-
ISSN 0377-2551
- . , . , . , . , .
ANAKOH .
. ..
. -
. , . , .
. , . , . , . , . , . , . -, . , . , . , . , . -
. , . , . , .. , . , . , .
.. , . , .. , . , .
GENERAL PAPERCurrent management of the undescended testisG.
Sakellaris, H. Kokkori, S. Vlazakis, A. Krasoudakis, G.
Charissis
REVIEW ARTICLESThe importance of iodine and thyroxine in the
hyman organismK. Pantsiotou
Chest pain in children. A clinical diagnostic approachG.S.
Varlamis
Abuse of children by their peersD. Protagora-Lianou
ORIGINAL PAPERSThe tubercular infection index among pre-school
age children in the district of Korinthos. , . , .
Infectious agents and low herd immunity in the etiology of
childhood leukemiaM. Dalamaga, E. Petridou, D. Trichopoulos, A.
Mentis, A. Skalkidou, T. Karpathios, F. Athanasiadou-Piperopoulou,
M. Kalmanti, D. Koliouskas, E. Kosmidou, J. Panagiotou, F.
Tzortzatou-Stathopoulou
Comparative trial of natural and synthetic surfactants in the
treatment of respiratory distress syndrome of prematurityE.
Hatzidaki, E. Korakaki, M. Christodoulaki, K.M. Margari, D.
Mamoulakis, A. Manoura, C. Giannakopoulou
Plasma total antioxidant status inphenylketonuria patients on
dietK.H. Schulpis, S. Tsakiris, G.A. Karikas, M. Moukas, P.
Behrakis
93
101
115
125
132
136
145
154
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Continuation of table of contents inside title page
E.AIIATP.MAPT-AP 17-10-01 15:37 1
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. , . , . , . , .
. , . , . , . , . , .
: . , . , . , . , . , .
N Kawasaki Epstein-Barr. , . , . , . , . , .
. , . , . , . , .
. , . , .
. -, . , .
E.. , . . , .
. -
CASE REPORTSCongenital diaphragmatic hernia presenting with
acute respiratory distress in an infantN. Baltogiannis, E.
Papandreou, C. Chiotinis, V. Charisi, D. Keramidas
Transient cortical hyperostosis and elevation of alkaline
phosphatasefollowing long-term administration ofprostaglandinJ.
Kaleyias, N. Iakovidou, E. Megaloyianni, S. Rammos, G. Kourakis, H.
Dellagrammaticas
Congenital syphilis: a current threatE. Korakaki, E. Hatzidaki,
A. Manoura, P. Smirnaki, I. Papamastoraki, C. Giannakopoulou
Kawasaki disease assosiated with primaryEpstein-Barr virus
infectionG. Triantafyllidis, D. Karakaidos, P. Zosi, T. Vlachou, L.
Kanaris, C. Karis
Facial palsy caused by latent mastoiditis . , . , . , . , .
Seizures after dermal exposure to DEETM. Narlioglou, G.
Briassoulis, T. Hatzis
Disorders of thyroid function in children with insulin dependent
diabetes mellitus (IDDM)A. Kaimara-Papathanasiou, C.
Hadjiathanasiou, C. Theodoridis
LETTERS.. , . . , .
PAEDIATRIC NEWS. Papadopoulou-Couloumbis
159
163
168
172
177
181
188
194
196
Continuation of table of contents
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2001 MAPT- API 17-10-01 15:34 5
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PCR : Couroucli XI, Welty SE, Ramsay PL, Wearden ME
Fuentes-Garcia FJ, Jiyuan NI, Jacobs TN Towbin JA, Bowles NE :
.
RSV Trefny P, Stricker T, Baerlocher C, Sennhauser FH : M. A
: ;Levesque BM, Pollack P, Griffin BE, Nielsen HC : M. A
Berg M, Cook L, Corneli H, Vernon D, Dean J : .
IL-8 RSVAbu-Harb M, Bell F, Finn A, Rao WH Nixon L, Shale D,
Everard ML : M. A
. Shaw MP, Bath LE, Duff J, Kelnar CJ, Wallace WHB : . -
: Ljungman G, Gordh T, Srensen S, Kreuger A : . -
LITERATURE ABSTRACTSDetection of microorganisms in the
trachealaspirates of preterm infants by polymerase chainreaction:
association of adenovirus infection withbronchopulmonary
dysplasiaCouroucli XI, Welty SE, Ramsay PL, Wearden
MEFuentes-Garcia FJ, Jiyuan NI, Jacobs TN Towbin JA, Bowles NEGreek
translation: S. Fotopoulos
Family history of atopy and clinical course of RSV infection in
ambulatory and hospitalized infantsTrefny P, Stricker T, Baerlocher
C, Sennhauser FHGreek translation: M. Anthrakopoulos
Pulse oximetry: Whats normal in the newborn nursery?Levesque BM,
Pollack P, Griffin BE, Nielsen HCGreek translation: M.
Anthrakopoulos
Effect of seating position and restrained use on injuries to
children in motor vehicle crashesBerg M, Cook L, Corneli H, Vernon
D, Dean JGreek translation: . Tsoumakas
IL-8 and neutrophil elastase levels in the respiratory tract of
infants with RSV bronchiolitisAbu-Harb M, Bell F, Finn A, Rao WH
Nixon L, Shale D, Everard MLGreek translation: M.
Anthrakopoulos
Obesity in leukemia survivors: The familialcontributionShaw MP,
Bath LE, Duff J, Kelnar CJ, Wallace WHBGreek translation: F.
Athanasiadou-Piperopoulou
Pain variations during cancer treatment inchildren: A
descriptive surveyLjungman G, Gordh T, Srensen S, Kreuger AGreek
translation: F. Athanasiadou-Piperopoulou
Scheduled Medical Meetings
Abbreviations
100
124
135
167
171
180
187
xv
xix
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2001 MAPT- API 17-10-01 15:34 6
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E E E
EK.
IE EM 92A 115 28T:. (01) 7771 140 / 7771 663, Fax: 7758 354
E E : . : . -M : . -
: . A-: . : . : . : . : . : . : . : A.
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. -
92 115 28: (01) 7771 140, Fax: 7758 354
Bimonthly PublicationThe Official Journal of the Hellenic
Paediatric Society
PublisherK. Griveas
OwnerHellenic Paediatric SocietyMichalakopoulou 92Athens 115
28Tel. (01) 7771 140 / 7771 663, Fax: 7758 354
Scientific Editorial BoardPresident : K. MalakaEditor : Z.
Papadopoulou-CouloumbisMembers : E. Agelaki-Georgaki
: F. Athanassiadou-Piperopoulou: M. Anthrakopoulos: G. Varlamis:
P. Kafritsa: A. Konstadopoulos: Th. Tsiligiannis: K. Tsoumakas: S.
Fotopoulos: . Hatzis
Manuscript Editing
Greek EditingF. Mavroidi
English EditingZ. Papadopoulou-Couloumbis
Correspondence Hellenic Paediatric Society Michalakopoulou
92Athens 115 28Tel: (01) 7771 140, Fax: 7758 354
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SSN 0377-2551i
2001 MAPT- API 17-10-01 15:34 7
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2001 MAPT- API 17-10-01 15:34 9
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H 15-25, 12-15 , 3-5 , 1000 250-300 .
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Proesmans W. Bartter syndrome and its neonatalvariant. Eur J
Pediatr 1997;156:669-679.
:Flyvbjerg A. Role of growth hormone, insulin-like
growth factors (IGFs) and IGF-binding proteins in therenal
complications of diabetes. Kidney Int 1997;52
(60Suppl):S12-S19.
:National Institutes of Health Consensus
Development Conference. Neurofibromatosisconference statement.
Arch Neurol 1988;45:575-578.
: , . -
[-]. 36 ; 1998 5-7; , ;1998. . 172.
Schreiner GF, Lange L. Ethanol modulation ofmacrophage influx in
glomerulonephritis [abstract]. J Am Soc Nephrol 1991;2:562.
Should antileukotriene therapies be used insteadof inhaled
corticosteroids in asthma? [Editorial]. Am JRespir Crit Care Med
1998;158:1697-1701.
Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG.Vasculitis
associated with levamisole and circulatingautoantibodies [letter].
Arch Dis Child 1996;75:355-356.
II.
: 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.
:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the
head and neck. 3rd ed. New York: Oxford UniversityPress;
1990.
:Bauer AW. The two definitions of bacterial
resistance. In: Smith AJ, Rogers CA, eds. Proceedingsof the
Third International Congress of Chemotherapy;1962 May 29-31; New
York: International Society ofChemotherapy; 1963. p. 484-500.
: .
[ ]. : - ; 1979.
Kaplan SJ. Post hospital home health care: the
elderlys access and utilization [dissertation]. St. Louis(Mo):
Washington Univ.; 1995.
A ( +
). - (8 cm) - (16,8 cm). T , , 22 cm.
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(, -, , .) . - . , . - . O - .
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vii
2001 MAPT- API 17-10-01 15:34 11
-
93
: 80% . - - (hCG) - 3 -. 2 , . , - . . , - , .
: , .
Abstract: The undescended testes are unilateralin
approroximately 80% of cases, are rarelycorrected by human
chorionic gonadotropin(hCG), and should be treated by
orchiopexybefore the patient reaches the age of 3 years topermit
optimal tubular development and spermfunction. A cryptorchid testis
does not maturenormally after the age of 2 year and may
produceantibodies which may have adverse effects on thenormal
contralateral descended testis. The highera cryptorchid testis
resides above the scrotum, themore dysgenetic the morphology is
likely to be.Hypoplastic cryptorhid testis should be removedearly.
In general, high-positioned testes that havenot been surgically
placed into the scrotum beforemidadolescence should be removed.
Key words: undescended testis, management.
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Current management of the undescended testisG. Sakellaris1, H.
Kokkori2, S. Vlazakis1, A. Krasoudakis1, G. Charissis1
GENERAL PAPER
2001;64:93-100 Paediatriki 2001;64:93-100
1 ... 2 -
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2001 MAPT- API 17-10-01 15:34 93
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2001;64:93-100 Paediatriki 2001;64:93-100
2001 MAPT- API 17-10-01 15:34 94
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2001;64:93-100 Paediatriki 2001;64:93-100
. - - -, . , . . .
,
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2001 MAPT- API 17-10-01 15:34 95
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2001;64:93-100 Paediatriki 2001;64:93-100
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(9-11).
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.
, .
(hCG) -
2001 MAPT- API 17-10-01 15:34 96
-
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2001;64:93-100 Paediatriki 2001;64:93-100
(13).
hCG - . 2 , hCG . , - hCG , - 10%. hCG -, -.
- (LHRH) -, , - hCG. - LHRH, spray.
LH-RH 10 - 400 mg x 3 . , - (CG) 1500 U ( -), . , LH-RH.
2 .
-, .
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- ( 5%), - , - . - - , - (15).
Fowler-Stephens , , - , - - (16). - - . (- 30%), - . - .
- , (17).
2001 MAPT- API 17-10-01 15:34 97
-
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2001;64:93-100 Paediatriki 2001;64:93-100
, , - Silastic, - - , -.
(Silber Kelly) - , -. .
, - , (La Roque) . - , . .
.
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6 , (18-20).
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, - .
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-
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, - , - (24).
100% . - , , . - 6 , - 50% 30% -.
, - 40%.
FSH . LH - Leydig - .
- 3 , 70%, - 13 , 15%.
, - 5% -. - , -, , .
,
2001 MAPT- API 17-10-01 15:34 98
-
99
2001;64:93-100 Paediatriki 2001;64:93-100
.
- - 4 .
- - - . .
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14 - . . - , - - -. -. , , - . , - .
1. Fonkalsrud E. Undescended Testes. In: Welch K,
Randolph J, Ravitch M, eds. Pediatric Surgery. 4th ed.1986. p.
793-807.
2. Swensons Pediatric Surgery. 5th ed. 1990-Undescended
Testicle. p. 145-154.
3. Fallat ME, Williams MPL, Farmer PJ, Galinaro RN,Stover BH ,
Winkersons. Histologic evaluation ofinguinoscrotal migration of the
gubernaculum inrodents during testicular descent and its
relationship tothe genitofemoral nerve. Pediatr Surg
Intern1992;7:265-270.
4. Hrabovszky Z, Farmer PJ, Hutson J. Does the sensorynucleus of
the genitofemoral nerve have a role intesticular descent. J Pediatr
Surg 2000;35:96-100.
5. Binqgol-Kologln M, Demirci M, BujuKpamuKcu M.Cremasteric
reflexes of boys with descended, retractile,or undescended testes:
An electrophysiologicalevaluation. J Pediatr Surg
1999;34:430-434.
6. , , , - . , K . 1998;70:460-468.
7. Puri P, Nixon HH. Bilateral retractile testes:
Subsequenteffect on fertility. J Pediatr Surg 1997;12:563-567.
8. Murthy GG, Peress NS, Kahn SA. Demonstration ofantibodies to
testicular basement membrane byimmunofluorescence in a patient with
multiple primaryendocrine deficiencies. J Clin Endocrinol
Metabol1976;42:637-640.
9. Mules LM, Holmes SJK. Human chorionic gonadotropinand
laparoscopy in the treatment of impalpable testes.J Pediatr Surg
1994;29:551-552.
10. Turek PJ, Ewalt DH, Snyder HM, Stampfers D, Blyth B,Huff DS
et al. The absent cryptorchid testis: Surgicalfindings and their
implications for diagnosis andetiology. J Urol
1994;151:718-721.
11. Oo, . . -. E ; 1993. . 253-258.
12. Moore RG, Peters CA, Bauer SB, Maudell J, Retik
AB.Laparoscopic evaluation of the nonpalpable testis: Aprospective
assessment of accuracy. J Urol1994;151:728-731.
13. Rajfer J, Handelsman DJ, Swerdloff RS, Hurwitz R,Kaplan H,
Vandergast T. Hormoral therapy ofcryptorchidism: A randomized
double-blind studycomparing HCG and gonadotropin releasing
hormone.N Engl J Med 1986;314:466-470.
14. Mengel W, Zimmerman FA, Hhecker WCh. Timing ofrepair for
undescended testes. In: Fonkalsrud EW,Mengel W, eds. The
Undescended Testis. Chicago, IL:Year Book Medical Publishers; 1981.
p. 170.
15. Palacio M, Sferco A, Fenrandez A, Vilarrodona H.Inguinal
Cordopexy: A simple and effective newtechnique for securing the
testes in reoperativeorchiopexy. J Pediatr Surg
1999;34:424-425.
16. , , , , - , . Stephens Fowler. 1995;67:626-629.
17. Corkery SJ. Staged orchiopexy: A new technique. JPediatr
Surg 1975;10:515-519.
18. Nassar AHM. Laparoscopic-assisted orchidopexy: Anew aproach
to the impalpable testis. J Pediatr Surg1995;30:39-41.
2001 MAPT- API 17-10-01 15:34 99
-
100
19. The Surgical Clinics of North America. Pediatr Surg;1992. p.
1299-1313.
20. Bloom DA. Two-step orchiopexy with pelviscopic clipligation
of the spermatic vessels. J Urol1991;145:1030-1033.
21. Jones PF, Youngson GG. Benefits of laparoscopy andJones
technique for nonpalpaple testis. J Urol1999;162:169.
22. Eiquist EG, Stratakis CA, Rushton HG, Wather M.Laparoscopic
diagnosis and clinical management of asolitary nonpalpable
cryptorchid testicle in apostpubertal male. J Urol
2000;163:959-960.
23. Ng JW, Cheng D. Scroto-peritoneal port for
laparoscopicorchidopexy. Pediatr Surg Int 1999;15:452.
24. Kieswetter WB, Shull WR, Fettermann GH. Histologicalchanges
in the testis following anatomically successfulorchiopexy. J
Pediatr Surg 1969;4:59-65.
25. , . . - 1995;67:623-625.
26. Cortes D, Thorup J, Frish M, Moller H, Jacobsen GK,Beck BL.
Examination for intratubular germ cellneoplasia at operation for
intratubular germ cellneoplasia at operation for undescended testis
in boys. JUrol 1994;151:722-725.
2001;64:93-100 Paediatriki 2001;64:93-100
H : 11-09-2000 H : 13-12-2000
: 6, 700 14, . ,
: () . , - . : - PCR , ,, , , . , 28 36 . - . : 89 28 , 13 , 45
31 -. 36 , 15 , 39 , 39 (). DNA , , 28 (12/45=27% 1/31=3%, p
-
101
: - (15 mg). (150-500g), , -. , , -, - -, . 10% -, - 24, - 100
g. , , - , , (, ) , -, , , Chernobyl. (, , ) . -, ( - ), 17% - , .
- 64% . - - , - .
Abstract: Iodine is an essential trace element inthe human body
and is present only in minutequantities (9 mg). The daily
consumption of iodineis small (150-500 g), but iodine deficiency is
oftenobserved, because there is small quantity of iodineon the
earth. In developing countries iodinedeficiency is observed among
the poor, who live inmountainous areas, without public
transportationand far away from the sea. Those people onlyconsume
locally produced vegetable foods, and aredeprived of animal and of
preserved foods whichcontain more iodine. When one finds goiters
inmore than 10% of the population, then there isiodine deficiency
in that district and the con-centration of iodine in 24 hour urine
collection isless than 100 g. Iodine deficiency duringintrauterine
life and during the first 3 years maycause unrepaired damage with
developmental,psychokinetic and intellectual delay
(Neurologicalcretinism and Myxedematous cretinism) and anincrease
in fetal loses. Iodine deficiency duringchildhood and adolescence
may cause an increasein the incidence of bronchocele,
developmentalretardation and an increase in the incidence ofthyroid
cancer following nuclear accidents such asthat of Chernobyl. In
adulthood iodine deficiencymay cause goitre, which causes
difficulty in swal-lowing and breathing, and hypothyroidism as
wellas toxic goitre and cold nodules which can becancerous. Today
iodine deficiency has beenreported to be present in about one
billion people(17% of the earths population) who live inmountainous
areas in developing countries.Enrichment of food with iodine
(water, salt, bread) is
2001;64:101-114 Paediatriki 2001;64:101-114
.
The importance of iodine and thyroxine in the human organism.
Pantsiotou
ndocrinologist
AH REVIEW ARTICLE
2001 MAPT- API 17-10-01 15:34 101
-
102
2001;64:101-114 Paediatriki 2001;64:101-114
, - , . , - . 1:3500 . , - , . , , - - . , 1979, .
: , , , - , , , , .
a national priority in every country. Iodine actsthrough the
action of thyroid hormones whichregulate the maturation of various
tissues, increasethe metabolic rate and augment the
enzymaticreactions. In areas with iodine deficiency theaffected
population has a low index of intelligence,growth retardation and
decreased hearing ability.The incidence of congenital
hypothyroidism is1:3500 newborns in the first month of life and
ifuntreated may cause mental retardation. During theprenatal period
congenital hypothyroidism, havenormal development because thyroxine
is providedby their mother. Since 1979, all the newborns in
ourcountry undergo screening for congenitalhypothyroidism and are
treated with thyroxinewithin the first month of life (approximately
30newborns are treated every year with thyroxine forhypothyroidism
and have a regular follow up).
Key words: iodine, iodine deficiency, goitre,endemic goitre,
neurological cretinism,myxedematous cretinism, selenium
deficiency,congenital hypothyroidism.
1811.
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100mg, . , - 15 mg . - (3,4) ( 1), - , () -.
1817 - (-) (2). - , - . - 1957. 20 - - ( 10 - ), , - - - . . - 4
3 rT3,
4 FT4 3 RT3 TSH TBG
WHO UNICEF ICCIDD
2001 MAPT- API 17-10-01 15:34 102
-
103
2001;64:101-114 Paediatriki 2001;64:101-114
, - (3).
, - , ( 1). 3.
-
, - , , , , -. , - - (5). 10% , (
). - 20 200-250 (6).
, . EdwardBrowne (1644-1708), : . , - . , - - , - (7). , 1180 ,
, (8). Lugol -, -, 19 ( ). 1907
3,3 (2)
(4) 3,5,3 - (3)
3,3,5 - ( - 3)
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D2,D1-1 (5)
D3-1 (5)
2001 MAPT- API 17-10-01 15:34 103
-
David Marine, , - .
(- 2) (9,10) , - (11,12). - - (13) , Chernobyl 26 1986. , - 131
- - . (- ), - , - (14) -.
, -. . , 30-50 g, 100-250 g.
( squamous), , -. , ( - ), ( ) ( )(15). , - Keshan ( )
Kashin-Beck
2001;64:101-114 Paediatriki 2001;64:101-114
104
1. 100 gr (4)
mg mg mg g g 240 270 3,0 4 2 170 410 2,5 1530 20 60 210 2,5 3 20
110 390 6,4 49 (;) 240 250 9,7 14 6 19 25 1,9 2 3 6 9 0,6 9 3 41 5
0,4 3 (;) 10 25 0,7 7 10 93 30 1,4 25 59 550 52 2,9 50 23 36 31 1,0
24 16 12 33 1,6 90 14 150 42 1,1 18 28 200 25 7,7 45 120 130 51 26
45 160 110 24 1,6 28 6
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. 1. 2. 3. 4.
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2001 MAPT- API 17-10-01 15:34 104
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2001;64:101-114 Paediatriki 2001;64:101-114
105
. 10 ng/ml, - 60-110 ng/ml. , .
, 80% 5 . 10% - , -, ( ), - , - , -, , ( 2). , , - . , - , -
(16,17). Kashin-Beck , - . - . , , .
-
- ( 17%) 6 , - (18). , - , - , -
(19). - (, -, ) , , , . - . 50-100 ( 3) (20). - , -, , - - ( 3).
, - - (, , , -, ) ( 4) - (21).
-
- -, (22). - 30-250
3. WHO
>30 g 0-5 90 g
5-12 90 g 1-3 90 g
4-6 90 g7-10 120 g
150 g 200 g 200 g
2. . .
2001 MAPT- API 17-10-01 15:34 105
-
-. 80% . 1g/. - , - . , - , . (23). - 4 . 64% 4.
- (24). , . ( 4-10 g/-) - . , , - - . , 300
40-90
150-250
150-330
-
40-70
-
40-130
-
30-110
10-130
150
10-130
30-80
90
20-60
40-130
50-60
20-70
60-170
130-160
60-130
. 70-130
2001 MAPT- API 17-10-01 15:34 106
-
2001;64:101-114 Paediatriki 2001;64:101-114
107
(25). -
- . - . - 50-60 g/ 0,7 g/ . (26), - -. - . -, - , . - , - , - -
. - - , - - .
(27). , , , . - , -. , . ,
- , . - , , - , (- 5). . - , , ( -) (28).
, - . . , . 1924 - , 1999 - (29).
1993, - WHO, UNICEF ICCIDD, - , , . -, , - (catering) - . -, ,
8-12 . - 10 -, 2 (), (, , -) 8 - ( 4) (30). ,
5. K ,
24 (g/L) 100 g/L 50-100 g/L 25-50 g/L 25 g/L
4. , 1923-1990
1923 1960 1974-78 1981-88
(ppm/kg NaCl) 0 3,75 7,5 15 (g/gr ) 18 8 90 45 150 7724 -131 %
52 13 27 5 22 6
2001 MAPT- API 17-10-01 15:34 107
-
, , - ( ). , - , - , - . 45 - - (31). - , . - , . - - - - , , .
, - . -, , (32).
, . (), (3), , 25-50 (ppm) (33,34). , 2,5-5 gr - 100-200 g . -
150-500g (0,15-0,5 mg).
25-
50 g, ., , 25 g, . : ) ( , - ), - , - , ) ( - TSH), .
, - TSH (22) - . , -, .
- (.. , 2 mg ). - - ( Hashimoto), Graves , - , , - -. - , , , .
, , - , , - - (35). -
2001;64:101-114 Paediatriki 2001;64:101-114
108
4. . : - . : - ( ). C: . D: - . E: . F: - .
( )
2001 MAPT- API 17-10-01 15:34 108
-
2001;64:101-114 Paediatriki 2001;64:101-114
109
( Wolf-Chaikoff) - (36,37).
, , - - (38,39). - , (, ) (40).
3 , - -, , - , -. - -, (41).
- , - (42,43), - (44,45). 4 14 g/dl ( - TBG), .
, 50% - 4 6 g/dl. - . 3 - , - TSH. 4 3, .
TSH - (46) , , -, - (47).
(48). - , (49).
- , - , - 10 - (50).
, - . , - - (51). - .
-
- - . 3 - 5 - , 4. 3 - , - . FT4, TBG TSH - , 12 - , 36 -.
- . 4 - , 4 - , - - - (52). -, 4 3. 4 - - (53). , FT4 - . -, FT4
. , FT4 - . - ,
2001 MAPT- API 17-10-01 15:34 109
-
, - 3 -. , , 4 -. , -. , . 4 6 .
4 , , , , - ( 5)(54). , , - .
,
-
. , 4 . - 100 g . - - , - (55,56), - (57).
FT4 , . - ( ) , . FT4 TSH --, -. , - - .
2001;64:101-114 Paediatriki 2001;64:101-114
110
5. , - .
4
0 1 2 3 4 5 6 7 8
, -
?
2001 MAPT- API 17-10-01 15:34 110
-
2001;64:101-114 Paediatriki 2001;64:101-114
111
, - .
-
, . 1979 ( ), - (58). , 3-7 , - . - . - - TSH. TSH >30 I U/L,
- . , -, , .
1 3427 -. 1996 - 545 (59). , - , , - . , . . - , 10% - .
85% ( 40%, - 40%, 5%) 15% - - . - 1 10.000 -
TSH (60), ( ) - (61,62).
- () - . , - , - - - (63). - 1 (F-1), - 2 (F-2) Pax 8. (Knock
out) , . - - . PAX 8 - - - .
15% , -
6. - (,, ).
2001 MAPT- API 17-10-01 15:34 111
-
. - , . : 1) -, 2) (64), 3) - (65), 4) Pendrel (66). - TSH (67)
- . - TSH - , TSH 4 (68).
-
- - (69). , - -. - , - . -, , , - - ( 6). , , -
. -, - . . , , ( 7) (70) , -, -, -. , , - , - .
1. Martin ND. . : Martin WD,
Mayes AP, Rodwell WV . Harpers ., ; 1985. . 597-610.
2. Asimov I. ., , 1993.
3. Goyens P, Golstein J, Nsombola B, Vis H, Dumont JE.Selenium
deficiency as a possible factor in thepathogenesis of myxematous
cretinism. Acta Endocrinol1987;114:497-502.
4. McCance and Widdowsons. The Composition of Foods.5th ed.
Cambridge: The Royal Society of Chemistry; 1993.
5. Gerber H. The transformation of normal thyroid cells
togoiter: the role of iodine depletion and repletion. In:Nauman J,
Glinoer D, Braverman LE, Hostalek U, eds.The Thyroid and Iodine,
Merck European Thyroid
2001;64:101-114 Paediatriki 2001;64:101-114
112
7. ( ).
2001 MAPT- API 17-10-01 15:34 112
-
2001;64:101-114 Paediatriki 2001;64:101-114
113
Symposium Warsaw; 1996 May 16-18. Stuttgart,Schattauer 1996. p.
65-74.
6. Solbiati L, Gioffi V, Ballarati E. Ultrasonography of
theneck. Thyroid Gland. In: Silver B, eds. The Radiologicclinics of
North America 1992;30:941-954.
7. , . - . : , . -. , . ,University Studio Press; 2000. .
17-23.
8. , . . . ; 1989.
9. Grunstein RR, Sullivan CE. Sleep apnea andhypothyroidism:
mechanism and management. Am JMed 1988;85:775-776.
10. Misiunas A, Niepomniszce H, Ravera B. Peripheralneuropathy
in subclinical hypothyroidism.Thyroid1995;5:283-291.
11. Karydis I, Tolis G. Orexis, anorexia and
thyrotropin-releasing hormone.Thyroid 1998;8:947-950.
12. Nikolai TF, Mulligan GM, Gribble RX, Harkins PG, MeierPR,
Robert RC. Thyroid function and treatment inpremenstrual syndrome.
J Clin Endocrinol1990;70:1108-1113.
13. Williams ED, Pacini F, Pinchera A.Thyroid cancerfollowing
Czernobyl. J Endocrinol Invest 1995;18:144-146.
14. Jackson IMD. Does thyroid hormone have a role asadjunctive
therapy in depression? Thyroid 1996;6:63-65.
15. Vanderpas JB, Contempr B, Duale NL, Goosens W,Bebe N, Thorpe
R et al. Iodine and selenium deficiencyassociated with cretinism in
nothern Zaire. Am J Clin Nutr1990;52:1087-1093.
16. Vanderpas J. Selenium and iodine deficiency as riskfactors
for goiter and hypothyroidism. In: The Thyroidand Environment,
Merck European Thyroid Symposium,Budapest; 2000 June 22-25.
Stuttgart, Schattauer; 2000.p. 25-40.
17. Bourdoux P, Delange F, Gerard M. Evidence that
cassavaingestion increase thyocyanate formation : A
possibleetiologic factor in endemic goiter. J Clin EndocrinolMetab
1978;46:613-618.
18. WHO, UNICEF, ICCIDD. Indicators for Assessing
IodineDeficiency Disorders and ther Control through SaltIodization.
Geneva: World Health Organization; 1994.
19. WHO, FAO, IAEA. Iodine. In: Trace Elements in HumanNutrition
and Health.Geneva: World Health Organization;1996. p. 49-57.
20. Delange F. Iodine nutrition in Europe, an update 1996.
In:Nauman J, Glinoer D, Braverman LE, Hostalek U, eds.The Thyroid
and Iodine, Merck European ThyroidSymposium Warsaw; 1996 May 16-18;
Stuttgart,Schattauer 1996. p. 31-41.
21. Burgi H, Supersaxo Z, Selzb B. Iodine deficiency
inSwitzerland one hundred years after. Theodor Kocherssurvey. A
historical review with some new goiterprevalence data. Acta
Endocrinol 1990;123:577-590.
22. Dai G, Carrasco L, Carrasco N. Cloning andcharacterization
of the thyroid iodine transporter. Nature
1996;379:458-460.23. Portmann L, Fitch EW, Harvan E et al.
Characterization of
the thyroid microsomal antigen and its relationship tothyroid
peroxidase, using monoclonal antibodies. J ClinInvest
1988;81:1217-1224.
24. Delange F. The disorders induced by iodine
deficiency.Thyroid 1994;4:107-128.
25. Pantsiotou SK, Stanhope R, Uruena M, Preece M, GrantDB.
Growth prognosis and growth after menarche inprimary
hypothyroidism. Arch Dis Child 1991;66:838-840.
26. Olson ER. Nutritional Disorders. In: Beers HM andBerkow R,
eds. The Merk Mannual of Diagnosis andtherapy. London: Merck
Research Lab. 1999. p. 2-62.
27. Koutras DA, Berman M, Sfontouris S, Rigopoulos
GA,Koukoulomati AS, Malamos B. Endemic goiter in Greece:Thyroid
Kinetics. J Clin Endocrinol 1970;30:479.
28. Brix TH, Kyvic KO, Hegedus L. Major Role of Genes in
theEtiology of Simple Goiter in Females: A Population-Based Twin
Study. J Clin Endocrinol Metab1999;84:3071-3075.
29. WHO, UNICEF, ICCIDD. Progress Towards theElimination of
Iodine Deficiency Disorders (IDD);Geneva:World Health Organization;
1999.
30. Burgi H, Helbling B. Methods of iodine supplementation.What
is the best where? In: Nauman J, Glinoer D,Braverman LE, Hostalek
U, eds. The Thyroid and iodine,Merck European Thyroid Symposium
Warsaw; 1996 May16-18; Stuttgart, Schattauer; 1996. p. 51-61.
31. Martin FIR, Tress BW, Colman PG, Dream DR. Iodineinduced
hyperthyroidism due to non-ionic contrastradiography in the
elderly. Am J Med 1993;95:78-83.
32. Martins ML, Lima N, Knobel M, Medeiros-Neto G. Naturalcourse
of iodine induced thyrotoxicosis (jodbasedow) inendemic goiter
area: A 5-year follow up. J EndocrinolInvest 1989;12:329.
33. . . : , , , ,. ; : ;1994. . 198-216.
34. Koutras DA, Papadopoulos SN, Sfonturis J, RigopoulosGA,
Pharmakiotis AD, Malamos B. Endemic goiter inGreece: clinical and
metabolic effects of iodized salt. JClin Endocrinol Metabol
1968;28:1651-1659.
35. Vagenakis AG. Effect of iodides: clinical studies.
Thyroid1990;1:5e.
36. Wolff J. Iodine goiter and the pharmacologic effects
ofexcess iodine. Am J Med 1969;47:101-103.
37. Senior B, Chernoff HL. Iodine goiter in the
newborn.Pediatrics 1971;47:510.
38. Contempre B, Jauniaux E, Calvo R, et al. Detection ofthyroid
hormone in human embryonic cavities during thefirst trimester of
pregnancy. J Clin Endocrinol Metab1993;77:1719-1722.
39. Burrow GN, Fisher DA, Larsen PR. Mechanisms ofdisease:
maternal and fetal thyroid function. N Engl JMed
1994;331:1072-1078.
40. Larsen PR. Ontogenesis of thyroid function, thyroid
2001 MAPT- API 17-10-01 15:34 113
-
2001;64:101-114 Paediatriki 2001;64:101-114
114
hormone and brain development, diagnosis andtreatment of
congenital hypothyroidism. In: DeGroot LJ,Larsen PR, Hennemann G,
eds. The thyroid and itsDiseases. 6th ed. New York: Churchill
Livingstone; 1996.p. 541-567.
41. Mandel SJ, Larsen PR, Seely EW, Brent GA. Increasedneed for
thyroxine during pregnancy in women withprimary hupothyroidism. N
Eng J Med 1990;323:91-96.
42. Fonseca V, Thomas M, Sweny P. Can urinary thyroidhormone
loss cause hypothyroidism? Lancet1991;338:475-480.
43. Campbell NRC, Hasinoff BB, Stalts H. Ferrous sulfatereduce
thyroxine efficacy in patients with hypothyroidism.Ann Intern Med
1992;117:1010-1016.
44. Koopman-Esseboom C, Morse DC, Weisglas-Kuperus
N,Lutkeschipholt IJ, Van Der Paauw CG, Tuinstra LGMT etal. Effects
of dioxins and polychlorinated biphenyl onthyroid hormones status
of pregnant women and theirinfants. Pediatr Res
1994;36:468-473.
45. Surks MI, DeFesi CR. Normal serum free thyroid
hormoneconcentrations in patients treatred with phenytoin
orcarbamazepine. JAMA 1996;275:1495-1501.
46. Bussen S, Steck T. Thyroid autoantibodies in
euthyroidnon-pregnant women with recurrent spontaneousabortion. Hum
Reproduction 1995;10:2938-2944.
47. Henneman G. Goiter and pregnancy: a new insight intoan old
problem-comment. Thyroid 1992;2:71-72.
48. Mandel SJ, Larsen PR, Seely EW, Brent GA. Increasedneed for
thyroxine during pregnancy in women withprimary hypothyroidism. N
Engl J Med 1990;323:91-95.
49. Man EB, Serunian SA. Thyroid function in humanpregnancy. IX.
Development or retardation of 7-year-oldprogeny of hypothyroxinemic
women. Am J ObstetGynecol 1976;125:949-957.
50. Pop VJ, de Vries E, van Baar AL et al. Maternal
thyroidperoxidase antibodies during pregnancy: a marker ofimpaired
child development? J Clin Endocrinol Metab1995;80:3561-3566.
51. Lasarus JH. Thyroid hormone and intellectualdevelopment: a
clinicians view. Thyroid 1999;9:659-660.
52. Cao XY, Jiang XM, Dou ZH, Rakeman MA, Zhang ML, ODonnell K
et al. Timing of vulnerability of brain to iodinedeficiency in
endemic cretinism. New England J Med1994;331:1739-1744.
53. Pop VJ, Kuiipens JL, van Baar AL, Verkerk G, van SonMM, de
Vijlder, JJ et al. Low maternal free thyroxineconcentrations during
early pregnancy are associatedwith impaired psychomotor development
in infancy. ClinEndocrinol 1999;50:149-155.
54. Obregon MJ, Calvo RM, Escobar del Rey F, Morreale deEscobar
G. Thyroid hormones and fetal development. In:Pinchera A, Mann K,
Hostalek U, eds. The Thyroid andAge, Merck European Thyroid
Sumposium; Italy: 1998April 30-May 2; Stuttgart, Schattauer; 1998.
p. 49-73.
55. Van Wassenaer AG, Kok JH, de Vijlder JJM et al. Effect
ofthyroxine supplementation on neurologic development ininfants
born at less than 30 weeks gestation. N Engl JMed
1997;336:21-26.
56. Delange F. Increased risk of primary hypothyroidism
inpreterm infants. J Pediatr 1984;105:402-408.
57. Ares S, Quero J, Dum S et al. Iodine content of formulasand
iodine intake of premature babies. Arch Dis
Child1994;71:F184-F191.
58. Dussalt JH, Coulombe P, Laberge N. Preliminary reporton mass
screening program for neonatalhypothyroidism. J Pediatr
1975;86:670-677.
59. , , , - . - . 1999;62:7-11.
60. McKenzie JM, Zakariza M. Feral and neonaral hyper-thyroidism
and hypothyroidism due to maternal TSHreceptor antibodies. Thyroid
1992;2:155.
61. Chanoine JP, Boulvain M, Bourdoux P et al. Increasedrecall
rate at sreening for congenital hypothyroidism inbreast fed infants
born to iodine overloaded mothers.Arch Dis Child
1988;63:1207-1210.
62. Smyth PPA. Variation in iodine handling during
normalpregnancy. Thyroid 1999;9:637-642.
63. Krude H, Biebermann H, Schnabel D, Ambrugger P,Gruters A.
Molecular pathogenesis of neonatalhypothyroidism. Horm Research
2000;53(1 Suppl):12-18.
64. Bikker H, den Hartog MT, Baas F, Gons MH, Vulsma T,Vijlder
JJ. A 20-basepair duplicationin the human thyroidperoxidase gene
results in a total iodine organificationdefect and congenital
hypothyroidism. J Clin EndocrinolMetab 1994;79:248-252.
65. Fujiwara H, Tatsumi K, Miki K, Harada T, Miyai K, Takai Set
al. Congenital hypothyroidism caused by a mutation inthe NA+/I-
symporter. Nat Genet 1997;16:124-125.
66. Scott DA, Wang R, Kreman TM, Sheffield VC, KarnishkiLP. The
Pendred syndrome gene encodes a chloride-iodine transport protein.
Nat Genet 1999;21:440-443.
67. Biebermann H, Schoneberg T, Krude H, Schultz G,Gudermann T,
Gruters A. Mutations of the humanthyrotropin receptor gene causing
thyroid hypoplasiaand persistent congenital hypothyroidism. J
ClinEndocrinol Metab 1997;347:3471-3480.
68. Dakou-Voutetakis C, Felquate DM, Drakopoulos M,Kouridis IA,
Drakopoli NC. Familial hypothyroidismcaused by a nonsence mutation
in thyroid stimulatinghormone b subunit gene. Am J Human
Genet1990;46:988-993.
69. Haddow JE, Glenn MD, Palomaki E, Walter BS, Alan C,Josephine
MD et al. Maternal thyroid deficiency duringpregnancy and
subsequent neuropsychologicaldevelopment of the child. N Engl J Med
1999;341:549-555.
70. Mezosi E, Molnar I, Jakab A, Balogh E, Karanyi Z, PakozdyZ
et al. Prevalence of iodine deficiency and goitrepregnancy in east
Hungary. Europ J Endocrinol2000;143:479-483.
H : 26-06-2000H : 08-01-2001
: 11,
2001 MAPT- API 17-10-01 15:34 114
-
2001;64:115-124 Paediatriki 2001;64:115-124
115
: , , - . - , - , . , . -, , , , , . - - - , - - , , - . , , -
.
: , .
Abstract: Chest pain or precordial pain is afrequent symptom in
childhood and a veryfrequent cause for seeking examination by
apediatric cardiologist. The fear of heart disease onthe part of
the parents is the main cause for anadditional anxiety to the
pediatrician, but alsochest pain itself is often a difficult
problem to solveif the diagnosis is based entirely on clinical
criteria.This review analyzes chest pain in children withemphasis
on the particularities pertinent to theyoung age group as well as
on the available dataaccumulated from studies in adults. Moreover,
thediagnostic approach on the part of the pediatricianis
meticulously analyzed which, among others, isbased on the etiology
and the specific clinicalsigns, as well as on the data derived from
ouroutpatient cardiology clinic. Specific emphasis isgiven on the
description of the clinical signs, aswell as on the various
etiologic factors. Despite thelow incidence of the cardiac causes
of chest painin childhood, their prompt recognition by theclinician
is essential since it will contributesignificantly to the overall
prognosis. A diagnosticalgorithm is finally presented which is used
in ourpediatric and pediatric cardiology clinics of
ourhospital.
Key words: chest pain, diagnostic approach.
. K . .
Chest pain in children. A clinical diagnostic approachG. S.
Varlamis
AH REVIEW ARTICLE
- , . ... ..., .....
Associate Professor of Pediatrics - Pediatric Cardiology4th
Pediatric Clinic, Aristotelion University of ThessalonikiA.H.E.P.A.
Hospital, Thessaloniki
2001 MAPT- API 17-10-01 15:34 115
-
() -
, . - , . , , , - (1,2).
- - , - - - .
-
, - - (Houssay, 1963) (3). 16 , : - , (4). , - (1,5,6). - , , -
- , (6,7). , , , -
, , , (2,8).
, - . - stress - , . , , - . - -, (1) (1,2,9-11). : ) , , - , )
, , (1,5,11).
, , , , , - 7-9 .
, - .
2001;64:115-124 Paediatriki 2001;64:115-124
116
1. (1,10,11)
-3 .6-18 .18-36 , . .3-7 .7-9 . .
.>9 .
2001 MAPT- API 17-10-01 15:34 116
-
, , , (6,7,12). Selbst (13) - ,6:1000. Brenner (14) Fyfe (15) -
. , - , (16), 0,18% 2:1000. -, 77 18570 (0,45%), , 7 100 , 3 (17).
, - - 2,59% (58/2236 ). - , - . - 13 . - ( -: = 1:1), , . -
- 12 , - , 12 . 3 45-69% 3 19% , - 3 , - (18-22). 103 , - ()
65%.
2,
- (24,25), - - . -, - -. , ( 1) (24-26).
- - (27). 3 (10,13-15,20,21,28) 4, (7,13-15,19,20,22). - : ,
2001;64:115-124 Paediatriki 2001;64:115-124
117
2. . (4,23-25)
, , , >30 min, , , , , - , , . .
, , , , , . . 5 min , .
- - . , 3 - : 1) 3 - , 2) , .. 1 3) 48 . - , , , , , , , .
( ), , , -, . , - , .
, - .
, - , 3 min, , - .
2001 MAPT- API 17-10-01 15:34 117
-
, - .
, -, - , , - (, - . ). - : ) - : 12-85%, ) -: 15-31%, ) :
12-21%, ) -- : 5-17%, ) - : 4-7%, ) : 4-21% ) : 1-6%
(1,7,15-17,19-22,26-30). - - , . 5 -
(7,13-15,19,21,22,26,31,32).
- , 2,5 103 - ,
( ). 34 (33%) - . 20 (19,4%), 4 (3,8%), - 21 (20,3%), 8 (7,7%).
16 (15,6%) .
, - (14,16,26). - 34/103 : 47%, - 38,2%, - ( , - .) 8,8%, 2,9%,
2,9% ( 2).
- . , , - , - , - , . - , , stress. , .. , ( 30%) , (29,31,32),
- .
1. :
2001;64:115-124 Paediatriki 2001;64:115-124
118
-
1. .
3. - (10,13-15,19,20,27)
1. 1. :2. - . 3. . + 4. .
2. :. .
2001 MAPT- API 17-10-01 15:34 118
-
. , . - . -: 4-6 , (27).
2. (precordial catch syndrome): , -, 0,5-5 min, - . -
(26,33).
3. Tietze: , - .
, , - . (26).
(27).
4. : 7-9 . - - (5-17%). stress, , ( )
2001;64:115-124 Paediatriki 2001;64:115-124
119
4. () (7,13-15,19,20,22)
. .
1. 1. . 2. . .
2. Kawasaki 1. . 2.
1. () 3. 2. 4.
. .
5. (7,13-15,19,21,22,26,31,32)
. , , (catch), Tietze, , - , - , , , , -, , , , , -, ( ), ( ),
.
. , , ( ), , , -, , , , .
. , stress, , , , , .
. , , , , , -, , , Zollinger-Elison, , , -, , .
. 1. : , , .2. : Hodgkin, , , , .3. : , , , , Marfan, -
, , .
2001 MAPT- API 17-10-01 15:34 119
-
(21,34). 103 , 20%, , , 45,6% (47 ) .
5. - - . -, , . - , - (35).
1. :
- ( 31% ), (30-32) - - -- . (18-25% ), , - . -, , -
(23,30-32,36). 103 , 16
103 (15,5%) . , , - 5% - , 1,7%.
2. Kawasaki: Ka-wasaki, 1 - , - / 50% . , , 2 3 , . -, - ( 2) -
(37).
:) -
.)
.
) -.
) , - .
: )
2001;64:115-124 Paediatriki 2001;64:115-124
120
238%
666%
116%
213%
33%
41%
51%
39%
43%
53%
N=34 N=103
1
2
3
4
5
1
2
3
4
5
6
2. % 34/103 . : 34 , . : 103 . : 1 = , 2 = , 3 = - , 4 = , 5 =
.
147%
2001 MAPT- API 17-10-01 15:34 120
-
, ) , ) , - - 3.
- . - . : - , , -, - , pH , , , , (19,26,27).
-
, 1:5-6 . - (19,22,26) ( 5 ):
1. : - 12 .
2.
.3. + -
+ Coxsackie.
4. : + .
5. : - .
6. : , .
7. : - .
-
. - 1:6 1:3 . (1,7,13-15,19-22,26) ( 5):
1. : 12 .
2. : .
3. : , .
4. : .
:
2001;64:115-124 Paediatriki 2001;64:115-124
121
: ; ; : ;
, , , - , , , -
, .
, , , , ,, , .
:
-
..
3. . .
..
2001 MAPT- API 17-10-01 15:34 121
-
) (13-15,19,26,27,35-37) ( 6):
1. - ( , , , , -, , -).
2. : , -, 1-6/6, , - (.. - -).
3. : : ) - ( / - ), ) (- , , - , - ).
4. : -,
. 5. :
, , - .
) (13-15,19,26,27,34-37) ( 7):
, , . - . :
1. - ( ) - .
2. -, -, (colla-psus).
3. , .
4. - -, ,
2001;64:115-124 Paediatriki 2001;64:115-124
122
7. (13-15,20,27,28,36-38)
1. 2. -- 3. Kawasaki 4. + , 5. , , 6. ,
7. - , , 8. - ,
= , = , =
6. (13-15,19,26,27,35-37)
1. , 2. , 3. Valsalva 4. , 5. 6. , , 7. 8. ,
= , = () ()
2001 MAPT- API 17-10-01 15:34 122
-
2001;64:115-124 Paediatriki 2001;64:115-124
123
. 5. : -
-, , - - , - , - ( ) - - - ( 50%) .
) (13-15,19,26,34-36):
1. .
2. + + - shock, - .
3. , - , .
1. Beyer EJ, Wells N. The Assessment of Pain in Children.
Pediatr Clin N Am 1989;36:837-854.2. Anand KJS, Hickey PR. Pain
and its effects in the human
neonate and fetus. N Engl J Med 1987;317:1321-1329.3. Houssay
AB. . : .
, : . ;1963. .548,557.
4. IASP Subcommittee on Taxonomy. Pain Terms. A list
withdefinitions and notes on usage. Pain 1979;6:249-252.
5. Mc Grath JP, Craig DK. Development andpsychological factors
in childrens pain. Pediatr Clin NAm 1989;36:823-836.
6. . . 1990;2 :186-189.
7. Schechter NL. Recurent pains in children. An overviewand an
approach. Pediatr Clin N Am 1984;31:949-968.
8. Beales JG, Kean JH, Lenox-Holt PJ. The childsperception of
the disease and the experience of pain injuvenile chronic
arthritis. J Rheumatol 1983;10:61-65.
9. , , , , , . - - . 1977;40:414-424.
10. Grunau RVE, Craig KD. Pain expression in neonates:Facial
action and cry. Pain 19 XX 28:395-410.
11. Craig KD, Mc Mahon RJ, Morison JD, Zaskow C.Development
changes in infant pain expression during
immunization injections. Soc Sci Med 1984;19:1331-1337.12. . .
-
1990;17:239-242.13. Selbst SM, Ruddy RM, Clark BJ. Pediatric
chest pain: A
prospective study. Pediatrics 1988;823:319-323.14. Brenner JI,
Ringel RE, Berman MA. Cardiologic
perspectives of chest pain in childhood: A referral problem?To
whom? Pediatr Clin N Am 1984;31:1241-1258.
15. Fyfe MD. Chest pain in pediatric patients presenting to
acardiac clinic. Clin Pediatr 1984;23:321-340.
16. , , , , , . - . 1988;51:367-373.
17. , , - . - - . 1555 . - 1988;51:348-358.
18. . . 1990;2: 195-201.
19. Kocis CK. Chest pain in Pediatrics. Pediatr Clin N
Am1999;46:189-203.
20. Selbst S. Chest pain in children.
Pediatrics1985;756:1068-1070.
21. Asnes RS, Bemporad SRJ. Psychogenic chest pain inchildren.
Clin Pediatr 1981;20 12:788-791.
22. Rowland TW, Richards MM. The natural history ofidiopathic
chest pain in children. Clin Pediatr 1986;2512:612-614.
23. . . . ; 1996.
24. Antony I, Valre EP. Angor instable: de laphysiopathologie la
thrapeutique. Arch Mal Cur1991;84:543-550.
25. . . & 1998;3:20-26.
26. Veasy LG. Chest Pain in Children. n: EmmanouilidesCG, Allen
DH, Riemenschneider AT, Gutgesell PH,editors. Moss and Adams Heart
Disease in infants,children, and adolescents. Williams &
Wilkins; 1995. p.653-657.
27. Coleman LW. Recurrent Chest Pain in Children.Symposium on
recurrent pain in children. Pediatr Clin NAm 1984;5:1007-1021.
28. Zavaras-Angelidou KA, Weinhouse E, Nelson DB.Review of 180
episodes of chest pain in 134 children.Pediatr Emerg Care
1992;84:189-193.
29. Schwartz JP. Idiopathic long QT syndrome: Progressand
questions. Am Heart J 1985;109:399-411.
30. Sharkey AM, Clark BJ. Common complaints with
cardiacimplications in children. Ped Cl N Am 1991;38:657-666.
31. Alpert MA, Mukerji V, Sabeti M. Mitral valve prolapse,panic
disorder, and chest pain. Med Clin N Am 1991;755:1119-1133.
32. , . - . . - 1998;10:88-95.
33. Pickering D. Precordial catch syndrome. Arch Dis
Child1981;56:401-403.
2001 MAPT- API 17-10-01 15:34 123
-
2001;64:115-124 Paediatriki 2001;64:115-124
124
34. Poikolainen K, Kanerva R, Lonnqvist J. Life events andother
risk factors for somatic symptoms in adolescence.Pediatrics
1995;96:59-63.
35. Hollander JE, Todd KH, Green G, Heilpern KL, KarrasDJ,
Singer AJ et al. Chest pain associated with coccaine:An assessment
of prevalence in suburban and urbanemergency departments. Ann Emerg
Med1995;266:671-676.
36. RoKicki W, Krzystolik-Ldzinska J, Gok B.
Clinicalcharacteristics of primary mitral valve prolapsesyndrome in
children. Acta Cardiol 1995;50 2:147-153.
37. Burns JC, Shike H, Gordon JB, Malhotra A,Schoenwetter M,
Kawasaki T. Sequelae of Kawasakidisease in adolescents and young
adults. J Am CollCardiol 1996;281:253-257.
H : 12-07-2000 H : 05-12-2000
: . . 85, 546 43,
: (RSV) . : 6, , - , . - RSV - . : 172 12 (99 73 ). - . : , 62%
29% (p
-
: 20 - - , - , -. - , - . , . - . . , , .
: , , .
Abstract: Over the past twenty years, indeveloped countries,
there is a growing convictionthat bullying constitutes a form of
child abuse. It hasbeen found that some children are
repeatedlyinvolved in such incidents, either as bullies or
asvictims. These experiences have adverseconsequences on their
mental and physical health,social development and academic
progress. Inparticular, children with special needs are atincreased
risk for victimization. The purpose of thisreview is to heighten
the pediatricians awareness ofthis problem. Epidemiological data,
characteristicsof bullies and victims, health consequences
andintervention modalities are discussed.
Key words: bullying, victimization, peer relation-ships,
children with special needs.
2001;64:125-131 Paediatriki 2001;64:125-131
125
. -
Abuse of children by their peersD. Protagora-Lianou
-
, . , peer abuse , -, ( ) . . , , -
- (1).
- : , -, , - .
, - .
AH REVIEW ARTICLE
2001 MAPT- API 17-10-01 15:34 125
-
. , - (2,3).
1999 -
350 . , 11,6% . (17,4%) - (8,5%). (16,8%) (6,6%). 23,2%, (36,5%)
(10,4%). , (22,7% 3,5% ) (26,1% 10,2% ). - , - (29,4% ) (6). , ,
29% 12-15 49% - 16-19 . - : 42% , 36% - 26% (7). - - . Olweus 1977
, 13.000 8-16, 8% , 9% (1). , - ( ) 27% -/ 10% (4), , , 17%, - 17%
15% (5).
, , , ( - ) (1,4,8). . , - , -
. -, (1,4,8). , - (4,8)., - (3).
-: , , -:
: (tempe-rament) , (9,10). (11). - . - , (12). - (13). ( -). , -
( - )(14). - . - - (15).
K : , (, .) , . - - , . , - . , - . - (1,3). .
2001;64:125-131 Paediatriki 2001;64:125-131
126
2001 MAPT- API 17-10-01 15:34 126
-
2001;64:125-131 Paediatriki 2001;64:125-131
127
- . , - (16,17). - , . , , -. - (18). - , (19,20). -, (21,22). -
- (23). . ( ) - - (24,25). - - - . 15 21 , - ( -) , , . , (26,27).
, - . , - , -, , (27,28).
: . -, , (29). .
- .
. : -
, , , - , , - . 30% . . - , - , - (30). , , - , (31).
: - - (32). -. , - , ( -) (33).
: , (34). , - . - , , - - (35).
: - , . , . , - -. - (33). , ( ) (29).
:
,
2001 MAPT- API 17-10-01 15:34 127
-
2001;64:125-131 Paediatriki 2001;64:125-131
128
/o - . , 50% (15% ) (3). -, - : ) - , ) - , ) (35).
: , -/ (1). , . . , - . , - (1,3).
: - (38%) (29).
: -
, - , -, - (37-40). (38,40). , - - , , 8% (41). - , . - , - , -
(16). 20 -, .
, - (38,44). : , , o (18,27,39,40,45,46). , - (47).
: - , (38). , - : , - , (40). , - (44).
-
8 16 . , . - 8 - (49,50).
, - (, -) (51). - 23 , , - (49). -- , , - (51). , . , - 24 , - -
(4,15).
-
,
2001 MAPT- API 17-10-01 15:34 128
-
129
2001;64:125-131 Paediatriki 2001;64:125-131
. , - . (1,25,53-56): ) - , ) - , ) - (.. , ), ) , ,) - - ( - )
) ( ).
. (1,3): ) - ,) , ) -, ) - ) , .
- - .
30 , -
Dan Olweus - (1). , - . - . , - . , (-o , - , ), - . , - -
, -, (1,3,49). -, - -, - . , - (57). - . - 50% (48). , ,
(57,58). , , : ) ) , ( - -) (31,59,60).
-
- - (2,3,58). To 1999, - (Policy Statement), , - (61).
Pediatrics in Review (- 2000), (62). - (2,57,61): () - - , ()
2001 MAPT- API 17-10-01 15:34 129
-
-, () - - , () , , - - ,() , , , - . , . - , () - , () - , () -
, - .
, . . - , - , . - , . - - .
1. Olweus D. Bullying at school. London: Blackwell
Publishers, Ltd; 1993. p. 2. Dawkins J. Bullying in schools:
doctors responsibilities
[letter]. BMJ 1995;310:274-275.3. Dawkins J, Hill P. Bullying:
Another form of abuse? Recent
Adv Pediatr 1995;13:103-121.4. Whitney I, Smith PK. A survey of
the nature and extent of
bullying in junior/middle and secondary schools. EducRes
1994;35:3-24.
5. Skinner A. Bullying: An annotated bibliography of
literatureand resources. Leicester: Youth Work Press; 1992. p.
22-28.
6. . . 16/3/2000. . 7.
7. Scheitel H. Student violence on the rise throughout theworld.
Hellenic Star; 2000. p. 11.
8. Tattum D. Violence and aggression in schools. In: TattumDP,
Lane DA, editors. Bullying in Schools. Stoke-on-Trent:Trentham
Books Ltd; 1994. p. 8-21.
9. Troy M, Sroufe A. Victimization among preschoolers: Roleof
attachment relationship history. J Amer Acad Child AdolPsychiat
1987;26:166-172.
10. Chazam M. Bullying in the infant school. In: Tattum DP,Lane
DA, editors. Bullying in Schools. Stoke-on-Trent:Trentham Books
Ltd; 1994. p. 33-45.
11. Boldizar J, Perry DG, Perry LC. Outcome values
andaggression. Child Develop 1989;60:571-579.
12. Perry DG, Bussey K. Self-reinforcement in high -and
low-aggressive boys following acts of aggression. ChildDevelop
1977;48:653-657.
13. Bjorkqvist K, Ekman K, Lagerspatz K. Bullies and
victims:Their ego picture, ideal ego picture and normative
egopicture. Scand J Psychol 1982;23:307-313.
14. Dodge KA, Coie JD, Petit GS, Price JM. Peer status
andaggression in boys groups: developmental andcontextual analyses.
Child Develop 1990;61:1289-1309.
15. Stephenson B, Smith D. Bullying in the junior school.
In:Tattum DP, Lane DA, editors. Bullying in Schools.
Stoke-on-Trent: Trentham Books Ltd; 1994. p. 45-59.
16. Kochendorfer BJ, Ladd G. Peer victimization: Cause
orconsequence of school maladjustment? Child
Develop1996;67:1305-1317.
17. Green KD, Forehand R, Beck SJ, Vosk B. An assessmentof the
relationship among measures of childrens socialcompetence and
childrens academic achievement. ChildDevelop 1980;51:1149-1156.
18. Ladd GW, Kochendorfer BJ, Coleman CC. Classroompeer
acceptance, friendship and victimization: Distinctrelational
systems that contribute uniquely to childrensschool adjustment?
Child Develop 1997;68:1181-1197.
19. Goleman D. Emotional Intelligence. London:
BloomsburyPublishing; 1995. p. 215-218.
20. Perry DG, Kusel SJ, Perry LC. Victims of peer
aggression.Develop Psychol 1988;24:807-814.
21. Perry DG, Williard JC, Perry LC. Peers perceptions of
theconsequences that victimized children provideaggressors. Child
Develop 1990;61:1310-1325.
22. Salmivalli C, Karhunen J, Lagerspetz KMJ. How do
victimsrespond to bullying? Aggressive Behav 1996;22:99-109.
23. Schwartz D, Dodge KA, Coie JD. The emergence ofchronic peer
victimization in boys play groups. ChildDevelop
1993;84:1755-1772.
24. Boulton M. Concurrent and longitudinal relations
betweenchildrens playground behavior and social
preference,victimization and bullying. Child Develop
1999;70:944-954.
25. Boulton MJ, Trueman M, Chau C, Whitehand C, Amatya
K.Concurrent and longitudinal links between friendship andpeer
victimization: Implications for befriendinginterventions J Adolesc
1999;22:461-466.
26. Kagan J, Reznick JS, Snidman N. The physiology andpsychology
of behavioral inhibition in children. ChildDevelop
1987;58:1459-1473.
27. Bjorkqvist K, Ekman K, Lagerspetz K. Bullies and
victims:
2001;64:125-131 Paediatriki 2001;64:125-131
130
2001 MAPT- API 17-10-01 15:34 130
-
2001;64:125-131 Paediatriki 2001;64:125-131
131
Their ego picture, ideal ego picture and normative egopicture.
Scand J Psychol 1982;23:307-313.
28. Mynard H, Joseph S. Bully/victim problems and
theirassociation with Eysencks Personality Dimensions in 8 to13
year olds. Br J Ed Psychol 1997;67:51-54.
29. Schwartz D, Dodge AD, Petit GS, Bates JE. The
earlysocialization of aggressive victims of bullying. ChildDevelop
1997;68:665-675.
30. Dawkins JL. Bullying, physical disability and the
paediatricpatient. Develop Med Child Psychol 1996;38:603-612.
31. Yuker HE. The effects of contact on attitudes
towardsdisabled persons: some empirical generalizations. In:Yuker
HE, editor. Attitudes toward persons with disabilities.New York,
N.Y: Springer Publishing Company; 1988. p.262-264.
32. Nabuzoka D, Smith PK. Sociometric status and socialbehavior
of children with and without learning difficulties. JChild Psychol
Psychiat 1993;34:1435-1448.
33. Kelly DP, Aylward GP. Attention deficits in
school-agedchildren and adolescents: Current issues and
practice.Pediatr Clin N Am 1992;39:487-512.
34. Montgomery JW. Easily overlooked language disabilitiesduring
childhood and adolescence: A cognitive-linguisticperspective.
Pediatr Clin N Am 1992;39:513-524.
35. Hugh-Jones S, Smith PK. Self-reports of short -and long-term
effects of bullying on children who stammer. Br JEduc Psychol
1999;69:141-158.
36. Bowers L. Cohesion and power in the families of
childreninvolved in bully/victim problems at school. J Fam
Ther1992;14:371-387.
37. Williams K, Chambers M, Logan S, Robinson D.Association of
common health symptoms with bullying inprimary school children. BMJ
1996;313:17-19.
38. Rigby K. The relationship between reported health
andinvolvement in bully/victim problems among male andfemale
secondary schoolchildren. J Health Psychol1997;3:465-476.
39. Sato K, Ito I, Morita S, Akaboshi K. Neuroses
andpsychosomatic syndromes of bullied children. Jap J ChildAdol
Psychiat 1987;28:110-115.
40. Due EP, Holstein BE, Jorgensen PS. Bullying as healthhazard
among schoolchildren. Ugskr Laegr1999;161:2201-2206.
41. Wright J. Accident and emergency departments needmanagement
guidelines [letter]. BMJ 1995;310:106.
42. Hawker DSJ, Boulton MJ. Twenty years of research onpeer
victimization and psychosocial maladjustment: Ameta-analytic review
of cross-sectional studies. J ChildPsychol Psychiatr
2000;41:441-455.
43. Kumpulainen K, Rasanen E, Hentonnen I et al. Bullyingand
psychiatric symptoms among elementary school-agechildren. Child
Abuse Negl 1998;22:715-717.
44. Kumpulainen K, Rasanen E, Henttonen I et al.
Childreninvolved in bullying: psychological disturbance and
thepersistence of the involvement. Child Abuse
Negl1999;23:1253-1262.
45. Coie JD, Dodge KA, Terry R, Wright V. The role ofaggression
in peer relations. Child Develop1991;62:812-826.
46. Slee PT. Situational and interpersonal correlates of
anxiety
associated with peer victimization. Child Psychiat Hum
Dev1994;25:97-107.
47. Reid K. Bullying and persistent school absenteeism In:Tattum
DP, Lane DA, editors. Bullying in Schools. Stoke-on-Trent: Trentham
Books Ltd; 1994. p. 89-94.
48. Bagwell CL, Newcomb AF, Bukowski WM. Preadolescentfriendship
and peer rejection as predictors of adultadjustment. Child Develop
1998;69:140-153.
49. Olweus D. Annotation: Bullying at school: Basic facts
andeffects of a school based intervention program. J ChildPsychol
Psychiatr 1994;35:1171-1190.
50. Sourander A, Helstela L, Helenius H, Jorma P. Persistenceof
bullying from childhood to adolescence a longitudinal8-year
follow-up study. Child Abuse Negl 2000;24:873-881.
51. Parker JG, Asher SR. Peer relations and later
personaladjustment: Are low accepted children at risk? PsycholBull
1987;102:357-389.
52. Coie JD, Krehbiel G. Effects of academic tutoring on
thesocial status of low-achieving, socially rejected children.Child
Develop 1984;55:1465-1478.
53. Furman W, Rahe DF, Hartup WW. Rehabilitation of
sociallywithdrawn preschool children through mixed-age andsame-age
socialization. Child Develop 1979;50:915-922.
54. Ladd GW. Effectiveness of a social learning method
forenhancing childrens social interaction and peeracceptance. Child
Develop 1981;52:171-178.
55. Oden S, Asher SR. Coaching children in social skills
forfriendship making. Child Develop 1977;48:495-506.
56. OConnell P, Pepler D, Craig W. Peer involvement inbullying:
Insights and challenges for intervention. JAdolesc
1999;22:437-452.
57. Department for Education. Bullying: Dont Suffer inSilence.
London: HMSO; 1994.
58. Pearce J, Thompson AE. Practical approaches to reducethe
impact of bullying. Arch Dis Child 1998;79:528-531.
59. Hannah MA. Teacher attitudes towards children
withdisabilities: An ecological analysis. In: Yuker HE,
editor.Attitudes towards persons with disabilities. New York,
N.Y:Springer Publishing Company; 1988. p. 154-171.
60. Horne MD. Modifying peer attitudes toward thehandicapped:
Procedures and research issues. In:Attitudes towards persons with
disabilities. New York, N.Y:Springer Publishing Company; 1988. p.
203-223.
61. American Academy of Pediatrics. The role of thepediatrician
in youth violence prevention in clinical practiceand at the
community level (Policy Statement). Pediatrics1999;103:173-181.
62. Glew G, Rivara F, Feudtner C. Bullying: Children
hurtingchildren. Pediatr Rev 2000;21:183-190.
H : 26-09-2000H : 15-12-2000
: - 15, , 153 51E-mail: [email protected]
2001 MAPT- API 17-10-01 15:34 131
-
H 2.000.000
. AIDS, - -, - . 2000 2020, 1 -, 200 - 35 -, . - , 1% , 5-10%
-
, - (1). - (2).
, , , - AIDS - , 0-30%.
- . 2/3 . -
2001;64:132-135 Paediatriki 2001;64:132-135
132
: - - . . - 248 (180, 68 ), - Mantoux. 0-4 mm, 5-9 mm 10 mm, - -
. -, . 1,2%. - .
: , -, , Mantoux.
Abstract: The aim of this study was todetermine the tubercular
infection index in thedistrict of Korinthos. We studied 248
children ofpre-school age (180 Greeks, 68 immigrants) inwhom we
performed the Mantoux test. Weconsidered as negative reaction a
diameter of 0-4mm, uncertain reaction a diameter of 5-9 mm,
andpositive reaction a diameter 10 mm. Weconclude that the
tubercular infection index inKorinthos is low (1,2%) and it is
primarily due tothe immigrant population of our town.
Key words: tuberculosis, pre-school age,tubercular infection
index, Mantoux test.
. 1, . 1, . 2
The tubercular infection index among pre-school age children in
the district of Korinthos. 1, . 1, . 2
ORIGINAL PAPER
1 2 -
General Prefecture Hospital of Korinthos1 Pediatric Clinic2
Obstetrics - Gynecology Clinic
2001 MAPT- API 17-10-01 15:34 132
-
, 1.500.000 AIDS(1,3-5).
- - . - 250.000 (1). , , - -, .
,
1999, 248 - 4-6 (180 , 68 ) 6 2 . 12% - - ( - ).
- BCG. -, 0,1 ml - PPD Pasteur 5 - 0,1 ml. 6-10 mm. - 48 . - 0-4
mm, 5-9 mm 10mm. 2.
248 , 236
Mantoux, 95,2%, 12 - Mantoux 4,8% (- 1). 2. , - 180 , 175
Mantoux ( 97,2%) 5 Mantoux ( 2,8%). 68 , 61 Mantoux ( 90%) 7 -
Mantoux ( 10%) (1). , 90% .
12 ( ) Mantoux ( 1), 9 - BCG( Mantoux) 3,6%, - 3 (), 1,2%.
-
- (6). , , - Mantoux , - BCG. BCG, 15 mm, 3-30 mm (7). ,
Mantoux>10 mm BCG, (8). - , : 1) . , , , - , 2) , 3) , 4) ,
(9).
Mantoux (10), - :
Mantoux >5 mm
2001;64:132-135 Paediatriki 2001;64:132-135
133
1. Mantoux.
95,20%
4,80%
2001 MAPT- API 17-10-01 15:34 133
-
: ) HIV , ) - , ) - Ro -.
Mantoux 10 mm -: ) -, ) , ) -, , ) , ) 15 mm - -.
- , HIV , - (7).
- Mantoux 9 (5 - 4 ), - 1 10 mm. 5 - - ( , - ). -, - . Mantoux 3
( ).
2 >10 mm BCG, 1 5, - >17 mm -
. 3 - , .
- 1,2% - . - . 1987-1998, - (11).
, - 1,8% (- . -) (2). - , 1995 , .
, , - . , , - , BCG, - Mantoux : ) 12-15, ) 6 , ) 11 , - . -
-
8. American Academy of Pediatrics: Report of the committeeon
infectious diseases. Tuberculosis 1994;480-503.
9. Snider D. Bacille CalmeteGuerin and Tuberculin skintests.
JAMA 1985;253:3483-3489.
10. American Thoracic Society. Diagnostic standards
andclassification of Tuberculosis. Am Rev Respir
Dis1990;142:450-456.
11. , , , , , .
. ; 1987-1998. 1999;62:482-489.
2001;64:132-135 Paediatriki 2001;64:132-135
135
H : 22-09-2000 H : 08-01-2001
: . 14, .. 203 00, -
: - () . () , 24 . : - , , , - , , - APGAR. - 92%. , . : 718 :
51% ,28% . 39,31,6 ( ), 3370550 g APGAR 8 9 . : 97,21,6% 97%. .
0,17% 24 (p = 0,0001). -
[ 0,44% (p = 0,001), 0,98% (p = 0,0001)]. : - 97,2%(2 :
94-100%). - . - . -.
: ;1
1Levesque BM, Pollack P, Griffin BE, Nielsen HCPulse oximetry:
Whats normal in the newborn nursery?Pediatr Pulmonol
2000;30:406-412
2001 MAPT- API 17-10-01 15:34 135
-
2001;64:136-144 Paediatriki 2001;64:136-144
136
. 1, . 1,2, . 1,2, . 3, . 1, . 4, . -5, . 6, . 7, . 8, . 9, .
-10
Infectious agents and low herd immunity in the etiology of
childhood leukemiaM. Dalamaga1, E. Petridou1,2, D. Trichopoulos2,
A. Mentis3, A. Skalkidou1, T. Karpathios4, F.
Athanasiadou-Piperopoulou5, M. Kalmanti6, D. Koliouskas7, E.
Kosmidou8, J. Panagiotou9, F. Tzortzatou-Stathopoulou10
1
2 , Harvard,
3 Pasteur,
4 / ,
5 -, , ,
6 -
7 -
8 -
9 -
10 -, ,
1 Department of Hygiene and EpidemiologyAthens University
Medical School
2 Department of Epidemiology Harvard School of Public Health,
USA
3 Diagnostic Services DepartmentHellenic Pasteur Institute,
Athens
4 Second Department of Pediatrics, Athens UniversityMedical
School, A. Kyriakou Childrens Hospital
5 Second Department of PaediatricsAristoteleion University of
ThessalonikiAHEPA General Hospital
6 Department of Paediatric Haematology-OncologyUniversity
Hospital of Heraklion
7 Department of Paediatric Haematology-OncologyIppokration
General Hospital, Thessaloniki
8 Department of Paediatric Haematology-OncologyA. Kyriakou
Childrens Hospital, Athens
9 Department of Paediatric Haematology-OncologyAgia Sophia
Childrens Hospital, Athens
10 Unit of Childhood Haematology-Oncology, FirstDepartment of
Paediatrics, Athens University MedicalSchool, Agia Sophia Childrens
Hospital
ORIGINAL PAPER
: - (ALL) - - - . - ALL - , - ALL. , 10 - , 94
Abstract: It has been suggested that acutelymphoblastic leukemia
(ALL) in children may be arare outcome of a delayed non specific
infection insituations of low herd immunity to a relatively
widerange of infectious agents. We assumed that newlydiagnosed
childhood leukemia cases, in compa-rison to their controls, would
be characterised by amore seronegative spectrum to the
infectiousagents examined, with the exception of a stronglypositive
response to that infectious agent, which isassumed to trigger ALL.
A case control study wasundertaken in Greece of 94 newly diagnosed
casesof ALL who were compared to an equal number ofhospitalized
children (controls) for minor non-infectious conditions, and who
were matched for
2001 MAPT- API 17-10-01 15:34 136
-
, - HTLV-1 , . - - : ) , - (1), ) , - (2,3), ) , -
(herdimmunity) (4) )
- - .
, - (2,4,5,7-10), , , Greaves - (10). , - (ALL) c-ALL ( ) - . ,
, - ,
2001;64:136-144 Paediatriki 2001;64:136-144
137
- - , - , , - . -, 5 . , 5-14 - Epstein-Barr, -6, 19, . 5 , - ,
- -, , , - .
: , -, , , , ( , , , , , , - 19, -6, Epstein-Barr, ).
age and gender. To assess past exposure against arange of
infectious agents, a battery of tenserological tests was used. The
results showed thatin children less than five years of age there
was littleevidence for an association of childhood leukemiawith the
serology of any of the ten studied. Incontrast, among children over
five years of age,there was a statistically significant
positiveassociation of leukemia with the Parainfluenza virusand a
series of inverse associations with EpsteinBarr virus, Human Herpes
Virus-6, Mycoplasmapneumonia and Parvovirus B19. In
conclusion,among children five years of age or older, the risk
ofleukemia is higher when in cases of low herdimmunity for several
agents their immune system ischallenged by late infection from an
infectiousagent which, as a rule, affects children at a
youngerage.
Key words: child, acute childhood leukemia,etiology, herd
immunity, delayed infection,infectious agents (Influenza virus A,
Influenza virusB, Adenovirus, Respiratory Syncytial
Virus,parainfluenza viruses, Cytomegalovirus, Epstein-Barr virus,
Human Herpesvirus-6, Parvovirus B19,Mycoplasma pneumoniae).
2001 MAPT- API 17-10-01 15:34 137
-
. , - - , - . - - -, , , (12).
, - - (4,9-11,13). -- (case control study). - - - - , - , - ALL.
- , , - , - .
1993-1997
, --, 450 (0-14 ), . 388 - . 104 ALL, - - , ., - - . 1995-1997,
- - (128 ) - , 126 - .
10 104 - ALL -. , 94 - . - ALL, , , . , - (matched control) ( 6
), - , 17 - , - .
1. E : , -, , (-20 C) - Pasteur, - , - -.
IgG , , , (RSV) , ELISA GenzymeVirotech Gmbh, -. - : - , - - , -
6 1, 2, 3 1, 2, 3, - RSV (RSV- ) . - IgG . , - , - . , - , - G. (
3,3,5,5-) - , -. . - 450 nm, 620 nm, - ELISA (Hitachi ELISA
reader). - (cut-off) - 10. - : 0,0-9,0: , 9-11: , >11: -. (+),
(++) (+++) ,
2001;64:136-144 Paediatriki 2001;64:136-144
138
2001 MAPT- API 17-10-01 15:34 138
-
2001;64:136-144 Paediatriki 2001;64:136-144
139
- .
To IMX CMV IgG Abott, IgG . (), - CMV. , -, - . - IgG CMV , - G,
. - - IMX. - (calibrator) . - 15 AU/ml - CMV. (+), - (++) (+++) .,
.
IgG (VCA) Epstein-Barr, - (IFA VCA IgG) Gull, - . - VCA HR1
Burkitt. 1:20 , VCA. -IgG -, --. - 200, Zeiss FITC - 515 nm. - . -
EBV.
IgG HHV-6, BIOS Gmbh, . 1:20, , - HHV-6. - - -IgG , -. -
200, - Zeiss FITC - - 515 nm. - . - HHV-6.
IgG -19 , ELISA Biotrin Parvovirus B 19 IgG (3 - ), -. IgG 19 -
VP 2 , . - , -, - - G. - - . 1 - , . - 450 nm, 620 nm,
ELISA(Hitachi ELISA reader). (cut-off, COV) - . : 1,1 COV - . - . -
(+), (++) (+++) , (cut-off) .
IgG - ELISA Mp-Savyon Diagnostics SeroELISA, . , - . - . -- - .
(-- ). - 405 nm (Hitachi ELISA reader). - . - (calibrators). .
.
2. : , - - (two by two table). , - (multiple logistic
regression), , - ,
2001 MAPT- API 17-10-01 15:34 139
-
. -, - (conditional logistic regression) . ( 5 5 ), - - , -
(matching factors).
1
, , -
-. , , - . -, , - - - , - . , -
140
2001;64:136-144 Paediatriki 2001;64:136-144
1. 94 ALL 94
p 2N (%) N (%)
56 59,6 56 59,6 38 40,4 38 40,4
() 4 52 55,3 48 51,15+ 42 44,7 46 48,9
1,00 88 93,6 88 93,6 6 6,4 6 6,4
0,696 27 28,7 23 24,57-9 16 17,0 20 21,310-12 32 34,1 30 31,913
19 20,2 21 22,3
0,02 74 78,7 59 62,7 20 21,3 35 37,2
0,04 55 58,5 41 43,6 39 41,5 53 56,4
0,05 73 77,7 83 88,3 21 22,3 11 11,7
(g) 0,03
-
2001;64:136-144 Paediatriki 2001;64:136-144
141
. , - , 2. - -.
3 . - (- ) Epstein-Barr .
4 - - (- ) - . , , 5 5. - (profile) - - , 5 . , 5 (p = 0,01),
Epstein-Barr (p = 0,11), HHV-6 (p = 0,05), (p = 0,02) 19 (p =
0,07). -, , -
Epstein-Barr, -6 , -, -, .
, - - EBV,HHV-6 . 94 -, 16 , - 10 ( -: 1,7, p = 0,20). - 52 48 5
( : 0,9, p = 0,87)., 5, ( : 3,9, p = 0,04). 5 , (80%) .
-
- . , - - , -
2. (ORs) 95% (95% CI) ALL - ( ) ( ): ( )
OR 95% CI OR 95% CI
1 0,99 0,92-1,07 1
1,14 0,61-2,14 1 1
0,48 0,25-0,93 0,51 0,28-0,95 1 1
0,56 0,28-1,11 0,53 0,27-1,03 1 1
2