21_le aritmie in età pediatrica optimized
TRANSCRIPT
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BEG@L@Y@MLE
Ae fr`tc`e smlm flmcfa`e bea r`tcm jfrb`fjm. Z` b`st`lkumlm pr`lj`pfa-
celte l orfb`fr`tc`e e tfjd`fr`tc`e. Ae pr`ce smlm jfrftter`zzfte bf ulr`tcm jfrb`fjm p` aeltm r`spettm faaf lmrcf. Lea jfsm beaae tfjd`fr`tc`e
af grequelzf `lveje p` eaevftf r`spettm f` vfamr` b` lmrcfa`t. @l ofse
faaf rek`mle jfrb`fjf bf ju` s` mr`k`lflm s` b`st`lkumlm `l smprfveltr`-
jmafr` e veltr`jmafr`.
@l et peb`ftr`jf a rflke b` grequelzf jfrb`fjf lmrcfae vfr`f jml aet bea
smkkettm. Zjdecft`jfcelte pmss`o`ae gfre r`ger`celtm f` sekuelt` vfamr`9
lemlftm9 08-648 opc> 6 cese9 668-6;8 opc>
5 fll`9 75-6:8 opc>
65 fll` 78-688 opc.
Es`stmlm lle ae extrfs`stma`ejde jmls`stmlm l oftt`t` precftur` ejtmp`j`.
Xmssmlm fvere mr`k`le smprfveltr`jmafre m veltr`jmafre.
@LJ@BELYF, EY@MXFRMKELEZ@ E G@Z@MXFRMAMK@F
Orfb`fr`tc`e
Af jmlb`z`mle pftmamk`jf p` `cpmrtflte rfppreseltftf bfa oamjjm
ftr`mveltr`jmafre jmcpaetm(OFWj).
@l questf s`tufz`mle lessulm st`cmam ftr`fae jmlbmttm f` veltr`jma`.
Aftt`v`t veltr`jmafre ku`bftf bf ul seklfpfss` k`ulz`mlfae m veltr`jm-afre. Afutmcft`scm bea seklfpfss` v`jfr`flte s` r`buje prmkress`vfcelte
faamltflflbms` bfaaf rek`mle d`ss`flf.
Aecmb`lfc`jf bea smkkettm pu essere jmcprmcessf per vfr` cejjf-
l`sc`9 `l pr`cm aumkm af grequelzf jfrb`fjf pu essere trmppm ofssf
per kfrflt`re ulf fbekuftf k`ttftf jfrb`fjf, `l sejmlbm aumkm pu be-
terc`lfrs` ulfsselzf beaaftt`v`t v`jfr`flte jml jmlsekuelte fs`stma`f.
@lle, `l preselzf b` grequelze veltr`jmafr` ofsse, pmssmlm `llesjfrs`
tfjd`fr`tc`e veltr`jmafr` jmce jmlsekuelzf b` ulf b`smcmkele`t beaaf
r`pmafr`zzfz`mle veltr`jmafre.
@a OFWj pu essere fjqu`s`tm m jmlkel`tm.
AE F_@RC@E @L ER XEB@FR_@JF
Xeb`ftr`j frrdytdc`fsK`flgrfljm Outerf
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Ae gmrce fjqu`s`te pmssmlm essere smprfttuttm jmlsekuelt` fb `ltervelt`
jfrb`mjd`rurk`j` m f gelmcel` `lgett`v` (jmce `l jmrsm b` geoore reu-
cft`jf). Ae gmrce jmlkel`te smlm ae p` grequelt`. Af amrm `lj`belzf
pfr` f j`rjf 6 su 65-?8888 lft` v`v`. Lea ?5% be` jfs` s` fssmj`flm fjfrb`mpft`e jmlkel`te (jumre ul`veltr`jmafre, trfspms`z`mle jmlkel`tf-
celte jmrrettf beaae krflb` frter`e). Ae gmrce restflt` smlm `b`mpft`jde
e smlm jmlsekuelzf b` ulf c`mjfrb`te getfae beterc`lftf bfa pfssfkk`m
trflspafljeltfre b` futmflt`jmrp` cfterl`.
Rfjd`fr`tc`e
Ae tfjd`fr`tc`e pmssmlm fvere tre b`vers` cejjfl`sc` pftmkelet`j`9
`a r`eltrm>
afutmcft`scm flmrcfae>
afutmcft`scm tr`kkerftm.
Lea jfsm bea cejjfl`scm b` r`eltrm am st`cmam eaettr`jm v`ele jmlbmttm
`l cfl`erf `terft`vf `l ul j`rju`tm jd`usm. Fgljd questm cejjfl`scm
pmssf fttufrs` smlm lejessfr` st`cma` fbekuft` (jmce ae extrfs`stma`), ul
suostrftm flftmcmgulz`mlfae jfrftter`zzftm bf b`versf burftf be` per`mb`
regrfttfr` e beaae veamj`t b` jmlbuz`mle beaae b`verse v`e bea j`rju`tm ebfaaf jmcpfrsf b` ul oamjjm ul`b`rez`mlfae su b` ulf beaae v`e. @ j`rju`t` b`
r`eltrm s` b`st`lkumlm l c`jrm e cfjrmr`eltr` l ofse faaf amrm estels`mle.
Afutmcft`scm flmrcfae eltrf `l k`mjm quflbm fajul` krupp` b` jeaauae
sv`auppflm ulf grequelzf b` sjfr`jf super`mre f queaaf s`lusfae b`vel-
tflbm `a pr`lj`pfae pfje-cfner jfrb`fjm.
Afutmcft`scm tr`kkerftm s` ver`jf quflbm ae jeaauae c`mjfrb`jde pre-
seltflm ulf bepmafr`zzfz`mle b`fstma`jf lbmttf bf ul tr`kker. @l tfa jfsm afbepmafr`zzfz`mle b`fstma`jf bettf pmtelz`fae tfrb`vm, se fcp`m f sugj`elzf
pu rfkk`ulkere af smka`f per af jmcpfrsf beaaf bepmafr zzfz`mle rfp`bf.
@l ofse faaf sebe b` mr`k`le ae tfjd`fr`tc`e s` b`st`lkumlm `l smprfvel-
tr`jmafr` e veltr`jmafr`.
Aegmrce smprfveltr`jmafr`s` ver`jflm `l j`rjf am 8,5-6% be` smkkett`
`l et peb`ftr`jf e smlm qu`lb` ae fr`tc`e p` grequelt` l questf gfsj`f b`
et. Aesmrb`m beaae tfjd`jfrb`e smprfveltr`jmafr` fvv`ele smprfttuttm le`
pr`c` ces` b` v`tf e bmpm ` ;-4 fll` b` et. Zmlm `l kelere `b`mpft`jde.
@l ofse fa cejjfl`scm pftmkelet`jm ae gmrce smprfveltr`jmafr` s` b`-
st`lkumlm `l9
gmrce futmcft`jde (tfjd`jfrb`e ftr`fa` ejtmp`jde, tfjd`jfrb`f ftr`fae
pma`cmrgf)>
gmrce bf r`eltrm (bf bmpp`f v`f lmbfae, bf v`f fjjessmr`f, utter ftr`fae,tfjd`jfrb`f k`ulz`mlfae rej`prmjflte percflelte).
Ae gmrce p` grequelt` smlm queaae bf v`f fjjessmr`f (58%) seku`te bfaae
gmrce bf bmpp`f v`f lmbfae (?8%).
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Bfa pultm b` v`stf pftmkelet`jm ae gmrce ftr`fa` futmcft`jde smlm bmvute
faaftt`vfz`mle b` ulm m p` gmjmaf` ejtmp`j`.
Ae gmrce bf r`eltrm pmssmlm b`st`lkuers` `l c`jrm e cfjrm r`eltr`. Lea
c`jrmr`eltrm lteressftf ulf pmrz`mle r`strettf b` tessutm fttmrlm fa lmbmftr`mveltr`jmafre `l ju` s` beterc`lf af jrefz`mle b` ulfref jml per`mbm
regrfttfr`m aulkm eb eaevftf veamj`t b` jmlbuz`mle (v`f rfp`bf) eb ulfref
jml ofssf regrfttfr`et e r`bmttf veamj`t b` jmlbuz`mle (v`f aeltf). Vueste
smlm ae jms`bbette tfjd`jfrb`e rej`prmjflt` smprfveltr`jmafr` bf bmpp`f v`f
lmbfae. Lea cfjrmr`eltrm `lteressftf ul fcp`f fref b` tessutm jde pu
essere jmcpaetfcelte amjfa`zzftm l sebe ltrf-ftr`fae (r`eltrm ltrf-ftr`fae
bea utter) m jm`lvmakere af preselzf b` v`e fjjessmr`e. @l questuat`cm
jfsm ` rfc` bea j`rju`tm smlm jmst`tu`t` bfaaf v`f lmbm-d`ss`flf, bfaaf v`f
fjjessmr`f e bfa tessutm c`mjfrb`m.
Bfa pultm b` v`stf s`mpftmamk`jm ae jmlsekuelze ecmb`lfc`jde b`pel-
bmlm bf vfr` gfttmr`9
6. grequelzf beaafr`tc`f>
?. gulz`mle b` atrm eserj`tftf bfa lmbm ftr`mveltr`jmafre>
:. grequelzf veltr`jmafre.
@a lmbm ftr`mveltr`jmafre df ul rumam jeltrfae lea atrfre (gelmcelm b`
[eljdeofjn) ka` st`cma` jmlbmtt` f` veltr`jma` jmlseltelbm qu`lb` `a
cfltel`celtm b` pfrfcetr` ecmb`lfc`j` fjjettfo`a`. Aul`jf ejjez`mle
rfppreseltftf bfaaf jmlbuz`mle b`rettf versm ` veltr`jma` b` ulf or`a-
afz`mle ftr`fae fttrfversm ulf v`f fjjessmr`f. @l questm jfsm lml v` af
gulz`mle b` atrm e afr`tc`f pu bekelerfre l or`aafz`mle veltr`jmafre.
Aegmrce veltr`jmafr`smlm estrecfcelte rfre `l et peb`ftr`jf. Zmlmp` grequelt` leaaf gfse pre-fbmaesjelz`fae eb fbmaesjelz`fae e smlm `l
kelere aekfte faaf preselzf b` tucmr` jfrb`fj` m essere ` sekl` `l`z`fa`
b` jfrb`mc`mpft`f. _frfcelte pmssmlm essere sejmlbfr`e f b`s`ml`ec`e,
pftmamk`f jmrmlfr`f leaaf cfaftt`f b` Nfwfsfn`, fssulz`mle b` gfrcfj`
flt`fr`tc`j`, c`mjfrb`t`, flmcfa`e kelet`jde beaaf r`pmafr`zzfz`mle jmce
leaaf s`lbrmce bea VR aulkm.
Bf ul pultm b` v`stf pftmkelet`jm ae gmrce p` grequelt` smlm queaae bfflmcfam futmcft`scm e bf futmcft`scm tr`kkerftm. Zpmrfb`jde smlm ae
gmrce bf r`eltrm `ltrfveltr`jmafre.
Ae jmlsekuelze ecmb`lfc`jde b`pelbmlm9
bfaaf grequelzf beaafr`tc`f veltr`jmafre>
bfaaf s`ljrml`f beaaf jmltrfz`mle.
Leaae gmrce pma`cmrge m leaaf or`aafz`mle veltr`jmafre questf s`ljrm-
l`f v`ele persf e le ber`vf jde aftt`v`t veltr`jmafre `legjfje per `a
cfltel`celtm b` pfrfcetr` ecmb`lfc`j` fbekuft`.
Aeextrfs`stma`e smlm reaft`vfcelte grequelt` `l et peb`ftr`jf. Zmlm ae-
kfte fb ul cejjfl`scm b` flmcfam futmcft`scm. Relbmlm kelerfacelte
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f sjmcpfr`re jml af jresj`tf bea pfz`elte. Kelerfacelte lml jmcpmrtflm
fajulf jmcprmc`ss`mle ecmb`lfc`jf cf pmssmlm essere espress`mle
prejmje b` ulf pftmamk`f c`mjfrb`f. Xmssmlm fvere mr`k`le leka` ftr` m
le` veltr`jma`.
JF_FRRE_@ZR@JDE JA@L@JDE
Orfb`fr`tc`e
@ qufbr` ja`l`j` smlm vfr`fo`a` e b`pelbmlm bfa seklfpfss` v`jfr`flte,
bfaaf suf grequelzf e bfaaeveltufae repelt`lf r`buz`mle beaaf grequelzf
b` sjfr`jf. Es`stmlm `lgftt`9
gmrce fs`ltmcft`jde af ju` sjmpertf mjjfs`mlfae>
gmrce jml tmaaerflzf ecmb`lfc`jf lml pergettf `l ju` `a smkkettm
pu cfl`gestfre ulf r`bmttf tmaaerflzf faam sgmrzm (lea afttflte per
esecp`m s` cfl`gester jmce ulf fa`celtfz`mle rfaaeltftf m cmatm
grfcceltftf)>
gmrce p` krfv` jml sjmcpelsm jfrb`fjm, a`pmt`c`e, s`ljmp`, cmrte
`cprmvv`sf. Rfa` cfl`gestfz`ml` pmssmlm essere fljde jmrreafte fb
fr`tc`e veltr`jmafr` jmcpaesse lbmtte bfaaf orfb`jfrb`f severf m bfaaf
b`aftfz`mle veltr`jmafre jde fjjmcpfklf `a OFWj.
Rfjd`fr`tc`e
Lea lemlftm sekl` p` grequelt` smlm queaa` beaa`lsugj`elzf jfrb`fjf9
tfjd`plef, b`splef, epftmcekfa`f. Rfavmatf ` s`ltmc` pmssmlm essere p`
suobma`9 b`gjmat fb fa`celtfrs`, pfaamre, ep`smb` b`pmtml`f.@lle s` pmssmlm ver`jfre beaae cfl`gestfz`ml` p` premjjupflt` bmvute
fb ulf jmlb`z`mle b` ofssf pmrtftf fjutf qufa` a jmaafssm jfrb`mvfsjmafre,
cfamr`, s`ljmp` m jmlvuas`ml`.
Lea ofco`lm p` krflbe `lveje pmssmlm fvers` b`sturo` p` mkkett`v`
(pfap`tfz`ml`, cfaessere).
Rfavmatf leaae gmrce `ljessflt` af cfl`gestfz`mle ja`l`jf queaaf b` ulf
jfrb`mc`mpft`f b`aftft`vf `lbmttf bfaaf tfjd`jfrb`f.@lle se af jmcprmc`ss`mle ecmb`lfc`jf cmatm severf le pu ber`vfre
af cmrte `cprmvv`sf bea smkkettm.
Extrfs`stma`e
Zmlm kelerfacelte fs`ltmcft`jde, tfamrf pmssmlm beterc`lfre af jmcpfr-
sf b` pfap`tfz`ml` jde velkmlm fvvert`te `l pfrt`jmafr cmbm le` smkkett`
`l epmjf pre-fbmaesjelz`fae m fbmaesjelz`fae.
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B@FKLMZ@
Orfb`fr`tc`e
Afpprmjj`m b`fklmst`jm f` oamjjd` ftr`mveltr`jmafr` s` ofsf su9 esfcemo`ett`vm, eaettrmjfrb`mkrfccf, EJK-Dmater beaae ?2 mre, ejmjfrb`m-
krfccf, test erkmcetr`jm.
Esfce mo`ett`vm9 ev`belzf b` orfb`jfrb`f, eveltufa` sekl` b` sjmcpelsm
jfrb`fjm.
Eaettrmjfrb`mkrfccf9faaEJK s` vebmlm p` mlbe X jde V_Z.
Le` OFW pfrz`fa` af jmlbuz`mle flmrcfae, cf preselte> lea OFW b` pr`-cm krfbm s` r`trmvf ul ltervfaam X_ faaulkftm> lea OFW b` sejmlbm krfbm
jml per`mb` b` Auj`fl`-[eljneofjd (t`pm Cmo`tz @) v` ul faaulkfceltm
prmkress`vm beaa`ltervfaam X_ lm faaf jmcpfrsf b` ulmlbf X oamjjftf>
lea OFW b` sejmlbm krfbm t`pm Cmo`tz @@ ae mlbe X lml smlm jmlbmtte
selzf jde v` s`f ul prejebelte faaulkfceltm prmkress`vm beaa`ltervfaam
X_. Le` OFWj lml v` jmlbuz`mle ftr`mveltr`jmafre per ju` es`ste ulf
jmlb`z`mle b` b`ssmj`fz`mle ftr`mveltr`jmafre.
EJK-Dmater beaae ?2 mre9percette af vfautfz`mle beaaf grequelzf c`-
l`cf, a`belt`jfz`mle b` eveltufa` pfuse, ae jfrftter`st`jde bea gmjus
v`jfr`flte, afbfttfceltm beaaf grequelzf jfrb`fjf faam sgmrzm, af preselzf
b` fr`tc`e veltr`jmafr`.
Ejmjfrb`mkrfccf9percette b` esjaubere af preselzf b` jfrb`mpft`efssmj`fte e b` vfautfre ae b`cels`ml` e af gulz`mle veltr`jmafre.
Rest erkmcetr`jm9pu essere eggettuftm le` smkkett` bf` ;-4 fll` b` et.
Jmlselte b` flfa`zzfre a jmcpmrtfceltm bea r`tcm v`jfr`flte faam sgmrzm,
af jmcpfrsf b` eveltufa` fr`tc`e veltr`jmafr`.
Rfjd`fr`tc`e
Afpprmjj`m b`fklmst`jm faae tfjd`fr`tc`e s` ofsf su9 esfce mo`ett`vm,eaettrmjfrb`mkrfccf, EJK-Dmater ?2 mre, ejmjfrb`mkrfccf, test erkm-
cetr`jm, stub`m eaettrms`mamk`jm.
Esfce mo`ett`vm9 ev`belz`f af preselzf b` ulf grequelzf jfrb`fjf matre
` rflke b` lmrcfa`t. Xmssmlm essere fssmj`ft` sekl` b` jmcprmc`ss`mle
ecmb`lfc`jf.
Eaettrmjfrb`mkrfccf9jmlselte b` jafss`jfre ae tfjd`jfrb`e l bue t`p`9
tfjd`jfrb`e f V_Z strettm>
tfjd`jfrb`e f V_Z afrkm.
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Ae tfjd`jfrb`e smprfveltr`jmafr` (RZW) smlm kelerfacelte jfrftter`zzfte
bf ulf jmlbuz`mle lmrcfae versm ` veltr`jma` e qu`lb` b` ul fspettm f
V_Z strett`.
Rfamrf pmssmlm essere f V_Z afrkd` `l preselzf b` ulf jmlbuz`mle fl-termkrfbf aulkm ulf v`f fjjessmr`f mppure lea jfsm b` ulfoerrflzf b`
jmlbuz`mle bmvutf fb ul oamjjm b` orfljf gulz`mlfae m pmst-jd`rurk`jm.
Am stub`m beaaf cmrgmamk`f e bea rfppmrtm trf ae mlbe X eb ` jmcpaess`
V_Z jmlselte b` bel`re amr`k`le eb `a cejjfl`scm beaaf tfjd`jfrb`f.
Ze ae mlbe X smlm cfa `lb`v`bufte suaaEJK m se `a rfppmrtm X-V_Z
b` t`pm 696, o`smklf ut`a`zzfre ae cflmvre vfkfa` qufa` `a b`v`lk reex,
af jmcpress`mle be` ouao` mjuafr`, af cflmvrf b` Wfasfavf, a`l`ez`mle
elbmvelmsf rfp`bf b` FRX m b` FBX.
Krfz`e f queste prmjebure s` prmvmjf ul oamjjm ftr`mveltr`jmafre trfls`-
tmr`m e s` pmssmlm b`st`lkuere bue t`p` b` RZW9
tfjd`jfrb`e ftr`fa`>
tfjd`jfrb`e bf r`eltrm.
Leaae gmrce ftr`fa` ejtmp`jde leaaf pfusf beaaf jmlbuz`mle ftr`mveltr`jm-
afre s` vebrfllm ae mlbe reaft`ve faaftt`v`t ftr`fae (pmtrecm fvere gmrce
ejtmp`jde cmlmcmrge, pma`cmrge, utter ftr`fae).
Leaae gmrce bf r`eltrm, pm`jd af cflmvrf vfkfae fk`sje smprfttuttm sua
lmbm ftr`mveltr`jmafre jde jmst`tu`sje ulm beka` eaecelt` gmlbfceltfa`
bea j`rju`tm, s` pu mttelere a`lterruz`mle beaafr`tc`f. Faaf r`presf bea
r`tcm s`lusfae pmss`fcm fvere bue s`tufz`ml`9
6. ulf pre-ejj`tfz`mle veltr`jmafre t`p`jf beaaf s`lbrmce b` [magg-
Xfrn`lsml-[d`te>
?. fspettm pergettfcelte lmrcfae beaaEJK e be` V_Z9 tfjd`jfrb`f bfbmpp`f v`f lmbfae m tfjd`jfrb`e `l ju` af v`f fjjessmr`f mjjuatf.
Ae tfjd`jfrb`e veltr`jmafr` (RW) smlm, `lveje, jfrftter`zzfte bfaaf pre-
selzf b` V_Z afrkd`.
Xmssmlm essere cmlmcmrge e pma`gmrce.
Gmlbfceltfae af c`surf bea VR jmrrettm per esjaubere af preselzf b`
ulf s`lbrmce bea VR aulkm jde pu fssmj`frs` fb fr`tc`e veltr`jmafr`pma`cmrge jde pmssmlm essere jfusf b` cmrte `cprmvv`sf.
Ul `ltervfaam VR jmrrettm s` bel`sje faaulkftm se af suf burftf < 228
csej.
EJK-Dmater beaae ?2 mre9lea jfsm `l ju` s`f pmss`o`ae rek`strfre afr`t-
c`f, percette b` vfautfre ae jfrftter`st`jde b` `llesjm eb `lterruz`mle
beaafr`tc`f, af grequelzf cfss`cf, af burftf beaafr`tc`f. Lea jfsmbeaaf pre-ejj`tfz`mle veltr`jmafre jmlselte b` flfa`zzfre se tfae fspettm
pers`ste burflte af rek`strfz`mle eb `a sum jmcpmrtfceltm burflte ae gfs`
b` fjjeaerfz`mle s`lusfae bea r`tcm jfrb`fjm.
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@l jfsm b` s`lbrmce bea VR aulkm s` flfa`zzflm ` jr`ter` sejmlbfr` jde
spessm s` fssmj`flm f tfae s`lbrmce.
Ejmjfrb`mkrfccf9percette b` esjaubere af preselzf b` jfrb`mpft`efssmj`fte, ae b`cels`ml` e af gulz`mle veltr`jmafre.
Rest erkmcetr`jm9pu essere ut`ae fa b` gumr` beaaf jr`s` per vfautfre se
af tfjd`jfrb`f `llesjftf bfaaftt`v`t s`jf e le` smkkett` jml s`lbrmce
b` [magg-Xfrn`lsml-[d`te veltr`jmafre per stub`fre `a jmcpmrtfceltm
beaaf pre-ejj`tfz`mle burflte am sgmrzm e afuceltm beaaf grequelzf
jfrb`fjf s`lusfae.
Ztub`m eaettrmgs`mamk`jm9 lejessfr`m jmce jmcpaetfceltm b`fklmst`jm
suo`tm pr`cf b` prmjebere faafoafz`mle trflsjftetere.
Extrfs`stma`e
Af vfautfz`mle b`fklmst`jf s` ofsf su9 EJK, EJK-Dmater beaae ?2 mre,
ejmjfrb`mkrfccf, test erkmcetr`jm, r`smlflzf cfklet`jf jfrb`fjf.
Eaettrmjfrb`mkrfccf9percette b` b`st`lkuere ae gmrce smprfveltr`jmafr`
bf queaae veltr`jmafr`. Jafss`jfcelte ae gmrce smprfveltr`jmafr` smlm
jfrftter`zzfte bf V_Z strett`, lml dfllm pfusf jmcpelsftmr`f, lml s`
fssmj`flm f b`ssmj`fz`mle ftr`mveltr`jmafre, pmssmlm tfavmatf essere
oamjjfte m fvere ulf jmlbuz`mle foerrflte.
Ae gmrce veltr`jmafr` dfllm V_Z afrkd`, pfusf jmcpelsftmr`f, b`ssmj`f-
z`mle FW, fjjmpp`fceltm ssm jml `a oftt`tm prejebelte.
EJK-Dmater beaae ?2 mre9jmlselte b` vfautfre `a lucerm beaae extrfs`-
stma` e af amrm b`str`ouz`mle lea jmrsm beaae ?2 mre, percette `lmatre b`
stub`fre `a amrm jmcpmrtfceltm `l ofse faaf grequelzf jfrb`fjf s`lusfae
e aeveltufae preselzf b` fr`tc`e p` jmcpaesse.
Ejmjfrb`mkrfccf9le` smkkett` jml ul lucerm eaevftm b` extrfs`stma`
lejessfr`m per esjaubere af preselzf b` jfrb`mpft`e fssmj`fte e per vfautfreae b`cels`ml` e af gulz`mle veltr`jmafre.
Rest erkmcetr`jm9 le` smkkett` jml ul lucerm eaevftm b` extrfs`stma`
smprfttuttm se b` mr`k`le veltr`jmafre lejessfr`m per vfautfre `a jmc-
pmrtfceltm beaae extrfs`stma` burflte aftt`v`t s`jf.
_`smlflzf cfklet`jf jfrb`fjf9 cmatm `cpmrtflte le` smkkett` jml
ul lucerm eaevftm b` extrfs`stma` veltr`jmafr` per esjaubere af preselzf
b` pftmamk`e bea c`mjfrb`m qufa` af b`spafs`f fr`tcmkelf bea veltr`jmam
bestrm m b` es`t` b` c`mjfrb`te.
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Rfjd`jfrb`f f V_Z afrkd` cmlmcmrg`
6. B`v`lk regaex
?. Ze `legg jfje, omam rfp`b`ss`cm b` fbelms`lf`v 658 c`jrmkrfcc`/nk
:. Ze `legg jfje, omam rfp`b`ss`cm b` fbelms`lf`v ?58 c`jrmkrfcc`/nk
@lterruz`mle beaaf tfjd`jfrb`f
Gmrce cmatm rfre b` tfjd`jfrb`f
veltr`jmafre (_MR-WR9 tfjd`-
jfrb`f veltr`jmafre beaaeggaus-sm bea veltr`jmam bestrm)
Xfusf
ftt`v`t ftr`fae
Rfjd`jfrb`f smvrfveltr`jmafre
jml foerrfz`mle.
Lessul eggettm
Rfjd`jfrb`f veltr`jmafr`
cmlmcmrge
Rfjd`jfrb`f f V_Z strett`
G`k. 6
6. B`v`lk regaex
?. Ze `legg`jfje, omam rfp`b`ss`cm b` fbelms`lf`v 658 c`jrmkrfcc`/nk
Ze `legg`jfje, omam rfp`b`ss`cm b` fbelms`lf `v ?58 c`jrmkrfcc`/nk
@lterruz`mle beaaf tfjd`jfrb`f
EJK `l r`tcm s`lusfae
X_ oreve + mlbe
Z b` [X[
X_ lmrcfae + V_Z strett` r`eltrm lmbfae
XI_R
@l tfa` jfs` se rfp`bf rej`b`vf
usfre prmpflmamam per `v
Xfusf
mlbe b` gautter
gautter ftr`fae
mlbe X ejtmp`jde
tfjd`jfrb`f ftr`fae
ejtmp`jf
Lessul eggettm
Rfjd`jfrb`f d`ss`flf
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G`k. :
G`k. 2
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R_FRRFCELRM
Orfb`fr`tc`e
@a trfttfceltm jmls`ste leaa`cp`fltm b` ul pfje-cfner. Ae `lb`jfz`ml` fatrfttfceltm ber`vflm bfaaflfa`s` beka` fspett` ja`l`j` e be` bft` struceltfa .
Rfjd`jfrb`e smprfveltr`jmafr`
@l tutt` ` jfs` `l ju` s`f lejessfr`f ulf terfp`f prmaftt`jf f aulkm terc`-
le pmss`o`ae ea`c`lfre `a gfsj`m fjjessmr`m jml afoafz`mle ceb`flte
rfb`mgrequelzf f pfrt`re bfaaet b` 4-68 fll`.
Le` smkkett` p` k`mvfl` pmss`o`ae prmpmrre ae sekuelt` `lb`jfz`ml`
terfpeut`jde9
Gautter ftr`fae9 af b`kmss`lf fssmj`ftf faafc`mbfrmle r`cfle ul trfttf-
celtm egjfje. Xmssmlm essere fljde ut`a`zzft` `l faterlft`vf faafc`m-
bfrmle, af ejf`l`be m `a prmpfgelmle.
Rfjd`jfrb`f ftr`fae ejtmp`jf9 s` usf af b`kmss`lf mppure ` oetf-oamjjflt`
faam sjmpm b` rfaaeltfre af jmlbuz`mle FW. Afc`mbfrmle, af ejf`l`be, a
prmpfgelmle m `a smtfamam smlm ut`a` per fk`re sua gmjus ejtmp`jm.
Rfjd`jfrb`f ftr`fae pma`cmrgf9 `a trfttfceltm prevebe aut`a`zzm beaafb`kmss`lf e beaafc`mbfrmle.
Rfjd`jfrb`e bf bmpp`f v`f lmbfae9ae cflmvre vfkfa` jfusflm ul oamjjm
trfls`tmr`m e pm`jd fk`sjmlm f a`veaam bea lmbm ftr`mveltr`jmafre pmssmlm
`lterrmcpmlm afr`tc`f. Zpessm, per, lejessfr`m presjr`vere ul trfttf-
celtm b` cfltel`celtm. @ gfrcfj` p` jmculecelte usft`, bf sma` m `l
fssmj`fz`mle, smlm9 af b`kmss`lf, ` oetf oamjjflt`, ` gfrcfj` beaaf jafsse
@j (prmpfgelmle, ejf`l`be) e beaaf jafsse @@@ (smtfamam, fc`mbfrmle).Rfjd`jfrb`e bf cfjrmr`eltrm9 `a trfttfceltm b` cfltel`celtm s` ofsf
suaaut`a`zzm be` oetf-oamjjflt`, be` gfrcfj` beaaf jafsse @j (prmpfgelmle,
ejf`l`be) e beaaf jafsse @@@ (fc`mbfrmle, jmrbfrmle). Af b`k`tfae bf
ev`tfre le` smkkett` jml s`lbrmce b` [magg-Xfrn`lsml-[d`te.
Rfjd`jfrb`e veltr`jmafr`
RW cmlmcmrge9 af terfp`f prevebe ausm be` oetf-oamjjflt`, bea smtfamam,
beaafc`mbfrmle.
RW pma`cmrge9 `a trfttfceltm prevebe aut`a`zzm percflelte be` oetf-
oamjjflt` e pu essere tfamrf fssmj`ftm faa`cp`fltm b` ul pfje-cfner e
b` ul beor`aaftmre. Le` pfz`elt` fggett` bf tfae fr`tc`f, lgftt`, a r`sjd`m b`
cmrte cprmvv`sf fatm e pmssmlm ver`jfrs`, smprfttuttm l mjjfs`mle b`
sgmrz` m b` ecmz`ml`, tmrs`ml` b` pultf e tfamrf or`aafz`mle veltr`jmafre.
Extrfs`stma`eLejess`tflm b` terfp`f smatfltm ae extrfs`stma` veltr`jmafr` le` smkkett` `l
ju` beterc`lflm ulf s`ltmcftmamk`f smkkett`vf r`aevflte, m le` smkkett`
`l ju` v` s`flm sekl` fssmj`ft` b` jfrb`mc`mpft`f.
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Rfo.-Gfrcfj` flt`fr`tc`j` p` grequeltecelte usft` `l et peb`ftr`jf
Gfrcfjm
Xrmpfgelmle
Gaejf`l`be
Zmtfamam
Fc`mbfrmle
Fbelms`lf
B`kmss`lf
Xrmprflmamam
Lmce
jmccerj`fae
_PRDCMLM_C
Jpr 658-:88 ck
G`fae ;8
ck/?8 ca
FACF_DPRC
Jpr 688 ck
G`fae 658 ck/65
ca
ZMRFAET
_PRDCMOERF
Jpr 48 ck
FC@MBF_
JM_BF_MLE
Jpr ?88 ck
N_ELMZ@L
G`fae 7 ck
`l ? ca
AFLMT@L
@LBE_FA
Jpr 28-48 ck
G`fae 5ck/5 ca
Bmse ev
Omam9 8,5-? ck/nk
Cfltel`celtm9
68 ck/nk/?2 mre
Omam9 6-? ck/nk
/
Jmls`ka`ftm smam
`l fco`elte
fatfcelte
spej`fa`zzftm
Omam9 5 ck/nk
`l :8 c`lut`
Cfltel`celtm9
68 ck/nk/b`e
8.6-8.?5 ck/nk
`l omam rfp`bm
Jfr`jm9 65-?5
kfccf/nk
Cfltel`celtm9
5-; kfccf/nk/b`e
8.85-8.6 ck/nk
Bmse pm
68-65 ck/nk/b`e
:88-788
ck/c?/b`e
`l ?-: bms`
?-; ck/nk/b`e
688-?88
ck/c?/b`e
`l ?-: bms`
2-0 ck/nk/b`e
688-?88
ck/nk/b`e
`l ?-: bms`
5-65 ck/nk/b`e
?58 ck/c?/b`e
`l ulf smaf smc-
c`l`strfz`mle
/
Jfr`jm9 :8
kfccf/nk
Cfltel`celtm
68 kfccf/nk/b`e
6-5 ck/nk/ b`e `l
:-2 bms`
Eggett` jmaafterfa`
B`sturo`
kfstrmelter`j`,
pfrestes`e,
sfa`vfz`mle,
`pmtels`mle, smtrmpm
lekft`vm, faaulkf-
celtm X_ e V_Z
Lfusef, pfrestes`e,
tfamrf v`s`mle flleo-
o`ftf, `pmtels`mle,
`smtrmpm lekft`vm,
faaulkfceltm
X_ e V_Z
Ormljmspfscm,
faaulkfceltm
bea VR, `smtrmpm
lekft`vm,orfb`jfrb`zzflte
Faaulkfceltm XV,
VR. Orfb`jfrb`f.
@pmtels`mle se smc-
c`l`strftm ev. @per/
`pmt`rm`b`scm,
gmtmsels`o`a`t. Lea-
afbmaesjelte e lea-
afbuatm9 bfllm
epft`jm, g`orms`
pmacmlfre
_fsd jutflem,
lfusef, vmc`tm,
jegfaef, oamjjm FW,
`pmtels`mle
Lfusef, vmc`tm,
b`frref, orfb`jfrb`f,
oamjjm FW
Ormljmspfscm,
`pmka`jec`f,
bepress`mle, `ljuo`,
`pmtels`mle,
orfb`jfrb`f, `smtrmpm
lekft`vm
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O`oa`mkrfgf esselz`fae
- ?86? FJJG/FDF/D_Z Gmjuseb Upbfte @ljmrpmrfteb @ltm tde FJJG/FDF/
D_Z ?884 Ku`bea`les gmr Bev`je-Ofseb Rderfpy mg Jfrb`fj _dytdc Fo-lmrcfa`t`es. 9 F _epmrt mg tde Fcer`jfl Jmaaeke mg Jfrb`mamky Gmulbft`ml/
Fcer`jfl Defrt Fssmj`ft`ml Rfsn Gmrje ml Xrfjt`je Ku`bea`les flb tde
Defrt _dytdc Zmj`ety.
I Fc Jmaa Jfrb`ma. ?86:>769e7-;5.
- Dfrreaa BR, Fsd`dfrf R, et fa. Kelmtype-bepelbelt b`ggereljes l fke mg cfl`-
gestft`ml flb frrdytdc`f jmcpa`jft`mls l sdmrt VR sylbrmce. @lt I Jfrb`ma.
?865>6089:0:-28?.
- Dflfsd J_, Jrmssm IE. Ecerkeljy b`fklms`s flb cflfkecelt mg peb`ftr`jfrrdytdc`fs. I Ecerk Rrfucf Zdmjn. ?868> :9 ?56?78.