Παιδιατρική | Τόμος 63 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2000 by E-chlld

ISSN 0377-2551

E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

AP£PA ™YNTA•H™

H ·ÔÊ˘Á‹ ÙË˜ ÚﬁÎÏËÛË˜ ﬁÓÔ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ì·˜

Ú·ÎÙÈÎ‹

º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

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

E. B·Ï¿ÛÛË- A‰¿Ì

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ˆ˜ Ì¤ÛÔ ‰È¿ÁÓˆÛË˜ Î·È ·Ú·-

ÎÔÏÔ‡ıËÛË˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÙˆÓ ·È‰ÈÒÓ

¶. NÈÎÔÏ·˝‰Ô˘

A¡∞™∫O¶∏™∏

KÔÎÎÈˆÌ·ÙÒ‰Ë˜ Ë·Ù›ÙÈ‰·

¢. AÏÂÍ›Ô˘, O. °Ú·Ê¿ÎÔ˘

Aƒ£ƒO ∂π¢π∫OÀ ∂¡¢π∞º∂ƒO¡∆O™

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·-

ÚÈÎ‹ ÓﬁÛÔ

M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË ÌÂ

ÙÔÓ Ê·ÈÓfiÙ˘Ô ÛÂ ·È‰ÈÎfi ÏËı˘ÛÌfi

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

™‡ÁÎÚÈÛË Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÂ ·ÂÚÔ·ÏÏÂÚÁÈÔÁﬁÓ· ·È‰ÈÒÓ ÙË˜ EÏÏ¿‰·˜ Î·È ÙË˜ AÁÁÏ›·˜ ËÏÈÎ›·˜ 5- 7,5 ¯ÚÔÓÒÓ

™. TÛ›ÙÔ˘Ú·, K. NÂÛÙÔÚ›‰Ô˘, N. ¶··‰ÔÔ‡ÏÔ˘, ¶. MﬁÙË˜, H. Arshad, T. Dean, S. Matthews, B. Mealy

X¿ÛÌ· ·ÓÈﬁÓÙˆÓ ·›Ì·ÙÔ˜/ Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿

X KÒÛÙ·ÏÔ˜, A TÛ·Î›ÚË˜, A KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M ¢·ÓÈËÏ›‰Ô˘, A °Ô‡Ó·ÚË˜

™˘ÛÙËÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÏÔ›ÌˆÍË˜ ·ﬁ ÈÔ‡˜ Coxsackie

B ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

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·

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

ŒÌÊÚ·ÎÙÔ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·ﬁ ÏÔ›ÌˆÍË ÌÂ Ì˘ÎﬁÏ·ÛÌ· ÓÂ˘ÌÔÓ›·˜

B. º·Ï·›Ó·, B. ¶··Â˘·ÁÁ¤ÏÔ˘, B. ™˘ÚÈÔÔ‡ÏÔ˘, M. £ÂÔ‰ˆÚ›‰Ô˘

OÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰· ÛÂ ·È‰› ÌÂ ÙÂÏÈÎﬁ ÛÙ¿‰ÈÔ ÓÂÊÚÈÎ‹˜

·ÓÂ¿ÚÎÂÈ·˜. £ÂÚ·Â›· ÌÂ octreotide

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

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

™˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· ÛÂ ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

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

A¶EIKONI™TIKH ¶EPI¶Tø™H

¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ ÌÂ ÈÛÙÈÔÎ‡ÙÙˆÛË ·ﬁ Î‡ÙÙ·Ú·

Langerhans

£. ¶··ÁÂˆÚÁ›Ô˘, º. Aı·Ó·ÛÈ¿‰Ô˘, A. X·ÚÈÙ¿ÓÙË, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡, ¢. K·ÙÚÈÔ‡

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

TÔ ÂÓ‰ÔÔÈÎÈ·Îﬁ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡

K. ¶Ú›ÊÙË˜

∂¶π™∆O§∂™

∞ÁˆÁ‹ ÀÁÂ›·˜

™. ¡¿ÎÔ˘

¶ÔÈÔ˜ ‰ÈÎ·ÈÔ‡Ù·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ Û˘ÁÁÚ·Ê¤·

™. ∞Ó‰ÚÔÓ›ÎÔ˘

¶∞π¢π∞∆ƒπ∫H ENHMEPø™H

¶∞π¢π∞∆ƒπ∫∏ - AÔÏÔÁÈÛÌﬁ˜ 1999

∂. µ·Ï¿ÛÛË - ∞‰¿Ì

∫ÚÈÙ¤˜ 1999

EÈÛÎﬁËÛË ∂ÏÏËÓÈÎÔ‡ π·ÙÚÈÎÔ‡ ¶ÂÚÈÔ‰ÈÎÔ‡ ∆‡Ô˘ 1999

ÁÈ· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡

πƒπ™-Online: µ¿ÛË ÂÏÏËÓÈÎ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘ÁÂ›·

ÙÔ˘ ·È‰ÈÔ‡ http://www.ich.gr

¶. ∞. ∫ÔÎÎÈÓ›‰Ë˜

∞Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿ ÌÂ Î·ÚÎ›ÓÔ

∞Ú¯¤˜ ÙË˜ ¶OY

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË ™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ·È‰› Ô˘ ıÚËÓÂ› ÙÔ ı¿Ó·ÙÔ ·Á·ËÌ¤ÓÔ˘

ÙÔ˘ ÚÔÛÒÔ˘

™. ∆Û›ÙÔ˘Ú·

∂·Ó·‰ËÌÔÛ›Â˘ÛË

∂›Â‰· Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎﬁÏÏËÛË˜ sICAM-1, sVCAM-1 ÛÂ ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎﬁ ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ¢. ∫·ÙÚÈÔ‡, º. ∞ı·Ó·ÛÈ¿‰Ô˘, Ã. ∞ÁÁÔ˘ÚÈ‰¿ÎË, £. ¶··ÁÂˆÚÁ›Ô˘, µ. ∆Û·‚‰·Ú›‰Ô˘, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ¶ÚÔÛÂ¯‹ ™˘Ó¤‰ÚÈ·

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË

E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎﬁ ÙË˜ EÏÏËÓÈÎ‹˜

¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

EÎ‰ﬁÙË˜

K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹ÙË˜©

EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·

MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92

Aı‹Ó·È 115 28

TËÏ:. (01) 7771 140 / 7771 663, Fax: 7758 354

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹

¶ÚﬁÂ‰ÚÔ˜ : A. KˆÓÛÙ·ÓÙﬁÔ˘ÏÔ˜

¢ÈÂ˘ı˘ÓÙ‹˜ : E. B·Ï¿ÛÛË-A‰¿Ì

M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿ : ™. AÓ‰ÚÔÓ›ÎÔ˘ : ™. K›ÙÛÈÔ˘-T˙¤ÏË : ™. N¿ÎÔ˘ : T. ¶·Ó·ÁÈˆÙﬁÔ˘ÏÔ˜ : A. ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏÂ›Ô˘ : K. ¶Ú›ÊÙË˜ : °. ™˘ÚÔÁÈ·ÓÓﬁÔ˘ÏÔ˜ : ™. TÛ›ÙÔ˘Ú·

™‡Ì‚Ô˘ÏÔÈ ∂Ù·ÈÚÂÈÒÓ ¶·È‰È·ÙÚÈÎÒÓ

ÀÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

™. °Ú·Ê¿ÎÔ˜∞ÈÌ·ÙÔÏÔÁ›·-OÁÎÔÏÔÁ›·

∂. ƒÒÌ·°·ÛÙÚÂÓÙÂÚÔÏÔÁ›· µ. ™ËÏÈÒÙË∂Ó‰ÔÎÚÈÓÔÏÔÁ›· µ. £·ÓﬁÔ˘ÏÔ˜∫·Ú‰ÈÔÏÔÁ›· ∂. ¶ÂÙÚ›‰Ô˘∫ÔÈÓˆÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ª. •¿ÓıÔ˘¡ÂÔÁÓÔÏÔÁ›· ∫. ™ÙÂÊ·Ó›‰Ë˜¡ÂÊÚÔÏÔÁ›· §. ¶··ÁÈ·ÓÓÔ‡ÏË¶·È‰Ô‰ÔÓÙÈ·ÙÚÈÎ‹ ∞. ¶··‚·ÛÈÏÂ›Ô˘¶·È‰ÔÓÂ˘ÚÔÏÔÁ›· π. ∆Û·Ó¿Î·˜¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁ›·

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ· º. ª·˘ÚÔÂÈ‰‹

™‡Ì‚Ô˘ÏÔ˜ ™Ù·ÙÈÛÙÈÎ‹˜ ∂. ™·Ú·Ê›‰Ô˘

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰ﬁÛÂˆ˜ E¶I™THMONIKE™EK¢O™EI™E.¶.E. ¶. TÛ·Ï‰¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 61 41 360-5 Fax: 61 41 365

E. Sarafidou TﬁÌÔ˜ 63, TÂ‡¯Ô˜

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 10000 ‰Ú¯.

EÈ‰ÈÎÂ˘ﬁÌÂÓÔÈ, ºÔÈÙËÙ¤˜:5000 ‰Ú¯.

πSSN 0377-2551

Bimonthly Publication

The Official Journal of the Hellenic Paediatric Society

Publisher K. Griveas

Owner© Hellenic Paediatric Society

Michalakopoulou 92

Athens 115 28

Tel. (01) 7771 140 / 7771 663, Fax: 7758 354

Scientific Editorial Board

President : A. Konstadopoulos

Editor : E. Valassi-Adam

Members : F. Athanassiadou-Piperopoulou

: M. Athanassiou-Metaxa

: S. Andronikou

: S. Kitsiou-Tzeli

: S. Nakou

: T. Panagiotopoulos

: A. Syrigou-Papavassiliou

: K. Priftis

: G. Syrogiannopoulos

: S. Tsitoura

Consultants, Paediatric Subspecialty

Societies

S. GrafacosHaematology-Oncology

E. RomaGastroenterology

V. SpiliotiEndocrinology

V. ThanopoulosCardiology

E. PetridouSocial Paediatrics

M. XanthouNeonatology

K. StefanidisNephrology

L. PapagianouliPaedodontics

A. PapavassiliouNeurology

J. TsanakasPneumonology

English Editing

S. Nakou

Statistics Consultant

Publishing Coordinator SCIENTIFICPUBLICATIONSLtd

P. Tsaldari 3, Marousi 151 22 Tel.: 61 41 360-5, Fax: 61 31 365

Annual Subscription

All foreign countries: US $ 30

¶AI¢IATPIKH

TﬁÌÔ˜ 63, TÂ‡¯Ô˜ 1Ô π·Ó.-ºÂ‚Ú. 2000

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

¶EPIEÃOMENACONTENTS

AP£PA ™YNTA•H™

H ·ÔÊ˘Á‹ ÙË˜ ÚﬁÎÏËÛË˜ ﬁÓÔ˘ ÛÙËÓ

Î·ıËÌÂÚÈÓ‹ Ì·˜ Ú·ÎÙÈÎ‹

º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘1

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

E. B·Ï¿ÛÛË- A‰¿Ì2

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ˆ˜ Ì¤ÛÔ ‰È¿ÁÓˆÛË˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÙˆÓ ·È‰ÈÒÓ

¶. NÈÎÔÏ·˝‰Ô˘6

A¡∞™∫O¶∏™∏ KÔÎÎÈˆÌ·ÙÒ‰Ë˜ Ë·Ù›ÙÈ‰· ¢. AÏÂÍ›Ô˘, O.

Aƒ£ƒO ∂π¢π∫OÀ ∂¡¢π∞º∂ƒO¡∆O™ H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ·

M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË 17

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË ÌÂ ÙÔÓ Ê·ÈÓfiÙ˘Ô ÛÂ ·È‰ÈÎfi ÏËı˘ÛÌfi

A. TÛ¤˙Ô˘, M. T˙¤ÙË, ™. K›ÙÛÈÔ˘, A. °·ÏÏ¿, E. K·‚·˙·Ú¿ÎË˜, A. X·Ù˙Ë‰ËÌÔ‡Ï·, E. ¶·ÙÂÚ¿ÎË, A. ¢Ú·Î¿ÙÔ˜, E. K·Ó·‚¿ÎË˜, £.K·Ú¿ıÈÔ˜21

™‡ÁÎÚÈÛË Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÂ ·ÂÚÔ·ÏÏÂÚÁÈÔÁﬁÓ· ·È‰ÈÒÓ ÙË˜ EÏÏ¿‰·˜ Î·È ÙË˜ AÁÁÏ›·˜ ËÏÈÎ›·˜ 5-7,5 ¯ÚﬁÓˆÓ

™. TÛ›ÙÔ˘Ú·, K. NÂÛÙÔÚ›‰Ô˘, N. ¶··‰ÔÔ‡ÏÔ˘, ¶. MﬁÙË˜, H. Arshad, T. Dean, S. Matthews, B. Mealy27

X¿ÛÌ· ·ÓÈﬁÓÙˆÓ ·›Ì·ÙÔ˜/ Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿ X KÒÛÙ·ÏÔ˜, A TÛ·Î›ÚË˜, A KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M ¢·ÓÈËÏ›‰Ô˘, A °Ô‡Ó·ÚË˜34

™˘ÛÙËÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÏÔ›ÌˆÍË˜ ·ﬁ ÈÔ‡˜ Coxsackie B ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· 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·38

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ŒÌÊÚ·ÎÙÔ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·ﬁ ÏÔ›ÌˆÍË ÌÂ

EDITORIALS

Managing children's pain

F. Athanassiadou-Piperopoulou1

To the reviewers of the journal, with deep appreciation!

E. Valassi-Adam2

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

P. Nikolaidou6

REVIEW ARTICLE

Granulomatous hepatitis

D. Alexiou, O. Grafakou9

ARTICLE OF SPECIAL INTEREST

The treatment of pain in children with sickle cell disease

M. Athanasiou-Metaxa, A. Koussi17

ORIGINAL PAPERS

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

A. Tsesou, M. Tzeti, S. Kitsiou, A. Galla, E. Kavasarakis, A. Hatzidimoula, E. Pateraki, A. Drakatos, E. Kanavakis, T. Karpathios21

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

S. Tsitoura, K. Nestoridou, N. Papadopoulou, P.Botis, H. Arshad, T.Dean, S. Matthews, B. Mealy27

Blood and urine anion gap in newborn infants

C. Costalos, A. Tsakiris, A. Constandinidou, M. Daniilidou, A. Gounaris34

Systemic manifestations of Coxsackie B virus infections in childhood

E. Roilides, C. Mantiou-Gratziou, T. Papastavrou, C. Panteliadis, M. Athanasiou, V. Kyriazopoulou-Dalaina38

CASE REPORTS

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

V. Falaina, V. Papaevangelou, V. Syriopoulou, M. Theodoridou43

OÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰· ÛÂ ·È‰› ÌÂ ÙÂÏÈÎﬁ ÛÙ¿‰ÈÔ

ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. £ÂÚ·Â›· ÌÂ octreotide

A. HÏ›·˜, K. ™ÙÂÊ·Ó›‰Ë˜, A. MËÙÛÈÒÓË, ¢. ™È·¤Ú·, A. ¶··‰ÔÔ‡ÏÔ˘, K. MÈ¯¤ÏË˜48

¶ÓÂ˘ÌÔÓÈÎ‹ ÏÔ›ÌˆÍË ·ﬁ ·Û¤ÚÁÈÏÏÔ Î·È M. avium

ÛÂ ·ÈÌÔÚÚÔÊÈÏÈÎﬁ ·ÛıÂÓ‹ ÌÂ AIDS

¢. M¿ÓÙ˙ÈÔ˘, °. MÔÛÙÚÔ‡, B. ¶··Â˘·ÁÁ¤ÏÔ˘, E. ¶Ï·ÙÔÎÔ‡ÎË, A. BÂÏÂÁÚ¿ÎË, M. £ÂÔ‰ˆÚ›‰Ô˘50

™˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· ÛÂ ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

I. K·Ï¤ÁÈ·˜, M. TÛÔÏÈ¿, K. ¶··ÁÂˆÚÁ›Ô˘, £. ¢ﬁÛÈÔ˜, E. K·‚·˙·Ú¿ÎË˜55

A¶EIKONI™TIKH ¶EPI¶Tø™H ¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ ÌÂ ÈÛÙÈÔÎ‡ÙÙˆÛË ·ﬁ Î‡ÙÙ·Ú· Langerhans

£. ¶··ÁÂˆÚÁ›Ô˘, º. Aı·Ó·ÛÈ¿‰Ô˘, A. X·ÚÈÙ¿ÓÙË, ª. Ã·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›ÊÙË˜63

∂¶π™∆O§∂™

∞ÁˆÁ‹ ÀÁÂ›·˜

™. ¡¿ÎÔ˘64

¶ÔÈﬁ˜ ‰ÈÎ·ÈÔ‡Ù·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ Û˘ÁÁÚ·Ê¤·;

™. AÓ‰ÚÔÓ›ÎÔ˘65

¶∞π¢π∞∆ƒπ∫H ENHMEPø™H

¶∞π¢π∞∆ƒπ∫∏ - AÔÏÔÁÈÛÌﬁ˜ 1999

∂. µ·Ï¿ÛÛË - ∞‰¿Ì66

∫ÚÈÙ¤˜ 1999 68

EÈÛÎﬁËÛË ∂ÏÏËÓÈÎÔ‡ π·ÙÚÈÎÔ‡ ¶ÂÚÈÔ‰ÈÎÔ‡ ∆‡Ô˘ 1999

ÁÈ· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡ 69

πƒπ™-Online: µ¿ÛË ÂÏÏËÓÈÎ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ

˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡ http://www.ich.gr

¶. ∞. ∫ÔÎÎÈÓ›‰Ë˜71

∞Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿ ÌÂ Î·ÚÎ›ÓÔ

∞Ú¯¤˜ ÙË˜ ¶OÀ75

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ·È‰› Ô˘ ıÚËÓÂ› ÙÔ ı¿Ó·ÙÔ ·Á·ËÌ¤ÓÔ˘

ÙÔ˘ ÚÔÛÒÔ˘ ™. ∆Û›ÙÔ˘Ú·77

∂·Ó·‰ËÌÔÛ›Â˘ÛË

∂›Â‰· Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ

ÚÔÛÎﬁÏÏËÛË˜ sICAM-1, sVCAM-1 ÛÂ ·È‰È¿ ÌÂ

Û˘ÛÙËÌ·ÙÈÎﬁ ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ¢. ∫·ÙÚÈÔ‡, º. ∞ı·Ó·ÛÈ¿‰Ô˘, Ã. ∞ÁÁÔ˘ÚÈ‰¿ÎË, £. ¶··ÁÚÂˆÚÁ›Ô˘, µ. ∆Û·‚‰·Ú›‰Ô˘, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡80

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

Octreotide treatment of acute pancreatitis in a child with end stage renal disease

A. Elias, C. Stefanidis, A. Mitsioni, D. Siapera, A. Papadopoulou, K. Michelis48

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

D. Mantziou, G. Mostrou, V. Papaevangelou, E. Platokouki, A. Velegraki, M. Theodoridou50

Congenital lobar emphysema in an adolescent. Case report

I. Kaleyias, M. Tsolia, K. Papageorgiou, T. Dosios, E. Kavasarakis55

RADIOLOGICAL CASE OF THE ISSUE

Case report of a child with Langerhans cell histiocytosis

T. Papageorgiou, F. Athanasiadou, A. Haritandi, M. Hatzistilianou, D. Katriou60

PAEDIATRICIANS’ PRACTICAL ADVICE TO PARENTS

K. Priftis63

LETTERS

S. ¡akou64

S. Andronikou65

PAEDIATRIC NEWS

Paediatriki - Report 1999 E. Valassi-Adam Reviewers 1999 68

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

IRIS- Online:Greek bibliography on child health http://www.ich.gr 71

Pain relief in children with cancer

WHO75

Book review

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. Hatzistilianou80

Forthcoming meetings

Abbreviations

H ¶AI¢IATPIKH Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈÎ‹ ¤Î‰ÔÛË

Î·È È‰ÈÔÎÙËÛ›· ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

(E ¶ E ).

Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙﬁ¯Ô˘˜ ·) ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘

·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ‚) ÙËÓ ÂÓËÌ¤ÚˆÛË ÙˆÓ ·È‰È¿ÙÚˆÓ

ÛÂ ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË˜

ÔÈÎÔÁ¤ÓÂÈ·˜ Î·ıÒ˜ Î·È ÙË˜ ‰ËÌﬁÛÈ·˜ ˘ÁÂ›·˜ Á) ÙË ‰ÈÂ˘-

ÎﬁÏ˘ÓÛË ÙË˜ ‰È·Î›ÓËÛË˜ ÙˆÓ È‰ÂÒÓ Î·È ÙË˜ ·Ó¿Ù˘ÍË˜

ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Â‰›Ô ÙË˜ ˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ‰) ÙËÓ

ÚﬁÔ‰Ô ÙË˜ ÂÏÏËÓÈÎ‹˜ ·È‰È·ÙÚÈÎ‹˜ Ì¤Ûˆ ÙË˜ ÎÚÈÙÈÎ‹˜

·ÍÈÔÏﬁÁËÛË˜ ÙˆÓ ÎÂÈÌ¤ÓˆÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ· ‰ËÌÔ-

Û›Â˘ÛË Â) ÙËÓ ÂÓı¿ÚÚ˘ÓÛË Î·È Î·ÏÏÈ¤ÚÁÂÈ· ÙË˜ ÂÈÛÙËÌÔÓÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜ ÛÙËÓ ÂÏÏËÓÈÎ‹ ÁÏÒÛÛ· °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË: ¿ÚıÚ· Û‡ÓÙ·ÍË˜ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË ÙË˜ EÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂÈ˜,Â›Î·ÈÚ· ı¤Ì·Ù·, ¿ÚıÚ· ÂÈ‰ÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜, ÂÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÎÏÈÓÈÎ¤˜ ·Ú·ÙËÚ‹ÛÂÈ˜, Ú·ÎÙÈÎ¿ ı¤Ì·Ù·, ÁÂÓÈÎ¿ ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË

ÙË˜ È·ÙÚÈÎ‹˜ ÂÎ·›‰Â˘ÛË˜ Î·È ˘ÁÂ›·˜, Û˘˙ËÙ‹ÛÂÈ˜ ÛÙÚÔÁÁ˘ÏÔ‡ ÙÚ·Â˙ÈÔ‡, ÎÏÈÓÈÎÔ·ıÔÏÔÁÈÎ¤˜ Û˘˙ËÙ‹ÛÂÈ˜, ÛÂÌÈÓ¿ÚÈ·, Û˘ÌfiÛÈ·, ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÎÏÈÓÈÎ¤˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜, ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜, ¿ÚıÚ· Û˘ÓÂ¯È˙fiÌÂÓË˜ È·ÙÚÈÎ‹˜ ÂÎ·›‰Â˘ÛË˜, ÂÈÛÙÔÏ¤˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ‚È‚ÏÈÔÎÚÈÛ›Â˜, ÂÈÛÙËÌÔÓÈÎ‹ ÂÈ‰ËÛÂÔÁÚ·Ê›· fiˆ˜ ÂÓËÌ¤ÚˆÛË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Û˘ÓÂ‰Ú›ˆÓ, Û˘ÌÔÛ›ˆÓ Î·È

ÁÈ· ‰Ú·ÛÙËÚÈﬁÙËÙÂ˜ Û¯ÂÙÈÎ¤˜ ÌÂ ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡.

OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰Ë-

ÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎﬁ ¶AI¢IATPIKH ·ÔÛÙ¤ÏÏÔÓÙ·È

ÂÈ˜ ÙÚÈÏÔ‡Ó ÛÙË ‰ÈÂ‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹

EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·

MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 11528 Aı‹Ó·

¶AI¢IATPIKH ·ÎÔÏÔ˘ıÂ› ÙÈ˜ KÔÈÓ¤˜ ¶ÚÔ‰È·ÁÚ·Ê¤˜

ÁÈ· XÂÈÚﬁÁÚ·Ê· Ô˘ YÔ‚¿ÏÏÔÓÙ·È ÛÂ BÈÔ˚·ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿ 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)

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ô˘ Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, ÛÙËÓ ÔÔ›·: ·) ÂÚÈÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈÎ¿ Ë Û˘Ì‚ÔÏ‹ ÂÎ¿ÛÙÔ˘ ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ (Û¯Â‰È·ÛÌfi˜, ·Ó¿Ï˘ÛË, ÂÚÌËÓÂ›· Â˘ÚËÌ¿ÙˆÓ,Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ, Û˘ÁÁÚ·Ê‹ ÂÚÁ·Û›·˜, ·Ó·ÌfiÚÊˆÛË ÎÂÈÌ¤ÓÔ˘), ‚) ‰ËÏÒÓÂÙ·È fiÙÈ fiÏÔÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘Ó Î·È ÌÔÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙÔ ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË ÎÂ›ÌÂÓÔ ‹ ÙÌ‹Ì· ÙÔ˘, Á) ‰ËÏÒÓÂÙ·È Ë ÚÔ¤ÏÂ˘ÛË ÙË˜ ¯ÚËÌ·ÙÔ‰fiÙËÛË˜ ÁÈ· ÙË

Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÚÁ·Û›· (£· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙË˜ ÂÚÁ·Û›·˜), ‰) ‰ËÏÒÓÂÙ·È ·Ó ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ¤¯Ô˘Ó Î¿ÔÈ· ÔÈÎÔÓÔÌÈÎ‹ Û¯¤ÛË ÌÂ ÂÙ·ÈÚÂ›· ‹ ÔÚÁ·ÓÈÛÌfi Ô˘ ¤¯ÂÈ ÔÈÎÔÓÔÌÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ÁÈ· Ù· Â˘Ú‹Ì·Ù· ‹ ÙÈ˜ ·fi„ÂÈ˜ ÙÔ˘ Û˘ÁÁÚ·Ê¤· (·˘Ùfi ‰ÂÓ ÂËÚÂ¿˙ÂÈ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÓÙ·ÎÙÒÓ ·ÏÏ¿ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÁÓˆÛÙfi ÛÙÔ˘˜ ·Ó·ÁÓÒÛÙÂ˜), Â) ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ÙÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ· ÎÚ›ÛË ÛÂ ¿ÏÏÔ

EÏÏËÓÈÎﬁ ÂÚÈÔ‰ÈÎﬁ.

H ¶AI¢IATPIKH ÂÓı·ÚÚ‡ÓÂÈ ÙËÓ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ

Ô˘ ¤¯Ô˘Ó ‹‰Ë ‰ËÌÔÛÈÂ˘ÙÂ› ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ÛÂ

ÍÂÓfiÁÏˆÛÛ· ÂÚÈÔ‰ÈÎ¿ ÌÂ ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Û˘Ó˘Ô‚¿ÏÏÔ˘Ó ÊˆÙÔ·ÓÙ›ÁÚ·ÊÔ ÙË˜ ÍÂÓfiÁÏˆÛÛË˜ ‰ËÌÔÛ›Â˘ÛË˜ Î·È ÙËÓ ¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ‰ÈÂ˘ı˘ÓÙ‹ Û‡ÓÙ·ÍË˜ ÙÔ˘ ÍÂÓfiÁÏˆÛÛÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¶AI¢IATPIKH Î·È Ë ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌﬁÓÔ ÌÂÙ¿ ·ﬁ ¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ¢ÈÂ˘ı˘ÓÙ‹ ÙË˜ E.™.E. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜ Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È

ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ﬁÙÈ ¤ÁÈÓ·Ó Û‡ÌÊˆÓ· ÌÂ ÙË ‰È·Î‹Ú˘ÍË ÙÔ˘ EÏÛ›ÓÎÈ ÙÔ˘ 1975 ﬁˆ˜ ·Ó·ıÂˆÚ‹ıËÎÂ ÙÔ 1983, Î·È Û‡ÌÊˆÓ· ÌÂ ÙË ™‡Ì‚·ÛË ÁÈ· Ù· ¢ÈÎ·ÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡.

H Î·Ù·¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙËÓ ¶AI¢IATPIKH ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙÂ ¤ÁÎÚÈÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·, ÙËÓ EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EÎ‰fiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊﬁÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ Û˘ÓÔ‰Â˘ﬁÌÂÓÔ ·ﬁ

‰ÈÛÎ¤Ù· Î·È ÂÈÛÙÔÏ‹ ﬁÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿, ÛËÌÂ›Ô ÚÔ˜ ÛËÌÂ›Ô, ÔÈ ÙÚÔÔÔÈ‹ÛÂÈ˜ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂÈ˜ ÛÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ.

H Î·ı˘ÛÙ¤ÚËÛË ÙË˜ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈËÌ¤ÓÔ˘ ÎÂÈÌ¤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

T· ÎÂ›ÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚÂ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊﬁÛÔÓ ˙ËÙËıÂ›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁÚ·Ê›Â˜ Ô˘ Ù· Û˘ÓÔ‰Â‡Ô˘Ó.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ˜ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜

Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È ÌÂ ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ Î·ÙÂ˘ıÂ›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

vii

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶ÂÚÈÔ‰ÈÎ¿ AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ 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·ÎÙÈÎ‹ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:

™ÙÂÊ·Ó›‰Ë˜ A, KÔÚÈÙÛÈ¿‰Ë˜ ™, MÈ¯·‹Ï B, AÓ‰ÚÔ˘Ï·Î¿ÎË˜ ºA. O˘ÚÔ‰˘Ó·ÌÈÎ¿ Â˘Ú‹Ì·Ù· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÏÈ¤˜ ‚·Ï‚›‰Â˜ ÙË˜ 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ÏËÚˆÌ·ÙÈÎﬁ ÙÂ‡¯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˘ÁÁÚ·Ê¤·:

Coffee drinking and cancer of the pancreas [editorial]. BMJ 1981;283:628.

¶ÚÔÛ‰ÈÔÚÈÛÌﬁ˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

§ÂÎ¤· B, M·ÎÔ‡Ï· X, M·ÙÛ·ÓÈÒÙË˜ N. ¢È·ÓÔÛÔÎÔÌÂÈ·Î¤˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ 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 ÛÂ ‚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·: OÈÎÔÁÂÓÂÈ·Î¿ ÚﬁÙ˘· Î·È Û˘˙˘ÁÈÎ¤˜ Ú·ÎÙÈÎ¤˜. Aı‹Ó·: EıÓÈÎﬁ K¤ÓÙÚÔ KÔÈÓˆÓÈÎÒÓ EÚÂ˘ÓÒÓ 1995.

¢ËÌÔÛ›Â˘ÛË ÛÂ 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.

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

ÕÚıÚ· ÛÂ ËÏÂÎÙÚÔÓÈÎ‹ 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

¶›Ó·ÎÂ˜ Î·È ÂÈÎﬁÓÂ˜

AÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙﬁÙ˘Ô+‰‡Ô

ÊˆÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ

Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓﬁÛÙËÏÔ˘ (8 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ ﬁÏË˜ ÙË˜

ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› ÌÂ ÙÔ˘˜ Ù›ÙÏÔ˘˜ ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛﬁÙÂÚÔ ·ﬁ 22 cm.

OÈ ›Ó·ÎÂ˜ ·ÚÈıÌÔ‡ÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÌÂ

ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ Ì¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·ÎÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ Î¿ıÂÙÂ˜ ÁÚ·ÌÌ¤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ÊˆÙÔÁÚ·Ê›Â˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓÂ˜. £·

Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙË˜ ÔÈﬁÙËÙ·˜ ÌÂ ÌÔÚÊ‹ ÊˆÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™˘ÛÙ‹ÓÂÙ·È ÛÙ· Û¯‹Ì·Ù· Ó·

·ÔÊÂ‡ÁÔÓÙ·È ÔÈ ÛÎÈ¿ÛÂÈ˜ ÛÙÔ ÊfiÓÙÔ Î·È ÙÔ ÎÂ›ÌÂÓÔ Ì¤Û· ÛÙËÓ ÂÈÎfiÓ·. ™ÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó·

ÌÂ ÌÔÏ‡‚È Ô ·ÚÈıÌﬁ˜ ÙË˜ ÂÈÎﬁÓ·˜ Î·È ÙÔ

ÙÔ˘

Û˘ÁÁÚ·Ê¤·, Î·ıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ Ì¤ÚÔ˜ ÙË˜ ÂÈÎﬁÓ·˜. ™ÙÈ˜ ÊˆÙÔÁÚ·Ê›Â˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë

ﬁÙÈ ‰ÂÓ ¤¯ÂÈ ˘Ô‚ÏËıÂ› Û˘Á¯ÚﬁÓˆ˜ ÛÂ ¿ÏÏÔ

ÂÚÈÔ‰ÈÎfi Î·È ‰ÂÓ ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈÂ˘ÙÂ›. - ·Ó¿Ù˘Ô Î·È ÂÈÛÙÔÏ‹ ¤ÁÎÚÈÛË˜ ÙÔ˘ ‰ÈÂ˘ı˘ÓÙ‹ Û‡ÓÙ·ÍË˜ ÛÂ ÂÚ›ÙˆÛË Ô˘ ¤¯ÂÈ ‰ËÌÔÛÈÂ˘ÙÂ› ÛÂ ÍÂÓfiÁÏˆÛÛÔ ÂÚÈÔ‰ÈÎfi - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ - fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁÚ·Ê¤ˆÓ (ÔÏÔÁÚ¿Êˆ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ Î¤ÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·

- ﬁÓÔÌ·, ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤ÊˆÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·

- ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- Î·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- ÎÂ›ÌÂÓÔ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó

- ÂÈÎﬁÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó

- Ù›ÙÏÔÈ ÂÈÎﬁÓˆÓ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

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

● 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

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

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

MÂ ·ÊÔÚÌ‹ ÙË ‰ËÌÔÛ›Â˘ÛË ÛÂ ·˘Ùﬁ ÙÔ ÙÂ‡¯Ô˜

ÙÔ˘ ¿ÚıÚÔ˘ "H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿

ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ" ÙˆÓ M. Aı·Ó·Û›Ô˘ Î·È A. KÔ‡ÛË (1), Î·ıÒ˜ Â›ÛË˜ Î·È ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ YÁÂ›·˜ (WHO), ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ ÌÂ Î·ÚÎ›ÓÔ, 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·ÎÙÈÎ‹ ÙÔ˘

"ÌË fiÓÔ˘", fi¯È ÌfiÓÔ ÁÈ· ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎ¤˜ ·ı‹ÛÂÈ˜, ·ÏÏ¿ Î·È ÁÈ· fiÏ· ÂÎÂ›Ó· Ù· ÓÂÔÁÓ¿, ‚Ú¤ÊË

Î·È ·È‰È¿ Ô˘ ‚ÈÒÓÔ˘Ó ÂÒ‰˘ÓÂ˜ ÂÌÂÈÚ›Â˜.

TÔ ÂÚÈÔÚÈÛÌ¤ÓÔ ÎÏÈÓÈÎfi Î·È ÂÚÂ˘ÓËÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ÁÈ· ÙÔÓ fiÓÔ ÛÙ· ·È‰È¿, ‰ËÌÈÔ‡ÚÁËÛÂ ÏËıÒÚ· "Ì‡ıˆÓ", ÌÂÚÈÎÔ‡˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ú·ı¤Ùˆ. T· ·È‰È¿ ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ fiˆ˜ ÔÈ ÂÓ‹ÏÈÎÂ˜, ‰ÂÓ ı˘ÌÔ‡ÓÙ·È ÙÈ˜ ÂÒ‰˘ÓÂ˜ ÂÌÂÈÚ›Â˜ ÙÔ˘˜, ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ·ÓÙÔ¯‹ ÛÙÔÓ fiÓÔ, Î·È Ù¤ÏÔ˜ Âı›˙ÔÓÙ·È Â˘ÎÔÏfiÙÂÚ· ÛÙ· Ó·ÚÎˆÙÈÎ¿-·Ó·ÏÁËÙÈÎ¿. MÂ ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ÔÈ Ì‡ıÔÈ ·˘ÙÔ› Î·Ù·ÚÚ›ÊıËÎ·Ó Î·È ·Ô‰Â›¯ıËÎÂ ÙÂÏÈÎ¿ fiÙÈ ·ÎfiÌË Î·È ¤Ì‚Ú˘·, ·fi ÙÔ 2Ô ÙÚ›ÌËÓÔ ÙË˜ Î‡ËÛË˜, Â›Ó·È ·Ó·ÙÔÌÈÎ¿ Î·È ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎ¿ ÈÎ·Ó¿ Ó· ÓÔÈÒÛÔ˘Ó fiÓÔ Î·È ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ ÚÔÛ·ıÔ‡Ó Î·È Ó· ÙÔÓ ·ÔÊ‡ÁÔ˘Ó. (3)

H ·Ó·ÎÔ‡ÊÈÛË ·fi ÙÔÓ fiÓÔ, ¤Ó· Û‡ÓıÂÙÔ ÔÏ˘·Ú·ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ, ·ÔÙÂÏÂ› ‚·ÛÈÎfi ·ÓıÚÒÈÓÔ ‰ÈÎ·›ˆÌ· Ô˘ Ú¤ÂÈ Ó· ÚÔÛÂÁÁ›˙ÂÙ·È ·ÓÂÍ¿ÚÙËÙ· ·fi ËÏÈÎ›·. ¢ÂÓ ‰ÈÎ·ÈÔÏÔÁÔ‡Ì·ÛÙÂ Û˘ÓÂÒ˜ ˆ˜

ÂÌÂÈÚ›Â˜ ‹ ÚÔÛˆÈÎ¤˜

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ÂÈÚ›Â˜ ·˘Ù¤˜, ‰ÂÓ Â›Ì·È Ô‡ÙÂ ÔÏ‡ Û›ÁÔ˘ÚË Ô‡ÙÂ ·ÈÛÈfi‰ÔÍË fiÙÈ ÙÈ˜ ·Ó·Î·ÏÔ‡ÌÂ ÛÙË ÌÓ‹ÌË Ì·˜ ‰È·ÚÎÒ˜ ÒÛÙÂ Ó· ÌËÓ ÚÔÍÂÓ‹ÛÔ˘ÌÂ fiÓÔ ÂÌÂ›˜ ÔÈ ›‰ÈÔÈ.

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÂ Û˘ÛÙËÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù·, ﬁˆ˜ ÔÈ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ 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¿ ÌÂ Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù·, È‰È·›ÙÂÚ· ÛÙÔ Î·Ù·ÏËÎÙÈÎfi ÛÙ¿‰ÈÔ, fiˆ˜ ·Ó·Ï‡ÂÙ·È ÛÙÔ poster ÙË˜ WHO, ·ÔÙÂÏÂ› È‰È·›ÙÂÚÔ ·ÓÙÈÎÂ›ÌÂÓÔ Î·È Â˘ı‡ÓË ÔÌ¿‰·˜ ÏÂÈÙÔ˘ÚÁÒÓ ˘ÁÂ›·˜, Ô˘ ı· ÂÊ·ÚÌfiÛÔ˘Ó fiÏ· Ù· Û‡Á¯ÚÔÓ· Ì¤Û· ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.(1,2) H ÂÚÈÔ¯ÈÎ‹ ·Ó·ÈÛıËÛ›· Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÙÔÈÎ‹ Â›ıÂÛË ·Ó·ÈÛıËÙÈÎÒÓ ÎÚÂÌÒÓ, fiˆ˜ Ô Û˘Ó‰˘·ÛÌfi˜ ÏÈ‰ÔÎ·˝ÓË˜ÚÈÏÔÎ·˝ÓË˜, Ô ‰È·‰ÂÚÌÈÎfi˜ ËÏÂÎÙÚÈÎfi˜ ÓÂ˘ÚÔÂÚÂıÈÛÌfi˜ ÌÂ ·ÚÔ¯‹ ËÏÂÎÙÚÈÎÔ‡ ÚÂ‡Ì·ÙÔ˜ ¯·ÌËÏ‹˜ Û˘-

¯ÓﬁÙËÙ·˜ Î·È ÌÈÎÚ‹˜ Ù¿ÛË˜, Ë Ú·¯È·›· ·Ó·ÈÛıËÛ›· ÌÂ

¤Á¯˘ÛË ·Ó·ÈÛıËÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÛÙÔÓ ˘·Ú·¯ÓÔÂÈ‰‹ ¯ÒÚÔ, Ë Û˘ÓÂ¯‹˜ ÂÈÛÎÏËÚ›‰È· ·Ó·ÈÛıËÛ›· Î·È Ë

ÛÙÂÏÂ¯È·›· ·Ó·ÈÛıËÛ›·, ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ· ÌÂÚÈÎ¤˜

Â‡ÎÔÏÂ˜ Ú·ÎÙÈÎ¤˜ ÁÈ· ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÛÙÔ

NÔÛÔÎÔÌÂ›Ô.(4,5) TÔ Â›Â‰Ô ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘

ÛÙ· NÔÛÔÎÔÌÂ›· ÙˆÓ

ÓÂÔÁÓ¿, ‚Ú¤ÊË Î·È ·È‰È¿ ·fi ·Ï¤˜ È·ÙÚÈÎ¤˜ Ú·ÎÙÈÎ¤˜, fiˆ˜ ÊÏÂ‚ÔÎÂÓÙ‹ÛÂÈ˜, ÂÌ‚ÔÏÈ·ÛÌÔ‡˜, ÙÔÔı¤ÙËÛË Î·ıÂÙ‹ÚˆÓ, ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂÈ˜, Î.Ï. (6) ø˜ ‰ÈÎ·ÈÔÏÔÁ›· ÚÔ‚¿ÏÏÂÙ·È Û˘Ó‹ıˆ˜ ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ÔÈ È·ÙÚÈÎ¤˜ ·˘Ù¤˜ Ú¿ÍÂÈ˜ Â›Ó·È ÙÈ˜ ÈÔ

ÔÏÏ¤˜ ÊÔÚ¤˜ ÂÂ›ÁÔ˘ÛÂ˜ ÛÙ· ·È‰È¿, ¤ÙÛÈ ÒÛÙÂ ‰ÂÓ

˘¿Ú¯ÂÈ ¯ÚﬁÓÔ˜ ÚÔÂÙÔÈÌ·Û›·˜ ÌÂ Ê¿ÚÌ·Î· ‹ „˘¯Ô-

ÏÔÁÈÎ‹ ˘ÔÛÙ‹ÚÈÍË. ¶Ú¿ÁÌ·ÙÈ, ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒ-

ÛÂÈ˜ Ô˘ Â›Ó·È ÂÂ›ÁÔ˘ÛÂ˜, Ô ÁÈ·ÙÚﬁ˜ ÛÙ·ıÌ›˙ÂÈ ÙÔ

fiÊÂÏÔ˜ ·fi ÌÈ· ÁÚ‹ÁÔÚË ‰È¿ÁÓˆÛË ¤Ó·ÓÙÈ ÙÔ˘ fi-

ÓÔ˘ Ô˘ ı· ÚÔÎ·Ï¤ÛÂÈ. ™Â fiÏÂ˜ fiÌˆ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ˘¿Ú¯ÂÈ ÙÚfiÔ˜ Ó· ÌÂÙÚÈ¿ÛÔ˘ÌÂ ÙÔÓ fiÓÔ, fiÙ·Ó

·Ê‹ÛÔ˘ÌÂ ÙË ÌËÙ¤Ú· Ó· ÎÚ·Ù¿ÂÈ ÙÔ ¯¤ÚÈ ÙÔ˘ ·È‰ÈÔ‡

ÙË˜ ‹ ¤Ó·Ó ¿ÏÏÔ ÁÈ·ÙÚﬁ Ó· ··Û¯ÔÏÂ› ÙÔ ·È‰›.

TÈ Á›ÓÂÙ·È ﬁÌˆ˜ ÌÂ ÙËÓ Î·ıËÌÂÚÈÓ‹ ¿ÛÎËÛË ÙË˜

·È‰È·ÙÚÈÎ‹˜ ÛÙÔ È·ÙÚÂ›Ô, ÙÔ K¤ÓÙÚÔ YÁÂ›·˜ ‹ ÙÔ

AÁÚÔÙÈÎﬁ I·ÙÚÂ›Ô; TÈ Á›ÓÂÙ·È ﬁÙ·Ó ÙÔ ·È‰› ·ÚÓÂ›Ù·È Ó·

¿ÂÈ ÛÙÔ ÁÈ·ÙÚﬁ ÁÈ· Ó· Î¿ÓÂÈ ÂÌ‚ﬁÏÈÔ, ÁÈ·Ù› ÛÙÔ

ÚÔËÁÔ‡ÌÂÓÔ ﬁÓÂÛÂ; H ·¿ÓÙËÛË Â›Ó·È ·Ï‹. £·

Ú¤ÂÈ Ó· ·ÊÈÂÚÒÓÔ˘ÌÂ Ï›ÁÔ ¯ÚﬁÓÔ ·Ú·¿Óˆ ÁÈ·

·È‰›, Ó· ·ÍÈÔÔÈÔ‡ÌÂ ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ÛˆÛÙ¿, Ó· ‰ÈÂÈÛ‰‡Ô˘ÌÂ ÛÙË ‰ÔÌ‹ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (‰È·˙‡ÁÈÔ, ÌÔÓÔÁÔÓÂ˚Î‹ ÔÈÎÔÁ¤ÓÂÈ·, ·ÒÏÂÈ· ·È‰ÈÔ‡) ÁÈ· Ó· ÎÂÚ‰›ÛÔ˘ÌÂ ÙËÓ ÂÌÈÛÙÔÛ‡ÓË ÁÔÓÈÔ‡ Î·È ·È‰ÈÔ‡. N· ÂÊ·ÚÌfi˙Ô˘ÌÂ fiÏÂ˜ ÂÎÂ›ÓÂ˜ ÙÈ˜ ÌÂıfi‰Ô˘˜ „˘¯ÔÏÔÁÈÎ‹˜ ˘ÔÛÙ‹ÚÈÍË˜ Ô˘ ıÂˆÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ ·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘, Â›ÙÂ ˆ˜ ·ÓÂÍ¿ÚÙËÙÂ˜ Â›ÙÂ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹. OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜ ÂÌÏ¤ÎÔ˘Ó Î·È ÙÔ˘˜ ÁÔÓÂ›˜, ÔÈ

ÔÔ›ÔÈ ı· Ú¤ÂÈ Ó· ÚÔÂÙÔÈÌ¿˙Ô˘Ó ÙÔ ·È‰› ÙÔ˘˜ ÁÈ·

Î¿ıÂ È·ÙÚÈÎ‹ Ú¿ÍË Î·È Ó· ÙÔ „˘¯·ÁˆÁÔ‡Ó Ì·˙› ÌÂ

ÙÔÓ ÁÈ·ÙÚﬁ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‰È¿ÊÔÚ· ·È¯Ó›‰È· ‹

‚È‚Ï›· ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘. °È· Ó· Ê¤ÚÔ˘Ó

fiÏÂ˜ ·˘Ù¤˜ ÔÈ Ú·ÎÙÈÎ¤˜ 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· ÙË˜ ÌÂıfi‰Ô˘. ¶·ÚfiÏÔ Ô˘ Ô ¯ÚfiÓÔ˜ Â›Ó·È ÔÏ‡ÙÈÌÔ˜, ÔÏÏÔ› ·È‰›·ÙÚÔÈ Â˘Ù˘¯Ò˜, ÂÓËÌÂÚÒÓÔ˘Ó ÙÔ˘˜ ÁÔÓÂ›˜ ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ·˘Ùfi Â›Ó·È ÔÏ‡ ÂÓı·ÚÚ˘ÓÙÈÎfi. ™‹ÌÂÚ·, Ô˘ Ë ÂÈÏÔÁ‹ ÙË˜ ÂÈ‰ÈÎfiÙËÙ·˜ ‰ÂÓ Á›ÓÂÙ·È Ù˘¯·›·, ·ÏÏ¿ Ô ÁÈ·ÙÚfi˜ ÌÂ ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ· Î·È Û˘ÓÂÎÙÈÌÒÓÙ·˜ ÙÔ ¯ÚfiÓÔ ·Ó·ÌÔÓ‹˜ ÁÈ· ¤Ó·ÚÍË ÙË˜ ÂÈ‰ÈÎfiÙËÙ·˜ ÙËÓ ÂÈÏ¤ÁÂÈ, ÓÔÌ›˙ˆ, fiÙÈ ÔÈ Û‡Á¯ÚÔÓÔÈ ·È‰›·ÙÚÔÈ ı· Á›ÓÔ˘Ó Î·Ï‡ÙÂÚÔÈ ·fi Ì·˜. £· Ú¤ÂÈ ‚¤‚·È· Î·È ÂÌÂ›˜ ˆ˜ ‰¿ÛÎ·ÏÔÈ Ó· ÙÔ˘˜ ‰È‰¿ÍÔ˘ÌÂ Î·È Ó· ÙÔ˘˜ ‰Â›ÍÔ˘ÌÂ ÌÂ ÙÔ ·Ú¿‰ÂÈÁÌ¿ Ì·˜, fiÙÈ ÂÎÙfi˜ ·fi ÙË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Î·È ÙË ıÂÚ·Â˘ÙÈÎ‹ ·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· ·ÔÙÂÏÂ› Î·ı‹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¿ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓﬁÛÔ. ¶·È‰È·ÙÚÈÎ‹ 2000;63:17-20.

2.TÛ›ÙÔ˘Ú· ™. Aﬁ‰ÔÛË Ô‰ËÁÈÒÓ ÙË˜ WHO. Cancer pain relief and palliative care in children. ¶·È‰È·ÙÚÈÎ‹ 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˘‚ÂÏ¤ÎË M, T˙Ô˘‚ÂÏ¤ÎË˜ °. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿. EÈÛÙËÌÔÓÈÎ‹ EÂÙËÚ›‰· TÌ‹Ì·ÙÔ˜ I·ÙÚÈÎ‹˜ A.¶.£. 1997;23:1, 51-63.

º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ MËÙÚÔﬁÏÂˆ˜ 55, 54623 £ÂÛÛ·ÏÔÓ›ÎË

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

EÏ¤ÓË B·Ï¿ÛÛË- A‰¿Ì

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

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

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

∫ey words: peer review, Paediatriki.

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. EÎ‰ﬁÛÂÈ˜ ¶··˙‹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,

Patterson L et al. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: a case review and cohort study. Lancet 1999;354:2101-2105.

11.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.

12.™ÔÏ‰¿ÙÔ˜ KP. ™˘ÓÙ·ÎÙÈÎfi ¤ÚÁÔ. ™Ùfi¯ÔÈ Î·È ‰È·‰ÈÎ·Û›·. ÛÙÔ °Ú·Ùfi Û˘ÌfiÛÈÔ: ¶Ò˜ ÁÚ¿ÊÂÙ·È ¤Ó· È·ÙÚÈÎfi ¿ÚıÚÔ. AÚ¯Â›· EÏÏ I·ÙÚ 1995,12215-217.

13.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

14.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 ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ª. ∞Û›·˜ 76, 115 27 ∞ı‹Ó·

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

● Abstract: The indications and limitations of chest radiographs are discussed with respect to childhood pneumonia. ∫ey words: radiographs, pneumonia.

ø˜ ÓÂ˘ÌÔÓ›· ÔÚ›˙ÂÙ·È Ë ÊÏÂÁÌÔÓ‹ ÙˆÓ Î˘„ÂÏ›‰ˆÓ ·fi ÏÔÈÌÔÁfiÓ· ·›ÙÈ·. ¢È·ÎÚ›ÓÂÙ·È, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ¤ÎÙ·ÛË ÙË˜ ‚Ï¿‚Ë˜, ÛÂ ÏÔ‚Ò‰Ë, ÙÌËÌ·ÙÈÎ‹, Î·È ˘ÔÙÌËÌ·ÙÈÎ‹ ‹ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓ›·. ¢È·ÎÚ›ÓÂÙ·È ·ÎfiÌË, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ÙfiÔ ÚÔ¤ÏÂ˘ÛË˜ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·, ÛÂ ÓÂ˘ÌÔÓ›· ÙË˜ ÎÔÈÓfiÙËÙ·˜ Î·È ÛÂ ÓÔÛÔÎÔÌÂÈ·Î‹. A˘Ùfi ÙÔ ¿ÚıÚÔ Û‡ÓÙ·ÍË˜ ·Ó·Ê¤ÚÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙËÓ

H ÓÂ˘ÌÔÓ›· ÙË˜ 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¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ (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 ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡, ÂÎÙfi˜ ·fi ÙË Û˘¯ÓfiÙËÙ·, Î·ıÔÚ›˙ÂÈ ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·. ŒÙÛÈ, Ë ÓÂ˘ÌÔÓ›· ÙÔ˘ ÓÂÔÁÓÔ‡ ÔÊÂ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÂ ‚·ÎÙ‹ÚÈ· (‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ ÙË˜ ÔÌ¿‰·˜ B, ÏÈÛÙ¤ÚÈ·, ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ·ÚÓËÙÈÎ¿ Î·Ù¿ Gram ‚·ÎÙ‹ÚÈ·), ·ÏÏ¿ ÛÂ ÈÔ‡˜ (.¯.

CMV, Èfi˜ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·). H ÓÂ˘ÌÔÓ›· ÛÙ· ‚Ú¤ÊË ÂÓfi˜ ¤ˆ˜ ÙÚÈÒÓ ÌËÓÒÓ Û˘¯Ó¿ ÔÊÂ›ÏÂÙ·È ÛÙÔ ¯Ï·Ì‡‰ÈÔ ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜, ÙÔ Ô˘ÚÂ¿Ï·ÛÌ· urealyticum, ÙÔ Ì˘ÎfiÏ·ÛÌ· hominis ·ÏÏ¿ Î·È ÛÂ ÈÔ‡˜ (CMV, RSV, ÈÔ› ÙË˜ ÁÚ›Ë˜ Î·È ÙË˜ ·Ú·ÁÚ›Ë˜, ·‰ÂÓÔ˚Ô›). H ÓÂ˘ÌÔÓ›· ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ 4 ÌËÓÒÓ Ì¤¯ÚÈ 5 ÂÙÒÓ Û˘¯ÓfiÙÂÚ· ÔÊÂ›ÏÂÙ·È ÛÂ ÈÔ‡˜ (RSV, ÈÔ› ÁÚ›Ë˜, ·Ú·ÁÚ›Ë˜, ·‰ÂÓÔ˚Ô›) Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÛÂ ‚·ÎÙ‹ÚÈ· (ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜, ·ÈÌfiÊÈÏÔ˜ ÙË˜ ÁÚ›Ë˜, Î·Ù·ÚÚÔ˚Î‹ ÌÔÚ·Í¤Ï·). H ÓÂ˘ÌÔÓ›· ÛÙË Û¯ÔÏÈÎ‹ Î·È ÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›· (6-21 ÂÙÒÓ) Î˘Ú›ˆ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ‚·ÎÙËÚÈ·Î¿ ·›ÙÈ· (ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜, Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È· ÓÂ˘ÌÔÓ›·˜) (1). H ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ·ÔÙÂÏÂ› ÙËÓ ÂÚÁ·ÛÙËÚÈ·Î‹ Ì¤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓÂ˘ÌÔÓ›·˜. TÔÓ›˙ÂÙ·È fiÌˆ˜, fiÙÈ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË, ÛÙËÓ ÔÔ›· ÌÂ ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ· Èı·ÓÔÏÔÁÂ›Ù·È ÓÂ˘ÌÔÓ›· (1,2) ‰ÈfiÙÈ: ·) ·ÚÎÂÙ¿ Û˘¯Ó¿, ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘, Ë ÓÂ˘ÌÔÓ›· Ô˘ ‰È·ÁÈÁÓÒÛÎÂÙ·È ÌÂ ‚¿ÛË ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ‰ÂÓ ÂÈ‚Â‚·ÈÒÓÂÙ·È ·ÎÙÈ-

ÓÔÏÔÁÈÎ¿, ‚) Ë ÂÈ‚¿Ú˘ÓÛË ·fi ÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· ÙË˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·Î· Â›Ó·È ˘ÔÏÔÁ›ÛÈÌË, È‰È·›ÙÂÚ· ·Ó ¤¯Ô˘Ó Á›ÓÂÈ ÚÔËÁÔ˘Ì¤Óˆ˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ ÁÈ· ÙÔÓ ›‰ÈÔ ‹ ¿ÏÏÔ ÏfiÁÔ, Î·È Á) ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ÓÂ˘ÌÔÓÈÒÓ ÛÙ· ·È‰È¿ Â›Ó·È ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÂÔÌ¤Óˆ˜ Ë ·ÂÈÎÔÓÈÛÙÈÎ‹ ÂÈ‚Â‚·›ˆÛË ‰ÂÓ ÚÔÛÊ¤ÚÂÈ ıÂÚ·Â˘ÙÈÎ‹ ‚Ô‹ıÂÈ·.

AÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÂÈ‚¿ÏÏÂÙ·È Ó· Á›ÓÂÙ·È (1,3) fiÙ·Ó: ·) ÔÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È Ù· ÛÙËı·ÎÔ˘ÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ÙË˜ ÓÂ˘ÌÔÓ›·˜ ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ‚·ÎÙËÚÈ·Î‹˜ ÓÂ˘ÌÔÓ›·˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÂÓ ÂÈÛËÁÔ‡ÓÙ·È Û·ÊÒ˜ ÈÔÁÂÓ‹ ÚÔ¤ÏÂ˘ÛË ÙË˜ (.¯. ÂÁÎ·Ù¿ÛÙ·ÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ ·ÈÊÓ›‰È· ÌÂ ˘„ËÏfi ˘ÚÂÙfi, ·Ô˘Û›· ÂÎ‰ËÏÒÛÂˆÓ ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·, ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ÛÙËı·ÎÔ˘ÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ), ‚) Ë ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÂËÚÂ·ÛÌ¤ÓË, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Èı·ÓÔÏÔÁÔ‡ÌÂÓÔ ·›ÙÈÔ (Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ·˘Ù‹˜ ı· ·ÔÙÂÏ¤ÛÔ˘Ó ÛÙÔÈ¯Â›· ·Ó·ÊÔÚ¿˜ ÁÈ· ÙËÓ ·ÂÈÎÔÓÈÛÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘), Î·È Á) Ë ·ÓÙÈ‚›ˆÛË Ô˘ ‹‰Ë ¤¯ÂÈ ¯ÔÚËÁËıÂ› ¤¯ÂÈ ·ÔÙ‡¯ÂÈ. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ë ·ÎÙÈÓÔÁÚ·Ê›· Â›Ó·È ÂÓ‰Â¯fiÌÂÓÔ Ó· ·ÔÎ·Ï‡„ÂÈ ˘¿Ú¯Ô˘Û· ÂÈÏÔÎ‹

H ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·, ÂÎÙﬁ˜ ·ﬁ ÙËÓ ÂÈ‚Â-

ÙË˜ ÎÏÈÓÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜, ‚ÔËı¿ ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ Èı·ÓÔÏfiÁËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÙË˜. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙËÓ ÈÔÁÂÓ‹ ÓÂ˘ÌÔÓ›· Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ¤¯ÂÈ ·ÌÊÔÙÂÚfiÏÂ˘Ú· ‰È¿Û·ÚÙ· Â˘Ú‹Ì·Ù· Ô˘ Û˘Ó›ÛÙ·ÓÙ·È ÛÂ ˘ÔÙÌËÌ·ÙÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜, Û˘Ó‹ıˆ˜ Î·Ù¿ ÙËÓ ‡ÏË, ·ÙÂÏÂÎÙ·Û›Â˜ Î·È ÂÛÙ›Â˜ ˘ÂÚ·ÂÚÈÛÌÔ‡ (4,5). ™ÙË ‚·ÎÙËÚÈ·Î‹ ÓÂ˘ÌÔÓ›· ÎÏ·ÛÈÎfi ·ÎÙÈÓÔÏÔÁÈÎfi Â‡ÚËÌ· Â›Ó·È Ë ‰È‹ıËÛË ÙÌ‹Ì·ÙÔ˜ ‹ ÔÏfiÎÏËÚÔ˘ ÏÔ‚Ô‡ ÓÂ‡ÌÔÓ· (6). MÔÚÂ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ·fiÛÙËÌ·, ÓÂ˘Ì·ÙÔÎ‹ÏË ‹ Î·È ˘Â˙ˆÎÔÙÈÎ‹ Û˘ÏÏÔÁ‹. H Ì˘ÎÔÏ·ÛÌÈÎ‹ Î·È Ë ¯Ï·Ì˘‰È·Î‹ ÓÂ˘ÌÔÓ›· ‰È·Ê¤-

ÚÔ˘Ó ·ÂÈÎÔÓÈÛÙÈÎ¿, ﬁˆ˜ ÂÍ¿ÏÏÔ˘ Î·È ÎÏÈÓÈÎ¿, ·ﬁ ÙÈ˜ ¿ÏÏÂ˜ ‚·ÎÙËÚÈ·Î¤˜ ÓÂ˘ÌÔÓ›Â˜ Î·È Ù· Â˘-

Ú‹Ì·Ù· ÌÔÈ¿˙Ô˘Ó ÌÂ ÙË˜ ÈÔÁÂÓÔ‡˜, ÙË˜ ‚·ÎÙËÚÈ·-

Î‹˜ ÓÂ˘ÌÔÓ›·˜ ‹ Î·È ÙˆÓ ‰‡Ô Ì·˙› (7,8). ŒÙÛÈ, Ù·

·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÙË˜ Ì˘ÎÔÏ·ÛÌÈÎ‹˜ ‹ ÙË˜

¯Ï·Ì˘‰È·Î‹˜ ÓÂ˘ÌÔÓ›·˜ ÌÔÚÂ› Ó· Â›Ó·È ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜ ‰È¿Û·ÚÙÂ˜ ÂÚÈ‚ÚÔÁ¯ÈÎ¤˜ ‹ ÂÚÈ·ÁÁÂÈ·Î¤˜ ‰ÈËı‹ÛÂÈ˜ ‹ ÂÙÂÚfiÏÂ˘ÚÂ˜ ÙÌËÌ·ÙÈÎ¤˜ ˘ÎÓÒÛÂÈ˜. ™˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ‰ÈfiÁÎˆÛË ÙˆÓ ˘Ï·›-

Î·È

ÊÔÚ¤˜ ˘Â˙ˆÎÔÙÈÎ‹ Û˘ÏÏÔÁ‹, Û˘Ó‹ıˆ˜ ÌÈÎÚ‹. H ÂÓ‰Â‰ÂÈÁÌ¤ÓË ÚÔ‚ÔÏ‹ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓÂ˘ÌÔÓ›·˜ Â›Ó·È Ë

ÚÔÛıÔ›ÛıÈ· (9). ¶ÚﬁÛıÂÙÂ˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ (.¯. Ï¿ÁÈÂ˜, ÏÔÍ¤˜) ÌÔÚÂ› Ó· ‰ÒÛÔ˘Ó ÂÈÏ¤ÔÓ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙËÓ ÂÓÙﬁÈÛË Î·È ÙËÓ ¤ÎÙ·ÛË ÙË˜

ÓÂ˘ÌÔÓ›·˜ ÌfiÓÔ ÛÂ ÔÛÔÛÙfi Ô˘ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 3% Î·È ÁÈ' ·˘Ùfi ÛÙËÓ Ú¿ÍË Û¿ÓÈ· ¯ÚÂÈ¿˙ÔÓÙ·È. E·Ó¿ÏË„Ë ÙË˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·Î· Á›ÓÂÙ·È ÌfiÓÔ ÛÙÈ˜ ‚·ÎÙËÚÈ·Î¤˜ ÓÂ˘ÌÔÓ›Â˜, ‰ËÏ·‰‹ ÛÙÈ˜ ÏÔ‚Ò‰ÂÈ˜ ‹ ÙÌËÌ·ÙÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜, ÁÈ· Ó· ‚Â‚·ÈˆıÂ› Î·È ·ÂÈÎÔÓÈÛÙÈÎ¿ Ë ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ‚Ï¿‚Ë˜ Î·È Î˘Ú›ˆ˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙÂ› ÙÔ ÂÓ‰Â¯fiÌÂÓÔ Ó· ÚÔ¸‹Ú¯Â ·Ó·ÙÔÌÈÎ‹ ‚Ï¿‚Ë (.¯. Û˘ÁÁÂÓ‹˜ Î‡ÛÙË, ·fiÏ˘Ì·) (1,10). MÂ ‰Â‰ÔÌ¤ÓÔ fiÙÈ ÔÈ ·ÎÙÈÓÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜

ÓÂ˘ÌÔÓ›·˜ ·ÔÎ·ı›ÛÙ·ÓÙ·È ÛÂ ‰È¿ÛÙËÌ· Ô˘

ÌÔÚÂ› Ó· Êı¿ÛÂÈ ÙÈ˜ 8 Â‚‰ÔÌ¿‰Â˜, Ô ·ÎÙÈÓÔÏÔÁÈÎﬁ˜ Â·Ó¤ÏÂÁ¯Ô˜ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ‰‡Ô Ì‹ÓÂ˜

ÂÚ›Ô˘ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓÂ˘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

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

4.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.

5. 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.

6.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.

7.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.

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.

●

ANA™KO¶H™H

KÔÎÎÈˆÌ·ÙÒ‰Ë˜ Ë·Ù›ÙÈ‰·

¢ËÌÔÛı¤ÓË˜ AÏÂÍ›Ô˘, ŸÏÁ· °Ú·Ê¿ÎÔ˘

¶ÂÚ›ÏË„Ë: ÕÚıÚÔ ·Ó·ÛÎﬁËÛË˜ ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙË Û˘¯ÓﬁÙËÙ·, ÙË Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·, Î·ıÒ˜ Î·È ÙËÓ ·ÈÙÈÔÏÔÁ›·, ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ È‰ÈÔ·ıÔ‡˜ (ÚˆÙÔ·ıÔ‡˜) Î·È ÙË˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÔÎÎÈˆÌ¿ÙˆÛË˜ ÙÔ˘ ‹·ÙÔ˜. ¶·È‰È·ÙÚÈÎ‹ 2000;63:9-16.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ë·Ù›ÙÈ‰·, ·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 ‰ÔÎÈ-

Ì·ÛÈÒÓ, ﬁˆ˜ ÌÈÎÚ¿ ·‡ÍËÛË, Ì¤¯ÚÈ 200 IU/l, ÙˆÓ

ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ Á-GT Î·È

ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÚÎÂÙ¿

Û˘¯Ó¿ ÛÂ ‰È¿ÊÔÚÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ (1).

™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ Ë ÎÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‹·ÙÔ˜ ‰ÂÓ Â›Ó·È Û˘¯Ó‹, ÂÓÒ ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ Û¿ÓÈÔ ·ÏÏ¿ ˘·ÚÎÙfi Â‡ÚËÌ· Â›Ó·È ÙÔ ÎÔÎÎ›ˆÌ·. ¶·Ï·ÈfiÙÂÚ·, ·Ó·ÊÂÚfiÙ·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ·ÓÂ‡ÚÂÛË˜ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÂ ˘ÏÈÎfi ‚ÈÔ„ÈÒÓ ‹·ÙÔ˜

ÁÂÓÈÎÔ‡ ÓÔÛÔÎÔÌÂ›Ô˘ ·ÓÂÚ¯ﬁÙ·Ó ÛÂ 3-10% (2).

¶›Ó·Î·˜ 1. A›ÙÈ· ÚﬁÎÏËÛË˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH Î·Ù¿ ÛÂÈÚ¿ Êı›ÓÔ˘Û·˜ Û˘¯ÓﬁÙËÙ·˜.

™·ÚÎÔÂ›‰ˆÛË

º˘Ì·Ù›ˆÛË

§ÔÈÌÒÍÂÈ˜

(ÌÈÎÚÔ‚È·Î¤˜, ÈÔÁÂÓÂ›˜, Ì˘ÎËÙÈ·ÛÈÎ¤˜, ÚÈÎÂÙÛÈÒÛÂÈ˜)

XÚﬁÓÈÂ˜ Ë·ÙÔ¿ıÂÈÂ˜ Î·È ÈÔÁÂÓÂ›˜ Ë·Ù›ÙÈ‰Â˜

(ÚˆÙÔ·ı‹˜ ¯ÔÏÈÎ‹ Î›ÚÚˆÛË, Ë·Ù›ÙÈ‰· A Î·È C)

º¿ÚÌ·Î·

IÛÙÔÏ¿ÛÌˆÛË

•¤ÓÂ˜ ÚÔ˜ ÙÔÓ ÔÚÁ·ÓÈÛÌﬁ Ô˘Û›Â˜ (¯·ÏÎﬁ˜, ‚ËÚ‡ÏÏÈÔ, Ù·ÏÎ Î·È ¿ÏÏ· Ì¤Ù·ÏÏ·)

Vial Î·È Descotes 1993, ÙÚÔÔ. (4).

OÈ Mac Cluggage Î·È Sloam (3) ÛÂ ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Î¿Ï˘Ù·Ó ÂÚ›Ô‰Ô 13 ¯ÚfiÓˆÓ (1980-92) ·Ú·Ù‹ÚËÛ·Ó ÂÈıËÏÈ·Î¿ ÎÔÎÎÈÒÌ·Ù· ÛÙÔ 4%. EÚfiÎÂÈÙÔ ‰ËÏ·‰‹ ÁÈ· ÂÚÈÙÒÛÂÈ˜ ÎÔÎÎÈˆÌ·ÙÒ‰Ô˘˜ Ë·Ù›ÙÈ‰·˜ (KH) Ô˘ ‚Ú¤ıËÎ·Ó ˆ˜ ‰Â˘ÙÂÚÔ·ıÂ›˜ ÂÎ‰ËÏÒÛÂÈ˜ Î¿ÔÈ·˜ ·ıÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÌÂ Û˘¯ÓfiÙÂÚË ÙËÓ ÚˆÙÔ·ı‹ ¯ÔÏÈÎ‹ Î›ÚÚˆÛË (55%) Î·È ÙË Û·ÚÎÔÂ›‰ˆÛË (19%). ÕÏÏÂ˜ ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ·ÈÙ›Â˜ ‹Ù·Ó Ë Ê˘Ì·Ù›ˆÛË, Ë ÓfiÛÔ˜ ÙÔ˘ Crohn, Ë ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ Ë·Ù›ÙÈ‰·, Ë ˘ÂÚÂ˘·ÈÛıËÛ›· ÛÂ Ê¿ÚÌ·Î· Î·È Ë ÂÍˆË·ÙÈÎ‹ ·fiÊÚ·ÍË ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·ÁÁÂ›ˆÓ. ™Â 11 ·ÛıÂÓÂ›˜ (ÔÛÔÛÙfi 75%) Ë KH ıÂˆÚ‹ıËÎÂ È‰ÈÔ·ı‹˜. ™ÙÔÓ ›Ó·Î· 1 Ê·›ÓÔÓÙ·È Ù· ·ıÔÁÂÓÂÙÈÎ¿ ·›ÙÈ· ÙË˜ KH ÛÂ ¿ÏÏË ÌÂÏ¤ÙË. ™Â ·Ó¿ÏÔÁË ¤ÚÂ˘Ó· ·fi ÙË BfiÚÂÈÔ IÙ·Ï›· (5) ÛÂ 1523 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÂ 5 ¯ÚfiÓÈ·, ÎÔÎÎÈÒÌ·Ù· ‚Ú¤ıËÎ·Ó ÛÙÔ 1%, ‰ËÏ·‰‹ ÛÂ 15 ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ 43-71 ¯ÚfiÓˆÓ (Ì¤ÛË ËÏÈÎ›· 57 ¯ÚfiÓÈ·). T· Â˘Ú‹Ì·Ù· ·Ô‰fiıËÎ·Ó Î˘Ú›ˆ˜ ÛÂ ÏÔÈÌÒ‰ÂÈ˜ ÓfiÛÔ˘˜.

B' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

¢È·¯ÚÔÓÈÎ¿, ÔÏÏÔ› Û˘ÁÁÚ·ÊÂ›˜ ‰È·›ÛÙˆÛ·Ó ÌÂÌÔÓˆÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ÛÂ Û˘Ó-

ı‹ÏÈÔ ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙˆÓ ÎﬁÏˆÓ ÙÔ˘ ‹·ÙÔ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔÈÎ‹˜ Ó¤ÎÚˆÛË˜ (50,51).

¶ÚﬁÛÊ·ÙÂ˜ ÂÈÚ·Ì·ÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ·Ó·ÊÔÚÈÎ¿

ÌÂ ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ÎÔÎÎÈˆÌ·ÙÒ‰Ô˘˜ Á·ÛÙÚÂÓÙÂ-

Ú›ÙÈ‰·˜ Î·È ÙË˜ KH ¤‰ÂÈÍ·Ó ﬁÙÈ ˘¿Ú¯ÂÈ ÁÂÓÂÙÈÎ‹ ÚÔ-

‰È¿ıÂÛË ÁÈ· ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Î·ÏÈ-

ÎÚÂ˝ÓË˜-ÎÈÓ›ÓË˜ Ë ÔÔ›· ÚÔ‰È·ı¤ÙÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›·

ÎÔÎÎÈˆÌ¿ÙˆÛË˜ ÛÙÔ ¤ÓÙÂÚÔ Î·È ÙÔ ‹·Ú. ¶ÚﬁÎÂÈÙ·È

ÁÈ· ‰ÈÊ·ÛÈÎ‹ ·Ú·ÙÂÙ·Ì¤ÓË ‰ÈÂÚÁ·Û›· ÌÂ ·˘ÙﬁÌ·ÙË

Î·Ù¿ ÙË 14Ë ËÌ¤Ú· ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡

‰ËÌÈÔ˘ÚÁ›·˜ ÎÔÎÎÈˆÌ¿ÙˆÛË˜ Ô˘ ‰È·ÚÎÂ› Ì¤¯ÚÈ Î·È

16 Â‚‰ÔÌ¿‰Â˜ (52).

IÛÙÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·

O Bernstein Î·È Û˘Ó.(51) ‹Û·Ó ÔÈ ÚÒÙÔÈ Ô˘ Â-

ÚÈ¤ÁÚ·„·Ó ÙËÓ ·ÚÔ˘Û›· ·Û˘Ó‹ıˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÂ

ÂÚÈÙÒÛÂÈ˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜ ·ﬁ coxiella Burnetti (ÔÍÂ›· ÚÔ‚ÔÏ‹ ˘ÚÂÙÔ‡ Q) (26). OÈ ‚Ï¿‚Â˜ ¯·Ú·-

ÎÙËÚ›˙ÔÓÙ·Ó ·ﬁ ÙËÓ ·ÚÔ˘Û›· ÎÂÓÙÚÈÎÔ‡ ÏÈÒ‰Ô˘˜

ÎÂÓÔÙÔ›Ô˘ Ô˘ ÂÚÈ‚·ÏÏﬁÙ·Ó ·ﬁ ÈÓÒ‰Â˜ ‰·ÎÙ‡ÏÈÔ, ·ÚÔ˘Û›· ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È Ì·ÎÚÔÊ¿ÁˆÓ. H ·-

ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ˘ÚÂÙﬁ Q ÂÈ‚Â‚·ÈÒıËÎÂ ÛÙË Û˘Ó¤¯ÂÈ· Î·È ·ﬁ ¿ÏÏÔ˘˜, ÒÛÙÂ

Î·Ù·Ú¯‹Ó Ó· ıÂˆÚÂ›Ù·È ˆ˜ ÂÈ‰ÈÎﬁ Â‡ÚËÌ· ÙË˜ ÏÔ›ÌˆÍË˜ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘. MÂÙ·ÁÂÓ¤ÛÙÂÚ· ·Ô‰Â›¯ÙËÎÂ

ﬁÙÈ Â›Ó·È Â‡ÚËÌ· Ô˘ ··ÓÙ¿Ù·È Î·È ÛÂ ¿ÏÏÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜. KÔÎÎÈÒÌ·Ù· ‰˘Ó·ÙﬁÓ Ó· ‚ÚÂıÔ‡Ó Î·È ÛÙÔ˘˜ Ì‡Â˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÁÂÓÈÎÂ˘Ì¤ÓË˜ ÎÔÎÎÈˆÌ¿ÙˆÛË˜. ™ÙËÓ È‰ÈÔ·ı‹ KH ·ÓÂ˘Ú›ÛÎÔÓÙ·È

Û˘Ó‹ıˆ˜ ÔÏÏ·Ï¿ ÎÔÎÎÈÒÌ·Ù· ·ﬁ ÂÈıËÏÈÔÂÈ‰‹

Î‡ÙÙ·Ú· Ô˘ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ÌÂ ÔÏ˘˘ÚËÓÈÎ¿

ÁÈÁ·ÓÙÔÎ‡ÙÙ·Ú· Î·È ÂÚÈ‚¿ÏÏÔÓÙ·È ·ﬁ ÌÈÎÚ¿ ÏÂÌ-

ÊÔÎ‡ÙÙ·Ú· Î·È ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ. EÓÙﬁ˜ ÙÔ˘ ‹·ÙÔ˜ ÔÈ

‚Ï¿‚Â˜ Â›Ó·È ‰È¿¯˘Ù· ‰ÈÂÛ·ÚÌ¤ÓÂ˜.

™Â ‰Â˘ÙÂÚÔ·ı‹ KH ·ﬁ ÏÔ›ÌˆÍË, ÔÈ ÈÛÙÔÏÔÁÈÎ¤˜

‚Ï¿‚Â˜ Û‡ÁÎÂÈÓÙ·È ·ﬁ Ô˘‰ÂÙÂÚﬁÊÈÏÔ ÎÔÎÎÈˆÌ·ÙÒ-

‰Ë ‰È‹ıËÛË ÌÂ Û¯ËÌ·ÙÈÛÌﬁ ÎÂÓÙÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜.

H ‰È¿ÌÂÙÚÔ˜ ÙˆÓ ‚Ï·‚ÒÓ ·Ó¤Ú¯ÂÙ·È ÛÂ ÌÂÚÈÎ¿ ¯ÈÏÈÔÛÙ¿ (2-5 mm).

£ÂÚ·Â›·

K·Ù¿ ÙË˜ ÓfiÛÔ˘ ·Ï·ÈfiÙÂÚ· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ë ·ÛÈÚ›ÓË Î·È Ù· ÌË ÛÙÂÚÈÓÔÂÈ‰‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿ÚÌ·Î· (53), ‚·ÛÈÎ¿ fiÌˆ˜ Ë ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓË˜ (54) Ë ÔÔ›· ·Ô‰Â›¯ÙËÎÂ ÔÏ‡ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÙfiÛÔ ÛÙËÓ ‡ÊÂÛË ÙÔ˘ ˘ÚÂÙÔ‡, fiÛÔ Î·È ÛÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÔ ‹·Ú. EÓÙÔ‡ÙÔÈ˜, ÔÚÈÛÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ‰ÂÓ ··ÓÙÔ‡Ó ‹ ¯ÚÂÈ¿˙ÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÔÏ‡ ˘„ËÏÒÓ ‰fiÛÂˆÓ ÎÔÚÙÈ˙fiÓË˜ ÁÈ· Ì·ÎÚ‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ¤¯Ô˘ÌÂ Â˘ÓÔ˚Î¿ ·ÔÙÂÏ¤ÛÌ·Ù·, ÔfiÙÂ

ÎÔ‹ ÙË˜, ‰ÔÎÈÌ¿ÛÙËÎÂ Ë ÌÂıÔÙÚÂÍ¿ÙË Î·È Ë ˘‰ÚÔ¯ÏˆÚÔÎ›ÓË.

H ÌÂıÔÙÚÂÍ¿ÙË ¤¯ÂÈ ‚Ú·‰Â›· ·¿ÓÙËÛË, ·ÏÏ¿ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· (55), ·Ó Î·È ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ. H ¯ÔÚ‹ÁËÛ‹ ÙË˜ Á›ÓÂÙ·È ÛÂ ÌÈÎÚ¤˜ ‰fiÛÂÈ˜ ÁÈ· Ó· ÌÂÈˆıÂ› Ë Èı·ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ·ÚÂÓÂÚÁÂÈÒÓ, ‰ËÏ·‰‹ ÛÂ ‰fiÛË 0,20 mg/kg B™ Â‚‰ÔÌ·‰È·›·. A˘ÚÂÍ›· ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÂ 3 ÂÚ›Ô˘ Ì‹ÓÂ˜ ·fi ÙËÓ ·Ú¯‹ ÙË˜ ¯ÔÚ‹ÁËÛË˜. MÂ ÙË ‰fiÛË ·˘Ù‹ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ‹ ·ÔÙ˘¯›Â˜. H ˘‰ÚÔÍ˘¯ÏˆÚÔÎ›ÓË, ÛÂ ‰fiÛË 400 mg/24ˆÚÔ ¯ÔÚËÁ‹ıËÎÂ ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ ÌÂ KH. O ÌË¯·ÓÈÛÌfi˜ ‰Ú¿ÛË˜ ÙË˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. º·›ÓÂÙ·È fiÙÈ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Ì¤Ûˆ ÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ ÚÔÎ·ÏÔ‡ÌÂÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ B ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ÏfiÁˆ ·Ó·ÛÙÔÏ‹˜ ÙË˜ ·ÂÏÂ˘ı¤ÚˆÛË˜ ·Ú·ÁfiÓÙˆÓ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ¤Ó·ÚÍË Î·È ‰È·Ù‹ÚËÛË ÙË˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛË˜ ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜-1 (56). H ‰Ú¿ÛË ·˘Ù‹ ‰˘Ó·ÙfiÓ Ó· ·Ó·ÛÙÂ›ÏÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Ô˘

··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ (57). ÕÏÏ· ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ Ê¿ÚÌ·Î· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ È‰ÈÔ·ı‹ KH ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë, ÙËÓ ‚ÈÌÏ·ÛÙ›ÓË Î·È ÙËÓ ¯ÏˆÚ·ÌÔ˘Î›ÏË. Afi ÙÔ˘˜ Knox Î·È Û˘Ó.(55) ÚÔÙ¿ıËÎÂ ÙÔ ·ÎfiÏÔ˘ıÔ ıÂÚ·Â˘ÙÈÎfi Û¯‹Ì·. K·Ù·Ú¯‹Ó, Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÊ˘Ì·ÙÈÎ‹˜ ·ÁˆÁ‹˜ ÛÙ· ¿ÙÔÌ· ÌÂ ıÂÙÈÎ‹ mantoux ‹ ÌÂ ·ÓÂÚÁ›· ÌÂ ÛÎÔfi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÎÂ¯ÚÔÂÈ‰Ô‡˜ Ê˘Ì·Ù›ˆÛË˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· Û˘ÌÙÒÌ·Ù· Û˘ÓÂ¯›˙ÔÓÙ·È, ¯ÔÚËÁÂ›Ù·È ÚÂ‰ÓÈ˙fiÓË. AÓ Ë ··ÈÙÔ‡ÌÂÓË ÁÈ· ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰fiÛË Â›Ó·È ÌÂÁ¿ÏË, Ù· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰‹ ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi ÙË ¯ÔÚ‹ÁËÛË ÌÂıÔÙÚÂÍ¿ÙË˜ ÛÙËÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓË ‰fiÛË.

BÈ‚ÏÈÔÁÚ·Ê›·

1. Camath PS. Clinical approach to the patient with abnormal liver tests. Mayo Clin Proc 1996;11:1086-1094.

2.Edmonson HA. Needle biopsy in differential diagnosis of acute liver disease. JAMA 1965;191:480-486.

3.Mc Cluggage WG,Sloam JM. Hepatic granulomas in Northern Ireland: a thirteen year review. Histopath 1994; 25: 219-28.

4. Vial T, Descotes J. Hepatities granulomateuses medicamenteuses. Gastroentrol Clin Biol 1993;17:H44-8.

5. Guglielmi V, Manghisi OG, Pirelli M, Caruso ML. Granulomatous hepatitis in a hospital population in southern Italy. Patol 1994;86:271-278.

6. Satrin JS, Walker RC. Granulomatous hepatitis: a retrospective review of 88 cases at the Mayo Clinic. Mayo Clin Proc 1991;66: 914-918.

7.Karat ABA, Job CK, Rao PSS. Liver in leprosy: histological and biochemical findings. BMJ 1971;1: 307-10.

8. Harrington PT, Guttierez JJ, Ramirez Ronda CH, Quinones Soto R, Bermudes JJ, Chaffey J. Granulomatous hepatitis. Rev Infect Dis 1982;4:638-55.

9.Giovagnoni A, Gabrielli O, Coppa GV, Catassi C, Giorgi P. MRI appearances in amoebic granulomatous hepatitis: a case report. Pediat Radio 1993; 23:536-537.

10.Villaverde M, Gurini L, Gonzalez A, Cohen R, Febrile syndrome; myocarditis and brucellosis Medicina B Aires 1995;55:145-146.

11.Satti BM, Al Feihi H, Ezzeldin M, Abu Melha IA, Al Ghassab FG, et al. Granuloma in Saudi Arabia. A clinicopathological study of 50 cases. Am J Gastrenterol 1990;85: 669-674.

12.Moreno A, Marazuala M, Yebra M, Hernandez M, Hellin T et al. Hepatic fibrin ring granulomas in visceral leishmaniasis. Gastroenterol 1988;95: 1123-26.

13.Miller MH, Urowitz MB, Gladman DD, Blendis LM. The liver in systemic lupus erythematosus. Quart J Med 1984;211: 401-409.

14.Heyries L, Perreau M, Monges D, Chrestian MA, Gerolani A. Hepatic granulomatosis associated with mononucleosis syndrome secondary to cytomegalovirus infection: a propos of 2 cases in healthy adults. Rev Med Intern 1994;15: 744-746.

15.Lorenzo DA, de Asanza GC, Duran GF, Piqueeras B, Romero et al. Cytomegalovirus infection as a cause of granulomatous hepatitis in an immunocompetent patient. Rev Esp Enferm Dig 1996;88: 295-297.

16.Font J, Bruguera M, Perez Villa F, Ingelmo M. Hepatic fibrin ring granulomas caused by staphylococcus epidermidis generalized infection (letter) Gastroenterol 1987;93: 1449-51.

17.Proctor DD, Chopra S, Rubenstein SC, Jokela JA, Uhlt . Mycobacteremia and granulomatous hepatitis following initial intravesical bacillus Calmette Guerin instillation for bladder carcinoma. Am J Gastroenterol 1993;88: 11121115.

18.Deresiewicz PL, Stone RM, Aster JC. Fatal disseminated mycobacterial infection following intravesical bacillus Calmette Guerin J Urol 144; 1331: 1990.

19. Hsueh PR, Hsiue TR, Jarn JJ, Ho SW, Hsieh WC. Disseminated infection due to Mycobacterium scrofulatum in an immunocompetent host. Clin Infect Dis 1996;22: 159161.

20.Rogler G, Balle C, Antoiniou E, Heinissch A, Bocker T et al. Miliary tuberculosis and silicosis with predominantly cerebral symptoms Dtsch Med Wochenschr 1996;121: 588-592.

21.Rey Diaz Rubio E, Toxonera Samso C, Real Martinez Y, Diaz Rubio M. Changes in the use of percutaneous liver biopsy over time. Rev Esp Enferm Dig 1995; 87: 375-378.

22.Dangman BC, Albanese BA, Kacica MA, Lepow ML, Wallach MT. Cat scratch disease in two children presenting with fever of unknown origin; imaging features and association with a new causative agent, Rochalimaea Henselae. Pediatrics 1995; 95: 767-771.

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.

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.

25.Lopez VF, Rippe ML, Soler T, Rodriquez A, Arribas JM et al. Erythema nodosum and acute Q fever. Report of a case with granulomatous hepatitis and immunological abnormalities (letter). Acta Derm Venereol 1997; 77: 73-74.

26. Orenstein MS, Tavitian A, York B, et al. Hepatic granulomas: experience over a ten year period in the west of Scotland Q J Med 1982;51: 162-170.

27.Leebek FW, Ouwendijk RJ, Kolk AH, Dees A, Meek JC et al Granulomatous hepatitis caused by bacillus Calmette Guerin (BCG) infection after bladder instillation. Gut 1996;38: 616-618.

28. Hilzenrat N, Lamoureay E, Sherker A, Cohen A. Cholestasis in Crohn’s disease: a diagnostic challenge. Can J Gastroenterol 1997; 11: 35-37.

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

30.Knobler H, Levu IS, Gavish D, Chajek Shaul T. Quinidine induced hepatitis. A common and reversible hypersensitivity reaction. Arch Intern Med 1986; 1’46: 526-528.

31.Horney E, Lagerstedt C, Waderwik H. A case report. Thrombocytopenia and granulomatous hepatitis caused by quinine. Lakartidnihgen 1996; 93: 361-364.

32.Van Everdingen Bongers JJ, Janssen P, Lammens M, Stricker BH, Bravenboer B. Granulomatous hepatitis attributed to the combination of pyrimethamine and chloroquine. Ne D Tijdsch Geneeskd 1996; 140: 320-322.

33.Ramond MJ, Nouel O, Degott C, Lebrec D, Benhamou JD. Hepatite a l’allopurinol. Etude d'un cas et revue de la litterature. Gastroenterol Clin Biol 1982; 6: 138-142.

34.Levy M, Goodman MW, van Dyke BJ, Summer HW. Granulomatous hepatitis secondary to carbamazepine. Ann Intern Med 1981; 95: 64-65.

35.Ruiz-Valverde P, Zaron C, Seggara A, Ribera R, Pierra L. Ticlopidine induced granulomatous hepatitis (letter). Ann Pharmacother 1995; 29: 633-634.

36.Lacaille F, Ortigas MB, Debre M, Rousioux C, Brousse N et al. Hepatic toxicity associated with 2'3'dideoxyinosine in children with AIDS. J Pediatr Gastroenterol Nutr;20: 287-290.

37.Lindgren A, Aldenborg F, Norkans G, Olaison L, Olsson R. Paracetamol induced cholestatic and granulomatous liver injuries. J Intern Med 1997;241: 435-439.

38.Elzouki AN, Lindgren S. Granulomatous hepatitis induced by aspirin-codeine analgesics. J Intern Med 1996;239: 279-281.

39. Mathur S, Dooley J, Scheuer PJ. Quinine induced granulomatous hepatitis and vasculitis. BMJ 1990; 300613.

40.Ingelmo M, Vivancos J, Bruguera M, Sierra J, Balcells A. Hypersensitivity angeitis and granulomatous hepatitis induced by glibenclamide: a propos of one case. Med Clin 1980;75: 306-308.

41.Pariente EA, Maitre F, Marchant JP. Hepatite due a la quinidine. Etude dun cas et review de la litterature.

Gastronterol Clin Biol 1986;10: 255-258.

42. Guillou L, Breaud P. Hepatitie granulomateuse et dermatite exfoliative secondaire a un traitement par la carmabazepine. Gastrenterol Clin Biol 1991;15: 170-1

43.Mir Madjlessi SH, Farmer RG, Hawk WA: Granulomatous hepatitis: a review of 50 cases. Am J Gastronetrol 1973; 60: 122-134.

44.Bunim JJ, Kinberg DV, Thomas KB, Van Scott EJ, Klatskin G. The syndrome of sarcoidosis, psorasis, and gout: combined clinical staff conference at the National Institute of Health. Ann Intern Med 1962;57: 1018-1040

45.Mills P, Saverymuttu S, Fellowfield M, Nussey S, Joseph AEA. Ultrasound in the diagnosis of granulomatous liver disease. Clin Radiol 1990; 41: 113-115.

46.Vilades C, Ferre R, Martin-Urda A, Vidal F, Mayayo E, Richard C. Granulomatous hepatitis and fever of unknown origin. Ann Intern Med 1994; 11: 334-337.

47.Pappo O, Ramos H, Starzi J, Demetris AJ. Structural integrity and identification of causes of liver allograft dysfunction occuring more than 5 years after transplantation. Am J Surg Pathol 1995; 19: 192-206.

48. Klatsin G. Hepatic granulomata: problems in interpretation. Ann NY Acad Sci 1976;278: 427-432.

49.Pelegrin M, Delsol G, Auvernat JC, et al. Granulomatous hepatitis in Q fever. Hum Pathol 1980;11: 51-57.

50.Bearer EA, Savides TJ, Mc Cutchan JA. Endoscopic diagnosis and management of hepatobiliary tuberculosis. Am J Gastroenterol 1996;91: 2602-2604.

51.Bernstein M, Edmonson HA, Barbour BH. The liver lesion in Q fever. Clinical and pathological features. Arch Intern Med 1965;116: 491-498.

52.Vanterstigel M, Zafrani S, Lejonc JL, Chaeffer A, Postos JL. Allopurinol hypersensitivity syndrome as a cause of hepatic fibrin ring granulomas. Gastroenterol 1986;90: 188-190.

53.Sartor RB, De La Cadera RA, Green KD, Stadnicki A Davis SW, Achwab JH et al. Selective kallikrein kinine system activation in inbred rats differentially susceptible to granulomatous enterocolitis. Gastroenterol 1996; 110: 1467-1481.

54. Berlin CM, Boal DK, Zaino RJ, Karl SR. Hepatic granulomata presenting with prolonged fever. Clin Pediatr 1990; 29: 339-342.

55. Knox TA, Kaplan MM, Gelfland SM. Metronidazole treatment of idiopathic granulomatous disease Ann Intern Med 1955; 122: 592-595.

56.Salmeron G, Lipsky PE. Immunosuppressive potential of antibacterials. Am J Med 1983;75: 19-24.

57.Soskel NT, Fox R. Sarcoidosis ... or something like it. South Med J 1990;83: 1190-1202.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-11 -98

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢. AÏÂÍ›Ô˘

B' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

●

H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓﬁÛÔ

MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘ - MÂÙ·Í¿, AÊÚÔ‰›ÙË KÔ‡ÛË

¶ÂÚ›ÏË„Ë: OÈ ÂÒ‰˘ÓÂ˜ ÎÚ›ÛÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÓÔÛËÚﬁÙËÙ·˜ ÛÙÔ˘˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜. O

ﬁÓÔ˜ ÙË˜ ıÚÔÌ‚ˆÙÈÎ‹˜ ÎÚ›ÛË˜ Â›Ó·È ÔÍ‡˜ Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙ· Ì·ÎÚ¿ ÔÛÙ¿, ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË Î·È ÛÙÈ˜ ÏÂ˘Ú¤˜.

E›Ó·È ÔÏ˘ÂÛÙÈ·Îfi˜, ·ÌÊÔÙÂÚfiÏÂ˘ÚÔ˜ ‹ ÌÂÙ·Ó·ÛÙÂ˘ÙÈÎfi˜. ¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÈÛÂ‡‰Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜ ÂÒ‰˘ÓË˜ ÎÚ›ÛË˜ ıÂˆÚÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂÈ˜, 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ËÚÂ¿˙ÂÙ·È ·fi ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ Î·ıÒ˜ Î·È ·fi ÎÔÈÓˆÓÈÎÔ‡˜ Î·È „˘¯ÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. H ÂÏ·ÊÚ¿ ˆ˜ Ì¤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ ÌÂ ÍÂÎÔ‡Ú·ÛË, ·ÂÚÈfiÚÈÛÙË

Ï‹„Ë ˘ÁÚÒÓ, ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏÏ›ÓË˜ Î·È ÌË ÔÈÔÂÈ‰ÒÓ ·Ó·ÏÁËÙÈÎÒÓ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÂÏ·ÊÚ¿ ËÚÂÌÈÛÙÈÎ¿. IÛ¯˘Úfi˜ fiÓÔ˜ ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 48 ˆÚÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÈÛ·ÁˆÁ‹ ÛÙÔ NÔÛÔÎÔÌÂ›Ô

¯ÔÚËÁÔ‡ÓÙ·È ÂÓ‰ÔÊÏ¤‚È· ˘ÁÚ¿, ·ÓÙÈ-

2000;63:17-20.

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.

ÎÚ›ÛÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (13). O fiÓÔ˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛË˜ ÛÙËÓ ¿ÛËÙË Ó¤ÎÚˆÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Ô˘ Û˘Ì‚·›ÓÂÈ ÏfiÁˆ ·fiÊÚ·ÍË˜ ÙË˜ ÙÂÏÈÎÔ‡ Ù‡Ô˘ ·ÁÁÂ›ˆÛË˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.(1) ™‹ÌÂÚ· È-

IVEÓ‰ÔÊÏ¤‚È· POAﬁ ÙÔ ÛÙﬁÌ·

SupAﬁ ÙÔ ÔÚıﬁ

PCAP˘ıÌÈ˙ﬁÌÂÓË ·ﬁ ÙÔÓ ·ÛıÂÓ‹ ·Ó·ÏÁËÛ›·

Aºª∞Ê·ÈÌ·ÍÔÌÂÙ¿ÁÁÈÛË

A' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ A.¶.£.

¶›Ó·Î·˜ 1. MË ÔÈÔÂÈ‰‹ ·Ó·ÏÁËÙÈÎ¿

O‰fiÃÓÒÙÂÚË ‰fiÛË (mg) AÓÒÙÂÚË ‰fiÛË (mg)

ºAPMAKA¯ÔÚ‹ÁËÛË˜¢ﬁÛË mg/Kg¶·È‰È¿∂Ó‹ÏÈÎÂ˜

¶APAKETAMO§H

Dolal, Panadol, LonaridPO, Sup15-20/4 ÒÚÂ˜3-6¯Ú. 500/24 ÒÚÂ˜2500/24 ÒÚÂ˜

ªH ™TEPOEI¢H

ANTIº§E°MONø¢H

ªÂÊ·ÈÓ·ÌÈÎﬁ ÔÍ‡ PonstanPO5-6/6 ÒÚÂ˜500/8 ÒÚÂ˜

N·ÚÔÍ¤ÓË NaprosynPO, Sup5-8/12 ÒÚÂ˜500/12 ÒÚÂ˜

IÌÔÚÔ˘Ê·›ÓË µrufenPO, Sup3-10/6 ÒÚÂ˜500/6 ÒÚÂ˜

IÓ‰ÔÌÂı·Î›ÓË IndocidPO, Sup,IM1-2/8-12 ÒÚÂ˜50/8 ÒÚÂ˜

∆ÔÏÊ·ÈÓ·ÌÈÎﬁ ÔÍ‡ GantilPO3-5/6/8 ÒÚÂ˜200/8 ÒÚÂ˜

¢ÈÎÏÔÊ·ÈÓ¿ÎË Ó·ÙÚÈÔ‡¯Ô˜ VoltarenPO Sup,IM150/24 ÒÚÂ˜ 2-6 ¯Ú. 50/24 ÒÚÂ˜

À‰ÚÔÍ˘˙›ÓË AtaraxPO, π.ª.1/24 ÒÚÂ˜6-12 ¯Ú. 100/24 ÒÚÂ˜50-100/6 ÒÚÂ˜

¶›Ó·Î·˜ 2. OÈÔÂÈ‰‹ ·Ó·ÏÁËÙÈÎ¿ O‰fiÃÓÒÙÂÚË ‰fiÛË (mg) AÓÒÙÂÚË ‰fiÛË (mg)

ºAPMAKA¯ÔÚ‹ÁËÛË˜¢ﬁÛË mg/Kg¶·È‰È¿∂Ó‹ÏÈÎÂ˜

Kˆ‰Â˝ÓË ºˆÛÊÔÚÈÎ‹PO, πª0,5-3/4-6 ÒÚÂ˜

¢È¸‰ÚÔÎˆ‰Â˝ÓË DolcontinPO1/4-6 ÒÚÂ˜60/12 ÒÚÂ˜

™À¡¢À∞™ªOÿ Kø¢∂´¡∏˜

Kˆ‰Â˝ÓË+·Ú·ÎÂÙ·ÌﬁÏË Depon plusPO LonalgalPO, Sup∞Ó¿ÏÔÁ· ÌÂ ÙË∞Ó¿ÏÔÁ· ÌÂ ÙË∞Ó¿ÏÔÁ· ÌÂ ÙË MedamolPO, SupÛ‡ÓıÂÛËÛ‡ÓıÂÛËÛ‡ÓıÂÛË

Kˆ‰Â˝ÓË+·Ú·ÎÂÙ·ÌﬁÏË+ ∫·ÊÂ˝ÓË∞Ó¿ÏÔÁ· ÌÂ ÙË∞Ó¿ÏÔÁ· ÌÂ ÙË∞Ó¿ÏÔÁ· ÌÂ ÙË Lonarid NPO, SupÛ‡ÓıÂÛËÛ‡ÓıÂÛËÛ‡ÓıÂÛË

¢ÂÍÙÚÔÚÔÔÍ˘Ê·›ÓË

RomidonPO, IM1 tabl(65mg)/6-8 ÒÚÂ˜

ZideronIV1 amp(75mg)/8-12 ÒÚÂ˜300/24 ÒÚÂ˜600/24 ÒÚÂ˜

PO(powder)25-50/3-4 ÒÚÂ˜

¶ÂıÈ‰›ÓË ˘‰ÚÔ¯ÏˆÚÈÎ‹IM1-5/2 ÒÚÂ˜

ªeperidineIV0,2-0,6/1 ÒÚ· Bolus0,5-1/2 ÒÚÂ˜

ªÔÚÊ›ÓË Sulfate

Morficontin (tabl 100 mg)PO0,3-0,6/12 ÒÚÂ˜

Mongol (caps 10,30,60,100 mg)PO0,2-0,5/4-6 ÒÚÂ˜

πª ‹ Sub0,1-0,2/3-4 ÒÚÂ˜

ªÔÚÊ›ÓË ˘‰ÚÔ¯ÏˆÚÈÎ‹IV0,01-0,06/1 ÒÚ·

Morficontin (tabl 100 mg)*Bolus,*PCA

*¶ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ ÛÙÔ ÎÂ›ÌÂÓÔ

Î·È ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· ÌÂ Û‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË ËÚÂÌÈÛÙÈÎÒÓ (¶›Ó·Î·˜ 1). E¿Ó Ô ﬁÓÔ˜ ÂÈÌ¤ÓÂÈ ‹ ÂÈ‰ÂÈÓÒÓÂÙ·È ¯ÔÚËÁÔ‡ÓÙ·È ÔÈÔÂÈ‰‹ ÛÂ Û˘Ó‰˘·ÛÌﬁ ÌÂ ÌË ÛÙÂÚÔÂÈ‰‹ ·Ó·ÏÁËÙÈÎ¿ Î·È ËÚÂÌÈÛÙÈÎ¿.

‹ IV ‹ bolus

¤Á¯˘ÛË, ‹ Ú˘ıÌÈ˙ﬁÌÂÓË ·ﬁ ÙÔÓ ·ÛıÂÓ‹ ·Ó·ÏÁËÛ›· ÌÂ ·ÓÙÏ›· (PCA) ÌÂ Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· (9,12,13).

XÚÂÈ¿˙ÂÙ·È ÚÔÛÔ¯‹ ÛÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÔÈÔÂÈ‰ÒÓ ·Ó·ÏÁËÙÈÎÒÓ Î·È ÂÍ·ÙÔÌ›ÎÂ˘ÛË ÙˆÓ ‰fiÛÂˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ıÂÚ·Â˘ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÏfiÁˆ ÙˆÓ ÂÌ-

Ê·ÓÈ˙ﬁÌÂÓˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ (·ÁÁÂÈÔ‰È·-

ÛÙÔÏ‹, ¿ÚÂÛË ÏÂ›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ, Û·ÛÌÔ›, ·Ú·È-

Ûı‹ÛÂÈ˜, Î·Ù·ÛÙÔÏ‹ ·Ó·ÓÔ‹˜) ÔÈ ÔÔ›Â˜ ÌÔÚÂ› Ó·

Â›Ó·È ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓ‹ (9).

£ÂˆÚÂ›Ù·È ÛÎfiÈÌË Ë ÂÚÈÁÚ·Ê‹ ·Ó·Ï˘ÙÈÎ¿ ÙË˜ bolus Î·È ÙË˜ ÂÏÂÁ¯fiÌÂÓË˜ ·fi ÙÔÓ ·ÛıÂÓ‹ ‹ ÙÔ ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi ¯ÔÚ‹ÁËÛË ÌÔÚÊ›ÓË˜. ¶·Ú·-

ÛÎÂ˘¿˙ÂÙ·È ‰È¿Ï˘Ì· ÌÔÚÊ›ÓË˜ 1 mg/kg ÛÂ 50ml ÔÚÔ‡ 5% Dextrose. ™ÙË ‚·ÛÈÎ‹ bolus ¤Á¯˘ÛË ÌÔÚÊ›ÓË˜ ¯ÔÚËÁÔ‡ÓÙ·È 5ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÂÊ¿·Í ‚Ú·‰¤ˆ˜.

E¿Ó Ô ﬁÓÔ˜ ÂÈÌ¤ÓÂÈ ¯ÔÚËÁÔ‡ÓÙ·È 2,5 ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÌÂÙ¿ 10-15'. E·Ó¿ÏË„Ë ÙË˜ ›‰È·˜ ‰ﬁÛË˜, ·Ó

¯ÚÂÈ¿˙ÂÙ·È ÌÂÙ¿ 10-15'. AÎÔÏÔ˘ıÂ› Ë ‰ﬁÛË Û˘ÓÙ‹ÚË-

ÛË˜ ÌÂ ¯ÔÚ‹ÁËÛË 1ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ·Ó¿ ÒÚ· Ì¤¯ÚÈ

ÛËÌ·ÓÙÈÎ‹˜ ˘Ô¯ÒÚËÛË˜ ÙÔ˘ ﬁÓÔ˘ ÌÂ ‚·ıÌÈ·›·

ÂÏ¿ÙÙˆÛË ÙË˜ ‰ﬁÛË˜ ¤ˆ˜ 0,5ml/h. H IV ¯ÔÚ‹ÁËÛË

ÌÔÚÊ›ÓË˜ ÌÂ PCA ÂÊ·ÚÌﬁ˙ÂÙ·È ÛÂ ·È‰È¿ ¿Óˆ ·ﬁ 7

¯ÚfiÓˆÓ Î·È Ú˘ıÌ›˙ÂÙ·È ·fi ÙÔ ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙÔÓ ·ÛıÂÓ‹ (9). XÔÚËÁÂ›Ù·È

1ml/h ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ¤ˆ˜ 12h ÛÂ Û˘ÓÂ¯‹ ¤Á¯˘ÛË. E¿Ó Ô fiÓÔ˜ ÂÈÌ¤ÓÂÈ ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÈ Û˘Ó‰˘·ÛÌfi˜ IV Î·È bolus ¤Á¯˘ÛË 1ml Î¿ıÂ 10’. AÓÙ›‰ÔÙÔ ÙË˜ ÌÔÚÊ›ÓË˜ Â›Ó·È Ë ˘‰ÚÔ¯ÏˆÚÈÎ‹ Ó·ÏÔÍfiÓË

(Narcan) Ô˘ ¯ÔÚËÁÂ›Ù·È IV ÛÂ ‰ﬁÛË 0,1-0,4 mg /2'- 3'.

¶ÚÔÙÈÌ¿Ù·È Ë IV ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ, ··È-

ÙÂ›Ù·È fiÌˆ˜ È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈfiÙÈ ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ

·ÚÂÓÂÚÁÂÈÒÓ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ› ·‡ÍËÛË ÙË˜

‰È·ÂÚ·ÙﬁÙËÙ·˜ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ Ô˘ ‰˘Ó·-

ÙfiÓ Ó· ÚÔ‰È·ı¤ÙÔ˘Ó ÛÂ ÔÍ‡ ıˆÚ·ÎÈÎfi ‹ ÓÂ˘ÌÔÓÈÎfi

Ô›‰ËÌ· (1,14).O Êﬁ‚Ô˜ ÙÔ˘ Èı·ÓÔ‡ ÂıÈÛÌÔ‡ ÛÙ·

ÔÈÔÂÈ‰‹ Â›Ó·È ·‚¿ÛÈÌÔ˜. H ÔÈÔÊÔ‚›· ‚·Û›˙ÂÙ·È ÛÙË

Û‡Á¯˘ÛË Ô˘ ˘¿Ú¯ÂÈ ÌÂÙ·Í‡ Ê˘ÛÈÎ‹˜ ÂÍ¿ÚÙËÛË˜

Î·È ÂıÈÛÌÔ‡. H Û˘¯ÓﬁÙËÙ· ÙÔ˘ ÂıÈÛÌÔ‡ ·ﬁ ¯Ú‹ÛË

ÔÈÔÂÈ‰ÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·Ó¤Ú¯ÂÙ·È ÛÙÔ 0,03% (9).

™ÙË ‚·ÚÈ¿ ÂÒ‰˘ÓË ÎÚ›ÛË Ô˘ ÂÈÌ¤ÓÂÈ ¿Óˆ ·fi 48 ÒÚÂ˜ Î·È ‰ÂÓ ÂÏ¤Á¯ÂÙ·È ÌÂ ÔÈÔÂÈ‰‹ ·Ó·ÏÁËÙÈÎ¿ 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· Î·Ù¿ ÌÈ·˜ ÌÂÙ¿ÁÁÈÛË˜ (1). E›ÛË˜ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ﬁÙÈ ÂÒ‰˘ÓË ıÚÔÌ‚ˆÙÈÎ‹ ÎÚ›ÛË Ô˘ ‰ÂÓ ÂÏ¤Á¯ıËÎÂ ÌÂ ÙËÓ ¯ÔÚ‹ÁËÛË ÔÈÔÂÈ‰ÒÓ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÂÈÙ˘¯Ò˜ ÌÂ Û˘ÓÂ¯‹ ÂÈÛÎÏËÚ›‰ÈÔ ·Ó·ÏÁËÛ›· (3,15).

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-07-99

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 24-09-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M. Aı·Ó·Û›Ô˘

AÁ. ™ÔÊ›·˜ 30, £ÂÛÛ·ÏÔÓ›ÎË 546 22

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 ËÌ¤ÚÂ˜ Î·È ‚·ıÌÈ·›· ‰È·ÎÔ‹ ÙˆÓ ·Ó·ÏÁËÙÈÎÒÓ. H ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÂÍ·ÎÔÏÔ˘ıÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· Ó· ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi Î·È ‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ· ÙË˜ È·ÙÚÈÎ‹˜. H ÂÈÙ˘¯‹˜ Î·È ·ÛÊ·Ï‹˜ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ˘˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂ ÙËÓ ÔÏ‡ÏÂ˘ÚË ÚÔÛ¤ÁÁÈÛ‹ ÙÔ˘, ı· ÌÔÚÔ‡ÛÂ Ó· ‚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˘‚ÂÏ¤ÎË M, T˙Ô˘‚ÂÏ¤ÎË˜ °. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ﬁÓÔ˘ ÛÙ· ·È‰È¿. EÈÛÙËÌÔÓÈÎ‹ ÂÂÙËÚ›‰· TÌ‹Ì·ÙÔ˜ I·ÙÚÈÎ‹˜ A.¶.£. 1996; 23:1:51-63.

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

11.£. §È·ÎÔÔ‡ÏÔ˘. MË ÛÙÂÚÈÓÔÂÈ‰‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿ÚÌ·Î·. ™ÙËÓ 27Ë ¶·È‰È·ÙÚÈÎ‹ £ÂÚ·Â˘ÙÈÎ‹ ÂÓËÌ¤ÚˆÛË; 1994 M¿ÈÔ˜ 7-8, Aı‹Ó·: ¢ÂÏÙ›Ô A' ¶·È‰È·ÙÚÈÎ‹˜ KÏÈÓÈÎ‹˜ ¶·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.

™‡Ó‰ÚÔÌÔ

Gilbert: °ÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË ÌÂ ÙÔÓ Ê·ÈÓﬁÙ˘Ô

AÛ·Û›· TÛ¤˙Ô˘1, M·Ú›· T˙¤ÙË2, ™ÔÊ›· K›ÙÛÈÔ˘1, AÁÁÂÏÈÎ‹ °·ÏÏ¿1, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿ÎË˜1, AÓ‰ÚÔÓ›ÎË X·Ù˙Ë‰ËÌÔ‡Ï·1, EÏÂ˘ıÂÚ›· ¶·ÙÂÚ¿ÎË1, AÓÙÒÓÈÔ˜ ¢Ú·Î¿ÙÔ˜3, EÌÌ·ÓÔ˘‹Ï K·Ó·‚¿ÎË˜2, £ÂÌÈÛÙÔÎÏ‹˜ K·Ú¿ıÈÔ˜1.

●

¶ÂÚ›ÏË„Ë: TÔ Û‡Ó‰ÚÔÌÔ Gilbert (Û. G.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·ﬁ ÂÂÈÛﬁ‰È· Î·ÏÔ‹ıÔ˘˜ ¤ÌÌÂÛË˜ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜

Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ UDP-ÁÏ˘ÎÔ˘ÚÔÓ˘Ï-ÙÚ·ÓÛÊÂÚ¿ÛË˜ 1 (ÂÍfiÓÈ· 1-5 ‹ ÂÎÎÈÓËÙ‹˜ TATAA box) ÛÙÔ ¯ÚˆÌfiÛˆÌ· 2q37. H ÌÂÏ¤ÙË ÛÎÔÂ‡ÂÈ ÛÙËÓ ·ÓÂ‡ÚÂÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û.G. ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ (ÂÈÛ·ÁˆÁ¤˜ ÙÔ ÚÒÙÔ ÂÓı‹ÌÂÚÔ Î¿ıÂ ÌËÓfi˜) Î·È ÛÙË Û˘Û¯¤ÙÈÛË ÁÔÓfiÙ˘Ô˘/ Ê·ÈÓfiÙ˘Ô˘. MÂÏÂÙ‹ıËÎ·Ó 285 ·È‰È¿ (¿Óˆ ÙˆÓ 24 ÌËÓÒÓ) ·ÊÔ‡ ·ÔÎÏÂ›ÛÙËÎÂ Ë Ë·ÙÈÎ‹ ‚Ï¿‚Ë, Ë ·Ó·ÈÌ›· Î·È

·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÂ ‚¿ÛË ÙÔ ÈÛÙÔÚÈÎfi, ÙÈ˜ ‚ÈÔ¯ËÌÈÎ¤˜ Î·È ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜. MÂ ÎÚÈÙ‹ÚÈÔ ÙË Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜ >1 mg/dl ‰È·ÈÛÙÒıËÎÂ Û˘¯ÓfiÙËÙ· Û.G. 12,3% (35/285 ·È‰È¿). ™ÙË Û˘Ó¤¯ÂÈ· ¤ÁÈÓÂ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ÛÂ 118 ·È‰È¿ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ·Ï˘ÛÈ‰ˆÙ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÔÏ˘ÌÂÚ¿ÛË˜ (PCR) ÌÂ ‰‡Ô ÂÎÎÈÓËÙ¤˜-ÔÏÈÁÔÓÔ˘ÎÏÂÔÙ›‰È· Î·È ·ÎÔÏÔ‡ıËÛÂ ·˘ÙfiÌ·ÙË ·Ó¿Ï˘ÛË ÙÔ˘

ÌÂÁ¤ıÔ˘˜ ÙˆÓ Â·Ó·Ï·Ì‚·ÓÔÌ¤ÓˆÓ TA ‰ÈÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ ÛÙÔ TATAA box ÙÔ˘ ÁÔÓÈ‰›Ô˘, ÒÛÙÂ Ó· ‰È·ÈÛÙˆıÂ› 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 ÛÂ 35 (4,3%), ÂÙÂÚÔ˙˘ÁÒÙÂ˜ (TA)6/(TA)7 ÛÂ 23 (32,4%) Î·È ÔÌÔ˙˘ÁÒÙÂ˜ (TA)7/(TA)7 ÛÂ 13 (18,3%), ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. ·ÓÂ˘Ú›ÛÎÂÙ·È ˘„ËÏfiÙÂÚË ÌÂ ÌÔÚÈ·Î¤˜ ÌÂıfi‰Ô˘˜. ™Â ¿ÏÏË ÔÌ¿‰· 35/285 ·È‰È¿ Ô˘ Â›¯·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 ÛÂ 8,6%, 31,4% Î·È 57,1% ·ÓÙÈÛÙÔ›¯ˆ˜ ÂÓÒ ‰È·ÈÛÙÒıËÎÂ Î·È Ì›· ÂÚ›ÙˆÛË ÌÂ ÙÔÓ Û·ÓÈfiÙ·ÙÔ ÁÔÓfiÙ˘Ô (TA)6/(TA)8. T¤ÏÔ˜, ÛÂ ¿ÏÏË ÔÌ¿‰· 83/285 ·È‰ÈÒÓ Ô˘ Â›¯·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 ÛÂ 51,9%, 37,3% Î·È 10,8% ·ÓÙÈÛÙÔ›¯ˆ˜. H ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ

·ÓˆÙ¤Úˆ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘ Ê·ÈÓﬁÙ˘Ô˘ (Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜) Î·È ÙÔ˘ ÁÔÓﬁÙ˘Ô˘ (p <0.001). ¶·È‰È·ÙÚÈÎ‹ 2000;63: 21-26.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: 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 B' ¶·È‰/Î‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - EÚÁ·ÛÙ‹ÚÈÔ K˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜, NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡"

2 A' ¶·È‰/Î‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - XˆÚ¤ÌÂÈÔ EÚÂ˘ÓËÙÈÎﬁ EÚÁ·ÛÙ‹ÚÈÔ / MÔÓ¿‰· MÔÚÈ·Î‹˜ I·ÙÚÈÎ‹˜ NÔÛ. ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

3 BÈÔ¯ËÌÈÎﬁ EÚÁ·ÛÙ‹ÚÈÔ NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡"

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).

EÈÛ·ÁˆÁ‹

TÔ Û‡Ó‰ÚÔÌÔ Gilbert (Û.G.) Â›Ó·È Ì›· Î·ÏÔ‹ıË˜ ¤Ì-

ÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· ¯ˆÚ›˜ ÛÙÔÈ¯Â›· Ë·ÙÔ¿-

ıÂÈ·˜ ‹ ÂÌÊ·ÓÔ‡˜ ·ÈÌﬁÏ˘ÛË˜ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·ﬁ

ÂÂÈÛﬁ‰È· ÂÏ·ÊÚÔ‡ Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ÈÎÙ¤ÚÔ˘ ÌÂ ·Ó·ÏÔÁ›· ·Ó‰ÚÒÓ/ Á˘Ó·ÈÎÒÓ 4:1 (1-3). MÂÙ·Í‡ ÙˆÓ

ÎÏËÚÔÓÔÌÔ˘Ì¤ÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÙÔ Û.G. ·ÔÙÂÏÂ› ÙË Û˘¯ÓfiÙÂÚË ˘ÔÎ·ÙËÁÔÚ›· ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 2-12% ÛÂ ‰È¿ÊÔÚÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ (46). AÍ›˙ÂÈ Ó· ÛËÌÂÈˆıÂ›, fiÙÈ ÙÔ Û. G Û˘¯Ó¿ ˘Ô‰È·ÁÈÁÓÒÛÎÂÙ·È ÏfiÁˆ ÙË˜ ËÈfiÙËÙ·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ Ù‡Ô ÙË˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ï·ÈfiÙÂÚÂ˜ ‚ÈÔ¯ËÌÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ ÔÈÎÔÁÂÓÂÈÒÓ ÌÂ

Û.G. ¤‰ÂÈÍ·Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔÛˆÌ·ÙÈÎfi

ÙËÙÈÎfi ÓfiÛËÌ· ÌÂ ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, ÌÂ ‚¿ÛË

ÙËÓ ·Ú·Ù‹ÚËÛË ﬁÙÈ ÌﬁÓÔ ÛÂ 27,5% ÙˆÓ ·‰ÂÏÊÒÓ

·Û¯ﬁÓÙˆÓ Î·È ÛÂ 16,2% ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ‰È·ÈÛÙÒ-

ıËÎÂ Û.G. (3,7). ¶ÚﬁÛÊ·Ù· ÔÈ Owens Î·È Ritter (1992)

ÂÍ¤ÊÚ·Û·Ó ÙËÓ ¿Ô„Ë ÙÔ˘ ·˘ÙÔÛˆÌ·ÙÈÎÔ‡ ˘ÔÏÂÈ-

ﬁÌÂÓÔ˘ Ù‡Ô˘ ÎÏËÚÔÓÔÌÈÎﬁÙËÙ·˜, ·Ó Î·È ÌÂÙ·ÁÂÓ¤-

ÛÙÂÚË ÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓÈ‰›Ô˘ ÁÈ·

ÙÔ Û.G. (UDP-glucuronosyltransferase-1, UGT1A1)

Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ÙÂÏÔÌÂÚÈ‰È·Îﬁ ¿ÎÚÔ ÙÔ˘ ·ÓıÚÒ-

ÈÓÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 2 (2q37), ÂÈ‚Â‚·›ˆÛÂ ÙÔÓ ÂÈ-

ÎÚ·ÙËÙÈÎﬁ Ù‡Ô (6,8).

TÔ ÁÔÓ›‰ÈÔ UGT1 (Ì‹ÎÔ˘˜ ÂÚ›Ô˘ 85 Kb) (EÈÎfiÓ· 1) ·ÔÙÂÏÂ›Ù·È ·fi ¤ÓÙÂ ÂÍfiÓÈ·, ÙÔ ÚÒÙÔ ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÚÈ¤¯ÂÈ ¤ÍÈ ˘ÔÌÔÓ¿‰Â˜ (1A ¤ˆ˜ 1F), ÔÈ ÔÔ›Â˜ Î·È Î·ıÔÚ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÈÛÔÂÓ˙‡ÌˆÓ (isoforms) ÙË˜ UDPglucuronosyltranferase. I‰È·›ÙÂÚ·, ÙÔ ¤Ó˙˘ÌÔ UDPglucuronosyltransferase ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ Â›Ó·È

ÚÔ˚fiÓ ÙˆÓ ‰‡Ô ˘ÔÌÔÓ¿‰ˆÓ 1A Î·È 1D ÙÔ˘ ÂÍÔÓ›Ô˘ 1. T· ˘fiÏÔÈ· ÂÍfiÓÈ· ÙÔ˘ ÁÔÓÈ‰›Ô˘ UGT1 (2 ¤ˆ˜ 5) Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÈ˜ ÎÔÈÓ¤˜ ÙÂÏÈÎ¤˜ ÂÚÈÔ¯¤˜ Î·Ú‚ÔÍ˘Ï›ˆÓ fiÏˆÓ ÙˆÓ ÈÛÔÂÓ˙‡ÌˆÓ ÙË˜ ÙÚ·ÓÛÊÂÚ¿ÛË˜ (9-11). ™ËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÈ˜ Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜ ÂÚÈÔ¯¤˜ (ÂÍfiÓÈ· 1 ¤ˆ˜ 5) ÙÔ˘ ÁÔÓÈ‰›Ô˘ UGT1

ÛÂ ¿ÙÔÌ· ÌÂ Û.G. ÌﬁÓÔ ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÔ ·ÚÈıÌﬁ

ÛÂ ¿ÙÔÌ· AÛÈ·ÙÈÎ‹˜ Î·Ù·ÁˆÁ‹˜ (12-15). AÓÙ›ıÂÙ·, fiÏÂ˜ ÔÈ ÌÔÚÈ·Î¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ ¿ÙÔÌ· ÌÂ Û.G. ÙË˜ ÏÂ˘Î‹˜ Ê˘Ï‹˜ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÛËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÈ˜ Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓÈ‰›Ô˘, ·ÏÏ¿ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘. ™˘ÁÎÂÎÚÈÌ¤Ó·, Ô ÂÎÎÈÓËÙ‹˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 1A (TATAA box) ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· ÂÚÈ¤¯ÂÈ ¤ÍÈ Â·Ó·Ï‹„ÂÈ˜ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ [A(TA)6TAA], ÂÓÒ ÛÙ· ¿ÙÔÌ· ÌÂ ÙÔ Û.G. ·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÂÈÏ¤ÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· TA ÌÂ ·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 ÔÊÂ›ÏÂÙ·È Ë ÌÂÈˆÌ¤ÓË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÁÔÓÈ‰›Ô˘ UGT1A1 Î·È ·Ô‰›‰ÔÓÙ·È Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÛÙÔ Û.G. ™Â ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔÈ¯Â›· Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G., fiˆ˜ ·˘Ùfi ‰È·ÁÈÁÓÒÛÎÂÙ·È ÌÂ ‚¿ÛË, Â›ÙÂ ÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜, Â›ÙÂ ÙË ÁÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË. ™ÙËÓ ·-

Key words: Gilbert’s syndrome, genotype, phenotype. EÈÎfiÓ· 1. ¢ÔÌ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘ UGT1A1 ÌÂ ÂÈÎ¤ÓÙÚˆÛË ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹. T· ÂÍfiÓÈ· ‰È·¯ˆÚ›˙ÔÓÙ·È ·fi ÌË Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜ ·ÏÏËÏÔ˘¯›Â˜. Afi Ù· ˙Â‡ÁË ÂÎÎÈÓËÙÒÓ A/B Î·È C/D ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÛÙËÓ PCR ÌfiÓÔ ÙÔ ˙Â‡ÁÔ˜ C/D.

ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÈÂÚÂ˘Ó‹ıËÎÂ Ë Û˘¯ÓﬁÙËÙ· ÙÔ˘ Û.G.

ÛÂ ÓÔÛËÏÂ˘ﬁÌÂÓ· ·È‰È¿ ÌÂ ÛÎÔﬁ: ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘

Ê·ÈÓﬁÙ˘Ô˘ (Â›Â‰· ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ -Ê‡ÏÔ-

‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙÂ˜ Î.¿.) ÌÂ ÙÔÓ ÁÔÓﬁÙ˘Ô.

YÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ

™ÙË ÌÂÏ¤ÙË Û˘ÌÌÂÙÂ›¯·Ó 285 ·È‰È¿ (145 ·ÁﬁÚÈ·, 140 ÎÔÚ›ÙÛÈ·) ¿Óˆ ÙˆÓ 24 ÌËÓÒÓ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·Ó ÛÙË B’ ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Î·È ‹Ù·Ó ÛÂ ı¤ÛË Ó· ·Ú·ÌÂ›ÓÔ˘Ó ÓËÛÙÈÎ¿ Â› 12ˆÚÔ ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·. °È· Ó· ÂÍ·ÛÊ·ÏÈÛÙÂ› Ô Ù˘¯·›Ô˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ÛÙËÓ

ÔÌ¿‰· Î·ÙÂÙ¿ÁËÛ·Ó ÌﬁÓÔ ·È‰È¿ Ô˘ ÂÈÛ¿ÁÔÓÙ·Ó

ÙÔ ÚÒÙÔ ÂÓı‹ÌÂÚÔ Î¿ıÂ ÌËÓﬁ˜. ™ÙÔ Ê‡ÏÏÔ ·Ú·ÎÔÏÔ‡ıËÛË˜ Î¿ıÂ ·È‰ÈÔ‡ Î·Ù·ÁÚ¿ÊÔÓÙ·Ó ÛÙÔÈ¯Â›·

·fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi (·Ó·ÈÌ›·, ›ÎÙÂÚÔ˜, Ë·Ù›ÙÈ‰·, Ï‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ) Î·È ·fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi (ÌÂÛÔÁÂÈ·Î‹

·Ó·ÈÌ›·, ¿ÏÏË ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂÈ·, ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘ G6PD) Î·ıÒ˜ Î·È Ë Ù˘¯fiÓ Ï‹„Ë ‰È·ÊfiÚˆÓ Ê·ÚÌ¿ÎˆÓ Î·Ù¿ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ 7 ËÌ¤ÚÂ˜ ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·. ™Â fiÏ· Ù· ·ÓˆÙ¤Úˆ ·È‰È¿, Ë ·ÈÌÔÏË„›· ¤ÁÈÓÂ ÌÂ ÛÎÔfi Ó· ·ÔÎÏÂÈÛıÔ‡Ó (1) Ë Ë·Ù›ÙÈ‰· Î·È Ë ·Ó·ÈÌ›· (Hb, Ht, ÏÂ˘Î¿-Ù‡Ô˜, ·ÈÌÔÂÙ¿ÏÈ·, ¢EK, SGOT, SGPT, ÁGT, ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË, ÔÏÈÎ¿ ÏÂ˘ÎÒÌ·Ù· ÔÚÔ‡, ÏÂ˘ÎˆÌ·Ù›ÓÂ˜, ÛÊ·ÈÚ›ÓÂ˜) Î·È (2) Ó· ÂÏÂÁ¯ıÂ› Ë Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜ (ÔÏÈÎ‹, ¿ÌÂÛË, ¤ÌÌÂÛË).

H ÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤ÁÈÓÂ ÛÂ 118 ·È‰È¿ ÌÂÙ¿ ·fi ·ÔÌfiÓˆÛË ÙÔ˘ ÁÔÓÈ‰ÈˆÌ·ÙÈÎÔ‡ DNA (genomic DNA) ·fi ÏÂÌÊÔÎ‡ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. °È· ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ PUROGENE DNA extraction kit (Gentra Systems). T· ‰Â›ÁÌ·Ù· ÙÔ˘ DNA ÔÏÏ·Ï·ÛÈ¿ÛıËÎ·Ó ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ·Ï˘ÛÈ‰ˆÙ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÔÏ˘ÌÂÚ¿ÛË˜ (PCR) ÌÂ ‰˘Ô ÂÎÎÈÓËÙ¤˜ - Û˘ÓıÂÙÈÎ¿ 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 ˙Â˘ÁÒÓ ‚¿ÛÂˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘. O ÂÎÎÈÓËÙ‹˜ D ‹Ù·Ó ÛËÌ·ÛÌ¤ÓÔ˜ ÌÂ ÙË ÊıÔÚÈÔ¯ÚˆÛÙÈÎ‹ Ô˘Û›· Texas Red. OÈ Û˘Óı‹ÎÂ˜ ÙË˜ ·ÓÙ›‰Ú·ÛË˜ PCR ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ıÂ˜: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó 35 Î‡ÎÏÔÈ ·Ú¯›˙ÔÓÙ·˜ ÌÂ 40ÔC ÁÈ· 40'', 72ÔC ÁÈ· 40'' Î·È 95ÔC ÁÈ· 30''. H ·Ó¿Ï˘ÛË ÙË˜ ·ÏÏËÏÔ˘¯›·˜ ÙˆÓ ÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ ÙË˜ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹, ¤ÁÈÓÂ ÌÂÙ¿ ·fi ËÏÂÎÙÚÔÊfiÚËÛË ÛÂ ‹ÎÙˆÌ· ·ÎÚ˘Ï·Ì›‰Ë˜ (6%), ÌÂ ÙË ¯Ú‹ÛË Û˘ÛÎÂ˘‹˜ ·˘ÙfiÌ·ÙË˜ ·Ó¿Ï˘ÛË˜ ÙË˜ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ DNA (VISTRA 725 version 2.0). T· 100 ˙Â‡ÁË ‚¿ÛÂˆÓ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ ·ÏÏËÏfiÌÔÚÊÔ A(TA)7TAA.

H ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓÂ ÌÂ ÙÈ˜ ‰ÔÎÈÌ·Û›Â˜: ·) ·Ó¿Ï˘ÛË ÌÂÙ·‚ÏËÙﬁÙËÙ·˜, ÁÈ·

ÙË Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘ Î·È Ê·ÈÓÔÙ‡Ô˘ (Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜) Î·È ‚) t-test ÁÈ· Û˘Û¯¤ÙÈÛË

ÁÔÓÔÙ‡Ô˘ Î·È Ê‡ÏÔ˘ (·ÁﬁÚÈ· Î·È ÎÔÚ›ÙÛÈ·).

AÔÙÂÏ¤ÛÌ·Ù·

™ÙÔ Û˘ÓÔÏÈÎﬁ ·ÚÈıÌﬁ ÙˆÓ 285 ·È‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜ Ô˘ ÂÏ¤Á¯ıËÎ·Ó ÌÂ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜

ÌÂıfi‰Ô˘˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ 35/285 Â›¯·Ó Ì¤ÛË Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜ >1 mg/dl (12,3%), ¤Ó· ·fi Ù· ··Ú·›ÙËÙ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û.G. H ÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· Ë ÌÂÏ¤ÙË ÙË˜ ·ÏÏËÏÔ˘¯›·˜ ÙË˜ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹ A (TA)nTAA ÙÔ˘ ÂÍÔÓ›Ô˘ 1A ¤ÁÈÓÂ ÛÂ 3 ÔÌ¿‰Â˜ ·È‰ÈÒÓ.

K·Ù·Ú¯‹Ó, ‰È·ÈÛÙÒıËÎÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓﬁÙËÙ· ÙÔ˘ Û.G. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙËÓ ÚÒÙË ÔÌ¿‰· 71/285

·È‰ÈÒÓ (Ù˘¯·›Ô ‰Â›ÁÌ·, 1:4 ·È‰›) ‰È·ÈÛÙÒıËÎÂ

ÔÌÔ˙˘ÁˆÙÈÛÌﬁ˜ ÁÈ· ÙÔ Û.G. (TA)7/TA)7 ÛÂ 13 ·È‰È¿ (18,3%), ÂÙÂÚÔ˙˘ÁˆÙÈÛÌﬁ˜ (TA)6/(TA)7 ÛÂ 23 (32,4%)

Î·È Ê˘ÛÈÔÏÔÁÈÎﬁ˜ ÁÔÓﬁÙ˘Ô˜ (TA)6/(TA)6 ÛÂ 35 ·È‰È¿ (49,3%) (¶›Ó·Î·˜ 1).

¶›Ó·Î·˜ 1. °ÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·ÛıÂÓÒÓ (n = 71/285).

°ONOTY¶O™¶AI¢IA(n = 71) n% 6/63549,3 6/72332,4 7/71318,3

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· ÌÂ ÙË Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜ >1 mg/dl Î·È ≤1 mg/dl. T· ·ÔÙÂÏ¤ÛÌ·Ù· ·ﬁ ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÁÔÓÔÙ‡ˆÓ ÙˆÓ 35/285 ·È‰ÈÒÓ ÙË˜ ‰Â‡ÙÂÚË˜ ÔÌ¿‰·˜ ÌÂ ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl, ¤‰ÂÈÍ·Ó ﬁÙÈ ÙÔ 57,1% ‹Ù·Ó ÔÌÔ˙˘ÁÒÙÂ˜ ÁÈ· (TA)7/(TA)7

Î·È ÙÔ 31,4% ÂÙÂÚÔ˙˘ÁÒÙÂ˜ (TA)6/TA)7. E›Ó·È ‰Â ÂÓ‰È·Ê¤ÚÔÓ ﬁÙÈ ÛÙËÓ ÔÌ¿‰· ·˘Ù‹ ‰ÂÓ ‰È·ÁÓÒÛıËÎÂ

ÔÌÔ˙˘ÁˆÙÈÛÌﬁ˜ ‹ ÂÙÂÚÔ˙˘ÁˆÙÈÛÌﬁ˜ ÛÙÔ 8,6% ÙˆÓ

·È‰ÈÒÓ ·ÚﬁÏÔ Ô˘ Ë Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›ÓË˜ ‹Ù·Ó >1 mg/dl. E›ÛË˜ Ú¤ÂÈ Ó· Û¯ÔÏÈ·ÛÙÂ› ﬁÙÈ ÛÂ

¤Ó·Ó ·ÛıÂÓ‹ ÙË˜ ÔÌ¿‰·˜ ·˘Ù‹˜ ‚Ú¤ıËÎÂ ÂÙÂÚÔ˙˘ÁˆÙÈÛÌﬁ˜ ÁÈ· ÙË Û¿ÓÈ· ÌÂÙ¿ÏÏ·ÍË (TA)6/(TA)8 (¶›Ó·Î·˜ 2).

ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÔÌ¿‰· ÙˆÓ 83/285 ·È‰ÈÒÓ ÌÂ

¯ÔÏÂÚ˘ıÚ›ÓË ≤1 mg/dl Â›Ó·È ÂÓÙ˘ˆÛÈ·Îfi fiÙÈ ÂÓÒ fiˆ˜ ·Ó·ÌÂÓfiÙ·Ó Ô ÁÔÓfiÙ˘Ô˜ ‰È·ÈÛÙÒıËÎÂ ¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘ÈÎ‹/ Ê·ÈÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË 23

XO§EPY£. > 1 mg/dl (n = 35)XO§EPY£. ≤ 1 mg/dl (n = 83)

°ÔÓfiÙ˘Ôñ%°ÔÓfiÙ˘Ôñ% 6/638,66/64351,9 6/71131,46/73137,3 7/72057,17/7910,8 6/812,9

Ê˘ÛÈÔÏÔÁÈÎﬁ˜ ÛÙÔ 51,9% ÂÚ›Ô˘, ÂÓÙÔ‡ÙÔÈ˜ 37,3%

‚Ú¤ıËÎ·Ó ÂÙÂÚÔ˙˘ÁÒÙÂ˜ (TA)6/(TA)7 Î·È 10,8%

ÔÌÔ˙˘ÁÒÙÂ˜ (TA)7/(TA)7 (¶›Ó·Î·˜ 2). H Û˘Û¯¤ÙÈÛË

ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÌÂ ÙÔ ÁÔÓﬁÙ˘Ô

¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈ-

ÎÔ‡ ÁÔÓfiÙ˘Ô˘ (TA)6/(TA)6 Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘ (TA)7/(TA)7 (p<0.001), Î·ıÒ˜ Î·È ÌÂÙ·Í‡ 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·ÙÈÎ¿ Ù· ·ÓˆÙ¤Úˆ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙÈ˜ 2 ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÌÂ ¯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˜ ÙÈÌ¤˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÁÔÓﬁÙ˘Ô. ÕÙÔÌ· ÌÂ ÔÌÔ˙˘ÁˆÙÈÛÌﬁ (TA)7/(TA)7, ¤¯Ô˘Ó Ì¤ÛË

ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›ÓË˜ 1,5 mg/dl ÌÂ ·ÓÒÙ·ÙË ÙÈÌ‹ 1,8 mg/dl ÂÓÒ, ÔÈ ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ¤¯Ô˘Ó Ì¤ÛË ÙÈÌ‹ 0.9 mg/dl ÌÂ ·ÓÒÙ·ÙË ÙÈÌ‹ ÂÚ›Ô˘ 1,1 mg/dl. T· ·ÔÏ‡Ùˆ˜ Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· ˆ˜ ÚÔ˜ ÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ

ÁÔÓﬁÙ˘Ô (TA)6/(TA)6, ¤¯Ô˘Ó ¯ÔÏÂÚ˘ıÚ›ÓË Ì¤¯ÚÈ 0,7 mg/dl. º·›ÓÂÙ·È Â›ÛË˜ ﬁÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÂÈ-

EÈÎﬁÓ· 2. IÛÙﬁÁÚ·ÌÌ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ¶›Ó·Î· 2.

Î¿Ï˘„Ë ÙˆÓ ÏËı˘ÛÌÒÓ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. A˜ ÛËÌÂÈˆıÂ›, fiÙÈ ÌÂÙ¿ ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ê‡ÏÔ˘ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÙÔ ÁÔÓfiÙ˘Ô ÁÈ· ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÙ¿ÏÏ·ÍË, ‰ÂÓ ‚Ú¤ıËÎÂ ‰È·ÊÔÚ¿. Ÿˆ˜ Â›ÛË˜, ‰ÂÓ ‚Ú¤ıËÎÂ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ, fiÙ·Ó ÙÔ Û.G. ‰È·ÁÓÒÛıËÎÂ ÌÂ ‚¿ÛË ÙÔ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜. ™˘˙‹ÙËÛË H ÎÏÈÓÈÎ‹ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘Ó‹ıˆ˜

ÓÂÙ·È Ù˘¯·›· ÌÂÙ¿ ·fi ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÓËÛÙÂ›·˜ (fiˆ˜ ÛÂ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓÂ˜ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜), Û·ÓÈfiÙÂÚ· ‰Â, ÛÙ· Ï·›ÛÈ· ‰ÈÂÚÂ‡ÓËÛË˜ Â›ÌÔÓˆÓ ‰È·ÏÂÈfiÓÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÓÔ¯ÏËÌ¿ÙˆÓ (1,2). ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÌÂÙ·‚ÔÏ¤˜ ÛÙÔ Ú˘ıÌfi ·Ú·ÁˆÁ‹˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜, ÛÙËÓ ·Ú·ÁˆÁ‹ Ë·ÙÈÎ‹˜ ·›ÌË˜ Î·È ÛÙËÓ Ë·ÙÈÎ‹ ÚfiÛÏË„Ë ¯ÔÏÂÚ˘ıÚ›ÓË˜ (2). §fiÁˆ ÙË˜ Î·ÏÔ‹ıÔ˘˜ Ê‡ÛË˜ Î·È ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ¤¯ÂÈ ÂÎÊÚ·ÛıÂ› Ë ¿Ô„Ë Ó· ıÂˆÚÂ›Ù·È ÙÔ Û‡Ó‰ÚÔÌÔ ˆ˜ ÌÈ· Ê˘ÛÈÎ‹ ÁÂÓÂÙÈÎ‹ ·Ú·ÏÏ·Á‹ ·Ú¿ ˆ˜ ·Ûı¤ÓÂÈ·.

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

TÔ ·ıÔÁÂÓÂÙÈÎfi ˘fi‚·ıÚÔ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

Gilbert Â›Ó·È Ë ÌÂÈˆÌ¤ÓË ÈÎ·ÓfiÙËÙ· ÁÏ˘ÎÔ˘ÚÔÓÔÔ›ËÛË˜ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ Ë ÔÔ›· ÂÈ‰ÂÈÓÒÓÂÙ·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ (fiˆ˜ ÓËÛÙÂ›·, ·Ûı¤ÓÂÈÂ˜ ‹ ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ) ÌÂ ·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 ÌÂ ÙÔ Ô˘ÚÈ‰ÈÓÔ-‰ÈÊˆÛÊÔ-ÁÏ˘ÎÔ˘ÚÔÓÈÎfi ÔÍ‡, ·ÓÙ›‰Ú·ÛË Ë ÔÔ›· Î·Ù·Ï‡ÂÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ·fi ÙÔ Ë·ÙÈÎfi ÌÈÎÚÔÛˆÌÈ·Îfi ¤Ó˙˘ÌÔ bilirubin UGT, (uridine diphosphoglucuronosyltransferase (UGT)), ÙÔ ÔÔ›Ô ·ÓÂ·ÚÎÂ› ÛÂ ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙ· ¿ÙÔÌ· ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ

Gilbert. OÈ ÙÈÌ¤˜ ÙË˜ ¤ÌÌÂÛË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÛÙ· ¿ÙÔÌ· ÌÂ Û‡Ó‰ÚÔÌÔ Gilbert Ô˘ ‰ÂÓ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÓËÛÙÂ›· Â›Ó·È ÂÏ·ÊÚÒ˜ ·˘ÍËÌ¤ÓÂ˜ (>1 mg/dl) Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ÍÂÂÚÓÔ‡Ó Ù· 2,9 mg/dl, ÂÎÙﬁ˜ ·ﬁ ÂÚÈÙÒÛÂÈ˜ ÓËÛÙÂ›·˜, ·Ûı¤ÓÂÈ·˜ ‹ ¯ÔÚ‹ÁËÛË˜ Ê·ÚÌ¿ÎˆÓ, ÂÓÒ ÙÔ Û. Gilbert ‰ÂÓ Û˘Ó‰¤ÂÙ·È ÌÂ Î›Ó‰˘ÓÔ ˘ÚËÓÈÎÔ‡ ÈÎÙ¤ÚÔ˘ (17-18).

ÕÙÔÌ· ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ¤¯Ô˘Ó ÔÈÎÈÏÔÌÔÚÊ›Â˜ (ÌÂÙ·ÏÏ¿ÍÂÈ˜) ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ TATAA box ÙÔ˘ ÁÔÓÈ‰È·ÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ UGT1, ‰ËÏ·‰‹ ‰‡Ô ÂÈÏ¤ÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· Ù· ÔÔ›· ÚÔÎ·ÏÔ‡Ó ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ¤Ó·ÚÍË ÌÂÙ·ÁÚ·Ê‹˜ (transcription initiation) (6,11).

E›Ó·È ‰Â ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ ÌÂ ÙË DNA ·Ó¿Ï˘ÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfiÌˆÓ, ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ›ÎÙÂÚÔ˘ Î·È ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ (·ÓÒÙÂÚË ÙÈÌ‹ 1 mg/dl) ˘ÔÏÔÁ›ÛıËÎÂ ÛÂ 40% Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÁÈ· ÙËÓ ÂÈÌËÎ¤ÛÙÂÚË ÂÚÈÔ¯‹ TATAA (11), ÂÓÒ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÎÏÈÓÈÎ‹˜-‚ÈÔ¯ËÌÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Û˘Ó‰ÚfiÌÔ˘ Gilbert ‰ÂÓ ÍÂÂÚÓ¿ÂÈ ÙÔ 12% (4-6).

E›Ó·È ÛËÌ·ÓÙÈÎfi fiÌˆ˜ Ó· ÙÔÓÈÛıÂ› fiÙÈ ÔÈ ÁÔÓÈ‰È·Î¤˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓÈ‰È·ÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ UGT1 Â›Ó·È ÌÂÓ ·Ó·ÁÎ·›· ÚÔ¸fiıÂÛË ÛÂ ÂÚÈÙÒÛÂÈ˜ ¯ˆÚ›˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÂ Î¿ÔÈÔ ÂÍfiÓÈÔ, ·ÏÏ¿ fi¯È ÈÎ·Ó‹ ÁÈ· ÙËÓ Ï‹ÚË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™˘ÁÎÂÎÚÈÌ¤Ó· ÁÈ· ÙËÓ ÎÏÈÓÈÎ‹ ¤ÎÊÚ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤¯ÂÈ ıÂˆÚËıÂ› ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ¿ÏÏˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ‹ Â›ÎÙËÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚÂ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÂÈÚÔÛı¤Ùˆ˜ ÌÂ ÙË ÌÂÈˆÌ¤ÓË ÁÏ˘ÎÔ˘ÚÔÓÔÔ›ËÛË (11).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ÙˆÓ ‰‡Ô ÂÈÏ¤ÔÓ ÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ [(TA)7/(TA)7], ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘ UGT1A1 ÛÂ 57,1% ÙˆÓ ·È‰ÈÒÓ ÌÂ Û.G., ÁÂÁÔÓﬁ˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙË Û˘ÌÌÂÙÔ¯‹ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÌÂÙ¿ÏÏ·ÍË˜ ÛÙÔ

Û.G. E›ÛË˜, ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ Î·È ÙÔ˘

Ù˘Ô˘. ¶·ÚﬁÌÔÈ· ·ÔÙÂÏ¤ÛÌ·Ù· ¤¯Ô˘Ó ‰È·ÈÛÙˆıÂ› Î·È ·ﬁ ÙÔ˘˜ Monaghan Î·È Û˘Ó. (1996) Î·È Bosma Î·È

Û˘Ó. (1995) (6,11). E›Ó·È ÂÓ‰È·Ê¤ÚÔÓ ﬁÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·ﬁ ÙË ÁÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË ÙÔ˘ Ù˘¯·›Ô˘

‰Â›ÁÌ·ÙÔ˜ (n=71) ·Ú·ÙËÚ‹ıËÎÂ ﬁÙÈ ÙÔ 18,3% ÙˆÓ

·È‰ÈÒÓ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙÂ˜ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË

(TA)7/(TA)7, ÂÓÒ Ë Û˘¯ÓﬁÙËÙ· ÙÔ˘ Û.G. ÛÂ ¿ÏÏÂ˜

ÏËı˘ÛÌÈ·Î¤˜ ÌÂÏ¤ÙÂ˜, ﬁˆ˜ ÚÔ·Ó·Ê¤ÚıËÎÂ, ‰ÂÓ

ÍÂÂÚÓ¿ ÙÔ 12% (4-6).

™ÙË ÌÂÏ¤ÙË Ì·˜ Â›ÛË˜ ‚Ú¤ıËÎÂ ﬁÙÈ 1 ·È‰› ·ﬁ

ÙÔ Û‡ÓÔÏÔ ÙˆÓ 118 Â›¯Â ÔÏÈÎ‹ ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›ÓË˜ 2,5 mg/dl, Ô ‰Â ÁÔÓﬁÙ˘Ô˜ ‹Ù·Ó (TA)6/(TA)8. A˘Ù‹ Â›Ó·È Ë ‰Â‡ÙÂÚË ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÊÔÚ¿ ÛÂ ¿ÙÔÌÔ ÏÂ˘Î‹˜

Ê˘Ï‹˜ ÌÂÙ¿ ÙÔ˘˜ Iolascon Î·È Û˘Ó. (1999) (19).

T¤ÏÔ˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ

Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊﬁÚˆÓ ÁÔÓÔÙ‡ˆÓ Î·È ÙÔ˘

Ê‡ÏÔ˘ ÛÙÈ˜ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó. H

·Ú·Ù‹ÚËÛË ·˘Ù‹ ‚Ú›ÛÎÂÙ·È ÛÂ Û˘ÌÊˆÓ›· ÌÂ ÙÈ˜ ÌÂ-

Ï¤ÙÂ˜ ÙˆÓ Monaghan Î·È Û˘Ó. (1996) Î·È Bancroft Î·È

Û˘Ó. (1998) Î·È ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ÛÙÔ fiÙÈ ‰ÈÂÚÂ˘Ó‹ıËÎ·Ó ¿ÙÔÌ· ÓÂ·Ú‹˜ ËÏÈÎ›·˜ Î·È ÂÔÌ¤Óˆ˜ ÂÏ·¯ÈÛÙÔÔÈ‹ıËÎÂ Ë Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ê¿ÚÌ·Î·, ·ÏÎÔfiÏ Î.¿. ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ (6,20).

fiÙÈ ÚfiÛÊ·Ù· ¤¯ÂÈ Û˘Ó‰ÂıÂ› Ë ·ÚÔ˘Û›· ÙË˜ ÔÈÎÈÏÔÌÔÚÊ›·˜ ÛÙÔÓ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÌÂ ÙËÓ ·Ú·ÙËÚÔ‡ÌÂÓË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· ÛÂ ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ (21) Û¯Â‰È¿˙ÂÙ·È Ë Â¤ÎÙ·ÛË ÙÔ˘ ÂÏ¤Á¯Ô˘ ÙÔ˘ Û.G. ÌÂ ÛÎÔfi ÙË Û˘Û¯¤ÙÈÛË ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ (TA)7/(TA)7 ÌÂ

ÁÔÓfiÙ˘Ô ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÛÂ 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

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.

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›· ¤ÁÎÚÈÛË˜: 26-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· K›ÙÛÈÔ˘, B' ¶·È‰/Î‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" 11527, Aı‹Ó·.

●

™‡ÁÎÚÈÛË

Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÂ ·ÂÚÔ·ÏÏÂÚÁÈÔÁﬁÓ· ·È‰ÈÒÓ

™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·1, K·ÙÂÚ›Ó· NÂÛÙÔÚ›‰Ô˘1, N·Ù¿Û· ¶··‰ÔÔ‡ÏÔ˘1, ¶·Ó·ÁÈÒÙË˜

MﬁÙË˜1, Hassan Arshad2, Taraneh Dean2, Sharron Matthews2, Bearny Mealy2

¶ÂÚ›ÏË„Ë: MÂÏ¤ÙÂ˜ Ô˘

ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙË˜ Â˘·ÈÛıËÙÔÔ›ËÛË˜ ·È‰ÈÒÓ ÌÂ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜, ÛÂ ‰‡Ô ¯ÒÚÂ˜ ÙË˜ BfiÚÂÈ·˜ Î·È NfiÙÈ·˜ E˘ÚÒË˜. ™Ù· Ï·›ÛÈ· ÌÈ·˜ ÌÂÏ¤ÙË˜ ÚfiÏË„Ë˜ ¿ÛıÌ·ÙÔ˜ ÛÂ ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (SPACE), ÌÂÏÂÙ‹ıËÎ·Ó 1439 ·È‰È¿ ·fi ÙËÓ EÏÏ¿‰· Î·È 364

E¿Ó ‹Ù·Ó ıÂ-

(Der Pteronyssinus Î·È Der Farinae), ÁÈ· ÌÂ›ÁÌ·

ÙÚ›¯ˆÌ· Á¿Ù·˜. ¢ÔÎÈÌ¿ÛÙËÎ·Ó Â›ÛË˜ ‰‡Ô ÚﬁÛıÂÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁﬁÓ· ÂÈ‰ÈÎ¿ ÛÂ Î¿ıÂ ÂÚÈÔ¯‹ Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÁÓˆÛÙ¤˜ ·ÏÏÂÚÁÈÎ¤˜ Â˘·ÈÛıËÛ›Â˜ ÛÂ ·˘Ù¤˜

‚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 Â‡ÚËÌ· ‹Ù·Ó Ë ÔÏ‡ ¯·ÌËÏ‹ Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ ÙË˜ ÔÈÎÈ·Î‹˜ ÛÎfiÓË˜ ÛÙ· EÏÏËÓfiÔ˘Ï· (Der P1: 1,81%, Der f1: 1,25%) ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È‰È¿ ÙË˜ AÁÁÏ›·˜, fiÔ˘ ·˘Ùfi ‹Ù·Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ (Der P1: 14,8%, Der f1: 5,2%). H Â˘·ÈÛıËÙÔÔ›ËÛË ÛÂ ÌÂ›ÁÌ· Á‡ÚË˜ ÁÚ·ÛÈ‰ÈÔ‡ ‹Ù·Ó 4,4% Î·È ÛÂ ÙÚ›¯ˆÌ· Á¿Ù·˜ 4,1%

ÛÙ· ·È‰È¿ ÙË˜ EÏÏ¿‰·˜, ÂÓÒ ÛÙ· ·È‰È¿ ÙË˜ AÁÁÏ›·˜ ÔÈ ÙÈÌ¤˜ ‹Ù·Ó 13,2% Î·È 10,2% ·ÓÙ›ÛÙÔÈ¯·. ŸÏÂ˜ ÔÈ Û˘ÁÎÚ›ÛÂÈ˜

‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ (p<0,001). ™˘ÌÂÚ·›ÓÔ˘ÌÂ fiÙÈ Ë ·ÏÏÂÚÁÈÎ‹ Â˘·ÈÛıËÙÔÔ›ËÛË ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Â›Ó·È ÔÏ‡ ¯·ÌËÏfiÙÂÚË ÛÙËÓ EÏÏ¿‰· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ AÁÁÏ›·. TÔ ¿Î·ÚÈ ÙË˜ ÔÈÎÈ·Î‹˜ ÛÎfiÓË˜ Â›Ó·È ÙÔ ÎÔÈÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ AÁÁÏ›·, ·ÏÏ¿ fi¯È Û˘¯Ófi ÛÙËÓ EÏÏ¿‰·. ¶·È‰È·ÙÚÈÎ‹ 2000;63:27-33.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Â˘·ÈÛıËÙÔÔ›ËÛË, ·ÂÚÔ·ÏÏÂÚÁÈÔÁﬁÓ·, ·Î¿ÚÂ·, ·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 TÌ‹Ì· KÔÈÓˆÓÈÎ‹˜ I·ÙÚÈÎ‹˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡", Aı‹Ó·

2 The David Hide Asthma & Allergy Research Centre, St. Mary's Hospital, Isle of Wight, UK

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 ‰ÂÎ·ÂÙÈÒÓ ÔÏÏ¤˜

¯ÒÚÂ˜ Â›¯·Ó ÙËÓ ÂÌÂÈÚ›· ·‡ÍËÛË˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡

(ÛÂ 20-30%) Î·È ÙË˜ ÛÔ‚·ÚﬁÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ

ÓÔÛËÌ¿ÙˆÓ. TËÓ ›‰È· ÂÚ›Ô‰Ô, Ô ÏËı˘ÛÌfi˜ ÙÔ˘ ·Ó·Ù˘ÁÌ¤ÓÔ˘ ÎfiÛÌÔ˘ ¿ÏÏ·ÍÂ ÙÈ˜ Û˘Óı‹ÎÂ˜ ‰È·‚›ˆÛ‹˜ ÙÔ˘ (1). H ÌfiÓˆÛË ÙˆÓ Î·ÙÔÈÎÈÒÓ Â›Ó·È Î·Ï‡ÙÂÚË ÌÂ

·ÔÙ¤ÏÂÛÌ· ÙË ‰È·Ù‹ÚËÛË ÛÙ·ıÂÚ¿ ıÂÚÌÔ‡ ·ÏÏ¿

Î·È ˘ÁÚÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ·Ú¤¯ÂÈ È‰·ÓÈÎ¤˜ Û˘Óı‹ÎÂ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·Î¿ÚÂˆÓ ÙË˜ ÔÈÎÈ·Î‹˜ ÛÎfiÓË˜ ÁÈ· ÌÂÁ¿ÏÂ˜ ¯ÚÔÓÈÎ¤˜ ÂÚÈfi‰Ô˘˜ Î¿ıÂ ¤ÙÔ˜. O Î·Îfi˜ ·ÂÚÈÛÌfi˜ Â›ÛË˜ ·˘Í¿ÓÂÈ ÙË Û˘ÁÎ¤ÓÙÚˆÛË

‰È·ÊﬁÚˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ Ú‡ˆÓ, ÂÓÒ Ù·˘Ùﬁ¯ÚÔÓ· ·˘-

Í¿ÓÔÓÙ·È ÔÈ Î¿ÙÔ¯ÔÈ Î·ÙÔÈÎ›‰ÈˆÓ ˙ÒˆÓ.

ŒÎıÂÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË ÛÂ ·ÏÏÂÚÁÈÔÁﬁÓ· ÙË˜

ÔÈÎÈ·Î‹˜ ÛÎﬁÓË˜ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ˆ˜ Î‡ÚÈ· ·ÈÙ›· ·Ó¿-

Ù˘ÍË˜ ¿ÛıÌ·ÙÔ˜ ÛÂ ÔÏÏ¿ Ì¤ÚË ÙÔ˘ ÎﬁÛÌÔ˘ (2-10).

¶ÚﬁÛÊ·ÙÂ˜ ¤ÚÂ˘ÓÂ˜ ÛÂ ÂÚÈÔ¯¤˜ ÌÂ ¯·ÌËÏ¿ Â›-

Â‰· ·Î¿ÚÂˆÓ ·¤‰ÂÈÍ·Ó ÙËÓ ÛËÌ·Û›· ÙË˜ ¤ÎıÂÛË˜ ÛÂ

¿ÏÏ· ÂÓ‰ÔÔÈÎÈ·Î¿ ·ÏÏÂÚÁÈÔÁﬁÓ·, ÂÈ‰ÈÎ¿ ·˘Ù¿ Ô˘

ÚÔ¤Ú¯ÔÓÙ·È ·fi Á¿ÙÂ˜, ÛÎ‡ÏÔ˘˜ Î·È Î·ÙÛ·Ú›‰Â˜ (11,12). P˘·ÓÙ¤˜, fiˆ˜ ÙÔ fi˙ÔÓ Î·È ÙÔ ‰ÈÔÍÂ›‰ÈÔ ÙÔ˘ ıÂ›Ô˘, Ê·›ÓÂÙ·È fiÙÈ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙË˜ IgE (13,14) Î·È Ù· ·È‰È¿ ÙˆÓ Î·ÓÈÛÙÒÓ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÙÔÈÎ‹ ÓfiÛÔ (15). EÔÌ¤Óˆ˜, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ Î·ıÔÚ›˙Ô˘Ó ÙÔ Â›‰Ô˜ Î·È ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚÂ¿ÛÔ˘Ó ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÁÂÓÂÙÈÎ‹ ÚÔ‰È¿ıÂÛË. H ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤ÁÈÓÂ ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ÔÏ˘ÎÂÓÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ÚfiÏË„Ë˜ ·ÏÏÂÚÁ›·˜ ÛÙ· ·È‰È¿ ÙË˜ E˘ÚÒË˜ (SPACE - Study on Prevention of Allergy in Children in Europe).

™ÎÔfi˜ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙË˜ Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÂ ‰È¿ÊÔÚ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ ÌÂ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ Ô˘ ˙Ô˘Ó ÛÂ ¯ÒÚÂ˜ ÌÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÎÏÈÌ·ÙÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜ (AÁÁÏ›·-N‹ÛÔ˜ Wight Î·È EÏÏ¿‰·-Aı‹Ó·).

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™Â ÁÔÓÂ›˜ ·È‰ÈÒÓ ËÏÈÎ›·˜ 5-7,5 ¯ÚfiÓˆÓ, Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙÔ ÚfiÁÚ·ÌÌ· ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ÓËÈ·ÁˆÁÂ›ˆÓ, È‰ÈˆÙÈÎÒÓ Î·È ‰ËÌÔÛ›ˆÓ Û¯ÔÏÂ›ˆÓ ÙÔ˘

¶›Ó·Î·˜ 1. EÚˆÙËÌ·ÙÔÏﬁÁÈÔ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡

ÈÛÙÔÚÈÎÔ‡ ·ÏÏÂÚÁ›·˜ (ISAAC) ÁÈ· ÌËÙ¤Ú·, ·Ù¤Ú·, ·‰ÂÏÊﬁ/‹.

1. E›¯Â ÔÙ¤ Î¿ÔÈÔ ·ﬁ Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ¿ÛıÌ·;

2. E›¯Â ÔÙ¤ Î¿ÔÈÔ ·ﬁ Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÂÔ¯È·Î‹ ·ÏÏÂÚÁÈÎ‹ ÚÈÓÔ-ÂÈÂÊ˘Î›ÙÈ‰· (Â·ÚÈÓﬁ Î·Ù¿ÚÚÔ˘);

3. E›¯Â ÔÙ¤ Î¿ÔÈÔ ·ﬁ Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÂÍ¿ÓıËÌ· ÌÂ Ê·ÁÔ‡Ú· Ô˘ Ó· ÂÌÊ·Ó›˙ÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 6 Ì‹ÓÂ˜;

4. E›¯Â ÔÙ¤ Î¿ÔÈÔ ·ﬁ Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ‚Ú¿ÛÈÌÔ ‹ ÛÊ‡ÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÔÔÈ·‰‹ÔÙÂ ÛÙÈÁÌ‹ ÛÙÔ ·ÚÂÏıﬁÓ;

5. E›¯Â ÔÙ¤ Î¿ÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÊÙÂÚÓ›ÛÌ·Ù·, ‚Ô˘ÏˆÌ¤ÓË Ì‡ÙË ‹ Û˘Ó¿¯È (¯ˆÚ›˜ fiÌˆ˜ Ó· ¤¯ÂÈ ÎÚ˘ÔÏfiÁËÌ· ‹ ÁÚ›Ë) Î·È/‹ ÚËÛÌ¤Ó· Ì¿ÙÈ· Ô˘ Ó· ¤¯Ô˘Ó Ê·ÁÔ‡Ú·;

Â˘Ú‡ÙÂÚÔ˘ Î¤ÓÙÚÔ˘ ÙˆÓ AıËÓÒÓ, ‰È·ÓÂÌ‹ıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ISAAC ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜ (›Ó·Î·˜ 1). E¿Ó Ë ·¿ÓÙËÛË ‹Ù·Ó ıÂÙÈÎ‹, Â›ÙÂ ÁÈ· ¤Ó· ÁÔÓ¤·, Â›ÙÂ ÁÈ· ·‰ÂÏÊfi/‹, ÙÔ ·È‰› ÂÓÙ·ÛÛfiÙ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ·. MÂ ÁÚ·Ù‹ Û˘Ó·›ÓÂÛË, ‡ÛÙÂÚ· ·fi ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓ¤ˆÓ, ¤ÁÈÓ·Ó ÛÂ 1439 ·È‰È¿ (63,1% ·ÁfiÚÈ·) ÌÂ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜, ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ (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. MÂ ·Ó¿ÏÔÁÔ ÙÚfiÔ ¤ÁÈÓÂ Ë ÂÈÏÔÁ‹ 364 ·È‰ÈÒÓ (59,4% ·ÁfiÚÈ·) ·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ ÌÂ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ÛÙËÓ Ó‹ÛÔ Wight ÙË˜ AÁÁÏ›·˜. T· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÁÈ· Ù· ·È‰È¿ ·˘Ù¿ ‹Ù·Ó ÙÔ ÙÚ›¯ˆÌ· ÙÔ˘ ÛÎ‡ÏÔ˘ Î·È Ë Á‡ÚË ‰¤ÓÙÚˆÓ. T· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÂÈÏ¤¯ıËÎ·Ó Û‡ÌÊˆÓ· ÌÂ Ù· ÈÔ ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÛÂ Î¿ıÂ ÁÂˆÁÚ·ÊÈÎ‹

T· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂÎÙÈ-

Ì‹ıËÎ·Ó ÌÂÙ¿ ·ﬁ 15 min Î·È ÌÂÙ¿ ·ﬁ Û‡ÁÎÚÈÛË ÌÂ ıÂ-

ÙÈÎfi Î·È ·ÚÓËÙÈÎfi Ì¿ÚÙ˘Ú·. ø˜ ıÂÙÈÎfi˜ Ì¿ÚÙ˘Ú·˜ ¯ÚËÛÈ-

ÌÔÔÈ‹ıËÎÂ ‰È˘‰ÚÔ¯ÏˆÚÈÎ‹ ÈÛÙ·Ì›ÓË 1mg%. £ÂÙÈÎ‹ ¯·Ú·ÎÙËÚ›ÛÙËÎÂ Ë ·ÓÙ›‰Ú·ÛË ÌÂ Ì¤ÛË ‰È¿ÌÂÙÚÔ ≥ 2 ¯ÈÏ. ™ÙÔ˘˜ ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ıÂÙÈÎ‹ ‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·Û›·

¶›Ó·Î·˜ 2. EÚˆÙËÌ·ÙÔÏﬁÁÈÔ.

ÂÚˆÙËÌ·ÙÔÏﬁÁÈÔ Û¯ÂÙÈÎ¿ ÌÂ Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ Ì¤¯ÚÈ ÂÎÂ›ÓË ÙË ÛÙÈÁÌ‹ (›Ó·Î·˜ 2).

1. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ¿ÛıÌ·;Ô Ó·ÈÔ fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 6)

2. Œ‚·ÏÂ ÔÙ¤ ÁÈ·ÙÚﬁ˜ ÙË ‰È¿ÁÓˆÛË ÓÂ˘ÌÔÓ›·˜ ÛÙÔ ·È‰› Û·˜; Ô Ó·ÈÔ ﬁ¯È

AÓ Ó·›, ﬁÛÂ˜ ÊÔÚ¤˜;

3. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·;Ô Ó·È Ô ﬁ¯È

(ISAAC: KÂÓÙÚÈÎﬁ ÂÚˆÙËÌ·ÙÔÏﬁÁÈÔ ÁÈ· ÚÈÓ›ÙÈ‰· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 6)

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

5. NÔÛËÏÂ‡ÙËÎÂ ÔÙ¤ ÙÔ ·È‰› Û·˜ ÛÂ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÂÚÈÛÛfiÙÂÚÂ˜ ·fi Ì›· ËÌ¤ÚÂ˜; Ô Ó·È Ô fi¯È AÓ Ó·È, ÔÈfi˜ ‹Ù·Ó Ô ÏfiÁÔ˜ ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘;

6. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ‹ ÛÊ‡ÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÛÙÔ ·ÚÂÏıfiÓ;Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ·

ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 1) AÓ ¤¯ÂÙÂ ··ÓÙ‹ÛÂÈ "OXI" ·Ú·Î·ÏÒ ËÁ·›ÓÂÙÂ ÛÙËÓ ÂÚÒÙËÛË 11

7. E›¯Â ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ‹ ÛÊ‡ÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜: Ô Ó·È Ô ﬁ¯È

(ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 2) AÓ ¤¯ÂÙÂ ··ÓÙ‹ÛÂÈ "OXI" ·Ú·Î·ÏÒ ËÁ·›ÓÂÙÂ ÛÙËÓ ÂÚÒÙËÛË 11 8.¶fiÛÂ˜ ÊÔÚ¤˜ Â›¯Â ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜: Ô Î·Ì›· Ô 1 ¤ˆ˜ 2 Ô 3 ¤ˆ˜12 Ô ÂÚÈÛÛfiÙÂÚÂ˜ ·fi 12 (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 3) 9. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜, fiÛÔ Û˘¯Ó¿, Î·Ù¿ Ì¤ÛÔ fiÚÔ, Ô ‡ÓÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ‰È·Ù·Ú¿¯ıËÎÂ ÂÍ·ÈÙ›·˜ ÙÔ˘ ‚Ú·Û›Ì·ÙÔ˜;Ô ÔÙ¤ ‰ÂÓ Í‡ÓËÛÂ ÌÂ ‚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· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 4)

10. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜ ÙÔ ‚Ú¿ÛÈÌÔ ‹Ù·Ó ÔÙ¤ ·ÚÎÂÙ¿ ÛÔ‚·Úﬁ ÒÛÙÂ Ó· ÂÚÈÔÚ›ÛÂÈ ÙËÓ ÔÌÈÏ›· ÙÔ˘

·È‰ÈÔ‡ Û·˜ ÛÂ ÌÈ· ‹ ‰‡Ô Ï¤ÍÂÈ˜ ·Ó¿ÌÂÛ· ÛÂ ‰‡Ô ·Ó·ÓÔ¤˜;Ô Ó·ÈÔ fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7ÂÙÒÓ. EÚÒÙËÛË 5) 11. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜, ¤‚Ú·˙Â ÙÔ ÛÙ‹ıÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Û·˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‹ ÌÂÙ¿ ·fi ¿ÛÎËÛË: Ô Ó·ÈÔ fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 7)

12. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜, Â›¯Â ÙÔ ·È‰› Û·˜ ÍËÚfi‚Ë¯· ÙÔ ‚Ú¿‰˘, ÂÍ·ÈÚÔ˘Ì¤ÓÔ˘ ÙÔ˘ ‚‹¯· Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ÎÚ˘ÔÏfiÁËÌ· ‹ ÏÔ›ÌˆÍË ÙˆÓ ÓÂ˘ÌfiÓˆÓ;Ô Ó·ÈÔ fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈÎ›Â˜ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 8) 13. E›Ó·È ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎfi ÛÂ ÙÚÔÊ¤˜;Ô Ó·ÈÔ fi¯È

¶·Ú·Î·ÏÒ ÁÚ¿„ÙÂ ÔÈÂ˜ ÙÚÔÊ¤˜: TÈ ¤Î·ÓÂ ÙÔ ·È‰› Û·˜ ﬁÙ·Ó ¤Ê·ÁÂ ·˘Ù‹ ÙË ÙÚÔÊ‹;Ô ¤ÌÂÙÔÔ ‰È¿ÚÚÔÈ·Ô ÂÍ¿ÓıËÌ· Ô ‚Ú¿ÛÈÌÔÔ ÎÔÏÈÎﬁÔ ¿ÏÏ· Û˘ÌÙÒÌ·Ù·: 14.

AÔÙÂÏ¤ÛÌ·Ù·

Aﬁ Ù· 1439 ·È‰È¿ Ô˘ ÂÏ¤Á¯ıËÎ·Ó ÌÂ ‰ÂÚÌ·ÙÈ-

Î¤˜ ‰ÔÎÈÌ·Û›Â˜ ÛÙËÓ Aı‹Ó·, 140 (9,7%) ‹Ù·Ó Â˘·ÈÛıËÙÔÔÈËÌ¤Ó· ÛÂ ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÏÂÚÁÈÔÁfiÓ·, ÂÓÒ ·fi Ù· 364 ·È‰È¿ ÛÙË Ó‹ÛÔ Wight Â˘·ÈÛıËÙÔÔÈËÌ¤Ó· ‹Ù·Ó 92 (25,3%) (p<0.001). H Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰ÈÒÓ ÙË˜ Aı‹Ó·˜ ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ·

ÙˆÓ ·Î¿ÚÂˆÓ ÙË˜ ÔÈÎÈ·Î‹˜ ÛÎﬁÓË˜ Der P1 Î·È Der f1

‹Ù·Ó 1,8% Î·È 1,2%, ÂÓÒ ÛÙ· ·È‰È¿ ÙË˜ Ó‹ÛÔ˘ Wight

‹Ù·Ó 14,8% Î·È 5,2% ·ÓÙ›ÛÙÔÈ¯·, ÌÂ ÙÔ Der P1 ˆ˜ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. TÔ ‰Â‡ÙÂÚÔ Û˘¯ÓfiÙÂÚÔ ·Ï-

ÏÂÚÁÈÔÁﬁÓÔ ÛÙË Ó‹ÛÔ Wight ‹Ù·Ó ÙÔ ÌÂ›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ (13,2%) Î·È ·ÎÔÏÔ˘ıÔ‡ÛÂ ÙÔ ÙÚ›¯ˆÌ· ÙË˜ Á¿Ù·˜ (10,2%). °È· Ù· ·È‰È¿ ÙË˜ Aı‹Ó·˜ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·ÓˆÙ¤Úˆ ·ÏÏÂÚÁÈÔÁﬁÓ· ‹Ù·Ó 4,4% Î·È 4,1% ·ÓÙ›ÛÙÔÈ¯·. ŸÏÂ˜ ÔÈ Û˘ÁÎÚ›ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ

·ÓÙ›ÛÙÔÈ¯ˆÓ Â˘ÚËÌ¿ÙˆÓ ÙˆÓ ‰‡Ô ÂÚÈÔ¯ÒÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰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˘ ÛÎ‡ÏÔ˘ ‹Ù·Ó 6,3% Î·È ÛÙË Á‡ÚË ÙˆÓ ‰¤Ó‰ÚˆÓ ‹Ù·Ó 2,2%.

™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È ÛÂ ‰È¿ÁÚ·ÌÌ· Ô ÂÈÔÏ·ÛÌfi˜ ÙË˜ Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÛÙÈ˜

‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÏ¤Á¯ıËÎ·Ó. ŸÛÔÓ

·ÊÔÚ¿ Ù· Û˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁ›·˜ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó

ÛÙ· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜, ﬁˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎﬁÓ·

2, ‹Ù·Ó Û˘¯ÓﬁÙÂÚ· ÛÙ· ·È‰È¿ ÙË˜ Ó‹ÛÔ˘ Wight ÛÂ Û¯¤ÛË ÌÂ Ù· ·È‰È¿ ÙË˜ Aı‹Ó·˜. H Û˘¯ÓﬁÙËÙ· ÙÔ˘

¿ÛıÌ·ÙÔ˜ ‹Ù·Ó ˘ÂÚ‰ÈÏ¿ÛÈ· (46,9%) ÛÙ· ·È‰È¿ ÙË˜

Ó‹ÛÔ˘ Wight, ÛÂ Û¯¤ÛË ÌÂ Ù· ·È‰È¿ ÙË˜ Aı‹Ó·˜ (22,5%). ŒÎ˙ÂÌ· ﬁˆ˜ Î·È ‚Ú¿ÛÈÌÔ ‹ ÛÊ‡ÚÈÁÌ· ÛÙÔ

ÛÙ‹ıÔ˜ Â›¯Â Â›ÛË˜ 56,3% ÙˆÓ ·È‰ÈÒÓ ÙË˜ Ó‹ÛÔ˘ Wight, ÂÓÒ 34,2% Î·È 29,7% ·ÓÙ›ÛÙÔÈ¯· ÙˆÓ AıËÓÒÓ.

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

EÈÎfiÓ· 2. ™˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁ›·˜ ÛÂ ·È‰È¿ 5- 7,5 ¯ÚfiÓˆÓ ÌÂ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜.

ÙˆÓ ·È‰ÈÒÓ ÙË˜ Ó‹ÛÔ˘ Wight Î·È 7,2% ÙˆÓ ·È‰ÈÒÓ ÙË˜ Aı‹Ó·˜. •ËÚﬁ ‚‹¯· ÙÔ ‚Ú¿‰˘ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ÎÚ˘ÔÏÔÁ‹Ì·ÙÔ˜ 43,8% Î·È 33,3% ÙˆÓ ·È‰ÈÒÓ ·ÓÙ›ÛÙÔÈ¯· ÛÙÈ˜ ‰‡Ô ÂÚÈÔ¯¤˜. OÈ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ ‹Ù·Ó Â›ÛË˜ Û˘¯ÓﬁÙÂÚÂ˜ ÛÙËÓ AÁÁÏ›· 21,9%, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ Aı‹Ó· 15,3%. ™Ù· Ï·›ÛÈ· ÙÔ˘ ÂÏ¤Á¯Ô˘ ¿ÏÏˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ

Ô˘ Â˘ÓÔÔ‡Ó ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙËÓ ÂÎ‰‹ÏˆÛË ·ÙÔÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‚Ú¤ıËÎÂ fiÙÈ Ù· ·È‰È¿ ÛÙËÓ Aı‹Ó· ÂÎÙ›ıÂÓÙÔ ÛÂ Î·Ófi ÙÛÈÁ¿ÚÔ˘ ÂÓ‰ÔÌ‹ÙÚÈ· ÛÂ ÔÛÔÛÙfi 14,4% Î·È ÛÙÔ ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÛÂ ÔÛÔÛÙfi 50,4%. T· ·ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿ ÛÙËÓ Ó‹ÛÔ Wight ‹Ù·Ó 6,3% Î·È 18,8% (›Ó·Î·˜ 3).

¶›Ó·Î·˜ 3. ŒÎıÂÛË ÙˆÓ ·È‰ÈÒÓ ÛÂ Î¿ÓÈÛÌ·. N‹ÛÔ˜ WightAı‹Ó·

EÓ‰ÔÌ‹ÙÚÈ·6,3%14,4% ™ÙÔ Û›ÙÈ18,8%50,4%

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

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

EÓÒ Ë ·ÙÔÈÎ‹ ÚÔ‰È¿ıÂÛË ˘‹Ú¯Â Î·È ÛÙÈ˜ ‰‡Ô

ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ¯ˆÚÒÓ, Ê·›ÓÂÙ·È

ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ﬁÙÈ ÙÔ ÌÈÎÚÔ- Î·È ÙÔ Ì·ÎÚÔ-Â-

ÚÈ‚¿ÏÏÔÓ ÂËÚÂ¿˙Ô˘Ó ÛËÌ·ÓÙÈÎ¿ ÙË ‰ÈÂÈÛ‰˘ÙÈÎﬁÙËÙ·

Î·È ÙËÓ ÂÎÊÚ·ÛÙÈÎﬁÙËÙ· ÙÔ˘ ÁﬁÓÔ˘ ÌÂ ÂÎ‰‹ÏˆÛË

·ÙÔÈÎ‹˜ ÓﬁÛÔ˘ ‰È·ÊÔÚÂÙÈÎ‹˜ Û˘¯ÓﬁÙËÙ·˜.

H ÚÔ‰ÚÔÌÈÎ‹ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛË˜ ÛÙÈ˜ ‰‡Ô

¯ÒÚÂ˜ ı· ··ÓÙ‹ÛÂÈ ÛÙËÓ ÛËÌ·ÓÙÈÎ‹ ÂÚÒÙËÛË ·Ó Ë

ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ ·ÏÏÂÚÁÈÔÁﬁÓˆÓ ÌÔÚÂ›

Ó· ÂÏ·ÙÙÒÛÂÈ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙËÓ ¤ÎÊÚ·Û‹ ÙË˜ ÛÂ ·ÏÏÂÚÁÈÎ‹ ÓﬁÛÔ.

E˘¯·ÚÈÛÙ›Â˜

£¤ÏÔ˘ÌÂ Ó·

¢ËÌÔÔ‡ÏÔ˘, AÈÌÈÏ›· ¶·Ó¿ÁÔ˘ Î·È

K·ÙÂÚ›Ó· NÈÎÔÏ¿Ô˘ ÁÈ· ÙË Û˘Ó‰ÚÔÌ‹ ÙÔ˘˜.

£¤ÏÔ˘ÌÂ Â›ÛË˜ Ó· Â˘¯·ÚÈÛÙ‹ÛÔ˘ÌÂ ÙËÓ ÂÙ·È-

ÚÂ›· ALK Scherax, Hamburg Germany ÁÈ· ÙËÓ ÚÔ-

ÛÊÔÚ¿ ÙˆÓ ·ÏÏÂÚÁÈÔÁﬁÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó

ÁÈ· ÙÈ˜ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜.

EÈ‰ÔÙ‹ÛÂÈ˜

H ·ÚÔ‡Û· ¤ÚÂ˘Ó· ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËÎÂ ·ﬁ ÙËÓ

E˘Úˆ·˚Î‹ ŒÓˆÛË, ·ﬁ ÙÔ ÚﬁÁÚ·ÌÌ· BIOMED 2, grant No PL 1211.

BÈ‚ÏÈÔÁÚ·Ê›·

1. Pope A.M, Patterson R, Burge H. Indoor allergensassessing and controlling adverse health effects. Washington, DC: National Academy Press, 1993.

2.Charpin D, Kleisbauer JP, Lanteaume A. Asthma and allergy to house dust mites in population living in high altitudes. Chest 1998;93:758-761.

3.Kuehr J, Frischer T, Meinert R, Bath R, Forster J, Schraub S, et al. Mite allergen exposure is a risk for the incidence of specific sensitisation. Allergy Clin Immunol 1994;94:4452.

4. Sporic R, Holgate S, Platts-Mills TAE, Cogswell J. Exposure to house dust mite allergen (Der P1) and the development of asthma in childhood. New Engl J Med 1990;323:502-507.

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.

6.Duff AL, Pomeranz ES, Gelber LE, Price GW, Farris H, Hayden FG, et al. Risk factors for acute wheezing in infants and children: viruses, passive smoke and IgE antibodies to inhalant allergens. Pediatrics 1993;92:535540.

7.Platts-Mills TAE, Hayden ML, Woodfolk JA, Call RS, Sporik R. House dust mite avoidance regimens for the treatment of asthma. In: David TS ed. Recent advances in

paediatrics 13. Edinburgh: Churchill Livingstone, 1995:4558.

8.Henderson FW, Henry MM, Ivins SS, Morris R, Neebe EC, Leu SY, et al. Correlates of recurrent wheezing in schoolage children. Am J Respir Crit Care Med 1995; 151:17861793.

9. 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.

10.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.

11.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.

12.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.

13. 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.

14. 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.

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

16.¶Ú›ÊÙË˜ K, Z‹‚· M, M·ıÈÔ˘‰¿ÎË˜ °, HÏ›· M, °Ú˘¿ÚË M, AÓ·ÁÓˆÛÙ¿ÎË˜ I, ™·ÍÒÓË-¶··ÁÂˆÚÁ›Ô˘ º. E˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ ÛÙ· ÎÔÈÓ¿ ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ·. E›‰Ú·ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. I·ÙÚÈÎ‹ 1990;58(2):161-166. 17.Z‹‚· - ¶ÂÙÚÔÔ‡ÏÔ˘ M, ¶È¤ÚÔ˘ B, £¤ÌÂÏË-¢È·Á·Ï¿ÎË K, K·˝ÚË˜ ¢, KÔ‡ÙÛÈ·-K·ÚÔ‡˙Ô˘ X, ¶··‰¿ÎÔ˘ §·ÁÔÁÈ¿ÓÓË ™. ŒÏÂÁ¯Ô˜ Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÂ ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ· ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ ÙË˜ N.A. AÙÙÈÎ‹˜ ÌÂ ·Ó›¯ÓÂ˘ÛË ÂÈ‰ÈÎÒÓ IgE ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi. ¶·È‰È·ÙÚÈÎ‹ 1995;158:176-182.

18.Hart B J. Life cycle and reproduction of house-dust mites: environmental factors influencing mite populations. Allergy 1998;53 (Suppl 48):13-17.

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

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

21.Marks GB. House dust mite exposure as a risk factor for asthma: benefits of avoidance. Allergy 1998; 53 Suppl. 48:108-114.

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˘‰¿ÎË˜ °, ¶Ú›ÊÙË˜ K, E˘·ÁÁÂÏÔÔ‡ÏÔ˘ E, TÚÈ·ÓÙ·Ê˘ÏÏÔÔ‡ÏÔ˘ X. ¢˘ÛÌÂÓÂ›˜ Û˘Ó¤ÂÈÂ˜ Ú˘¿ÓÛÂˆ˜ ÙË˜ ·ÙÌﬁÛÊ·ÈÚ·˜ ÙˆÓ AıËÓÒÓ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. 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.

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˙Ë‰¿ÎÈ˜ ¢. AÍÈÔÏfiÁËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ú‡·ÓÛË˜ ·fi ‰ÈÔÍÂ›‰ÈÔ ÙÔ˘ ıÂ›Ô˘ Î·È Î·Ófi ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ÙË˜ Aı‹Ó·˜. AÚ¯ EÏÏËÓ I·ÙÚ 1990;7:109-116.

30.TÔ˘ÏÔ‡ÌË °, K·ÙÛÔ˘ÁÈ¿ÓÓË K. AÙÌÔÛÊ·ÈÚÈÎ‹ Ú‡·ÓÛË ÛÙÔ ÏÂÎ·ÓÔ¤‰ÈÔ AıËÓÒÓ: ¢È·¯ÚÔÓÈÎ¤˜ Ù¿ÛÂÈ˜, ËÌÂÚ‹ÛÈÂ˜ ‰È·Î˘Ì¿ÓÛÂÈ˜ 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·ÈÚÈÎ‹ Ú‡·ÓÛË Î·È ·È‰ÈÎ‹ ÓÔÛËÚﬁÙËÙ·. EÚÁ·ÛÙ‹ÚÈÔ YÁÈÂÈÓ‹˜ & EÈ‰ËÌÈÔÏÔÁ›·˜ ÙÔ˘ ¶·Ó/Ì›Ô˘ AıËÓÒÓ, IÓÛÙÈÙÔ‡ÙÔ YÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. TÂÏÈÎ‹ ¤ÎıÂÛË M¿ÈÔ˜ 1994.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-99

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·

TÌ‹Ì· KÔÈÓˆÓÈÎ‹˜ I·ÙÚÈÎ‹˜, NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" MÂÛÔÁÂ›ˆÓ 24, 115 27 Aı‹Ó·

X¿ÛÌ· ·ÓÈﬁÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿

XÚ‹ÛÙÔ˜ KÒÛÙ·ÏÔ˜, AÓ·ÛÙ¿ÛÈÔ˜ TÛ·Î›ÚË˜, AÈÎ·ÙÂÚ›ÓË KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M·Ú›· ¢·ÓÈËÏ›‰Ô˘, AÓÙÒÓÈÔ˜ °Ô‡Ó·ÚË˜

● ¶ÂÚ›ÏË„Ë: O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¯¿ÛÌ·ÙÔ˜ ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) Î·È Ô‡ÚˆÓ (XAO) ‚ÔËı¿ÂÈ ÛÙË ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÌÈ·˜ ÌÂÙ·‚ÔÏÈÎ‹˜ ÔÍ¤ˆÛË˜. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAA Î·È XAO ÛÂ ÚfiˆÚ· Î·È ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Î·Ù·ÁÚ¿„Ô˘ÌÂ ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜. MÂÏÂÙ‹ıËÎ·Ó 35 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (ÔÌ¿‰· A: ËÏÈÎ›· Î¿Ùˆ ÙˆÓ 15 ËÌÂÚÒÓ-ÔÌ¿‰· B: ËÏÈÎ›· 16-30 ËÌÂÚÒÓ) Î·ıÒ˜ Î·È 15 ÚfiˆÚ· ÓÂÔÁÓ¿ ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 21 ËÌÂÚÒÓ. EÎÙÈÌ‹ıËÎ·Ó Ù· Â›Â‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ·›Ì·ÙÔ˜ Î·ıÒ˜ Î·È Ù· Â›Â‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·Ï›Ô˘ ÛÙ· Ô‡Ú·. T· Â›Â‰· Ó·ÙÚ›Ô˘ Î·È ¯ÏˆÚ›Ô˘ ·›Ì·ÙÔ˜ ÙË˜ ÔÌ¿‰·˜ A ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È °. AÓÙ›ıÂÙ·, ÙÔ XAA ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚÔ ÛÙ·

Î‡ËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡. H ·¤ÎÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú· ·˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÌ¤Ú· ˙ˆ‹˜, Î·È ÌÂ ÙËÓ ËÏÈÎ›· Î‡ËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈÎ‹ 2000;63:34-37.

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 ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÌÈ·˜

ÌÂÙ·‚ÔÏÈÎ‹˜ ÔÍ¤ˆÛË˜ (1,2).

ø˜ ¯¿ÛÌ· ·ÓÈﬁÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) ıÂˆÚÔ‡ÌÂ ÙË

‰È·ÊÔÚ¿ Ô˘ ÚÔÎ‡ÙÂÈ, ﬁÙ·Ó ·ﬁ ÙËÓ ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ÙÔ˘ ·›Ì·ÙÔ˜, ·Ê·ÈÚ¤ÛÔ˘ÌÂ ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘

¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ. TÔ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ Ô‡ÚˆÓ (XAO) ·ÔÙÂÏÂ› ·‰Úfi ‰Â›ÎÙË ÙË˜ ·¤ÎÎÚÈÛË˜ ·ÌÌˆÓ›·˜ ÛÙ· Ô‡Ú· Î·È ‚ÔËı¿ÂÈ ÛÙÔÓ Î·ıÔÚÈÛÌfi ·Ó ÌÈ· ˘ÂÚ¯ÏˆÚ·ÈÌÈÎ‹ ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË Â›Ó·È ÓÂÊÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ fi¯È. K·ıÔÚ›˙ÂÙ·È ·˘Ùfi

(3, 4).

™ÎÔﬁ˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· Î·ıÔÚÈ-

ÛıÂ› Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ÙÈÌ‹ ÙÔ˘ XAA Î·ıÒ˜ Î·È ÙÔ˘ XAO

ÙfiÛÔ ÛÂ ÚfiˆÚ· fiÛÔ Î·È ÛÂ ÙÂÏÂÈfiÌËÓ· ˘ÁÈ‹ ÓÂÔÁÓ¿.

YÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ

MÂÏÂÙ‹ıËÎ·Ó 35 ÙÂÏÂÈﬁÌËÓ· ÓÂÔÁÓ¿ - 27 ËÏÈÎ›·˜

Î¿Ùˆ ÙˆÓ 15 ËÌÂÚÒÓ (ÔÌ¿‰· A) Î·È 8 ÌÂÙ·Í‡ 16-30

ËÌÂÚÒÓ (ÔÌ¿‰· B) - Î·ıÒ˜ Î·È 15 ÚﬁˆÚ· ÓÂÔÁÓ¿

ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 21 ËÌÂÚÒÓ (ÔÌ¿‰· °). H Ì¤ÛË ËÏÈ-

Î›· ˙ˆ‹˜ ÛÙ· ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ A ‹Ù·Ó 7,2 (±3)

ËÌ¤ÚÂ˜, ÂÓÒ ÁÈ· Ù· ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ B Ë ·ÓÙ›ÛÙÔÈ-

¯Ë ËÏÈÎ›· ‹Ù·Ó 21 (±5) ËÌ¤ÚÂ˜. H Ì¤ÛË ËÏÈÎ›· Î‡Ë-

ÛË˜ ÛÙ· ÚﬁˆÚ· ÙË˜ ÔÌ¿‰·˜ ° ‹Ù·Ó 34±1 Â‚‰ÔÌ¿-

‰Â˜ Î·È Ì¤ÛË ËÏÈÎ›· ˙ˆ‹˜ 13 ±2 ËÌ¤ÚÂ˜. ŸÏ· Ù· ÓÂ-

ÔÁ¤ÓÓËÙ· ‹Ù·Ó ˘ÁÈ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜

Î·È ÛÈÙ›˙ÔÓÙ·Ó ÌÂ Í¤ÓÔ Á¿Ï· ÛÂ ÙÚ›ˆÚË ‚¿ÛË

(Almiron 1 ÌÂ ÂÚÈÂÎÙÈÎﬁÙËÙ· ÛÂ ÏÂ‡ÎˆÌ· 1.4 g%).

H ÌÂÏ¤ÙË ¤ÁÈÓÂ ÙÔ Úˆ› ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÁÂ‡Ì·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‹ıËÎÂ Ô˘ÚÔÛ˘ÏÏ¤ÎÙË˜ 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·ÎÈÎ¿ ·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ ÌÂ ·Ó·Ï˘Ù‹ ·ÂÚ›ˆÓ AVL.

°È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ t

test. ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎﬁ ıÂˆÚ‹ıËÎÂ ÙÔ ·ÔÙ¤ÏÂÛÌ· ÂÊﬁÛÔÓ ÙÔ p < 0.05.

AÔÙÂÏ¤ÛÌ·Ù·

™Â ﬁ,ÙÈ ·ÊÔÚ¿ ÛÙ· Â˘Ú‹Ì·Ù· ·ﬁ ÙÔ ·›Ì·, Ù· Â›-

Â‰· Ó·ÙÚ›Ô˘ Î·È ¯ÏˆÚ›Ô˘ ÙˆÓ ÓÂÔÁÓÒÓ ÙË˜ ÔÌ¿‰·˜

A ‹Ù·Ó ˘„ËÏﬁÙÂÚ· ·ﬁ ·˘Ù¿ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È ° (p<0.01 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È °, p<0.05 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È B ÁÈ· ÙÔ Ó¿ÙÚÈÔ,Î·È p<0.01 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È B ÁÈ· ÙÔ ¯ÏÒÚÈÔ). AÓÙ›ıÂÙ·, ÙÔ

XAA ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏﬁÙÂÚÔ ÛÙ· ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ ° (p<0.05 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È °). T·

Î·Ï›Ô˘ Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó

ÛËÌ·ÓÙÈÎ¿ ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜. (¶›Ó·Î·˜ 1).

™Â ﬁ,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú·, Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏﬁÙÂÚË ÛÙËÓ ÔÌ¿‰· A ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· ° (p<0.01), ·ÓÙ›ıÂÙ·, ÙÔ Î¿ÏÈÔ ‹Ù·Ó

ÛËÌ·ÓÙÈÎ¿ ˘„ËÏﬁÙÂÚÔ ÛÙËÓ ÔÌ¿‰· B ÛÂ Û‡ÁÎÚÈÛË

ÙﬁÛÔ ÌÂ ÙËÓ ÔÌ¿‰· A (p<0.05) ﬁÛÔ Î·È ÌÂ ÙËÓ ÔÌ¿‰· ° (p<0.05).

Y„ËÏﬁÙÂÚÔ ‹Ù·Ó Î·È ÙÔ ¯ÏÒÚÈÔ ÛÙËÓ ÔÌ¿‰· B ÛÂ

Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ‰‡Ô ¿ÏÏÂ˜ ÔÌ¿‰Â˜, Ë ‰È·ÊÔÚ¿ ﬁÌˆ˜

·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹. TÔ XAO ‹Ù·Ó

˘„ËÏﬁÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ° ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ‰‡Ô ¿ÏÏÂ˜

ÔÌ¿‰Â˜, ﬁÌˆ˜ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-

ÓÙÈÎ‹ Ô‡ÙÂ Â‰Ò. (¶›Ó·Î·˜ 2).

™ÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ÌÈ·˜ ‰È·Ù·Ú·¯‹˜ ÙË˜

ÔÍÂÔ‚·ÛÈÎ‹˜ ÈÛÔÚÚÔ›·˜ ÔÏ‡ÙÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜

Ó·

Î·ÓÂ›˜ ÂÍÂÙ¿˙ÔÓÙ·˜ Ù· Â›Â‰·

Ó·ÙÚ›Ô˘, ÙÔ˘ ¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ,

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) ıÂˆÚÂ›Ù·È Ë ‰È·ÊÔÚ¿ Ô˘ ÚÔÎ‡ÙÂÈ fiÙ·Ó ·fi ÙËÓ ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ·Ê·ÈÚ¤ÛÔ˘ÌÂ ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ ¯ÏˆÚ›Ô˘ ÌÂ Ù· ‰ÈÙÙ·ÓıÚ·ÎÈÎ¿. H ‰È·ÊÔÚ¿ ·˘Ù‹ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Ó·È 816 (Ì¤ÛË ÙÈÌ‹ 12), Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÌË ÚÔÛ‰ÈÔÚÈ˙fiÌÂÓ· ·ÓÈfiÓÙ· .¯. ÊˆÛÊÔÚÈÎ¿, ıÂÈÈÎ¿, Á·Ï·ÎÙÈÎ¿, ÚˆÙÂ˝ÓÂ˜ (6). K·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔ XAA

Â›Ó·È ÔÚÈÛÌ¤ÓÂ˜ Û‡ÌÊ˘ÙÂ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ·ÌÈÓÔÍ¤ˆÓ, ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÔÚÁ·ÓÈÎÒÓ

ÔÍ¤ˆÓ. ŒÙÛÈ, Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAA ÌÔÚÂ› Ó· ‰ÒÛÂÈ ÔÏ‡ÙÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· Ù· ·›ÙÈ· ÌÈ·˜ ÌÂÙ·‚ÔÏÈÎ‹˜ ÔÍ¤ˆÛË˜ (7). ™ÙÔ ÓÂÔÁ¤ÓÓËÙÔ Î·È ÂÈ‰ÈÎ¿ ÛÙÔ

ÚﬁˆÚÔ, ÙÔ XAA Ê˘ÛÈÔÏÔÁÈÎ¿ Î˘Ì·›ÓÂÙ·È Á‡Úˆ ÛÙÔ 16 (8).

¶›Ó·Î·˜ 1. BÈÔ¯ËÌÈÎ¤˜ ÙÈÌ¤˜ (x±SD) ·›Ì·ÙÔ˜ ÛÂ mmol/l (ÔÈ ÙÈÌ¤˜ ÛÂ mEq/l Â›Ó·È Ù·˘ÙﬁÛËÌÂ˜).

N¿ÙÚÈÔK¿ÏÈÔXÏÒÚÈÔ¢ÈÙÙ·ÓıÚ·ÎÈÎ¿XAA

OÌ¿‰· A143,5±5,15,3±0,7109,9±5,220,6±2,310,9±3,7

OÌ¿‰· B138,0±2,14,6±1,8103,6±1,922,2±2,99,2±2,9

OÌ¿‰· °139,3±3,35,3±0,6107,5±4,020,8±2,513,4±3,7

¶›Ó·Î·˜ 2. BÈÔ¯ËÌÈÎ¤˜ ÙÈÌ¤˜ (x±SD ) Ô‡ÚˆÓ ÛÂ mmol/l (ÔÈ ÙÈÌ¤˜ ÛÂ mEq/l Â›Ó·È Ù·˘ÙﬁÛËÌÂ˜).

N¿ÙÚÈÔK¿ÏÈÔXÏÒÚÈÔXAO OÌ¿‰· A15,5±8,715,7±10,125,9±9,73,5±8,0

OÌ¿‰· B14,0±25,829,6±21,234,5±26,71,4±10,4

OÌ¿‰· °7,5± 7,216,7± 6,120,2±8,54,7±12,1

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

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

4.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.

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

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

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

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

9.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.

10.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.

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›· ¤ÁÎÚÈÛË˜: 03-09-99 ¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: X. KÒÛÙ·ÏÔ˜

AÚÙ¤ÌÈ‰Ô˜ 130, ¶·Ï·Èﬁ º¿ÏËÚÔ 17562

™˘ÛÙËÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÏÔ›ÌˆÍË˜

·ﬁ

ÈÔ‡˜ Coxsackie B ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

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·ÛÈÏÈÎ‹ K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó·3

● ¶ÂÚ›ÏË„Ë: AÓ·ÛÎÔÔ‡ÓÙ·È ÔÈ Û˘ÛÙËÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÁÂÓÈÎÂ˘Ì¤ÓË˜ ÏÔ›ÌˆÍË˜ ·fi Èfi Coxsackie B ÛÂ 11 ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÚfiÛÊ·Ù· ÛÙÔ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô ·fi I·ÓÔ˘¿ÚÈÔ 1996 Ì¤¯ÚÈ M¿ÈÔ 1997. O ÈÔ Û˘¯Ófi˜ Ù‡-

Ô˜ ‹Ù·Ó Ô B4 Î·È ÔÈ Î˘Ú›·Ú¯Â˜ ÂÎ‰ËÏÒÛÂÈ˜ ‹Ù·Ó ·ÚıÚ›ÙÈ‰·, ÓÂ˘ÌÔÓ›·, Ì˘ÔÎ·Ú‰›ÙÈ‰· Î·È ıÚÔÌ‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú·.

ÏÔ›ÌˆÍË ·ﬁ ÈÔ‡˜ Coxsackie B. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ·Ó Î·È Û¿ÓÈ·, Â›Ó·È ‰˘Ó·ÙﬁÓ

ÏÔ›ÌˆÍË ·ﬁ ÈÔ‡˜ Coxsackie B. ¶·È‰È·ÙÚÈÎ‹ 2000;63:38-42 . §¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Coxsackie B, ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜.

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 ÚÔÎ·ÏÔ‡Ó Î˘Ú›ˆ˜ ·Û˘ÌÙˆÌ·ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ‹ ÌË ÂÈ‰ÈÎ¤˜ ÂÌ‡ÚÂÙÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, ·ÚfiÌÔÈÂ˜ ÌÂ ·˘Ù¤˜ Ô˘ ÚÔÎ·ÏÔ‡Ó Î·È ÔÈ ¿ÏÏÔÈ ÂÓÙÂÚo˚Ô› (1,2). EÈÏ¤ÔÓ, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÔÈÎ›ÏÏÂÈ ·fi ·Û˘ÌÙˆÌ·ÙÈÎ‹ Ì¤¯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 ËÏÈÎ›· Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓ‹. Afi

ÙÔ˘˜ ÂÓÙÂÚÔÈÔ‡˜, ÔÈ ÈÔ› Coxsackie B Â›Ó·È ·˘ÙÔ› Ô˘

1 °' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹, A.¶.£.

2 A' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹, A.¶.£.

3 EÚÁ·ÛÙ‹ÚÈÔ MÈÎÚÔ‚ÈÔÏÔÁ›·˜, A.¶.£.

Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ ÌÂ ÚÔÛ‚ÔÏ‹ ÙË˜ Î·Ú‰È¿˜, ÙˆÓ ÓÂ˘ÌfiÓˆÓ, ÙÔ˘ ‹·ÙÔ˜, ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ Î·È ÙÔ˘ K.N.™. (2). T· ÈÔ ÎÔÈÓ¿ Â˘Ú‹Ì·Ù· ÛÂ ·˘Ù¤˜ ÙÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ‹Ù·Ó Ì˘ÔÂÚÈÎ·Ú‰›ÙÈ‰·, ÂÚÈÎ·Ú‰›ÙÈ‰·, ÏÂ˘ÚÔ‰˘Ó›·, ÌËÓÈÁÁ›ÙÈ‰· Î·È ·ÁÎÚÂ·Ù›ÙÈ‰·. ™Â ÌÈ· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ BfiÚÂÈ· EÏÏ¿‰·, Ë ÈÔ Û˘¯Ó‹ ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ‹Ù·Ó Ë Ì˘ÔÂÚÈÎ·Ú‰›ÙÈ‰· (3). KÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, fiˆ˜ ·ÚıÚ›ÙÈ‰·, Ë·Ù›ÙÈ‰·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›ÙÈ‰·

1¶¶3

AÎ·ıﬁÚÈÛÙÔ˜**O˘‰ÂÙÂÚÔÂÓ›·,¶ÂÚ›ÙˆÛË 2 Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·

2MO4B4 ¶ÓÂ˘ÌÔÓ›·, ÏÂ˘Ú›ÙÈ‰·,AÓ¿ÚÚˆÛË Ì˘ÔÎ·Ú‰›ÙÈ‰·

3TX 1,25B1 + B5

4KK8B4

AÚıÚ›ÙÈ‰·AÓ¿ÚÚˆÛË

H·Ù›ÙÈ‰·, ÓÂ˘ÌÔÓ›·,¶ÂÚ›ÙˆÛË 1 ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›ÙÈ‰·, ·ÚıÚ›ÙÈ‰·

5°A 3,5AÎ·ıﬁÚÈÛÙÔ˜OÍÂ›· ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹AÓ¿ÚÚˆÛË ·Ù·Í›·

6¶M6B4

7X™5B2

AÚıÚ›ÙÈ‰·AÓ¿ÚÚˆÛË

£ÚÔÌ‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú·AÓ¿ÚÚˆÛË

8K™ 1,5AÎ·ıﬁÚÈÛÙÔ˜H·ÙÔÛÏËÓÔÌÂÁ·Ï›·AÓ¿ÚÚˆÛË

9M£7 AÎ·ıﬁÚÈÛÙÔ˜M˘ÔÎ·Ú‰›ÙÈ‰·BÂÏÙ›ˆÛË*** 10MK11B5

11§¶4,5B1 + B4 ¶ÓÂ˘ÌÔÓ›· ÌÂ ÏÂ˘Ú›ÙÈ‰·,AÓ¿ÚÚˆÛË ÂÍ¿ÓıËÌ· * ŒÌÌÂÛÔ˜ Î·ıÔÚÈÛÌfi˜ ÌÂ ·Ó›¯ÓÂ˘ÛË ÂÈ‰ÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÂÓfi˜ ÂÎ¿ÛÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Coxsackie B1-B6 ** AÓ›¯ÓÂ˘ÛË ÂÈ‰ÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ B1-B6 *** O ·ÛıÂÓ‹˜ Â›¯Â ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·

ÚÂÙÔ˜ Î·È Â¤ÛÙÚÂ„Â ÛÙÔ Û›ÙÈ ÙÔ˘ ÌÂÙ¿ ·ﬁ Ï‹ÚË

˘Ô¯ÒÚËÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. TËÓ 16Ë ËÌ¤Ú· ·ﬁ

ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓﬁÛÔ˘, ÌÂÙ¿ ·ﬁ ÌÈ· ÂÚ›Ô‰Ô 4 ËÌÂ-

ÚÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù·, Ô ·ÛıÂÓ‹˜ ·Ú·ÔÓ¤ıËÎÂ

ÁÈ· ¿ÏÁÔ˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ Ô‰ÔÎÓËÌÈÎ‹ ¿ÚıÚˆÛË, Ë

ÔÔ›· ˘Ô¯ÒÚËÛÂ ÛÂ 4 ËÌ¤ÚÂ˜, ·ÏÏ¿ ·ÎÔÏÔ‡ıËÛÂ

¿ÏÁÔ˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ Î·Ù¿ ÁfiÓ˘ ¿ÚıÚˆÛË. H ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·ÔÎ¿Ï˘„Â ·ÚıÚ›ÙÈ‰· Ë ÔÔ›· ÂÈ‚Â‚·ÈÒıËÎÂ Î·È ÌÂ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. H ·ÚıÚ›ÙÈ‰· ‰È‹ÚÎÂÛÂ ÂÚ›Ô˘ 2 Â‚‰ÔÌ¿‰Â˜. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È fiÏË Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙÔ˘ ·ÛıÂÓ‹. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B, Ô˘ ¤ÁÈÓÂ 3 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÚÒÙË ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ›¯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 ÛÂ ÔÏ‡ Î·Ï‹ Î·Ù¿ÛÙ·ÛË.

¶ÂÚ›ÙˆÛË 2Ë

AÁfiÚÈ, ËÏÈÎ›·˜ 3 ¯ÚÔÓÒÓ, ·Ú·¤ÌÊıËÎÂ ÛÙÔ ÂÍˆÙÂÚÈÎfi AÈÌ·ÙÔÏÔÁÈÎfi I·ÙÚÂ›Ô ÙË˜ A'

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˘ÓÂ¯Â›˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÂÈ‚Â‚·›ˆÛÂ ÙË ‰ÈfiÁÎˆÛË ‹·ÙÔ˜ Î·È ÛÏËÓfi˜ Î·È ·ÔÎ¿Ï˘„Â „ËÏ·ÊËÙÔ‡˜ ÙÚ·¯ËÏÈÎÔ‡˜ ÏÂÌÊ·‰¤ÓÂ˜. O ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ Ô˘‰ÂÙÂÚÔÂÓ›· (ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 4.500/mm3 ÌÂ ·fiÏ˘ÙÔ ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ 450) Î·È ıÂÙÈÎ‹ ÙËÓ ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs. TÔ Ì˘ÂÏfiÁÚ·ÌÌ· ¤‰ˆÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È ÙˆÓ T ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ·¤‚Ë ·ÚÓËÙÈÎfi˜ ÁÈ· ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÌÂÁ·ÏÔÎ˘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 ÏÔ›ÌˆÍË. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B ¤‰ÂÈÍÂ IgM ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi, ÂÓÒ Ù· IgG ‹Ù·Ó ÂÏ·ÊÚ¿ ·˘ÍËÌ¤Ó·. ¢‡Ô Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·, Ë Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Â›¯Â ˘Ô¯ˆÚ‹ÛÂÈ Î·È Ë ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ‹Ù·Ó ·ÚÓËÙÈÎ‹.T· IgG ·ÓÙÈÛÒÌ·Ù·

EÈÎﬁÓ· 1. ™˘ÌÙˆÌ·ÙÔÏÔÁ›· ·ÛıÂÓ‹ 1.

OÈ ÈÔ› ·˘ÙÔ› ÂÚÈÛÙ·ÛÈ·Î¿ ÚÔÎ·ÏÔ‡Ó ÁÂÓÈÎÂ˘Ì¤ÓÂ˜

ÏÔÈÌÒÍÂÈ˜ ÌÂ ·˘ÙÔÂÚÈÔÚÈ˙ﬁÌÂÓË ÔÚÂ›·, ÛÂ Î·Ù¿ Ù· ¿ÏÏ· ˘ÁÈ‹ ·È‰È¿, ·ÏÏ¿ Â›ÛË˜ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-

ÛÔ˘Ó Î·È ÂÌÌ¤ÓÔ˘Û· Ô˘‰ÂÙÂÚÔÂÓ›·. T· ·ÔÙÂÏ¤ÛÌ·-

Ù· ·˘Ù¿ Û¯ÂÙ›˙ÔÓÙ·È Â›ÙÂ ÌÂ ÙËÓ ˘„ËÏ‹ ÏÔÈÌÔÁﬁÓÔ ‰‡-

Ó·ÌË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ù‡ˆÓ ÙˆÓ ÈÒÓ Coxsackie B, ‹ ÌÂ ·ÓÔÛÔÏÔÁÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜ Ô˘ ‰ÂÓ Â›Ó·È Â·ÚÎÒ˜ Î·ıÔÚÈÛÌ¤ÓÔÈ 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˘-™˘ÌÂˆÓ›‰Ô˘ E, ™˘ÌÂˆÓ›‰Ë˜ °, ¶··‚·ÛÈÏÂ›Ô˘ ¶. IÔ› Coxsackie B Î·È ÎÏÈÓÈÎ¤˜ ÔÓÙﬁÙËÙÂ˜. EÏÏËÓÈÎ‹ I·ÙÚÈÎ‹ 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›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: E. PÔËÏ›‰Ë˜ °' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ A.¶.£. IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô

KˆÓÛÙ·ÓÙÈÓÔ˘ﬁÏÂˆ˜ 49, 54642 £ÂÛÛ·ÏÔÓ›ÎË

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.

B›Î˘ º·Ï·˝Ó·, B·ÛÈÏÈÎ‹ ¶··Â˘·ÁÁ¤ÏÔ˘, B·ÛÈÏÈÎ‹ ™˘ÚÈÔÔ‡ÏÔ˘, M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘

●

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈÎ›·˜ 4 ÂÙÒÓ Ô˘ ÂÈÛ‹¯ıË ÛÙË ÎÏÈÓÈÎ‹ Ì·˜ ÌÂ ˘ÚÂÙfi, ‚‹¯· Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙÂ˜ ÛÂ ·ÌÊfiÙÂÚ· Ù· ÓÂ˘ÌÔÓÈÎ¿ Â‰›·. TËÓ 3Ë Ì¤Ú· ÓÔÛËÏÂ›·˜ ÙË˜, ˘fi ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ıÂÚ·Â›·, ÂÌÊ¿ÓÈÛÂ ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·. T¤ÛÛÂÚÈ˜ ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ· Î·È ÂÓÒ Ô ˘ÚÂÙfi˜ Â›¯Â ˘ÊÂıÂ›, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ÙË˜ ·ÚÈÛÙÂÚ¿˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ¿ÚÂÛË ÙÔ˘ ‰ÂÍÈÔ‡ ÚÔÛˆÈÎÔ‡ ÓÂ‡ÚÔ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. T· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ENY ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (CT Î·È MRI ÂÁÎÂÊ¿ÏÔ˘) ¤‰ÂÈÍÂ ÂÎÙÂÙ·Ì¤ÓË ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈÎ¿ ÌÂ ·ÁÁÂÈ·Î‹ Î·Ù·ÓÔÌ‹, Â‡ÚËÌ· Û˘Ì‚·Ùfi ÌÂ ¤ÌÊÚ·ÎÙÔ ÙË˜ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜.

ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ·Ù› Ë ÂÓÙÔÈÛÌ¤ÓË ·ÁÁÂÈ›ÙÈ‰· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡

ÏÔ›ÌˆÍË˜

2000;63:43-47.

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 ÓÂ˘ÌÔÓ›· ·ÔÙÂÏÂ› ÙËÓ ÈÔ Û˘¯Ó‹ Î·È ÛËÌ·ÓÙÈÎ‹ ÂÎ‰‹ÏˆÛË ÏÔ›ÌˆÍË˜ ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜. YÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ Ì˘ÎfiÏ·ÛÌ· Â˘ı‡ÓÂÙ·È ÁÈ· ÂÚ›Ô˘ 20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂ˘ÌÔÓ›·˜ ÙË˜ ÎÔÈÓfiÙËÙ·˜. H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· (0,1%), ·ÏÏ¿ ·˘Í¿ÓÂÈ ·Ú¿ÏÏËÏ· ÌÂ ÙË ‚·Ú‡ÙËÙ· ÙË˜ ÓÂ˘ÌÔÓ›·˜, ·ÊÔ‡ ÊÙ¿ÓÂÈ ÛÙÔ 7% ÛÙÔ˘˜ ÓÔÛËÏÂ˘fiÌÂÓÔ˘˜ ÌÂ ÓÂ˘ÌÔÓ›· ·fi Ì˘ÎfiÏ·ÛÌ· (1). H ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÂ ÓÂ·Ú¿ ¿ÙÔÌ· (< 20 ÂÙÒÓ) Î·È È‰È·›ÙÂÚ· ÛÂ ¿ÚÚÂÓÂ˜, ÂÌÊ·Ó›˙ÂÙ·È ‰Â Î·Ù¿ Ì¤ÛÔ fiÚÔ 10 Ì¤ÚÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ

H ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙÈ‰· ·ÔÙÂÏÂ› ÙË Û˘¯ÓﬁÙÂÚË ÂÈÏÔÎ‹. ™·ÓÈﬁÙÂÚ· ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÂÁÎÂÊ·Ï›ÙÈ‰·, ÂÁÎ¿ÚÛÈ· Ì˘ÂÏ›ÙÈ‰·, ÓÂ˘Ú›ÙÈ‰·, Û‡Ó‰ÚÔÌÔ ·Ó¿ÏÔÁÔ ÌÂ ÙËÓ ÔÏ˘ÔÌ˘ÂÏ›ÙÈ‰·, Û‡Ó‰ÚÔÌÔ GuillainBarré Î·È „‡¯ˆÛË. H ‰È¿ÁÓˆÛË ÙË˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ-

Î‹˜ ÏÔ›ÌˆÍË˜ Û˘Ó‹ıˆ˜ Ù›ıÂÙ·È ÌÂ ÙÈ˜ ÔÚÔÏÔÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜.

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 4 ÂÙÒÓ ÌÂ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·ﬁ ÏÔ›ÌˆÍË ÌÂ ÙÔ Ì˘ÎﬁÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜.

YÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ

KÔÚ›ÙÛÈ ËÏÈÎ›·˜ 4 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜

ÌÂ ˘ÚÂÙﬁ, ‚‹¯· Î·È ‹È· ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·.

¶ÚﬁÎÂÈÙ·È ÁÈ· ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿

˘ÁÈÒÓ ÁÔÓ¤ˆÓ. TÔ ·ÙÔÌÈÎfi, ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÔÓÙ·È ÂÏÂ‡ıÂÚ·. H ·ÛıÂÓ‹˜ Ù¤ÛÛÂÚÈ˜ Ì¤ÚÂ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙË˜ ·ÚÔ˘Û›·ÛÂ

˘„ËÏfi ˘ÚÂÙfi ¤ˆ˜ 39ÔC Î·È ÍËÚfi ‚‹¯·. ¶ÚÔÔ‰Â˘ÙÈÎ¿, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ·ÛıÂÓÔ‡˜ ÂÈ‰ÂÈÓÒıËÎÂ ÏfiÁˆ ÂÈÌÔÓ‹˜ ÙÔ˘ ˘ÚÂÙÔ‡ Î·È ÂÌÊ¿ÓÈÛË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ . K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ÛÂ ÂËÚÂ·ÛÌ¤ÓË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙÂ˜ ÛÂ ·ÌÊfiÙÂÚ· Ù· ÓÂ˘ÌÔÓÈÎ¿ Â‰›·, ¯ˆÚ›˜ ¿ÏÏ· ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·-

O ÂÚÁ·ÛÙËÚÈ·Îﬁ˜ ¤ÏÂÁ¯Ô˜ Î·Ù¿ 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 Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ ÛÙÂ›Ú·. H ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ¤‰ÂÈÍÂ ‡ÎÓˆÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Î¿Ùˆ ÏÔ‚Ô‡ Î·È ‰È¿ÌÂÛ· ÛÙÔÈ¯Â›· ¿ÌÊˆ.

MÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓÂ˘ÌÔÓ›·˜ ¯ÔÚËÁ‹ıËÎ·Ó

·ÌÔÍ˘ÎÈÏÏ›ÓË-ÎÏ·‚Ô˘Ï·ÓÈÎﬁ i.v. Î·È ÂÚ˘ıÚÔÌ˘Î›ÓË p.o.s.

TËÓ 7Ë Ì¤Ú· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜, Ë ·ÛıÂÓ‹˜ Û˘Ó¤¯È˙Â Ó· ˘Ú¤ÛÛÂÈ Î·È Ù· ·ÎÚÔ·ÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÎÚfi·ÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ‹Ù·Ó ·ÌÂÙ¿‚ÏËÙ·. ™ÙË ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÚÔÛÂÙ¤ıË ·Ú·Èfi ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·, Î·ıÒ˜ Î·È ÂÓ¿ÓıËÌ· ÛÙË ÛÙÔÌ·ÙÈÎ‹ ÎÔÈÏfiÙËÙ·. EÛÙ¿ÏË ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤Ó·ÓÙÈ ÈÒÓ Î·È ‚·ÎÙËÚÈ‰›ˆÓ Ô˘ ÂÌÏ¤ÎÔÓÙ·È ÛÂ ·ÚfiÌÔÈ· Û˘ÌÙˆÌ·ÙÔÏÔÁ›· fiˆ˜ ÙÔ Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜, Ô Èfi˜ Epstein-Barr, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Î·È Ô Èfi˜ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·. TËÓ 11Ë Ì¤Ú· ÙË˜ ÓfiÛÔ˘ Ë ÁÂÓÈÎ‹

ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ‰È¿ÚÎÂÈ·˜ ÂÚ›Ô˘ 1-2 ÏÂÙÒÓ Î·È ÂÓ Û˘ÓÂ¯Â›· ÂÌÊ¿ÓÈÛÂ ·Û˘ÌÌÂÙÚ›· ÚÔÛÒÔ˘, ÌÂ ÙÒÛË ÙË˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰ÂÍÈ¿. H ÛËÌÂÈÔÏÔÁ›· ÙË˜ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Û˘Ì‚·Ù‹ ÌÂ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÓÂ‡ÚÔ˘ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. H ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙˆÓ Â›ÎÙËÙˆÓ ·ÈÙÈÒÓ ¿ÚÂÛË˜ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÓÂ‡ÚÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜, ÏÔÈÌÒÍÂÈ˜, ÂÓ‰ÔÎÚ¿ÓÈÔ˘˜ fiÁÎÔ˘˜ ‹ ¤ÌÊÚ·ÎÙ·, ˘¤ÚÙ·ÛË, ÙÔÍ›ÓÂ˜ Î·È ÙË Ì˘·Ûı¤ÓÂÈ· Gravis. °È· ÙËÓ ·ÈÙÈÔÏÔÁÈÎ‹ ‰ÈÂÚÂ‡ÓËÛË ·ÎÔÏÔ‡ıËÛ·Ó ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. H ÂÍ¤Ù·ÛË ÙÔ˘ E.N.Y. ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·, Ë ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ fiÌˆ˜, ¤‰ÂÈÍÂ ÂÎÙÂÙ·Ì¤ÓË ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈÎ¿ ÌÂ Â˘ÚÂ›· ÂÚÈÊÂÚÈÎ‹ ‚¿ÛË Î·È ·ÁÁÂÈ·Î‹ Î·Ù·ÓÔÌ‹, ÂÈÎfiÓ· Ô˘ Û˘ÓËÁÔÚÂ› ˘¤Ú ÂÌÊÚ¿ÎÙÔ˘ ÙË˜ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ (ÂÈÎfiÓ· 1). H ·ÛıÂÓ‹˜, Ô˘ Â›¯Â Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ÂÙ¤ıË ÛÂ ·ÔÈ‰ËÌ·ÙÈÎ‹ ·ÁˆÁ‹ ÌÂ Ì·ÓÈÙfiÏË Î·È ‰ÂÍ·ÌÂı·˙fiÓË. T·˘Ùfi¯ÚÔÓ·, ·fi ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‚Ú¤ıËÎÂ ÂÍ·ÈÚÂÙÈÎ¿ ·˘ÍËÌ¤ÓÔ˜ Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÌÂ ÙË Ì¤ıÔ‰Ô Û‡Ó‰ÂÛË˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ IgG> 1/1024, fiˆ˜ Î·È ÌÂ ÙËÓ ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ‰Ô (Elisa) IgM > 1/2560 Î·È IgG > 1/2560 ·ÓÙ›ÛÙÔÈ¯·. TÔ Â‡ÚËÌ·

EÈÎfiÓÂ˜ 2,3. M·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, T1 Î·È T2 Ï‹„Ë ·ÓÙ›ÛÙÔÈ¯·, fiÔ˘ ÂÈ‚Â‚·ÈÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ ¤ÌÊÚ·ÎÙÔ˘ ÙË˜ ‰ÂÍÈ¿˜ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈÎ‹˜ ÂÚÈÔ¯‹˜ (Ê·›ÓÂÙ·È ÛÙÔ ·ÚÈÛÙÂÚfi Ì¤ÚÔ˜ ÙË˜ ÂÈÎfiÓ·˜).

ÛÊ·ÙË˜ ÏÔ›ÌˆÍË˜ ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÂÚÈ¤Ï·‚Â Î·È ¿ÏÏÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÌÂ ıÚfiÌ‚ˆÛË ÙË˜ ¤Ûˆ Î·ÚˆÙ›‰·˜ Î·È ÎÏ¿‰ˆÓ ·˘Ù‹˜ fiˆ˜ Â›Ó·È Ë Û˘Ó‡·ÚÍË Û˘ÁÁÂÓÔ‡˜ Î·Ú‰ÈÔ¿ıÂÈ·˜, ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ ‹ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜. AÎfiÌ· ¤ÁÈÓÂ ¤ÏÂÁ¯Ô˜ ¿ÏÏˆÓ Èı·ÓÒÓ ·ÈÙ›ˆÓ ıÚfiÌ‚ˆÛË˜ ÌÂÁ¿ÏË˜ ·ÚÙËÚ›·˜. ™˘ÁÎÂÎÚÈÌ¤Ó·, ¤ÁÈÓÂ ÔÛÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, ÙË˜ ·ÓÙÈıÚÔÌ‚›ÓË˜ III, ÚˆÙÂ˝ÓË˜ C Î·È S, ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÂÓÂÚÁÔÔÈËÌ¤ÓË ÚˆÙÂ˝ÓË C, Î·-

¶›Ó·Î·˜ 1. ¶ÚÔÛ‰ÈÔÚÈÛÌﬁ˜ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜.

∂ÈÛ·ÁˆÁ‹3 Â‚‰ÔÌ¿‰Â˜3 Ì‹ÓÂ˜ ÌÂÙ¿ÌÂÙ¿

M¤ıÔ‰Ô˜ ELISA

IgG1/ 25601/ 25601/ 2160

IgM1/ 25601/ 3201/ 220

M¤ıÔ‰Ô˜ Û‡Ó‰ÂÛË˜ Û˘ÌÏËÚÒÌ·ÙÔ˜

IgG1/ 10241/ 10241/ 512

ıÒ˜ Î·È ¤ÏÂÁ¯Ô˜ ÔÌÔÎ˘ÛÙÈÓ·ÈÌ›·˜. K·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ ·›ÙÈ· ıÚÔÌ‚ÔÊÈÏ›·˜ ‰ÂÓ ÂÈ‚Â‚·ÈÒıËÎÂ. H ·ÛıÂÓ‹˜ ‰ÂÓ ÂÌÊ¿ÓÈÛÂ Í·Ó¿ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È Ë ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÓÂ‡ÚÔ˘ ·ÂÎ·Ù·ÛÙ¿ıË Ï‹Úˆ˜ ÌÂÙ¿ 10 Ì¤ÚÂ˜. TÔ ÎÔÚ›ÙÛÈ ÂÍ‹ÏıÂ ·fi ÙË ÎÏÈÓÈÎ‹ Ì·˜ ÛÂ ¿ÚÈÛÙË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. H Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI) ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ¤ÁÈÓÂ ¤Ó· Ì‹Ó· ·ÚÁfiÙÂÚ·, ¤‰ÂÈÍÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈÎ‹ ¯ÒÚ· (ÂÈÎfiÓÂ˜ 2,3). O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Â·ÓÂÏ‹ÊıË 1 Î·È 3 Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·, ÂÈ‚Â‚·›ˆÛÂ ÙËÓ ÔÍÂ›· ÏÔ›ÌˆÍË ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÛÙËÓ ·ÛıÂÓ‹ Ì·˜. (¶›Ó·Î·˜ I)

O Û˘Ó‰˘·ÛÌﬁ˜ ÙË˜ ÂÚÁ·ÛÙËÚÈ·Î¿ ÙÂÎÌËÚÈˆÌ¤-

ÓË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜ ·ﬁ Ì˘ÎﬁÏ·ÛÌ· ÓÂ˘ÌÔÓ›·˜, ÙÔ˘ Â˘Ú‹Ì·ÙÔ˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜

·ÚÙËÚ›·˜ ÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô ·ÔÎÏÂÈÛÌﬁ˜

¿ÏÏˆÓ ·ÈÙ›ˆÓ ıÚÔÌ‚ÔÊÈÏ›·˜ ÛÙÔÈ¯ÂÈÔıÂÙÔ‡Ó ÙË ‰È¿ÁÓˆÛË ÙË˜ ÂÓÙÔÈÛÌ¤ÓË˜ ·ÁÁÂÈ›ÙÈ‰·˜ ÙÔ˘ KN™ ÌÂÙ¿ ·fi ÏÔ›ÌˆÍË ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜.

™˘˙‹ÙËÛË H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ ÌÂÙ¿ ·fi Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÏÔ›ÌˆÍË Â›Ó·È Û¿ÓÈ· (0,1%). ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ›

ÔÍÂ›· ÏÔ›ÌˆÍË ÌÂ Ì˘ÎﬁÏ·ÛÌ· ÓÂ˘ÌÔÓ›·˜ (5-7).

™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë Ì˘ÎÔÏ·-

ÛÌ·ÙÈÎ‹ ÏÔ›ÌˆÍË ‰ÈÂÁÓÒÛıË ÌÂ ‚¿ÛË ÙË Û˘ÌÙˆÌ·-

ÙÔÏÔÁ›· Î·È ÛËÌÂÈÔÏÔÁ›· ·ﬁ ÙÔ ·Ó·ÓÂ˘ÛÙÈÎﬁ, Ù·

·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Î·È ÙÔÓ ÔÚÔÏÔÁÈÎﬁ ¤ÏÂÁ¯Ô

Ô˘ ¤ÁÈÓÂ ÛÙËÓ ÔÍÂ›· Ê¿ÛË ·ÏÏ¿ Î·È Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛË˜.

H ·ÛıÂÓ‹˜ Ì·˜ ÌÂ ÂÏÂ‡ıÂÚÔ ÓÂ˘ÚÔÏÔÁÈÎﬁ ÈÛÙÔ-

ÚÈÎﬁ, ÂÌÊ¿ÓÈÛÂ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ·ÚÈÛÙÂÚÔ‡

ÚÔÛÒÔ˘ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÓÂ‡ÚÔ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘, ‰ÂÍÈ¿ ÙËÓ 11Ë Ì¤Ú· ÙË˜ ÓfiÛÔ˘. AÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ Â›¯Â ÎÏÈÓÈÎ‹ ‹ ÂÚÁ·-

ÛÙËÚÈ·Î‹ ¤Ó‰ÂÈÍË ÌËÓÈÁÁ›ÙÈ‰·˜. Aﬁ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈ-

Îﬁ ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ê¿ÓËÎÂ ﬁÙÈ Ë ÔÍÂ›· ÎÏÈÓÈÎ‹ ÛËÌÂÈÔÏÔÁ›· ÙÔ˘ ·È‰ÈÔ‡ ÔÊÂ›ÏÂÙÔ ÛÂ ¤ÌÊÚ·ÎÙÔ

ÙË˜ ‰ÂÍÈ¿˜ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜, Èı·ÓfiÙ·Ù· ÛÂ ¤‰·ÊÔ˜ ÚfiÛÊ·ÙË˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜ (8). EÈÏ¤ÔÓ, Ô Û˘ÌÏËÚˆÌ·ÙÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ Î·Ù¿‰ÂÈÍË ¿ÏÏˆÓ Èı·ÓÒÓ ·ÈÙ›ˆÓ ıÚfiÌ‚ˆÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ ‹Ù·Ó Ê˘-

ÛÈÔÏÔÁÈÎﬁ˜. H ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ KN™ ÌÂÙ¿ ·ﬁ

ÏÔ›ÌˆÍË ·ﬁ Ì˘ÎﬁÏ·ÛÌ· ÓÂ˘ÌÔÓ›·˜ ·Ú·Ì¤ÓÂÈ

¿ÁÓˆÛÙÔ˜. øÛÙfiÛÔ, ¤¯Ô˘Ó ÚÔÙ·ıÂ› ÙÚÂÈ˜ Èı·ÓÔ› ÌË¯·ÓÈÛÌÔ› (2,4, 9-14). OÚÈÛÌ¤ÓÔÈ ÂÚÂ˘ÓËÙ¤˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÙÔ˘ KN™ ÔÊÂ›ÏÂÙ·È ÛÂ Â¤ÎÙ·ÛË ÙË˜ ÌfiÏ˘ÓÛË˜ Î·È ¿ÌÂÛË ‰ÈÂ›Û‰˘ÛË ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÛÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi.

Y¤Ú ·˘Ù‹˜ ÙË˜ ¿Ô„Ë˜ Û˘ÓËÁÔÚÂ› Ë ·ÔÌﬁÓˆÛË

ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ (ÌÂ Î·ÏÏÈ¤ÚÁÂÈ· Î·È PCR) ÛÂ ÂÁÎÂÊ·ÏÈÎﬁ ÈÛÙﬁ (9,10,13). ÕÏÏÔÈ

ÂÚÂ˘ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÓÂ˘ÚÔÙÔÍÈ-

ÓÒÓ (4,11,12) ·ﬁ ÙÔ Ì˘ÎﬁÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜

ÂÓÒ Ù¤ÏÔ˜ ¤¯ÂÈ ÚÔÙ·ıÂ› Î·È ·˘ÙÔ¿ÓÔÛÔ˜ ÌË¯·ÓÈ-

ÛÌﬁ˜ ÌÂ ·Ú·ÁˆÁ‹ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ, Û¯ËÌ·ÙÈÛÌﬁ

·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ, ‹ Î·È Ì¤Ûˆ ·˘ÙÔ¿ÓÔÛË˜ ·ÁÁÂ›ÙÈ‰·˜ (11). º·›ÓÂÙ·È fiÙÈ Ë ÏÔ›ÌˆÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·Ú·ÁˆÁ‹ ÔÏÏ·ÏÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ, ·ÎfiÌ· Î·È ¤Ó·ÓÙÈ ·ÓÙÈÁÔÓÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (14). T· ·ÓÔÛÔÛ˘ÌÏ¤ÁÌ·Ù· Èı·ÓfiÓ ÂÓ·ÔÙ›ıÂÓÙ·È ÛÙÔ ÂÈı‹ÏÈÔ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁÂ›ˆÓ ÙÔ˘ KN™ Î·È Ô‰ËÁÔ‡Ó ÛÂ 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 ¿ÏÏˆÛÙÂ Î·È Ë ÂÌÊ¿ÓÈÛË ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›ÙÈ‰·˜, Î·Ú‰›ÙÈ‰·˜, ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜ Î·È ·ÚıÚ›ÙÈ‰·˜ ÌÂÙ¿ ·fi Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÏÔ›ÌˆÍË (12). BÈÔ„›Â˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÈÛÙÔ‡ ÛÂ ·È‰È¿ ÌÂ ÂÁÎÂÊ·Ï›ÙÈ‰· ÌÂÙ¿ ·fi Ì˘ÎfiÏ·ÛÌ· ÓÂ˘ÌÔÓ›·˜, ÂÌÊ·Ó›˙Ô˘Ó Ô›‰ËÌ·, ÌÈÎÚÔıÚÔÌ‚ÒÛÂÈ˜, ÂÚÈ·ÁÁÂÈ·Î¤˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ Î·È ·fiÊÚ·ÍË ÌÈÎÚÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁÂ›ˆÓ Ô˘ ÂÍËÁÔ‡Ó ÙËÓ

ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ (7,15). ™ÙËÓ ·ÛıÂÓ‹ Ì·˜ Ô Û¯ËÌ·ÙÈÛÌﬁ˜

Ì¤ÛË ÂÁÎÂÊ·ÏÈÎ‹ ·ÚÙËÚ›· ı· ÌÔÚÔ‡ÛÂ Ó· ·Ô‰ÔıÂ› ÛÂ ÂÓÙÔÈÛÌ¤ÓË ·ÁÁÂÈ›ÙÈ‰· ·ÊÔ‡ Ô ÏÂÙÔÌÂÚ‹˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ Ô˘ ¤ÁÈÓÂ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÙËÓ Û˘Ó‡·ÚÍË ¿ÏÏÔ˘ ·›ÙÈÔ˘ ıÚÔÌ‚ÔÊÈÏ›·˜.

°È· ÙË ıÂÚ·Â›· ÙˆÓ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ› Ù· ÎÔÚÙÈÎÔÂÈ‰‹, Ù· ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, Ù· ‰ÈÔ˘ÚËÙÈÎ¿ ·ÏÏ¿ Î·È Ë Ï·ÛÌ·Ê·›ÚÂÛË ÌÂ ·ÏÏËÏÔ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂÏ¤ÛÌ·Ù· (11). H ÚfiÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙË˜ ÂÈÏÔÎ‹˜. H ıÓËÙfiÙËÙ· ÊÙ¿ÓÂÈ ÙÔ 10% (5). H ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Û˘Ó‹ıˆ˜ Â›Ó·È Ù·¯Â›· (12,15). ™Â ·Ï·ÈfiÙÂÚË ÌÂÏ¤ÙË (4), ÛËÌ·ÓÙÈÎ‹ ˘ÔÏÂÈÌÌ·ÙÈÎ‹ ÓfiÛÔ˜ ‚Ú¤ıËÎÂ ÛÙÔ ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ. ¢˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË Â›¯·Ó ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 14 ÂÙÒÓ ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÂÁÎÂÊ·Ï›ÙÈ‰·˜ ‹ ÔÏ˘ÓÂ˘Ú›ÙÈ‰·˜. H ·ÛıÂÓ‹˜ Ì·˜ ¤Ï·‚Â ·ÔÈ‰ËÌ·ÙÈÎ‹

ÁÈ· ÙË Û·ÓÈﬁÙËÙ¿ ÙË˜, ·ÏÏ¿ Î·È ÁÈ· Ó· ÙÔÓÈÛÙÂ› ﬁÙÈ ·Ú¿ ÙË ıÔÚ˘‚Ò‰Ë ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ ÙË˜

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

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.

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›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘, A' ¶·È‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ,

TÌ‹Ì· EÈ‰ÈÎÒÓ §ÔÈÌÒÍÂˆÓ, NÔÛ. ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·",

£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, °Ô˘‰›, Aı‹Ó· 11527

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˜ MÈ¯¤ÏË˜1

●

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ËÏÈÎ›·˜ 6,5 ÂÙÒÓ, ÌÂ ÔÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰· Î·È ÈÛÙÔÚÈÎfi ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ·fi ËÏÈÎ›·˜ 10 ÌËÓÒÓ. ¶·Ú¿ ÙË Û˘Ó‹ıË Û˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ‚ÂÏÙ›ˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ ÙË˜ ·ÛıÂÓÔ‡˜. TËÓ 5Ë ËÌ¤Ú· ÓÔÛËÏÂ›·˜, ¯ÔÚËÁ‹ıËÎÂ ¤Ó· ·Ó¿ÏÔÁÔ ÙË˜ ÛˆÌ·ÙÔÛÙ·Ù›ÓË˜, Ë Ôctreotide (9 Ìg/Kg/24ˆÚÔ ˘Ô‰fiÚÈ·). Afi ÙÔ ÙÚ›ÙÔ 24ˆÚÔ ıÂÚ·Â›·˜ ‰È·ÈÛÙÒıËÎÂ ‚·ıÌÈ·›· ÂÏ¿ÙÙˆÛË ÙˆÓ ·ÁÎÚÂ·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›· ÚÔÎ‡ÙÂÈ fiÙÈ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË ¯ÔÚ‹ÁËÛË˜ ÙË˜ Ôctreotide ÛÂ ·È‰› ÌÂ ÔÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰· Î·È ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ¶·È‰È·ÙÚÈÎ‹ 2000;63:47-50.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÔÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰·, ÓÂÊÚÈÎ‹ ·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.

1 NÂÊÚÔÏÔÁÈÎﬁ

2 ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹,

™¯‹Ì· 1. ¢È·Î‡Ì·ÓÛË ·Ì˘Ï¿ÛË˜ ÔÚÔ‡ ·Ó¿ ËÌ¤Ú· ÓÔÛËÏÂ›·˜.

·ÁÎÚ¤·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎﬁ. MÂÙ¿ ·ﬁ ¤Ó·Ó ÂÚ›-

Ô˘ Ì‹Ó· ÓÔÛËÏÂ›·˜, Ë ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ ÛÂ Î·Ï‹ ÁÂ-

ÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. H ıÂÚ·Â›· ÌÂ ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË ¿Ú¯ÈÛÂ ¿ÏÈ 3 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙË˜, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËıÂ› ˘ÔÙÚÔ‹ ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜, ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛË˜.

™˘˙‹ÙËÛË

H ÔÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÙÂÏÈÎﬁ

ÛÙ¿‰ÈÔ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ·ÔÙÂÏÂ› ÓÔÛÔÏÔÁÈÎ‹

ÔÓÙfiÙËÙ· ÌÂ È‰È·›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. H ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· (¤ˆ˜ Î·È 58 ÊÔÚ¤˜) ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (3). OÈ ·ÎÚÈ‚Â›˜ ÏfiÁÔÈ ÙË˜ ·˘ÍËÌ¤ÓË˜ ·˘Ù‹˜ Û˘¯ÓfiÙËÙ·˜, ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙÔ› ·Ó Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ù· ÔÏÏ¿ Ê¿ÚÌ·Î· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÔÈ ·ÛıÂÓÂ›˜ ·˘ÙÔ›, Î·ıÒ˜ Î·È Ë Û˘ÓÔ‰fi˜ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· (7), Ô ‰Â˘ÙÂÚÔ·ı‹˜ ˘ÂÚ·Ú·ı˘ÚÂÔÂÈ‰ÈÛÌfi˜ (3) Î·È Ë ˘ÂÚÏÈÈ‰·ÈÌ›·. º·›ÓÂÙ·È fiÙÈ Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ Î·È Èı·ÓÒ˜ Î·È

·˘ÙÔ¿ÓÔÛÔÈ ·Ú¿ÁÔÓÙÂ˜, ˘ÚÔ‰ÔÙÔ‡Ó ÌË¯·ÓÈÛÌÔ‡˜ ·˘ÙÔÂ„›·˜ Î·È Î·Ù·ÛÙÚÔÊ‹˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜.

H ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜. A˘Ùfi ÔÊÂ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ fiÙÈ Ù· ¤Ó˙˘Ì· ‰È¿ÁÓˆÛË˜ ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ Â›Ó·È

¶›Ó·Î·˜ 1. ™‡ÛÙËÌ· ‚·ıÌÔÏÔÁ›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË

·ÓÂ¿ÚÎÂÈ·.

E‡ÚËÌ·B·ıÌÔ›

OÍ‡ ÎÔÈÏÈ·Îﬁ ¿ÏÁÔ˜1

E˘·ÈÛıËÛ›· ÛÙËÓ ÎÔÈÏÈ¿1

AÌ˘Ï¿ÛË ÔÚÔ‡ ÌÂÙ·Í‡ -3x-6xAºT* 1

AÌ˘Ï¿ÛË ÔÚÔ‡ >6xAºT*2

CT ‹ U/S ıÂÙÈÎﬁ2

IÛÙÔÏÔÁÈÎ‹ ÂÈ‚Â‚·›ˆÛË3

*AºT: AÓÒÙÂÚË Ê˘ÛÈÔÏÔÁÈÎ‹ ÙÈÌ‹

ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ÂÍ¤Ù·ÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓﬁÛÔ˘.

·fi ÙÈ˜ ‰˘ÛÎÔÏ›Â˜ ÛÙË ‰È¿ÁÓˆÛË, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÔÍÂ›· ·ÁÎÚÂ·Ù›ÙÈ‰· ÛÂ ¤‰·ÊÔ˜ ¯ÚfiÓÈ·˜ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÏ‡ ·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ· Ô˘ Êı¿ÓÂÈ Î·È ÙÔ 33%, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÔ˘ Ë ıÓËÙfiÙËÙ· Â›Ó·È ÌfiÏÈ˜ 3,5% (3).

H ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È·ÎÔ‹ ÙË˜ Û›ÙÈÛË˜, ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ Î·ıÂÙ‹Ú·, ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Â¿Ó ˘¿Ú¯Ô˘Ó, ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ, H2 ·ÓÙ·ÁˆÓÈÛÙÒÓ Î·È ¯ÔÚ‹ÁËÛË ·ÚÂÓÙÂÚÈÎ‹˜ ‰È·ÙÚÔÊ‹˜. EÈÏ¤ÔÓ, ‰˘Ó·ÙfiÓ Ó· ¯ÔÚËÁËıÂ› Ë ÛˆÌ·ÙÔÛÙ·Ù›ÓË ‹ ÙÔ ·Ó¿ÏÔÁfi ÙË˜ Ë Ôctreotide. H ÛˆÌ·ÙÔÛÙ·Ù›ÓË Â›Ó·È ¤Ó· ‰ÂÎ·ÙÂÙÚ·ÂÙ›‰ÈÔ ÂÓÒ Ë Ôctreotide ¤Ó· ÔÎÙ·ÂÙ›‰ÈÔ ÌÂ ·ÚfiÌÔÈÔ ÙÚfiÔ ‰Ú¿ÛË˜, ÌÂ ÌÂÁ·Ï‡ÙÂÚÔ fiÌˆ˜ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, Ú¿ÁÌ· Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ¯ÔÚ‹ÁËÛ‹ ÙË˜ Î·È ˘Ô‰fiÚÈ· (10). O Î˘ÚÈfiÙÂÚÔ˜ ÙÚfiÔ˜ ‰Ú¿ÛË˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ÛÙË ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜, Â›Ó·È Ì¤Ûˆ ÙË˜ ·Ó·ÛÙÔÏ‹˜ ÙË˜ ·ÁÎÚÂ·ÙÈÎ‹˜ ¤ÎÎÚÈÛË˜. EÈÚfiÛıÂÙ· Ê·›ÓÂÙ·È fiÙÈ ‰ÈÂÁÂ›ÚÔ˘Ó Î·È ÙË Ê·ÁÔÎ˘ÙÙ¿ÚˆÛË ·fi ÙÔ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·Îfi Û‡ÛÙËÌ·, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ Ù·¯‡ÙÂÚË ˘Ô¯ÒÚËÛË ÙË˜ ÊÏÂÁÌÔÓ‹˜. ¶·ÚfiÏÔ Ô˘ Ë ÛˆÌ·ÙÔÛÙ·Ù›ÓË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ·-

ÁÎÚÂ·Ù›ÙÈ‰·˜ ÙÔ 1975, ÂÓÙÔ‡ÙÔÈ˜ Ì¤¯ÚÈ Î·È Û‹ÌÂÚ·

‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔÊˆÓ›· ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·

ﬁÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎﬁÙËÙ¿ ÙË˜ (10-12).

øÛÙfiÛÔ ·fi ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÈÛÙËÌÔÓÈÎ¤˜ ÂÚÁ·Û›Â˜ ÚÔÎ‡ÙÂÈ fiÙÈ: ÌÂÈÒÓÂÈ ÙÈ˜ ·Ó¿ÁÎÂ˜ ¯ÔÚ‹ÁËÛË˜ ·Ó·ÏÁËÙÈÎÒÓ, ÌÂÈÒÓÂÈ Ù·¯‡ÙÂÚ· ÙËÓ ·Ì˘Ï¿ÛË ÔÚÔ‡,

Ê˘ÛÈÔÏÔÁÈÎ¿ ·˘ÍËÌ¤Ó· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, Ë ·Ì˘Ï¿ÛË ÛÂ ÔÛÔÛÙfi 80% Î·È Ë ÏÈ¿ÛË 60%, Â› ·Ô˘Û›·˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ (3,8). °È· Ó· ·ÔÊÂ˘¯ıÂ› Ë Èı·ÓfiÙËÙ· Ï·Óı·ÛÌ¤ÓË˜ ‰È¿ÁÓˆÛË˜, ¤¯ÂÈ ÚÔÙ·ıÂ› ¤Ó· Û‡ÛÙËÌ· ‚·ıÌÔÏÔÁ›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·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›·˜ ÙË˜ ·ÛıÂÓÔ‡˜ Ì·˜ ‹Ù·Ó 6, ÔfiÙÂ Ë ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ ‹Ù·Ó ‚¤‚·ÈË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ‰ÂÓ ÎÚ›ıËÎÂ ·Ó·ÁÎ·›· Ë

ÌÂÈÒÓÂÈ ÙÔÓ ·ÚÈıÌﬁ ÙˆÓ ÙÔÈÎÒÓ ÂÈÏÔÎÒÓ, ÂÓÒ ‰ÂÓ

Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÈ ÙË ıÓËÙﬁÙËÙ· ÙË˜ ÓﬁÛÔ˘ (12).

H Ôctreotide ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË

ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜ ÙË˜ ·È‰ÈÎ‹˜

ËÏÈÎ›·˜ ÌﬁÏÈ˜ ÙÔ 1995 ÛÂ ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 9 ÂÙÒÓ ÌÂ

·Ó·ÊÂÚﬁÌÂÓ· Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜

ÓﬁÛÔ˘ (4), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·-

Ê›·, ‰ËÌÔÛÈÂ˘Ì¤ÓË ÂÚÁ·Û›· ¯ÔÚ‹ÁËÛË˜ ÙË˜ ÛÂ ·È‰›

ÌÂ ÙÂÏÈÎﬁ ÛÙ¿‰ÈÔ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜.

H ·Ó¿ÁÎË ·Ó·˙‹ÙËÛË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎﬁÙÂÚˆÓ ıÂ-

Ú·Â˘ÙÈÎÒÓ Ì¤ÛˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜

·ÁÎÚÂ·Ù›ÙÈ‰·˜, È‰È·›ÙÂÚ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘ﬁÛÙÚˆ-

Ì· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, Â›Ó·È ÂÈ-

‚Â‚ÏËÌ¤ÓË, ÏﬁÁˆ ÙË˜ ÔÏ‡ ÌÂÁ¿ÏË˜ ıÓËÙﬁÙËÙ·˜ Ô˘

·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÓﬁÛÔ˜. H ¯ÔÚ‹ÁËÛË ÙË˜ Ôctreotide

ÛÙËÓ ·ÛıÂÓ‹ Ì·˜ Ê·›ÓÂÙ·È Ó· ¤‰Ú·ÛÂ Â˘ÓÔ˚Î¿ ÛÙËÓ

ÂÍ¤ÏÈÍË ÙË˜ ÓﬁÛÔ˘. OˆÛ‰‹ÔÙÂ ﬁÌˆ˜, ÂÚ·ÈÙ¤Úˆ

ÎÏÈÓÈÎ¤˜ ‰ÔÎÈÌ¤˜ Â›Ó·È ··Ú·›ÙËÙÂ˜ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎﬁÙËÙ¿˜ ÙË˜.

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.

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›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡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·

¶ÓÂ˘ÌÔÓÈÎ‹ ÏÔ›ÌˆÍË ·ﬁ ·Û¤ÚÁÈÏÏÔ Î·È M. avium ÛÂ ·ÈÌÔÚÚÔÊÈÏÈÎﬁ ·ÛıÂÓ‹ ÌÂ AIDS

¢ÒÚ· M¿ÓÙ˙ÈÔ˘1, °Ï˘ÎÂÚ›· MÔÛÙÚÔ‡1, B·ÛÈÏÈÎ‹ ¶··Â˘·ÁÁ¤ÏÔ˘1, EÏ¤ÓË ¶Ï·ÙÔÎÔ‡ÎË2, AÚÈÛÙ¤· BÂÏÂÁÚ¿ÎË3, M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘1.

● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÌÈÎÙ‹˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÔ›ÌˆÍË˜ ·fi Aspergillus fumigatus Î·È ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (Mycobacterium avium intracellulare, Mycobacterium avium) ÛÂ ·ÛıÂÓ‹ ËÏÈÎ›·˜ 16 ÂÙÒÓ ÌÂ ·ÈÌÔÚÚÔÊÈÏ›· Î·È AIDS. O ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙Â Â›ÌÔÓÔ ÍËÚfi ‚‹¯· Î·È ‰ÂÎ·ÙÈÎ‹ ˘ÚÂÙÈÎ‹ Î›ÓËÛË ·fi

Î·È ‰È·‚ÚÔÁ¯ÈÎ‹

ÙË˜ Ì¿˙·˜. O ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËÎÂ ÌÂ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ Î·È ·ÓÙÈÌ˘ÎÔ‚·ÎÙËÚÈ‰È·Î‹ ıÂÚ·Â›·, ÌÂ ÈÎ·ÓÔÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ¶·È‰È·ÙÚÈÎ‹ 2000;63:50-55. §¤ÍÂÈ˜ ÎÏÂÈ‰È¿: AIDS, ·ÛÂÚÁ›ÏÏˆÛË, M. avium.

A' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" 1, MÔÓ¿‰· EÈ‰ÈÎÒÓ §ÔÈÌÒÍÂˆÓ - AIDS

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 ÌÂ›ˆÛË ÙË˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ÈÎ·ÓﬁÙËÙ·˜ ÙÔ˘ HIVÔÚÔıÂÙÈÎÔ‡ ·ÛıÂÓ‹ ·˘Í¿ÓÂÈ ÙË Û˘¯ÓﬁÙËÙ· ·ÏÏ¿ Î·È

ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ. H Èı·ÓﬁÙËÙ· ÂÌÊ¿ÓÈÛË˜ Â˘Î·ÈÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ·ﬁÏ˘ÙÔ ·ÚÈıÌﬁ CD4 T ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

ÌÈÎÚﬁÙÂÚÔ ÙˆÓ 200/ml. (1)

™˘¯ÓfiÙÂÚÂ˜ Â˘Î·ÈÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È Ù· ·È‰È¿ ÌÂ HIV ÏÔ›ÌˆÍË Â›Ó·È Ë ÓÂ˘ÌÔÓ›· ·fi pneumocystis carinii (PCP), Ë Û˘ÛÙËÌ·ÙÈÎ‹ ÏÔ›ÌˆÍË ·fi Candida albicans (.¯. ÔÈÛÔÊ·Á›ÙÈ‰·), Ë ‰È¿Û·ÚÙË ÏÔ›ÌˆÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (MAC) Î·È Ë ÙÔÍÔÏ·ÛÌÈÎ‹ ÂÁÎÂÊ·Ï›ÙÈ‰·. (1) H ÏÔ›ÌˆÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ÌÔÚÂ›

ÎÏÈÓÈÎ¿ Ó· ÚÔ‚¿ÏÏÂÈ ˆ˜ ÂÓÙÔÈÛÌ¤ÓË ÏÂÌÊ·‰ÂÓ›ÙÈ‰·

‹ ÓÂ˘ÌÔÓÈÎ‹ ÓﬁÛÔ˜ ·ÏÏ¿ Û˘ÓËı¤ÛÙÂÚ· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ AIDS ‰È·ÁÈÁÓÒÛÎÂÙ·È ˆ˜ ‰È¿Û·ÚÙË ÓﬁÛÔ˜

(Ì˘ÎÔ‚·ÎÙËÚÈ·ÈÌ›·). (1,2)

Aﬁ ÙÈ˜ Û˘ÛÙËÌ·ÙÈÎ¤˜ Ì˘ÎËÙÈ·ÛÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ÔÈ

Ï¤ÔÓ Û˘Ó‹ıÂÈ˜ Â›Ó·È Ë ÔÈÛÔÊ·Á›ÙÈ‰· ·ﬁ Candida albicans Î·È Ë ÎÚ˘ÙÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ˜. (1) H ·ÛÂÚÁ›ÏÏˆÛË ·ÔÙÂÏÂ› ı·Ó·ÙËÊﬁÚÔ ÏÔ›ÌˆÍË ÛÂ ·ÛıÂÓÂ›˜

ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ‰È·Ù·Ú·¯‹ ÏÂÈÙÔ˘ÚÁÈÎﬁÙËÙ·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ. ™·ÓÈﬁÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ·ÛıÂÓÂ›˜

Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÚﬁÓÈ· ıÂÚ·Â›· ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹ ‹ ·ÓÙÈ‚ÈÔÙÈÎ¿ Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜. (3) H ÏÔ›ÌˆÍË ·ﬁ

·Û¤ÚÁÈÏÏÔ Â›Ó·È Û¿ÓÈ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ AIDS, Î·ıÒ˜

Ë ·ÓÔÛÈ·Î‹ ‰È·Ù·Ú·¯‹ ÙË˜ ÓfiÛÔ˘ ·ÊÔÚ¿ Ù· T-ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È Ì·ÎÚÔÊ¿Á· Î·È fi¯È Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· Ô˘ Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙËÓ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·Ù¿ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘. (4,5) K‡ÚÈÔ ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÛÂÚÁ›ÏÏˆÛË˜ ÛÂ ·ÛıÂÓ‹ ÌÂ AIDS, ·ÔÙÂÏÂ› Ë ·Ú·ÙÂÙ·Ì¤ÓË Ô˘‰ÂÙÂÚÔÂÓ›· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ıÂÚ·Â›· ‹ ÚÔ¸¿Ú¯Ô˘Û· ÏÔ›ÌˆÍË ÓÂ˘ÌfiÓˆÓ ·fi P.carinii, ÎÔÈÓ¿ ÌÈÎÚfi‚È· ‹ ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·. (5,6)

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Ù·˘Ùﬁ¯ÚÔÓË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÔ›ÌˆÍË˜ ·ﬁ A. fumigatus Î·È M. avium ÛÂ ·ÛıÂÓ‹ ËÏÈÎ›·˜ 16 ÂÙÒÓ ÌÂ ·ÈÌÔÚÚÔÊÈÏ›· A Î·È AIDS.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜:

AIDS:Acquired Immunodeficiency Syndrome

HIV:Human Immunodeficiency Virus

CD4 T lymphocytes: T4 ‚ÔËıËÙÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú·

AÁﬁÚÈ ËÏÈÎ›·˜ 16 ÂÙÒÓ ÌÂ ·ÈÌÔÚÚÔÊÈÏ›· A Î·È AIDS ÂÈÛ‹ÏıÂ ÛÙÔ ÙÌ‹Ì· ÂÈ‰ÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ NÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ "H AÁ›· ™ÔÊ›·" ÏﬁÁˆ Â›ÌÔÓÔ˘ ‚‹¯·.

¶ÚﬁÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ

ÁÔÓ¤ˆÓ. TÔ ÔÈÎÔÁÂÓÂÈ·Îﬁ ÈÛÙÔÚÈÎﬁ ÙË˜ ÙÂÙÚ·ÌÂÏÔ‡˜

ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ÂÏÂ‡ıÂÚÔ. H ‰È¿ÁÓˆÛË ÙË˜ ·ÈÌÔÚÚÔÊÈÏ›·˜ ÂÙ¤ıË ÛÂ ËÏÈÎ›· 11 ÌËÓÒÓ ÔﬁÙÂ ¿Ú¯ÈÛÂ ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ Û˘Ì‚·ÙÈÎﬁ Û˘Ì˘ÎÓˆÌ¤ÓÔ ·Ú¿ÁÔÓÙ· VIII. ™Â ËÏÈÎ›· 3 ÂÙÒÓ ·ÚÔ˘Û›·ÛÂ

ÚÒÈÌË ‰È·Ù·Ú·¯‹ „˘¯ÈÎ‹˜ ÂÍ¤ÏÈÍË˜ Ô˘ ·Ô‰ﬁıËÎÂ

ÛÙËÓ ˘ÂÚÚÔÛÙ·ÙÂ˘ÙÈÎ‹ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÁÔÓ¤ˆÓ

ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·Ù˘¯ËÌ¿ÙˆÓ. TÔ 1985 ÛÂ ·Ó·‰ÚÔÌÈÎﬁ ¤ÏÂÁ¯Ô ÔÚÔ‡ ·›Ì·ÙÔ˜

Ô‡ Â›¯Â Ê˘Ï·¯ıÂ› ÛÙË MÔÓ¿‰· AÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ Î·È AÈÌﬁÛÙ·ÛË˜, ‰È·ÈÛÙÒıËÎÂ ﬁÙÈ ÙÔ ·È‰›

Â›¯Â ÌÔÏ˘ÓıÂ› ÌÂ ÙÔÓ Èﬁ HIV ¤Ó· ¯ÚﬁÓÔ ÓˆÚ›ÙÂÚ·, ÛÂ

ËÏÈÎ›· 4 ÂÙÒÓ. H ÎÏÈÓÈÎ‹ ÂÍ¤ÏÈÍË ÙË˜ HIV ÏÔ›ÌˆÍË˜ ˆ˜

ÙËÓ ËÏÈÎ›· ÙˆÓ 9 ÂÙÒÓ ‹Ù·Ó ÔÌ·Ï‹ Î·È ÔÈ ·ÓÔÛÔÏÔÁÈÎÔ› ÙÔ˘ ‰Â›ÎÙÂ˜ ÈÎ·ÓÔÔÈËÙÈÎÔ› (CD4>500/mm3). ™Â

ËÏÈÎ›· 9 ÂÙÒÓ ¿Ú¯ÈÛÂ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¤˜ ÈÔÁÂÓÂ›˜

ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ·ÏÏ¿ Î·È ÌÈ-

ÎÚÔ‚È·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ﬁˆ˜ ˆÙ›ÙÈ‰·, ÈÁÌÔÚ›ÙÈ‰· Î·È

ÓÂ˘ÌÔÓ›·. ¶·Ú¿ÏÏËÏ· ÂÌÊ¿ÓÈÛÂ ÛÙ·‰È·Î‹ ¤ÎÙˆÛË

ÙË˜ ·ÓÔÛÈ·Î‹˜ ÙÔ˘ Î·Ù¿ÛÙ·ÛË˜ (CD4<100/mm3) ·-

Ú¿ ÙËÓ ¤Ó·ÚÍË ·ÓÙÈÚÂÙÚÔ˚Î‹˜ ·ÁˆÁ‹˜. TÚ›· ¯ÚﬁÓÈ·

·ÚÁﬁÙÂÚ·, ÓÔÛËÏÂ‡ÙËÎÂ ÛÙÔ ·È‰Ô„˘¯È·ÙÚÈÎﬁ ÙÌ‹Ì·

ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜ ÏﬁÁˆ ¤ÓÙÔÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜

Û˘ÌÂÚÈÊÔÚ¿˜, ÔﬁÙÂ ÂÈ‚Â‚·ÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË ÙË˜ ·È‰ÈÎ‹˜ „‡¯ˆÛË˜ ÁÈ· ÙËÓ ÔÔ›· ÂÙ¤ıË ÛÂ ıÂÚ·-

·ÁˆÁ‹. ™ÙËÓ ËÏÈÎ›· ÙˆÓ 15 ÂÙÒÓ, ÔfiÙÂ Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜

CD4 ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ‹Ù·Ó <50/mm3, ·-

ÚÔ˘Û›·ÛÂ Â›ÌÔÓË Î·È ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì˘ÎËÙÈ·ÛÈÎ‹

ÛÙÔÌ·Ù›ÙÈ‰· ÌÂ ÌÂÚÈÎ‹ ·ÓÙ·ﬁÎÚÈÛË ÛÙËÓ ÙÔÈÎ‹ Î·È

·ﬁ ÙÔ˘ ÛÙﬁÌ·ÙÔ˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ ·ÁˆÁ‹. §›ÁÔ˘˜

Ì‹ÓÂ˜ ·ÚÁﬁÙÂÚ· ÂÌÊ¿ÓÈÛÂ ÙËÓ ÚÒÙË Â˘Î·ÈÚÈ·Î‹

ÏÔ›ÌˆÍË, ÔÈÛÔÊ·Á›ÙÈ‰· ·ﬁ C. albicans, Î·Ù¿ÛÙ·ÛË

Ô˘ ¯·Ú·ÎÙ‹ÚÈÛÂ ÙË ÌÂÙ¿ÙˆÛ‹ ÙÔ˘ ÛÂ ÓﬁÛÔ AIDS.

MÂÙ¿ ·ﬁ ÂÓ‰ÔÊÏ¤‚È· ·ÁˆÁ‹ ÌÂ ÏÈÔÛˆÌÈÎ‹ ·ÌÊÔ-

ÙÂÚÈÎ›ÓË B Û˘Ó¤¯ÈÛÂ ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË ÌÂ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÈÙÚ·ÎÔÓ·˙fiÏË ‚¿ÛÂÈ Ì˘ÎËÙÔÁÚ¿ÌÌ·ÙÔ˜.

K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈÎ‹, ÛÂ ËÏÈÎ›· 16

ÂÙÒÓ, ·Ó¤ÊÂÚÂ ‰ÂÎ·ÙÈÎ‹ ˘ÚÂÙÈÎ‹ Î›ÓËÛË Î·È Â›ÌÔÓÔ

ÌË ·Ú·ÁˆÁÈÎﬁ ‚‹¯· ÁÈ· ¤Ó· Ì‹Ó· ÂÚ›Ô˘. TÈ˜ ÙÂÏÂ˘Ù·›Â˜ 2-3 Ì¤ÚÂ˜ ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÚÔÛÂÙ¤ıË Î·È Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹. EÚﬁÎÂÈÙÔ ÁÈ· ¤Ó·

Î·Ï¿ ·Ó·Ù˘ÁÌ¤ÓÔ ·‰‡Ó·ÙÔ ·ÁfiÚÈ ÌÂ È‰ÈfiÙ˘Ë Û˘ÌÂÚÈÊÔÚ¿. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ·¯‡ÙËÙ· ·Ó·ÓÂ˘ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜

ÌÂ ·Ú¿Ù·ÛË ÂÎÓÔ‹˜ Î·ıÒ˜ Â›ÛË˜ Î·È Ì˘ÎËÙÈ·ÛÈÎ‹ ÛÙÔÌ·Ù›ÙÈ‰·. Aﬁ ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îﬁ ¤ÏÂÁ¯Ô ÙË˜ ÂÈÛ·ÁˆÁ‹˜, Ë

ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Î·È Ô ‚ÈÔ¯ËÌÈÎﬁ˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ÂÓÙﬁ˜

ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Ë ‰Â Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜

ÛÙÂ›Ú·. AÍÈÔÛËÌÂ›ˆÙË ‹Ù·Ó Ë ·‡ÍËÛË ÙˆÓ ÛÊ·ÈÚÈÓÒÓ, IgG: 2751mg/dl, IgM: 977mg/dl, IgA: 546mg/dl Î·È Ô ¯·ÌËÏfi˜ ·ÚÈıÌfi˜ ÙˆÓ CD4 ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ: 4% (25/mm3). TÔ ÈÈÎfi ÊÔÚÙ›Ô Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó: 30,5 x 103 vc/ml. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· (CT) ıÒÚ·ÎÔ˜ (EÈÎfiÓ· 1, 2) ·ÂÎ¿Ï˘„Â ÛÙÚÔÁÁ‡ÏË ÛÎ›·ÛË ·Ú·˘Ï·›· ‰ÂÍÈ¿, ÌÂÁ›ÛÙË˜ ‰È·Ì¤ÙÚÔ˘ 4 ÂÎ. ÌÂ ·Û·Ê‹ ‰ÈËıËÙÈÎ¿

ﬁÚÈ· ÚÔ˜ ÙÔ ÁÂÈÙÔÓÈÎﬁ ·Ú¤Á¯˘Ì·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ıÔÏÔÁÈÎ¿ ‰ÈÔÁÎˆÌ¤ÓÔÈ ÏÂÌÊ·‰¤ÓÂ˜ ÛÙÔ ÌÂ-

ÛÔıˆÚ¿ÎÈÔ ‹ ÙÈ˜ Ì·Û¯·ÏÈ·›Â˜ ¯ÒÚÂ˜. MÂ ÙËÓ Èı·Ó‹

‰È¿ÁÓˆÛË ÏÂÌÊÒÌ·ÙÔ˜ ¤ÁÈÓÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·

ÎÔÈÏ›·˜ Î·È ÂÁÎÂÊ¿ÏÔ˘. ™ÙËÓ CT ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıË-

Î·Ó ÌÈÎÚÔ› ÌÂÛÂÓÙ¤ÚÈÔÈ ÏÂÌÊ·‰¤ÓÂ˜ Î·È Ë CT ÂÁÎÂ-

Ê¿ÏÔ˘ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. O ¤ÏÂÁ¯Ô˜

Û˘ÓÂ¯›ÛıËÎÂ ÌÂ ÎÚÈÙ‹ÚÈ· ·ÈÙÈÔÏÔÁÈÎ‹˜ ‰ÈÂÚÂ‡ÓËÛË˜

ÓÂ˘ÌÔÓÈÎ‹˜ Ì¿˙·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ AIDS. EÎÙfi˜ ·fi Ï¤ÌÊˆÌ·, ÓÂ˘ÌÔÓÈÎ‹ Ì¿˙· ÛÂ ÛÔ‚·Ú¿ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔ ·ÛıÂÓ‹ ı· ÌÔÚÔ‡ÛÂ Ó· ÚÔÎÏËıÂ› ÌÂÙ¿ ·fi ÏÔ›ÌˆÍË ·fi Mycobacterium tuberculosis, M. avium, C. albicans, Aspergillus species, Nocardia, Cryptococcus neoformans, P. carinii, ‹ Ù¤ÏÔ˜ ÎÔÈÓ¿ ‚·ÎÙ‹ÚÈ·.

™ÙË ‚ÚÔÁ¯ÔÛÎﬁËÛË

(BAL) ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘ ÔÔ›Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ¿ÊıÔÓÔÈ Ì‡ÎËÙÂ˜ A. fumigatus. H ÔÚÈÛÙÈÎ‹ ‰È¿ÁÓˆÛË ÂÙ¤ıË ÌÂ ‰Â‡ÙÂÚË ‚ÚÔÁ¯ÔÛÎﬁËÛË Î·È

EÈÎﬁÓ· 1. A/· ıÒÚ·ÎÔ˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ﬁÔ˘ Ê·›-

EÈÎfiÓ· 2. AÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, fiÔ˘ Ê·›ÓÂÙ·È Ì¿˙· ÌÂÁ›ÛÙË˜ ‰È·Ì¤ÙÚÔ˘ 4 ÂÎ. ÌÂ ·Û·Ê‹ fiÚÈ·. ¢ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ‰ÈÔÁÎˆÌ¤ÓÔÈ ÏÂÌÊ·‰¤ÓÂ˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ‹ ÙÈ˜ Ì·Û¯·ÏÈ·›Â˜ ¯ÒÚÂ˜.

‰È·‚ÚÔÁ¯ÈÎ‹ ‚ÈÔ„›· ÙË˜ Ì¿˙·˜. ™ÙÔ ˘ÏÈÎfi ÙË˜ ‚ÈÔ„›·˜ ‚Ú¤ıËÎÂ ÊÏÂÁÌÔÓÒ‰Ë˜ ÈÛÙfi˜, ¿ÊıÔÓ· ÔÍÂ¿ÓÙÔ¯· ‚·ÎÙËÚ›‰È· Ù‡Ô˘ M. avium Î·È Ì‡ÎËÙÂ˜. ™ÙË ¯ÚÒÛË Î·Ù¿ Ziel-Nielsen ‚Ú¤ıËÎ·Ó ¿ÊıÔÓ· ÈÛÙÈÔÎ‡ÙÙ·Ú· ÌÂ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ıÂÙÈÎ‹ ¯ÚÒÛË, ¯ˆÚ›˜ ÙËÓ ‡·ÚÍË ÎÔÎÎÈˆÌ·ÙÒ‰Ô˘˜ ÈÛÙÔ‡. H Ù·˘ÙÔÔ›ËÛË ÙˆÓ Ì˘Î‹ÙˆÓ ·Ó¤‰ÂÈÍÂ ·ÏËıÂ›˜ ˘Ê¤˜ A. fumigatus. ™ÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙÔ˘ BAL, Â›ÛË˜ ·ÔÌÔÓÒıËÎÂ ·Û¤ÚÁÈÏÏÔ˜. ™ÙÔÈ¯Â›· Î·ÎÔ‹ıÂÈ·˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛÙÔ ˘ÏÈÎfi ÙË˜ ‚ÈÔ„›·˜ Ô‡ÙÂ ÛÙÔ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎfi ¤ÎÏ˘Ì·. ÕÙ˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ÔÌÔÓÒıË-

Î·Ó ·fi Ù· Ù‡ÂÏ· ÙÔ˘ ·ÛıÂÓ‹, ÂÓÒ ·Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ M. avium ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ·fi ÙÈ˜ Â·ÓÂÈ-

ÏËÌÌ¤ÓÂ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓ‹.

EÚfiÎÂÈÙÔ ÏÔÈfiÓ ÁÈ· Ù·˘Ùfi¯ÚÔÓË ÏÔ›ÌˆÍË ·fi

¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Î·È ·Û¤ÚÁÈÏÏÔ.

TÔ ·È‰› ·Ú¯ÈÎ¿ ¤Ï·‚Â ‰ÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ ·ÁˆÁ‹ ÌÂ ·ÌÊÔÙÂÚÈÎ›ÓË B ÛÂ Û˘Ó‰˘·ÛÌﬁ ÌÂ ÊÏÔ˘-

Î˘ÙÔÛ›ÓË Î·ıÒ˜ Î·È ÙÂÙÚ·Ïﬁ Û¯‹Ì· ÁÈ· ÙË ÏÔ›ÌˆÍË ·ﬁ M. avium (·˙ÈıÚÔÌ˘Î›ÓË, ÚÈÊ·ÌÔ˘Ù›ÓË, ÛÈÚÔÊÏÔÍ·Û›ÓË, ·ÌÈÎ·Û›ÓË).

H ‰ÂÎ·ÙÈÎ‹ ˘ÚÂÙÈÎ‹ Î›ÓËÛË Î·È Ô ‚‹¯·˜ ÂÌÊ¿ÓÈÛ·Ó ÛÙ·‰È·Î‹ ˘Ô¯ÒÚËÛË, Ù· ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· fiÌˆ˜ ·Ú¤ÌÂÈÓ·Ó ·ÌÂÙ¿‚ÏËÙ· ·ÎfiÌ· Î·È ¤ÓÙÂ Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ÂÓÒ Û˘ÓÂ¯È˙fiÙ·Ó Ë ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ·ÌÊÔÙÂÚÈÎ›ÓË˜ B

ÙÚÂÈ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Î·È ÙÚÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ ·ÁˆÁ‹. H ÂÓÙﬁÈÛË ÙË˜ Ì¿˙·˜ ‹Ù·Ó ··ÁÔÚÂ˘ÙÈÎ‹

ÁÈ· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË.

™ÙË ‰Â‡ÙÂÚË ‰È·‚ÚÔÁ¯ÈÎ‹ ‚ÈÔ„›· ‰È·ÈÛÙÒıËÎ·Ó

·ÏÏÔÈÒÛÂÈ˜ ¯ÚﬁÓÈ·˜ ÊÏÂÁÌÔÓ‹˜. EÓÙÔ›ÛıËÎ·Ó Ï›Á·

ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ÔÍÂ¿ÓÙÔ¯· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ÏÏ¿ ‰ÂÓ

·ÓÂ˘Ú¤ıËÛ·Ó Ì‡ÎËÙÂ˜ ‹ ÛÙÔÈ¯Â›· Î·ÎÔ‹ıÂÈ·˜. MÂ Ù·

·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù· ¯ÔÚËÁ‹ıËÎÂ ·ﬁ ÙÔ˘ ÛÙﬁÌ·ÙÔ˜

ıÂÚ·Â›· Û˘ÓÙ‹ÚËÛË˜ ÁÈ· ÙË ÏÔ›ÌˆÍË ·ﬁ ·Û¤Ú-

ÁÈÏÏÔ ÌÂ ÈÙÚ·ÎÔÓ·˙ﬁÏË.

™‹ÌÂÚ· 2,5 ¯ÚﬁÓÈ· ·ÚÁﬁÙÂÚ·, Ô ·ÛıÂÓ‹˜ Â›Ó·È ÛÂ

Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ˘ﬁ ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË ÌÂ

ÈÙÚ·ÎÔÓ·˙ﬁÏË Î·È ·˙ÈıÚÔÌ˘Î›ÓË. ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùﬁ

‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›ÛÂÈ ¿ÏÏË Â˘Î·ÈÚÈ·Î‹ ÏÔ›ÌˆÍË Î·È Ë

·ÎÙÈÓÔÏÔÁÈÎ‹ ÙÔ˘ ÂÈÎﬁÓ· Â›Ó·È ‚ÂÏÙÈˆÌ¤ÓË. MﬁÓÔ

Úﬁ‚ÏËÌ¿ ÙÔ˘ ·Ú·Ì¤ÓÂÈ Ë ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì˘ÎËÙÈ·ÛÈÎ‹ ÛÙÔÌ·Ù›ÙÈ‰· Î·È ÙÔ ·˘ÍËÌ¤ÓÔ ÈÈÎﬁ ÊÔÚÙ›Ô ·-

Ú¿ ÙËÓ ÙÚÈÏ‹ ·ÓÙÈÚÂÙÚÔ˚Î‹ ·ÁˆÁ‹.

™˘˙‹ÙËÛË TÔ AIDS ÂÚÈÁÚ¿ÊËÎÂ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔÚÚÔÊÈÏ›· ÙÔ 1982. (7) TÔ 1985, ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÏ¤Á¯Ô˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ HIV ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÙÔ 40-90% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ Â›¯·Ó ÌÔÏ˘ÓıÂ› Ì¤Ûˆ ÙË˜ ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ (Û˘Ì‚·ÙÈÎÔ› Û˘Ì˘ÎÓˆÌ¤ÓÔÈ ·Ú¿ÁÔÓÙÂ˜). (8) H ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÚÔÌÂÙ·ÙÚÔÒÓ Û˘Ó¤‚Ë Î·Ù¿ Ù· ¤ÙË 1982 Î·È 1983. (9) H ÔÚÂ›· ÙË˜ HIV ÏÔ›ÌˆÍË˜ ÛÂ ·ÈÌÔÚÚÔÊÈÏÈÎ¿ ·È‰È¿ Â›Ó·È Èfi Ì·ÎÚfi¯ÚÔÓË ·fi fiÙÈ ÛÂ ·È‰È¿ ÌÂ Î¿ıÂÙË HIV ÏÔ›ÌˆÍË, ÂÓÒ ÔÈ Î·ÎÔ‹ıÂÈÂ˜ Î·È ÔÈ Â˘Î·ÈÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ Â›Ó·È Î·ıÔÚÈÛÙÈÎ¤˜ ÁÈ· ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ Î·È ÙË ıÓËÙfiÙËÙ· (10,11). O ·ÛıÂÓ‹˜ Ì·˜ ÌÔÏ‡ÓıËÎÂ ÌÂ ÙÔÓ HIV ÛÂ ËÏÈÎ›· 4 ÂÙÒÓ Î·È ·ÚÔ˘Û›·ÛÂ ÙËÓ ÚÒÙË ÙÔ˘ Â˘Î·ÈÚÈ·Î‹ ÏÔ›ÌˆÍË ÛÂ ËÏÈÎ›· 15 ÂÙÒÓ. H Û˘¯ÓfiÙËÙ· ÏÔ›ÌˆÍË˜ ·fi M. avium ÛÂ ·È‰È¿ ÌÂ AIDS ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Â›Ó·È ÂÚ›Ô˘ ›‰È· ÌÂ ·˘Ù‹ ÙˆÓ ÂÓËÏ›ÎˆÓ, ‰ËÏ·‰‹ 1,1-4 %. K·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÏÔ›ÌˆÍË˜ ·fi M. avium ıÂˆÚÂ›Ù·È Ë ÙÒÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4

ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î¿Ùˆ ·ﬁ 100/mm3 (1). EÌÊ·Ó›˙ÂÙ·È

Û˘Ó‹ıˆ˜ ˆ˜ ‰È¿Û·ÚÙË ÏÔ›ÌˆÍË (Ì˘ÎÔ‚·ÎÙËÚÈ·ÈÌ›·)

ÌÂ ˘ÚÂÙﬁ, ·Ó·ÈÌ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. øÛÙﬁÛÔ

¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÂÓÙÔÈÛÌ¤ÓÂ˜ ÌÔÚÊ¤˜ ÙË˜ ÓﬁÛÔ˘

ÛÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜ ‹ Î·È ÛÂ ¿ÏÏ· ﬁÚÁ·Ó· (‰¤ÚÌ·, ÏÂÌÊ·‰¤ÓÂ˜). H ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË˜ ÌÂÈÒÓÂÈ

ÙËÓ Èı·ÓfiÙËÙ· ÏÔ›ÌˆÍË˜ ·fi M. avium ÛÂ ·ÛıÂÓÂ›˜ ÌÂ HIV ÏÔ›ÌˆÍË Î·È CD4 ÏÂÌÊÔÎ‡ÙÙ·Ú· Î¿Ùˆ ·fi 100/mm3. (1,2)

H ‰ÈËıËÙÈÎ‹ ÓÂ˘ÌÔÓÈÎ‹ ·ÛÂÚÁ›ÏÏˆÛË ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ¿ÙÔÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹ ÏﬁÁˆ Ì·ÎÚÔ¯ÚﬁÓÈ·˜ ¯ÔÚ‹ÁËÛË˜ ÎÔÚÙÈÎÔÂÈ‰ÒÓ, Ô˘‰ÂÙÂ-

ÚÔÂÓ›·˜ ‹ ¤¯Ô˘Ó ÏÂÈÙÔ˘ÚÁÈÎ‹ ‰È·Ù·Ú·¯‹ ÙˆÓ Ô˘‰Â-

ÙÂÚÔÊ›ÏˆÓ (3). ™Â ·ÛıÂÓÂ›˜ ÌÂ AIDS ·ÚÔ˘ÛÈ¿˙ÂÙ·È

Û¿ÓÈ· ÌÂ Û˘¯ÓﬁÙËÙ· Ô˘ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ˘ÔÏÔÁ›-

˙ÂÙ·È ÛÙÔ 0,7% (6) Î·È ÛÙ· ·È‰È¿ ÛÙÔ 1,5% (5). §ﬁÁˆ

ÙË˜ ‰‡ÛÎÔÏË˜ ÙÂÎÌËÚ›ˆÛË˜ ÙË˜ ÏÔ›ÌˆÍË˜ Û˘¯Ó¿ Ë

‰È¿ÁÓˆÛË ‰È·ÊÂ‡ÁÂÈ, ¤ÙÛÈ ÔÈ ÂÚÈÛÛﬁÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜

ÛÙËÚ›˙ÔÓÙ·È ÛÂ ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi (6). ø˜ Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜ ÌfiÏ˘ÓÛË˜ ·Ó·Ê¤ÚÂÙ·È Ë ÂÈÛÓÔ‹ ÎÔÓÈ‰›ˆÓ ·Û¤ÚÁÈÏÏÔ˘. ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ Ù· Ì·ÎÚÔÊ¿Á· ÂÈÙ˘Á¯¿ÓÔ˘Ó ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÓÈ‰›ˆÓ, ·Ó fiÌˆ˜ Ë ÏÔ›ÌˆÍË ‰ÂÓ ÂÚÈÔÚÈÛÙÂ›, ·Ú¯›˙ÂÈ Ë ‰È·‰ÈÎ·Û›· ·Ó¿Ù˘ÍË˜ Ì˘ÎËÏ›ˆÓ. (3)

OÈ ·ÛıÂÓÂ›˜ ÌÂ AIDS Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·ﬁ

·Û¤ÚÁÈÏÏÔ Û˘Ó‹ıˆ˜ ‚Ú›ÛÎÔÓÙ·È ÛÂ ‚·ÚÈ¿ ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹. ¶ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ·ÛÂÚÁ›Ï-

ÏˆÛË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ AIDS ·ÔÙÂÏÔ‡Ó Ë Ô˘‰ÂÙÂÚÔ-

ÂÓ›·, Ë ¯ÚﬁÓÈ· ıÂÚ·Â›· ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹, Ë Ì·ÎÚÔ-

¯ÚﬁÓÈ· ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ıÂÚ·Â›· Â˘Ú¤ˆ˜ Ê¿ÛÌ·ÙÔ˜

ﬁˆ˜ Î·È Ë ˘ÔÎÂ›ÌÂÓË ÓÂ˘ÌÔÓÈÎ‹ ÓﬁÛÔ˜. H ÏÂÈ-

ÙÔ˘ÚÁÈÎ‹ ‰È·Ù·Ú·¯‹ ÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ Ô˘-

‰ÂÙÂÚÔÊ›ÏˆÓ Ê·›ÓÂÙ·È ÔÙÈ ·ÔÙÂÏÂ› ÙÔÓ Î‡ÚÈÔ ÚÔ‰È·ıÂÛÈÎﬁ ·Ú¿ÁÔÓÙ· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ AIDS Ô˘

‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·.(4,5) O ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ ÂÌÊ¿ÓÈ˙Â Ô˘‰ÂÙÂÚÔÂÓ›· ·ÏÏ¿ Ë

ÚÔ¸¿Ú¯Ô˘Û· ÓÂ˘ÌÔÓÈÎ‹ ÏÔ›ÌˆÍË ·fi M. avium Èı·ÓfiÓ Ó· ·ÔÙ¤ÏÂÛÂ ÙÔÓ Î‡ÚÈÔ ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‰ÈËıËÙÈÎ‹˜ ·ÛÂÚÁ›ÏÏˆÛË˜. H ‰È¿ÁÓˆÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÛÂÚÁ›ÏÏˆÛË˜ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂ Î·ÏÏÈ¤ÚÁÂÈ· ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎÔ‡ ÂÎÏ‡Ì·ÙÔ˜ Î·È ‚ÈÔ„›· ÓÂ‡ÌÔÓÔ˜, ÂÓÒ ÔÈ ÔÚÔÏÔÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ·Ó›¯ÓÂ˘ÛË˜ ·ÓÙÈÁfiÓÔ˘ Î·È ·ÓÙiÛÒÌ·ÙÔ˜ Î·Ù¿ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ ¤¯Ô˘Ó ¯·ÌËÏ‹ ·ÍÈÔÈÛÙ›·. (3,12)

Ë ·ÌÊÔÙÂÚÈÎ›ÓË B, ¤¯Ô˘Ó fiÌˆ˜ ¯ÚËÛÈÌÔÔÈËıÂ› ÌÂ ÂÈÙ˘¯›· Î·È ¿ÏÏ· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ¿ Ê¿ÚÌ·Î· fiˆ˜ Â›Ó·È ÔÈ ·˙fiÏÂ˜ Î·È Ë ÊÏÔ˘Î˘ÙÔÛ›ÓË, Û˘Ó‹ıˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ·ÌÊÔÙÂÚÈÎ›ÓË B (3,5,6,13). H ÏÈÔÛˆÌÈÎ‹ ·ÌÊÔÙÂÚÈÎ›ÓË B ÚÔÙÈÌ¿Ù·È ÛÂ ÂÚÈÙÒÛÂÈ˜ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¯ÔÚ‹ÁËÛË˜ ÏfiÁˆ ÌÈÎÚfiÙÂÚË˜ ÙÔÍÈÎfiÙËÙ·˜ (13,14). XÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ÙË˜ Ì˘ÎËÙÈ·ÛÈÎ‹˜ Ì¿˙·˜ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙÂ› ÌÂ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· (15) ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ fiÌˆ˜ Ù¤ÙÔÈ· Â¤Ì‚·ÛË ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹ ÏfiÁˆ ÙË˜

ÂÓÙﬁÈÛË˜ ÙË˜ Ì¿˙·˜.

O Ì¤ÛÔ˜ ¯ÚﬁÓÔ˜ ÂÌÊ¿ÓÈÛË˜ ·ÛÂÚÁ›ÏÏˆÛË˜ ·ﬁ

ÙË ÌÂÙ¿ÙˆÛË ÙË˜ HIV ÏÔ›ÌˆÍË˜ ÛÂ AIDS Â›Ó·È 10 Ì‹ÓÂ˜, (6) ﬁÛÔ ‹Ù·Ó Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜.

H ÚfiÁÓˆÛË ÙË˜ ‰ÈËıËÙÈÎ‹˜ ·ÛÂÚÁ›ÏÏˆÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ AIDS ¤›Ó·È ÔÏ‡ Î·Î‹, Ë ıÓËÙfiÙËÙ· Êı¿ÓÂÈ ÙÔ 70-90%, (5) Ô ‰Â Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛË˜ ·Ó¤Ú¯ÂÙ·È ÛÂ Ï›ÁÂ˜ Â‚‰ÔÌ¿‰Â˜ (5). O ·ÛıÂÓ‹˜ Ì·˜

ÛÂ ÔÏ‡ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ÂÚÈÛÛﬁÙÂÚÔ

ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË, ÁÂÁÔÓﬁ˜

EÓ‰È·Ê¤ÚÔÓÙ· ÛËÌÂ›· ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È Ë Û¿ÓÈ· ÂÓÙfiÈÛË ÙË˜ ÂÓ‰Ô‚ÚÔÁ¯ÈÎ‹˜ ÏÔ›ÌˆÍË˜ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Î·È ·Û¤ÚÁÈÏÏÔ, Î·ıÒ˜ Â›ÛË˜ Î·È Ë ¿ÚÈÛÙË

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

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

9. 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.

10.M‹ÙÛÈÎ· -K·Ú·Ó¿ÛÔ˘ A. ¢È·¯ÚÔÓÈÎ‹ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Î‹ ÂÎÙ›ÌËÛË HIV ÔÚÔıÂÙÈÎÒÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·È‰ÈÒÓ.

¶ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜ ÁÈ· ¤ÁÎ·ÈÚË ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË. Aı‹Ó· : A' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, 1993.

11.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.

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

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

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›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘, A' ¶·È‰È·ÙÚÈÎ‹ KÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ,

MÔÓ¿‰· EÈ‰ÈÎÒÓ §ÔÈÌÒÍÂˆÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·",

£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, °Ô˘‰›.

IˆÛ‹Ê K·Ï¤ÁÈ·˜1, M·Ú›˙· TÛÔÏÈ¿1, KˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··ÁÂˆÚÁ›Ô˘2, £ÂÔ‰ﬁÛË˜ ¢ﬁÛÈÔ˜, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿ÎË˜1

● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ Ô˘ ‰È·ÁÓÒÛıËÎÂ ÛÂ ·ÁfiÚÈ ËÏÈÎ›·˜ 14 ÂÙÒÓ, ÙÔ ÔÔ›Ô ·fi ËÏÈÎ›·˜ 2 ÂÙÒÓ ·ÚÔ˘Û›·˙Â ÂÂÈÛfi‰È· ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ. H ıÂÚ·Â›· ‹Ù·Ó ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÌÂ ÂÎÙÔÌ‹ ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜. H ÎÏÈÓÈÎ‹ ˘Ô„›·

ÁÈ· ÙÔ Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â›·.

¶·È‰È·ÙÚÈÎ‹ 2000;63:55-59.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ·, ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘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‹

˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ (1,2).

Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· (™§E) ÚÔ-

Û˘Ó‹ıˆ˜ ÌÂ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·Ó·ÓÂ˘-

ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·, ÏÈÁﬁÙÂÚÔ

Û˘¯Ó¿ ÌÔÚÂ› Ó· ‰È·ÁÓˆÛıÂ› ÛÙË ÌÂÙ¤ÂÈÙ· ‚ÚÂÊÈ-

Î‹ ËÏÈÎ›· (5%), ÂÓÒ ÛÔÚ·‰ÈÎ¿ ÂÚÈÛÙ·ÙÈÎ¿ ÂÚÈ-

ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·È‰ÈÎ‹, ÂÊË‚ÈÎ‹ ‹ Î·È ÂÓ‹ÏÈÎÔ

˙ˆ‹ (3). H ËÏÈÎ›· ‰È¿ÁÓˆÛË˜ ÂÍ·ÚÙ¿Ù·È ·ﬁ ÙÔÓ ‚·ıÌﬁ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ Ô˘

ÚÔÎ·ÏÂ›Ù·È.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

ŒÊË‚Ô˜ 14 ÂÙÒÓ, ·ÚÔ˘Û›·ÛÂ ˘ÚÂÙﬁ Î·È ‚‹¯·

Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰‡ÛÓÔÈ·, ·ÓÙÈÏËÙ‹ ˆ˜ Ù·¯‡-

ÓÔÈ·. MÂ ·˘Ù‹ ÙËÓ ÂÈÎﬁÓ· ÂÈÛ‹¯ıË ÛÂ NÔÛÔÎÔÌÂ›Ô

ﬁÔ˘ ÛÙË ÁÂÓﬁÌÂÓË ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·È-

ÛÙÒıËÎÂ ˘ÂÚ‰È·‡Á·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂ‡ÌÔÓ·

Î·È ÌÂÙ·ÙﬁÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿ (ÂÈÎﬁÓ· 1).

TÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. Afi

ËÏÈÎ›·˜ 2 ÂÙÒÓ ·ÚÔ˘Û›·˙Â ‹È· ÂÂÈÛﬁ‰È· ·Ó·-

ÓÂ˘ÛÙÈÎ‹˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô-

ÓÙ·Ó ˆ˜ ‚ÚÔÁ¯ÈÎﬁ ¿ÛıÌ· ‹/ Î·È ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Â ËÏÈÎ›· 9 ÂÙÒÓ ÓÔÛË-

ÏÂ‡ÙËÎÂ ÁÈ· ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Î·È ·ﬁ ÙﬁÙÂ

¿Ú¯ÈÛÂ Ó· ¯ÚËÛÈÌÔÔÈÂ› ÂÈÛÓÂﬁÌÂÓ· ‚ÚÔÁ¯Ô‰È·-

ÛÙ·ÏÙÈÎ¿ Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ¯ˆÚ›˜ fiÌˆ˜ ÂÌÊ·Ó‹ ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË. ¢ÂÓ ·Ó¤ÊÂÚÂ Ó˘¯ÙÂÚÈÓfi

‚‹¯· ‹ ‚‹¯· ÌÂÙ¿ ·ﬁ ¿ÛÎËÛË. TÔ ÔÈÎÔÁÂÓÂÈ·Îﬁ

ÈÛÙÔÚÈÎﬁ ‹Ù·Ó ÂÏÂ‡ıÂÚÔ.

TÔ ·È‰› ‹Ù·Ó ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, Ù·

ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÙÔ˘ ÛÙÔÈ¯Â›· ‹Ù·Ó ÛÙËÓ 95Ë ÂÎ·ÙÔ-

ÛÙÈ·›· ı¤ÛË. H ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘ ‹Ù·Ó ÌÂÈˆÌ¤ÓË ÌÂ ˘ÂÚÛ·Ê‹ Ù˘Ì·ÓÈÎfi ‹¯Ô, ÔÈ ÊˆÓËÙÈÎ¤˜ ‰ÔÓ‹ÛÂÈ˜ Î·È ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi „Èı‡ÚÈÛÌ· ‹Ù·Ó ÌÂÈˆÌ¤Ó· ·ÚÈÛÙÂÚ¿, ÂÓÒ ‰ÂÍÈ¿ ˘‹Ú¯Â Î˘„ÂÏÈ‰ÈÎfi „Èı‡ÚÈÛÌ· ÌÂ ÚfiÛıÂÙÔ˘˜ ·¯Â›˜ ˘ÁÚÔ‡˜ ‹¯Ô˘˜ Î·È Û˘Ú›ÙÔÓÙÂ˜. H ÂÎÙ›ˆ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ¤‰ÂÈÍÂ ÂÈÎfiÓ· ˘ÂÚ·ÂÚÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂ‡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‡ÛÂ ˘¤Ú ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜. Afi Ù· ·›ÙÈ· Ô˘ ÚÔÎ·ÏÔ‡Ó ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· ˆ˜ ÂÚÈÛÛfiÙÂÚÔ Èı·Ó¿ ıÂˆÚ‹ıËÎ·Ó Ë ÌÂÚÈÎ‹ ·fiÊÚ·ÍË ÏfiÁˆ ¿ÛıÌ·ÙÔ˜ ‹ ·fi Í¤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·˘ÏÈÎ¿ ‹ ÂÍˆ·˘ÏÈÎ¿, ·Ó Î·È ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ·ÔÎÏÂÈÛÙÔ‡Ó, ıÂˆÚ‹ıËÎ·Ó ÏÈÁfiÙÂÚÔ Èı·Ó¿. H ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ‹Ù·Ó ·ÚfiÌÔÈ· ÂÎÂ›ÓË˜ Ô˘ Â›¯Â ÛÂ ËÏÈÎ›· 9 ÂÙÒÓ Î·Ù¿ ÙËÓ ÙfiÙÂ ÓÔÛËÏÂ›· ÙÔ˘ ·È‰ÈÔ‡ ÛÂ NÔÛÔÎÔÌÂ›Ô (ÂÈÎfiÓ· 2). O ·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıËÎÂ ÌÂ ÙÈ˜ ·ÎfiÏÔ˘ıÂ˜ ÂÍÂÙ¿ÛÂÈ˜. AÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ Â˘ÎÚ›ÓÂÈ·˜ Ë ÔÔ›· ¤‰ÂÈÍÂ ÙÌËÌ·ÙÈÎfi ÂÌÊ‡ÛËÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Î¿Ùˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆıÂ› ·Á›‰Â˘ÛË ·¤Ú· ‹ ‚ÚÔÁ¯ÂÎÙ·Û›Â˜ (ÂÈÎfiÓ· 3), ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛË˜ -·¤ÚˆÛË˜ ·fi ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËÎÂ ·Ô˘Û›· ·ÈÌ¿ÙˆÛË˜ Î·È ·¤ÚˆÛË˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ ÔÏ˘ÂÛÙÈ·Î¤˜ ‚Ï¿‚Â˜ (ÂÈÎfiÓ· 4), ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· EÈÎfiÓ· 1. AÎÙÈÓÔÁÚ·Ê›·

EÈÎﬁÓ· 3. AÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·Î· ˘„ËÏ‹˜ Â˘ÎÚ›ÓÂÈ·˜ (HRCT): TÌËÌ·ÙÈÎﬁ ÂÌÊ‡ÛËÌ· ÙÔ˘ ·ÚÈÛÙÂ-

ÚÔ‡ ¿Óˆ Î·È ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Î¿Ùˆ ÏÔ‚Ô‡.

Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. H ‰˘Ó·ÌÈÎ‹ ÛÈÚÔÌ¤ÙÚËÛË (FEV1=86%, FEVC=87%, FEV1/ FEVC=84%, MMF=64%) Î·È Ë ·ÚÓËÙÈÎ‹ ‰ÔÎÈÌ·Û›· ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹˜ Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú ÌË ·Ó·ÛÙÚ¤„ÈÌË˜ ·ﬁÊÚ·ÍË˜ ÙˆÓ ÌÈÎÚÒÓ ·ÂÚ·ÁˆÁÒÓ. T· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ Î·È ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜ ·ÔÌ¿ÎÚ˘Ó·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡

¿ÛıÌ·ÙÔ˜. H ·Ô˘Û›· ÂÌÊ·ÓÔ‡˜ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÂÈÎfiÓ· Î·Ù¿ ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· (·Ô˘Û›· ‚ÚÔÁ¯ÂÎÙ·ÛÈÒÓ, ÌË ‰È·›ÛÙˆÛË ·Á›‰Â˘ÛË˜ ·¤Ú·) ·ÔÌ¿ÎÚ˘Ó·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ SJML (4). ø˜ Èı·ÓfiÙÂÚË ‰È¿ÁÓˆÛË ıÂˆÚ‹ıËÎÂ ÂÎÂ›ÓË ÙÔ˘ ™§E. H ‚ÚÔÁ¯ÔÛÎfiËÛË ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ‹ ¿ÏÏÔ˘ ÂÓ‰Ô·˘ÏÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ‰ÂÓ ÎÚ›ıËÎÂ ÛÎfiÈÌË ÂÂÈ‰‹ ı· ÌÔÚÔ‡ÛÂ Ó· ÚÔÎ·Ï¤ÛÂÈ Ú‹ÍË Ù˘¯fiÓ ÂÌÊ˘ÛËÌ·ÙÈÎ‹˜ ÂÚÈÔ¯‹˜. ø˜ Î·Ù·ÏÏËÏfiÙÂÚË ÎÚ›ıËÎÂ Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË. ŒÁÈÓÂ ·ÚÈÛÙÂÚ‹ ¿Óˆ ÏÔ‚ÂÎÙÔÌ‹ Î·È ÙÌËÌ·ÙÂÎÙÔÌ‹ ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Î¿Ùˆ ÏÔ‚Ô‡. H ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Ô˘ ·Ê·ÈÚ¤ıËÎÂ ¤‰ÂÈÍÂ ˘ÂÚ·ÂÚÈÛÌfi ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ú‹ÍË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ (ÂÈÎfiÓ· 5). TÔ ÙÔ›¯ˆÌ· ÙˆÓ ‚ÚfiÁ¯ˆÓ ‰ÂÓ ‹Ù·Ó Â·¯˘ÛÌ¤ÓÔ Î·È ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‚ÚÔÁ¯ÂÎÙ·ÛÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ (ÂÈÎfiÓ· ıÂˆÚ‹ıËÎÂ Û˘Ì‚·Ù‹ ÌÂ ™§E). MÂÙÂÁ¯ÂÈÚËÙÈÎ¿ Ô ·ÚÈÛÙÂÚfi˜ Î¿Ùˆ ÏÔ‚fi˜ ÂÎÙ‡¯ıËÎÂ Ï‹Úˆ˜ (ÂÈÎfiÓ· 6).

™˘˙‹ÙËÛË

TÔ ™§E Û¯Â‰ﬁÓ ¿ÓÙ· Á›ÓÂÙ·È ·ÓÙÈÏËÙﬁ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜ Î·È ÚÔ‚¿ÏÏÂÈ ÌÂ ÙËÓ ÂÈ-

EÈÎﬁÓ· 4. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛË˜ Î·È ·¤ÚˆÛË˜ ÓÂ˘ÌﬁÓˆÓ: ·Ô˘Û›· ·ÈÌ¿ÙˆÛË˜ Î·È ·¤ÚˆÛË˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ ÔÏ˘ÂÛÙÈ·Î¤˜ ‚Ï¿‚Â˜.

EÈÎfiÓ· 5. IÛÙÔÏÔÁÈÎ‹ ÂÈÎfiÓ· ·Ê·ÈÚÂı¤ÓÙÔ˜ ÙÌ‹Ì·ÙÔ˜ ÓÂ˘ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜: ˘ÂÚ·ÂÚÈÛÌfi˜ ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ú‹ÍË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ.

ÎfiÓ· ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ ‹/ Î·È Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡. Y¿Ú¯Ô˘Ó ÛÔÚ·‰ÈÎ¿ ÂÚÈÛÙ·ÙÈÎ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÛÙË ·È‰ÈÎ‹, ÂÊË‚ÈÎ‹ ‹ 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·¯¤˜ Î·Ù¿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ, fiˆ˜ Ë ‰˘ÛÏ·Û›·

ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙˆÓ ‚ÚﬁÁ¯ˆÓ ‹ /Î·È Ô ÌÂÈˆÌ¤ÓÔ˜ ·ÚÈıÌﬁ˜ Î˘„ÂÏ›‰ˆÓ, Ô‰ËÁÔ‡Ó ÛÂ ™§E (2,3).

AÂÈÎÔÓÈÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ™§E Â›Ó·È Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·, Ë

ÔÔ›· ÛÙË ‰ÈÎ‹ Ì·˜ ÂÚ›ÙˆÛË ¤ıÂÛÂ ÈÛ¯˘Ú‹ ˘Ô„›· ÁÈ· ÙÔ ÓfiÛËÌ·. O ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıËÎÂ ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ Â˘ÎÚ›ÓÂÈ·˜, ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛË˜- ·¤ÚˆÛË˜, ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·. MÂ ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÓÈÛ¯‡ÂÙ·È Ë ‰È¿ÁÓˆÛË. TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·¤ÚˆÛË˜- ·ÈÌ¿ÙˆÛË˜ ¤ÁÈÓÂ ÁÈ· Ó· ‰ÈÂ˘ÎÚÈÓÈÛıÂ› Ù˘¯fiÓ ÔÏ˘ÂÛÙÈ·Îfi ™§E (8-11). ŒÁÈÓÂ

Â›ÛË˜ ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌﬁ Û˘ÁÁÂÓÔ‡˜ Î·Ú‰ÈÔ¿ıÂÈ·˜ ‹ ·ÓˆÌ·Ï›·˜ ÌÂÁ¿-

ÏˆÓ ·ÁÁÂ›ˆÓ Ô˘ ﬁˆ˜ Â›Ó·È ÁÓˆÛÙﬁ Û˘Ó˘¿Ú¯Ô˘Ó

ÛÂ ÔÛÔÛÙﬁ 14% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÌÂ ™§E (10) Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌﬁ ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘Ï›Ô˘.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ÌÂ ™§E ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÌÂ ÂÎÙÔÌ‹ ÙÔ˘ ˘Ô·ÂÚÈ˙fiÌÂÓÔ˘ ÈÛÙÔ‡ (1,11-14). ŸÌˆ˜, ·Ó Î·È Â›Ó·È ÁÂÓÈÎ¿ ·Ú·‰ÂÎÙfi fiÙÈ Ë ·Ê·›ÚÂÛË ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Â›Ó·È ÛˆÙ‹ÚÈ· ÛÂ ÓÂÔÁÓ¿ ÌÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ÔÈ ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈÎ‹

¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜, Ë ÔÔ›· ·fi ÙË Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ÈÂıÓ‹ ÂÌÂÈÚ›· ıÂˆÚÂ›Ù·È ÚÔÙÈÌfiÙÂÚË. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ Ë ·Ê·›ÚÂÛË ÙË˜ ÂÌÊ˘ÛËÌ·ÙÈÎ‹˜ ÂÚÈÔ¯‹˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ 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˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂ ÙËÓ ·Ó·Á¤ÓÓËÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ·ÔÙÚ¤ÂÈ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÓÂ˘ÌÔÓÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜. ¶·Ú¿ÏÏËÏ·, ·ÔÊÂ‡ÁÂÙ·È Ë ·ÈÊÓ›‰È· Ú‹ÍË Î·È ÚfiÎÏËÛË ·˘ÙfiÌ·ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î·. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÙÔ ™§E Ô˘ Â›Ó·È ¤Ó· Û¿ÓÈÔ

ÙË˜ ‰È·Ì·ÚÙ›·˜ ÛÂ

ÌÂ

ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¤˜ ÂÈÏÔÎ¤˜. MÂ ‚¿ÛË ÙËÓ ˘¿Ú¯Ô˘Û· ÂÌÂÈÚ›·, ·È‰È¿ ÌÂ Û˘ÌÙˆÌ·ÙÈÎfi ™§E Ú¤ÂÈ Ó· ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÏfiÁˆ ÙË˜ Û·ÓÈfiÙËÙ·˜, ·ÏÏ¿ Î·È ÁÈ· Ó· ˘ÂÓı˘Ì›ÛÂÈ ÛÙÔÓ ·ÛÎÔ‡ÓÙ· ¶·È‰›·ÙÚÔ fiÙÈ ÛÙËÓ ‹È· ·ÏÏ¿ Â›ÌÔÓË

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. J Thorac Cardiovasc Surg1990; 99:597-603.

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

Pulmonology 1992; 14:160-170.

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.

10. Hugosson C. Congenital bilobar emphysema. Ped Pulmonology 1995; 25:649-651.

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.

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›· ¤ÁÎÚÈÛË˜: 05-11-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: IˆÛ‹Ê K·Ï¤ÁÈ·˜

XÚ˘Û·Óı¤ÌˆÓ 79, 15772 Aı‹Ó·

ÈÛÙÈÔÎ‡ÙÙˆÛË ·ﬁ Î‡ÙÙ·Ú· Langerhans

£ÂÔ‰ﬁÙË˜ ¶··ÁÂˆÚÁ›Ô˘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 ËÏÈÎ›·˜ 18 ÌËÓÒÓ, ¿Û¯Ô˘Û· ·ﬁ ÂÙÂÚﬁ-

˙˘ÁË-‚ ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· Î·È ¤ÏÏÂÈ„Ë G-6PD ÂÌ-

Ê¿ÓÈÛÂ ‰ÂÚÌ·Ù›ÙÈ‰· ÛÙË ÌËÚÔ˚ÁÓÈ·Î‹ Î·È ÙËÓ ÔÛÊ˘˚-

Î‹ ¯ÒÚ·, Î·ıÒ˜ Î·È ÛÙÔ ÙÚÈ¯ˆÙﬁ ÙË˜ ÎÂÊ·Ï‹˜. H

·ÁˆÁ‹ Ô˘ Û˘ÓÂÛÙ‹ıË ·ﬁ ‰ÂÚÌ·ÙÔÏﬁÁÔ ‰ÂÓ Â¤ÊÂÚÂ Î·Ì›· ‚ÂÏÙ›ˆÛË. ™Â ÂÍ¤Ù·ÛË ÚÔ˘Ù›Ó·˜ ÛÙÔ ÂÍˆ-

ÙÂÚÈÎﬁ È·ÙÚÂ›Ô ÙÔ˘ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ‰È·È-

ÛÙÒıËÎÂ fiÙÈ ÂÎÙfi˜ ·fi ÙË ‰ÂÚÌ·Ù›ÙÈ‰·, ÂÌÊ¿ÓÈ˙Â ÛÏËÓÔÌÂÁ·Ï›· (ÂÚ›Ô˘ 10 ÂÎ·ÙÔÛÙ¿), ‰È¿Ù·ÛË ÙË˜ ÎÔÈÏÈ¿˜ Î·È ¤ÓÙÔÓË ÔÏ˘‰È„›·. MÂ Èı·Ó‹ ‰È¿ÁÓˆÛË ÙËÓ ÈÛÙÈÔÎ‡ÙÙˆÛË ·fi Î‡ÙÙ·Ú· Langerhans ˘Ô‚Ï‹ıËÎÂ ÛÂ Ï‹ÚË ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ÌÂ ·Ï¤˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜, ˘ÔÏÔÁÈÛÙÈÎ‹ Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ·ÔÎÏÂ›ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ˘ÂÚÛÏËÓÈÛÌfi Î·È ÙËÓ Ë·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. OÈ ·/· ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È Ë ˘ÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·

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

EÈÎfiÓ· 3. M·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI) ˘ÔÊ‡ÛÂˆ˜. O‚ÂÏÈ·›Ô Â›Â‰Ô T1W1, ÌÂÙ¿ ·fi ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ·Ú·Ì·ÁÓËÙÈÎ‹˜ Ô˘Û›·˜. ¶·Ú·ÙËÚÂ›Ù·È ·ıÔÏÔÁÈÎ‹ ¿¯˘ÓÛË Î·È ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ Ì›Û¯Ô˘ ÙË˜ ˘fiÊ˘ÛË˜.

ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘ ÌÂ ·ÎÂÚ·ÈﬁÙËÙ· ÙˆÓ ÌÂÛÔÛÔÓ‰˘Ï›ˆÓ ‰›ÛÎˆÓ

·Ô˘Û›· Ì¿˙·˜ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ (ÂÈÎfiÓ· 2). H Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI) ¤‰ÂÈÍÂ ¿¯˘ÓÛË Î·È ¤ÓÙÔÓÔ ÂÌÏÔ˘ÙÈÛÌfi ÙÔ˘ Ì›Û¯Ô˘ ÙË˜ ˘fiÊ˘ÛË˜, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¿ÔÈÔ˘ ‰È·‚‹ÙË (ÂÈÎfiÓ· 3). H ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ÂÈ‚Â‚·›ˆÛÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ IÛÙÈÔÎ‡ÙÙˆÛË˜ ·fi Î‡ÙÙ·Ú· Langerhans. T¤ıËÎÂ ÛÂ ·ÁˆÁ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÛÙ·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (VP16,VBL,6MP, PDN, MTX) Û‡ÌÊˆÓ· ÌÂ ÂÈ‰ÈÎfi ÚˆÙfiÎÔÏÏÔ (1). H ¯ËÌÂÈÔıÂÚ·Â›· Û˘ÌÏËÚÒıËÎÂ ÌÂ ·ÎÙÈÓÔ‚ÔÏ›· ÙÔ˘ ÎÚ·Ó›Ô˘ ÛÂ 6 Û˘ÓÂ‰Ú›Â˜.

H ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›· ‹Ù·Ó ıÂ·Ì·ÙÈÎ‹, ·ÊÔ‡ ÔÈ Ï˘ÙÈÎ¤˜ ÂÛÙ›Â˜ ÛÙÔ ÎÚ·Ó›Ô ·ÔÎ·Ù·ÛÙ¿ıËÎ·Ó, ÂÎÙfi˜ ·fi ¤Ó· ÌÈÎÚfi ¤ÏÏÂÈÌÌ· ·ÚÈÛÙÂÚ¿ ÎÚÔÙ·-

ÊÈÎ¿. O £12 ÛﬁÓ‰˘ÏÔ˜ ·ÔÎ·Ù·ÛÙ¿ıËÎÂ ÛËÌ·ÓÙÈÎ¿

ÙfiÛÔ ˆ˜ ÚÔ˜ ÙÔ ‡„Ô˜ fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙË Û‡ÛÙ·ÛË (ÂÈÎfiÓ· 4). O ¿ÔÈÔ˜ ‰È·‚‹ÙË˜ ÂÏ¤Á¯ÂÙ·È ÈÎ·ÓÔÔÈËÙÈÎ¿ ÌÂ ÙË ¯Ú‹ÛË ÂÈÛÓÂfiÌÂÓÔ˘ ÛÎÂ˘¿ÛÌ·ÙÔ˜ ¢ÂÛÌÔÚÂÛ›ÓË˜ (Defirin) 0,05mg x2/ ËÌ¤Ú·. ™˘˙‹ÙËÛË H IÛÙÈÔÎ‡ÙÙˆÛË ·fi Î‡ÙÙ·Ú· Langerhans, Ô˘ Ì¤¯ÚÈ ÚfiÛÊ·Ù· ·Ó·ÊÂÚfiÙ·Ó ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·

ÈÛÙÈÔÎ‡ÙÙˆÛË-X, ÂÎÊÚ¿˙ÂÈ ÙÈ˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜ Ô˘ ÛÙ· ÚÔËÁÔ‡ÌÂÓ· ¯ÚfiÓÈ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó ÛÙÔ˘˜ fiÚÔ˘˜ "HˆÛÈÓfiÊÈÏÔ ÎÔÎÎ›ˆÌ·", ÓfiÛÔ˜ HandSchueller-Christian Î·È ÓfiÛÔ˜ Abt-Letterer-Siwe. K·È ÔÈ ÙÚÂÈ˜ ·Ûı¤ÓÂÈÂ˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È‹ıËÛË ÙˆÓ

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

ÚÔÛ‚Â‚ÏËÌ¤ÓˆÓ ÈÛÙÒÓ ÌÂ ÈÛÙÈÔÎ‡ÙÙ·Ú· (2). T· ÈÛÙÈÔÎ‡ÙÙ·Ú· Â›Ó·È ‰ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú· ÌÂ Ê·ÈÓﬁÙ˘Ô Î˘ÙÙ¿-

ÚˆÓ Langerhans, Ù· ÔÔ›· ·ÓÂ˘Ú›ÛÎÔÓÙ·È Ê˘ÛÈÔÏÔÁÈÎ¿

ÛÙÔ ‰¤ÚÌ·. H ÓﬁÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈ-

Î›·, Î˘Ú›ˆ˜ ﬁÌˆ˜ ÛÂ ·È‰È¿ ·ﬁ 1-3 ¯ÚÔÓÒÓ. ¶ÚÔÛ‚¿Ï-

ÏÂÈ ÔÔÈÔ‰‹ÔÙÂ ﬁÚÁ·ÓÔ ‹ ÈÛÙﬁ, ÛÙ· ÔÔ›· Ê˘ÛÈÔÏÔÁÈ-

Î¿ ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÌÔÓÔ‡ÚËÓ· Ê·ÁÔÎ‡ÙÙ·Ú·. MÔÚÂ›

Ó· ÚÔÛ‚ÏËıÂ› ÙÔ ‰¤ÚÌ· (Î‡ÙÙ·Ú· Langerhans), Ù· ÔÛÙ¿ (ÔÛÙÂÔÎÏ¿ÛÙÂ˜), ÙÔ ‹·Ú (Î‡ÙÙ·Ú· Kupffer) Ô

ÂÁÎ¤Ê·ÏÔ˜ (ÌÈÎÚÔÁÏÔÈ·Î¿ Î‡ÙÙ·Ú·),ÙÔ ·›Ì· (ÌÔÓÔÎ‡ÙÙ·Ú·), Ô ÛÏ‹Ó·˜, Ô ı‡ÌÔ˜, ÔÈ ÏÂÌÊ·‰¤ÓÂ˜, Ù· Ì·Ï·Î¿ ÌﬁÚÈ·, Ô Ì˘ÂÏﬁ˜ ÙˆÓ ÔÛÙÒÓ (ÈÛÙÈÎ¿ Ì·ÎÚÔÊ¿Á·) Î·È ÔÈ

ÓÂ‡ÌÔÓÂ˜ (Î˘„ÂÏÈ‰ÈÎ¿ Ì·ÎÚÔÊ¿Á·) (3).

ıÂ

H ÓfiÛÔ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚¿ÏÂÈ Û¯Â‰fiÓ Î¿-

ﬁÚÁ·ÓÔ, ÌÂ Â·ÎﬁÏÔ˘ıÔ Ó· ÂÎ‰ËÏÒÓÂÙ·È ÎÏÈÓÈÎ¿

ÌÂ ÔÈÎÈÏ›· Û˘ÌÙˆÌ¿ÙˆÓ. X·Ú·ÎÙËÚ›˙ÂÙ·È: ·) ˆ˜ ÌÔ-

ÓÔÂÛÙÈ·Î‹, ·Ó ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÌÔÓ‹ÚË ÔÛÙÈÎ‹ ·ÏÏÔ›ˆÛË, ‹ ÂÓÙÔÈÛÌ¤ÓË ‰ÂÚÌ·ÙÈÎ‹ ‰È‹ıËÛË ‹ ÌÂ ÚÔ-

Û‚ÔÏ‹ ÂÓﬁ˜ ÏÂÌÊ·‰¤Ó·, ‚) ˆ˜ ÔÏ˘ÂÛÙÈ·Î‹, ·Ó ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÔÏÏ·Ï¤˜ ÔÛÙÈÎ¤˜ Ï˘ÙÈÎ¤˜ ÂÛÙ›Â˜ ‹ ÚÔÛ‚ÔÏ‹ ÔÏÏ·ÏÒÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È Á) ˆ˜ ÔÏ˘Û˘-

ÛÙËÌ·ÙÈÎ‹, ·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˘ÛÈÔÏÔÁÈÎ‹ 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 ÓÂ‡ÌÔÓÂ˜, Ë ˘fiÊ˘ÛË (¿ÔÈÔ˜ ‰È·‚‹ÙË˜), ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È Ù· Ì¿ÙÈ· (4).

ŸÙ·Ó Ë ÓﬁÛÔ˜ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÚÔÛ‚ÔÏ‹ ÙÔ˘

‰¤ÚÌ·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ·ÔÎÏÂÈÛıÔ‡Ó ¿ÏÏÂ˜

·ı‹ÛÂÈ˜ ﬁˆ˜ Ë ‰ÂÚÌ·Ù›ÙÈ‰· ·ﬁ Ù· Û¿ÚÁ·Ó· Î·È

Ë ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·. H ˘ﬁÓÔÈ· ÙË˜ ‡·ÚÍË˜

¿ÔÈÔ˘ ‰È·‚‹ÙË, ··ÈÙÂ› ¿ÓÙÔÙÂ ÙË ‰ÈÂÚÂ‡ÓËÛË ÌÂ

Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI), ÁÈ· Ó·

·ÔÎÏÂÈÛıÔ‡Ó ﬁÁÎÔÈ ÙÔ˘ KN™ ÌÂ ‰È‹ıËÛË ÙË˜ ˘ﬁÊ˘ÛË˜. H ÚÔÛ‚ÔÏ‹ ÙˆÓ ÔÛÙÒÓ ÂÎ‰ËÏÒÓÂÙ·È ÎÏÈÓÈÎ¿

·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛËÌÂ›Ô ÙË˜ ÚÔÛ‚ÔÏ‹˜. ŸÙ·Ó ÚÔÛ‚¿ÏÏÂÙ·È Ë ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË, Ë ÓﬁÛÔ˜ ÌÔÚÂ› Ó·

ÂÎ‰ËÏˆıÂ› ÌÂ ﬁÓÔ Î·È ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹ ·ﬁ

›ÂÛË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. H ·ÎÙÈÓÔÏÔÁÈÎ‹ ‰ÈÂÚÂ‡-

ÓËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ó· ·ÔÎÏÂÈÛıÔ‡Ó ﬁÁÎÔÈ

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.

Î·È ¿ÏÏÂ˜ ·ı‹ÛÂÈ˜ ÙË˜ ÂÚÈÔ¯‹˜ Ô˘ ÂÎ‰ËÏÒÓÔÓÙ·È ÌÂ ·ÚfiÌÔÈ· Û˘ÌÙˆÌ·ÙÔÏÔÁ›·. H Â›ÌÔÓË ‰ÂÚÌ·Ù›ÙÈ‰· ÛÙË ‰ÈÎ‹ Ì·˜ ·ÛıÂÓ‹ Ô˘ ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó ·ÓÂÈÙ˘¯Ò˜ ÌÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi ·fi ÙÔ ÔÔ›Ô ÂÓÙÔ›ÛÙËÎÂ Ë ÔÏ˘Ô˘Ú›· Î·È Ë ÔÏ˘‰È„›· Î·ıÒ˜ Â›ÛË˜ Î·È Ë ‰ÈfiÁÎˆÛË ÙˆÓ ˘Ô¯ÔÓ‰Ú›ˆÓ ÛÏ¿¯ÓˆÓ Ì·˜ Ô‰‹ÁËÛ·Ó ÛÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË. H ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÔÈÎ›ÏÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙË ÌÔÚÊ‹ ÙË˜ ÓfiÛÔ˘. AÛıÂÓÂ›˜ ÌÂ ÌÔÓÔÂÛÙÈ·Î‹ ÓfiÛÔ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·˘ÙfiÌ·ÙË ‡ÊÂÛË Î·È ÁÂÓÈÎ¿ Î·ÏÔ‹ıË ÔÚÂ›·. OÛÙÈÎ¤˜ Ï˘ÙÈÎ¤˜ ÂÛÙ›Â˜ Î˘Ú›ˆ˜ ÛÙË ™.™, ÌÂ Î›Ó‰˘ÓÔ ·˘ÙfiÌ·ÙÔ˘ Î·Ù¿ÁÌ·ÙÔ˜, ‹ ÌÂ ¤ÓÙÔÓÔ fiÓÔ Û˘Ó‹ıˆ˜ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ ¤Á¯˘ÛË ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË˜ ÙÔÈÎ¿, ‹ ¯·ÌËÏ‹˜ ‰fiÛË˜ ·ÎÙÈÓÔ‚ÔÏ›· (5). AÛıÂÓÂ›˜ ÌÂ ÚÔÛ‚ÔÏ‹ ÌÔÓ‹ÚÔ˘˜ ÏÂÌÊ·‰¤Ó· ‹ ÌÂ ÂÓÙÔÈÛÌ¤ÓË ÙÔÈÎ‹ ‰È‹ıËÛË ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÂÈÙ˘¯Ò˜ ÌÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ÙË˜ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜. ¶·È‰È¿ ÌÂ ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ ÓfiÛÔ ıÂÚ·Â‡ÔÓÙ·È Û‹ÌÂÚ· ÌÂ ÙË ¯Ú‹ÛË ÂÓÙ·ÙÈÎÒÓ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ. H ¯Ú‹ÛË ÙË˜ ÂÙÔÔÛ›‰Ë˜, ÙË˜ ÌÂıÔÙÚÂÍ¿ÙË˜, ÙË˜ ‚ÈÓÌÏ·ÛÙ›ÓË˜, ÙË˜ ÌÂÚÎ·ÙÔÔ˘Ú›ÓË˜ Î·È ÙË˜ ÚÂ‰ÓÈ˙fiÓË˜ ÛÂ Û˘Ó‰˘·ÛÌfi, ·‡ÍËÛÂ ÙËÓ ÂÈ‚›ˆÛË ÛÙÔ 79% ÙˆÓ ·È‰ÈÒÓ ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· Û˘ÓÙËÚËÙÈÎ¿ ÚˆÙfiÎÔÏÏ·, Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÔ›ˆÓ ÂÈÙ‡Á¯·ÓÂ

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

05-11-99

26-11-99

TÔ ÂÓ‰ÔÔÈÎÈ·Îﬁ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡

KÒÛÙ·˜ ¶Ú›ÊÙË˜

H ÊÚÔÓÙ›‰· ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡

¤¯ÂÈ ÍÂ¯ˆÚÈÛÙ‹ ÛËÌ·Û›·. M¤Û· ÛÙÔ Û›ÙÈ ÂÚÓ¿ ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÒÚÂ˜ ÙÔ˘ 24ÒÚÔ˘ Î·È Â›Ó·È ÁÓˆÛÙfi fiÙÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔÈ ·Ú¿ÁÔÓÙÂ˜ ÙÔ˘ ÂÓ‰ÔÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ˆ˜ ˘Â‡ı˘ÓÔÈ ÁÈ· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ·È‰ÈÎÒÓ ·ÏÏÂÚÁÈÒÓ.

O ·Ú¿ÁÔÓÙ·˜ ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· Â›Ó·È Ô Î·Ófi˜ ÙÔ˘ ÙÛÈÁ¿ÚÔ˘. E›Ó·È ÁÓˆÛÙfi fiÙÈ ÁÈ· Ó· ÚÔÛÙ·ÙÂ‡ÛÔ˘ÌÂ Ù· ·È‰È¿ ·fi ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÛÂ Î¿ÔÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ Î·È Ó· ÂÏ·ÙÙÒÛÔ˘ÌÂ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ·ÛıÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ, Ú¤ÂÈ ÔÈ ÂÓ‹ÏÈÎÔÈ Ó· ·‡ÛÔ˘ÌÂ Ó· Î·Ó›˙Ô˘ÌÂ.

¶Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È Ë Î·‡ÛË Ì¤Û· ÛÙÔ ‰ˆÌ¿ÙÈÔ ÂÙÚÂÏ·›Ô˘, Î¿Ú‚Ô˘ÓÔ˘, Í‡ÏÔ˘ Î·È ·Ú·Ê›ÓË˜, ÁÈ·Ù› ÌÔÚÂ› Ó· ·˘Í‹ÛÂÈ ÙË Û˘ÁÎ¤ÓÙÚˆÛË ÂÚÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ.

N· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ ˘ÁÚ·ÓÙ‹ÚÂ˜ ÁÈ·Ù› ‰ËÌÈÔ˘ÚÁÔ‡Ó

ÙÚÔÊ‹ ÙÔ˘˜ ¤¯Ô˘Ó ÙÔ ˘ÏÈÎﬁ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·ﬁ ÙËÓ

ÙË˜ ÂÈ‰ÂÚÌ›‰·˜ ÙˆÓ ·ÓıÚÒˆÓ. BÚ›ÛÎÔÓÙ·È ÛÂ ÌÂÁ¿ÏÂ˜ ÔÛfiÙËÙÂ˜ ÂÎÂ› Ô˘ Û˘ÁÎÂÓÙÚÒÓÂÙ·È ÛÎfiÓË. T· ¤ÈÏ· Ó· Â›Ó·È ÌÂ ·Ï¤˜ ÁÚ·ÌÌ¤˜, ¯ˆÚ›˜ ÔÏÏ¿ ·ÓÙÈÎÂ›ÌÂÓ· Ô˘ Û˘ÁÎÚ·ÙÔ‡Ó ÛÎfiÓË.

¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó·, ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÚÈÛÛﬁÙÂÚÔ ˘ÁÈÂÈÓÒÓ Û˘ÓıËÎÒÓ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡, ÚÔÙÂ›ÓÔ˘ÌÂ ÙÈ˜ ·Ú·Î¿Ùˆ Ô‰ËÁ›Â˜:

1. ¢È·Îﬁ„ÙÂ ÙÔ Î¿ÓÈÛÌ· Î·È ÌËÓ ÂÈÙÚ¤ÂÙÂ ÛÂ ¿ÏÏÔ˘˜ Ó· Î·Ó›˙Ô˘Ó ﬁÙ·Ó ÂÈÛÎ¤ÙÔÓÙ·È ÙÔ Û›ÙÈ Û·˜.

2. EÍ·ÛÊ·Ï›ÛÙÂ Â·ÚÎ‹ ·ÂÚÈÛÌﬁ ÙÔ˘ ÛÈÙÈÔ‡.

3. AÂÚ›˙ÂÙÂ Î·È ÏÈ¿˙ÂÙÂ Ù· ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù· Î·ıËÌÂÚÈÓ¿, Ï¤ÓÂÙ¤ Ù· ÌÂ Î·˘Ùﬁ ÓÂÚﬁ (>55ÔC) Î¿ıÂ 7-10 ËÌ¤ÚÂ˜.

4. MËÓ ¤¯ÂÙÂ ÔÏÏ¿ ·ÓÙÈÎÂ›ÌÂÓ· ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡. •ÂÛÎÔÓ›˙ÂÙÂ ÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘ Î·ıËÌÂÚÈÓ¿ (Óˆfi ÍÂÛÎÔÓfi·ÓÔ). XÚËÛÈÌÔÔÈÂ›ÙÂ ËÏÂÎÙÚÈÎ‹ ÛÎÔ‡· Î¿ıÂ ‚‰ÔÌ¿‰· (Ó· ÏÂ›ÂÈ ·fi ÙÔ Û›ÙÈ ÙÔ ·È‰›).

5. °È· ÙÔ ‰¿Â‰Ô Â›Ó·È ÚÔÙÈÌﬁÙÂÚÔ ÙÔ Í‡ÏÔ Î·È ÙÔ Ï·Î¿ÎÈ. MËÓ ÙÔ Î·Ï‡ÙÂÙÂ ÌÂ ÌÔÎ¤Ù· ·ﬁ ÙÔ›¯Ô ÛÂ ÙÔ›¯Ô.

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

7. MË ¯ÚËÛÈÌÔÔÈÂ›ÙÂ ˘ÁÚ·ÓÙ‹Ú·. EÏ¤ÁÍÙÂ ÙÈ˜ ÛˆÏËÓÒÛÂÈ˜ (Ì¿ÓÈÔ˘-ÎÔ˘˙›Ó·˜) ÁÈ· Ù˘¯ﬁÓ ‰È·ÚÚÔ¤˜. MËÓ ¤¯ÂÙÂ Ê˘Ù¿

™Î¤ÊÙËÎ· ﬁÙÈ ÔÈ Û˘Ó¿‰ÂÏÊÔ› Ì·˜ ı· ‹ıÂÏ·Ó Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙËÓ ÚˆÙÔÔÚÈ·Î‹

˘ÁÂ›·˜ Ô˘ ÔÚÁ·ÓÒÓÂÈ ÙÔ EıÓÈÎﬁ ™‡ÛÙËÌ· YÁÂ›·˜ (NHS) ÛÙË BÚÂÙ·Ó›·.

MÈ· Ê›ÏË ÌÔ˘, Ô˘ Â›Ó·È ÔÈÎÔÁÂÓÂÈ·Î‹ ÁÈ·ÙÚﬁ˜ ÛÙËÓ AÁÁÏ›·, ÌÔ˘ ¤ÛÙÂÈÏÂ ÙÈ˜ Â˘¯¤˜ ÙË˜ ÁÈ· ÙË ÁÈÔÚÙ‹ ÌÔ˘ ÛÂ Î·ÚÙÔÛÙ¿Ï ÙÔ˘ NHS Ô˘ ÂÈÛ˘Ó¿ÙÂÙ·È.

H Î¿ÚÙ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔÓ "Î. AÓÙÈ‚ÈÔÙÈÎfi" Ó· ·ÚÓÂ›Ù·È Ó· Â¤Ì‚ÂÈ ÛÂ Ì‡ÙË Ô˘ ÛÙ¿˙ÂÈ. TÔ Ì‹Ó˘Ì· ÁÚ¿ÊÂÈ "T· ·ÓÙÈ‚ÈÔÙÈÎ¿ ¢EN ¢OY§EYOYN ÛÙ· ÎÚ˘ÔÏÔÁ‹Ì·Ù·... Ô‡ÙÂ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ‚‹¯· Î·È ÔÓfiÏ·ÈÌÔ˘. NHS". ™ÙÔ ›Ûˆ Ì¤ÚÔ˜, ÂÎÂ› Ô˘ Ô ·ÔÛÙÔÏ¤·˜ ÁÚ¿ÊÂÈ ÙÔ Ì‹Ó˘Ì¿ ÙÔ˘, ÁÚ¿ÊÂÈ ÌÂ ÈÔ ÌÈÎÚ¿ ÁÚ¿ÌÌ·Ù· "T· ÎÚ˘ÔÏÔÁ‹Ì·Ù· Î·È ÔÏÏ¤˜ ÊÔÚ¤˜ Ô ‚‹¯·˜ Î·È Ô ÔÓfiÏ·ÈÌÔ˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÈÔ‡˜, Î·È Ù· ·ÓÙÈ‚ÈÔÙÈÎ¿ ‰ÂÓ ‚ÔËıÔ‡Ó Î·ıfiÏÔ˘. T· ·ÓÙÈ‚ÈÔÙÈÎ¿ Û¯Â‰È¿ÛÙËÎ·Ó ÁÈ· ÙË ıÂÚ·Â›· ÙˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ fiˆ˜ Â›Ó·È Ë ÓÂ˘ÌÔÓ›·. ŸÔÙÂ ¯ÚÂÈ·ÛÙÔ‡Ó, ÌËÓ ·ÓËÛ˘¯Â›˜, Ô ÁÈ·ÙÚfi˜ ÛÔ˘ ı· ÛÔ˘ ÁÚ¿„ÂÈ ÌÈ· Û˘ÓÙ·Á‹

™›Ó· N¿ÎÔ˘

πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

ª. ∞Û›·˜ 76, 115 27 ∞ı‹Ó· ∞ÁˆÁ‹ ˘ÁÂ›·˜

...MÈ· ·ﬁ ÙÈ˜ ÛÎ¤„ÂÈ˜ Ô˘ ¤¯ˆ Î¿ÓÂÈ Â›Ó·È ﬁÙÈ ›Ûˆ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏËÊıÂ› ÛÙÈ˜ Ô‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜

Û˘ÁÁÚ·ÊÂ›˜ 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È‚Â‚ÏËÌ¤ÓË Ë Û˘ÌÌÂÙÔ¯‹ ÂÚÈÛÛfiÙÂÚˆÓ, 8 Â›Ó·È ÓÔÌ›˙ˆ ¤Ó·˜ ÏÔÁÈÎfi˜ ·ÚÈıÌfi˜. ÿÛˆ˜ ı·

¤ÚÂÂ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Î¿ÔÈÔ Û¯ﬁÏÈÔ ÁÈ·Ù› Î·È ÔÈﬁ˜ ı· ¤ÚÂÂ Ó· ÔÓÔÌ¿˙ÂÙ·È Û˘ÁÁÚ·Ê¤·˜.

Y¿Ú¯ÂÈ ·ÁÎÔÛÌ›ˆ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÁÈ· ÙÔ ÔÈÔ˜ Ú¤ÂÈ Ó· ¯·Ú·ÎÙËÚ›˙ÂÙ·È “Û˘ÁÁÚ·Ê¤·˜” ÛÂ ÌÈ· ÌÂÏ¤ÙË. E›Ó·È Ô fiÚÔ˜ Û˘Ó-Û˘ÁÁÚ·Ê¤·˜ ‹ Û˘Ó-ÂÚÂ˘ÓËÙ‹˜ ÈÔ ‰fiÎÈÌÔ˜; ∆È ÛËÌ·›ÓÂÈ Û˘ÌÌÂÙÔ¯‹ ÛÂ ÌÈ· ÌÂÏ¤ÙË; ™‡ÌÊˆÓ· ÌÂ ÙË ‰ÈÂıÓ‹ EÈÙÚÔ‹ EÎ‰ÔÙÒÓ I·ÙÚÈÎÒÓ ¶ÂÚÈÔ‰ÈÎÒÓ(1), ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ Û˘ÁÁÚ·Ê¤· ‰ÈÎ·ÈÔ‡ÓÙ·È fiÛÔÈ ÏËÚÔ‡Ó ÙÈ˜ ·ÎfiÏÔ˘ıÂ˜ ÚÔ¸Ôı¤ÛÂÈ˜: ·) Û‡ÏÏË„Ë Î·È Û¯Â‰È·ÛÌfi˜ ÌÂÏ¤ÙË˜ ‹ ·Ó¿Ï˘ÛË Î·È ÂÎÙ›ÌËÛË ‰Â‰ÔÌ¤ÓˆÓ ‚) Û¯Â‰È·ÛÌfi˜ Î·È ÎÚÈÙÈÎ‹ ·Ó·ÛÎfiËÛË ÙÔ˘ ¿ÚıÚÔ˘ ÁÈ· ÙËÓ Ô˘Û›· ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ Á) ÙÂÏÈÎ‹ ÂÈ‰ÔÎÈÌ·Û›· ÙÔ˘ ¿ÚıÚÔ˘ ÁÈ· ‰ËÌÔÛ›Â˘ÛË. §fiÁÔÈ fiˆ˜ Ë “·Ó¿ÁÎË” ÁÈ· “‚Ô‹ıÂÈ·” ÂÓfi˜ Ó¤Ô˘ Û˘Ó·‰¤ÏÊÔ˘, ‹

Î·È

ÈÛÙÔÚÈÎÒÓ ÙÔ˘˜ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈÎ‹ Û˘ÌÌÂÙÔ¯‹ ÛÙÔÓ Û¯Â‰È·ÛÌﬁ

ÌÂÏ¤ÙË˜ ‰ÂÓ ‰ÈÎ·ÈÔÏÔÁÔ‡Ó Î·Ù¿ ÁÂÓÈÎ‹ ÔÌÔÏÔÁ›· ÙÔÓ ¯·Ú·ÎÙËÚÈÛÌﬁ ÙÔ˘

O Gulio J d’ Angio(2) ÂÎ‰fiÙË˜ ÙÔ˘ Medical and Pediatric Oncology ÙÔ ¤ıÂÛÂ ÔÏ‡ ˆÚ·›· fiÙÈ ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô‰ËÁÔ‡Ó ÛÂ Û‡ÌÊˆÓÔ Û˘ÁÁÚ·Ê¤ˆÓ ÌÂ ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Ó-Û˘ÁÁÚ·ÊÂ›˜ Ó· ˘ÂÚ‚·›ÓÔ˘Ó Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Û˘ÌÌÂÙÂ¯fiÓÙˆÓ ÛÙË ÌÂÏ¤ÙË ·ÛıÂÓÒÓ. O ›‰ÈÔ˜ ÂÎ‰fiÙË˜ Î·ÏÂ› ÙÔ˘˜ ¢ÈÂ˘ı˘ÓÙ¤˜ TÌËÌ¿ÙˆÓ Ó·

ÙËÓ Ú·ÎÙÈÎ‹ ÙË˜ ·Ó·ÊÔÚ¿˜ ÙÔ˘˜ Û·Ó Û˘Ó-Û˘ÁÁÚ·ÊÂ›˜ ﬁÙ·Ó ·˘Ùﬁ Â›Ó·È

ı¤ÛË˜ Î·È fi¯È ÙË˜ Ô˘ÛÈ·ÛÙÈÎ‹˜ Û˘ÌÂÙÔ¯‹˜ ÙÔ˘˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi, ‰ÈÂÎÂÚ·›ˆÛË Î·È Û˘ÁÁÚ·Ê‹ ÙË˜ ÌÂÏ¤ÙË˜. K·Ù·Ï‹ÁÂÈ ‰Â fiÙÈ Ô Û˘Ó-Û˘ÁÁÚ·Ê¤·˜ Ú¤ÂÈ Ó· Â›Ó·È Î·È Û˘Ó-ÂÚÂ˘ÓËÙ‹˜. E›Ó·È Î·Ï‡ÙÂÚ· Ó· ·ÔÊÂ˘¯ıÂ› Ë

ÙË˜ Î˘ÓÈÎ‹˜ ÓÔÔÙÚÔ›·˜ ÛÙÔ˘˜ Ó¤Ô˘˜ Û˘-

Ó·‰¤ÏÊÔ˘˜ ÁÈ· “free rides” Ô˘ ÛÂ ÂÏÂ‡ıÂÚË ÌÂÙ¿ÊÚ·ÛË ÛËÌ·›ÓÂÈ Û˘ÁÁÚ·Ê¤·˜ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈÎ‹ Û˘Ì‚ÔÏ‹.

MÂ ÂÎÙ›ÌËÛË

™Ù¤ÏÏ· AÓ‰ÚÔÓ›ÎÔ˘

AÓ. K·ıËÁ‹ÙÚÈ·

TÔÌ¤·˜ YÁÂ›·˜ 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.

¶AI¢IATPIKH - AÔÏÔÁÈÛÌﬁ˜ 1999

¶AI¢IATPIKH, 1998; ÙfiÌÔ˜ 61, ™˘ÌÏËÚˆÌ·ÙÈÎfi ÙÂ‡¯Ô˜ 1. K˘ÎÏÔÊfiÚËÛÂ ÙÔÓ M¿ÚÙÈÔ 1999 ÌÂ 15 Ù›ÙÏÔ˘˜, 125 ÛÂÏ›‰Â˜ Î·È ıÂÌ·ÙÔÏÔÁ›· ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·. ™˘ÓÙ·ÎÙÈÎ‹ ÂÈÌ¤ÏÂÈ· X. KÒÛÙ·ÏÔ˜, K. ¶Ú›ÊÙË˜, A. X·Ù˙‹˜.

¶AI¢IATPIKH, 1999; ÙfiÌÔ˜ 62, TÂ‡¯Ë 6. - K˘ÎÏÔÊÔÚ›·: EÌÚfiıÂÛÌË. ™˘Ó‹ıˆ˜, ÙÂ‡¯Ë ·Ú·‰›‰ÔÓÙ·È ÛÙ· ÁÚ·ÊÂ›· ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜ ÙÔ ÚÒÙÔ ‰ÂÎ·‹ÌÂÚÔ ÙÔ˘ ‰ÈÌ‹ÓÔ˘ ÛÙÔ ÔÔ›Ô ·ÓÙÈÛÙÔÈ¯Â› ÙÔ ÙÂ‡¯Ô˜ Î·È ·Ú·Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙÔ˘˜ Û˘Ó‰ÚÔÌËÙ¤˜ Ù·¯˘‰ÚÔÌÈÎ¿ ÙÔ ÙÚ›ÙÔ ‰ÂÎ·‹ÌÂÚÔ. - ™ÂÏ›‰Â˜: 510 - T›ÙÏÔÈ: 119 (54 ÚˆÙÔÁÂÓÂ›˜ ÂÚÁ·Û›Â˜) ¶›Ó·Î·˜ 1

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

AÚÈıÌﬁ˜ Ù›ÙÏˆÓ

E›‰Ô˜ ¿ÚıÚÔ˘ ™‡ÓÔÏÔ ÙﬁÌÔ˘TÂ‡¯Ë

1Ô2Ô3Ô4Ô5Ô6Ô

ÕÚıÚ· ™‡ÓÙ·ÍË˜19242443

AÓ·ÛÎÔ‹ÛÂÈ˜/ÕÚıÚ·

ÂÈ‰ÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜/

™˘ÓÂ¯È˙ﬁÌÂÓË ÂÎ·›‰Â˘ÛË/

E›Î·ÈÚ· ı¤Ì·Ù·21424425

EÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜/

KÏÈÓÈÎ‹ ÂÌÂÈÚ›·30544467

EÓ‰È·Ê¤ÚÔ˘ÛÂ˜

ÂÚÈÙÒÛÂÈ˜1855332-

AÂÈÎÔÓÈÛÙÈÎ¤˜

ÂÚÈÙÒÛÂÈ˜6111111

¶Ú·ÎÙÈÎ¤˜ Ô‰ËÁ›Â˜

·È‰È¿ÙÚÔ˘ ÛÙÔ˘˜ ÁÔÓÂ›˜7121111

EÈÛÙÔÏ¤˜82-2121

¶·È‰È·ÙÚÈÎ‹ ÂÓËÌ¤ÚˆÛË ÕÏÏ·10113311

™‡ÓÔÏÔ119211920211919

ŒÁÈÓÂ ÚÔÛ¿ıÂÈ· Ó· ‰ËÌÔÛÈÂ‡ÔÓÙ·È ¿ÚıÚ· ÌÂ ÙÔ ›‰ÈÔ ı¤Ì· ÛÙÔ ›‰ÈÔ ÙÂ‡¯Ô˜. Afi 105 ÎÂ›ÌÂÓ· Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÙÔ 1999, Ù· 36 ‹Ù·Ó Î·ÙfiÈÓ ÚÔÛÎÏ‹ÛÂˆ˜ Â›ÙÂ ÁÈ· Ó· Û¯ÔÏÈ·ÛÙÂ› Î¿ÔÈ· ÂÚÁ·Û›· (K¿ÓÈÛÌ·, ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ 6Ô ÙÂ‡¯Ô˜, AÈÌÔÚ·ÁÈÎ‹ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ 1Ô, AÏÏÂÚÁ›· ·fi Ê˘ÛÈÎfi Ï¿ÛÙÈ¯Ô ÛÙÔ 2Ô Î.¿.) Â›ÙÂ ÁÈ· Ó· Î·Ï˘ÊıÂ› ¤Ó· Â›Î·ÈÚÔ ı¤Ì· (¶·È‰È¿ ÙÔ˘ ÔÏ¤ÌÔ˘, ·È‰È¿ ·ÏÏÔ‰·ÒÓ ÚÔÛÊ‡ÁˆÓ ÛÙËÓ EÏÏ¿‰·, ‰ÈÔÍ›ÓÂ˜ ÛÙÔ 4Ô ÙÂ‡¯Ô˜. N· ÌË Ì¿ıÔ˘ÌÂ Ó· ˙Ô‡ÌÂ

ÌÂ ÙÔ˘˜ ÛÂÈÛÌÔ‡˜ ÛÙÔ 5Ô Î.¿.). ¶∞π¢π∞∆ƒπ∫∏

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

- M¤ÛÔ˜ ¯ÚﬁÓÔ˜ ·¿ÓÙËÛË˜ ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙÈ˜ ÚÔÙÂÈÓﬁÌÂÓÂ˜ ‰ÈÔÚıÒÛÂÈ˜: 38 ËÌ¤ÚÂ˜.

- BÈ‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜: 1807, ·ﬁ ·˘Ù¤˜ 35 ÛÙËÓ ¶AI¢IATPIKH Î·È 162 ÛÂ ¿ÏÏ· ÂÏÏËÓÈÎ¿ ÂÚÈÔ‰ÈÎ¿. ™ÙÈ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Î·È ÁÈ· ÙÔ˘˜ ÎÚÈÙ¤˜ Ë ¶AI¢IATPIKH ‰ËÏÒÓÂÈ ﬁÙÈ ‰˘ÛÎÔÏÂ‡ÂÙ·È Ó· ‰Â¯ıÂ›

ÂÚÁ·Û›Â˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÏÏËÓÈÎ¤˜ ·Ú·ÔÌ¤˜. H ÊÚ¿ÛË “ÂÎ ÙË˜ ÚÔÛÈÙ‹˜ ÚÔ˜ ËÌ¿˜ ‚È‚ÏÈÔÁÚ·Ê›·˜” Î·Ù·ÚÁ‹ıËÎÂ ÁÈ· ÙËÓ Í¤ÓË ‚È‚ÏÈÔÁÚ·Ê›· ·fi ÙfiÙÂ Ô˘ ˘¿Ú¯ÂÈ Â‡ÎÔÏË ÚfiÛ‚·ÛË ÛÙÔ Medline. TÒÚ· Â›Ó·È ÚÔÛÈÙ‹ Î·Ù¿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ Î·È Ë ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì¤Ûˆ IATPOTEK (www.mednet.gr/iatrotek) Î·È ÔÈ ÂÏ-

‰ËÌÔÛÈÂ‡ÛÂÈ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡ Ì¤Ûˆ “IPI™” (www.ich.gr). BÏ¤Â ÛÂÏ. 86 Î·È ÛÂÏ. 71. H ¤ÏÏÂÈ„Ë ÂÏÏËÓÈÎÒÓ ·Ó·ÊÔÚÒÓ ‰ÂÓ ÌÔÚÂ› È· Ó·

5 Ì‹ÓÂ˜. - XÚfiÓÔ˜ ·fi ÙËÓ ˘Ô‚ÔÏ‹ ÙË˜ ÂÚÁ·Û›·˜ Ì¤¯ÚÈ ÙË ‰ËÌÔÛ›Â˘ÛË: M¤ÛÔ˜ ¯ÚfiÓÔ˜ 8,26 Ì‹ÓÂ˜, 25% ÙˆÓ ¿ÚıÚˆÓ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÛÂ ÏÈÁfiÙÂÚÔ ·fi 6 Ì‹ÓÂ˜, 50% ÛÂ 6 Ì¤¯ÚÈ 10 Ì‹ÓÂ˜ Î·È 25% ÛÂ ÂÚÈÛÛfiÙÂÚÔ ·fi 10 Ì‹ÓÂ˜. - KÚÈÙ¤˜: ™ÙÔ ‰È¿ÛÙËÌ· 1-1-1999 Ì¤¯ÚÈ 15-12-1999 Ë ¶AI¢IATPIKH ˙‹ÙËÛÂ 147 ÎÚ›ÛÂÈ˜ ·fi 81 ÎÚÈÙ¤˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ 11 ÌÂÏÒÓ ÙË˜ EÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈÙÚÔ‹˜ (35 ÎÚÈÙ¤˜ ÚfiÛÊÂÚ·Ó 2-6 ÎÚ›ÛÂÈ˜). BÏ¤Â ÔÓÔÌ·ÛÙÈÎfi Î·Ù¿ÏÔÁÔ ÛÂÏ. 68 Î·È Û¯ÂÙÈÎfi ¿ÚıÚÔ Û‡ÓÙ·ÍË˜ ÛÂÏ. 2-6.

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

AÓ·Ï˘ÙÈÎ¿ ÂÈÛÙÚ¿ÊËÎ·Ó:

38% ÛÂ ÏÈÁfiÙÂÚÔ ·fi 30 ËÌ¤ÚÂ˜, 26% ÛÂ 30-60, 21% ÛÂ 61-90, 15% ÛÂ ÂÚÈÛÛfiÙÂÚÔ ·fi 90 ËÌ¤ÚÂ˜.

K·Ù¿ ÂÚ›ÙˆÛË ÌÂÏ¤ÙË ÙˆÓ ÎÚ›ÛÂˆÓ Ô˘ Î·ı˘ÛÙ¤ÚËÛ·Ó ¤Ú·Ó ÙˆÓ ÙÚÈÒÓ ÌËÓÒÓ, ·ÔÎ·Ï‡ÙÂÈ ÛÂ Û˘ÓÙÚÈÙÈÎfi ÔÛÔÛÙfi ‰˘ÛÎÔÏ›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÎÚÈÙÒÓ Ó· ‰È·Ù˘ÒÛÔ˘Ó ·ÔÚÚÈÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ ‹ ÚÔÛ¿ıÂÈ· Ó· ÛÎÂÊÙÔ‡Ó ÙÚfiÔ˘˜ ÚÈ˙ÈÎ‹˜ ·Ó·ÌfiÚÊˆÛË˜ ÙË˜ ˘fi ÎÚ›ÛË ÂÚÁ·Û›·˜ ÒÛÙÂ Ó· Á›ÓÂÈ ‰ËÌÔÛÈÂ‡ÛÈÌË. OÈ ÎÚÈÙ¤˜ Ô˘ Î·ı˘ÛÙÂÚÔ‡Ó ÙÈ˜ ÎÚ›ÛÂÈ˜ ÂÎ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·‰ÈÎ·ÈÔÏfiÁËÙ· Â›Ó·È ÂÏ¿¯ÈÛÙÔÈ.

- KÚ›ÛÂÈ˜: OÈ ÂÈÌ¤ÚÔ˘˜ ÎÚ›ÛÂÈ˜ ¤ÁÈÓ·Ó ·Ô‰ÂÎÙ¤˜ ÛÂ ÔÛÔÛÙfi 80%. H ÔÚıfiÙËÙ· ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ ÙˆÓ ÎÚÈÙÒÓ Î·È ÙÔ ÂÊÈÎÙfi ÙˆÓ ˙ËÙÔ‡ÌÂÓˆÓ ÙÚÔÔÔÈ‹ÛÂˆÓ ·ÌÊÈÛ‚ËÙ‹ıËÎÂ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ÛÂ ÔÛÔÛÙfi ÂÚ›Ô˘ 20% Î·È 25%, ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÊÔÚ¤˜ ÙÂÎÌËÚÈˆÌ¤Ó·. H ÂÁÎ˘ÚfiÙËÙ· ÙˆÓ ÎÚÈÙÒÓ ·ÌÊÈÛ‚ËÙ‹ıËÎÂ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ÛÂ ‰‡Ô ÂÚÈÙÒÛÂÈ˜.

- EÚÁ·Û›Â˜ Ô˘ ·ÔÚÚ›ÊıËÎ·Ó/·ÔÛ‡ÚıËÎ·Ó: 8 H ·fiÚÚÈ„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÂÎÙfi˜ ÂÏ¿¯ÈÛÙˆÓ ÂÍ·ÈÚ¤ÛÂˆÓ, ‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÂ ¯·ÌËÏ‹ ÔÈfiÙËÙ· ÙË˜ ÂÚÁ·Û›·˜ ·ÏÏ¿ ÛÂ ·Ù˘¯Â›˜ Û˘ÁÎ˘Ú›Â˜ .¯. ·Ó·ÛÎfiËÛË ˘„ËÏfiÙ·ÙÔ˘ ÂÈ¤‰Ô˘ ‰ÂÓ

™Â ÙÚ›· ÙÂ‡¯Ë

ÂÎ‰ÔÙÈÎ¿ Ï¿ıË (Ï¿ıÔ˜ ÎÂÊ·Ï›‰· ÛÂ ÂÚÁ·Û›·, ÌË ‰ËÌÔÛ›Â˘ÛË ÈÓ¿ÎˆÓ Î·È ÂÈÎﬁÓ·˜, ÌË ‰ËÌÔÛ›Â˘ÛË ıÂÌ·ÙÈÎÔ‡ Î·Ù·ÏﬁÁÔ˘ ÙÔ˘ Û˘ÌÏËÚˆÌ·ÙÈÎÔ‡ ÙÂ‡¯Ô˘˜ ÙÔ˘ 1998).

T· Ï¿ıË ÛÂ ¿ÏÏ· ÙÂ‡¯Ë ‹Ù·Ó ÌÈÎÚﬁÙÂÚË˜ ÛËÌ·Û›·˜.

- ™˘ÓÂÚÁ·Û›· ÌÂ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.: AÚÌÔÓÈÎ‹

°Ú·ÌÌ·ÙÂÈ·Î‹ ˘ÔÛÙ‹ÚÈÍË: Õ„ÔÁË. H Î˘Ú›· PÔ‡Ï·

Ù‹ÚËÛÂ ÌÂ Û˘Ó¤ÂÈ·, Û¯ÔÏ·ÛÙÈÎfiÙËÙ·, ˘ÔÌÔÓ‹ Î·È ÂÈÌÔÓ‹, ÙÔ ·Ú¯Â›Ô ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÙÔ˘˜ Ê·Î¤ÏÔ˘˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÙËÓ ·ÏÏËÏÔÁÚ·Ê›·, “ÛÙ¿ÛË ÙÛÈÌÔ˘ÚÈÔ‡” ÌÂ ÙÔ˘˜ ÎÚÈÙ¤˜ Ô˘ Î·ı˘ÛÙÂÚÔ‡Ó, “ÛÙ¿ÛË K¤Ú‚ÂÚÔ˘” ÌÂ ÙÔ˘˜ Û˘ÓÙ¿ÎÙÂ˜ Ô˘ ·Ó·Î·ÙÂ‡Ô˘Ó ÙÔ˘˜ Ê·Î¤ÏÏÔ˘˜ Î·È ÛÙ¿ÛË “¢OMH™” ÌÂ fiÛÔ˘˜ ı¤ÙÔ˘Ó ÔÔÈÔ‰‹ÔÙÂ ÂÚÒÙËÌ· (fiÙÂ ı· Á˘Ú›ÛÂÈ Ô X ÎÚÈÙ‹˜ ·fi ÙÔ Û˘-

Ó¤‰ÚÈÔ,ÔÈÔ˜ ¤ÎÚÈÓÂ ÙÈ, fiÙÂ Î·È ÁÈ·Ù› Î·ı˘ÛÙ¤ÚËÛÂ, ÔÈÔ ÙÔ ÌÈÎÚfi fiÓÔÌ· ÙÔ˘ Û˘ÁÁÚ·Ê¤· æ, ÛÂ ÔÈÔ ÓÔÛÔÎÔÌÂ›Ô ÂÚÁ¿˙ÂÙ·È ÙÒÚ· Ë Î˘Ú›· Xæ ÎÏ ÎÏ.).

- ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ T· Ì¤ÏË ÙË˜ EÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈÙÚÔ‹˜ ÌÔÈÚ¿ÛÙËÎ·Ó ÙÔ Û˘ÓÙ·ÎÙÈÎfi ¤ÚÁÔ. ™˘ÌÌÂÙÂ›¯·Ó ÛÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÙˆÓ ÙÂ˘¯ÒÓ, ÛÙËÓ ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÛÙËÓ ÂÈÏÔÁ‹ ıÂÌ¿ÙˆÓ, Û˘ÁÁÚ·Ê¤ˆÓ Î·È ÎÚÈÙÒÓ, ÛÙÈ˜ ·ÔÊ¿ÛÂÈ˜ ÁÈ· ÙËÓ ÌÔÚÊ‹ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÛÙË ‰È·ÌfiÚÊˆÛË ÂÛˆÙÂÚÈÎÔ‡ Î·ÓÔÓÈÛÌÔ‡ ÏÂÈÙÔ˘ÚÁ›·˜, Ô‰ËÁÈÒÓ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ. AÊÈ¤ÚˆÛ·Ó ÛÙËÓ ¶AI¢IATPIKH ¯ÚfiÓÔ ·Ô‰ÔÙÈÎfi Î·È ÔÏ‡ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÈ˜ 12 ÙÚ›ˆÚÂ˜ Û˘ÓÂ‰ÚÈ¿ÛÂÈ˜ ÙË˜ EÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈÙÚÔ‹˜.

18.12.1999

EÏ¤ÓË B·Ï¿ÛÛË-A‰¿Ì ¢ÈÂ˘ı˘ÓÙ‹˜ ÙË˜ E.™.E.

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

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

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

¿ÚıÚ·

T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡ Î·Ù·ÏÔÁÔÁÚ·ÊÔ‡ÓÙ·È ·fi ÙÔ ÂÈÙÂÏÂ›Ô ÙÔ˘ IÓÛÙÈÙÔ‡ÙÔ˘ YÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÙË ‚¿ÛË IPI™ (IPI™ B¿ÛË EÏÏËÓÈÎ‹˜ BÈ‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ YÁÂ›· ÙÔ˘ ¶·È‰ÈÔ‡, ¶AI¢IATPIKH 1999,62:247 Î·È 2000,63:71-74). ŸÔÈÔ˜ ÂÓ‰È·Ê¤ÚÂÙ·È ÁÈ· ÙË Û¯ÂÙÈÎ‹ EÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÙË˜ ÙÂÏÂ˘Ù·›·˜ ÂÈÎÔÛ·ÂÙ›·˜, ÌÔÚÂ› Ó· Î¿ÓÂÈ ıÂÌ·ÙÈÎ‹ ·Ó·˙‹ÙËÛË ÌÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Î·È ·Ó·˙‹ÙËÛË Û˘ÁÁÚ·Ê¤ˆÓ, Â›ÙÂ ÂÈÎÔÈÓˆÓfiÓÙ·˜ ÌÂ ÙÔ IÓÛÙÈÙÔ‡ÙÔ YÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÙËÏÂÊˆÓÈÎ¿ (01-7719733), ÌÂ fax (01-7700111), e-mail (inchildh@otenet.gr) ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË ‹ ·Â˘ıÂ›·˜ Ì¤Û· ·fi ÙÔ ‰È·‰›ÎÙ˘Ô (www.ich.gr).

°È· Ó· ¤¯Ô˘Ó ÔÈ ·Ó·ÁÓÒÛÙÂ˜ ÙË˜ ¶AI¢IATPIKH™ ÌÈ· ÁÂÓÈÎﬁÙÂÚË ÂÔÙÂ›· ÙË˜ ·È‰È·ÙÚÈÎ‹˜ Û˘ÁÁÚ·ÊÈÎ‹˜ ·Ú·ÁˆÁ‹˜ ·Ú·ı¤ÙÔ˘ÌÂ ÂÓËÌÂÚˆÙÈÎ¿ ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ÂÈÛËÌ¿ÓıËÎ·Ó ÛÙ· ÙÂ‡¯Ë ÙˆÓ ·Ú·Î¿Ùˆ

ÂÚÈÔ‰ÈÎÒÓ Ô˘ Â›¯·Ó Î˘ÎÏÔÊÔÚ‹ÛÂÈ Ì¤¯ÚÈ 20 ¢ÂÎÂÌ‚Ú›Ô˘ 1999.

I·ÙÚÈÎ‹, IÔ‡ÏÈÔ˜ 1999

AÚ¯Â›· EÏÏËÓÈÎ‹˜ I·ÙÚÈÎ‹˜, M¿ÈÔ˜-IÔ‡ÓÈÔ˜ 1999,

EÏÏËÓÈÎ‹ M·ÈÂ˘ÙÈÎ‹ Î·È °˘Ó·ÈÎÔÏÔÁ›·, AÚ›ÏÈÔ˜-IÔ‡ÓÈÔ˜ 1999

M·ÈÂ˘ÙÈÎ¿ XÚÔÓÈÎ¿, IÔ‡ÏÈÔ˜-™ÂÙ¤Ì‚ÚÈÔ˜ 1999

°ÂÓÂÙÈÎ‹ ÙÔ˘ AÓıÚÒÔ˘, I·Ó-IÔ‡ÓÈÔ˜ 1999

¶·È‰È·ÙÚÈÎ‹ BÔÚÂ›Ô˘ EÏÏ¿‰Ô˜, I·Ó-ºÂ‚Ú-M¿ÚÙÈÔ˜ 1999, ¢ÂÏÙ›Ô A’ ¶·È‰È·ÙÚÈÎ‹˜ KÏÈÓÈÎ‹˜ ¶·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‰ÈÎ¿ ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÂÙËÛ›ˆ˜ ÂÚ›Ô˘ 100 ¿ÚıÚ· Ô˘ ÂÓ‰È·Ê¤ÚÔ˘Ó ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜. A˘Ù¿, Ì·˙› ÌÂ ÙÈ˜ ÂÚ›Ô˘ 100 ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÙËÓ ¶AI¢IATPIKH ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÚ›Ô˘ 80% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Ó·ÊÔÚÒÓ ÛÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡, ÛÙÔÓ ÂÏÏËÓÈÎfi ‚ÈÔ˚·ÙÚÈÎfi ÂÚÈÔ‰ÈÎfi Ù‡Ô.

™Ù· ÙÂ‡¯Ë ÙˆÓ ·Ú·¿Óˆ ÂÚÈÔ‰ÈÎÒÓ ÂÈÛËÌ¿Ó·ÌÂ 48 ¿ÚıÚ· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡. (29 ÛÂ ·È‰È·ÙÚÈÎ¿ ÂÚÈÔ‰ÈÎ¿ Î·È 19 ÛÂ ¿ÏÏ·).

EÚÁ·Û›Â˜ (13)

- ¢ËÏËÙËÚÈ¿ÛÂÈ˜ ·ﬁ ‰‹ÁÌ·Ù· ÊÈ‰ÈÒÓ ÛÙËÓ EÏÏ¿‰·. K ºÔ˘ÓÙ¿˜, ¶ BÏ¿¯Ô˜, H B·ÏÙ‹, E T˙ÒÏ·, E Z·ÊÂÈÚ›Ô˘. I·ÙÚÈÎ‹ 1999;75: 503-507.

- EÈÔÏ·ÛÌﬁ˜ ÙÂÚË‰ﬁÓ·˜ Î·È ·Ó¿ÁÎÂ˜ Ô‰ÔÓÙÈ·ÙÚÈÎ‹˜ ÂÚ›ı·Ï„Ë˜ ·È‰ÈÒÓ ËÏÈÎ›·˜ -12 ÂÙÒÓ ÛÙËÓ ·Ó·ÙÔÏÈÎ‹ Â·Ú¯›·

£Ë‚ÒÓ ÙÔ˘ ÓÔÌÔ‡ BÔÈˆÙ›·˜. I º·Ó‰Ú›‰Ë˜, ¢ ¢ÂÏ‚ÂÓ·ÎÈÒÙË˜ ¶·È‰Ô‰ÔÓÙ›· 1999;13:55-63.

- ¶ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ ÛÂ ·È‰È¿ ·ﬁ ÙËÓ E˘ÚÒË Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙËÓ KÚ‹ÙË. E °·Ï·Ó¿ÎË˜, E ¶·Ú·ÛÎ¿ÎË˜, ™ MÔ˘ÎÔ˘‚·Ú¿ÎË˜, N K·Ù˙ËÏ¿ÎË˜, ™ ™Ì˘Ú¿ÎÈ˜. ¶·È‰È·ÙÚÈÎ‹ BÔÚÂ›Ô˘ EÏÏ¿‰Ô˜ 1999; 11: 28-31.

- EÈ‰ËÌ›· ÈÏ·Ú¿˜ 1996: EÚÁ·ÛÙËÚÈ·Î¿ ‰Â‰ÔÌ¤Ó·. X °È·ÓÓ·ÎÔÔ‡ÏÔ˘, X MﬁÚ·, ¢ NÂ·ÌÔÓÈÙÔ‡, B KÔ˘ÎÔ‡, § §È¿Ë, O °Ú·Ê¿ÎÔ˘, ¢ °Ô˘ÚÁÈÒÙË˜, ¢ AÏÂÍ›Ô˘. ¶·È‰È·ÙÚÈÎ‹ BÔÚÂ›Ô˘

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›ÚË˜, M KÔÎÎfiÏË, X º·ÚÌ¿ÎË˜, X ¢ËÌfiÔ˘ÏÔ˜. ¶·È‰È·ÙÚÈÎ‹ BÔÚÂ›Ô˘ EÏÏ¿‰Ô˜ 1999;11: 37-39.

- MÂÏ¤ÙË ÙË˜ ÓÂ·ÓÈÎ‹˜ ¯ÚﬁÓÈ·˜ ·ÚıÚ›ÙÈ‰·˜ ÛÂ ŒÏÏËÓÂ˜. X ¢Ú¿ÎÔ˘, N KˆÛÙ·ÓÙÈÓ›‰Ô˘, A KˆÛÙ·ÓÙﬁÔ˘ÏÔ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:78-83.

- A˘ÍËÌ¤Ó· Â›Â‰· ‰ÂÈÎÙÒÓ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÂÓÂÚÁÔÔ›ËÛË˜ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÂ ·È‰È¿ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ º K·Ó·ÎÔ‡‰Ë-TÛ·Î·Ï›‰Ô˘, M. Aı·Ó·Û›Ô˘MÂÙ·Í¿, B. T˙ÈÌÔ‡ÏË, A. KÔ‡ÛË, A. T·¿ÚÎÔ˘, M TÚ·¯·Ó¿, I TÛ¿ÙÚ·. AÚ¯Â›· EÏÏËÓÈÎ‹˜ I·ÙÚÈÎ‹˜ 1999;16:147-153. - ¶·ÓÂÏÏ·‰ÈÎ‹ ÌÂÏ¤ÙË Î·Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. T ¶·Ó·ÁÈˆÙfi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‡ÙË˜, X §ÈÔÓ‹˜. AÚ¯Â›· EÏÏËÓÈÎ‹˜ I·ÙÚÈÎ‹˜ 1999;16:154-162. - ¢ÈÂÚÂ‡ÓËÛË ÙË˜ Î¿ıÂÙË˜ ÌÂÙ¿‰ÔÛË˜ ÙÔ˘ ÈÔ‡ ÙË˜ Ë·Ù›ÙÈ‰·˜ C. ° º·ÚÌ¿ÎË, B ¶··Â˘·ÁÁ¤ÏÔ˘, E K·‰¿, ° ¶··Â˘·ÁÁ¤ÏÔ˘. AÚ¯Â›· EÏÏËÓÈÎ‹˜ I·ÙÚÈÎ‹˜ 1999;16:249-252. - AÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË ÌËÙÚÈÎ‹ Î˘ÎÏÔÊÔÚ›· ÌÂ Ì·ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi, ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ¯ÚÒÛË Î·È FISH. A M·‡ÚÔ˘, A KÔÏÈ·Ï¤ÍË, ° TÛ·ÁÎ¿ÚË˜, A AÓÙÛ·ÎÏ‹˜, E ¢·Ê¤ÚÌÔ˘, X TÛÂÁÎ‹, A MÂÙ·ÍˆÙÔ‡. °ÂÓÂÙÈÎ‹ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:40-48. - °ÔÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË ·È‰ÈÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Turner Î·È Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ Ê·ÈÓfiÙ˘Ô. ™ K›ÙÛÈÔ˘, E K·‚·˙·Ú¿ÎË˜, A TÛ¤˙Ô˘, A °·ÏÏ¿, ¢ °Ô˘ÚÁÈÒÙË˜, 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¿˜. °ÂÓÂÙÈÎ‹ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:49-54.

http://www.ich.gr

¶·Ó·ÁÈÒÙË˜ A. KÔÎÎÈÓ›‰Ë˜

To IÓÛÙÈÙÔ‡ÙÔ YÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (IY¶) ¤¯ÂÈ ‹‰Ë ·ﬁ ÙÔ 1979 Û˘ÁÎÚÔÙ‹ÛÂÈ ÙËÓ ‚¿ÛË ÂÏÏËÓÈÎ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡. H ‚¿ÛË ·˘Ù‹ ÂÌÏÔ˘Ù›˙ÂÙ·È Û˘ÓÂ¯Ò˜ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· ÁÈ· ÙÈ˜ ÂÏÏËÓÈÎ¤˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ ÂÚÈÔ‰ÈÎ¿ 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 ÛÂ ·˘Ù‹Ó ÛÂ ÔÔÈÔÓ‰‹ÔÙÂ ¯Ú‹ÛÙË ¤¯ÂÈ ÚfiÛ‚·ÛË ÛÙÔ Internet. OÈ ¯Ú‹ÛÙÂ˜ ÌÔÚÔ‡Ó Ó· Î¿ÓÔ˘Ó online ·Ó·˙ËÙ‹ÛÂÈ˜ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·˜ ‰È¿ÊÔÚ· ÎÚÈÙ‹ÚÈ· Î·È ÂÚÈÔÚÈÛÌÔ‡˜ Î·È Ó· ‰Ô˘Ó ÙÈ˜ ÂÚÈÏ‹„ÂÈ˜ ÙˆÓ ‰ËÌÔÛÈÂ‡ÛÂˆÓ

OÈ fiÚÔÈ ·Ó·˙‹ÙËÛË˜ ÌÔÚÂ› Ó· Â›Ó·È ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ. EÎÙfi˜ ·fi ÙËÓ ·Ú¿ıÂÛË ÙˆÓ fiÚˆÓ, Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Î·È ÔÚÈÛÌ¤ÓÔ˘˜ Î·ÓfiÓÂ˜ ÁÈ· ÙËÓ ÏÔÁÈÎ‹ ÙË˜ ·Ó·˙‹ÙËÛË˜. OÈ Î·ÓfiÓÂ˜ ·˘ÙÔ› ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiÙ·Ó ÔÈ fiÚÔÈ ·Ó·˙‹ÙËÛË˜ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ÙÔ˘ ÂÓfi˜. EÍ' ÔÚÈÛÌÔ‡ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔÈ fiÚÔÈ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ÙË ÏÔÁÈÎ‹ ‰È¿˙Â˘ÍË (OR). E¿Ó ÌÚÔÛÙ¿ ·fi ÙÔÓ fiÚÔ ÙÔÔıÂÙËıÂ› ÙÔ Û‡Ì‚ÔÏÔ +, ÙfiÙÂ Ô fiÚÔ˜ Á›ÓÂÙ·È ˘Ô¯ÚÂˆÙÈÎfi˜. AÓÙ›ıÂÙ· Â¿Ó ÌÚÔÛÙ¿ ·fi ÙÔÓ fiÚÔ ÚÔÛÙÂıÂ› ÙÔ Û‡Ì‚ÔÏÔ -, Ô fiÚÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· ÂÚÈ¤¯ÂÙ·È ÛÙÈ˜ ÂÁÁÚ·Ê¤˜ Ô˘ ı· ‚ÚÂıÔ‡Ó. °È· Ó· ÚÔÛ‰ÈÔÚÈÛıÔ‡Ó Û‡ÓıÂÙÔÈ fiÚÔÈ, Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó·

¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ‰ÈÏ¿ ÂÈÛ·ÁˆÁÈÎ¿.

™ÙÔÓ ›Ó·Î· 1 ‰›ÓÔÓÙ·È ·Ú·‰Â›ÁÌ·Ù· Î·È ÂÂÍËÁ‹ÛÂÈ˜ ÁÈ· ÙË ¯Ú‹ÛË ÙˆÓ Û˘Ì‚ﬁÏˆÓ.

¶›Ó·Î·˜ 1.

ŸÚÔÈ ·Ó·˙‹ÙËÛË˜AÔÙ¤ÏÂÛÌ· ·Ó·˙‹ÙËÛË˜

ÈÏ·Ú¿ ÂÚ˘ıÚ¿ŸÏÂ˜ ÔÈ ÂÁÁÚ·Ê¤˜ Ô˘

ÙÔÓ ﬁÚÔ "ÈÏ·Ú¿" (ÚÒÙÂ˜ ÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù·

·Ó·ÙÔÌÈÎ‹ŸÏÂ˜ ÔÈ ÂÁÁÚ·Ê¤˜

ÁÏÒÛÛ· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛıÔ‡Ó fiÚÔÈ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ¿ÏÏË ÙÒÛË ·fi ·˘Ù‹Ó Ô˘ ¯ÚËÛÈÌÔÔÈÂ› Ô ¯Ú‹ÛÙË˜ (Û˘Ó‹ıˆ˜ ÙËÓ ÔÓÔÌ·ÛÙÈÎ‹). °È· ÙÔ ÏfiÁÔ ·˘Ùfi Û˘Ó›ÛÙ·Ù·È Ë ¯Ú‹ÛË ÙË˜ Ú›˙·˜ ÙÔ˘ ·Ó·˙ËÙÔ‡ÌÂÓÔ˘ fiÚÔ˘ ¤ÙÛÈ ÒÛÙÂ Ó· ÌÂÁÈÛÙÔÔÈËıÂ› Ë ÂÈÙ˘¯›· ÙË˜ ·Ó·˙‹ÙËÛË˜. ¶.¯. ·ÓÙ› ÙÔ˘ fiÚÔ˘ "ÂÌ‚ÔÏÈ·ÛÌfi˜" ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› Ô fiÚÔ˜ "ÂÌ‚ÔÏÈ", fiÔÙÂ ÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ı· Û˘ÌÂÚÈÏËÊıÔ‡Ó Î·È ÔÈ ÂÁÁÚ·Ê¤˜ Ô˘ ÂÚÈ¤¯Ô˘Ó ÙÔ˘˜ fiÚÔ˘˜ ÂÌ‚fiÏÈÔ, ÂÌ‚ÔÏ›ˆÓ, Î.Ï.

EÎÙfi˜ ·fi ÙÔ˘˜ fiÚÔ˘˜ ·Ó·˙‹ÙËÛË˜ Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÌÈ· ÛÂÈÚ¿ ·fi ÂÚÈÔÚÈÛÌÔ‡˜. ¶ÚÒÙÔ˜ ÂÚÈÔÚÈÛÌfi˜ Â›Ó·È Ë ÂÚÈÔ¯‹ ·Ó·˙‹ÙËÛË˜. EÍ' ÔÚÈÛÌÔ‡ Ë ·Ó·˙‹ÙËÛË ÙˆÓ fiÚˆÓ Á›ÓÂÙ·È ÛÙÔÓ Ù›ÙÏÔ Î·È ÙÈ˜ Ï¤ÍÂÈ˜-ÎÏÂÈ‰È¿ ÙˆÓ ÂÁÁÚ·ÊÒÓ. EÓ·ÏÏ·ÎÙÈÎ¿ Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· Î¿ÓÂÈ ÙËÓ ·Ó·˙‹ÙËÛË ÙÔ˘ ÛÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ‹/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Ï¤ÔÓ Ë ·Ó·˙‹ÙËÛË ÌÔÚÂ› Ó· ÂÚÈÔÚÈÛıÂ› ÛÂ ¤Ó· ÌfiÓÔ ·fi Ù· ÂÚÈÔ‰ÈÎ¿ Ô˘ Î·Ù·ÏÔÁÔÁÚ·ÊÔ‡ÓÙ·È ÛÙË ‚¿ÛË. A˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÂÈÏ¤ÁÔÓÙ·˜ ÙÔÓ Ù›ÙÏÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ·fi ÙÔÓ Î·Ù¿ÏÔÁÔ. TÚ›ÙÔ˜ ÂÚÈÔÚÈÛÌfi˜ Â›Ó·È ÙÔ ¤ÙÔ˜ ‰ËÌÔÛ›Â˘ÛË˜. O ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ ÂÚ›Ô‰Ô Ô˘ ÙÔÓ ÂÓ‰È·Ê¤ÚÂÈ, ÂÈÛ¿ÁÔÓÙ·˜ Ù· ¤ÙË ÛÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ı¤ÛÂÈ˜ ÙË˜ ÊfiÚÌ·˜. T¤ÏÔ˜, Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ fiÛÂ˜ ÂÁÁÚ·Ê¤˜ ı· ÂÌÊ·Ó›˙ÔÓÙ·È ·Ó¿ ÛÂÏ›‰· ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ.

∂ÈÎﬁÓ· 2.

™ÙËÓ ÂÈÎfiÓ· 2 Ê·›ÓÔÓÙ·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ ·Ó·˙‹ÙËÛË˜. °È· Î¿ıÂ ÂÁÁÚ·Ê‹ Ô˘ ÈÎ·ÓÔÔÈÂ› Ù· ÎÚÈÙ‹ÚÈ· ·Ó·˙‹ÙËÛË˜ ‰›ÓÂÙ·È Ô Ù›ÙÏÔ˜ ÙË˜ ÂÚÁ·Û›·˜ Î·È Ë ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÊÔÚ¿. O ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ‰ÂÈ ÌÈ· ÂÚ›ÏË„Ë Î¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÙÔÓ Ù›ÙÏÔ ÙË˜ ÂÁÁÚ·Ê‹˜. EÓ·ÏÏ·ÎÙÈÎ¿ ÌÔÚÂ› Ó· ÂÈÏ¤ÍÂÈ ÌÈ· ÛÂÈÚ¿ ·fi ÂÁÁÚ·Ê¤˜ Î¿ÓÔÓÙ·˜ ÎÏÈÎ ÌÚÔÛÙ¿ ·fi ÙÔÓ Ù›ÙÏÔ Î·È ·ÎÔÏÔ‡ıˆ˜ Ó· ·Ù‹ÛÂÈ ÙÔ ÎÔ˘Ì› "EÌÊ¿ÓÈÛË ÂÈÏÂÁÌ¤ÓˆÓ". TÔ ÎÔ˘Ì› "EfiÌÂÓÂ˜ 20" ÂÌÊ·Ó›˙ÂÈ ÙÈ˜ ÂfiÌÂÓÂ˜ ÂÁÁÚ·Ê¤˜ Ô˘ ÈÎ·ÓÔÔÈÔ‡Ó ÙÔ˘˜ fiÚÔ˘˜ ·Ó·˙‹ÙËÛË˜. T¤ÏÔ˜, ÙÔ ÎÔ˘Ì› "N¤· ·Ó·˙‹ÙËÛË" ÂÌÊ·Ó›˙ÂÈ ÙË ÊfiÚÌ· ·Ó·˙‹ÙËÛË˜.

∂ÈÎﬁÓ· 3.

™ÙËÓ ÂÈÎﬁÓ· 3 Ê·›ÓÂÙ·È ÌÈ· Ï‹ÚË˜ ÂÁÁÚ·Ê‹

·fi ·Ó·˙‹ÙËÛË. K·Ù¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ Û‡Ó‰ÂÛÌÔÈ (links) Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ Î·È ÔÈ Ï¤ÍÂÈ˜-ÎÏÂÈ‰È¿. K¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÙÔ fiÓÔÌ· ÂÓfi˜ Û˘ÁÁÚ·Ê¤·, ÂÌÊ·Ó›˙ÔÓÙ·È fiÏÂ˜ ÔÈ ÂÁÁÚ·Ê¤˜ Ô˘ ÂÚÈ¤¯Ô˘Ó ÙÔÓ Û˘ÁÁÚ·Ê¤· ·˘ÙfiÓ, ÂÓÒ Î¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÂ ÌÈ· Ï¤ÍË-ÎÏÂÈ‰›, ÂÌÊ·Ó›˙ÔÓÙ·È fiÏÂ˜ ÔÈ ÂÁÁÚ·Ê¤˜ Ô˘ ÂÚÈ¤¯Ô˘Ó ÙË Ï¤ÍË-ÎÏÂÈ‰›.

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 ÂÚÈÂ¯fiÌÂÓÔ ÙË˜ ‚¿ÛË˜ IPI™-Online ÂÓËÌÂÚÒÓÂÙ·È Ù·ÎÙÈÎ¿ ·fi ÙÔ IÓÛÙÈÙÔ‡ÙÔ YÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Î·È ÙË ‰È·Û‡Ó‰ÂÛË ÌÂ ÙÔ ¯Ú‹ÛÙË, ı· Á›ÓÔÓÙ·È ‚ÂÏÙÈÒÛÂÈ˜ ¤ÙÛÈ ÒÛÙÂ Ó· ·ÔÙÂÏ¤ÛÂÈ ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ÎfiÛÌÔ ÂÓÙfi˜ Î·È ÂÎÙfi˜ EÏÏ¿‰·˜.

™Â ·˘Ùﬁ ÙÔ ÙÂ‡¯Ô˜ 2000,63:(1) ‰ËÌÔÛÈÂ‡ÔÓÙ·È Û˘ÌÏËÚˆÌ·ÙÈÎ¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜. OÈ Ô‰ËÁ›Â˜

ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘Ú›ˆ˜ ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜/ ··ÈÙ‹ÛÂÈ˜ Ô˘ ¤¯Ô˘Ó ÔÚÈÛÙÂ› ·ﬁ ÙÔ˘˜ ‰ÈÂ˘ı˘ÓÙ¤˜ Û‡ÓÙ·ÍË˜ ÙˆÓ

ÂÚÈÛÛfiÙÂÚˆÓ ÍÂÓfiÁÏˆÛÛˆÓ ‚ÈÔ˚·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ (Uniform Requirements for Manuscripts Submitted to Biomedical Journals 1997). EÈÛËÌ·›ÓÂÙ·È fiÙÈ Ë ¶AI¢IATPIKH ˙ËÙ¿ ÂÈÏ¤ÔÓ ·fi ÙÔ˘˜ ŒÏÏËÓÂ˜ Û˘ÁÁÚ·ÊÂ›˜ Ó·

¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È ÂÏÏËÓÈÎ¤˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜.

1- ™ÙÔ ¿ÚıÚÔ Û‡ÓÙ·ÍË˜ ÙË˜ ™. N¿ÎÔ˘ "¶ÂÚÈ‚·ÏÏÔÓÙÈÎﬁ˜

ÙÛÈÁ¿ÚˆÓ. ŒÓ· Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜" ¶AI¢IATPIKH 1999,62:415, Ë ÛÂÈÚ¿ 2 Ú¤ÂÈ Ó· ‰È·‚·ÛÙÂ›: (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‡ÓË˜ Î·È MÂÚ¿ÙË˜ ÛÂÏ 457-463)

2- ™ÙËÓ ÂÚÁ·Û›· ÙˆÓ ¢. K·ÙÚÈÔ‡, º. Aı·Ó·ÛÈ¿‰Ô˘, X. AÁÁÔ˘ÚÈ‰¿ÎË, £. ¶··ÁÂˆÚÁ›Ô˘, B. TÛ·‚‰·Ú›‰Ô˘, M. X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ "E›Â‰· Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜, sICAM-1 sVCAM-1 ÛÂ ·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. ™ÙÈ˜ ÛÂÏ›‰Â˜ 80-85 ‰ËÌÔÛÈÂ‡ÂÙ·È Ë Ï‹ÚË˜ ÂÚÁ·Û›·. ∏ ÂÚÁ·Û›·

Î·Ù·ÏÔÁÔÁÚ·ÊËıÂ› ÌÂ Ù· ÛÙÔÈ¯Â›· ¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85. ∞˘Ù¿ Ù· ÛÙÔÈ¯Â›· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÈ˜ ·Ó·ÊÔÚ¤˜. ¶·ÚÔÚ¿Ì·Ù·

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

1. H ·ÓÙÈÌÂÙÒÈÛË

3. H ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È

5. °È· Ù· ·È‰È¿ Ô˘ ·›ÚÓÔ˘Ó

·˘Ù¤˜ ÙÈ˜ Ú¿ÍÂÈ˜ ı· Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Î·È Ó· ıÂÚ·Â‡ÂÙ·È ‰Ú·ÛÙÈÎ¿.

6. H "ÎÏ›Ì·Î· ·Ó·ÏÁËÛ›·˜" ÙË˜ ¶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 ÎÏÈÌ·ÎˆÙ‹ ÚÔÛ¤ÁÁÈÛË, Î·ıÔÚ›˙ÂÙ·È Ë ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ fiÓÔ˘ ÙÔ˘ ·È‰ÈÔ‡, Ô Ù‡Ô˜ Î·È Ë ‰fiÛË ÙÔ˘ ·Ó·ÏÁËÙÈÎÔ‡.

7. E·ÚÎÂ›˜ ·Ó·ÏÁËÙÈÎ¤˜ ‰fiÛÂÈ˜ ı· Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È ÛÂ Ù·ÎÙ¿ ‰È·ÛÙ‹Ì·Ù· - "ÌÂ ÙÔ ÚÔÏfiÈ" Î·È fi¯È "fiÙ·Ó ¯ÚÂÈ·ÛÙÂ›".

8. T· ·Ó·ÏÁËÙÈÎ¿, ﬁÔ˘ Â›Ó·È ‰˘Ó·Ùﬁ, Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È

9. H Î·Ù¿ÏÏËÏË ‰ﬁÛË ÂÓﬁ˜ ÔÔÈÔ‡¯Ô˘ Â›Ó·È

11. OÈ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙˆÓ ÔÈÔ‡¯ˆÓ ı· Ú¤ÂÈ Ó·

Ù·ÎÙÈÎ¿.

12. ŸÙ·Ó ÌÂÈÒÓÔÓÙ·È ‹ ‰È·ÎﬁÙÔÓÙ·È Ù· ÔÔÈÔ‡¯·, ÔÈ ‰ﬁÛÂÈ˜

‚·ıÌÈ·›· ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÂ› ÛÔ‚·Ú‹ ·ﬁÙÔÌË ˘ÔÙÚÔ‹ ÙÔ˘ ﬁÓÔ˘

ÛÙ¤ÚËÛË˜.

13. AÓ Î·È Ë Î·Ù·ÓfiËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ ·fi Ù· ·È‰È¿ ·ÏÏ¿˙ÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÙÔ˘˜ ÛÙ¿‰ÈÔ, Û˘¯Ó¿

ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÚfiÎÂÈÙ·È Ó· Âı¿ÓÔ˘Ó. O Êfi‚Ô˜ ÙË˜ ÂÁÎ·Ù¿ÏÂÈ„Ë˜ Î·È Ô Êfi‚Ô˜ fiÙÈ ı· ˘ÔÊ¤ÚÔ˘Ó Â›Ó·È ÔÈ

Î‡ÚÈÂ˜ ·ÓËÛ˘¯›Â˜ ÙˆÓ ·È‰ÈÒÓ Î¿ıÂ ËÏÈÎ›·˜ ÌÂ ·ÚÚÒÛÙÈ· Ô˘ Ô‰ËÁÂ› ÛÙÔÓ ı¿Ó·ÙÔ. °È' ·˘Ùfi ÙÔÓ ÏfiÁÔ, ÔÈ Â·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜ ı· Ú¤ÂÈ Ó· ÙÔÓ›˙Ô˘Ó ÛÂ ·˘Ù¿ Ù· ·È‰È¿ fiÙÈ ı· ÙÔ˘˜ ÚÔÛÊÂÚıÂ› ·Ó·ÎÔ‡ÊÈÛË Î·È fiÙÈ Ù· ·Á·ËÌ¤Ó· ÙÔ˘˜ ÚfiÛˆ· ı· Â›Ó·È ‰È·ÚÎÒ˜ ‰›Ï· ÙÔ˘˜.

14. H ·Ó·ÎÔ˘ÊÈÛÙÈÎ‹ ıÂÚ·Â›· ı· Ú¤ÂÈ Ó· Â›Ó·È ÛÊ·ÈÚÈÎ‹ Î·È Ó· Ï·Ì‚¿ÓÂÈ ˘ﬁ„Ë ÙÈ˜ „˘¯ÔÏÔÁÈÎ¤˜, ÔÏÈÙÈÛÙÈÎ¤˜ Î·È ÓÂ˘Ì·ÙÈÎ¤˜ ·Ó¿ÁÎÂ˜. E¿Ó ÂÎ‰ËÏˆıÂ› Û¯ÂÙÈÎ‹ ÂÈı˘Ì›·, ı· Ú¤ÂÈ ·˘Ù‹ Ë ıÂÚ·Â›· Ó· ÚÔÛÊ¤ÚÂÙ·È ÛÙÔ Û›ÙÈ.

15. E›Ó·È Â˘ı‡ÓË Î¿ıÂ Â·ÁÁÂÏÌ·Ù›· ˘ÁÂ›·˜, Î¿ıÂ È‰Ú‡Ì·ÙÔ˜ Î·È Î¿ıÂ Î˘‚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.

EÎ‰ﬁÛÂÈ˜ ÙË˜ ¶·ÁÎﬁÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ YÁÂ›·˜

A˘Ù¤˜ ÔÈ ·Ú¯¤˜ ¤¯Ô˘Ó ÏËÊıÂ› ·ﬁ ÙÔ ‚È‚Ï›Ô "Cancer Pain Relief and Palliative Care in Children"

Ô˘ ÂÎ‰fiıËÎÂ ·fi ÙËÓ ¶OY ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙË ¢ÈÂıÓ‹ EÙ·ÈÚÂ›· MÂÏ¤ÙË˜ ¶fiÓÔ˘.

¢ÈÂ‡ı˘ÓÛË ÁÈ· ·Ú·ÁÁÂÏ›Â˜: bookorders@who.ch

Aﬁ‰ÔÛË ÛÙ· ÂÏÏËÓÈÎ¿

™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·

BÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

1.1.Z.2)

Œ¯ÂÈ ÂÚ¿ÛÂÈ Î·ÈÚﬁ˜ Ô˘ Ë ÂÍ‹ÁËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ ÛÂ ¤Ó· ·È‰› ·ÔÙÂÏÔ‡ÛÂ Ù·ÌÔ‡ Î·È Ô˘ ıÂˆÚÂ›ÙÔ ﬁÙÈ Ô ı¿Ó·ÙÔ˜ ı· ÂÍ·Ê·ÓÈÛÙÂ› Ì·ÁÈÎ¿ ·Ó ‰ÂÓ Û˘˙ËÙËıÂ›.

TÒÚ· fiÏÔÈ ·Ó·ÁÓˆÚ›˙Ô˘ÌÂ fiÙÈ Ô ı¿Ó·ÙÔ˜ Â›Ó·È ÌÈ· ·ÁÎfiÛÌÈ· Î·È ·Ó·fiÊÂ˘ÎÙË ‰È·‰ÈÎ·Û›· Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó fiÏÂ˜ ÔÈ ËÏÈÎ›Â˜ Î·È fiÙÈ Ë Î·Ï‹ „˘¯ÈÎ‹ ˘ÁÂ›· 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 ˘ÁÂ›·˜) Â›Ó·È Ë Û˘˙‹ÙËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ ÌÂ ¤Ó· ·È‰› Ô˘ ¤¯·ÛÂ Î¿ÔÈÔ ·Á·ËÌ¤ÓÔ 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, ÔÈÂ˜ Â›Ó·È ÔÈ ·Ó¿ÁÎÂ˜ 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· ÙË˜ ˙ˆ‹˜ ÙÔ˘˜, fiÙÂ ı· Ú¤ÂÈ Ó· ·ÓËÛ˘¯‹ÛÔ˘Ó, MÂ ÛÎÔfi Ó· ··ÓÙ‹ÛÂÈ ÛÂ fiÏ· ·˘Ù¿ Ù· ÂÚˆÙ‹Ì·Ù· Î·È Ó· ‚ÔËı‹ÛÂÈ ·˘ÙÔ‡˜ Ô˘ ı· ÛÙËÚ›ÍÔ˘Ó ÙÔ ·È‰›, ¤¯ÂÈ ÂÎ‰ÔıÂ› ¤Ó· Î·ÏfiÁÔ˘ÛÙÔ Ê˘ÏÏ¿‰ÈÔ ÌÂ Ù›ÙÏÔ "™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ¶·È‰› Ô˘ £ÚËÓÂ› ÙÔ £¿Ó·ÙÔ AÁ·ËÌ¤ÓÔ˘ ÙÔ˘ ¶ÚÔÛÒÔ˘". Œ¯ÂÈ ÁÚ·ÊÙÂ› ·fi ÙÔ˘˜ ÂÈ‰ÈÎÔ‡˜ ÙÔ˘ ™˘Ì‚Ô˘ÏÂ˘ÙÈÎÔ‡ K¤ÓÙÚÔ˘ ÙË˜ MEPIMNA™, ¢·Ó¿Ë ¶··‰¿ÙÔ˘, EÈÚ‹ÓË M·Ì·ÓÙ¿ÎË, EÈÚ‹ÓË ¶·¿˙ÔÁÏÔ˘, EÏÂ˘ıÂÚ›· P¿ÏÏË Î·È M˘ÚÙÒ N›ÏÛÂÓ.

¢È·Ó¤ÌÂÙ·È ‰ˆÚÂ¿Ó ·ﬁ Ù· ÁÚ·ÊÂ›· ÙË˜ MEPIMNA™, TÈÌÔÏ¤ÔÓÙÔ˜ B¿ÛÛÔ˘ 16, ¶Ï·ÙÂ›· M·‚›ÏË, 11521 Aı‹Ó·. TËÏ. 6452013 Î·È 6463367.

™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·

Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎﬁÏÏËÛË˜, sICAM-1 Î·È sVCAM-1 ÛÂ ·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˘ÚÈ‰¿ÎË2, £ÂÔ‰ﬁÙË˜ ¶··ÁÂˆÚÁ›Ô˘1, B·ÛÈÏÈÎ‹ TÛ·‚‰·Ú›‰Ô˘2, M·Ú›· X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1.

● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂÏ¤ÙË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ (sICAM1 Î·È sVCAM-1) ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘. H ÌÂÏ¤ÙË ÂÚÈÏ¿Ì‚·ÓÂ 8 ·È‰È¿ ÌÂ ™E§ ËÏÈÎ›·˜ 18 ÌËÓÒÓ ¤ˆ˜ 14 ¯ÚfiÓˆÓ (ÔÌ¿‰· A) Î·È 16 ˘ÁÈ‹ ·È‰È¿ (ÔÌ¿‰· B) ÙË˜ ›‰È·˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘ ÌÂ ·˘Ù¿ ÙË˜ ÔÌ¿‰·˜ A. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· Â›Â‰· ÛÙÔÓ ÔÚfi: ÙˆÓ sIL2R, ÙˆÓ CIC, ÙË˜ CRP, ÙˆÓ C3 Î·È C4 Î·È ÙˆÓ sICAM-1 Î·È sVCAM-1 Î·ıÒ˜ Â›ÛË˜ Î·È Ë TKE. OÈ ·Ú¿ÌÂÙÚÔÈ ·˘ÙÔ› ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·Ó¿ Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ÛÙÈ˜ ˘ÔÙÚÔ¤˜ ÙË˜ ÓfiÛÔ˘. H ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÔÚÂ›·˜ ÙË˜ ÓfiÛÔ˘ ÙˆÓ ·ÛıÂÓÒÓ, Î˘Ì¿ÓıËÎÂ ·fi 5 Ì‹ÓÂ˜ Ì¤¯ÚÈ 4 ¯ÚfiÓÈ·. AÔÙÂÏ¤ÛÌ·Ù·: T· Â›Â‰· ÙˆÓ sICAM-1 Î·È sVCAM-1 ÛÙËÓ ÔÌ¿‰· A, ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘, ·ÚÔ˘Û›·Û·Ó ‰È·Î˘Ì¿ÓÛÂÈ˜ 368,2-994,8 ng/mL (Ì¤ÛË ÙÈÌ‹ 599,3±96,3 ng/mL), Î·È 2154,4-2972,2 ng/mL (Ì¤ÛË ÙÈÌ‹ 2559,2±378,7 ng/mL), ·ÓÙ›ÛÙÔÈ¯·, ¤Ó·ÓÙÈ ÙˆÓ 104,7-328,9 ng/mL (Ì¤ÛË ÙÈÌ‹ 228,2±49,4 ng/mL) Î·È 315-789 ng/mL (Ì¤ÛË ÙÈÌ‹ 592±104 ng/mL) ÙË˜ ÔÌ¿‰·˜ B. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ‡ÊÂÛË˜ 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›ÛÙÔÈ¯·, ‰ËÏ·‰‹ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. T· Â›Â‰· ÙˆÓ sICAM-1 Î·È sVCAM-1 ÛÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙË˜ ‡ÊÂÛË˜ (p< 0,001). H ·‡ÍËÛË ·˘Ù‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sICAM-1 Î·È sVCAM-1 Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂ ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ C3 Î·È ÙÔ˘ C4, ÙËÓ ·‡ÍËÛË ÙˆÓ CIC, ÙˆÓ sIL-2Rs, ÙË˜ TKE Î·È ÙË˜ CRP. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· Â›Â‰· ÙˆÓ sICAM-1 Î·È sVCAM-1, ·˘Í¿ÓÔ˘Ó Î·Ù¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ·‡ÍËÛË ÙˆÓ CIC, ÙË˜ TKE, ÙË˜ CRP Î·È ÙË˜ ÂÏ¿ÙÙˆÛË˜ ÙÔ˘ C3 Î·È ÙÔ˘ C4, ÂÓÈÛ¯‡ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ˘fiıÂÛË ÙÔ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ÙˆÓ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ, ÙË˜ ÂÓÂÚÁÔÔ›ËÛË˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È fiÙÈ Ù· sICAM-1 Î·È sVCAM-1 ÌÔÚÂ› Ó· ıÂˆÚËıÔ‡Ó fiÙÈ ·ÔÙÂÏÔ‡Ó ‰‡Ô ÂÈÏ¤ÔÓ ‰Â›ÎÙÂ˜ ÂÓÂÚÁÔÔ›ËÛË˜ ÙË˜ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈÎ‹ 2000;63:80-85.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜, Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·ÙÒ‰Ë˜ Ï‡ÎÔ˜, 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,

1 B' ¶·Ó/Î‹ ¶·È‰/Î‹ KÏÈÓÈÎ‹, NÔÛÔÎÔÌÂ›Ô AXE¶A, A.¶.£.

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

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 ·ÛıÂÓÂ›˜ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (™E§) ¤¯Ô˘Ó ‰È·Ù·Ú·¯‹ ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ Î·È ÙË˜ ¯˘ÌÈÎ‹˜ ·ÓÔÛ›·˜ (1). H ÛËÌ·Û›· ÙË˜ ‰È·Ù·Ú·¯‹˜ ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ ·ÓÔÛ›·˜ Î·È Ë Û¯¤ÛË ÙË˜ ÌÂ ÙË ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ Û·ÊÒ˜ Î·ıÔÚÈÛıÂ› (2). H ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÓ·Ôı¤ÛÂÈ˜ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙ· ·ÁÁÂ›· ‰È·ÊfiÚˆÓ ÔÚÁ¿ÓˆÓ, ÌÂ Â·ÎfiÏÔ˘ıÔ ÙËÓ ÂÎ‰‹ÏˆÛË ·ÁÁÂÈ›ÙÈ‰·˜. ™ÙË Ê¿ÛË ·˘Ù‹ ÙË˜ ÓfiÛÔ˘ ˘¿Ú¯ÂÈ ¤ÓÙÔÓË ÂÓÂÚÁÔÔ›ËÛË Î·È ÌÂÙ·Ó¿ÛÙÂ˘ÛË ÙfiÛÔ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰ÈË˘Ú˘ÛÌ¤ÓÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁÂ›ˆÓ, ÛÙÔ˘˜ ÈÛÙÔ‡˜ (3). T· Î‡ÙÙ·Ú· ·˘Ù¿ ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ

ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Ú·ÁÌ·ÙÔÔÈËıÂ› Ë ÌÂÙ·Ó¿ÛÙÂ˘Û‹ ÙÔ˘˜. H ¤ÎÊÚ·ÛË ·˘Ù‹ ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ ÙˆÓ ÚÔ·-

Ó·ÊÂÚı¤ÓÙˆÓ Î˘ÙÙ¿ÚˆÓ Û˘Ì›ÙÂÈ ¯ÚÔÓÈÎ¿ ÌÂ ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎﬁÏÏËÛË˜ ÙˆÓ ÂÓ‰ÔıËÏÈ·-

ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ·ÁÁÂ›ˆÓ Î·È Û˘Ì‚¿ÏÏÂÈ ¤ÙÛÈ ÛÙË

ÌÂÙ·Ó¿ÛÙÂ˘ÛË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (4).

T· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ ÌÔÚÂ› Ó· ·ÔÎfiÙÔÓÙ·È

·ﬁ ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ÌÂÌ‚Ú¿ÓË Î·È Ó· Î˘ÎÏÔÊÔÚÔ‡Ó

ÛÙÔÓ ÔÚfi ÌÂ ÙË ÌÔÚÊ‹ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ. H Ì¤ıÔ‰Ô˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÛÙÔÓ ÔÚfi ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜, ÙfiÛÔ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÏÂÔÓÂÎÙÂ› ¤Ó·ÓÙÈ ÙË˜ ÌÂıfi‰Ô˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÛÂ Î˘ÙÙ·ÚÈÎfi Â›Â‰Ô ÁÈ·Ù› Â›Ó·È ÈÔ ·Ï‹ Î·È ÁÚ‹ÁÔÚË (3,4). ™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂÏ¤ÙË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ (sICAM-1 Î·È sVCAM-1) ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ ÌÂ ™E§ Î·È Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ÂÈ¤‰ˆÓ ·˘ÙÒÓ ÛÂ Û¯¤ÛË ÌÂ ÙË ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘.

YÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ H ÌÂÏ¤ÙË ÂÚÈÏ¿Ì‚·ÓÂ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ A Î·È

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

™E§™˘ÛÙËÌ·ÙÈÎﬁ˜ EÚ˘ıËÌ·ÙÒ‰Ë˜ §‡ÎÔ˜

CICK˘ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÔÛÔÛ˘ÌÏ¤ÁÌ·Ù· (circulating immunocomplex)

sIL-2R‰È·Ï˘Ùﬁ˜ ˘Ô‰Ô¯¤·˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 2

sICAM-1soluble intercellular adhesion molecule 1

sVCAM-1soluble vascular cell adhesion molecule 1

H ÂÎÙ›ÌËÛË ÙË˜ ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ ÔÌ¿‰·˜ A ÁÈÓfiÙ·Ó ÌÂ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ÎÚÈÙ‹ÚÈ· Ô˘ Î·Ù·ÁÚ¿ÊÔÓÙ·Ó ÛÂ ÂÈ‰ÈÎfi

Î·Ù¿ ÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙËÓ ÎÏÈÓÈÎ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔÓ Ì‹Ó· ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›·, ÂÓÒ ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜

ÙË˜ ÓfiÛÔ˘ Î·È ÓÔÛËÏÂ‡ÔÓÙ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ Ì›· ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰·. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ·Ì‚¿ÓÔÓÙÔ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔÓ Ì‹Ó· ·fi Î¿ıÂ ·ÛıÂÓ‹ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. O ·ÚÈıÌfi˜ ‰ÂÈÁÌ¿ÙˆÓ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡ÛÂ ÛÂ Î¿ıÂ ·ÛıÂÓ‹ Î·Ù¿ Ì¤ÛÔ fiÚÔ ‹Ù·Ó 22 (·fi 14 ¤ˆ˜ 68 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜). K·Ù¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ¯ÔÚËÁÂ›ÙÔ ÎÔÚÙÈ˙fiÓË ÛÂ ‰fiÛË 1 mg/Kg ËÌÂÚËÛ›ˆ˜ ÌÂ ‹ ¯ˆÚ›˜ ·˙·ıÂÈÔÚ›ÌË. MÂÙ¿ ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ¿Ú¯È˙Â Ë ÛÙ·‰È·Î‹ ÌÂ›ˆÛË ÙË˜ ÎÔÚÙÈ˙fiÓË˜.

B. H ÔÌ¿‰· A ·ÔÙÂÏÂ›ÙÔ ·fi 8 ·È‰È¿, 2 ·ÁfiÚÈ· Î·È 6 ÎÔÚ›ÙÛÈ· Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛË˜ ÙÔ˘ ™E§ (1). H Ì¤ÛË ËÏÈÎ›· ÙÔ˘˜ ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó 8,1 ¯ÚfiÓÈ· (‰È·Î‡Ì·ÓÛË 18 ÌËÓÒÓ - 14 ¯ÚÔÓÒÓ). O ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì¿ÓıËÎÂ ·fi 5 Ì‹ÓÂ˜ ¤ˆ˜ 4 ¯ÚfiÓÈ·. H ÔÌ¿‰· B ·ÔÙÂÏÂ›ÙÔ ·fi 16 ·È‰È¿ ÙË˜ È‰›·˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘ ÌÂ ·˘Ù¿ ÙË˜ ÔÌ¿‰·˜ A, ÒÛÙÂ Ó· ·ÓÙÈÛÙÔÈ¯Ô‡Ó 2 ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ B ÛÂ 1 ÙË˜ ÔÌ¿‰·˜ A.

OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÌÂÙÚ‹ıËÎ·Ó Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‹Ù·Ó Ë TKE, Ë C ·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË (CRP), Ù· ÎÏ¿ÛÌ·Ù· C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, Ù· Î˘ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÔÛÔÛ˘ÌÏ¤ÁÌ·Ù· (circulating immunocomplex, CIC), Ù· Â›Â‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 2 (sIL-2R), Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ (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 ÌÂ ÙËÓ Ì¤ıÔ‰Ô ÙË˜ ÓÂÊÂÏÔÌÂÙÚ›·˜, ÂÓÒ Ù· CIC, Ô ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ sIL-2R Î·È Ù· ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ sICAM-1 Î·È sVCAM-1 ÌÂ ÙËÓ Ì¤ıÔ‰Ô ELISA. ™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË: ÁÈ· ÙËÓ Û‡ÁÎÚÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·Ó¿Ï˘ÛË ÙÔ˘ x2, student's t test. H ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ ıÂˆÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ fiÙ·Ó ÙÔ P<0,05. °È· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂÙ·Í‡ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Î·Ù¿ Pearson Û˘Û¯¤ÙÈÛË. ¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85¢È·Ï˘Ù¿

AÔÙÂÏ¤ÛÌ·Ù· H Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sIL-2R, ÙˆÓ CIC, ÙË˜ CRP, ÙˆÓ C3 Î·È C4 Î·È ÙˆÓ sICAM-1, sVCAM-1 Î·ıÒ˜ Â›ÛË˜ Î·È Ë TKE ÛÙËÓ ÔÌ¿‰· A, ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ Î·È ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ÂÎÂ›Ó· ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜

B (¶›Ó·Î·˜ 1). H ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-

Î‹ (p<0,001). MﬁÓÔ ÛÂ 2 ·ÛıÂÓÂ›˜ ÙË˜ ÔÌ¿‰·˜ A Ë ÙÈÌ‹ ÙË˜ CRP ‹Ù·Ó ÂÓÙﬁ˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ.

K·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·Ù·ÁÚ¿ÊËÎ·Ó 7 ˘ÔÙÚÔ¤˜ ÙË˜ ÓﬁÛÔ˘ Ô˘ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó ÌÂ ·ÚÔ˘Û›· ÏÔ›ÌˆÍË˜.

OÈ ÙÈÌ¤˜ ÙË˜ TKE, ÙË˜ CRP Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÛÙËÓ ‡ÊÂÛË, ÚÈÓ ÙËÓ

ÂÎ‰‹ÏˆÛË ÙË˜ ˘ÔÙÚÔ‹˜, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ˘ÔÙÚÔ‹˜ Î·È ÛÙÔ˘˜ ÚÒÙÔ˘˜ 3 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ˘ÔÙÚÔ‹, Ê·›ÓÔÓÙ·È ÛÙ· Û¯‹Ì·Ù· 1 Î·È 2, ÂÓÒ Ù· Â›Â‰· ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÛÙÔ Û¯‹Ì· 3. ™Â 4 ·ÛıÂÓÂ›˜ 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 ÂÎÂ› ‰È·ÁÓÒÛıËÎÂ ÂÚÁ·ÛÙËÚÈ·Î¿ Ë ÚÒÈÌË ‰È·Ù·Ú·¯‹ ÙˆÓ C3 Î·È C4. OÈ ÙÈÌ¤˜ ÙˆÓ C3 Î·È C4 Î˘Ì¿ÓıËÎ·Ó ·ﬁ 0,12-0,95 Î·È ·ﬁ 0,06-0,15 ·ÓÙ›ÛÙÔÈ¯· ÛÙÔ˘˜ 4 ·˘ÙÔ‡˜ ·ÛıÂÓÂ›˜. ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜ ‰È·Ù·Ú¿¯ıË-

¶›Ó·Î·˜ 1. TKECRPCIC

⁄ÊÂÛË150,71 1Ì‹Ó· ÚÈÓ ÙËÓ ˘ÔÙÚÔ‹220,91,3 ÀÔÙÚÔ‹ ÙË˜ ÓﬁÛÔ˘1054,44,6 1 Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ıÂÚ·Â›·˜6513,1 2 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ıÂÚ·Â›·˜320,82,2 3 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ıÂÚ·Â›·˜180,61,2

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

ÌÂ ÚÔËÁÔ˘Ì¤Óˆ˜. ¢È·ÈÛÙÒıËÎÂ ÈÛ¯˘Ú‹ ÁÚ·ÌÌÈÎ‹

Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ sIL-2R Î·È ÙˆÓ sICAM-1 (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛË˜ Î·Ù¿ Pearson, r=0,892) Î·-

ıÒ˜ Â›ÛË˜ Î·È ÌÂÙ·Í‡ ÙˆÓ sIL-2R Î·È ÙˆÓ sVCAM-1 (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛË˜ Î·Ù¿ Pearson r=0,914).

™˘˙‹ÙËÛË

H ·˘ÍËÌ¤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ B ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ Â›Ó·È ÙÔ Î‡ÚÈÔ ÛËÌÂ›Ô ÛÙËÓ ÂÓÂÚÁfiÙËÙ· ÙË˜ ÓfiÛÔ˘. ¶·ÚfiÏ· ·˘Ù¿ Û‹ÌÂÚ· ÈÛÙÂ‡ÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ·˘ÍËÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÙˆÓ T ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, Ë ÔÔ›· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË

ÙˆÓ B ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (1). OÈ sIL-2R ÂÎÊÚ¿˙ÔÓÙ·È

ÛÙ· ÂÓÂÚÁÔÔÈËÌ¤Ó· T-ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ·ﬁ ·˘Ù¿

·ÂÏÂ˘ıÂÚÒÓÔÓÙ·È (5). H ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ÂÈ-

¤‰ˆÓ ·˘ÙÒÓ, Ô˘ ·Ú·ÙËÚ‹ıËÎÂ ÛÙËÓ ·ÚÔ‡Û· ÂÚ-

Á·Û›·, ÚÈÓ ÙËÓ ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ ˘ÔÙÚÔ‹˜

ÙË˜ ÓﬁÛÔ˘ Û˘ÌÊˆÓÂ› ÌÂ ÙËÓ ¿Ô„Ë ÙˆÓ ÂÚÂ˘ÓËÙÒÓ

ﬁÙÈ ·˘Í¿ÓÔ˘Ó ÛÂ ·ÚÈıÌﬁ Ù· ÂÓÂÚÁÔÔÈËÌ¤Ó· T-ÏÂÌ-

ÊÔÎ‡ÙÙ·Ú· (5,6).

™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÂÚÁ·Û›·˜ ÔÈ

ÛËÌ·ÓÙÈÎ¤˜ ·˘Í‹ÛÂÈ˜ ÙˆÓ ÙÈÌÒÓ ÙˆÓ sIL-2R ÛÙÔÓ ÔÚﬁ 85% ÙˆÓ ·ÛıÂÓÒÓ, ÂÎ‰ËÏÒıËÎ·Ó Ï›ÁÔ ·ÚÁﬁÙÂÚ·

¯ÚÔÓÈÎ¿, ·ﬁ ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ C3 /C4.

TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ, Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ·

ÙË˜ ÂÓÂÚÁﬁÙËÙ·˜ ÙË˜ ÓﬁÛÔ˘, Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ T

ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ, ÌÔÚÂ› Ó· Â›Ó·È Â·ÎfiÏÔ˘ıÔ ÌÈ·˜ ÁÂÓÈÎfiÙÂÚË˜ ÂÓÂÚÁÔÔ›ËÛË˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂ

ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜.

O ÚÔÛ‰ÈÔÚÈÛÌﬁ˜ ÏÔÈﬁÓ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ sIL-

2R ÛÙÔÓ ÔÚﬁ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ™E§, ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·, Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÙË˜ ˘ÔÙÚÔ‹˜ ÙË˜ ÓﬁÛÔ˘ ÚÈÓ ÙËÓ ÎÏÈÓÈÎ‹ ÙË˜ ÂÎ‰‹ÏˆÛË Î·È ·ÔÙÂÏÂ› Â˘·›ÛıËÙÔ ‰Â›ÎÙË ·Ú·ÎÔÏÔ‡ıËÛË˜

ÙË˜ ÔÚÂ›·˜ ÙË˜ ÓﬁÛÔ˘. O ‰Â›ÎÙË˜ ·˘Ùﬁ˜ ¤¯ÂÈ ÙÔ ÏÂ-

ÔÓ¤ÎÙËÌ· ﬁÙÈ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹ÁÔÚ·.

T· ÂÓÂÚÁÔÔÈËÌ¤Ó· ÏÂÌÊÔÎ‡ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó

ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ (ICAM1) Ô˘ ÌÂ Î¿ÔÈÔ ¿ÁÓˆÛÙÔ ÌË¯·ÓÈÛÌfi ·ÔÎfiÙÔÓÙ·È ·fi ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ÌÂÌ‚Ú¿ÓË Î·È Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔÓ ÔÚfi ÌÂ ÙËÓ ÌÔÚÊ‹ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ (7,8). T·˘Ùfi¯ÚÔÓ· ÌÂ Ù· ÂÓÂÚÁÔÔÈËÌ¤Ó· ÏÂÌÊÔÎ‡ÙÙ·Ú· ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Î·È Ù· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· ÙˆÓ ·ÁÁÂ›ˆÓ Î·È ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ (VCAM-1) ‰ÈÂ˘ÎÔÏ‡ÓÔÓÙ·˜ ¤ÙÛÈ Ù· ÚÒÙ· Ó· Î˘Ï‹ÛÔ˘Ó ¿Óˆ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁÂ›ˆÓ. T· ·ÁÁÂ›· ‰ÈÂ˘Ú‡ÓÔÓÙ·È Î·È ÂÈÙÚ¤Ô˘Ó ÛÙ·

ÏÂÌÊÔÎ‡ÙÙ·Ú· Ó·

·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·. H ÈÛ¯˘Ú‹ ÁÚ·ÌÌÈÎ‹ Û˘Û¯¤ÙÈÛË Ô˘ ‰È·ÈÛÙÒıËÎÂ ÌÂÙ·Í‡ 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 ÌÂ ·˘Ù‹ ÙˆÓ T-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ÚÈÓ ·ÎfiÌË ÂÎ‰ËÏˆıÂ› ÎÏÈÓÈÎ¿ Ë ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘. ™˘ÌÂÚ·›ÓÔ˘ÌÂ 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 ÌÂ ™E§ ÛÂ ÔÛÔÛÙfi 55% Î·È 85% ·ÓÙ›ÛÙÔÈ¯·, ÚÈÓ ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ ˘ÔÙÚÔ‹˜ ÙË˜ ÓfiÛÔ˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÓÂÚÁÔÔ›ËÛË˜ ÙˆÓ T ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÙ· Ï·›ÛÈ·

ÁÂÓÈÎﬁÙÂÚË˜ ÂÓÂÚÁÔÔ›ËÛË˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H Û˘ÛÙËÌ·ÙÈÎ‹ ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·Ú·¿Óˆ

ÛÙÔÓ ÔÚﬁ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ™E§, ÌÔÚÂ› Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ˘ÔÙÚÔ‹˜

ÓﬁÛÔ˘. T· Â›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‡ıËÛË˜ ÙË˜ ÓﬁÛÔ˘ Î·È

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

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.

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›· ¤ÁÎÚÈÛË˜: 25-06-99

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ˆÚÔı¤· K·ÙÚÈÔ‡ ¶. AÓÙˆÓ›Ô˘ 9

54632 £ÂÛÛ·ÏÔÓ›ÎË

International Committee of Medical Editors: Uniform Requirements for Manuscripts Submitted to Biomedical Journals, 1997.(1)

ii.

iv.

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ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜

•ÂÓÔ‰Ô¯Â›Ô Divani Caravel

OÚÁ¿ÓˆÛË-°Ú·ÌÌ·ÙÂ›·

C&C International A.E.

TËÏ: 01 6889100, Fax: 01 6844777

e-mail: congress@cnc.gr

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

xvii

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

Î·È ·È‰ÈÎfi˜ ÓÂ‡ÌÔÓ·˜ ¢ÈÔÚÁ¿ÓˆÛË:∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· ∞ÈÁ›‰·:∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ™˘ÌÌÂÙÔ¯‹:∂ÏÏËÓÈÎ‹ ¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· ∂Î·È‰Â˘ÙÈÎfi ∫¤ÓÙÚÔ ∞ÁÚÔÙÈÎ‹˜ ∆Ú¿Â˙·˜, ∫·ÛÙÚ› (∂Ï. µÂÓÈ˙¤ÏÔ˘ 154 & ∞ÓÙÈÁfiÓË˜, ¡. ∂Ú˘ıÚ·›·) ¶ÏËÚÔÊÔÚ›Â˜:∫ÒÛÙ·˜ ¡. ¶Ú›ÊÙË˜ ∆ËÏ.: 80 36 484, fax: 61 31 173

¶∞π¢OæÀÃπ∞∆ƒπ∫∏ ∂∆∞πƒπ∞ ∂§§∞¢O™ HELLENIC SOCIETY OF CHILD & ADOLESCENT PSYCHIATRY

ªÂÙ¿ ÙÈ˜ ·Ú¯·ÈÚÂÛ›Â˜ Ô˘ ¤ÁÈÓ·Ó ÛÙÈ˜ 15.10.1999, ÙÔ ÓÂÔÂÎÏÂÁ¤Ó ¢.™. Î·Ù¿ ÙËÓ ÚÒÙË Û˘ÓÂ‰Ú›·Û‹ ÙÔ˘ Î·Ù¿ ÙÈ˜ 5.11.1999, Û˘ÁÎÚÔÙ‹ıËÎÂ ÛÂ ÛÒÌ· ˆ˜ ÂÍ‹˜:

¶ÚfiÂ‰ÚÔ˜:∂ÈÚ‹ÓË ∆Û·Ó›Ú· ∞ÓÙÈÚfiÂ‰ÚÔ˜:¢ËÌ‹ÙÚÈÔ˜ °ÂˆÚÁÈ¿‰Ë˜ °Ú·ÌÌ·Ù¤·˜:™Ù˘ÏÈ·Ófi˜ ÃÚÈÛÙÔÁÈÒÚÁÔ˜ ∆·Ì›·˜:∞ÈÎ·ÙÂÚ›ÓË Ã¿ÚË ª¤ÏÔ˜:πˆ¿ÓÓ· ∫·Ú·ÁÈ·ÓÓ¿ÎË ª¤ÏÔ˜:∂˘ÁÂÓ›· ™Ô˘Ì¿ÎË ª¤ÏÔ˜:¢ËÌ‹ÙÚÈÔ˜ ª·ÁÚÈÏ‹˜ °È· ÙÔ ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ

∏ ¶ÚfiÂ‰ÚÔÕ °ÂÓ. °Ú·ÌÌ·Ù¤·˜ TÛ·Ó›Ú· ∂ÈÚ‹ÓËÃÚÈÛÙÔÁÈÒÚÁÔ˜ ™Ù˘ÏÈ·Ófi˜

™YNTOMO°PAºIE™ - (Abbreviations)

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

AIDS

AMP, ADP, ATP

ATPase cal

CSF ‹ ENY

CNS ‹ ∫¡™ cm

CoA cmÑ cm2 cAMP

ÆC CRP

DNA

ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA

ESR ‹ ∆∫∂ EDTA g Hct

Hb HLA 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

PCO2

PO2 p

EÏÏËÓÈÎÔ› ﬁÚÔÈ Û‡Ó‰ÚÔÌÔ

ÌÔÓÔ-,

‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜

ıÂÚÌ›‰·

ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚﬁ

ÎÂÓÙÚÈÎﬁ ÓÂ˘ÚÈÎﬁ Û‡ÛÙËÌ·

ÂÎ·ÙÔÛÙﬁ

Û˘Ó¤Ó˙˘ÌÔ ∞

Î˘‚ÈÎﬁ ÂÎ·ÙÔÛÙﬁ

ÙÂÙÚ·ÁˆÓÈÎﬁ ÂÎ·ÙÔÛÙﬁ

Î‡ÎÏÈÎﬁ AMP

‚·ıÌﬁ˜ KÂÏÛ›Ô˘

C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË

‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎﬁ ÔÍ‡

ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·

ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·

¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚfiÊËÛË˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi ÔÍ‡

ÁÚ·ÌÌ¿ÚÈo

·ÈÌ·ÙÔÎÚ›ÙË˜

·ÈÌÔÛÊ·ÈÚ›ÓË

·ÓÙÈÁﬁÓÔ ÈÛÙÔÛ˘Ì‚·ÙﬁÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓË

ÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜

‰ÈÂıÓ‹˜ ÌÔÓ¿‰·

ÂÓ‰ÔÌ˘˚Î¿

ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿

ÂÓ‰ÔÊÏ¤‚È· Ï›ÙÚÔ(·)

ÏÔÁ¿ÚÈıÌÔ˜

ÁÚ·ÌÌÔÌﬁÚÈÔ

ÌÔÚÈ·Îﬁ ‚¿ÚÔ˜

Ì¤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ

Ì¤ÛÔ˜ ﬁÁÎÔ˜ ÂÚ˘ıÚÒÓ

·ÁÁÂÏÈÔÊﬁÚÔ˜ RNA

Ì¤ÙÚÔ

ÏÂÙﬁ ·ÚÈıÌﬁ˜

ÓÂ˘ÙÒÓÈÔ

ÌË ÛËÌ·ÓÙÈÎﬁ

ÔÛÌÒÏÈÔ Â› ÙÔÈ˜ ÂÎ·Ùﬁ ·Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË

AÁÁÏÈÎÔ› ﬁÚÔÈ acquiredimmunodeficiency 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

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE U ™˘Ó‰˘·˙ﬁÌÂÓ·

tera- (1012) giga- (109) mega-(106) kilo- (103) hecto(102) deca (101) deci (10-1) centi- (10-2) milli(10-3) micro (10-5) nano (10-9) pico (10-12) femto (10-15) atto (10-18)

AÁÁÏÈÎÔ› ﬁÚÔÈ EÏÏËÓÈÎÔ› ﬁÚÔÈ

ÙÔ ÛÙﬁÌ·

Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈÎ‹

by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit ·ﬁ