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Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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OSPEDALE PEDIATRICO SANTOBONO – PAUSILIPON
Struttura Semplice Dipartimentale
Centro di Riferimento Regionale per la Diagnosi ed il Trattamento della Retinopatia della Prematurità
Direttore dott. Salvatore Capobianco
www.salvatorecapobianco.it
“Farmaci antiglaucomatosi in età pediatrica”
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L’uso off-la= bel dei farm= aci
nMolti dei farmaci somministrati ai bambini sono utilizzati al di fuori delle ind= icazioni, dosaggi o for= mulazioni per i quali è stata concessa la licenza d’uso.
nNon hanno cioè una autorizzazione per uso pediatrico, ma vengono utilizzati in m= aniera off-label (cioè al di fuori delle indica= zioni riportate nella licenz= a).
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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L’uso off-la= bel dei farm= aci
nQuesto avviene nel caso dell’utilizzo dei farmaci ant= iglaucomatosi, in quanto essendo il glaucoma una malatt= ia prevalentemente dell&#= 8217;adulto, nella maggioranza dei ca= si, non esistono indicazioni specifiche all’uso di tali farmaci nel bambino nL’utilizzo di farmaci off-label può= ; essere associato ad un aumento di rischi di reazioni avverse anche gravi.
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Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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L’uso off-la= bel dei farm= aci
nPer tale ragione,= il medico deve essere bene informato sulle proprietà del farmaco prescritto e sulle reazioni avverse che questo può provocare, specialmente se utilizzato in maniera off-label.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Diapositiva 1
Classificazione = del glaucoma nei primi anni di vita
nG= laucoma congenito
<= span class=3DHBB style=3D'position:absolute;left:-9.61%;top:.49em'>nG= laucoma infantile
<= span class=3DHBB style=3D'position:absolute;left:-9.09%;top:.49em'>nG= laucoma giovanile <= /span>
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Il glaucoma nei primi anni di vita<= /span>
nIl glaucoma congenito e' principalmente un problema di natura= = chirurgica: i farmaci possono essere utili nel = periodo preoperatorio, per ridurre i rischi dell'intervento, e dopo l'intervento stesso per = trattare un eventuale glaucoma residuo.
 <= /span>
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Il glaucoma nei primi anni di vita<= /span>
nIl glaucoma infantile può compa= rire all'inizio dell'età scolare e si manifesta con una sintomatologia molto pi&ug= rave; sfumata rispetto al glauc= oma congenito: in parti= colare non c'è ingro= ssamento del bulbo oculare. Si manif= esta con mal di testa, annebbiamento visivo, lacrimazione ed intolleranza alla luce. Può rispondere be= ne anche alla sola te= rapia medica.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Il glaucoma nei primi anni di vita<= /span>
nViene definito glaucoma giovanile la  malattia ch= e = viene evidenziata entro il trentesimo anno di età. Il = trattamento è del tutto sovrapponibile al glaucoma dell’adu= lto.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Autorizzazione alla commercializzazione
dei farmaci antiglaucomatosi in età = pediatrica
= nl’uso non è autorizzat= o per i bambini.
= n(fonte: Ministero della Salute, “Guida all’uso dei farmaci per i bambini”):
<= span style=3D'font-size:115%;color:#CC3300;visibility:hidden'>n
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Miotici
nPoco efficaci e tollerati nell’infanzia. = ;
nPossono essere utilizzati, dopo la chirurgia, = per tenere l’angolo aperto ed evitare la formazione di sinechie anteriori.
nDa utilizzare, solo in maniera occasionale = (gel o ocusert), nei bambini più grandi con= glaucoma giovanile ad angolo aperto.
qWilliam A., et coll.: Pharmaceutical management of= the childhood glaucomas. Exp. O= pin Pharmacother, 2000, 1(4): 697-711.
q
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Miotici
nPilocarpina
qdal foglio illustrativo: “…la formulazione in collirio non de= ve essere impiegata nei bambini sotto i 3 anni di età…”
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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Betabloccanti
nSono stati i primi farmaci usati nella gestione del glaucoma in età pediatrica.  Continuano ad essere utilizzati per la loro efficacia e sicurezza, se non esistono controindicazioni specifiche quali l’asma bronchiale o aritmie cardiache.
n
n(Moore W et al.: Pharmacologic Management of Glaucoma in Childhood, Paediatric Dr= ugs, 2007, 9 (2), 71:9)
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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Betabloccanti
nTimololo maleato (Timoptol),
qdal foglio illustrativo: “… Timoptol è anche indicato = come terapia concomitante nel glaucoma pediatrico, che = sia inadeguatamente controllato con altre terapie antiglaucoma….”
nTimololo maleato (Timogel),
qdal foglio illustrativo: “…non c’è esperienza nei bambini e negli adolescenti…”.
nLa preparazione in gel ne riduce l’assorbime= nto per via generale e quindi= gli effetti collaterali,
nla posologia ridotta (una volta al giorno) ne faci= lita l’uso in et&ag= rave; pediatrica,
nper l’assenza di conservanti (monodose) &egr= ave; meglio tollerato.<= /span>
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Betabloccanti
nTimololo maleato (Ialutim),
qdal foglio illustrativo: “… nei bambini la posologia e la dur= ata del trattamento dovranno essere stabiliti dal medico su base individuale…” =
nTimololo maleato (Nyogel),
qdal foglio illustrativo: “… l'uso pediatrico del prodot= to non è raccomandato…”
nTimololo maleato (Timolabak),
qNessuna indicazione
nTimololo maleato (Cusimolol),
qNessuna indicazione
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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Betabloccanti
nBetaxololo cloridrato = (Betoptic)
qdal foglio illustrativo: “… non sono stati effettuati studi clinici per stabilire la sicurezza e l'efficacia di Betoptic nei bambini…”
nCarteolo cloridrato = (Carteol)
qdal foglio illustrativo: “… per assenza di dati clini= ci, se ne sconsiglia l'uso in pediatria…”
nLevombutolo cloridrato = (Vistagan)
qNessuna indicazione.
n
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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Agonisti adrenergici alfa-2<= span style=3D'font-family:Garamond;mso-ascii-font-family:Garamond'>
nSebbene abbiano un buon effetto ipotonizzante a breve termine, provocano gravi effetti collaterali<= span style=3D'font-size:77%'> nel neonato e nel bambino.
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qSami A. et al.: Side effect profile of Briomidine Tartrate in Children. Ophthalmology, Vol 112, 12, 2005.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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file:///C:/C9834A01/NAPOLI-FarmaciGlaucoma_file/slide0022.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Diapositiva 1
Agonisti adrenergici alfa-2<= span style=3D'font-family:Garamond;mso-ascii-font-family:Garamond'>
<= span style=3D'font-size:92%'>nBrimonidina (Alphagan)
ndal foglio illustrativo: “̷= 0; Alphagan non è raccomandato nei = bambini al di sotto dei 12 anni di età ed è controindicato nei neonati.
nE' noto che nei neonati possono verificarsi gravi reazioni avverse.
nLa sicurezza e l'efficacia di Alphagan non sono state stabilite = nei bambini.
= nSintomi di sovradosaggio di brimonidina, come ipotensione, bradicardia, ipotermia ed apnea sono stati rip= ortati in alcuni neonati ai quali v= eniva somministrata Alphagan nell'ambito del trattamento medico del glaucoma congenito…”
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Inibitori dell’anid= rasi carbonica sistemici
nAcetazolamide (Diamox)
qdal foglio illustrativo: “… La sicurezza e l'efficacia dell'acetazolamide nei pazienti pediatrici non è stata stabilita. Un ritardo della crescita è stato riportato= nei bambini che ricevono una terapia a lungo termine, si pensa per acidosi secondaria o cronica…”
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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Inibitori dell’anid= rasi carbonica utilizzati per via locale=
nSembrano essere meno efficaci rispetto ai beta-bloccanti, ma più sicuri dal punto di vista sistemico,= anche se possono provocare irritaz= ione congiuntivale.
nVengono usati in associazione con i beta-bloccanti o in loro sostituzione in caso di  controindicazione di questi ultimi.
n
qWilliam A., et coll.: Pharmaceutical management of= the childhood glaucomas. Exp. Opin Pharmacother, 2000, 1(4): 697-711.
qJess T. Whitson et al.: Efficacy of brinzolamide a= nd levobetaxolol in pediatric glaucomas: a randomized clinical trial. J AAPOS= , 2008, in press.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Inibitori dell’anid= rasi carbonica utilizzati per via locale=
nBrinzolamide (Azopt)
qdal foglio illustrativo: “… l'efficacia e la sicurezza di Azo= pt in pazienti minori di 18 anni non sono state stabilit= e e il suo uso non è raccoman= dato in questi pazienti…”
qda indicazioni fornite dall’Alcon: “= ;in seguito a studi recenti (Jess T. et al 2008) è in fase di approvazi= one da parte dell’EMEA lR= 17;indicazione all’uso in età pediatrica
nDorzolamide (Trusopt)
qdal foglio illustrativo: “… la sicurezza e l'efficacia nei ba= mbini non sono state dimostrate…”.
qViene spesso utilizzato in età pediatrica d= a sola o in associazione.
qE’ provata, da studi clinici, la sua azione = di neuroprotezione.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Analoghi delle prostaglandine
nNon sono stati sufficientemente testati in et&agra= ve; pediatrica tanto quanto nell’adulto.
nSembrano dare buoni risultati in alcuni glaucomi giovanili ad angolo aperto e nel glaucoma secondario ad afachia.
nRiducono il tono oculare in pazienti con glaucoma congenito associato a S. di Sturge –Weber.
nGli effetti collaterali sistemici ed oculari sono = stati lievi e rari.
nNon si è riscontrato un cambio nel colore dell’iride
n
qWilliam A., et coll.: Pharmaceutical management of= the childhood glaucomas. Exp. Opin Pharmacother, 2000, 1(4): 697-711.
qEneydi LB, et al: Latanoprost for the treatment of pediatric glaucoma. Surv Ophthalmol.<= /span> 2002 Aug;47 Suppl 1:S129-32. <= /div>
qEneydi LB, et al: The effectiveness of Latanoprost= for the treatment of pediatric glaucoma. J AAPOS, 1999, Feb 3 (1): 33-9. <= /span>
qMaselli E, et al: Sull’uso delle prostagland= ine in età pediatrica. 15° Congresso di Oftalmologia Pediatrica. <= /span>
qCharles B. Yang et al: Use of Latanoprost in the treatment of glaucoma associated with Sturge-Weber Syndrome. Am. J. Ophthalmol. 1998, Vol. 126, no. 4.
q&= #13;
n
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Analoghi delle prostaglandine
nLatanoprost (Xalatan)
qdal foglio illustrativo: “… non sono disponibili dati di sicurezza ed efficacia in età pediatrica. Pertanto l'uso di Xa= latan nei bambini non è raccomandato...”
nTravoprost (Travatan)
qdal foglio illustrativo: “… l'efficacia e la sicurezza di Travatan in pazienti minori di 18 anni non sono st= ate stabilite e il suo uso non è raccomandato in questi pazienti finch&ea= cute; non saranno disponibili ulteriori dati…”
nBimatoprost (Lumigan)
qdal foglio illustrativo: “… Lumigan è stato studiato <= /span>solo in pazienti adulti, pertanto se ne sconsiglia= l'uso nei bambini o negli adolescenti…”
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
<= span style=3D'color:#CC3300;visibility:hidden'>n
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Associazioni
nVale quanto detto per i prodotti che le compongono
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
nAutorizzazione alla commercializzazione (fonte: Ministero della Salute, “Guida all’= ;uso dei farmaci per i bambini”):
= nl’uso non è autorizzato per i bambini= .
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Nostre esperienze
nNella pratica clini= ca noi utilizziamo correntemente, quando necessario, <= span style=3D'position:absolute;top:33.75%;left:9.73%;width:46.81%;height:5.5%'= >betabloccanti ed inibitori dell’anidrasi carbonica.
nNel glaucoma giovan= ile u= tilizziamo anche gli analoghi delle prostaglandine. =
nNon abbiamo mai = <= b>riscontrato reazioni avverse degne di nota.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Unione Europea e farmaci off-la= bel
nAl fine di superare la carenza di informazioni specifiche su
qefficacia,
qsicurezza,
qdosaggi adeguati,
qpossibile eventi avversi immediati o a distanza dei farmaci
nl’Unione Europea ha dedicato un nuovo Regola= mento ai farmaci utilizzati sulla b= ase della pratica corrente ma in maniera = off-label,
nregolamento per effetto del quale tutti i farmaci destinati al = bambino devono essere sottoposti a sperimentazione siano essi nuovi o con brevetto vigente.
n
n(Di Pietro et al: Consiglio Naz= ionale Società Italiana di Pediatria, Genova, 13 Gennaio 2008)
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
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Conclusioni
nAllo stato, qualsiasi farmaco prescritto per il glaucoma in età pediatrica, viene usato per= un “= compassionate use”, cioè dal loro impiego ci si attende una notevole utilità = terapeutica.
nL’autorizzazione viene rilasciata dal medico curante. Questi
qdeve disporre delle informazioni specifiche sul medicamento utilizzato e
qsi assume tutte le responsabilità medico-le= gali sugli  eventuali eventi avversi che tali farmaci possono provocare.
Dr. Salvatore Capobianco = 211; Ospedale Santobono – Napoli
www.salvatorecap= obianco.it
Grazie per <= /b>l’attenzione!
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Fare clic per uscire.", SCREE= N_MODE=3D"Frames", gIsEndShow=3D0, NUM_VIS_SLDS=3D27, SCRIPT_HREF=3D"script= .js", FULLSCR_HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var g_fBaseHyperlink =3D false; var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(= "slide0002.htm",1,-1,1),new hrefList("slide0003.htm",1,-1,1),new hrefList("= slide0004.htm",1,-1,1),new hrefList("slide0005.htm",1,-1,1),new hrefList("s= lide0011.htm",1,-1,1),new hrefList("slide0026.htm",1,-1,1),new hrefList("sl= ide0013.htm",1,-1,1),new hrefList("slide0014.htm",1,-1,1),new hrefList("sli= de0024.htm",1,-1,1),new hrefList("slide0027.htm",1,-1,1),new hrefList("slid= e0006.htm",1,-1,1),new hrefList("slide0018.htm",1,-1,1),new hrefList("slide= 0012.htm",1,-1,1),new hrefList("slide0016.htm",1,-1,1),new hrefList("slide0= 010.htm",1,-1,1),new hrefList("slide0015.htm",1,-1,1),new hrefList("slide00= 22.htm",1,-1,1),new hrefList("slide0019.htm",1,-1,1),new hrefList("slide000= 8.htm",1,-1,1),new hrefList("slide0020.htm",1,-1,1),new hrefList("slide0009= .htm",1,-1,1),new hrefList("slide0021.htm",1,-1,1),new hrefList("slide0025.= htm",1,-1,1),new hrefList("slide0028.htm",1,-1,1),new hrefList("slide0017.h= tm",1,-1,1),new hrefList("slide0023.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function RemoveFilePrefixFromHref(href) { var regExp =3D /^file:\/\/\//i; return href.replace(regExp, "") } function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if (MHTMLPrefix !=3D "") href =3D RemoveFilePrefixFromHref(href) if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; =09 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(obj.mSldHref= )) else PPTSld.location.replace(obj.mSldHref) =09 if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(href)) else PPTSld.location.replace(href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Successivo",sPrev=3D"Precedente",sEnd=3D"Fine presentazione",s= Font=3D"Arial",sArrow=3D"Freccia",sFreeform=3D"Figura a mano libera",sRect= =3D"Rettangolo",sOval=3D"Ovale" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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charset="us-ascii" Diapositiva 1 ------=_NextPart_01C92969.D67B75D0 Content-Location: file:///C:/C9834A01/NAPOLI-FarmaciGlaucoma_file/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
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