Παιδιατρική | Τόμος 63 • Τεύχος 4 • Ιούλιος - Αύγουστος 2000

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA AºIEPøMA: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000 265 H ÓÂÔÁÓÔÏÔÁ›· ÛÙËÓ ·Ó·ÙÔÏ‹ Ù˘ ÙÚ›Ù˘ ¯ÈÏÈÂÙ›·˜

319 BPAXEIA ¢HMO™IEY™H EÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Û ‚Ú¤ÊË

M. •¿ÓıÔ˘

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268 H Ïԛ̈ÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ÛÙ· ·È‰È¿ 322 EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™ IÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· Û ·ÛıÂÓ‹ Ì ΢ÛÙÈ΋ ›ÓˆÛË

E. PÒÌ·-°È·ÓÓ›ÎÔ˘

272 H ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜

TOMO™ 63 ●

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™. NÙÔ˘ÓÙÔ˘Ó¿Î˘, A. ZËÛÔ‡ÏË, A. §Ô˘Ú›‰·, E. PÒÌ·-°È·ÓÓ›ÎÔ˘, N. M·ÓˆÏ¿ÎË

°. KÔÙÙ·Ú›‰Ë

326 Ÿ„ÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi: ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·

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275 AP£PO ™YNTA•H™ H ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ›

O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘, M. Z·Ú›ÊË, I. OÈÎÔÓÔÌ›‰Ë˜, A. •˘ÔÏ˘Ù¿-Z·¯·ÚÈ¿‰Ë

M.A. M·ÁÈ¿ÎÔ˘, °.¶. XÚÔ‡ÛÛÔ˜

278 ANA™KO¶H™H ™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË: ¢ÈηÈÔÏÔÁÂ›Ù·È ·ÎfiÌË Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜;

330 ™YNEXIZOMENH EK¶AI¢EY™H AÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙ· ·È‰È¿ M.°. ¶··‰¿ÎË, I. ™. K·ÛηڤÏ˘

X. K·Ó·Î¿-Gantenbein

337 ¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY TÚÔ¯·›· ·Ù˘¯‹Ì·Ù· - O‰ËÁ›Â˜ ÚfiÏ˄˘ 287 EPEYNHTIKE™ EP°A™IE™ E›‰· ·Ú·ÁfivÙˆv ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂv›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜" K. ™o‡ÏË, E. ¶Ï·ÙoÎo‡ÎË, E. ¶··ÎˆvÛÙ·vÙ›vo˘, E. MȯÂϷοÎË, ™. AÚÒvË

K.£. TÛÔ˘Ì¿Î·˜

339 I™TOPIA TH™ E§§HNIKH™ ¶AI¢IATPIKH™ ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ- ¶ÔÚ›· 39 ÂÙÒÓ X. TÛÂÁ΋

292 ¶ÚˆÙfiÎÔÏÏÔ ¤ÁηÈÚ˘ ÂÏÂÁ¯fiÌÂÓ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿ °. MÚÈ·ÛÔ‡Ï˘, N. Z¿‚Ú·˜, M. N·ÚÏ›ÔÁÏÔ˘, A. X·Ù˙‹˜

342 E¶π™∆O§Œ˜ ¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ £. ¶ÂÚÚ¿Î˘ ¶.¢. §··ÙÛ¿Ó˘ ¡. ª·ÙÛ·ÓÈÒÙ˘

302 ¢È·ÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÛÙ· ÓÂÔÁÓ¿: ÂÎÙ›ÌËÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ A.E. M·ÚÁÂÙ¿Î˘, X. TÚ¿·ÏË, ¢. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜, °. °ÚËÁÔÚÈ¿‰Ô˘, N. I·Îˆ‚›‰Ô˘, °. KÔ˘Ú¿Î˘, H. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜

347 ¶AI¢IATPIKH ENHMEPø™∏ ∂. µ·Ï¿ÛÛË-∞‰¿Ì

309 E›‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ·fi Candida albicans ¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

I. §·Ì·‰·Ú›‰Ë˜, E. ¢ËÌËÙÚ›Ô˘, M. £ÂÔ‰ˆÚ¿ÎË, A. X›˙·, M. ™·‚‚¿Ï·, E. MȯÂϷοÎË

314 §ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Û ·È‰È¿

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™‡Ì‚Ô˘ÏÔÈ ∂Ù·ÈÚÂÈÒÓ ¶·È‰È·ÙÚÈÎÒÓ ÀÔÂȉÈÎÔÙ‹ÙˆÓ ™. °Ú·Ê¿ÎÔ˜ ∞ÈÌ·ÙÔÏÔÁ›·-OÁÎÔÏÔÁ›· ∂. ƒÒÌ· °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· µ. ™ËÏÈÒÙË ∂Ó‰ÔÎÚÈÓÔÏÔÁ›· µ. £·ÓfiÔ˘ÏÔ˜ ∫·Ú‰ÈÔÏÔÁ›· ∂. ¶ÂÙÚ›‰Ô˘ ∫ÔÈÓˆÓÈ΋ ¶·È‰È·ÙÚÈ΋ ª. •¿ÓıÔ˘ ¡ÂÔÁÓÔÏÔÁ›· ∫. ™ÙÂÊ·Ó›‰Ë˜ ¡ÂÊÚÔÏÔÁ›· §. ¶··ÁÈ·ÓÓÔ‡ÏË ¶·È‰Ô‰ÔÓÙÈ·ÙÚÈ΋ ∞. ¶··‚·ÛÈÏ›Ԣ ¶·È‰ÔÓ¢ÚÔÏÔÁ›· π. ∆۷ӿη˜ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁ›·

Consultants, Paediatric Subspecialty Societies S. Grafacos Haematology-Oncology E. Roma Gastroenterology V. Spilioti Endocrinology V. Thanopoulos Cardiology E. Petridou Social Paediatrics M. Xanthou Neonatology K. Stefanidis Nephrology L. Papagianouli Paedodontics A. Papavassiliou Neurology J. Tsanakas Pneumonology

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

HELLENIC PAEDIATRIC SOCIETY

¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 4Ô πÔ‡Ï.-∞˘Á. 2000

Volume 63, No. 4, Jul-Aug. 2000

¶EPIEÃOMENA

CONTENTS ™ÂÏ.

AºIEPøMA: YÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

Page

SPECIAL SERIES: Children's Health 2000

H ÓÂÔÁÓÔÏÔÁ›· ÛÙËÓ ·Ó·ÙÔÏ‹ Ù˘ ÙÚ›Ù˘ ¯ÈÏÈÂÙ›·˜ M. •¿ÓıÔ˘

Neonatology at the dawn of the third millenium 265

H Ïԛ̈ÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ÛÙ· ·È‰È¿ E. PÒÌ·-°È·ÓÓ›ÎÔ˘

M. Xanthou

265

Helicobacter pylori infection in children E. Roma-Yiannikou

268

268

H ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜

The family and care of the child with disability

°. KÔÙÙ·Ú›‰Ë

Y. Kottaridi

272

272

AP£PO ™YNTA•H™

EDITORIAL

H ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ›

The use of growth hormone in the treatment of short stature in Turner syndrome

M.A. M·ÁÈ¿ÎÔ˘, °.¶. XÚÔ‡ÛÛÔ˜

M.A. Magiakou, G.P. Chroussos

275

275

ANA™KO¶H™H

REVIEW ARTICLE

™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË: ¢ÈηÈÔÏÔÁÂ›Ù·È ·ÎfiÌË Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜;

Turner syndrome and growth hormone: Is the initial enthusiasm justified?

X. K·Ó·Î¿-Gantenbein

C. Kanaka-Gantenbein

278

EPEYNHTIKE™ EP°A™IE™

ORIGINAL PAPERS

E›‰· ·Ú·ÁfivÙˆv ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂv›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜"

Haemostatic factors in patients with galactosaemia on soybean diet

K. ™o‡ÏË, E. ¶Ï·ÙoÎo‡ÎË, E. ¶··ÎˆvÛÙ·vÙ›vo˘, E. MȯÂϷοÎË, ™. AÚÒvË

K. Schulpis, E. Platokouki, E. Papakonstantinou, E. Michelakakis, S. Aroni

287

278

287

¶ÚˆÙfiÎÔÏÏÔ ¤ÁηÈÚ˘ ÂÏÂÁ¯fiÌÂÓ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿

Optimized enteral feeding in critically ill children; a prospective study in a paediatric intensive care unit

°. MÚÈ·ÛÔ‡Ï˘, N. Z¿‚Ú·˜, M. N·ÚÏ›ÔÁÏÔ˘, A. X·Ù˙‹˜

G. Briassoulis, N. Zavras, M. Narlioglou, T. Hatzis

292

¢È·ÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÛÙ· ÓÂÔÁÓ¿: ÂÎÙ›ÌËÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ A.E. M·ÚÁÂÙ¿Î˘, X. TÚ¿·ÏË, ¢. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜, °. °ÚËÁÔÚÈ¿‰Ô˘, N. I·Îˆ‚›‰Ô˘, °. KÔ˘Ú¿Î˘, H. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜

A. Margetakis, C.Trapali, D. Georgakopoulos, G. Grigoriadou, N. Iakovidou, G. Kourakis, H Dellagrammaticas

302

Chitotriosidase levels in Candida albicans infection J. Labadaridis, E. Dimitriou, M. Theodoraki, A. Hiza, M. Savala, H. Michelakakis

309

309

§ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Û ·È‰È¿ ¶. ™˘Ú›‰Ë˜, E. M·ÏÙ¤˙Ô˘, ¢. K·ÊÂÙ˙‹˜

Transoesophageal pacing in neonates: Estimation of the appropriate site of minimum pacing threshold

302

E›‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ·fi Candida albicans I. §·Ì·‰·Ú›‰Ë˜, E. ¢ËÌËÙÚ›Ô˘, M. £ÂÔ‰ˆÚ¿ÎË, A. X›˙·, M. ™·‚‚¿Ï·, E. MȯÂϷοÎË

292

Non-tuberculous mycobacterial lymphadenitis in children 314

™˘Ó¯›˙ÔÓÙ·È

P. Spyridis, H. Maltezou, D. Kafetzis

314

Continued

iii

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

HELLENIC PAEDIATRIC SOCIETY

¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 4Ô πÔ‡Ï.-∞˘Á. 2000

Volume 63, No. 4, Jul-Aug 2000

™ÂÏ.

Page

BPAXEIA ¢HMO™IEY™H

SHORT REPORT

EÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Û ‚Ú¤ÊË

A study of ventricular septal defects in the first year of life

A. TÛÈÏÈÌÈÁοÎË, A. M·ÓÔ˘Ú¿, £. TÛÂÎÔ˘Ú¿, B. AÁÁÂÏ¿ÎÔ˘, A. ™¯ÔÈÓ¿ÎË, ¶. ™Ù·ÛÈÓfi˜, §. ¶ÏÔ˘Ì›‰Ë˜ 319

A. Tsilimingaki, A. Manoura, T. Tsekoura, V. Agelakou, A. Schoinaki, P. Stasinos, L. Ploumidis

EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™

CASE REPORTS

IÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· Û ·ÛıÂÓ‹ Ì ΢ÛÙÈ΋ ›ÓˆÛË

Fibrosing colonopathy in cystic fibrosis

™. NÙÔ˘ÓÙÔ˘Ó¿Î˘, A. ZËÛÔ‡ÏË, A. §Ô˘Ú›‰·, E. PÒÌ·-°È·ÓÓ›ÎÔ˘, N. M·ÓˆÏ¿ÎË

322

Ÿ„ÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi: ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘, M. Z·Ú›ÊË, I. OÈÎÔÓÔÌ›‰Ë˜, A. •˘ÔÏ˘Ù¿-Z·¯·ÚÈ¿‰Ë

S. Doudounakis, A. Zissouli, A. Lourida, E. Roma-Giannicou, N. Manolaki

326

O. Papadaki-Papandreou, M. Zarifi, I. Oikonomidis, A. Xypolyta-Zachariadi

CONTINUING MEDICAL EDUCATION

AÎÙÈÓÔÏÔÁÈ΋ ¢ÈÂÚ‡ÓËÛË Ù˘ °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ¶·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙ· ¶·È‰È¿

GastroÔesophageal reflux in children: methods of radiological evaluation 330

¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY

M. Papadaki, I. Kaskarelis

326

330

PAEDIATRICIAN'S PRACTICAL ADVICE TO PARENTS

TÚÔ¯·›· ·Ù˘¯‹Ì·Ù· - O‰ËÁ›Â˜ ¶ÚfiÏ˄˘ K.£. TÛÔ˘Ì¿Î·˜

322

Late intrauterine cytomegalovirus infection: clinical and imaging findings

™YNEXIZOMENH EK¶AI¢EY™H M.°. ¶··‰¿ÎË, I. ™. K·ÛηڤÏ˘

319

337

I™TOPIA TH™ E§§HNIKH™ ¶AI¢IATPIKH™

K.T. Tsoumakas

337

HISTORY OF HELLENIC PAEDIATRICS C. Tsegi

339

342

LETTERS

342

347

PAEDIATRIC NEWS

347

¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ- ¶ÔÚ›· 39 ÂÙÒÓ X. TÛÂÁ΋

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Forthcoming meetings

™˘ÓÙÔÌÔÁڷʛ˜

Abbreviations

iv

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·9

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

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

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

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

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

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

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

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

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

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

vii

JULY-AUG.2000

30-05-03

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 2931; New York: International Society of Chemotherapy, 1963:484-500. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: MÂÓ¤ÙÔ˘-M·Ú·ÓÙ›‰Ô˘ A. XÚËÛÈÌÔÔ›ËÛË ÔÏÏ·ÏÒÓ ÂȉÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÌÔÏ˘‚‰È¿Ûˆ˜ ÛÙÔ K.N.™. ·È‰ÈÒÓ (¢È‰·ÎÙ. ¢È·ÙÚ.). Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ 1988.

ÕÚıÚ· Û ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹: Morse SS. Factors in the emergence of infectious diseases.Emerg Infect Dis [serial online]1995 JanMar[cited 1996 June 5];1(1):[24 screens]. Available from: URL: http://www.cdc.gov/ncidod/EID/eid.htm ¶›Ó·Î˜ Î·È ÂÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜ ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

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

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

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H ÓÂoÁÓÔÏÔÁ›· ÛÙËÓ ·Ó·ÙÔÏ‹ Ù˘ ÙÚ›Ù˘ ¯ÈÏÈÂÙ›·˜ M·ÚȤÙÙ· •¿ÓıÔ˘ M. Xanthou. Neonatology at the dawn of the third millenium. Paediatriki 2000;63:265-267. ● Abstract: During the second half of the 20th century impressive progress was made in neonatology based on knowledge that was gained from research on the fetus and the newborn. With the help of the technological revolution which occurred at the same time, the first neonatal intensive care units were created. The neonatal morbidity and mortality rates fell dramatically during the following years and today 80% of the babies of BW<1000g survive, and only 8-15% of them develop major handicaps. The reduction of neonatal morbidity and mortality was due in part to the new methods of treatment and prophylaxis which were applied, including the administration of surfactant and high frequency ventilation to babies suffering from respiratory distress syndrome, the administration of i.v. lg and growth factors to increase neonatal host defense mechanisms against infections, and total parenteral nutrition. A second factor in improved survival comprises the improved methods of diagnosis. Today with the new methods of imaging and with the help of molecular biology, congenital illness can be diagnosed very early and even at the beginning of intrauterine life. Thirdly there has been improvement in the quality and organization of perinatal care. In Greece perinatal mortality has decreased considerably during the last 20 years, and this is of added importance as the birth rate during the same time period has been decreasing.

Key words: neonatology, intensive care, morbidity, mortality.

H ÚfiÔ‰Ô˜ ÛÙËÓ ÓÔÛËÏ›· ÙˆÓ ÓÂÔÁÓÒÓ ·ÔÙÂÏ› ¤Ó· ·fi Ù· ÈÔ ÛËÌ·ÓÙÈο ÂÈÙ‡ÁÌ·Ù· ÙÔ˘ 20Ô‡ ·ÈÒÓ·.

M¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ· ÚfiˆÚ· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ıˆÚÔ‡ÓÙ·Ó ·˘Ù¿ Ì B°<2500ÁÚ.Î·È ·fi ·˘Ù¿ ÙÔ 70% ¤ı·ÈÓ·Ó. TÔ 1900 Ô Pierre Budin ÛÙÔ ¶·Ú›ÛÈ Î·Ù·Û··Û ÙËÓ ÚÒÙË ıÂÚÌÔÎÔÈÙ›‰· Î·È ÂÈÛ‹Á·Á ÙÔ χÛÈÌÔ ÙˆÓ ¯ÂÚÈÒÓ ÚÈÓ ·fi ÙËÓ Â·Ê‹ Ì ÙÔ ÓÂÔÁ¤ÓÓËÙÔ. M ·˘Ù¿ Î·È ÌfiÓÔ Ù· ̤ÙÚ· ÌÂÈÒıËÎÂ Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ Ì B°<2500 ÁÚ. ÂÚ›Ô˘ ÛÙÔ 20%.

K·Ù¿ ÙÔ ÚÒÙÔ ‹ÌÈÛ˘ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, Ù›ÔÙ ÛËÌ·ÓÙÈÎfi ‰ÂÓ Û˘Ó¤‚Ë. K·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ‹ÌÈÛ˘ ÛËÌÂÈÒÓÂÙ·È ÌÈ· Ú·ÁÌ·ÙÈ΋ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔÒÚˆÓ Î·È ‚·ÚÈ¿ ¿ÚÚˆÛÙˆÓ ÓÂÔÁÓÒÓ. TÔ ÌÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ¿Ú¯ÈÛ Á‡Úˆ ÛÙ· 1950, fiÙ·Ó ÔÈ ÂÚ¢ÓËÙ¤˜ ÛÙÚ¿ÊËÎ·Ó ÛÙË ÌÂϤÙË Ù˘ Ê˘ÛÈÔÏÔÁ›·˜ Î·È Ê˘ÛÈÔ·ıÔÏÔÁ›·˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡. OÈ ÁÓÒÛÂȘ ·˘Ù¤˜, Ì·˙› Ì ÙËÓ ÌÂÁ¿ÏË Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô Ô˘ ¿ÓıÈ˙ Â›Û˘ ÂΛÓË ÙËÓ ÂÔ¯‹, Ô‰‹ÁËÛ ÛÙËÓ ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ÚÒÙˆÓ MÔÓ¿‰ˆÓ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ ÛÙËÓ ‰ÂηÂÙ›· 1960-1970. ŒÙÛÈ, ÂÓÒ Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ Ôχ ÌÈÎÚÒÓ ÚÔÒÚˆÓ Ì B°<1200 ÁÚ. ÚÈÓ ·fi ÙÔ 1970 ‹Ù·Ó Á‡Úˆ ÛÙÔ 80% ÌÂÙ¿ ÙÔ 1980 ¤ÂÛ ÛÙÔ 20%. ™Â ·˘Ùfi, ÂÎÙfi˜ ·fi ÙȘ MÔÓ¿‰Â˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ Û˘Ó¤‚·Ï·Ó ÛËÌ·ÓÙÈο Î·È Ó¤Â˜ ıÂÚ·¢ÙÈΤ˜ ̤ıÔ‰ÔÈ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ. ¶ÚÈÓ ·fi ÙÔ 1970 ÙÔ I‰ÈÔ·ı¤˜ ™‡Ó‰ÚÔÌÔ AÓ·Ó¢ÛÙÈ΋˜ ¢˘Û¯¤ÚÂÈ·˜ (I™A¢) ·ÔÙÂÏÔ‡Û ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Ù˘ ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘. H ·Ó·Î¿Ï˘„Ë Î·È ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (Surfactant) ÂÏ¿ÙÙˆÛ ÙËÓ ıÓËÛÈÌfiÙËÙ· ÙÔ˘ I™A¢ ηٿ 40% Î·È ÙȘ ÂÈÏÔΤ˜ ÙÔ˘ ηٿ 60% (1). TÂÏÂ˘Ù·›· Û˘ÓÈÛÙ¿Ù·È Ô ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁˆÓ Ó· ‰›‰ÂÙ·È fi¯È ÌfiÓÔ ıÂÚ·¢ÙÈο, ·ÏÏ¿ Î·È ÚÔÊ˘Ï·ÎÙÈο Û ÓÂÔÁ¤ÓÓËÙ· Ì ËÏÈΛ· ΢‹Ûˆ˜ <32 ‚‰ÔÌ¿‰ˆÓ Ù· ÔÔ›· ηٿ ÙËÓ ·Ó¿ÓË„Ë ¯ÚÂÈ¿˙ÔÓÙ·È ‰È·ÛˆÏ‹ÓˆÛË (2). O Û˘Ó‰˘·ÛÌfi˜ ¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÛÙË ÌËÙ¤Ú· ÚÔ ÙÔ˘ ÙÔÎÂÙÔ‡ Î·È ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙ· ÓÂÔÁÓ¿ ʤÚÓÂÈ Ù· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· (3).

OÈ Î·ÈÓÔ‡ÚÁȘ ̤ıÔ‰ÔÈ Ù¯ÓËÙÔ‡ ·ÂÚÈÛÌÔ‡, fiˆ˜ ·˘Ù¤˜ Ô˘ ·Ú¤¯ÔÓÙ·È Ì ·Ó·Ó¢ÛÙ‹Ú˜ ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ Ì ٷϷÓÙÒÛÂȘ ‹ ·ÂÚÈÒıËÛË Î·È ‰›‰Ô˘Ó 200-1200 ·Ó·ÓÔ¤˜/ÏÂÙfi, ‰ÂÓ ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· fiÙÈ

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ÛÒ˙Ô˘Ó ÓÂÔÁÓ¿ Ù· ÔÔ›· ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙÔÓ Û˘Ó‹ıË ·ÂÚÈÛÌfi(4).

H ¯Ú‹ÛË ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (NO) Ì·˜ ÚÔÛʤÚÂÈ ¿ÌÂÛË Î·È ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘. H ıÂÚ·›· Ì ˘„›Û˘¯ÓÔ Ù·Ï·ÓÙˆÛÈÎfi ·ÂÚÈÛÌfi Î·È Û˘Á¯ÚfiÓˆ˜ ÂÈÛÓÔ‹ NO, ‰›‰ÂÈ Ù· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Û ‚·ÚȤ˜ Ó¢ÌÔÓÈΤ˜ ˘ÂÚÙ¿ÛÂȘ (5).

T¤ÏÔ˜, Ë Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË Ì¤Ûˆ ÌÂÌ‚Ú¿Ó˘ (ECMO) Â›Ó·È Ë ÙÂÏÂ˘Ù·›· ̤ıÔ‰Ô˜ Ë ÔÔ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È fiÙ·Ó ¤¯Ô˘Ó ·ÔÙ‡¯ÂÈ fiϘ ÔÈ ÚÔ·Ó·ÊÂÚı›Û˜ ̤ıÔ‰ÔÈ, Ì ηϿ ·ÔÙÂϤÛÌ·Ù· ΢ڛˆ˜ fiÙ·Ó ·ÊÔÚ¿ ÓÂÔÁ¤ÓÓËÙ· Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 2000 ÁÚ. (6). ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ì›ˆÛË Ù˘ ˘„ËÏ‹˜ ÓÂÔÁÓÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÔÊ›ÏÔÓÙ·È Û ÛÔ‚·Ú¤˜ ÓÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ ¤¯Ô˘Ó ·›ÍÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÈ ÓÂÒÙÂÚ˜ ̤ıÔ‰ÔÈ ÂÓ›Û¯˘Û˘ ÙˆÓ ·ÓÔÛÔ‚ÈÔÏÔÁÈÎÒÓ ·Ì˘ÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ ÓÂÔÁÓÔ‡. OÈ ÏÔÈÌÒÍÂȘ ·ÎfiÌË Î·È Û‹ÌÂÚ· ·ÔÙÂÏÔ‡Ó Ì›· ·fi ÙȘ ·ÚȘ ·Èٛ˜ ÓÂÔÁÓÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Î·È È‰È·›ÙÂÚ· ÛÙȘ ˘fi ·Ó¿Ù˘ÍË ¯ÒÚ˜ Î·È ÛÙȘ MÔÓ¿‰Â˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ. T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¯ÔÚËÁÔ‡ÓÙ·È Û ÓÂÔÁ¤ÓÓËÙ· ÂÓ‰ÔÊϤ‚Ș ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ Î·È ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ·ÈÌÔÔÈËÙÈÎÔ› ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ì ÛÎÔfi ÙËÓ ÂÓ›Û¯˘ÛË ÙˆÓ ·Ì˘ÓÙÈÎÒÓ ÙÔ˘˜ Ì˯·ÓÈÛÌÒÓ.

OÈ ÂÓ‰ÔÊϤ‚Ș ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ (IVIG) ÚÔÛʤÚÔ˘Ó ·ÓÙÈÛÒÌ·Ù· ÛÙ· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ÙˆÓ ÔÔ›ˆÓ Ù· Â›‰· Â›Ó·È Ôχ ¯·ÌËÏ¿. £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÔÈ IV ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ÂÎÙfi˜ ·fi ÙËÓ ·ÓÙÈÏÔÈÌÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘˜ ¤¯Ô˘Ó Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË (7).

OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (G-CSF Î·È GM-CSF) ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ·ÏÏ¿ Î·È ÛÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘˜ (8). ŒÙÛÈ ÔÈ ÂÓ‰ÔÊϤ‚Ș ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ηıÒ˜ Î·È ÔÈ ·ÈÌÔÔÈËÙÈÎÔ› ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ fiÙ·Ó ‰›‰ÔÓÙ·È ıÂÚ·¢ÙÈο Û ÓÂÔÁÓÈΤ˜ ÛË„·È̛˜ ‹ ÚÔÊ˘Ï·ÎÙÈο ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ÏÔÈÌÒÍÂˆÓ ¤¯Ô˘Ó ‰ÒÛÂÈ Ôχ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (7,8).

T¤ÏÔ˜, ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› Ë ÌÂÁ¿ÏË Û˘Ì‚ÔÏ‹ Ù˘ ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ȉȷ›ÙÂÚ· ÛÙ· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÚfiˆÚ· ÓÂÔÁÓ¿. M ÙË ¯ÔÚ‹ÁËÛË ·ÌÈÓÔͤˆÓ Î·È ÏÈÒÓ ÂÓ‰ÔÊÏ‚›ˆ˜ ·fi ÙËÓ ÚÒÙË ÎÈfiÏ·˜ ̤ڷ Ù˘ ˙ˆ‹˜, ÂÈÙ‡¯ıËΠfi¯È ÌfiÓÔ Ë Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜, ·ÏÏ¿ ·˘Í‹ıËÎÂ Î·È Ë ÌÂÙ¤ÂÈÙ· Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ (9).

Afi ÙÔ 1990 Î·È ÌÂÙ¿, ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÓÂÔÁÓÒÓ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1000 ÁÚ. Î·È ‰È¿ÚÎÂÈ· ΢‹Ûˆ˜ ÛÙ· fiÚÈ· Ù˘ ‚ȈÛÈÌfiÙËÙ·˜ (23 Ì 24 ‚‰ÔÌ¿‰Â˜), ÂÈ˙Ô‡Ó. EÓÒ ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ Û‹ÌÂÚ· ‰ÈÏ·ÛÈ¿ÛÙËΠÊÙ¿ÓÔÓÙ·˜ ÙÔ 80%, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÛÔ‚·ÚÒÓ ·Ó·ËÚÈÒÓ ‰ÂÓ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÛÙ· ÂÈ˙‹Û·ÓÙ· ÓÂÔÁÓ¿ Î·È Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 8-15% (10-12). TÂÏÂ˘Ù·›Â˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ì ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ Ôχ ÌÈÎÚÒÓ ·˘ÙÒÓ ÓÂÔÁÓÒÓ ‰ÂÓ ·˘Í‹ıËÎÂ Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ·ÏÏ¿ ·˘Í‹ıËÎ·Ó Ë ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜, Ë Ì˘ˆ›· Î·È Ô ÛÙÚ·‚ÈÛÌfi˜. ¢È·ÈÛÙÒıËΠÂ›Û˘, fiÙÈ ÔÏÏ¿ ·fi Ù· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÛÙÔ Û¯ÔÏÂ›Ô Î·È ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚË ˘ÔÛÙ‹ÚÈÍË ÁÈ· Ó· ÌËÓ ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Úfi‚ÏËÌ· ÛÙË Û¯ÔÏÈ΋ ÙÔ˘˜ Â›‰ÔÛË.

H ÌË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÌÂÙ¤ÂÈÙ· ·Ó·ËÚÈÒÓ ÔÊ›ÏÂÙ·È, ÂÎÙfi˜ ·fi ÙË ¯Ú‹ÛË ÙˆÓ Ó¤ˆÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ, ÛÙËÓ ÔÚÁ¿ÓˆÛË Î·È ‚ÂÏÙ›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜. ™ÙË ¯ÒÚ· Ì·˜ ηٿ ÙËÓ 15ÂÙ›· 19831998 Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ˘Ô‰ÈÏ·ÛÈ¿ÛÙËÎÂ Î·È ¤ÊÙ·Û ÛÙÔ 10,5% (13). TÔ ÂӉȷʤÚÔÓ Î·È Ë ÂÓ·Û¯fiÏËÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ ·ÓÙÈηÙÔÙÚ›˙ÂÙ·È ÙfiÛÔ ÛÙÔ Ï‹ıÔ˜ ÙˆÓ ÂÏÏËÓÈÎÒÓ ‰ËÌÔÛȇÛÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÓÂÔÁÓ¿ ÛÙÔÓ ‰ÈÂıÓ‹ Î·È ÂÏÏËÓÈÎfi È·ÙÚÈÎfi Ù‡Ô (ÌfiÓÔ ÛÙ· ·È‰È·ÙÚÈο ÂÚÈÔ‰Èο, ÛÙË B¿ÛË EÏÏËÓÈ΋˜ BÈ‚ÏÈÔÁÚ·Ê›·˜ "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡" ·Ó·Ê¤ÚÔÓÙ·È 80 ‰ËÌÔÛȇÛÂȘ) fiÛÔ Î·È ·fi ÙÔ ÁÂÁÔÓfi˜ Ù˘ ·Ó·ÁÓÒÚÈÛ˘ ·fi ÙËÓ ¶ÔÏÈÙ›· ÂÍÂȉ›Î¢Û˘ ÙˆÓ ·È‰È¿ÙÚˆÓ Â› ‰ÈÂÙ›· ÛÙËÓ ÂÓÙ·ÙÈ΋ ÓÔÛËÏ›· ÓÂÔÁÓÒÓ. T¤ÏÔ˜, Ë Ì›ˆÛË ÙˆÓ ·Ó·ËÚÈÒÓ ÔÊ›ÏÂÙ·È ·ÎfiÌË ÛÙËÓ ¤ÁηÈÚË, Û˘¯Ó¿ ÂÓ‰ÔÌ‹ÙÚÈ·, ‰È¿ÁÓˆÛË ÓfiÛˆÓ, Ì ÙËÓ ‚Ô‹ıÂÈ· ÙˆÓ Ó¤ˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ ηıÒ˜ Î·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÂıfi‰ˆÓ ÚfiÏ˄˘ ÓÔÛËÚÒÓ Î·Ù·ÛÙ¿ÛˆÓ, fiˆ˜ ÂÁÎÂÊ·ÏÈÎÒÓ ‚Ï·‚ÒÓ, ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜, ·Ó·ÈÌÈÒÓ ÎÏ. ŒÙÛÈ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ˘ÔÍÈ΋˜ ÈÛ¯·ÈÌÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜, ¤¯Ô˘Ó ‰Ôı› Û ÓÂÔÁÓ¿ Ì ·ÛÊ˘Í›· Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ıÂÈÈÎfi Ì·ÁÓ‹ÛÈÔ, ‚ÈÙ·Ì›ÓË E Î·È ÙÒÚ· ÙÂÏÂ˘Ù·›· ·ÏÏÔÔ˘ÚÈÓfiÏË Î·È ÈÓ‰ÔÌÂı·Î›ÓË (14). OÈ ¤Ú¢Ó˜ ÛÙÔÓ ÙÔ̤· ·˘Ùfi Û˘Ó¯›˙ÔÓÙ·È. °È· ÙËÓ ÚÔʇϷÍË Ù˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ Û ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓÂÔÁ¤ÓÓËÙ· ‰›‰ÔÓÙ·È ÚÔÊ˘Ï·ÎÙÈο ÔÈ ‚Èٷ̛Ә A Î·È E (15). H ¯ÔÚ‹ÁËÛË ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ ·˘ÙÒÓ Ì·˙› Ì ÙËÓ ÎÚ˘ÔıÂÚ·›· Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÎÙ›ÓˆÓ Laser ¤¯Ô˘Ó ÂÏ·ÙÙÒÛÂÈ ÙËÓ Ù‡ÊψÛË.

T¤ÏÔ˜, ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ·Ó·ÈÌ›·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û‹ÌÂÚ· Ë ·Ó·Û˘Ó‰˘·Ṳ̂ÓË ÂÚ˘ıÚÔÔÈËÙ›ÓË Ë ÔÔ›· ¤¯ÂÈ ÂÏ·ÙÙÒÛÂÈ ÛËÌ·ÓÙÈο ÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜ ·ÎfiÌË Î·È Û ‚·ÚÈ¿ ¿Û¯ÔÓÙ· ÚfiˆÚ· (16).

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∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

E›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ Ì ÙËÓ ÂͤÏÈÍË Ù˘ ÂÈÛÙ‹Ì˘ fiÏÔ Î·È ÌÈÎÚfiÙÂÚÔ˘ ‚¿ÚÔ˘˜ Î·È ËÏÈΛ·˜ ΢‹Ûˆ˜ ÓÂÔÁÓ¿ ÂÈ˙Ô‡Ó. K·È ÙÔ ÛËÌ·ÓÙÈÎfi ÂÚÒÙËÌ· Ô˘ ·Ó·Î‡ÙÂÈ Â›Ó·È: Ô‡ ı· Ú¤ÂÈ Ó· ÛÙ·Ì·Ù‹ÛÔ˘Ì ÒÛÙ ӷ ÌËÓ ¤¯Ô˘Ì ÌÂÁ¿ÏË ·‡ÍËÛË ·Ó·ËÚÈÒÓ; ¶·ÏÈ¿ ϤÁ·Ì fiÙÈ ı· Ú¤ÂÈ Ó· ÛÙ·Ì·Ù‹ÛÔ˘Ì ÛÙ· 1500 ÁÚ. ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ·ÚÁfiÙÂÚ· ÛÙ· 1000 ÁÚ., Û‹ÌÂÚ· ıˆÚÂ›Ù·È ‚ÈÒÛÈÌÔ ¤Ó· ÓÂÔÁÓfi 500ÁÚ. Î·È ˘ÔÏÔÁ›˙ÂÙ·È ÛÙÔ˘˜ ÂÚÈÁÂÓÓËÙÈÎÔ‡˜ ı·Ó¿ÙÔ˘˜, ‰ËÏ·‰‹ ·ÎfiÌË ÎÈ ·Ó Âı¿ÓÂÈ ÂÓ‰ÔÌËÙÚ›ˆ˜. H ÁÂÓÈ΋ ÙÔÔı¤ÙËÛË Â›Ó·È fiÙÈ ·Ó ¤Ó· Ôχ ÌÈÎÚfi ̈Úfi "ı¤ÏÂÈ Ó· ˙‹ÛÂÈ" ¯ˆÚ›˜ Ó· ¤¯ÂÈ ‚·ÚȤ˜ ‚Ï¿‚˜, fiˆ˜ .¯. 4Ô˘ ‚·ıÌÔ‡ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ÙfiÙ Ú¤ÂÈ Ó· ÙÔ ‚ÔËı‹ÛÔ˘Ì fiÛÔ ÌÔÚԇ̠ÁÈ·Ù› ¤¯ÂÈ ÔÏϤ˜ Èı·ÓfiÙËÙ˜ Ó· ÂÍÂÏȯı› Ê˘ÛÈÔÏÔÁÈο.

E›ÏÔÁÔ˜ H Ì¿¯Ë ÁÈ· ÙËÓ ÂÈ‚›ˆÛË Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÂͤÏÈÍË ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ Û˘Ó¯›˙ÂÙ·È Î·È Î·Ù¿ ÙËÓ ÙÚ›ÙË ¯ÈÏÈÂÙ›· Î·È ·ÔÎÙ¿ ·ÎfiÌË ÈÔ ÌÂÁ¿ÏË ÛËÌ·Û›· ·Ó Ï¿‚Ô˘Ì ˘fi„Ë Ì·˜ fiÙÈ ÔÈ ÁÂÓÓ‹ÛÂȘ ÛÙËÓ ¯ÒÚ· Ì·˜ ·fi 150.000 ÚÈÓ 20 ¯ÚfiÓÈ·, ¤¯Ô˘Ó η٤ÏıÂÈ Û‹ÌÂÚ· ÛÙȘ 98.000.

TÂÏÂÈÒÓÔÓÙ·˜, ı· ‹ıÂÏ· Ó· ·Ó·ÊÂÚıÒ ÛÙÔ fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë Ù¯ÓËÙ‹ ÁÔÓÈÌÔÔ›ËÛË ÂÊ·ÚÌfi˙ÂÙ·È Â˘Ú¤ˆ˜ Ì ÌÂÁ¿Ï˜ ÂÈÙ˘¯›Â˜ ·ÏÏ¿ Î·È Ì ·‡ÍËÛË ÙˆÓ ÚÔÒÚˆÓ ÙÔÎÂÙÒÓ ÏfiÁˆ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ.

O 20fi˜ ·ÈÒÓ·˜ ʇÁÂÈ Î·È ·Ó·Ù¤ÏÏÂÈ Ô 21Ô˜, Ô ÔÔ›Ô˜ Ì ÙȘ ÂÈÙ‡ÍÂȘ Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÙ¯ÓÔÏÔÁ›·˜, Ì·˜ ˘fiÛ¯ÂÙ·È ı·‡Ì·Ù· Ô˘ Â›Ó·È ‰‡ÛÎÔÏÔ ·ÎfiÌË Î·È Ó· Ù· Û˘ÏÏ¿‚Ô˘ÌÂ, fiˆ˜ ÙË ıÂÚ·›· ·ÓÈ¿ÙˆÓ ÓfiÛˆÓ Ì ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ·ıÔÏÔÁÈÎÒÓ ÁÔÓȉ›ˆÓ, ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓıÚˆ›ÓˆÓ ÔÚÁ¿ÓˆÓ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È... ‰È·ÎÔ¤˜ ÛÙÔÓ ÕÚË! ÕÚ·Á ÙÈ ı·‡Ì·Ù· Ó· Ì·˜ ÂÈÊ˘Ï¿ÛÛÂÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÙfiÛÔ ÌÈÎÚÒÓ Î·È Â˘·›ÛıËÙˆÓ ÓÂÔÁÓÒÓ; BÈ‚ÏÈÔÁÚ·Ê›· 1. Morley CJ. Systematic review of prophylactic versus rescue surfactant. Arch Dis Child 1997;77:F70-F4.

2. Renie JM, Bokhari SA. Recent advances in neonatology. Arch Dis Child Fetal Neonatal 1990;81:F1-F4.

3. Jobe AH, Mitchell BR, Gunkel JH. Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants. Am J Obstet Gynecol 1993;168:508-513.

4. Clark RH, Yoder BA, Sell MS. Prospective randomized comparison of high frequency oscillation and conventional ventilation in candidates for extra-corporeal membrane oxygenation. J Ped 1994;124:447-454.

5. Kinsella JP, Truog WE, Walsh WF. Randomized, multicenter trial of inhaled nitric oxide and high frequency oscillatory ventilation in severe persistent pulmonary hypertension of the newborn. J Ped 1997;131:55-62.

6. Collaborative ECMO Trial Group. UK Collaborative randomized trial of neonatal extracorporeal membrane oxygenation. Lancet 1996; 348: 75-82.

7. Seth T, Cairo MS. The role of cytokines in the prevention and treatment of neonatal sepsis. In: Neonatal hematology and Immunology III. Bellanti JA, Bracci R, Prindull G, Xanthou M, eds. Excepta Medica, International Congress Series 1131.

Amsterdam: Elsevier 1997:49-53.

8. Haque KN. Does intravenous immunoglobulin therapy have a role in the treatment of neonatal sepsis? Bellanti JA, Bracci R, Prindull G, Xanthou M, eds. Excepta Medica, International Congress Series 1131. Amsterdam: Elsevier 1997:55-61.

9. Fletcher A, ed. Neonatology: Pathophysiology and Management of the Newborn. 4rth ed. Nutrition 1994;24:343-348.

10. The Victorian infant collaborative study group. Improved outcome in the 1990s for infants weighing 500-999gr at birth. Arch Dis Child 1997;77:91-94.

11. Battin M, Ling E, Whitfield MF, Mackinnon M, Effer SB. Has the outcome for extremely low gestational age (ELGA) infants improved following recent advances in neonatal intensive care? Amer J Perinat 1998;8:469-477.

12. O'Shea TM, Klinepeter KL, Goldstein DJ. Survival and developmental disability in infants with B.W. of 501 to 800gr born between 1979 and 1994. Ped 1997;100:982-986.

13. M·ÎԇϷ X. ¶ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·, 2000.

14. Vannucci RC, Perlman JM. Interventions for perinatal hypoxic-ischemic encephalopathy. Ped 1997;100:1004-1014.

15. Papagaroufalis C, Spyropoulos G, Stamocosta E, Megreli C, Xanthou M. A trial of Vitamin A supplementation for the prevention of retinopathy of prematurity in very low birth weight infants. In: Koppe JG, Eskes TKAB, van Geijn HP, Wiesenhaan PF, Ruys JH, eds. Care, Concern and Cure in Perinatal Medicine: Proceedings of the XIIIth European Congress of Perinatal Medicine, Amsterdam, The Netherlands, May 1992. Lancs, England: The Parthenon Publishing Group 1993:187-193.

16. Obladen M, Maier RF. Recombinant human erythropoietin: A therapeutic option in anemia of prematurity. Xanthou M, Bracci L, Prindull G, eds. In: Neonatal Haematology and Immunology II. Excepta Medica International Congress Series 1038.

Amsterdam: Elsevier, 1993: 99-110.

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· •¿ÓıÔ˘ ¢È¢ı‡ÓÙÚÈ· B' M.E.N. NÂÔÁÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∏ AÁ›· ™ÔÊ›·", ∞ı‹Ó·

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H Ïԛ̈ÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ÛÙ· ·È‰È¿ EÏ¢ıÂÚ›· PÒÌ·-°È·ÓÓ›ÎÔ˘ E. Roma-Yiannikou. Helicobacter pylori infection in children. Paediatriki 2000;63:268-271. ● Abstract: Helicobacter pylori infection is common among the adult population and its incidence in the paediatric population increases with age ranging between 5 and 80% in the developed and the developing world respectively.

It is responsible for human diseases such as gastritis and peptic ulcer and there is evidence that early infection in childhood predisposes to atrophic gastritis and gastric cancer in adulthood. Symptomatic children should be investigated by gastroscopy for the isolation of H. pylori, and H. pylori positive children treated with effective short regimes for 7-10 days consisting of proton pump inhibitors, combined with two antibiotics such as amoxicillin, clarithromycin or metronidazole, according to the sensitivity test of the gastric culture. Large-scale screening of all asymptomatic children is impossible due to the large numbers of infected children, increased antibiotic resistance and high rates of treatment failure. Prevention of H. pylori infection by improving hygienic status and probably by the use of the appropriate vaccine will diminish infection and its consequent morbidity in children and adults.

Key words: Helicobacter pylori, therapeutic regimes, cancer.

TÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ (H. pylori) ·Ó·Î·Ï‡ÊıËÎÂ Ù˘¯·›· Û ηÏÏȤÚÁÂÈ· ÈÛÙÔ‡ ·fi ÙÔ ˘ÏˆÚÈÎfi ¿ÓÙÚÔ ÚÈÓ 18 ¯ÚfiÓÈ·. ŒÎÙÔÙÂ, ·ÎÔÏÔ‡ıËÛ·Ó ¯ÈÏÈ¿‰Â˜ ÌÂϤÙ˜ Ô˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó ·Ê' ÂÓfi˜ ÙËÓ ·ÁÎfiÛÌÈ· ηٷÓÔÌ‹ Ù˘ Ïԛ̈͢ Î·È ·Ê' ÂÙ¤ÚÔ˘ ÙËÓ ·ıÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔÓ ¿ÓıÚˆÔ.(1) EȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ Ïԛ̈͢ Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË ÙˆÓ Û˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ Î·È ·˘Í¿ÓÂÙ·È ·Ú¿ÏÏËÏ· Ì ÙËÓ ËÏÈΛ· (1-3). EӉȷʤÚÔÓ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ Á˘ Ë Ïԛ̈ÍË ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ùfi Û˘Ì‚¿ÏÏÂÈ fi¯È ÌfiÓÔ ÛÙË ÓÔÛËÚfiÙËÙ· ÛÙ· ·È‰È¿ ·ÏÏ¿ Î·È Èı·ÓfiÓ Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÛÔ‚·ÚfiÙÂÚ˜ ÂÈÙÒÛÂȘ ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÌÔÓ‹ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔ ÛÙÔÌ¿¯È, ηٿ ÙËÓ ÂÓ‹ÏÈÎÔ ‰ËÏ·‰‹ ˙ˆ‹. H Û˘¯ÓfiÙËÙ· Ù˘ Ïԛ̈͢ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Î˘Ì·›ÓÂÙ·È ·fi 6 ¤ˆ˜ 15%, ÂÓÒ ÛÙȘ ˘fi ·Ó¿Ù˘ÍË ÂÚ›Ô˘ ÙÔ 80% ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ̤¯ÚÈ Ù· 15 ¯ÚfiÓÈ· ¤¯ÂÈ ÌÔÏ˘Óı›. ™ÙËÓ EÏÏ¿‰· ÔÈ ÌÂϤÙ˜ Â›Ó·È Ï›Á˜. H Û˘¯ÓfiÙËÙ· ÛÙ· ·Û˘Ìو̷ÙÈο ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi 15 ¤ˆ˜ 40%, ÂÓÒ ÙÔ ÔÛÔÛÙfi Â›Ó·È ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· Û˘Ìو̷ÙÈο ·È‰È¿. TÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰È·ÁÓÒÛıËÎ·Ó ÈÛÙÔÏÔÁÈο ÛÙËÓ A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Ì Ïԛ̈ÍË ·fi H. pylori ˘ÂÚ‚·›ÓÂÈ Ù· 400. H Û˘¯ÓfiÙËÙ· ÛÙËÓ ÂÊ˂›· ·Ó¤Ú¯ÂÙ·È ÛÙÔ 60% ÙˆÓ ·È‰ÈÒÓ Ô˘ Á·ÛÙÚÔÛÎÔÔ‡ÓÙ·È.(3) AÓ Î·È ·ÎfiÌ· Û˘˙ËÙÂ›Ù·È Ô ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ H. pylori- ÈÔ Èı·Ó‹ Ê·›ÓÂÙ·È Ë ÌÂÙ¿‰ÔÛË Ì ÙË ÛÙÔÌ·ÙÈ΋ Î·È ÛÙÔÌ·ÙÔÚˆÎÙÈ΋ Ô‰fi - ÂÓÙÔ‡ÙÔȘ, Â›Ó·È Û·Ê¤˜ fiÙÈ Ë Â·Ê‹ Ì ÌÔÏ˘Ṳ̂ӷ ¿ÙÔÌ· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Ô Û˘Á¯ÚˆÙÈÛÌfi˜ Û ȉڇ̷ٷ ¢ÓÔÔ‡Ó ÙËÓ ÌÂÙ¿‰ÔÛ‹ ÙÔ˘. ¶Ú¿ÁÌ·ÙÈ, ÛÙËÓ A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ ÌÂÏÂÙ‹ıËÎ·Ó Ì Á·ÛÙÚÔÛÎfiËÛË Ù· ̤ÏË ÔÈÎÔÁÂÓÂÈÒÓ 41 ·È‰ÈÒÓ Ì Á·ÛÙÚ›Ùȉ· ·fi H. pylori Î·È ‚Ú¤ıËÎ·Ó ÌÔÏ˘Ṳ̂ӷ Û ÔÛÔÛÙfi 90%, ÂÓÒ Û οı ÔÈÎÔÁ¤ÓÂÈ· ˘‹Ú¯Â ¤Ó· ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤ÏÔ˜ ÌÔÏ˘Ṳ̂ÓÔ(4). ™¯ÂÙÈο Ì ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ Ïԛ̈͢ Ê·›ÓÂÙ·È fiÙÈ ÌÔÚ› Ó· Á›ÓÂÈ ·˘ÙfiÌ·ÙË ›·ÛË Î·È ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ‚Ú¤ÊË Ô˘ ÌÔχÓıËÎ·Ó ·fi H. pylori Û˘¯Ó¿ ··ÏÏ¿ÛÛÔÓÙ·È ·ÚÁfiÙÂÚ· ·fi ·˘Ùfi.(5) ™ÙËÓ ÏÂÈÔÓfiÙËÙ· fï˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ı· ÂÁηٷÛÙ·ı› ÙÔ ÌÈÎÚfi‚ÈÔ ÛÙÔ ÛÙÔÌ¿¯È, ·Ó ‰ÂÓ ˘¿ÚÍÂÈ ·Ú¤Ì‚·ÛË, ı· Ì›ÓÂÈ ‰È· ‚›Ô˘. H Ïԛ̈ÍË ÚÔηÏ› ÈÛÙÔÏÔÁÈ΋ ‚Ï¿‚Ë Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÔÍ›· Á·ÛÙÚ›Ùȉ· Î·È Û˘Óԉ‡ÂÙ·È ·fi ·¯ÏˆÚ˘‰Ú›·, Î·È ÌÂÙ·›ÙÂÈ Û ¯ÚfiÓÈ· ÂÓÂÚÁfi Á·ÛÙÚ›Ùȉ·. H ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹ ÚÔηÏ› ÛÙË Û˘Ó¤¯ÂÈ· ‚Ï¿‚Ë ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Ì ·ÔÙ¤ÏÂÛÌ· ·ÙÚÔÊ›· Î·È ˘Ô¯ÏˆÚ˘‰Ú›·, ÂÓÒ ¿ÏÏÔÙÂ Ë Ïԛ̈ÍË ÚÔηÏ› ÂÈÏÔΤ˜ fiˆ˜ ÂÙÈÎfi ¤ÏÎÔ˜ Î·È Î·ÚΛÓÔ ÛÙÔÌ¿¯Ô˘.

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∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

¶›Ó·Î·˜ 1.

¶›Ó·Î·˜ 2.

™˘ÌÙÒÌ·Ù·

EΉËÏÒÛÂȘ Ù˘ Ïԛ̈͢ ·fi H. pylori ÂÎÙfi˜

* ÎÔÈÏȷο ¿ÏÁË

ÂÙÈÎÔ‡

* ·ÈÌ·Ù¤ÌÂÛË

* ηډȷÁÁÂȷ΋ ÓfiÛÔ˜

* ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·

* Ê·ÈÓfiÌÂÓÔ Raynaud

* ˘ÔÚˆÙÂ˚Ó·ÈÌ›·

* ËÌÈÎÚ·Ó›·

* ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘

* ·˘ÙÔ·ÓÔÛ›· * ‰ÂÚÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù· * ·ı‹ÛÂȘ ÙÔ˘ ‹·ÙÔ˜

™Â ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙÔ˘ ÏËı˘ÛÌÔ‡ Ë Ïԛ̈ÍË Â›Ó·È ·Û˘Ìو̷ÙÈ΋.(1) EÚ¢ÓËÙ¤˜ Ô˘ ÂÈÚ·Ì·ÙÈο ÌfiÏ˘Ó·Ó ÙÔ˘˜ ·˘ÙÔ‡˜ ÙÔ˘˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÚÔηÏ› ÔÍ›· Ïԛ̈ÍË Ì ¯ÚfiÓÔ ÂÒ·Û˘ 1 ¤ˆ˜ 7 Ë̤Ú˜, Ô˘ ÂΉËÏÒÓÂÙ·È Ì ÂÈÁ·ÛÙÚ·ÏÁ›·, Ó·˘Ù›·, ηÎÔ˘¯›· Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ Â̤ÙÔ˘˜. T· Û˘ÌÙÒÌ·Ù· ÂΉËÏÒÓÔÓÙ·È Û ÔÛÔÛÙfi 50% ÙˆÓ ÂÓËÏ›ÎˆÓ Ô˘ ÌÔχÓıËηÓ, ÂÓÒ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë Û˘¯ÓfiÙËÙ· Ù˘ ÎÏÈÓÈ΋˜ ÂΉ‹ÏˆÛ˘ Ù˘ Ïԛ̈͢ ÛÙ· ·È‰È¿. ™Ù· ·È‰È¿ ÙÔ H. pylori ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· Á·ÛÙÚ›Ùȉ·˜ Ô˘ ÌÔÚ› Ó· ÚÔ‚¿ÏÂÈ Ì ¯ÚfiÓÈ· ÎÔÈÏȷο ¿ÏÁË, Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙÔ ÂÙÈÎfi ¤ÏÎÔ˜ (ÛÙ· ÌÈÛ¿ ÂÚ›Ô˘ ·È‰È¿ Ì ¤ÏÎÔ˜ Û˘Ó˘¿Ú¯ÂÈ H. pylori) (1,3,6,7), Û¿ÓÈ· ÁÈ· ˘ÂÚÙÚÔÊÈ΋ Á·ÛÙÚÂÓÙÂÚÔ¿ıÂÈ· Î·È ˘ÔÚˆÙÂ˚Ó·ÈÌ›·, ·ÈÌ·Ù¤ÌÂÛË, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· Î·È Á·ÛÙÚÈÎfi ϤÌʈ̷ (›Ó·Î·˜ 1). ŸÛÔÓ ·ÊÔÚ¿ Ù· ÎÔÈÏȷο ¿ÏÁË Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓÔ Î·Ù¿ fiÛÔÓ Â˘ı‡ÓÂÙ·È ÙÔ H. pylori, ÂÓÒ ÌÔÏ˘Ṳ̂ӷ ·È‰È¿ ‰ÂÓ ·Ó¤ÊÂÚ·Ó ÎÔÈÏȷο ¿ÏÁË Û˘¯ÓfiÙÂÚ· ·fi ¿ÏÏ· Ô˘ ‰ÂÓ Â›¯·Ó ÌÔÏ˘Óı›. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ì·˜, ·fi Ù· 396 ·È‰È¿ Ì ¯ÚfiÓÈ· ÎÔÈÏȷο ¿ÏÁË Ô˘ Á·ÛÙÚÔÛÎÔ‹ıËηÓ, ÌfiÓÔ 28,5% ›¯·Ó Ïԛ̈ÍË ·fi H. pylori.(6) Y¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ H. pylori ¢ı‡ÓÂÙ·È ÁÈ· Â͈ÂÓÙÂÚÈΤ˜ ÂΉËÏÒÛÂȘ, ‰ËÏ·‰‹ Û˘ÌÌÂÙÔ¯‹ ·fi ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· Ì ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘, Ê·ÈÓfiÌÂÓÔ Raynaud, ËÌÈÎÚ·Ó›·, ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· fiˆ˜ ȉÈÔ·ı‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ, ·˘ÙÔ¿ÓÔÛÔ ı˘ÚÂÔÂȉÔ¿ıÂÈ· (ı˘ÚÂÔÂȉ›Ùȉ·, ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi), ‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ fiˆ˜ ¯ÚfiÓÈ· ÎÓ›‰ˆÛË Î·È ·ÎÌ‹ roseaca Î·È Ù¤ÏÔ˜ Ë·ÙÈ΋ Û˘ÌÌÂÙÔ¯‹ Ì Èı·Ó‹ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜ Û ÎÈÚÚˆÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ηıÒ˜ Â›Û˘ Î·È ¯ÚfiÓÈ· ¯ÔÏÔ΢ÛÙ›Ùȉ· 1 (›Ó·Î·˜ 2). H ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· ·ÔÙÂÏ› Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ Ïԛ̈͢, ÂÓÒ Ë Î·ı˘ÛÙ¤ÚËÛË ÛÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Ì¿ÏÏÔÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙˆÓ ·È‰ÈÒÓ ·Ú¿ Ì ÙËÓ ¿ÌÂÛË Â›‰Ú·ÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙËÓ ÛˆÌ·ÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·È‰ÈÔ‡. °È· ÙȘ ÂΉËÏÒÛÂȘ ÂÎÙfi˜ ÂÙÈÎÔ‡ ̤ÓÂÈ Ó· ‰È¢ÎÚÈÓÈÛı› ·Ó Ë Ïԛ̈ÍË Â›Ó·È Ë ·ÈÙ›· ‹ Û˘Ì‚¿ÏÏÔ˘Ó ÎÈ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË ‰È¿ÁÓˆÛË, Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ÔÈΛϘ ̤ıÔ‰ÔÈ (›Ó·Î·˜ 3). H ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ·Ú·Ì¤ÓÂÈ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ Î·È ÙÔ CLO test ¤¯ÂÈ Â˘·ÈÛıËÛ›· ÂÚ›Ô˘ 90%.(1,3,7) H ηÏÏȤÚÁÂÈ· ÈÛÙÔ‡ ·ÔÙÂÏ› ÙËÓ ÈÔ ÂȉÈ΋ ̤ıÔ‰Ô ·ÏÏ¿ Ë Â˘·ÈÛıËÛ›· Ù˘ ‰È·Ê¤ÚÂÈ ÛÙ· ‰È¿ÊÔÚ· ÂÚÁ·ÛÙ‹ÚÈ·. TÔ ÌÂÁ¿ÏÔ Ù˘ ÏÂÔÓ¤ÎÙËÌ· Â›Ó·È fiÙÈ ÂϤÁ¯ÂÙ·È Ë Â˘·ÈÛıËÛ›· ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Î·È ¤ÙÛÈ Á›ÓÂÙ·È Ë ÛˆÛÙ‹ ÂÈÏÔÁ‹ ÙÔ˘˜ ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. H PCR ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÙÂÎÌËÚȈı› Û·Ó Ì¤ıÔ‰Ô˜ ÚÔ˘Ù›Ó·˜, ·ÏÏ¿ ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂϤÁ¯Ô˘ ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Î·È ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂÒÓ ÙÔ˘. ŸÛÔÓ ·ÊÔÚ¿ Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ H. pylori Ù· IgG ¶›Ó·Î·˜ 3.

¶›Ó·Î·˜ 4.

¢È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi H. pylori

NÔÛ‹Ì·Ù· ÙÔ˘ ÂÙÈÎÔ‡ ·fi Ïԛ̈ÍË Ì H.pylori

* * * * * * * *

* * * *

BÈÔ„›· ηÏÏȤÚÁÂÈ· ÈÛÙÔ‡ CLO test PCR ÈÛÙÔ‡ ·ÓÙÈÛÒÌ·Ù· ·ÓÙÈÁfiÓÔ ÙÔ˘ HP ÛÙ· ÎfiÚ·Ó· ·ÓÙÈÁfiÓÔ ÙÔ˘ HP ÛÙ· Ô‡Ú· test ·Ó·ÓÔ‹˜ Ì 13C- Ô˘Ú›·

Á·ÛÙÚ›Ùȉ· ¤ÏÎÔ˜ ηÚΛÓÔ˜ ÛÙÔÌ¿¯Ô˘ ϤÌʈ̷ ÛÙÔÌ¿¯Ô˘

269

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13:24

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∂. PÒÌ·-°È·ÓÓ›ÎÔ˘

Â›Ó·È ÈÔ ·ÍÈfiÈÛÙ· Û˘ÁÎÚÈÙÈο Ì ٷ IgA Î·È Ù· IgM, ·ÏÏ¿ Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿, Â›Ó·È ÌÈÎÚ‹ (̤¯ÚÈ 60%) Î·È ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ¿ÓÙÔÙ ÙËÓ ÂÓÂÚÁfi Ïԛ̈ÍË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÌÔÚ› Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙÔÓ ÔÚfi ̤¯ÚÈ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ·fi ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘.(1,7) EÔ̤ӈ˜, ‰ÂÓ ÂӉ›ÎÓ˘Ù·È Ë ¤Ó·ÚÍË ıÂÚ·›·˜ ÌfiÓÔ Ì ÙËÓ ·Ó‡ÚÂÛË ıÂÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi. ™ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ë ‰ÔÎÈÌ·Û›· ÂÎÓÔ‹˜ Ù˘ Ô˘Ú›·˜ ¤¯ÂÈ ÙÂÎÌËÚȈı› Û·Ó ·ÍÈfiÈÛÙË ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ ÂϤÁ¯Ô˘ Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÛÙÔÓ Á·ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ ·ÏÏ¿ ÛÙ· ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ·ÍÈÔÈÛÙ›·˜ Ù˘ ÌÂıfi‰Ô˘.(8,9) MÈ· ·Ï‹, ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ Ì ÈηÓÔÔÈËÙÈ΋ ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· Â›Ó·È Ë ·Ó·˙‹ÙËÛË ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ H. pylori ÛÙ· ÎfiÚ·Ó·. OÈ ÌÂϤÙ˜ Â›Ó·È Ï›Á˜ ·ÎfiÌË Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ¤Ú¢ӷ Ô˘ Á›ÓÂÙ·È ÛÙÔ ÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ·›‰ˆÓ "AÁ›· ™ÔÊ›·" Û ۇÁÎÚÈÛË Ì ÙËÓ ÈÛÙÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ÂÓı·ÚÚ˘ÓÙÈο. AÎfiÌË ÈÔ ÚfiÛÊ·ÙË Â›Ó·È ·Ó·˙‹ÙËÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙ· Ô‡Ú·, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÎfiÌË ÙÂÎÌËÚȈ̤Ó˜ ÌÂϤÙ˜. H Â˘Úˆ·˚΋ ÔÌ¿‰· ÌÂϤÙ˘ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ¤¯ÂÈ Î·È Ë A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ·˘Ù‹ ÙËÓ ÂÔ¯‹ ‰ÈÂÍ¿ÁÂÈ ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË fiÏˆÓ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· Ó· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙÔ ı¤Ì· ·˘Ùfi.

AÓ ˘¿Ú¯Ô˘Ó Û‹ÌÂÚ· ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢ ÛÙÔÓ ÂÓ‹ÏÈη, ·˘ÙÔ› Á›ÓÔÓÙ·È Ôχ ÂÚÈÛÛfiÙÂÚÔÈ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ·È‰›. K·È ·˘Ùfi Â›Ó·È Â‡ÏÔÁÔ ·Ó ·Ó·ÏÔÁÈÛı› ηÓ›˜ fiÙÈ Ë ıÂÚ·›· ÛÙÔ ·È‰› ¤¯ÂÈ ¿ÌÂÛÔ ÛÙfi¯Ô ÙËÓ ÂÎÚ›˙ˆÛË Î·È ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·ÒÙÂÚÔ ÛÙfi¯Ô ÙËÓ ÚfiÏË„Ë ÙˆÓ ÂÈÏÔÎÒÓ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹(1) (›Ó·Î·˜ 4) ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛı› ÙÔ ·È‰› Ì Ïԛ̈ÍË ·fi H. pylori ı· Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘fi„Ë ÔÈ È‰È·ÈÙÂÚfiÙËÙ˜ ÙÔ˘ ·È‰ÈÔ‡, ‰ËÏ·‰‹ ÙÔ fiÙÈ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È -ȉȷ›ÙÂÚ· ÛÙË ‚ÚÂÊÈ΋- ˘¿Ú¯ÂÈ Û ·ÚÎÂÙfi ÔÛÔÛÙfi ·˘ÙfiÌ·ÙË ›·ÛË, Ë ·Ó·ÍÈÔÈÛÙ›· ÙˆÓ ÌË ÂÂÌ‚·ÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È Ë ÌË Î·Ï‹ -ÚÔ˜ ÙÔ ·ÚfiÓ- ÙÂÎÌËÚ›ˆÛ‹ ÙÔ˘˜, Î·È Ù¤ÏÔ˜ ÙÔ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ.(10-12) EÚˆÙ‹Ì·Ù· ÏÔÈfiÓ Ô˘ ··Û¯ÔÏÔ‡Ó ÚÈÓ Û˘ÛÙËı› ıÂÚ·›· Û ¤Ó· ·È‰› ›ӷÈ: ·) ·Ó ˘¿Ú¯Ô˘Ó Û˘Ì-ÙÒÌ·Ù·, ‚) ·Ó ı· ÎÈÓ‰˘Ó‡ÛÂÈ Ú·ÁÌ·ÙÈο ·fi ηÚΛÓÔ ÛÙÔÌ¿¯Ô˘ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ ÂÊfiÛÔÓ ‰ÂÓ ÂÈÙ¢¯ı› ÂÎÚ›˙ˆÛË, Á) Ì‹ˆ˜ ·Ó·Ù˘¯ıÔ‡Ó ·ÓıÂÎÙÈο ÛÙÂϤ¯Ë, ‰) Ì‹ˆ˜ Ë ÂÎÚ›˙ˆÛË ‰È·Ù·Ú¿ÍÂÈ ÙÔ ÔÈÎÔÛ‡ÛÙËÌ· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÚÔηÏÒÓÙ·˜ ¤ÙÛÈ ¿ÏÏ· ÓÔÛ‹Ì·Ù· fiˆ˜ ·ÏÈÓ‰ÚÔÌÈ΋ ÓfiÛÔ. E›Ó·È ȉȷ›ÙÂÚ· ‰‡ÛÎÔÏÔ Ó· ··ÓÙ‹ÛÂÈ Î·Ó›˜ ÛÙ· ÈÔ ¿Óˆ ÂÚˆÙ‹Ì·Ù·. H E˘Úˆ·˚΋ ÔÌ¿‰· ÂÚÁ·Û›·˜ ÁÈ· ÙË Ïԛ̈ÍË Ì H. pylori ÛÙ· ·È‰È¿ η٤ÏËÍ fiÙÈ Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÁÈ· Ïԛ̈ÍË ·fi H. pylori οı ·È‰› Ô˘ ¤¯ÂÈ Û˘ÌÙÒÌ·Ù·.(7) EΛÓÔ fï˜, Ô˘ ÚÔηÏ› ‰˘ÛÎÔÏ›· Â›Ó·È fiÙÈ ÛÙ· ·È‰È¿ Â›Ó·È ··Ú·›ÙËÙË Ë Á·ÛÙÚÔÛÎfiËÛË ÁÈ·Ù› ‰ÂÓ ˘¿Ú¯ÂÈ ·ÍÈfiÈÛÙË ÌË ÂÂÌ‚·ÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÂͤٷÛË. ŸÛÔÓ ·ÊÔÚ¿ Ù· ıÂÚ·¢ÙÈο Û¯‹Ì·Ù·, ˘¿Ú¯ÂÈ ÔÌÔÈfiÙËÙ· Ì ·˘Ù¿ ÙˆÓ ÂÓËϛΈÓ. ¢ËÏ·‰‹, ·Ó·˙ËÙÔ‡ÓÙ·È ·Ï¿, ¢¤ÏÈÎÙ·, ·ÔÙÂÏÂÛÌ·ÙÈο Î·È ¯ˆÚ›˜ ·ÚÂÓ¤ÚÁÂȘ ıÂÚ·¢ÙÈο Û¯‹Ì·Ù·, ¤ÙÛÈ ÒÛÙ ÙÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ Ó· Êı¿ÛÂÈ 90%.(12,13) ¢˘ÛÙ˘¯Ò˜, ÛÙ· ·È‰È¿ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÓÙ· ηϋ Û˘ÌÌfiÚʈÛË, ˘¿Ú¯Ô˘Ó ·ÓıÂÎÙÈο ÛÙÂϤ¯Ë Î·È ÙÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ Û˘¯Ó¿ Â›Ó·È ¯·ÌËÏfi ·ÎfiÌË Î·È Ì ٷ ›‰È· Û¯‹Ì·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÔÈ ÂÓ‹ÏÈΘ. £· Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ÔÙ¤ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ¤Ó· ÌfiÓÔ ·ÓÙÈ‚ÈÔÙÈÎfi, ÁÈ·Ù› ·Ó·Ù‡ÛÛÂÙ·È ·ÓıÂÎÙÈÎfiÙËÙ·. ™Ù· ·È‰È¿ ‰ÔÎÈÌ¿ÛıËÎ·Ó Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ıÂÚ·¢ÙÈο Û¯‹Ì·Ù· ̤¯ÚÈ 6 ‚‰ÔÌ¿‰Â˜. TÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Ì Á·ÛÙÚÔÛÎfiËÛË ·Ó¿ÏÔÁ· Ì ٷ ıÂÚ·¢ÙÈο Û¯‹Ì·Ù· Î˘Ì¿ÓıËΠ·fi 70 ¤ˆ˜ 80%. T· ‰‡Ô ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¯ÔÚËÁÔ‡ÓÙ·È Ù· ‚Ú·¯¤· Û¯‹Ì·Ù·, ‰È¿ÚÎÂÈ·˜ 7 ¤ˆ˜ 10 ËÌÂÚÒÓ(13,14). T· ÚÔÙÂÈÓfiÌÂÓ· ıÂÚ·¢ÙÈο Û¯‹Ì·Ù· Â›Ó·È ·Ó·ÛÙÔÏ›˜ Ù˘ ·ÓÙÏ›·˜ ÚˆÙÔÓ›Ô˘ (omeprazole, lanzoprazole ÎÙÏ.) Î·È Û˘Ó‰˘·ÛÌfi˜ ‰‡Ô ·ÓÙÈ‚ÈÔÙÈÎÒÓ (ÎÏ·Ú˘ıÚÔÌ˘Î›ÓË, ·ÌÔ͢ÎÈÏÏ›ÓË, ÌÂÙÚÔÓȉ·˙fiÏË). E¿Ó ‰ÂÓ ÂÈÙ¢¯ı› ÂÎÚ›˙ˆÛË ÚÔÛÙ›ıÂÙ·È ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ Û¯‹Ì· Î·È ‚ÈÛÌÔ‡ıÈÔ (Denol). ŸÌˆ˜, ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ·ÔÙ˘¯›·˜ ÂÎÚ›˙ˆÛ˘ ÙÔ˘ H. pylori ÛÙ· ·È‰È¿, Ë ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜, Î·È Ô ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÔÏ˘ÛÌ¤ÓˆÓ ·È‰ÈÒÓ ÛÙÔÓ Ï·Ó‹ÙË Î·ıÈÛÙÔ‡Ó ·Ó¤ÊÈÎÙË ÙË Ì·˙È΋ ıÂÚ·›· ÂÎÚ›˙ˆÛ˘ ÙÔ˘ H. pylori ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi. ŒÓ· ÂÌ‚fiÏÈÔ ·ÔÙÂÏ› ÙË ÌÔÓ·‰È΋ ÂÏ›‰· ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ÂÍ·Ê¿ÓÈÛË Ù˘ Ïԛ̈͢, Ú·ÎÙÈ΋ Ô˘ ÂÊ·ÚÌfiÛıËÎÂ Î·È ¤Ù˘¯Â ÙËÓ ÂÍ·Ê¿ÓÈÛË ÔÏÏÒÓ ¿ÏÏˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ(15).

A’ fi,ÙÈ Ê·›ÓÂÙ·È ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·Ù· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢ Ì H. pylori ÛÙ· ·È‰È¿ Î·È ¿ÓÙ· ˘¿Ú¯ÂÈ Ô ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ Ì‹ˆ˜ ˘¿Ú¯Ô˘Ó ·Ú·Ï‹„ÂȘ, ·ÏÏ¿ ›Ûˆ˜ Î·È ˘ÂÚ‚ÔϤ˜. ™‡Ìʈӷ Ì ÙÔ ÙÂÏÂ˘Ù·›Ô consensus ¯ÔÚËÁÂ›Ù·È ıÂÚ·›· ÂÎÚ›˙ˆÛ˘ Û οı ·È‰› Ì ıÂÙÈ΋ ‚ÈÔ„›·, Î·È 6 ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ· Á›ÓÂÙ·È screening ·Ó·ÓÔ‹˜ Ì 13C- Ô˘Ú›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ıÂÚ·›·˜. ¢ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù·, Ô‡Ù ıÂÚ·›· ¯ˆÚ›˜ ıÂÙÈ΋ ‚ÈÔ„›·. AÓ ‰ÂÓ ÛÎÔ‡ԢÌ ӷ ıÂÚ·‡ÛÔ˘Ì ‰ÂÓ ¤¯ÂÈ ÓfiËÌ· Ó· ÂϤÁ¯ÂÙ·È ÙÔ ·È‰› ÁÈ· ÙËÓ ·ÚÔ˘Û›· Ïԛ̈͢ ·fi H. pylori. §fiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ ·Ó¿Ù˘Í˘ ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ ÚÔÙÈÌ¿Ù·È Ó· Á›ÓÂÙ·È Î·ÏÏȤÚÁÂÈ· Î·È ÙÂÛÙ Â˘·ÈÛıËÛ›·˜. ™ÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, ÔÈ MÂÓÙ‹˜ Î·È Û˘Ó. ‰È·›ÛÙˆÛ·Ó ·ÓıÂÎÙÈÎfiÙËÙ· 28% ÛÙË ÌÂÙÚÔÓȉ·˙fiÏË Î·È 5,5% ÛÙËÓ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË ÛÙ· ·È‰È¿.(16)

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∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ÛÙ· ·È‰È¿ ›̷ÛÙ ÈÔ ÂÏ·ÛÙÈÎÔ› fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÂӉ›ÍÂȘ ıÂÚ·›·˜ ÂÎÚ›˙ˆÛ˘ ÙÔ˘ H. pylori, ›Ûˆ˜ ÁÈ·Ù› ‰ÂÓ ˘¿Ú¯Ô˘Ó ÙÂÎÌËÚȈ̤Ó˜ Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙȘ ·ÒÙÂÚ˜ ÂÈÙÒÛÂȘ ÛÙËÓ ˘Á›·. E›Ì·ÛÙ ÂÈÊ˘Ï·ÎÙÈÎÔ› ÁÈ· ÙË Ì·˙È΋ ÂÎÚ›˙ˆÛË ÛÙ· ·Û˘Ìو̷ÙÈο ·È‰È¿, ÏfiÁˆ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ. EÍ¿ÏÏÔ˘, ‰ÂÓ ˘¿Ú¯ÂÈ ÙÂÎÌËÚ›ˆÛË fiÙÈ Ë ÂÎÚ›˙ˆÛË Ù˘ Ïԛ̈͢ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ· ı· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÌÂÏÏÔÓÙÈÎfi ηÚΛÓÔ ÛÙÔÓ ÂÓ‹ÏÈη.

E›ÏÔÁÔ˜ MÂÙ¿ ÙÔÓ ˘ÂÚ‚¿ÏÏÔÓÙ· ˙‹ÏÔ ÁÈ· ÙËÓ ÂÍ·Ê¿ÓÈÛË ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ·fi ÙÔ Á·ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Û ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ ÂÈÎÚ·Ù› ÛÎÂÙÈÎÈÛÌfi˜ ·Ó ÙÂÏÈο ¤¯ÂÈ ¤Ó‰ÂÈÍË Ë ÂÎÚ›˙ˆÛË. ¶·Ú·Ù‹ÚËÛ·Ó ‰ËÏ·‰‹, fiÙÈ ÂÓ‹ÏÈΘ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H. pylori ·ÚÔ˘Û›·Û·Ó Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÂÓÒ ÙÂÏÂ˘Ù·›· ·˘Í‹ıËÎÂ Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÂÓÈÛ¯‡ÂÈ ÙËÓ ¿Ô„Ë fiÙÈ ›Ûˆ˜ ÙÔ H. pylori ÚÔÛٷهÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. AÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÚÔ‚ÏËÌ·ÙÈÛÌfi ÚÔηÏ› Ù· ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ· Ë ¿Ô„Ë ÌÂÚÈÎÒÓ ÂÚ¢ÓËÙÒÓ Ô˘ ı¤ÙÔ˘Ó ÛÔ‚·Ú¿ ÙËÓ Èı·ÓfiÙËÙ· fiÙÈ ÙÔ H. pylori ›Ûˆ˜ ·ÔÙÂÏ› Ê˘ÛÈÔÏÔÁÈ΋ ¯ÏˆÚ›‰· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ fiÙÈ ›Ûˆ˜ Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙÔÓ ÍÂÓÈÛÙ‹. O Ó¤Ô˜ ·˘Ùfi˜ ÛÎÂÙÈÎÈÛÌfi˜ ¤Ú¯ÂÙ·È ·ÎÚÈ‚Ò˜ ÙË ÛÙÈÁÌ‹ Ô˘ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ ı¤Ì· ÙÂÏÈο ¤¯Ô˘Ó ÂÈÛı› ÁÈ· ÙȘ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ˘Á›· ·fi ÙË Ïԛ̈ÍË ·˘Ù‹. ŸÌˆ˜, ·fi fiÏÔ˘˜ ÔÌÔÏÔÁÂ›Ù·È fiÙÈ Ë ·Ó·Î¿Ï˘„Ë ÙÔ˘ H. pylori Î·È Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘ Ì ÙË Á·ÛÙÚ›Ùȉ·, ÙÔ ¤ÏÎÔ˜, ÙÔ Á·ÛÙÚÈÎfi ηÚΛÓÔ Î·È ÙÔ MALT-ϤÌʈ̷ ·ÔÙÂÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ÚfiÔ‰Ô Ù˘ Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜ Ù· ÙÂÏÂ˘Ù·›· 50 ¯ÚfiÓÈ·. H ÁÓÒÛË ·˘Ù‹ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÍ·Ê·ÓÈÛıÔ‡Ó ÓfiÛÔÈ Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ¯ÈÏÈ¿‰Â˜ ı·Ó¿ÙÔ˘˜ οı ¯ÚfiÓÔ.(1,7) TÂÏÈο, ‰ÂÓ Â›Ó·È ·ÎfiÌË ‚¤‚·ÈÔ ·Ó Ë ‰È·Ù·Ú·¯‹ ·˘Ù‹ Ù˘ Û˘Ì‚›ˆÛ˘ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ Ì ÙÔÓ ÍÂÓÈÛÙ‹, Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙË ıÂÚ·›· ÂÎÚ›˙ˆÛ˘ ÙÔ˘, ¤¯ÂÈ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ. ¶ÚÔ˜ ÙÔ ·ÚfiÓ fï˜, ÂÈÎÚ·Ù› Ë ¿Ô„Ë ˘¤Ú Ù˘ ¯ÚËÛÈÌÔÔ›ËÛ˘ ÚÔÏËÙÈÎÒÓ Ì¤ÛˆÓ ÁÈ· ÙË Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ïԛ̈͢ ·fi ÙÔ ÌÈÎÚfi‚ÈÔ ·˘Ùfi.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Koletzko S, Ashorn M. The year in Helicobacter pylori. Paediatrics. Current opinion in Gastroenterology (Supplement 1) 1998;14:S 57-S63.

2. Barden PK. Epidemiological features of Helicobacter pylori infection in developing countries. Clin Infect Dis 1997;25:973-978.

3. Roma-Giannikou, Panayiotou J, Vanvliet C, Charissiadou A, Anasi H, Pangali A, Matsaniotis N. Helicobacter pylori in Greek children with upper gastrointestinal symptoms. Hellenic J Gastroenterol 1993;6:251-259.

4. Roma-Giannikou E, Balatsos B, Panayiotou J, Van-Vliet C, Papaliodi J, Charissiadou A, Siahanidou T, Skandalis N. Intrafamilial spread of Helicobacter pylori. Hellenic J Gastroenter 1999;12:96-100.

5. Xia HH, Talley NJ. Natural acquisition and spontaneous elimination of Helicobacter pylori infection: clinical implications. Am J Gastroenterol 1997;92:1780-1787.

6. Roma E, Panayiotou J, Kafritsa P, Vanvliet C, Giannoulia A, Constantopoulos A. Upper gastrointestinal disease, Helicobacter Pylori and recurrent abdominal pain. Acta Paediatr 1999;88:1-4.

7. Drum B, Koletzko S, Oderda G. Helicobacter pylori Infection in Children: A concensus statement. J P Gastr Nutr 2000;30:207-213.

8. Kindermann A, Demmelmair H, Koletzko B, Wiebecke B, Koletzko S. Diagnostic value and errors of the 13C- urea breath test in children. Gut 1997;41(Suppl.):A67.

9. Jones NL, Bourke B, Sherman PM. Breath testing for Helicobacter pylori infection in children: a breath of fresh air? (editorial, comment) J Pediatr 1997;131:791-793.

10. Abdel RS, Nahata MC. Guidelines for the treatment of Helicobacter pylori in the pediatric population. Ann Pharmacother 1997;32-1247-1249.

11. Oderda G. Cure of Helicobacter pylori in children. Helicobacter 1997;2(Suppl1):S73-76.

12. Walsh D, Goggin N, Rowland M, Durnin M, Moriatri S, Drumm B. One week treatment for Helicobacter pylori infection. Arch Dis Child 1997;76:352-355.

13. Blecker U, Gold Bd. Treatment of Helicobacter pylori infection; a review. Pediatr Infect Dis J 1997;16:391-399.

14. Berquist W. New, Improved Helicobacter pylori eradication therapy in children. J Ped Gastroent Nutr 1998;26:360-362.

15. Czinn S. What is the role for vaccination in Helicobacter pylori? Gastroenterol 1997;113:S149-S153.

16. Mentis A, Roma E, Pangalis A, Katsigiannakis E. Susceptibilities of Helicobacter pylori strains isolated from children with gastritis to selected antibiotics. J Antimicrob Chemother 1999;44:720-22.

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: E. ƒÒÌ·-°È·ÓÓ›ÎÔ˘ ∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈ΋˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, Aı‹Ó· 115 27

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H ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜ °›ÙÛ· KÔÙÙ·Ú›‰Ë Y. Kottaridi. The family and care of the child with disability. Paediatriki 2000;63:272-274. ● Abstract: In the Greek context, the care of the child with disability is undertaken mainly by the family with inadequate information and support from the community and the state. Parents complain about negative attitudes on the part of society, social and physical barriers and problems of communication and relationships with health professionals, as well as about delays in detection and intervention. They meet the needs of the child to the best of their ability, but they are very concerned about the future of the child when they are gone, as the family unit is gradually loosening its bonds and its traditional function is changing.

Key words: disability, special needs.

T· ÚÔ‚Ï‹Ì·Ù· Î·È Ù· ˙ËÙ‹Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔ ·Ó¿ËÚÔ ·È‰› ·ÔÎÙÔ‡Ó Û˘ÓÔ¯‹, fi¯È ̤ۈ οÔÈ·˜ ÔÚÁ·ÓˆÌ¤Ó˘ ÔÚıÔÏÔÁÈ΋˜ ÂÓfiÙËÙ·˜, ·ÏÏ¿ ΢ڛˆ˜ ‰ÈfiÙÈ ¤¯Ô˘Ó ÌÈ· ÎÔÈÓ‹ Û˘Ó·ÈÛıËÌ·ÙÈ΋ ‚¿ÛË: ÙËÓ ·ÓËÛ˘¯›· Ô˘ fiÏÔÈ ÓÔÈÒıÔ˘Ì ÁÈ· ÙË ÌÔ›Ú· ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ ÛÙÔÓ ÎfiÛÌÔ ÙÔ˘ ·‡ÚÈÔ. AÓËÛ˘¯Ô‡Ì ÁÈ· ÙË Ê˘ÛÈ΋ Î·È ÙËÓ ÓÂ˘Ì·ÙÈ΋ ÙÔ˘˜ ˘Á›·, ÁÈ· ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘˜ ÛÙÔÓ Ú˘ıÌfi Ù˘ Û‡Á¯ÚÔÓ˘ ˙ˆ‹˜, ÁÈ· ÙË Û¯¤ÛË ÙÔ˘˜ Ì ÙÔ ¿ÌÂÛÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ.

Aӷʤڈ ÔÚÈṲ̂Ó˜ ‰È·ÈÛÙÒÛÂȘ Î·È ·Ú·ÙËÚ‹ÛÂȘ ·fi ÂÎ ‚·ı¤ˆÓ Û˘ÓÂÓÙ‡ÍÂȘ Ì ÔÈÎÔÁ¤ÓÂȘ ·È‰ÈÒÓ Ì ÎÈÓËÙÈ΋, ·ÈÛıËÙËÚȷ΋, ÓÔËÙÈ΋ ·Ó·ËÚ›·. OÈ Û˘ÓÂÓÙ‡ÍÂȘ ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÌÈ·˜ ¢ڇÙÂÚ˘ ÌÂϤÙ˘ Ô˘ ¤ÁÈÓ ÛÙÔ Ï·›ÛÈÔ ÂÓfi˜ ‰È·ÎÚ·ÙÈÎÔ‡ ÂÚ¢ÓËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂٷ͇ ÌÂÛÔÁÂÈ·ÎÒÓ ¯ˆÚÒÓ Ì ΤÓÙÚÔ Û˘ÓÙÔÓÈÛÌÔ‡ ÙÔ EıÓÈÎfi IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ Î·È I·ÙÚÈ΋˜ ŒÚ¢ӷ˜ ÛÙÔ ¶·Ú›ÛÈ (INSERM). ŒÓ· ·fi Ù· ÚÒÙ· ÛËÌ·ÓÙÈο Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ·Ó·‰‡ıËΠ·fi ÙȘ Û˘ÓÂÓÙ‡ÍÂȘ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ,ÛÙË ¯ÒÚ· Ì·˜, ›Ûˆ˜ Î·È ÂÏÏ›„ÂÈ ÔÚÁ·ÓˆÌ¤ÓˆÓ ˘Ô‰ÔÌÒÓ, Â›Ó·È Ô ÔÈÎÔÁÂÓÂÈ·Îfi˜ ıÂÛÌfi˜ ·˘Ùfi˜ Ô˘ ۯ‰fiÓ ·ÔÎÏÂÈÛÙÈο ¤¯ÂÈ ÂÈÊÔÚÙÈÛı› Ì ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜. °È· ÙȘ ÔÈÎÔÁ¤ÓÂȘ ·˘Ù¤˜ Ë ÂÌÂÈÚ›· Ì ÙËÓ ·Ó·ËÚ›· Â›Ó·È ¤Ó· ‚·Ú‡ ÊÔÚÙ›Ô Ô˘ ÛËÎÒÓÂÈ Ë ÔÈÎÔÁ¤ÓÂÈ·, ΢ڛˆ˜ Ë ÌËÙ¤Ú·, ¯ˆÚ›˜ ÏËÚÔÊfiÚËÛË, ηıÔ‰‹ÁËÛË ‹ ÛÙ‹ÚÈÍË ·fi ÙÔ ÎÚ¿ÙÔ˜ ‹ ÙËÓ ÎÔÈÓˆÓ›·.

EÂȉ‹ Ë ÎÔÈÓˆÓ›· Â›Ó·È ‰ÔÌË̤ÓË ¤ÙÛÈ ÒÛÙ ӷ ÈηÓÔÔÈ› ÚˆÙ·Ú¯Èο ÙȘ ·Ó¿ÁΘ ÙˆÓ ˘ÁÈÒÓ ·ÙfïÓ, Ë ·Ó·ËÚ›· Â›Ó·È ‰··ÓËÚ‹. TÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘ ÎfiÛÙÔ˘˜ - ÔÈÎÔÓÔÌÈÎÔ‡ Î·È „˘¯ÔÎÔÈÓˆÓÈÎÔ‡ - Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ÔÈÎÔÁ¤ÓÂȘ ÂÈ‚¿ÏÏÂÙ·È ÎÔÈÓˆÓÈο Î·È ‰ÂÓ Â›Ó·È ÂÁÁÂÓ¤˜ ÛÙË Ê‡ÛË Ù˘ ·Ó·ËÚ›·˜. TÔ ÔÈÎÔÓÔÌÈÎfi ‚¿ÚÔ˜ ÚÔ·ÙÂÈ ·fi ÙÔ fiÙÈ ÁÂÓÈο, ÔÈ ÁÔÓ›˜ Î·È fi¯È Ë ÎÔÈÓˆÓ›· ·Ó·Ì¤ÓÂÙ·È Ó· ÏËÚÒÛÔ˘Ó ÙȘ ˘¤ÚÔÁΘ ‰·¿Ó˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙȘ ÂȉÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡. ¶·ÚÔÌÔ›ˆ˜, ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙÔ˘ „˘¯ÔÎÔÈÓˆÓÈÎÔ‡ ÊÔÚÙ›Ô˘ Ô˘ ÂˆÌ›˙ÔÓÙ·È ÔÈ ÁÔÓ›˜ ÙÔ‡˜ ÂÈ‚¿ÏÏÂÙ·È ÂÂȉ‹ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÔÈ Î·Ù¿ÏÏËϘ ˘ÔÛÙËÚÈÎÙÈΤ˜ ˘ËÚÂۛ˜ fiˆ˜ ηÙ' Ô›ÎÔÓ ÊÚÔÓÙ›‰·, ÏËÚÔÊfiÚËÛË Û¯ÂÙÈο Ì ÙË ‰È¿ÁÓˆÛË, ÙËÓ ·ÁˆÁ‹ Î·È ÙË ıÂÚ·›·, ηıÒ˜ Î·È ÂÎ·È‰Â˘ÙÈο Î·È ÌÔÚʈÙÈο ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· ÙÔ ·È‰›. O ÛÙÈÁÌ·ÙÈÛÌfi˜ Ù˘ ·Ó·ËÚ›·˜ ·fi ÙËÓ ÎÔÈÓˆÓ›· Î·È Ù· ÚfiÙ˘· Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ·˘ÙfiÓ ÙÔÓ ÛÙÈÁÌ·ÙÈÛÌfi Â›Û˘ ÂÌÔ‰›˙Ô˘Ó ÙȘ ÔÈÎÔÁ¤ÓÂȘ Ó· ¤¯Ô˘Ó ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ÙÚfiÔ ˙ˆ‹˜. ŸÌˆ˜, Î·È ÙÔ ÔÈÎÔÓÔÌÈÎfi Î·È ÙÔ „˘¯ÔÎÔÈÓˆÓÈÎfi ÎfiÛÙÔ˜ ·ÓÙÈÛÙ·ıÌ›˙ÔÓÙ·È, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÚÈÎÒ˜, Ì ÔʤÏË Ô˘ ·ÔÚÚ¤Ô˘Ó ·fi ·˘ÍË̤ÓË Û˘ÓÂȉËÙÔÔ›ËÛË, ·fi ‚ÂÏÙȈ̤Ó˜ ÈηÓfiÙËÙ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Î·È ·fi ÙËÓ ·Ó¿ÁÎË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÁÈ· ÂÓۈ̿وÛË Î·È ÎÔÈÓˆÓÈ΋ ¤ÓÙ·ÍË Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ÂÌÂÈÚ›· Ù˘ ·Ó·ËÚ›·˜. ¶ÔÏÏ¿ ·fi Ù· ¤ÍÔ‰· Ù˘ ·Ó·ËÚ›·˜ Ô˘ ʤÚÂÈ Ë ÔÈÎÔÁ¤ÓÂÈ· ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂȈıÔ‡Ó Ì ÌÈ· ÂÓÙÔÓfiÙÂÚË ˘ÔÛÙËÚÈÎÙÈ΋ ·ÓÙ·fiÎÚÈÛË ÂΠ̤ÚÔ˘˜ Ù˘ ÎÔÈÓˆÓ›·˜.

H ·Ó·ËÚ›· Û' ¤Ó· ·È‰› Â›Ó·È ÌÈ· ·fi ÙȘ ÈÔ Ô‰˘ÓËÚ¤˜ ÂÌÂÈڛ˜ Ó· ·ԉ¯ı› ηÓ›˜. TÔ ‚·ı‡ Î·È Û˘¯Ó¿ ÎÚ˘Êfi Û˘Ó·›ÛıËÌ· Ù˘ ·ÒÏÂÈ·˜ Î·È Ù˘ ·‰ÈΛ·˜, ÂÁÁÂÓ¤˜ Û ·˘Ù‹ ÙËÓ ÂÌÂÈÚ›·, ÙËÓ Î·ıÈÛÙÔ‡Ó ÚfiÎÏËÛË ÁÈ·

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∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙË ‰˘ÛÎÔÏÂ‡Ô˘Ó Ó· ΢ÚÈ·Ú¯‹ÛÂÈ ¿Óˆ Û ·˘Ù‹Ó Î·È Ó· ÙËÓ ÂϤÁÍÂÈ. M ÙËÓ ÚfiÔ‰Ô ÛÙËÓ È·ÙÚÈ΋ Ù¯ÓÔÏÔÁ›·, Ù· ·Ó¿ËÚ· ·È‰È¿ ˙Ô˘Ó ˆ˜ ÙËÓ ÂÊ˂›· ·ÏÏ¿ Î·È Ôχ ÂÚÈÛÛfiÙÂÚÔ, ˆ˜ ÂÓ‹ÏÈΘ. A˘Ùfi ÙÔ ıÂÙÈÎfi ÁÂÁÔÓfi˜ ‰ËÌÈÔ˘ÚÁ› ÚfiÛıÂÙ· „˘¯ÔÎÔÈÓˆÓÈο ‚¿ÚË Ô˘ ÂˆÌ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÔÈ ÔÈÎÔÁ¤ÓÂȘ. ŒÓ· ‰Â‡ÙÂÚÔ ÛËÌ·ÓÙÈÎfi Û˘Ì¤Ú·ÛÌ· Â›Ó·È fiÙÈ Ë ÎÔÈÓ‹ ÁÓÒÌË ÙÔÔıÂÙÂ›Ù·È ˘¤Ú Ù˘ ‡·Ú͢ Î·È ÂÓ›Û¯˘Û˘ ÙÔ˘ KÚ¿ÙÔ˘˜ ¶ÚfiÓÔÈ·˜, Ì ÛÔ‚·ÚfiÙÂÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·Ú¤Ì‚·ÛË Û fiÏ· Ù· Â›‰·. OÈ ÁÔÓ›˜ ·¢ı‡ÓÔ˘Ó "ÛÎÏËÚ‹" ÎÚÈÙÈ΋ ÛÙËÓ ˘Ô‚¿ıÌÈÛË ÙˆÓ ÚÔÓÔÈ·ÎÒÓ Ï¢ÚÒÓ ÙÔ˘ ÎÚ¿ÙÔ˘˜, ·ÈÛı·ÓfiÌÂÓÔÈ ¤ÓÙÔÓ· ÙËÓ ·Ó·ÛÊ¿ÏÂÈ· Ù˘ ·ÁÔÚ¿˜ Î·È Ù˘ ·ıÂÛÌÔÔ›ËÙ˘ ÎÔÈÓˆÓ›·˜. ŒÓ· ÙÚ›ÙÔ Â‡ÚËÌ· Â›Ó·È fiÙÈ Ô ‚·ıÌfi˜ ÂÓË̤ڈÛ˘ Ù˘ ÂÏÏËÓÈ΋˜ ÎÔÈÓˆÓ›·˜ ÁÈ· Ù· ˙ËÙ‹Ì·Ù· Ù˘ ·Ó·ËÚ›·˜ ÂÌÊ·Ó›˙ÂÙ·È ¯·ÌËÏfi˜. EÍ·ÈÙ›·˜ Ù˘ ¿ÁÓÔÈ·˜ Î·È Ù˘ ÂÏÏÈÔ‡˜ ÏËÚÔÊfiÚËÛ˘, ·Ó·Ù‡ÛÛÔÓÙ·È ÚÔηٷϋ„ÂȘ, ·ÚÓËÙÈΤ˜ ÛÙ¿ÛÂȘ Î·È ‰È·ı¤ÛÂȘ ÌÂ Û˘Ó¤ÂÈ· ÙË ‰È¿ÎÚÈÛË, ÙË ÌË ·Ô‰Ô¯‹, ÙËÓ ÂÚÈıˆÚÈÔÔ›ËÛË Î·È ÙÔÓ ÛÙÈÁÌ·ÙÈÛÌfi Ô˘ ‰˘ÛÎÔÏÂ‡Ô˘Ó ÙËÓ ÔÚı‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·Ó·ËÚ›·˜, ·ÎfiÌË Î·È ·fi ÙËÓ ›‰È· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ™ËÌ·ÓÙÈÎfi Â›Ó·È Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ÎÔÈÓˆÓÈ΋ ·Ô‰Ô¯‹ ÂËÚ¿˙ÂÙ·È Î·È ·fi ÙËÓ ÙÔÔı¤ÙËÛË ÙˆÓ ÁÔÓÈÒÓ ·¤Ó·ÓÙÈ ÛÙÔ Úfi‚ÏËÌ·. ™˘¯Ó¿ ÔÈ ÁÔÓ›˜ ÚÔ‚¿ÏÏÔ˘Ó ÛÙËÓ ÎÔÈÓˆÓ›· ·˘Ùfi Ô˘ ÊÔ‚Ô‡ÓÙ·È, fiÙÈ ‰ËÏ·‰‹ ÙÔ˘˜ Ï˘Ô‡ÓÙ·È, ÂÂȉ‹ ·˘ÙÔ› ÔÈ ›‰ÈÔÈ Ï˘Ô‡ÓÙ·È ÙÔÓ Â·˘Ùfi ÙÔ˘˜. ÕÚ·, Ë ÌË ·Ô‰Ô¯‹ Û˘¯Ó¿ ÍÂÎÈÓ¿ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ÁÔÓ›˜. ŒÙÛÈ, ηٷϋÁÔ˘Ì ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·Ó·ËÚ›· Â›Ó·È ¤Ó· ÁÂÁÔÓfi˜, ÂÓÒ Ë ÌÂÈÔÓÂÍ›· ÁÈ· ÙËÓ ·Ó·ËÚ›· ηٷÛ΢¿˙ÂÙ·È ·Ú¯Èο ·fi ÙËÓ ›‰È· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.

H ¢¿ÊÓË OÈÎÔÓfiÌÔ˘, Ô˘ ¤¯ÂÈ ·Ó·ÏÒÛÂÈ ÙË ˙ˆ‹ Ù˘ ÛÙË ÊÚÔÓÙ›‰· ÙˆÓ ·Ó¿ËÚˆÓ ·È‰ÈÒÓ, ϤÂÈ Û οÔÈ· ÔÌÈÏ›· Ù˘: "E›Ó·È ‚¤‚·ÈÔ fiÙÈ ÌÚÔ˜ ÛÙÔÓ ı¿Ó·ÙÔ ‹ ÛÙËÓ ·Ó·ËÚ›· ÂÓfi˜ ·È‰ÈÔ‡, ÔÈ ÁÔÓ›˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó Ô‡Ù ·ÓÙÈÛÒÌ·Ù· Ô‡Ù ηÌÈ¿ ¿ÏÏË ÌÔÚÊ‹ Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó·ÎÔ‡ÊÈÛ˘.(...) OÈ ·ÓÙȉڿÛÂȘ ÙÔ˘˜ Â›Ó·È ÚˆÙfiÁÔÓ˜ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ·›ÚÓÔ˘Ó ÙË ÌÔÚÊ‹ ηı·Ú‹˜ ·ÓÙ›ÛÙ·Û˘. A˘Ùfi ÌÔÚ› Ó· Ê·›ÓÂÙ·È ·Ú¿ÏÔÁÔ ÛÙÔ˘˜ ¿ÏÏÔ˘˜, ·ÏÏ¿ Ë ÂÍ‹ÁËÛË ›Ûˆ˜ Â›Ó·È fiÙÈ ÔÈ ÁÔÓ›˜, ÂÓÙÂÏÒ˜ ·ÚÔÂȉÔÔ›ËÙÔÈ Î·È ·Ó¤ÙÔÈÌÔÈ, ÚÔÛ·ıÔ‡Ó Ó· ηٷϿ‚Ô˘Ó Î·È Ó· ‰Â¯ıÔ‡Ó ÙË Ó¤· ·˘Ù‹ Ú·ÁÌ·ÙÈÎfiÙËÙ·.(...) ŒÙÛÈ, ·Ú¯›˙ÂÈ Ë ·Ó·˙‹ÙËÛË. OÈ ÁÔÓ›˜ ÍÂÎÈÓÔ‡Ó ÁÈ· Ó· ·Ó·Î·Ï‡„Ô˘Ó ÙÈ Û˘Ì‚·›ÓÂÈ Ì ÙÔ ·È‰› ÙÔ˘˜. ZËÙÔ‡Ó ÏËÚÔÊÔڛ˜ Î·È ¿ÌÂÛ˜ χÛÂȘ.(...) ZËÙÔ‡Ó ‚Ô‹ıÂÈ· Î·È ·ÓÙ› ÁÈ' ·˘Ù‹Ó ÙÔ˘˜ ÚÔÛʤÚÂÙ·È Û˘Ó‹ıˆ˜ ¤Ó· ·fi Ù· ÙÚ›· ηο: ›Ù ÌÂÚ‰Â̤Ó˜ Î·È ·Î·Ù·ÓfiËÙ˜ ÁÓÒ̘, ¤ÙÔÈ̘ ÊÚ¿ÛÂȘ, ˘ÂÎÊ˘Á¤˜, ›Ù ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ Ô˘ ÂÈ‚¿ÏÏÔÓÙ·È ˆ˜ ‰fiÁÌ·Ù·, ›ÙÂ, ÙÔ ¯ÂÈÚfiÙÂÚÔ, ·ÏÏËÏÔÛ˘ÁÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ.(...) AÓ ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó fiÏÔÈ ÔÈ ÁÔÓ›˜ ÙȘ ȉÂÒ‰ÂȘ Û˘Óı‹Î˜ ÁÈ· ‰È¿ÁÓˆÛË, ıÂÚ·›·, ÏËÚÔÊfiÚËÛË Î·È ÛÙ‹ÚÈÍË Ô˘ ˘¿Ú¯Ô˘Ó Û ÔÚÈṲ̂ӷ K¤ÓÙÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡, ı· ÏÈÁfiÛÙ¢ ÛËÌ·ÓÙÈο Ë ·›ÛıËÛË ÙÔ˘ ¯¿Ô˘˜ Î·È Ù˘ ηٷÛÙÚÔÊ‹˜".

H ÂÌÂÈÚ›· Ì·˜ ·fi ÙȘ Â·Ê¤˜ Ì·˜ Ì ÔÈÎÔÁ¤ÓÂȘ Ô˘ ¤¯Ô˘Ó ·Ó¿ËÚÔ ·È‰› ›ӷÈ: M·Ó¿‰Â˜ Ô˘ ‰ÂÓ ¿ÓÙÂÍ·Ó ÙÔ ‚·Ú‡ ÊÔÚÙ›Ô Ù˘ ÊÚÔÓÙ›‰·˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ "¤ÎÏÂÈÛ·Ó" Û ›‰Ú˘Ì· ‹ ¿Û˘ÏÔ. ¶·Ù¤Ú˜ ÔÈ ÔÔ›ÔÈ ÂÁη٤ÏÂÈ„·Ó ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÌË ÌÔÚÒÓÙ·˜ Ó· ·ÓÙ¤ÍÔ˘Ó ÙÔ ÁÂÁÔÓfi˜ Ù˘ ·Ó·ËÚ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. OÈÎÔÁ¤ÓÂȘ Ô˘ Ífi‰Â„·Ó ÂÚÈÔ˘Û›Â˜ ÛÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜ Ó· ηχ„Ô˘Ó ÔÈÎÔÓÔÌÈο ÙȘ ÙÂÚ¿ÛÙȘ ··ÈÙ‹ÛÂȘ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Î·ıÒ˜ Î·È ÔÈÎÔÁ¤ÓÂȘ Ô˘, ¯ˆÚ›˜ ηӤӷ ÔÈÎÔÓÔÌÈÎfi ÂÊfi‰ÈÔ, ÍÂÎÈÓÔ‡Ó ÙÔÓ ·ÁÒÓ· ÌËÓ Í¤ÚÔÓÙ·˜ Ò˜ Î·È ·fi Ô‡ Ó· ˙ËÙ‹ÛÔ˘Ó ‚Ô‹ıÂÈ·. OÈÎÔÁ¤ÓÂȘ Ô˘ ÂÎÌÂÙ·ÏχÔÓÙ·È ÙȘ ·Ó·Ëڛ˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Ì ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜ Î·È ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜. OÈÎÔÁ¤ÓÂȘ Ô˘ ·ÚÓÔ‡ÓÙ·È Ó· ‰Ô˘Ó ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÚÔÛÎÔÏÏË̤ÓÔÈ Û ÚÔηٷϋ„ÂȘ Ô˘ ı¤ÏÔ˘Ó Ù· ¿ÙÔÌ· Ì ·Ó·Ëڛ˜ ¿ÙÔÌ· ÎÏÂÈṲ̂ӷ ÛÙÔ Û›ÙÈ Î·È Ù¤ÏÔ˜, ÔÈÎÔÁ¤ÓÂȘ Ô˘ ÍÂÂÚÓÔ‡Ó Ù· ·‰È¤ÍÔ‰· Ì ‰‡Ó·ÌË Î·È ı¤ÏËÛË.

Y¿Ú¯Ô˘Ó Û›ÁÔ˘Ú·, Î·È ÔÏϤ˜ ¿ÏϘ ÂÚÈÙÒÛÂȘ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ·Ó·ËÚ›·˜ ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ·ÊÔ‡ οı ·È‰› Â›Ó·È ÌÔÓ·‰ÈÎfi Î·È Î¿ı ÁÔÓÈfi˜ ¤¯ÂÈ ÙÔ ‰ÈÎfi ÙÔ˘ ÙÚfiÔ Ó· ÛΤÊÙÂÙ·È Î·È Ó· ÂÓÂÚÁ›.

OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜ ¤¯Ô˘Ó ÌÂÚÈΤ˜ ÎÔÈÓ¤˜ ·Ó¿ÁΘ: - TËÓ ·Ó¿ÁÎË Ó· ¤¯Ô˘Ó ·ÎÚÈ‚‹ ÏËÚÔÊfiÚËÛË Á‡Úˆ ·fi ÙË Ê‡ÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘ ·È‰ÈÔ‡.

- TËÓ ·Ó¿ÁÎË Ó· ‰Â¯ÙÔ‡Ó ˘ÔÛÙ‹ÚÈÍË, Û˘Ì‚Ô˘Ï‹ Î·È ÂÎ·›‰Â˘ÛË Ì ÛÎÔfi Ó· ÈηÓÔÔÈÔ‡Ó ÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹.

- TËÓ ·Ó¿ÁÎË ˘ËÚÂÛÈÒÓ Ô˘ Ó· ·ÚÌfi˙Ô˘Ó ÛÙÔ ·È‰› ÙÔ˘˜, Î·È Ù¤ÏÔ˜, - TËÓ ·Ó¿ÁÎË Ó· ÛÎÂÊıÔ‡Ó ÙËÓ Â˘‰ÔΛÌËÛË fiÏˆÓ ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ŸÌˆ˜, fiˆ˜ Ê¿ÓËΠ·fi ÙËÓ ¤Ú¢ӷ ·˘Ù‹, ÔÈ ÔÈÎÔÁ¤ÓÂȘ Ì ·Ó¿ËÚÔ ·È‰› ÛÙË ¯ÒÚ· Ì·˜ ÓÔÈÒıÔ˘Ó ÌfiÓ˜ Î·È ·‚Ô‹ıËÙ˜ ÛÙÔÓ ·ÁÒÓ· ÙÔ˘˜. OÈ ÁÔÓ›˜ ‰È·Ù˘ÒÓÔ˘Ó Ù· ·Ú¿ÔÓ¿ ÙÔ˘˜ ¤ÌÌÂÛ· ‹ ¿ÌÂÛ· Î·È Ì ‰È·ÊÔÚÂÙÈ΋ ¤ÓÙ·ÛË Î·È Û˘¯ÓfiÙËÙ·. ¶·Ú·ÔÓÔ‡ÓÙ·È: - ÁÈ· ·ÚÓËÙÈ΋ ÛÙ¿ÛË ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÎÔÈÓˆÓ›·˜, - ÁÈ· ÎÔÈÓˆÓÈο Î·È Ê˘ÛÈο ÂÌfi‰È·, - ÁÈ· ·ÓÂ·Ú΋ ÏËÚÔÊfiÚËÛË, - ÁÈ· ·ÓÂ·Ú΋ ÂÈÛÙËÌÔÓÈ΋ ηıÔ‰‹ÁËÛË Î·È ˘ÔÛÙ‹ÚÈÍË, - ÁÈ· ÚÔ‚Ï‹Ì·Ù· ÂÈÎÔÈÓˆÓ›·˜ Î·È Û¯¤ÛÂˆÓ Ì ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙÔ˘˜ ¿ÏÏÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, - ÁÈ· ÌË ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·Ú¤Ì‚·ÛË,

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:272-274

°. KÔÙÙ·Ú›‰Ë

- ÁÈ· ·ÓÂ·Ú΋ ÂÍÂȉÈÎÂ˘Ì¤ÓË ÊÚÔÓÙ›‰·, - ÁÈ· ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ ηٿÏÏËÏÔ˘ ÁÈ· ÔÏÈÛÙÈ΋ ÊÚÔÓÙ›‰· Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË „˘¯ÔÏÔÁÈÎÒÓ, ÎÔÈÓˆÓÈÎÒÓ, ·Ó·Ù˘ÍÈ·ÎÒÓ ·Ó·ÁÎÒÓ, „˘¯·ÁˆÁ›·˜ Î·È ·È‰Â›·˜, - ÁÈ· ¤ÏÏÂÈ„Ë ˘ËÚÂÛÈÒÓ ÊÚÔÓÙ›‰·˜ ÛÙÔ Û›ÙÈ. ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·Ó·Ê¤ÚÔ˘Ó Â›Ó·È ÙÔ ÎÚ¿ÙÔ˜ ÁÚ·ÊÂÈÔÎÚ·Ù›·˜ Ô˘ ¤¯Ô˘Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó, ÙÔ ÔÔ›Ô ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ·ÔÙÂÏ› ÌÈ· ÂÓÙÂÏÒ˜ ·Ú·ÓÔ˚΋ ηٿÛÙ·ÛË.

TÔ˘˜ ··Û¯ÔÏ› Ôχ ÙÔ Ì¤ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡ fiÙ·Ó ÔÈ ›‰ÈÔÈ Ï›„Ô˘Ó, ηıÒ˜ ÔÈ ÔÈÎÔÁÂÓÂÈ·ÎÔ› ‰ÂÛÌÔ› ¯·Ï·ÚÒÓÔ˘Ó Î·È Ë ·Ú·‰ÔÛȷ΋ ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ·ÏÏ¿˙ÂÈ. ZËÙÔ‡Ó ÙË ‰Ú·ÛÙËÚÈÔÔ›ËÛË ÙÔ˘ ÎÚ¿ÙÔ˘˜ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·˘Í·ÓfiÌÂÓ˜ ·Ó¿ÁΘ Ô˘ Û‹ÌÂÚ· ÂˆÌ›˙ÂÙ·È Ë ›‰È· Ë ÔÈÎÔÁ¤ÓÂÈ·.

E›ÏÔÁÔ˜ H ‰˘Ó·ÙfiÙËÙ· Ó· ÂÈÙ‡¯ÂÈ Î·Ó›˜ ÈηÓÔÔÈËÙÈ΋ ÔÈfiÙËÙ· ˙ˆ‹˜ οو ·fi ÙȘ ȤÛÂȘ Î·È ÙȘ ·‚‚·ÈfiÙËÙ˜ Ô˘ ÚÔηÏ› Ë ·Ó·ËÚ›· Â›Ó·È ÌÈ· ÙÂÚ¿ÛÙÈ· ÚfiÎÏËÛË. H ÂÌÂÈÚ›· οı ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ÌÔÓ·‰È΋ Î·È ‰ÂÓ ÌÔÚ› Ó· ÂÚÈÔÚÈÛÙ› Û ¤Ó·Ó ÎÏÈÓÈÎfi Ù‡Ô. ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ˙ËÙ‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ÚÔ‚ÏÂÊıÔ‡Ó Î·È Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙË ÊÚÔÓÙ›‰· Ù˘ ·Ó·ËÚ›·˜. °È' ·˘ÙfiÓ ÙÔ ÛÎÔfi, ‰ÂÓ ·ÚÎÔ‡Ó ÔÈ ÁÓÒÛÂȘ Î·È ÔÈ Î·Ï¤˜ ‰È·ı¤ÛÂȘ. XÚÂÈ¿˙ÔÓÙ·È ÔÏÈÙÈΤ˜ ˘Á›·˜ Î·È ÚfiÓÔÈ·˜ Î·È ÚˆÙÔ‚Ô˘Ï›Â˜ ÁÈ· ÚÔÁÚ¿ÌÌ·Ù· Ô˘ Ó· ¤¯Ô˘Ó ˆ˜ Â›ÎÂÓÙÚÔ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °. KÔÙÙ·Ú›‰Ë, KÔÈÓˆÓÈÔÏfiÁÔ˜, IÓÛÙÈÙÔ‡ÙÔ KÔÈÓˆÓÈ΋˜ ¶ÔÏÈÙÈ΋˜, E.K.K.E MÂÛÔÁ›ˆÓ 14-18, Aı‹Ó·

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Aƒ£ƒO ™À¡∆∞•∏™

H ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ› M·Ú›·-AÏÂÍ¿Ó‰Ú· M·ÁÈ¿ÎÔ˘1, °ÂÒÚÁÈÔ˜ ¶. XÚÔ‡ÛÔ˜2

M. Magiakou, G. Chroussos. The use of growth hormone in the treatment of short stature in Turner syndrome. Paediatriki 2000;63:275-277. ● Abstract: Girls with Turner syndrome are short and the great majority of them achieve a suboptimal final height. Although these patients do not have growth hormone (GH) deficiency, those with the worst final height prognosis may benefit from treatment with GH. Their gain in final height varies from 0 to 10 cm, with

a modest average gain of between 4 and 7 cm. Since GH treatment is parenteral, of long duration and expensive, considerable thought and commitment on the part of the physician, the patient and her parents is required.

TÔ Û‡Ó‰ÚÔÌÔ Turner, Ô˘ Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· ÛÙ· ÎÔÚ›ÙÛÈ·, ·ÚÈıÌ› Û‹ÌÂÚ· ÂηÙÔÓÙ¿‰Â˜ ¯ÈÏÈ¿‰Â˜ ¿Û¯Ô˘Û˜ Û ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ. YÔÏÔÁ›˙ÂÙ·È fiÙÈ Ô ÛËÌÂÚÈÓfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ÛÙȘ Hӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ AÌÂÚÈ΋˜ Â›Ó·È 75.000.

TȘ ÚÒÙ˜ ‰ÂηÂٛ˜ ÌÂÙ¿ ÙËÓ ÂÚÈÁÚ·Ê‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (1938), fiˆ˜ ‹Ù·Ó Ê˘ÛÈÎfi, ÔÈ ÂÈÛÙ‹ÌÔÓ˜ ÚÔÛ¿ıËÛ·Ó Ó· ··ÓÙ‹ÛÔ˘Ó ‚·ÛÈο ÂÚˆÙËÌ·ÙÈο Û¯ÂÙÈο Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙËÓ ÁÂÓÂÙÈ΋ Î·È ÙË ıÂÚ·›· ÙÔ˘. TȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ÙÔ Û.

Turner ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÂÎÙÂٷ̤Ó˘ ¤Ú¢ӷ˜ ‰È·ÊfiÚˆÓ È·ÙÚÈÎÒÓ ÔÌ¿‰ˆÓ (¶·È‰È¿ÙÚˆÓ EÓ‰ÔÎÚÈÓÔÏfiÁˆÓ - ¶·ıÔÏfiÁˆÓ - æ˘¯È¿ÙÚˆÓ - M·ÈÂ˘Ù‹ÚˆÓ), Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¤¯Ô˘Ó ÛËÌÂȈı› ÙÂÚ¿ÛÙȘ ÚfiÔ‰ÔÈ ÛÙËÓ Î·Ù·ÓfiËÛË Î·È ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ™‹ÌÂÚ·, ·ÛıÂÓ›˜ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÌÔÚÔ‡Ó Ó· Â›Ó·È ˘ÁÈ‹, Â˘Ù˘¯‹ Î·È ·Ú·ÁˆÁÈο ̤ÏË Ù˘ ÎÔÈÓˆÓ›·˜, Î·È ÛÙfi¯Ô˜ Â›Ó·È Ó· Ï˘ı› ηٿ ÙÔ ‰˘Ó·ÙfiÓ Î·È ÙÔ ·Ú·ÌÈÎÚfi Úfi‚ÏËÌ· Ô˘ ÙȘ ··Û¯ÔÏ›.

A˜ ÌË Í¯Óԇ̠fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰È¿ÊÔÚ· ΤÓÙÚ· Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘ ·Ó·Ê¤ÚÔ˘Ó ÂÈÙ˘¯Â›˜ ΢‹ÛÂȘ ÌÂÙ¿ ÂÌʇÙ¢ÛË ˆ·Ú›ˆÓ Û ÔÛÔÛÙfi 50-60% Û Á˘Ó·›Î˜ Ì Û. Turner (1,2).

H ¤ÁηÈÚË Î·È ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, Ô˘ ··ÓÙ¿ Û ÔÛÔÛÙfi 95-100%, Â›Ó·È ÂȂ‚ÏË̤ÓË ÛÙÔ Ï·›ÛÈÔ Ù˘ ÚÔÛ¿ıÂÈ·˜ Ù˘

‚ÂÏÙ›ˆÛ˘ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ.

H ÚÔÛ¿ıÂÈ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó¯‹ ˘ÔÛÙËÚÈÎÙÈ΋ Â·Ê‹ ÙˆÓ ıÂÚ·fiÓÙˆÓ ·È‰›·ÙÚˆÓ-ÂÓ‰ÔÎÚÈÓÔÏfiÁˆÓ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙȘ ·ÛıÂÓ›˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÛˆÛÙ‹ ÏËÚÔÊfiÚËÛË Î·È ÂÎ·›‰Â˘ÛË ·ÌÊÔÙ¤ÚˆÓ, ‰È·ÎÚÈÙÈÎfi ¯ÂÈÚÈÛÌfi ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜, Î·È ‚·ıÌÈ·›· ηıÔ‰‹ÁËÛË Î·È ‰È·Û‡Ó‰ÂÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ÔÌ¿‰· I·ÙÚÒÓ EÓËϛΈÓ.

H ·Ó·Û˘Ó‰˘·Ṳ̂ÓË ·˘ÍËÙÈ΋ ÔÚÌfiÓË (GH), Ô˘ ·ÔÙÂÏ› ÙËÓ ÌfiÓË Ô˘ÛÈ·ÛÙÈ΋ ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ¿Ú¯ÈÛ ӷ ÂÊ·ÚÌfi˙ÂÙ·È Û ·È‰È¿ Ì Û. Turner ·fi ÙÔ 1985. T· ÚÒÙ· ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÂÚ·›·˜ ‹Ù·Ó ÂÏȉÔÊfiÚ· (3). EÓÙÔ‡ÙÔȘ, Û˘Ó Ùˆ ¯ÚfiÓˆ, ·ÚÎÂÙ¿ ΤÓÙÚ· ·Ó¤ÊÂÚ·Ó ÌË ı·̷ÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, Î·È ¤ÙÛÈ, ¿Ú¯ÈÛ·Ó Ó· ÂÁ›ÚÔÓÙ·È ÂÚˆÙËÌ·ÙÈο Û¯ÂÙÈο Ì ÙË Û¯¤ÛË ÎfiÛÙÔ˘˜-ÔʤÏÔ˘˜ Ù˘ ÂÓ ÏfiÁˆ ıÂÚ·›·˜, ‰Â‰Ô̤Ó˘ Ù˘ Ì·ÎÚÔ¯ÚÔÓÈfiÙËÙ¿˜ Ù˘ Î·È ÙÔ˘ ˘„ËÏfiÙ·ÙÔ˘ ÎfiÛÙÔ˘˜ Ù˘. OÈ ÂÈÛÙ‹ÌÔÓ˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ ı¤Ì· ‰È·¯ˆÚ›˙ÔÓÙ·È Û‹ÌÂÚ· ÛÙÔ˘˜ ÂÓıÔ˘ÛÈÒ‰ÂȘ ˘ÔÛÙËÚÈÎÙ¤˜ Ù˘ ıÂÚ·›·˜ Ì GH Î·È ÛÙÔ˘˜ ÛÎÂÙÈÎÈÛÙ¤˜, Î·È ÙÔ ¯¿ÛÌ· ÌÂٷ͇ ÙÔ˘˜ Ê·›ÓÂÙ·È Û˘Ó¯Ҙ Ó· ÌÂÁ·ÏÒÓÂÈ. OÈ ÌÂÓ ÚÒÙÔÈ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÛÙÂÚËıÔ‡Ó ÔÈ ·ÛıÂÓ›˜ ÌÈ· ıÂÚ·›· Ì ÔÏÏ¿ ÔʤÏË Î·È ¯ˆÚ›˜

1 2

∫ey words: Turner syndrome, GH treatment, final height.

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

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ÎÈÓ‰‡ÓÔ˘˜, ÔÈ ‰Â ‰Â‡ÙÂÚÔÈ fiÙÈ ÛÔ‚·Úfi fiÊÂÏÔ˜ (ˆ˜ ÚÔ˜ ÙËÓ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜) ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ·Ô‰Âȯı› (2,4-6).

H ‰ËÌÔÛ›Â˘ÛË ·Ó·ÛÎfiËÛ˘ Ù˘ Û¯ÂÙÈ΋˜ Ì ÙÔ ı¤Ì· ‚È‚ÏÈÔÁÚ·Ê›·˜ Û ·˘Ùfi ÙÔ Ù‡¯Ô˜ Ù˘ "¶·È‰È·ÙÚÈ΋˜" (X.K·Ó·Î¿ -Gantenbein, ÛÂÏ. ) Ì·˜ ‰›‰ÂÈ fiϘ ÙȘ ÏÂÙÔ̤ÚÂȘ ÙˆÓ Ì¤¯ÚÈ ÙÒÚ· ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚ¢ÓÒÓ. Afi ÙËÓ Ôχ ÂÌÂÚÈÛٷو̤ÓË ·˘Ù‹ ·Ó·ÛÎfiËÛË, Ë /Ô ¶·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ·ÓÙÏ‹ÛÂÈ Ù· ÂÍ‹˜ ‚·ÛÈο Û˘ÌÂÚ¿ÛÌ·Ù·: 1. ™Â ·ÁÎfiÛÌÈÔ Â›‰Ô, ‰ÂÓ ıˆÚÔ‡ÓÙ·È ÈηÓÔÔÈËÙÈο Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜ Ì GH ÛÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ·ÛıÂÓÒÓ Ì Û. Turner (·Ó·ÊÂÚfiÌÂÓÔ Ì¤ÛÔ Î¤Ú‰Ô˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Ù˘ ٿ͈˜ ÙˆÓ 4-7 ÂηÙÔÛÙÒÓ, ‰È·Î˘Ì¿ÓÛÂȘ ÌÂٷ͇ ÙˆÓ ÌÂÏÂÙÒÓ ·fi 0-10 ÂηÙÔÛÙ¿).

2. ¶·Ú¿ ÙÔÓ ÌÂÁ¿ÏÔ ÚÔ‚ÏËÌ·ÙÈÛÌfi Î·È ÙË Ì›ˆÛË ÙÔ˘ ·Ú¯ÈÎÔ‡ ÂÓıÔ˘ÛÈ·ÛÌÔ‡, ·Ú·Ì¤ÓÂÈ ·Ó·ÌÊÈÛ‚‹ÙËÙÔ ÁÂÁÔÓfi˜ fiÙÈ ıÂÚ·›· Ì GH ‚ÂÏÙÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·, Î·È ¤¯ÂÈ Â˘ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù· ÛÙÔ ÏÈȉ·ÈÌÈÎfi profile Î·È ÛÙËÓ „˘¯ÔÏÔÁ›· ÙˆÓ ·ÛıÂÓÒÓ (7-9).

3. Afi ÙȘ ̤¯ÚÈ ÙÒÚ· ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ Î·È ÙÔÓ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÂÏÂÙÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÂͤÏÈÍË ‰È·ÈÛÙÒÓÂÙ·È, Ôχ ÛˆÛÙ¿ ηٿ ÙË ÁÓÒÌË Ì·˜, fiÙÈ ÔÈ ·Ó¿ ÙÔÓ ÎfiÛÌÔ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ Ê·›ÓÔÓÙ·È ‰È·ÙÂıÂÈ̤ÓÔÈ Ó· "·ÔÚÚ›„Ô˘Ó" ÙËÓ ¯Ú‹ÛË Ù˘ GH ÛÙÔ Û.

Turner, ·Ú¿ ÌfiÓÔÓ ·Ó ·Ô‰Âȯı› fiÙÈ Ë Û¯¤ÛË ÎfiÛÙÔ˘˜-ÔʤÏÔ˘˜ Â›Ó·È ·ÚÓËÙÈ΋. ŒÙÛÈ, Û‹ÌÂÚ· ÂÚ¢ÓÒÓÙ·È fiÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ¤Î‚·ÛË Ù˘ ıÂÚ·›·˜ Ì GH, fiˆ˜ .¯. ·) ÙÔ ‰˘Ó·ÌÈÎfi ·Ó¿Ù˘Í˘ ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ (·Ó ‰ËÏ·‰‹ ˆÊÂÏÔ‡ÓÙ·È ·fi ÙË ıÂÚ·›· ÂÚÈÛÛfiÙÂÚÔ ÔÈ ÎÔÓÙfiÙÂÚ˜ ‹ ÔÈ „ËÏfiÙÂÚ˜ ·ÛıÂÓ›˜ ‹ ÙÈ ÚfiÏÔ ·›˙ÂÈ ÙÔ ÎÏËÚÔÓÔÌÈÎfi ‰˘Ó·ÌÈÎfi ÁÈ· ÙÔ ‡„Ô˜), ‚) Ë ÂӉ‰ÂÈÁ̤ÓË ¯ÚÔÓÔÏÔÁÈ΋ Î·È ÔÛÙÈ΋ ËÏÈΛ· ÂÓ¿Ú͈˜ Ù˘ ıÂÚ·›·˜, Á) Ë ÌÔÚÊ‹ ηڢÔÙ‡Ô˘, ‰) Ù· Â›‰· Ù˘ ÂÓ‰ÔÁÂÓÔ‡˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, Â) Ë ÂӉ‰ÂÈÁ̤ÓË ‰fiÛË, Û˘¯ÓfiÙËÙ· Î·È ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜, ÛÙ) Ô Û˘Ó‰˘·ÛÌfi˜ Ì ¿ÏÏ· Ê¿Ú̷η (ÔÍ·Ó‰ÚÔÏfiÓË), ˙) Ë ÂӉ‰ÂÈÁ̤ÓË ËÏÈΛ· ÔÈÛÙÚÔÁÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘. Afi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÓ ÏfiÁˆ ÂÚ¢ÓÒÓ ÂÏ›˙Ô˘Ì fiÙÈ Û‡ÓÙÔÌ· ı· ˘¿ÚÍÔ˘Ó ÙÂÏÈο Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ· ÙËÓ "¿ÚÈÛÙË" Â›Ï˘ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙȘ ·ÛıÂÓ›˜ Ì Û.

Turner. ¶ÚÈÓ Û·˜ ηٷı¤ÛÔ˘Ì ÙËÓ ÚÔÛˆÈ΋ Ì·˜ ¿Ô„Ë ÛÙÔ ÂÚÒÙËÌ· "E›ÛÙ ˘¤Ú Ù˘ ıÂÚ·›·˜ Ì GH ÛÙÔ Û. Turner;", ÂÈÙÚ¤„Ù ̷˜ Ó· ÂÍËÁ‹ÛÔ˘Ì ÙÔ ÁÈ·Ù› Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜ Ì GH ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ Ó· Á›ÓÔ˘Ó ÈηÓÔÔÈËÙÈο. ¶ÚÒÙÔÓ, ‰ÈfiÙÈ ÛÙÔ Û. Turner ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÓÂ¿ÚÎÂÈ· Ù˘ GH Ì ÙËÓ "ÎÏ·ÛÈ΋" ¤ÓÓÔÈ· ÙÔ˘ fiÚÔ˘, ·ÏÏ¿ Ë ·ÈÙ›· ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ (X. K·Ó·Î¿-Gantenbein, ÛÂÏ. 278-286). §fiÁˆ ·ÎÚÈ‚Ò˜ Ù˘ ·ÈÙ›·˜ ·˘Ù‹˜, ÙÔ Ì¤ÛÔ ·Ó¿ÛÙËÌ· ·ÛıÂÓÒÓ Ì Û. Turner Ô˘ ‰ÂÓ ¤Ï·‚·Ó ÔÚÌÔÓÈ΋ ıÂÚ·›· Â›Ó·È 3,1 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ οو ·fi ÙÔÓ

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̤ÛÔ fiÚÔ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÓËÏ›ÎˆÓ (10). H "·ÒÏÂÈ·" ·˘ÙÒÓ ÙˆÓ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘ ‡„Ô˘˜ Á›ÓÂÙ·È ÂÓ Ì¤ÚÂÈ Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹ (ÏfiÁˆ ÌÈÎÚ‹˜ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ ·‡ÍËÛ˘ Ù· ·È‰È¿ Ì Û. Turner ÁÂÓÓÈÔ‡ÓÙ·È Ì ̋ÎÔ˜ ÌÂȈ̤ÓÔ Î·Ù¿ 0,6 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ), ÂÚ›Ô˘ 1,4 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ ¯¿ÓÔÓÙ·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ, ÂÓÒ Ô ÌÂȈ̤ÓÔ˜ ÂÙ‹ÛÈÔ˜ Ú˘ıÌfi˜ ·‡ÍËÛ˘ ÌÂÙ¿ ·˘Ù‹ ÙËÓ ËÏÈΛ· Î·È Ë ¤ÏÏÂÈ„Ë ÙÔ˘ "growth spurt" ηٿ ÙËÓ ÂÊ˂›· Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ÙÔ˘ ‡„Ô˘˜. H ¯ÔÚ‹ÁËÛË GH (Û ‰fiÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 25% ·Ú·¿Óˆ ·fi ÙË ‰fiÛË ˘ÔηٿÛÙ·Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ˘ÔÊ˘Ûȷ΋ ·ÓÂ¿ÚÎÂÈ·) ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÓ Ì¤ÚÂÈ ÛÙËÓ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ Û›ÁÔ˘Ú·, ‰ÂÓ ÌÔÚ› Ó· "·Ú¤Ì‚ÂÈ" ÛÙËÓ ·ÒÏÂÈ· ÙˆÓ 2 ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘ ‡„Ô˘˜, Ô˘ ¯¿ıËÎ·Ó Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ.

M fiϘ ÙȘ ÂÈÊ˘Ï¿ÍÂȘ Ô˘ ÚԷӷʤÚıËηÓ, Î·È ÂÓ ·Ó·ÌÔÓ‹ ÙˆÓ ÙÂÏÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Ù˘ ·ÁÎfiÛÌÈ·˜ ¤Ú¢ӷ˜, ÈÛÙ‡ԢÌ fiÙÈ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıËıÔ‡Ó ÔÈ ÙÂÏÂ˘Ù·›Â˜ Â›ÛË̘ Ô‰ËÁ›Â˜ Ù˘ AÌÂÚÈηÓÈ΋˜ Aη‰ËÌ›·˜ ¶·È‰È¿ÙÚˆÓ (1997), Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ Û. Turner ÛÙȘ ÂӉ›ÍÂȘ ¯ÔÚËÁ‹Ûˆ˜ GH (11).

H ıÂÚ·›· Ì GH ‰ÂÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ, Ë ÂӉ‰ÂÈÁ̤ÓË ‰fiÛË Â›Ó·È 0,7-0,9 IU/kg/‚‰ÔÌ¿‰· (20-30 IU/m2/‚‰ÔÌ¿‰·) Â› 6 Ë̤Ú˜/‚‰ÔÌ¿‰·, Î·È Ë ÛˆÛÙfiÙÂÚË ËÏÈΛ· ÔÈÛÙÚÔÁÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ Â›Ó·È Ù· 13 ¤ÙË (2).

H ¿Ô„‹ Ì·˜ Â›Ó·È fiÙÈ Ë ¯Ú‹ÛË Ù˘ GH ÛÙÔ Û.

Turner ı· Ú¤ÂÈ Ó· Û˘˙ËÙÂ›Ù·È ‰ÈÂÍÔ‰Èο Û·Ó ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙȘ ·ÛıÂÓ›˜, Ë ‰Â ·fiÊ·ÛË ÁÈ· ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÂÛ¢Ṳ̂ӷ Î·È ˘fi Û˘Óı‹Î˜ "¿Á¯Ô˘˜" ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÔÓ¤ˆÓ, ÂÊfiÛÔÓ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Î·ı˘ÛÙ¤ÚËÛË ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ ÁÈ· ÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ‰ÂÓ ·ÏÏ¿˙ÂÈ Ù· ·ÔÙÂϤÛÌ·Ù·.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ ·ÔÊ·Û›˙Ô˘Ó, ÌÂÙ¿ ÛˆÛÙ‹ ÂÓË̤ڈÛË, Ó· ˘Ô‚¿ÏÔ˘Ó Ù· ·È‰È¿ ÙÔ˘˜ ÛÙË ıÂÚ·›· Ì ÙÔ ÛÎÂÙÈÎfi fiÙÈ Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ “οÓÔ˘Ó fi,ÙÈ Á›ÓÂÙ·È Î·Ï‡ÙÂÚÔ ÁÈ· ÙÔ ·È‰› ÙÔ˘˜”. £ÂˆÚԇ̠·ÎfiÌË, fiÙÈ ·ÛıÂÓ›˜ Ì ÈηÓÔÔÈËÙÈÎfi ·Ó¿ÛÙËÌ· ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘Ô‚ÏËıÔ‡Ó Û ıÂÚ·›· Ì GH. BÈ‚ÏÈÔÁÚ·Ê›· 1. Turner HH. A syndrome of infantilism, congenital webbed neck and cubitus valgus. Endocrinology 1938;28:566-574.

2. Saenger P. Turner's syndrome: Current concepts. NEJM 1996;335(23):1749-1754.

3. Rosenfeld RG, Frane J, Attie KM, Brasel JA, Burstein S, Cara JF et al. Six year results of a randomized, prospective trial of human growth hormone and oxandrolone in Turner syndrome. J Pediatr 1992;121:49-55.

4. Donaldson MD. Growth hormone therapy in Turner syndrome: Current uncertainties and future strategies.

Horm Res 1997;48 (Suppl 5):35-44.

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5. Haeusler G. Growth hormone therapy in patients with Turner syndrome. Horm Res 1998;49 (suppl 2):62-66.

6. Donaldson MDC. Unresolved problems in the treatment of short stature for Turner syndrome. International Growth Monitor 1998;8:2-9.

7. Sylven L, Hagenfeldt K, Ringertz H. Impact of hormonal replacement therapy on bone mineral density in women with Turner syndrome. In: Albertsson-Wikland K, Ranke MB, eds. Turner syndrome in a life span perspective: Research and clinical aspects. Amsterdam: Elsevier Science BV, 1995:241-248.

8. Lanes R, Gunczler P, Palacios A, Villaroel O. Serum lipids, lipoprotein lp(a) and plasminogen activator inhibitor-1 in patients with Turner's syndrome before and during growth hormone and estrogen therapy. Fertil Steril 1997;68:473-477.

™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË

9. Lagrou K, Xhrouet-Heinrichs D, Heinrichs C, Graen M, Chanoine JP, Malvaux P et al. Age-related perception of stature, acceptance of therapy and psychosocial functioning in human growth hormone-treated girls with Turner's syndrome. J Clin Endocrinol Metab 1998;83:1494-1501.

10. Ranke MB, Pfluger H, Rosendahl W, Stubbe P, Enders H, Bierich JR et al. Turner syndrome: spontaneous growth in 150 cases and review of the literature. Eur J Pediatr 1983;141:81-88.

11. American Academy of Pediatrics. Committee on Bioethics and Committee on Drugs: Considerations related to the use of recombinant human growth hormone in children.

Pediatrics 1997;99:122-129.

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›·-AÏÂÍ¿Ó‰Ú· M·ÁÈ¿ÎÔ˘ B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

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ANA™KO¶∏™∏

™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË: ¢ÈηÈÔÏÔÁÂ›Ù·È ·ÎfiÌË Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜; XÚÈÛÙ›Ó· K·Ó·Î¿ - Gantenbein

● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ë ÎÚÈÙÈ΋ ·Ó·ÛÎfiËÛË Î·È ÌÂÙ·-·Ó¿Ï˘ÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÎÔÚÈÙÛÈÒÓ Ì ۇӉÚÔÌÔ Turner Ô˘ ¤Ï·‚·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË. TÔ Û‡Ó‰ÚÔÌÔ Turner Â›Ó·È ¤Ó· ·fi Ù· Û˘¯ÓfiÙÂÚ· ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·ÊÔÚ¿ 1 ÂÚÈÛÙ·ÙÈÎfi /2000-2500 ÁÂÓÓ‹ÛÂȘ ıËϤˆÓ ÓÂÔÁÓÒÓ Î·È ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ·Ó¢ڛÛÎÂÙ·È ÛÙÔ 95-100% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ. Y¿Ú¯ÂÈ ÏËıÒÚ· ÚÔÛÊ¿ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ Ì ‰Â‰Ô̤ӷ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙ· ÎÔÚ›ÙÛÈ· Ô˘ ¤Ï·‚·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË. ¶·Ú¿ ÙÔÓ ‰È·ÊÔÚÂÙÈÎfi ۯ‰ȷÛÌfi ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ Î·È Ù· ÌÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· Û‡ÁÎÚÈÛ˘ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÂÚÁ·ÛÈÒÓ, Ë ¯ÔÚ‹ÁËÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ê·›ÓÂÙ·È Ó· ÂÈʤÚÂÈ ¤Ó· ̤ÛÔ Î¤Ú‰Ô˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Ù˘ ٿ͈˜ ÙˆÓ 6 ÂηÙÔÛÙÒÓ (Ì ‰È·Î˘Ì¿ÓÛÂȘ ·fi 0-10 ÂηÙÔÛÙ¿) Î·È ‚ÂÏÙ›ˆÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ, ¤ÙÛÈ ÒÛÙ ӷ ÂӉ›ÎÓ˘Ù·È Ë ¯ÔÚ‹ÁËÛË Ù˘ ÛÙÔ ™‡Ó‰ÚÔÌÔ Turner ÛÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ‰fiÛÂȘ ÙˆÓ 0,7-0,9 IU/kg/‚‰ÔÌ¿‰·. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Ê·›ÓÂÙ·È Ó· Â›Ó·È Ë ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜, Ô ‚·ıÌfi˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜, Ô Î·Ú˘fiÙ˘Ô˜ Î·È ÙÔ ÁÔÓÂ˚Îfi ‡„Ô˜, ÂÓÒ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, .¯. Ë ‰fiÛË, Û˘¯ÓfiÙËÙ· Î·È ‰È¿ÚÎÂÈ· Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ηıÒ˜ Î·È Ë ¤ÎÎÚÈÛË ÂÓ‰ÔÁÂÓÔ‡˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ‰ÂÓ Ê·›ÓÔÓÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙÔ ·ÔÙ¤ÏÂÛÌ·. ™˘ÌÏËڈ̷ÙÈΤ˜ ÌÂϤÙ˜ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙË ‰È·Ï‡ηÓÛË Ù˘ ȉ·ÓÈ΋˜ ËÏÈΛ·˜ ¯ÔÚ‹ÁËÛ˘ ÔÈÛÙÚÔÁfiÓˆÓ Î·È ÚÔÛı‹Î˘ ÔÍ·Ó‰ÚÔÏfiÓ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:278-286. §¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Turner, ·˘ÍËÙÈ΋ ÔÚÌfiÓË, ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·.

C. Kanaka-Gantenbein. Turner syndrome and growth hormone: Is the initial enthusiasm justified?

Paediatriki 2000;63:278-286. ● Abstract: This paper summarizes data published on the final height of growth hormone (GH) treated girls with Turner syndrome, with emphasis on meta-analysis of the published data. Turner syndrome is a common genetic disorder, with a frequency of 1 case in 2,000-2,500 live newborn females. Extremely severe short stature, with a final height of 20 cm shorter than the average for the female population is observed in 95-100% of girls with Turner syndrome. Human growth hormone (hGH) is used worldwide for the treatment of these girls.

Recent data on final height with hGH therapy reveal an average benefit of about 6 cm over the projected adult height, with a wide variation within studies, ranging from 0 to 10 cm, along with improvement in the bone density. Prognostic factors influencing the outcome are the chronological age and bone age delay at initiation of treatment, the karyotype and the parental height, while other factors such as dose, frequency and duration of hGH administration or levels of endogenous GH secretion do not seem to play a major role. Prospective studies are under way which aim to elucidate the ideal age for oestrogen substitution and oxandrolone therapy.

Key words: Turner syndrome, growth hormone treatment, final height.

TÔ Û‡Ó‰ÚÔÌÔ Turner ·ÔÙÂÏ› ¤Ó· ·fi Ù· Û˘¯ÓfiÙÂÚ· ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ· ÌÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ 1/2000-2500 ÁÂÓÓ‹ÛÂȘ ı‹ÏÂˆÓ ÓÂÔÁÓÒÓ (1,2). H Û˘¯ÓfiÙËÙ· Â›Ó·È Ôχ ÌÂÁ·Ï‡ÙÂÚË ÌÂٷ͇ ÙˆÓ ıËϤˆÓ

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ÂÌ‚Ú‡ˆÓ 1Ô˘ ÙÚÈÌ‹ÓÔ˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ 99,9% ÙˆÓ Î˘ËÌ¿ÙˆÓ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ‰ÂÓ Î·Ù·Ï‹ÁÂÈ Û Á¤ÓÓËÛË ÏfiÁˆ ·˘ÙfiÌ·ÙˆÓ ·Ô‚ÔÏÒÓ (1).

H ˘ÔΛÌÂÓË ¯ÚˆÌÔÛˆÌȷ΋ ·ÓˆÌ·Ï›· ›ӷÈ

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·Ô˘Û›· ÙÔ˘ ÂÓfi˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ X, ‰ËÏ. ηڢfiÙ˘Ô˜ 45,XO ÛÙfi 55%-60% ÙˆÓ ÂÚÈÙÒÛˆÓ, ‰·ÎÙ˘ÏÈÔÂȉ¤˜ ¯ÚˆÌfiۈ̷ X Û 3,5%, ÈÛÔ¯ÚˆÌfiۈ̷ X Û 8,5%, ̈۷˚ÎÈÛÌfi˜ 45,XO/46,XY Û 6,5%, ÂÓÒ ¿ÏϘ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ·Ó¢ڛÛÎÔÓÙ·È Û ÌÈÎÚfiÙÂÚ· ÔÛÔÛÙ¿ (2).

K‡ÚÈ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο TÔ ™‡Ó‰ÚÔÌÔ Turner ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ˘ÔÁÔÓ·‰ÈÛÌfi, ·˘¯ÂÓÈÎfi ÙÂÚ‡ÁÈÔ, ‚Ï·ÈÛÔ‡˜ ·ÁÎÒÓ˜, ÏÂÌÊÔ›‰ËÌ· ¯ÂÈÚÒÓ Î·È Ô‰ÒÓ Î·Ù¿ ÙË Á¤ÓÓËÛË, Ï·Ù‡ ıÒڷη Ì ÌÂÁ¿ÏË ·fiÛÙ·ÛË ıËÏÒÓ Î·È ÂÈÛ¤¯Ô˘Û˜ ıËϤ˜, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË Ì·ÏÏÈÒÓ, Ó‡¯È· "‰›ÎËÓ ÛÊ˘Úfi˜" (ongles en marteau), ÌÏ ÛÎÏËÚÔ‡˜ (blue sclera), ÎÏ (2-4). EÈϤÔÓ, ··ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ .¯. ÛÙ¤ÓˆÛË ÙÔ˘ ÈÛıÌÔ‡ Ù˘ ·ÔÚÙ‹˜, ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜, ‰ÈÏfi ·Ô¯ÂÙ¢ÙÈÎfi Û‡ÛÙËÌ·), ‚·ÚËÎÔ˝· (2,5,6) Î·È ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (7,8). ¶Úfi‚ÏËÌ· ·Ó¿Ù˘Í˘ TÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ·Ó¢ڛÛÎÂÙ·È Û ¿Óˆ ÙˆÓ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘ ™˘Ó‰ÚfiÌÔ˘ (9), Ì ·ÔÙ¤ÏÂÛÌ· Ù· ÎÔÚ›ÙÛÈ· ·˘Ù¿ Ó· ηٷϋÁÔ˘Ó, ¯ˆÚ›˜ ıÂÚ·›·, Û fiÏ· Ù· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘, ηٿ ̤ÛÔÓ fiÚÔ 20 ÂηÙÔÛÙ¿ ÎÔÓÙ‡ÙÂÚ· ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ Á˘Ó·ÈÎÒÓ ÙÔ˘ ÂοÛÙÔÙ ÏËı˘ÛÌÔ‡ (10-12).

Afi ÓˆÚ›˜ ·Ó·˙ËÙ‹ıËÎ·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ Ó· ÂËÚ¿˙Ô˘Ó ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, .¯. Ô Î·Ú˘fiÙ˘Ô˜, Ë ¤Ó·ÚÍË ÂÊ˂›·˜ ‹ fi¯È, ÙÔ Ì¤ÛÔ ÁÔÓÂ˚Îfi ‡„Ô˜ ÎÏ.

(10-12).

NÂfiÙÂÚ˜ ÌÂϤÙ˜ η٤‰ÂÈÍ·Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ηڢÔÙ‡Ô˘ ÛÙÔ ·Ó¿ÛÙËÌ· (13). AÛıÂÓ›˜ Ì ηڢfiÙ˘Ô 46,X,I(Xq) ηٷϋÁÔ˘Ó Û ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÂÓÒ ·ÛıÂÓ›˜ Ì ηڢfiÙ˘Ô 45,XO/46,XY ‹ Ì ηڢfiÙ˘Ô 46,X, del (Xq) ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ï‡ÙÂÚÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. EÈϤÔÓ, ·ÛıÂÓ›˜ Ì ‰Èۈ̛· ÙÔ˘ ‚Ú·¯¤Ô˜ ÛΤÏÔ˘˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ X (Xp) ηٷϋÁÔ˘Ó ÛËÌ·ÓÙÈο „ËÏfiÙÂÚ˜ ·fi ·ÛıÂÓ›˜ Ì ÌÔÓÔۈ̛· ÙÔ˘ Xp. TÔ Ì¤ÛÔ ÁÔÓÂ˚Îfi ‡„Ô˜ ÂËÚ¿˙ÂÈ Â›Û˘ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ, fiˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ˘ÁÈÒÓ ·È‰ÈÒÓ (12,14,15).

EÈϤÔÓ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, .¯. ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÛÙ· Ï·›ÛÈ· ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto ‹ ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ηٷÛÙ¿ÛÂȘ Ô˘ ··ÓÙÒÓÙ·È Û¯ÂÙÈο Û˘¯Ó¿ ÛÙÔ ™‡Ó‰ÚÔÌÔ, ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ·ÚÓËÙÈο ÙËÓ ·Ó¿Ù˘ÍË (8), ÂÓÒ ·˘ÙfiÌ·ÙË ÂÌÊ¿ÓÈÛË ÂÊ˂›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ηχÙÂÚÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (14).

T· ·›ÙÈ· ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, Ê·›ÓÂÙ·È ¿ÓÙˆ˜ fiÙÈ Ë ·Ô˘Û›· ÙÔ˘ ÁÔÓȉ›Ô˘ SHOX (16), Ô˘ ηıÔÚ›˙ÂÈ ÙÔ ·Ó¿-

™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË

™˘ÓÙÔÌÔÁڷʛ˜ hGH = human Growth Hormone = ·ÓıÚÒÈÓË A˘ÍËÙÈ΋ OÚÌfiÓË IGF I = Insulin-like Growth factor I = ™ˆÌ·ÙỔ›ÓË C

ÛÙËÌ· Î·È ‚Ú›ÛÎÂÙ·È ÛÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ X, ·›˙ÂÈ ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ, ÂÓÒ ÂÈϤÔÓ ·Ú¿ÁÔÓÙ˜ fiˆ˜ ‡·ÚÍË ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ¿ÍÔÓ· GH-IGFI Î·È ÛÎÂÏÂÙÈ΋˜ ‰˘ÛÏ·Û›·˜ Û˘Ì‚¿ÏÏÔ˘Ó Â›Û˘ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· (17). §fiÁˆ ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ηٷÛ΢¿ÛÙËÎ·Ó ÂȉÈΤ˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ Û ‰È¿ÊÔÚ˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ (10). ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ÚԂϤ„ÂȘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ, ¤ÁÈÓ ÂÌÊ·Ó‹˜ Ë ‰˘ÛÎÔÏ›· ÂÊ·ÚÌÔÁ‹˜ ÚԂϤ„ÂˆÓ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ÚԂϤ„ÂȘ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙÔÓ ˘ÁÈ‹ ÏËı˘ÛÌfi (18). ŒÙÛÈ, ÔÈ Lyon et al. (19) ÚfiÙÂÈÓ·Ó fiÙÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ ÌÔÚ› Ó· ÚÔ‚ÏÂÊı› ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ·È‰ÈÔ‡ Û ÌÈ· ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ÌÂÙ¿ ·fi ÚÔ¤ÎÙ·ÛË ÙÔ˘ ‰Â‰Ô̤ÓÔ˘ ‡„Ô˘˜ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ¿Óˆ ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ηÌ‡Ï˜ ‡„Ô˘˜ ÙÔ˘ ÂοÛÙÔÙ ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ, ‚·ÛÈ˙fiÌÂÓÔÈ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ·˘Ù¿ ‰ÂÓ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÙÔ ¿ÏÌ· Û ‡„Ô˜ Ô˘ Ê˘ÛÈÔÏÔÁÈο ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ù¿ ÙËÓ ÂÊ˂›· (pubertal growth spurt). ŒÙÛÈ ÚԤ΢„Â Ô fiÚÔ˜ ÙÔ˘ "ÚÔ‚·ÏÏfiÌÂÓÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜"= projected adult height: PAH) Ô ÔÔ›Ô˜ ıˆÚÂ›Ù·È Ë ÈÔ ¤Á΢ÚË Ì¤ıÔ‰Ô˜ Úfi‚Ï„˘ ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙÔ ™‡Ó‰ÚÔÌÔ Turner (20-22).

TÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ¤ÛÙÚ„ ·fi ÓˆÚ›˜ ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ÂÓ‰ÔÎÚÈÓÔÏfiÁˆÓ Û ‰˘Ó·ÙfiÙËÙ˜ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘.

AÚ¯Èο ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ıÂÚ·›˜ Ì ‚¿ÛË ·Ó·‚ÔÏÈο Û΢¿ÛÌ·Ù·, Ì ·ÚÈÔ ÂÎÚfiÛˆÔ ÙËÓ ÔÍ·Ó‰ÚÔÏfiÓË Î·ıÒ˜ Î·È ¯ÔÚ‹ÁËÛË ·Èı˘Ó˘Ï-ÔÈÛÙÚ·‰ÈfiÏ˘, Ù· ÔÔ›· Â¤ÊÂÚ·Ó ÌfiÓÔ ÌÈÎÚ‹ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ (23).

AÈÛÈfi‰ÔÍ· ·ÔÙÂϤÛÌ·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó ·ÓÙÈı¤Ùˆ˜ ÌÂÙ¿ ·fi ‚Ú·¯‡¯ÚÔÓË ¯ÔÚ‹ÁËÛË ·ÓıÚÒÈÓ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (hGH) Û ÎÔÚ›ÙÛÈ· Ì ÙÔ ™‡Ó‰ÚÔÌÔ (24), ¤ÙÛÈ ÒÛÙÂ Ë ¯ÔÚ‹ÁËÛË hGH ÛÙÔ ™‡Ó‰ÚÔÌÔ Turner ηıÈÂÚÒıËΠ‰ÈÂıÓÒ˜.

TÂÏÈÎfi AÓ¿ÛÙËÌ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ú·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË MfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘‹ÚÍ·Ó ϤÔÓ ‰Â‰Ô̤ӷ, fi¯È ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ÙÂÏÈÎÔ‡ ‡„Ô˘˜, ·ÏÏ¿ ÙÔ˘ Ú·ÁÌ·ÙÈÎÔ‡ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ Ô˘ ‹Ú·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË, Î·È Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜ ¿Ú¯ÈÛ ϤÔÓ Ó· ÌÂÙÚÈ¿˙ÂÙ·È.

Y¿Ú¯ÂÈ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÂÚÁ·ÛÈÒÓ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙÔ fiÊÂÏÔ˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ·fi ÙË

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X. K·Ó·Î¿ - Gantenbein

¶›Ó·Î·˜ 1·. ™˘ÓÔÙÈ΋ ·Ú¿ıÂÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Î·Ù·‰ÂÈÎÓ‡Ô˘Ó Î¤Ú‰Ô˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÎÔÚÈÙÛÈÒÓ Ì ™‡Ó‰ÚÔÌÔ Turner Ô˘ ¤Ï·‚·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË. ∞ӷʤÚÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ ± ™Ù·ıÂÚ¤˜ ∞ÔÎÏ›ÛÂȘ (SD=standard deviation). ™Â ·Ú¤ÓıÂÛË ·Ó·Ê¤ÚÂÙ·È ÙÔ Â‡ÚÔ˜ ‰È·Î‡Ì·ÓÛ˘ ÙˆÓ ÙÈÌÒÓ.

EÚÁ·Û›·

AÛıÂÓ›˜ (n)

XH ¤Ó·Ú͢ (ŒÙË)

¢fiÛË hGH OÍ·Ó‰ÚÔÏfiÓË EE ng/kg/d, IU/Kg/week mg/Kg/day XH

TA cm

PAH Lyon cm

ŸÊÂÏÔ˜ cm

Werther A˘ÛÙÚ·Ï›·, 1995

n=18 n=15

11(7-14) 11(7-14)

1,2 +EE 1,2+ placebo (2yrs), + EE

5Ì/d, XH:11 5Ì/d, XH:13

147,3 ± 5,6 148,1 ± 4,5

143,6 ± 4,2 142,6 ± 4,7

3,7 5,4

Takano, I·ˆÓ›·, 1995

n=12 n=16

10,3 ± 2,4 9,3 ± 2,6

0,5 1,0

XH>13

145,1 ± 4,7 144,0 ± 2,2

137 137

8,1 7,0

0,5, then 1,0

100→200 XH= 15,7

147,6

142,2

5,0

147,7

141-142

5,0-6,0

Pasquino, IÙ·Ï›·, 1996

n=18 Ctrl=18

Rochiccioli, °·ÏÏ›·, 1995

n=117

12,9 ± 2,0

0,7- 0,9

0,05-0,1 n=24

Nilsson, ™Ô˘Ë‰›·, 1996

I(n=13) II(n=17) III(n=15)

12,3 ±1,7 12,1 ±1,7 12,3 ±2,1

Ox(1yr), II or III Ox+GH 0,7 Ox+GH0,7+EE

0,05-0,1

100

151,0 ± 6,7 154,2 ± 6,6 151,1 ± 4,6

143,6 ± 4,9 145,7 ± 5,1 148,1 ± 6,2

7,4 8,5 3,0

Haeusler, A˘ÛÙÚ›·, 1996

n=20

11,8±2,4 (7,3-16,4)

0,4-0,6

0,0625

50 16,3±1,7

152,9±3,5

143,7±4,0

9,2

V. den Broeck 5 ¯ÒÚ˜, 1995

n=56

12,9

0,5-1,2

50-125 XH=14,5

150,7±4,9

147,8

2,9

Massa OÏÏ·Ó‰›·, 1995

n=45

0,85

100 XH>12

152,3±5,3

147-149,7

2,6-5,3

Ranke, KIGS, 1995

n=82

12,0 (10,3-14,7)

0,7 (0,5-0,9)

n=31 XH=13,8

149,6 (141-155,4)

142,4

7,2

Plotnick H¶A, 1998

n=622

10,1±3,6

1,0

148,3±5,6

141,9±6,2

6,4

Rosenfeld, H¶A,1998

n=17 n=43 Ctrl=25(R)

9,1±2,1 9,7±2,5 9,1±1,7

0,8 0,8+Ox -

XH:15,2±0,9 XH:14,9±0,9 XH:15,8±1,8

150,4±5,5 152,1±5,9 144,2±6,0

142,0±5,9 141,8±5,9 144,2±5,6

8,4 10,3 -

Hochberg, IÛÚ·‹Ï,1998

n=25 Ctrl=24(M)

10,7±1,4 10,7±1,4

0,8 -

XH:13,2±1,0 XH:13,2±1,0

147,3±4,9 142,9±5,1

142,6±5,2 143,5±4,2

4,7±2,9

Stephure, K·Ó·‰¿˜,1998

n=41 Ctrl=29(M)

11,1±1,5 11,3±1,4

1,0

XH:13 XH:13

146,1±6,5 141,4±4,7

Quigley, H¶A, 1998

n=83

11,5±2,2

0,9

™˘ÓÔÏÈο

¯ÔÚ‹ÁËÛË hGH Û ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ (17,21,22,25-33), ÂÓÒ ÌÈÎÚfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ‰ËÌÔÛȇÛÂˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚ‹ ¤ˆ˜ ·Û‹Ì·ÓÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ (34-37). OÈ ›Ó·Î˜ 1·, 1‚ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÓÔÏÈο Ù· ·ÔÙÂϤÛÌ·Ù· fiÏˆÓ ÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·ÛÈÒÓ (¶›Ó·Î˜ 1·, 1‚).

AӷχÔÓÙ·È ÂȉÈÎfiÙÂÚ· ‰‡Ô ΢ڛˆ˜ ·Ó·ÛÎÔ‹ÛÂȘ, Ô˘ Û˘ÓÔ„›˙Ô˘Ó Ù· ‰Â‰Ô̤ӷ ‰È·ÊfiÚˆÓ ÂÚ-

280

XH=13,6 n=31

0,0625

148,9±6,7

6,3±1,1 vs.controls 143,6±5,8

5,4 ±2,2

6,07 cm

Á·ÛÈÒÓ Î·È ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ Hormone Research, Â›ÛËÌÔ ÂÈÛÙËÌÔÓÈÎfi ÂÚÈÔ‰ÈÎfi Ù˘ E˘Úˆ·˚΋˜ EÙ·ÈÚ›·˜ ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁ›·˜, Ë Ì›· ÙÔ 1997 ·fi ÙÔÓ Donaldson (27) Î·È Ë ‰Â‡ÙÂÚË ÙÔ 1998 ·fi ÙÔÓ Haeusler (17).

O Donaldson (27) ·Ó¤Ï˘Û ٷ ‰Â‰Ô̤ӷ 10 ÂÚÁ·ÛÈÒÓ ·fi AÌÂÚÈ΋, A˘ÛÙÚ·Ï›·, E˘ÚÒË, Î·È ¤‰ÂÈÍ fiÙÈ ÛÙȘ 8 ·fi ÙȘ 10 ÂÚÁ·Û›Â˜ ˘¿Ú¯ÂÈ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Ì ¯ÔÚ‹ÁËÛË A˘ÍËÙÈ΋˜

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·281

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286

™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË

¶›Ó·Î·˜ 1‚. ™˘ÓÔÏÈ΋ ·Ú¿ıÂÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ηٷ‰ÂÈÎÓ‡Ô˘Ó Î¤Ú‰Ô˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÎÔÚÈÙÛÈÒÓ Ì ™‡Ó‰ÚÔÌÔ Turner Ô˘ ¤Ï·‚·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË. ∞ӷʤÚÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ ± ™Ù·ıÂÚ¤˜ ∞ÔÎÏ›ÛÂȘ (SD=standard deviation).

EÚÁ·Û›·

AÛıÂÓ›˜ (n)

XH ¤Ó·Ú͢ (ŒÙË)

Taback, K·Ó·‰¿˜, 1996

n=17

12,4

Chu, ™ÎˆÙ›·, 1997

n=26

Dacou, EÏÏ¿‰·, 1998

¢fiÛË hGH OÍ·Ó‰ÚÔÏfiÓË IU/Kg/week mg/Kg/day

EE ng/kg/d, XH

TA cm

PAH Lyon cm

ŸÊÂÏÔ˜ cm

0,9

125-500 XH:13,3

148,0

148,2

0,2 N.S.

12,5

0,9

50 XH:12,8

142,6

142,0

0,6 N.S.

n=35

12,0±1,8

0,7± 0,2

XH:15,6±1,3 146,1 ± 6,6

Ctrl=27(M)

12,4±3,3

-

XH:14,2±1,8 144,0 ± 6,1

ÔÚÌfiÓ˘, ÙÔ Â‡ÚÔ˜ fï˜ ÙÔ˘ ÔʤÏÔ˘˜ Û ÂηÙÔÛÙ¿ (cm) ·fi ÙË ıÂÚ·›· ‹Ù·Ó Ôχ ÌÂÁ¿ÏÔ, ÙfiÛÔ ·fi ÂÚÁ·Û›· Û ÂÚÁ·Û›· (Î˘Ì·ÈÓfiÌÂÓÔ ·fi 2,6 ¤ˆ˜ 10 cm), fiÛÔ Î·È ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·ÛıÂÓÒÓ Ù˘ ÂοÛÙÔÙ ÂÚÁ·Û›·˜. H ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ Ì hGH ‹Ù·Ó Û¯ÂÙÈο ÚÔ¯ˆÚË̤ÓË (9,113,1 ÂÙÒÓ) Î·È ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· Ù· ̤ÙÚÈ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜, ÏfiÁˆ ·Ú·ÌÔÓ‹˜ ÌÈÎÚÔ‡ ‰˘Ó·ÌÈÎÔ‡ ‡„Ô˘˜. ™Â ·Ó¿ÏÔÁ· Û˘ÌÂÚ¿ÛÌ·Ù· η٤ÏËÍÂ Î·È Ë ·Ó·ÛÎfiËÛË ÙÔ˘ Haeusler (17), Ô˘ ·Ó¤Ï˘Û ٷ ‰ÈÂıÓ‹ ‰Â‰Ô̤ӷ ¯ÔÚ‹ÁËÛ˘ hGH Û ‰fiÛÂȘ 0.5-1.2 IU/Kg/‚‰ÔÌ¿‰· Ì ‹ ¯ˆÚ›˜ ÔÍ·Ó‰ÚÔÏfiÓË.

M›· ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙËÓ AÌÂÚÈ΋ (21) Ô˘ ·Ó¤Ï˘Û ٷ ‰Â‰Ô̤ӷ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ Ô˘ ÂÚÈÏ‹ÊıËÎ·Ó ÛÙËÓ EıÓÈ΋ MÂϤÙË ·Ó¿Ù˘Í˘ ÌÂÙ¿ ¯ÔÚ‹ÁËÛË A˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ù˘ Genentech, η٤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË hGH Â¤ÊÂÚ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ù˘ ٿ͈˜ ÙˆÓ 6,4±4,9 cm.

EÈÚÔÛı¤Ùˆ˜, Ë Ì·ÎÚÔ¯ÚfiÓÈ·, ÔÏ˘ÎÂÓÙÚÈ΋, ÚÔ‰ÚÔÌÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË Ù˘ AÌÂÚÈ΋˜ ÙˆÓ Rosenfeld Î·È Û˘Ó. Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·Ù· (22) ‰Â›¯ÓÂÈ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÌfiÓ˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÔÍ·Ó‰ÚÔÏfiÓË. H ÂÚÁ·Û›· ·˘Ù‹ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ Â›Ó·È ÚÔ‰ÚÔÌÈ΋ ÌÂÙ¿ ·fi Û˘ÓÔÏÈÎfi ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ 12 ÂÙÒÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ‰Â‰Ô̤ӷ ÎÔÚÈÙÛÈÒÓ Ô˘ ¤Ï·‚·Ó ıÂÚ·›· Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ (4,7-12,4 ÂÙÒÓ, ̤ÛË ËÏÈΛ· 9,3 ÂÙÒÓ) ·' fi,ÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜. M ‚¿ÛË ÙËÓ ÌÂϤÙË ·˘Ù‹, Ù· ÎÔÚ›ÙÛÈ· Ô˘ ¤Ï·‚·Ó ÌfiÓÔ ·˘ÍËÙÈ΋ ÔÚÌfiÓË ¤Êı·Û·Ó ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· 8,4±4,5 cm ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÚÔ‚·ÏÏfiÌÂÓÔ˘, ·˘Ù¿ Ô˘ ¤Ï·‚·Ó Û˘Ó‰˘·ÛÌfi A˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È ÔÍ·Ó‰ÚÔÏfiÓ˘ ¤Êı·Û·Ó ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· 10,3± 4,7 cm ·ÓÒÙÂÚÔ ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘, ÂÓÒ ÈÛÙÔÚÈ΋ ÔÌ¿‰· Û˘ÁÎÚ›Ûˆ˜, fiÌÔÈ· ·fi ÏÂ˘Ú¿˜ ËÏÈΛ·˜, ̤ÛÔ˘ ÁÔÓÂ˚ÎÔ‡ ‡„Ô˘˜, ‡„Ô˘˜

N.S.

EÂÍËÁ‹ÛÂȘ Û˘ÓÙÌ‹ÛÂˆÓ ÈÓ¿ÎˆÓ n= AÚÈıÌfi˜ ·ÛıÂÓÒÓ XH ¤Ó·Ú͢= XÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ¤Ó·Ú͢ ¢fiÛË hGH= ¢fiÛË A˘ÍËÙÈ΋˜ OÚÌfiÓ˘ IU/Kg/wk=¢ÈÂıÓ›˜ MÔÓ¿‰Â˜/ XÈÏÈfiÁÚ·ÌÌÔ ‚¿ÚÔ˘˜/ ‚‰ÔÌ¿‰· Ctrl= Controls: ÔÌ¿‰· ÂϤÁ¯Ô˘ R= restrospective: ·Ó·‰ÚÔÌÈ΋ ÔÌ¿‰· ÂϤÁ¯Ô˘ M= matched: ÔÌ¿‰· ÂϤÁ¯Ô˘, fiÌÔÈ· Ì ÙÔ˘˜ ·ÛıÂÓ›˜ EE= Ethinyl-estradiol= AÈı˘Ó˘Ï/ÔÈÛÙÚ·‰ÈfiÏË TA= TÂÏÈÎfi AÓ¿ÛÙËÌ· PAH= Projected adult height: ÚÔ‚·ÏfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· NS= ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi

¤Ó·Ú͢ Î·È Î·Ú˘ÔÙ‡Ô˘ η٤ÏËÁ Û ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· fiÌÔÈÔ Ì ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ. ¢‡Ô ÂÚÁ·Û›Â˜ Ô˘ ‰ÂÓ ¤‰ÂÈÍ·Ó ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ›ӷÈ, Ë ÂÚÁ·Û›· ÙˆÓ Taback Î·È Û˘Ó. ·fi ÙÔÓ K·Ó·‰¿ (34), Î·È Ë ÙˆÓ Chu Î·È Û˘Ó. ·fi ÙË ™ÎÔÙ›· (35). ™‡Ìʈӷ Ì ÙËÓ ÚÒÙË, ÙÔ ÚÔ‚·ÏÏfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ›¯Â ˘ÔÏÔÁÈÛÙ› ·ÚÎÂÙ¿ „ËÏ¿, 148 cm, ÒÛÙÂ Ë ¯ÔÚ‹ÁËÛË hGH Ó· ÌËÓ Ê·›ÓÂÙ·È Ó· ÂÈʤÚÂÈ ÂÈϤÔÓ fiÊÂÏÔ˜ (34). ™ÙËÓ ÂÚÁ·Û›· ÙˆÓ Chu Î·È Û˘Ó. (35), ·ÓÙÈı¤Ùˆ˜, ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó A˘ÍËÙÈ΋ ÔÚÌfiÓË Ì ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ 12,5 ¤ÙË (‡ÚÔ˜ 9,7-16,8 ¤ÙË), ¤Êı·Û·Ó ̤ÛÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· 142,6 cm, fiÌÔÈÔ Ì ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ 142,0 cm. TÔ ÁÂÁÔÓfi˜ fï˜ fiÙÈ ÛÙËÓ ÂÚÁ·Û›· ·˘Ù‹ Ë ¯ÔÚ‹ÁËÛË hGH ¿Ú¯ÈÛ Û ÚÔ¯ˆÚË̤ÓË ËÏÈΛ·, ›Ûˆ˜ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ·Ô˘Û›· ΤډԢ˜ ·fi ÙË ıÂÚ·›·.

M›· ·ÎfiÌË ÂÚÁ·Û›· Ô‡ ‰Â›¯ÓÂÈ ·Ô˘Û›· ‚ÂÏÙ›ˆÛ˘ ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ¯ÒÚ· Ì·˜ (36).

H ÂÚÁ·Û›· ·˘Ù‹ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù·˘Ùfi¯ÚÔÓË ÔÌ¿‰· ÂϤÁ¯Ô˘, Ë ÔÔ›· ‰ÂÓ ¤Ï·‚ hGH ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ·ÔʇÁÂÈ Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÂÎÙ›ÌËÛ˘ ÙÔ˘

281

JULY-AUG.2000

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™ÂÏ›‰·282

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286

ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Ì ‚¿ÛË ÚԂϤ„ÂȘ ‹ Ì ‚¿ÛË ÈÛÙÔÚÈο ‰Â‰Ô̤ӷ Ô˘ ›Ûˆ˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ϤÔÓ Ù· ‰Â‰Ô̤ӷ ·Ó¿Ù˘Í˘ ÙÔ˘ ÏËı˘ÛÌÔ‡.

M ‚¿ÛË ÙË ÌÂϤÙË ·˘Ù‹, 35 ÎÔÚ›ÙÛÈ· Ô‡ ¤Ï·‚·Ó hGH ¤Êı·Û·Ó Û ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· 146,1±6,6 cm, ÛÙ·ÙÈÛÙÈο ÌË ‰È·ÊÔÚÂÙÈÎfi ·fi ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ 27 ÎÔÚÈÙÛÈÒÓ Ô˘ ‰ÂÓ ¤Ï·‚·Ó hGH Î·È ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (144,0±6,1 cm). H ·Ô˘Û›· ÔʤÏÔ˘˜ Û ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, ÌÔÚ› Â›Û˘ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ıÂÚ·›· ¿Ú¯ÈÛ Û ÚÔ¯ˆÚË̤ÓË Û¯ÂÙÈο ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· (12,0 ±1,8 ÂÙÒÓ) ‹ ÛÙËÓ ÌÈÎÚ‹ Ù˘ Û¯ÂÙÈο ‰È¿ÚÎÂÈ· (2,7 ±1,2 ¤ÙË) ‹ ·ÎfiÌË ÛÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÚÔÛı‹Î˘ ÔÈÛÙÚÔÁfiÓˆÓ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ (15,6±1,3 ÂÙÒÓ). ŒÙÛÈ, Ô‡ÙÂ Ë ÂÚÁ·Û›· ·˘Ù‹ ÌÔÚ› Ó· ·Ó·ÈÚ¤ÛÂÈ ·Ú¿ ÌfiÓÔ Ó· ÌÂÙÚÈ¿ÛÂÈ ›Ûˆ˜ Ù· ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÔÏ˘¿ÚÈıÌˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰Â›¯ÓÔ˘Ó Î¤Ú‰Ô˜ Ì ÙË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË.

MÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· H ÌÂÁ¿ÏË ÏËıÒÚ· ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ Î·È Ù· ·ÓÙÈÎÚÔ˘fiÌÂÓ· ÔÏϤ˜ ÊÔÚ¤˜ ·ÔÙÂϤÛÌ·Ù· ¤Î·Ó·Ó ÂÌÊ·Ó‹ Ù· ÌÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· οı ÂÚÁ·Û›·˜ Î·È ÙË ‰˘ÛÎÔÏ›· Û‡ÁÎÚÈÛ˘ ÙˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÙÔ˘˜.

AÚ¯Èο ¤ÁÈÓ ۷ʋ˜ Ë ‰˘ÛÎÔÏ›· Û‡ÁÎÚÈÛ˘ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ú·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË Ì ÈÛÙÔÚÈο ‰Â‰Ô̤ӷ ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙˆÓ ÂÙÒÓ ˘¿Ú¯ÂÈ ÁÂÓÈο Ì›· ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚ÈÔÙÈÎÔ‡ ÂÈ¤‰Ô˘ Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘ ¢ÓÔ› ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÂÚÈϤÎÔÓÙ·˜ ÏÔÈfiÓ ÙË ‰˘Ó·ÙfiÙËÙ· Û‡ÁÎÚÈÛ˘ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È Û‡Á¯ÚÔÓˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ.

E›Û˘ Ë Û‡ÁÎÚÈÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Ì ÙÔ ÚÔ‚·ÏÏfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ηٿ Lyon, Â›Ó·È ÌÂÓ Ë Ì¤ıÔ‰Ô˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜, ·ÏÏ¿ Â›Ó·È ÁÓˆÛÙ‹ Ë ·Ó·ÎÚ›‚ÂÈ· ÚԂϤ„ÂˆÓ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ˘ÔÏÔÁÈÛÌfi˜ ·˘Ùfi˜ ‰ÂÓ Ï·Ì‚¿ÓÂÈ ˘fi„Ë ÙËÓ ÂοÛÙÔÙ ηı˘ÛÙ¤ÚËÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜. T¤ÏÔ˜, Ì ٷ ·Ú¯Èο ÂÓı·ÚÚ˘ÓÙÈο ‰Â‰Ô̤ӷ Ù˘ ‚Ú·¯˘ÚfiıÂÛÌ˘ ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, Â›Ó·È ‰‡ÛÎÔÏÔ ÁÈ· ËıÈÎÔ‡˜ ÏfiÁÔ˘˜ Ó· ÂÈÏÂÁ› ÌÈ· ÔÌ¿‰· ÎÔÚÈÙÛÈÒÓ Ì ÙÔ Û‡Ó‰ÚÔÌÔ Ô˘ ‰ÂÓ ı· ¿ÚÂÈ ·˘ÍËÙÈ΋ ÔÚÌfiÓË, ÁÈ· Ó· ·ÔÙÂϤÛÂÈ Û˘ÁÎÚ›ÛÈÌË ÔÌ¿‰· ÂϤÁ¯Ô˘. ÕÏψÛÙÂ Ë ‰˘Ó·ÙfiÙËÙ· placebo, ‰ËÏ. ηıËÌÂÚÈÓ‹˜ ¤ÓÂÛ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ Û ÔÌ¿‰· ÂϤÁ¯Ô˘ ı· ÚÔÛ¤ÎÚÔ˘Â Î·È ¿ÏÈ Û ËıÈο ÂÌfi‰È·.

AÎfiÌË, ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÌÂÁ¿ÏË ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÁ·ÛÈÒÓ ·ÊÔÚ¿ ·Ó·‰ÚÔÌÈΤ˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ ÂÎ ÙÔ˘ ۯ‰ȷÛÌÔ‡ ÙÔ˘˜ ‰ÂÓ Â›Ó·È Ù˘¯·ÈÔÔÈË̤Ó˜ Î·È ÂÌÂÚȤ¯Ô˘Ó Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÌÈ·˜ ·Ó·‰ÚÔÌÈ΋˜ ·Ó¿Ï˘Û˘ ·ÔÙÂÏÂÛÌ¿ÙˆÓ.

EÈϤÔÓ, ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÙfiÛÔ Ù˘

282

X. K·Ó·Î¿ - Gantenbein

‰fiÛˆ˜ fiÛÔ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ‚‰ÔÌ·‰È·›·˜ ¯ÔÚËÁ‹Ûˆ˜ Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰È¿ÊÔÚ˜ ÔÌ¿‰Â˜ Ô˘ ¤Ï·‚·Ó ıÂÚ·›·.

M›· ÚfiÛıÂÙË ÔÈÎÈÏÔÌÔÚÊ›· ÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÏϤ˜ ÔÌ¿‰Â˜ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÔÍ·Ó‰ÚÔÏfiÓË ·Ú¿ÏÏËÏ· ‹ fi¯È Ì ÙË ¯ÔÚ‹ÁËÛË A·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘.

E›Û˘, Ô ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Ù˘ ¯ÔÚ‹ÁËÛ˘ hGH Ì ‹ ¯ˆÚ›˜ ÔÍ·Ó‰ÚÔÏfiÓË ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ÛÙȘ ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜ ·Ó·Ï‡Ô˘Ó ‰Â‰Ô̤ӷ ÎÔÚÈÙÛÈÒÓ Ì ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Û ۯÂÙÈο ÚÔ¯ˆÚË̤ÓË ËÏÈΛ· (12 ÂÙÒÓ), Ì ·ÔÙ¤ÏÂÛÌ· Ù· ÂÚÈıÒÚÈ· ÁÈ· ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Ó· Â›Ó·È ϤÔÓ ÂÚÈÔÚÈṲ̂ӷ Î·È Ó· ¢ı‡ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÁÈ¿ ÙËÓ ·‰˘Ó·Ì›· ηٿ‰ÂÈ͢ ÔʤÏÔ˘˜ ·fi ÙË ıÂÚ·›· (27,35,36). ŒÓ· ÂÈÚfiÛıÂÙÔ Úfi‚ÏËÌ· ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÁ·ÛÈÒÓ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÚÔÛı‹ÎË ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ (·Èı˘Ó˘Ï-ÔÈÛÙÚ·‰ÈfiÏ˘) Á›ÓÂÙ·È Û ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘ ÛÙȘ ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜ (22,27,35,36,38). ¶·Ú¿ Ù· ÌÂıÔ‰ÔÏÔÁÈο ·˘Ù¿ ÚÔ‚Ï‹Ì·Ù·, Ë ÌÂÙ·-·Ó¿Ï˘ÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÛÎÔfi ¤¯ÂÈ Ó· ··ÓÙ‹ÛÂÈ ÛÙ· η›ÚÈ· ÂÚˆÙ‹Ì·Ù·: XÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘: - ¶fiÙÂ Â›Ó·È Ë È‰·ÓÈ΋ ËÏÈΛ· ¤Ó·Ú͢; - ¶ÔÈ· Â›Ó·È Ë È‰·ÓÈ΋ Î·È ·ÛÊ·Ï‹˜ ‰fiÛË Î·È Û˘¯ÓfiÙËÙ· ¯ÔÚ‹ÁËÛ˘; - M ‹ ¯ˆÚ›˜ ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘; - ¶ÔÈ· Â›Ó·È Ë Â›ÙˆÛË ÛÙËÓ ÔÛÙÈ΋ ËÏÈΛ·; - Y¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ù˘ ·¿ÓÙËÛ˘ Ù˘ ÂÓ‰ÔÁÂÓÔ‡˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰˘Ó·ÌÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÚfiÎÏËÛ˘ Ù˘ Î·È ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘; - Y¿Ú¯ÂÈ Â›‰Ú·ÛË ÙÔ˘ ηڢÔÙ‡Ô˘ ÛÙËÓ ·ÓÙ·fiÎÚÈÛË ıÂÚ·›·˜ Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË; ¢È¿ÊÔÚÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ‰ÂÓ ‚Ú‹Î·Ó Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ËÏÈΛ·˜ ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ Î·È ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ (17,27,29,32,36). AÍ›˙ÂÈ fï˜ Ó· ÛËÌÂȈı› fiÙÈ fiϘ ÔÈ ·ÛıÂÓ›˜ Ô‡ ¤Êı·Û·Ó ÙÔ ÙÂÏÈÎfi ÙÔ˘˜ ·Ó¿ÛÙËÌ· ¿Ú¯ÈÛ·Ó ıÂÚ·›· Û¯ÂÙÈο ·ÚÁ¿ (9 -12 ¤ÙË), ÔÏϤ˜ ÊÔÚ¤˜ Ì¿ÏÈÛÙ· Û ËÏÈΛ· 16 ÂÙÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ·ÚÎÂÙfi ‰˘Ó·ÌÈÎfi ‡„Ô˘˜ Ó· ¤¯ÂÈ ‹‰Ë ¯·ı›, ÒÛÙ ٷ Û˘ÌÂÚ¿ÛÌ·Ù· Ó· ÌËÓ ÌÔÚÔ‡Ó Ó· ÁÂÓÈ΢ıÔ‡Ó ÁÈ· ÙË ¯ÔÚ‹ÁËÛË Û ÈÔ ÌÈÎÚ¤˜ ËÏÈ˘. ™ÙËÓ ÂÚÁ·Û›· ÙÔ˘ Plotnick Î·È Û˘Ó. (21) Ê·›ÓÂÙ·È fiÙÈ ÎÔÚ›ÙÛÈ· Ô˘ ¿Ú¯ÈÛ·Ó ıÂÚ·›· Ì hGH Û Ó·ÚfiÙÂÚË ËÏÈΛ· ›¯·Ó ηχÙÂÚË ‚ÂÏÙ›ˆÛË ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÙÔ˘˜ (21). E›Û˘, ÔÈ Rosenfeld Î·È Û˘Ó. (22) Î·È Ranke Î·È Û˘Ó. (38) ÂȂ‚·ÈÒÓÔ˘Ó Ù· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù·, fiÙ·Ó Ë ıÂÚ·›· ·Ú¯›˙ÂÈ

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·283

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286

Û ÌÈÎÚfiÙÂÚË ËÏÈΛ·, ÂÓÒ ÔÈ Haeusler Î·È Û˘Ó. (17,29) Î·È Joss Î·È Û˘Ó. (26) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÙÔ fiÊÂÏÔ˜ ¤Ó·Ú͢ Û Ó·ÚfiÙÂÚË ËÏÈΛ· ¤¯ÂÈ Û·Ó ·ÚÓËÙÈÎfi ·ÓÙ›Ô‰· ÙËÓ ÂÈÙ¿¯˘ÓÛË ˆÚ›Ì·ÓÛ˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Î·ı·Úfi ΤډԘ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Ó· Â›Ó·È Ìˉ·ÌÈÓfi.

H ‰fiÛË Ù˘ ¯ÔÚËÁËı›۷˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (15,17,21,29,32,36), ÂÓÒ ÔÈ Ranke Î·È Û˘Ó. (38) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ‰fiÛË Ù˘ hGH Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·. ™Â Ì›· ÚfiÛÊ·ÙË ÂÚÁ·Û›· (28), ÚÔÙ›ÓÂÙ·È ‰˘Ó·ÙfiÙËÙ· ‚ÂÏÙ›ˆÛ˘ ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜, Ì ·‡ÍËÛË Ù˘ ‰fiÛ˘ Ù˘ hGH ̤¯ÚÈ Î·È 2,1 IU/Kg/‚‰ÔÌ¿‰· fiÙ·Ó Ô Ú˘ıÌfi˜ ·Ó¿Ù˘Í˘ ÂÈ‚Ú·‰‡ÓÂÙ·È.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÓ¤ÛÂˆÓ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· (27,36) ÂÓÒ ·ÓÙÈı¤Ùˆ˜. ÔÈ Plotnick Î·È Û˘Ó. (21) ˘ÔÛÙËÚ›˙Ô˘Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË.

H ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ÂËÚ¿˙ÂÈ ıÂÙÈο ÙËÓ ¤Î‚·ÛË Î·Ù¿ ÔÚÈṲ̂ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ (21), ÂÓÒ Î·Ù¿ ¿ÏÏÔ˘˜ ‰ÂÓ ÙËÓ ÂËÚ¿˙ÂÈ (32,36,37). ŒÓ·˜ ÂÚ·ÈÙ¤Úˆ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÌÂÏÂÙ‹ıËÎÂ Â›Ó·È Ë Â›‰Ú·ÛË ÙÔ˘ ‚·ıÌÔ‡ ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ¤Ó·ÚÍË ÛÙÔ Î¤Ú‰Ô˜ ·fi ÙË ıÂÚ·›·. ŸÛÔ ÂÓÙÔÓfiÙÂÚÔ ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ηٿ ÙËÓ ¤Ó·ÚÍË ıÂÚ·›·˜, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ Î¤Ú‰Ô˜ Ù˘ ¯ÔÚ‹ÁËÛ˘ hGH (21,25) Î·È fiÛÔ „ËÏfiÙÂÚÔ ÙÔ ÎÔÚ›ÙÛÈ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ÙfiÛÔ Î·Ï‡ÙÂÚÔ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (38).

H Â›ÙˆÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙËÓ ˆÚ›Ì·ÓÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ ·ÔÙ¤ÏÂÛ ı¤Ì· ·ÌÊÈÏÂÁoÌ¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. OÈ Joss et al.

(26) ÂͤÊÚ·Û·Ó ·ÓËÛ˘¯›Â˜ fiÙÈ ÂÓˆÚ›˜ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ì ‹ ¯ˆÚ›˜ ÔÍ·Ó‰ÚÔÏfiÓË ÂÈÙ·¯‡ÓÂÈ ‰˘Û·Ó¿ÏÔÁ· ÙËÓ ÔÛÙÈ΋ ËÏÈΛ·, Ì ·ÔÙ¤ÏÂÛÌ· ·ÒÏÂÈ· ‰˘Ó·ÌÈÎÔ‡ ÙÂÏÈÎÔ‡ ‡„Ô˘˜, ¤ÙÛÈ ÒÛÙ ÚfiÙÂÈÓ·Ó Ë ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ hGH Ó· ÌËÓ Á›ÓÂÙ·È ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 9 ÂÙÒÓ, ÂÓÒ ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ (17,22,27) ‰ÂÓ ÂȂ‚·›ˆÛ·Ó ÙÔ˘˜ Êfi‚Ô˘˜ ·˘ÙÔ‡˜. ¶¿ÓÙˆ˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ Ô ‚·ıÌfi˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ ηٿ ÙËÓ ¤Ó·ÚÍË hGH, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ Î¤Ú‰Ô˜ ·fi ÙËÓ ıÂÚ·›· (21,25).

E›Ó·È ÁÓˆÛÙfi, fiÙÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÎÔÚÈÙÛÈÒÓ Ì ™‡Ó‰ÚÔÌÔ Turner ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÂ·Ú΋ (GHmax<11ng/ml Û 22%) ‹ ÂÏÏÈ‹ ¤ÎÎÚÈÛË (GHmax<7ng/ml Û 9,7%) ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰˘Ó·ÌÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÚfiÎÏËÛ˘ Ù˘ (25). º·›ÓÂÙ·È fiÙÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË hGH ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·¿ÓÙËÛË Ù˘ ÂÓ‰ÔÁÂÓÔ‡˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰˘Ó·ÌÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÚfiÎÏËÛ‹˜ Ù˘ (21,25,36)

™‡Ó‰ÚÔÌÔ Turner Î·È A˘ÍËÙÈ΋ ÔÚÌfiÓË

ŒÓ·˜ ÂÈϤÔÓ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÌÂÏÂÙ‹ıËÎÂ Â›Ó·È Ô Î·Ú˘fiÙ˘Ô˜. KÔÚ›ÙÛÈ· Ì ηڢfiÙ˘Ô ÈÛÔ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Â›Ó·È ÈÔ ÎÔÓÙ¿ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ ·fi ÙËÓ ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (25). Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, ÙÔ Ì¤ÛÔ ÁÔÓÂ˚Îfi ‡„Ô˜ ·ÔÙÂÏ› ¤Ó· ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙÔ ·Ó¿ÛÙËÌ· ÎÔÚÈÙÛÈÔ‡ Ì ÙÔ ™‡Ó‰ÚÔÌÔ Î·È Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ ıÂÚ·›·˜ (15,36,38). K·Ù¿ ÔÚÈṲ̂ÓÔ˘˜ Ì¿ÏÈÛÙ· ÂÚ¢ÓËÙ¤˜, ÙÔ ‡„Ô˜ Ù˘ ÌËÙ¤Ú·˜ ·ÔÙÂÏ› ÈÛ¯˘ÚfiÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ·Ù¤Ú· (36).

AÛÊ¿ÏÂÈ·/ ¶·ÚÂÓ¤ÚÁÂȘ, ÂÈϤÔÓ ÔʤÏË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, Ô‡Ù ηÏÔ‹ıÔ˘˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘, Ô‡Ù ÂÍ¿ÚıÚËÌ· Ù˘ ÎÂÊ·Ï‹˜ ÙÔ˘ ÌËÚÈ·›Ô˘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ¯ÚËÛÈÌÔÔÈËı›Û˜ ‰fiÛÂȘ (21,22,27). ŒÙÛÈ, ‰fiÛÂȘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ù˘ ٿ͈˜ ÙˆÓ 0,7-0,9 IU/Kg/‚‰ÔÌ¿‰· (20-30 IU/m2/ ‚‰ÔÌ¿‰·) Â›Ó·È ÁÂÓÈÎÒ˜ ·Ô‰ÂÎÙ¤˜ Î·È ·ÛÊ·Ï›˜ (21,22,27).

AÍ›˙ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ ¤Ó· ÂÈϤÔÓ fiÊÂÏÔ˜ ·fi ÙËÓ ¯ÔÚ‹ÁËÛË hGH ÛÙ· ÎÔÚ›ÙÛÈ· Ì ™‡Ó‰ÚÔÌÔ Turner Â›Ó·È Ë ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ (39). KÔÚ›ÙÛÈ· Ô˘ ¤Ï·‚·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ ‚·ıÌfi ÔÛÙÂÔÂÓ›·˜ Ô˘ ¤¯Ô˘Ó ÎÔÚ›ÙÛÈ· Ì ÙÔ ™‡Ó‰ÚÔÌÔ Ô˘ ‰ÂÓ ‹Ú·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË (39-41).

M ‹ ¯ˆÚ›˜ ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘ Afi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÚÁ·ÛÈÒÓ ˘¿Ú¯Ô˘Ó ÈÛ¯˘Ú¤˜ ÂӉ›ÍÂȘ fiÙÈ Ë ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘ ÛÙË ıÂÚ·›· Ì hGH ÂÈʤÚÂÈ ÂÈϤÔÓ fiÊÂÏÔ˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (17,22,26), ¤ÙÛÈ ÒÛÙ ӷ ÚÔÙ›ÓÂÙ·È Ô Û˘Ó‰˘·ÛÌfi˜ ·˘Ùfi˜ Û·Ó Î·Ï‡ÙÂÚË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÚÔÛʤÚÂÈ ÂÈϤÔÓ ÙÔ ÏÂÔÓ¤ÎÙËÌ· ÂÓfi˜ ηχÙÂÚÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ· Ô‡ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ „˘¯ÔÏÔÁÈο Ù· ÎÔÚ›ÙÛÈ· ·˘Ù¿ Î·È Ó· ÂÈÙÚ¤„ÂÈ ÙËÓ ÚÔÛı‹ÎË ÔÈÛÙÚÔÁfiÓˆÓ Û ÌÈÎÚfiÙÂÚË ËÏÈΛ·, Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ı· ‰Ú¿ÛÔ˘Ó Â˘ÓÔ˚ο ÛÙË „˘¯ÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ Î·È ÛÙËÓ ÂÏ¿ÙÙˆÛË Î·Ù¿ ÙÔ ‰˘Ó·Ùfi ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ù˘ ÔÛÙÂÔfiÚˆÛ˘ (22,27,39-42).

Y¿Ú¯Ô˘Ó οÔÈÔÈ ÂÓ‰ÔÈ·ÛÌÔ› ÛÙË ¯ÔÚ‹ÁËÛË Ù˘ Û Ó·ڋ ËÏÈΛ·, ÏfiÁˆ Ù˘ Èı·ÓfiÙËÙ·˜ ÛËÌ·ÓÙÈ΋˜ ÚÔfi‰Ô˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ Ô˘ ı· ÂÈʤÚÂÈ ÂÏ¿ÙÙˆÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ (26), ÔÈ ÔÔ›ÔÈ fï˜ ‰ÂÓ ÂȂ‚·ÈÒÓÔÓÙ·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (22). AÓÂÈı‡ÌËÙ˜ ‰Ú¿ÛÂȘ Ù˘ ÔÍ·Ó‰ÚÔÏfiÓ˘ fiˆ˜, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÎÏÂÈÙÔÚ›‰·˜ ‹ Î·È ‚¿ı˘ÓÛË Ù˘ ʈӋ˜, Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ·fi ÙË

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¯Ú‹ÛË „ËÏÒÓ ‰fiÛˆÓ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û ‰fiÛË 0,05-0,0625 mg/kg/Ë̤ڷ (22,27,38). £ÂˆÚÂ›Ù·È Û·Ó ·ÛÊ·Ï‹˜ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ Ì ÔÍ·Ó‰ÚÔÏfiÓË Ë ËÏÈΛ· ÙˆÓ 8-9 ÂÙÒÓ, fiÙ·Ó Ê˘ÛÈÔÏÔÁÈο ·Ó·Ì¤ÓÂÙ·È ¤Ó·ÚÍË ·‰ÚÂÓ·Ú¯‹˜ (26,27). ¶fiÙ Ú¤ÂÈ Ó· ÚÔÛÙÂı› ÌÈÎÚ‹ ‰fiÛË ÔÈÛÙÚÔÁfiÓˆÓ ÁÈ· ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ʇÏÔ˘; Y¿Ú¯ÂÈ ÁÂÓÈο Ô Êfi‚Ô˜ fiÙÈ ÂÓˆÚ›˜ ÚÔÛı‹ÎË ÔÈÛÙÚÔÁfiÓˆÓ ı· ÂÈʤÚÂÈ ÂÈÙ¿¯˘ÓÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ Ì ‰˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (14,17,27,36) ÂÓÒ Î·ı˘ÛÙ¤ÚËÛË ˘ÔηٿÛÙ·Û˘ Ì ÔÈÛÙÚÔÁfiÓ· Û ¤Ó· ™‡Ó‰ÚÔÌÔ Ô‡ Û˘Óԉ‡ÂÙ·È ·fi ÙÔ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· Ù˘ ÔÛÙÂÔfiÚˆÛ˘ ÚÔ‚ÏËÌ·Ù›˙ÂÈ (22,27,32,39-42).

E›Û˘, ηı˘ÛÙ¤ÚËÛË ÚfiÎÏËÛ˘ ÂÊ˂›·˜ ηٷϋÁÂÈ Û ·ÒÏÂÈ· ÙÔ˘ ΤډԢ˜ Û ‡„Ô˜ (loss of pubertal growth spurt) fiˆ˜ ¤‰ÂÈÍÂ Ë ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÙˆÓ Shah Î·È Û˘Ó. (37) Î·È Ù· ‰Â‰Ô̤ӷ Ù˘ ÂÚÁ·Û›·˜ ÙˆÓ Hochberg Î·È Û˘Ó. (32) ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ËÏÈΛ· ÚÔÛı‹Î˘ ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ¤Î‚·ÛË Ù˘ ıÂÚ·›·˜ Ì hGH, ˘ÔÛÙËÚ›˙ÔÓÙ·˜ fiÙÈ ˘ÔηٿÛÙ·ÛË Ì ÔÈÛÙÚÔÁfiÓ· ‰ÂÓ Ú¤ÂÈ Ó· ηı˘ÛÙÂÚ› ¤Ú·Ó Ù˘ ËÏÈΛ·˜ ÙˆÓ 13-14 ÂÙÒÓ (27,32). ŒÙÛÈ, Â›Ó·È Ì¿ÏÏÔÓ ·Ô‰ÂÎÙfi fiÙÈ ÚÔÛı‹ÎË ÔÈÛÙÚÔÁfiÓˆÓ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ Î·È ‰ÂÓ ı· Ú¤ÂÈ Ó· ηı˘ÛÙÂÚ› Ôχ ÌÂÙ¿ Ù· 13-14 ¤ÙË Î·È fiÙÈ ·ÛÊ·Ï‹˜ ‰fiÛË ¤Ó·Ú͢ ıˆÚÔ‡ÓÙ·È Ù· 50ng/Kg/Ë̤ڷ ·Èı˘Ó˘Ï-ÔÈÛÙÚ·‰ÈfiÏ˘ (27,32,42).

MÈ· ÂıÓÈ΋ ÚÔ‰ÚÔÌÈ΋ ÌÂϤÙË Ô˘ ¿Ú¯ÈÛ ‹‰Ë ÛÙÔ Hӈ̤ÓÔ B·Û›ÏÂÈÔ ÌÂ Ù˘¯·ÈÔÔ›ËÛË ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ ˘fi hGH ÁÈ· Ó· Ï¿‚Ô˘Ó ÔÈÛÙÚÔÁfiÓ· Û ËÏÈ˘ 12 ‹ 14 ÂÙÒÓ, ÛÎÔfi ¤¯ÂÈ ·ÎÚÈ‚Ò˜ Ó· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙËÓ È‰·ÓÈ΋ ËÏÈΛ· ¤Ó·Ú͢ ÔÈÛÙÚÔÁÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ (27). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ıÂÚ·›· Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ÎÔÚÈÙÛÈÒÓ Ì ™‡Ó‰ÚÔÌÔ Turner, Û ‰fiÛÂȘ 0,7-0,9 IU/Kg/week Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ÂÈʤÚÂÈ Î·Ù¿ ̤ÛÔ fiÚÔ, ¤Ó· Û˘ÓÔÏÈÎfi ΤډԘ Ù˘ ٿ͈˜ ÙˆÓ 6,07 ÂηÙÔÛÙÒÓ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. ø˜ ·ÛÊ·Ï‹˜ Î·È Î·Ù¿ÏÏËÏË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ ıˆÚÂ›Ù·È Ë ËÏÈΛ· ÙˆÓ 6 -8 ÂÙÒÓ, ÂÓÒ ¯ÔÚ‹ÁËÛË Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˘.

OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ¤Î‚·ÛË Ù˘ ıÂÚ·›·˜ ›ӷÈ: - TÔ ‡„Ô˜ ηٿ ÙËÓ ¤Ó·ÚÍË - H ÔÛÙÈ΋ ËÏÈΛ· ηٿ ÙËÓ ¤Ó·ÚÍË - O ηڢfiÙ˘Ô˜ - TÔ ÁÔÓÂ˚Îfi ‡„Ô˜

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H ‰fiÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ¤Î‚·ÛË, ÂÓÒ ÚÔÛ·ÚÌÔÁ‹, ‰ËÏ. ·‡ÍËÛË Ù˘ ‰fiÛ˘ ̤¯ÚÈ Î·È 2,1 IU/Kg/‚‰ÔÌ¿‰· fiÙ·Ó Ô Ú˘ıÌfi˜ ·Ó¿Ù˘Í˘ ÂÈ‚Ú·‰‡ÓÂÙ·È, ›Ûˆ˜ ‚ÂÏÙÈÒÓÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. ¶ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘ ÛÙË ıÂÚ·›· Ì hGH, Û ËÏÈΛ· 8-9 ÂÙÒÓ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜. T¤ÏÔ˜, Ë ıÂÚ·›· ˘ÔηٷÛÙ¿Ûˆ˜ Ì ÌÈÎÚ¤˜ ‰fiÛÂȘ ÔÈÛÙÚÔÁfiÓˆÓ ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÂÚ›Ô˘ ÛÙË ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ, ·ÊÂÓfi˜ ÌÂÓ ÁÈ· Ó· ÌËÓ ÂȉÂÈÓÒÓÂÙ·È ÙÔ Úfi‚ÏËÌ· Ù˘ ÔÛÙÂÔfiÚˆÛ˘ Ì ηı˘ÛÙ¤ÚËÛË Ù˘ ÔÚÌÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ Î·È ·ÊÂÙ¤ÚÔ˘, ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ „˘¯ÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ˘ÂÚ‚ÔÏÈ΋ ηı˘ÛÙ¤ÚËÛË ÚÔÛı‹Î˘ ÔÈÛÙÚÔÁfiÓˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ Â˘ÓÔ˚ο ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Lippe B. Turner syndrome. Endocrinol Metab Clin N Am 1991;20:121-152.

2. Chatelain P, Berlier P, Francois R. Pathology of the ovary: Gonadal dysgenesis. In: Bertrand J, Rappaport R, Sizonenko PC, eds. Pediatric Endocrinology: Physiology, Pathophysiology and Clinical Aspects, 2nd ed. New York: Williams and Wilkins, 1993:420-428.

3. Ullrich O. Ueber typische Kombinationsbilder multipler Abartungen. Z Kinderheilk 1930; 49:271-276.

4. Turner HH. A syndrome of infantilism, congenital webbed neck and cubitus valgus. Endocrinology 1938; 23: 566574.

5. Lippe B, Gefner ME, Dietrich RB, Boechatmi, Kangarloo H. Renal malformation in patients with Turner's Syndrome: imaging in 141 patients. Pediatrics 1988;82:852-856.

6. Ranier-Pope CR, Cunningham RD, Nadas AS, Crigler JF Jr. Cardiovascular malformations in Turner's syndrome.

Pediatrics 1964; 33: 919-925.

7. Williams ED, Engel F, Forbes AP.Thyroiditis and gonadal dysgenesis. N Engl J Med 1964;270:805-810.

8. Vanderschueren-Lodeweyckx M. Autoimmunity problems in Turner syndrome. In: Albertsson-Wikland K, Ranke MB, eds. Turner syndrome in a life span perspective:Research and clinical aspects. Amsterdam: Elsevier Science BV, 1995: 267-273.

9. Park E, Bailey JD, Ciwell CA. Growth and maturation of patients with Turner's syndrome. Pediatr res. 1983;17:1-7.

10. Ranke MB, Pfluger H, Rosendahl W, Stubbe P, Enders H, Bierich JR et al. Turner syndrome: spontaneous growth in 150 cases and review of the literature. Eur J Pediatr 1983; 141:81-88.

11. Ranke MB, Grauer ML. Adult height in Turner syndrome: results of a multinational survey. Horm Res 1994;42:90-94.

12. Karlberg J, Albertsson-Wikland K. Natural Growth ·nd aspects of growth standards in Turner syndrome. In: Albertsson-Wikland K, Ranke MB, eds. Turner syndrome

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·285

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

in a life span perspective:Research and clinical aspects.

Amsterdam: Elsevier Science BV, 1995: 75-86.

Low LC, Sham C, Kwan E, Karlberg J, Tang G, Cheung PT et al. Spontaneous growth in Chinese patients with Turner’s syndrome and influence of karyotype. Acta Paediatr 1997 Jan 86(1):18-21.

Massa G, Vanderschueren-Lodeweyckx M, Malvaux M. Linear growth in patients with Turner syndrome:influence of spontaneous puberty and parental height. Eur J Pediatr 1990; 149: 246-250.

Rochiccioli P, David M, Malpeuch G, Colle M, Limal JM, Barrin J, et al. Study of final height in Turner's syndrome: ethnic and genetic influences. Acta Paediatr 1994;83:305308.

Rao E, Weiss B, Fukami M, Rump A, Niesler B, Mertz A et al. Pseudoautosomal deletions encompassing a novel homeobox gene cause growth failure in idiopathic short stature and Turner syndrome. Nat Genet 1997;16:54-63.

Haeusler G. Growth hormone therapy in patients with Turner Syndrome.Horm Res 1998; 49 (suppl 2):62-66.

Naeraa RW, Eiken M, Legarth EG, Nieben J. Spontaneous growth, final height and prediction of final height in Turner syndrome. In: Ranke MB, Rosenfeld RG (eds) Turner syndrome: Growth promoting therapies. Amsterdam: Elsevier Science BV,1991:113-116.

Lyon AJ, Preece MA, Grant DB. Growth curve for girls with Turner syndrome. Arch Dis Child 1985;60:932-935.

Attie KM, Frane JW. Accuracy of adult height prediction methods for Turner syndrome using US untreated control data. Horm Res 1997;48(suppl. 2):60.

Plotnick L, Attie KM, Blethen SL, Sy JP. Growth hormone treatment of girls with Turner syndrome: The National Cooperative Growth Study experience. Pediatrics 1998;102:479-481.

Rosenfeld RG, Attie KM, Frane J, Brasel JA, Burstein S, Cara JF, et al. Growth Hormone therapy of Turner's Syndrome: Beneficial effect on adult height. J Pediatr 1998;132:319-324.

Bareille P, Massarano AA, Stanhope R. Final height outcome in girls with Turner syndrome treated with a combination of low dose oestrogen and oxandrolone. Eur J Pediatr 1997;156:358-362.

Rosenfeld RG, Frane J, Attie KM, Brasel JA, Burstein S, Cara JF et al. Six-year results of a randomized, prospective trial of human growth hormone and oxandrolone in Turner syndrome. J Pediatr 1992;121:4955.

Schmitt K, Haeusler G, Blümel P, Plöchl E, Frisch H. Short and long-term (final height) growth responses to growth hormone (GH) therapy in patients with Turner syndrome: Correlation of growth response to stimulated GH levels, spontaneous GH secretion and karyotype Horm Res 1997;47:67-72.

Joss E, Mullis PE, Werder EA, Partsch CJ, Sippell WG. Growth promotion and Turner-specific bone age after

™‡Ó‰ÚÔÌÔ Turner Î·È A˘ÍËÙÈ΋ ÔÚÌfiÓË

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

therapy with Growth hormone and in combination with Oxandrolone: When should therapy be started in Turner syndrome? Horm Res 1997; 47:102-109.

Donaldson MD. Growth hormone therapy in Turner syndrome - Current uncertainties and future strategies.

Horm Res 1997;48 (Suppl 5):35-44.

Carel JC, Mathivon L, Gendrel C, Ducret JP, Chaussain JL. Near normalization of final height with adapted doses of GH in Turner’s syndrome. J Clin Endocrinol Metab 1998;83:1462-1466.

Haeusler G, Schmitt K, Blümel P, Plöschl E, Waldhör T. Growth hormone in combination with anabolic steroids in patients with Turner syndrome: effect on bone maturation and adult height. Acta Paediatr 1996;85:1408-1414.

Canadian Growth Hormone Advisory Committee. Growth hormone treatment to final height in Turner syndrome: a randomized controlled trial. Horm Res 1998; 50 Suppl.3:25 (P7).

Quigley CA, Anglin G, Whittaker N, Chipman JJ and the Lilly US Turner Syndrome Study Group. Growth hormone increases final height of patients with Turner syndrome.

Horm Res 1998; 50 Suppl.3:26 (P13).

Hochberg Z, Zadik Z. Final height in Turner syndrome on Growth hormone therapy: a controlled study. Horm Res 1998; 50 Suppl.3:28 (P18).

Rouwe CW, Drayer NM. Increased final height in girls with Turner syndrome after treatment with recombinant human growth hormone. Horm Res 1998; 50 Suppl.3:53 (P121).

Taback SP, Collu R, Deal CL, Guyda HJ, Salisbury S, Dean HJ et al. Does growth hormone supplementation affect adult height in Turner’s syndrome? Lancet 1996; 348:25-26.

Chu CE, Paterson WF, Kelnar CJH, Smail PJ, Greene SA, Donaldson MDC. Variable effect of growth hormone on growth and final adult height in Scottish patients with Turner’s syndrome. Acta Paediatr 1997;86:160-164.

Dacou-Voutetakis C, Karavanaki-Karanassiou K, Petrou V, Georgopoulos N, Maniati-Christidi M, Mavrou A. The growth pattern and final height of girls with Turner syndrome with and without human growth hormone treatment. Pediatrics, 1998;101:663-668.

Shah NS, Spoudeas HA, Preece MA, on behalf of British Society for Paediatric Endocrinology and Diabetes. Does treatment usefully increase final height in Turner girls?

Horm Res 1998; 50 Suppl.3:25 (P8).

Ranke MB, Price DA, Maes M, Albertsson-Wikland K, Lindberg A. Factors influencing final height in Turner syndrome following GH treatment: results of the Kabi International Growth Study (KIGS). In: Albertsson-Wikland K, Ranke MB, eds. Turner syndrome in a life span perspective: Research and clinical aspects. Amsterdam: Elsevier Science BV, 1995:161-165.

Rubin K. Turner syndrome and osteoporosis: mechanisms and prognosis. Pediatrics 1998;102:481-485.

Bachrach LK. Osteopenia in Turner girls. In: AlbertssonWikland K, Ranke MB, eds. Turner syndrome in a life span

285

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·286

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286

perspective:Research and clinical aspects. Amsterdam: Elsevier Science BV, 1995: 233-239.

41. Sylven L, Hagenfeldt K, Ringertz H. Impact of hormonal replacement therapy on bone mineral density in women with Turner syndrome. In: Albertsson-Wikland K, Ranke MB, eds. Turner syndrome in a life span perspective: Research and clinical aspects. Amsterdam: Elsevier Science BV, 1995:241-248.

X. K·Ó·Î¿ - Gantenbein

42. Ross JL, McCauley E, Roeltgen D, Long L, Kushner H, Feuillan P et al. Self-Concept and behavior in adolescent girls with Turner syndrome: Potential estrogen effects. J Clin Endocrinol Metab 1996;81:926-931.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-04-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢Ú. XÚÈÛÙ›Ó· K·Ó·Î¿ - Gantenbein ¶·È‰›·ÙÚÔ˜- ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏfiÁÔ˜ - §¤ÎÙÔÚ·˜ ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁ›·˜ T˘ÌÊÚËÛÙÔ‡ 52 - 15234 X·Ï¿Ó‰ÚÈ, Aı‹Ó·

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∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

E›‰· ·Ú·ÁfiÓÙˆÓ ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜" KÏÂo¿ÙÚ· ™o‡ÏË1, EϤÓË ¶Ï·ÙoÎo‡ÎË2, E˘¿ÁÁÂÏo˜ ¶··ÎˆÓÛÙ·ÓÙ›Óo˘1, EϤÓË MȯÂϷοÎË1, ™oÊ›· AÚÒÓË2 ● ¶ÂÚ›ÏË„Ë: TÚÂȘ Ù‡oÈ ‰È·Ù·Ú·¯ÒÓ Ù˘ Á·Ï·ÎÙo˙·ÈÌ›·˜ ¤¯o˘Ó ÂÚÈÁÚ·Ê› oÈ oo›oÈ ·ÓÙ·oÎÚ›ÓoÓÙ·È ÛÙË ıÂÚ·¢ÙÈ΋ ‰È·ÈÙËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ì Úo˚fiÓÙ· ÂχıÂÚ· Ï·ÎÙfi˙˘/Á·Ï·ÎÙfi˙˘ Ì ·ÚÈo ·ÓÙÈÚfiÛˆfi Ùo˘˜ Ù· Úo˚fiÓÙ· ÛfiÁÈ·˜ ηٿ ÙË ÓÂoÁÓÈ΋ Î·È ‚ÚÂÊÈ΋ ËÏÈΛ·. E›Ó·È ÁÓˆÛÙfi fiÙÈ oÈ Ê˘ÙÈΤ˜ ÚˆÙ½Ó˜, fiˆ˜ oÈ ÚoÂÚ¯fiÌÂÓ˜ ·fi ÛfiÁÈ· o˘ ÂÌÂÚȤ¯ÂÈ ÈÛoÊÏ·‚oÓoÂȉ‹, ‚oËıo‡Ó ÛÙËÓ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯oÏËÛÙÂÚfiÏ˘.

AÎfiÌË ¤¯o˘Ó ·Ú·ÙËÚËı› ÌÂȈ̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ·Ú·ÁfiÓÙˆÓ VII, Ù˘ ÈÓˆ‰oÁoÓoÏ˘ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, Ù˘ ÚˆÙ½Ó˘ C (PC) Î·È Ù˘ AÓÙÈıÚoÌ‚›Ó˘ III (ATIII) ÛÂ Ê˘ÙoÊ¿Áo˘˜. MÂÏÂÙ‹Û·Ì ÙfiÛo ÙȘ ·Ú·Ì¤ÙÚo˘˜ Ù˘ ‹Íˆ˜ fiÛo Î·È Ù· ÏÈ›‰È· Û oÚfi 18 ·ÛıÂÓÒÓ (ËÏÈΛ· ‰È¿ÁÓˆÛ˘ 8,5±3,5 Ë̤Ú˜), oÈ 15 ¤·Û¯·Ó ·fi ÎÏ·ÛÛÈ΋ Á·Ï·ÎÙo˙·ÈÌ›· Î·È oÈ 3 ·fi ·ÓÂ¿ÚÎÂÈ· ÂÈÌÂÚ¿Û˘, ËÏÈΛ·˜ 3,2+0,2 ÌËÓÒÓ. H ¯oÚ‹ÁËÛË Ùo˘ Û΢¿ÛÌ·Ùo˜ Ù˘ ÛfiÁÈ·˜ ¿Ú¯ÈÛ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ‰È¿ÁÓˆÛË Î·È Ùo˘˜ Û˘ÁÎÚ›Ó·Ì Ì ÂΛÓo˘˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ·ÚfiÌoÈ·˜ ËÏÈΛ·˜. H ¯oÏËÛÙÂÚfiÏË, Ë ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈoÚˆÙ½Ó˘ (LDL) Î·È Ë ·oÏÈoÚˆÙ½ÓË B ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì Ùo˘˜ Ì¿ÚÙ˘Ú˜. E›Û˘ ¯·ÌËÏfiÙÂÚ· ‚Ú¤ıËÎ·Ó Ù· Â›‰· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ II, VII, IX, X Î·È PC. £ÂˆÚo‡Ì fiÙÈ Ù· ¯·ÌËÏ¿ Â›‰· ÏÈȉ›ˆÓ ÙˆÓ Á·Ï·ÎÙo˙·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ Ì·˜ Â›Ó·È ˘‡ı˘Ó· ÙfiÛo ÁÈ· ÙËÓ ·oÚÚfiÊËÛË, fiÛo Î·È ÁÈ· ÙË ÌÂÙ·ÊoÚ¿ Ù˘ BÈÙ·Ì›Ó˘ K ÛÙoÓ Ùfio Û‡ÓıÂÛ˘ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, oÈ Á·Ï·ÎÙo˙·ÈÌÈÎo› ·ÛıÂÓ›˜ ˘fi ‰›·ÈÙ· Ì Úo˚fiÓÙ· ÛfiÁÈ·˜ ·Úo˘ÛÈ¿˙o˘Ó ÌÂÙ·‚oϤ˜ ÙˆÓ ÏÈȉ›ˆÓ Ùo˘˜ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ·ÚfiÌoȘ Ì ÂΛӘ ÙˆÓ Ê˘ÙoÊ¿ÁˆÓ. ¶·È‰È·ÙÚÈ΋ 2000;63:287-291. §¤ÍÂȘ ÎÏÂȉȿ: Á·Ï·ÎÙo˙·ÈÌ›·, ·Ú¿ÁoÓÙ˜ ‹Íˆ˜, ‰›·ÈÙ· Ì ÛfiÁÈ·.

K. Schulpis, E. Platokouki, E. Papakonstantinou, E. Michelakakis, S. Aroni. Haemostatic factors in patients with galactosaemia on soybean diet. Paediatriki 2000;63:287-291. ● Abstract: Three major disorders associated with galactose metabolism which respond to dietary treatment have been described. A nutritionally adequate galactose/lactose free soybean formula is the basis of this diet, which is one of the main means of management of the disease during infancy. Intake of vegetable protein, such as soybean protein, results in low plasma cholesterol levels. Lower concentrations of Factor VII, fibrinolytic activity and Antithrombin III (AT III) have been observed in vegetarians. Of 18 patients with galactosaemia at a mean diagnosed age of 8.5±3.5 days, on soybean diet, 15 suffered from classic galactosaemia and 3 from epimerase deficiency. From these children, at a mean age of 3.2±0.8 months, and from 38 healthy children of comparable age on a commercial formula a 5.0 ml blood sample was drawn, after 8 hours' fasting, for estimation of lipid and haemostatic variables. Cholesterol, LDL and Apo B concentrations were found significantly lower in the galactosaemic infants than in the control group. Factors II, VII, IX, X and PC were found to be decreased. It has been suggested that the low levels of haemostatic factors in galactosaemic patients are due to reduced absorption or delivery of vitamin K to the site of synthesis of haemostatic factors. The galactosaemic patients in this study on a soybean diet demonstrated changes in their haemostatic and lipid profile similar to those seen in vegetarians.

Key words: galactosaemia, haemostatic factors, soybean diet.

1 2

IÓÛÙÈÙo‡Ùo YÁ›·˜ Ùo˘ ¶·È‰Èo‡ NoÛoÎoÌ›o ¶·›‰ˆÓ "AÁ›· ™oÊ›·" 11527 Aı‹Ó· MoÓ¿‰· AÈÌfiÛÙ·Û˘, AÈÌoÚÚoÊÈÏ›·˜ NoÛoÎoÌ›o ¶·›‰ˆÓ "AÁ›· ™oÊ›·" 11527 Aı‹Ó·

287

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291

EÈÛ·ÁˆÁ‹ H Á·Ï·ÎÙo˙·ÈÌ›· Â›Ó·È Ì›· ÎÏËÚoÓoÌÈ΋ ‰È·Ù·Ú·¯‹ Ùo˘ ÌÂÙ·‚oÏÈÛÌo‡ Ùo˘ ˘‰·Ù¿ÓıÚ·Îo˜ Á·Ï·ÎÙfi˙Ë. TÚÂȘ Â›Ó·È oÈ Ù‡oÈ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ o˘ ÂÚÈÁÚ¿ÊoÓÙ·È ·Ó¿ÏoÁ· Ì ÙËÓ ·ÈÙÈoÏoÁ›· Ùo˘˜: ·) H ÚoÂÚ¯fiÌÂÓË ·fi ·ÓÂ¿ÚÎÂÈ· Ùo˘ ÂÓ˙‡Ìo˘ ÂÈÌÂÚ¿ÛË Ù˘ o˘Úȉ˘ÏÈ΋˜ ‰ÈʈÛÊoÚÈ΋˜ Á·Ï·ÎÙfi˙˘, o˘ ¤¯ÂÈ ˆ˜ ·oÙ¤ÏÂÛÌ· ÙË ÌÂȈ̤ÓË ÌÂÙ·ÙÚo‹ Ù˘ Á·Ï·ÎÙfi˙˘ Û ÁÏ˘Îfi˙Ë, ‚) H ·ÓÂ¿ÚÎÂÈ· Ù˘ o˘Úȉ˘ÏÈ΋˜ ÙÚ·ÓÛÊÂÚ¿Û˘ Ù˘ ʈÛÊoÚÈ΋˜-1Á·Ï·ÎÙfi˙˘ (ÎÏ·ÛÈ΋ Á·Ï·ÎÙo˙·ÈÌ›·) Î·È Á) H ·ÓÂ¿ÚÎÂÈ· Ù˘ Á·Ï·ÎÙoÎÈÓ¿Û˘ o˘ ηٷχÂÈ ÙËÓ ·ÓÙ›‰Ú·ÛË ·Ú·ÁˆÁ‹˜ ʈÛÊoÚÈ΋˜-1-Á·Ï·ÎÙfi˙˘ ·fi Á·Ï·ÎÙfi˙Ë. H ÌÂÁ·Ï‡ÙÂÚË oÛfiÙËÙ· Ù˘ ÚoÂÚ¯fiÌÂÓ˘ ·fi ÙȘ ÙÚoʤ˜ Á·Ï·ÎÙfi˙˘ Úo¤Ú¯ÂÙ·È ·fi ÙoÓ ˘‰·Ù¿Óıڷη Ï·ÎÙfi˙Ë, ¤Ó· ‰˘Û·Î¯·Ú›ÙË o˘ ÂÌÂÚȤ¯ÂÙ·È Î˘Ú›ˆ˜ ÛÙo Á¿Ï· Î·È ˘‰ÚoχÂÙ·È Û Á·Ï·ÎÙfi˙Ë Î·È ÁÏ˘Îfi˙Ë Ì ÙËÓ ‰Ú¿ÛË Ù˘ ÂÓÙÂÚÈ΋˜ Ï·ÎÙ¿Û˘, Ë oo›· ¤¯ÂÈ Ê˘ÛÈoÏoÁÈ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ÛÙo˘˜ ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· (1-3). MoÓ·‰È΋ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛo˘ Â›Ó·È Ë ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ ·fi ÙËÓ oo›· ·o˘ÛÈ¿˙o˘Ó oÈ ˘‰·Ù¿ÓıڷΘ Ï·ÎÙfi˙Ë/Á·Ï·ÎÙfi˙Ë. ™˘ÓÂÒ˜ Ùo ÚoÛÊÂÚfiÌÂÓo Ïo‡ÛÈo ÛÙo˘˜ Úo·Ó·ÊÂÚfiÌÂÓo˘˜ ˘‰·Ù¿ÓıڷΘ Á¿Ï·, ·ÓÙÈηı›ÛÙ·Ù·È ÛÙo˘˜ ¿Û¯oÓÙ˜ ·fi ¿ÏÏo ÚoÂÚ¯fiÌÂÓo ·fi ÚˆÙ½ÓË ÛfiÁÈ·˜ Î·È Ùo oo›o ‰ÂÓ ÂÚȤ¯ÂÈ Á·Ï·ÎÙfi˙Ë/Ï·ÎÙfi˙Ë. Œ¯ÂÈ ·o‰Âȯı›, ·fi oÏÏÒÓ ÂÙÒÓ, fiÙÈ Ë ÚfiÛÏË„Ë ÚˆÙ½Ó˘ Â›Ó·È ·fi Ùo˘˜ ϤoÓ ÛËÌ·ÓÙÈÎo‡˜ ‰È·ÈÙËÙÈÎo‡˜ ·Ú¿ÁoÓÙ˜ o˘ ÂËÚ¿˙o˘Ó Ùo ÌÂÙ·‚oÏÈÛÌfi Ù˘ XoÏËÛÙÂÚfiÏ˘ (XoÏ). EȉÈÎfiÙÂÚ·, fiÛoÓ ·ÊoÚ¿ ÛÙo ›‰o˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ, Ë ¯oÚ‹ÁËÛË ÚˆÙ½Ó˘ Ê˘ÙÈ΋˜ Úo¤Ï¢Û˘ Û ۇÁÎÚÈÛË Ì ÂΛÓË Ù˘ ˙ˆÈ΋˜ Úo¤Ï¢Û˘ ¤¯ÂÈ ˆ˜ ·oÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ù˘ XoÏ. OÈ ϤoÓ ÁÓˆÛÙ¤˜ ÌÂϤÙ˜ ·ÊoÚo‡Ó ÛÙËÓ Î·˙½ÓË Î·È ÙË ÛfiÁÈ·. H ‰Ú¿ÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ¤¯ÂÈ ·ÍÈfiÏoÁo ˘o¯oÏËÛÙÂÚÈÓ·ÈÌÈÎfi ·oÙ¤ÏÂÛÌ· (4,5). H Â›‰Ú·ÛË ·˘Ùo‡ Ùo˘ ›‰o˘˜ ‰È·ÙÚoÊ‹˜ ÛÙo˘˜ ·Ú¿ÁoÓÙ˜ Ù˘ ‹Íˆ˜ o˘ ÂÍ·ÚÙÒÓÙ·È ·fi ÙË ÏÈo‰È·Ï˘Ù‹ ‚ÈÙ·Ì›ÓË K ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÛËÌ·ÓÙÈ΋.

O Haines Î·È Û˘Ó. (6) ·Ó¤ÊÂÚ·Ó fiÙÈ oÈ BÚÂÙÙ·Óo› Ê˘ÙoÊ¿ÁoÈ Â›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›‰· fi¯È ÌfiÓoÓ Ùo˘ ·Ú¿ÁoÓÙ· ‹Íˆ˜ VII Û˘ÁÎÚÈÓfiÌÂÓoÈ Ì ÂΛÓo˘˜ o˘ ‰ÂÓ ‹Ù·Ó Ê˘ÙoÊ¿ÁoÈ, ·ÏÏ¿ Î·È Ù˘ ·ÓÙÈıÚoÌ‚›Ó˘ III (AT III) Î·È Ù˘ ÈÓˆ‰oÁoÓÔÏ˘ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. £ÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ·Ú·ÙËÚ‹ıËÎ·Ó Â›Û˘, fiÛoÓ ·ÊoÚ¿ ÛÙËÓ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È oÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ oͤˆÓ Ì ÙËÓ AT III. ™Â ·ÓÙ›ıÂÛË Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ Haines ηÈ

288

K. ™o‡ÏË Î·È Û˘Ó.

Û˘Ó. (6), oÈ Miller Î·È Û˘Ó. (7) ·¤‰ÂÈÍ·Ó Û ÌÈ· Û‡ÓÙoÌË ÌÂϤÙË Ùo˘˜ fiÙÈ Â¿Ó Ùo ηıËÌÂÚÈÓfi ‰È·ÈÙoÏfiÁÈo ÂÌÂÚȤ¯ÂÈ 80% Ï›o˜ ·˘Í¿ÓoÓÙ·È Ù· Â›‰· Ùo˘ ·Ú¿ÁoÓÙ· ‹Íˆ˜ VII ÛÙo ·›Ì·, ÂÓÒ Ù· Ïo‡ÛÈ· Û ˘‰·Ù¿ÓıڷΘ ‰È·ÈÙoÏfiÁÈ· ¤¯o˘Ó ·oÙ¤ÏÂÛÌ· ÙËÓ Ì›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ VII, VIII Î·È X ·ÏÏ¿ ·˘Í¿Óo˘Ó ÙËÓ ÈÓˆ‰oÁÔÓÔÏ˘ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (8). ¶ÚoÛ¿ıÂÈ· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ÂÎÙÈÌËıo‡Ó Ù· Â›‰· ·Ú·Ì¤ÙÚˆÓ Ù˘ ·ÈÌfiÛÙ·Û˘ Û Á·Ï·ÎÙo˙·ÈÌÈÎo‡˜ ·ÛıÂÓ›˜ o˘ ‰È·ÙÚ¤ÊoÓÙ·È ·oÎÏÂÈÛÙÈο Ì "Á¿Ï·" ÛfiÁÈ·˜.

¶›Ó·Î·˜ 1. E›‰· ·Ú·ÁfiÓÙˆÓ ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÂΛӷ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ¶·Ú¿ÁÔÓÙ˜

∞ÛıÂÓ›˜ N=15

ª¿ÚÙ˘Ú˜ (N=38)

P

TT (%)

16,15 ±3,43

15,4 ±1,04

NS

PT (%)

11,98 ±0,66

11,43 ±0,45

NS

APTT (%)

30,42 ±7,86

27,96 ±3,15

(NS)

I (%)

248,3 ±63,6

278,1 ±12,4

NS

II (%)

85,7 ±9,1

94,8 ±10,2

0.012

VII (U/dl)

81,7 ±16,6

95,4 ±15,2

0.006

VIII (%)

106,0 ±28,7

109,2 25,8

(NS)

X (%)

81,3 ±16,2

98,4 ±12,8

0.01

IX (U/dl)

74,1 ±20,7

84,0 ±22,67

0.016

33,25 ±3,85

NS

ATIII (%)

36,82 ±2,01

Plg (%)

96,9 ±15,3

92,8 ± 20,5

NS

PC (%)

72,9 ±28,1

92,0 ±11,5

0.0001

NS: MË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÙÈÌ‹ OÈ ÙÈ̤˜ ÂÎÊÚ¿˙oÓÙ·È: ̤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË

JULY-AUG.2000

30-05-03

13:24

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291

¶·Ú¿ÁÔÓÙ˜ ·ÈÌfiÛÙ·Û˘ ÛÙË Á·Ï·ÎÙÔ˙·ÈÌ›·

¶›Ó·Î·˜ 2. E›‰· ÏÈȉ›ˆÓ ÛÙo˘˜ ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÂΛӷ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. §È›‰È· AÛıÂÓ›˜ M¿ÚÙ˘Ú˜ P (mg/dl) (N=12) (N=38) XoÏ

143,8 ±28,4

181,0 ±12,1

0,0001

TÚÈÁÏ

126,6 ±49,7

100,1 ±10,6

0,001

HDL

42,0 ±12,9

45,0 ±5,6

0,079 (NS)

LDL

80,8 ±27,1

118,0 ±6,7

0,0001

24,9 ±9,6

15,6 ±5,6

0,0001

Ao A1

130,6 ±27,7

101,1 ±21,3

0,0001

Ao B

50,5 ±13,0

71,3 ±4,1

0,0001

VLDL

NS: MË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÙÈÌ‹ OÈ ÙÈ̤˜ ÂÎÊÚ¿˙oÓÙ·È: ̤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË

YÏÈÎfi Î·È M¤ıÔ‰ÔÈ ¢ÂηoÎÙÒ (18) ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›·, ̤Û˘ ËÏÈΛ·˜ ‰È¿ÁÓˆÛ˘ 8,5±3,5 ËÌÂÚÒÓ, o˘ Ù¤ıËÎ·Ó Û ‰›·ÈÙ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ‰È¿ÁÓˆÛ‹ Ùo˘˜, ·fi Ùo˘˜ oo›o˘˜ oÈ 15 ¤·Û¯·Ó ·fi ÙËÓ ÎÏ·ÛÈ΋ ÌoÚÊ‹ Ù˘ ÓfiÛo˘ Î·È oÈ ˘fiÏoÈoÈ 3 ·fi ·ÓÂ¿ÚÎÂÈ· Ù˘ ÂÈÌÂÚ¿Û˘, Ì ̤ÛË ËÏÈΛ· 3,2+0,8 ÌËÓÒÓ, ¤Ï·‚·Ó ̤Úo˜ ÛÙË ÌÂϤÙË Ì·˜. TÚÈ¿ÓÙ· oÎÙÒ (38) ˘ÁÈ‹ ‚Ú¤ÊË ·ÚfiÌoÈ·˜ ËÏÈΛ·˜, Ù· oo›· ‰È·ÙÚ¤ÊoÓÙo Ì ÎoÓÈooÈË̤Óo Á¿Ï·, ·oÙ¤ÏÂÛ·Ó ÙËÓ oÌ¿‰· Ì·ÚÙ‡ÚˆÓ. OÈ ·ÛıÂÓ›˜ ÙÚ¤ÊoÓÙ·È Ì ÂȉÈÎfi "Á¿Ï·" ·fi ÛfiÁÈ· (Izomil), ÂχıÂÚo Á·Ï·ÎÙfi˙˘/Ï·ÎÙfi˙˘. To "Á¿Ï·" ·˘Ùfi ÂÚȤ¯ÂÈ 2,1g/100ml ÚˆÙ½ÓË, 6,9 gr/100 ml ˘‰·Ù¿ÓıڷΘ Î·È 2,69g/100ml Ï›o˜. OÈ Ì¿ÚÙ˘Ú˜ ‰È·ÙÚ¤ÊoÓÙ·Ó Ì Á¿Ï· ÎoÓÈooÈË̤Óo Ùo oo›o ÂÚÈ›¯Â 3,4 g/100ml ÚˆÙ½ÓË, 4,8g/100ml ˘‰·Ù¿ÓıڷΘ Î·È 4,7g/100ml Ï›o˜. H ‚ÈÙ·Ì›ÓË K ÂÌÂÚȤ¯ÂÙo Û ˘ÎÓfiÙËÙ· 10Ìg/100ml Î·È ÛÙ· ‰‡o Á¿Ï·Ù·.

TfiÛo oÈ ·ÛıÂÓ›˜ fiÛo Î·È oÈ Ì¿ÚÙ˘Ú˜ ·Ú¤ÌÂÈÓ·Ó ÓËÛÙÈÎo› Â› 5 ÒÚ˜ ÚÈÓ ÙËÓ ·ÈÌoÏË„›· (5,0 ml) ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÏÈȉ›ˆÓ ÛÙoÓ oÚfi Ùo˘˜.

·) ¶·Ú¿ÁoÓÙ˜ ‹Íˆ˜ O ¯ÚfiÓo˜ ÚoıÚoÌ‚›Ó˘ (PT), o ¯ÚfiÓo˜ ÂÓÂÚÁoo›ËÛ˘ ıÚoÌ‚oÏ·ÛÙ›Ó˘ (APTT), o ¯ÚfiÓo˜ ıÚoÌ‚›Ó˘ (TT), Ùo ÈÓˆ‰oÁfiÓo (I), oÈ ·Ú¿ÁoÓÙ˜ II, VII, VIII, IX, X, Î·È Ùo Ï·ÛÌÈÓoÁfiÓo (Plg) ÌÂÙÚ‹ıËÎ·Ó ÛÙo Ï¿ÛÌ· ÌÂÙ¿ ·fi ÚoÛı‹ÎË ÎÈÙÚÈÎo‡ Ó·ÙÚ›o˘, ¯ÚËÛÈÌooÈÒÓÙ·˜ ÂȉÈÎfi Ì˯¿ÓËÌ· (RA, Organon Teknika) Ì ·ÓÙȉڷÛÙ‹ÚÈ· Ù˘ AKZO. H ·ÓoÛo‰È¿¯˘ÛË (Berling Hoechst) Î·È Ë Ì¤ıo‰o˜ Elisa ¯ÚËÛÈÌooÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ATIII (·ÓÙÈıÚoÌ‚›ÓË πππ) Î·È PC (ÚˆÙ½ÓË C). ‚) §ÈȉÈoÁÚ¿ÌÌ·Ù· ŸÏoÈ oÈ oÚo› Ê˘Ï¿¯ÙËÎ·Ó Û ‚·ıÈ¿ ηٿ„˘ÍË ¤ˆ˜ fiÙo˘ ÌÂÙÚËıo‡Ó Ì ÂȉÈÎfi Kit-test Î·È ·Ó·Ï˘Ù‹ BA-500.

OÈ ÛÙ·ÙÈÛÙÈΤ˜ ·Ó·Ï‡ÛÂȘ o˘ ·ÊoÚo‡Û·Ó ÙfiÛo ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ fiÛo Î·È ÛÙo˘˜ ·Ú¿ÁoÓÙ˜ ‹Íˆ˜ ÌÂٷ͇ ÙˆÓ oÌ¿‰ˆÓ ¤ÁÈÓ·Ó Ì Ùo Student's ttest. TÈ̤˜ p<0,05 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜. H ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ¯ÚËÛÈÌooÈ‹ıËΠÁÈ· ÙËÓ ·Ó‡ÚÂÛË Û˘Û¯ÂÙ›ÛÂˆÓ ÌÂٷ͇ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜, Ë ÙÈÌ‹ r>±0,60 ıˆڋıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∞ÔÙÂϤÛÌ·Ù· T· Ë·ÙÈο ¤Ó˙˘Ì· ¢ڤıËÛ·Ó ÛÂ Ê˘ÛÈoÏoÁÈο Â›‰· ÙfiÛo ÛÙo˘˜ ·ÛıÂÓ›˜ fiÛo Î·È ÛÙo˘˜ Ì¿ÚÙ˘Ú˜. ¶·Ú¿ÁoÓÙ˜ ‹Íˆ˜: OÈ ·Ú¿ÁoÓÙ˜ ‹Íˆ˜ ·Úo˘ÛÈ¿˙oÓÙ·È ÛÙoÓ ¶›Ó·Î· 1. ¶·ÚfiÏo o˘ oÈ ·Ú¿ÁoÓÙ˜ ‹Û·Ó ̤۷ ÛÙ· Ê˘ÛÈoÏoÁÈο fiÚÈ·, oÈ ·Ú¿ÁoÓÙ˜ II, VII, IX, X Î·È PC ¢ڤıËÎ·Ó ÌÂȈ̤ÓoÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Û˘ÁÎÚÈÓfiÌÂÓoÈ, Ì ÂΛÓo˘˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. §È›‰È·: ™ÙoÓ ¶›Ó·Î· 2 ·Úo˘Û›·˙oÓÙ·È Ë Ì¤ÛË ÙÈÌ‹ Î·È Ë ÛÙ·ıÂÚ¿ ·fiÎÏÈÛË ÙˆÓ ÏÈȉ›ˆÓ ÛÙoÓ oÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì·˜. OÈ ÙÈ̤˜ ÙˆÓ XoÏ, Ë LDL Î·È Ë AoB ‹Û·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì ÂΛӘ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. AÓÙ›ıÂÙ·, Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜ ‹Û·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ÂÓÒ ÛÙ· Â›‰· Ù˘ HDL ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊoÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ. ™ÙoÓ ¶›Ó·Î· 3 ÂÌÊ·Ó›˙oÓÙ·È oÈ Û˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ·ÈÌoÛÙ·ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÙˆÓ ÏÈȉ›ˆÓ. ™˘˙‹ÙËÛË ¶oÏϤ˜ ÂÚÁ·Û›Â˜ ¤¯o˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ ÚoÂÚ¯oÌ¤ÓˆÓ ·fi ÛfiÁÈ· ¤¯ÂÈ Â˘ÂÚÁÂÙÈο ·oÙÂϤÛÌ·Ù· ˆ˜ Úo˜ ÙËÓ ÚfiÏË„Ë Ù˘ ·ÚÙËÚÈoÛÎÏ‹Ú˘ÓÛ˘ ÌÂÈÒÓoÓÙ·˜ ÙfiÛo Ù· Â›‰· Ù˘

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K. ™o‡ÏË Î·È Û˘Ó.

¶›Ó·Î·˜ 3. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ·Ú·ÁfiÓÙˆÓ ·ÈÌfiÛÙ·Û˘ Î·È ÏÈȉ›ˆÓ Û ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›·. ¶·Ú¿ÁoÓÙ˜ §È›‰È· XoÏ

TÚÈÁÏ

HDL

LDL

VLDL

Ao B

Ao A

II

+0,71

*

*

*

*

*

*

VII

+0,70

+0,81

*

+0,72

*

+0,76

*

IX

*

*

*

0,68

*

*

*

X

*

+0,80

*

*

+0,80

*

*

PC

+0,61

*

*

*

*

+0,61

*

XoÏ fiÛo Î·È Ù˘ LDL ηıfiÙÈ ÂÌÂÚȤ¯ÂÈ ÈÛoÊÏ·‚oÓoÂȉ‹ (genistein) (9,10). OÈ Á·Ï·ÎÙo˙·ÈÌÈÎo› ·ÛıÂÓ›˜ Ì·˜ ˘fi ‰›·ÈÙ· Ì ÛfiÁÈ· Â›Û˘ ÂÌÊ¿ÓÈÛ·Ó ¯·ÌËϤ˜ XoÏ, LDL Î·È AoB ‰Â›¯ÓoÓÙ·˜ ÌÈ· ·ÓÙÈ-·ıËÚoÁÂÓÂÙÈ΋ ÂÈÎfiÓ· (9,10). ∂›Û˘, ÂÂȉ‹ Ë Á‡ÛË ÙˆÓ Úo˚fiÓÙˆÓ ÛfiÁÈ·˜ Â›Ó·È ·ÚÎÂÙ¿ ‰˘Û¿ÚÂÛÙË, Ë ÚoÛı‹ÎË ˙¿¯·Ú˘ ›¯Â ˆ˜ ·oÙ¤ÏÂÛÌ· ÙËÓ Â˘¯¿ÚÈÛÙË ÚfiÛÏË„‹ Ùo˘˜ ·ÏÏ¿ Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙoÓ oÚfi, o˘ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜. ŸÌˆ˜, Ù· ·˘ÍË̤ӷ Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ›¯·Ó Â›Û˘ Û·Ó ·oÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ VLDL ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜ (11).

OÈ ·Ú¿ÁoÓÙ˜ ‹Íˆ˜ II Î·È VII ¢ڤıËÛ·Ó ¯·ÌËÏo› ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜ Û˘ÁÎÚÈÓfiÌÂÓoÈ Ì ÂΛÓo˘˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ¶Èı·ÓfiÓ Ùo ‡ÚËÌ· ·˘Ùfi Ó· oÊ›ÏÂÙ·È ÛÙ· ¯·ÌËÏ¿ Â›‰· Ù˘ XoÏ. E›Ó·È ¿ÏψÛÙ ÁÓˆÛÙfi, fiÙÈ Ù· ˘„ËÏ¿ Â›‰· Ù˘ XoÏ Û˘Û¯ÂÙ›˙oÓÙ·È Ì ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ùo˘ ·Ú¿ÁoÓÙ· VII Ù˘ ‹Íˆ˜ (11,12). O Úo·Ó·ÊÂÚfiÌÂÓo˜ ·Ú¿ÁoÓÙ·˜ ‹Íˆ˜ ·Ú·ÙËÚ‹ıËΠ·ÚÎÂÙ¿ ÌÂȈ̤Óo˜ Û oÌ¿‰Â˜ ÏËı˘ÛÌo‡ fiˆ˜ ·˘Ù‹ Ù˘ Ê˘Ï‹˜ Bantu (13) Î·È ÙˆÓ Ê˘ÙoÊ¿ÁˆÓ (12). ¶·Ú¿ÏÏËÏ·, Ë ˘‰·Ù·ÓıÚ·Îo‡¯o˜ ‰›·ÈÙ· o˘ ·ÎoÏo˘ıo‡Ó oÈ Á·Ï·ÎÙo˙·ÈÌÈÎo› ·ÛıÂÓ›˜ ı· ÌoÚo‡Û ÎÈ ·˘Ù‹, Ó· ÌÂÈÒÛÂÈ ÙoÓ ·Ú¿ÁoÓÙ· VII (10), fiˆ˜ ‚Ú¤ıËÎ·Ó Â›Û˘ ÌÂȈ̤ÓoÈ oÈ ·Ú¿ÁoÓÙ˜ II, VII Î·È PC Û oÌ¿‰Â˜ Ê˘ÙoÊ¿ÁˆÓ (8,12). AÎfiÌË, oÈ Úo·Ó·ÊÂÚfiÌÂÓoÈ ·Ú¿ÁoÓÙ˜ ‹Íˆ˜ ·Ú¿ÁoÓÙ·È ÛÙo ‹·Ú Î·È Ë Û‡ÓıÂÛ‹ Ùo˘˜ ÂÍ·ÚÙ¿Ù·È ·fi Ù· Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ K, ÌÈ·˜ ÏÈo‰È·Ï˘ÙÈ΋˜ ‚ÈÙ·Ì›Ó˘. ¶·ÚfiÏo o˘ Ë ‰›·ÈÙ· ÙˆÓ Ê˘ÙoÊ¿ÁˆÓ Â›Ó·È Ïo‡ÛÈ· Û ‚ÈÙ·Ì›ÓË K, ÂÓÙo‡ÙoȘ, Ë ÌÂȈ̤ÓË ÚfiÛÏË„Ë Ï›o˘˜ Ì Ùo Á¿Ï· (2,69 g/100ml Á·Ï·ÎÙo˙·ÈÌÈÎo› Î·È 4,7 g/100 ml Ì¿ÚÙ˘Ú˜) ·fi ÙÔ˘˜ Á·Ï·ÎÙo˙·ÈÌÈÎÔ‡˜ ı· ÌoÚo‡Û ӷ ÂËÚ¿ÛÂÈ ÙËÓ ·oÚÚfiÊËÛË Ù˘ ‚ÈÙ·Ì›Ó˘ K ÛÙo ¤ÓÙÂÚo, Ì ·oÙ¤ÏÂÛÌ· ÙËÓ ÌÂȈ̤ÓË ·ÍÈoo›ËÛ‹ Ù˘ ·fi ̤Úo˘˜ Ùo˘ ‹·Ùo˜ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÂÍ·ÚÙˆÌ¤ÓˆÓ ·fi ·˘Ù‹Ó ·Ú·ÁfiÓÙˆÓ. A˘Ù‹ Ë ˘fiıÂÛË ˘oÛÙËÚ›˙ÂÙ·È Î·È ·fi ÙË ÛÙÂÓ‹ Û˘Û¯¤ÙÈÛË o˘ ¢ڤıË ÌÂٷ͇ ÙˆÓ

290

ÂÍ·ÚÙˆÌ¤ÓˆÓ ·fi ÙËÓ ‚ÈÙ·Ì›ÓË K ·Ú·ÁfiÓÙˆÓ ·ÈÌfiÛÙ·Û˘ (II, VII, IX, X, PC) Î·È ÙˆÓ ÏÈȉ›ˆÓ (XoÏ, TÚÈÁÏ, LDL Î·È AoB) o˘ ·Ú·ÙËÚ‹ıËΠÛÙo˘˜ Á·Ï·ÎÙo˙·ÈÌÈÎo‡˜ ·ÛıÂÓ›˜ Ì·˜ ˘fi ‰›·ÈÙ· (14,15). ™˘ÌÂÚ·ÛÌ·ÙÈο, oÈ Á·Ï·ÎÙo˙·ÈÌÈÎo› ·ÛıÂÓ›˜ ˘fi ‰›·ÈÙ· Ì ÛfiÁÈ· ÂÌÊ·Ó›˙o˘Ó ÌÂÙ·‚oϤ˜ ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙfiÛo ÙˆÓ ÏÈȉ›ˆÓ fiÛo Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜, ·ÚfiÌoȘ Ì ÙȘ ·Ú·ÙËÚo‡ÌÂÓ˜ ÛÙo˘˜ Ê˘ÙoÊ¿Áo˘˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Segal S. Disorders of galactose metabolism. In: Scriver CR, Beadet AI, Sly W, eds. The metabolic and molecular basis of inherited disease: London: MTP, 1995:967-990.

2. Schweitzer S, Shin NS, Jacobs C, Broedehl J. Longterm outcome in 134 patients with galactosemia. Eur J Pediatr 1993;152:36-43.

3. Francis D. Galactosemia. In: Diets for sick children.

London: Blackwell Scientific Publications, 1986:386-396.

4. Karasawa T, Tanaka M, Uemura T, Osanai T. Antiatherogenicity of soybean protein. Ann NY Acad Sci 1992;676:202-214.

5. Dwyer JT. Health aspects of vegetarian diet. Am J Clin Nutr 1988;48:712-738.

6. Haines AP, Chakrabarti R, Fisher D, Meade TW, North WRS. Haemostatic and other variables in vegetarians and non vegetarians. Thromb Res 1980;19:139-148.

7. Miller FJ, Martin JC, Webster J. Association between dietary fat intake and plasma factor VII coagulant activity.

Atherosclerosis 1986;60:269-277.

8. Masarei J, Rouse J, Lynch W, Robertson K. Effects of a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, HDL, apoprotein B, and Lp (a).

Am J Clin Nutr 1984;40:468-479.

9. Schulpis KH, Papakonstantinou EP, Michelakakis H, Shin Y. The antiatherogenic profile of galactosemic children on soybean diet. J Inher Metab Dis 1996;19:91-92.

10. Fehily AM, Millbank JE, Yarnell JWG, Hayes TM. Dietary determinants of lipoproteins, total cholesterol, viscosity, fibrinogen and blood pressure. Am J Clin Nutr 1982;36:890-918.

11. Durrington D. Triglyceride levels in children. In: Hyperlipidaemia Diagnosis and treatment. London: Wright Ed, 1989:42-43.

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12. Pan Wen Harn, Chia Jung Chin, Chin-Tou Shew.

Hemostatic factors and blood lipids in young Buddhist vegetarians and omnivores. Am J Clin Nutr 1993;58: 354-359.

13. Merskey C, Nossel HL. Blood coagulation after the ingestion of saturated and unsaturated fats. Lancet 1997;i:806-810.

¶·Ú¿ÁÔÓÙ˜ ·ÈÌfiÛÙ·Û˘ ÛÙË Á·Ï·ÎÙÔ˙·ÈÌ›·

14. Meade TW, North WRS, Chakrabarti R. Haemostatic function and cardiovascular death, early results of a prospective study. Lancet 1980;17:1050-1053.

15. Nahouny GN. Dietary fiber, lipid metabolism and atherosclerosis. Feb Proc 1982;41:2801-2806.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-08-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-04-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ÏÂÔ¿ÙÚ· ™Ô‡ÏË πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, °Ô˘‰›, ∞ı‹Ó·

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¶ÚˆÙfiÎÔÏÏÔ ¤ÁηÈÚ˘ ÂÏÂÁ¯fiÌÂÓ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿ °ÂÒÚÁÈÔ˜ MÚÈ·ÛÔ‡Ï˘, NÈÎfiÏ·Ô˜ Z¿‚Ú·˜, M·Ú›· N·ÚÏ›ÔÁÏÔ˘, AÓ·ÛÙ¿ÛÈÔ˜ X·Ù˙‹˜ ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ηٷÁÚ¿„ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÂÓfi˜ ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈÚ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ (E°™) ÛÙËÓ ÔÍ›· Ê¿ÛË ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘ Û ·È‰È¿ Ô˘ ÂÈÛ¿ÁÔÓÙ·È Û ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ (ME£). ™ÙË ÌÂϤÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 36 ·ÛıÂÓ›˜, ËÏÈΛ·˜ 2 ¤ˆ˜ 204 ÌËÓÒÓ Ì ÛÔ‚·Ú¤˜ ·ı‹ÛÂȘ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÛË„·ÈÌ›·˜, ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎÒÓ Î·ÎÒÛÂˆÓ Î·È ÂÁη˘Ì¿ÙˆÓ. H ËÌÂÚ‹ÛÈ· ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë (¶) Û˘Û¯ÂÙ›ÛıËΠ̠ÙÔÓ ÚÔ‚ÏÂfiÌÂÓÔ ‚·ÛÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi (¶BM), ÙËÓ ÚÔ‚ÏÂfiÌÂÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ (¶KE) Î·È ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, Û‡Ìʈӷ Ì ٷ Û˘ÛÙ‹Ì·Ù· ·ÍÈÔÏfiÁËÛ˘ PRISM Î·È TISS. H £¶ ÚÔÛ¤ÁÁÈÛ ÛËÌ·ÓÙÈο ÙÔÓ ¶BM ÙÔ 2Ô 24-ˆÚÔ ÓÔÛËÏ›·˜ (46,4±3 vs 45±1,4 kcal/kg/day) Î·È ÙËÓ ¶KE ÙÔ 5Ô 24-ˆÚÔ (71±4,7 vs 74,8±12,7 kcal/kg/day). TÔ Û‡ÓÔÏÔ ÙˆÓ ˆÚÒÓ ¯ˆÚ›˜ Û›ÙÈÛË (1,4% ÙÔ˘ Û˘ÓfiÏÔ˘ ˆÚÒÓ Û›ÙÈÛ˘) Û¯ÂÙ›ÛıËΠÛËÌ·ÓÙÈο Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ (p<0,001) Î·È ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ‰È·Ù·Ú·Á̤ÓË ·ÓÔ¯‹ Ù˘ Û›ÙÈÛ˘ ·ÏÏ¿ Ì ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· (ÚÔÛ¿ıÂÈ· ·ÔۈϋӈÛ˘). ™Â ÁÚ·ÌÌÈ΋ ·Ó¿Ï˘ÛË ÔÏÏ·Ï‹˜ ·ÏÈÓ‰ÚfiÌËÛ˘, ·ÚÓËÙÈο ÛÙË ÂÊ·ÚÌÔÁ‹ Ù˘ E°™ Û˘Ó¤‚·Ï·Ó ·ÓÂÍ¿ÚÙËÙ· Ë Î·Î‹ ÙÂÏÈ΋ ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘ (p<0,0001) Î·È ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· TISS. Y„ËÏ¿ Ì˘Ôηډȷο ÎÏ¿ÛÌ·Ù· (EF 66% vs 32%, p<0,0001 ‹ SF 35% vs 19%, p=0,001) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Û¯ÂÙ›ÛıËÎ·Ó Ì ÂÈÙ˘¯›· Ù˘ E°™. MfiÓÔ ¤Ó· 5,6% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·Û ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›·, ‰È¿ÚÚÔȘ ‹ ¯ÚÂÈ¿ÛıËΠ·ÁˆÁ‹ Ì ÛÈÛ·Ú›‰Ë ÏfiÁˆ ÌË ÚÔÒıËÛ˘ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘. H ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 5,6%. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË ÌÂ Î¿Ï˘„Ë ÙˆÓ ‚·ÛÈÎÒÓ ÌÂÙ·‚ÔÏÈÎÒÓ ·Ó·ÁÎÒÓ Ì ÂȉÈ΋ Ï‹ÚË ˘ÁÚ‹ ÙÚÔÊ‹ Â›Ó·È ÂÊÈÎÙ‹, ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ¿ÌÂÛË ÌÂÙ·ÎÚÈÙÈ΋ (post-stress) ηٿÛÙ·ÛË Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿ Ô˘ ÓÔÛËχÔÓÙ·È Û ME£. H ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ E°™ Ì ÙË Ì˘Ôηډȷ΋ Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿. ¶·È‰È·ÙÚÈ΋ 2000;63:292-301. §¤ÍÂȘ ÎÏÂȉȿ: ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË, ÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË, ηٷӿψÛË ÂÓ¤ÚÁÂÈ·˜, ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜, Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ·, ÎÚ›ÛÈÌË ÓfiÛÔ˜.

G. Briassoulis, N. Zavras, M. Narlioglou, T. Hatzis. Optimized enteral feeding in critically ill children; a prospective study in a paediatric intensive care unit. Paediatriki 2000;63:292-301. ● Abstract: The aim of this study was to investigate the feasibility, adequacy and efficacy of early intragastric feeding (EGF) in critically ill children. In the study 36 critically ill children received EGF through a naso-gastric tube from day 1 (energy intake equal to 1/2, 1, 5/4, 6/4 and 6/4 of the predicted basal metabolic rate (PBMR) on days 1 to 5, respectively). Severity of illness was assessed by the PRISM Score, the TISS and indices of organ failure.

Predicted energy expenditure (PEE), PBMR, and caloric intake (CI) were calculated using recommended formulae.

EF and SF were measured by echocardiography on day 1. The early success rate was 94.4% and predicted late enteral feeding success accurately (p=0.005). CI approached PBMR on the 2nd day (46.4±3 vs 45±1.4 kcal/kg/day) and PEE on the 5th day (71±4.7 vs 74.8±12.7 kcal/kg/day). Non-feeding hours (1.4% of the total feeding hours) correlated to the PRISM (p<0.001), while transient withholding EGF was not primarily due to feeding intolerance (extubation). Multivariate stepwise regression analysis showed that poor outcome and high TISS correlated with failure of EGF (p<0.0001). Patients who succeeded EGF had significantly higher EF (66% vs 32%, p<0.0001) or SF (35% vs 19%, p=0.001) than those who failed. Most patients tolerated EGF well; only 5.6%

MÔÓ¿‰· EÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·", Aı‹Ó·

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developed nosocomial pneumonia or diarrhoea, and 8.3% needed treatment with cisapride because of delay gastric emptying. The mortality rate (5.6%) was different in the final success and failure groups (p<0.002) and was lower than predicted by the admission severity scores (12±0.03%). In conclusion, this study showed that escalated increases of CI during the acute phase of a critical illness are very well tolerated and are not clinically detrimental.

Key words: early enteral feeding, nasogastric feeding, energy expenditure, residual, critical illness.

EÈÛ·ÁˆÁ‹ H ·ÔÙ˘¯›· ÛÙËÓ ¿ÌÂÛË ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿ Ô‰ËÁ› Û˘¯Ó¿ ÛÙËÓ ¯ÔÚ‹ÁËÛË O¶¢ Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙËÙ·˜, ıÓËÛÈÌfiÙËÙ·˜, ÙË ÌË ÈÛfiÚÚÔË Û›ÙÈÛË Î·È ·ÎfiÌË ÙÔ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ (1). §fiÁˆ Ù˘ Û˘¯Ó¿ ÂËÚ·Ṳ̂Ó˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÚÈÔÚÈÛÌÔ‡ Ù˘ O¶¢, ÙÂÏÂ˘Ù·›· Û ÔÏϤ˜ ME£ ÂÊ·ÚÌfi˙ÂÙ·È Ë ‰È·˘ÏˆÚÈ΋ ‹ ÓËÛÙȉÈ΋ ̤ıÔ‰Ô˜ Û›ÙÈÛ˘. ŒÙÛÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ¤ÁηÈÚË ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Û ÂÓ‹ÏÈΘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¯Ú‹ÛË Á·ÛÙÚÔÛÙÔÌ›·˜ ‹ ÓËÛÙȉÔÛÙÔÌ›·˜ (2). Ÿˆ˜ fï˜, Î·È Ë ÂÊ·ÚÌÔÁ‹ Ù˘ O¶¢ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÂËÚ·Ṳ̂ÓË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡, ¤ÙÛÈ Î·È Ë ÓËÛÙȉÈ΋ Û›ÙÈÛË Û˘Ó‰¤ÂÙ·È Ì ÙË ÌË Ê˘ÛÈÔÏÔÁÈ΋ Ú·ÎÙÈ΋ Ù˘ ·Ú¿Î·Ì„˘ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ‚ÏÂÓÔÁfiÓÔ˘, ÙÔ˘ Ù˘ ‰È¤ÁÂÚÛ˘ ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ Î·È Ù˘ ÔÛ̈ڇıÌÈÛ˘ Ô˘ ÚÔÛʤÚÂÈ.

BÈÔÏÔÁÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ, Â›Û˘ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë Ù˘ ÂÈÏÔÁ‹˜ Ù˘ ‰È·Á·ÛÙÚÈ΋˜ Ô‰Ô‡ Û›ÙÈÛ˘ ÙˆÓ ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ. E›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ Á·ÛÙÚÈΤ˜ ÂÎÎÚ›ÛÂȘ, Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔÓ Î˘ÚÈfiÙÂÚÔ ·ÓÙÈ‚·ÎÙËÚȉȷÎfi Ì˯·ÓÈÛÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÌÂÈÒÓÔÓÙ·È fiÙ·Ó Ë ÙÚÔÊ‹ ·ÂÏ¢ıÂÚÒÓÂÙ·È ÛÙÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ (3). EÈÚfiÛıÂÙ·, Ë Û›ÙÈÛË Ì¤Ûˆ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· Â›Ó·È Â‡ÎÔÏË, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÂȉÈ΋ Ù¯ÓÈ΋ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ηıÂÙ‹Ú· Î·È Û˘ÁÎÚÈÙÈο, ¤¯ÂÈ ÙÔ ¯·ÌËÏfiÙÂÚÔ ÎfiÛÙÔ˜. H ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË ·ԉ›¯ıËΠ¢ÂÚÁÂÙÈ΋ Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ì ÂÁη‡Ì·Ù· (4), ‹ ÌÂÙÂÁ¯ÂÈÚËÙÈο (5).

EÓÙÔ‡ÙÔȘ, Ë ·ÛÊ¿ÏÂÈ· Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ¤ÓÔ˜ ¤ÁηÈÚÔ˘ ÂÈıÂÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿ (¤Ú¢ӷ ÛÙÔ MEDLINE). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÍÂÙ¿ÛË ÙËÓ ˘fiıÂÛË fiÙÈ Ë E°™ ηٿ ÙË ‰¿ÚÎÂÈ· ÛÔ‚·Ú‹˜ ¿ıËÛ˘ Â›Ó·È ÂÊÈÎÙ‹ Î·È ·ÛÊ·Ï‹˜ Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ AÛıÂÓ›˜ ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó 36 ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿ Ô˘ ˘ÔÛÙËÚ›˙ÔÓÙ·Ó Ì Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi. °È· Ó· ÂÚÈÏËÊıÔ‡Ó ÛÙË ÌÂϤÙË, ÔÈ ·ÛıÂÓ›˜

™˘ÓÙÔÌÔÁڷʛ˜ O¶¢

OÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹

ME£

MÔÓ¿‰· EÓÙ·ÙÈ΋˜ £ÂÚ·›·˜

¶BM

¶ÚÔ‚ÏÂfiÌÂÓÔ˜ ‚·ÛÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜

E°™

ŒÁηÈÚË ÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË

SIRS

™‡Ó‰ÚÔÌÔ Û˘ÛÙËÌ·ÙÈ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘

PRISM

Pediatric Risk of Mortality

TISS

Therapeutic Intervention Scoring System

MOSF

¶ÔÏ˘ÔÚÁ·ÓÈ΋ ·ÓÂ¿ÚÎÂÈ·

¶KE

¶ÚÔ‚ÏÂfiÌÂÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜

£¶

£ÂÚÌȉÈ΋ ÚfiÛÏË„Ë

™HA

™˘ÓÈÛÙÒÌÂÓ˜ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ

A£¶

AÓ·ÌÂÓfiÌÂÓË ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë

EF

KÏ¿ÛÌ· ÂÍÒıËÛ˘

SF

KÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘

¤ÚÂ ӷ ÏËÚÔ‡Ó Ù· ·ÎfiÏÔ˘ı· ÎÚÈÙ‹ÚÈ·: ·) ·Ó·ÌÂÓfiÌÂÓË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙË ME£>5 Ë̤Ú˜, ‚) ·Ó·ÌÂÓfiÌÂÓË ‰È¿ÚÎÂÈ· Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ >3 Ë̤Ú˜, Á) ·Ô˘Û›· ÓÂÊÚÈ΋˜ ‹ Ë·ÙÈ΋˜ ÓfiÛÔ˘, ‰) ÈÛÙÔÚÈÎfi ÂχıÂÚÔ ¯ÚfiÓÈ·˜ Á·ÛÙÚÂÓÙÂÚÈ΋˜ ÓfiÛÔ˘, Â) ¤Ó·ÚÍË ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ ÙȘ ÚÒÙ˜ 12 ÒÚ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹. ¶ÚˆÙfiÎÔÏÏÔ Û›ÙÈÛ˘ ¶Ï‹Ú˘ ˘ÁÚ‹ ÙÚÔÊ‹ (Nutrison Pediatric ÁÈ· ·È‰È¿ οو ÙˆÓ 10 ÂÙÒÓ, Nutrison Standard ÁÈ· ·È‰È¿ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ) ¯ÔÚËÁ›ÙÔ Ì¤Ûˆ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ۈϋӷ ̤۷ ÛÙȘ 12 ÚÒÙ˜ ÒÚ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙË ME£. TÔ ˆÚÈ·›Ô ÔÛfi ˘ÔÏÔÁÔ˙fiÙ·Ó Û‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ, Ì ÛÙfi¯Ô Ó· Êı¿ÛÂÈ ÙÔÓ ¶BM ÛÙÔ 2Ô 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜ Î·È Ó· ÙÔÓ ˘Âڂ› ηٿ 50% ÙȘ ÂfiÌÂÓ˜ Ë̤Ú˜, Î·È ÂÓÒ Ô ·ÛıÂÓ‹˜ ·Ú¤ÌÂÓ Û ηٿÛÙ·ÛË stress (ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ›ÛË Ì ÙÔ 1/2, 1, 5/4, 6/4 Î·È 6/4 ÙÔ˘ ¶BM ‰È·‰Ô¯Èο ÙȘ Ë̤Ú˜ 1-5).

K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ E°™, ÔÈ ·ÛıÂÓ›˜ Ì ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÚÔÒıËÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÂÎÙÈÌÒÓÙ·Ó ÁÈ· ÙÔ Â›Â‰Ô Ù˘ ηٷÛÙÔÏ‹˜ Î·È Ù˘ ·Ú¿Ï˘Û˘, Î·È ·Ó ˘‹Ú¯Â Úfi‚ÏËÌ·, ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Ì ¯ÔÚ‹ÁËÛË ÛÈÛ·Ú›‰Ë˜ (2 mg/kg/8ˆÚÔ) ÁÈ· 48 ÒÚ˜.

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°. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

™˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ OÈ ·ÛıÂÓ›˜ Ù·ÍÈÓÔÌÔ‡ÓÙ·Ó a priori ÛÙȘ ·ÎfiÏÔ˘ı˜ ‰È·ÁÓˆÛÙÈΤ˜ ηÙËÁÔڛ˜: ÛË„·ÈÌ›· / ÌËÓÈÁÁ›Ùȉ·, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË, ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ó¢ÚÔÌ˘˚΋ ¿ıËÛË Î·È ÂÁη‡Ì·Ù·. ™Ë„·ÈÌ›·, ÛËÙÈ΋ ηٷÏËÍ›· Î·È SIRS ÔÚ›ÛıËÎ·Ó Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÔÌÔʈӛ·˜ Ù˘ AÌÂÚÈοÓÈ΢ EÙ·ÈÚ›·˜ £ˆÚ·ÎÔ¯ÂÈÚÔ˘ÚÁÒÓ Î·È Ù˘ EÙ·ÈÚ›·˜ EÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ (6). H ÂÎÙ›ÌËÛË Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ¿ıËÛ˘ ÁÈÓfiÙ·Ó Ì ‚¿ÛË ÙÔ PRISM score (7), ÙÔ TISS ÙÚÔÔÔÈË̤ÓÔ ÁÈ· Ù· ·È‰È¿ (8), Î·È ÙÔ˘˜ ‰Â›ÎÙ˜ ÔÚÁ·ÓÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. H MOSF ÔÚ›ÛıËΠ̠ٷ ÎÚÈÙ‹ÚÈ· ÙˆÓ Wilkinson Î·È Û˘Ó (9). O ¶BM ˘ÔÏÔÁÈ˙fiÙ·Ó Ì ‚¿ÛË ÙȘ ÂÍÈÛÒÛÂȘ ÙˆÓ Schofield (10) Î·È Harris-Benedict (11). AÎÔÏÔ‡ıˆ˜, ÔÏÏ·Ï·ÛÈ·˙fiÙ·Ó Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‰ÈfiÚıˆÛ˘ fiˆ˜ ÚÔÙ¿ıËÎ·Ó ·fi ÙÔÓ Seashore (12) ÁÈ· Ó· ÂÎÙÈÌËı› Ë ¶KE. H £¶ ˘ÔÏÔÁÈ˙fiÙ·Ó Î·ıËÌÂÚÈÓ¿ ·fi ÙȘ οÚÙ˜ ÓÔÛËÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ. OÈ ™HA ˘ÔÏÔÁ›˙ÔÓÙ·Ó ·fi ÙÔ˘˜ ›Ó·Î˜ ÙÔ˘ ÂıÓÈÎÔ‡ Û˘Ì‚Ô˘Ï›Ô˘ ¤Ú¢ӷ˜ Û ı¤Ì·Ù· ÙÚÔÊ›ÌˆÓ Î·È Û›ÙÈÛ˘ ÙˆÓ H¶A (13). T· ÎÏ¿ÛÌ·Ù· Ì˘Ôηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ SF Î·È EF ˘ÔÏÔÁ›˙ÔÓÙ·Ó Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ÛÙË ME£ Â·ÓÂÈÏËÌ̤ӷ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘. TÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÁÈÓfiÙ·Ó ‰›Ï· ÛÙËÓ ÎÏ›ÓË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÙÔ Ultramark 8 Ultrasound System, Advanced Technology Laboratory, Squibb, Washington, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˯ԂÔÏ›˜ 3 Î·È 5 MHz, Î·È ÔÈ Î·Ù·Áڷʛۘ ÙÈ̤˜ ÙÔ˘ ÚÒÙÔ˘ 24ˆÚÔ˘ ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ù˘ ÌÂϤÙ˘. H ÔÛfiÙËÙ· ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜, ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Á·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÓÔÛÔÎÔÌÂȷ΋˜ Ó¢ÌÔÓ›·˜ Î·È ÔÈ ÂÈÏÔΤ˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi (¤ÌÂÙÔÈ, ‰È¿ÚÚÔȘ) ÛËÌÂÈÒÓÔÓÙ·Ó Î·ı' fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. EÈÙ˘¯‹˜ ıˆڋıËÎÂ Ë Û›ÙÈÛË Ô˘ ÔÏÔÎÏËÚÒıËΠۇÌʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ¤ÛÙˆ Ì ÌÈÎÚ¤˜ ·ÚÔ‰ÈΤ˜ ·ÔÎÏ›ÛÂȘ ÙˆÓ Î·Ï˘ÙfiÌÂÓˆÓ ¤Ó·ÓÙÈ ÙˆÓ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓˆÓ ıÂÚÌ›‰ˆÓ. AÔÙ˘¯›· Ù˘ Û›ÙÈÛ˘ ıˆڋıËÎÂ Ë ‰È·ÎÔ‹ ÂÊ·ÚÌÔÁ‹˜

ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ Î·È Ë ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ ÌË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙˆÓ ˘ÔÏÔÁÈÛıÂÈÛÒÓ ıÂÚÌ›‰ˆÓ ‚¿ÛÂÈ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘. E›Û˘, Ô ÙÚfiÔ˜ Û›ÙÈÛ˘ Î·È Ë £¶ ηٿ ÙËÓ ¤ÍÔ‰Ô Î·Ù·ÁÚ¿ÊÔÓÙ·Ó Î·È Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË T· Ê˘ÛÈÔÏÔÁÈÎÒ˜ ηٷÓÂÌË̤ӷ ‰Â‰Ô̤ӷ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û·Ó Ì¤ÛË ÙÈÌ‹±sem, ÂÓÒ Ù· ÌË Ê˘ÛÈÔÏÔÁÈÎÒ˜ ηٷÓÂÌË̤ӷ ‰Â‰Ô̤ӷ ‰›ÓÔÓÙ·È Û·Ó ‰È¿ÌÂÛË ÙÈÌ‹ Î·È Â‡ÚÔ˜ ÙÈÌÒÓ. H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙÔ two-tailed t-test ÁÈ· Ù· Ê˘ÛÈÔÏÔÁÈÎÒ˜ ηٷÓÂÌË̤ӷ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË Î·Ù¿ Levene ÁÈ· ÙËÓ ÈÛfiÙËÙ· ÙˆÓ ·ÓÙÈı¤ÙˆÓ ‹ Ì ÙË Mann-Whitney U Wilcoxon ηٿٷÍË sum W test ÁÈ· Ù· ÌË Ê˘ÛÈÔÏÔÁÈο ηٷÓÂÌË̤ӷ ‰Â‰Ô̤ӷ. TÈ̤˜ Èı·ÓfiÙËÙ·˜ <0,05 Ì ٷ two-tailed tests ıˆڋıËÎ·Ó ÛËÌ·ÓÙÈΤ˜. ŸÙ·Ó ˘ÔÏÔÁÈ˙fiÙ·Ó Ë ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ÙfiÙ ¯ÚËÛÈÌÔÔÈ›ÙÔ Ë Î·Ù¿ Pearson ·Ó¿Ï˘ÛË. H ‰ÔÎÈÌ·Û›· ηٿ Fisher ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‰Â‰Ô̤ӈÓ. H ÔÏ˘·Ú·ÁÔÓÙȷ΋ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· Ó· ·Ó·Ï‡ÛÂÈ ÙËÓ Û˘Ì‚ÔÏ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÎÏÈÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Ù˘ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ÙËÓ ·ÓıÚˆÔÌÂÙÚ›· Î·È ÙËÓ ÛÔ‚·ÚfiÙËÙ· ÙˆÓ ÙÈÌÒÓ Ù˘ ¿ıËÛ˘ Û ۯ¤ÛË Ì ÙË ÌÂÙ·‚ÔÏ‹ ÛÙË ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ. ŸÏ˜ ÔÈ ·Ó·Ï‡ÛÂȘ ¤ÁÈÓ·Ó Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ™Ù·ÙÈÛÙÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· ÙȘ KÔÈÓˆÓÈΤ˜ EÈÛً̘ (SPSS) ÁÈ· Windows, ¤Î‰ÔÛË 8.0.

AÔÙÂϤÛÌ·Ù· KÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ™˘ÓÔÏÈο 4320 ÒÚ˜ Û›ÙÈÛ˘ ÂÚÈÏ‹ÊıËÎ·Ó ÛÙÔ ÚˆÙfiÎÔÏÏÔ E°™ ÙˆÓ 36 ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ Ë·ÙÈ΋ Î·È ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È Î·Ì›· ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÂÓÙÂÚÈ΋ Û›ÙÈÛË. T· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ¢¤Î· ·È‰È¿ (27,8%)

¶›Ó·Î·˜ 1. KÏÈÓÈο ‰Â‰Ô̤ӷ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ ÚÒÙÔ 24ˆÚÔ (n=36).

MÂÙ·‚ÏËÙ¤˜ HÏÈΛ· (Ì‹Ó˜) B¿ÚÔ˜ (kg) PRISM TISS ¶Èı·ÓfiÙËÙ· ı·Ó¿ÙÔ˘ Ì ÙËÓ Îϛ̷η PRISM (%) EF (%) SF (%)

M¤Û˱SEM M

¢È¿ÌÂÛË ÙÈÌ‹ ÙÈÌ‹

EÏ¿¯ÈÛÙË Ë

54,8±9,1 21±1,9 11,1±1,4 27±1,8

42 18 9,0 25,0

2,0 3,6 2,0 9,0

11±0,09 65±1,8 34±1,2

4,0 68 35

0,00 33 16 -

M¤ÁÈÛÙË Ë

-

SEM= ™Ù·ıÂÚfi ÛÊ¿ÏÌ·; PRISM=Pediatric Risk of Mortality; TISS=Therapeutic Intervention Scoring System, EF=Ejection Fraction, SF=Shortening Fraction.

294

204 50 47,0 56,0 99 77 46

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EÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Û ·È‰È¿ Û ME£

›¯·Ó ÛË„·ÈÌ›·,12 (33,3%) ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË, 6 (16,7%) ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, 3 (8,3%) Ó¢ÚÔÌ˘˚΋ ÓfiÛÔ Î·È 5 (13,9%) ÂÁη‡Ì·Ù·. H ‰È¿ÚÎÂÈ· ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ‹Ù·Ó 5±0,7 Ë̤Ú˜ (‡ÚÔ˜ 1-16 Ë̤Ú˜), ÂÓÒ Ë Ì¤ÛË ·Ú·ÌÔÓ‹ ÛÙË ME£ ‹Ù·Ó 9,8±1,3 Ë̤Ú˜ (‡ÚÔ˜ 1-46 Ë̤Ú˜). H Û¯¤ÛË ·ÁÔÚÈÒÓ/ÎÔÚÈÙÛÈÒÓ ‹Ù·Ó 1,3:1. ¢‡Ô ·ÛıÂÓ›˜ (5,6%) η٤ÏËÍ·Ó (ÌË ·Ó·ÛÙÚ¤„ÈÌË ÛËÙÈ΋ ηٷÏËÍ›·). K·Ù¿ ÙË 1Ë Ì¤Ú· Ù˘ ÌÂϤÙ˘ 30,6% ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó Û ΛӉ˘ÓÔ ÁÈ· Ì›ˆÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ Ï›Ô˘˜ Î·È 25% ÁÈ· Ì›ˆÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÚˆÙ›Ó˘ Û‡Ìʈӷ Ì ÙÔ˘˜ Frisancho (14), Ryan Î·È Martinez (15). EÈϤÔÓ, 16,7% ‹Ù·Ó Û ΛӉ˘ÓÔ ÁÈ· ¯ÚfiÓÈ· Î·È 22,2% ÁÈ· ÔÍ›· ÚˆÙÂ˚ÓÈ΋ ÂÓÂÚÁÂȷ΋ ˘ÔıÚ„›· Û‡Ìʈӷ Ì ÙË ÛÙ·‰ÈÔÔ›ËÛË Î·Ù¿ Waterlow ( ). ™˘ÓÔÏÈο, ÙÔ 16,7% ›¯Â ‹‰Ë ÌÂȈ̤ӷ ·Ôı¤Ì·Ù· Ï›Ô˘˜ ‹ ÚˆÙ›Ó˘ Î·È 5,5% ‹Ù·Ó ‹‰Ë Û ¯ÚfiÓÈ· ‹ ÔÍ›· ÚˆÙÂ˚ÓÈ΋ ÂÓÂÚÁÂȷ΋ ˘ÔıÚ„›·. ™¯¤ÛË ÌÂٷ͇ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ Î·È ·Ó·ÌÂÓfiÌÂÓ˘ ÂÓÂÚÁÂȷ΋˜ ηٷӿψÛ˘ K·Ù¿ ÙËÓ 1Ë Ì¤Ú·, Ë £¶ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ·fi ÙÔÓ ¶BM, ¶KE Î·È ™HA. H £¶ ÏËÛ›·Û ÙËÓ ¶BM ηٿ ÙË ‰Â‡ÙÂÚË Ì¤Ú· (46,4±3 vs 45±1,4 kcal/kg/Ë̤ڷ) Î·È ÙËÓ ¶KE ÙËÓ 5Ë Ì¤Ú· (71±4,7 vs 74,8±12,7 kcal/kg/Ë̤ڷ). K·Ù¿ ÙËÓ 5Ë Ì¤Ú·, Ë £¶ ÍÂ¤Ú·Û ÙÔÓ ¶BM ÛËÌ·ÓÙÈο (71±4,7 vs 45±1,4 kcal/kg/Ë̤ڷ, p<0,0001), ˘ÂÚ‚·›ÓÔÓÙ·˜ ÙËÓ ·Ó·ÌÂÓfiÌÂÓË (expected) £¶ (A£¶) ηٿ ÙËÓ 5Ë Ì¤Ú· (71±4,7 vs 67,9±2,1 kcal/kg/Ë̤ڷ) (EÈÎfiÓ· 1). ¢È·ÊÔÚ¤˜ ÌÂٷ͇ £¶ (·Ú·ÙËÚËı›۷) Î·È A£¶ (·Ó·ÌÂÓfiÌÂÓË), ÙˆÓ ÚÔ‚ÏÂfiÌÂÓˆÓ ÙÈÌÒÓ ıÂÚÌȉÈ΋˜ ηٷӿψÛ˘, ηıÒ˜ Î·È ÙˆÓ Û˘ÓÈÛÙÒÌÂÓˆÓ ÂÓÂÚÁÂÈ·ÎÒÓ ‰··ÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. MfiÓÔ ÔÈ Î·Ù¿ ˙‡ÁË ‰È·ÊÔÚ¤˜ ÌÂٷ͇ £¶ Î·È ™HA ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ì ·ÚÓËÙÈ΋ Û¯¤ÛË Î·Ù¿ ÙÔ Ù¤-

EÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË Ù˘ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ (£¶) Ì ÙȘ ÚÔ‚ÏÂÊı›Û˜ ÙÈ̤˜ ‚·ÛÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ (¶BM), ηٷӷψı›۷˜ ÂÓ¤ÚÁÂÈ·˜ (¶KE), Û˘ÓÈÛÙÒÌÂÓˆÓ ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ (™HA) Î·È ·Ó·ÌÂÓfiÌÂÓ˘ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ (A£¶) ÙËÓ 5Ë Ë̤ڷ ÂÓfi˜ ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈÚ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ (E°™) Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿. ÏÔ˜ ÙÔ˘ E°™ ÚˆÙÔÎfiÏÏÔ˘. TË 2Ë Ì¤Ú· Ë ‰È·ÊÔÚ¿ ¶£-¶BM ‹Ù·Ó ·ÚÓËÙÈ΋ Û ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ (58%), ÂÓÒ Î·Ù¿ ÙËÓ 5Ë Ì¤Ú· Ë ‰È·ÊÔÚ¿ ÌÂٷ͇ ¶£-¶BM ‹Ù·Ó <0 ÌfiÓÔ Û ÔÛÔÛÙfi 8,3% Î·È >0 Û ÔÛÔÛÙfi 91,7% ÙˆÓ ·ÛıÂÓÒÓ. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ £¶ Î·È ÎÏÈÓÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ M¤¯ÚÈ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ E°™, Ë £¶ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Î·È ·ıÔÏÔÁÈÎÒÓ ·ÛıÂÓÒÓ (69,9±5,0 vs 79,2±5,3 kcal/kg/Ë̤ڷ, p=0,5) ‹ Û ·ÛıÂÓ›˜ Ì ‹ ¯ˆÚ›˜ ıÂÙÈÎfi ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi (66±5,3 vs 72±5,3

¶›Ó·Î·˜ 2. ¢È·ÊÔÚ¤˜ ηٿ ˙‡ÁË ÌÂٷ͇ ÙˆÓ ·Ú·ÙËÚÔ‡ÌÂÓ˘, ·Ó·ÌÂÓfiÌÂÓ˘, Û˘ÓÈÛÙÒÌÂÓ˘ Î·È ÚÔ‚ÏÂfiÌÂÓ˘ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ ηٿ ÙËÓ 5Ë Ë̤ڷ ÂÓfi˜ ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈÚ˘ ‰È·Á·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ ÛÙËÓ ÔÍ›· Ê¿ÛË ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘ (n=36).

Paired Samples Test

¢È·ÊÔÚ¤˜ ηٿ ˙‡ÁË M¤ÛË ÙÈÌ‹ ± SEM

™HA - £¶ (kcal/kg/Ë̤ڷ) ¶KE - £¶ (kcal/kg/Ë̤ڷ) ¶BM - £¶ (kcal/kg/Ë̤ڷ) A£¶ - £¶ (kcal/kg/Ë̤ڷ)

17,8 ± 4,4 * 3,8 ± 11,7 -25,9 ± 4,1 * -3,3 ± 3,9

95% ŸÚÈ· ·ÍÈÔÈÛÙ›·˜ X·ÌËÏfiÙÂÚ·

Y„ËÏfiÙÂÚ·

8,8 -19,8 -34,4 -11,4

26,8 27,5 -17,4 4,8

* p <0,0001 SEM= ™Ù·ıÂÚfi ÛÊ¿ÏÌ·, £¶= ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë (·Ú·ÙËÚËı›۷), A£¶= ·Ó·ÌÂÓfiÌÂÓË ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë, ™HA= Û˘ÓÈÛÙÒÌÂÓ˜ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ, ¶KE= ÚÔ‚ÏÂfiÌÂÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜, ¶BM= ÚÔ‚ÏÂfiÌÂÓÔ˜ ‚·ÛÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜

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°. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

EÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË Ì˘Ôηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ Î·È Û˘ÓÔÏÈÎÔ‡ ÚÔÛÏ·Ì‚·ÓfiÌÂÓÔ˘ ÔÛÔ‡ Û›ÙÈÛ˘. kcal/kg/Ë̤ڷ, p=0,7). EÈÚfiÛıÂÙ·, Ù· ÔÛ¿ Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÔÌ¿‰ˆÓ ·ÛıÂÓÂÈÒÓ. AÓÙ›ıÂÙ·, ÛËÌ·ÓÙÈ΋ ‹Ù·Ó Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓÔ˘ ÔÛÔ‡ Û›ÙÈÛ˘ Î·È ÙˆÓ Ì˘ÔηډȷÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ EF (r=0,40, p=0,002) Î·È SF (r=0,34, p=0,004) (EÈÎfiÓ· 2).

E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ ÂÓÂÚÁÂȷ΋˜ ÚfiÛÏ˄˘ E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ A£¶-£¶ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ì ‹ ¯ˆÚ›˜ MOSF (p<0,0001) ‹ ÛËÙÈ΋ ηٷÏËÍ›· (p<0,0001) ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ÌÂϤÙ˘ (EÈÎfiÓ· 3). AÓÙ›ıÂÙ·, Â·ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ‰È·ÊÔÚÒÓ A£¶-£¶ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ì ‹ ¯ˆÚ›˜ SIRS (p=0,6). ™¯¤ÛË ÌÂٷ͇ £¶ Î·È Ê·ÚÌ¿ÎˆÓ H £¶ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó ‹ fi¯È ÔÈÔÂȉ‹ (67,9±5,9 vs 78±6,9 kcal/kg/Ë̤ڷ, p=0,3) ‹ ·ÁÁÂÈÔ‰Ú·ÛÙÈο Ê¿Ú̷η (63,2±10,8 vs 73,5±5,0 kcal/kg/Ë̤ڷ, p=0,4). AÓÙ›ıÂÙ·, ·ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó Ó¢ÚÔÌ˘˚ÎÔ‡˜ ·ÔÎÏÂÈÛÙ¤˜ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË £¶ Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ·Ú¿Ï˘ÛË (65,8±4,9 vs 93,8±7,9 kcal/kg/Ë̤ڷ, p<0,02). H ‰È·ÊÔÚ¿ ·˘Ù‹ ·ÓÙ·Ó·ÎÏÔ‡Û ·ÓÙ›ÛÙÔÈ¯Ë ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ E°™ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (6±2,3 vs 0±0 ml/ÒÚ·, p=0,015). ¶·ÚfiÌÔÈ·, ·ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó ÔÈÔÂȉ‹ ¿ÊËÓ·Ó ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜ Û˘ÁÎÚÈÙÈο Ì ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ÔÈÔÂȉ‹ (7,2±2,7 vs 0,2±0,1 ml/ÒÚ·, p=0,018). AÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ‹ fi¯È ·Á-

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EÈÎfiÓ· 3. E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ‰È·ÊÔÚÒÓ A£¶-£¶ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ì ‹ ¯ˆÚ›˜ MOSF (¿Óˆ) ‹ ÛËÙÈ΋ ηٷÏËÍ›· (οو) ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈÚ˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘. ÁÂÈÔ‰Ú·ÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ˆ˜ ÚÔ˜ ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ ˘ÔÏ›ÌÌ·ÙÔ˜ (6,9 vs 4,3 ml/ÒÚ·, p=0,6).

E°™: ÂÈÙ˘¯›·-·ÔÙ˘¯›· H ¿ÌÂÛË ÂÈÙ˘¯›· ¤Êı·Û ÙÔ ÔÛÔÛÙfi 94,4%, ÚԂϤÔÓÙ·˜ ÙËÓ ÂÈÙ˘¯‹ ÙÂÏÈ΋ (¤ˆ˜ Î·È ÙËÓ ¤ÍÔ‰Ô) ÂÓÙÂÚÈ΋ Û›ÙÈÛË Û ÔÛÔÛÙfi 97,1% (p-=0,005). H ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô Ô˘ ¤ÊÂÚ·Ó Û ¤Ú·˜ ÙÔ ÚˆÙfiÎÔÏÏÔ E°™ ‹Ù·Ó 84 (45-130) kcal/kg/Ë̤ڷ. H ÙÂÏÈ΋ ‰È·ÊÔÚ¿ ÂÓ¤ÚÁÂÈ·˜ ÌÂٷ͇ Ù˘ 5˘ Ë̤ڷ˜ Î·È ·˘Ù‹˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ‹Ù·Ó -9,6 kcal/kg/Ë̤ڷ (-73-+18). AÔÙ˘¯›· Ù˘ E°™ ·Ú·ÙËÚ‹ıËΠ΢ڛˆ˜ Û ÌË ·Ó·ÛÙÚ¤„ÈÌË ÛËÙÈ΋ ηٷÏËÍ›·. OÈ ·ÛıÂÓ›˜ Ô˘ ·¤Ù˘¯·Ó ηٿ ÙËÓ E°™ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÎÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ (19% vs 35%, p=0,001) ‹ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ (32% vs 66%, p<0,0001) ÛÂ

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Û‡ÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤ÊÂÚ·Ó Û ¤Ú·˜ ÙÔ ÚˆÙfiÎÔÏÏÔ (EÈÎfiÓ· 4). TÔ ¿ıÚÔÈÛÌ· ÙˆÓ ˆÚÒÓ ¯ˆÚ›˜ Û›ÙÈÛË ·ÓÙÈÛÙÔȯԇÛ ÛÙÔ 1,4% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ˆÚÒÓ Û›ÙÈÛ˘, ·ÓÙÈÛÙÔȯÒÓÙ·˜ Û 3,6±1,7 ÒÚ˜ (0-60) ÁÈ· οı ·ÛıÂÓ‹ Û fiÏË ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. OÈ ÒÚ˜ ·˘Ù¤˜ ‰È·ÎÔ‹˜ Ù˘ Û›ÙÈÛ˘ Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈο ÚÔ˜ ÙȘ ÙÈ̤˜ ÙˆÓ PRISM, TISS, Î·È ·ÚÓËÙÈο Ì ÙÔ EF (r=-0,32, p=0,007) ‹ SF (r=0,37, p=0,002). ™Â ÔÏ˘·Ú·ÁÔÓÙȷ΋ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘, ÌfiÓÔ Ë ÂÈ‚›ˆÛË (r2=0,62, p<0,0001) Î·È ÙÔ TISS (r2=-3, p<0,02) Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ·ÓÂÍ¿ÚÙËÙ· Ì ÙË ‰È·ÊÔÚ¿ £¶-¶BM. E°™ -ÂÈÏÔΤ˜ OÈ ·ÛıÂÓ›˜ ·Ó¤¯ıËÎ·Ó ÙËÓ E°™ Ôχ ηϿ. H Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙË Û›ÙÈÛË Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· ‹Ù·Ó ÌÈÎÚ‹ (13,9%). ¢È¿ÚÚÔÈ· (5,6%) Î·È ÂËÚ·Ṳ̂ÓË Á·ÛÙÚÈ΋ ΤӈÛË (8,3%) ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì ‚Ú·¯‡¯ÚÔÓË Ì›ˆÛË Ù˘ Û›ÙÈÛ˘. H ·ÚÔ‰È΋ ‰È·ÎÔ‹ Ù˘ E°™ ‰ÂÓ ÔÊÂÈÏfiÙ·Ó ÛÙË ÌË ·ÓÔ¯‹ Ù˘ Û›ÙÈÛ˘ ΢ڛˆ˜, ·ÏÏ¿ ÛÙËÓ ÚÔ·ÈÚÂÙÈ΋ ‰È·ÎÔ‹ Ù˘ ÁÈ· ÙËÓ ·ÔۈϋӈÛË. MfiÓÔ ¤Ó·˜ ·ÛıÂÓ‹˜ ›¯Â ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Á·ÛÙÚÈÎÔ‡ ηٿ ÙËÓ 5Ë Ì¤Ú· (Klebsiella) Î·È ‰‡Ô ·Ó¤Ù˘Í·Ó ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›·, ÂÓÒ 12 ·ÛıÂÓ›˜ (33.3%) ›¯·Ó ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜. TÚÂȘ ·ÛıÂÓ›˜ ıÂÚ·‡ıËÎ·Ó Ì ÂÈÙ˘¯›· Ì ¯ÔÚ‹ÁËÛË ÛÈÛ·Ú›‰Ë˜ ÏfiÁˆ ηı˘ÛÙÂÚË̤Ó˘ Á·ÛÙÚÈ΋˜ ΤӈÛ˘. Ÿ„ÈÌ· ÚÔ‚Ï‹Ì·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË Û›ÙÈÛË, Ì ‰È·ÎÔ‹ Ù˘ Û›ÙÈÛ˘ ÁÈ· ÏÈÁfiÙÂÚÔ ·fi 1 Ë̤ڷ, ÂÚÈÂÏ¿Ì‚·Ó·Ó ÙȘ ‰È¿ÚÚÔȘ (5,6%) Î·È ÙË Á·ÛÙÚÔ¿ÚÂÛË

EÈÎfiÓ· 4. ™‡ÁÎÚÈÛË ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÂÍÒıËÛ˘ (EF) Î·È ‚Ú¿¯˘ÓÛ˘ (SF), ÂÓ‰ÂÈÎÙÈÎÒÓ Ù˘ Ì˘Ôηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜, ÌÂٷ͇ ·ÛıÂÓÒÓ Ô˘ ÔÏÔÎÏ‹ÚˆÛ·Ó ‹ ·¤Ù˘¯·Ó Ó· ·Ó¯ıÔ‡Ó ÙÔ ÚˆÙfiÎÔÏÏÔ ¤ÁηÈÚ˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ (p=0,001).

EÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Û ·È‰È¿ Û ME£

(5,6%) Û 4 ·ÛıÂÓ›˜ Ì ÛËÙÈ΋ ηٷÏËÍ›·. MfiÓÔ 2 ·ÛıÂÓ›˜ ¯ÚÂÈ¿ÛıËÎ·Ó O¶¢ ÌÂÙ¿ ·fi ÙË Û˘ÌÏ‹ÚˆÛË Ù˘ E°™ ÂÓÒ 21 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ (58,3%) ÂÍ‹Ïı·Ó Û˘Ó¯›˙ÔÓÙ·˜ ÙË Û›ÙÈÛË Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú·. H ıÓËÙfiÙËÙ· ÛÙË ME£ (5,6%) ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ÁÈ· ÙËÓ ÔÌ¿‰· Ì ÂÈÙ˘¯Ë̤ÓË ÙÂÏÈ΋ Û›ÙÈÛË Û ۇÁÎÚÈÛË Ì ÂΛÓË Ù˘ ÔÌ¿‰·˜ Ô˘ ·¤Ù˘¯Â Ó· ÔÏÔÎÏËÚÒÛÂÈ ÙÔ ÚˆÙfiÎÔÏÏÔ (p<0,002), Î·È ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ·fi ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ·fi ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ (PRISM) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ (12±0,3). ™˘˙‹ÙËÛË EÏ¿¯ÈÛÙ˜ ÌÂϤÙ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÛÙȘ ıÂÚÌȉÈΤ˜ ·Ó¿ÁΘ ÙˆÓ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ ÛÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰Â›¯ıËΠfiÙÈ ÔÈ ÂÓÂÚÁÂȷΤ˜ ·Ó¿ÁΘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÚԂϤÔÓÙ·È ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ™HA ‹ ÂȉÈΤ˜ ÂÍÈÛÒÛÂȘ ˘ÂÚÂÎÙÈÌÔ‡Ó ÙËÓ Ú·ÁÌ·ÙÈο ‰··ÓfiÌÂÓË ÂÓ¤ÚÁÂÈ· ÛÙË Ê¿ÛË ÙÔ˘ stress. H ÌÂÙÚËı›۷ ÂÓ¤ÚÁÂÈ· ÛÙË Ê¿ÛË ÙÔ˘ stress ‚Ú¤ıËΠӷ ÚÔÛÂÁÁ›˙ÂÈ ÙÔÓ ¶BM (17) ÂÓÒ ÔÈ ˘ÔÏÔÁÈÛÌÔ› ¶KE ¤¯Ô˘Ó ‰Âȯı› ÙÂÏ›ˆ˜ ·Î·Ù¿ÏÏËÏÔÈ ÁÈ· ˘ÔÏÔÁÈÛÌfi Ù˘ ıÂÚÌȉÈ΋˜ Î¿Ï˘„˘ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ (18). AÙ˘¯Ò˜, ÔÈ ÚÔÙÂÈÓfiÌÂÓ˜ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ Û ·È‰È¿ Û stress ¤¯Ô˘Ó ‚·ÛÈÛı› Û ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Û ˘ÁÈ‹, ¯ˆÚ›˜ stress ¿ÙÔÌ· (19,20), Ô‰ËÁÒÓÙ·˜ ÔÏϤ˜ ÊÔÚ¤˜ Û ˘ÂÚÛ›ÙÈÛË (21). H ˘ÂÚÛ›ÙÈÛË, fï˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÚÂÓ¤ÚÁÂȘ, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÚÔηÏÔ‡ÌÂÓ˘ ·fi ÙË Û›ÙÈÛË ıÂÚÌÔÁ¤ÓÂÛË, Ù˘ ·˘ÍË̤Ó˘ ·Ú·ÁˆÁ‹˜ CO2, Î·È ÙË ÏÈÒ‰Ë ÂÓ·fiıÂÛË ÛÙÔ ‹·Ú (22).

T·˘Ùfi¯ÚÔÓ·, ÌÂϤÙ˜ ‚Ú·¯‡¯ÚÔÓ˘ ‹ ·ÓÂ·ÚÎÔ‡˜ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ (23) ·¤Ù˘¯·Ó Ó· ‰Â›ÍÔ˘Ó ÔÔÈÔ‰‹ÔÙ ¢ÓÔ˚Îfi ·ÔÙ¤ÏÂÛÌ· Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ˜ ·ÛıÂÓ›˜. AÓÙ›ıÂÙ·, ¤Ú¢ӷ Û ·ÛıÂÓ›˜ Ì ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÓÂ·Ú΋˜ ıÂÚÌȉÈ΋ Î¿Ï˘„Ë Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· Î·È ıÓËÙfiÙËÙ·. ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÔÈ ÂÓÂÚÁÂȷΤ˜ ·Ó¿ÁΘ ÙˆÓ ·ÛıÂÓÒÓ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ Ê¿ÛË Ù˘ ÓfiÛÔ˘. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË, ÛÙËÓ ÔÔ›· Ë Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ ÚÔÔÛ‰ÈÔÚ›ÛıËΠ۠‰È¿ÊÔÚ· ÛÙ¿‰È· ÔÍ›·˜ ÓfiÛÔ˘, Ë ÌÂÙÚËı›۷ ÂÓ¤ÚÁÂÈ· ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙË Ê¿ÛË Ù˘ ÛËÙÈ΋˜ ηٷÏËÍ›·˜, ÂÓÒ ¤Êı·Û ÛÙȘ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ó¿Î·Ì„˘ ·fi ÙË ÛË„·ÈÌ›· (24). ¶ÚfiÛıÂÙ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô ˘ÂÚÌÂÙ·‚ÔÏÈÛÌfi˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ ‰ÂÓ Â›Ó·È ÙfiÛÔ Û˘¯Ófi˜ Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿ (25-26) Î·È ÓÂÔÁÓ¿ (27) fiˆ˜ ›¯Â ÚÔËÁÔ‡ÌÂÓ· ˘ÔÙÂı›. EÔ̤ӈ˜, Ô Î›Ó‰˘ÓÔ˜ ·fi ˘ÂÚÛ›ÙÈÛË Î·È ÌÂÙ·‚ÔÏÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ (28). ŒÙÛÈ, Û‡Ìʈӷ Ì ÙÔ Û¯Â‰È·ÛÌfi ÙÔ˘ ·ÚfiÓÙÔ˜

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ÚˆÙÔÎfiÏÏÔ˘, Ë E°™ ‚Ô‹ıËÛ ӷ Î·Ï˘Êı› Ô ¶BM ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ Î·È Ë ¶KE ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·Ó¿ÚÚˆÛ˘, fiˆ˜ ·˘Ù‹ ÚÔÛ‰ÈÔÚÈ˙fiÙ·Ó ·fi ÙËÓ ÚÔÛ¿ıÂÈ· ·Ô‰¤ÛÌ¢Û˘ ·fi ÙÔÓ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi. H ¿ÌÂÛË ÂÈÙ˘¯›· ‹Ù·Ó 94,4%, ÚԂϤÔÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· ÙËÓ fi„ÈÌË ÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì ·ÛÊ¿ÏÂÈ· (97,1%). AÔÙÂϤÛÌ·Ù· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Á·ÛÙÚÈ΋ Ô‰fi˜ Â›Ó·È Ì›· ÂÊÈÎÙ‹ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÛÙËÓ ·ÚÂÓÙÂÚÈ΋ Î·È ÂÓÙÂÚÈ΋ Û›ÙÈÛË ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‚·ÚÈ¿˜ ÓfiÛÔ˘. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ Â›Ó·È Â˘ÓÔ˚ÎfiÙÂÚ· ·fi ÂΛӷ ÌÂÏÂÙÒÓ Û ME£ ÂÓËÏ›ÎˆÓ fiÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÌfiÓÔ Û 75% ÂÈÙ˘Á¯¿ÓÂÙ·È ÈηÓÔÔÈËÙÈ΋ Û›ÙÈÛË (29). ¶·ÚfiÌÔÈ·, Û ÌÂϤÙË Ì ÚÒÈÌË Û›ÙÈÛË Û ÂÓ‹ÏÈΘ, ÌfiÓÔ ÙÔ 42% ¤Ù˘¯Â ÈηÓÔÔÈËÙÈ΋ Û›ÙÈÛË ÙËÓ 5Ë Ì¤Ú· (30). H ÚÒÈÌË Û›ÙÈÛË fï˜, Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋, ηıÒ˜ ÌÂÈÒÓÂÈ ÙËÓ ˘ÂÚηٷ‚ÔÏÈ΋ ·¿ÓÙËÛË ÛÙÔ stress, Ë ‰Â ¯Ú‹ÛË ÛÈÙÈÛÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Â˘ÓÔ› ȉȷ›ÙÂÚ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ 94% ÙˆÓ ·È‰ÈÒÓ Ì stress ¤Ù˘¯Â Ï‹ÚË Û›ÙÈÛË Ì¤Û· Û 4 Ë̤Ú˜ ÌÂÙ¿ ÙÔ stress. To ‡ÚËÌ· ·˘Ùfi Â›Ó·È ·ÚfiÌÔÈÔ Ì ÙȘ ·Ú·ÙËÚ‹ÛÂȘ Û ÂÓ‹ÏÈΘ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û Ì›˙ÔÓ· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Î·È ÛÈÙ›ÛÙËÎ·Ó ÚÔÁÚ·ÌÌ·ÙÈṲ̂ӷ ÂÓÙÂÚÈο ¤ˆ˜ ÙËÓ 4Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ‰Â›¯ıËΠ̛· ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ·ÔÙ˘¯›·˜ ÛÙËÓ ·ÓÔ¯‹ Ù˘ E°™ Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, fiˆ˜ ÂÎÙÈÌ‹ıËΠ̠ٷ Û˘ÛÙ‹Ì·Ù· PRISM Î·È TISS, Î·È Î˘Ú›ˆ˜ Ì ٷ ÎÏ¿ÛÌ·Ù· ‚Ú¿¯˘ÓÛ˘ Î·È ÂÍÒıËÛ˘ Ù˘ ηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË, Ë ÌÂÙÚËı›۷ ηٷӿψÛË ÂÓ¤ÚÁÂÈ·˜ ‚Ú¤ıËΠÛËÌ·ÓÙÈο ÌÂȈ̤ÓË Û ·ÛıÂÓ›˜ Ì ÛË„·ÈÌ›·, Î·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ Û ·ÛıÂÓ›˜ Ì ÛËÙÈÎfi shock, ÂÓÒ ·ÓÙ›ıÂÙ· Ë Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ ·˘Í‹ıËΠÌfiÓÔ ÌÂÙ¿ ÙËÓ ·Ó¿ÚÚˆÛË ·fi ÙË ÛË„·ÈÌ›·. ŒÙÛÈ, ‰Â›¯ıËΠÌÈ· ·Ó·ÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÛË„·ÈÌ›·˜ Î·È Ù˘ ηٷӿψÛ˘ ÂÓ¤ÚÁÂÈ·˜ (24). ŸÌˆ˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Â›Ó·È Ë ÚÒÙË ÊÔÚ¿ Ô˘ ‰Â›¯ÓÂÙ·È Ì›· ·ÚfiÌÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ÚÒÈÌ˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ÌÂȈ̤Ó˘ ηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙÔ˘˜ ·ÛıÂÓ›˜ ‚·Ú¤ˆ˜ (MEDLINE). H Â·Ú΋˜ ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙË ÛÏ·¯ÓÈ΋ ΢ÎÏÔÊÔÚ›· ‰È·ÛÊ·Ï›˙ÂÙ·È fi¯È ÌfiÓÔ ·fi ÙËÓ ÈηÓÔÔÈËÙÈ΋ Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ·ÏÏ¿ Î·È ·fi ÙËÓ Û˘Ó¯‹ ‰È¤ÁÂÚÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ·fi ÙËÓ E°™. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë E°™ ‰ÈÂÁ›ÚÂÈ ÙËÓ ›‰È· ÙË ıÚÂÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, ·ÔÙÚ¤ÔÓÙ·˜ ηÙ' Â¤ÎÙ·ÛË ÙËÓ ·ÙÚÔÊ›· ÙÔ˘ Î·È Â˘ÓÔÒÓÙ·˜ ÙËÓ ·Ó¿ÎÙËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿˜ ÙÔ˘ (31). B¤‚·È·, Û ηٷÛÙ¿ÛÂȘ ÌÂȈ̤ÓÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡, fiˆ˜ Û ηٷÛÙ¿ÛÂȘ ‚·ÚÈ¿˜ ÛËÙÈ΋˜ ηٷÏËÍ›·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÛËÌ·ÓÙÈο ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙÔ˘ Ì˘Ô-

298

°. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

ηډ›Ô˘, Ë ÛÏ·¯ÓÈ΋ ·ÈÌ¿ÙˆÛË ·Ú·Ì¤ÓÂÈ Û Ôχ ¯·ÌËÏ¿ Â›‰·. K·È ·˘Ùfi ·Ú¿ ÙËÓ ·Ó·ÌÊÈÛ‚‹ÙËÙË ‰È¤ÁÂÚÛË Ù˘ ÂÓÙÂÚÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ̤ۈ Ù˘ Û˘Ó¯ԇ˜ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘. EȂ‚·›ˆÛË Ù˘ ˘fiıÂÛ˘ ·˘Ù‹˜ ·ÔÙÂÏ› ÙÔ Â‡ÚËÌ· fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ Ë ·ÔÙ˘¯›· Ù˘ E°™ ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ ÛÙË ÌË ·ÓÙÈÛÙÚÂÙ‹ ÛËÙÈ΋ ηٷÏËÍ›·. A˘Ùfi Û˘ÌʈÓ› Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÌÂϤÙ˘ Ô˘ ¤ÁÈÓ Û ·È‰È¿ Ì ÛÔ‚·Ú¿ ÂÁη‡Ì·Ù·, ÛÙ· ÔÔ›· Ë ÌË ·ÓÔ¯‹ Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ÂΉ‹ÏˆÛË ÛË„·ÈÌ›·˜ Î·È ·‡ÍËÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ (32).

H ÛÔ‚·Ú‹ ÓfiÛËÛË Û˘Ó‰¤ÂÙ·È Ì ·ÙÚÔÊ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ·˘ÍË̤ÓË ‰È·‚·ÙfiÙËÙ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û ‚·ÎÙËÚ›‰È· Î·È Ì·ÎÚÔÌfiÚÈ· fiˆ˜ ÔÈ ÂÓ‰ÔÙÔ͛Ә (33). H ·ÚÔ˘Û›· ÙÚÔÊ‹˜ ÛÙÔÓ ÂÓÙÂÚÈÎfi ۈϋӷ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÂÚ¤ıÈÛÌ· ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ù˘ ÛÏ·Á¯ÓÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ·›Ì·ÙÔ˜ (34) Î·È Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘. ŒÓ·˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ Û ÂÓ‹ÏÈΘ ‰È·Ù˘ÒÓÂÈ ÙËÓ ˆÊ¤ÏÂÈ· ·fi ÙËÓ ¿ÌÂÛË ÂÓÙÂÚÈ΋ Û›ÙÈÛË Û ‚·ÚÈ¿ ¿Û¯ÔÓÙ˜ ·ÛıÂÓ›˜ (35). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ıÓËÛÈÌfiÙËÙ· ÛÙË ME£ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·fi ÙËÓ ·Ó·ÌÂÓfiÌÂÓË Û ۯ¤ÛË Ì ÙËÓ Îϛ̷η ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛÔ˘ (5.6% vs 12%). H ıÓËÛÈÌfiÙËÙ· Â›Û˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÛÈÙ›ÛıËÎ·Ó ÂÈÙ˘¯Ò˜ Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ·¤Ù˘¯·Ó Ó· ÛÈÙÈÛıÔ‡Ó ¿ÌÂÛ· ‰È·Á·ÛÙÚÈο. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó Ó· ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË ÂÈ‚›ˆÛË Î·È Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË (36).

T· ‚·ÚÈ¿ ¿Û¯ÔÓÙ· ·È‰È¿ Û’ ·˘Ù‹ ÙË ÌÂϤÙË ·Ó¤¯ÙËÎ·Ó Î·Ï¿ ÙËÓ E°™, ηıÒ˜ ÙÔ 86% ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›¯Â ‰˘ÛÎÔÏ›· ÛÙËÓ ÚÔÒıËÛË Ù˘ Û›ÙÈÛ˘. TÔ Â‡Ú‹Ì· ·˘Ùfi Â›Ó·È ·ÚfiÌÔÈÔ Ì ÚÔËÁÔ‡ÌÂÓË ÂÌÂÈÚ›· Ô˘ ›¯Â ‰Â›ÍÂÈ fiÙÈ ÙÔ 80-90% ÙˆÓ ‚·ÚÈ¿ ·Û¯fiÓÙˆÓ ÂÓËÏ›ÎˆÓ ·Ó¤¯ÔÓÙ·È ÙËÓ ÂÓÙÂÚÈ΋ Û›ÙÈÛË ÙȘ ÚÒÙ˜ ̤Ú˜ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ. T· Úfi‰ÚÔÌ· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¤ÁηÈÚË Á·ÛÙÚÈ΋ Û›ÙÈÛË Â›Ó·È ÂÊÈÎÙ‹ Û ‰È¿ÊÔÚ˜ ·ı‹ÛÂȘ fiÔ˘ ··ÈÙÂ›Ù·È Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ‰Â›¯ıËΠÂ›Û˘, fiÙÈ Ë ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË Â›Ó·È ‰˘Ó·Ù‹ ·ÎfiÌË Î·È Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· (37). ™Â ÌÂϤÙ˜ Û ·È‰È¿, ÚfiÛÊ·ÙË ¤Ú¢ӷ ÂȂ‚·›ˆÛ ÙËÓ ·ÛÊ·Ï‹ ¯ÔÚ‹ÁËÛË ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Û ·È‰È¿ Û Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË (38). B¤‚·È·, Ë ÛÔ‚·Ú‹ ÓfiÛËÛË ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ·ÚÓËÙÈο ÙË Á·ÛÙÚÂÓÙÂÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (39). AÓ Î·È ÔÈ ÙÚ¤¯Ô˘Û˜ ·fi„ÂȘ ÁÈ· ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÙÔ˘˜ ˘‡ı˘ÓÔ˘˜ ÁÈ· ÙËÓ Á·ÛÙÚÈ΋ ΤӈÛË Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜, Â›Ó·È Ê·ÓÂÚfi fiÙÈ Ë Á·ÛÙÚÔ¿ÚÂÛË ÍÂÎÈÓ¿ ·fi ¤Ó· Ê¿ÛÌ· ÎÈÓËÙÈÎÒÓ ‰˘ÛÏÂÈÙÔ˘ÚÁÈÒÓ (40).

H ·˘ÍË̤ÓË ÂÓ‰ÔÎÚ¿ÓÈ· ›ÂÛË, ÔÈ Î˘ÙÔΛÓ˜ Ô ·Ú¿ÁˆÓ ·ÂÏ¢ı¤ÚˆÛ˘ Ù˘ ÎÔÚÙÈÎÔÙÚÔ›Ó˘, Ù· ÔÈÔ-

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·299

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301

Âȉ‹ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÛÎÔ‡Ó Î¿ÔÈ· Â›‰Ú·ÛË. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ ·ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó Ó¢ÚÔÌ˘˚ÎÔ‡˜ ·ÔÎÏÂÈÛÙ¤˜ ˘ÔÏ›ÔÓÙ·Ó Ù˘ ÚÔ‚ÏÂfiÌÂÓ˘ £¶ ÏfiÁˆ ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÔÛÔ‡ Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜. T· ÔÈÔÂȉ‹ Ê·›ÓÂÙ·È Â›Û˘ Ó· ·ÛÎÔ‡Ó ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙËÓ Á·ÛÙÚÈ΋ ΤӈÛË. ™Â ¿ÏÏË ÌÂϤÙË, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÈÏÔÎÒÓ ‹Ù·Ó Â›Û˘ ¯·ÌËÏ‹ ÌÂٷ͇ ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ Ì ÂÁη‡Ì·Ù· Ô˘ ÛÈÙ›˙ÔÓÙ·Ó Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· (41). AÚÔÛ‰fiÎËÙ·, ÌÂÁ·Ï‡ÙÂÚË ‹Ù·Ó Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÈÏÔÎÒÓ ÌÂٷ͇ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó Ì ÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ‰È·˘ÏˆÚÈο (42).

KÔÈÏȷ΋ ‰È¿Ù·ÛË, ÌÂÁ¿ÏÔ Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ· (17%), Î·È ‰È¿ÚÚÔÈ· (9,7%) ‹Ù·Ó ÔÈ Î˘ÚÈfiÙÂÚ˜ ÂÈÏÔΤ˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜, Ë ‰È¿ÚÚÔÈ· ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó Ì ÚÔÛˆÚÈÓ‹ ÌfiÓÔ Ì›ˆÛË Ù˘ Û›ÙÈÛ˘, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË ÛÈÛ·Ú›‰Ë˜ ‚ÂÏÙ›ˆÓ ·ÔÙÂÏÂÛÌ·ÙÈο ÙË Á·ÛÙÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ·. H ÛÈÛ·Ú›‰Ë ¤¯ÂÈ ‰Âȯı› fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙËÓ Á·ÛÙÚÈ΋ ΤӈÛË Ú˘ıÌ›˙ÔÓÙ·˜ ÙË Û¯¤ÛË ÌÂٷ͇ ÙˆÓ Û˘Û¿ÛÂˆÓ ÙÔ˘ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ˘ Î·È ÙÔ˘ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, Î·È ·˘Í¿ÓÔÓÙ·˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Û˘ÛÙÔÏÒÓ ÙÔ˘ ¿ÓÙÚÔ˘ (43). EÍ¿ÏÏÔ˘, Ë ÓËÛÙ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰È¿ÚÚÔÈ·˜ ·Ú·Ù›ÓÂÈ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ·˘ÍË̤Ó˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÛÙ· ÌÂÁ¿Ï· ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÌfiÚÈ· ÁÏ˘Îfi˙˘, ÂÓÒ Ë Û˘Ó¤¯ÈÛË Ù˘ ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ¢ÓÔ› ÙË ÁÚËÁÔÚfiÙÂÚË ·Ó¿Ï·ÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ (60). A˘Ù‹ Î·È ¿ÏϘ ÌÂϤÙ˜ ‰›ÓÔ˘Ó ¤ÌÊ·ÛË ÛÙËÓ ÂÍ¿ÚÙËÛË Ù˘ Á·ÛÙÚÂÓÙÂÚÈ΋˜ Ô‰Ô‡ ·fi ÙȘ ÂÓ‰Ô·˘ÏÈΤ˜ ıÚÂÙÈΤ˜ Ô˘Û›Â˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ·Ó·Î·Ù·Û΢‹ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. EÈÚfiÛıÂÙ·, ÔÏÏ·Ϥ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ÂȂ‚·ÈÒÛÂÈ fiÙÈ Ë ¿ÌÂÛË Û›ÙÈÛË, Û ‰È¿ÊÔÚ· ‰È·ÚÚÔ˚ο Û‡Ó‰ÚÔÌ·, Û˘Ó‰¤ÂÙ·È Ì ηχÙÂÚË ¤Î‚·ÛË, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ ÓfiÛÔ˘ (44), Ù˘ ·Ó¿ÎÙËÛ˘ ‚¿ÚÔ˘˜ Î·È ‚ÂÏÙ›ˆÛ˘ Ù˘ ηٿÛÙ·Û˘ ıÚ¤„˘ (45). A˘Ùfi ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ÙȘ ÙÂÏÂ˘Ù·›Â˜ Ô‰ËÁ›Â˜ Ù˘ AÌÂÚÈοÓÈ΢ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ÁÈ· ÙÔ ·È‰› ¯ˆÚ›˜ stress, Ë ÔÔ›· ÂȉÔÎÈÌ¿˙ÂÈ ÙËÓ ¿ÌÂÛË Û›ÙÈÛË Ì ·Ó¿ÏÔÁË ÁÈ· ÙËÓ ËÏÈΛ· ‰È·ÙÚÔÊ‹, ÛËÌÂÈÒÓÔÓÙ·˜ fiÙÈ ·˘Ù‹ Ë Ú·ÎÙÈ΋ ‰ÂÓ ¯ÂÈÚÔÙÂÚ‡ÂÈ ÙË ‰È¿ÚÚÔÈ·, ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙȘ ÎÂÓÒÛÂȘ, Ó· ‚Ú·¯‡ÓÂÈ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙË ıÚ¤„Ë (46). E˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰Â›¯ÓÔ˘Ó Â›Û˘, fiÙÈ Î·È Û ηٿÛÙ·ÛË ‚·ÚÈ¿˜ ÓfiÛÔ˘, ÙÔ ·È‰› Ì ÙË ‰È¿ÚÚÔÈ· ‹ ÙËÓ Î·ı˘ÛÙ¤ÚËÛË Ù˘ Á·ÛÙÚÈ΋˜ ΤӈÛ˘ ı· Ú¤ÂÈ Ó· Û˘Ó¯›˙ÂÈ Ó· ÛÈÙ›˙ÂÙ·È, ·Ó Î·È Û ÌÈÎÚfiÙÂÚÔ Ú˘ıÌfi ·ÚÔ‰Èο.

MfiÓÔ 2 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ·¤Ù˘¯·Ó ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘, Î·È ˘ÔÛÙËÚ›¯ıËÎ·Ó Ì O¶¢. A˘Ùfi ÙÔ ÔÛÔÛÙfi Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ 9,7% ÌÈ·˜ ÌÂϤÙ˘ Ì ÂÓÙÂÚÈ΋ Û›ÙÈÛË, ÛÙËÓ ÔÔ›· Ë ÂÓÙÂÚÈ΋ Û›ÙÈÛË ‰ÈÂÎfiË. ¶ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹ Ù˘

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Û›ÙÈÛ˘ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ‰ÂÓ ÔÊÂÈÏfiÙ·Ó ÛÙË ÌË ·ÓÔ¯‹ Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘, ·ÏÏ¿ ÛÙËÓ ÂÎÏÂÎÙÈ΋ ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹ ÏfiÁˆ ·ÔۈϋӈÛ˘. ¶·ÚfiÏÔ Ô˘ ÙÔ ÚˆÙfiÎÔÏÏÔ Ù˘ E°™ ηıfiÚÈ˙Â Û˘ÁÎÂÎÚÈ̤ÓÔ ıÂÚÌȉÈÎfi ÛÙfi¯Ô, ÔÈ ÒÚ˜ ¯ˆÚ›˜ Û›ÙÈÛË Ù˘ ÚÔÛˆÚÈÓ‹˜ ‰È·ÎÔ‹˜ ‰ÂÓ ·Ó·ÏËÚÒÓÔÓÙ·Ó ¿ÓÙÔÙ (81,8 %). TÔ Â‡ÚËÌ· ·˘Ùfi ÙÔÓ›˙ÂÈ ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ¯Ú‹Û˘ ÂÓfi˜ ηٿÏÏËÏ· ۯ‰ȷṲ̂ÓÔ˘ ÚˆÙÔÎfiÏÏÔ˘, Ì ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔ ÚÔÛˆÈÎfi, ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ¯ÂÈÚÈÛÌÒÓ Î·Ù¿ ÙË Û›ÙÈÛË. M ÂÈÌÔÓ‹ (‰È·ÎÔ‹ Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ ÌfiÓÔ fiÙ·Ó Ë ÔÛfiÙËÙ· ÙÔ˘ ˘ÔÏ›ÌÌ·ÙÔ˜ ÍÂÂÚÓÔ‡Û ÙËÓ Û›ÙÈÛË ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 12ÒÚÔ˘) Î·È ÏÔÁÈ΋ ¯ÔÚ‹ÁËÛË ÚÔÎÈÓËÙÈÎÒÓ Ô˘ÛÈÒÓ, Ë ·Ó·ÏÔÁ›· ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó ÌfiÓÔ ÂÓÙÂÚÈ΋ Û›ÙÈÛË ·˘Í‹ıËΠÛËÌ·ÓÙÈο ·fi 48,5 Û 91% (47). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Û˘Ó¯‹˜ 24-ˆÚË ÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË ·ÔÙÂÏ› ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ̤ıÔ‰Ô ÁÈ· ÙËÓ ÂÈÙ˘¯‹ Î¿Ï˘„Ë ÙˆÓ ıÂÚÌȉÈÎÒÓ ·Ó·ÁÎÒÓ Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘ ıÚÂÙÈ΋˜ ηٿÛÙ·Û˘ ·È‰ÈÒÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘. H ¤ÁηÈÚË ÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË ·ԉ›¯ıËΠÂÊ·ÚÌfiÛÈÌË Û ‰È¿ÊÔÚ˜ ·ı‹ÛÂȘ, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÛË„·ÈÌ›·˜ Î·È Ù˘ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋˜ οΈÛ˘, Î·È Î·Ï¿ ·ÓÂÎÙ‹ ÛÙ· ÂÚÈÛÛfiÙÂÚ· ‚·ÚÈ¿ ¿Û¯ÔÓÙ· ·È‰È¿. H Û˘Û¯¤ÙÈÛË Ù˘ Â›ÌÔÓ˘ ¯·ÌËÏ‹˜ Ì˘Ôηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ (ÌË ·ÓÙÈÚÚÔÔ‡ÌÂÓË Î·Ù·ÏËÍ›·) Ì ÙËÓ ·ÓÂÈÙ˘¯‹ ¤Î‚·ÛË ÂÓfi˜ ÂÈıÂÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘, ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿.

BÈ‚ÏÈÔÁÚ·Ê›· 1. McClave SA, Lowen CC, Snider HL. Immunonutrition and enteral hyperalimentation of critically ill patients. Dig Dis Sci 1992;37:1153-1161.

2. Braga M, Gianotti L, Vignali A, Cestari A, Bisagi P, Carlo VD. Artificial nutrition after major abdominal surgery: Impact of route of administration and composition of the diet. Crit Care Med 1998;26:24-30.

3. Layan AJ, Orlando FG, Day AL, Kilroy RA, James PB, McGuigan JE. The effect of duodenojejunal alimentation on gastric pH and hormones in intensive care unit patients. Chest 1991;99:695.

4. Chiarelli A, Enzi G, Casadei A, Baggio B, Valerio A, Mazzoleni F. Very early nutritional supplementation in burned patients. Am J Clin Nutr 1990;51:1035-1039.

5. Moore MEE, Jones TH. Benefits of immediate jejunostomy feeding after major abdominal trauma. A prospective randomized study. J Trauma 1986;26:874-881.

6. Members of the American College of Chest Physicians / Society of Critical Care Medicine Consensus Conference Committee. American College of Chest Physicians / Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-874.

7. Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of

299

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·300

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

mortality (PRISM) score. Crit Care Med 1988;16:11101116.

Keene AR, Cullen DJ. Therapeutic Intervention Scoring System: Update 1983. Crit Care Med 1983;11:1-3.

Wilkinson JD, Pollack MM, Glass NL, Kanter RK, Katz RW, Steihart CM. Mortality associated with multiple organ system failure and sepsis in pediatric intensive care unit. J Pediatr 1987;111:324-328.

Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Human Nutrition: Clinical Nutrition 1985;39C (I Suppl):S5-S41.

Harris JA, Benedict FG. Biometric studies of basal metabolism in man. Washington, DC: Carnegie Institute.

1919, publication 2793.

Seashore JH. Nutritional support of children in the intensive care unit. Yale J Biol Med 1984;57:111-134.

Subcommittee on the tenth edition of the RDAs, Food and Nutritional Research Council. Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Press;1989: 25-77.

Friscancho AR. Triceps skinfold and upper arm muscle size norms for assessment of nutritional status. Am J Clinic Nutr 1974;27:1052-1058.

Ryan A, Martinez GA. Physical growth of infants 7 to 13 months of age: Results from a national survey. Am J Phys Anthopol 1987;73:449-457.

Waterlow JC. Classification and definition of protein calorie malnutrition. BMJ 1972;3:566.

Briassoulis G, Shekhar Venkataraman S, Thompson A. Energy expenditure in critically ill children. Crit Care Med. 2000 Apr;28(4):1166-1172.

Verhoeven JJ, Hazelzet Verhoeven JJ, Hazelzet JA, van der Voort E, Joosten KF. Comparison of measured and predicted energy expenditure in mechanically ventilated children. Intensive Care Med 1998;24:464-468.

Beaton GH. Nutritional needs during the first year of life: Some concepts and perspectives. Pediatr Clin North Amer 1985:32:275-288.

Talbot FB. Basal metabolism standards for children. Amer J Dis Child 1938;55:455-459.

Weissman C, Kemper M. Assessing hypermetabolism and hypometabolism in the postoperative critically ill patient.

Chest 1992;102:1566-1571.

Bursztein S, Elwyn DH, Askanazi J. Energy metabolism and indirect calorimetry in critically ill and injured patients.

Acute Care 1989;15:91-110. de Ledinghen V, Beau P, Mannant PR, Borderie C, Ripault MP, Silvain C et al. Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study. Dig Dis Sci 1997;42:536-541.

Kreymann G, Grosser S, Buggisch P, Gottschall C, Matthaei S, Greten H. Oxygen consumption and resting metabolic rate in sepsis, sepsis syndrome, and septic shock. Crit Care Med 1993;21:1012-1019.

Winthrop AL, Wesson DE, Penchars PB, Jacobs DG, Tibor H, Filler RM. Injury severity, whole-body protein turnover and energy expenditure in pediatric trauma. J Pediatr Surg 1987;22:534-537.

300

°. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

26. Cebara BM, Gelmini M, Sarnik A. Oxygen consumption, energy expenditure, and substrate utilization after cardiac surgery in children. Crit Care Med 1992;20:1550-1554.

27. Forsyth JS, Crighton A. Low birthweight infants and total parenteral nutrition immediately after birth. I. Energy expenditure and respiratory quotient of ventilated and non-ventilated infants. Arch Dis Child 1995;73:F4-F7.

28. Joosten KF, Verhoeven JJ, Hazelzet JA. Energy expenditure and substrate utilization in mechanically ventilated children. Nutrition 1999;15:444-448.

29. Adam S, Batson S.A study of problems with the delivery of enteral feed in critically ill patients in 5 ICUs in the UK. Intensive Care Med 1997;23:261-266.

30. Heyland DK, Cook DJ, Winder B, Guyatt GH. Do critically ill patients tolerate early intragastric enteral nutrition? Clin Intensive Care 1996;7:68-73.

31. Gianotti L, Alexander JW, Nelson JL, Fukushima R, Pyles T, Chalk CL. Role of early enteral feeding and acute starvation on postburn bacterial translocation and host defense: prospective, randomized trials. Crit Care Med 1994;22:265-272.

32. Wolf SE, Jeschke MG, Rose JK, Desai MH, Herndon DN. Enteral feeding intolerance: an indicator of sepsisassociated mortality in burned children. Arch Surg 1997;132:1310-1314.

33. Alexander JW. Nutrition and translocation. JPEN 1990;14 (suppl):S170-S174.

34. Purcell PN, Danis K, Branson RD, Johnson DJ. Continuous duodenal feeding restores gut blood flow and increases gut blood flow and increases gut oxygen utilization during PEEP ventilation for lung injury. Am J Surg 1993;165:188-194.

35. Kudsk KA, Kudsk MD, Minard G. Enteral versus parenteral nutrition in the critically ill and injured. Curr Opin Crit Care 1995;1:255-260.

36. Moore MEE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma. A prospective, randomised study. J Trauma 1986;26:874-881.

37. Kalfarentzos F, Kehagias J, Mead N, Kokkinis K, Gogos CA. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 1997;84:1665-1669.

38. Pettignano R, Heard M, Davis R, Labuz M, Hart M. Total enteral nutrition versus total parenteral nutrition during pediatric extracorporeal membrane oxygenation. Crit Care Med 1998;26:358-363.

39. Zaloga GP. Bedside method for placing small bowel feeding tubes in critically ill patients. Chest 1991;100:1643-1646.

40. Horowitz M, Fraser RJ. Gastroparesis: diagnosis and management. Scand J Gastroenterol Suppl 1995;213:716.

41. Trocki O, Michelini JA, Robbins ST, Eichelberger MR Evaluation of early enteral feeding in children less than 3 years old with smaller burns (8-25 per cent TBSA). Burns 1995;21(1):17-23.

42. Panadero E, Lopez-Herce J, Caro L, Sac\nchez A, Cueto E, Bustinza A. Transpyloric enteral feeding in critically ill children. J Pediatr Gastroenterol 1998;26:43-48.

JULY-AUG.2000

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43. Fraser RJ, Horowitz M, Maddox AF, Deut J. Postprandial antropyloroduodenal motility and gastric emptying in gastroparesis - effects of cisapride. Gut 1994;35:172-178.

44. Black R, Brown K, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics 1984;73:799-805.

45. Brown KH, Gastanaduy AS, Saavedra JM, Lembcke J, Rivas D, Robertson AD, et al. Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children. J Pediatr 1988;112:191-200.

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46. Duggan C, Nurko S. “Feeding the gut”: The scientific basis for continued enteral nutrition during acute diarrhea.

J Pediatr 1997;131:801-808.

47. Beale RJ, Maynard N, Smithies MN. Changing nutritional therapy in a general ICU. Intensive Care Med 1992;18 (2 suppl):S104.

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¢ÈÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÛÙ· ÓÂÔÁÓ¿: EÎÙ›ÌËÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ AÓ‰Ú¤·˜ E. M·ÚÁÂÙ¿Î˘1, XÚÈÛÙ›Ó· TÚ¿·ÏË1, ¢ËÌ‹ÙÚ˘ °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜1, °ÂˆÚÁ›· °ÚËÁÔÚÈ¿‰Ô˘1, NÈÎÔϤٷ I·Îˆ‚›‰Ô˘2, °ÂÒÚÁÈÔ˜ KÔ˘Ú¿Î˘2, HÚ·ÎÏ‹˜ ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜2 ● ¶ÂÚ›ÏË„Ë: H ‰ÈÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË Î·È ËÏÂÎÙÚÔηډÈÔÁÚ·Ê›· ¤¯ÂÈ ÛÔ˘‰·›· ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ÛËÌ·Û›· ÛÙ· ÓÂÔÁÓ¿. H ÌÂϤÙË ·˘Ù‹ ÂÎÙÈÌ¿ ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ Û 26 ÓÂÔÁÓ¿ ËÏÈΛ·˜ ·fi 2 ̤¯ÚÈ 16 ËÌÂÚÒÓ, ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· (15 ÓÂÔÁÓ¿) ‹ Ê˘ÛÈÔÏÔÁÈ΋ ηډȿ (11 ÓÂÔÁÓ¿) Î·È ·ÚÚ˘ı̛˜. XÚËÛÈÌÔÔÈ‹ıËΠ‰ÈÔÏÈÎfi ÔÈÛÔÊ¿ÁÂÈÔ ËÏÂÎÙÚfi‰ÈÔ 6 Fr Ì ‰È·ÔÏÈÎfi ‰È¿ÛÙËÌ· 20 mm Î·È Ë ‰È¤ÁÂÚÛË ¤ÁÈÓ ηٿ ÙË ‰È¿ÚÎÂÈ· ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ Ì ÚÔÁÚ·ÌÌ·ÙÈ˙fiÌÂÓÔ ‰ÈÂÁ¤ÚÙË, Ì ‰È¿ÚÎÂÈ· ÂÚÂı›ÛÌ·ÙÔ˜ 10 msec Î·È Ì ‰˘Ó·ÙfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÛÙ·ıÂÚÔ‡, ÙÂÙÚ¿ÁˆÓÔ˘ Ú‡̷ÙÔ˜ Ì ¤ÓÙ·ÛË ·fi 020 mA. O ̤ÛÔ˜ ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ ‹Ù·Ó 8,39 mA (‰È·Î‡Ì·ÓÛË 7-10 mA), ÙÔ Ì¤ÛÔ ‡„Ô˜ ÙÔ˘ ‰ÈÔÏÈÎÔ‡ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ‹Ù·Ó 0,57 mV (‰È·Î‡Ì·ÓÛË 0,45-0,65 mV). TÔ Ì¤ÛÔ ‚¿ıÔ˜ ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ‹Ù·Ó 12,93 cm (‰È·Î‡Ì·ÓÛË 11-14,5 cm), Ô ÂÏ¿¯ÈÛÙÔ˜ Ô˘‰fi˜ ·ÓȯÓ¢fiÙ·Ó 0,5 cm Âη٤ڈıÂÓ ÙÔ˘ ̤ÛÔ˘ ‚¿ıÔ˘˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· (ÚÈÓÔÁ·ÛÙÚÈο) Î·È Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ (r=0,59). TÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ËÏÂÎÙÚfiÁÚ·ÌÌ· ›¯Â Ôχ ÈÛ¯˘Ú‹ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔ Ô˘‰fi (r=-0,95) ÛÙË ı¤ÛË ·Ó›¯Ó¢Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡. ¢ÂÓ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ Û η̛· ·Ú¿ÌÂÙÚÔ ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ Î·È ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·. ™Ù· ÓÂÔÁÓ¿, Ô ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ‚¿ıÔ˘˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ηıÂÙ‹Ú· Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ı¤Û˘ Ô˘ ηٷÁÚ¿ÊÂÙ·È ÙÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ËÏÂÎÙÚfiÁÚ·ÌÌ· Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ˜ ·fi ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ì ‚¿ÛË ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈ΋ 2000;63:302-308. §¤ÍÂȘ ÎÏÂȉȿ: ‰ÈÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË, ÓÂÔÁÓfi, ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜.

A. Margetakis, C. Trapali, D. Georgakopoulos, G. Grigoriadou, N. Iakovidou, G. Kourakis, H. Dellagrammaticas. Transoesophageal pacing in neonates: Estimation of the appropriate site of minimum pacing threshold. Paediatriki 2000;63:302-308. ● Abstract: Transoesophageal pacing and electrocardiography have important diagnostic and therapeutic uses in the neonate. This study evaluated the depth of esophageal insertion in minimizing transoesophageal atrial pacing threshold in 26 neonates aged 2 to 16 days with congenital heart disease (15) or normal heart (11) and arrhythmias. A 6 Fr oesophageal electrode with interelectrode spacing of 20 mm was used. Stimulation was performed during sinus rhythm with a programmable stimulator capable of delivering a constant-current, square-wave of 0-20 mA, with pulse width of 10 msec. The average minimal pacing threshold was 8.39 mA (range 7 to 10). The average maximum bipolar atrial electrogram amplitude was 0.57 mA (range 0.45 to 0.65).

The average depth of catheter insertion in the site of minimal pacing threshold was 12.93 cm (range 11 to 14.5), it occurred within 0.5 cm bilaterally, and was correlated with patient height (r=0.59). The maximum bipolar atrial electrogram was highly negatively correlated with the minimum pacing threshold (r=-0.95) in the site of minimal threshold. There was no difference between neonates with and without congenital heart disease. In neonates, the estimation of catheter insertion depth using the maximum atrial electrogram amplitude is preferable to that for using the patient's height, and is critical for minimizing pacing threshold.

Key words: transoesophageal atrial pacing, neonate, threshold.

NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ AıËÓÒÓ "¶.& A. K˘ÚÈ·ÎÔ‡" 1 K·Ú‰ÈÔÏÔÁÈÎfi TÌ‹Ì· 2 ME£ ÓÂÔÁÓÒÓ

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EÈÛ·ÁˆÁ‹ T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Á›ÓÔÓÙ·È ÚÔÛ¿ıÂȘ ÁÈ· Ó· ÙÂÎÌËÚȈıÔ‡Ó ÔÈ ÂȉÈΤ˜ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈΤ˜ ‰È·ÁÓÒÛÂȘ Û ÓÂÔÁÓ¿ Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡. TÔ ¤Ó·˘ÛÌ·, ηٿ ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜, ÔÊ›ÏÂÙ·È ÛÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ηٷÓfiËÛ˘ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ú˘ıÌÔ‡ Î·È ÛÙË ‰È¿ıÂÛË ÏËıÒÚ·˜ Ê·Ú̿ΈÓ, ‚ËÌ·ÙÔ‰ÔÙÒÓ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Ù¯ÓÈÎÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘˜. A˘Ù¤˜ ÔÈ ıÂÚ·¢ÙÈΤ˜ Î·È ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜ ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó Â‡ÎÔÏ· Î·È Â·ÚÎÒ˜ Û ÓÂÔÁÓ¿ Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡, fiÙ·Ó ‰Ôı› ÚÔÛÔ¯‹ Û ÌÂÚÈΤ˜ ÏÂÙÔ̤ÚÂȘ.

H ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ·ÔÙÂÏ› Ì›· ·fi ÙȘ ·ÚȘ Û˘ÓÈÛÙÒÛ˜ ÂÈÙ˘¯Ô‡˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘, ·ÊÔ‡ Ì ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ·ÊÂÓfi˜, Î·È ·ÊÂÙ¤ÚÔ˘ Ó· ·ÔÊ¢¯ı› ÙÔ ·›ÛıËÌ· η‡ÛÔ˘ ‹ ÂÏ·ÊÚÔ‡ fiÓÔ˘ Ô˘ ÚÔηÏ›ٷÈ, fiÙ·Ó Ë ¤ÓÙ·ÛË ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ú‡̷ÙÔ˜ ÍÂÂÚ¿ÛÂÈ Ù· 15 mA(1). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‰ÈÔÈÛÔÊ¿ÁÂÈÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ÛÙ· ÓÂÔÁÓ¿ Î·È Ë Û¯¤ÛË ÙÔ˘ Ì‹ÎÔ˘˜ ÛÒÌ·ÙÔ˜ ÚÔ˜ ÙÔ ‚¿ıÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ ËÏÂÎÙÚÔ‰›Ô˘. ¶·ÚfiÌÔÈ· ÌÂϤÙË ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛÈ¢Ù› ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, ÂÓÒ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ·' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ›ÛÙÔÈ¯Ë ÌÂϤÙË Ô˘ Ó· ·Ó·Ê¤ÚÂÙ·È ·ÔÎÏÂÈÛÙÈο Û ÓÂÔÁÓ¿.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ TÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 26 ÓÂÔÁÓ¿ (12 ¿ÚÚÂÓ·, 14 ı‹Ï·), ËÏÈΛ·˜ ·ËÛ˘ 32-41 ‚‰ÔÌ¿‰ˆÓ (38±1,42), ËÏÈΛ·˜ 2-16 ËÌÂÚÒÓ (6,96±4,27 ËÌ), ‚¿ÚÔ˘˜ 1750-4200 g (2858±754 g) Î·È Ì‹ÎÔ˘˜ 37-50 cm (43,04±4,08), ÛÙ· Ï·›ÛÈ· Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ‰È¿ÊÔÚˆÓ ·ÚÚ˘ıÌÈÒÓ ÙÔ˘˜ Ì ‰ÈÔÈÛÔÊ¿ÁÂÈ· ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈ΋ ÌÂϤÙË. ¢Âη¤ÓÙ ·fi Ù· ÓÂÔÁÓ¿ ·˘Ù¿ ›¯·Ó Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È 11 ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ ηډȿ.

OÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜

BËÌ·ÙÔ‰fiÙ˘/Stimulator ™Â fiϘ ÙȘ ÌÂϤÙ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠÔÏ˘ÚÔÁÚ·ÌÌ·ÙÈ˙fiÌÂÓÔ˜ ‰ÈÂÁ¤ÚÙ˘ (FIAB programmable stimulator model 8817). H ‰ÈÔÈÛÔÊ¿ÁÂÈ· ‰È¤ÁÂÚÛË ÁÈÓfiÙ·Ó Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÛÙ·ıÂÚÔ‡ Î·È ÙÂÙÚ¿ÁˆÓ˘ ÌÔÚÊ‹˜ Ú‡̷ÙÔ˜, ‰È¿ÚÎÂÈ·˜ 10 msec (Pulse width).

T¯ÓÈ΋ ÔÈÛÔÊ¿ÁÂÈ·˜ ηٷÁÚ·Ê‹˜ Î·È ‰È¤ÁÂÚÛ˘: ™Â fiϘ ÙȘ ÌÂϤÙ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠ¢ΛÓËÙÔ, Ì·Ï·Îfi Î·È ·ÚÈıÌË̤ÓÔ ‰ÈÔÏÈÎfi ‚ËÌ·ÙÔ‰ÔÙÈÎfi ËÏÂÎÙÚfi‰ÈÔ ÛÈÏÈÎfiÓ˘ 6 Fr (FIAB mod. 25125E ESOKID 2) Ì ‰È·ÔÏÈÎfi ‰È¿ÛÙËÌ· 20 mm. TÔ ËÏÂÎÙÚfi‰ÈÔ ÂÈÛ‹¯ıË ·fi ÙÔ ÚÒıˆÓ· ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ Ô˘ ÂÈÛ¿ÁÂÙ·È ¤Ó·˜ ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ Ì ·Ú¯ÈÎfi ‚¿ıÔ˜ Ù· 16 ÂηÙÔÛÙ¿. H ·fiÛÙ·ÛË ·˘Ù‹ ÛËÌÂÈÒıËΠ¿Óˆ ÛÙÔ ËÏÂÎÙÚfi‰ÈÔ Î·È ·ÓÙÈÛÙÔȯԇÛ ÛÙËÓ ·fiÛÙ·ÛË ÚÒıˆÓ·˜-¿ˆ ¿ÎÚÔ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ (distal). ™ÙË ı¤ÛË ·˘Ù‹ ηٷÁÚ¿ÊÔÓÙ·Ó Î·È ÊÈÏÙÚ¿ÚÔÓÙ·Ó ÛÙ· 40 Hz Ù· ‰ÈÔÏÈο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù·.

MÂÙÚÔ‡Û·Ì ÙÔ peak-to-peak ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ ÚÔÂÚ¯fiÙ·Ó ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÊÏ‚ÔÎÔÌ‚È΋ ÂÓÂÚÁÔÔ›ËÛË (EÈÎfiÓ· 1). ™ÙË ı¤ÛË ·˘Ù‹ ¯ÔÚËÁÔ‡Û·Ì ̛· ÛÂÈÚ¿ ÂÚÂıÈÛÌ¿ÙˆÓ Ì ̋ÎÔ˜ ·ÎÏÔ˘ 80% ·˘ÙÔ‡ ÙÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡, ·Ú¯›˙ÔÓÙ·˜ ·fi Ù· 16 mA Î·È ÌÂÈÒÓÔÓÙ·˜ Û˘Ó¯Ҙ ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ Ú‡̷ÙÔ˜ (amplitude) ηٿ 1 mA ̤¯ÚȘ fiÙÔ˘ Ó· ÌË "Û˘ÏÏ·Ì‚¿ÓÂÙ·È" Ô ÎfiÏÔ˜ (EÈÎfiÓ· 1). H ÂÏ¿¯ÈÛÙË ··ÈÙÔ‡ÌÂÓË ¤ÓÙ·ÛË Ë ÔÔ›· ‰È¤ÁÂÈÚ ÙÔÓ ÎfiÏÔ ÔÚ›ÛÙËÎÂ Û·Ó "Ô ÙÔÈÎfi˜ ‰ÈÔÈÛÔÊ¿ÁÂÈÔ˜ Ô˘‰fi˜". K¿ı ‚ËÌ·ÙÔ‰ÔÙÈ΋ ÚÔÛ¿ıÂÈ· ηٷÁÚ·ÊfiÙ·Ó ÛÙÔÓ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊÔ.

AÓ·ÈÛıËÛ›·-ηٷÛÙÔÏ‹ H ÌÂϤÙË Û fiÏ· Ù· ÓÂÔÁÓ¿ ¤ÁÈÓ ÛÙËÓ ÎÏ›ÓË ÙÔ˘˜. ™Â ηӤӷ ‰ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·Ó·ÈÛıËÛ›·. ™Â ‰‡Ô ÏfiÁˆ ¤ÓÙÔÓ˘ ·ÓËÛ˘¯›·˜ ¯ÔÚËÁ‹ıËΠ¯ÏˆÚ¿ÏË (50 mg /Kg POs).

HÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ηٷÁڷʤ˜ XÚËÛÈÌÔÔÈ‹ıËΠÎÔÈÓfi˜ ÙÚÈηӷÏÈÎfi˜ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊÔ˜ (Mac PC Marquet) ÁÈ· ÙËÓ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙˆÓ V1, V2 ‹ D2, Ì ʛÏÙÚÔ ÛÙ· 40 Hz. H ηٷÁÚ·Ê‹ ÁÈÓfiÙ·Ó Ì ٷ¯‡ÙËÙ· ¯·ÚÙÈÔ‡ 25 Î·È 50 mm/sec Î·È Â˘·ÈÛıËÛ›· 20mm/mV.

EÈÎfiÓ· 1: (A) ‚ËÌ·ÙÔ‰fiÙËÛË (s) ·Ú¯Èο Ì ¤ÓÙ·ÛË 8 mA ÛÙËÓ ÔÔ›· ·Ú·ÙËÚÂ›Ù·È "Û‡ÏÏË„Ë" ÙÔ˘ ÎfiÏÔ˘ ·ÏÏ¿ Ë ‚ËÌ·ÙÔ‰fiÙËÛË Ì 7mA ·ÔÙ˘Á¯¿ÓÂÈ Ó· Û˘ÏÏ¿‚ÂÈ ÙÔÓ ÎfiÏÔ. K·Ù¿ Û˘Ó¤ÂÈ· Ô ÂÏ¿¯ÈÛÙÔ˜ Ô˘‰fi˜ Â›Ó·È 8 mA. (B) ÔÈÛÔÊ¿ÁÂÈÔ HK° ÛÙÔ ÔÔ›Ô ÌÂÙÚ¿Ù·È ÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308

A. M·ÚÁÂÙ¿Î˘ Î·È Û˘Ó.

™ÙË Û˘Ó¤¯ÂÈ· ÌÂÙ·ÎÈÓÔ‡Û·Ì ÙÔÓ Î·ıÂÙ‹Ú· Ì ¤ÏÍË (Û·Ó "„¿ÚÂÌ·") ηٿ 0,5 cm Î·È Â·Ó·Ï·Ì‚¿Ó·Ì ÙȘ ηٷÁڷʤ˜, ÙȘ ÌÂÙÚ‹ÛÂȘ Î·È ÙȘ ‚ËÌ·ÙÔ‰ÔÙ‹ÛÂȘ ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ, fiˆ˜ ·Ú¯Èο ·Ó·Ê¤ÚıËÎÂ, ÁÈ· οı Ӥ· ı¤ÛË Î·È Ë ÌÂϤÙË ÙÂÚÌ·ÙÈ˙fiÙ·Ó ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ ÛÙÔ ‚¿ıÔ˜ ÙˆÓ 9 ÂηÙÔÛÙÒÓ. ™Â ÂÚ›ÙˆÛË Ô˘ ··ÈÙ›ÙÔ ¤ÓÙ·ÛË Ú‡̷ÙÔ˜ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 16 mA, ıˆڋıËΠfiÙÈ Ô Ô˘‰fi˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙˆÓ 16 mA. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ·) XÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÁÚ·ÌÌÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (linear regression), ÁÈ· Ó· ÂÎÙÈÌËı› 1) Ë Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ Ì‹ÎÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ ‰È¤ÁÂÚÛ˘ Î·È 2) Ë Û¯¤ÛË ÌÂٷ͇ ÙˆÓ Ì¤ÛˆÓ ÙÔÈÎÒÓ ‚ËÌ·ÙÔ‰ÔÙÈÎÒÓ Ô˘‰ÒÓ Ì ÙÔ Ì¤ÛÔ ÂÏ¿¯ÈÛÙÔ ÙÔÈÎfi voltage. ‚) XÚËÛÈÌÔÔÈ‹ıËÎÂ Ô Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ (correlation coefficients) ÁÈ· Ó· ÂÎÙÈÌËı› Ë Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ Ì‹ÎÔ˘˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ ¤Ó·ÓÙÈ

ÙÔ˘ ̤ÁÈÛÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡. Á) XÚËÛÈÌÔÔÈ‹ıËΠÙÔ Student t-test ÁÈ· Ó· ÂÏÂÁ¯ı› Â¿Ó ÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ Î·È Ô ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜, ‰È·Ê¤ÚÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙË ı¤ÛË (‚¿ıÔ˜ ÙÔÔı¤ÙËÛ˘) ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ .

AÔÙÂϤÛÌ·Ù· T· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›·, ÙÔ ‚¿ıÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔ‰›Ô˘, Ô ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ Î·È ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. ¶·ÚÔ˘Û›· ‹ fi¯È ·Ó·ÙÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜ Ù˘ ηډȿ˜ H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË (Student t-test) ‰ÂÓ ¤‰ÂÈÍ η̛· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ Ì‹ÎÔ˜, ÛÙÔ ‚¿ÚÔ˜, ÛÙÔ ‚¿ıÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡, ÛÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔ-

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈο ÛÙÔȯ›·, ‚¿ıÔ˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ηıÂÙ‹Ú· ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ (mA), Î·È ÙÔ˘ ̤ÁÈÛÙÔ˘ ÎÔÏÈÎÔ‡ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ (‡„Ô˜ A) NÂÔÁÓfi

HÏÈΛ· (Ë̤Ú˜)

µ¿ÚÔ˜ (g )

M‹ÎÔ˜ (cm)

B·ı-K·ı

O˘‰fi˜ (mA)

⁄„Ô˜ A (mV)

1 2 3 4 5

2 5 10 8 3

2350 3000 3100 2200 2150

42 48 46 39 39

13 14 14 11 12

7 8 8 7 9

0,55 0,6 0,6 0,5 0,55

6 7 8 9 10

4 2 16 11 14

4150 3000 2860 3200 2680

46 45 41 46 41

14 13 12,5 13,5 14

10 7 8 8 10

0,6 0,6 0,6 0,5 0,6

11 12 13 14 15

5 9 3 5 7

3010 2800 2700 1900 4200

44 39 39 39 48

14,5 12,5 13 13,5 14

10 9 10 9 7

0,5 0,6 0,6 0,65 0,6

16 17 18 19 20

2 6 8 10 4

2680 4100 2200 3100 1800

44 50 43 43 37

13 13,5 12 13 11,5

8 8 9 8 8

0,6 0,55 0,6 0,6 0,6

21 22 23 24 25 26

3 5 4 9 15 7

2000 1750 3400 2650 4100 3000

37 38 46 42 49 47

12 11,5 13 12,5 12 14

9 10 8 7 8 8

0,5 0,45 0,5 0,5 0,6 0,6

Min Max Mean SD Median

2 16 6,96 4,27 5,5

1750 4200 2858,21 754,90 2829,107

37 50 43,04 4,08 43

11 14,5 12,93 1,01 13

7 10 8,39 1,05 8

0,45 0,65 0,57 0,06 0,6

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308

OÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜

Ê¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÛÙÔÓ ÂÏ¿¯ÈÛÙÔ Ô˘‰fi, ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È ÂÎÂ›ÓˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ηډȿ (p>0,05).

B¿ıÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ηıÂÙ‹Ú· ™Â οı ·ÛıÂÓ‹ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ÙÔÈÎÔ› ÂÏ¿¯ÈÛÙÔÈ Ô˘‰Ô› Î·È ÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· οı ı¤ÛË ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘. ™Â ¤Ó· ·ÛıÂÓ‹ Ù˘ ÌÂϤÙ˘ Ì·˜ (ÓÂÔÁÓfi 16), Ì ÙË ‚ËÌ·ÙÔ‰fiÙËÛË ÚÔÎÏ‹ıËΠۇÛ·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ·, Èı·ÓÒ˜ ÏfiÁˆ ‰È¤ÁÂÚÛ˘ ÙÔ˘ ‚Ú·¯ÈÔÓ›Ô˘ ϤÁÌ·ÙÔ˜, Û ¤Ó· ¿ÏÏÔ ÚÔÎÏ‹ıËΠ(ÓÂÔÁÓfi 14) Û‡Û·ÛË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™ÙÔ ›‰ÈÔ ÓÂÔÁÓfi ÚÔÎÏ‹ıËΠÎÔÈÏȷ΋ ‰È¤ÁÂÚÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‚ËÌ·ÙÔ‰fiÙËÛ˘ Ì ÌÔÓ‹ÚË ÚÒÈÌË ‚ËÌ·ÙÔ‰ÔÙÈ΋ Û˘ÛÙÔÏ‹ (EÈÎfiÓ· 2).

TÔ Ì¤ÛÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ Î˘Ì¿ÓıËΠ·fi 0,45 mV ̤¯ÚÈ 0,65 mV (Mean ±SD: 0,57±0,06 mV), ÂÓÒ Ô Ì¤ÛÔ˜ ÂÏ¿¯ÈÛÙÔ˜ Ô˘‰fi˜ Î˘Ì¿ÓıËΠÌÂٷ͇ 7 mA Î·È 10 mA (Mean ±SD: 8,39±1,05 mA). ¢È·ÈÛÙÒıËΠıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ۈ̷ÙÈÎÔ‡ Ì‹ÎÔ˘˜ -‚¿ÚÔ˘˜ Î·È ‚¿ıÔ˘˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ηıÂÙ‹Ú· (r=0,59 p=0,0006 (EÈÎfiÓ· 3) Î·È r=0,84 p=0,004 ·ÓÙ›ÛÙÔȯ·) ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ۈ̷ÙÈÎÔ‡ Ì‹ÎÔ˘˜-‚¿ÚÔ˘˜ Î·È ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ ‚ËÌ·ÙÔ‰fiÙËÛ˘ (r=0,33 p=0,099 Î·È r=0,17 p=0,386 ·ÓÙ›ÛÙÔȯ·).

H Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ ̤ÁÈÛÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡, ·Ó¿ÏÔÁ· ÚÔ˜ ÙË ı¤ÛË ÙÔ˘ ηıÂÙ‹Ú· ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÌÂϤÙ˘ Ì·˜, Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ· 4. ™ÙËÓ ÂÈÎfiÓ· 5 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Û¯¤ÛË ·˘Ù‹ ÁÈ· ÙÔ ÓÂÔÁÓfi 8, Ù· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›· ÙÔ˘ ÔÔ›Ô˘ ÚÔÛÂÁÁ›˙Ô˘Ó ÙÔÓ Ì¤ÛÔ fiÚÔ. Y‹Ú¯Â Ì›· ÈÛ¯˘Ú‹ ·ÌÔÈ‚·›· Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ ̤ÁÈÛÙÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ÛÙȘ ‰È¿ÊÔÚ˜ ı¤ÛÂȘ ÂϤÁ¯Ô˘ ÁÈ· οı ·ÛıÂÓ‹, ¤ÙÛÈ ÒÛÙ fiÙ·Ó ÙÔ ÎÔÏÈÎfi ¤·ÚÌ· ÌÂÁ¿ÏˆÓÂ, Ô ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ ÂÏ·ÙÙˆÓfiÙ·Ó.

EÈÎfiÓ· 2. ¢È¤ÁÂÚÛË Ù˘ ÎÔÈÏ›·˜ Ì ÌÔÓ‹ÚË ‰ÈÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰ÔÙÈ΋ Û˘ÛÙÔÏ‹.

∂ÈÎfiÓ· 3. B¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ Û ۯ¤ÛË Ì ÙÔ Ì‹ÎÔ˜ ÙˆÓ ÓÂÔÁÓÒÓ. H ÁÚ·ÌÌ‹ ·˘Ù‹ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙËÓ Â͛ۈÛË ÁÚ·ÌÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (linear regression) y=11,17+2,45x, fiÔ˘ y=ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È x=ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ÌÂÙÚË̤ÓÔ ·fi ÙÔ ÚÒıˆÓ·.

∂ÈÎfiÓ· 4. O ̤ÛÔ˜ ÙÔÈÎfi˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ (·ÎÏÔÈ) Î·È ÙÔ Ì¤ÛÔ Ì¤ÁÈÛÙÔ ÔÈÛÔÊ¿ÁÂÈÔ ÎÔÏÈÎfi ¤·ÚÌ· (ÙÚ›ÁˆÓ·) Û ۯ¤ÛË Ì ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜. H ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ۯ‰fiÓ Û˘Ì›ÙÂÈ Ì ÙË ı¤ÛË ÙÔ˘ ̤ÁÈÛÙÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜.

∂ÈÎfiÓ· 5. O ÙÔÈÎfi˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ (·ÎÏÔÈ) Î·È ÙÔ Ì¤ÁÈÛÙÔ ÔÈÛÔÊ¿ÁÂÈÔ ÎÔÏÈÎfi ¤·ÚÌ· (ÙÚ›ÁˆÓ·) Û ۯ¤ÛË Ì ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· Û ÓÂÔÁÓfi 16-ËÌÂÚÒÓ (No 8 Ù˘ ÌÂϤÙ˘ Ì·˜). H ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ۯ‰fiÓ Û˘Ì›ÙÂÈ Ì ÙË ı¤ÛË ÙÔ˘ ̤ÁÈÛÙÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜.

305

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308

™˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜, ˘‹Ú¯Â ۯ‰fiÓ ·fiÏ˘ÙË ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË (linear regression) (r=-0,95065 p=0,000) ÙÔ˘ ̤ÁÈÛÙÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔ ‚ËÌ·ÙÔ‰ÔÙÈÎfi Ô˘‰fi ÛÙȘ ı¤ÛÂȘ ·fi 11 ¤ˆ˜ 15 ÂηÙÔÛÙ¿.

K·Ù¿ ̤ÛÔÓ fiÚÔ, Ë ı¤ÛË ÛÙËÓ ÔÔ›· ηٷÁÚ·ÊfiÙ·Ó ÙÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ¤·ÚÌ· (mean 0,57±0,06 mV) ·›¯Â 0,5 cm Âη٤ڈıÂÓ ÙÔ˘ ̤ÛÔ˘ ‚¿ıÔ˘˜ (12,94±0,94 cm) ÛÙÔ ÔÔ›Ô ‰È·ÈÛÙˆÓfiÙ·Ó Ô ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ (8,38±1,02 mA). ŸÙ·Ó Ë Û˘Û¯¤ÙÈÛË Ô˘‰Ô‡/ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ ¤ÁÈÓ ÛÙȘ ‰‡Ô ÈÔ ÂӉȷʤÚÔ˘Û˜ ˘ÔÔÌ¿‰Â˜ ‚¿ıÔ˘˜ ÙÔ˘ ηıÂÙ‹Ú· (11-13cm Î·È 13-15cm), ‰È·ÈÛÙÒıËΠfiÙÈ Ë Û˘Û¯¤ÙÈÛË ÛÙËÓ ÚÒÙË ÔÌ¿‰· ‹Ù·Ó Û¯ÂÙÈο ÌÈÎÚfiÙÂÚË (r=-0,93189 p=0,000) Û˘ÁÎÚÈÙÈο Ì ÙËÓ ‰Â‡ÙÂÚË (r=-0,99624 p=0,000).

H Û‡ÁÎÚÈÛË ÙÔ˘ ÙÔÈÎÔ‡ ‡„Ô˘˜ ÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿Ì·ÙÔ˜ Ì ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ (Student t-test) ¤‰ÂÈÍ fiÙÈ: ·) ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÌÂٷ͇ 12,5 cm Î·È 13 cm ‚¿ıÔ˘˜ (t-value=-1,48 p=0,153), 13cm Î·È 13,5 cm (t-value=1,36 p=0,185), Î·È 12,5 cm Î·È 13,5 cm (t-value=-0,09 p=0,927). ‚) Y‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û fiϘ ÙȘ ˘fiÏÔÈ˜ ı¤ÛÂȘ ÂϤÁ¯Ô˘ (p<0,01). Á) ¢ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· Û˘ÌÌÂÙÚÈο, ˆ˜ ÚÔ˜ ÙÔ Ì¤ÛÔ ‚¿ıÔ˜ (13 cm), ˙‡ÁË ÂϤÁ¯Ô˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: Z‡ÁÔ˜ 12-14 cm (t-value=0,05 p=0,957) 11,5-14,5 cm (t-value=1,14 p=0,264) 11-15 cm (t-value=2,17 p=0,04) H Û‡ÁÎÚÈÛË ÙˆÓ ÙÔÈÎÒÓ Ô˘‰ÒÓ Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔ Ô˘‰fi (Student t-test) ¤‰ÂÈÍ fiÙÈ: ·) ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÌÂٷ͇ 12,5 cm Î·È 13 cm ‚¿ıÔ˘˜ (t-value=-1,94 p=0,064), 13 cm Î·È 13,5 cm (t-value=-0,8 p=0,430), Î·È 12,5 cm Î·È 13,5 cm (t-value=0,62 p=0,538). EÔ̤ӈ˜, ÙÔ "·Ú¿ı˘ÚÔ" ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ Â›Ó·È 1 ÂηÙÔÛÙfi. ‚) Y‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û fiϘ ÙȘ ˘fiÏÔÈ˜ ı¤ÛÂȘ ÂϤÁ¯Ô˘ (p<0,05) Á) ¢ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· Û˘ÌÌÂÙÚÈο, ˆ˜ ÚÔ˜ ÙÔ Ì¤ÛÔ ‚¿ıÔ˜ (13 cm), ˙‡ÁË ÂϤÁ¯Ô˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: Z‡ÁÔ˜ 12-14 cm (t-value=0,04 p=0,970) 11,5-14,5 cm (t-value=0 p=1,000) 11-15 cm (t-value=-0,44 p=0,662) ™˘˙‹ÙËÛË Œ¯ÂÈ ˘¿ÚÍÂÈ ·fi Ôχ ·Ï·È¿ ÌÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ÁÈ· ÙÔÓ ÔÈÛÔÊ¿ÁÔ Û·Ó Ì›· Â͈ηډȷ΋ ı¤ÛË Î·Ù·ÁÚ·Ê‹˜ ÙÔ˘ HK°, ·ÏÏ¿ Ë ‚ËÌ·ÙÔ‰fiÙËÛË Ù˘ ηډȿ˜ ·fi ÙË ı¤ÛË ·˘Ù‹ ¤¯ÂÈ ·ÔÎÙ‹ÛÂÈ ÂӉȷʤÚÔÓ

306

A. M·ÚÁÂÙ¿Î˘ Î·È Û˘Ó.

ÌfiÓÔ Î·Ù¿ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·ÊÔ‡ ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ Î·È ıÂÚ·¢ÙÈΤ˜ ¯Ú‹ÛÂȘ Ù˘ ηډȷ΋˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘ ¤¯Ô˘Ó ·˘ÍËı› ÛËÌ·ÓÙÈο (2-8).

H ÎÏÈÓÈ΋ ¤Ú¢ӷ Î·È ·Ô‰Ô¯‹ Ù˘ ÔÈÛÔÊ¿ÁÂÈ·˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘ ‹Ù·Ó ‚Ú·‰Â›· ÂÍ·ÈÙ›·˜ Ù˘ ÂÚÈÔÚÈṲ̂Ó˘ ·Ô‰Ô¯‹˜ ÙˆÓ ·Ú¯ÈÎÒÓ ÌÂÏÂÙÒÓ. O Benson (9) ÙÔÓ›˙ÂÈ fiÙÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ÎÚ›ÛÈÌÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË. T· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ô˘‰Ô‡ ‰È¤ÁÂÚÛ˘ ·Ó·Ï‡ÔÓÙ·È Ì ÙËÓ Î·Ì‡ÏË ¤ÓÙ·Û˘-‰È¿ÚÎÂÈ·˜ (strength-duration curve).

H ÌÔÚÊ‹ Ù˘ ηÌ‡Ï˘ ¤¯ÂÈ ÌÂÏÂÙËı› Û ‚·ÛÈÎfi Â›Â‰Ô Î·È ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÌÈ· ÁÚ·ÌÌÈ΋ ÌÂÌ‚Ú¿ÓË Û ¤Ó·Ó ÈÛÙfi Ì ·Ï‹ ÁˆÌÂÙÚ›·, ··ÈÙÂ›Ù·È Ì›· ÛÙ·ıÂÚ‹ ÌÂÙ·‚ÔÏ‹ Û ¤Ó· ÛÙ·ıÂÚfi ÛËÌÂ›Ô Ù˘ ÌÂÌ‚Ú¿Ó˘ ÒÛÙ ӷ Á›ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‰È¤ÁÂÚÛË. M ÙËÓ ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË ÂÊ·ÚÌfi˙ÂÙ·È ¤Ó· ‰›Ô ÂÚÂıÈÛÌ¿ÙˆÓ Û ÌÈ· ÁÚ·ÌÌÈ΋ ÌÂÌ‚Ú¿ÓË Î·È ·fi ıˆÚËÙÈ΋ ¿Ô„Ë, Ô ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ı· ‹Ù·Ó ¤Ó·˜ ‚Ú·¯‡˜ ·ÏÏ¿ Ì ÌÂÁ¿ÏÔ ‡„Ô˜ (¤ÓÙ·ÛË), ÂÚÂıÈÛÌfi˜. ŸÌˆ˜, Ë ÂÈÏÔÁ‹ ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ¤ÓÙ·Û˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‰˘ÛÊÔÚ›· Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÙÔÓ ·ÛıÂÓ‹. TÔ Ì¤ÁÂıÔ˜ Ù˘ ηډȿ˜ (Ë ·ÚÔ˘Û›· ‹ fi¯È Ì˘Ôηډȷ΋˜ ˘ÂÚÙÚÔÊ›·˜) ÌÔÚ› Ó· Â›Ó·È ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁˆÓ Ô˘ ÂËÚ¿˙ÂÈ ÙËÓ ÂÈÙ˘¯›· Ù˘ ‚ËÌ·ÙÔ‰fiÙËÛ˘.

T· ÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù· ηٷÁÚ¿ÊÔÓÙ·È Û οÔÈ· ·fiÛÙ·ÛË ·fi ÙËÓ Î·Ú‰È¿ Î·È ÂÔ̤ӈ˜ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Ì›· Û‡ÓıÂÛË ÔÏÏÒÓ ‰ÈÂÁÂÚÙÈÎÒÓ Î˘Ì¿ÙˆÓ. OÈ ·Ó·ÙÔÌÈÎÔ› Î·È ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ÎÔÏÈ΋˜ Ì¿˙·˜ (̤ÁÂıÔ˜) Î·È Ë ÂÁÁ‡ÙËÙ· ÚÔ˜ ÙÔ ÎÔÏÈÎfi Ì˘ÔοډÈÔ Ô˘ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó Ù· ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Û ‰È·ÊÔÚÂÙÈΤ˜ ı¤ÛÂȘ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ‰ÂÓ ¤¯Ô˘Ó ÙÂÎÌËÚȈı› Ï‹Úˆ˜. AÓ Î·È Ë ÂÁÁ‡ÙËÙ· ÙˆÓ ÔÈÛÔÊ¿ÁÂÈˆÓ ËÏÂÎÙÚÔ‰›ˆÓ ¤¯ÂÈ ·Ô‰Âȯı› ·ÎÙÈÓÔÁÚ·ÊÈο, Ë ¤ÎÙ·ÛË ÛÙËÓ ÔÔ›· Ù· ÔÈÛÔÊ¿ÁÂÈ· ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù· ·ÓÙ·Ó·ÎÏÔ‡Ó ÙËÓ "·ÚÈÛÙÂÚ‹ ÎÔÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·" ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓË. ™ÙȘ ı¤ÛÂȘ Ô˘ ÂÍÂÙ¿Û·ÌÂ, ÂÓÒ Ë ÁˆÌÂÙÚÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ ηډȿ˜ Î·È ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Â›Ó·È ÔχÏÔÎË, ÂÓÙÔ‡ÙÔȘ, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÔÏ˘ÏÔÎfiÙËÙ· ÙˆÓ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ÂȉڿÛÂˆÓ ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙÔ˘ ÎfiÏÔ˘ Î·È Ë ÂÁÁ‡ÙËÙ· ÚÔ˜ ÙÔÓ ÔÈÛÔÊ¿ÁÔ, ÔÌ·ÏÔÔÈÔ‡ÓÙ·È ·fi ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, ·ÊÔ‡ ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜, ÙÔ ‚ËÌ·ÙÔ‰ÔÙÈÎfi ·Ú¿ı˘ÚÔ Î·È Ô ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜, ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Ì‹ÎÔ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜.

TÔ ‚¿ıÔ˜ ÛÙÔ ÔÔ›Ô ÂÈÛ¿ÁÂÙ·È ÙÔ ÔÈÛÔÊ¿ÁÂÈÔ ËÏÂÎÙÚfi‰ÈÔ, Û‡Ìʈӷ Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (4,9), ·ÔÙÂÏ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡.

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·307

¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308

™Â ÌÂϤÙË ÙÔ˘ Benson et al (9), Ô˘ ·ÊÔÚÔ‡Û 30 ·ÛıÂÓ›˜ ËÏÈΛ·˜ ·fi 1 Ë̤ڷ˜ ̤¯ÚÈ 77 ÂÙÒÓ (ÙÚ›· ÓÂÔÁÓ¿) ‰È·ÈÛÙÒÓÂÙ·È ˘„ËÏ‹ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË (r=0,987 p<0,001) ÌÂٷ͇ ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙÔ˘ ‚¿ıÔ˘˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔ‰›Ô˘. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û ·ÔÎÏÂÈÛÙÈο ÓÂÔÁÓ¿, Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÌÂÙ·‚ÏËÙÒÓ ‹Ù·Ó ÌÂÓ ıÂÙÈ΋, ·ÏÏ¿ fi¯È ÙfiÛÔ ÈÛ¯˘Ú‹ (r=0,594 p<0,001) fï˜, ‰È·ÈÛÙÒÓÂÙ·È ÈÛ¯˘ÚfiÙ·ÙË ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË (r=-0,95065 p=0,000) ÌÂٷ͇ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ Î·È Ì¤ÁÈÛÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜. £ÂˆÚԇ̠ÂÔ̤ӈ˜, fiÙÈ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÓÂÔÁÓ¿, Ë ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ·ÓÙÈÛÙÔȯ› Ôχ ηχÙÂÚ· ÛÙË ı¤ÛË Ô˘ ηٷÁÚ¿ÊÂÙ·È ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¿ ÛÙË ı¤ÛË Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. EÓÙÔ‡ÙÔȘ, Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ı· ÌÔÚÔ‡Û ӷ Â›Ó·È ÔχÙÈÌË ÁÈ· ÙËÓ Â›ÁÔ˘Û· ÔÈÛÔÊ¿ÁÂÈ· ËÏÂÎÙÚÈ΋ ·Ó¿Ù·ÍË, ÂÂȉ‹ Ë ÂÓÙfiÈÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ Ì ‚¿ÛË ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÔÚ› Ó· Â›Ó·È ‰‡ÛÎÔÏË ÂÍ·ÈÙ›·˜ Ù˘ "ÌËÊÏ‚ÔÎÔÌ‚È΋˜" ÂÈÎfiÓ·˜ Ù˘ ÎÔÏÈ΋˜ ‰È¤ÁÂÚÛ˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙËÓ Ù·¯˘Î·Ú‰›· (4,9). ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ Î·È ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· Ù· ÓÂÔÁÓ¿, ÚÔÙ›ÓÔ˘Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ηÌ‡Ï˘ Ô˘ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ· 3, ·ÓÂÍ¿ÚÙËÙ· ·Ó ÙÔ ÓÂÔÁÓfi ¿Û¯ÂÈ ‹ fi¯È ·fi Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·. ¶Ú·ÎÙÈο, ÚÔÙ›ÓÔ˘Ì ÙËÓ ·Ú¯È΋ ÚÈÓÔÁ·ÛÙÚÈ΋ ›ÛÔ‰Ô ÙÔ˘ ηıÂÙ‹Ú· Û ‚¿ıÔ˜ 13 ÂηÙÔÛÙÒÓ (mean±SD - 12,94±0,94 ÂηÙÔÛÙ¿) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÂٷΛÓËÛË ÙÔ˘ ηıÂÙ‹Ú· ηٿ 0,5 ÂηÙÔÛÙfi ¿Óˆ ‹ οو ·fi ÙË ı¤ÛË ·˘Ù‹ (‚ËÌ·ÙÔ‰ÔÙÈÎfi ·Ú¿ı˘ÚÔ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡) ̤¯ÚȘ fiÙÔ˘ ηٷÁÚ·Ê› ÙÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ËÏÂÎÙÚfiÁÚ·ÌÌ·. EȉÈÎfiÙÂÚ·, Ì ‚¿ÛË Ù· ÛÙÔȯ›· Ù˘ ÌÂϤÙ˘ Ì·˜, ıˆÚԇ̠fiÙÈ Ë ÚÔÒıËÛË Î·Ù¿ 0,5 ÂÎ. ÙÔ˘ ηıÂÙ‹Ú· ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· "Û˘Ó·ÓÙ‹ÛÂÈ" ÙÔÓ ÂÏ¿¯ÈÛÙÔ Ô˘‰fi (r=-0,99624 p=0,000) ·' fi,ÙÈ ¤¯ÂÈ Ë ·fiÛ˘ÚÛË ÙÔ˘ ηٿ ÙËÓ ›‰È· ·fiÛÙ·ÛË (r=-0,93189 p=0,000). M ÙÔÓ ¯ÂÈÚÈÛÌfi ·˘Ùfi ÈÛÙ‡ԢÌ fiÙÈ ı· ÂÚÈÔÚÈÛÙ› ‰Ú·ÛÙÈο Ô ¯ÚfiÓÔ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ı· ÂÏ·¯ÈÛÙÔÔÈËı› Ô ¯ÚfiÓÔ˜ Ù˘ ÔÈÛÔÊ¿ÁÂÈ·˜ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋˜ ÌÂϤÙ˘.

T¤ÏÔ˜, ÂÂȉ‹ ˘¿Ú¯ÂÈ ÂÏ¿¯ÈÛÙË ˆÊ¤ÏÂÈ· ·fi ÙË ¯Ú‹ÛË Ú‡̷ÙÔ˜ Ì ‰È¿ÚÎÂÈ· >10 ms(9) (pulse width), ıˆÚԇ̠fiÙÈ ·˘Ùfi ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ Û ÂÚÈÙÒÛÂȘ Ô˘ Ô Ô˘‰fi˜ ÍÂÂÚÓ¿ Ù· 14 mA, fiÚÈÔ ¤Ú·Ó ÙÔ˘ ÔÔ›Ô˘ ÚÔηÏÂ›Ù·È ·›ÛıËÌ· ÂÏ·ÊÚÔ‡ ÔÈÛıÔÛÙÂÚÓÈÎÔ‡ η‡ÛÔ˘ ‹ fiÓÔ˘.

OÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜

AÓ·ÊÔÚÈο Ì ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ ÌÂıfi‰Ô˘, ‰ÂÓ ¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› η̛· ÛÔ‚·Ú‹ fi„ÈÌË ÂÈÏÔ΋. O McNally (10) ¤‰ˆÛ 20 shocks ÙˆÓ 200 J ¤Î·ÛÙÔ ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ 6 ÛÎ‡ÏˆÓ Î·È 15 shocks ÙˆÓ 60 J Û 8 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËΠη̛· ‚Ï¿‚Ë. A˘Ù¿ Ù· ÂÓÂÚÁÂȷο Â›‰· Â›Ó·È ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ· ·fi ÂΛӷ Ô˘ ‰›ÓÔÓÙ·È ÁÈ· ÙËÓ ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË. O Montoyo (2) ˘¤‚·Ï Û ÔÈÛÔÊ·ÁÔÛÎfiËÛË 6 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË Î·È ‰ÂÓ ‚ڋΠη̛· ·ÓˆÌ·Ï›·. ™Â Ì›· ÂÚ›ÙˆÛË, Ë ·˘ÙÔ„›· ÌÂÙ¿ ·fi Û˘Ó¯‹ ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË 60 ˆÚÒÓ, ·ÔÎ¿Ï˘„ ÌÂÚÈΤ˜ ÂÚÈÔ¯¤˜ ‹È·˜ Ó¤ÎÚˆÛ˘ ÂÎ ȤÛˆ˜, fiˆ˜ ·˘Ù¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ÚÔ˘Ù›Ó·˜.

OÌÔ›ˆ˜, ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÔ‚·Ú¤˜ ¿ÌÂÛ˜ ÂÈÏÔΤ˜ Ù˘ ÔÈÛÔÊ¿ÁÂÈ·˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘. ™ÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜, Ë ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ˘ÚÔ‰fiÙËÛ ·ԉ‰ÂÈÁ̤ӷ ÚÔ¸¿Ú¯Ô˘Û· ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· Û ‰‡Ô ·ÛıÂÓ›˜ Î·È ‰È¤ÁÂÚÛË ÙÔ˘ ÊÚÂÓÈÎÔ‡ Û ¤Ó· ·fi 65 ·ÛıÂÓ›˜. ™Â 4/38 ·ÛıÂÓ›˜ Ì ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ÚÔÎÏ‹ıËΠÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÔÛ¿ıÂÈ·˜ ·Ó¿Ù·Í˘ Ù˘ Û ÊÏ‚ÔÎÔÌ‚ÈÎfi Ú˘ıÌfi. ¢È¤ÁÂÚÛË ÙÔ˘ ‚Ú·¯ÈÔÓ›Ô˘ ϤÁÌ·ÙÔ˜ Û˘Ó¤‚Ë Û ¤Ó· ‚Ú¤ÊÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛ˘ ÛÙËÓ ÂÁÁ‡˜ ÂÚÈÔ¯‹ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. AÓÙ›ıÂÙ· ÚÔ˜ ÙËÓ ‰È·ÊϤ‚È· ‚ËÌ·ÙÔ‰fiÙËÛË, Ë ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ·ÎÙÈÓÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ·ÔʇÁÔÓÙ·È fiϘ ÔÈ ÂÈÏÔΤ˜ Ô˘ ·ÊÔÚÔ‡Ó Ù· ·ÁÁ›·. ™˘ÌÂÚ¿ÛÌ·Ù· T· ·ÚÈ· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ Â›Ó·È fiÙÈ ÛÙ· ÓÂÔÁÓ¿: 1) ‰ÂÓ ‰È·ÈÛÙÒıËΠη̛· ‰È·ÊÔÚ¿ ÛÙÔ ‚¿ıÔ˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘, ÛÙÔÓ ÂÏ¿¯ÈÛÙÔ ‚ËÌ·ÙÔ‰ÔÙÈÎfi Ô˘‰fi Î·È ÛÙÔ ‡„Ô˜ ÙÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È ·˘ÙÒÓ Ì ·Ó·ÙÔÌÈο Ê˘ÛÈÔÏÔÁÈ΋ ηډȿ, 2) ÙÔ È‰·ÓÈÎfi ‚¿ıÔ˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ηıÂÙ‹Ú· ÌÔÚ› Ó· ÂÎÙÈÌËı› ηٿ ·ÚÈÔ ÏfiÁÔ ·fi ÙË ı¤ÛË ÛÙËÓ ÔÔ›· ηٷÁÚ¿ÊÂÙ·È ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ Î·È ÏÈÁfiÙÂÚÔ ·fi ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, 3) Ô ÂÏ¿¯ÈÛÙÔ˜ ‰ÈÔÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ ·Ú·ÙËÚÂ›Ù·È Û ·fiÛÙ·ÛË 0,5 ÂηÙÔÛÙ¿ Âη٤ڈıÂÓ Ù˘ ı¤Û˘ ÙÔ˘ ̤ÁÈÛÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ (mean ±SD: 12,93±1,01 cm) Î·È 4) Ô Ù·¯‡˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ı¤Û˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ı· ÂÏ·ÙÙÒÛÂÈ ‰Ú·ÛÙÈο ÙÔ ¯ÚfiÓÔ Ù˘ ÌÂϤÙ˘, ı· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ‚ËÌ·ÙÔ‰fiÙËÛ˘ Î·È ı· ÂÚÈÔÚ›ÛÂÈ ÙȘ fiÔȘ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (ÔÈÛıÔÛÙÂÚÓÈÎfi˜ fiÓÔ˜-η‡ÛÔ˜).

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BÈ‚ÏÈÔÁÚ·Ê›· 1. Benson W Jr: Transesophageal electrocardiography and cardiac pacing:state of art. Circulation 1987;75(Suppl III):86-90.

2. Montoyo JV, Angel J, Valle V, Gausl C. Conversion of tachycardias by transesophageal atrial pacing. Am J Cardiol 1973;32:85-90.

3. Sterz H, Prager H, Koller H. Transesophageal rapid stimulation of the left atrium in atrial tachycardia. Z Kardiol 1978:67:136-138.

4. Gallagher JJ, SmIth WM, Kerr CR, Kasell J, Cook L, Relter M, Sterba R, Harte M. Esophageal pacing: a diagnostic and therapeutic tool. Circulation 1982;65:336-341.

5. Kerr C, Gallagher JJ, SmIth WM, Sterba R, German LD, Cook L, Kasell JH. The induction of atrial flutter and fibrillation and the termination of atrial flutter by esophageal pacing. PACE 1983:6:60-72.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-02-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: AÓ‰Ú¤·˜ EÌÌ. M·ÚÁÂÙ¿Î˘ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶.& A. K˘ÚÈ·ÎÔ‡" £Ë‚ÒÓ & §Â‚·‰Â›·˜ 115 27 °Ô˘‰›, Aı‹Ó·

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A. M·ÚÁÂÙ¿Î˘ Î·È Û˘Ó.

6. Benson DW Jr, Dunnlgan A, Sterba R, Bend}U DG. Atrial pacing from the esophagus in diagnosis and management of tachycardia and palpitations. J Pediatr 1983;102:40-46.

7. Lucet V. Esophageal pacing in children. 38 consecutive cases. Arch Fr Pediatr.1990;47(3):185-9.

8. Moquet B, et al. Value of the esophageal approach in the diagnosis, treatment and therapeutic surveillance of arrhythmia in children. Arch Fr Pediatr.1 1989;46(1):1 1-7.

Review.

9. Benson DW Jr, Sanford M, Dunnigan A, Bendit DG: Transesophageal atrial pacing threshold: role of interelectrode spacing, pulse width, and catheter insertion depth. Am J Cardiol 53:63;1984.

10. McNally EM, Meyer EC, Langendorf R. Elective countershock in unanesthetized patients with use of an esophageal electrode. Circulation 33:124, 1966.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313

E›‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ·fi Candida albicans Iˆ¿ÓÓ˘ §·Ì·‰·Ú›‰Ë˜1, E˘·ÁÁÂÏ›· ¢ËÌËÙÚ›Ô˘2, M¿Úı· £ÂÔ‰ˆÚ¿ÎË1, AÛÛÂÌ X›˙·1, M·ÚÈ¿ÓÓ· ™·‚‚¿Ï·3, EϤÓË MȯÂϷοÎË2

● ¶ÂÚ›ÏË„Ë: OÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÛÔ‚·Úfi ·Ú¿ÁÔÓÙ· ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ ÛÙȘ EÓÙ·ÙÈΤ˜ MÔÓ¿‰Â˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ (MENN). H ¤ÁηÈÚË ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ÂÊ·ÚÌÔ˙ÔÌ¤ÓˆÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈΤ˜. H ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È ¤Ó· ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚÈṲ̂ÓÔ ¤Ó˙˘ÌÔ, ÙÔ ÌÔÓ·‰ÈÎfi Ì ·ԉ‰ÂÈÁ̤ÓË ¯ÈÙÈÓÔÏ˘ÙÈ΋ ‰Ú¿ÛË. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹Û·Ì ٷ Â›‰· Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ÔÊÂÈÏfiÌÂÓË Û Candida albicans. MÂÙÚ‹ÛÂȘ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Û ‰È·‰Ô¯Èο ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ¤‰ÂÈÍ·Ó ˆ˜ Ù· Â›‰· ÙÔ˘ ÌÂÈÒıËÎ·Ó ‹ ·˘Í‹ıËÎ·Ó ·Ó¿ÏÔÁ· Ì ÙËÓ ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘. T· Â˘Ú‹Ì·Ù¿ Ì·˜ ‰Â›¯ÓÔ˘Ó ˆ˜ ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÚÒÈÌÔ ‰Â›ÎÙË Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·ÏÏ¿ Î·È ÎÚÈÙ‹ÚÈÔ ·ÓÙ·fiÎÚÈÛ˘ ÛÙËÓ ÂÊ·ÚÌÔ˙fiÌÂÓË ıÂÚ·›·. ¶·È‰È·ÙÚÈ΋ 2000;63:309-313. §¤ÍÂȘ ÎÏÂȉȿ: Candida albicans, ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË.

J. Labadaridis, E. Dimitriou, M. Theodoraki, A. Hiza, M. Savala, H. Michelakakis. Chitotriosidase levels in Candida albicans infection. Paediatriki 2000;63:309-313. ● Abstract: Fungal infections have become an important factor in neonatal morbidity and mortality in neonatal intensive care units. Early diagnosis and proper assessment of the efficacy of the antifungal treatment are of the outmost importance. Human chitotriosidase is a recently identified enzyme and is the only one known so far to have proven chitinolytic activity. The levels of chitotriosidase were studied in two neonates with systemic Candida albicans infection. Assays of the enzymic activity in sequential urine and plasma samples showed that the enzyme levels increased or decreased in relation to the outcome of the infection. The data indicate that serial chitotriosidase assays can be used as an early indicator of fungal infection as well as for evaluating the efficacy of the applied therapy.

Key words: Candida albicans, chitotriosidase.

EÈÛ·ÁˆÁ‹ H Û˘¯ÓfiÙËÙ· ÙˆÓ Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙȘ MÔÓ¿‰Â˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ (MENN) ¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌÂ Û˘¯ÓfiÙÂÚ˜ ÙȘ ÏÔÈÌÒÍÂȘ ·fi Candida albicans (1,2).

T· ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ηÓÙÈÓÙ›·Û˘ ÛÙ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·Ô‰Ôı› ÛÙËÓ Î·ı˘ÛÙ¤ÚËÛË Ù˘ ‰È¿ÁÓˆÛ˘ ·ÏÏ¿

1 2 3

Î·È ÛÙËÓ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÂÊ·ÚÌÔ˙ÔÌ¤ÓˆÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ (3). H ‡ÚÂÛË ÏÔÈfiÓ, ‰ÂÈÎÙÒÓ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙˆÓ Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·ÏÏ¿ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ıÂÚ·›· Â›Ó·È È‰È·›ÙÂÚ˘ ÛËÌ·Û›·˜.

H ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È ¤Ó· ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚÈṲ̂ÓÔ ¤Ó˙˘ÌÔ Ô˘ ·Ó‹ÎÂÈ, Ì ‚¿ÛË

NÂÔÁÓÔÏÔÁÈÎfi TÌ‹Ì· ¶°N N›Î·È·˜, ¶ÂÈÚ·È¿˜ ¢/ÓÛË EÓ˙˘ÌÔÏÔÁ›·˜ Î·È K˘ÙÙ·ÚÈ΋˜ §ÂÈÙÔ˘ÚÁ›·˜, IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, Aı‹Ó· MÈÎÚÔ‚ÈÔÏÔÁÈÎfi TÌ‹Ì· ¶°N N›Î·È·˜, ¶ÂÈÚ·È¿˜

309

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·310

¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313

ÙËÓ ÔÌÔÏÔÁ›· ÛÙËÓ ·ÏÏËÏÔ˘¯›· ·ÌÈÓÔͤˆÓ, ÛÙË ÌÂÁ¿ÏË ÔÈÎÔÁ¤ÓÂÈ· 18 ÙˆÓ ÁÏ˘ÎÔ˙˘ÏÔ-˘‰ÚÔÏ·ÛÒÓ (4). ™ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·˘Ù‹ ·Ó‹ÎÔ˘Ó ÔÏϤ˜ ÔÌÔÂȉ›˜ ˆ˜ ÚÔ˜ ÙË ‰ÔÌ‹ ÙÔ˘˜ ÚˆÙ½Ó˜ Ô˘ ·Ó¢ڛÛÎÔÓÙ·È Û ¤Ó· Â˘Ú‡Ù·ÙÔ Ê¿ÛÌ· ÔÚÁ·ÓÈÛÌÒÓ (.¯. ‚·ÎÙ‹ÚÈ·, ̇ÎËÙ˜, Ê˘Ù¿, ¤ÓÙÔÌ·, ıËÏ·ÛÙÈο Î.·.) Î·È Ô˘ ‰È·Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· Î·Ù·Ï‡Ô˘Ó ÙË ‰È¿Û·ÛË Ù˘ ¯ÈÙ›Ó˘ (5,6). H ·ÓıÚÒÈÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Â›Ó·È Ë ÌÔÓ·‰È΋ ̤¯ÚÈ ÙÒÚ· ÚˆÙÂ˚ÓË ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜ Ì ·ԉ‰ÂÈÁ̤ÓË ¯ÈÙÈÓÔÏ˘ÙÈ΋ ‰Ú¿ÛË, Â›Ó·È ‰ËÏ·‰‹ Ì›· ¯ÈÙÈÓ¿ÛË (7,8). ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙȘ ‚ÈÔÏÔÁÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ ¯ÈÙÈÓ·ÛÒÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ¿Ì˘Ó· ¤Ó·ÓÙÈ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Ô˘ ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓË, fiˆ˜ Â›Ó·È ÔÈ Ì‡ÎËÙ˜ (9), ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹Û·Ì ÙË Û˘ÌÂÚÈÊÔÚ¿ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ÓÂÔÁÓ¿ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ÔÊÂÈÏfiÌÂÓË Û Candida albicans. M¤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜, Ô˘ ·ÔÙÂÏ› ÙËÓ ÚÒÙË ‰ÈÂıÓÒ˜ ÌÂϤÙË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÛÂ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÛÙÔÓ ¿ÓıÚˆÔ, ‰ËÌÔÛȇıËΠÛÙÔÓ ‰ÈÂıÓ‹ Ù‡Ô (10). ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ AÛıÂÓ‹˜ A: ¶ÚfiÎÂÈÙ·È ÁÈ· ¿ÚÚÂÓ ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3870 g ÌÂÙ¿ ·fi ÂÚÁÒ‰Ë ÙÔÎÂÙfi. NÔÛËχıËΠÛÙË MENN, ÏfiÁˆ ÂÚÈÁÂÓÓËÙÈ΋˜ ·ÛÊ˘Í›·˜ - ÂÈÛÚfiÊËÛ˘ Ì˘ÎˆÓ›Ô˘, Î·È ¯ÚÂÈ¿ÛıËΠÌ˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜. TÔ ÓÂÔÁÓfi Û ËÏÈΛ· 24 ËÌÂÚÒÓ ÂÍ‹Ïı ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ¢¤Î· Ë̤Ú˜ ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ÂÈÛ‹¯ıË ÂÎ Ó¤Ô˘ ÏfiÁˆ ¿ÚÓËÛ˘ Ï‹„˘ ÙÚÔÊ‹˜, ˘ÚÂÙÔ‡ Î·È Â˘ÂÚÂıÈÛÙfiÙËÙ·˜. §ÂÙÔÌÂÚ‹˜ ÂÚÈÁÚ·Ê‹ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ¤ÁÈÓ ÛÙÔ ¢ÂÏÙ›Ô Ù˘ A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ (11). H ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÌÂÙÚ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ Û ‰Â›ÁÌ· Ï¿ÛÌ·ÙÔ˜ ÙË 15Ë Ë̤ڷ Ù˘ ‰Â‡ÙÂÚ˘ ÓÔÛËÏ›·˜ fiÙ·Ó ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ‹Ù·Ó ıÂÙÈΤ˜ ÁÈ· Candida albicans. MÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó Â›Û˘ Û ‰È·‰Ô¯Èο ‰Â›ÁÌ·Ù· Ï¿ÛÌ·ÙÔ˜ Î·È Ô‡ÚˆÓ (II-V) (¶›Ó·Î·˜ 1) Ô˘ ÂÏ‹ÊıËÛ·Ó ÛÙË Û˘Ó¤¯ÂÈ· ·Ó¿ ‚‰ÔÌ¿‰· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜. ™ÙÔ Ù¤ÏÔ˜ Ù˘ ·Ú·¿Óˆ ¯ÚÔÓÈ΋˜ ÂÚÈfi‰Ô˘ ÔÈ Î·ÏÏȤÚÁÂȘ ÙÚÈÒÓ ‰È·‰Ô¯ÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ Ô‡ÚˆÓ ‹Ù·Ó ÛÙ›Ú˜.

AÛıÂÓ‹˜ B: ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÚfiˆÚÔ ¿ÚÚÂÓ ÓÂÔÁÓfi 900 g Ô˘ ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ‡ÛÙÂÚ· ·fi ·ËÛË 28 ‚‰ÔÌ¿‰ˆÓ. H ÌËÙ¤Ú· ‰ÂÓ Â›¯Â Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË, ‹Ù·Ó Ë 7Ë ÂÁ΢ÌÔÛ‡ÓË Ù˘ Î·È ÙÔ 4Ô ÛÙË ˙ˆ‹ Ù¤ÎÓÔ Ù˘. H ¤Ó·ÚÍË ÙˆÓ Ô‰˘ÓÒÓ ‹Ù·Ó ·˘ÙfiÌ·ÙË Î·È Ë Ú‹ÍË ÙˆÓ ˘Ì¤ÓˆÓ Û˘Ó¤‚Ë 2 ÒÚ˜ ÚÔ ÙÔ˘ ÙÔÎÂÙÔ‡. Apgar score ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È. A̤ۈ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‰È·ÛˆÏËÓÒ-

310

π. §·Ì·‰·Ú›‰Ë˜ Î·È Û˘Ó.

ıËÎÂ, ÛÙ·ıÂÚÔÔÈ‹ıËÎÂ Î·È ÌÂٷʤÚıËΠÛÙË MÔÓ¿‰· Ì·˜ ÙË 2Ë ÒÚ· ˙ˆ‹˜. AÚ¯Èο ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ¤ÓÙÔÓÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, Ì‹Î Û Ì˯·ÓÈ΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË, ÙÔ˘ ¯ÔÚËÁ‹ıËÎ·Ó ÙÚÂȘ ‰fiÛÂȘ Â͈ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (surfactant), ÓÙÔ·Ì›ÓË ÂÓÒ ·Ú¿ÏÏËÏ· ¯ÔÚËÁ‹ıËΠ·ÌÈÎÈÏÏ›ÓË Î·È ÓÂÙÈÏÌÈΛÓË.

TÔÔıÂÙ‹ıËΠ·ÚÙËÚÈ·Îfi˜ ÔÌÊ·ÏÈÎfi˜ ηıÂÙ‹Ú·˜ Î·È ÂÚÈÊÂÚÈ΋ ÁÚ·ÌÌ‹. EÌÊ¿ÓÈÛ ÛËÌ·ÓÙÈÎfi ·ÈÌÔ‰˘Ó·ÌÈÎfi ‚ÔÙ¿ÏÂÈÔ Î·È ÙÔ˘ ¯ÔÚËÁ‹ıËÎ·Ó ·Ú¯Èο ÊÔ˘ÚÔÛÂÌ›‰Ë Î·È ‰ÈÁÔÍ›ÓË Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÈÓ‰ÔÌÂı·Î›ÓË.

TËÓ 11Ë Ë̤ڷ ˙ˆ‹˜ ÂÓÒ ‹Ù·Ó ·ÎfiÌË Û Ì˯·ÓÈ΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË, ·ÚÔ˘Û›·Û Âȉ›ӈÛË Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ïԛ̈͢ (§Â˘Î¿=5140 mm3, AÈÌÔÂÙ¿ÏÈ·=6000 mm3, CRP=314 mg/L) Î·È ÙÚÔÔÔÈ‹ıËΠÙÔ Û¯‹Ì· Ù˘ ·ÓÙÈ‚›ˆÛ˘ Û ·ÌÈηۛÓË Î·È ÙÂ˚ÎÔÏ·Ó›ÓË ÁÈ· ÙËÓ Î¿Ï˘„Ë ÙˆÓ gram (-) Î·È ÁÈ· ÙÔ ÂӉ¯fiÌÂÓÔ Ïԛ̈͢ ·fi ÂȉÂÚÌÈÎfi ÛÙ·Ê˘ÏfiÎÔÎÎÔ ·ÓÙ›ÛÙÔȯ·. YÔÛÙËÚ›¯ıËΠ·ÎfiÌË Ì ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ (Sandaglobulin) Î·È ÊÚ¤ÛÎÔ˘ ηÙ„˘Á̤ÓÔ˘ Ï¿ÛÌ·ÙÔ˜. ¶·Ú¿ ÙËÓ ·ÁˆÁ‹ ÙÔ ÓÂÔÁÓfi η٤ÏËÍ Ì ÂÈÎfiÓ· ÛËÙÈÎÔ‡ shock ÙË 13Ë Ë̤ڷ ˙ˆ‹˜. ™ÙȘ ηÏÏȤÚÁÂȘ (Ï‹„Ë 11Ë Ë̤ڷ) ·›Ì·ÙÔ˜, ÙÚ·¯ÂÈÔۈϋӷ Î·È ÔÌÊ·ÏÈÎÔ‡ ηıÂÙ‹Ú· ·Ó·Ù‡¯ıËΠCandida albicans. T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‚¤‚·È· Ù· Ï¿‚·Ì ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ÓÂÔÁÓÔ‡, ÁÈ' ·˘Ùfi Î·È ‰ÂÓ ¯ÔÚËÁ‹ıËΠ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹.

MÂÙÚ‹ÛÂȘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ¤ÁÈÓ·Ó Û ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Ô˘ ÂÏ‹ÊıËÛ·Ó ÙËÓ 1Ë, 7Ë Î·È ÙË 13Ë Ë̤ڷ ˙ˆ‹˜.

H ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÌÂÙÚ‹ıËΠ̠ÙÔ ÊıÔÚ›˙ÔÓ ˘fiÛÙڈ̷ ÌÂı˘ÏÔ˘ÌÂÏÏÈÊÂÚ‡Ï-‚-D-NN’N’’-ÙÚÈ·ÎÂÙ˘ÏÔÙÚÈfi˙Ë ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ÙˆÓ ·ÛıÂÓÒÓ Û‡Ìʈӷ Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Hollak Î·È Û˘Ó.

(12). TËÓ ·Ó¿ ‚‰ÔÌ¿‰· Ï‹„Ë ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÙËÓ ÂÈϤͷÌÂ Û·Ó ¤Ó· ÏÔÁÈÎfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÔÚ›·˜ Ù˘ Ïԛ̈͢ Î·È Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›· ÌÈ· Î·È Â›Ó·È Ë ÚÒÙË ÌÂϤÙË Ô˘ Á›ÓÂÙ·È ‰ÈÂıÓÒ˜ ¿Óˆ ÛÙÔ ı¤Ì· ·˘Ùfi. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ˘¿Ú¯Ô˘Ó ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ ÁÈ· Ù· Â›‰· Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ÓÂÔÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó 10 ÓÂÔÁÓ¿ ·ÓÙ›ÛÙÔȯ˘ ËÏÈΛ·˜ ˆ˜ Ì¿ÚÙ˘Ú˜.

AÔÙÂϤÛÌ·Ù· ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ·˘ÍË̤ӷ Â›‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘, Û ۇÁÎÚÈÛË ÌÂ Ê˘ÛÈÔÏÔÁÈο ÓÂÔÁÓ¿ Ù˘ ›‰È·˜ ËÏÈΛ·˜, ‚Ú¤ıËÎ·Ó ÛÙ· ·Ú¯Èο ‰Â›ÁÌ·Ù· Î·È È‰È·›ÙÂÚ· ÛÙ· Ô‡Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜ A. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ù· Â›‰· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒıËÎ·Ó ÙfiÛÔ ÛÙÔ Ï¿ÛÌ· fiÛ· Î·È ÛÙ· Ô‡Ú·.

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∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Û Ïԛ̈ÍË Candida albicans

¶›Ó·Î·˜ 1: E›‰· XÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰È·‰Ô¯Èο ‰Â›ÁÌ·Ù· Ô‡ÚˆÓ Î·È ·›Ì·ÙÔ˜ ÙˆÓ ÓÂÔÁÓÒÓ A,B. XÈÙÚÔÙÚÈÔ˙ȉ¿ÛË

AÛıÂÓ‹˜ A

AÛıÂÓ‹˜ B

º˘ÛÈÔÏÔÁÈΤ˜ TÈ̤˜

H̤ڷ NÔÛËÏ›·˜

¢Â›ÁÌ·

¶Ï¿ÛÌ· (nmoles/ml/hr)

O‡Ú· (nmoles/mg ÎÚ·ÙÈÓ./hr)

§Â˘Î¿ /mm3

TKE (mm/1h)

CRP (mg/L)

15Ë 22Ë 29Ë 36Ë 43Ë

I II III IV V

88 105 80 57 53

440 67 4 0

22670 13430 11000 9200 -

84 60 -

++ ++

1Ë 7Ë 13Ë

π ππ πππ

40 123 -

34 808 3275

21610 20200 5140

25-52 n=10

0-30 n=10

ŒÙÛÈ, ÛÙÔ Ù¤ÏÔ˜ ÙˆÓ 5 ‚‰ÔÌ¿‰ˆÓ, fiÙ·Ó ÔÈ Î·ÏÏȤÚÁÂȘ ÙÚÈÒÓ ‰È·‰Ô¯ÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ‹Ù·Ó ÛÙ›Ú˜, Ù· Â›‰· Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο ÛÙ· Ô‡Ú· Î·È ÂÏ·ÊÚÒ˜ ·˘ÍË̤ӷ ÛÙÔ Ï¿ÛÌ·. H Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÂÍÂÏ›¯ıËΠ·Ú¿ÏÏËÏ· Ì ÙË ‚ÂÏÙ›ˆÛË ÙfiÛÔ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ fiÛÔ Î·È ÙˆÓ ¿ÏÏˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ (¶›Ó·Î·˜ 1).

AÓÙ›ıÂÙ· ÛÙÔÓ ·ÛıÂÓ‹ B, ÛÙ· ·Ú¯Èο ‰Â›ÁÌ·Ù·, Ù· Â›‰· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‹Ù·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· (¶›Ó·Î·˜ 1). A‡ÍËÛË ·Ú·ÙËÚ‹ıËΠÛÙÔ 2Ô ‰Â›ÁÌ·, Ì ÙË Ï‹„Ë ÙÔ˘ ÔÔ›Ô˘ ÙÔ ÓÂÔÁÓfi ·Ó¤Ù˘Í ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ‰Â›ÎÙ˜ Ïԛ̈͢, Ô˘ fiˆ˜ ·ԉ›¯ıËΠ۠ηÏÏȤÚÁÂȘ Ô˘ ÂÏ‹ÊıËÛ·Ó ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹, ÔÊ›ÏÂÙÔ Û Candida albicans. ¶ÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ·Ú·ÙËÚ‹ıËΠÛÙÔ 3Ô ‰Â›ÁÌ· Ô˘ ÂÏ‹ÊıË ÙË 13Ë Ë̤ڷ ˙ˆ‹˜. ™˘˙‹ÙËÛË H ¯ÈÙ›ÓË Â›Ó·È ¤Ó· ÁÚ·ÌÌÈÎfi ÔÏ˘ÌÂÚ¤˜, ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi ÌÔÓ¿‰Â˜ N-·ÎÂÙ˘ÏÔ-ÁÏ˘ÎÔ˙·Ì›Ó˘ Û˘Ó‰Â‰Â̤Ó˜ Ì ‚-1,4 ‰ÂÛÌÔ‡˜. E›Ó·È ·fi Ù· ϤÔÓ ‰È·‰Â‰Ô̤ӷ ÔÏ˘ÌÂÚ‹ ÛÙË Ê‡ÛË Î·È ·ÔÙÂÏ› ‰ÔÌÈÎfi ˘ÏÈÎfi ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÙÔȯˆÌ¿ÙˆÓ ÔÏÏÒÓ ÔÚÁ·ÓÈÛÌÒÓ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ Ì˘Î‹ÙˆÓ (13). H ·ÔÈÎÔ‰fiÌËÛ‹ Ù˘ Á›ÓÂÙ·È Ì ÙË ‰Ú¿ÛË ˘‰ÚÔÏ·ÛÒÓ ÛÙȘ Ôԛ˜ Û˘ÁηٷϤÁÂÙ·È Î·È Ë ÔÌ¿‰· ÙˆÓ ¯ÈÙÈÓ·ÛÒÓ, ÂÓ˙‡ÌˆÓ Ô˘ ¤¯Ô˘Ó ·Ó¢ÚÂı› ÙfiÛÔ Û ÔÚÁ·ÓÈÛÌÔ‡˜ Î·È Â›‰Ë Ô˘ ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓË fiÛÔ Î·È Û ¿ÏÏÔ˘˜ Ô˘ ‰ÂÓ ÙËÓ ÂÚȤ¯Ô˘Ó (9,14,15). ™Â ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·Ó‹ÎÂÈ Î·È Ë ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚÈṲ̂ÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÙÔ˘ ·ÓıÚÒÔ˘. OÈ ‚ÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ô‰Ôı› ÛÙȘ ¯ÈÙÈÓ¿Û˜ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙË ÌÔÚÊÔÁ¤ÓÂÛË, ÙË ıÚ¤„Ë ÙˆÓ ÔÚ-

-

<2 <2 314 3-9

Á·ÓÈÛÌÒÓ Ô˘ ÙȘ ·Ú¿ÁÔ˘Ó, ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÔÈÎÈÛÙÔ‡- ·Ú·Û›ÙˆÓ, ÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ÌfiÏ˘ÓÛ˘ ·ÏÏ¿ Î·È ÙËÓ ¿Ì˘Ó· ¤Ó·ÓÙÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Ô˘ ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓË Î·È È‰È·›ÙÂÚ· ÙˆÓ Ì˘Î‹ÙˆÓ Î·È ÙˆÓ ÂÓÙfiÌˆÓ (15-18).

O ‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ Ù˘ ·ÓıÚÒÈÓ˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ‰ÈÂÚÂ˘Ó¿Ù·È. Y¿Ú¯Ô˘Ó fï˜ ÔÏÏ¿ ÛÙÔȯ›· Ô˘ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë ˆ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ¿Ì˘Ó· ¤Ó·ÓÙÈ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, fiˆ˜ ÔÈ Ì‡ÎËÙ˜, Ô˘ ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓË.

T· Ì·ÎÚÔÊ¿Á· Ô˘ ·ÔÙÂÏÔ‡Ó ¤Ó·Ó ·fi ÙÔ˘˜ ÚÒÙÔ˘˜ Î·È Î˘ÚÈfiÙÂÚÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ¿Ì˘Ó·˜ ¤Ó·ÓÙÈ ÙˆÓ Ì˘Î‹ÙˆÓ (19), Â›Ó·È Û˘Á¯ÚfiÓˆ˜ Ë Î‡ÚÈ· ËÁ‹ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘, Ë ÔÔ›· ›Ù ·ÂÎÎÚ›ÓÂÙ·È ÂÍˆÎ˘ÙÙ·ÚÈο ›Ù ԉËÁÂ›Ù·È ÛÙ· Ï˘ÛÈۈ̿ÙÈ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘. XÈÙÈÓÔÏ˘ÙÈ΋ ‰Ú¿ÛË ¤¯Ô˘Ó Î·È ÔÈ ‰‡Ô ÌÔÚʤ˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ‰È·Ê¤ÚÔ˘Ó fï˜ ˆ˜ ÚÔ˜ ÙÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙËÓ ÈηÓfiÙËÙ· ÚfiÛ‰ÂÛ˘ ¯ÈÙ›Ó˘. ŒÙÛÈ ÌfiÓÔ Ë ÂÍˆÎ˘ÙÙ·ÚÈο ¢ÚÈÛÎfiÌÂÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Ì ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 50kDa, ¤Ó·ÓÙÈ 39kDa ÙÔ˘ ÂÓ‰ÔÏ˘ÛÈÛˆÌÈ·ÎÔ‡ ÂÓ˙‡ÌÔ˘, ÂÚȤ¯ÂÈ Ì›· ·ÏÏËÏÔ˘¯›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 49 ·ÌÈÓÔͤˆÓ ÛÙÔ ·ÓıÚ·ÎÈÎfi ¿ÎÚÔ Ù˘ Ô˘ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÚfiÛ‰ÂÛË Ù˘ ¯ÈÙ›Ó˘ (12,20). A˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ·fi Ù· Ì·ÎÚÔÊ¿Á· ¤¯ÂÈ ·Ú·ÙËÚËı› ÛÙË ÓfiÛÔ Gaucher (11), ÛÙȘ ·ıËÚÔÌ·ÙÈΤ˜ ϿΘ (21) Î·È ÈÔ ÚfiÛÊ·Ù· Û ÈÓ‰Èο ¯ÔÈÚ›‰È· Ô˘ ›¯·Ó ÌÔÏ˘Óı› Ì AÛ¤ÚÁÈÏÏÔ (Aspergillus fumigatus) (22).

EÈϤÔÓ, ÂÒ·ÛË ÌÔÓÔ·ÙÙ·ÚˆÓ ÌÔÚÊÒÓ Candida albicans Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ 50kDa ¤Ó˙˘ÌÔ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ï‡ÛË ÙˆÓ Ì˘Î‹ÙˆÓ Î·È Ë ÂÓ‰ÔÂÚÈÙÔÓ·˚΋ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ Û ÔÓÙ›ÎÈ· ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ÌfiÏ˘ÓÛË ·fi Candida albicans ‹ Aspergillus ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ı·̷ÙÈ΋ ·Ó¿ÚÚˆÛ‹ ÙÔ˘˜ (23).

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ŸÏ˜ ÔÈ ·Ú·¿Óˆ ·Ú·ÙËÚ‹ÛÂȘ Û˘ÓËÁÔÚÔ‡Ó ÁÈ· ÙÔ fiÙÈ Ë ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ·ÔÙÂÏ› ¤Ó· ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ¿Ì˘Ó·˜ ¤Ó·ÓÙÈ ÙˆÓ Ì˘Î‹ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ÂÓÈÛ¯‡Ô˘Ó ·˘Ù‹ ÙËÓ Èı·ÓfiÙËÙ·, Û˘Á¯ÚfiÓˆ˜ fï˜ ‰Â›¯ÓÔ˘Ó ˆ˜ Ë ·‡ÍËÛË Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ‰ÂÓ Â›Ó·È ·ÚÎÂÙ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒ͈Ó, οÙÈ Ô˘ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ¿Ì˘Ó· ¤Ó·ÓÙÈ ÙˆÓ Ì˘Î‹ÙˆÓ ÛÙËÚ›˙ÂÙ·È ÛÙË Û˘Ó‰˘·Ṳ̂ÓË ‰Ú¿ÛË ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ (19).

OÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ¤Ó· ÛËÌ·ÓÙÈο ·˘Í·ÓfiÌÂÓÔ Úfi‚ÏËÌ· ÛÙȘ MÔÓ¿‰Â˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ. T· ÓÂÔÁÓ¿ Î·È È‰È·›ÙÂÚ· Ù· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÚfiˆÚ·, ¤¯Ô˘Ó ·ÓÒÚÈÌÔ ·ÓÔÛÔÏÔÁÈÎfi Û‡ÛÙËÌ· Ô˘ Ù· Úԉȷı¤ÙÂÈ Û ٤ÙÔȘ ÏÔÈÌÒÍÂȘ. EÈϤÔÓ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÈÛ¯˘ÚÒÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â˘Ú¤ˆ˜ Ê¿ÛÌ·ÙÔ˜, ÎÔÚÙÈ˙fiÓ˘, ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ‰ËÌÈÔ˘ÚÁ› ȉ·ÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (2,3). H ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏË, ÂÓÒ ˘ÔÏÔÁ›˙ÂÙ·È ˆ˜ ÙÔ ÔÛÔÛÙfi „¢‰Ò˜ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Û ηÏÏȤÚÁÂȘ Êı¿ÓÂÈ ÙÔ 20-50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (2). H ·Ú·Ù‹ÚËÛ‹ Ì·˜ ˆ˜ ÔÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ Ô‰ËÁÔ‡Ó Û ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÙˆÓ ·ÛıÂÓÒÓ, Ù· ÔÔ›· ÌÂÈÒÓÔÓÙ·È ‹ ·˘Í¿ÓÔÓÙ·È ·Ó¿ÏÔÁ· Ì ÙËÓ ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘, ‰Â›¯ÓÂÈ ˆ˜ ÔÈ ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÎÚÈÙ‹ÚÈÔ ·ÓÙ·fiÎÚÈÛ˘ ÛÙËÓ ÂÊ·ÚÌÔ˙fiÌÂÓË ıÂÚ·›· ·ÏÏ¿ Î·È ÚÒÈÌÔ ‰Â›ÎÙË Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒ͈Ó. OÈ Èı·Ó¤˜ ·˘Ù¤˜ ÂÊ·ÚÌÔÁ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Â›Ó·È ˘fi ‰ÈÂÚ‡ÓËÛË, ÛÙ· Ï·›ÛÈ· ÂÓfi˜ ¢ڇÙÂÚÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ÌÂϤÙË ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ÓÂÔÁÓÒÓ ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÔÌ¿‰ˆÓ fiˆ˜ ÔÈ ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔÈ ·ÛıÂÓ›˜.

π. §·Ì·‰·Ú›‰Ë˜ Î·È Û˘Ó.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Baley J.E. Neonatal candidiasis. The current challenge.

Clin Perinatol. 1991;18:263-280.

2. Nichols JM, Yuen KY, Tan AYC: Systemic fungal infections in neonates. Br J Hosp Med 1993;49:420-424.

3. Leibovitz E, Luster-Reicher A, Amitai M, Moligner S. Systemic candidal infections associated with the use of peripheral venous catheters in neonates: A 9 year experience. Clin Infec Dis 1992;14:485-491.

4. Henrissat B, Bairoch A. New families in the classification of glycosyl hydrolases based on amino acid sequence similarities. Biochem J 1993;293:781-788.

5. Hakala BE, White C, Recklies AD. Human cartilage gp-39, a major secretory product of articular chondrocyte and synovial cell, is a mammalian member of a chitinase protein family. J Biol Chem 1993;268:25803-25810.

6. Malette B, Merlen Y, Bleau G, Paquette Y. Oviductins posses chitinase- and mucin - like domains: a lead to the

312

19.

20.

21.

22.

search for the biological function of these oviduct-specific ZP-associated glycoproteins. Mol Reprod Dev 1995; 41:384-397.

Den Tandt WR, Scharp S, Overdijk B. Evaluation of the hydrolysis of methylumbelliferyl-tetra-N-acetyl chiototetraoside by various glucosidases. A comparative study.

Int J Biochem 1993;25:113-119.

Overdijk B, van Steijn GJ. Human serum contains a chitinase: identification of an enzyme, formerly described as 4-methylumbelliferyl-tetra-N-acetylchitotetraoside hydrolase (MU-TCACT). Glycobiology 1994;4:797-803.

Sahai AS, Manocha RW. Chitinases of fungi and plants: their involvement in morphogenesis and host-parasite interaction FEMS Microbiology Reviews 1993;11:317-338.

Labadaridis J, Dimitriou E, Costalos C, et al. Serial chitotriosidase activity estimations in neonatal systemic candidiasis. Acta Paediatrica 1998;87:605-606.

AÓ·ÁÓˆÛÙ¿Î˘ ¢, §·Ì·‰·Ú›‰Ë˜ I, AÓÙˆÓÔÔ‡ÏÔ˘ N. OÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Û ‚Ú¤ÊÔ˜ 2 ÌËÓÒÓ. ¢ÂÏÙ. A' ¶·È‰È·ÙÚ. KÏÈÓ. ¶·ÓÂ. AıËÓÒÓ 1998;45:180-186.

Hollak CEM, van Weely S, van Oers MHJ and Aerts JMFG. Marked elevation of plasma chitotriosidase activity. J Clin Invest 1994;93:1288-1292.

Mulisch M. Chitin in protistan organisms. Eur J Protistol 1993;29:1-18.

Flach J, Pilet PE, Jolles P. What's new in chitinase research? Experientia 1992;48:701-716.

Gooday GW. Diversity of roles for chitinases in nature. In: Zakaria MB, Nudna WMW, Abdullah MP eds. Chitin and chitosan - the versatile environmentally friendly modern materials. Pangi, Penerbit University Kebangsaan Malaysia 1995:191-202.

Shahabudin M, Kaslow DC. Chitinase: a novel target for blocking parasite transmission? Parasitol Today 1993;9:252-258.

Schlein Y, Jacobson RL, Shlomai J. Chitinase secreted by Leishmania functions in the sandfly vector. Proc R Soc B 1991;245:121-26.

Broekaert WF, van Parijs J. Allen AK, Peumans WJ. Comparison of some molecular, enzymatic and antifungal properties of Chitinases from thorn-apple, tobacco and wheat. Physiol Mol Pl Pathol 1988;33:319-33.

Vazquez-Torres A, Balish E. Macrophages in Resistance to Candidiasis. Microbiol Molec Biol Rev 1997;61:170-192.

Renkema GH, Boot RG, Strijland A, Donker-Koopman WE, van den Berg M, Muijsers AO et al. Synthesis, sorting, and processing into distinct isoforms of human macrophage chitotriosidase. Eur J Biochem 1997;244: 279-285.

Boot RG, van Archterberg TA, van Aken BE, Renkema GH, Jacobs MJ, Aerts JM et al. Strong induction of members of the chitinase family of proteins in atherosclerosis: Chitotriosidase and human cartilage hp-39 expressed in lesion macrophages. Arterioscler Thromb Vasc Biol 1999;19:687-694.

Overdijk B, Van Steijn GJ, Odds FC. Distribution of chitinase in guinea pig tissues and increases in levels of

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this enzyme after systemic infection with Aspergillus fumigatus. Microbiology 1999; 145:259-269.

23. Blommaart E, van Weely S, Boot R, Aerts JM, Friedman

∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Û Ïԛ̈ÍË Candida albicans

BA. Chitotriosidase: A natural antifungal agent? (Abstract) 3rd Workshop European Working Group on Gaucher Disease, Lemnos 1999.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-03-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢Ú. EϤÓË MȯÂϷοÎË IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ NÔÛ/ÌÂ›Ô ¶·›‰ˆÓ "H AÁ›· ™ÔÊ›·", Aı‹Ó· 11527

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§ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Û ·È‰È¿ ¶·Ó·ÁÈÒÙ˘ ™˘Ú›‰Ë˜, EϤÓË M·ÏÙ¤˙Ô˘, ¢ËÌ‹ÙÚÈÔ˜ K·ÊÂÙ˙‹˜

● ¶ÂÚ›ÏË„Ë: ™ÙËÓ ·Ó·‰ÚÔÌÈ΋ ·˘Ù‹ ÌÂϤÙË ÂÍÂÙ¿ÛıËÎ·Ó Ù· ÎÏÈÓÈο Î·È ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ηıÒ˜ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ¤Î‚·ÛË ·È‰ÈÒÓ Ì Ïԛ̈ÍË ·fi ÕÙ˘· M˘ÎÔ‚·ÎÙËÚ›‰È· (A.M.). MÂÏÂÙ‹ıËÎ·Ó Ù· ÈÛÙÔÚÈο 52 ·È‰ÈÒÓ ËÏÈΛ·˜ 0-14 ÂÙÒÓ Ù· ÔÔ›· ÓÔÛËχıËÎ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 19821997 Ì Ïԛ̈ÍË ·fi AM ηٿ ÙÔ ‰Â‡ÙÂÚÔ ‹ÌÈÛ˘ Ù˘ ÌÂϤÙ˘ ‰È·ÁÓÒÛıËÎ·Ó 40 ·ÛıÂÓ›˜ (76,5%). Afi ÙÔ˘˜ 52 ·ÛıÂÓ›˜ ÔÈ 47 ›¯·Ó ÂÈÔÏ‹˜ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÙÚÂȘ Ó¢ÌÔÓÈ΋ Î·È ‰‡Ô ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ. TÔ M. Avium ‹Ù·Ó ÙÔ Î·ÙÂÍÔ¯‹Ó A.M. ÌÂٷ͇ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ. H ÔÚ›· ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ηıÒ˜ Î·È ÙÔ ÙÂÏÈÎfi ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤ÓÔ Ì ÙÔ ¯ÚfiÓÔ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÔηٿÛÙ·Û˘. OÈ ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈ΋ ÓfiÛÔ Â›¯·Ó Ôχ ηϋ ÔÚ›· Ì ÙË ¯ÔÚ‹ÁËÛË 3-4 ·ÓÙÈÊ˘Ì·ÙÈÎÒÓ Ê·Ú̿ΈÓ, ÂÓÒ ÔÈ ‰‡Ô ·ÛıÂÓ›˜ Ì ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ Î·Ù¤ÏËÍ·Ó Ì¤Û· ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ·Ú¿ ÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. ¶·È‰È·ÙÚÈ΋ 2000;63:314-318. §¤ÍÂȘ ÎÏÂȉȿ: ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ÏÂÌÊ·‰ÂÓ›Ùȉ·, M. Avium.

P. Spyridis, H. Maltezou, D. Kafetzis. Non-tuberculous mycobacterial lymphadenitis in children. Paediatriki 2000;63:314-318. ● Abstract: A study was made to review the clinical and epidemiological features, management and outcome associated with the development of non-tuberculous mycobacterial (NTM) infection in children. The medical records of all children aged 0-14 years with NTM infection diagnosed at the P. and A. Kyriakou Children's Hospital between January 1982 and December 1997 were reviewed. During the study period 52 such children were identified, in 76.5% of whom the diagnosis was made during the second half of the period studied. Of the 52 patients, 47 had lymphadenitis, 3 pulmonary and 2 disseminated disease. Mycobacterium avium complex was the predominant isolate in these cases. Satisfactory aesthetic results were achieved when total excision of the affected lymph nodes was perfomed within one month of the onset of NTM lymphadenitis. The outcome was good for the 3 patients with pulmonary disease, but the 2 patients with the disseminated form died. In conclusion NTM infection in children is being diagnosed in increasing frequency during the last decade. Prompt total excision of the involved lymph nodes is indicated for an optimal outcome.

Key words: non-tuberculous mycobacteria, lymphadenitis, M. Avium.

EÈÛ·ÁˆÁ‹ T· ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (A.M.) Â›Ó·È ıÂÙÈÎÔ› ηٿ gram ÔÍÂfiÊÈÏÔÈ ‚¿ÎÈÏÏÔÈ ÔÈ ÔÔ›ÔÈ ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ È‰È·›ÙÂÚ· ÛÙÔ ÓÂÚfi Î·È ÙË ÛÎfiÓË. T· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·˘Ù¿ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÚÈÓ ·fi ¤Ó·Ó ·ÈÒÓ·, ÂÓÙÔ‡ÙÔȘ ÌfiÓÔ ÌÂÙ¿ ÙÔ 1950 ¿Ú¯ÈÛ·Ó Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÛÔ‚·ÚÔ› ·ıÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ. Œ¯ÂÈ ÂÚÈÁÚ·Ê› ηٿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â˘Ú‡Ù·ÙÔ Ê¿ÛÌ· ÏÔÈÌÒÍÂˆÓ ·fi A.M.

ÛÙÔÓ ¿ÓıÚˆÔ, ·fi ÙËÓ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (΢ڛˆ˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÙÔ˘ ÙÚ·¯‹ÏÔ˘), ̤¯ÚÈ ÙËÓ ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ‰È·ÛÔÚ¿ Û ÔÏÏ¿ fiÚÁ·Ó·, Û ¿ÙÔÌ· Ì ·ÓÔÛÔηٷÛÙÔÏ‹. H ÙÂÏÂ˘Ù·›· ‰È·ÈÛÙÒÓÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÚfiÛÊ·Ù·, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÚfiÛÊÔÚÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÙÔ ÔÔ›Ô ·Ó·Ù‡ÛÛÂÙ·È Û ¿ÙÔÌ· Ì AIDS ‹ Û ÂÚÈÙÒÛÂȘ ηٷÛÙÔÏ‹˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·fi ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· (1,2).

B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, π·ÙÚÂ›Ô º˘Ì·ÙÈÒÛˆ˜ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. Î·È A. K˘ÚÈ·ÎÔ‡", °Ô˘‰›

314

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§ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·

™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÚÈÁÚ·ÊÔ‡Ó Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·ıÒ˜ Î·È Ë ¤Î‚·ÛË ·È‰ÈÒÓ Ì Ïԛ̈ÍË ·fi A.M. YÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ TÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó ·ÛıÂÓ›˜ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡", ËÏÈΛ·˜ 014 ÂÙÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÁÓÒÛıËΠÏԛ̈ÍË ·fi A.M. ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1982-1997. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ·ÛıÂÓ›˜ Ì ·ÔÌfiÓˆÛË A.M. Û ηٿÏÏËÏÔ ‰Â›ÁÌ· ·fi ÙÔ ÓÔÛÔ‡Ó Û‡ÛÙËÌ· ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ· Û ˘ÏÈÎfi LowensteinJensen ‹ Ì ÙË Ú·‰ÈÔÌÂÙÚÈ΋ ̤ıÔ‰Ô BACTEC. ™ÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ‰ÂÓ ·ÔÌÔÓÒıËΠA.M., Ë ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi A.M. ÛÙËÚ›¯ıËΠÛÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· Ë ÔÔ›· ‹Ù·Ó Û˘Ì‚·Ù‹ Ì Ïԛ̈ÍË ·fi Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ì ٷ˘Ùfi¯ÚÔÓË ¤ÏÏÂÈ„Ë Â·Ê‹˜ Ì ÂÓ‹ÏÈη Ê˘Ì·ÙÈÎfi, ·ÚÓËÙÈ΋ ‹ ·ÌÊ›‚ÔÏË Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË Mantoux, ·Ô˘Û›· ÚfiÛÊ·ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì BCG, Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη. T· ·ÓˆÙ¤Úˆ Ô‰ËÁÔ‡Ó Ì ·ÚÎÂÙ‹ ·ÛÊ¿ÏÂÈ· ÛÙË ‰È¿ÁÓˆÛË Ïԛ̈͢ ·fi A.M. 7 6 5 4 3 2

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

0

1982

1

∂ÈÎfiÓ· 1. K·Ù·ÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi ÕÙ˘· M˘ÎÔ‚·ÎÙËÚ›‰È· ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘.

AÔÙÂϤÛÌ·Ù· K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ηٷÁÚ¿ÊËÎ·Ó Û˘ÓÔÏÈο 52 ·È‰È¿ (26 ·ÁfiÚÈ·) Ì Ïԛ̈ÍË ·fi A.M. OÈ ÂÈ̤ÚÔ˘˜ ‰È·ÁÓÒÛÂȘ ÂÚÈÂÏ¿Ì‚·Ó·Ó: ÂÈÔÏ‹˜ ÏÂÌÊ·‰ÂÓ›Ùȉ· (47 ·È‰È¿), Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ (3 ·È‰È¿), Î·È ‰È¿¯˘ÙË Ïԛ̈ÍË (2 ·È‰È¿). ™˘ÓÔÏÈο, 12 ·È‰È¿ (23%) ‰È·ÁÓÒÛıËÎ·Ó ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 198289 Î·È Ù· ˘fiÏÔÈ· 40 (77%) ÛÙÔ ‰Â‡ÙÂÚÔ ‹ÌÈÛ˘ Ù˘ ÌÂϤÙ˘, 1991-1997 (∂ÈÎfiÓ· 1). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙËÓ Âԯȷ΋ ηٷÓÔÌ‹, ÙÔ 41% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ¿ÓÈÛ ٷ ÚÒÙ· ÛËÌ›· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ηٿ ÙËÓ ÕÓÔÈÍË. Afi ÙÔ ÈÛÙÔÚÈÎfi ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ÚÔ·ÙÔ˘Ó ·ÛÊ·Ï‹ ÛÙÔȯ›· ÁÈ· ÙËÓ ËÁ‹ ÌfiÏ˘ÓÛ˘ ÛÂ

¶›Ó·Î·˜ 1. KÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ (NÔ, %). ™ÎÏËÚfi˜ - ÎÈÓËÙfi˜ K·ıËψ̤ÓÔ˜ M·Ï·Îfi˜ (Z˘Ì҉˘) EÚ˘ıÚfiÙËÙ· KÏ˘‰·ÛÌfi˜ £ÂÚÌfi˜ ™˘Ú›ÁÁÈÔ ¶ÔÏÏ·Ï‹ ·˘ÙfiÌ·ÙË Ú‹ÍË

21 (45) 13 (28) 12 (26) 11 (23) 5 (11) 2 (4) 3 (6) 1 (2)

¶›Ó·Î·˜ 2. AÓ·ÙÔÌÈ΋ ı¤ÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ (No, %).

YÔÁÓ¿ıÈÔÈ ¶ÚfiÛıÈÔÈ ÙÚ·¯ËÏÈÎÔ› ¶ÚÔˆÙÈ·›ÔÈ BÔ˘‚ˆÓÈÎÔ› O›ÛıÈÔÈ ÙÚ·¯ËÏÈÎÔ› M·Û¯·ÏÈ·›ÔÈ

24 (51) 15 (32) 4 (9) 2 (4) 1 (2) 1 (2)

Â›Â‰Ô ÔÈÎÔÁ¤ÓÂÈ·˜, ¤ÎıÂÛË Û ˙Ò·, ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ‹ Ù·Í›‰È· Û ÂÚÈÔ¯¤˜ ÂÓ‰ËÌÈΤ˜ ÁÈ· A.M. H ̤ÛË ËÏÈΛ· ÙˆÓ 47 ·ÛıÂÓÒÓ Ì ÂÈÔÏ‹˜ ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi A.M. ‹Ù·Ó Ù· 3 ¤ÙË (4 Ì‹Ó˜ - 10 ¤ÙË).

H ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‰È·ÈÛÙÒıËΠηٿ ̤ÛÔÓ fiÚÔ 30 Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (1 Ë̤ڷ - 2 ¯ÚfiÓÈ·). £ÂÚÌÔÎÚ·Û›· 38o38,5oC ‰È·ÈÛÙÒıËΠ۠٤ÛÛÂÚȘ ·ÛıÂÓ›˜ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‹ Ï›ÁÔ ·ÚÁfiÙÂÚ· (1Ë-12Ë Ë̤ڷ). EÌÂÈÚÈ΋ ıÂÚ·›·, ΢ڛˆ˜ Ì ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈο ·ÓÙÈ‚ÈÔÙÈο, ¤Ï·‚·Ó 20/47 ·ÛıÂÓ›˜ (43%), ¯ˆÚ›˜ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË, ÂÓÒ Ì ÙËÓ ˘Ô„›· Ïԛ̈͢ ·fi M. Ê˘Ì·Ù›ˆÛ˘ 9/47 ·ÛıÂÓ›˜ (19%) ¤Ï·‚·Ó ·fi ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·ÙÚÔ‡˜ ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹. ∏ ·ÁˆÁ‹ ÂÚÈÂÏ¿Ì‚·Ó ÈÛÔÓÈ·˙›‰Ë Î·È ÚÈÊ·ÌÈΛÓË, ¯ˆÚ›˜ ˘Ô¯ÒÚËÛË Ù˘ ÏÂÌÊ·‰ÂÓÈ΋˜ ‰ÈfiÁΈÛ˘. H ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ ¯ÔÚËÁ‹ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·fi 12 Ë̤Ú˜ ¤ˆ˜ 12 Ì‹Ó˜ Ì ̤ÛË ‰È¿ÚÎÂÈ· 60 Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi A.M. ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‹ ÎÏÈÓÈο Â˘Ú‹Ì·Ù·. T· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ηٿ ÙËÓ ÚÔۤϢÛË ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÂÚȤ¯ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1, ÂÓÒ Ë ·Ó·ÙÔÌÈ΋ ı¤ÛË ÛÙÔÓ ›Ó·Î· 2. TÔ Ì¤ÛÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‹Ù·Ó 3x3 cm (1,5x1,5 ¤ˆ˜ 5x8 cm). ¢ÂÓ ‰È·ÈÛÙÒıËΠ‰ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ Û ¿ÏÏË ı¤ÛË ÏËÓ Ù˘ ·Ú¯È΋˜ ÚÔÛ‚ÔÏ‹˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜, C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË, TKE, ¤ÏÂÁ¯Ô Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· ÈÔ‡˜, Bartonella henselae

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EÈÎfiÓ· 2. A˘ÙfiÌ·ÙË Ú‹ÍË Î·È ·Ó¿Ù˘ÍË ¯ËÏÔÂȉԇ˜. Î·È Toxoplasma gondii Î·È ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi A.M. ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË ÌÂ Ê˘Ì·Ù›ÓË Lot 5180A πÓÛÙÈÙÔ‡ÙÔ˘ Pasteur-Merieux. TÔ Ì¤ÁÂıÔ˜ Ù˘ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·Û˘ Î˘Ì¿ÓıËΠ·fi 0-15 ¯ÈÏ. Ì ̤ÛË ÙÈÌ‹ Ù· 7 ¯ÈÏ. H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ.

OÈ ·ÛıÂÓ›˜ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ˘Ô‚Ï‹ıËÎ·Ó Û ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó ÔÏÈ΋ ·Ê·›ÚÂÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Û 40 ·ÛıÂÓ›˜, ·ÚÔ¯¤Ù¢ÛË ·ÔÛÙËÌ·ÙÔÔÈËı¤ÓÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Û ¤ÓÙ ·ÛıÂÓ›˜ Î·È Î·ı·ÚÈÛÌfi Î·È Ó·ÚÔÔ›ËÛË Â› ·˘ÙfiÌ·Ù˘ ڋ͢ ‹ ·Ó¿Ù˘Í˘ Û˘ÚÈÁÁ›Ô˘, Û ‰‡Ô.

H ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠηٿ ̤ÛÔ fiÚÔ Û 36 Ë̤Ú˜ ·fi ÙËÓ ·Ú¯È΋ ÂÌÊ¿ÓÈÛË Ù˘ ‰ÈfiÁΈÛ˘ (6 Ë̤Ú˜ - 2 ¯ÚfiÓÈ·). IÛÙÔÏÔÁÈ΋ ÂͤٷÛË ˘ÏÈÎÔ‡ ÏÂÌÊ·‰¤ÓÔ˜ ¤ÁÈÓ Û 42 ·fi ÙÔ˘˜ 47 ¯ÂÈÚÔ˘ÚÁËı¤ÓÙ˜ ·ÛıÂÓ›˜, fiÔ˘ ¢ڤıËÛ·Ó ·ÏÏÔÈÒÛÂȘ ¯ÚfiÓÈ·˜ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÓÂÎÚÒÛÂȘ Û˘Ì‚·Ù¤˜ Ì Ïԛ̈ÍË ·fi Ì˘ÎÔ‚·ÎÙËÚ›-

EÈÎfiÓ· 3. ¶·ÚÔ¯¤Ù¢ÛË ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ÂԇψÛË Î·Ù¿ ‰Â‡ÙÂÚÔ ÛÎÔfi.

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¶. ™˘Ú›‰Ë˜ Î·È Û˘Ó.

‰È·. K·ÏÏȤÚÁÂÈ· ÁÈ· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ¤ÁÈÓ Û 45 ·ÛıÂÓ›˜ Î·È ·¤‚Ë ıÂÙÈ΋ Û 40. AÔÌÔÓÒıËΠM. Avium complex Û 33 ·ÛıÂÓ›˜ Î·È M. Kansasii Û ÙÚÂȘ. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 4 ·ÛıÂÓ›˜ ‰ÂÓ Ù˘ÔÔÈ‹ıËΠÙÔ ¿Ù˘Ô Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ. H ‰È¿ÁÓˆÛË Ù˘ ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ԉ›¯ıËΠÌÈÎÚÔ‚ÈÔÏÔÁÈο Û 40 ·ÛıÂÓ›˜ ÂÓÒ ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ÂÙ¿ ÛÙËÚ›¯ıËΠÛÙË Û˘Ì‚·Ù‹ ÌÂ Ì˘ÎÔ‚·ÎÙËÚȉȷ΋ Ïԛ̈ÍË ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÌÈÎÚfiÙÂÚË ·fi 10 ¯ÈÏ. Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË, ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÙËÓ ¤ÏÏÂÈ„Ë Â·Ê‹˜ Ì ÂÓ‹ÏÈη Ê˘Ì·ÙÈÎfi Î·È Ù¤ÏÔ˜, ÙËÓ ·ÔηٿÛÙ·ÛË ¯ˆÚ›˜ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÊ˘Ì·ÙÈÎÒÓ Ê·Ú̿ΈÓ. ™ÙÔ˘˜ 13 ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·Û·Ó Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË ¿Óˆ ÙˆÓ 10 ¯ÈÏ. Ë ‰È¿ÁÓˆÛË Ù˘ ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ ·fi A.M. ÂȂ‚·ÈÒıËΠÌÈÎÚÔ‚ÈÔÏÔÁÈο. EÓ ·Ó·ÌÔÓ‹ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ηÏÏȤÚÁÂÈ·˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ, ¯ÔÚËÁ‹ıËΠ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó IÛÔÓÈ·˙›‰Ë Î·È PÈÊ·ÌÈΛÓË, Û 14 ·ÛıÂÓ›˜. ¢‡Ô ·ÛıÂÓ›˜ Ì M. Avium complex Î·È ¤Ó·˜ ·ÛıÂÓ‹˜ Ì M. Kansasii ¤Ï·‚·Ó ÙËÓ ·ÓˆÙ¤Úˆ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· 9 Ì‹Ó˜ Î·È 12 Ì‹Ó˜ ·ÓÙ›ÛÙÔȯ· ¯ˆÚ›˜ ·ÔÙ¤ÏÂÛÌ·, ÚÈÓ ÚÔÛ¤ÏıÔ˘Ó ÛÙÔ ÓÔÛÔÎÔÌ›Ô.

H ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi A.M. ‰È‹ÚÎÂÛ ·fi 6 Ì‹Ó˜ ¤ˆ˜ 2 ¤ÙË ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË. K·Ó›˜ ‰ÂÓ ÂÌÊ¿ÓÈÛ ÏÂÌÊ·‰ÂÓ›Ùȉ· Û ı¤ÛË ¿ÏÏË ÂÎÙfi˜ Ù˘ ·Ú¯È΋˜, Û ¤ÓÙ fï˜ ·ÛıÂÓ›˜ ¯ÚÂÈ¿ÛÙËΠӷ Á›ÓÂÈ Î·È ‰Â‡ÙÂÚË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Â›Ù ‰ÈfiÙÈ ‰ÂÓ Â›¯Â Á›ÓÂÈ ·Ê·›ÚÂÛË fiÏˆÓ ÙˆÓ ÚÔÛ‚ÏËı¤ÓÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (4 ·ÛıÂÓ›˜) ›Ù ÁÈ·Ù› ·Ó·Ù‡¯ıËΠÏÂÌÊ·‰ÂÓ›Ùȉ· ÛÙË ÁÂÈÙÓÈ¿˙Ô˘Û· ÂÚÈÔ¯‹ ÚÔ˜ ÙËÓ ·Ú¯È΋ (1 ·ÛıÂÓ‹˜).

H ‰Â‡ÙÂÚË Â¤Ì‚·ÛË ¤ÁÈÓ 3-4 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÚÒÙË. ™Â 43/47 ·ÛıÂÓ›˜ ÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙË ı¤ÛË Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â¤Ì‚·Û˘ ‹Ù·Ó Ôχ ηÏfi, ÂÓÒ Ù¤ÛÛÂÚȘ ·ÛıÂÓ›˜ ·Ó¤Ù˘Í·Ó ‰‡ÛÌÔÚÊË Ô˘Ï‹ (¯ËÏÔÂȉ¤˜) Î·È ÔÈ ÙÚÂȘ ·fi ·˘ÙÔ‡˜ ¯ÚÂÈ¿ÛıËΠӷ ·ÔηٷÛÙ·ıÔ‡Ó Ì ·ÈÛıËÙÈ΋ Â¤Ì‚·ÛË. O ̤ÛÔ˜ ¯ÚfiÓÔ˜ Ù˘ ·ÈÛıËÙÈ΋˜ ·˘Ù‹˜ ·ÔηٿÛÙ·Û˘ ‹Ù·Ó 5 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË.

OÈ 3 ·ÛıÂÓ›˜ (ËÏÈΛ·˜ 7, 10 Î·È 11 ÂÙÒÓ) Ì Ó¢ÌÔÓÈ΋ ÓfiÛÔ ·fi A.M. ¤·Û¯·Ó ·fi ˘ÔΛÌÂÓÔ ÓfiÛËÌ·: ϤÌʈ̷ Hodgkin (1 ·ÛıÂÓ‹˜), ‚·ÚÂÈ¿ Û˘Ó‰˘·Ṳ̂ÓË ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· (1) Î·È ·ÏÏÂÚÁÈÎfi ¿ÛıÌ· (1). ŒÓ·˜ ·ÛıÂÓ‹˜ ÂÏ¿Ì‚·ÓÂ Û˘ÛÙËÌ·ÙÈ΋ ·ÁˆÁ‹ Ì ÛÙÂÚÔÂȉ‹. K·È ÔÈ 3 ·ÛıÂÓ›˜ ›¯·Ó ÈÛÙÔÚÈÎfi ˘ÚÂÙÈ΋˜ ΛÓËÛ˘ ¤ˆ˜ 38,5oC Î·È ‚‹¯· ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó·. H Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·Û‹ ÙÔ˘˜ ‹Ù·Ó οو ÙˆÓ 10 ¯ÈÏÈÔÛÙÒÓ. OÈ 3 ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη Ë ÔÔ›· ¤‰ÂÈÍ Ô˙Ò‰ÂȘ ÛÎÈ¿ÛÂȘ, ‰È¿ÌÂÛ˜ ‰ÈËı‹ÛÂȘ Î·È ·ÙÂÏÂÎٷۛ˜ Û fiÏÔ˘˜.

H ηÏÏȤÚÁÂÈ· Á·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡ ¤‰ÂÈÍ M. Avium

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complex Î·È ÛÙÔ˘˜ 3 ·ÛıÂÓ›˜. K·Ó¤Ó·˜ ‰ÂÓ ¤Ï·‚ ÂȉÈ΋ ·ÁˆÁ‹ ηٿ A.M. ŒÓ·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ‰ÂÓ Â·Ó‹Ïı ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË. OÈ ¿ÏÏÔÈ 2 ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ·˘ÙfiÌ·ÙË ÎÏÈÓÈ΋ Î·È ·ÎÙÈÓÔÏÔÁÈ΋ ›·ÛË. MÂÙ¿ ·fi 2 Î·È 8 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ Â›Ó·È ˘ÁÈ›˜ Î·È ÂχıÂÚÔÈ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘Ì‚·ÙÒÓ Ì Ïԛ̈ÍË ·fi A.M. T· 2 ·È‰È¿ Ì ‰È¿¯˘ÙË Ïԛ̈ÍË ·fi A.M. (ËÏÈΛ·˜ 7 Î·È 11 ÂÙÒÓ) ¤·Û¯·Ó ·fi Û‡Ó‰ÚÔÌÔ Evans Î·È AIDS, ·ÓÙ›ÛÙÔȯ·. E›¯·Ó ˘ÚÂÙÈ΋ ΛÓËÛË ¤ˆ˜ 39,0oC ÁÈ· ¤Ó· Ì‹Ó·, ÂÓÒ ¤Ó·˜ ·fi ·˘ÙÔ‡˜ ÂÌÊ¿ÓÈ˙ ‰È¿¯˘Ù· ÎÔÈÏȷο ¿ÏÁË. K·È ÔÈ 2 ·ÛıÂÓ›˜ ›¯·Ó Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ŒÓ·˜ ·fi ·˘ÙÔ‡˜ ˘Ô‚Ï‹ıËΠ۠Á·ÛÙÚÔÛÎfiËÛË Ë ÔÔ›· ¤‰ÂÈÍ ‰È¿¯˘Ù˜ ‚Ï¿‚˜ ηٿ Ì‹ÎÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ¤‰ÂÈÍ·Ó M. Avium complex Î·È ÛÙÔ˘˜ 2 ·ÛıÂÓ›˜. E›Û˘, ·ÔÌÔÓÒıËΠ۠˘ÏÈÎfi ·fi ÙÔÓ ÔÈÛÔÊ¿ÁÔ (1 ·ÛıÂÓ‹˜), ÙÔ ÛÏ‹Ó· (1), Î·È ÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (1). K·È ÔÈ 2 ·ÛıÂÓ›˜ ¤Ï·‚·Ó ÔχÌËÓË ·ÁˆÁ‹ Ì 3 ‹ 4 Ê¿Ú̷η Ì ‰Ú¿ÛË Î·Ù¿ ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ ·˘ÙÔ‡, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘, fï˜ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË. K·È ÔÈ 2 ·ÛıÂÓ›˜ Ì ‰È¿¯˘ÙË Ïԛ̈ÍË ·fi A.M. η٤ÏËÍ·Ó Ì¤Û· Û 1 ¤ÙÔ˜ ·fi ÙË ‰È¿ÁÓˆÛ‹ Ù˘. ™˘˙‹ÙËÛË T· A.M. ‰È·‚ÈÔ‡Ó ÛÙÔ Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÓıÚÒÔ˘. H ÌfiÏ˘ÓÛË ÙÔ˘ ·ÓıÚÒÔ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ¤ÎıÂÛË Û ÛÎfiÓË Ë ÔÔ›· ÂÚȤ¯ÂÈ A.M. ‹ Ì ηٿÔÛË ‹ Î·È ¿ÌÂÛÔ ÂÌ‚ÔÏÈ·ÛÌfi ÛÙÔ ‰¤ÚÌ· (1,3).

H ÂÌÊ¿ÓÈÛË ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ fï˜ ÂÍ·ÚÙ¿Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ÍÂÓÈÛÙ‹ ¤Ó·ÓÙÈ Ù˘ ÌfiÏ˘ÓÛ˘ ·fi A.M. ™Ù· ·È‰È¿, Ë ÏÂÌÊ·‰ÂÓ›Ùȉ· ÙˆÓ ÂÈÔÏ‹˜ ÏÂÌÊ·‰¤ÓˆÓ ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ÂΉ‹ÏˆÛË, ȉȷ›ÙÂÚ· ÛÙȘ ËÏÈ˘ οو ÙˆÓ 5 ÂÙÒÓ (5). H Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË Ù˘ ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ ÙËÓ ÕÓÔÈÍË Ë ÔÔ›· ‰È·ÈÛÙÒıËΠÛÙË ÌÂϤÙË Ì·˜,

EÈÎfiÓ· 4. ¢ËÌÈÔ˘ÚÁ›· „˘¯ÚÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Ì ۇÁ¯ÚÔÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜.

§ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·

·ÔÙÂÏ› ‡ÚËÌ· ÙÔ ÔÔ›Ô ¤¯ÂÈ ·Ó·ÊÂÚı› Î·È Û ¿ÏÏË ÌÂϤÙË (6). O ¯ÚfiÓÔ˜ Ô ÔÔ›Ô˜ ÌÂÛÔÏ·‚› ÌÂٷ͇ Ù˘ ÌfiÏ˘ÓÛ˘ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜, Â›Ó·È ÏÔÁÈÎfi fï˜ Ó· ˘Ôı¤ÛÂÈ Î·Ó›˜ fiÙÈ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÌÔχÓÛÂˆÓ Û˘Ì‚·›ÓÂÈ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹Ó˜, fiÔ˘ Ù· ·È‰È¿ ¤Ú¯ÔÓÙ·È Û ÛÙÂÓfiÙÂÚË Â·Ê‹ Ì ÙÔ Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ (¯ÒÌ·, ÓÂÚfi).

H ÊÏÂÁÌÔÓ‹ ÙˆÓ ÂÈÔÏ‹˜ ÏÂÌÊ·‰¤ÓˆÓ ¤¯ÂÈ ˘ÔÍ›· ‹ ¯ÚfiÓÈ· ÔÚ›· Î·È ÚfiÁÓˆÛË Î·Ï‹, Ë ÔÔ›· fï˜ ÌÔÚ› Ó· ηٷϋÍÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›· Û˘ÚÈÁÁ›Ô˘ Â¿Ó ‰ÂÓ Á›ÓÂÈ ¤ÁηÈÚ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË (5). ™ÙË ÌÂϤÙË Ì·˜, ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÛıËÙÈο ηÎfi ·ÔÙ¤ÏÂÛÌ· ·ÊÔÚÔ‡Û·Ó ÂÚÈÙÒÛÂȘ fiÔ˘ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Î·ı˘ÛÙ¤ÚËÛ ¤ÓÙ ̋Ó˜ ηٿ ̤ÛÔ fiÚÔ ·fi ÙËÓ ·Ú¯È΋ ÂÌÊ¿ÓÈÛË Ù˘ ÏÂÌÊ·‰ÂÓÈ΋˜ ‰ÈfiÁΈÛ˘. AÓÙ›ıÂÙ·, ÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó Ôχ ηÏfi fiÙ·Ó Ë ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó ¿ÌÂÛË Î·È ¿ÓÙˆ˜ fi¯È ¤Ú·Ó ÙÔ˘ ÂÓfi˜ ÌËÓfi˜.

Afi ÙË ÌÂϤÙË Ì·˜ Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÛÔ‚·Ú¤˜ ˘Ô„›Â˜ fiÙÈ ÙÔ ·›ÙÈÔ Ù˘ ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ Â›Ó·È Ù· A.M., Â›Ó·È ÂÈÙ·ÎÙÈ΋ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙfiÛÔ ÙˆÓ ÂÌÊ·ÓÒ˜ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ, fiÛÔ Î·È ÙˆÓ ‡ÔÙˆÓ ¤ÚÈÍ Ù˘ ‚Ï¿‚˘. H ÚfiÛÊ·ÙË ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÓÂÒÙÂÚˆÓ Ì·ÎÚÔÏȉÒÓ ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋ ıÂÚ·›· ¤Ó·ÓÙÈ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ê·›ÚÂÛ˘ Â›Ó·È ÂÏȉÔÊfiÚÔ˜, ‰ÂÓ ˘¿Ú¯ÂÈ fï˜ Â·Ú΋˜ ÂÌÂÈÚ›· (7,8). E›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ù· Û˘Ó‹ıË ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η, fiˆ˜ Ê·›ÓÂÙ·È Î·È ·fi ÙË ÌÂϤÙË Ì·˜, ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙËÓ ÔÚ›· ÙˆÓ ÏÂÌÊ·‰ÂÓ›ÙȉˆÓ ·fi A.M. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ÌfiÓÔ ÔÈ ÏÂÌÊ·‰ÂÓ›Ùȉ˜ ÔÈ Ôԛ˜ ÌÈÎÚÔ‚ÈÔÏÔÁÈο ‹ ÈÛÙÔÏÔÁÈο ·ԉ›¯ıËΠfiÙÈ ÔÊ›ÏÔÓÙ·È Û A.M., Ê·›ÓÂÙ·È fï˜ fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË.

E›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Ù· ÙÚ›· ٤ٷÚÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·ÙÂÁÚ¿ÊËÛ·Ó Î·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‹ÌÈÛ˘ Ù˘ ÌÂϤÙ˘ Ì·˜. AÍÈÔÛËÌ›ˆÙË ·‡ÍËÛË ÏÔÈÌÒÍÂˆÓ ·fi A.M. ‰È·ÈÛÙÒÓÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, fiˆ˜ Ê·›ÓÂÙ·È Î·È ·fi ÌÂϤÙ˜ Û ¿ÏϘ ¯ÒÚ˜. A˘Ù‹ Ë ·‡ÍËÛË ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ·Ó·˙‹ÙËÛË ÏÔÈÌÒÍÂˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û A.M., fï˜ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ú¤ÂÈ Ó· ·›˙ÂÈ Â›Û˘ Ë ·˘ÍË̤ÓË ÏÔÈÌÔÁfiÓÔ˜ ÈηÓfiÙËÙ· ÙˆÓ A.M. Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ηıÒ˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ (5,9,10). O ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û M. Avium complex ¤Ó·ÓÙÈ ÙˆÓ ¿ÏÏˆÓ Ì˘ÎÔ‚·ÎÙËÚȉ›ˆÓ Î·È Î˘Ú›ˆ˜ ÙÔ˘ M. Scrufolaceum ÙfiÛÔ ÛÙË ‰È΋ Ì·˜ fiÛÔ Î·È Û ¿ÏϘ ÌÂϤÙ˜, ÙÔÓ›˙ÂÈ ÙȘ ÔÈÎÔÏÔÁÈΤ˜ ·˘Ù¤˜ ÌÂÙ·‚ÔϤ˜ (4,6). ™Ù· ·È‰È¿ Ë Ó¢ÌÔÓÈ΋ ÂÓÙfiÈÛË Ïԛ̈͢ ·fi A.M. Â›Ó·È Û¿ÓÈ· ÂÎÙfi˜ ·fi ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ÈÓÒ‰Ë Î˘ÛÙÈ΋ ÓfiÛÔ. TÔ M. Avium complex Î·È ÙÔ M.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:314-318

Kansasii Â›Ó·È Ù· ϤÔÓ ˘‡ı˘Ó· ÁÈ· ÙËÓ ÚfiÎÏËÛË Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘. ¶Ú¿ÁÌ·ÙÈ, ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË ÌfiÓÔ 3 ·fi Ù· 52 ·È‰È¿ ›¯·Ó Ó¢ÌÔÓÈ΋ ÂÓÙfiÈÛË Ù˘ Ïԛ̈͢ ·fi A.M. (1). ™Ù· ·È‰È¿ ·˘Ù¿ Û˘Ó‹ıˆ˜ ÚÔ¸¿Ú¯ÂÈ Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ÙÔ˘ Ù‡Ô˘ Ù˘ ¯ÚfiÓÈ·˜ ·ÔÊÚ·ÎÙÈ΋˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ Î·È ÈÓÒ‰Ô˘˜ ΢ÛÙÈ΋˜ ÓfiÛÔ˘. T· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯ÚfiÓÈÔ ‚‹¯·, ¯·ÌËÏ‹ ˘ÚÂÙÈ΋ ΛÓËÛË, ·ÓÔÚÂÍ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. T· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Û˘Ó›ÛÙ·ÓÙ·È Û ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ, Ï¢ڛÙȉ·, ‡ÎÓˆÛË, Î·È fi˙Ô˘˜ ¯ˆÚ›˜ ÂÈÎfiÓ· ÛËÏ·›Ô˘ (11). ™ÙË ·ÚÔ‡Û· ÌÂϤÙË, fiÏ· Ù· ·È‰È¿ Ì Ó¢ÌÔÓÈ΋ ÓfiÛÔ ·fi A.M. ›¯·Ó ˘ÔΛÌÂÓÔ ÓfiÛËÌ· Î·È ·Ó¿ÏÔÁ· ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·.

H ‰È¿¯˘ÙË Ïԛ̈ÍË ·fi A.M. Û˘Ó·ÓÙ¿Ù·È Ôχ Û¿ÓÈ· ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ·ÎfiÌË Î·È Û ·È‰È¿ Ì ‚·ÚÈ¿ ·ÓÔÛÔηٷÛÙÔÏ‹, fiˆ˜ Ë ‚·ÚÈ¿ Û˘Ó‰˘·Ṳ̂ÓË ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Î·È Î·ÎÔ‹ıÂȘ ˘fi ¯ËÌÂÈÔıÂÚ·›·. TÔÓ›˙ÂÙ·È ¿ÓÙˆ˜, fiÙÈ Ë ·ÔÌfiÓˆÛË ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ ·fi ÛÙ›Ú˜ ÂÚÈÔ¯¤˜, fiˆ˜ Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ ·›Ì·, Â›Ó·È ‰È·ÁÓˆÛÙÈΤ˜ (12). ¶·Ú¿ ÙË ¯ÔÚ‹ÁËÛË ÔÏÏ·ÏÒÓ Î·È Ì·ÎÚÔ¯ÚfiÓÈˆÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ, Ë ÚfiÁÓˆÛË Â›Ó·È ‰˘ÛÌÂÓ¤ÛÙ·ÙË Î·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÚÈıÌËÙÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ·ÓÔÛÔÏÔÁÈ΋ Â¿ÚÎÂÈ· ÙˆÓ ·ÛıÂÓÒÓ (2,12). OÈ ‰˘Ô ÂÚÈÙÒÛÂȘ ‰È¿¯˘Ù˘ ÓfiÛÔ˘ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ÊÔÚÔ‡Û·Ó ‚·ÚÈ¿ ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿ Ù· ÔÔ›· η٤ÏËÍ·Ó Ì¤Û· Û ¤Ó· ¤ÙÔ˜ ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ÏÔÈÌÒÍÂȘ ·È‰ÈÒÓ ·fi A.M. ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ÌÂ Û˘ÓËı¤ÛÙÂÚË ÂÓÙfiÈÛË ÙÔ˘˜ ÂÈÔÏ‹˜ ÏÂÌÊ·‰¤Ó˜. OÚÈÛÙÈ΋ χÛË ÛÙÔ Úfi‚ÏËÌ· ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ¤ÁηÈÚË ÔÏÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ, Ë ÔÔ›· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÓÙfi˜ ÙÔ˘ ÚÒÙÔ˘ ÌËÓfi˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÏÂÌÊ·‰ÂÓÈ΋˜ ÚÔÛ‚ÔÏ‹˜. H ηı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ô‰ËÁ› ÛÙË ‰ËÌÈÔ˘ÚÁ›· „˘¯ÚÒÓ ·ÔÛÙËÌ¿ÙˆÓ, ·˘ÙÔÌ¿ÙˆÓ Ú‹ÍÂˆÓ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È Ù¤ÏÔ˜ ÛÙË ‰ËÌÈÔ˘ÚÁ›· Â›ÌÔÓˆÓ Û˘ÚÈÁÁ›ˆÓ Î·È ‰‡ÛÌÔÚÊˆÓ Ô˘ÏÒÓ. ™Â ·È‰È¿ Ì Ó¢ÌÔÓÈ΋ ÂÓÙfiÈÛË Ù· ÔÔ›· Â›Ó·È Û ηϋ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË, Ë ÎÏÈÓÈ΋ Î·È ·ÎÙÈÓÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÙË Ï‡ÛË. ÿÛˆ˜ ·Ô‰Âȯı› fiÙÈ ÔÈ ÓÂfiÙÂÚ˜ Ì·ÎÚÔÏ›‰Â˜ Â›Ó·È ¯Ú‹ÛÈ̘. H ÂÌÊ¿ÓÈÛË ‰È¿¯˘Ù˘ ÓfiÛÔ˘ Û ·È‰È¿ Ì ·ÓÔÛÔηٷÛÙÔÏ‹ ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË.

¶. ™˘Ú›‰Ë˜ Î·È Û˘Ó.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Resp Dis 1979;119:107-59.

2. Lincoln EM, Gilbert LA. Disease in children due to mycobacteria other than Mycobacterium tuberculosis. Am Rev Resp Dis 1972;105:683-714.

3. Pattz EF, Swensen SJ, Erasmus J. Pulmonary manifestations of nontuberculous mycobacterium. Radiol Clin North Am 1995;33:719-29.

4. O’ Brienn RJ, Geiter LJ, Snider DE. The epidemiology of nontuberculous mycobacterial diseases in the United States. Am Rev Respir Dis 1987;135:1007-14.

5. Starke JR, Correa AG. Management of mycobacterial infection and disease in children. Pediatr Infect Dis J 1995;14:455-70.

6. Wolinsky E. Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with longterm follow-up. Clinic Infect Dis 1995;20:954-63.

7. Tessier MH, Amoric JC, Mechinaud F, Dubesset D, Litoux P, Stalder JF. Clarithromycin for atypical mycobacterial lymphadenitis in non-immunocompromised children.

Lancet 1994;344:1778.

8. Berger C, Pfyffer GE, Nadal D. Treatment of nontuberculous mycobacterial lymphadenitis with clarithromycin plus rifabutin. J Pediatr 1996;128:383-6.

9. Iseman MD. Mycobacterium avium complex and the normal host. N Engl Med J 1989;321:869-8.

10. Romanus V, Hallander HO, Wahlen P, Olinder - Nielsen AM, Magnusson PH, Juhlin I. Atypical mycobacteria in extrapulmonary disease among children. Incidence in Sweden from 1969 through 1990, related to changing BCG - vaccination coverage. Tubercle Lung Dis 1995;76:300-10.

11. American Thoracic Society: Diagnosis and treatment of disease caused by non-tuberculous mycobacteria. Am J Respir Crit Care Med 1997;156:1-25.

12. Stone A, Schelonka R, Drehner D, Ascher D. Disseminated M. avium complex in non-human immunodeficiency virus-infected pediatric patients.

Pediatr Infect Dis J 1992;11:960-964.

™ËÌ›ˆÛË: M¤ÚÔ˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ¤¯ÂÈ ‰ËÌÔÛÈ¢ı› ÛÙÔ ÂÚÈÔ‰ÈÎfi Pediatr Infect Dis J 1999;18:968-70.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 25-10-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙ˘ ™˘Ú›‰Ë˜, E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ B’ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. Î·È A. K˘ÚÈ·ÎÔ‡" £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, 115 27, Aı‹Ó·

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µP∞XEIA ¢HMO™π∂À™H

EÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Û ‚Ú¤ÊË AÌ·Ï›· TÛÈÏÈÌÈÁοÎË, AÓÙˆÓ›· M·ÓÔ˘Ú¿, £ÂÔÊ·Ó‹ TÛÂÎÔ˘Ú¿, B·ÛÈÏÈ΋ AÁÁÂÏ¿ÎÔ˘, AıËÓ¿ ™¯ÔÈÓ¿ÎË, ¶·Ó·ÁÈÒÙ˘ ™Ù·ÛÈÓfi˜, §¿ÌÚÔ˜ ¶ÏÔ˘Ì›‰Ë˜ ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜, Ë ÌÂϤÙË Ù˘ ÂͤÏÈ͢ ÙÔ˘˜ Î·È Ë ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ·ÓÙÈÌÂÙÒÈÛË ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜. YÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 48 ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ÌÈÎÚfiÙÂÚ· ÙÔ˘ ¤ÙÔ˘˜, Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi È·ÙÚÂ›Ô Û ÌÈ· ‰ÈÂÙ›·, Î·È ÛÙ· ÔÔ›· ‰È·ÈÛÙÒıËΠÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Û·Ó ÌÔÓ‹Ú˘ ηډȷ΋ ‚Ï¿‚Ë. H ‰È¿ÁÓˆÛË ¤ÁÈÓ Ì ˯ÔηډÈÔÁÚ¿ÊËÌ· M-mode, ‰‡Ô ‰È·ÛÙ¿ÛÂˆÓ Î·È ¤Á¯ÚˆÌÔ Doppler. ¢È·ÈÛÙÒıËΠfiÙÈ 41 ‚Ú¤ÊË (85,5%) ›¯·Ó ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘, 6 ‚Ú¤ÊË (12,5%) ›¯·Ó ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë Î·È 1 ‚Ú¤ÊÔ˜ (2%) ›¯Â ˘ÔÓ¢ÌÔÓÈ΋ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·Ú·ÙËÚ‹ıËΠ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË Û 20 ‚Ú¤ÊË (41,6%) Ì ÌÈÎÚ‹ Ì˘˚΋ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. K·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ·ÚÔ˘Û›·Û·Ó 5 ‚Ú¤ÊË (10,4%) Î·È 3 ‚Ú¤ÊË (6,2%) Ì ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì˘˚΋ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚË ·fi ÙËÓ ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë. A˘Ùfi Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÓÙfiÈÛ˘ ÙˆÓ ÌÈÎÚÒÓ Ì˘˚ÎÒÓ ÌÂÛÔÎÔÈÏÈ·ÎÒÓ ÂÈÎÔÈÓˆÓÈÒÓ Ì ÙËÓ Â˘Ú›· ¯Ú‹ÛË Ù˘ ˘ÂÚ˯ÔηډÈÔÁÚ·Ê›·˜ ÛÙÔÓ ¤ÏÂÁ¯Ô ‚ÚÂÊÒÓ Ì Èı·Ó‹ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·. ¶·È‰È·ÙÚÈ΋ 2000;63:319-321. §¤ÍÂȘ ÎÏÂȉȿ: ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, ˘ÂÚ˯ÔηډÈÔÁÚ·Ê›·, ‚ÚÂÊÈ΋ ËÏÈΛ·.

A. Tsilimingaki, A. Manoura, T. Tsekoura, V. Angelakou, A. Schinaki, P. Stasinos, L. Ploumidis. A study of ventricular septal defects in the first year of life. Paediatriki 2000;63:319-321. ● Abstract: A ventricular septal defect (VSD) as a single cardiac lesion was detected in 48 infants aged less than one year between January 1995 and February 1997. The diagnosis was made by two-dimensional echocardiography and Doppler colour flow mapping. Forty-one infants (85.5%) had a muscular septal defect, six (12.5%) a perimembranous defect and one (2%) a subpulmonary defect. Within the observation period spontaneous closure occurred in 20 small muscular septal defects (41.6%) while infants with a perimembranous VSD needed surgical closure of the defect. Congestive heart failure developed in five infants (10.4%). Muscular VSD seems to be a much more common than finding perimembranous VSD. This is probably a consequence of the detection of small muscular VSDs following the introduction of echocardiography as a standard method for investigating suspected congenital heart defects.

Key words: ventricular septal defect, echocardiography, infants.

H ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ 20-30% ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È, Ì ÂÍ·›ÚÂÛË ÙË ‰ÈÁÏÒ¯ÈÓ·-·ÔÚÙÈ΋ ‚·Ï‚›‰·, Â›Ó·È Ë ÈÔ Û˘¯Ó‹ Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·.(1-6) AӷʤÚÔÓÙ·È 1,53,5 ÂÚÈÙÒÛÂȘ ÛÙ· 1000 ˙ÒÓÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Î·È 4,5-7 ÛÙ· 1000 ÚfiˆÚ·.(1,7) øÛÙfiÛÔ, Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ÌÂÈÒÓÂÙ·È Û 1 ÛÙ· 1000 ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È 0,5 Û 1000 ÂÓ‹ÏÈΘ.(2) H ÚÔԉ¢ÙÈ΋ ·˘Ù‹ Ì›ˆÛË ·ÓÙ·Ó·ÎÏ¿ ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ ¿ıË-

Û˘ ·ÊÔ‡ ·Ú·ÙËÚÂ›Ù·È ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÛÙÔ 25-50%, ÂÓÒ ÔÈ ÌÈÎÚ¤˜ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜ Û˘ÁÎÏ›ÓÔ˘Ó ·˘ÙfiÌ·Ù· Û ÔÛÔÛÙfi Ô˘ ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 80%. (1,3,4,7-11) H ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·˘ÙfiÌ·ÙˆÓ Û˘ÁÎÏ›ÛÂˆÓ Û˘Ì‚·›ÓÂÈ ÛÙ· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ Î·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 8 ¯ÚfiÓˆÓ, ¤¯ÂÈ ÂÈÙÂÏÂÛÙ› ÙÔ 90% ÙˆÓ Û˘ÁÎϛۈÓ.(1,2,8) H ˯ÔηډÈÔÁÚ·Ê›· ‰‡Ô ‰È·ÛÙ¿ÛÂˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ ·ÏÌÈÎfi Î·È Û˘Ó¯¤˜ Doppler ˯Ô-

B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ BÂÓÈ˙ÂÏ›Ԣ NÔÛÔÎÔÌ›Ԣ HÚ·ÎÏ›Ԣ KÚ‹Ù˘

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ηډÈÔÁÚ¿ÊËÌ· Î·È ÙÔ ¤Á¯ÚˆÌÔ Doppler ¤¯Ô˘Ó ηıÈÂÚˆı› ˆ˜ ̤ıÔ‰Ô˜ ‰È¿ÁÓˆÛ˘ Î·È ÂÓÙfiÈÛ˘ Ù˘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜, ·ÏÏ¿ Î·È ˆ˜ ̤ÛÔ ÂÎÙ›ÌËÛ˘ ÙˆÓ ·ÈÌÔ‰˘Ó·ÌÈÎÒÓ Û˘ÓÂÂÈÒÓ, ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Î·ıÒ˜ Î·È ÂÓÙfiÈÛ˘ Ù˘¯fiÓ ÂÈÏÔÎÒÓ Ù˘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜. (3,12,13) ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÂÈÚ›· ‰˘Ô ÂÙÒÓ ·fi 48 ÂÚÈÙÒÛÂȘ ‚ÚÂÊÒÓ Ô˘ ‰È·ÁÓÒÛÙËÎ·Ó Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÙÔ˘ BÂÓÈ˙¤ÏÂÈÔ˘ °ÂÓÈÎÔ‡ NÔÛÔÎÔÌ›Ԣ KÚ‹Ù˘.

YÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ YÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó Ù· 48 ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ÌÈÎÚfiÙÂÚ· ÙÔ˘ ¤ÙÔ˘˜, 19 ·ÁfiÚÈ· Î·È 29 ÎÔÚ›ÙÛÈ·, Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ·È‰›·ÙÚÔ˘˜ ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi È·ÙÚ›Ô, Û ‰È¿ÛÙËÌ· 2 ÂÙÒÓ, ÁÈ· ¤ÏÂÁ¯Ô ηډȷÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ Î·È ÛÙ· ÔÔ›· ‰È·ÁÓÒÛÙËΠÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, Û·Ó ÌÔÓ‹Ú˘ ηډȷ΋ ‚Ï¿‚Ë. H ‰È¿ÁÓˆÛË ¤ÁÈÓ Ì ˯ÔηډÈÔÁÚ¿ÊËÌ· M-mode, ‰‡Ô ‰È·ÛÙ¿ÛÂˆÓ Î·È ¤Á¯ÚˆÌÔ Doppler Ì Ì˯¿ÓËÌ· Hewlett-Packard Sonos 1000. °È· ÙË Ï‹„Ë ÙˆÓ Ë¯ÔηډÈÔÁÚ·ÊËÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠ˯ԂfiÏÔ˜ ÎÂÊ·Ï‹ 5 MHz. OÈ Ï‹„ÂȘ ¤ÁÈÓ·Ó ·fi ÙËÓ ˘ÔÍÈÊÔÂȉ‹, ÙËÓ ÎÔÚ˘Ê·›·, ÙËÓ ·Ú·ÛÙÂÚÓÈ΋ Î·È ÙËÓ ˘ÂÚÛÙÂÚÓÈ΋ ı¤ÛË. MÈ· Ù˘È΋ Û˘ÛÙÔÏÈ΋ ÚÔ‹ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ì ÙÔ ¤Á¯ÚˆÌÔ Î·È ÙÔ ·ÏÌÈÎfi Doppler ¤ıÂÙ ÙË ‰È¿ÁÓˆÛË Ù˘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜. K·ıÔÚ›ÛÙËÎ·Ó Ë ı¤ÛË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ Ô˘ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë, Ì˘˚ο, ˘Ô·ÚÙËÚȷο Î·È ÂÏÏ›ÌÌ·Ù· ÂÈÛfi‰Ô˘. TÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ ηıÔÚ›ÛÙËΠ·Ó¿ÏÔÁ· Ì ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÔÚÙÈ΋˜ Ú›˙·˜. MÂÁ¿Ï· ıˆڋıËÎ·Ó Ù· ÂÏÏ›ÌÌ·Ù· fiÙ·Ó ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ ÏËÛ›·˙ ÙË ‰È¿ÌÂÙÚÔ Ù˘ ·ÔÚÙÈ΋˜ Ú›˙·˜, ̤ÙÚÈ·, fiÙ·Ó ‹Ù·Ó ·fi ÙÔ 1/3 ¤ˆ˜ Ù· 2/3 Ù˘ ·ÔÚÙÈ΋˜ Ú›˙·˜ Î·È ÌÈÎÚ¿, ·˘Ù¿ Ô˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚ· ·fi ÙÔ 1/3 Ù˘ ‰È·Ì¤ÙÚÔ˘.

H ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ‚ÚÂÊÒÓ Û˘Ó¯›ÛÙËΠ̤¯ÚÈ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ‹˜. ŸÏ· Ù· ‚Ú¤ÊË Â·ÓÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi È·ÙÚ›Ô, Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ¿ıËÛ‹˜ ÙÔ˘˜. £ÂˆÚ‹ıËΠfiÙÈ Â‹Ïı ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜ fiÙ·Ó ÙÔ Ê‡ÛËÌ· ‰ÂÓ ‹Ù·Ó È· ·ÎÔ˘ÛÙfi. H Û‡ÁÎÏÂÈÛË ÂȂ‚·ÈÒıËΠ˘ÂÚ˯ÔÁÚ·ÊÈο.

MfiÓÔ Ù¤ÛÛÂÚ· ·fi Ù· 48 ‚Ú¤ÊË, ¯ÚÂÈ¿ÛÙËΠӷ ·Ú·ÂÌÊıÔ‡Ó Û ·È‰ÔηډÈÔÏÔÁÈÎfi ΤÓÙÚÔ Ù˘ Aı‹Ó·˜, fiÔ˘ Ù· 3 ˘Ô‚Ï‹ıËÎ·Ó Û ηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË.

AÔÙÂϤÛÌ·Ù· Afi Ù· 48 ‚Ú¤ÊË Ì ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, ÛÙ· 24 (50%) Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË

320

A. TÛÈÏÈÌÈÁοÎË Î·È Û˘Ó.

ÙˆÓ 4 ‚‰ÔÌ¿‰ˆÓ, Ì ̤ÛË ËÏÈΛ· 9 Ë̤Ú˜. ™Ù· ˘fiÏÔÈ· 24, ¤ÁÈÓ Û ËÏÈΛ· ·fi 1 ¤ˆ˜ 12 ÌËÓÒÓ, Ì ̤ÛË ËÏÈΛ· 4,5 Ì‹Ó˜. ¢È·ÈÛÙÒıËΠfiÙÈ 41 ‚Ú¤ÊË (85,5%) ›¯·Ó ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘, 6 ‚Ú¤ÊË (12,5%) ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Î·È 1 ‚Ú¤ÊÔ˜ (2%) ˘Ô·ÚÙËÚȷ΋ (˘ÔÓ¢ÌÔÓÈ΋). ŒÏÏÂÈÌÌ· ÂÈÛfi‰Ô˘ ‰ÂÓ ‰È·ÈÛÙÒıËΠ۠ηӤӷ ·fi Ù· ‚Ú¤ÊË. Afi Ù· 41 ‚Ú¤ÊË Ì ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘, Ù· 40 ›¯·Ó ÌÈÎÚ¿ Î·È Ôχ ÌÈÎÚ¿ ÂÏÏ›ÌÌ·Ù· Î·È 1 ›¯Â ̤ÙÚÈÔ˘ ÌÂÁ¤ıÔ˘˜ ¤ÏÏÂÈÌÌ·. T· 6 ‚Ú¤ÊË Ì ÙȘ ÂÚÈÌÂÌ‚Ú·ÓÒ‰ÂȘ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜ Î·È ÙÔ 1 ‚Ú¤ÊÔ˜ Ì ÙËÓ ˘Ô·ÚÙËÚȷ΋ ÂÈÎÔÈÓˆÓ›· ›¯·Ó ̤ÙÚÈÔ˘ Î·È ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÂÏÏ›ÌÌ·Ù·.

A˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË ·Ú·ÙËÚ‹ıËΠ۠20 ·È‰È¿ (41,6%), fiÏ· Ì ÌÈÎÚ‹ ‹ Ôχ ÌÈÎÚ‹ Ì˘˚ÎÔ‡ Ù‡Ô˘ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. K·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ·ÚÔ˘Û›·Û·Ó 5 ‚Ú¤ÊË (10,4%), ·fi Ù· ÔÔ›· 1 ›¯Â Ì˘˚ÎÔ‡ Ù‡Ô˘ ¤ÏÏÂÈÌÌ· Î·È 4 ÂÚÈÌÂÌ‚Ú·Ó҉˜. T· ‚Ú¤ÊË ·˘Ù¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ¯ÔÚ‹ÁËÛË ‰ÈÁÔ͛Ӣ, ÊÔ˘ÚÔÛÂÌ›‰Ë˜ Î·È Î·ÙÔÚ›Ï˘ ηٿ ÂÚ›ÙˆÛË. TÚ›· ·fi Ù· ‚Ú¤ÊË ·˘Ù¿ (6,2%) ÙÔ˘ Û˘ÓfiÏÔ˘) Ì ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË, Ù· 2 ÏfiÁˆ ÌË ·ÓÙÈÚÚÔÔ‡ÌÂÓ˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÙÔ 1 ÏfiÁˆ ÛÔ‚·Ú‹˜ ˘ÔÓ¢ÌÔÓÈ΋˜ ÛÙ¤ÓˆÛ˘. ™˘˙‹ÙËÛË TÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· ÌÔÚ› Ó· ¯ˆÚÈÛÙ› Û ÌÂÌ‚Ú·Ó҉˜ Î·È ÛÂ Ì˘˚Îfi, Ì ÙÚÂȘ Û˘ÓÈÛÙÒÛ˜: ÙÔ Ì˘˚Îfi ‰È¿ÊÚ·ÁÌ· ÂÈÛfi‰Ô˘, ÙÔ ‰ÔÎȉ҉˜ ‰È¿ÊÚ·ÁÌ· Î·È ÙÔ ‰È¿ÊÚ·ÁÌ· ÂÍfi‰Ô˘.(2,11) OÈ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜ (MKE) Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÎÔÓÙ¿ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÌ‚Ú·ÓÒ‰Ô˘˜ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, οو ·fi ÙËÓ ·ÔÚÙÈ΋ ‚·Ï‚›‰·, ÔÓÔÌ¿˙ÔÓÙ·È ÂÚÈÌÂÌ‚Ú·ÓÒ‰ÂȘ Î·È Â›Ó·È Û˘Ó‹ıˆ˜ ÌÔÓ‹ÚÂȘ. ŸÙ·Ó ÙÔ ¤ÏÏÂÈÌÌ· ÂÚÈ‚¿ÏÏÂÙ·È ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ·fi Ù· Ì˘˚ο Û˘ÛÙ·ÙÈο ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ÚfiÎÂÈÙ·È ÁÈ· ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘. ŸÙ·Ó Ï›ÂÈ ÙÂÏ›ˆ˜ ÙÔ ‰È¿ÊÚ·ÁÌ· ÂÍfi‰Ô˘ Î·È ÙÔ ¤ÏÏÂÈÌÌ· ‚Ú›ÛÎÂÙ·È ·ÎÚÈ‚Ò˜ οو ·fi ÙËÓ Ó¢ÌÔÓÈ΋ Î·È ÙËÓ ·ÔÚÙÈ΋ ‚·Ï‚›‰·, Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÔÓÔÌ¿˙ÂÙ·È ˘Ô·ÚÙËÚȷ΋. TÔ ¤ÏÏÂÈÌÌ· Ô˘ ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙË ‰È·ÊÚ·ÁÌ·ÙÈ΋ Áψ¯›Ó· Ù˘ ÙÚÈÁÏÒ¯ÈÓ·˜ ‚·Ï‚›‰·˜ Î·È ›Ûˆ Î·È Î¿Ùˆ ·fi Ù· ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÂÏÏ›ÌÌ·Ù·, ÔÓÔÌ¿˙ÂÙ·È ¤ÏÏÂÈÌÌ· ÂÈÛfi‰Ô˘.(1,2,11,12) ™ÙË ÌÂϤÙË Ì·˜, ÔÈ ÂÚÈÌÂÌ‚Ú·ÓÒ‰ÂȘ MKE ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÌfiÓÔ ÙÔ 12,5%, ÂÓÒ ÙÔ 85,5% ·ÔÙÂÏÔ‡Ó ÔÈ Ì˘˚ÎÔ‡ Ù‡Ô˘ MKE. T· ÔÛÔÛÙ¿ ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, fiÔ˘ Û˘¯ÓfiÙÂÚ˜ Â›Ó·È ÔÈ Ì˘˚ÎÔ‡ Ù‡Ô˘ MKE ÌÂ Û˘¯ÓfiÙËÙ· 51-85%.(35,14) K·Ó¤Ó· ·fi Ù· ‚Ú¤ÊË ÌÂ Ì˘˚ÎÔ‡ Ù‡Ô˘ ¤ÏÏÂÈÌÌ· ‰ÂÓ ¯ÚÂÈ¿ÛÙËΠ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË Î·È ÌfiÓÔ 1

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:319-321

·fi Ù· 41 ·ÚÔ˘Û›·Û ÛËÌ›· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. AÓÙ›ıÂÙ·, ·fi Ù· 6 ·È‰È¿ Ì ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë MKE, Ù· 4 ·ÚÔ˘Û›·Û·Ó ÛËÌ›· ÌË ·Ó·Ù·ÛÛfiÌÂÓ˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È Ù· 3 ·fi ·˘Ù¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈο. ™ÙÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘, ·Ú·ÙËÚ‹ıËΠ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË Û 20 ‚Ú¤ÊË Ì ÌÈÎÚ¤˜, Ì˘˚ÎÔ‡ Ù‡Ô˘ MKE (48,8% ÙˆÓ Ì˘˚ÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ), ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜. ™Â ·Ó¿ÏÔÁ˜ ÂÚÁ·Û›Â˜ ÙÔ ÔÛÔÛÙfi Î˘Ì·›ÓÂÙ·È ·fi 43% ̤¯ÚÈ 84%.(3-5,7,15) Afi ÙȘ ÂÚÈÌÂÌ‚Ú·ÓÒ‰ÂȘ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜, Û η̛· ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì˘˚ÎÔ‡ Ù‡Ô˘ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Èı·ÓfiÙËÙ· ·˘ÙfiÌ·Ù˘ Û‡ÁÎÏÂÈÛ˘ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜ Î·È Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚË Ù˘ ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ô˘˜. H ÚfiÁÓˆÛË ÁÈ· ÙËÓ Ì˘˚ÎÔ‡ Ù‡Ô˘ ÂÈÎÔÈÓˆÓ›· Â›Ó·È Î·Ï‡ÙÂÚË, fi¯È ÌfiÓÔ ˆ˜ ÚÔ˜ ÙËÓ Èı·ÓfiÙËÙ· ·˘ÙfiÌ·Ù˘ Û‡ÁÎÏÂÈÛ˘ ·ÏÏ¿ Î·È ÙË Û·ÓÈfiÙËÙ· ·Ó¿Ù˘Í˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Graham T, Gutgesell H. Ventricular Septal Defects In: Emmanouilidis GC, Allen HD, Riemenschneider TA, Gutgesell HP eds. Heart disease in infants, children and adolescents. 5th ed. Baltimore: Williams & Wilkins 1995:724-726.

2. ¢·ÛηÏfiÔ˘ÏÔ˜ ¢. MÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. ™ÙÔ: TÔ‡ÙÔ˘˙· ¶, MÔ˘ÓÙԇϷ X. K·Ú‰È·Î¤˜ ·ı‹ÛÂȘ, Aı‹Ó·: EΉ. °. ¶·ÚÈ˙È¿ÓÔ˜ 1992:941-965.

3. Trowitzsch E, Braun W, Stute M, Pielemeier W. Diagnosis, therapy and outcome of ventricular septal defect in the 1st year of life: a two-dimensional colour Doppler echocardiography study. Eur J Pediatr 1990;149:758-761.

4. Mehta A, Chidambaram B. Ventricular septal defect in the

MÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·

first year of life. Am J Cardiol 1992;70:364-366.

5. Meberg A, Otterstad JE, Froland G, Sorland S, NitterHauge S. Increasing incidence of ventricular septal defect caused by improved detection rate. Acta Paediatr 1994, 83(6):653-657.

6. Backer C, Winters R, Zales V, Takami H, Muster A, Benson W, Mavroudis C. Restrictive ventricular septal defect: how small is too small to close? Ann Thorac Surg 1993;56:1014-1019.

7. Moe D, Guntheroth W. Spontaneous closure of uncomplicated ventricular septal defect. Am J Cardiol 1987;60:674-678.

8. Shirali G, O'Brian Smith, Geva T. Quantitation of echocardiographic predictors of outcome in infants with isolated ventricular septal defect. Am Heart J 1995;130:1228-1235.

9. Byard R. Ventricular septal defect and sudden death in early childhood. J Paediatr Child Health 1994;30:439-44.

10. Frontera-Izquierdo P, Cabezuelo-Huerta G. Natural and modified history of isolated ventricular septal defect: a 17year study. Pediatr Cardiol 1992;13:193-197.

11. Perloff GK. The clinical recognition of congenital heart disease. 4th ed. Philadelphia: W.B. Saunders Company, 1994.

12. Silverman NH. Pediatric echocardiography. Baltimore: Williams & Wilkins, 1993.

13. Sutherland GR, Godman MJ, Smallhorn JF. Ventricular septal defects: two-dimensional echocardiographic and morphologic correlations. Br Heart J 1982;47:316-328.

14. Ruangritnamchai C, Khowsathit P, Pongpanich B. Spontaneous closure of small ventricular septal defect first six months of life. J Med Assoc Thai 1993;76 Suppl 2:63-71.

15. Hiraishi S, Agata Y, Nowatari M, Oguchi K, Misawa H, Hirota H et al. Incidence and natural course of trabecular ventricular septal defect: Two-dimensional echocardiography and color Doppler flow imaging study. J Pediatr 1992;120:409-415.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-10-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-04-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: AÌ·Ï›· TÛÈÏÈÌÈÁοÎË HÚÔ‰fiÙÔ˘ 214, N¤· AÏÈηÚÓ·ÛÛfi˜ HÚ¿ÎÏÂÈÔ KÚ‹Ù˘, 71 601

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E¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

IÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· Û ·ÛıÂÓ‹ Ì ΢ÛÙÈ΋ ›ÓˆÛË ™Ù·‡ÚÔ˜ NÙÔ˘ÓÙÔ˘Ó¿Î˘1, AÓ·ÛÙ·Û›· ZËÛÔ‡ÏË1, Aı·Ó·Û›· §Ô˘Ú›‰·2, EÏ¢ıÂÚ›· PÒÌ·-°È·ÓÓ›ÎÔ˘2, N›Ó· M·ÓˆÏ¿ÎË2

● ¶ÂÚ›ÏË„Ë: H ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ·ÔÙÂÏ› ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·, Ë ÔÔ›· ·Ó·ÁÓˆÚ›ÛıËΠÚfiÛÊ·Ù· Û ¿Û¯ÔÓÙ˜ ·fi ΢ÛÙÈ΋ ›ÓˆÛË Î·È Û¯ÂÙ›ÛıËΠ̠ÙË Ï‹„Ë ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜, ËÏÈΛ·˜ 9 ¯ÚfiÓˆÓ, Ì ΢ÛÙÈ΋ ›ÓˆÛË Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢ ·fi ËÏÈΛ·˜ 17 ÌËÓÒÓ. °È· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ë ·ÛıÂÓ‹˜ ÂÏ¿Ì‚·Ó >35.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ. H ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠ٷ Â˘Ú‹Ì·Ù· ÙÔ˘ ‚·ÚÈÔ‡¯Ô˘ ˘ÔÎÏ˘ÛÌÔ‡ (ÛËÌ·ÓÙÈ΋ ÛÙ¤ÓˆÛË Î·È ÚÔÛÙÂÓˆÙÈ΋ ‰È¿Ù·ÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÂÈÏÂÔ‡, Ú›ÎÓˆÛË Î·È ·Ú·ÌfiÚʈÛË ÙÔ˘ ÎfiÏÔ˘), ÙË Ì·ÎÚÔÛÎÔÈ΋ ÂÈÎfiÓ· ηٿ ÙË Ï··ÚÔÙÔÌ›· Î·È ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË, Ô˘ ·¤ÎÏÂÈÛ ¿ÏϘ ·ı‹ÛÂȘ ÙÔ˘ ÂÓÙ¤ÚÔ˘. M ÙËÓ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰ÔÛÔÏÔÁ›·˜ ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ‚ÂÏÙÈÒıËÎ·Ó Ù· ·ÎÙÈÓÔÏÔÁÈο, ÎÔÏÔÓÔÛÎÔÈο Î·È ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ¯ˆÚ›˜ fï˜ Ó· ·ÔÙÚ·› Ë ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ, ·Ó Î·È ·˘Ù¿ ‹Ù·Ó, ÁÂÓÈο, ÈÔ ‹È·. AÓ·ÛÎÔÂ›Ù·È Ë ÙÚ¤¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÈ·, ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:322-325. §¤ÍÂȘ ÎÏÂȉȿ: ΢ÛÙÈ΋ ›ÓˆÛË, ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ·, ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·.

S. Doudounakis, A. Zissouli, A. Lourida, E. Roma-Giannicou, N. Manolaki. Fibrosing colonopathy in cystic fibrosis. Paediatriki 2000;63:322-325. ● Abstract: Colonopathy has recently been recognized as a complication of cystic fibrosis, and is related to the consumption of high doses of pancreatic enzymes. The case of a 9 year-old girl with cystic fibrosis and colonopathy is described. She presented with recurrent episodes of intestinal obstruction starting at the age of 17 months. In an attempt to control the number of bowel motions, the daily intake of lipase, over extended periods, was maintained at >35,000 UI/Kg. Diagnosis was based on the radiologic findings on barium enema (significant stenosis with prestenotic dilatation of the ileus and abnormal appearance of the colon), laparotomy findings and the histological picture which excluded other forms of intestinal disease. With appropriate changes in the amounts of pancreatic enzymes given daily, the endoscopic and radiologic findings improved significantly, but the patient suffered further episodes, although much less severe. Current literature on the pathogenesis, clinical presentation, diagnosis and treatment of the condition is reviewed.

Key words: cystic fibrosis, fibrosing colonopathy, pancreatic enzymes.

EÈÛ·ÁˆÁ‹ H ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ÂÚÈÁÚ¿ÊËΠˆ˜ ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ÙÔ 1994 Û ·ÛıÂÓ›˜ Ì ΢ÛÙÈ΋ ›ÓˆÛË, Ô˘ ¤·ÈÚÓ·Ó ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÁÈ· ‰È¿ÛÙËÌ· ϤÔÓ ÙˆÓ 12-15 ÌËÓÒÓ (1). H ÎÔÏÔÓÔ¿ıÂÈ· ÂÌÊ·Ó›ÛıËΠÌÂÙ¿ ÙËÓ Î˘ÎÏÔÊÔÚ›· Î·È ¯Ú‹ÛË Û΢·ÛÌ¿ÙˆÓ Ì ÌÂÁ¿ÏË ÂÚÈÂÎÙÈÎfiÙËÙ·

1 2

·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Û ÌÈ· ÚÔÛ¿ıÂÈ· ηχÙÂÚ˘ Î·È Â˘¯ÂÚ¤ÛÙÂÚ˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ (2). ¢ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë ·ÎÚÈ‚‹˜ Û˘¯ÓfiÙËÙ· Ù˘ ÂÈÏÔ΋˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, ÂÂȉ‹ Ë ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ·fi Ù· ‰È¿ÊÔÚ· K¤ÓÙÚ· ‰ÂÓ Â›Ó·È ÔÌÔÈfiÌÔÚÊË Î·È ˘¿Ú¯Ô˘Ó ‰È¿ÊÔÚ· Û΢¿ÛÌ·Ù· Ì ‰È·ÊÔÚÂÙÈο ¤Î‰Ô¯· ηÈ

TÌ‹Ì· IÓÔ΢ÛÙÈ΋˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

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‰È·ÊÔÚÂÙÈ΋ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì· (3). H ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Û˘Ó›ÛٷٷÈ, ΢ڛˆ˜, Û ÂÂÈÛfi‰È· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢ Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ¿¯˘ÓÛ˘ Î·È ÛÙ¤ÓˆÛ˘ ÙÔ˘ ·˘ÏÔ‡ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. X·Ú·ÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· Î·È Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· (4,5). °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ··ÈÙ‹ıËΠ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (ÂÓÙÂÚÂÎÙÔÌ‹) (6). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ΢ÛÙÈ΋ ›ÓˆÛË Î·È ÈÓÒ‰Ë ÎÔÏÔÓÔ¿ıÂÈ· Ô˘ ÔÊ›ÏÂÙ·È ÛÙË Ï‹„Ë ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ H ·ÛıÂÓ‹˜, ËÏÈΛ·˜ Û‹ÌÂÚ· 9 ¯ÚfiÓˆÓ, ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ 3.200 gr. ¶·ÚÔ˘Û›·Û ÓÂÔÁÓÈÎfi ›ÎÙÂÚÔ Î·È ı‹Ï·Û ÁÈ· 1 Ì‹Ó·. ™Â ËÏÈΛ· 1ó ÌËÓfi˜ ÂÙ¤ıË Ë ÎÏÈÓÈ΋ ˘Ô„›· Ù˘ ΢ÛÙÈ΋˜ ›ÓˆÛ˘ ÏfiÁˆ ÔÏÏÒÓ, ÌÂÁ¿ÏˆÓ, ‰‡ÛÔÛ̈Ó, ÏÈ·ÚÒÓ ÎÂÓÒÛˆÓ, ÏËÌÌÂÏÔ‡˜ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜ Î·È Â›ÌÔÓÔ˘ ‚‹¯· ·fi ÙË Á¤ÓÓËÛË. H ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ¯ÏˆÚÈÔ‡¯ˆÓ ÛÙÔÓ È‰ÚÒÙ· Ì ÙË Ì¤ıÔ‰Ô Gibson - Cooke (95 mEq/L) Û ‰‡Ô ͯˆÚÈÛÙ¤˜ ÌÂÙÚ‹ÛÂȘ. MÂÙ¿ ÙË ‰È¿ÁÓˆÛË ¿Ú¯ÈÛ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ Ì ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì· Î·È ‚Èٷ̛Ә, Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË Ù˘ ·ÛıÂÓÔ‡˜ ‚ÂÏÙÈÒıËÎÂ Î·È Ë ÂͤÏÈÍ‹ Ù˘, ·fi ÏÂ˘Ú¿˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘, ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋. ™Â ËÏÈΛ· 13 ÌËÓÒÓ Î·È 4ó ¯ÚfiÓˆÓ ÓÔÛËχıËΠÁÈ· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·. ™Â ËÏÈΛ· 3 ¯ÚfiÓˆÓ Ô ·Ó·Ó¢ÛÙÈÎfi˜ ‚ÏÂÓÓÔÁfiÓÔ˜ ·ÔÈΛÛıËΠ·fi „¢‰ÔÌÔÓ¿‰·. Afi ÙËÓ ËÏÈΛ· ÙˆÓ 17 ÌËÓÒÓ Ì¤¯ÚÈ 5ó ¯ÚfiÓˆÓ, ·ÚÔ˘Û›·Û 6 ÂÂÈÛfi‰È· ·ÔÊÚ·ÎÙÈÎÔ‡ ÂÈÏÂÔ‡, Ô˘ ¯·Ú·ÎÙËÚ›ÛıËÎ·Ó ˆ˜ ÈÛÔ‰‡Ó·ÌÔ ÂÈÏÂÔ‡ ·fi ÌËÎÒÓÈÔ (Distal intestinal obstruction syndrome - DIOS). ŸÏ· ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙËÚËÙÈο. T· ¤ÓÙ ÙÂÏÂ˘Ù·›· Û˘Ó¤‚ËÛ·Ó ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ. K·Ù¿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÂÈÛfi‰ÈÔ ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢, ˘‹Ú¯Â Â›ÌÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÌÂÙˆÚÈÛÌfi˜ ÎÔÈÏ›·˜, ·˘ÍË̤ÓÔÈ ÂÓÙÂÚÈÎÔ› ‹¯ÔÈ Î·È, ÂÈϤÔÓ, ÚÔÛÙ¤ıËΠÂÈÛÎÔÈο ÂÌÊ·Ó‹˜ ÂÚÈÛÙ·ÏÙÈÛÌfi˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ŒÙÛÈ, ‚¿ÛÂÈ ÙˆÓ Û˘¯ÓÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙˆÓ ¤ÓÙÔÓˆÓ Î·È Â›ÌÔÓˆÓ Û˘Ìو̿وÓ, ÂÙ¤ıË Ë ˘Ô„›· Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜. ™Â ‚·ÚÈÔ‡¯Ô ˘ÔÎÏ˘ÛÌfi Ì Á·ÛÙÚÔÁÚ·Ê›ÓË ·ÂÈÎÔÓ›ÛıËΠÓËÌ·ÙÔÂȉ‹˜ ÛÙ¤ÓˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÂÈÏÂÔ‡ Ì ÚÔÛÙÂÓˆÙÈ΋ ‰È¿Ù·ÛË, ÂÓÒ ÙÔ ‰ÂÍÈfi ÎfiÏÔÓ, ·fi ÙËÓ ÎÔÏÈ΋ ηÌ‹ ̤¯ÚÈ ÙÔ Ù˘ÊÏfi, ‹Ù·Ó ÚÈÎÓfi Î·È ·Ú·ÌÔÚʈ̤ÓÔ (EÈÎfiÓ· 1).

AÎÔÏÔ‡ıËÛ ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÙÔÌ›· ηٿ ÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËΠ¤ÓÙÔÓË ÂÚ˘ıÚfiÙËÙ· Ì ÂÈÎfiÓ· ÊÏÂÁÌÔÓ‹˜ Î·È ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÙÂÏÈÎÔ‡ ÂÈÏÂÔ‡, ÙÔ˘ Ù˘ÊÏÔ‡ Î·È ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘, Ô˘ ¤‰ÈÓ ÙËÓ ÂÓÙ‡ˆÛË ÓfiÛÔ˘ Crohn, ÏfiÁˆ Ù˘ ÔÔ›·˜ Ë Ï‹„Ë ‚ÈÔ„›·˜ ÂÁ΢ÌÔÓÔ‡Û ÙÔÓ Î›Ó‰˘ÓÔ

EÈÎfiÓ· 1. ¡ËÌ·ÙÔÂȉ‹˜ ÛÙ¤ÓˆÛË ÙÔ˘ ÂÈÏÂÔ‡ Ì ÚÔÛÙÂÓˆÙÈ΋ ‰È¿Ù·ÛË. ‰ËÌÈÔ˘ÚÁ›·˜ Û˘ÚÈÁÁ›ˆÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ‰ÂÓ ÂÏ‹ÊıËÛ·Ó ‚ÈÔ„›Â˜ ·fi ÙÔ ¤ÓÙÂÚÔ. TȘ ›‰È˜ Ì·ÎÚÔÛÎÔÈο ·ÏÏÔÈÒÛÂȘ ·ÚÔ˘Û›·˙Â Ë ÛΈÏËÎÔÂȉ‹˜ ·fiÊ˘ÛË, Ë ÔÔ›· Î·È ·Ê·ÈÚ¤ıËÎÂ. TÔ ‹·Ú ›¯Â Ô˙Ò‰Ë ÂÌÊ¿ÓÈÛË Î·È ÂÏ‹ÊıË ‰Â›ÁÌ· ÁÈ· ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈο, Ë ÛΈÏËÎÔÂȉ‹˜ ‰ÂÓ ·ÚÔ˘Û›·˙ ·ÍÈfiÏÔÁ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ ÂÎÙfi˜ ·fi ÙËÓ ·ÚÔ˘Û›· ˘ÎÓ‹˜ ‚ϤÓÓ˘ Î·È ¿ÊıÔÓˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ. T· Á·ÁÁÏȷο ·ÙÙ·Ú· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. H ÈÛÙÔÏÔÁÈ΋ ·˘Ù‹ ÂÈÎfiÓ· ·¤ÎÏÂÈ ÙË ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘. TÔ ‹·Ú ·ÚÔ˘Û›·˙ ‰È‡ڢÓÛË ÙˆÓ ˘Ï·›ˆÓ ‰È·ÛÙËÌ¿ÙˆÓ Î·È ÂÚȯÔÏ·ÁÁÂÈ›Ùȉ·, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ·ÓÙ›‰Ú·ÛË ·fi Ù· ¯ÔÏËÊfiÚ· ÛÙ· Ï·›ÛÈ· Ù˘ ΢ÛÙÈ΋˜ ›ÓˆÛ˘.

T· Â˘Ú‹Ì·Ù· ·˘Ù¿, ‰ËÏ·‰‹ Ë ÛÙ¤ÓˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙÔ˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÂÓÙ¤ÚÔ˘, ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜. ¢È·ÎfiËÎÂ Ë ¯ÔÚ‹ÁËÛË ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ¯ÔÚËÁ‹ıËΠÛÙÔȯÂÈ·Îfi Á¿Ï·.

H ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ 2 Ì‹Ó˜ ÙÔ ·È‰› ›¯Â ¿ÚÂÈ 3 ÎÈÏ¿. ™Â Â·Ó¤ÏÂÁ¯Ô Ì ÎÔÏÔÓÔÛÎfiËÛË / ‚ÈÔ„›· ÂÓÙ¤ÚÔ˘ 6 Ì‹Ó˜

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™. NÙÔ˘ÓÙÔ˘Ó¿Î˘ Î·È Û˘Ó.

¯ÓÒÓ ·ÚÔ͇ÓÛÂˆÓ Ù˘ ¯ÚfiÓÈ·˜ ÂÓ‰Ô‚ÚÔÁ¯È΋˜ Ïԛ̈͢ ·fi „¢‰ÔÌÔÓ¿‰·, ÔÈ Ôԛ˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ÂÓ‰ÔÊϤ‚È· ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÔÛÙÂÔÂÓ›·, ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ·Ú¯fiÌÂÓË ¯ÔÏÈ΋ ΛÚÚˆÛË, Ô˘ ÂÈ‚·Ú‡ÓÔ˘Ó Û˘ÓÔÏÈο ÙËÓ ÚfiÁÓˆÛË.

EÈÎfiÓ· 2. ∞ÂÈÎfiÓÈÛË 12 Ì‹Ó˜ ÌÂÙ¿ ÙË Ï··ÚÔÙÔÌ›·. ·ÚÁfiÙÂÚ·, Ô ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ ÙÂÏÈÎÔ‡ ÂÈÏÂÔ‡ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ·ÚÔ˘Û›·˙ ̤ÙÚÈÔ Ô›‰ËÌ· Ì ÂÛÙȷ΋ ·‡ÍËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ·‡ÍËÛË ÙˆÓ ËˆÛÈÓÔʛψÓ. ™Â ‚·ÚÈÔ‡¯Ô ˘ÔÎÏ˘ÛÌfi (12 Ì‹Ó˜ ÌÂÙ¿ ÙË Ï··ÚÔÙÔÌ›·), Ë ÚÔ¸¿Ú¯Ô˘Û· ÛÙ¤ÓˆÛË Î·È Ë ‰È¿Ù·ÛË ÙÔ˘ ÂÈÏÂÔ‡ ‹Ù·Ó ÏÈÁfiÙÂÚÔ ÂÎÛÂÛËÌ·Ṳ̂Ó˜ (EÈÎfiÓ· 2).

EÎÙfi˜ ·fi ‰‡Ô ·ÎfiÌË ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú¿ ÂÂÈÛfi‰È· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢, Û ËÏÈΛ· 7ó Î·È 8 ¯ÚfiÓˆÓ, Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙËÚËÙÈο, ÙÔ ·È‰› ›¯Â ÂÚÈÔ‰Èο ‹È· ÂÓԯϋ̷ٷ ·fi ÙÔ ÂÙÈÎfi, ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÓÙÂÚÈ΋˜ ÛÙ¤ÓˆÛ˘. E·Ó·¯ÔÚËÁ‹ıËηÓ, ÛÙ·‰È·Î¿, ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì· Û ÌÈÎÚ¤˜ ‰fiÛÂȘ, ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÈηÓÔÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È Ó· ÂÈÙ¢¯ı› ηϋ ıÚ¤„Ë.

H ÚfiÁÓˆÛË Ù˘ ·ÛıÂÓÔ‡˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÚ›· Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜, Â›Ó·È ¿ÁÓˆÛÙË. H ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (ÂÓÙÂÚÂÎÙÔÌ‹), ‰ÂÓ ıˆڋıËΠÂȂ‚ÏË̤ÓË ÂÍ·ÈÙ›·˜ Ù˘ ¤ÎÙ·Û˘ Ù˘ ‚Ï¿‚˘ Î·È Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ ÂÈÏÂÔ‡ ÛÙË ÓfiÛÔ. ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË Ì›· Ì›˙ˆÓ Â¤Ì‚·ÛË ÂÎÙÈÌ‹ıËΠˆ˜ ȉȷ›ÙÂÚ· ·ÎÚˆÙËÚÈ·ÛÙÈ΋ Î·È ÂÈ‚·Ú˘ÓÙÈ΋ ÁÈ· ÙËÓ ·ÛıÂÓ‹, Ë ÔÔ›· ÂÎÙfi˜ ·fi Ù· ÚÔ‚Ï‹Ì·Ù· ÙÔ˘ ÂÙÈÎÔ‡, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÔ‚·Ú‹ Ì›ˆÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (FVC: 44, FEV1: 41), ·ÔÙ¤ÏÂÛÌ· ÙˆÓ Û˘-

324

™˘˙‹ÙËÛË O fiÚÔ˜ ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ·Ô‰›‰ÂÈ ÙÔÓ Ù‡Ô Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ÎfiÏÔ˘, Ô˘ ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ Û ·È‰È¿ Ì ΢ÛÙÈ΋ ›ÓˆÛË ÙÔ 1994 (1). ŒÎÙÔÙÂ, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚ›Ô˘ 80 ÂÚÈÙÒÛÂȘ, Û ËÏÈ˘ Ô˘ Î˘Ì·›ÓÔÓÙ·È ·fi 9 ÌËÓÒÓ Ì¤¯ÚÈ 13 ¯ÚfiÓˆÓ, ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ ‰ÂÓ ¤¯Ô˘Ó ÂȂ‚·Èˆı› ÈÛÙÔÏÔÁÈο, ·ÏÏ¿ ÌfiÓÔ ‚¿ÛÂÈ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Î·È ÙÔ˘ ·ÎÙÈÓÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ (2,3). ™Ù¤ÓˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ÛÙÔ ·ÚÂÏıfiÓ Û ÂÓ‹ÏÈΘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË Î·È ¿ÏÏˆÓ Ê·Ú̿ΈÓ, fiˆ˜ Â›Ó·È Ù· ‰ÈÔ˘ÚËÙÈο , Î·È Ù· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η.

H ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û˘Ó›ÛÙ·ÙÔ ÛÂ Û˘Ìو̷ÙÔÏÔÁ›· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢ Ô˘ Û˘Ó‰˘·˙fiÙ·Ó Ì ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ·ÓÈfiÓÙÔ˜ Î·È ÂÁοÚÛÈÔ˘ ÎfiÏÔ˘ Î·È ÛÙ¤ÓˆÛË ÙÔ˘ ·˘ÏÔ‡. Afi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı›, ÙÔ ÎÏÈÓÈÎfi Ê¿ÛÌ· Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ÏËÌÌÂÏ‹ ·‡ÍËÛË Î·È Â›ÌÔÓË ‰˘Û·ÔÚÚfiÊËÛË ·Ú¿ ÙËÓ Î·ÓÔÓÈ΋ ¯ÔÚ‹ÁËÛË ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ‚) Â›ÌÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Ì ÌÂÙˆÚÈÛÌfi ‹ ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË, Á) ·ÈÌ·ÙËÚ¤˜ ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ, ‰) Û·Ó›ˆ˜, ¯˘ÏÒ‰Ë ·ÛΛÙË. ¶·Ú¿ÏÏËÏ·, Û ·ÎÙÈÓԉȷÁÓˆÛÙÈÎfi ¤ÏÂÁ¯Ô ·ÂÈÎÔÓ›˙ÂÙ·È ¿¯˘ÓÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Ì ÌÂȈ̤ÓË ÂÚ›ÛÙ·ÏÛË, ‚Ú¿¯˘ÓÛË ÙÔ˘ ÎfiÏÔ˘, ·Î·Ì„›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ‰È¿Ù·ÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÂÈÏÂÔ‡ (2,3).

T· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÌÔÈfiÙËÙ˜ Ì ۇӉÚÔÌÔ ÈÛÔ‰‡Ó·ÌÔ ÂÈÏÂÔ‡ ·fi ÌËÎÒÓÈÔ Ô˘ Û˘Ó·ÓÙ¿Ù·È ÛÙÔ 1030% ÙˆÓ ·ÛıÂÓÒÓ Ì ΢ÛÙÈ΋ ›ÓˆÛË Î·È ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ·¯‡ÚÚ¢ÛÙ˘ ÂÓÙÂÚÈ΋˜ ‚ϤÓÓ˘ Î·È ÂÓÛÊ‹ÓˆÛË ÎÔÚ¿ÓˆÓ, ·ÏÏ¿ ‰ÂÓ Û˘Óԉ‡ÂÙ·È Ì ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ‹ ÛÙ¤ÓˆÛË ÙÔ˘ ·˘ÏÔ‡ ÙÔ˘ ÂÓÙ¤ÚÔ˘. E›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË (distal intestinal obstruction syndrome, DIOS) ÚÔ‚¿ÏÏÂÈ ÌÂ Û˘ÌÙÒÌ·Ù· fiˆ˜ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÌÂÙˆÚÈÛÌfi, ‰˘ÛÎÔÈÏÈfiÙËÙ·, ÛÙ·ÛÈÌfiÙËÙ· ‹ ·ÒÏÂÈ· ‚¿ÚÔ˘˜. H ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ÚÔÛ‚¿ÏÏÂÈ ÙÔ ÎfiÏÔÓ Î·È, ȉȷ›ÙÂÚ·, ÙÔ Ù˘ÊÏfi Î·È ÙÔ ·ÓÈfiÓ, ÂÓÒ Û ϛÁ˜ ÂÚÈÙÒÛÂȘ Ë ÚÔÛ‚ÔÏ‹ ·ÊÔÚ¿ Î·È ÛÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi (5). ¶·ıÔÁÓˆÌÔÓÈο ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·ÔÙÂÏÔ‡Ó Ë ˘Ô‚ÏÂÓÓÔÁfiÓÈ· ›ÓˆÛË Ì Â¤ÎÙ·ÛË Î·È ÛÙÔ Ì˘˚Îfi ¯ÈÙÒÓ·, ÙÔ Ô›‰ËÌ· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ë ‰È‹ıËÛË ·fi ˈÛÈÓfiÊÈÏ· Î·È Ì·ÛÙÔ·ÙÙ·Ú· (5).

Afi ÙȘ ÚÒÙ˜ ·Ú·ÙËÚ‹ÛÂȘ Èı·ÓÔÏÔÁ‹ıËΠοÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÎÔÏÔÓÔ¿ıÂÈ·˜ Î·È Ù˘ ¯ÔÚ‹ÁËÛ˘ ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ·ÁÎÚ·ÙÈÎÒÓ

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·325

¶∞π¢π∞∆ƒπ∫∏ 2000;63:322-325

ÂÓ˙‡ÌˆÓ (1,7). K·È ·˘Ùfi Û˘Ì‚·›ÓÂÈ Â˘ÎÔÏfiÙÂÚ· Ì ÙË ¯Ú‹ÛË Û΢·ÛÌ¿ÙˆÓ ÌÂÁ¿Ï˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·. OÈ Smyth Î·È Û˘Ó. (1995) ‚Ú‹Î·Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÎÔÏÔÓÔ¿ıÂÈ· ¤·ÈÚÓ·Ó, ηٿ ̤ÛÔ fiÚÔ, ¿Óˆ ·fi 46.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë Ì¤ÛË ÚfiÛÏË„Ë ÏÈ¿Û˘ ‰ÂÓ ÍÂÂÚÓÔ‡Û ÙȘ 21.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ. T· Â˘Ú‹Ì·Ù¿ ÙÔ˘˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Û˘Û¯¤ÙÈÛË Ù˘ ÎÔÏÔÓÔ¿ıÂÈ·˜ Ì ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ‹Ù·Ó ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Ì ۯÂÙÈÎfi ΛӉ˘ÓÔ 8,0 Û ۇÁÎÚÈÛË Ì ÙË ¯Ú‹ÛË ˘·ÎÙÈÎÒÓ, ÁÈ· ÙËÓ ÔÔ›· Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ‹Ù·Ó ÌfiÓÔ 2,4 (7). ™Â ¿ÏÏË ÌÂϤÙË, Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ˘ÔÏÔÁ›ÛıËΠ۠8,4 ÁÈ· ÔÛfiÙËÙ˜ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ >25.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ Î·È 64 ÁÈ· ÔÛfiÙËÙ˜ >50.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ (8).

O ·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ ÚfiÎÏËÛ˘ Ù˘ ‚Ï¿‚˘ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔ˜. EÓÔ¯ÔÔÈÂ›Ù·È Ë ÙÔÍÈ΋ ‰Ú¿ÛË ÙˆÓ ÌÂÁ¿ÏˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ηıÒ˜ Î·È ÙˆÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ (ÔÏ˘ÌÂÚ‹) ÙÔ˘ ÂÚÈ‚Ï‹Ì·ÙÔ˜ ÙˆÓ ÌÈÎÚÔ‰ÈÛΛˆÓ Î·È ÙˆÓ ÌÈÎÚÔÛÊ·ÈÚȉ›ˆÓ Ô˘ ÂÚȤ¯ÔÓÙ·È ÛÙËÓ Î¿„Ô˘Ï·. EÂȉ‹ Ù· ·È‰È¿ Ì ΢ÛÙÈ΋ ›ÓˆÛË ¤¯Ô˘Ó ÈÔ ¯·ÌËÏfi PH ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ·Ú·ÁˆÁ‹˜ ·ÁÎÚ·ÙÈÎÒÓ ˘ÁÚÒÓ, ηı˘ÛÙÂÚ› Ë ‰È¿Ï˘ÛË ÙÔ˘ ÂÚÈ‚Ï‹Ì·ÙÔ˜ Î·È ¤ÙÛÈ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, ‹ ·ÎfiÌË Î·È ÙÔ ·¯‡, ÂÚÈÔ¯¤˜, ‰ËÏ·‰‹, Ô˘ ‰ÂÓ Â›Ó·È ·Ó·ÙÔÌÈο ÚÔÂÙÔÈÌ·Ṳ̂Ó˜ Ó· ÙȘ ‰Â¯ıÔ‡Ó Î·È Ó· ÙȘ ·Ó¯ıÔ‡Ó. ™ÙËÓ ÚfiÎÏËÛË Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ Èı·ÓfiÓ Ó· Û˘Ì‚¿ÏÏÔ˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë Î·ı˘ÛÙÂÚË̤ÓË ‰›Ô‰Ô˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ ·Ú·ÙÂٷ̤ÓË Â·Ê‹ Ì ÙÔ ‚ÏÂÓÓÔÁfiÓÔ, ‹ Ù· ÂÂÈÛfi‰È· ÂÓÙÂÚÈ΋˜ ÛÙ¿Û˘ ‹ ·fiÊڷ͢ Ô˘ ÂÈϤÎÔ˘Ó ÙËÓ Î˘ÛÙÈ΋ ›ÓˆÛË. ™Â ÂÈÚ·Ì·ÙÈο ÚfiÙ˘·, ¤¯ÂÈ ‰È·ÈÛÙˆı› ÙÔÍÈ΋ ‰Ú¿ÛË ÛÙÔ ¤ÓÙÂÚÔ ÙˆÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ Ô˘ ÂÚÈ‚¿ÏÏÔ˘Ó Ù· ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·, fiˆ˜ ÙÔ Âı˘Ï-·ÎÚ‡ÏÈÔ (Panzytrat, Pancrease HL, Nutrizyme 22), ‰ÂÓ Â›Ó·È, fï˜ ·ÓÙ›ÛÙÔÈ¯Ë Ì ·˘Ù‹ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔÓ ¿ÓıÚˆÔ (3). AÓÙ›ıÂÙ·, ÙÔ Êı·ÏÈÎfi (Creon) ıˆÚÂ›Ù·È ÈÔ ·ÛʷϤ˜, ÂÂȉ‹, Èı·ÓÒ˜, ‰È·Ï‡ÂÙ·È Û ¯·ÌËÏfiÙÂÚÔ PH Î·È ÂÏ¢ıÂÚÒÓÂÙ·È Ù·¯‡ÙÂÚ· Û ·ÓÒÙÂÚÔ ÙÌ‹Ì· ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ (3,10). H ˘fiıÂÛË Ó· ÂÌϤÎÂÙ·È Î·È ·˘ÙÔ¿ÓÔÛÔ˜ Ì˯·ÓÈÛÌfi˜ ‹ Ó· Â›Ó·È ·ıÔÏÔÁÈÎfi˜ Ô Ì˯·ÓÈÛÌfi˜ Ô˘ Ú˘ıÌ›˙ÂÈ ÙË Û‡ÓıÂÛË ÎÔÏÏ·ÁfiÓÔ˘ ·fi ÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘ÁÎÂÓÙÚÒÓÂÈ ÔÏϤ˜ Èı·ÓfiÙËÙ˜ (9).

H ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜, ÛÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ ÙˆÓ ÂÓ˙‡ÌˆÓ. H ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ÂÓÙÂÚÂÎÙÔÌ‹ Û˘ÓÈÛÙ¿Ù·È ÛÙȘ ÂÚÈÙÒÛÂȘ ÂÈÌÔÓ‹˜ Ù˘ ÎÏÈÓÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Î·È ‡·Ú͢ ÛÔ‚·Ú‹˜ ÛÙ¤ÓˆÛ˘

ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È ı· Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÂÙ·È, fiÛÔÓ Â›Ó·È ‰˘Ó·ÙfiÓ, ÛÙÔ ÚÔۂ‚ÏË̤ÓÔ ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘ (4,6). H ÚfiÏË„Ë Ù˘ ÓfiÛÔ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Û‡Ìʈӷ Ì ÙËÓ EÈÙÚÔ‹ I·ÙÚÈ΋˜ AÛÊ¿ÏÂÈ·˜ - Committee on the Safety of Medicine (NԤ̂ÚÈÔ˜ 1995) - Ì ÙËÓ ·ÔÊ˘Á‹ ¯ÔÚ‹ÁËÛ˘ Û΢·ÛÌ¿ÙˆÓ Ù· ÔÔ›· ÂÚȤ¯Ô˘Ó ÌÂÁ¿Ï˜ ‰fiÛÂȘ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Û ·ÛıÂÓ›˜ Ì ΢ÛÙÈ΋ ›ÓˆÛË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ¯ÚfiÓˆÓ. H ËÌÂÚ‹ÛÈ· ‰fiÛË ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ ÙȘ 10.000 UI/Kg/Ë̤ڷ Î·È Ù· ¤Ó˙˘Ì· ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Ì ȷÙÚÈ΋ Û˘ÓÙ·Á‹ (10). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ·ÔÙÂÏ› Ì›· Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ ıÂÚ·›·˜ Ù˘ ΢ÛÙÈ΋˜ ›ÓˆÛ˘ ·fi ÌÂÁ¿Ï˜ ‰fiÛÂȘ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, Ë ÔÔ›· ¤¯ÂÈ ·ÌÊ›‚ÔÏË ÚfiÁÓˆÛË. H ÙÚÔÔÔ›ËÛË Ù˘ ‰ÔÛÔÏÔÁ›·˜ ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ıˆÚÂ›Ù·È Ô ÌfiÓÔ˜ ÙÚfiÔ˜ ÚfiÏ˄˘.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Smyth RL, Van Velzen D, Smyth AR, Lloyd DA, Heaf DP. Strictures of ascending colon in cystic fibrosis and high strength pancreatic enzymes. Lancet 1994;343:85-86.

2. Powel CJ. Colonic toxicity from pancreatins: a contemporary safety issue. Lancet 1999;353:911-915.

3. Littlewood JM. Update on intestinal strictures. JR Soc Med 1999;92 (suppl 37): S41-S49.

4. Borowitz DS, Grand RJ, Durie PR and the CF Consensus Committee. Use of pancreatic enzyme supplements for patients with cystic fibrosis in the context of fibrosing colonopathy. J Pediatr 1995;127:681-684.

5. Hasler WL. Pancreatic enzymes and colonic strictures with cystic fibrosis: A case- control study. Selected summaries.

Gastroenterology 1998;114:609-612.

6. Reichard KW, Vinocour CD, Franco M, Crisci KL, Flick JA, Billmire DF et al. Fibrosing colonopathy in children with cystic fibrosis. J Pediatr Surg 1997;32:237-242.

7. Smyth RL, Ashby D, O’ Hea U, Burrows E, Lewis P, van Velzen D, et al. Fibrosing colonopathy in cystic fibrosis: results of a case control study. Lancet 1995; 346:1247-1251.

8. Fitzsimmons SC, Burkhart GA, Borowitz D, Grand RJ, Hammer strom T, Durie PR et al. High dose pancreatic enzyme supplements and fibrosing colonopathy in children with cystic fibrosis. N Engl J Med 1997;336:1283-1289.

9. Lee J, Ip W, Durie P. Is fibrosing colonopathy an immune mediated disease? Arch Dis Child 1997;77:66-70.

10. Current problems in Pharmacovigilance, Committee on Safety of Medicines Nov 1995;21:11.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-12-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-04-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù·‡ÚÔ˜ ¡ÙÔ˘ÓÙÔ˘Ó¿Î˘ ∆Ì‹Ì· πÓÔ΢ÛÙÈ΋˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 115 27

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Ÿ„ÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi: ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· O˘Ú·Ó›· ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘1, ª·Ú›· ∑·Ú›ÊË2, πˆ¿ÓÓ˘ OÈÎÔÓÔÌ›‰Ë˜3, ∞ÛË̛ӷ •˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë1 ● ¶ÂÚ›ÏË„Ë: H ÚÒÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û˘Ó‹ıˆ˜ Ô‰ËÁ› Û ‚·ÚÈ¿ Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· Î·È Ù˘Èο Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·: ÂÓ‰ÔÂÁÎÂÊ·ÏÈΤ˜ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ·ÔÙÈÙ·ÓÒÛÂȘ, ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Ó¢ÚÒÓˆÓ (·Á˘Ú›· - ·¯˘Á˘Ú›· - ÔÏ˘ÌÈÎÚÔÁ˘Ú›·), ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Ì˘ÂϛӈÛË, ·Ú·ÎÔÈÏȷΤ˜ ·ÛÙÂȘ, ‰È¿Ù·ÛË ÙˆÓ Ï·Á›ˆÓ ÎÔÈÏÈÒÓ Î·È ˘ÔÏ·Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜.

AÓÙ›ıÂÙ·, Ë fi„ÈÌË Ïԛ̈ÍË Û ÚÔ¯ˆÚË̤ÓË ÂÁ΢ÌÔÛ‡ÓË ¤¯ÂÈ ËÈfiÙÂÚ˜ ÂΉËÏÒÛÂȘ Ì ÌÈÎÚÔÎÂÊ·Ï›·, ‚·ÚËÎÔ˝· Î·È ÂÏ·ÊÚ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡, 3 ÂÙÒÓ Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· ÁÈ· ÙËÓ ÔÔ›· ÙÔÔıÂÙ‹ıËΠÎÔ¯ÏÈ·Îfi ÂÌʇÙÂ˘Ì·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ηϋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· (47 ÂÎ., 5Ë ÂηÙÔÛÙÈ·›· ı¤ÛË). ™Ù· Ï·›ÛÈ· ÙÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ÎÔ¯ÏÈ·ÎÔ‡ ÂÌÊ˘Ù‡̷ÙÔ˜ ˘Ô‚Ï‹ıËΠ۠·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÏÈıÔÂȉÒÓ ÔÛÙÒÓ. ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú·ÙËÚ‹ıËÎÂ Û˘ÌÌÂÙÚÈο ˘fi˘ÎÓË ·ÂÈÎfiÓÈÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜ ΢ڛˆ˜ ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ ËÌȈԉÒÓ Î¤ÓÙÚˆÓ ·ÌÊÔÙÂÚfiÏ¢ڷ, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·ÂÈÎfiÓÈÛË ÙÔ˘ ˘ÔÏÔ›Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜ Î·È ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ™ÙËÓ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó·‰Â›¯ıËÎ·Ó Û˘ÌÌÂÙÚÈΤ˜ ÂÛٛ˜ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ Ì ·Û·Ê‹ fiÚÈ· ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁÌ·ÙÈÎÒÓ, ÌÂÙˆÈ·›ˆÓ Î·È ÎÚÔÙ·ÊÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÌË ÂȉÈ΋ Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·. K·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜ Ë ·ÂÈÎfiÓÈÛË ÙˆÓ ·Ó·ÙÔÌÈÎÒÓ ÌÔÚ›ˆÓ ÙˆÓ ÏÈıÔÂȉÒÓ ÔÛÙÒÓ Î·È ÙˆÓ ·ÎÔ˘ÛÙÈÎÒÓ ÓÂ‡ÚˆÓ ˘‹ÚÍÂ Ê˘ÛÈÔÏÔÁÈ΋. H ·ÛıÂÓ‹˜ ·˘Ù‹ Ô˘ ÓÔÛËχÙËΠÁÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ÛÙËÓ ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, Èı·ÓÔÏÔÁԇ̠fiÙÈ ÓfiÛËÛ ÛÙÔ 3Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Ì ·ÔÙ¤ÏÂÛÌ· ‹È· ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Î·È ÂÚÈÔÚÈṲ̂ӷ ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·. ¶·È‰È·ÙÚÈ΋ 2000;63:326-329. §¤ÍÂȘ ÎÏÂȉȿ: ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË, ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜, ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·.

O. Papadaki-Papandreou, M. Zarifi, I. Oikonomidis, A. Xypolyta-Zachariadou. Late intrauterine cylomegalovirus infection: clinical and imaging findings. Paediatriki 2000;63:326-329. ● Abstract: Early intrauaterine cylomegalovirus (CMV) infection typically leads to severe neurological deficits in the child, with sensorineural hearing loss and typical neuroradiological findings: cerebral calcifications, migrational anomalies (lissencephaly, polymicrogyria), myelination disorders, paraventricular cysts, dilatation of the lateral ventricles and cerebellar hypoplasia. By contrast CMV infection at a later stage of pregnancy causes milder clinical symptoms: microcephaly, hearing loss and less severe neurological findings. The case is presented of a 3-year old girl with sensorineural hearing loss, mild behavioural problems with hyperactivity, good psychomotor evolution and head circumference at the lower normal limits. Before the installation of a cochlear implant the girl underwent brain and petrous bone CT and MRI. The CT revealed irregular hypodense areas symmetrically in the posterior parts of the corona radiata. The MRI showed patchy areas of increased signal on T2-weighted images in the deep white matter of the frontal, parietal and temporal lobes bilaterally. It is believed that the CMV infection in this child, who had been hospitalised for CMV infection in the perinatal period, occurred in the third trimester of pregnancy and therefore the disease presented with a mild clinical picture and limited neuroradiological findings.

Key words: intrauterine cytomegalovirus infection, central nervous system, CT, MRI. 1 2 3

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∆Ì‹Ì· ∞ÍÔÓÈÎÒÓ ∆ÔÌÔÁÚ¿ÊˆÓ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∞ÈÌ·ÙÔÏÔÁÈÎfi ÙÌ‹Ì·, ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

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EÈÛ·ÁˆÁ‹ H Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi (CMV) Â›Ó·È Ë ϤÔÓ Û˘¯Ó‹ ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ÙˆÓ ÓÂÔÁÓÒÓ Î·È Û˘Ì‚·›ÓÂÈ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 1%.(1-3) MfiÓÔ 10% ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Â›Ó·È Û˘Ìو̷ÙÈο ηٿ ÙË Á¤ÓÓËÛË.(1) T· ϤÔÓ ¤Î‰ËÏ· ÛËÌ›· Â›Ó·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ·Ù¤¯ÂȘ(50%).(1) B·ÚÈ¿ Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 55% ÙˆÓ ·ÛıÂÓÒÓ, ËÈfiÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ 31%, ÂÓÒ ‚·ÚËÎÔ˝· ·Ú·ÙËÚÂ›Ù·È Û 27% ÂÚ›Ô˘ (1,2). H ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÈÔ‡ ÛÙ· Ô‡Ú· ‹ ÙÔÓ Û›ÂÏÔ Î·Ù¿ ÙȘ 4 ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ˙ˆ‹˜, Ì ٷ ÂȉÈο IgM ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi Î·È ÙÂÏÂ˘Ù·›· Ì ÙË Ì¤ıÔ‰Ô PCR. MÂÙ¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Ë ‰È¿ÁÓˆÛË Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ Ïԛ̈͢ Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË Î·È ‚·Û›˙ÂÙ·È ÛÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ·. M ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÈÔ‡ Î·È ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ηıÔÚÈÛÙ› Ô ·ÎÚÈ‚‹˜ ¯ÚfiÓÔ˜ ÚÔÛ‚ÔÏ‹˜ ·fi ÙÔÓ Èfi ηٿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ‹ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô.

T· Ù˘Èο ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Ô˘ ÂÈÙÚ¤Ô˘Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÚÒÈÌ˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ Ïԛ̈͢ ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ÌÂÙ¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ۯÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·(2,3). ŒÙÛÈ, Û˘Ìو̷ÙÈ΋ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ÛÙ· ÚÒÙ· ÛÙ¿‰È· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Û˘Ó‹ıˆ˜ Ô‰ËÁ› Û ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· Ì ÌÈÎÚÔÎÂÊ·Ï›·, Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· Î·È ‚·ÚÂÈ¿ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. OÊı·ÏÌÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÔÊÂÈÏfiÌÂÓ· Û ¯ÔÚÈÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉ›Ùȉ·, ηıÒ˜ Î·È ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ¤¯Ô˘Ó Â›Û˘ ·Ó·ÊÂÚı›(3).

AÓÙ›ıÂÙ· Ë fi„ÈÌË Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ηٿ Ù· ÙÂÏÂ˘Ù·›· ÛÙ¿‰È· Ù˘ ΢‹Ûˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ËÈfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË, ÁÈ’ ·˘Ùfi Î·È Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ‰ÂÓ Â›Ó·È Û·Ê‹ Î·È Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Ùˆ¯¿(5). ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ηٿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛˆ˜ KÔÚ›ÙÛÈ ËÏÈΛ·˜ 3 ÂÙÒÓ ÚÔÛ‹Ïı ÁÈ· Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘Ô‚ÏËı› Û Â¤Ì‚·ÛË ÙÔÔı¤ÙËÛ˘ ÎÔ¯ÏÈ·ÎÔ‡ ÂÌÊ˘Ù‡̷ÙÔ˜ ÏfiÁˆ ‚·ÚÂÈ¿˜ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ·˜ ‚·ÚËÎÔ˝·˜ ÁÓˆÛÙ‹˜ ·fi ËÏÈΛ·˜ 4 ÌËÓÒÓ. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› ˘ÁÈÒÓ ÌË Û˘ÁÁÂÓÒÓ ÁÔÓ¤ˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÂÁ΢ÌÔÛ‡ÓË Î·È ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 2.850 Kg. NÔÛËχÙËΠ۠ÓÂÔÁÓÔÏÔÁÈÎfi ÙÌ‹Ì· ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, fiÔ˘ ‰È·ÁÓÒÛıËΠÏԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Ì ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù·. ™Â ËÏÈΛ· 4 ÌËÓÒÓ ‰È·ÈÛÙÒıËÎÂ

‚·ÚËÎÔ˝·, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛıËΠ·Ú¯Èο Ì ·ÎÔ˘ÛÙÈο Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÚÔÛÙ¤ıËÎÂ Î·È ·ÁˆÁ‹ ÏfiÁÔ˘, ¯ˆÚ›˜ fï˜ Ô˘ÛÈ·ÛÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÏfiÁÔ˘, ·Ó Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ˘‹ÚÍ ÔÌ·Ï‹. ŒÙÛÈ, Û ËÏÈΛ· 3 ÂÙÒÓ ·ÔÊ·Û›ÛÙËÎÂ Ë ÙÔÔı¤ÙËÛË ÎÔ¯ÏÈ·ÎÔ‡ ÂÌÊ˘Ù‡̷ÙÔ˜ ÁÈ· ÚÈ˙ÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚·ÚËÎÔ˝·˜ ÛÙÔ ·ÎÔÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜. Afi ÙËÓ ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ‰ÂÓ ÚԤ΢„ ·ıÔÏÔÁÈÎfi ‡ÚËÌ·. TÔ ·È‰› ›¯Â ηϋ ÂÈÎÔÈÓˆÓ›· ‹Ù·Ó fï˜ ȉȷ›ÙÂÚ· ˘ÂÚÎÈÓËÙÈÎfi Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÙÔ˘ (47 ÂÎ.) ·ÓÙÈÛÙÔȯԇÛ ÛÙËÓ 5Ë ÂηÙÔÛÙÈ·›· ı¤ÛË. ™Ù· Ï·›ÛÈ· ÙÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ÂÌÊ˘Ù‡̷ÙÔ˜, ÙÔ ·È‰› ˘Ô‚Ï‹ıËΠÂ›Û˘ Û ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÏÈıÔÂȉÒÓ ÔÛÙÒÓ. ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú·ÙËÚ‹ıËÎÂ Û˘ÌÌÂÙÚÈο ˘fi˘ÎÓË ·ÂÈÎfiÓÈÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜ ΢ڛˆ˜ ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ ËÌȈÔÂȉÒÓ Î¤ÓÙÚˆÓ ·ÌÊÔÙÂÚfiÏ¢ڷ, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·ÂÈÎfiÓÈÛË ÙÔ˘ ˘ÔÏÔ›Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜ Î·È ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ™ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó·‰Â›¯ıËÎ·Ó Û˘ÌÌÂÙÚÈΤ˜ ÂÛٛ˜ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ Ì ·Û·Ê‹ fiÚÈ· ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁÌ·ÙÈÎÒÓ, ÌÂÙˆÈ·›ˆÓ Î·È ÎÚÔÙ·ÊÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ÌË ÂȉÈ΋ Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·.

EÈÎfiÓ· 1. ™˘ÌÌÂÙÚÈο ˘fi˘ÎÓË ·ÂÈÎfiÓÈÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ ËÌȈÔÂȉÒÓ Î¤ÓÙÚˆÓ ·ÌÊÔÙÂÚfiÏ¢ڷ. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÂÓ›Û¯˘ÛË ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ·˘ÙÒÓ ÌÂÙ¿ ÙËÓ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ̤ÛÔ˘.

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13:24

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K·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜ Ë ·ÂÈÎfiÓÈÛË ÙˆÓ ‰ÔÌÒÓ ÙˆÓ ÏÈıÔÂȉÒÓ ÔÛÙÒÓ Î·È ÙˆÓ ·ÎÔ˘ÛÙÈÎÒÓ ÓÂ‡ÚˆÓ ˘‹ÚÍÂ Ê˘ÛÈÔÏÔÁÈ΋. T· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ‹Ù·Ó ÂȉÈο Î·È Ô ¤ÏÂÁ¯Ô˜ ÔÏÔÎÏËÚÒıËΠÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜.

Afi ÙÔÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô: ‚˘ıfi˜ Ê˘ÛÈÔÏÔÁÈÎfi˜, Ï˘ÛÔÛˆÌȷο ¤Ó˙˘Ì· Ê˘ÛÈÔÏÔÁÈο, ÏÈ·Ú¿ Ôͤ· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ Î·È Ê˘Ù·ÓÈÎfi Ô͇ Ê˘ÛÈÔÏÔÁÈο. E›Û˘, ÙÔ ·ÌÈÓfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Î·È Ù· ÔÚÁ·ÓÈο Ôͤ· Ô‡ÚˆÓ ‚Ú¤ıËÎ·Ó Ê˘ÛÈÔÏÔÁÈο. ™˘˙‹ÙËÛË H Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·fi ÙȘ Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. TfiÛÔ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· fiÛÔ Î·È Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÔÈΛÏÏÔ˘Ó ·Ó·ÏfiÁˆ˜ ÙÔ˘ ‚·ıÌÔ‡ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔÛ‚ÔÏ‹˜ ·fi ÙÔÓ Èfi. ŸÙ·Ó Ë Ïԛ̈ÍË Û˘Ì‚Â› ÛÙÔ ÚÒÙÔ ‹ ÛÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ ÔÈ ‚Ï¿‚˜ ·fi ÙÔ KN™ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È ÛÔ‚·Ú¤˜ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÈÎÚÔÎÂÊ·Ï›·, ‰È·Ù·Ú·¯¤˜ ÌÂÙ·Ó¿ÛÙ¢Û˘ ÙˆÓ Ó¢ÚÒÓˆÓ (·Á˘Ú›·, ·¯˘Á˘Ú›·, ÔÏ˘ÌÈÎÚÔÁ˘Ú›·, ÂÙÂÚÔÙÔ›Â˜), ÂÚÈÎÔÈÏȷΤ˜ ·ÔÙÈÙ·ÓÒÛÂȘ, ˘‰Ú·ÓÂ-

EÈÎfiÓ· 2. ™˘ÌÌÂÙÚÈΤ˜ ÂÛٛ˜ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ Ì ·Û·Ê‹ fiÚÈ· ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·Ú¿ Ù· ÈÓȷο Τڷٷ. ¶·ÚfiÌÔȘ ·ÏÏÔÈÒÛÂȘ ·ÂÈÎÔÓ›ÛıËÎ·Ó Î·È ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ô˘Û›· ÙˆÓ ÌÂÙˆÈ·›ˆÓ Î·È ÎÚÔÙ·ÊÈÎÒÓ ÏÔ‚ÒÓ ¿Ìʈ.

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O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

ÁÎÂÊ·Ï›· ‹ ÔÚÂÁÎÂÊ·Ï›· Î·È Û·ÓÈfiÙÂÚ· ‰È¿Ù·ÛË ÙÔ˘ Ï·Á›Ô˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ·ÚÔ˘Û›· ‰È·ÊÚ·ÁÌ·Ù›ˆÓ ÂÓÙfi˜ ·˘ÙÔ‡. E›Û˘, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Ó˘¿Ú¯Ô˘Ó ·ÙÚÔÊ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ˘ÔÏ·Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜, ˘ÔÂÂÓ‰˘Ì·ÙÈΤ˜ ·ÛÂȘ ÙËÓ Ï¢΋ Ô˘Û›·, ΢ڛˆ˜ ·Ú¿ Ù· ÈÓȷο Τڷٷ, ‰È·Ù·Ú·¯¤˜ Ù˘ Ì˘ÂϛӈÛ˘, Ï¢ÎÔ̷ϷΛ· Î·È Î˘ÛÙÈ΋ ÂÁÎÂÊ·ÏÔ̷ϷΛ·. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂÎÙfi˜ ÙˆÓ ·ÔÙÈÙ·ÓÒÛÂˆÓ ·ÂÈÎÔÓ›˙ÔÓÙ·È Î˘Ú›ˆ˜ Ì ÙËÓ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. H ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó·‰ÂÈÎÓ‡ÂÈ ÙȘ ·ÔÙÈÙ·ÓÒÛÂȘ, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚfiÙÂÚË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ·fi ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÙËÓ ·Ó¿‰ÂÈÍË ÙˆÓ ˘ÔÏÔ›ˆÓ ·ÏÏÔÈÒÛˆÓ. TÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÌÔÚ› Â›Û˘ Ó· ·Ôηχ„ÂÈ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ·Ó Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ¯·ÌËÏfiÙÂÚË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ·fi ÙË Ì·ÁÓËÙÈ΋ Î·È ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·.(4,6) OÈ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ·ÔÙÈÙ·ÓÒÛÂȘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È Â‡ÚËÌ· Ù˘ÈÎfi Ïԛ̈͢ ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi, ·ÏÏ¿ fi¯È ·ıÔÁÓˆÌÔÓÈÎfi. Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙÔ 40% ÂÚ›Ô˘ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Î·È ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ Î·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·. H ÂÁÁÂÓ‹˜ ·‰˘Ó·Ì›· Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ó· ·Ó·‰Â›ÍÂÈ ÙȘ ·ÔÙÈÙ·ÓÒÛÂȘ Â›Ó·È ÁÓˆÛÙ‹. OÈ ·ÔÙÈÙ·ÓÒÛÂȘ ¯·Ú·ÎÙËÚÈÛÙÈο ÂÓÙÔ›˙ÔÓÙ·È ÂÚÈÎÔÈÏȷο, ·ÏÏ¿ ÌÔÚ› Â›Û˘ Ó· ˘¿Ú¯Ô˘Ó ÙfiÛÔ ÛÙÔÓ ÊÏÔÈfi Î·È ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë ÌÔ›Ú· Ù˘ Ï¢΋˜ Ô˘Û›·˜ fiÛÔ Î·È ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ·.

OÈ ·Ú·ÎÔÈÏȷΤ˜ ·ÛÙÂȘ ÔÊ›ÏÔÓÙ·È Û ӤÎÚˆÛË, ÁÏÔ›ˆÛË ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È ·ÂÈÎÔÓ›˙ÔÓÙ·È Â˘¯ÂÚ¤ÛÙÂÚ· Ì ÙËÓ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·.(4) ™ÙËÓ ·ÛıÂÓ‹ Ì·˜ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·Ù·Ú·¯¤˜ Ù˘ Ì˘ÂϛӈÛ˘, Ô˘ ·ÂÈÎÔÓ›ÛıËÎ·Ó ÛÙËÓ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ˆ˜ ÂÛٛ˜ ·ıÔÏÔÁÈÎÔ‡ Û‹Ì·ÙÔ˜ ÛÙËÓ Ï¢΋ Ô˘Û›·, ÂÓÒ Ë ·ÂÈÎfiÓÈÛË ÙÔ˘ ÊÏÔÈÔ‡ ˘‹ÚÍÂ Ê˘ÛÈÔÏÔÁÈ΋. ™˘ÓÂÒ˜, ÙÔ ·ıÔÏÔÁÈÎfi ·›ÙÈÔ Ú¤ÂÈ Ó· ¤‰Ú·Û ÌÂÙ¿ ÙËÓ 26Ë-28Ë Â‚‰ÔÌ¿‰· ·ËÛ˘ ‰ËÏ·‰‹ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ‰È·‰Èηۛ·˜ ÌÂÙ·Ó¿ÛÙ¢Û˘ ÙˆÓ Ó¢ÚÒÓˆÓ. H ÌÈÎÚ‹ ·ÛıÂÓ‹˜ Ì·˜ ÚÔÛ‹Ïı ·ÚÈ· Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÓÒ Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ Ù˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. ÕÏÏ· ÚÔ‚Ï‹Ì·Ù· ÏËÓ Ù˘ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ fiˆ˜ ÌÂȈ̤ÓË ·›ÛıËÛË ÛÙÔÓ fiÓÔ, ·Ù·Í›·, ˘ÔÙÔÓ›· ‹ ·‰ÂÍÈfiÙËÙ·, Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ‚È‚ÏÈÔÁÚ·Ê›· Û ·È‰È¿ Ì fi„ÈÌË Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi(6) ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ·ÛıÂÓ‹ Ì·˜.

T· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ù˘ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ·˜ ‚·ÚËÎÔ˝·˜, ÌÈÎÚÔÎÂÊ·Ï›·˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ıˆÚÔ‡ÓÙ·È ÂÓ‰ÂÈÎÙÈο fi„ÈÌ˘ Ïԛ̈͢ ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ηٿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘(6).

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K·Ù¿ ÙfiÔ˘˜ ÔÈ Û˘ÚÚ¤Ô˘Û˜ ·ÔÌ˘ÂÏÈÓˆÙÈΤ˜, ÌË ÂÍÂÏÈÛÛfiÌÂÓ˜ ÂÛٛ˜ ÛÙË Ï¢΋ Ô˘Û›·, Ô˘ ·Ô‰›‰ÔÓÙ·È ÛÂ Ô˘Ï¤˜ ÁÏÔ›ˆÛ˘, fiˆ˜ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ηıÒ˜ Î·È ¿ÏÏ· ¿Ù˘· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ÂÚÈÙÒÛÂȘ Ïԛ̈͢ Ì ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi, ·fi ÙÔ˘˜ Sugita et al(9) Î·È Alonso et al(10) ·ÓÙ›ÛÙÔȯ·. OÈ Steinlin et al (6) ÂÚȤÁÚ·Ê·Ó ÙÔ 1966 ÂÙ¿ ·È‰È¿ Ì ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ·Ó¿ÏÔÁ· Ì ·˘Ù¿ Ù˘ ÌÈÎÚ‹˜ ·ÛıÂÓÔ‡˜ Ì·˜, Èı·ÓÔÏÔÁÒÓÙ·˜ fi„ÈÌË Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi.

M·ÎÚÔ¯ÚfiÓÈÔÈ Â·Ó¤ÏÂÁ¯ÔÈ ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÎÏÂÈÛı› Ù˘¯fiÓ ÂÍÂÏÈÎÙÈÎfiÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. Œ¯ÂÈ ¿ÓÙˆ˜ ·Ó·ÊÂÚı› ÚÔԉ¢ÙÈ΋ ‚·ÚËÎÔ˝· Û ·È‰È¿ Ì ·Û˘Ìو̷ÙÈ΋ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi(11), ÚÔԉ¢ÙÈ΋ ˘ÔÂÂÓ‰˘Ì·ÙÈ΋ Ó¤ÎÚˆÛË ÌÂÙ¿ ÙË Á¤ÓÓËÛË(12) ÛÂ Û˘ÁÁÂÓ‹ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Î·È Ù¤ÏÔ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ‚·ÚÂÈ¿ ÂÍÂÏÈÎÙÈ΋ ÂÁÎÂÊ·ÏÈ΋ ·ÙÚÔÊ›· Û ·È‰› Ì ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi(13). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ Ë ·ıÔÏÔÁÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜, Ô˘ Â›Ó·È Â‡ÚËÌ· ÌË ÂȉÈÎfi, Î·È Ë ·Ô˘Û›· ¿ÏÏˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Û˘Ì‚·ÙÒÓ Ì ÚÒÈÌË Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi fiˆ˜ ÚԷӷʤÚıËÎ·Ó ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ‹È·, ·ÏÏ¿ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ·˜ ‚·ÚËÎÔ˝·˜, Ù˘ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Î·È Ù˘ ÌÈÎÚ‹˜ ÂÚÈ̤ÙÚÔ˘ Ù˘ ÎÂÊ·Ï‹˜ Ô˘ Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÚÔÛ‚ÔÏ‹ ·fi ÙÔ Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û˘Ó¤‚Ë fi„ÈÌ· Î·È Ì¿ÏÈÛÙ· ηٿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ Î·È Ë ÂÈÙ˘¯‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚·ÚËÎÔ˝·˜ Ì ÎÔ¯ÏÈ·Îfi ÂÌʇÙÂ˘Ì· ÛÙÔ ·ÎÔÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ NÔÛÔÎÔÌ›Ԣ Ì·˜ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÏfiÁÔ˘˜ ·ÚÔ˘Û›·Û˘ Ù˘ ÂÚÁ·Û›·˜ Ì·˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Dobbins JG, Stewart JA, Demmler GJ. Surveillance of congenital cytomegalovirus disease, 1990-1991.

Collaborating Registry Group MMWR CDC Surveill Summ 1992;41:35-39.

2. Alford CA, Stagnos S. Pass RF, Britt WJ. Congenital and perinatal cytomegalovirus infection. Res Intet Dis 1990;12: 5745-5753.

3. Yair D, Gull I, Peyser MR, Lessing JB. Congenital cytomegalovirus infection. Eur J Obstet Gynecol Reprod Biol 1995;63:7-16.

4. Barkovich AJ, Lindau CE. Congenital cytomegalovirus infection of the brain: Imaging analysis and embryological considerations. AJNR 1994;15:703-704.

5. Boech C, Issakainen J, Kewitz G, Kikinis R, Martin E, Boltshause E. Magnetic resonance imaging of the brain in congenital cytomegalocirus infection. Pediatr Radiol 1989;19:91-93.

6. Steinlin MI, Nadal D, Eich GF, Martin E, Boltshauser EJ. Late intrauterine cytomegalovirus infection: clinical and neuroimaging findings. Pediatr Neurol 1996;15:249-253.

7. Barnes PD, Poussaint TY, Burrows PE. Imaging of pediatric central nervous system infections. Pediatric Neuroradiology 1994;4:367-391.

8. Hayward JC, Titelbaum DS, Clancy RR, Zimmerman RA. Lissesncephaly-pachygyria associeted with congenital cytomegalovirus infection. J Child Neurol 1991;6:109-114.

9. Sugita K, Ando M, Makino M, Takanashi J, Fujimoto N, Miimi H. Magnetic resonance imaging of the brain in congenital rubella virus and cytomegalovirus infection. ¡euroradiology 1996;3:315-319.

10. Alonso A, Alvarez A, Seara MJ, Lipares M, Villalon J. Unusual manifestations of postnatally acquired cytomegalovirus infection: findings on CT and MR. Pediatr Radiol 1997;2:217-221.

11. Williamson WD, Demmler GJ, Percy AK, Catlin FI. Progressice hearing loss in infants with asymptomatic congenital cytomegalovirus infection. Pediatrics 1992;90:862-866.

12. Bale JF, Sato Y, Eisert D. Progressive postnatal subependymal necrosis in an infant with congenital cytomegalovirus infection. Pediatr Neurol 1986;2:367.

13. Nabetani M, Tsuneishi S, Kugo M, Konishi H, Yamazaki T. A case of perinatal cytomegalovirus infection with severe progressive brain atrophy. No To Hattatsu 1993;25:76-80.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-04-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, °Ô˘‰› 115 27

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AÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙ· ·È‰È¿ M·Ú›Ó· °. ¶··‰¿ÎË1, Iˆ¿ÓÓ˘ ™. K·ÛηڤÏ˘2

● ¶ÂÚ›ÏË„Ë: O fiÚÔ˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) Â›Ó·È ÂÚÈÁÚ·ÊÈÎfi˜ Î·È ·Ó·Ê¤ÚÂÙ·È Û οı "¯ˆÚ›˜ ÚÔÛ¿ıÂÈ·" ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÂÓÙfi˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. H ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Ù˘ °O¶ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ‰ÔÎÈÌ·Û›· Bernstein, ÙËÓ ‰ÔÎÈÌ·Û›· Tuttle, ÙËÓ pH/ÌÂÙÚ›·, ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ÙËÓ Ì·ÓÔÌÂÙÚ›·, ÙËÓ ÂÓ‰ÔÛÎfiËÛË, ÙÔ ‚·ÚÈÔ‡¯Ô Á‡̷ (B°) Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (U/S). H ·ÚÔ‡Û· ÌÂϤÙË Â›Ó·È ÂÎÙÂÓ‹˜ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÛÙÔ ı¤Ì· Ù˘ °O¶ ÛÙ· ·È‰È¿, Û¯ÂÙÈο Ì ÙÔ˘˜ ÙÚfiÔ˘˜ ·ÂÈÎÔÓÈÛÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ‹˜ Ù˘. K‡ÚÈÔ˜ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì B° Â›Ó·È Ë ‰È·›ÛÙˆÛË ‹ Ô ·ÔÎÏÂÈÛÌfi˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Î·È ÙˆÓ ·‰ÚÒÓ ÌÔÚÊÒÓ ÔÈÛÔÊ·Á›Ùȉ·˜, ÂÓÒ Û˘Ó‹ıˆ˜ ÌÂÏÂÙ¿Ù·È ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H ¢·ÈÛıËÛ›· Î˘Ì·›ÓÂÙ·È ·fi 20-73% (Ì.Ô. 35%) Î·È Ë ÂȉÈÎfiÙËÙ· ÂÚ› ÙÔ 30% ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ. TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì Tc99m ıˆÚÂ›Ù·È Ì¤ıÔ‰Ô˜ ÏÈÁfiÙÂÚÔ Â˘·›ÛıËÙË ÙÔ˘ B°, ¯Ú‹ÛÈÌË fï˜ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ·˘ÙÔηı¿ÚÛˆ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ¤¯ÂÈ Î·ÙÂÍÔ¯‹Ó ¤Ó‰ÂÈÍË fiÔ˘ Ë °O¶ ÂΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi Èı·Ó‹˜ ÂÈÛÚÔÊ‹Ûˆ˜ ÛÙÔ˘˜ Ó‡ÌÔÓ˜, Û ÂÚÈÙÒÛÂȘ ηı˘ÛÙÂÚË̤Ó˘ Á·ÛÙÚÈ΋˜ ΤӈÛ˘ Î·È ·Ó·ÁˆÁ‹˜ ÌË ÔÍ›ÓÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘. TÔ U/S ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ °O¶ Î·È Ù˘ ÔÈÛÔÊ·Á›Ùȉ·˜ ˆÛÙfiÛÔ, ÌÔÚ› Ó· ÌÂÏÂÙËıÔ‡Ó ÏÂÙÔÌÂÚÒ˜ Ë ·Ó·ÙÔÌ›· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ Û˘Ì‚ÔÏ‹˜. £· ÌÔÚÔ‡Û ӷ Û˘ÛÙËı› ˆ˜ screening test Û ÎÏÈÓÈο ˘fiÙÔ˘˜ ÁÈ· °O¶ ·ÛıÂÓ›˜ Î·È Ì¿ÏÈÛÙ· ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ, Ì ‹ ¯ˆÚ›˜ Ù·˘Ùfi¯ÚÔÓË ÂÊ·ÚÌÔÁ‹ pH/ÌÂÙÚ›·˜. TÔ U/S ˆ˜ ÌfiÓË Ì¤ıÔ‰Ô˜ ˘ÔÏ›ÂÙ·È Û ·ÎÚ›‚ÂÈ· Ù˘ pH/ÌÂÙÚ›·˜ Î·È ¤¯ÂÈ ÙËÓ ›‰È· Ì ÙÔ B° ÂȉÈÎfiÙËÙ· (30%). ¶·È‰È·ÙÚÈ΋ 2000;63:330-336. §¤ÍÂȘ ÎÏÂȉȿ: Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ·È‰È΋ ËÏÈΛ·, ·ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË.

M. Papadaki, I. Kaskarelis. GastroÔesophageal reflux in children: methods of radiological evaluation.

Paediatriki 2000;63:330-336. ● Abstract: GastroÔesophageal reflux (GER) is the passage of gastric contents into the lower oesophagus and the term usually refers to symptomatic GER with or without histological oesophageal abnormalities. Various diagnostic tests are available for the assessment of the patient with suspected GER; the Bernstein test, the Tuttle test, intraoesophageal pH monitoring, gastric scintigraphy, oesophageal manometry, endoscopy, upper gastrointestinal (GI) barium studies and ultrasonography. The main aims of upper GI barium studies in examining children with suspected GER are to assess the adequacy of the antireflux mechanism and to detect gross morphological changes of reflux oesophagitis and possible upper gastrointestinal tract anatomical abnormalities.

The sensitivity of barium studies varies between 20% and 73% and the specificity is estimated at 30% of symptomatic patients. Gastric scintigraphy is probably less sensitive than upper GI barium studies, although it is useful for evaluating oesophageal function and clearance. and is indicated primarily for evaluating infants with suspected aspiration, delayed gastric emptying and nonacid reflux. Ultrasonography (US) permits only poor assessment of the severity of GER and oesophagitis but it provides unique morphological information about the gastrooesophageal junction. US evaluation is almost as specific as upper GI barium studies for demonstrating GER in children but less accurate than oesophageal pH monitoring. It could be used as a screening test, coupled or not to pH analysis, in patients at risk, especially those under the age of 5 years.

Key words: gastroÔesophageal reflux, childhood, radiological evaluation.

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AÎÙÈÓԉȷÁÓˆÛÙÈÎfi TÌ‹Ì· °.¶.N. ¶·›‰ˆÓ AıËÓÒÓ "AÁ›· ™ÔÊ›·" AÎÙÈÓԉȷÁÓˆÛÙÈÎfi TÌ‹Ì· ¶.°.N.A. "O E˘·ÁÁÂÏÈÛÌfi˜”

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EÈÛ·ÁˆÁ‹ O fiÚÔ˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) Â›Ó·È ÂÚÈÁÚ·ÊÈÎfi˜ Î·È ·Ó·Ê¤ÚÂÙ·È Û οı "¯ˆÚ›˜ ÚÔÛ¿ıÂÈ·" ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÂÓÙfi˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘.(1) O ÂÈÔÏ·ÛÌfi˜ (fï˜ ÛÙËÓ ·ıÔÏÔÁ›· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 75% Ì prevalence) Ù˘ °O¶ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÂÎÙÈÌ¿Ù·È ÛÙÔ 2-5% (2), Ë Û˘Ì‚ÔÏ‹ Ù˘ Û˘¯Ó¤˜, ·Ù˘¯Ò˜, ηٷ¯Ú‹ÛÂȘ Î·È ÛÙË ‰È¿ÁÓˆÛË Î·È ÛÙË ıÂÚ·›· Ù˘.

AÓ Î·È Ë ·ÓÙ›ÏË„Ë ÁÈ· ÙË °O¶ ¿Ú¯ÈÛ ӷ ·Ó·Ù‡ÛÛÂÙ·È ÛÙË ‰ÂηÂÙ›· ÙÔ˘ 1930, Û˘¯ÓfiÙÂÚË ·Ó·ÊÔÚ¿ Û ·˘Ù‹Ó ·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ Î·Ù¿ Ù· ÙÂÏÂ˘Ù·›· 15-20 ¯ÚfiÓÈ·(3). A˘Ùfi, ÚÔÊ·ÓÒ˜, Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙȘ Û‡Á¯ÚÔÓ˜ ηÏÏ›ÙÂÚ˜ ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜ ·ÏÏ¿ Î·È Ì ÙËÓ ·˘ÍË̤ÓË ÂÓË̤ڈÛË - ÂÙÔÈÌfiÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÁÈ·ÙÚÒÓ. ¶·ıÔÊ˘ÛÈÔÏÔÁ›· ◊‰Ë ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1950 Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ °O¶ ›¯Â Û˘Û¯ÂÙÈÛı› Ì ÙÔ ÌÂȈ̤ÓÔ ÙfiÓÔ (¯·Ï·ÚfiÙËÙ·) ÙÔ˘ ηÙÒÙÂÚÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÛÊÈÁÎÙ‹Ú· (KO™) Ô ÔÔ›Ô˜ ıˆÚÂ›Ù·È ˆ˜ Ô Î˘ÚÈfiÙÂÚÔ˜ ÊÚ·ÁÌfi˜ ÚÔÛÙ·Û›·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·fi ÙÔ fiÍÈÓÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘.(3,4) ™ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ÌÔÓÙ¤ÏÔ Ô ÔÈÛÔÊ¿ÁÔ˜ ÛÙÔ Û‡ÓÔÏfi ÙÔ˘ ÏÂÈÙÔ˘ÚÁ› ˆ˜ ÚÔˆıËÙÈ΋ ·ÓÙÏ›·, Ô ÛÙfiÌ·¯Ô˜ ˆ˜ ·Ôı‹ÎË ÂÓÒ Ô KO™ ˆ˜ ‚·Ï‚›‰· ÌÔÓ‹˜ ηÙ¢ı‡ÓÛˆ˜. ¶ÏËÌÌÂÏ‹˜ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ KO™, Û˘ÓÂÈÎÔ˘ÚÔ‡ÌÂÓË ÂӉ¯Ô̤ӈ˜ ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ (·ÚÔ˘Û›· ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘, ·˘ÍË̤ÓË ÔÛfiÙËÙ· Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, ·˘ÍË̤ÓË ÂÓ‰ÔÎÔÈÏȷ΋ ›ÂÛË, ηı˘ÛÙÂÚË̤ÓË Î¤ÓˆÛË ÛÙÔÌ¿¯Ô˘, ÌÂȈ̤ÓË ·ÓÙÔ¯‹ ÔÈÛÔÊ·ÁÈÎÔ‡ ÂÈıËÏ›Ô˘, ÌË Ê˘ÛÈÔÏÔÁÈ΋ ÎÈÓËÙÈÎfiÙËÙ· - ·˘ÙÔοı·ÚÛË ÔÈÛÔÊ¿ÁÔ˘ Î.¿.) Ô‰ËÁ› ÛÙËÓ ·Ó·ÁˆÁ‹ Î·È Ù· Â·ÎfiÏÔ˘ı¿ Ù˘ (3-5). O KO™ ‰È·ÙËÚÂ›Ù·È Û ÙÔÓÈ΋ Û‡Û·ÛË Û ÂÚ›Ô‰Ô ËÚÂÌ›·˜ Î·È ¯·Ï·ÚÔ‡Ù·È ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÂÚÈÛÙ·ÏÙÈÎÔ‡ ·̷ÙÔ˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙË ‰›Ô‰Ô ÙÔ˘ ‚ψÌÔ‡(6). O Û˘ÓÙÔÓÈÛÌfi˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ Î·Ù¿ÏÏËÏË Ó‡ڈÛË Ù˘ ÂÚÈÔ¯‹˜ ÂÎ ÙˆÓ ˆÓ ԢΠ¿Ó¢ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. TÔ ÁÂÁÔÓfi˜ fiÙÈ Ë °O¶ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙÔ˘˜ 2 ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜ (1:300 ¤ˆ˜ 1:1000)(4) ηıÒ˜ Î·È ÛÙÔ 10% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Ì Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, Ù¤ÙÚ·- ‹ ËÌÈ·ÚÂÙÈ΋ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÎÏ)(5,7) ·Ô‰›‰ÂÙ·È Û ·Ó·ÙÔÌÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ Ó¢ÚÔÌ˯·ÓÈÛÌÔ‡ ÚÔÛÙ·Û›·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. (1) EÈϤÔÓ, Ë ÔÛfiÙËÙ· ÔÍ›ÓÔ˘ ÂÎÎÚ›Ûˆ˜ Â› ÎÂÓÔ‡ ÛÙÔÌ¿¯Ô˘ Â›Ó·È Ë ›‰È· Ì ÙÔ˘ ÂÓËÏ›ÎÔ˘ (30Mmol/Kgr/ÒÚ·), Ë ¯ˆÚËÙÈÎfiÙËÙ· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÌÈÎÚfiÙÂÚË(4) ÂÓÒ Î·È ÙÔ ÂÓ‰ÔÎÔÈÏÈ·Îfi ÙÌ‹Ì· (ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·ÚÂ-

∞ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË

Ìfi‰ÈÛË ·ÏÈÓ‰ÚÔÌ‹Ûˆ˜) Â›Ó·È Û˘ÁÎÚÈÙÈο ‚Ú·¯‡ÙÂÚÔ ·fi ·˘Ùfi ÙÔ˘ ÂÓËÏ›ÎÔ˘.(1) TÔ Ì‹ÎÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·˘Í¿ÓÂÈ Ì ÙËÓ ·‡ÍËÛË Î·È ‰È¿Ï·ÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ·˘Ùfi Èı·ÓÒ˜ ÂÍËÁ› ÙËÓ ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÙˆÓ ·Ó·ÁˆÁÒÓ ÌÂÙ¿ ÙÔ 18Ô Ì‹Ó·.(8) T¤ÏÔ˜, ¤¯ÂÈ ÂÚÈÁÚ·Ê› °O¶ Ì ·˘ÍË̤ÓÔ ÙfiÓÔ KO™ ËÈfiÙÂÚ˘ ¿ÓÙˆ˜ ‰È·‰ÚÔÌ‹˜(9) ÂÓÒ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Û˘Ó‰˘¿˙Ô˘Ó ·ÈÙÈÔÏÔÁÈο ÙË °O¶ Ì ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜.(10) KÏÈÓÈ΋ ÂÈÎfiÓ· T· ΢ÚÈfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Ù˘ °O¶ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. H °O¶ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó¿Ù˘Í˘, ÂÈÏÔΤ˜ ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· (ÙÂÚˉfiÓ·, ÔÈÛÔÊ·Á›Ùȉ·, Ô˘ÏÒ‰Ë ÛÙ¤ÓˆÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ÔÈÛÔÊ¿ÁÔ Barrett, ÂÓ‰ÔÔÈÛÔÊ·ÁÈÎÔ‡˜ Ôχԉ˜), ·fi ÙÔ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· (˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ, ·ÓÙȉڷÛÙÈ΋ ÓfiÛÔ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, ·ÛıÌ·ÙÈ΋ ‚ÚÔÁ¯›Ùȉ·, ¿ÓÔÈ·, ‚Ú·‰˘Î·Ú‰›·, ÛÈÁÌfi, Ï·Ú˘ÁÁÈÎfi ÎÔÎΛˆÌ· Î.¿.) ÂÓÒ Ë Û¯¤ÛË Ù˘ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ (SIDS) ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓË(4,7). ¶›Ó·Î·˜ 1. T· ΢ÚÈfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Ù˘ °O¶.

1. ŒÌÂÙÔÈ - ·Ó·ÁˆÁ¤˜ 2. ¢˘ÛÊ·Á›· 3. EÈÁ¿ÛÙÚÈÔ ‹ ÔÈÛıÔÛÙÂÚÓÈÎfi ¿ÏÁÔ˜ Ù‡Ô˘ ÛÙËı¿Á¯Ë˜ 4. OÈÛıÔÛÙÂÚÓÈÎfi˜ η‡ÛÔ˜ 5. EÚ˘Á¤˜, ÌÂÙ·ÁÂ˘Ì·ÙÈÎfi ·›ÛıËÌ· ÏËÚÒÛˆ˜ 6. AÓÔÚÂÍ›· Èı·ÓÒ˜ ÏfiÁˆ ¿ÏÁÔ˘˜ ηٿ ÙËÓ Î·Ù¿ÔÛË (odynophagia) 7. MËڢηÛÌfi˜ 8. AÓ·ÈÌ›· ÛȉËÚÔÂÓÈ΋ 9. AÈÌ·Ù¤ÌÂÛË - ̤ϷÈÓ· 10. AÒÏÂÈ· ‚¿ÚÔ˘˜ - η΋ ıÚ¤„Ë 11. E˘ÂÚÂıÈÛÙfiÙËÙ· - ¿Ù˘ÔÈ ÎÔÏÈÎÔ› 12. ¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘ 13. XÚfiÓÈ· ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù· 14. ™‡Ó‰ÚÔÌÔ Sandifer (ÔÈÛıfiÙÔÓÔ˜, ÌË Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË ÎÂÊ·Ï‹˜)

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ °O¶ H ÏÂÙÔÌÂÚ‹˜ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÚÔÛÂÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ÔÙÂÏÔ‡Ó, ÛÙ· ¯¤ÚÈ· ÙÔ˘ ¤ÌÂÈÚÔ˘ ÁÈ·ÙÚÔ‡, ÙÔ ÚÒÙÔ Î·È Î·Ï‡ÙÂÚÔ ‰È·ÁÓˆÛÙÈÎfi ÂÚÁ·Ï›Ô. ∂ÓÙÔ‡ÙÔȘ, ÁÈ· ÙË ‰È¿ÁÓˆÛË, Â›Ó·È ··Ú·›ÙËÙË Ë ÂÚÁ·ÛÙËÚȷ΋ Û˘Ó‰ÚÔÌ‹ ÔÈ Î˘ÚÈfiÙÂÚÔÈ ÂÎÚfiÛˆÔÈ Ù˘ ÔÔ›·˜ ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2.

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¶›Ó·Î·˜ 2. EÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· ÙËÓ ‰È¿ÁÓˆÛË Ù˘ °O¶.

EÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË 1.

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¢ÔÎÈÌ·Û›· Bernstein ¢ÔÎÈÌ·Û›· Tuttle 24-ˆÚË ÂÓ‰ÔÔÈÛÔÊ·ÁÈ΋ PH/ÌÂÙÚ›· OÈÛÔÊ·ÁÔÁ·ÛÙÚÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì Ó¢ÌÔÓÈÎfi monitoring OÈÛÔÊ·ÁÔÁ·ÛÙÚÈ΋ Ì·ÓÔÌÂÙÚ›· EÓ‰ÔÛÎfiËÛË - ‚ÈÔ„›· ÔÈÛÔÊ¿ÁÔ˘ B·ÚÈÔ‡¯Ô ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· (‚·ÚÈÔ‡¯Ô Á‡̷ - B°) YÂÚ˯ÔÁÚ¿ÊËÌ· (UltraSound - U/S)

£· ·Ó·ÊÂÚıÔ‡ÌÂ Û˘ÓÔÙÈÎÒ˜, Û fiÛ˜ ·fi ÙȘ ·Ú·¿Óˆ ÌÂıfi‰Ô˘˜ ‰ÂÓ Â›Ó·È ·ÌÈÁÒ˜ ·ÎÙÈÓÔÏÔÁÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜, ÂÓÒ ¤ÌÊ·ÛË ı· ‰Ôı› ÛÙȘ ΢ڛˆ˜ ·ÎÙÈÓÔÏÔÁÈΤ˜ (‚·ÚÈÔ‡¯Ô Á‡̷ Î·È ˘ÂÚ˯ÔÁÚ¿ÊËÌ·) Î·È ÛÙË ÌÂٷ͇ ÙÔ˘˜ Û˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË.

H ‰ÔÎÈÌ·Û›· Bernstein ™˘Ó›ÛÙ·Ù·È Û ÙÔÔı¤ÙËÛË Î·ıÂÙ‹Ú· ̤¯ÚÈ ÙÔ˘ ̤ÛÔ˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Î·È ÂÓ·ÏÏ·ÛÛfiÌÂÓ˜ ÂÁ¯‡ÛÂȘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ - ÔÍ›ÓÔ˘ ‰È·Ï‡Ì·ÙÔ˜ Ì ٷ˘Ùfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ë ‰Â ÂÌÂÈÚ›· ÛÙ· ·È‰È¿ Â›Ó·È Ìˉ·ÌÈÓ‹ (7). ™‹ÌÂÚ· ϤÔÓ Ë ‰ÔÎÈÌ·Û›· Bernstein ‰ÂÓ ¯ÚËÛÈÌÔÔÈ›ٷÈ.

H ‰ÔÎÈÌ·Û›· Tuttle E›Ó·È Ë ÂÏÂÁ¯fiÌÂÓË, ÌÂÙ¿ ¯ÔÚ‹ÁËÛË ¯˘ÌÔ‡ Ì‹ÏÔ˘, pH/ÌÂÙÚ›· Ì ÌÂÁ·Ï‡ÙÂÚË ›Ûˆ˜ ¢·ÈÛıËÛ›· Î·È Ôχ ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ˘ı‹Ûˆ˜ ·fi fiÙÈ Ë ‰ÔÎÈÌ·Û›· Berstein (7). T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ‰ÔÎÈÌ·Û›·˜ Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏÔ Ó· ÂÚÌËÓ¢ıÔ‡Ó Î·È ‰ÂÓ Â›Ó·È ·ÍÈfiÈÛÙ·.

H pH/ÌÂÙÚ›· °ÂÓÈο ıˆÚÂ›Ù·È ˆ˜ Ë Î·Ï‡ÙÂÚË ÂÚÁ·ÛÙËÚȷ΋ ̤ıÔ‰Ô˜ ÚÔÛÂÁÁ›Ûˆ˜ Ù˘ °O¶ Î·È Ì¿ÏÈÛÙ· ÛȈËÏÒÓ ÌÔÚÊÒÓ Ù˘, ÂÊfiÛÔÓ ‰Â ÂÎÙÂÏÂ›Ù·È Lege artis, ÚÔÙ›ÓÂÙ·È ˆ˜ ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â› ˘fiÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ.(1,3) ¶ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙÔ ¯ÚfiÓÔ ÂÎı¤Ûˆ˜ ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ÛÙÔ fiÍÈÓÔ Á·ÛÙÚÈÎfi ÂÚȯfiÌÂÓÔ, Ë Â˘·ÈÛıËÛ›· Ù˘ ·˘Í¿ÓÂÈ Ì ÙÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ˘ı‹Ûˆ˜ (monitoring) Â›Ó·È fï˜ ‰··ÓËÚ‹ Î·È fi¯È ‰È·ı¤ÛÈÌË Û fiÏ· Ù· ΤÓÙÚ·.(11) ™Ù· ‚Ú¤ÊË ıˆÚÂ›Ù·È ıÂÙÈ΋ ·Ó ÙÔ pH ÛÙÔÓ ÎÔÈÏÈ·Îfi ÔÈÛÔÊ¿ÁÔ Â›Ó·È Î¿Ùˆ ÙÔ˘ 4 ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 5% ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔÏÔ˘ı‹Ûˆ˜ (Û˘Ó‹ıˆ˜ ¤Ó· 24/ˆÚÔ) (12). EÓÒ ‰ÂÓ ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙÔÓ fiÁÎÔ ·Ó·ÁˆÁ‹˜, ÚÔÛ‰ÈÔÚ›˙ÂÈ fï˜ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙÔ ¯ÚfiÓÔ ·ÔηٷÛÙ¿Ûˆ˜ ηÓÔÓÈÎÔ‡ pH ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ. ™Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù˘ PH/ÌÂÙÚ›·˜ ηٷÁÚ¿-

332

M. ¶··‰¿ÎË, π. ™. ∫·ÛηڤÏ˘

ÊÂÙ·È Ë ·‰˘Ó·Ì›· Ù˘ Ó· Û˘ÏÏ¿‚ÂÈ ·Ó·ÁˆÁ¤˜ ÛÙË ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ Ê¿ÛË ÏfiÁˆ ÂÍÔ˘‰ÂÙÂÚÒÛˆ˜ Ù˘ Á·ÛÙÚÈ΋˜ Ô͇ÙËÙ·˜ ·fi ÙËÓ ÙÚÔÊ‹ (6). ™‹ÌÂÚ· Â›Ó·È ‰˘Ó·ÙfiÓ Ë ÂͤٷÛË Ó· Á›ÓÂÈ Ì ÊÔÚËÙfi fiÚÁ·ÓÔ ·ÎfiÌË Î·È Û Â͈ÙÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜.

TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì Tc99m ıˆÚÂ›Ù·È Ì¤ıÔ‰Ô˜ ÏÈÁfiÙÂÚÔ Â˘·›ÛıËÙË, ¯Ú‹ÛÈÌË fï˜ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ·˘ÙÔηı¿ÚÛˆ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ (13) ηıÒ˜ Î·È Û ÂÚÈÙÒÛÂȘ ·Ó·ÁˆÁ‹˜ ¯ÔÏ‹˜ ‹ ·¯ÏˆÚ˘‰Ú›·˜ fiÔ˘ Ë PH/ÌÂÙÚ›· ÌÔÚ› Ó· ‰ÒÛÂÈ „¢‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·.(12) EÈÙÚ¤ÂÈ Â›Û˘ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ Ú˘ıÌÔ‡ Á·ÛÙÚÈ΋˜ ÎÂÓÒÛˆ˜, ÛËÌ·ÓÙÈ΋˜ ·Ú·Ì¤ÙÚÔ˘ ÛÙË ÌÂϤÙË Ù˘ °O¶, ÙÔÓ ÂÓÙÔÈÛÌfi Ó¢ÌÔÓÈÎÒÓ ÂÈÛÚÔÊ‹ÛˆÓ(6) ηÈ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÔÈÛÔÊ·ÁÈ΋ Ì·ÓÔÌÂÙÚ›·, ÙËÓ ·Ó›¯Ó¢ÛË ÂÚÈÙÒÛÂˆÓ °O¶ Ì ‰È·Ù·Ú·¯‹ Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ÂÙÈÎÔ‡.(1) ø˜ ·Ú·Ù‹ÚËÛË fï˜, ÂÎÙ›ÓÂÙ·È Û ÂÚÈÔÚÈṲ̂ÓÔ ¯ÚfiÓÔ, ·Ó··Ú¿ÁÂÙ·È ‰‡ÛÎÔÏ·, ‰ÂÓ ÚÔÛ‰ÈÔÚ›˙ÂÈ Ì ·ÎÚ›‚ÂÈ· ÙËÓ ÔÛfiÙËÙ· ·Ó·ÁˆÁ‹˜ Î·È Î·ıfiÏÔ˘ ÙȘ Ù˘¯fiÓ ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜.(6) E›Ó·È ̤ıÔ‰Ô˜ ¿ÓÂÙË ÁÈ· ÙÔÓ ¿ÚÚˆÛÙÔ Î·È ¯·ÌËÏ‹˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ (¯·ÌËÏfiÙÂÚ˘ ·fi ÂΛӢ ÙÔ˘ B°)(6,14) Î·È ¤¯ÂÈ Î·ÙÂÍÔ¯‹Ó ¤Ó‰ÂÈÍË fiÔ˘ Ë °O¶ ÂΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi Èı·Ó‹˜ ÂÈÛÚÔÊ‹Ûˆ˜ ÛÙÔ˘˜ Ó‡ÌÔÓ˜. H ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÔÈΛÏÂÈ Â˘Ú¤ˆ˜ ·Ó¿ÌÂÛ· ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Î·È Î˘Ì·›ÓÂÙ·È ·fi 14-90% (Ì.Ô. 65%).(13) H Ì·ÓÔÌÂÙÚ›· H Ì·ÓÔÌÂÙÚ›· ·Ú¿ ÙÔ fiÙÈ ıˆڋıËΠ̤ıÔ‰Ô˜ "ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË" Ì ‰˘Ó·ÙfiÙËÙ˜ ηٷÁÚ·Ê‹˜ ÌÂÙ·‚ÔÏÒÓ ÛÙÔ ‚·ÛÈÎfi ÙfiÓÔ ÙÔ˘ KO™, ·‰›¯ıË ÙÂÏÈÎÒ˜ ÌÈÎÚ‹˜ ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜, Û˘Ó‰˘·˙fiÌÂÓË Û·ÓÈfiÙÂÚ· Ì ¿ÏϘ ‰ÔÎÈ̷ۛ˜ Î·È ·Ú·Ì¤ÓÔ˘Û·, ΢ڛˆ˜, ˆ˜ ÂÚÁ·ÏÂ›Ô ¤Ú¢ӷ˜.(6) H ÂÓ‰ÔÛÎfiËÛË H ÂÓ‰ÔÛÎfiËÛË, Ì ٷ˘Ùfi¯ÚÔÓË Î·Ù¿ ηÓfiÓ· ‚ÈÔ„›·,(15) ÏËÚÔÊÔÚ› ÁÈ· ÙËÓ ‡·ÚÍË ‹ fi¯È ÔÈÛÔÊ·Á›Ùȉ·˜ Î·È ÙË ÛÔ‚·ÚfiÙËÙ¿ Ù˘ ηıÒ˜ Î·È ÁÈ· ÙË ÁÚ·ÌÌ‹ ÌÂÙ·ÙÒÛˆ˜ ÙÔ˘ Ï·ÎÒ‰Ô˘˜ ÂÈıËÏ›Ô˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÛÙÔ Î˘ÏÈÓ‰ÚÈÎfi ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (ÔÈÛÔÊ¿ÁÔ˜ Barrett).(8) MÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ‰È¿ÁÓˆÛË ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ Î·È ÁÂÓÈÎÒ˜ ıˆÚÂ›Ù·È ··Ú·›ÙËÙË Û ÛÔ‚·Ú¤˜, ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ.

H ÌÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ H ÌÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ (B°) ıˆÚÂ›Ù·È Ì¤ıÔ‰Ô˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÚÔÛÈÙ‹ Î·È ÊıËÓ‹. ™˘Ó‹ıˆ˜ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ ·ÏÏ¿ ·ÊÔÚ¿ ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ (¤ˆ˜ ÙÔ Û‡Ó‰ÂÛÌÔ ÙÔ˘

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·333

¶∞π¢π∞∆ƒπ∫∏ 2000;63:330-336

Treitz ‹ ̤¯ÚÈ ÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi). EϤÁ¯ÂÙ·È ¤ÙÛÈ ÙÔ ÂӉ¯fiÌÂÓÔ ˘ÏˆÚÈ΋˜ ‹ 12/‰·ÎÙ˘ÏÈ΋˜ ÛÙÂÓÒÛˆ˜, Û˘ÁÁÂÓÒÓ 12/‰·ÎÙ˘ÏÈÎÒÓ Û˘ÌʇÛˆÓ, ‰È·ÊÚ·ÁÌ¿ÙˆÓ, ÌÂÌ‚Ú·ÓÒÓ, ‰˘ÛÎÈÓËÛÈÒÓ, malrotation, ÛÙÂÓÒÛˆ˜ ‹ ·ÙÚËÛ›·˜ ÂÓÙ¤ÚÔ˘ Î.¿.(6) ™Â ·ÛıÂÓ›˜ Ì ÎÏÈÓÈ΋ ˘Ô„›· °O¶ ·ÚÈÔ˜ ÛÎÔfi˜ Ê˘ÛÈο ·Ú·Ì¤ÓÂÈ Ë ‰È·›ÛÙˆÛË ‹ Ô ·ÔÎÏÂÈÛÌfi˜ ·ÓÂ·ÚΛ·˜ ÙÔ˘ ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ (antireflux) Î·È ÙˆÓ ·‰ÚÒÓ ÌÔÚÊÒÓ ÔÈÛÔÊ·Á›Ùȉ·˜. ™ÙË ‰È¿ÁÓˆÛË ¿ÓÙˆ˜ Ù˘ ÔÈÛÔÊ·Á›Ùȉ·˜ Ë ÂÓ‰ÔÛÎfiËÛË ˘ÂÚ¤¯ÂÈ Ì ¢·ÈÛıËÛ›· ÂÚ›Ô˘ 70% ¤Ó·ÓÙÈ 35% ÙÔ˘ B°(1).

K·Ù¿ ÙËÓ ÌÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ ·Ú¤¯ÔÓÙ·È Â›Û˘ ÏËÚÔÊÔڛ˜ ˆ˜ ÚÔ˜ ÙËÓ ‡·ÚÍË ‹ fi¯È ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ (ÂÈÎfiÓ· 1), ÙÔ Ì¤ÁÂıÔ˜ ˘¿Ú¯Ô˘Û·˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘, ÙËÓ ‡·ÚÍË ÔÈÛÔÊ·ÁÈ΋˜ ÛÙÂÓÒÛˆ˜ (‚·ıÌfi˜-¤ÎÙ·ÛË), ‰È·Ù·Ú·¯ÒÓ Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ηı˘ÛÙÂÚË̤Ó˘ Á·ÛÙÚÈ΋˜ ÎÂÓÒÛˆ˜ (antral dyskinesia) Î·È ÂÈÛÚÔÊ‹Ûˆ˜ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ B° ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ Á·ÛÙÚÈ΋˜ ÎÂÓÒÛˆ˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·ıÒ˜ ÙÔ ‚¿ÚÈÔ Â›Ó·È Ô˘Û›· ·‰Ú·Ó‹˜ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ‰ÂÓ ÂÓÂÚÁÔÔÈ› ÙÔ˘˜ ‰ˆ‰Âη‰·ÎÙ˘ÏÈÎÔ‡˜ ˘ԉԯ›˜ Ô˘ ÙË Ú˘ıÌ›˙Ô˘Ó (8). Œ¯ÂÈ ÚÔÙ·ı› Ù·ÍÈÓfiÌËÛË ÛÙË ÌÂϤÙË Ù˘ °O¶ Ì B° ·Ó·ÏfiÁˆ˜ ÙÔ˘ ÂÈ¤‰Ô˘ ·Ó·ÁˆÁ‹˜, ·fi 1 (·Ó·ÁˆÁ‹ ÛÙÔ ÂÓ‰ÔÎÔÈÏÈ·Îfi ÙÌ‹Ì· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘) ̤¯ÚÈ 5 (·Ó·ÁˆÁ‹ Ì ÂÈÛÚfiÊËÛË)(16), ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ fï˜ ÎÏÈÓÈÎÔ› ‰ÂÓ ıˆÚÔ‡Ó ·Ó·Áη›· ÌÈ· Ù¤ÙÔÈ· ÔÛÔÙÈ΋ ‰È·‚¿ıÌÈÛË ·ÊÔ‡ ÙÔ ‡„Ô˜ Ù˘ ·Ó·ÁˆÁ‹˜ ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ô‡Ù Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, Ô‡Ù Ì ٷ PH/ÌÂÙÚÈο Â˘Ú‹Ì·Ù·, Ô‡Ù Ì ÙË ıÂÚ·¢ÙÈ΋ ·¿ÓÙËÛË.(12,16) H ÌÂϤÙË Ì B° Û˘ÓÂ¿ÁÂÙ·È ¤ÎıÂÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Û ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·. K·ıÒ˜ Ô ·Ô‰ÂÎÙfi˜ ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎÔ‹Ûˆ˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙˆÓ ÂÓÙÔÈÛÌfi ÂÚÈÛÙ·ÛÈ·ÎÒÓ °O¶ ‹ ¿ÏÏˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÌfiÓÔ ˘fi ÔÚÈṲ̂Ó˜ Û˘Óı‹Î˜ (.¯. ÌfiÓÔ Û fiÚıÈ· ÛÙ¿ÛË, ÌfiÓÔ ÙË Ó‡¯Ù· ‹ ÌfiÓÔ Û ηٿÛÙ·ÛË ÓËÛÙ›·˜) Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÌÂÈÒÓÂÙ·È Î·È Ë ·Í›· Ù˘, ȉ›ˆ˜ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ Ù¯ÓÈÎÒÓ, Û˘˙ËÙ›ٷÈ.(15,17) ™Â ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜ Ë Â˘·ÈÛıËÛ›· Î˘Ì·›ÓÂÙ·È ·fi 20-73% (Ì.fi. 35%) Î·È Ë ÂȉÈÎfiÙËÙ· ÂÚ› ÙÔ 30% ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ.(12,15) ™ÙÔ „¢‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Û˘Ì‚¿ÏÏÂÈ Ë ¯ÔÚ‹ÁËÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ‚·Ú›Ô˘ ÛÙÔ ‰Â „¢‰Ò˜ ıÂÙÈÎfi ÔÈ ÎÚ·˘Á¤˜, Ë ¿ÛÎËÛË ȤÛˆ˜ ÛÙÔ ÎÔÈÏÈ·Îfi ÙÔ›¯ˆÌ·, Ë ¯·ÌËÏfiÙÂÚË ı¤ÛË Ù˘ ÎÂÊ·Ï‹˜ Î·È Ô ˘ÂÚ‚¿ÏÏˆÓ ˙‹ÏÔ˜ ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÌÈÎÚÔ·Ó·ÁˆÁÒÓ (12). TÔ B° ÏÔÈfiÓ Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ÔÛfiÙËÙ· Û˘Ó‹ıÔ˘˜ Á‡̷ÙÔ˜ Î·È Ì ÙÔÓ ·ÛıÂÓ‹, ηٿ ÙÔ ‰˘Ó·ÙfiÓ, ‹ÚÂÌÔ.

TÔ ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· ıˆÚÂ›Ù·È ıÂÙÈÎfi fiÙ·Ó ·Ú·ÙËÚËıÔ‡Ó ‹ 2 ·Ó·ÁˆÁ¤˜ ÛÙÔ Û‡ÓÙÔÌÔ ¯ÚfiÓÔ ÂÍÂÙ¿Ûˆ˜ ‹ 1 ·Ó·ÁˆÁ‹ Ì ۷ʋ fï˜ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ Î¿ı·ÚÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·fi ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi(12). ¶ÚÒÈÌË ÎÚÈÎÔÊ·Ú˘ÁÁÈ΋ Û‡Û·ÛË ÌÂÙ¿ ÙȘ ÚÒÙ˜ ηٷ-

∞ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË

EÈÎfiÓ· 1. MÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ Û ·È‰› ËÏÈΛ·˜ 2 ÂÙÒÓ: ÔÏÈÛı·›ÓÔ˘Û· ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË. ¢È‡ڢÓÛË ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÙÚ‹Ì·ÙÔ˜ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (‚¤ÏÔ˜) ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÔÔ›Ô˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙÚÂȘ Á·ÛÙÚÈΤ˜ Ù˘¯¤˜ Ó· ·Ó¤Ú¯ÔÓÙ·È ÚÔ˜ ÙÔÓ ıˆÚ·ÎÈÎfi ÔÈÛÔÊ¿ÁÔ. fiÛÂȘ ‚·Ú›Ô˘, ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· °O¶.(18) XÂÈÚÈÛÌÔ› ÚfiÎÏËÛ˘ (provocative maneuvers), fiÙ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÊ·ÚÌÔÛıÔ‡Ó, ÂÈÙÚ¤Ô˘Ó ÌÂÓ ÙË Û‡ÏÏË„Ë ÂÚÈÛÛÔÙ¤ÚˆÓ ·Ó·ÁˆÁÒÓ, ·˘Í¿ÓÔ˘Ó ‰ËÏ·‰‹ ÙËÓ Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘, ÌÂÈÒÓÔ˘Ó fï˜ ÙËÓ ÂȉÈÎfiÙËÙ¿ Ù˘.(15) ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ ‚‹¯·, ÙË ‰ÔÎÈÌ·Û›· Valsava, ÙË ÌÂÙ·‚ÔÏ‹ ı¤Ûˆ˜ ·fi ‡ÙÈ· Û ‰ÂÍÈ¿ Ï¿ÁÈ· Î·È ÙË ‰ÔÎÈÌ·Û›· water siphon. ™Â ÌÂϤÙË ÙˆÓ J Keith-Thompson et al.(11) ÂÓÒ Ë ·˘ÙfiÌ·ÙË ·Ó·ÁˆÁ‹ Ì B° ·‰›¯ıË ıÂÙÈ΋ ÛÙÔ 26% ÙˆÓ Â›Û˘ ıÂÙÈÎÒÓ ÛÙËÓ PH/ÌÂÙÚ›·, ÂÚÈÙÒÛˆÓ, Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·Ú·¿Óˆ ¯ÂÈÚÈÛÌÒÓ ÙÔ ÔÛÔÛÙfi ·˘Í‹ıËΠÛÙÔ 70% ·ÎfiÌË Î·È Û ÂÚÈÙÒÛÂȘ (Û·ÓÈfiÙÂÚ·) ·ÚÓËÙÈΤ˜ ÛÙËÓ PH/ÌÂÙÚ›· (11). ¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÙÔ B°, ·ÚfiÙÈ ıˆÚÂ›Ù·È Ì¤ıÔ‰Ô˜ ·ÛÊ·Ï‹˜, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜ Û ¿ÙÔÌ· Ì ÛÔ‚·Ú‹ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ÛÙ· ÔÔ›· Ú¤ÂÈ Ó· ÚÔÙÈÌ¿Ù·È ÙÔ Î·ı·Úfi ıÂÈÈÎfi ‚¿ÚÈÔ(18). TÔ B° ¤¯ÂÈ Î·ÙÂÍÔ¯‹Ó ¤Ó‰ÂÈÍË ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, fiÙ·Ó Ë °O¶ Â›Ó·È ÌÂÁ¿ÏË ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Û˘ÁÁÂÓÔ‡˜ ·Ó·ÙÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:330-336

O ˘ÂÚ˯ÔÙÔÌÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ O ˘ÂÚ˯ÔÙÔÌÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ (UltraSoundUS) ¿Ú¯ÈÛ ӷ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ °O¶ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980. E›Ó·È ̤ıÔ‰Ô˜ ¿ÓÂÙË ÁÈ· ÙÔÓ ·ÛıÂÓ‹, ¯ˆÚ›˜ ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·, ÂÈÙÚ¤ÂÈ ‰Â Ì·ÎÚ‡ÙÂÚË ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ˘ı‹Ûˆ˜ Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ÂÚÈÔ¯‹˜. E›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÍÈfiÈÛÙË ÁÈ· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÂÌ¤ÙˆÓ Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ Î·È ı· ÌÔÚÔ‡Û ӷ Û˘ÛÙËı› ˆ˜ screening test Û ÎÏÈÓÈÎÒ˜ ‡ÔÙÔ˘˜ ÁÈ· °O¶ Î·È Ì¿ÏÈÛÙ· ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ (3,17,19-21). YÔÏ›ÂÙ·È Û ·ÎÚ›‚ÂÈ· Ù˘ PH/ÌÂÙÚ›·˜ Î·È ¤¯ÂÈ ÙËÓ ›‰È· Ì ÙÔ B° ÂȉÈÎfiÙËÙ· (ÂÚ› ÙÔ 30%) (3).

K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 10ÏÂÙ˘ (Û˘Ó‹ıˆ˜) ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛËÌÂÈÒÓÂÙ·È Ô ·ÚÈıÌfi˜ Î·È Ë ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ °O¶, Ù· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·˘ÙÒÓ Î·ıÒ˜ Î·È ÔÈ Ù˘¯fiÓ ˘¿Ú¯Ô˘Û˜ ÌÔÚÊÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ Û˘Ì‚ÔÏ‹˜ (22).

YÂÚ˯ÔÙÔÌÔÁÚ·ÊÈο, ¤Ó· ÂÂÈÛfi‰ÈÔ °O¶ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi (22): ·) ‰È¿ÓÔÈÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÛÊÈÁÎÙ‹Ú· ‚) ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÛÙÔÓ "¿ˆ" ÔÈÛÔÊ¿ÁÔ (∂ÈÎfiÓ· 2) Á) οı·ÚÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Ì ÂÚÈÛÙ·ÏÙÈΤ˜ ÎÈÓ‹ÛÂȘ ‰) ÎÏ›ÛÈÌÔ ÙÔ˘ ÛÊÈÁÎÙ‹Ú·. ™ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ‰ÂÓ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÂÈÛfi‰È· ·Ï›Ó‰ÚÔÌ˘ ΛÓËÛ˘ ·¤Ú·, Ù· ÔÔ›· ıˆÚÔ‡ÓÙ·È Ê˘ÛÈÔÏÔÁÈο (22).

TÔ U/S Û monitor ÌÔÚ› Ó· ÂÊ·ÚÌÔÛı› Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ PH/ÌÂÙÚ›·, ÂÈÙ˘Á¯¿ÓÂÙ·È ¤ÙÛÈ Ë ÂÚÌËÓ›· ÙˆÓ ‰È·ÊfiÚˆÓ Ê¿ÛÂˆÓ Ù˘ pH/ÌÂÙÚÈ΋˜ ηÌ‡Ï˘ ·Ó·ÏfiÁˆ˜ Ù˘ ËÏÈΛ·˜, Ï‹„ˆ˜ ÙÚÔÊ‹˜, ı¤Ûˆ˜ ·ÛıÂÓÔ‡˜, ·˘Í‹Ûˆ˜ Ù˘ ÂÓ‰ÔÎÔÈÏȷ΋˜ ȤÛˆ˜ ÎÏ (23).

EÈÎfiÓ· 2. YÂÚ˯ÔÁÚ¿ÊËÌ· ÁÈ· °O¶ Û ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 4 ÌËÓÒÓ, Ô‚ÂÏÈ·›·/ÏÔÍ‹ ÙÔÌ‹ ηٿ ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ· ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘: ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÛÙÔÓ "¿ˆ" ÔÈÛÔÊ¿ÁÔ. H ÂÚÈÔ¯‹ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ‚¤ÏË ·ÓÙÈÛÙÔȯ› ÛÙÔ ÔÈÛÔÊ·ÁÈÎfi ÙÚ‹Ì· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜.

334

M. ¶··‰¿ÎË, π. ™. ∫·ÛηڤÏ˘

TÔ ¤Á¯ÚˆÌÔ Doppler ·‡ÍËÛ ÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘ U/S ·fi 87 Û 94% ÙˆÓ ıÂÙÈÎÒÓ ÛÙËÓ PH/ÌÂÙÚ›· ÂÚÈÙÒÛˆÓ, Â›Ó·È ÈÔ Â˘·›ÛıËÙÔ Û ÁÚ‹ÁÔÚ˜, ÌÈÎÚ¤˜ ·Ó·ÁˆÁ¤˜ Î·È Î·Ù¿ÏÏËÏÔ Â›Û˘ ˆ˜ screening test (24,25). ŒÁ¯ÚˆÌÔ ·ÏÏfiÌÂÓÔ Doppler ÌÔÚ› Ó· ‰È·ÁÓÒÛÂÈ ·ÎfiÌË Î·È ÚÔÁÂÓÓËÙÈο ÙËÓ ‡·ÚÍË °O¶ Û˘Ó‰˘·˙fiÌÂÓ˘ Ì ˘ÏˆÚÈ΋ ·ÙÚËÛ›· (26). TÔ U/S ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ °O¶ Î·È Ù˘ ÔÈÛÔÊ·Á›Ùȉ·˜ (27). ¢ÂÓ ÏËÚÔÊÔÚ› Â›Û˘ ÁÈ· ÙËÓ ·˘ÙÔοı·ÚÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·fi ÙÔ ·Ó·¯ı¤Ó ÛÙÔÌ·¯ÈÎfi ÂÚȯfiÌÂÓÔ Ë ÔÔ›· ηٿ 90% ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂÙ¿ 2 ÌfiÏȘ ÂÚÈÛÙ·ÏÙÈο ·̷ٷ(4), Ô‡Ù ÁÈ· ÙÔ Ê·Ú˘ÁÁÔ-Ï·Ú˘ÁÁÈÎfi Û˘ÓÙÔÓÈÛÌfi (8).

M ÙÔ U/S ÌÔÚÔ‡Ó Ó· ÌÂÏÂÙËıÔ‡Ó ÏÂÙÔÌÂÚÒ˜ Ë ·Ó·ÙÔÌ›· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ Û˘Ì‚ÔÏ‹˜ - ÂÚÈÔ¯‹˜ ÎÚ›ÛÈÌ˘ ÁÈ· ÙË °O¶ - Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. O ÙfiÓÔ˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ KO™, 2. TÔ Ì‹ÎÔ˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Î·È Ë ÁˆÓ›· His Ô˘ ÂÓÂÚÁÔÔÈ› ÙÔ Ì˯·ÓÈÛÌfi Ù˘ ‚·Ï‚›‰·˜ ÂϤÁ¯Ô˘ (check valve) ηٿ ÙË ‰È¿Ù·ÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ıfiÏÔ˘. E‰Ò Ë ÌÔÚÊÔÏÔÁÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ÌÂϤÙË Ì U/S, fiÙ·Ó Á›ÓÂÙ·È ÚÔÛÂÎÙÈο Î·È Î¿Ùˆ ·fi ·˘ÛÙËÚ¿ ηıÔÚÈṲ̂Ó˜ ÎÏÈÓÈΤ˜ Û˘Óı‹Î˜, ˘ÂÚ¤¯ÂÈ.

OÈ Û˘Óı‹Î˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ˘fi„Ë ÙË Ê¿ÛË Ù˘ ·Ó·ÓÔ‹˜, ÙË Á·ÛÙÚÈ΋ ÏËÚfiÙËÙ· Î·È ÙËÓ ÂÓ‰ÔÎÔÈÏȷ΋ ›ÂÛË(8). ™˘ÓÈÛÙ¿Ù·È ÏÔÈfiÓ ÙÔ U/S Ó· Á›ÓÂÙ·È ÌÂÙ¿ ÙÔ Á‡̷, Ì ÙÔ ·È‰› ‹ÚÂÌÔ Î·È Ì ÚÔÛ‰ÈÔÚÈÛÌfi Ì¤ÛˆÓ ÙÈÌÒÓ ÌÂٷ͇ ÂÈÛÓÔ‹˜ Î·È ÂÎÓÔ‹˜(8). TÔ optimum ·Ó·ÙÔÌÈÎfi Ì‹ÎÔ˜ ÙÔ˘ ÛÊÈÁÎÙ‹Ú· Ô˘ ı· ÂÈÙÚ¤„ÂÈ ÂÈÙ˘¯‹ ·ÓÙÈÚÚfiËÛË ·˘ÍË̤Ó˘ ÂÓ‰ÔÎÔÈÏȷ΋˜ ȤÛˆ˜ ›ӷÈ, ηٿ ÙÔ˘˜ De Meester et al (28), ÌÂٷ͇ 20-25mm ÂÓÒ Ù· ·ÓÙ›ÛÙÔȯ· U/S-Ì‹ÎË, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È Á·ÛÙÚÈÎÒÓ Ù˘¯ÒÓ, Â›Ó·È 25-30mm. ™ËÌÂȈ٤ÔÓ fiÙÈ Ë ÂÎÙ›ÌËÛË ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘ Ì ¿ÏϘ Ù¯ÓÈΤ˜ (PH/ÌÂÙÚ›·, Ì·ÓÔÌÂÙÚ›·, ÛÈÓıËÚÔÁÚ¿ÊËÌ·) Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·˘Ù¤˜ ·ÂÈÎÔÓ›˙Ô˘Ó ÌfiÓÔ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ¿Ô„Ë Ù˘ ·Ó·ÁˆÁ‹˜ (8). EÍ·ÈÙ›·˜ ·ÎÚÈ‚Ò˜ Ù˘ ¢·ÈÛıËÛ›·˜ ·˘Ù‹˜ ÙÔ˘ U/S, ÌÂÚÈÎÔ› Û˘ÓÈÛÙÔ‡Ó Ë ÌÂϤÙË Ì B° Ó· ÂÚÈÔÚ›˙ÂÙ·È ÛÙ· ·È‰È¿ ÂΛӷ Ô˘, ·Ú¿ ÙÔ ·ÚÓËÙÈÎfi U/S ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· (29,30).

3. H ÈηÓfiÙËÙ· ÙˆÓ ÛÎÂÏÒÓ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ó· Û˘ÁÎÚ·ÙÔ‡Ó ÛÙË ı¤ÛË ÙÔ˘ ÙÔÓ ÂÓ‰ÔÎÔÈÏÈ·Îfi ÔÈÛÔÊ¿ÁÔ ÂÌÔ‰›˙ÔÓÙ·˜ ÙË ‰ÈÔÏ›ÛıËÛ‹ ÙÔ˘ ÚÔ˜ ÙÔ ıÒڷη (17). TÔ U/S Â›Ó·È ÈÔ Â˘·›ÛıËÙÔ ·fi ÙÔ B° ÛÙË ‰È¿ÁÓˆÛË ÌÈÎÚÒÓ ‰È·ÊÚ·ÁÌ·ÙÔÎËÏÒÓ (8). AÔ˘Û›· ·ÂÈÎÔÓ›Ûˆ˜ Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ Û˘Ì‚ÔÏ‹˜, ‚Ú·¯‡˜ ÂÓ‰ÔÎÔÈÏÈ·Îfi˜ ÔÈÛÔÊ¿ÁÔ˜, ·˘ÍË̤ÓË ‰È¿ÌÂÙÚÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÛÙÔ Á·ÛÙÚÈÎfi ¿ÎÚÔ ÙÔ˘ Î·È ·ÓÒÌ·ÏË ÁˆÓ›· ÙÔ˘ His ıˆÚÔ‡ÓÙ·È ÛÙÔȯ›· ÂÓ‰ÂÈÎÙÈο ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ (∂ÈÎfiÓ· 3· & ∂ÈÎfiÓ· 3‚).

H ·ÎÚÈ‚‹˜ ÂÎÙ›ÌËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ¤Ú·ÙÔ˜ ÙÔ˘

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ÔÈÛÔÊ·ÁÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Â›Ó·È ··Ú·›ÙËÙË ‰ÈfiÙÈ ÔÈ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ϙ Â›Ó·È Û˘¯Ó¿ Ìˉ·ÌÈÓ¤˜. ™Â ÓÂÔÁÓ¿ Î·È ÌÈÎÚ¿ ‚Ú¤ÊË Î‹Ï˜ ¤ˆ˜ Î·È 5 mm ‰ÂÓ Û·Ó›˙Ô˘Ó Î·È ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ·ÒÏÂÈ· ÙÔ˘ 1/4 ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘. TÔ U/S ÂÈÙÚ¤ÂÈ ‰È·›ÛÙˆÛË ‚Ú·¯‡ÓÛˆ˜ ̤¯ÚÈ Î·È 2 mm ÁÂÁÔÓfi˜ Ô‡ ÂÍËÁ› ÙË ‰È·ÁÓˆÛÙÈ΋ ˘ÂÚÔ¯‹ ÙÔ˘ Â› ÙÔ˘ B° ÛÙȘ ÌÈÎÚ¤˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ϙ (8). ¢ÂÓ Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ·Ú·‚ϤÂÙ·È Ë ·Í›· ÙÔ˘ U/S ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Á·ÛÙÚÈ΋˜ ÂÍfi‰Ô˘ ÁÈ· ηٷÎÚ¿ÙËÛË ‹ ·fiÊÚ·ÍË.

5. ™˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· ÙËÓ ‰È¿ÁÓˆÛË Ù˘ °O¶ EӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Ù¯ÓÈÎÒÓ. M standard ÙËÓ pH/ÌÂÙÚ›·, Ë Â˘·ÈÛıËÛ›· ÙÔ˘ U/S Êı¿ÓÂÈ ÙÔ 95% Î·È Ë ÂȉÈÎfiÙËÙ¿ ÙÔ˘ ÙÔ 58%. OÙ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÈÓ‰ÚÔÌ‹ÛÂȘ ıˆÚËıÔ‡Ó ·ıÔÏÔÁÈΤ˜ ¤ÛÙˆ Î·È ·Ó Â›Ó·È ·Û˘Ìو̷ÙÈΤ˜, ÙfiÙÂ Î·È Ë ÂȉÈÎfiÙËÙ· ÙÔ˘ U/S ‚ÂÏ-

EÈÎfiÓ· 3·, 3‚: YÂÚ˯ÔÁÚ¿ÊËÌ· ÁÈ· °O¶ Û ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 6 ÌËÓÒÓ, Ô‚ÂÏÈ·›·/ÏÔÍ‹ ÙÔÌ‹ ηٿ ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ· ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘: ÂÏ·Ùو̤ÓÔ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÂϤÁ¯ÂÙ·È ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘ Ì ÙÈ̤˜ Ô˘ Î˘Ì·›ÓÔÓÙ·È ·fi 12 ¤ˆ˜ 16 ¯ÈÏ. (ÌÂÙÚ‹ÛÂȘ ·Ó¿ÌÂÛ· ÛÙ· ۇ̂ÔÏ· +). H ˘Ô„›· ÔÏÈÛı·›ÓÔ˘Û·˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ ÂȂ‚·ÈÒıËΠ̠B°.

∞ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË

ÙÈÒÓÂÙ·È (17). ™Â ÌÂϤÙË ÙˆÓ Hirsch et al Â› 84 ˘„ËÏ‹˜ Èı·ÓfiÙËÙ·˜ ÁÈ· °O¶ ·È‰ÈÒÓ, ÔÈ Â˘·ÈÛıËۛ˜ PH/ÌÂÙÚ›·˜, U/S Î·È ¤Á¯ÚˆÌÔ˘ Doppler ‹Û·Ó, ·ÓÙ›ÛÙÔȯ·, 60,71 - 51,20 - 59,50% (24). AÓ Î·È Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ Û˘ÁÎÚÈÙÈÎÒÓ ÌÂÏÂÙÒÓ Î·Ù·Ï‹ÁÂÈ ÛÙËÓ ·Ô‰Ô¯‹ Ù˘ PH/ÌÂÙÚ›·˜ ˆ˜ ÚÒÙ˘ ÌÂıfi‰Ô˘, ˘¿Ú¯Ô˘Ó Î·È ·Ó·ÊÔÚ¤˜ Ì ÚÔËÁÔ‡ÌÂÓÔ ÙÔ B° Î·È Ì¿ÏÈÛÙ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯ÂÈÚÈÛÌÔ‡˜ ÚÔÎÏ‹Ûˆ˜ (11). MÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ‹ ·˘ÙfiÌ·ÙË ·Ó·ÁˆÁ‹ ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì B°, Ô‡Ù fï˜ Ë Â˘·ÈÛıËÛ›· Ô‡ÙÂ Ë ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ ÙËÓ Î·ıÈÛÙÔ‡Ó Î·Ù¿ÏÏËÏË ÁÈ· ‰ÔÎÈÌ·Û›· ‰È·ÏÔÁ‹˜ (31). H Û‡ÁÎÚÈÛË U/S Î·È PH/ÌÂÙÚ›·˜ ·Ô‰ÂÈÎÓ‡ÂÈ Û‡ÌÙˆÛË ÛÙÔ 87% Ë ÔÔ›· Ì ¤Á¯ÚˆÌÔ Doppler Êı¿ÓÂÈ ÙÔ 94% (24). ™Â ·Ó¿ÏÔÁË ÌÂϤÙË ÙˆÓ S J Westra et al, U/S Î·È PH/ÌÂÙÚ›· Û˘Ì›ÙÔ˘Ó ÛÙË ıÂÙÈ΋ ‹ ·ÚÓËÙÈ΋ ‰È¿ÁÓˆÛË Û ÔÛÔÛÙfi 81-84% (17). EӉȷʤÚÔ˘Û· Â›Ó·È Î·È Ë Û‡ÁÎÚÈÛË ÌÂٷ͇ B° Î·È U/S Û ÌÂϤÙË ÙˆÓ DiMario et al: Û‡ÌÙˆÛË Î·Ù¿ 93% (5). H ¢·ÈÛıËÛ›· ÙÔ˘ U/S ıˆÚÂ›Ù·È ÌÂÁ·Ï‡ÙÂÚË ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ, ÏfiÁˆ ‰Â Î·È ÙˆÓ ¿ÏÏˆÓ ÚÔÛfiÓÙˆÓ ÙÔ˘, ÚÔÙ›ÓÂÙ·È ˆ˜ ÚÒÙË ÂÈÏÔÁ‹ fi¯È ÌfiÓÔ ÁÈ· ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË (32).

6. ™˘ÌÂÚ¿ÛÌ·Ù· °ÂÓÈο, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙËÓ Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·: ● NÂÔÁÓ¿ Î·È ‚Ú¤ÊË Ì¤¯ÚÈ 2 ÌËÓÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Â̤ÙÔ˘˜ ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ˘. ™ÙËÓ ËÏÈΛ· ·˘Ù‹ ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ÛˆÛÙ‹ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÚÔÛÂÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË ÂÓÒ Ë ÂÚÁ·ÛÙËÚȷ΋ Û˘Ó‰ÚÔÌ‹, ÂÊfiÛÔÓ ÎÚÈı› ··Ú·›ÙËÙË, Û˘Ó‹ıˆ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ U/S, ÙËÓ PH/ÌÂÙÚ›· ηÈ, Û·ÓÈfiÙÂÚ· ÙÔ B°. ● ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‚ÚÂÊÒÓ ËÏÈΛ·˜ 2-12 ÌËÓÒÓ ÂÌÊ·Ó›˙ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÏÂÈÙÔ˘ÚÁÈ΋ °O¶. E¿Ó Ë ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ÂÊ·ÚÌÔÁ‹ ÂÂÌ‚·ÙÈÎÒÓ Ù¯ÓÈÎÒÓ ‹ ‰ÔÎÈÌ·ÛÈÒÓ Ì ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·. TÔ U/S ı· ÌÔÚÔ‡Û ӷ Û˘ÛÙËı› Û·Ó screening test Û ÎÏÈÓÈο ‡ÔÙÔ˘˜ ÁÈ· °O¶ ·ÛıÂÓ›˜. E¿Ó ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ˘Ô„›· fiÙÈ Ë °O¶ Â›Ó·È ‰Â˘ÙÂÚÔ·ı‹˜, Û˘ÓÈÛÙ¿Ù·È Ë ‰ÈÂÍ·ÁˆÁ‹ U/S ‹/Î·È B°. ● H °O¶ Ô˘ ·Ú·Ù›ÓÂÙ·È ¤Ú· ·fi ÙÔÓ 18Ô Ì‹Ó· Ù˘ ˙ˆ‹˜ Û˘¯Ó¿ ηٷϋÁÂÈ ¯ÚfiÓÈÔ Úfi‚ÏËÌ·, ·Ó¿ÏÔÁÔ Ì ÙË ÓfiÛÔ ÙˆÓ ÂÓËϛΈÓ. H °O¶ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ȉ›ˆ˜ Â¿Ó Ë ¤Ó·ÚÍË Ù˘ ÂÓÙÔ›˙ÂÙ·È ÌÂÙ¿ ÙÔÓ 12Ô Ì‹Ó· Ù˘ ˙ˆ‹˜, ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ˘. H ÂÈÏÔÁ‹ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÂÍ·ÚÙ¿Ù·È ·fi Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜.

OÔÈ·‰‹ÔÙ ̤ıÔ‰Ô˜ ‹ Û˘Ó‰˘·ÛÌfi˜ ÌÂıfi‰ˆÓ Î·È ·Ó ÂÈÏÂÁ› ÁÈ· ÙËÓ ‰È¿ÁÓˆÛË Ù˘ °O¶ ÛÙ· ·È‰È¿ ‰ÂÓ Ú¤ÂÈ Ó· ÏËÛÌÔÓÂ›Ù·È fiÙÈ:

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·) TÔ ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ÚˆÙfiÎÔÏÏÔ ¤Ú¢ӷ˜ ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· Ù· ·ÔÙÂϤÛÌ·Ù¿ Ù˘. ‚) H ÂÌÂÈÚ›· ÙÔ˘ ÂÍÂÙ¿˙ÔÓÙÔ˜ ÂËÚ¿˙ÂÈ Â˘ı¤ˆ˜ Î·È ÙËÓ Â˘·ÈÛıËÛ›· Î·È ÙËÓ ÂȉÈÎfiÙËÙ· fiÏˆÓ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ Î·È ‰Ë ÙˆÓ Î˘ÚÈÔÙ¤ÚˆÓ (pH/ÌÂÙÚ›·˜, B°, U/S) Î·È Á) K·Ì›· ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ‰ÂÓ Â‰Ú·ÈÒÓÂÙ·È ¯ˆÚ›˜ ÙË Û‡ÌÚ·ÍË ÙÔ˘ ¤ÌÂÈÚÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ Ô ÔÔ›Ô˜ ı· ÚÔÛʤÚÂÈ Î·È ÙËÓ ·ÍÈfiÈÛÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÙËÓ ex juventibus ÙÂÏÈ΋ ÙÂÎÌËÚ›ˆÛË.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Hyman PE. Gastroesophageal reflux: one reason why baby won't eat. J Pediatr 1994; 125:103-109.

2. Vandenplas Y. Gastroesophageal reflux in children. Scand J Gastroenterol 1995;30 (Suppl 213):s31-38.

3. Fonkalsrud EW, Ament ME. Gastroesophageal reflux in childhood. Curr Prob Surg 1996 ;33:1-70.

4. Gastroesophageal reflux. In: Behrman RE, Kliegmann RM, Alvin AM eds. Nelson Textbook of Pediatrics.15th ed.

Philadelphia: W.B.Saunders Co. 1996:1055-1056.

5. Di Mario M, Bergami G, Fariello G et al. Diagnosis of gastroesophageal reflux in childhood. Comparison of ultrasonography and barium swallow. Radiol Med (Torino) 1995;89:76-81.

6. Hillemeier AC. Gastroesophageal reflux. Diagnostic and therapeutic approaches. Pediatr Clin N Am 1996;43:197-212.

7. Glassman M, Donald G, Grill B. Gastroesophageal reflux in children. Clinical manifestations, diagnosis, and therapy. Gastroenterol Clin N Am 1995;24:71-98.

8. Gomes H, Lallemand A, Lallemand P. Ultrasound of the gastroesophageal junction. Pediatr Radiol 1993;23:94-99.

9. Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter pressures and gastroesophageal reflux: an apparent paradox that is not unusual. Am J Gastroenterol 1995;90:280-4.

10. Cavataio F, Iacono G, Montalto G et al. Gastroesophageal reflux associated with cow's milk allergy in infants: which diagnostic examinations are useful? Am J Gastroenterol 1996;91:1215-1220.

11. Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. Am J Roentgenol 1994;162:621-626.

12. Sondheimer JM. Gastroesophageal reflux: update on pathogenesis and diagnosis. Pediatr Clin N Am 1988;35:103-116.

13. Ott DJ. Gastroesophageal reflux disease. Radiol Clin N Am 1994;32:1147-1166.

14. Laudizi L, Zaniol P, Venuta A et al. Gastroesophageal reflux in children. A combined radiologic and scintigraphic study. Radiol Med (Torino) 1990;79:381-383.

15. Ott DJ. Gastroesophageal reflux: what is the role of barium studies? Am J Roentgenol 1994;162:627-629.

16. McCauley RG, Darling DB, Leonidas JC. Et al.

Gastroesophageal reflux in infants and children: a useful classification and reliable physiologic technique for its demonstration. Am J Roentgenol 1978;130:47-50.

336

M. ¶··‰¿ÎË, π. ™. ∫·ÛηڤÏ˘

17. Westra SJ, Wolf BH, Staalman CR. Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children. J Clin Ultrasound 1990 ;18: 477-485.

18. Brady AP, Stevenson GW, Somers S et al. Premature contraction of the cricopharyngeus: a new sign of gastroesophageal reflux disease. Abdom Imaging 1995;20:225-229.

19. Stringer DA, Hassall E, Ferguson A. et al. Hypersensitivity reaction to single contrast barium meal studies in children.

Pediatr Radiol 1993;23:587-588.

20. Naik DR, Bolia A, Moore DJ. Comparison of barium swallow and ultrasound in diagnosis of gastroesophageal reflux in children. BMJ 1985;290:1943-1945.

21. Wynchank S, Mann MD, Fisher R. et al. Ultrasound as a screening study for gastroesophageal reflux in children.

Ann Trop Paediatr 1997;17:343-348.

22. Anvi EF, Rypens FR. Pediatric gastrointestinal tract. In: Dubbins PA, Joseph AEA, eds. Ultrasound in Gastroenterology. New York, Edinburgh, London: Churchill Livingstone, 1994:27-54.

23. Gomes H. Gastroesophageal reflux in infants: ultrasonographic reading of pHmetry. Arch Pediatrie 1994;7:639-645.

24. Hirsch W, Kedar R, Prei( U. Color doppler in the diagnosis of the gastroesophageal reflux in children: comparison with pH measurements and B-mode ultrasound. Pediatr Radiol 1996;26:232-235.

25. Hirsch W, Prei( U, Kedar R. Color coded Doppler ultrasound in diagnosis of gastroesophageal reflux. Clin Paediatr 1997;209:6-10.

26. Rizzo G, Capponi A, Arduini D et al. Prenatal diagnosis of gastroesophageal reflux by color and pulsed Doppler ultrasonography in a case of congenital pyloric atresia.

Ultrasound Obst Gyn 1995;6:290-292.

27. Le Dosseur P, Moutounet L, Eurin D et al.

Ultrasonography of the esophagus in children. Ann Radiol (Paris) 1994;37:494-499.

28. De Meester TR, Wernly GA, Bryant CH. Clinical and in vitro analysis of determinants of gastroesophageal competence: A study of principles of antireflux surgery.

Am J Surg 1979;137:39-46.

29. Rollins MD, Shields MD, Quinn R et al. Value of ultrasound in differentiating causes of persisting vomiting in children.

Gut 1991;32:612-614.

30. Aliotta A, Rapaccini GL, Pompili M et al. Ultrasonographic signs of sliding gastric hiatal hernia and their prospective evaluation. J Ultras Med 1995;14:457-461.

31. Johnston BT, Troshinsky MB, Castell JA et al. Comparison of barium radiology with esophageal pH monitoring in the diagnosis of gastroesophageal reflux disease. Am J Gastroenterol 1996;91:1181-1185.

32. Tani G, Sciutti R, Teglia F et al. Diagnosis of gastroesophageal reflux in children. Ultrasonography versus pH monitoring. Radiol Med (Torino) 1993;86:626-9.

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A. TÔ ·È‰› Â˙fi˜ ¶·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 9 ÂÙÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ΢ÎÏÔÊÔÚÔ‡Ó ÌfiÓ· ÙÔ˘˜, ¯ˆÚ›˜ ÂÈÙ‹ÚËÛË. MÂÙ¿ Ù· 9 ¯ÚfiÓÈ· ÌfiÓÔ ÌÂÙ¿ ·fi ηϋ ÂÎ·›‰Â˘ÛË ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ Î·È ÂÍÔÈΛˆÛË Ì ÙË ‰È·‰ÚÔÌ‹ ÌÔÚÔ‡Ó Ó· ΢ÎÏÔÊÔÚÔ‡Ó ÌfiÓ· ÙÔ˘˜. ¶·È‰È¿ ¿Óˆ ÙˆÓ 12 ¯ÚfiÓˆÓ ÌÔÚÔ‡Ó Ó· Û˘ÌÂÚÈʤÚÔÓÙ·È ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ ÛˆÛÙ¿ fiˆ˜ Î·È ÔÈ ÂÓ‹ÏÈÎÔÈ.

B. TÔ ·È‰› ÂÈ‚¿Ù˘ - °È· ÙËÓ ·ÛÊ·Ï‹ ÌÂÙ·ÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂ÓÔÈ ‚·ÛÈÎÔ› ηÓfiÓ˜: - ¶ÔÙ¤ Ù· ·È‰È¿ ÛÙÔ ÌÚÔÛÙÈÓfi οıÈÛÌ· (ÂȉÈο ·Ó ˘¿Ú¯ÂÈ ·ÂÚfiÛ·ÎÔ˜), ¿ÓÙÔÙ ÛÙÔ ›Ûˆ. AÎfiÌ· Î·È Û ÂÏ·ÊÚÈ¿ Û‡ÁÎÚÔ˘ÛË ‹ Û ·fiÙÔÌÔ ÊÚÂÓ¿ÚÈÛÌ· ÙÔ ·È‰› ÎÈÓ‰˘Ó‡ÂÈ Ó· ÎÙ˘‹ÛÂÈ ÛÙÔ Ù·ÌÏfi ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘. ¶ÔÙ¤ ÛÙÔ ÔÚÙ-ÌÂÌ¤, ÛÙ· ÁfiÓ·Ù· ‹ ÛÙËÓ ·ÁηÏÈ¿ οÔÈÔ˘. Œ¯ÂÈ ‚ÚÂı› ˆ˜ ÙÔ 90% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÓÂÏ¿ÎËÛ·Ó Û ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· Î·È ÎÚ·ÙÔ‡Û·Ó ·È‰È¿ ÛÙËÓ ·ÁηÏÈ¿ ÙÔ˘˜ Î·È ÛÒıËηÓ, ÛÒıËÎ·Ó ÂÂȉ‹ ÙÔ ·È‰› ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ·Û›‰·.

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°. TÔ ·È‰› Ô‰ËÏ¿Ù˘ TÔ ·È‰› ˆ˜ Ô‰ËÏ¿Ù˘ Ú¤ÂÈ Ó· Û˘ÌÂÚÈʤÚÂÙ·È È· fiˆ˜ Ô Ô‰ËÁfi˜ Ô¯‹Ì·ÙÔ˜. T· ̤ÙÚ· Ô˘ ı· ÙÔ˘ ÂÍ·ÛÊ·Ï›ÛÔ˘Ó ÈηÓÔÔÈËÙÈ΋ ÚÔÛÙ·Û›· ›ӷÈ: - ηϋ ÂÎ·›‰Â˘ÛË, ˆÚÈÌfiÙËÙ·, ·˘ÍË̤ÓÔ ·›ÛıËÌ· ¢ı‡Ó˘. Ÿ¯È ·ÚÔÚÌËÙÈÎfiÙËÙ· Î·È ÂÚÈÊÚfiÓËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘.

- ¿ÚÈÛÙË ÁÓÒÛË ÙˆÓ ÂÓÓÔÈÒÓ ÙˆÓ ÛËÌ¿ÙˆÓ Î·È ÙˆÓ ‚·ÛÈÎÒÓ Î·ÓfiÓˆÓ Ô‰È΋˜ ΢ÎÏÔÊÔÚ›·˜.

- ÊÚÔÓÙ›‰· ÁÈ· ÙËÓ Î·Ï‹ Û˘ÓÙ‹ÚËÛË ÙÔ˘ Ô‰ËÏ¿ÙÔ˘ Î·È Ù·ÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜.

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TÔ 1961 ÙËÓ ¶·È‰È·ÙÚÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ·ÔÙÂÏ› ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÏÏ¿ ÈηÓfi˜ ·ÚÈıÌfi˜ ·È‰È¿ÙÚˆÓ. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÛÙÂϤ¯ˆÓ·Ó Ù· NÔÛÔÎÔÌ›· ‹ ·ÛÎÔ‡Û·Ó ÙÔ Â¿ÁÁÂÏÌ· ÛÙËÓ ÚˆÙÂ‡Ô˘Û· ‹ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË. §›ÁÔÈ ·È‰›·ÙÚÔÈ ·ÊÔ‡ ·¤ÎÙËÛ·Ó ÙËÓ ÂȉÈÎfiÙËÙ· ÛÙȘ ¶·È‰È·ÙÚÈΤ˜ KÏÈÓÈΤ˜ ‹Ú·Ó ÙÔ ‰ÚfiÌÔ ÁÈ· Ù· ¿ÙÚÈ· ‰¿ÊË ÁÈ· Ó· ÚÔÛʤÚÔ˘Ó ÙȘ ˘ËÚÂۛ˜ ÙÔ˘˜ ÛÙ· ·È‰È¿ ·ÔÌ·ÎÚ˘ÛÌ¤ÓˆÓ ÂÚÈÔ¯ÒÓ Ì ˘ÔÙ˘Ò‰Ë Ì¤Û·. ¶ÔÏϤ˜ ÊÔÚ¤˜ ÔÈ Û˘Ó¿‰ÂÏÊÔÈ ·fi ÙËÓ Â·Ú¯›· ÂÈÎÔÈÓˆÓÔ‡Û·Ó Ì·˙› Ì·˜ ÁÈ· Ó· ˙ËÙ‹ÛÔ˘Ó Ù· ÊÒÙ· Ì·˜ Û ‰‡ÛÎÔϘ ÂÚÈÙÒÛÂȘ ‹ ÁÈ· Ó· ÂȂ‚·ÈÒÛÔ˘Ó ÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘˜.

EΛÓË ÙË ¯ÚÔÓÈ¿ Û˘ÌÏËÚÒıËÎ·Ó 30 ¯ÚfiÓÈ· ·fi ÙËÓ ›‰Ú˘ÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ (E¶E) Î·È ÙÔ ¢.™. Ô˘ ÙÔ ·ÔÙÂÏÔ‡Û·Ó ÔÈ N›Î·˜ ZÂÚ‚fi˜ ¶Úfi‰ÚÔ˜, KˆÓ/ÓÔ˜ XˆÚ¤Ì˘ ∞ÓÙÈÚfi‰ÚÔ˜, ™ÔÊÔÎÏ‹˜ X·Ù˙ˉ¿Î˘ Î·È ¢ËÌ‹ÙÚ˘ §È·Î¿ÎÔ˜ °Ú·ÌÌ·Ù›˜, Iˆ¿ÓÓ˘ AÏ·Ì¿Ó˘ T·Ì›·˜, B·Û›ÏÂÈÔ˜ KˆÓÛÙ·ÓÙÈÓ›‰Ë˜, ™‡ÚÔ˜ ¢ÔÍÈ¿‰Ë˜ Î·È KˆÓ/ÓÔ˜ ¶·‰È·Ù¤Ï˘ M¤ÏË, Û ÌÈ· Û˘Ó‰ڛ·Û‹ ÙÔ˘ ¤Î·Ó ·ÔÏÔÁÈÛÌfi ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ù˘ E¶E ·˘Ù¿ Ù· 30 ¯ÚfiÓÈ· Ô˘ ¤Ú·Û·Ó ·fi ÙËÓ ›‰Ú˘Û‹ Ù˘. ™Â ·˘Ùfi ÙÔ ÛËÌÂ›Ô ·Í›˙ÂÈ Ó· ·Ó·Ê¤ÚÔ˘Ì ÙÔ ¯ÚÔÓÈÎfi ›‰Ú˘Û˘ Ù˘ E¶E.(1) H E¶E ȉڇıËΠÛÙȘ 25.2.1931 Ì ÚˆÙÔ‚Ô˘Ï›· ÙÔ˘ ·Â›ÌÓËÛÙÔ˘ ηıËÁËÙ‹ Ù˘ ¶·È‰È·ÙÚÈ΋˜ °ÂˆÚÁ›Ô˘ M·Îο, Ô ÔÔ›Ô˜ ˘‹ÚÍÂ Î·È Ô ÚÒÙÔ˜ ¶Úfi‰ÚÔ˜ ÙÔ˘ ¢.™. Ù˘. T· È‰Ú˘ÙÈο ̤ÏË ·ÔÙÂÏÔ‡Û·Ó Î·È ¿ÏÏÔÈ 25 ‰È·ÎÂÎÚÈ̤ÓÔÈ ·È‰›·ÙÚÔÈ Ù˘ ÂÔ¯‹˜ ÂΛӢ.(2) Ÿˆ˜ ·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔ ÚÒÙÔ K·Ù·ÛÙ·ÙÈÎfi Ù˘ EÙ·ÈÚ›·˜ ÛÎÔfi˜ ‹Ù·Ó "Ë ÚÔ·ÁˆÁ‹ Ù˘ ·È‰È·ÙÚÈ΋˜ ηıfiÏÔ˘ Î·È Ë ÛÙÂÓˆÙ¤Ú· Û˘Ó·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÂȉÈÎÒ˜ ÙÔÓ ÎÏ¿‰ÔÓ ÙÔ‡ÙÔÓ Ù˘ È·ÙÚÈ΋˜ ·ÛÎÔ‡ÓÙˆÓ È·ÙÚÒÓ".(3) T· ÚÒÙ· 30 ¯ÚfiÓÈ· ˙ˆ‹˜ Ù˘ E¶E ˘‹ÚÍ·Ó ·Ô‰ÔÙÈο Î·È ÙfiÛÔ Ù· ¢.™. Ì ÚÔ¤‰ÚÔ˘˜ Âͤ¯Ô˘Û˜ Î·È ‰È·ÎÂÎÚÈ̤Ó˜ ÌÔÚʤ˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ fiÛÔ Î·È ÔÈ ·È‰›·ÙÚÔÈ Ì¤ÏË ÂÍÂÙ¤ÏÂÛ·Ó Ï‹Úˆ˜ ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘˜ ÒÛÙ "Ë ¶·È‰È·ÙÚÈ΋ Ó· ¤¯ÂÈ ÂÈ‚ÏËı› ˆ˜ ÂȉÈÎfiÙ˘, ˆ˜ ÎÏ¿‰Ô˜ ÂÚ‡Ó˘ ÔÏÏ¿ ÚÔÛÊ¤ÚˆÓ ÂȘ ÙËÓ EÏÏËÓÈÎ‹Ó ÂÈÛÙ‹ÌËÓ Î·È ˆ˜ Â¿ÁÁÂÏÌ·, Ô‡ÙÈÓÔ˜ Ë ÎÔÈÓˆÓÈ΋ ·ÔÛÙÔÏ‹ Î·È Ë ÚÔÛÊÔÚ¿ ·fi È·ÙÚÔÎÔÈÓˆÓÈ΋˜ ÏÂ˘Ú¿˜, ÙfiÛÔÓ ‰È· ÙËÓ ÚÔÏËÙÈÎ‹Ó È·ÙÚÈÎ‹Ó fiÛÔÓ ‰È· ÙËÓ ÚÔÛÙ·Û›·Ó ÙÔ˘ ·È‰ÈÔ‡ ÁÂÓÈÎÒÙÂÚÔÓ, ·Ú' Ô˘‰ÂÓfi˜ Ó· ·ÌÊÈÛ‚ËًٷÈ". ™ÙË Û˘Ó‰ڛ·ÛË Ù˘ E¶E ÙÔ 1961 ÙÔ ¢.™. ·ÚfiÏÔ Ô˘ ¤ÌÂÈÓ ÈηÓÔÔÈË̤ÓÔ ·fi ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ E¶E ηٿ Ù· 30 ¯ÚfiÓÈ· Ô˘ ¤Ú·Û·Ó, ‰È·›ÛÙˆÛ fiÙÈ ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ·ÊÔÚÔ‡Û·Ó ÌfiÓÔ ÙÔ˘˜ ¶·È‰È¿ÙÚÔ˘˜ Ù˘ Aı‹Ó·˜ Î·È ı· ¤ÚÂ ӷ ‚ÚÂı› ÙÚfiÔ˜ ÒÛÙ ӷ ·¢ı‡ÓÔÓÙ·È Î·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ fiÏ˘ Ù˘ ¯ÒÚ·˜. ™ÙËÓ ÂfiÌÂÓË Û˘Ó‰ڛ·ÛË ÙÔ˘ ¢.™. ÌÂÙ¿ ·fi ÚfiÙ·ÛË ÙÔ˘ AÓÙÈÚÔ¤‰ÚÔ˘ Ù˘ E¶E, ÙÔ˘ ·Â›ÌÓËÛÙÔ˘ K·ıËÁËÙ‹ KˆÓÛÙ·ÓÙ›ÓÔ˘ XˆÚ¤ÌË, Ë ÔÔ›· ¤ÁÈÓ ÔÌfiʈӷ ·Ô‰ÂÎÙ‹ ·ÔÊ·Û›ÛÙËÎÂ: Ì›· ÊÔÚ¿ ÙÔ ¯ÚfiÓÔ Ó· Á›ÓÂÙ·È Ì›· ÂΉ‹ÏˆÛË Ù˘ EÙ·ÈÚ›·˜ Û ‰È¿ÊÔÚ˜ fiÏÂȘ Ù˘ EÏÏ¿‰·˜ Ô˘ ı· ‰›ÓÂÈ ·ÊÔÚÌ‹ ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Ù˘ ÂÚÈʤÚÂÈ·˜ Ó· ‰Ú·ÛÙËÚÈÔÔÈËıÔ‡Ó, Ó· ·ÔÎÙ‹ÛÔ˘Ó Ó¤Â˜ ÁÓÒÛÂȘ, Ó· ·ÓÙ·ÏÏ¿ÍÔ˘Ó ·fi„ÂȘ, Ó· Û˘Ó·ÓÙËıÔ‡Ó Ì ʛÏÔ˘˜ Î·È Ó· Û˘ÛÊȯıÔ‡Ó ÔÈ ÌÂٷ͇ ÙÔ˘˜ Û¯¤ÛÂȘ.(4) ŒÙÛÈ Î·ıÈÂÚÒıËΠÙÔ ™¿‚‚·ÙÔ ·fiÁÂ˘Ì· Î·È Ë K˘Úȷ΋ Ù˘ ¶ÂÓÙËÎÔÛÙ‹˜ ˆ˜ ÂÙ‹ÛÈ· ÂÈÛÙËÌÔÓÈ΋ ÂΉ‹ÏˆÛË ÛÙËÓ ÂÚÈʤÚÂÈ·, ·Ú¯‹˜ ÁÂÓÔ̤Ó˘ ·fi ÙË £ÂÛÛ·ÏÔÓ›ÎË. ∫·È ÙÔ fiÓÔÌ· ·˘Ù‹˜ "¶·È‰È·ÙÚÈη› H̤ڷÈ". Ÿˆ˜ ·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔ 1Ô ÚfiÁÚ·ÌÌ· "AÈ ¶·È‰È·ÙÚÈη› HÌ¤Ú·È ÔÚÁ·ÓÔ‡ÓÙ·È ÙÔ ÚÒÙÔÓ Î·Ù¿ ÙËÓ 27ËÓ Î·È 28ËÓ M·˝Ô˘ 1961 ÂÓ £ÂÛÛ·ÏÔÓ›ÎË ˘fi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ÂÓ ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· ÌÂÙ¿ Ù˘ EÓÒÛˆ˜ ¶·È‰È¿ÙÚˆÓ £ÂÛÛ·ÏÔӛ΢". H ÂΉ‹ÏˆÛË ÂÙ¤ıË ˘fi ÙËÓ ·ÈÁ›‰· ÙÈÌËÙÈ΋˜ ÂÈÙÚÔ‹˜ ÂÍ ÂÎÚÔÛÒˆÓ ¶ÓÂ˘Ì·ÙÈÎÒÓ I‰Ú˘Ì¿ÙˆÓ Ù˘ £ÂÛÛ·ÏÔӛ΢, ‰ËÏ. ÙÔ˘ ¶Ú˘Ù¿Óˆ˜ ÙÔ˘ AÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ °ÂˆÚÁ›Ô˘ B¿Ú‚ÔÁÏË, ÙÔ˘ KÔÛÌ‹ÙÔÚÔ˜ Ù˘ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ NÈÎÔÏ¿Ô˘ K·‚·˙·Ú¿ÎË Î·È ÙÔ˘ ¶ÚÔ¤‰ÚÔ˘ Ù˘ I·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ £ÂÛÛ·ÏÔӛ΢ E˘ÛÙ·ı›Ô˘ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘. ø˜ ¯ÒÚÔ˜ Û˘Ó‰ÚÈ¿ÛÂˆÓ ·Ú¯ˆÚ‹ıË ÙÔ ·ÌÊÈı¤·ÙÚÔ ÙÔ˘ XËÌ›Ԣ ÙÔ˘ AÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢.(5) "AÈ ¶·È‰È·ÙÚÈη› H̤ڷÈ" ¤Î·Ó·Ó ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘˜ ‰ÂÈÏ¿ - ‰ÂÈÏ¿ Î·È Ì ÛÎÂÙÈÎÈÛÌfi. ŒÁÈÓ·Ó 3 Û˘Ó‰ÚÈ¿ÛÂȘ Î·È ·Ó·ÎÔÈÓÒıËÎ·Ó 33 ÂÚÁ·Û›Â˜ ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Û·Ó fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ™Â ¿ÏÏË ·›ıÔ˘Û·

339

JULY-AUG.2000

30-05-03

13:24

™ÂÏ›‰·340

¶∞π¢π∞∆ƒπ∫∏ 2000;63:339-341

ÃÚÈÛÙ›Ó· ∆ÛÂÁ΋

˘‹Ú¯Â ¤ÎıÂÛË ‰È·ÊfiÚˆÓ ÂӉȷÊÂÚÔ˘ÛÒÓ ÂÚÈÙÒÛˆÓ. ¶·Ú¿ÏÏËÏ· Û οÔÈÔ ¯ÒÚÔ ÔÈ º·Ú̷΢ÙÈΤ˜ Î·È ÔÈ EÙ·ÈÚ›˜ °¿Ï·ÎÙÔ˜ ÂͤıÂÙ·Ó Ù· ÚÔ˚fiÓÙ· ÙÔ˘˜ Î·È ÂÓËÌ¤ÚˆÓ·Ó ÙÔ˘˜ È·ÙÚÔ‡˜ ÁÈ· Ù· Ó¤· ÚÔ˚fiÓÙ·. H Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ·ÎÚÔ·ÙËÚ›Ô˘ ‹Ù·Ó ÌÂÁ¿ÏË Ì ÂÚˆÙ‹ÛÂȘ, Û¯fiÏÈ· Î·È ÂÔÈÎÔ‰ÔÌËÙÈΤ˜ Û˘˙ËÙ‹ÛÂȘ Î·È fiÏÔÈ ‰È·›ÛÙˆÛ·Ó ˆ˜ ‹Ù·Ó Ì›· ÂΉ‹ÏˆÛË Ô˘ ı· ¤ÚÂ ӷ ›¯Â Á›ÓÂÈ ·fi ηÈÚfi. TÔ ‚Ú¿‰˘ Ù˘ K˘Úȷ΋˜ Ë ÂΉ‹ÏˆÛË ¤ÎÏÂÈÓ Ì Á‡̷ ÛÙÔ ÔÔ›Ô Û˘ÌÌÂÙ›¯·Ó Î·È ÔÈ/·È Û˘ÓÔ‰Ô› ÙˆÓ Û˘Ó·‰¤ÏʈÓ. H ¢Â˘Ù¤Ú· ÙÔ˘ AÁ›Ô˘ ¶Ó‡̷ÙÔ˜ ‹Ù·Ó ·ÊÈÂڈ̤ÓË Û ÂΉÚÔÌ‹ ÛÙË Á‡Úˆ ÂÚÈÔ¯‹ Î·È ¤ÙÛÈ ‰ËÌÈÔ˘ÚÁ›ÙÔ Ì›· ÛÙÂÓ‹ Î·È ÂÁοډȷ ·ÙÌfiÛÊ·ÈÚ· Ì fiÏÔ˘˜ Ì·˜.

O ·ÔÏÔÁÈÛÌfi˜ ·fi ÙȘ ¶ÚÒÙ˜ ¶·È‰È·ÙÚÈΤ˜ H̤Ú˜ ÍÂ¤Ú·Û ÙȘ ÚԂϤ„ÂȘ fiψÓ, Ë Û˘ÌÌÂÙÔ¯‹ ‹Ù·Ó ÌÂÁ¿ÏË Î·È ·fi fiÏË ÙËÓ EÏÏ¿‰· ·ÎfiÌË Î·È ·fi ÙËÓ KÚ‹ÙË. AÛÊ·ÏÒ˜ Ú¤ÂÈ Ó· ˘ÔÏÔÁ›ÛÔ˘ÌÂ Î·È ÙȘ ‰˘ÛÎÔϛ˜ Ô˘ ˘‹Ú¯·Ó ÛÙË ÌÂÙ·ÊÔÚ¿ ·fi ÙfiÛÔ Ì·ÎÚÈÓ¤˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜. H ·ÙÌfiÛÊ·ÈÚ· Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËΠ‹Ù·Ó Ôχ ˙ÂÛÙ‹ Î·È ÊÈÏÈ΋ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ηıÈÂÚˆıÔ‡Ó Î·È Ó· Á›ÓÔ˘Ó ϤÔÓ ıÂÛÌfi˜.(6) AÎÔÏÔ‡ıËÛ·Ó Ë ¶¿ÙÚ·, ÙÔ HÚ¿ÎÏÂÈÔ KÚ‹Ù˘, Ù· Iˆ¿ÓÓÈÓ·, Ô BfiÏÔ˜. H Û˘ÌÌÂÙÔ¯‹ οı ¯ÚfiÓÔ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË Î·È ÙÔ Úfi‚ÏËÌ· Ô˘ ·ÓÙÈÌÂÙÒÈ˙·Ó ÔÈ ÔÚÁ·ÓˆÙ¤˜ ‹Ù·Ó Ó· ‚ÚÂıÔ‡Ó Î·Ù¿ÏÏËϘ ·›ıÔ˘Û˜ ÁÈ· ™˘Ó‰ÚÈ¿ÛÂȘ Î·È ÍÂÓԉԯ›· ÁÈ· ‰È·ÌÔÓ‹.(7) TËÓ ÂÔ¯‹ ÂΛÓË Ù· ÍÂÓԉԯ›· ‹Ù·Ó Ï›Á·, Ì ˘ÔÙ˘Ò‰ÂȘ ·Ó¤ÛÂȘ Î·È Ù· ÌÔÓ·‰Èο ηϿ ‹Ù·Ó ÁÈ· ÙÔÓ K·ıËÁËÙ‹, YÊËÁËÙ¤˜ Î·È ÁÂÓÈÎÒ˜ ÙÔ˘˜ ÌÂÁ·Ï‡ÙÂÚÔ˘˜. OÈ ÓÂÒÙÂÚÔÈ Û˘Ó‹ıˆ˜ ̤ӷÌ Û 3˘ ηÙËÁÔÚ›·˜ Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ Ì·˜ ÊÈÏÔÍÂÓÔ‡Û·Ó Û˘Ó¿‰ÂÏÊÔÈ ÛÙ· Û›ÙÈ· ÙÔ˘˜.

TÔ 1967 ÛÙËÓ K·‚¿Ï· ÔÈ ¤ÎÙ˜ "¶·È‰È·ÙÚÈΤ˜ H̤Ú˜" ‹Ù·Ó ͯˆÚÈÛÙ¤˜ ·ÊÔ‡ ÂÚfiÎÂÈÙÔ Ó· ·ÔÓÂÌËıÔ‡Ó ÁÈ· ÚÒÙË ÊÔÚ¿ Ù· "XˆÚ¤ÌÂÈ· Œ·ıÏ·" Ô˘ ·ıÏÔıÂÙ‹ıËÎ·Ó ·fi ÙËÓ E¶E ÛÙË ÌÓ‹ÌË ÙÔ˘ ‰·ÛοÏÔ˘ KˆÓÛÙ·ÓÙ›ÓÔ˘ XˆÚ¤ÌË Ô˘ ¤Ê˘Á ͷÊÓÈο ÙÔ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 1966. TÔ ¤·ıÏÔ ·ÔÙÂÏÔ‡Û·Ó 3 ‚Ú·‚›· (A, B Î·È °) ÚˆÙfiÙ˘ˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ÂÎÚ›ÓÔÓÙÔ ·fi ÂÈÙÚÔ‹, ÛÙËÓ ÔÔ›· ÂÎÙfi˜ ÙˆÓ EÏÏ‹ÓˆÓ Û˘ÌÌÂÙ›¯·Ó Î·È 2 ‰È·ÎÂÎÚÈ̤ÓÔÈ Í¤ÓÔÈ Î·ıËÁËÙ¤˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ™ÙË ÌÓ‹ÌË ÙÔ˘ ηıÈÂÚÒıËΠÂ›Û˘ Î·È Ì›· ÔÌÈÏ›· ·fi ͤÓÔ Î·ıËÁËÙ‹. H ÚÒÙË ¤ÁÈÓ ·fi ÙÔÓ K·ıËÁËÙ‹ Ù˘ 2˘ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ BÔ˘‰·¤ÛÙ˘ E. Körpel-Froni˘s. ŒÁÈÓ·Ó 8 Û˘Ó‰ÚÈ¿ÛÂȘ Ô˘ ÂÚÈÏ¿Ì‚·Ó·Ó 3 ÂÈÛËÁ‹ÛÂȘ ·Ó·ÎÔÈÓÒıËηÓ, 94 ÂÚÁ·Û›Â˜ Â› fiÏˆÓ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ıÂÌ¿ÙˆÓ Î·È ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó 17 ·Ó·ÚÙË̤Ó˜ ·Ó·ÎÔÈÓÒÛÂȘ TÔ 1971 ÔÈ "¶·È‰È·ÙÚÈΤ˜ H̤Ú˜" Û˘ÌÏ‹ÚˆÛ·Ó ÙËÓ ÚÒÙË 10ÂÙ›· ÙÔ˘˜ Î·È ÙÔ ¢.™. Ù˘ E.¶.E. Ì ¶Úfi‰ÚÔ ÙÔÓ K·ıËÁËÙ‹ NÈÎfiÏ·Ô M·ÙÛ·ÓÈÒÙË ·ÔÊ¿ÛÈÛ ӷ ÙÔ˘˜ ‰ÒÛÂÈ ·ÓËÁ˘ÚÈ΋ ÌÔÚÊ‹. K¿ÏÂÛ 14 ‰È·ÎÂÎÚÈ̤ÓÔ˘˜ ͤÓÔ˘˜ ÔÌÈÏËÙ¤˜ Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó Ì ÂÈÛËÁ‹ÛÂȘ Î·È ÛÙÚÔÁÁ˘Ï¿ ÙÚ·¤˙È·. MÂٷ͇ ·˘ÙÒÓ ·Ó·Ê¤ÚÔ˘Ì ÙÔ˘˜ ηıËÁËÙ¤˜ J. Dogramaci K·ıËÁËÙ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ ÕÁ΢ڷ˜ Î·È ¶Úfi‰ÚÔ Ù˘ ¢ÈÂıÓÔ‡˜ ¶·È‰È·ÙÚÈ΋˜ ŒÓˆÛ˘, ÙÔÓ S. Krugman ·fi ÙËÓ N.Y., ÙÔÓ A. Prader ·fi ÙË Z˘Ú›¯Ë, ÙÔÓ A. Sabin ·fi ÙÔ IÛÚ·‹Ï, ÙÔÓ G. Mathé ·fi ÙÔ ¶·Ú›ÛÈ Î·È ¿ÏÏÔ˘˜. TËÓ ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË KˆÓ. XˆÚ¤ÌË ¤Î·ÓÂ Ô Nillo Halman, K·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ÛÙÔ ¶·Ó/ÌÈÔ ÙÔ˘ EÏÛ›ÓÎÈ Ì ı¤Ì· "Heredity of Kidney diseases". Œ‰Ú· Ù˘ ÂΉ‹ÏˆÛ˘ ‹Ù·Ó Ë Aı‹Ó· ÛÙËÓ ¶¿ÓÙÂÈÔ AÓˆÙ¿ÙË ™¯ÔÏ‹ ¶ÔÏÈÙÈÎÒÓ EÈÛÙËÌÒÓ. H ÂÈÙ˘¯›· ‹Ù·Ó ¿Ó¢ ÚÔËÁÔ˘Ì¤ÓÔ˘, Ë Û˘ÌÌÂÙÔ¯‹ ÙfiÛÔ ÙˆÓ ·È‰È¿ÙÚˆÓ fiÛÔ Î·È È·ÙÚÒÓ fiÏˆÓ ÙˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ ·È‰› ‹Ù·Ó Ôχ ÌÂÁ¿ÏË. TÔ ÚfiÁÚ·ÌÌ· ÂÚÈÏ¿Ì‚·Ó 3 ÂÈÛËÁ‹ÛÂȘ, 2 ÛÙÚÔÁÁ˘Ï¿ ÙÚ·¤˙È·, 72 ·Ó·ÎÔÈÓÒÛÂȘ EÏÏ‹ÓˆÓ Î·È Í¤ÓˆÓ ÔÌËÏËÙÒÓ. ◊Ù·Ó ϤÔÓ ÔÊı·ÏÌÔÊ·Ó‹˜ Ë ÂÈÙ˘¯›· ÙÔ˘ ıÂÛÌÔ‡ ·Ó ·Ó·ÏÔÁÈÛıԇ̠fiÙÈ ÛÙȘ ÚÒÙ˜ ¶·È‰È·ÙÚÈΤ˜ H̤Ú˜ ¤ÁÈÓ·Ó 3 Û˘Ó‰ÚÈ¿ÛÂȘ ÛÙȘ Ôԛ˜ ·Ó·ÎÔÈÓÒıËÎ·Ó 33 ÂÚÁ·Û›Â˜ Î·È ÌÂÙ¿ 10 ¯ÚfiÓÈ· 15 Û˘Ó‰ÚÈ¿ÛÂȘ Ì 3 ÂÈÛËÁ‹ÛÂȘ, 2 ÛÙÚÔÁÁ˘Ï¿ ÙÚ·¤˙È· Î·È 76 ·Ó·ÎÔÈÓÒÛÂȘ.

K¿ı ¯ÚfiÓÔ "AÈ ¶·È‰È·ÙÚÈη› H̤ڷÈ" ›¯·Ó fiÏÔ Î·È ÌÂÁ·Ï‡ÙÂÚË Û˘ÌÌÂÙÔ¯‹. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ÙÔ ¢.™. Ù˘ E¶E ÙÔ 1973 ·ÔÊ¿ÛÈÛ ˆ˜ ‹Ù·Ó ηÈÚfi˜ Ó· ıˆÚËı› È· ˆ˜ ™˘Ó¤‰ÚÈÔ Î·È ÌÂÙÔÓÔÌ¿ÛÙËÎ·Ó Û "¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ".(8) ŒÙÛÈ, ÙÔ 1973 ¤ÁÈÓ ÛÙË §Â˘ÎˆÛ›· ÛÙËÓ K‡ÚÔ ÙÔ 11Ô "¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ" ÌÂ Û˘ÌÌÂÙÔ¯‹ ÂÎÙfi˜ ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È È·ÙÚÒÓ fiÏˆÓ ÙˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ·È‰›.

H ÂÈÙ˘¯›· Ô˘ ÍÂ¤Ú·Û ÙȘ ÚԂϤ„ÂȘ fiÏˆÓ ‰Èη›ˆÛ ÙË ÌÂÙÔÓÔÌ·Û›· Û "¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ".

AÎÔÏÔ˘ıÔ‡Ó Î·È ¿ÏÈ ‰È·‰Ô¯Èο ‰È¿ÊÔÚ˜ fiÏÂȘ Î·È ÓËÛÈ¿ Ù˘ ¯ÒÚ·˜ ÁÈ· Ó· Í·Ó·Á˘Ú›ÛÔ˘Ì ÛÙË £ÂÛÛ·ÏÔÓ›ÎË ÛÙÔ 28Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÙÔ 1990 ÛÙÔ ÍÂÓÔ‰Ô¯Â›Ô "M·Î‰ÔÓ›· ¶·ÏÏ¿˜".

H ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË KˆÓ. XˆÚ¤ÌË ¤ÁÈÓ ·fi ÙÔÓ ŒÏÏËÓ· K·ıËÁËÙ‹ ÛÙÔ National Institute of Health ÛÙȘ H¶A Î. °ÂÒÚÁÈÔ XÚÔ‡ÛÔ, Ô ÔÔ›Ô˜ ÚfiÛÊ·Ù· ÂÍÂϤÁË K·ıËÁËÙ‹˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙÔ ¶·Ó/ÌÈÔ AıËÓÒÓ.

TÔ ı¤Ì· Ô˘ ·Ó¤Ù˘Í ‹Ù·Ó "KÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ·ÂÏ¢ıÂÚˆÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ù˘ ÎÔÚÙÈÎÔÙÚÔ›Ó˘ (CRH)". ™ÙÔ ÚfiÁÚ·ÌÌ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó 2 EÈÛËÁ‹ÛÂȘ, 1 ™ÙÚÔÁÁ˘Ïfi TÚ·¤˙È, 168 AÓ·ÎÔÈÓÒÛÂȘ Î·È 53 ·Ó·ÚÙË̤Ó˜ ·Ó·ÎÔÈÓÒÛÂȘ. £· ‹ıÂÏ· Ó· ·Ó·Ê¤Úˆ fiÙÈ ÎÈ ¿ÏÏÔÈ ŒÏÏËÓ˜ È·ÙÚÔ› ÔÈ ÔÔ›ÔÈ ÛÔ‡‰·Û·Ó ÛÙË ¯ÒÚ· Ì·˜ ‹Ú·Ó ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘ K. XˆÚ¤ÌË Î·È ¤¯Ô˘Ó ‰È·Ú¤„ÂÈ ÛÙÔ Â͈ÙÂÚÈÎfi, ¤¯Ô˘Ó ÚÔÛÎÏËı› ÁÈ· ÙËÓ Î·ıÈÂڈ̤ÓË ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË ÙÔ˘ ‰¿ÛηÏÔ˘ ÙÔ˘˜ fiˆ˜: TÔ 1982 ÛÙÔ 20Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÛÙË X·ÏÎȉÈ΋, Ô Î. °È¿ÓÓ˘ §ÂˆÓ›‰·˜, K·ıËÁËÙ‹˜ Ù˘

340

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13:24

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:339-341

¶·È‰È·ÙÚÈ΋˜ AÎÙÈÓÔÏÔÁ›·˜ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Tufts ÙˆÓ H¶A Ì ı¤Ì·: O ·ÎÙÈÓÔÏfiÁÔ˜ Û·Ó Û‡Ì‚Ô˘ÏÔ˜ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ¶·È‰È¿ÙÚÔ˘.

TÔ 1983 ÛÙÔ 21Ô ÛÙËÓ Kˆ, Ë Î. E‡· ¶··Ì·Ùı·È¿ÎË-Lester, K·ıËÁ‹ÙÚÈ· Ù˘ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ McGill ÙÔ˘ K·Ó·‰¿, Ì ı¤Ì·: A˘ÙÔÎÙÔӛ˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜.

TÔ 1985 ÛÙÔ 23Ô ÛÙËÓ EÚÌÈfiÓË, Ë Î. ™Ù¤ÏÏ· Z·¯·ÚÈÔ˘‰¿ÎË-Van Praagh, K·ıËÁ‹ÙÚÈ· Ù˘ ¶·È‰È΋˜ K·Ú‰ÈÔÏÔÁ›·˜ ÛÙÔ ¶·È‰È·ÙÚÈÎfi NÔÛÔÎÔÌÂ›Ô Ù˘ BÔÛÙÒÓ˘, Ì ı¤Ì·: º˘ÛÈÔÏÔÁÈ΋ Î·È ·ıÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ Î·È ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ù˘ ηډȿ˜ ÙÔ˘ ·ÓıÚÒÔ˘.

TÔ 1998 ÛÙÔ 36Ô ÛÙËÓ ¶¿ÊÔ Ù˘ K‡ÚÔ˘, Ë Î. M·Ú›· ¢ÂÏË‚ÔÚÈ¿- ¶··‰ÔÔ‡ÏÔ˘ ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈ΋˜ Î·È º˘ÛÈÔÏÔÁ›·˜ ÛÙË ºÈÏ·‰¤ÏÊÈ· ÙˆÓ ∏.¶.∞.

Afi ÙÔ 28Ô ™˘Ó¤‰ÚÈÔ Ô˘ ¤ÁÈÓ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË, Ô ·ÚÈıÌfi˜ ÙˆÓ Û˘Ó¤‰ÚˆÓ ·˘Í‹ıËΠÙfiÛÔ ÒÛÙ ϤÔÓ ÌfiÓÔ Û fiÏÂȘ Ô˘ ‰È·ı¤ÙÔ˘Ó ÙË ÛˆÛÙ‹ ˘Ô‰ÔÌ‹ ÁÈ· Ó· ÊÈÏÔÍÂÓ‹ÛÔ˘Ó ¤Ó· ÙfiÛÔ ÌÂÁ¿ÏÔ Ï‹ıÔ˜ ÌÔÚ› Ó· Ú·ÁÌ·ÙÔÔÈËı› ÙÔ ™˘Ó¤‰ÚÈÔ Ì·˜. A˜ ÌËÓ Í¯ӿÌ fiÙÈ ÏfiÁˆ ÂÔ¯‹˜ Î·È ÙÔ˘ ÂÔÚÙ·ÛÙÈÎÔ‡ ÙÚÈË̤ÚÔ˘ Ë ÏÂÈÔÓfiÙ˘ ÙˆÓ Û˘Ó¤‰ÚˆÓ Û˘Óԉ‡ÔÓÙ·È Î·È ·fi ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜.(9) ŒÙÛÈ, ·ÎÔÏÔ˘ıËÛ·Ó ÙÔ HÚ¿ÎÏÂÈÔ KÚ‹Ù˘, Ë §ÂÌÂÛfi˜ K‡ÚÔ˘, Ë X·ÏÎȉÈ΋, Ë K¤Ú΢ڷ, Ë §‹ÌÓÔ˜, Ë Pfi‰Ô˜ Î·È ¿ÏÈ ÙÔ HÚ¿ÎÏÂÈÔ Î·È Ë ¶¿ÊÔ˜ K‡ÚÔ˘.

TÔ ™˘Ó¤‰ÚÈÔ Â‰Ò Î·È ÌÂÚÈο ¯ÚfiÓÈ· ·Ú¯›˙ÂÈ ·fi ÙËÓ ¶·Ú·Û΢‹ ÙÔ ·fiÁÂ˘Ì· ̤¯ÚÈ ÙËÓ K˘Úȷ΋ ÙÔ ‚Ú¿‰˘.

K·È ÊÙ¿ÓÔ˘Ì ÛÙÔ 37Ô Ì ÛÂÈÚ¿ Î·È ¿ÏÈ ·fi ÂΛ Ô˘ ·Ú¯›Û·ÌÂ, ÙË £ÂÛÛ·ÏÔÓ›ÎË, ÛÙÔ ÍÂÓÔ‰Ô¯Â›Ô "M·Î‰ÔÓ›· ¶·ÏÏ¿˜" Î·È Ì ·˘Ùfi ÎÏ›ÓÂÈ Ë ÙÂÏÂ˘Ù·›· ¯ÚÔÓÈ¿ ÙÔ˘ ·ÈÒÓ·.

H ¤Ó·ÚÍË ÙÔ˘ ™˘Ó‰ڛԢ ¤ÁÈÓ Ì ÙËÓ ÔÌÈÏ›· ÙÔ˘ Aη‰ËÌ·˚ÎÔ‡ Î·È OÌfiÙÈÌÔ˘ K·ıËÁËÙ‹ Ù˘ ¶·È‰È·ÙÚÈ΋˜ NÈÎÔÏ¿Ô˘ M·ÙÛ·ÓÈÒÙË Ì ı¤Ì· "BÈÔ˚·ÙÚÈ΋ Î·È HıÈ΋". H ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË KˆÓ. XˆÚ¤ÌË ¤ÁÈÓ ·fi ÙÔÓ K·ıËÁËÙ‹ Bush, Reader and Honorary Consultant in Pediatric Respiratory Medicine Ì ı¤Ì· "The child with very difficult asthma. ªechanisms and managment". Y‹Ú¯·Ó ¿ÏÏÔÈ ‰‡Ô ͤÓÔÈ ÚÔÛÎÂÎÏË̤ÓÔÈ ÔÌÈÏËÙ¤˜ Ô˘ ·Ó¤Ù˘Í·Ó ı¤Ì·Ù· Ù˘ ÂȉÈÎfiÙËÙ¿˜ ÙÔ˘˜. ŒÁÈÓ·Ó 2 ™ÙÚÔÁÁ˘Ï¿ TÚ·¤˙È·, 6 EÈÛËÁ‹ÛÂȘ, 3 ¢ÔÚ˘ÊÔÚÈο ™˘ÌfiÛÈ·, 98 ·Ó·ÎÔÈÓÒÛÂȘ Î·È Û˘˙ËÙ‹ıËÎ·Ó 286 ·Ó·ÚÙË̤Ó˜ ·Ó·ÎÔÈÓÒÛÂȘ.

H Û˘ÌÌÂÙÔ¯‹ ‹Ù·Ó Ôχ ÌÂÁ¿ÏË, ÂÚ›Ô˘ 1500 Û‡Ó‰ÚÔÈ Ô˘ Û˘ÌÌÂÙ›¯·Ó Ô˘ÛÈ·ÛÙÈο Ì ÂÚˆÙ‹ÛÂȘ Î·È Û¯fiÏÈ· ÛÙȘ 30 Û˘Ó‰ÚÈ¿ÛÂȘ Î·È ¤‰ˆÛ·Ó Ì›· ·ÓËÁ˘ÚÈ΋ fi„Ë ÛÙÔ ™˘Ó¤‰ÚÈfi Ì·˜, ÙÔ ™˘Ó¤‰ÚÈÔ ÙÔ˘ 1999.

TÂÏÂÈÒÓÔÓÙ·˜ ·˘Ù‹ ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ó·‰ÚÔÌ‹ ı· ‹ıÂÏ· Ó· ÙÔÓ›Ûˆ fiÙÈ fiÏÔÈ Ì·˜ ›̷ÛÙ ‚¤‚·ÈÔÈ fiÙÈ Ô ıÂÛÌfi˜ ·˘Ùfi˜ Ô˘ ¿Ú¯ÈÛ ‰ÂÈÏ¿ - ‰ÂÈÏ¿ ˆ˜ "¶·È‰È·ÙÚÈη› H̤ڷÈ" Î·È ÂÍÂÏ›¯ıËΠÛÈÁ¿ - ÛÈÁ¿ Û ¤Ó· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ·, ÔÏ˘ÏËı¤ÛÙÂÚ· Î·È ·ÍÈfiÏÔÁ· I·ÙÚÈο ™˘Ó¤‰ÚÈ· ı· Û˘Ó¯›ÛÂÈ ÙËÓ ›‰È· ÔÚ›· Î·È Û fiÏË ÙË ‰È·‰ÚÔÌ‹ ÙÔ˘ 21Ô˘ ·ÈÒÓ·.

BÈ‚ÏÈÔÁÚ·Ê›· 1. ¶Ô˘Ï¿ÎÔ˘-PÂÌÂÏ¿ÎÔ˘ ŒÊË, ¶Ú›ÊÙ˘ K. ¶ÂÓ‹ÓÙ· ¯ÚfiÓÈ· "¶·È‰È·ÙÚÈ΋" (ÈÛÙÔÚÈÎÔ› ÛÙ·ıÌÔ› ÛÙËÓ ÔÚ›· ÌÈÛÔ‡ ·ÈÒÓ·) ¶·È‰È·ÙÚÈ΋ 1997;60:474-487.

2. M·ÚÙÛfiη˜ ™X. T· ÂÓ‹ÓÙ· ¯ÚfiÓÈ· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. ¶·È‰È·ÙÚÈ΋ 1981;44:377-378.

3. M·ÚÙÛfiη˜ ™X. Nˆ٤ڷ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋. Aگ›· E¶E, 1972;35:479-482.

4. ™¯fiÏÈ· Î·È ·fi„ÂȘ. AÈ ¶·È‰È·ÙÚÈη› HÌ¤Ú·È £ÂÛÛ·ÏÔӛ΢. Aگ›· E¶E 1961;24:53-54.

5. ¶·È‰È·ÙÚÈη› HÌ¤Ú·È £ÂÛÛ·ÏÔӛ΢. ¶ÚÔÛÊÒÓËÛË ¶ÚÔ¤‰ÚÔ˘ Ù˘ E¶E N›Î· ZÂÚ‚Ô‡ ηٿ ÙËÓ EÓ·ÚÎÙ‹ÚÈÔ TÂÏÂÙ‹, £ÂÛÛ·ÏÔÓ›ÎË 5-6 IÔ˘Ó›Ô˘ 1961.

6. ¶·È‰È·ÙÚÈη› Âȉ‹ÛÂȘ ·fi ÙËÓ EÏÏ¿‰· Î·È ÙÔ E͈ÙÂÚÈÎfi. Aگ›· E¶E 1961;24:107-108.

7. Z¿ÓÓÔ˘-M·ÚÈÔϤ· §. ™Î¤„ÂȘ Î·È ÂÓÙ˘ÒÛÂȘ. ¶·È‰È·ÙÚÈ΋ 1974;37:413-416.

8. ¶·È‰È·ÙÚÈη› Eȉ‹ÛÂȘ ·fi ÙËÓ EÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi. ¶ÂÚ·Á̤ӷ ¢.™. Ù˘ ¯ÚÔÓÈ΋˜ ÂÚÈfi‰Ô˘ 1964-1965. Aگ›· E¶E 1972;35:582-584.

9. ¶ÚÔÛÊÒÓËÛË ÙÔ˘ ¶ÚÔ¤‰ÚÔ˘ Ù˘ E¶E I. MÂÛÛ·ÚÈÙ¿ÎË. 28Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. ¶·È‰È·ÙÚÈ΋ 1990;53:251-252.

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AÙÂÏ›˜ ·Ó·ÊÔÚ¤˜ ÛÙÔ˘˜ ·Ú¯·›Ô˘˜ ÎÏ·ÛÈÎÔ‡˜ È·ÙÚÔ‡˜

™Â ÔÚÈṲ̂Ó˜ ÂÚÁ·Û›Â˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¶AI¢IATPIKH ÙfiÌÔ˜ 63, Ù‡¯Ô˜ 2, M·ÚÙ›Ô˘ - AÚÈÏ›Ô˘ 2000, ÂÓÒ Á›ÓÔÓÙ·È ·Ó·ÊÔÚ¤˜ Û ·Ú¯·›Ô˘˜ ŒÏÏËÓ˜ È·ÙÚÔ‡˜, ı· ‹ıÂÏ· Ó· ÂÈÛËÌ¿Óˆ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û¯ÂÙÈ΋ ·Ú·ÔÌ‹ ÛÙ· ÂÏÏËÓÈο ΛÌÂÓ¿ ÙÔ˘˜, ·ÏÏ¿ ·ÓÙ›ıÂÙ· ÔÈ ·Ú·ÔÌ¤˜ Â›Ó·È Û ͤÓ˜ ÂÚÁ·Û›Â˜. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ Û˘ÁÁÚ·Ê›˜ ÙÔ˘ ¿ÚıÚÔ˘ "¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ¯˘ÏÔ˘Ú›·", ÛÂÏ. 163-166, ‰›ÓÔ˘Ó ÙË ÛËÌ·ÓÙÈ΋ ÏËÚÔÊÔÚ›· ˆ˜ "ÁÈ· ÚÒÙË ÊÔÚ¿ Ô IÔÎÚ¿Ù˘ ·Ó·ÁÓÒÚÈÛÂ Î·È ÂÚȤÁÚ·„ ÙË ÓfiÛÔ". K·È ÂÓÒ ı· ÂÚ›ÌÂÓ ηÓ›˜ Ó· ‰ÂÈ ÙËÓ ·Ó·ÊÔÚ¿ ÛÙËÓ IÔÎÚ·ÙÈ΋ ™˘ÏÏÔÁ‹, ›Ûˆ˜ Î·È Ì ÙËÓ ·Ú¿ıÂÛË Û¯ÂÙÈÎÒÓ ÊÚ¿ÛˆÓ, ÔÈ Û˘ÁÁÚ·Ê›˜ ·Ú·¤ÌÔ˘Ó Û ‰‡Ô ͤÓ˜ ÂÚÁ·Û›Â˜. MÈ· Î·È ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο ÏÂÍÈο-¢ÚÂÙ‹ÚÈ· Ù˘ IÔÎÚ·ÙÈ΋˜ ™˘ÏÏÔÁ‹˜, ÓÔÌ›˙ˆ fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ ı· ‰˘ÛÎÔÏ¢fiÓÙÔ˘Û·Ó Ó· ¤‚ÚÈÛÎ·Ó ÙȘ ÊÚ¿ÛÂȘ "Ô‡ÚËÛ Ï›ÔÓ, ÂÏ·È҉˜ Ô˘Ï‡" Î·È "Ô‡ÚËÛÂÓ ÂÏ·È҉˜", ÔÈ Ôԛ˜ Â›Ó·È ·fi ÙÔ "EȉËÌÈÒÓ ÙÔ ÚÒÙÔÓ, 13, ¿ÚÚˆÛÙÔ˜ ‰ˆ‰¤Î·ÙÔ˜" Î·È ÙÔ "EȉËÌÈÒÓ ÙÔ ÙÚ›ÙÔÓ. ÕÚÚˆÛÙÔ˜ ÂÎηȉ¤Î·ÙÔ˜" ·ÓÙ›ÛÙÔȯ·.

E›Û˘, ÔÈ Û˘ÁÁÚ·Ê›˜ ÙÔ˘ ¿ÚıÚÔ˘ "H ‚·ÛÈ΋ ÂÎÎÚÈÙÈ΋ Âʉڛ· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1", ÛÂÏ. 129-136, ÛËÌÂÈÒÓÔ˘Ó ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ¿ÚıÚÔ˘ ÙÔ˘˜ fiÙÈ "...Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Â›Ó·È ÁÓˆÛÙfi˜ ÁÈ· ÂÚÈÛÛfiÙÂÚ· ·fi 2000 ¯ÚfiÓÈ·..." ·Ú·¤ÌÔÓÙ·˜ fï˜, Û ͤÓÔ ¿ÚıÚÔ. B‚·›ˆ˜, Î·È ·˘Ùfi ÙÔ ¿ÚıÚÔ ı· ÙÔ ÌÓËÌÔÓ‡ÛÔ˘Ó, ·ÏÏ¿ ηχÙÂÚ· ı· ‹Ù·Ó Ó· ›¯·Ó ÚÒÙ· ·Ó·Ê¤ÚÂÈ ÙÔ "¶ÂÚ› ‰È·‚ËÙ¤ˆ" ·fi ÙÔ ¤ÚÁÔ ÙÔ˘ AÚÂÙ·›Ô˘, "¶ÂÚ› ·ÈÙ›ˆÓ Î·È ÛËÌ›ˆÓ ¯ÚÔÓ›ˆÓ ·ıÒÓ" B, II. A˜ ÛËÌÂȈı› fiÙÈ Ù· ¿·ÓÙ· ÙÔ˘ AÚÂÙ·›Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó Û ‰‡Ô ÙfiÌÔ˘˜, Ì ÙÔ ·Ú¯·›Ô ΛÌÂÓÔ Î·È ·Ú¿ÏÏËÏ· Ì ÙË ÓÂÔÂÏÏËÓÈ΋ ÌÂÙ¿ÊÚ·ÛË, ·fi ÙȘ ÂΉfiÛÂȘ K¿ÎÙÔ˜.

T¤ÏÔ˜, ÛÙÔ ¿ÚıÚÔ "H ÈÛÙÔÚ›· Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜. EÈÙ‡ÁÌ·Ù· Î·È ÛÎȤ˜ ÙÔ˘ ¯ı˜ - ÚÔÛ‰Ô˘ Ù˘ ·‡ÚÈÔÓ", ÛÂÏ. 93-96, ÌÓËÌÔÓ‡ÂÙ·È ˆ˜ IÔÎÚ¿ÙÂÈÔ˜ ·Ú¯‹ ÙÔ "¶ÚÔÏ·Ì‚¿ÓÂÈÓ Î·È Ô˘¯› ıÂÚ·‡ÂÈÓ", ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ·Ó·Ê¤ÚÂÙ·È Ë ·Ú·ÔÌ‹ ÙÔ˘ ¤ÚÁÔ˘, ÛÙÔ ÔÔ›Ô Î·Ù·¯ˆÚ›˙ÂÙ·È ·˘Ù‹ Ë Ú‹ÛË. ™Ù· ¢ÚÂÙ‹ÚÈ· fï˜, Ù˘ IÔÎÚ·ÙÈ΋˜ ™˘ÏÏÔÁ‹˜, ·fi fiÛÔ ‰ÈÂÚ¢ӋıËÎ·Ó ‰ÂÓ ÂÓÙÔ›ÛÙËÎÂ Ë ·Ó·ÊÂÚfiÌÂÓË Ú‹ÛË. ¶Èı·ÓfiÓ, Ë Û˘ÁÁڷʇ˜ ı· ‹ıÂÏ ӷ ÌÓËÌÔÓ‡ÛÂÈ ÙË Ú‹ÛË "ˆÊÂϤÂÈÓ ‹ ÌË ‚Ï¿ÙÂÈÓ", Ô˘ Â›Ó·È ·fi ÙÔ "EȉËÌÈÒÓ ÙÔ ÚÒÙÔÓ" II, 5. ™˘ÓÔ„›˙ÔÓÙ·˜, ÓÔÌ›˙ˆ fiÙÈ Î·Ïfi ı· Â›Ó·È ÔÈ Û˘ÁÁÚ·Ê›˜ fiÙ·Ó ı· ı¤ÏÔ˘Ó Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ˘˜ ·Ú¯·›Ô˘˜ ŒÏÏËÓ˜ È·ÙÚÔ‡˜, Ó· ÌÓËÌÔÓÂ‡Ô˘Ó ÚÒÙ· ÙËÓ ÂÏÏËÓÈ΋ ËÁ‹ ÙˆÓ ÎÂÈÌ¤ÓˆÓ ÙÔ˘˜, ÙËÓ ÔÔ›· ‡ÎÔÏ· ÌÔÚÔ‡Ó Ó· ·Ó·˙ËÙ‹ÛÔ˘Ó Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ó· ·Ú·ı¤ÙÔ˘Ó ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Í¤ÓË.

M ÙÈÌ‹ ¢ËÌ‹ÙÚÈÔ˜ K·Ú·ÌÂÚfiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ ¢È‰¿ÎÙˆÚ IÛÙÔÚ›·˜ Ù˘ I·ÙÚÈ΋˜

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O˘Î Â’ ¿ÚÙˆ ÌfiÓÔÓ ˙‹ÛÂÙ·È ¿ÓıÚˆÔ˜...

Y¿Ú¯Ô˘Ó ÔÏÏÔ› Û˘Ó¿‰ÂÏÊÔÈ ÌÂٷ͇ Ì·˜, ÔÈ ÔÔ›ÔÈ ÂÎÙfi˜ ·fi ÙÔ ÌÂÚ¿ÎÈ Ù˘ I·ÙÚÈ΋˜ ÂȉÈÎfiÙËÙ·˜ ¤¯Ô˘Ó Î·È ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘˜ ÛÙËÓ Ù¤¯ÓË, ÛÙË ÌÔ˘ÛÈ΋, ÛÙ· ÁÚ¿ÌÌ·Ù·, ÛÙÔÓ ·ıÏËÙÈÛÌfi. M ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ ·˘ÙÔ‰‡ÙË-ʈÙÔÁÚ¿ÊÔ˘, ı· ÌÔ˘ ÂÈÙÚ¤„ÂÙ ӷ ÌÔÈÚ·ÛÙÒ Ì·˙› Û·˜ (·Ó ÙÂÏÈο ‰ËÌÔÛȇÛÂÙ ¤Á¯ÚˆÌ˜ ÙȘ ʈÙÔÁڷʛ˜ Ô˘ ÙÚ¿‚ËÍ· ÙËÓ 25.05.2000 ÛÙÔÓ ¶·Á·ÛËÙÈÎfi) ÙË ı¤· ÂÓfi˜ ˘Ôı·Ï¿ÛÛÈÔ˘ Î·È ÂÓfi˜ ·Ú·ı·Ï¿ÛÛÈÔ˘ ÙÔ›Ô˘, ÚÈÓ ÍÂÛ¿ÛÂÈ ¤Ó· ÙÔÈÎfi ÌÔ˘Ú›ÓÈ.

M·ÚÙ˘ÚÔ‡Ó fiÙÈ Ë ·ÙÚ›‰· Ì·˜, ·fi ·fi„ˆ˜ ÔÈÎÔÏÔÁ›·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ, ¤¯ÂÈ ·ÎfiÌË ÔÏÏ¿ Ó· ÚÔÛʤÚÂÈ Î·È ÛÙÔ Ì¤ÏÏÔÓ, ·ÚΛ Ó· ·Ó·ıÚ¤„Ô˘Ì ٷ ·È‰È¿ Î·È ˆ˜ ÔÈÎÔÏfiÁÔ˘˜. M ·ÊÔÚÌ‹ ·˘Ù‹ ÙË ‰ËÌÔÛ›Â˘ÛË, ›Ûˆ˜ ÎÚ›ÓÂÙ fiÙÈ ÁÈ· Ó· ÁÓˆÚÈÛÙԇ̠ηχÙÂÚ· ÌÂٷ͇ Ì·˜, Û οı Ù‡¯Ô˜ ·Ó·ÁÚ¿ÊÂÙÂ Î·È ¤Ó· Û¯fiÏÈÔ ÁÈ· Ù· ÂӉȷʤÚÔÓÙ· ÙˆÓ Û˘Ó·‰¤ÏÊˆÓ ÛÙËÓ Ù¤¯ÓË.

Y¿Ú¯Ô˘Ó Î·È ÔÏÏÔ› Î·È Ì ÔÏÏ¿ ÂӉȷʤÚÔÓÙ·.

MÂ Û˘Ó·‰ÂÏÊÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜ £Âfi‰ˆÚÔ˜ ¶ÂÚÚ¿Î˘

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¶·È‰È¿ ∞Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ÛÙ· ¡ÔÛÔÎÔÌ›· K˘Ú›Â˜ Î·È Î‡ÚÈÔÈ Ù˘ ™‡ÓÙ·Í˘, ™ÙÔ ÙÚ›ÙÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ "¶AI¢IATPIKH" Î·È ÛÙÔ ÎÂÊ¿Ï·ÈÔ "¶AI¢IATPIKH ENHMEPø™H" ·Ó·Ê¤ÚÂÙ·È Ô ÏfiÁÔ˜ Ô˘ ‰ËÌÔÛȇıËΠÛÙÔ ÂÚÈÔ‰ÈÎfi Ë ÂȉËÌ›· ÈÏ·Ú¿˜ ÛÙËÓ AÏ‚·Ó›· ·fi ÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ "MËÙ¤Ú· TÂÚ¤˙·" ÙˆÓ TÈÚ¿ÓˆÓ (1). EÈÛËÌ·›ÓÂÙ·È fiÙÈ "™ÙËÓ ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ ‹‰Ë ·fi ÙËÓ ÂÓÙ·ÂÙ›· 1991-1994 Ù· ·È‰È¿ AÏ‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ Î¿Ï˘Ù·Ó 16% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ" (1). TÔ ÛÙÔÈ¯Â›Ô ·˘Ùfi Â›Ó·È ·Ôχو˜ ·Ó·ÎÚÈ‚¤˜, Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Â͈Ú·ÁÌ·ÙÈÎfi. §fiÁˆ Ù˘ Ì·ÎÚ¿˜ ÌÔ˘ ıËÙ›·˜ ˆ˜ ‰È¢ı˘ÓÙ‹ Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙˆÓ Iˆ·ÓÓ›ÓˆÓ ·fi ÙÔ 1979 ̤¯ÚÈ ÙÔ 1997 ı· Ú¤ÂÈ Ó· Û·˜ ÂÓËÌÂÚÒÛˆ fiÙÈ ·fi Ù· ÛÙÔȯ›· Ù˘ ÎÏÈÓÈ΋˜ ÚÔ·ÙÂÈ fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·È‰ÈÒÓ AÏ‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ηٿ ̤ÛÔ fiÚÔ ÌfiÏȘ ÏËÛ›·˙ ÙÔ 7% οı ¯ÚfiÓÔ. ¶ÚÔÙ¿ÛÛÔÓÙ·˜ ÙË ÏÔÁÈ΋ ÙˆÓ ·ÚÈıÌÒÓ ı· Ú¤ÂÈ Ó· Ï¿‚ÂÙ ˘fi„Ë Û·˜ fiÙÈ ·fi 1-1-1990 ̤¯ÚÈ 31-12-1995 ÓÔÛËχıËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ 24.534 ·È‰È¿. EÏÏËÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜ 22.823 (93,03%) Î·È AÏ‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ 1.711 (6,97%) (2).

T· ÛÙÔȯ›· ‚Ú›ÛÎÔÓÙ·È ÛÙË ‰È¿ıÂÛË fiÛˆÓ ÂÈı˘ÌÔ‡Ó Ó· Ù· ÌÂÏÂÙ‹ÛÔ˘Ó ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÌÔÚÔ‡Ó Ó· Ù· ·Ó·˙ËÙ‹ÛÔ˘Ó ÛÙËÓ ·È‰È·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ÛÙË °Ú·ÌÌ·Ù›· Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜, ÛÙ· ÂÚ·Á̤ӷ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ NÔÛÔÎÔÌ›Ԣ Iˆ·ÓÓ›ÓˆÓ ·ÏÏ¿ Î·È ÛÙÔÓ AıËÓ·˚Îfi Ù‡Ô (3) fiÔ˘ ‰ËÌÔÛȇÙËÎÂ Û˘ÁÎÚÔÙË̤ÓË ÂÈÎfiÓ· Ù˘ Èı·Á¤ÓÂÈ·˜ ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·È‰ÈÒÓ ·fi ÙÔÓ ÁÚ¿ÊÔÓÙ·, ÏfiÁˆ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ÏÔÁÈ΋ ÙˆÓ ·ÚÈıÌÒÓ Â›¯Â Î·È ÙfiÙ ηÎÔÔÈËı› ·fi ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙˆÓ AıËÓÒÓ Ì ÙË ‰ËÌÔÛ›Â˘ÛË ¿ÚıÚÔ˘ ÛÙËÓ ¤ÁÎÚÈÙË ÂÊËÌÂÚ›‰· K·ıËÌÂÚÈÓ‹ (4) ˘fi ÙÔÓ Â͈Ú·ÁÌ·ÙÈÎfi fiÛÔ Î·È ÍÂÓfiÊÔ‚Ô Ù›ÙÏÔ "¶·ÓÂÈÛÙËÌȷ΋ KÏÈÓÈ΋ ÁÈ·... AÏ‚·Ó¿ÎÈ·"!

TÔ ˆ˜ ¿Óˆ ¿ÚıÚÔ ÛÙËÓ K·ıËÌÂÚÈÓ‹ ÛÙËÚ›¯ıËΠ۠ÛÙÔȯ›· Ô˘ Û˘Ó¤Ù·Í ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙˆÓ AıËÓÒÓ, Ë ÔÔ›· ‰ÂÓ ÂÚ‡ÓËÛ ÂÈÙfiÔ˘ ÙÔ ı¤Ì·, ‰ÂÓ Î·ÙfiÙ¢Û ÙÔ˘˜ ¯ÒÚÔ˘˜, ‰ÂÓ Â›‰Â ȉ›ÔȘ fiÌÌ·ÛÈ ÙËÓ Î·Ù¿ÛÙ·ÛË, fï˜ ›¯Â ÙËÓ ÙfiÏÌË Ó· ·ÔÊ·Óı› ÂÍ ·ÔÛÙ¿Ûˆ˜. ¢˘ÛÙ˘¯Ò˜ Ë ‰ËÌÔÛÈÔÁÚ¿ÊÔ˜ Î. N. K·Ú·ÌÔ‡˙Ë Ô˘ Û˘Ó¤Ù·Í ÙÔ ¿ÚıÚÔ ‰ÂÓ ˙‹ÙËÛ ÙË ÁÓÒÌË ÙˆÓ Â¯fiÓÙˆÓ ÙfiÙ ÙËÓ Â˘ı‡ÓË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ KÏÈÓÈ΋˜ ÙˆÓ Iˆ·ÓÓ›ÓˆÓ, ÒÛÙ ӷ ¤¯ÂÈ ÙË ¯·Ú¿ ÙÔ˘ ·ÓÙÈÏfiÁÔ˘, ·ÏÏ¿ ÂÏ·ÊÚ¿ ÙË Î·Ú‰›·, ·Ó·Î‹Ú˘Í ÙËÓ ÎÏÈÓÈ΋ domaine reservé ÙˆÓ ·Ï‚·ÓÔ·›‰ˆÓ (4). E˘Ù˘¯Ò˜, Ë Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰È¤„¢Û ·ÌÊÔÙ¤ÚÔ˘˜ (2).

T· ÛÙÔȯ›· Ô˘ ·Ó·Ê¤ÚÔ˘Ó Ù· ÂÈÛÙËÌÔÓÈο, ȉ›ˆ˜ Ù· È·ÙÚÈο ÂÚÈÔ‰Èο Î·È Î˘Ú›ˆ˜ ÙÔ ÓÔ‡ÌÂÚÔ Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Â·ÚÎÒ˜ Î·È Â·ÓÂÈÏËÌ̤ӷ ÁÈ· Ó· ÏËÛÈ¿˙ÂÈ ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, ÒÛÙ ÔÈ ‰È·ÚıÚˆÙÈΤ˜ ·ÏÏ·Á¤˜ Ó· Â›Ó·È Â‡ÛÙԯ˜, ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ Î·È Ó· ‰›ÓÔ˘Ó Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ· Î·È fi¯È Ó· ‰ËÌÈÔ˘ÚÁÔ‡Ó ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÏÈÓÈÎÒÓ, ȉ›ˆ˜ Ù˘ Â·Ú¯›·˜. °È· ÌÈ· ÊÔÚ¿ ·ÎfiÌË ·ԉ›¯ıËΠfiÙÈ Ë ÌÂÙÚÈÔ¿ıÂÈ·, Ë Û‡ÓÂÛË Î·È Ô ÚÔÛÂÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÛÙÔȯ›ˆÓ ·ÔÙÂÏÔ‡Ó fiÏÔ ÛÙ· ¯¤ÚÈ· fiÛˆÓ ÂÈı˘ÌÔ‡Ó Ú·ÁÌ·ÙÈο Ó· Ï˘ıÔ‡Ó Ù· ÚÔ‚Ï‹Ì·Ù·.

M ÙÈÌ‹ ¶¤ÙÚÔ˜ ¢. §··ÙÛ¿Ó˘ OÌ. K·ıËÁËÙ‹˜ - ¢È¢ı˘ÓÙ‹˜ ¶·Ó/΋˜ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙˆÓ Iˆ·ÓÓ›ÓˆÓ (1979-1997) BÈ‚ÏÈÔÁÚ·Ê›· 1. H ™‡ÓÙ·ÍË. ¶AI¢IATPIKH ENHMEPø™H. ¶·È‰È·ÙÚÈ΋ 2000;63:254-261.

2. °·Ï·Ó¿Î˘ E., KÚ¿ÏÏ˘ N., NÙÔ‡ÚÔ˜ £., E˘·ÁÁÂÏ›‰Ô˘ E., AÓ‰ÚÔÓ›ÎÔ˘ ™., ™È·ÌÔÔ‡ÏÔ˘ A. NÔÛËÏ›· ·È‰ÈÒÓ ·Ï‚·ÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜: Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÚÔ‚Ï‹Ì·Ù·, ÚÔÔÙÈΤ˜. ¶·È‰È·ÙÚÈ΋ 1998;61:276-286.

3. §··ÙÛ¿Ó˘ ¶. ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ Iˆ·ÓÓ›ÓˆÓ. KA£HMEPINH -°PAMMATA 20 I·ÓÔ˘·Ú›Ô˘ 1996.

4. K·Ú·ÌÔ‡˙Ë N. ¶·ÓÂÈÛÙËÌȷ΋ KÏÈÓÈ΋ ÁÈ·... AÏ‚·Ó¿ÎÈ·. KA£HMEPINH 4 I·ÓÔ˘·Ú›Ô˘ 1996.

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¶·È‰È¿ ∞Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ÛÙ· ¡ÔÛÔÎÔÌ›· A¿ÓÙËÛË ·fi ÙË ™‡ÓÙ·ÍË

E›Ó·È Ôχ ÎÔϷ΢ÙÈÎfi ÁÈ· ÙËÓ ¶AI¢IATPIKH Ó· ‰È·‚¿˙ÂÈ Ô ¶¤ÙÚÔ˜ §··ÙÛ¿Ó˘ ·ÎfiÌË Î·È ÙËÓ ¶·È‰È·ÙÚÈ΋ EÓË̤ڈÛË Î·È ·ÎfiÌË ÎÔϷ΢ÙÈÎfiÙÂÚÔ Ó· Ì·›ÓÂÈ ÛÙÔÓ ÎfiÔ Ó· ÛÙ›ÏÂÈ ÂÈÛÙÔÏ‹. E˘¯·ÚÈÛÙÔ‡ÌÂ.

H ÏËÚÔÊÔÚ›· ÁÈ· ÙÔ 16% ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÂÚÁ·Û›· ÙˆÓ ¶. §··ÙÛ¿ÓË, I. ¶··Â˘ÛÙ·ı›Ô˘, X. ¶ÂÙÛÔ‡ÎË, M. T˙Ô‡ÊË, E. °·Ï·Ó¿ÎË. "NÔÛÔÎÔÌÂȷ΋ ÂÚ›ı·Ï„Ë ·È‰ÈÒÓ AÏ‚·ÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜" 33Ô ¶·ÓÂÏÏ. ¶·È‰ ™˘Ó 1995, AA257 fiÔ˘ ÁÚ¿ÊÂÙ·È: "™ÙËÓ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ ÔÈ ÂÈÛ·ÁˆÁ¤˜ ÙˆÓ ·È‰ÈÒÓ AÏ‚·ÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜ ¤ÊÙ·Û·Ó Î·Ù¿ ÙËÓ ÙÂÙÚ·ÂÙ›· 1991-1994 ÙȘ 1.516 (16% ÙÔ˘ Û˘ÓfiÏÔ˘ ÂÈÛ·ÁˆÁÒÓ Ù˘ KÏÈÓÈ΋˜)".

OÈ ÂȉËÌÈÔÏÔÁÈΤ˜ Û¯¤ÛÂȘ Ì ÙÔÓ AÏ‚·ÓÈÎfi ÏËı˘ÛÌfi ÂȂ‚·ÈÒÓÔÓÙ·È ·fi Ù· ÛÙÔȯ›· Ô˘ ‰›ÓÂÈ Ô Î. §··ÙÛ¿Ó˘. ¢ÂÓ ·Ó·ÈÚÔ‡ÓÙ·È ·Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙ· ÓÔÛÔÎÔÌ›· Â›Ó·È 6% ·ÓÙ› 16% Ô˘ ˘ÔÏfiÁÈ˙ ·Ï·ÈfiÙÂÚ·. AÏÏ¿, ÁÈ·Ù› ÔÈ ÚÔÛ‚ÏËÙÈΤ˜ ‰˘Ô ÙÂÏÂ˘Ù·›Â˜ ·Ú¿ÁÚ·ÊÔÈ; £· ‹Ù·Ó ¿‰ÈΘ ·ÎfiÌË ÎÈ ·Ó ›¯·Ì ·ÓÙÈÁÚ¿„ÂÈ Ï¿ıÔ˜ ÙÔ ÓÔ‡ÌÂÚÔ. H ˘ÔÁÚ¿ÊÔ˘Û· Â›Ó·È ‚·ı‡Ù·Ù· ¢ÁÓÒÌˆÓ ÁÈ· ÙȘ ÂÔÈÎÔ‰ÔÌËÙÈΤ˜ ηÙÛ¿‰Â˜ ÙÔ˘ ÂÈÛÙÔÏÔÁÚ¿ÊÔ˘ Ô˘ ‰È·ÌfiÚÊˆÛ·Ó ÙËÓ ÎÏÈÓÈ΋ Ù˘ ÛΤ„Ë ÛÙËÓ ·Ú¯‹ Ù˘ ÛÙ·‰ÈÔ‰ÚÔÌ›·˜ Ù˘.

AÏÏ¿ Ó· ηÙËÁÔÚÂ›Ù·È ÁÈ· ¤ÏÏÂÈ„Ë ÛÔ‚·ÚfiÙËÙ·˜ Î·È ¤ÏÏÂÈ„Ë Â·ÚÎÔ‡˜ ÂϤÁ¯Ô˘ ÙˆÓ ÁÚ·ÙÒÓ Ù˘, ‰ÂÓ ÙÔ ·Í›˙ÂÈ. K·È ÙËÓ ·›ÚÓÂÈ ÙÔ ·Ú¿ÔÓÔ...

°È· ÙËÓ E.™.E. EϤÓË B·Ï¿ÛÛË-A‰¿Ì

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X·ÚÙÔÁÚ¿ÊËÛË ÁÔÓȉÈÒÌ·ÙÔ˜ Î·È ˘Á›·

K¿ı ÛÙ·ıÌfi˜ ÂÈÛÙËÌÔÓÈ΋˜ ÚÔfi‰Ô˘ Â›Ó·È ¿ÍÈÔ˜ ÂÔÚÙ·ÛÌÔ‡. AÚΛ ÙÔ Â›Ù¢ÁÌ· Ó· ÂÚÌËÓ‡ÂÙ·È ÛˆÛÙ¿ Î·È Ó· ÌËÓ ‰ËÌÈÔ˘ÚÁ› Â͈Ú·ÁÌ·ÙÈΤ˜ ÚÔÛ‰Ô˘, fiˆ˜ ‰˘ÛÙ˘¯Ò˜ Û˘Ó¤‚Ë ÙËÓ Â‚‰ÔÌ¿‰· ·˘Ù‹ - NÈ΋ıËÎ·Ó ÔÈ ·ÚÚÒÛÙȘ, ÓÈ΋ıËΠÙÔ Á‹Ú·˜ - ÕÂÈÚ˜ Û˘ÓÂÓÙ‡ÍÂȘ Ì ÛÔ‚·ÚÔ‡˜ Î·È ÏÈÁfiÙÂÚÔ ÛÔ‚·ÚÔ‡˜ ÂÈÛÙ‹ÌÔÓ˜. £· ¤ÚÂ fï˜, ÚˆÙ›ÛÙˆ˜ Ó· ÂÚˆÙËı› Ô Î·ıËÁËÙ‹˜ Î. ºÒÙ˘ K·Ê¿ÙÔ˜, °ÂÓÈÎfi˜ ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ E˘Úˆ·˚ÎÔ‡ K¤ÓÙÚÔ˘ MÔÚȷ΋˜ BÈÔÏÔÁ›·˜ Ô˘ ‰Ú‡ÂÈ ÛÙË X·˚‰ÂÏ‚¤ÚÁË Î·È Û˘ÓÙÔÓ›˙ÂÈ Ù· ÈÔ ÛËÌ·ÓÙÈο ΤÓÙÚ· ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ ÙˆÓ ÎÚ·ÙÒÓ ÌÂÏÒÓ Ù˘ E˘Úˆ·˚΋˜ ŒÓˆÛ˘. TÔÓ ·ÚÂÏıfiÓÙ· M¿ÚÙÈÔ, fiÙ·Ó ÙÔ˘ ·ÔÓÂÌ‹ıËΠÙÔ AÚÈÛÙÂ›Ô Ù˘ Aη‰ËÌ›·˜, ÌÔ˘ › ¯·Ú·ÎÙËÚÈÛÙÈο: AÓ ¯ÚÂÈ¿ÛıËÎ·Ó 10 ÂÚ›Ô˘ ¯ÚfiÓÈ· ÁÈ· ÙË ¯·ÚÙÔÁÚ¿ÊËÛË ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ı· ¯ÚÂÈ·Ûı› ÂӉ¯Ô̤ӈ˜ ¤Ó·˜ ·ÈÒÓ·˜ ÁÈ· ÙËÓ ·ÎÚÈ‚‹ ·ÔÎ¿Ï˘„Ë Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘.

AÛÊ·ÏÒ˜ ı· ˆÊÂÏËı› - Û ÌÈÎÚ‹ Îϛ̷η - Ë È·ÙÚÈ΋ ·fi Ù· Û˘ÓÙÂÏÔ‡ÌÂÓ· ÂÚ¢ÓËÙÈο ÂÈÙ‡ÁÌ·Ù· ÌÂÙ¿ 10 ÂÚ›Ô˘ ¯ÚfiÓÈ·. OÈ Û˘¯ÓÔ› Î·È ˘ÂÚ‚ÔÏÈÎÔ› ÂÔÚÙ·ÛÌÔ› ÁÈ· ÙȘ ÂÈÙÂÏÔ‡ÌÂÓ˜ È·ÙÚÔ‚ÈÔÏÔÁÈΤ˜ ÚÔfi‰Ô˘˜ Ì·˜ ·Ú·Û‡ÚÔ˘Ó ¤Íˆ ·fi ÙË ˙¤Ô˘Û· Ú·ÁÌ·ÙÈÎfiÙËÙ· Ô˘ ‰È‰¿ÛÎÂÈ fiÙÈ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ Û‡ÌÌ·¯Ô˜ Ù˘ ˘Á›·˜ Ì·˜ Â›Ó·È Ë ·˘ÙÔÊÚÔÓÙ›‰·. ŸÏÔÈ ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÔÈ ÌÂÁ¿ÏÔÈ Â¯ıÚÔ› Ù˘ ˘Á›·˜ Ì·˜ Â›Ó·È ÙÔ Î¿ÓÈÛÌ·, Ë ·¯˘Û·ÚΛ·, Ë Î·ıÈÛÙÈ΋ ˙ˆ‹, ÙÔ ¿Á¯Ô˜, Ë ·˘ÙÔηٷÛÙÚÔÊÈ΋ ÙÚÔ¯·›· Û˘ÌÂÚÈÊÔÚ¿ Î·È Ù· Û˘Ó·Ê‹. H ·ÔÊ˘Á‹ ÙÔ˘˜ Û˘ÓÂÈÛʤÚÂÈ ÛÙË Ì·ÎÚÔË̤Ú¢ÛË Î·È ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Ì·˜ ‰ÂηÏ¿ÛÈ· ·fi ÙËÓ È·ÙÚÈ΋. °È· Ó· ÂˆÊÂÏËıԇ̠·fi Ù· ÌÂÏÏÔÓÙÈο È·ÙÚÈο ı·‡Ì·Ù· Ú¤ÂÈ ÚÒÙÔÓ Ó· ˘¿Ú¯Ô˘ÌÂ Î·È ‰Â‡ÙÂÚÔ Ó· ÌËÓ ¤¯Ô˘Ì ÂÈÙÚ¤„ÂÈ Ó· ˘ÔÛÙ› Ë ˘Á›· Ì·˜ ·ÓÂ·ÓfiÚıˆÙ˜ ‚Ï¿‚˜.

H ÌÂÁ·Ï‡ÙÂÚË ÚfiÔ‰Ô˜ Ù˘ Û‡Á¯ÚÔÓ˘ È·ÙÚÈ΋˜ Î·È Ë ÌÂÁ·Ï‡ÙÂÚË Û˘ÓÂÈÛÊÔÚ¿ Ù˘ ÛÙËÓ ˘Á›· Ì·˜ Â›Ó·È Ë Û˘ÓÂȉËÙÔÔ›ËÛË Ù˘ ·Í›·˜ Ù˘ ·˘ÙÔÊÚÔÓÙ›‰·˜.

K·ıËÁËÙ‹˜ N. M·ÙÛ·ÓÈÒÙ˘ °ÂÓÈÎfi˜ °Ú·ÌÌ·Ù‡˜ Ù˘ Aη‰ËÌ›·˜ AıËÓÒÓ

AÓ·‰ËÌÔÛ›Â˘ÛË ·fi ÙËÓ K·ıËÌÂÚÈÓ‹

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¶AI¢IATPIK∏ ∂¡∏ª∂ƒø™∏

∞fi ÙËÓ ∂. µ·Ï¿ÛÛË-∞‰¿Ì AÏÏ·Á‹ ™‡ÓÙ·Í˘ H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Û˘ÌÏ‹ÚˆÛ ‰‡Ô ¯ÚfiÓÈ· ‰Ô˘ÏÂÈ¿˜ ÛÙËÓ ¶AI¢IATPIKH Î·È ı· ·Ú·‰ÒÛÂÈ Ù· ·Ú¯Â›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÛÙÔÓ Ó¤Ô ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ™˘Ó¤‰ÚÈÔ ÔfiÙ ·Ó·Ï·Ì‚¿ÓÂÈ Î·È ÙÔ Ó¤Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. TÔ 5Ô Ù‡¯Ô˜ ÙÔ˘ 2000 ı· ‰ÈÂÎÂڷȈı› ·fi ÙËÓ ÂfiÌÂÓË E.™.E. ÂÓÒ Ë ÚÒËÓ... ı· οÓÂÈ ¿ÓÂÙ· ÙȘ ‰È·ÎÔ¤˜ Ù˘!

H ¶AI¢IATPIKH ·Ó¤Î·ıÂÓ ÛÙËÚÈ˙fiÙ·Ó ÛÙÔÓ "·ÙÚȈÙÈÛÌfi ÙˆÓ Û˘ÓÙ·ÎÙÒÓ Ù˘" Î·È ‰ÂÓ Ù· ηٷʤÚÓÂÈ ÎÈ ¿ÛÎËÌ·, ·ÏÏ¿ ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Ó¯›˙ÂÙ·È. ™ÙȘ ÚԉȷÁڷʤ˜ ÂÓfi˜ Û‡Á¯ÚÔÓÔ˘, ¤ÁÎÚÈÙÔ˘ ÂÈÛÙËÌÔÓÈÎÔ‡ ÂÚÈÔ‰ÈÎÔ‡ Î·È ÛÙ· ÎÚÈÙ‹ÚÈ· ·ÍÈÔÏfiÁËÛ‹˜ ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·Ù·ÛÙ·ÙÈÎfi Î·È Î·ÓÔÓÈÛÌfi˜ ÏÂÈÙÔ˘ÚÁ›·˜. H ·ÚÔ‡Û· E.™.E. ¤¯ÂÈ Î·Ù·ı¤ÛÂÈ ¤Ó· Û¯¤‰ÈÔ Î·ÓÔÓÈÛÌÔ‡ ÏÂÈÙÔ˘ÚÁ›·˜ Ì·˙› Ì ÚÔÙ¿ÛÂȘ ÁÈ· ÙÚÔÔÔÈ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó ·fi Ù· ̤ÏË Ù˘ Î·È ·fi ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘ (£. K·Ú¿ıÈÔ, N. M·ÓˆÏ¿ÎË, ™. X·˚‰¿, X. M·ÚÙÛfiη) ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘Ì‚Ô˘Ï‡ÙËÎÂ. EÏ›˙Ô˘Ì ÙÔ ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ E.¶.E. Ó· ÙÔ ÂÂÍÂÚÁ·ÛÙ› fiÛÔ ÓÔÌ›˙ÂÈ fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È Î·È Ó· ηϤÛÂÈ Û‡ÓÙÔÌ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Û ηٷÛÙ·ÙÈ΋ ÁÂÓÈ΋ Û˘Ó¤Ï¢ÛË ÁÈ· Ó· Ù·ÎÙÔÔÈËı› ÙÔ ı¤Ì·.

*** N¤ÔÈ Î·ıËÁËÙ¤˜ ·È‰È·ÙÚÈ΋˜ Afi Ù· Ôχ ¢¯¿ÚÈÛÙ· ·È‰È·ÙÚÈο Ó¤·: ÂÍÂÏ›¯ÙËÎ·Ó Û ηıËÁËÙ¤˜ ÚÒÙ˘ ‚·ıÌ›‰·˜ ÔÈ Û˘Ó¿‰ÂÏÊÔÈ: A. KˆÛÙ·ÓÙfiÔ˘ÏÔ˜, A. ¢¿ÎÔ˘-BÔ˘ÙÂÙ¿ÎË, £. K·Ú¿ıÈÔ˜, º. K·Ó·ÎÔ‡‰Ë- T۷ηϛ‰Ô˘. E›Ó·È fiÏÔÈ ÁÓˆÛÙÔ› ÛÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜ Ù˘ ¶AI¢IATPIKH™ ÎÈ Ô ÂÏÏËÓÈÎfi˜ ·È‰È·ÙÚÈÎfi˜ Ù‡Ô˜ ÙÔ˘˜ ÔÊ›ÏÂÈ ÔÏÏ¿. TÔÓ ¤¯Ô˘Ó ˘ÔÛÙËÚ›ÍÂÈ fi¯È ÌfiÓÔ ˆ˜ Û˘ÁÁÚ·Ê›˜ ·ÏÏ¿ Î·È ˆ˜ ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘, Û˘ÓÙ¿ÎÙ˜ Î·È ÎÚÈÙ¤˜. £ÂÚÌfiٷٷ Û˘Á¯·ÚËÙ‹ÚÈ·!

O ηıËÁËÙ‹˜ °. XÚÔ‡ÛÔ˜ Ô˘ ÂÍÂϤÁË ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1999 ¤¯ÂÈ Ï·ÌÂÚ‹ ·ÚÔ˘Û›· ÛÙÔÓ Í¤ÓÔ ÂÈÛÙËÌÔÓÈÎfi Ù‡Ô ·ÏÏ¿ fi¯È ÛÙÔÓ ÂÏÏËÓÈÎfi, ·È‰È·ÙÚÈÎfi. AÓÙ·ÔÎÚ›ıËΠÚfiı˘Ì· ÛÙËÓ ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ Ó· ÁÚ¿„ÂÈ ¤Ó· ¿ÚıÚÔ Û‡ÓÙ·Í˘ ÁÈ· ÙËÓ ¶AI¢IATPIKH (ÛÂÏ. 275-277 ). K·Ï‹ ·Ú¯‹!

*** K¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ Afi ÙÔ˘˜ ¢¯¿ÚÈÛÙÔ˘˜ ÛÙ·ıÌÔ‡˜ Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜: ÙÔ K¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ Û˘ÌÏ‹ÚˆÛ 25 ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜. T· ÁÈfiÚÙ·Û Û ÌÈ· Ôχ ÛÂÌÓ‹ ÂÔÚÙ·ÛÙÈ΋ ÂΉ‹ÏˆÛË fiÔ˘ ·ÚÎÂÙÔ› ÔÌÈÏËÙ¤˜ ·Ó·Ê¤ÚıËÎ·Ó ÛÙÔ Ò˜ ÍÂΛÓËÛ ÙÔ K¤ÓÙÚÔ. H ˘Ê˘Ô˘ÚÁfi˜ YÁ›·˜ ΢ڛ· XÚÈÛÙ¿ÎË ˘ÔÛ¯¤ıËΠÌÂÏÏÔÓÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ¤ÚÁÔ˘ ÙÔ˘ K¤ÓÙÚÔ˘ (˘Ô˘ÚÁfi˜ ›ӷÈ, ÌÔÚ› Ú¿ÁÌ·ÙÈ Ó· ÙÔ ˘ÔÛÙËÚ›ÍÂÈ). AӷʤÚıËΠÂ›Û˘ ÛÙËÓ ˘ÔÛÙ‹ÚÈÍË Ô˘ ¤¯ÂÈ ‰Â¯ı› Ë ›‰È· ·fi ÙÔ K¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ ˆ˜ Â·ÁÁÂÏÌ·Ù›·˜ ˘Á›·˜ Î·È Â˘¯·Ú›ÛÙËÛ ÁÈ’ ·˘Ù‹Ó. ¶ÈÛÙ‡ˆ fiÙÈ ÔÈ Â˘¯·ÚÈÛٛ˜ Ù˘ ÂÎÊÚ¿˙Ô˘Ó fiÏÔ ÙÔÓ ·È‰È·ÙÚÈÎfi ÎfiÛÌÔ. E˘¯·ÚÈÛÙÔ‡ÌÂ, Û˘Ó¿‰ÂÏÊÔÈ ÙÔ˘ K¤ÓÙÚÔ˘ ¢ËÏËÙËÚÈ¿ÛˆÓ.

*** EÓËÌÂÚˆÙÈÎfi˜ ·ÔÏÔÁÈÛÌfi˜ H ˘ÔÁÚ¿ÊÔ˘Û· ¤Ï·‚ ¤Ó· ÂÓËÌÂÚˆÙÈÎfi ‰ÂÏÙ›Ô Ù˘ MÔÓ¿‰·˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ NÔÛÔÎÔÌ›Ԣ I·ÛÒ. EÓÙ˘ˆÛÈ¿˙ÂÈ ÙÔ fiÙÈ Ô ÚfiÏÔÁÔ˜ ‰ÂÓ ˘ÔÁÚ¿ÊÂÙ·È ÌfiÓÔ ·fi ÙÔÓ ‰È¢ı˘ÓÙ‹ ·ÏÏ¿ ·fi ÙÔ˘˜ 8 ÁÈ·ÙÚÔ‡˜ Ù˘ MÔÓ¿‰·˜ Î·È ÙȘ 2 ÚÔ˚ÛÙ¿ÌÂÓ˜. EÓÙ˘ˆÛÈ¿˙ÂÈ Â›Û˘, ÙÔ fiÙÈ Ë ÂÈ‚›ˆÛË ÙˆÓ ÌÈÎÚÒÓ ÚÔÒÚˆÓ (<1500 ÁÚ) ¤¯ÂÈ Êı¿ÛÂÈ ·ÈÛ›ˆ˜ ÛÙÔ 90%. OÈ ·ÔÏÔÁÈÛÌÔ› Û˘Ó‹ıˆ˜ ·ԂϤÔ˘Ó ÛÙËÓ ÚÔ‚ÔÏ‹ ÙÔ˘ ¤ÚÁÔ˘ ÙˆÓ ÂÚÁ·˙fiÌÂÓˆÓ. ™ÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË, ÙÔ ˘ÏÈÎfi Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Â›Ó·È ÏËÚÔÊÔÚÈ·Îfi Î·È ÂӉȷʤÚÔÓ. £· ‹Ù·Ó ηϋ ȉ¤· Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ÛÙÔȯ›· ·fi ÙÔ˘˜ ·ÔÏÔÁÈÛÌÔ‡˜ Î·È ¿ÏÏˆÓ ÌÔÓ¿‰ˆÓ.

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BÈ‚ÏÈÔÁÚ·ÊÈ΋ ÂÓË̤ڈÛË K¿ı ‰Ú·ÛÙËÚÈfiÙËÙ· ·È‰È¿ÙÚˆÓ Ô˘ ÍÂʇÁÂÈ ·fi ÙÔÓ ‚ÈÔ˚·ÙÚÈÎfi ˘Ú‹Ó· Ù˘ ¶·È‰È·ÙÚÈ΋˜, ÂÎ ÙˆÓ Ú·ÁÌ¿ÙˆÓ ·ÁÓÔÂ›Ù·È ·fi ÙÔÓ ÂÚÈÔ‰ÈÎfi ·È‰È·ÙÚÈÎfi Ù‡Ô. EӉȷʤÚÔ˘Û· ‰Ô˘ÏÂÈ¿ Û˘Ó·‰¤ÏÊˆÓ ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ÁÈ· ÂÈÎÔÈÓˆÓ›·, ÁÈ· Ù· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡, ÁÈ· ÓÔÌÔıÂÛ›·, ÁÈ· ÈÛÙÔÚ›· Ù˘ È·ÙÚÈ΋˜, ‰ËÌÔÛȇÂÙ·È Û˘Ó‹ıˆ˜ Û ÌË È·ÙÚÈÎfi Ù‡Ô ‹ ΢ÎÏÔÊÔÚ› ˆ˜ ÌÔÓÔÁÚ·Ê›·. ¢ÂÓ Î·Ù·ÏÔÁÔÁÚ·ÊÂ›Ù·È ·fi ÙËÓ IATPOTEK (www.mednet.gr) Ô‡Ù ·fi ÙËÓ IPI™ (www.ich.gr) ÎÈ ¤ÙÛÈ Î·Ó›˜ Ì·˜ ‰ÂÓ ¤¯ÂÈ ÚfiÛ‚·ÛË Û' ·˘Ù‹Ó. E›Ó·È Îڛ̷! Ÿ¯È ÌfiÓÔ ÁÈ·Ù› ·˘Ù¿ Ù· ‰›· ‰›ÓÔ˘Ó ÌÈ· ¿ÏÏË ıÂÒÚËÛË, ȉȷ›ÙÂÚ· ¯Ú‹ÛÈÌË ÛÙËÓ ¿ÛÎËÛË Ù˘ ·È‰È·ÙÚÈ΋˜ ·ÏÏ¿, Û˘¯Ó¿ Î·È ÁÈ· ÔÏÏÔ‡˜, Ë ·Ó¿ÁÓˆÛ‹ ÙÔ˘˜ Â›Ó·È Î·È ÌÈ· ¢¯·Ú›ÛÙËÛË. "T¤ÚÔ˘Ó ¿Ì· Î·È ‰È‰¿ÛÎÔ˘Ó"!

TÔ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÚÔÁÚ·ÌÌ·Ù›˙ÂÈ, ÂÎÙfi˜ ·fi ÙȘ ‰ËÌÔÛȇÛÂȘ ÛÙÔÓ È·ÙÚÈÎfi Ù‡Ô Î·È ÙȘ ·Ó·ÎÔÈÓÒÛÂȘ ÛÂ Û˘Ó¤‰ÚÈ· Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡, Ó· ηٷÏÔÁÔÁÚ·Ê› Â›Û˘ Û¯ÂÙÈο ‚È‚Ï›· Î·È ÌÔÓÔÁڷʛ˜. H ·Ó·˙‹ÙËÛ‹ ÙÔ˘˜ ‰ÂÓ Â›Ó·È Î·ıfiÏÔ˘ ‡ÎÔÏË. °È’ ·˘Ùfi, Ôχ ı· ‚ÔËıÔ‡Û ·Ó οıÂ Û˘ÁÁڷʤ·˜ ¤ÛÙÂÏÓ ÛÙÔ I.Y.¶. ¤Ó· ·ÓÙ›Ù˘Ô Ù˘ ÂÚÁ·Û›·˜ ÙÔ˘ ÁÈ· ηٷÏÔÁÔÁÚ¿ÊËÛË.

O Û˘Ó¿‰ÂÏÊÔ˜ ·È‰›·ÙÚÔ˜ ¢. K·Ú·ÌÂÚfiÔ˘ÏÔ˜, ‰È‰¿ÎÙˆÚ Ù˘ IÛÙÔÚ›·˜ Ù˘ I·ÙÚÈ΋˜ ›¯Â ÙËÓ Î·ÏÔÛ‡ÓË Ó· ÛÙ›ÏÂÈ ÛÙË ™‡ÓÙ·ÍË ÌÂÚÈΤ˜ ·fi ÙȘ ‰ËÌÔÛȇÛÂȘ ÙÔ˘. AӷʤÚÔ˘Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜: 1. O È·ÙÚfi˜ M·ÓÔ˘‹Ï ™·Ú‹˜ TÂÓ¤‰ÈÔ˜ (1778-1802) Î·È ÙÔ ‰È·ÊˆÙÈÛÙÈÎfi ÙÔ˘ ¤ÚÁÔ, ™Ù·ÌÔ‡Ï˘, Aı‹Ó· 1999.

2. Iˆ¿ÓÓ˘ NÈÎÔÏ›‰Ë˜ Î·È Anton Stoerck Ù·‡ÙÈÛË ÙÔ˘ ÎÂÈ̤ÓÔ˘ ÙÔ˘ ‚È‚Ï›Ô˘ "EÚÌËÓ›· ÂÚ› ÙÔ˘ Ò˜ Ú¤ÂÈ Ó· ıÂÚ·‡ÂÙ·È ÙÔ Á·ÏÏÈÎfiÓ ¿ıÔ˜, ‹ÁÔ˘Ó Ë Ì·Ï·ÊÚ¿ÓÙ˙·" BȤÓÓË 1794. Aı‹Ó· 1999.

3. H ·Ô‰Ô¯‹ Ù˘ Â˘Úˆ·˚΋˜ È·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘ ̤ۈ ÙˆÓ È·ÙÚÈÎÒÓ ‚È‚Ï›ˆÓ Ù˘ ÚÔÂÂÓ·ÛÙ·ÙÈ΋˜ ÂÚÈfi‰Ô˘. ¶Ú·ÎÙÈο "H ÂÈÛÙËÌÔÓÈ΋ ÛΤ„Ë ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ 18Ô˜-19Ô˜ ·ÈÒÓ·˜" Aı‹Ó· 1998, 331-346.

4. H È·ÙÚÈ΋ ÛΤ„Ë Ì¤Û· ·fi Ù· ‚È‚Ï›· Ê˘ÛÈ΋˜ Ù˘ ÚÔÂ·Ó·ÛÙ·ÙÈ΋˜ ÂÚÈfi‰Ô˘. ¶Ú·ÎÙÈο "OÈ ÂÈÛً̘ ÛÙÔÓ EÏÏËÓÈÎfi ¯ÒÚÔ" K¤ÓÙÚÔ NÂÔÂÏÏËÓÈÎÒÓ ∂Ú¢ÓÒÓ E.I.E., Aı‹Ó· 1997,223-248.

5. ŒÓ· ·‚È‚ÏÈÔÁÚ¿ÊËÙÔ Î›ÌÂÓÔ ÙÔ˘ 1815 ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ·fi ÙËÓ ·ÓÒÏË. °ÂˆÚÁ›Ô˘ KÔ˙¿ÎË T˘¿Ï‰Ô˘: "¶ÂÚ› ÙÔ˘ ηı·ÚÈÛÌÔ‡ ÙÔ˘ ·¤ÚÔ˜ ‰È· ÙÔ˘ ·ÏÈÎÔ‡ ÔͤԘ" EΉfiÛÂȘ ™Ù·ÌÔ‡Ï˘, Aı‹Ó· - ¶ÂÈÚ·È¿˜ 1994.

6. H ¶ÚÒÙË IÛÙÔÚ›· Ù˘ I·ÙÚÈ΋˜ ÛÙËÓ EÏÏËÓÈ΋ °ÏÒÛÛ·. ¶·Ú¿ÚÙËÌ·: KˆÛÙ·ÓÙ›ÓÔ˘ Mȯ·‹Ï, ™˘ÓÔÙÈ΋ IÛÙÔÚ›· Ù˘ I·ÙÚÈ΋˜, BȤÓÓË 1794. EΉfiÛÂȘ ™Ù·ÌÔ‡Ï˘, Aı‹Ó· - ¶ÂÈÚ·È¿˜,1994.

***

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§Â‡ÎˆÌ· ˙ˆ‹˜ Aӷηχ„·Ì ÙË ı·˘Ì¿ÛÈ· ¤Î‰ÔÛË "§Â‡ÎˆÌ· ˙ˆ‹˜” ºˆÙÔÁÚ·ÊÈΤ˜ ·Ó·ÌÓ‹ÛÂȘ ·fi ÙÔ ¢ËÌÔÙÈÎfi BÚÂÊÔÎÔÌÂ›Ô AıËÓÒÓ 1947-1950, EΉfiÛÂȘ "ENTO™".

E˘¯·ÚÈÛÙԇ̠ÙÔÓ ÂΉfiÙË Î. £.§. º·ÛÔ˘Ï¿ Ô˘ Â¤ÙÚ„ ӷ ‰ËÌÔÛÈ¢ÙÔ‡Ó ÛÙËÓ ¶AI¢IATPIKH οÔȘ ʈÙÔÁڷʛ˜ Î·È ÙÔ ·Ú·Î¿Ùˆ ÂÓËÌÂÚˆÙÈÎfi ÛËÌ›ˆÌ·.

TÔ ¢ËÌÔÙÈÎfi BÚÂÊÔÎÔÌÂ›Ô Ù˘ Aı‹Ó·˜ ȉڇıËΠÙÔ 1874, Ì ÛÎÔfi ÙËÓ ÂÚ›ı·Ï„Ë Î·È Û˘ÓÙ‹ÚËÛË ÙˆÓ ÂÁηٷÏÂÏÂÈÌÌ¤ÓˆÓ ‹ ÔÚÊ·ÓÒÓ ÓÂÔÁÓÒÓ. K·Ù¿ ̤ÛÔÓ fiÚÔ ‰‡Ô ‚Ú¤ÊË ÙËÓ Ë̤ڷ ÂÈÛ¿ÁÔÓÙ·Ó ÛÙÔ ÊÈÏ·ÓıÚˆÈÎfi ·˘Ùfi ›‰Ú˘Ì· ÙËÓ ÂÚ›Ô‰Ô 1947-1950. ŒÓ· Û‡ÓÔÏÔ 230 ·È‰ÈÒÓ, ÔÏÏ¿ ·fi Ù· ÔÔ›· ÍÂÂÚÓÔ‡Ó Ù· ‰‡Ô ¤ÙË Î·È ˘ÔÛÙËÚ›¯ıËÎ·Ó ÙËÓ ÎÚ›ÛÈÌË ·˘Ù‹ ÂÚ›Ô‰Ô ·fi ÙËÓ ÔÚÁ¿ÓˆÛË UNRRA ÙÔ˘ OHE Î·È ÙÔÓ ÂıÂÏÔÓÙÈÎfi ÂÏÏËÓÈÎfi ÔÚÁ·ÓÈÛÌfi ÿ‰Ú˘Ì· ÁÈ· ÙË ™ˆÙËÚ›· ÙÔ˘ ¶·È‰ÈÔ‡.

H BԇϷ ¶··˚ˆ¿ÓÓÔ˘ (1898-1990), ÌÈ· ·fi ÙȘ ÎÔÚ˘Ê·›Â˜ EÏÏËÓ›‰Â˜ ʈÙÔÁÚ¿ÊÔ˘˜, ·Ó·Ï·Ì‚¿ÓÂÈ Ó· ··ı·Ó·Ù›ÛÂÈ Ì ÙÔ Ê·Îfi Ù˘ ÙÔ BÚÂÊÔÎÔÌÂ›Ô ÁÈ· ÏÔÁ·ÚÈ·ÛÌfi Ù˘ UNRRA. ™·Ú¿ÓÙ· ÔÎÙÒ ¯ÚfiÓÈ· ÌÂÙ¿, ÙÔ 1998, ȉڇÂÙ·È ÛÙËÓ Aı‹Ó· ÙÔ K¤ÓÙÚÔ EÚ¢ÓÒÓ "P›˙˜", ÌÈ· ÂÙ·ÈÚ›· ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· Ô˘ ¤¯ÂÈ ˆ˜ ÛÎÔfi ÙËÓ ·Ó·˙‹ÙËÛË ÙˆÓ Ê˘ÛÈÎÒÓ ÁÔÓÈÒÓ ÙˆÓ ˘ÈÔıÂÙËÌ¤ÓˆÓ ·È‰ÈÒÓ Ì¤Û· ·fi ÙË ‰ˆÚÂ¿Ó ÂÓË̤ڈÛË Î¿ı ÂӉȷÊÂÚfiÌÂÓÔ˘ Î·È ÙË Û˘ÛÙËÌ·ÙÈ΋ ·Ó·˙‹ÙËÛË ÛÙ· ·Ú¯Â›· ‚ÚÂÊÔÎÔÌ›ˆÓ, ÔÚÊ·ÓÔÙÚÔÊ›ˆÓ ‹ ¿ÏÏˆÓ È‰Ú˘Ì¿ÙˆÓ, ÛÙËÓ EÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi.

TÔ K¤ÓÙÚÔ ·ÔÊ·Û›˙ÂÈ Ó· ÂΉÒÛÂÈ ÙÔÓ ·ÓÂÎÙ›ÌËÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ıËÛ·˘Úfi Ù˘ B. ¶··˚ˆ¿ÓÓÔ˘ Ô˘ ·fi ÙÔ 1978 Ê˘Ï¿ÛÛÂÙ·È ÛÙÔ MÔ˘ÛÂ›Ô MÂÓ¿ÎË, Ì "ÛÎÔfi Ó· ʤÚÂÈ ÛÙÔ Êˆ˜ ͯ·Ṳ̂Ó˜ ÂÈÎfiÓ˜ ·fi ÙÔ ÛÎÏËÚfi ·ÚÂÏıfiÓ".

TÔ ÔÏ˘ÙÂϤ˜ ¿ÏÌÔ˘Ì ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚÈ¿ÓÙ· ÔÎÙÒ ·ÛÚfiÌ·˘Ú˜ ʈÙÔÁڷʛ˜ Î·È Î˘ÎÏÔÊfiÚËÛ Û ÂÚÈÔÚÈṲ̂ÓÔ - Û˘ÏÏÂÎÙÈÎfi - ·ÚÈıÌfi ·ÓÙÈÙ‡ˆÓ, Ô˘ ʤÚÔ˘Ó ÙËÓ ˘ÔÁÚ·Ê‹ Î·È ÙË ÛÊÚ·Á›‰· ÙÔ˘ K¤ÓÙÚÔ˘ EÚ¢ÓÒÓ "P›˙˜". T· ¤ÛÔ‰· ·fi ÙËÓ ÒÏËÛË ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ ı· Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ‰‡ÛÎÔÏÔ˘ Î·È ÔÏ˘‰¿·ÓÔ˘ ¤ÚÁÔ˘ ÙÔ˘ K¤ÓÙÚÔ˘.

TÔ "§Â‡ÎˆÌ· ˙ˆ‹˜" Ô˘ ΢ÎÏÔÊfiÚËÛ Ì ÙËÓ Â˘ÁÂÓÈ΋ ÚÔÛÊÔÚ¿ ÙÔ˘ MÔ˘Û›Ԣ MÂÓ¿ÎË, ΢ÎÏÔÊÔÚ› Ì ·Ú¿ÏÏËÏË ÌÂÙ¿ÊÚ·ÛË ÛÙ· AÁÁÏÈο. ¢È·Ù›ıÂÙ·È ·fi ÙÔ K¤ÓÙÚÔ EÚ¢ÓÒÓ "P›˙˜" (0945-414493) Î·È ÙȘ ÂΉfiÛÂȘ "ENTO™".

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ºˆÙÔÁÚ·ÊÈΤ˜ ·Ó·ÌÓ‹ÛÂȘ ·fi ÙÔ ¢ËÌÔÙÈÎfi µÚÂÊÔÎÔÌÂ›Ô ∞ıËÓÒÓ 1947-1950

"BÚÂÊÔ‰fi¯Ô˜. ∞fi ÙË “ªÂÁ¿ÏË ∂ÏÏËÓÈ΋ ∂Á΢ÎÏÔ·›‰ÂÈ·”. KÈ‚ÒÙÈÔÓ Â˘ÌÂÁ¤ı˜ ‰˘Ó¿ÌÂÓÔÓ Ó· ¯ˆÚ› ¤ˆ˜ ‰‡Ô ‚Ú¤ÊË ÂÍËψ̤ӷ. TÔ ÙÔÈÔ‡ÙÔÓ ÂÓÙÔȯ›˙ÂÙ·È ·Ú¿ ÙËÓ ÂÍÒı˘Ú·Ó ÙˆÓ ‚ÚÂÊÔÎÔÌ›ˆÓ ÚÔ˜ ÙÔÓ ÛÎÔfiÓ Ó· ÂÎÙ›ıÂÓÙ·È ÂÓ ·˘ÙÒ ÎÚ˘Ê¿ Ù· ‰È' ¤Ó· ÔÈÔÓ‰‹ÔÙ ÏfiÁÔÓ ·ÔÚÚÈÙfiÌÂÓ· ‹ ÂÁηٷÏÂÈfiÌÂÓ· ÓÂÔÁÓ¿ ‹ ‚Ú¤ÊË. ø˜ ‰Â ‹ıÂÏÂÓ ·ÔÙÂı› ÂΛ ÙÔ ·È‰›ÔÓ ·˘ÙfiÌ·ÙÔ˜ ËÏÂÎÙÚÈÎfi˜ ÎÒ‰ˆÓ ·ÁÁ¤ÏÏÂÈ ÙËÓ Ú¿ÍÈÓ Ù·‡ÙËÓ Ù˘ ÂÁηٷÏ›„ˆ˜".

ªˆÚfi ÛÙËÓ ÎÔ‡ÓÈ· ÎÔÈÌ¿Ù·È

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π·ÙÚÈ΋ ÂͤٷÛË ÌˆÚÒÓ. ∂Î ÙÔ˘ π·ÙÚÈÎÔ‡ ÔÚ›ÛÌ·ÙÔ˜: £‹Ï˘, 25 ËÌÂÚÒÓ, 2700 ÁÚ·Ì. £¿Ó·ÙÔ˜ ·fi ·ÙÚÔÊ›· ‹·ÙÔ˜

ªˆÚfi ·ÊË̤ÓÔ ÛÙ· ÛηÏÈ¿

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"¶·È‰È¿, ı‡Ì·Ù· ÙÔ˘ ÔϤÌÔ˘, ·fi οı ÁˆÓÈ¿ Ù˘ ∂ÏÏ¿‰·˜ ÌÂٷʤÚÔÓÙ·È Û π‰Ú‡Ì·Ù·

. °˘Ó·›Î· Ì ̈Úfi, ÙÔ ÎÚ·Ù¿ ÛÊÈÎÙ¿ ÎÈ fï˜ ı· ÙÔ ÂÁηٷÏ›„ÂÈ

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¶PO™EXH ™YNE¢PIA ™Â٤̂ÚÈÔ˜ 2000 1-3 ™ÂÙÂÌ‚Ú›Ô˘ ™¿ÌÔ˜ 5Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ¶·È‰È¿ÙÚˆÓ ∞Ó·ÙÔÏÈ΋˜ ª·Î‰ÔÓ›·˜ & £Ú¿Î˘ ™˘Ó‰ÈÔÚÁ¿ÓˆÛË: ¢ËÌÔÎÚ›ÙÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £Ú¿Î˘ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ÈÁ·›Ô˘ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ∫‡ÚÔ˘ •ÂÓÔ‰Ô¯Â›Ô Doryssa Bay, ¶˘ı·ÁfiÚÂÈÔ ™¿ÌÔ˘ OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›· Minerva Fairs & Congresses, TËÏ.: 01 3217 456 Fax: 01 3220 595 e-mail: minerva@mdnet.gr

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 OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›· C&C International A.E. TËÏ.: 01 68 89 100 Fax: 01 68 44 777 e-mail: congress@cnc.gr

30 ™ÂÙÂÌ‚Ú›Ô˘ 2000 ∞ı‹Ó· 14Ô ™ÂÌÈÓ¿ÚÈÔ E›ÁÔ˘Û·˜ Î·È EÓÙ·ÙÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ £¤Ì·: “AÓ·Ó¢ÛÙÈÎfi ™‡ÛÙËÌ· Î·È EÓÙ·ÙÈ΋ £ÂÚ·›·” OÚÁ¿ÓˆÛË: MÔÓ¿‰· EÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ AıËÓÒÓ “¶. & A. K˘ÚÈ·ÎÔ‡” AÌÊÈı¤·ÙÚÔ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ AıËÓÒÓ “¶. & A. K˘ÚÈ·ÎÔ‡” ¶ÏËÚÔÊÔڛ˜: Î. °ÂˆÚÁ›· ™È‰ÂÚ‹ TËÏ. 77 98 033

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™YNTOMO°PAºIE™ - (Abbreviations) ™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ·ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

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30-05-03

13:25

™ÂÏ›‰·355

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) 9 giga- (10 ) 6 mega-(10 ) 3 kilo- (10 ) 2 hecto(10 ) 1 deca (10 ) -1 deci (10 ) -2 centi- (10 ) -3 milli(10 ) -5 micro (10 ) -9 nano (10 ) -12 pico (10 ) -15 femto (10 ) -18 atto (10 )

Combining prefixes T G M k h da d c m Ì n p f a

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