÚ· Ì·˜ fiÛÔ Î·È Ë ·‡ÍËÛ‹ ÙÔ˘˜ Ì ÙËÓ ËÏÈΛ·, ·Ô‰›‰ÔÓÙ·È Èı·Ófiٷٷ ÛÙËÓ ˘ÈÔı¤ÙËÛË Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ Ô˘ ¢ÓÔ› ÙËÓ ·ÚÔ˘Û›· ÙÔ˘˜. ∆Ô ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÙÔ 1982 ‹Ù·Ó 20%, fiˆ˜ ¤‰ÂÈÍ ÌÂϤÙË Û ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ·È‰ÈÒÓ ËÏÈΛ·˜ 9-16 ÂÙÒÓ

ÛÙÔÓ ¡ÔÌfi ∏Ú·ÎÏ›Ԣ (21). ¶·Ú¿ÏÏËÏ·, ·fi ·Ó¿ÏÔÁÔ ‰Â›ÁÌ· ·È‰ÈÒÓ ÙÔ 2002 ‚Ú¤ıËΠ‰ÈÏ¿ÛÈÔ ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (40%), ÂÓÒ ÙÚÈÏ·ÛÈ¿ÛÙËΠÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·fi 4,2% Û 12,7%. øÛÙfiÛÔ, ÙÔ Ì¤ÛÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 5,5-7 ÂÙÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ·È‰È¿ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ (One sample Student test: 23 ¤Ó·ÓÙÈ 24,4 kg,

¶›Ó·Î·˜ 7. ¢Â›ÎÙ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds ratio) ۷ί¿ÚÔ˘ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ÙÔÓ ¢ª™ Î·È ÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘ ·È‰ÈÒÓ ·fi ÓËÈ·ÁˆÁ›· Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘ ™∞¶ (mm Hg)

¢∞¶ (mm Hg)

¶ª (cm)

>95Ë ∂£*

>95Ë ∂£

>90‹ ∂£

¢ª™ (kg/m2) 25-30

>30

Odds ratio [95%¢∂] (¡) p-value GLU (mg/dl)

>90‹ ∂£

0,65 [0,18-2,27] (578) ª™

0,29 [0,11-0,76] (578) ª™

0,54 [0,16-1,79] (576) ª™

1,70 [0,82-3,54] (507) ª™

1,38 [0,58-3,27] (485) ª™

TCHOL (mg/dl)

>200

0,49 [0,11-2,12] (578) ª™

2,00 [0,46-8,67] (578) ª™

0,53 [0,21-1,38] (576) ª™

1,17 [0,63-2,19] (507) ª™

0,68 [0,29-1,56] (485) ª™

TG (mg/dl)

>100

0,80 [0,10-6,28] (576) ª™

0,89 [0,11-6,91] (576) ª™

3,43 [1,28-9,17] (574) 0,014

1,00 [0,28-3,60] (505) ª™

2,87 [1,05-7,85] (483) 0,041

HDL-C (mg/dl)

<45

0,52 (0,07-3,97] (578) ª™

1,56 [0,45-5,42] (578) ª™

0,54 [0,27-1,11] (576) ª™

0,65 [0,34-1,25] ª™

0,71 [0,34-1,49] (485) ª™

LDL-C (mg/dl)

>130

0,43 [0,13-1,47] (576) ª™

1,44 [0,60-3,42] (576) ª™

0,70 [0,29-1,69] (574) ª™

0,81 [0,41-1,62] (507) ª™

0,56 [0,23-1,34] (484) ª™

# *

§ÔÁÈÛÙÈ΋ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘: ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ‹ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÈΛ· ∂£: ÂηÙÔÛÙÈ·›· ı¤ÛË (Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ʇÏÔ˘ Î·È Ù˘ ËÏÈΛ·˜) ¶·È‰È·ÙÚÈ΋ 2007;70:97-106

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·104

104

∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

p>0,05, ·ÓÙ›ÛÙÔȯ·) Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÌfiÏȘ ÂÓÂÁÚ¿ÊËÛ·Ó ÛÙËÓ ∞ã Ù¿ÍË fiÏˆÓ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ ÙÔ 1992-1993 (16,22). øÛÙfiÛÔ, ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ¢ª™ ›¯·Ó Ù· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 1992-1993 (16,7 ¤Ó·ÓÙÈ 16,3 kg/m2 , p<0,001, ·ÓÙ›ÛÙÔȯ·) Î·È ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Â›‰· TCHOL (171 ¤Ó·ÓÙÈ 176 mg/dl, p<0,001, ·ÓÙ›ÛÙÔȯ·), HDL-C (57 ¤Ó·ÓÙÈ 60 mg/dl, p<0,001, ·ÓÙ›ÛÙÔȯ·) Î·È LDL-C (103 ¤Ó·ÓÙÈ 106 mg/dl, p=0,022, ·ÓÙ›ÛÙÔȯ·). ªÂϤÙË Û 7767 ·È‰È¿, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ∞ıËÓÒÓ ÙÔ 1995-1996 (23), ¤‰ÂÈÍ fiÙÈ ÂΛӷ ËÏÈΛ·˜ 6-7 ÂÙÒÓ Â›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Â›‰· TCHOL, Û ۇÁÎÚÈÛË Ì ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (166 ¤Ó·ÓÙÈ 171 mg/dl, p=0,012) Î·È LDL-C (93 ¤Ó·ÓÙÈ 103,8 mg/dl, p<0,001), ÂÓÒ Â›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Â›‰· HDL-C (63 ¤Ó·ÓÙÈ 56,8 mg/dl, p<0,001) Î·È TG (74 ¤Ó·ÓÙÈ 53,7 mg/dl, p<0,001). ™Â Û¯¤ÛË Ì ·È‰È¿ ËÏÈΛ·˜ 3-6 ÂÙÒÓ ·fi ÌÂϤÙË ÛÙËÓ ∆¯ÂÚ¿ÓË Û ÔÌ¿‰· 3.148 ·È‰ÈÒÓ 3-19 ÂÙÒÓ ÙÔ 1999-2000 (36), Ù· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›‰· TCHOL (172 ¤Ó·ÓÙÈ 171,3 mg/dl, p>0,05), ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· TG (87 ¤Ó·ÓÙÈ 53 mg/dl, p<0,001) Î·È LDL-C (108 ¤Ó·ÓÙÈ 103,3 mg/dl, p<0,001), ÂÓÒ Â›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Â›‰· HDL-C (46 ¤Ó·ÓÙÈ 57,4 mg/dl, p<0,001). ∂›Û˘, Û ۯ¤ÛË Ì ·È‰È¿ ËÏÈΛ·˜ 6-8 ÂÙÒÓ ·fi ÙË ÌÂϤÙË NHANES III ÙˆÓ ∏¶∞ (37), Ù· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Â›‰· TCHOL (166 ¤Ó·ÓÙÈ 171,3 mg/dl, p<0,001) Î·È HDL-C (52 ¤Ó·ÓÙÈ 57,4 mg/dl, p<0,001). ∏ ·‡ÍËÛË ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ë ·¯˘Û·ÚΛ· ‹ Ë ˘¤ÚÙ·ÛË ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘, ‰È·ÈÛÙÒÓÂÙ·È ‰È·¯ÚÔÓÈο Î·È Û ¿ÏϘ ¯ÒÚ˜. ™ÙË °ÂÚÌ·Ó›·, ÌÂϤÙË 127.735 ·È‰ÈÒÓ ËÏÈΛ·˜ 5-6 ÂÙÒÓ ÛÙË B·˘·Ú›· ÙÔ 1997 (24), ¤‰ÂÈÍ fiÙÈ 12,3% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ˘¤Ú‚·Ú· Û ۇÁÎÚÈÛË Ì ·Ó¿ÏÔÁË ÌÂϤÙË ÙÔ˘ 1982 fiÔ˘ ‹Ù·Ó 8,5%. ∂ÈϤÔÓ, ÙÔ ÔÛÔÛÙfi ·¯˘Û·ÚΛ·˜ ·˘Í‹ıËΠ·fi 1,8% ÙÔ 1982 Û 2,8% ÙÔ 1997. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Û ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ ‰È·ÈÛÙÒıËÎ·Ó Ôχ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿, fiÔ˘ Ì ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ ‹Ù·Ó ÙÔ 17,4% Î·È Ì ·¯˘Û·ÚΛ· ÙÔ 11%. ŸÛÔÓ ·ÊÔÚ¿ ·ÎfiÌË ÛÙ· Â›‰· Ù˘ ™∞¶ Î·È ¢∞¶, Ù· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Â›‰· Û˘ÁÎÚÈÙÈο Ì ·È‰È¿ ËÏÈΛ·˜ 5-6 ÂÙÒÓ Ù˘ πÙ·Ï›·˜ (38) (™∞¶: 94,3 ¤Ó·ÓÙÈ 100,6 mmHg, p<0,001 Î·È ¢∞¶: 60,4 ¤Ó·ÓÙÈ 63,0 mmHg, p<0,001), ·ÏÏ¿ ˘„ËÏfiÙÂÚ· ·fi ·È‰È¿ ËÏÈΛ·˜ 4-6 ÂÙÒÓ Ù˘ ∫›Ó·˜ (39) (™∞¶: 94,3 ¤Ó·ÓÙÈ 89,5 mmHg, p<0,001 Î·È ¢∞¶: 60,4 ¤Ó·ÓÙÈ 55,5 mmHg, p<0,001). ™ÙÔÓ ∫·Ó·‰¿, ÛÙȘ ÂÚÈÔ¯¤˜ Newfoundland Î·È Labrador ÙÔ 2002, Û 4161 ·È‰È¿ ËÏÈΛ·˜ 3-5 ÂÙÒÓ Paediatriki 2007;70:97-106

(25), ‚Ú¤ıËΠۯ‰fiÓ ›‰ÈÔ˜ ¢ª™ Ì ٷ ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (One sample Student test, 16,6 ¤Ó·ÓÙÈ 16,5 kg/m2 , p>0,05, ·ÓÙ›ÛÙÔȯ·), ÂÓÒ ·ÚfiÌÔÈ· ۯ‰fiÓ ‹Ù·Ó Î·È Ù· ÔÛÔÛÙ¿ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (17,7% ¤Ó·ÓÙÈ 18,1% Î·È 8% ¤Ó·ÓÙÈ 8,1%, ·ÓÙ›ÛÙÔȯ·). ∞fi ÙË ÌÂϤÙË Bogalusa ÛÙȘ ∏¶∞ (8) Û 9.147 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 5-17 ÂÙÒÓ Î·Ù¿ Ù· ¤ÙË 1973 ¤ˆ˜ Î·È 1994, ‚Ú¤ıËΠ۠·È‰È¿ ËÏÈΛ·˜ 5-7 ÂÙÒÓ ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ ÌfiÏȘ 6,5%, Ì ηıÔÚÈÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ ¿Óˆ ·fi ÙËÓ 95‹ ÂηÙÔÛÙÈ·›· ı¤ÛË ÙÔ˘ ¢ª™. √ ̤ÛÔ˜ ¢ª™ ÁÈ· ÙȘ ËÏÈ˘ ·˘Ù¤˜ ‹Ù·Ó ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· 15,7 kg/m2, ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ ·fi ÙÔ 16,7 kg/m2 ÙˆÓ ·È‰ÈÒÓ ›‰È·˜ ËÏÈΛ·˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (One sample Student test, p<0,001). øÛÙfiÛÔ, ÔÈ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ odds ratio ¤‰ÂÈÍ·Ó Î›Ó‰˘ÓÔ ÛÙ· ˘¤Ú‚·Ú· ·È‰È¿ (¢ª™ >95‹ ÂηÙÔÛÙÈ·›· ı¤ÛË) ÁÈ· ·Ó¿Ù˘ÍË ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ (TCHOL >200 mg/dl) 1,4 ÊÔÚ¤˜ ¤Ó·ÓÙÈ 0,68 ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› >30 kg/m2 ÙˆÓ ÂÓËϛΈÓ). √ ΛӉ˘ÓÔ˜ ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· (TG >130 mg/dl) ‹Ù·Ó 7,1 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚÔ˜ ÛÙ· ·È‰È¿ ·fi ÙË ÌÂϤÙË Bogalusa, ÂÓÒ ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‚Ú¤ıËΠ(Ì TG >100 mg/dl) 2,87 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚÔ˜. °È· ˘„ËÏ‹ LDL-C (>130 mg/dl) Ô Î›Ó‰˘ÓÔ˜ ‹Ù·Ó ÂÚ›Ô˘ ›‰ÈÔ˜ Î·È ÛÙȘ ‰‡Ô ÌÂϤÙ˜ Ì 0,7 Î·È 0,56 ÊÔÚ¤˜, ·ÓÙ›ÛÙÔȯ·. ∏ ÂÈÎfiÓ· ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÚÔÛ‰›‰Ô˘Ó Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙˆÓ ¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ ı· ‹Ù·Ó ·ÎfiÌ· ÏËÚ¤ÛÙÂÚË ÁÈ· fiÏ· Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÂÊfiÛÔÓ Û˘ÌÌÂÙ›¯·Ó ÛÙȘ ·ÈÌÔÏË„›Â˜ Î·È ·È‰È¿ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜ (<5 ÂÙÒÓ). ∏ ÂÈÊ˘Ï·ÎÙÈ΋ ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤ˆÓ Û¯ÂÙÈο Ì ÙË Ï‹„Ë ·›Ì·ÙÔ˜ Û ·È‰È¿ ÙˆÓ ‚ÚÂÊÔÓËÈ·ÎÒÓ ÛÙ·ıÌÒÓ, ·¤ÙÚ„ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜. øÛÙfiÛÔ, ÛÙ· ·È‰È¿ ÓËȷ΋˜ ËÏÈΛ·˜ (≥5 ÂÙÒÓ), ÙÔ ÔÛÔÛÙfi ÙÂÏÈ΋˜ Û˘ÌÌÂÙÔ¯‹˜ ÛÙȘ ·ÈÌÔÏË„›Â˜ ‹Ù·Ó 75%, ÂÓÒ Û˘ÌÌÂÙ›¯Â ÛÙȘ ÂÍÂÙ¿ÛÂȘ ÙÔ 68% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ 1761 ·È‰ÈÒÓ fiÏˆÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ Î·È ‚ÚÂÊÔÓËÈ·ÎÒÓ ÛÙ·ıÌÒÓ ÙˆÓ ¤ÍÈ ‰‹ÌˆÓ. ™˘ÓÔÏÈο, ÂÍÂÙ¿ÛÙËΠÙÔ 43% ÙˆÓ 2740 ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ. ™ËÌÂÈÒÓÂÙ·È ‰Â, fiÙÈ ÙÔ 6% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜, ÂÓÒ Î·Ù¿ ÙÔ ¤ÙÔ˜ 2004-2005 Û˘Ó¯›˙ÂÙ·È Ë ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙȘ ˘fiÏÔÈ˜ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ¡ÔÌÔ‡. °ÂÓÈο, ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÔÈ ·˘Í‹ÛÂȘ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·ÊfiÚˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ‰ÂÓ Â›Ó·È ·ÓÂÍ¿ÚÙËÙ˜ ÌÂٷ͇ ÙÔ˘˜, ·ÏÏ¿ Û˘Ó˘¿Ú¯Ô˘Ó ȉȷ›ÙÂÚ· Ì ÙÔ ·˘ÍË̤ÓÔ ‹ Ôχ ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜.

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·105

105

∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

∏ ·Ú·‰ÔÛȷ΋ ÂÏÏËÓÈ΋ ‰È·ÙÚÔÊ‹ Î·È Ë Ì¤ÙÚÈ· ÚÔ˜ ¤ÓÙÔÓË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Â›Ó·È Ë ÌfiÓË ‰È¤ÍÔ‰Ô˜ ÁÈ· ÙË Ì›ˆÛË ‹ ÂÍ·Ê¿ÓÈÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ. ∏ Û˘Ì‚ÔÏ‹ Ì·ÎÚÔ¯ÚfiÓÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ·È‰È¿ ·Ó¿ÏÔÁ˘ ‹ Î·È ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰È·ÙÚÔÊ‹ Î·È ÙËÓ ¿ÛÎËÛË (16,22,26,27), ıˆÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ Î·È Ù· ÔʤÏË ÙÔ˘˜ Ê·›ÓÔÓÙ·È ·fi ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·˘ÙÒÓ. ∂ÈϤÔÓ ÛÙfi¯Ô Û ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÛÙȘ ∏¶∞, ·ÔÙÂÏÔ‡Ó ÔÈ ‰Ú¿ÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ‰È·ÊfiÚˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ (΢ڛˆ˜ Ù˘ ·¯˘Û·ÚΛ·˜), ̤ۈ Ù˘ ÂÎ·›‰Â˘Û˘ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÁÈ· ÙËÓ ·fiÎÙËÛË ˘ÁÈÂÈÓÒÓ Û˘ÓËıÂÈÒÓ ‰È·ÙÚÔÊ‹˜ Î·È ÙÚfiÔ˘ ˙ˆ‹˜ (28). ŒÙÛÈ, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÛÙȘ ∏¶∞, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰ÈÏ·ÛÈ·ÛÌfi Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ (15% ÙˆÓ ·È‰ÈÒÓ) ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜, ηı›ÛÙ·Ù·È ·Ó·Áη›· Ë ·Ó‡ÚÂÛË ÌÂıfi‰ˆÓ Ô˘ÛÈ·ÛÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù¤ÙÔÈˆÓ ÂÍ¿ÚÛÂˆÓ (5,28). øÛÙfiÛÔ, Ë ·Ó¿ÁÎË ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· Ì›· Û˘ÓÔÏÈ΋, Û˘ÓÙÔÓÈṲ̂ÓË ÚÔÛ¿ıÂÈ· ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· ÙˆÓ ÔÏÔ¤Ó· Î·È ·˘Í·ÓfiÌÂÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, Â›Ó·È ÂÈÙ·ÎÙÈ΋, ηıÒ˜ Ù· ÚfiÙ˘· ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ·fi ÙÔ ·ÚÂÏıfiÓ Î·È ·ÓÙÈÁÚ¿ÊÔ˘Ó ‰È·ÚÎÒ˜ ÂΛӷ ¿ÏÏˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ ÛÙÔ Ï·›ÛÈÔ Ù˘ ·ÁÎÔÛÌÈÔÔ›ËÛ˘. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ¿ÌÂÛË ÚÔÙÂÚ·ÈfiÙËÙ· Â›Ó·È Ë ÂıÓÈ΋ ÔÏÈÙÈ΋ ÁÈ· ÙË ‰È·ÙÚÔÊ‹, ÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Î·È ÙËÓ ·ÔÊ˘Á‹ Ô˘ÛÈÒÓ (ȉȷ›ÙÂÚ· ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ Î·È ÙˆÓ ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ ÔÙÒÓ), Ì ÚfiÙ˘Ô ÙËÓ ·Ú·‰ÔÛȷ΋ ÂÏÏËÓÈ΋ ‰È·ÙÚÔÊ‹ Î·È ÁÂÓÈÎfiÙÂÚ· ÙÔÓ ÂÏÏËÓÈÎfi ÙÚfiÔ ˙ˆ‹˜. ∞ÔÙÂÏ›, ›Ûˆ˜, ÙÔÓ ÌÔÓ·‰ÈÎfi ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÂȉËÌ›·˜ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÙË Û˘ÓÔ‰Â‡Ô˘Ó Î·È Ô‰ËÁÔ‡Ó Û˘Ó¯Ҙ Û ·˘Í·ÓfiÌÂÓÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË Ù˘ ÌÂϤÙ˘ ÙËÓ ÂÙ·ÈÚ›· Friesland. ∂˘¯·ÚÈÛÙÔ‡ÌÂ, Â›Û˘, ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙËÓ ÔÚÁ¿ÓˆÛË Î·È ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÌÂϤÙ˘: ÙË ¡Ô̷گȷ΋ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ Î·È È‰È·›ÙÂÚ· ÙÔÓ ¡ÔÌ¿Ú¯Ë Î. °ÂÒÚÁÈÔ ∫·ÙÛ·Ó‚¿ÎË, ÙÔÓ ∞ÓÙÈÓÔÌ¿Ú¯Ë Î. ¶·‡ÏÔ ƒÔ˙¿ÎË Î·È ÙÔÓ Î. ∆¿ÛÔ ¢È·Ì·ÓÙ¿ÎË, ÙË ¢ËÌÔÙÈ΋ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ Î·È È‰È·›ÙÂÚ· ÙÔÓ ¢‹Ì·Ú¯Ô Î. ∫˘ÚÈ¿ÎÔ µÈڂȉ¿ÎË Î·È ÙÔ˘˜ ∞ÓÙȉËÌ¿Ú¯Ô˘˜ Î.Î. °ÚËÁfiÚË ∞Ú¯ÔÓÙ¿ÎË, °ÂÒÚÁÈÔ µÔ‡Ú‚·¯Ë Î·È ∞ÚÈÛÙ›‰Ë ¶··‰ÔÁÈ¿ÓÓË, ηıÒ˜ Î·È ÙÔÓ Ô‰ËÁfi Î. ª·ÓÒÏË ÃȈٿÎË, ÙÔ π·ÙÚÔÎÔÈÓˆÓÈÎfi ∫¤ÓÙÚÔ Ã·Ó›ˆÓ, ÙË ¢È‡ı˘ÓÛË ¶ÚˆÙÔ‚¿ıÌÈ·˜ ∂Î·›‰Â˘Û˘ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ, ÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ Î·È Ù· ÂÚÁ·ÛÙ‹ÚÈ· µÈÔ¯ËÌÈÎfi,

∞ÈÌ·ÙÔÏÔÁÈÎfi & ∞ÈÌÔ‰ÔÛ›·˜ ÙÔ˘ ¡Ô̷گȷÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ÷ӛˆÓ “O ÕÁÈÔ˜ °ÂÒÚÁÈÔ˜” Î·È È‰È·›ÙÂÚ· ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· Î. ∞Ó·ÛÙ·Û›· ª·ÚÈÓ¿ÎË. ∂›Û˘, ÙËÓ Î. ª˘ÚˆÓ›· §·ÓÙ˙Ô˘Ú¿ÎË ÁÈ· ÙËÓ Î·Ù·¯ÒÚÈÛË ÙˆÓ ÛÙÔȯ›ˆÓ ÛÙÔ˘˜ ∏/À.

*™˘ÓÂÚÁ·˙fiÌÂÓÔÈ ÂÚ¢ÓËÙ¤˜ ÛÙË ÌÂϤÙË ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘: ™ÔÊ›· ºÏÔ˘Ú‹, ∂ÈÚ‹ÓË ª¿ÚηÙ˙Ë, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ª·Ú›· √ÈÎÔÓfiÌÔ˘, ºÚfiÛˆ ªÂÚ‚·Ó¿ÎË, ªÈ¯¿Ï˘ ∫˘Úȷο΢. ¶Â™˘¶ ∫Ú‹Ù˘: ∂ÈÚ‹ÓË ™Â‚·ÛÙ¿ÎË. ¡Ô̷گȷÎfi ¡ÔÛÔÎÔÌÂ›Ô Ã·Ó›ˆÓ: ∞ÈÌÈÏ›· ∫·Ù¿ÎË, ÕÚÙÂÌȘ µ·ÛÈÏÂÈ¿‰Ë, °·‚ÚȤÏÏ· ∫Ô˘ÙÛ¿ÎË-Brie, ª·Ú›· ™Î·Ïȉ¿ÎË, ™Ù¤ÏÏ· ª·ÚÌ‹, ∂ϤÓË ¢·Ó¿, πˆ¿ÓÓ· ¶·ÏÎÔ˘ÛÔ˘ÚÈ¿, ¶·Ó·ÁÈÒÙ˘ °È¿ÁÎÔ˘, ºÏÒÚ· ª·Ú·ÌÔ‡ÙË, ∞Ϥ͢ ∞ÏÂÍfiÔ˘ÏÔ˜, µ·ÛÈÏÈ΋ ª·ÎÚ‹. ∞ã µ¿ıÌÈ· ∂Î·›‰Â˘ÛË ÓÔÌÔ‡ ÷ӛˆÓ: ¢ÒÚ· ¡È·Ô˘Ó¿ÎË. ¢‹ÌÔ˜ ÷ӛˆÓ: ∞ÈηÙÂÚ›ÓË ∫Ô˘ÓÂÏ¿ÎË. ¢È‡ı˘ÓÛË ÀÁ›·˜ ¡ÔÌ·Ú¯›·˜ ÷ӛˆÓ: ∞ı·Ó·Û›· ∞Ó·ÛÙ·ÛÔÔ‡ÏÔ˘, ∂˘Ù˘¯›· ∫·ÏÔÁÂÚ¿ÎË. π·ÙÚÔÎÔÈÓˆÓÈÎfi ∫¤ÓÙÚÔ Ã·Ó›ˆÓ: ¢ËÌ‹ÙÚ˘ ∫·ÙÛ·‚ÚÈ¿˜, ÕÓÓ· ∫˘ÚȷοÎË, ¢¤ÛÔÈÓ· π·ÙÚ›‰Ô˘.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Voukiklaris GE, Kafatos A, Dontas AS. Changing prevalence of coronary heart disease risk factors and cardiovascular diseases in men of a rural area of Crete from 1960 to 1991. Angiology 1996;47:43-49.

2. ∫·Ê¿ÙÔ˜ ∞, ¶·Ô˘ÙÛ¿Î˘ °. ¢Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ˘ ∂ÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ™¯¤ÛË Ì ·ÁˆÁ‹ ˘Á›·˜ Î·È ÌÂÛÔÁÂȷ΋ ‰›·ÈÙ·. π·ÙÚÈ΋ 1998;73:287-301.

3. Kafatos A, Mamalakis G. Changing patterns of fat intake in Crete. Eur J Clin Nutr 1993;47 (Suppl 1):S21-S24.

4. ¢ËÌÔÏÈ¿Ù˘ °, ∫˘ÚÈfiÔ˘ÏÔ˜ °, §¿ÁÁ·˜ ¢, ºÈÏ·Ï‹ı˘ ∆. ∏ ‰ËÌfiÛÈ· ˘Á›· ÛÙËÓ ∂ÏÏ¿‰·. ∞ı‹Ó·: ∂ΉfiÛÂȘ £Â̤ÏÈÔ; 2002. ÛÂÏ. 266-280.

5. Lobstein T, Baur L, Uauy R; IASO International Obesity Task Force. Obesity in children and young people: a crisis in public health. Report to the WHO. Obes Rev 2004;5 (Suppl 1):S4-S104.

6. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338:1650-1656.

7. McGill HC Jr, McMahan CA, Malcom GT, Oalmann MC, Strong JP. Relation of glycohemoglobin and adiposity to atherosclerosis in youth. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol 1995;15:431-440.

8. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999;103: 1175-1182.

9. Tershakovec AM, Jawad AF, Stouffer NO, Elkasabany A, Srinivasan SR, Berenson GS. Persistent hypercholesterolemia is associated with the development of obesity among girls: the Bogalusa Heart Study. Am J Clin Nutr 2002;76:730-735.

10. Shea S, Aymong E, Zybert P, Shamoon H, Tracy RP, Deckelbaum RJ et al. Obesity, fasting plasma insulin, and C-reactive protein levels in healthy children. Obes Res 2003;11:95-103.

11. Nicklas TA, von Duvillard SP, Berenson GS. Tracking of ¶·È‰È·ÙÚÈ΋ 2007;70:97-106

Pediatr Mar-Apr 07

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™ÂÏ›‰·106

106

∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

serum lipids and lipoproteins from childhood to dyslipidemia in adults: the Bogalusa Heart Study. Int J Sports Med 2002;23 (Suppl 1):S39-S43.

Trinder P. Determination of glucose in blood using glucose oxidase with an alternative oxygen acceptor. Ann Clin Biochem 1969;6:24-27.

Sugiuchi H, Uji Y, Okabe H, Irie T, Uekama K, Kayahara N et al. Direct measurement of high-density lipoprotein cholesterol in serum with polyethylene glycol-modified enzymes and sulfated alpha-cyclodextrin. Clin Chem 1995;41:717-723.

Manual of Laboratory Operation, Lipid Research Clinics Program. Bethesda, MD: National Institutes of Health; 1974:1. US Dept of Health, Education and Welfare publication (NIH) 75-628. ªÔÛ¯·Ó‰Ú¤· I, ÷Ù˙‹˜ X, ª·ÌÌ¿˜ I, ªÂÚÙÛÈ¿˜ °, §ÈÓ·Ú‰¿Î˘ ª, ∫˘Úȷο΢ ª Î·È Û˘Ó. ¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ Î·È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ·ÁÚÔÙÈ΋˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 2003;66:264-277. §ÈÓ·Ú‰¿Î˘ ª, ™·ÚÚ‹ ∫, ªÂÚ‚·Ó¿ÎË º, ª¿ÚηÙ˙Ë ∂, ÷Ù˙‹˜ Ã, ºÏÔ˘Ú‹ ™ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∞ÁˆÁ‹˜ ÀÁ›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 2003;66:436-447. §ÈÓ·Ú‰¿Î˘ ª, ªÔÛ¯·Ó‰Ú¤· I, ∫·Ê¿ÙÔ˜ ∞. ∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ ‚ÚÂÊÈ΋˜ Î·È ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ∫Ú‹Ù˘ Ô˘ ÚԤ΢„·Ó ·fi ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜. ¶·È‰È·ÙÚÈ΋ 2000; 63: 391-407.

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240-1243. §ÈÓ·Ú‰¿Î˘ ª, ™·ÚÚ‹ ∫, ªÂÚÙÛÈ¿˜ °, ∫·Ê¿ÙÔ˜ ∞. ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. ¶·È‰È·ÙÚÈ΋ 2007; 70:24-36.

Jessup A, Harrell JS. The metabolic syndrome: look for it in children and adolescents, too! Clin Diabetes 2005;23: 26-32.

Magkos F, Manios Y, Christakis G, Kafatos AG. Secular trends in cardiovascular risk factors among school-aged boys from Crete, Greece, 1982-2002. Eur J Clin Nutr 2005; 59:1-7. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, ÷Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ “∞ÁˆÁ‹ ÀÁ›·˜” ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1998;61:483-497.

Schulpis K, Karikas GA. Serum cholesterol and triglyceride distribution in 7767 school-aged Greek children. Pediatrics 1998;101:861-864.

Kalies H, Lenz J, von Kries R. Prevalence of overweight and obesity and trends in body mass index in German preschool children, 1982-1997. Int J Obes Relat Metab Disord 2002;26:1211-1217.

Canning PM, Courage ML, Frizzell LM. Prevalence of overweight and obesity in a provincial population of Canadian preschool children. CMAJ 2004;171:240-242.

Manios Y, Moschandreas J, Hatzis C, Kafatos A. Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme. Br J Nutr 2002;88:315-324.

Paediatriki 2007;70:97-106

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

28. Passehl B, McCarroll C, Buechner J, Gearring C, Smith AE, Trowbridge F. Preventing childhood obesity: establishing healthy lifestyle habits in the preschool years. J Pediatr Health Care 2004;18:315-319.

29. Bland M. An introduction to medical statistics. Oxford: Oxford University Press; 2000. p. 31-32.

30. Wingard DL, Barrett-Connor E, Criqui MH, Suarez L. Clustering of heart disease risk factors in diabetic compared to nondiabetic adults. Am J Epidemiol 1983;117:19-26.

31. WHO. Definition, diagnosis and classification of diabetes mellitus and its complications: report a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus. Geneva, Switzerland; 1999. Webpage: http://whqlibdoc.who.int/hq/1999/WHO_NHD_99.4_spa.pdf 32. Cruz ML, Goran MI. The metabolic syndrome in children and adolescents. Curr Diab Rep 2004;4:53-62.

33. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106: 3143-3421.

34. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433-438.

35. ª˘Á‰¿Ï˘ ∏. ÕÛÎËÛË Î·È ‰›·ÈÙ· ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ. ∞ı‹ÚˆÌ· 2004;8:1-2.

36. Azizi F, Rahmani M, Madjid M, Allahverdian S, Ghanbili J, Ghanbarian A et al. Serum lipid levels in an Iranian population of children and adolescents: Tehran lipid and glucose study. Eur J Epidemiol 2001;17:281-288.

37. Hickman TB, Briefel RR, Carroll MD, Rifkind BM, Cleeman JI, Maurer et al. Distributions and trends of serum lipid levels among United States children and adolescents ages 4-19 years: data from the Third National Health and Nutrition Examination Survey. Prev Med 1998;27:879-890.

38. Menghetti E, Virdis R, Strambi M, Patriarca V, Riccioni MA, Fossali E et al. Blood pressure in childhood and adolescence: the Italian normal standards. Study Group on Hypertension ‘of the Italian Society of Pediatrics’. J Hypertens 1999;17: 1363-1372.

39. Wang X, Wang B, Zhang F, Chen C, Yang J, Fang Z et al.

Blood pressure at age 3-24 years in a rural community in Anhui, China. Ann Epidemiol 1998;8:504-512.

40. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 2002;91:1307-1312.

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ORIGINAL ARTICLE

107

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜, Û˘¯ÓfiÙËÙ· ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ Î·È ·˘ÙÔ·ÓÔÛ›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ∂. ∫·ÏÔ˘Ì¤ÓÔ˘1, §. ¡ÙÔ‡ÓÙ·˜2, ª. ∞Ï‚È˙¿ÎË2, °. ª·ÛÙÔÚ¿ÎÔ˜2, ∞. ª¿ÓÙ˙Ô˘2, ∞. ∞ÓÙˆÓ›Ô˘3, Ã. §·‰fiÔ˘ÏÔ˜3, Ã. ªÂÁÁÚ¤ÏË4, ¢. ÃÈÒÙ˘1, π. ¶··ÛˆÙËÚ›Ô˘5, ∞. ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó: ·) Ë ÔÚÈÔı¤ÙËÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Î·È ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ·›Ì· Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· ‚) Ô Î·ıÔÚÈÛÌfi˜ Ù˘ ÂÍÂÏÈÎÙÈ΋˜ ÔÚ›·˜ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ Ì ÙËÓ ËÏÈΛ· Î·È Ù· ÛÙ¿‰È· ÂÓ‹‚ˆÛ˘ Á) Ë Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Ì ÙȘ ÙÈ̤˜ Ù˘ ı˘ÚÂÔÂȉÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (TSH) Î·È ‰) Ë Û˘Û¯¤ÙÈÛË Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ·˘ÙÔ·ÓÔÛ›·˜ ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™Â 440 ˘ÁÈ‹ ·È‰È¿, ËÏÈΛ·˜ 5-18 ÂÙÒÓ ÌÂÙÚ‹ıËÎÂ Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·, ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· (˘ÂÚ˯ÔÁÚ·ÊÈο), ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ Î·È Ù· ·ÓÙÈı˘ÚÂÔÂȉÈο ·ÓÙÈÛÒÌ·Ù·. ªÂ ‚¿ÛË ÙȘ ÙÈ̤˜ Ù˘ TSH Ù˘ 97˘ ∂ηÙÔÛÙÈ·›·˜ £¤Û˘ (∂.£.) ˘ÔÏÔÁ›ÛıËÎÂ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·˘Í‹ıËΠ̠ÙËÓ ËÏÈΛ· Î·È Ù· ÛÙ¿‰È· ÂÓ‹‚ˆÛ˘ ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ·ÁfiÚÈ· ·’ fi,ÙÈ ÛÙ· ÎÔÚ›ÙÛÈ·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ‹Ù·Ó 4,8% ÛÙ· ·ÁfiÚÈ· Î·È 4,4% ÛÙ· ÎÔÚ›ÙÛÈ·. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ Ì ÙȘ ÙÈ̤˜ TSH. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ˘ÂÚÔÍÂȉ¿Û˘ (·ÓÙÈ-∆ƒ√·) ‹Ù·Ó 3,2% ÛÙ· ·ÁfiÚÈ· Î·È 5,8% ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ·˘Í‹ıËΠÛÙËÓ ÂÊ˂›·, ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ÎÔÚ›ÙÛÈ· ·’ fi,ÙÈ ÛÙ· ·ÁfiÚÈ·. £ÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 82% ÙˆÓ ÌËÙ¤ÚˆÓ, ·È‰ÈÒÓ Ì ıÂÙÈο ·ÓÙÈÛÒÌ·Ù·, ÂÓÒ ıÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 18% ÙˆÓ ÌËÙ¤ÚˆÓ ·È‰ÈÒÓ Ì ·ÚÓËÙÈο ·ÓÙÈÛÒÌ·Ù· (p<0,0005). ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ı· ¯ÚËÛÈ̇ÛÔ˘Ó ÛÙÔÓ ·ÎÚÈ‚¤ÛÙÂÚÔ ÔÚÈÛÌfi Ù˘ ·ıÔÏÔÁ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.

1 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ªÔÓ¿‰· ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∂˘ÁÂÓ›‰ÂÈÔ £ÂÚ·Â˘Ù‹ÚÈÔ 3 A’ ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ∞ÚÂÙ·›ÂÈÔ ¡ÔÛoÎÔÌÂ›Ô 4 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, ∞ı‹Ó· 5 ∫ÏÈÓÈ΋ µÈÔ¯ËÌ›· ¶·›‰ˆÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∂ÈÚ‹ÓË ∫·ÏÔ˘Ì¤ÓÔ˘ irekalou@yahoo.gr ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, £Ë‚ÒÓ Î·È ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘, °Ô˘‰›, ∞ı‹Ó·

§¤ÍÂȘ ÎÏÂȉȿ: ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (˘ÂÚ˯ÔÁÚ·ÊÈο), ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉ›Ùȉ·, ˘ÔÎÏÈÓÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, ÂÊ˂›·.

Thyroid volume, prevalence of subclinical hypothyroidism and autoimmunity in children and adolescents I. Kaloumenou1, L. Duntas2, M. Alevizaki2, G. Mastorakos2, E. Mantzou2, A. Antoniou3, C. Ladopoulos3, C. Mengreli4, D. Chiotis1, I. Papassotiriou5, C. Dacou-Voutetakis1 Abstract Background: The aim of the study was to determine, in a normal population of children: a) the values of thyroid volume, the serum concentrations of thyroid hormones, thyroid antibodies (anti-TPOab and antiTG) and the prevalence of subclinical hypothyroidism, b) the effect of age and puberty on these parameters, c) the correlation of Body Mass Index (BMI) with TSH, and d) the relationship of thyroid autoimmunity in children and their mothers.

Methods: The following parameters were assessed in 440 healthy children, aged 5-18 years: height, weight, stage of puberty according to Tanner’s criteria, BMI, BMIsds, Body Surface Area (BSA), urine iodine concentration, thyroid volume by ultrasonography, thyroid hormones, anti-TPOab and anti-TG, using validated techniques. Based on the TSH value of the 97th percentile, subclinical hypothyroidism was determined.

Results: Thyroid volume increased with age and puberty stage, to a greater degree in boys than in girls.

The prevalence of subclinical hypothyroidism was 4.8% in boys and 4.4% in girls. No correlation was found between BMIsds and TSH. The prevalence of positive anti-TPOab was 3.2% and 5.8% for boys and girls, respectively and it increased at puberty in girls more than in boys. When children had positive anti-TPOab, 82% of their mothers had positive anti-TPOab, whereas only 18% of the mothers of anti-TPOab negative children had positive anti-TPOab.

1 Endocrine Unit, First Department of Paediatrics, Athens University School of Medicine 2 Endocrine Unit, Athens University School of Medicine, Evgenidion Hospital 3 First Department of Radiology Athens University School of Medicine 4 Institute of Child Health, “Aghia Sofia” Children’s Hospital 5 Clinical Biochemistry Laboratory, “Aghia Sofia” Children’s Hospital, Athens Correspondence: Irene Kaloumenou irekalou@yahoo.gr Endocrine Unit, A’ Dept of Paediatrics, Athens University School of Medicine, Thivon & Papadiamandopoulou, Goudi Athens, Greece

∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚‡ıËΠ̠ÙÔ ÃˆÚ¤ÌÂÈÔ Œ·ıÏÔ ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ƒfi‰Ô˜, 9-11 πÔ˘Ó›Ô˘ 2006 ¶·È‰È·ÙÚÈ΋ 2007;70:107-114

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·108

108

∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

Conclusions: The definition of normal values of various parameters related to thyroid function in a healthy paediatric population sample will facilitate early recognition of deviations by the paediatrician.

Key words: Thyroid volume (ultrasonography), autoimmune thyroiditis, children, subclinical hypothyroidism, puberty.

™˘ÓÙÔÌÔÁڷʛ˜ ¢ª™ ¢ª™sds ∂™ ÀÀ ∫Ú

¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ ‰Â›ÎÙ˘ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘ ¢ª™ ∂ÈÊ¿ÓÂÈ· ™ÒÌ·ÙÔ˜ ˘ÔÎÏÈÓÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÎÚ·ÙÈÓ›ÓË

∂ÈÛ·ÁˆÁ‹ ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·ÔÙÂÏ› ‚·ÛÈÎfi ·Ú¿ÁÔÓÙ·, ÁÈ· ÙË ÛˆÌ·ÙÈ΋ Î·È ‰È·ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·ÙfiÌÔ˘. ª›· ·Ú¿ÌÂÙÚÔ˜ Ô˘ ÂËÚ¿˙ÂÈ Î·ıÔÚÈÛÙÈο ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· Î·È Ú˘ıÌ›˙ÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘, Â›Ó·È Ù· Â›‰· Ȉ‰›Ô˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. ∏ ‰ÈfiÁΈÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (‚ÚÔÁ¯Ô΋ÏË) Â›Ó·È Ë ϤÔÓ Û˘¯Ó‹ ÂÓ‰ÔÎÚÈÓÈ΋ ¿ıËÛË Î·ıÒ˜ ··ÓÙ¿Ù·È Û ÂÚÈÛÛfiÙÂÚÔ ·fi 2,4 ‰ÈÛÂηÙÔÌ̇ÚÈ· ¿ÙÔÌ· Û fiÏÔ ÙÔÓ ÎfiÛÌÔ (1). ™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ¤¯Ô˘Ó ηıÔÚÈÛı› Ù· fiÚÈ· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙ· ·È‰È¿, Û‡Ìʈӷ Ì ÙËÓ ËÏÈΛ· Î·È Ù· ÛÙ¿‰È· ÂÓ‹‚ˆÛ˘ Û ÂÚÈÔ¯¤˜ Ì Â·Ú΋ ÚfiÛÏË„Ë Èˆ‰›Ô˘. ∂›Û˘, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ·Ó·ÊÔÚÈο Ì ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÛÙ· ·È‰È¿ Û ÂÚÈÔ¯¤˜ Ì Â¿ÚÎÂÈ· Ȉ‰›Ô˘. ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ÔÈ Û˘ÁÁÚ·Ê›˜ ۯ‰›·Û·Ó ÌÈ· ÌÂϤÙË Ì ÛÎÔfi ÙËÓ ÔÚÈÔı¤ÙËÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó·, ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Î·È ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi, ηıÒ˜ Î·È ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ (ÀÀ) Û ηٿ ÙÂÎÌ‹ÚÈÔ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ËÏÈΛ·˜ 5-18 ÂÙÒÓ. ∂ÎÙÈÌ‹ıËΠÂ›Û˘, Ë Â›‰Ú·ÛË Ù˘ ËÏÈΛ·˜ Î·È ÂÓ‹‚ˆÛ˘ ÛÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ·˘Ù¤˜, ͯˆÚÈÛÙ¿ ÁÈ· Ù· ‰‡Ô ʇϷ Î·È Û˘Û¯ÂÙ›ÛıËÎÂ Ë ı˘ÚÂÔÂȉÈ΋ ·˘ÙÔ·ÓÔÛ›· ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÕÙÔÌ· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ªÂÏÂÙ‹ıËÎ·Ó 440, ηٿ ÙÂÎÌ‹ÚÈÔ ˘ÁÈ›˜ Ì·ıËÙ¤˜ (200 ·ÁfiÚÈ· Î·È 240 ÎÔÚ›ÙÛÈ·), ËÏÈΛ·˜ 5-18 ÂÙÒÓ (̤ÛË ËÏÈΛ· ±™∞: 10±2,9 ¤ÙË) Ô˘ ‰È¤ÌÂÓ·Ó ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ÙÔ˘ ¡ÔÌÔ‡ ∞ÙÙÈ΋˜ (ÂÚÈÔ¯‹ Ì Â¿ÚÎÂÈ· Ȉ‰›Ô˘) Î·È 150 ÌËÙ¤Ú˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ. ∞fi fiÏÔ˘˜ ÙÔ˘˜ ÁÔÓ›˜ ˘‹ÚÍ ÁÚ·Ù‹ Û˘ÁηٿıÂÛË ÌÂÙ¿ ·fi Paediatriki 2007;70:107-114

ÂÓË̤ڈÛË. ∏ ÌÂϤÙË Ì·˜ ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ ∞ıËÓÒÓ “∞Á›· ™ÔÊ›·”. ¶ÚˆÙfiÎÔÏÏÔ ŸÏ· Ù· ·È‰È¿ ÂÍÂÙ¿ÛıËÎ·Ó ÎÏÈÓÈο Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ÛÙ¿‰ÈÔ ÂÓ‹‚ˆÛ˘ ηٿ Tanner. ÀÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) Ì ÙÔÓ Ù‡Ô: ¢ª™ = ‚¿ÚÔ˜ / ⁄„Ô˜2 (kg/m2) Î·È Ô ‰Â›ÎÙ˘ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘ ¢ª™ (¢ª™sds), ‰ËÏ·‰‹, Ô ·ÚÈıÌfi˜ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ Ô˘ ‰È·Ê¤ÚÂÈ Ô ¢ª™ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË Ì¤ÛË ÙÈÌ‹ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘. ∏ ÂÈÊ¿ÓÂÈ· ÛÒÌ·ÙÔ˜ (∂™) ˘ÔÏÔÁ›ÛıËΠ̠ÙÔÓ Ù‡Ô: ∂™ = ‚¿ÚÔ˜0,425 ‡„Ô˜0,725 ñ 71,84 ñ 10-4, ÙÔ ‚¿ÚÔ˜ ÂÎÊÚ¿˙ÂÙ·È Û ÎÈÏ¿ Î·È ÙÔ ‡„Ô˜ Û ÂηÙÔÛÙ¿ (2). ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÂÎÙÈÌ‹ıËΠ˘ÂÚ˯ÔÁÚ·ÊÈο Û fiÏ· Ù· ·È‰È¿, ·fi ÙÔÓ ›‰ÈÔ ·ÎÙÈÓÔÏfiÁÔ. ™Â ÚˆÈÓfi Ù˘¯·›Ô ‰Â›ÁÌ· Ô‡ÚˆÓ ÌÂÙÚ‹ıËΠÙÔ ÈÒ‰ÈÔ -¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ê·ÛÌ·ÙÔʈÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô ÙˆÓ Pino Î·È Û˘Ó (3)- ηıÒ˜ Î·È Ë ÎÚ·ÙÈÓ›ÓË. ∏ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÂÎÊÚ¿ÛıËΠ۠ÌÈÎÚÔÁÚ·ÌÌ¿ÚÈ· Ȉ‰›Ô˘ ·Ó¿ ÁÚ·ÌÌ¿ÚÈÔ ÎÚ·ÙÈÓ›Ó˘ (Ìg I/g KÚ). √È ÚÔÛ‰ÈÔÚÈÛÌÔ› Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·›Ì· ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÈ ÂÍ‹˜: ÔÏÈ΋ ı˘ÚÔÍ›ÓË (T4), ÙÚÈȈ‰Ôı˘ÚÔÓ›ÓË (T3), ı˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË (TSH), ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ˘ÂÚÔÍÂȉ¿Û˘ (·ÓÙÈ-∆ƒ√·) Î·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË. ™Â 150 ·fi Ù· 440 ·È‰È¿ ÌÂÙÚ‹ıËÎ·Ó ÂÈϤÔÓ Î·È ÔÈ ÂÍ‹˜ ·Ú¿ÌÂÙÚÔÈ ÛÙÔÓ ÔÚfi: ÂχıÂÚË ı˘ÚÔÍ›ÓË (FT4), ı˘ÚÂÔÛÊ·ÈÚÈÓÈο ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈ-Tg), ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÏÈÔÚˆÙ½ÓË (LDL), ˘„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÏÈÔÚˆÙ½ÓË (HDL) Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È·. √È ÚÔÛ‰ÈÔÚÈÛÌÔ› Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·›Ì· ÛÙȘ ÌËÙ¤Ú˜ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÈ ÂÍ‹˜: T3, T4, FT4, TSH, ·ÓÙÈTPO· Î·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË. ÀÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘ ˘Ê‹˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ¤ÁÈÓ ·fi ÙÔÓ ›‰ÈÔ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ·ÎÙÈÓÔÏfiÁÔ Ì ˘ÂÚ˯ÔÙÔÌÔÁÚ¿ÊÔ General Electric Pro Series Ì ÁÚ·ÌÌÈÎfi ÔÌÔ‰¤ÎÙË Û˘¯ÓfiÙËÙ·˜ 7,5 MHz. ∆· ·È‰È¿ ÂÍÂÙ¿˙ÔÓÙ·Ó Í·ψ̤ӷ Ì ˘ÂÚ˘„ˆÌ¤ÓÔ ÙÔ ¿Óˆ ̤ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ˘ÂÚ¤ÎÙ·ÛË Ù˘ ÎÂÊ·Ï‹˜. √ fiÁÎÔ˜ οı ÏÔ‚Ô‡ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· (V) ÂÎÙÈÌ‹ıËΠ·fi ÙË Û¯¤ÛË: V (ml): 0,479 ñ ÚÔÛıÈÔ›ÛıÈ· ñ ÂÁοÚÛÈ· ñ ÎÂÊ·ÏÔ˘Ú·›· ‰È¿ÌÂÙÚÔ˜ ı˘ÚÂÔÂȉԇ˜ (4). √ Û˘ÓÔÏÈÎfi˜ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ‹Ù·Ó ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ‰‡Ô ÏÔ‚ÒÓ ¯ˆÚ›˜ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÈÛıÌÔ‡. ∂›Û˘, ηٷÁÚ¿ÊËÎÂ Ë Ë¯ˆÁ¤ÓÂÈ· ÙÔ˘ ı˘ÚÂÔÂȉÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ·ÚÔ˘Û›· ‰È¿¯˘Ù˘ ‹ ÂÓÙÔÈṲ̂Ó˘ ˘Ô˯ˆÁ¤ÓÂÈ·˜, Ë ·ÚÔ˘Û›· fi˙ˆÓ,

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·109

109

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜

·ÛÙÂˆÓ ‹ ‰È·ÊÚ·ÁÌ¿ÙˆÓ (5). ÀÔÏÔÁ›ÛıËÎ·Ó Ë 50‹ Î·È Ë 97Ë ∂ηÙÔÛÙÈ·›· £¤ÛË (∂.£.) ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ. √ÚÌÔÓÈÎÔ› ÚÔÛ‰ÈÔÚÈÛÌÔ› ∏ ̤ÙÚËÛË Ù˘ T4 Î·È ∆3 ¤ÁÈÓ Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi RIA (Brahms Hennigsdorf Germany) Ì fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 5-13 Ìg/dl Î·È 80-220 ng/dl ·ÓÙ›ÛÙÔȯ·, Ù˘ ∆SH Ì ¯ËÌÂÈÔʈٷ‡ÁÂÈ· Chemiluminescence ILMA (two site Chemiluminescence immunoassay Nichols Institute Diagnostics) Ì fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 0,5-5 ÌU/ml. ∏ ̤ÙÚËÛË Ù˘ FT4 ¤ÁÈÓ Ì ¯ËÌÂÈÔʈٷ‡ÁÂÈ· Chemiluminescence Abbott (fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 9-25 pmol/L), ÙˆÓ ·ÓÙÈTPO· Î·È ·ÓÙÈ-Tg ¤ÁÈÓ Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi RIA Brahms Dynotest (Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ <60 U/ml Î·È <100 U/ml ·ÓÙ›ÛÙÔȯ·). ∏ ̤ÙÚËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ¤ÁÈÓ Ì ÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 120-200 mg/dL), Ù˘ HDL Ì ηı›˙ËÛË (Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ >35 mg/dL), ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ì ÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 30-130 mg/dL) Î·È Ù¤ÏÔ˜, ˘ÔÏÔÁÈÛÌfi˜ Ù˘ LDL Ì ÙËÓ Â͛ۈÛË: LDL= ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË - ÙÚÈÁÏ˘ÎÂÚ›‰È·/ 5 - HDL (Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ < 100 mg/dL). ™Ù·ÙÈÛÙÈ΋ ∞Ó¿Ï˘ÛË °È· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ Î·ÙËÁÔÚÈ·ÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙËÓ ‰ÔÎÈÌ·Û›· χ-ÙÂÙÚ¿ÁˆÓÔ (Chi-square test) Î·È ÙÔ Fisher’s exact test. ÃÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÌÔÓÙ¤ÏÔ Ù˘ ·Ó¿Ï˘Û˘ ‰È·Î‡Ì·ÓÛ˘ ηٿ ¤Ó· ·Ú¿ÁÔÓÙ·, ¯ˆÚ›˜ Â·Ó·ÏËÙÈΤ˜ ÌÂÙÚ‹ÛÂȘ (one way ANOVA). °È· ÙȘ ÔÏÏ·Ϥ˜ Û˘ÁÎÚ›ÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ ÔÌ¿‰Â˜ ·Ó¿ 2 (pair wise multiple comparisons) ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ Scheffer test. ŸÏ˜ ÔÈ ‰ÔÎÈ̷ۛ˜ Â›Ó·È ‰ÈÏ‹˜ ηÙ‡ı˘ÓÛ˘ (two-sided) Ì Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ p=0,05. ∏ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÂ Û˘Ó¯›˜ ÌÂÙ·‚ÏËÙ¤˜ ¤ÁÈÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ˘˜ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ÙÔ˘ Pearson Î·È ÙÔ˘ Spearman. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS vr 10.00 (Statistical Package for the Social Sciences).

∞ÔÙÂϤÛÌ·Ù· ∆· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÔÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ Î·È Û‡Ìʈӷ Ì ÙÔ Ê‡ÏÔ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∏ ̤ÛË ÙÈÌ‹ Ù˘ TSH ‹Ù·Ó 2,60±1,22 ÌU/ml ÛÙ· ·ÁfiÚÈ·, 2,44±1,22 ÌU/ml ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 2,51±1,22 ÌU/ml ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi, Ë 97Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (∂.£.) ‹Ù·Ó ·ÓÙÈÛÙÔ›¯ˆ˜ 5,01 ÌU/ml, 4,92 ÌU/ml Î·È 4,96 ÌU/ml Î·È Ë 5Ë ∂.£. ‹Ù·Ó 1,1 ÌU/ml, 0,84 ÌU/ml Î·È 0,97 ÌU/ml. ¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Ì¤ÛË ÙÈÌ‹ Ù˘ TSH ·Ó¿ÌÂÛ· ÛÙ· ·ÁfiÚÈ· Î·È ÛÙ· ÎÔÚ›ÙÛÈ· (p=0,175). ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ (ÀÀ), (∆S∏ >97Ë ∂.£. ‹ ≥5,01 ÌU/ml ÁÈ· Ù· ·ÁfiÚÈ·, ≥4,92 ÌU/ml ÁÈ· Ù· ÎÔÚ›ÙÛÈ· Î·È ≥4,96 ÌU/ml ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ∆3, ∆4), ‹Ù·Ó 4,8% ÛÙ· ·ÁfiÚÈ·, 4,4% ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 4,6% ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙȘ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜, ‰È·ÈÛÙÒıËÎ·Ó Ù· ÂÍ‹˜: ÛÙ· ÎÔÚ›ÙÛÈ· Ë Ì¤ÛË ÙÈÌ‹ Ù˘ TSH, Ù˘ ∆4 Î·È Ù˘ ∆3 ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙËÓ ÂÊ˂›· ·’ fi,ÙÈ ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (p=0,02, p=0,0005, p<0,0005), ÂÓÒ ÛÙ· ·ÁfiÚÈ· ÌfiÓÔ Ë Ì¤ÛË ÙÈÌ‹ Ù˘ ∆3 ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙËÓ ÂÊ˂›· ·’ fi,ÙÈ ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (p<0,0005, ¶›Ó·Î·˜ 2). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TPO· ‹Ù·Ó ÛÙ· ·ÁfiÚÈ· 3,2%, ÛÙ· ÎÔÚ›ÙÛÈ· 5,8% Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi 4,6%, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TG ‹Ù·Ó ÛÙ· ·ÁfiÚÈ· 3,3% Î·È ÛÙ· ÎÔÚ›ÙÛÈ· 7,9%. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TPO· Î·È ·ÓÙÈ-TG ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ.

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ. √È ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ ̤ÛË ÙÈÌ‹ ±∆∞ ‹ ‰È¿ÌÂÛË Î·È ‰È·Î‡Ì·ÓÛË

∏ÏÈΛ· (¤ÙË) ¢ª™ (kg/m2) ¢ª™sds ∂™ (m2) T3 (ng/dl) T4 (Ìg/dl) FT4 (pmol/L) TSH (ÌU/ml) T4 / T3 ∞ÓÙÈ-TPO· (U/ml) ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË) ∞ÓÙÈ-TG (U/ml) ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË) ÃÔÏËÛÙÂÚ›ÓË ÔÏÈ΋ (mg/dL) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) LDL (mg/dL) HDL (mg/dL) πÒ‰ÈÔ/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (Ìg/g)

∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ·

™‡ÓÔÏÔ

10,12 ± 2,96 19,98 ± 4,48 0,21 ± 1,20 1,25 ± 0,34 167,61 ± 34,65 8,51 ± 1,35 17,22 ± 3,08 2,60 ± 1,22 0,05 ± 0,01 23 (1,0-3000) 24,6 (9,6-471) 179,41 ± 27,34 69,91 ± 44,40 114,40 ± 25,08 53,93 ± 12,18 344,91± 188,22

10,19 ± 2,87 19,16 ± 3,87 0,03 ± 1,05 1,23 ± 0,28 164,52 ± 35,06 8,62 ± 1,45 16,91 ± 4,16 2,44 ± 1,22 0,05 ± 0,01 25 (1,0-1716) 23,2 (9,6-3000) 180,66 ± 29,12 69,00 ± 27,04 113,65 ± 27,39 55,65 ± 18 332,62 ± 173,65

10,15 ± 2,91 19,53 ± 4,17 0,11 ± 1,12 1,24 ± 0,31 165,91 ± 34,87 8,57 ± 1,41 17,04 ± 3,75 2,51 ± 1,22 0,05 ± 0,01 25 (1,0-3000) 23,45 (9,6-3000) 180,10 ± 28,3 69,35 ± 34,61 113,95 ± 26,41 54,98 ± 15,96 338,19 ± 180,17 ¶·È‰È·ÙÚÈ΋ 2007;70:107-114

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·110

110

∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ª¤ÛË ÙÈÌ‹ ∆S∏, ∆4 Î·È ∆3 Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (∆anner π) Î·È ÛÙËÓ ÂÊ˂›· (∆anner ππ-V) TSH (ÌU/ml) I 2,6 2,6

II-V 2,5 2,2

p <0,3 0,02

ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙÔÓ Ù›ÙÏÔ ÙˆÓ ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒÛ·Ì fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TPO· ‰ÂÓ ‰È¤ÊÂÚ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÛÙ· ‰‡Ô ʇϷ, ÙfiÛÔ ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (·ÁfiÚÈ·: 2,7%, ÎÔÚ›ÙÛÈ·: 2,2% p=0,824) fiÛÔ Î·È ÛÙËÓ ÂÊ˂›· (·ÁfiÚÈ·: 4,2%, ÎÔÚ›ÙÛÈ·: 8,2%, p=0,387). ™Ù· ·ÁfiÚÈ· ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈ-∆ƒ√· ÌÂٷ͇ ÚÔÂÊ˂›·˜ Î·È ÂÊ˂›·˜ (2,7% Î·È 4,2% p=0,679), ·ÓÙ›ıÂÙ· ÛÙ· ÎÔÚ›ÙÛÈ· ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÚÔÂÊË‚ÈÎÔ‡ Î·È ÂÊË‚ÈÎÔ‡ ÛÙ·‰›Ô˘ ·Ó¿Ù˘Í˘ (2,2% Ì 8,2% p=0,05). ∆· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ‰ÂÓ Â›¯·Ó ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ TSH (p=0,165). ŸÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· Û fiÏ· Ù· ·È‰È¿ ‹Ù·Ó 4,99±2,7 ml (·ÁfiÚÈ·: 4,94±2,76 ml, ÎÔÚ›ÙÛÈ·: 5,03±2,65 ml, p=0,797). ∏ 50‹ Î·È 97Ë ∂.£. ÙˆÓ ÙÈÌÒÓ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙ· ·ÁfiÚÈ· Î·È ÛÙ· ÎÔÚ›ÙÛÈ·, ÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈ˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 Î·È ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. √ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈο Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ Î·È ÛÙ· ‰‡Ô ʇϷ (·ÁfiÚÈ·: r=0,779, p<0,0005 ÎÔÚ›ÙÛÈ·: r=0,669, p<0,0005), Ì ÙËÓ ·‡ÍËÛË Ù˘ ∂™ Î·È ÛÙ· ‰‡Ô ʇϷ (·ÁfiÚÈ·: r =0,730, p<0,0005 ÎÔÚ›ÙÛÈ·: r=0,623, p<0,0005), ÂÓÒ ·˘Í¿ÓÂÙ·È ·ÛıÂÓÒ˜ Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ¢ª™sds ÌfiÓÔ ÛÙ· ·ÁfiÚÈ· (·ÁfiÚÈ·: r=0,166, p=0,023 ÎÔÚ›ÙÛÈ·: r=0,095, p=0,150). √ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ·˘Í¿ÓÂÙ·È Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ÂÊ˂›·˜ ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ¶›Ó·Î·˜ 3. 50‹ ∂.£. Î·È 97Ë ∂.£. ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (ml) Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· ∏ÏÈΛ· (¤ÙË)

∞ÁfiÚÈ·

n

50‹ ∂.£. 97Ë ∂.£.

5-6,9 7-8,9 9-10,9 11-12,9 13-14,9 15-18 Paediatriki 2007;70:107-114

2,72 2,88 3,83 5,08 7,76 11,69

6,67 6,89 9,89 10,72 12,21 14,93

∫ÔÚ›ÙÛÈ·

n

50‹ ∂.£. 97Ë ∂.£.

30 41 45 37 30 17

2,97 3,45 4,24 5,4 5,81 11,50

7,41 7,64 9,15 9,82 11,75 13,33

21 65 60 43 29 22

I 8,6 9,0

II-V 8,3 8,3

T3 (ng/dl)

p 0,15 0,0005

I 174,7 174,3

II-V 156 157

p 0,0005 0,0005

ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,0005). ∏ ̤ÛË ÙÈÌ‹±™∞ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙ· ·ÁfiÚÈ· ÛÙÔ ÛÙ¿‰ÈÔ Tanner I ‹Ù·Ó 3,42±1,31 ml Î·È ÛÙ· ÛÙ¿‰È· Tanner II-V 7,35±2,76 ml (p<0,0005). √È ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ÛÙ· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 3,74±1,78 ml Î·È 5,9±2,8 ml (p<0,0005). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÛÙÔ ÛÙ¿‰ÈÔ Tanner I (3,42 ml ¤Ó·ÓÙÈ 3,74 ml, p=0,202), ÂÓÒ ÛÙ· ÛÙ¿‰È· Tanner II-V Ù· ·ÁfiÚÈ· ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÁÎÔ ı˘ÚÂÔÂȉԇ˜ ·’ fi,ÙÈ Ù· ÎÔÚ›ÙÛÈ· (7,35 ml ¤Ó·ÓÙÈ 5,9 ml, p=0,001). ∏ ̤ÛË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ / g ÎÚ·ÙÈÓ›Ó˘ ÛÙ· Ô‡Ú· ‹Ù·Ó 338,18±180,16 Ìg π/g ∫Ú. ŸÏ· Ù· ·È‰È¿ ›¯·Ó Û˘ÁΤÓÙÚˆÛË Èˆ‰›Ô˘ ÛÙ· Ô‡Ú· ¿Óˆ ·fi 25 Ìg π/g ∫Ú, 99,3% ¿Óˆ ·fi 50 Ìg π/g ∫Ú Î·È 97% ¿Óˆ ·fi 100 Ìg π/g ∫Ú. √ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Û˘Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο Ì ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ / ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú· (r =-0,260, p<0,0005). ŸÛÔ ¯·ÌËÏfiÙÂÚË Â›Ó·È Ë ·¤ÎÎÚÈÛË Èˆ‰›Ô˘ / ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú·, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ Â›Ó·È Ô fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· (∂ÈÎfiÓ· 2). √ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈ-TPO· ÌfiÓÔ ÛÙ· ÎÔÚ›ÙÛÈ·. ¢ËÏ·‰‹, Ù· ÎÔÚ›ÙÛÈ· Ô˘ ¤¯Ô˘Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ı˘ÚÂÔÂȉ‹ ·‰¤Ó· (8,32 ml ¤Ó·ÓÙÈ 4,84 ml p=0,0005) Û˘ÁÎÚÈÙÈο Ì ÂΛӷ Ô˘ ¤¯Ô˘Ó ·ÚÓËÙÈο ·ÓÙÈ-TPO·. ∞Ó¿ÏÔÁË ‰È·ÊÔÚ¿ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·ÁfiÚÈ· (6,76 ml ¤Ó·ÓÙÈ 4,93 ml p=0,111) (∂ÈÎfiÓ· 3). µÚÔÁ¯Ô΋ÏË, ‰ËÏ·‰‹ fiÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ >97Ë ∂.£., ÂÌÊ¿ÓÈÛ·Ó ÙÔ 3,2% (n=14) ÙˆÓ ·È‰ÈÒÓ. ∏ ̤ÛË ÙÈÌ‹ ·¤ÎÎÚÈÛ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ÛÙ· ·È‰È¿ Ì ‚ÚÔÁ¯Ô΋ÏË ‹Ù·Ó 216 Ìg π/g ∫Ú, Î·È ‰ÂÓ ‰È¤ÊÂÚÂ

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (ml)

™Ù¿‰È· ÂÓ‹‚ˆÛ˘ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

T4 (Ìg/dl)

16 14 12 10 8 6 4 2 0

97Ë ∂.£. ∞ÁfiÚÈ· 97Ë ∂.£. ∫ÔÚ›ÙÛÈ· 50Ë ∂.£. ∞ÁfiÚÈ· 50Ë ∂.£. ∫ÔÚ›ÙÛÈ· 5-6,9

7-8,9 9-10,9 11-12,9 13-14,9 15-18 ∏ÏÈΛ· (¤ÙË)

∂ÈÎfiÓ· 1. ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (ml) Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ (50‹ Î·È 97Ë ∂.£.).

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·111

111

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜

14

ŸÁÎÔ˜ £˘ÚÂÔÂȉԇ˜

12 10 8 6 4 2 R Sq Linear=0,057

0 0

200

800 400 600 πÒ‰ÈÔ/∫Ú·ÙÈÓ›ÓË

1000

1200

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË fiÁÎÔ˘ ı˘ÚÂÔÂȉԇ˜ (ml) Î·È Èˆ‰›Ô˘ / ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (Ìg I/g ∫Ú), r=-0,260, p<0,0005.

M¤ÛË ÙÈÌ‹ fiÁÎÔ˘ ı˘ÚÂÔÂȉԇ˜ (ml)

ÛËÌ·ÓÙÈο ÂΛӢ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ‚ÚÔÁ¯Ô΋ÏË (340,2 Ìg I/g ∫Ú). ŒÓ·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ fi˙ÔÈ ‰È·ÈÛÙÒıËÎ·Ó Û ÔÛÔÛÙfi 5,1% ÂÓÒ fi˙ÔÈ Î·È ˘Ô˯ˆÁÂÓ›˜ ÂÚÈÔ¯¤˜ Û ÔÛÔÛÙfi 4,1%. ∆· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ›¯·Ó 6 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÚÔÁ¯Ô΋ÏË (p=0,026 OR: 6,08 95% CI (1,55-23,83). ŸÛÔÓ ·ÊÔÚ¿ ÙË Û¯¤ÛË ÙˆÓ ·ÓÙÈ-∆ƒ√· Î·È ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ÛÙËÓ Ë¯ÔÌÔÚÊÔÏÔÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ‰È·ÈÛÙÒıËΠfiÙÈ ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ·ÚÔ˘Û›·˙·Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ‰È¿¯˘ÙË ‹ ÂÓÙÔÈṲ̂ÓË ˘Ô˯ˆÁ¤ÓÂÈ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (p=0,0005). ¢ÂÓ ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ Ì ·ÚÓËÙÈο Î·È ıÂÙÈο ·ÓÙÈ-TPO·. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ (ıÂÙÈο ·ÓÙÈ-∆ƒ√· Î·È ÂÓÙÔÈṲ̂ÓË ‹ ‰È¿¯˘ÙË ˘Ô˯ˆÁ¤ÓÂÈ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·) ‹Ù·Ó 2,5% (11 ·È‰È¿) ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ.

∞ÚÓËÙÈο ·ÓÙÈ-∆ƒ√ £ÂÙÈο ·ÓÙÈ-∆ƒ√

12 10

p=0,111

p=0,0005

8 6

£ÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 82% ÙˆÓ ÌËÙ¤ÚˆÓ ÙˆÓ ÔÔ›ˆÓ Ù· ·È‰È¿ ›¯·Ó ıÂÙÈο ·ÓÙÈÛÒÌ·Ù·, ÂÓÒ ÛÙȘ ÌËÙ¤Ú˜ ·È‰ÈÒÓ Ì ·ÚÓËÙÈο ·ÓÙÈ∆ƒ√· Ë Û˘¯ÓfiÙËÙ· ·ÓÙÈ-∆ƒ√· ‹Ù·Ó 18% (p<0,0005). £ÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 30% ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· (p<0,0005). ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ TSH Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∆· ·È‰È¿ Ì TSH<4 ÌU/ml ›¯·Ó ̤ÛË ÙÈÌ‹ ¯ÔÏËÛÙÂÚfiÏ˘ 179,53 mg/dL, Ù· ·È‰È¿ Ì TSH 4-5 ÌU/ml, 188,06 mg/dL Î·È Ù· ·È‰È¿ Ì TSH>5 ÌU/ml, 177,57 mg/dL ·ÓÙ›ÛÙÔȯ· (p=0,243, ¶›Ó·Î·˜ 4). ™˘Û¯ÂÙ›Û·Ì ÙÔÓ ¢ª™sds Ì ÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜: ∆3, ∆4, T4/T3, FT4, TSH. √È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: ∆4/∆3 (r=-0,128 p=0,009) Î·È FT4 (r=-0,213 p=0,01).

™˘˙‹ÙËÛË √È ÌÂÙ·‚ÔϤ˜ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Î·È Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηٿ ÙËÓ ÂÊ˂›· ‰ÂÓ ¤¯Ô˘Ó Â·ÎÚÈ‚Ò˜ ηıÔÚÈÛı› (6). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜, ·Ú·ÙËÚ‹Û·Ì ÙÒÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ ÙÈÌÒÓ ∆SH, ∆4, ∆3 ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÌfiÓÔ Ù˘ ∆3 ÛÙ· ·ÁfiÚÈ·. ∞ÓÙ›ÛÙÔȯ· ÔÈ Dunger Î·È Û˘Ó (7) ‰È·›ÛÙˆÛ·Ó ÙÒÛË Ù˘ F∆4, ∆4 Î·È F∆3 Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ÂÊ˂›·˜ ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÌfiÓÔ Ù˘ F∆4 ÛÙ· ·ÁfiÚÈ·. ™Â ÌÈ· ÂÚÁ·Û›· ·fi ÙËÓ πÛ·Ó›· (8) ÛÙËÓ ÔÔ›· ÂÍÂÙ¿ÛıËÎ·Ó 371 ·È‰È¿ ‰È·ÈÛÙÒıËΠÙÒÛË ÙˆÓ ÙÈÌÒÓ ∆SH, F∆4, F∆3 ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜. ∞ÓÙ›ıÂÙ· ÛÙËÓ ÂÚÁ·Û›· ÙˆÓ Elmlinger Î·È Û˘Ó (9) ‰ÂÓ ‰È·ÈÛÙÒıËΠÂ›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ. ∆· ‰È·ÊÔÚÂÙÈο ·ÔÙÂϤÛÌ·Ù· Û˘ÁÎÚÈÙÈο Ì ¿ÏϘ ÌÂϤÙ˜, Èı·Ófiٷٷ Ó· ÔÊ›ÏÔÓÙ·È Û ÌÂıÔ‰ÔÏÔÁÈΤ˜ ‰È·ÊÔÚ¤˜. √È Elmlinger Î·È Û˘Ó, ÌÂϤÙËÛ·Ó Î¿ı ÛÙ¿‰ÈÔ ÂÓ‹‚ˆÛ˘ ͯˆÚÈÛÙ¿ (Tanner π, ππ, πππ, πV, V) Î·È ›Ûˆ˜ Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ ‰ÂÓ ·Ó·‰‡ıËÎÂ Ë Â›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙȘ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË Ù˘ ËÏÈΛ·˜ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ, ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÌÂÙ·‚ÔÏ‹ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ F∆3, F∆4,

4 ¶›Ó·Î·˜ 4. ™¯¤ÛË TSH Î·È ¯ÔÏËÛÙÂÚfiÏ˘ Û ˘ÁÈ‹ ·È‰È¿

2 0

TSH (ÌU/ml) AÁfiÚÈ·

n

M¤ÛË ÙÈÌ‹ ÃÔÏËÛÙÂÚfiÏ˘ (mg/dL)

p

383 38 19

179,53 ± 28,30 188,06 ± 28,47 177,57 ± 27,38

0,243

∫ÔÚ›ÙÛÈ·

∂ÈÎfiÓ· 3. ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (ml) Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Ì ıÂÙÈο Î·È ·ÚÓËÙÈο ·ÓÙÈ-∆ƒ√ ·ÓÙÈÛÒÌ·Ù·.

<4 4-5 >5

¶·È‰È·ÙÚÈ΋ 2007;70:107-114

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·112

112

∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

TSH Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ ·fi ÔÚÈṲ̂ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ (10-12), ÂÓÒ ‰È·ÈÛÙÒıËΠÙÒÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ F∆3, ∆3, F∆4, TSH Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ ·fi ¿ÏÏÔ˘˜ (13-16). ™ÙËÓ ÂÚÁ·Û›· Ì·˜ ‰ÂÓ ‰È·ÈÛÙÒÛ·Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Ì¤ÛË ÙÈÌ‹ Ù˘ TSH ·Ó¿ÌÂÛ· ÛÙ· ·ÁfiÚÈ· Î·È ÛÙ· ÎÔÚ›ÙÛÈ·. ∞Ó¿ÏÔÁ· ‰Â‰Ô̤ӷ ·Ó·Ê¤ÚÔÓÙ·È ·fi ÙÔ˘˜ Franklyn Î·È Û˘Ó (10). ™¯ÂÙÈο Ì ÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÛËÌ·ÓÙÈ΋ ‰È·Î‡Ì·ÓÛË ·˘ÙÔ‡ ÛÙȘ ‰È¿ÊÔÚ˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜, Ô˘ ÚÔÊ·ÓÒ˜ ηıÔÚ›˙ÔÓÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ¿ÏÏÔ˘˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (17-24). √È Zimmermann Î·È Û˘Ó (25) ÙÔ 2004 Û ÌÈ· ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÌÂϤÙË 3529 Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6-12 ÂÙÒÓ, ·fi ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘, Ì Â¿ÚÎÂÈ· Ȉ‰›Ô˘, ‰È·›ÛÙˆÛ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙËÓ ∂™, ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô˘ ·Ô‰fiıËÎ·Ó Û ÁÂÓÂÙÈΤ˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ. ™‡Ìʈӷ ÏÔÈfiÓ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Â›Ó·È ··Ú·›ÙËÙÔ Ó· ˘¿Ú¯Ô˘Ó ͯˆÚÈÛÙ¤˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙȘ ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜. ∂›Ó·È Â›Û˘ ÛËÌ·ÓÙÈÎfi ÛÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ȉȷÈÙ¤Úˆ˜ Û ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜, Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌÈ· ¢ڤˆ˜ ·Ô‰ÂÎÙ‹ Ù¯ÓÈ΋ ÒÛÙ ӷ ÌÂÈÒÓÂÙ·È ÙÔ ˘ÔÎÂÈÌÂÓÈÎfi ÛÊ¿ÏÌ· ÙÔ˘ ÂÍÂÙ·ÛÙ‹ (25). ™ÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ¤¯Ô˘Ó ηٷÁÚ·Ê› Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ·È‰ÈÒÓ Ô˘ ‰È·Ì¤ÓÔ˘Ó Ì·ÎÚÔ¯ÚfiÓÈ· Û ÂÚÈÔ¯¤˜ Ì Â¿ÚÎÂÈ· Ȉ‰›Ô˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ∆ƒ√·, ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË ‹Ù·Ó 4,6%. ™ÙË ™·Ú‰ËÓ›·, Û 29 ÂÚÈÔ¯¤˜ Ì Â¿ÚÎÂÈ· Ȉ‰›Ô˘, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-∆P√· Î˘Ì¿ÓıËΠ·fi 0% ¤ˆ˜ 7,6% (26). ™ÙË ÌÂϤÙË ·˘Ù‹ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ·ÚÔ˘Û›·˙·Ó ÈÔ Û˘¯Ó¿ ÀÀ, ‰ÂÓ ÂÌÊ¿ÓÈ˙·Ó ‚ÚÔÁ¯Ô΋ÏË Î·È ‰ÂÓ Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘ÁΤÓÙÚˆÛË Èˆ‰›Ô˘ ÛÙ· Ô‡Ú·. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË Ù· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ·ÚÔ˘Û›·˙·Ó 6 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ·˘ÍË̤ÓÔ fiÁÎÔ ı˘ÚÂÔÂȉԇ˜, ‰ÂÓ Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· Î·È ‰ÂÓ ·ÚÔ˘Û›·˙·Ó Û˘¯ÓfiÙÂÚ· ÀÀ, ·ÔÙ¤ÏÂÛÌ· Û˘Ì‚·Ùfi ÌÂ Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰È·ÈÛÙÒÓÔ˘Ó fiÙÈ Ë ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉ›Ùȉ· ÛÙ· ·È‰È¿ Â›Ó·È ·Ú¯fiÌÂÓË, Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈ΋ Ì ÂÏ¿¯ÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÛÙËÓ ÙÈÌ‹ Ù˘ TSH (27). ™Â ÌÂϤÙË ÛÙË °ÂÚÌ·Ó›· Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÙÔ 2003 (28), ‚Ú¤ıËÎÂ Û˘¯ÓfiÙËÙ· ıÂÙÈÎÒÓ ·ÓÙÈPaediatriki 2007;70:107-114

∆ƒ√· 3,4%, ÀÀ 0,8% Î·È ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ 3%. ∆· ıÂÙÈο ·ÓÙÈ-∆ƒ√· ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·, ÂÓÒ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Â˘Ú‹Ì·Ù· ·Ó¿ÏÔÁ· Ì ·˘Ù¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∏ Â›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈ∆ƒ√· ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ·Ó·ÎÔÈÓˆı›. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË ·Ú·ÙËÚ‹Û·Ì fiÙÈ ÛÙ· ·ÁfiÚÈ· ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈ-∆ƒ√· ÌÂٷ͇ ÚÔÂÊË‚ÈÎÔ‡ Î·È ÂÊË‚ÈÎÔ‡ ÛÙ·‰›Ô˘ ·Ó¿Ù˘Í˘ (2,7% Î·È 4,2% ·ÓÙ›ÛÙÔȯ·, p=0,679). ∞ÓÙ›ıÂÙ·, ÛÙ· ÎÔÚ›ÙÛÈ· ·ÓȯÓ‡ÂÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÚÔÂÊË‚ÈÎÔ‡ Î·È ÂÊË‚ÈÎÔ‡ ÛÙ·‰›Ô˘ ·Ó¿Ù˘Í˘ (2,2% Î·È 8,2% ·ÓÙ›ÛÙÔȯ·, p=0,05). ∞fi ÌÂϤÙ˜ Û ÂÓËÏ›ÎÔ˘˜ ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ Ê‡ÏÔ ÂËÚ¿˙ÂÈ ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË. ™˘ÁÎÂÎÚÈ̤ӷ ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ·ı‹ÛÂˆÓ ÛÙȘ Á˘Ó·›Î˜ (29). ™ÙÔ ‰ÈÎfi Ì·˜ ÏËı˘ÛÌÈ·Îfi ‰Â›ÁÌ·, Ë Ì¤ÛË ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ‹Ù·Ó 338 Ìg π/gr ∫Ú, ·ÔÙ¤ÏÂÛÌ· Ô˘ ηٷ‰ÂÈÎÓ‡ÂÈ ˘ÂÚÂ¿ÚÎÂÈ· Ȉ‰›Ô˘, Ë ‰Â Û˘¯ÓfiÙËÙ· Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ ‹Ù·Ó 3,2%. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó ·‡ÍËÛË Ù˘ ·¤ÎÎÚÈÛ˘ ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· Î·È Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ Û ۯ¤ÛË Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ·fi ÙË ¯ÒÚ· Ì·˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ÛÙËÓ ∞ı‹Ó· ÙÔ 1980, ‹Ù·Ó 95 Ìg π/gr ∫Ú (30), ÂÓÒ ÙÔ 1999, ÏfiÁˆ ‚ÂÏÙ›ˆÛ˘ ÙˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Û˘ÓıËÎÒÓ Î·È ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ, Î˘Ì·ÈÓfiÙ·Ó ·fi 111-164 Ìg I/gr ∫Ú (31). ¶·Ï·ÈfiÙÂÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Û ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜ Ì ¤Ó‰ÂÈ· Ȉ‰›Ô˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÌË ÙÔÍÈ΋˜ ‚ÚÔÁ¯Ô΋Ï˘ Û ÔÛÔÛÙfi 40%-60% Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ (32,33) Î·È ÂËÚ·ÛÌfi Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Û ·È‰È¿ Ì ‚ÚÔÁ¯Ô΋ÏË Ô˘ ˙Ô‡Û·Ó Û Ȉ‰ÈÔÂÓÈΤ˜ ÂÚÈÔ¯¤˜ (34,36). ™ÙË ‚ÔÚÂÈÔ‰˘ÙÈ΋ ∂ÏÏ¿‰·, ÙÔ 1996 ÔÈ ∆Û·ÙÛÔ‡Ï˘ Î·È Û˘Ó ÌÂϤÙËÛ·Ó 3.916 ·È‰È¿ ËÏÈΛ·˜ 12-15 ÂÙÒÓ Î·È ‰È·›ÛÙˆÛ·Ó Û˘¯ÓfiÙËÙ· ‚ÚÔÁ¯Ô΋Ï˘ 21%. ∏ ÂÎÙ›ÌËÛË ¤ÁÈÓ Ì „ËÏ¿ÊËÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Î·È ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÎÚÈÙËÚ›ˆÓ WHO (35). ™ÙËÓ ›‰È· ÂÚÈÔ¯‹ ÙÔ 1999 (36), Û 97 ·È‰È¿ Ì ÎÏÈÓÈο ‰È·ÁÓˆṲ̂ÓË ‚ÚÔÁ¯Ô΋ÏË ‰È·ÈÛÙÒıËΠ̤ÛË ÙÈÌ‹ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· 84 Ìg I/L. ∂ÈÚfiÛıÂÙ·, Ù· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·˙·Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√· ›¯·Ó ˘„ËÏfiÙÂÚË Ì¤ÛË Û˘ÁΤÓÙÚˆÛË Èˆ‰›Ô˘ ÛÙ· Ô‡Ú·, ·ÓÙ›ıÂÙ· Ì ÙË ‰È΋ Ì·˜ ÂÚÁ·Û›· fiÔ˘ ‰ÂÓ ‰È·ÈÛÙÒÛ·Ì ٤ÙÔÈ· Û˘Û¯¤ÙÈÛË, ÚÔÊ·ÓÒ˜ ‰ÈfiÙÈ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ∞ıËÓÒÓ ˘¿Ú¯ÂÈ Â¿ÚÎÂÈ· Ȉ‰›Ô˘ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∆Ô 2003 Û ÔÚÂÈÓ‹ ÂÚÈÔ¯‹ ÙˆÓ πˆ·ÓÓ›ÓˆÓ ÌÂÏÂÙ‹ıËÎ·Ó 300 ·È‰È¿ ËÏÈΛ·˜ 12-18 ÂÙÒÓ (37). ∏ ̤ÛË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ‹Ù·Ó 202 Ìg π/L, ÛÙÔÈ¯Â›Ô Ô˘ ‰Â›¯ÓÂÈ Â·Ú΋ ÚfiÛÏË„Ë Èˆ‰›Ô˘.

Pediatr Mar-Apr 07

28-03-07

17:23

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113

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÀÀ ‹Ù·Ó 2,5%, ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (·ÓÙÈ-∆ƒ√· ‹/Î·È ·ÓÙÈ∆g) 10,6%. ∏ Â›ÙˆÛË Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ ˘ÂÚ˯ÔÁÚ·ÊÈο ‹Ù·Ó 5% Î·È Ë Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ 9,6%. º·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Èˆ‰›Ô˘ Û ÌÈ· Ȉ‰ÔÂÓÈ΋ ÂÚÈÔ¯‹, Ô‰ËÁ› ·Ú¯Èο Û ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ (31,36,38,39), ÂÓÒ Û ÌÈ· ÂÚÈÔ¯‹ Ì ̷ÎÚ¿ ÂÚ›Ô‰Ô Â¿ÚÎÂÈ·˜ Ȉ‰›Ô˘, Ë ÂÈϤÔÓ ÚfiÛÏË„Ë ‰ÂÓ Ô‰ËÁ› ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ (37,40). ∞ӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÂÓ‹ÏÈΘ Ì ÂÏ·ÊÚ¿ ·˘ÍË̤ÓË TSH ¤¯Ô˘Ó ·˘ÍË̤ӷ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ (41,42). ™ÙÔÓ ‰ÈÎfi Ì·˜ ÏËı˘ÛÌfi ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ‰ÂÓ ·Ó·‰‡ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ‰˘Ô ·˘ÙÒÓ ·Ú·Ì¤ÙÚˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ó·˙‹ÙËÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ Î·È ÏÂÈÙÔ˘ÚÁ›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ˙Ô˘Ó Û ÂÚÈÔ¯‹ Ô˘ ¤¯ÂÈ Â¿ÚÎÂÈ· Ȉ‰›Ô˘ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ¤‰ÂÈÍ ٷ ÂÍ‹˜: 1) Û˘¯ÓfiÙËÙ· ÙÔ˘ ÀÀ 4,6%, 2) Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-∆ƒ√· 4,6% ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi (3,2% ÛÙ· ·ÁfiÚÈ· Î·È 5,8% ÛÙ· ÎÔÚ›ÙÛÈ·) Î·È ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TG 3,3% ÛÙ· ·ÁfiÚÈ· Î·È 7,9% ÛÙ· ÎÔÚ›ÙÛÈ·, 3) Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-∆ƒ√· ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ ·Ó¿Ù˘Í˘ 2,7% ÛÙ· ·ÁfiÚÈ· Î·È 4,2% ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÛÙËÓ ÂÊ˂›· 4,2% ÛÙ· ·ÁfiÚÈ· Î·È 8,2% ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 4) Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ (ıÂÙÈο ·ÓÙÈ-∆ƒ√· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÓÙÔÈṲ̂ÓË ‹ ‰È¿¯˘ÙË ˘Ô˯ˆÁ¤ÓÂÈ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·) 2,5%. ¢È·ÈÛÙÒıËΠÂ›Û˘, fiÙÈ Ô fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ÙËÓ ËÏÈΛ·, ÙËÓ ÂÊ˂›·, ÙËÓ ∂™ Î·È ÌfiÓÔ ÛÙ· ·ÁfiÚÈ·, ·ÛıÂÓÒ˜ Ì ÙÔÓ ¢ª™sds. ∆· ıÂÙÈο ·ÓÙÈ-∆ƒ√· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ·˘ÍË̤ÓÔ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (‚ÚÔÁ¯Ô΋ÏË), Î·È ÙËÓ ‡·ÚÍË ‰È¿¯˘Ù˘ ‹ ÂÓÙÔÈṲ̂Ó˘ ˘Ô˯ˆÁ¤ÓÂÈ·˜ ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ÂÓÒ ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ÀÀ Ô‡Ù Ì ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·. ∏ ‚ÚÔÁ¯Ô΋ÏË ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·. ŸÙ·Ó ÔÈ ÌËÙ¤Ú˜ ¤¯Ô˘Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√· ˘¿Ú¯ÂÈ 30% Èı·ÓfiÙËÙ· Ù· ·È‰È¿ ÙÔ˘˜ Ó· ·ÔÎÙ‹ÛÔ˘Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. WHO, UNICEF, ICCIDD. Progress towards elimination of iodine deficiency disorders. Geneva, World Health Organization. 1999;WHO/NHD/99.4.

2. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known.

Arch Intern Med 1916;17:863-871.

3. Pino S, Fang SL, Braverman LE. Ammonium persulfate: a

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem 1996;42:239-243.

Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetrie der Schilddrüsenlappen mittels Real-timeSonographie. [Volumetric analysis of thyroid lobes by real-time ultrasound]. Dtsch Med Wochenschr 1981;106:1338-1340.

Gutekunst R, Hafermann W, Mansky T, Scriba PC. Ultrasonography related to clinical and laboratory findings in lymphocytic thyroiditis. Acta Endocrinol (Copenh) 1989;121:129-135.

Weber G, Vigone MC, Stroppa L, Chiumello G. Thyroid function and puberty. J Pediatr Endocrinol Metab 2003;16 (2 Suppl):253-257.

Dunger DB, Perkins JA, Jowett TP, Edwards PR, Cox LA, Preece MA, et al. A longitudinal study of total and free thyroid hormones and thyroxine binding globulin during normal puberty. Acta Endocrinol (Copenh) 1990;123 (3 Suppl):305-310.

Garcia Cuartero B, Garcia Lacalle C, Jimenez Lobo C, Nebreda Perez V, Calvo Rey C, Garcia Vergaz A, et al. Values of thyrotropin, free triiodothyronine and free thyroxine using chemiluminescence in children and adolescents in the Autonomous Community of Madrid (Spain). An Pediatr (Barc) 2003;58:222-227.

Elmlinger MW, Kuhnel W, Lambrecht HG, Ranke MB. Reference intervals from birth to adulthood for serum thyroxine (T4), triiodothyronine (T3), free T3, free T4, thyroxine binding globulin (TBG) and thyrotropin (TSH). Clin Chem Lab Med 2001;39:973-979.

Franklyn JA, Ramsden DB, Sheppard MC. The influence of age and sex on tests of thyroid function. Ann Clin Biochem 1985;22:502-505.

Cioffi M, Gazzerro P, Vietri MT, Magnetta R, Durante A, D'Auria A, et al. Serum concentration of free T3, free T4 and TSH in healthy children. J Pediatr Endocrinol Metab 2001;14:1635-1639.

Soldin OP, Hoffman EG, Waring MA, Soldin SJ. Pediatric reference intervals for FSH, LH, estradiol, T3, free T3, cortisol, and growth hormone on the DPC IMMULITE1000.

Clin Chim Acta 2005;355:205-210.

Gonzalez-Sagrado M, Martin-Gil FJ. Population-specific reference values for thyroid hormones on the Abbott ARCHITECT i2000 analyzer. Clin Chem Lab Med 2004;42:540-542.

Djemli A, Van Vliet G, Belgoudi J, Lambert M, Delvin EE. Reference intervals for free thyroxine, total triiodothyronine, thyrotropin and thyroglobulin for Quebec newborns, children and teenagers. Clin Biochem 2004;37:328-330.

Hubner U, Englisch C, Werkmann H, Butz H, Georgs T, Zabransky S, et al. Continuous age-dependent reference ranges for thyroid hormones in neonates, infants, children and adolescents established using the ADVIA Centaur Analyzer. Clin Chem Lab Med 2002;40:1040-1047.

Gutekunst R, Smolarek H, Hasenpusch U, Stubbe P, Friedrich HJ, Wood WG, et al. Goitre epidemiology: thyroid volume, iodine excretion, thyroglobulin and thyrotropin in Germany and Sweden. Acta Endocrinol (Copenh) 1986;112:494-501.

Delange F, Benker G, Caron P, Eber O, Ott W, Peter F, et al. Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment ¶·È‰È·ÙÚÈ΋ 2007;70:107-114

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∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

of iodine deficiency. Eur J Endocrinol 1997;136:180-187.

18. Hegedus L, Perrild H, Poulsen LR, Andersen JR, Holm B, Schnohr P, et al. The determination of thyroid volume by ultrasound and its relationship to body weight, age, and sex in normal subjects. J Clin Endocrinol Metab 1983;56: 260-263.

19. Ueda D. Normal volume of the thyroid gland in children.

J Clin Ultrasound 1990;18:455-462.

20. Xu F, Sullivan K, Houston R, Zhao J, May W, Maberly G. Thyroid volumes in US and Bangladeshi schoolchildren: comparison with European schoolchildren. Eur J Endocrinol 1999;140:498-504.

21. Burgi H, Portmann L, Podoba J, Vertongen F, Srbecky M. Thyroid volumes and urinary iodine in Swiss school children, 17 years after improved prophylaxis of iodine deficiency. Eur J Endocrinol 1999;140:104-106.

22. Foo LC, Mafauzy M. Does the use of mean or median Zscore of the thyroid volume indices provide a more precise description of the iodine deficiency disorder status of a population? Eur J Endocrinol 1999;141:557-560.

23. Ivarsson SA, Persson PH, Ericsson UB. Thyroid gland volume as measured by ultrasonography in healthy children and adolescents in a non-iodine deficient area. Acta Paediatr Scand 1989;78:633-634.

24. Wiersinga WM, Podoba J, Srbecky M, van Vessem M, van Beeren HC, Platvoet-Ter Schiphorst MC. A survey of iodine intake and thyroid volume in Dutch schoolchildren: reference values in an iodine-sufficient area and the effect of puberty. Eur J Endocrinol 2001;144:595-603.

25. Zimmermann MB, Hess SY, Molinari L, De Benoist B, Delange F, Braverman LE, et al. New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. Am J Clin Nutr 2004;79:231-237.

26. Loviselli A, Velluzzi F, Mossa P, Cambosu MA, Secci G, Atzeni F, et al; Sardinian Schoolchildren Study Group.

The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in Sardinian schoolchildren: relationship to goiter prevalence and thyroid function.

Thyroid 2001;11:849-857.

27. Moore DC. Natural course of “subclinical” hypothyroidism in childhood and adolescence. Arch Pediatr Adolesc Med 1996;150:293-297.

28. Kabelitz M, Liesenkotter KP, Stach B, Willgerodt H, Stablein W, Singendonk W, et al. The prevalence of antithyroid peroxidase antibodies and autoimmune thyroiditis in children and adolescents in an iodine replete area.

Eur J Endocrinol 2003;148 :301-307.

29. Chiovato L, Lapi P, Fiore E, Tonacchera M, Pinchera A. Thyroid autoimmunity and female gender. J Endocrinol Invest 1993;16:384-391.

Paediatriki 2007;70:107-114

30. Koutras DA, Katsouyanni K, Livadas DP, Piperingos GD, Tzonou A, Trichopoulos D. An epidemiologic survey of thyroid enlargement among schoolchildren in a non-endemic area. Endokrinologie 1982;79:349-354.

31. Doufas AG, Mastorakos G, Chatziioannou S, TseleniBalafouta S, Piperingos G, Boukis MA, et al. The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis. Eur J Endocrinol 1999;140:505-511.

32. Malamos B, Koutras DA, Kostamis P, Kralios AC, Rigopoulos G, Zerefos N. Endemic goiter in Greece: epidemiologic and genetic studies. J Clin Endocrinol Metab 1966;26:688-695.

33. Malamos B, Koutras DA, Marketos SG, Rigopoulos GA, Yataganas XA, Binopoulos D, et al. Endemic goiter in Greece: an iodine balance study in the field. J Clin Endocrinol Metab 1967;27:1372-1380.

34. Koutras DA, Christakis G, Trichopoulos D, DakouVoutetaki A, Kyriakopoulos V, Fontanares P, et al. Endemic goiter in Greece: nutritional status, growth, and skeletal development of goitrous and non goitrous populations. Am J Clin Nutr 1973;26:1360-1368.

35. Tsatsoulis A, Johnson EO, Sacharis K, Soucacos PK, Soucacos PN. An epidemiological survey on the prevalence of goitre among schoolchildren in Northwestern Greece. Eur J Inter Med 1996;7:35-39.

36. Tsatsoulis AG, Johnson EO, Andricula M, Kalogera C, Svarna E, Spyrou P, et al. Thyroid autoimmunity is associated with higher urinary iodine concentrations in an iodine-deficient area of Northwestern Greece. Thyroid 1999; 9:279-283.

37. Zois C, Stavrou I, Kalogera C, Svarna E, Dimoliatis I, Seferiadis K, et al. High prevalence of autoimmune thyroiditis in schoolchildren after elimination of iodine deficiency in northwestern Greece. Thyroid 2003;13:485-489.

38. Braverman LE. Iodine-induced thyroid disease. In Ingbar SH, The Thyroid. Lippincott, Philadelphia, p 738-746.

39. Papanastasiou L, Alevizaki M, Piperingos G, Mantzos E, Tseleni-Balafouta S, Koutras DA. The effect of iodine administration on the development of thyroid autoimmunity in patients with nontoxic goiter. Thyroid 2000;10:493-497.

40. Ruwhof C, Drexhage HA. Iodine and thyroid autoimmune disease in animal models. Thyroid 2001;11:427-436.

41. Duntas LH. Thyroid disease and lipids. Thyroid 2002;12: 287-293.

42. Michalopoulou G, Alevizaki M, Piperingos G, Mitsibounas D, Mantzos E, Adamopoulos P, et al. High serum cholesterol levels in persons with ‘high-normal’ TSH levels: should one extend the definition of subclinical hypothyroidism? Eur J Endocrinol 1998;138:141-145.

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ORIGINAL ARTICLE

115

¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ∂. ªÔ‡˙·1, π. ∞ÓÙˆÓÈ¿‰Ô˘2, ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘3, ª. ∞Ó·ÁÓˆÛÙ¿ÎÔ˘1, º. ∞Ó·ÙÔÏ›ÙÔ˘1, ª. ªÔÚÔ˙›ÓË3, °. ™·Ú·Ê›‰Ô˘2, ª. •¿ÓıÔ˘1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∆· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (¶Ãµ°) ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·. ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÔ‚·Ú¤˜ ·Ó·Ëڛ˜ ·ÏÏ¿ ‹È· ÚÔ‚Ï‹Ì·Ù· Ô˘ Û˘¯Ó¿ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ‹ Û¯ÔÏÈ΋ ËÏÈΛ·. √ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ¶Ãµ° ÓÂÔÁÓÒÓ ÛÙË ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓȯÓ¢ıÔ‡Ó Î˘Ú›ˆ˜ ‹È· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË 40 ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1500 g. ªÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, Ù· ·È‰È¿ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ‰È·¯ÚÔÓÈο. ™ÙËÓ ËÏÈΛ· ÙˆÓ ‰‡Ô ÂÙÒÓ ¤ÁÈÓ ÏÂÙÔÌÂÚ‹˜ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ÌÈ· ÏÂÙÔÌÂÚ‹˜ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Ì ¤Ó·Ó Û˘Ó‰˘·ÛÌfi ·fi ÚÔÙ˘ÔÔÈË̤Ó˜ ‰ÔÎÈ̷ۛ˜: Touwen, Griffiths Î·È Miller. ™ÙÔ˘˜ ÁÔÓ›˜ ‰fiıËΠ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ÂÓÙ‡ˆÛË Ô˘ ›¯·Ó ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ∞ÔÙÂϤÛÌ·Ù·: ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, Ù¤ÛÛÂÚ· ·È‰È¿ ›¯·Ó ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (10%). ∆· ˘fiÏÔÈ· 36 ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ Ê˘ÛÈÔÏÔÁÈο ‹ ˆ˜ ¤¯ÔÓÙ· ‹Ș ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰˘ÛÎÔϛ˜. ™Â ·˘Ù¿ Ù· ·È‰È¿, Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ¤‰ÂÈÍ ‚·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔًوÓ. ∞fi Ù· ·È‰È¿ Ô˘ ›¯·Ó ıˆÚËı› Ê˘ÛÈÔÏÔÁÈο Û ÚÔËÁÔ‡ÌÂÓ˜ ËÏÈ˘, ÔÈ ‰ÔÎÈ̷ۛ˜ ¤‰ÂÈÍ·Ó ·fi‰ÔÛË Î¿Ùˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÁÈ· ÙȘ ÈÔ ·ÓÙÈÚÔÛˆ¢ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜. ¶·Ú’ fiÏ· ·˘Ù¿ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ ›ÛÙ¢·Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ‰ÂÓ Â›¯Â Úfi‚ÏËÌ·. ™˘ÌÂÚ¿ÛÌ·Ù·: ◊Ș Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ·ÓȯÓ‡ıËÎ·Ó Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÛÙ· ¶Ãµ° ÓÂÔÁÓ¿ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ·. ∞˘Ù¿ Ù· ÚÔ‚Ï‹Ì·Ù· ‰ÂÓ Â›¯·Ó ‰È·ÁÓˆÛÙ› Û ÚÔËÁÔ‡ÌÂÓ˜ ËÏÈ˘, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÎÙÈÌÔ‡Û·Ó fiÙÈ ‰ÂÓ ˘‹Ú¯Â ηӤӷ Úfi‚ÏËÌ·. ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ·Ó¿ÁÎË ÌÈ·˜ ÏÂÙÔÌÂÚÔ‡˜ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÂÎÙ›ÌËÛ˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‚ÔËıËıÔ‡Ó Ù· ·È‰È¿ ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË Ì·ıËÛÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

1 µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, ¡ÔÛ. ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜ Î·È ∞Ó·Ù˘Íȷ΋˜ ¶·È‰È·ÙÚÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó· 3 ™˘ÓÂÚÁ¿Ù˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¢È·¯ÚÔÓÈ΋˜ ¶·Ú·ÎÔÏÔ‡ıËÛ˘ ¶ÚfiˆÚˆÓ µ’ ª∂¡ AÏÏËÏÔÁÚ·Ê›·: ∂ϤÓË ªÔ‡˙· ebouzaat@otenet.gr

§¤ÍÂȘ ÎÏÂȉȿ: ¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË, ÚfiˆÚÔ, ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·.

Neurodevelopmental outcome of very low birth weight neonates at preschool age H. Bouza1, I. Antoniadou2, H. Antonopoulou3, M. Anagnostakou1, F. Anatolitou1, M. Morosini3, J. Sarafidou2, ª. Xanthou1 Abstract Background: Very Low Birth Weight (VLBW) neonates are at increased risk of neurodevelopmental disabilities. Most affected children present mild deficits rather than severe handicap, often appearing at the preschool or school age. The purpose of this study was to assess VLBW infants at the preschool age in order to detect neurodevelopmental disabilities, mainly mild in nature.

Methods: Forty children with a birth weight of <1500 g, participated in the study. Following discharge from the Neonatal Intensive Care Unit, the children were monitored longitudinally. At the age of two years they underwent detailed neurological assessment. At the age of four years they underwent neurodevelopmental assessment with a combination of structured tests: the Touwen, the Griffiths and the Miller tests. A questionnaire was completed by the parents concerning their opinion of their children’s condition.

Results: At the age of four years, four children had cerebral palsy (10%). The remaining 36 were considered as normal or as having minor functional disabilities. In these children, the combination of neurodevelopmental tests showed suboptimal scores in coordination and performance. In the children who had been considered to have a normal outcome at an earlier age, the tests showed a suboptimal performance in most representative tasks, although 85% of the parents considered that their children had no problems. ∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚‡ıËΠ̠ÙÔ ‚Ú·‚Â›Ô ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ÛÙË ÌÓ‹ÌË ™. ¢ÔÍÈ¿‰Ë ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ƒfi‰Ô˜, 9-11 πÔ˘Ó›Ô˘ 2006

1 2nd Neonatal Intensive Care Unit, “Aghia Sophia” Children’s Hospital, Athens, Greece 2 Department of Social and Developmental Paediatrics, Institute of Child Health, Athens, Greece 3 Collaborating Scientist in the Neonatal Continuing Follow-up Programme in the 2nd NICU Correspondence: Helen Bouza ebouzaat@otenet.gr

¶·È‰È·ÙÚÈ΋ 2007;70:115-122

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·116

116

∂. ªÔ‡˙· Î·È Û˘Ó.

Conclusion: Subtle functional disabilities were identified in VLBW neonates at the age of four years.

These disabilities had not been detected at earlier ages, and the parents of these children believed that their children had no problems. These findings underline the need for a detailed neurodevelopmental assessment of VLBW children at the preschool age in order to intervene, where necessary, before school entry.

Key words: Neurodevelopmental outcome, preterm, preschool age.

∂ÈÛ·ÁˆÁ‹ ∏ ‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ΢ڛˆ˜ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ Ù¯ÓÔÏÔÁ›·˜ Î·È Ì ÙË ¯Ú‹ÛË Ó¤ˆÓ Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ, ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÈ‚›ˆÛ˘ ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ (¶Ãµ¡). ¶·Ú¿ÏÏËÏ· fï˜, ·˘Í‹ıËÎÂ Î·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Î·È Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· (1,2). ŒÙÛÈ, Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ÛÔ‚·Ú¿ Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ÛÙÔ 10-30% ·È‰ÈÒÓ ÛÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ (3,4). ∆· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ Â›Ó·È Ì›˙ÔÓ˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Î˘Ú›ˆ˜ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ÛÔ‚·Ú¿ Ó¢ÚÔ·ÈÛıËÙËÚȷο ÚÔ‚Ï‹Ì·Ù· (fiÚ·Û˘, ·ÎÔ‹˜). ∏ÈfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ ·Ú¯›˙Ô˘Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (5-7). ∆· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ¶Ãµ¡ Â›Ó·È ‰˘Ó·Ùfi Ó· ‰È·ÁÓˆÛıÔ‡Ó ÛÙËÓ ËÏÈΛ· ·˘Ù‹ Ì ÌÈ· ÏÂÙÔÌÂÚ‹ ÂÎÙ›ÌËÛË. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ›ӷÈ, ·ÎÚÈ‚Ò˜, Ë ÏÂÙÔÌÂÚ‹˜ ÂÎÙ›ÌËÛË ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ Ô˘ ÓÔÛËχıËÎ·Ó ÛÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÁÓˆÛÙÈο ÂÚÁ·Ï›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓȯÓ¢ıÔ‡Ó ‹Ș Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ‰ÂÓ Â›¯·Ó ·ÓȯÓ¢Ù› Û ÚÔËÁÔ‡ÌÂÓ˜ ËÏÈ˘. ∞ÒÙÂÚÔ˜ ÛÎÔfi˜ Â›Ó·È Ë ÚfiÏË„Ë ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Ì¤Ûˆ Ù˘ ¤ÁηÈÚ˘ ·Ú¤Ì‚·Û˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÀÏÈÎfi Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 40 ·È‰È¿ ËÏÈΛ·˜ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Ô˘ ›¯·Ó ÓÔÛËÏ¢ı› Î·È Â›¯·Ó ÂÈ˙‹ÛÂÈ ÛÙË µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ÌÂٷ͇ ª·˝Ô˘ 1997 Î·È ¢ÂÎÂÌ‚Ú›Ô˘ 1998, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ οو ·fi 1500 g. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ›¯Â ̤ÛË ÙÈÌ‹ 1122 g Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 231 g, ÂÓÒ Ë ‰È¿ÚÎÂÈ· ·ËÛ˘ ›¯Â ̤ÛË ÙÈÌ‹ 29,1 ‚‰ÔÌ¿‰Â˜. Ì ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 2,3 ‚‰ÔÌ¿‰Â˜.

15 ‚Ú¤ÊË Â›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1000 g (ÔÌ¿‰· ∞) (̤ÛÔ ‚¿ÚÔ˜ 883 g Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 101 g, ̤ÛË Paediatriki 2007;70:115-122

‰È¿ÚÎÂÈ· ·ËÛ˘ 28,3 ‚‰ÔÌ¿‰Â˜. Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 2,2 ‚‰ÔÌ¿‰Â˜.) Î·È 25 ›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 10011500 g (ÔÌ¿‰· µ) (̤ÛÔ ‚¿ÚÔ˜ 1265 g Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 154 g, ̤ÛË ‰È¿ÚÎÂÈ· ·ËÛ˘ 29,7 ‚‰ÔÌ¿‰Â˜ Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 2,2 ‚‰ÔÌ¿‰Â˜). ªÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰·, Ù· ·È‰È¿ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ ηÓÔÓÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 3, 6, 12 ÌËÓÒÓ, Î·È ÌÂٷ͇ 18 Î·È 24 ÌËÓÒÓ. ŸÛ· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ·Ú·¤ÌÊıËÎ·Ó ÚÒÈÌ· ÁÈ· Ê˘ÛÈÔıÂÚ·›·. ™ÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ ¤ÁÈÓ ÌÈ· ÏÂÙÔÌÂÚ‹˜ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Ì ÙË Ì¤ıÔ‰Ô Dubowitz (8) Î·È ÌÈ· ·‰Ú‹ ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË. ∆· ·È‰È¿ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜: 1) Ê˘ÛÈÔÏÔÁÈο Â¿Ó Ë Ó¢ÚÔÏÔÁÈ΋ Î·È Ë ·Ó·Ù˘Íȷ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋, 2) Ì ‹È· ÚÔ‚Ï‹Ì·Ù· Â¿Ó Â›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ·ÚÔ‰ÈΤ˜ ‰˘ÛÙÔӛ˜ Ô˘ ‰ÂÓ ˘‹Ú¯·Ó ϤÔÓ ÛÙËÓ ÙÂÏÂ˘Ù·›· ÂͤٷÛË ‹ Â¿Ó Ù· ·È‰È¿ ›¯·Ó ‹È· Ó¢ÚÔÏÔÁÈο ‹ ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· Î·È 3) Ì ÛÔ‚·Ú‹ ·Ó·ËÚ›·, ·Ó Ù· ·È‰È¿ ›¯·Ó ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο ‹ ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·. ™ÙÔ Ï·›ÛÈÔ Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÔÈ ÁÔÓ›˜ ÂÓËÌÂÚÒÓÔÓÙ·Ó ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù· ·È‰È¿ ‹È· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ·ÚÁfiÙÂÚ·, ηıÒ˜ Î·È ÁÈ· ÙË ÛËÌ·Û›· Ù˘ ÚÔÛ¯ÔÏÈ΋˜ ÊÔ›ÙËÛ˘. ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÚÈÒÓ ÂÙÒÓ ÔÈ ÁÔÓ›˜ ÂÓı·ÚÚ‡ÓÔÓÙ·Ó Ó· ÂÓÙ¿ÍÔ˘Ó ÙÔ ·È‰› ÛÙÔ ÔÚÁ·ÓˆÌ¤ÓÔ ÂÎ·È‰Â˘ÙÈÎfi ÚfiÁÚ·ÌÌ· ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡. ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ¤ÁÈÓ ÌÈ· ÏÂÙÔÌÂÚ‹˜ ÂÎÙ›ÌËÛË ‚¿ÛÂÈ ÚˆÙÔÎfiÏÏÔ˘ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ¤Ó·Ó Û˘Ó‰˘·ÛÌfi ·fi Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰ÔÎÈ̷ۛ˜.

1) ¡Â˘ÚÔÏÔÁÈ΋ ÂͤٷÛË ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ‹ÈˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·Û›· Touwen examination for minor neurological dysfunctions (9).

2) ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·Û›· Griffiths Mental Development scales (10).

3) ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·Û›· Miller Assessment for Preschoolers (11). ∂›Û˘, ÛÙÔ˘˜ ÁÔÓ›˜ ‰fiıËΠӷ Û˘ÌÏËÚÒÛÔ˘Ó ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ÙËÓ ¿Ô„Ë Ô˘ ¤¯Ô˘Ó ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ì ÏËÚÔÊÔڛ˜ Û¯ÂÙÈΤ˜ Ì ÙË ÊÔ›ÙËÛË Û ·È‰ÈÎfi ÛÙ·ıÌfi. √ Û˘Ó‰˘·ÛÌfi˜ ·fi Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰ÔÎÈ̷ۛ˜ ÂÂϤÁË ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ·ÓȯÓ¢ıÔ‡Ó ‹Ș ‰È·Ù·Ú·¯¤˜ Ô˘ ‰ÂÓ ‰È·ÁÓÒÛÙËÎ·Ó ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÂÍÂÙ¿ÛÂȘ ‹ ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ∆Ô Touwen examination for minor

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¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÓÂÔÁÓÒÓ

neurological dysfunctions ÂÎÙÈÌ¿ ÙÔ˘˜ ÂÍ‹˜ Ó¢ÚÔÏÔÁÈÎÔ‡˜ ÙÔÌ›˜ ÙÔ˘ ·È‰ÈÔ‡: ÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ̤·, ÙË ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜, ÙËÓ ÈÛÔÚÚÔ›· ÙÔ˘ ÎÔÚÌÔ‡, ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ, ÙËÓ ‡·ÚÍË ‰˘ÛÎÈÓËÛ›·˜, ÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·, ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ÎÈÓ‹ÛˆÓ, ÙËÓ ‡·ÚÍË Û˘ÁÎÈÓËÛÈÒÓ Î·È ÙËÓ fiÚ·ÛË (9). ∆· ·È‰È¿ ıˆڋıËÎ·Ó fiÙÈ Â›¯·Ó ‚·ıÌÔÏÔÁ›· οو ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi, fiÙ·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÈÙ˘¯ÈÒÓ Û ۯ¤ÛË Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙËÓ Î¿ı ˘ÔÎϛ̷η ‹Ù·Ó <100%. To Griffiths Mental Development scales ÂÎÙÈÌ¿ ÙÔ˘˜ ÂÍ‹˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘: ÙËÓ ÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË, ÙËÓ ÚÔÛˆÈÎfiÙËÙ· Î·È ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ÙËÓ ·ÎÔ‹ Î·È ÙÔÓ ÏfiÁÔ, ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹ÙˆÓ Î·È ÙÔÓ Ú·ÎÙÈÎfi Û˘ÏÏÔÁÈÛÌfi (10). ∆· ·È‰È¿ ıˆڋıËÎ·Ó fiÙÈ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Ì ÌÈ· ‚·ıÌÔÏÔÁ›· >85, Ì ‹ÈÔ ‹ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ Úfi‚ÏËÌ· Ì ‚·ıÌÔÏÔÁ›· 70-85 Î·È Ì ÛÔ‚·Úfi Úfi‚ÏËÌ· Ì ‚·ıÌÔÏÔÁ›· <70. ∆Ô Miller Assessment for Preschoolers Â›Ó·È ÌÈ· ‰ÔÎÈÌ·Û›· Ô˘ ÂÎÙÈÌ¿ Â›Û˘ ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·. √È ÙÔÌ›˜ Ô˘ ÂÍÂÙ¿˙ÔÓÙ·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙÔ˘˜ ÂÍ‹˜ ‰Â›ÎÙ˜ ·fi‰ÔÛ˘: ÙÔÓ ‰Â›ÎÙË ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔًوÓ, ÙÔÓ ‰Â›ÎÙË Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛˆÓ, ÙÔÓ ÏÂÎÙÈÎfi ‰Â›ÎÙË, ÙÔÓ ÌË ÏÂÎÙÈÎfi ‰Â›ÎÙË Î·È ÙÔÓ ‰Â›ÎÙË Û˘Ó‰˘·ÛÌ¤ÓˆÓ ‰ÂÍÈÔÙ‹ÙˆÓ (Ô˘ Û˘Ó‰˘¿˙ÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ·ÈÛıËÙÈÎÒÓ, ÎÈÓËÙÈÎÒÓ, Î·È ÁÓˆÛÙÈÎÒÓ ÈηÓÔًوÓ) (11) ∆· ·È‰È¿ ıˆڋıËÎ·Ó fiÙÈ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Ì ‚·ıÌÔÏÔÁ›· >25, Ì ‹ÈÔ/̤ÙÚÈÔ˘ ‚·ıÌÔ‡ Úfi‚ÏËÌ· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ì ‚·ıÌÔÏÔÁ›· 6-25, Î·È ÛÔ‚·Ú‹ ·Ó·ËÚ›· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ıÂÚ·¢ÙÈÎfi ÚfiÁÚ·ÌÌ· Ì ‚·ıÌÔÏÔÁ›· <5. ™ÙË ÏÂÙÔÌÂÚ‹ ÂÎÙ›ÌËÛË ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Û˘ÌÌÂÙ›¯·Ó ÙÚÂȘ ÓÂÔÁÓÔÏfiÁÔÈ ÂÎ ÙˆÓ ÔÔ›ˆÓ Ô ¤Ó·˜ Ì ÂÍÂȉ›Î¢ÛË ÛÙË Ó¢ÚÔÏÔÁ›· ÙÔ˘ ÓÂÔÁÓÔ‡, ‰‡Ô ·Ó·Ù˘ÍÈ·ÎÔ› ·È‰›·ÙÚÔÈ Î·È ¤Ó·˜ ÂÚÁÔıÂÚ·Â˘Ù‹˜. ∞Ó¿ÏÔÁ· Ì ٷ ·ÔÙÂϤÛÌ·Ù·, Â¿Ó ˘‹Ú¯Â ¤Ó‰ÂÈÍË, ÚÔÙÂÈÓfiÙ·Ó ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘: ÂÚÁÔıÂÚ·›·, ÏÔÁÔıÂÚ·›·, ·È‰·ÁˆÁÈ΋ / ÂÎ·È‰Â˘ÙÈ΋ ··Û¯fiÏËÛË ‹ ·ÏÒ˜ ÊÔ›ÙËÛË ÛÙÔ ÚÔÓ‹ÈÔ. ™ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ MannWhitney test ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘ÁÎÚÈıÔ‡Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÛÙ· ÚfiˆÚ· Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1000 g (ÔÌ¿‰· ∞) Û ۇÁÎÚÈÛË Ì ·˘Ù¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1001-1500 g (ÔÌ¿‰· µ).

∞ÔÙÂϤÛÌ·Ù· ™ÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ ¤ÓÙ ·È‰È¿ (12,5%) ›¯·Ó ÛÔ‚·Ú‹ ·Ó·ËÚ›·, 14 (35%) ›¯·Ó ‹È· ÚÔ‚Ï‹Ì·Ù· Î·È Ù· ˘fiÏÔÈ· 21 (52,5%) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, Ù¤ÛÛÂÚ· ·È‰È¿ ›¯·Ó ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (10%). ∞fi ·˘Ù¿ ¤Ó· ›¯Â Û·ÛÙÈ΋ ‰ÈÏËÁ›·, ¤Ó· ›¯Â Û·ÛÙÈ΋ ÙÂÙÚ·ÏËÁ›· Î·È ‰‡Ô ›¯·Ó ËÌÈÏËÁ›·. ∏ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Â›¯Â ‹‰Ë ‰È·ÁÓˆÛÙ› Î·È ÛÙ· Ù¤ÛÛÂÚ· ·È‰È¿ ·fi ÙËÓ Âͤٷۋ ÙÔ˘˜ ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜. ∆· ˘fiÏÔÈ· 36 ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ Ê˘ÛÈÔÏÔÁÈο ‹ ˆ˜ ¤¯ÔÓÙ· ‹Ș ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜. °È· ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·ÔÎÏ›ÛıËÎ·Ó Ù· ·È‰È¿ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÂÓÒ ÂÚÈÂÏ‹ÊıËÛ·Ó Ù· 36 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÂͤÏÈÍË ‹ Ì ‹Ș ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜.

∆Ô Touwen examination for minor neurological dysfunctions ¤‰ÂÈÍ fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ‚·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‹Ù·Ó ˘„ËÏfi, ΢ڛˆ˜ ÛÙÔÓ ÙÔ̤· ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ (36%), Ù˘ ·‰Ú‹˜ ÎÈÓËÙÈÎfiÙËÙ·˜ (45%) Î·È ÙËÓ ·ÚÔ˘Û›· Û˘ÁÎÈÓËÛÈÒÓ (39%) (∂ÈÎfiÓ· 1). ∏ ‚·ıÌÔÏÔÁ›· ÛÙÔ Griffiths Mental Development scales ‹Ù·Ó ηٿ ̤ÛÔÓ fiÚÔ ¯·ÌËÏ‹ ÛÙÔ˘˜ ÙÔÌ›˜ ÙÔ˘ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ (̤ÛË ÙÈÌ‹=90,11, SD=15,78) Î·È Ù˘ ÂÎÙ¤ÏÂÛ˘ ‰ÂÍÈÔÙ‹ÙˆÓ (̤ÛË ÙÈÌ‹=93,60, SD=14,96) (∂ÈÎfiÓ· 2). ™ÙÔ Miller Assessment for Preschoolers, ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ê¿ÓËΠfiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ô˘ ·ÊÔÚ¿ ÛÙÔ˘˜ ÙÔÌ›˜ ÙˆÓ ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ (44%), ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ (56%) Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ (44%) (∂ÈÎfiÓ· 3). ∂›Û˘ Ë ›‰È· ‰ÔÎÈÌ·Û›· ¤‰ÂÈÍ ˆ˜ Û ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ ··ÈÙÂ›Ù·È ·Ú¤Ì‚·ÛË Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ‰ÔÎÈÌ·Û›·˜, Ô˘ ·ÊÔÚ¿ ÛÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔÌ›˜, ÛÙÔÓ ÙÔ̤· ÙˆÓ ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ (14%), ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ (14%) Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ (14%) (∂ÈÎfiÓ· 4). √ Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ·Ú·¿Óˆ ‰ÔÎÈÌ·ÛÈÒÓ ‰Â›¯ÓÂÈ fiÙÈ ÙÔ Û˘ÓËı¤ÛÙÂÚÔ Úfi‚ÏËÌ· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Â›Ó·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÙˆÓ Û˘Óı¤ÙˆÓ ‰ÂÍÈÔًوÓ. ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ, Ù· ÓÂÔÁÓ¿ Ì ¯·ÌËÏfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÛÙÔ Griffiths Mental Development scales ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔ˘˜ ÙÔÌ›˜ Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ / ÎÔÈÓˆÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ù˘ ÂÎÙ¤ÏÂÛ˘ ‰ÂÍÈÔÙ‹ÙˆÓ Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi ‰Â›ÎÙË ·Ó¿Ù˘Í˘. ™ÙÔ Miller Assessment for Preschoolers ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔÓ ‰Â›ÎÙË

∞ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi˜

27

™Ù¿ÛË ÛÒÌ·ÙÔ˜

21

πÛÔÚÚÔ›· ÎÔÚÌÔ‡

9

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

36

¢˘ÛÎÈÓËÛ›· 3 ∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·

45

¶ÔÈfiÙËÙ· ÎÈÓ‹ÛÂˆÓ 3 ™˘ÁÎÈÓËۛ˜ ŸÚ·ÛË

39

6 0

10 20 30 40 % ·È‰ÈÒÓ Ì ‚·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡

50

∂ÈÎfiÓ· 1. ¡Â˘ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË (Touwen). ¶·È‰È·ÙÚÈ΋ 2007;70:115-122

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·118

118

∂. ªÔ‡˙· Î·È Û˘Ó.

∞Ó·Ù˘Íȷ΋ ∂ÎÙ›ÌËÛË (Griffiths) ¶Ú·ÎÙÈÎfi˜ Û˘ÏÔÁÈÛÌfi˜ ¢ÂÍÈfiÙËÙ·

µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜

14

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

14

§ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ 0

√ÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓ.

ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ 0

∞ÎÔ‹-§fiÁÔ˜

™˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜

¶ÚÔÛˆ./∫ÔÈÓˆÓ.

14

°ÂÓÈÎfi˜ ‰Â›ÎÙ˘ 3

∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· °ÂÓÈÎfi˜ ∞Ó·Ù˘ÍÈ·Îfi˜ ¢.

80

90 100 110 ª¤ÛË ÙÈÌ‹ Î·È 95% ¢È¿ÛÙËÌ· ∂ÌÈÛÙÔÛ‡Ó˘

0 5 10 15 20 25 30 % ·È‰ÈÒÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÁÔıÂÚ·›· ∂ÈÎfiÓ· 4. ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (Miller).

∂ÈÎfiÓ· 2. AÓ·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (Griffiths).

ÙˆÓ ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔًوÓ, ÛÙÔÓ ‰Â›ÎÙË Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛˆÓ, ÛÙÔÓ ÏÂÎÙÈÎfi ‰Â›ÎÙË Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi ‰Â›ÎÙË (¶›Ó·Î·˜ 1). ŒÁÈÓ ۇÁÎÚÈÛË ÌÂٷ͇ Ù˘ ÂÎÙ›ÌËÛ˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ Î·È ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙȘ ‰È¿ÊÔÚ˜ ‰ÔÎÈ̷ۛ˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ·. ∆· ·È‰È¿ Ô˘ ›¯·Ó ıˆÚËı› ˆ˜ Ê˘ÛÈÔÏÔÁÈο ÛÙÔ˘˜ 18-24 Ì‹Ó˜ Î·È Â›¯·Ó ¯·ÌËÏ¿ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ·, Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∞fi Ù· ·È‰È¿ Ô˘ ›¯·Ó ıˆÚËı› Ê˘ÛÈÔÏÔÁÈο, ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ÛÙÔ Touwen test: 19% ÛÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ̤·, 19% ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È 33,3% ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·. ∂›Û˘ ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË ÛÙÔ Griffiths test: 36,8% ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, Î·È 25% ÛÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔًوÓ. ∆¤ÏÔ˜ ÛÙÔ Miller test, ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË Î·È ¯ÚÂÈ¿˙ÔÓÙ·Ó Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË 47,6% ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ, ·ÏÏ¿ ۯ‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜, ÌÂٷ͇ 28,6% Î·È 38,1%. ∂›Û˘, ·ÚÔ˘Û›·˙·Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Ô˘ ··ÈÙÔ‡Û·Ó ÂÚÁÔıÂÚ·µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

44 56

§ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

31

ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

8

™˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜

44

°ÂÓÈÎfi˜ ‰Â›ÎÙ˘

44 0

10 20 30 40 50 60 % ·È‰ÈÒÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ·Ú·ÎÔÏÔ‡ıËÛË

∂ÈÎfiÓ· 3. ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (Miller).

Paediatriki 2007;70:115-122

›·, 14,3% ÛÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ Î·È 9,5% ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ. ™ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ¿Ô„Ë Ô˘ ›¯·Ó Û¯ÂÙÈο Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ˙ˆ‹˜, 34 (85%) ıÂÒÚËÛ·Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, 5 (12,5%) fiÙÈ ¤¯ÂÈ Î¿ÔȘ ‰˘ÛÎÔϛ˜ Î·È 1 (2,5%) fiÙÈ ¤¯ÂÈ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¿Ԅ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· Î·È ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙȘ ‰È¿ÊÔÚ˜ ‰ÔÎÈ̷ۛ˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∞fi Ù· ·È‰È¿ Ô˘ ıˆڋıËÎ·Ó Ê˘ÛÈÔÏÔÁÈο ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ÛÙÔ Touwen test οÔÈ· ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË, ΢ڛˆ˜ ÛÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ̤· (26,5%), ÛÙË ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ (20,6%), ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ (37,5%), ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· (46,9) Î·È ÛÙȘ Û˘ÁÎÈÓËۛ˜ (40,6%). ™ÙÔ Griffiths test οÔÈ· ›¯·Ó ‹È· ‹ ̤ÙÚÈ· ÌÂȈ̤ÓË ·fi‰ÔÛË, ΢ڛˆ˜ ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (40,6%) Î·È ÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹ÙˆÓ (24,2%). ™ÙÔ Miller test οÔÈ· ›¯·Ó ‰˘ÛÎÔϛ˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·Ó Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË, ۯ‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜, 32,4% ÛÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜, 44,1% ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ, 32,4% ÛÙÔÓ ÏÂÎÙÈÎfi ‰Â›ÎÙË Î·È 29,4 ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜. ™ÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜, ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ 14,7% ÙˆÓ ·È‰ÈÒÓ Â›¯·Ó ·fi‰ÔÛË Ô˘ ··ÈÙÔ‡Û ÂÚÁÔıÂÚ·›·. ™Â Û¯¤ÛË Ì ÙËÓ ¤ÓÙ·ÍË ÛÙÔ ÔÚÁ·ÓˆÌ¤ÓÔ ÚfiÁÚ·ÌÌ· ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡, ÌfiÓÔ 19 (47,5%) ·È‰È¿ ‹Á·ÈÓ·Ó ÛÙÔÓ ·È‰ÈÎfi ÛÙ·ıÌfi ‹ ÛÙÔ ÚÔÓ‹ÈÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ.

™˘˙‹ÙËÛË ∆· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Â›Ó·È ·ÓÒÚÈÌÔÈ ÔÚÁ·ÓÈÛÌÔ› Ì ÂÁΤʷÏÔ ÂÍ·ÈÚÂÙÈο

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·119

119

¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÓÂÔÁÓÒÓ

¶›Ó·Î·˜ 1. ∞ÓÒÌ·Ï· Â˘Ú‹Ì·Ù· Û ۯ¤ÛË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (√Ì¿‰· ∞: <1000 g, √Ì¿‰· µ: 1001-1500 g) Griffiths Mental Development scales ÚÔÛˆÈÎfiÙËÙ·/ ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹ÙˆÓ Û˘ÓÔÏÈÎfi˜ ‰Â›ÎÙ˘ ·Ó¿Ù˘Í˘ Miller Assessment for Preschoolers ‰Â›ÎÙ˘ ÙˆÓ ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ ‰Â›ÎÙ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ Û˘ÓÔÏÈÎfi˜ ‰Â›ÎÙ˘

∞<µ

p=0,045

∞<µ ∞<µ

p=0,015 p=0,016

∞<µ

p=0,036

∞<µ ∞<µ ∞<µ

p=0,010 p=0,033 p=0,010

¢¿ÏˆÙÔ Û ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∆fiÛÔ ÂÓ‰ÔÌ‹ÙÚÈÔÈ fiÛÔ Î·È Â͈̋ÙÚÈÔÈ ‚Ï·ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ ‹ ÌÈÎÚfiÙÂÚ˜ ÂÁÎÂÊ·ÏÈΤ˜ ‚Ï¿‚˜ Ì ·ÔÙ¤ÏÂÛÌ· ÛÔ‚·Ú¿ ‹ ËÈfiÙÂÚ· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·. ∆Ô ÛÔ‚·ÚfiÙÂÚÔ Ó¢ÚÔÏÔÁÈÎfi Úfi‚ÏËÌ· ÛÙ· ·È‰È¿ ·˘Ù¿ Â›Ó·È Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË. ™ÙË ÌÂϤÙË Ì·˜, 10% ÙˆÓ ·È‰ÈÒÓ Â›¯Â ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÔÛÔÛÙfi ·Ó¿ÏÔÁÔ Ì ·˘Ùfi Ô˘ ·Ó·Ê¤ÚÂÙ·È Û ¿ÏϘ ÌÂϤÙ˜ (7,7-12,6%) (12). ∆· ÛÔ‚·Ú¿ Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ‰È·ÈÛÙÒÓÔÓÙ·È Î˘Ú›ˆ˜ ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ ‰‡Ô ÂÙÒÓ. ™ÙË ÌÂϤÙË ·˘Ù‹ Ù· 4 ·È‰È¿ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Â›¯·Ó ‹‰Ë ‰È·ÁÓˆÛÙ› Û ÌÈÎÚ‹ ËÏÈΛ· Î·È ‚Ú›ÛÎÔÓÙ·Ó Û ÚÔÁÚ¿ÌÌ·Ù· ·Ô-

ηٿÛÙ·Û˘. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ (13,14). ™·ÓÈfiÙÂÚ·, ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ÌÈ· ˘ÂډȿÁÓˆÛË ÛÔ‚·ÚÒÓ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙ· ‰‡Ô ¤ÙË, ÂÓÒ ¿ÏÏÔÈ ·Ó·Ê¤ÚÔ˘Ó ·‡ÍËÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ ÌÂٷ͇ ÂÓ¿ÌÈÛË ¤ÙÔ˘˜ Î·È ¤ÓÙ ÂÙÒÓ. £ÂˆÚÔ‡Ó Ì¿ÏÈÛÙ· fiÙÈ Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÌÔÚ› Ó· ‰È·ÁÓˆÛÙ› ÔÚÈÛÙÈο ÛÙ· Ù¤ÛÛÂÚ· ¤ÙË (6). √È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ì ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ, ÙÔ ÂӉȷʤÚÔÓ ÂÛÙÈ¿˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ‹È· Ó¢ÚÔÏÔÁÈο Î·È ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Ì·ÎÚÔÚfiıÂÛÌ· ÚÔ‚Ï‹Ì·Ù· ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ·, ·Ú¿ ÛÙ· ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÁÈ· Ù· ÔÔ›· ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÁÓÒÛË Î·È ˆ˜ ÚÔ˜ ÙËÓ ÚԤϢÛË Î·È ˆ˜ ÚÔ˜ ÙÔ˘˜ ÙÚfiÔ˘˜ ¤ÁηÈÚ˘ ·Ú¤Ì‚·Û˘. ∏ ‰È¿ÁÓˆÛË ËÈfiÙÂÚˆÓ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË ·fi ÙË ‰È¿ÁÓˆÛË ÛÔ‚·ÚÒÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ, ÙfiÛÔ ÂÍ·ÈÙ›·˜ Ù˘ ËÏÈΛ·˜ ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ fiÛÔ Î·È ÂÍ·ÈÙ›·˜ Ù˘ ·Ó¿Á΢ ¯Ú‹Û˘ ÂÎÙfi˜ Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ Î·È ÂÓfi˜ Û˘Ó‰˘·ÛÌÔ‡ ¿ÏÏˆÓ ÂȉÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÂÚÁ·Ï›ˆÓ Ì ˘„ËÏ‹ ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ·. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ·ÊÔÚÔ‡Ó ·È‰È¿ ËÏÈΛ·˜ ¤ÓÙ ÂÙÒÓ. √È Mikkola Î·È Û˘Ó (6) ÂÓÙfiÈÛ·Ó ÚÔ‚Ï‹Ì·Ù· ΢ڛˆ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈο, ÔÙÈÎÔ¯ˆÚÈο, ÏÂÎÙÈ΋˜ ÌÓ‹Ì˘,

¶›Ó·Î·˜ 2. ¶·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË ÛÙÔ˘˜ 18-24 Ì‹Ó˜ Î·È ¯·ÌËÏ¿ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙ· 4 ¯ÚfiÓÈ· Touwen test

Griffiths test

Miller test

µ·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (<100% ÂÈÙ˘¯›Â˜)

◊È· ÚÔ‚Ï‹Ì·Ù· (∏) ™Ô‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (™)

¶Èı·Ó‹ ∫·ı˘ÛÙ¤ÚËÛË (∫) ÃÚÂÈ¿˙ÂÙ·È ·Ú¤Ì‚·ÛË (¶)

∞ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi˜ ÙÔ̤·˜ ™Ù¿ÛË ÛÒÌ·ÙÔ˜

4 (19%)

πÛÔÚÚÔ›· ÎÔÚÌÔ‡

2 (9%)

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

4 (19%)

¢˘ÛÎÈÓËÛ›·

0 (0%)

∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·

7 (33%)

¶ÔÈfiÙËÙ· ÎÈÓ‹ÛˆÓ

0 (0%)

™˘ÁÎÈÓËۛ˜

6 (29%)

ŸÚ·ÛË

2 (9%)

2 (9%)

∫ÈÓËÙÈ΋ ·Ó¿Ù˘ÍË H 3 (15%) ™ 0 (0%) ¶ÚÔÛˆÈÎfiÙËÙ·/ÎÔÈÓˆÓÈÎfiÙËÙ· ∏ 2 (10%) ™ 0 (0%) ∞ÎÔ‹/ÏfiÁÔ˜ ∏ 1 (5%) ™ 0 (0%) √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ∏ 1 (5%) ™ 0 (0%) ¢ÂÍÈfiÙËÙ˜ ∏ 7 (37%) ™ 0 (0%) ¶Ú·ÎÙÈÎfi˜ Û˘ÏÏÔÁÈÛÌfi˜ ∏ 5 (25%) ™ 0 (0%) ™˘ÓÔÏÈÎfi ¶ËÏ›ÎÔ ∏ 3 (15%) ™ 0 (0%)

µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ∫ 6 (29%) ¶ 3 (14,3%) ™˘ÓÙÔÓÈÛÌfi˜ ∫ 10 (48%) ¶ 2 (9,5%) §ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ ∫ 10 (48%) ¶ 2 (9,5%) ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ ∫ 8 (38%) ¶ 0 ™˘Ó‰È·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ ∫ 1 (5%) ¶ 0 °ÂÓÈÎfi˜ ‰Â›ÎÙ˘ ∫ 7 (33%) ¶ 4 (19%)

¶·È‰È·ÙÚÈ΋ 2007;70:115-122

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·120

120

∂. ªÔ‡˙· Î·È Û˘Ó.

ÏfiÁÔ˘ Î·È ÚÔÛÔ¯‹˜. √È Hanke Î·È Û˘Ó (5) ÂÓÙfiÈÛ·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓÔËÌÔÛ‡Ó˘, ÛÙËÓ ·ÓÙ›ÏË„Ë ÙÔ˘ ÏfiÁÔ˘, ÛÙËÓ ÚÔÛÔ¯‹ ηıÒ˜ Î·È ÛÙËÓ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·. ∏ ÛËÌ·Û›· Ù˘ ÚÒÈÌ˘ ·Ú¤Ì‚·Û˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓÈÛ¯˘ıÔ‡Ó ÔÈ ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ Î·È ÔÈ ÁÓˆÛÙÈΤ˜ ÈηÓfiÙËÙ˜ ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÙÔÓ›˙ÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (15). ∂¿Ó Ô ÛÙfi¯Ô˜ Ù˘ ÂÎÙ›ÌËÛ˘ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Â›Ó·È Ë ¤ÁηÈÚË ·Ú¤Ì‚·ÛË ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ Û¯ÔÏ›Ԣ Ì ÛÎÔfi ÙË Ì›ˆÛË Ù˘ Èı·ÓfiÙËÙ·˜ ‹ Ù˘ ‚·Ú‡ÙËÙ·˜ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ, Ë ÂÎÙ›ÌËÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ÂӉ›ÎÓ˘Ù·È ·fiÏ˘Ù·. ◊È· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ·Ó·Ê¤ÚÔÓÙ·È Û ¤Ó· ÔÛÔÛÙfi 34-49% (13,16,17). ∆· ÔÛÔÛÙ¿ ‰È·Ê¤ÚÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔÓ ÏËı˘ÛÌfi Ô˘ ÌÂÏÂٿٷÈ, ÙÔÓ ÔÚÈÛÌfi Ù˘ ‚·Ú‡ÙËÙ·˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÙË ÌÂıÔ‰ÔÏÔÁ›·, Î·È Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·˘ÍË̤ӷ ÛÙ· ÓÂÔÁÓ¿ Ì µ°<1000 g. ∂›Ó·È ΢ڛˆ˜ ÚÔ‚Ï‹Ì·Ù· ÎÈÓËÙÈο, ·ÓÙÈÏËÙÈο Î·È ÁÓˆÛÙÈο (7). √ÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ÂÓÙÔ›˙Ô˘Ó ˆ˜ ·ÚÈÔ Úfi‚ÏËÌ· ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ (6,18). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ÂÓÙÔ›˙Ô˘Ó ÈÔ ÂÍÂȉÈÎÂ˘Ì¤Ó·, ÚÔ‚Ï‹Ì·Ù· ÔÙÈÎÔÎÈÓËÙÈο Î·È ÔÙÈÎÔ¯ˆÚÈο (19). ªÂÁ¿ÏÔ ÔÛÔÛÙfi ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ·, ΢ڛˆ˜ ÛÙ· ·È‰È¿ Ì µ°<1000 g, ¤ˆ˜ 81%(20), ÂÌÔ‰›˙Ô˘Ó ÙÔ ·È‰› ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹, ÛÙËÓ ·˘ÙÔÂ͢ËÚ¤ÙËÛË Î·È ÙÔ ·È¯Ó›‰È. √È Forslund ηÈ

Û˘Ó (21) ÂÚÈÁÚ¿ÊÔ˘Ó ¤Ó· Ó¢ÚÔÏÔÁÈÎfi ÚÔÊ›Ï ÛÙ· ÚfiˆÚ· ·È‰È¿ ÛÙ· Ù¤ÛÛÂÚ· ¤ÙË Ì ÌÈ· Û¯ÂÙÈ΋ ˘ÔÙÔÓ›· Î·È ‰˘ÛÎÔϛ˜ ÛÙËÓ ÈÛÔÚÚÔ›·, ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·. √È Fily Î·È Û˘Ó (22) ÛÙ· ÓÂÔÁÓ¿ Ì µ°<1500 g ‰Â›¯ÓÔ˘Ó ¤Ó· ÔÛÔÛÙfi ‹ÈˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ‰˘ÛÏÂÈÙÔ˘ÚÁÈÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· 28%, ÙÔ ÔÔ›Ô ·ÓȯÓ‡ÂÙ·È Î·È Ì ÙÔ Touwen test Î·È Ì ¤Ó· ·ÏÔÔÈË̤ÓÔ Touwen test Ì ÙËÓ ›‰È· ¢·ÈÛıËÛ›·, ÙÔ ÔÔ›Ô Ì¿ÏÈÛÙ· ÚÔÙ›ÓÔ˘Ó ˆ˜ ÈÔ Â‡¯ÚËÛÙÔ ÛÙ· Ï·›ÛÈ· ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘. √È Halsey Î·È Û˘Ó (23) ·Ó·Ê¤ÚÔ˘Ó Û ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÁÓˆÛÙÈΤ˜ ÈηÓfiÙËÙ˜ ‰˘Û·Ó¿ÏÔÁ· ¯·ÌËÏ‹ ‚·ıÌÔÏÔÁ›· Û ÙÔÌ›˜ fiˆ˜ Ô ÏfiÁÔ˜, Ë ·‰Ú‹ Î·È ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÔÈ ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì¿˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ Û˘ÓËı¤ÛÙÂÚÔ Úfi‚ÏËÌ· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ Î·È Û˘ÌʈÓÔ‡Ó Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜. ∆· ÚfiˆÚ· ·È‰È¿ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË Ì·˜ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο Û ¤Ó· ÔÏÔÎÏËڈ̤ÓÔ ÚfiÁÚ·ÌÌ· ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Î·È ·‰Úfi ¤ÏÂÁ¯Ô Ù˘ „˘¯ÔÎÈÓËÙÈ΋˜ ÂͤÏÈ͢ ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ ‰‡Ô ÂÙÒÓ. ∏ ÂÎÙ›ÌËÛË Ù˘ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÂͤÏÈ͢ ÛÙ· ‰‡Ô ¤ÙË ‰ÂÓ ÚÔ¤‚Ï„ ÌÂ

¶›Ó·Î·˜ 3. ¶·È‰È¿ Ô˘ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ›ÛÙ¢·Ó fiÙÈ ‰ÂÓ Â›¯·Ó Úfi‚ÏËÌ· ÛÙ· 4 ¯ÚfiÓÈ· Î·È ¯·ÌËÏ¿ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙ· 4 ¯ÚfiÓÈ· Touwen test

Griffiths test

Miller test

µ·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (<100% ÂÈÙ˘¯›Â˜)

◊È· ÚÔ‚Ï‹Ì·Ù· (∏) ™Ô‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (™)

¶Èı·Ó‹ ∫·ı˘ÛÙ¤ÚËÛË (∫) ÃÚÂÈ¿˙ÂÙ·È ·Ú¤Ì‚·ÛË (¶)

∞ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi˜

4 (19%)

™Ù¿ÛË ÛÒÌ·ÙÔ˜

7 (21%)

πÛÔÚÚÔ›· ÎÔÚÌÔ‡

3 (9%)

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛÂˆÓ ¢˘ÛÎÈÓËÛ›·

12 (37%) 1 (3%)

∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·

15 (47%)

¶ÔÈfiÙËÙ· ÎÈÓ‹ÛˆÓ

1 (3%)

™˘ÁÎÈÓËۛ˜ ŸÚ·ÛË

Paediatriki 2007;70:115-122

13 (41%) 2 (6%)

∫ÈÓËÙÈ΋ ·Ó¿Ù˘ÍË H 3 (9%) ™ 1 (3%) ¶ÚÔÛˆÈÎfiÙËÙ·/ÎÔÈÓˆÓÈÎfiÙËÙ· ∏ 1 (3%) ™ 0 (0%) ∞ÎÔ‹/ÏfiÁÔ˜ ∏ 3 (9%) ™ 0 (0%) √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ∏ 13 (41%) ™ 0 (0%) ¢ÂÍÈfiÙËÙ˜ ∏ 8 (24%) ™ 1 (3%) ¶Ú·ÎÙÈÎfi˜ Û˘ÏÏÔÁÈÛÌfi˜ ∏ 3 (9%) ™ 0 (0%) ™˘ÓÔÏÈÎfi ¶ËÏ›ÎÔ ∏ 1 (3%) ™ 0 (0%)

µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ∫ 11 (32%) ¶ 5 (15%) ™˘ÓÙÔÓÈÛÌfi˜ ∫ 15 (44%) ¶ 5 (15%) §ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ ∫ 11 (32%) ¶ 0 ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ ∫ 3 (9%) ¶ 0 ™˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ ∫ 10 (29%) ¶ 5 (15%) °ÂÓÈÎfi˜ ‰Â›ÎÙ˘ ∫ 15 (44%) ¶ 1 (3%)

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·121

121

¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÓÂÔÁÓÒÓ

·ÎÚ›‚ÂÈ· ÙËÓ ÂͤÏÈÍË ÛÙ· Ù¤ÛÛÂÚ· ¤ÙË, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∫¿ÔÈ· ·fi Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË Û‡Ìʈӷ Ì ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‰‡Ô ÂÙÒÓ, ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, ΢ڛˆ˜ ÛÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ̤·, ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· ÛÙÔ Touwen test, ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, Î·È ÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹ÙˆÓ ÛÙÔ Griffiths test Î·È ÛÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ Î·È ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ, ·ÏÏ¿ Î·È Û¯Â‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜ ÛÙÔ Miller test. ∏ ÚÒÙË ÂÌÊ¿ÓÈÛË ‹ÈˆÓ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ¤¯ÂÈ ‰È·ÈÛÙˆı› Î·È Û ¿ÏϘ ÌÂϤÙ˜. ™ÙË ÌÂϤÙË Ù˘ Mikkola Î·È Û˘Ó (6), ·fi Ù· ·È‰È¿ Ô˘ ÛÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓ¿ÌÈÛË ¤ÙÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÛÙËÓ ËÏÈΛ· ÙˆÓ ¤ÓÙ ÂÙÒÓ 1% ›¯Â ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Î·È 7% ‹È· ÚÔ‚Ï‹Ì·Ù·. ∫·È Û ¿ÏϘ ÌÂϤÙ˜, Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ì ‹È· ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ‹ ¤ÓÙ ÂÙÒÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ÙˆÓ 24 ÌËÓÒÓ (13,16). √È Goyen Î·È Û˘Ó (20) ·Ó·Ê¤ÚÔ˘Ó, Û ʷÈÓÔÌÂÓÈο ˘ÁÈ‹ ÚfiˆÚ· ÓÂÔÁÓ¿ µ°<1000 g Ô˘ ÂÎÙÈÌ‹ıËÎ·Ó Û ËÏÈΛ· 18 ÌËÓÒÓ, ÙÚÈÒÓ Î·È ¤ÓÙ ÂÙÒÓ, ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· (54% ¤ˆ˜ 64%), ÂÓÒ ·Ú·Ù‹ÚËÛ·Ó ·‡ÍËÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ·‰Ú‹˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÌÂٷ͇ Ù˘ ËÏÈΛ·˜ ÙˆÓ 18 ÌËÓÒÓ, ÙÚÈÒÓ ÂÙÒÓ Î·È ¤ÓÙ ÂÙÒÓ (·fi 14% Û 81%), Èı·ÓÒ˜ ÏfiÁˆ Ù˘ ÔÏ˘ÏÔÎfiÙËÙ·˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂÎÙ›ÌËÛ˘. ø˜ ·ÈÙ›· ·˘Ù‹˜ Ù˘ ‰È·ÊÔÚ¿˜ ÌÂٷ͇ ‰‡Ô Î·È ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Î·ıÒ˜ ÙÔ ·È‰› ÌÂÁ·ÏÒÓÂÈ, οÔȘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ Ô˘ ˘‹Ú¯·Ó Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ ÂÍÂÏ›ÛÛÔÓÙ·È. ∂›Û˘, ËÈfiÙÂÚ˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÂÌÊ·Ó›˙ÔÓÙ·È Î·ıÒ˜ ·˘Í¿ÓÔÓÙ·È ÔÈ ·Ó·Ù˘ÍȷΤ˜ ··ÈÙ‹ÛÂȘ. ∆¤ÏÔ˜, Ë ‰˘Ó·ÙfiÙËÙ· ¯Ú‹Û˘ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ Û‡ÓıÂÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Ì ÌÂÁ¿ÏË ‰È·ÁÓˆÛÙÈ΋ ‰˘Ó·ÙfiÙËÙ·, ·ÓȯÓ‡ÂÈ ‹Ș ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜. √È ÁÔÓ›˜ ‰›ÓÔ˘Ó ÌÈ· ÈÔ ·ÈÛÈfi‰ÔÍË ¿Ô„Ë Ù˘ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÂÈÎfiÓ·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Û ۯ¤ÛË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ·fi ÙȘ ‰ÔÎÈ̷ۛ˜ ·ÍÈÔÏfiÁËÛ˘. ŒÙÛÈ, ‰ÂÓ Î·Ù·ÓÔÔ‡Ó ÙËÓ ·Ó¿ÁÎË ¤ÎıÂÛ˘ Û ÂÚÂı›ÛÌ·Ù· ̤۷ ·fi ¤Ó· ÔÚÁ·ÓˆÌ¤ÓÔ ÂÎ·È‰Â˘ÙÈÎfi ÚfiÁÚ·ÌÌ· ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡, ·Ú¿ ÙȘ Û˘ÛÙ¿ÛÂȘ Ù˘ ÔÌ¿‰·˜ ÙˆÓ È·ÙÚÒÓ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™ÙË ÌÂϤÙË Ì·˜ ÌfiÓÔ 47,5% ÙˆÓ ·È‰ÈÒÓ ‹Á·ÈÓ·Ó ÛÙÔÓ ·È‰ÈÎfi ÛÙ·ıÌfi ‹ ÛÙÔ ÚÔÓ‹ÈÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ. ∞Èٛ˜ ‹Ù·Ó Ë ÂÔ›ıËÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ Î·Ï‹ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È Ë ‰Â‰Ô̤ÓË ˘ÂÚÚÔÛÙ·Û›· Ô˘ Û˘ÓÙÂÏÔ‡Ó ÛÙÔ Ó· ÚÔÙÈÌÔ‡Ó ÙÔ ÈÔ ÚÔÛÙ·ÙÂ˘Ì¤ÓÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡, ΢ڛˆ˜

·fi ÈÒÛÂȘ, ·ÓÙ› ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈ΋ ÂÎ·›‰Â˘ÛË. ∏ ÊÔ›ÙËÛË ÛÙÔÓ ·È‰ÈÎfi ÛÙ·ıÌfi Î·È ÙÔ ÓËÈ·ÁˆÁÂ›Ô ·›˙ÂÈ ÌÂÁ¿ÏÔ ÚfiÏÔ ÛÙËÓ ÂͤÏÈÍË ÙˆÓ ÚfiˆÚˆÓ ·È‰ÈÒÓ. ™ÙË ÌÂϤÙË ÙˆÓ Liebhardt Î·È Û˘Ó (18), Ù· ÚfiˆÚ· ·È‰È¿ Ô˘ ‹Á·ÈÓ·Ó ÛÙÔ ÚÔÓ‹ÈÔ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ›¯·Ó ηχÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ηχÙÂÚË ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È Î·Ï‡ÙÂÚË Û˘ÁΤÓÙÚˆÛË Î·È Û˘ÓÂÚÁ·Û›· Û ۯ¤ÛË Ì ÚfiˆÚ· Ô˘ ‰ÂÓ ‹Á·ÈÓ·Ó ÛÙÔ ÚÔÓ‹ÈÔ. ∆· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ·ÎfiÌË Î·È ·˘Ù¿ Ô˘ ÈÛÙ‡ÂÙ·È fiÙÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ·˘ÍË̤ÓÔ ÔÛÔÛÙfi Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ· (24-28). Œ¯ÂÈ ‚ÚÂı› οÔÈ· Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙË Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÈÎfiÓ· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Î·È ÛÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜ ÛÙÔ Û¯ÔÏÂ›Ô (23,21,29). √È Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÛÙ· ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· ·ÊÔÚÔ‡Ó ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ Ù˘ Ì¿ıËÛ˘. ∏ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› ·ÎÚÈ‚Ò˜, ·ÏÏ¿ ÈÛÙ‡ÂÙ·È fiÙÈ Û˘ÌÌÂÙ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÁÓˆÛÙÈΤ˜, ÔÙÈÎÔÎÈÓËÙÈΤ˜, ÔÙÈÎÔ¯ˆÚÈΤ˜, ÌÓ‹Ì˘, ÏÂÎÙÈΤ˜, Î·È ÂӉ¯Ô̤ӈ˜ ¿ÏϘ Ô˘ ÚÔ˜ ÙÔ ·ÚfiÓ Â›Ó·È ¿ÁÓˆÛÙ˜ (24). √ Marlow Î·È Û˘Ó Û˘Û¯ÂÙ›˙ÂÈ ‹Ș ÎÈÓËÙÈΤ˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜, ΢ڛˆ˜ ÛÙ· Ì·ıËÌ·ÙÈο (30). √ Sommerfelt (31) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ÚÔ‚Ï‹Ì·Ù· ÛÙÔÓ ÏfiÁÔ Î·ıÒ˜ Î·È ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ÛÙ· ÚfiˆÚ· ·È‰È¿ Â›Ó·È Úfi‰ÚÔÌ· Â˘Ú‹Ì·Ù· Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ¶·Ú¿ ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÔ‚·Ú¿ Î·È Î˘Ú›ˆ˜ ËÈfiÙÂÚ· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ·Ú·Ì¤ÓÂÈ ·˘ÍË̤ÓÔ. ∏ ÏÂÙÔÌÂÚ‹˜ ÂͤٷÛË Ì ‰ÔÌË̤Ó˜ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ·ÓȯÓ‡ÂÈ ‹Ș ‰È·Ù·Ú·¯¤˜ Ô˘ ‰ÂÓ Â›¯·Ó ‰È·ÈÛÙˆı› Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘. ™˘ÓÂÒ˜, Ù· ÚÔÁÚ¿ÌÌ·Ù· ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÚÔÒÚˆÓ ·È‰ÈÒÓ ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, Ù· ÔÔ›· Û˘Ó‹ıˆ˜ ÛÙ·Ì·ÙÔ‡Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ ‰‡Ô ÂÙÒÓ Ú¤ÂÈ Ó· ÂÎÙ›ÓÔÓÙ·È ¤ˆ˜ ÙËÓ ÚÔÛ¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Wilson-Costello D, Friedman H, Minich N, Fanaroff A∞, Hack M. Improved survival rates with increased neurodevelopmental disability for Extremely Low Birth Weight infants in the 1990s. Pediatrics 2005;115: 997-1003.

2. Hack M, Fanaroff A∞. Outcomes of children of extremely low birthweight and gestational age in the 1990’s. Early Hum Dev 1999;53:193-218. ¶·È‰È·ÙÚÈ΋ 2007;70:115-122

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3. Hack M, Wilson-Costello D, Friedman H, Taylor GË, Schluchter M, Fanaroff A∞. Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g. Arch |Pediatr Adolesc Med 2000;154:725-731.

4. Wood N™, Marlow N, Costeloe K, Gibson A∆, Wilkinson Aƒ. EPICure study group. Neurologic and developmental disability after extremely preterm birth. N Engl J Med. 2000;343:378-384.

5. Hanke C, Lohaus A, Gawrilow C, Hartke I, Kohler B, Leonhardt A. Preschool development of very low birth weight children born 1994-1995. Eur J Pediatr 2003;162: 159-164.

6. Mikkola K, Ritari N, Tommiska V, Salokorpi T, Lehtonen L, Tammela O, et al. Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-1997. Pediatrics 2005;116: 1391-1400.

7. Torrioli MG, Frisone MF, Bonvini L, Luciano R, Pasca MG, Lepori R, et al. Perceptual-motor, visual and cognitive ability in very low birthweight preschool children without neonatal ultrasound abnormalities. Brain Dev 2000;22:163-168.

8. Haataja L, Mercuri E, Regev R, Cowan F, Rutherford M, Dubowitz V, et al. Optimality score for the neurologic examination of the infant at 12 and 18 months of age. J Pediatr 1999;135:153-161.

9. Touwen BCL. Examination of the child with minor neurologic dysfunction. Clinics in Developmental Medicine, No 71. 2nd edition. London: Mac Keith Press; 1979.

10. Griffiths R. The abilities of Young Children. Amersham: Association for Research in Infant and Child Development. 1971.

11. Miller LJ. Miller Assessment for Preschoolers. The Psychological Corporation. San Antonio, TX, USA; Harcourt Brace Jovanovitch, Inc.: 1988.

12. McCormick MC. The outcomes of very low birth weight infants: are we asking the right question? Pediatrics 1997; 99:869-876.

13. Fazzi E, Orcesi S, Telesta C, Ometto A, Rondini G, Lanzi G. Neurodevelopmental outcome in very low birth weight infants at 24 months and 5 to 7 years of age: changing diagnosis. Pediatr Neurol 1997;17:240-248.

14. Crowe TK, Deitz JC, Bennett FC, Tekolste K. Preschool motor skills of children born prematurely and not diagnosed as having cerebral palsy. Dev Behav Pediatr 1988; 9:189-193.

15. Brooks-Gunn J, Liaw F, Klebanov PK. Effects of early intervention on cognitive function of low birth weight preterm infants. J Pediatr 1992;120:350-359.

16. Salokorpi T, Rautio T, Sajaniemi N, Serenius-Sirve S, Tuomi H, von Wendt L. Neurological development up to the age of four years of extremely low birthweight infants born in Southern Finland in 1991-94. Acta Paediatr 2001;90(2): 218-221.

Paediatriki 2007;70:115-122

17. Msall ME, Rogers BT, Buck GM, Mallen S, Catanzaro NL, Duffy LC. Functional status of extremely preterm infants at kindergarten entry. Dev Med Child Neurol 1993;35:312-320.

18. Liebhardt G, Sontheimer D, Linderkamp O. Visual-motor function of very low birth weight and full-term children at 3ó to 4 years of age. Earl Hum Dev 2000;57:33-47.

19. Pasman JW, Rotteveel JJ, Maassen B. Neurodevelopmental profile in low-risk preterm infants at 5 years of age. Eur J Paediatr Neurol 1998;2:7-17.

20. Goyen TA, Lui K. Longitudinal motor development of “apparently normal” high-risk infants at 18 months, 3 and 5 years. Early Hum Dev 2002;70:103-115.

21. Forslund M, Bjerre I. Follow-up of preterm children. I. Neurological assessment at 4 years of age. Early Hum Dev 1989;20:45-66.

22. Fily A, Truffert P, Ego A, Depoortere MH, Haquin C, Pierrat V. Neurological assessment at five years of age in infants born preterm. Acta Paediatr 2003;92:1433-1437.

23. Halsey CL, Collin MF, Anderson CL. Extremely low birth weight children and their peers: a comparison of preschool performance. Pediatrics 1993;91:807-811.

24. Grunau RE, Whitfield MF, Davis C. Pattern of learning disabilities in children with extremely low birth weight and broadly average intelligence. Arch Pediatr Adolesc Med 2002;156:615-620.

25. Saigal S, Szatmari P, Rosenbaum P, Campbell D, King S. Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: a regional study. J Pediatr 1991;118: 751-760.

26. Saigal S, Hoult LA, Streiner DL, Stoskopf BL, Rosenbaum PL. School difficulties at adolescence in a regional cohort of children who were extremely low birth weight. Pediatrics 2000;105:325-331.

27. Marlow N, Wolke D, Bracewell MA, Samara M.EPICure Study. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352:9-19.

28. Marlow N. Neurocognitive outcome after very preterm birth. Arch Dis Child Fetal Neonat Ed 2004;89:F224-F228.

29. Hansen BM, Dinesen J, Hoff B, Greisen G. Intelligence in preterm children at four years of age as a predictor of school function: a longitudinal controlled study. Dev Med Child Neurol 2002;44:517-521.

30. Marlow N, Roberts L, Cooke R. Outcome at 8 years for children with birth weights of 1250gr or less. Arch Dis Child 1993;68:286-290.

31. Sommerfelt K. Long term outcome for non-handicapped low birth weight infants - is the fog clearing? Eur J Pediatr 1998;157:1-3

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∫·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Û ·È‰È¿ Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·: ¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ· ·ÔÙÂϤÛÌ·Ù· π. ¶··ÁÈ¿ÓÓ˘1, °. ∫˘Ú‚·Û›Ï˘2, π. ™ÔÊÈ·Ó›‰Ô˘2, ∫. §¿ÛηÚË1, ª. ∫È¿ÊÊ·1, ™. ∞ÔÛÙÔÏÔÔ‡ÏÔ˘1, ™. ƒ¿ÌÌÔ˜1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ˘ÂÚÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ ÛÙ· ·È‰È¿ Â›Ó·È ¤Ó· ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ (¶¢). §fiÁˆ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ, Ë ¯ÚfiÓÈ· ‹ ‰È¿ ‚›Ô˘ ·ÓÙÈ·ÚÚ˘ıÌÈ΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È È‰Â҉˘ χÛË. ∏ Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÚÈ˙È΋ ıÂÚ·›·. ∏ ÌÂϤÙË ·˘Ù‹ ›¯Â ˆ˜ ÛÎÔfi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ¿ÌÂÛˆÓ Î·È Ì·ÎÚÔÚfiıÂÛÌˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·Ù¿Ï˘Û˘ ¶¢ ÛÙ· ·È‰È¿ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÍÂÙ¿ÛÙËÎ·Ó ·Ó·‰ÚÔÌÈο Ù· ÛÙÔȯ›· 94 ·È‰ÈÒÓ, ËÏÈΛ·˜ 4-18 (12,3±3,6) ÂÙÒÓ, Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û Ï‹ÚË ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È Î·Ù¿Ï˘ÛË ¶¢. √È ÂӉ›ÍÂȘ Î·Ù¿Ï˘Û˘ ÂÚÈÂÏ¿Ì‚·Ó·Ó: ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (78), Û˘ÁÎÔ‹ (9), Ù·¯Â›· ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ Ì ηډÈÔÁÂÓ¤˜ shock (2) Î·È ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ‚Ú·¯Â›· ÔÚıfi‰ÚÔÌË ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô ÙÔ˘ ¶¢ (5). ∞ÔÙÂϤÛÌ·Ù·: ∏ ÙÂÏÈ΋ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘ ¶¢ ÌÂÙ¿ ·fi Ù˘¯fiÓ ˘ÔÙÚÔ¤˜, ‹Ù·Ó 96%. ™Â ·ÛıÂÓ›˜ Ì ÚfiÛıÈ·/‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο ¶¢ ·Ú·ÙËÚ‹ıËΠ˘„ËÏfiÙÂÚÔ˜ ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘ (p=0,05) Î·È ¯·ÌËÏfiÙÂÚË ÙÂÏÈ΋ ÂÈÙ˘¯›· (p=0,02). √È ˘fiÏÔÈ˜ ηÙËÁÔڛ˜ ›¯·Ó ·ÚfiÌÔÈ· ÌÂٷ͇ ÙÔ˘˜ ·ÔÙÂϤÛÌ·Ù·. ∆· ‰ÂÍÈ¿ Ï¿ÁÈ· ¶¢ ›¯·Ó ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (p<0,001). √È ˘ÔÙÚÔ¤˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚ˜ Û ·ÛıÂÓ›˜ Ì ÔÏÏ·Ï¿ ¶¢ (p=0,007). ¶·Ú·ÙËÚ‹ıËΠÌfiÓÔ Ì›· ¯ÚfiÓÈ· ÂÈÏÔ΋ (·ÓÂ¿ÚÎÂÈ· ·ÔÚÙ‹˜ ÌÂÙ¿ ·fi Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ Ì ‰È·ÔÚÙÈ΋ Ù¯ÓÈ΋). ¶·ÚÔ‰ÈΤ˜ ÂÈÏÔΤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Û 3 ·ÛıÂÓ›˜ (ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ Û 2 Î·È ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹ Û 1). ∏ ÙÂÏÈ΋ ÂÈÙ˘¯›· Ù˘ Â¤Ì‚·Û˘ Î·È Ù· ÔÛÔÛÙ¿ ˘ÔÙÚÔÒÓ Î·È ÂÈÏÔÎÒÓ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙ· Ù˘ ËÏÈΛ·˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Î·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÚÈ˙È΋ ıÂÚ·›· Ì ˘„ËÏ¿ ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ Î·È ¯·ÌËÏfi ΛӉ˘ÓÔ ÂÈÏÔÎÒÓ, ¯ˆÚ›˜ ‰È·ÊÔÚ¤˜ ÛÙ· ·ÔÙÂϤÛÌ·Ù· Û ËÏÈ˘ ¿Óˆ ÙˆÓ 4 ÂÙÒÓ.

1 ¶·È‰ÔηډÈÔÏÔÁÈÎfi ∆Ì‹Ì·, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ, ∞ı‹Ó· 2 ¶·È‰Ô·Ó·ÈÛıËÛÈÔÏÔÁÈÎfi ∆Ì‹Ì·, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ˘ ¶··ÁÈ¿ÓÓ˘ papagi@otenet.gr øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ §. ™˘ÁÁÚÔ‡ 356, ∆.∫. 176 74, ∫·ÏÏÈı¤·

§¤ÍÂȘ ÎÏÂȉȿ: ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ, Î·Ù¿Ï˘ÛË, Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜.

Radiofrequency catheter ablation of accessory pathways in children: immediate and long-term results J. Papagiannis1, G. Kirvassilis2, I. Sofianidou2, C. Laskari1, M. Kiaffas1, S. Apostolopoulou1, S. Rammos1 Abstract Background: The most common cause of supraventricular tachycardia in children is an accessory pathway (AP). Because of the chronic course, long-term treatment with antiarrhythmic drugs is not an ideal solution. Radiofrequency ablation (RFA) may offer curative treatment. The purpose of this study was to analyze the immediate and long-term outcome of radiofrequency ablation of accessory pathways in children.

Methods: The charts were reviewed retrospectively of 94 children aged 4-18 (12.3±3.6) years who had undergone complete electrophysiologic study and radiofrequency ablation of AP. The indications for ablation were: supraventricular tachycardia (78), syncope (9), rapidly occurring atrial fibrillation with cardiogenic shock (2) and asymptomatic patients with a short antegrade accessory pathway refractory period (5).

Results: The final success rate of AP ablation, after possible recurrences, was 96%. Longer fluoroscopy time (p=0.05) and a lower final success rate (p=0.02) were observed in patients with anterior/mid-septal AP. The other categories had comparably favourable results. Patients with right lateral AP had a higher prevalence of congenital heart disease (p<0.001). Recurrences were more frequent in patients with multiple AP (p=0.007). There was only one permanent complication, a patient who had aortic insufficiency after retrograde transaortic ablation of left lateral AP). Transient complications were observed in 3 patients (temporary atrioventricular block in 2 and pericardial effusion in one). The final success, recurrence rates and complication rates were independent of age.

1 Paediatric Cardiology Department, Onassis Cardiac Surgery Center, Athens 2 Paediatric Anaesthesiology Department, Onassis Cardiac Surgery Center, Athens Correspondence: John Papagiannis papagi@otenet.gr Onassis Cardiac Surgery Center 356, Sygrou Ave. 176 74, Kallithea, Athens

¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·124

124

π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Conclusions: Radiofrequency catheter ablation of accessory pathways in children may offer a permanent cure, with high success and low complication rates and without differences in outcome in patients above 4 years of age.

Key words: Supraventricular tachycardia, accessory pathway, radiofrequency ablation.

™˘ÓÙÔÌÔÁڷʛ˜ À∆ ¶¢ ƒƒ ∏ºª ™∫

ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· ¶·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ ƒÂ‡Ì· Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ∏ÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·

∂ÈÛ·ÁˆÁ‹ ∏ ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (À∆) ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÓÔ¯ÏËÙÈο Û˘ÌÙÒÌ·Ù·, ÂÈÛΤ„ÂȘ Û ÙÌ‹Ì·Ù· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ·ÔÎÏÂÈÛÌfi ·fi ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ¿Á¯Ô˜, ÂÓÒ - Û·ÓÈfiÙÂÚ· - ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ Î›Ó‰˘ÓÔ ÁÈ· ÙË ˙ˆ‹. ∏ Û˘¯ÓfiÙËÙ· Ù˘ À∆ ÛÙ· ·È‰È¿ ÂÎÙÈÌ¿Ù·È fiÙÈ Â›Ó·È ÂÚ›Ô˘ 1:250 ·È‰È¿ (1). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· À∆ ÛÙ· ·È‰È¿ Â›Ó·È ¤Ó· ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ (¶¢), Ô˘ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÙ·È Ì ÙË ÌÔÚÊ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Wolff-ParkinsonWhite (‰ËÏ·‰‹ ‚Ú·¯‡ ‰È¿ÛÙËÌ· PR Î·È Î‡Ì· ‰ ÛÙÔ ∏∫°) fiÙ·Ó ¤¯ÂÈ ÔÚıfi‰ÚÔÌË ·ÁˆÁ‹ ‹ Ó· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° ËÚÂÌ›·˜ fiÙ·Ó ‰ÂÓ ¤¯ÂÈ ÔÚıfi‰ÚÔÌË ·ÁˆÁ‹. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Û‡Ó‰ÚÔÌÔ Wolff-Parkinson-White, ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ÙfiÛÔ Û ÂÓ‹ÏÈΘ fiÛÔ Î·È Û ·È‰È¿, Ô˘ ‰Â›¯ÓÔ˘Ó Ì›· Û˘¯ÓfiÙËÙ· ·fi 1,48ò (2) ¤ˆ˜ 3ò (3). ∏ ıÂÚ·›· Ù˘ À∆ Ì ʿÚ̷η ÌÔÚ› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ·ÚÂÓ¤ÚÁÂȘ ‹ Ó· ÌËÓ Â›Ó·È Ï‹Úˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋. ∞ÎfiÌË Î·È fiÙ·Ó Â›Ó·È ÂÈÙ˘¯‹˜, ‰ÂÓ ·ÔÙÂÏ› ȉÂÒ‰Ë Ï‡ÛË, ÏfiÁˆ Ù˘ ·Ó¿Á΢ ÁÈ· Ì·ÎÚÔ¯ÚfiÓÈ· Û˘Ó¤¯ÈÛ‹ Ù˘ Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ·ÎfiÌË ÔÏϤ˜ ‰ÂηÂٛ˜ ÂÓÂÚÁÔ‡ ˙ˆ‹˜. ∏ ıÂÚ·›· ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ¯ÔÚ‹ÁËÛ˘ Ú‡̷ÙÔ˜ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ (ƒƒ) ̤ۈ ηıÂÙ‹Ú·, ¤¯ÂÈ ·Ó·Ù˘¯ı› Ú·Á‰·›· Ù· ÙÂÏÂ˘Ù·›· 15 ¯ÚfiÓÈ· Î·È ¤¯ÂÈ Î·Ù·Ï¿‚ÂÈ ÚˆÙÂ‡Ô˘Û· ı¤ÛË (5-11). ∏ ̤ıÔ‰Ô˜ Û˘Ó›ÛÙ·Ù·È Û ÂÊ·ÚÌÔÁ‹ Ú‡̷ÙÔ˜ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ̤ۈ ÂÓfi˜ ËÏÂÎÙÚÔ‰›Ô˘-ηıÂÙ‹Ú· ÛÙÔ ÌÔÚÊÔÏÔÁÈÎfi ˘fiÛÙڈ̷ Ù˘ ·ÚÚ˘ıÌ›·˜ (fiˆ˜ .¯. ¤Ó· ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ), Ì Â·ÎfiÏÔ˘ıË ÚfiÎÏËÛË ÈÛÙÈ΋˜ ı¤ÚÌ·ÓÛ˘ Î·È ÙÔÈ΋˜ Ó¤ÎÚˆÛ˘. °È· Ó· ÂÓÙÔÈÛÙ› Ë ı¤ÛË ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ Ù˘ ·ÚÚ˘ıÌ›·˜, ÂÎÙÂÏÂ›Ù·È ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ¯·ÚÙÔÁÚ¿ÊËÛË. ∞Ó Î·È Ë Paediatriki 2007;70:123-134

ÂÂÌ‚·ÙÈ΋ ıÂÚ·›· Á›ÓÂÙ·È Â‡ÎÔÏ· ·Ô‰ÂÎÙ‹ Û ÂÓ‹ÏÈΘ, Û˘¯Ó¿ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ÛÎÂÙÈÎÈÛÌfi fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜. √ Êfi‚Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· Èı·Ó¤˜ ÂÈÏÔΤ˜ Î·È Û˘¯Ó¿ Ë ÂÏÏÈ‹˜ ÂÓË̤ڈÛË ÙˆÓ ıÂÚ·fiÓÙˆÓ È·ÙÚÒÓ Ô˘ ·Ú¤¯Ô˘Ó ÙËÓ ÚˆÙÔÁÂÓ‹ ÊÚÔÓÙ›‰· ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ ·ÔÙÂÏÔ‡Ó ·Ó·ÛÙ·ÏÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ Â˘Ú‡ÙÂÚË ÂÊ·ÚÌÔÁ‹ ·˘Ù‹˜ Ù˘ ıÂÚ·›·˜ ÛÙ· ·È‰È¿. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÂÈÚ›· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙËÓ Î·Ù¿Ï˘ÛË ¶¢ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÛÙ· ·È‰È¿.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ 94 ·ÛıÂÓ›˜ (37 ÎÔÚ›ÙÛÈ·, 57 ·ÁfiÚÈ·) Ì ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ (¶¢), Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË (∏ºª) Î·È Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÛÙÔ øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ, ηٿ ÙËÓ ÂÚ›Ô‰Ô 01/07/1994 ¤ˆ˜ 30/06/2003. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ·fi 4 ¤ˆ˜ 18 ¤ÙË (̤ÛË: 12,3±3,6, ‰È¿ÌÂÛË: 12). √È ÂӉ›ÍÂȘ Î·Ù¿Ï˘Û˘ ÂÚÈÂÏ¿Ì‚·Ó·Ó: ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (78 ·ÛıÂÓ›˜), Û˘ÁÎÔ‹ (9 ·ÛıÂÓ›˜), ÂÂÈÛfi‰È· Ù·¯Â›·˜ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Ì ηډÈÔÁÂÓ¤˜ shock (2 ·ÛıÂÓ›˜) Î·È ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ‚Ú·¯Â›· ÔÚıfi‰ÚÔÌË ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô ÙÔ˘ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ (<250 msec) (5 ·ÛıÂÓ›˜). ∏ ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÙ¿ ÙËÓ Î·Ù¿Ï˘ÛË ‹Ù·Ó ·fi 2 ¤ˆ˜ 11 ¤ÙË (‰È¿ÌÂÛË: 5). ¢ÂÓ ÂÚÈÂÏ‹ÊıËÛ·Ó ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Î·Ù¿Ï˘ÛË Ù· ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘¿Ú¯ÂÈ ÈηÓfi˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘. ¶ÚÈÓ ·fi ÙËÓ ÂÎÙ¤ÏÂÛË Ù˘ ∏ºª Î·È ÙË ‰ÈÂÓ¤ÚÁÂÈ· Î·Ù¿Ï˘Û˘, Ï·Ì‚·ÓfiÙ·Ó ÁÚ·Ù‹ ‰‹ÏˆÛË Û˘ÁηٿıÂÛ˘ ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·ÛıÂÓÒÓ, ÌÂÙ¿ ·fi ÏÂÙÔÌÂÚ‹ ÂÂÍ‹ÁËÛË ÙˆÓ ÔÛÔÛÙÒÓ ÂÈÙ˘¯›·˜ Î·È ÙˆÓ Èı·ÓÒÓ ÂÈÏÔÎÒÓ. √È ·ÛıÂÓ›˜ ˘Ô‚¿ÏÏÔÓÙ·Ó Û Ï‹ÚË ∏ºª Î·È Î·Ù¿Ï˘ÛË ÙÔ˘ ·ÚÚ˘ıÌÈÔÁfiÓÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜, ›Ù ˘fi ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›· ›Ù ˘fi ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Î·È Î·Ù·ÛÙÔÏ‹ Ì ÂÓ‰ÔÊϤ‚È· ËÚÂÌÈÛÙÈο Î·È ·Ó·ÏÁËÙÈο. ∏ ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›· ÚÔÙÈÌ‹ıËΠÛÙ· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ÂÙÒÓ, ·ÏÏ¿ Î·È Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ fiÙ·Ó ‹Ù·Ó Ë ÂÈı˘Ì›· ÙÔ˘ ·ÛıÂÓÔ‡˜. ™Ù· ˘fiÏÔÈ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ¯ÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· ηٷÛÙÔÏ‹ Ì Ìȉ·˙ÔÏ¿ÌË Î·È Âıȉ›ÓË ‹ ÌÔÚÊ›ÓË Î·È ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Ì ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË Í˘ÏÔη˝Ó˘ 1% ÛÙȘ ÂÚÈÔ¯¤˜ ·Ú·Î¤ÓÙËÛ˘. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ÔÚËÁÔ‡ÓÙ·Ó ÚÔÏËÙÈ΋ ·ÓÙÈ‚›ˆÛË (1 ‰fiÛË ÎÂÊ·ÏÔı›Ó˘ ÂÓ‰ÔÊϤ‚È· ‹ - Û ·ÏÏÂÚÁÈο ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ¿ÙÔÌ· - 1 ‰fiÛË ‚·ÓÎÔÌ˘Î›Ó˘) ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ Î·ıÂÙ‹ÚˆÓ.

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·125

125

∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

∏ ÂÈÛ·ÁˆÁ‹ ÙˆÓ Î·ıÂÙ‹ÚˆÓ-ËÏÂÎÙÚÔ‰›ˆÓ ÁÈÓfiÙ·Ó ‰È·‰ÂÚÌÈο ÌÂÙ¿ ·fi ·ÔÛÙ›ڈÛË ÙˆÓ ÂÚÈÔ¯ÒÓ ·Ú·Î¤ÓÙËÛ˘ (ÌËÚÈ·›Â˜ ¯ÒÚ˜ ± ÛÊ·Á›Ùȉ˜ ‹ ˘ÔÎÏ›‰È˜ ÂÚÈÔ¯¤˜). ∆ÔÔıÂÙÔ‡ÓÙ·Ó Î·ıÂÙ‹Ú˜ (Ì 4-10 ËÏÂÎÙÚfi‰È·) ‰È·Ì¤ÙÚÔ˘ 4-7 Fr. √È Î·ıÂÙ‹Ú˜ ÙÔÔıÂÙÔ‡ÓÙ·Ó ÛÙȘ Û˘Ó‹ıÂȘ ı¤ÛÂȘ (˘„ËÏfi˜ ‰ÂÍÈfi˜ ÎfiÏÔ˜ ‹ ˆÙ›Ô ‰ÂÍÈÔ‡ ÎfiÏÔ˘ ÁÈ· ηٷÁÚ·Ê‹ ÎÔÏÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË, ‰·ÎÙ‡ÏÈÔ˜ ÙÚÈÁÏÒ¯ÈÓÔ˜ ÁÈ· ηٷÁÚ·Ê‹ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÙÔ˘ ‰ÂÌ·Ù›Ô˘ ÙÔ˘ His, ÛÙÂÊ·ÓÈ·›Ô˜ ÎfiÏÔ˜ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÈÙÚÔÂȉÈÎÔ‡ ‰·ÎÙ˘Ï›Ô˘-·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Î·È ÎÔÚ˘Ê‹ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ÁÈ· ηٷÁÚ·Ê‹ Ù˘ ÎÔÈÏȷ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÎÔÈÏȷ΋ ‚ËÌ·ÙÔ‰fiÙËÛË). ∏ÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ∏ ‚·ÛÈ΋ ∏ºª ¿Ú¯È˙ Ì ÙË Ì¤ÙÚËÛË ÙˆÓ ‚·ÛÈÎÒÓ ‰È·ÛÙËÌ¿ÙˆÓ (ÌÂÙÚ‹ÛÂȘ ÙˆÓ ‰È·ÛÙËÌ¿ÙˆÓ PR, QRS, QT, RR ·fi ÙÔ ∏∫° ÂÈÊ·Ó›·˜, ηıÒ˜ Î·È ÙˆÓ ‰È·ÛÙËÌ¿ÙˆÓ PA, AH Î·È HV ·fi Ù· ÂÓ‰Ôηډȷο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù·). ∞ÎÔÏÔ˘ıÔ‡Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÎÔÏÈ΋ ‰È¤ÁÂÚÛË Ì ÎÔÏÈο ÚÒÈÌ· ÂÚÂı›ÛÌ·Ù· Î·È ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÌÂ Û˘Ó¯Ҙ ÌÂÈÔ‡ÌÂÓÔ Ì‹ÎÔ˜ ·ÎÏÔ˘ (decremental atrial pacing). ∂›Û˘, Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·Ó ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË Î·Ù¿ ÚÈ¤˜ (burst atrial pacing) Ì ÛÎÔfi ÙËÓ ÚfiÎÏËÛË Ù·¯˘Î·Ú‰ÈÒÓ, Û ÂÚ›ÙˆÛË Ô˘ ·˘Ù¤˜ ‰ÂÓ ÚÔηÏÔ‡ÓÙ·Ó Ì ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈÓfiÙ·Ó ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·ÓÂÚ¤ıÈÛÙ˘ ÂÚÈfi‰Ô˘ ÙÔ˘ ¶¢. À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó Ù· ¶¢ Ì ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô <250 msec. ∞ÎÔÏÔ‡ıˆ˜ ÁÈÓfiÙ·Ó ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÎÔÈÏȷ΋ ‚ËÌ·ÙÔ‰fiÙËÛË Ì ÚÒÈÌ· ÎÔÈÏȷο ÂÚÂı›ÛÌ·Ù· Ì ‰È·ÚÎÒ˜ ÌÂÈÔ‡ÌÂÓÔ Û˘˙¢ÎÙÈÎfi ‰È¿ÛÙËÌ· Î·È ÎÔÈÏȷ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÌÂ Û˘Ó¯Ҙ ÌÂÈÔ‡ÌÂÓÔ Ì‹ÎÔ˜ ·ÎÏÔ˘ (decremental ventricular pacing). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÔÈÏȷ΋˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘ ‹ Ù˘ Ù·¯˘Î·Ú‰›·˜, ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈÓfiÙ·Ó ÛÙËÓ ·ÏÏËÏÔ˘¯›· Ù˘ ·Ï›Ó‰ÚÔÌ˘ ÎÔÏÈ΋˜ ÂÎfiψÛ˘, Â¿Ó ‰ËÏ·‰‹ ·˘Ù‹ ·ÎÔÏÔ˘ıÔ‡Û ÎÂÓÙÚÈ΋ ÔÚ›· ̤ۈ ÙÔ˘ ‰ÂÌ·Ù›Ô˘ ÙÔ˘ His ‹ ¤ÎÎÂÓÙÚË, ̤ۈ ÂÓfi˜ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ (∂ÈÎfiÓ· 1). ™Â ÂÚ›ÙˆÛË Ô˘ Ë Ù·¯˘Î·Ú‰›· ‰ÂÓ ‹Ù·Ó ÚÔ-

ÎÏËÙ‹ ηٿ ÙË ‚·ÛÈ΋ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË, ¯ÔÚËÁÔ‡ÓÙ·Ó ÈÛÔÚÔÙÂÚÂÓfiÏË ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË Ì 0,01 mcg/kg/min ·Ú¯Èο Î·È ·˘Í·ÓfiÌÂÓË Ì¤¯ÚȘ fiÙÔ˘ ·Ú·ÙËÚËı› Ì›ˆÛË ÙÔ˘ ‚·ÛÈÎÔ‡ Ì‹ÎÔ˘˜ ·ÎÏÔ˘ (·‡ÍËÛË Ù˘ ‚·ÛÈ΋˜ Û˘¯ÓfiÙËÙ·˜) ηٿ 25-30%. ∫·ÙfiÈÓ, ·ÎÔÏÔ˘ıÔ‡Û Â·Ó·ÏËÙÈ΋ ∏ºª ˘fi ¯ÔÚ‹ÁËÛË ÈÛÔÚÔÙÂÚÂÓfiÏ˘. ∫·Ù¿Ï˘ÛË ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ∏ºª Î·È ÂÊfiÛÔÓ ·ÔÊ·ÛÈ˙fiÙ·Ó Ë ÂÚ·ÈÙ¤Úˆ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë ¯·ÚÙÔÁÚ¿ÊËÛË ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·È Ë Î·Ù¿Ï˘Û‹ ÙÔ˘˜. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ÂÈÛ¿ÁÔÓÙ·Ó Ô ÂȉÈÎfi˜ ηıÂÙ‹Ú·˜ Î·Ù¿Ï˘Û˘, ‰È·Ì¤ÙÚÔ˘ 5-7 Fr (·Ó¿ÏÔÁ· Ì ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜). ∏ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ηıÂÙ‹Ú· ¯·ÚÙÔÁÚ¿ÊËÛ˘-Î·Ù¿Ï˘Û˘ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÁÈÓfiÙ·Ó ·fi ÙË ÌËÚÈ·›· ÊϤ‚·. ™Â ·ÛıÂÓ›˜ Ì ·ÚÈÛÙÂÚ¿ ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·, Ë ÚfiÛ‚·ÛË ÁÈÓfiÙ·Ó Â›Ù ·Ï›Ó‰ÚÔÌ· ‰È·Ì¤ÛÔ˘ Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ (∂ÈÎfiÓ· 2), ›Ù Ì ÙË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ (transseptal) Ù¯ÓÈ΋ (∂ÈÎfiÓ· 3). ∏ ¯ÔÚ‹ÁËÛË Ú‡̷ÙÔ˜ ÁÈÓfiÙ·Ó ·fi Ì›· Û˘Û΢‹ Ô˘ ›¯Â ÙË ‰˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ˘ Û˘Ó¯ԇ˜ ËÌÈÙÔÓÔÂȉԇ˜ ÌË ÙÚÔÔÔÈË̤ÓÔ˘ ·̷ÙÔ˜, Ì ̤ÁÈÛÙË ÈÛ¯‡ 50 Watts, Ì ‰˘Ó·ÙfiÙËÙ· Û˘Ó¯ԇ˜ ÂϤÁ¯Ô˘ Î·È ·˘ÙfiÌ·Ù˘ ·Ó·ÚÔÛ·ÚÌÔÁ‹˜ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ÈÛ¯‡Ô˜ ·Ó¿ÏÔÁ· Ì ÙË ÌÂÙÚÔ‡ÌÂÓË ıÂÚÌÔÎÚ·Û›· ÛÙÔ ¿ÎÚÔ ÙÔ˘ ηıÂÙ‹Ú·. ∏ ÂÓ¤ÚÁÂÈ· ¯ÔÚËÁ›ÙÔ ÌÂٷ͇ ÙÔ˘ ÙÂÏÈÎÔ‡ ËÏÂÎÙÚÔ‰›Ô˘ ÙÔ˘ ηıÂÙ‹Ú· Î·È ÂÓfi˜ ËÏÂÎÙÚÔ‰›Ô˘-Ͽη˜ Ô˘ ÙÔÔıÂÙ›ÙÔ ÛÙËÓ Ï¿ÙË ‹ ÛÙÔÓ ÌËÚfi ÙÔ˘ ·ÛıÂÓÔ‡˜. ∏ ıÂÚÌÔÎÚ·Û›·-ÛÙfi¯Ô˜ ÁÈ· Ù· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ‹Ù·Ó 6070ÔC (ÂÎÙfi˜ ·fi Ù· ÚfiÛıÈ· ‹ ‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο, ÔfiÙÂ Ë Ì¤ÁÈÛÙË ıÂÚÌÔÎÚ·Û›· ‹Ù·Ó 50-55ÔC). ∏ ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ Ú‡̷ÙÔ˜ ‹Ù·Ó 30-60 sec. ™ÙȘ ÂÚÈÙÒÛÂȘ ÂÈÙ˘¯Ô‡˜ ‚Ï¿‚˘, ¯ÔÚËÁÔ‡ÓÙ·Ó Û˘¯Ó¿ Ì›· ÂÈϤÔÓ Û˘Ó‰ڛ· (bonus) ÁÈ· ÔÚÈÛÙÈÎÔÔ›ËÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜. ∏ Î·Ù¿Ï˘ÛË Î·ıÔ‰ËÁ›ÙÔ Â›Ù Ì ÙËÓ ·Ó‡ÚÂÛË Ù˘ ÚˆÈÌfiÙÂÚ˘ ·Ï›Ó‰ÚÔÌ˘ ÎÔÏÈ΋˜ ÂÎfiψÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ù·¯˘Î·Ú‰›·˜ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÎÔÈÏȷ΋˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘, ›Ù Ì ÙËÓ ·Ó‡ÚÂÛË Ù˘ ÚˆÈÌfiÙÂÚ˘ ÎÔÈÏȷ΋˜ ÂÎfiψÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ ‹ ÎÔÏÈ΋˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘. ªÂÙ¿ ÙËÓ ÂÈÙ˘¯‹ Î·Ù¿Ï˘ÛË, ·ÎÔÏÔ˘ıÔ‡Û ÂÚ›Ô‰Ô˜ ·Ó·ÌÔÓ‹˜ 30-45 min, ÌÂÙ¿ ÙËÓ ÔÔ›· ÁÈÓfiÙ·Ó Â·Ó·ÏËÙÈ΋ ∏ºª, ÌÂ Î·È ¯ˆÚ›˜ ÈÛÔÚÔÙÂÚÂÓfiÏË. ∂¿Ó ‰ÂÓ ÚÔηÏ›ÙÔ Ù·¯˘Î·Ú‰›· ‹ Â·ÓÂÌÊ¿ÓÈÛË ÚԉȤÁÂÚÛ˘, Ë Â¤Ì‚·ÛË ÙÂÚÌ·ÙÈ˙fiÙ·Ó.

CS A V POSSIBLE KENT ∂ÈÎfiÓ· 1. ∫ÔÏÔÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· Â·ÓÂÈÛfi‰Ô˘, ÔÊÂÈÏfiÌÂÓË Û ·ÚÈÛÙÂÚfi ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ. ∫·Ù·ÁÚ¿ÊÔÓÙ·È Î·Ù¿ ÛÂÈÚ¿ ÔÈ ··ÁˆÁ¤˜ ÂÈÊ·Ó›·˜ (π ¤ˆ˜ V6) Î·È Ù· ÂÓ‰Ôηډȷο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù· ·fi ÙÔÓ ‰ÂÍÈfi ÎfiÏÔ (HRA), ‰ÂÌ¿ÙÈÔ ÙÔ˘ His (HBEP, HBED), ÛÙÂÊ·ÓÈ·›Ô ÎfiÏÔ (CS), ‰ÂÍÈ¿ ÎÔÈÏ›· (RV). ∂ÈϤÔÓ, ηٷÁÚ¿ÊÂÙ·È ÙÔ ËÏÂÎÙÚfiÁÚ·ÌÌ· ·fi ÙÔÓ Î·ıÂÙ‹Ú· ¯·ÚÙÔÁÚ¿ÊËÛ˘-Î·Ù¿Ï˘Û˘ (MAP), ÛÙÔ ÔÔ›Ô Î·Ù·ÁÚ¿ÊÂÙ·È ‰˘Ó·ÌÈÎfi ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ (KENT).

HR A

HIS ABL

∂ÈÎfiÓ· 2. ∫·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ Ï¿ÁÈÔ˘ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ Ì ÙËÓ ·Ï›Ó‰ÚÔÌË ‰È·ÔÚÙÈ΋ Ù¯ÓÈ΋. ∞ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ Î·ıÂÙ‹Ú˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘ (HRA), HIS Î·È ÛÙÂÊ·ÓÈ·›Ô˘ ÎfiÏÔ˘ (CS), ηıÒ˜ Î·È Ô Î·ıÂÙ‹Ú·˜ Î·Ù¿Ï˘Û˘ (ABL). ¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·126

126

π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

∞ÔÙÂϤÛÌ·Ù· ∂ÓÙfiÈÛË/Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ∏ ηٷÓÔÌ‹ ÙˆÓ ¶¢ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 4. ¶ÔÏÏ·Ï¿ ‰ÂÌ¿ÙÈ· ‚Ú¤ıËÎ·Ó Î˘Ú›ˆ˜ Û ·ÛıÂÓ›˜ Ì ·ÚÈÛÙÂÚ¿ ‰ÂÌ¿ÙÈ· (6 ·ÛıÂÓ›˜, 3 ÂÎ ÙˆÓ ÔÔ›ˆÓ ›¯·Ó 2 ‰ÂÌ¿ÙÈ· Î·È 3 ›¯·Ó 3 ‰ÂÌ¿ÙÈ·). ¢‡Ô ‰ÂÍÈ¿ ‰ÂÌ¿ÙÈ· ‚Ú¤ıËÎ·Ó Û ¤Ó·Ó ·ÛıÂÓ‹. ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· (™∫) Û˘Ó˘‹Ú¯Â Û 14 ·ÛıÂÓ›˜ (14,8%). √ Ù‡Ô˜ Ù˘ ™∫ Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ¶¢ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √È ·ÛıÂÓ›˜ ¯ˆÚ›˜ ™∫ ›¯·Ó ÔÏÏ·Ï¿ ‰ÂÌ¿ÙÈ· Û ÔÛÔÛÙfi 6% (5/82), ÂÓÒ ·˘ÙÔ› Ì ™∫ ›¯·Ó ÔÏÏ·Ï¿ ‰ÂÌ¿ÙÈ· Û ÔÛÔÛÙfi 25% (3/12) (p=0,06).

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∂ÈÎfiÓ· 3. ∫·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ ÔÈÛıÈÔÏ¿ÁÈÔ˘ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ Ì ÙË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ (transseptal) Ù¯ÓÈ΋: ∞fi ·ÚÈÛÙÂÚ¿ Â¿Óˆ: ·) ·Ú·Î¤ÓÙËÛË ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ì ÙËÓ ÂȉÈ΋ ‚ÂÏfiÓ· (*), ‚) ›ÛÔ‰Ô˜ Ù˘ ‚ÂÏfiÓ·˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ (*), Á) ›ÛÔ‰Ô˜ ÙÔ˘ Ì·ÎÚÔ‡ ıËηڛԢ Î·È ÛÎÈ·ÁÚ¿ÊËÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Î·È ‰) ›ÛÔ‰Ô˜ ÙÔ˘ ηıÂÙ‹Ú· Î·Ù¿Ï˘Û˘ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ıËηڛԢ Î·È ÙÔÔı¤ÙËÛ‹ ÙÔ˘ ÛÙËÓ ÎÔÏÔÎÔÈÏȷ΋ ·‡Ï·Î· (*).

™Â fiϘ ÙȘ ·ÚÈÛÙÂÚfiÏ¢Ú˜ ÂÂÌ‚¿ÛÂȘ ¯ÔÚËÁ›ÙÔ Ë·Ú›ÓË ÌÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÙˆÓ ËÏÂÎÙÚÔ‰›ˆÓ (50-100 iu/kg ·Ú¯È΋ ‰fiÛË Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ‰fiÛÂȘ), ÒÛÙ ӷ ‰È·ÙËÚÂ›Ù·È o ACT (activated clotting time) >250 sec. ™ÙÔ Ù¤ÏÔ˜ Ù˘ Â¤Ì‚·Û˘, Ë ‰Ú¿ÛË Ù˘ Ë·Ú›Ó˘ ·Ó·ÛÙÚ¤ÊÔÓÙ·Ó Ì ıÂÈÈ΋ ÚˆÙ·Ì›ÓË Â¿Ó o ACT ‹Ù·Ó >180 sec. ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ıËηڛˆÓ Î·È ÙËÓ ÂÈÌÂÏ‹ ·ÈÌfiÛÙ·ÛË, Ô ·ÛıÂÓ‹˜ ÌÂÙ·ÊÂÚfiÙ·Ó ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi ÙÌ‹Ì· fiÔ˘ ÂÙ›ıÂÙÔ ÛÂ Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË Ì monitor. √ ·ÛıÂÓ‹˜ ÂÏÂÁ¯fiÙ·Ó Ì ∏∫° ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È Û 24 ÒÚ˜, ηıÒ˜ Î·È Ì ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È Holter 24ÒÚÔ˘ ÙËÓ ÂfiÌÂÓË Ë̤ڷ. ∂ÊfiÛÔÓ ‰ÂÓ ˘‹Ú¯·Ó ÂÈÏÔΤ˜, Ô ·ÛıÂÓ‹˜ ÂÍ‹Ú¯ÂÙÔ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÌÂÙ¿ 24-48 ÒÚ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, ˘fi ·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋ ·ÁˆÁ‹ Ì ·ÛÈÚ›ÓË (5 mg/kg) ÁÈ· 2 Ì‹Ó˜. ∂·Ó¤ÏÂÁ¯Ô˜ ÁÈÓfiÙ·Ó ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÛÙÔ˘˜ 2, 6 Î·È 12 Ì‹Ó˜ Î·È Î·ÙfiÈÓ ·Ó¿ ¤ÙÔ˜ ‹ ‰ÈÂÙ›·, Ì ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ∏∫°. ŒÓ· ÙÔ˘Ï¿¯ÈÛÙÔÓ Holter 24ÒÚÔ˘ Î·È Ì›· ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂͤٷÛË ÁÈÓfiÙ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ™Â ÂÚ›ÙˆÛË ˘ÔÙÚÔ‹˜, ÚÔÙÂÈÓfiÙ·Ó Â·Ó·ÏËÙÈ΋ ÌÂϤÙË Î·È Î·Ù¿Ï˘ÛË Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË √È ÙÈ̤˜ ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ̤Û˜ Ì ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ÔÛÔÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓ Ì t-test, ÂÓÒ ÙˆÓ ÔÈÔÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ì Fisher’s exact test. √È ·Ú¿ÌÂÙÚÔÈ ÂÓÙfi˜ ÙˆÓ ÔÌ¿‰ˆÓ Ì ÙȘ ‰È¿ÊÔÚ˜ ÂÓÙÔ›ÛÂȘ ¶¢ ·Ó·Ï‡ıËÎ·Ó ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô one-way ANOVA. ∆È̤˜ p<0,05 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.

Paediatriki 2007;70:123-134

∞ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË √È ÂÂÌ‚·ÙÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ (·ÚÈıÌfi˜ ‚Ï·‚ÒÓ, ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘, ÂÈÏÔΤ˜), ηıÒ˜ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ Î·Ù¿Ï˘Û˘ (¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ·) Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ¶¢ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∫·Ù·ÁÚ¿ÊÂÙ·È, Â›Û˘, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË. §fiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÔÌ¿‰ˆÓ, ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ·Ó¿Ï˘Û˘, Ù· ‰ÂÍÈ¿ ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο Î·È ‰ÂÍÈ¿ ‰È¿ÌÂÛ· ‰ÂÌ¿ÙÈ· Û˘ÌÙ‡¯ıËÎ·Ó Û ̛· ηÙËÁÔÚ›·, ·Ó Î·È ·Ó·Ê¤ÚÔÓÙ·È ¯ˆÚÈÛÙ¿ ÛÙÔÓ ›Ó·Î· ÒÛÙ ӷ Â›Ó·È ÂÌÊ·Ó›˜ ÔÈ ‰È·ÊÔÚ¤˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ı¤ÛÂˆÓ (p=0,249). ∞Ó Î·È Ô ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ Ù· ‰ÂÍÈ¿ ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· ¯ÚÂÈ¿ÛÙËÎ·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ‚Ï·‚ÒÓ. √ ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘ His ¢¶¢ 5 ¢¶ 9

∆V

¢¢¢ 5

¢√¢ 28

MV

∞¶ 38

∞√¢ 11 CS

∂ÈÎfiÓ· 4. ∂ÓÙfiÈÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ ‰‡Ô ÎÔÏÔÎÔÈÏÈ·ÎÒÓ ‚·Ï‚›‰ˆÓ Î·È ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎfiÏÔ˘ Û ÂÁοÚÛÈ· ‰È·ÙÔÌ‹. ∞ÂÈÎÔÓ›˙ÂÙ·È Ë ı¤ÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ Î·È Ô ·ÚÈıÌfi˜ ·˘ÙÒÓ Û οı ı¤ÛË. ∞√¢: ·ÚÈÛÙÂÚfi Ô›ÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, A¶: ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ, ¢¢¢: ‰ÂÍÈfi ‰È¿ÌÂÛÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢√¢: ‰ÂÍÈfi ÔÈÛıÈԉȷÊÚ·ÁÌ·ÙÈÎfi, ¢¶: ‰ÂÍÈfi Ï¿ÁÈÔ, ¢¶¢: ‰ÂÍÈfi ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi, His: ‰ÂÌ¿ÙÈÔ ÙÔ˘ His, TV: ÙÚÈÁÏÒ¯ÈÓ ‚·Ï‚›‰·, MV: ÌÈÙÚÔÂȉ‹˜ ‚·Ï‚›‰·, CS: ÛÙÂÊ·ÓÈ·›Ô˜ ÎfiÏÔ˜.

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·127

127

∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

¶›Ó·Î·˜ 1. ™˘Ó˘¿Ú¯Ô˘Û˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ∆‡Ô˜ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ∞ӈ̷ϛ· Ebstein Ù˘ ÙÚÈÁÏÒ¯ÈÓÔ˜ ªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· L-TGA, ·ÓˆÌ·Ï›· Ebstein Ù˘ ∞∫µ ∆ÂÙÚ·ÏÔÁ›· Fallot ÀÔ‚·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜ DORV, Situs inversus ¢›Ù˘¯Ë ·ÔÚÙÈ΋ ‚·Ï‚›‰· ∂ÎÎfiÏˆÌ· ÛÙÂÊ·ÓÈ·›Ô˘ ÎfiÏÔ˘ ™‡ÓÔÏÔ

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

£¤ÛË ¶¢ (·ÚÈıÌfi˜ ‰ÂÌ·Ù›ˆÓ)

4

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2

∞¶

1

∞√¢

1 1

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1 1 1

¢¶ ∞¶ ∞√¢ (3)

12

AKB: ·ÚÈÛÙÂÚ‹ ÎÔÏÔÎÔÈÏȷ΋ ‚·Ï‚›‰·, ∞√¢: ·ÚÈÛÙÂÚfi Ô›ÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, A¶: ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ, ¢¢¢: ‰ÂÍÈfi ‰È¿ÌÂÛÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢√¢: ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢¶: ‰ÂÍÈfi Ï¿ÁÈÔ, ¢¶¢: ‰ÂÍÈfi ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi, DORV: ‰ÈÏÔ¤ÍÔ‰Ô˜ ‰ÂÍÈ¿ ÎÔÈÏ›·, L-TGA: Û˘ÁÁÂÓÒ˜ ‰ÈÔÚıˆÌ¤ÓË ÌÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ

‹Ù·Ó ÔÚȷο ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·ÚÈÛÙÂÚ¿ ÔÈÛıÈԉȷÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· (p=0,0556), ·’ fi,ÙÈ ÛÙȘ ˘fiÏÔÈ˜ ı¤ÛÂȘ. ∞Ó Î·È Ô ·ÚÈıÌfi˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Â›Ó·È ÌÈÎÚfi˜, Ù· ‰ÂÍÈ¿ ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· ›¯·Ó Â›Û˘ ˘„ËÏfi Û¯ÂÙÈο ¯ÚfiÓÔ ·ÎÙÈÓÔÛÎfiËÛ˘ Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ı¤ÛÂȘ. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Û˘Ì‚·‰›˙ÂÈ Ì ÙÔÓ ˘„ËÏfi ·ÚÈıÌfi ‚Ï·‚ÒÓ Ô˘ ·Ó·Ê¤ÚıËΠÚÔËÁÔ˘Ì¤Óˆ˜. ∂ÈÏÔΤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ ÛÙ· ‰ÂÍÈ¿ ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο Î·È ·ÚÈÛÙÂÚ¿ Ï¿ÁÈ· ‰ÂÌ¿ÙÈ·. ¢ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi ÂÈÏÔÎÒÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ı¤ÛÂˆÓ (p=0,726). ¢‡Ô ·ÛıÂÓ›˜ Ì ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi ‰ÂÌ¿ÙÈÔ ÂÌÊ¿ÓÈÛ·Ó ·ÚÔ‰ÈΤ˜ ‰È·Ù·Ú·¯¤˜

Ù˘ ÎÔÏÔÎÔÈÏȷ΋˜ ·ÁˆÁ‹˜. ™ÙÔÓ ¤Ó· ·Ú·ÙËÚ‹ıËΠÎÔÏoÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ 3Ô˘ ‚·ıÌÔ‡ Ô˘ ˘Ô¯ÒÚËÛ ÛÙ·‰È·Î¿ Û 5 Ë̤Ú˜, ÂÓÒ ÛÙÔÓ ¿ÏÏÔ ‰È·ÈÛÙÒıËΠÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ ‰È¿ÚÎÂÈ·˜ Ï›ÁˆÓ ÏÂÙÒÓ Ô˘ ·Ú‹Ïı ·˘ÙfiÌ·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Â¤Ì‚·Û˘. ∫·Ó›˜ ¿ÏÏÔ˜ ·ÛıÂÓ‹˜ ‰ÂÓ ÂÌÊ¿ÓÈÛ ‰È·Ù·Ú·¯¤˜ Ù˘ ÎÔÏÔÎÔÈÏȷ΋˜ ·ÁˆÁ‹˜. ŒÓ·˜ ·ÛıÂÓ‹˜ Ì ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ ¶¢ Ô˘ ˘Ô‚Ï‹ıËΠÛÂ Î·Ù¿Ï˘ÛË Ì ÙË ‰È·ÔÚÙÈ΋ Ù¯ÓÈ΋, ÂÌÊ¿ÓÈÛ ·‡ÍËÛË Ù˘ ·ÔÚÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ·fi 1Ô˘ Û 2Ô˘ ‚·ıÌÔ‡. ™ÙÔÓ ·ÛıÂÓ‹ ·˘Ùfi ‰È·ÈÛÙÒıËΠ‰›Ù˘¯Ë ·ÔÚÙÈ΋ ‚·Ï‚›‰· ÌÂÙ¿ ÙËÓ Î·Ù¿Ï˘ÛË. ŒÓ·˜ ¿ÏÏÔ˜ ·ÛıÂÓ‹˜ Ô˘ ˘Ô‚Ï‹ıËΠÛÂ Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ ¶¢ Ì ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ (transseptal) ÚÔÛ¤Ï·ÛË, ÂÌÊ¿ÓÈÛ ̛· ÌÈÎÚ‹ ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹ Ô˘ ·ÔÚÚÔÊ‹ıËΠ·˘ÙfiÌ·Ù· ÙËÓ ÂfiÌÂÓË Ë̤ڷ. ∏ ·Ú¯È΋ ÂÈÙ˘¯›· ‹Ù·Ó ˘„ËÏ‹ Î·È Û˘ÁÎÚ›ÛÈÌË Û fiϘ ÙȘ ηÙËÁÔڛ˜, ¯ˆÚ›˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ (p=0,0916 Ì Fisher’s exact test). ∏ ÙÂÏÈ΋ ÂÈÙ˘¯›· ·Ú¤ÌÂÈÓ ¯·ÌËÏfiÙÂÚË ÛÙ· ‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο, ÏfiÁˆ ˘„ËÏfiÙÂÚÔ˘ ÔÛÔÛÙÔ‡ ˘ÔÙÚÔ‹˜ Î·È ÌË Â·Ó¿Ï˄˘ Ù˘ Â¤Ì‚·Û˘ ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi. ∆Ô ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙ· ‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·, ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. √È ˘ÔÙÚÔ¤˜ ‹Ù·Ó ÛËÌ·ÓÙÈο Û˘¯ÓfiÙÂÚ˜ Û ·ÛıÂÓ›˜ Ì ÔÏÏ·Ï¿ ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· (‰ÂÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2), Û ÔÛÔÛÙfi 57% ¤Ó·ÓÙÈ 11% (p=0,0075). π‰È·›ÙÂÚ· Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÔÈ ÂÚÈÙÒÛÂȘ ‰‡Ô ·ÛıÂÓÒÓ Ì ÔÏÏ·Ï¿ ¶¢ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó Â·Ó·ÏËÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ. ª›· ·ÛıÂÓ‹˜ 18 ÂÙÒÓ Ì ·Ó‡ڢÛÌ· ÙÔ˘ ·Ú¯ÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎfiÏÔ˘ ›¯Â ÔÏÏ·Ï¿ ÂÈηډȷο ‰ÂÌ¿ÙÈ· ÛÙÔ ¤‰·ÊÔ˜ ÙÔ˘ ·Ó¢ڇÛÌ·ÙÔ˜ Î·È ÂÓÙfi˜ Ù˘ ̤Û˘ ηډȷ΋˜ ÊϤ‚·˜. ∏ Î·Ù¿Ï˘ÛË fiÏˆÓ ÙˆÓ ‰ÂÌ·Ù›ˆÓ ÂÂÙ‡¯ıË Ì ‰‡Ô ÚÔÛ¿ıÂȘ. ŒÓ·˜ ·ÛıÂÓ‹˜ 12

¶›Ó·Î·˜ 2. ∂ÂÌ‚·ÙÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ Î·È ·ÔÙ¤ÏÂÛÌ· Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ¶¢ ∂ÓÙfiÈÛË

¢¢¢ ¢¶¢ ¢¶ ¢√¢ ∞√¢ ∞¶ ™‡ÓÔÏÔ ∆ÈÌ‹ p

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

∞ÚÈıÌfi˜ ‚Ï·‚ÒÓ

5 5 9 27 10 38 94

10,8±4,3 26,8±17,2 12,7±17,7 11,8±14,1 12,3±15,4 9,4±6,5 14±13 0,2496

ÃÚfiÓÔ˜ ∞ÚÈıÌfi˜ ·ÎÙÈÓÔÛÎfiËÛ˘ ÂÈÏÔÎÒÓ (min) 15,0±20,6 51,8±31,4* 22,3±17,6 27,7±29,7 52,5±50,6* 31,2±17,2 33,4±27,9 0,0556

0 0 0 2 (7,1%) 0 2 (5,2%) 4 (4%) 0,762

AÚ¯È΋ ÂÈÙ˘¯›·

∞ÚÈıÌfi˜ ˘ÔÙÚÔÒÓ

5 (100%) 5 (100%) 8 (89%) 27 (100%) 9 (90%) 37 (97%) 91 (96,8%) 0,0916

2 (40%) 1 (20%) 1 (12,5%) 2 (7,1%) 1 (10%) 7 (18,4%) 15 (15,9%) 0,0837

∆ÂÏÈ΋ ™˘ÁÁÂÓ‹˜ ÂÈÙ˘¯›· ηډÈÔ¿ıÂÈ· 3 (60%)* 5 (100%) 8 (89%) 27 (100%) 9 (90%) 38 (100%) 90 (95,7%) 0,0211

1 (20%) 0 6 (66%)* 2 (7,1%) 2 (20%) 3 (7,8%) <0,0001

∞√¢: ·ÚÈÛÙÂÚfi Ô›ÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, A¶: ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ, ¢¢¢: ‰ÂÍÈfi ‰È¿ÌÂÛÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢√¢: ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢¶: ‰ÂÍÈfi Ï¿ÁÈÔ, ¢¶¢: ‰ÂÍÈfi ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi *∆È̤˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۇÁÎÚÈÛË Ì ÙȘ ˘fiÏÔÈ˜ Ù˘ ›‰È·˜ ηÙËÁÔÚ›·˜ ¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·128

128

π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

ÂÙÒÓ Ì 3 ¶¢ (·ÚÈÛÙÂÚfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi Î·È 2 Ï¿ÁÈ·), ηıÒ˜ Î·È ÎÔÌ‚È΋ Ù·¯˘Î·Ú‰›· Â·ÓÂÈÛfi‰Ô˘, ¯ÚÂÈ¿ÛÙËΠ٤ÛÛÂÚȘ Û˘ÓÔÏÈο ÂÂÌ‚¿ÛÂȘ ÁÈ· ÙËÓ ÙÂÏÈ΋ ÂÈÙ˘¯›·. ªÂÙ¿ ÙÔ ¤Ú·˜ ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ·˘ÙÒÓ Ô ·ÛıÂÓ‹˜ Â›Ó·È ÂχıÂÚÔ˜ Ù·¯˘Î·Ú‰ÈÒÓ.

T· ÔÛÔÛÙ¿ Û˘Ó˘¿Ú¯Ô˘Û·˜ ™∫, fiˆ˜ ÚԷӷʤÚıËÎÂ, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙ· ‰ÂÍÈ¿ Ï¿ÁÈ· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ·fi ÔÔÈ·‰‹ÔÙ ¿ÏÏË Î·ÙËÁÔÚ›· (p<0,0001). ∏ ‡·ÚÍË Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ‰ÂÓ ÂËÚ¤·Û ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙË ÛÂÈÚ¿ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜. ∞ÛıÂÓ›˜ Ì ·Î·Ù¿·˘ÛÙË Ù·¯˘Î·Ú‰›· ÔÊÂÈÏfiÌÂÓË Û ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ‚Ú·‰Â›·˜ ·ÁˆÁ‹˜ ¶¤ÓÙ ·ÛıÂÓ›˜ Ì ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi ‰ÂÌ¿ÙÈÔ Î·È 2 ·ÛıÂÓ›˜ Ì ·ÚÈÛÙÂÚfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi ‰ÂÌ¿ÙÈÔ Â›¯·Ó ·Î·Ù¿·˘ÛÙË Ù·¯˘Î·Ú‰›· ÏfiÁˆ ‚Ú·‰Â›·˜ ·Ï›Ó‰ÚÔÌ˘ ÌfiÓÔ ·ÁˆÁ‹˜ ̤ۈ ÙÔ˘ ‰ÂÌ·Ù›Ô˘ (permanent junctional reciprocating tachycardia). ∏ Î·Ù¿Ï˘ÛË ‹Ù·Ó ÂÈÙ˘¯‹˜ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÂÎÙfi˜ ·fi ¤Ó·Ó Ì ·ÚÈÛÙÂÚfi ÔÈÛıÈԉȷÊÚ·ÁÌ·ÙÈÎfi ‰ÂÌ¿ÙÈÔ. ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, 3 ›¯·Ó Ì˘ÔηډÈÔ¿ıÂÈ· ÂÎ Ù·¯˘Î·Ú‰›·˜. ∫·È ÛÙÔ˘˜ 3, ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ·ÔηٷÛÙ¿ıËΠÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. ¢ÂÓ ˘‹ÚÍ·Ó ÂÈÏÔΤ˜, Ô‡Ù ˘ÔÙÚÔ¤˜ Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ. ™‡ÁÎÚÈÛË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋˜ Ì ·Ï›Ó‰ÚÔÌË Ù¯ÓÈ΋ ÁÈ· ÙËÓ Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚfiÏÂ˘ÚˆÓ ‰ÂÌ·Ù›ˆÓ ∏ Û‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô Ù¯ÓÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ‚·ıÌfi ‰˘ÛÎÔÏ›·˜ (·ÚÈıÌfi˜ ‚Ï·‚ÒÓ, ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘, ‰È¿ÚÎÂÈ· Â¤Ì‚·Û˘), Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ Î·È ˘ÔÙÚÔÒÓ, ÙȘ ÂÈÏÔΤ˜ Î·È Ù· ÔÛÔÛÙ¿ ·ÏÏ·Á‹˜ ÚÔÛ¤ÁÁÈÛ˘ ·fi ÙË Ì›· Ù¯ÓÈ΋ ÛÙËÓ ¿ÏÏË, ‰ÂÓ ¤‰ÂÈÍ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ∏ ÙÂÏÈ΋ ÂÈÙ˘¯›· ‹Ù·Ó 100% Î·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜. ™˘Û¯¤ÙÈÛË ËÏÈΛ·˜ Î·È ·ÔÙÂϤÛÌ·ÙÔ˜ (ÂÈÙ˘¯›·, ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜, ÔÛÔÛÙ¿ ÂÈÏÔÎÒÓ) ™ÙÔÓ ¶›Ó·Î· 3 ηٷÁÚ¿ÊÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ›¯·Ó ÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ÂÏ·ÊÚÒ˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÓÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ·, ¯ˆÚ›˜ Ë ‰È·ÊÔÚ¿ ·˘Ù‹ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ¢ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ËÏÈΛ·˜ Î·È ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ ‹ ˘ÔÙÚÔÒÓ.

™˘˙‹ÙËÛË ∏ ıÂÚ·›· ÙˆÓ ˘ÂÚÎÔÈÏÈ·ÎÒÓ Ù·¯˘Î·Ú‰ÈÒÓ ¿ÏÏ·Í ‰Ú·Ì·ÙÈο ·fi ÙÔ 1968, ÌÂÙ¿ ÙËÓ ÚÒÙË ¯ÂÈPaediatriki 2007;70:123-134

¶›Ó·Î·˜ 3. ∞ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ∂ÈÙ˘¯›· ∞ÔÙ˘¯›·

12,4±3,6 ¤ÙË 9,7±3,8 ¤ÙË

p=0,541

Èڛ˜ ˘ÔÙÚÔ‹ ªÂ ˘ÔÙÚÔ‹

12,3±3,6 ¤ÙË 12,9±3,8 ¤ÙË

p=0,620

Èڛ˜ ÂÈÏÔΤ˜ M ÂÈÏÔΤ˜

12,7±3,6 ¤ÙË 12,9±3,9 ¤ÙË

p=0,861

ÚÔ˘ÚÁÈ΋ ıÂÚ·›· ·ÛıÂÓÔ‡˜ Ì ۇӉÚÔÌÔ WolffParkinson-White ·fi ÙÔ˘˜ Sealy Î·È Û˘Ó (4), ·ÏÏ¿ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÌÂÙ¿ ÙËÓ Â˘Ú›· ÂÊ·ÚÌÔÁ‹ Ù˘ Î·Ù¿Ï˘Û˘ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ·fi ÙÔ 1987 Î·È ÌÂÙ¿ (5). ∞fi ÙËÓ ·Ú¯‹ Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Î·Ù¿Ï˘Û˘ Ì ƒƒ ¿Ú¯ÈÛ ̛· Û˘ÛÙËÌ·ÙÈ΋ ηٷÁÚ·Ê‹ ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ·˘ÙÒÓ ÛÙ· ·È‰È¿ ΢ڛˆ˜ ÛÙȘ ∏¶∞ (Pediatric Radiofrequency Ablation Registry), Ì ÙË ‚Ô‹ıÂÈ· Ù˘ ÔÔ›·˜ Û˘ÁÎÂÓÙÚÒıËÎ·Ó Î·È ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÏϤ˜ ¯ÈÏÈ¿‰Â˜ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Î·Ù¿Ï˘ÛË (6,7). ™ÙË ¯ÒÚ· Ì·˜, Ë Î·Ù¿Ï˘ÛË ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·ÚÚ˘ıÌÈÒÓ ¿Ú¯ÈÛ ‹‰Ë ·fi ÙÔ 1994, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› Û˘ÁÎÂÓÙÚˆÙÈο ¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ· ·ÔÙÂϤÛÌ·Ù·, ÂÎÙfi˜ ·fi ¤Ó·Ó ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ (8). ∏ ·ÚÔ‡Û· ÌÂϤÙË Â›Ó·È Ë ÚÒÙË Û˘ÛÙËÌ·ÙÈ΋ ÂÚÈÁÚ·Ê‹ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·Ù¿Ï˘Û˘ ¶¢ Û ̛· ÛÂÈÚ¿ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ Ì ·Ó·ÊÔÚ¿ ÛÙ· ¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ· ·ÔÙÂϤÛÌ·Ù· Ù˘ Â¤Ì‚·Û˘ ·˘Ù‹˜ ÛÙË ¯ÒÚ· Ì·˜. ∂ÓÙfiÈÛË ¶¢ - ∏ÏÈΛ· ·ÛıÂÓÒÓ ∏ ηٷÓÔÌ‹ ÂÓÙfiÈÛ˘ ÙˆÓ ¶¢ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Û˘ÌʈÓ› Ì ÂΛÓË Ô˘ ÂÚÈÁÚ¿ÊËΠ۠‰È¿ÊÔÚ˜ ‰ÈÂıÓ›˜ ÛÂÈÚ¤˜: ‰ÂÍÈ¿ ‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· Û 4% ÙˆÓ ·ÛıÂÓÒÓ, ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο Û 6%, ‰ÂÍÈ¿ Ï¿ÁÈ· Û 12%, ÔÈÛıÈԉȷÊÚ·ÁÌ·ÙÈο Û ÂÚ›Ô˘ 30% Î·È ·ÚÈÛÙÂÚ¿ Ï¿ÁÈ· Û 40-70% (9-11). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ, ÁÂÓÈÎÒ˜ Û˘ÓÈÛÙ¿Ù·È ·ÔÊ˘Á‹ Î·Ù¿Ï˘Û˘ Û ·ÛıÂÓ›˜ ÌÈÎÚÒÓ ËÏÈÎÈÒÓ Î·È ÂȉÈÎfiÙÂÚ· Û ‚Ú¤ÊË, ‰Â‰Ô̤Ó˘ Ù˘ ˘„ËÏfiÙÂÚ˘ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ Î·È Û ·ÛıÂÓ›˜ Ì ¯·ÌËÏfiÙÂÚÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜, Ô˘ ¤¯ÂÈ ·Ú·ÙËÚËı› ÙfiÛÔ Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ (6,12) fiÛÔ Î·È Û ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ Û ˙Ò· (13,14). ∂Í¿ÏÏÔ˘, ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Û ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ‚ÚÂÊÒÓ Ì ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ, ÔÈ Ù·¯˘Î·Ú‰›Â˜ ·‡Ô˘Ó ÔÚÈÛÙÈο ÌÂÙ¿ ·fi ÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ‹ ‰È·ÎfiÙÔÓÙ·È ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÔÏÏÒÓ ÂÙÒÓ (15) Î·È ¤ÙÛÈ ÔÏÏÔ› ·ÛıÂÓ›˜

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·129

129

∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ ÌÔÚ› Ó· ÌË ¯ÚÂÈ·ÛÙÔ‡Ó ÔÙ¤ ÂÂÌ‚·ÙÈ΋ ıÂÚ·›·. ™˘Û¯¤ÙÈÛË ÌÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ∂›Ó·È ÁÓˆÛÙ‹ Ë Û˘¯Ó‹ Û˘Ó‡·ÚÍË ™∫ Û ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì À∆. ∏ Û˘¯ÓfiÙËÙ· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ‚Ú¤ÊË (¤ˆ˜ Î·È 30%) (16) Î·È Û ·ÛıÂÓ›˜ Ì ‰ÂÍÈ¿ Ï¿ÁÈ· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·, ÏfiÁˆ Ù˘ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ΢ڛˆ˜ Ì ·ÓˆÌ·Ï›· Ebstein (16-18). ™Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, Ë Û˘¯ÓfiÙËÙ· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 10% Î·È 30% (6,19), ÔÛÔÛÙfi Ô˘ Û˘ÌʈÓ› Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (14,8%). ™ÙË ÛÂÈÚ¿ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ ˘‹Ú¯Â ¤Ó· ȉȷ›ÙÂÚ· ˘„ËÏfi ÔÛÔÛÙfi ™∫ Û ·ÛıÂÓ›˜ Ì ‰ÂÍÈ¿ Ï¿ÁÈ· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· (66%). ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙ· ·ÔÙÂϤÛÌ·Ù· ÌÂٷ͇ ·ÛıÂÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ ™∫, ·Ó Î·È Ô ÌÈÎÚfi˜ Û¯ÂÙÈο ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ™∫ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi ÙÂÏÈ΋˜ ÂÈÙ˘¯›·˜ (68%) Û ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· (20). ™‡ÁÎÚÈÛË Ì ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ ∏ ·Ú¯È΋ Â¤Ì‚·ÛË Î·Ù¿Ï˘Û˘ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ÛÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ÂÈÙ˘¯‹˜ Û 91/94 ·ÛıÂÓ›˜ (ÔÛÔÛÙfi 96,8%), Ì ÙÂÏÈÎfi ÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ¿ ·fi ˘ÔÙÚÔ¤˜ Î·È Â·Ó·ÏËÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ Û 90/94 (95,7%). √È Tanel Î·È Û˘Ó ·Ó¤ÊÂÚ·Ó ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù·, Ì ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ 96% (21). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Â›Ó·È ÂÏ·ÊÚÒ˜ ηχÙÂÚ· ·fi Ù· Û˘ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ Pediatric Radiofrequency Ablation Registry, fiÔ˘ Û ۇÓÔÏÔ 3110 ·ÛıÂÓÒÓ Ì ¶¢, Ë ·Ú¯È΋ Â¤Ì‚·ÛË ‹Ù·Ó ÂÈÙ˘¯‹˜ Û 90% ÙˆÓ ·ÛıÂÓÒÓ (7). ∆· ·ÔÙÂϤÛÌ·Ù· Î·Ù¿Ï˘Û˘ Û ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ‚ÂÏÙȈı› ÛËÌ·ÓÙÈο Ì ÙËÓ ·‡ÍËÛË Ù˘ ÂÌÂÈÚ›·˜. ∏ Û‡ÁÎÚÈÛË ‰‡Ô ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ (1991-1995 Î·È 1995-1999) ¤‰ÂÈÍ Ì›ˆÛË ÙˆÓ ·ÔÙ˘¯ËÌ¤ÓˆÓ ÂÂÌ‚¿ÛÂˆÓ ·fi 9,6% Û 4,8% (22). ∏ ı¤ÛË ÂÓÙfiÈÛ˘ ÙÔ˘ ¶¢ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙ· Û˘ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ Pediatric Radiofrequency Ablation Registry, ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙ· ·ÚÈÛÙÂÚ¿ Ï¿ÁÈ· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· (95%) Î·È ¯·ÌËÏfiÙÂÚ· ÛÙ· ‰È·ÊÚ·ÁÌ·ÙÈο (87%) Î·È ÛÙ· ‰ÂÍÈ¿ Ï¿ÁÈ· (86%) (7). ¶·ÚÔÌÔ›ˆ˜, ÔÈ Park Î·È Û˘Ó (22) Û ̛· ÛÂÈÚ¿ 443 ·ÛıÂÓÒÓ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ·È‰È¿ Î·È ÂÓ‹ÏÈΘ, ›¯·Ó ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜

ÛÙ· ‰ÂÍÈ¿ Î·È ÛÙ· ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· (85% Î·È 88%, ·ÓÙ›ÛÙÔȯ·) Û ۯ¤ÛË Ì ٷ ·ÚÈÛÙÂÚ¿ (97%). ™‡Ìʈӷ Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ·Ú¯È΋ ÂÈÙ˘¯›· ‹Ù·Ó ·ÚfiÌÔÈ· Û fiϘ ÙȘ ı¤ÛÂȘ. ÀÔÙÚÔ‹ ·Ú·ÙËÚ‹ıËΠ۠13,8% ÙˆÓ ·ÛıÂÓÒÓ, ÔÛÔÛÙfi Ô˘ Â›Û˘ Â›Ó·È Û¯ÂÙÈο ηχÙÂÚÔ ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ Pediatric Radiofrequency Ablation Registry, fiÔ˘ ·Ú·ÙËÚ‹ıËΠ˘ÔÙÚÔ‹ Û 23% ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ (7). ¶·ÚfiÌÔÈ· ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜ Ì ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· (13%) ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ (24), ÂÓÒ Û ¿ÏϘ ÛÂÈÚ¤˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÌÈÎÚfiÙÂÚ· ÔÛÔÛÙ¿ (25). √È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌʈÓÔ‡Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ Â›Ó·È ˘„ËÏfiÙÂÚÔ ÛÙ· ‰ÂÍÈ¿ ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ηÙËÁÔڛ˜, Ì ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜ ·fi 17-24% (26-28). ∞ÔÙÂϤÛÌ·Ù· Î·Ù¿Ï˘Û˘ ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3, ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË Ù˘ ËÏÈΛ·˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÙ˘¯›· ÙˆÓ ÂÂÌ‚¿ÛˆÓ, ÛÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ Î·È ÛÙȘ ÂÈÏÔΤ˜. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘ Ô˘ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ËÏÈΛ· (6,23,29). ª¿ÏÈÛÙ·, Û ÔÚÈṲ̂Ó˜ ηÙËÁÔڛ˜ ·ÛıÂÓÒÓ, ÙÔ ÌÈÎÚfiÙÂÚÔ ÛˆÌ·ÙÈÎfi ̤ÁÂıÔ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜. ∞Ó¿Ï˘ÛË ÙˆÓ Î·Ù·Ï‡ÛÂˆÓ Û ·ÛıÂÓ›˜ Ì ·ÓˆÌ·Ï›· Ebstein ¤‰ÂÈÍ fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÌÈÎÚfiÙÂÚË ÛˆÌ·ÙÈ΋ ÂÈÊ¿ÓÂÈ· ›¯·Ó ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ (30). ¢È¿ÊÔÚÔÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó Û˘ÁÎÚ›ÓÂÈ Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ ÛÙËÓ Î·Ù¿Ï˘ÛË ·ÚÚ˘ıÌÈÒÓ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ. √È Park Î·È Û˘Ó (23) ÌÂϤÙËÛ·Ó Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ Û 413 ·ÛıÂÓ›˜ Ô˘ ÙÔ˘˜ ‰È¤ÎÚÈÓ·Ó Û ·È‰È¿ (2-12 ÂÙÒÓ), ÂÊ‹‚Ô˘˜ (13-19 ÂÙÒÓ) Î·È ÂÓ‹ÏÈΘ (>20 ÂÙÒÓ). ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙËÓ ÂÈÙ˘¯›· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ËÏÈÎÈÒÓ (93-95%), Ô‡Ù ÛÙË Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· Â¤Ì‚·Û˘, ÙÔÓ ¯ÚfiÓÔ ·ÎÙÈÓÔÛÎfiËÛ˘ Î·È ÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ. ™Â fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜, Ë Î·Ù¿Ï˘ÛË ‰ÂÍÈÒÓ Î·È ‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ‹Ù·Ó ‰˘ÛÎÔÏfiÙÂÚË Î·È Ì ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜. √È Manolis Î·È Û˘Ó (31), Â›Û˘, ÌÂϤÙËÛ·Ó Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ (47 ·È‰È¿ Î·È 280 ÂÓ‹ÏÈΘ) Î·È ‰ÂÓ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ηٷ‰ÂÈÎÓ‡Ô˘Ó ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÌÔÚ› Ó· Ú·ÁÌ·ÙÔÔÈËı› Ì ÙËÓ ›‰È· ·ÛÊ¿ÏÂÈ· Î·È ÂÈÙ˘¯›· Î·È ÛÙ· ·È‰È¿ fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07

28-03-07

17:23

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130

π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

·ÚΛ ‚‚·›ˆ˜ Ó· Á›ÓÂÙ·È ·fi ¤ÌÂÈÚÔ˘˜ ¯ÂÈÚÈÛÙ¤˜. ∂Í·›ÚÂÛË ›Ûˆ˜ ·ÔÙÂÏ› Ë ÔÌ¿‰· ÙˆÓ ‚ÚÂÊÒÓ, ÛÙËÓ ÔÔ›· - fiˆ˜ ı· ·Ó·ÊÂÚı› ·Ú·Î¿Ùˆ - ÌÔÚ› ÌÂÓ Ë Î·Ù¿Ï˘ÛË Ó· ¤¯ÂÈ ·ÚfiÌÔÈ· ÂÈÙ˘¯›· fiˆ˜ Î·È ÛÙȘ ¿ÏϘ ÔÌ¿‰Â˜ (29), ·ÏÏ¿ Ë Èı·ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË. ∂ȉÈΤ˜ ÂÚÈÙÒÛÂȘ ª›· ÂȉÈ΋ ηÙËÁÔÚ›· ¶¢ Â›Ó·È ·˘Ù¿ Ô˘ ¤¯Ô˘Ó ‚Ú·‰Â›· Î·È ÌfiÓÔ ·Ï›Ó‰ÚÔÌË ·ÁˆÁ‹. §fiÁˆ Ù˘ ‚Ú·‰Â›·˜ ·˘Ù‹˜ ·ÁˆÁ‹˜, ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÌÈ· ·Î·Ù¿·˘ÛÙË Ù·¯˘Î·Ú‰›·, ‰ÈfiÙÈ Ô ÎÔÏÔÎÔÈÏÈ·Îfi˜ ÎfiÌ‚Ô˜ Â›Ó·È Û˘Ó¯Ҙ ¤ÙÔÈÌÔ˜ Ó· ‰Â¯ı› Î·È Ó· ¿ÁÂÈ ÚÔ˜ ÙȘ ÎÔÈϛ˜ Ù· ÂÚÂı›ÛÌ·Ù· Ô˘ ¿ÁÔÓÙ·È ·Ï›Ó‰ÚÔÌ· ·fi ÙÔ ‰ÂÌ¿ÙÈÔ. ∏ Ù·¯˘Î·Ú‰›· ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ¤¯ÂÈ ÔÓÔÌ·ÛÙ› “permanent junctional reciprocating tachycardia” (PJRT), ÏfiÁˆ Ù˘ ¯ÚÔÓÈfiÙËÙ¿˜ Ù˘. ™ÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ˘‹Ú¯·Ó 7 ·ÛıÂÓ›˜ Ì ·˘Ù‹ ÙËÓ Ù·¯˘Î·Ú‰›·, Ì ÂÈÙ˘¯‹ Î·Ù¿Ï˘ÛË ÛÙÔ˘˜ 6, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËıÔ‡Ó ÂÈÏÔΤ˜ ‹ ˘ÔÙÚÔ¤˜. ∞Ó Î·È ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ·˘ÙfiÌ·Ù˘ ›·Û˘ Ù˘ Ù·¯˘Î·Ú‰›·˜ ·˘Ù‹˜, Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÔ˘Ó Û ‚Ú¤ÊË. ∂Âȉ‹ Ë Ù·¯˘Î·Ú‰›· Â›Ó·È ¯ÚfiÓÈ· Î·È ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Â‡ÎÔÏ· ÛÙ· ·ÓÙÈ·ÚÚ˘ıÌÈο Ê¿Ú̷η, ÌÔÚ› Ó· ÚÔÎÏËı› ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÂÎ Ù·¯˘Î·Ú‰›·˜. Œ¯Ô˘Ó Ì¿ÏÈÛÙ· ·Ó·ÊÂÚı› Î·È ·ÈÊÓ›‰ÈÔÈ ı¿Ó·ÙÔÈ Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ÌÂ Ì˘ÔηډÈÔ¿ıÂÈ· (32). °È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, Ë Î·Ù¿Ï˘ÛË Â›Ó·È ÚÔÙÈÌfiÙÂÚË ·fi ÙË ¯ÚfiÓÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ª›· ¿ÏÏË ÂȉÈ΋ ÔÌ¿‰·, ÁÈ· ÙËÓ ÔÔ›· ¤¯ÂÈ Á›ÓÂÈ ÌÂÁ¿ÏË Û˘˙‹ÙËÛË Î·È ˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· ˆ˜ ÚÔ˜ ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘, ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÂÌÊ·Ó‹ ÚԉȤÁÂÚÛË ÛÙÔ ∏∫° (·Û˘Ìو̷ÙÈÎfi Û‡Ó‰ÚÔÌÔ WPW). ∂›Ó·È ÁÓˆÛÙfi ·fi ÔÏÏ¿ ¯ÚfiÓÈ· fiÙÈ ·ÎfiÌË Î·È ·Û˘Ìو̷ÙÈÎÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ¤Ó·Ó ÌÈÎÚfi, ·ÏÏ¿ ˘·ÚÎÙfi ΛӉ˘ÓÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, Ô˘ ÔÊ›ÏÂÙ·È Û ٷ¯Â›· ·ÁˆÁ‹ ̤ۈ ÙÔ˘ ¶¢ ηٿ ÙË ‰È¿ÚÎÂÈ· ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜, Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹. ¶·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ˆ˜ ÚÔ˜ ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘. ∂Âȉ‹ Ë Úfi‚ÏÂ„Ë ·fi ÙȘ ·Ó·›Ì·ÎÙ˜ ÂÍÂÙ¿ÛÂȘ (Holter 24ÒÚÔ˘, ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜) Â›Ó·È ·‚¤‚·ÈË, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÓÈÛÙÔ‡Ó ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ì ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË, ›Ù ‰ÈÔÈÛÔÊ·ÁÈ΋ ›Ù ÂÓ‰Ôηډȷ΋. ªÈ· ÚfiÛÊ·ÙË ÚÔÔÙÈ΋ ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ·ÛıÂÓ›˜ Ì ·Û˘Ìو̷ÙÈÎfi Û‡Ó‰ÚÔÌÔ WPW Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÚÔÏËÙÈ΋ Î·Ù¿Ï˘ÛË, ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi Û˘Ì‚·Ì¿ÙˆÓ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ÛÙËÓ ÔÔ›· ˘‹ÚÍ·Ó Î·È ‰‡Ô ·ÛıÂÓ›˜ Ì ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ô ¤Ó·˜ ¤ı·Ó ·ÈÊÓ›‰È· (33).

Paediatriki 2007;70:123-134

£ÂˆÚÂ›Ù·È fiÙÈ Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ ‰ÈηÈÔÏÔÁÔ‡Ó ÙË Û˘ÁÎÂÎÚÈ̤ÓË Ú·ÎÙÈ΋, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Wolff-Parkinson-White (ÂÎÙfi˜ ·˘ÙÒÓ Ì Û¿ÓÈ·, ‰È·Ï›Ô˘Û· ÚԉȤÁÂÚÛË) ˘Ô‚¿ÏÏÔÓÙ·È Û ∏ºª, ÂÓÒ Â¿Ó Ë ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô˜ ÙÔ˘ ‰ÂÌ·Ù›Ô˘ Â›Ó·È <250 msec, ‹ ÚÔηÏÂ›Ù·È ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ Ì ٷ¯Â›· ÎÔÈÏȷ΋ ·ÓÙ·fiÎÚÈÛË, Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È Î·Ù¿Ï˘ÛË. ∂ÈÏÔΤ˜ ∏ ˘„ËÏ‹ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘ ·ÚÚ˘ıÌÈÒÓ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ı· Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌ¿Ù·È Ì ÙË ÌÈÎÚ‹, ·ÏÏ¿ ˘·ÚÎÙ‹ Èı·ÓfiÙËÙ· ÂÈÏÔÎÒÓ. √È ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ Â›Ó·È ·ÚÔ‰ÈΤ˜ Î·È ·˘ÙÔ˚¿ÛÈ̘, fiˆ˜ Ë ·Ó¿Ù˘ÍË ·ÈÌ·ÙÒÌ·ÙÔ˜ ÛÙ· ÛËÌ›· ÂÈÛ·ÁˆÁ‹˜ ÙˆÓ Î·ıÂÙ‹ÚˆÓ, Ë ÌÂȈ̤ÓË ·ÚÙËÚȷ΋ ΢ÎÏÔÊÔÚ›· Û ÂÚÈÙÒÛÂȘ ·Ï›Ó‰ÚÔÌÔ˘ ηıÂÙËÚÈ·ÛÌÔ‡ Ù˘ ·ÔÚÙ‹˜ ·fi Ù· ÌËÚÈ·›· ·ÁÁ›· Î·È ¿ÏϘ ·ÚÔ‰ÈΤ˜ ÂÈÏÔΤ˜. √È Ì›˙ÔÓ˜ ÂÈÏÔΤ˜, fiˆ˜ ‚Ï¿‚Ë ÙˆÓ Î·Ú‰È·ÎÒÓ ‚·Ï‚›‰ˆÓ, ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ 2Ô˘ Î·È 3Ô˘ ‚·ıÌÔ‡, ηډȷ΋ ‰È¿ÙÚËÛË, ÂÚÈηډȷÎfi ˘ÁÚfi, ıÚÔÌ‚ÔÂÌ‚ÔÏÈο Ê·ÈÓfiÌÂÓ·, ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ‚Ú·¯ÈÔÓ›Ô˘ ϤÁÌ·ÙÔ˜ Î·È Ó¢ÌÔıÒڷη˜, Â›Ó·È Â˘Ù˘¯Ò˜ Û¿ÓȘ. µÏ¿‚Ë Î·Ú‰È·ÎÒÓ ‚·Ï‚›‰ˆÓ, ΢ڛˆ˜ Ù˘ ·ÔÚÙ‹˜ Î·È Û·ÓÈfiÙÂÚ· Ù˘ ÌÈÙÚÔÂȉԇ˜, ÌÔÚ› Ó· ·Ú·ÙËÚËı› ΢ڛˆ˜ ηٿ ÙÔÓ ·Ï›Ó‰ÚÔÌÔ Î·ıÂÙËÚÈÛÌfi Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ÁÈ· Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚfiÏÂ˘ÚˆÓ ˘ÔÛÙÚˆÌ¿ÙˆÓ Ù·¯˘Î·Ú‰›·˜. ∞ÓÙ›ıÂÙ·, Ì ÙË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ Ù¯ÓÈ΋ ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ‰È¿ÙÚËÛ˘ ÙÔ˘ ÎÔÏÈÎÔ‡ Ì˘Ôηډ›Ô˘ Î·È Ù˘ ÂÌ‚ÔÏ‹˜ ‰È’ ·¤ÚÔ˜. ™ÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù¯ÓÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ, ÂÈÏÔÎÒÓ, ÙËÓ ·Ó¿ÁÎË ·ÏÏ·Á‹˜ ·fi ÙË Ì›· Ù¯ÓÈ΋ ÛÙËÓ ¿ÏÏË, ÙȘ ˘ÔÙÚÔ¤˜ Î·È ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·. °ÂÓÈο ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ô ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘ Î·È Ë Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· Â¤Ì‚·Û˘, ηıÒ˜ Î·È Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ‚Ï·‚ÒÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù¯ÓÈÎÒÓ (34-36). ™ÙËÓ ·È‰È·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË Ù˘ ‰È·ÔÚÙÈ΋˜ Ì ÙËÓ ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ ÚÔÛ¤Ï·ÛË ¤ÁÈÓ ·fi ÙÔ˘˜ Law Î·È Û˘Ó (37) Û 136 ·ÛıÂÓ›˜, ̤Û˘ ËÏÈΛ·˜ 12,2 ÂÙÒÓ (30 ‰È·ÔÚÙÈΤ˜ Î·È 106 ‰È·-‰È·ÊÚ·ÁÌ·ÙÈΤ˜ ÚÔÛÂÏ¿ÛÂȘ). √È ‰È·ÔÚÙÈΤ˜ ÚÔÛÂÏ¿ÛÂȘ ··›ÙËÛ·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ηıÂÙ‹ÚˆÓ, ¯ÚfiÓÔ ·ÎÙÈÓÔÛÎfiËÛ˘ (71,3 ¤Ó·ÓÙÈ 43 min) Î·È ¯ÚfiÓÔ Â¤Ì‚·Û˘ (5,0 ¤Ó·ÓÙÈ 4,1 ÒÚ˜). ¢ÂÓ ˘‹ÚÍ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙÂÏÈ΋ ÂÈÙ˘¯›·, ÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ Î·È ÙȘ ÂÈÏÔΤ˜. °ÂÓÈο ÛÙËÓ ·È‰È·ÙÚÈ΋ ÂÌÂÈÚ›·, Ë ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ ÚÔÛ¤Ï·ÛË ÚÔÙÈÌ¿Ù·È Ù˘ ‰È·ÔÚÙÈ΋˜, ÏfiÁˆ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ¢ÎÔÏ›·˜ ¯ÂÈÚÈÛÌÒÓ Û ۇÁÎÚÈÛË

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·131

131

∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

Ì ÙË ‰È·ÔÚÙÈ΋, ÙÔ˘ ÌÈÎÚfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘ ‚Ï¿‚˘ Ù˘ ·ÔÚÙÈ΋˜ Î·È ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ Î·È Ù˘ ·ÔÊ˘Á‹˜ ‚Ï·‚ÒÓ ÛÙÔ ÎÔÈÏÈ·Îfi Ì˘ÔοډÈÔ. ∏ Î·Ù¿Ï˘ÛË ‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ˘„ËÏfi Û¯ÂÙÈο ‚·ıÌfi ‰˘ÛÎÔÏ›·˜ Î·È Ì ÙÔÓ Î›Ó‰˘ÓÔ ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. √È Mandapati Î·È Û˘Ó (38), Û ̛· ÛÂÈÚ¿ 127 ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ (0,3-18 ÂÙÒÓ) Ì ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·, ›¯·Ó ·Ú¯È΋ ÂÈÙ˘¯›· Û ÔÛÔÛÙfi 95,6%. √È ˘ÔÙÚÔ¤˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ˜ ÛÙ· ‰ÂÍÈ¿ ‰È¿ÌÂÛ· Î·È ÚfiÛıÈ· ‰È·ÊÚ·ÁÌ·ÙÈο (12 Î·È 14%, ·ÓÙ›ÛÙÔȯ·) Û ۯ¤ÛË Ì ٷ ˘fiÏÔÈ· ‰ÂÌ¿ÙÈ· (3-4%), fiˆ˜ Î·È ÛÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∫ÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 3% ÙˆÓ ·ÛıÂÓÒÓ. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Â›Ó·È ·Ó¿ÏÔÁ· Ì ·˘Ù¿ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘ÓÔÏÈ΋ ·Ú¯È΋ ÂÈÙ˘¯›· (98%) Î·È ÛÙȘ ˘ÔÙÚÔ¤˜ (12,5%). ∂ÎÙfi˜ ·fi ‰‡Ô ·ÛıÂÓ›˜ Ì ·ÚÔ‰ÈÎfi ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ¿ÏϘ ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÁˆÁ‹˜. ™Ù· ·È‰È¿, Ë Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚfiÏÂ˘ÚˆÓ Ù·¯˘Î·Ú‰ÈÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ, ·ÎfiÌË Î·È ıÓËÙfiÙËÙ·. √È Schaffer Î·È Û˘Ó (12) ·Ó¤ÊÂÚ·Ó ıÓËÙfiÙËÙ· 0,22%, Û¯ÂÙÈ˙fiÌÂÓË ÌÂ Ì˘Ôηډȷ΋ ‚Ï¿‚Ë, ‰È¿ÙÚËÛË, ·ÈÌÔÂÚÈοډÈÔ, ıÚÔÌ‚ÔÂÌ‚ÔÏÈΤ˜ ÂÈÏÔΤ˜ ·fi Ù· ÛÙÂÊ·ÓÈ·›· ‹ ÂÁÎÂÊ·ÏÈο ·ÁÁ›· Î·È ÎÔÈÏȷ΋ ·ÚÚ˘ıÌ›·. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Û·Ó Û ·ÚÈÛÙÂÚfiÏ¢Ú˜ ÂÂÌ‚¿ÛÂȘ, ›Ù ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ Â›Ù ÛÙËÓ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·. ∏ Î·Ù¿Ï˘ÛË ·ÚÚ˘ıÌÈÒÓ Û ‚Ú¤ÊË ·ÔÙÂÏ› ÛËÌÂ›Ô ‰È·ÊˆÓ›·˜. ∞Ó Î·È ÔÈ Blaufox Î·È Û˘Ó (29) ‰ÂÓ ‚Ú‹Î·Ó ‰È·ÊÔÚÂÙÈÎfi ÔÛÔÛÙfi ÂÈÏÔÎÒÓ Û ۯ¤ÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Û ̛· ÛÂÈÚ¿ ‚ÚÂÊÒÓ ËÏÈΛ·˜ ≤18 ÌËÓÒÓ, ‰ÂÓ ı· Ú¤ÂÈ Ó· ÏËÛÌÔÓÂ›Ù·È fiÙÈ Ù· ‚Ú¤ÊË ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ÂÈÏÔÎÒÓ Û‡Ìʈӷ Ì ¿ÏÏ· ÎÏÈÓÈο (6,39) Î·È ÂÈÚ·Ì·ÙÈο (13,14) ‰Â‰Ô̤ӷ. ∆Ô ‚ÚÂÊÈÎfi Ì˘ÔοډÈÔ ·ÓÙȉڿ ‰È·ÊÔÚÂÙÈο ÛÙȘ ÂÊ·ÚÌÔÁ¤˜ Ú‡̷ÙÔ˜ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜, Ì ۯËÌ·ÙÈÛÌfi ÌÂÁ·Ï‡ÙÂÚˆÓ ‚Ï·‚ÒÓ, ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ÂÂÎÙ·ıÔ‡Ó Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Î·È Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ·ÓÒ̷Ϙ ·Ú˘Ê¤˜, ȉ›ˆ˜ fiÙ·Ó ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙÔ ÎÔÈÏÈ·Îfi Ì˘ÔοډÈÔ (13). ∂›Û˘, Ù· ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· ‚Ú›ÛÎÔÓÙ·È ÂÁÁ‡ÙÂÚ· ÛÙÔ ÛËÌÂ›Ô ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÂÓ¤ÚÁÂÈ·˜ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Î·È ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÌÂÚÈ΋ ‹ Û¿ÓÈ· ÔÏÈ΋ ·fiÊÚ·ÍË, fiˆ˜ ¤¯ÂÈ ‰Âȯı› Û ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ (14) Î·È Û Û¿ÓȘ ÎÏÈÓÈΤ˜ ÂÚÈÙÒÛÂȘ (40,41). °È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, Ë ¯Ú‹ÛË ÂÂÌ‚·ÙÈ΋˜ ıÂÚ·›·˜ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÛÙ· ‚Ú¤ÊË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ ÁÈ· ıÂÚ·›· ÂÚÈÙÒÛÂˆÓ ·ÂÈÏËÙÈÎÒÓ ÁÈ· ÙË ˙ˆ‹ Î·È ÌfiÓÔ ÌÂÙ¿ ·fi ÂÍ¿ÓÙÏËÛË ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ÌÂıfi‰ˆÓ.

∏ ÚfiÎÏËÛË ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ ÌÂÙ¿ ·fi ÂÂÌ‚¿ÛÂȘ Î·Ù¿Ï˘Û˘ ¶¢ Û ·È‰È¿ Â›Ó·È Â˘Ù˘¯Ò˜ Û¿ÓÈ·. √È Schaffer Î·È Û˘Ó (42) ·Ó¤ÊÂÚ·Ó ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi Û 23/1964 ηٷχÛÂȘ (1,2% ÙˆÓ ÂÚÈÙÒÛˆÓ). ™Â 14 ÂÚÈÙÒÛÂȘ Ô ·ÔÎÏÂÈÛÌfi˜ ‹Ù·Ó Ï‹Ú˘ Î·È Û ÂÓÓ¤· 2Ô˘ ‚·ıÌÔ‡. ∏ ·Ó¿Ù˘ÍË ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙË ı¤ÛË Î·Ù¿Ï˘Û˘ (2,7% ÁÈ· ‰ÂÍÈ¿ ÚÔÛıÈԉȷÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·, 10,4% ÁÈ· ‰ÂÍÈ¿ ‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· Î·È 1% ÁÈ· ‰ÂÍÈ¿ ÔÈÛıÈԉȷÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·). ∏ ÂÌÂÈÚ›· ÙÔ˘ ¯ÂÈÚÈÛÙ‹ ‹Ù·Ó ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. ∂Âȉ‹ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÔÈ ÌfiÓÔÈ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·ÚÔ‰ÈÎfi ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi ‹Ù·Ó ‰‡Ô ·ÛıÂÓ›˜ ËÏÈΛ·˜ 5 ÂÙÒÓ Ì ‰ÂÍÈ¿ ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·, ıˆÚÂ›Ù·È fiÙÈ Ë Î·Ù¿Ï˘ÛË ‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ Û ÌÈÎÚ¤˜ ËÏÈ˘ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ Â› ·ÂÈÏËÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ ·‰˘Ó·Ì›·˜ ÂϤÁ¯Ô˘ Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÍ¿ÏÏÔ˘ ¤¯ÂÈ ·Ó·Ù˘¯ı› Î·È Ë Ù¯ÓÈ΋ Ù˘ ÎÚ˘ÔËÍ›·˜, Ì ÙËÓ ÔÔ›· ÌÔÚ› Ó· Ú·ÁÌ·ÙÔÔÈËı› Ì ·ÛÊ¿ÏÂÈ· Î·Ù¿Ï˘ÛË ¶¢ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÛÙÂÓ‹ ÁÂÈÙÓ›·ÛË Ì ÙÔÓ ÎÔÏÔÎÔÈÏÈ·Îfi ÎfiÌ‚Ô, ·ÏÏ¿ Î·È ÎÔÌ‚È΋˜ Ù·¯˘Î·Ú‰›·˜ (43,44). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ·Ó·Ì¤ÓÂÙ·È Ó· ·›ÍÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Û ÂÚÈÙÒÛÂȘ Ô˘ Ë Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. ŒÎıÂÛË ÛÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· √È ÂÚÈÛÛfiÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ Î·Ù¿Ï˘Û˘ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Â›Ó·È ÂÌÊ·Ó›˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ Â¤Ì‚·Û˘. ∞ÓÙ›ıÂÙ·, ÔÈ Èı·Ó¤˜ ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ Ù˘ ¤ÎıÂÛ˘ Û ·ÎÙÈÓÔ‚ÔÏ›· ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ¿ÌÂÛ· ÔÚ·Ù¤˜. ÕÌÂÛ˜ ÂÈÏÔΤ˜ Ù˘ ·ÎÙÈÓÔ‚ÔÏ›·˜, fiˆ˜ ‰ÂÚÌ·Ù›Ùȉ· ‹ Ó¢ÌÔÓ›Ùȉ·, ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Û¿ÓÈ· ÌÂÙ¿ ·fi ÂÍ·ÈÚÂÙÈο ˘„ËϤ˜ ‰fiÛÂȘ. √È Ì·ÎÚÔ¯ÚfiÓȘ ÂÈÏÔΤ˜, fiˆ˜ Ë ·Ó¿Ù˘ÍË Î·ÎÔ‹ıˆÓ ÓÂÔÏ·ÛÈÒÓ, ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÔÛÙÒÓ, ÙÂÚ·ÙÔÁÂÓ¤ÛÂȘ ‹ ηٷÚÚ¿ÎÙ˘, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÌÂÙ¿ ·fi ¿Ú· ÔÏÏ¿ ¯ÚfiÓÈ·. √È Geise Î·È Û˘Ó (45) ÌÂϤÙËÛ·Ó Ì›· ÔÌ¿‰· 9 ·ÛıÂÓÒÓ, ËÏÈΛ·˜ 2-20 ÂÙÒÓ Î·È ‚¿ÚÔ˘˜ 13-72 kg. ∏ ̤ÁÈÛÙË ‰ÂÚÌ·ÙÈ΋ ‰fiÛË ÌÂÙÚ‹ıËΠÌÂٷ͇ 0,012,35 Gy (1-233 rad). ∂ӉȷʤÚÔÓ Â›Ó·È fiÙÈ Ô ‚·ıÌfi˜ ¤ÎıÂÛ˘ ·˘Í¿ÓÂÙ·È ÂÎıÂÙÈο Ì ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ‰ÈÏ·ÛÈ¿˙ÂÙ·È ÁÈ· οı 2-4 cm ·‡ÍËÛ˘ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ̤ÁÈÛÙË ‰ÂÚÌ·ÙÈ΋ ‰fiÛË (2,35 Gy) ‚Ú¤ıËΠ۠¤Ó·Ó ·ÛıÂÓ‹ ËÏÈΛ·˜ 20 ÂÙÒÓ Ô˘ ›¯Â ¯ÚfiÓÔ ·ÎÙÈÓÔÛÎfiËÛ˘ 105 min. ¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07

28-03-07

17:23

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132

π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

√È Calkins Î·È Û˘Ó (46) Î·È ÔÈ Lindsay Î·È Û˘Ó (47) ÂÎÙ›ÌËÛ·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ·‡ÍËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηÎÔ‹ıÂÈ·˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›· ÁÈ· 60 min, ‹Ù·Ó ·fi 1/1000 ¤ˆ˜ 1/745 ÂÚÈÛÙ·ÙÈο. ∂¿Ó ˘ÔÏÔÁÈÛÙ› fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÂÓfi˜ ÂÓ‹ÏÈη ÁÂÓÈο ÁÈ· ηÎÔ‹ıÂÈ· Â›Ó·È 10-20% Î·È fiÙÈ Ë ÂÚÈ‚·ÏÏÔÓÙÈ΋ ‰fiÛË ·ÎÙÈÓÔ‚ÔÏ›·˜ Â›Ó·È 10-30 Gy ·Ó¿ ¤ÙÔ˜, ÙÔ ÔÛÔÛÙfi ·‡ÍËÛ˘ Â›Ó·È Ôχ ÌÈÎÚfi. √È Û˘ÁÁÚ·Ê›˜ ·˘ÙÔ› ÂÎÙ›ÌËÛ·Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÂÓÂÙÈÎÒÓ ‚Ï·‚ÒÓ ‹Ù·Ó ¿Ú· Ôχ ¯·ÌËÏfi˜ (0,0010,002%). ∞Ó Î·È ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ·¢ı›·˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·ÎÙÈÓÔ‚ÔÏ›·˜ Î·È Ù˘ ‰fiÛ˘ Ô˘ ¤Ï·‚·Ó ÔÈ ·ÛıÂÓ›˜, Ô ¯ÚfiÓÔ˜ ¤ÎıÂÛ˘ ÛÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó ̤۷ ÛÙ· ·Ú·¿Óˆ Ï·›ÛÈ·: Ô Ì¤ÛÔ˜ fiÚÔ˜ ¤ÎıÂÛ˘ ‹Ù·Ó 32,1±26,3 (6-135) min. ™Â ηӤӷ ·ÛıÂÓ‹ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ¿ÌÂÛ˜ Ô‡Ù ̷ÎÚÔÚfiıÂÛ̘ ÂÈÏÔΤ˜ ηٿ ÙËÓ ¤ˆ˜ ÙÒÚ· ·Ú·ÎÔÏÔ‡ıËÛË (̤¯ÚÈ Î·È 10 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË). ∆· ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù· ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ¤ÎıÂÛË ÛÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· ηٿ ÙȘ ÂÂÌ‚¿ÛÂȘ Î·Ù¿Ï˘Û˘, ÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û· fiÛÔ Î·È ÛÙË ‰ÈÂıÓ‹ ÂÌÂÈÚ›·, Â›Ó·È ÁÂÓÈο ̤۷ ÛÙ· ÂÈÙÚÂÙ¿ fiÚÈ· ·ÛÊ·Ï›·˜. ¶·Ú’ fiÏ· ·˘Ù¿, ··ÈÙÂ›Ù·È Û˘Ó¯‹˜ Â·ÁÚ‡ÓËÛË Î·È ÚÔÛ¿ıÂÈ· ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚ˘ Ì›ˆÛ˘ Ù˘ ¤ÎıÂÛ˘, Ì ÛÎÔfi ÙÔÓ ÂÚÈÔÚÈÛÌfi Èı·ÓÒÓ ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ. ∏ ·Ó¿Ù˘ÍË ÓÂfiÙÂÚˆÓ Ù¯ÓÈÎÒÓ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ‹ Î·È ÂÍ¿ÏÂÈ„Ë Ù˘ ¤ÎıÂÛ˘ Û ·ÎÙÈÓÔ‚ÔÏ›·, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ Ì¤ÚÔ˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ù˘ Â¤Ì‚·Û˘ Û ·Ó·Ù˘ÛÛfiÌÂÓÔ˘˜ Ó·ÚÔ‡˜ ÔÚÁ·ÓÈÛÌÔ‡˜, οÙÈ Ô˘ Ô‰ËÁ› ·ÚÎÂÙÔ‡˜ ·ÛıÂÓ›˜ Î·È È·ÙÚÔ‡˜ Û ÛÎÂÙÈÎÈÛÌfi ˆ˜ ÚÔ˜ ÙȘ ÂÂÌ‚¿ÛÂȘ ·˘Ù¤˜. ∏ ¯Ú‹ÛË ÙÚÈۉȿÛÙ·ÙˆÓ Ù¯ÓÈÎÒÓ ¯·ÚÙÔÁÚ¿ÊËÛ˘ (48) ·ÔÙÂÏ› Ì›· Ôχ ÛËÌ·ÓÙÈ΋ ÂͤÏÈÍË Ô˘ ‹‰Ë ÂÊ·ÚÌfi˙ÂÙ·È Ì ÌÂÁ¿ÏË ÂÈÙ˘¯›·, ÙfiÛÔ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÓÔÛÔÎÔÌÂ›Ô fiÛÔ Î·È ‰ÈÂıÓÒ˜ Î·È ‚ÔËı¿ Û Ôχ ÌÂÁ¿ÏÔ ‚·ıÌfi ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË ·˘Ù‹. ªÂ ÙȘ ÓÂfiÙÂÚ˜ ÌÂıfi‰Ô˘˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù· ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ·, Ô ¯ÚfiÓÔ˜ ¤ÎıÂÛ˘ ¤¯ÂÈ ÌÂȈı› ÂÚ›Ô˘ ÛÙ· 10 min (49). ∂Ӊ›ÍÂȘ Î·Ù¿Ï˘Û˘ Û ·È‰È¿ Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ªÂ ‚¿ÛË ÙfiÛÔ ÙË ‰ÈÂıÓ‹ ÂÌÂÈÚ›·, Ô˘ Û˘ÓÔ„›ÛÙËΠ̛۠· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË (50), fiÛÔ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ë ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ ÂӉ›ÍÂȘ ÂÂÌ‚¿ÛÂˆÓ Î·Ù¿Ï˘Û˘ Û ·È‰È¿ Ì ¶¢ ¤¯Ô˘Ó ‰È·ÌÔÚʈı› ˆ˜ ·ÎÔÏÔ‡ıˆ˜: ∫Ï¿ÛË π (°ÂÓÈ΋ Û˘Ìʈӛ· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤Ó‰ÂÈÍË): Paediatriki 2007;70:123-134

·) ∞ÛıÂÓ‹˜ Ì ۇӉÚÔÌÔ Wolff-Parkinson-White Ì ÂÂÈÛfi‰ÈÔ ·ÔÛÔ‚Ëı¤ÓÙÔ˜ ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘. ‚) ™‡Ó‰ÚÔÌÔ Wolff-Parkinson-White Û¯ÂÙÈ˙fiÌÂÓÔ ÌÂ Û˘ÁÎÔ‹ Î·È ‚Ú·¯Â›· ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô ÙÔ˘ ‰ÂÌ·Ù›Ô˘ (<250 msec) ‹ Ù·¯¤ˆ˜ ·ÁfiÌÂÓË ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ (‚Ú·¯‡ÙÂÚÔ ÚÔ‰ÈÂÁÂṲ́ÓÔ ‰È¿ÛÙËÌ· RR <250 msec). Á) ÃÚfiÓÈ· À∆ Ì ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÎÔÈÏÈÒÓ - Ì˘ÔηډÈÔ¿ıÂÈ·. ∫Ï¿ÛË ππ∞ (√È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌʈÓÔ‡Ó): ·) ÀÔÙÚÔÈ¿˙Ô˘Û·, Û˘Ìو̷ÙÈ΋ À∆, ·ÓıÂÎÙÈ΋ ÛÙË Û˘Ó‹ıË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ‚) ∞›ÛıËÌ· ·ÏÌÒÓ Ì ÚÔÎÏËÙ‹ À∆ ηٿ ÙË ‰È¿ÚÎÂÈ· ∏ºª. Á) ∂ÈΛÌÂÓË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Ô˘ ÌÔÚ› Ó· ÙÚÔÔÔÈ‹ÛÂÈ ÙËÓ ÂÓ‰Ôηډȷ΋ ·Ó·ÙÔÌ›· Î·È Ó· ηٷÛÙ‹ÛÂÈ Èı·Ó‹ Î·Ù¿Ï˘ÛË ÛÙÔ Ì¤ÏÏÔÓ Ôχ ‰‡ÛÎÔÏË ‹ ·‰‡Ó·ÙË. ‰) ∞ηٿ·˘ÛÙË Ù·¯˘Î·Ú‰›· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·. ∫Ï¿ÛË ππµ (À¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·ÊˆÓ›· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤Ó‰ÂÈÍË): ·) ∞Û˘Ìو̷ÙÈÎfi˜ ·ÛıÂÓ‹˜ Ì ۇӉÚÔÌÔ Wolff-Parkinson-White, ËÏÈΛ·˜ >5 ÂÙÒÓ, ·ÊÔ‡ ÂÍËÁËıÔ‡Ó Ù· ÔʤÏË Î·È ÔÈ Î›Ó‰˘ÓÔÈ Ù˘ Â¤Ì‚·Û˘, ηıÒ˜ Î·È Ô Î›Ó‰˘ÓÔ˜ Èı·Ó‹˜ ·ÚÚ˘ıÌ›·˜. ‚) À∆ Û ËÏÈΛ· >5 ÂÙÒÓ, ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ¯ÚfiÓÈ·˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Ô˘ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋. Á) À∆ Û ·ÛıÂÓ›˜ <5 ÂÙÒÓ, fiÙ·Ó Ë ¯ÚfiÓÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È ÛÔÙ·ÏfiÏ˘ ‹ ·ÌÈÔ‰·ÚfiÓ˘) Â›Ó·È ·ÓÂÈÙ˘¯‹˜ ‹ ¤¯ÂÈ ·ÚÂÓ¤ÚÁÂȘ. ∫Ï¿ÛË πππ (À¿Ú¯ÂÈ Û˘Ìʈӛ· fiÙÈ Ë Î·Ù¿Ï˘ÛË ·ÓÙÂӉ›ÎÓ˘Ù·È ‹ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi Ù· ÔʤÏË): ·) ∞Û˘Ìو̷ÙÈÎfi˜ ·ÛıÂÓ‹˜ <5 ÂÙÒÓ Ì ۇӉÚÔÌÔ Wolff-Parkinson-White. ‚) À∆ ÂÏÂÁ¯fiÌÂÓË ÌÂ Û˘Ó‹ıË ·ÓÙÈ·ÚÚ˘ıÌÈο Ê¿Ú̷η Û ·ÛıÂÓ‹ ËÏÈΛ·˜ <5 ÂÙÒÓ. Á) ∂ÂÈÛfi‰È· ÌË ÂÌ̤ÓÔ˘Û·˜ À∆, Û ÔÏÈÁÔÛ˘Ìو̷ÙÈÎÔ‡˜ ‹ ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Ludomirsky A, Garson A. Supraventricular tachycardia.

In: Gillette PC, Garson A Jr, editors. Pediatric Arrhythmias, Electrophysiology and Pacing. Philadelphia: WB Saunders; 1990. p. 380-426.

2. Sorbo MD, Buja GF, Miorelli M, Nistri S, Perrone C, Manca S et al. The prevalence of the Wolff-ParkinsonWhite syndrome in a population of 116,542 young males.

G Ital Cardiol 1995;25:681-687.

3. Chung KY, Walsh TJ, Massie E. Wolff-Parkinson-White syndrome. Am Heart J 1965;69:116-133.

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∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

4. Cobb FR, Blumenschein SD, Sealy WC, Boineau JP, Wagner GS, Wallace AG. Successful surgical interruption of the bundle of Kent in a patient with Wolff-ParkinsonWhite syndrome. Circulation 1968;38:1018-1029.

5. Huang SK, Bharati S, Graham AR, Lev M, Marcus FI, Odell RC. Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy: a new method of catheter ablation. J Am Coll Cardiol 1987;9:349-358.

6. Kugler JD, Danford DA, Deal BJ, Gillette PC, Perry JC, Silka MJ, et al, Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. N Engl J Med 1994;330:14811487.

7. Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997;80:1438-1443.

8. Manolis AS, Vassilikos V, Maounis TN, Chiladakis J, Cokkinos DV. Radiofrequency ablation in older children and adolescents by an adult electrophysiology team. J Interv Card Electrophysiol 1999;3:79-86.

9. Jackman WM, Wang XZ, Friday KJ, Roman CA, Moulton KP, Beckman KJ et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991;324: 1605-1611.

10. Calkins H, Sousa J, el-Atassi R, Rosenheck S, de Buitleir M, Kou WH et al. Diagnosis and cure of the Wolff-ParkinsonWhite syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med 1991;324:1612-1618.

11. Schluter M, Geiger M, Siebels J, Duckeck W, Kuck KH. Catheter ablation using radiofrequency current to cure symptomatic patients with tachyarrhythmias related to an accessory atrioventricular pathway. Circulation 1991;84: 1644-1661.

12. MS, Gow RM, Moak JP, Saul JP. Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry). Participating members of the Pediatric Electrophysiology Society. Am J Cardiol 2000;86:639-643.

13. Saul JP, Hulse JE, Papagiannis J, Van Praagh R, Walsh EP. Late enlargement of radiofrequency lesions in infant lambs. Implications for ablation procedures in small children. Circulation 1994;90:492-499.

14. Paul T, Bokenkamp R, Mahnert B, Trappe HJ. Coronary artery involvement early and late after radiofrequency current application in young pigs. Am Heart J 1997;133: 436-440.

15. Perry JC, Garson A Jr. Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol 1990;16: 1215-1220.

16. Smith WM, Gallagher JJ, Kerr CR, Sealy WC, Kasell JH, Benson DW Jr et al. The electrophysiologic basis and management of symptomatic recurrent tachycardia in patients with Ebstein's anomaly of the tricuspid valve. Am J Cardiol 1982;49:1223-1234.

17. Van Hare GF, Lesh MD, Stanger P. Radiofrequency catheter ablation of supraventricular arrhythmias in pa-

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

tients with congenital heart disease: results and technical considerations. J Am Coll Cardiol 1993;22:883-890.

Chiou CW, Chen SA, Chiang CE, Wu TJ, Tai CT, Lee SH et al. Radiofrequency catheter ablation of paroxysmal supraventricular tachycardia in patients with congenital heart disease. Int J Cardiol 1995;50:143-151.

Cox JL, Gallagher JJ, Cain ME. Experience with 118 consecutive patients undergoing operation for the WolffParkinson-White syndrome. J Thorac Cardiovasc Surg 1985;90:490-501.

Chetaille P, Walsh EP, Triedman JK. Outcomes of radiofrequency catheter ablation of atrioventricular reciprocating tachycardia in patients with congenital heart disease. Heart Rhythm 2004;1:168-173.

Tanel RE, Walsh EP, Triedman JK, Epstein MR, Bergau DM, Saul JP. Five-year experience with radiofrequency catheter ablation: implications for management of arrhythmias in pediatric and young adult patients. J Pediatr 1997;131:878-887.

Kugler JD, Danford DA, Houston KA, Felix G; Pediatric Radiofrequency Ablation Registry of the Pediatric Electrophysiology Society. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002;13: 336-341.

Park JK, Halperin BD, McAnulty JH, Kron J, Silka MJ. Comparison of radiofrequency catheter ablation procedures in children, adolescents, and adults and the impact of accessory pathway location. Am J Cardiol 1994;74:786-789.

Wu MH, Lin JL, Lai LP, Young ML, Lu CW, Chang YC et al. Radiofrequency catheter ablation of tachycardia in children with and without congenital heart disease: indications and limitations. Int J Cardiol 2000;72:221-227.

Weng KP, Wolff GS, Young ML. Multiple accessory pathways in pediatric patients with Wolff-Parkinson-White syndrome. Am J Cardiol 2003;91:1178-1183.

Langberg JJ, Calkins H, Kim YN, Sousa J, el-Atassi R, Leon A et al. Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter ablation. J Am Coll Cardiol 1992;19:15881592.

Timmermans C, Smeets JL, Rodriguez LM, Oreto G, Medina E, Notheis W et al. Recurrence rate after accessory pathway ablation. Br Heart J 1994;72:571-574.

Wang L, Hu D, Ding Y, Powell AC, Davis MJ. Predictors of early and late recurrence of atrioventricular accessory pathway conduction after apparently successful radiofrequency catheter ablation. Int J Cardiol 1994;46:61-65.

Blaufox AD, Felix GL, Saul JP; Pediatric Catheter Ablation Registry. Radiofrequency catheter ablation in infants ≤18 months old: when is it done and how do they fare?: shortterm data from the pediatric ablation registry. Circulation 2001;104:2803-2808.

Reich JD, Auld D, Hulse E, Sullivan K, Campbell R. The Pediatric Radiofrequency Ablation Registry's experience with Ebstein's anomaly. Pediatric Electrophysiology Society. J Cardiovasc Electrophysiol 1998;9:1370-1377.

Manolis AS, Vassilikos V, Maounis TN, Chiladakis J, Cokkinos DV. Radiofrequency ablation in pediatric and adult patients: comparative results. J Interv Card Electrophysiol 2001;5:443-453. ¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07

28-03-07

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™ÂÏ›‰·134

134

π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

32. Vaksmann G, D’Hoinne C, Lucet V, Guillaumont S, Lupoglazoff JM, Chantepie A et al. Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome. Heart 2006;92:101-104.

33. Pappone C, Manguso F, Santinelli R, Vicedomini G, Sala S, Paglino G et al. Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 2004;351:1197-1205.

34. Lesh MD, Van Hare GF, Scheinman MM, Ports TA, Epstein LA. Comparison of the retrograde and transseptal methods for ablation of left free wall accessory pathways. J Am Coll Cardiol 1993;22:542-549.

35. Natale A, Wathen M, Yee R, Wolfe K, Klein G. Atrial and ventricular approaches for radiofrequency catheter ablation of left-sided accessory pathways. Am J Cardiol 1992; 70:114-116.

36. Deshpande SS, Bremner S, Sra JS, Dhala AA, Blanck Z, Bajwa TK et al. Ablation of left free-wall accessory pathways using radiofrequency energy at the atrial insertion site: transseptal versus transaortic approach. J Cardiovasc Electrophysiol 1994;5:219-231.

37. Law IH, Fischbach PS, LeRoy S, Lloyd TR, Rocchini AP, Dick M. Access to the left atrium for delivery of radiofrequency ablation in young patients: retrograde aortic vs transseptal approach. Pediatr Cardiol 2001;22:204-209.

38. Mandapati R, Berul CI, Triedman JK, Alexander ME, Walsh EP. Radiofrequency catheter ablation of septal accessory pathways in the pediatric age group. Am J Cardiol 2003;92:947-950.

39. Benito Bartolome F, Sanchez Fernandez-Bernal C. Catheter ablation of accessory pathways in infants and children weighing less than 10 kg. Rev Esp Cardiol 1999;52: 398-402.

40. Paul T, Kakavand B, Blaufox AD, Saul JP. Complete occlusion of the left circumflex coronary artery after radiofrequency catheter ablation in an infant. J Cardiovasc Electrophysiol 2003;14:1004-1006.

41. Benito Bartolome F, Sanchez Fernandez-Bernal C, Jimenez Casso S. Coronary ischemia during radiofrequency ablation of left lateral accessory pathway in an infant. Rev Esp Cardiol 1998;51:343-345.

Paediatriki 2007;70:123-134

42. Schaffer MS, Silka MJ, Ross BA, Kugler JD. Inadvertent atrioventricular block during radiofrequency catheter ablation. Results of the Pediatric Radiofrequency Ablation Registry. Pediatric Electrophysiology Society. Circulation 1996;94:3214-3220.

43. Drago F, De Santis A, Grutter G, Silvetti MS. Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients: efficacy, safety, and midterm follow-up. J Am Coll Cardiol 2005;45:1096-1103.

44. Kriebel T, Broistedt C, Kroll M, Sigler M, Paul T. Efficacy and safety of cryoenergy in the ablation of atrioventricular reentrant tachycardia substrates in children and adolescents. J Cardiovasc Electrophysiol 2005;16:960-969.

45. Geise RA, Peters NE, Dunnigan A, Milstein S. Radiation doses during pediatric radiofrequency catheter ablation procedures. Pacing Clin Electrophysiol 1996;19:1605-1611.

46. Calkins H, Niklason L, Sousa J, el-Atassi R, Langberg J, Morady F. Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections. Circulation 1991;84:2376-2382.

47. Lindsay BD, Eichling JO, Ambos HD, Cain ME. Radiation exposure to patients and medical personnel during radiofrequency catheter ablation for supraventricular tachycardia. Am J Cardiol 1992;70:218-223.

48. Drago F, Silvetti MS, Di Pino A, Grutter G, Bevilacqua M, Leibovich S. Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. J Cardiovasc Electrophysiol 2002;13:778-782.

49. Papagiannis J, Tsoutsinos A, Kirvassilis G, Sofianidou I, Koussi T, Laskari C et al. Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventricular tachycardia in children. Pacing Clin Electrophysiol 2006;29:971-978.

50. Friedman RA, Walsh EP, Silka MJ, Calkins H, Stevenson WG, Rhodes LA et al. NASPE Expert Consensus Conference: Radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 2002;25:1000-1017.

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ORIGINAL ARTICLE

135

ÃÚ‹ÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ Î·È Û˘ÌÏËڈ̷ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ Û ·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ∞. ¶Ô˘ÚÙÛ›‰Ë˜, ¢. ¢ÔÁ¿Ó˘, ª. ª¿Î·, ª. µ·Ú‚Ô˘ÙÛ‹, ¢. ªÔ˘¯Ô‡ÙÛÔ˘, ¶. ÷Ù˙‹, ∂. ∫ÔÛÌ›‰Ë

√ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ ¯Ú‹ÛË Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ (™∂£) Â›Ó·È Û˘¯Ó‹ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÔ‰È΋ Ù¿ÛË, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌ‹ÛÔ˘Ì ÙË Û˘¯ÓfiÙËÙ· Ù˘ ¯Ú‹Û˘ ™∂£ Î·È ÙȘ ·Èٛ˜ Ô˘ Ô‰‹ÁËÛ·Ó ÛÙË ¯Ú‹ÛË, Ù·¯˘‰ÚÔÌ‹ıËΠÛÙÔ˘˜ ÁÔÓ›˜ 184 ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ¤Ó· ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. ∞ÔÙÂϤÛÌ·Ù·: ∞·ÓÙ‹ıËÎ·Ó 110 ·fi Ù· 184 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (59,8%). 23/110 ÔÈÎÔÁ¤ÓÂȘ (21%) ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÌÔÚÊ‹ ™∂£. √È Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ™∂£ ‹Ù·Ó ÚÔÛ¢¯¤˜/ ÙÂÏÂÙÔ˘ÚÁ›Â˜ 18/23 (78%), ıÂÚ·›˜ Ù¤¯Ó˘ 4, ‰È·ÈÙËÙÈο Û˘ÌÏËÚÒÌ·Ù· 3, Ì·Û¿˙ 3, ÔÌÔÈÔ·ıËÙÈ΋ 2 Î·È ‚fiÙ·Ó· 2. √È ÏfiÁÔÈ ¯Ú‹Û˘ ™∂£ ‹Ù·Ó Ó· Á›ÓÂÈ ÙÔ ·È‰› ÈÔ ‰˘Ó·Ùfi (17/23), Ë ÂÏ›‰· fiÙÈ ı· ÛÙ·Ì·Ù‹ÛÂÈ Ë ÂͤÏÈÍË ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ (11/23) Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Ù˘ ıÂÚ·›·˜ Î·È Ù˘ ÓfiÛÔ˘ (6/23). √È ÁÔÓ›˜ Ô˘ ‰ÂÓ ¤Î·Ó·Ó ¯Ú‹ÛË ™∂£ ·Ó¤ÊÂÚ·Ó ˆ˜ ÏfiÁÔ˘˜ ÙËÓ ÂÌÈÛÙÔÛ‡ÓË ÛÙË ıÂÚ·¢ÙÈ΋ ÔÌ¿‰· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ï‹ ÔÚ›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ (84%), ÙËÓ ¤ÏÏÂÈ„Ë ÏËÚÔÊfiÚËÛ˘ (24%) ÂÓÒ 7,5% ‰ÂÓ ·¤ÎÏÂÈ·Ó a priori ÙË ¯Ú‹ÛË ÙÔ˘˜. ∏ ¯Ú‹ÛË ™∂£ ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ËÏÈΛ·, ʇÏÔ, ÂıÓÈÎfiÙËÙ·, ÌfiÚʈÛË, Â¿ÁÁÂÏÌ· ÁÔÓÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘, Ô‡Ù Ì ÙË ‰È¿ÁÓˆÛË, ÙÔÓ ÙÚfiÔ ıÂÚ·›·˜ Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙË ‰È¿ÁÓˆÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË ™∂£ ÛÙȘ ÂÏÏËÓÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ‰ËÌÔÊÈÏ‹˜. √È ÂÌÂÈڛ˜ ·fi ÙË ¯Ú‹ÛË ‹Ù·Ó ÁÂÓÈο ıÂÙÈΤ˜.

AÏÏËÏÔÁÚ·Ê›·: ∞. °. ¶Ô˘ÚÙÛ›‰Ë˜ tolisp@otenet.gr ∞Ê·›·˜ 14, ∆.∫. 15452, æ˘¯ÈÎfi

§¤ÍÂȘ ÎÏÂȉȿ: ™˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜, ·È‰›, ηÎfiËı˜ ÓÂfiÏ·ÛÌ·.

Use of alternative and complementary therapy by paediatric oncology patients in Greece A. Pourtsidis, D. Doganis, M. Baka, M. Varvoutsi, D. Bouhoutsou, P. Xatzi, H. Kosmidis Abstract Background: Complementary and alternative medicine (CAM) therapies are used by increasing numbers of children with cancer.

Methods: A self-reported questionnaire was given to parents of 184 children with cancer. The prevalence of the use and non-use of CAM therapies and factors that influence the use were estimated.

Results: Based on the 110 questionnaires which were completed (59.8% of the families), 23 families (21%) had used at least one alternative treatment. The most common forms of CAM therapy were: spiritual healing/prayer/blessings 18/23 (78%), art therapies 4, dietary supplements 3, massage 3, homeopathy 2, and herbal treatments 2. The reasons given for use of CAM included: making the child stronger 17/23, hope of stopping the cancerous process 11/23, and coping with side effects 6/23.

Those parents not using CAM referred to their confidence to the medical team, and the child doing well and therefore their not seeing the need for CAM use (84%), or not being aware of CAM (24%); another 7.5 % had considered using it. In bivariate analysis, CAM use was not found to be associated either with the age, sex, nationality, education or occupation of the respondents at the time of the survey, or with the diagnosis, mode of therapy or the age of the child at diagnosis.

Conclusions: The use of CAM therapies by Greek families for their children with cancer does not appear to be very popular, although the experiences of those who did use them were generally positive.

Oncology Department, “P. & A. Kyriakou” Children’s Hospital Correspondence: A. G. Pourtsidis tolisp@otenet.gr 14, Aphaias St., 15452 Psychiko, Athens, Greece

Key words: Complementary and alternative therapies, child, cancer.

¶·È‰È·ÙÚÈ΋ 2007;70:135-140

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·136

136

∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.

™˘ÓÙÔÌÔÁڷʛ˜ ™∂π MM∂ ™∂£

Û˘ÌÏËڈ̷ÙÈ΋ Î·È ÂÓ·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋ ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ Û˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜

∂ÈÛ·ÁˆÁ‹ ∏ ÌË Û˘Ì‚·ÙÈ΋ È·ÙÚÈ΋, ÁÓˆÛÙ‹ Â›Û˘ ˆ˜ Û˘ÌÏËڈ̷ÙÈ΋ Î·È ÂÓ·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋ (™∂π), Â›Ó·È ÛËÌ·ÓÙÈ΋ Î·È Ë ¯Ú‹ÛË Ù˘ ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓË, ȉȷ›ÙÂÚ· ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ηÎfiËı˜ ÓÂfiÏ·ÛÌ·. º·›ÓÂÙ·È fiÙÈ Ë ÏÂÈÔ„ËÊ›· ¯ÚËÛÈÌÔÔÈ› ÙË ™∂π ˆ˜ Û˘Ìϋڈ̷ Ù˘ Û˘Ì‚·ÙÈ΋˜ È·ÙÚÈ΋˜ Î·È fi¯È ÂÓ·ÏÏ·ÎÙÈο (1). ∫·Ù¿ ÙÔ˘˜ Eisenberg Î·È Û˘Ó. (2), ˆ˜ ™∂π ÔÚ›˙ÂÙ·È ÔÌ¿‰· ‰È·ÊÔÚÂÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ, È·ÙÚÈÎÒÓ Î·È ·ÚÔ¯‹˜ ˘Á›·˜, Ú·ÎÙÈÎÒÓ Î·È ÚÔ˚fiÓÙˆÓ Ù· ÔÔ›· ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ Ù˘ Û˘Ì‚·ÙÈ΋˜ È·ÙÚÈ΋˜ Ô‡Ù ·ÓÙÈΛÌÂÓÔ ‰È‰·Ûηϛ·˜ ÛÙȘ È·ÙÚÈΤ˜ Û¯ÔϤ˜. ∞ÔÙÂÏÂ›Ù·È ·fi ÔÈΛϘ Ù¯ÓÈΤ˜ fiˆ˜ ÚÔÛ¢¯¤˜, ıÚËÛ΢ÙÈΤ˜ ÙÂÏÂÙÔ˘ÚÁ›Â˜, ÔÓÂÈÚÔfiÏËÛË, ¯·Ï¿ÚˆÛË, Ì·Û¿˙, ‚fiÙ·Ó·, ‰È¿ÊÔÚ˜ ‰›·ÈÙ˜, ¯ÂÈÚÔÚ·ÎÙÈ΋ Î·È ‚ÂÏÔÓÈÛÌfi, (¶›Ó·Î·˜ 1). √˘ÛÈ·ÛÙÈο Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi “ıÂÚ·ÂÈÒÓ” ·fi ÙËÓ ÔÌÔÈÔ·ıËÙÈ΋ ̤¯ÚÈ ÙË yoga (3), Ô˘ Û˘Ó‹ıˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ‚ÔËıËÙÈΤ˜ ÁÈ· ÙË ıÂÚ·›· ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Î·È ÁÈ· ·Ó·ÎÔ‡ÊÈÛË ·fi Ù· Û˘ÌÙÒÌ·Ù· (4-6). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë ·ÁÎfiÛÌÈ· ‚È‚ÏÈÔÁÚ·Ê›· ¤¯ÂÈ Î·Ù·ÎÏ˘Ûı› ·fi ÌÂϤÙ˜ ÁÈ· Û˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜ (™∂£) Ì ÔÛÔÛÙ¿ ¯ÚËÛÙÒÓ ·fi 22% ¤ˆ˜ 73%, ·ÏÏ¿ Ù· ·ÔÙÂϤÛÌ·Ù· ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙË Î·È ¤Ú¢ӷ (7). ŒÓ· ·fi Ù· ϤÔÓ ‰‡ÛÎÔÏ· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÂÚ¢ÓÒÓ Â›Ó·È Ô ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ ÏÂÁfiÌÂ-

ÓˆÓ ·ÏÒÓ “˘ÔÛÙËÚÈÎÙÈÎÒÓ” Ì¤ÛˆÓ (.¯. ıÂÚ·¢ÙÈ΋ Â·Ê‹, Ì·Û¿˙, ‚ÂÏÔÓÈÛÌfi˜, ÚÔÛÊ˘Á‹ ÛÙË ıÚËÛΛ·) ·fi ÂΛӘ Ì ϋ„Ë Ê·Ú̿ΈÓ, ‚ÈÙ·ÌÈÓÒÓ ‹ ·Ú·Û΢·ÛÌ¿ÙˆÓ ·fi ‚fiÙ·Ó· Ô˘ ·ÔÛÎÔÔ‡Ó ÛÙËÓ “¢ÓÔ˚΋ ÙÚÔÔÔ›ËÛË Ù˘ ÓÔÛÔÁfiÓÔ˘ ‰È·‰Èηۛ·˜, ÛÙËÓ ÂÓ‰˘Ó¿ÌˆÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÓÔÛ›·˜ ‹ ÛÙË Ì›ˆÛË Ù˘ ÙÔÍÈÎfiÙËÙ·˜ Ù˘ ıÂÚ·›·˜” ÔÈ Ôԛ˜ Â›Ó·È ÔÈ ϤÔÓ ÛÔ‚·Ú¤˜ Î·È ÚÔ‚ÏËÌ·ÙÈΤ˜ ÌË Û˘Ì‚·ÙÈΤ˜ “ıÂÚ·›˜” (8). ∏ ÚÔÛÊ˘Á‹ ÛÙȘ ™∂£ ÂÌÊ·Ó›˙ÂÙ·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Î·È ÛÙËÓ ·È‰È·ÙÚÈ΋, ȉ›ˆ˜ ÌÂٷ͇ ÙˆÓ ÁÔÓÈÒÓ Ì ˘„ËÏfi ÂÈÛfi‰ËÌ· Î·È ÌfiÚʈÛË (9). ∆· ÔÛÔÛÙ¿ ÁÈ· ·È‰È¿ Ì ¯ÚfiÓȘ Î·È ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ˜ ·ÚÚÒÛÙȘ fiˆ˜ ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ¿ÛıÌ·, ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·, ΢ÛÙÈ΋ ›ÓˆÛË Î˘Ì·›ÓÔÓÙ·È ·fi 30-70% (10). √È ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ ’70 Î·È ’80 ˘ÔÛÙ‹ÚÈÍ·Ó fiÙÈ Ë ¯Ú‹ÛË ™∂£ ‹Ù·Ó οو ÙÔ˘ 20%, ·ÏÏ¿ ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ 31 ¤ˆ˜ Î·È 84% ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ¯ÚËÛÈÌÔÔ›ËÛ·Ó Ù¤ÙÔȘ ıÂÚ·›˜. √ ÙÚfiÔ˜ Ô˘ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÁÔÓ›˜ ÙË ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË .¯. Ë ÂÈı˘Ì›· “Ó· ‰ÔÎÈÌ¿ÛÔ˘Ì ٷ ¿ÓÙ·” ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·fiÊ·Û‹ ÙÔ˘˜ Ó· ¯ÚËÛÈÌÔÔÈ‹ÛÔ˘Ó ™∂£. ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Â›Ó·È Ë Î·Î‹ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, Ë ÚÔËÁÔ‡ÌÂÓË ÂÌÂÈÚ›· ·fi ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ·ÚÂÌ‚¿ÛˆÓ, ÙÔ ˘„ËÏfi ÌÔÚʈÙÈÎfi Î·È ÔÈÎÔÓÔÌÈÎfi Â›‰Ô, Ë ÌÂÁ¿ÏË ËÏÈΛ·, Î·È ÙÔ ·Ó·Ù˘Á̤ÓÔ ıÚËÛ΢ÙÈÎfi Û˘Ó·›ÛıËÌ· (11).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂ ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ¯Ú‹Û˘ ™∂£ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÛÙË

¶›Ó·Î·˜ 1. ∫·ÙËÁÔڛ˜ Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ·fi ÙÔ ∂ıÓÈÎfi ΤÓÙÚÔ ™∂π ÛÙȘ ∏¶∞ ∆‡Ô˜ ™∂π

√ÚÈÛÌfi˜

¶·Ú·‰Â›ÁÌ·Ù·

∂Ó·ÏÏ·ÎÙÈο Û˘ÛÙ‹Ì·Ù· π·ÙÚÈ΋˜

¶Ï‹ÚË Û˘ÛÙ‹Ì·Ù· ıˆڛ·˜ Î·È Ú¿Í˘

√ÌÔÈÔ·ıËÙÈ΋, ·Ú·‰ÔÛȷ΋ ÎÈÓ¤˙ÈÎË È·ÙÚÈ΋, ayurvedic È·ÙÚÈ΋, Ê˘ÛÈÔıÂÚ·›·

æ˘¯Ôۈ̷ÙÈ΋ È·ÙÚÈ΋

¶ÔÈÎÈÏ›· Ù¯ÓÈÎÒÓ Û¯Â‰È·ÛÌ¤ÓˆÓ Ó· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ Ó‡̷ÙÔ˜ Ó· ÂËÚ¿˙ÂÈ ÛˆÌ·ÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÙÒÌ·Ù·

∞˘ÙÔÛ˘ÁΤÓÙÚˆÛË (ÛÙÔ¯·ÛÌfi˜), ÚÔÛ¢¯‹, ÔÌ¿‰Â˜ ÛÙ‹ÚÈ͢ ·ÛıÂÓÒÓ, Ù¤¯ÓË, ÌÔ˘ÛÈ΋, ¯ÔÚfi˜, ¯·Ï¿ÚˆÛË, ÂÓfiÚ·ÛË, ˘ÓÔıÂÚ·›·, yoga

µÈÔÏÔÁÈΤ˜ ıÂÚ·›˜

√˘Û›Â˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙË Ê‡ÛË

¢È·ÈÙËÙÈο Û˘ÌÏËÚÒÌ·Ù·, ‚Èٷ̛Ә, ‚fiÙ·Ó·, ‰È¿ÊÔÚ· Âί˘Ï›ÛÌ·Ù· Î·È ¿ÏϘ “Ê˘ÛÈΤ˜” ıÂÚ·›˜ ·ÏÏ¿ ·ÓÂ·ÚΛ˜ Ì ÂÈÛÙËÌÔÓÈο ÎÚÈÙ‹ÚÈ· (.¯. ¯fiÓ‰ÚÔ˜ ·fi ηگ·Ú›·)

∂ȉ¤ÍÈÔÈ ¯ÂÈÚÈÛÌÔ› Ì ٷ ¯¤ÚÈ·

º˘ÛÈÎÔıÂÚ·›· Î·È / ‹ ÎÈÓ‹ÛÂȘ ÌÂÚÒÓ ÙÔ˘ ÛÒÌ·ÙÔ˜

ÃÂÈÚÔÚ·ÎÙÈ΋ ‹ ÔÛÙÈ΋ Ê˘ÛÈÎÔıÂÚ·›·, Ì·Û¿˙

£ÂÚ·›˜ ÂÓ¤ÚÁÂÈ·˜ - µÈÔÂÓÂÚÁËÙÈΤ˜ ıÂÚ·›˜ ™Ùfi¯Ô ¤¯Ô˘Ó Ó· ÂËÚ¿˙Ô˘Ó ÂÓÂÚÁÂȷο ‰›· Ô˘ ÛËÌÂÈÔÏÔÁÈο ÂÚÈ‚¿ÏÔ˘Ó Î·È ÂÈÛ¯ˆÚÔ‡Ó ÛÙÔ ·ÓıÚÒÈÓÔ ÛÒÌ· - µÈÔËÏÂÎÙÚÔÌ·ÁÓËÙÈΤ˜ ªË Û˘Ì‚·ÙÈ΋ ¯Ú‹ÛË ËÏÂÎÙÚÔÌ·ÁÓËÙÈÎÒÓ ‰›ˆÓ Paediatriki 2007;70:135-140

Qi gong, Reiki, ıÂÚ·¢ÙÈÎfi ¿ÁÁÈÁÌ·

∆ÔÓÈο ‰›·, Ì·ÁÓËÙÈο ‰›·, ÂÓ·ÏÏ·ÛÛfiÌÂÓ· ÙÚ¤¯ÔÓÙ· ‹ ¿ÌÂÛ· ÙÚ¤¯ÔÓÙ· ‰›·

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·137

137

∂Ó·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜ Û ·È‰È¿ Ì ηÎÔ‹ıÂȘ

¯ÒÚ· Ì·˜, ÙËÓ ·ÈÙÈÔÏfiÁËÛË ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÔÓÈÒÓ Ù˘ Ú·ÎÙÈ΋˜ ·˘Ù‹˜ ηıÒ˜ Î·È ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÛÙË ¯ÒÚ· Ì·˜ Ì ÂΛӷ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÚÔ¯ˆÚ‹Û·Ì ÛÙË Û‡ÓÙ·ÍË ¤ÓÙ˘Ô˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ì ÙÚ›· ‰›·: 1. ∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ (ʇÏÔ, ËÏÈΛ·, Â¿ÁÁÂÏÌ·, Û˘ÁÁÂÓÈ΋ Û¯¤ÛË Ì ÙÔ ·È‰›, ÂıÓÈÎfiÙËÙ·) Î·È ÛÙÔȯ›· ÁÈ· ÙÔ ·È‰› Î·È ÙË ÓfiÛÔ ÙÔ˘ (ʇÏÔ, ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË, ›‰Ô˜ ÓfiÛÔ˘, ›‰Ô˜ ıÂÚ·›·˜, ¯ÚfiÓÔ ·fi ÙË ‰È¿ÁÓˆÛË ‹ ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂÚ·›·˜ Î·È ÙÔ ·Ó Ë ÓfiÛÔ˜ ‚Ú›ÛÎÂÙ·È Û ‡ÊÂÛË ‹ fi¯È ηٿ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘).

2. ∞˘ÙÔ› Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ ·Ó¤ÊÂÚ·Ó ÙÔ Â›‰Ô˜ ÙÔ˘˜, Ù· ÔʤÏË Ô˘ ÚԤ΢„·Ó, Ù· ΛÓËÙÚ· Ô˘ ÙÔ˘˜ Ô‰‹ÁËÛ·Ó ÛÙË ¯Ú‹ÛË ÙÔ˘˜, ÙÔ˘˜ ‰È·‡ÏÔ˘˜ ÏËÚÔÊfiÚËÛ˘ ÁÈ’ ·˘Ù¤˜ ÙȘ ıÂÚ·›˜, ÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ ¯Ú‹Û˘ ÙÔ˘˜, ÙË Û˘¯ÓfiÙËÙ· ¯Ú‹Û˘ ÙÔ˘˜ ηıÒ˜ Î·È ÙËÓ ÚfiıÂÛ‹ ÙÔ˘˜ Ó· ÂÓËÌÂÚÒÛÔ˘Ó ¿ÏÏÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘˜. ∆¤ÏÔ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙËÓ ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ ‚·ıÌÔÏÔÁÒÓÙ·˜ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ Ì ‚¿ÛË ÙËÓ Îϛ̷η 1-10.

3. ∞˘ÙÔ› Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ ·Ó¤Ï˘Û·Ó ÙÔ˘˜ ÏfiÁÔ˘˜ Ù˘ ÂÈÏÔÁ‹˜ ÙÔ˘˜. √ ÏËı˘ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ÂÚÈÂÏ¿Ì‚·Ó ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰È·ÁÓÒÛıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ ·fi ÙËÓ 1Ë π·ÓÔ˘·Ú›Ô˘ 2001 ¤ˆ˜ Î·È ÙËÓ 31Ë ¢ÂÎÂÌ‚Ú›Ô˘ 2003 Î·È Ù· ÔÔ›· ‹Ù·Ó ÂÓ ˙ˆ‹ ηٿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ÌÂϤÙ˘ (ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ ÙÔ˘ 2004). ∆·¯˘‰ÚÔÌ‹ıËÎ·Ó 184 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ì ÙËÓ ·Ú¿ÎÏËÛË Ó· ÂÈÛÙÚ·ÊÔ‡Ó ··ÓÙË̤ӷ ¯ˆÚ›˜ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔȯ›· Ô˘ Ó· ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ Ù·˘ÙfiÙËÙ· ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ÛÙËÓ ··ÓÙËÙÈ΋ ÂÈÛÙÔÏ‹. ∞ÊÔ‡ ¤ÁÈÓÂ Û˘ÏÏÔÁ‹ ÙˆÓ ÂÈÛÙÔÏÒÓ, Ù· ÛÙÔȯ›· ηٷÁÚ¿ÊËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó ÛÙ·ÙÈÛÙÈο. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ Fisher’s exact test, chi-square test Î·È non parametric Mann Whitney test. ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ÂÈÙÚÔ‹ ËıÈ΋˜ Î·È ‰ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ.

∞ÔÙÂϤÛÌ·Ù· ∞·ÓÙ‹ıËÎ·Ó 110 ·fi Ù· 184 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (59,8%). ™∂£ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‹ ‹Ù·Ó Û ¯Ú‹ÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ Û 23 ·È‰È¿ (21%). ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙË ÌÂϤÙË Î·È ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∆Ô Ê‡ÏÔ, Ë ËÏÈΛ·, Ë ÂıÓÈÎfiÙËÙ· Î·È ÙÔ Â¿ÁÁÂÏÌ· ·˘ÙÒÓ Ô˘ ·¿ÓÙËÛ·Ó ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙËÓ ÂÈÏÔÁ‹ ‹ fi¯È Ù˘ ¯Ú‹Û˘ ™∂£. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ·ÛıÂÓ›˜, ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ·ÊÔÚÔ‡Û 68 ·ÁfiÚÈ· (61,8%) Î·È 42 ÎÔÚ›ÙÛÈ· (38,2%). ∆Ô Ê‡ÏÔ, Ë ËÏÈΛ· Î·È ÙÔ Â›‰Ô˜ Ù˘ ıÂÚ·›·˜ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ÙËÓ ÂÈÏÔÁ‹ ¯Ú‹Û˘ ™∂£. ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ¤·Û¯·Ó ·fi ÔÍ›· Ï¢¯·ÈÌ›· (48/110), ·ÏÏ¿ Ô ·ÚÈıÌfi˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ‰ÂÓ Â¤ÙÚ„ ӷ ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙË Û¯¤ÛË Ù˘ ÓfiÛÔ˘ Ì ÙËÓ ÂÈÏÔÁ‹ ¯Ú‹Û˘ ™∂£. √ ¯ÚfiÓÔ˜ Ô˘ ÌÂÛÔÏ¿‚ËÛ ·fi ÙË ‰È¿ÁÓˆÛË ¤ˆ˜ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Î˘Ì¿ÓıËΠ·fi 1-102 Ì‹Ó˜ (‰È¿ÌÂÛË ÙÈÌ‹ 28) Î·È ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ¯Ú‹ÛË ™∂£ (22 ¤Ó·ÓÙÈ 30 ÌËÓÒÓ, p=0,035). 30/110 ·È‰È¿ (27,3%) ‚Ú›ÛÎÔÓÙ·Ó ˘fi ıÂÚ·›· ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘. °È· Ù·

˘fiÏÔÈ· (72,7%) Ô ¯ÚfiÓÔ˜ Ô˘ ÌÂÛÔÏ¿‚ËÛ ·fi ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂÚ·›·˜ ¤ˆ˜ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Î˘Ì¿ÓıËΠ·fi 1-45 Ì‹Ó˜ (‰È¿ÌÂÛË ÙÈÌ‹ 15) Î·È ‰ÂÓ Û¯ÂÙ›ÛıËΠ̠ÙËÓ ÂÈÏÔÁ‹ ¯Ú‹Û˘. ™Â 95/110 ·È‰È¿ (86,4%) Ë ÓfiÛÔ˜ ‹Ù·Ó Û ‡ÊÂÛË, ÂÓÒ Û ˘ÔÙÚÔ‹ ‹ ÌÂÙ¿ ·fi ˘ÔÙÚÔ‹ ÛÙ· 15 (13,6%), ·ÏÏ¿ ‰ÂÓ ‰È·ÈÛÙÒıËΠۯ¤ÛË ¯Ú‹Û˘ ™∂£ Ì ÙËÓ ‡ÊÂÛË ‹ ÙËÓ ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ . ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ÏfiÁÔ˘˜ ¯Ú‹Û˘ ™∂£, 11/23 ·¿ÓÙËÛ·Ó fiÙÈ ‹ıÂÏ·Ó Ó· ÂÍ·ÓÙÏ‹ÛÔ˘Ó Î¿ı ıÂÚ·¢ÙÈ΋ ‰˘Ó·ÙfiÙËÙ·, 2/23 ÏfiÁˆ ·ÚfiÙÚ˘ÓÛ˘ οÔÈÔ˘ ¿ÏÏÔ˘, 4/23 Ì ÙËÓ ÚÔÛ‰ÔΛ· Ì›ˆÛ˘ ·ÚÂÓÂÚÁÂÈÒÓ Ù˘ Û˘Ì‚·ÙÈ΋˜ ıÂÚ·›·˜ ÂÓÒ Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙȘ ¯ÚËÛÈÌÔÔ›ËÛ ÁÈ· Ó· ÚÔ·Á¿ÁÂÈ ÙËÓ „˘¯ÔÏÔÁÈ΋ ¢ÂÍ›· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ (17/23). ™ÙË ÌÂÁ¿ÏË ÙÔ˘˜ ÏÂÈÔ„ËÊ›· ˆ˜ ™∂£ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÚÔÛ¢¯¤˜ / ıÚËÛ΢ÙÈΤ˜ ÙÂÏÂÙÔ˘ÚÁ›Â˜ (18/23) Î·È Û ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ¿ÏϘ “ıÂÚ·›˜” (¶›Ó·Î·˜ 3). ŸÛÔÓ ·ÊÔÚ¿ Ù· ÔʤÏË ·fi ÙË ¯Ú‹ÛË Ù¤ÙÔÈˆÓ “ıÂÚ·ÂÈÒÓ”, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ (21/23) ·Ó¤ÊÂÚ·Ó ˆ˜ fiÊÂÏÔ˜ ÙËÓ „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË, 5 ÙË Ì›ˆÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ, 5 ÙË ‰Ú¿ÛË ¤Ó·ÓÙÈ Ù˘ ÓfiÛÔ˘ Î·È ¤Ó·˜ ·¿ÓÙËÛ fiÙÈ ‰ÂÓ ‰È·›ÛÙˆÛ ηӤӷ fiÊÂÏÔ˜. ªÂ Îϛ̷η ÈηÓÔÔ›ËÛ˘ ·fi 1 ¤ˆ˜ 10, Ë Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ‹Ù·Ó Û·ÊÒ˜ ÈηÓÔÔÈË̤ÓË ÂÈϤÁÔÓÙ·˜ ÙÔÓ ‚·ıÌfi 10, ÂÓÒ 22/23 ı· Û˘ÓÈÛÙÔ‡Û·Ó Î·È Û ¿ÏÏÔ˘˜ ÁÔÓ›˜ ÙË “ıÂÚ·›·” Ô˘ ÂÊ¿ÚÌÔÛ·Ó ÛÙÔ ·È‰› ÙÔ˘˜. ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ·˘ÙÒÓ Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ (68/81, 84%) ·ÈÙÈÔÏfiÁËÛ·Ó ÙË ÛÙ¿ÛË ÙÔ˘˜ ˆ˜ ÂÌÈÛÙÔÛ‡ÓË ÛÙËÓ È·ÙÚÈ΋ ÔÌ¿‰· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ï‹ ÔÚ›· Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, 19/81 (23,5%) ·¿ÓÙËÛ·Ó fiÙÈ ‰ÂÓ ‹ÍÂÚ·Ó Ù›ÔÙ· Û¯ÂÙÈο Ì ·˘Ù¤˜ ÙȘ “ıÂÚ·›˜”, ÂÓÒ 6/81 ı· ÙȘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ·Ó Û˘Ó¤ÙÚ¯·Ó ÂȉÈÎÔ› ÏfiÁÔÈ (η΋ ÔÚ›· Ù˘ ÓfiÛÔ˘).

™˘˙‹ÙËÛË ∆Ô ÔÛÔÛÙfi ··ÓÙ‹ÛÂˆÓ ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (110/184, 59,8%) ‹Ù·Ó Û¯ÂÙÈο ¯·ÌËÏfi, ·ÏÏ¿ ˆ˜ ·ÚÈıÌfi˜ (110 ··ÓÙ‹ÛÂȘ) Â›Ó·È ·fi ÙÔ˘˜ ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂÈÎÔÛ·ÂÙ›·˜. ™‡Ìʈӷ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÌfiÓÔ ÛÙÔ 21% ¯ÚËÛÈÌÔÔÈ‹ıËΠοÔÈ· ÌÔÚÊ‹ ™∂£ Î·È ÙÔ ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È È‰È·›ÙÂÚ· ¯·ÌËÏfi Î·È ‰ÂÓ Û˘ÌʈÓ› Ì ٷ Â˘Ú‹Ì·Ù· ·ÚfiÌÔÈˆÓ ÌÂÏÂÙÒÓ. ¶Ú¤ÂÈ Ó· ÛËÌÂÈÒÛÔ˘Ì fiÙÈ ‰ÂÓ ÛÙ¿ÏıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÛÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·‚›ˆÛ·Ó ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ Î·È ·˘Ùfi Èı·ÓfiÓ Ó· ÂËÚ¤·Û ÙÔÓ ·ÚÈıÌfi ÙˆÓ ıÂÙÈÎÒÓ ··ÓÙ‹ÛˆÓ, ·ÏÏ¿ ÈÛÙ‡ԢÌ fiÙÈ Ë Û˘ÁÎÂÎÚÈ̤ÓË ÔÌ¿‰· ÁÔÓÈÒÓ ‰ÂÓ ¤ÚÂ ӷ Û˘ÌÂÚÈÏËÊı› ÁÈ· ¢ÓfiËÙÔ˘˜ ÏfiÁÔ˘˜. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ¯Ú‹ÛË ÌË Û˘Ì‚·ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ Û ÔÛÔÛÙ¿ ·fi 36 ¤ˆ˜ 84% (6,10,12-14) Û ·È‰È¿ Ì ¶·È‰È·ÙÚÈ΋ 2007;70:135-140

Pediatr Mar-Apr 07

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º‡ÏÔ Û˘ÌÌÂÙ¤¯ÔÓÙÔ˜ ÕÚÚÂÓ £‹Ï˘ ÕÚÚÂÓ & ı‹Ï˘ ™˘ÁÁÂÓÈ΋ Û¯¤ÛË ¶·Ù¤Ú·˜ ªËÙ¤Ú· ¶·Ù¤Ú·˜ & ÌËÙ¤Ú· ÕÏÏÔ ¢È¿ÌÂÛË ËÏÈΛ· (¤ÙË) ∂ıÓÈÎfiÙËÙ· ŒÏÏËÓ˜ ∞ÏÏÔ‰·Ô› ∂¿ÁÁÂÏÌ· √ÈÎȷο ¢ËÌfiÛÈÔÈ ˘¿ÏÏËÏÔÈ π‰ÈˆÙÈÎÔ› ˘¿ÏÏËÏÔÈ-·˘ÙÔ··Û¯ÔÏÔ‡ÌÂÓÔÈ ™Ô˘‰·ÛÙ¤˜ ÕÓÂÚÁÔÈ º‡ÏÔ ·È‰ÈÔ‡ ÕÚÚÂÓ £‹Ï˘ ¢È¿ÌÂÛË ËÏÈΛ· (¤ÙË) ¡fiÛÔ˜ §Â˘¯·ÈÌ›· §¤Ìʈ̷ ™¿ÚΈ̷ ¡ÂÊÚÔ‚Ï¿Ûو̷ ¡Â˘ÚÔ‚Ï¿Ûو̷ ŸÁÎÔÈ ∫¡™ ÕÏÏÔ ∂›‰Ô˜ ıÂÚ·›·˜ ÃËÌÂÈÔıÂÚ·›· (ã) ÃÂÈÚÔ˘ÚÁÂ›Ô (Ã∂πƒ) ∞ÎÙÈÓÔıÂÚ·›· (A£) ã+Ã∂πƒ+∞£ ã+Ã∂πƒ ã+∞£ ∫·Ì›·

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ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·. √È ÌÂÁ¿Ï˜ ‰È·ÊÔÚ¤˜ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Î·È ÛÙËÓ ÂÚ›Ô‰Ô ·Ó¿ÎÏËÛ˘ Ù˘ ÌÓ‹Ì˘ Ë ÔÔ›· ÛÙËÓ ‰È΋ Ì·˜ ÌÂϤÙË ‹Ù·Ó Ôχ ÌÂÁ·Ï‡ÙÂÚË (3 ¯ÚfiÓÈ·) Û ۇÁÎÚÈÛË Ì ٷ ÌÈÎÚfiÙÂÚ· ¶›Ó·Î·˜ 3. ∂›‰Ô˜ ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ Û 23 ·ÛıÂÓ›˜ ¶ÚÔÛ¢¯¤˜ ªÔ˘ÛÈ΋ / ˙ˆÁÚ·ÊÈ΋ ¢›·ÈÙ˜ ª·Û¿˙ √ÌÔÈÔ·ıËÙÈ΋ ∂ί˘Ï›ÛÌ·Ù· Ê˘ÙÒÓ ∫ÈÓ¤˙ÈÎË È·ÙÚÈ΋ ÕÛÎËÛË / Á˘ÌÓ·ÛÙÈ΋ ¶ÓÂ˘Ì·ÙÈΤ˜ / „˘¯ÔÏÔÁÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Paediatriki 2007;70:135-140

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‰È·ÛÙ‹Ì·Ù· (2-12 Ì‹Ó˜) ÙˆÓ ·ÓˆÙ¤Úˆ ÌÂÏÂÙÒÓ. ™ÙË ÌÂϤÙË Ì·˜ fiÏÔÈ ÔÈ ÁÔÓ›˜ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ Û˘Á¯ÚfiÓˆ˜ Ì ÙË Û˘Ì‚·ÙÈ΋ ıÂÚ·›·, fiˆ˜ Î·È ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ Û ·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· (5,6,12,13) Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ (16/23) ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıËÌÂÚÈÓ¿ ·˘Ù¤˜ ÙȘ “ıÂÚ·›˜” ÂȂ‚·ÈÒÓÂÈ ÙËÓ ·Ú¿Ï¢ÚË ¯Ú‹ÛË ÙÔ˘˜. ¶ÚÔÛ¢¯¤˜ / £Â›· ¯¿ÚȘ / ıÚËÛ΢ÙÈΤ˜ ÙÂÏÂÙÔ˘ÚÁ›Â˜ ‹Ù·Ó Ë ÈÔ Û˘¯Ó‹ ™∂£ ÛÙË ÌÂϤÙË Ì·˜ (18/23, 78%) Î·È ·˘Ùfi Û˘ÌʈÓ› Ì ÌÈÎÚfi ·ÚÈıÌfi ¿ÏÏˆÓ ÌÂÏÂÙÒÓ fiˆ˜ ÙˆÓ Friedman Î·È Û˘Ó. (4) Î·È ÙˆÓ Yeh Î·È Û˘Ó. (14) Ô˘ ·Ó¤ÊÂÚ·Ó ÔÛÔÛÙ¿ 64% Î·È 40% ·ÓÙÈÛÙÔ›¯ˆ˜. ∆Ô ˘„ËÏfi ÔÛÔÛÙfi Ù˘ ‰È΋˜ Ì·˜

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ÌÂϤÙ˘ (78%) ÌÔÚ› Ó· ÂÍËÁËı› fi¯È ÌfiÓÔ ·fi ÙËÓ ÔÏÈÙÈÛÌÈ΋ Î·È ıÚËÛ΢ÙÈ΋ ·È‰Â›· ÙÔ˘ Ï·Ô‡ Ì·˜ ·ÏÏ¿ Î·È ·fi ÙÔ ¤ÓÙÔÓÔ ıÚËÛ΢ÙÈÎfi Û˘Ó·›ÛıËÌ· Î·È ÙËÓ Ôχ Û˘¯Ó‹ Ù¿ÛË ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆÓ›· Ó· ¯ÚËÛÈÌÔÔÈ› ÙËÓ Â›ÎÏËÛË Ù˘ ıÚËÛΛ·˜ ˆ˜ Û˘ÌÏËڈ̷ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Û οı ÛÔ‚·Úfi Úfi‚ÏËÌ·. ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÁÔÓ›˜ Ô˘, Û ˘ÂÚ‚ÔÏÈÎfi ‚·ıÌfi, ÛÙÚ¿ÊËÎ·Ó ÛÙËÓ ÂÎÎÏËÛ›·, Ù· Ì˘ÛÙ‹ÚÈ· Î·È ÙȘ ÚÔÛ¢¯¤˜, ÂÓÒ Ôχ Û˘¯Ó¿ ·Ó·˙‹ÙËÛ·Ó ‚Ô‹ıÂÈ· ·fi ‰ËÌÔÊÈÏ‹ ÌÔÓ·ÛÙ‹ÚÈ· Û fiÏË ÙËÓ ÂÈÎÚ¿ÙÂÈ·, fiˆ˜ Ô ÕÁÈÔ˜ ƒ·Ê·‹Ï, Î·È ÙÔÔı¤ÙËÛ·Ó ÏËıÒÚ· ÂÈÎfiÓˆÓ ·Á›ˆÓ, ÛÙ·˘ÚÔ˘‰¿ÎÈ·, Ù›ÌÈÔ Í‡ÏÔ Î.Ï. fi¯È ÌfiÓÔ Î¿Ùˆ ·fi ÙÔ Ì·ÍÈÏ¿ÚÈ Î·È ÙÔ ÛÙÚÒÌ· ÙÔ˘ ·È‰ÈÔ‡ ·ÏÏ¿ ·ÎfiÌË Î·È Ì¤Û· Û ʷΤÏÔ˘˜ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Î·È ¿ÏÏˆÓ ÂÍÂÙ¿ÛˆÓ. ∏ ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ¯Ú‹Û˘ ™∂£ ‹Ù·Ó ÙÔ˘ “Ó‡̷ÙÔ˜ / ÛÒÌ·ÙÔ˜” fiˆ˜ ÌÔ˘ÛÈ΋ / ˙ˆÁÚ·ÊÈ΋ 4/23, Ì·Û¿˙ 3, ·Û΋ÛÂȘ ÛÒÌ·ÙÔ˜ Î·È Ó‡̷ÙÔ˜ 2 ÌÂ Û˘ÓÔÏÈ΋ Û˘¯ÓfiÙËÙ· 39%. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È ·ÚfiÌÔÈÔ Ì ÂΛӷ ÙˆÓ ÌÂÏÂÙÒÓ Fernadez Î·È Û˘Ó (6) Î·È Friedman Î·È Û˘Ó (4). ∂‰Ò Ú¤ÂÈ Ó· ÛËÌÂÈÒÛÔ˘Ì fiÙÈ Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÔÁÎÔÏÔÁÈÎÒÓ Î¤ÓÙÚˆÓ ÛÙËÓ ∂˘ÚÒË Î·È ÙËÓ ∞ÌÂÚÈ΋ ÔÈ ·Ú·¿Óˆ ÌÔÚʤ˜ Û˘ÌÏËڈ̷ÙÈ΋˜ ıÂÚ·›·˜ ÚÔÛʤÚÔÓÙ·È ÛÙ· Ï·›ÛÈ· Ù˘ ÔÏÈÛÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆¤ÏÔ˜, ÛÙËÓ ÙÚ›ÙË ÌÂÁ¿ÏË Î·ÙËÁÔÚ›· ™∂£ Ì ‚fiÙ·Ó· / ÔÌÔÈÔ·ıËÙÈ΋ / ÂȉÈΤ˜ ‰›·ÈÙ˜ / ‚Èٷ̛Ә, ÙÔ ÔÛÔÛÙfi ÙˆÓ ¯ÚËÛÙÒÓ ÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ (7/23, 30%) Û ۯ¤ÛË Ì ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ Ù˘ ÙÂÏÂ˘Ù·›·˜ 20ÂÙ›·˜ Î·È ·˘Ùfi ηٿ ·ÚÈÔ ÏfiÁÔ ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÚÔÊ‹ Û ٤ÙÔÈÔ˘ ›‰Ô˘˜ ÚÔ˚fiÓÙ· Î·È ·ÚÂÌ‚¿ÛÂȘ. ¶ÈÛÙ‡ԢÌ ÏÔÈfiÓ fiÙÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ·˘Ù¿ ı· Á›ÓÔ˘Ó Ôχ ‰ËÌÔÊÈÏ‹, fiˆ˜ ‹‰Ë Â›Ó·È Û ¿ÏϘ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘ Î·È Ù˘ ∞ÌÂÚÈ΋˜ (15). √È ÁÔÓ›˜ ÏËÚÔÊÔÚ‹ıËÎ·Ó ÁÈ· ÙȘ ™∂£ ΢ڛˆ˜ ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È ·fi ÂÈÛÙ‹ÌÔÓ˜ ˘Á›·˜ (14/18), ÂÓÒ ÂÏ¿¯ÈÛÙÔÈ ·Ó¤ÊÂÚ·Ó ˆ˜ ËÁ¤˜ Ù· ªª∂ Î·È ÙÔ ¢È·‰›ÎÙ˘Ô, οÙÈ Ô˘ ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ¿ÏϘ ÌÂϤÙ˜ (16). ŸÏÔÈ ÔÈ ÁÔÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜, ÏËÓ ÂÓfi˜, Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ ÂÎÊÚ¿˙Ô˘Ó ÈηÓÔÔ›ËÛË. °È· ÙÔ˘˜ ÁÔÓ›˜ ÔÈ ÏfiÁÔÈ ¯Ú‹Û˘ Ù¤ÙÔÈˆÓ ıÂÚ·ÂÈÒÓ ‹Ù·Ó ÁÈ· Ó· οÓÔ˘Ó ÙÔ ·È‰› ÈÔ ‰˘Ó·Ùfi (17/23), Ë ÂÏ›‰· fiÙÈ ı· ÛÙ·Ì·Ù‹ÛÔ˘Ó ÙËÓ ÚfiÔ‰Ô ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ (11/23) Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Ù˘ ıÂÚ·›·˜ Î·È Ù˘ ÓfiÛÔ˘ (6/23). √È ı¤ÛÂȘ ·˘Ù¤˜ ÙˆÓ ÁÔÓÈÒÓ Â›Ó·È Û ·fiÏ˘ÙË Û˘Ìʈӛ· Ì ÔÏϤ˜ ¿ÏϘ ·ÚfiÌÔȘ ÌÂϤÙ˜ (6,12). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ¯Ú‹ÛË ™∂£ ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙËÓ ÂıÓÈÎfiÙËÙ·, ÙË ÌfiÚʈÛË, Î·È ÙÔ Â¿ÁÁÂÏÌ· ÙˆÓ ÁÔÓÈÒÓ, Î·È Ì ÙË ‰È¿ÁÓˆÛË, ÙÔÓ ÙÚfiÔ ıÂÚ·›·˜

Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙË ‰È¿ÁÓˆÛË,. ∞Ó¿ÏÔÁ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ˘ÔÛÙËÚ›ÍÂÈ Û˘Û¯ÂÙ›ÛÂȘ Ì ÙËÓ ÂıÓÈÎfiÙËÙ· Î·È Ù· ÔÏÈÙÈÛÙÈο ‰Â‰Ô̤ӷ ÙˆÓ ÎÔÈÓˆÓÈÒÓ (17,18), ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓÈÒÓ (18), ÙÔ Â›Â‰Ô ÂÎ·›‰Â˘Û˘ ÙˆÓ ÁÔÓÈÒÓ (6), ÙËÓ ·ÚÔ˘Û›· ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ (19), ÙËÓ ÚÔËÁÔ‡ÌÂÓË ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ıÂÚ·ÂÈÒÓ (6) Î·È ÙÔ ·Ó·Ù˘Á̤ÓÔ ıÚËÛ΢ÙÈÎfi Û˘Ó·›ÛıËÌ· (18,20). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¯Ú‹ÛË Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ÛÙ· ·È‰È¿ Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· . °È· Ó· ··ÓÙËı› ÙÔ ÂÚÒÙËÌ· Â¿Ó ·ÚÂÌ‚¿ÛÂȘ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ¤¯Ô˘Ó ·ÔÙ¤ÏÂÛÌ·, ı· Ú¤ÂÈ ÂÌ›˜ ˆ˜ ÁÈ·ÙÚÔ› Ó· ‰È¢ÎÚÈÓ›˙Ô˘Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Î·È ÙȘ ÚÔÛ‰Ô˘ ÙˆÓ ÁÔÓÈÒÓ ˆ˜ ÚÔ˜ ÙË ıÂÚ·›·, Ó· ÂÓËÌÂÚˆÓfiÌ·ÛÙ ÁÈ· ÙȘ Ô˘Û›Â˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÔÈ ·ÛıÂÓ›˜ Ì·˜, Ó· οÓÔ˘ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ Î·È Û·Ê›˜ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙȘ ıÂÚ·›˜ ·˘Ù¤˜ Î·È Ó· Ï·Ì‚¿ÓÔ˘Ì ˘’ fi„ÈÓ Ì·˜ ÙË ‰È·ÏÔ΋ ÌÂٷ͇ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊfiÚËÛ˘ Î·È ‰˘Ó¿ÌÂˆÓ Ù˘ ·ÁÔÚ¿˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ ‰È·ıÂÛÈÌfiÙËÙ· Î·È ÙÔ ÎfiÛÙÔ˜ ÙÔ˘˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË ¯ÒÚ· Ì·˜ ÔˆÛ‰‹ÔÙ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ Î·Ù·ÁÚ·Ê‹ fiÏˆÓ ÙˆÓ Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ÚÔ˚fiÓÙˆÓ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó, ÓfiÌÈÌ· ‹ fi¯È, Î·È Ó· ‰ÔıÔ‡Ó ÙÂÎÌËÚȈ̤Ó˜ ηÙ¢ı‡ÓÛÂȘ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ÙȘ ·ÚÂÓ¤ÚÁÂȘ Î·È ÙȘ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· Ê¿Ú̷η. √ÚÈṲ̂ӷ Ê˘ÙÈο Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ ÌÔÚÔ‡Ó Ó· ÚÔÛʤÚÔ˘Ó ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜, Î·È Î¿ÔȘ ÂÓ·ÏÏ·ÎÙÈΤ˜ ÌÔÚʤ˜ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ Î·Ï‡ÙÂÚË „˘¯È΋, ۈ̷ÙÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· (21). ∏ ·fiÚÚÈ„‹ ÙÔ˘˜ ¯ˆÚ›˜ Û˘˙‹ÙËÛË Î·È ¤Ú¢ӷ Â›Ó·È ·ÎÚ·›· ÛÙ¿ÛË ·ÏÏ¿ ÙÔ ›‰ÈÔ ‹ Î·È ¯ÂÈÚfiÙÂÚÔ Â›Ó·È Ó· Ù· ‰Â¯fiÌ·ÛÙ ˆ˜ ı·˘Ì·ÙÔ˘ÚÁ¿, Ó· Ù· ÏËÚÒÓÔ˘Ì ȉȷ›ÙÂÚ· ·ÎÚÈ‚¿ Î·È Ó· ÙÚ¤¯Ô˘Ì ÛÙ· ¤Ú·Ù· ÙÔ˘ ÎfiÛÌÔ˘ ÁÈ· Ó· Ù· ¿ÚÔ˘ÌÂ. ∂ÈÁÚ·ÌÌ·ÙÈο ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Â›ÛË̘ ı¤ÛÂȘ Î·È Ô‰ËÁ›Â˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ ŒÓˆÛ˘ ¶·È‰È¿ÙÚˆÓ √ÁÎÔÏfiÁˆÓ ÁÈ· ÙË ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ıÂÚ·ÂÈÒÓ (22). √È Ô‰ËÁ›Â˜ ·˘Ù¤˜ ‰ÂÓ ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô Ó· ÂÚÈÁÚ¿„Ô˘Ó fiϘ ÙȘ ÂÈ‚Ï·‚›˜ ÌË Û˘Ì‚·ÙÈΤ˜ ıÂÚ·›˜, ·ÏÏ¿ Ó· ÂÓı·ÚÚ‡ÓÔ˘Ó ÙÔ˘˜ ÁÔÓ›˜, ÚÈÓ ·ÔÊ·Û›ÛÔ˘Ó Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙËÓ ·ÁˆÁ‹ ÙÔ˘ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚÔ‡, Ó· Û˘˙ËÙ‹ÛÔ˘Ó Ì·˙› ÙÔ˘ Â¿Ó Ë Û˘ÁÎÂÎÚÈ̤ÓË ·Ú¤Ì‚·ÛË ı· ÌÔÚÔ‡Û ӷ ‚Ï¿„ÂÈ ÙÔ ·È‰› ÙÔ˘˜. √È ÁÔÓ›˜ ı· Ú¤ÂÈ Ó· Â›Ó·È È‰È·›ÙÂÚ· ÂÈÊ˘Ï·ÎÙÈÎÔ› ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÔÔÈ·Û‰‹ÔÙ ¿ÏÏ˘ ÏËÓ Ù˘ Û˘Ì‚·ÙÈ΋˜ ıÂÚ·›·˜ fiÙ·Ó Ë ÌË Û˘Ì‚·ÙÈ΋ “ıÂÚ·›·” Â›Ó·È ¤Ó· “Ì˘ÛÙÈÎfi” Ô˘ ÌfiÓÔ ÔÚÈṲ̂ӷ ¿ÙÔÌ· ÙËÓ ÚÔÌËıÂ‡Ô˘Ó Î·È ˘fiÛ¯ÂÙ·È ›·ÛË ÁÈ· fiÏ· Ù· ›‰Ë ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Î·È fiÙ·Ó ÂΛÓÔÈ Ô˘ ÙËÓ ·Ú¤¯Ô˘Ó ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Î·Ù·‰ÈÒÎÔÓÙ·È ·fi ÙÔ È·ÙÚÈÎfi “ηÙÂÛÙË̤ÓÔ”, ÂÈÙ›ıÂÓÙ·È ÛÙËÓ È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ· ‹ Î·È È‰È·›ÙÂÚ· fiÙ·Ó ··ÈÙÔ‡Ó ÌÂÁ¿ÏÔ ÔÛfi ¯ÚËÌ¿ÙˆÓ ·fi ÙËÓ ·Ú¯‹ (23). ¶·È‰È·ÙÚÈ΋ 2007;70:135-140

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∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Weiger WA, Smith M, Boon H, Richardson MA, Kaptchuk TJ, Eisenberg DM. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med 2002;137:889-903.

2. Eisenberg DM, Kessler RC, Foster C, Foster C, Norlock FE, Calkins DR, et al. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246-252.

3. Ernst E. The current position of complementary/alternative medicine in cancer. Eur J Cancer 2003;39:2273-2277.

4. Friedman T, Slayton WB, Allen LS, Pollock BH, DumontDriscoll M, Mehta P, et al. Use of alternative therapies for children with cancer. Pediatrics 1997;100:E1.

5. Sawyer MG, Gannoni AF, Toogood IR, Antoniou G, Rice M.. The use of alternative therapies by children with cancer. Med J Aust 1994;160:320-322.

6. Fernandez CV, Stutzer CA, MacWilliam L, Fryer C. Alternative and complementary therapy use in pediatric oncology patients in British Columbia: prevalence and reasons for use and nonuse. J Clin Oncol 1998;16:1279-1286.

7. Kelly KM. Complementary and alternative medical therapies for children with cancer. Eur J Cancer 2004;40:20412046.

8. National Center for Complementary and Alternative Medicine. What is CAM. National Institutes of Health.

[Website] http://nccam.nih.gov/health/whatiscam/#1.

9. Fletcher PC, Clarke J. The use of complementary and alternative medicine among pediatric patients. Cancer Nurs 2004;27:93-99.

10. Kelly KM, Jacobson JS, Kennedy DD, Braudt SM, Mallick M, Weiner MA. Use of unconventional therapies by children with cancer at an urban medical center. J Pediatr Hematol Oncol 2000;22:412-416.

11. Kemper K, Jacobs J. Homeopathy in pediatrics - no harm likely, but how much good? Contemp Pediatr 2003;20:97.

12. Bold J, Leis A. Unconventional therapy use among children with cancer in Saskatchewan. J Pediatr Oncol Nurs 2001;18:16-25.

13. Neuhouser ML, Patterson RE, Schwartz SM, Hedderson MM, Bowen DJ, Standish LJ. Use of alternative medicine

Paediatriki 2007;70:135-140

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

by children with cancer in Washington state. Prev Med 2001;33:347-354.

Yeh CH, Tsai JL, Li W, Chen HM, Lee SC, Lin CF, et al.

Use of alternative therapy among pediatric oncology patients in Taiwan. Pediatr Hematol Oncol 2000;17:55-65.

Myers C, Stuber ML, Bonamer-Rheingans JI, Zeltzer LK. Complementary therapies and childhood cancer. Cancer Control 2005;12:172-180.

Molassiotis A, Cubbin D. “Thinking outside the box”: complementary and alternative therapies use in paediatric oncology patients. Eur J Oncol Nurs 2004;8:50-60.

Maskarinec G, Shumay DM, Kakai H, Gotay CC. Ethnic differences in complementary and alternative medicine use among cancer patients. J Altern Complement Med 2000;6:531-538.

Weyl Ben Arush M, Geva H, Ofir R, Mashiach T, Uziel R, Dashkovsky Z. Prevalence and characteristics of complementary medicine used by pediatric cancer patients in a mixed western and middle-eastern population. J Pediatr Hematol Oncol 2006;28:141-146.

Martel D, Bussieres JF, Theoret Y, Lebel D, Kish S, Moghrabi A, Laurier C. Use of alternative and complementary therapies in children with cancer. Pediatr Blood Cancer 2005;44:660-668.

McCurdy EA, Spangler JG, Wofford MM, Chauvenet AR, McLean TW. Religiosity is associated with the use of complementary medical therapies by pediatric oncology patients. J Pediatr Hematol Oncol 2003;25:125-129.

Cohen MH. Legal and ethical issues relating to use of complementary therapies in pediatric haematology/oncology. J Pediatr Hematol Oncol 2006;28:190-193.

Jankovic M, Spinetta JJ, Martins AG, Pession A, Sullivan M, D'Angio GJ, et al. Non-conventional therapies in childhood cancer: guidelines for distinguishing nonharmful from harmful therapies: a report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Pediatr Blood Cancer 2004;42:106-108. ¶Ô˘ÚÙÛ›‰Ë˜ ∞. ™˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜ ÛÙÔÓ Î·ÚΛÓÔ. ™ÙÔ: ∂. µ·ÛÈÏ¿ÙÔ˘ ∫ÔÛÌ›‰Ë, ÂÈ̤ÏÂÈ· ¤Î‰ÔÛ˘. æ˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Ì ηÚΛÓÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘. 2005. Û. 836-852.

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

ORIGINAL ARTICLE

141

∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ ÚÒÙ˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÚÈÓ ÙËÓ ÂÊ˂›· ÛÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜ ∞. ∫·ÙÛ·Ê¿‰Ô˘, µ. ¶··Â˘·ÁÁ¤ÏÔ˘, °. ºÂÚÂÓÙ›ÓÔ˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ ÚÒÙ˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (∞’ ‰ËÌÔÙÈÎÔ‡) Î·È ÚÈÓ ÙËÓ ÂÊ˂›· (™∆’ ‰ËÌÔÙÈÎÔ‡), Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™˘ÌÏËÚÒıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ Ì·ıËÙÒÓ ÛÙ· ÔÔ›· ηٷÁÚ¿ÊËÎ·Ó ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›·, ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ‹ Î·È ÓÔÛËÏ›·˜ ÏfiÁˆ ÂÈÏÔÎÒÓ ·ÓÂÌ¢ÏÔÁÈ¿˜, ÈÛÙÔÚÈÎfi ÂÌÊ¿ÓÈÛ˘ ¤ÚËÙ· ˙ˆÛÙ‹Ú·, Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘ Î·È Ë ËÏÈΛ· ¤Ó·Ú͢ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡. ∞ӷχıËÎ·Ó 19.381 ÂÚˆÙËÌ·ÙÔÏfiÁÈ·: 48,45% ·ÊÔÚÔ‡Û·Ó ·È‰È¿ Ù˘ ∞’ ‰ËÌÔÙÈÎÔ‡ Î·È 51,55% ·È‰È¿ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡. ∞ÔÙÂϤÛÌ·Ù·: πÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ›¯Â ÙÔ 66,65% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ Ù¿Í˘ Î·È 78,69% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ™∆’ Ù¿Í˘. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ‹Ù·Ó ·ÓÙÈÛÙÔ›¯ˆ˜ 3,97 Î·È 5,37 ¤ÙË (p<0,001). πÛÙÔÚÈÎfi ¤ÚËÙ· ˙ˆÛÙ‹Ú· ›¯Â ÙÔ 0,48%. ∆Ô 1,62% ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ú·Û·Ó ·ÓÂÌ¢ÏÔÁÈ¿ ÓÔÛËχÙËΠÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘. ∆· ·È‰È¿ Ô˘ ‹Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi (72,85%) ›¯·Ó ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 4,46 ¤ÙË, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ·fi ·˘Ù‹ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰ÂÓ ‹Á·Ó (5,69 ¤ÙË, (p<0,001)). ∂›Û˘ Ù· ·È‰È¿ Ô˘ ‹Ù·Ó ÚˆÙfiÙÔη ÓfiÛËÛ·Ó Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ô˘ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ·, Ì ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 5,13 Î·È 4,36 ¤ÙË, ·ÓÙ›ÛÙÔȯ· (p <0,001). ∆¤ÏÔ˜, ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙË Ì¤ÛË ËÏÈΛ·˜ ÓfiÛËÛ˘ ÌÂٷ͇ ·È‰ÈÒÓ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È ÌÂÙ·Ó·ÛÙÒÓ, ‰ÈfiÙÈ, Ù· ÚÒÙ· ·Ú·ÎÔÏÔ‡ıËÛ·Ó Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÎfi ÛÙ·ıÌfi Û ۯ¤ÛË Ì ٷ ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ. ™˘ÌÂÚ¿ÛÌ·Ù·: ∞fi Ù· ÛÙÔȯ›· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È‰ÈÒÓ Ô˘ ËÁ·›ÓÔ˘Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ ̤Û˘ ËÏÈΛ·˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘.

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” AÏÏËÏÔÁÚ·Ê›·: ∫·ÙÛ·Ê¿‰Ô˘ ∞ÏÂÍ¿Ó‰Ú· akatsafadou@in.gr ™˘ÁÁÚÔ‡ 59, ∆.∫. 15125, ª·ÚÔ‡ÛÈ

§¤ÍÂȘ ÎÏÂȉȿ: ∞ÓÂÌ¢ÏÔÁÈ¿, ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË, ÂÌ‚fiÏÈÔ ·ÓÂÌ¢ÏÔÁÈ¿˜, ·È‰ÈÎfi˜ ÛÙ·ıÌfi˜.

The epidemiology of chickenpox in school-age children from the prefecture of Attica ∞. Katsafadou, V. Papaevangelou, G. Ferentinos, A. Constantopoulos Abstract Background: Epidemiologic data are described regarding varicella in primary school children from the entire prefecture of Attica.

Methods: Parents of children attending the 1st and 6th grades of primary school completed a questionnaire including questions on demographic data, the history of chickenpox, hospitalization secondary to chickenpox complications and herpes zoster, and the age at which the children first attended day care.

Results: On analysis of 19,381 questionnaires, 48.45% from 1st grade and 51.55% from 6th grade children, a history of varicella was reported in 66.65% of 1st grade children and 78.69% of 6th grade children, and the mean age of the children at the varicella illness was 3.93 and 5.37 years respectively (p<0.001). A history of herpes zoster was reported in 0.48%, and 1.62% of the children had been hospitalized because of a varicella-associated complication. Children who had attended day care (72.85%) and children with older siblings were reported to have contracted chickenpox at a younger age (mean age 4.46 years and 4.36 years, respectively) compared to children who had not attended day care or who were firstborn (mean age: 5.69 and 5.13 years, respectively, p<0.001). Children of immigrants were reported to have had varicella at a comparatively later age but this might be secondary to their low attendance rate at day care (59.3%).

Conclusions: A significant lowering in the mean age at which varicella is contracted by children in Attica was observed, probably due to the increasing rate of children attending day care.

2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece Correspondence: Katsafadou Alexandra akatsafadou@in.gr 59, Syggrou St. 15125, Maroussi, Greece

Key words: Varicella, epidemiology, varicella vaccine, day care.

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∞. ∫·ÙÛ·Ê¿‰Ô˘ Î·È Û˘Ó.

∂ÈÛ·ÁˆÁ‹ √ Èfi˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜-˙ˆÛÙ‹Ú· (VZV) ·Ó‹ÎÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÂÚËÙÔ˚ÒÓ (·ÓıÚÒÂÈÔ˜ ÂÚËÙÔ˚fi˜ 3: HHV-3). √ VZV ·ÔÙÂÏÂ›Ù·È ·fi ÌÈ· ‰ÈÏ‹ ·Ï˘Û›‰· DNA Ô˘ Έ‰ÈÎÔÔÈ› ÂÚ› ÙȘ 75 ÚˆÙ½Ó˜ Î·È ¤Ó· Î¿Ï˘ÌÌ· ·fi ÏÈ›‰È· Î·È ÁÏ˘ÎÔÚˆÙ½Ó˜. ∏ Ïԛ̈ÍË ·fi ÙÔÓ VZV ÌÔÚ› Ó· ÂΉËψı› Ì ‰‡Ô ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, ÙËÓ ·ÓÂÌ¢ÏÔÁÈ¿ Î·È ÙÔÓ ¤ÚËÙ· ˙ˆÛÙ‹Ú· (1). ∏ ·ÓÂÌ¢ÏÔÁÈ¿ Â›Ó·È Ë ÚˆÙÔÁÂÓ‹˜ Ïԛ̈ÍË. ¶ÚfiÎÂÈÙ·È ÁÈ· ‹È· ·È‰È΋ ÓfiÛÔ Ì ˘„ËÏ‹ ÌÂÙ·‰ÔÙÈÎfiÙËÙ·. √È ÂÈÏÔΤ˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ™˘¯ÓfiÙÂÚ˜ Â›Ó·È ÔÈ ‰ÂÚÌ·ÙÈΤ˜ ÂÈÏÔÈÌÒÍÂȘ ·fi ÛÙ·Ê˘ÏfiÎÔÎÎÔ ‹ ÛÙÚÂÙfiÎÔÎÎÔ Ù˘ ÔÌ¿‰·˜ ∞. ¶ÈÔ ÛÔ‚·Ú‹ Â›Ó·È Ë ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ·fi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ΢ÙÙ·Ú›Ùȉ·, Ì˘ÔÛ›Ùȉ·, ÓÂÎÚˆÙÈ΋ ÂÚÈÙÔÓ›Ùȉ·, Ó¢ÌÔÓ›·, ‚·ÎÙËÚÈ·ÈÌ›· Î·È Û‡Ó‰ÚÔÌÔ ÙÔ˘ ÛÙÚÂÙÔÎÔÎÎÈÎÔ‡ ÙÔÍÈÎÔ‡ shock (2). √È ÂÈÏÔΤ˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰È¿¯˘ÙË ÂÁÎÂÊ·Ï›Ùȉ· Ô˘ Â›Ó·È È‰È·›ÙÂÚ· ÂÈΛӉ˘ÓË (10% ıÓËÛÈÌfiÙËÙ·), ÙËÓ ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›· Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Reye, ÙÔ Û¯ÂÙÈ˙fiÌÂÓÔ Ì ÙËÓ Ï‹„Ë Û·ÏÈ΢ÏÈÎÒÓ. ∏ Ó¢ÌÔÓ›· ·fi VZV Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ. ∫ÏÈÓÈ΋ Ë·Ù›Ùȉ· ·fi VZV Â›Ó·È Û¿ÓÈ· Û ˘ÁÈ‹ ¿ÙÔÌ·, ·ÏÏ¿ Ë ·Û˘Ìو̷ÙÈ΋ ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Â›Ó·È Û˘Ó‹ı˘ (1,3,4). √ ¤ÚËÙ·˜ ˙ˆÛÙ‹Ú·˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ‰ÂηÂٛ˜ ÌÂÙ¿ ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË. √Ê›ÏÂÙ·È ÛÙËÓ Â·Ó·‰Ú·ÛÙËÚÈÔÔ›ËÛË ÙÔ˘ ÈÔ‡ Ô˘ ·Ú·Ì¤ÓÂÈ Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË Ì¤Û· ÛÙ· Á¿ÁÁÏÈ· ÙˆÓ Ô›ÛıÈˆÓ Ó¢ÚÈÎÒÓ ÚÈ˙ÒÓ ÌÂÙ¿ ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË. ∂›Ó·È Û¿ÓÈÔ˜ Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 10 ÂÙÒÓ Î·È Û˘Ó‹ıˆ˜ ÙÔ ÂÍ¿ÓıËÌ· Â›Ó·È ‹ÈÔ ÛÂ Ê˘ÛÈÔÏÔÁÈο ·È‰È¿, Î·È Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÔÍ›·˜ Ó¢ڛÙȉ·˜ ÂÏ¿¯ÈÛÙ·. ¶ÚÈÓ ÙÔ ÂÍ¿ÓıËÌ· ÚÔËÁÂ›Ù·È ÂÓÙÔÈṲ̂ÓÔ˜ fiÓÔ˜, ˘ÂÚ¢·ÈÛıËÛ›·, ÎÓËÛÌfi˜ Î·È ¯·ÌËÏfi˜ ˘ÚÂÙfi˜. ™˘Ó‹ı˘ ÂÈÏÔ΋ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Â›Ó·È Ë ÌÂıÂÚËÙÈ΋ Ó¢ڷÏÁ›· (1,3,4). ∞fi ÔÚÔÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙȘ ‡ÎÚ·Ù˜ ¯ÒÚ˜ ÙÔ 90-95% ÙˆÓ ·ÙfiÌˆÓ ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ÙÔÓ VZV ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1). ™ÙȘ ÙÚÔÈΤ˜ ÂÚÈÔ¯¤˜ Ë ÔÚÔıÂÙÈÎfiÙËÙ· ÙˆÓ ÂÓËÏ›ÎˆÓ Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚË. ™ÙȘ ∏¶∞ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980 Ë ÂÎÙÈÌÒÌÂÓË ËÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·ÓÂÌ¢ÏÔÁÈ¿˜ ‹Ù·Ó 33% Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ (1-4 ÂÙÒÓ) Î·È 44% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (5-9 ÂÙÒÓ). ™˘ÓÔÏÈο ¿Óˆ ·fi 90% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·ÊÔÚÔ‡Û·Ó ¿ÙÔÌ· οو ÙˆÓ 15 ÂÙÒÓ. ¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ˘‹Ú¯Â ÌÈ· Ù¿ÛË ÁÈ· Ì›ˆÛË Ù˘ ËÏÈΛ·˜ Paediatriki 2007;70:141-145

ÂΉ‹ÏˆÛ˘ Ù˘ ÓfiÛÔ˘, Ô˘ ÈÛÙ‡ÂÙ·È fiÙÈ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ·È‰ÈÎfi ÛÙ·ıÌfi (3,5,6). ∆o ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ·ÔÙÂÏÂ›Ù·È ·fi ˙ÒÓÙ˜ ÂÍ·ÛıÂÓË̤ÓÔ˘˜ ÈÔ‡˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Oka. √ √ÚÁ·ÓÈÛÌfi˜ ∆ÚÔÊ›ÌˆÓ Î·È º¿ÚÌ·ÎˆÓ ÙˆÓ ∏¶∞ (FDA) ¯ÔÚ‹ÁËÛ ¿‰ÂÈ· ΢ÎÏÔÊÔÚ›·˜ ÛÙÔ ÂÌ‚fiÏÈÔ ·fi ÙÔÓ ª¿ÚÙÈÔ ÙÔ˘ 1995. √ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û‡Ìʈӷ Ì ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ Ì ¢Ú›· ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë (5). °È· ÙÔÓ Û¯Â‰È·ÛÌfi ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÛÙÚ·ÙËÁÈ΋˜ ·fi ÙȘ ÀËÚÂۛ˜ ÀÁ›·˜ Â›Ó·È ··Ú·›ÙËÙË Ë ÁÓÒÛË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘ ÛÙË ¯ÒÚ· Ì·˜ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ Ù· ÔÛÔÛÙ¿ Ê˘ÛÈ΋˜ ·ÓÔÛ›·˜ ·Ó¿ ËÏÈΛ·, Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏÔÎÒÓ Î·È Ù· ÔÛÔÛÙ¿ ÓÔÛËÏ›·˜ (7). ∆· ÂȉËÌÈÔÏÔÁÈο ·˘Ù¿ ÛÙÔȯ›· ı· ¯ÚËÛÈ̇ÛÔ˘Ó Â›Û˘, ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙË ¯ÒÚ· Ì·˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∏ ÌÂϤÙË ·ÔÛÎÔ› ÛÙËÓ ·ÔÙ‡ˆÛË ÈÛÙÔÚÈÎÔ‡ Ê˘ÛÈ΋˜ Ïԛ̈͢ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·È‰ÈÒÓ ÚÒÙ˘ Û¯ÔÏÈ΋˜ Î·È ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜, ηٿ ÙËÓ ÂÚ›Ô‰Ô Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ÛÙËÓ ∂ÏÏ¿‰·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÙ¿ ·fi ¤ÁÎÚÈÛË Ù˘ ÌÂϤÙ˘ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÂÛÙ¿ÏËÛ·Ó Û fiÏ· Ù· ‰ËÌÔÙÈο Û¯ÔÏ›· ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈ΋˜ (1046 ‰ËÌfiÛÈ· Û¯ÔÏ›· Î·È 109 ȉȈÙÈο Û¯ÔÏ›·) ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ù· ÔÔ›· ̤ۈ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ‰È·ÓÂÌ‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ Î·È ™∆’ ‰ËÌÔÙÈÎÔ‡. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Û¯ÔÏ›ˆÓ ÛÙËÓ ¤Ú¢ӷ Î·È Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ‹Ù·Ó ÚÔ·ÈÚÂÙÈ΋. √È ÁÔÓ›˜ Û˘ÌÏ‹ÚˆÛ·Ó ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (ÁÈ· ÙË ‰È·ÛÊ¿ÏÈÛË ÙˆÓ ÚÔÛˆÈÎÒÓ ‰Â‰Ô̤ӈÓ) Ì ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›·, ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, ÈÛÙÔÚÈÎfi ÓÔÛËÏ›·˜ ÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘ Î·È ÈÛÙÔÚÈÎfi ÂÌÊ¿ÓÈÛ˘ ¤ÚËÙ· ˙ˆÛÙ‹Ú· ÌÂÙ¿ ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË. ∂›Û˘, ηٷÁÚ¿ÊËÎÂ Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ·ÎÚÈ‚‹˜ ËÏÈΛ· ¤Ó·Ú͢ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡. ™ÙË Û˘Ó¤¯ÂÈ· ˘ÔÏÔÁ›ÛÙËÎÂ Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ Î·È ¤ÁÈÓ ۇÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ: ·) ∞’ Î·È ™∆’ ‰ËÌÔÙÈÎÔ‡, ‚) Ô˘ ‹Á·Ó ·È‰ÈÎfi ÛÙ·ıÌfi ‹ fi¯È Î·È Á) Ô˘ ‹Ù·Ó ÚˆÙfiÙÔη ‹ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ·. ∂ÈϤÔÓ Î·ıÔÚ›ÛÙËΠÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜ ÏfiÁˆ ·ÓÂÌ¢ÏÔÁÈ¿˜ Î·È ¯ÚÂÈ¿ÛÙËΠӷ ÓÔÛËÏ¢ıÔ‡Ó, Î·È ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ¤ÚËÙ· ˙ˆÛÙ‹Ú· ÌÂÙ¿ ·fi ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· Stata SE 8.0 ÁÈ· Windows. ∏ Û‡ÁÎÚÈÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÓfiÛËÛ˘ ÌÂٷ͇ ÙˆÓ ˘ÔÔÌ¿‰ˆÓ Ù˘ ÌÂϤÙ˘ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ¯-ÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ Pearson (Pearson’s chi square). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ËÏÈÎÈÒÓ ÓfiÛËÛ˘ ÌÂٷ͇ ÙˆÓ

Pediatr Mar-Apr 07

28-03-07

17:23

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143

∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜

˘ÔÔÌ¿‰ˆÓ Î·È ·ÊÔ‡ ›¯·Ì ÂϤÁÍÂÈ ÚÒÙ· ÙËÓ Î·ÓÔÓÈÎfiÙËÙ· Ù˘ ÌÂÙ·‚ÏËÙ‹˜ “ËÏÈΛ· ÓfiÛËÛ˘” Ì ÙË ‚Ô‹ıÂÈ· ÈÛÙÔÁÚ·ÌÌ¿ÙˆÓ Î·È ÙÔ˘ sktest (Skewness and kurtosis test for normality - ‰ÔÎÈÌ·Û›· ÏÔÍfiÙËÙ·˜ Î·È Î‡ÚÙˆÛ˘ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ηÓÔÓÈÎfiÙËÙ·˜), ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ t-test (Û‡ÁÎÚÈÛË Ì¤ÛˆÓ ÙÈÌÒÓ ‰ÂÈÁÌ¿ÙˆÓ). °È· fiÏ· Ù· ·ÓˆÙ¤Úˆ test ÙÔ Â›Â‰Ô Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËΠÛÙÔ 0,05.

∞ÔÙÂϤÛÌ·Ù· ∞·ÓÙËÙÈÎÔ› ʷΤÏÔÈ ÂÏ‹ÊıËÛ·Ó ·fi ÙÔ 43,5% ÙˆÓ ‰ËÌfiÛÈˆÓ Û¯ÔÏ›ˆÓ Î·È ÙÔ 21% ÙˆÓ È‰ÈˆÙÈÎÒÓ Û¯ÔÏ›ˆÓ. ∞ӷχıËÎ·Ó 19.381 ÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ∞fi ·˘Ù¿ ÙÔ 48,45% ·ÊÔÚÔ‡Û·Ó ·È‰È¿ Ù˘ ∞’ ‰ËÌÔÙÈÎÔ‡ Î·È 51,55% ·È‰È¿ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡ ·ÓÙ›ÛÙÔȯ·. ∆Ô 45,39% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·ÁfiÚÈ·. ∆Ô 94,57% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È ÙÔ 5,43% ‹Ù·Ó ÌÂÙ·Ó¿ÛÙ˜. £ÂÙÈÎfi ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ›¯·Ó 13.816 Ì·ıËÙ¤˜ (72,85%). ∆Ô 66,65% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ Ù¿Í˘ Î·È 78,69% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ™∆’ Ù¿Í˘ ·Ó¤ÊÂÚ ÓfiÛËÛË ·fi ·ÓÂÌ¢ÏÔÁÈ¿. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó 4,75 (sd±2,36) ¤ÙË, ·Ó·Ï˘ÙÈο, ÛÙËÓ ∞ã Î·È ™∆ã ‰ËÌÔÙÈÎÔ‡ ‹Ù·Ó 3,97 (sd±1,48) Î·È 5,37 (sd±2,71) ¤ÙË ·ÓÙ›ÛÙÔȯ· (p<0,001). πÛÙÔÚÈÎfi ¤ÚËÙ· ˙ˆÛÙ‹Ú· ·Ó¤ÊÂÚ ÙÔ 0,48% ÂÓÒ 1,62% ÙˆÓ ·È‰ÈÒÓ Ì ÈÛÙÔÚÈÎfi ·ÓÂÌ¢ÏÔÁÈ¿˜ ÓÔÛËχÙËΠÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘. ∆· ·È‰È¿ Ô˘ ‹Á·Ó ·È‰ÈÎfi ÛÙ·ıÌfi (72,85%) ›¯·Ó ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 4,46 (sd±2,6) ¤ÙË, ÂÓÒ Ù· ·È‰È¿ Ô˘ ‹Á·Ó ÌfiÓÔ ÓËÈ·ÁˆÁ›Ô, ›¯·Ó ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 5,69 (±2,6) ¤ÙË (p<0,001). ∞Ó·Ï˘ÙÈ-

ο, Ù· ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ Ô˘ ·Ú·ÎÔÏÔ‡ıËÛ·Ó ·È‰ÈÎfi ÛÙ·ıÌfi, ÓfiÛËÛ·Ó Û ̤ÛË ËÏÈΛ· 3,88 (sd±1,88) ¤ÙË, ¤Ó·ÓÙÈ Ù˘ ̤Û˘ ËÏÈΛ·˜ ÙˆÓ 4,42 (sd±1,62) ¤ÙË Ô˘ ÓfiÛËÛ·Ó Ù· ·È‰È¿ Ô˘ ‰ÂÓ ‹Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi (p<0,001). °È· Ù· ·È‰È¿ ™∆’ Ù¿Í˘, ÔÈ Ì¤Û˜ ËÏÈ˘ Â›Ó·È 5,02 Î·È 6,20 ¤ÙË ·ÓÙ›ÛÙÔȯ· (p<0,001). ™˘ÓÔÏÈο, Ù· ÚˆÙfiÙÔη ·È‰È¿ ›¯·Ó ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 5,13 (sd±2,6) ¤ÙË Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ì ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· (̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 4,36(sd±2,2) ¤ÙË, (p<0,001). °È· Ù· ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ Ô˘ Â›Ó·È ÚˆÙfiÙÔη ‹ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ·, Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ Â›Ó·È 4,26 Î·È 3,66 ¤ÙË ·ÓÙ›ÛÙÔȯ· (p<0,001). °È· Ù· ·È‰È¿ ™∆’ Ù¿Í˘, Ë Ì¤ÛË ËÏÈΛ· Â›Ó·È 5,82 Î·È 4,91 ¤ÙË, ·ÓÙ›ÛÙÔȯ· (p<0,001) (∂ÈÎfiÓ· 1). ∆Ô ÔÛÔÛÙfi ÓfiÛËÛ˘ ÛÙ· ÚˆÙfiÙÔη ·È‰È¿ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·’ fi,ÙÈ ÛÙ· ·È‰È¿ Ô˘ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· ÛÙËÓ ∞’ Ù¿ÍË (63,42% Î·È 71,18%, ·ÓÙ›ÛÙÔȯ·, p<0,001), Ë ‰È·ÊÔÚ¿ ·˘Ù‹ fï˜, ÂÍ·Ï›ÊÂÙ·È Ì ÙÔ ¤Ú·ÛÌ· ÙˆÓ ¯ÚfiÓˆÓ Î·È ¤ÙÛÈ ÛÙ· ·È‰È¿ Ù˘ ™∆ã Ù¿Í˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi ÓfiÛËÛ˘ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ (79,19% Î·È 78,49%, ·ÓÙ›ÛÙÔȯ·, p=0,799). ™ËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi ÓfiÛËÛ˘ ·ÏÏ¿ Î·È ÛÙË Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ ·È‰ÈÒÓ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Û ۯ¤ÛË Ì ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ. ∆Ô ÔÛÔÛÙfi ÓfiÛËÛ˘ ‹Ù·Ó 73,75% Î·È 59,12%, ÂÓÒ Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ‹Ù·Ó 4,72 (sd±2,3) Î·È 6,25 (sd±2,7) ¤ÙË, ·ÓÙ›ÛÙÔȯ· (p<0,001). ∆Ô ÔÛÔÛÙfi ÊÔ›ÙËÛ˘ Û ·È‰ÈÎfi ÛÙ·ıÌfi ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ Â›Ó·È 75,08% ÁÈ· Ù·

6

6

ª¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ (¤ÙË)

ª¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ (¤ÙË)

7

6,2

5

4,42

4 3

3,88

5,02

2

5,82

5

4,26

4 4,91

3 3,66 2 1

1 0

0 ∞ã ∆¿ÍË ¶∏°∞¡ ¶∞π¢π∫√ ™∆∞£ª√

p<0,001 ™∆ã ∆¿ÍË ¢∂¡ ¶∏°∞¡ ¶∞π¢π∫√ ™∆∞£ª√

p<0,001

∞ã ∆¿ÍË ™∆ã ∆¿ÍË MH ¶ƒø∆√∆√∫∞

¶ƒø∆√∆√∫∞

∂ÈÎfiÓ· 1. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, ÙfiÛÔ Û ·È‰È¿ Ù˘ ∞’ fiÛÔ Î·È Û ·È‰È¿ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡, ‹Ù·Ó ÌÈÎÚfiÙÂÚË Û ·È‰È¿ Ô˘ ‹Á·Ó ·È‰ÈÎfi ÛÙ·ıÌfi ‹ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· (p<0,001). ¶·È‰È·ÙÚÈ΋ 2007;70:141-145

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·144

144

∞. ∫·ÙÛ·Ê¿‰Ô˘ Î·È Û˘Ó.

·È‰È¿ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È 59,35% ÁÈ· ÙÔ˘˜ ÌÂÙ·Ó¿ÛÙ˜ (p<0,001). ø˜ ÚÔ˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ¤ÚËÙ· ˙ˆÛÙ‹Ú· (∂∑) ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ·Ó·Ï‡ÔÓÙ·˜ Ù· ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ Ì·˜, ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ∂∑ ÛÙ· ·È‰È¿ Ì ÌÈÎÚfiÙÂÚË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Î·È ÛÙ· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ. ∏ ̤ÛË ËÏÈΛ· ÚˆÙÔÏԛ̈͢ Û ·È‰È¿ Ì ∂∑ ‹Ù·Ó 3,89 (sd±2,44) Î·È ÛÙ· ·È‰È¿ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ¤ÚËÙ· ˙ˆÛÙ‹Ú· 4,75 (sd±2,36) ¤ÙË, ·ÓÙ›ÛÙÔȯ· (p<0,003). ∏ ÂıÓÈÎfiÙËÙ· Â›Û˘ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË ¤ÚËÙ· ˙ˆÛÙ‹Ú· ·ÊÔ‡, ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ¤ÚËÙ· ˙ˆÛÙ‹Ú·, ÙÔ 16% ‹Ù·Ó ÌÂÙ·Ó¿ÛÙ˜, ÂÓÒ ÛÙÔÓ ÏËı˘ÛÌfi Ù˘ ÌÂϤÙ˘ Ì·˜ ·ÔÙÂÏÔ‡Û·Ó ÙÔ 5,43% (p<0,000).

™˘˙‹ÙËÛË ∏ ·ÓÂÌ¢ÏÔÁÈ¿ ·ÔÙÂÏ› ÌÈ· Û˘¯Ó‹ Î·È ‹È·, ÌÂÙ·‰ÔÙÈ΋ ÓfiÛÔ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·Ú·ÙËÚÂ›Ù·È ‰ÈÂıÓÒ˜ ·‡ÍËÛË ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ȉȷ›ÙÂÚ· Û ·È‰È¿ <4 ÂÙÒÓ ÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘. ∞fi ÙÔ 1995 ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ ∏¶∞ Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜, ·ÏÏ¿ Î·È Ù˘ ıÓËÙfiÙËÙ¿˜ Ù˘ (4). ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙȘ ∏¶∞, ÌÂÈÒıËÎÂ Ë ÓÔÛËÏ›· ·fi ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ ηٿ 50% Î·È 75% ÌÂÙ¿ Ù¤ÛÛÂÚ· Î·È Û ¤ÍÈ ¯ÚfiÓÈ·, ·ÓÙ›ÛÙÔȯ· (8), Î·È ‰È·ÈÛÙÒıËΠÌÂÁ¿ÏË Ì›ˆÛË ÙˆÓ ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ÂÍfi‰ˆÓ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ (9). ∂›Û˘, Ù· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙ› ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ¤¯Ô˘Ó ÌÂȈ̤Ó˜ Èı·ÓfiÙËÙ˜ Ó· ÓÔÛ‹ÛÔ˘Ó ·ÚÁfiÙÂÚ· ·fi ¤ÚËÙ· ˙ˆÛÙ‹Ú·, Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ ÌÂ Ê˘ÛÈ΋ Ïԛ̈ÍË (10,11). ∆Ô ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Â›Ó·È ·ÛʷϤ˜. √È ·Ú·ÙËÚÔ‡ÌÂÓ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Â›Ó·È Û¿ÓȘ. √È ÈÔ Û˘¯Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Â›Ó·È ÔÈ ÙÔÈΤ˜ ·ÓÙȉڿÛÂȘ Î·È Ë ‹È· ˘ÚÂÙÈ΋ ΛÓËÛË (12,13). ¶ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛÂ Î·È ÛÙËÓ ∂ÏÏ¿‰· ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. √ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ Ì ˘„ËÏ‹ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ·ÓÂÏÏ‹ÓÈ·, ÂÓÒ ·Ó ‰ÂÓ ÂÈÙ¢¯ı› ˘„ËÏ‹ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÌÂÙ·ÙfiÈÛ˘ ÙÔ˘ Â›ÓÔÛÔ˘ ÏËı˘ÛÌÔ‡ Û ¿ÙÔÌ· ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. ∫¿ÙÈ Ù¤ÙÔÈÔ ı· ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ Û ÂÊ‹‚Ô˘˜ Î·È ÂÓ‹ÏÈΘ, fiÔ˘ ÔÈ ÂÈÏÔΤ˜ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ Î·È ÛÔ‚·ÚfiÙÂÚ˜. °È· ÙÔÓ Û¯Â‰È·ÛÌfi Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÛÙÚ·ÙËÁÈPaediatriki 2007;70:141-145

΋˜, ·ÏÏ¿ Î·È ÁÈ· ÙË ÌÂϤÙË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÁÓˆÚ›˙Ô˘Ì ÙËÓ ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Î·È ÙˆÓ ÂÈÏÔÎÒÓ ·˘Ù‹˜ ÛÙËÓ ∂ÏÏ¿‰·, ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∏ ÌÂϤÙË ·˘Ù‹ ·ÔÙÂÏ› ÙÌ‹Ì· ÌÈ·˜ ¶·ÓÂÏÏ‹ÓÈ·˜ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¤Ú¢ӷ˜, fiÔ˘ ·Ó·Ï‡ıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜. ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ÂÎÏ‹ıËÛ·Ó ÔÈ ÁÔÓ›˜ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ‹Ù·Ó ·Ïfi Û‡ÓÙÔÌÔ Î·È Û·Ê¤˜. ¶·ÚfiÏÔ Ô˘ ÔÏÏ¿ Û¯ÔÏ›· Â¤ÏÂÍ·Ó Ó· ÌË Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ÌÂϤÙË, Û˘Ó‹ıˆ˜ ÏfiÁˆ ·˘ÍË̤ÓÔ˘ ÊfiÚÙÔ˘ ÂÚÁ·Û›·˜, ÙÔ ‰Â›ÁÌ· Â›Ó·È ÌÂÁ¿ÏÔ (>19.000 ·È‰È¿). ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ ÂÚ›Ô˘ ‰‡Ô ÛÙ· ÙÚ›· ·È‰È¿ Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÂÎ·›‰Â˘ÛË ¤¯Ô˘Ó ‹‰Ë ÓÔÛ‹ÛÂÈ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, fiˆ˜ Î·È Ù¤ÛÛÂÚ· ÛÙ· ¤ÓÙ ·È‰È¿ Ô˘ ÙÂÏÂÈÒÓÔ˘Ó ÙÔ ‰ËÌÔÙÈÎfi Û¯ÔÏ›Ô. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Â›Ó·È Û‹ÌÂÚ· ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ·Ï·ÈfiÙÂÚ˜ ÂÏÏËÓÈΤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (14,15). ∏ ̤ÛË ËÏÈΛ· Ô˘ ÓÔÛÔ‡Ó Ù· ·È‰È¿ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û‹ÌÂÚ·, Â›Ó·È Ù· 4,75 ¤ÙË, ÂÓÒ ÚÈÓ ·fi 15 ¯ÚfiÓÈ· ˆ˜ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ Û˘ÓÔÏÈο, ·Ó·Ê¤ÚÔÓÙ·Ó Ù· 6,5 ¤ÙË (15-18). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ ¿ÏÏˆÓ Â˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ fiÔ˘ ¤¯ÂÈ ÌÂȈı› ÛËÌ·ÓÙÈο Ô Ì¤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ÚˆÙÔÏԛ̈͢ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, Èı·Ófiٷٷ ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·È‰ÈÒÓ Ô˘ ËÁ·›ÓÔ˘Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi (6,7,19-20). ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ‰ÂÓ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ·fi ÙȘ ¿ÏϘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ (8). ∂Ȃ‚·ÈÒÓÔÓÙ·˜ Ù· ·Ú·¿Óˆ, ‚Ú¤ıËΠfiÙÈ Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ÛÙ· ·È‰È¿ Ô˘ ‹Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË Û ۇÁÎÚÈÛË Ì ÂΛӷ Ô˘ ‰ÂÓ ‹Á·Ó. ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, Â›Ó·È Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Û ۯ¤ÛË Ì ٷ ·‰¤ÏÊÈ· ÙÔ˘. ∏ ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· Â›Ó·È ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·˘Ù‹˜ ÙˆÓ ÚˆÙfiÙÔÎˆÓ ·È‰ÈÒÓ, ÂÓÒ ÌÂÈÒÓÂÙ·È ÎÈ ¿ÏÏÔ ÛÙ· ·È‰È¿ Ô˘ ‹Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi Î·È ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ·, ÚÔÊ·ÓÒ˜ ÁÈ·Ù› ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ¿ÏÏ· ·È‰È¿ ·fi ÌÈÎÚ‹ ËÏÈΛ· Î·È ·˘Í¿ÓÔÓÙ·È ÔÈ Èı·ÓfiÙËÙ˜ Ó· ÂÎÙÂıÔ‡Ó ÛÙÔÓ Èfi Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. ∂›Û˘, Ù· ∂ÏÏËÓfiÔ˘Ï· ÓÔÛÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Î·È Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· ·fi Ù· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ, Èı·Ófiٷٷ ÁÈ·Ù› ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·fi Ù· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ËÁ·›ÓÔ˘Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi. ∆¤ÏÔ˜, fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›· (1,3), ‚ڋηÌ fiÙÈ ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ∂∑ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ¤¯Ô˘Ó ÓÔÛ‹ÛÂÈ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ÌÈÎÚ‹ ËÏÈΛ·. ¶·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ, ·Ó Î·È ÓfiÛËÛ·Ó ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ÌÂÁ·Ï‡ÙÂÚË

Pediatr Mar-Apr 07

28-03-07

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∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜

ËÏÈΛ· Û ۯ¤ÛË Ì ٷ ∂ÏÏËÓfiÔ˘Ï·, ÂÌÊ¿ÓÈÛ·Ó ∂∑ Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi. ∆Ô Â‡ÚËÌ· ·˘Ùfi ı· ÌÔÚÔ‡Û ıˆÚËÙÈο Ó· ÂÍËÁËı› ·fi ·˘ÍË̤ÓÔ ÛÙÚ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂÙ·Ó·ÛÙÒÓ, ·ÏÏ¿ ¯Ú‹˙ÂÈ ÂȂ‚·›ˆÛ˘ ·fi ¿ÏϘ ÌÂϤÙ˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ∂ÏÏËÓfiÔ˘Ï· Û‹ÌÂÚ·, ÓÔÛÔ‡Ó ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ηٿ ÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ· (<5 ÂÙÒÓ), ÔfiÙÂ Î·È ÔÈ Èı·ÓfiÙËÙ˜ ÂÈÏÔÎÒÓ Â›Ó·È ·˘ÍË̤Ó˜ (4,21,22), ÁÂÁÔÓfi˜ Ô˘ Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ıˆÚԇ̠fiÙÈ Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÁηÈÚ· ηٿ ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ ˙ˆ‹˜, ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡, fiˆ˜ Û˘ÓÈÛÙ¿Ù·È ÛÙȘ ∏¶∞ Î·È Û ÔÏϤ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜. ªÂ ‚¿ÛË Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ Î·È ÌÂÙ¿ ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·, ı· Ú¤ÂÈ Ó· ˘ÔÏÔÁÈÛÙ› Ô ÏfiÁÔ˜ ÙÔ˘ ÎfiÛÙÔ˘˜-ÔʤÏÔ˘˜ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ÛÙË ¯ÒÚ· Ì·˜.

9.

10.

11.

12.

13.

14.

15.

16.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Ann M. Arvin. Varicella Zoster Virus. Textbook Nelson.

15th ed. 2000; p. 1413-1418.

2. Patel RA, Binns HJ, Shulman ST. Reduction in pediatric hospitalization for varicella-related invasive group A streptococcal infection in the varicella vaccine era. J Pediatr 2004;144:68-74.

3. Weller T. Varicella and herpes zoster: a perspective and overview. J Infect Dis 1992;166 (1 Suppl):S1-S6.

4. Choo PW, Donahue JG, Manson JE, Platt R. The epidemiology of varicella and its complications. J Infect Dis 1995;172:706-712.

5. Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1996;45:1-36 6. Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, et al. Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect 2001;127:305-314.

7. ¶··Â˘·ÁÁ¤ÏÔ˘ µ, ™˘ÚÈÔÔ‡ÏÔ˘ µ, ªÔÛÙÚÔ‡ °, °ÎÈ˙¿Ú˘ µ, £ÂÔ‰ˆÚ›‰Ô˘ ª. ∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ·ÓÔÛ›·˜ ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ. π·ÙÚÈ΋ 2001;79:544-546.

8. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality

17.

18.

19.

20.

21.

22.

due to varicella after implementation of varicella vaccination in the United States. N Engl J Med 2005;352:450-458.

Lieu TA, Cochi SL, Black SB, Halloran ME, Shinefield HR, Holmes SJ, et al. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994;271: 375-381.

Seward JF, Watson BM, Peterson CL, Mascola L, Pelosi JW, Zhang JX, et al. Varicella disease after introduction of varicella vaccine in the United States 1995-2000. JAMA 2002;287:606-611.

Goldman GS. Universal varicella vaccination: efficacy trends and effect on herpes zoster. Int J Toxicol 2005;24: 205-213.

American Academy of Pediatrics. Committee on Infectious Diseases. Varicella vaccine update. Pediatrics 2000;105:136-141.

Wise RP, Salive ME, Braun MM, Mootrey GT, Seward JF, Rider LG, et al. Postlicensure safety surveillance for varicella vaccine. JAMA 2000; 284:1271-1279. à ¢ÚfiÛÔ˜. ∏ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ Û ·È‰È¿ Ì ·ÓÂÌ¢ÏÔÁÈ¿. ¶·È‰È·ÙÚÈ΋ 1998;51:236-240. °∫ §·Áfi˜. ∂ÈÏÔΤ˜ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ·fi ·ÓÂÌ¢ÏÔÁÈ¿. ∂ÁΤʷÏÔ˜ 1988;25:182-185. µ·˙·›Ô˘ £, µ·ÛÈÏ¿ÎÔ˘ µ, ¢ÂÏ‹˜ ¢, ª·ÚÙÛfiη˜ Ã, ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ∂Ï¿ÙÙˆÛË Ù˘ ËÏÈΛ·˜ ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ·È‰ÈÎfi ÏËı˘ÛÌfi, 1989-1997. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 2000. Û. 220. ¶··Â˘·ÁÁ¤ÏÔ˘ µ, ∫·ÙÛ·Ê¿‰Ô˘ ∞, §È¿Ë °, ¶ÈÙÛÔ‡ÏË ∂, ºÂÚÂÓÙ›ÓÔ˜ °, ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ∂ȉËÌÈÔÏÔÁ›· ·ÓÂÌ¢ÏÔÁÈ¿˜ ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ. 42Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 2004. ∫·‚·ÏÈÒÙ˘ π, ∫·ÓÛÔ˘˙›‰Ô˘ ∞, ∫·Ú·Ì·ÍfiÁÏÔ˘ ¢, ∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘ º, ¶ÂÙÚ›‰Ô˘ ™, ∆Û·ÁηÚÔÔ‡ÏÔ˘ ∏, ÷Ù˙Ë·ÁfiÚÔ˘ ∂. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ Ù˘ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜.

38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 2000. Û. 139.

Davis MM, Patel MS, Gebremariam A. Decline in varicella-related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States. Pediatrics 2004;114:786-792.

Rentier B, Gershon AA. European Working Group on Varicella. Consensus: varicella vaccination of healthy children - a challenge for Europe. Pediatr Infect Dis J 2004;23: 379-389. ∂ ∞ÏÂÍfiÔ˘ÏÔ˜, ∞ ™·Ï·‚Ô‡Ú·, µ ¶··Â˘·ÁÁ¤ÏÔ˘, ° ªÔÛÙÚÔ‡, ∂ ∫ˆÛÙ·‰‹Ì·, ª £ÂÔ‰ˆÚ›‰Ô˘. ∂ÌÂÈÚ›· ·fi ÙË ÓÔÛËÏ›· ·È‰ÈÒÓ Ì ·ÓÂÌ¢ÏÔÁÈ¿ (1993-1997). ¶·È‰È·ÙÚÈ΋ 1999;62:499-502.

Kavaliotis J, Petridou S, Karabaxoglou D. How reliable is the history of chickenpox? Varicella serology among children up to 14 years of age. Int J Infect Dis 2003;7:274-277.

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Homocystinuria due to cystathionine ‚-synthase deficiency: two sides to the same coin 1 University 1st Pediatric Department, Hippocration General Hospital of Thessaloniki, Greece 2 Ophthalmology Department, Hippocration General Hospital of Thessaloniki, Greece 3 University 3rd Pediatric Department, Hippocration General Hospital of Thessaloniki, Greece Correspondence: Persephone AugoustidesSavvopoulou persefon@med.auth.gr University 1st Pediatric Department-Metabolic Lab Hippocration General Hospital of Thessaloniki 49, Constantinoupoleos St. Thessaloniki 546 42, Greece

P. Augoustides-Savvopoulou1, H. Ioannou1, N. Kozeis2, A. Karagiannidou3, M. Athanasiou-Metaxa1 Abstract: Cystathionine ‚-synthase (C‚S) deficiency (OMIM#236200) is a rare, autosomal recessive defect of methionine metabolism, considered to be the most frequent cause of homocystinuria. Clinical features include severe myopia, ectopia lentis, marfanoid skeletal abnormalities with osteoporosis, mental retardation and thromboembolism which is the most frequent cause of death. The mainstay of therapy is pyridoxine, the precursor of the coenzyme for C‚S, but only 50% of patients respond. Two patients with C‚S deficiency are described, a B6-responsive boy and a B6-non-responsive girl, with the objective of highlighting: 1) the clinical heterogeneity of this disorder, 2) the crucial importance of early diagnosis and treatment and 3) the difficulties in management of B6 non-responsive patients. Patient 1 was admitted at the age of 10 because of a cerebrovascular stroke. His history included severe progressive myopia from a young age and ectopia lentis. Patient 2, a nine year old girl with pseudophakia and a clinical diagnosis of Marfan’s syndrome, presented with severe behavioural symptoms. In both patients, a metabolic workup revealed high plasma levels of total homocysteine and methionine and C‚S deficiency was confirmed by enzyme assay. Pyridoxine administration resulted in a dramatic decrease of homocysteine and methionine levels in patient 1 but not in patient 2 necessitating alternative therapeutic measures. It is concluded that C‚S deficiency is a clinically heterogenous disorder which if untreated can lead to life-threatening consequences. Plasma total homocysteine should be a first-line test in patients with early onset of severe myopia, ectopia lentis, skeletal changes reminiscent of Marfan’s syndrome, thromboembolism, mental retardation with psychiatric symptoms, bearing in mind that the complete clinical spectrum may not always be apparent.

Key words: C‚S deficiency, homocystinuria, ectopia lentis, marfanoid, thromboembolism, pyridoxine.

Introduction Homocystinuria (HCU) due to cystathionine ‚-synthase deficiency (C‚Sd) (OMIM#+236200) is a potentially lethal autosomal recessive defect of methionine (Me) metabolism resulting in the accumulation of homocysteine (Hcy) and Me in body fluids (Figure 1) (1). It is considered the second most common treatable inherited disorder of amino acid metabolism (2). The worldwide incidence of C‚Sd based on data from newborn screening is ~1: 344.000 live births but the true incidence is estimated to be much higher (3,4). The most frequent clinical manifestations of C‚Sd affect four organ systems: the eye (ectopia lentis), the skeleton (dolichostenomelia, osteoporosis), the central nervous system (psychiatric problems, mental retardation) and the vascular system, with thromboembolic events being the commonest cause of death (2,3). The age of presentation and extent to which affected patients manifest these abnormalities varies widely (2). The main target of treatment is the high Hcy levels. Two clinical forms of the disease have been delineated on the basis of responsiveness to pharmacological doses of vitamin Paediatriki 2007;70:146-151

B6 (pyridoxine), a precursor of pyridoxal phosphate, the coenzyme for C‚S. About 50% of patients respond to B6 therapy, whereas 50% do not, requiring additional treatment strategies, including a low Me, cystine-supplemented diet and/or betaine (5,6). Two patients with C‚Sd are described: a B6-responsive boy and a B6-nonresponsive girl, in order to highlight the clinical heterogeneity of this disorder, the crucial importance of early diagnosis and treatment, and the difficulties encountered in the treatment of B6non-responsive patients.

Case reports Patient 1 A 9-year-old boy, offspring of unrelated parents, was admitted to the pediatric ICU of our hospital in a comatose state. On admission, brain magnetic resonance imaging (MRI) revealed thrombosis of the superior sagittal sinus (Figure 2) and a regimen of anticoagulants, anticonvulsants and antimicrobial agents was immediately initiated. On day six of hospitalization the patient was transferred to our pediatric department for further evaluation and treatment. On day 11

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(2) Folic acid

(3) Diet

Tetrahydrofolate 5,10-Methylenetetrahydrofolate

Methionine N,N Dimethyl glycine

S-Adenosyl methionine

+

Betaine homocysteine methyltransferase S-Adenosyl homocysteine Betaine (4) 5-MethylHomocysteine tetrahydrofolate Cystathionine MTHFR (1) Pyridoxine beta-synthase deficiency (B6) Cystathionine +

3a

3b

Figure 3. Photographs showing long digits in hand (3a) and feet (3b) of patient 1.

+

Methionine synthase (2) B12

(3) Cysteine

Figure 1. Metabolic pathway of methionine and potential sites of therapeutic intervention in C‚S deficiency.

The transsulfuration pathway is the chief route of disposal of Me, converting the sulfur atom of Me into the sulfur atom of cysteine. Two additional metabolic sequences are the transmethylation reactions whereby 1) the methyl group of Me is ultimately used in the formation of many methylated compounds and 2) the reformation of Me by methylation of Hcy. Remethylation of Hcy is dependent on B12 (active form, methylcobalamin) and folic acid (active form, MTFHR), and its transmethylation to cystathionine is dependent on C‚S coenzyme B6 (active form 5 pyridoxyl phosphate).

The level of C‚Sd is shown by X. Potential sites of therapeutic intervention are shown by (1) B6, (2) B12 & folic acid, which increase remethylation of Hcy to Me; (3) low-protein, low-Me, cystine supplemented diet; (4 ) betaine, a donor of methyl groups that increases remethylation of Hcy to Me.

he developed thrombosis of the right popliteal vein, whereupon his anticoagulant regimen was intensified.

Physical examination revealed a tall, obese male with weight and height above the 97th percentile, mild genu

Figure 2. Brain MRI scan of patient 1 showing thrombosis of the superior sagittal sinus.

valgum, marginal disproportion of limbs to trunk, and long digits (Figures 3, 4). Opthalmological examination revealed bilateral ectopia lentis with total subluxation of the left lens into the anterior chamber. According to his history myopia (3.5 diopters) was first diagnosed at age six when he entered primary school.

Thereafter there was a rapid increase in myopia to 6.5 diopters, iridodonesis and phakodonesis was observed and 2.5 years later total subluxation of the lens occurred. From the family history his father had been treated surgically for thrombophlebitis in a lower limb two years previously.

A coagulation screen for thrombophilic factors (FV Leiden, FII prothrombin, factors VII, VIII, IX, Protein C, Protein S, anti-cardiolipin) was unremarkable but measurement of plasma total homocysteine [(tHcy) (FPIA IMX, Abbott Labs)] revealed a highly increased level: 256 Ìmol/L (reference range 3-10).

Quantitative analysis of deproteinized plasma amino acids (post-column cation-exchange HPLC) showed increased unbound (free) homocystine (fHcy) (101 Ìmol/l, ref. range 0-5) and methionine (181 Ìmol/l, ref. range 9-36). Investigation of cobalamin and folate status of the patient revealed low levels of vitamin B12 (195 pg/ml, ref. range 223-1132) and folic acid (2.2 ng/ml, ref. range 2.8-16.9). He was shown to be homozygous (677TT) for the 677C→T polymorphism in the gene that encodes 5, 10-methylenetetrahydrofolate reductase (MTHFR).

The clinical features of this patient in combination with the very high plasma tHcy and methionine levels were conclusive for C‚Sd. Vitamin supplementation with a B1, B6, B12 complex (Trivimine 125 mg+125 mg +0.125 mg X 2/d) as well as folic acid (5 mg/d) was immediately initiated. Trivimine was initially used in spite of the lack of indication for B1 because it was the only product commercially available. C‚Sd was further confirmed when assay of the activity of CbS in cultured skin fibroblasts revealed a very low value: 0.05 nmol cystathionine/ h/mg protein (control range: 2.3-18.2, homozygote range: 0.0-0.19). A molecular screen for the common B6-responsive C‚S ¶·È‰È·ÙÚÈ΋ 2007;70:146-151

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4a

4b

Figures 4a, 4b. Photographs of patient 1 showing genu valgum and mild disproportion of limbs to trunk

mutation T833C (I278T) was negative. After 20 consecutive days of treatment with the vitamin supplements, striking decreases of tHcy to 32 Ìmol/l, fHcy to 0 Ìmol/l, and Me to 30 Ìmol/l were found. Family investigation revealed normal plasma tHcy and Me levels in the patient’s sibling whereas both his father and mother had increased tHcy (49 Ìmol/l and 21 Ìmol/l respectively) with normal levels of Me, B12 and folic acid. Plasma tHcy values of his parents normalized 14 days after initiation of 5 mg/d folic acid therapy.

In view of the diagnosis, he was assessed for osteoporosis by a DEXA bone scan, which was normal. In addition, psychological assessment did not reveal signs of mental retardation or psychiatric disturbances. Re-evaluation of the patient before discharge showed major improvement in brain MRI imaging and adequate flow of the popliteal vein. To date (2 years after diagnosis), the patient has not had another vascular episode and his plasma tHcy levels are within the normal range (~10-15 Ìmol/l). Anticoagulant (warfarin) and anticonvulsant (phenytoin) therapy was discontinued after one year, but supplementation with vitamins B6, B12, and folic acid is being continued as a life-long regimen with regular monitoring of tHcy levels. The follow-up protocol for this patient includes opthalmological examination every 6 months and yearly monitoring of bone-density (DEXA scan) and his vascular system (triplex Doppler scan).

Patient 2 This 9-year-old girl, who had been clinically diagnosed as having Marfan’s syndrome at age 8, was referred for investigation because of learning problems and severe behavioral symptoms (negative attitude, frequent outbursts of crying). Physical examination Paediatriki 2007;70:146-151

revealed a body weight and height above the 75th and 97th percentile respectively. Her limbs were disproportionately long in relation to her trunk (dolichostenomelia). She had pes cavus, genu valgum, arachnodactyly and a narrow-face with a high-arched palate (Figures 5, 6, 7) Cardiac ultrasonography was normal. She had a history of very severe myopia (10 diopters) and astigmatism (1.5 diopters) from age 6.

By age 8, myopia had increased to 18 diopters and astigmatism had doubled. At age 8 years, 5 months she had manifested right lens subluxation for which she was surgically treated with a lens implant. Three months later, because of the resulting difference in refractive error (anisometropia) the lens of the left eye was also replaced. Psychological assessment confirmed the cognitive deficits and emotional lability (affective inappropriateness). Her family history was unremarkable.

In view of the clinical combination of tall stature with marfanoid skeletal dysmorphy and ectopia lentis, the initial aim of the diagnostic workup was to ascertain if she had Marfan’s syndrome or C‚Sd. Amino acid analysis revealed very high plasma levels of tHcy (268 Ìmol/l), fHcy (93 Ìmol/l) and Me (630 Ìmol/l), indicating CBS deficiency. This was confirmed by the fact that CbS activity in cultured skin fibroblasts was not detected (0.0 nmol cystathionine/ h/mg protein).

Other abnormal laboratory results were the reduced serum levels of both vitamin B12 (190 pg/ml) and folic acid. Results of routine haematology and biochemistry analyses were unremarkable.

A trial of B6 therapy (250 g/d) was initiated. Amino acid analysis performed 20 days later showed only slight reduction of the tHcy level to 260 Ìmol/l, whereas the Me level was essentially unchanged. Consequently, over a period of 2 weeks B6 dosage was gradually increased to 500 mg/day but, after two weeks plasma levels of tHcy and Me remained elevated (535 and 248 Ìmol/l respectively), indicating that the patient was not responding to pyridoxine. In view of these findings she was placed on a low protein, Merestricted diet with a Me-free amino acid supplement

5a

5b

Figure 5. Photograph of: a) feet of patient 2 depicting long digits and pes cavum and b) hands with long digits (arachnodactyly).

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Table 1. Comparison of clinical features of patient 1 and patient 2

Severe myopia Ectopia lentis Marfanoid habitus Osteoporosis Vascular events Mental retardation B6 response Age at diagnosis

Figure 6. Photograph depicting high palate of patient 2.

rich in cystine and other essential amino acids (Hom2 Secunda, SHS). In addition, betaine (Cystadane, Orphan Europe) was administered in a dosage of 4 g/day. Subsequent monitoring of amino acids revealed a significant reduction in plasma tHcy to 156 Ìmol/l, but also a significant increase in Me to 1238 Ìmol/l. In view of the potential risk of cerebral edema due to severe hypermethioninemia, the betaine dosage was reduced, and methionine restriction intensified. With frequent monitoring of this regimen plasma tHcy levels below 100 Ìmol/l (~90 Ìmol/l) and Me levels ~600 Ìmol/l were achieved. Assessment of bone-density (DXA scan) has revealed incipient osteoporosis of the spinal vertebrae. A vascular screen was negative (normal Triplex Doppler test), and brain MRI scans are essentially normal. Monitoring of these parameters is carried out on a yearly basis.

7a

7b

Figures 7a, 7b. Marfanoid habitus of patient 2 (dolichostenomelia, genu valgum, pes cavus) is depicted.

Patient 1

Patient 2

+ + + + + 10 y

+++ + +++ + + 9y

Discussion Despite the presence of major clinical features of C‚Sd in both our patients, they remained undiagnosed until late childhood, with severe and nearly fatal consequences. As shown in Table 1, these two patients had common features, but also significant differences that illustrate the clinical heterogeneity of C‚Sd. The striking clinical clues common to both were the opthalmological findings of severe myopia from a young age and ectopia lentis (Figure 8). Ectopia lentis occurs in about 85% of C‚S-deficient patients but often a systemic disorder is not suspected, or the patients are misdiagnosed as having Marfan’s syndrome (2,7,8). Indeed, such a misdiagnosis was made for both our patients. Marfan’s syndrome is a relatively common (~1:5-10000 live births), but as yet untreatable, autosomal dominant disorder of connective tissue in which lens dislocation also occurs. However, such patients do not have the increased levels of plasma tHcy and Me characteristic of C‚Sd (2,3,8).

The lenticular origin of myopia in C‚S deficient patients is not always recognized. Clues for lenticular myopia are abnormally rapid progression of myopia, severe myopia in children and progressive myopia in adults (7). Nevertheless, it should be stressed that a normal ophthalmological examination at any age does not exclude the diagnosis of C‚Sd (2,9,10). Further similarities between patients with Marfan’s syndrome and those with C‚Sd are that both typically have increased limb length and genu valgum. Patient 2 was marfanoid in structure, but she had osteoporosis and signs of involvement of the central nervous system which are distinguishing features of C‚Sd (2).

In accord with the findings in our patients, spinal osteoporosis and other skeletal abnormalities generally occur earlier in pyridoxine non-responsive patients than in those responsive to pyridoxine (2).

Thromboembolism, affecting both large and small arteries and veins, is the most striking cause of morbidity and mortality in C‚Sd. Sagittal sinus thrombosis was the presenting feature in patient 1. Because the ¶·È‰È·ÙÚÈ΋ 2007;70:146-151

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Figure 8. Photograph of eye of patient with C‚Sd depicting total subluxation of the lens (from the Atlas of International Council of Ophthalmology).

laboratory workup for thrombotic events included measurement of tHcy in plasma, the diagnosis of C‚Sd was made. This life-threatening complication in our B6-responsive patient is in agreement with observations that, although such responsive patients tend to have less severe clinical manifestations than do B6-non-responsive patients, the probability of untreated patients of both types having vascular events is about the same (2). Homozygosity (677TT) for the MTFHR polymorphism in our patient together with low folic acid and B12 levels may have been an additional contributory factor (11).

Mental retardation is the most frequent central nervous system abnormality and, together with psychiatric symptoms, may be the first recognizable sign of C‚Sd (9). It is of note that the cognitive deficits and psychiatric problems of patient 2 were the main reasons for which her parents sought help.

The prognosis for an individual diagnosed with C‚Sd, if untreated, is one of progressive morbidity and mortality, as documented by Mudd et al in the largest to-date survey of C‚S-deficient patients (2). Treatment of this disorder usually halts progression of skeletal, neurological and vascular problems, but advanced opthalmological problems are more difficult to control (6). In a multicenter study involving 158 patients with 2822 patient-years of treatment, homocysteine-lowering treatment was shown to reduce the vascular risk significantly, despite imperfect biochemical control (5).

The main target of treatment in CbSd is to control or eliminate the severe hyperhomocystinemia characteristic of this disorder, the ultimate goal being to prevent the life-endangering thromboembolic events and to prevent further escalation of complications already present. The basic treatment strategy is: 1) to increase, where possible, the residual enzyme activity by administration of the coenzyme precursor, pyridoxine; 2) to Paediatriki 2007;70:146-151

decrease the load on the affected pathway with a low protein, low Me diet; 3) to supplement deficient products (cystine); 4) and/or to use alternative pathways to remove toxic substrates or their metabolites (betaine) (Figure 1) (6). As evidenced by the dramatic response in patient 1, this is achieved relatively easily in the pyridoxine-responsive patient by the administration of pharmacological doses of B6, together with folic acid 5 mg/d and B12. Patients not given folic acid while on pyridoxine therapy become folate-depleted, hampering the biochemical response in a potentially B6-responsive patient (6,12). All newly diagnosed patients should be given a pyridoxine trial while remaining on a normal diet. Biochemically, vitamin responsiveness is indicated by decreasing Hcy and Me levels. If tHcy and Me levels remain persistently elevated while on high (500 mg/d) pyridoxine for several weeks, the patient is deemed biochemically pyridoxine-non-responsive and is commenced on a Me restricted diet. Doses of pyridoxine required for a response vary markedly among pyridoxine responders and have been associated with different mutations within the CbS gene (13). Rarely, very high (2-6 g/d) doses of B6 have caused reversible peripheral neuropathy but, as yet, this has been seen only in nonC‚S-deficient patients (12). Treatment of the B6-nonresponsive patient is a challenge because many patients will not comply with the unpalatable, low protein, Merestricted, cystine-supplemented diet which, in addition, requires frequent biochemical monitoring. Betaine may be useful in pyridoxine-non-responsive patients who will not tolerate Me restriction, or as an adjunct to such a diet. This compound acts as a methyl donor, increasing the rate of remethylation of Hcy to Me by betaine-homocysteine methyltransferase. Until recently it was believed that the resultant hypermethioninaemia did not influence the pathophysiology of the disease. However there has been more than one report of progressive cerebral edema associated with very high levels of Me (>1000 Ìmol/l) indicating that regular biochemical monitoring of Me levels should be performed in B6-non-responsive patients on betaine therapy (14,15). The very high levels of Me in patient 2 were a cause for concern, necessitating intensification of the low Me diet and regulation of the betaine dose with concomitant titration of Me. The biochemical hallmark of C‚Sd is hyperhomocystinaemia in combination with hypermethioninaemia. It should be stressed that hypermethioninemia is not completely obligatory in C‚Sd (absent in about 6% of cases) and isolated hyperhomocystinaemia does not confirm C‚Sd (2). Pitfalls in the measurements of Hcy levels can be avoided if blood samples are from fasting patients and promptly

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processed. Diagnosis is confirmed if C‚S enzyme activity in cultured skin fibroblasts is non-detectable or up to 15% of mean control levels. In addition to the above tests, C‚S mutational screening is another option. There are now at least 139 known disease-causing C‚S mutations. (13) The two most common are the G307S, also known as the “Celtic” mutation, and the 833 T>C (I278T) mutation. The former is associated with the more severe pyridoxine-non-responsive phenotype whereas the latter is associated with the milder pyridoxine-responsive phenotype. I278T was not present in our B6-responsive patient. Although mutation analysis is a tool for better understanding the variability of the clinical phenotype, the existence of a large number of very rare, often private, mutations limits the usefulness of this approach in routine diagnosis. Prenatal diagnosis of C‚Sd is available either by metabolite or enzyme analysis in amniotic fluid/cells or mutation analysis in chorionic villi (16).

Regarding the detection of C‚Sd by newborn screening by searching for hypermethioninemia, a cause of concern is the high number of false-negative results.

Pyridoxine-responsive disease is often missed by such newborn screening because increased Me levels are not prominent in these newborns. Newborn screening for common mutations has been suggested by some workers (4).

In conclusion, C‚Sd is a potentially treatable condition, especially if detected and treated early. Untreated, this disorder can lead to life-threatening complications. Its clinical heterogeneity necessitates increased awareness of the variety of clinical presentations. The recognition of myopia in patients with thromboembolism, skeletal abnormalities or central nervous system complications, aptly coined by Cruysberg et al (7) as “myopia plus”, should alert physicians to the possibility of C‚Sd. Plasma total homocysteine should be a first-line test in patients with early onset of severe myopia, ectopia lentis, skeletal changes reminiscent of Marfan’s syndrome, thromboembolism, mental retardation with psychiatric symptoms, bearing in mind that these features may be isolated or in combination.

Accurate diagnosis of a genetic disease has important consequences for the patient and his family because of the implications for appropriate therapy and genetic counseling. In the event of diagnosis, highrisk family members should be investigated as well.

Acknowledgements We express our gratitude to Dr S Harvey Mudd for reviewing the manuscript and for his advice as regards the management of our patients and to Dr Leo Kluijtmans for his help with the enzyme and molecular assays.

References 1. Mudd SH, Finkelstein JD, Irreverre F, Laster L. Homocystinuria: an enzymatic defect. Science 1964;143:14431445.

2. Mudd SH, Skovby F, Levy HL, Pettigrew KD, Wilcken B, Pyeritz RE, et al. The natural history of homocystinuria due to cystathionine beta-synthase deficiency. Am J Hum Genet 1985;37:1-31 3. Mudd SH, Levy HL, Kraus JP. Disorders of transsulfuration. In: Scriver CR, Beaudet AL, Sly WS, Valle D, Childs B, Kinzler KW, editors. The Metabolic and Molecular Bases of Inherited Disease, 8th ed. New York: McGraw-Hill; 2001. p. 2007-2056.

4. Refsum H, Fredriksen A, Meyer K, Ueland PM, Kase BF. Birth prevalence of homocystinuria. J Pediatr 2004;144: 830-832.

5. Yap S, Boers GH, Wilcken B, Wilcken DE, Brenton DP, Lee PJ, et al. Vascular outcome in patients with homocystinuria due to cystathionine beta-synthase deficiency treated chronically: a multicenter observational study. Arterioscler Thromb Vasc Biol 2001;21:2080-2085.

6. Walter JH, Wraith JE, White FJ, Bridge C, Till J. Strategies for the treatment of cystathionine beta-synthase deficiency: the experience of the Willink Biochemical Genetics Unit over the past 30 years. Eur J Pediatr 1998;157 (Suppl 2):S71-S76.

7. Cruysberg JR, Boers GH, Trijbels JM, Deutman AF. Delay in diagnosis of homocystinuria: retrospective study of consecutive patients. BMJ 1996;313:1037-1040.

8. Boers GH, Polder TW, Cruysberg JR, Schoonderwaldt HC, Peetoom JJ, van Ruyven TW, et al. Homocystinuria versus Marfan’s syndrome: the therapeutic relevance of the differential diagnosis. Neth J Med 1984;27:206-212.

9. Li SC, Stewart PM. Homocystinuria and psychiatric disorder: a case report. Pathology 1999;31:221-224.

10. Lu CY, Hou JW, Wang PJ, Chiu HH, Wang TR. Homocystinuria presenting as fatal common carotid artery occlusion. Pediatr Neurol 1996;15:159-162.

11. Kluijtmans LA, Boers GH, Verbruggen B, Trijbels JM, Novaã kovaã IR, Blom HJ. Homozygous cystathionine betasynthase deficiency, combined with factor V Leiden or thermolabile methylenetetrahydrofolate reductase in the risk of venous thrombosis. Blood 1998;91:2015-2018.

12. Boers GH, Yap S, Naughten E, Wilcken B. The treatment of high homocysteine concentrations in homocystinuria: Biochemical control in patients and their vascular outcome. In: K. Robinson, ed. Homocysteine and vascular disease. Dordrecht, The Netherlands: Kluwer Academic Publishers; 2000. p. 349-411.

13. Krauslab Homepage. [Webpage, Internet]. Denver, Colorado. University of Colorado Health Sciences Center: http://www.uchsc.edu/sm/cbs.

14. Braverman NE, Mudd SH, Barker PB, Pomper MG. Characteristic MR imaging changes in severe hypermethioninemic states. AJNR Am J Neuroradiol 2005;26:2705-2706.

15. Devlin AM, Hajipour L, Gholkar A, Fernandes H, Ramesh V, Morris AA. Cerebral edema associated with betaine treatment in classical homocystinuria. J Pediatr 2004;144: 545-548.

16. Fowler B, Jakobs C. Post- and prenatal diagnostic methods for the homocystinurias. Eur J Pediatr 1998;157 (Suppl 2): S88-S93. ¶·È‰È·ÙÚÈ΋ 2007;70:146-151

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CASE REPORT

¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” AÏÏËÏÔÁÚ·Ê›·: µ·ÛÈÏÈ΋ ™˘ÚÈÔÔ‡ÏÔ˘ vsyriop@cc.uoa.gr ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 11527, ∞ı‹Ó·

ª. £ÂÔ‰ˆÚ›‰Ô˘, µ. µ·ÛÈÏÔÔ‡ÏÔ˘, ∞. ∑ËÛÔ‡ÏË, °. ªÔÛÙÚÔ‡, µ. ™˘ÚÈÔÔ‡ÏÔ˘ ¶ÂÚ›ÏË„Ë: ∏ ΢ÛÙÈΤÚΈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (Ó¢ÚÔ΢ÛÙÈΤÚΈÛË) ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ÓfiÛÔ Ô˘ ÚÔηÏÂ›Ù·È ·fi ·Ú¿ÛÈÙ·, ΢ڛˆ˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜. ™ÙËÓ ∂˘ÚÒË Î·Ù·ÁÚ¿ÊÔÓÙ·È ÛÔÚ·‰Èο ÎÚÔ‡ÛÌ·Ù·, ·ÚfiÙÈ Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ Û˘ÓıËÎÒÓ Î·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô ·ÈÒÓ· Û˘ÓÂÙ¤ÏÂÛ ÛÙÔÓ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ ÓfiÛÔ˘. √È ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÛÙ· ·È‰È¿. ∏ ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ‰ËÌÔÛÈÂ˘Ì¤ÓÔ ÂÚÈÛÙ·ÙÈÎfi ·ÚÂÁ¯˘Ì·ÙÈ΋˜ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ Û ·È‰› ÛÙËÓ ∂ÏÏ¿‰·. ∂ΉËÏÒıËΠÎÏÈÓÈο Ì Û·ÛÌÔ‡˜, ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘ Î·È ÂÙÂÚfiÏ¢ÚË ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∏ ·ÍÔÓÈ΋ (CT) Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„·Ó ÔÏÏ·Ϥ˜ ˘fi˘ÎÓ˜ ‹ ÈÛfi˘ÎÓ˜ ‚Ï¿‚˜ Ì ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ· ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂÁÎÂÊ·Ï›‰·, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘ ÛÙÔÓ ÔÚfi Ì ELISA ·¤‚Ë ıÂÙÈÎfi˜. ÃÔÚËÁ‹ıËÎ·Ó Û˘ÓÔÏÈο ÙÚ›· Û¯‹Ì·Ù· ·Ï‚ÂÓ‰·˙fiÏ˘, ‰È¿ÚÎÂÈ·˜ 28 ËÌÂÚÒÓ ¤Î·ÛÙÔ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÁÈ· ¤Ó· Ì‹Ó·. ŒÓ· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ·, ÙÔ ·È‰› ‹Ù·Ó ˘ÁȤ˜ Î·È ÛÙËÓ MRI ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌfiÓÔ Ì›· ÌÈÎÚ‹, ·ÔÙÈٷӈ̤ÓË ‚Ï¿‚Ë ÛÙÔÓ ÌÂÙˆÈ·›Ô ÏÔ‚fi ‰ÂÍÈ¿. ∏ ¤ÁηÈÚË ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈ΋˜ Î·È ·ÓÙÈ·Ú·ÛÈÙÈ΋˜ ·ÁˆÁ‹˜, Û˘ÓÂÙ¤ÏÂÛ·Ó ÛÙËÓ ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË. ∏ ·ÚÔ˘Û›·ÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ ·ÔÛÎÔ› ÛÙÔ Ó· ÙÔÓ›ÛÂÈ fiÙÈ Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Î¿ı ·È‰ÈÔ‡ Ì Û·ÛÌÔ‡˜ Î·È ÂÛÙȷ΋ Ó¢ÚÔÏÔÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, ·ÎfiÌ· Î·È Û ¯ÒÚ˜ fiÔ˘ Ë ÓfiÛÔ˜ ‰ÂÓ ÂÓ‰ËÌ›. §¤ÍÂȘ ÎÏÂȉȿ: ∫˘ÛÙÈΤÚΈÛË, Ó¢ÚÔ΢ÛÙÈΤÚΈÛË, ·È‰È¿, Taenia solium.

Neurocysticercosis in childhood: a case report First Department of Paediatrics, Aghia Sofia Children’s Hospital, University of Athens, Greece Correspondence: Vasiliki Syriopoulou vsyriop@cc.uoa.gr First Department of Paediatrics, University of Athens Aghia Sofia Children’s Hospital, Thivon and Levadias St., 11527, Athens, Greece

M. Theodoridou, V. Vasilopoulou, A. Zisouli, G. Mostrou, V. Syriopoulou Abstract: Cysticercosis of the central nervous system (neurocysticercosis) is the commonest parasitic disease of the human nervous system, affecting mainly populations of developing countries. In Europe, sporadic cases still occur, although the progress in sanitation during the last century has contributed to the elimination of the disease. Affected children usually present with epileptic seizures. The case reported is the first published case of childhood parenchymal neurocysticercosis in Greece. The child presented with seizures, signs and symptoms of increased intracranial pressure and unilateral peripheral facial palsy. Brain CT and MRI showed multiple hypodense and isodense lesions with peripheral oedema in the cerebral hemispheres and the cerebellum, while the ELISA test for serum anticysticercal antibodies was positive. Three courses of albendazole were administered, each of 28 days, combined with corticosteroids for one month. One year later the child was healthy and MRI showed only one calcified lesion in the right frontal lobe. Early diagnosis followed by antiepileptic and antiparasitic therapy contributed to a successful outcome. This case report aims to point out that neurocysticercosis should be included in the differential diagnosis of every child presenting with seizures and focal neurologic deficits, even in non-endemic countries.

Key words: Cysticercosis, neurocysticercosis, children, Taenia solium.

™˘ÓÙÔÌÔÁڷʛ˜ EITB

enzyme-linked immunoelectrotransfer blot assay ELISA enzyme-linked immunosorbent assay ∂¡À ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi MRI Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· CT ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

Paediatriki 2007;70:152-155

∂ÈÛ·ÁˆÁ‹ ∏ ΢ÛÙÈΤÚΈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (Ó¢ÚÔ΢ÛÙÈΤÚΈÛË) ÚÔηÏÂ›Ù·È ·fi ÙȘ ÚÔÓ‡Ìʘ (΢ÛÙ›ÎÂÚÎÔÈ) Ù˘ Ù·ÈÓ›·˜ ÙÔ˘ ¯Ô›ÚÔ˘ (Taenia solium). √ ·ÎÏÔ˜ ˙ˆ‹˜ ÙÔ˘ ·Ú·Û›ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ¿ÓıÚˆÔ ˆ˜ ·ÚÈÔ Î·È ÙÔÓ ¯Ô›ÚÔ ˆ˜ ÂӉȿÌÂÛÔ ÍÂÓÈÛÙ‹.

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√È ¯Ô›ÚÔÈ ÌÔχÓÔÓÙ·È Ï·Ì‚¿ÓÔÓÙ·˜ Ì ÙËÓ ÙÚÔÊ‹ ÙÔ˘˜ ˆ¿ Ù˘ T. solium ·fi ·ÓıÚÒÈÓ· ÎfiÚ·Ó·, Ô˘ ÂÍÂÏ›ÛÛÔÓÙ·È ÛÙÔ˘˜ Ì˘˜ Î·È ÛÙÔÓ ÂÁΤʷÏÔ ÙˆÓ ˙ÒˆÓ Û ΢ÛÙ›ÎÂÚÎÔ˘˜. ∏ ηٷӿψÛË ·fi ÙÔ˘˜ ·ÓıÚÒÔ˘˜ ·ÙÂÏÒ˜ „Ë̤ÓÔ˘ ¯ÔÈÚÈÓÔ‡ ÎÚ¤·ÙÔ˜ Ô˘ ÂÚȤ¯ÂÈ ˙ˆÓÙ·ÓÔ‡˜ ΢ÛÙ›ÎÂÚÎÔ˘˜ ÚÔηÏ› ·Ú·ÛÈÙÈ΋ Ïԛ̈ÍË ÙÔ˘ ÂÓÙ¤ÚÔ˘, ·ÏÏ¿ fi¯È Ó¢ÚÔ΢ÛÙÈΤÚΈÛË. √È ¿ÓıÚˆÔÈ ÌÔÚ› Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó Î·È ˆ˜ ÂӉȿÌÂÛÔÈ ÍÂÓÈÛÙ¤˜ Ì ·¢ı›·˜ ÌÂÙ¿‰ÔÛË ÙÔ˘ ·Ú·Û›ÙÔ˘ ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ, ̤ۈ Ù˘ ÎÔÚ·ÓÔÛÙÔÌ·ÙÈ΋˜ Ô‰Ô‡. ∆· ˆ¿, ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ÌÂÙ·ÙÚ¤ÔÓÙ·È Û ΢ÛÙ›ÎÂÚÎÔ˘˜ Ô˘ ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ÛÙÔ˘˜ Ì˘˜, ÛÙÔÓ ˘Ô‰fiÚÈÔ ÈÛÙfi ‹ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, fiÔ˘ ÛÙ·‰È·Î¿ ˆÚÈÌ¿˙Ô˘Ó Û ·ÛÙÂȘ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔ ·Ú¿ÛÈÙÔ Î·È Ô·Ï›˙ÔÓ ˘ÁÚfi (1,2). √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÔ˘Ó Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔÓ ·ÚÈıÌfi Î·È ÙËÓ ÂÓÙfiÈÛË ÙˆÓ Î‡ÛÙÂˆÓ Î·ıÒ˜ Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ÍÂÓÈÛÙ‹. ∏ Ïԛ̈ÍË ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÙÂÏ›ˆ˜ ·Û˘Ìو̷ÙÈ΋. ∆· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È fiÙ·Ó ÙÔ ·Ú¿ÛÈÙÔ Ô˘ ÂÚȤ¯ÂÙ·È ÛÙËÓ Î‡ÛÙË Î·Ù·ÛÙÚ·Ê›, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÎÈÓËÙÔÔ›ËÛË ·fi ÙÔÓ ÍÂÓÈÛÙ‹ ÙÔÈ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›‰Ú·Û˘. ∞’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, Ë ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ‰ËÌÔÛÈÂ˘Ì¤ÓÔ ÂÚÈÛÙ·ÙÈÎfi ·ÚÂÁ¯˘Ì·ÙÈ΋˜ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ Û ·È‰› ÛÙËÓ ∂ÏÏ¿‰·.

¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 14 ÂÙÒÓ, Ì ÂχıÂÚÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi, ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ÏfiÁˆ Û·ÛÌÒÓ Î·È ÂÚÈÊÂÚÈ΋˜ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∫·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ·ÚÔ˘Û›·˙ ӷ˘Ù›·, Â̤ÙÔ˘˜, ÎÂÊ·Ï·ÏÁ›· Î·È ¯·ÌËÏ‹ ˘ÚÂÙÈ΋ ΛÓËÛË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ‰ÂÓ ·ÚÔ˘Û›·˙ ¿ÏÏ· Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù·, ÂÓÒ ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‰ÂÓ ÚԤ΢„·Ó ÂÚ·ÈÙ¤Úˆ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÏËÓ ‰‡Ô ÌÈÎÚÒÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÂÛÙÈÒÓ ÛÙÔÓ ·ÚÈÛÙÂÚfi ‚˘ıfi ηٿ ÙËÓ ÔÊı·ÏÌÔÛÎfiËÛË. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÂÏ¿Ì‚·Ó ÏÔÈÌÒÍÂȘ (ÂÁÎÂÊ·Ï›Ùȉ·, ÌËÓÈÁÁ›Ùȉ·, ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·) Î·È ÓÂÔϷۛ˜ ÙÔ˘ ∫¡™, ηıÒ˜ Î·È ¿ÏÏ· Û·ÓÈfiÙÂÚ· ·›ÙÈ· fiˆ˜ ·ÁÁÂÈ›Ùȉ·, ÙÔÍÔÏ¿Û̈ÛË, Ê˘Ì·Ù›ˆÛË, ‚Ï·ÛÙÔ̇ΈÛË, ÈÛÙÔÏ¿Û̈ÛË, ·ÛÂÚÁ›ÏψÛË, ηÓÙÈÓÙ›·ÛË, ÎÚ˘ÙÔÎfiÎΈÛË, ¯ÈÓÔÎÔÎΛ·ÛË Î·È Û·ÚÎÔ›‰ˆÛË. ∏ ·ÍÔÓÈ΋ (CT) Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„·Ó ÔÏÏ·Ϥ˜ ‚Ï¿‚˜ ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂÁÎÂÊ·Ï›‰· (∂ÈÎfiÓ· 1). √ÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÂÚÈ‚¿ÏÏÔÓÙ·Ó ·fi ÂÚÈÔ¯¤˜ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ¿ÏϘ ˘fi-

˘ÎÓ˜ ‹ ÈÛfi˘ÎÓ˜ ‚Ï¿‚˜, Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ· Î·È ‰·ÎÙ˘ÏÈÔÂȉ‹ Â›Ù·ÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‰ÂÓ ·Ó¤‰ÂÈÍ ÂÈϤÔÓ ‚Ï¿‚˜. ™ÙÔ ÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ηٷÁÚ¿ÊËΠ·‡ÍËÛË ÙˆÓ Î˘Ì¿ÙˆÓ ı. √È Û˘Ó‹ıÂȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜, ˆÛÙfiÛÔ Ë IgA ·ÓÔÛÔÛÊ·ÈÚ›ÓË ‹Ù·Ó ·˘ÍË̤ÓË ÛÙÔÓ ÔÚfi. ™ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) ‰È·ÈÛÙÒıËΠÙÒÛË Ù˘ ÁÏ˘Îfi˙˘, ·‡ÍËÛË ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ Î·È ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË, ηıÒ˜ Î·È ·‡ÍËÛË ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ IgG Î·È IgA. √ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÍfiÏ·ÛÌ·, ·Û¤ÚÁÈÏÏÔ, Candinda albicans, Cryptococcus neoformans Î·È Echinococcus granulosus ·¤‚Ë ·ÚÓËÙÈÎfi˜. ∆· ·ÓÙÈÛÒÌ·Ù· ÔÚÔ‡ Î·È ∂¡À ηٿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘, ·Ú¯Èο, ‹Ù·Ó Â›Û˘ ·ÚÓËÙÈο. ∏ Ê˘Ì·Ù›ˆÛË ·ÔÎÏ›ÛÙËÎÂ, ηıÒ˜ Ë ‰ÔÎÈÌ·Û›· Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·Û˘ ‹Ù·Ó ·ÚÓËÙÈ΋ Î·È Ô ¤ÏÂÁ¯Ô˜ Ì PCR ÁÈ· DNA ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙÔ ∂¡À Î·È ÛÙÔ Á·ÛÙÚÈÎfi ˘ÁÚfi ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∞fi ÙÔ ÈÛÙÔÚÈÎfi ‰ÂÓ ·Ó·ÊÂÚfiÙ·Ó Ù·Í›‰È Û ÂÓ‰ËÌÈ΋ ¯ÒÚ· ·fi ÙÔ ·È‰› ‹ ¿ÏÏÔ Ì¤ÏÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ô‡Ù ÂÎÙÚÔÊ‹ ¯Ô›ÚˆÓ ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∂›Û˘ ·fi ÙËÓ ÂͤٷÛË ÎÔÚ¿ÓˆÓ ‰ÂÓ ‰È·ÈÛÙÒıËΠÊÔÚ›· ÙÔ˘ ·Ú·Û›ÙÔ˘ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο, ÂÚÁ·ÛÙËÚȷο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Ë ·ÛıÂÓ‹˜ ÂÙ¤ıË Û ·ÁˆÁ‹ Ì ʷÈÓ˘ÙÔ˝ÓË, ‰ÂÍ·ÌÂı·˙fiÓË (0,4 mg/kg/Ë̤ڷ) Î·È ·Ï‚ÂÓ‰·˙fiÏË (15 mg/kg/Ë̤ڷ). ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙËÓ fiÁ‰ÔË Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ÙÔ ·È‰› ·Ú·ÔÓ¤ıËΠÁÈ· ÎÂÊ·Ï·ÏÁ›·, Â̤ÙÔ˘˜ Î·È ‰Èψ›·, Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ˘Ô¯ÒÚËÛ·Ó Û ̛· ‚‰ÔÌ¿‰·. ¡¤Ô˜ ¤ÏÂÁ¯Ô˜ Ì ELISA ÁÈ· ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘ ÛÙÔÓ ÔÚfi ·¤‚Ë ıÂÙÈÎfi˜. ŒÓ· Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ·Û˘Ìو̷ÙÈ΋, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÛÙÔÓ ÔÚfi Î·È ÛÙÔ ∂¡À, ÂÓÒ ÛÙËÓ MRI ·ÚÔ˘Û›·˙ ‚ÂÏÙ›ˆÛË. ŒÏ·‚Â Û˘ÓÔÏÈο ÙÚ›· Û¯‹Ì·Ù· ·Ï‚ÂÓ‰·˙fiÏ˘, ‰È¿ÚÎÂÈ·˜ 28 ËÌÂÚÒÓ ¤Î·ÛÙÔ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌËÓÈ·›Ô ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È Ë·ÙÈÎfi ¤ÏÂÁ¯Ô. ∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ¯ÔÚËÁ‹ıËÎ·Ó ÌfiÓÔ Î·Ù¿ ÙÔÓ ÚÒÙÔ Ì‹Ó· ıÂÚ·›·˜. ŒÓ· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ·, ÙÔ ·È‰› ‹Ù·Ó ˘ÁȤ˜ Î·È ÛÙËÓ MRI ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌfiÓÔ Ì›· ÌÈÎÚ‹, ·ÔÙÈٷӈ̤ÓË ‚Ï¿‚Ë ÛÙÔÓ ÌÂÙˆÈ·›Ô ÏÔ‚fi ‰ÂÍÈ¿ (∂ÈÎfiÓ· 1).

™˘˙‹ÙËÛË ∏ Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·Ú·ÛÈÙÈ΋ Ïԛ̈ÍË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Â ¯ÒÚ˜ fiÔ˘ Ë T. solium ÂÓ‰ËÌ›, Ë Î˘ÛÙÈΤÚΈÛË ·ÔÙÂÏ› ·fi ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·Èٛ˜ ÂÈÏË„›·˜. ∂Ó‰ËÌ› ÛÙË ÓfiÙÈ· Î·È ÎÂÓÙÚÈ΋ ¶·È‰È·ÙÚÈ΋ 2007;70:152-155

Pediatr Mar-Apr 07

28-03-07

17:23

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154

ª. £ÂÔ‰ˆÚ›‰Ô˘ Î·È Û˘Ó.

∞ÌÂÚÈ΋, ÛÙËÓ ∫›Ó·, ÛÙËÓ ÈÓ‰È΋ ¯ÂÚÛfiÓËÛÔ, ÛÙË ÓÔÙÈÔ·Ó·ÙÔÏÈ΋ ∞Û›· Î·È ÛÙËÓ ˘ÔÛ·¯¿ÚÈ· ∞ÊÚÈ΋, Ì ÂÈÔÏ·ÛÌfi ¿Óˆ ·fi 1% (2). ¶ÂÚÈÛÙ·ÙÈο ηٷÁÚ¿ÊÔÓÙ·È Â›Û˘ Û ÈÔ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (∏¶∞, ¶ÔÚÙÔÁ·Ï›·, πÛ·Ó›·, °·ÏÏ›·, °ÂÚÌ·Ó›·, ¡ÔÚ‚ËÁ›·, ¶Ôψӛ·). ∏ ·‡ÍËÛË ÙˆÓ ÌÂÙ·ÎÈÓ‹ÛÂˆÓ ‰ÈÂıÓÒ˜, Ô ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌfi˜ ÌÂÙ·Ó·ÛÙÒÓ ·fi ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Î·È Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ù¯ÓÈÎÒÓ Ô‰‹ÁËÛ·Ó ÛÙË ‰È·›ÛÙˆÛË fiÙÈ Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› Û˘¯Ó‹ Ïԛ̈ÍË. øÛÙfiÛÔ, Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ÛÙËÓ ∂ÏÏ¿‰·. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó¢ڛÛÎÔÓÙ·È Ï›Á˜ ÌfiÓÔ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ÂÓËÏ›ÎˆÓ ·fi ÙËÓ ∂ÏÏ¿‰· (3). ∆Ô ÓfiÛËÌ· ‰ÂÓ ·Ó‹ÎÂÈ ÛÙ· ˘Ô¯ÚˆÙÈο ‰ËÏÔ‡ÌÂÓ·, ·ÚfiÙÈ Ë ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁ›·˜ ¤¯ÂÈ ÂÓı·ÚÚ‡ÓÂÈ ÙËÓ ÂȉËÌÈÔÏÔÁÈ΋ ÂÈÙ‹ÚËÛË Î·È ÙË ‰‹ÏˆÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Û ÂıÓÈÎfi Â›Â‰Ô (4). ∏ ·ÚÂÁ¯˘Ì·ÙÈ΋ Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Î·È ··ÓÙ¿Ù·È Û >60% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Û‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ (5). ∂ÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 70%-90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÛÙ· ·È‰È¿ (6,7). ÕÏÏ· Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ·˘ÍË̤Ó˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛ˘ fiˆ˜ ÎÂÊ·Ï·ÏÁ›·, Ó·˘Ù›·, ¤ÌÂÙÔÈ Î·È Ô›‰ËÌ· ÔÙÈ΋˜ ıËÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ÂΉËÏÒÓÂÙ·È Ì ËÌÈ¿ÚÂÛË, ·ÈÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›·, Â͈˘Ú·ÌȉÈο ÛËÌ›·, ‰È·Ù·Ú·¯¤˜ Ù˘ fiÚ·Û˘, ÌËÓÈÁÁ›Ùȉ· ‹ ¿ÓÔÈ·. ÕÏϘ ÈÔ Û¿ÓȘ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ ·ÔÙÂÏÔ‡Ó ÔÈ „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ·Ê·Û›· ÂÎÔÌ‹˜ Î·È Ë ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· (8). √ ˘‰ÚÔΤʷÏÔ˜ Î·È ÔÈ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Û˘˙˘ÁÈÒÓ Û˘Ó‰¤ÔÓÙ·È Û˘Ó‹ıˆ˜ Ì ˘·Ú·¯ÓÔÂȉÈΤ˜ Î·È ÂÓ‰ÔÎÔÈÏȷΤ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ (1). ∏ ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·Û Û·ÛÌÔ‡˜, ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘ fiˆ˜ Ó·˘Ù›·, Â̤ÙÔ˘˜, ÎÂÊ·Ï·ÏÁ›· Î·È ·ıÔÏÔÁÈ΋ ‚˘ıÔÛÎfiËÛË, ηıÒ˜ Î·È ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∞fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÂÓÙÔ›ÛÙËÎ·Ó ¿ÏϘ Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ÂÓËÏ›ÎˆÓ Ì Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Î·È ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ (9-11). ™Â Ì›· ·fi ·˘Ù¤˜, Á˘Ó·›Î· 28 ÂÙÒÓ Ì ÈÛÙÔÚÈÎfi ÎÂÊ·Ï·ÏÁ›·˜, Â̤وÓ, Ó˘ÛÙ·ÁÌÔ‡ Î·È ËÌÈ¿ÚÂÛ˘ ·fi ÂÍ·Ì‹ÓÔ˘, Û˘Û¯ÂÙ›ÛÙËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ (Û‡ÛÙÔÈ¯Ô ‹ÌÈÛ˘ ÙÔ˘ ÚÔÛÒÔ˘) Ì ÙËÓ ÂÓÙfiÈÛË Î‡ÛÙÂˆÓ ÛÙË ÁÂÊ˘ÚÔ-·ÚÂÁÎÂÊ·ÏȉÈ΋ ·‡Ï·Î·. √È Î‡ÛÙÂȘ Ê·›ÓÂÙ·È fiÙÈ Ȥ˙Ô˘Ó ÙÔ Û٤ϯԘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙÔÓ ÎÈÓËÙÈÎfi ˘Ú‹Ó· ÙÔ˘ ÚÔÛˆÈÎÔ‡ ‹ ÙÔ ›‰ÈÔ ÙÔ Ó‡ÚÔ (10). ∞ÓÙ›ıÂÙ·, Â¿Ó Ë ·Ú¿Ï˘ÛË ·ÊÔÚ¿ ÌfiÓÔ ÙÔ Î·ÙÒÙÂÚÔ Paediatriki 2007;70:152-155

∂ÈÎfiÓ· 1. MRI ÂÁÎÂÊ¿ÏÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ·ÛıÂÓÔ‡˜ (·ÚÈÛÙÂÚ¿). MRI ÂÁÎÂÊ¿ÏÔ˘ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·ÁˆÁ‹˜ ÁÈ· Ó¢ÚÔ΢ÛÙÈΤÚΈÛË (‰ÂÍÈ¿).

ÙÌ‹Ì· ÙÔ˘ ÚÔÛÒÔ˘ (ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡), Ú¤ÂÈ Ó· ·Ó·˙ËÙËı› ÎÂÓÙÚÈ΋ (˘ÂÚ˘ÚËÓÈ΋) ÂÓÙfiÈÛË Ù˘ ‚Ï¿‚˘. ™ÙËÓ ·ÛıÂÓ‹ Ì·˜, ÔÈ CT Î·È MRI ·Ó¤‰ÂÈÍ·Ó ÔÏÏ·Ϥ˜ ·ÛÙÂȘ, ÂÎÙfi˜ ·fi Ù· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂÁÎÂÊ·Ï›‰·, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ˆ˜ Èı·Ó‹ ·ÈÙ›· Ù˘ ÂÚÈÊÂÚÈ΋˜ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡. √È Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ‰È·ÁÓˆÛÙÈÎfi ̤ÛÔ (7). ∏ CT Â›Ó·È Î·Ï‡ÙÂÚË ÛÙËÓ ·ÂÈÎfiÓÈÛË ·ÔÙÈÙ·ÓÒÛÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·Ï·ÈfiÙÂÚË Ïԛ̈ÍË (12). ∏ MRI Â›Ó·È ÈÔ Â˘·›ÛıËÙË ÛÙËÓ ·ÔÎ¿Ï˘„Ë ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ‹ ˘·Ú·¯ÓÔÂȉÈÎÒÓ Î‡ÛÙˆÓ. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°) Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·Ó¢ڛÛÎÔÓÙ·È ÌË ÂȉÈΤ˜ ·ÓˆÌ·Ï›Â˜, Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ·ÛıÂÓÒ˜ Ì ٷ Û˘ÌÙÒÌ·Ù· Î·È ÙȘ ‚Ï¿‚˜ ÛÙË CT. ∏ ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·˙ ·‡ÍËÛË ÙˆÓ Î˘Ì¿ÙˆÓ ı ÛÙÔ ∏∂°. ™ÙȘ CT Î·È MRI ·Ó‚ڤıËÎ·Ó ÔÏÏ·Ϥ˜ ‚Ï¿‚˜ ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂÁÎÂÊ·Ï›‰·, ÂÓÒ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜ ¤Ó· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ·, ·ÂÈÎÔÓ›ÛÙËΠÌfiÓÔ Ì›· ·ÔÙÈٷӈ̤ÓË ÂÛÙ›·. ∏ ÂÓÂÚÁfi˜ ÓfiÛÔ˜ Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ӷ Â›‰· Ï¢ÎÒÌ·ÙÔ˜ ÛÙÔ ∂¡À, ¯·ÌËÏ‹ ÁÏ˘Îfi˙Ë Î·È ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ÏÂÈÔ·ÙÙˆÛË Ì ϛÁ· ˈÛÈÓfiÊÈÏ·, Ô˘ ·ÔÙÂÏ› ·fi‰ÂÈÍË ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÙÔ˘ ÍÂÓÈÛÙ‹ ηٿ ÙÔ˘ ·Ú·Û›ÙÔ˘. ∏ ÂͤٷÛË ÙÔ˘ ∂¡À ÛÙËÓ ·ÛıÂÓ‹ Ì·˜ ¤‰ÂÈÍ ·˘ÍË̤ÓÔ Ï‡Έ̷, ¯·ÌËÏ‹ ÁÏ˘Îfi˙Ë Î·È ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË. √È Ì¤ıÔ‰ÔÈ EITB Î·È ELISA, Ô˘ ·ÓȯÓÂ‡Ô˘Ó ·ÓÙÈÛÒÌ·Ù· ηٿ Ù˘ T. solium ‹ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘¯ÓfiÙÂÚ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ΢ÛÙÈΤÚΈÛ˘ ÛÙÔÓ ¿ÓıÚˆÔ. ∏ ¢·ÈÛıËÛ›· Ù˘ EITB ˘ÔÏÔÁ›˙ÂÙ·È Û 100% Î·È Ù˘ ELISA Û 74% (12). ™ÙËÓ ·ÛıÂÓ‹ Ì·˜ Ë ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘

Pediatr Mar-Apr 07

28-03-07

17:23

™ÂÏ›‰·155

155

¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

ÛÙÔÓ ÔÚfi, Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜, ·ÚfiÙÈ ·Ú¯Èο ‹Ù·Ó ·ÚÓËÙÈο. ¶Èı·Ó‹ ÂÍ‹ÁËÛË ·ÔÙÂÏ› ÙÔ fiÙÈ Ì ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ·Ú·ÛÈÙÈ΋˜ ıÂÚ·›·˜ ηٷÛÙÚ¿ÊËÎ·Ó ÔÈ Î‡ÛÙÂȘ, ·ÂÏ¢ıÂÚÒÓÔÓÙ·˜ ·ÓÙÈÁÔÓÈΤ˜ Ô˘Û›Â˜ Ô˘ ÎÈÓËÙÔÔ›ËÛ·Ó ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È Ì ‚¿ÛË ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘ Û οı ·ÛıÂÓ‹. ∏ ¯ÚfiÓÈ· ·ÚÂÁ¯˘Ì·ÙÈ΋ Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Ù˘Èο ÂΉËÏÒÓÂÙ·È Ì Û·ÛÌÔ‡˜, Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ·ÓÙÈÂÈÏËÙÈ΋ ıÂÚ·›·. ¶·ÚfiÙÈ ·ÓÙÈ·Ú·ÛÈÙÈο Ê¿Ú̷η fiˆ˜ Ë ·Ï‚ÂÓ‰·˙fiÏË Î·È Ë Ú·˙ÈÎÔ˘·ÓÙ¤ÏË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜, ˘¿Ú¯ÂÈ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ‰ÈÂıÓÒ˜ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘˜ (7). ∫·ıÒ˜ ÔÈ ÌÂÌÔӈ̤Ó˜ ‚Ï¿‚˜ ˘Ô¯ˆÚÔ‡Ó Û˘Ó‹ıˆ˜ ·˘ÙfiÌ·Ù·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂȉÈÎÔ› Û˘ÓÈÛÙÔ‡Ó ÙËÓ ·ÓÙÈ·Ú·ÛÈÙÈ΋ ıÂÚ·›· Û ·È‰È¿ Ì ÔÏÏ·Ϥ˜ ·ÛÙÂȘ ‹ Ì ˙ÒÛ˜ ·ÛÙÂȘ (¯ˆÚ›˜ ÛËÌ›· ·ÔÙÈÙ¿ÓˆÛ˘ ‹ Ôȉ‹Ì·ÙÔ˜ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô). ∏ ÂÊ·ÚÌÔÁ‹ ‰ÈÏÒÓ - Ù˘ÊÏÒÓ ÌÂÏÂÙÒÓ Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÓÙÈ·Ú·ÛÈÙÈÎÒÓ ÛÙË Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ‰ÔÛÔÏÔÁÈÎÔ‡ Û¯‹Ì·ÙÔ˜. ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ì·ÓÓÈÙfiÏË Î·È ·Ó·ÏÁËÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Û˘. ∏ Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË ÌÔÚ› Ó· Â›Ó·È ·Ó·Áη›· Û ˘‰ÚÔΤʷÏÔ Ô˘ ··ÈÙ› ÎÔÈÏÈÔÂÚÈÙÔÓ·˚΋ ·Ú¿Î·Ì„Ë ‹ Û ÂÓ‰ÔÎÔÈÏȷΤ˜ ·ÛÙÂȘ. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È, ¯ÔÚËÁ‹ıËÎ·Ó 3 ·ÎÏÔÈ ·Ï‚ÂÓ‰·˙fiÏ˘ (28 Ë̤Ú˜ ¤Î·ÛÙÔ˜), ̤¯ÚÈ ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙ›ÓÔ˘Ó Û˘ÓÙÔÌfiÙÂÚ· ıÂÚ·¢ÙÈο Û¯‹Ì·Ù· (10). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË, ÂÎÙfi˜ ·fi ÙÔ˘˜ Û·ÛÌÔ‡˜, ÌÔÚ› Ó· ÂΉËψı› Ì ÌÂÁ¿ÏË ÔÈÎÈÏ›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Ë ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∆· Â˘Ú‹Ì·Ù· ÙˆÓ CT Î·È MRI Â›Ó·È Î·ıÔÚÈÛÙÈο ÁÈ· ÙË ‰È¿ÁÓˆÛË. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi

ÂÓ‰¤¯ÂÙ·È Ó· ˘Ô‰ËÏÒÓÂÈ fiÙÈ ˘ÔÂÎÙÈÌ¿Ù·È Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È fiÙÈ ı· ‹Ù·Ó ¯Ú‹ÛÈ̘ ÂÚ·ÈÙ¤Úˆ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ‹ Î·È Î·ıȤڈÛË ˘Ô¯ÚˆÙÈ΋˜ ‰‹ÏˆÛ˘ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. √È ·È‰›·ÙÚÔÈ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ÛÙË ‰È·ÊÔÚÈ΋ ÙÔ˘˜ ‰È¿ÁÓˆÛË, fiÙ·Ó ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ·È‰È¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û·ÛÌÔ‡˜ Î·È ÂÛÙȷ΋ Ó¢ÚÔÏÔÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, ·ÎfiÌ· Î·È Û ÌË-ÂÓ‰ËÌÈΤ˜ ¯ÒÚ˜, fiˆ˜ Ë ∂ÏÏ¿‰·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Caprio A. Neurocysticercosis: an update. Lancet Infect Dis 2002;2:751-762.

2. WHO 56th World Health Assembly. A56/10. Control of neurocysticercosis. Report by the Secretariat 6 March 2003. [Internet]. Webpage: http://www.who.int/gb/ebwha/pdf_files/WHA56/ea5610.pdf 3. Palasis S, Drevelengas A. Extramedullary spinal cysticercosis. Eur J Radiol 1991;12:216-218.

4. Roman G, Sotelo J, Del Brutto O, Flisser A, Dumas M, Wadia N, et al. A proposal to declare neurocysticercosis an international reportable disease. Bull World Health Organ 2000;78:399-406.

5. Botero D, Tanowitz HB, Weiss LM, Wittner M. Taeniasis and cysticercosis. Infect Dis Clin N Am 1993;7:683-697.

6. Riley T, White AC Jr. Management of neurocysticercosis.

CNS Drugs 2003;17:577-591.

7. Singhi P, Singhi S. Neurocysticercosis in children. J Child Neurol 2004;19:482-492.

8. Sawhney IM, Singh G, Lekhra OP, Mathuriya SN, Parihar PS, Prabhakar S. Uncommon presentations of neurocysticercosis. J Neurol Sci 1998;154:94-100.

9. Valenca MM, Valenca LP, Lima MC. Idiopathic facial paralysis (Bell's palsy): a study of 180 patients. Arq Neuropsiquiatr 2001;59:733-739.

10. Del Brutto OH. Cysticercosis of the cerebellopontine angle: treatment with single-dose praziquantel. Rev Neurol 2000; 31:835-837.

11. Bouillot S, Monteil P, Dautheribes M, Rougier A, Guerin J, Vital A. Two cases of neurocysticercosis mimicking brain tumor. Ann Pathol 2003;23:355-357.

12. Yancey LS, Diaz-Marchan PJ, White AC. Cysticercosis: Recent advances in diagnosis and management of neurocysticercosis. Curr Infect Dis Rep 2005;7:39-47.

¶·È‰È·ÙÚÈ΋ 2007;70:152-155

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AÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘ egalanak@med.uoc.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

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¶fiÛ˜ ‰fiÛÂȘ ÙÔ˘ Ó¢ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È; ∆· Û¯‹Ì·Ù· ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÔÈΛÏÏÔ˘Ó ·fi ηÈÚfi Û ηÈÚfi ÎÈ ·fi ¯ÒÚ· Û ¯ÒÚ·, Î·È fi¯È Û¿ÓÈ· ‰ËÌÈÔ˘ÚÁÂ›Ù·È Î¿ÔÈ· Û‡Á¯˘ÛË. ¶ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙȘ ∏¶∞ ÛÙÔ Lancet ÙÔ˘ √ÎÙˆ‚Ú›Ô˘ 2006 (Lancet 2006;368:1495) ·Û¯ÔÏ‹ıËΠ̠ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÙ·‰‡Ó·ÌÔ˘ Û˘˙¢Á̤ÓÔ˘ Ó¢ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ Û ‰È¿ÊÔÚ· ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù·. ∞Ó·ÛÎÔ‹ıËÎ·Ó 782 ·È‰È¿ ËÏÈΛ·˜ 3-59 ÌËÓÒÓ Ì ‰ÈÂÈÛ‰˘ÙÈ΋ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ Ïԛ̈ÍË Î·È ÙÚÈÏ¿ÛÈÔ˜ ÏËı˘ÛÌfi˜ Ì·ÚÙ‡ÚˆÓ ›‰È·˜ ËÏÈΛ·˜ Î·È ‰È·ÌÔÓ‹˜. °È· Ù· ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ 7 ÌËÓÒÓ, Ì›· ÌfiÓÔ ‰fiÛË ÂÌ‚ÔÏ›Ô˘ ·Ú›¯Â ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 73% ÛÙËÓ ÚfiÏË„Ë Ù˘ Ïԛ̈͢, ÂÓÒ ÔÈ 2 Î·È 3 ‰fiÛÂȘ ·Ú›¯·Ó 96% Î·È 95%, ·ÓÙ›ÛÙÔȯ·. ∆ÚÂȘ ‹ 4 ‰fiÛÂȘ Ô˘ ›¯·Ó ‰Ôı› Û ‰È¿ÊÔÚ· Û¯‹Ì·Ù·, ·ÏÏ¿ Ì ¤Ó·ÚÍË ÚÈÓ ÙÔ˘˜ 7 Ì‹Ó˜ ›¯·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 98%. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÓË›ˆÓ 12-23 ÌËÓÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ÂÌ‚ÔÏÈ·Ûı› ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ›¯Â ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 93% Ì ̛· ‰fiÛË Î·È 96% Ì ‰‡Ô ‰fiÛÂȘ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÓË›ˆÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Ì 1 ‰fiÛË Â›¯Â ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 94%. ∆Ô Û¯‹Ì· 3 ‰fiÛÂˆÓ ÚÈÓ ÙÔ˘˜ 7 Ì‹Ó˜ ¯ˆÚ›˜ ·Ó·ÌÓËÛÙÈ΋ ‰fiÛË ‹Ù·Ó ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi (p=0,03) ·fi ÙÔ ÔÏÔÎÏËڈ̤ÓÔ Û¯‹Ì· Ì ·Ó·ÌÓËÛÙÈ΋ ‰fiÛË (Û‡ÓÔÏÔ 4 ‰fiÛˆÓ). π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯ÂÈ ÙÔ Â‡ÚËÌ· fiÙÈ Ì›· ¯·Ì¤ÓË ‰fiÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ ‰ÂÓ Ô‰ËÁ› Û ԢÛÈ·ÛÙÈ΋ Ì›ˆÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·ÚΛ Ó· ¯ÔÚËÁËı› Ë ·Ó·ÌÓËÛÙÈ΋ ÙˆÓ 12-16 ÌËÓÒÓ (·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 98%). √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹Ù·Ó ‰Ú·ÛÙÈÎfi˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ÙˆÓ 7 ÔÚÔÙ‡ˆÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ Ô˘ ÂÚȤ¯ÔÓÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ Î·È ÂÈϤÔÓ ÁÈ· ÙÔÓ ÔÚfiÙ˘Ô 6∞. √È Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi Û ·ÚÎÂÙ¿ ÂÌ‚ÔÏÈ·ÛÙÈο Û¯‹Ì·Ù· Î·È Â‡¯ÔÓÙ·È ÙËÓ Â¤ÎÙ·Û‹ ÙÔ˘ Î·È ÛÙȘ ÊÙˆ¯fiÙÂÚ˜ ¯ÒÚ˜. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ 800.000 Ì 1.000.000 ı·Ó¿ÙÔ˘˜ ·È‰ÈÒÓ ÂÙËÛ›ˆ˜. ∆ËÏÂʈÓÈ΋ (·È‰)È·ÙÚÈ΋ ∏ ·fi ÙËÏÂÊÒÓÔ˘ È·ÙÚÈ΋, Ì ٷ ˘¤Ú Î·È Ù· ηٿ Ù˘, Ê·›ÓÂÙ·È fiÙÈ ·ÏÒÓÂÙ·È ‰˘Ó·ÌÈο ÛÙÔ ÛËÌÂÚÈÓfi ‰›ÎÙ˘Ô ·ÚÔ¯‹˜ ˘ËÚÂÛÈÒÓ ˘Á›·˜. √È ÙËÏÂʈÓÈΤ˜ Û˘Ì‚Ô˘Ï¤˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Î·Ù·ÁÚ¿ÊÔÓÙ·È (Î·È ‰ÂÓ ·Ì›‚ÔÓÙ·È) ÌÂ Û˘Ó¤ÂÈ· Ó· Â›Ó·È ‰‡ÛÎÔÏË Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙÔ˘˜. ™Â ÌÈ· ÌÂϤÙË (Pediatrics 2007;119:e305) ·fi ÙÔ Children’s Hospital ÙÔ˘ Denver ÛÙÔ Colorado ÙˆÓ ∏¶∞, Û 8.980 ÁÔÓ›˜ Ô˘ ˙‹ÙËÛ·Ó ÙËÏÂʈÓÈ΋ Û˘Ì‚Ô˘Ï‹ ·fi ÙÔ ˘ÁÂÈÔÓÔÌÈÎfi ÚÔÛˆÈÎfi ·ÓÙ›ÛÙÔȯ˘ ÙËÏÂʈÓÈ΋˜ ˘ËÚÂÛ›·˜ (Û ÒÚ· ÂÊËÌÂÚ›·˜) ÂÙ¤ıË ÂÍ·Ú¯‹˜ ÙÔ ·Ú·Î¿Ùˆ ·ÓÔÈÎÙfi ÂÚÒÙËÌ·: “£· Ì·˜ ›Ù ÙÈ ı· οӷÙÂ, ·Ó ‰ÂÓ ÌÔÚÔ‡Û·Ù ӷ Ì·˜ ηϤÛÂÙ ·fi„Â;”. ∞fi ÙÔ˘˜ ÁÔÓ›˜, 46% ı· ‹Á·ÈÓ·Ó ÙÔ ·È‰› ÙÔ˘˜ Û ÂÊËÌÂÚ‡ÔÓ ÓÔÛÔÎÔÌ›Ô, 21% ı· ·ÓÙÈÌÂÙÒÈ˙·Ó ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·È‰ÈÔ‡ ÌfiÓÔÈ ÙÔ˘˜ ÛÙÔ Û›ÙÈ, 12% ı· ÂÈÎÔÈÓˆÓÔ‡Û·Ó Ì ÙÔÓ ÁÈ·ÙÚfi ÙËÓ ÂfiÌÂÓË Ë̤ڷ, Î·È 13% ı· ÚˆÙÔ‡Û·Ó ÁÓˆÛÙÔ‡˜. ∞fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ÁÔÓ›˜ ›·Ó fiÙÈ ı· ‹Á·ÈÓ·Ó ÛÙÔ ÂÊËÌÂÚ‡ÔÓ ÓÔÛÔÎÔÌ›Ô, ÌfiÓÔ ÛÙÔ 13,5% ‰fiıËΠÙÂÏÈο Û˘Ì‚Ô˘Ï‹ Ó· οÓÔ˘Ó Î¿ÙÈ Ù¤ÙÔÈÔ. ∂ӉȷʤÚÔÓ Â›Ó·È fiÙÈ Î·È ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÙˆÓ ÁÔÓÈÒÓ Ô˘ ‰ÂÓ ı· ‹Á·ÈÓ·Ó Ô˘ıÂÓ¿, ÛÙÔ 15% ‰fiıËÎÂ Û˘Ì‚Ô˘Ï‹ Ó· ¿Ó ÂÂÈÁfiÓÙˆ˜ Û ÂÊËÌÂÚ‡ÔÓ ÓÔÛÔÎÔÌ›Ô. ™Â Â›Â‰Ô ÙÔÈÎÔ‡ ÎfiÛÙÔ˘˜ ˘ÔÏÔÁ›ÛÙËΠfiÙÈ Î¿ı ÙËÏÂÊÒÓËÌ· ·¤ÊÂÚ 42,6 ‰ÔÏ¿ÚÈ· ΤډԘ ÛÙÔ Û‡ÛÙËÌ· ÂÚ›ı·Ï„˘. ∏ ÔÚÁ¿ÓˆÛË Ù˘ ¤ÎÙ·ÎÙ˘ ·È‰È·ÙÚÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ‰È·Ê¤ÚÂÈ Ôχ ·fi ¯ÒÚ· Û ¯ÒÚ· Î·È Â›Ó·È ·‚¤‚·ÈÔ Î·Ù¿ fiÛÔ Ù· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ı· ›Û¯˘·Ó ÁÈ· ÙËÓ ∂ÏÏ¿‰·. ŸÏÔÈ fï˜ ÔÈ ¶·È‰›·ÙÚÔÈ Ù˘ ¯ÒÚ·˜ Ì·˜ ÁÓˆÚ›˙Ô˘Ó Ôχ ηϿ ÙË ÛËÌ·Û›· Ù˘ ÙËÏÂʈÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘ ·È‰ÈÔ‡. ∞Ó·ÛÎfiËÛË Ù˘ ÙËÏÂʈÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ Ì ¯Ú‹ÛÈ̘ Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜ ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈ¢ı› ÛÙËÓ “¶·È‰È·ÙÚÈ΋” (¶·È‰È·ÙÚÈ΋ 2005;68:29-35).

Paediatriki 2007;70:156-157

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∫ÔÚÙÈÎÔÂȉ‹ Î·È Kawasaki ∏ ÚÔÛı‹ÎË ÂÓ‰ÔÊϤ‚È·˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ (‹‰Ë ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980) ÛÙÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì· Ù˘ ÓfiÛÔ˘ Kawasaki Â›Ó·È È· ÁÓˆÛÙfi fiÙÈ ÌÂÈÒÓÂÈ, ·ÏÏ¿ ‰ÂÓ ÌˉÂÓ›˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÂÈÏÔÎÒÓ ·fi Ù· ÛÙÂÊ·ÓÈ·›· ·ÁÁ›·. ∞fi ÙËÓ ¿ÏÏË ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ˘ԉ›ÍÂÈ Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÎÔÚÙÈÎÔÂȉÒÓ ÛÙË ÓfiÛÔ Kawasaki. ∆Ô Â‡ÏÔÁÔ ÂÚÒÙËÌ·, ηٿ fiÛÔ Ë ÚÔÛı‹ÎË ÂÓ‰ÔÊϤ‚È·˜ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÛÙÔ Û‡ÓËı˜ Û¯‹Ì· ÂÓ‰ÔÊϤ‚È·˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ı· ‚ÔËıÔ‡Û ٷ ·È‰È¿ Ì ÓfiÛÔ Kawasaki, ÂÍÂÙ¿ÛÙËΠ۠Ôχ ηϿ ۯ‰ȷṲ̂ÓË ÌÂϤÙË 199 ·È‰ÈÒÓ ·fi 8 ΤÓÙÚ· ÙˆÓ ∏¶∞ Î·È ÙÔ˘ ∫·Ó·‰¿ Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·Ù· (N Engl J Med 2007;356:663). ∆· ·È‰È¿ Ô˘ ‹Ú·Ó Î·È ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË Î·È ÂÓ‰ÔÊϤ‚È· ·ÓÔÛÔÛÊ·ÈÚ›ÓË Â›¯·Ó οˆ˜ ‚Ú·¯‡ÙÂÚÔ ¯ÚfiÓÔ ·Ú¯È΋˜ ÓÔÛËÏ›·˜ (p=0,05) Î·È ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ Ù·¯‡ÙËÙ·˜ ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ Î·È C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ ÛÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· (p=0,02 Î·È p=0,07) Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ‹Ú·Ó ÌfiÓÔ ÂÓ‰ÔÊϤ‚È· ·ÓÔÛÔÛÊ·ÈÚ›ÓË Î·È placebo. øÛÙfiÛÔ Ë ÚÔÛı‹ÎË Ù˘ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ‰ÂÓ ‚Ú¤ıËΠӷ ÂËÚ¿˙ÂÈ ÙË Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡, ÙËÓ ·Ó¿ÁÎË Â·Ó·¯ÔÚ‹ÁËÛ˘ ÂÓ‰ÔÊϤ‚È·˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘, ÙË Û˘¯ÓfiÙËÙ· ·ÚÂÓÂÚÁÂÈÒÓ Î·È, ÙÔ Î˘ÚÈfiÙÂÚÔ, ‰ÂÓ ‚Ú¤ıËΠӷ ÂËÚ¿˙ÂÈ ÙȘ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. √È ÂÚ¢ÓËÙ¤˜ ηٷϋÁÔ˘Ó fiÙÈ Ù· ‰Â‰Ô̤ӷ ÙÔ˘˜ ‰ÂÓ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ÚÔÛı‹ÎË ÂÓ‰ÔÊϤ‚È·˜ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÛÙÔ Î·ıÈÂڈ̤ÓÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì· ÙˆÓ ·È‰ÈÒÓ Ì ÓfiÛÔ Kawasaki. ™ÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ˘¿Ú¯ÂÈ Û¯ÔÏÈ·ÛÌfi˜ ÙÔ˘ ¿ÚıÚÔ˘ Ì·˙› Ì ÌÈ· ·Ó·ÛÎfiËÛË ÙˆÓ ·ÈÓÈÁÌ¿ÙˆÓ Î·È ÙˆÓ ÚÔÎÏ‹ÛÂˆÓ Ù˘ ÓfiÛÔ˘ Kawasaki ÁÈ· 40 ÙfiÛ· ¯ÚfiÓÈ·, Î·È ‰‡Ô ÁÂÓȤ˜ ÁÈ·ÙÚÒÓ ÌÂÙ¿ ÙËÓ ÂÚÈÁÚ·Ê‹ Ù˘ ·fi ÙÔÓ Tomisaku Kawasaki (N Engl J Med 2007;356:659). ∆Ô Ù‡¯Ô˜ ª·ÚÙ›Ô˘ 2007 ÙÔ˘ Pediatric Infectious Disease Journal ÂÚȤ¯ÂÈ ¿ÏÏË ÌÈ· ÂӉȷʤÚÔ˘Û· ÌÂϤÙË (PIDJ 2007;26:256) ·fi ÙÔ San Diego ÙˆÓ ∏¶∞: Ô ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ·Ó¢ڢÛÌ¿ÙˆÓ ÛÙ· ÛÙÂÊ·ÓÈ·›· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È fi¯È Ì ÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ·Ó·˙‹ÙËÛË È·ÙÚÈ΋˜ ‚Ô‹ıÂÈ·˜ ·fi ÙÔ˘˜ ÁÔÓ›˜. °Ú›Ë ÙˆÓ ÙËÓÒÓ, Í·Ó¿ Î·È Í·Ó¿ ∆Ô SARS Ì¿˜ ÙÚfiÌ·Í ÚÈÓ Ï›Á· ¯ÚfiÓÈ· ·ÏÏ¿ ‰ÂÓ Ì·˜ Ôχ··Û¯ÔÏ› ¤ÎÙÔÙÂ, ·ÂÓ·ÓÙ›·˜ Ë ÁÚ›Ë ÙˆÓ ÙËÓÒÓ ÛÙ¤ÏÓÂÈ Î¿ı ÙfiÛÔ ·ÓËÛ˘¯ËÙÈο ÌËӇ̷ٷ: ̤۷ ÛÙÔ ÚÒÙÔ ‰›ÌËÓÔ ÙÔ˘ 2007 ·Ó·Ê¤ÚıËÎ·Ó ÎÚÔ‡ÛÌ·Ù· fi¯È ÌfiÓÔ Û ÔÏϤ˜ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜, ·ÏÏ¿ Î·È ÛÙËÓ ∞ÁÁÏ›· (Ì ÙȘ ¯ÈÏÈ¿‰Â˜ Á·ÏÔԇϘ Ô˘ ı·Ó·ÙÒıËÎ·Ó ÚÔÏËÙÈο) Î·È ÛÙËÓ ∞›Á˘ÙÔ Ì ·Ó·ÊÔÚ¿ ÎÚÔ‡ÛÌ·ÙÔ˜ Û ·È‰› ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ. °È· ÙË ÓfiÛÔ ¯ÔÚËÁÂ›Ù·È ÙÔ ·ÓÙÈ-ÈÈÎfi ÔÛÂÏÙ·ÌÈ‚›ÚË (oseltamivir/Tamiflu, Roche Laboratories), ·Ó·ÛÙÔϤ·˜ Ù˘ Ó¢ÚÔ·ÌÈÓȉ¿Û˘, ÁÓˆÛÙfi ·fi ÙË ıÂÚ·›· Ù˘ “ÎÏ·ÛÈ΋˜” ÁÚ›˘ ∞ Î·È µ. ™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ Â›Ó·È ‰È·‰Â‰Ô̤ÓË Ë ¯Ú‹ÛË ÙÔ˘, ˆÛÙfiÛÔ ÛÙȘ ∏¶∞ ÙÔ ·ÓÙÈ-ÈÈÎfi Â›Ó·È ÂÁÎÂÎÚÈ̤ÓÔ Î·È ÁÈ· ·È‰È¿ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ Î·È ˘¿Ú¯ÂÈ ‹‰Ë ÂÍ·ÈÚÂÙÈ΋ ÂÌÂÈÚ›· ·fi ÙËÓ π·ˆÓ›· (Clin Infect Dis 2006;43:439, Clin Infect Dis 2006;43:445). ∞ÓËÛ˘¯ËÙÈ΋ ˆÛÙfiÛÔ (Science 2007,315:448) Â›Ó·È Ë ÂÌÊ¿ÓÈÛË Î¿ÔÈ·˜ ·ÓÙÔ¯‹˜ ÙÔ˘ ÈÔ‡ Ù˘ ÁÚ›˘ ÙˆÓ ÙËÓÒÓ (∞ H5N1) ÛÙËÓ ÔÛÂÏÙ·ÌÈ‚›ÚË, Ô˘ ÂȂ‚·ÈÒıËΠ۠‰‡Ô ÌÔÈÚ·›· ÎÚÔ‡ÛÌ·Ù· ÛÙËÓ ∞›Á˘ÙÔ ÙÔÓ ÂÚ·Ṳ̂ÓÔ ¢ÂΤ̂ÚÈÔ (ÙÔ ¤Ó· Ì¿ÏÈÛÙ· Û ÎÔÚ›ÙÛÈ 16 ÂÙÒÓ). ∏ ‰ÂÈÁÌ·ÙÔÏË„›· ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ›¯Â Á›ÓÂÈ ÌfiÏȘ ‰‡Ô Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ Ù˘ ÔÛÂÏÙ·ÌÈ‚›Ú˘, Î·È Û˘ÓÂÒ˜ Â›Ó·È Â‡ÏÔÁË Ë ˘fiıÂÛË fiÙÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó ÌÔÏ˘Óı› ÂÍ·Ú¯‹˜ Ì ·ÓıÂÎÙÈÎfi Èfi. ∞Ó ˘¿Ú¯Ô˘Ó ÎÈ ¿ÏÏ· ÙËÓ¿ Ì ·ÓıÂÎÙÈÎfi Èfi, Ù· ·ÁÎfiÛÌÈ· ·Ôı¤Ì·Ù· ÔÛÂÏÙ·ÌÈ‚›Ú˘ ÂӉ¯Ô̤ӈ˜ ·¯ÚËÛÙ‡ÔÓÙ·È. ∫·È ÂÈϤÔÓ, ÛÙÔ Ù‡¯Ô˜ ÙÔ˘ British Medical Journal Ù˘ 3˘ ª·ÚÙ›Ô˘ (BMJ 2007;334:442) ÂÌÊ·Ó›˙ÂÙ·È Ë Úfi‚ÏÂ„Ë ·fi ÙÔ European Centre for Disease Prevention and Control (‰ڿ˙ÂÙ·È ÛÙË ™ÙÔίfiÏÌË) fiÙÈ Ë ∂˘ÚÒË ¯ÚÂÈ¿˙ÂÙ·È ·ÎfiÌË ‰‡Ô Ì ÙÚ›· ¯ÚfiÓÈ· ÁÈ· Ó· ıˆÚËı› ¤ÙÔÈÌË Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÂӉ¯fiÌÂÓË ·Ó‰ËÌ›· Ù˘ ÁÚ›˘ ÙˆÓ ÙËÓÒÓ. ∂ԯȷ΋ ÁÚ›Ë: ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹ fi¯È; ∏ ÂÙ‹ÛÈ· Âԯȷ΋ ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÁÚ›˘ ÛÙ· ·È‰È¿ ¤Ú·Û ‹ ‚Ú›ÛÎÂÙ·È ÛÙ· ÙÂÏÂ˘Ù·›· Ù˘ ÛÙË ¯ÒÚ· Ì·˜. ∆Ô ÂÚÒÙËÌ· ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÁÚ›Ë Â›Ó·È ·ÏÈfi Î·È ·Ú·Ì¤ÓÂÈ, Î·È ı· Â·Ó¤ÏıÂÈ ÙÔ ÊıÈÓfiˆÚÔ. ∞ÏÏÔ‡ ÂÊ·ÚÌfi˙ÂÙ·È Î·ıÔÏÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ (.¯., ÛÙȘ ∏¶∞ ÁÈ· Ù· ‚ÚÂÊÔÓ‹È· 6-23 ÌËÓÒÓ) Î·È ·ÏÏÔ‡ ÚÔÙÈÌ¿Ù·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌfiÓÔ ÔÌ¿‰ˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (.¯., ÛÙËÓ ∂ÏÏ¿‰·). √ ηıÔÏÈÎfi˜ ‹ fi¯È ÂÌ‚ÔÏÈ·ÛÌfi˜ ·Ú·Ì¤ÓÂÈ ÏÔÈfiÓ ˘fi Û˘˙‹ÙËÛË, Ë ·ÛÊ¿ÏÂÈ· ¿ÓÙˆ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ‰Â‰Ô̤ÓË Î·È Ê·›ÓÂÙ·È Ó· ÙÂÎÌËÚÈÒÓÂÙ·È Î·È ·fi ÌÈ· ·ÎfiÌË ÚfiÛÊ·ÙË ÌÂϤÙË, ·Ó·‰ÚÔÌÈ΋ Î·È ÙË ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ Â›‰Ô˜ Ù˘ (JAMA 2006;296:1990) Ô˘ Û˘ÌÂÚȤϷ‚ 45.356 ·È‰È¿ 6-23 ÌËÓÒÓ Ô˘ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó Ì 69.359 ‰fiÛÂȘ ÙÚȉ‡Ó·ÌÔ˘ ·‰Ú·ÓÔÔÈË̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ Ù˘ ÁÚ›˘ ÛÙȘ ∏¶∞ ·fi ÙÔ 1991 ˆ˜ ÙÔ 2003. ªÂ Ôχ ÚÔÛÂÎÙÈ΋ ·Ó¿Ï˘ÛË, Ë ÌÂÁ¿ÏË ·˘Ù‹ ÌÂϤÙË ÂȂ‚·›ˆÛ ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ù˘ ÁÚ›˘ Î·È ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 6-23 ÌËÓÒÓ.

¶·È‰È·ÙÚÈ΋ 2007;70:156-157

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AÏÏËÏÔÁÚ·Ê›·: Ã. ∫ÒÛÙ·ÏÔ˜ ccostalos@yahoo.gr ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶.°. ¡ÔÛÔÎÔÌ›Ԣ ∞ÏÂÍ¿Ó‰Ú·

¶ÚfiˆÚÔ ı‹Ï˘ ÓÂÔÁÓfi ËÏÈΛ·˜ ·ËÛ˘ 32 ‚‰ÔÌ¿‰ˆÓ Î·È ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ 900 g Ì ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹. ∆Ô Apgar score ‹Ù·Ó 8 ÛÙÔ 1Ô ÏÂÙfi Î·È 8 ÛÙÔ 5Ô ÏÂÙfi ˙ˆ‹˜. §fiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙÔÔıÂÙ‹ıËΠÎÂÓÙÚÈÎfi˜ ÊÏ‚ÈÎfi˜ ηıÂÙ‹Ú·˜ ̤ۈ Ù˘ ‰ÂÍÈ¿˜ ‚Ú·¯ÈÔÓ›Ô˘ ·ÚÙËÚ›·˜ ÁÈ· ÙËÓ ·ÚÔ¯‹ ·ÚÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘. ∆ËÓ 10Ë Ë̤ڷ ˙ˆ‹˜ ·ÚÔ˘Û›·Û ϋı·ÚÁÔ, ˆ¯ÚÔ··ÓÔ ¯ÚÒÌ·, ÂÂÈÛfi‰È· ¿ÓÔÈ·˜ Î·È ‚Ú·‰˘Î·Ú‰›·. ªÂ ÙËÓ ˘Ô„›· Ïԛ̈͢ ÂÏ‹ÊıËÛ·Ó Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, Ô‡ÚˆÓ Î·È ∂¡À Î·È Î·Ï‡ÊıËΠ̠ÎÂÊÔÙ·Í›ÌË, ·ÌÈηۛÓË Î·È ‚·ÓÎÔÌ˘Î›ÓË. ∆ËÓ 12Ë Ë̤ڷ ˙ˆ‹˜ Ë ÁÂÓÈ΋ ÙÔ˘ ηٿÛÙ·ÛË ÂȉÂÈÓÒıËΠ̠η΋ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›·,

Ù·¯˘Î·Ú‰›·, ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·, Ë·ÙÔÛÏËÓÈÎfi. ∫·Ù¿ ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ‰È·ÈÛÙÒıËΠηÏ·ÛÙÈÎfi˜ Ú˘ıÌfi˜, Û˘ÛÙÔÏÈÎfi ÎÏÈÎ Î·È ÔÏÔÛ˘ÛÙÔÏÈÎfi ʇÛËÌ· 3Ô˘ ‚·ıÌÔ‡ ·ÚÈÛÙÂÚ¿ ·Ú·ÛÙÂÚÓÈο ÛÙÔ 4Ô ÌÂÛÔχÚÈÔ ‰È¿ÛÙËÌ·. ∏ ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ¤‰ÂÈÍ ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·, ıÚÔÌ‚ÔÂÓ›·, ÔÏÈÎfi ·ÚÈıÌfi Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ 5000/Ìl Ì 39% ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, ·ÈÌÔÛÊ·ÈÚ›ÓË 10,4 g/dl Î·È ·˘ÍË̤ÓË CRP. ∂›¯Â Â›Û˘ ÂÏ·ÊÚ¿ ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË. ™ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ·Ó·Ù‡¯ıËΠÂȉÂÚÌÈÎfi˜ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ÌÂÁ·ÏÔηډ›·. ŒÁÈÓ Â›Û˘ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ (∂ÈÎfiÓ· 1). ¶ÔÈ¿ Â›Ó·È Ë ‰È¿ÁÓˆÛË;

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

¢ÈÎÙ˘·ÎÔ› ÙfiÔÈ ÁÈ· ÙËÓ ÂÊË‚È΋ ËÏÈΛ· ∏ ÂÊ˂›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈΤ˜ ۈ̷ÙÈΤ˜ Î·È „˘¯ÈΤ˜ ÌÂÙ·‚ÔϤ˜ Î·È ··ÈÙ› ȉȷ›ÙÂÚË ÚÔÛÔ¯‹. ™ÙÔ ‰È·‰›ÎÙ˘Ô ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏ›· sites Û¯ÂÙÈÎÒÓ Ì ÙËÓ ÂÊË‚È΋ ÂÚ›Ô‰Ô, Ì ÂÌÏÔ˘ÙÈṲ̂ÓÔ ÂÚȯfiÌÂÓÔ, ÂӉȷʤÚÔÓÙ· ¿ÚıÚ·, ·ÔÙÂϤÛÌ·Ù· ÂÚ¢ÓÒÓ, forums, È·ÙÚÈο Ó¤· Î·È ·Ó·ÎÔÈÓÒÛÂȘ Û˘Ó‰ڛˆÓ.

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

IÛÙÔÛÂÏ›‰· ÁÈ· ÙËÓ ÀÁ›· ÙÔ˘ ∂Ê‹‚Ô˘ Ù˘ ∞ª∞ http://www.ama-assn.org/ama/pub/category/ 1947.html ªÂ ÙÔ ÏÔÁfiÛËÌÔ “Helping Doctors help Patients” ·˘Ù‹ Ë ÈÛÙÔÛÂÏ›‰· ÁÈ· ÙËÓ ÀÁ›· ÙÔ˘ ∂Ê‹‚Ô˘, ‚Ú›ÛÎÂÙ·È ÛÙÔ Ï·›ÛÈÔ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ π·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ (∞ª∞). ¶·Ú¤¯ÂÈ ÛÙÔ˘˜ ÂÈÛΤÙ˜ Ù˘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈΤ˜ Ì ÙËÓ ÂÊË‚È΋ ËÏÈΛ· ̤ۈ ·Ó·ÎÔÈÓÒÛÂˆÓ Ù‡Ô˘ Î·È ÚÂÔÚÙ¿˙. ™ÙÔ site ˘¿Ú¯ÂÈ ·ÎfiÌË ÛˆÚ›· ¿ÚıÚˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÊϤÁÔÓÙ· ˙ËÙ‹Ì·Ù· Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜, fiˆ˜ Ë ‰È·ÙÚÔÊ‹, Ë Ê˘ÛÈ΋ ηٿÛÙ·ÛË Î·È Ë ‚ÂÏÙ›ˆÛ‹ Ù˘, Ë Ì›ˆÛË ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ, Ë ‚›·, Ù· „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, ÙÔ ·ÏÎÔfiÏ, Ù· Ó·ÚΈÙÈο, ÙÔ Î¿ÓÈÛÌ·, Ë ÂÁ΢ÌÔÛ‡ÓË Î·È Ù· ÛÂÍÔ˘·ÏÈÎÒ˜ ÌÂÙ·‰È‰fiÌÂÓ· ÓÔÛ‹Ì·Ù·. √ ÂÈÛΤÙ˘ ÌÔÚ› ·ÎfiÌË Ó· ÂÓËÌÂÚˆı› ÁÈ· ÙËÓ È·ÙÚÈ΋ ÂÈηÈÚfiÙËÙ· ‰È·‚¿˙ÔÓÙ·˜ ·ÔÛ¿ÛÌ·Ù· ·fi ÂÈÏÂÁ̤ӷ È·ÙÚÈο ÂÚÈÔ‰Èο. ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÈÛÙÔÛÂÏ›‰· ·ÈÛıËÙÈο ·Ï‹ Î·È Û˘Ó¿Ì· ·ÚÎÂÙ¿ ÂÍÂȉÈÎÂ˘Ì¤ÓË Ô˘ ·¢ı‡ÓÂÙ·È Î˘Ú›ˆ˜ Û ÁÈ·ÙÚÔ‡˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÚÔÛʤÚÂÈ ÔÌ·‰ÔÔÈË̤ӷ ÔÏÏ¿ links Û¯ÂÙÈÎÒÓ ÔÚÁ·ÓÈÛÌÒÓ (Adolescent health links), Î·È ËÁ¤˜ Ì ÏÔ‡ÛÈÔ ˘ÏÈÎfi ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ÙˆÓ È·ÙÚ›ˆÓ ÙÔ˘˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÙ·È ·ÎfiÌË Î·È agenda ÁÈ· ÙÔ ÚfiÁÚ·ÌÌ· ÙˆÓ Û˘Ó‰ڛˆÓ ÔÏÏÒÓ È·ÙÚÈÎÒÓ ÔÚÁ·ÓÒÛˆÓ.

∂Ù·ÈÚ›· ∂ÊË‚È΋˜ π·ÙÚÈ΋˜ - http://www.adolescenthealth.org/ ÿÛˆ˜ ¤Ó· ·fi Ù· ηχÙÂÚ· site ÛÙÔ Â›‰Ô˜ ÙÔ˘. √ ÔÚÁ·ÓÈÛÌfi˜ SAM (The Society for Adolescent Medicine) ·ÔÙ¤ÏÂÛÌ· Û˘ÓÂÚÁ·Û›·˜ ÂȉÈÎÒÓ ÂÈÛÙËÌfiÓˆÓ, ·Ú¤¯ÂÈ Ì¤Ûˆ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ÙÔ˘ Û˘Ì‚Ô˘Ï¤˜, ·ÚıÚÔÁÚ·Ê›·, ÂÈÌÔÚʈÙÈΤ˜ ‰È·‰Èηۛ˜ ÁÈ· ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÂÓË̤ڈÛË Û¯ÂÙÈο Ì ÙË ‰ÈÂÍ·ÁˆÁ‹ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÂÚ¢ÓÒÓ, ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÓ‰˘Ó¿ÌˆÛ˘ Ù˘ ‰ËÌfiÛÈ·˜ ÂÓË̤ڈÛ˘ ÁÈ· Ù· ÂÊË‚Èο ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜. ∆Ô site Â›Ó·È ‰È·¯ˆÚÈṲ̂ÓÔ Û ÙÔ̤· Â·ÁÁÂÏÌ·ÙÈÎÒÓ ËÁÒÓ ÚÔ˜ ÂÓË̤ڈÛË ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Î·È Û ‰ËÌfiÛÈÔ ÙÔ̤·, fiÔ˘ ÔÈ ¤ÊË‚ÔÈ ·ÏÏ¿ Î·È Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘˜ ÌÔÚÔ‡Ó Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Î·È ÂȉÈÎfiÙÂÚ· ÁÈ· ÙÔÓ ÙÚfiÔ ¯ÂÈÚÈÛÌÔ‡ ·˘Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ÂÚÈfi‰Ô˘. ™ÙËÓ ·ÚÈÛÙÂÚ‹ ÛÙ‹ÏË, Ô ÂÈÛΤÙ˘ ‚Ú›ÛÎÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ· ·Ó‡ÚÂÛ˘ ÁÈ·ÙÚÔ‡ (ÛÙËÓ ∞ÌÂÚÈ΋), ·Ó·ÎÔÈÓÒÛÂȘ Ù‡Ô˘ Î·È ·Ó·ÁÁÂϛ˜ ÙˆÓ ÂÙ‹ÛÈˆÓ Û˘Ó‰ڛˆÓ.

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ∂ÊË‚È΋ ÀÁ›· - http://www.adolescenthealth.com/menu.html ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ site ·¢ı‡ÓÂÙ·È ÙfiÛÔ Û ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ÂÓ Á¤ÓÂÈ, fiÛÔ Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜. ∆Ô ÂÚȯfiÌÂÓfi ÙÔ˘ ·ÔÙÂÏÂ›Ù·È ·fi ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Î·È È‰¤Â˜ ÚÔÎÂÈ̤ÓÔ˘ ÔÈ Ó¤ÔÈ Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÌÈ· ˘ÁÈÂÈÓ‹ ˙ˆ‹ Î·È Ó· ÛÙ·ıÂÚÔÔÈËıÔ‡Ó Û ÌÈ· ηٿÛÙ·ÛË ÛˆÌ·ÙÈ΋˜ Î·È ÓÂ˘Ì·ÙÈ΋˜ ¢ÂÍ›·˜. ∆Ô site ÙÔ ÔÔ›Ô ·Ó·ÓÂÒÓÂÙ·È ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ‰È·¯ˆÚ›˙ÂÙ·È Û ÙÔ̤· ·Ó‰ÚÈÎfi Î·È Á˘Ó·ÈΛÔ, ÚÔÛʤÚÔÓÙ·˜ ¤ÙÛÈ ‰È·ÊÔÚÔÔÈË̤Ó˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ Î¿ı ʇÏÔ. ∆Ô ÂÚȯfiÌÂÓÔ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ËÁ¿˙ÂÈ ·fi Â·ÁÁÂÏ̷ٛ˜ ÁÈ·ÙÚÔ‡˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ∂ÊË‚È΋˜ / ¡Â·ÓÈ΋˜ π·ÙÚÈ΋˜ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ Ù˘ µÔÛÙfiÓ˘. ™ÙÔ site ˘ÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÔÈ ÏËÚÔÊÔڛ˜ ·Ú¤¯ÔÓÙ·È ÁÈ· ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Î·È fi¯È ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜, ÂÓÒ ÔÈ ¤ÊË‚ÔÈ Û˘ÌÌÂÙ¤¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙË Û˘ÁÁÚ·Ê‹ Î·È ÙËÓ ÔÚÁ¿ÓˆÛË ÙÔ˘ ˘ÏÈÎÔ‡. ∞ÎfiÌË, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙÔ˘ design ·ÏÏ¿ Î·È Ù˘ ıÂÌ·ÙÔÏÔÁ›·˜. To site, ̤۷ ·fi ÌÈ· ÏËıÒÚ· ¿ÚıÚˆÓ (·ÓÙÈÛ‡ÏÏË„Ë, ηٿıÏÈ„Ë, ·ÎÌ‹, AIDS Î.¿), ·Ú·ÎÈÓ› ÙÔ˘˜ Ó¤Ô˘˜ Ó· ÂÍÂÙ¿˙ÔÓÙ·È Û˘¯Ó¿ Î·È Ó· ÚÔÛ¤¯Ô˘Ó ÙÔ ÛÒÌ· ÙÔ˘˜ ÌÂ Û˘¯Ó¤˜ ÂÈÛΤ„ÂȘ Û ÂȉÈÎÔ‡˜ ÁÈ·ÙÚÔ‡˜.

“Your body is a complicated machine, and like all machines it needs regular maintenance”

Teen Health FX - http://www.teenhealthfx.com/answers/ans_index.php ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· site ȉȷ›ÙÂÚ· ‡¯ÚËÛÙÔ Ì ÂӉȷʤÚÔÓ, Â›Î·ÈÚÔ Î·È ·Ó·Óˆ̤ÓÔ ÂÚȯfiÌÂÓÔ. ∞¢ı‡ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙÔ˘˜ ¤ÊË‚Ô˘˜ Î·È ÛÙ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ¿ ÙÔ˘˜. ªÂ ÂÈÎÔÓÔÁÚ¿ÊËÛË ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ Î·È ıÂÌ·ÙÔÏÔÁ›· ‰È·¯ˆÚÈṲ̂ÓË Û ËÏÂÎÙÚÔÓÈÎfi Â›Â‰Ô (4 top tabs), ÙÔ site ÎÂÚ‰›˙ÂÈ ÙȘ ÂÓÙ˘ÒÛÂȘ. √È ÛÎÔÔ› ·Ó·Ê¤ÚÔÓÙ·È Û·ÊÒ˜ - ÔÈ ˘‡ı˘ÓÔÈ ÙÔ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ˆ˜ online ËÁ‹ ··ÓÙ‹ÛÂˆÓ ÁÈ· ÌÈ· ÏËıÒÚ· ÂÚˆÙ‹ÛÂˆÓ Ô˘ Ù›ıÂÓÙ·È ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘˜, ÙȘ Û¯¤ÛÂȘ, ÙÔ ÛÒÌ· Î·È ÙË ÛÂÍÔ˘·ÏÈÎfiÙËÙ¿ ÙÔ˘˜. ™ÙË Û˘Ó¤¯ÂÈ·, ·ÎÔÏÔ˘ı› ÙÔ FX Answers tab ̤ۈ ÙÔ˘ ÔÔ›Ô˘ Ô ¯Ú‹ÛÙ˘ ¤¯ÂÈ ÚfiÛ‚·ÛË Û ÌÈ· ÔÈÎÈÏ›· ·ÚıÚÔÁÚ·Ê›·˜ Û¯ÂÙÈ΋ Ì ÙÔ˘˜ ÈÔ‡˜, ÙË ‰È·ÙÚÔÊ‹, ÙË ÛÂÍÔ˘·ÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÙÔ ·ÏÎÔfiÏ, ÙÔ Î¿ÓÈÛÌ· Î.¿., ÂÓÒ ·ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ Û‡Ìʈӷ Ì ÙÔ ÔÔ›Ô ÙÔ ›‰ÈÔ ÙÔ site ‰È·ÎËÚ‡ÛÛÂÈ ÙË ‰ËÌÔÙÈÎfiÙËÙ¿ ÙÔ˘ ÛÙÔ Who We Are tab, Ì ÙËÓ ·Ó·ÊÔÚ¿ 5.000.000 ¯ÚËÛÙÒÓ ·fi ÙÔ ™Â٤̂ÚÈÔ ÙÔ˘ 1999. ™ÙÔ Links tab ηٷ¯ˆÚÔ‡ÓÙ·È ¿ÚıÚ· ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚȯfiÌÂÓÔ, fiˆ˜ Û¯ÂÙÈο Ì ‰È·Ù·Ú·¯¤˜ ‰È·ÙÚÔÊ‹˜ Î.¿., ÂÓÒ ¤Í˘ÓË ·Ú¤Ì‚·ÛË Â›Ó·È Î·È Ù· quiz ηıÒ˜ Î·È Ù· link Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂıÂÏÔÓÙÈ΋ ÂÚÁ·Û›· ÛÙÔÓ ÙÔ̤· Ù˘ ˘Á›·˜. ∆¤ÏÔ˜, ÙÔ Emergency Help tab, ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ó· ‚ÚÔ˘Ó ÙÚfiÔ˘˜ ‰ÈÂÍfi‰Ô˘ ·fi ‰‡ÛÎÔϘ ηٷÛÙ¿ÛÂȘ ηıÒ˜ ÂΛ ‚Ú›ÛÎÂÙ·È Ï›ÛÙ· ÙËÏÂÊÒÓˆÓ ÚÒÙˆÓ ‚ÔËıÂÈÒÓ (ÛÙȘ ∏.¶.∞.). ∞Ó ÙÔ ÚÔÙ›ÓÂÙ Û ÂÊ‹‚Ô˘˜ ı· Ê·Ó›Ù ȉȷ›ÙÂÚ· ÂÓËÌÂڈ̤ÓÔÈ!

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NEWS FROM THE INTERNET

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Global Teenager Project - http://www.globalteenager.org/ ∆Ô site ÙÔ˘ Global Teenager Project ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤ÓÙÔÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ‰È·‰Ú·ÛÙÈÎfi ÂÚȯfiÌÂÓÔ. ∫‡ÚÈÔ˜ ÛÙfi¯Ô˜ ÙÔ˘ Â›Ó·È Ë ‡·ÚÍË ÌÈ·˜ ÁÚ·ÌÌ‹˜ ÂÈÎÔÈÓˆÓ›·˜ ÌÂٷ͇ Ì·ıËÙÒÓ Î·È Î·ıËÁËÙÒÓ, ‰ËÏ·‰‹ ÂÊ‹‚ˆÓ Î·È ÂÓ‹ÏÈÎˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÍ¿ÁÔÓÙ·È ÂӉȷʤÚÔÓÙ˜ Û˘˙ËÙ‹ÛÂȘ ÁÈ· ÙÚ¤¯ÔÓÙ· ˙ËÙ‹Ì·Ù· Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ Ó¤ÔÈ ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ¿ ÙÔ˘˜. ™ËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô Â›Ó·È Ô ÌË ÙÔÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ÂÚȯÔ̤ÓÔ˘, Ô ÔÔ›Ô˜ ÂÛÙÈ¿˙ÂÈ Û ʷÈÓfiÌÂÓ· ·ÁÎfiÛÌÈ·˜ Îϛ̷η˜ fiˆ˜ ÙÔ HIV/AIDS Î·È Ë Ú‡·ÓÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ™˘ÌÌÂÙ¤¯ÔÓÙ˜ ÛÙÔ project Â›Ó·È 6000 ÂÚ›Ô˘ Ì·ıËÙ¤˜ ·fi 30 ¯ÒÚ˜, ÂÓÒ ÔÈ ·ÚÈıÌÔ› ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍËÙÈ΋ Ù¿ÛË ·fi ÙÔ ¤ÙÔ˜ ȉڇÛÂÒ˜ ÙÔ˘, ÙÔ 1999. ¶ÂÚ·ÈÙ¤Úˆ ÛÙfi¯Ô˜ Â›Ó·È Ë ÛÊ·ÈÚÈ΋ ÂÈÌfiÚʈÛË ÙˆÓ Ó¤ˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍÂÏȯıÔ‡Ó ÛÂ Û˘ÓÂȉËÙÔÔÈË̤ÓÔ˘˜ Ôϛ٘ ÙÔ˘ ÎfiÛÌÔ˘. ∆Ô site ‰È·¯ˆÚ›˙ÂÙ·È Û ÙÔÌ›˜ Ì ÛÔ‚·Ú‹ ıÂÌ·ÙÔÏÔÁ›·, fiˆ˜ ÔÈ ÌÂÈÔÓfiÙËÙ˜, ÂÈÌÔÚʈÙÈÎÔ› ÙÔÌ›˜, Ó¤· ·fi ÔÏÏ¿ ‰È·ÊÔÚÂÙÈο ̤ÚË ÙÔ˘ Ï·Ó‹ÙË ·ÏÏ¿ Î·È chatrooms fiÔ˘ ÔÈ Ì·ıËÙ¤˜ ÌÔÚÔ‡Ó Ó· ·ÓÙ·ÏÏ¿ÍÔ˘Ó È‰¤Â˜ Î·È Ó· ‰È¢ڇÓÔ˘Ó ÙÔÓ ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ ·ÎÏÔ. ™Ù· Ï·›ÛÈ· Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ÂÓÙ¿ÛÛÂÙ·È Î·È ÙÔ ÂÙ‹ÛÈÔ Johan Kooij Fellowship Workshop ÙÔ ÔÔ›Ô ¯ÚËÌ·ÙÔ‰ÔÙÂ›Ù·È ·fi ÙÔ Global Teenager Project Î·È Î‡ÚÈÔ˜ ÛÙfi¯Ô˜ ÙÔ˘ Â›Ó·È Ë ‰ÈÔÚÁ¿ÓˆÛË Û˘Ó‰ڛˆÓ Î·È ÔÌÈÏÈÒÓ ¤ÙÛÈ ÒÛÙ ÙÔ project Ó· ·ÔÎÙ¿ Ú·ÁÌ·ÙÈÎfi ¯·Ú·ÎÙ‹Ú· ¤Ú· ·fi ÙÔÓ ÂÈÎÔÓÈÎfi. ªÈ· Ï›ÛÙ· ·fi ÂӉȷʤÚÔÓÙ· URL Û¯ÂÙÈο Ì ÙË Ê‡ÛË, Ù· ·ÓıÚÒÈÓ· ‰ÈηÈÒÌ·Ù·, Î·È ¿ÏÏ· ÁÂÓÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, ¤Ú¯ÔÓÙ·È Ó· ÚÔÛÙÂıÔ‡Ó ÛÙË Ì˯·Ó‹ ÙÔ˘ site. ¶ÚÔÙ›ÓÂÙ·È ÁÈ· ÂÊ‹‚Ô˘˜ Ì ·ÓÂÙ˘Á̤ÓË ÎÔÈÓˆÓÈ΋ Û˘Ó›‰ËÛË.

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CLINICAL QUIZ

∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏

∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰Â›¯ÓÂÈ ıÚfiÌ‚Ô ÛÙËÓ ÙÚÈÁÏÒ¯ÈÓ· ‚·Ï‚›‰·. ™ÙÔ ÓÂÔÁÓfi ¯ÔÚËÁ‹ıËΠÂÓÂÚÁÔÔÈËÙ‹˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ (Actilyse) ÂÓ‰ÔÊϤ‚È·, ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË. ª¤Û· Û 48 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ·Ú·ÙËÚ‹ıËΠÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Ì ÂÍ·Ê¿ÓÈÛË ÙÔ˘ ηډȷÎÔ‡ Ê˘Û‹Ì·ÙÔ˜. ∆Ô ÓÂÔÁÓfi ¤Ï·‚ ÙËÓ ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÂÙ¿ Ë̤Ú˜. ¡¤Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ Ï‹ÚË Ï‡ÛË ÙÔ˘ ÂÓ‰ÔηډȷÎÔ‡ ıÚfiÌ‚Ô˘. √È ÂÍÂÙ¿ÛÂȘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜-¯ÚfiÓÔ˜ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘, ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘, ÈÓˆ‰ÔÁfiÓÔ, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∆Ô ÓÂÔÁÓfi ¤Ï·‚Â Û˘ÓÔÏÈο 3 ‚‰ÔÌ¿‰Â˜ ·ÓÙÈ‚›ˆÛ˘ Î·È Ë ÂÚ·ÈÙ¤Úˆ ÔÚ›· ÙÔ˘ ‹Ù·Ó ηϋ. Doppler ˘ÂÚ˯ÔÁÚ·Ê›· ηډȿ˜ Î·È ÂÁÎÂÊ¿ÏÔ˘ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ ηıÒ˜ Î·È ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. £ÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È· ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘ ¯Ú‹Û˘ ÎÂÓÙÚÈÎÒÓ ÊÏ‚ÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ÛÙȘ ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ÓÂÔÁÓÒÓ (1,2). ∆· ·›ÙÈ· ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Û˘ÁÁÂÓ‹ ‹ Â›ÎÙËÙ·. ™Ù· Û˘ÁÁÂÓ‹ ·›ÙÈ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È: 1. ªÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ·Ú¿ÁÔÓÙ· V (·Ú¿ÁˆÓ V Leiden) 2. ªÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÚÔıÚÔÌ‚›Ó˘ (ÚÔıÚÔÌ‚›ÓË 20210∞) 3. ∞ÓÂ¿ÚÎÂÈ· Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ 4. ∞ÓÂ¿ÚÎÂÈ· Ù˘ ÚˆÙ½Ó˘ C ‹ S 5. √ÌÔ΢ÛÙÂ˚Ó·ÈÌ›· 6. ¢˘ÛÈÓˆ‰ÔÁÔÓ·ÈÌ›· (3) ™Ù· Â›ÎÙËÙ· ·›ÙÈ· ˘¿ÁÔÓÙ·È: 1. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· 2. √È ÏÔÈÌÒÍÂȘ 3. ∏ ·ÚÔ˘Û›· ÂÓ‰Ô·ÁÁÂÈ·ÎÒÓ Î·ıÂÙ‹ÚˆÓ 4. ∏ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›· 5. √È Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ 6. ∆· ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (4) √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ıÚfiÌ‚Ô˘: ·. ∂› ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È Û·ÛÌÔ›, ËÌÈÏËÁ›·. ‚. ∂› ÚÔÛ‚ÔÏ‹˜ Ù˘ ηډȿ˜ ·Ú·ÙËÚÂ›Ù·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·.

Paediatriki 2007;70:158,162

Á. ™Â ÂÓÙfiÈÛË ÛÙ· ÓÂÊÚ¿ ·Ú·ÙËÚÂ›Ù·È ·ÈÌ·ÙÔ˘Ú›·, Ôȉ‹Ì·Ù·, ˘¤ÚÙ·ÛË. ‰. ∂› ÚÔÛ‚ÔÏ‹˜ Ù˘ ·ÔÚÙ‹˜ ·Ú·ÙËÚÂ›Ù·È ÈÛ¯·ÈÌ›· ÙˆÓ ¿ÎÚˆÓ. Â. ™Â ÚÔÛ‚ÔÏ‹ Ù˘ ¿Óˆ ÎÔ›Ï˘ ·Ú·ÙËÚÂ›Ù·È Ô›‰ËÌ· ÙˆÓ ¿Óˆ ¿ÎÚˆÓ Î·È Ù˘ ÎÂÊ·Ï‹˜ (5). ÛÙ. ∞fi ÙÔ ‰¤ÚÌ· ·Ú·ÙËÚÂ›Ù·È ÎÂÚ·˘ÓÔ‚fiÏÔ˜ ÔÚʇڷ (6). §fiÁˆ Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ÚԉȿıÂÛ˘ Ô˘ ˘¿Ú¯ÂÈ, Û οı ÂÚ›ÙˆÛË ıÚÔÌ‚ˆÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÙfiÛÔ ÙÔ ÓÂÔÁÓfi fiÛÔ Î·È Ë ÌËÙ¤Ú·, ·ÏÏ¿ Î·È Ô ·Ù¤Ú·˜ ÁÈ· ÙËÓ ‡·ÚÍË ÔÈÎÔÁÂÓÂȷ΋˜ ÚԉȿıÂÛ˘. √È ÂÍÂÙ¿ÛÂȘ ·˘Ù¤˜ Á›ÓÔÓÙ·È Û ÂȉÈο ÌfiÓÔ Î¤ÓÙÚ·. ∏ ıÂÚ·›· Ì ÂÓÂÚÁÔÔÈËÙ¤˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ ÚÔÙÈÌ¿Ù·È ¤Ó·ÓÙÈ ÙˆÓ ·Ï·ÈÔÙ¤ÚˆÓ Ê·Ú̿ΈÓ, ‰ËÏ·‰‹ Ù˘ Ô˘ÚÔÎÈÓ¿Û˘, ÁÈ·Ù› ÚÔηÏ› ÏÈÁfiÙÂÚ˜ ·ÏÏÂÚÁÈΤ˜ ÂΉËÏÒÛÂȘ Î·È ¤¯ÂÈ ÌfiÓÔ ÙÔÈ΋ ‰Ú¿ÛË Â› ÙÔ˘ ıÚfiÌ‚Ô˘ ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ÙË ÁÂÓÈÎfiÙÂÚË ËÎÙÈÎfiÙËÙ· ÙÔ˘ ·›Ì·ÙÔ˜ (7). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿„·ÌÂ, Ô ¤ÏÂÁ¯Ô˜ ·¤ÎÏÂÈÛ ÙËÓ ‡·ÚÍË Û˘ÁÁÂÓÒÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ë ıÚfiÌ‚ˆÛË ·Ô‰fiıËΠÛÙÔÓ Û˘Ó‰˘·ÛÌfi Ïԛ̈͢ Î·È Ù˘ ·ÚÔ˘Û›·˜ ·ÁÁÂÈ·ÎÔ‡ ηıÂÙ‹Ú·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Hoppe C, Matsunaga A. Pediatric thrombosis. Pediatr Clin North Am 2002;49:1257-1283.

2. Edstrom C, Christensen RD. Evaluation and treatment of thrombosis in the neonatal intensive care unit. Clin Perinatol 2000;27:623-641.

3. Rao AK, Sheth S, Kaplan R. Inherited hypercoagulable states. Vasc Med 1997;2:313-320.

4. Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics 1995;96:939-943.

5. Ellis D, Kaye RD, Bontempo FA. Aortic and renal artery thrombosis in a neonate: recovery with thrombolytic therapy. Pediatr Nephrol 1997;11:641-644.

6. Marlar RA, Neumann A. Neonatal purpura fulminans due to homozygous protein C or protein S deficiencies. Semin Thromb Hemost 1990;16:299-309.

7. Van Overmeire B, Van Reempts PJ, Van Acker KJ. Intracardiac thrombus formation with rapidly progressive heart failure in the neonate: treatment with tissue type plasminogen activator. Arch Dis Child 1992;67:443-445.

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∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

LETTER TO THE EDITOR

163

¡ÂÎÚÔÏÔÁ›·: R. J. Gorlin £ÂˆÚÒ ˘Ô¯Ú¤ˆÛË Ó· ÂÓËÌÂÚÒÛˆ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ÁÈ· ÙÔÓ ÚfiÛÊ·ÙÔ ı¿Ó·ÙÔ ÙÔ˘ Robert James Gorlin (1923-2006), ÁÓˆÛÙÔ‡ ÛÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ·fi ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙË ÁÂÓÂÙÈ΋ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ Û˘Ó‰ÚfïÓ. √ Bob Gorlin ¤Û‚ËÛ Û ËÏÈΛ· 83 ÂÙÒÓ, ¯Ù˘Ë̤ÓÔ˜ ·fi ÙËÓ Â¿Ú·ÙË ÓfiÛÔ, ÛÙȘ 29 ∞˘ÁÔ‡ÛÙÔ˘ 2006. √ Gorlin ˘‹ÚÍ ÌÈ· ÌÂÁ¿ÏË ÂÈÛÙËÌÔÓÈ΋ ÚÔÛˆÈÎfiÙËÙ·, ·Ó·ÁÓˆÚÈṲ̂ÓÔ˜ ‰ÈÂıÓÒ˜ ˆ˜ ÎÏÈÓÈÎfi˜, ÂÚ¢ÓËÙ‹˜ Î·È ‰È·ÓÔÔ‡ÌÂÓÔ˜. ∞Ó Î·È ‰ÂÓ ‹Ù·Ó ·È‰›·ÙÚÔ˜, Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙË ÁÂÓÂÙÈ΋ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È Û˘Ó‰ÚfiÌˆÓ ˘‹ÚÍ ÂÓÙ˘ˆÛȷ΋. ¶ÂÚȤÁÚ·„ ÂÚÈÛÛfiÙÂÚ· ·fi 100 Û‡Ó‰ÚÔÌ·, ÂÎ ÙˆÓ ÔÔ›ˆÓ 6 ʤÚÔ˘Ó ÙÔ fiÓÔÌ¿ ÙÔ˘. √ Gorlin ÁÂÓÓ‹ıËΠÛÙÔ Hudson Ù˘ ÔÏÈÙ›·˜ ¡¤·˜ ÀfiÚ΢ ÙÔ 1923. √È ÎÔÏÂÁȷΤ˜ ÛÔ˘‰¤˜ ÙÔ˘ ÔÏÔÎÏËÚÒıËÎ·Ó ÛÙÔ ∫ÔϤÁÈÔ Columbia Ù˘ ¡¤·˜ ÀfiÚ΢ Î·È ·ÊÔ‡ ˘ËÚ¤ÙËÛ Ì ÙÔÓ ·ÌÂÚÈηÓÈÎfi ÛÙÚ·Ùfi ÛÙÔÓ µã ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ÛÔ‡‰·Û ÛÙËÓ √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Washington fiÔ˘ ·ÂÊÔ›ÙËÛ ÙÔ 1947. ™ÙË Û˘Ó¤¯ÂÈ· ¤Ï·‚ Master’s of Science ÛÙË ÃËÌ›· ÛÙÔ ¶ÔÏÈÙÂÈ·Îfi ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ Iowa. ∂·ÎÔÏÔ‡ıËÛ·Ó ‰ÈÔÚÈÛÌÔ› Û ·Î·‰ËÌ·˚Τ˜ ı¤ÛÂȘ ̤¯ÚÈ ÙÔ 1956, fiÔÙ ÌÂÙ·ÎÈÓ‹ıËΠÛÙËÓ √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ Minnesota. ™ÙË Û¯ÔÏ‹ ·˘√ Robert Gorlin ÛÂ Û˘Ó¤‰ÚÈÔ ÛÙËÓ ∫¤Ú΢ڷ Ù‹ ÂÍÂϤÁË ∫·ıËÁËÙ‹˜ Î·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔ(1990) ÌÈ΋˜ ÙÔ˘ ™ÙfiÌ·ÙÔ˜ ÙÔ 1958 Î·È regents-ηıËÁËÙ‹˜ ÙÔ 1979. ∏ ¤ÚÂ˘Ó¿ ÙÔ˘ ÂÈÎÂÓÙÚÒıËΠÛÙ· ÎÚ·ÓÈÔÚÔÛˆÈο Û‡Ó‰ÚÔÌ·, ηıÒ˜ Î·È ÛÙ· Û‡Ó‰ÚÔÌ· Ì ÎÒʈÛË. ∏ ÛËÌ·ÓÙÈÎfiÙÂÚË ÂÈÛÙËÌÔÓÈ΋ ÚÔÛÊÔÚ¿ ÙÔ˘ ˘‹ÚÍÂ Ë ·Ó·ÁÓÒÚÈÛË ÎÚ·ÓÈÔÚÔÛˆÈÎÒÓ Û˘Ó‰ÚfïÓ, ¤¯ÔÓÙ·˜ ‰ËÌÔÛȇÛÂÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi 400 ÂÚÁ·Û›Â˜ ÛÙÔ ‰›Ô ·˘Ùfi. ∆Ô ÂÎ 1000 ÂÚ›Ô˘ ÛÂÏ›‰ˆÓ Û‡ÁÁÚ·ÌÌ¿ ÙÔ˘: “Syndromes of the Head and Neck”, 3Ë ¤Î‰ÔÛË ·fi ÙÔÓ Oxford University Press, ·ÔÙÂÏ› ÎÏ·ÛÈ΋ ÌÔÓÔÁÚ·Ê›· ÛÙÔ ı¤Ì· ·˘Ùfi. ∆Ô 1974 Ô Gorlin ‚Ú·‚‡ıËΠ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Washington ˆ˜ ‰È·ÎÂÎÚÈ̤ÓÔ˜ ·fiÊÔÈÙÔ˜. ∞fi ÙÔ 2000 Ô Ù›ÙÏÔ˜ ÙÔ˘ ‹Ù·Ó Regents’. √ÌfiÙÈÌÔ˜ ∫·ıËÁËÙ‹˜ ™ÙÔÌ·ÙÈ΋˜ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜ Î·È °ÂÓÂÙÈ΋˜, ÂÓÒ Â›¯Â ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙÔ˘ ηıËÁËÙ‹ Ù˘ ·ıÔÏÔÁÈ΋˜ ·Ó·ÙÔÌÈ΋˜, Ù˘ ‰ÂÚÌ·ÙÔÏÔÁ›·˜, Ù˘ ·È‰È·ÙÚÈ΋˜, Ù˘ Ì·È¢ÙÈ΋˜ Î·È Á˘Ó·ÈÎÔÏÔÁ›·˜ Î·È Ù˘ ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁ›·˜. ∂›¯Â ÂÎÏÂÁ› Úfi‰ÚÔ˜ Ù˘ ¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚ›·˜ √‰ÔÓÙÈ·ÙÚÈ΋˜ ŒÚ¢ӷ˜, Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ™ÙÔÌ·ÙÈ΋˜ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜ Î·È Ù˘ ¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚ›·˜ ∫Ú·ÓÈÔÚÔÛˆÈ΋˜ µÈÔÏÔÁ›·˜. À‹ÚÍ Â›Û˘ ·fi ÙÔ˘˜ È‰Ú˘Ù¤˜ Î·È ‰Èψ̷ÙÔ‡¯Ô˘˜ ÙÔ˘ American Board of Medical Genetics/Clinical. ∂›Û˘, Â› 30ÂÙ›· Û˘Ó¤‚·Ï ÛËÌ·ÓÙÈο ˆ˜ Û˘ÓÙ¿Î˘ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ™ÙÔÌ·ÙÈ΋˜ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ The Journal of Oral Surgery, Oral Medicine and Oral Pathology. ¢ÈÂÙ¤ÏÂÛ ̤ÏÔ˜ Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ American Journal of Medical Genetics ·fi ÙÔ 1977 Î·È Dysmorphology and Clinical Genetics ·fi ÙÔ 1982. ∆ÈÌ‹ıËΠ̠ÙÔ ÈÙ·ÏÈÎfi ‚Ú·‚Â›Ô Premio Anni Verdi ÛÙÔ Spoleto, ηıÒ˜ Î·È Ì ÔÏϤ˜ ‰ÈÂıÓ›˜ ÙÈÌËÙÈΤ˜ ‰È·ÎÚ›ÛÂȘ, fiˆ˜ Î·È ÙÔ˘ ÂÈÙ›ÌÔ˘ ‰È‰¿ÎÙÔÚ· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ◊Ù·Ó ·ÓÒÙÂÚÔ Ì¤ÏÔ˜ ÙÔ˘ (·ÌÂÚÈηÓÈÎÔ‡) πÓÛÙÈÙÔ‡ÙÔ˘ π·ÙÚÈ΋˜ Î·È Ù˘ ∂ıÓÈ΋˜ ∞η‰ËÌ›·˜ ∂ÈÛÙËÌÒÓ. À‹ÚÍ ÚÔÛÎÂÎÏË̤ÓÔ˜ ÔÌÈÏËÙ‹˜ ÙÔ˘ π‰Ú‡Ì·ÙÔ˜ Nobel ÛÙË ™ÙÔίfiÏÌË ÁÈ· ÙË ÁÂÓÂÙÈ΋ Û˘Ì‚ÔÏ‹ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È Ù· ÓÔÛ‹Ì·Ù·. ªÂٷ͇ ÙˆÓ Û˘ÁÁÚ·ÌÌ¿ÙˆÓ ÙÔ˘ Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó Ù· ÂÍ‹˜: ñ R. J. Gorlin, Jens JÔ/ rgen Pindborg (1921-1995): Syndromes of the Head and Neck. 1st edition, McGraw-Hill, New York, 1964. ñ R.J. Gorlin, J.J. Pindborg, M. M. Cohen. Syndromes of the Head and Neck. 2nd edition; 1976. ñ R.J. Gorlin, M.M. Cohen Jr., L. Stefan Levin. Syndromes of the Head and Neck. 3rd edition. New York: Oxford University Press; 1990. ñ M. M. Cohen, F. C. Fraser, R. J. Gorlin: Craniofacial disorders. In: Principles and Practice of Medical Genetics, edited by A.E. Emery and D. Rimoin. London: Churchill Livingstone; 1990. ñ Hereditary Hearing Loss and its Syndromes: Edited by Robert J. Gorlin, University of Minnesota School of Dentistry, Minneapolis, Helga V. Toriello, Michigan State University, Grand Rapids, and M. Michael Cohen, Jr., Dalhousie University. New York: Oxford University Press; 1995. ¶·È‰È·ÙÚÈ΋ 2007;70:163-164

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∞fi Ù· ÂÒÓ˘Ì· Û‡Ó‰ÚÔÌ· Î·È Ù· ÎÏÈÓÈο ÛËÌ›· Ô˘ ÂÚȤÁÚ·„Â Ô Gorlin Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÙÔ Û‡Ó‰ÚÔÌÔ Goltz-Gorlin, Ë Î‡ÛÙË Gorlin, ÙÔ ÛËÌÂ›Ô Gorlin, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin II, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin III, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin-Chaudry-Moss, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin-Cohen, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin-Goltz, ÙÔ Û‡Ó‰ÚÔÌÔ GorlinSedano. π‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ¤¯ÂÈ Ë ÈÛfi‚È· Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Û¿ÓÈˆÓ ÌÔÚÊÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Ì ·Ó·˙‹ÙËÛË ÛÙÔȯ›ˆÓ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË. ∏ Û˘ÁÁÚ·ÊÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ ˘ÂÚ¤‚Ë ÙȘ 600 ‰ËÌÔÛȇÛÂȘ. π‰È·›ÙÂÚ· ÁÓˆÛÙfi˜ ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ¿ÏψÛÙ ‰ÈÂÙ¤ÏÂÛÂ Î·È Î·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜, Ô Gorlin ηÏ›ÙÔ Ôχ Û˘¯Ó¿ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ªÈÓÓ¿ÔÏ˘ Î·È ÙÔ˘ St. Paul, fiÙ·Ó ÁÂÓÓÈfiÙ·Ó ‚Ú¤ÊÔ˜ Ì ÎÚ·ÓÈÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜. ∞Ó·ÁÓÒÚÈ˙ ÙÔ Û‡Ó‰ÚÔÌÔ, ηıÔ‰ËÁÔ‡Û ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ÁÈ· Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÌÊ·ÓÈÛıÔ‡Ó Î·È ·Ú›¯Â ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÛÙÔ˘˜ ÁÔÓ›˜. ∞Ó Î·È Û˘ÓÙ·ÍÈÔ‰ÔÙ‹ıËΠÙÔ 1993, Ô Gorlin ·Ú¤ÌÂÈÓ ‰Ú·ÛÙ‹ÚÈÔ˜, ‰›ÓÔÓÙ·˜ ‰È·Ï¤ÍÂȘ, Û˘ÁÁÚ¿ÊÔÓÙ·˜ Î·È Û˘Ì‚Ô˘Ï‡ÔÓÙ·˜. ¢ÈÂıÓÒ˜ ÁÓˆÛÙfi˜ ›¯Â ÙÈÌËı› ˆ˜ Â›ÙÈÌÔ˜ ‰È‰¿ÎÙˆÚ fi¯È ÌfiÓÔ ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ, ·ÏÏ¿ Î·È ÙÔ˘ ¢Ô˘‚Ï›ÓÔ˘ Î·È Ù˘ ∫ÔÂÁ¯¿Á˘ ÌÂٷ͇ ¿ÏψÓ. ™ÙËÓ ∂ÏÏ¿‰·, Ô˘ Û˘¯Ó¿ ÂÈÛÎÂÙfiÙ·Ó, ›¯Â ÔÏÏÔ‡˜ Ê›ÏÔ˘˜. ∂›¯Â Ì›ÓÂÈ Ì¿ÏÈÛÙ· Î·È ÛÙÔ ÕÁÈÔ ŸÚÔ˜. À‹ÚÍ ·Ú¿‰ÂÈÁÌ· ÚÔ˜ Ì›ÌËÛË ÁÈ· ÙËÓ ÂÚÁ·ÙÈÎfiÙËÙ·, Â˘Ú˘Ì¿ıÂÈ·, ÌÂÙÚÈÔÊÚÔÛ‡ÓË, ·Ú¿ ÙÔ “ÁÈÁ¿ÓÙÈÔ” ٷϤÓÙÔ Î·È ·Ó¿ÛÙËÌ¿ ÙÔ˘. √ ı¿Ó·Ùfi˜ ÙÔ˘ ·ÔÙÂÏ› ÌÈ· ÌÂÁ¿ÏË ·ÒÏÂÈ· ÁÈ· ÙËÓ ∫ÏÈÓÈ΋ °ÂÓÂÙÈ΋. ÿÛˆ˜ ·ÔÙÂÏ› Î·È ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÚÈfi‰Ô˘ ·Ó¿Ù˘Í˘ Î·È ‰È¿‰ÔÛ‹˜ Ù˘ ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ÌÈ· Î·È ÙË ‰È·‰¤¯ÂÙ·È ϤÔÓ Ë °ÔÓȉȈ̷ÙÈ΋ Î·È ÔÈ ÎÏÈÓÈΤ˜ ÂÈÙÒÛÂȘ Ù˘. ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛfiη˜

Abduazimova Govhar, 13 ¯ÚÔÓÒÓ, O˘˙ÌÂÎÈÛÙ¿Ó ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

Abduazimova Govhar, 12 years old, Uzbekistan Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

Paediatriki 2007;70:163-164

Pediatr Mar-Apr 07

28-03-07

17:23

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xxv

31 ª·ÚÙ›Ô˘ 2007

5Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· ∂˘ÚˆÎÏÈÓÈ΋˜ ¶·›‰ˆÓ ∞›ıÔ˘Û· Olympia •ÂÓÔ‰Ô¯Â›Ô Royal Olympic ¶ÏËÚÔÊÔڛ˜: FIRSTEVENT ∂¶∂ ∆ËÏ.: 210 8228950 Fax: 210 8228901 E-mail: info@firstevent.gr

∞ı‹Ó·

25-28 ∞ÚÈÏ›Ô˘ 2007

18th Annual Congress of the European Society for Paediatric Urology (ESPU) HALL Ambassadeur, Oud-Sint Jan, Zonnekemeers Website: www.espu2007.com/

Brugge, Belgium

28 ∞ÚÈÏ›Ô˘ 2007

55 ÃÚfiÓÈ· ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ∂ÌÂÈÚ›·, ∂ÍÂÏ›ÍÂȘ, ¶ÚÔÔÙÈΤ˜ ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ Î·È ÛÙËÓ ∫ÏÈÓÈ΋ ¶Ú¿ÍË ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” ∆ËÏ.: 210 7467766 Fax: 210 7757401 Website: www.esid.org

∞ı‹Ó·

2-4 ª·˝Ô˘ 2007

25th European Congress for Pediatric Infectious Diseases Centro de Congressos e Exposiço~es Contact: Kenes International / ESPID 2007 17, Rue du Cendrier, PO Box 1726 CH-1211 Geneva 1, Switzerland Tel: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: espid@kenes.com Website: www.kenes.com/espid/

Porto, Portugal

2-5 ª·˝Ô˘ 2007

15th TRANSMED: 15th European / Mediterranean Congress about Mother & Child Health Contact: Kamel BARGAOUI Tel.: 33-607-686-118 Fax: 33-143-839-985 E-mail: kamel@medicom-international.com

Cairo, Egypt

2-5 ª·˝Ô˘ 2007

33Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Hilton ¢ÈÔÚÁ¿ÓˆÛË: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ª·È¿Ó‰ÚÔ˘ 23, 11528, ∞ı‹Ó· ∆ËÏ.: 210 7211845 Fax: 210 7215082 E-mail: iea@mednet.gr

∞ı‹Ó·

9-12 ª·˝Ô˘ 2007

40th Annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Catalunya Congress Palace Contact: ESPGHAN 2007 C/o Colloquium 12, rue de la Croix Faubin 75557 Paris Cedex 11 - France Tel.: 33 (0) 1 44 64 15 15 Fax: 33 (0) 1 44 64 15 16 E-mail: espghan2007@colloquium.fr

Barcelona, Spain

Pediatr Mar-Apr 07

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xxvi

11-13 ª·˝Ô˘ 2007

37o ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰Ô‰ÔÓÙÈÎfi ™˘Ó¤‰ÚÈÔ ™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ ¡ÔÌ·Ú¯›·˜ ∫·‚¿Ï·˜ ∆ËÏ.: 210 6107213 ∂-mail: info@themateam.gr

∫·‚¿Ï·

25-27 ª·˝Ô˘ 2007

45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ Porto Carras “Olympic” ¶ÏËÚÔÊÔڛ˜: AC&C International S.A. ∆ËÏ.: 210 6889 100 Fax: 210 6844 777 ∂-mail: pediatric2007@acnc.gr Website: www.pediatric2007.gr

™ÈıˆÓ›·, ÷ÏÎȉÈ΋

7-10 πÔ˘Ó›Ô˘ 2007

5Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ∂ÏÏ¿‰Ô˜ ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: AC&C International ∆ËÏ.: 210 6889100 Fax: 210 6844777 E-mail: hscaconinfo@acnc.gr Website: www.hscapcongress2007.com/

∞ı‹Ó·

27-30 πÔ˘Ó›Ô˘ 2007

46th European Society for Pediatric Endocrinology Meeting Contact: Meeting Secretariat Congrex Sweden AB P.O. Box 5619, SE-114 86 Stockholm, Sweden Tel.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: espe2007@congrex.com Website: www.espe2007.org/

Helsinki, Finland

5-7 πÔ˘Ï›Ô˘ 2007

17th Annual Meeting of the European Childhood Obesity Group (ECOG) Athenaeum Intercontinental ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress S.A 15, Mesogion Avenue. 115 26 Athens, Greece ∆ËÏ.: 210 7499 372 / 304 / 300 Fax: 210 7713 795 E-mail: congress@triaenatours.gr Website: www.ecog2007.gr

∞ı‹Ó·

25-30 A˘ÁÔ‡ÛÙÔ˘ 2007

25th International Congress of Pediatrics ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ∞C&C International, PCO Tel: 210 68 89 100 Fax: 210 68 44 777 E-mail: icp2007@acnc.gr Website: www.icp2007.gr

∞ı‹Ó·

31 ∞˘ÁÔ‡ÛÙÔ˘ 4 ™ÂÙÂÌ‚Ú›Ô˘ 2007

14th Congress of the International Pediatric Nephrology Association Blaguss Congress Bureau Tel.: +36 1 374 7030, Fax: +36 1 312 1582 E-mail: info@blaguss-congress.hu Website: www.ipna2007.com

µÔ˘‰·¤ÛÙË, √˘ÁÁ·Ú›·