ISSN 0377-2551

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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. , . , . , . , . , .

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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

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194

196

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2001 MAPT- API 17-10-01 15:34 5

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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E E E

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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

EITHMONIKE EKOEI E..E. 14, 151 25 MT.: 68 89 180 Fax: 68 89 290

E 10000 .E, : 5000 .

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdParadisou 14, Marousi 151 25Tel.: 68 89 180 Fax: 68 89 290

Annual SubscriptionAll foreign countries: US $ 30

MM -- 22000011 6644 22.. ..

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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.

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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.

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elderlys access and utilization [dissertation]. St. Louis(Mo): Washington Univ.; 1995.

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2001 MAPT- API 17-10-01 15:34 11

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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

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2001 MAPT- API 17-10-01 15:34 93

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2001 MAPT- API 17-10-01 15:34 96

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2001 MAPT- API 17-10-01 15:34 97

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2001 MAPT- API 17-10-01 15:34 98

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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

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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, .

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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.

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2001 MAPT- API 17-10-01 15:34 102

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2001 MAPT- API 17-10-01 15:34 103

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2001;64:101-114 Paediatriki 2001;64:101-114

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2001 MAPT- API 17-10-01 15:34 104

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2001 MAPT- API 17-10-01 15:34 105

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2001 MAPT- API 17-10-01 15:34 107

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2001;64:101-114 Paediatriki 2001;64:101-114

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2001 MAPT- API 17-10-01 15:34 108

2001;64:101-114 Paediatriki 2001;64:101-114

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2001 MAPT- API 17-10-01 15:34 109

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2001;64:101-114 Paediatriki 2001;64:101-114

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2001 MAPT- API 17-10-01 15:34 111

. - , . : 1) -, 2) (64), 3) - (65), 4) Pendrel (66). - TSH (67) - . - TSH - , TSH 4 (68).

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1. Martin ND. . : Martin WD,

Mayes AP, Rodwell WV . Harpers ., ; 1985. . 597-610.

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112

7. ( ).

2001 MAPT- API 17-10-01 15:34 112

2001;64:101-114 Paediatriki 2001;64:101-114

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Symposium Warsaw; 1996 May 16-18. Stuttgart,Schattauer 1996. p. 65-74.

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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

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2001 MAPT- API 17-10-01 15:34 117

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2001 MAPT- API 17-10-01 15:34 118

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2001 MAPT- API 17-10-01 15:34 119

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2001 MAPT- API 17-10-01 15:34 120

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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

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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: Sophieirene53@hotmail.com

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