Παιδιατρική | Τόμος 63 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2000

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48 OÍ›· ·ÁÎÚ·ٛÙȉ· Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. £ÂÚ·›· Ì octreotide

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¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 1Ô π·Ó.-ºÂ‚Ú. 2000

Volume 63, No. 1, Jan.-Feb. 2000

¶EPIEÃOMENA

CONTENTS ™ÂÏ.

AP£PA ™YNTA•H™

H ·ÔÊ˘Á‹ Ù˘ ÚfiÎÏËÛ˘ fiÓÔ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ì·˜ Ú·ÎÙÈ΋

Page

EDITORIALS

Managing children's pain F. Athanassiadou-Piperopoulou

º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

1

1

™ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Ì ‚·ı˘Ù¿ÙË ÂÎÙ›ÌËÛË!

E. B·Ï¿ÛÛË- A‰¿Ì

To the reviewers of the journal, with deep appreciation!

E. Valassi-Adam

2

2

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ˆ˜ ̤ÛÔ ‰È¿ÁÓˆÛ˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ Ó¢ÌÔÓ›·˜ ÙˆÓ ·È‰ÈÒÓ ¶. NÈÎÔÏ·˝‰Ô˘

Chest radiographs in the diagnosis and follow-up of pneumonia in children 6

P. Nikolaidou

6

REVIEW ARTICLE

A¡∞™∫O¶∏™∏

Granulomatous hepatitis

KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ· ¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘

9

D. Alexiou, O. Grafakou

9

ARTICLE OF SPECIAL INTEREST

Aƒ£ƒO ∂π¢π∫OÀ ∂¡¢π∞º∂ƒO¡∆O™

The treatment of pain in children with sickle cell disease

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË

17

M. Athanasiou-Metaxa, A. Koussi

17

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ORIGINAL PAPERS

™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Ê·ÈÓfiÙ˘Ô Û ·È‰ÈÎfi ÏËı˘ÛÌfi

Gilbert’s syndrome: Genotype analysis and correlation with phenotype in children

A. TÛ¤˙Ô˘, M. T˙¤ÙË, ™. K›ÙÛÈÔ˘, A. °·ÏÏ¿, E. K·‚·˙·Ú¿Î˘, A. X·Ù˙ˉËÌԇϷ, E. ¶·ÙÂÚ¿ÎË, A. ¢Ú·Î¿ÙÔ˜, E. K·Ó·‚¿Î˘, £.K·Ú¿ıÈÔ˜

A. Tsesou, M. Tzeti, S. Kitsiou, A. Galla, E. Kavasarakis, A. Hatzidimoula, E. Pateraki, A. Drakatos, E. Kanavakis, T. Karpathios

21

Comparison of sensitisation to aeroallergens in British and Greek school children aged 5 to 7.5 years

™‡ÁÎÚÈÛË Â˘·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ Ù˘ EÏÏ¿‰·˜ Î·È Ù˘ AÁÁÏ›·˜ ËÏÈΛ·˜ 5-7,5 ¯ÚfiÓˆÓ ™. TÛ›ÙÔ˘Ú·, K. NÂÛÙÔÚ›‰Ô˘, N. ¶··‰ÔÔ‡ÏÔ˘, ¶. MfiÙ˘, H. Arshad, T. Dean, S. Matthews, B. Mealy

27

34

™˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ ·È‰È΋ ËÏÈΛ· E. PÔËÏ›‰Ë˜, X. M·ÓÙÈÔ‡-°ÎÚ¿Ù˙ÈÔ˘, £. ¶··ÛÙ·‡ÚÔ˘, X. ¶·ÓÙÂÏÈ¿‰Ë˜, M. Aı·Ó·Û›Ô˘, B. K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó·

27

C. Costalos, A. Tsakiris, A. Constandinidou, M. Daniilidou, A. Gounaris

34

Systemic manifestations of Coxsackie B virus infections in childhood 38

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

E. Roilides, C. Mantiou-Gratziou, T. Papastavrou, C. Panteliadis, M. Athanasiou, V. Kyriazopoulou-Dalaina

38

CASE REPORTS

ŒÌÊÚ·ÎÙÔ Ì¤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·fi Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ B. º·Ï·˝Ó·, B. ¶··Â˘·ÁÁ¤ÏÔ˘, B. ™˘ÚÈÔÔ‡ÏÔ˘, M. £ÂÔ‰ˆÚ›‰Ô˘

S. Tsitoura, K. Nestoridou, N. Papadopoulou, P.Botis, H. Arshad, T.Dean, S. Matthews, B. Mealy

Blood and urine anion gap in newborn infants

X¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜/ Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿ X KÒÛÙ·ÏÔ˜, A T۷ΛÚ˘, A KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M ¢·ÓÈËÏ›‰Ô˘, A °Ô‡Ó·Ú˘

21

Occlusion of the middle cerebral artery and Bell's palsy associated with Mycoplasma pneumoniae infection 43

V. Falaina, V. Papaevangelou, V. Syriopoulou, M. Theodoridou

43

Continued

™˘Ó¯›˙ÔÓÙ·È

iii

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

HELLENIC PAEDIATRIC SOCIETY

¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 1Ô π·Ó.-ºÂ‚Ú. 2000

Volume 63, No. 1, Jan.-Feb. 2000

OÍ›· ·ÁÎÚ·ٛÙȉ· Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. £ÂÚ·›· Ì octreotide

™ÂÏ.

A. HÏ›·˜, K. ™ÙÂÊ·Ó›‰Ë˜, A. MËÙÛÈÒÓË, ¢. ™È·¤Ú·, A. ¶··‰ÔÔ‡ÏÔ˘, K. Mȯ¤Ï˘

48

¶Ó¢ÌÔÓÈ΋ Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Î·È M. avium Û ·ÈÌÔÚÚÔÊÈÏÈÎfi ·ÛıÂÓ‹ Ì AIDS ¢. M¿ÓÙ˙ÈÔ˘, °. MÔÛÙÚÔ‡, B. ¶··Â˘·ÁÁ¤ÏÔ˘, E. ¶Ï·ÙÔÎÔ‡ÎË, A. BÂÏÂÁÚ¿ÎË, M. £ÂÔ‰ˆÚ›‰Ô˘

Octreotide treatment of acute pancreatitis in a child with end stage renal disease A. Elias, C. Stefanidis, A. Mitsioni, D. Siapera, A. Papadopoulou, K. Michelis

Page

48

Concurrent pulmonary infection with Aspergillus fumigatus and Mycobacterium avium in an HIVinfected hemophiliac patient 50

D. Mantziou, G. Mostrou, V. Papaevangelou, E. Platokouki, A. Velegraki, M. Theodoridou

50

™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Û ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

Congenital lobar emphysema in an adolescent. Case report

I. K·Ï¤ÁÈ·˜, M. TÛÔÏÈ¿, K. ¶··ÁˆÚÁ›Ô˘, £. ¢fiÛÈÔ˜, E. K·‚·˙·Ú¿Î˘

I. Kaleyias, M. Tsolia, K. Papageorgiou, T. Dosios, E. Kavasarakis

55

A¶EIKONI™TIKH ¶EPI¶Tø™H

¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ÈÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans £. ¶··ÁˆÚÁ›Ô˘, º. Aı·Ó·ÛÈ¿‰Ô˘, A. X·ÚÈÙ¿ÓÙË, ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡, ¢. K·ÙÚÈÔ‡

60

¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY ™TOY™ °ONEI™

TÔ ÂÓ‰ÔÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡ K. ¶Ú›ÊÙ˘

RADIOLOGICAL CASE OF THE ISSUE

Case report of a child with Langerhans cell histiocytosis T. Papageorgiou, F. Athanasiadou, A. Haritandi, M. Hatzistilianou, D. Katriou

60

PAEDIATRICIANS’ PRACTICAL ADVICE TO PARENTS K. Priftis

63

63

LETTERS

∂¶π™∆O§∂™ ∞ÁˆÁ‹ ÀÁ›·˜ ™. ¡¿ÎÔ˘

55

64

S. ¡akou

64

65

S. Andronikou

65

¶ÔÈfi˜ ‰ÈηÈÔ‡Ù·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ Û˘ÁÁڷʤ·; ™. AÓ‰ÚÔÓ›ÎÔ˘

PAEDIATRIC NEWS

¶∞π¢π∞∆ƒπ∫H ENHMEPø™H ¶∞π¢π∞∆ƒπ∫∏ - AÔÏÔÁÈÛÌfi˜ 1999 ∂. µ·Ï¿ÛÛË - ∞‰¿Ì

66 68

Paediatriki - Report 1999 E. Valassi-Adam

∫ÚÈÙ¤˜ 1999 EÈÛÎfiËÛË ∂ÏÏËÓÈÎÔ‡ π·ÙÚÈÎÔ‡ ¶ÂÚÈÔ‰ÈÎÔ‡ ∆‡Ô˘ 1999 69 ÁÈ· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡

Reviewers 1999 68 Scanning of the Greek Medical Peers for articles in child health 69

πƒπ™-Online: µ¿ÛË ÂÏÏËÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ http://www.ich.gr

IRIS- Online: Greek bibliography on child health http://www.ich.gr

¶. ∞. ∫ÔÎÎÈÓ›‰Ë˜

71

∞Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ηÚΛÓÔ ∞Ú¯¤˜ Ù˘ ¶OÀ

75

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË ™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ·È‰› Ô˘ ıÚËÓ› ÙÔ ı¿Ó·ÙÔ ·Á·Ë̤ÓÔ˘ ÙÔ˘ ÚÔÛÒÔ˘ ™. ∆Û›ÙÔ˘Ú·

¢. ∫·ÙÚÈÔ‡, º. ∞ı·Ó·ÛÈ¿‰Ô˘, Ã. ∞ÁÁÔ˘Úȉ¿ÎË, £. ¶··ÁÚˆÚÁ›Ô˘, µ. ∆Û·‚‰·Ú›‰Ô˘, ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ 80

iv

Pain relief in children with cancer WHO

75

Book review

77

∂·Ó·‰ËÌÔÛ›Â˘ÛË ∂›‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ sICAM-1, sVCAM-1 Û ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ· ™˘ÓÙÔÌÔÁڷʛ˜

71

Republication Levels of the soluble adhesion molecules sICAM-1 and sVCAM-1 in children with systemic lupus erythematosus D. Catriou, F. Athanasiadou, C. Aggouridaki, T. Papageorgiou, V. Tsabdaridou, M. Hatzistilianou 80

Forthcoming meetings Abbreviations

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·9

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ H ¶AI¢IATPIKH Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ (E ¶ E ). Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ·) ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ‚) ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ηıÒ˜ Î·È Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Á) ÙË ‰È¢ÎfiÏ˘ÓÛË Ù˘ ‰È·Î›ÓËÛ˘ ÙˆÓ È‰ÂÒÓ Î·È Ù˘ ·Ó¿Ù˘Í˘ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ ‰›Ô Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ‰) ÙËÓ ÚfiÔ‰Ô Ù˘ ÂÏÏËÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ ̤ۈ Ù˘ ÎÚÈÙÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÎÂÈÌ¤ÓˆÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË Â) ÙËÓ ÂÓı¿ÚÚ˘ÓÛË Î·È Î·ÏÏȤÚÁÂÈ· Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ· °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ,Â›Î·ÈÚ· ı¤Ì·Ù·, ¿ÚıÚ· ÂȉÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜, ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜, ÎÏÈÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ, Ú·ÎÙÈο ı¤Ì·Ù·, ÁÂÓÈο ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È ˘Á›·˜, Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÔ‡ ÙÚ·Â˙ÈÔ‡, ÎÏÈÓÈÎÔ·ıÔÏÔÁÈΤ˜ Û˘˙ËÙ‹ÛÂȘ, ÛÂÌÈÓ¿ÚÈ·, Û˘ÌfiÛÈ·, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ¿ÚıÚ· Û˘Ó¯È˙fiÌÂÓ˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙËÌÔÓÈ΋ ÂȉËÛÂÔÁÚ·Ê›· fiˆ˜ ÂÓË̤ڈÛË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Û˘Ó‰ڛˆÓ, Û˘ÌÔÛ›ˆÓ Î·È ÁÈ· ‰Ú·ÛÙËÚÈfiÙËÙ˜ Û¯ÂÙÈΤ˜ Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡.

OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi ¶AI¢IATPIKH ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 11528 Aı‹Ó· H ¶AI¢IATPIKH ·ÎÔÏÔ˘ı› ÙȘ KÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· XÂÈÚfiÁÚ·Ê· Ô˘ YÔ‚¿ÏÏÔÓÙ·È Û BÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο Ô˘ ‰È·ÌÔÚÊÒıËÎ·Ó ·fi ÙËÓ ICMJE (International Committee of Medical Journal Editors.

Uniform Requirements for Manuscripts Submitted to Biomedical Journals. N Eng J Med 1997;337:309315,http://jama.ama-assn.org/info/auinst-req.htlm) ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ô˘ Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›·: ·) ÂÚÈÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈο Ë Û˘Ì‚ÔÏ‹ ÂοÛÙÔ˘ ÙˆÓ Û˘ÁÁڷʤˆÓ (ۯ‰ȷÛÌfi˜, ·Ó¿Ï˘ÛË, ÂÚÌËÓ›· ¢ÚËÌ¿ÙˆÓ,Û˘ÏÏÔÁ‹ ‰Â‰Ô̤ӈÓ, Û˘ÁÁÚ·Ê‹ ÂÚÁ·Û›·˜, ·Ó·ÌfiÚʈÛË ÎÂÈ̤ÓÔ˘), ‚) ‰ËÏÒÓÂÙ·È fiÙÈ fiÏÔÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó Î·È ÌÔÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙÔ ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË Î›ÌÂÓÔ ‹ ÙÌ‹Ì· ÙÔ˘, Á) ‰ËÏÒÓÂÙ·È Ë ÚԤϢÛË Ù˘ ¯ÚËÌ·ÙÔ‰fiÙËÛ˘ ÁÈ· ÙË

Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›· (£· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÚÁ·Û›·˜), ‰) ‰ËÏÒÓÂÙ·È ·Ó ÔÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó οÔÈ· ÔÈÎÔÓÔÌÈ΋ Û¯¤ÛË Ì ÂÙ·ÈÚ›· ‹ ÔÚÁ·ÓÈÛÌfi Ô˘ ¤¯ÂÈ ÔÈÎÔÓÔÌÈÎfi ÂӉȷʤÚÔÓ ÁÈ· Ù· Â˘Ú‹Ì·Ù· ‹ ÙȘ ·fi„ÂȘ ÙÔ˘ Û˘ÁÁڷʤ· (·˘Ùfi ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÓÙ·ÎÙÒÓ ·ÏÏ¿ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÁÓˆÛÙfi ÛÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜), Â) ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢Ù› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ EÏÏËÓÈÎfi ÂÚÈÔ‰ÈÎfi.

H ¶AI¢IATPIKH ÂÓı·ÚÚ‡ÓÂÈ ÙËÓ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‹‰Ë ‰ËÌÔÛÈ¢Ù› ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ Û ÍÂÓfiÁψÛÛ· ÂÚÈÔ‰Èο Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ Û˘Ó˘Ô‚¿ÏÏÔ˘Ó ÊˆÙÔ·ÓÙ›ÁÚ·ÊÔ Ù˘ ÍÂÓfiÁψÛÛ˘ ‰ËÌÔÛ›Â˘Û˘ Î·È ÙËÓ ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ ÙÔ˘ ÍÂÓfiÁψÛÛÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¶AI¢IATPIKH Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ¢È¢ı˘ÓÙ‹ Ù˘ E.™.E. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó Û‡Ìʈӷ Ì ÙË ‰È·Î‹Ú˘ÍË ÙÔ˘ EÏÛ›ÓÎÈ ÙÔ˘ 1975 fiˆ˜ ·Ó·ıˆڋıËΠÙÔ 1983, Î·È Û‡Ìʈӷ Ì ÙË ™‡Ì‚·ÛË ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡.

H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙËÓ ¶AI¢IATPIKH ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο, ÛËÌÂ›Ô ÚÔ˜ ÛËÌ›Ô, ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

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

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏ̘ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

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™‡ÓÙ·ÍË ÙˆÓ ÂÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (22X28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢ڤ˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘. H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 Î·È ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) Î·È ÙÔ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë ÙˆÓ ÂÚ¢ÓËÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË. N· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ·) ÙÔ˘˜ ÛÙfi¯Ô˘˜, ‚) ÙË ÌÂıÔ‰ÔÏÔÁ›·, Á) Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È ‰) Û¯fiÏÈ· ‹ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi. ¶ÂÚ›ÏË„Ë ‰ÂÓ ¤¯Ô˘Ó ÔÈ Ô‰ËÁ›Â˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë. K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

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

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¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜.

H ÂÚÈÁÚ·Ê‹ ÙÔ˘ ˘ÏÈÎÔ‡ Î·È ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË.

OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional - ™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA ÙÔ˘ 1986 (255:23292339). ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. H ·Ó·ÊÔÚ¿ ÂÏÏËÓÈÎÒÓ ‰ËÌÔÛȇÛÂˆÓ ıˆÚÂ›Ù·È ··Ú·›ÙËÙË.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ National Library of Medicine (H¶A) Î·È Ù˘ International Committee of Medical Journal Editors (N Eng J Med 1997;337:309315,http://jama.ama-assn.org/info/auinst-req.htlm). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Index Medicus (List of Journals Indexed in Index Medicus http://www.nlm.nih.gov).

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¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ™ÙÂÊ·Ó›‰Ë˜ A, KÔÚÈÙÛÈ¿‰Ë˜ ™, Mȯ·‹Ï B, AÓ‰ÚÔ˘Ï·Î¿Î˘ ºA. O˘ÚÔ‰˘Ó·ÌÈο Â˘Ú‹Ì·Ù· Û ·ÛıÂÓ›˜ Ì ·ÏȤ˜ ‚·Ï‚›‰Â˜ Ù˘ ÔÈÛı›·˜ Ô˘Ú‹ıÚ·˜. AÚ¯ EÏÏ I·ÙÚ 1988;15:448-455.

Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with an increased risk for pancreatobiliary disease. Ann Intern Med 1996;124:980-983. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Llach F. Parathyroidectomy in chronic renal failure: Indications, surgical approach and the use of calcitriol.

Kidney Int 1990; 38 (29 suppl):S62-S68.

XˆÚ›˜ Û˘ÁÁڷʤ·: Coffee drinking and cancer of the pancreas [editorial]. BMJ 1981;283:628. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: §ÂΤ· B, M·ÎԇϷ X, M·ÙÛ·ÓÈÒÙ˘ N. ¢È·ÓÔÛÔÎÔÌÂȷΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·. TÈ ˘Ô‰ÂÈÎÓ‡Ô˘Ó; ¶ÂÚÈÏ. 78, 26Ô ¶·ÓÂÏ. ¶·È‰. ™˘Ó. Iˆ¿ÓÓÈÓ· 28-29 M·˚Ô˘ 1988.

Spargo PM, Manners JM. DDAVP and open heart surgery [letter]. Anaesthesia 1989;44:363-364.

II. BÈ‚Ï›· KÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Schuster V. Renal clearance. In: Seldin DW, Giebich G, eds. The kidney: physiology and pathophysiology.

2nd ed. New York: Raven Press, 1992:943-978. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: M·Ú¿ÙÔ˘-AÏÈÚ¿ÓÙË §. OÈÎÔÁ¤ÓÂÈ· ÛÙËÓ Aı‹Ó·: OÈÎÔÁÂÓÂȷο ÚfiÙ˘· Î·È Û˘˙˘ÁÈΤ˜ Ú·ÎÙÈΤ˜. Aı‹Ó·: EıÓÈÎfi K¤ÓÙÚÔ KÔÈÓˆÓÈÎÒÓ EÚ¢ÓÒÓ 1995. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance.

In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 2931; New York: International Society of Chemotherapy, 1963:484-500.

¶›Ó·Î˜ Î·È ÂÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜ ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™˘ÛÙ‹ÓÂÙ·È ÛÙ· Û¯‹Ì·Ù· Ó· ·ÔʇÁÔÓÙ·È ÔÈ ÛÎÈ¿ÛÂȘ ÛÙÔ ÊfiÓÙÔ Î·È ÙÔ Î›ÌÂÓÔ Ì¤Û· ÛÙËÓ ÂÈÎfiÓ·. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο. ¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ - ‰‹ÏˆÛË fiÙÈ ‰ÂÓ ¤¯ÂÈ ˘Ô‚ÏËı› Û˘Á¯ÚfiÓˆ˜ Û ¿ÏÏÔ EÏÏËÓÈÎfi ÂÚÈÔ‰ÈÎfi Î·È ‰ÂÓ ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈ¢Ù›.

- ·Ó¿Ù˘Ô Î·È ÂÈÛÙÔÏ‹ ¤ÁÎÚÈÛ˘ ÙÔ˘ ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ Û ÂÚ›ÙˆÛË Ô˘ ¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› Û ÍÂÓfiÁψÛÛÔ ÂÚÈÔ‰ÈÎfi - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ - fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: MÂÓ¤ÙÔ˘-M·Ú·ÓÙ›‰Ô˘ A. XÚËÛÈÌÔÔ›ËÛË ÔÏÏ·ÏÒÓ ÂȉÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÌÔÏ˘‚‰È¿Ûˆ˜ ÛÙÔ K.N.™. ·È‰ÈÒÓ (¢È‰·ÎÙ. ¢È·ÙÚ.). Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ 1988.

ix ÕÚıÚ· Û ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹: Morse SS. Factors in the emergence of infectious diseases.Emerg Infect Dis [serial online]1995 JanMar[cited 1996 June 5];1(1):[24 screens].Available from :URL: http://www.cdc.gov/ncidod/EID/eid.htm

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AP£PA ™YNTA•H™

H ·ÔÊ˘Á‹ Ù˘ ÚfiÎÏËÛ˘ fiÓÔ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ì·˜ Ú·ÎÙÈ΋ º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

F. Athanassiadou - Piperopoulou. Managing children's pain. Paediatriki 2000;63:1-2 000000000

basic human right and everyday paediatric practice offers many opportunities for reducing or preventing pain and the anxiety with which it is associated.

● Abstract: Many childhood illnesses and paediatric procedures are accompanied by pain. There has been a tendency for paediatricians to ignore or minimize this aspect of child care. Pain relief is a

∫ey words: pain, chronic illness, painful episodes, children.

M ·ÊÔÚÌ‹ ÙË ‰ËÌÔÛ›Â˘ÛË Û ·˘Ùfi ÙÔ Ù‡¯Ô˜ ÙÔ˘ ¿ÚıÚÔ˘ "H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ" ÙˆÓ M. Aı·Ó·Û›Ô˘ Î·È A. KÔ‡ÛË (1), ηıÒ˜ Â›Û˘ Î·È ÙȘ Ô‰ËÁ›Â˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ YÁ›·˜ (WHO), ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ηÚΛÓÔ, Ô˘ ÂÈÌÂÏ‹ıËÎÂ Ë ™. TÛ›ÙÔ˘Ú· (2), ı· ‹ıÂÏ· ·fi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ·È‰È¿ÙÚÔ˘ Ó· ˘ÂÚıÂÌ·Ù›Ûˆ ÙËÓ Ú·ÎÙÈ΋ ÙÔ˘ "ÌË fiÓÔ˘", fi¯È ÌfiÓÔ ÁÈ· ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ·ı‹ÛÂȘ, ·ÏÏ¿ Î·È ÁÈ· fiÏ· ÂΛӷ Ù· ÓÂÔÁÓ¿, ‚Ú¤ÊË Î·È ·È‰È¿ Ô˘ ‚ÈÒÓÔ˘Ó ÂÒ‰˘Ó˜ ÂÌÂÈڛ˜.

TÔ ÂÚÈÔÚÈṲ̂ÓÔ ÎÏÈÓÈÎfi Î·È ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ ÁÈ· ÙÔÓ fiÓÔ ÛÙ· ·È‰È¿, ‰ËÌÈÔ‡ÚÁËÛ ÏËıÒÚ· "̇ıˆÓ", ÌÂÚÈÎÔ‡˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ú·ı¤Ùˆ. T· ·È‰È¿ ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ fiˆ˜ ÔÈ ÂÓ‹ÏÈΘ, ‰ÂÓ ı˘ÌÔ‡ÓÙ·È ÙȘ ÂÒ‰˘Ó˜ ÂÌÂÈڛ˜ ÙÔ˘˜, ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ·ÓÙÔ¯‹ ÛÙÔÓ fiÓÔ, Î·È Ù¤ÏÔ˜ Âı›˙ÔÓÙ·È Â˘ÎÔÏfiÙÂÚ· ÛÙ· Ó·ÚΈÙÈο-·Ó·ÏÁËÙÈο. M ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ÔÈ Ì‡ıÔÈ ·˘ÙÔ› ηٷÚÚ›ÊıËÎ·Ó Î·È ·ԉ›¯ıËΠÙÂÏÈο fiÙÈ ·ÎfiÌË Î·È ¤Ì‚Ú˘·, ·fi ÙÔ 2Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, Â›Ó·È ·Ó·ÙÔÌÈο Î·È Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈο Èηӿ Ó· ÓÔÈÒÛÔ˘Ó fiÓÔ Î·È ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ ÚÔÛ·ıÔ‡Ó Î·È Ó· ÙÔÓ ·ÔʇÁÔ˘Ó. (3) H ·Ó·ÎÔ‡ÊÈÛË ·fi ÙÔÓ fiÓÔ, ¤Ó· Û‡ÓıÂÙÔ ÔÏ˘·Ú·ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ, ·ÔÙÂÏ› ‚·ÛÈÎfi ·ÓıÚÒÈÓÔ ‰Èη›ˆÌ· Ô˘ Ú¤ÂÈ Ó· ÚÔÛÂÁÁ›˙ÂÙ·È ·ÓÂÍ¿ÚÙËÙ· ·fi ËÏÈΛ·. ¢ÂÓ ‰ÈηÈÔÏÔÁԇ̷ÛÙÂ Û˘ÓÂÒ˜ ˆ˜ ÁÈ·ÙÚÔ› Ó· ÌËÓ ‰ËÌÈÔ˘ÚÁԇ̠ÚÔ¸Ôı¤ÛÂȘ "ÌË fiÓÔ˘" Û οı ÂÚ›ÙˆÛË Ô˘ ÁÓˆÚ›˙Ô˘Ì ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ fiÙÈ ı· ÙÔÓ ÚÔηϤÛÔ˘ÌÂ, ÂÍ·ÈÙ›·˜ ÌÈ·˜

ÂÒ‰˘Ó˘ Ù¯ÓÈ΋˜ Ô˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌfiÛÔ˘ÌÂ. O ηı¤Ó·˜ Ì·˜ ¤¯ÂÈ ÙÚ·˘Ì·ÙÈΤ˜ ÂÌÂÈڛ˜ ‹ ÚÔÛˆÈΤ˜ ‹ ·fi ÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ (·Ó¿Ù·ÍË Î·Ù¿ÁÌ·ÙÔ˜, Û˘ÚÚ·Ê‹ ÙÚ·‡Ì·ÙÔ˜, Î.¿). TÔ Ò˜ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÔÈ ÂÌÂÈڛ˜ ·˘Ù¤˜, ‰ÂÓ Â›Ì·È Ô‡Ù Ôχ Û›ÁÔ˘ÚË Ô‡Ù ·ÈÛÈfi‰ÔÍË fiÙÈ ÙȘ ·Ó·Î·Ïԇ̠ÛÙË ÌÓ‹ÌË Ì·˜ ‰È·ÚÎÒ˜ ÒÛÙ ӷ ÌËÓ ÚÔÍÂÓ‹ÛÔ˘Ì fiÓÔ ÂÌ›˜ ÔÈ ›‰ÈÔÈ.

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÂ Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ ÔÈ Û˘ÁÎÂÎÚÈ̤Ó˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ, Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÛÙÔ ¿ÚıÚÔ ÙÔ˘˜ ÔÈ M. Aı·Ó·Û›Ô˘ Î·È A. KÔ‡ÛË, ·ÏÏ¿ Î·È ÛÙ· ·È‰È¿ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ȉȷ›ÙÂÚ· ÛÙÔ Î·Ù·ÏËÎÙÈÎfi ÛÙ¿‰ÈÔ, fiˆ˜ ·Ó·Ï‡ÂÙ·È ÛÙÔ poster Ù˘ WHO, ·ÔÙÂÏ› ȉȷ›ÙÂÚÔ ·ÓÙÈΛÌÂÓÔ Î·È Â˘ı‡ÓË ÔÌ¿‰·˜ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜, Ô˘ ı· ÂÊ·ÚÌfiÛÔ˘Ó fiÏ· Ù· Û‡Á¯ÚÔÓ· ̤۷ ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.(1,2) H ÂÚÈÔ¯È΋ ·Ó·ÈÛıËÛ›· Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÙÔÈ΋ Â›ıÂÛË ·Ó·ÈÛıËÙÈÎÒÓ ÎÚÂÌÒÓ, fiˆ˜ Ô Û˘Ó‰˘·ÛÌfi˜ ÏȉÔη˝Ó˘ÚÈÏÔη˝Ó˘, Ô ‰È·‰ÂÚÌÈÎfi˜ ËÏÂÎÙÚÈÎfi˜ Ó¢ÚÔÂÚÂıÈÛÌfi˜ Ì ·ÚÔ¯‹ ËÏÂÎÙÚÈÎÔ‡ Ú‡̷ÙÔ˜ ¯·ÌËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ Î·È ÌÈÎÚ‹˜ Ù¿Û˘, Ë Ú·¯È·›· ·Ó·ÈÛıËÛ›· Ì ¤Á¯˘ÛË ·Ó·ÈÛıËÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÛÙÔÓ ˘·Ú·¯ÓÔÂȉ‹ ¯ÒÚÔ, Ë Û˘Ó¯‹˜ ÂÈÛÎÏËÚ›‰È· ·Ó·ÈÛıËÛ›· Î·È Ë ÛÙÂϯȷ›· ·Ó·ÈÛıËÛ›·, ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ· ÌÂÚÈΤ˜ ‡ÎÔϘ Ú·ÎÙÈΤ˜ ÁÈ· ·È‰È¿ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙÔ NÔÛÔÎÔÌ›Ô.(4,5) TÔ Â›Â‰Ô Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ fiÓÔ˘ ÛÙ· NÔÛÔÎÔÌ›· ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÛÙÈÎÒÓ Î¤ÓÙÚˆÓ Â›Ó·È Î·Ïfi, ÌÔÚ› fï˜ Ó· Á›ÓÂÈ ·ÎfiÌ· ηχÙÂÚÔ. EΛÓÔ Ô˘ ·Ú·ÁÓˆÚ›˙ÂÙ·È Û˘ÛÙËÌ·ÙÈο, Â›Ó·È Ë ÚfiÏË„Ë ÙÔ˘ fiÓÔ˘ Ô˘ ‚ÈÒÓÔ˘Ó Î·ıËÌÂÚÈÓ¿ Ù·

1

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ÕÚıÚ· ™‡ÓÙ·Í˘

ÓÂÔÁÓ¿, ‚Ú¤ÊË Î·È ·È‰È¿ ·fi ·Ϥ˜ È·ÙÚÈΤ˜ Ú·ÎÙÈΤ˜, fiˆ˜ ÊÏ‚ÔÎÂÓÙ‹ÛÂȘ, ÂÌ‚ÔÏÈ·ÛÌÔ‡˜, ÙÔÔı¤ÙËÛË Î·ıÂÙ‹ÚˆÓ, ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ, Î.Ï. (6) ø˜ ‰ÈηÈÔÏÔÁ›· ÚÔ‚¿ÏÏÂÙ·È Û˘Ó‹ıˆ˜ ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ÔÈ È·ÙÚÈΤ˜ ·˘Ù¤˜ Ú¿ÍÂȘ Â›Ó·È ÙȘ ÈÔ ÔÏϤ˜ ÊÔÚ¤˜ Â›ÁÔ˘Û˜ ÛÙ· ·È‰È¿, ¤ÙÛÈ ÒÛÙ ‰ÂÓ ˘¿Ú¯ÂÈ ¯ÚfiÓÔ˜ ÚÔÂÙÔÈÌ·Û›·˜ Ì ʿÚ̷η ‹ „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË. ¶Ú¿ÁÌ·ÙÈ, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Ô˘ Â›Ó·È Â›ÁÔ˘Û˜, Ô ÁÈ·ÙÚfi˜ ÛÙ·ıÌ›˙ÂÈ ÙÔ fiÊÂÏÔ˜ ·fi ÌÈ· ÁÚ‹ÁÔÚË ‰È¿ÁÓˆÛË ¤Ó·ÓÙÈ ÙÔ˘ fiÓÔ˘ Ô˘ ı· ÚÔηϤÛÂÈ. ™Â fiϘ fï˜ ÙȘ ÂÚÈÙÒÛÂȘ ˘¿Ú¯ÂÈ ÙÚfiÔ˜ Ó· ÌÂÙÚÈ¿ÛÔ˘Ì ÙÔÓ fiÓÔ, fiÙ·Ó ·Ê‹ÛÔ˘Ì ÙË ÌËÙ¤Ú· Ó· ÎÚ·Ù¿ÂÈ ÙÔ ¯¤ÚÈ ÙÔ˘ ·È‰ÈÔ‡ Ù˘ ‹ ¤Ó·Ó ¿ÏÏÔ ÁÈ·ÙÚfi Ó· ··Û¯ÔÏ› ÙÔ ·È‰›.

TÈ Á›ÓÂÙ·È fï˜ Ì ÙËÓ Î·ıËÌÂÚÈÓ‹ ¿ÛÎËÛË Ù˘ ·È‰È·ÙÚÈ΋˜ ÛÙÔ È·ÙÚ›Ô, ÙÔ K¤ÓÙÚÔ YÁ›·˜ ‹ ÙÔ AÁÚÔÙÈÎfi I·ÙÚ›Ô; TÈ Á›ÓÂÙ·È fiÙ·Ó ÙÔ ·È‰› ·ÚÓÂ›Ù·È Ó· ¿ÂÈ ÛÙÔ ÁÈ·ÙÚfi ÁÈ· Ó· οÓÂÈ ÂÌ‚fiÏÈÔ, ÁÈ·Ù› ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ fiÓÂÛÂ; H ·¿ÓÙËÛË Â›Ó·È ·Ï‹. £· Ú¤ÂÈ Ó· ·ÊÈÂÚÒÓÔ˘Ì ϛÁÔ ¯ÚfiÓÔ ·Ú·¿Óˆ ÁÈ· οı ·È‰›, Ó· ·ÍÈÔÔÈԇ̠ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ÛˆÛÙ¿, Ó· ‰ÈÂÈÛ‰‡Ô˘Ì ÛÙË ‰ÔÌ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (‰È·˙‡ÁÈÔ, ÌÔÓÔÁÔÓÂ˚΋ ÔÈÎÔÁ¤ÓÂÈ·, ·ÒÏÂÈ· ·È‰ÈÔ‡) ÁÈ· Ó· ÎÂÚ‰›ÛÔ˘Ì ÙËÓ ÂÌÈÛÙÔÛ‡ÓË ÁÔÓÈÔ‡ Î·È ·È‰ÈÔ‡. N· ÂÊ·ÚÌfi˙Ô˘Ì fiϘ ÂΛӘ ÙȘ ÌÂıfi‰Ô˘˜ „˘¯ÔÏÔÁÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ô˘ ıˆÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘, ›Ù ˆ˜ ·ÓÂÍ¿ÚÙËÙ˜ ›Ù ÛÂ Û˘Ó‰˘·ÛÌfi Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹. OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜ ÂÌϤÎÔ˘Ó Î·È ÙÔ˘˜ ÁÔÓ›˜, ÔÈ ÔÔ›ÔÈ ı· Ú¤ÂÈ Ó· ÚÔÂÙÔÈÌ¿˙Ô˘Ó ÙÔ ·È‰› ÙÔ˘˜ ÁÈ· οı ȷÙÚÈ΋ Ú¿ÍË Î·È Ó· ÙÔ „˘¯·ÁˆÁÔ‡Ó Ì·˙› Ì ÙÔÓ ÁÈ·ÙÚfi, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‰È¿ÊÔÚ· ·È¯Ó›‰È· ‹ ‚È‚Ï›· ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘. °È· Ó· ʤÚÔ˘Ó fiϘ ·˘Ù¤˜ ÔÈ Ú·ÎÙÈΤ˜ ÙÔ ÂÈı˘ÌËÙfi ·ÔÙ¤ÏÂÛÌ·, ı· Ú¤ÂÈ Ô ÁÈ·ÙÚfi˜ Ó· ·ÊÈÂÚÒÛÂÈ ·ÚÎÂÙfi ¯ÚfiÓÔ ÛÙÔ Ó· ÂÓËÌÂÚÒÛÂÈ ÙÔ˘˜ ‹ ÙÔÓ ÁÔÓ¤· ÁÈ· ÙË ÛÎÔÈÌfiÙËÙ·

Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘. ¶·ÚfiÏÔ Ô˘ Ô ¯ÚfiÓÔ˜ Â›Ó·È ÔχÙÈÌÔ˜, ÔÏÏÔ› ·È‰›·ÙÚÔÈ Â˘Ù˘¯Ò˜, ÂÓËÌÂÚÒÓÔ˘Ó ÙÔ˘˜ ÁÔÓ›˜ ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ·˘Ùfi Â›Ó·È Ôχ ÂÓı·ÚÚ˘ÓÙÈÎfi. ™‹ÌÂÚ·, Ô˘ Ë ÂÈÏÔÁ‹ Ù˘ ÂȉÈÎfiÙËÙ·˜ ‰ÂÓ Á›ÓÂÙ·È Ù˘¯·›·, ·ÏÏ¿ Ô ÁÈ·ÙÚfi˜ Ì ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ· Î·È Û˘ÓÂÎÙÈÌÒÓÙ·˜ ÙÔ ¯ÚfiÓÔ ·Ó·ÌÔÓ‹˜ ÁÈ· ¤Ó·ÚÍË Ù˘ ÂȉÈÎfiÙËÙ·˜ ÙËÓ ÂÈϤÁÂÈ, ÓÔÌ›˙ˆ, fiÙÈ ÔÈ Û‡Á¯ÚÔÓÔÈ ·È‰›·ÙÚÔÈ ı· Á›ÓÔ˘Ó Î·Ï‡ÙÂÚÔÈ ·fi Ì·˜. £· Ú¤ÂÈ ‚¤‚·È· Î·È ÂÌ›˜ ˆ˜ ‰¿ÛηÏÔÈ Ó· ÙÔ˘˜ ‰È‰¿ÍÔ˘ÌÂ Î·È Ó· ÙÔ˘˜ ‰Â›ÍÔ˘Ì Ì ÙÔ ·Ú¿‰ÂÈÁÌ¿ Ì·˜, fiÙÈ ÂÎÙfi˜ ·fi ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ¿ÏÏ· Ô˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙËÓ ¿ÛÎËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁ‹Ì·Ùfi˜ Ì·˜. ŒÓ· ·fi ·˘Ù¿, Ë Ì¤ÚÈÌÓ· ÁÈ· ÙË ÌË ÚfiÎÏËÛË fiÓÔ˘ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏ› ηı‹ÎÔÓ Î·È ˘Ô¯Ú¤ˆÛË fiÏˆÓ Ì·˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Aı·Ó·Û›Ô˘-MÂÙ·Í¿ M, KÔ‡ÛË A. AÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ. ¶·È‰È·ÙÚÈ΋ 2000;63:17-20.

2. TÛ›ÙÔ˘Ú· ™. Afi‰ÔÛË Ô‰ËÁÈÒÓ Ù˘ WHO. Cancer pain relief and palliative care in children. ¶·È‰È·ÙÚÈ΋ 2000;63:75-76 3. Schechter NL, Berde CB, Yaster M. Pain in infants, children and adolescents. Williams & Wilkins. 1993.

4. Collins MJ. A child’s pain. JAMA 1997;277:21.

5. Taddio A et al. Efficacy and safety of lidocaine-prilacaine cream for pain during circumcision. New Eng J Med, 1997; 336:17, 1197-1201.

6. Derbyshire SWG, Furedi A. Do fetuses feel pain? BMJ 1996; 313: 796-799.

7. M˘ÚˆÓ›‰Ô˘-T˙Ô˘‚ÂϤÎË M, T˙Ô˘‚ÂϤ΢ °. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿. EÈÛÙËÌÔÓÈ΋ EÂÙËÚ›‰· TÌ‹Ì·ÙÔ˜ I·ÙÚÈ΋˜ A.¶.£. 1997;23:1, 51-63. º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ MËÙÚÔfiψ˜ 55, 54623 £ÂÛÛ·ÏÔÓ›ÎË

™ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Ì ‚·ı˘Ù¿ÙË ÂÎÙ›ÌËÛË!

EϤÓË B·Ï¿ÛÛË- A‰¿Ì

E. Valassi-Adam. To the reviewers of the journal, with deep appreciation! Paediatriki 2000;63:2-6

paediatrics. The benefits, weaknesses and difficulties of peer reviewing in biomedical journals are discussed.

● Abstract: A tribute is paid to the reviewers of PAEDIATRIKI for their major contribution to Greek

∫ey words: peer review, Paediatriki.

2

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·3

¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8

™ÙË ÛÂÏ›‰· 68 ηٷÁÚ¿ÊÔÓÙ·È Ù· ÔÓfiÌ·Ù· ÙˆÓ ÎÚÈÙÒÓ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛÂ Ë ¶AI¢IATPIKH ÙÔ 1999.

E›ıÈÛÙ·È Ó· ·Ú·Ù›ıÂÓÙ·È Ù· ÔÓfiÌ·Ù¿ ÙÔ˘˜ Ì ÙȘ ¢¯·ÚÈÛٛ˜ ÙÔ˘ ‰È¢ı˘ÓÙ‹ ™‡ÓÙ·Í˘. H ¢ÁÂÓÈ΋, ·fiÚÈÛÙË Î·È Û˘ÁÎÚ·ÙË̤ÓË ·Ó·ÊÔÚ¿ ÛÙË Û˘Ì‚ÔÏ‹ ÙˆÓ ÎÚÈÙÒÓ, ÚÔÛÏ·Ì‚¿ÓÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ ·Ï‹ ·‚ÚÔÊÚÔÛ‡ÓË Ù˘ ™‡ÓÙ·Í˘! ºÔ‚Ô‡Ì·È Ì‹ˆ˜ ·ÓÂ·ÈÛı‹Ùˆ˜, ˘Ô‚·ıÌ›˙ÂÈ ÙÔÓ Ú·ÁÌ·ÙÈÎfi ÚfiÏÔ ÙˆÓ ÎÚÈÙÒÓ ÛÙÔÓ È·ÙÚÈÎfi Ù‡Ô.

H ϤÍË "ÎÚ›ÛË" Â›Ó·È ·ÚÂÍËÁË̤ÓË. ¶·Ú·¤ÌÂÈ Û ‰È·ÁˆÓÈÛÌfi, ‰ÈÂΉ›ÎËÛË ı¤Û˘, Û ÛÙ›ڷ ·ÍÈÔÏfiÁËÛË Í¤ÓÔ˘ ¤ÚÁÔ˘, Û ‚·ıÌÔÏÔÁ›· ·fi ı¤ÛË ÂÍÔ˘Û›·˜. A˘Ù‹ Ë ÎÚ›ÛË Â›Ó·È, ‚¤‚·È·, ÌÈ· ÂÈÛÙËÌÔÓÈο ¿¯ÚËÛÙË ‰È·‰Èηۛ·. O˘‰Â›˜ ‚ÂÏÙÈÒıËΠÂÈÛÙËÌÔÓÈο ‰È·‚¿˙ÔÓÙ·˜ ÂÈÛ‹ÁËÛË ÁÈ· ‚Ú¿‚¢ÛË ‹ ÁÈ· Ï‹ÚˆÛË ı¤Ûˆ˜! ™ÙËÓ ÂÚ›ÙˆÛË ÂÓfi˜ ¿ÚıÚÔ˘ ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË, Ë ÎÚ›ÛË ¤¯ÂÈ ÂÓÙÂÏÒ˜ ¿ÏÏÔ ÓfiËÌ·, ¿ÏÏÔ˘˜ ÛÙfi¯Ô˘˜ ÎÈ ¿ÏÏË ‰È·‰Èηۛ·. OÈ ÎÚÈÙ¤˜ ‰ÂÓ ÎÚ›ÓÔ˘Ó ÌfiÓÔ ·Ó Ë ÂÚÁ·Û›· Â›Ó·È Î·Ï‹ ‹ ÏÈÁfiÙÂÚÔ Î·Ï‹, ‰ËÌÔÛȇÛÈÌË ‹ fi¯È, ‰ÂÓ ‚·ıÌÔÏÔÁÔ‡Ó ·ÏÒ˜. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÎÚÈÙ¤˜ Ô˘ ÁÓÒÚÈÛ· ˆ˜ Û˘ÓÙ¿ÎÙ˘ Î·È ˆ˜ Û˘ÁÁڷʤ·˜, οÓÔ˘Ó Î¿ÙÈ Û·Ó "ÂÈ̤ÏÂÈ·" Î·È Û˘¯Ó¿ Ôχ ÂÚÈÛÛfiÙÂÚ· (1). ¶ÚÔÙ›ÓÔ˘Ó ÙÚÔÔÔÈ‹ÛÂȘ, ‰È¢ÎÚÈÓ›ÛÂȘ, ‰ÈÔÚıÒÛÂȘ, Û˘ÌÏËÚÒÛÂȘ! OÈ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘˜, ‰˘ÓËÙÈο ÂËÚ¿˙Ô˘Ó ÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ¿ÚıÚÔ˘. ™˘¯Ó¿ ÂËÚ¿˙Ô˘Ó Î·È ÙÔÓ Û˘ÁÁڷʤ·-ÂÚ¢ÓËÙ‹. TÔÓ Î¿ÓÔ˘Ó Ó· ÔÚÁ·ÓÒÛÂÈ Î·È Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ Î·Ï‡ÙÂÚ· ÙË ‰Ô˘ÏÂÈ¿ ÙÔ˘ ÎÈ fi¯È ÌfiÓÔ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›·. ¢ËÏ·‰‹, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰ÂÓ Û˘Ì‚¿ÏÏÔ˘Ó ÌfiÓÔ ÛÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÂÈÎÔÈÓˆÓ›· ·ÏÏ¿ ÛÙËÓ ›‰È· ÙËÓ ÂÈÛÙ‹ÌË. O ÎÚÈÙ‹˜ ÙÔ˘ ¿ÚıÚÔ˘ ‰ÂÓ ‰Ú· ·fi ı¤ÛË ÂÍÔ˘Û›·˜. E›Ó·È Û˘ÓÂÚÁ¿Ù˘ - Û‡ÌÌ·¯Ô˜ ÙÔ˘ Û˘ÁÁڷʤ·-ÂÚ¢ÓËÙ‹ Î·È Û˘Á¯ÚfiÓˆ˜ ÙÔ˘ ¢È¢ı˘ÓÙ‹ ™‡ÓÙ·Í˘ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ¢Ú· Î·È ˆ˜ ÚÔÛٷ٢ÙÈÎfi˜ ÎÏÔÈfi˜ ÁÈ· Ó· ÌË ‚ÚÂı› Ô ·Ó·ÁÓÒÛÙ˘ ÂÎÙÂıÂÈ̤ÓÔ˜ Û η΋, ·ÓÂ·Ú΋ ‹ ‰˘ÛÓfiËÙË ÏËÚÔÊÔÚ›· (2,3).

H ÎÚ›ÛË Â›Ó·È ‚¤‚·È·, ¤ÚÁÔ Ô˘ Á›ÓÂÙ·È ÛÙÔ ·Ú·Û΋ÓÈÔ Î·È Ô˘‰¤ÔÙ ·Ó·ÁÓˆÚ›˙ÂÙ·È. §¤Ì "Ï·ÌÚfi˜ ÎÏÈÓÈÎfi˜", "ÛÔ˘‰·›Ô˜ ÂÚ¢ÓËÙ‹˜", "ηÏfi˜ ‰¿ÛηÏÔ˜". ¢ÂÓ Â›·Ì ÁÈ· Î·Ó¤Ó·Ó "ÛÔ˘‰·›Ô˜ ÎÚÈÙ‹˜".

T· ÛÔ‚·Ú¿ ÂÚÈÔ‰Èο ÛÙËÚ›˙ÔÓÙ·È ÛÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘˜.(2) OÈ Û˘ÓÙ¿ÎÙ˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÙË ÁÓÒÌË Î·ı' ‡ÏËÓ ·ÚÌfi‰ÈˆÓ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó ÂÁ΢ÚfiÙËÙ· Î·È ·Ó·ÁÓˆÛÈÌfiÙËÙ· ÛÙÔ ÂÚÈÔ‰ÈÎfi ÙÔ˘˜. MÔÚ› fiÏÔÈ Ó· ÁÎÚÈÓÈ¿˙Ô˘Ó ÁÈ· ÙȘ ·‰˘Ó·Ì›Â˜ Ô˘ ÂÓ¤¯ÂÈ Ë ÎÚ›ÛË, ÌÔÚ› ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ (70%) Ó· ÌË ‰ÂÛ̇ÔÓÙ·È ÛÙȘ ·ÔÊ¿ÛÂȘ ÙÔ˘˜ ·ÏÏ¿ ÂȉÈÒÎÔ˘Ó Ó· ¤¯Ô˘Ó ÔÏÏÔ‡˜ Î·È Î·ÏÔ‡˜ ÎÚÈÙ¤˜ (2-5).

ÕÚıÚ· ™‡ÓÙ·Í˘

H Ù¤¯ÓË ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÎÚÈÙÒÓ, ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, Ì·ı·›ÓÂÙ·È ·fi ÙÔÓ Û˘ÓÙ¿ÎÙË Ì ÙË Ì¤ıÔ‰Ô "‰ÔÎÈÌ‹˜ Î·È Ï¿ıÔ˘˜" Î·È ·Ú·‰ÔÛȷο, ÌÂÙ·‰È‰fiÙ·Ó ÛÙÔÓ ÂfiÌÂÓÔ Û˘ÓÙ¿ÎÙË ‰È· "·Ú·ÁÁÂϛ˘ Î·È ¯Ú‹Ûˆ˜" ‹ "Û˘ÓÙ¯ÓÈ·ÎÔ‡ ÎÔ˘ÙÛÔÌÔÏÈÔ‡". MfiÓÔ Ù· ÙÂÏÂ˘Ù·›· 10 ¯ÚfiÓÈ· Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Ó· Ù˘ÔÔÈËı› Î·È Ó· ÛÙ·ıÌÈÛÙ› Î·È ·˘Ù‹ Ë ‰È·‰Èηۛ· fiˆ˜ fiϘ ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (6). ¶ÔȘ Â›Ó·È ÔÈ ··Ú·›ÙËÙ˜ ȉÈfiÙËÙ˜ ÙÔ˘ ηÏÔ‡ ÎÚÈÙ‹; ¶ÚˆÙ·Ú¯ÈÎfi ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ Â›Ó·È Ë ÁÓÒÛË ÙÔ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘. A·Ú·›ÙËÙË, ·ÏÏ¿ ‰ÂÓ ·ÚΛ. ¢Â‡ÙÂÚË Û ÛÂÈÚ¿ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ȉÈfiÙËÙ· Â›Ó·È -ÈÛÙ‡ˆ- Ë ·›ÛıËÛË ÈÛÔÚÚÔ›·˜ ¢ı˘ÓÒÓ ·¤Ó·ÓÙÈ ÛÙÔÓ Û˘ÁÁڷʤ·, ÙÔÓ Û˘ÓÙ¿ÎÙË ,ÙÔÓ ·Ó·ÁÓÒÛÙË. ¢ÂÓ ÙËÓ ‰È·ı¤ÙÔ˘Ó fiÏÔÈ. TÚ›ÙÔ ı· ¤‚·˙· ÙÔ ÎÚÈÙÈÎfi Ì˘·Ïfi Î·È Ù¤Ù·ÚÙË ÙË ıÂÙÈ΋ ‰È¿ıÂÛË, ÙËÓ ÂÔ›ıËÛË fiÙÈ Ù· Ú¿ÁÌ·Ù· Âȉ¤¯ÔÓÙ·È ‚ÂÏÙ›ˆÛË. H Ù·¯‡ÙËÙ· ÛÙËÓ ·¿ÓÙËÛË, Ë Â˘Á¤ÓÂÈ· Î·È Ë Û·Ê‹ÓÂÈ· ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ ·Ó·Ê¤ÚÔÓÙ·È ·fi ÔÏÏÔ‡˜ Û˘ÓÙ¿ÎÙ˜ Î·È Û˘ÁÁÚ·Ê›˜ (2,3). ™Â ÌÈ· ¤Ú¢ӷ ·ÍÈÔÏÔÁ‹ıËÎ·Ó 507 ÎÚ›ÛÂȘ Î·È ÎÚÈÙ¤˜ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ¿ÚıÚˆÓ Î·È ·fi ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ ÙÔ˘ BMJ. BÚ¤ıËΠfiÙÈ Ë ÔÈfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ ‹Ù·Ó ηχÙÂÚË Û ÎÚÈÙ¤˜ Ô˘ ›¯·Ó ÂÎ·›‰Â˘ÛË Û ÂȉËÌÈÔÏÔÁ›· Î·È ÛÙ·ÙÈÛÙÈ΋, Û ÓÂÒÙÂÚÔ˘˜ Û ËÏÈΛ· Î·È ‚ÂÏÙȈÓfiÙ·Ó ·Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈÂÚˆÓfiÙ·Ó ÛÙËÓ ÎÚ›ÛË ·ÏÏ¿ ̤¯ÚÈ 3 ÒÚ˜. OÈ ÎÚÈÙ¤˜Ì¤ÏË Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ ›¯·Ó ¯·ÌËÏfiÙÂÚ˜ ‚·ıÌÔÏÔÁ›Â˜ (6). A˜ ¿ÚÔ˘Ì ٷ Â˘Ú‹Ì·Ù· ¤Ó·-¤Ó·: 1- TÔ Â‡ÚËÌ· fiÙÈ ÔÈ Û˘ÓÙ¿ÎÙ˜ Â›Ó·È ¯ÂÈÚfiÙÂÚÔÈ ÎÚÈÙ¤˜ ‰ÂÓ ÓÔÌ›˙ˆ Ó· ·ÊÔÚ¿ ÙËÓ EÏÏ¿‰·. ¶Èı·ÓfiÓ Ó· Û˘Ì‚·›ÓÂÈ Û ÂÚÈÔ‰Èο Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Ó ·ÚÎÂÙÔ‡˜ Â͈ÙÂÚÈÎÔ‡˜ ÎÚÈÙ¤˜ (7,8) ÔfiÙÂ Ô ÊfiÚÙÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ë Â·ÁÁÂÏÌ·ÙÈ΋ ÂÍ¿ÓÙÏËÛË (ı· ÙËÓ ¤ÏÂÁ· ‚·ÚÂÌ¿Ú·) οÓÂÈ ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ Ó· ÁÚ¿ÊÔ˘Ó ÏÈÁfiÙÂÚÔ Ô˘ÛÈ·ÛÙÈΤ˜ ÎÚ›ÛÂȘ (6). AÛÊ·ÏÒ˜ Â›Ó·È ÈÔ ··ÈÙËÙÈÎÔ› Û ı¤Ì·Ù· Û˘ÌÌfiÚʈÛ˘ ÛÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ô˘ Û˘Ó‹ıˆ˜ ÔÈ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ Ù· ıˆÚÔ‡Ó ¿ÍÈ· ÏfiÁÔ˘. ÿÛˆ˜ ÙÔ˘˜ È¿ÓÂÈ ÙÔ ·Ú¿ÔÓÔ, ÙÔ ·›ÚÓÔ˘Ó ÚÔÛˆÈο Î·È ÌÂÚÔÏËÙÔ‡Ó fiÙ·Ó Ô Û˘ÁÁڷʤ·˜ ·ÁÓÔ› ÙȘ Ô‰ËÁ›Â˜ Î·È ı›ÁÂÈ ÙÔ Î‡ÚÔ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

2- H Û‡ÛÙ·ÛË ÛÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ BMJ Ó· ·ÊÈÂÚÒÓÔ˘Ó ÛÙËÓ ÎÚ›ÛË ÌfiÓÔ Ì¤¯ÚÈ 3 ÒÚ˜ ( 6) Â͈Ú·ÁÌ·ÙÈ΋ ÌÔ˘ Ê·›ÓÂÙ·È! (1) YÔÏÔÁ›˙ˆ fiÙÈ ÌfiÓÔ Û ÌÈ· ηϋ ÂÚÁ·Û›· ¯ÚÂÈ¿˙ÂÙ·È Î·Ó›˜ 3-4 ÒÚ˜ ÁÈ· Ó· ÎÚ›ÓÂÈ Î·È Ó· ‰È·Ù˘ÒÛÂÈ ÂÁÁڿʈ˜ ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘. AÓ ¯ÚÂÈ·ÛÙ› Ó· ÂϤÁÍÂÈ Î¿ÔÈ· ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹, Ó· ·ÓÔ›ÍÂÈ ÙÔ MEDLINE ‹ οÔÈÔ ·ÏÈfi Ù‡¯Ô˜ Ù˘ ¶AI¢IATPIKH™, ¯ÚÂÈ¿˙ÂÙ·È

3

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·4

¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8

ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ. AÓ Ë ÂÚÁ·Û›· ÂÚÈÁÚ¿ÊÂÈ ÌÈ· ηϋ ÂÚ¢ÓËÙÈ΋ ‰Ô˘ÏÂÈ¿ ·ÏÏ¿ Â›Ó·È Î·ÎÔÁÚ·Ì̤ÓË (Ú¿ÁÌ· fi¯È Û¿ÓÈÔ) ¤Ó·˜ Â˘Û˘Ó›‰ËÙÔ˜ ÎÚÈÙ‹˜ ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› ‰‡Ô ÔÏfiÎÏËÚ· ·ÔÁ‡̷ٷ. AÓ ÚfiÎÂÈÙ·È ÁÈ· ηϋ ·ÏÏ¿ ηÎÔ·ÚÔ˘ÛÈ·Ṳ̂ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ‰ÂÓ ÊÙ¿ÓÔ˘Ó Ù· ‰‡Ô ·ÔÁ‡̷ٷ ÁÈ· Ó· ÚÔÙ›ÓÂÈ ¯Ú‹ÛÈ̘ ‰ÈÔÚıÒÛÂȘ.

3- ¢ÂÓ ÂÎÏ‹ÛÛÂÈ Ô˘ ÎÚÈÙ¤˜ Ì ·È‰Â›· ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· Î·È ÛÙË ÛÙ·ÙÈÛÙÈ΋ ıˆڋıËÎ·Ó ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ fiÙÈ Î¿ÓÔ˘Ó Î·Ï‡ÙÂÚ˜ ÎÚ›ÛÂȘ.

EΛ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÔÈ Û˘ÁÁÚ·Ê›˜ fiÙÈ ¯ˆÏ·›ÓÔ˘Ó Î·È ‰¤¯ÔÓÙ·È Ì ¢ÁÓˆÌÔÛ‡ÓË ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙˆÓ "ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ". (9) E›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Ë ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÎÚ›ÛÂˆÓ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ¤ÁÈÓ·Ó ·Ô‰ÂÎÙ¿ Î·È ·˘ÙÒÓ Ô˘ ·ÔÚÚ›ÊıËηÓ. EÍ¿ÏÏÔ˘ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ ·ÍÈÔÔÈÔ‡Ó ÙȘ ÎÚ›ÛÂȘ ÁÈ· Ó· ÙÚÔÔÔÈ‹ÛÔ˘Ó ÙËÓ ÂÚÁ·Û›· ÙÔ˘˜ Î·È Ó· ÙËÓ ˘Ô‚¿ÏÔ˘Ó Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi ‚ÂÏÙȈ̤ÓË. M¤Û· Û 3-6 ¯ÚfiÓÈ· ›¯·Ó ‰ËÌÔÛÈ¢Ù› Û ¿ÏÏ· ÂÚÈÔ‰Èο 85% ÙˆÓ ¿ÚıÚˆÓ Ô˘ ·ÔÚÚ›ÊıËÎ·Ó ·fi ÙÔ New England Journal of Medicine Î·È ÙÔ Journal of Clinical Investigation Î·È 68% ·fi ÙÔ British Medical Journal. (4) Afi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ÎÚÈÙ‹, ÔÈ ÂÚÁ·Û›Â˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÂȉËÌÈÔÏÔÁÈ΋ ÌÂıÔ‰ÔÏÔÁ›· Î·È ÛÙ·ÙÈÛÙÈ΋ Â›Ó·È Û˘Ó‹ıˆ˜ ¢ÎÔÏfiÙÂÚÔ Ó· ÎÚÈıÔ‡Ó. AÓÙ›ıÂÙ·, Ë ·ÓÂΉÔÙÔÏÔÁÈ΋ ·Ó·ÊÔÚ¿ Î·È Ë ¤ÏÏÂÈ„Ë Û¯Â‰È·Ṳ̂Ó˘ ÁÓˆÛÙ‹˜ ÌÂıÔ‰ÔÏÔÁ›·˜ ¯ÚÂÈ¿˙ÔÓÙ·È Ôχ ÂÚÈÛÛfiÙÂÚË ‰Ô˘ÏÂÈ¿ Î·È "‰È·›ÛıËÛË". O ÎÚÈÙ‹˜ ÓÈÒıÂÈ ·Ó·ÛÊ¿ÏÂÈ· fiÙ·Ó ÎÚ›ÓÂÈ ÌÈ· "ηÎÔÊÙÈ·Á̤ÓË" ÂÚÁ·Û›·. ºÔ‚¿Ù·È fiÙÈ ·ÔÚÚ›ÙÔÓÙ¿˜ ÙËÓ ÌÔÚ› Ó· ·‰ÈΛ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ó· ηı˘ÛÙÂÚ› ÙËÓ ÎÔÈÓÔÔ›ËÛË ÌÈ·˜ ¯Ú‹ÛÈÌ˘ ÁÓÒÛ˘. A˜ ¿ÚÔ˘Ì ÁÈ· ·Ú¿‰ÂÈÁÌ· ÙËÓ ·ÎÚ·›· ÂÚ›ÙˆÛË ÌÈ·˜ ÂÚÁ·Û›·˜ fiÔ˘ ¤Ó·˜ ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜ ÁÚ¿ÊÂÈ: "¤‰ˆÛ· ÂÚ˘ıÚÔÌ˘Î›ÓË Û fiÏ· Ù· ÓÂÔÁÓ¿ ÙÔ˘ Ì·È¢ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÁÈ·Ù› ›¯· ¤Ó· ÎÚÔ‡ÛÌ· ÎÔΛÙË, ›‰· 7 ÂÚÈÙÒÛÂȘ Û˘ÁÁÂÓÔ‡˜ ˘ÏˆÚÔÛÙ¤ÓˆÛ˘ Û ¤Ó· ¯ÚfiÓÔ, Î·È ÓÔÌ›˙ˆ fiÙÈ ÊÙ·›ÂÈ Ë ÂÚ˘ıÚÔÌ˘Î›ÓË". TÔ ·ÊÂϤ˜ Î·È ·ÙÂÎÌËÚ›ˆÙÔ Û˘Ì¤Ú·ÛÌ· οÓÂÈ ÙÔÓ ÎÚÈÙ‹ Ó· ·ÌÊÈÛ‚ËÙ‹ÛÂÈ, ‰›Î·È·, ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÛΤ„Ë ÙÔ˘ Û˘ÁÁڷʤ·. A˘Ùfi ÙÔÓ ·Ú·Û‡ÚÂÈ fï˜, Ó· ·ÁÓÔ‹ÛÂÈ ÙËÓ Ô˘Û›· Ù˘ ·Ú·Ù‹ÚËÛ˘ Ô˘ ‰ÂÓ ·ÌÊÈÛ‚ËÙ›ٷÈ: ÂÌÊ·Ó›ÛÙËÎ·Ó ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ÌÈ·˜ Û¿ÓÈ·˜ ηٿÛÙ·Û˘ Û ¤Ó· ÌÈÎÚfi ÓÔÛÔÎÔÌÂ›Ô Î·È ÙÔ ÁÂÁÔÓfi˜ Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı›. TÔ ¿ÚıÚÔ ·ÔÚÚ›ÙÂÙ·È. MÂÙ¿ ·fi ·ÚÎÂÙ¿ ¯ÚfiÓÈ· Ô ÎÚÈÙ‹˜ ‰È·‚¿˙ÂÈ ÛÙÔ Lancet ÂÚÁ·Û›· fiÔ˘ ÙÂÎÌËÚÈÒÓÂÙ·È ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË ÂÚ˘ıÚÔÌ˘Î›Ó˘ Î·È ˘ÏˆÚÔÛÙ¤ÓˆÛ˘ (!) Î·È Í¤ÚÂÈ fiÙÈ ·˘Ùfi˜ "¤ı·„Â" ÙÔÓ ÚÒÙÔ Ô˘ ¤Î·Ó ÙËÓ ·Ú·Ù‹ÚËÛË. (10)

4

ÕÚıÚ· ™‡ÓÙ·Í˘

ŸÌˆ˜ Î·È Ë Î·ÏÔÊÙÈ·Á̤ÓË ÂÚÁ·Û›· ¤¯ÂÈ ·Á›‰Â˜ Ô˘ ÌÔÚ› Ó· ·Ú·Û‡ÚÔ˘Ó ÙÔÓ ÎÚÈÙ‹ Ì·ÎÚÈ¿ ·fi ÙËÓ Ô˘Û›·. MÈ· Ù¤ÏÂÈ· ·ÚÔ˘ÛÈ·Ṳ̂ÓË ÂÚÁ·Û›· fiÔ˘ ¤Ó·˜ ÛÙ·ÙÈÛÙÈÎfi˜ ¤¯ÂÈ ÂÂÍÂÚÁ·ÛÙ› ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ì ·‰È¿‚ÏËÙ˜ ÌÂıfi‰Ô˘˜, ·Ú·ı¤ÙÂÈ risk factors, correlation coefficient, multivariate analysis ÎÏ, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ù˘ ÔÌ¿‰·˜ Û ·fiÏ˘Ù· ÛˆÛÙ¿ Û˘ÌÂÚ¿ÛÌ·Ù· ÙÔ˘ Ù‡Ô˘ "Ë ‰È·ÊÔÚ¿ ‚¿ÚÔ˘˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ÙˆÓ ·¯‡Û·ÚÎˆÓ Î·È ÏÈfiÛ·ÚÎˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, ‹ Ë ÔÌ¿‰· ÙˆÓ ·ÁÔÚÈÒÓ Â›¯Â ÌÂÁ·Ï‡ÙÂÚÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ Ó· ÂÌÊ·Ó›ÛÂÈ ÎÚ˘„ÔÚ¯›· ·fi fiÙÈ Ë ÔÌ¿‰· ÙˆÓ ÎÔÚÈÙÛÈÒÓ, ‹ Ë ‰È·ÊÔÚ¿ ÛÙËÓ ËÌÂÚ‹ÛÈ· ηٷӿψÛË ÛÈÁ·Ú¤ÙˆÓ ÌÂٷ͇ ηÓÈÛÙÚÈÒÓ Î·È ÌË Î·ÓÈÛÙÚÈÒÓ ÌËÙ¤ÚˆÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋". (T· ·Ú·‰Â›ÁÌ·Ù· ‰ÂÓ Â›Ó·È ·Ô΢‹Ì·Ù· Ê·ÓÙ·Û›·˜, Â›Ó·È ·fi ÎÚ›ÛÂȘ ¿ÚıÚˆÓ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÓÙ·ÂÙ›·˜). ¢‡ÛÎÔϘ ηٷÛÙ¿ÛÂȘ: AÓ·ÛÎfiËÛË Î·ÏÔÁÚ·Ì̤ÓË, ÂÎÙÂÓ‹˜, Û ÂӉȷʤÚÔÓ ı¤Ì·, ·fi Û˘Ó¿‰ÂÏÊÔ Ô˘ ‰ÂÓ ¤¯ÂÈ ·Û¯ÔÏËı› Ì ÙÔ ·ÓÙÈΛÌÂÓÔ. TÔ ¿ÚıÚÔ ‰ÂÓ ¤¯ÂÈ Ï¿ıË ·ÏÏ¿ ¤¯ÂÈ ÙËÓ ·ÌÂÛfiÙËÙ· ͤÓÔ˘ ÎÂÈ̤ÓÔ˘ ÌÂÙ·ÊÚ·Ṳ̂ÓÔ˘ ·fi ‰ËÌfiÛÈ· ˘ËÚÂÛ›·! O ÎÚÈÙ‹˜ ‰ÂÓ ¤¯ÂÈ Î¿ÙÈ Û˘ÁÎÂÎÚÈ̤ÓÔ Ó· ÚÔÛ¿„ÂÈ. ¢ÂÓ ¤¯ÂÈ Î·ÌÈ¿ ÚfiÙ·ÛË Ó· οÓÂÈ. H ¢ı‡ÓË ÙÔ˘ ·¤Ó·ÓÙÈ ÛÙÔ ÂÚÈÔ‰ÈÎfi ÙÔÓ ÂÌÔ‰›˙ÂÈ Ó· ÂÁÎÚ›ÓÂÈ ÙÔ ¿ÚıÚÔ. H Û˘Ì¿ıÂÈ¿ ÙÔ˘ ÛÙËÓ Ôχ ηϋ ÚÔÛ¿ıÂÈ· ÙÔ˘ Û˘ÁÁڷʤ· ÙÔÓ ÂÌÔ‰›˙ÂÈ Ó· ÚÔÙ›ÓÂÈ ·fiÚÚÈ„Ë. AÌÊÈÙ·Ï·ÓÙ‡ÂÙ·È. ¢ÂÓ Í¤ÚÂÈ Ò˜ Ó· ÙÂÎÌËÚÈÒÛÂÈ ÙËÓ ·ÓÙ›‰Ú·Û‹ ÙÔ˘: T¤ÙÔÈ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ‰ÂÓ ÁÚ¿ÊÔÓÙ·È Â‡ÎÔÏ·. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÎÚÈÙ¤˜ ÂÌÈÛÙ‡ÔÓÙ·È ÙÔ˘˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ ÙÔ˘˜ ÛÙÔ Û˘ÓÙ¿ÎÙË Ô˘ fiÔÈ· ·fiÊ·ÛË ÎÈ ·Ó ¿ÚÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ı· Ì›ÓÂÈ ÙÂÏÈο Ì ÙȘ ·ÌÊÈ‚Ôϛ˜ ÙÔ˘. ÿÛˆ˜ ÙÔ Úfi‚ÏËÌ· ı· ·ÚÔ˘ÛÈ·˙fiÙ·Ó Û·ÓÈfiÙÂÚ· ·Ó Ù· ‰Â˘ÙÂÚÔÁÂÓ‹ ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÁÚ¿ÊÔÓÙ·Ó ÌfiÓÔ ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË.

A˘Ùfi fï˜ ı· ÂÚÈfiÚÈ˙ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙȘ ÁÓˆÛÙ¤˜ ηٷÍȈ̤Ó˜ ·˘ıÂÓٛ˜ Î·È ı· ÛÙÂÚÔ‡Û ÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜ ·fi ÙËÓ ·Ó·ÓˆÙÈ΋ ·ÚÔ˘Û›· ÙÔ˘ ηÈÓÔ‡ÚÁÈÔ˘ Û˘ÁÁڷʤ·. Afi ÙËÓ ¿ÏÏË, ÓÔÌ›˙ˆ fiÙÈ ÔÈ ·Ó·ÁÓÒÛÙ˜ ‰ÂÓ ı· ‹ıÂÏ·Ó Ó· ‰È·ÎÈÓ‰˘Ó‡ÛÔ˘Ó Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· Ù· ÙÂÏÂ˘Ù·›· ÂÈÙ‡ÁÌ·Ù· Ù˘ Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·fi οÔÈÔÓ ·Ó·Ù˘ÍÈÔÏfiÁÔ, Ô‡Ù ÁÈ· ÙȘ ÂÍÂÏ›ÍÂȘ ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ˘Á›· ·fi ÂÈÌÂÏËÙ‹ A' MÔÓ¿‰·˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ (2,4).

TÔ ÂÚÒÙËÌ· ·Ó Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ó ÔÈ ÎÚÈÙ¤˜ Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ Ôχ ÙÔÓ È·ÙÚÈÎfi Ù‡Ô (5,11). Afi 269 ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘ ¤ÁÎÚÈÙˆÓ BÔÚÂÈÔ·ÌÂÚÈηÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ ÌfiÓÔ 46% ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·fiÎÚ˘„Ë ÙˆÓ

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·5

¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8

ÔÓÔÌ¿ÙˆÓ ÙˆÓ Û˘ÁÁڷʤˆÓ (5). YÔÙ›ıÂÙ·È fiÙÈ ·˘Ùfi Á›ÓÂÙ·È ÁÈ· Ó· ÚÔÊ˘Ï·¯ıÔ‡Ó ÔÈ Û˘ÁÁÚ·Ê›˜ ·fi ÙË ÌÂÚÔÏË„›· ÙÔ˘ ÎÚÈÙ‹, ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ‰È·ÊÔÚ¿ ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ÎÚ›Û˘ (5,11). ™ÙËÓ ¶AI¢IATPIKH ·ÎÔÏÔ˘ıÂ›Ù·È Ë ·fiÎÚ˘„Ë Ì Ï‹ÚË Â›ÁÓˆÛË fiÙÈ Â›Ó·È ÂÓÙÂÏÒ˜ ¿ÛÎÔË: Ô ¯ÒÚÔ˜ Â›Ó·È ÌÈÎÚfi˜ Î·È Ô ÎÚÈÙ‹˜, ˆ˜ ÂȉÈÎfi˜, ÁÓˆÚ›˙ÂÈ Ôχ ηϿ ÔÈÔ˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ÂÈÚ·Ì·ÙÈο ÙÔ X Ê¿ÚÌ·ÎÔ ÛÙËÓ æ ·Ûı¤ÓÂÈ·, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙÔ ¤¯ÂÈ ‹‰Ë ·ÎÔ‡ÛÂÈ ˆ˜ Úfi‰ÚÔÌË ·Ó·ÎÔ›ÓˆÛË ÛÂ Û˘Ó¤‰ÚÈÔ Î·È Â›Ó·È Û ı¤ÛË Ó· ˘ÔÏÔÁ›ÛÂÈ ·ÎfiÌË Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÈϤÔÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ËÌÔÛ›Â˘ÛË. T· ÔÓfiÌ·Ù· ÙˆÓ ÎÚÈÙÒÓ ‰ÂÓ ÎÔÈÓÔÔÈÔ‡ÓÙ·È ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ·ÚfiÏÔ Ô˘ ÌÂÚÈÎÔ› Û˘ÓÙ¿ÎÙ˜ ı· ÙÔ ‹ıÂÏ·Ó (5,7), Î·È ÔÏÏÔ› ÎÚÈÙ¤˜ ·Ó ÚˆÙËıÔ‡Ó ‰ÂÓ ¤¯Ô˘Ó ·ÓÙ›ÚÚËÛË.(11) AÚÎÂÙÔ› ÎÚÈÙ¤˜ Ù˘ ¶AI¢IATPIKH™ fiÙ·Ó Î¿ÓÔ˘Ó ÂÚ›ÏÔΘ Î·È ‰˘ÛÎÔÏÔÂÊ¿ÚÌÔÛÙ˜ ÚÔÙ¿ÛÂȘ ÁÈ· ÙÚÔÔÔÈ‹ÛÂȘ, ÚÔÛʤÚÔÓÙ·È Ó· Û˘ÓÂÚÁ·ÛÙÔ‡Ó Û ÚÔÛˆÈ΋ Â·Ê‹ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Â¿Ó ·˘ÙÔ› ÙÔ ÂÈı˘ÌÔ‡Ó. H ÚfiÙ·ÛË ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·Ô‰ÂÎÙ‹ ̤¯ÚÈ ÛÙÈÁÌ‹˜ ·fi ηӤӷ Û˘ÁÁڷʤ·.

H ··ÙËÏ‹ ‰ËÌÔÛ›Â˘ÛË Â›Ó·È Ô ÂÊÈ¿ÏÙ˘ ÙˆÓ ‰È¢ı˘ÓÙÒÓ Û‡ÓÙ·Í˘.(2,3,5,13) K·Ù¿ÏÏËÏ· ÂÈÏÂÁ̤ÓÔÈ ÎÚÈÙ¤˜ Î·È Û˘ÓÙ¿ÎÙ˜ Â›Ó·È Ë ÌfiÓË ÂÍ·ÛÊ¿ÏÈÛË. ™ÙËÓ ¶AI¢IATPIKH Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ "·¿ÙË" ·ÏÏ¿ οÔÈÔ ıfiψ̷ ÙˆÓ ÛÙÔȯ›ˆÓ: .¯. ϤÁÂÙ·È fiÙÈ "ηٿ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ‹Û·Ó ˘ÁÈ›˜" Î·È ·ÔÛȈ¿Ù·È fiÙÈ ·Ú·ÎÔÏÔ˘ı‹ıËΠÌfiÓÔ ÙÔ 62%. ◊ ·ÔÛȈ¿Ù·È fiÙÈ Ë ÂÚÁ·Û›· ¤¯ÂÈ ˘Ô‚ÏËı› Î·È Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ™ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÎÚÈÙÒÓ ··Û¯ÔÏ› ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ Ë Èı·Ó‹ Û‡ÁÎÚÔ˘ÛË Û˘ÌÊÂÚfiÓÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ Î·È ÔÈÎÔÓÔÌÈÎÒÓ (3,5). °È· ÙÔÓ ‰ÈÎfi Ì·˜ ¯ÒÚÔ, Ë Î·Ï‹ ¯ˆÚÔÙ·ÍÈ΋ ηٷÓÔÌ‹ ÙˆÓ ÌÂÏÒÓ Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ Â›Ó·È ·Ôχو˜ ··Ú·›ÙËÙË ÁÈ· Ó· ·ÔʇÁÔÓÙ·È ÔÏÈÛı‹Ì·Ù· fiˆ˜ Ë ÂÈÏÔÁ‹ ÎÚÈÙ‹ Ô˘ Â›Ó·È Û˘ÓÂÚÁ¿Ù˘, ˘ÊÈÛÙ¿ÌÂÓÔ˜ ‹ ÚÔ˚ÛÙ¿ÌÂÓÔ˜ ÙˆÓ Û˘ÁÁڷʤˆÓ ‹ ÙÔ ¯ÂÈÚfiÙÂÚÔ, ÚÔۂϤÂÈ ÛÙËÓ ›‰È· ·Î·‰ËÌ·˚΋ ı¤ÛË Ì ÙÔÓ Û˘ÁÁڷʤ·. T· ÛÊ¿ÏÌ·Ù· Ô˘ ÛËÌÂÈÒıËÎ·Ó ÛÙËÓ ¶AI¢IATPIKH ÂÚÈÔÚ›˙ÔÓÙ·È Û ÂÚÈÙÒÛÂȘ fiÔ˘ ˙ËÙ‹ıËΠÎÚ›ÛË ·fi Û˘Ó·‰¤ÏÊÔ˘˜ Ô˘ ıˆÚÔ‡Û·Ó ‰ÂÔÓÙÔÏÔÁÈο ··Ú¿‰ÂÎÙÔ fiÙÈ ‰ÂÓ Â›¯Â ÂÚÈÏËÊı› ÙÔ fiÓÔÌ¿ ÙÔ˘˜ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‹ Ô˘ fiÓÙ·˜ ·Ï·ÈÔ› Û˘ÓÂÚÁ¿Ù˜ ÙˆÓ Û˘ÁÁڷʤˆÓ ‰È·ÊˆÓÔ‡Û·Ó Ì ÙÔ ¯ÂÈÚÈÛÌfi Ù˘ ˘fi ÎÚ›ÛÈÓ ÂÚÁ·Û›·˜. AÚÓ‹ıËÎ·Ó Â˘ÁÂÓÈο ÙËÓ ÎÚ›ÛË Ì οÔÈÔ ÚfiÛ¯ËÌ·.

H ÛÎÔÈÌfiÙËÙ· Ù˘ ÎÚ›Û˘ ¿ÚıÚˆÓ ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËı› (3-5,13). M¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜

ÕÚıÚ· ™‡ÓÙ·Í˘

ÙÔ˘ '80 ‰ÂÓ ˘‹Ú¯Â ۯ‰fiÓ Î·ÌÈ¿ ÙÂÎÌËÚ›ˆÛË ÁÈ· Ù· ˆÊ¤ÏË Ù˘ ‰È·‰Èηۛ·˜ ÎÚ›Û˘ ÂÓÒ ˘‹Ú¯·Ó ·ÚÎÂÙ¿ ÛÙÔȯ›· ÁÈ· ÙȘ ·‰˘Ó·Ì›Â˜: ÎfiÛÙÔ˜, ¯ÚÔÓÈ΋ ηı˘ÛÙ¤ÚËÛË, ·ÓÔȯً Û ÌÂÚÔÏË„›Â˜ Î·È Û ÂÎÌÂÙ¿ÏÏ¢ÛË, ¤ÓÙÔÓ· ÂÈÊ˘Ï·ÎÙÈ΋ Û Ӥ˜ ȉ¤Â˜, ·ÓÂ·Ú΋˜ ÛÙÔÓ ¤ÏÂÁ¯Ô ÂÈÛÙËÌÔÓÈ΋˜ ·¿Ù˘, Û˘¯Ó¿ ¯ÔÓ‰ÚÔÂȉҘ ÂÏÏÈ‹˜. (ŒÓ· ¿ÚıÚÔ Ô˘ ÂÚÈ›¯Â 8 ηٷÛ΢·Ṳ̂ӷ Ï¿ıË ÛÙ¿ÏıËΠ۠420 ÎÚÈÙ¤˜.

Afi fiÛÔ˘˜ ·¿ÓÙËÛ·Ó, Ô˘‰Â›˜ ÂÂÛ‹Ì·Ó ÂÚÈÛÛfiÙÂÚ· ·fi 5 Ï¿ıË Î·È 16% ‰ÂÓ ‚Ú‹Î·Ó Ô‡Ù ¤Ó·!)

(3) M ÙËÓ ÂͤÏÈÍË ÙÔ˘ Internet ÌÂÚÈÎÔ› ¤Êı·Û·Ó Ó· ÚÔÊËÙ‡ÛÔ˘Ó ÙÔ ı¿Ó·ÙÔ ÙÔ˘ ‚ÈÔ˚·ÙÚÈÎÔ‡ Ù‡Ô˘ (Ì ÙË ÛËÌÂÚÈÓ‹ ÙÔ˘ ÌÔÚÊ‹ Ù˘ ÂÏÂÁ̤Ó˘ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊÔÚ›·˜ Ô˘ ¤¯ÂÈ ÂÏÂÁ¯ı›, ÊÈÏÙÚ·ÚÈÛÙ›, ·Ó·ÌÔÚʈı›, ·fi οÔÈÔ ˘‡ı˘ÓÔ ÂÈÛÙËÌÔÓÈÎfi ÛÒÌ· Î·È ·Ú·‰›‰ÂÙ·È ¤ÙÔÈÌË ÛÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ·Ó·ÁÓÒÛÙË). (3,14) ŸÌˆ˜, ·Ú¿ ÙȘ ÂÈÊ˘Ï¿ÍÂȘ, ÔÈ Û˘ÓÙ¿ÎÙ˜ ÎÈÓ‹ıËÎ·Ó ÚÔ˜ ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ Ù‡Ô˘. ™ÙË ›‰È· ‰ÂηÂÙ›· Ù˘ ·ÌÊÈÛ‚‹ÙËÛ‹˜ Ù˘, Ë ‰È·‰Èηۛ· Ù˘ ÎÚ›Û˘ ÂÓfi˜ ÂÈÛÙËÌÔÓÈÎÔ‡ ¿ÚıÚÔ˘ ¤·„ È· Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Û·Ó ÂÚ·ÛÈÙ¯ÓÈ΋ ··Û¯fiÏËÛË. AÓ·ÁÓˆÚ›ÛÙËΠˆ˜ ÓÂ˘Ì·ÙÈ΋ ¿ÛÎËÛË ·Ó¿ÏÔÁË ÚÔ˜ ÙȘ ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜, Ì ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· (4,13). ¢ËÏÒÓÂÙ·È fiÙÈ ‚Ú›ÛÎÂÙ·È "ÛÙËÓ Î·Ú‰È¿ Ù˘ ÂÈÛÙ‹Ì˘".(3) OÈ ÔÚÁ·ÓˆÌ¤Ó˜ ¤Ú¢Ó˜ Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·ÓÙÈΛÌÂÓÔ, ÚfiÛÊÂÚ·Ó ÙÂÎÌËÚȈ̤ӷ ÛÙÔȯ›· ÁÈ· Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ "ÊÈÏÙÚ·Ú›ÛÌ·ÙÔ˜" Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊÔÚ›·˜ Î·È ‚·ıÌÈ·›· Ê·›ÓÂÙ·È Ó· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÔÈ ÎÚ›ÛÂȘ ÛÙÔÓ ‚ÈÔ˚·ÙÚÈÎfi Ù‡Ô Î·È ÛÙËÓ ËÏÂÎÙÚÔÓÈ΋ ÂÈÎÔÈÓˆÓ›· ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ô‡Ù ÛÎfiÈÌÔ Ó· ηٷÚÁËıÔ‡Ó. AÏÒ˜ ı· ÌÂÙÂÍÂÏȯıÔ‡Ó, ı· Á›ÓÔ˘Ó ·ÓÔÈÎÙ¤˜, ›Ûˆ˜ ÈÔ ‰˘Ó·ÌÈΤ˜. ◊‰Ë οÔÈ· ¤ÁÎÚÈÙ· ÍÂÓfiÁψÛÛ· ÂÚÈÔ‰Èο ¿ÓÔÈÍ·Ó ÂχıÂÚÔ ‰›Ô ÛÙÔ ‰È·‰›ÎÙ˘Ô fiÔ˘ ηÏÂ›Ù·È ÙÔ ÎÔÈÓfi Ó· ‰È·Ù˘ÒÓÂÈ ÎÚ›ÛÂȘ ÁÈ· ¿ÚıÚ· ÚÈÓ ·fi ÙËÓ ÙÂÏÈ΋ ÙÔ˘˜ ‰ËÌÔÛ›Â˘ÛË. (3) OÈ ÎÚÈÙ¤˜, ̤¯ÚÈ ÙÒÚ· ·˘ÙÔ‰›‰·ÎÙÔÈ, ÂÎ·È‰Â‡ÔÓÙ·È Û ÂȉÈο Û˘Ó¤‰ÚÈ·, ·ÎÔÏÔ˘ıÔ‡Ó ÏÂÙÔÌÂÚ›˜ Ô‰ËÁ›Â˜ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ (4,12,13), ı¤ÙÔ˘Ó ÂÚ¢ÓËÙÈο ÂÚˆÙ‹Ì·Ù· Î·È ÔÚÁ·ÓÒÓÔ˘Ó ÙË ÌÂıÔ‰ÔÏÔÁ›· ÙˆÓ ÎÚ›ÛÂˆÓ Ì ٷ ÎÚÈÙ‹ÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÁÈ· οı ÂÈÛÙËÌÔÓÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. Ÿ¯È! TÔ Internet ‰ÂÓ ÂÎÙfiÈÛ ÙÔ˘˜ ÎÚÈÙ¤˜. TÔ˘˜ ¤‰ˆÛ ÙÔ ¤Ó·˘ÛÌ· Ó· Á›ÓÔ˘Ó "ÂÈÛÙ‹ÌÔÓ˜" Î·È "Â·ÁÁÂÏ̷ٛ˜"!

BÈ‚ÏÈÔÁÚ·Ê›· 1. B·Ï¿ÛÛË-A‰¿Ì E. KÚÈÙÒÓ ÂÁÎÒÌÈÔ. EÈÛÙÔÏ‹, Aگ›· EÏÏËÓ I·ÙÚ 1989,6: 489-490.

2. Goldbeck-Wood S. What makes a good reviewer of manuscripts? BMJ 1998;316:86.

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ÕÚıÚ· ™‡ÓÙ·Í˘

3. Smith R. Peer review: reform or revolution? BMJ 1997; 315:759-760.

4. °ÂÚÌÂÓ‹˜ AE. Afi ÙÔÓ °Ô˘ÙÂÌ‚¤ÚÁÈÔ ÛÙÔ Internet, KÚÈÙ¤˜ Î·È ™‡ÓÙ·ÍË. EΉfiÛÂȘ ¶··˙‹ÛË, Aı‹Ó· 1999.

5. Wilkes MS, Kravitz RL. Policies,practices, and attitudes of North American medical journal editors. J Gen Intern Med 1995;10:443-450.

6. Black N,van Rooyen S, Godlee F, Smith R, Evans S. What makes a good reviewer and a good review for a general medical journal? JAMA 1998;280:231-233.

7. Garrow J, Butterfield M, Marshall J,Williamson A. The reported training and experience of editors in chief of specialist clinical medical journals. JAMA 1998;280:286287.

8. Howard L, Wilkinson G. Peer review and editorial decisionmaking . Br J Psychiatry 1998;173:110-113.

9. Garfunkel JM, Lawson EE, Hamrick HL, Ulshen MH. Effect of acceptance or rejection on the author’s evaluation of peer review of medical manuscripts. JAMA 1990; 263:1376-1378.

10. Honein MA,Paulozzi LJ,Himelright IM,LeeB, Cragan JD,

11.

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Patterson L et al. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: a case review and cohort study. Lancet 1999;354:2101-2105. van Rooyen S,Godlee F, Evans S,Black N,Smith R Effect of open peer review on quality of reviews and on reviewers' recommendations: a randomised trial. BMJ 1999;318:23-27. ™Ôω¿ÙÔ˜ KP. ™˘ÓÙ·ÎÙÈÎfi ¤ÚÁÔ. ™Ùfi¯ÔÈ Î·È ‰È·‰Èηۛ·. ÛÙÔ °Ú·Ùfi Û˘ÌfiÛÈÔ: ¶Ò˜ ÁÚ¿ÊÂÙ·È ¤Ó· È·ÙÚÈÎfi ¿ÚıÚÔ.

Aگ›· EÏÏ I·ÙÚ 1995,12215-217.

Rennie D. Editorial Peer Review in Biomedical Publication: The First International Congress in Guarding the Guardians. Research on Editorial Peer Review. Selected Proceedings JAMA 1990;263:1317 La Porte RE, Marler E, Akazawa S, Sauer F, Gamboa C,Shenton C et al Death of biomedical journals. BMJ 1995;310:1387-1390.

E. µ·Ï¿ÛÛË-∞‰¿Ì πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ª. ∞Û›·˜ 76, 115 27 ∞ı‹Ó·

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ˆ˜ ̤ÛÔ ‰È¿ÁÓˆÛ˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ Ó¢ÌÔÓ›·˜ ÙˆÓ ·È‰ÈÒÓ ¶ÔÏ˘Í¤ÓË NÈÎÔÏ·˝‰Ô˘

P. Nikolaidou. Chest radiographs in the diagnosis and follow-up of pneumonia in children. Paediatriki 2000;63:6-8

radiographs are discussed with respect to childhood pneumonia. ∫ey words: radiographs, pneumonia.

● Abstract: The indications and limitations of chest

ø˜ Ó¢ÌÔÓ›· ÔÚ›˙ÂÙ·È Ë ÊÏÂÁÌÔÓ‹ ÙˆÓ Î˘„ÂÏ›‰ˆÓ ·fi ÏÔÈÌÔÁfiÓ· ·›ÙÈ·. ¢È·ÎÚ›ÓÂÙ·È, ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘, Û ÏÔ‚Ò‰Ë, ÙÌËÌ·ÙÈ΋, Î·È ˘ÔÙÌËÌ·ÙÈ΋ ‹ ‚ÚÔÁ¯ÔÓ¢ÌÔÓ›·. ¢È·ÎÚ›ÓÂÙ·È ·ÎfiÌË, ·Ó¿ÏÔÁ· Ì ÙÔÓ ÙfiÔ ÚÔ¤Ï¢Û˘ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·, Û Ó¢ÌÔÓ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ Î·È Û ÓÔÛÔÎÔÌÂȷ΋. A˘Ùfi ÙÔ ¿ÚıÚÔ Û‡ÓÙ·Í˘ ·Ó·Ê¤ÚÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙËÓ Ó¢ÌÔÓ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ Î·È ·ÔÛÎÔ› ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚfiÏÔ˘ Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒڷη ÛÙË ‰È¿ÁÓˆÛË Ù˘ Î·È ÙËÓ Èı·ÓÔÏfiÁËÛË ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· Ô˘ ÙËÓ ÚÔοÏÂÛÂ.

6

H Ó¢ÌÔÓ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂÚ· ‚Ú¤ÊË Î·È Ó‹È· (4 ÂÂÈÛfi‰È· ÙÔÓ ¯ÚfiÓÔ ·Ó¿ 100 ‚Ú¤ÊË Î·È Ó‹È·), ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (2 ÂÂÈÛfi‰È· ÙÔÓ ¯ÚfiÓÔ ·Ó¿ 100 ·È‰È¿) Î·È ·ÎfiÌË ÈÔ Û¿ÓÈ· ÂÊ‹‚Ô˘˜ (1 ÂÂÈÛfi‰ÈÔ ÙÔÓ ¯ÚfiÓÔ ·Ó¿ 100 ÂÊ‹‚Ô˘˜). H ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, ÂÎÙfi˜ ·fi ÙË Û˘¯ÓfiÙËÙ·, ηıÔÚ›˙ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·. ŒÙÛÈ, Ë Ó¢ÌÔÓ›· ÙÔ˘ ÓÂÔÁÓÔ‡ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ‚·ÎÙ‹ÚÈ· (‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ B, ÏÈÛÙ¤ÚÈ·, ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ·ÚÓËÙÈο ηٿ Gram ‚·ÎÙ‹ÚÈ·), ·ÏÏ¿ Û ÈÔ‡˜ (.¯.

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CMV, Èfi˜ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·). H Ó¢ÌÔÓ›· ÛÙ· ‚Ú¤ÊË ÂÓfi˜ ¤ˆ˜ ÙÚÈÒÓ ÌËÓÒÓ Û˘¯Ó¿ ÔÊ›ÏÂÙ·È ÛÙÔ ¯Ï·Ì‡‰ÈÔ ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜, ÙÔ Ô˘Ú¿Ï·ÛÌ· urealyticum, ÙÔ Ì˘ÎfiÏ·ÛÌ· hominis ·ÏÏ¿ Î·È Û ÈÔ‡˜ (CMV, RSV, ÈÔ› Ù˘ ÁÚ›˘ Î·È Ù˘ ·Ú·ÁÚ›˘, ·‰ÂÓÔ˚Ô›). H Ó¢ÌÔÓ›· ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 4 ÌËÓÒÓ Ì¤¯ÚÈ 5 ÂÙÒÓ Û˘¯ÓfiÙÂÚ· ÔÊ›ÏÂÙ·È Û ÈÔ‡˜ (RSV, ÈÔ› ÁÚ›˘, ·Ú·ÁÚ›˘, ·‰ÂÓÔ˚Ô›) Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ‚·ÎÙ‹ÚÈ· (Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, ·ÈÌfiÊÈÏÔ˜ Ù˘ ÁÚ›˘, ηٷÚÚÔ˚΋ ÌÔڷͤϷ). H Ó¢ÌÔÓ›· ÛÙË Û¯ÔÏÈ΋ Î·È ÙËÓ ÂÊË‚È΋ ËÏÈΛ· (6-21 ÂÙÒÓ) ΢ڛˆ˜ ÔÊ›ÏÂÙ·È Û ‚·ÎÙËÚȷο ·›ÙÈ· (Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È· Ó¢ÌÔÓ›·˜) (1).

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÔÙÂÏ› ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜. TÔÓ›˙ÂÙ·È fï˜, fiÙÈ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Û οı ÂÚ›ÙˆÛË, ÛÙËÓ ÔÔ›· Ì ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· Èı·ÓÔÏÔÁÂ›Ù·È Ó¢ÌÔÓ›· (1,2) ‰ÈfiÙÈ: ·) ·ÚÎÂÙ¿ Û˘¯Ó¿, ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, Ë Ó¢ÌÔÓ›· Ô˘ ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ‚¿ÛË ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È ·ÎÙÈÓÔÏÔÁÈο, ‚) Ë ÂÈ‚¿Ú˘ÓÛË ·fi ÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒڷη Â›Ó·È ˘ÔÏÔÁ›ÛÈÌË, ȉȷ›ÙÂÚ· ·Ó ¤¯Ô˘Ó Á›ÓÂÈ ÚÔËÁÔ˘Ì¤Óˆ˜ ·ÎÙÈÓÔÁڷʛ˜ ÁÈ· ÙÔÓ ›‰ÈÔ ‹ ¿ÏÏÔ ÏfiÁÔ, Î·È Á) ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Ó¢ÌÔÓÈÒÓ ÛÙ· ·È‰È¿ Â›Ó·È ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÂÔ̤ӈ˜ Ë ·ÂÈÎÔÓÈÛÙÈ΋ ÂȂ‚·›ˆÛË ‰ÂÓ ÚÔÛʤÚÂÈ ıÂÚ·¢ÙÈ΋ ‚Ô‹ıÂÈ·.

AÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÂÈ‚¿ÏÏÂÙ·È Ó· Á›ÓÂÙ·È (1,3) fiÙ·Ó: ·) ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ÛÙËı·ÎÔ˘ÛÙÈο Â˘Ú‹Ì·Ù· Ù˘ Ó¢ÌÔÓ›·˜ ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ‚·ÎÙËÚȷ΋˜ Ó¢ÌÔÓ›·˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÂÓ ÂÈÛËÁÔ‡ÓÙ·È Û·ÊÒ˜ ÈÔÁÂÓ‹ ÚԤϢÛË Ù˘ (.¯. ÂÁηٿÛÙ·ÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ·ÈÊÓ›‰È· Ì ˘„ËÏfi ˘ÚÂÙfi, ·Ô˘Û›· ÂΉËÏÒÛÂˆÓ ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ÛÙËı·ÎÔ˘ÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ), ‚) Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÂËÚ·Ṳ̂ÓË, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Èı·ÓÔÏÔÁÔ‡ÌÂÓÔ ·›ÙÈÔ (Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ·˘Ù‹˜ ı· ·ÔÙÂϤÛÔ˘Ó ÛÙÔȯ›· ·Ó·ÊÔÚ¿˜ ÁÈ· ÙËÓ ·ÂÈÎÔÓÈÛÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘), Î·È Á) Ë ·ÓÙÈ‚›ˆÛË Ô˘ ‹‰Ë ¤¯ÂÈ ¯ÔÚËÁËı› ¤¯ÂÈ ·ÔÙ‡¯ÂÈ. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ë ·ÎÙÈÓÔÁÚ·Ê›· Â›Ó·È ÂӉ¯fiÌÂÓÔ Ó· ·Ôηχ„ÂÈ ˘¿Ú¯Ô˘Û· ÂÈÏÔ΋ fiˆ˜ ÂÌ‡ËÌ· ‹ ·fiÛÙËÌ·.

ÕÚıÚ· ™‡ÓÙ·Í˘

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÂÎÙfi˜ ·fi ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Ù˘ Ó¢ÌÔÓ›·˜, ‚ÔËı¿ ÛËÌ·ÓÙÈο ÛÙËÓ Èı·ÓÔÏfiÁËÛË ÙÔ˘ ·ÈÙ›Ô˘ Ù˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÈÔÁÂÓ‹ Ó¢ÌÔÓ›· Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤¯ÂÈ ·ÌÊÔÙÂÚfiÏ¢ڷ ‰È¿Û·ÚÙ· Â˘Ú‹Ì·Ù· Ô˘ Û˘Ó›ÛÙ·ÓÙ·È Û ˘ÔÙÌËÌ·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ, Û˘Ó‹ıˆ˜ ηٿ ÙËÓ ‡ÏË, ·ÙÂÏÂÎٷۛ˜ Î·È ÂÛٛ˜ ˘ÂÚ·ÂÚÈÛÌÔ‡ (4,5). ™ÙË ‚·ÎÙËÚȷ΋ Ó¢ÌÔÓ›· ÎÏ·ÛÈÎfi ·ÎÙÈÓÔÏÔÁÈÎfi ‡ÚËÌ· Â›Ó·È Ë ‰È‹ıËÛË ÙÌ‹Ì·ÙÔ˜ ‹ ÔÏfiÎÏËÚÔ˘ ÏÔ‚Ô‡ Ó‡ÌÔÓ· (6). MÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ·fiÛÙËÌ·, ÓÂ˘Ì·ÙÔ΋ÏË ‹ Î·È ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹. H Ì˘ÎÔÏ·ÛÌÈ΋ Î·È Ë ¯Ï·Ì˘‰È·Î‹ Ó¢ÌÔÓ›· ‰È·Ê¤ÚÔ˘Ó ·ÂÈÎÔÓÈÛÙÈο, fiˆ˜ ÂÍ¿ÏÏÔ˘ Î·È ÎÏÈÓÈο, ·fi ÙȘ ¿ÏϘ ‚·ÎÙËÚȷΤ˜ Ó¢ÌÔӛ˜ Î·È Ù· Â˘Ú‹Ì·Ù· ÌÔÈ¿˙Ô˘Ó Ì Ù˘ ÈÔÁÂÓÔ‡˜, Ù˘ ‚·ÎÙËÚȷ΋˜ Ó¢ÌÔÓ›·˜ ‹ Î·È ÙˆÓ ‰‡Ô Ì·˙› (7,8). ŒÙÛÈ, Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ù˘ Ì˘ÎÔÏ·ÛÌÈ΋˜ ‹ Ù˘ ¯Ï·Ì˘‰È·Î‹˜ Ó¢ÌÔÓ›·˜ ÌÔÚ› Ó· Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢Ú˜ ‰È¿Û·ÚÙ˜ ÂÚÈ‚ÚÔÁ¯ÈΤ˜ ‹ ÂÚÈ·ÁÁÂȷΤ˜ ‰ÈËı‹ÛÂȘ ‹ ÂÙÂÚfiÏ¢Ú˜ ÙÌËÌ·ÙÈΤ˜ ˘ÎÓÒÛÂȘ. ™˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ‰ÈfiÁΈÛË ÙˆÓ ˘Ï·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹, Û˘Ó‹ıˆ˜ ÌÈÎÚ‹.

H ÂӉ‰ÂÈÁ̤ÓË ÚÔ‚ÔÏ‹ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È Ë ÚÔÛıÔ›ÛıÈ· (9). ¶ÚfiÛıÂÙ˜ ·ÎÙÈÓÔÁڷʛ˜ (.¯. Ï¿ÁȘ, ÏÔͤ˜) ÌÔÚ› Ó· ‰ÒÛÔ˘Ó ÂÈϤÔÓ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÂÓÙfiÈÛË Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ Ó¢ÌÔÓ›·˜ ÌfiÓÔ Û ÔÛÔÛÙfi Ô˘ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 3% Î·È ÁÈ' ·˘Ùfi ÛÙËÓ Ú¿ÍË Û¿ÓÈ· ¯ÚÂÈ¿˙ÔÓÙ·È.

E·Ó¿ÏË„Ë Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒڷη Á›ÓÂÙ·È ÌfiÓÔ ÛÙȘ ‚·ÎÙËÚȷΤ˜ Ó¢ÌÔӛ˜, ‰ËÏ·‰‹ ÛÙȘ ÏÔ‚Ò‰ÂȘ ‹ ÙÌËÌ·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ, ÁÈ· Ó· ‚‚·Èˆı› Î·È ·ÂÈÎÔÓÈÛÙÈο Ë ·ÔηٿÛÙ·ÛË Ù˘ ‚Ï¿‚˘ Î·È Î˘Ú›ˆ˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› ÙÔ ÂӉ¯fiÌÂÓÔ Ó· ÚÔ¸‹Ú¯Â ·Ó·ÙÔÌÈ΋ ‚Ï¿‚Ë (.¯. Û˘ÁÁÂÓ‹˜ ·ÛÙË, ·fiÏ˘Ì·) (1,10). M ‰Â‰Ô̤ÓÔ fiÙÈ ÔÈ ·ÎÙÈÓÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ ·Ôηı›ÛÙ·ÓÙ·È Û ‰È¿ÛÙËÌ· Ô˘ ÌÔÚ› Ó· Êı¿ÛÂÈ ÙȘ 8 ‚‰ÔÌ¿‰Â˜, Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ Â·Ó¤ÏÂÁ¯Ô˜ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ‰‡Ô Ì‹Ó˜ ÂÚ›Ô˘ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Schidlow DV, Callahan CW. Pneumonia Pediatr Rev 1997; 17: 300-309.

2. Swingler GH, Hussey GD, Zwarenstein MZ. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children.

Lancet 1998; 351: 404-408.

3. Redd SC, Patrick E, Vreuls R, Metsing M, Moteetee M. Comparison of the clinical and radiographic diagnosis of

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4.

5.

6.

7.

paediatric pneumonia. Trans R Soc Trop Med Hyg 1994; 88: 307-310.

Han BK, Yoon HK, Lee SI. Epidemic adenoviral lower respiratory tract infection in pediatric patients: radiographic and clinical characteristics. AJR Am J Roentgenol 1998; 170: 1077-1080.

Wahlgren H, Mortensson W, Eriksson M, Finkel Y, Forsgren M. Radiographic patterns and viral studies in childhood pneumonia at various ages. Pediatr Radiol 1995; 25: 627-630.

Davies HD, Wang EE, Manson D, Babyn P, Shuckett B. Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. Pediatr Infect Dis J 1996; 15:600-604.

Castriota-Scanderbeg A, Popolizio T, Sacco M, Coppi M, Scarale MG, Cammisa M. Diagnosis of mycoplasma pneumonia in children: which is the role of thoracic radiography? Radiol Med 1995; 89: 782-786.

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8. Kauppinen MT, Lahde S, Syrjala H. Roentgenographic findings of pneumonia caused by Chlamydia pneumoniae. A comparison with streptococcus pneumonia. Arch Intern Med 1996; 156: 1851-1856.

9. Patenaude Y, Blais C, Leduc CP. Reliability of frontal chest x-ray in diagnosing pulmonary opacities in children. Invest Radiol 1995; 30: 44-48.

10. Heaton P, Arthur K. The utility of chest radiography in the follow-up of pneumonia. N Z Med J 1998; 111: 315-317.

¶ÔÏ˘Í¤ÓË NÈÎÔÏ·˝‰Ô˘ ∞’ ¶·È‰. ∫ÏÈÓÈ΋ ¶·Ó. ∞ıËÓÒÓ ¡ÔÛ. ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·», 115 27 ∞ı‹Ó·

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ANA™KO¶H™H

KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ· ¢ËÌÔÛı¤Ó˘ AÏÂ͛Ԣ, ŸÏÁ· °Ú·Ê¿ÎÔ˘

● ¶ÂÚ›ÏË„Ë: ÕÚıÚÔ ·Ó·ÛÎfiËÛ˘ ·Ó·ÊÔÚÈο Ì ÙË Û˘¯ÓfiÙËÙ·, ÙË Û˘Ìو̷ÙÔÏÔÁ›·, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È ÙËÓ ·ÈÙÈÔÏÔÁ›·, ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ȉÈÔ·ıÔ‡˜ (ÚˆÙÔ·ıÔ‡˜) Î·È Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÔÎÎȈ̿وÛ˘ ÙÔ˘ ‹·ÙÔ˜. ¶·È‰È·ÙÚÈ΋ 2000;63:9-16. §¤ÍÂȘ ÎÏÂȉȿ: Ë·Ù›Ùȉ·, ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜, ÎÔÎÎÈÒÌ·Ù· ‹·ÙÔ˜.

D. Alexiou, O. Grafakou. Granulomatous Hepatitis. Paediatriki 2000;63:9-16. ● Abstract: This paper presents a review of the frequency, the clinical and laboratory findings and the histological features, as well as the pathogenesis and the treatment of idiopathic and secondary granulomatous hepatitis.

Key words: hepatitis, prolonged fever of unknown origin, hepatic granulomata.

EÈÛ·ÁˆÁ‹ EÏ·ÊÚ¿ ‰È·Ù·Ú·¯‹ ÙˆÓ Û˘Ó‹ıˆÓ Ë·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, fiˆ˜ ÌÈÎÚ¿ ·‡ÍËÛË, ̤¯ÚÈ 200 IU/l, ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ Á-GT Î·È Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ Û˘¯Ó¿ Û ‰È¿ÊÔÚ˜ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ (1). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ë ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‹·ÙÔ˜ ‰ÂÓ Â›Ó·È Û˘¯Ó‹, ÂÓÒ ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ Û¿ÓÈÔ ·ÏÏ¿ ˘·ÚÎÙfi ‡ÚËÌ· Â›Ó·È ÙÔ ÎÔÎΛˆÌ·. ¶·Ï·ÈfiÙÂÚ·, ·Ó·ÊÂÚfiÙ·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ÎÔÎÎÈˆÌ¿ÙˆÓ Û ˘ÏÈÎfi ‚ÈÔ„ÈÒÓ ‹·ÙÔ˜ ÁÂÓÈÎÔ‡ ÓÔÛÔÎÔÌ›Ԣ ·ÓÂÚ¯fiÙ·Ó Û 3-10% (2).

OÈ Mac Cluggage Î·È Sloam (3) Û ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Î¿Ï˘Ù·Ó ÂÚ›Ô‰Ô 13 ¯ÚfiÓˆÓ (1980-92) ·Ú·Ù‹ÚËÛ·Ó ÂÈıËÏȷο ÎÔÎÎÈÒÌ·Ù· ÛÙÔ 4%. EÚfiÎÂÈÙÔ ‰ËÏ·‰‹ ÁÈ· ÂÚÈÙÒÛÂȘ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ Ë·Ù›Ùȉ·˜ (KH) Ô˘ ‚Ú¤ıËÎ·Ó ˆ˜ ‰Â˘ÙÂÚÔ·ı›˜ ÂΉËÏÒÛÂȘ οÔÈ·˜ ·ıÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÌÂ Û˘¯ÓfiÙÂÚË ÙËÓ ÚˆÙÔ·ı‹ ¯ÔÏÈ΋ ΛÚÚˆÛË (55%) Î·È ÙË Û·ÚÎÔ›‰ˆÛË (19%). ÕÏϘ ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ·Èٛ˜ ‹Ù·Ó Ë Ê˘Ì·Ù›ˆÛË, Ë ÓfiÛÔ˜ ÙÔ˘ Crohn, Ë ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ Ë·Ù›Ùȉ·, Ë ˘ÂÚ¢·ÈÛıËÛ›· Û ʿÚ̷η Î·È Ë Â͈Ë·ÙÈ΋ ·fiÊÚ·ÍË ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ. ™Â 11 ·ÛıÂÓ›˜ (ÔÛÔÛÙfi 75%) Ë KH ıˆڋıËΠȉÈÔ·ı‹˜. ™ÙÔÓ ›Ó·Î· 1 Ê·›ÓÔÓÙ·È Ù· ·ıÔÁÂÓÂÙÈο ·›ÙÈ· Ù˘ KH Û ¿ÏÏË ÌÂϤÙË.

¶›Ó·Î·˜ 1. A›ÙÈ· ÚfiÎÏËÛ˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ηٿ ÛÂÈÚ¿ Êı›ÓÔ˘Û·˜ Û˘¯ÓfiÙËÙ·˜. ™·ÚÎÔ›‰ˆÛË º˘Ì·Ù›ˆÛË §ÔÈÌÒÍÂȘ (ÌÈÎÚԂȷΤ˜, ÈÔÁÂÓ›˜, Ì˘ÎËÙÈ·ÛÈΤ˜, ÚÈÎÂÙÛÈÒÛÂȘ) XÚfiÓȘ Ë·ÙÔ¿ıÂȘ Î·È ÈÔÁÂÓ›˜ Ë·Ù›Ùȉ˜ (ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË, Ë·Ù›Ùȉ· A Î·È C) º¿Ú̷η IÛÙÔÏ¿Û̈ÛË •¤Ó˜ ÚÔ˜ ÙÔÓ ÔÚÁ·ÓÈÛÌfi Ô˘Û›Â˜ (¯·ÏÎfi˜, ‚ËÚ‡ÏÏÈÔ, Ù·ÏÎ Î·È ¿ÏÏ· ̤ٷÏÏ·) Vial Î·È Descotes 1993, ÙÚÔÔ. (4).

™Â ·Ó¿ÏÔÁË ¤Ú¢ӷ ·fi ÙË BfiÚÂÈÔ IÙ·Ï›· (5) Û 1523 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û 5 ¯ÚfiÓÈ·, ÎÔÎÎÈÒÌ·Ù· ‚Ú¤ıËÎ·Ó ÛÙÔ 1%, ‰ËÏ·‰‹ Û 15 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 43-71 ¯ÚfiÓˆÓ (̤ÛË ËÏÈΛ· 57 ¯ÚfiÓÈ·). T· Â˘Ú‹Ì·Ù· ·Ô‰fiıËÎ·Ó Î˘Ú›ˆ˜ Û ÏÔÈÌÒ‰ÂȘ ÓfiÛÔ˘˜. ¢È·¯ÚÔÓÈο, ÔÏÏÔ› Û˘ÁÁÚ·Ê›˜ ‰È·›ÛÙˆÛ·Ó ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÏÔÈÌÒ‰Ë ‹ ÌË ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ‹ ÛÂ

B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16

‰È¿ÊÔÚ˜ ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ fiˆ˜, Û¯ÈÛÙÔۈ̛·ÛË, ÓfiÛÔ˜ ÙÔ˘ Hodgkin, ·ÎÙÈÓÔ‚ÔÏ›·, ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË, ¯ËÌÂÈÔıÂÚ·›· Î·È Ê¿Ú̷η. ÕÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ Û˘Ó‰ÂfiÙ·Ó Ì ÙËÓ ·Ó‡ÚÂÛË ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú ‹Ù·Ó: fiÁÎÔÈ ÂÓÙÔÈṲ̂ÓÔÈ ÛÙËÓ ÎÔÈÏȷ΋ ¯ÒÚ·, fiˆ˜ ηÚΛӈ̷ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Î·È ÌË Hodgkin ϤÌʈ̷ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. TÔ 1991, ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ›‰ÈÔ˘ ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ Û ˘ÏÈÎfi ·fi ÙË Mayo Clinic ÁÈ· Ì›· ÂÚ›Ô‰Ô 13 ¯ÚfiÓˆÓ, ·ÔÎ¿Ï˘„ 88 ÂÚÈÙÒÛÂȘ ÎÔÎÎÈˆÌ¿ÙˆÓ (6). ™ÙÔ ˘ÏÈÎfi ·˘Ùfi Ë È‰ÈÔ·ı‹˜ KH ·ÔÙÂÏÔ‡Û ÙÔ 50% Î·È ·fi Ù· ˘fiÏÔÈ· ·›ÙÈ·, ÙÔ 22% Ë Û·ÚÎÔ›‰ˆÛË Î·È 6% Ù· Ê¿Ú̷η. TÔ 28% ÔÊÂÈÏfiÙ·Ó Û ¿ÏÏ· ·›ÙÈ·.

H KH ˆ˜ ÈÛÙÔÏÔÁÈÎfi ‡ÚËÌ· ·Ú·ÙËÚÂ›Ù·È Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÌÂÏÈÙ·›Ô˜, Î·È Ï¤Ú· (7). Afi ¿Ô„Ë Û˘¯ÓfiÙËÙ·˜, ÛÙȘ ·ÏÈfiÙÂÚ˜ ÂÚÁ·Û›Â˜ Ë ‰Â˘ÙÂÚÔ·ı‹˜ ·fi Ê¿Ú̷η KH ·Ó·ÊÂÚfiÙ·Ó fiÙÈ ·Ó¤Ú¯ÂÙ·È Û 1-2% (8), ÂÓÒ Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ÂÚÁ·Û›Â˜, ÙÔ ÔÛÔÛÙfi ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·ÓÂÚ¯fiÌÂÓÔ Û 6-29% (6).

Afi Ù· ·ÓˆÙ¤Úˆ Â›Ó·È ÚÔÊ·Ó¤˜, fiÙÈ Û˘¯ÓfiÙÂÚË Â›Ó·È Ë ‰Â˘ÙÂÚÔ·ı‹˜ KH ·Ú·ÙËÚÔ‡ÌÂÓË Î˘Ú›ˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÏÔÈÌÒ‰Ë ‹ ÌË ·›ÙÈ·. TÔ Ï›ÛÙÔ ÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ó·ÊÔÚÒÓ ÛÙËÓ KH ·ÊÔÚÔ‡Ó Û ÂÓ‹ÏÈΘ. TÂÏÂ˘Ù·›·, Û fiÏÔ Î·È ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ‰Â˘ÙÂÚÔ·ı›˜ Û ÏÔÈÌÒÍÂȘ ÂÚÈÙÒÛÂȘ, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿. ¶ÚÔÊ·Ó¤˜ Â›Ó·È fiÙÈ Ë KH Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌfiÏȘ ÙÒÚ· ·Ú¯›˙ÂÈ Ó· ·ÔηχÙÂÙ·È.

AÈÙÈÔÏÔÁ›· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÔÎÎȈ̿وÛ˘ ÙÔ˘ ‹·ÙÔ˜ ¶ÔÏÏ¿ Î·È ÔÈΛϷ Â›Ó·È Ù· ·›ÙÈ· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH. H Ï›ÛÙ· ÙˆÓ ·ÈÙ›ˆÓ ·˘Í¿ÓÂÈ Û˘Ó¯Ҙ Ì ÙËÓ ÚÔÛı‹ÎË ·Û˘Ó‹ıˆÓ ·fi ¿Ô„Ë ·ÈÙÈÔÏÔÁ›·˜ ÂÚÈÙÒÛˆÓ. ·) §ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ¶ÔÏÏ¿ Â›Ó·È Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÛÙ· ÔÔ›· ·Ú·ÙËÚ‹ıËÎ·Ó ÎÔÎÎÈÒÌ·Ù· ÛÙÔ ‹·Ú. OÈ ÂÚÈÙÒÛÂȘ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È, fiÛÔ Ë KH Á›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÁÓˆÛÙ‹. O ›Ó·Î·˜ ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË KH ÚԂϤÂÙ·È fiÙÈ ı· ÏÔ˘Ù›˙ÂÙ·È ÛÙ· ÂfiÌÂÓ· ¯ÚfiÓÈ·. ¶ÂÚÈÛÙ·Ûȷο ÂÚÈÁÚ¿ÊÙËÎ·Ó Î·È ¿ÏÏ· ÓÔÛ‹Ì·Ù· ÛÙ· ÔÔ›· ‰È·ÈÛÙÒıËΠKH Û ‚ÈÔ„›Â˜, fiˆ˜ Ë ·ÌÔÈ‚¿‰ˆÛË (9), Ë ÔÔ›· ÛÙÔ ‹·Ú ‰ËÌÈÔ˘ÚÁ› ΢ڛˆ˜ ·ÔÛÙ‹Ì·Ù·, Ë ‚ÚԢΤÏψÛË (10), Ô Ù˘ÊÔÂȉ‹˜ ˘ÚÂÙfi˜ (11) Î·È Ë ÛÏ·¯ÓÈ΋ ÏÂ˚ÛÌ·Ó›·ÛË (12). KÔÎÎȈ̷ÙÒ‰ÂȘ ‚Ï¿‚˜ ÛÙÔ ‹·Ú ·Ó·Ê¤ÚıËÎ·Ó Â›Û˘ Û Ïԛ̈ÍË ·fi EB (13), Î·È CMV (14,15), fiˆ˜ Î·È Û ÁÂÓÈÎÂ˘Ì¤ÓË ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ïԛ̈ÍË (16). TÔ ÂӉȷʤÚÔÓ ÛÙȘ ÂÚÈÙÒÛÂȘ CMV Â›Ó·È fiÙÈ Ù· Ù˘Èο Û˘ÌÙÒÌ·Ù·

10

¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘

Ù˘ ÓfiÛÔ˘ ·Ú·ÙËÚ‹ıËÎ·Ó 3 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú. KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ÓfiÛËÛË ·fi Ë·Ù›Ùȉ· A Î·È ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C. º˘Ì·Ù›ˆÛË Î·È ‰È·ÛÔÚ¿ BCG: H ‰È·ÛÔÚ¿ ÙÔ˘ ‚·Î›ÏÔ˘ Calmette-Guerin (BCG) Ì ÚfiÎÏËÛË KH ‹ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘ Â›Ó·È ÁÓˆÛÙ‹ Î·È ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ Û ·È‰È¿ Ì ·ÓÔÛÔÏÔÁÈ΋ ÌÂÈÔÓÂÎÙÈÎfiÙËÙ·, ÌÂÙ¿ ·fi ÂÓ‰Ô‰ÂÚÌÈ΋ ¤Á¯˘ÛË ÚÔÎÂÈ̤ÓÔ˘ ÂÚ› ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·ÏÏ¿ Î·È Û ÂÓ‹ÏÈΘ fiÔ˘ ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ¿ ·fi ÂÓ‰Ô΢ÛÙÈ΋ ¤Á¯˘ÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÂÈ ÌË ÂȉÈ΋ ·ÁˆÁ‹, ΢ڛˆ˜ ηٿ ÙÔ˘ ÂÈÔÏ‹˜ ηÚΛÓÔ˘ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ (17). H ‰È·ÛÔÚ¿ ÚÔηÏÂ›Ù·È ÏfiÁˆ οΈÛ˘ Ù˘ Ô˘Ú‹ıÚ·˜ ‹ ·ÎfiÌ· Î·È ·Ô˘Û›· οΈÛ˘. ™ÙÔ Ï›ÛÙÔ ÙˆÓ ·ÛıÂÓÒÓ, Ë ‰È·ÛÔÚ¿ ·ÎÔÏÔ˘ı› Ù· Ê·ÈÓfiÌÂÓ· ÙÔÍÈÎfiÙËÙ·˜ Î·È ˘„ËÏÔ‡ ˘ÚÂÙÔ‡ Ô˘ ÂΉËÏÒıËÎ·Ó Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÓ‰Ô΢ÛÙÈΤ˜ ÂÁ¯‡ÛÂȘ BCG (18). ¶ÂÚ›ÙˆÛË ‰È·ÛÔÚ¿˜ ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ "mycobacterium scrofulatum" ·Ó·Ê¤ÚıËΠ۠¿ÙÔÌ· Ì AIDS ‹ Ì ¿ÏÏË ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Â ÂÓ‹ÏÈη ·ÛıÂÓ‹ ÂÌÊ·Ó›ÛÙËÎ·Ó ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ίÚÔÂȉԇ˜ Ê˘Ì·Ù›ˆÛ˘, ÏÂÌÊ·‰ÂÓ›Ùȉ·, ˘Ô‰fiÚÈ· ·ÔÛÙ‹Ì·Ù· Î·È KH (19).

Afi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ ¤¯ÂÈ ·Ó·ÊÂÚı› Û˘Ó‰˘·ÛÌfi˜ ˘ÚÈÙ›·Û˘ (silicosis), ίÚÔÂȉԇ˜ Ê˘Ì·Ù›ˆÛ˘ Î·È KH (20). TÂÏÂ˘Ù·›· (21) ·ÈÙÈÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÙÔ˘ ‹·ÙÔ˜ ¤‰ÂÈÍ fiÙÈ, Û˘ÁÎÚÈÙÈο Ì ÙÔ ·ÚÂÏıfiÓ, ÔÈ ÂÚÈÙÒÛÂȘ KH fiˆ˜ Î·È ÔÈ ÂÚÈÙÒÛÂȘ Ê˘Ì·Ù›ˆÛ˘ ÙÔ˘ ‹·ÙÔ˜ ·˘Í‹ıËÎ·Ó ÛÙÔ˘˜ HIV ıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜.

NfiÛÔ˜ ·fi ·Ì˘¯¤˜ Á¿Ù·˜: EÎÙfi˜ ·fi ÙȘ Ù˘ÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Û 5% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ¿Ù˘˜ ÂΉËÏÒÛÂȘ ÛÙȘ Ôԛ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÂÁÎÂÊ·Ï›Ùȉ·, ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ Parinaud Î·È Ë KH. OÈ ÂÚÈÙÒÛÂȘ KH ·Ó·Ê¤ÚÔÓÙ·È Û ·È‰È¿ Ì ·‰ÂÓ›Ùȉ·, ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÔÏÏ·Ï¿ ÎÔÎÎÈÒÌ·Ù· ÛÙÔ ‹·Ú Î·È ÙÔ ÛÏ‹Ó·. ™Â 28 ·È‰È¿ Ì ÓfiÛÔ ·fi ·Ì˘¯¤˜ Á¿Ù·˜ Ô˘ ÓÔÛËχÙËÎ·Ó ÂÓ ÛÂÈÚ¿ ÛÙË B' ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, KH ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 15,4%. H ÓfiÛÔ˜ ·fi ·Ì˘¯¤˜ Á¿Ù·˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜, ÌÂÙ¿ ÙËÓ ÔÍ›· ÓfiÛËÛË ·fi ˘ÚÂÙfi Q ·Èٛ˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ·fi Ïԛ̈ÍË. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È 40 Î·È ϤÔÓ ÂÚÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ Ì ·Ó¿Ù˘ÍË ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú (22).

OÍ›· ÓfiÛËÛË ·fi ˘ÚÂÙfi Q: H ÓfiÛÔ˜ Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÂÏ·ÊÚ¤˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ‹·ÙÔ˜, ·ÏÏ¿ KH ··ÓÙ¿Ù·È Û·ÓÈfiÙÂÚ·. H KH, ˆ˜ ÌÔÓ·‰È΋ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Û¿ÓÈ· ·Ó Î·È ·Ú·ÙËÚÔ‡ÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û˘¯ÓfiÙËÙ·˜ ·fi ¯ÒÚ· Û ¯ÒÚ·. ™ÙË °·ÏÏ›· .¯. ÙÔ 61,9% ÙˆÓ ÔͤˆÓ ÂÚÈÙÒÛÂˆÓ ˘ÚÂÙÔ‡ Q ·ÚÔ˘-

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·11

¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16

ÛÈ¿˙Ô˘Ó Ë·Ù›Ùȉ·, ÂÓÒ ÛÙÔÓ K·Ó·‰¿ ·ÔÎÏÂÈÛÙÈ΋ ۯ‰fiÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë Ó¢ÌÔÓ›· (23,24). ¶ÂÚÈÁÚ¿ÊËΠÂÚ›ÙˆÛË ÔÍ›·˜ ÓfiÛËÛ˘ ·fi coxciella burnetti Ë ÔÔ›· ÂΉËÏÒıËΠˆ˜ KH. ™˘Ó‰˘·ÛÌfi˜ ˘ÚÂÙÔ‡ Q, Ô˙Ò‰Ô˘˜ ÂÚ˘ı‹Ì·ÙÔ˜ Î·È KH Û ¿ÙÔÌÔ Ì ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÂÚÈÁÚ¿ÊÙËΠ·fi ¿ÏÏÔ˘˜ (25). ™¯ÈÛÙÔۈ̛·ÛË: ™ÙË ™·Ô˘‰È΋ AÚ·‚›· Ë Û¯ÈÛÙÔۈ̛·ÛË Â›Ó·È Û˘¯Ó‹ ÓfiÛÔ˜. ™Â 404 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËηÓ, KH ‚Ú¤ıËΠ۠ÔÛÔÛÙfi 14,6%. H ·ÈÙÈÔÏÔÁÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù· ÎÔÎÎÈÒÌ·Ù· ÔÊÂÈÏfiÙ·Ó ÛÙË ÓfiÛÔ 54,2%) (11). ‚) MË ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ¶ÚfiÎÂÈÙ·È Î˘Ú›ˆ˜ ÁÈ· ÓÔÛ‹Ì·Ù· ÙÔ˘ ÏÂÌÊÔÔÈËÙÈÎÔ‡ ÈÛÙÔ‡, ηÎÔ‹ıÂȘ Î·È ÓÔÛ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡. ™·ÚÎÔ›‰ˆÛË: E›Ó·È ‰˘Ó·ÙfiÓ, ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ Ù˘ÈÎÒÓ Î·È ¿Ù˘ˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ÓfiÛÔ˘ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Î·È ‚Ï¿‚˜ KH. °ÂÓÈο, Ë Û·ÚÎÔ›‰ˆÛË Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓË ÎÔÎÎȈ̷Ù҉˘ ÓfiÛÔ˜ Ô˘ Û˘ÓËı¤ÛÙÂÚ· ÚÔÛ‚¿ÏÏÂÈ ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Î·È ÙÔ˘˜ ·‰¤Ó˜ ÙÔ˘ ÌÂÛÔÓ¢ÌfiÓÈÔ˘. H ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ÛÏ‹Ó· Â›Ó·È Û˘Ó‹ı˘ ·Ó Î·È ·Ô‰ÂÈÎÓ‡ÂÙ·È ÌfiÓÔ ·fi ÙȘ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜. H ‚ÈÔ„›· ÙÔ˘ ÛÏ‹Ó· Ì ‚ÂÏfiÓ· Û ·ÛıÂÓ›˜ Ì ۷ÚÎÔ›‰ˆÛË ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ Û ÔÛÔÛÙfi 24-29% Î·È ÛÙÔ ‹·Ú Û ÔÛÔÛÙfi 24-79%, ÂÓÒ Ë ‰ÈÂÚ‡ÓËÛË Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·ÔηχÙÂÈ ÎÔÎÎȈ̷ÙÒ‰ÂȘ ‚Ï¿‚˜ Û ÔÛÔÛÙfi ÌfiÓÔ 5-15%. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ACE (angiotensin converting enzyme) ‚ÔËı¿ ÛÙËÓ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË (26), ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó Ó¢ÌÔÓÈΤ˜ ‚Ï¿‚˜. ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜: H KH, ˆ˜ Û¿ÓÈ· ·ÈÙ›· ‰È·Ù·Ú·¯‹˜ Ù˘ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ¤¯ÂÈ ·Ó·ÊÂÚı› ÙfiÛÔ ÛÙÔÓ ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (27) fiÛÔ Î·È ÛÙË ÓfiÛÔ Crohn (28). Á) º¿Ú̷η ‹ ̤ٷÏÏ· H ÎÈÓȉ›ÓË, Ë ·ÏÏÔÔ˘ÚÈÓfiÏË Î·È Ë Î·Ú‚·Ì·˙Â›ÓË Î·È Ôχ Û·ÓÈfiÙÂÚ· Ù· ·ÓÙÈ‚ÈÔÙÈο Â›Ó·È Ê¿Ú̷η Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH. °ÂÓÈÎfiÙÂÚ·, ÔÏÏ¿ Î·È ÔÈΛϷ Â›Ó·È Ù· Ê¿Ú̷η Ô˘ ηÙËÁÔÚ‹ıËÎ·Ó fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÈÏÔ΋ ·˘Ù‹. ¶Ï‹Ú˘ ηٿÏÔÁÔ˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ Vial Î·È Descombe (4) ÁÈ· ‰Â Ù· ·ÓÙÈ‚ÈÔÙÈο ÛÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ Georges Î·È Grawford (29).

KÈÓ›ÓË-KÈÓȉ›ÓË: E›Ó·È ·ÓıÂÏÔÓÔÛȷο Ê¿Ú̷η Ô˘ ηÙËÁÔÚ‹ıËÎ·Ó fiÙÈ ÚÔηÏÔ‡Ó KH. H ·ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú Â›Ó·È Û˘¯Ófi ‡ÚËÌ· ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ Î·È ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 70% ÙˆÓ

KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ·

·ÛıÂÓÒÓ (30). H ÂÈÏÔ΋ ·Ú·ÙËÚÂ›Ù·È Ì fiÏ· Ù· ¿Ï·Ù· Ù˘ ÎÈÓȉ›Ó˘, ÂÓÒ Â›Ó·È Ôχ Û·ÓÈfiÙÂÚË Û ϋ„Ë ÎÈÓ›Ó˘ (31). KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ϋ„Ë Û˘Ó‰˘·ÛÌÔ‡ ˘ÚÈÌÂı·Ì›Ó˘-¯ÏˆÚÔΛÓ˘ (32).

AÏÏÔÔ˘ÚÈÓfiÏË: KH ÂÚÈÁÚ¿ÊÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ 50% ÙˆÓ ·ÙfiÌˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙÔ Ê¿ÚÌ·ÎÔ (33). T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Â›Ó·È ·˘Ù¿ Ù˘ ¯ÔÏfiÛÙ·Û˘ ‹ Â˘Ú‹Ì·Ù· ÌÈÎÙÔ‡ Ù‡Ô˘. H ÔÚ›· Â›Ó·È Î·ÏÔ‹ı˘ ·Ú¿ ÙÔ fiÙÈ ¤¯ÂÈ ·Ó·ÊÂÚı› Û˘Ó‡·ÚÍË ˘¤ÚÙ·Û˘ Ù˘ ˘Ï·›·˜ Ì ·Ó¿Ù˘ÍË ·ÛΛÙË.

K·Ú‚·Ì·˙Â›ÓË: EÌÊ¿ÓÈÛË KH ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÙ· ËÏÈÎȈ̤ӷ ¿ÙÔÌ· AÓ¢ڛÛÎÂÙ·È Û >75% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙÔ Ê¿ÚÌ·ÎÔ (34).

AÓÙÈ‚ÈÔÙÈο: OÈ Ë·ÙÔÙÔÍÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Ôχ Û¿ÓȘ ÌÂ Û˘¯ÓfiÙËÙ· ˘ÔÏÔÁÈ˙fiÌÂÓË Û 5 Ì 10/100.000 Ï‹„ÂȘ ÁÈ· ÙÔ Ï›ÛÙÔ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ.

AÓ Î·È Û˘Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ¯·Ú·ÎÙËÚÈÛÙÈ΋ ·ÓˆÌ·Ï›·, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ‰˘Ó·ÙfiÓ ÙÔ ›‰ÈÔ Ê¿ÚÌ·ÎÔ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÏÏÒÓ ÂȉÒÓ ·ÚÂÓ¤ÚÁÂȘ ·fi ÙÔ ‹·Ú fiˆ˜ ÔÍ›· Ë·Ù›Ùȉ·, KH ‹ ¯ÚfiÓÈ· ÂÓÂÚÁfi Ë·Ù›Ùȉ·. ÕÏÏ· Ê¿Ú̷η: AӷʤÚıËÎ·Ó ÂÚÈÛÙ·Ûȷο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÚÔη˚Ó·Ì›‰Ë, fiÔ˘ Ù· Û˘ÌÙÒÌ·Ù· ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÁÚ‹ÁÔÚ· (Û ̛· Ë̤ڷ) ‹ ·ÚÁ¿ (ÌÂÙ¿ ·fi 6 ‚‰ÔÌ¿‰Â˜ ¯ÔÚ‹ÁËÛ˘), Ë ÙÈÎÏÔȉ›ÓË (35) Î·È Ë 2', 3' dideoxyinosine (ddl), Ë ¯ÔÚ‹ÁËÛË Ù˘ ÔÔ›·˜ Û ·È‰È¿ Ô˘ ¤·Û¯·Ó ·fi AIDS ›¯Â ˆ˜ ·ÚÂÓ¤ÚÁÂÈ· ÙËÓ ÂÌÊ¿ÓÈÛË KH Û ÔÛÔÛÙfi 17,6% (36). TÔ Ê¿ÚÌ·ÎÔ glyburine ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË KH, fiˆ˜ Î·È Ë ·Ú·ÎÂÙ·ÌfiÏË. ŒÚ¢ӷ ÛÙË ™Ô˘Ë‰›· ·ÔÎ¿Ï˘„ fiÙÈ Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›· ηٷÁÚ¿ÊËΠ̛· ÂÚ›ÙˆÛË KH Ô˘ ÔÊÂÈÏfiÙ·Ó ÛÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (37). AÓ¿Ù˘ÍË KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Ì ÙË Ï‹„Ë Û˘Ó‰˘·ÛÌÔ‡ ·ÛÈÚ›Ó˘-Έ‰Â˝Ó˘ Ô˘ ·Ô‰fiıËΠ۠·Ú·ÙÂٷ̤ÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓˆÙ¤Úˆ ‰‡Ô Ê·ÚÌ¿ÎˆÓ (38).

XÚfiÓÈ· ‚˘ÚÈÏÏ›ˆÛË: ¶ÚfiÎÂÈÙ·È ÁÈ· ‰Â˘ÙÂÚÔ·ı‹ ÎÔÎÎȈ̿وÛË ÙÔ˘ Ó‡ÌÔÓ· Ô˘ ÂÚÈÁÚ¿ÊÙËΠÙÔ 1946. ™Â ¯ÚfiÓÈ· ¤ÎıÂÛË ÚÔÛ‚¿ÏÏÂÙ·È Î·È ÙÔ ‹·Ú.

T· Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Â›Ó·È ˘ÚÂÙfi˜, ‚‹¯·˜, ·ÓÔÚÂÍ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. T· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ· Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ. H ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ÎÔÎÎÈÒÌ·ÙÔ˜ Î·È ÙËÓ ¤Ó‰ÂÈÍË fiÙÈ ·˘Ùfi ÚÔÎÏ‹ıËΠ·fi ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ ÙÔ˘ ‹·ÙÔ˜ ·¤Ó·ÓÙÈ ÛÙÔ Ì¤Ù·ÏÏÔ ‚˘Ú›ÏÏÈÔ.

KÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ KH, ·ÊÔ‡ ÛÙÔ ÈÛÙÔÚÈÎfi Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ΢ÚÈ·Ú¯Ô‡Ó Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ù˘ ÚˆÙÔ·ıÔ‡˜ ÓfiÛÔ˘, ÛÙ·

11

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·12

¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16

ÔÔ›· ÚÔÛÙ›ıÂÓÙ·È Ù· Â˘Ú‹Ì·Ù· Ù˘ ÎÔÎÎȈ̿وÛ˘.

E›Û˘ ‰È·Ê¤ÚÂÈ Ë ÔÚ›· Î·È Ë ÚfiÁÓˆÛË. ·) ¢Â˘ÙÂÚÔ·ı‹˜ KH E›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÛÙË ‰Â˘ÙÂÚÔ·ı‹ KH ÙfiÛÔ Ë Û˘Ìو̷ÙÔÏÔÁ›·, fiÛÔ Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· Ì ÙËÓ ˘ÔΛÌÂÓË ÚˆÙÔ·ı‹ ·ÈÙ›· Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ÏÔÈÌ҉˜ ·›ÙÈÔ, Û·ÓÈfiÙÂÚ· Ë Ï‹„Ë Ê·ÚÌ¿ÎÔ˘ Î·È Û Û¿ÓȘ ÂÚÈÙÒÛÂȘ ̤ٷÏÏ· ‹ ¿ÏϘ Ô˘Û›Â˜.

H ‰Â˘ÙÂÚÔ·ı‹˜ KH ‰˘Ó·ÙfiÓ Ó· ·Ú·Ì¤ÓÂÈ ·Ê·Ó‹˜ ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ÂΉËÏÒÛÂˆÓ Ù˘ ΢ڛ·˜ ÓfiÛÔ˘ ‹ Ó· ÂΉËÏÒÓÂÙ·È Ì Âȉ›ӈÛË ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Ë ·ÓÙ›‰Ú·ÛË ·›ÚÓÂÈ ÛÔ‚·Ú‹ ÙÚÔ‹ Ì ÂΉ‹ÏˆÛË ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘, fiˆ˜ ·Ú·ÙËÚ‹ıËΠ̠ÔÚÈṲ̂ӷ Ê¿Ú̷η (30,39,40) Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙÔ ı¿Ó·ÙÔ. ¶ÚfiÎÂÈÙ·È ÁÈ· ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘, ÂÓ›ÔÙÂ Û˘Ó‰˘·˙fiÌÂÓ˘ Ì ·ÁÁÂÈ˝Ùȉ· (41). ™˘¯ÓfiÙÂÚË Â›Ó·È Ë Ù˘¯·›· ·ÔÎ¿Ï˘„Ë ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÎÔÎÎȈ̿وÓ, ·ÊÔ‡ ÛÙÔ 25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ‹·ÙÔ˜ ·Ú·Ì¤ÓÂÈ ·Û˘Ìو̷ÙÈ΋ Ì ÌfiÓË ÂΉ‹ÏˆÛË ÙËÓ ÂÏ·ÊÚ¿ ‰È·Ù·Ú·¯‹ ÙˆÓ Ë·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ. ™ÙÔÓ Ô͇ Ù‡Ô Ù˘ Û˘Ìو̷ÙÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÓÙ›‰Ú·Û˘, Ë KH ·Ú·ÙËÚÂ›Ù·È 2-4 ‚‰ÔÌ¿‰Â˜ ̤¯ÚÈ 4 Ì‹Ó˜ ·fi ÙËÓ ·Ú¯‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

T· Û˘ÌÙÒÌ·Ù· ‰ÂÓ Â›Ó·È ÂȉÈο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¿ÓÔ‰Ô ÙÔ˘ ˘ÚÂÙÔ‡, ηÎԉȷıÂÛ›·, Ú›ÁË, ·ÓÔÚÂÍ›· Î·È ÎÔÈÏȷο ¿ÏÁË. H ÂÌÊ¿ÓÈÛË ›ÎÙÂÚÔ˘ Â›Ó·È ÂÚÈÛÙ·Ûȷ΋ Î·È Û˘¯Ó¿ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡. ™ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Û˘¯Ó¿ ·Ó¢ڛÛÎÂÙ·È Ì¤ÙÚÈ· Ë·ÙÔÌÂÁ·Ï›· ‹/ Î·È ÛÏËÓÔÌÂÁ·Ï›·. T· Â˘Ú‹Ì·Ù· ‰ÂÓ ÚÔ‰Èο˙Ô˘Ó ÙË Ê‡ÛË Ù˘ ˘ÔΛÌÂÓ˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘. O Ù‡Ô˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Â›Ó·È Û˘¯ÓfiÙÂÚ· ˘¤Ú Ù˘ ¯ÔÏÔÛÙ·ÙÈ΋˜ ‚Ï¿‚˘ Ì ¿ÓÔ‰Ô Ù˘ ÁGT Î·È Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘.

EÓ›ÔÙÂ, ÚÔËÁÔ‡ÓÙ·È ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÛËÌ›· ˘ÂÚ¢·ÈÛıËÛ›·˜, fiˆ˜ ÂÍ¿ÓıËÌ·, ˘ÚÂÙfi˜, ·ÚıÚ·ÏÁ›Â˜, ˈÛÈÓÔÊÈÏ›·, ȉȷ›ÙÂÚ· Û ¯ÔÚ‹ÁËÛË ÛÔ˘ÏÊÔÓ·ÌȉÒÓ, ηڂ·Ì·˙Â›Ó˘, ·ÏÏÔÔ˘ÚÈÓfiÏ˘ Î·È ÎÈÓ›Ó˘. AÔÊÔÏȉˆÙÈ΋ ‰ÂÚÌ·Ù›Ùȉ·, ·ÁÁÂÈ˝Ùȉ·, ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· ‹ Ï¢ÎÔÂÓ›· Â›Ó·È ‰˘Ó·Ùfi Ó· Û˘ÓÔ‰Â‡Ô˘Ó ÙȘ Ë·ÙÈΤ˜ ‚Ï¿‚˜ (30,39,40,42). H ‰È·ÎÔ‹ Ï‹„˘ ÙÔ˘ ˘‡ı˘ÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ·ÎÔÏÔ˘ıÂ›Ù·È ÂÓÙfi˜ 10Ë̤ÚÔ˘ ·fi ‡ÊÂÛË ÙˆÓ Û˘Ìو̿وÓ. T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ˘Ô¯ˆÚÔ‡Ó ·ÚÁfiÙÂÚ·, Û ‰È¿ÛÙËÌ· ÌÂÚÈÎÒÓ Â‚‰ÔÌ¿‰ˆÓ ̤¯ÚÈ Î·È 1 ¤ÙÔ˜. ‚) ¶ÚˆÙÔ·ı‹˜ (ȉÈÔ·ı‹˜) KH ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· Ë·Ù›Ùȉ· Ô˘ ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔ-

12

¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘

Á›·˜. Afi ¿Ô„Ë Û˘¯ÓfiÙËÙ·˜, ÙÔ ÔÛÔÛÙfi Ù˘ ȉÈÔ·ıÔ‡˜ Î˘Ì·›ÓÂÙ·È Û ¢ڤ· Ï·›ÛÈ· ·Ó¿ÏÔÁ· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È Ù˘ ÁˆÁÚ·ÊÈ΋˜ ÂÚÈÔ¯‹˜. OÈ Mir Madjlessi Î·È Û˘Ó.(43) ·Ó·Ê¤ÚÔ˘Ó ÔÛÔÛÙfi ȉÈÔ·ıÔ‡˜ KH ·ÓÂÚ¯fiÌÂÓÔ Û 36%, ÔÈ Bunnim Î·È Û˘Ó.(44) ÌfiÓÔ 3% Î·È ÔÈ Sartin Î·È Û˘Ó. (6) Û 50%, ÂÓÒ Ù¤ÏÔ˜ ÔÈ Mc Luggage Î·È Û˘Ó.(3) Û ÔÛÔÛÙfi 7,6%.

H ¿ıËÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ˘ÚÂÙfi Î·È ·fi ÙËÓ ·Ó‡ÚÂÛË Ù˘ÈÎÒÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙËÓ ‚ÈÔ„›· ‹·ÙÔ˜. ¶ÚÔÛ¿ıÂȘ Ô˘ ¤ÁÈÓ·Ó ÁÈ· ·ÔÛ·Ê‹ÓÈÛË Ù˘ ·ÎÚÈ‚Ô‡˜ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘, ‰ÂÓ Î·Ù¤ÏËÍ·Ó Û ۷ʋ Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·Ó¢ڛÛÎÂÙ·È ÌÈÎÚÔ‡ ‚·ıÌÔ‡ Ë·ÙÔÌÂÁ·Ï›· ‹/ Î·È ÛÏËÓÔÌÂÁ·Ï›·, ÂÓÒ Ë ÂͤٷÛË ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ·Ô‚·›ÓÂÈ ·ÚÓËÙÈ΋. ÕÏÏ· Û˘ÌÙÒÌ·Ù· Ù˘ ȉÈÔ·ıÔ‡˜ KH Â›Ó·È Ë Î·ÎԉȷıÂÛ›·, Ë ·ÓÔÚÂÍ›·, Ë ÎfiˆÛË, Ô fiÓÔ˜ ÛÙËÓ ·ÓÒÙÂÚË ‰ÂÍÈ¿ ÎÔÈÏȷ΋ ¯ÒÚ·, ÛÂ Û˘Ó‰˘·ÛÌfi ‹ fi¯È Ì Ë·ÙÔÌÂÁ·Ï›·, ÂÓÒ Ó·˘Ù›·, ¤ÌÂÙÔ˜ ‹ ‰È¿ÚÚÔÈ· ·Ú·ÙËÚÔ‡ÓÙ·È Û·ÓÈfiÙÂÚ·. ¶ÔÛÔÛÙfi 26% ÙˆÓ ·ÛıÂÓÒÓ ·Ú·Ì¤ÓÔ˘Ó ·Û˘Ìو̷ÙÈÎÔ›. ŒÙÛÈ ÛÙËÓ È‰ÈÔ·ı‹ KH Ë ‚·ÛÈ΋ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Â›Ó·È Ô ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜ ‰È¿ÚÎÂÈ·˜ > 3 Ì‹Ó˜ (7). OÈ Satrin Î·È Û˘Ó.(6) ·Ó·Ê¤ÚÔ˘Ó Ì¤ÛË ‰È¿ÚÎÂÈ· Û˘ÌÙˆÌ¿ÙˆÓ 19 Î·È ϤÔÓ Ì‹Ó˜. ™Â >50% ÙˆÓ ÂÚÈÙÒÛˆÓ, Ù· Ë·ÙÈο ¤Ó˙˘Ì· Â›Ó·È ·˘ÍË̤ӷ Î·È Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi Ë TKE. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È ÔÈ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ·Ú·Ì¤ÓÔ˘Ó ·ÚÓËÙÈΤ˜.

T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÚÔÛ·Ó·ÙÔÏ›˙Ô˘Ó ÚÔ˜ Ë·ÙÔ¯ÔÏÈ΋ ‰È·Ù·Ú·¯‹ Ì ·‡ÍËÛË Ù˘ Á-GT Î·È Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ‹ ÚÔ˜ ÌÈÎÙ‹ ‚Ï¿‚Ë Ì ·‡ÍËÛË Î·È ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ¯ˆÚ›˜ ˆÛÙfiÛÔ ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ó· Â›Ó·È ¤Î‰ËϘ. H ÂͤٷÛË Ô˘ ÚÔÛ·Ó·ÙÔÏ›˙ÂÈ ÂÚÈÛÛfiÙÂÚÔ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Ë·ÙÈ΋˜ ¯ÒÚ·˜ Ì ˘ÂÚ‹¯Ô˘˜ (45). AÓ¢ڛÛÎÔÓÙ·È ‰È¿Û·ÚÙ˜ ηÏÒ˜ ·ÊÔÚÈ˙fiÌÂÓ˜ ˘Ô˯ÔÁfiÓ˜ ÂÚÈÔ¯¤˜ ‰È·Ì¤ÙÚÔ˘ ÌÂÚÈÎÒÓ mm. AÓ¿ÏÔÁ· Â›Ó·È Ù· Â˘Ú‹Ì·Ù· Î·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (9,46). H ‚ÈÔ„›· ‹·ÙÔ˜ Â›Ó·È Ë ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ Ì ÙËÓ ÔÔ›· Ù›ıÂÙ·È Ë ÛÊÚ·Á›‰· Ù˘ ‰È¿ÁÓˆÛ˘ Ì ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡ ÂÈıËÏÈÔÂȉԇ˜ ÓÂÎÚˆÙÈÎÔ‡ ÎÔÎÎÈÒÌ·ÙÔ˜. °È· ÙÔÓ ÏfiÁÔ ·˘ÙfiÓ, Û˘ÓÈÛÙ¿Ù·È Û‹ÌÂÚ· Ë ‰ÈÂÓ¤ÚÁÂÈ· ‚ÈÔ„›·˜ ‹·ÙÔ˜ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ™Â 70 ·ÛıÂÓ›˜ Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‚ÈÔ„›· ‹·ÙÔ˜ KH, ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 42,8% (46). I‰ÈÔ·ı‹˜ KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ÌÔۯ‡̷ٷ ‹·ÙÔ˜ ÌÂÙ¿ ÂÓÙ·ÂÙ›· ·fi ÙËÓ ÂÈÙ˘¯‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË (47). OÈ Klatsin Î·È Û˘Ó.(48) Û 5500 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ ·Ú·Ù‹ÚËÛ·Ó 550

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·13

¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16

ÂÚÈÙÒÛÂȘ KH (ÔÛÔÛÙfi 10%). ™Â 17 ·fi ÙȘ ‚ÈÔ„›Â˜ (ÔÛÔÛÙfi 3,1%) ÂÚfiÎÂÈÙÔ ÁÈ· ¿ÙÔÌ· Ì ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë È‰ÈÔ·ı‹˜ KH Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ÓfiÛÔ˜ Ì ·ÚÈ· ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÙÔÓ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ¶¿ÓÙˆ˜, ·ÎfiÌ· Î·È Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ¿Ï˘Ù· ÚÔ‚Ï‹Ì·Ù·, ȉȷ›ÙÂÚ· ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, Î·È ÂÚ·ÈÙ¤Úˆ Û˘ÛÙËÌ·ÙÈ΋ ÚÔÔÙÈ΋ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ¤¯Ô˘Ì ÙÂÎÌËÚȈ̤ӷ ·ÔÙÂϤÛÌ·Ù·. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË AÓ Î·È Ë ‚ÈÔ„›· ‹·ÙÔ˜ ÂȂ‚·ÈÒÓÂÈ Î·Ù·Ú¯‹Ó ÙË ‰È¿ÁÓˆÛË Ù˘ KH, ‰ÂÓ ÚÔÛʤÚÂÈ ÔÏÏ¿ ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘, ·ÊÔ‡ Ë ›‰È· ÈÛÙÔÏÔÁÈ΋ ‚Ï¿‚Ë ‰˘Ó·ÙfiÓ Ó· ·ÓÙ·ÔÎÚ›ÓÂÙ·È Û ÏËıÒÚ· ·ÈÙ›ˆÓ. O ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘˜ ‚·Û›˙ÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, Ù· ·ÓÙÈÎÂÈÌÂÓÈο Â˘Ú‹Ì·Ù· Î·È ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. TÂÏÈο, Ë ‰È¿ÁÓˆÛË Ù˘ ȉÈÔ·ıÔ‡˜ KH Ù›ıÂÙ·È Ì ·ÔÎÏÂÈÛÌfi ÙˆÓ ‰È·ÊfiÚˆÓ ·ÈÙ›ˆÓ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Û˘ÓÈÛÙ¿Ù·È Ë ÂÌÂÈÚÈ΋ ·ÓÙÈ-TB ·ÁˆÁ‹ ÁÈ· ‰È·ÁÓˆÛÙÈ΋ ‚Ô‹ıÂÈ· (46). ¢È·ÁÓÒÛÂȘ Ô˘ ÂÚÈÛÙ·Ûȷο ·Ó·Ê¤ÚıËÎ·Ó Â›Ó·È Ë ÁÂÓÈÎÂ˘Ì¤ÓË ‚·ÎÙËÚȷ΋ ‹ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË Î·È Î˘Ú›ˆ˜ Ë Î¯ÚÔÂȉ‹˜ Ê˘Ì·Ù›ˆÛË Ì ÂÓÙfiÈÛË ÛÙÔ ‹·Ú. Œ¯Ô˘Ó Â›Û˘ ·Ó·ÊÂÚı› Ë Ó·ÓÈ΋ ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ·, Ë ÛÏ·¯ÓÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ·fi ·Ì˘¯¤˜ Á¿Ù·˜, Ô Ù˘ÊÔÂȉ‹˜ ˘ÚÂÙfi˜, Ë ¯ÚfiÓÈ· ÎÔÎÎȈ̷Ù҉˘ ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È ÔÈÎÈÏ›· ÏÔÈÌÒ͈Ó, fiˆ˜ ‚ÚԢΤÏψÛË, Ïԛ̈ÍË ·fi ˘ÂÚÛ›ÓÈ·, Î·È Ë ÁÂÓÈÎÂ˘Ì¤ÓË ·ÎÙÈÓÔÌ˘ÎËÙ›·ÛË. Afi ÙȘ ηÎÔ‹ıÂȘ ·Ó·Ê¤ÚÔÓÙ·È Ë Û·ÚÎÔ›‰ˆÛË, ÙÔ ÂÈıËÏÂÈÔÂȉ¤˜ Û¿ÚΈ̷, Ù· ÏÂÌÊÒÌ·Ù· Î·È Ë ÓfiÛÔ˜ Hodgkin.

M ‚¿ÛË ÙȘ ·Ó·ÊÂÚı›Û˜ ·ÈÙÈÔÏÔÁ›Â˜ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH Ë ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÙȘ ηÏÏȤÚÁÂȘ ÁÈ· ‚·ÎÙËÚ›‰È·, ÌÈÎÚfi‚È· Î·È Ì‡ÎËÙ˜ Î·È ÙȘ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ.

Afi ¿Ô„Ë ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH, Ù· ÂÈıËÏÈÔÂȉ‹ ÎÔÎÎÈÒÌ·Ù· Ô˘ ÔÊ›ÏÔÓÙ·È Û ʿÚ̷η ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù˘ÚÔÂȉ‹ ÎÂÓÙÚÈ΋ Ó¤ÎÚˆÛË (11). H ηٷÓÔÌ‹ ÙÔ˘˜ Â›Ó·È ÏԂ҉˘ Î·È Û˘Ó˘¿Ú¯ÂÈ ÔχÌÔÚÊÔ˜ ˘Ï·›· ‹ ÂÚÈ˘Ï·›· ÊÏÂÁÌÔÓ҉˘ ‰È‹ıËÛË, Û˘ÓÈÛÙ¿ÌÂÓË ·fi ÏÂÌÊÔ·ÙÙ·Ú·, ÈÛÙÈÔ·ÙÙ·Ú· Î·È ËˆÛÈÓfiÊÈÏ·. H ·ÚÔ˘Û›· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ, Û ·ÚÈıÌfi 5-10/ÎÔÎΛˆÌ·, Â›Ó·È ¤Ó‰ÂÈÍË KH ·fi Ê¿Ú̷η Î·È ÂÓ·ÓÙ›ÔÓ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ Û·ÚÎÔ›‰ˆÛ˘ ‹ Ù˘ Ê˘Ì·Ù›ˆÛ˘.

AÓÙ›ıÂÙ·, ÎÔÎΛˆÌ· Ì ÎÂÓÙÚÈ΋ ÏÈÒ‰Ë ‰È‹ıËÛË Ô˘ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ÂÚÈÊÂÚÈÎfi ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ

KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ·

Â›Ó·È ˘¤Ú Ù˘ KH ÏÔÈÌÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜ (4). ™˘Ó‡·ÚÍË ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú Ì ÎÔÎÎÈÒÌ·Ù· ÛÙÔ Ì˘ÂÏfi, ÙÔ ÛÏ‹Ó·, ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ÙÔ Ì˘ÔοډÈÔ ·Ó·Ê¤ÚıËÎ·Ó Ì ÙË ¯Ú‹ÛË ÔÚÈÛÌ¤ÓˆÓ Ê·Ú̿ΈÓ. ŸÙ·Ó Ù· ÎÔÎÎÈÒÌ·Ù· ÔÊ›ÏÔÓÙ·È Û ʿÚ̷η Ì ÙË ‰È·ÎÔ‹ Ù˘ Ï‹„˘ ÙÔ˘ ˘‡ı˘ÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ÔÈ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ ˘Ô¯ˆÚÔ‡Ó Û 1 ¤ˆ˜ 6 Ì‹Ó˜ ¯ˆÚ›˜ Ó· ·Ê‹ÛÔ˘Ó ˘ÔÏ›ÌÌ·Ù·, ·Ó Î·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÚÈÁÚ¿ÊËÎ·Ó ¯ÚfiÓȘ ÌÔÚʤ˜. H Ï‹„Ë ÙÔ˘ ›‰ÈÔ˘ Ê·ÚÌ¿ÎÔ˘ ÚÔηÏ› ÙËÓ Ù·¯Â›· Â·ÓÂÌÊ¿ÓÈÛË Î·È ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú. °ÂÓÈο, Ë Ê·Ú̷΢ÙÈ΋˜ ÚÔ¤Ï¢Û˘ KH Â›Ó·È Î·ÏÔ‹ı˘, ÂÓÒ Ë ·Ú·ÙÂÈÓfiÌÂÓË ÌÔÚÊ‹ Ù˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·, fiˆ˜ Î·È ÔÈ ı·Ó·ÙËÊfiÚ˜ ÌÔÚʤ˜.

EÎÙfi˜ Ù˘ ‚ÈÔ„›·˜ ‹·ÙÔ˜, ¿ÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Ô˘ ‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÔÈ Î·ÏÏȤÚÁÂȘ Î·È ÔÈ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ÁÈ· ·ÔÎÏÂÈÛÌfi ÙÔ˘ ÔͤԘ ˘ÚÂÙÔ‡ Q, Ù˘ ‚ÚԢΤÏψÛ˘ Î·È Ù˘ Ê˘Ì·Ù›ˆÛ˘ (50). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ‰È·ÛÔÚ¿˜ ÙÔ˘ ‚·Î›ÏÔ˘ Calmette Guerin, ÙÔ ÈÛÙÔÚÈÎfi, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÌ˘ÎÔ‚·ÎÙËÚÈ·ÎÒÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ë ÂÓ‰ÔÛÎfiËÛË ‚ÔËıÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË. Afi ÎÏÈÓÈ΋ ¿Ô„Ë ·Ú·ÙËÚÂ›Ù·È ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜ ÂÌÊ·ÓÈ˙fiÌÂÓÔ˜ ÂÓÙfi˜ 6 ‚‰ÔÌ¿‰ˆÓ ·fi ÙËÓ ÂÓ‰Ô΢ÛÙÈ΋ ¤Á¯˘ÛË, ÂÓÒ ÙÔ˘ ˘ÚÂÙÔ‡ ¿ÓÙ· ÚÔËÁÔ‡ÓÙ·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ ‰È·Ù·Ú·¯‹˜ Ù˘ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ™ÙË ‚ÈÔ„›· ‹·ÙÔ˜ ·Ó¢ڛÛÎÔÓÙ·È ÂÈıËÏÈÔÂȉ‹ ÎÔÎÎÈÒÌ·Ù· Ô˘ ÂÓ›ÔÙÂ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÎÂÓÙÚÈ΋ Ó¤ÎÚˆÛË ‹ Ù˘ÚÔÂȉÔÔ›ËÛË. OÈ ‚Ï¿‚˜ ÚÔ¤Ú¯ÔÓÙ·È Â›Ù ·fi ‰È·ÛÔÚ¿ ÙˆÓ ‚·Î›ÏÔ˘ Ì ۯËÌ·ÙÈÛÌfi ÎÔÎÎÈÒÌ·ÙÔ˜, ›ÙÂ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔÈ΋˜ ˘ÂÚÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÂÓ·ÓÙ›ÔÓ ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ‚·Î›ÏÔ˘.

H ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙËÓ ·Ó·˙‹ÙËÛË Ù˘ ·ÈÙ›·˜ ÛÙÔ ›‰ÈÔ ÙÔ ÎÔÎΛˆÌ· Ì ÏÂÙÔÌÂÚ‹ ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‹ ·ÎfiÌ· Î·È ÙË ¯Ú‹ÛË ËÏÂÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘. ¶·ıÔÁ¤ÓÂÈ· O Ì˯·ÓÈÛÌfi˜ ÚfiÎÏËÛ˘ Ù˘ KH ÂÓÙ¿ÛÛÂÙ·È ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·ÓÔÛÔ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÈÛÙÔ‡ Û ‰È¿ÊÔÚ· ·ÓÙÈÁfiÓ·. O Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ıˆÚÂ›Ù·È ÈÛÔ‰‡Ó·ÌÔ˜ Ù˘ ˘ÂÚÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÂÈ‚Ú·‰˘ÓfiÌÂÓÔ˘ Ù‡Ô˘ ÛÙËÓ ÔÔ›· ÂӉȿÌÂÛÔ˜ ÌÂÙ·‚ÔÏ›Ù˘ ·›˙ÂÈ ÙÔ ÚfiÏÔ Ù˘ ·Ù›Ó˘. ¢ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ‰ÔÎÈÌ·Û›· Ë ÔÔ›· ÌÔÚ› Ó· ·ԉ›ÍÂÈ ÙË Û¯¤ÛË ·ÈÙ›Ô˘-·ÔÙÂϤÛÌ·ÙÔ˜. H ÂÚÈÛÙ·Ûȷ΋ ·Ó‡ÚÂÛË ·ÓÙÈÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ‹ ·ÓÙÈ˘ÚËÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ȉȷ›ÙÂÚË ÛËÌ·Û›·. ø˜ ·ÈÙ›· ·Ó¿Ù˘Í˘ ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ·Ó·Ê¤ÚıËÎÂ Î·È Ë ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙÔ ÂÓ‰Ô-

13

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·14

¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16

ı‹ÏÈÔ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ÎfiÏˆÓ ÙÔ˘ ‹·ÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔÈ΋˜ Ó¤ÎÚˆÛ˘ (50,51). ¶ÚfiÛÊ·Ù˜ ÂÈÚ·Ì·ÙÈΤ˜ ÂÚÁ·Û›Â˜ ·Ó·ÊÔÚÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ Î·È Ù˘ KH ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÁÈ· ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ηÏÈÎÚ½Ó˘-ÎÈÓ›Ó˘ Ë ÔÔ›· Úԉȷı¤ÙÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÎÔÎÎȈ̿وÛ˘ ÛÙÔ ¤ÓÙÂÚÔ Î·È ÙÔ ‹·Ú. ¶ÚfiÎÂÈÙ·È ÁÈ· ‰ÈÊ·ÛÈ΋ ·Ú·ÙÂٷ̤ÓË ‰ÈÂÚÁ·Û›· Ì ·˘ÙfiÌ·ÙË Î·Ù¿ ÙË 14Ë Ë̤ڷ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‰ËÌÈÔ˘ÚÁ›·˜ ÎÔÎÎȈ̿وÛ˘ Ô˘ ‰È·ÚΛ ̤¯ÚÈ Î·È 16 ‚‰ÔÌ¿‰Â˜ (52).

IÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· O Bernstein Î·È Û˘Ó.(51) ‹Û·Ó ÔÈ ÚÒÙÔÈ Ô˘ ÂÚȤÁÚ·„·Ó ÙËÓ ·ÚÔ˘Û›· ·Û˘Ó‹ıˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ Û ÂÚÈÙÒÛÂȘ ÔÍ›·˜ Ïԛ̈͢ ·fi coxiella Burnetti (ÔÍ›· ÚÔ‚ÔÏ‹ ˘ÚÂÙÔ‡ Q) (26). OÈ ‚Ï¿‚˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÙËÓ ·ÚÔ˘Û›· ÎÂÓÙÚÈÎÔ‡ ÏÈÒ‰Ô˘˜ ÎÂÓÔÙÔ›Ô˘ Ô˘ ÂÚÈ‚·ÏÏfiÙ·Ó ·fi ÈÓ҉˜ ‰·ÎÙ‡ÏÈÔ, ·ÚÔ˘Û›· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È Ì·ÎÚÔÊ¿ÁˆÓ. H ·ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÚÂÙfi Q ÂȂ‚·ÈÒıËΠÛÙË Û˘Ó¤¯ÂÈ· Î·È ·fi ¿ÏÏÔ˘˜, ÒÛÙ ηٷگ‹Ó Ó· ıˆÚÂ›Ù·È ˆ˜ ÂȉÈÎfi ‡ÚËÌ· Ù˘ Ïԛ̈͢ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘. MÂÙ·ÁÂÓ¤ÛÙÂÚ· ·ԉ›¯ÙËΠfiÙÈ Â›Ó·È Â‡ÚËÌ· Ô˘ ··ÓÙ¿Ù·È Î·È Û ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ. KÔÎÎÈÒÌ·Ù· ‰˘Ó·ÙfiÓ Ó· ‚ÚÂıÔ‡Ó Î·È ÛÙÔ˘˜ ̇˜ Û ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘. ™ÙËÓ È‰ÈÔ·ı‹ KH ·Ó¢ڛÛÎÔÓÙ·È Û˘Ó‹ıˆ˜ ÔÏÏ·Ï¿ ÎÔÎÎÈÒÌ·Ù· ·fi ÂÈıËÏÈÔÂȉ‹ ·ÙÙ·Ú· Ô˘ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Ì ÔÏ˘˘ÚËÓÈο ÁÈÁ·ÓÙÔ·ÙÙ·Ú· Î·È ÂÚÈ‚¿ÏÏÔÓÙ·È ·fi ÌÈÎÚ¿ ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ. EÓÙfi˜ ÙÔ˘ ‹·ÙÔ˜ ÔÈ ‚Ï¿‚˜ Â›Ó·È ‰È¿¯˘Ù· ‰ÈÂÛ·Ṳ́Ó˜. ™Â ‰Â˘ÙÂÚÔ·ı‹ KH ·fi Ïԛ̈ÍË, ÔÈ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ Û‡ÁÎÂÈÓÙ·È ·fi Ô˘‰ÂÙÂÚfiÊÈÏÔ ÎÔÎÎȈ̷ÙÒ‰Ë ‰È‹ıËÛË Ì ۯËÌ·ÙÈÛÌfi ÎÂÓÙÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜.

H ‰È¿ÌÂÙÚÔ˜ ÙˆÓ ‚Ï·‚ÒÓ ·Ó¤Ú¯ÂÙ·È Û ÌÂÚÈο ¯ÈÏÈÔÛÙ¿ (2-5 mm). £ÂÚ·›· K·Ù¿ Ù˘ ÓfiÛÔ˘ ·Ï·ÈfiÙÂÚ· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ë ·ÛÈÚ›ÓË Î·È Ù· ÌË ÛÙÂÚÈÓÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η (53), ‚·ÛÈο fï˜ Ë ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘ (54) Ë ÔÔ›· ·ԉ›¯ÙËΠÔχ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÙfiÛÔ ÛÙËÓ ‡ÊÂÛË ÙÔ˘ ˘ÚÂÙÔ‡, fiÛÔ Î·È ÛÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÔ ‹·Ú. EÓÙÔ‡ÙÔȘ, ÔÚÈṲ̂ÓÔÈ ·ÛıÂÓ›˜ ‰ÂÓ ··ÓÙÔ‡Ó ‹ ¯ÚÂÈ¿˙ÂÙ·È Ë ¯ÔÚ‹ÁËÛË Ôχ ˘„ËÏÒÓ ‰fiÛÂˆÓ ÎÔÚÙÈ˙fiÓ˘ ÁÈ· Ì·ÎÚ‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ¤¯Ô˘Ì ¢ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù·, ÔfiÙ ÚÔ·ÙÂÈ ı¤Ì· ÂÈÏÔÎÒÓ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ Ù˘. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë ¯ÔÚ‹ÁËÛË Ù˘ ÎÔÚÙÈ˙fiÓ˘ ‰È·ÎfiÙÂÙ·È ÛÙÔ˘˜ 6 Ì‹Ó˜.

E› Â·ÓÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û˘Ìو̿وÓ, ÌÂÙ¿ ÙË ‰È·-

14

¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘

ÎÔ‹ Ù˘, ‰ÔÎÈÌ¿ÛÙËÎÂ Ë ÌÂıÔÙÚÂÍ¿ÙË Î·È Ë ˘‰ÚԯψÚÔΛÓË.

H ÌÂıÔÙÚÂÍ¿ÙË ¤¯ÂÈ ‚Ú·‰Â›· ·¿ÓÙËÛË, ·ÏÏ¿ ηϿ ·ÔÙÂϤÛÌ·Ù· (55), ·Ó Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠ۠ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ. H ¯ÔÚ‹ÁËÛ‹ Ù˘ Á›ÓÂÙ·È Û ÌÈÎÚ¤˜ ‰fiÛÂȘ ÁÈ· Ó· ÌÂȈı› Ë Èı·ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ·ÚÂÓÂÚÁÂÈÒÓ, ‰ËÏ·‰‹ Û ‰fiÛË 0,20 mg/kg B™ ‚‰ÔÌ·‰È·›·. A˘ÚÂÍ›· ÂÈÙ˘Á¯¿ÓÂÙ·È Û 3 ÂÚ›Ô˘ Ì‹Ó˜ ·fi ÙËÓ ·Ú¯‹ Ù˘ ¯ÔÚ‹ÁËÛ˘. M ÙË ‰fiÛË ·˘Ù‹ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂȘ ‹ ·ÔÙ˘¯›Â˜.

H ˘‰ÚÔ͢¯ÏˆÚÔΛÓË, Û ‰fiÛË 400 mg/24ˆÚÔ ¯ÔÚËÁ‹ıËΠ۠ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ Ì KH. O Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ Ù˘ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. º·›ÓÂÙ·È fiÙÈ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Ì¤Ûˆ ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÚÔηÏÔ‡ÌÂÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÏfiÁˆ ·Ó·ÛÙÔÏ‹˜ Ù˘ ·ÂÏ¢ı¤ÚˆÛ˘ ·Ú·ÁfiÓÙˆÓ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ¤Ó·ÚÍË Î·È ‰È·Ù‹ÚËÛË Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-1 (56). H ‰Ú¿ÛË ·˘Ù‹ ‰˘Ó·ÙfiÓ Ó· ·Ó·ÛÙ›ÏÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Ô˘ Â›Ó·È ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ (57). ÕÏÏ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ È‰ÈÔ·ı‹ KH ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î˘ÎÏÔʈÛÊ·Ì›‰Ë, ÙËÓ ‚ÈÌÏ·ÛÙ›ÓË Î·È ÙËÓ ¯ÏˆÚ·ÌԢΛÏË.

Afi ÙÔ˘˜ Knox Î·È Û˘Ó.(55) ÚÔÙ¿ıËΠÙÔ ·ÎfiÏÔ˘ıÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì·. K·Ù·Ú¯‹Ó, Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÊ˘Ì·ÙÈ΋˜ ·ÁˆÁ‹˜ ÛÙ· ¿ÙÔÌ· Ì ıÂÙÈ΋ mantoux ‹ Ì ·ÓÂÚÁ›· Ì ÛÎÔfi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î¯ÚÔÂȉԇ˜ Ê˘Ì·Ù›ˆÛ˘. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· Û˘ÌÙÒÌ·Ù· Û˘Ó¯›˙ÔÓÙ·È, ¯ÔÚËÁÂ›Ù·È Ú‰ÓÈ˙fiÓË. AÓ Ë ··ÈÙÔ‡ÌÂÓË ÁÈ· ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰fiÛË Â›Ó·È ÌÂÁ¿ÏË, Ù· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉ‹ ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi ÙË ¯ÔÚ‹ÁËÛË ÌÂıÔÙÚÂÍ¿Ù˘ ÛÙËÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓË ‰fiÛË.

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23. Langley JM, Marrie TJ, Covert A, Waag DM, Williams JC. Poker players pneumonia. An urban outbreak following exposure to a parturient cat. N Engl J Med 1988; 319: 354-356.

KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ·

24. Marrie TJ, Durrant H, Williams JC, Mintz E, Waag DM. Exposure to particular cats is a risk factor for acquisition of Q fever in Maritime Canada. J Infect Dis 1988; 158: 101-106.

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29. George DK, Crawford DH. Antibacterial induced hepatotoxicity: incidence and management. Drug Saf 1996;15:79-85.

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34. Levy M, Goodman MW, van Dyke BJ, Summer HW. Granulomatous hepatitis secondary to carbamazepine.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-11 -98 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢. AÏÂ͛Ԣ B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

16

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50. Bearer EA, Savides TJ, Mc Cutchan JA. Endoscopic diagnosis and management of hepatobiliary tuberculosis.

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™ÂÏ›‰·17

¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20

AP£PO EI¢IKOY EN¢IAºEPONTO™

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘ - MÂÙ·Í¿, AÊÚÔ‰›ÙË KÔ‡ÛË

● ¶ÂÚ›ÏË„Ë: OÈ ÂÒ‰˘Ó˜ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓ›˜. O fiÓÔ˜ Ù˘ ıÚÔÌ‚ˆÙÈ΋˜ ÎÚ›Û˘ Â›Ó·È Ô͇˜ Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙ· Ì·ÎÚ¿ ÔÛÙ¿, ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË Î·È ÛÙȘ Ï¢ڤ˜.

E›Ó·È ÔÏ˘ÂÛÙÈ·Îfi˜, ·ÌÊÔÙÂÚfiÏ¢ÚÔ˜ ‹ ÌÂÙ·Ó·ÛÙ¢ÙÈÎfi˜. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂÈÛ‡‰Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜ ÂÒ‰˘Ó˘ ÎÚ›Û˘ ıˆÚÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂȘ, Ô ˘ÚÂÙfi˜, Ë ·Ê˘‰¿ÙˆÛË, Ë ·ÏÏ·Á‹ ıÂÚÌÔÎÚ·Û›·˜, ÙÔ ˘„fiÌÂÙÚÔ Î.¿. H ·ÓÙ›ÏË„Ë Î·È Ë ¤ÎÊÚ·ÛË ÙÔ˘ fiÓÔ˘ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ ηıÒ˜ Î·È ·fi ÎÔÈÓˆÓÈÎÔ‡˜ Î·È „˘¯ÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. H ÂÏ·ÊÚ¿ ˆ˜ ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ Ì ÍÂÎÔ‡Ú·ÛË, ·ÂÚÈfiÚÈÛÙË Ï‹„Ë ˘ÁÚÒÓ, ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏÏ›Ó˘ Î·È ÌË ÔÈÔÂȉÒÓ ·Ó·ÏÁËÙÈÎÒÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÏ·ÊÚ¿ ËÚÂÌÈÛÙÈο. IÛ¯˘Úfi˜ fiÓÔ˜ ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 48 ˆÚÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÈÛ·ÁˆÁ‹ ÛÙÔ NÔÛÔÎÔÌÂ›Ô fiÔ˘ ¯ÔÚËÁÔ‡ÓÙ·È ÂÓ‰ÔÊϤ‚È· ˘ÁÚ¿, ·ÓÙÈ‚›ˆÛË Î·È ÔÈÔÂȉ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌË ÛÙÂÚÔÂȉ‹ ·Ó·ÏÁËÙÈο Î·È ËÚÂÌÈÛÙÈο. ¶·È‰È·ÙÚÈ΋ 2000;63:17-20. §¤ÍÂȘ ÎÏÂȉȿ: ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜, ÂÒ‰˘ÓË ÎÚ›ÛË, ·ÓÙÈÌÂÙÒÈÛË.

M. Athanasiou - Metaxa, A. Koussi. The treatment of pain in children with sickle cell disease. Paediatriki 2000;63:17-20. ● Abstract: The painful crisis is one of the most characteristic manifestations of sickle cell disease. The pain is acute and is usually bilateral and symmetrical, and located most frequently in the long bones, lumbar vertebrae and ribs. Multiple sites are commonly affected simultaneously. Several precipitating factors such as cold, infection, acidosis, sleep apnoea, high altitude and emotional stress may immediately precede the painful crisis.

Management of the painful crisis is one of the commonest clinical problems facing physicians, and the patients and their parents. The response to pain is heavily influenced by psychological, social and cultural factors and a multidisciplinary approach is required. Mild to moderate pain often responds to paracetamol, non steroid antiinflammatory drugs and sedatives. Severe pain may require oral analgesia with pethidine or codeine. Persistence of pain in spite of the above treatment necessitates hospital admission and additional therapy with iv administration of fluids, and pethidine or morphine in standard doses, always taking side-effects into consideration. Psychological support for these children and their families is always helpful and should never be omitted.

Key words: sickle cell disease, painful crisis, treatment.

OÈ ÂÒ‰˘Ó˜ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓ›˜ (13). O fiÓÔ˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÛÙËÓ ¿ÛËÙË Ó¤ÎÚˆÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Ô˘ Û˘Ì‚·›ÓÂÈ ÏfiÁˆ ·fiÊڷ͢ Ù˘ ÙÂÏÈÎÔ‡ Ù‡Ô˘ ·ÁÁ›ˆÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.(1) ™‹ÌÂÚ· ÈÛÙ‡ÂÙ·È fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÙˆÓ ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÏÏËÏÂ›‰Ú·Û˘ ηÈ

™˘ÓÙÔÌÔÁڷʛ˜: IM IV PO Sup PCA Aºª

EÓ‰ÔÌ˘˚ο EÓ‰ÔÊϤ‚È· Afi ÙÔ ÛÙfiÌ· Afi ÙÔ ÔÚıfi P˘ıÌÈ˙fiÌÂÓË ·fi ÙÔÓ ·ÛıÂÓ‹ ·Ó·ÏÁËÛ›· ∞Ê·ÈÌ·ÍÔÌÂÙ¿ÁÁÈÛË

¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÂÎÙfi˜ Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÌË ·Ó·-

A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ A.¶.£.

17

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·18

¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20

ÛÙÚ¤„ÈÌˆÓ ‰ÚÂ·ÓÔ΢ÙÙ¿ÚˆÓ. EÓÔ¯ÔÔÈÔ‡ÓÙ·È ·Ú¿ÁÔÓÙ˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ fiˆ˜ ÔÈ ÚˆÙ½Ó˜ ÔÍ›·˜ Ê¿Ûˆ˜, Ù· ·ÈÌÔÂÙ¿ÏÈ·, Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· Î·È Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (1).

O fiÓÔ˜ Ù˘ ıÚÔÌ‚ˆÙÈ΋˜ ÎÚ›Û˘ Â›Ó·È Ô͇˜, ÂÓÙÔ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙ· Ì·ÎÚ¿ ÔÛÙ¿, ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË Î·È ÙȘ Ï¢ڤ˜. ™Ù· ·È‰È¿ ̤¯ÚÈ ÙËÓ ËÏÈΛ· 10-12 ¯ÚfiÓˆÓ ÂÓÙÔ›˙ÂÙ·È Û˘¯Ó¿ ÛÙȘ ÌÂٷʇÛÂȘ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ fiÔ˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ú¿Ï¢ÚË Î˘ÎÏÔÊÔÚ›·. ™ÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ Ô fiÓÔ˜ Â›Ó·È ÔÏ˘ÂÛÙÈ·Îfi˜ ·ÌÊÔÙÂÚfiÏ¢ÚÔ˜ ‹ ÌÂÙ·Ó·ÛÙ¢ÙÈÎfi˜ Î·È Ë ‰È¿ÚÎÂÈ¿ ÙÔ˘ Î˘Ì·›ÓÂÙ·È ·fi 3-10 Ë̤Ú˜. ™˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi ̤ÙÚÈ· ˘ÚÂÙÈ΋ ΛÓËÛË (38ÔC) ÂÓÒ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ˘Ô‰fiÚÈ· ÊÏÂÁÌÔÓ‹ ÛÙÔ ÛËÌÂ›Ô ÙÔ˘ fiÓÔ˘. ¶ÔÏÏÔ› ·ÛıÂÓ›˜ ·Ó·Ê¤ÚÔ˘Ó ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ fiÓÔ˘ Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· fiˆ˜ ÌÔ‡‰È·ÛÌ· ‹ ˘·ÈÛıËÛ›· Ù˘ ÂÚÈÔ¯‹˜, ‰È¿ÚÎÂÈ·˜ 24 ˆÚÒÓ ÂÚ›Ô˘ Ô˘ Èı·ÓfiÓ ÛËÌ·›ÓÔ˘Ó ÙËÓ ¤Ó·ÚÍË Ù˘ Ó¤ÎÚˆÛ˘ ÙÔ˘ ÈÛÙÔ‡. H Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÒ‰˘ÓˆÓ ÎÚ›ÛÂˆÓ Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ·ÛıÂÓÔ‡˜. Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÌÂٷ͇ 15 Î·È 25 ¯ÚfiÓˆÓ ÔÓÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ Ù· ·ÁfiÚÈ·. MÂÙ¿ Ù· 30 ¯ÚfiÓÈ· Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÒ‰˘ÓˆÓ ÎÚ›ÛÂˆÓ ·Ú·ÈÒÓÂÈ (1). ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂÈÛ‡‰Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜ ÂÒ‰˘Ó˘ ÎÚ›Û˘ ıˆÚÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂȘ, Ô ˘ÚÂÙfi˜, Ë ·Ê˘‰¿ÙˆÛË, Ë ·fiÙÔÌË ·ÏÏ·Á‹ ıÂÚÌÔÎÚ·Û›·˜ (ÎÚ‡Ô-˙ÂÛÙfi), ÙÔ ˘„fiÌÂÙÚÔ, Ë ˘ÔÍ›·, Ë ¤ÓÙÔÓË ¿ÛÎËÛË Î·È Û˘ÁÎÈÓËÛÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ (1,3,4). ™Ù· ·È‰È¿ ·ÓÔ˚ο ÂÂÈÛfi‰È· ÙËÓ Ó‡¯Ù· ·fi ·fiÊÚ·ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (˘ÂÚÙÚÔÊ›· ·‰ÂÓÔÂȉÒÓ, ·Ì˘Á‰·ÏÒÓ) ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÂÒ‰˘ÓË ÎÚ›ÛË ÏfiÁˆ ÂÏ¿ÙÙˆÛ˘ ÙÔ˘ ÎÔÚÂÛÌÔ‡ ÙÔ˘ Ô͢ÁfiÓÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (5). °ÂÓÈο Ë ·ÓÙ›ÏË„Ë Î·È Ë ¤ÎÊÚ·ÛË ÙÔ˘ fiÓÔ˘ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ ηıÒ˜ Î·È ·fi ÎÔÈÓˆÓÈÎÔ‡˜ Î·È „˘¯ÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (1,6) ÂÓÒ Ë ¤ÓÙ·ÛË Î·È Ë ‰È¿ÚÎÂÈ· ÙÔ˘ fiÓÔ˘ ı· Ô‰ËÁ‹ÛÔ˘Ó ÙÔÓ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈÎfi ·ÛıÂÓ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô.

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Â›Ó·È ¤Ó· ‰‡ÛÎÔÏÔ Úfi‚ÏËÌ· ÙfiÛÔ ÁÈ· ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙÔ˘˜ ÓÔÛËÏÂ˘Ù¤˜, fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜. °ÂÓÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ô fiÓÔ˜ ÛÙ· ·È‰È¿ ˘ÔıÂÚ·‡ÂÙ·È (7). B·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ÂÈÙ˘¯‹ Î·È ·ÛÊ·Ï‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ ·ÔÙÂÏ› Ë ÔχÏ¢ÚË ÚÔÛ¤ÁÁÈÛË Ô˘ Ú¤ÂÈ Ó· Û˘Ó‰˘¿˙ÂÈ ÙË ÁÓÒÛË ÙˆÓ È‰ÈÔÙ‹ÙˆÓ ÙˆÓ ¯ÔÚËÁÔ˘Ì¤ÓˆÓ Ê·Ú̿ΈÓ, ÙÔ˘˜ ‰˘Ó·ÙÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ì ‚¿ÛÂÈ ¿ÓÙ· ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ ·ÏÏ¿ Î·È ÙËÓ ÂÈı·Ú¯›· ÙfiÛÔ ÙÔ˘ ȉ›Ô˘ fiÛÔ Î·È ÙÔ˘ ·Ú·˚·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡. A·Ú·›ÙËÙË ÎÚ›ÓÂÙ·È Ë ÂÓË̤ڈÛË ·ÛıÂÓÒÓ Î·È ÁÔÓ¤ˆÓ Î·È Ë „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ¿Á¯Ô˘˜ Ô˘ ÂȉÂÈÓÒÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ fiÓÔ˘. H ÏÂÙÔÌÂÚ‹˜ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ ηÈ

18

M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË

Ë ÚÔÛÂÎÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ·ÛıÂÓ‹ ıˆÚÂ›Ù·È ‚·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙÔ Û¯Â‰È·ÛÌfi Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜. °ÂÓÈΤ˜ ·Ú¯¤˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ Û›ÙÈ ‹ ÛÙÔ NÔÛÔÎÔÌÂ›Ô ·ÔÙÂÏÔ‡Ó Ë ÂÓ˘‰¿ÙˆÛË, Ë ·ÓÙÈÌÂÙÒÈÛË Û˘Ó˘¿Ú¯Ô˘Û·˜ Ïԛ̈͢ ‹ ¿ÏÏ˘ ÂÈÏÔ΋˜ Î·È Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ (1,8).

T· ·Ó·ÏÁËÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ÎÚ›Û˘ ‰È·ÎÚ›ÓÔÓÙ·È Û ÌË ÔÈÔÂȉ‹ (¶›Ó·Î·˜ 1) Î·È ÔÈÔÂȉ‹ (¶›Ó·Î·˜ 2). H ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·ÎÔÏÔ˘ı› ÚÔԉ¢ÙÈ΋ ÔÚ›· ·fi ‹È· ·Ó·ÏÁËÙÈο Û ̤ÙÚÈ· Î·È ÙÂÏÈο Û ÈÛ¯˘Ú¿ ÔÈÔÂȉ‹ (9,10). MÈ· ÂÏ·ÊÚ¿ ˆ˜ ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ Ì ÌË ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο Ê¿Ú̷η ·fi ÙÔ ÛÙfiÌ·. H ‰Ú¿ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ Â›Ó·È ÂÚÈÊÂÚÈ΋, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙË Û‡ÓıÂÛË ÙˆÓ ÚÔÛÙ·ÁÏ·‰ÈÓÒÓ Ô˘ ·Ú¿ÁÔÓÙ·È ·fi ÙËÓ ÊÏÂÁÌÔÓ‹ ÙˆÓ ÈÛÙÒÓ (11). ™Â ¤ÓÙÔÓÔ fiÓÔ Ù· ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο ·ÔÙÂÏÔ‡Ó Ù· ·ÚÈ· Ê¿Ú̷η ·Ó·ÏÁËÛ›·˜. H ‰Ú¿ÛË ÙÔ˘˜ Â›Ó·È ÎÂÓÙÚÈ΋ ̤ۈ ˘Ô‰Ô¯¤ˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (9). OÈÔÂȉ‹ ·Ó·ÏÁËÙÈο ·fi ÙÔ ÛÙfiÌ· fiˆ˜ Έ‰Â˝ÓË ‹ Âıȉ›ÓË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘ÔÛÙËÚÈÎÙÈ΋ ıÂÚ·›· ‰˘Ó·ÙfiÓ Ó· ÂÏ·ÙÙÒÛÂÈ ÙÔÓ fiÓÔ Î·È Ó· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ NÔÛÔÎÔÌ›Ô.

AÓÙÈÌÂÙÒÈÛË ÛÙÔ Û›ÙÈ: H ÂÏ·ÊÚ¿ ˆ˜ ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ Ì ÍÂÎÔ‡Ú·ÛË Û ˙ÂÛÙfi ÂÚÈ‚¿ÏÏÔÓ, ·ÂÚÈfiÚÈÛÙË Ï‹„Ë ˘ÁÚÒÓ ·fi ÙÔ ÛÙfiÌ·. XÔÚ‹ÁËÛË ÂÓÈÎÈÏ›Ó˘ Ì ‹ ¯ˆÚ›˜ ·ÚÔ˘Û›· Ïԛ̈͢, Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ÌË ÔÈÔÂȉÒÓ ·Ó·ÏÁËÙÈÎÒÓ ÌfiÓ· ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌÔ‡˜, ÂÏ·ÊÚ¿ ËÚÂÌÈÛÙÈο (·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ ‚ÂÓ˙ԉȷ˙Â›Ó˜) ·Ó¿ÏÔÁ· Ì ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ (¶›Ó·Î·˜ 1).

IÛ¯˘Úfi˜ fiÓÔ˜, ÔÏ˘ÂÛÙÈ·Îfi˜ ‹ ÂÓÙÔÈ˙fiÌÂÓÔ˜ ÛÙÔ ıÒڷη ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 48 ˆÚÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô.

AÓÙÈÌÂÙÒÈÛË ÛÙÔ NÔÛÔÎÔÌ›Ô: ÕÌÂÛË ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ¯·Ú·ÎÙ‹ÚˆÓ ÙÔ˘ fiÓÔ˘ Û ۇÁÎÚÈÛË Ì ÚÔËÁÔ‡ÌÂÓ· ÂÂÈÛfi‰È·, ¤ÏÂÁ¯Ô˜ ÁÈ· Ù˘¯fiÓ Û˘Ó‡·ÚÍË Ïԛ̈͢ Î·È ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: °ÂÓ. ·›Ì·ÙÔ˜, ¢EK, CRP, ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Û ˘ÚÂÙfi ¿Óˆ ÙˆÓ 38,5oC, ·¤ÚÈ· ·›Ì·ÙÔ˜ Î·È ·/· ıÒڷη Û ıˆÚ·ÎÈÎfi ‹ ÔÏ˘ÂÛÙÈ·Îfi fiÓÔ Î·È Ïԛ̈ÍË ·Ó·Ó¢ÛÙÈÎÔ‡, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Û ÎÔÈÏȷο ¿ÏÁË. H Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈο ÂÓ˘‰¿ÙˆÛË Ì ÂÓ‰ÔÊϤ‚È· (IV) ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ‰È·Ï‡Ì·ÙÔ˜ (1+4) ‚¿ÛÂÈ ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ +50% Î·È ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏ›Ó˘ ‹ ¿ÏÏˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·Ù¿ ÂÚ›ÙˆÛË. ™Â ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ÂÎÙfi˜ ·fi Ù· ÁÂÓÈο ̤ÙÚ· ¯ÔÚËÁÔ‡ÓÙ·È ·Ú¯Èο ·Ú·ÎÂÙ·ÌfiÏË Î·È ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ÛÙȘ ·ÓÒٷ٘ ‰fiÛÂȘ

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·19

¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20

∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘

¶›Ó·Î·˜ 1. MË ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο O‰fi˜ ºAPMAKA ¯ÔÚ‹ÁËÛ˘

¢fiÛË mg/Kg

AÓÒÙÂÚË ‰fiÛË (mg) AÓÒÙÂÚË ‰fiÛË (mg) ¶·È‰È¿ ∂Ó‹ÏÈΘ

¶APAKETAMO§H Dolal, Panadol, Lonarid

PO, Sup

15-20/4 ÒÚ˜

3-6¯Ú. 500/24 ÒÚ˜

PO

5-6/6 ÒÚ˜

500/8 ÒÚ˜

N·ÚÔͤÓË Naprosyn

PO, Sup

5-8/12 ÒÚ˜

500/12 ÒÚ˜

IÌÔÚÔ˘Ê·›ÓË µrufen

PO, Sup

3-10/6 ÒÚ˜

500/6 ÒÚ˜

PO, Sup,IM

1-2/8-12 ÒÚ˜

50/8 ÒÚ˜

PO

3-5/6/8 ÒÚ˜

200/8 ÒÚ˜

2500/24 ÒÚ˜

ªH ™TEPOEI¢H ANTIº§E°MONø¢H ªÂÊ·ÈÓ·ÌÈÎfi Ô͇ Ponstan

IÓ‰ÔÌÂı·Î›ÓË Indocid ∆ÔÏÊ·ÈÓ·ÌÈÎfi Ô͇ Gantil ¢ÈÎÏÔÊ·ÈÓ¿ÎË Ó·ÙÚÈÔ‡¯Ô˜ Voltaren À‰ÚÔ͢˙›ÓË Atarax

PO Sup,IM PO, π.ª.

¶›Ó·Î·˜ 2. OÈÔÂȉ‹ ·Ó·ÏÁËÙÈο O‰fi˜ ºAPMAKA ¯ÔÚ‹ÁËÛ˘ Kˆ‰Â˝ÓË ºˆÛÊÔÚÈ΋

150/24 ÒÚ˜ 1/24 ÒÚ˜

¢fiÛË mg/Kg

2-6 ¯Ú. 50/24 ÒÚ˜ 6-12 ¯Ú. 100/24 ÒÚ˜

50-100/6 ÒÚ˜

AÓÒÙÂÚË ‰fiÛË (mg) AÓÒÙÂÚË ‰fiÛË (mg) ¶·È‰È¿ ∂Ó‹ÏÈΘ

PO, πª

0,5-3/4-6 ÒÚ˜

¢È¸‰ÚÔΈ‰Â˝ÓË Dolcontin

PO

1/4-6 ÒÚ˜

™À¡¢À∞™ªOÿ Kø¢∂´¡∏˜ Kˆ‰Â˝ÓË+·Ú·ÎÂÙ·ÌfiÏË Depon plus Lonalgal Medamol

PO PO, Sup PO, Sup

∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË

∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË

∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË

Kˆ‰Â˝ÓË+·Ú·ÎÂÙ·ÌfiÏË+ ∫·Ê½ÓË Lonarid N

PO, Sup

∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË

∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË

∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË

PO, IM IV

1 tabl(65mg)/6-8 ÒÚ˜ 1 amp(75mg)/8-12 ÒÚ˜

300/24 ÒÚ˜

600/24 ÒÚ˜

PO(powder) IM IV Bolus

25-50/3-4 ÒÚ˜ 1-5/2 ÒÚ˜ 0,2-0,6/1 ÒÚ· 0,5-1/2 ÒÚ˜

¢ÂÍÙÚÔÚÔÔÍ˘Ê·›ÓË Romidon Zideron ¶Âıȉ›ÓË ˘‰ÚԯψÚÈ΋ ªeperidine

ªÔÚÊ›ÓË Sulfate Morficontin (tabl 100 mg) PO Mongol (caps 10,30,60,100 mg) PO ªÔÚÊ›ÓË ˘‰ÚԯψÚÈ΋ Morficontin (tabl 100 mg)

πª ‹ Sub IV *Bolus,*PCA

60/12 ÒÚ˜

0,3-0,6/12 ÒÚ˜ 0,2-0,5/4-6 ÒÚ˜ 0,1-0,2/3-4 ÒÚ˜ 0,01-0,06/1 ÒÚ·

*¶ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔ Î›ÌÂÓÔ Î·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· Ì ۇÁ¯ÚÔÓË ¯ÔÚ‹ÁËÛË ËÚÂÌÈÛÙÈÎÒÓ (¶›Ó·Î·˜ 1). E¿Ó Ô fiÓÔ˜ ÂÈ̤ÓÂÈ ‹ ÂȉÂÈÓÒÓÂÙ·È ¯ÔÚËÁÔ‡ÓÙ·È ÔÈÔÂȉ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌË ÛÙÂÚÔÂȉ‹ ·Ó·ÏÁËÙÈο Î·È ËÚÂÌÈÛÙÈο.

™Â ‚·ÚÈ¿ ÎÚ›ÛË ¯ÔÚËÁÔ‡ÓÙ·È ÚÔԉ¢ÙÈο Έ‰Â˝ÓË ‹ Û˘Ó‰˘·ÛÌÔ› Ù˘, ‰ÂÍÙÚÔÚÔÔÍ˘Ê·›ÓË, Âıȉ›ÓË ‹ ÌÔÚÊ›ÓË Î·Ù¿ ÂÚ›ÙˆÛË, ·Ú¯Èο ·fi ÙÔ ÛÙfiÌ· ‹ ÙÔ ÔÚıfi Î·È Û ÌË ·ÓÙ·fiÎÚÈÛË, ˘Ô‰fiÚÈ· ‹ IV ‹ bolus

19

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·20

¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20

¤Á¯˘ÛË, ‹ Ú˘ıÌÈ˙fiÌÂÓË ·fi ÙÔÓ ·ÛıÂÓ‹ ·Ó·ÏÁËÛ›· Ì ·ÓÙÏ›· (PCA) Ì ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· (9,12,13).

XÚÂÈ¿˙ÂÙ·È ÚÔÛÔ¯‹ ÛÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÔÈÔÂȉÒÓ ·Ó·ÏÁËÙÈÎÒÓ Î·È ÂÍ·ÙƠ̂΢ÛË ÙˆÓ ‰fiÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÏfiÁˆ ÙˆÓ ÂÌÊ·ÓÈ˙fiÌÂÓˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ (·ÁÁÂÈԉȷÛÙÔÏ‹, ¿ÚÂÛË Ï›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ, Û·ÛÌÔ›, ·Ú·ÈÛı‹ÛÂȘ, ηٷÛÙÔÏ‹ ·Ó·ÓÔ‹˜) ÔÈ Ôԛ˜ ÌÔÚ› Ó· Â›Ó·È ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓ‹ (9). £ÂˆÚÂ›Ù·È ÛÎfiÈÌË Ë ÂÚÈÁÚ·Ê‹ ·Ó·Ï˘ÙÈο Ù˘ bolus Î·È Ù˘ ÂÏÂÁ¯fiÌÂÓ˘ ·fi ÙÔÓ ·ÛıÂÓ‹ ‹ ÙÔ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘. ¶·Ú·Û΢¿˙ÂÙ·È ‰È¿Ï˘Ì· ÌÔÚÊ›Ó˘ 1 mg/kg Û 50ml ÔÚÔ‡ 5% Dextrose. ™ÙË ‚·ÛÈ΋ bolus ¤Á¯˘ÛË ÌÔÚÊ›Ó˘ ¯ÔÚËÁÔ‡ÓÙ·È 5ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÂÊ¿·Í ‚Ú·‰¤ˆ˜.

E¿Ó Ô fiÓÔ˜ ÂÈ̤ÓÂÈ ¯ÔÚËÁÔ‡ÓÙ·È 2,5 ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÌÂÙ¿ 10-15'. E·Ó¿ÏË„Ë Ù˘ ›‰È·˜ ‰fiÛ˘, ·Ó ¯ÚÂÈ¿˙ÂÙ·È ÌÂÙ¿ 10-15'. AÎÔÏÔ˘ı› Ë ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ Ì ¯ÔÚ‹ÁËÛË 1ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ·Ó¿ ÒÚ· ̤¯ÚÈ ÛËÌ·ÓÙÈ΋˜ ˘Ô¯ÒÚËÛ˘ ÙÔ˘ fiÓÔ˘ Ì ‚·ıÌÈ·›· ÂÏ¿ÙÙˆÛË Ù˘ ‰fiÛ˘ ¤ˆ˜ 0,5ml/h. H IV ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ Ì PCA ÂÊ·ÚÌfi˙ÂÙ·È Û ·È‰È¿ ¿Óˆ ·fi 7 ¯ÚfiÓˆÓ Î·È Ú˘ıÌ›˙ÂÙ·È ·fi ÙÔ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ·ÛıÂÓ‹ (9). XÔÚËÁÂ›Ù·È 1ml/h ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ¤ˆ˜ 12h ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË. E¿Ó Ô fiÓÔ˜ ÂÈ̤ÓÂÈ ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÈ Û˘Ó‰˘·ÛÌfi˜ IV Î·È bolus ¤Á¯˘ÛË 1ml οı 10’. AÓÙ›‰ÔÙÔ Ù˘ ÌÔÚÊ›Ó˘ Â›Ó·È Ë ˘‰ÚԯψÚÈ΋ Ó·ÏÔÍfiÓË (Narcan) Ô˘ ¯ÔÚËÁÂ›Ù·È IV Û ‰fiÛË 0,1-0,4 mg /2'- 3'. ¶ÚÔÙÈÌ¿Ù·È Ë IV ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·Ú̿ΈÓ, ··ÈÙÂ›Ù·È fï˜ ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈfiÙÈ ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ ·ÚÂÓÂÚÁÂÈÒÓ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ·‡ÍËÛË Ù˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ Ô˘ ‰˘Ó·ÙfiÓ Ó· Úԉȷı¤ÙÔ˘Ó Û Ô͇ ıˆÚ·ÎÈÎfi ‹ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (1,14).O Êfi‚Ô˜ ÙÔ˘ Èı·ÓÔ‡ ÂıÈÛÌÔ‡ ÛÙ· ÔÈÔÂȉ‹ Â›Ó·È ·‚¿ÛÈÌÔ˜. H ÔÈÔÊÔ‚›· ‚·Û›˙ÂÙ·È ÛÙË Û‡Á¯˘ÛË Ô˘ ˘¿Ú¯ÂÈ ÌÂٷ͇ Ê˘ÛÈ΋˜ ÂÍ¿ÚÙËÛ˘ Î·È ÂıÈÛÌÔ‡. H Û˘¯ÓfiÙËÙ· ÙÔ˘ ÂıÈÛÌÔ‡ ·fi ¯Ú‹ÛË ÔÈÔÂȉÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·Ó¤Ú¯ÂÙ·È ÛÙÔ 0,03% (9). ™ÙË ‚·ÚÈ¿ ÂÒ‰˘ÓË ÎÚ›ÛË Ô˘ ÂÈ̤ÓÂÈ ¿Óˆ ·fi 48 ÒÚ˜ Î·È ‰ÂÓ ÂϤÁ¯ÂÙ·È Ì ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο Ë ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ ‹ Ë ·Ê·ÈÌ·ÍÔÌÂÙ¿ÁÁÈÛË (AºM) ·Ó·Ê¤ÚÂÙ·È fiÙÈ ‰˘Ó·ÙfiÓ Ó· ‚ÔËı‹ÛÂÈ Ï·Ì‚¿ÓÔÓÙ·˜ ¿ÓÙ· ˘fi„Ë Ù· ˘¤Ú Î·È Ù· ηٿ ÌÈ·˜ ÌÂÙ¿ÁÁÈÛ˘ (1). E›Û˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÂÒ‰˘ÓË ıÚÔÌ‚ˆÙÈ΋ ÎÚ›ÛË Ô˘ ‰ÂÓ ÂϤÁ¯ıËΠ̠ÙËÓ ¯ÔÚ‹ÁËÛË ÔÈÔÂȉÒÓ ·ÓÙÈÌÂÙˆ›ÛÙËΠÂÈÙ˘¯Ò˜ ÌÂ Û˘Ó¯‹ ÂÈÛÎÏËÚ›‰ÈÔ ·Ó·ÏÁËÛ›· (3,15).

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-07-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-09-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M. Aı·Ó·Û›Ô˘ AÁ. ™ÔÊ›·˜ 30, £ÂÛÛ·ÏÔÓ›ÎË 546 22

20

M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË

MÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓ‹ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Û˘ÓÈÛÙ¿Ù·È ·Ô¯‹ ·fi ÙÔ Û¯ÔÏÂ›Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 3 Ë̤Ú˜ Î·È ‚·ıÌÈ·›· ‰È·ÎÔ‹ ÙˆÓ ·Ó·ÏÁËÙÈÎÒÓ.

H ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÂÍ·ÎÔÏÔ˘ı› ̤¯ÚÈ Û‹ÌÂÚ· Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi Î·È ‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ· Ù˘ È·ÙÚÈ΋˜. H ÂÈÙ˘¯‹˜ Î·È ·ÛÊ·Ï‹˜ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ˘˜ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ÔχÏ¢ÚË ÚÔÛ¤ÁÁÈÛ‹ ÙÔ˘, ı· ÌÔÚÔ‡Û ӷ ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÙfiÌˆÓ ·˘ÙÒÓ.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Serjeant G. The painful crisis. In: Serjeant G. Sickle cell disease 2nd ed. Oxford University Press 1992: 245-260.

2. Platt S, Thorington D, Brambilla J, Milner F, Rosse F, Vichinsky E et al. Pain in sickle cell disease: rates and risk factors. N Engl J Med 1991; 325:11-16.

3. Evans J. Practical management of sickle cell diseases.

Arch Dis Child 1989; 64:1748-1751.

4. Shapiro B. The management of pain in sickle cell disease.

Pediatr Clin North Am 1989; 36:1029-1045.

5. Samuels M, Stebbens V, Davies S, Picton-Johnes E, Southall D. Sleep related upper airway obstruction and hypoxaemia in sickle cell disease. Arch Dis Child 1992; 67:925-929.

6. McGrath J, McAlpine L. Psychologic perspectives on pediatric pain. J Pediatr 1993; 122:52-57.

7. Pain relief in children (editorial) BMJ 1998; 316:1552.

8. Ware M, Hableton I, Ochaya I, Serjeant G. Day Care management of sickle cell painful crisis in Jamaica: a model applicable elsewhere? B J Haemat. 1999;104:93-96.

9. M˘ÚˆÓ›‰Ô˘-T˙Ô˘‚ÂϤÎË M, T˙Ô˘‚ÂϤ΢ °. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿. EÈÛÙËÌÔÓÈ΋ ÂÂÙËÚ›‰· TÌ‹Ì·ÙÔ˜ I·ÙÚÈ΋˜ A.¶.£. 1996; 23:1:51-63.

10. Goldman A, Pain management. Arch Dis Child 1993; 68:423-425.

11. £. §È·ÎÔÔ‡ÏÔ˘. MË ÛÙÂÚÈÓÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η. ™ÙËÓ 27Ë ¶·È‰È·ÙÚÈ΋ £ÂÚ·¢ÙÈ΋ ÂÓË̤ڈÛË; 1994 M¿ÈÔ˜ 7-8, Aı‹Ó·: ¢ÂÏÙ›Ô A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ 1994 (™˘ÌÏËÚ.) 47-51.

12. Trentadue O, Kachoyeanos K, Lea G. A comparison of two regimens of patient-controlled analgesia for children with sickle cell disease. J Pediatr Nurs 1998; 13 (1):15-19.

13. Grundy R, Howard R, Evans J. Practical management of pain in sickling disorders. Arch Dis Child 1993; 69:256-259.

14. Rucknagel L, Kalinya KA, Gelfand J. Rib infarcts and acute chest syndrome in sickle cell diseases. Lancet 1991; 80:833-840.

15. Yaster M, Tobin JR, Billett C, Casella JF, Dover G. Epidural analgesia in the management of severe vaso-occlusive sickle-cell crisis. Pediatrics 1994; 93:310-315.

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∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Ê·ÈÓfiÙ˘Ô Û ·È‰ÈÎfi ÏËı˘ÛÌfi AÛ·Û›· TÛ¤˙Ô˘1, M·Ú›· T˙¤ÙË2, ™ÔÊ›· K›ÙÛÈÔ˘1, AÁÁÂÏÈ΋ °·ÏÏ¿1, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿Î˘1, AÓ‰ÚÔÓ›ÎË X·Ù˙ˉËÌԇϷ1, EÏ¢ıÂÚ›· ¶·ÙÂÚ¿ÎË1, AÓÙÒÓÈÔ˜ ¢Ú·Î¿ÙÔ˜3, EÌÌ·ÓÔ˘‹Ï K·Ó·‚¿Î˘2, £ÂÌÈÛÙÔÎÏ‹˜ K·Ú¿ıÈÔ˜1.

● ¶ÂÚ›ÏË„Ë: TÔ Û‡Ó‰ÚÔÌÔ Gilbert (Û. G.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÂÈÛfi‰È· ηÏÔ‹ıÔ˘˜ ¤ÌÌÂÛ˘ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ UDP-ÁÏ˘ÎÔ˘ÚÔÓ˘Ï-ÙÚ·ÓÛÊÂÚ¿Û˘ 1 (ÂÍfiÓÈ· 1-5 ‹ ÂÎÎÈÓËÙ‹˜ TATAA box) ÛÙÔ ¯ÚˆÌfiۈ̷ 2q37. H ÌÂϤÙË ÛÎÔ‡ÂÈ ÛÙËÓ ·Ó‡ÚÂÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û.G. ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ (ÂÈÛ·ÁˆÁ¤˜ ÙÔ ÚÒÙÔ ÂÓı‹ÌÂÚÔ Î¿ı ÌËÓfi˜) Î·È ÛÙË Û˘Û¯¤ÙÈÛË ÁÔÓfiÙ˘Ô˘/ Ê·ÈÓfiÙ˘Ô˘. MÂÏÂÙ‹ıËÎ·Ó 285 ·È‰È¿ (¿Óˆ ÙˆÓ 24 ÌËÓÒÓ) ·ÊÔ‡ ·ÔÎÏ›ÛÙËÎÂ Ë Ë·ÙÈ΋ ‚Ï¿‚Ë, Ë ·Ó·ÈÌ›· Î·È Ë Ï‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ì ‚¿ÛË ÙÔ ÈÛÙÔÚÈÎfi, ÙȘ ‚ÈÔ¯ËÌÈΤ˜ Î·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜. M ÎÚÈÙ‹ÚÈÔ ÙË Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ >1 mg/dl ‰È·ÈÛÙÒıËÎÂ Û˘¯ÓfiÙËÙ· Û.G. 12,3% (35/285 ·È‰È¿). ™ÙË Û˘Ó¤¯ÂÈ· ¤ÁÈÓ ·Ó¿Ï˘ÛË ÙÔ˘ DNA Û 118 ·È‰È¿ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) Ì ‰‡Ô ÂÎÎÈÓËÙ¤˜-ÔÏÈÁÔÓÔ˘ÎÏÂÔÙ›‰È· Î·È ·ÎÔÏÔ‡ıËÛ ·˘ÙfiÌ·ÙË ·Ó¿Ï˘ÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ Â·Ó·Ï·Ì‚·ÓÔÌ¤ÓˆÓ TA ‰ÈÓÔ˘ÎÏÂÔÙȉ›ˆÓ ÛÙÔ TATAA box ÙÔ˘ ÁÔÓȉ›Ô˘, ÒÛÙ ӷ ‰È·ÈÛÙˆı› Ù˘¯fiÓ ÌÂÙ¿ÏÏ·ÍË, ‰ËÏ·‰‹ (TA)7 ·ÓÙ› ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (TA)6. ™Â ÔÌ¿‰· 71/285 Ù˘¯·›· ÂÈÏÂÁÌ¤ÓˆÓ ·È‰ÈÒÓ (1:4 ·È‰È¿) ‰È·ÈÛÙÒıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi˜ ÁÔÓfiÙ˘Ô˜ (TA)6/(TA)6 Û 35 (4,3%), ÂÙÂÚÔ˙˘ÁÒÙ˜ (TA)6/(TA)7 Û 23 (32,4%) Î·È ÔÌÔ˙˘ÁÒÙ˜ (TA)7/(TA)7 Û 13 (18,3%), ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. ·Ó¢ڛÛÎÂÙ·È ˘„ËÏfiÙÂÚË Ì ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜. ™Â ¿ÏÏË ÔÌ¿‰· 35/285 ·È‰È¿ Ô˘ ›¯·Ó ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl ‚Ú¤ıËÎ·Ó ÁÔÓfiÙ˘ÔÈ: (TA)6/(TA)6, (TA)6/(TA)7 Î·È (TA)7/(TA)7 Û 8,6%, 31,4% Î·È 57,1% ·ÓÙÈÛÙÔ›¯ˆ˜ ÂÓÒ ‰È·ÈÛÙÒıËÎÂ Î·È Ì›· ÂÚ›ÙˆÛË Ì ÙÔÓ Û·ÓÈfiÙ·ÙÔ ÁÔÓfiÙ˘Ô (TA)6/(TA)8. T¤ÏÔ˜, Û ¿ÏÏË ÔÌ¿‰· 83/285 ·È‰ÈÒÓ Ô˘ ›¯·Ó ¯ÔÏÂÚ˘ıÚ›ÓË ≤1mg/dl ‰È·ÈÛÙÒıËÎ·Ó ÁÔÓfiÙ˘ÔÈ (TA)6/(TA)6, (TA)6/(TA)7 Î·È (TA)7/(TA)7 Û 51,9%, 37,3% Î·È 10,8% ·ÓÙÈÛÙÔ›¯ˆ˜. H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÓˆÙ¤Úˆ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ (Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘) Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘ (p <0.001). ¶·È‰È·ÙÚÈ΋ 2000;63: 21-26. §¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Gilbert, ÁÔÓfiÙ˘Ô˜, Ê·ÈÓfiÙ˘Ô˜.

A. Tsesou, M. Tzeti, S. Kitsiou, A. Galla, E. Kavasarakis, A. Hatzidimoula, E. Pateraki, A. Drakatos, E. Kanavakis, T. Karpathios. Gilbert’s syndrome: Genotype analysis and correlation with phenotype in children. Paediatriki 2000;63: 21-26 . ● Abstract: Gilbert’s syndrome (GS) is characterized by mild unconjugated hyperbilirubinaemia due to mutations of UDP-glucuronosyltransferase 1 (UGT1A1) gene mapped on the human chromosome at 2q37.

The aim of this study was the determination of GS frequency in a random sample of children (admissions on the first 5 days of every month) and the correlation between genotype and phenotype. The 285 children studied had no history of hepatitis, anaemia or anticonvulsant therapy based on haematological and biochemical tests. The frequency of GS based on a level of serum total bilirubin (STB) > 1 mg/dl was 12.3% (35/285 children). In these children, genotypic analysis in the promoter region (TATAA box) of the UGT1A1 gene was performed in order to detect the presence of (TA)7 repeats. In a random group of 1:4 children (71/285) it was observed that 35 children (49.3%) had the (TA)6/(TA)6 genotype, 23 children (32.4%) were

1 2

3

B' ¶·È‰/΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - EÚÁ·ÛÙ‹ÚÈÔ K˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" A' ¶·È‰/΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - XˆÚ¤ÌÂÈÔ EÚ¢ÓËÙÈÎfi EÚÁ·ÛÙ‹ÚÈÔ / MÔÓ¿‰· MÔÚȷ΋˜ I·ÙÚÈ΋˜ NÔÛ. ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" BÈÔ¯ËÌÈÎfi EÚÁ·ÛÙ‹ÚÈÔ NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡"

21

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A. TÛ¤˙Ô˘ Î·È Û˘Ó.

heterozygotes (TA)6/(TA)7 and 13 (18.3%) had the (TA)7/(TA)7 genotype, indicating that GS frequency is found to be higher when studied by DNA analysis. In the GS group of 35 children it was observed that 8.6% had the 6/6 genotype, 31.4% had the (TA)6/(TA)7 and 57.1% had the (TA)7/(TA)7 genotype, while the rare genotype (TA)6/(TA)8 was found in one child. Finally, in a group of 83/285 children with STB ≤1 mg/dl, the (TA)6/(TA)6 genotype was observed in 51.9%, (TA)6/(TA)7 in 37.3% and (TA)7/(TA)7 in 10.8%. Statistical evaluation of these results showed a significant association between phenotype (STB levels) and genotype (p <0.001).

Key words: Gilbert’s syndrome, genotype, phenotype.

EÈÛ·ÁˆÁ‹ TÔ Û‡Ó‰ÚÔÌÔ Gilbert (Û.G.) Â›Ó·È Ì›· ηÏÔ‹ı˘ ¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· ¯ˆÚ›˜ ÛÙÔȯ›· Ë·ÙÔ¿ıÂÈ·˜ ‹ ÂÌÊ·ÓÔ‡˜ ·ÈÌfiÏ˘Û˘ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÂÈÛfi‰È· ÂÏ·ÊÚÔ‡ Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ÈÎÙ¤ÚÔ˘ Ì ·Ó·ÏÔÁ›· ·Ó‰ÚÒÓ/ Á˘Ó·ÈÎÒÓ 4:1 (1-3). MÂٷ͇ ÙˆÓ ÎÏËÚÔÓÔÌÔ˘Ì¤ÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÙÔ Û.G. ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ˘ÔηÙËÁÔÚ›· ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 2-12% Û ‰È¿ÊÔÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (46). AÍ›˙ÂÈ Ó· ÛËÌÂȈı›, fiÙÈ ÙÔ Û. G Û˘¯Ó¿ ˘ԉȷÁÈÁÓÒÛÎÂÙ·È ÏfiÁˆ Ù˘ ËÈfiÙËÙ·˜ ÙˆÓ Û˘Ìو̿وÓ. ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ Ù‡Ô Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ï·ÈfiÙÂÚ˜ ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ÔÈÎÔÁÂÓÂÈÒÓ Ì Û.G. ¤‰ÂÈÍ·Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi ÓfiÛËÌ· Ì ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, Ì ‚¿ÛË ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ ÌfiÓÔ Û 27,5% ÙˆÓ ·‰ÂÏÊÒÓ ·Û¯fiÓÙˆÓ Î·È Û 16,2% ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ‰È·ÈÛÙÒıËΠÛ.G. (3,7). ¶ÚfiÛÊ·Ù· ÔÈ Owens Î·È Ritter (1992) ÂͤÊÚ·Û·Ó ÙËÓ ¿Ô„Ë ÙÔ˘ ·˘ÙÔۈ̷ÙÈÎÔ‡ ˘ÔÏÂÈfiÌÂÓÔ˘ Ù‡Ô˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ó Î·È ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ÁÈ· ÙÔ Û.G. (UDP-glucuronosyltransferase-1, UGT1A1) Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ÙÂÏÔÌÂÚȉȷÎfi ¿ÎÚÔ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 2 (2q37), ÂȂ‚·›ˆÛ ÙÔÓ ÂÈÎÚ·ÙËÙÈÎfi Ù‡Ô (6,8).

TÔ ÁÔÓ›‰ÈÔ UGT1 (Ì‹ÎÔ˘˜ ÂÚ›Ô˘ 85 Kb) (EÈÎfiÓ· 1) ·ÔÙÂÏÂ›Ù·È ·fi ¤ÓÙ ÂÍfiÓÈ·, ÙÔ ÚÒÙÔ ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÚȤ¯ÂÈ ¤ÍÈ ˘ÔÌÔÓ¿‰Â˜ (1A ¤ˆ˜ 1F), ÔÈ Ôԛ˜ Î·È Î·ıÔÚ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÈÛÔÂÓ˙‡ÌˆÓ (isoforms) Ù˘ UDPglucuronosyltranferase. I‰È·›ÙÂÚ·, ÙÔ ¤Ó˙˘ÌÔ UDPglucuronosyltransferase Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Â›Ó·È ÚÔ˚fiÓ ÙˆÓ ‰‡Ô ˘ÔÌÔÓ¿‰ˆÓ 1A Î·È 1D ÙÔ˘ ÂÍÔÓ›Ô˘ 1. T· ˘fiÏÔÈ· ÂÍfiÓÈ· ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1 (2 ¤ˆ˜ 5) Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÎÔÈÓ¤˜ ÙÂÏÈΤ˜ ÂÚÈÔ¯¤˜ ηڂÔÍ˘Ï›ˆÓ fiÏˆÓ ÙˆÓ ÈÛÔÂÓ˙‡ÌˆÓ Ù˘ ÙÚ·ÓÛÊÂÚ¿Û˘ (9-11). ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙȘ Έ‰ÈÎÔÔÈÔ‡Û˜ ÂÚÈÔ¯¤˜ (ÂÍfiÓÈ· 1 ¤ˆ˜ 5) ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1 ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ¿ÙÔÌ· Ì Û.G. ÌfiÓÔ Û ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ÌÂÏÂÙÒÓ ·fi ÙËÓ I·ˆÓ›·, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ·˘Ù¤˜ ÂÚÈÔÚ›˙ÔÓÙ·È

22

Û ¿ÙÔÌ· AÛÈ·ÙÈ΋˜ ηٷÁˆÁ‹˜ (12-15).

AÓÙ›ıÂÙ·, fiϘ ÔÈ ÌÔÚȷΤ˜ ÌÂϤÙ˜ Û ¿ÙÔÌ· Ì Û.G. Ù˘ Ï¢΋˜ Ê˘Ï‹˜ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙȘ Έ‰ÈÎÔÔÈÔ‡Û˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘, ·ÏÏ¿ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ô ÂÎÎÈÓËÙ‹˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 1A (TATAA box) ÛÙ· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ÂÚȤ¯ÂÈ ¤ÍÈ Â·Ó·Ï‹„ÂȘ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ [A(TA)6TAA], ÂÓÒ ÛÙ· ¿ÙÔÌ· Ì ÙÔ Û.G. ·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· TA Ì ·ÔÙ¤ÏÂÛÌ· 7 ·ÓÙ› ÙˆÓ Û˘Ó‹ıˆÓ 6 Â·Ó·Ï‹„ÂˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ (6,11). ™Â ·˘ÙfiÓ ·ÎÚÈ‚Ò˜ ÙÔÓ ÔÏ˘ÌÔÚÊÈÛÌfi ÙÔ˘ DNA ÔÊ›ÏÂÙ·È Ë ÌÂȈ̤ÓË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Î·È ·Ô‰›‰ÔÓÙ·È Ù· ·˘ÍË̤ӷ Â›‰· ¯ÔÏÂÚ˘ıÚ›Ó˘ ÛÙÔ Û.G. ™Â ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ̤¯ÚÈ ÛÙÈÁÌ‹˜ ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G., fiˆ˜ ·˘Ùfi ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ‚¿ÛË, ›Ù ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, ›Ù ÙË ÁÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË. ™ÙËÓ ·-

EÈÎfiÓ· 1. ¢ÔÌ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Ì ÂÈΤÓÙÚˆÛË ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹. T· ÂÍfiÓÈ· ‰È·¯ˆÚ›˙ÔÓÙ·È ·fi ÌË Îˆ‰ÈÎÔÔÈÔ‡Û˜ ·ÏÏËÏÔ˘¯›Â˜. Afi Ù· ˙‡ÁË ÂÎÎÈÓËÙÒÓ A/B Î·È C/D ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÓ PCR ÌfiÓÔ ÙÔ ˙‡ÁÔ˜ C/D.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋/ Ê·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË

ÚÔ‡Û· ÌÂϤÙË ‰ÈÂÚ¢ӋıËÎÂ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. Û ÓÔÛËÏ¢fiÌÂÓ· ·È‰È¿ Ì ÛÎÔfi: ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ (Â›‰· ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ -ʇÏÔ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ Î.¿.) Ì ÙÔÓ ÁÔÓfiÙ˘Ô.

H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙȘ ‰ÔÎÈ̷ۛ˜: ·) ·Ó¿Ï˘ÛË ÌÂÙ·‚ÏËÙfiÙËÙ·˜, ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘ Î·È Ê·ÈÓÔÙ‡Ô˘ (Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘) Î·È ‚) t-test ÁÈ· Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘ Î·È Ê‡ÏÔ˘ (·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·).

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 285 ·È‰È¿ (145 ·ÁfiÚÈ·, 140 ÎÔÚ›ÙÛÈ·) ¿Óˆ ÙˆÓ 24 ÌËÓÒÓ Ô˘ ÓÔÛËχÔÓÙ·Ó ÛÙË B’ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Î·È ‹Ù·Ó Û ı¤ÛË Ó· ·Ú·Ì›ÓÔ˘Ó ÓËÛÙÈο Â› 12ˆÚÔ ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·. °È· Ó· ÂÍ·ÛÊ·ÏÈÛÙ› Ô Ù˘¯·›Ô˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ÛÙËÓ ÔÌ¿‰· ηÙÂÙ¿ÁËÛ·Ó ÌfiÓÔ ·È‰È¿ Ô˘ ÂÈÛ¿ÁÔÓÙ·Ó ÙÔ ÚÒÙÔ ÂÓı‹ÌÂÚÔ Î¿ı ÌËÓfi˜. ™ÙÔ Ê‡ÏÏÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ οı ·È‰ÈÔ‡ ηٷÁÚ¿ÊÔÓÙ·Ó ÛÙÔȯ›· ·fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi (·Ó·ÈÌ›·, ›ÎÙÂÚÔ˜, Ë·Ù›Ùȉ·, Ï‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ) Î·È ·fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi (ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ¿ÏÏË ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂÈ·, ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘ G6PD) ηıÒ˜ Î·È Ë Ù˘¯fiÓ Ï‹„Ë ‰È·ÊfiÚˆÓ Ê·ÚÌ¿ÎˆÓ Î·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 7 Ë̤Ú˜ ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·. ™Â fiÏ· Ù· ·ÓˆÙ¤Úˆ ·È‰È¿, Ë ·ÈÌÔÏË„›· ¤ÁÈÓ Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛıÔ‡Ó (1) Ë Ë·Ù›Ùȉ· Î·È Ë ·Ó·ÈÌ›· (Hb, Ht, ÏÂ˘Î¿-Ù‡Ô˜, ·ÈÌÔÂÙ¿ÏÈ·, ¢EK, SGOT, SGPT, ÁGT, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË, ÔÏÈο Ï¢ÎÒÌ·Ù· ÔÚÔ‡, ÏÂ˘ÎˆÌ·Ù›Ó˜, ÛÊ·ÈÚ›Ó˜) Î·È (2) Ó· ÂÏÂÁ¯ı› Ë Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ (ÔÏÈ΋, ¿ÌÂÛË, ¤ÌÌÂÛË).

H ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤ÁÈÓ Û 118 ·È‰È¿ ÌÂÙ¿ ·fi ·ÔÌfiÓˆÛË ÙÔ˘ ÁÔÓȉȈ̷ÙÈÎÔ‡ DNA (genomic DNA) ·fi ÏÂÌÊÔ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. °È· ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ¯ÚËÛÈÌÔÔÈ‹ıËΠPUROGENE DNA extraction kit (Gentra Systems). T· ‰Â›ÁÌ·Ù· ÙÔ˘ DNA ÔÏÏ·Ï·ÛÈ¿ÛıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) Ì ‰˘Ô ÂÎÎÈÓËÙ¤˜ - Û˘ÓıÂÙÈο ÔÏÈÁÔÓÔ˘ÎÏÂÔÙ›‰È· (primers): C - 5' -GTCACGTGACACAGTCAAAC-3' Î·È D - 5' -TTTGCTC-CTGCCAGAGGTT-3' Ù· ÔÔ›· ÔÏÏ·Ï·ÛÈ¿˙Ô˘Ó ÙÌ‹Ì·Ù· DNA ÌÂÁ¤ıÔ˘˜ 98-100 ˙¢ÁÒÓ ‚¿ÛÂˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘. O ÂÎÎÈÓËÙ‹˜ D ‹Ù·Ó ÛËÌ·Ṳ̂ÓÔ˜ Ì ÙË ÊıÔÚÈÔ¯ÚˆÛÙÈ΋ Ô˘Û›· Texas Red. OÈ Û˘Óı‹Î˜ Ù˘ ·ÓÙ›‰Ú·Û˘ PCR ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó 35 ·ÎÏÔÈ ·Ú¯›˙ÔÓÙ·˜ Ì 40ÔC ÁÈ· 40'', 72ÔC ÁÈ· 40'' Î·È 95ÔC ÁÈ· 30''.

H ·Ó¿Ï˘ÛË Ù˘ ·ÏÏËÏÔ˘¯›·˜ ÙˆÓ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹, ¤ÁÈÓ ÌÂÙ¿ ·fi ËÏÂÎÙÚÔÊfiÚËÛË Û ‹Îو̷ ·ÎÚ˘Ï·Ì›‰Ë˜ (6%), Ì ÙË ¯Ú‹ÛË Û˘Û΢‹˜ ·˘ÙfiÌ·Ù˘ ·Ó¿Ï˘Û˘ Ù˘ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ DNA (VISTRA 725 version 2.0).

T· 100 ˙‡ÁË ‚¿ÛÂˆÓ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ ·ÏÏËÏfiÌÔÚÊÔ A(TA)7TAA.

AÔÙÂϤÛÌ·Ù· ™ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ 285 ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ Ô˘ ÂϤÁ¯ıËÎ·Ó Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÌÂıfi‰Ô˘˜ ‰È·ÈÛÙÒıËΠfiÙÈ 35/285 ›¯·Ó ̤ÛË Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ >1 mg/dl (12,3%), ¤Ó· ·fi Ù· ··Ú·›ÙËÙ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û.G. H ÌÔÚȷ΋ ·Ó¿Ï˘ÛË Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ÌÂϤÙË Ù˘ ·ÏÏËÏÔ˘¯›·˜ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹ A (TA)nTAA ÙÔ˘ ÂÍÔÓ›Ô˘ 1A ¤ÁÈÓ Û 3 ÔÌ¿‰Â˜ ·È‰ÈÒÓ.

K·Ù·Ú¯‹Ó, ‰È·ÈÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÚÒÙË ÔÌ¿‰· 71/285 ·È‰ÈÒÓ (Ù˘¯·›Ô ‰Â›ÁÌ·, 1:4 ·È‰›) ‰È·ÈÛÙÒıËΠÔÌÔ˙˘ÁˆÙÈÛÌfi˜ ÁÈ· ÙÔ Û.G. (TA)7/TA)7 Û 13 ·È‰È¿ (18,3%), ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi˜ (TA)6/(TA)7 Û 23 (32,4%) Î·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ÁÔÓfiÙ˘Ô˜ (TA)6/(TA)6 Û 35 ·È‰È¿ (49,3%) (¶›Ó·Î·˜ 1). ¶›Ó·Î·˜ 1. °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·ÛıÂÓÒÓ (n = 71/285). °ONOTY¶O™

¶AI¢IA

(n = 71)

n

%

6/6

35

49,3

6/7

23

32,4

7/7

13

18,3

H ‰Â‡ÙÂÚË Î·È ÙÚ›ÙË ÔÌ¿‰· ·ÊÔÚÔ‡Û·Ó 35 Î·È 83 ·È‰È¿ ·ÓÙÈÛÙÔ›¯ˆ˜ Ù· ÔÔ›· Ù·ÍÈÓÔÌ‹ıËÎ·Ó ·Ó¿ÏÔÁ· Ì ÙË Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ >1 mg/dl Î·È ≤1 mg/dl. T· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÁÔÓÔÙ‡ˆÓ ÙˆÓ 35/285 ·È‰ÈÒÓ Ù˘ ‰Â‡ÙÂÚ˘ ÔÌ¿‰·˜ Ì ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl, ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ 57,1% ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· (TA)7/(TA)7 Î·È ÙÔ 31,4% ÂÙÂÚÔ˙˘ÁÒÙ˜ (TA)6/TA)7. E›Ó·È ‰Â ÂӉȷʤÚÔÓ fiÙÈ ÛÙËÓ ÔÌ¿‰· ·˘Ù‹ ‰ÂÓ ‰È·ÁÓÒÛıËΠÔÌÔ˙˘ÁˆÙÈÛÌfi˜ ‹ ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi˜ ÛÙÔ 8,6% ÙˆÓ ·È‰ÈÒÓ ·ÚfiÏÔ Ô˘ Ë Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ ‹Ù·Ó >1 mg/dl. E›Û˘ Ú¤ÂÈ Ó· Û¯ÔÏÈ·ÛÙ› fiÙÈ Û ¤Ó·Ó ·ÛıÂÓ‹ Ù˘ ÔÌ¿‰·˜ ·˘Ù‹˜ ‚Ú¤ıËΠÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi˜ ÁÈ· ÙË Û¿ÓÈ· ÌÂÙ¿ÏÏ·ÍË (TA)6/(TA)8 (¶›Ó·Î·˜ 2). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÔÌ¿‰· ÙˆÓ 83/285 ·È‰ÈÒÓ Ì ¯ÔÏÂÚ˘ıÚ›ÓË ≤1 mg/dl Â›Ó·È ÂÓÙ˘ˆÛÈ·Îfi fiÙÈ ÂÓÒ fiˆ˜ ·Ó·ÌÂÓfiÙ·Ó Ô ÁÔÓfiÙ˘Ô˜ ‰È·ÈÛÙÒıËÎÂ

23

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™ÂÏ›‰·24

¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

A. TÛ¤˙Ô˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Ù·ÍÈÓfiÌËÛË ·È‰ÈÒÓ Ì ÎÚÈÙ‹ÚÈÔ ÙËÓ ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘.

XO§EPY£. > 1 mg/dl (n = 35)

XO§EPY£. ≤ 1 mg/dl (n = 83)

°ÔÓfiÙ˘Ô˜

n

%

°ÔÓfiÙ˘Ô˜

n

%

6/6

3

8,6

6/6

43

51,9

6/7

11

31,4

6/7

31

37,3

7/7

20

57,1

7/7

9

10,8

6/8

1

2,9

Ê˘ÛÈÔÏÔÁÈÎfi˜ ÛÙÔ 51,9% ÂÚ›Ô˘, ÂÓÙÔ‡ÙÔȘ 37,3% ‚Ú¤ıËÎ·Ó ÂÙÂÚÔ˙˘ÁÒÙ˜ (TA)6/(TA)7 Î·È 10,8% ÔÌÔ˙˘ÁÒÙ˜ (TA)7/(TA)7 (¶›Ó·Î·˜ 2). H Û˘Û¯¤ÙÈÛË Ù˘ ̤Û˘ ÙÈÌ‹˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ Ì ÙÔ ÁÔÓfiÙ˘Ô ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÁÔÓfiÙ˘Ô˘ (TA)6/(TA)6 Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘ (TA)7/(TA)7 (p<0.001), ηıÒ˜ Î·È ÌÂٷ͇ ÙˆÓ ÁÔÓÔÙ‡ˆÓ (TA)6/(TA)7 Î·È (TA)7/(TA)7 (p < 0.001) (¶›Ó·Î·˜ 2). ™ÙÔ ÈÛÙfiÁÚ·ÌÌ· (EÈÎfiÓ· 2) Ê·›ÓÔÓÙ·È ·Ú·ÛÙ·ÙÈο Ù· ·ÓˆÙ¤Úˆ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ 2 ÔÌ¿‰Â˜ ·È‰ÈÒÓ Ì ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl (·ÚÈÛÙÂÚ¿) Î·È ≤1 mg/dl (‰ÂÍÈ¿). ™ÙËÓ EÈÎfiÓ· 3, ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Ì¤ÛË Î·È ÔÈ ·ÎÚ·›Â˜ ÙÈ̤˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ Û ۯ¤ÛË Ì ÙÔ ÁÔÓfiÙ˘Ô. ÕÙÔÌ· Ì ÔÌÔ˙˘ÁˆÙÈÛÌfi (TA)7/(TA)7, ¤¯Ô˘Ó ̤ÛË ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘ 1,5 mg/dl Ì ·ÓÒÙ·ÙË ÙÈÌ‹ 1,8 mg/dl ÂÓÒ, ÔÈ ÂÙÂÚÔ˙˘ÁÒÙ˜ ¤¯Ô˘Ó ̤ÛË ÙÈÌ‹ 0.9 mg/dl Ì ·ÓÒÙ·ÙË ÙÈÌ‹ ÂÚ›Ô˘ 1,1 mg/dl. T· ·Ôχو˜ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ˆ˜ ÚÔ˜ ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓfiÙ˘Ô (TA)6/(TA)6, ¤¯Ô˘Ó ¯ÔÏÂÚ˘ıÚ›ÓË Ì¤¯ÚÈ 0,7 mg/dl. º·›ÓÂÙ·È Â›Û˘ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÂÈ-

Î¿Ï˘„Ë ÙˆÓ ÏËı˘ÛÌÒÓ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ.

A˜ ÛËÌÂȈı›, fiÙÈ ÌÂÙ¿ ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ ʇÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ ÁÔÓfiÙ˘Ô ÁÈ· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÌÂÙ¿ÏÏ·ÍË, ‰ÂÓ ‚Ú¤ıËΠ‰È·ÊÔÚ¿. Ÿˆ˜ Â›Û˘, ‰ÂÓ ‚Ú¤ıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ, fiÙ·Ó ÙÔ Û.G. ‰È·ÁÓÒÛıËΠ̠‚¿ÛË ÙÔ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘.

EÈÎfiÓ· 2. IÛÙfiÁÚ·ÌÌ· Ì ٷ ·ÔÙÂϤÛÌ·Ù·

EÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÁÔÓfiÙ˘Ô˘ Î·È Û˘ÁΤÓÙÚˆÛ˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (± fiÚÈÔ ÂÌÈÛÙÔÛ‡Ó˘ 95%).

ÙÔ˘ ¶›Ó·Î· 2.

24

™˘˙‹ÙËÛË H ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È Ù˘¯·›· ÌÂÙ¿ ·fi ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÓËÛÙ›·˜ (fiˆ˜ Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ), Û·ÓÈfiÙÂÚ· ‰Â, ÛÙ· Ï·›ÛÈ· ‰ÈÂÚ‡ÓËÛ˘ Â›ÌÔÓˆÓ ‰È·ÏÂÈfiÓÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÓÔ¯ÏËÌ¿ÙˆÓ (1,2). ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÌÂÙ·‚ÔϤ˜ ÛÙÔ Ú˘ıÌfi ·Ú·ÁˆÁ‹˜ ¯ÔÏÂÚ˘ıÚ›Ó˘, ÛÙËÓ ·Ú·ÁˆÁ‹ Ë·ÙÈ΋˜ ·›Ì˘ Î·È ÛÙËÓ Ë·ÙÈ΋ ÚfiÛÏË„Ë ¯ÔÏÂÚ˘ıÚ›Ó˘ (2). §fiÁˆ Ù˘ ηÏÔ‹ıÔ˘˜ ʇÛ˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ¤¯ÂÈ ÂÎÊÚ·Ûı› Ë ¿Ô„Ë Ó· ıˆÚÂ›Ù·È ÙÔ Û‡Ó‰ÚÔÌÔ ˆ˜ ÌÈ· Ê˘ÛÈ΋ ÁÂÓÂÙÈ΋ ·Ú·ÏÏ·Á‹ ·Ú¿ ˆ˜ ·Ûı¤ÓÂÈ·.

JAN.-FEB.2000

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋/ Ê·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË

TÔ ·ıÔÁÂÓÂÙÈÎfi ˘fi‚·ıÚÔ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert Â›Ó·È Ë ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ÁÏ˘ÎÔ˘ÚÔÓÔÔ›ËÛ˘ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Ë ÔÔ›· ÂȉÂÈÓÒÓÂÙ·È Û ÔÚÈṲ̂Ó˜ ηٷÛÙ¿ÛÂȘ (fiˆ˜ ÓËÛÙ›·, ·Ûı¤ÓÂȘ ‹ ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ) Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ›ÎÙÂÚÔ (¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·) (16). H ¤ÌÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË Â›Ó·È ÙÔÍÈÎfi ÌfiÚÈÔ Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙÔ Ô˘ÚȉÈÓÔ-‰ÈʈÛÊÔ-ÁÏ˘ÎÔ˘ÚÔÓÈÎfi Ô͇, ·ÓÙ›‰Ú·ÛË Ë ÔÔ›· ηٷχÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ·fi ÙÔ Ë·ÙÈÎfi ÌÈÎÚÔÛˆÌÈ·Îfi ¤Ó˙˘ÌÔ bilirubin UGT, (uridine diphosphoglucuronosyltransferase (UGT)), ÙÔ ÔÔ›Ô ·ÓÂ·ÚΛ Û ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙ· ¿ÙÔÌ· Ì ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert. OÈ ÙÈ̤˜ Ù˘ ¤ÌÌÂÛ˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÛÙ· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Gilbert Ô˘ ‰ÂÓ ˘Ô‚Ï‹ıËÎ·Ó Û ÓËÛÙ›· Â›Ó·È ÂÏ·ÊÚÒ˜ ·˘ÍË̤Ó˜ (>1 mg/dl) Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ÍÂÂÚÓÔ‡Ó Ù· 2,9 mg/dl, ÂÎÙfi˜ ·fi ÂÚÈÙÒÛÂȘ ÓËÛÙ›·˜, ·Ûı¤ÓÂÈ·˜ ‹ ¯ÔÚ‹ÁËÛ˘ Ê·Ú̿ΈÓ, ÂÓÒ ÙÔ Û. Gilbert ‰ÂÓ Û˘Ó‰¤ÂÙ·È Ì ΛӉ˘ÓÔ ˘ÚËÓÈÎÔ‡ ÈÎÙ¤ÚÔ˘ (17-18). ÕÙÔÌ· Ì ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ¤¯Ô˘Ó ÔÈÎÈÏÔÌÔÚʛ˜ (ÌÂÙ·ÏÏ¿ÍÂȘ) ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ TATAA box ÙÔ˘ ÁÔÓȉȷÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ UGT1, ‰ËÏ·‰‹ ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· Ù· ÔÔ›· ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ¤Ó·ÚÍË ÌÂÙ·ÁÚ·Ê‹˜ (transcription initiation) (6,11).

E›Ó·È ‰Â ÂӉȷʤÚÔÓ fiÙÈ Ì ÙË DNA ·Ó¿Ï˘ÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfïÓ, ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ›ÎÙÂÚÔ˘ Î·È ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ (·ÓÒÙÂÚË ÙÈÌ‹ 1 mg/dl) ˘ÔÏÔÁ›ÛıËΠ۠40% Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÁÈ· ÙËÓ ÂÈÌËΤÛÙÂÚË ÂÚÈÔ¯‹ TATAA (11), ÂÓÒ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÎÏÈÓÈ΋˜-‚ÈÔ¯ËÌÈ΋˜ ‰È¿ÁÓˆÛ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ‰ÂÓ ÍÂÂÚÓ¿ÂÈ ÙÔ 12% (4-6).

E›Ó·È ÛËÌ·ÓÙÈÎfi fï˜ Ó· ÙÔÓÈÛı› fiÙÈ ÔÈ ÁÔÓȉȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉȷÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ UGT1 Â›Ó·È ÌÂÓ ·Ó·Áη›· ÚÔ¸fiıÂÛË Û ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ ÌÂÙ·ÏÏ¿ÍÂȘ Û οÔÈÔ ÂÍfiÓÈÔ, ·ÏÏ¿ fi¯È ÈηӋ ÁÈ· ÙËÓ Ï‹ÚË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤¯ÂÈ ıˆÚËı› ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ¿ÏÏˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ‹ Â›ÎÙËÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÂÈÚÔÛı¤Ùˆ˜ Ì ÙË ÌÂȈ̤ÓË ÁÏ˘ÎÔ˘ÚÔÓÔÔ›ËÛË (11). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ÙˆÓ ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ [(TA)7/(TA)7], ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Û 57,1% ÙˆÓ ·È‰ÈÒÓ Ì Û.G., ÁÂÁÔÓfi˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙË Û˘ÌÌÂÙÔ¯‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ Û.G. E›Û˘, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ̤Û˘ ÙÈÌ‹˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘. ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ó ‰È·ÈÛÙˆı› Î·È ·fi ÙÔ˘˜ Monaghan Î·È Û˘Ó. (1996) Î·È Bosma ηÈ

Û˘Ó. (1995) (6,11). E›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·fi ÙË ÁÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÙÔ˘ Ù˘¯·›Ô˘ ‰Â›ÁÌ·ÙÔ˜ (n=71) ·Ú·ÙËÚ‹ıËΠfiÙÈ ÙÔ 18,3% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË (TA)7/(TA)7, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. Û ¿ÏϘ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜, fiˆ˜ ÚԷӷʤÚıËÎÂ, ‰ÂÓ ÍÂÂÚÓ¿ ÙÔ 12% (4-6). ™ÙË ÌÂϤÙË Ì·˜ Â›Û˘ ‚Ú¤ıËΠfiÙÈ 1 ·È‰› ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 118 ›¯Â ÔÏÈ΋ ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘ 2,5 mg/dl, Ô ‰Â ÁÔÓfiÙ˘Ô˜ ‹Ù·Ó (TA)6/(TA)8. A˘Ù‹ Â›Ó·È Ë ‰Â‡ÙÂÚË ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÊÔÚ¿ Û ¿ÙÔÌÔ Ï¢΋˜ Ê˘Ï‹˜ ÌÂÙ¿ ÙÔ˘˜ Iolascon Î·È Û˘Ó. (1999) (19).

T¤ÏÔ˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÁÔÓÔÙ‡ˆÓ Î·È ÙÔ˘ ʇÏÔ˘ ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. H ·Ú·Ù‹ÚËÛË ·˘Ù‹ ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÙȘ ÌÂϤÙ˜ ÙˆÓ Monaghan Î·È Û˘Ó. (1996) Î·È Bancroft Î·È Û˘Ó. (1998) Î·È ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙÔ fiÙÈ ‰ÈÂÚ¢ӋıËÎ·Ó ¿ÙÔÌ· Ó·ڋ˜ ËÏÈΛ·˜ Î·È ÂÔ̤ӈ˜ ÂÏ·¯ÈÛÙÔÔÈ‹ıËÎÂ Ë Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ê¿Ú̷η, ·ÏÎÔfiÏ Î.¿. ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (6,20). ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÚfiÛÊ·Ù· ¤¯ÂÈ Û˘Ó‰Âı› Ë ·ÚÔ˘Û›· Ù˘ ÔÈÎÈÏÔÌÔÚÊ›·˜ ÛÙÔÓ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ Ì ÙËÓ ·Ú·ÙËÚÔ‡ÌÂÓË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· Û ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ (21) ۯ‰ȿ˙ÂÙ·È Ë Â¤ÎÙ·ÛË ÙÔ˘ ÂϤÁ¯Ô˘ ÙÔ˘ Û.G. Ì ÛÎÔfi ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÌÂÙ¿ÏÏ·Í˘ (TA)7/(TA)7 Ì ÙÔÓ ÁÔÓfiÙ˘Ô Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Fevery J. Pathogenesis of Gilbert syndrome. Eur J Clin Invest 1981; 11:417-418.

2. Watson KJR, Collan JL. Gilbert’s syndrome. Baillieres Clin Gastroenterol 1989; 3:337-355.

3. Powel LW, Hemingway E, Billing BH, Sherlock S. Idiopathic unconjugated hyperbilirubinemia (Gilbert’s syndrome): a study of 42 families. N. Engl J Med 1967; 277:1108-1112.

4. Bailey A, Robinson D, Dawson AM. Does Gilberts disease exist? Lancet 1977; 1:931-933.

5. Owens D, Evans J. Population studies on Gilberts syndrome. J Med Genet 1975; 12:152-156.

6. Monaghan G, Ryan M, Sedon R, Hume R, Burchell B. Genetic variation in bilirubin UDP-glucuronosyltransferase gene promoter and Gilbert’s syndrome. Lancet 1996; 347:578-581.

7. Thompson RPH. Genetic transmission of Gilbert’s syndrome and drug metabolism. Clin Pharmacokinet 1981; 4:223-232.

8. Owens IS, Ritter JK. The novel bilirubinphenol UDPglucuronyl transferase UGT1 locus: implications for multiple nonhemolytic familial hyperbilirubinemia phenotypes. Pharmacogenetics 1992; 2:93-108.

9. Ritter JK, Chen F, Sheen YY, Tran HM, Kimura S, Yeatman

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MT et al. A novel complex locus UGT1 encodes human bilirubin phenol, and other UDP-glucoronosyltransferase isoenzymes with identical carboxyl termini. J Biological Chemistry 1992; 267:3257-3261.

10. Seppen J, Bosma PJ, Goldhoorn BG, Bokker CTM, Chowdhury JR, Chowdhury NR, et al. Discrimination between Crigler-Najjar Type I and II by Expression of mutant bilirubin uridine diphosphate glucuronosyltransferase. J Clin Invest 1994; 94:2385-2391.

11. Bosma PJ, Chowdhury JR, Bakker C, Gantla S, DeBoer A, Oostra BA, et al. The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert’s syndrome. N Engl J Med 1995; 333(18):1171-1175.

12. Aono S, Adachi Y, Uyama E, Yamada Y, Keino H, Nanno T, et al. Analysis of genes for bilirubin UDPglucuronosyltranferase in Gilbert’s syndrome. Lancet 1995; 345:58-59.

A. TÛ¤˙Ô˘ Î·È Û˘Ó.

13. Koiwai O, Nishizawa M, Hasada K, Aono S, Adachi Y, Mamiya N, et al. Gilberts syndrome is caused by a heterozygous missense mutation in the gene for bilirubin UDP-glucuronosyltransferase. Hum Molec Genet 1995; 4:1183-1186.

14. Soeda Y, Yamamoto K, Adachi Y, Hori T, Aono S, Koiwai O, et al. Predicted homozygous missense mutation in Gilbert’s syndrome. Lancet 1995; 346:1494.

15. Sato H, Adachi Y, Koiwai O. The genetic basis of Gilbert’s syndrome. Lancet 1996; 345:557-558.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· K›ÙÛÈÔ˘, B' ¶·È‰/΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" 11527, Aı‹Ó·.

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™‡ÁÎÚÈÛË Â˘·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ Ù˘ EÏÏ¿‰·˜ Î·È Ù˘ AÁÁÏ›·˜ ËÏÈΛ·˜ 5 - 7,5 ¯ÚfiÓˆÓ ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·1, K·ÙÂÚ›Ó· NÂÛÙÔÚ›‰Ô˘1, N·Ù¿Û· ¶··‰ÔÔ‡ÏÔ˘1, ¶·Ó·ÁÈÒÙ˘ MfiÙ˘1, Hassan Arshad2, Taraneh Dean2, Sharron Matthews2, Bearny Mealy2

● ¶ÂÚ›ÏË„Ë: MÂϤÙ˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·È ÛÙÔ ÛÙ·ıÌÈṲ̂ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ISAAC Û ‰È·ÊÔÚÂÙÈο ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ Â˘Ú›· ÔÈÎÈÏ›· ÛÙÔÓ ÂÈÔÏ·ÛÌfi ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ Û˘Ìو̿وÓ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ·È‰ÈÒÓ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜, Û ‰‡Ô ¯ÒÚ˜ Ù˘ BfiÚÂÈ·˜ Î·È NfiÙÈ·˜ E˘ÚÒ˘. ™Ù· Ï·›ÛÈ· ÌÈ·˜ ÌÂϤÙ˘ ÚfiÏ˄˘ ¿ÛıÌ·ÙÔ˜ Û ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (SPACE), ÌÂÏÂÙ‹ıËÎ·Ó 1439 ·È‰È¿ ·fi ÙËÓ EÏÏ¿‰· Î·È 364 ·È‰È¿ ·fi ÙËÓ AÁÁÏ›·, ËÏÈΛ·˜ 5 - 7,5 ¯ÚfiÓˆÓ. Afi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ˙ËÙ‹ıËΠӷ Û˘ÌÏËÚÒÛÔ˘Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ ‡·ÚÍË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜. E¿Ó ‹Ù·Ó ıÂÙÈÎfi, ÁÈÓfiÙ·Ó ÛÙ· ·È‰È¿ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÁÈ· ‰‡Ô ÎÔÈÓ¿ ·Î¿Ú· (Der Pteronyssinus Î·È Der Farinae), ÁÈ· Ì›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ Î·È ÙÚ›¯ˆÌ· Á¿Ù·˜. ¢ÔÎÈÌ¿ÛÙËÎ·Ó Â›Û˘ ‰‡Ô ÚfiÛıÂÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÂȉÈο Û οı ÂÚÈÔ¯‹ Û‡Ìʈӷ Ì ÙȘ ÁÓˆÛÙ¤˜ ·ÏÏÂÚÁÈΤ˜ ¢·ÈÛıËۛ˜ Û ·˘Ù¤˜ ÙȘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜. E˘·ÈÛıËÙÔÔÈË̤ӷ Û ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÏÂÚÁÈÔÁfiÓ· ‚Ú¤ıËÎ·Ó 140 (9,7%) ·È‰È¿ ÛÙËÓ EÏÏ¿‰· Î·È 92 (25,3%) ·È‰È¿ ÛÙËÓ AÁÁÏ›· (p<0,001). ÕÏÏÔ ÂÓÙ˘ˆÛÈ·Îfi ‡ÚËÌ· ‹Ù·Ó Ë Ôχ ¯·ÌËÏ‹ ¢·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ÛÙ· EÏÏËÓfiÔ˘Ï· (Der P1: 1,81%, Der f1: 1,25%) Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ù˘ AÁÁÏ›·˜, fiÔ˘ ·˘Ùfi ‹Ù·Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ (Der P1: 14,8%, Der f1: 5,2%). H ¢·ÈÛıËÙÔÔ›ËÛË Û Ì›ÁÌ· Á‡Ú˘ ÁÚ·ÛȉÈÔ‡ ‹Ù·Ó 4,4% Î·È Û ÙÚ›¯ˆÌ· Á¿Ù·˜ 4,1% ÛÙ· ·È‰È¿ Ù˘ EÏÏ¿‰·˜, ÂÓÒ ÛÙ· ·È‰È¿ Ù˘ AÁÁÏ›·˜ ÔÈ ÙÈ̤˜ ‹Ù·Ó 13,2% Î·È 10,2% ·ÓÙ›ÛÙÔȯ·. ŸÏ˜ ÔÈ Û˘ÁÎÚ›ÛÂȘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ (p<0,001). ™˘ÌÂÚ·›ÓÔ˘Ì fiÙÈ Ë ·ÏÏÂÚÁÈ΋ ¢·ÈÛıËÙÔÔ›ËÛË Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Â›Ó·È Ôχ ¯·ÌËÏfiÙÂÚË ÛÙËÓ EÏÏ¿‰· Û ۇÁÎÚÈÛË Ì ÙËÓ AÁÁÏ›·. TÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È ÙÔ ÎÔÈÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ AÁÁÏ›·, ·ÏÏ¿ fi¯È Û˘¯Ófi ÛÙËÓ EÏÏ¿‰·. ¶·È‰È·ÙÚÈ΋ 2000;63:27-33. §¤ÍÂȘ ÎÏÂȉȿ: ¢·ÈÛıËÙÔÔ›ËÛË, ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·, ·Î¿Ú·, ·È‰È¿.

S. Tsitoura, K. Nestoridou, N. Papadopoulou, P. Botis, H. Arshad, T. Dean, S. Matthews, B. Mealy.

Comparison of sensitisation to aeroallergens in British and Greek school children aged 5 to 7.5 years.

Paediatriki 2000;63:27-33. ● Abstract: ISAAC studies from different parts of the world have shown wide variations in the prevalence of allergic symptoms according to response to a standardised questionnaire. We studied the prevalence of sensitisation in 57.5 year-old children with a family history of atopy, by skin prick tests to common aeroallergens, in two countries, Great Britain and Greece, in Northern and Southern Europe respectively. As a part of a study on prevention of allergy in at risk children (SPACE), parents of school children aged 5 to 7.5 years were asked to complete a questionnaire on the presence of family atopy. If the atopy history was positive, the children were tested by skin prick to two, common house dust mites (Der pteronyssinus: Der P1 and Der farinae: Der f1), grass pollen and cat.

Two additional allergens specific to each country were also tested, according to the known allergen sensitivities in those geographical locations. We studied 1439 Greek and 364 British children, of which 140 (9.7%) Greek children were sensitised to one or more allergens, compared to 92 (25.3%) British children (p<0.001). A striking finding

1 2

TÌ‹Ì· KÔÈÓˆÓÈ΋˜ I·ÙÚÈ΋˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡", Aı‹Ó· The David Hide Asthma & Allergy Research Centre, St. Mary's Hospital, Isle of Wight, UK

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was the very low sensitisation to house dust mites in Greek children (Der P1: 1.81%, Der f1: 1.25%) compared to British children in whom this was the commonest allergen (Der P1: 14.8%, Der f1: 5.2%). Sensitisation to grass pollen mix was 4.4% and cat 4.1% in Greek children, whereas for British children the respective values were 13.2% and 10.2%. All the differences were highly significant (p<0.001). We conclude that allergic sensitisation in primary school age children is much lower in Greece than in Britain. House dust mite was the commonest allergen in Britain, but rare in Greece.

Key words: sensitisation, aeroallergens, mites, children.

EÈÛ·ÁˆÁ‹ ™ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ ÔÏϤ˜ ¯ÒÚ˜ ›¯·Ó ÙËÓ ÂÌÂÈÚ›· ·‡ÍËÛ˘ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ (Û 20-30%) Î·È Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. TËÓ ›‰È· ÂÚ›Ô‰Ô, Ô ÏËı˘ÛÌfi˜ ÙÔ˘ ·Ó·Ù˘Á̤ÓÔ˘ ÎfiÛÌÔ˘ ¿ÏÏ·Í ÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ‹˜ ÙÔ˘ (1). H ÌfiÓˆÛË ÙˆÓ Î·ÙÔÈÎÈÒÓ Â›Ó·È Î·Ï‡ÙÂÚË Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·Ù‹ÚËÛË ÛÙ·ıÂÚ¿ ıÂÚÌÔ‡ ·ÏÏ¿ Î·È ˘ÁÚÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ·Ú¤¯ÂÈ È‰·ÓÈΤ˜ Û˘Óı‹Î˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ÁÈ· ÌÂÁ¿Ï˜ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜ οı ¤ÙÔ˜. O ηÎfi˜ ·ÂÚÈÛÌfi˜ Â›Û˘ ·˘Í¿ÓÂÈ ÙË Û˘ÁΤÓÙÚˆÛË ‰È·ÊfiÚˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ Ú‡ˆÓ, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·˘Í¿ÓÔÓÙ·È ÔÈ Î¿ÙÔ¯ÔÈ Î·ÙÔÈΛ‰ÈˆÓ ˙ÒˆÓ. ŒÎıÂÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË Û ·ÏÏÂÚÁÈÔÁfiÓ· Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ¤¯ÂÈ ·Ô‰Âȯı› ˆ˜ ·ÚÈ· ·ÈÙ›· ·Ó¿Ù˘Í˘ ¿ÛıÌ·ÙÔ˜ Û ÔÏÏ¿ ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘ (2-10). ¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ Û ÂÚÈÔ¯¤˜ Ì ¯·ÌËÏ¿ Â›‰· ·Î¿ÚÂˆÓ ·¤‰ÂÈÍ·Ó ÙËÓ ÛËÌ·Û›· Ù˘ ¤ÎıÂÛ˘ Û ¿ÏÏ· ÂÓ‰ÔÔÈÎȷο ·ÏÏÂÚÁÈÔÁfiÓ·, ÂȉÈο ·˘Ù¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi Á¿Ù˜, Û·ÏÔ˘˜ Î·È Î·ÙÛ·Ú›‰Â˜ (11,12). P˘·ÓÙ¤˜, fiˆ˜ ÙÔ fi˙ÔÓ Î·È ÙÔ ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ı›Ԣ, Ê·›ÓÂÙ·È fiÙÈ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ IgE (13,14) Î·È Ù· ·È‰È¿ ÙˆÓ Î·ÓÈÛÙÒÓ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÙÔÈ΋ ÓfiÛÔ (15).

EÔ̤ӈ˜, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙÔ Â›‰Ô˜ Î·È ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË.

H ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ ÚfiÏ˄˘ ·ÏÏÂÚÁ›·˜ ÛÙ· ·È‰È¿ Ù˘ E˘ÚÒ˘ (SPACE - Study on Prevention of Allergy in Children in Europe). ™ÎÔfi˜ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ‰È¿ÊÔÚ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ Ô˘ ˙Ô˘Ó Û ¯ÒÚ˜ Ì ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ (AÁÁÏ›·-N‹ÛÔ˜ Wight Î·È EÏÏ¿‰·-Aı‹Ó·).

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™Â ÁÔÓ›˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 5-7,5 ¯ÚfiÓˆÓ, Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙÔ ÚfiÁÚ·ÌÌ· ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ÓËÈ·ÁˆÁ›ˆÓ, ȉȈÙÈÎÒÓ Î·È ‰ËÌÔÛ›ˆÓ Û¯ÔÏ›ˆÓ ÙÔ˘

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¶›Ó·Î·˜ 1. EÚˆÙËÌ·ÙÔÏfiÁÈÔ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÏÏÂÚÁ›·˜ (ISAAC) ÁÈ· ÌËÙ¤Ú·, ·Ù¤Ú·, ·‰ÂÏÊfi/‹.

1. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ¿ÛıÌ·; 2. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· Âԯȷ΋ ·ÏÏÂÚÁÈ΋ ÚÈÓÔ-ÂÈÂÊ˘Î›Ùȉ· (·ÚÈÓfi ηٿÚÚÔ˘); 3. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÂÍ¿ÓıËÌ· Ì ʷÁÔ‡Ú· Ô˘ Ó· ÂÌÊ·Ó›˙ÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 6 Ì‹Ó˜; 4. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÔÔÈ·‰‹ÔÙ ÛÙÈÁÌ‹ ÛÙÔ ·ÚÂÏıfiÓ; 5. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÊÙÂÚÓ›ÛÌ·Ù·, ‚Ô˘ÏˆÌ¤ÓË Ì‡ÙË ‹ Û˘Ó¿¯È (¯ˆÚ›˜ fï˜ Ó· ¤¯ÂÈ ÎÚ˘ÔÏfiÁËÌ· ‹ ÁÚ›Ë) ηÈ/‹ ÚËṲ̂ӷ Ì¿ÙÈ· Ô˘ Ó· ¤¯Ô˘Ó Ê·ÁÔ‡Ú·; ¢ڇÙÂÚÔ˘ ΤÓÙÚÔ˘ ÙˆÓ AıËÓÒÓ, ‰È·ÓÂÌ‹ıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ISAAC ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜ (›Ó·Î·˜ 1). E¿Ó Ë ·¿ÓÙËÛË ‹Ù·Ó ıÂÙÈ΋, ›Ù ÁÈ· ¤Ó· ÁÔÓ¤·, ›Ù ÁÈ· ·‰ÂÏÊfi/‹, ÙÔ ·È‰› ÂÓÙ·ÛÛfiÙ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ·. M ÁÚ·Ù‹ Û˘Ó·›ÓÂÛË, ‡ÛÙÂÚ· ·fi ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓ¤ˆÓ, ¤ÁÈÓ·Ó Û 1439 ·È‰È¿ (63,1% ·ÁfiÚÈ·) Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜, ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ (SPT) ÁÈ· 6 ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·, [Dermatophagoides Pteronyssinus (Der P1), Dermatophagoides Farinae (Der f1), Ì›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ, ÙÚ›¯ˆÌ· Á¿Ù·˜] Î·È ‰‡Ô ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÁÈ· ÙËÓ EÏÏ¿‰· ‹Ù·Ó Á‡ÚË ÂÏÈ¿˜ Î·È parietaria.

M ·Ó¿ÏÔÁÔ ÙÚfiÔ ¤ÁÈÓÂ Ë ÂÈÏÔÁ‹ 364 ·È‰ÈÒÓ (59,4% ·ÁfiÚÈ·) ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ÛÙËÓ Ó‹ÛÔ Wight Ù˘ AÁÁÏ›·˜. T· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÁÈ· Ù· ·È‰È¿ ·˘Ù¿ ‹Ù·Ó ÙÔ ÙÚ›¯ˆÌ· ÙÔ˘ Û·ÏÔ˘ Î·È Ë Á‡ÚË ‰¤ÓÙÚˆÓ. T· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÂÈϤ¯ıËÎ·Ó Û‡Ìʈӷ Ì ٷ ÈÔ ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· Û οı ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹.

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T· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂÎÙÈÌ‹ıËÎ·Ó ÌÂÙ¿ ·fi 15 min Î·È ÌÂÙ¿ ·fi Û‡ÁÎÚÈÛË Ì ıÂÙÈÎfi Î·È ·ÚÓËÙÈÎfi Ì¿ÚÙ˘Ú·. ø˜ ıÂÙÈÎfi˜ Ì¿ÚÙ˘Ú·˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰È˘‰ÚԯψÚÈ΋ ÈÛÙ·Ì›ÓË 1mg%. £ÂÙÈ΋ ¯·-

E˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·

Ú·ÎÙËÚ›ÛÙËÎÂ Ë ·ÓÙ›‰Ú·ÛË Ì ̤ÛË ‰È¿ÌÂÙÚÔ ≥ 2 ¯ÈÏ. ™ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ì ıÂÙÈ΋ ‰ÂÚÌ·ÙÈ΋ ‰ÔÎÈÌ·Û›· ‰È·ÓÂÌ‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ٷ Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ ̤¯ÚÈ ÂΛÓË ÙË ÛÙÈÁÌ‹ (›Ó·Î·˜ 2).

¶›Ó·Î·˜ 2. EÚˆÙËÌ·ÙÔÏfiÁÈÔ.

1. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ¿ÛıÌ·; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 6) 2. Œ‚·Ï ÔÙ¤ ÁÈ·ÙÚfi˜ ÙË ‰È¿ÁÓˆÛË Ó¢ÌÔÓ›·˜ ÛÙÔ ·È‰› Û·˜; AÓ Ó·›, fiÛ˜ ÊÔÚ¤˜;

Ô Ó·È

Ô fi¯È

3. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·; Ô Ó·È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÚÈÓ›Ùȉ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 6)

Ô fi¯È

4. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ¤Î˙ÂÌ·; Ô Ó·È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ¤Î˙ÂÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 7)

Ô fi¯È

5. NÔÛËχÙËΠÔÙ¤ ÙÔ ·È‰› Û·˜ Û ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· Ë̤Ú˜; Ô Ó·È AÓ Ó·È, ÔÈfi˜ ‹Ù·Ó Ô ÏfiÁÔ˜ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘;

Ô fi¯È

6. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÛÙÔ ·ÚÂÏıfiÓ; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 1) AÓ ¤¯ÂÙ ··ÓÙ‹ÛÂÈ "OXI" ·Ú·Î·ÏÒ ËÁ·›ÓÂÙ ÛÙËÓ ÂÚÒÙËÛË 11 7. E›¯Â ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜: Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 2) AÓ ¤¯ÂÙ ··ÓÙ‹ÛÂÈ "OXI" ·Ú·Î·ÏÒ ËÁ·›ÓÂÙ ÛÙËÓ ÂÚÒÙËÛË 11 8.¶fiÛ˜ ÊÔÚ¤˜ ›¯Â ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜: Ô Î·Ì›· Ô 1 ¤ˆ˜ 2 Ô 3 ¤ˆ˜12 Ô ÂÚÈÛÛfiÙÂÚ˜ ·fi 12 (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 3) 9. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜, fiÛÔ Û˘¯Ó¿, ηٿ ̤ÛÔ fiÚÔ, Ô ‡ÓÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ‰È·Ù·Ú¿¯ıËΠÂÍ·ÈÙ›·˜ ÙÔ˘ ‚ڷ̷ۛÙÔ˜; Ô ÔÙ¤ ‰ÂÓ Í‡ÓËÛ Ì ‚Ú¿ÛÈÌÔ Ô ÏÈÁfiÙÂÚÔ ·fi ¤Ó· ‚Ú¿‰˘ ÙËÓ Â‚‰ÔÌ¿‰· Ô ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ‚Ú¿‰È· ÙËÓ Â‚‰ÔÌ¿‰· (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 4) 10. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜ ÙÔ ‚Ú¿ÛÈÌÔ ‹Ù·Ó ÔÙ¤ ·ÚÎÂÙ¿ ÛÔ‚·Úfi ÒÛÙ ӷ ÂÚÈÔÚ›ÛÂÈ ÙËÓ ÔÌÈÏ›· ÙÔ˘ ·È‰ÈÔ‡ Û·˜ Û ÌÈ· ‹ ‰‡Ô ϤÍÂȘ ·Ó¿ÌÂÛ· Û ‰‡Ô ·Ó·ÓÔ¤˜; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7ÂÙÒÓ. EÚÒÙËÛË 5) 11. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜, ¤‚Ú·˙ ÙÔ ÛÙ‹ıÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Û·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ‹ ÌÂÙ¿ ·fi ¿ÛÎËÛË: Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 7) 12. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜, ›¯Â ÙÔ ·È‰› Û·˜ ÍËÚfi‚˯· ÙÔ ‚Ú¿‰˘, ÂÍ·ÈÚÔ˘Ì¤ÓÔ˘ ÙÔ˘ ‚‹¯· Ô˘ ÔÊ›ÏÂÙ·È Û ÎÚ˘ÔÏfiÁËÌ· ‹ Ïԛ̈ÍË ÙˆÓ Ó¢ÌfiÓˆÓ; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 8) 13. E›Ó·È ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎfi Û ÙÚÔʤ˜; ¶·Ú·Î·ÏÒ ÁÚ¿„Ù ÔȘ ÙÚÔʤ˜: TÈ ¤Î·Ó ÙÔ ·È‰› Û·˜ fiÙ·Ó ¤Ê·Á ·˘Ù‹ ÙË ÙÚÔÊ‹; 14. E›Ó·È ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎfi ÛÙ· ˙Ò·; AÓ Ó·È, Û ÔÈ· ˙Ò·; 15. ¶ÔÈÔ˜ Û˘ÌÏ‹ÚˆÛ ·˘Ùfi ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ;

Ô Ó·È Ô ¤ÌÂÙÔ Ô ‚Ú¿ÛÈÌÔ

Ô ‰È¿ÚÚÔÈ· Ô ÎÔÏÈÎfi Ô Ó·È

Ô ÌËÙ¤Ú· Ô ÌËÙ¤Ú· Î·È ·Ù¤Ú·˜

Ô fi¯È Ô ÂÍ¿ÓıËÌ· Ô ¿ÏÏ· Û˘ÌÙÒÌ·Ù·: Ô fi¯È Ô ·Ù¤Ú·˜ Ô ¿ÏÏÔ˜

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AÔÙÂϤÛÌ·Ù· Afi Ù· 1439 ·È‰È¿ Ô˘ ÂϤÁ¯ıËÎ·Ó Ì ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ Aı‹Ó·, 140 (9,7%) ‹Ù·Ó ¢·ÈÛıËÙÔÔÈË̤ӷ Û ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÏÂÚÁÈÔÁfiÓ·, ÂÓÒ ·fi Ù· 364 ·È‰È¿ ÛÙË Ó‹ÛÔ Wight ¢·ÈÛıËÙÔÔÈË̤ӷ ‹Ù·Ó 92 (25,3%) (p<0.001). H ¢·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ Aı‹Ó·˜ ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÙˆÓ ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Der P1 Î·È Der f1 ‹Ù·Ó 1,8% Î·È 1,2%, ÂÓÒ ÛÙ· ·È‰È¿ Ù˘ Ó‹ÛÔ˘ Wight ‹Ù·Ó 14,8% Î·È 5,2% ·ÓÙ›ÛÙÔȯ·, Ì ÙÔ Der P1 ˆ˜ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. TÔ ‰Â‡ÙÂÚÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙË Ó‹ÛÔ Wight ‹Ù·Ó ÙÔ Ì›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ (13,2%) Î·È ·ÎÔÏÔ˘ıÔ‡Û ÙÔ ÙÚ›¯ˆÌ· Ù˘ Á¿Ù·˜ (10,2%). °È· Ù· ·È‰È¿ Ù˘ Aı‹Ó·˜ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·ÓˆÙ¤Úˆ ·ÏÏÂÚÁÈÔÁfiÓ· ‹Ù·Ó 4,4% Î·È 4,1% ·ÓÙ›ÛÙÔȯ·. ŸÏ˜ ÔÈ Û˘ÁÎÚ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ¢ÚËÌ¿ÙˆÓ ÙˆÓ ‰‡Ô ÂÚÈÔ¯ÒÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (p<0,001). ™Ù· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ·, ÛÙËÓ Aı‹Ó·, Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙË Á‡ÚË ÂÏÈ¿˜ ‹Ù·Ó 3,1% Î·È ÛÙËÓ parietaria 1,6%. ™ÙË Ó‹ÛÔ Wight Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ÙÚ›¯ˆÌ· ÙÔ˘ Û·ÏÔ˘ ‹Ù·Ó 6,3% Î·È ÛÙË Á‡ÚË ÙˆÓ ‰¤Ó‰ÚˆÓ ‹Ù·Ó 2,2%. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È Û ‰È¿ÁÚ·ÌÌ· Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ÛÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ıËηÓ. ŸÛÔÓ ·ÊÔÚ¿ Ù· Û˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁ›·˜ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ· 2, ‹Ù·Ó Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ Ù˘ Ó‹ÛÔ˘ Wight Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ù˘ Aı‹Ó·˜. H Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹Ù·Ó ˘ÂÚ‰ÈÏ¿ÛÈ· (46,9%) ÛÙ· ·È‰È¿ Ù˘ Ó‹ÛÔ˘ Wight, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ù˘ Aı‹Ó·˜ (22,5%). ŒÎ˙ÂÌ· fiˆ˜ Î·È ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ›¯Â Â›Û˘ 56,3% ÙˆÓ ·È‰ÈÒÓ Ù˘ Ó‹ÛÔ˘ Wight, ÂÓÒ 34,2% Î·È 29,7% ·ÓÙ›ÛÙÔȯ· ÙˆÓ AıËÓÒÓ.

BÚÔÁ¯fiÛ·ÛÌÔ ÌÂÙ¿ ·fi ¿ÛÎËÛË ·ÚÔ˘Û›·˙ 34,4%

EÈÎfiÓ· 1. ¶ÔÛÔÛÙ¿ ¢·ÈÛıËÙÔÔÔ›ËÛ˘ ÛÙ· ÂÏÂÁ¯ı¤ÓÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· Û Aı‹Ó· Î·È Wight.

30

™. TÛ›ÙÔ˘Ú· Î·È Û˘Ó.

EÈÎfiÓ· 2. ™˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁ›·˜ Û ·È‰È¿ 5- 7,5 ¯ÚfiÓˆÓ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜. ÙˆÓ ·È‰ÈÒÓ Ù˘ Ó‹ÛÔ˘ Wight Î·È 7,2% ÙˆÓ ·È‰ÈÒÓ Ù˘ Aı‹Ó·˜. •ËÚfi ‚‹¯· ÙÔ ‚Ú¿‰˘ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ÎÚ˘ÔÏÔÁ‹Ì·ÙÔ˜ 43,8% Î·È 33,3% ÙˆÓ ·È‰ÈÒÓ ·ÓÙ›ÛÙÔȯ· ÛÙȘ ‰‡Ô ÂÚÈÔ¯¤˜. OÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ ‹Ù·Ó Â›Û˘ Û˘¯ÓfiÙÂÚ˜ ÛÙËÓ AÁÁÏ›· 21,9%, Û ۯ¤ÛË Ì ÙËÓ Aı‹Ó· 15,3%. ™Ù· Ï·›ÛÈ· ÙÔ˘ ÂϤÁ¯Ô˘ ¿ÏÏˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ¢ÓÔÔ‡Ó ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙËÓ ÂΉ‹ÏˆÛË ·ÙÔÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‚Ú¤ıËΠfiÙÈ Ù· ·È‰È¿ ÛÙËÓ Aı‹Ó· ÂÎÙ›ıÂÓÙÔ Û ηÓfi ÙÛÈÁ¿ÚÔ˘ ÂÓ‰ÔÌ‹ÙÚÈ· Û ÔÛÔÛÙfi 14,4% Î·È ÛÙÔ ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Û ÔÛÔÛÙfi 50,4%. T· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÛÙËÓ Ó‹ÛÔ Wight ‹Ù·Ó 6,3% Î·È 18,8% (›Ó·Î·˜ 3). ¶›Ó·Î·˜ 3. ŒÎıÂÛË ÙˆÓ ·È‰ÈÒÓ Û οÓÈÛÌ·.

N‹ÛÔ˜ Wight

Aı‹Ó·

EÓ‰ÔÌ‹ÙÚÈ·

6,3%

14,4%

™ÙÔ Û›ÙÈ

18,8%

50,4%

™˘˙‹ÙËÛË ¢ÂÓ ˘¿Ú¯ÂÈ ÌÂϤÙË ·Ó¿ÏÔÁÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ EÏÏ¿‰·. ™Â ·Ï·ÈfiÙÂÚË ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡ÛÂ Ù˘¯·›Ô ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ÂÏÏËÓÈÎÔ‡ ÂÓ‹ÏÈÎÔ˘ ÏËı˘ÛÌÔ‡ (20-60 ¯ÚfiÓˆÓ) ‚Ú¤ıËÎ·Ó ıÂÙÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Û 31,5% Î·È Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ Der P1 13,7%. ™Ù· ·È‰È¿, ÔÈ ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ ÛÙË ¯ÒÚ· Ì·˜, ·ÊÔÚÔ‡Ó ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ‹‰Ë ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Î·È ‰Â›¯ÓÔ˘Ó ıÂÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Û ÔÛÔÛÙfi 68%, Ì ¢·ÈÛıËÙÔÔ›ËÛË ÛÙÔ Der P1 22,6-27,7%, ÛÙ· ·ÁÚÔÛÙÒ‰Ë 21,3-38,6% Î·È ÛÙÔ ÙÚ›¯ˆÌ· Ù˘ Á¿Ù·˜ 21,1-44% (16,17). H ¯·ÌËÏ‹

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¢·ÈÛıËÙÔÔ›ËÛË Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· (9,7%) Î·È È‰È·›ÙÂÚ· ÛÙÔ Der P1 (1,8%) ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ˘ÏÈÎfi Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÊÔÚÔ‡ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ ÌÈÎÚ‹˜ ËÏÈΛ·˜ (5-7,5 ¯ÚÔÓÒÓ) Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜. O ÏfiÁÔ˜ Ô˘ ÂÈϤ¯ıËΠ·˘Ùfi ÙÔ ‰Â›ÁÌ· ‹Ù·Ó Ó· ÂÈÎÂÓÙÚˆıԇ̠۠¤Ó·Ó ÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË ·ÏÏÂÚÁ›·˜ ÒÛÙ ӷ ·˘Í‹ÛÔ˘Ì ÙȘ Èı·ÓfiÙËÙ˜ Ó· ·Ú·ÙËÚ‹ÛÔ˘Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ÛÙÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘. °È· ÙȘ ‰È·ÊÔÚ¤˜ Ô˘ ¤¯Ô˘Ó ‚ÚÂı› ÛÙËÓ Û˘¯ÓfiÙËÙ· ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚÈÔ¯‹ ‰È·ÌÔÓ‹˜ ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚ˜ ÂÚÌËÓ›˜. EÓÔ¯ÔÔÈÔ‡ÓÙ·È ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË, ÛÙÂÓfi˜ Û˘Á¯ÚˆÙÈÛÌfi˜, ÔÏÈÙÈÛÌÈΤ˜ ‰È·ÊÔÚ¤˜.

H ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ‰È¿ÊÔÚ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙȘ ‰‡Ô ¯ÒÚ˜ Î·È È‰È·›ÙÂÚ· ÛÙÔ Der pteronyssinus (14,8% Î·È 1,8% ·ÓÙ›ÛÙÔȯ·) ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. E›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È Ë ˘ÁÚ·Û›· ÙÔ˘ ·¤Ú· Î·È fiÙÈ ¤¯Ô˘Ó ‚ÚÂı› Û ÔÏϤ˜ ÌÂϤÙ˜ ıÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ·Ó¿ÌÂÛ· ÛÙ· Â›‰· ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙˆÓ ·Î¿ÚÂˆÓ Î·È ÙËÓ Û¯ÂÙÈ΋ ‹ ·fiÏ˘ÙË ˘ÁÚ·Û›· ÙÔ˘ ·¤Ú· ÛÙÔ Û›ÙÈ (18). MÂÁ·Ï‡ÙÂÚÔÈ ÏËı˘ÛÌÔ› ·Î¿ÚÂˆÓ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ·Ó·Ù‡ÛÛÔÓÙ·È fiÙ·Ó Ë ·fiÏ˘ÙË ˘ÁÚ·Û›· ÙÔ˘ ·¤Ú· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi 7 g/kg Î·È Ë Û¯ÂÙÈ΋ ˘ÁÚ·Û›· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi 45% (ȉ·ÓÈΤ˜ ÙÈ̤˜ Û¯ÂÙÈ΋˜ ˘ÁÚ·Û›·˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·Î¿ÚÂˆÓ Â›Ó·È 70-90%) (19).

H ̤ÛË Û¯ÂÙÈ΋ ˘ÁÚ·Û›· ÁÈ· ÙËÓ ÂÚÈÔ¯‹ Ù˘ AÙÙÈ΋˜ ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· ‹Ù·Ó 67,8% Ì ‰È·Î˘Ì¿ÓÛÂȘ ÌÂٷ͇ ÌÂÁ›ÛÙ˘ 70-78% (¢ÂΤ̂ÚÈÔ˜) Î·È ÂÏ·¯›ÛÙ˘ 45-56% (IÔ‡ÏÈÔ˜) (16). AÓÙ›ıÂÙ· Ë Ó‹ÛÔ˜ Wight, ÛÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÙ·È Ë ·ÚÔ‡Û· ÌÂϤÙË, ¤¯ÂÈ ‹ÈÔ Î·È ˘ÁÚfi Îϛ̷, Ì ۯÂÙÈ΋ ˘ÁÚ·Û›· Ô˘ ‰È·Î˘Ì·›ÓÂÙ·È ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÌÂٷ͇ ÌÂÁ›ÛÙ˘ 92% Î·È ÂÏ·¯›ÛÙ˘ 84% Î·È ÙÔÓ IÔ‡ÏÈÔ ÌÂٷ͇ 92% Î·È 55% ·ÓÙ›ÛÙÔȯ· (ÛÙÔȯ›· ·fi ÙË MÂÙˆÚÔÏÔÁÈ΋ YËÚÂÛ›· AÁÁÏ›·˜), ÛÙÔ ÔÔ›Ô Ù· ·Î¿Ú· ·Ó·Ù‡ÛÛÔÓÙ·È fiÏÔ ÙÔ ¯ÚfiÓÔ (20). ¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ Â›Â‰Ô ÙˆÓ ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È Ô ÂÍ·ÂÚÈÛÌfi˜, Ô ÎÏÈÌ·ÙÈÛÌfi˜, ÔÈ ÌÔΤÙ˜ Î·È Ù· ¯·ÏÈ¿, Ë Û˘¯ÓfiÙËÙ· ηı·ÚÈÛÌÔ‡, Ù· ηÙÔÈΛ‰È· ˙Ò·, ÔÈ ‚·ÚȤ˜ ÎÔ˘ÚÙ›Ó˜ Î·È Ù· ˘Ê·ÛÌ¿ÙÈÓ· ¤ÈÏ· ηıÒ˜ Î·È Ù· ¯ÓÔ˘‰ˆÙ¿ ·È¯Ó›‰È· (18). OÈ Û˘Óı‹Î˜ ˙ˆ‹˜ ÛÙȘ ‰‡Ô ¯ÒÚ˜ Â›Ó·È ‰È·ÊÔÚÂÙÈΤ˜ Î·È ·˘Ùfi ÌÔÚ› Ó· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ‰È·ÊÔÚÂÙÈ΋ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ·Î¿ÚˆÓ.

E›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿-

E˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·

ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È fiÙÈ fiÛÔ ˘„ËÏfiÙÂÚË Â›Ó·È Ë Û˘ÁΤÓÙÚˆÛË ·Î¿ÚÂˆÓ (>2 Ìg/gr) ÙfiÛÔ ·˘Í¿ÓÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ·Ó¿Ù˘ÍË ¿ÛıÌ·ÙÔ˜ (21).

EÊfiÛÔÓ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ Der P1 Î·È ÛÙÔ Der f1 Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙË Ó‹ÛÔ Wight ‰ÈηÈÔÏÔÁÂ›Ù·È Ô ·˘ÍË̤ÓÔ˜ ÂÈÔÏ·ÛÌfi˜ Û˘ÌÙˆÌ¿ÙˆÓ ·ÙÔ›·˜ Û ۯ¤ÛË Ì ·˘Ùfi ÙˆÓ ·È‰ÈÒÓ Ù˘ Aı‹Ó·˜.

OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¤Ó·ÚÍË ¿ÛıÌ·ÙÔ˜ Â›Ó·È Î·È ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ›. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ·È‰È¿ ¯·ÌËÏfiÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ¿ÛıÌ·ÙÔ˜ (22,23). Y¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ·›˙Ô˘Ó ÚfiÏÔ Ë ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË (24,25), ÙÔ ÌËÙÚÈÎfi οÓÈÛÌ· ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË (26) Î·È ÙÔ ·ıËÙÈÎfi οÓÈÛÌ· (27). T¤ÏÔ˜, ÔÈ ·ÙÔÌÈΤ˜ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙˆÓ ·È‰ÈÒÓ, ·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ¤ÎıÂÛË Û ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È ·ÏÏÂÚÁÈÔÁfiÓ˜ Ô˘Û›Â˜ ·ÏÏ¿ Î·È ÛÙÔÓ ‚·ıÌfi Ù˘ ¤ÎıÂÛ˘ ÛÙËÓ ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË (28-31).

T· ·È‰È¿ Ù˘ Aı‹Ó·˜, ·Ú¿ ÙËÓ ¤ÎıÂÛË Û ÌÂÁ·Ï‡ÙÂÚË ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË Î·È Û οÓÈÛÌ· (ÂÓ‰ÔÌ‹ÙÚÈ· Î·È ÂÓ‰ÔÔÈÎȷο), ›¯·Ó Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·ÏÏÂÚÁÈο ÓÔÛ‹Ì·Ù·. ÕÚ· Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ¤Ó·ÚÍË ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È Ë ÚÒÈÌË Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·Î¿Ú· Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë ÚÒÈÌË Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·Î¿Ú· ‰ÂÓ ·ÚÓËÙÈÎÔÔÈÂ›Ù·È ·ÚÁfiÙÂÚ· Î·È fiÙÈ Ù· ·È‰È¿ Ô˘ ›¯·Ó ıÂÙÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 5 ¯ÚfiÓˆÓ, ›¯·Ó Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 11 ¯ÚfiÓˆÓ (4). T· ·È‰È¿ Ù˘ Aı‹Ó·˜ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ ¤¯Ô˘Ó Ôχ ¯·ÌËÏ‹ ¢·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘.

EÔ̤ӈ˜, Ô ¯ÂÈÚÈÛÌfi˜ ÙÔ˘ ÂÓ‰ÔÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÒÛÙ ӷ ÌËÓ ·Ó·Ù‡ÛÛÔÓÙ·È ÏËı˘ÛÌÔ› ·Î¿ÚÂˆÓ ı· ·ԉ›ÍÂÈ ·Ó ·˘Ù‹ Â›Ó·È Ë Î·Ï‡ÙÂÚË ÚÔÛ¤ÁÁÈÛË ÁÈ· Ó· ÚÔÏËÊı› Ë ·ÏÏÂÚÁÈ΋ ÓÔÛËÚfiÙËÙ· Û ‰È·ÊÔÚÂÙÈο Â›‰·: ÚfiÏË„Ë Â˘·ÈÛıËÙÔÔ›ËÛ˘ (ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë), ÚfiÏË„Ë Û˘ÌÙˆÌ¿ÙˆÓ (‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë) Î·È ÚfiÏË„Ë ¯ÚÔÓÈfiÙËÙ·˜ ÓfiÛÔ˘ (ÙÚÈÙÔÁÂÓ‹˜ ÚfiÏË„Ë). ™˘ÌÂÚ¿ÛÌ·Ù· H ¤ÚÂ˘Ó¿ Ì·˜ ¤‰ÂÈÍ fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË Û ·È‰È¿ ËÏÈΛ·˜ 5 - 7,5 ¯ÚfiÓˆÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ Â›Ó·È Ôχ ¯·ÌËÏfiÙÂÚË ÛÙËÓ EÏÏ¿‰· Û ۇÁÎÚÈÛË Ì ÙËÓ AÁÁÏ›·.

TÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Der P1 Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ AÁÁÏ›·, ·ÏÏ¿ fi¯È ÛÙËÓ EÏÏ¿‰·. ™ËÌ·ÓÙÈο ·ÏÏÂÚÁÈÔÁfiÓ· ÁÈ· ÙËÓ AÁÁÏ›· Â›Ó·È ÙÔ ÙÚ›¯ˆÌ· Ù˘ Á¿Ù·˜ Î·È Ù· ·ÁÚÔÛÙÒ‰Ë Ô˘ ÁÈ· ÙËÓ EÏÏ¿‰· Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿.

H Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ AÁÁÏ›· ·fi ÙËÓ EÏÏ¿‰·.

EÓÒ Ë ·ÙÔÈ΋ ÚԉȿıÂÛË ˘‹Ú¯Â Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ¯ˆÚÒÓ, Ê·›ÓÂÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fiÙÈ ÙÔ ÌÈÎÚÔ- Î·È ÙÔ Ì·ÎÚÔ-ÂÚÈ‚¿ÏÏÔÓ ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÙË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ÙËÓ ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÁfiÓÔ˘ Ì ÂΉ‹ÏˆÛË ·ÙÔÈ΋˜ ÓfiÛÔ˘ ‰È·ÊÔÚÂÙÈ΋˜ Û˘¯ÓfiÙËÙ·˜.

H ÚÔ‰ÚÔÌÈ΋ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÙȘ ‰‡Ô ¯ÒÚ˜ ı· ··ÓÙ‹ÛÂÈ ÛÙËÓ ÛËÌ·ÓÙÈ΋ ÂÚÒÙËÛË ·Ó Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÌÔÚ› Ó· ÂÏ·ÙÙÒÛÂÈ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙËÓ ¤ÎÊÚ·Û‹ Ù˘ Û ·ÏÏÂÚÁÈ΋ ÓfiÛÔ.

E˘¯·ÚÈÛٛ˜ £¤ÏÔ˘Ì ӷ ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÙȘ Û˘ÓÂÚÁ¿Ùȉ˜ Ì·˜ ∞ÈηÙÂÚ›ÓË ¢ËÌÔÔ‡ÏÔ˘, AÈÌÈÏ›· ¶·Ó¿ÁÔ˘ Î·È K·ÙÂÚ›Ó· NÈÎÔÏ¿Ô˘ ÁÈ· ÙË Û˘Ó‰ÚÔÌ‹ ÙÔ˘˜. £¤ÏÔ˘Ì Â›Û˘ Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÙËÓ ÂÙ·ÈÚ›· ALK Scherax, Hamburg Germany ÁÈ· ÙËÓ ÚÔÛÊÔÚ¿ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙȘ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜.

EȉÔÙ‹ÛÂȘ H ·ÚÔ‡Û· ¤Ú¢ӷ ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙËÓ E˘Úˆ·˚΋ ŒÓˆÛË, ·fi ÙÔ ÚfiÁÚ·ÌÌ· BIOMED 2, grant No PL 1211.

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5. Peat JK, Tovey E, Mellis CM, Leeder SR, Woolcock AJ. Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clin. Exp Allergy 1993;23:812-820.

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Sears MR, Herbison GP, Holdaway MD, Hewitt CJ, Flannery EM, Silva PA. The realtive risk of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy 1989;19:419-424.

Kuehr J, Frischer T, Meinert R, et al. Sensitisation to mite allergens is a risk factor for early and late onset of asthma and for the persistence of asthmatic signs in children. J Allergy Clin Immunol 1995;95:655-662.

Rosenstreich DL, Eggleston P, Katton M, Baker D, Slavin RG, Gergen P et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner city children with asthma. N Engl J Med 1997;336:1356-1363.

Ingram JM, Sporik R, Rose G, Honsinger R, Chapman MD, Platts-Mills TA. Quantitative assessment of exposure to dog (Can f1) and cat (Fel d1) allergens: Relationship to sensitisation and asthma among children living in Los Alamos, New Mexico. J Allergy Clin Immunol 1995;69:449456.

Osebold J, Gershwin L, Zee Y. Studies on the enhancement of allergic lung sensitisation by inhalation of ozone and sulfuric acid aerosol. J Environ Pathol Toxicol 1980;3:221-234.

Gershwin L, Osebold J, Zee Y. Immunoglobulin Econtaining cells in mouse lung following allergen inhalation and ozone exposure. Int Arch Allergy Appl Immunol 1981;65:266-277.

Ferguson DM, Horwood LJ, Shannon FT. Parental smoking and respiratory illness in infancy. Arch Dis Child 1980;55:358-361. ¶Ú›ÊÙ˘ K, Z‹‚· M, M·ıÈÔ˘‰¿Î˘ °, HÏ›· M, °Ú˘¿ÚË M, AÓ·ÁÓˆÛÙ¿Î˘ I, ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º. E˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ ÛÙ· ÎÔÈÓ¿ ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ·. E›‰Ú·ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. I·ÙÚÈ΋ 1990;58(2):161-166.

Z‹‚· - ¶ÂÙÚÔÔ‡ÏÔ˘ M, ¶È¤ÚÔ˘ B, £¤ÌÂÏË-¢È·Á·Ï¿ÎË K, K·˝Ú˘ ¢, KÔ‡ÙÛÈ·-K·ÚÔ‡˙Ô˘ X, ¶··‰¿ÎÔ˘ §·ÁÔÁÈ¿ÓÓË ™. ŒÏÂÁ¯Ô˜ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ· ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Ù˘ N.A. AÙÙÈ΋˜ Ì ·Ó›¯Ó¢ÛË ÂȉÈÎÒÓ IgE ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi. ¶·È‰È·ÙÚÈ΋ 1995;158:176-182.

Hart B J. Life cycle and reproduction of house-dust mites: environmental factors influencing mite populations.

Allergy 1998;53 (Suppl 48):13-17.

Arlian LG. Water balance and humidity requirements of house dust mites. Exp Appl Acarol 1992;16:15-36.

Arshad SH, Hide DW. Effect of environmental factors on the development of allergic disorders in infancy. J Allergy Clin Immunol 1992;90:235-241.

Marks GB. House dust mite exposure as a risk factor for asthma: benefits of avoidance. Allergy 1998; 53 Suppl.

48:108-114.

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22. Wissow LS, Gittlesohn AM, Szklo M, Starfield B, Mussman M. Poverty, race and hospitalization for childhood asthma.

Am J Public Health 1988;78:777-782.

23. Taylor B. Social factors and related influences on lower respiratory illness of early childhood. Resp Dis in Practice 1983 (1):30-35.

24. Wardlow AJ. The role of air pollution in asthma. Clin Exp Allergy 1993;23:81-96.

25. M·ıÈÔ˘‰¿Î˘ °, ¶Ú›ÊÙ˘ K, E˘·ÁÁÂÏÔÔ‡ÏÔ˘ E, TÚÈ·ÓÙ·Ê˘ÏÏÔÔ‡ÏÔ˘ X. ¢˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ Ú˘¿ÓÛˆ˜ Ù˘ ·ÙÌfiÛÊ·ÈÚ·˜ ÙˆÓ AıËÓÒÓ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. AÚ¯ EÏÏËÓ I·ÙÚ 1990, 7®159-162.

26. Taylor B, Wadsworth J. Maternal smoking during pregancy and lower respirarory illness of early life. Arch Dis Child 1987;62:786-791.

27. Fergusson DM, Horwood LJ, Shannon FT. Parental smoking and respiratory illness in infancy. Arch Dis Child 1980;55:358-361.

E˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·

28. Moschandreas DJ. Exposure to pollutants and daily time budgets of people. Bull N Y Acad Med 1981;57:845-859.

29. ™Ù·Ì·ÙÈ¿‰Ë˜ ¢, X·Ù˙ˉ¿ÎȘ ¢. AÍÈÔÏfiÁËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ú‡·ÓÛ˘ ·fi ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ı›Ԣ Î·È Î·Ófi ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ Ù˘ Aı‹Ó·˜. AÚ¯ EÏÏËÓ I·ÙÚ 1990;7:109-116.

30. TÔ˘ÏÔ‡ÌË °, K·ÙÛÔ˘ÁÈ¿ÓÓË K. AÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË ÛÙÔ ÏÂηÓÔ¤‰ÈÔ AıËÓÒÓ: ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ, ËÌÂÚ‹ÛȘ ‰È·Î˘Ì¿ÓÛÂȘ Î·È Û˘Ó‰È·Î‡Ì·ÓÛË ÙˆÓ Ú‡ˆÓ. AÚ¯ EÏÏËÓ I·ÙÚ 1990;7:97-103.

31. N¿ÎÔ˘ ™, K·ÙÛÔ˘ÁÈ¿ÓÓË KÏ. AÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË Î·È ·È‰È΋ ÓÔÛËÚfiÙËÙ·. EÚÁ·ÛÙ‹ÚÈÔ YÁÈÂÈÓ‹˜ & EȉËÌÈÔÏÔÁ›·˜ ÙÔ˘ ¶·Ó/Ì›Ô˘ AıËÓÒÓ, IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. TÂÏÈ΋ ¤ÎıÂÛË M¿ÈÔ˜ 1994.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú· TÌ‹Ì· KÔÈÓˆÓÈ΋˜ I·ÙÚÈ΋˜, NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" MÂÛÔÁ›ˆÓ 24, 115 27 Aı‹Ó·

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X¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿ XÚ‹ÛÙÔ˜ KÒÛÙ·ÏÔ˜, AÓ·ÛÙ¿ÛÈÔ˜ T۷ΛÚ˘, AÈηÙÂÚ›ÓË KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M·Ú›· ¢·ÓÈËÏ›‰Ô˘, AÓÙÒÓÈÔ˜ °Ô‡Ó·Ú˘

● ¶ÂÚ›ÏË„Ë: O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¯¿ÛÌ·ÙÔ˜ ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) Î·È Ô‡ÚˆÓ (XAO) ‚ÔËı¿ÂÈ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAA Î·È XAO Û ÚfiˆÚ· Î·È Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÁÚ¿„Ô˘Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜. MÂÏÂÙ‹ıËÎ·Ó 35 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (ÔÌ¿‰· A: ËÏÈΛ· οو ÙˆÓ 15 ËÌÂÚÒÓ-ÔÌ¿‰· B: ËÏÈΛ· 16-30 ËÌÂÚÒÓ) ηıÒ˜ Î·È 15 ÚfiˆÚ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ οو ÙˆÓ 21 ËÌÂÚÒÓ. EÎÙÈÌ‹ıËÎ·Ó Ù· Â›‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ·›Ì·ÙÔ˜ ηıÒ˜ Î·È Ù· Â›‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·Ï›Ô˘ ÛÙ· Ô‡Ú·. T· Â›‰· Ó·ÙÚ›Ô˘ Î·È ¯ÏˆÚ›Ô˘ ·›Ì·ÙÔ˜ Ù˘ ÔÌ¿‰·˜ A ‹Ù·Ó ˘„ËÏfiÙÂÚ· Û ۯ¤ÛË Ì ·˘Ù¿ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È °. AÓÙ›ıÂÙ·, ÙÔ XAA ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÛÙ· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ °. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú· ÙÔ Ó¿ÙÚÈÔ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ A, ÂÓÒ ÙÔ Î¿ÏÈÔ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· B. ¢ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÙÈÌ‹ ÙÔ˘ XAO ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ XAA ·fi fiÙÈ Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ÂÓÒ Û fiÙÈ ·ÊÔÚ¿ ÛÙÔ XAO ·˘Ùfi ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ËÏÈΛ· ·ËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. H ·¤ÎÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú· ·˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ Ë̤ڷ ˙ˆ‹˜, Î·È Ì ÙËÓ ËÏÈΛ· ·ËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈ΋ 2000;63:34-37. §¤ÍÂȘ ÎÏÂȉȿ: ÓÂÔÁÓfi, ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË, ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ.

C. Costalos, A. Tsakiris, A. Constandinidou, M. Daniilidou, A. Gounaris. Blood and urine anion gap in newborn infants. Paediatriki 2000;63:34-37. ● Abstract: The estimation of the blood (BAG) and urine (UAG) anion gap can help in the investigation of the cause of metabolic acidosis.The aim of this study was to assess BAG and UAG in healthy preterm and term neonates.Thirty five term and 15 preterm infants were studied. Term babies were divided into 2 groups according to their postnatal age (group A <15 days, group B: 16-30 days). The preterm infants (group C) were all under 21 days of life. Blood sodium, chloride and bicarbonate levels, and urine chloride, potassium and sodium levels were estimated. From these values the BAG and UAG were calculated. Blood sodium and chloride values were higher in group A than in groups B and C, but the BAG was higher in group C. With regard to urine findings, sodium was higher in infants of group A while potassium was higher in group B.There was no significant difference in the UAG values among the three groups. In conclusion, preterm infants have a higher BAG than term infants but a similar UAG. Potassium excretion increases with both gestational and postnatal age.

Key words: newborn infant, metabolic acidosis, renal tubular acidosis, anion gap.

EÈÛ·ÁˆÁ‹ O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¯¿ÛÌ·ÙÔ˜ ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ‚ÔËı¿ÂÈ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘ (1,2). ø˜ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) ıˆÚԇ̠ÙË ‰È·ÊÔÚ¿ Ô˘ ÚÔ·ÙÂÈ, fiÙ·Ó ·fi ÙËÓ ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ÙÔ˘ ·›Ì·ÙÔ˜, ·Ê·ÈÚ¤ÛÔ˘Ì ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘

NÂÔÁÓÔÏÔÁÈÎfi TÌ‹Ì· ÙÔ˘ ¶°N N›Î·È·˜, ¶ÂÈÚ·È¿˜

34

¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ. TÔ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ Ô‡ÚˆÓ (XAO) ·ÔÙÂÏ› ·‰Úfi ‰Â›ÎÙË Ù˘ ·¤ÎÎÚÈÛ˘ ·Ì̈ӛ·˜ ÛÙ· Ô‡Ú· Î·È ‚ÔËı¿ÂÈ ÛÙÔÓ Î·ıÔÚÈÛÌfi ·Ó ÌÈ· ˘ÂگψڷÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË Â›Ó·È ÓÂÊÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ fi¯È. K·ıÔÚ›˙ÂÙ·È ·˘Ùfi fiÙ·Ó ·fi ÙÔ ¿ıÚÔÈÛÌ· Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Î·Ï›Ô˘ Î·È Ó·ÙÚ›Ô˘ ÛÙ· Ô‡Ú· ·Ê·ÈÚÂı› Ë ÙÈÌ‹ ÙÔ˘ ¯ÏˆÚ›Ô˘ ÙˆÓ Ô‡ÚˆÓ (3, 4).

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ÿÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ

™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ηıÔÚÈÛı› Ë Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ÙÔ˘ XAA ηıÒ˜ Î·È ÙÔ˘ XAO ÙfiÛÔ Û ÚfiˆÚ· fiÛÔ Î·È Û ÙÂÏÂÈfiÌËÓ· ˘ÁÈ‹ ÓÂÔÁÓ¿.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ MÂÏÂÙ‹ıËÎ·Ó 35 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ - 27 ËÏÈΛ·˜ οو ÙˆÓ 15 ËÌÂÚÒÓ (ÔÌ¿‰· A) Î·È 8 ÌÂٷ͇ 16-30 ËÌÂÚÒÓ (ÔÌ¿‰· B) - ηıÒ˜ Î·È 15 ÚfiˆÚ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ οو ÙˆÓ 21 ËÌÂÚÒÓ (ÔÌ¿‰· °). H ̤ÛË ËÏÈΛ· ˙ˆ‹˜ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ A ‹Ù·Ó 7,2 (±3) Ë̤Ú˜, ÂÓÒ ÁÈ· Ù· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ B Ë ·ÓÙ›ÛÙÔÈ¯Ë ËÏÈΛ· ‹Ù·Ó 21 (±5) Ë̤Ú˜. H ̤ÛË ËÏÈΛ· ·ËÛ˘ ÛÙ· ÚfiˆÚ· Ù˘ ÔÌ¿‰·˜ ° ‹Ù·Ó 34±1 ‚‰ÔÌ¿‰Â˜ Î·È Ì¤ÛË ËÏÈΛ· ˙ˆ‹˜ 13 ±2 Ë̤Ú˜. ŸÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· ‹Ù·Ó ˘ÁÈ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ Î·È ÛÈÙ›˙ÔÓÙ·Ó Ì ͤÓÔ Á¿Ï· Û ÙÚ›ˆÚË ‚¿ÛË (Almiron 1 Ì ÂÚÈÂÎÙÈÎfiÙËÙ· ۠χΈ̷ 1.4 g%).

H ÌÂϤÙË ¤ÁÈÓ ÙÔ Úˆ› ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Á‡̷ÙÔ˜. EÏ‹ÊıË ‰Â›ÁÌ· ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ ¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ, ÂÓÒ ·Ú¿ÏÏËÏ· ÙÔÔıÂÙ‹ıËΠԢÚÔÛ˘ÏϤÎÙ˘ ÁÈ· ÙË Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ Î·È ÙË Ì¤ÙÚËÛË ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ Î·Ï›Ô˘ Î·È ÙÔ˘ ¯ÏˆÚ›Ô˘. T· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ, ÂÛÙ¿ÏËÛ·Ó ÛÙÔ ‚ÈÔ¯ËÌÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ ÁÈ· ¿ÌÂÛÔ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ, ÂÓÒ Ù· ‰ÈÙÙ·ÓıÚ·ÎÈο ·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ Ì ·Ó·Ï˘Ù‹ ·ÂÚ›ˆÓ AVL. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ t test. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ıˆڋıËΠÙÔ ·ÔÙ¤ÏÂÛÌ· ÂÊfiÛÔÓ ÙÔ p < 0.05.

AÔÙÂϤÛÌ·Ù· ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Â˘Ú‹Ì·Ù· ·fi ÙÔ ·›Ì·, Ù· Â›‰· Ó·ÙÚ›Ô˘ Î·È ¯ÏˆÚ›Ô˘ ÙˆÓ ÓÂÔÁÓÒÓ Ù˘ ÔÌ¿‰·˜ A ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È ° (p<0.01 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È °, p<0.05 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È B ÁÈ· ÙÔ Ó¿ÙÚÈÔ,Î·È p<0.01 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È B ÁÈ· ÙÔ ¯ÏÒÚÈÔ). AÓÙ›ıÂÙ·, ÙÔ

XAA ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ° (p<0.05 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È °). T· Â›‰· Î·Ï›Ô˘ Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜. (¶›Ó·Î·˜ 1). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú·, Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· A Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ° (p<0.01), ·ÓÙ›ıÂÙ·, ÙÔ Î¿ÏÈÔ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· B Û ۇÁÎÚÈÛË ÙfiÛÔ Ì ÙËÓ ÔÌ¿‰· A (p<0.05) fiÛÔ Î·È Ì ÙËÓ ÔÌ¿‰· ° (p<0.05).

Y„ËÏfiÙÂÚÔ ‹Ù·Ó Î·È ÙÔ ¯ÏÒÚÈÔ ÛÙËÓ ÔÌ¿‰· B Û ۇÁÎÚÈÛË Ì ÙȘ ‰‡Ô ¿ÏϘ ÔÌ¿‰Â˜, Ë ‰È·ÊÔÚ¿ fï˜ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. TÔ XAO ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ° Û ۯ¤ÛË Ì ÙȘ ‰‡Ô ¿ÏϘ ÔÌ¿‰Â˜, fï˜ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ô‡Ù ‰Ò. (¶›Ó·Î·˜ 2). ™˘˙‹ÙËÛË ™ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ÌÈ·˜ ‰È·Ù·Ú·¯‹˜ Ù˘ ÔÍÂÔ‚·ÛÈ΋˜ ÈÛÔÚÚÔ›·˜ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÌÔÚ› Ó· ·ÓÙÏ‹ÛÂÈ Î·Ó›˜ ÂÍÂÙ¿˙ÔÓÙ·˜ Ù· Â›‰· ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ ¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙÔ 85-90% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÙÈfiÓÙˆÓ Î·È ÙˆÓ ·ÓÈfiÓÙˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ (1,5). ø˜ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) ıˆÚÂ›Ù·È Ë ‰È·ÊÔÚ¿ Ô˘ ÚÔ·ÙÂÈ fiÙ·Ó ·fi ÙËÓ ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ·Ê·ÈÚ¤ÛÔ˘Ì ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ ¯ÏˆÚ›Ô˘ Ì ٷ ‰ÈÙÙ·ÓıÚ·ÎÈο. H ‰È·ÊÔÚ¿ ·˘Ù‹ Ê˘ÛÈÔÏÔÁÈο Â›Ó·È 816 (̤ÛË ÙÈÌ‹ 12), Î·È ÔÊ›ÏÂÙ·È Û ÌË ÚÔÛ‰ÈÔÚÈ˙fiÌÂÓ· ·ÓÈfiÓÙ· .¯. ʈÛÊÔÚÈο, ıÂÈÈο, Á·Ï·ÎÙÈο, ÚˆÙ½Ó˜ (6). K·Ù·ÛÙ¿ÛÂȘ Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔ XAA Â›Ó·È ÔÚÈṲ̂Ó˜ Û‡ÌÊ˘Ù˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ·ÌÈÓÔͤˆÓ, ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ. ŒÙÛÈ, Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAA ÌÔÚ› Ó· ‰ÒÛÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ·›ÙÈ· ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘ (7). ™ÙÔ ÓÂÔÁ¤ÓÓËÙÔ Î·È ÂȉÈο ÛÙÔ ÚfiˆÚÔ, ÙÔ XAA Ê˘ÛÈÔÏÔÁÈο Î˘Ì·›ÓÂÙ·È Á‡Úˆ ÛÙÔ 16 (8).

¶›Ó·Î·˜ 1. BÈÔ¯ËÌÈΤ˜ ÙÈ̤˜ (x±SD) ·›Ì·ÙÔ˜ Û mmol/l (ÔÈ ÙÈ̤˜ Û mEq/l Â›Ó·È Ù·˘ÙfiÛË̘).

N¿ÙÚÈÔ

K¿ÏÈÔ

XÏÒÚÈÔ

¢ÈÙÙ·ÓıÚ·ÎÈο

XAA

OÌ¿‰· A

143,5±5,1

5,3±0,7

109,9±5,2

20,6±2,3

10,9±3,7

OÌ¿‰· B

138,0±2,1

4,6±1,8

103,6±1,9

22,2±2,9

9,2±2,9

OÌ¿‰· °

139,3±3,3

5,3±0,6

107,5±4,0

20,8±2,5

13,4±3,7

¶›Ó·Î·˜ 2. BÈÔ¯ËÌÈΤ˜ ÙÈ̤˜ (x±SD ) Ô‡ÚˆÓ Û mmol/l (ÔÈ ÙÈ̤˜ Û mEq/l Â›Ó·È Ù·˘ÙfiÛË̘).

N¿ÙÚÈÔ

K¿ÏÈÔ

XÏÒÚÈÔ

XAO

OÌ¿‰· A

15,5±8,7

15,7±10,1

25,9±9,7

3,5±8,0

OÌ¿‰· B

14,0±25,8

29,6±21,2

34,5±26,7

1,4±10,4

OÌ¿‰· °

7,5± 7,2

16,7± 6,1

20,2±8,5

4,7±12,1

35

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·36

¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

ŸÌˆ˜, Î·È Ë ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ ·Ú¤¯ÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ٷ ·›ÙÈ· ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘. H ÂÎÙ›ÌËÛË ÙÔ˘ Ú˘ıÌÔ‡ ·¤ÎÎÚÈÛ˘ ·Ì̈ӛ·˜ ÛÙ· Ô‡Ú· Â›Ó·È ··Ú·›ÙËÙË ÚÔÎÂÈ̤ÓÔ˘ Ó· ηıÔÚ›ÛÂÈ Î·Ó›˜ ·Ó ÌÈ· ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË ÔÊ›ÏÂÙ·È Û ÓÂÊÚÈο ‹ Â͈ÓÂÊÚÈο ·›ÙÈ·. AÓ Ë ·¤ÎÎÚÈÛË ·Ì̈ӛ·˜ ÛÙ· Ô‡Ú· Â›Ó·È ¯·ÌËÏ‹, ·ÚÔ˘Û›· ÔͤˆÛ˘, ·˘Ùfi Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi fiÙÈ Ë ÔͤˆÛË ÔÊ›ÏÂÙ·È Û ÓÂÊÚÈο ·›ÙÈ· (3). EÂȉ‹ fï˜ Ë ¿ÌÂÛË Ì¤ÙÚËÛË Ù˘ ·Ì̈ӛ·˜ Â›Ó·È Â›ÔÓË, ¤Ó·˜ ¤ÌÌÂÛÔ˜ ÙÚfiÔ˜ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Â›Ó·È Ë Ì¤ÙÚËÛË ÙÔ˘ XAO. O ˘ÔÏÔÁÈÛÌfi˜ ·˘Ùfi˜ ÛÙËÚ›˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Î·ı·Úfi ¿ıÚÔÈÛÌ· ÙˆÓ Î·ÙÈfiÓÙˆÓ Î·È ÙˆÓ ·ÓÈfiÓÙˆÓ ÛÙ· Ô‡Ú· Ú¤ÂÈ Ó· Â›Ó·È 0. EÂȉ‹ Ê˘ÛÈÔÏÔÁÈο Ë Û˘ÁΤÓÙÚˆÛË ÔÚÈÛÌ¤ÓˆÓ Î·ÙÈfiÓÙˆÓ Î·È ·ÓÈfiÓÙˆÓ (ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ) Â›Ó·È ÂÏ¿¯ÈÛÙË, ·˘Ù¿ Ù· ÈfiÓÙ· ÌÔÚÔ‡Ó Ó· ·ÁÓÔËıÔ‡Ó Î·È ¤ÙÛÈ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ XAO ÌÂÙÚ¿Ì ÌfiÓÔ ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ Î·Ï›Ô˘ Î·È ÙÔ˘ ¯ÏˆÚ›Ô˘ (Ô˘ ·ÔÙÂÏ› Î·È ÙÔ Î‡ÚÈÔ ·ÓÈfiÓ Ô˘ Û˘Óԉ‡ÂÈ ÙÔ ·ÌÌÒÓÈÔ) (9).

H ÂÎÙ›ÌËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ·ÌÌˆÓ›Ô˘ ÛÙ· Ô‡Ú· ÌÔÚ› Ó· Á›ÓÂÈ Ì ‚¿ÛË ÙËÓ Â͛ۈÛË (Ó¿ÙÚÈÔ Ô‡ÚˆÓ + οÏÈÔ Ô‡ÚˆÓ) - ¯ÏÒÚÈÔ. Yfi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ Ó·ÙÚ›Ô˘ Î·È ÙÔ˘ Î·Ï›Ô˘ ˘ÂÚ‚·›ÓÂÈ ·˘Ùfi ÙÔ˘ ¯ÏˆÚ›Ô˘ ÎÈ ¤ÙÛÈ ÙÔ XAO Â›Ó·È ÂÏ¿¯ÈÛÙ· ıÂÙÈÎfi. ™Â ÔͤˆÛË ÌË ÓÂÊÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ¯ÏˆÚ›Ô˘ ÛÙ· Ô‡Ú· ˘ÂÚ‚·›ÓÂÈ ÙÔ ¿ıÚÔÈÛÌ· Ó¿ÙÚÈÔ + οÏÈÔ. ¢ËÏ·‰‹ ÙÔ XAO Â›Ó·È ·ÚÓËÙÈÎfi. ™Â ÔͤˆÛË Ù¤ÏÔ˜ ÓÂÊÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (Ì ÂÍ·›ÚÂÛË ÙËÓ Ù‡Ô˘ II ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË fiÔ˘ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ·ÒÏÂÈ· ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÙ· Ô‡Ú·) ÙÔ XAO Â›Ó·È ıÂÙÈÎfi (2,9,10).

AÓ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAO ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÓËϛΘ, Ë ÂÌÂÈÚ›· ÛÙ· ÓÂÔÁÓ¿ Â›Ó·È ÂÏ¿¯ÈÛÙË. OÈ Sulyok Î·È Guignard (11) Â›Ó·È ÔÈ ÌfiÓÔÈ Ô˘ ÌÂϤÙËÛ·Ó ÙÔ XAO Û ÌÈÎÚfi ·ÚÈıÌfi ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ Ì ̤ÛË ËÏÈΛ· ·ËÛ˘ 31,8 ‚‰ÔÌ¿‰Â˜ ηıÒ˜ Î·È Û ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ 7 ËÌÂÚÒÓ. K·Ù' ·˘ÙÔ‡˜, ÙÔ XAO ·ÔÙÂÏ› ·ÍÈfiÈÛÙÔ ‰Â›ÎÙË ÙÔ˘ Ú˘ıÌÔ‡ ·¤ÎÎÚÈÛ˘ ·Ì̈ӛ·˜ ÌÂÙ¿ fï˜ ·fi ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ˙ˆ‹˜, ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙÂÏÂÈfiÌËÓ· Î·È ÌÂÙ¿ ÙËÓ 3Ë Â‚‰ÔÌ¿‰· ˙ˆ‹˜ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÚfiˆÚ· ÓÂÔÁÓ¿.

H ÌÂϤÙË Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ì ›¯Â Û·Ó ÛÙfi¯Ô Ó· ÌÂÏÂÙ‹ÛÂÈ ÙÔ XAA Î·È XAO Û ϤÔÓ ÒÚÈÌ· ÚfiˆÚ· ·ÏÏ¿ Î·È Û ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 7 ËÌÂÚÒÓ. T· ·ÔÙÂϤÛÌ·Ù· Ì·˜ ‰Â›¯ÓÔ˘Ó ÌÂȈ̤ӷ Â›‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·È Î·Ï›Ô˘ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 15 ËÌÂÚÒÓ Û ۇÁÎÚÈÛË Ì ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ οو ÙˆÓ 15 ËÌÂÚÒÓ. H ÙÒÛË ·˘Ù‹ ÙÔ˘ Î·Ï›Ô˘ ·›Ì·ÙÔ˜ ÛÙ· ÓÂÔÁÓ¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È ·Ô‰›‰ÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË ·¤Î-

36

Ã. ∫ÒÛÙ·ÏÔ˜ Î·È Û˘Ó.

ÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú·. AÓÙ›ıÂÙ·, ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ÛÙ· ÙÂÏÂÈfiÌËÓ· οو ÙˆÓ 15 ËÌÂÚÒÓ Ë ·¤ÎÎÚÈÛË Î·Ï›Ô˘ Â›Ó·È ÌÂȈ̤ÓË, ÏfiÁˆ ÌÂȈ̤Ó˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ N·+-K+ ATP¿ÛË ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· Î·È ÌÂȈ̤Ó˘ ¢·ÈÛıËÛ›·˜ ÛÙË ‰Ú¿ÛË Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ (12,13).

H ·Ú·ÙËÚÔ‡ÌÂÓË ÙÒÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ¯ÏˆÚ›Ô˘ Ì ·Ú¿ÏÏËÏË ÂÏ·ÊÚ¿ ·‡ÍËÛË ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÙÔ ·›Ì· ÓÂÔÁÓÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, ÔÊ›ÏÂÙ·È Û Ì›ˆÛË ÙÔ˘ Ô˘‰Ô‡ ·¤ÎÎÚÈÛ˘ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÙ· Ô‡Ú· ÛÙ· ÈÔ ÒÚÈÌ· ÓÂÔÁÓ¿, Ì ·Ú¿ÏÏËÏË ·‡ÍËÛË Ù˘ ·Ô‚ÔÏ‹˜ ¯ÏˆÚ›Ô˘ (14,15). TÔ XAA ‹Ù·Ó Â›Û˘ ÂÏ·ÊÚ¿ ÌÈÎÚfiÙÂÚÔ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ÓÂÔÁÓ¿ Î·È ·˘Ùfi Â›Ó·È Û‡ÌʈÓÔ Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›· (8,16). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú·, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ ·Ô‚ÔÏ‹˜ Î·Ï›Ô˘ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË Û ۇÁÎÚÈÛË Ì ٷ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜ ÙÂÏÂÈfiÌËÓ· ·ÏÏ¿ Î·È Ì ٷ ÚfiˆÚ· ‚Ú¤ÊË. T· ÚfiˆÚ· ÓÂÔÁÓ¿ fï˜ ›¯·Ó ÂÏ·ÊÚ¿ ˘„ËÏfiÙÂÚË ·Ô‚ÔÏ‹ Î·Ï›Ô˘ Û ۯ¤ÛË Ì ٷ ÌÈÎÚ‹˜ ËÏÈΛ·˜ ÙÂÏÂÈfiÌËÓ·. A˘Ùfi, fiˆ˜ ÚԷӷʤÚıËÎÂ, ÔÊ›ÏÂÙ·È ÛÙËÓ ÚÔԉ¢ÙÈ΋ ˆÚ›Ì·ÓÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ·ıÚÔÈÛÙÈÎÔ‡ ÛˆÏËÓ·Ú›Ô˘ Ë ÔÔ›· ¤¯ÂÈ Û¯¤ÛË fi¯È ÌfiÓÔ Ì ÙÔ ‚·ıÌfi ˆÚÈÌfiÙËÙ·˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ ÙË Á¤ÓÓËÛË ·ÏÏ¿ Î·È Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ÓÂÔÁÓÔ‡ (12). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ XAO, ·˘Ùfi ‹Ù·Ó ÂÏ·ÊÚ¿ ıÂÙÈÎfi Î·È ÛÙȘ 3 ÔÌ¿‰Â˜. H ÙÈÌ‹ ÙÔ˘ ¿ÓÙˆ˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ÈÔ ÒÚÈÌ· ÓÂÔÁÓ¿ (ÛËÌÂ›Ô ÌÂÁ·Ï‡ÙÂÚ˘ ·¤ÎÎÚÈÛ˘ ·ÌÌˆÓ›Ô˘ ÛÙ· Ô‡Ú·). ŸÌˆ˜ Ë ‰È·ÊÔÚ¿ ·fi ÙȘ ¿ÏϘ 2 ÔÌ¿‰Â˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. OÈ ÙÈ̤˜ Ô˘ ‚Ú¤ıËÎ·Ó ‹Ù·Ó ¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ Sulyok Î·È Guignard (11), ÙfiÛÔ ÁÈ· Ù· ÚfiˆÚ· fiÛÔ Î·È ÁÈ· Ù· ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ ÂÙ¿ ËÌÂÚÒÓ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ÚfiˆÚ·, Â›Ó·È Èı·ÓfiÓ Ë ‰È·ÊÔÚ¿ Ì·˜ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ‰Èο Ì·˜ ‹Ù·Ó ÈÔ ÒÚÈÌ· ·fi ·˘Ù¿ ÙˆÓ ·Ú·¿Óˆ ÂÚ¢ÓËÙÒÓ. ™Â fiÙÈ ·ÊÔÚ¿ ÛÙ· ÙÂÏÂÈfiÌËÓ· fï˜ ‰ÂÓ ˘¿Ú¯ÂÈ Èı·Ó‹ ÂÍ‹ÁËÛË. ÿÛˆ˜ fï˜ Ë ‰È·ÊÔÚ¿ ÛÙÔ XAO Ó· ÔÊ›ÏÂÙ·È ÛÙË ¯ÚËÛÈÌÔÔ›ËÛË ·fi ÙÔ˘˜ Sulyok Î·È Guignard Á¿Ï·ÎÙÔ˜ Ì ‰È·ÊÔÚÂÙÈ΋ ÂÚÈÂÎÙÈÎfiÙËÙ· ۠χΈ̷ ·fi ÙÔ ‰ÈÎfi Ì·˜ (ÙÔ Â›‰Ô˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ÂÚÁ·Û›·). ™˘ÌÂÚ·ÛÌ·ÙÈο Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ XAA ·fi fiÙÈ Ù· ÙÂÏÂÈfiÌËÓ·. AÓÙ›ıÂÙ·, Ë ËÏÈΛ· ·ËÛ˘ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙÔ XAO. H ·¤ÎÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú· ηıÔÚ›˙ÂÙ·È ÙfiÛÔ ·fi ÙËÓ ËÏÈΛ· ·ËÛ˘ fiÛÔ Î·È ·fi ÙËÓ ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ÙÔ˘ ÓÂÔÁÓÔ‡.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Narins RG, Emmett M. Simple and mixed acid-base disorders. A practical approach. Medicine 1980;59:161169.

2. Battle DC, Hizon M, Cohen G, Gutterman C, Gupta R. The use of the urinary anion gap in the diagnosis of

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hyperchloremic metabolic acidosis. N Engl J Med 1988;318:594-599.

Hanna JD,Scheinman JI, Chan JCM. The kidney in acidbase balance. Pediatr Clin North Am 1995;42:1365-1395.

Carlisle EJF, Donnelly SM, Halperin MC. Renal tubular acidosis (RTA): Recognize the ammonium defect and forget the urine pH. Pediatr Nephrol 1991;5:242-246.

Halperin MC, Jungas RL. The metabolic production and renal dÈsposal of hydrogen ions. Kidney Int 1983;24:709713.

Gabows PA, Kaehny WD. The anion gap: Its meaning and clinical utility. Kidney Int 1977;12:5-11.

Oh MS, Carroll JH. The anion gap. N Engl J Med 1979;297:814-820.

Brewer ED. Disorders of acid-base balance. Pediatr Clin North Am 1990;37:429-447.

Goldstein MB,Bear R, Richardson RMA, Mardsen RA, Halperin ML. The urine anion gap: a clinically useful index of ammonium excretion. Am J Med Sci 1986;29:198-202.

Hatemi N, Mc Cance RA. Renal aspects of acid-base control in the newly born III. Response to acidifying drugs.

Acta Paediatr Uppsala 1961;50:603-616.

ÿÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ

11. Sulyok E, Guignard JP. Relationship of urinary anion gap to urinary ammonium excretion in the neonate. Biol Neonate 1990;57:98-106.

12. Segal S, Smith I. Delineation of cystine and cysteine transport systems in rat kidney cortex by developmental patterns. Proc Natl Acad Sci 1969;63:926-933.

13. Stephenson G, Hammett M, Hardaway G. Ontogeny of renal mineralocorticoid receptors and urinary electrolyte responses in the rat. Am J Physiol 1984;247:F651-F665.

14. Edelmann CM Jr, Rodriguez-Soriano J, Boichis H. Renal bicarbonate reabsorption and hydrogen ion excretion in normal infants. J Clin Invest 1967;46:1309-1314.

15. Tudvad FH, Mc Namara H, Barnett HL. Renal response of premature infants to administration of bicarbonate and potassium. Pediatrics 1954;13:4-10.

16. Usha Raj J, Franco G. Acid/base fluid and electrolyte management. In Shaffer and Averys Diseases of the Newborn. Sixth ed, Taeusch HW, Ballard RA, Avery ME eds. Philadelphia: WB Saunders Co. 1991: 260-275.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 03-09-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: X. KÒÛÙ·ÏÔ˜ AÚÙ¤ÌȉԘ 130, ¶·Ï·Èfi º¿ÏËÚÔ 17562

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™˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ ·È‰È΋ ËÏÈΛ· EÌÌ·ÓÔ˘‹Ï PÔËÏ›‰Ë˜1, XÚ˘Û·Ê¤ÓÈ· M·ÓÙÈÔ‡-°ÎÚ¿Ù˙ÈÔ˘1, £ÂÔ‰Ô‡ÏË ¶··ÛÙ·‡ÚÔ˘1, XÚ‹ÛÙÔ˜ ¶·ÓÙÂÏÈ¿‰Ë˜1, MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘2, B·ÛÈÏÈ΋ K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó·3 ● ¶ÂÚ›ÏË„Ë: AÓ·ÛÎÔÔ‡ÓÙ·È ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ Ïԛ̈͢ ·fi Èfi Coxsackie B Û 11 ·È‰È¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÚfiÛÊ·Ù· ÛÙÔ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô ·fi I·ÓÔ˘¿ÚÈÔ 1996 ̤¯ÚÈ M¿ÈÔ 1997. O ÈÔ Û˘¯Ófi˜ Ù‡Ô˜ ‹Ù·Ó Ô B4 Î·È ÔÈ Î˘Ú›·Ú¯Â˜ ÂΉËÏÒÛÂȘ ‹Ù·Ó ·ÚıÚ›Ùȉ·, Ó¢ÌÔÓ›·, Ì˘Ôηډ›Ùȉ· Î·È ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ. §fiÁˆ ȉȷÈÙÂÚfiÙËÙ·˜ Î·È ‚·Ú‡ÙËÙ·˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ·fi ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜. O ÚÒÙÔ˜ ·ÛıÂÓ‹˜ ·Ú¯Èο ·ÚÔ˘Û›·Û ÌÈ· ÌË ÂȉÈ΋ ÂÌ‡ÚÂÙË Î·Ù¿ÛÙ·ÛË, ·ÏÏ¿ ÛÙË Û˘Ó¤¯ÂÈ· ÂΉ‹ÏˆÛ Ë·Ù›Ùȉ·, Ó¢ÌÔÓ›·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· Î·È ·ÚıÚ›Ùȉ·. O ‰Â‡ÙÂÚÔ˜ ·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËΠÁÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ÂÚ›Ô˘ ‰‡Ô Ì‹Ó˜ ÚÈÓ. H ÂÌÊ¿ÓÈÛË ·˘ÙÒÓ ÙˆÓ ÂΉËÏÒÛÂˆÓ Î·È ÛÙ· ‰˘Ô ·È‰È¿ Û˘Û¯ÂÙ›ÛÙËΠÔÚÔÏÔÁÈο Ì ÚfiÛÊ·ÙË Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. ™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ó Î·È Û¿ÓÈ·, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÚÔ˘ÛÈ·ÛÙ› Û ·È‰È¿ ÁÂÓÈÎÂ˘Ì¤ÓË Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. ¶·È‰È·ÙÚÈ΋ 2000;63:38-42 . §¤ÍÂȘ ÎÏÂȉȿ: Coxsackie B, ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ.

E. Roilides, C. Mantiou-Gratziou, T. Papastavrou, C. Panteliadis, M. Athanasiou, V. Kyriazopoulou-Dalaina.

Systemic manifestations of Coxsackie B virus infections in childhood. Paediatriki 2000;63:38-42. ● Abstract: The systemic manifestations are reviewed of generalized Coxsackie B virus infection in 11 children hospitalized between January 1996 and May 1997. The most common serological type was B4 and the predominant manifestations were arthritis, pneumonia, myocarditis and thrombocytopenic purpura. Two of the cases are described in detail because of their unique characteristics and severity. The first presented with a febrile illness, and subsequently developed hepatitis, pneumonia, glomerulonephritis and arthritis. The second suffered from neutropenia and hepatosplenomegaly which had developed two months prior to admission. These manifestations in the two patients were associated with serological evidence of concurrent Coxsackie B virus infection. Although uncommon, multisystem manifestations due to Coxsackie B virus infections can occur in childhood.

Key words: Coxsackie B, clinical manifestations.

EÈÛ·ÁˆÁ‹ OÈ ÈÔ› Coxsackie B ÚÔηÏÔ‡Ó Î˘Ú›ˆ˜ ·Û˘Ìو̷ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ‹ ÌË ÂȉÈΤ˜ ÂÌ‡ÚÂÙ˜ ηٷÛÙ¿ÛÂȘ, ·ÚfiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡Ó Î·È ÔÈ ¿ÏÏÔÈ ÂÓÙÂÚo˚Ô› (1,2). EÈϤÔÓ, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÈΛÏÏÂÈ ·fi ·Û˘Ìو̷ÙÈ΋ ̤¯ÚÈ ÌÔÈÚ·›· ÁÈ· ÙÔÓ ·ÛıÂÓ‹. A˘Ùfi ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ Ù‡Ô ÙÔ˘ ÈÔ‡ Î·È ÙË ÏÔÈÌÔÁfiÓÔ ‰‡Ó·Ì‹ ÙÔ˘, ·ÏÏ¿ Î·È ·fi ÙËÓ ËÏÈΛ· Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓ‹. Afi fiÏÔ˘˜ ÙÔ˘˜ ÂÓÙÂÚÔÈÔ‡˜, ÔÈ ÈÔ› Coxsackie B Â›Ó·È ·˘ÙÔ› Ô˘

1 2 3

°' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, A.¶.£.

A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, A.¶.£.

EÚÁ·ÛÙ‹ÚÈÔ MÈÎÚÔ‚ÈÔÏÔÁ›·˜, A.¶.£.

38

Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ Ì ÚÔÛ‚ÔÏ‹ Ù˘ ηډȿ˜, ÙˆÓ Ó¢ÌfiÓˆÓ, ÙÔ˘ ‹·ÙÔ˜, ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Î·È ÙÔ˘ K.N.™. (2). T· ÈÔ ÎÔÈÓ¿ Â˘Ú‹Ì·Ù· Û ·˘Ù¤˜ ÙȘ ηٷÛÙ¿ÛÂȘ ‹Ù·Ó Ì˘ÔÂÚÈηډ›Ùȉ·, ÂÚÈηډ›Ùȉ·, Ï¢ÚÔ‰˘Ó›·, ÌËÓÈÁÁ›Ùȉ· Î·È ·ÁÎÚ·ٛÙȉ·. ™Â ÌÈ· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ BfiÚÂÈ· EÏÏ¿‰·, Ë ÈÔ Û˘¯Ó‹ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ‹Ù·Ó Ë Ì˘ÔÂÚÈηډ›Ùȉ· (3). KÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ ·ÚıÚ›Ùȉ·, Ë·Ù›Ùȉ·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÈÔ‡˜

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

Coxsackie B Û ÌÂÚÈΤ˜ ·Ó·ÊÔÚ¤˜ (4,6), ÂÓÒ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ‰ÂÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ̤¯ÚÈ ÙÒÚ·. ™Â ·˘Ù‹Ó ÙË ÌÂϤÙË, ·Ó·ÛÎÔÔ‡ÌÂ Û˘ÓÔÙÈο fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Ô˘ ÓÔÛËχÙËÎ·Ó ÚfiÛÊ·Ù· ÛÙÔ NÔÛÔÎÔÌÂ›Ô Ì·˜ Î·È ÂÚÈÁÚ¿ÊÔ˘Ì ÏÂÙÔÌÂÚÒ˜ ‰˘Ô ·fi ·˘Ù¤˜ ÏfiÁˆ ȉȷÈÙÂÚfiÙËÙ·˜ Î·È ‚·Ú‡ÙËÙ·˜.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ MÂÏÂÙ‹Û·Ì ٷ ÈÛÙÔÚÈο 11 ·ÛıÂÓÒÓ Ô˘ ÓÔÛËχÙËÎ·Ó ·fi ÙÔÓ I·ÓÔ˘¿ÚÈÔ 1996 ̤¯ÚÈ ÙÔÓ M¿ÈÔ 1997 ÏfiÁˆ ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Î·È ÂÌÊ¿ÓÈÛ˘ Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛˆÓ. H ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 15 Ì‹Ó˜ ̤¯ÚÈ 11 ¯ÚfiÓÈ· (̤ÛË ËÏÈΛ· 4,8 ¯ÚfiÓÈ·). H ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· ‹Ù·Ó 1,75:1. ø˜ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ıˆڋıËÎÂ Ë ·Ó›¯Ó¢ÛË ÂȉÈÎÒÓ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B1-6. H ·Ó›¯Ó¢ÛË ÁÈÓfiÙ·Ó Ì ̤ıÔ‰Ô ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ì ÙÔ kit ÂÌÔÚ›Ô˘ Ù˘ Bios GmbH Labordiagnostik (Munchen, Germany). H ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ kit ·ÏÏ¿ Î·È fiÏˆÓ fiÛˆÓ Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ ‰ÂÓ ‰›‰ÂÙ·È ·fi ÙȘ ÂÙ·ÈÚ›˜. TÔ‡ÙÔ, ‰ÈfiÙÈ Ë Ì¤ıÔ‰Ô˜ ·Ó·ÊÔÚ¿˜ (ÂÍÔ˘‰ÂÙÂÚˆÙÈ΋ ‰ÔÎÈÌ·Û›·) Ì ÙËÓ ÔÔ›· Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÔÈ Û˘ÁÎÚ›ÛÂȘ Â›Ó·È ÂÚÁ҉˘, ¯ÚÔÓÔ‚fiÚ·, Â›ÔÓË Î·È ‰··ÓËÚ‹ Î·È ‰ÂÓ ÚÔÛʤÚÂÙ·È. ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›·, Ë ‰ÔÎÈÌ·Û›· ÂÌ̤ÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ϤÔÓ ·ÍÈfiÈÛÙË Î·È ÚÔÙÈÌ‹ıËΠ·fi ÙȘ ·ÓÔÛÔÂÓ˙˘ÌÈΤ˜ ÌÂıfi‰Ô˘˜ ÂÂȉ‹ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Â›Ó·È ÏÈÁfiÙÂÚÔ Â˘·›ÛıËÙË ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ÂȉÈ΋, ÁÂÁÔÓfi˜ Ô˘ ÙËÓ Î·ıÈÛÙ¿ ÏÂÔÓÂÎÙÈ΋ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÛÎÔÔ‡˜.

E›Û˘ ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B1-6 ·ÓȯÓ‡ÔÓÙ·Ó ÙfiÛÔ ÛÙÔÓ ÔÚfi Ù˘ ÔÍ›·˜ Ê¿Û˘ fiÛÔ Î·È Î·Ù¿ ÙËÓ ·Ó¿ÚÚˆÛË. E› ıÂÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ ÔÈ ÔÚÔ› Â·ÓÂÍÂÙ¿˙ÔÓÙ·Ó Ì ·ÓÙÈÁfiÓ· ÂȉÈο ÁÈ· οı ¤Ó· ·fi ÙÔ˘˜ Ù‡Ô˘˜ B1-B6 ÙˆÓ ÈÒÓ Coxsackie B Î·È ¤ÙÛÈ ¤ÌÌÂÛ· ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ Ù‡ÔÈ ÙˆÓ ˘‡ı˘ÓˆÓ ÁÈ· ÙË Ïԛ̈ÍË ÈÒÓ.

AÔÙÂϤÛÌ·Ù· Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔ 1996 ̤¯ÚÈ ÙÔ M¿ÈÔ 1997, 11 ·È‰È¿ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ 2 ·È‰ÈÒÓ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ì ÏÂÙÔÌÂÚÒ˜ ÈÔ Î¿Ùˆ, ÓÔÛËχÙËÎ·Ó ÛÙȘ ‰‡Ô ¶·È‰È·ÙÚÈΤ˜ KÏÈÓÈΤ˜ ÙÔ˘ IÔÎÚ·Ù›Ԣ NÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢ Ì ÂÈÎfiÓ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋˜ Ïԛ̈͢ Ô˘ ÔÊÂÈÏfiÙ·Ó Û ÈÔ‡˜ Coxsackie B. H ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 15 Ì‹Ó˜ ̤¯ÚÈ 11 ¯ÚfiÓÈ· (̤ÛË ËÏÈΛ· 4,8 ¯ÚfiÓÈ·). H ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· ‹Ù·Ó 1,75:1. ™Ù· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿, Ô ˘ÚÂÙfi˜ ‹Ù·Ó ÙÔ Î˘Ú›·Ú¯Ô Û‡Ìو̷.

OÈ Ù‡ÔÈ ÙˆÓ ÈÒÓ Coxsackie B, Ô˘ ÚÔοÏÂÛ·Ó ·˘Ù¤˜ ÙȘ ÏÔÈÌÒÍÂȘ, ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘

§ÔÈÌÒÍÂȘ Coxsackie B

Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ·˘Ù¤˜ Î·È Ë ÂͤÏÈÍË ÙˆÓ ·ÛıÂÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1.

Afi Ù· 11 ÈÛÙÔÚÈο ·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰˘Ô ÏÂÙÔÌÂÚ¤ÛÙÂÚ· ÏfiÁˆ ȉȷÈÙÂÚfiÙËÙ·˜ Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È/ ‹ ‚·Ú‡ÙËÙ·˜ ÂΉËÏÒÛˆÓ. ¶ÂÚ›ÙˆÛË 1Ë AÁfiÚÈ ËÏÈΛ·˜ 8 ¯ÚÔÓÒÓ, ÚÔÛÎÔÌ›ÛÙËΠÛÙË °' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ IÔÎÚ¿ÙÂÈÔ˘ NÔÛÔÎÔÌ›Ԣ Ì ÂÌ‡ÚÂÙÔ ‰È¿ÚÎÂÈ·˜ 2 ËÌÂÚÒÓ Î·È ÌÂ Û˘ÓÔ‰fi Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Î·È ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË (ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 18.500/mm3 Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ 16.650). K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰ÂÓ ·ÔÎ¿Ï˘„ ٛÔÙ· ÙÔ ·ıÔÏÔÁÈÎfi, ÂÎÙfi˜ ·fi ıÂÚÌÔÎÚ·Û›· 39C. T· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ‹Ù·Ó 12.000/mm3 Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ 9.960, Ë TKE 91mm/1Ë ÒÚ· Î·È Ë CRP > 20 mg/l.

TË ‰Â‡ÙÂÚË Ë̤ڷ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ (4Ë Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘), Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÈÎfiÓ· Ë·Ù›Ùȉ·˜. TÔ ‹·Ú ‚Ú¤ıËΠ‰ÈÔÁΈ̤ÓÔ. H SGPT ‹Ù·Ó 117 IU/l, (Ê.Ù. 15-40 IU/l) Î·È Ë Á-GT ‹Ù·Ó 128 U/l (Ê.Ù. 5-32 U/l). O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÙË ‰ÈfiÁΈÛË ÙÔ˘ ÔÚÁ¿ÓÔ˘ ¯ˆÚ›˜ fï˜ ÂÛÙȷΤ˜ ·ÏÏÔÈÒÛÂȘ. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰È‹ÚÎÂÛ·Ó 2 Ë̤Ú˜.

TËÓ 5Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, ÙÔ ·È‰› ·ÚÔ˘Û›·Û ‚‹¯·. K·Ù¿ ÙËÓ ·ÎÚfi·ÛË ÙÔ˘ ıÒڷη ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙ˜ ÚfiÁ¯ÔÈ ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ. H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ‰È¿ÌÂÛË Ó¢ÌÔÓ›Ùȉ· Ì ·ÙÂÏÂÎÙ·Û›· ÛÙÔ ‰ÂÍÈfi Ó‡ÌÔÓ·. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ‹Ù·Ó ·ÚÓËÙÈΤ˜ ÁÈ· ÌÈÎÚfi‚È· Î·È Ì‡ÎËÙ˜.

TËÓ 7Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·, Ì ›¯ÓË Ï¢ÎÒÌ·ÙÔ˜ ÛÙ· Ô‡Ú·. H ÎÚ·ÙÈÓ›ÓË ÙÔ˘ ÔÚÔ‡ ‹Ù·Ó 88 Ìmol (1 mg/dl), Ë ÔÔ›· Â›Ó·È Î·È Ë ·ÓÒÙÂÚË Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘. H ‰ÈÔ‡ÚËÛ‹ ÙÔ˘ ‹Ù·Ó <1 ml/kg/ÒÚ·, ÂÓÒ Ë ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó Û˘Ó¯Ҙ 130/90 mmHg, ÍÂÂÚÓÒÓÙ·˜ Ù· ·ÓÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘. H ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ ÂÚ˘ıÚÒÓ Û ÚfiÛÊ·Ù· Ô‡Ú· ·ÔÎ¿Ï˘„ ÙËÓ ÛÂÈÚ·Ì·ÙÈ΋ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜. H TKE ·˘Í‹ıËΠ(113 mm/1Ë ÒÚ·) Î·È Ô Ù›ÙÏÔ˜ ASTO ‹Ù·Ó 58 U Todd. A˘Ù‹ Ë ‹È· ÂÈÎfiÓ· ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜ ‰È‹ÚÎÂÛ 3 Ë̤Ú˜.

O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ¤ÁÈÓ ÙËÓ 8Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚Ô‡, ·‰ÂÓÔ˚ÒÓ, Epstein-Barr, ÈÒÓ Ë·Ù›Ùȉ·˜ B Î·È C, ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘Á΢ÙÈ·ÎÔ‡ ÈÔ‡, ÈÒÓ ECHO, Î·È ÂÓ·ÓÙ›ÔÓ Toxoplasma gondii, ‹Ù·Ó ·ÚÓËÙÈÎfi˜. AÓÙ›ıÂÙ·, Ô ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÈÔ‡˜ Coxsackie B ¤‰ÂÈÍ ÚfiÛÊ·ÙË Ïԛ̈ÍË ÏfiÁˆ Ù˘ ·Ó›¯Ó¢Û˘ ÂȉÈÎÒÓ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi Û ˘„ËÏÔ‡˜ Ù›ÙÏÔ˘˜ Î·È È¯ÓÒÓ IgG. TËÓ 12Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, Ô ·ÛıÂÓ‹˜ ‹Ù·Ó ·‡-

39

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·40

¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

E.PÔËÏ›‰Ë˜ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ™˘ÛÙËÌ·ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B. AÚÈıÌfi˜ AÚ¯Èο HÏÈΛ· T‡Ô˜ ÈÔ‡ KÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ·ÛıÂÓ‹ ·ÛıÂÓ‹ (¯ÚfiÓÈ·) Coxsackie B*

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3

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1,25

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4

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8

B4

H·Ù›Ùȉ·, Ó¢ÌÔÓ›·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·, ·ÚıÚ›Ùȉ·

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5

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3,5

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6

B4

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7

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5

B2

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11

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¶Ó¢ÌÔÓ›· Ì Ï¢ڛÙȉ·, ÂÍ¿ÓıËÌ·

AÓ¿ÚÚˆÛË

* ŒÌÌÂÛÔ˜ ηıÔÚÈÛÌfi˜ Ì ·Ó›¯Ó¢ÛË ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÂÓfi˜ ÂοÛÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Coxsackie B1-B6 ** AÓ›¯Ó¢ÛË ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ B1-B6 *** O ·ÛıÂÓ‹˜ ›¯Â ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ÚÂÙÔ˜ Î·È Â¤ÛÙÚ„ ÛÙÔ Û›ÙÈ ÙÔ˘ ÌÂÙ¿ ·fi Ï‹ÚË ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ. TËÓ 16Ë Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, ÌÂÙ¿ ·fi ÌÈ· ÂÚ›Ô‰Ô 4 ËÌÂÚÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù·, Ô ·ÛıÂÓ‹˜ ·Ú·ÔÓ¤ıËΠÁÈ· ¿ÏÁÔ˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ Ô‰ÔÎÓËÌÈ΋ ¿ÚıÚˆÛË, Ë ÔÔ›· ˘Ô¯ÒÚËÛ Û 4 Ë̤Ú˜, ·ÏÏ¿ ·ÎÔÏÔ‡ıËÛ ¿ÏÁÔ˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ηٿ ÁfiÓ˘ ¿ÚıÚˆÛË. H ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·ÔÎ¿Ï˘„ ·ÚıÚ›Ùȉ· Ë ÔÔ›· ÂȂ‚·ÈÒıËÎÂ Î·È Ì ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. H ·ÚıÚ›Ùȉ· ‰È‹ÚÎÂÛ ÂÚ›Ô˘ 2 ‚‰ÔÌ¿‰Â˜. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È fiÏË Ë Û˘Ìو̷ÙÔÏÔÁ›· ÙÔ˘ ·ÛıÂÓ‹. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B, Ô˘ ¤ÁÈÓ 3 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÚÒÙË ÂͤٷÛË ¤‰ÂÈÍ ›¯ÓË IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÔÚÔÌÂÙ·ÙÚÔ‹ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ B4. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿, Ô ·ÛıÂÓ‹˜ Â›Ó·È Û Ôχ ηϋ ηٿÛÙ·ÛË. ¶ÂÚ›ÙˆÛË 2Ë AÁfiÚÈ, ËÏÈΛ·˜ 3 ¯ÚÔÓÒÓ, ·Ú·¤ÌÊıËΠÛÙÔ Â͈ÙÂÚÈÎfi AÈÌ·ÙÔÏÔÁÈÎfi I·ÙÚÂ›Ô Ù˘ A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÁÈ· ¤ÏÂÁ¯Ô Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Ë·ÙÔÛÏËÓÔ-

40

ÌÂÁ·Ï›·˜ Ù· ÔÔ›· ·Ó·Î·Ï‡ÊıËÎ·Ó Ù˘¯·›· ÚÔ ‰ÈÌ‹ÓÔ˘. ™ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙÔ˘ ·ÛıÂÓÔ‡˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Û˘Ó¯›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÂȂ‚·›ˆÛ ÙË ‰ÈfiÁΈÛË ‹·ÙÔ˜ Î·È ÛÏËÓfi˜ Î·È ·ÔÎ¿Ï˘„ „ËÏ·ÊËÙÔ‡˜ ÙÚ·¯ËÏÈÎÔ‡˜ ÏÂÌÊ·‰¤Ó˜. O ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ Ԣ‰ÂÙÂÚÔÂÓ›· (ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 4.500/mm3 Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ 450) Î·È ıÂÙÈ΋ ÙËÓ ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs. TÔ Ì˘ÂÏfiÁÚ·ÌÌ· ¤‰ˆÛÂ Ê˘ÛÈÔÏÔÁÈο ·ÔÙÂϤÛÌ·Ù·. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·¤‚Ë ·ÚÓËÙÈÎfi˜ ÁÈ· ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚Ô‡, ÙÔ˘ ÈÔ‡ Epstein-Barr, ÙÔ˘ ÈÔ‡ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·, ·‰ÂÓÔ˚ÒÓ Î·È ÙÔ˘ Toxoplasma gondii ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÚfiÛÊ·ÙË Ïԛ̈ÍË. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B ¤‰ÂÈÍ IgM ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi, ÂÓÒ Ù· IgG ‹Ù·Ó ÂÏ·ÊÚ¿ ·˘ÍË̤ӷ. ¢‡Ô Ì‹Ó˜ ·ÚÁfiÙÂÚ·, Ë Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· ›¯Â ˘Ô¯ˆÚ‹ÛÂÈ Î·È Ë ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ‹Ù·Ó ·ÚÓËÙÈ΋.T· IgG ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ

JAN.-FEB.2000

30-05-03

12:56

™ÂÏ›‰·41

¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42

Coxsackie B ‚Ú¤ıËÎ·Ó ÙÂÙÚ·Ï¿ÛÈ· ·˘ÍË̤ӷ ÛÙÔÓ ÔÚfi ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ B1-B6.

T¤ÛÛÂÚȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· Ù· IgM ·ÓÙÈÛÒÌ·Ù· ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·Ó Î·ıfiÏÔ˘ ÛÙÔÓ ÔÚfi. H Ô˘‰ÂÙÂÚÔÂÓ›· fï˜ ·Ú¤ÌÂÈÓÂ Î·È ÌÂÙ¿ 8 Ì‹Ó˜, Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠Ú‰ÓÈ˙ÔÏfiÓË Û ‰fiÛË 2 mg/kg ËÌÂÚ‹ÛÈ· ÁÈ· 15 Ë̤Ú˜ Î·È ÛÙ·‰È·Î‹ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È Â·ÓÂÈÏËÌ̤ӷ Û¯‹Ì·Ù· ÂÓ‰ÔÊϤ‚È·˜ Á-ÛÊ·ÈÚ›Ó˘ Û ‰fiÛË 2 gr/kg ÂÊ¿·Í. MÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·ÔηٷÛÙ¿ıËÎÂ Î·È Ô ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ¿ÚÈÛÙË Î·Ù¿ÛÙ·ÛË Ì¤¯ÚÈ Û‹ÌÂÚ·. ™˘˙‹ÙËÛË ™Â ·˘Ù‹Ó ÙË ÌÂϤÙË, ·Ó·ÛÎÔÔ‡ÓÙ·È 11 ÂÚÈÙÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Ô˘ Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ. OÈ ‰‡Ô ϤÔÓ ¿Ù˘˜ ‹ ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÂȉÈÎfiÙÂÚ·. AÓ Î·È ÏÔÈÌÒÍÂȘ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ÈÔ‡˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÚÔËÁÔ‡ÌÂÓ·, ÏÔÈÌÒÍÂȘ Ì ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó Ôχ ÏÈÁfiÙÂÚÔ ÙÂÎÌËÚȈı›, Î·È Ë ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ·ÊÔÚ¿ ΢ڛˆ˜ ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ (4,5,7-10). I‰È·›ÙÂÚ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÔÈ ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Â›Ó·È Û¿ÓȘ Î·È ·ÊÔÚÔ‡Ó ÈÔ Û˘¯Ó¿ ÓÂÔÁÓ¿ Î·È ÌÈÎÚ¿ ‚Ú¤ÊË, ÛÙ· ÔÔ›· ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·Ô‚·›ÓÔ˘Ó ÌÔÈÚ·›Â˜ (2). H ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·ÊÔÚ¿ Û¯ÂÙÈο ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·È‰ÈÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. O ÈÔ Û˘¯Ófi˜ Ù‡Ô˜ Ô˘ ‚Ú¤ıËΠÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó Ô B4 (‚Ú¤ıËΠ۠4 ·fi ÙÔ˘˜ 7 ·ÛıÂÓ›˜ Ô˘ ÂϤÁ¯ıËηÓ). A˘Ùfi ÙÔ Â‡ÚËÌ· Û˘ÌʈÓ› Ì ÚÔËÁÔ‡ÌÂÓ· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÂÚÈÔ¯‹ Ì·˜ fiÙÈ Ô ÈÔ Û˘¯Ó¿ ÂÌÊ·ÓÈ˙fiÌÂÓÔ˜ Ù‡Ô˜ ÈÔ‡ Coxsackie B ÛÙË BfiÚÂÈÔ EÏÏ¿‰· Â›Ó·È Ô B4 (3). ™Â ·ÓÙ›ıÂÛË, Ô B3 ‰ÂÓ ‚Ú¤ıËΠ۠ηӤӷ ·fi Ù· ·È‰È¿. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ 2 ·fi Ù· 7 ·È‰È¿ Ô˘ ÂϤÁ¯ıËÎ·Ó Â›¯·Ó Û‡Á¯ÚÔÓË Ïԛ̈ÍË ·fi 2 ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ù‡Ô˘˜ ÈÒÓ Coxsackie B (›Ó·Î·˜ 1). ™Â Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ (1,5,8,9) ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÈÔ‡ Coxsackie B ‰ÈfiÙÈ ·ÓȯÓ‡ıËÎ·Ó ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ Ù‡ˆÓ (B1-6) Î·È ÛÙÔÓ ›‰ÈÔ Ù›ÙÏÔ.

TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÂÓ Â›Ó·È Û¿ÓÈÔ Û ÈÔ‡˜ Ô˘ ÌÔÈÚ¿˙ÔÓÙ·È ÎÔÈÓ¿ ·ÓÙÈÁfiÓ· fiˆ˜ ÔÈ ÈÔ› Coxsackie B. ™ÙÔÓ ›Ó·Î· 1, ‰›‰ÂÙ·È ‹‰Ë Ë ÂÍ‹ÁËÛË ·˘Ù‹.

O ·ÛıÂÓ‹˜ Ù˘ ÂÚ›ÙˆÛ˘ 1 (›Ó·Î·˜ 1: ·ÛıÂÓ‹˜ 4) ·Ó¤Ù˘Í ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ Î·È, ·Ú¿ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ‹·ÙÔ˜, Ó¢ÌfiÓˆÓ, ÓÂÊÚÒÓ Î·È ·ÚıÚÒÛˆÓ, Ë ÓfiÛÔ˜ ›¯Â ‹È· ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÂͤÏÈÍË. °È· ÚÒÙË ÊÔÚ¿ ·Ó·Ê¤ÚÂÙ·È Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B Ì ÙfiÛÔ ÁÂÓÈÎÂ˘Ì¤ÓË Û˘ÌÌÂÙÔ¯‹. I‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂΉ‹ÏˆÛË Ù˘ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜ Û ·˘ÙfiÓ ÙÔÓ ·ÛıÂÓ‹ Ô˘ ›¯Â Û¯¤ÛË Ì Ïԛ̈ÍË ·fi Èfi Coxsackie B4. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·,

§ÔÈÌÒÍÂȘ Coxsackie B

˘¿Ú¯Ô˘Ó Û¿ÓȘ ·Ó·ÊÔÚ¤˜ ÓÂÊÚ›Ùȉ·˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔ˘˜ ÂÓÙÂÚÔ˚Ô‡˜ (2). O ÓÂÊÚÔÙÚÔÈÛÌfi˜ ÙˆÓ ÈÒÓ Coxsackie B4 Â›Ó·È ·fi ηÈÚfi ÁÓˆÛÙfi˜. O Bayatpour Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ÂÚȤÁÚ·„·Ó ÂÚ›ÙˆÛË ÔÍ›·˜ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜ Û ·ÁfiÚÈ 9 ¯ÚÔÓÒÓ Ì ÛÔ‚·Ú¤˜ ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘ Û˘Û¯ÂÙ›ÛÙËΠ̠ÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË Ïԛ̈͢ ·fi Èfi Coxsackie B4.

EÓÙÔ‡ÙÔȘ, ·˘Ùfi˜ Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ Û˘Á¯ÚfiÓˆ˜ Î·È ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ASTO (7). Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Ô Burch Î·È Colcolough ÂÚȤÁÚ·„·Ó ÌÈ· ÂÚ›ÙˆÛË ÚÔԉ¢ÙÈ΋˜ ·Óηډ›Ùȉ·˜ Î·È ÓÂÊÚ›Ùȉ·˜ Û ·ÛıÂÓ‹ Ì Ïԛ̈ÍË ·fi Èfi Coxsackie B4 (9). ¶ÈÔ ÚfiÛÊ·Ù·, Ô Kamiyama Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ·¤‰ÂÈÍ·Ó ÙË ÓÂÊÚÈÙȉÔÁfiÓÔ È‰ÈfiÙËÙ· ÙÔ˘ Coxsackie B4 ÚÔηÏÒÓÙ·˜ ÛÂÈÚ·Ì·ÙoÓÂÊÚ›Ùȉ· ÙÔ˘ Ù‡Ô˘ ÙˆÓ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ Û ÔÓÙ›ÎÈ· (6). EÈÚfiÛıÂÙ·, Ô Yoshida Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ÚÔοÏÂÛ·Ó ¿ÏÈ Û ÔÓÙ›ÎÈ· IgA ÓÂÊÚÔ¿ıÂÈ· ·fi Èfi Coxsackie B4 Ì ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ (11).

O ·ÛıÂÓ‹˜ Ù˘ ÂÚ›ÙˆÛ˘ 2, (›Ó·Î·˜ 1: ·ÛıÂÓ‹˜ 1) ·ÚÔ˘Û›·Û Ԣ‰ÂÙÂÚÔÂÓ›·, Ë ÔÔ›·, Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, Û˘Û¯ÂÙ›ÛÙËΠ̠Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. H Ô˘‰ÂÙÂÚÔÂÓ›· ÚÔÎÏ‹ıËΠ̿ÏÏÔÓ ·fi οÔÈÔ ÌË Î·Ï¿ ηٷÓÔËÙfi ·˘ÙÔ¿ÓÔÛÔ Ì˯·ÓÈÛÌfi, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙË ıÂÙÈ΋ ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs. A' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, Ô˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÔÍ›· Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı›. AÓÙ›ıÂÙ·, ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ¤ÊË‚Ô, ÂÚ›ÙˆÛË Û˘Ó‰ÚfiÌÔ˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ Ô˘ ÂΉËÏÒıËΠ̠ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ê·Ú˘ÁÁ›Ùȉ·, ÌËÓÈÁÁÔÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·, Ë·Ù›Ùȉ· Î·È ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, Ô˘ ÔÊÂÈÏfiÙ·Ó Û Ïԛ̈ÍË Ì Èfi Coxsackie Ù‡Ô˘ B3 (8). ¢˘ÛÙ˘¯Ò˜, Î·È ÛÙÔÓ ·ÛıÂÓ‹ ·˘ÙfiÓ ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÈÔ‡ Coxsackie B ‰ÈfiÙÈ ·ÓȯÓ‡ıËÎ·Ó ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ Ù‡ˆÓ (B1-6) Î·È ÛÙÔÓ ›‰ÈÔ Ù›ÙÏÔ.

H ·ÚıÚ›Ùȉ· Î·È Ë Ó¢ÌÔÓ›· ‹Ù·Ó ÔÈ ÈÔ Û˘¯Ó¤˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë Î·ıÂÌ›· ¯ˆÚÈÛÙ¿ ÂÌÊ·Ó›ÛÙËΠÛÙÔ˘˜ 3 ·fi ÙÔ˘˜ 11 ·ÛıÂÓ›˜ Ì·˜ (›Ó·Î·˜ 1). OÈ ÈÔ› Coxsackie A Î·È B ¢ı‡ÓÔÓÙ·È ÁÈ· ·Ó·ÏÔÁ›· <1% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÈÔÁÂÓÔ‡˜ Ó¢ÌÔÓ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (2). Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Û ·Ï·ÈfiÙÂÚ˜ ·Ó·ÊÔÚ¤˜ Û˘Û¯ÂÙ›ÛÙËÎÂ Ë ·ÚıÚ›Ùȉ· Ì Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B (4,5,12). ™Â ÌÈ· ·Ó·ÊÔÚ¿, Û˘Û¯ÂÙ›ÛÙËÎÂ Ë ÂÌÊ¿ÓÈÛË ÓÔÛ‹Ì·ÙÔ˜ Ô˘ ¤ÌÔÈ·˙ Ì ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· Û 2 ·ÛıÂÓ›˜ (¤Ó·Ó ¤ÊË‚Ô Î·È ¤Ó·Ó ÂÓ‹ÏÈη) Ì Ïԛ̈ÍË ·fi Èfi Coxsackie B4. ™ÙË ÌÂϤÙË ·˘Ù‹, ÔÈ 2 ·fi ÙÔ˘˜ 3 ·ÛıÂÓ›˜ Ì ·ÚıÚ›Ùȉ· ›¯·Ó Ïԛ̈ÍË ·fi Èfi Coxsackie B4.

OÈ ÂÚÈÙÒÛÂȘ, Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Û ·˘Ù‹ ÙË ÌÂϤÙË, ÙÔÓ›˙Ô˘Ó ÙË ÛËÌ·Û›· Î·È ÔÈÎÈÏ›· ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B.

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E.PÔËÏ›‰Ë˜ Î·È Û˘Ó.

EÈÎfiÓ· 1. ™˘Ìو̷ÙÔÏÔÁ›· ·ÛıÂÓ‹ 1.

OÈ ÈÔ› ·˘ÙÔ› ÂÚÈÛÙ·Ûȷο ÚÔηÏÔ‡Ó ÁÂÓÈÎÂ˘Ì¤Ó˜ ÏÔÈÌÒÍÂȘ Ì ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÔÚ›·, Û ηٿ Ù· ¿ÏÏ· ˘ÁÈ‹ ·È‰È¿, ·ÏÏ¿ Â›Û˘ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó Î·È ÂÌ̤ÓÔ˘Û· Ô˘‰ÂÙÂÚÔÂÓ›·. T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û¯ÂÙ›˙ÔÓÙ·È Â›Ù Ì ÙËÓ ˘„ËÏ‹ ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ù‡ˆÓ ÙˆÓ ÈÒÓ Coxsackie B, ‹ Ì ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ‰ÂÓ Â›Ó·È Â·ÚÎÒ˜ ηıÔÚÈṲ̂ÓÔÈ Ì¤¯ÚÈ Û‹ÌÂÚ·.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Modlin JF. Coxsackie viruses, ECHO viruses and enteroviruses. In: Mandell GL, Bennett JE, Dolin R, eds.

Principles and Practice of Infectious Diseases. New York: Churchill Livingstone, 1995: 1620-1636.

2. Cherry JD. Enteroviruses: Coxsackieviruses, Echoviruses and Polioviruses. In: Feigin RD, Cherry JD, ed. Textbook of Pediatric Infectious Diseases. Philadelphia: Saunders,4th Ed. 1998: 1787-1839.

3. K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó· B,ºÚ·ÓÙ˙›‰Ô˘-A‰·ÌÔÔ‡ÏÔ˘ º, ™Ô‡ÏÈÔ˘-™˘Ìˆӛ‰Ô˘ E, ™˘Ìˆӛ‰Ë˜ °, ¶··‚·ÛÈÏ›Ԣ ¶.

IÔ› Coxsackie B Î·È ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜. EÏÏËÓÈ΋ I·ÙÚÈ΋ 1991;57, 5: 334-338.

4. Heaton DC, Moller PW. Still’s disease associated with Coxsackie infection and haemophagocytic syndrome.

Ann Rheum Dis 1985;44:341-344.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-10-98 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: E. PÔËÏ›‰Ë˜ °' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ A.¶.£. IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô KˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, 54642 £ÂÛÛ·ÏÔÓ›ÎË

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5. David JJ, Dietz FR, Jones MM. Coxsackie B monoarthritis with hepatitis. A case report. J Bone Joint Surg Am 1993;75:1685-1686.

6. Kamiyama S. Experimental glomerulonephritis induced by Coxsackie B4 virus in mice-glomerular changes associated with intermittent viral inoculations. Nippon Jinzo Gakkai Shi 1990;32:939-948.

7. Bayatpour M, Zbitnew A, Dempster G. Role of Coxsackie virus B4 in the pathogenesis of acute glomerulonephritis.

Can Med Assoc J 1973;109:873-875.

8. Begovac J, Puntaric V, Borcic D, Barsic B, Zrinscak J, Beus I, et al. Mononucleosis-like syndrome associated with a multisystem Coxsackie virus type B3 infection in adolescence. Eur J Pediatr 1988;147:426-427.

9. Burch GE, Colcolough HL. Progressive Coxsackie viral pancarditis and nephritis. Ann Intern Med 1969;71:963-970.

10. Hurst NP, Martynoga AG, Nuki G, Sewell JR, Mitchell A, Hughes GR. Coxsackie B infection and arthritis. BMJ 1983;286:605-607.

11. Yoshida K, Suzuki J, Suzuki S, Kume K, Mutoh S, Kato K, et al. Experimental IgA nephropathy induced by Coxsackie B4 virus in mice. Am J Nephrol 1997;17:81-88.

12. Huppertz HI, Niki NP, Chantler JK. Susceptibility of normal human joint tissue to viruses. J Rheumatol 1991;18:699-704.

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E¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

ŒÌÊÚ·ÎÙÔ Ì¤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·fi Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ B›Î˘ º·Ï·˝Ó·, B·ÛÈÏÈ΋ ¶··Â˘·ÁÁ¤ÏÔ˘, B·ÛÈÏÈ΋ ™˘ÚÈÔÔ‡ÏÔ˘, M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘

● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 4 ÂÙÒÓ Ô˘ ÂÈÛ‹¯ıË ÛÙË ÎÏÈÓÈ΋ Ì·˜ Ì ˘ÚÂÙfi, ‚‹¯· Î·È ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙ˜ Û ·ÌÊfiÙÂÚ· Ù· Ó¢ÌÔÓÈο ‰›·. TËÓ 3Ë Ì¤Ú· ÓÔÛËÏ›·˜ Ù˘, ˘fi ·ÓÙÈÌÈÎÚԂȷ΋ ıÂÚ·›·, ÂÌÊ¿ÓÈÛ ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·. T¤ÛÛÂÚȘ Ë̤Ú˜ ·ÚÁfiÙÂÚ· Î·È ÂÓÒ Ô ˘ÚÂÙfi˜ ›¯Â ˘ÊÂı›, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ¿ÚÂÛË ÙÔ˘ ‰ÂÍÈÔ‡ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. T· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙÔ˘ ENY ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (CT Î·È MRI ÂÁÎÂÊ¿ÏÔ˘) ¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο Ì ·ÁÁÂȷ΋ ηٷÓÔÌ‹, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ¤ÌÊÚ·ÎÙÔ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. H ÔÚ›· Ù˘ ·ÛıÂÓÔ‡˜ Ì ·ÓÙÈÌÈÎÚԂȷ΋ Î·È Û˘Ìو̷ÙÈ΋ ·ÁˆÁ‹ ÂÍÂÏ›¯ıËΠÈηÓÔÔÈËÙÈο Ì Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ 10 ̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·Û‹ Ù˘. H ÂÚ›ÙˆÛË ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ·Ù› Ë ÂÓÙÔÈṲ̂ÓË ·ÁÁÂÈ›Ùȉ· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÔÙÂÏ› Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜. ¶·È‰È·ÙÚÈ΋ 2000;63:43-47. §¤ÍÂȘ ÎÏÂȉȿ: ¿ÚÂÛË ÚÔÛˆÈÎÔ‡, ¤ÌÊÚ·ÎÙÔ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜.

V. Falaina, V. Papaevangelou, V. Syriopoulou, M. Theodoridou. Occlusion of the middle cerebral artery and Bell's palsy associated with Mycoplasma pneumoniae infection. Paediatriki 2000;63:43-47. ● Abstract: A four-year old girl, with an unremarkable past medical history, was admitted with fever, cough and respiratory distress. On the third day of hospitalization, she developed a diffuse maculopapular rash. Four days later, she had an episode of partial seizures with clonic contractions of the left corner of her mouth with no loss of consciousness, which was accompanied by a right-sided Bell’s palsy. The CSF examination was normal and brain CT and MRI revealed a hypopyknotic area in the right fronto-temporal region indicating infarction due to occlusion of the middle cerebral artery. Serum antibodies tested by both Elisa and complement fixation indicated recent M. pneumoniae infection. There was complete remission of the Bell’s palsy within 10 days. This is a rare case of cerebral infarction following Mycoplasma pneumoniae infection. The pathogenesis, clinical presentation and prognosis of the neurologic complications of M. pneumoniae infection are discussed.

Key words: Bell’s palsy, M. pneumoniae infection, cerebral infarction.

EÈÛ·ÁˆÁ‹ H Ó¢ÌÔÓ›· ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ Î·È ÛËÌ·ÓÙÈ΋ ÂΉ‹ÏˆÛË Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. YÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ Ì˘ÎfiÏ·ÛÌ· ¢ı‡ÓÂÙ·È ÁÈ· ÂÚ›Ô˘ 20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ó¢ÌÔÓ›·˜ Ù˘ ÎÔÈÓfiÙËÙ·˜. H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· (0,1%),

·ÏÏ¿ ·˘Í¿ÓÂÈ ·Ú¿ÏÏËÏ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ Ó¢ÌÔÓ›·˜, ·ÊÔ‡ ÊÙ¿ÓÂÈ ÛÙÔ 7% ÛÙÔ˘˜ ÓÔÛËÏ¢fiÌÂÓÔ˘˜ Ì Ó¢ÌÔÓ›· ·fi Ì˘ÎfiÏ·ÛÌ· (1). H ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ Â›Ó·È Û˘¯ÓfiÙÂÚË Û Ó·ڿ ¿ÙÔÌ· (< 20 ÂÙÒÓ) Î·È È‰È·›ÙÂÚ· Û ¿ÚÚÂÓ˜, ÂÌÊ·Ó›˙ÂÙ·È ‰Â ηٿ ̤ÛÔ fiÚÔ 10 ̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ (2-4) .

A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·".

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:43-47

H ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ· ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÂÈÏÔ΋. ™·ÓÈfiÙÂÚ· ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂÁÎÂÊ·Ï›Ùȉ·, ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·, Ó¢ڛÙȉ·, Û‡Ó‰ÚÔÌÔ ·Ó¿ÏÔÁÔ Ì ÙËÓ ÔÏ˘ÔÌ˘ÂÏ›Ùȉ·, Û‡Ó‰ÚÔÌÔ GuillainBarré Î·È „‡¯ˆÛË. H ‰È¿ÁÓˆÛË Ù˘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ Û˘Ó‹ıˆ˜ Ù›ıÂÙ·È Ì ÙȘ ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ÂÙÒÓ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·fi Ïԛ̈ÍË Ì ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ KÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Ì ˘ÚÂÙfi, ‚‹¯· Î·È ‹È· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. TÔ ·ÙÔÌÈÎfi, ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÔÓÙ·È ÂχıÂÚ·. H ·ÛıÂÓ‹˜ Ù¤ÛÛÂÚȘ ̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi ¤ˆ˜ 39ÔC Î·È ÍËÚfi ‚‹¯·. ¶ÚÔԉ¢ÙÈο, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ·ÛıÂÓÔ‡˜ ÂȉÂÈÓÒıËΠÏfiÁˆ ÂÈÌÔÓ‹˜ ÙÔ˘ ˘ÚÂÙÔ‡ Î·È ÂÌÊ¿ÓÈÛ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ .

K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ·ÛıÂÓ‹˜ ‹Ù·Ó Û ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙ˜ Û ·ÌÊfiÙÂÚ· Ù· Ó¢ÌÔÓÈο ‰›·, ¯ˆÚ›˜ ¿ÏÏ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙˆÓ ˘ÔÏÔ›ˆÓ Û˘ÛÙËÌ¿ÙˆÓ.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍÂ: Hb: 12,2 gr/dl, Ht:37,5%, §Â˘Î¿: 6.900/mm3 (¶ÔÏ˘/69%, §ÂÌÊÔ/21%, MÔÓÔ/5%), AÈÌÔÂÙ¿ÏÈ·: 260.000/mm3, T.K.E.: 65mm/1Ë ÒÚ·, C.R.P.: 42,2 mg/lt. O ·‰Úfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, Ë ‰Â ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÛÙ›ڷ. H ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ‡ÎÓˆÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡ Î·È ‰È¿ÌÂÛ· ÛÙÔȯ›· ¿Ìʈ.

M ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜ ¯ÔÚËÁ‹ıËÎ·Ó ·ÌÔ͢ÎÈÏÏ›ÓË-ÎÏ·‚Ô˘Ï·ÓÈÎfi i.v. Î·È ÂÚ˘ıÚÔÌ˘Î›ÓË p.o.s.

TËÓ 7Ë Ì¤Ú· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜, Ë ·ÛıÂÓ‹˜ Û˘Ó¤¯È˙ ӷ ˘Ú¤ÛÛÂÈ Î·È Ù· ·ÎÚÔ·ÛÙÈο Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ‹Ù·Ó ·ÌÂÙ¿‚ÏËÙ·. ™ÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÚÔÛÂÙ¤ıË ·Ú·Èfi ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·, ηıÒ˜ Î·È ÂÓ¿ÓıËÌ· ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. EÛÙ¿ÏË ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤Ó·ÓÙÈ ÈÒÓ Î·È ‚·ÎÙËÚȉ›ˆÓ Ô˘ ÂÌϤÎÔÓÙ·È Û ·ÚfiÌÔÈ· Û˘Ìو̷ÙÔÏÔÁ›· fiˆ˜ ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, Ô Èfi˜ Epstein-Barr, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Î·È Ô Èfi˜ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·.

TËÓ 11Ë Ì¤Ú· Ù˘ ÓfiÛÔ˘ Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÛËÌ·ÓÙÈο ‚ÂÏÙȈ̤ÓË Î·È Ô ˘ÚÂÙfi˜ ›¯Â ˘ÊÂı›. H ·ÛıÂÓ‹˜, ÂÓÒ ‰È·ÙËÚÔ‡Û ¿ÚÈÛÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘, ·ÚÔ˘Û›·Û ÎÏÔÓÈΤ˜ Û˘Û¿ÛÂȘ

44

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

Ù˘ ·ÚÈÛÙÂÚ‹˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ‰È¿ÚÎÂÈ·˜ ÂÚ›Ô˘ 1-2 ÏÂÙÒÓ Î·È ÂÓ Û˘Ó¯›· ÂÌÊ¿ÓÈÛ ·Û˘ÌÌÂÙÚ›· ÚÔÛÒÔ˘, Ì ÙÒÛË Ù˘ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰ÂÍÈ¿. H ÛËÌÂÈÔÏÔÁ›· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘.

H ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ Â›ÎÙËÙˆÓ ·ÈÙÈÒÓ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜, ÏÔÈÌÒÍÂȘ, ÂÓ‰ÔÎÚ¿ÓÈÔ˘˜ fiÁÎÔ˘˜ ‹ ¤ÌÊÚ·ÎÙ·, ˘¤ÚÙ·ÛË, ÙÔ͛Ә Î·È ÙË Ì˘·Ûı¤ÓÂÈ· Gravis. °È· ÙËÓ ·ÈÙÈÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË ·ÎÔÏÔ‡ıËÛ·Ó ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. H ÂͤٷÛË ÙÔ˘ E.N.Y. ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ fï˜, ¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο Ì ¢Ú›· ÂÚÈÊÂÚÈ΋ ‚¿ÛË Î·È ·ÁÁÂȷ΋ ηٷÓÔÌ‹, ÂÈÎfiÓ· Ô˘ Û˘ÓËÁÔÚ› ˘¤Ú ÂÌÊÚ¿ÎÙÔ˘ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ (ÂÈÎfiÓ· 1). H ·ÛıÂÓ‹˜, Ô˘ ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, ÂÙ¤ıË Û ·ÔȉËÌ·ÙÈ΋ ·ÁˆÁ‹ Ì ̷ÓÈÙfiÏË Î·È ‰ÂÍ·ÌÂı·˙fiÓË. T·˘Ùfi¯ÚÔÓ·, ·fi ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‚Ú¤ıËΠÂÍ·ÈÚÂÙÈο ·˘ÍË̤ÓÔ˜ Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ Ì ÙË Ì¤ıÔ‰Ô Û‡Ó‰ÂÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ IgG> 1/1024, fiˆ˜ Î·È Ì ÙËÓ ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (Elisa) IgM > 1/2560 Î·È IgG > 1/2560 ·ÓÙ›ÛÙÔȯ·. TÔ Â‡ÚËÌ· ·˘Ùfi ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ Úfi-

EÈÎfiÓ· 1. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ fiÔ˘ Ê·›ÓÂÙ·È ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο.

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EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

EÈÎfiÓ˜ 2,3. M·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, T1 Î·È T2 Ï‹„Ë ·ÓÙ›ÛÙÔȯ·, fiÔ˘ ÂȂ‚·ÈÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ ¤ÌÊÚ·ÎÙÔ˘ Ù˘ ‰ÂÍÈ¿˜ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜ (Ê·›ÓÂÙ·È ÛÙÔ ·ÚÈÛÙÂÚfi ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜). ÛÊ·Ù˘ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÂÚȤϷ‚Â Î·È ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ıÚfiÌ‚ˆÛË Ù˘ ¤Ûˆ ηڈٛ‰·˜ Î·È ÎÏ¿‰ˆÓ ·˘Ù‹˜ fiˆ˜ Â›Ó·È Ë Û˘Ó‡·ÚÍË Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ ‹ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜. AÎfiÌ· ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ¿ÏÏˆÓ Èı·ÓÒÓ ·ÈÙ›ˆÓ ıÚfiÌ‚ˆÛ˘ ÌÂÁ¿Ï˘ ·ÚÙËÚ›·˜. ™˘ÁÎÂÎÚÈ̤ӷ, ¤ÁÈÓ ÔÛÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ III, ÚˆÙ½Ó˘ C Î·È S, Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÂÓÂÚÁÔÔÈË̤ÓË ÚˆÙ½ÓË C, η¶›Ó·Î·˜ 1. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜. ∂ÈÛ·ÁˆÁ‹

3 ‚‰ÔÌ¿‰Â˜

3 Ì‹Ó˜

ÌÂÙ¿

ÌÂÙ¿

M¤ıÔ‰Ô˜ ELISA IgG

1/ 2560

1/ 2560

1/ 2160

IgM

1/ 2560

1/ 320

1/ 220

M¤ıÔ‰Ô˜ Û‡Ó‰ÂÛ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ IgG

1/ 1024

1/ 1024

1/ 512

ıÒ˜ Î·È ¤ÏÂÁ¯Ô˜ ÔÌÔ΢ÛÙÈÓ·ÈÌ›·˜. K·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ ·›ÙÈ· ıÚÔÌ‚ÔÊÈÏ›·˜ ‰ÂÓ ÂȂ‚·ÈÒıËÎÂ.

H ·ÛıÂÓ‹˜ ‰ÂÓ ÂÌÊ¿ÓÈÛ ͷӿ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È Ë ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ·ÂηٷÛÙ¿ıË Ï‹Úˆ˜ ÌÂÙ¿ 10 ̤Ú˜. TÔ ÎÔÚ›ÙÛÈ ÂÍ‹Ïı ·fi ÙË ÎÏÈÓÈ΋ Ì·˜ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË.

H Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ¤ÁÈÓ ¤Ó· Ì‹Ó· ·ÚÁfiÙÂÚ·, ¤‰ÂÈÍÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ· (ÂÈÎfiÓ˜ 2,3). O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Â·ÓÂÏ‹ÊıË 1 Î·È 3 Ì‹Ó˜ ·ÚÁfiÙÂÚ·, ÂȂ‚·›ˆÛ ÙËÓ ÔÍ›· Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ÛÙËÓ ·ÛıÂÓ‹ Ì·˜. (¶›Ó·Î·˜ I) O Û˘Ó‰˘·ÛÌfi˜ Ù˘ ÂÚÁ·ÛÙËÚȷο ÙÂÎÌËÚȈ̤Ó˘ ÔÍ›·˜ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜, ÙÔ˘ Â˘Ú‹Ì·ÙÔ˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ ÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô ·ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ·ÈÙ›ˆÓ ıÚÔÌ‚ÔÊÈÏ›·˜ ÛÙÔȯÂÈÔıÂÙÔ‡Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÓÙÔÈṲ̂Ó˘ ·ÁÁÂÈ›Ùȉ·˜ ÙÔ˘ KN™ ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ™˘˙‹ÙËÛË H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ ÌÂÙ¿ ·fi Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË Â›Ó·È Û¿ÓÈ· (0,1%). ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÌÂÙ¿ ·fi

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:43-47

ÔÍ›· Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ (5-7). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË ‰ÈÂÁÓÒÛıË Ì ‚¿ÛË ÙË Û˘Ìو̷ÙÔÏÔÁ›· Î·È ÛËÌÂÈÔÏÔÁ›· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ·ÏÏ¿ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘.

H ·ÛıÂÓ‹˜ Ì·˜ Ì ÂχıÂÚÔ Ó¢ÚÔÏÔÁÈÎfi ÈÛÙÔÚÈÎfi, ÂÌÊ¿ÓÈÛ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ·ÚÈÛÙÂÚÔ‡ ÚÔÛÒÔ˘ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘, ‰ÂÍÈ¿ ÙËÓ 11Ë Ì¤Ú· Ù˘ ÓfiÛÔ˘. AÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ Â›¯Â ÎÏÈÓÈ΋ ‹ ÂÚÁ·ÛÙËÚȷ΋ ¤Ó‰ÂÈÍË ÌËÓÈÁÁ›Ùȉ·˜. Afi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ê¿ÓËΠfiÙÈ Ë ÔÍ›· ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· ÙÔ˘ ·È‰ÈÔ‡ ÔÊ›ÏÂÙÔ Û ¤ÌÊÚ·ÎÙÔ Ù˘ ‰ÂÍÈ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, Èı·Ófiٷٷ Û ¤‰·ÊÔ˜ ÚfiÛÊ·Ù˘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ (8). EÈϤÔÓ, Ô Û˘ÌÏËڈ̷ÙÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ Î·Ù¿‰ÂÈÍË ¿ÏÏˆÓ Èı·ÓÒÓ ·ÈÙ›ˆÓ ıÚfiÌ‚ˆÛ˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜.

H ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ KN™ ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ˜. øÛÙfiÛÔ, ¤¯Ô˘Ó ÚÔÙ·ı› ÙÚÂȘ Èı·ÓÔ› Ì˯·ÓÈÛÌÔ› (2,4, 9-14). OÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÙÔ˘ KN™ ÔÊ›ÏÂÙ·È Û Â¤ÎÙ·ÛË Ù˘ ÌfiÏ˘ÓÛ˘ Î·È ¿ÌÂÛË ‰È›ۉ˘ÛË ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÛÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi.

Y¤Ú ·˘Ù‹˜ Ù˘ ¿Ԅ˘ Û˘ÓËÁÔÚ› Ë ·ÔÌfiÓˆÛË ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ (Ì ηÏÏȤÚÁÂÈ· Î·È PCR) Û ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi (9,10,13). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ó¢ÚÔÙÔÍÈÓÒÓ (4,11,12) ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ÂÓÒ Ù¤ÏÔ˜ ¤¯ÂÈ ÚÔÙ·ı› Î·È ·˘ÙÔ¿ÓÔÛÔ˜ Ì˯·ÓÈÛÌfi˜ Ì ·Ú·ÁˆÁ‹ ·˘ÙÔ·ÓÙÈۈ̿وÓ, Û¯ËÌ·ÙÈÛÌfi ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ, ‹ Î·È Ì¤Ûˆ ·˘ÙÔ¿ÓÔÛ˘ ·ÁÁ›Ùȉ·˜ (11). º·›ÓÂÙ·È fiÙÈ Ë Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Û˘Óԉ‡ÂÙ·È ·fi ·Ú·ÁˆÁ‹ ÔÏÏ·ÏÒÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ, ·ÎfiÌ· Î·È ¤Ó·ÓÙÈ ·ÓÙÈÁÔÓÈÎÒÓ ÛÙÔȯ›ˆÓ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (14). T· ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· Èı·ÓfiÓ ÂÓ·ÔÙ›ıÂÓÙ·È ÛÙÔ ÂÈı‹ÏÈÔ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ ÙÔ˘ KN™ Î·È Ô‰ËÁÔ‡Ó Û ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜. M¤Ûˆ Û¯ËÌ·ÙÈÛÌÔ‡ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÂÍËÁÂ›Ù·È ¿ÏψÛÙÂ Î·È Ë ÂÌÊ¿ÓÈÛË ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜, ηډ›Ùȉ·˜, ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ·ÚıÚ›Ùȉ·˜ ÌÂÙ¿ ·fi Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË (12).

BÈÔ„›Â˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÈÛÙÔ‡ Û ·È‰È¿ Ì ÂÁÎÂÊ·Ï›Ùȉ· ÌÂÙ¿ ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜, ÂÌÊ·Ó›˙Ô˘Ó Ô›‰ËÌ·, ÌÈÎÚÔıÚÔÌ‚ÒÛÂȘ, ÂÚÈ·ÁÁÂȷΤ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÓÙȉڿÛÂȘ Î·È ·fiÊÚ·ÍË ÌÈÎÚÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ Ô˘ ÂÍËÁÔ‡Ó ÙËÓ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ (7,15). ™ÙËÓ ·ÛıÂÓ‹ Ì·˜ Ô Û¯ËÌ·ÙÈÛÌfi˜ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ‰ÂÍÈ¿

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̤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› Û ÂÓÙÔÈṲ̂ÓË ·ÁÁÂÈ›Ùȉ· ·ÊÔ‡ Ô ÏÂÙÔÌÂÚ‹˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ Ô˘ ¤ÁÈÓ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÙËÓ Û˘Ó‡·ÚÍË ¿ÏÏÔ˘ ·›ÙÈÔ˘ ıÚÔÌ‚ÔÊÈÏ›·˜. °È· ÙË ıÂÚ·›· ÙˆÓ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› Ù· ÎÔÚÙÈÎÔÂȉ‹, Ù· ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, Ù· ‰ÈÔ˘ÚËÙÈο ·ÏÏ¿ Î·È Ë Ï·ÛÌ·Ê·›ÚÂÛË Ì ·ÏÏËÏÔ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· (11).

H ÚfiÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ Ù˘ ÂÈÏÔ΋˜. H ıÓËÙfiÙËÙ· ÊÙ¿ÓÂÈ ÙÔ 10% (5). H ·ÔηٿÛÙ·ÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Û˘Ó‹ıˆ˜ Â›Ó·È Ù·¯Â›· (12,15). ™Â ·Ï·ÈfiÙÂÚË ÌÂϤÙË (4), ÛËÌ·ÓÙÈ΋ ˘ÔÏÂÈÌÌ·ÙÈ΋ ÓfiÛÔ˜ ‚Ú¤ıËΠÛÙÔ ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ. ¢˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË Â›¯·Ó ·ÛıÂÓ›˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 14 ÂÙÒÓ Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÁÎÂÊ·Ï›Ùȉ·˜ ‹ ÔÏ˘Ó¢ڛÙȉ·˜.

H ·ÛıÂÓ‹˜ Ì·˜ ¤Ï·‚ ·ÔȉËÌ·ÙÈ΋ ·ÁˆÁ‹ ÛÙËÓ ÔÔ›· ·ÓÙ·ÔÎÚ›ıËΠ·fiÏ˘Ù· ÈηÓÔÔÈËÙÈο Ì ٷ¯‡Ù·ÙË Î·È Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡.

H Ïԛ̈ÍË ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È Ôχ Û˘¯Ó‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Û˘Ó‹ıˆ˜ ‰È·‰Ú¿ÌÂÈ ¯ˆÚ›˜ ÂÈÏÔΤ˜. H ÂÚ›ÙˆÛË ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÙË Û·ÓÈfiÙËÙ¿ Ù˘, ·ÏÏ¿ Î·È ÁÈ· Ó· ÙÔÓÈÛÙ› fiÙÈ ·Ú¿ ÙË ıÔÚ˘‚Ò‰Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ ıÚfiÌ‚ˆÛ˘ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, Ë Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Ù˘ ·ÛıÂÓÔ‡˜ Ì·˜ ÁÚ‹ÁÔÚ· ·ÂηÙÂÛÙ¿ıË Ï‹Úˆ˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Lehtokoski - Lehtiniemi E, Koskiniemi ML.Mycoplasma pneumonia encephalitis a severe entity in children. Pediatr Infect Dis J 1989; 8: 651-653.

2. Behan P, Feldman R, Segerra J, Draper I. Neurological aspects of mycoplasma infection. Acta Neurol Scand 1986;74:314-322.

3. Rothstein T, Kenny G. Cranial neuropathy, myeloradiculopathy, and myositis complications of Mycoplasma pneumoniae infection. Arch Neurol 1979; 36:476-477.

4. Lerer R, Kalavsky S. Central nervous system disease associated with Mycoplasma pneumoniae infection report of five cases and review of the literature. Pediatrics 1973;52:658-668.

5. Visudhiphan P, Chiemchanya S, Sirinavin S. Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection. Pediatr Neurol 1992;8(3):237-239.

6. Fu M, Wong KS, Lam WW, Wong GW. Middle cerebral artery occlusion after recent Mycoplasma pneumoniae infection. J Neurol Sci 1998; 157(1): 113-115.

7. Parker P, Puck J, Fernandez F. Cerebral infarction associated with Mycoplasma pneumoniae. Pediatrics 1981;67:373-375.

8. Francis DA, Brown A, Miller DH, Wiles CM, Bennet ED and Leigh N. MRI appearances of the CNS manifestations of Mycoplasma pneumoniae: a report of two cases. J Neurol

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1988;235:441-443.

9. Abramovitz P, Schuartzman P, Harel D, Lis I, Naot Y. Direct invasion of the CNS by Mycoplasma pneumoniae: a report of two cases. J Infect Dis 1987;155:482-487.

10. Hata D, Kuze F, Mochizuki Y, Ohkubo H, Kanazashi S, Maeda S et al: Evaluation of DNA probe test for rapid diagnosis of Mycoplasma pneumoniae infections. J Pediatr 1990;116:273-276.

11. Koskiniemi ML. CNS manifestations associated with Mycoplasma pneumoniae infections. Summary of cases at the University of Helsinki and review. Clin Infect Dis 1993;17(suppl 1): S52-57.

12. Fernandez CV, Bortolussi R, Gordon K, Lee SHS, Gatien JG, Shahdrabadi MS. Mycoplasma pneumoniae infection associated with central nervous system complications. J Child Neurol 1993;8:27-31.

13. Narita M, Matsuzono Y, Togashi T and Kajii N. DNA diagnosis of central nervous system infection by Mycoplasma pneumoniae. Pediatrics 1992;90:250-253.

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

14. Cimolai N, Mah D, Roland E. Anticentriolar autoantibodies in children with central nervous system manifestations of Mycoplasma pneumoniae infection. J Neurol Neurosurg Psychiatry 1994;57:638-639.

15. Rawitt L, Hills W. Childhood focal encephalitis associated with positive cold agglutinin titers. Amer J Dis Child 1971;121:248-249.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘, A' ¶·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, TÌ‹Ì· EȉÈÎÒÓ §ÔÈÌÒ͈Ó, NÔÛ. ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·", £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, °Ô˘‰›, Aı‹Ó· 11527

OÍ›· ·ÁÎÚ·ٛÙȉ· Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. £ÂÚ·›· Ì octreotide A‚Ú·¿Ì HÏ›·˜1, KˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜1, AÓ‰ÚÔÌ¿¯Ë MËÙÛÈÒÓË1, ¢‹ÌËÙÚ· ™È·¤Ú·1, AÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘2, K˘ÚÈ¿ÎÔ˜ Mȯ¤Ï˘1 ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ËÏÈΛ·˜ 6,5 ÂÙÒÓ, Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Î·È ÈÛÙÔÚÈÎfi ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ·fi ËÏÈΛ·˜ 10 ÌËÓÒÓ. ¶·Ú¿ ÙË Û˘Ó‹ıË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ù˘ ·ÛıÂÓÔ‡˜. TËÓ 5Ë Ë̤ڷ ÓÔÛËÏ›·˜, ¯ÔÚËÁ‹ıËΠ¤Ó· ·Ó¿ÏÔÁÔ Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘, Ë Ôctreotide (9 Ìg/Kg/24ˆÚÔ ˘Ô‰fiÚÈ·). Afi ÙÔ ÙÚ›ÙÔ 24ˆÚÔ ıÂÚ·›·˜ ‰È·ÈÛÙÒıËΠ‚·ıÌÈ·›· ÂÏ¿ÙÙˆÛË ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ÙÔ fiÁ‰ÔÔ 24ˆÚÔ Â›¯·Ó ˘Ô¯ˆÚ‹ÛÂÈ Ù· Û˘ÌÙÒÌ·Ù·. Afi ÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÚÔ·ÙÂÈ fiÙÈ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË ¯ÔÚ‹ÁËÛ˘ Ù˘ Ôctreotide Û ·È‰› Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Î·È ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ¶·È‰È·ÙÚÈ΋ 2000;63:47-50. §¤ÍÂȘ ÎÏÂȉȿ: ÔÍ›· ·ÁÎÚ·ٛÙȉ·, ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, octreotide.

A. Elias, C. Stefanidis, A. Mitsioni, D. Siapera, A. Papadopoulou, K. Michelis. Octreotide treatment of acute pancreatitis in a child with end stage renal disease. Paediatriki 2000;63:47-50. ● Abstract: The case of a 6.5 year-old girl admitted with end stage renal disease which she had had since the age of 10 months, and acute pancreatitis is described. There had been no clinical improvement with conventional supportive management. Treatment with a somatostatin analogue octreotide (9Ìg/kg/24h SC) was initiated on the fifth day after admission. Serum amylase levels started to decline three days after initiation of treatment and the pain resolved after eight days. Octreotide was discontinued on 18th day. This is the first report of octreotide administration in a child with acute pancreatitis and end stage renal disease.

Key words: acute pancreatitis, chronic renal failure, octreotide.

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NÂÊÚÔÏÔÁÈÎfi TÌ‹Ì·, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ AıËÓÒÓ "¶. & A. K˘ÚÈ·ÎÔ‡". ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, TÌ‹Ì· NÔÛËÏ¢ÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:47-50

EÈÛ·ÁˆÁ‹ H ÔÍ›· ·ÁÎÚ·ٛÙȉ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‰ÂÓ Â›Ó·È ÙfiÛÔ Û¿ÓÈ· fiÛÔ Â›¯Â ıˆÚËı› ·Ï·ÈfiÙÂÚ· (1). YÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1:50.000 Î·È Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ‰È·Ê¤ÚÂÈ Û ۇÁÎÚÈÛË Ì ·˘Ù‹ ÙˆÓ ÂÓËϛΈÓ. TÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ÛÙ· ·È‰È¿ Â›Ó·È ÙÔ ÙÚ·‡Ì· Ù˘ ÎÔÈÏȷ΋˜ ¯ÒÚ·˜, ÂÓÒ ÛÙÔ 1/4 ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·ÁÓˆÚÈÛÙ› ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, ÔfiÙÂ Ë ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ȉÈÔ·ı‹˜ (2). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Ë ÔÍ›· ·ÁÎÚ·ٛÙȉ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Î·È Ôχ ˘„ËÏ‹ ıÓËÙfiÙËÙ· (3), ÂÔ̤ӈ˜ ··ÈÙÂ›Ù·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› ¤Ó· ·Ó¿ÏÔÁÔ Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘, Ë Ôctreotide, ÁÈ· ÙË ıÂÚ·›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·È‰› ËÏÈΛ·˜ 9 ÂÙÒÓ Ì ·Ó·ÊÂÚfiÌÂÓË Èı·Ó‹ ¢ÓÔ˚΋ Â›‰Ú·ÛË ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (4). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ËÏÈΛ·˜ 6,5 ÂÙÒÓ, Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Â› ‰¿ÊÔ˘˜ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. §fiÁˆ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ¯ÔÚËÁ‹ıËΠÛÙËÓ ·ÛıÂÓ‹ Ôctreotide. H ÔÚ›· ÓfiÛÔ˘ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÔÌ·Ï‹ Î·È ¯ˆÚ›˜ ÂÈÏÔΤ˜. Afi ÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÚÔ·ÙÂÈ fiÙÈ ·˘Ù‹ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË ıÂÚ·›·˜ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Ì Ôctreotide, Û ·È‰› Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ H ·ÛıÂÓ‹˜ ËÏÈΛ·˜ 6,5 ÂÙÒÓ ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ÂÌ¤ÙˆÓ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. H ·ÚÔ‡Û· ÓfiÛÔ˜ ·Ú¯›˙ÂÈ 24 ÒÚ˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ Ì Â›ÌÔÓÔ˘˜ Â̤ÙÔ˘˜, Ô˘ 6 ÒÚ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤ÁÈÓ·Ó Á·ÛÙÚÔÏËÁÈÎÔ›. ¶·Ú¿ÏÏËÏ· ·Ó·Ê¤ÚÂÙ·È ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Ì ·ÚÈ· ÂÓÙfiÈÛË ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ Î·È ÂÚÈÔÌÊ·ÏÈο. E›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ.

Afi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û ËÏÈΛ· 10 ÌËÓÒÓ ·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi Î·È ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠Â͈ÓÂÊÚÈ΋ οı·ÚÛË. ™Â ËÏÈΛ· 11 ÌËÓÒÓ, ˘o‚Ï‹ıËΠ۠‰È·‰ÂÚÌÈ΋ ‚ÈÔ„›· ÓÂÊÚÔ‡ Î·È ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÚˆÙÔ·ı‹˜ ÓfiÛÔ˜ ‹Ù·Ó ·ÈÌÔÏ˘ÙÈÎfi Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ. H ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‰ÂÓ ·ÔηٷÛÙ¿ıËÎÂ Î·È ¤ÎÙÔÙ ˘Ô‚¿ÏÏÂÙ·È ÛÂ Û˘Ó¯‹ ÊÔÚËÙ‹ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË. ¶·ÚÔ˘Û›·Û ÂÂÈÛfi‰È· ÂÚÈÙÔÓ›Ùȉ·˜ Û ËÏÈΛ· 2,5, 3,5 Î·È 5,5 ÂÙÒÓ Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ Ì ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ™Â ËÏÈΛ· 6 ÂÙÒÓ, ˘o‚Ï‹ıËΠ۠ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi و̷ÙÈÎfi ‰fiÙË ËÏÈΛ·˜ 10 ÂÙÒÓ. ¶·ÚÔ˘Û›·Û fï˜ ÔÍ›· ·fiÚÚÈ„Ë, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ 21Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ Ó· ·Ê·ÈÚÂı› ÙÔ ÌfiÛ¯Â˘Ì·. K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ÛÙËÓ KÏÈÓÈ΋ ‹Ù·Ó ÛÂ

48

∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

Û¯ÂÙÈο ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ·‡ÚÂÙË, ¯ˆÚ›˜ ÛËÌ›· ·Ê˘‰¿ÙˆÛ˘. ¶·ÚÔ˘Û›·˙ ۈ̷ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Ì ‚¿ÚÔ˜ Î·È ‡„Ô˜ ÛÒÌ·ÙÔ˜ οو ·fi ÙËÓ 3Ë ÂηÙÔÛÙÈ·›· ı¤ÛË. H ÎÔÈÏÈ¿ ‹Ù·Ó ̷Ϸ΋ Ì ‰È¿¯˘ÙË Â˘·ÈÛıËÛ›· Î·È ·Ú·ÈÔ‡˜ ÂÓÙÂÚÈÎÔ‡˜ ‹¯Ô˘˜, ÂÓÒ ·fi ÙËÓ ÂÈ̤ÚÔ˘˜ ÂͤٷÛË ÙˆÓ ÏÔÈÒÓ Û˘ÛÙËÌ¿ÙˆÓ ‰ÂÓ ·ÚÔ˘Û›·˙ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. °È· ÙË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Ù˘ ·ÓÙÈÌÂÙˆÈ˙Ô̤Ó˘ Ì οı·ÚÛË ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÂÏ¿Ì‚·Ó ÂÚ˘ıÚÔÔÈËÙ›ÓË, ·ÓıÚ·ÎÈÎfi ·Û‚¤ÛÙÈÔ, ˘‰ÚÔ͢¯ÔÏËηÏÛÈÊÂÚfiÏË, ·˘ÍËÙÈ΋ ÔÚÌfiÓË Î·È Î·ÙÔÚ›ÏË. ™ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ë ÔÍ›· ÈÔÁÂÓ‹˜ Á·ÛÙÚ›ÙÈÙȉ·, Ë ÂÚÈÙÔÓ›Ùȉ· Î·È Ë ÔÍ›· ·ÁÎÚ·ٛÙȉ·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÛÙÚ¿ÊËΠÚÔ˜ ·ÔÎÏÂÈÛÌfi ‹ ÂȂ‚·›ˆÛË ÌÈ·˜ ·fi ÙȘ ÈÔ ¿Óˆ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ô ·ÎfiÏÔ˘ıÔ˜: ·ÈÌÔÛÊ·ÈÚ›ÓË 12,4 g/dL, ÏÂ˘Î¿ 23700/mmÑ, Ù‡Ô˜ Ï¢ÎÒÓ: ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 85%, ÏÂÌÊÔ·ÙÙ·Ú· 10%, ÌÔÓÔ‡ÚËÓ· 5%, ·ÈÌÔÂÙ¿ÏÈ· 515.000/mmÑ, CRP(-), Ô˘Ú›· 47 mg/dL, ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 4,3 mg/dL, K 2,1 mEq/L, Na 129 mEq/L, Ca 11,4 mg/dL, P 2,4 mg/dL, ALP 181 IU/L, SGOT 22 IU/L, SGPT 10 IU/L, ÔÏÈο Ï¢ÎÒÌ·Ù· ÔÚÔ‡ 5,6 g/100mL, ·Ï‚Ô˘Ì›ÓË 2,7 g/100mL, ·Ì˘Ï¿ÛË ÔÚÔ‡ 840 IU/L, ÏÈ¿ÛË ÔÚÔ‡ 1540 IU/L, ·Ì˘Ï¿ÛË ÂÚÈÙÔÓ·˚ÎÔ‡ ˘ÁÚÔ‡ 25 IU/L, ·ÙÙ·Ú· Î·È Î·ÏÏȤÚÁÂÈ· ÂÚÈÙÔÓ·˚ÎÔ‡ ˘ÁÚÔ‡ ·ÚÓËÙÈο. O ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜, ÂÓÒ ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÙÔ ¿ÁÎÚ·˜ ›¯Â ·˘ÍË̤Ó˜ ‰È·ÛÙ¿ÛÂȘ.

M ‚¿ÛË Ù· ·Ú·¿Óˆ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠıÂÚ·¢ÙÈο Ì ‰È·ÎÔ‹ Û›ÙÈÛ˘ Î·È ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·, ‰ÈfiÚıˆÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ¯ÔÚ‹ÁËÛË Ú·ÓÈÙȉ›Ó˘ Î·È ¤Ó·ÚÍË ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. EÈÚfiÛıÂÙ·, ‰È·ÎfiËÎÂ Ë ıÂÚ·›· Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ·ÚfiÏÔ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛ‹ Ù˘ Ì ÙËÓ ·Ó¿Ù˘ÍË ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ (5,6). H ηٿÛÙ·ÛË Ù˘ ·ÛıÂÓÔ‡˜ ·Ú¤ÌÂÈÓ ·ÌÂÙ¿‚ÏËÙË Ì ÂÈÌÔÓ‹ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È ·Ú¿ÏÏËÏË ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË Ù˘ ·Ì˘Ï¿Û˘ ÔÚÔ‡. TËÓ 5Ë Ë̤ڷ ÓÔÛËÏ›·˜ ·ÔÊ·Û›ÛÙËÎÂ Ë ¤Ó·ÚÍË ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Ì Ôctreotide Û ‰fiÛË 9 Ìg/kg/24ˆÚÔ ˘Ô‰fiÚÈ·. ¶·Ú·ÙËÚ‹ıËΠ‡ÊÂÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Ì Ï‹ÚË ˘Ô¯ÒÚËÛË ÙÔ˘ ÙË 12Ë Ë̤ڷ ÓÔÛËÏ›·˜, ÂÓÒ Ë ·Ì˘Ï¿ÛË ¿Ú¯ÈÛ ӷ ˘Ô¯ˆÚ› ·fi ÙË 13Ë Ë̤ڷ ÓÔÛËÏ›·˜. H Ôctreotide ‰È·ÎfiËΠÙËÓ 18Ë Ë̤ڷ ıÂÚ·›·˜. H ·Ì˘Ï¿ÛË ÔÚÔ‡ ·ÚÔ˘Û›·Û ·ÓÒÙ·ÙË ÙÈÌ‹ (2140 IU/L) ÙËÓ 7Ë Ë̤ڷ ÓÔÛËÏ›·˜ (2 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂÚ·›·˜ Ì Ôctreotide) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ú·ÙËÚ‹ıËΠÂÓÙ˘ˆÛȷ΋ ÙÒÛË Ù˘ (Û¯‹Ì· 1).

TËÓ 3Ë Â‚‰ÔÌ¿‰· ÓÔÛËÏ›·˜ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·

JAN.-FEB.2000

30-05-03

12:57

™ÂÏ›‰·49

¶∞π¢π∞∆ƒπ∫∏ 2000;63:47-50

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

¶›Ó·Î·˜ 1. ™‡ÛÙËÌ· ‚·ıÌÔÏÔÁ›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·.

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AÌ˘Ï¿ÛË ÔÚÔ‡ ÌÂٷ͇ -3x-6xAºT*

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AÌ˘Ï¿ÛË ÔÚÔ‡ >6xAºT*

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IÛÙÔÏÔÁÈ΋ ÂȂ‚·›ˆÛË

3

*AºT: AÓÒÙÂÚË Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ™¯‹Ì· 1. ¢È·Î‡Ì·ÓÛË ·Ì˘Ï¿Û˘ ÔÚÔ‡ ·Ó¿ Ë̤ڷ ÓÔÛËÏ›·˜. ·ÁÎÚ¤·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. MÂÙ¿ ·fi ¤Ó·Ó ÂÚ›Ô˘ Ì‹Ó· ÓÔÛËÏ›·˜, Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. H ıÂÚ·›· Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ¿Ú¯ÈÛ ¿ÏÈ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi Ù˘, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËı› ˘ÔÙÚÔ‹ Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™˘˙‹ÙËÛË H ÔÍ›· ·ÁÎÚ·ٛÙȉ· Û ·ÛıÂÓ›˜ Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ·ÔÙÂÏ› ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· Ì ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο. H ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· (¤ˆ˜ Î·È 58 ÊÔÚ¤˜) ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· (3). OÈ ·ÎÚȂ›˜ ÏfiÁÔÈ Ù˘ ·˘ÍË̤Ó˘ ·˘Ù‹˜ Û˘¯ÓfiÙËÙ·˜, ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙÔ› ·Ó Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ù· ÔÏÏ¿ Ê¿Ú̷η Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ›, ηıÒ˜ Î·È Ë Û˘ÓÔ‰fi˜ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· (7), Ô ‰Â˘ÙÂÚÔ·ı‹˜ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ (3) Î·È Ë ˘ÂÚÏÈȉ·ÈÌ›·. º·›ÓÂÙ·È fiÙÈ Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ Î·È Èı·ÓÒ˜ Î·È ·˘ÙÔ¿ÓÔÛÔÈ ·Ú¿ÁÔÓÙ˜, ˘ÚÔ‰ÔÙÔ‡Ó Ì˯·ÓÈÛÌÔ‡˜ ·˘ÙÔ„›·˜ Î·È Î·Ù·ÛÙÚÔÊ‹˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜.

H ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈΤ˜ ‰˘ÛÎÔϛ˜. A˘Ùfi ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ fiÙÈ Ù· ¤Ó˙˘Ì· ‰È¿ÁÓˆÛ˘ Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ·˘ÍË̤ӷ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ë ·Ì˘Ï¿ÛË Û ÔÛÔÛÙfi 80% Î·È Ë ÏÈ¿ÛË 60%, Â› ·Ô˘Û›·˜ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ (3,8). °È· Ó· ·ÔÊ¢¯ı› Ë Èı·ÓfiÙËÙ· Ï·Óı·Ṳ̂Ó˘ ‰È¿ÁÓˆÛ˘, ¤¯ÂÈ ÚÔÙ·ı› ¤Ó· Û‡ÛÙËÌ· ‚·ıÌÔÏÔÁ›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· (›Ó·Î·˜ 1). °È· ÙË ‰È¿ÁÓˆÛË Â›Ó·È ··Ú·›ÙËÙÔ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‚·ıÌÒÓ Ó· Â›Ó·È 3 ‹ ÂÚÈÛÛfiÙÂÚÔ (9). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, ÙÔ ¿ıÚÔÈÛÌ· ‚·ıÌÔÏÔÁ›·˜ Ù˘ ·ÛıÂÓÔ‡˜ Ì·˜ ‹Ù·Ó 6,

ÔfiÙÂ Ë ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ‹Ù·Ó ‚¤‚·ÈË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ‰ÂÓ ÎÚ›ıËΠ·Ó·Áη›· Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÂͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘.

EÎÙfi˜ ·fi ÙȘ ‰˘ÛÎÔϛ˜ ÛÙË ‰È¿ÁÓˆÛË, ÔÈ ·ÛıÂÓ›˜ Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Û ¤‰·ÊÔ˜ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ôχ ·˘ÍË̤ÓË ıÓËÙfiÙËÙ· Ô˘ Êı¿ÓÂÈ Î·È ÙÔ 33%, Û ·ÓÙ›ıÂÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÔ˘ Ë ıÓËÙfiÙËÙ· Â›Ó·È ÌfiÏȘ 3,5% (3).

H ıÂÚ·›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È·ÎÔ‹ Ù˘ Û›ÙÈÛ˘, ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·, ·ÔηٿÛÙ·ÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Â¿Ó ˘¿Ú¯Ô˘Ó, ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ, H2 ·ÓÙ·ÁˆÓÈÛÙÒÓ Î·È ¯ÔÚ‹ÁËÛË ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. EÈϤÔÓ, ‰˘Ó·ÙfiÓ Ó· ¯ÔÚËÁËı› Ë ÛˆÌ·ÙÔÛÙ·Ù›ÓË ‹ ÙÔ ·Ó¿ÏÔÁfi Ù˘ Ë Ôctreotide. H ۈ̷ÙÔÛÙ·Ù›ÓË Â›Ó·È ¤Ó· ‰ÂηÙÂÙÚ·ÂÙ›‰ÈÔ ÂÓÒ Ë Ôctreotide ¤Ó· ÔÎÙ·ÂÙ›‰ÈÔ Ì ·ÚfiÌÔÈÔ ÙÚfiÔ ‰Ú¿Û˘, Ì ÌÂÁ·Ï‡ÙÂÚÔ fï˜ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, Ú¿ÁÌ· Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ¯ÔÚ‹ÁËÛ‹ Ù˘ Î·È ˘Ô‰fiÚÈ· (10). O ΢ÚÈfiÙÂÚÔ˜ ÙÚfiÔ˜ ‰Ú¿Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ÛÙË ıÂÚ·›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, Â›Ó·È Ì¤Ûˆ Ù˘ ·Ó·ÛÙÔÏ‹˜ Ù˘ ·ÁÎÚ·ÙÈ΋˜ ¤ÎÎÚÈÛ˘. EÈÚfiÛıÂÙ· Ê·›ÓÂÙ·È fiÙÈ ‰ÈÂÁ›ÚÔ˘Ó Î·È ÙË Ê·ÁÔ΢ÙÙ¿ÚˆÛË ·fi ÙÔ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·Îfi Û‡ÛÙËÌ·, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ Ù·¯‡ÙÂÚË ˘Ô¯ÒÚËÛË Ù˘ ÊÏÂÁÌÔÓ‹˜. ¶·ÚfiÏÔ Ô˘ Ë ÛˆÌ·ÙÔÛÙ·Ù›ÓË ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ıÂÚ·›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ÙÔ 1975, ÂÓÙÔ‡ÙÔȘ ̤¯ÚÈ Î·È Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ (10-12). øÛÙfiÛÔ ·fi ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ ÚÔ·ÙÂÈ fiÙÈ: ÌÂÈÒÓÂÈ ÙȘ ·Ó¿ÁΘ ¯ÔÚ‹ÁËÛ˘ ·Ó·ÏÁËÙÈÎÒÓ, ÌÂÈÒÓÂÈ Ù·¯‡ÙÂÚ· ÙËÓ ·Ì˘Ï¿ÛË ÔÚÔ‡,

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ÌÂÈÒÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÔÈÎÒÓ ÂÈÏÔÎÒÓ, ÂÓÒ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙË ıÓËÙfiÙËÙ· Ù˘ ÓfiÛÔ˘ (12).

H Ôctreotide ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ıÂÚ·›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌfiÏȘ ÙÔ 1995 Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 9 ÂÙÒÓ Ì ·Ó·ÊÂÚfiÌÂÓ· ηϿ ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (4), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ‰ËÌÔÛÈÂ˘Ì¤ÓË ÂÚÁ·Û›· ¯ÔÚ‹ÁËÛ˘ Ù˘ Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜.

H ·Ó¿ÁÎË ·Ó·˙‹ÙËÛ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚˆÓ ıÂÚ·¢ÙÈÎÒÓ Ì¤ÛˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, ȉȷ›ÙÂÚ· Û ·ÛıÂÓ›˜ Ì ˘fiÛÙڈ̷ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Â›Ó·È ÂȂ‚ÏË̤ÓË, ÏfiÁˆ Ù˘ Ôχ ÌÂÁ¿Ï˘ ıÓËÙfiÙËÙ·˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÓfiÛÔ˜. H ¯ÔÚ‹ÁËÛË Ù˘ Ôctreotide ÛÙËÓ ·ÛıÂÓ‹ Ì·˜ Ê·›ÓÂÙ·È Ó· ¤‰Ú·Û ¢ÓÔ˚ο ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘. OˆÛ‰‹ÔÙ fï˜, ÂÚ·ÈÙ¤Úˆ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ Ù˘.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Weizman Z, Durie P. Acute pancreatitis in childhood. J Pediatr 1988;113: 24-29.

2. Mader T, McHugh T. Acute pancreatitis in children. Ped Emer Care 1992;8: 157-161.

3. Pitchumoni C, Arguello P, Agarwal N, Yoo J. Acute pancreatitis in chronic renal failure. Am J Gastroenterol 1996;91: 2477-2482.

4. Rosenberg A, Hutchinson T. Octreotide treatment of acute pancreatitis in a child. Am J Gastroenterol 1995;90: 1701.

∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

5. Allen D. Safety of human growth hormone therapy: current topics. J Pediatr 1996;128: 8-13.

6. Berard E, Crosnier H, Beneton A, Chevallier T, Cochat P, Broyer M. Recombinant human growth hormone treatment of children on hemodialysis. Pediatr Nephrol 1998;12: 304-310.

7. Osorio A, Seidel F, Warady A. Hypercalcemia and pancreatitis in a child with adynamic bone disease.

Pediatr Nephrol 1997;11: 223-225.

8. Royse V, Jensen D, Corwin H. Pancreatic enzymes in chronic renal failure. Arch Intern Med 1987;147: 537-539.

9. Padilla B, Pollak V, Pesce A, Kant S, Gilinsky N, Deddens J. Pancreatitis in patients with end-stage renal disease.

Medicine(Baltimore) 1994;73: 8-20.

10. Paran H, Neufeld D, Mayo A, Shwartz I, Singer P, Kaplan O, et al. Preliminary report of a prospective randomized study of Octreotide in the treatment of severe acute pancreatitis. J Am Coll Surg 1995;181: 121-124.

11. McKay C, Imrie C, Baxter J. Somatostatin and somatostatin analogues- are they indicated in the management of acute pancreatitis? Gut 1993; 34: 16221626.

12. Planas M, Perez A, Iglesia R, Porta I, Masclans J, Bermejo B. Severe acute pancreatitis: treatment with somatostatin.

Intensive Care Med 1998; 24: 37-39.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: A‚Ú·¿Ì HÏ›·˜ NÂÊÚÔÏÔÁÈÎfi TÌ‹Ì· NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ AıËÓÒÓ "¶. & A. K˘ÚÈ·ÎÔ‡". £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜ °Ô˘‰› 11527 Aı‹Ó·

¶Ó¢ÌÔÓÈ΋ Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Î·È M. avium Û ·ÈÌÔÚÚÔÊÈÏÈÎfi ·ÛıÂÓ‹ Ì AIDS ¢ÒÚ· M¿ÓÙ˙ÈÔ˘1, °Ï˘ÎÂÚ›· MÔÛÙÚÔ‡1, B·ÛÈÏÈ΋ ¶··Â˘·ÁÁ¤ÏÔ˘1, EϤÓË ¶Ï·ÙÔÎÔ‡ÎË2, AÚÈÛÙ¤· BÂÏÂÁÚ¿ÎË3, M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘1. ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÌÈÎÙ‹˜ Ó¢ÌÔÓÈ΋˜ Ïԛ̈͢ ·fi Aspergillus fumigatus Î·È ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (Mycobacterium avium intracellulare, Mycobacterium avium) Û ·ÛıÂÓ‹ ËÏÈΛ·˜ 16 ÂÙÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· Î·È AIDS. O ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ Â›ÌÔÓÔ ÍËÚfi ‚‹¯· Î·È ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË ·fi ¤Ó· Ì‹Ó·. M ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠÓ¢ÌÔÓÈ΋ Ì¿˙· ·Ú·˘Ï·›· ‰ÂÍÈ¿. H ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË ÔÏÔÎÏËÚÒıËΠ̠ϋ„Ë ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎÔ‡ ÂÎχ̷ÙÔ˜ Î·È ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›· Ù˘ Ì¿˙·˜. O ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËΠ̠·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ Î·È ·ÓÙÈÌ˘ÎÔ‚·ÎÙËÚȉȷ΋ ıÂÚ·›·, Ì ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ¶·È‰È·ÙÚÈ΋ 2000;63:50-55. §¤ÍÂȘ ÎÏÂȉȿ: AIDS, ·ÛÂÚÁ›ÏψÛË, M. avium.

A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" 1, MÔÓ¿‰· EȉÈÎÒÓ §ÔÈÌÒÍÂˆÓ - AIDS

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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

D. Mantziou, G. Mostrou, V. Papaevangelou, E. Platokouki, A. Velegraki, M. Theodoridou. Concurrent pulmonary infection with Aspergillus fumigatus and Mycobacterium avium in an HIV-infected haemophiliac patient. Paediatriki 2000;63:50-55. ● Abstract: A 16 year-old boy with haemophilia A and AIDS presented with a one month history of dry cough and low grade fever. The initial investigation revealed a pulmonary mass in the right perihilar area. The diagnosis was established by bronchoscopy, bronchioalveolar lavage and biopsy of the mass which revealed concurrent invasive infection with Aspergillus fumigatus and Mycobacterium avium. He was treated aggressively with a combination of antifungal and antimycobacterial therapy for a prolonged period and responded successfully to the treatment.

Key words: AIDS, aspergillosis, M. avium.

EÈÛ·ÁˆÁ‹ H Ì›ˆÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ÈηÓfiÙËÙ·˜ ÙÔ˘ HIVÔÚÔıÂÙÈÎÔ‡ ·ÛıÂÓ‹ ·˘Í¿ÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ·ÏÏ¿ Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÏÔÈÌÒ͈Ó. H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¢ηÈÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ·ÛıÂÓ›˜ Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi CD4 T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 200/ml. (1) ™˘¯ÓfiÙÂÚ˜ ¢ηÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Ù· ·È‰È¿ Ì HIV Ïԛ̈ÍË Â›Ó·È Ë Ó¢ÌÔÓ›· ·fi pneumocystis carinii (PCP), Ë Û˘ÛÙËÌ·ÙÈ΋ Ïԛ̈ÍË ·fi Candida albicans (.¯. ÔÈÛÔÊ·Á›Ùȉ·), Ë ‰È¿Û·ÚÙË Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (MAC) Î·È Ë ÙÔÍÔÏ·ÛÌÈ΋ ÂÁÎÂÊ·Ï›Ùȉ·. (1) H Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ÌÔÚ› ÎÏÈÓÈο Ó· ÚÔ‚¿ÏÏÂÈ ˆ˜ ÂÓÙÔÈṲ̂ÓË ÏÂÌÊ·‰ÂÓ›Ùȉ· ‹ Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ·ÏÏ¿ Û˘ÓËı¤ÛÙÂÚ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì AIDS ‰È·ÁÈÁÓÒÛÎÂÙ·È ˆ˜ ‰È¿Û·ÚÙË ÓfiÛÔ˜ (Ì˘ÎÔ‚·ÎÙËÚÈ·ÈÌ›·). (1,2) Afi ÙȘ Û˘ÛÙËÌ·ÙÈΤ˜ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÔÈ ϤÔÓ Û˘Ó‹ıÂȘ Â›Ó·È Ë ÔÈÛÔÊ·Á›Ùȉ· ·fi Candida albicans Î·È Ë ÎÚ˘ÙÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›ÙȘ. (1) H ·ÛÂÚÁ›ÏψÛË ·ÔÙÂÏ› ı·Ó·ÙËÊfiÚÔ Ïԛ̈ÍË Û ·ÛıÂÓ›˜ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ‹ ‰È·Ù·Ú·¯‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ™·ÓÈfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÚfiÓÈ· ıÂÚ·›· Ì ÎÔÚÙÈÎÔÂȉ‹ ‹ ·ÓÙÈ‚ÈÔÙÈο Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜. (3) H Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Â›Ó·È Û¿ÓÈ· Û ·ÛıÂÓ›˜ Ì AIDS, ηıÒ˜ Ë ·ÓÔÛȷ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÓfiÛÔ˘ ·ÊÔÚ¿ Ù· T-ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ì·ÎÚÔÊ¿Á· Î·È fi¯È Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· Ô˘ Â›Ó·È ˘‡ı˘Ó· ÁÈ· ÙËÓ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ηٿ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘. (4,5) K‡ÚÈÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÛÂÚÁ›ÏψÛ˘ Û ·ÛıÂÓ‹ Ì AIDS, ·ÔÙÂÏ› Ë ·Ú·ÙÂٷ̤ÓË Ô˘‰ÂÙÂÚÔÂÓ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙÈÌÈÎÚԂȷ΋ ıÂÚ·›· ‹ ÚÔ¸¿Ú¯Ô˘Û· Ïԛ̈ÍË Ó¢ÌfiÓˆÓ ·fi P.carinii, ÎÔÈÓ¿ ÌÈÎÚfi‚È· ‹ ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·. (5,6) ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Ù·˘Ùfi¯ÚÔÓ˘ Ó¢ÌÔÓÈ΋˜ Ïԛ̈͢ ·fi A. fumigatus Î·È M. avium Û ·ÛıÂÓ‹ ËÏÈΛ·˜ 16 ÂÙÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· A Î·È AIDS.

™˘ÓÙÔÌÔÁڷʛ˜: AIDS: Acquired Immunodeficiency Syndrome HIV: Human Immunodeficiency Virus CD4 T lymphocytes: T4 ‚ÔËıËÙÈο ÏÂÌÊÔ·ÙÙ·Ú·

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ AÁfiÚÈ ËÏÈΛ·˜ 16 ÂÙÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· A Î·È AIDS ÂÈÛ‹Ïı ÛÙÔ ÙÌ‹Ì· ÂȉÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "H AÁ›· ™ÔÊ›·" ÏfiÁˆ Â›ÌÔÓÔ˘ ‚‹¯·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. TÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ù˘ ÙÂÙÚ·ÌÂÏÔ‡˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ÂχıÂÚÔ. H ‰È¿ÁÓˆÛË Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ ÂÙ¤ıË Û ËÏÈΛ· 11 ÌËÓÒÓ ÔfiÙ ¿Ú¯ÈÛ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ ÌÂ Û˘Ì‚·ÙÈÎfi Û˘Ì˘Îӈ̤ÓÔ ·Ú¿ÁÔÓÙ· VIII. ™Â ËÏÈΛ· 3 ÂÙÒÓ ·ÚÔ˘Û›·Û ÚÒÈÌË ‰È·Ù·Ú·¯‹ „˘¯È΋˜ ÂͤÏÈ͢ Ô˘ ·Ô‰fiıËΠÛÙËÓ ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·Ù˘¯ËÌ¿ÙˆÓ.

TÔ 1985 Û ·Ó·‰ÚÔÌÈÎfi ¤ÏÂÁ¯Ô ÔÚÔ‡ ·›Ì·ÙÔ˜ Ô‡ ›¯Â Ê˘Ï·¯ı› ÛÙË MÔÓ¿‰· AÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ Î·È AÈÌfiÛÙ·Û˘, ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ·È‰› ›¯Â ÌÔÏ˘Óı› Ì ÙÔÓ Èfi HIV ¤Ó· ¯ÚfiÓÔ ÓˆÚ›ÙÂÚ·, Û ËÏÈΛ· 4 ÂÙÒÓ. H ÎÏÈÓÈ΋ ÂͤÏÈÍË Ù˘ HIV Ïԛ̈͢ ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 9 ÂÙÒÓ ‹Ù·Ó ÔÌ·Ï‹ Î·È ÔÈ ·ÓÔÛÔÏÔÁÈÎÔ› ÙÔ˘ ‰Â›ÎÙ˜ ÈηÓÔÔÈËÙÈÎÔ› (CD4>500/mm3). ™Â ËÏÈΛ· 9 ÂÙÒÓ ¿Ú¯ÈÛ ӷ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÏÏ¿ Î·È ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ fiˆ˜ ˆÙ›Ùȉ·, ÈÁÌÔÚ›Ùȉ· Î·È Ó¢ÌÔÓ›·. ¶·Ú¿ÏÏËÏ· ÂÌÊ¿ÓÈÛ ÛÙ·‰È·Î‹ ¤ÎÙˆÛË Ù˘ ·ÓÔÛȷ΋˜ ÙÔ˘ ηٿÛÙ·Û˘ (CD4<100/mm3) ·Ú¿ ÙËÓ ¤Ó·ÚÍË ·ÓÙÈÚÂÙÚÔ˚΋˜ ·ÁˆÁ‹˜. TÚ›· ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ÓÔÛËχÙËΠÛÙÔ ·È‰Ô„˘¯È·ÙÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ ÏfiÁˆ ¤ÓÙÔÓˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÔfiÙ ÂȂ‚·ÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ·È‰È΋˜ „‡¯ˆÛ˘ ÁÈ· ÙËÓ ÔÔ›· ÂÙ¤ıË Û ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. ™ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÂÙÒÓ, ÔfiÙÂ Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ CD4 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ‹Ù·Ó <50/mm3, ·-

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:50-55

ÚÔ˘Û›·Û Â›ÌÔÓË Î·È ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì˘ÎËÙÈ·ÛÈ΋ ÛÙÔÌ·Ù›Ùȉ· Ì ÌÂÚÈ΋ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ÙÔÈ΋ Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹. §›ÁÔ˘˜ Ì‹Ó˜ ·ÚÁfiÙÂÚ· ÂÌÊ¿ÓÈÛ ÙËÓ ÚÒÙË Â˘Î·ÈÚȷ΋ Ïԛ̈ÍË, ÔÈÛÔÊ·Á›Ùȉ· ·fi C. albicans, ηٿÛÙ·ÛË Ô˘ ¯·Ú·ÎÙ‹ÚÈÛ ÙË ÌÂÙ¿ÙˆÛ‹ ÙÔ˘ Û ÓfiÛÔ AIDS. MÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ·ÁˆÁ‹ Ì ÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË B Û˘Ó¤¯ÈÛ ¯ËÌÂÈÔÚÔʇϷÍË Ì ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÈÙÚ·ÎÔÓ·˙fiÏË ‚¿ÛÂÈ Ì˘ÎËÙÔÁÚ¿ÌÌ·ÙÔ˜.

K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋, Û ËÏÈΛ· 16 ÂÙÒÓ, ·Ó¤ÊÂÚ ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË Î·È Â›ÌÔÓÔ ÌË ·Ú·ÁˆÁÈÎfi ‚‹¯· ÁÈ· ¤Ó· Ì‹Ó· ÂÚ›Ô˘. TȘ ÙÂÏÂ˘Ù·›Â˜ 2-3 ̤Ú˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÚÔÛÂÙ¤ıË Î·È Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹. EÚfiÎÂÈÙÔ ÁÈ· ¤Ó· ηϿ ·Ó·Ù˘Á̤ÓÔ ·‰‡Ó·ÙÔ ·ÁfiÚÈ Ì ȉÈfiÙ˘Ë Û˘ÌÂÚÈÊÔÚ¿. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ·¯‡ÙËÙ· ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ Ì ·Ú¿Ù·ÛË ÂÎÓÔ‹˜ ηıÒ˜ Â›Û˘ Î·È Ì˘ÎËÙÈ·ÛÈ΋ ÛÙÔÌ·Ù›Ùȉ·.

Afi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ù˘ ÂÈÛ·ÁˆÁ‹˜, Ë ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Ë ‰Â ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÛÙ›ڷ. AÍÈÔÛËÌ›ˆÙË ‹Ù·Ó Ë ·‡ÍËÛË ÙˆÓ ÛÊ·ÈÚÈÓÒÓ, IgG: 2751mg/dl, IgM: 977mg/dl, IgA: 546mg/dl Î·È Ô ¯·ÌËÏfi˜ ·ÚÈıÌfi˜ ÙˆÓ CD4 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ: 4% (25/mm3). TÔ ÈÈÎfi ÊÔÚÙ›Ô Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó: 30,5 x 103 vc/ml. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT) ıÒÚ·ÎÔ˜ (EÈÎfiÓ· 1, 2) ·ÂÎ¿Ï˘„ ÛÙÚÔÁÁ‡ÏË ÛΛ·ÛË ·Ú·˘Ï·›· ‰ÂÍÈ¿, ÌÂÁ›ÛÙ˘ ‰È·Ì¤ÙÚÔ˘ 4 ÂÎ. Ì ·Û·Ê‹ ‰ÈËıËÙÈο fiÚÈ· ÚÔ˜ ÙÔ ÁÂÈÙÔÓÈÎfi ·Ú¤Á¯˘Ì·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ıÔÏÔÁÈο ‰ÈÔÁΈ̤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ‹ ÙȘ Ì·Û¯·ÏÈ·›Â˜ ¯ÒÚ˜. M ÙËÓ Èı·Ó‹ ‰È¿ÁÓˆÛË ÏÂÌÊÒÌ·ÙÔ˜ ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ Î·È ÂÁÎÂÊ¿ÏÔ˘. ™ÙËÓ CT ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıËÎ·Ó ÌÈÎÚÔ› ÌÂÛÂÓÙ¤ÚÈÔÈ ÏÂÌÊ·‰¤Ó˜ Î·È Ë CT ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ¤ÏÂÁ¯Ô˜ Û˘Ó¯›ÛıËΠ̠ÎÚÈÙ‹ÚÈ· ·ÈÙÈÔÏÔÁÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘ Ó¢ÌÔÓÈ΋˜ Ì¿˙·˜ Û ·ÛıÂÓ›˜ Ì AIDS. EÎÙfi˜ ·fi ϤÌʈ̷, Ó¢ÌÔÓÈ΋ Ì¿˙· Û ÛÔ‚·Ú¿ ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ ·ÛıÂÓ‹ ı· ÌÔÚÔ‡Û ӷ ÚÔÎÏËı› ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi Mycobacterium tuberculosis, M. avium, C. albicans, Aspergillus species, Nocardia, Cryptococcus neoformans, P. carinii, ‹ Ù¤ÏÔ˜ ÎÔÈÓ¿ ‚·ÎÙ‹ÚÈ·. ™ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË ‰È·ÈÛÙÒıËΠ‡·ÚÍË ÂÓ‰Ô‚ÚÔÁ¯È΋˜ Ì¿˙·˜ Ô˘ ÚÔηÏÔ‡Û ‰È‡ڢÓÛË Ù˘ ‰Â˘ÙÂÚÂ‡Ô˘Û·˜ ÙÚfiȉ·˜ ÌÂٷ͇ ÙÔ˘ ¿Óˆ Î·È ‰È¿ÌÂÛÔ˘ ÏÔ‚·›Ô˘ ‚ÚfiÁ¯Ô˘, ·¤ÊÚ·Û ۯ‰fiÓ Ï‹Úˆ˜ ÙÔÓ ‰È¿ÌÂÛÔ Î·È ÚÔηÏÔ‡Û ÌÂÁ¿ÏË ÛÙ¤ÓˆÛË ÙÔ˘ ¿Óˆ ÏÔ‚·›Ô˘ ‚ÚfiÁ¯Ô˘. EÏ‹ÊıË ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ¤ÎÏ˘Ì· (BAL) ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÔÔ›Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ¿ÊıÔÓÔÈ Ì‡ÎËÙ˜ A. fumigatus. H ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË ÂÙ¤ıË Ì ‰Â‡ÙÂÚË ‚ÚÔÁ¯ÔÛÎfiËÛË Î·È

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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

EÈÎfiÓ· 1. A/· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ fiÔ˘ Ê·›ÓÂÙ·È ÛÙÚÔÁÁ‡ÏË ÛΛ·ÛË ‰ÂÍÈ¿ ·Ú·˘Ï·›·.

EÈÎfiÓ· 2. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, fiÔ˘ Ê·›ÓÂÙ·È Ì¿˙· ÌÂÁ›ÛÙ˘ ‰È·Ì¤ÙÚÔ˘ 4 ÂÎ. Ì ·Û·Ê‹ fiÚÈ·. ¢ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ‰ÈÔÁΈ̤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ‹ ÙȘ Ì·Û¯·ÏÈ·›Â˜ ¯ÒÚ˜. ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›· Ù˘ Ì¿˙·˜. ™ÙÔ ˘ÏÈÎfi Ù˘ ‚ÈÔ„›·˜ ‚Ú¤ıËΠÊÏÂÁÌÔÓ҉˘ ÈÛÙfi˜, ¿ÊıÔÓ· ÔÍ¿ÓÙÔ¯· ‚·ÎÙËÚ›‰È· Ù‡Ô˘ M. avium Î·È Ì‡ÎËÙ˜. ™ÙË ¯ÚÒÛË Î·Ù¿ Ziel-Nielsen ‚Ú¤ıËÎ·Ó ¿ÊıÔÓ· ÈÛÙÈÔ·ÙÙ·Ú· Ì ÂÓ‰Ô΢ÙÙ¿ÚÈ· ıÂÙÈ΋ ¯ÚÒÛË, ¯ˆÚ›˜ ÙËÓ ‡·ÚÍË ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÈÛÙÔ‡. H Ù·˘ÙÔÔ›ËÛË ÙˆÓ Ì˘Î‹ÙˆÓ ·Ó¤‰ÂÈÍ ·ÏËı›˜ ˘Ê¤˜ A. fumigatus. ™ÙȘ ηÏÏȤÚÁÂȘ ÙÔ˘ BAL, Â›Û˘ ·ÔÌÔÓÒıËΠ·Û¤ÚÁÈÏÏÔ˜. ™ÙÔȯ›· ηÎÔ‹ıÂÈ·˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛÙÔ ˘ÏÈÎfi Ù˘ ‚ÈÔ„›·˜ Ô‡Ù ÛÙÔ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ¤ÎÏ˘Ì·. ÕÙ˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ÔÌÔÓÒıË-

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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

Î·Ó ·fi Ù· Ù‡ÂÏ· ÙÔ˘ ·ÛıÂÓ‹, ÂÓÒ ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ M. avium ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ·fi ÙȘ Â·ÓÂÈÏËÌ̤Ó˜ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓ‹.

EÚfiÎÂÈÙÔ ÏÔÈfiÓ ÁÈ· Ù·˘Ùfi¯ÚÔÓË Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Î·È ·Û¤ÚÁÈÏÏÔ.

TÔ ·È‰› ·Ú¯Èο ¤Ï·‚ ‰ÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹ Ì ·ÌÊÔÙÂÚÈΛÓË B ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÊÏԢ΢ÙÔÛ›ÓË Î·ıÒ˜ Î·È ÙÂÙÚ·Ïfi Û¯‹Ì· ÁÈ· ÙË Ïԛ̈ÍË ·fi M. avium (·˙ÈıÚÔÌ˘Î›ÓË, ÚÈÊ·ÌÔ˘Ù›ÓË, ÛÈÚÔÊÏÔÍ·Û›ÓË, ·ÌÈηۛÓË).

H ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË Î·È Ô ‚‹¯·˜ ÂÌÊ¿ÓÈÛ·Ó ÛÙ·‰È·Î‹ ˘Ô¯ÒÚËÛË, Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· fï˜ ·Ú¤ÌÂÈÓ·Ó ·ÌÂÙ¿‚ÏËÙ· ·ÎfiÌ· Î·È ¤ÓÙ ̋Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È ÂÓÒ Û˘Ó¯È˙fiÙ·Ó Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÌÊÔÙÂÚÈΛÓ˘ B ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Î·È ÙÚÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹. H ÂÓÙfiÈÛË Ù˘ Ì¿˙·˜ ‹Ù·Ó ··ÁÔÚ¢ÙÈ΋ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË. ™ÙË ‰Â‡ÙÂÚË ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›· ‰È·ÈÛÙÒıËÎ·Ó ·ÏÏÔÈÒÛÂȘ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜. EÓÙÔ›ÛıËÎ·Ó Ï›Á· ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÔÍ¿ÓÙÔ¯· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ÏÏ¿ ‰ÂÓ ·Ó¢ڤıËÛ·Ó Ì‡ÎËÙ˜ ‹ ÛÙÔȯ›· ηÎÔ‹ıÂÈ·˜. M ٷ ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù· ¯ÔÚËÁ‹ıËΠ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ıÂÚ·›· Û˘ÓÙ‹ÚËÛ˘ ÁÈ· ÙË Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Ì ÈÙÚ·ÎÔÓ·˙fiÏË. ™‹ÌÂÚ· 2,5 ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, Ô ·ÛıÂÓ‹˜ Â›Ó·È Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË ˘fi ¯ËÌÂÈÔÚÔʇϷÍË Ì ÈÙÚ·ÎÔÓ·˙fiÏË Î·È ·˙ÈıÚÔÌ˘Î›ÓË. ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›ÛÂÈ ¿ÏÏË Â˘Î·ÈÚȷ΋ Ïԛ̈ÍË Î·È Ë ·ÎÙÈÓÔÏÔÁÈ΋ ÙÔ˘ ÂÈÎfiÓ· Â›Ó·È ‚ÂÏÙȈ̤ÓË. MfiÓÔ Úfi‚ÏËÌ¿ ÙÔ˘ ·Ú·Ì¤ÓÂÈ Ë ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì˘ÎËÙÈ·ÛÈ΋ ÛÙÔÌ·Ù›Ùȉ· Î·È ÙÔ ·˘ÍË̤ÓÔ ÈÈÎfi ÊÔÚÙ›Ô ·Ú¿ ÙËÓ ÙÚÈÏ‹ ·ÓÙÈÚÂÙÚÔ˚΋ ·ÁˆÁ‹. ™˘˙‹ÙËÛË TÔ AIDS ÂÚÈÁÚ¿ÊËΠ۠·ÛıÂÓ›˜ Ì ·ÈÌÔÚÚÔÊÈÏ›· ÙÔ 1982. (7) TÔ 1985, Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂϤÁ¯Ô˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ HIV ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 40-90% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ Â›¯·Ó ÌÔÏ˘Óı› ̤ۈ Ù˘ ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘ (Û˘Ì‚·ÙÈÎÔ› Û˘Ì˘Îӈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜). (8) H ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÚÔÌÂÙ·ÙÚÔÒÓ Û˘Ó¤‚Ë Î·Ù¿ Ù· ¤ÙË 1982 Î·È 1983. (9) H ÔÚ›· Ù˘ HIV Ïԛ̈͢ Û ·ÈÌÔÚÚÔÊÈÏÈο ·È‰È¿ Â›Ó·È Èfi Ì·ÎÚfi¯ÚÔÓË ·fi fiÙÈ Û ·È‰È¿ Ì οıÂÙË HIV Ïԛ̈ÍË, ÂÓÒ ÔÈ Î·ÎÔ‹ıÂȘ Î·È ÔÈ Â˘Î·ÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ Â›Ó·È Î·ıÔÚÈÛÙÈΤ˜ ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ Î·È ÙË ıÓËÙfiÙËÙ· (10,11). O ·ÛıÂÓ‹˜ Ì·˜ ÌÔχÓıËΠ̠ÙÔÓ HIV Û ËÏÈΛ· 4 ÂÙÒÓ Î·È ·ÚÔ˘Û›·Û ÙËÓ ÚÒÙË ÙÔ˘ ¢ηÈÚȷ΋ Ïԛ̈ÍË Û ËÏÈΛ· 15 ÂÙÒÓ.

H Û˘¯ÓfiÙËÙ· Ïԛ̈͢ ·fi M. avium Û ·È‰È¿ Ì AIDS ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Â›Ó·È ÂÚ›Ô˘ ›‰È· Ì ·˘Ù‹ ÙˆÓ ÂÓËϛΈÓ, ‰ËÏ·‰‹ 1,1-4 %. K·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ïԛ̈͢ ·fi M. avium ıˆÚÂ›Ù·È Ë ÙÒÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4

ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î¿Ùˆ ·fi 100/mm3 (1). EÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ ‰È¿Û·ÚÙË Ïԛ̈ÍË (Ì˘ÎÔ‚·ÎÙËÚÈ·ÈÌ›·) Ì ˘ÚÂÙfi, ·Ó·ÈÌ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. øÛÙfiÛÔ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÓÙÔÈṲ̂Ó˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ Ó‡ÌÔÓ˜ ‹ Î·È Û ¿ÏÏ· fiÚÁ·Ó· (‰¤ÚÌ·, ÏÂÌÊ·‰¤Ó˜). H ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔʇϷ͢ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ Èı·ÓfiÙËÙ· Ïԛ̈͢ ·fi M. avium Û ·ÛıÂÓ›˜ Ì HIV Ïԛ̈ÍË Î·È CD4 ÏÂÌÊÔ·ÙÙ·Ú· οو ·fi 100/mm3. (1,2)

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H ‰ÈËıËÙÈ΋ Ó¢ÌÔÓÈ΋ ·ÛÂÚÁ›ÏψÛË ÂÌÊ·Ó›˙ÂÙ·È Û ¿ÙÔÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ·ÓÔÛÔηٷÛÙÔÏ‹ ÏfiÁˆ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÂȉÒÓ, Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‹ ¤¯Ô˘Ó ÏÂÈÙÔ˘ÚÁÈ΋ ‰È·Ù·Ú·¯‹ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (3). ™Â ·ÛıÂÓ›˜ Ì AIDS ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¿ÓÈ· ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ ˘ÔÏÔÁ›˙ÂÙ·È ÛÙÔ 0,7% (6) Î·È ÛÙ· ·È‰È¿ ÛÙÔ 1,5% (5). §fiÁˆ Ù˘ ‰‡ÛÎÔÏ˘ ÙÂÎÌËÚ›ˆÛ˘ Ù˘ Ïԛ̈͢ Û˘¯Ó¿ Ë ‰È¿ÁÓˆÛË ‰È·Ê‡ÁÂÈ, ¤ÙÛÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ÛÙËÚ›˙ÔÓÙ·È Û ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi (6). ø˜ Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜ ÌfiÏ˘ÓÛ˘ ·Ó·Ê¤ÚÂÙ·È Ë ÂÈÛÓÔ‹ ÎÔÓȉ›ˆÓ ·Û¤ÚÁÈÏÏÔ˘. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ù· Ì·ÎÚÔÊ¿Á· ÂÈÙ˘Á¯¿ÓÔ˘Ó ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÓȉ›ˆÓ, ·Ó fï˜ Ë Ïԛ̈ÍË ‰ÂÓ ÂÚÈÔÚÈÛÙ›, ·Ú¯›˙ÂÈ Ë ‰È·‰Èηۛ· ·Ó¿Ù˘Í˘ Ì˘ÎËÏ›ˆÓ. (3) OÈ ·ÛıÂÓ›˜ Ì AIDS Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ·Û¤ÚÁÈÏÏÔ Û˘Ó‹ıˆ˜ ‚Ú›ÛÎÔÓÙ·È Û ‚·ÚÈ¿ ·ÓÔÛÔηٷÛÙÔÏ‹. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ·ÛÂÚÁ›ÏψÛË Û ·ÛıÂÓ›˜ Ì AIDS ·ÔÙÂÏÔ‡Ó Ë Ô˘‰ÂÙÂÚÔÂÓ›·, Ë ¯ÚfiÓÈ· ıÂÚ·›· Ì ÎÔÚÙÈÎÔÂȉ‹, Ë Ì·ÎÚÔ¯ÚfiÓÈ· ·ÓÙÈÌÈÎÚԂȷ΋ ıÂÚ·›· ¢ڤˆ˜ Ê¿ÛÌ·ÙÔ˜ fiˆ˜ Î·È Ë ˘ÔΛÌÂÓË Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜. H ÏÂÈÙÔ˘ÚÁÈ΋ ‰È·Ù·Ú·¯‹ ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ê·›ÓÂÙ·È ÔÙÈ ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì AIDS Ô˘ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·.(4,5) O ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ ÂÌÊ¿ÓÈ˙ Ԣ‰ÂÙÂÚÔÂÓ›· ·ÏÏ¿ Ë ÚÔ¸¿Ú¯Ô˘Û· Ó¢ÌÔÓÈ΋ Ïԛ̈ÍË ·fi M. avium Èı·ÓfiÓ Ó· ·ÔÙ¤ÏÂÛ ÙÔÓ Î‡ÚÈÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘.

H ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ηÏÏȤÚÁÂÈ· ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎÔ‡ ÂÎχ̷ÙÔ˜ Î·È ‚ÈÔ„›· Ó‡ÌÔÓÔ˜, ÂÓÒ ÔÈ ÔÚÔÏÔÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ·Ó›¯Ó¢Û˘ ·ÓÙÈÁfiÓÔ˘ Î·È ·ÓÙiÛÒÌ·ÙÔ˜ ηٿ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ ¤¯Ô˘Ó ¯·ÌËÏ‹ ·ÍÈÔÈÛÙ›·.

(3,12) ™ÙË ÂÚ›ÙˆÛË Ì·˜ Ë ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Ù˘ Ì¿˙·˜ ¤‰ÂÈÍ ·ÏËı›˜ ˘Ê¤˜, ÁÂÁÔÓfi˜ Ô˘ ÂÓÈÛ¯‡ÂÈ ÙËÓ ‰È¿ÁÓˆÛË Ù˘ ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘, ·ÊÔ‡ Ô A. fumigatus ‹Ù·Ó Ô ÌfiÓÔ˜ ̇ÎËÙ·˜ o‡ ·Ó·Ù‡-

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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

¯ıËΠÛÙȘ ηÏÏȤÚÁÂȘ ·fi ÙÔ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ¤ÎÏ˘Ì·. £ÂÚ·›· ÂÎÏÔÁ‹˜ ıˆÚÂ›Ù·È Ë ·ÌÊÔÙÂÚÈΛÓË B, ¤¯Ô˘Ó fï˜ ¯ÚËÛÈÌÔÔÈËı› Ì ÂÈÙ˘¯›· Î·È ¿ÏÏ· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο Ê¿Ú̷η fiˆ˜ Â›Ó·È ÔÈ ·˙fiϘ Î·È Ë ÊÏԢ΢ÙÔÛ›ÓË, Û˘Ó‹ıˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÌÊÔÙÂÚÈΛÓË B (3,5,6,13). H ÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË B ÚÔÙÈÌ¿Ù·È Û ÂÚÈÙÒÛÂȘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¯ÔÚ‹ÁËÛ˘ ÏfiÁˆ ÌÈÎÚfiÙÂÚ˘ ÙÔÍÈÎfiÙËÙ·˜ (13,14). XÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ Ì˘ÎËÙÈ·ÛÈ΋˜ Ì¿˙·˜ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ì ηϿ ·ÔÙÂϤÛÌ·Ù· (15) ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ fï˜ Ù¤ÙÔÈ· Â¤Ì‚·ÛË ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹ ÏfiÁˆ Ù˘ ÂÓÙfiÈÛ˘ Ù˘ Ì¿˙·˜.

O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·ÛÂÚÁ›ÏψÛ˘ ·fi ÙË ÌÂÙ¿ÙˆÛË Ù˘ HIV Ïԛ̈͢ Û AIDS Â›Ó·È 10 Ì‹Ó˜, (6) fiÛÔ ‹Ù·Ó Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜.

H ÚfiÁÓˆÛË Ù˘ ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ Û ·ÛıÂÓ›˜ Ì AIDS ¤›Ó·È Ôχ η΋, Ë ıÓËÙfiÙËÙ· Êı¿ÓÂÈ ÙÔ 70-90%, (5) Ô ‰Â ̤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛ˘ ·Ó¤Ú¯ÂÙ·È Û ϛÁ˜ ‚‰ÔÌ¿‰Â˜ (5). O ·ÛıÂÓ‹˜ Ì·˜ Â›Ó·È Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË ÂÚÈÛÛfiÙÂÚÔ ·fi ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË, ÁÂÁÔÓfi˜ Ô˘ ÙÔ˘ ÂÈÙÚ¤ÂÈ Û¯Â‰fiÓ Ê˘ÛÈÔÏÔÁÈ΋ ˙ˆ‹. ¶ÈÛÙ‡ԢÌ fiÙÈ Û ·˘Ùfi Û˘ÓÂÙ¤ÏÂÛÂ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ‰ÈÏ‹˜ Ó¢ÌÔÓÈ΋˜ Ïԛ̈͢ ηıÒ˜ Î·È Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÂÓÙ·ÙÈ΋ ıÂÚ·›·.

EӉȷʤÚÔÓÙ· ÛËÌ›· ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È Ë Û¿ÓÈ· ÂÓÙfiÈÛË Ù˘ ÂÓ‰Ô‚ÚÔÁ¯È΋˜ Ïԛ̈͢ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Î·È ·Û¤ÚÁÈÏÏÔ, ηıÒ˜ Â›Û˘ Î·È Ë ¿ÚÈÛÙË ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ·ÛıÂÓ‹ ÛÙËÓ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Pizzo Ph. The challenge of HIV infection in infants, children and adolescents. In Wilfert C ed. 2nd ed. William and Wilkins 1996.

2. Rubin D, Rahal J. Mycobacterium-Avium Complex. Infect Dis Clinics N Am 1994;8:413-425.

3. Blum M, Wiedermann B. Fungal diseases.Aspergillus In: Feigin & Cherry Eds. Textbook of Pediatric Infectious Diseases. 3rd Ed. Saunders Company 1992;1891-1898.

4. Lorthclary O, Meyohas M-C, Dupont B, Cadranel J, Salmon-Ceron D, Peyramond D et al. Invasive aspergillosis in patients with acquired immunodeficiency syndrome: Report of 33 cases. Am J Med 1993;95:177187.

5. Shetty D, Giri N, Gonzalez C, Pizzo P, Walsh T. Invasive aspergillosis in human immunodeficiency virus infected children. Pediatr Infect Dis J 1997;16:216-221 6. Minamoto G, Bazlam T, Vander Els N. Invasive aspergillosis in patients with AIDS. Clin Infect Dis 1992;14:66-74.

7. Centers for Disease Control. Update on acquired immunodeficiency syndrome(AIDS) among patients with haemophilia A. MMWR 1982;31:664.

8. Ramsey B, Palmer L, McDougal S. Antibody to

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9.

10.

11.

12.

13.

lymphadenopathy-assosiated virus in haemophiliacs with and without AIDS. Lancet 1984;2:397.

Evatt C, Gomperts D, McDougal S, Ramsey B. Coincidental appearance of LAV/HTLV-III antibodies in hemophiliacs and the onset of the AIDS epidemic. N Eng J Med 1985;312:318.

M‹ÙÛÈη -K·Ú·Ó¿ÛÔ˘ A. ¢È·¯ÚÔÓÈ΋ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋ ÂÎÙ›ÌËÛË HIV ÔÚÔıÂÙÈÎÒÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·È‰ÈÒÓ. ¶ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÁÈ· ¤ÁηÈÚË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË. Aı‹Ó· : A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, 1993.

Phillips A, Lee A, Elford J. Prediction of progression to AIDS by analysis of CD4 lymphocyte counts in a haemophilic cohort. AIDS 1989;3:737.

Andrile V: Infections with Aspergillus species. Clin Infect Dis 1993;17(2 suppl): S481-S486.

Denning D. Therapeutic Outcome in invasive Aspergillosis. Clin Infect Dis 1996;23:608-615.

∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

14. Meunier F, Prentice HG, Ringden O. Liposomal Amphotericin B(Ambisome): safety data from a phase ii/iii clinical trial. J Antimicrob Chemother 1991;28(B suppl):S83-S91.

15. Robinson L, Reed E, Galbraith T, Alonso A, Moulton A, Fleming W. Pulmonary resection for invasive aspergillus infection in immunocompromised patients. J Thor Cardiovasc Surg 1995;109(6):1182-1197.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘, A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, MÔÓ¿‰· EȉÈÎÒÓ §ÔÈÌÒ͈Ó, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·", £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, °Ô˘‰›.

™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Û ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ IˆÛ‹Ê K·Ï¤ÁÈ·˜1, M·Ú›˙· TÛÔÏÈ¿1, KˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··ÁˆÚÁ›Ô˘2, £ÂÔ‰fiÛ˘ ¢fiÛÈÔ˜, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿Î˘1 ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ Ô˘ ‰È·ÁÓÒÛıËΠ۠·ÁfiÚÈ ËÏÈΛ·˜ 14 ÂÙÒÓ, ÙÔ ÔÔ›Ô ·fi ËÏÈΛ·˜ 2 ÂÙÒÓ ·ÚÔ˘Û›·˙ ÂÂÈÛfi‰È· ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒ͈Ó. H ıÂÚ·›· ‹Ù·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Ì ÂÎÙÔÌ‹ ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜. H ÎÏÈÓÈ΋ ˘Ô„›· ÁÈ· ÙÔ Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·›·. ¶·È‰È·ÙÚÈ΋ 2000;63:55-59. §¤ÍÂȘ ÎÏÂȉȿ: Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ·, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·.

I. Kaleyias, M. Tsolia, K. Papageorgiou, T. Dosios, E. Kavasarakis. Congenital lobar emphysema in an adolescent. Case report. Paediatriki 2000;63:55-59. ● Abstract: This is a case report of a boy with congenital lobar emphysema diagnosed and treated surgically at the age of 14 years. From the age of two years he had episodes of respiratory distress and recurrent pulmonary infections.

Clinical awareness of congenital lobar emphysema is important for prompt diagnosis and effective surgical treatment.

Key words: congenital lobar emphysema, respiratory distress.

EÈÛ·ÁˆÁ‹ ¢È·Ù·Ú·¯¤˜ ηٿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË ÙˆÓ Ó¢ÌfiÓˆÓ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¢ڇ Ê¿ÛÌ· ·ÓˆÌ·-

1 2 3

ÏÈÒÓ ÔÈ Ôԛ˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È·Ù·Ú·¯‹ Ù˘ ‰ÔÌ‹˜ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Â›Ó·È Û¿ÓȘ ÛÂ Û˘¯ÓfiÙËÙ·, ·ÏÏ¿ ÂӉ¯Ô̤ӈ˜ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË

B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ Aı‹Ó·˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶.& A.K˘ÚÈ·ÎÔ‡" ¶·ıÔÏÔÁÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ KÏÈÓÈ΋ IÔÎÚ·Ù›Ԣ NÔÛÔÎÔÌ›Ԣ B' ¶. XÂÈÚÔ˘ÚÁÈ΋ KÏÈÓÈ΋ §·˚ÎÔ‡ NÔÛÔÎÔÌ›Ԣ

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:55-59

˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ (1,2).

TÔ Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· (™§E) ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ Ì ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÌÔÚ› Ó· ‰È·ÁÓˆÛı› ÛÙË ÌÂÙ¤ÂÈÙ· ‚ÚÂÊÈ΋ ËÏÈΛ· (5%), ÂÓÒ ÛÔÚ·‰Èο ÂÚÈÛÙ·ÙÈο ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·È‰È΋, ÂÊË‚È΋ ‹ Î·È ÂÓ‹ÏÈÎÔ ˙ˆ‹ (3). H ËÏÈΛ· ‰È¿ÁÓˆÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ‚·ıÌfi Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ÚÔηÏ›ٷÈ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ŒÊË‚Ô˜ 14 ÂÙÒÓ, ·ÚÔ˘Û›·Û ˘ÚÂÙfi Î·È ‚‹¯· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰‡ÛÓÔÈ·, ·ÓÙÈÏËÙ‹ ˆ˜ Ù·¯‡ÓÔÈ·. M ·˘Ù‹ ÙËÓ ÂÈÎfiÓ· ÂÈÛ‹¯ıË Û NÔÛÔÎÔÌÂ›Ô fiÔ˘ ÛÙË ÁÂÓfiÌÂÓË ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·ÈÛÙÒıËΠ˘Âډȷ‡Á·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿ (ÂÈÎfiÓ· 1).

TÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. Afi ËÏÈΛ·˜ 2 ÂÙÒÓ ·ÚÔ˘Û›·˙ ‹È· ÂÂÈÛfi‰È· ·Ó·Ó¢ÛÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ˆ˜ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· ‹/ Î·È ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Â ËÏÈΛ· 9 ÂÙÒÓ ÓÔÛËχÙËΠÁÈ· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ·fi ÙfiÙ ¿Ú¯ÈÛ ӷ ¯ÚËÛÈÌÔÔÈ› ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ¯ˆÚ›˜ fï˜ ÂÌÊ·Ó‹ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË. ¢ÂÓ ·Ó¤ÊÂÚ Ӣ¯ÙÂÚÈÓfi ‚‹¯· ‹ ‚‹¯· ÌÂÙ¿ ·fi ¿ÛÎËÛË. TÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ.

TÔ ·È‰› ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ù· ۈ̷ÙÔÌÂÙÚÈο ÙÔ˘ ÛÙÔȯ›· ‹Ù·Ó ÛÙËÓ 95Ë ÂηÙÔ-

EÈÎfiÓ· 1. AÎÙÈÓÔÁÚ·Ê›· £Òڷη Û ËÏÈΛ· 14 ÂÙÒÓ: ˘Âډȷ‡Á·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿

56

∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

ÛÙÈ·›· ı¤ÛË. H ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘ ‹Ù·Ó ÌÂȈ̤ÓË Ì ˘ÂÚÛ·Ê‹ Ù˘Ì·ÓÈÎfi ‹¯Ô, ÔÈ ÊˆÓËÙÈΤ˜ ‰ÔÓ‹ÛÂȘ Î·È ÙÔ ·Ó·Ó¢ÛÙÈÎfi „Èı‡ÚÈÛÌ· ‹Ù·Ó ÌÂȈ̤ӷ ·ÚÈÛÙÂÚ¿, ÂÓÒ ‰ÂÍÈ¿ ˘‹Ú¯Â ΢„ÂÏȉÈÎfi „Èı‡ÚÈÛÌ· Ì ÚfiÛıÂÙÔ˘˜ ·¯Â›˜ ˘ÁÚÔ‡˜ ‹¯Ô˘˜ Î·È Û˘Ú›ÙÔÓÙ˜. H ÂÎÙ›ˆ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ÂÈÎfiÓ· ˘ÂÚ·ÂÚÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿. O Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ÛËÌÂÈÔÏÔÁÈÎÒÓ Î·È ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘ÓËÁÔÚÔ‡Û ˘¤Ú ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜. Afi Ù· ·›ÙÈ· Ô˘ ÚÔηÏÔ‡Ó ÏԂ҉˜ ÂÌʇÛËÌ· ˆ˜ ÂÚÈÛÛfiÙÂÚÔ Èı·Ó¿ ıˆڋıËÎ·Ó Ë ÌÂÚÈ΋ ·fiÊÚ·ÍË ÏfiÁˆ ¿ÛıÌ·ÙÔ˜ ‹ ·fi ͤÓÔ ÛÒÌ·, ÙÔ ™§E Î·È ÙÔ Û‡Ó‰ÚÔÌÔ SweyerJames-MacLeod (Û.SJML). ÕÏÏ· ·›ÙÈ· ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ ÂÓ‰Ô·˘ÏÈο ‹ Â͈·˘ÏÈο, ·Ó Î·È ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ·ÔÎÏÂÈÛÙÔ‡Ó, ıˆڋıËÎ·Ó ÏÈÁfiÙÂÚÔ Èı·Ó¿.

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·Ó ·ÚfiÌÔÈ· ÂΛӢ Ô˘ ›¯Â Û ËÏÈΛ· 9 ÂÙÒÓ Î·Ù¿ ÙËÓ ÙfiÙ ÓÔÛËÏ›· ÙÔ˘ ·È‰ÈÔ‡ Û NÔÛÔÎÔÌÂ›Ô (ÂÈÎfiÓ· 2). O ·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıËΠ̠ÙȘ ·ÎfiÏÔ˘ı˜ ÂÍÂÙ¿ÛÂȘ.

AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ Ë ÔÔ›· ¤‰ÂÈÍ ÙÌËÌ·ÙÈÎfi ÂÌʇÛËÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡ ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆı› ·Á›‰Â˘ÛË ·¤Ú· ‹ ‚ÚÔÁ¯ÂÎٷۛ˜ (ÂÈÎfiÓ· 3), ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ -·¤ÚˆÛ˘ ·fi ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËΠ·Ô˘Û›· ·ÈÌ¿ÙˆÛ˘ Î·È ·¤ÚˆÛ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ ÔÏ˘ÂÛÙȷΤ˜ ‚Ï¿‚˜ (ÂÈÎfiÓ· 4), ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·

EÈÎfiÓ· 2. AÎÙÈÓÔÁÚ·Ê›· £Òڷη Û ËÏÈΛ· 9 ÂÙÒÓ: ˘ÂÚ·ÂÚÈÛÌfi˜ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ¿ıÂÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿ (Â˘Ú‹Ì·Ù· ·ÚfiÌÔÈ· Ì ·˘Ù¿ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· Ô˘ ¤ÁÈÓ Û ËÏÈΛ· 14 ÂÙÒÓ).

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EÈÎfiÓ· 3. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ (HRCT): TÌËÌ·ÙÈÎfi ÂÌʇÛËÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡.

Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. H ‰˘Ó·ÌÈ΋ ÛÈÚÔ̤ÙÚËÛË (FEV1=86%, FEVC=87%, FEV1/ FEVC=84%, MMF=64%) Î·È Ë ·ÚÓËÙÈ΋ ‰ÔÎÈÌ·Û›· ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹˜ Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú ÌË ·Ó·ÛÙÚ¤„ÈÌ˘ ·fiÊڷ͢ ÙˆÓ ÌÈÎÚÒÓ ·ÂÚ·ÁˆÁÒÓ. T· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ ·ÔÌ¿ÎÚ˘Ó·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜. H ·Ô˘Û›· ÂÌÊ·ÓÔ‡˜ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÂÈÎfiÓ· ηٿ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (·Ô˘Û›· ‚ÚÔÁ¯ÂÎÙ·ÛÈÒÓ, ÌË ‰È·›ÛÙˆÛË ·Á›‰Â˘Û˘ ·¤Ú·) ·ÔÌ¿ÎÚ˘Ó·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ SJML (4). ø˜ Èı·ÓfiÙÂÚË ‰È¿ÁÓˆÛË ıˆڋıËΠÂΛÓË ÙÔ˘ ™§E. H ‚ÚÔÁ¯ÔÛÎfiËÛË ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ͤÓÔ˘ ÛÒÌ·ÙÔ˜ ‹ ¿ÏÏÔ˘ ÂÓ‰Ô·˘ÏÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ‰ÂÓ ÎÚ›ıËΠÛÎfiÈÌË ÂÂȉ‹ ı· ÌÔÚÔ‡Û ӷ ÚÔηϤÛÂÈ Ú‹ÍË Ù˘¯fiÓ ÂÌÊ˘ÛËÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜. ø˜ ηٷÏÏËÏfiÙÂÚË ÎÚ›ıËÎÂ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË. ŒÁÈÓ ·ÚÈÛÙÂÚ‹ ¿Óˆ ÏÔ‚ÂÎÙÔÌ‹ Î·È ÙÌËÌ·ÙÂÎÙÔÌ‹ ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡. H ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Ô˘ ·Ê·ÈÚ¤ıËΠ¤‰ÂÈÍ ˘ÂÚ·ÂÚÈÛÌfi ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ú‹ÍË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ (ÂÈÎfiÓ· 5). TÔ ÙÔ›¯ˆÌ· ÙˆÓ ‚ÚfiÁ¯ˆÓ ‰ÂÓ ‹Ù·Ó Â·¯˘Ṳ̂ÓÔ Î·È ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‚ÚÔÁ¯ÂÎÙ·ÛÈΤ˜ ·ÏÏÔÈÒÛÂȘ (ÂÈÎfiÓ· ıˆڋıËÎÂ Û˘Ì‚·Ù‹ Ì ™§E). MÂÙÂÁ¯ÂÈÚËÙÈο Ô ·ÚÈÛÙÂÚfi˜ οو ÏÔ‚fi˜ ÂÎÙ‡¯ıËΠÏ‹Úˆ˜ (ÂÈÎfiÓ· 6). ™˘˙‹ÙËÛË TÔ ™§E ۯ‰fiÓ ¿ÓÙ· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ Î·È ÚÔ‚¿ÏÏÂÈ Ì ÙËÓ ÂÈ-

EÈÎfiÓ· 4. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ Î·È ·¤ÚˆÛ˘ Ó¢ÌfiÓˆÓ: ·Ô˘Û›· ·ÈÌ¿ÙˆÛ˘ Î·È ·¤ÚˆÛ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ ÔÏ˘ÂÛÙȷΤ˜ ‚Ï¿‚˜.

EÈÎfiÓ· 5. IÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ·Ê·ÈÚÂı¤ÓÙÔ˜ ÙÌ‹Ì·ÙÔ˜ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜: ˘ÂÚ·ÂÚÈÛÌfi˜ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ú‹ÍË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ.

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EÈÎfiÓ· 6. AÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÌÂÙÂÁ¯ÂÈÚËÙÈο: ¶Ï‹Ú˘ ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡. ÎfiÓ· ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ‹/ Î·È Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. Y¿Ú¯Ô˘Ó ÛÔÚ·‰Èο ÂÚÈÛÙ·ÙÈο ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÛÙË ·È‰È΋, ÂÊË‚È΋ ‹ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (1,5,6). Y¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ ™§E Ô ÌÔÓÔÂÛÙÈ·Îfi˜ Î·È Ô ÔÏ˘ÂÛÙÈ·Îfi˜. H ÂÚ›ÙˆÛË Ì·˜ ·Ó‹ÎÂÈ ÛÙÔ ÌÔÓÔÂÛÙÈ·Îfi Ù‡Ô (2). ¢È·Ù·Ú·¯¤˜ ηٿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË ÙˆÓ Ó¢ÌfiÓˆÓ, fiˆ˜ Ë ‰˘ÛÏ·Û›· ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ ‹ /Î·È Ô ÌÂȈ̤ÓÔ˜ ·ÚÈıÌfi˜ ΢„ÂÏ›‰ˆÓ, Ô‰ËÁÔ‡Ó Û ™§E (2,3).

AÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ™§E Â›Ó·È Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, Ë ÔÔ›· ÛÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË ¤ıÂÛ ÈÛ¯˘Ú‹ ˘Ô„›· ÁÈ· ÙÔ ÓfiÛËÌ·. O ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıËΠ̠·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜, ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘- ·¤ÚˆÛ˘, ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·. M ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÓÈÛ¯‡ÂÙ·È Ë ‰È¿ÁÓˆÛË. TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·¤ÚˆÛ˘- ·ÈÌ¿ÙˆÛ˘ ¤ÁÈÓ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛı› Ù˘¯fiÓ ÔÏ˘ÂÛÙÈ·Îfi ™§E (8-11). ŒÁÈÓ Â›Û˘ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ‹ ·ÓˆÌ·Ï›·˜ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi Û˘Ó˘¿Ú¯Ô˘Ó Û ÔÛÔÛÙfi 14% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ì ™§E (10) Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘Ï›Ô˘.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ì ™§E ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ¯ÂÈÚÔ˘ÚÁÈο Ì ÂÎÙÔÌ‹ ÙÔ˘ ˘Ô·ÂÚÈ˙fiÌÂÓÔ˘ ÈÛÙÔ‡ (1,11-14). ŸÌˆ˜, ·Ó Î·È Â›Ó·È ÁÂÓÈο ·Ú·‰ÂÎÙfi fiÙÈ Ë ·Ê·›ÚÂÛË ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Â›Ó·È ÛˆÙ‹ÚÈ· Û ÓÂÔÁÓ¿ Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÔÈ ÂӉ›ÍÂȘ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Û ÌÂÙÚ›ˆ˜ ‰˘ÛÓÔÔ‡ÓÙ· ‹ ¢ÓÔ˚ο ‚Ú¤ÊË Î·È ·È‰È¿ Â›Ó·È ·Û·Ê›˜. H Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·Ú·-

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οÌÙÂÈ ‚¤‚·È· ÙÔ˘˜ ¿ÌÂÛÔ˘˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ·ÏÏ¿ Ô ·ÛıÂÓ‹˜ ·Ú·Ì¤ÓÂÈ Û ˘„ËÏfi ΛӉ˘ÓÔ ÏfiÁˆ Èı·ÓÔ‡ ·˘ÙfiÌ·ÙÔ˘ Ó¢ÌÔıÒڷη. ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ ÚÔÙÈÌ‹Û·Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜, Ë ÔÔ›· ·fi ÙË Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ÈÂıÓ‹ ÂÌÂÈÚ›· ıˆÚÂ›Ù·È ÚÔÙÈÌfiÙÂÚË. ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ë ·Ê·›ÚÂÛË Ù˘ ÂÌÊ˘ÛËÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÁÈ·Ù› ÂÈÙÚ¤ÂÈ ÙËÓ ·ÔÛ˘Ì›ÂÛË ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Èı·ÓÒ˜ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË Ó¤Ô˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ Ì ÙËÓ ·Ó·Á¤ÓÓËÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ·ÔÙÚ¤ÂÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ Ó¢ÌÔÓÈΤ˜ ÏÔÈÌÒÍÂȘ. ¶·Ú¿ÏÏËÏ·, ·ÔʇÁÂÙ·È Ë ·ÈÊÓ›‰È· Ú‹ÍË Î·È ÚfiÎÏËÛË ·˘ÙfiÌ·ÙÔ˘ Ó¢ÌÔıÒڷη. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ ™§E Ô˘ Â›Ó·È ¤Ó· Û¿ÓÈÔ ÓfiÛËÌ·, Û˘Ó‹ıˆ˜ ÚÔ‚¿ÏÏÂÈ Ì ıÔÚ˘‚Ò‰Ë ÂÈÎfiÓ· ·fi ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, Û Û¿ÓȘ fï˜ ÂÚÈÙÒÛÂȘ ·Ú·Ì¤ÓÂÈ Ì ·Ì‚Ï˯ڋ Û˘Ìو̷ÙÔÏÔÁ›· ̤¯ÚÈ ÙË ÌÂÁ·Ï‡ÙÂÚË ·È‰È΋ ‹ Î·È ÂÊË‚È΋ ËÏÈΛ· fiˆ˜ ÛÙÔ Ó·Úfi ·ÛıÂÓ‹ Ì·˜. H ·fiÊ·ÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÛÙË ÂÚ›ÙˆÛË Ô˘ ÚÔ‚¿ÏÏÂÈ Ì ̤ÙÚÈ· Û˘Ìو̷ÙÔÏÔÁ›· Â›Ó·È ‰‡ÛÎÔÏË Î·È Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌËıÔ‡Ó ÔÈ Î›Ó‰˘ÓÔÈ ·Ú·ÌÔÓ‹˜ Ù˘ ‰È·Ì·ÚÙ›·˜ Û ۯ¤ÛË Ì ÙȘ Èı·Ó¤˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜. M ‚¿ÛË ÙËÓ ˘¿Ú¯Ô˘Û· ÂÌÂÈÚ›·, ·È‰È¿ ÌÂ Û˘Ìو̷ÙÈÎfi ™§E Ú¤ÂÈ Ó· ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜, ·ÏÏ¿ Î·È ÁÈ· Ó· ˘ÂÓı˘Ì›ÛÂÈ ÛÙÔÓ ·ÛÎÔ‡ÓÙ· ¶·È‰›·ÙÚÔ fiÙÈ ÛÙËÓ ‹È· ·ÏÏ¿ Â›ÌÔÓË ·Ó·Ó¢ÛÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Ú¤ÂÈ Ó· ·Ó·˙ËÙÔ‡ÓÙ·È Î·È Ù· Û·ÓÈfiÙÂÚ· ·›ÙÈ·.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Wesley JR. Diagnosis and management of congenital cystic disease of the lung in children. J Pediatr Surg 1986; 1:202-207.

2. Bailey PV. Congenital bronchopulmonary malformations.

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3. Critchley PS. Adult congenital lobar emphysema in pregnancy. Thorax 1995; 50:909-910.

4. Ghossain MA. Sweyer-James Syndrome documented by spiral CT angiography and high resolution inspiratory and expiratory CT: an accurate single modality exploration. J Comput Assist Tomogr 1997;21:616-618.

5. Wegener WA. Ventilation-perfusion scintigraphy in congenital lobar emphysema. Clin Nucl Med 1990; 15:683-687.

6. Mc Donald. Congenital lobar emphysema requiring surgery in adult life. Aust NZ J Med 1986; 16:501-505.

7. Stigers KB. The clinical and imaging spectrum of findings in patients with congenital lobar emphysema. Pediatr

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8. Markowitz R. Congenital lobar emphysema. The roles of CT and V/Q scan. Scan Clin Pediatr 1989; 1:19-23.

9. McGinnis HD. Bubbly intrapleural mucous simulating congenital lobar emphysema. Ped Radiology 1993; 23:386-7.

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11. Kennedy D. Lobar emphysema: Long-term imaging follow-up. Radiology 1991; 180:189-193.

12. Loockman Saim. Congenital lobar emphysema case with bronchial septum. Ped Oto Rhino Laryngology 1994; 28:241-246.

∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

13. Eigen H. Congenital lobar emphysema: long-term evaluation of surgically and conservatively treated children. Am Rev Resp Dis 1976; 113:823-830.

14. Roghair GD. Nonoperative management of lobar emphysema. Long-term follow-up. Ped Radiology 1972; 102:125-127.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: IˆÛ‹Ê K·Ï¤ÁÈ·˜ XÚ˘Û·Óı¤ÌˆÓ 79, 15772 Aı‹Ó·

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A¶∂π∫O¡π™∆π∫∏ ¶∂ƒπ¶∆ø™∏

¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ÈÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘1, º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘1, AÊÚÔ‰›ÙË X·ÚÈÙ¿ÓÙË2, ª·Ú›· ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1, ¢ˆÚÔı¤· K·ÙÚÈÔ‡1

T. Papageorgiou, F. Athanasiadou, A. Haritandi, M. Hatzistylianou, D. Katriou. Case report of a child with Langerhans cell histiocytosis. Paediatriki 2000;63:60-62. ● Abstract: A female child was admitted at the age of 18 months with seborrhoeic dermatitis, splenic enlargement and water deprivation. No organ dysfunction was established. Multiple typical osteolytic areas were observed on the skull X-ray. The diagnosis of diabetes insipidus was confirmed by the magnetic resonance imaging (MRI) of the pituitary gland on which the typical morphological changes were demonstrated. The diagnosis of Langerhans cell histiocytosis was confirmed by skin lesion biopsy. The child was treated with methotraxate, etoposide, vinblastine, 6-mercaptopurine and prednisone according to an intensive chemotherapeutic protocol and achieved complete remission. Three years after the cessation of chemotherapy the only residual problem was diabetes insipidus.

Key words: Langerhans cell histiocytosis, histiÔcytosis-X.

KÔÚ›ÙÛÈ ËÏÈΛ·˜ 18 ÌËÓÒÓ, ¿Û¯Ô˘Û· ·fi ÂÙÂÚfi˙˘ÁË-‚ ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È ¤ÏÏÂÈ„Ë G-6PD ÂÌÊ¿ÓÈÛ ‰ÂÚÌ·Ù›Ùȉ· ÛÙË ÌËÚÔ˚ÁÓȷ΋ Î·È ÙËÓ ÔÛÊ˘˚΋ ¯ÒÚ·, ηıÒ˜ Î·È ÛÙÔ ÙÚȯˆÙfi Ù˘ ÎÂÊ·Ï‹˜. H ·ÁˆÁ‹ Ô˘ Û˘ÓÂÛÙ‹ıË ·fi ‰ÂÚÌ·ÙÔÏfiÁÔ ‰ÂÓ Â¤ÊÂÚ η̛· ‚ÂÏÙ›ˆÛË. ™Â ÂͤٷÛË ÚÔ˘Ù›Ó·˜ ÛÙÔ Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ÙÔ˘ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËΠfiÙÈ ÂÎÙfi˜ ·fi ÙË ‰ÂÚÌ·Ù›Ùȉ·, ÂÌÊ¿ÓÈ˙ ÛÏËÓÔÌÂÁ·Ï›· (ÂÚ›Ô˘ 10 ÂηÙÔÛÙ¿), ‰È¿Ù·ÛË Ù˘ ÎÔÈÏÈ¿˜ Î·È ¤ÓÙÔÓË ÔÏ˘‰È„›·. M Èı·Ó‹ ‰È¿ÁÓˆÛË ÙËÓ ÈÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans ˘Ô‚Ï‹ıËΠ۠Ï‹ÚË ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, Ì ·Ϥ˜ ·ÎÙÈÓÔÁڷʛ˜, ˘ÔÏÔÁÈÛÙÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ·ÔÎÏ›ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ˘ÂÚÛÏËÓÈÛÌfi Î·È ÙËÓ Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. OÈ ·/· ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È Ë ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· η٤‰ÂÈÍ·Ó ÔÏÏ·Ϥ˜ ÔÛÙÂÔÏ˘ÙÈΤ˜ ÂÛٛ˜ Ì ηٷÛÙÚÔÊ‹ Ù˘ ‰ÈÏfi˘ Î·È ÙˆÓ ÂÙ¿ÏˆÓ ¯ˆÚ›˜ ÛÎÏËÚ˘ÓÙÈο fiÚÈ· (ÂÈÎfiÓ· 1). H ·/· Î·È Ë ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›·

1 2

B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ∞¶£ ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞

60

EÈÎfiÓ· 1. AÏ‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ ÚÈÓ ·fi ÙËÓ ·ÁˆÁ‹. ¢È·ÎÚ›ÓÔÓÙ·È Â˘ÌÂÁ¤ıÂȘ ÔÛÙÂÔÏ˘ÙÈΤ˜ ÂÚÈÔ¯¤˜ ¯ˆÚ›˜ ÛÎÏËÚ˘ÓÙÈο fiÚÈ·.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:60-62

IÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans

ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ η٤‰ÂÈÍ·Ó Î·ı›˙ËÛË Î·È ÛÊËÓÔÂȉ‹ ·Ú·ÌfiÚʈÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘ Ì ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ÌÂÛÔÛÔÓ‰˘Ï›ˆÓ ‰›ÛÎˆÓ Î·È ·Ô˘Û›· Ì¿˙·˜ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ (ÂÈÎfiÓ· 2). H Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI) ¤‰ÂÈÍ ¿¯˘ÓÛË Î·È ¤ÓÙÔÓÔ ÂÌÏÔ˘ÙÈÛÌfi ÙÔ˘ Ì›Û¯Ô˘ Ù˘ ˘fiÊ˘Û˘, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¿ÔÈÔ˘ ‰È·‚‹ÙË (ÂÈÎfiÓ· 3). H ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË Ù˘ IÛÙÈÔ·ÙÙˆÛ˘ ·fi ·ÙÙ·Ú· Langerhans. T¤ıËΠ۠·ÁˆÁ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÛÙ·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (VP16,VBL,6MP, PDN, MTX) Û‡Ìʈӷ Ì ÂȉÈÎfi ÚˆÙfiÎÔÏÏÔ (1).

H ¯ËÌÂÈÔıÂÚ·›· Û˘ÌÏËÚÒıËΠ̠·ÎÙÈÓÔ‚ÔÏ›· ÙÔ˘ ÎÚ·Ó›Ô˘ Û 6 Û˘Ó‰ڛ˜.

H ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›· ‹Ù·Ó ı·̷ÙÈ΋, ·ÊÔ‡ ÔÈ Ï˘ÙÈΤ˜ ÂÛٛ˜ ÛÙÔ ÎÚ·Ó›Ô ·ÔηٷÛÙ¿ıËηÓ, ÂÎÙfi˜ ·fi ¤Ó· ÌÈÎÚfi ¤ÏÏÂÈÌÌ· ·ÚÈÛÙÂÚ¿ ÎÚÔÙ·ÊÈο. O £12 ÛfiÓ‰˘ÏÔ˜ ·ÔηٷÛÙ¿ıËΠÛËÌ·ÓÙÈο ÙfiÛÔ ˆ˜ ÚÔ˜ ÙÔ ‡„Ô˜ fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙË Û‡ÛÙ·ÛË (ÂÈÎfiÓ· 4). O ¿ÔÈÔ˜ ‰È·‚‹Ù˘ ÂϤÁ¯ÂÙ·È ÈηÓÔÔÈËÙÈο Ì ÙË ¯Ú‹ÛË ÂÈÛÓÂfiÌÂÓÔ˘ Û΢¿ÛÌ·ÙÔ˜ ¢ÂÛÌÔÚÂÛ›Ó˘ (Defirin) 0,05mg x2/ Ë̤ڷ.

EÈÎfiÓ· 2. AÏ‹ ·ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÚÈÓ ·fi ÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. K·ı›˙ËÛË ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘.

EÈÎfiÓ· 3. M·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ˘ÔʇÛˆ˜.

O‚ÂÏÈ·›Ô Â›Â‰Ô T1W1, ÌÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·Ú·Ì·ÁÓËÙÈ΋˜ Ô˘Û›·˜. ¶·Ú·ÙËÚÂ›Ù·È ·ıÔÏÔÁÈ΋ ¿¯˘ÓÛË Î·È ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ Ì›Û¯Ô˘ Ù˘ ˘fiÊ˘Û˘.

™˘˙‹ÙËÛË H IÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans, Ô˘ ̤¯ÚÈ ÚfiÛÊ·Ù· ·Ó·ÊÂÚfiÙ·Ó ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ ÈÛÙÈÔ·ÙÙˆÛË-X, ÂÎÊÚ¿˙ÂÈ ÙȘ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ Ô˘ ÛÙ· ÚÔËÁÔ‡ÌÂÓ· ¯ÚfiÓÈ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó ÛÙÔ˘˜ fiÚÔ˘˜ "HˆÛÈÓfiÊÈÏÔ ÎÔÎΛˆÌ·", ÓfiÛÔ˜ HandSchueller-Christian Î·È ÓfiÛÔ˜ Abt-Letterer-Siwe. K·È ÔÈ ÙÚÂȘ ·Ûı¤ÓÂȘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È‹ıËÛË ÙˆÓ

EÈÎfiÓ· 4. AÏ‹ ·ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜. ™·Ê‹˜ ‚ÂÏÙ›ˆÛË ÙÔ˘ ‡„Ô˘˜, ÙÔ˘ Û¯‹Ì·ÙÔ˜ Î·È ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘.

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ÚÔۂ‚ÏËÌ¤ÓˆÓ ÈÛÙÒÓ Ì ÈÛÙÈÔ·ÙÙ·Ú· (2). T· ÈÛÙÈÔ·ÙÙ·Ú· Â›Ó·È ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· Ì ʷÈÓfiÙ˘Ô Î˘ÙÙ¿ÚˆÓ Langerhans, Ù· ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È Ê˘ÛÈÔÏÔÁÈο ÛÙÔ ‰¤ÚÌ·. H ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·, ΢ڛˆ˜ fï˜ Û ·È‰È¿ ·fi 1-3 ¯ÚÔÓÒÓ. ¶ÚÔÛ‚¿ÏÏÂÈ ÔÔÈÔ‰‹ÔÙ fiÚÁ·ÓÔ ‹ ÈÛÙfi, ÛÙ· ÔÔ›· Ê˘ÛÈÔÏÔÁÈο ·Ó¢ڛÛÎÔÓÙ·È ÌÔÓÔ‡ÚËÓ· Ê·ÁÔ·ÙÙ·Ú·. MÔÚ› Ó· ÚÔÛ‚ÏËı› ÙÔ ‰¤ÚÌ· (·ÙÙ·Ú· Langerhans), Ù· ÔÛÙ¿ (ÔÛÙÂÔÎÏ¿ÛÙ˜), ÙÔ ‹·Ú (·ÙÙ·Ú· Kupffer) Ô ÂÁΤʷÏÔ˜ (ÌÈÎÚÔÁÏÔȷο ·ÙÙ·Ú·),ÙÔ ·›Ì· (ÌÔÓÔ·ÙÙ·Ú·), Ô ÛÏ‹Ó·˜, Ô ı‡ÌÔ˜, ÔÈ ÏÂÌÊ·‰¤Ó˜, Ù· ̷Ϸο ÌfiÚÈ·, Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ (ÈÛÙÈο Ì·ÎÚÔÊ¿Á·) Î·È ÔÈ Ó‡ÌÔÓ˜ (΢„ÂÏȉÈο Ì·ÎÚÔÊ¿Á·) (3).

H ÓfiÛÔ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚¿ÏÂÈ Û¯Â‰fiÓ Î¿ı fiÚÁ·ÓÔ, Ì Â·ÎfiÏÔ˘ıÔ Ó· ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈο Ì ÔÈÎÈÏ›· Û˘Ìو̿وÓ. X·Ú·ÎÙËÚ›˙ÂÙ·È: ·) ˆ˜ ÌÔÓÔÂÛÙȷ΋, ·Ó ÂΉËÏÒÓÂÙ·È Ì ÌÔÓ‹ÚË ÔÛÙÈ΋ ·ÏÏÔ›ˆÛË, ‹ ÂÓÙÔÈṲ̂ÓË ‰ÂÚÌ·ÙÈ΋ ‰È‹ıËÛË ‹ Ì ÚÔÛ‚ÔÏ‹ ÂÓfi˜ ÏÂÌÊ·‰¤Ó·, ‚) ˆ˜ ÔÏ˘ÂÛÙȷ΋, ·Ó ÂΉËÏÒÓÂÙ·È Ì ÔÏÏ·Ϥ˜ ÔÛÙÈΤ˜ Ï˘ÙÈΤ˜ ÂÛٛ˜ ‹ ÚÔÛ‚ÔÏ‹ ÔÏÏ·ÏÒÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È Á) ˆ˜ ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋, ·Ó ÚÔÛ‚ÏËıÔ‡Ó ÔÏÏ¿ fiÚÁ·Ó· Ù·˘Ùfi¯ÚÔÓ·. T· ÚÔÛ‚ÏËı¤ÓÙ· fiÚÁ·Ó· Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÌÊ·Ó›˙Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ Ó· ‰˘ÛÏÂÈÙÔ˘ÚÁÔ‡Ó. ™˘¯ÓfiÙÂÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È Ù· ÔÛÙ¿ (79%) Î·È ÙÔ ‰¤ÚÌ· (25%). AÎÔÏÔ˘ıÔ‡Ó ÙÔ ‹·Ú (11%), Ô ÛÏ‹Ó·˜ (9%), Ù· ·˘ÙÈ¿, ÔÈ Ó‡ÌÔÓ˜, Ë ˘fiÊ˘ÛË (¿ÔÈÔ˜ ‰È·‚‹Ù˘), ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È Ù· Ì¿ÙÈ· (4). ŸÙ·Ó Ë ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È Ì ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ·ÔÎÏÂÈÛıÔ‡Ó ¿ÏϘ ·ı‹ÛÂȘ fiˆ˜ Ë ‰ÂÚÌ·Ù›Ùȉ· ·fi Ù· Û¿ÚÁ·Ó· Î·È Ë ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·. H ˘fiÓÔÈ· Ù˘ ‡·Ú͢ ¿ÔÈÔ˘ ‰È·‚‹ÙË, ··ÈÙ› ¿ÓÙÔÙ ÙË ‰ÈÂÚ‡ÓËÛË Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI), ÁÈ· Ó· ·ÔÎÏÂÈÛıÔ‡Ó fiÁÎÔÈ ÙÔ˘ KN™ Ì ‰È‹ıËÛË Ù˘ ˘fiÊ˘Û˘. H ÚÔÛ‚ÔÏ‹ ÙˆÓ ÔÛÙÒÓ ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈο ·Ó¿ÏÔÁ· Ì ÙÔ ÛËÌÂ›Ô Ù˘ ÚÔÛ‚ÔÏ‹˜. ŸÙ·Ó ÚÔÛ‚¿ÏÏÂÙ·È Ë ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË, Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÂΉËψı› Ì fiÓÔ Î·È Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ ·fi ›ÂÛË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. H ·ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ó· ·ÔÎÏÂÈÛıÔ‡Ó fiÁÎÔÈ Î·È ¿ÏϘ ·ı‹ÛÂȘ Ù˘ ÂÚÈÔ¯‹˜ Ô˘ ÂΉËÏÒÓÔÓÙ·È

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-11-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘ µ’ ¶·È‰. ∫ÏÈÓÈ΋ ∞¶£ ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

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Ì ·ÚfiÌÔÈ· Û˘Ìو̷ÙÔÏÔÁ›·.

H Â›ÌÔÓË ‰ÂÚÌ·Ù›Ùȉ· ÛÙË ‰È΋ Ì·˜ ·ÛıÂÓ‹ Ô˘ ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó ·ÓÂÈÙ˘¯Ò˜ Ì ʷÚ̷΢ÙÈο Û΢¿ÛÌ·Ù· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi ·fi ÙÔ ÔÔ›Ô ÂÓÙÔ›ÛÙËÎÂ Ë ÔÏ˘Ô˘Ú›· Î·È Ë ÔÏ˘‰È„›· ηıÒ˜ Â›Û˘ Î·È Ë ‰ÈfiÁΈÛË ÙˆÓ ˘Ô¯ÔÓ‰Ú›ˆÓ ÛÏ¿¯ÓˆÓ Ì·˜ Ô‰‹ÁËÛ·Ó ÛÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË.

H ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÔÈΛÏÂÈ ·Ó¿ÏÔÁ· Ì ÙË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘. AÛıÂÓ›˜ Ì ÌÔÓÔÂÛÙȷ΋ ÓfiÛÔ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·˘ÙfiÌ·ÙË ‡ÊÂÛË Î·È ÁÂÓÈο ηÏÔ‹ıË ÔÚ›·. OÛÙÈΤ˜ Ï˘ÙÈΤ˜ ÂÛٛ˜ ΢ڛˆ˜ ÛÙË ™.™, Ì ΛӉ˘ÓÔ ·˘ÙfiÌ·ÙÔ˘ ηٿÁÌ·ÙÔ˜, ‹ Ì ¤ÓÙÔÓÔ fiÓÔ Û˘Ó‹ıˆ˜ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ ¤Á¯˘ÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÙÔÈο, ‹ ¯·ÌËÏ‹˜ ‰fiÛ˘ ·ÎÙÈÓÔ‚ÔÏ›· (5). AÛıÂÓ›˜ Ì ÚÔÛ‚ÔÏ‹ ÌÔÓ‹ÚÔ˘˜ ÏÂÌÊ·‰¤Ó· ‹ Ì ÂÓÙÔÈṲ̂ÓË ÙÔÈ΋ ‰È‹ıËÛË ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÂÈÙ˘¯Ò˜ Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜. ¶·È‰È¿ Ì ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ ıÂÚ·‡ÔÓÙ·È Û‹ÌÂÚ· Ì ÙË ¯Ú‹ÛË ÂÓÙ·ÙÈÎÒÓ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÒÓ ÚˆÙÔÎfiÏψÓ. H ¯Ú‹ÛË Ù˘ ÂÙÔÔÛ›‰Ë˜, Ù˘ ÌÂıÔÙÚÂÍ¿Ù˘, Ù˘ ‚ÈÓÌÏ·ÛÙ›Ó˘, Ù˘ ÌÂÚηÙÔÔ˘Ú›Ó˘ Î·È Ù˘ Ú‰ÓÈ˙fiÓ˘ ÛÂ Û˘Ó‰˘·ÛÌfi, ·‡ÍËÛ ÙËÓ ÂÈ‚›ˆÛË ÛÙÔ 79% ÙˆÓ ·È‰ÈÒÓ Û ·ÓÙ›ıÂÛË Ì ٷ Û˘ÓÙËÚËÙÈο ÚˆÙfiÎÔÏÏ·, Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÔ›ˆÓ ÂÈÙ‡Á¯·Ó ÂÈ‚›ˆÛË ÛÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ (1).

BÈ‚ÏÈÔÁÚ·Ê›· 1. Gadner H, Heitger A, Grois N, Gatterer-Menz I, Ladisch S. Treatment strategy for disseminated Langerhans cell histiocytosis. DAL HX-83 Study Group. Med Pediatr Oncology 1994;23: 72-80.

2. Linchtenstein L. Histiocytosis X; integration of eosinophilic granulation of bone, Letterer-Siwe Disease and SchuellerChristian disease as related manifestations of a single nosologic entity. Arch Pathol 1953; 56-84.

3. Groopman J, Golde D. The histiocytic disorders; a pathophysiologic analysis. Ann Intern Med 1981; 94-95.

4. Gadner H, Grois N. Langerhans cell histiocytosis In: Voute PA, Kalifa C, Barre A, eds. Cancer in children, clinical management. SIOP 4th edition Oxford University Press, 1998:154-169.

5. Engeler RM,Neglia JP, Puccetti DM, Brennan CA, Nesbit ME. Association of Langerhans cell histiocytosis with malignant neoplasms. Cancer (1993);71: 865-873.

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¶ƒ∞∫∆π∫∂™ O¢∏°π∂™ ∆OÀ ¶∞π¢π∞∆ƒOÀ ™∆OÀ™ °O¡∂π™

TÔ ÂÓ‰ÔÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡ KÒÛÙ·˜ ¶Ú›ÊÙ˘ H ÊÚÔÓÙ›‰· ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡ ¤¯ÂÈ Í¯ˆÚÈÛÙ‹ ÛËÌ·Û›·. M¤Û· ÛÙÔ Û›ÙÈ ÂÚÓ¿ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÙÔ˘ 24ÒÚÔ˘ Î·È Â›Ó·È ÁÓˆÛÙfi fiÙÈ Û˘ÁÎÂÎÚÈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜ ÙÔ˘ ÂÓ‰ÔÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ˆ˜ ˘‡ı˘ÓÔÈ ÁÈ· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ·È‰ÈÎÒÓ ·ÏÏÂÚÁÈÒÓ.

O ·Ú¿ÁÔÓÙ·˜ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· Â›Ó·È Ô Î·Ófi˜ ÙÔ˘ ÙÛÈÁ¿ÚÔ˘. E›Ó·È ÁÓˆÛÙfi fiÙÈ ÁÈ· Ó· ÚÔÛٷهÛÔ˘Ì ٷ ·È‰È¿ ·fi ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Û οÔÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ Î·È Ó· ÂÏ·ÙÙÒÛÔ˘Ì ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÛıÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ, Ú¤ÂÈ ÔÈ ÂÓ‹ÏÈÎÔÈ Ó· ·‡ÛÔ˘Ì ӷ ηÓ›˙Ô˘ÌÂ. ¶Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Ë Î·‡ÛË Ì¤Û· ÛÙÔ ‰ˆÌ¿ÙÈÔ ÂÙÚÂÏ·›Ô˘, Î¿Ú‚Ô˘ÓÔ˘, ͇ÏÔ˘ Î·È ·Ú·Ê›Ó˘, ÁÈ·Ù› ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙË Û˘ÁΤÓÙÚˆÛË ÂÚÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ.

N· ·ÔʇÁÔÓÙ·È ÔÈ ˘ÁÚ·ÓÙ‹Ú˜ ÁÈ·Ù› ‰ËÌÈÔ˘ÚÁÔ‡Ó Û˘Óı‹Î˜ ¢ÓÔ˚Τ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·Î¿ÚÂˆÓ Î·È ÙˆÓ Ì˘Î‹ÙˆÓ. N· ·ÔʇÁÂÙ·È Â›Û˘ Ë ˘ÁÚ·Û›· ÛÙÔ˘˜ ÙÔ›¯Ô˘˜, Ù·‚¿ÓÈ·, ‰¿‰· Î·È Ó· Ï·Ì‚¿ÓÔÓÙ·È Ì¤ÙÚ· ÂÚÈÔÚÈÛÌÔ‡ Ù˘.

XÚÂÈ¿˙ÂÙ·È Î·Ïfi˜ ·ÂÚÈÛÌfi˜ ÙÔ˘ ÛÈÙÈÔ‡. H ·Ó·Ó¤ˆÛË ÙÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ·¤Ú· ÛÙ· ηÈÓÔ‡ÚÁÈ· ÎÙ›ÚÈ· Ô˘ ¤¯Ô˘Ó ηϋ ÌfiÓˆÛË Î·È ‰ÈÏ¿ ·Ú¿ı˘Ú· Â›Ó·È ÂÏÏÈ‹˜. T· Ê›ÏÙÚ· ·¤Ú· ÌÂÈÒÓÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ¿Ú· Î·È ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. OÈ ÈÔÓÈÛÙ¤˜ ›Ûˆ˜ ‚ÔËıÔ‡Ó, ·Ó Î·È ıˆÚÂ›Ù·È fiÙÈ ·˘Í¿ÓÔ˘Ó Ù· Â›‰· ÙÔ˘ fi˙ÔÓÙÔ˜ Ô˘ ÌÔÚ› Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ ÂÚÂıÈÛÙÈο. ™˘ÓÈÛÙ¿Ù·È Û¯ÔÏ·ÛÙÈÎfi˜ ·ÂÚÈÛÌfi˜ ÙˆÓ ÎÏÈÓÔÛÎÂ·ÛÌ¿ÙˆÓ ÂÂȉ‹ Ù· ·Î¿Ú· ˆ˜ ·ÚÈ· ÙÚÔÊ‹ ÙÔ˘˜ ¤¯Ô˘Ó ÙÔ ˘ÏÈÎfi Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ·ÔϤÈÛË Ù˘ ÂȉÂÚÌ›‰·˜ ÙˆÓ ·ÓıÚÒˆÓ. BÚ›ÛÎÔÓÙ·È Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ÂΛ Ô˘ Û˘ÁÎÂÓÙÚÒÓÂÙ·È ÛÎfiÓË. T· ¤ÈÏ· Ó· Â›Ó·È Ì ·Ϥ˜ ÁÚ·Ì̤˜, ¯ˆÚ›˜ ÔÏÏ¿ ·ÓÙÈΛÌÂÓ· Ô˘ Û˘ÁÎÚ·ÙÔ‡Ó ÛÎfiÓË. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÚÈÛÛfiÙÂÚÔ ˘ÁÈÂÈÓÒÓ Û˘ÓıËÎÒÓ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡, ÚÔÙ›ÓÔ˘Ì ÙȘ ·Ú·Î¿Ùˆ Ô‰ËÁ›Â˜: 1. ¢È·Îfi„Ù ÙÔ Î¿ÓÈÛÌ· Î·È ÌËÓ ÂÈÙÚ¤ÂÙ Û ¿ÏÏÔ˘˜ Ó· ηÓ›˙Ô˘Ó fiÙ·Ó ÂÈÛΤÙÔÓÙ·È ÙÔ Û›ÙÈ Û·˜.

2. EÍ·ÛÊ·Ï›ÛÙ Â·Ú΋ ·ÂÚÈÛÌfi ÙÔ˘ ÛÈÙÈÔ‡.

3. AÂÚ›˙ÂÙÂ Î·È ÏÈ¿˙ÂÙ ٷ ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù· ηıËÌÂÚÈÓ¿, ϤÓÂÙ¤ Ù· Ì η˘Ùfi ÓÂÚfi (>55ÔC) οı 7-10 Ë̤Ú˜.

4. MËÓ ¤¯ÂÙ ÔÏÏ¿ ·ÓÙÈΛÌÂÓ· ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡. •ÂÛÎÔÓ›˙ÂÙ ÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘ ηıËÌÂÚÈÓ¿ (Óˆfi ÍÂÛÎÔÓfi·ÓÔ). XÚËÛÈÌÔÔț٠ËÏÂÎÙÚÈ΋ ÛÎÔ‡· οı ‚‰ÔÌ¿‰· (Ó· Ï›ÂÈ ·fi ÙÔ Û›ÙÈ ÙÔ ·È‰›).

5. °È· ÙÔ ‰¿Â‰Ô Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ ÙÔ Í‡ÏÔ Î·È ÙÔ ϷοÎÈ. MËÓ ÙÔ Î·Ï‡ÙÂÙ Ì ÌÔΤٷ ·fi ÙÔ›¯Ô Û ÙÔ›¯Ô.

6. H ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ ηٿ ÙÔ˘˜ „˘¯ÚÔ‡˜ Ì‹Ó˜ Ó· Â›Ó·È Ì¤¯ÚÈ 18ÔC Î·È Ë Û¯ÂÙÈ΋ ˘ÁÚ·Û›· ̤¯ÚÈ 50% (ȉ·ÓÈ΋ 25-40%). ¢ÂÓ Û˘ÓÈÛÙÒÓÙ·È Ù· ·ÂÚfiıÂÚÌ·. K·Ï‡ÙÂÚ· Â›Ó·È Ù· ËÏÂÎÙÚÈο ÛÒÌ·Ù· Î·È Ù· ηÏÔÚÈʤÚ. ¶ÚÔÙÈÌ¿Ù·È Ë ÂÓ‰Ô‰·¤‰È· ı¤ÚÌ·ÓÛË.

7. MË ¯ÚËÛÈÌÔÔț٠˘ÁÚ·ÓÙ‹Ú·. EϤÁÍÙ ÙȘ ÛˆÏËÓÒÛÂȘ (Ì¿ÓÈÔ˘-ÎÔ˘˙›Ó·˜) ÁÈ· Ù˘¯fiÓ ‰È·ÚÚÔ¤˜.

MËÓ ¤¯ÂÙÂ Ê˘Ù¿ ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘ Ô˘ Û˘ÓÙËÚÔ‡Ó ˘ÁÚ·Û›·.

8. MËÓ ¤¯ÂÙ ˙Ò· (.¯. Á¿Ù·) ̤۷ ÛÙÔ Û›ÙÈ. AÓ ·˘Ùfi Â›Ó·È ·‰‡Ó·ÙÔÓ, ϤÓÂÙ¤ Ù· Û˘¯Ó¿.

AÔÌ·ÎÚ‡ÓÂÙ ٷ Ô˘Ô˘Ï¤ÓÈ· Ì·ÍÈÏ¿ÚÈ·.

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∂¶π™∆O§∂™ ∞ÁˆÁ‹ ˘Á›·˜ ™Î¤ÊÙËη fiÙÈ ÔÈ Û˘Ó¿‰ÂÏÊÔ› Ì·˜ ı· ‹ıÂÏ·Ó Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙËÓ ÚˆÙÔÔÚȷ΋ ̤ıÔ‰Ô ·ÁˆÁ‹˜ ˘Á›·˜ Ô˘ ÔÚÁ·ÓÒÓÂÈ ÙÔ EıÓÈÎfi ™‡ÛÙËÌ· YÁ›·˜ (NHS) ÛÙË BÚÂÙ·Ó›·.

MÈ· Ê›ÏË ÌÔ˘, Ô˘ Â›Ó·È ÔÈÎÔÁÂÓÂȷ΋ ÁÈ·ÙÚfi˜ ÛÙËÓ AÁÁÏ›·, ÌÔ˘ ¤ÛÙÂÈÏ ÙȘ ¢¯¤˜ Ù˘ ÁÈ· ÙË ÁÈÔÚÙ‹ ÌÔ˘ Û ηÚÙÔÛÙ¿Ï ÙÔ˘ NHS Ô˘ ÂÈÛ˘Ó¿ÙÂÙ·È.

H οÚÙ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔÓ "Î. AÓÙÈ‚ÈÔÙÈÎfi" Ó· ·ÚÓÂ›Ù·È Ó· Â¤Ì‚ÂÈ Û ̇ÙË Ô˘ ÛÙ¿˙ÂÈ. TÔ Ì‹Ó˘Ì· ÁÚ¿ÊÂÈ "T· ·ÓÙÈ‚ÈÔÙÈο ¢EN ¢OY§EYOYN ÛÙ· ÎÚ˘ÔÏÔÁ‹Ì·Ù·... Ô‡Ù ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‚‹¯· Î·È ÔÓfiÏ·ÈÌÔ˘. NHS". ™ÙÔ ›Ûˆ ̤ÚÔ˜, ÂΛ Ô˘ Ô ·ÔÛÙÔϤ·˜ ÁÚ¿ÊÂÈ ÙÔ Ì‹Ó˘Ì¿ ÙÔ˘, ÁÚ¿ÊÂÈ Ì ÈÔ ÌÈÎÚ¿ ÁÚ¿ÌÌ·Ù· "T· ÎÚ˘ÔÏÔÁ‹Ì·Ù· Î·È ÔÏϤ˜ ÊÔÚ¤˜ Ô ‚‹¯·˜ Î·È Ô ÔÓfiÏ·ÈÌÔ˜ ÔÊ›ÏÔÓÙ·È Û ÈÔ‡˜, Î·È Ù· ·ÓÙÈ‚ÈÔÙÈο ‰ÂÓ ‚ÔËıÔ‡Ó Î·ıfiÏÔ˘. T· ·ÓÙÈ‚ÈÔÙÈο ۯ‰ȿÛÙËÎ·Ó ÁÈ· ÙË ıÂÚ·›· ÙˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ fiˆ˜ Â›Ó·È Ë Ó¢ÌÔÓ›·. ŸÔÙ ¯ÚÂÈ·ÛÙÔ‡Ó, ÌËÓ ·ÓËÛ˘¯Â›˜, Ô ÁÈ·ÙÚfi˜ ÛÔ˘ ı· ÛÔ˘ ÁÚ¿„ÂÈ ÌÈ· Û˘ÓÙ·Á‹ ÁÈ· ·ÓÙÈ‚ÈÔÙÈο. °È· ÙÔÓ ·Ïfi ‚‹¯·, ÎÚ˘ÔÏfiÁËÌ· ‹ ÔÓfiÏ·ÈÌÔ fï˜, Ë Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ÔÏÏ¿ ˘ÁÚ¿ Î·È ÍÂÎÔ‡Ú·ÛË. K·È ÌË Í¯¿ÛÂȘ fiÙÈ ÌÔÚ›˜ Ó· ¿ÚÂȘ οÔÈ· ¿ÏÏ· Ê¿Ú̷η ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ Û˘Ìو̿وÓ. Z‹ÙËÛ ÙË Û˘Ì‚Ô˘Ï‹ ÙÔ˘ Ê·ÚÌ·ÎÔÔÈÔ‡. NHS". ™›Ó· N¿ÎÔ˘ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ª. ∞Û›·˜ 76, 115 27 ∞ı‹Ó·

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:65

¶ÔÈfi˜ ‰ÈηÈÔ‡Ù·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ Û˘ÁÁڷʤ·; ...MÈ· ·fi ÙȘ ÛΤ„ÂȘ Ô˘ ¤¯ˆ οÓÂÈ Â›Ó·È fiÙÈ ›Ûˆ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏËÊı› ÛÙȘ Ô‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Î¿ÔÈÔ˜ ÂÚÈÔÚÈÛÌfi˜ ÛÙÔÓ ·ÚÈıÌfi ÙÔ˘˜ .¯. fiÙÈ ı· ‹Ù·Ó ÂÈı˘ÌËÙfi Ó· ÌËÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ 6. E¿Ó Â›Ó·È ÂȂ‚ÏË̤ÓË Ë Û˘ÌÌÂÙÔ¯‹ ÂÚÈÛÛfiÙÂÚˆÓ, 8 Â›Ó·È ÓÔÌ›˙ˆ ¤Ó·˜ ÏÔÁÈÎfi˜ ·ÚÈıÌfi˜. ÿÛˆ˜ ı· ¤ÚÂ ӷ ·ÎÔÏÔ˘ı‹ÛÂÈ Î¿ÔÈÔ Û¯fiÏÈÔ ÁÈ·Ù› Î·È ÔÈfi˜ ı· ¤ÚÂ ӷ ÔÓÔÌ¿˙ÂÙ·È Û˘ÁÁڷʤ·˜.

Y¿Ú¯ÂÈ ·ÁÎÔÛÌ›ˆ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÁÈ· ÙÔ ÔÈÔ˜ Ú¤ÂÈ Ó· ¯·Ú·ÎÙËÚ›˙ÂÙ·È “Û˘ÁÁڷʤ·˜” Û ÌÈ· ÌÂϤÙË. E›Ó·È Ô fiÚÔ˜ Û˘Ó-Û˘ÁÁڷʤ·˜ ‹ Û˘Ó-ÂÚ¢ÓËÙ‹˜ ÈÔ ‰fiÎÈÌÔ˜; ∆È ÛËÌ·›ÓÂÈ Û˘ÌÌÂÙÔ¯‹ Û ÌÈ· ÌÂϤÙË; ™‡Ìʈӷ Ì ÙË ‰ÈÂıÓ‹ EÈÙÚÔ‹ EΉÔÙÒÓ I·ÙÚÈÎÒÓ ¶ÂÚÈÔ‰ÈÎÒÓ(1), ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ Û˘ÁÁڷʤ· ‰ÈηÈÔ‡ÓÙ·È fiÛÔÈ ÏËÚÔ‡Ó ÙȘ ·ÎfiÏÔ˘ı˜ ÚÔ¸Ôı¤ÛÂȘ: ·) Û‡ÏÏË„Ë Î·È Û¯Â‰È·ÛÌfi˜ ÌÂϤÙ˘ ‹ ·Ó¿Ï˘ÛË Î·È ÂÎÙ›ÌËÛË ‰Â‰ÔÌ¤ÓˆÓ ‚) ۯ‰ȷÛÌfi˜ Î·È ÎÚÈÙÈ΋ ·Ó·ÛÎfiËÛË ÙÔ˘ ¿ÚıÚÔ˘ ÁÈ· ÙËÓ Ô˘Û›· ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Á) ÙÂÏÈ΋ ÂȉÔÎÈÌ·Û›· ÙÔ˘ ¿ÚıÚÔ˘ ÁÈ· ‰ËÌÔÛ›Â˘ÛË. §fiÁÔÈ fiˆ˜ Ë “·Ó¿ÁÎË” ÁÈ· “‚Ô‹ıÂÈ·” ÂÓfi˜ Ó¤Ô˘ Û˘Ó·‰¤ÏÊÔ˘, ‹ Ë ·ÚÔ¯‹ ·ÛıÂÓÒÓ Î·È ÙˆÓ ÈÛÙÔÚÈÎÒÓ ÙÔ˘˜ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÛÙÔÓ Û¯Â‰È·ÛÌfi ‹ ÙËÓ ‰ÈÂÎÂÚ·›ˆÛË Ù˘ ÌÂϤÙ˘ ‰ÂÓ ‰ÈηÈÔÏÔÁÔ‡Ó Î·Ù¿ ÁÂÓÈ΋ ÔÌÔÏÔÁ›· ÙÔÓ ¯·Ú·ÎÙËÚÈÛÌfi ÙÔ˘ Û˘ÁÁڷʤ·. O Gulio J d’ Angio(2) ÂΉfiÙ˘ ÙÔ˘ Medical and Pediatric Oncology ÙÔ ¤ıÂÛ Ôχ ˆÚ·›· fiÙÈ ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô‰ËÁÔ‡Ó Û ۇÌʈÓÔ Û˘ÁÁڷʤˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Ó-Û˘ÁÁÚ·Ê›˜ Ó· ˘ÂÚ‚·›ÓÔ˘Ó Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙË ÌÂϤÙË ·ÛıÂÓÒÓ. O ›‰ÈÔ˜ ÂΉfiÙ˘ ηÏ› ÙÔ˘˜ ¢È¢ı˘ÓÙ¤˜ TÌËÌ¿ÙˆÓ Ó· ·Ó·ıˆڋÛÔ˘Ó ÙËÓ Ú·ÎÙÈ΋ Ù˘ ·Ó·ÊÔÚ¿˜ ÙÔ˘˜ Û·Ó Û˘Ó-Û˘ÁÁÚ·Ê›˜ fiÙ·Ó ·˘Ùfi Â›Ó·È ·fiÚÚÔÈ· Ù˘ ı¤Û˘ Î·È fi¯È Ù˘ Ô˘ÛÈ·ÛÙÈ΋˜ Û˘ÌÂÙÔ¯‹˜ ÙÔ˘˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi, ‰ÈÂÎÂÚ·›ˆÛË Î·È Û˘ÁÁÚ·Ê‹ Ù˘ ÌÂϤÙ˘. K·Ù·Ï‹ÁÂÈ ‰Â fiÙÈ Ô Û˘Ó-Û˘ÁÁڷʤ·˜ Ú¤ÂÈ Ó· Â›Ó·È Î·È Û˘Ó-ÂÚ¢ÓËÙ‹˜. E›Ó·È ηχÙÂÚ· Ó· ·ÔÊ¢¯ı› Ë ‰ËÌÈÔ˘ÚÁ›· Ù˘ ΢ÓÈ΋˜ ÓÔÔÙÚÔ›·˜ ÛÙÔ˘˜ Ó¤Ô˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÁÈ· “free rides” Ô˘ Û ÂχıÂÚË ÌÂÙ¿ÊÚ·ÛË ÛËÌ·›ÓÂÈ Û˘ÁÁڷʤ·˜ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈ΋ Û˘Ì‚ÔÏ‹.

M ÂÎÙ›ÌËÛË ™Ù¤ÏÏ· AÓ‰ÚÔÓ›ÎÔ˘ AÓ. K·ıËÁ‹ÙÚÈ· TÔ̤·˜ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¶·ÓÂÈÛÙ‹ÌÈÔ Iˆ·ÓÓ›ÓˆÓ T.£. 1186 45332 Iˆ¿ÓÓÈÓ·

1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. NEJM 1997;337:309-315.

2. D’ Angio G. J Multiple authorship (Editorial) Medical and Pediatric Oncology, 1998.

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¶∞π¢π∞∆ƒπ∫∏ E¡∏ª∂ƒø™∏ ¶AI¢IATPIKH - AÔÏÔÁÈÛÌfi˜ 1999

¶AI¢IATPIKH, 1998; ÙfiÌÔ˜ 61, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ 1.

K˘ÎÏÔÊfiÚËÛ ÙÔÓ M¿ÚÙÈÔ 1999 Ì 15 Ù›ÙÏÔ˘˜, 125 ÛÂÏ›‰Â˜ Î·È ıÂÌ·ÙÔÏÔÁ›· ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ™˘ÓÙ·ÎÙÈ΋ ÂÈ̤ÏÂÈ· X. KÒÛÙ·ÏÔ˜, K. ¶Ú›ÊÙ˘, A. X·Ù˙‹˜. ¶AI¢IATPIKH, 1999; ÙfiÌÔ˜ 62, T‡¯Ë 6.

- K˘ÎÏÔÊÔÚ›·: EÌÚfiıÂÛÌË. ™˘Ó‹ıˆ˜, Ù‡¯Ë ·Ú·‰›‰ÔÓÙ·È ÛÙ· ÁÚ·Ê›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ÙÔ ÚÒÙÔ ‰Âη‹ÌÂÚÔ ÙÔ˘ ‰ÈÌ‹ÓÔ˘ ÛÙÔ ÔÔ›Ô ·ÓÙÈÛÙÔȯ› ÙÔ Ù‡¯Ô˜ Î·È ·Ú·Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙÔ˘˜ Û˘Ó‰ÚÔÌËÙ¤˜ Ù·¯˘‰ÚÔÌÈο ÙÔ ÙÚ›ÙÔ ‰Âη‹ÌÂÚÔ.

- ™ÂÏ›‰Â˜: 510 - T›ÙÏÔÈ: 119 (54 ÚˆÙÔÁÂÓ›˜ ÂÚÁ·Û›Â˜) ¶›Ó·Î·˜ 1

¶›Ó·Î·˜ 1. AÚÈıÌfi˜ Î·È Â›‰Ô˜ ¿ÚıÚˆÓ Î·Ù¿ Ù‡¯Ô˜ (¶AI¢IATPIKH, TfiÌÔ˜ 62, 1999) E›‰Ô˜ ¿ÚıÚÔ˘

AÚÈıÌfi˜ Ù›ÙÏˆÓ T‡¯Ë

™‡ÓÔÏÔ ÙfiÌÔ˘ 1Ô

2Ô

3Ô

4Ô

5Ô

6Ô

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19

2

4

2

4

4

3

AÓ·ÛÎÔ‹ÛÂȘ/ÕÚıÚ· ÂȉÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜/ ™˘Ó¯È˙fiÌÂÓË ÂÎ·›‰Â˘ÛË/ E›Î·ÈÚ· ı¤Ì·Ù·

21

4

2

4

4

2

5

EÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜/ KÏÈÓÈ΋ ÂÌÂÈÚ›·

30

5

4

4

4

6

7

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

18

5

5

3

3

2

-

AÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ

6

1

1

1

1

1

1

¶Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜ ·È‰È¿ÙÚÔ˘ ÛÙÔ˘˜ ÁÔÓ›˜

7

1

2

1

1

1

1

EÈÛÙÔϤ˜

8

2

-

2

1

2

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10

1

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3

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119

21

19

20

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19

19

¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË ÕÏÏ· ™‡ÓÔÏÔ

ŒÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ‰ËÌÔÛȇÔÓÙ·È ¿ÚıÚ· Ì ÙÔ ›‰ÈÔ ı¤Ì· ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜. Afi 105 ΛÌÂÓ· Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÙÔ 1999, Ù· 36 ‹Ù·Ó ηÙfiÈÓ ÚÔÛÎÏ‹Ûˆ˜ ›Ù ÁÈ· Ó· Û¯ÔÏÈ·ÛÙ› οÔÈ· ÂÚÁ·Û›· (K¿ÓÈÛÌ·, ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ 6Ô Ù‡¯Ô˜, AÈÌÔÚ·ÁÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ 1Ô, AÏÏÂÚÁ›· ·fi Ê˘ÛÈÎfi Ï¿ÛÙÈ¯Ô ÛÙÔ 2Ô Î.¿.) ›Ù ÁÈ· Ó· Î·Ï˘Êı› ¤Ó· Â›Î·ÈÚÔ ı¤Ì· (¶·È‰È¿ ÙÔ˘ ÔϤÌÔ˘, ·È‰È¿ ·ÏÏÔ‰·ÒÓ ÚÔÛʇÁˆÓ ÛÙËÓ EÏÏ¿‰·, ‰ÈÔ͛Ә ÛÙÔ 4Ô Ù‡¯Ô˜. N· ÌË Ì¿ıÔ˘Ì ӷ ˙ԇ̠·ıËÙÈο Ì ÙÔ˘˜ ÛÂÈÛÌÔ‡˜ ÛÙÔ 5Ô Î.¿.).

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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË

- ™˘ÁÁÚ·Ê›˜: 258, ÔÈ 52 Ì 2-7 Ù›ÙÏÔ˘˜. EÙ¿ ·fi ÙȘ 30 ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 6 Û˘ÁÁÚ·Ê›˜ Î·È 8 ÛÙȘ 18 ÂÚÈÁڷʤ˜ ÂÚÈÙÒÛÂˆÓ ˘ÔÁÚ¿ÊÔÓÙ·È ·fi ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 5 Û˘ÁÁÚ·Ê›˜.(‚Ϥ ÂÈÛÙÔÏ‹ ÛÂÏ. 65 Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜).

- M¤ÛÔ˜ ¯ÚfiÓÔ˜ ·¿ÓÙËÛ˘ ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙȘ ÚÔÙÂÈÓfiÌÂÓ˜ ‰ÈÔÚıÒÛÂȘ: 38 Ë̤Ú˜.

- BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜: 1807, ·fi ·˘Ù¤˜ 35 ÛÙËÓ ¶AI¢IATPIKH Î·È 162 Û ¿ÏÏ· ÂÏÏËÓÈο ÂÚÈÔ‰Èο. ™ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È ÁÈ· ÙÔ˘˜ ÎÚÈÙ¤˜ Ë ¶AI¢IATPIKH ‰ËÏÒÓÂÈ fiÙÈ ‰˘ÛÎÔχÂÙ·È Ó· ‰Â¯ı› ÂÚÁ·Û›Â˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÏÏËÓÈΤ˜ ·Ú·ÔÌ¤˜. H ÊÚ¿ÛË “ÂÎ Ù˘ ÚÔÛÈÙ‹˜ ÚÔ˜ ËÌ¿˜ ‚È‚ÏÈÔÁÚ·Ê›·˜” ηٷÚÁ‹ıËΠÁÈ· ÙËÓ Í¤ÓË ‚È‚ÏÈÔÁÚ·Ê›· ·fi ÙfiÙ Ô˘ ˘¿Ú¯ÂÈ Â‡ÎÔÏË ÚfiÛ‚·ÛË ÛÙÔ Medline. TÒÚ· Â›Ó·È ÚÔÛÈÙ‹ ηٿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ Î·È Ë ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ̤ۈ IATPOTEK (www.mednet.gr/iatrotek) Î·È ÔÈ ÂÏÏËÓÈΤ˜ ‰ËÌÔÛȇÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ ̤ۈ “IPI™” (www.ich.gr). BϤ ÛÂÏ. 86 Î·È ÛÂÏ.

71. H ¤ÏÏÂÈ„Ë ÂÏÏËÓÈÎÒÓ ·Ó·ÊÔÚÒÓ ‰ÂÓ ÌÔÚ› È· Ó· ‰ÈηÈÔÏÔÁÂ›Ù·È ˆ˜ ·‰˘Ó·Ì›·. X·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÚÈÊÚfiÓËÛË ÚÔËÁÔ‡ÌÂÓÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ Ô˘ ‰ÂÓ Ú¤ÂÈ Ô ·È‰È·ÙÚÈÎfi˜ ÎfiÛÌÔ˜ Ó· ÙËÓ ÂÈÙÚ¤ÂÈ.

- M¤ÛÔ˜ ¯ÚfiÓÔ˜ ·fi ÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜ ̤¯ÚÈ ÙËÓ ¤ÁÎÚÈÛË/·fiÚÚÈ„Ë: 5 Ì‹Ó˜.

- XÚfiÓÔ˜ ·fi ÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜ ̤¯ÚÈ ÙË ‰ËÌÔÛ›Â˘ÛË: M¤ÛÔ˜ ¯ÚfiÓÔ˜ 8,26 Ì‹Ó˜, 25% ÙˆÓ ¿ÚıÚˆÓ ‰ËÌÔÛȇÙËÎ·Ó Û ÏÈÁfiÙÂÚÔ ·fi 6 Ì‹Ó˜, 50% Û 6 ̤¯ÚÈ 10 Ì‹Ó˜ Î·È 25% Û ÂÚÈÛÛfiÙÂÚÔ ·fi 10 Ì‹Ó˜.

- KÚÈÙ¤˜: ™ÙÔ ‰È¿ÛÙËÌ· 1-1-1999 ̤¯ÚÈ 15-12-1999 Ë ¶AI¢IATPIKH ˙‹ÙËÛ 147 ÎÚ›ÛÂȘ ·fi 81 ÎÚÈÙ¤˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ 11 ÌÂÏÒÓ Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ (35 ÎÚÈÙ¤˜ ÚfiÛÊÂÚ·Ó 2-6 ÎÚ›ÛÂȘ). BϤ ÔÓÔÌ·ÛÙÈÎfi ηٿÏÔÁÔ ÛÂÏ. 68 Î·È Û¯ÂÙÈÎfi ¿ÚıÚÔ Û‡ÓÙ·Í˘ ÛÂÏ. 2-6.

OÈ ÎÚ›ÛÂȘ ÂÈÛÙÚ¿ÊËÎ·Ó ÛÙËÓ ¶AI¢IATPIKH 5-138 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘˜.

AÓ·Ï˘ÙÈο ÂÈÛÙÚ¿ÊËηÓ: 38% Û ÏÈÁfiÙÂÚÔ ·fi 30 Ë̤Ú˜, 26% Û 30-60, 21% Û 61-90, 15% Û ÂÚÈÛÛfiÙÂÚÔ ·fi 90 Ë̤Ú˜.

K·Ù¿ ÂÚ›ÙˆÛË ÌÂϤÙË ÙˆÓ ÎÚ›ÛÂˆÓ Ô˘ ηı˘ÛÙ¤ÚËÛ·Ó ¤Ú·Ó ÙˆÓ ÙÚÈÒÓ ÌËÓÒÓ, ·ÔηχÙÂÈ ÛÂ Û˘ÓÙÚÈÙÈÎfi ÔÛÔÛÙfi ‰˘ÛÎÔÏ›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÎÚÈÙÒÓ Ó· ‰È·Ù˘ÒÛÔ˘Ó ·ÔÚÚÈÙÈΤ˜ ÎÚ›ÛÂȘ ‹ ÚÔÛ¿ıÂÈ· Ó· ÛÎÂÊÙÔ‡Ó ÙÚfiÔ˘˜ ÚÈ˙È΋˜ ·Ó·ÌfiÚʈÛ˘ Ù˘ ˘fi ÎÚ›ÛË ÂÚÁ·Û›·˜ ÒÛÙ ӷ Á›ÓÂÈ ‰ËÌÔÛȇÛÈÌË. OÈ ÎÚÈÙ¤˜ Ô˘ ηı˘ÛÙÂÚÔ‡Ó ÙȘ ÎÚ›ÛÂȘ ÂÎ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·‰ÈηÈÔÏfiÁËÙ· Â›Ó·È ÂÏ¿¯ÈÛÙÔÈ.

- KÚ›ÛÂȘ: OÈ ÂÈ̤ÚÔ˘˜ ÎÚ›ÛÂȘ ¤ÁÈÓ·Ó ·Ô‰ÂÎÙ¤˜ Û ÔÛÔÛÙfi 80%. H ÔÚıfiÙËÙ· ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ ÙˆÓ ÎÚÈÙÒÓ Î·È ÙÔ ÂÊÈÎÙfi ÙˆÓ ˙ËÙÔ‡ÌÂÓˆÓ ÙÚÔÔÔÈ‹ÛÂˆÓ ·ÌÊÈÛ‚ËÙ‹ıËΠ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 20% Î·È 25%, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙÂÎÌËÚȈ̤ӷ. H ÂÁ΢ÚfiÙËÙ· ÙˆÓ ÎÚÈÙÒÓ ·ÌÊÈÛ‚ËÙ‹ıËΠ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ‰‡Ô ÂÚÈÙÒÛÂȘ.

- EÚÁ·Û›Â˜ Ô˘ ·ÔÚÚ›ÊıËηÓ/·ÔÛ‡ÚıËηÓ: 8 H ·fiÚÚÈ„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÂÎÙfi˜ ÂÏ¿¯ÈÛÙˆÓ ÂÍ·ÈÚ¤ÛˆÓ, ‰ÂÓ ÔÊ›ÏÂÙ·È Û ¯·ÌËÏ‹ ÔÈfiÙËÙ· Ù˘ ÂÚÁ·Û›·˜ ·ÏÏ¿ Û ·Ù˘¯Â›˜ Û˘ÁÎ˘Ú›Â˜ .¯. ·Ó·ÛÎfiËÛË ˘„ËÏfiÙ·ÙÔ˘ ÂÈ¤‰Ô˘ ‰ÂÓ ¤ÁÈÓ ‰ÂÎÙ‹ ÁÈ·Ù› ¤Êı·Û ÛÙ· ÁÚ·Ê›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÂÓÒ Â›¯Â ‹‰Ë ÂÁÎÚÈı› ÌÂÙ¿ ·fi ÔÏϤ˜ ÙÚÔÔÔÈ‹ÛÂȘ ¿ÏÏË ·Ó·ÛÎfiËÛË ÛÙÔ ›‰ÈÔ ı¤Ì·.

- EΉÔÙÈο Ï¿ıË/·ÚÔÚ¿Ì·Ù·: ™Â ÙÚ›· Ù‡¯Ë ¤ÁÈÓ·Ó ÛÔ‚·Ú¿ ÂΉÔÙÈο Ï¿ıË (Ï¿ıÔ˜ ÎÂÊ·Ï›‰· Û ÂÚÁ·Û›·, ÌË ‰ËÌÔÛ›Â˘ÛË ÈÓ¿ÎˆÓ Î·È ÂÈÎfiÓ·˜, ÌË ‰ËÌÔÛ›Â˘ÛË ıÂÌ·ÙÈÎÔ‡ ηٷÏfiÁÔ˘ ÙÔ˘ Û˘ÌÏËڈ̷ÙÈÎÔ‡ Ù‡¯Ô˘˜ ÙÔ˘ 1998).

T· Ï¿ıË Û ¿ÏÏ· Ù‡¯Ë ‹Ù·Ó ÌÈÎÚfiÙÂÚ˘ ÛËÌ·Û›·˜.

- ™˘ÓÂÚÁ·Û›· Ì E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.: AÚÌÔÓÈ΋

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- °Ú·ÌÌ·ÙÂȷ΋ ˘ÔÛÙ‹ÚÈÍË: Õ„ÔÁË. H ΢ڛ· PԇϷ ¢¿Ó·ÛË Ù‹ÚËÛ ÌÂ Û˘Ó¤ÂÈ·, Û¯ÔÏ·ÛÙÈÎfiÙËÙ·, ˘ÔÌÔÓ‹ Î·È ÂÈÌÔÓ‹, ÙÔ ·Ú¯Â›Ô ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÙÔ˘˜ ʷΤÏÔ˘˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÙËÓ ·ÏÏËÏÔÁÚ·Ê›·, “ÛÙ¿ÛË ÙÛÈÌÔ˘ÚÈÔ‡” Ì ÙÔ˘˜ ÎÚÈÙ¤˜ Ô˘ ηı˘ÛÙÂÚÔ‡Ó, “ÛÙ¿ÛË K¤Ú‚ÂÚÔ˘” Ì ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ Ô˘ ·Ó·Î·ÙÂ‡Ô˘Ó ÙÔ˘˜ ʷΤÏÏÔ˘˜ Î·È ÛÙ¿ÛË “¢OMH™” Ì fiÛÔ˘˜ ı¤ÙÔ˘Ó ÔÔÈÔ‰‹ÔÙ ÂÚÒÙËÌ· (fiÙ ı· Á˘Ú›ÛÂÈ Ô X ÎÚÈÙ‹˜ ·fi ÙÔ Û˘Ó¤‰ÚÈÔ,ÔÈÔ˜ ¤ÎÚÈÓ ÙÈ, fiÙÂ Î·È ÁÈ·Ù› ηı˘ÛÙ¤ÚËÛÂ, ÔÈÔ ÙÔ ÌÈÎÚfi fiÓÔÌ· ÙÔ˘ Û˘ÁÁڷʤ· æ, Û ÔÈÔ ÓÔÛÔÎÔÌÂ›Ô ÂÚÁ¿˙ÂÙ·È ÙÒÚ· Ë Î˘Ú›· Xæ ÎÏ ÎÏ.).

- ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ T· ̤ÏË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ÌÔÈÚ¿ÛÙËÎ·Ó ÙÔ Û˘ÓÙ·ÎÙÈÎfi ¤ÚÁÔ. ™˘ÌÌÂÙ›¯·Ó ÛÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÙˆÓ Ù¢¯ÒÓ, ÛÙËÓ ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÛÙËÓ ÂÈÏÔÁ‹ ıÂÌ¿ÙˆÓ, Û˘ÁÁڷʤˆÓ Î·È ÎÚÈÙÒÓ, ÛÙȘ ·ÔÊ¿ÛÂȘ ÁÈ· ÙËÓ ÌÔÚÊ‹ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÛÙË ‰È·ÌfiÚʈÛË ÂÛˆÙÂÚÈÎÔ‡ ηÓÔÓÈÛÌÔ‡ ÏÂÈÙÔ˘ÚÁ›·˜, Ô‰ËÁÈÒÓ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ. AÊÈ¤ÚˆÛ·Ó ÛÙËÓ ¶AI¢IATPIKH ¯ÚfiÓÔ ·Ô‰ÔÙÈÎfi Î·È Ôχ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙȘ 12 ÙÚ›ˆÚ˜ Û˘Ó‰ÚÈ¿ÛÂȘ Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜.

18.12.1999 EϤÓË B·Ï¿ÛÛË-A‰¿Ì ¢È¢ı˘ÓÙ‹˜ Ù˘ E.™.E.

Κριτές 1999 Aθανασιάδου-Πιπεροπούλου Φανή Aθανασίου-Mεταξά Mιράντα Aϊβάζης Bίκτωρας Aναγνωστάκης ∆ηµήτριος Aναστασέα-Bλάχου Kαλλιόπη Aνδρονίκου Στυλιανή Aντύπας Σπύρος Aντωνιάδου-Kουµάτου Iωάννα Aρώνη-Bουρνά Σοφία Bαλάσση-Aδάµ Eλένη Bατόπουλος Aλκιβιάδης Bοσκάκη-Bούλγαρη Eιρήνη Γαλανάκης Eµµανουήλ Γιαννούλια-Kαραντανά Aγλαΐα Γιουρούκος Σωτήριος Γκατζόλα Mάγδα Γυφτοδήµου-Kαράγιωργα Γιολάντα ∆ελλαγραµµάτικας Hρακλής ∆ρόσου-Aγακίδου Bασιλική Zέης Πέτρος Zερβός Γεράσιµος Θεοδωρίδης Xαράλαµπος Kαβαζαράκης Eµµανουήλ Kαλπογιάννης Nικόλαος Kαράγιωργα-Λαγανά Mαρκησία Kαραµπούλα Aικατερίνη Kαρανίκας Hλίας

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Kαρής Xρίστος Kαρπάθιος Θεµιστοκλής Kασσιού-Προύντζου Kυριακή Kατσαρού-Πεκτασίδη Eυσταθία Kαττάµης Xρήστος Kαφάτος Aντώνης Kίτσιου-Tζέλη Σοφία Kοντόπουλος Eλευθέριος Kοσµίδη-Bασιλάτου Eλένη Λαµπαδαρίδης Iωάννης Mαθιουδάκης Iωάννης Mανταγός Στέφανος Mανωλάκη Nίνα Mιχελακάκη Eλένη Mπαζίγου-Φωτοπούλου Eλένη Mπαζοπούλου Eυτέρπη Mπαρτσόκας Xρήστος Mπένος Aλέξανδρος Mπλάκµπερν-Nάκου Σίνα Nούσια-Aρβανιτάκη Σάντα Ξάνθου Mαριέτα Παναγιωτόπουλος Tάκης Παπαβασιλείου Στάθης Παπαγρηγορίου-Θεοδωρίδου Mαρία Παπαδάτου ∆ανάη Παπαδηµητρίου Aναστάσιος Παπαδοπούλου Φρειδερίκη

Παπαχατζή-Kαλµαντή Mαρία Παπαχρήστου Φώτιος Πετρίδου-Σκαλκίδου Eλένη Pούσσου Eιρήνη Pώµα-Γιαννίκου Eλευθερία Σαξώνη-Παπαγεωργίου Φωτεινή Σαραφίδου Γιασεµή Σκαρδούτσου Aγγελική Σκεντέρης Nίκος Σούλπη Kλεοπάτρα Σπηλιώτη-Γκρέκα Bασιλική Σπυρίδης Παναγιώτης Σταµογιάννου-Mαυροειδή Λέλα Στεφανίδης Kωνσταντίνος Συρίγου-Παπαβασιλείου Aντιγόνη Συριοπούλου Bασιλική Συρογιαννόπουλος Γεώργιος Tούντας Iωάννης Tσαγκαροπούλου-Στίγγα Hρακλεία Tσανίρα Eιρήνη Tσίτουρα Στέλλα Tσόλας Γεώργιος Φρετζάγιας Aνδρέας Xαροκόπος Eυστάθιος Xατζηµιχάλης Σωκράτης Ψύχου-Kόρκα Φωτεινή

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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË

EÈÛÎfiËÛË EÏÏËÓÈÎÔ‡ I·ÙÚÈÎÔ‡ ¶ÂÚÈÔ‰ÈÎÔ‡ T‡Ô˘ 1999 ÁÈ· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ ηٷÏÔÁÔÁÚ·ÊÔ‡ÓÙ·È ·fi ÙÔ ÂÈÙÂÏÂ›Ô ÙÔ˘ IÓÛÙÈÙÔ‡ÙÔ˘ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÙË ‚¿ÛË IPI™ (IPI™ B¿ÛË EÏÏËÓÈ΋˜ BÈ‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡, ¶AI¢IATPIKH 1999,62:247 Î·È 2000,63:71-74). ŸÔÈÔ˜ ÂӉȷʤÚÂÙ·È ÁÈ· ÙË Û¯ÂÙÈ΋ EÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂÈÎÔÛ·ÂÙ›·˜, ÌÔÚ› Ó· οÓÂÈ ıÂÌ·ÙÈ΋ ·Ó·˙‹ÙËÛË Ì ϤÍÂȘ ÎÏÂȉȿ Î·È ·Ó·˙‹ÙËÛË Û˘ÁÁڷʤˆÓ, ›Ù ÂÈÎÔÈÓˆÓfiÓÙ·˜ Ì ÙÔ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÙËÏÂʈÓÈο (01-7719733), Ì fax (01-7700111), e-mail (inchildh@otenet.gr) ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ‹ ·¢ı›·˜ ̤۷ ·fi ÙÔ ‰È·‰›ÎÙ˘Ô (www.ich.gr). °È· Ó· ¤¯Ô˘Ó ÔÈ ·Ó·ÁÓÒÛÙ˜ Ù˘ ¶AI¢IATPIKH™ ÌÈ· ÁÂÓÈÎfiÙÂÚË ÂÔÙ›· Ù˘ ·È‰È·ÙÚÈ΋˜ Û˘ÁÁÚ·ÊÈ΋˜ ·Ú·ÁˆÁ‹˜ ·Ú·ı¤ÙÔ˘Ì ÂÓËÌÂÚˆÙÈο ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ÂÈÛËÌ¿ÓıËÎ·Ó ÛÙ· Ù‡¯Ë ÙˆÓ ·Ú·Î¿Ùˆ ÂÚÈÔ‰ÈÎÒÓ Ô˘ ›¯·Ó ΢ÎÏÔÊÔÚ‹ÛÂÈ Ì¤¯ÚÈ 20 ¢ÂÎÂÌ‚Ú›Ô˘ 1999.

I·ÙÚÈ΋, IÔ‡ÏÈÔ˜ 1999 Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜, M¿ÈÔ˜-IÔ‡ÓÈÔ˜ 1999, EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›·, AÚ›ÏÈÔ˜-IÔ‡ÓÈÔ˜ 1999 M·È¢ÙÈο XÚÔÓÈο, IÔ‡ÏÈÔ˜-™Â٤̂ÚÈÔ˜ 1999 °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘, I·Ó-IÔ‡ÓÈÔ˜ 1999 ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜, I·Ó-ºÂ‚Ú-M¿ÚÙÈÔ˜ 1999, ¢ÂÏÙ›Ô A’ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, AÚ›ÏÈÔ˜ -IÔ‡ÓÈÔ˜ 1999, ¶·È‰Ô‰ÔÓÙ›·, AÚ›ÏÈÔ˜ - IÔ‡ÓÈÔ˜ 1999.

YÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙ· ·Ú·¿Óˆ ÂÚÈÔ‰Èο ‰ËÌÔÛȇÔÓÙ·È ÂÙËÛ›ˆ˜ ÂÚ›Ô˘ 100 ¿ÚıÚ· Ô˘ ÂӉȷʤÚÔ˘Ó ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜. A˘Ù¿, Ì·˙› Ì ÙȘ ÂÚ›Ô˘ 100 ‰ËÌÔÛȇÛÂȘ ÛÙËÓ ¶AI¢IATPIKH ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÚ›Ô˘ 80% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Ó·ÊÔÚÒÓ ÛÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡, ÛÙÔÓ ÂÏÏËÓÈÎfi ‚ÈÔ˚·ÙÚÈÎfi ÂÚÈÔ‰ÈÎfi Ù‡Ô. ™Ù· Ù‡¯Ë ÙˆÓ ·Ú·¿Óˆ ÂÚÈÔ‰ÈÎÒÓ ÂÈÛËÌ¿Ó·Ì 48 ¿ÚıÚ· Û¯ÂÙÈο Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡. (29 Û ·È‰È·ÙÚÈο ÂÚÈÔ‰Èο Î·È 19 Û ¿ÏÏ·).

EÚÁ·Û›Â˜ (13) - ¢ËÏËÙËÚÈ¿ÛÂȘ ·fi ‰‹ÁÌ·Ù· ÊȉÈÒÓ ÛÙËÓ EÏÏ¿‰·. K ºÔ˘ÓÙ¿˜, ¶ BÏ¿¯Ô˜, H B·ÏÙ‹, E T˙ÒÏ·, E Z·ÊÂÈÚ›Ô˘. I·ÙÚÈ΋ 1999;75: 503-507.

- A˘ÍË̤ӷ Â›‰· ‰ÂÈÎÙÒÓ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ º K·Ó·ÎÔ‡‰Ë-T۷ηϛ‰Ô˘, M. Aı·Ó·Û›Ô˘MÂÙ·Í¿, B. T˙ÈÌÔ‡ÏË, A. KÔ‡ÛË, A. T·¿ÚÎÔ˘, M TÚ·¯·Ó¿, I TÛ¿ÙÚ·. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:147-153.

- ¶·ÓÂÏÏ·‰È΋ ÌÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. T ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜, E B·Ï¿ÛÛË-A‰¿Ì, E ™·Ú·Ê›‰Ô˘, A M·Ó‰¤ÎË, Z ™ÙÚ·Ù›ÎË, A M¤ÓÔ˜, ¢ A‰·Ì›‰Ë˜, A KÔ‡Ù˘, X §ÈÔÓ‹˜.

Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:154-162.

- ¢ÈÂÚ‡ÓËÛË Ù˘ οıÂÙ˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ C. ° º·ÚÌ¿ÎË, B ¶··Â˘·ÁÁ¤ÏÔ˘, E K·‰¿, ° ¶··Â˘·ÁÁ¤ÏÔ˘. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:249-252.

- AÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË ÌËÙÚÈ΋ ΢ÎÏÔÊÔÚ›· Ì ̷ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi, ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ¯ÚÒÛË Î·È FISH. A M·‡ÚÔ˘, A KÔÏȷϤÍË, ° TÛ·ÁοÚ˘, A AÓÙÛ·ÎÏ‹˜, E ¢·Ê¤ÚÌÔ˘, X TÛÂÁ΋, A MÂٷ͈ÙÔ‡. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:40-48.

- °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔ Ê·ÈÓfiÙ˘Ô. ™ K›ÙÛÈÔ˘, E K·‚·˙·Ú¿Î˘, A TÛ¤-

˙Ô˘, A °·ÏÏ¿, ¢ °Ô˘ÚÁÈÒÙ˘, X £ÂÔ‰ˆÚ›‰Ë˜, X X·Ù˙Ëı·Ó·Û›Ô˘, X K·Ú‹˜, º ¶·ÙÛ·Ï‹˜, K ™ÈÛÌ¿ÓË, A ¶·Û·Ï¿ÎË, N MÔÛ¯ÔÓ¿˜. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:49-54.

- EÈÔÏ·ÛÌfi˜ ÙÂÚˉfiÓ·˜ Î·È ·Ó¿ÁΘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÂÚ›ı·Ï„˘ ·È‰ÈÒÓ ËÏÈΛ·˜ -12 ÂÙÒÓ ÛÙËÓ ·Ó·ÙÔÏÈ΋ Â·Ú¯›· £Ë‚ÒÓ ÙÔ˘ ÓÔÌÔ‡ BÔȈٛ·˜. I º·Ó‰Ú›‰Ë˜, ¢ ¢ÂÏ‚ÂÓ·ÎÈÒÙ˘ ¶·È‰Ô‰ÔÓÙ›· 1999;13:55-63.

- ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Û ·È‰È¿ ·fi ÙËÓ E˘ÚÒË Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙËÓ KÚ‹ÙË. E °·Ï·Ó¿Î˘, E ¶·Ú·Ûο΢, ™ MÔ˘ÎÔ˘‚·Ú¿Î˘, N K·Ù˙ËÏ¿Î˘, ™ ™Ì˘Ú¿ÎȘ. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999; 11: 28-31.

- EȉËÌ›· ÈÏ·Ú¿˜ 1996: EÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ. X °È·ÓÓ·ÎÔÔ‡ÏÔ˘, X MfiÚ·, ¢ N·ÌÔÓÈÙÔ‡, B KÔ˘ÎÔ‡, § §È¿Ë, O °Ú·Ê¿ÎÔ˘, ¢ °Ô˘ÚÁÈÒÙ˘, ¢ AÏÂ͛Ԣ. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:32-36.

- A˘ÙfiÌ·ÙË ‰È¿ÙÚËÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÛÙ· ÓÂÔÁÓ¿. ¢ AÓ·ÁÓˆÛÙfiÔ˘ÏÔ˜, • ™ÈÓˆ›‰Ë˜, K T˙È·Ì›Ú˘, M KÔÎÎfiÏË, X º·ÚÌ¿Î˘, X ¢ËÌfiÔ˘ÏÔ˜. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11: 37-39.

- MÂϤÙË Ù˘ Ó·ÓÈ΋˜ ¯ÚfiÓÈ·˜ ·ÚıÚ›Ùȉ·˜ Û ŒÏÏËÓ˜. X ¢Ú¿ÎÔ˘, N KˆÛÙ·ÓÙÈÓ›‰Ô˘, A KˆÛÙ·ÓÙfiÔ˘ÏÔ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:78-83.

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¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ (9) - MËÙÚÈ΋ Î·È Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË. ¶ T·Ì·ÎÔ‡‰Ë˜, º T˙‚ÂϤ΢, K PÒÛÈÔ˘, I K·Ï·¯¿Ó˘, ¶ MÈ˙›Ì˘, E AÓ·ÁÓÒÛÙÔ˘, ¶ ¶ÏÈ¿ÎË, E KÔÏ·Í›‰Ô˘, A AÓ‰Ú¤Ô˘, ™ M·ÓÙ·ÏÂÓ¿Î˘. EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1999;11(2)197-202.

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AÓ·ÛÎÔ‹ÛÂȘ-EÈÛËÁ‹ÛÂȘ- EÓËÌÂÚˆÙÈο ¿ÚıÚ· ÕÚıÚ· ™‡ÓÙ·Í˘ (26) - AÒÙÂÚÔÈ Î›Ó‰˘ÓÔÈ ·fi ÙÔÓ ÚfiˆÚÔ ÙÔÎÂÙfi. ¢ PÔ‡ÛÛÔ˜, ¢ ¶·Ó›‰Ë˜, M M·ÌfiÔ˘ÏÔ˜. EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1999; 11(2) 148-154.

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I·ÙÚÈ΋ 1999;75:(2):290-297.

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- H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÌ·ÙÈÎÔ‡ ·È‰ÈÔ‡ ÛÙÔ Ô‰ÔÓÙÈ·ÙÚ›Ô. E TÛ·ÁηÚÔ˘Ï¿ÎË, A MfiÚÊË. ¶·È‰Ô‰ÔÓÙ›· 1999;13:64-70.

- º˘Ì·ÙÈ҉˘ ÌfiÏ˘ÓÛË Î·È ÓfiÛÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· M EÌÔÚÈ¿‰Ô˘, K X·˚‰ÔÔ‡ÏÔ˘. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999; 11:15-24.

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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË

IPI™-Online: B¿ÛË ÂÏÏËÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ http://www.ich.gr ¶·Ó·ÁÈÒÙ˘ A. KÔÎÎÈÓ›‰Ë˜ To IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (IY¶) ¤¯ÂÈ ‹‰Ë ·fi ÙÔ 1979 Û˘ÁÎÚÔÙ‹ÛÂÈ ÙËÓ ‚¿ÛË ÂÏÏËÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡. H ‚¿ÛË ·˘Ù‹ ÂÌÏÔ˘Ù›˙ÂÙ·È Û˘Ó¯Ҙ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ÁÈ· ÙȘ ÂÏÏËÓÈΤ˜ ‰ËÌÔÛȇÛÂȘ Û ÂÚÈÔ‰Èο Î·È Û˘Ó¤‰ÚÈ·.

Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2000 Ë ‚¿ÛË ‰È·Ù›ıÂÙ·È on-line ÛÙÔÓ ·ÁÎfiÛÌÈÔ ÈÛÙfi (WWW) ÙÔ˘ Internet, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ÚfiÛ‚·ÛË Û ·˘Ù‹Ó Û ÔÔÈÔÓ‰‹ÔÙ ¯Ú‹ÛÙË ¤¯ÂÈ ÚfiÛ‚·ÛË ÛÙÔ Internet. OÈ ¯Ú‹ÛÙ˜ ÌÔÚÔ‡Ó Ó· οÓÔ˘Ó online ·Ó·˙ËÙ‹ÛÂȘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·˜ ‰È¿ÊÔÚ· ÎÚÈÙ‹ÚÈ· Î·È ÂÚÈÔÚÈÛÌÔ‡˜ Î·È Ó· ‰Ô˘Ó ÙȘ ÂÚÈÏ‹„ÂȘ ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ Ô˘ ‚Ú¤ıËηÓ. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È Ë ÊfiÚÌ· ·Ó·˙‹ÙËÛ˘, ÛÙËÓ ÔÔ›· Ô ¯Ú‹ÛÙ˘ ÚÔÛ‰ÈÔÚ›˙ÂÈ Ù· ÎÚÈÙ‹ÚÈ· Î·È ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·Ó·˙‹ÙËÛ˘.

∂ÈÎfiÓ· 1.

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OÈ fiÚÔÈ ·Ó·˙‹ÙËÛ˘ ÌÔÚ› Ó· Â›Ó·È ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ. EÎÙfi˜ ·fi ÙËÓ ·Ú¿ıÂÛË ÙˆÓ fiÚˆÓ, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Î·È ÔÚÈṲ̂ÓÔ˘˜ ηÓfiÓ˜ ÁÈ· ÙËÓ ÏÔÁÈ΋ Ù˘ ·Ó·˙‹ÙËÛ˘. OÈ Î·ÓfiÓ˜ ·˘ÙÔ› ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiÙ·Ó ÔÈ fiÚÔÈ ·Ó·˙‹ÙËÛ˘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ÙÔ˘ ÂÓfi˜. EÍ' ÔÚÈÛÌÔ‡ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔÈ fiÚÔÈ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙË ÏÔÁÈ΋ ‰È¿˙¢ÍË (OR). E¿Ó ÌÚÔÛÙ¿ ·fi ÙÔÓ fiÚÔ ÙÔÔıÂÙËı› ÙÔ Û‡Ì‚ÔÏÔ +, ÙfiÙÂ Ô fiÚÔ˜ Á›ÓÂÙ·È ˘Ô¯ÚˆÙÈÎfi˜. AÓÙ›ıÂÙ· Â¿Ó ÌÚÔÛÙ¿ ·fi ÙÔÓ fiÚÔ ÚÔÛÙÂı› ÙÔ Û‡Ì‚ÔÏÔ -, Ô fiÚÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· ÂÚȤ¯ÂÙ·È ÛÙȘ ÂÁÁڷʤ˜ Ô˘ ı· ‚ÚÂıÔ‡Ó. °È· Ó· ÚÔÛ‰ÈÔÚÈÛıÔ‡Ó Û‡ÓıÂÙÔÈ fiÚÔÈ, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ‰ÈÏ¿ ÂÈÛ·ÁˆÁÈο. ™ÙÔÓ ›Ó·Î· 1 ‰›ÓÔÓÙ·È ·Ú·‰Â›ÁÌ·Ù· Î·È ÂÂÍËÁ‹ÛÂȘ ÁÈ· ÙË ¯Ú‹ÛË ÙˆÓ Û˘Ì‚fiψÓ.

¶›Ó·Î·˜ 1. ŸÚÔÈ ·Ó·˙‹ÙËÛ˘

AÔÙ¤ÏÂÛÌ· ·Ó·˙‹ÙËÛ˘

ÈÏ·Ú¿ ÂÚ˘ıÚ¿

ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" Î·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÂÚ˘ıÚ¿" (ÏÔÁÈÎfi OR) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" (ÚÒÙ˜ ÛÙ· ·ÔÙÂϤÛÌ·Ù· fiÛ˜ ·fi ·˘Ù¤˜ ¤¯Ô˘Ó Î·È ÙÔÓ fiÚÔ ÂÚ˘ıÚ¿) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" Î·È ÙÔÓ fiÚÔ "ÂÚ˘ıÚ¿" (ÏÔÁÈÎfi AND) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" ÂÎÙfi˜ ·fi ·˘Ù¤˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÂÚ˘ıÚ¿" (ÏÔÁÈÎfi NOT) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "·ıÔÏÔÁÈ΋" Î·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "·Ó·ÙÔÌÈ΋" ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "·ıÔÏÔÁÈ΋ ·Ó·ÙÔÌÈ΋"

+ÈÏ·Ú¿ ÂÚ˘ıÚ¿ +ÈÏ·Ú¿ +ÂÚ˘ıÚ¿ ÈÏ·Ú¿ -ÂÚ˘ıÚ¿ ·ıÔÏÔÁÈ΋ ·Ó·ÙÔÌÈ΋ "·ıÔÏÔÁÈ΋ ·Ó·ÙÔÌÈ΋"

§fiÁˆ ÙˆÓ ÁÚ·ÌÌ·ÙÈÎÒÓ Î·ÓfiÓˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ· Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛıÔ‡Ó fiÚÔÈ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ¿ÏÏË ÙÒÛË ·fi ·˘Ù‹Ó Ô˘ ¯ÚËÛÈÌÔÔÈ› Ô ¯Ú‹ÛÙ˘ (Û˘Ó‹ıˆ˜ ÙËÓ ÔÓÔÌ·ÛÙÈ΋). °È· ÙÔ ÏfiÁÔ ·˘Ùfi Û˘Ó›ÛÙ·Ù·È Ë ¯Ú‹ÛË Ù˘ Ú›˙·˜ ÙÔ˘ ·Ó·˙ËÙÔ‡ÌÂÓÔ˘ fiÚÔ˘ ¤ÙÛÈ ÒÛÙ ӷ ÌÂÁÈÛÙÔÔÈËı› Ë ÂÈÙ˘¯›· Ù˘ ·Ó·˙‹ÙËÛ˘. ¶.¯. ·ÓÙ› ÙÔ˘ fiÚÔ˘ "ÂÌ‚ÔÏÈ·ÛÌfi˜" ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Ô fiÚÔ˜ "ÂÌ‚ÔÏÈ", fiÔÙ ÛÙ· ·ÔÙÂϤÛÌ·Ù· ı· Û˘ÌÂÚÈÏËÊıÔ‡Ó Î·È ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔ˘˜ fiÚÔ˘˜ ÂÌ‚fiÏÈÔ, ÂÌ‚ÔÏ›ˆÓ, Î.Ï.

EÎÙfi˜ ·fi ÙÔ˘˜ fiÚÔ˘˜ ·Ó·˙‹ÙËÛ˘ Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÌÈ· ÛÂÈÚ¿ ·fi ÂÚÈÔÚÈÛÌÔ‡˜. ¶ÚÒÙÔ˜ ÂÚÈÔÚÈÛÌfi˜ Â›Ó·È Ë ÂÚÈÔ¯‹ ·Ó·˙‹ÙËÛ˘. EÍ' ÔÚÈÛÌÔ‡ Ë ·Ó·˙‹ÙËÛË ÙˆÓ fiÚˆÓ Á›ÓÂÙ·È ÛÙÔÓ Ù›ÙÏÔ Î·È ÙȘ ϤÍÂȘ-ÎÏÂȉȿ ÙˆÓ ÂÁÁÚ·ÊÒÓ. EÓ·ÏÏ·ÎÙÈο Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· οÓÂÈ ÙËÓ ·Ó·˙‹ÙËÛË ÙÔ˘ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‹/Î·È ÛÙËÓ ÂÚ›ÏË„Ë ÙˆÓ ÂÁÁÚ·ÊÒÓ. H ·Ó·˙‹ÙËÛË ÙˆÓ fiÚˆÓ ÛÙËÓ ÂÚ›ÏË„Ë Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ¯ÚÔÓÔ‚fiÚ·.

EÈϤÔÓ Ë ·Ó·˙‹ÙËÛË ÌÔÚ› Ó· ÂÚÈÔÚÈÛı› Û ¤Ó· ÌfiÓÔ ·fi Ù· ÂÚÈÔ‰Èο Ô˘ ηٷÏÔÁÔÁÚ·ÊÔ‡ÓÙ·È ÛÙË ‚¿ÛË. A˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÂÈϤÁÔÓÙ·˜ ÙÔÓ Ù›ÙÏÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ·fi ÙÔÓ Î·Ù¿ÏÔÁÔ. TÚ›ÙÔ˜ ÂÚÈÔÚÈÛÌfi˜ Â›Ó·È ÙÔ ¤ÙÔ˜ ‰ËÌÔÛ›Â˘Û˘. O ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ ÂÚ›Ô‰Ô Ô˘ ÙÔÓ ÂӉȷʤÚÂÈ, ÂÈÛ¿ÁÔÓÙ·˜ Ù· ¤ÙË ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ı¤ÛÂȘ Ù˘ ÊfiÚÌ·˜. T¤ÏÔ˜, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ fiÛ˜ ÂÁÁڷʤ˜ ı· ÂÌÊ·Ó›˙ÔÓÙ·È ·Ó¿ ÛÂÏ›‰· ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ.

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∂ÈÎfiÓ· 2.

™ÙËÓ ÂÈÎfiÓ· 2 Ê·›ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ·Ó·˙‹ÙËÛ˘. °È· οı ÂÁÁÚ·Ê‹ Ô˘ ÈηÓÔÔÈ› Ù· ÎÚÈÙ‹ÚÈ· ·Ó·˙‹ÙËÛ˘ ‰›ÓÂÙ·È Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÊÔÚ¿. O ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ‰ÂÈ ÌÈ· ÂÚ›ÏË„Ë Î¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÙÔÓ Ù›ÙÏÔ Ù˘ ÂÁÁÚ·Ê‹˜. EÓ·ÏÏ·ÎÙÈο ÌÔÚ› Ó· ÂÈϤÍÂÈ ÌÈ· ÛÂÈÚ¿ ·fi ÂÁÁڷʤ˜ οÓÔÓÙ·˜ ÎÏÈÎ ÌÚÔÛÙ¿ ·fi ÙÔÓ Ù›ÙÏÔ Î·È ·ÎÔÏÔ‡ıˆ˜ Ó· ·Ù‹ÛÂÈ ÙÔ ÎÔ˘Ì› "EÌÊ¿ÓÈÛË ÂÈÏÂÁ̤ӈÓ". TÔ ÎÔ˘Ì› "EfiÌÂÓ˜ 20" ÂÌÊ·Ó›˙ÂÈ ÙȘ ÂfiÌÂÓ˜ ÂÁÁڷʤ˜ Ô˘ ÈηÓÔÔÈÔ‡Ó ÙÔ˘˜ fiÚÔ˘˜ ·Ó·˙‹ÙËÛ˘. T¤ÏÔ˜, ÙÔ ÎÔ˘Ì› "N¤· ·Ó·˙‹ÙËÛË" ÂÌÊ·Ó›˙ÂÈ ÙË ÊfiÚÌ· ·Ó·˙‹ÙËÛ˘.

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∂ÈÎfiÓ· 3.

™ÙËÓ ÂÈÎfiÓ· 3 Ê·›ÓÂÙ·È ÌÈ· Ï‹Ú˘ ÂÁÁÚ·Ê‹ Ô˘ ÚԤ΢„ ·fi ·Ó·˙‹ÙËÛË. K·Ù¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ Û‡Ó‰ÂÛÌÔÈ (links) Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È ÔÈ Ï¤ÍÂȘ-ÎÏÂȉȿ. K¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÙÔ fiÓÔÌ· ÂÓfi˜ Û˘ÁÁڷʤ·, ÂÌÊ·Ó›˙ÔÓÙ·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ Û˘ÁÁڷʤ· ·˘ÙfiÓ, ÂÓÒ Î¿ÓÔÓÙ·˜ ÎÏÈÎ Û ÌÈ· ϤÍË-ÎÏÂȉ›, ÂÌÊ·Ó›˙ÔÓÙ·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙË Ï¤ÍË-ÎÏÂȉ›.

H ÂÎÙ‡ˆÛË ÙfiÛÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ fiÛÔ Î·È ÙˆÓ ÂÚÈÏ‹„ÂˆÓ Á›ÓÂÙ·È Ì¤Ûˆ ÙÔ˘ ÏÔÁÈÛÌÈÎÔ‡ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÚÔ‚ÔÏ‹ ÛÂÏ›‰ˆÓ (browser).

TÔ ÂÚȯfiÌÂÓÔ Ù˘ ‚¿Û˘ IPI™-Online ÂÓËÌÂÚÒÓÂÙ·È Ù·ÎÙÈο ·fi ÙÔ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Î·È ÙË ‰È·Û‡Ó‰ÂÛË Ì ÙÔ ¯Ú‹ÛÙË, ı· Á›ÓÔÓÙ·È ‚ÂÏÙÈÒÛÂȘ ¤ÙÛÈ ÒÛÙ ӷ ·ÔÙÂϤÛÂÈ ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ÎfiÛÌÔ ÂÓÙfi˜ Î·È ÂÎÙfi˜ EÏÏ¿‰·˜.

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O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜

™Â ·˘Ùfi ÙÔ Ù‡¯Ô˜ 2000,63:(1) ‰ËÌÔÛȇÔÓÙ·È Û˘ÌÏËڈ̷ÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜. OÈ Ô‰ËÁ›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘Ú›ˆ˜ ÙȘ ÚԉȷÁڷʤ˜/ ··ÈÙ‹ÛÂȘ Ô˘ ¤¯Ô˘Ó ÔÚÈÛÙ› ·fi ÙÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÍÂÓfiÁψÛÛˆÓ ‚ÈÔ˚·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ (Uniform Requirements for Manuscripts Submitted to Biomedical Journals 1997). EÈÛËÌ·›ÓÂÙ·È fiÙÈ Ë ¶AI¢IATPIKH ˙ËÙ¿ ÂÈϤÔÓ ·fi ÙÔ˘˜ ŒÏÏËÓ˜ Û˘ÁÁÚ·Ê›˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È ÂÏÏËÓÈΤ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜.

¶·ÚÔÚ¿Ì·Ù· 1- ™ÙÔ ¿ÚıÚÔ Û‡ÓÙ·Í˘ Ù˘ ™. N¿ÎÔ˘ "¶ÂÚÈ‚·ÏÏÔÓÙÈÎfi˜ ηÓfi˜ ÙÛÈÁ¿ÚˆÓ. ŒÓ· Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜" ¶AI¢IATPIKH 1999,62:415, Ë ÛÂÈÚ¿ 2 Ú¤ÂÈ Ó· ‰È·‚·ÛÙ›: (TÛfiÏ·˜ Î·È TÛ·ÁÚ‹˜, ÛÂÏ 437-446, TÛfiÏ·˜ Î·È TÛ·ÁÚ‹˜, ÛÂÏ 447-449, K·Ú·Ù˙¿, B·Ú‚·Ú‹ÁÔ˘, XÚÈÛÙÔÊ›‰Ô˘, B·ÛÈÏ¿ÎÔ˜, TÛ·¿ÓÔ˜, KÔ˘ÚÔ‡Ó˘ Î·È MÂÚ¿Ù˘ ÛÂÏ 457-463) 2- ™ÙËÓ ÂÚÁ·Û›· ÙˆÓ ¢. K·ÙÚÈÔ‡, º. Aı·Ó·ÛÈ¿‰Ô˘, X. AÁÁÔ˘Úȉ¿ÎË, £. ¶··ÁˆÚÁ›Ô˘, B. TÛ·‚‰·Ú›‰Ô˘, M. X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ "E›‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, sICAM-1 sVCAM-1 Û ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ" ¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85, ÂÎ ·Ú·‰ÚÔÌ‹˜ ‰ÂÓ ÂÚÈÏ‹ÊıËÎ·Ó Ù· Û¯‹Ì·Ù· Î·È Ô ›Ó·Î·˜ Ô˘ ÙË Û˘Ófi‰Â˘·Ó. ™ÙȘ ÛÂÏ›‰Â˜ 80-85 ‰ËÌÔÛȇÂÙ·È Ë Ï‹Ú˘ ÂÚÁ·Û›·. ∏ ÂÚÁ·Û›· ı· ηٷÏÔÁÔÁÚ·ÊËı› Ì ٷ ÛÙÔȯ›· ¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85. ∞˘Ù¿ Ù· ÛÙÔȯ›· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙȘ ·Ó·ÊÔÚ¤˜.

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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË

A¡∞∫O⁄ºπ™∏ ∆OÀ ¶O¡OÀ ™∆∞ ¶∞π¢πÕ ª∂ ∫∞ƒ∫ÿ¡O

ŸÏ· ۯ‰fiÓ Ù· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ηÚΛÓÔ ¤¯Ô˘Ó ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ fiÓÔ˘. ¶ÂÚÈÛÛfiÙÂÚ· ·fi 70% ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Û οÔÈ· Ê¿ÛË, ı· ˘ÔʤÚÔ˘Ó ·fi ÛÔ‚·Úfi fiÓÔ.

H ÁÓÒÛË Î·È Ë Ù¯ÓÔÏÔÁ›· ˘¿Ú¯Ô˘Ó ÁÈ· Ó· ıÂÚ·Â‡Ô˘Ó ·˘ÙfiÓ ÙÔÓ fiÓÔ.

K·Ó¤Ó· ·È‰› ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘ÔʤÚÂÈ ·fi ÛÔ‚·Úfi ‹ ·Ú·ÙÂÈÓfiÌÂÓÔ fiÓÔ.

AÚ¯¤˜ Ù˘ ¶OY ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ 1. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ·Ú¯›˙ÂÈ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ı· ‰È·ÁÓˆÛı› Ô Î·ÚΛÓÔ˜ Û ¤Ó· ·È‰› Î·È Û˘Ó¯›˙ÂÙ·È Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÚÚÒÛÙÈ·˜.

2. O ηÚΛÓÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Â›Ó·È ÔχÏÔÎÔ˜ Î·È ··ÈÙ› ‰ÈÂÈÛÙËÌÔÓÈ΋ ÚÔÛ¤ÁÁÈÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ ÙÔ Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÔÈ ÛÙ¿ÛÂȘ Î·È ÔÈ Û˘ÌÂÚÈÊÔÚ¤˜ ÌÔÚ› Ó· ·˘Í‹ÛÔ˘Ó ÛËÌ·ÓÙÈο ‹ Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ fiÓÔ ÙÔ˘ ·È‰ÈÔ‡.

3. H ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙË ¯Ú‹ÛË ·Ó·ÏÁËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙÈÏËÙÈΤ˜, Û˘ÌÂÚÈÊÔÚÈΤ˜, ۈ̷ÙÈΤ˜ Î·È ˘ÔÛÙËÚÈÎÙÈΤ˜ Ú·ÎÙÈΤ˜ ıÂÚ·›˜. ¶ÔÏϤ˜ ·fi ·˘Ù¤˜ ÙȘ ıÂÚ·›˜ ÌÔÚÔ‡Ó Ó· ·Ú¤¯ÔÓÙ·È ·fi ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜.

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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË

4. ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ Ô˘ ÚÔÛʤÚÂÙ·È, ı· Ú¤ÂÈ Ó· ηıÔÚÈÛÙ› Î·È Ó· ıÂÚ·¢Ù› Ë ˘ÔΛÌÂÓË ·ÈÙ›· ÙÔ˘ fiÙ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ.

5. °È· Ù· ·È‰È¿ Ô˘ ·›ÚÓÔ˘Ó ıÂÚ·›·, Û˘¯Ó¿ Ô fiÓÔ˜ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Î·È ıÂÚ·¢ÙÈÎÒÓ Ú¿ÍÂˆÓ Â›Ó·È ¯ÂÈÚfiÙÂÚÔ˜ ·fi ·˘ÙfiÓ Ù˘ ·ÚÚÒÛÙÈ·˜. O fiÓÔ˜ Ô˘ ÚÔηÏÂ›Ù·È ·fi ·˘Ù¤˜ ÙȘ Ú¿ÍÂȘ ı· Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Î·È Ó· ıÂÚ·‡ÂÙ·È ‰Ú·ÛÙÈο.

6. H "Îϛ̷η ·Ó·ÏÁËÛ›·˜" Ù˘ ¶OY ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÂÈÏÔÁ‹ Ê·ÚÌ¿ÎˆÓ Ô˘ ·Ó·ÎÔ˘Ê›˙Ô˘Ó ÙÔÓ fiÓÔ. ™Â ·˘Ù‹ ÙËÓ ÎÏÈ̷Έً ÚÔÛ¤ÁÁÈÛË, ηıÔÚ›˙ÂÙ·È Ë ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ fiÓÔ˘ ÙÔ˘ ·È‰ÈÔ‡, Ô Ù‡Ô˜ Î·È Ë ‰fiÛË ÙÔ˘ ·Ó·ÏÁËÙÈÎÔ‡.

7. E·ÚΛ˜ ·Ó·ÏÁËÙÈΤ˜ ‰fiÛÂȘ ı· Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È Û ٷÎÙ¿ ‰È·ÛÙ‹Ì·Ù· - "Ì ÙÔ ÚÔÏfiÈ" Î·È fi¯È "fiÙ·Ó ¯ÚÂÈ·ÛÙ›".

8. T· ·Ó·ÏÁËÙÈο, fiÔ˘ Â›Ó·È ‰˘Ó·Ùfi, Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È ·fi ÙÔ ÛÙfiÌ·.

9. H ηٿÏÏËÏË ‰fiÛË ÂÓfi˜ ÔÔÈÔ‡¯Ô˘ Â›Ó·È ÂΛÓË Ô˘ ·Ó·ÎÔ˘Ê›˙ÂÈ ÙÔÓ fiÓÔ ·ÔÙÂÏÂÛÌ·ÙÈο. T· ·È‰È¿ ÌÔÚ› Ó· ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚ· ÌÂÁ¿Ï˜ ‰fiÛÂȘ ÁÈ· Ó· ·Ó·ÎÔ˘ÊÈÛÙÔ‡Ó.

10. ŒÓ·˜ ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÏfiÁÔ˘˜ Ô˘ Ù· ·È‰È¿ Ì ÛÔ‚·Úfi fiÓÔ ÏfiÁˆ ηÚΛÓÔ˘ ‰ÂÓ ·›ÚÓÔ˘Ó Â·Ú΋ ·Ó·ÏÁËÛ›·, Â›Ó·È Ô Êfi‚Ô˜ Ù˘ "ÂÍ¿ÚÙËÛ˘" ·fi Ù· ÔÔÈÔ‡¯·. A˘Ùfi˜ Ô Êfi‚Ô˜ Ô˘ ¤¯ÂÈ ˘ÂÚ‚ÔÏÈο ÌÂÁ·ÏÔÔÈËı›, ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› Î·È Ó· ̤ÓÂÈ Û ۈÛÙ¿ ̤ÙÚ·.

11. OÈ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ÔÈÔ‡¯ˆÓ ı· Ú¤ÂÈ Ó· ÚԂϤÔÓÙ·È, Ó· ıÂÚ·‡ÔÓÙ·È ‰Ú·ÛÙÈο Î·È Ó· ÂÎÙÈÌÒÓÙ·È Ù·ÎÙÈο.

12. ŸÙ·Ó ÌÂÈÒÓÔÓÙ·È ‹ ‰È·ÎfiÙÔÓÙ·È Ù· ÔÔÈÔ‡¯·, ÔÈ ‰fiÛÂȘ Ú¤ÂÈ Ó· ÌÂÈÒÓÔÓÙ·È ‚·ıÌÈ·›· ÒÛÙ ӷ ·ÔÊ¢¯ı› ÛÔ‚·Ú‹ ·fiÙÔÌË ˘ÔÙÚÔ‹ ÙÔ˘ fiÓÔ˘ ‹ Û˘ÌÙÒÌ·Ù· ÛÙ¤ÚËÛ˘.

13. AÓ Î·È Ë Î·Ù·ÓfiËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ ·fi Ù· ·È‰È¿ ·ÏÏ¿˙ÂÈ ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÙÔ˘˜ ÛÙ¿‰ÈÔ, Û˘¯Ó¿ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÚfiÎÂÈÙ·È Ó· Âı¿ÓÔ˘Ó. O Êfi‚Ô˜ Ù˘ ÂÁηٿÏÂȄ˘ Î·È Ô Êfi‚Ô˜ fiÙÈ ı· ˘ÔʤÚÔ˘Ó Â›Ó·È ÔÈ Î‡ÚȘ ·ÓËÛ˘¯›Â˜ ÙˆÓ ·È‰ÈÒÓ Î¿ı ËÏÈΛ·˜ Ì ·ÚÚÒÛÙÈ· Ô˘ Ô‰ËÁ› ÛÙÔÓ ı¿Ó·ÙÔ. °È' ·˘Ùfi ÙÔÓ ÏfiÁÔ, ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ı· Ú¤ÂÈ Ó· ÙÔÓ›˙Ô˘Ó Û ·˘Ù¿ Ù· ·È‰È¿ fiÙÈ ı· ÙÔ˘˜ ÚÔÛÊÂÚı› ·Ó·ÎÔ‡ÊÈÛË Î·È fiÙÈ Ù· ·Á·Ë̤ӷ ÙÔ˘˜ ÚfiÛˆ· ı· Â›Ó·È ‰È·ÚÎÒ˜ ‰›Ï· ÙÔ˘˜.

14. H ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ıÂÚ·›· ı· Ú¤ÂÈ Ó· Â›Ó·È ÛÊ·ÈÚÈ΋ Î·È Ó· Ï·Ì‚¿ÓÂÈ ˘fi„Ë ÙȘ „˘¯ÔÏÔÁÈΤ˜, ÔÏÈÙÈÛÙÈΤ˜ Î·È ÓÂ˘Ì·ÙÈΤ˜ ·Ó¿ÁΘ. E¿Ó ÂΉËψı› Û¯ÂÙÈ΋ ÂÈı˘Ì›·, ı· Ú¤ÂÈ ·˘Ù‹ Ë ıÂÚ·›· Ó· ÚÔÛʤÚÂÙ·È ÛÙÔ Û›ÙÈ.

15. E›Ó·È ¢ı‡ÓË Î¿ı Â·ÁÁÂÏÌ·Ù›· ˘Á›·˜, οı ȉڇ̷ÙÔ˜ Î·È Î¿ı ΢‚ÂÚÓËÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ¤¯ÂÈ ÙË ÊÚÔÓÙ›‰· Ù¤ÙÔÈˆÓ ·È‰ÈÒÓ, Ó· ˘ÔÛÙËÚ›ÍÂÈ, Ó· ÂÎ·È‰Â‡ÛÂÈ Î·È Ó· Û˘ÓËÁÔÚ‹ÛÂÈ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ·Ú¯ÒÓ.

EΉfiÛÂȘ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ YÁ›·˜ A˘Ù¤˜ ÔÈ ·Ú¯¤˜ ¤¯Ô˘Ó ÏËÊı› ·fi ÙÔ ‚È‚Ï›Ô "Cancer Pain Relief and Palliative Care in Children" Ô˘ ÂΉfiıËΠ·fi ÙËÓ ¶OY ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙË ¢ÈÂıÓ‹ EÙ·ÈÚ›· MÂϤÙ˘ ¶fiÓÔ˘. ¢È‡ı˘ÓÛË ÁÈ· ·Ú·ÁÁÂϛ˜: bookorders@who.ch

Afi‰ÔÛË ÛÙ· ÂÏÏËÓÈο ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·

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BÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

ŒÎ‰ÔÛË ÛÙ· Ï·›ÛÈ· ŒÚÁÔ˘ Ì ٛÙÏÔ: "E˘·ÈÛıËÙÔÔ›ËÛË Î·È Î·Ù¿ÚÙÈÛË Â·ÁÁÂÏÌ·ÙÈÒÓ ·È‰Â›·˜ Î·È ˘Á›·˜, ÛÙËÓ ˘ÔÛÙ‹ÚÈÍË ·È‰ÈÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ·ÚÚÒÛÙÈ· Î·È ı¿Ó·ÙÔ ÛÙË ˙ˆ‹ ÙÔ˘˜" (E¶EAEK-EÓ¤ÚÁÂÈ· 1.1.Z.2)

Œ¯ÂÈ ÂÚ¿ÛÂÈ Î·ÈÚfi˜ Ô˘ Ë ÂÍ‹ÁËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ Û ¤Ó· ·È‰› ·ÔÙÂÏÔ‡Û ٷÌÔ‡ Î·È Ô˘ ıˆÚ›ÙÔ fiÙÈ Ô ı¿Ó·ÙÔ˜ ı· ÂÍ·Ê·ÓÈÛÙ› Ì·ÁÈο ·Ó ‰ÂÓ Û˘˙ËÙËı›.

TÒÚ· fiÏÔÈ ·Ó·ÁÓˆÚ›˙Ô˘Ì fiÙÈ Ô ı¿Ó·ÙÔ˜ Â›Ó·È ÌÈ· ·ÁÎfiÛÌÈ· Î·È ·Ó·fiÊ¢ÎÙË ‰È·‰Èηۛ· Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó fiϘ ÔÈ ËÏÈ˘ Î·È fiÙÈ Ë Î·Ï‹ „˘¯È΋ ˘Á›· ÂÍ·ÚÙ¿Ù·È fi¯È ·fi ÙËÓ ¿ÚÓËÛË ÙÔ˘ ıÚ‹ÓÔ˘, ·ÏÏ¿ ·fi ÙËÓ ÂÈÏÈÎÚÈÓ‹ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÂÒ‰˘ÓÔ˘ ·Ô¯ˆÚÈÛÌÔ‡. ŒÓ· ·fi Ù· ÈÔ ‰‡ÛÎÔÏ· ¤ÚÁ· Î·È Î·ı‹ÎÔÓÙ· ÙˆÓ ÂÓËÏ›ÎˆÓ (ÁÔÓÈÒÓ, ‰·ÛÎ¿ÏˆÓ Î·È Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜) Â›Ó·È Ë Û˘˙‹ÙËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ Ì ¤Ó· ·È‰› Ô˘ ¤¯·Û οÔÈÔ ·Á·Ë̤ÓÔ ÙÔ˘ ÚfiÛˆÔ. ™˘¯Ó¿ ·Ó·ÚˆÙÈÔ‡ÓÙ·È ÔÈ· Â›Ó·È Ë Î·Ù·ÓfiËÛË ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙÔÓ ı¿Ó·ÙÔ, Ò˜ ıÚËÓÔ‡Ó, ÔȘ Â›Ó·È ÔÈ ·Ó¿ÁΘ ÙÔ˘˜, Ò˜ ÌÔÚÔ‡Ó Ó· Ù· ÂÓËÌÂÚÒÛÔ˘Ó, Ò˜ ı· ÂÓı·ÚÚ‡ÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ÙÔ˘˜, Ò˜ ı· ÚÔˆı‹ÛÔ˘Ó ÙË ÛÙ·ıÂÚfiÙËÙ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜, fiÙ ı· Ú¤ÂÈ Ó· ·ÓËÛ˘¯‹ÛÔ˘Ó, M ÛÎÔfi Ó· ··ÓÙ‹ÛÂÈ Û fiÏ· ·˘Ù¿ Ù· ÂÚˆÙ‹Ì·Ù· Î·È Ó· ‚ÔËı‹ÛÂÈ ·˘ÙÔ‡˜ Ô˘ ı· ÛÙËÚ›ÍÔ˘Ó ÙÔ ·È‰›, ¤¯ÂÈ ÂΉÔı› ¤Ó· ηÏfiÁÔ˘ÛÙÔ Ê˘ÏÏ¿‰ÈÔ Ì ٛÙÏÔ "™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ¶·È‰› Ô˘ £ÚËÓ› ÙÔ £¿Ó·ÙÔ AÁ·Ë̤ÓÔ˘ ÙÔ˘ ¶ÚÔÛÒÔ˘". Œ¯ÂÈ ÁÚ·ÊÙ› ·fi ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÙÔ˘ ™˘Ì‚Ô˘Ï¢ÙÈÎÔ‡ K¤ÓÙÚÔ˘ Ù˘ MEPIMNA™, ¢·Ó¿Ë ¶··‰¿ÙÔ˘, EÈÚ‹ÓË M·Ì·ÓÙ¿ÎË, EÈÚ‹ÓË ¶·¿˙ÔÁÏÔ˘, EÏ¢ıÂÚ›· P¿ÏÏË Î·È M˘ÚÙÒ N›ÏÛÂÓ. ¢È·Ó¤ÌÂÙ·È ‰ˆÚÂ¿Ó ·fi Ù· ÁÚ·Ê›· Ù˘ MEPIMNA™, TÈÌÔϤÔÓÙÔ˜ B¿ÛÛÔ˘ 16, ¶Ï·Ù›· M·‚›ÏË, 11521 Aı‹Ó·. TËÏ. 6452013 Î·È 6463367. ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·

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E›‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, sICAM-1 Î·È sVCAM-1 Û ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ¢ˆÚÔı¤· K·ÙÚÈÔ‡1, º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘1, XÚÈÛÙ›Ó· AÁÁÔ˘Úȉ¿ÎË2, £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘1, B·ÛÈÏÈ΋ TÛ·‚‰·Ú›‰Ô˘2, M·Ú›· X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1. ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂϤÙË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ (sICAM1 Î·È sVCAM-1) ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ, Û ۯ¤ÛË Ì ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘. H ÌÂϤÙË ÂÚÈÏ¿Ì‚·Ó 8 ·È‰È¿ Ì ™E§ ËÏÈΛ·˜ 18 ÌËÓÒÓ ¤ˆ˜ 14 ¯ÚfiÓˆÓ (ÔÌ¿‰· A) Î·È 16 ˘ÁÈ‹ ·È‰È¿ (ÔÌ¿‰· B) Ù˘ ›‰È·˜ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ì ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ A. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· Â›‰· ÛÙÔÓ ÔÚfi: ÙˆÓ sIL2R, ÙˆÓ CIC, Ù˘ CRP, ÙˆÓ C3 Î·È C4 Î·È ÙˆÓ sICAM-1 Î·È sVCAM-1 ηıÒ˜ Â›Û˘ Î·È Ë TKE. OÈ ·Ú¿ÌÂÙÚÔÈ ·˘ÙÔ› ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·Ó¿ Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È ÛÙȘ ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘. H ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ ÙˆÓ ·ÛıÂÓÒÓ, Î˘Ì¿ÓıËΠ·fi 5 Ì‹Ó˜ ̤¯ÚÈ 4 ¯ÚfiÓÈ·. AÔÙÂϤÛÌ·Ù·: T· Â›‰· ÙˆÓ sICAM-1 Î·È sVCAM-1 ÛÙËÓ ÔÌ¿‰· A, ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÚÔ˘Û›·Û·Ó ‰È·Î˘Ì¿ÓÛÂȘ 368,2-994,8 ng/mL (̤ÛË ÙÈÌ‹ 599,3±96,3 ng/mL), Î·È 2154,4-2972,2 ng/mL (̤ÛË ÙÈÌ‹ 2559,2±378,7 ng/mL), ·ÓÙ›ÛÙÔȯ·, ¤Ó·ÓÙÈ ÙˆÓ 104,7-328,9 ng/mL (̤ÛË ÙÈÌ‹ 228,2±49,4 ng/mL) Î·È 315-789 ng/mL (̤ÛË ÙÈÌ‹ 592±104 ng/mL) Ù˘ ÔÌ¿‰·˜ B. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‡ÊÂÛ˘ Ë Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sICAM-1 Î·È sVCAM-1 ‹Ù·Ó 101±39 ng/mL Î·È 586±92 ng/mL ·ÓÙ›ÛÙÔȯ·, ‰ËÏ·‰‹ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. T· Â›‰· ÙˆÓ sICAM-1 Î·È sVCAM-1 ÛÙËÓ ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ Ù˘ ‡ÊÂÛ˘ (p< 0,001). H ·‡ÍËÛË ·˘Ù‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sICAM-1 Î·È sVCAM-1 Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ C3 Î·È ÙÔ˘ C4, ÙËÓ ·‡ÍËÛË ÙˆÓ CIC, ÙˆÓ sIL-2Rs, Ù˘ TKE Î·È Ù˘ CRP. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· Â›‰· ÙˆÓ sICAM-1 Î·È sVCAM-1, ·˘Í¿ÓÔ˘Ó Î·Ù¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË ÙˆÓ CIC, Ù˘ TKE, Ù˘ CRP Î·È Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙÔ˘ C3 Î·È ÙÔ˘ C4, ÂÓÈÛ¯‡ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ˘fiıÂÛË ÙÔ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ÙˆÓ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ, Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È fiÙÈ Ù· sICAM-1 Î·È sVCAM-1 ÌÔÚ› Ó· ıˆÚËıÔ‡Ó fiÙÈ ·ÔÙÂÏÔ‡Ó ‰‡Ô ÂÈϤÔÓ ‰Â›ÎÙ˜ ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:80-85. §¤ÍÂȘ ÎÏÂȉȿ: ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘, Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, sICAM-1, sVCAM, sIL-2R. D. CatriÔu, F. Athanasiadou, C. Aggouridaki, T. Papageorgiou, V. Tsabdaridou, M. Hatzistilianou.

Levels of the soluble adhesion molecules sICAM-1 and sVCAM-1 in children with systemic lupus erythematosus. Paediatriki 2000;63:80-85. ● Abstract: The aim of this paper was to study the levels of soluble adhesion molecules (sICAM-1 and sVCAM-1) in the serum of children with systemic lupus erythematosus (SLE), in relation to the activity of the disease. The study included 8 children with SLE, aged 18 months to 14 years (group A) and 16 healthy children of the same age and sex (group B). The levels of sIL-2R, CIC, CRP, C3, C4, sICAM-1, sVCAM-1 and the ESR were determined at diagnosis, once a month after the beginning of therapy, and at relapse. Monitoring of the disease ranged from 5 months to 4 years. Results: The levels of sICAM-1 and sVCAM-1 in group A at diagnosis showed ranges of 368.2-994.8 ng/mL (MV±SD 599.3±96.3 ng/mL), and 2154.4-2972.2 ng/mL (MV±SD 2559.2±378.7 ng/mL), respectively compared with 104.7-328.9 ng/mL (MV±SD 228.2±49.4 ng/mL) and 315-789 ng/mL respectively in (MV±SD 592±104 ng/mL) group B. During remission the mean levels of sICAM-1 and sVCAM-1 were within normal limits 101±39 ng/mL and 586±92 ng/mL respectively in group A. The levels of sICAM-1 and sVCAM-1 at relapse were significantly higher than those during remission (p<0.001). These increases in the sICAM-1 and sVCAM-1 levels were correlated to decreases in levels of C3 and C4 and increases in levels of CIC, sIL-2R, ESR and CRP. In conclusion, sICAM-1 and sVCAM-1 levels increase during disease activity of SLE, in parallel with increases in CIC, SER and CRP and decreases in C3 and C4,

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B' ¶·Ó/΋ ¶·È‰/΋ KÏÈÓÈ΋, NÔÛÔÎÔÌÂ›Ô AXE¶A, A.¶.£.

OÚÔÏÔÁÈÎfi EÚÁ·ÛÙ‹ÚÈÔ, NÔÛÔÎÔÌÂ›Ô AXE¶A, £ÂÛÛ·ÏÔÓ›ÎË

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¢È·Ï˘Ù¿ ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ ™∂§

reinforcing the hypothesis of immune complex formation and activation of complement, lymphocytes and endothelial cells. Thus, sICAM-1 and sVCAM-1 may be considered as two additional indicators of disease activation in SLE. Key words: soluble adhesion molecules, lupus erythematosus, sICAM-1, sVCAM-1, SEL, sIL-2R.

EÈÛ·ÁˆÁ‹ OÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (™E§) ¤¯Ô˘Ó ‰È·Ù·Ú·¯‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ Î·È Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜ (1). H ÛËÌ·Û›· Ù˘ ‰È·Ù·Ú·¯‹˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ Î·È Ë Û¯¤ÛË Ù˘ Ì ÙË ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ Û·ÊÒ˜ ηıÔÚÈÛı› (2).

H ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÓ·Ôı¤ÛÂȘ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙ· ·ÁÁ›· ‰È·ÊfiÚˆÓ ÔÚÁ¿ÓˆÓ, Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ÂΉ‹ÏˆÛË ·ÁÁÂÈ›Ùȉ·˜. ™ÙË Ê¿ÛË ·˘Ù‹ Ù˘ ÓfiÛÔ˘ ˘¿Ú¯ÂÈ ¤ÓÙÔÓË ÂÓÂÚÁÔÔ›ËÛË Î·È ÌÂÙ·Ó¿ÛÙ¢ÛË ÙfiÛÔ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰ÈˢڢṲ̂ÓÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁ›ˆÓ, ÛÙÔ˘˜ ÈÛÙÔ‡˜ (3). T· ·ÙÙ·Ú· ·˘Ù¿ ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· Ú·ÁÌ·ÙÔÔÈËı› Ë ÌÂÙ·Ó¿ÛÙÂ˘Û‹ ÙÔ˘˜. H ¤ÎÊÚ·ÛË ·˘Ù‹ ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ Î˘ÙÙ¿ÚˆÓ Û˘Ì›ÙÂÈ ¯ÚÔÓÈο Ì ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ·ÁÁ›ˆÓ Î·È Û˘Ì‚¿ÏÏÂÈ ¤ÙÛÈ ÛÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (4).

T· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÌÔÚ› Ó· ·ÔÎfiÙÔÓÙ·È ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË Î·È Ó· ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔÓ ÔÚfi Ì ÙË ÌÔÚÊ‹ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ. H ̤ıÔ‰Ô˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÛÙÔÓ ÔÚfi ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, ÙfiÛÔ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ Ù˘ ÌÂıfi‰Ô˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Û ΢ÙÙ·ÚÈÎfi Â›Â‰Ô ÁÈ·Ù› Â›Ó·È ÈÔ ·Ï‹ Î·È ÁÚ‹ÁÔÚË (3,4). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂϤÙË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ (sICAM-1 Î·È sVCAM-1) ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ Ì ™E§ Î·È Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ÂÈ¤‰ˆÓ ·˘ÙÒÓ Û ۯ¤ÛË Ì ÙË ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ H ÌÂϤÙË ÂÚÈÏ¿Ì‚·Ó ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ A Î·È B. H ÔÌ¿‰· A ·ÔÙÂÏ›ÙÔ ·fi 8 ·È‰È¿, 2 ·ÁfiÚÈ· Î·È 6 ÎÔÚ›ÙÛÈ· Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ ÙÔ˘ ™E§ (1). H ̤ÛË ËÏÈΛ· ÙÔ˘˜ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 8,1 ¯ÚfiÓÈ· (‰È·Î‡Ì·ÓÛË 18 ÌËÓÒÓ - 14 ¯ÚÔÓÒÓ). O ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì¿ÓıËΠ·fi 5 Ì‹Ó˜ ¤ˆ˜ 4 ¯ÚfiÓÈ·.

H ÔÌ¿‰· B ·ÔÙÂÏ›ÙÔ ·fi 16 ·È‰È¿ Ù˘ ȉ›·˜ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ì ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ A, ÒÛÙ ӷ ·ÓÙÈÛÙÔÈ¯Ô‡Ó 2 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ B Û 1 Ù˘ ÔÌ¿‰·˜ A.

™˘ÓÙÔÌÔÁڷʛ˜ ™E§ CIC sIL-2R sICAM-1 sVCAM-1

™˘ÛÙËÌ·ÙÈÎfi˜ EÚ˘ıËÌ·Ù҉˘ §‡ÎÔ˜ K˘ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· (circulating immunocomplex) ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ ÈÓÙÂÚÏ¢ΛÓ˘ 2 soluble intercellular adhesion molecule 1 soluble vascular cell adhesion molecule 1

H ÂÎÙ›ÌËÛË Ù˘ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ A ÁÈÓfiÙ·Ó Ì ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ· Ô˘ ηٷÁÚ¿ÊÔÓÙ·Ó Û ÂȉÈÎfi ÚˆÙfiÎÔÏÏÔ Î·Ù¿ ÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔÓ Ì‹Ó· ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›·, ÂÓÒ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È ÓÔÛËχÔÓÙ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì›· ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰·. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ·Ì‚¿ÓÔÓÙÔ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔÓ Ì‹Ó· ·fi οı ·ÛıÂÓ‹ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. O ·ÚÈıÌfi˜ ‰ÂÈÁÌ¿ÙˆÓ Ô˘ ·ÓÙÈÛÙÔȯԇÛ Û οı ·ÛıÂÓ‹ ηٿ ̤ÛÔ fiÚÔ ‹Ù·Ó 22 (·fi 14 ¤ˆ˜ 68 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜).

K·Ù¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ¯ÔÚËÁ›ÙÔ ÎÔÚÙÈ˙fiÓË Û ‰fiÛË 1 mg/Kg ËÌÂÚËÛ›ˆ˜ Ì ‹ ¯ˆÚ›˜ ·˙·ıÂÈÔÚ›ÌË. MÂÙ¿ ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ¿Ú¯È˙Â Ë ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ÎÔÚÙÈ˙fiÓ˘.

OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÌÂÙÚ‹ıËÎ·Ó Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‹Ù·Ó Ë TKE, Ë C ·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP), Ù· ÎÏ¿ÛÌ·Ù· C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· (circulating immunocomplex, CIC), Ù· Â›‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 2 (sIL-2R), Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ (soluble intercellular adhesion molecule 1, sICAM-1), Î·È soluble vascular cell adhesion molecule 1, sVCAM-1) H CRP Î·È Ù· ÎÏ¿ÛÌ·Ù· C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó Ì ÙËÓ Ì¤ıÔ‰Ô Ù˘ ÓÂÊÂÏÔÌÂÙÚ›·˜, ÂÓÒ Ù· CIC, Ô ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ sIL-2R Î·È Ù· ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ sICAM-1 Î·È sVCAM-1 Ì ÙËÓ Ì¤ıÔ‰Ô ELISA. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ÁÈ· ÙËÓ Û‡ÁÎÚÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·Ó¿Ï˘ÛË ÙÔ˘ x2, student's t test. H ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ ıˆڋıËΠÛËÌ·ÓÙÈ΋ fiÙ·Ó ÙÔ P<0,05. °È· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Î·Ù¿ Pearson Û˘Û¯¤ÙÈÛË.

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AÔÙÂϤÛÌ·Ù· H ̤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sIL-2R, ÙˆÓ CIC, Ù˘ CRP, ÙˆÓ C3 Î·È C4 Î·È ÙˆÓ sICAM-1, sVCAM-1 ηıÒ˜ Â›Û˘ Î·È Ë TKE ÛÙËÓ ÔÌ¿‰· A, ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Î·È ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ÂΛӷ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ B (¶›Ó·Î·˜ 1). H ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,001). MfiÓÔ Û 2 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ A Ë ÙÈÌ‹ Ù˘ CRP ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ.

K·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ηٷÁÚ¿ÊËÎ·Ó 7 ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ Ô˘ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ·ÚÔ˘Û›· Ïԛ̈͢.

OÈ ÙÈ̤˜ Ù˘ TKE, Ù˘ CRP Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÛÙËÓ ‡ÊÂÛË, ÚÈÓ ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˘ÔÙÚÔ‹˜ Î·È ÛÙÔ˘˜ ÚÒÙÔ˘˜ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ˘ÔÙÚÔ‹, Ê·›ÓÔÓÙ·È ÛÙ· Û¯‹Ì·Ù· 1 Î·È 2, ÂÓÒ Ù· Â›‰· ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÛÙÔ Û¯‹Ì· 3. ™Â 4 ·ÛıÂÓ›˜ ÔÈ ·Ú·¿Óˆ ·Ú¿ÌÂÙÚÔÈ TKE, CRP, sIL-2R, sICAM-1, sVCAM-1, C3 Î·È C4 ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó 2 ÊÔÚ¤˜ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ÚÈÓ ÙËÓ ˘ÔÙÚÔ‹ Î·È ÂΛ ‰È·ÁÓÒÛıËΠÂÚÁ·ÛÙËÚȷο Ë ÚÒÈÌË ‰È·Ù·Ú·¯‹ ÙˆÓ C3 Î·È C4. OÈ ÙÈ̤˜ ÙˆÓ C3 Î·È C4 Î˘Ì¿ÓıËÎ·Ó ·fi 0,12-0,95 Î·È ·fi 0,06-0,15 ·ÓÙ›ÛÙÔȯ· ÛÙÔ˘˜ 4 ·˘ÙÔ‡˜ ·ÛıÂÓ›˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ‰È·Ù·Ú¿¯ıË-

¢. K·ÙÚÈÔ‡ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ⁄ÊÂÛË 1Ì‹Ó· ÚÈÓ ÙËÓ ˘ÔÙÚÔ‹ ÀÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ 1 Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ 2 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜

CRP

CIC

15 22 105

0,7 0,9 4,4

1 1,3 4,6

65

1

3,1

32

0,8

2,2

18

0,6

1,2

Î·Ó ÚÈÓ ·fi ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜ ÚÒÙ· Ù· Â›‰· ÙˆÓ C3 (ÛÙȘ 4/7 ˘ÔÙÚÔ¤˜) Î·È C4 (Û 2/7 ˘ÔÙÚÔ¤˜), ·ÎÔÏÔ˘ıÔ‡Û·Ó ·˘Ù¿ ÙˆÓ sIL-2R (Û 6/7 ˘ÔÙÚÔ¤˜), ÙˆÓ sICAM-1 (ÛÙȘ 6/7 ˘ÔÙÚÔ¤˜) Î·È ÙˆÓ sVCAM-1 (6/7 ˘ÔÙÚÔ¤˜) Î·È Ù¤ÏÔ˜ Ù˘ CRP (4/7 ˘ÔÙÚÔ¤˜) Î·È Ù˘ TKE (7/7 ˘ÔÙÚÔ¤˜). H ·ÔηٿÛÙ·ÛË ‰Â ÙˆÓ ÙÈÌÒÓ Î·Ù¿ ÙËÓ ‡ÊÂÛË Ù˘ ÓfiÛÔ˘ ·ÎÔÏÔ˘ıÔ‡Û ÙËÓ ›‰È· ÛÂÈÚ¿. ¶Ï¤ÔÓ Â˘·›ÛıËÙÔÈ ·Ú¿ÌÂÙÚÔÈ ‰È¿ÁÓˆÛ˘ ÙˆÓ ˘ÔÙÚÔÒÓ ıˆڋıËÎ·Ó ÔÈ ·Ú¿ÌÂÙÚÔÈ: TKE, sIL2R, sICAM-1 Î·È sVCAM-1. OÈ ·Ú¿ÌÂÙÚÔÈ ·˘Ù¤˜ ‰È·Ù·Ú¿¯ıËÎ·Ó Û ÔÛÔÛÙfi 85-100% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘. O ¯ÚfiÓÔ˜ fï˜ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘˜ ‹Ù·Ó ÔÈΛÏÔ˜ fiˆ˜ ·Ó·Ê¤Ú·-

™¯‹Ì· 1. ∏ ̤ÛË ÙÈÌ‹ Ù˘ ∆∫∂ ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘.

82

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¢È·Ï˘Ù¿ ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ ™∂§

™¯‹Ì· 2. ∏ ̤ÛË ÙÈÌ‹ ÙˆÓ CRP, CIC, C3 Î·È C4 ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘.

™¯‹Ì· 3. ª¤ÛË ÙÈÌ‹ ÙˆÓ sIL-2R, sICAM Î·È sVCAM Û fiÏ· Ù· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘.

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Ì ÚÔËÁÔ˘Ì¤Óˆ˜. ¢È·ÈÛÙÒıËΠÈÛ¯˘Ú‹ ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ sIL-2R Î·È ÙˆÓ sICAM-1 (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Pearson, r=0,892) ηıÒ˜ Â›Û˘ Î·È ÌÂٷ͇ ÙˆÓ sIL-2R Î·È ÙˆÓ sVCAM-1 (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Pearson r=0,914). ™˘˙‹ÙËÛË H ·˘ÍË̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Â›Ó·È ÙÔ Î‡ÚÈÔ ÛËÌÂ›Ô ÛÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘. ¶·ÚfiÏ· ·˘Ù¿ Û‹ÌÂÚ· ÈÛÙ‡ÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (1). OÈ sIL-2R ÂÎÊÚ¿˙ÔÓÙ·È ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ T-ÏÂÌÊÔ·ÙÙ·Ú· Î·È ·fi ·˘Ù¿ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È (5). H ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ·˘ÙÒÓ, Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ÚÈÓ ÙËÓ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ Û˘ÌʈÓ› Ì ÙËÓ ¿Ô„Ë ÙˆÓ ÂÚ¢ÓËÙÒÓ fiÙÈ ·˘Í¿ÓÔ˘Ó Û ·ÚÈıÌfi Ù· ÂÓÂÚÁÔÔÈË̤ӷ T-ÏÂÌÊÔ·ÙÙ·Ú· (5,6). ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·Û›·˜ ÔÈ ÛËÌ·ÓÙÈΤ˜ ·˘Í‹ÛÂȘ ÙˆÓ ÙÈÌÒÓ ÙˆÓ sIL-2R ÛÙÔÓ ÔÚfi 85% ÙˆÓ ·ÛıÂÓÒÓ, ÂΉËÏÒıËÎ·Ó Ï›ÁÔ ·ÚÁfiÙÂÚ· ¯ÚÔÓÈο, ·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ C3 /C4.

TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ, ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ, ÌÔÚ› Ó· Â›Ó·È Â·ÎfiÏÔ˘ıÔ ÌÈ·˜ ÁÂÓÈÎfiÙÂÚ˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜.

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÏÔÈfiÓ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sIL2R ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì ™E§, Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ ÚÈÓ ÙËÓ ÎÏÈÓÈ΋ Ù˘ ÂΉ‹ÏˆÛË Î·È ·ÔÙÂÏ› ¢·›ÛıËÙÔ ‰Â›ÎÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘. O ‰Â›ÎÙ˘ ·˘Ùfi˜ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹ÁÔÚ·.

T· ÂÓÂÚÁÔÔÈË̤ӷ ÏÂÌÊÔ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (ICAM1) Ô˘ Ì οÔÈÔ ¿ÁÓˆÛÙÔ Ì˯·ÓÈÛÌfi ·ÔÎfiÙÔÓÙ·È ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË Î·È Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔÓ ÔÚfi Ì ÙËÓ ÌÔÚÊ‹ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ (7,8). T·˘Ùfi¯ÚÔÓ· Ì ٷ ÂÓÂÚÁÔÔÈË̤ӷ ÏÂÌÊÔ·ÙÙ·Ú· ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ÙˆÓ ·ÁÁ›ˆÓ Î·È ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (VCAM-1) ‰È¢ÎÔχÓÔÓÙ·˜ ¤ÙÛÈ Ù· ÚÒÙ· Ó· Î˘Ï‹ÛÔ˘Ó ¿Óˆ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁ›ˆÓ. T· ·ÁÁ›· ‰È¢ڇÓÔÓÙ·È Î·È ÂÈÙÚ¤Ô˘Ó ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ ÏÂÌÊÔ·ÙÙ·Ú· Ó· ÌÂÙ·Ó·ÛÙ‡ÛÔ˘Ó ÛÙÔ˘˜ ÈÛÙÔ‡˜ fiÔ˘ Û˘Ó·ÓÙÔ‡Ó ÙÔÓ ÛÙfi¯Ô ÙÔ˘˜ (911). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‰È·ÈÛÙÒıËΠ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Û ÔÛÔÛÙfi 85%, ÁÂÁÔÓfi˜ Ô˘ ·ÓÙÈηÙÔÙÚ›˙ÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔ-

84

¢. K·ÙÚÈÔ‡ Î·È Û˘Ó.

΢ÙÙ¿ÚˆÓ Ôχ ÚÈÓ ÂΉËψı› Ë ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ ÎÏÈÓÈο Î·È ¤ÙÛÈ Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÔÈ ·Ú¿ÌÂÙÚÔÈ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·.

H ÈÛ¯˘Ú‹ ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË Ô˘ ‰È·ÈÛÙÒıËΠÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sIL-2R Î·È sICAM-1 Î·È ÙˆÓ sIL-2R Î·È sVCAM-1, ·Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ Û¯Â‰fiÓ Ù·˘Ùfi¯ÚÔÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ·˘Ù‹ ÙˆÓ T-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÚÈÓ ·ÎfiÌË ÂΉËψı› ÎÏÈÓÈο Ë ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ·›ÓÔ˘Ì ÏÔÈfiÓ fiÙÈ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ 3 Î·È 4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ Î·È Ë ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì ™E§ Û ÔÛÔÛÙfi 55% Î·È 85% ·ÓÙ›ÛÙÔȯ·, ÚÈÓ ·fi ÙËÓ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙ· Ï·›ÛÈ· ÁÂÓÈÎfiÙÂÚ˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

H Û˘ÛÙËÌ·ÙÈ΋ ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì ™E§, ÌÔÚ› Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘.

T· Â›‰· ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÌÔÚÔ‡Ó Ó· ÚÔÛÙÂıÔ‡Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Â˘·›ÛıËÙˆÓ ‰ÂÈÎÙÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÓfiÛÔ˘ Î·È Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÂÊ·ÚÌÔ˙fiÌÂÓË ıÂÚ·›·.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Kotzin BL, O'Dell JR. Systemic lupus erythematosus. In : Frank MM, Austen KF, Claman HN, Unanue ER eds.

Immunologic diseases. 5th ed. Boston: Little Brown, 1995:667-697.

2. Feldmann M.: T-cell activation in health and disease.

Immunology Today 1988; 9:121-124.

3. Gorski A. The role of cell adhesion molecules in immunopathology. Immunology Today 1994;15(6):251255.

4. Shimizu Y, Newman W, Tanaka Y, Shaw S. Lymphocyte interactions with endothelial cells. Immunology Today 1992;13(3):106-112.

5. Srivastava M, Rossi TM, Lebenthal E. Serum soluble interleukin-2 receptor, soluble CD8 and soluble intercellular adhesion molecule-1 levels in Crohn’s disease, celiac disease, and systemic lupus erythematosus. Res Commun Mol Pathol Pharmac 1995; 87(1):21-26.

6. Spronk PE, Ter Borg EJ, Huitema MG, Limburg PC, Kallenberg CG. Changes in levels of soluble T-cell activation markers, sIL-2R, sCD4, and sCD8 in relation to disease exacerbations in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis 1994;53:235-239

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85

7. Straub RH, Zeuner M, Antoniou E, Scholmerich J, Lang B. Dehydro-epiandroepiandrosterone sulfate is positively correlated with soluble interleukin 2 receptor and soluble intercellular adhesion molecule in systemic lupus erythematosus. J Rheumatol, 1996;23:5, 856-861.

8. Sfikakis PP, Charalambopoulos D, Vayiopoulos G, Oglesby R, Sfikakis P, Tsokos GC. Increased levels of intercellular adhesion molecule-1 in the serum of patients with systemic lupus erythematosus. Clin-Exp-Rheumatol 1994;12(1): 5-9.

9. Spronk PE, Bootsma H, Huitema MG, Limburg PC, Kallenberg CG. Levels of soluble VCAM-1, soluble ICAM1, and soluble E-selectin during disease exacerbations in patients with systemic lupus erythematosus (SLE); a long term prospective study. Clin-Exp-Immunol. 1994;97(3): 439-444.

¢È·Ï˘Ù¿ ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ ™∂§

10. Sfikakis PP, Tsokos GC. Clinical use of the measurement of soluble cell adhesion molecules in patients with autoimmune rheumatic diseases. Clin Diagn Lab Immunol, 1997, 4(3): 241-246.

11. Nyberg F, Acevedo F, Stephansson E. Different patterns of soluble adhesion molecules in systemic and cutaneous lupus erythematosus. Exp Dermatol, 1997;6(5): 230-235.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-10-98 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-06-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ˆÚÔı¤· K·ÙÚÈÔ‡ ¶. AÓÙˆÓ›Ô˘ 9 54632 £ÂÛÛ·ÏÔÓ›ÎË

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∆ιαδικασία αξιολόγησης και αποδελτιωσης βιοϊατρικών περιοδικών στη Βάση του IATPOTEK

A. Προδιαγραφές i. Yποψήφια για αποδελτίωση είναι µόνο περιοδικά που εµπίπτουν στο χώρο των Eπιστηµών Yγείας και τα οποία συντάσσονται εξ ολοκλήρου ή παραθέτουν τα τεκµηριωτικά στοιχεία των άρθρων τους (τίτλος, περίληψη, λέξεις ευρετηρίου, ονόµατα συγγραφέων και κέντρων προέλευσης) στην Eλληνική γλώσσα.

A1. Συντακτικές-Eκδοτικές i. Tήρηση των οδηγιών της International Committee of Medical Editors: Uniform Requirements for Manuscripts Submitted to Biomedical Journals, 1997.(1) ii. Tακτική έκδοση. Tα τεύχη των περιοδικών οφείλουν να κυκλοφορούν και να φθάνουν στη Γραµµατεία, µε το συνήθη τρόπο διανοµής του περιοδικού, µέχρι 6 µήνες από το τέλος της εκδοτικής περιόδου, στην οποία αντιστοιχούν.

A2. Προδιαγραφές λειτουργίας i. O φορέας, στον οποίο ανήκει το περιοδικό, οφείλει να έχει συντάξει Kανονισµό Λειτουργίας, στον οποίο καταγράφονται τα µέσα και οι διαδικασίες, δια των οποίων επιδιώκει τη διασφάλιση της ποιότητας του περιοδικού. O Kανονισµός Λειτουργίας περιλαµβάνει κατ’ ελάχιστον: • τη διάρκεια ισχύος του • το σκοπό έκδοσης του περιοδικού • το γνωστικό πεδίο που καλύπτει η έκδοση του περιοδικού • τη βασική διαδικασία αξιολόγησης των υπό δηµοσίευση εργασιών (εξωτερικοί κριτές, εσωτερική αξιολόγηση από τη Συντακτική Eπιτροπή, άλλος) • τον αριθµό των µελών της Συντακτικής Eπιτροπής • τη διαδικασία επιλογής του ∆ιευθυντή Σύνταξης και των µελών της Συντακτικής Eπιτροπής • τη διάρκεια της θητείας του ∆ιευθυντή Σύνταξης και των µελών της Συντακτικής Eπιτροπής και τη διαδικασία παύσης τους, στις καταγεγραµµένες περιπτώσεις ανεπάρκειάς τους • τα καθήκοντα και τα δικαιώµατα του ∆ιευθυντή Σύνταξης • τους οικονοµικούς πόρους του περιοδικού και τον τρόπο διαχείρισής τους. ii. H Σύνταξη του περιοδικού οφείλει να τηρεί: • Πρακτικά των συνεδριάσεών της • Bιβλίο διακίνησης των υπό δηµοσίευση άρθρων, στο οποίο θα φαίνεται λεπτοµερώς η διαδικασία, την οποία ακολούθησε κάθε κείµενο που υποβλήθηκε στο περιοδικό, µέχρι τη στιγµή που λήφθηκε η τελική απόφαση για το δηµοσιεύσιµό του.

• Aρχείο από την αλληλογραφία κάθε άρθρου.

B. ∆ιαδικασία αξιολόγησης i. O φορέας, στον οποίο ανήκει το περιοδικό και επιθυµεί την καταλογογράφηση και αποδελτίωση του στη βάση του IATPOTEK, υποβάλλει, δια του νοµίµου εκπροσώπου του, στη Γραµµατεία του IATPOTEK, Aίτηση Aξιολόγησης.(2)

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ii. H Aίτηση Aξιολόγησης συνοδεύεται από (α) τα τεύχη του περιοδικού των δύο τελευταίων ετών, (β) συµπληρωµένο το επισυναπτόµενο Στατιστικό ∆ελτίο Περιοδικού, και (γ) υποχρέωση τακτικής αποστολής των µελλοντικών τευχών του περιοδικού στη Γραµµατεία του IATPOTEK. iii. H Γραµµατεία ελέγχει την αντιστοιχία του περιοδικού µε τις προδιαγραφές. H αντιστοιχία µε τις συντακτικές και εκδοτικές προδιαγραφές ελέγχεται στα τεύχη του τρέχοντος έτους.

iv. Aν το περιοδικό δεν καλύπτει πλήρως τις προδιαγραφές, αλλά κρίνεται ότι έχει τη δυνατότητα να τις καλύψει µετά από κάποιο χρόνο, η Γραµµατεία προβαίνει σε συγκεκριµένες υποδείξεις προς το φορέα του περιοδικού και προτείνει επανυποβολή της Aίτησης Aξιολόγησης σε χρόνο όχι µικρότερο του ενός έτους, οπότε επαναλαµβάνεται η ίδια διαδικασία. v. Σε κάθε άλλη περίπτωση, η Γραµµατεία συντάσσει και υποβάλλει αιτιολογηµένη εισήγηση στο Συµβούλιο Kρίσεως, που αποτελείται από οµάδα Aκαδηµαϊκών και Oµοτίµων Kαθηγητών της Iατρικής µε Πρόεδρο τον κ. N. Mατσανιώτη και το οποίο αποφασίζει για την αποδοχή ή την απόρριψη της Aίτησης Aξιολόγησης του περιοδικού. vi. Mετά από την αποδοχή της Aίτησης Aξιολόγησης, η Γραµµατεία φροντίζει για την αποδελτίωση των τευχών του περιοδικού και παρακολουθεί διαρκώς τη συµµόρφωσή του µε τις προδιαγραφές. vii. Aν διαπιστωθεί ότι παραβαίνονται οι προδιαγραφές, η Γραµµατεία έχει το δικαίωµα (α) να προβεί σε συστάσεις συµµόρφωσης, (β) να διακόψει προσωρινά την αποδελτίωση, (γ) να εισηγηθεί στο Συµβούλιο Kρίσεως την οριστική διακοπή της αποδελτίωσης του περιοδικού.

Γ. Όροι αποδελτίωσης Προκειµένου να αρχίσει η αποδελτίωσή τους στη βάση του IATPOTEK, τα περιοδικά, των οποίων γίνεται αποδεκτή η Aίτηση Aξιολόγησης, έχουν υποχρέωση: i. Nα αποστέλλουν ανελλιπώς στη Γραµµατεία του IATPOTEK τα τεύχη που εκδίδονται ii. Nα αποστέλλουν στη Γραµµατεία του IATPOTEK, σε ηλεκτρονική µορφή, το σύνολο της ύλης των τευχών, όπως ακριβώς είναι σε έντυπη µορφή. iii. Nα καταβάλουν ως τέλος αποδελτίωσης 50.000 δρχ. ανά τεύχος.

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¶PO™EXH ™YNE¢PIA ª¿ÚÙÈÔ˜ 2000 26-30 March 2000 Taipei, Taiwan 10th Asian Congress of Pediatrics Secretariat: 6F, 400, Kee Lung Rd., Sec. 1 Taipei, 110, TAIWAN Tel: 886-2-2722-1227, Fax: 886-2-2723-4187 e-mail: pcogis@ms14.hinet.net website: http://www.pcogis.com.tw

∞Ú›ÏÈÔ˜ 2000 1-2 ∞ÚÈÏ›Ô˘ 2000 ∞ı‹Ó· 1Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›· C&C International A.E. TËÏ: 01 6889100, Fax: 01 6844777 e-mail: congress@cnc.gr

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ª¿ÈÔ˜ 2000 10-13 ª·˝Ô˘ Santander, Spain European Conference on Health Promotion and Health Education Organised by the International Union for Health Promotion and Education Andalusian School of Public Health - Campus Universitario de Cartuja Apdo. Correos 2070 18080 Granada (Spain) e-mail: iuhpe@easp.es Tel: (34) 958 161 044 Fax: (34) 958 161 142

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OÎÙÒ‚ÚÈÔ˜ 2000 4-6 OÎÙˆ‚Ú›Ô˘ Portoroz, Slovenia 26th Annual Congress of the Union of Middle-Eastern & Mediterranean Paediatric Societies Information: Dr Ivan Vidmar Division for Paediatric Surgery & Intensive Care 1525 Ljubljana - Slovenia Fax: 0038661-1301714

∏ÌÂÚ›‰Â˜ 3-4 πÔ˘Ó›Ô˘ 2000 9Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ £¤Ì·: ¶ÂÚÈ‚¿ÏÏÔÓ Î·È ·È‰ÈÎfi˜ Ó‡ÌÔÓ·˜ ¢ÈÔÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· ∞ÈÁ›‰·: ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ™˘ÌÌÂÙÔ¯‹: ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ∂Î·È‰Â˘ÙÈÎfi ∫¤ÓÙÚÔ ∞ÁÚÔÙÈ΋˜ ∆Ú¿Â˙·˜, ∫·ÛÙÚ› (∂Ï. µÂÓÈ˙¤ÏÔ˘ 154 & ∞ÓÙÈÁfiÓ˘, ¡. ∂Ú˘ıÚ·›·) ¶ÏËÚÔÊÔڛ˜: ∫ÒÛÙ·˜ ¡. ¶Ú›ÊÙ˘ ∆ËÏ.: 80 36 484, fax: 61 31 173

¶∞π¢OæÀÃπ∞∆ƒπ∫∏ ∂∆∞πƒπ∞ ∂§§∞¢O™ HELLENIC SOCIETY OF CHILD & ADOLESCENT PSYCHIATRY

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™YNTOMO°PAºIE™ - (Abbreviations) ™˘ÓÙÔÌÔÁڷʛ˜

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Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

xviii

JAN.-FEB.2000

30-05-03

12:57

™ÂÏ›‰·90

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) 9 giga- (10 ) 6 mega-(10 ) 3 kilo- (10 ) 2 hecto(10 ) 1 deca (10 ) -1 deci (10 ) -2 centi- (10 ) -3 milli(10 ) -5 micro (10 ) -9 nano (10 ) -12 pico (10 ) -15 femto (10 ) -18 atto (10 )

xix

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