Παιδιατρική | Τόμος 63 • Τεύχος 6 • Νοέμβριος - Δεκέμβριος 2000

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ANA™KO¶H™H 447 °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ∫. ¶·ÓÙÛÈÒÙÔ˘

TOMO™ 63 ●

¶AI¢IATPIKH

EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™ 519 µ·ÚÈ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Û ·È‰› ÏfiÁˆ ‰ËÏËÙËÚ›·Û˘ Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη ª. ∫·ÙÛ¿Ú·, ∫. ¶·¿˙ÔÁÏÔ˘, µ. ∑·¯·ÚÈ¿‰Ë˜, π. ¶··‰¿ÙÔ˜

™À¡∂Ãπ∑√ª∂¡∏ ¶∞π¢π∞∆ƒπ∫∏ ∂∫¶∞π¢∂À™∏ 460 ™À¡¢ƒ√ª∞ ªÀ∂§π∫∏™ ∞¡∂¶∞ƒ∫∂π∞™ 461 ªË¯·ÓÈÛÌÔ› –·ÈÙÈÔÏÔÁ›· ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜

524 ™ÔÁÁ҉˘ ÓÂÊÚfi˜ Û ‰‡Ô ·‰¤ÏÊÈ· K. KÔÏÏÈfi˜, A. ¢ÚÔ‡ÁÈ·, E. ™ÈfiÓÙË, K. TÛ·ÌԇϷ˜, Z. ¶··‰ÔÔ‡ÏÔ˘-KÔ˘ÏÔ˘Ì‹

529 ƒ·‚‰ÔÌ˘fiÏ˘ÛË Û ·È‰› Ì ÔÍ›· Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Salmonella

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘

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TEYXO™ 6

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470 ∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È Ì˘ÂÏÔ‰˘ÛÏ·Û›·

°. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, °. ∆ÛfiÏ·˜, ¶. ∑ÒÛË, ¢. ∫·Ú·Î·˚‰fi˜, π. ∫·Ú·Ì·ÓÙ˙¿Ó˘, µ. ™›‰ÂÚË, Ã. ∫·Ú‹˜

∞. ¶Ô˘ÚÙÛ›‰Ë˜

478 ∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜

534 ∏ˆÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Û ÓÂÔÁÓfi ∆. ™È·¯·Ó›‰Ô˘, ∂. ª¿Ó‰˘Ï·, ∫. ™·Ï·‚Ô‡Ú·, ¢. ¢ËÌËÙÚÈ¿‰Ë˜, C. Van-Vliet, ¢. ∞Ó·ÁÓˆÛÙ¿Î˘

ª. ªÔÛ¯fi‚Ë

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ 483 ∂›‰Ú·ÛË ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (rhG-CSF) ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›· ∫. ™·Ú·Ê›‰Ë˜, µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, Ã. ∞Á·Î›‰Ë˜, ¶. ¶··Î˘ÚȷΛ‰Ô˘, ∞. ∞ı·Ó·Û›Ô˘, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜

490 ¶Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÈÛ‹Ì·ÓÛË Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È Ë Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ¤Î‚·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Ã. ∆Ú¿·ÏË, ∞. ª·ÚÁÂÙ¿Î˘

538 ∞ÈÌÔÂÚÈÙfiÓ·ÈÔ ÌÂÙ¿ ·fi Ú‹ÍË ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Û ·ÛıÂÓ‹ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿, ∞. ∫Ô‡ÛË, ª. √ÈÎÔÓfiÌÔ˘, ¢. ¶·˘Ï›‰Ë˜, ∞. ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘

¶PAKTIKE™ O¢H°IE™ ™TOY™ °O¡∂π™ 542 ¢È·Ù·Ú·¯‹ ∂ÏÏÂÈÌÌ·ÙÈ΋˜ ¶ÚÔÛÔ¯‹˜ Ì ‹ ¯ˆÚ›˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶À) ™. ∆Û›ÙÔ˘Ú·

544 ∞Ó·ÎÔ›ÓˆÛË 545 ∂ÈÛÙÔϤ˜

499 ™‡Ó‰ÚÔÌÔ Turner: ™˘Û¯¤ÙÈÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ Ù˘ ÌÔÓÔۈ̛·˜ à Ì ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·˘ÍËÙÈ΋ ÔÚÌfiÓË Ã.°. ÷Ù˙Ë·ı·Ó·Û›Ô˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∞. ∆Û¤˙Ô˘, ∫. ∆Û›ÁÎÔ˜, ¢. °Ô˘ÚÁÈÒÙ˘, ∂. ∫·‚·˙·Ú¿Î˘, Ã. ∫‡ÚÔ˘, ∞. °·ÏÏ¿, ∞. ¶·Û·Ú¿ÎË, º. ¶·ÙÛ·Ï‹˜, ¡. ªÔÛ¯ÔÓ¿˜, ™. ∫›ÙÛÈÔ˘

546 ∫ÚÈÙ¤˜ ÙÔ˘ ∆fiÌÔ˘ 63 547 ∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 63 550 §¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ∆fiÌÔ˘ 63 ¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ· ™˘ÓÙÔÌÔÁڷʛ˜

507 ∏ Â›‰Ú·ÛË ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜

¶ÂÚÈÏ‹„ÂȘ ¿ÚıÚˆÓ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

PAEDIATRIKI

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HELLENIC PAEDIATRIC SOCIETY

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

I‰ÈÔÎÙ‹Ù˘© EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó·È 115 28

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∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ º. ª·˘ÚÔÂȉ‹

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Editorial Board : K. Malaka : Z. Papadopoulou-Couloumbis : E. Agelaki-Georgaki : F. Athanassiadou-Piperopoulou : M. Anthrakopoulos : G. Varlamis : P. Kafritsa : A. Konstadopoulos : Th. Tsiligiannis : K. Tsoumakas : S. Fotopoulos : ∞. Hatzis

English Editing Z. Papadopoulou-Couloumbis

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Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: (01) 7771 140, Fax: 7758 354

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¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 6Ô ¡ÔÂÌ.-¢ÂÎ. 2000

Volume 63, No 6, Nov.-Dec. 2000

¶EPIEÃOMENA

CONTENTS ™ÂÏ.

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜

vii

ANA™KO¶H™H

Page

Instructions for Authors

vii

REVIEW ARTICLE

°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·

Genetically modified foods

∫. ¶·ÓÙÛÈÒÙÔ˘

447

K. Pantsiotou

447

™À¡∂Ãπ∑√ª∂¡∏ ¶∞π¢π∞∆ƒπ∫∏ ∂∫¶∞π¢∂À™∏

CONTINUING MEDICAL EDUCATION

™À¡¢ƒ√ª∞ ªÀ∂§π∫∏™ ∞¡∂¶∞ƒ∫∂π∞™ ªË¯·ÓÈÛÌÔ› –·ÈÙÈÔÏÔÁ›· ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜

460

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘

461

THE BONE MARROW FAILURE SYNDROMES ∂tiology and pathogenetic mechanisms of acquired and inherited aplastic anemia in childhood

∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È Ì˘ÂÏÔ‰˘ÛÏ·Û›· ∞. ¶Ô˘ÚÙÛ›‰Ë˜

461

Aplastic syndromes and myelodysplasia 470

∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ª. ªÔÛ¯fi‚Ë

S. Polychronopoulou-Androulakaki ∞. Pourtsidis

470

Aplastic syndromes and hematopoietic growth factors 478

M. Moschovi

478

ORIGINAL PAPERS

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ∂›‰Ú·ÛË ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (rhG-CSF) ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›·

Effect of recombinant human granulocyte-colony stimulating factor (rhG-CSF) on red cells and platelets in septic neonates

∫. ™·Ú·Ê›‰Ë˜, µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, Ã. ∞Á·Î›‰Ë˜, ¶. ¶··Î˘ÚȷΛ‰Ô˘, ∞. ∞ı·Ó·Û›Ô˘, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜

∫. Sarafidis, V. Drossou-Agakidou, C. Agakidis, P. Papakyriakidou, A. Athanasiou, G. Kremenopoulos

483

483

¶Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÈÛ‹Ì·ÓÛË Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È Ë Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ¤Î‚·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘

Detailed fetal echocardiography for the detection of congenital heart disorders and its impact on the outcome of pregnancy

Ã. ∆Ú¿·ÏË, ∞. ª·ÚÁÂÙ¿Î˘

C. Trapali, A. Margetakis

490

490

™‡Ó‰ÚÔÌÔ Turner: ™˘Û¯¤ÙÈÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ Ù˘ ÌÔÓÔۈ̛·˜ à Ì ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·˘ÍËÙÈ΋ ÔÚÌfiÓË

Turner syndrome: Relationship between the parental origin of monosomy X and the response to rhGH therapy

Ã.°. ÷Ù˙Ë·ı·Ó·Û›Ô˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∞. ∆Û¤˙Ô˘, ∫. ∆Û›ÁÎÔ˜, ¢. °Ô˘ÚÁÈÒÙ˘, ∂. ∫·‚·˙·Ú¿Î˘, Ã. ∫‡ÚÔ˘, ∞. °·ÏÏ¿, ∞. ¶·Û·Ú¿ÎË, º. ¶·ÙÛ·Ï‹˜, ¡. ªÔÛ¯ÔÓ¿˜, ™. ∫›ÙÛÈÔ˘

C.G. Hadjiathanasiou, C. Theodoridis, A. Tsezou, K. Tsigos, D. Gourgiotis, E. Kavazarakis, C. Kyrou, A. Galla, A. Pasparaki, F. Patsalis, N. Moschonas, S. Kitsiou

499

499

∏ Â›‰Ú·ÛË ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜

The effect of parental attitudes on the presence of childhood obesity

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

E. Kakouros, K. Maniadaki

507

507

EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™

CASE REPORTS

µ·ÚÈ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Û ·È‰› ÏfiÁˆ ‰ËÏËÙËÚ›·Û˘ Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη

Severe neurological dysfunction in a child due to acute intoxication by carbon monoxide

ª. ∫·ÙÛ¿Ú·, ∫. ¶·¿˙ÔÁÏÔ˘, µ. ∑·¯·ÚÈ¿‰Ë˜, π. ¶··‰¿ÙÔ˜

519

™ÔÁÁ҉˘ ÓÂÊÚfi˜ Û ‰‡Ô ·‰¤ÏÊÈ·

M. Katsara, K. Papazoglou, V. Zachariadis, I. Papadatos

519

Medullary sponge kidney in two siblings.

K. KÔÏÏÈfi˜, A. ¢ÚÔ‡ÁÈ·, E. ™ÈfiÓÙË, K. TÛ·ÌԇϷ˜, Z. ¶··‰ÔÔ‡ÏÔ˘-KÔ˘ÏÔ˘Ì‹

524

™˘Ó¯›˙ÔÓÙ·È

A. Drougia, K.D. Kollios, I. Siondi, K. Tsampulas, Z. Papadopoulou-Couloumbis

524

Continued

iii

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30-05-03

17:43

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

HELLENIC PAEDIATRIC SOCIETY

¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 6Ô ¡ÔÂÌ.-¢ÂÎ. 2000

Volume 63, No 6, Nov.-Dec. 2000

™ÂÏ.

Page

ƒ·‚‰ÔÌ˘fiÏ˘ÛË Û ·È‰› Ì ÔÍ›· Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Salmonella

Rhabdomyolysis associated with Salmonella gastrointestinal infection

°. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, °. ∆ÛfiÏ·˜, ¶. ∑ÒÛË, ¢. ∫·Ú·Î·˚‰fi˜, π. ∫·Ú·Ì·ÓÙ˙¿Ó˘, µ. ™›‰ÂÚË, Ã. ∫·Ú‹˜ 529

G. Triantafyllidis, G. Tsolas, P. Zosi, D. Karakaidos, I. Karamantzanis, V. Sideri, C. Karis

∏ˆÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Û ÓÂÔÁÓfi

Eosinophilic gastroenteritis in a neonate.

∆. ™È·¯·Ó›‰Ô˘, ∂. ª¿Ó‰˘Ï·, ∫. ™·Ï·‚Ô‡Ú·, ¢. ¢ËÌËÙÚÈ¿‰Ë˜, C. Van-Vliet, ¢. ∞Ó·ÁÓˆÛÙ¿Î˘ 534

T. Siahanidou, H. Mandyla, K. Salavoura, D. Dimitriadis, C. Van-Vliet, D. Anagnostakis

∞ÈÌÔÂÚÈÙfiÓ·ÈÔ ÌÂÙ¿ ·fi Ú‹ÍË ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Û ·ÛıÂÓ‹ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›·

Intra-abdominal hemorrhage due to a ruptured corpus luteum cyst in a girl with congenital afibrinogenemia

ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿, ∞. ∫Ô‡ÛË, ª. √ÈÎÔÓfiÌÔ˘, ¢. ¶·˘Ï›‰Ë˜, ∞. ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘

538

M. Athanasiou-Metaxa, A. Koussi, M. Economou, D. Pavlidis, E. Malaka-Zafiriou

529

534

538

¶PAKTIKE™ O¢H°IE™ ™TOY™ °O¡∂π™

PRACTICAL ADVICE TO PARENTS

¢È·Ù·Ú·¯‹ ∂ÏÏÂÈÌÌ·ÙÈ΋˜ ¶ÚÔÛÔ¯‹˜ Ì ‹ ¯ˆÚ›˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶À)

S. Tsitoura

542

™. ∆Û›ÙÔ˘Ú·

542

∞Ó·ÎÔ›ÓˆÛË

544

Communication

544

∂ÈÛÙÔϤ˜

545

Letters

545

∫ÚÈÙ¤˜ ¿ÚıÚˆÓ ÙÔ˘ ∆fiÌÔ˘ 63

546

Reviewers of manuscripts, vol 63

546

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 63

547

Author Index, vol 63

547

§¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ∆fiÌÔ˘ 63

550

Subject Index, vol 63

550

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xi

Scheduled Medical Meetings

xi

™˘ÓÙÔÌÔÁڷʛ˜

xii

Abbreviations

xii

¶ÂÚÈÏ‹„ÂȘ ¿ÚıÚˆÓ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

498,528

Literature abstracts

498,528

∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ, OÈ Ô‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ÙÚÔÔÔÈËı›. ¶·Ú·Î·Ï›Ûı ÛÙÔ ÂÍ‹˜ Ó· ‰È·ÌÔÚÊÒÓÂÙ ÙȘ ÂÚÁ·Û›Â˜ Ô˘ ÚfiÎÂÈÙ·È Ó· ·ÔÛÙ›ÏÂÙ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈ΋ Û‡Ìʈӷ Ì ÙȘ Ӥ˜ Ô‰ËÁ›Â˜. ∏ ∂ÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹

iv

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·9

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫◊" Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘Ó¯‹ È·ÙÚÈ΋ ÂÓË̤ڈÛË Î·È ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ì ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚȯfiÌÂÓÔ, 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›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘Ó‰ڛˆÓ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ·Ó·ÊÔÚ¤˜ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‚Ú·‚¢ı› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫◊" ·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˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫◊". ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ "¶∞π¢π∞∆ƒπ∫◊" Î·È Ë ÔÏÈ΋ ‹ ÌÂ-

ÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927934, http://jama.ama-assn.org/info/auinst_req.html.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ 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 Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word .doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Exel ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο 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‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ÂÙ¿ (7) Ë̤Ú˜.

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.

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. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·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˘, ‚Ú·¯‡˜ 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˘.

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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 ÛÂÏ›‰Â˜, ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ 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) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - 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 Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È 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.

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 ÎÏÂȉȿ 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‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤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‹ ÙˆÓ ªÂıfi‰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 ™˘˙‹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˘ ηÈ

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‚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˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜.

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 1986;255:2329-2339. ™˘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 Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors / Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov). ¶·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‡: ∞ÏÂ͛Ԣ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·, ·ÚfiÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È-

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Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference.

Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: ∫Ô˘Ú›‰Ë˜ Ã, ∫Ô˘Ú›‰Ë˜ °. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· Û ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈ΋˜ ∫‡ÚÔ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜;1998. ÛÂÏ. 172.

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Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [letter]. Arch Dis Child 1996;75:355-356.

II. µÈ‚Ï›· ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢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 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.

Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. ¶›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. ™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 ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜ - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ - 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›‰·) - ¢¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¡ÙÔ˘ÓÙÔ˘Ï¿Î˘ π. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ·È‰È¿ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

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°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ∫˘Ú·ÙÛԇϷ ¶·ÓÙÛÈÒÙÔ˘

● ¶ÂÚ›ÏË„Ë: √ ¿ÓıÚˆÔ˜ ¿Ú¯ÈÛ οÔÙ ӷ ηÏÏÈÂÚÁ› Ê˘Ù¿ Î·È Ó· ÂÎÙÚ¤ÊÂÈ ˙Ò· ÁÈ· ÙËÓ ÙÚÔÊ‹ ÙÔ˘ Î·È ·ÚÁfiÙÂÚ· ÚÔÛ·ıÔ‡Û ӷ ·˘Í‹ÛÂÈ ÙËÓ ÔÛfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ·Ú·ÁÔÌ¤ÓˆÓ ÚÔ˚fiÓÙˆÓ. OÈ Î·ÏÏÈÂÚÁÔ‡ÌÂÓ˜ Û‹ÌÂÚ· ÔÈÎÈϛ˜ Ê˘ÙÒÓ Î·È Ù· ›‰Ë ˙ÒˆÓ ‰ÂÓ ÔÌÔÈ¿˙Ô˘Ó Î·ıfiÏÔ˘ Ì ÙȘ ¿ÁÚȘ ÌÔÚʤ˜ ·fi ÙȘ Ôԛ˜ ÚÔ‹Ïı·Ó. ∆ÔÓ ÙÂÏÂ˘Ù·›Ô ·ÈÒÓ· ÂÓÙ·ÙÈÎÔÔÈ‹ıËÎÂ Ë Î·ÏÏȤÚÁÂÈ· Ì ÂÈÏÔÁ‹ ÂÎÏÂÎÙÒÓ ÔÈÎÈÏÈÒÓ, ¯Ú‹ÛË ÏÈ·ÛÌ¿ÙˆÓ, Ê˘ÙÔÔÚÌÔÓÒÓ Î·È Ê˘ÙÔÊ·ÚÌ¿ÎˆÓ Î·ıÒ˜ Î·È ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È ÔÚÌÔÓÒÓ ÛÙ· ˙Ò·. ¶ÔÏÏ·Ï·ÛÈ¿ÛıËÎ·Ó ÌÂÓ ÔÈ ·Ô‰fiÛÂȘ, ·ÏÏ¿ Ì ÙȘ ÙÚÔʤ˜ ηٷӷÏÒÓÔ˘Ì ÙÔÍÈΤ˜ Ô˘Û›Â˜, Ù· ÌÈÎÚfi‚È· Á›ÓÔÓÙ·È ·ÓıÂÎÙÈο, ÂÓÒ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÎÈÓ‰˘Ó‡ÂÈ Ó· ηٷÛÙÚ·Ê›. ¶·ÚfiÏ· ·˘Ù¿ ÙÔ 50% Ù˘ ·ÁÎfiÛÌÈ·˜ ÁˆÚÁÈ΋˜ ·Ú·ÁˆÁ‹˜ ηٷÛÙÚ¤ÊÂÙ·È. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ˘fiÛ¯ÂÙ·È ÌÂÁ·Ï‡ÙÂÚË ·Ú·ÁˆÁ‹, ÏÈÁfiÙÂÚ˜ ·ÒÏÂȘ ·fi ·Ûı¤ÓÂȘ, ÏÈÁfiÙÂÚ· Ê˘ÙÔÊ¿Ú̷η. ∞fi ÙÔ ˙¢Á¿ÚˆÌ· ‰‡Ô ÂÈÏÂÁÌ¤ÓˆÓ Á·ÌÂÙÒÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Ù˘¯·›· ηÈÓÔ‡ÚÁȘ ÔÈÎÈϛ˜. ªÂ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î·ÈÓÔ‡ÚÁȘ ÔÈÎÈϛ˜ ¯ˆÚ›˜ ˙¢Á¿ÚˆÌ·, ÔÈ ÔÔ›ÔÈ ÂÚȤ¯Ô˘Ó DNA 2-3 ÂÈı˘ÌËÙÒÓ ÁÔÓȉ›ˆÓ, ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯ÂÈ ÂÈÏÂÁ› Ù˘¯·›·. ∏ ·Ú·ÁˆÁ‹ ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÚÔÈfiÓÙˆÓ ·˘Í¿ÓÂÙ·È, ·ÏÏ¿ Ë Á‡ÛË Î·È Ë ÔÈfiÙËÙ· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÔÏÏ¿ ÁÔÓ›‰È· ‰ÂÓ ‚ÂÏÙÈÒÓÂÙ·È. ∆· ÁÔÓ›‰È· ·fi Ù· ·ÙÙ·Ú· οÔÈÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÂÍ¿ÁÔÓÙ·È Î·È ÂÈÛ¿ÁÔÓÙ·È Ì ÙË ‚Ô‹ıÂÈ· ÈÒÓ (·Ú¿ÁÔÓÙ˜ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ), Û ·ÙÙ·Ú· ‰È·ÊÔÚÂÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡. ∆Ô Î·ÈÓÔ‡ÚÁÈÔ, ‰È·ÁÔÓÈÎfi Ê˘Ùfi, ÌÂÙ·‚È‚¿˙ÂÈ ÙÔ Í¤ÓÔ ÁÔÓ›‰ÈÔ ÛÙȘ ÌÂÙ¤ÂÈÙ· ÁÂÓ¤˜. OÈ Î›Ó‰˘ÓÔÈ Â›Ó·È ÔÈ ·˘ÍË̤Ó˜ ·ÏÏÂÚÁ›Â˜, Ë ·ÏÏÔ›ˆÛË Ù˘ ·Ó›‰·˜ Î·È Ù˘ ¯ÏˆÚ›‰·˜ Ù˘ Á˘, ·ÏÏ¿ ΢ڛˆ˜ Ë Û˘ÁΤÓÙÚˆÛË Ù˘ ·ÁÎfiÛÌÈ·˜ ·Ú·ÁˆÁ‹˜ ÙÚÔÊ›ÌˆÓ ÛÙ· ¯¤ÚÈ· ÔÏ˘ÂıÓÈÎÒÓ ÂÙ·ÈÚÂÈÒÓ, Ù˘ ·ÁÚÔ‚ÈÔÙ¯ÓÔÏÔÁ›·˜. OÚÈṲ̂ӷ ·fi Ù· ˆÊ¤ÏË Ô˘ ÚÔ·ÙÔ˘Ó Â›Ó·È Ë ·Ú·ÁˆÁ‹ ÂÌ‚ÔÏ›ˆÓ ·fi ‰È·ÁÔÓÈΤ˜ ·ÁÚÔÙÈΤ˜ ηÏÏȤÚÁÂȘ (.¯. Ì·Ó¿Ó˜) ‹ Ë ÂÍ·ÁˆÁ‹ ÛÊ·ÈÚÈÓÒÓ ·fi ÙÔ Á¿Ï· ‰È·ÁÔÓÈÎÒÓ ˙ÒˆÓ, Ô˘ Â›Ó·È ¯Ú‹ÛÈ̘ ÛÙËÓ È·ÙÚÈ΋ (·1-·ÓÙÈıÚ˘„›ÓË, ·Ú¿ÁÔÓÙ·˜ ‹Íˆ˜ IX). ∏ ÁË Ì·˜ ¤¯ÂÈ Û‹ÌÂÚ· 6 ‰ÈÛÂηÙÔÌ̇ÚÈ· ηÙÔ›ÎÔ˘˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Ù· 3/4 ˘ÔÛÈÙ›˙ÔÓÙ·È. O ÏËı˘ÛÌfi˜ Ù˘ Á˘ ı· ‰ÈÏ·ÛÈ·Ûı› Ù· ÂfiÌÂÓ· 40-50 ¯ÚfiÓÈ·. ∏ Û‡Á¯ÚÔÓË ‚ÈÔÙ¯ÓÔÏÔÁ›· ¤¯ÂÈ Û‹ÌÂÚ· ÙÂÚ¿ÛÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÛÙË ÁˆÚÁ›· Î·È ÙËÓ È·ÙÚÈ΋ Î·È ı· Û˘Ì‚¿ÏÂÈ ·ÔÊ·ÛÈÛÙÈο ÛÙË Ï‡ÛË ÎÚ›ÛÈÌˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ÁˆÚÁÈ΋˜ ·Ú·ÁˆÁ‹˜, ·ÚΛ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛˆÛÙ¿ Î·È Ó· ˘ËÚÂÙ› ÙËÓ ·ÓıÚˆfiÙËÙ·. ¶·È‰È·ÙÚÈ΋ 2000;63:447-459. §¤ÍÂȘ ÎÏÂȉȿ: ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·, ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋, ·ÁÚÔ‚ÈÔÙ¯ÓÔÏÔÁ›·, ·Ú¿ÁÔÓÙ˜ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ, ‰È·ÁÔÓÈο Ê˘Ù¿, ‰È·ÁÔÓÈο ˙Ò·.

K. Pantsiotou. Genetically modified foods. Paediatriki 2000;63:447-459. ● Abstract: Ever since man began growing plants and animals for his food, he has tried to achieve better quantity and quality of crop products. Today the species of plants and animals are different from the original ones. During the last century the crops have increased as a result of using selected species, fertilizers, hormone in plants and animals as well as antibiotics. The crops are increased so that the population of the earth is fed, but the plants are often in danger by adverse environmental conditions and diseases, and the chemical combat in cultivations is often necessary. All the foods we eat today have toxic substances because of the use of chemicals, and the environment is in danger. By using genetic engineering, we have genetically modified foods, which means, larger and better crops, less loss from disease and less use of chemicals and hormones. It is known that the fusion of two gametes will result in the production of new species. With genetic engineering we achieve new species (transgenic pest-protected plants, and transgenic animals), without animal pairing, which carry the desired gene. °ÂˆfiÓÔ˜, π·ÙÚfi˜ ∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

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∫. ¶·ÓÙÛÈÒÙÔ˘

The genes (2-3) from the cells of one species are extracted and by the use of a virus (vector to carry genes) are reintroduced into the nucleus of the cell of a different species. The new species that is created will transmid this foreign gene to subsequent generations. The dangers encountered include the creation of new allergic substances, alteration of the different flora and fauna in the earth, and most important, the transfer of the world’s production of foods to multinational companies. The benefits achieved include the production of vaccines from transgenic agricultural crops (e.g. bananas) or the extraction of globulins from the milk of transgenic cows for medical use (e.g. a1-antithrypsin, clotting factor IX). Our planet has today 6 billion inhabitants of whom 3/4 are underfed. The population of earth will be doubled in the next 40-50 years. The contemporary biotechnology has immense possibilities in the fields of farming and medicine, and can contribute decisively to the solution of critical problems in agricultural production as long as it is used wisely for the benefit of mankind.

Key words: genetically modified foods, genetic engineering, crop biotechnology, vector to carry genes, transgenic pest-proteced plants, transgenic animals.

∂ÈÛ·ÁˆÁ‹ O ¿ÓıÚˆÔ˜ ·fi ÙfiÙ Ô˘ ¿Ú¯ÈÛ ӷ ηÏÏÈÂÚÁ› ÙË ÁË, ÚÈÓ ·fi 10.000 ¯ÚfiÓÈ· ÂÚ›Ô˘, ÂӉȷÊÂÚfiÙ·Ó ÁÈ· ·‡ÍËÛË Ù˘ ÁˆÚÁÈ΋˜ Î·È ÎÙËÓÔÙÚÔÊÈ΋˜ ·Ú·ÁˆÁ‹˜. ™Ù·‰È·Î¿ ÌÂÙ¤‚·Ï ٷ ÁÔÓ›‰È· ‰È·ÊfiÚˆÓ ¯ÚËÛ›ÌˆÓ Ê˘ÙÒÓ Î·È ˙ÒˆÓ, ÒÛÙ ÔÈ Î·ÏÏÈÂÚÁÔ‡ÌÂÓ˜ Û‹ÌÂÚ· ÔÎÈϛ˜ Ê˘ÙÒÓ Î·È Â›‰Ë ˙ÒˆÓ Ó· ÌË ÔÌÔÈ¿˙Ô˘Ó Î·ıfiÏÔ˘ Ì ÙȘ ¿ÁÚȘ ·fi ÙȘ Ôԛ˜ ÚÔ‹Ïı·Ó. ∆· ÁÔÓ›‰È· ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÒÓ Â›Ó·È ÛÙ·ıÂÚ¿ Î·È ÌÂÙ·‚¿ÏÏÔÓÙ·È ÌfiÓÔ Ì ÌÂÙ·ÏÏ¿ÍÂȘ Î·È ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜ (1). OÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Â›Ó·È ÂÈ‚Ï·‚›˜, ·ÏÏ¿ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi Â›Ó·È ¯Ú‹ÛÈ̘ Î·È ˆÊ¤ÏÈ̘ ÛÙÔ Ê˘Ùfi Î·È ‰È·ÈˆÓ›˙ÔÓÙ·È ·Ó ÂÈÏÂÁÔ‡Ó ·fi ÙÔÓ Î·ÏÏÈÂÚÁËÙ‹. ∏ ÔÈÎÈÏfiÙËÙ· ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÒÓ Ô˘ ˘¿Ú¯ÂÈ Û‹ÌÂÚ· ÛÙ· Ê˘Ù¿, ˆÊ›ÏÂÙ·È ÛÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ·Ó¿ ÙÔ˘˜ ·ÈÒÓ˜. ŸÛÔ ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ Û˘Ó˘¿Ú¯ÂÈ ¤Ó· Ê˘Ùfi Û ̛· ÂÚÈÔ¯‹, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ ı· Â›Ó·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÔÈÎÈÏÈÒÓ ÏfiÁˆ ÌÂÙ·ÏϿ͈Ó. OÈ ¿ÓıÚˆÔÈ ÂÎÌÂÙ·ÏχÔÓÙ·È Ù· ÌÂÙ·ÏÏ·Á̤ӷ Ê˘Ù¿ Â‰Ò Î·È ·ÈÒÓ˜, ‰È·ÛÙ·˘ÚÒÓÔÓÙ·˜ Ù· Ì ‰È·ÊÔÚÂÙÈο Ê˘Ù¿, fiÏÔ Î·È Èfi Û˘ÛÙËÌ·ÙÈο (2). ∞fi ÙË ÌÂÁ¿ÏË ÁÂÓÂÙÈ΋ ·Ú·ÏÏ·ÎÙÈÎfiÙËÙ· ÏfiÁˆ ÙˆÓ ‰È·ÛÙ·˘ÚÒÛˆÓ, ·Ú¿ÁÔÓÙ·È ÔÈÎÈϛ˜ ÚÔÛ·ÚÌÔṲ̂Ó˜ Û ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. µÂÏÙ›ˆÛË Ù˘ ·fi‰ÔÛ˘ ÙˆÓ Ê˘ÙÒÓ ¤¯Ô˘ÌÂ Î·È Ì ٷ ˘‚Ú›‰È·, Ô˘ ¤¯Ô˘Ó Î·È Î·Ï‡ÙÂÚË ÔÈfiÙËÙ·, Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ӷ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ·ÓÙ¤¯Ô˘Ó Û ¯ıÚÔ‡˜ Î·È ·Ûı¤ÓÂȘ (3). Ÿ,ÙÈ ÙÚÒÌ ÚÔ¤Ú¯ÂÙ·È ·fi ˙Ò·, Ê˘Ù¿ Î·È ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ÂÎÙÚ¤ÊÔÓÙ·È ‹ ηÏÏÈÂÚÁÔ‡ÓÙ·È ÂȉÈο ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙÚÔÊ‹˜. O ¿ÓıÚˆÔ˜ ¤¯ÂÈ ÚÔηϤÛÂÈ Î·È ÁˆÁÚ·ÊÈ΋ ·Ó·Î·Ù·ÓÔÌ‹ ÙˆÓ ÁÔÓȉ›ˆÓ. ∏ ÛfiÁÈ· Â›Ó·È ·˘ÙÔÊ˘‹˜ ÛÙËÓ ∞Û›·, ·ÏÏ¿ Û‹ÌÂÚ· ηÏÏÈÂÚÁÂ›Ù·È Û fiÏË ÙËÓ ∞ÌÂÚÈ΋. ∆Ô ‰ÂÓ‰Ú‡ÏÈÔ ÙÔ˘ ηʤ Â›Ó·È ·˘ÙÔÊ˘¤˜ ÛÙËÓ ¯ÂÚÛfiÓËÛÔ Ù˘ ∞Ú·‚›·˜, ·ÏÏ¿ Û‹ÌÂÚ· ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ Ê˘Ù›Â˜ ηÊÂfi‰ÂÓ‰ÚÔ˘ Â›Ó·È ÛÙË ¡fiÙÈÔ ∞ÌÂÚÈ΋. ∏ ·Ù¿Ù· ÙÔ Î·Ï·ÌfiÎÈ Î·È Ô Î·Ófi˜, ¤ÁÈÓ·Ó ÁÓˆÛÙ¿ ÌÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë Ù˘

448

·ÌÂÚÈοÓÈ΢ Ë›ÚÔ˘, fiÔ˘ ·ÔÙÂÏÔ‡Û·Ó ·˘ÙÔÊ˘‹ Ê˘Ù¿, ·ÏÏ¿ Û‹ÌÂÚ· ηÏÏÈÂÚÁÔ‡ÓÙ·È Û fiÏË ÙËÓ Â‡ÎÚ·ÙË ˙ÒÓË Ù˘ Á˘. ∏ ÁˆÚÁ›· ·Ó¿ ÙÔ˘˜ ·ÈÒÓ˜ Î·È ÂÍÂÏ›ÍÂȘ ™ÙËÓ ÂÏÏËÓÈ΋ Ì˘ıÔÏÔÁ›·, Ë ÁˆÚÁ›· ıˆÚÂ›Ù·È ıÂ›Ô ‰ÒÚÔ (∂ÈÎfiÓ· 1). ∏ ÁˆÚÁ›· ·ÔÙ¤ÏÂÛ ÁÈ· ÙÔÓ ÚˆÙfiÁÔÓÔ ¿ÓıÚˆÔ Ì›· ·Ó·Î¿Ï˘„Ë, fiÙÈ ‰ËÏ·‰‹ ÔÈ ÛfiÚÔÈ ÌÔÚÔ‡Ó Ó· Û·ÚÔ‡Ó Î·È Ó· ·Ú¿ÁÔ˘Ó Ê˘Ù·, fiÔ˘ Î·È fiÙ·Ó ·˘Ùfi˜ ‹ıÂÏÂ. ∞ÏÏ¿ Ë Û˘ÛÙËÌ·ÙÈ΋ ÁˆÚÁ›· ηٷӷÏÒÓÂÈ ÂÚÈÛÛfiÙÂÚË ÂÓ¤ÚÁÂÈ· ·’ fi,ÙÈ ·Ú¿ÁÂÈ. O ¿ÓıÚˆÔ˜ Ú¤ÂÈ Ó· ÂÚÁ·Ûı› ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÁÈ· Ó· ·Ú¿ÁÂÈ ÙÚfiÊÈÌ·, ·’ fi,ÙÈ ·Ó Ì¿˙¢ ηÚÔ‡˜ ·fi ·˘ÙÔÊ˘‹ Ê˘Ù¿ Î·È Î˘ÓËÁÔ‡Û ˙Ò·. ∆Ô Ê˘Ùfi ¤¯ÂÈ ÂÚÈÔÚÈṲ̂ÓË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ Î·È Ì ÙȘ ÂÓ·ÏÏ·Á¤˜ ÙˆÓ ÁÂÓÂÒÓ ‰È·ÈˆÓ›˙ÂÙ·È. ∏ ·Ó··Ú·ÁˆÁ‹ ÙˆÓ Ê˘ÙÒÓ Á›ÓÂÙ·È ·ÁÂÓÒ˜ Î·È ÂÁÁÂÓÒ˜. ªÂ ÙÔÓ ·ÁÂÓ‹ ÔÏÏ·Ï·ÛÈ·Ìfi ¤¯Ô˘Ì ÁÚ‹ÁÔÚË ·‡ÍËÛË ÂÓfi˜ ÔÌÔÈfiÌÔÚÊÔ˘ ÏËı˘ÛÌÔ‡, ·ÏÏ¿ Û ¤Ó· ÛÙ·ıÂÚfi ÂÚÈ‚¿ÏÏÔÓ. ™Ù· Ê˘Ù¿ Ô˘ ¤¯Ô˘Ó Û·ÚÎÒ‰Ë fiÚÁ·Ó·-Ú›˙˜ ÁÈ· ·Ôı‹Î¢ÛË ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ (·-

∂ÈÎfiÓ· 1. O ‚·ÛÈÏÈ¿˜ Ù˘ ∂ÏÂ˘Û›Ó·˜ ∆ÚÈÙfiÏÂÌÔ˜ ¤Ï·‚ ·fi ÙËÓ ı¿ ¢‹ÌËÙÚ· ÛÙ¿¯˘· ÁÈ· Ó· ‰È‰¿ÍÂÈ ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙˆÓ ‰ËÌËÙÚÈ·ÎÒÓ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜.

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°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·

ٿٷ), ÔÈ ÔÊı·ÏÌÔ› ÙÔ˘˜ ÌÔÚÔ‡Ó Ó· ‚Ï·ÛÙ‹ÛÔ˘Ó Î·È Ó· ‰ÒÛÔ˘Ó Î·ÈÓÔ‡ÚÁÈ· Ê˘Ù¿. ∆· ‰ÂÓ‰ÚÔÎÔÌÈο Î·È ÎË¢ÙÈο Ê˘Ù¿ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Û‹ÌÂÚ· Â›Û˘ ·ÁÂÓÒ˜, Ì ÌÔۯ‡̷ٷ, ÂÎÎÂÓÙÚÈÛÌÔ‡˜, ηٷ‚ÔÏ¿‰Â˜ (·Ú·ÁˆÁ‹ ÎÏÒÓˆÓ). ∆· ¿ÓıË ÂÓÒ Â›Ó·È fiÚÁ·Ó· ÙÔ˘ ÂÁÁÂÓÔ‡˜ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡, ÙÚÔÔÔÈ‹ıËÎ·Ó ÂÍÂÏÈÎÙÈο Û ÔÚÈṲ̂ӷ Ê˘Ù¿. ÒÛÙ ӷ ·Ú¿ÁÔ˘Ó ÛfiÚÔ ·ÚıÂÓÔÁÂÓÂÙÈο (·Á·ÌÔÛÂÚÌ›·) .¯. ÔÚÙÔοÏÈ· ª¤ÚÏÈÓ.

O ÂÁÁÂÓ‹˜ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Â›Ó·È Ô Û˘ÓËıÈṲ̂ÓÔ˜ ÙÚfiÔ˜ ·Ó··Ú·ÁˆÁ‹˜ ÙˆÓ ·ÓˆÙ¤ÚˆÓ Ê˘ÙÒÓ Î·Ù¿ ÙÔÓ ÔÔ›Ô ·Ó·Î·Ù·Ó¤ÌÂÙ·È ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÒÓ Î·È ‰›ÓÂÈ Î·ÈÓÔ‡ÚÁÈÔ˘˜ ÁÂÓÂÙÈÎÔ‡˜ ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜ ÙˆÓ Ê˘ÙÒÓ, Ô˘ Â›Ó·È ÈηÓÔ› Ó· ÚÔÛ·ÚÌÔÛıÔ‡Ó Û ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ (∂ÈÎfiÓ· 2). ™‹ÌÂÚ· Ë ÂÓÙ·ÙÈ΋ ηÏÏȤÚÁÂÈ· Ù˘ Á˘ Á›ÓÂÙ·È Ì ÂÈÏÂÁ̤Ó˜ ÂÎÏÂÎÙ¤˜ ÔÈÎÈϛ˜ Ê˘ÙÒÓ Ô˘ ¤¯Ô˘Ó Ù· ÂÈı˘ÌËÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÁÈ· ÙÔ˘˜ ηٷӷψ٤˜. ™˘Á¯ÚfiÓˆ˜, ÌÂÈÒıËÎÂ Ë Î·ÏÏȤÚÁÂÈ· ·˘ÙÔÊ˘ÒÓ ÔÈÎÈÏÈÒÓ. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ê˘ÙÈΤ˜ ÔÚÌfiÓ˜ (ÁÈ‚‚ÂÚÈϛӘ) Ô˘ ÂÈÙ·¯‡ÓÔ˘Ó ÙËÓ ·‡ÍËÛË Î·È ÙËÓ ¿ÓıÈÛË, Î·È Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ ·Ú·ÁˆÁ‹˜ (ȉ›ˆ˜ ÛÙ· ÛٷʇÏÈ·). ∏ ¯Ú‹ÛË ÏÈ·ÛÌ¿ÙˆÓ, Ë Î·ÏÏȤÚÁÂÈ· ÂÎÏÂÎÙÒÓ ÎÏÒÓˆÓ Ê˘ÙÒÓ Î·È Ë Û˘ÛÙËÌ·ÙÈ΋ ¿Ú‰Â˘ÛË Ù˘ Á˘, ·‡ÍË-

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∂ÈÎfiÓ· 2. ∆· ÂÚÈÛÛfiÙÂÚ· ›‰Ë Ê˘ÙÒÓ (90%), ȉ›ˆ˜ Ù· ÂÙ‹ÛÈ· Ì ÌÈÎÚ‹ ‰È¿ÚÎÂÈ· ˙ˆ‹˜ Â›Ó·È ÂÚÌ·ÊÚfi‰ÈÙ· (‚). ∆· Ê˘Ù¿ Ô˘ ÂÈÎÔÓÈ¿˙ÔÓÙ·È Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ·Ó¤ÌÔ˘, Â›Ó·È ÌfiÓÔÈη (·) ‹ ‰›ÔÈη (‰,Á). Û·Ó ÙËÓ ·Ú·ÁˆÁ‹, ·ÏÏ¿ ÔÈ Î·ÏÏȤÚÁÂȘ ÎÈÓ‰‡Ó¢·Ó Ó· ηٷÛÙÚ·ÊÔ‡Ó ÔÏÔÎÏËÚˆÙÈο ·fi ·Ûı¤ÓÂȘ Î·È Â¯ıÚÔ‡˜ (4). ¶ÂÚÈÔÚÈÛÙÈÎfi˜ ·Ú¿ÁˆÓ Ù˘ ·‡ÍËÛ˘, Â›Ó·È Ù· ÓÈÙÚÈο ¿Ï·Ù· ÙÔ˘ ‰¿ÊÔ˘˜ Ô˘ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ ·fi Ù· Ê˘Ù¿ (5). ∆· ÓÈÙÚÈο ¿Ï·Ù· Â›Ó·È Â˘‰È¿Ï˘Ù· Î·È ÂÎχÓÔÓÙ·È ·fi ÙÔ ¤‰·ÊÔ˜, ÂÓÒ Ù· Ê˘Ù¿ (ÏËÓ ÙˆÓ „˘¯·ÓıÒÓ) ‰ÂÓ ÌÔÚÔ‡Ó Ó· ‰ÂÛ̇ÛÔ˘Ó ¿˙ˆÙÔ ·fi ÙËÓ ·ÙÌfiÛÊ·ÈÚ·. ∞Ó ‰ÂÓ ÚÔÛÙ›ıÂÓÙÔ ÓÈÙÚÈο ÏÈ¿ÛÌ·Ù· ÛÙÔ ¤‰·ÊÔ˜, ı· ˘‹Ú¯Â ·ÚÓËÙÈÎfi ÈÛÔ˙‡ÁÈÔ ·˙ÒÙÔ˘ (∂ÈÎfiÓ· 3). ∆Ô ¿˙ˆÙÔ ÙˆÓ ÏÈ·ÛÌ¿ÙˆÓ ‰ÂÛ̇ÂÙ·È ·fi ÙËÓ ·ÙÌfiÛÊ·ÈÚ· Ì ηٷӿψÛË ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ ÂÓ¤ÚÁÂÈ·˜ (6). ∏ ¯ËÌÈ΋ ηٷÔϤÌËÛË ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Ì¤ıÔ‰Ô ·ÓÙÈÌÂÙÒÈÛ˘ ÌÂ-

∞ÙÌÔÛÊ·ÈÚÈÎfi ¿˙ˆÙÔ

µÈÔÌ˯·ÓÈ΋ ‰¤ÛÌ¢ÛË

µÈÔÏÔÁÈ΋ ‰¤ÛÌ¢ÛË ¡ÈÙÚÔÁfiÓ· ‚ÚÔ¯‹˜

∞¤ÚÈÔ ¿˙ˆÙÔ µÈÔÏÔÁÈΤ˜ ÂÎÎÚ›ÛÂȘ Î·È ÙÒÌ·Ù· ¡ÈÙÚÈο

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OÚÁ·ÓÈ΋ Ô˘Û›· Û ·ÔÛ‡ÓıÂÛË

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∞Ì̈ÓÈÔÔ›ËÛË ∞ÒÏÂÈ· ÏfiÁˆ ¤ÎÏ˘Û˘

¡ÈÙÚÒ‰Ë ÕÏ·Ù· ·ÌÌˆÓ›Ô˘

∂ÈÎfiÓ· 3. O ·ÎÏÔ˜ ÙÔ˘ ·˙ÒÙÔ˘ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ·, ηıÒ˜ ÌÂÙ·‚¿ÏÏÂÙ·È ·fi ·¤ÚÈÔ ¿˙ˆÙÔ Û ÓÈÙÚÈο ÈfiÓÙ· Î·È ÔÚÁ·ÓÈΤ˜ Ô˘Û›Â˜.

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™ÂÏ›‰·16

¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459

Á¿ÏÔ˘ ·ÚÈıÌÔ‡ ·ÛıÂÓÂÈÒÓ, ¯ıÚÒÓ Î·È ˙È˙·Ó›ˆÓ ÙˆÓ Î·ÏÏÈÂÚÁÔ‡ÌÂÓˆÓ Ê˘ÙÒÓ. ∆Ô ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ·fi ÙËÓ ÂÓÙ·ÙÈ΋ ηÏÏȤÚÁÂÈ· Ù˘ Á˘ Â›Ó·È ‰È¿‚ÚˆÛË ÙˆÓ Â‰·ÊÒÓ, Ë ÂÏ¿ÙÙˆÛË Ù˘ ¯ÏˆÚ›‰·˜ (ÔÈÎÈÏ›· Ê˘ÙÈÎÒÓ ÔÚÁ·ÓÈÛÌÒÓ) Î·È Ù˘ ·Ó›‰·˜ (ÔÈÎÈÏ›· ˙ˆÈÎÒÓ ÔÚÁ·ÓÈÛÌÒÓ) ÙÔ˘ ‰¿ÊÔ˘˜ Ù˘ ÂÚÈÔ¯‹˜, Ë Ú‡·ÓÛË ÙˆÓ ˘‰¿ÙˆÓ ·fi Ê˘ÙÔÊ¿Ú̷η Î·È Ë Û˘ÛÙËÌ·ÙÈ΋ ·ÚÔ˘Û›· ˘ÔÏÂÈÌÌ¿ÙˆÓ Ê˘ÙÔÊ·ÚÌ¿ÎˆÓ ÛÙ· ÚÔ˚fiÓÙ· Ô˘ ηٷӷÏÒÓÂÈ Ô ¿ÓıÚˆÔ˜. ∫¿ı ¯ÚfiÓÔ ¯¿ÓÔÓÙ·È ‰Âο‰Â˜ ¯ÈÏÈ¿‰Â˜ ›‰Ë. ∏ ‚ÈÔÔÈÎÈÏfiÙËÙ·, ÚÔ˚fiÓ ÂͤÏÈ͢ ¯ÈÏÈ¿‰ˆÓ ÂÙÒÓ, ÌÂÈÒÓÂÙ·È Ì ·ÓÂͤÏÂÁÎÙÔ˘˜ Ú˘ıÌÔ‡˜. ÀÔÏ›ÌÌ·Ù· ÙˆÓ ¯ÏˆÚÈˆÌ¤ÓˆÓ ˘‰ÚÔÁÔÓ·ÓıÚ¿ÎˆÓ (DDT) ˘¿Ú¯Ô˘Ó Û‹ÌÂÚ· ÛÙÔ Á¿Ï·. OÈ ÂÓÒÛÂȘ ·ÚÛÂÓÈÎÔ‡, Ù· ¿Ï·Ù· ¯·ÏÎÔ‡, Ô Ê·ÈÓÔÍÂ˚Îfi˜ ˘‰Ú¿ÚÁ˘ÚÔ˜, ÙÔ ÊıÔÚÈÔ‡¯Ô Ó¿ÙÚÈÔ Î·È ¿ÏÏ· Ê˘ÙÔÊ¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ηٷÔϤÌËÛË ÙˆÓ Â¯ıÚÒÓ Î·È ÙˆÓ ·ÛıÂÓÂÈÒÓ ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ, ÌÂٷʤÚÔÓÙ·È ÛÙËÓ ÙÚÔÊÈ΋ ·Ï˘Û›‰·. ™ÙÔ ÂÚÈ‚¿ÏÏÔÓ ·fi ÙËÓ ·‰È¿ÎÔË ¯Ú‹ÛË ÁˆÚÁÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÂÍÔÓÙÒÓÔÓÙ·È Û˘Ó¯Ҙ Ù· ˙ˆÈο ›‰Ë, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Êı¿ÛÂÈ Î¿ÔÙ ̛· ÕÓÔÈÍË Ô˘ ‰ÂÓ ı· ·ÎÔ‡ÁÂÙ·È Î·Ó¤Ó· ÎÂϿˉÈÛÌ· Ô˘ÏÈÒÓ. ¶ÂÚ›Ô˘ 5 ÂηÙÔÌ̇ÚÈ· ÙfiÓÔÈ Ê˘ÙÔÊ¿Ú̷η ÂÙËÛ›ˆ˜ ·Ú¿ÁÔÓÙ·È Î·È ‰È·Û›ÚÔÓÙ·È ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ ÙÚÔÊÈ΋ ·Ï˘Û›‰· Ì ÁÓˆÛÙ¤˜ Î·È ¿ÁÓˆÛÙ˜ ÂÈÙÒÛÂȘ ÛÙ· Ê˘Ù¿, Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ. ¶·ÚfiÏ· ·˘Ù¿ ÔÈ Û˘ÓÔÏÈΤ˜ ·ÒÏÂȘ Ù˘ ÁˆÚÁÈ΋˜ ·Ú·ÁˆÁ‹˜ Ô˘ ˆÊ›ÏÔÓÙ·È Û ·Ûı¤ÓÂȘ, ¯ıÚÔ‡˜ Î·È ˙È˙¿ÓÈ· ·Ó¤Ú¯ÔÓÙ·È Û ·ÁÎfiÛÌÈ· Îϛ̷η ÛÙÔ 34%, Ù˘ ·Ó·ÌÂÓfiÌÂÓ˘ ÁˆÚÁÈ΋˜ ·Ú·ÁˆÁ‹˜. OÈ ·ÒÏÂȘ Ô˘ ÔÊ›ÏÔÓÙ·È Û ÌÂÙ·Û˘ÏÏÂÎÙÈΤ˜ ·ı‹ÛÂȘ Â›Ó·È 9-20%. ∆Ô Û‡ÓÔÏÔ ÙˆÓ ·ˆÏÂÈÒÓ ÙˆÓ ·Ú·ÁÔÌ¤ÓˆÓ ÚÔÈfiÓÙˆÓ Â›Ó·È ÙÔ ‹ÌÈÛ˘ (48%) Ù˘ ·Ú·ÁˆÁ‹˜ Û ·ÁÎfiÛÌÈÔ Â›‰Ô. ∂ÓÙ·ÙÈÎÔÔÈË̤ÓË ÂÎÙÚÔÊ‹ ˙ÒˆÓ Î·È ÂÈÙÒÛÂȘ ∆· ·ÓÙÈ‚ÈÔÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÛÙËÓ ÂÎÙÚÔÊ‹ ˙ÒˆÓ ÁÈ· ·‡ÍËÛË Ù˘ ·Ú·ÁˆÁ‹˜ Î·È ÚÔʇϷÍË ·fi ÏÔÈÌÒÍÂȘ. ¶ÂÚÈÛÛfiÙÂÚ· ·ÓÙÈ‚ÈÔÙÈο ηٷӷÏÒÓÔÓÙ·È ·fi Ù· ˙Ò· ·Ú¿ ·fi ÙÔÓ ¿ÓıÚˆÔ. ∆· ˙Ò· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈ‚ÈÔÙÈο Ì ÙËÓ ÙÚÔÊ‹ ÙÔ˘˜, ·˘Í¿ÓÔ˘Ó ÙÔ ‚¿ÚÔ˜ ηٿ 5% Û ۯ¤ÛË Ì ˙Ò· Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÔ˘Ó. ™ÙË ¢·Ó›· ÙÔ 1994 ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 24 ÎÈÏ¿ ‚·ÓÎÔÌ˘Î›Ó˘ ·fi ÙÔÓ ¿ÓıÚˆÔ, ÂÓÒ 24.000 ÎÈÏ¿ ÙÔ˘ ›‰ÈÔ˘ ÁÏ˘ÎÔÂÙȉ›Ô˘ ·‚Ô·ÚΛÓË, ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÓ ÂÎÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ·ÓÙÈ‚ÈÔÙÈο ÛÙ· ˙Ò·, ·Ó·Ù‡ÛÛÔÓÙ·È ·ÓıÂÎÙÈÎÔ› ÏËı˘ÛÌÔ› Û·ÏÌÔӤϷ˜ Ô˘ ‰ÂÓ ÚÔηÏÔ‡Ó fï˜ Ù‡ÊÔ. ∏ ÊÏÔ˘ÔÚÔÎÈÓÔÏfiÓË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· Ô˘ÏÂÚÈο, ÁÈ· ·‡ÍËÛË Ù˘ ·fi‰ÔÛ˘ ÛÙÔ ÎÚ¤·˜. µÚ¤ıËΠηÌ˘ÏÔ‚·ÎÙËÚ›‰ÈÔ ÛÙ· Ô˘ÏÂÚÈο Ô˘ ¤¯ÂÈ ·ÓÙ›ÛÙ·ÛË ÛÙË ÊÏÔ˘ÔÚÔÎÈÓÔÏfi-

450

∫. ¶·ÓÙÛÈÒÙÔ˘

ÓË ÏfiÁˆ ÌÂÙ¿ÏÏ·Í˘ ÂÓ˙‡ÌÔ˘ Î·È ÙÔ ›‰ÈÔ ‚Ú¤ıËΠ۠·ÓıÚÒÔ˘˜ Ì ‰È¿ÚÚÔÈ·. ∏ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ ηÌ˘ÏÔ‚·ÎÙËÚȉ›Ô˘ ÛÙËÓ ÎÈÓÔÏfiÓË, ‹Ù·Ó ¿ÁÓˆÛÙË ÛÙÔÓ ¿ÓıÚˆÔ, ÚÔ Ù˘ ¯Ú‹Ûˆ˜ Ù˘ ÎÈÓÔÏfiÓ˘, ÛÙËÓ ÂÎÙÚÔÊ‹ ÙˆÓ Ô˘ÏÂÚÈÎÒÓ. ™ÙËÓ ∂ӈ̤ÓË ∂˘ÚÒË Ë ¯Ú‹ÛË Ù˘ ·‚Ô·ÚΛÓ˘ ··ÁÔÚ‡ıËΠÙÔ 1997, ·ÏÏ¿ Ë Ù˘ÏÔÛ›ÓË Î·È Ë ‚ÈÚÁÈÓÈ·Ì˘Î›ÓË ·ÎfiÌË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È. O˘Û›Â˜ Ô˘ ÂÈÙÚ¤ÂÙ·È Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ·‡ÍËÛË ÙˆÓ ˙ÒˆÓ ÛÙËÓ ∂ӈ̤ÓË ∂˘ÚÒË, Â›Ó·È Ù· ÂÙȉÈο ·ÓÙÈ‚ÈÔÙÈο, Ù· ʈÛÊÔÏÈ›‰È·, Ù· ÔÏÈÁÔ۷ί·Ú›‰È· Î·È ÔÈ ÎÈÓÔͷϛӘ. ™ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ô˘ ·Ú¿ÁÔ˘Ó ÙÔ 25% Ù˘ ·ÁÎfiÛÌÈ·˜ ·Ú·ÁˆÁ‹˜ ÎÚ¤·ÙÔ˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÏÈÙÈ΋ Ô˘ Ó· ÂϤÁ¯ÂÈ ÙË ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ™ÙËÓ ∫›Ó· ¯ÔÚËÁÔ‡Ó ·Î·Ù¤ÚÁ·ÛÙ· Ì˘Î‹ÏÈ· Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ·‡ÍËÛË ÙˆÓ ˙ÒˆÓ. ™ÙË ƒˆÛ›· Ë ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· ˙Ò·. ™ÙË ÓÔÙÈÔ·Ó·ÙÔÏÈ΋ ∞Û›· Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û ʿÚ̘ ˙ÒˆÓ Â›Ó·È ·ÓÂͤÏÂÁÎÙË. ™ÙËÓ ÂÎÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ ·Ï·ÈfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ÔÈÛÙÚÔÁfiÓ· ÁÈ· ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ (·˘Í¿ÓÔ˘Ó ÙÔ Ï›Ô˜ Î·È fi¯È ÙË Ì˘˚΋ Ì¿˙· ÙÔ˘ ˙ÒÔ˘) ηıÒ˜ Î·È ·ÓÙÈı˘ÚÂÔÂȉÈο Ê¿Ú̷η, Ô˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙȘ η‡ÛÂȘ Î·È ·˘Í¿ÓÔ˘Ó ÙÔ ‚¿ÚÔ˜ ·˘Í¿ÓÔÓÙ·˜ ÙË Î·Ù·ÎÚ¿ÙËÛË ‡‰·ÙÔ˜ Î·È fi¯È Ì˘˚ÎÔ‡ ÈÛÙÔ‡. πÛÙÔÚ›· Ù˘ ÁÂÓÂÙÈ΋˜ ŸÙ·Ó ÔÚÈṲ̂ӷ Ê˘Ù¿ ·˘ÙÔÁÔÓÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó¯Ҙ ÒÛÙ ӷ ‰ËÌÈÔ˘ÚÁËıÔ‡Ó Î·ı·Ú¤˜ ÛÂÈÚ¤˜ (Ù· ÁÔÓ›‰È· ÔÌfi˙˘Á·) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰È·ÛÙ·˘ÚˆıÔ‡Ó ‰‡Ô ÙÂÏ›ˆ˜ ‰È·ÊÔÚÂÙÈΤ˜ ηı·Ú¤˜ ÛÂÈÚ¤˜ ¤¯Ô˘Ì ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·fi‰ÔÛË ·Ú·ÁˆÁ‹˜ (∂ÈÎfiÓ· 4). ∆Ô 1937 ‚Ú¤ıËΠfiÙÈ ÙÔ ·ÏηÏÔÂȉ¤˜ ÎÔϯÈΛÓË ÚÔηÏ› ÙÔÓ ‰ÈÏ·ÛÈ·ÛÌfi ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Î·È Ô‰ËÁ› ÛÙËÓ ·Ú·ÁˆÁ‹ ÔÏ˘ÏÔÂȉÒÓ, Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Û ÔÚÈṲ̂ӷ Ê˘Ù¿ Î·È ÂÎ ÙÔ˘ Ê˘ÛÈÎÔ‡. ∆Ô ÌËÙÚÈÎfi ·ÙÙ·ÚÔ ‰ÂÓ ‰È·ÈÚÂ›Ù·È ÂÓÒ Ù· ¯ÚˆÌÔÛÒÌ·Ù· ¤¯Ô˘Ó ‰È·ÈÚÂı›. ∆Ô Ó¤Ô Î‡Ù·ÚÔ Ô˘ ÚÔ·ÙÂÈ ¤¯ÂÈ ‰ÈÏ¿ÛÈÔ ·ÚÈıÌfi ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Î·È ‰ËÌÈÔ˘ÚÁ› ÌÈ· ηÈÓÔ‡ÚÁÈ· ÔÈÎÈÏ›· Ô˘ Â›Ó·È ÈηӋ Ó· ‰ÒÛÂÈ ·ÔÁfiÓÔ˘˜ (ÛfiÚÔ˘˜) Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi. ∆· ÔÏ˘ÏÔÂȉ‹ Ê˘Ù¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ˘Ú‹Ó˜ Î·È Î‡ÙÙ·Ú· Î·È ÌÂÁ·Ï‡ÙÂÚ· Î·È ·¯‡ÙÂÚ· ʇÏÏ·. ∆Ô ÙÚÈÏÔÂȉ¤˜ ηÚÔ‡˙È ‰ÂÓ ¤¯ÂÈ ÛfiÚÔ˘˜ Î·È ‰›ÓÂÈ Î·Ï‡ÙÂÚË Û¿Úη. ∞ÚÎÂÙ¤˜ ÔÈÎÈϛ˜ ÌËÏÈ¿˜ Î·È ·¯Ï·‰È¿˜ Â›Ó·È ÙÚÈÏÔÂȉ›˜, Î·È ‰È·ÎÚ›ÓÔÓÙ·È ·fi ÙÔ˘˜ η΋˜ ÔÈfiÙËÙÔ˜ ÛfiÚÔ˘˜ ÙÔ˘˜. OÈ ÙÚÈÏÔÂȉ›˜ ηÚÔ› ¤¯Ô˘Ó fi„ÈÌË ˆÚ›Ì·ÓÛË, ‰È·ÙËÚÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ÛÙËÓ ·Ôı‹ÎË Î·È ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ‚Èٷ̛Ә. OÈ Î·Ï‡ÙÂÚ˜ ÂÌÔÚÈο ÔÈÎÈϛ˜ Ì·Ó¿Ó·˜ Â›Ó·È ÔÈ ÙÚÈÏÔÂȉ›˜. ∏ ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ÛfiÚˆÓ ÛÙ· ÔÏ˘ÏÔÂȉ‹ Ê˘Ù¿, ÔÊ›ÏÔÓÙ·È Û ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘˙‡Íˆ˜

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·17

¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459

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∂ÈÎfiÓ· 4. ∏ ·Ú·ÁˆÁ‹ ÂÓfi˜ ·ÏÔ‡ ˘‚Úȉ›Ô˘ ÛÙÔ Î·Ï·ÌfiÎÈ. ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ô˘ Ô‰ËÁÔ‡Ó Û ¿ÓÈÛÔ ‰È·¯ˆÚÈÛÌfi. ™ÙÔÓ ˘Ú‹Ó· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÌÔÚ› Ó· Á›ÓÂÈ ÂÈÛ·ÁˆÁ‹ ηÈÓÔ‡ÚÁÈÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜, ·ÏÏ¿ ÙÔ Î‡ÙÙ·ÚÔ ‰ÂÓ ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È, ·Ú¿ ÌfiÓÔ ·Ó Á›ÓÂÈ ‰ÈÏ·ÛÈ·ÛÌfi˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ‰È· ÎÔϯÈΛÓ˘, ÙfiÙ ÙÔ Î‡ÙÙ·ÚÔ ‰›ÓÂÈ Î·ÈÓÔ‡ÚÁÈ· ›‰Ë Ê˘ÙÒÓ. ∏ ÔÈÎÈÏ›· ÛÈÙ·ÚÈÔ‡ ÙÚÈÙÈοÏÂ, Â›Ó·È ¤Ó· Ù¯ÓËÙfi ˘‚Ú›‰ÈÔ ·fi ÛÈÙ¿ÚÈ, Ì ÙÂÙÚ·ÏÔÂȉ‹ ‹ ÂÍ·ÏÔÂȉ‹ ˘Ú‹Ó· Î·È Û›Î·ÏË Ì ‰ÈÏÔÂȉ‹ ˘Ú‹Ó·. ∆Ô ÙÚÈÙÈοÏÂ, ˘fi ÙȘ ›‰È˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ·Ô‰›‰ÂÈ fiÛÔ Î·È ÙÔ ÛÈÙ¿ÚÈ ·ÏÏ¿ Ë ÚˆÙ½ÓË ÙÔ˘ Â›Ó·È ˘„ËÏfiÙÂÚ˘ ‚ÈÔÏÔÁÈ΋˜ ·Í›·˜, ÁÈ·Ù› ÂÚȤ¯ÂÈ ÂÚÈÛÛfiÙÂÚË Ï˘Û›ÓË. ∏ ÂÈÙ˘¯›· ÙˆÓ ˘‚Úȉ›ˆÓ ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÓÂÎÙÈÎfiÙËÙ· ÙˆÓ ÔÏ˘ÏÔÂȉÒÓ ÂȉÒÓ, Ô˘ ÏÂÈ-

ÙÔ˘ÚÁÔ‡Ó Ì ÚÔÛı‹ÎË ‹ ·ÒÏÂÈ· ¯ÚˆÌÔۈ̿وÓ.

OÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Â›Ó·È ÂÈ˙‹ÌȘ, ·ÏÏ¿ ÌÂÚÈΤ˜ ‚ÂÏÙÈÒÓÔ˘Ó ÙȘ ÔÈÎÈϛ˜ ÙˆÓ ˘·Ú¯fiÓÙˆÓ ÂȉÒÓ. O ¿ÓıÚˆÔ˜ ·Ó¿ ÙÔ˘˜ ·ÈÒÓ˜ ÂÈϤÁÂÈ Î·È Î·ÏÏÈÂÚÁ› ÙȘ ÔÈÎÈϛ˜ Ô˘ Â͢ËÚÂÙÔ‡Ó ÙȘ ÂοÛÙÔÙ ·Ó¿ÁΘ ÙÔ˘ (∂ÈÎfiÓ· 5). ∏ ·ÎÙÈÓÔ‚ÔÏ›· Ì ·ÎÙ›Ó˜ à ‹ Ì ÓÂÙÚfiÓÈ· ÛÙÔ ÎÚÈı¿ÚÈ, ‰›ÓÂÈ ‚ÈÒÛÈ̘ ÌÂÙ·ÏÏ¿ÍÂȘ ÔÈ Ôԛ˜ ¤¯Ô˘Ó ˘ÎÓ¿ ÛÙ¿¯˘·, ‰˘Ó·Ùfi Û٤ϯԘ Î·È ·ÓÙÔ¯‹ ÛÙÔ Ï¿ÁÈ·ÛÌ· ÙˆÓ Ê˘ÙÒÓ ÒÛÙ ӷ Á›ÓÂÙ·È Â‡ÎÔÏ· Ë Û˘ÁÎÔÌȉ‹. ªÂ ÌÂÙ·ÏÏ¿ÍÂȘ ·fi ·ÎÙÈÓÔ‚ÔÏ›· ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ÔÈÎÈϛ˜ ÎÚÈı·ÚÈÔ‡ Ô˘ ˆÚÈÌ¿˙Ô˘Ó ÓˆÚ›ÙÂÚ·, ÒÛÙ ӷ ¢‰ÔÎÈÌÔ‡Ó Û ‚ÔÚÂÈfiÙÂÚ· ÁˆÁÚ·ÊÈο Ï¿ÙË. ™ÙËÓ ·Ú¯·ÈfiÙËÙ· ‰ÂÓ ˘‹Ú¯·Ó Ù· ÛËÌÂÚÈÓ¿ Ï¿¯·Ó·. À‹Ú¯·Ó Ï¿¯·Ó· Ô˘ ÙÔ Ê·ÁÒÛÈÌÔ Ì¤ÚÔ˜ ‹Ù·Ó Ô ÂÈÌË΢Ṳ̂ÓÔ˜ ‚Ï·ÛÙfi˜ Î·È Ù· Ó·ڿ ʇÏÏ·. ∆· Ï¿¯·Ó· fiˆ˜ Â›Ó·È Û‹ÌÂÚ·, ¿Ú¯ÈÛ·Ó Ó· ηÏÏÈÂÚÁÔ‡ÓÙ·È ·fi ÙÔÓ 12Ô ·ÈÒÓ·, ÚÔÊ·ÓÒ˜ ÏfiÁˆ οÔÈ·˜ Ê˘ÛÈ΋˜ ÌÂÙ¿ÏÏ·Í˘. ∏ ÔÈÎÈÏ›· ÌÈ˙ÂÏÈÒÓ stral, ‰ËÌÈÔ˘ÚÁ‹ıËΠÛÙË ™Ô˘Ë‰›· ÌÂÙ¿ ·fi ÌÂÙ¿ÏÏ·ÍË ·fi ·ÎÙ›Ó˜ Ã, ·Ô‰›‰ÂÈ 7% ÂÚÈÛÛfiÙÂÚÔ ·fi ÙË ÔÈÎÈÏ›· ·fi ÙËÓ ÔÔ›· ÚÔ‹ÏıÂ. ™ÙË °ÂÚÌ·Ó›· ·fi ÌÂÙ·ÏÏ¿ÍÂȘ Ì ·ÎÙÈÓÔ‚ÔÏ›·, ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ÔÈÎÈϛ˜ ÛfiÁÈ·˜ Ô˘ ˆÚÈÌ¿˙Ô˘Ó 2-3 ‚‰ÔÌ¿‰Â˜ ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ·Ú¯È΋ ÔÈÎÈÏ›· ηıÒ˜ Î·È ¿ÏϘ Ô˘ Ê˘ÙÚÒÓÔ˘Ó Î·È ·Ó·Ù‡ÛÛÔÓÙ·È Û ¯·ÌËÏfiÙÂÚ˜ ıÂÚÌÔÎڷۛ˜. ∆Ô ÏÔ‡ÈÓÔ, ‰ÂÓ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ, ÁÈ·Ù› ÂÚȤ¯ÂÈ ¤Ó· ·ÏηÏÔÂȉ¤˜ Û ÌÂÁ¿ÏË ÔÛfiÙËÙ·, Ô˘ ‰›ÓÂÈ ÛÙ· ʇÏÏ· Î·È ÛÙÔ˘˜ ÛfiÚÔ˘˜ ÈÎÚ‹ Á‡ÛË. ∂ÍÂÙ¿ÛıËÎ·Ó ÂηÙÔÌ̇ÚÈ· Ê˘Ù¿, Ì ÁÚ‹ÁÔÚË Ì¤ıÔ‰Ô ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘ ·ÏηÏÔÂȉԇ˜ Î·È ‚Ú¤ıËΠ¤Ó· Ô˘ ‰ÂÓ Â›¯Â ηıfiÏÔ˘ ·ÏηÏÔÂȉ¤˜ Î·È Â›¯Â ÁÏ˘ÎÈ¿ Á‡ÛË. ∆Ô Ê˘Ùfi ·˘Ùfi ÚÔ‹Ïı ·fi ÌÂÙ¿ÏÏ·ÍË, ÌÂÙ¿ ·fi Ì›· Â›ÔÓË Î·È ÂÈÏÂÎÙÈ΋ ÚÔÛ¿ıÂÈ·. ∆· Ê˘ÙÈο ·ÙÙ·Ú· ¤¯Ô˘Ó ΢ÙÙ·ÚÈÎfi ÙÔ›¯ˆÌ· Î·È ·˘Ùfi Â›Ó·È Ô˘ Ù· οÓÂÈ Ó· ‰È·Ê¤ÚÔ˘Ó ·fi Ù· ˙ˆÈο ·ÙÙ·Ú·. ªÂÙ¿ ·fi ÂÓ˙˘Ì·ÙÈ΋ ‹ Ì˯·ÓÈ΋ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Ù· ·ÙÙ·Ú· ÔÓÔÌ¿˙ÔÓÙ·È ÚˆÙÔÏ¿ÛÙ˜ Î·È ·ÔÚÚÔÊÔ‡Ó ÌÂÁ¿Ï· ÌfiÚÈ· ‹ ÌÔÚÔ‡Ó Ó· Û˘ÓÂÓˆıÔ‡Ó ‰‡Ô ·ÙÙ·Ú· (Û‡ÓÙËÍË ÚˆÙÔÏ·ÛÙÒÓ). ∂›Ó·È ‰˘Ó·Ù‹ Ë Û‡ÓÙËÍË ÚˆÙÔÏ·ÛÙÒÓ ·fi ‰È·ÊÔÚÂÙÈο ›‰Ë ‹ Î·È Á¤ÓË Î·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ۈ̷ÙÈÎÒÓ ˘‚Úȉ›ˆÓ. ŸÙ·Ó ηÏÏÈÂÚÁËıÔ‡Ó Û ηٿÏÏËÏÔ ıÚÂÙÈÎfi ‰È¿Ï˘Ì·, Ù· ۈ̷ÙÈο ˘‚Ú›‰È· ‰›ÓÔ˘Ó Ï‹ÚË Ó¤· Ê˘Ù¿, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ‹Ù·Ó ‰‡Ô ۈ̷ÙÈο ·ÙÙ·Ú· Î·È fi¯È ¿ÚÚÂÓ Î·È ı‹Ï˘ Á·Ì¤Ù˘. °ÂÓÂÙÈ΋ ªË¯·ÓÈ΋ ∆Ô ·‰È¤ÍÔ‰Ô ÙˆÓ ·ˆÏÂÈÒÓ Ù˘ ÁˆÚÁÈ΋˜ ·Ú·ÁˆÁ‹˜ ·fi ¯ıÚÔ‡˜, ·Ûı¤ÓÂȘ, ˘ÔÏ›ÌÌ·Ù· Ê˘ÙÔÊ·Ú̿ΈÓ, ÌÂÙ·Û˘ÏÏÂÎÙÈΤ˜ ·ı‹ÛÂȘ ÚÔÛ·ı› Ó· χÛÂÈ Ì›· Ó¤· Ù¯ÓÔÏÔÁ›·, Ë ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋. ∏ ÁÂÓÂ-

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∫. ¶·ÓÙÛÈÒÙÔ˘

ÕÁÚÈÔ ÛÈÙ¿ÚÈ OÈ ÛfiÚÔÈ ·Ô¯ˆÚ›˙ÔÓÙ·È Â‡ÎÔÏ·

ÕÁÚÈÔ ÛÈÙ¿ÚÈ §Â›· ÂÈÊ¿ÓÂÈ· ∂‡ÎÔÏÔ˜ ·Ô¯ˆÚÈÛÌfi˜ ÛfiÚÔ˘

™fiÚÔ˜ ƒ¿¯Ë ∂ÍËÌÂڈ̤ÓÔ ÛÈÙ¿ÚÈ

∆Ú·¯Â›· ÂÈÊ¿ÓÂÈ· ∂ÍËÌÂڈ̤ÓÔ ÛÈÙ¿ÚÈ

¢‡ÛÎÔÏÔ˜ ·Ô¯ˆÚÈÛÌfi˜ ÛfiÚÔ˘

∂ÈÎfiÓ· 5. ∆Ô ¿ÁÚÈÔ ÛÈÙ¿ÚÈ Î·ÏÏÈÂÚÁ›ÙÔ fiÙ·Ó ÙÔ ·ÏÒÓÈÛÌ· ÁÈÓfiÙ·Ó Ì ÚˆÙfiÁÔÓ· ̤۷ Î·È Ô ÛfiÚÔ˜ ·Ô¯ˆÚÈ˙fiÙ·Ó Â‡ÎÔÏ· ·fi Ù· ¿Á·Ó·. ∆Ô ÂÍËÌÂڈ̤ÓÔ ÛÈÙ¿ÚÈ ÂÈϤ¯ıËΠÁÈ· ηÏÏȤÚÁÂÈ· fiÙ·Ó ÙÔ ·ÏÒÓÈÛÌ· ¿Ú¯ÈÛ ӷ Á›ÓÂÙ·È Ì˯·ÓÈο Î·È Ô ‰‡ÛÎÔÏÔ˜ ·Ô¯ˆÚÈÛÌfi˜ ÙÔ˘ ÛfiÚÔ˘ ·‡Í·Ó ÙËÓ ·fi‰ÔÛË, ÏfiÁˆ ÌÈÎÚfiÙÂÚˆÓ ·ˆÏÂÈÒÓ Î·Ù¿ ÙË Û˘ÁÎÔÌȉ‹. ÙÈ΋ Ì˯·ÓÈ΋ ˘fiÛ¯ÂÙ·È Î·ÏÏȤÚÁÂȘ Ì ÌÂÁ·Ï‡ÙÂÚË ÛÔ‰ÂÈ¿, ÏÈÁfiÙÂÚ˜ ·ÒÏÂȘ ·fi ·Ûı¤ÓÂȘ, ÏÈÁfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Ê˘ÙÔÊ¿Ú̷η, ÔÈÎÈϛ˜ ÚÔÛ·ÚÌÔṲ̂Ó˜ ÛÙȘ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÙÔ ˙¢Á¿ÚˆÌ· ‰‡Ô ΢ÙÙ¿ÚˆÓ (Á·ÌÂÙÒÓ) ÁÈ· Ó· ·Ú¿ÁÂÈ Î·ÈÓÔ‡ÚÁȘ ÔÈÎÈϛ˜ Î·È Â›‰Ë. ∆· ÁÔÓ›‰È· (2-3) ·fi Ù· ·ÙÙ·Ú· οÔÈÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÂÍ¿ÁÔÓÙ·È Î·È ÂÈÛ¿ÁÔÓÙ·È Û ·ÙÙ·Ú· ‰È·ÊÔÚÂÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Ì ·ÚÎÂÙ‹ ÂÈÙ˘¯›· Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ¤Ó·˜ Ó¤Ô˜ ÁÂÓÂÙÈο ÌÂÙ·ÏÏ·Á̤ÓÔ˜ (‹ ÙÚÔÔÔÈË̤ÓÔ˜) ÔÚÁ·ÓÈÛÌfi˜, Ì ηÈÓÔ‡ÚÁÈ· ¯·Ú·ÎÙËÚÈÛÙÈο. OÈ ÂÌÊ·Ó›˜ ΛӉ˘ÓÔÈ Â›Ó·È ÔÈ ·ÏÏÂÚÁ›Â˜, Ë ·ÏÏÔ›ˆÛË Ù˘ Ê˘ÛÈ΋˜ ·Ó›‰·˜, Ë ÂÍ·Ê¿ÓÈÛË ÔÈÎÈÏÈÒÓ, ·ÏÏ¿ ΢ڛˆ˜ Ë Û˘ÁΤÓÙÚˆÛË Ù˘ ·ÁÎfiÛÌÈ·˜ ·Ú·ÁˆÁ‹˜ ÙÚÔÊ›ÌˆÓ ÛÙ· ¯¤ÚÈ· Ï›ÁˆÓ ÔÏ˘ÂıÓÈÎÒÓ ÂÙ·ÈÚÂÈÒÓ Ù˘ ·ÁÚÔ‚ÈÔÙ¯ÓÔÏÔÁ›·˜, Ô˘ ·Ú¿ÁÔ˘Ó Î·È

452

‰È·ÎÈÓÔ‡Ó ÙÔ˘˜ ÛfiÚÔ˘˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ Ê˘ÙÒÓ. OÈ ÂÙ·Èڛ˜ Ô˘ ˆÏÔ‡Ó ÙÔ˘˜ ÛfiÚÔ˘˜ ‰È·ÁÔÓÈÎÒÓ Ê˘ÙÒÓ ÂϤÁ¯Ô˘Ó ÙËÓ ¿ÓıÈÛË Î·È ÙËÓ Î·ÚÔÊÔÚ›· ÙÔ˘˜. ∆· ηÏÏÈÂÚÁÔ‡ÌÂÓ· ‰È·ÁÔÓÈο Ê˘Ù¿ ÁÈ· Ó· ·Óı›ÛÔ˘Ó Ú¤ÂÈ Ó· „Âο˙ÔÓÙ·È Ì ÂȉÈ΋ Ô˘Û›· Ô˘ Ú¤ÂÈ Ó· ÚÔÌËı‡ÂÙ·È Ô ·Ú·ÁˆÁfi˜ ·fi ÙȘ ›‰È˜ ÂÙ·Èڛ˜, ·fi ÙȘ Ôԛ˜ ı· ÂÍ·ÚٿٷÈ. À¿Ú¯ÂÈ ·ÎfiÌË Î›Ó‰˘ÓÔ˜ Ì ٷ ‰È·ÁÔÓÈο Ê˘Ù¿ Ó· ÂÈÛ·¯ıÔ‡Ó Î·ÈÓÔ‡ÚÁÈÔÈ ÈÔ› ÛÙË ‰È·ÙÚÔÊ‹ Ì·˜, ÁÈ·Ù› Ù· ‰È·ÁÔÓÈο Ê˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ·Ú·ÁˆÁ‹ ¯ˆÚ›˜ Ó· ÚÔËÁÂ›Ù·È ¤ÏÂÁ¯Ô˜ ÁÈ· Ù˘¯fiÓ Û˘Ó‡·ÚÍË ÈÒÓ ÛÙÔ ÁÔÓȉ›ˆÌ¿ ÙÔ˘˜. ∆Ô 1970 ÔÈ ∞ÌÂÚÈηÓÔ› ÌÈÎÚÔ‚ÈÔÏfiÁÔÈ H. Smith Î·È D. Nathans, ·Ó·Î¿Ï˘„·Ó ¤Ó· ¤Ó˙˘ÌÔ Ô˘ ÌÔÚÔ‡Û ӷ Îfi„ÂÈ ÙÔ ÌfiÚÈÔ ÙÔ˘ DNA ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÛËÌ›· (ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ). ∆· ÙÌ‹Ì·Ù· ÙÔ˘ DNA Ô˘ ÚԤ΢Ù·Ó ‹Ù·Ó ·ÚÎÂÙ¿ ÌÂÁ¿Ï· ÒÛÙ ӷ ÂÚȤ¯Ô˘Ó ÁÂÓÂÙÈΤ˜

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ÏËÚÔÊÔڛ˜. ∏ ·Ó·Î¿Ï˘„Ë Ô‰‹ÁËÛ ÛÙË ‰˘Ó·ÙfiÙËÙ· Û¯ËÌ·ÙÈÛÌÔ‡ ÙÌËÌ¿ÙˆÓ DNA Ô˘ ÌÔÚÔ‡Û·Ó Ó· Â·Ó·Û˘Ó‰¤ÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜, Û¯ËÌ·Ù›˙ÔÓÙ·˜ Ó¤· ÁÔÓ›‰È· Ô˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙË Ê‡ÛË. ∆Ô 1973 ÔÈ ‚ÈÔ¯ËÌÈÎÔ› S. Cohen Î·È H. Boyer, ·¤‰ÂÈÍ·Ó ˆ˜ fiÙ·Ó ÙÔ DNA ÎÂÚÌ·ÙÈÛı› Û ıÚ·‡ÛÌ·Ù· Î·È ·˘Ù¿ ·Ó·Û˘Ó‰˘·ÛıÔ‡Ó, ¤ÙÛÈ ÒÛÙ ӷ Û¯ËÌ·Ù›ÛÔ˘Ó Ó¤· ÁÔÓ›‰È·, Â›Ó·È ‰˘Ó·ÙfiÓ Ù· ÁÔÓ›‰È· Ó· ÂÈÛ·¯ıÔ‡Ó Û ‚·ÎÙËÚ›‰È· Î·È Ó· ·Ó··Ú·¯ıÔ‡Ó Ì ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ (7). ªÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÂÈı˘ÌËÙÒÓ ÁÔÓȉ›ˆÓ ÛÙ· ˙Ò· (‰È·ÁÔÓÈο ˙Ò·) ‹ Ì ‰ËÌÈÔ˘ÚÁ›· ÙÚÔÔÔÈËÌ¤ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (ÂÈÛ¿ÁÔÓÙ·È ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È·) ·Ú¿ÁÔÓÙ·È Û ÌÂÁ¿ÏË ÔÛfiÙËÙ· ˘„ËÏ‹˜ ηı·ÚfiÙËÙ·˜ ÔχÙÈÌ· ÚÔ˚fiÓÙ· fiˆ˜ ¤Ó˙˘Ì· Î·È ÚˆÙ½Ó˜ ÌÂÁ¿Ï˘ Ê·Ú̷΢ÙÈ΋˜ ·Í›·˜ (8).

OÈ ·Ú¿ÁÔÓÙ˜ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô ¤Î·Ó·Ó ÂÊÈÎÙ‹ ÙË ÁÔÓȉȷ΋ ıÂÚ·›·. ø˜ ·Ú¿ÁÔÓÙ˜ ÌÂÙ·ÊÔÚ¿˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÈÔ› (9), ÁÈ·Ù› ÏfiÁˆ Ù˘ ʇÛÂÒ˜ ÙÔ˘˜ «ÌÔχÓÔ˘Ó» Ù· ·ÙÙ·Ú· Ì ÙÔ ÁÂÓÂÙÈÎfi ÊÔÚÙ›Ô ÙÔ˘˜. ∞fi ÙÔÓ Èfi ·Ê·ÈÚÔ‡ÓÙ·È Ù· ‚Ï·‚ÂÚ¿ ÁÔÓ›‰È· Î·È ÙÔÔıÂÙÔ‡Ó Ù· ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È· Ô˘ ı¤ÏÔ˘Ì ӷ ÂÎÊÚ¿˙ÔÓÙ·È ‹ Ó· ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙ· ·ÙÙ·Ú· - ÛÙfi¯Ô˘˜. OÈ ÚÒÙÔÈ ÊÔÚ›˜ ·Ó·Ù‡¯ıËÎ·Ó ·fi ÚÂÙÚÔ˚Ô‡˜. O ÚÂÙÚÔ˚fi˜ ÂÓ·Ôı¤ÙÂÈ ÙÔ ÁÂÓÂÙÈÎfi ÙÔ˘ ÊÔÚÙ›Ô ÛÙ· ·ÙÙ·Ú· Î·È Î¿ı ÊÔÚ¿ Ô˘ ÙÔ Î‡ÙÙ·ÚÔ ‰È·ÈÚ›ٷÈ, Ù· Ó¤· ·ÙÙ·Ú· ÂÚȤ¯Ô˘Ó Â›Û˘ ÙÔ DNA ÙÔ˘ ÈÔ‡. ∞ÏÏ¿ ÔÈ ÚÂÙÚÔ˚Ô› ÌÔχÓÔ˘Ó ÌfiÓÔ Ù· ·ÙÙ·Ú· Ô˘ ‰È·ÈÚÔ‡ÓÙ·È, ÂÓÒ Ù· ÂÚÈÛÛfiÙÂÚ· ·ÙÙ·Ú· ÙÔ˘ ÛÒÌ·ÙÔ˜ ‰ÂÓ ‰È·ÈÚÔ‡ÓÙ·È.

OÈ ·‰ÂÓÔ˚Ô›, ÁÓˆÛÙÔ› Î·È ˆ˜ ÈÔ› ÙÔ˘ ÎÔÈÓÔ‡ ÎÚ˘ÔÏÔÁ‹Ì·ÙÔ˜ ÌÂٷʤÚÔ˘Ó ÁÔÓ›‰È· ÛÙ· ÌË ‰È·ÈÚÔ‡ÌÂÓ· ·ÙÙ·Ú·, ·ÏÏ¿ ÚÔηÏÔ‡Ó ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË, ÁÈ·Ù› ‰ÂÓ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÂÍ··Ù‹ÛÔ˘Ó ÙÔÓ ÔÚÁ·ÓÈÛÌfi. ∆Ô ·Ì˘ÓÙÈÎfi Û‡ÛÙËÌ· ·Ó·ÁÓˆÚ›˙ÂÈ ÙÔÓ Èfi Î·È Ù· ÚÔۂ‚ÏË̤ӷ ·fi ÙÔÓ Èfi ·ÙÙ·Ú· Î·È ÂÍ·Ê·Ó›˙ÂÈ Î·È Ù· ‰‡Ô. O ·Ó·‰˘Ó‰˘·Ṳ̂ÓÔ˜ Èfi˜ Î·È Ù· ÏÈÔÛÒÌ·Ù· - fi¯È ÈÔ› ·ÏÏ¿ DNA ÂÂÓ‰˘Ì¤ÓÔ ÛÙ· ÏÈ›‰È· - ‰ÂÓ ÚÔηÏ› ÓfiÛÔ ·ÏÏ¿ ÌÂٷʤÚÂÈ ÁÔÓ›‰È· ÛÙ· ·ÙÙ·Ú·. ∆· ÙÔÔıÂÙ› Û ÌË ‰È·ÈÚÔ‡ÌÂÓ· ·ÙÙ·Ú· Î·È Ë ¤ÎÊÚ·Û‹ ÙÔ˘˜ ‰È·ÚΛ Ì·ÎÚÔ¯ÚfiÓÈ·.

1. ¶ÚÔ˚fiÓÙ· ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ÌÔÓÔ·ÙÙ·ÚÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜ ∆Ô ÂÈı˘ÌËÙfi ÁÔÓ›‰ÈÔ ÂÓfi˜ ΢ÎÏÈÎÔ‡ DNA, ÙÔ˘ Ï·ÛÌȉ›Ô˘, ÂÈÛ¿ÁÂÙ·È ÂÓÙfi˜ ‚·ÎÙËÚÈ·ÎÔ‡ ΢ÙÙ¿ÚÔ˘.

O ·˘ÙfiÓÔÌÔ˜ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙÔ˘ Ï·ÛÌȉ›Ô˘ ÂÓÙfi˜ ÙÔ˘ ‚·ÎÙËÚȉ›Ô˘ ‰ËÌÈÔ˘ÚÁ› ÔÏÏ·Ï¿ ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÁÔÓȉ›Ô˘ Ù· ÔÔ›· ·Ú¿ÁÔ˘Ó Û ÂÌÔÚÈ΋ ÔÛfiÙËÙ· ÙÔ ÂÈı˘ÌËÙfi ÚÔ˚fiÓ. ∞fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ÌÔÓÔ·ÙÙ·ÚÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜, ·Ú¿ÁÂÙ·È ÙÔ ¤Ó˙˘ÌÔ ·-·Ì˘Ï¿ÛË Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ˙˘ıÔÔÈ›· Î·È ·ÚÙÔÔÈ›· ÁÈ· ÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿Û·ÛË ÙÔ˘ ·Ì‡ÏÔ˘ Û ÁÏ˘Îfi˙Ë, Ô˘

°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·

ÂÓ Û˘Ó¯›·, ‰È·Û¿Ù·È Û ·ÏÎÔfiÏË Î·È ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη ̤ۈ ÙˆÓ ˙˘ÌÔÌ˘Î‹ÙˆÓ. OÌÔ›ˆ˜, ·Ú¿ÁÂÙ·È ÙÔ ¤Ó˙˘ÌÔ ÏÈ¿ÛË, Ô˘ ‰È·Û¿ Ù· Ï›Ë ÙÔ˘ Á¿Ï·ÎÙÔ˜ Û ÁÏ˘ÎÂÚ›ÓË Î·È ÂχıÂÚ· ÏÈ·Ú¿ Ôͤ· Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Ù˘Ú› Ô˘ ·Ú¿ÁÂÙ·È Ó· Â›Ó·È ÓÔÛÙÈÌfiÙÂÚÔ Î·È Ó· ÌËÓ ¯·Ï¿ÂÈ Î·Ù¿ ÙË ˙‡ÌˆÛË. ªÂ ÙÔÓ ›‰ÈÔ ÙÚfiÔ ·Ú¿ÁÂÙ·È ÙÔ ¤Ó˙˘ÌÔ ËÎÙÈÓ¿ÛË, Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ˙‡ÌˆÛË ÙˆÓ ÛÙ·Ê˘ÏÈÒÓ, ÛÙËÓ ·Ú·ÁˆÁ‹ ¯˘ÌÒÓ ·fi ÊÚÔ‡Ù· Î·È ÛÙËÓ ÎÔÓÈÔÔ›ËÛË ÙˆÓ Î·ÚÒÓ ÙÔ˘ ηʤ. ∏ ËÎÙÈÓ¿ÛË ‰È·Û¿ ÙȘ ËÎÙ›Ó˜ Û ¢‰È¿Ï˘Ù· ۿί·Ú· Î·È ÔÈ ÙÚÔʤ˜ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÈÍ҉˜. OÈ ËÎÙ›Ó˜ Â›Ó·È Ê˘ÙÈΤ˜ ›Ó˜, ·fi ÔÏ˘Û·Î¯·Ú›Ù˜ Ô˘ ·ÔÙÂÏÔ‡ÓÙ·È ·fi ÌË ‰È·ÎÏ·‰È˙fiÌÂÓ˜ ·Ï˘Û›‰Â˜ D-Á·Ï·ÎÙÔ˘ÚÔÓÈÎÔ‡ ÔͤԘ. Œ¯Ô˘Ó ÙËÓ È‰ÈfiÙËÙ· Ó· ηٷÎÚ·ÙÔ‡Ó ÓÂÚfi Î·È Û˘Ó‰¤ÔÓÙ·È Ì ÔÚÁ·ÓÈο ÛÙÔȯ›· (10). OÌÔ›ˆ˜, ·Ú¿ÁÂÙ·È ÙÔ ¤Ó˙˘ÌÔ ÚˆÙ¿ÛË Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ·ÚÙÔÔÈ›·, ÛÙËÓ ·Ï·ÓÙÔÔÈ›· Î·È ÛÙ· Á·Ï·ÎÙÔÎÔÌÈο ÚÔÈfiÓÙ·. OÈ ÚˆÙ½Ó˜ ‰È·ÛÒÓÙ·È Û ·ÌÈÓÔͤ· ÒÛÙ ÙÔ ÎÚ¤·˜, Ù· ·ÚÙÔÛ΢¿ÛÌ·Ù· Î·È Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· Á›ÓÔÓÙ·È ϤÔÓ Â‡ÂÙ·. °È· ÙËÓ ·Ú·Û΢‹ ÙˆÓ Ù˘ÚÈÒÓ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ˘Ù›· Ô˘ Ï·Ì‚¿ÓÂÙ·È ·fi ÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Ó·ÚÒÓ ‚ÔÔÂȉÒÓ, ÌÂÙ¿ ÙË ÛÊ·Á‹ ÙÔ˘˜, ÂÂȉ‹ ÂÚȤ¯ÂÈ ÙÔ ¤Ó˙˘ÌÔ ¯˘ÌÔÛ›ÓË Ô˘ ÌÂÙ·‚¿ÏÏÂÈ ÙÔ P∏ ÙÔ˘ Á¿Ï·ÙÔ˜ ÒÛÙ ӷ ηıÈ˙¿ÓÔ˘Ó ÔÈ ÚˆÙ½Ó˜ Î·È Ó· ‹˙ÂÈ ÙÔ Ù˘Ú›. ∆Ô ÁÔÓ›‰ÈÔ Ù˘ ¯˘ÌÔÛ›Ó˘ ˘¿Ú¯ÂÈ Û ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ˙˘ÌÔ̇ÎËÙ˜, ÔÈ ÔÔ›ÔÈ ·ÔÙÂÏÔ‡Ó ϤÔÓ ÂÚÁÔÛÙ¿ÛÈ· ·Ú·ÁˆÁ‹˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘. ™ÙËÓ ∞ÌÂÚÈ΋ ÙÔ 50% ÙˆÓ Ù˘ÚÈÒÓ ‹˙Ô˘Ó Î·È ˙˘ÌÒÓÔÓÙ·È Ì ¯˘ÌÔÛ›ÓË Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ˙˘ÌÔ̇ÎËÙ˜.

2. ¶ÚÔ˚fiÓÙ· ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ˙Ò· ∆Ô ÂÈı˘ÌËÙfi DNA ÂÈÛ¿ÁÂÙ·È Î·È ÂÓۈ̷ÙÒÓÂÙ·È ·¢ı›·˜ ÛÙÔ ¯ÚˆÌfiۈ̷ ÙÔ˘ ˙ˆÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ Ì ÌÈÎÚÔ¤ÓÂÛË. Œ¯Ô˘Ì ÌÂÁ·Ï‡ÙÂÚË ÂÈÙ˘¯›· fiÙ·Ó Ë ÌÈÎÚÔ¤ÓÂÛË Á›ÓÂÈ ÛÙÔ ˙˘ÁˆÙfi ·ÙÙ·ÚÔ, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ÁÔÓÈÌÔÔ›ËÛË ÙÔ˘ ˆ·Ú›Ô˘. °›ÓÂÙ·È ¤ÓÂÛË ·ÚÎÂÙÒÓ ÂηÙÔÌÌ˘Ú›ˆÓ ·ÓÙÈÁÚ¿ÊˆÓ ÙÔ˘ ÁÔÓȉ›Ô˘ ÛÙÔÓ ˘Ú‹Ó· ÙÔ˘ ÁÔÓÈÌÔÔÈË̤ÓÔ˘ ˆ·Ú›Ô˘. À¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ÂÚ›Ô˘ 1%, ÙÔ ÁÔÓ›‰ÈÔ Ó· ÂÓۈ̷وı› ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· ÙÔ˘ ˙˘ÁÒÙÔ˘ Î·È Ó· ÌÂÙ·ÊÂÚı› ÛÙ· ÂfiÌÂÓ· ·ÙÙ·Ú· Î·È ˘¿Ú¯ÂÈ Û fiÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∞ÏÏ¿ Ë ϤÔÓ Û˘ÓËıÈṲ̂ÓË Ì¤ıÔ‰Ô˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ DNA ÛÙ· ·ÙÙ·Ú· ÙˆÓ ıËÏ·ÛÙÈÎÒÓ Á›ÓÂÙ·È Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘˜ ÈÔ‡˜ (8) Ô˘ ÂÈÛ¿ÁÔ˘Ó Ì›· ·Ï‹ ‰È΋ ÙÔ˘˜ ¤ÏÈη DNA ÛÙÔ DNA ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó Î·È ÛÙÔ ÔÔ›Ô ÂÓۈ̷ÙÒÓÔÓÙ·È. OÈ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ÈÔ› ‰ÂÓ ¤¯Ô˘Ó ·ıÔÁfiÓ· ÁÔÓ›‰È· Î·È ¤¯Ô˘Ó Ù· ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È·, ηıÒ˜ Î·È Ù· Ú˘ıÌÈÛÙÈο ÛÙÔȯ›· Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ ÁÔÓȉ›Ô˘. O ÁÔÓfiÙ˘Ô˜ ÙˆÓ Î·ÏÏÈÂÚÁÔ˘Ì¤ÓˆÓ

453

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·20

¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459

∫. ¶·ÓÙÛÈÒÙÔ˘

΢ÙÙ¿ÚˆÓ ÌÔÚ› Ó· ÌÂÙ·‚ÏËı› Ì ÙËÓ Ù¯ÓÔÏÔÁ›· ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ DNA, ÛÙԯ‡ÔÓÙ·˜ ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÁÔÓ›‰È· Ô˘ Ù· ηٷÛÙÚ¤ÊÔ˘Ó ‹ Ù· ·ÓÙÈηıÈÛÙÔ‡Ó Ì ¿ÏÏ·. ∆· ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ˙Ò· ÌÔÚÔ‡Ó Ó· ·Ú¿ÁÔ˘Ó ÔχÙÈ̘ Ê·Ú̷΢ÙÈΤ˜ Ô˘Û›Â˜ ÛÙÔ Á¿Ï· ÙÔ˘˜ ‹ Ù· Ô‡Ú· ÙÔ˘˜. ªÔÚ› Ó· ·Ú¿ÁÂÙ·È Á¿Ï· ¯ˆÚ›˜ ÙËÓ ÚˆÙ½ÓË Ô˘ ÚÔηÏ› ·ÏÏÂÚÁ›· ÛÙÔÓ ¿ÓıÚˆÔ, ‹ Á¿Ï· Ì ÚˆÙ½Ó˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÙÔ ·ÌÈÓÔ͇ Ê·ÈÓ˘Ï·Ï·Ó›ÓË Î·Ù¿ÏÏËÏÔ ÁÈ· ·È‰È¿ Ì ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·. ∏ η˙½ÓË ·ÔÙÂÏ› ÙËÓ ÚˆÙ½ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ Î·È ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÂÎÊÚ¿˙ÂÙ·È ÌfiÓÔ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ Ì·˙ÈÎÔ‡ ·‰¤Ó· ÙˆÓ ıËÏ·ÛÙÈÎÒÓ. ∂ÈÛ¿ÁÔÓÙ·È ÁÔÓ›‰È· ÚˆÙÂ˚ÓÒÓ Á¿Ï·ÎÙÔ˜, Û ıËÏ·ÛÙÈο (12) ηıÒ˜ Î·È Ú˘ıÌÈÛÙÈο ÛÙÔȯ›· Ù˘ ¤ÎÊÚ·Û‹˜ ÙÔ˘˜, ÒÛÙ ٷ ‰È·ÁÔÓÈο ˙Ò· Ó· ·Ú¿ÁÔ˘Ó ÛÙÔ Á¿Ï· ÙÔ˘˜ ÙËÓ ÂÈı˘ÌËÙ‹ ÚˆÙ½ÓË. ∆· ˙Ò· Â›Ó·È Î·Ï‡ÙÂÚ· ÂÚÁÔÛÙ¿ÛÈ· ·Ú·ÁˆÁ‹˜

ÚˆÙÂ˚ÓÒÓ Û ÌÂÁ¿ÏË ÔÛfiÙËÙ· ÁÈ· ‚ÈÔÌ˯·ÓÈ΋ ‹ Ê·Ú̷΢ÙÈ΋ ¯Ú‹ÛË, ·’ fi,ÙÈ ÌÔÓÔ·ÙÙ·ÚÔÈ ÔÚÁ·ÓÈÛÌÔ› (ÎÔÏÔ‚·ÎÙËÚ›‰È·) ÁÈ·Ù› ¤¯Ô˘Ó ¯·ÌËÏfi ÎfiÛÙÔ˜ Ù˘ ÚÒÙ˘ ‡Ï˘ (ÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ Â›Ó·È ÙÔ ¯fiÚÙÔ) Î·È ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ·Ú·ÁfiÌÂÓÔ˘ ÚÔÈfiÓÙÔ˜(13). ªÈ· ·ÁÂÏ¿‰· ·Ú¿ÁÂÈ ËÌÂÚËÛ›ˆ˜ 30 ÎÈÏ¿ Á¿Ï· Î·È ÚˆÙ½ÓË Á¿Ï·ÎÙÔ˜ (4%) 1,2 ÎÈÏ¿ (ÂÙ‹ÛÈ· ·Ú·ÁˆÁ‹ ÚˆÙ½Ó˘ ÛÙÔ Á¿Ï·, 300 ÎÈÏ¿). ∆Ô 10% Ù˘ ÔÛfiÙËÙ·˜ ·˘Ù‹˜ ·ÔÙÂÏ› ÙËÓ ÂÈı˘ÌËÙ‹ ÚˆÙ½ÓË, ‰ËÏ·‰‹ 30 ÎÈÏ¿, Î·È ·fi ·˘Ù‹ ÙËÓ ÔÛfiÙËÙ· Ï·Ì‚¿ÓÂÙ·È Î·ı·Ú‹ ÂÚ›Ô˘ (Ù· 2/3) 20 ÎÈÏ¿ ˘„ËÏ‹˜ ηı·ÚfiÙËÙ·˜ ÚˆÙ›ÓË ÁÈ· Ê·Ú̷΢ÙÈÎÔ‡˜ ÛÎÔÔ‡˜. ŒÙÛÈ, ·Ú¿ÁÂÙ·È ·ÓıÚÒÈÓË ·ÈÌÔÁÏÔ‚›ÓË ·fi ¯Ô›ÚÔ˘˜, ÈÓÙÂÚÊÂÚfiÓË, ·-1-·ÓÙÈÙÚ˘„›ÓË ·fi Úfi‚·Ù· Î·È ·Ú¿ÁÔÓÙ·˜ VIII, IX Ù˘ ‹Íˆ˜ ÙÔ˘ ·›Ì·ÙÔ˜ (∂ÈÎfiÓ· 6).

a ªÂÙ·ÊÔÚ¿ COL1A1 ÁÔÓ›‰ÈÔ

πÓÔ‚Ï¿ÛÙ˜

¢È·ÎÔ‹

¶Ôχ (∞) ÏÂ˘Ú¿

Ã

COL1A1 ÁÔÓ›‰ÈÔ IRES-neo ¢È·ÎÔ‹ ∫·Ù·Û΢‹ ÛÙfi¯Ô˘

Transgene

à ¶Ôχ (∞) ÏÂ˘Ú¿

∂ÈÏÔÁ‹ ΢ÙÙ¿ÚˆÓ Ì ·ÓÙ›ÛÙ·ÛË ÛÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi º˘ÛÈÔÏÔÁÈÎfi ·ÓÙ›ÁÚ·ÊÔ

b ∆ÚÔÔÔÈË̤ÓÔ ·ÓÙ›ÁÚ·ÊÔ

πÓÔ‚Ï¿ÛÙ˜ Ì ÂÓۈ̷و̤ÓÔ ÙÔ Í¤ÓÔ ÁÔÓ›‰ÈÔ

c

ªÂÙ·ÊÔÚ¿ ˘Ú‹Ó·

¢È·ÎÔ‹ IRES-neo

Transgene ¶Ôχ (∞) ÏÂ˘Ú¿

d ªÂÙ·ÊÔÚ¿ ÛÙË Ì‹ÙÚ· ¿ÏÏ˘ ÚÔ‚·Ù›Ó·˜ Ô˘ ı· ΢ÔÊÔÚ‹ÛÂÈ ÙÔ ¤Ì‚Ú˘Ô

ø¿ÚÈÔ ¯ˆÚ›˜ ˘Ú‹Ó·

ŒÌ‚Ú˘Ô

¶Úfi‚·ÙÔ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ Û ÂÚÈÔ¯‹ ÛÙfi¯Ô

∂ÈÎfiÓ· 6. ∆ÚÔÔÔÈË̤ӷ Û ÂȉÈΤ˜ ÂÚÈÔ¯¤˜ ÁÔÓ›‰È· ÛÙÔ Úfi‚·ÙÔ. O McCreath (25) Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ‰ËÌÈÔ‡ÚÁËÛ·Ó Úfi‚·ÙÔ Ô˘ ›¯Â ÛÙ· ÁÔÓ›‰È¿ ÙÔ˘ ÂÓۈ̷و̤ÓÔ ·ÓıÚÒÈÓÔ ÁÔÓ›‰ÈÔ Û ÂȉÈ΋ ÂÚÈÔ¯‹. a) ∆Ô fi¯ËÌ· ÛÙfi¯Ô˜ (ÌÂٷʤÚÂÈ ÙÔ ÁÔÓ›‰ÈÔ Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÓÂÔÌ˘Î›ÓË -neo- Î·È ÙÔ Í¤ÓÔ ÁÔÓ›‰ÈÔ -transgene- Έ‰ÈÎÔÔÈ› ÙËÓ ·ÓıÚÒÈÓË ·1-·ÓÙÈıÚ˘„›ÓË) ÂÈÛ¤Ú¯ÂÙ·È ÛÙ· ·ÙÙ·Ú· ÈÓÔ‚Ï·ÛÙÒÓ ÚÔ‚¿ÙÔ˘. ∆· ‰È·ÊÔÚÔÔÈË̤ӷ ·ٷڷ ÈÓÔ‚Ï·ÛÙÒÓ, ÚÔÙÈÌÒÓÙ·È ·fi Ù· ·‰È·ÊÔÚÔÔ›ËÙ· ·ÙÙ·Ú· ÙÔ˘ ÂÌ‚Ú˘ÔÓÈÎÔ‡ ÛÙ¤ÌÌ·ÙÔ˜, ÁÈ·Ù› ÌÔÚ› Ó· ÂÓÙÔÈÛı› ηχÙÂÚ· Ë ÂÚÈÔ¯‹ ¤ÎÊÚ·Û˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ COL1A1 ÎÈ ÂΛ Ó· ÂÓۈ̷وı› ÙÔ Í¤ÓÔ ÁÔÓ›‰ÈÔ. ∆Ô ÁÔÓ›‰ÈÔ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÂÎÊÚ¿˙ÂÙ·È ÛÙ· ·ÙÙ·Ú· ÙÔ˘ Ì·˙ÈÎÔ‡ ·‰¤Ó· fiÔ˘ ı¤ÏÔ˘Ì ӷ ÂÎÊÚ¿˙ÂÙ·È Î·È Ë Í¤ÓË ÚˆÙ½ÓË. ∆Ô ÂÛˆÙÂÚÈÎfi ÚÈ‚fiۈ̷- ÛËÌÂ›Ô ÂÈÛfi‰Ô˘ (IRES), ÂÈÙÚ¤ÂÈ ÛÙÔ ·ÁÁÂÏÈÔÊfiÚÔ RNA Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙÔ Í¤ÓÔ ÁÔÓ›‰ÈÔ Ó· ÌÂÙ·ÊÚ¿˙ÂÙ·È Û ÚˆÙ½ÓË. ∆Ô Í¤ÓÔ ÁÔÓ›‰ÈÔ Î·È ÙÔ ÁÔÓ›‰ÈÔ IRES ÂÓۈ̷ÙÒÓÔÓÙ·È ÛÙË ÂÚÈÔ¯‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÌÂÙ·ÁÚ·Ê‹˜ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ COL1A1 Î·È ÚÈÓ ÙËÓ ÔÏ˘·‰ÂÓÔÛ›ÓË (¶ÔÏ˘ ∞). ™Ù· ·ÙÙ·Ú· Ô˘ ¤ÁÈÓ ÂÈÙ˘¯Ò˜ Ë ÂÈÛ·ÁˆÁ‹, ÂÎÊÚ¿˙ÂÙ·È ÙÔ Ó¤Ô ÁÔÓ›‰ÈÔ Î·È ÁÈ’ ·˘Ùfi ÌÔÚÔ‡Ó Ó· ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Û ıÚÂÙÈÎfi ˘ÏÈÎfi Ô˘ ¤¯ÂÈ ÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi G418 (¤Ó· ·Ó¿ÏÔÁÔ Ù˘ ÓÂÔÌ˘Î›Ó˘). b) To DNA ·fi ·˘Ù¿ Ù· ·ÙÙ·Ú· ·Ó·Ï‡ÂÙ·È Ì ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (PCR), ÁÈ· Ó· ÂȂ‚·Èˆı› Ë ÂÈÙ˘¯‹˜ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ÂÚÈÔ¯‹ COL1A1. c) OÈ ˘Ú‹Ó˜ ·˘ÙÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÌÂÙ·ÊÔÚ¿ Û ˆ¿ÚÈ· ·fi Ù· ÔÔ›· ·Ê·ÈÚ¤ıËÎ·Ó ÔÈ ˘Ú‹Ó˜. ∆Ô ¤Ì‚Ú˘Ô ÌÂٷʤÚÂÙ·È ÛÙË Ì‹ÙÚ· ÌÈ·˜ ¿ÏÏ˘ ÚÔ‚·Ù›Ó·˜ Ô˘ ı· ÙÔ Î˘ÔÊÔÚ‹ÛÂÈ. d) ªÂÚÈο ·fi Ù· ÂÌÊ˘ÙÂ˘Ì¤Ó· ˆ¿ÚÈ· ¤¯Ô˘Ó ÙÂÏÂÈfiÌËÓË Î˘ÔÊÔÚ›· Î·È ·Ó·Ù‡ÛÛÛÔÓÙ·È Û ˘ÁÈ‹ Úfi‚·Ù· Ô˘ ·Ú¿ÁÔ˘Ó ÛÙÔ Á¿Ï· ÙÔ˘˜ ÙËÓ ·1-·ÓÙÈıÚ˘„›ÓË.

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°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·

TÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1997 ÛÙÔ πÓÛÙÈÙÔ‡ÙÔ Roslin Ù˘ ∞ÁÁÏ›·˜ (ÂΛ ÁÂÓÓ‹ıËΠÙÔ Úfi‚·ÙÔ Dolly, ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ 1997, ·fi ·ÙÙ·Ú· Ì·ÛÙÔ‡ ÂÓ‹ÏÈÎÔ˜ ÚÔ‚¿ÙÔ˘) ÁÂÓÓ‹ıËÎÂ Ë Polly ·fi ˘Ú‹Ó˜ ΢ÙÙ¿ÚˆÓ ÂÌ‚Ú˘˚ÎÔ‡ ÛÙ¤ÌÌ·ÙÔ˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÓۈ̷ÙÒıËΠÙÔ ÁÔÓ›‰ÈÔ ÌÈ·˜ ÔχÙÈÌ˘ ÚˆÙ½Ó˘, Ô ·Ú¿ÁÔÓÙ·˜ ‹Íˆ˜ IX ÙÔ˘ ·›Ì·ÙÔ˜, ·ÏÏ¿ fi¯È ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÛËÌÂ›Ô ÛÙÔ ÁÔÓȉ›ˆÌ· ÒÛÙÂ Ë ÚˆÙ½ÓË Ó· ·Ú¿ÁÂÙ·È ÛÙÔ Á¿Ï·.

3. ¶ÚÔ˚fiÓÙ· ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿ ∏ ÂÈÛ·ÁˆÁ‹ DNA ÛÙ· ·ÙÙ·Ú· ÙˆÓ ‰ÈÎÔÙ˘Ï‹‰Ô-

ÓˆÓ Ê˘ÙÒÓ Á›ÓÂÙ·È ·fi ÙÔÓ Èfi Agrobacterium tumefaciens, Ô˘ ÚÔÛ‚¿ÏÏÂÈ Ù· Ê˘Ù¿ (14). O Èfi˜ ÂÚȤ¯ÂÈ ÁÔÓ›‰È· Ô˘ ·Ú¿ÁÔ˘Ó Ê˘ÙÔÔÚÌfiÓ˜, fiˆ˜ ·˘Í›ÓË Î·È Î˘ÙÔΛÓË Ô˘ ÚÔηÏÔ‡Ó ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡˜ fiÁÎÔ˘˜ (ηÚÎÈÓÒÌ·Ù·) ÙˆÓ Ê˘ÙÒÓ. ∞ÔÌ·ÎÚ‡ÓÔÓÙ·È Ù· ·ÓÂÈı‡ÌËÙ· ÁÔÓ›‰È· ·fi ÙÔÓ Èfi Î·È ÂΛ ÂÈÛ¿ÁÔÓÙ·È Ù· ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È· (∂ÈÎfiÓ· 7). ∂Ó Û˘Ó¯›·, ÙÔ ÙÚÔÔÔÈË̤ÓÔ Ï·ÛÌ›‰ÈÔ ÂÈÛ¿ÁÂÙ·È ÂÓÙfi˜ ÙÔ˘ ‚·ÎÙËÚ›Ô˘, ÙÔ ‚·ÎÙ‹ÚÈÔ ÚÔÛ‚¿ÏÂÈ ÙÔ Ê˘ÙÈÎfi ·ÙÙ·ÚÔ, ÙÔ DNA Ô˘ ¤¯ÂÈ ÙÔ ÂÈı˘ÌËÙfi ÁÔÓ›‰ÈÔ ÂÓۈ̷ÙÒÓÂÙ·È ÛÙÔ DNA ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È ¤ÙÛÈ ÂÈÙ˘Á-

EcoR1

EcoR1 D¡A §ÈÁ¿ÛË

Agrobacterium

∂ÈÎfiÓ· 7. ∆ÚfiÔ˜ ·Ú·ÁˆÁ‹˜ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘ Ê˘ÙÔ‡, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‚·ÎÙËÚ›‰ÈÔ ˆ˜ fi¯ËÌ· ÌÂÙ·ÊÔÚ¿˜.

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™ÂÏ›‰·22

¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459

¯¿ÓÂÙ·È Ë ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ‰È·ÁÔÓÈÎÔ‡ Ê˘ÙÔ‡. °È· ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ DNA ÛÙ· ·ÙÙ·Ú· ÙˆÓ ÌÔÓÔÎÔÙ˘Ï‹‰ÔÓˆÓ Ê˘ÙÒÓ (‰ËÌËÙÚȷο), ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë Ù¯ÓÔÏÔÁ›· particle-gum, fiÔ˘ ·fi Ù· ΢ÙÙ·ÚÈο ÙÔȯÒÌ·Ù· ÂÚÓÔ‡Ó ÌÈÎÚ¿ ÌÂÙ·ÏÏÈο ۈ̷ٛ‰È· Ì ÂÓۈ̷و̤ÓÔ ÙÔ DNA, Ù· ÔÔ›· ¤¯Ô˘Ó ÂÈÙ·¯˘ÓfiÌÂÓË Ù·¯‡ÙËÙ· ÌÂÚÈÎÒÓ ÂηÙÔÓÙ¿‰ˆÓ ̤ÙÚˆÓ ·Ó¿ ‰Â˘ÙÂÚfiÏÂÙÔ. ∏ ÂÈÙ˘¯‹˜ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ DNA ̤ۈ ÙÔ˘ ÈÔ‡ Agrobacterium Û ¤Ó· ·Ïfi Ê˘ÙÈÎfi ·ÙÙ·ÚÔ (ÚˆÙÔÏ¿ÛÙ˘) ÂÈϤÁÂÙ·È Î·È ÂÓ Û˘Ó¯›·, ·Ó·Ù‡ÛÛÂÙ·È Û Ï‹Ú˜ Ê˘Ùfi Û ηٿÏÏËÏÔ ıÚÂÙÈÎfi ˘ÏÈÎfi ÛÙ· ‰ÈÎÔÙ˘Ï‹‰ÔÓ· Ê˘Ù¿ (·Ù¿Ù˜, ÙÔÌ¿Ù·, ηÓfi˜, ‚·Ì‚¿ÎÈ) (15). ∂›Û˘, ·fi ÙÔ ÌÂÚ›Ûو̷ (ÎÔÚ˘Ê‹) ÂÓfi˜ ‰È·ÁÔÓÈÎÔ‡ Ê˘ÙÔ‡ ÌÔÚ› Ó· ·Ó·Ù˘¯ı› ¤Ó· ηÈÓÔ‡ÚÁÈÔ ‰È·ÁÔÓÈÎfi Ê˘Ùfi. ∆Ô Ï·ÛÌ›‰ÈÔ Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÂÚȤ¯ÂÈ Î·È ÌÈÎÚ¤˜ Â·Ó·Ï‹„ÂȘ DNA Ô˘ ‰Â›¯ÓÔ˘Ó Ô‡ ·Ú¯›˙ÂÈ Î·È Ô‡ ÙÂÏÂÈÒÓÂÈ ÙÔ ÁÔÓ›‰ÈÔ, ‰ËÏ·‰‹ ¤Ó· promoter Ô˘ Ú˘ıÌ›˙ÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘. °È· Ó· ‰È·ÈÛÙˆı› Û ÔÈ· Ê˘Ù¿ ¤ÁÈÓÂ Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘ DNA, ÂÈÛ¿ÁÔÓÙ·È Û˘Á¯ÚfiÓˆ˜ Ì ٷ ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È· Î·È ÁÔÓ›‰È· Û‹Ì·ÓÛ˘ .¯. ÁÔÓ›‰È· Ô˘ οÓÔ˘Ó ÙÔÓ ÔÚÁ·ÓÈÛÌfi ·ÓıÂÎÙÈÎfi ÛÙ· ·ÓÙÈ‚ÈÔÙÈο. ∞Ó ÙÔ Ê˘ÙÈÎfi ·ÙÙ·ÚÔ ¤¯ÂÈ ·ÓıÂÎÙÈÎfiÙËÙ· ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ·ÓÙÈ‚ÈÔÙÈÎfi, ÙfiÙ ÙÔ ÂÈı˘ÌËÙfi ÁÔÓ›‰ÈÔ ÂÓۈ̷ÙÒıËΠÛÙ· ÁÔÓ›‰È· ÙˆÓ Ê˘ÙÒÓ. ∆· ·ÓÙÈ‚ÈÔÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙ· Û˘ÛÙ‹Ì·Ù· Û‹Ì·ÓÛ˘, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ Î·Ù·ÔϤÌËÛË ÓfiÛˆÓ. ∆Ô ÁÔÓ›‰ÈÔ Î·ıÒ˜ Î·È ÙÔ ÚÔ˚fiÓ ÙÔ˘ (‰ËÏ·‰‹ ÙÔ ¤Ó˙˘ÌÔ Ô˘ ·ÂÓÂÚÁÔÔÈ› ÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi Î·È Î¿ÓÂÈ ÙÔ Ê˘Ùfi ·ÓıÂÎÙÈÎfi) Û˘Ó‹ıˆ˜ ηٷÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ ÙË ı¤ÚÌ·ÓÛË Ù˘ ÙÚÔÊ‹˜. ŸÌˆ˜, ¤Ó· ›‰Ô˜ ηϷÌÔÎÈÔ‡ Ô˘ ·Ó·Ù‡¯ıËΠ·fi ÙËÓ ÂÙ·ÈÚ›· Novartis ÂÚȤ¯ÂÈ ¤Ó· ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈÎÈÏÏ›ÓË. ªÈ· ·Ù¿Ù· Ô˘ ·Ó·Ù‡¯ıËΠ·fi ÙËÓ ÂÙ·ÈÚ›· Avebe ÂÚÈ›¯Â ¤Ó· ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈηۛÓË. ∆Ô Î·Ï·ÌfiÎÈ ÂÚfiÎÂÈÙÔ Ó· ¯ÚËÛÈÌÔÔÈËı› ·Î·Ù¤ÚÁ·ÛÙÔ, ÁÈ· ÙÚÔÊ‹ ˙ÒˆÓ Î·È ÙÔ ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ·ÓÙÔ¯‹ ÛÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi ‹Ù·Ó ˘fi ÙÔÓ ¤ÏÂÁ¯Ô ÂÓfi˜ ‚·ÎÙËÚÈ·ÎÔ‡ ˘ÔÎÈÓËÙ‹. ªÔÚ› ÙÔ ÂÓ ÏfiÁˆ ÁÔÓ›‰ÈÔ Ó· ÌÂÙ·ÊÂÚı› ·fi ÙËÓ ÙÚÔÊ‹ Û ‚·ÎÙËÚ›‰È· Ù˘ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÙÔ˘ ˙ÒÔ˘ Î·È Ù· ›‰È· ‚·ÎÙËÚ›‰È· Û˘Ì‚ÈÔ‡Ó Î·È ÛÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ÙÔ˘ ·ÓıÚÒÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ‰ËÌÈÔ˘ÚÁËı› Ù˘¯·›· ¤Ó· ‚·ÎÙËÚ›‰ÈÔ Ì ·ÓÙÔ¯‹ Û ¤Ó· ÎÏÈÓÈο ¯Ú‹ÛÈÌÔ ·ÓÙÈ‚ÈÔÙÈÎfi (16). °›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Ù· ‰È·ÁÔÓÈο Ê˘Ù¿ Ó· ÛËÌ·›ÓÔÓÙ·È ÁÈ· ÂÓۈ̿وÛË ÙÔ˘ ͤÓÔ˘ ÁÔÓȉ›Ô˘ Ì ¿ÏϘ Ô˘Û›Â˜ Î·È fi¯È Ì ٷ Û˘Ó‹ıË ·ÓÙÈ‚ÈÔÙÈο. ·. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿, ·ÓıÂÎÙÈο ÛÙ· ¤ÓÙÔÌ·, ·Ûı¤ÓÂȘ Î·È ˙È˙·ÓÈÔÎÙfiÓ· ∆Ô Ê˘Ùfi ηÓfi˜, fiÙ·Ó ¤¯ÂÈ ÙÔ ÁÔÓ›‰ÈÔ Ô˘ ÂϤÁ¯ÂÈ ÙË Û‡ÓıÂÛË Ù˘ ÚˆÙ½Ó˘ ÙÔ˘ ÂÚÈ‚Ï‹Ì·ÙÔ˜ ÙÔ˘ ÈÔ‡ ÙÔ˘ ̈۷˚ÎÔ‡ ÙÔ˘ ηÓÔ‡, ‰ÂÓ ÚÔÛ‚¿ÏÏÂÙ·È

456

∫. ¶·ÓÙÛÈÒÙÔ˘

·fi ÙÔÓ Èfi ÙÔ˘ ̈۷˚ÎÔ‡ ÁÈ·Ù› Â›Ó·È Î·Ù¿ οÔÈÔÓ ÙÚfiÔ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡. ªÂÚÈΤ˜ ÊÔÚ¤˜ ÂÈÛ¿ÁÔÓÙ·È ÛÙ· Ê˘Ù¿ ÁÔÓ›‰È· Ô˘ ÂϤÁ¯Ô˘Ó ÙË Û‡ÓıÂÛË ÂÓfi˜ ΢ÙÙ·ÚÔÙÔÍÈÎÔ‡ ÂÓ˙‡ÌÔ˘ (17), Ô˘ ÂÓÂÚÁÔÔÂ›Ù·È ÌfiÓÔ fiÙ·Ó ÔÈ ÈÔ› ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ Î‡ÙÙ·ÚÔ. ∞˘Ù¿ Ù· ΢ÙÙ·ÚÔÙÔÍÈο ¤Ó˙˘Ì· Â›Ó·È ÚˆÙ¿Û˜ Ô˘ ηٷÛÙÚ¤ÊÔ˘Ó ÙȘ ΢ÙÙ·ÚÈΤ˜ ÚˆÙ½Ó˜ ‹ ÚÈ‚ÔÓÔ˘ÎÏ¿Û˜ Ô˘ ηٷÛÙÚ¤ÊÔ˘Ó Ù· ÌfiÚÈ· ÙÔ˘ RNA. ŒÙÛÈ, Ù· ÚÔۂ‚ÏË̤ӷ ·ÙÙ·Ú· ÁÚ‹ÁÔÚ· ηٷÛÙÚ¤ÊÔÓÙ·È, Ô ·ıÔÁfiÓÔ˜ Èfi˜ ‰ÂÓ ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È Î·È ÂÔ̤ӈ˜ ‰ÂÓ ÌÂÙ·‰›‰ÂÙ·È Û ¿ÏÏ· ·ÙÙ·Ú·. ∆· Ê˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ˆ˜ ÊÔÚ›˜ ÁÔÓȉ›ˆÓ ÚˆÙÂ˚ÓÒÓ (ÙÔ͛Ә) Ô˘ ÛÎÔÙÒÓÔ˘Ó ¤ÓÙÔÌ· (ÚÔÓ‡Ìʘ) Î·È ˘¿Ú¯Ô˘Ó ÛÙÔ ˆÊ¤ÏÈÌÔ ‚·ÎÙËÚ›‰ÈÔ Bacillus thuringiensis. ∆· ‰È·ÁÔÓÈο Ê˘Ù¿ ÁÈ· ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÙÔ͛Ӣ Â›Ó·È ·ÓıÂÎÙÈο ÛÙȘ ÚÔÛ‚ÔϤ˜ ÂÓÙfïÓ. ¢È·ÁÔÓÈÎfi ‚·Ì‚¿ÎÈ Â›Ó·È ·ÓıÂÎÙÈÎfi Û ÚÔÛ‚ÔϤ˜ ÙÔ˘ Úfi‰ÈÓÔ˘ ÛÎÒÏËη Î·È ‰È·ÁÔÓÈÎfi ηϷÌfiÎÈ ‰ÂÓ ÚÔÛ‚¿ÏÏÂÙ·È ·fi ÙÔ ¤ÓÙÔÌÔ ˘Ú·Ï›‰·. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ‰·ÛÈο ‰¤Ó‰Ú· Ì ·ÓÙÔ¯‹ Û ¯ıÚÔ‡˜ Î·È ·Ûı¤ÓÂȘ ı· ·Ó·Ù‡ÛÛÔÓÙ·È Ù·¯¤ˆ˜ Î·È ı· ηχÙÔ˘Ó ÁÚ‹ÁÔÚ· Á˘ÌÓ¿ ‚Ô˘Ó¿ Î·È ·ÔÙÂÊڈ̤ӷ ‰¿ÛË ÂÓÒ Ù· Ê˘ÛÈο ‰¤Ó‰Ú· ı¤ÏÔ˘Ó ‰ÈÏ¿ÛÈÔ Î·È ϤÔÓ ¯ÚfiÓÔ ÁÈ· Ó· ·˘ÍËıÔ‡Ó. ∆Ô ˙È˙·ÓÈÔÎÙfiÓÔ glyphosate (ÂÌÔÚÈÎfi fiÓÔÌ· Roundup) ηٷÛÙÚ¤ÊÂÈ ÔÏÏ¿ ÂÙ‹ÛÈ· Ê˘Ù¿, ÔÒ‰Ë ˙È˙¿ÓÈ· Î·È ÔÏ˘ÂÙ‹ Ï·Ù‡Ê˘ÏÏ·. ∆Ô ÁÔÓ›‰ÈÔ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ηٷÛÙÚ¤ÊÂÈ ÙÔ ˙È˙·ÓÈÔÎÙfiÓÔ, ÌÂٷʤÚÂÙ·È ÛÂ Ê˘Ù¿ ‚¿Ì‚·ÎÔ˜, Ù‡ÙψÓ, ÛfiÁÈ·˜ Î·È Î·Ï·ÌÔÎÈÔ‡ Ô˘ ·ÔÎÙÔ‡Ó ÂÍ·ÈÚÂÙÈ΋ ·ÓıÂÎÙÈÎfiÙËÙ· Û ·˘Ùfi ÙÔ ˙È˙·ÓÈÔÎÙfiÓÔ ÒÛÙ ӷ ÌË Î·Ù·ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ ÙÔÓ „ÂηÛÌfi, ÂÓÒ Î·Ù·ÛÙÚ¤ÊÔÓÙ·È fiÏ· Ù· ˙È˙¿ÓÈ· ¯fiÚÙ·. ‚. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿ Ì ‚ÂÏÙȈ̤ÓË ÂÌÔÚÈÎfiÙËÙ· ™ÙȘ ÓÙÔÌ¿Ù˜, Ù· ‰È·Ï˘Ù¿ ÛÙÂÚ¿ (ۿί·Ú·, ÔÚÁ·ÓÈο Ôͤ· Î·È ·ÚˆÌ·ÙÈο ·Ú¿ÁˆÁ·) ·ÔÙÂÏÔ‡Ó ÂÚ›Ô˘ ÙÔ 4-5% ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ (ÙÔ 95% ÂÚ›Ô˘ Â›Ó·È ÓÂÚfi). ªÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ù˘ ÈÌ‚ÂÚÙ¿Û˘ ·˘Í¿ÓÂÙ·È Ë ‰È¿Û·ÛË Ù˘ ÛÔ˘ÎÚfi˙˘ (ÎÔÈÓ‹˜ ۿί·Ú˘) Û ÁÏ˘Îfi˙Ë Î·È ÊÚÔ˘ÎÙfi˙Ë Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È ·‡ÍËÛË ÙˆÓ ‰È·Ï˘ÙÒÓ ÛÙÂÚÂÒÓ ·fi 5 Û 6%. ∂Âȉ‹ ÔÏÏ¿ ÚÔ˚fiÓÙ· ÓÙÔÌ¿Ù·˜ (ÂÏÙ¤˜, Ketchup) ··ÈÙÔ‡Ó ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ÓÂÚÔ‡ ¤¯Ô˘Ì ÌÂÁ¿ÏË ÂÍÔÈÎÔÓfiÌËÛË. ∆Ô ÁÔÓ›‰ÈÔ Ù˘ ˘ÚÔʈÛÊÔÚ˘Ï¿Û˘ Ù˘ ADPÁÏ˘Îfi˙˘, fiÙ·Ó ÂÓۈ̷وı› ÛÙËÓ ·Ù¿Ù·, ÚÔηÏ› ·‡ÍËÛË ÙÔ˘ ·Ì‡ÏÔ˘ ·fi 22% Û 25% Î·È ÔÈ ÙËÁ·ÓËÙ¤˜ ·Ù¿Ù˜ ·ÔÚÔÊÔ‡Ó ÏÈÁfiÙÂÚÔ Ï¿‰È ηٿ ÙÔ ÙËÁ¿ÓÈÛÌ· Î·È Â›Ó·È ÈÔ ˘ÁÈÂÈÓ¤˜ (18). ªÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ›‰ÈÔ˘ ÁÔÓȉ›Ô˘ ÛÙȘ ÓÙÔÌ¿Ù˜, ÂÈÙ˘Á¯¿ÓÂÙ·È (ÏfiÁˆ ÌÈÎÚ‹˜ ·‡ÍËÛ˘ ÙÔ˘ ·Ì‡ÏÔ˘) ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÈÍÒ‰Ô˘˜ ÛÙÔÓ ÙÔÌ·ÙÔÂÏÙ¤.

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·23

¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459

¶ÔÏÏÔ› ηÚÔ› ÂÓÒ ·ÔÙÂÏÔ‡Ó ÙË ‚¿ÛË Ù˘ ÙÚÔÊ‹˜ ÙˆÓ ˙ÒˆÓ, ¤¯Ô˘Ó ¯·ÌËÏ‹ ıÚÂÙÈ΋ ·Í›· ÏfiÁˆ ÌÈÎÚ‹˜ ·ÚÔ˘Û›·˜ ÔÚÈÛÌ¤ÓˆÓ ··Ú·›ÙËÙˆÓ ·ÌÈÓÔͤˆÓ. ∆· ·ÁÚÔÛÙÒ‰Ë (ÛÈÙ¿ÚÈ, ÎÚÈı¿ÚÈ, ηϷÌfiÎÈ Î·È ÛfiÚÁÔ) Â›Ó·È ÊÙˆ¯¿ ÛÂ Ï˘Û›ÓË, Ù· „˘¯·Óı‹ (Ê·ÛfiÏÈ, ÙÚÈʇÏÈ, ÌˉÈ΋, ÛfiÁÈ·) Û ·ÌÈÓÔͤ· Ì ÛÔ˘ÏÊÈ‰Ú˘ÏÈΤ˜ ÔÌ¿‰Â˜ (΢ÛÙÂ˚ÓË, ΢ÛÙ›ÓË, ÌÂıÂÈÔÓ›ÓË, ÔÌÔ΢ÛÙ½ÓË), ÙÔ ÎÚÈı¿ÚÈ Î·È ÙÔ ÛfiÚÁÔ Û ıÚÂÔÓ›ÓË, ÙÔ Î·Ï·ÌfiÎÈ Û ÙÚ˘ÙÔÊ¿ÓË (5). OÈ ¯Ô›ÚÔÈ Î·È Ù· Ô˘ÏÂÚÈο Ô˘ ·Ô‰›‰Ô˘Ó ÌÂÁ¿ÏË ÔÛfiÙËÙ· Û ÎÚ¤·˜ (3,5 ÎÈÏ¿ ÙÚÔÊ‹, ¤Ó· ÎÈÏfi ÎÚ¤·˜) ¤¯Ô˘Ó ÂȉÈΤ˜ ··ÈÙ‹ÛÂȘ Û ·ÌÈÓÔͤ·, ÁÈ’ ·˘Ùfi Û˘Ó‹ıˆ˜ Ë ÙÚÔÊ‹ ÙÔ˘˜ ÂÌÏÔ˘Ù›˙ÂÙ·È Ì ·ÌÈÓÔͤ· Ô˘ ·˘Í¿ÓÂÈ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘˜. ªÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÁÔÓȉ›ˆÓ ÚˆÙÂ˚ÓÒÓ, ÏÔ‡ÛÈˆÓ ÛÙ· ÂÈı˘ÌËÙ¿ ·ÌÈÓÔͤ· (.¯. ÛÙË ÛfiÁÈ·, ÚˆÙ½Ó˜ Ì ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÙÔ ·ÌÈÓÔ͇ ÌÂıÂÈÔÓ›ÓË) ‚ÂÏÙÈÒÓÂÙ·È Ë ·fi‰ÔÛË Û ÎÚ¤·˜ ÙˆÓ ˙ÒˆÓ Ô˘ ηٷӷÏÒÓÔ˘Ó ‰È·ÁÔÓÈ΋ ÛfiÁÈ·. ∏ ·ÌÂÚÈοÓÈÎË ÂÙ·ÈÚ›· Pioner Hi-Bred ‰ËÌÈÔ‡ÚÁËÛ ÔÈÎÈÏ›· ‰È·ÁÔÓÈ΋˜ ÛfiÁÈ·˜ Ô˘ ›¯Â ÁÔÓ›‰È· ·fi ηڇ‰È· µÚ·˙ÈÏ›·˜, ÁÈ· Ó· ·˘Í‹ÛÂÈ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ Î·ÚÒÓ Ù˘ ÛfiÁÈ·˜ Û ÌÈ· ÚˆÙ½ÓË Ì ÔÏÏ¿ ·ÌÈÓÔͤ· Ô˘ ¤¯Ô˘Ó ı›Ô. ∏ ÛfiÁÈ· ÚÔÔÚÈ˙fiÙ·Ó ÁÈ· ‰È·ÙÚÔÊ‹ ˙ÒˆÓ, ·ÏÏ¿ Ë ÂÈÛ·ÁfiÌÂÓË ÚˆÙ½ÓË Ù˘ ÛfiÁÈ·˜ ‹Ù·Ó ·ÏÏÂÚÁÈÔÁfiÓÔ˜ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ Î·È Ë ÂÙ·ÈÚ›· ÛÙ·Ì¿ÙËÛ ÙËÓ ·Ú·ÁˆÁ‹ ÁÈ· Ó· ÌË ÌÂÈ ¤Ó· ηÈÓÔ‡ÚÁÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ ÙÚÔÊÈ΋ ·Ï˘Û›‰· ÙÔ˘ ·ÓıÚÒÔ˘. ∆Ô Ì·ÏÏ› ÙÔ ÚÔ‚¿ÙˆÓ Â›Ó·È ÏÔ‡ÛÈÔ Û ·ÌÈÓÔͤ· Ô˘ ÂÚȤ¯Ô˘Ó ıÂ›Ô (΢ÛÙ½ÓË, ΢ÛÙ›ÓË). ™ÙÔ ÙÚÈʇÏÏÈ Î·È Û ¿ÏÏ· Ê˘Ù¿ Ù˘ ‚ÔÛ΋˜ ÂÈÛ¿ÁÔÓÙ·È ÁÔÓ›‰È· Ô˘ ·Ú¿ÁÔ˘Ó ÚˆÙ½Ó˜ ÏÔ‡ÛȘ Û ·˘Ù¿ Ù· ·ÌÈÓÔͤ· Î·È ·˘Í¿ÓÂÙ·È Ë ·Ú·ÁˆÁ‹ Ì·ÏÏÈÔ‡. ∆Ô Ú‡˙È fiˆ˜ Î·È fiÏ· Ù· ·ÁÚÔÛÙÒ‰Ë ÂÚȤ¯Ô˘Ó ÌÈÎÚ‹ ÔÛfiÙËÙ· ÙÔ˘ ··Ú·›ÙËÙÔ˘ ·ÌÈÓÔͤԘ Ï˘Û›ÓË, ·ÏÏ¿ ÔÏÏÔ› ÏËı˘ÛÌÔ› Ù˘ Á˘ ȉ›ˆ˜ ÛÙËÓ ∞Û›· ¤¯Ô˘Ó ·ÔÎÏÂÈÛÙÈ΋ ‰È·ÙÚÔÊ‹ ÌfiÓÔ Ì ڇ˙È Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ÏfiÁˆ ¤ÏÏÂȄ˘ ·˘ÙÔ‡ ÙÔ˘ ·ÌÈÓÔͤԘ. ¢È·ÁÔÓÈÎfi Ú‡˙È ÂÚȤ¯ÂÈ ÁÔÓ›‰È· Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÚˆÙ½Ó˜ Ì ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÙÔ ·ÌÈÓÔ͇ Ï˘Û›ÓË. ªÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ηٿÏÏËÏˆÓ ÁÔÓȉ›ˆÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈο Ì ˘„ËÏfiÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ‚Èٷ̛Ә C, E Î·È ‚-ηڈٛÓË Ô˘ Â›Ó·È Ê˘ÛÈο ·ÓÙÈÔÍÂȉˆÙÈο. ∆· ·ÓÙÈÔÍÂȉˆÙÈο ·ÚÂÌÔ‰›˙Ô˘Ó ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ·ıËڈ̷و‰ÒÓ Ï·ÎÒÓ ÛÙ· ·ÁÁ›· Î·È ÂÏ·ÙÙÒÓÂÙ·È Ë Èı·ÓfiÙËÙ· ηډȷÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ·ÏÏ¿ ·ÚÂÌÔ‰›˙Ô˘Ó Î·È ÙË Á‹Ú·ÓÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Î·ÚΛÓÔ˘. ∏ ÔÈfiÙËÙ· ÙÔ˘ „ˆÌÈÔ‡ ÂÍ·ÚÙ¿Ù·È ·fi ÙȘ ȉÈfiÙËÙ˜ Ù˘ ÁÏÔ˘Ù¤Ó˘ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ÙȘ ÚˆÙ½Ó˜ ÁÏÈ·‰›ÓË Î·È ÁÏÔ˘ÙÂÓ›ÓË. OÈ ‰ÈÛÔ˘ÏÊȉÈÎÔ› ‰ÂÛÌÔ› Ù˘ ÁÏÈ·‰›Ó˘ οÓÔ˘Ó ÙË ˙‡ÌË Ï·ÛÙÈ΋ ÒÛÙ ӷ ÊÔ˘ÛÎÒÓÂÈ ÙÔ „ˆÌ›, ÂÓÒ Ë ÁÏÔ˘ÙÂÓ›ÓË Î¿ÓÂÈ ÙË ˙‡ÌË

°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·

ÂÏ·ÛÙÈ΋ Î·È ÙÔ ÊÔ‡ÛΈ̷ ‰È·ÙËÚ›ٷÈ. ªÂ ÙÚÔÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ ÁÏÔ˘Ù¤Ó˘ ÛÙȘ ÂÚÈÔ¯¤˜ Ù˘ ΢ÛÙ½Ó˘ Â›Ó·È ‰˘Ó·Ù‹ Ë ‚ÂÏÙ›ˆÛË Ù˘ Ï·ÛÙÈÎfiÙËÙ·˜ Î·È Ù˘ ÂÏ·ÛÙÈÎfiÙËÙ·˜ ÙÔ˘ „ˆÌÈÔ‡ Î·È ÙˆÓ ¿ÏÏˆÓ ·ÚÙÔÛ΢·ÛÌ¿ÙˆÓ (ʇÏÏ·, ÛÊÔÏÈ¿Ù·). Á. µÂÏÙ›ˆÛË Ù˘ ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ·Ú·ÁÔÌ¤ÓˆÓ ÚÔ˚fiÓÙˆÓ OÈ ÎfiÓ‰˘ÏÔÈ Ù˘ ·Ù¿Ù·˜ Û ¯·ÌËϤ˜ ıÂÚÌÔÎڷۛ˜ ·ÔÎÙÔ‡Ó, ÏfiÁˆ ÂÓ˙˘ÌÈ΋˜ ‰Ú¿Û˘, ÁÏ˘ÎÈ¿ Á‡ÛË. ∆· ÙÛÈ˜ Ô˘ ·Ú·Û΢¿˙ÔÓÙ·È ·fi ÙÔ˘˜ ÎÔÓ‰‡ÏÔ˘˜ ·˘ÙÔ‡˜ ÂÌÊ·Ó›˙Ô˘Ó Î·Ù¿ ÙËÓ ÂÂÍÂÚÁ·Û›· ÙÔ˘˜ ¤ÓÙÔÓÔ ÛÎÔ‡ÚÔ ¯ÚÒÌ· Î·È ‰ÂÓ Â›Ó·È ÂÏ΢ÛÙÈο ÂÌÔÚÈο. ªÂ ÙËÓ ÙÚÔÔÔ›ËÛË ÙˆÓ Â˘·›ÛıËÙˆÓ ÛÙÔ „‡¯Ô˜ ÂÓ˙‡ÌˆÓ ·ÔʇÁÂÙ·È ÙÔ Ì·‡ÚÈÛÌ· Ù˘ ·Ù¿Ù·˜ ηٿ ÙËÓ ÂÂÍÂÚÁ·Û›· Û ÙÛÈ˜.

O Ê˘ÙÈÎfi˜ ÈÛÙfi˜ Á›ÓÂÙ·È Î·Ê¤ fiÙ·Ó ÎÔ› ‹ ÍÂÊÏÔ˘‰ÈÛı›, Î·È ·ÔʇÁÂÙ·È Ì ÙË ¯Ú‹ÛË Û˘ÓÙËÚÈÎÒÓ fiˆ˜ ÔÈ ÂÓÒÛÂȘ ı›Ԣ. ∆· ηÙÂÛÙÚ·Ì̤ӷ ·ÙÙ·Ú· ÂÎÏ‡Ô˘Ó ÙÔ ¤Ó˙˘ÌÔ ÔÍÂȉ¿ÛË Ù˘ ÔÏ˘Ê·ÈÓfiÏ˘ Ô˘ ÌÂÙ·ÙÚ¤ÂÈ ÙȘ ÌÔÓÔÊ·ÈÓfiϘ Ô˘ ÂÎχÔÓÙ·È ·fi Ù· Û·Ṳ̂ӷ ·ÙÙ·Ú· Û ÎÈÓfiÓ˜, Ô˘ ÔÍÂȉÒÓÔÓÙ·È Î·È Û¯ËÌ·Ù›˙Ô˘Ó Î·Ê¤ ÔÏ˘Ê·ÈÓÔÏÈΤ˜ ¯ÚˆÛÙÈΤ˜. ∏ ÌË ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÔÍÂȉ¿Û˘ Ù˘ ÔÏ˘Ê·ÈÓfiÏ˘ Á›ÓÂÙ·È Ì ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË, ÒÛÙ ÌÂÙ¿ ÙÔ ÍÂÊÏÔ‡‰ÈÛÌ· ÙÔ ÊÚÔ‡ÙÔ Ó· ÌË Ì·˘Ú›˙ÂÈ (19). OÈ Ê˘ÛÈΤ˜ ÙÔÍÈΤ˜ Ô˘Û›Â˜ (Ù· ÁÏ˘ÎÔ·ÏηÏÔÂȉ‹ Ù˘ ·Ù¿Ù·˜ Î·È Ë ÏÂÎÙ›ÓË ÙˆÓ Ê·ÛÔÏÈÒÓ), ÔÈ ·ÓÙȉȷÙÚÔÊÈΤ˜ Ô˘Û›Â˜ (ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ıÚ˘„›Ó˘) Î·È ·ÏÏÂÚÁÈÔÁfiÓ˜ Ô˘Û›Â˜ .¯. ÔÚÈṲ̂Ó˜ ÚˆÙ½Ó˜ ÙˆÓ Î·Ú˘‰ÈÒÓ ÌÔÚ› ÛÙÔ Ì¤ÏÏÔÓ Ó· ÌËÓ Â›Ó·È ‚Ï·‚ÂÚ¤˜ ÛÙËÓ ˘Á›· ·Ó Ù· Ê˘Ù¿ Ô˘ ÙȘ ÂÚȤ¯Ô˘Ó ÙÚÔÔÔÈËıÔ‡Ó ÁÂÓÂÙÈο. OÈ ÂÍÂÏ›ÍÂȘ Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ı· Ô‰ËÁ‹ÛÔ˘Ó Ì·ÎÚÔÚfiıÂÛÌ· ÛÙËÓ ·Ó¿Ù˘ÍË ÙÚÔÊÒÓ Ô˘ ‰ÂÓ ı· ÂÚȤ¯Ô˘Ó Ù· ·ÓÂÈı‡ÌËÙ· Û˘ÛÙ·ÙÈο. ∏ ÓÙÔÌ¿Ù· fiÙ·Ó Â›Ó·È Ï‹Úˆ˜ ÒÚÈÌË, Â›Ó·È Ì·Ï·Î‹ Î·È Â˘·ı‹˜ ÛÙȘ ÌÂÙ·ÊÔÚ¤˜. °È’ ·˘Ùfi ÔÈ Î·ÚÔ› Û˘ÏϤÁÔÓÙ·È Ú¿ÛÈÓÔÈ, ‰È·ÙËÚÔ‡ÓÙ·È Û ¯·ÌËÏ‹ ıÂÚÌÔÎÚ·Û›· ηٿ ÙË ÌÂÙ·ÊÔÚ¿ Î·È Ï›ÁÔ ÚÈÓ ‰È·ÙÂıÔ‡Ó ÛÙËÓ ·ÁÔÚ¿ ÂÎÙ›ıÂÓÙ·È ÛÙËÓ Â›‰Ú·ÛË ·Èı˘ÏÂÓ›Ô˘. ∆Ô ·Èı˘Ï¤ÓÈÔ ‰ÈÂÁ›ÚÂÈ ÙËÓ ˆÚ›Ì·ÓÛË Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Û‡ÓıÂÛË Î·ÚˆÙÈÓÔÂȉÒÓ (·Ó¿Ù˘ÍË ¯ÚÒÌ·ÙÔ˜), Û‡ÓıÂÛË Û·Î¯¿ÚˆÓ Î·È Ô˘ÛÈÒÓ Ì ¿ÚˆÌ· ηıÒ˜ Î·È Ì·Ï¿ÎˆÌ· ÙÔ˘ ηÚÔ‡ (20).

OÈ ÓÙÔÌ¿Ù˜ ·˘Ù¤˜ Â›Ó·È ÎfiÎÎÈÓ˜ Î·È ¯˘ÌÒ‰ÂȘ, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó Á‡ÛË, Â›Ó·È Ì·Ï·Î¤˜ Î·È Î·Ù·ÛÙÚ¤ÊÔÓÙ·È ÛÙË ÌÂÙ·ÊÔÚ¿. ∆Ô ¤Ó˙˘ÌÔ ÔÏ˘Á·Ï·ÎÙÔ˘ÚÔÓ¿ÛË ‰È·Ï‡ÂÈ ÙËÓ ËÎÙ›ÓË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÙÔȯˆÌ¿ÙˆÓ Î·È ¤ÙÛÈ Ì·Ï·ÎÒÓÂÈ Ë ÓÙÔÌ¿Ù·. ∞Ó ·ÚÂÌÔ‰ÈÛı› Ó· ‰Ú¿ÛÂÈ ·˘Ùfi ÙÔ ¤Ó˙˘ÌÔ, ı· ÂÈ‚Ú·ı˘Óı› ÙÔ Ì·Ï¿ÎˆÌ· ÙÔ˘ ηÚÔ‡, ÂÓÒ Ë ˆÚ›Ì·ÓÛË (¿ÚˆÌ·, ¯ÚÒÌ·) ı· Û˘Ó¯ÈÛı› ηÓÔÓÈο. ∏ ÓÙÔÌ¿Ù· ·˘-

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459

∫. ¶·ÓÙÛÈÒÙÔ˘

Ù‹ Â›Ó·È ÁÓˆÛÙ‹ Ì ÙÔ fiÓÔÌ· FLAV SAVR Î·È Ë Î˘ÎÏÔÊÔÚ›· Ù˘ ÂÈÙÚ¤ÂÙ·È ÛÙȘ ∏¶∞ ·fi ÙÔ 1994. ∏ ÔÈÎÈÏ›· ·˘Ù‹ ʤÚÂÈ ÙÔ ÁÔÓ›‰ÈÔ (antisense) ·ÓÙÈÓÔËÌ·ÙÈÎfi, ÙÔ ÔÔ›Ô ·Ó·ÛÙ¤ÏÏÂÈ ÂÈ Ì·ÎÚfiÓ ÙËÓ ·Ú·ÁˆÁ‹ ÔÏ˘Á·Ï·ÎÙÔ˘ÚÔÓ¿Û˘, ¯ˆÚ›˜ Ó· ·ÚÂÌÔ‰›˙ÔÓÙ·È ÔÈ ¿ÏϘ ÏÂÈÙÔ˘ÚÁ›Â˜ Ù˘ ˆÚ›Ì·ÓÛ˘. ∆Ô ÁÔÓ›‰ÈÔ Ô˘ Ì·›ÓÂÈ ÂËÚ¿˙ÂÈ ÙÔÓ promoter ·ÓÙ›ÛÙÚÔÊ·. ¢ËÏ·‰‹ fiÙ·Ó ÙÔ ÁÔÓ›‰ÈÔ ·Ú¯›˙ÂÈ Ó· ÂÎÊÚ¿˙ÂÙ·È ÙÔ ·ÓÙÈÓÔËÌ·ÙÈÎfi ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ¤ÎÊÚ·Û‹ ÙÔ˘.

ÙȘ ·Ù¿Ù˜ ·Ó¤Ù˘Í·Ó ·ÓÙÈÛÒÌ·Ù· ÂÓ·ÓÙ›ÔÓ Ù˘ ˘ÔÔÌ¿‰·˜ µ Ù˘ ÂÓÙÂÚÔÙÔ͛Ӣ. ¶Ú¤ÂÈ Ó· ÌÂÏÂÙËı› ·Ó ÔÈ ÔÓÙÈÎÔ› ·˘ÙÔ› ÚÔÛٷهÔÓÙ·È ·fi ÚÔÛ‚ÔϤ˜ ÙÔ˘ ‚·ÎÙËÚȉ›Ô˘. OÈ ¿ÓıÚˆÔÈ fï˜, ‰ÂÓ ÙÚÒÓ ˆÌ¤˜ ÙȘ ·Ù¿Ù˜ Î·È Ì ÙÔ Ì·Á›ÚÂ˘Ì· ·ÔÈÎÔ‰ÔÌÔ‡ÓÙ·È ÔÈ ÚˆÙ½Ó˜. ™˘ÓÂÒ˜, Ë ·Ù¿Ù· ‰ÂÓ ·ÔÙÂÏ› ηٿÏÏËÏË ÂÈÏÔÁ‹ ÁÈ· ·Ú·ÁˆÁ‹ ‚ÚˆÛ›ÌˆÓ ÂÌ‚ÔÏ›ˆÓ. ªÈ· ÂÓ·ÏÏ·ÎÙÈ΋ χÛË Â›Ó·È Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ‰È·ÁÔÓÈο Ê˘Ù¿ Ì·Ó¿Ó·˜ Ô˘ ı· ¤¯Ô˘Ó ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÂÓÂÚÔÙÔ͛Ӣ Î·È ÙÒÚ· Á›ÓÔÓÙ·È ÂÈÚ¿Ì·Ù· (21).

‰. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿ ÁÈ· ·Ú·ÁˆÁ‹ ÂÌ‚ÔÏ›ˆÓ ∂›Ó·È ‰˘Ó·Ù‹ Ë ·Ú·ÁˆÁ‹ ‚ÚˆÛ›ÌˆÓ ÂÌ‚ÔÏ›ˆÓ ·fi Ê˘Ù¿. ∆· ‰È·ÁÔÓÈο Ê˘Ù¿ fiÙ·Ó Ê·ÁˆıÔ‡Ó ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÛıÂÓÂÈÒÓ. OÈ ¤Ú¢Ó˜ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙȘ ÂÓÙÂÚÈΤ˜ ÏÔÈÌÒÍÂȘ, fiˆ˜ ¯ÔϤڷ Î·È ‚·ÎÙËÚȷ΋ ‰È¿ÚÚÔÈ·, ÔÈ Ôԛ˜ ·ÔÙÂÏÔ‡Ó Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿ ÙˆÓ ¯ˆÚÒÓ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘. ∆· ‚·ÎÙËÚ›‰È· ·Ú¿ÁÔ˘Ó ÂÓÙÂÚÔÙÔ͛Ә ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ Î·È ‰ÈÂÁ›ÚÂÙ·È Ë ¤ÎÎÚÈÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ˘ÁÚÒÓ ·fi ÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ, Ô˘ ÚÔηÏ› ÔÍ›· ‰È¿ÚÚÔÈ·, ‚·ÚÈ¿ ·Ê˘‰¿ÙˆÛË Î·È ı¿Ó·ÙÔ. OÈ ÂÓÙÂÚÔÙÔ͛Ә ·ÔÙÂÏÔ‡ÓÙ·È ·fi Ù· Ù· ÔÏ˘ÂÙ›‰È· ∞ Î·È µ, Ô˘ fiÙ·Ó ‰ÂÓ Â›Ó·È Âӈ̤ӷ Â›Ó·È ·‚Ï·‚‹ ÁÈ· ÙÔÓ ÔÚÁ·ÓÈÛÌfi. ŒÁÈÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ µ ˘ÔÔÌ¿‰· Ù˘ ÂÓÙÂÚÔÙÔ͛Ӣ Ù˘ E. coli, ÛÙÔ Ê˘Ùfi ·Ù¿Ù·. ™Ù· ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿ Ë ˘ÔÔÌ¿‰· µ Û˘ÛÛˆÚ‡ıËΠÛÙÔ˘˜ ÎÔÓ‰‡ÏÔ˘˜. ¶ÔÓÙÈÎÔ› Ô˘ ¤Ê·Á·Ó ·˘Ù¤˜

∂ÈÊ˘Ï¿ÍÂȘ Î·È ÚÔÔÙÈΤ˜ ™ÙȘ ¯ÒÚ˜ Ù˘ ∂ӈ̤Ó˘ ∂˘ÚÒ˘ ˘¿Ú¯Ô˘Ó ÂÙÈΤÙ˜ ÛÙ· ÚÔÈfiÓÙ· Î·È ·Ó·Ê¤ÚÂÙ·È ·Ó ·˘Ù¿ Â›Ó·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ, Ì fiϘ ÙȘ ··Ú·›ÙËÙ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ Î·Ù·Ó·ÏˆÙ‹. ÿÛˆ˜ ·˘Ùfi Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·‡ÍËÛË Ù˘ ˙‹ÙËÛ˘ ·Ó ÎÂÚ‰›ÛÔ˘Ó ÙËÓ ÂÌÈÛÙÔÛ‡ÓË ÙˆÓ Î·Ù·Ó·ÏˆÙÒÓ (22). ¶ÔÈÔ˜ ‰ÂÓ ı· ÚÔÙÈÌÔ‡Û ÙÚfiÊÈÌ· Ô˘ ÂÁÁ˘ÒÓÙ·È ÙË Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ÙËÓ ·‡ÍËÛË Ù˘ ·ÓÙÔ¯‹˜ Û ÌÔχÓÛÂȘ ‹ ÙËÓ ·Ô˘Û›· ˘ÔÏÂÈÌÌ¿ÙˆÓ ÁˆÚÁÈÎÒÓ Ê·Ú̿ΈÓ. ∆· ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ‰ÂÓ ¤¯Ô˘Ó ÌfiÓÔ ‰È·ÙÚÔÊÈ΋ ‹ ÔÈÎÔÏÔÁÈ΋ ÛËÌ·Û›·, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È ÙÂÚ¿ÛÙÈÔ ÔÈÎÔÓÔÌÈÎfi ÂӉȷʤÚÔÓ. ™Â ·ÁÎfiÛÌÈ· Îϛ̷η, Ë ¤ÎÙ·ÛË ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·˘Í‹ıËΠ·fi 109 ÂηÙÔÌ̇ÚÈ· ÛÙÚ¤ÌÌ·Ù· ÙÔ 1977, Û 279 ÂηÙÔÌ̇ÚÈ· ÙÔ 1998. ¶ÚfiÎÂÈÙ·È ÁÈ· ηÏÏȤÚÁÂȘ ÛfiÁÈ·˜ (52%), ·Ú·‚ÔÛ›ÙÔ˘ (30%), ‚·Ì‚·ÎÈÔ‡ (9%), ÂÏ·ÈÔÎڿ̂˘ (9%)

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∂ÈÎfiÓ· 8. ¶·È‰› Ô˘ ÁÂÓÓ‹ıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi, ·ÏÏ¿ ÏfiÁˆ ¤ÏÏÂȄ˘ ÙÚÔÊ‹˜ ·Ó¤Ù˘Í ‰˘ÛÙÚÔÊ›· (·). £· ÙËÓ ·¤Ê¢Á ·Ó Ë ÌËÙ¤Ú· ÙÔ˘ ›¯Â ÙÚfiÊÈÌ· Ó· ÙÔ ÛÈÙ›˙ÂÈ (‚).

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Î·È ÁÂˆÌ‹ÏˆÓ (<1%), ÔÈ Ôԛ˜ ηٿ Ù· 3/4 ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙȘ ∏¶∞. ∆Ô 1998, ·ÁÎfiÛÌÈ· ·Ú·ÁˆÁ‹ ÛfiÁÈ·˜ Û ÔÛÔÛÙfi 44% Î·È ·Ú·‚ÔÛ›ÙÔ˘ 36% ÚÔ‹Ïı ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ηÏÏȤÚÁÂȘ. ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÂÊ·ÚÌfiÛıËÎ·Ó ÂÓÙ·ÙÈο Û˘ÛÙ‹Ì·Ù· ηÏÏȤÚÁÂÈ·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·˘Í·ÓfiÌÂÓ˘ ˙‹ÙËÛ˘ ÙÚÔÊÒÓ, ȉ›ˆ˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ (23). OÈ ı·̷ÙÈΤ˜ ·Ô‰fiÛÂȘ ÙˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ ÔÎÈÏÈÒÓ ÂÈÙ‡¯ıËÎ·Ó Ì ¯Ú‹ÛË ÏÈ·ÛÌ¿ÙˆÓ, ˙È˙·ÓÈÔÎÙfiÓˆÓ, Ê˘ÙÔÊ·Ú̿ΈÓ, ÔÚÌÔÓÒÓ Î·È Â›¯·Ó ·˘ÍË̤ÓÔ ÂÚÈ‚·ÏÏÔÓÙÈÎfi ÎfiÛÙÔ˜. ™ÙȘ Û‡Á¯ÚÔÓ˜ ˘ÂÚηٷӷψÙÈΤ˜ ÎÔÈӈӛ˜ ÙˆÓ ·Ó·Ù˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ Ì ÙËÓ Ï‹ÚË Â΂ÈÔÌ˯¿ÓÈÛË Î·È ·ÛÙÈÎÔÔ›ËÛË, ‰ÂÓ Û˘ÓÂȉËÙÔÔÈ› ‡ÎÔÏ· ηÓ›˜ fiÛÔ ÂÈÛÊ·Ï‹˜ ·Ú·Ì¤ÓÂÈ Ë ÁˆÚÁÈ΋ ·Ú·ÁˆÁ‹ Î·È ‰ÂÓ ÁÓˆÚ›˙ÂÈ fiÙÈ Ù· 3/4 ÙˆÓ Î·ÙÔ›ÎˆÓ Ù˘ Á˘ ˘ÔÛÈÙ›˙ÔÓÙ·È (∂ÈÎfiÓ· 8).∏ ÁË Ì·˜ ¤¯ÂÈ Û‹ÌÂÚ· 6 ‰ÈÛÂηÙÔÌ̇ÚÈ· ηÙÔ›ÎÔ˘˜ Î·È Ô ÏËı˘ÛÌfi˜ ı· ‰ÈÏ·ÛÈ·Ûı› ÛÙ· ÂfiÌÂÓ· 40-50 ¯ÚfiÓÈ·. ¶Ò˜ ı· ‰È·ÙÚ¤ÊÔÓÙ·È ÙfiÙ ÙfiÛÔÈ ¿ÓıÚˆÔÈ, fiÙ·Ó Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ÂÍ·ÛÊ·ÏÈÛı› Â·Ú΋˜ ÙÚÔÊ‹ ÁÈ· ÙÔ˘˜ ÌÈÛÔ‡˜; ∏ Û‡Á¯ÚÔÓË ‚ÈÔÙ¯ÓÔÏÔÁ›· ¤¯ÂÈ Û‹ÌÂÚ· ÙÂÚ¿ÛÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÛÙË ÁˆÚÁ›· ÙËÓ È·ÙÚÈ΋ Î·È ÙË ‚ÈÔÌ˯·Ó›· Î·È ı· Û˘Ì‚¿ÏÂÈ ·ÔÊ·ÛÈÛÙÈο ÛÙË Ï‡ÛË ÎÚ›ÛÈÌˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ÁˆÚÁÈ΋˜ ·Ú·ÁˆÁ‹˜ (24). ™ÙÔÓ ·ÁÒÓ· ÙÔ˘ ·ÓıÚÒÔ˘ ηٿ Ù˘ ›ӷ˜, ηٿ ÙÔ˘ ˘ÔÛÈÙÈÛÌÔ‡ Î·È Ù˘ ηٷÛÙÚÔÊ‹˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, Ë Û‡Á¯ÚÔÓË ‚ÈÔÙ¯ÓÔÏÔÁ›· ÚÔÛʤÚÂÈ Ôχ ÈÛ¯˘Ú¿ ÂÚÁ·Ï›· Î·È ÂÏ›‰Â˜ ÁÈ· Ó· ÚÔ¯ˆÚ‹ÛÂÈ Î·È Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙÔ Ì¤ÏÏÔÓ ÙÔ˘, ·ÚΛ Ó· Ù· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ Ì ۈÛÙfi Î·È ·ÓıÚÒÈÓÔ ÙÚfiÔ. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ¤¯ÂÈ ·ԉ›ÍÂÈ ÙËÓ ÙÂÚ¿ÛÙÈ· ·Ú·ÁˆÁÈ΋ Ù˘ ‰‡Ó·ÌË. ¶Ú¤ÂÈ Ë ‰‡Ó·ÌË ·˘Ù‹ Ó· ¯ÚËÛÈÌÔÔÈËı› ̤۷ Û fiÚÈ· ·ÛÊ·Ï‹ Î·È ËıÈο ·Ô‰ÂÎÙ¿ ·fi ÙËÓ ÎÔÈÓˆÓ›·, ¤ÙÛÈ ÒÛÙÂ Ë Ù¯ÓÔÏÔÁ›· Ó· ˘ËÚÂÙ› ÙÔÓ ¿ÓıÚˆÔ Î·È fi¯È Ô ¿ÓıÚˆÔ˜ ÙËÓ Ù¯ÓÔÏÔÁ›·.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-06-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-10-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫˘Ú·ÙÛԇϷ ¶·ÓÙÛÈÒÙÔ˘ ¢ÚfiÛË 11, °Î‡˙Ë, 114 74 ∞ı‹Ó·

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ªË¯·ÓÈÛÌÔ› Î·È ·ÈÙÈÔÏÔÁ›· Ù˘ ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ™ÔÊ›· ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË

● ¶ÂÚ›ÏË„Ë: ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞) Â›Ó·È Û¿ÓÈÔ ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÙ¿ÛÛÂÙ·È ÛÙËÓ Â˘Ú‡ÙÂÚË ÔÌ¿‰· ÙˆÓ Û˘Ó‰ÚfiÌˆÓ Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ‰È·ÎÚ›ÓÂÙ·È Û Â›ÎÙËÙË Î·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓË. OÈ Î˘ÚÈfiÙÂÚ˜ ·fi„ÂȘ Ô˘ ÂÈÎÚ·ÙÔ‡Ó Û‹ÌÂÚ· ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ Â›ÎÙËÙ˘ ∞∞, Û˘Ì˘ÎÓÒÓÔÓÙ·È ÛÙÔ fiÙÈ Ë ÓfiÛÔ˜ ·ÔÙÂÏ› ÙËÓ ÙÂÏÈ΋ ·ÈÌ·ÙÔÏÔÁÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÔÈÔÙÈ΋˜ ‹ Î·È ÔÛÔÙÈ΋˜ ‚Ï¿‚˘ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› Ù· ·Ú¯¤ÁÔÓ· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú· (stem cells-SC) ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Û ¿ÏÏÔÙ ¿ÏÏÔ Â›Â‰Ô Ù˘ ‰È·ÊÔÔ›ËÛ‹˜ ÙÔ˘˜ (µÏ¿‚Ë Ù‡Ô˘ π Î·È ‚Ï¿‚Ë Ù‡Ô˘ ππ). °È· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ Â›ÎÙËÙ˘ ∞∞, ıˆÚËÙÈο ÂÓÔ¯ÔÔÈÂ›Ù·È ÚÔËÁËı›۷ ‚Ï·ÙÈ΋ ‰Ú¿ÛË Î¿ÔÈÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ‹ Â͈ÁÂÓÔ‡˜ ·Ú¿ÁÔÓÙ· Â› ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ∆Ë ıˆÚËÙÈ΋ ·˘Ù‹ ‚Ï¿‚Ë ÙˆÓ ·Ú¯¤ÁÔÓˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛˆÓ, ·ÎÔÏÔ˘ı› Ì›· ÈÛ¯˘Ú‹ ·˘ÙÔ·ÓfiÛÔ˘ Ù‡Ô˘ ·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Ë ÔÔ›· ÛÙÚ¤ÊÂÙ·È Î·Ù·ÛÙÚÔÊÈο ÂÓ·ÓÙ›ÔÓ ÙˆÓ È‰›ˆÓ ·˘ÙÔ‡ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (SC), ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ‰È·Ù·Ú·Á̤Ó˘ Î·È ·ÓÒÌ·Ï˘ ·ÓÔÛÔÔÈËÙÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (·ÒÏÂÈ· ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÔ¯‹˜ Î·È ·˘ÙÔ·ÓfiÛÔ˘ Ù‡Ô˘ ηٷÛÙÚÔÊ‹ ÙˆÓ «ÚÔÛ‚ÏËı¤ÓÙˆÓ» ·fi ÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·Ú¯¤ÁÔÓˆÓ ÌËÙÚÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ). O ÚfiÏÔ˜ Ô˘ η٤¯ÂÈ ÛÙËÓ fiÏË ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ ‰È·‰Èηۛ· Ù˘ Â›ÎÙËÙ˘ ∞∞ ¤Ó·˜ ˘ÔΛÌÂÓÔ˜ ÈÛ¯˘Úfi˜ ·˘ÙÔ¿ÓÔÛÔ˜ Ì˯·ÓÈÛÌfi˜ Â›Ó·È Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜, ÂÓÒ ˆ˜ ÏÈÁfiÙÂÚÔ Èı·Ó‹ Ê·›ÓÂÙ·È Ë Û˘ÌÌÂÙÔ¯‹ Ù˘ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (΢ÙÙ¿ÚˆÓ ÛÙÚÒÌ·ÙÔ˜, ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÎÏ). ∏ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ·ÎÔÏÔ˘ı› Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÛÙËÓ ÏÂÈÔÓfiÙËÙ· fï˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ ·ÔÌÔÓÒÓÂÙ·È, Ì ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ÏÂÈÔ„ËÊ›· Ù˘, Ë Â›ÎÙËÙË ∞∞ Ó· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÙÂÏÈο ˆ˜ ȉÈÔ·ı‹˜. ∏ ÎÏËÚÔÓÔÌÈ΋ ∞∞ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÛÙËÓ ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È Ù· ÔÈΛϷ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÛÔÚ·‰Èο ‹ ÔÈÎÔÁÂÓ‹ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ì ‹ ¯ˆÚ›˜ Ê˘ÛÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÂÎÚÔÛˆÂ›Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ ·Ó·ÈÌ›· Fanconi. OÈ ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Á¤ÓÂÛ˘ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ, Â›Ó·È ÔχÏÔÎÔÈ Î·È ÙÔ ıˆÚËÙÈÎfi ÙÔ˘˜ Ï·›ÛÈÔ, ̤¯ÚÈ Û‹ÌÂÚ· ÙÔ˘Ï¿¯ÈÛÙÔÓ, Û˘ÓÙ›ıÂÙ·È ÛÙ·‰È·Î¿. O Ù‡Ô˜ Î·È Ë ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·ıÔÚ›˙Ô˘Ó ÙÔÓ ·Ó·ÛÙÚ¤„ÈÌÔ ‹ ÌË ¯·Ú·ÎÙ‹Ú· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ÌÂÙ¿ ·fi ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹, ÙËÓ ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ·, ÙËÓ ÎÏÈÓÈ΋ ‚·Ú‡ÙËÙ· Î·È ÙËÓ ÔÈÎÈÏ›· ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ·Ó·ÛÎfiËÛ˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Û‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· ÙËÓ Ù·ÍÈÓfiÌËÛË Ù˘ ∞∞ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÔÈ ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ·Ó¿Ù˘Í˘ ÙÔ˘ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÔÈ ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ·ıÔÊ˘ÛÈÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:461-469. §¤ÍÂȘ ÎÏÂȉȿ: ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· Â›ÎÙËÙË Î·È ÎÏËÚÔÓÔÌÈ΋, ·È‰È΋ ËÏÈΛ·, ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ›, ·Ó·ÈÌ›· Fanconi.

S. Polychronopoulou-Androulakaki. Aetiology and pathogenetic mechanisms of acquired and inherited aplastic anemia in childhood. Paediatriki 2000;63:461-469. ● Abstract: Aplastic anemia (AA) of childhood, represents a rare nosologic entity which belongs to bone marrow failure syndromes and is classified as acquired or inherited, either congenital or not. The bulk of evidence regarding the pathogenesis of AA indicates the presence of a severe defect in the stem cell (SC)

∂ÈÌÂÏ‹ÙÚÈ· ∞’, ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·», ∞ı‹Ó·

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compartment resulting in a disturbance of SC proliferation, division and differentiation rate, as well as in a substantial reduction of the SC number. Two different pathways of bone marrow damage are hypothesized: Type I involves DNA impairment of the most primitive hematopoietic SC at the top of the hierarchy of hematopoiesis, by irradiation, rediomimetic agents such as busulphan and other drugs, while Fanconi’s anemia is an inherited example of Type I damage with inability to repair DNA defects. Type II takes place at the level of the more mature hematopoietic cell, involving cell membrane or metabolism, such as damage by many drugs, viruses and immune mechanisms. For most of the cases of acquired AA a strong underlying mechanism of immune destruction of hematopoietic progenitors is prevalent (loss of immune tolerance leading to an abnormal reaction and an immune mediated SC catastrophe), while the contribution of various alterations of stromal factors (e.g. defect of stromal cells or inadequate local action of hematopoietic growth factors) to the basic pathophysiologic process appears to be only of minor importance. Theoretically, an overt clinical manifestation of the acquired disease is generally preceded by a toxic effect (by any factor) upon the bone marrow stem cells.

In most of the cases however, no etiologic factor is isolated, and the majority of cases of acquired AA are categorized as idiopathic. In the inherited form of the disease, the clinical manifestations of bone marrow aplasia of one or more cell lines, may appear at any age. Moreover, there is a diversity regarding the SC defect and the underlying pathogenetic mechanisms. Fanconi’s anemia represents the most common type of inherited AA. The onset of the disease can be insidious or acute, and patients may have an acute, transient or chronic course.

Clinical features and laboratory findings are in most cases common in both types of AA, acquired or inherited, depending on the defect of one or all cell lines. Similarly, the severity of the disease, its symptoms and signs are based on the degree of anemia, neutropenia, and thrombocytopenia. In inherited AA (Fanconi’s anemia), physical examination, often but not always, reveals characteristic findings related to the underlying nosologic entity (malformations of the skeleton and urinary tract, growth retardation etc). In this review article, current data on classification, etiology and pathogenetic mechanisms are discussed.

Key words: aquired and inherited aplastic anemia, childhood, pathogenetic mechanisms, Fanconi’s anemia.

∂ÈÛ·ÁˆÁ‹ H ‚ÈÔÏÔÁÈ΋ ·Í›· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ë Ì›˙ˆÓ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÛÙËÓ Â‡Ú˘ıÌË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Â›Ó·È ÁÓˆÛÙ‹ ·fi ·Ú¯·›ˆÓ ¯ÚfiÓˆÓ. ¶ÚÒÙÔ˜, Ô ÌÂÁ·ÏÔÊ˘‹˜ ÚÔÛˆÎÚ·ÙÈÎfi˜ ÊÈÏfiÛÔÊÔ˜, ÔÈËÙ‹˜ Î·È È·ÙÚfi˜, ∂Ì‰ÔÎÏ‹˜ Ô ∞ÎÚ·Á·ÓÙ›ÓÔ˜, ˘oÛÙ‹ÚÈÍ fiÙÈ: «ŸÚÁ·ÓÔÓ Ù˘ ÓÔ‹Ûˆ˜ ÙÔ ·›Ì· Î·È fiÛÔÓ Î·ÓÔÓÈΈ٤ڷ Î·È ‰ÈηÈÔÙ¤Ú· Â›Ó·È Ë Ì›ÍȘ ÙˆÓ ÛÙÔȯ›ˆÓ, ÙfiÛÔÓ ·ÚÙȈ٤ڷ Ë ÊÚfiÓËÛȘ» (˘fi ÔÈËÙÔ‡ ∫. ¶·Ï·Ì¿)(1), ı¤ÏÔÓÙ·˜ ÚÔÊ·ÓÒ˜ Ó· ‰ËÏÒÛÂÈ ÙÔÓ ıÂÌÂÏÈÒ‰Ë ÚfiÏÔ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ù˘ ÈÛÔÚÚÔ›·˜ ÙˆÓ Â› ̤ÚÔ˘˜ ÛÙÔȯ›ˆÓ ÙÔ˘, ÛÙË ‚¿ÛË Ù˘ ˙ˆ‹˜. ∆ËÓ ·ÔÚ‡ıÌÈÛË Ù˘ ÈÛÔÚÚÔ›·˜ ·˘Ù‹˜ ÂÎÊÚ¿˙Ô˘Ó, ÎÏÈÓÈο Î·È ·ÈÌ·ÙÔÏÔÁÈο, Ù· Û‡Ó‰ÚÔÌ· ·ÓÂ¿ÚÎÂÈ·˜ ª˘ÂÏÔ‡ ÙˆÓ OÛÙÒÓ (MO), Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿. ™ÙËÓ ÔÌ¿‰· ·˘Ù‹ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈΛϘ Î·È ÛÔ‚·Ú¤˜ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, Ì ÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Î·È ‰Ú·Ì·ÙÈÎfi ÂÎÚfiÛˆÔ ÙËÓ ·ÓÂ¿ÚÎÂÈ· Î·È ÙˆÓ ÙÚÈÒÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ ÙÔ˘ ªO (ÂÚ˘ıÚ¿˜, Ì˘ÂÏÈ΋˜, ÌÂÁ·Î·Ú˘Ô΢ÙÙ·ÚÈ΋˜), Ô˘ Â›Ó·È ÁÓˆÛÙ‹ ˆ˜ AÏ·ÛÙÈ΋ AÓ·ÈÌ›· (AA). ∏ AA, ˆ˜ ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·, Â›Ó·È ÁÓˆÛÙ‹ ·fi ÙÔ 1888 Ô˘ ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔÓ Paul Erlich (2). ø˜ fiÚÔ˜ fï˜, Â›Ó·È ÁÓˆÛÙfi˜ ·fi ÙÔ 1904,

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fiˆ˜ ·Ô‰fiıËΠ·fi ÙÔÓ Chauffard (2), ÚÔÎÂÈ̤ÓÔ˘ Ó· ¯·Ú·ÎÙËÚ›ÛÂÈ ÙËÓ ÎÏÈÓÈ΋ ·˘Ù‹ ÔÓÙfiÙËÙ·. O ÂÏÏËÓÈÎfi˜ Î·È ‰ÈÂıÓÒ˜ ¤ÎÙÔÙ ηıÈÂڈ̤ÓÔ˜ fiÚÔ˜, AÏ·ÛÙÈ΋ ·Ó·ÈÌ›·, ıˆÚÂ›Ù·È ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ ÂÙ˘ÌÔÏÔÁÈο, ·ÏÏ¿ Î·È ·ıÔÊ˘ÛÈÔÏÔÁÈο ÂÈÙ˘¯‹˜ ÁÈ·Ù› ÂÎÊÚ¿˙ÂÈ Â·ÎÚÈ‚Ò˜ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÂÈÎÚ·Ù› ÛÙË ÓfiÛÔ (2,3). ∏ ∞∞ ‰È·ÎÚ›ÓÂÙ·È Û ‰‡Ô ÌÂÁ¿Ï˜ ηÙËÁÔڛ˜ ÙËÓ Â›ÎÙËÙË Î·È ÙËÓ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË (2-5). ∏ ÚÒÙË ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ·fi ¤ÎıÂÛË ÙˆÓ Ì˘ÂÏÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ÔÈΛÏÔ˘˜ ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ ÚÔηÏÔ‡Ó ·ÚÔ‰Èο ‹ ÌfiÓÈÌ· ‰È·Ù·Ú·¯‹ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ Ù˘ ·ÈÌÔÔ›ËÛ˘ (6). ∏ ηÙËÁÔÚ›· Ù˘ Â›ÎÙËÙ˘ ∞∞ ηÙÂÍÔ¯‹Ó ÂÎÚÔÛˆÂ›Ù·È ·fi ÙË ÌÂÁ¿ÏË ÔÌ¿‰· Ù˘ «È‰ÈÔ·ıÔ‡˜ ∞∞» (2,3,6,7). ™ÙË ‰Â‡ÙÂÚË Î·ÙËÁÔÚ›·, Ë ÓfiÛÔ˜ ÌÂÙ·‚È‚¿˙ÂÙ·È ÁÂÓÂÙÈο ¯ˆÚ›˜ fï˜ Ó· ÂΉËÏÒÓÂÙ·È ˘Ô¯ÚˆÙÈο ÛÙË ÓÂÔÁÓÈ΋, ÙË ‚ÚÂÊÈ΋ ‹ ÙËÓ ·È‰È΋ ËÏÈΛ· (2). ™ÙËÓ Â˘Ú‡ÙÂÚË ÔÌ¿‰· Ù˘ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˘ ∞∞, Ë ·Ó·ÈÌ›· Fanconi (FA) ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi Û˘Ó¤‚·ÏÏ ÛÙË ‰È¿ÎÚÈÛË Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ∞∞ ÁÈ· ÏfiÁÔ˘˜ Ú·ÎÙÈÎÔ‡˜, Û Fanconi Î·È ÌË Fanconi AA (2,4,5,7).

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·463

¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469

∞. ∂›ÎÙËÙË ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· √ÚÈÛÌfi˜ ø˜ Â›ÎÙËÙË ÔÚ›˙ÂÙ·È Ë ∞∞ Ë ÔÔ›· ·ÓÂÍ¿ÚÙËÙ· ËÏÈΛ·˜ Î·È ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜, ‰ÂÓ Û˘Ó‰¤ÂÙ·È Ì ÎÏËÚÔÓÔÌÈο ÌÂÙ·‚È‚·˙fiÌÂÓË ÓfiÛÔ (5,7). ∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ∏ ∞∞ Â›Ó·È Û¯ÂÙÈο Û¿ÓÈÔ ÓfiÛËÌ· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ·ÏÏ¿ Î·È ÛÙ· ·È‰È¿ Î·È Û ۇÁÎÚÈÛË Ì ÙËÓ Ï¢¯·ÈÌ›· ÂÌÊ·Ó›˙ÂÙ·È 30-50 ÊÔÚ¤˜ ÏÈÁfiÙÂÚÔ (7). ∏ ÂÙ‹ÛÈ· Â›ÙˆÛ‹ Ù˘ ÛÙȘ ∏¶∞ Î·È ÙËÓ ∂˘ÚÒË, ·Ó¿ÏÔÁ· Ì ÙËÓ ÚԤϢÛË ÙÔ˘ ΤÓÙÚÔ˘ ÌÂϤÙ˘, Î˘Ì·›ÓÂÙ·È ·fi 1 ¤ˆ˜ Î·È 6 Ó¤· ÂÚÈÛÙ·ÙÈο 106 ¿ÙÔÌ· (7,8). ∞Í›˙ÂÈ ¿ÓÙˆ˜ Ó· ÛËÌÂȈı› fiÙÈ Ë ∞∞ ·fi ÙfiÙ Ô˘ ·Ó·ÁÓˆÚ›ÛıËÎÂ, ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛı› ˆ˜ ÓfiÛËÌ· ÙˆÓ Ó·ڋ˜ ËÏÈΛ·˜ ·ÙfïÓ, ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚ˜ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ, ÂÓÒ ·ÓÙ›ıÂÙ· ÂÌÊ·Ó›˙ÂÈ ÛËÌ·ÓÙÈΤ˜ ÁˆÁÚ·ÊÈΤ˜ ·ÔÎÏ›ÛÂȘ (3,7,8). ∂ȉÈÎfiÙÂÚ· ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎȷ΋ ηٷÓÔÌ‹ Ù˘ ∞∞, fiˆ˜ Ê·›ÓÂÙ·È ·fi Ù· ‰Â‰Ô̤ӷ ‰‡Ô ÌÂÁ¿ÏˆÓ ∫¤ÓÙÚˆÓ Î·Ù·ÁÚ·Ê‹˜ Ù˘ ÛÙȘ ∏¶∞, ÙÔ Seattle Î·È ÙÔ National Institute of Health (NIH), Ë Â›ÎÙËÙË ∞∞ ·ÚÔ˘ÛÈ¿˙ÂÈ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÛÙË 2Ë Î·È ÂÓ Ì¤ÚÂÈ ÙËÓ 3Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 60 ÂÙÒÓ ‰Â›¯ÓÂÈ ÌÈ· ÛÙ·ıÂÚ‹ ¿ÓÔ‰Ô (7). ∞Ó fï˜ ÛÙ· ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ ÂÚÈÏËÊı› Î·È Ë ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ∞∞, ÙfiÙ ۯËÌ·Ù›˙ÂÙ·È Ì›· ÙÚ›ÙË ÎÔÚ˘Ê‹, ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ 1˘ ‰ÂηÂÙ›·˜ Ù˘ ˙ˆ‹˜, Î·È ÂȉÈÎfiÙÂÚ· ÌÂٷ͇ 5-9 ÂÙÒÓ. ∏ ÙÚ›ÙË ·˘Ù‹ ÎÔÚ˘Ê‹, Ô˘ ÂÎÚÔÛˆ› ÙËÓ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ∞∞, ‰˘ÛÙ˘¯Ò˜ ˘ÔÂÎÙÈÌ¿Ù·È ·ÚÈıÌËÙÈο Î·È Ô˘ÛÈ·ÛÙÈο, ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È Ï‹Úˆ˜ Î·È Â›Ó·È ÂΛÓË Ô˘ ÛËÌ·ÙÔ‰ÔÙ› ÙËÓ ‚·ÛÈ΋ ȉȷÈÙÂÚfiÙËÙ· Ù˘ ∞∞ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÊfiÛÔÓ Î·Ù’ ÂÍÔ¯‹Ó ‰È·ÁÈÁÓÒÛÎÂÙ·È Î·Ù¿ ÙËÓ ËÏÈΛ· ·˘Ù‹ (5,7). ¶·ıÔÊ˘ÛÈÔÏÔÁ›· ∏ ηٷÓfiËÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ Ù˘ ¤ÎÙˆÛ˘ Ù˘ ·ÈÌÔÔ›ËÛ˘ ÛÙËÓ Â›ÎÙËÙË ∞∞, ¤¯ÂÈ ÛÙËÚȯı› ÛÙË ÁÓÒÛË Ô˘ ·ÔÎÙ‹ıËΠٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ̤ۈ: (·) ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ (‚Ú·¯Â›·˜ Î·È Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜) (9-12), (‚) ÙˆÓ ÂÈÚ·Ì·ÙÔ˙ÒˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· Ó· ·Ó··Ú¿ÁÔ˘Ó ÚfiÙ˘· Ù˘ ʇÛˆ˜ ‹ ÚfiÙ˘· ÓÔÛËÌ¿ÙˆÓ (12) Î·È (Á) Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ Î·È ÌÔÚÈ·ÎÒÓ Ù¯ÓÈÎÒÓ (13-15). ª¤Û· ·fi ÙȘ ÁÓÒÛÂȘ ·˘Ù¤˜ Û˘ÓÂÙ¤ıË ÙÔ ıˆÚËÙÈÎfi ÚfiÙ˘Ô Ù˘ ÈÂÚ¿Ú¯ËÛ˘ Î·È ·Ó¿Ù˘Í˘ Ù˘ ·ÈÌÔÔ›ËÛ˘ Î·È ÙˆÓ ·ÔÎÏ›ÛÂˆÓ ‹ ·Ú·ÏÏ·ÁÒÓ Ù˘ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi (2,5,12). ™‡Ìʈӷ ÏÔÈfiÓ, Ì ÙÔ ÈÛ¯‡ÔÓ Û‹ÌÂÚ· ıˆÚËÙÈÎfi ÚfiÙ˘Ô Ù˘ ·ÈÌÔÔ›ËÛ˘, ¤Ó·˜ Ôχ ÌÈÎÚfi˜ ÌfiÓÔ ·ÚÈıÌfi˜ ·Ú¯¤ÁÔÓˆÓ ÌËÙÚÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, (Ù· ÔÔ›· Ì ÌÂϤÙ˜ ηٷÓÔÌ‹˜ ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ Ù˘ ÁÏ˘ÎÔ˙Ô-6-ʈÛÊÔÚÈ΋˜ ‰Â¸‰ÚÔÁÂÓ¿Û˘ (G-

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

6PD) Û ı‹ÏÂȘ ÂÙÂÚÔ˙˘ÁÒÙ˜ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ·Ó¤Ú¯ÔÓÙ·È ÂÚ›Ô˘ Û 10-24 ÙÔÓ ·ÚÈıÌfi (16)), Û˘Óı¤ÙÔ˘Ó ÙËÓ ·Ú¯¤ÁÔÓË ·ÈÌÔÔÈËÙÈ΋ ËÁ‹ Î·È ÌfiÓÔ ·˘Ù¿ ¤¯Ô˘Ó ˘„ËÏ‹ ÈηÓfiÙËÙ· ·˘ÙÔ·Ó·Ó¤ˆÛ˘, ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È Â·Ó·Ô›ÎÈÛ˘ (5,12-17). ∞fi ·Ó·Ï‡ÛÂȘ ÎψÓÈÎfiÙËÙ·˜ Ù˘ ‰È·‰Ô¯‹˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÌÈÎÚfi˜ Î·È ÌfiÓÔÓ ·ÚÈıÌfi˜ Ù¤ÙÔÈˆÓ È‰È·›ÙÂÚ· ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ, ÙˆÓ ·ÏËıÈÓÒÓ ·Ú¯¤ÁÔÓˆÓ ÌËÙÚÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (Stem cellsSC), ·ÚΛ ÁÈ· ÙËÓ Â·Ó·Ô›ÎÈÛË ÙÔ˘ ªO (12,18,19). ∞fi Ù· ·ÙÙ·Ú· ·˘Ù¿, ̤ۈ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È ‰È·‰Ô¯ÈÎÒÓ ÌÈÙÒÛÂˆÓ ÚÔ·ÙÂÈ ¤Ó·˜ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌËÙÈο Î·È ‰È·ÊÔÚÔÔÈÔ‡ÌÂÓÔ˜ ÏËı˘ÛÌfi˜ ·ÈÌÔÔÈËÙÈÎÒÓ ·ÔÁfiÓˆÓ, Ù· ÔÔ›· ·ÎÔÏÔ˘ıÒÓÙ·˜ ¿ÓÙÔÙ ̛· ÛÔÊ‹ ÈÂÚ·Ú¯È΋ ÔÚÁ¿ÓˆÛË, ·ÔÙÂÏÔ‡Ó ÙÂÏÈο ÙÔÓ Û˘ÓÔÏÈÎfi ˙ˆÙÈÎfi ·ÈÌÔÔÈËÙÈÎfi ¯ÒÚÔ. ŸÛÔ ‰Â ·˘Í¿ÓÂÈ, ÌÂÙ¿ ·fi οı ̛وÛË, Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÙfiÛÔ ÙÔ ÔÛÔÛÙfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Â›Ó·È «Â˘·ÈÛıËÙÔÔÈË̤ӷ» ÁÈ· Ó· ˘·ÎÔ‡ÛÔ˘Ó ÛÙË ÌÂÙ¿‰ÔÛË ÂÓfi˜ Û‹Ì·ÙÔ˜, ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ù· ¢·ÈÛıËÙÔÔÈË̤ӷ ·˘Ù¿ ·ÙÙ·Ú· ‰¤¯ÔÓÙ·È ÈÔ Â‡ÎÔÏ· ÂÈÚÚÔ¤˜ ·fi ÂÓ‰ÔÁÂÓ›˜ ‹ Â͈ÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜ Î·È ˘fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ ¢ԉÒÓÂÙ·È Ë ÙÂÏÈ΋ ÙÔ˘˜ ‰È·ÊÔÚÔÔ›ËÛË, ÂÓÒ ·Ú¿ÏÏËÏ· ÂÏ·ÙÙÒÓÂÙ·È ÛËÌ·ÓÙÈο Ë ÔÏÏ·Ï·ÛÈ·ÛÙÈ΋ ÙÔ˘˜ ÈηÓfiÙËÙ· (12). ¶·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› OÈ Î˘ÚÈfiÙÂÚ˜ ·fi„ÂȘ Ô˘ ÂÈÎÚ·ÙÔ‡Ó Û‹ÌÂÚ·, ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ Â›ÎÙËÙ˘ ∞∞, ·ÊÔÚÔ‡Ó: ·) ÙËÓ ÔÛÔÙÈ΋ ‹/Î·È ÔÈÔÙÈ΋ ‚Ï¿‚Ë ÙˆÓ SC, ‚) ÙË ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ªO, Á) ÙËÓ ·ÚÔ˘Û›· ·ÓÒÌ·Ï˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·È Ù¤ÏÔ˜ ‰) ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÙˆÓ ·ÓˆÙ¤Úˆ (3,5,6,12,13,20). ∏ ·ÚÔ˘Û›· Ù˘ ÔÛÔÙÈ΋˜ ·ÏÏ¿ Î·È Ù˘ ÔÈÔÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ ÙˆÓ SC ÛÙËÓ ∞∞, ˘fi ÙËÓ ¤ÓÓÔÈ· Ù˘ ÂÏ·Ùو̤Ó˘ ÔÏÏ·Ï·ÛÈ·ÛÙÈ΋˜ Î·È Â·Ó·ÔÈÎÈÛÙÈ΋˜ ÙÔ˘˜ ÈηÓfiÙËÙ·˜, Û‹ÌÂÚ· Â›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙË (14,20,21). ¶ÔÏϤ˜ ÌÂϤÙ˜, ·Ï·ÈfiÙÂÚ˜ ·ÏÏ¿ Î·È ÚfiÛÊ·Ù˜, ¤¯Ô˘Ó ·ԉ›ÍÂÈ ÂÏ·Ùو̤ÓË ·Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ Ù˘ ÂÚ˘ıÚ¿˜ Î·È Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜ Û ·ÛıÂÓ›˜ Ì ∞∞, ÙfiÛÔ Û ‚Ú·¯Â›·˜ fiÛÔ Î·È Û ̷ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ (9-12) ÂÓÒ ·Ú¿ÏÏËÏ· Â›Ó·È ÁÓˆÛÙfi, fiÙÈ Î·Ù¿ ÙÔÓ ¯ÚfiÓÔ ÎÏÈÓÈ΋˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ∞∞, Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙˆÓ SC Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ÙÔ˘ 1%, ÙÔ˘ ˘fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙÔ˘˜ (12). ª›· ıˆÚËÙÈ΋ ÚÔÛ¿ıÂÈ· ÂÚÌËÓ›·˜ Ù˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ Ù˘ Â›ÎÙËÙ˘ ∞∞, ·Ó¿ÏÔÁ· Ì ÙÔ˘˜ ÂοÛÙÔÙ ÂÎÏ˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÙÔÓ ÔÈΛÏÔ ‚·ıÌfi Ù˘ ΢ÙÙ·ÚÈÎfiÙËÙ·˜ ÙÔ˘ ªO, ÙË ‰È·ÊÔÚÂÙÈ΋ ÎÏÈÓÈ΋

463

NOV.-DEC.2000(ÙÂÏÈÎfi N)

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469

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ÔÚ›·, ÙË ÛÔÚ·‰È΋ ·ÚÔ˘Û›· ·˘ÙfiÌ·Ù˘ ›·Û˘ Î·È Ù¤ÏÔ˜ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ıÂÚ·¢ÙÈ΋ ·ÓÙ·fiÎÚÈÛË Î·È ÚfiÁÓˆÛË, ·ÔÙÂÏ› Ë ÚfiÙ·ÛË ‰‡Ô ‰È·ÊÔÚÂÙÈÎÒÓ Ù‡ˆÓ ‚Ï¿‚˘ ÙˆÓ SC, ÙÔ˘ ∆‡Ô˘ π Î·È ÙÔ˘ ∆‡Ô˘ ππ. ™ÙË ‚Ï¿‚Ë ∆‡Ô˘ π ·Ú·‚Ï¿ÙÂÙ·È Ô ÎÔÚ˘Ê·›Ô˜ ÏËı˘ÛÌfi˜ ÙˆÓ ϤÔÓ ·Ú¯¤ÁÔÓˆÓ SC, Ì ÙȘ ÌÂÁ¿Ï˜ ‰˘Ó·ÙfiÙËÙ˜ ·˘ÙÔ·Ó·Ó¤ˆÛ˘ Î·È ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡, ‰ËÏ·‰‹ Ô Î˘ÙÙ·ÚÈÎfi˜ ÏËı˘ÛÌfi˜ Ô ÔÔ›Ô˜ ÛÙËÚ›˙ÂÈ ÔÏfiÎÏËÚÔ ÙÔ ÔÈÎÔ‰fiÌËÌ· Ù˘ ·ÈÌÔÔ›ËÛ˘. ∆· ·ÙÙ·Ú· ·˘Ù¿ Û˘Ó‹ıˆ˜ ‚Ú›ÛÎÔÓÙ·È Û ʿÛË ËÚÂÌ›·˜ (G0) ˆ˜ ÚÔ˜ ÙËÓ ‰È·‰Èηۛ· ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÈÙÒÛÂˆÓ Î·È ¤ÙÛÈ Û˘Ó‹ıˆ˜ ‰È·Ê‡ÁÔ˘Ó ÙˆÓ ‚Ï·‚ÒÓ Ô˘ ÔÈ ÙÔÍÈÎÔ›, Â͈ÁÂÓ›˜ ΢ڛˆ˜, ·Ú¿ÁÔÓÙ˜ ÚÔηÏÔ‡Ó. O Ù‡Ô˜ ·˘Ùfi˜ Ù˘ ‚Ï¿‚˘ Û˘Ó‰˘¿˙ÂÙ·È Ì ‰ÔÌÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ DNA ÙˆÓ ϤÔÓ ·ÒÚˆÓ ÌËÙÚÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˘ ‚·Ú‡ÙËÙ·˜ Î·È Û˘Ó‹ıˆ˜ Ë ÂÈÛ˘Ì‚·›ÓÔ˘Û· ‰È·Ù·Ú·¯‹ Â›Ó·È ÌË ·Ó·ÛÙÚ¤„ÈÌË Î·È ·ÓÂ·ÓfiÚıˆÙË (12). ¶·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó ·ÈÙÈÔ·ıÔÁÂÓÂÙÈο Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ∆‡Ô˘ π ‚Ï¿‚Ë, Â›Ó·È Ë ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·, ÙÔ ‚ÂÓ˙¤ÓÈÔ, ÔÚÈṲ̂ӷ Ê¿Ú̷η Î·È ¯ËÌÈΤ˜ Ô˘Û›Â˜ (3,12,22-24). ∞ÓÙ›ıÂÙ· ÛÙË ‚Ï¿‚Ë ∆‡Ô˘ ππ, Ô ÎÔÚ˘Ê·›Ô˜ ÏËı˘ÛÌfi˜ ÙˆÓ SC ·Ú·Ì¤ÓÂÈ ·ÏÒ‚ËÙÔ˜ Î·È ‚Ï¿ÙÔÓÙ·È Ù· ‰È·ÊÔÚÔÔÈÔ‡ÌÂÓ· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ ‚¿Ûˆ˜ Ù˘ ˘Ú·Ì›‰·˜, Ù· ÔÔ›· ηٿ ηÓfiÓ· ‚Ú›ÛÎÔÓÙ·È Û ΢ÙÙ·ÚÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∏ ‚Ï¿‚Ë ·˘Ù‹ ·ÊÂÓfi˜ ·ÊÔÚ¿ ÈÔ ÒÚÈÌ· ·ÙÙ·Ú·, ·ÊÂÙ¤ÚÔ˘ Ê·›ÓÂÙ·È fiÙÈ Èı·Ófiٷٷ ÛÙÚ¤ÊÂÙ·È ÂÓ·ÓÙ›ÔÓ ÔÚÁ·Ó˘Ï›ˆÓ ‹ Ì·ÎÚÔÌÔÚ›ˆÓ ÙÔ˘ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜, ÂÌÔ‰›˙ÔÓÙ·˜ ¤ÙÛÈ ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÌÂÙ·‚ÔÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ (12). ∞fi Ù· ·Ú·¿Óˆ Û˘Ó¿ÁÂÙ·È fiÙÈ Ë ÂÓ ÏfiÁˆ ‚Ï¿‚Ë Â›Ó·È ÂÏ·ÊÚ‡ÙÂÚË Î·È ·Ó·ÛÙÚ¤„ÈÌË Î·È Â˘Ù˘¯Ò˜ ·ÊÔÚ¿ ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ì Â›ÎÙËÙË ∞∞. µÏ¿‚Ë ∆‡Ô˘ ππ Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔÎÏËı› ·fi ÈÔ‡˜, Ê¿Ú̷η, ÙÔ͛Ә ‹ Ó· Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·Ù·ÛÙÚÔÊ‹˜ (12-14,20-33). °È· Ó· ·ÔÎÏÂÈÛı› ÙÔ ÂӉ¯fiÌÂÓÔ Ó· «ÊÙ·›ÂÈ ÙÔ ¯ÒÌ· Î·È fi¯È Ô ÛfiÚÔ˜», ÌÂÏÂÙ‹ıËΠÂÎÙÂٷ̤ӷ Î·È Ë Èı·Ó‹ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ªO ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ Â›ÎÙËÙ˘ ∞∞ (10,11,16,20,34). Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÔÏÏ·Ϥ˜ ÎÏÈÓÈΤ˜ in vivo ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· Î·È ·fi in vitro ÌÂϤÙ˜ Û ̷ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ì Â›ÎÙËÙË ∞∞ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Î·È ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜, ÂÓÒ Ê·›ÓÂÙ·È ·ÓÒÌ·ÏË Î·È ‰È·Ù·Ú·Á̤ÓË Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ SC (9-12). ∆Ô‡ÙÔ Â›Ó·È È‰È·›ÙÂÚ· ÚÔÊ·Ó¤˜ Û ÌÂϤÙ˜ Ì ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ· ÂÈÚ¿Ì·Ù· fiÔ˘ ·ÙÙ·Ú· ÛÙÚÒÌ·ÙÔ˜ ·ÛıÂÓÒÓ Ì ∞∞, ˘ÂÛÙ‹ÚÈÍ·Ó ÈηÓÔÔÈËÙÈο ÙËÓ ·Ó¿Ù˘ÍË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ‰fiÙ˜,

464

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË

ÂÓÒ ·ÓÙÈı¤Ùˆ˜ Ù· SC (CD34+) ·ÙÙ·Ú· ÙˆÓ ·ÛıÂÓÒÓ Ì ∞∞, ÂÌÊ¿ÓÈÛ·Ó ÊÙˆ¯‹ ·Ó¿Ù˘ÍË Û ·Ó¿ÏÔÁ˜ ηÏÏȤÚÁÂȘ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÛÙÚÒÌ· (9-12,16,20, 34). °È· Èı·Ó‹ Û˘ÌÌÂÙÔ¯‹ Ù˘ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ù˘ ·ÚÔ˘Û›·˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ¤¯Ô˘Ó Â›Û˘ Á›ÓÂÈ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (12,13,17,35,36). ∆· ‰Â‰Ô̤ӷ ÙÔ˘˜ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙÔ fiÙÈ Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ Â›Ó·È ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ∞∞ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÛÙÔ ·ÚfiÓ ¿ÚıÚÔ ‰ÂÓ ı· Û˘˙ËÙËıÔ‡Ó ·Ó·Ï˘ÙÈο. ∞Í›˙ÂÈ fï˜, Ó· ÛËÌÂȈı› fiÙÈ Ë ÂοÛÙÔÙ Â¿ÚÎÂÈ¿ ÙÔ˘˜, Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙÔ ıÂÙÈÎfi ÈÛÔ˙‡ÁÈÔ Ù˘ ·ÈÌÔÔ›ËÛ˘ Î·È ·ÓÙÈı¤Ùˆ˜ (37,38). ¶¤Ú·Ó Ù˘ ‰È·Ù‡ˆÛ˘ fiÏˆÓ ÙˆÓ ·ÓˆÙ¤Úˆ ıˆÚËÙÈÎÒÓ ÚÔÙ‡ˆÓ ·Ó¿Ù˘Í˘ Ù˘ Â›ÎÙËÙ˘ ∞∞, Ë ·ÚÔ˘Û›· ÂÓfi˜ ˘ÔΛÌÂÓÔ˘ ÈÛ¯˘ÚÔ‡ ·˘ÙÔ·ÓfiÛÔ˘ Ì˯·ÓÈÛÌÔ‡ Ô˘ ÛÙÚ¤ÊÂÙ·È Î·Ù·ÛÙÚÔÊÈο ¤Ó·ÓÙÈ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙË (13,20,33). ª›· ÛÂÈÚ¿ ÎÏÈÓÈÎÒÓ ·Ú·ÙËÚ‹ÛˆÓ, Ô˘ ÂȂ‚·ÈÒıËÎ·Ó ÛÙË Û˘Ó¤¯ÂÈ· Î·È ÂÈÚ·Ì·ÙÈο, ¤‰ˆÛ·Ó ÙÔ ÛÙ›ÁÌ· Ù˘ ÈÛ¯˘Ú‹˜ Î·È ‰˘Ó·ÌÈ΋˜ ·ÚÔ˘Û›·˜ Ù˘ ‰È·Ù·Ú·Á̤Ó˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ηٿ ÙˆÓ SC Î·È Î·Ù’ Â¤ÎÙ·ÛË ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ÚfiÏÔ˘ Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ ÛÙËÓ ÂÓ ÏfiÁˆ ‰È·‰Èηۛ· (39-42). ∏ ÚÒÙË ·Ú·Ù‹ÚËÛË Ô˘ ¤ıÂÛ ˘fiÓÔȘ ÁÈ· ÙËÓ ‡·ÚÍË ˘ÔΛÌÂÓÔ˘ ·˘ÙÔ·ÓfiÛÔ˘ Ì˯·ÓÈÛÌÔ‡ ÛÙËÓ ∞∞ ¤ÁÈÓ ·fi ÙÔÓ Mathé Î·È Û˘Ó., fiÙ·Ó ·Ú·Ù‹ÚËÛÂ Î·È ÂÚȤÁÚ·„ ¤Ó·Ó ·ÛıÂÓ‹ ÙÔ˘ Ì ∞∞, Ô ÔÔ›Ô˜ ·Ú¯Èο ˘‚ϋıË Û ·ÏÏÔÁÂÓ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÛÙË Û˘Ó¤¯ÂÈ· ·¤ÚÚÈ„Â ÙÔ ·ÏÏÔÁÂÓ¤˜ ÌfiÛ¯Â˘Ì· Î·È ÙÂÏÈο ÚÔ˜ ÌÂÁ¿ÏË ÙÔ˘˜ ¤ÎÏËÍË ÚÔ‹Á·Á ·˘Ùfi¯ıÔÓË ·ÈÌÔÔ›ËÛË (43). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ·Ô‰fiıËΠÛÙËÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÚÔÂÙÔÈÌ·Û›·˜ ÛÙÔ ÔÔ›Ô Â›¯Â ˘Ô‚ÏËı› Ô ·ÛıÂÓ‹˜ (conditioning regimen), ÛÙ· Ï·›ÛÈ· Ù˘ ÂÈΛÌÂÓ˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ (43,44). ∏ ‰Â‡ÙÂÚË ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË ·ÚÔ˘Û›·˜ ˘ÔΛÌÂÓ˘ ·˘ÙÔ·ÓfiÛÔ˘ Ù‡Ô˘ ηٷÛÙÚÔÊ‹˜ ÛÙËÓ Â›ÎÙËÙË ∞∞, ÚԤ΢„ ·fi ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ ÁÈ· ÙËÓ ·ÏÈÓfiÚıˆÛË Ù˘ ·ÈÌÔÔ›ËÛ˘, Û ÌÂÙ·ÌÔۯ‡ÛÂȘ ÌÂٷ͇ ÌÔÓÔˆ˚ÎÒÓ ‰È‰‡ÌˆÓ, ‰ÂÓ ·ÚΛ ÌfiÓÔ Ë ¯ÔÚ‹ÁËÛË ÔÈÔÙÈο ·Î¤Ú·ÈˆÓ SC, Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 50% ÙˆÓ ·ÛıÂÓÒÓ, ·ÏÏ¿ ··ÈÙÂ›Ù·È ÂÈϤÔÓ, ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi ÚÔ·Ú·Û΢·ÛÙÈÎfi Û¯‹Ì· (13,45-48). ™Ù·Ø Ï·›ÛÈ· Ù˘ Û˘ÓÔÏÈ΋˜ ηٷÛÙÔÏ‹˜/ηٷÛÙÚÔÊ‹˜ Ù˘ ·ÈÌÔÔ›ËÛ˘, ‰ÂÓ ·ÔÎÏ›ÂÙ·È Î·È Ë ¿ÌÂÛË Â·Ê‹ ÙˆÓ ∆ ΢ÙÙ·ÚÔÙÔÍÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì ٷ ·ÈÌÔÔÈËÙÈο «Î‡ÙÙ·Ú· - ÛÙfi¯Ô˘˜» Î·È Ë ı·Ó·ÙËÊfiÚÔ˜ ÂÓ·ÓÙ›ÔÓ ÙÔ˘˜ ‰Ú¿ÛË (20). ∂ÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·465

¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469

OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ˆ˜ ˘‡ı˘ÓÔÈ Ù˘ ˘ÚÔ‰fiÙËÛ˘ Ù˘ ‰È·‰Èηۛ·˜, Ë ÔÔ›· ÛÙÚ¤ÊÂÙ·È ÂÓ·ÓÙ›ÔÓ Ù˘ ·ÈÌÔÔ›ËÛ˘, Â›Ó·È ÔÏÏÔ›, Û ¯ÚfiÓÔ ¿ÌÂÛÔ ‹ ¤ÌÌÂÛÔ, Ì ÈÔ ÁÓˆÛÙÔ‡˜ ÙÔ˘˜ ÈÔ‡˜ Î·È Ù· Ê¿Ú̷η. ∏ ÙÂÏÈ΋ Â›ıÂÛË ÙËÓ ÔÔ›· ‰¤¯ÔÓÙ·È Ù· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú·, ·fi Ù· ∆-΢ÙÙ·ÚÔÙÔÍÈο ÏÂÌÊÔ·ÙÙ·Ú· fiÙ·Ó ·˘Ù¿ ÚÔÛ‚ÏËıÔ‡Ó ·fi οÔÈÔ Èfi ‹ ˘ÔÛÙÔ‡Ó ÙË ‚Ï·ÙÈ΋ ‰Ú¿ÛË Ê·ÚÌ¿ÎˆÓ ‹ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ ‹ ÌÂÙ·ÏÏ·¯ıÔ‡Ó Ì¤Ûˆ ÔÈÎ›ÏˆÓ ÁÂÓÂÙÈÎÒÓ ‚Ï·‚ÒÓ, Ô‰ËÁ› ÛÙËÓ ÂÈÎfiÓ· Ù˘ Ì˘ÂÏÈ΋˜ ·Ï·Û›·˜ (25). πÔ› Î·È Â›ÎÙËÙË ∞∞ πÔ› ·fi ‰È·ÊÔÚÂÙÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Â›Ó·È ÈηÓÔ› Ó· ÌÔχÓÔ˘Ó Ù· ·ÙÙ·Ú· ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ªO Î·È Ó· ÚÔηϤÛÔ˘Ó ‚Ï¿‚Ë Û ·˘Ù¿ ›Ù ¿ÌÂÛ·, ÚÔηÏÒÓÙ·˜ ÙÔÓ ı¿Ó·Ùfi ÙÔ˘˜ ‹ ¤ÌÌÂÛ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÌÈ· ÔÈÎÈÏ›· Ì˯·ÓÈÛÌÒÓ (25,27,31,32,52). ∏ ‚Ï·ÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÈÒÓ ÛÙ· ·ÙÙ·Ú·, Ù· fiÚÁ·Ó· ‹ ÙÔ˘˜ ÈÛÙÔ‡˜-ÛÙfi¯Ô˘˜, (¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ Î·È ı· ··Û¯ÔÏ› ¤Ó·Ó ÙÂÚ¿ÛÙÈÔ fiÁÎÔ ‚È‚ÏÈÔÁÚ·Ê›·˜ (25,27,31,32,52). ∂Ó‰ÂÈÎÙÈο ÌfiÓÔ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ Èı·ÓfiÙÂÚÔÈ Ì˯·ÓÈÛÌÔ›, ̤ۈ ÙˆÓ ÔÔ›ˆÓ ‰È¿ÊÔÚ˜ ÔÈÎÔÁ¤ÓÂȘ ÈÒÓ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ªO: ·) Ë ¿ÌÂÛË Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· (·Ú‚Ô˚fi˜), ‚) Ë ‰È·ÌÂÛÔÏ¿‚ËÛË ·˘ÙÔ¿ÓÔÛˆÓ Ì˯·ÓÈÛÌÒÓ (Èfi˜ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘ÚËÓÒÛˆ˜), Á) Ë ·Ó·ÛÙÔÏ‹ ÔÚÈÛÌ¤ÓˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ (‰¿ÁÁÂÈÔ˜) ‹ ‰) Ë Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ (΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜;) (25). ŸÏÔÈ ·˘ÙÔ› ÔÈ Ì˯·ÓÈÛÌÔ› fï˜, ‰ÂÓ ¤¯Ô˘Ó ‰È¢ÎÚÈÓÈÛı› ·Ôχو˜ ‹ ‰ÂÓ ¤¯Ô˘Ó Û˘Ó‰Âı› ¿ÓÙÔÙ ·Ô‰ÂÈÎÙÈο Ì ÙËÓ ·ÚÔ˘Û›· ‹ ÙË ‰Ú¿ÛË Î¿ÔÈÔ˘ ÈÔ‡. º¿Ú̷η Î·È Â›ÎÙËÙË ∞∞ ¶ÔÏϤ˜ Ê·Ú̷΢ÙÈΤ˜ Î·È ¯ËÌÈΤ˜ Ô˘Û›Â˜ ¤¯Ô˘Ó Û˘Ó‰Âı› ηٿ ηÈÚÔ‡˜ Ì ÙËÓ ÚfiÎÏËÛË ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ (22,53). O ηٿÏÔÁÔ˜ Â›Ó·È Ì·ÎÚ‡˜ Î·È ÂÎÙfi˜ ·fi Ù· ΢ÙÙ·ÚÔÛÙ·ÙÈο ·ÓÙÈηÚÎÈÓÈο Ê¿Ú̷η Î·È ÙÔ ‚ÂÓ˙¤ÓÈÔ, Ù· ÔÔ›· Û Â·ÚΛ˜ ‰fiÛÂȘ ÛÙ·ıÂÚ¿ Ô‰ËÁÔ‡Ó ÛÂ Ì˘ÂÏÈ΋ ·Ï·Û›·, Ù· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ¿ÏÏ· Ê¿Ú̷η ÚÔηÏÔ‡Ó ∞∞ ̤ۈ ÙˆÓ ÂÓ‰È·Ì¤ÛˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙÔ˘˜ Î·È Ì¤Ûˆ ȉÈÔÛ˘ÛÙ·ÛÈ·ÎÒÓ ·ÓÙȉڿÛÂˆÓ Û ¤Ó· ¢·›ÛıËÙÔ Î·È Â˘ÚfiÛ‚ÏËÙÔ ÂοÛÙÔÙÂ, ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ (12-23). °ÂÓÈο, Ë Ê·Ú̷΢ÙÈ΋ ÙÔÍÈÎfiÙËÙ· Â› ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·ÛÎÂ›Ù·È Ì¤Ûˆ ÙˆÓ ÂÓ‰È·Ì¤ÛˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙˆÓ Ê·Ú̿ΈÓ, ÔÈ ÔÔ›ÔÈ Û˘Ó‰¤ÔÓÙ·È Ì ÙȘ ÚˆÙ›Ó˜ Î·È ÙÔ DNA ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ (23). ∞ÎÔÏÔ˘ı› Ë ·ÒÏÂÈ· Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÔ¯‹˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÙÔ ·ÓÔÛÔÏÔÁÈÎfi Û‡ÛÙËÌ· ·Ó·ÁÓˆÚ›˙ÂÈ ˆ˜ ͤӷ Ù· ·Ú·ÏÏ·Á̤ӷ ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú· Î·È ¤ÂÙ·È Ë ·˘ÙÔ¿ÓÔÛË ‰È·‰Èηۛ· Ù˘ ηٷÛÙÚÔÊ‹˜ (20).

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

∂˘Ù˘¯Ò˜, ÔÏÏÔ› Â›Ó·È ÔÈ Ú˘ıÌÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ È‰ÈÔÛ˘ÛÙ·Ûȷ΋ ·¿ÓÙËÛË ÛÙ· Ê¿Ú̷η (20,23). ™ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÔÊ›ÏÂÙ·È fi¯È ÌfiÓÔ Ë ÔÏ˘ÏÔÎfiÙËÙ· Ù˘ ‰Ú¿Û˘ ÙÔ˘˜, ·ÏÏ¿ Î·È Ë Û·ÓÈfiÙËÙ· Ê·Ú̷΢ÙÈ΋˜ ÚfiÎÏËÛ˘ Â›ÎÙËÙ˘ ∞∞. ™˘ÓÔÙÈο, ÔÈ ·ÏÏËÏÂȉڿÛÂȘ ÌÂٷ͇ ÌÂÙ·‚ÔÏÈÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ È‰ÈÔÛ˘ÛÙ·Ûȷ΋ ÙÔ˘˜ ‰Ú¿ÛË, Ë ÔÔ›· ÙÂÏÈο ηٷϋÁÂÈ ÛÂ Ì˘ÂÏÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÊÔÚ¿ ¿ÌÂÛË ÁÂÓÂÙÈ΋ ‹ ÌÂÙ·‚ÔÏÈ΋ ‚Ï¿‚Ë Ì Â·ÎfiÏÔ˘ıË ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ DNA Î·È ÙÂÏÈο ÚfiÎÏËÛË ·˘ÙÔ·ÓfiÛÔ˘ ηٷÛÙÚÔÊ‹˜ (·ÏÏÔ›ˆÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ Ú‡ıÌÈÛ˘) (23). µ. ∫ÏËÚÔÓÔÌÔ‡ÌÂÓË ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· OÈ ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (54-56). ∏ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ·˘ÙÒÓ, ¯ˆÚ›˜ Ó· ıˆÚÔ‡ÓÙ·È ˘Ô¯ÚˆÙÈΤ˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, Â›Ó·È ‰˘Ó·Ùfi Ó· ‚ÔËı‹ÛÂÈ ÛÙÔÓ ¤ÁηÈÚÔ Î·ıÔÚÈÛÌfi ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÙˆÓ ÂÚ·ÈÙ¤Úˆ ÂȉڿÛÂˆÓ Â› Ù˘ ·ÈÌÔÔ›ËÛ˘, Ì ÙȘ Ôԛ˜ ÙÔ ÂοÛÙÔÙ ۇӉÚÔÌÔ Û˘Ó‰¤ÂÙ·È, Ôχ ÚÈÓ ÂΉËψı› Ë Ï‹Ú˘ ·ıÔÏÔÁÈ΋ ·ÈÌ·ÙÔÏÔÁÈ΋ ÂÈÎfiÓ· (57). ∆· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ıˆÚÔ‡ÓÙ·È Û¿ÓÈ· ÓÔÛ‹Ì·Ù·, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· fï˜, Â›Ó·È Ôχ Èı·ÓfiÓ Ë ÙÂÏÈ΋ Û˘¯ÓfiÙËÙ· ÙÔ˘ ηıÂÓfi˜ ·fi ·˘Ù¿, ·ÏÏ¿ Î·È Ë Û˘ÓÔÏÈ΋ ÙÔ˘˜ Û˘¯ÓfiÙËÙ· ηıÒ˜ Î·È Ë ÛËÌ·Û›· ÙÔ˘˜, Û˘¯Ó¿ Ó· ˘ÔÙÈÌ¿Ù·È ÛÔ‚·Ú¿! OÈ ÏfiÁÔÈ Ù˘ ˘ÔÙ›ÌËÛ˘ ·˘Ù‹˜ ÔÊ›ÏÔÓÙ·È: ÛÙËÓ ·ÓÂ·Ú΋ ‰È¿ÁÓˆÛË, ÛÙËÓ ÂÏÏÈ‹ ηٷÁÚ·Ê‹, ÛÙËÓ ÏËÌÌÂÏ‹ ·Ó·ÎÔ›ÓˆÛ‹ ÙÔ˘˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ÛÙËÓ Â˘Ú›· ‰È·ÛÔÚ¿ ÙˆÓ ·ÛıÂÓÒÓ Û ÔÏϤ˜ ËÏÈ˘ Î·È Î˘Ú›ˆ˜ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì¤¯ÚÈ ÚÔ ‰ÂηÂÙ›·˜ ÂÚ›Ô˘, Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ÛÙËÚÈ˙fiÙ·Ó Î·Ù’ ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· ÛÙËÓ ÎÏÈÓÈ΋ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙÔ˘˜. °È· ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ¢ı˘ÓfiÙ·Ó Ë ·Ó˘·ÚÍ›· ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ ÂϤÁ¯Ô˘ Î·È ÙÂÎÌËÚ›ˆÛ˘ Ù˘ ‰È¿ÁÓˆÛ˘. ∂Ó‰ÂÈÎÙÈο, ÙÚÂȘ ÌfiÓÔÓ ·ÚÈıÌÔ› Â›Ó·È ÈηÓÔ› Ó· ‰ÒÛÔ˘Ó ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, Ô˘ ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÙÔ ·Áfi‚Ô˘ÓÔ Î¿Ùˆ ·fi ÙÔ ÓÂÚfi. ™˘ÁÎÂÎÚÈ̤ӷ: 1. ∆Ô 25-30% ÙÔ˘ Û˘ÓfiÏÔ˘ Ù˘ ·È‰È΋˜ ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ Èı·Ófiٷٷ Û˘Ì‚·›ÓÂÈ Â› «‰È·Ù·Ú·Á̤ÓÔ˘» ÁÂÓÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜, ÙÔ ÔÔ›Ô ÙÂÏÈο Ê·›ÓÂÙ·È Ó· ÂÓ¤¯ÂÙ·È ÛÙËÓ ÚfiÎÏËÛË Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (54,55-58).

2. ∆Ô 5-10% ÙˆÓ ·ÛıÂÓÒÓ Ì ‰È·ÁÓˆṲ̂ÓË Â›ÎÙËÙË ∞∞ ÌÂÁ¿ÏˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Î·È ıÂÚ·¢ÙÈÎÒÓ Î¤ÓÙÚˆÓ, ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ¿Û¯Ô˘Ó ÙÂÏÈο ·fi ·Ó·ÈÌ›· Fanconi (55).

3. À¿Ú¯ÂÈ ¤ÓÙÔÓË ·›ÛıËÛË fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÙÂ-

465

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·466

¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469

ÚÔ˙˘ÁˆÙÒÓ Ù˘ ·Ó·ÈÌ›·˜ Fanconi ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ÛÙȘ ∏¶∞ Î·È ∂˘ÚÒË ‰˘Ó·ÙfiÓ Ó· ·Ó¤Ú¯ÂÙ·È Û 1/300 (5,55,59). ∆· ÎÏ·ÛÈο Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·Ï·Û›· Î·È ÙˆÓ 3 Ì˘ÂÏÈÎÒÓ ÛÂÈÚÒÓ, Â›Ó·È Ë ·Ó·ÈÌ›· Fanconi, Ë ™˘ÁÁÂÓ‹˜ ¢˘ÛÎÂÚ¿ÙˆÛË Î·È ÙÔ ™‡Ó‰ÚÔÌÔ Schwachman-Diamond ÂÓÒ ÂÎÙfi˜ ·fi ·˘Ù¿, ˘¿Ú¯Ô˘Ó Ù‡ÔÈ ∞∞ ÛÔÚ·‰Èο ÂÌÊ·ÓÈ˙fiÌÂÓÔÈ ÌÂ Ê˘ÛÈΤ˜ ·ÓˆÌ·Ï›Â˜, Î·È Ù‡ÔÈ ∞∞ ÔÈÎÔÁÂÓÒ˜ ÌÂÙ·‰È‰fiÌÂÓÔÈ Ì ‹ ¯ˆÚ›˜ Ê˘ÛÈΤ˜ ·ÓˆÌ·Ï›Â˜. ªÂٷ͇ ·˘ÙÒÓ ÂÈϤ¯ıËÎÂ Ë Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ, ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ·Ó·ÈÌ›·˜ Fanconi, ˆ˜ ÙÔ˘ ·ÚÈÔ˘ ÂÎÚÔÛÒÔ˘ ÌÂٷ͇ ÙˆÓ ÎÏËÚÔÓÔÌÔ‡ÌÂÓˆÓ Û˘Ó‰ÚfiÌˆÓ Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ˆ˜ ÚfiÙ˘Ô˘ ÓÔÛ‹Ì·ÙÔ˜ ÌÂϤÙ˘. ¶Ú·ÁÌ·ÙÈο, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ó·Ù˘¯ı› ÌÈ· ‰˘Û·Ó¿ÏÔÁË Ì ÙËÓ ÚÔËÁÔ‡ÌÂÓË ‰ÂηÂÙ›· Î·È ÚˆÙÔÊ·ÓÔ‡˜ ÌÂÁ¤ıÔ˘˜ ÂÈÛÙËÌÔÓÈ΋ ·Ó·˙‹ÙËÛË ÛÙ· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∂ȉÈÎfiÙÂÚ· ÛÙËÓ ·Ó·ÈÌ›· Fanconi ˘¿Ú¯Ô˘Ó ÂÓÙ˘ˆÛȷο ·ÔÙÂϤÛÌ·Ù· Ô˘ ÌÔÚÔ‡Ó Ó· ÂÂÓ‰˘ıÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÛÙË ‰È¿ÁÓˆÛË ·ÏÏ¿ Î·È ÛÙË ıÂÚ·›· ÔχÏÔÎÔ˘ ·˘ÙÔ‡ ÁÂÓÂÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Î·È ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ›Ûˆ˜ ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÙÔ˘ ‰È¿ÁÓˆÛË. ∏ ·Ó·ÈÌ›· Fanconi (FA) Â›Ó·È ÓfiÛËÌ· ÌÂÙ·‚È‚·˙fiÌÂÓÔ Ì ÙÔÓ ÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÚÔÛ‚¿ÏÏÂÈ Ù· ¿ÚÚÂÓ· Û ۯ¤ÛË Ì ٷ ı‹Ï· ¿ÙÔÌ· Û ·Ó·ÏÔÁ›· 1,3:1 (5). ∏ ̤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÁÈ· ÌÂÓ Ù· ·ÁfiÚÈ· Â›Ó·È Ù· 7,9 ¤ÙË, ÂÓÒ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ~ ·Ó¤Ú¯ÂÙ·È ÛÙ· 9 ¤ÙË ~ (5,55,59). ∏ Ù˘È΋ ÂÈÎfiÓ· Ù˘ ·Ó·ÈÌ›·˜ Fanconi ·ÊÔÚ¿ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ·ÓÒÌ·ÏÔ˘˜ ·ÓÙ›¯ÂÈÚ˜, café au lait ÎËÏ›‰Â˜, ÌÈÎÚÔÎÂÊ·Ï›·, ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆÂ›Ô Î·È ˘ÔÁÔÓ·‰ÈÛÌfi ÙˆÓ ·ÚÚ¤ÓˆÓ (5,59), ÂÓÒ Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› ȉȷ›ÙÂÚ· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 33% ( 1/3) ÙˆÓ ·ÛıÂÓÒÓ Ì Fanconi ÂÌÊ·Ó›˙ÂÈ Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÙ˘Ô, ÔÈ ‰Â ˘fiÏÔÈÔÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÌÔӈ̤Ó˜ ‹ ÔÏÏ·Ϥ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒÓÂÙ·È ·Á΢ÙÙ·ÚÔÂÓ›· Ù˘ ÔÔ›·˜ ηٿ ηÓfiÓ· ÚÔËÁÂ›Ù·È ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÌÔӈ̤Ó˘ ıÚÔÌ‚ÔÂÓ›·˜ ‹ Ï¢ÎÔÂÓ›·˜. ™ÙÔ Â›¯ÚÈÛÌ· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ˘¿Ú¯ÂÈ Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË ÌÂ Û˘ÓÔ‰fi ‹ÈÔ˘ ‚·ıÌÔ‡ ·ÓÈÛÔ΢ÙÙ¿ÚˆÛË Î·È ÔÈÎÈÏÔ΢ÙÙ¿ÚˆÛË. ∂ÈϤÔÓ, ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ F, ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ i, ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÂÚ˘ıÚÔÔÈËÙ›Ó˘ ÂÓÒ ·Ú¿ÏÏËÏ· Ê·›ÓÂÙ·È fiÙÈ Ë ÂÈ‚›ˆÛË ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Â›Ó·È Û¯ÂÙÈο ÂÏ·Ùو̤ÓË. ªÂϤÙ˜ Ù˘ ÎÈÓËÙÈ΋˜ ÙÔ˘ Fe ·Ô‰ÂÈÎÓ‡Ô˘Ó ÌË ·Ô‰ÔÙÈ΋ ÂÚ˘ıÚÔÔ›ËÛË Î·È ·ÓÂ·Ú΋ Ì˘ÂÏÈ΋ ÏÂÈÙÔ˘ÚÁ›·. O Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ Â›Ó·È ÏÈ҉˘, ˘Ô΢ÙÙ·ÚÈÎfi˜ Ì ϛÁ· ·ÈÌÔÔÈËÙÈο ÛÙÔȯ›· Î·È Û¯ÂÙÈο ·˘ÍË̤ÓÔ ·ÚÈı-

466

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË

Ìfi ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ, Ï·ÛÌ·ÙÔ΢ÙÙ¿ÚˆÓ Î·È ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (5,54,59). ∏ ·Ó·ÈÌ›· Fanconi ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ÚԉȿıÂÛË ÁÈ· ·Ó¿Ù˘ÍË Î·ÎÔËıÂÈÒÓ, ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ·ÛÙ¿ıÂÈ·˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ë ÔÔ›· ·Ó·‰ÂÈÎÓ‡ÂÙ·È ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ· ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì ÎÏ·ÛÙÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ÌÈÙÔÌ˘Î›ÓË Î·È Ë ‰ÈÂÔ͢‚Ô˘Ù¤ÓË (DEB) (5,59-63). ªÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ‰È·ÈÛÙÒÓÔÓÙ·È Ù· ϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛÔ˘, Ô˘ Â›Ó·È Ù· ıÚ·‡ÛÌ·Ù·, ÔÈ ÌÂÙ·ı¤ÛÂȘ Î·È Ë ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ·›Ì·ÙÔ˜. ∂ÈÚfiÛıÂÙ·, Ô ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·›Ì·ÙÔ˜ Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜, ·Ô‰ÂÈÎÓ‡ÂÈ ÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ÛÙÔ ÌÂÙ·›¯ÌÈÔ ÌÂٷ͇ ÙˆÓ Ê¿ÛÂˆÓ G2 Î·È ª ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘ (59,60). ∏ ¯ÚˆÌÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË Ì ÙË ¯Ú‹ÛË ÌÈÙÔÌ˘Î›Ó˘ ‹ ‰ÈÂÔ͢‚Ô˘Ù¤Ó˘ (DEB) ›ӷÈ: 1. π‰È·›ÙÂÚ· ÔχÙÈÌË ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË Ù˘ ÓfiÛÔ˘, fiÔ˘ ·˘Ù‹ ÎÏÈÓÈο ‰ÂÓ Â›Ó·È Ù˘È΋ (.¯. Û ¤Ó· ·È‰› ÌÂ Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· ‹ Û Ó·Úfi ÂÓ‹ÏÈη ÌÂ Û˘Ì·Á‹ fiÁÎÔ, ¯ˆÚ›˜ Ê˘ÛÈΤ˜ ·ÓˆÌ·Ï›Â˜).

2. ∂˘·›ÛıËÙË Î·È ÂȉÈ΋ ̤ıÔ‰Ô˜ (95%).

3. ∞ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ÛÙÔ ÛÙ¿‰ÈÔ Ù˘ ÙÚÔÊÔ‚Ï¿ÛÙ˘ (·ËÛË 6-8 ‚‰ÔÌ¿‰ˆÓ) ‹ ÙËÓ ·ÌÓÈÔΤÓÙËÛË (·ËÛË 10-12 ‚‰ÔÌ¿‰ˆÓ).

4. πηӋ Ó· ‰È·ÎÚ›ÓÂÈ ÙËÓ FA ·fi ÙËÓ Â˘ıÚ·˘ÛÙfiÙËÙ· Ô˘ ··ÓÙ¿Ù·È Û ¿ÏÏ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ù· Û‡Ó‰ÚÔÌ· BloÔm Î·È ·Ù·Í›·˜ - ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜.

5. ∫·ıÔÚÈÛÙÈ΋, ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi Ù˘ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˘ ∞∞ Û Fanconi Î·È ÌË Fanconi. ¶·ÚfiÏ· ·˘Ù¿, Ë Ì¤ıÔ‰Ô˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù· ÔÔ›· ÂÓÙÔ›˙ÔÓÙ·È ÛÙËÓ ·‰˘Ó·Ì›· Ù˘ Ó· ‰È·ÎÚ›ÓÂÈ ÙÔ˘˜ ÊÔÚ›˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ó· ÚԂϤ„ÂÈ ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È Ó· ‰È·ÁÓÒÛÂÈ ‰ÈÏÔ‡˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ì ̈۷˚ÎÈÛÌfi (54,62-66). O ̈۷˚ÎÈÛÌfi˜ Â›Ó·È ¤Ó· Ê·ÈÓfiÌÂÓÔ Ô˘ ÚÔ·ÙÂÈ ·fi ÌÂÙ·ÏÏ¿ÍÂȘ Û ۈ̷ÙÈο ·ÙÙ·Ú· (postzygotic) Î·È Â›Ó·È ÌÈ· ηٿÛÙ·ÛË Î·Ù¿ ÙËÓ ÔÔ›· ¤Ó· ¿ÙÔÌÔ ÂÌÊ·Ó›˙ÂÈ 2 ‹ ÂÚÈÛÛfiÙÂÚ˜ ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜, ‰È·ÊÔÚÂÙÈ΋˜ ÁÂÓÂÙÈ΋˜ Û‡ÛÙ·Û˘. ∆Ô Ê·ÈÓfiÌÂÓÔ ÙÔ˘ ̈۷˚ÎÈÛÌÔ‡ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 25% ÙˆÓ ·ÛıÂÓÒÓ Ì FA, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‹È· ·ÈÌ·ÙÔÏÔÁÈ΋ ÔÚ›·, ‰ËÌÈÔ˘ÚÁ› fï˜ ÚÔ‚Ï‹Ì·Ù· ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ηıÒ˜ Î·È ÛÙË ıÂÚ·¢ÙÈ΋ Ù˘ ·ÓÙÈÌÂÙÒÈÛË (·ÏÏÔÁÂÓ‹˜ ªªO, ÁÔÓȉȷ΋ ıÂÚ·›·) (62-66). ∞ÔÙ¤ÏÂÛÌ· fiÏˆÓ ÙˆÓ ·ÓˆÙ¤Úˆ ‰˘ÛÎÔÏÈÒÓ Â›Ó·È Ó· ·Ú·Ì¤ÓÂÈ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ‹ ÊÔÚ¤ˆÓ ¯ˆÚ›˜ ‰È¿ÁÓˆÛË ÂÊfiÛÔÓ Ë ‰ÔÎÈÌ·Û›· ·Ô‚·›ÓÂÈ ·ÚÓËÙÈ΋ Î·È ‰ÂÓ Û˘Ó˘¿Ú¯ÂÈ ¿ÓÙÔÙÂ Ô Ï‹Ú˘ ÎÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ Ù˘ ÓfiÛÔ˘ (66). ∞fi ÙË ÌÔÚȷ΋ ÌÂϤÙË Ù˘ FA ¤¯ÂÈ ·Ó·‰Âȯı›

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·467

¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469

̤¯ÚÈ Û‹ÌÂÚ·, Ë ·ÚÔ˘Û›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 8 ÔÌ¿‰ˆÓ Û˘ÌÏËڈ̷ÙÈÎÒÓ ÁÔÓȉ›ˆÓ ÛÙËÓ FA (FAA, FAB, FAC, FAD, FAE, FAG, FAH). ∏ ·Ó¿‰ÂÈÍË ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ·˘ÙÒÓ ÔÌ¿‰ˆÓ ÁÔÓȉ›ˆÓ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì FA, ˘¤‰ÂÈÍ ÙÔÓ ‰ÚfiÌÔ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ˘ÔΛÌÂÓ˘ ÁÂÓÂÙÈ΋˜ ‚Ï¿‚˘ (60-65). ∞ÎÔÏÔ‡ıˆ˜ Ë ˘fiıÂÛË fiÙÈ ›Ûˆ ·fi οı ÔÌ¿‰· Û˘ÌÏËڈ̷ÙÈÎÒÓ ÁÔÓȉ›ˆÓ ˘¿Ú¯ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·˜ ·ıÔÏÔÁÈο ‰È·Ù·Ú·Á̤ÓÔ˜ ÁfiÓÔ˜, Ô‰‹ÁËÛ ÛÙË ¯·ÚÙÔÁÚ¿ÊËÛË Ì¤¯ÚÈ Û‹ÌÂÚ· 3 ·ıÔÏÔÁÈÎÒÓ ÁÔÓȉ›ˆÓ FA Î·È ÙËÓ ÎψÓÔÔ›ËÛË 2 ·fi ·˘Ù¿, ÙˆÓ FAA Î·È FAC, Ô˘ fiˆ˜ Ê·›ÓÂÙ·È Â›Ó·È ·fi Ù· ÂÈÎÚ·Ù¤ÛÙÂÚ· ·ÚÈıÌËÙÈο ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·Û¯fiÓÙˆÓ. ∂›Û˘ ¤¯ÂÈ Á›ÓÂÈ ÁÓˆÛÙ‹ Ë Û˘¯ÓfiÙËÙ· 8 ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ÁÔÓȉ›ˆÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ Ì Fanconi, ηıÒ˜ Î·È Ë ¯ÚˆÌÔۈ̷ÙÈ΋ ÂÓÙfiÈÛË Î·È ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ·ıÔÏÔÁÈÎfi ÚˆÙÂ˚ÓÈÎfi ÙÔ˘˜ ·Ú¿ÁˆÁÔ. ∞fi ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÔÈ ÁÔÓȉȷΤ˜ ·˘Ù¤˜ ÔÌ¿‰Â˜ ÏÂÈÙÔ˘ÚÁÔ‡Ó Î·Ù¿ ¤Ó·Ó Û˘ÌÏËڈ̷ÙÈÎfi ÙÚfiÔ fiÛÔÓ ·ÊÔÚ¿ ÙË ‚ÂÏÙ›ˆÛË ‹ ÙËÓ Â·Ó·ÊÔÚ¿ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÙˆÓ ÂȉÈÔÚıˆÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ DNA ÙˆÓ FA ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· Û˘ÁÎÂÎÚÈ̤ÓÔÈ Û˘Ó‰˘·ÛÌÔ› ÙÔ˘˜ in vitro Ó· ·ÔηıÈÛÙÔ‡Ó Ê˘ÛÈÔÏÔÁÈ΋ ·ÈÌÔÔ›ËÛË Û ·ÛıÂÓ›˜ Ì ·Ó·ÈÌ›· Fanconi (60,64,65-71). ∞˘Ùfi fï˜ Ô˘ ˘‹ÚÍ ÛËÌ·ÓÙÈÎfi Î·È Û ÔÏÏ¿ ÛËÌ›· ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ·‰È¢ÎÚ›ÓÈÛÙÔ, Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙˆÓ ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ‹ ÁÂÓÂÙÈο ¢ڇÙÂÚ· ‰È·Ù·Ú·ÁÌ¤ÓˆÓ (ÌÂÙ¿ÏÏ·ÍË-¤ÏÏÂÈÌÌ·) ÁÔÓȉ›ˆÓ, ‰ËÏ·‰‹, ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Î·ıÒ˜ Î·È Ò˜ ·˘Ù¤˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ‰È·ÌfiÚʈÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘ Ù˘ FA. Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÙȘ ˘¿Ú¯Ô˘Û˜ Û‹ÌÂÚ· ÌÂϤÙ˜, ÔÈ FA ÚˆÙ½Ó˜ ʤÚÔ˘Ó ÂÏ¿¯ÈÛÙË ‹ η̛· ÔÌÔÏÔÁ›· Ì ÙȘ ˘¿Ú¯Ô˘Û˜ ÁÓˆÛÙ¤˜ ÚˆÙ½Ó˜ ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Ë ‰Ú¿ÛË ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ Û ÔÏÏ¿ ÛËÌ›· ¿ÁÓˆÛÙË (65,66). ∂ÈϤÔÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÁÂÓÈ΋˜ ʇÛˆ˜ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ‰ÂÓ ·ÔÙÂÏÔ‡Ó ¿ÌÂÛÔ Û˘ÛÙ·ÙÈÎfi ÙˆÓ ÂȉÈÔÚıˆÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ¶Èı·Ófiٷٷ Ù· 5 ÌfiÏȘ ¯ÚfiÓÈ· ÂÓÙ·ÙÈ΋˜ ¤Ú¢ӷ˜ ‰ÂÓ Â›Ó·È ·ÚÎÂÙ¿ ÁÈ· Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ó Â·ÎÚÈ‚Ò˜ ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÚfiÏÔ ÙˆÓ ÁÔÓȉ›ˆÓ Î·È ÙˆÓ ÚˆÙÂ˚ÓÈÎÒÓ ÙÔ˘˜ ·Ú·ÁÒÁˆÓ. ¶Ôχ ÂÚÈÛÛfiÙÂÚÔ ‰ÂÓ Â›Ó·È Û ı¤ÛË Ó· ··ÓÙ‹ÛÔ˘Ó ÛÙ· ÂÚˆÙ‹Ì·Ù· Ô˘ ˘Ê›ÛÙ·ÓÙ·È ÁÈ· ÙÔ Ò˜ ÔÈ ·ıÔÏÔÁÈΤ˜ ÚˆÙ½Ó˜ ‰ÚÔ˘Ó Î·È ÂÎÙÚ¤Ô˘Ó ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·ÈÌÔÔ›ËÛË Û ·ıÔÏÔÁÈ΋ (64-71). ™ÙËÓ fiÏË ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ ‰È·‰Èηۛ· Ù˘ ÓfiÛÔ˘, ÂÎÙfi˜ ·fi ÙȘ ·Ú·¿Óˆ ÌÔÚȷΤ˜ ‚Ï¿‚˜, Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Î·È ÔÚÈṲ̂Ó˜ ΢ÙÔΛÓ˜ fiˆ˜ Ë IFN-Á (49) Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ (TNF), Ù· ·˘ÍË̤ӷ Â›‰· ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È ÁÓˆ-

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

ÛÙfi fiÙÈ Ô‰ËÁÔ‡Ó Û ηٷÛÙÔÏ‹ Ù˘ ·ÈÌÔÔ›ËÛ˘. ∂›Û˘, Ë ·Ó¢ÚÂı›۷ Û ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IL-6 ÛÙËÓ ·Ó·ÈÌ›· Fanconi, Ê·›ÓÂÙ·È fiÙÈ Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·fiÙˆÛË ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÈÙ›ÓÔÓÙ·˜ ηْ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙÔÓ ‚·ıÌfi Ù˘ Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (49, 60-65). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ Û‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ·Ó·ÈÌ›·˜ Fanconi ÂÛÙÈ¿˙ÔÓÙ·È ÛÙËÓ ·ÚÔ˘Û›· ·ÛÙ¿ıÂÈ·˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ·‰˘Ó·Ì›·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ó· ÂȉÈÔÚıÒÛÔ˘Ó ÙȘ ‚Ï¿‚˜ ÙÔ˘˜ Û Â›Â‰Ô DNA, ȉÈfiÙËÙ˜ ·fi ÙȘ Ôԛ˜ ÚÔ·ÙÔ˘Ó fi¯È ÌfiÓÔÓ ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÈÌÔÔ›ËÛ˘ ·ÏÏ¿ Î·È Ë ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ηÎÔËıÂÈÒÓ, ÁÂÓÈÎfiÙÂÚ· (62,63,66). µÈ‚ÏÈÔÁÚ·Ê›· 1. ¶·‡ÏÔ˜ ¢·Ó‰Ú¿Î˘. ªÂÁ¿ÏË ∂ÏÏËÓÈ΋ ∂Á΢ÎÏÔ·›‰ÂÈ·. ŒÎ‰ÔÛË 2Ë. ∂ΉfiÛÂȘ ºÔ›ÓÈÍ; ÛÂÏ. 59-61.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-06-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-11-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË πˆ¿ÓÓÔ˘ °ÂÓÓ·‰›Ô˘ 14∞, 115 21 ∞ı‹Ó·

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∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È Ì˘ÂÏÔ‰˘ÛÏ·Û›· ∞fiÛÙÔÏÔ˜ ¶Ô˘ÚÙÛ›‰Ë˜

● ¶ÂÚ›ÏË„Ë: ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞), Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (ª¢™), ÔÈ ÌÂÌÔӈ̤Ó˜ ΢ÙÙ·ÚÔÂӛ˜, ȉȷ›ÙÂÚ· ÔÈ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜, Î·È ÁÂÓÈο fiÏ· Ù· ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÛÙ· ÔÔ›· ¿Û¯ÂÈ ÚˆÙÔ·ıÒ˜ ÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ, ·ÔÙÂÏÔ‡Ó Ì›· ȉȷ›ÙÂÚË ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ, Ôχ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, Ù· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· Â›Ó·È Û¿ÓÈ· ÓfiÛÔ˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Á΢ÙÙ·ÚÔÂÓ›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ·fi Ì›ˆÛË ‹ ÂÍ·Ê¿ÓÈÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÙÔȯ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi, ÔÊÂÈÏfiÌÂÓË Û ÌÈ· ÔÛÔÙÈ΋ ‹ ÔÈÔÙÈ΋ ‰È·Ù·Ú·¯‹ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ ‰È¿ÁÓˆÛË Ù˘ ∞∞ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·ÍÈÔÏfiÁËÛË fiÏˆÓ ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È Ì ÙÔÓ ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÂΉËÏÒÓÔÓÙ·È Ì ·Á΢ÙÙ·ÚÔÂÓ›·. ™ÙËÓ ÚÔÛ¤ÁÁÈÛË Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ Â›ÎÙËÙ˘ ‹ ȉÈÔ·ıÔ‡˜ ∞∞ Î·È ˘Ô΢ÙÙ·ÚÈÎÔ‡ ª¢™. ∏ Ù·˘Ùfi¯ÚÔÓË ÂÎÙ¤ÏÂÛË ÔÛÙÂÔÌ˘ÂÏÈ΋˜ ‚ÈÔ„›·˜ Î·È ·Ó·ÚÚfiÊËÛ˘ Ì˘ÂÏÔ‡ ÁÈ· ÌÔÚÊÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË Î·È Ë Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ÌÂϤÙË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋. ∏ ·Ó‡ÚÂÛË ÎψÓÈ΋˜ ·ÓˆÌ·Ï›·˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜ Â›Ó·È ˘¤Ú Ù˘ ‰È¿ÁÓˆÛ˘ Ì˘ÂÏÔ‰˘ÛÏ·Û›·˜ ‹ ·ÎfiÌË Î·È Ï¢¯·ÈÌ›·˜. ∆· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Â›Ó·È ÎψÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË, ΢ÙÙ·ÚÔÂӛ˜ ÛÙÔ ·›Ì· Î·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂͤÏÈ͢ Û ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›·. ∏ ·Ó·ÛÎfiËÛË ·ÚÔ˘ÛÈ¿˙ÂÈ Ù· Ó¤· ‰Â‰Ô̤ӷ ÛÙ· ‚ÈÔÏÔÁÈο Î·È ‰È·ÁÓˆÛÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·ÊfiÚˆÓ ˘fiÙ˘ˆÓ ÙˆÓ ª¢™ Î·È ÙËÓ ÙÚÔÔÔÈË̤ÓË, ÚfiÛÊ·Ù·, ÌÔÚÊÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË. ¶·È‰È·ÙÚÈ΋ 2000;63:470-477. §¤ÍÂȘ ÎÏÂȉȿ: ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Ì˘ÂÏÔ‰˘ÛÏ·Û›·, Ì˘ÂÏÈ΋ ·ÓÂ¿ÚÎÂÈ·.

A. Pourtsidis. Aplastic syndromes and myelodysplasia. Paediatriki 2000;63:470-477. ● Abstract: Aplastic anemia (AA), the myelodysplastic syndromes (MDS), the single cytopenias, especially the congenital types, are a heterogeneous group of rare bone marrow failure disorders in children. Aplastic anemia is a marrow failure syndrome characterized by peripheral pancytopenia with a hypocellular bone marrow. By definition, other causes of marrow failure with pancytopenia must be excluded, especially malignant diseases of the hematopoietic system, metastatic cancer to bone marrow and other benign conditions. AA is a rare disease and for which a differential diagnoses must be made between acquired and constitutional disease and hypocellular myelodysplasia. However, such problems can often be resolved by simultaneous bone marrow biopsy and aspiration for cytologic morphology. Detection of a clonal cytogenetic abnormality in the majority of the patient’s cells would suggest a diagnosis of myelodysplasia or even occult leukemia. Myeloldysplastic syndromes are clonal disorders characterized by ineffective hematopoiesis leading to blood cytopenias and a high incidence of progression to acute myeloid leukemia. This review aims at highlighting the advances in biological and diagnostic features of various subtypes of MDS and the modified FAB classification.

Key words: aplastic anemia, myelodysplastic syndromes, childhood, marrow failure.

¶·È‰›·ÙÚÔ˜, ∂ÈÌÂÏËÙ‹˜ √ÁÎÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ «¶ & ∞ ∫˘ÚÈ·ÎÔ‡»

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

∂ÈÛ·ÁˆÁ‹ ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞), Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (ª¢™), ÔÈ ÌÂÌÔӈ̤Ó˜ ΢ÙÙ·ÚÔÂӛ˜, ȉȷ›ÙÂÚ· ÔÈ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜, Î·È ÁÂÓÈο fiÏ· Ù· ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÛÙ· ÔÔ›· ¿Û¯ÂÈ ÚˆÙÔ·ıÒ˜ ÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ, ·ÔÙÂÏÔ‡Ó ÌÈ· ȉȷ›ÙÂÚË ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ, Ôχ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, Ù· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ·Ó¿Ù˘ÍË Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ‚Ô‹ıËÛ ÛÙË ÌÂϤÙË Î·È Î·Ù·ÓfiËÛË ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ Ù˘ ·ÈÌÔÔ›ËÛ˘ Î·È ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘. ™ÙÔ ÌÔÓÙ¤ÏÔ ·˘Ùfi, ·fi ÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ (stem cell) ·Ú¿ÁÔÓÙ·È Ù· ‰ÂÛÌÂ˘Ì¤Ó· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ô˘ ηٷϷ̂¿ÓÔ˘Ó ÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, ̤ۈ ‰È·‰Ô¯ÈÎÒÓ ‰È·ÊÔÚÔÔÈ‹ÛÂˆÓ Î·È ÔÏÏ·Ï·ÛÈ·ÛÌÒÓ, ηٷϋÁÔ˘Ó ÛÙËÓ ·Ú·ÁˆÁ‹ ÏÂÈÙÔ˘ÚÁÈο ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÒÚÈÌˆÓ Î˘ÙÙ¿ÚˆÓ ·ÔÁfiÓˆÓ Ù· ÔÔ›· ÛÙË Û˘Ó¤¯ÂÈ· ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›· Î·È ÙÔ˘˜ ÈÛÙÔ‡˜. ™‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ‰È·‰Èηۛ· ·˘Ù‹ Ù˘ ·˘ÙÔ·Ó·Ó¤ˆÛ˘ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ù˘ ‰¤ÛÌ¢Û˘, Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ Î·È ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· Û ¤Ó· Ù¤ÏÂÈ· Ú˘ıÌÈ˙fiÌÂÓÔ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ÙÔ ÛÙÚÒÌ·, Ù· ‚ÔËıËÙÈο ·ÙÙ·Ú· Î·È ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ªÂϤÙ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ Û˘Ó‰ÚfiÌˆÓ Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ·Ô‰›‰ÔÓÙ·È ÛÙÔ˘˜ ·Ú·Î¿Ùˆ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ● ·ÓÂ¿ÚÎÂÈ· ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ ● ÂÏ¿¯ÈÛÙ˜ ÂȉڿÛÂȘ ÛÙÔ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ● ÂÍ¿ÓÙÏËÛË ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ∆· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Â›Ó·È Ì›· ÂÙÂÚÔÁÂÓ‹˜ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ Ì ‰È·ÊÔÚÂÙÈ΋ ·ıÔÊ˘ÛÈÔÏÔÁ›·. ∂ÚÁ·ÛÙËÚȷο ÂÌÊ·Ó›˙ÔÓÙ·È Û·Ó ·Á΢ÙÙ·ÚÔÂÓ›· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‹ ÌÂÌÔӈ̤Ó˜ ΢ÙÙ·ÚÔÂӛ˜ Ô˘ ÔÊ›ÏÔÓÙ·È: - ÛÙËÓ ÂÏ·Ùو̤ÓË ÌÂÙ·ÊÔÚ¿ ÒÚÈÌˆÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÛÙÔ ·›Ì·, ÏfiÁˆ Ì›ˆÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ‹ ÌÂȈ̤Ó˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿˜ ÙÔ˘˜ .¯. ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, ·Ó·ÈÌ›· Diamond-Blakfan - ‰È·Ù·Ú·¯‹ ÛÙË ‰È·‰Èηۛ· ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ .¯. Ô˘‰ÂÙÂÚÔÂӛ˜ (ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË ) - ‰Â˘ÙÂÚÔ·ıÒ˜ ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂÚ·›·, ·ÎÙÈÓÔ‚ÔÏ›·, ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ‰È‹ıËÛË ·fi ͤӷ ÚÔ˜ ÙÔ Ì˘ÂÏfi ·ÙÙ·Ú·. ∂ΉËÏÒÓÔÓÙ·È Û·Ó ·Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È Ì˘ÂÏÔ‰˘ÛÏ·Û›·. OÈ ‰‡Ô ·˘Ù¤˜ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

¤¯Ô˘Ó ·ÚÎÂÙ¤˜ ÔÌÔÈfiÙËÙ˜, ·ÏÏ¿ Î·È ‰È·ÊÔÚ¤˜.. ∫ÔÈÓfi˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Â›Ó·È Ë ·ÓÂ¿ÚÎÂÈ· ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘. ™Ù· ·Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Ë ·ÈÌÔÔ›ËÛË Â›Ó·È ·Ô‡Û·, Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ÂÌÊ·Ó›˙ÂÙ·È ·Ï·ÛÙÈÎfi˜ ‹ Ì ÌÂȈ̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Î·È Ë ·Á΢ÙÙ·ÚÔÂÓ›· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ Â‡ÚËÌ·. ™Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ¤¯Ô˘Ì ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ Î·È ÌÂÌÔӈ̤Ó˜ ‹ Û˘Ó‰˘·Ṳ̂Ó˜ ΢ÙÙ·ÚÔÂӛ˜ ÛÙÔ ·›Ì·. ∫·È ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÎψÓÈΤ˜ Î·È ÌË ·ÓˆÌ·Ï›Â˜ Î·È ·fi ÙËÓ Ù¿ÛË ÙÔ˘˜ Ó· ÂÍÂÏ›ÛÛÔÓÙ·È Û ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›·. ™˘Ó‹ıˆ˜ Â›Ó·È Â›ÎÙËÙ˜ ‰È·Ù·Ú·¯¤˜ ÂÓÒ Ù· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ‹ Û˘ÁÁÂÓ‹ Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. π‰È·›ÙÂÚË ÔÌ¿‰· ·ÔÙÂÏÔ‡Ó Ù· ‰Â˘ÙÂÚÔ·ı‹ ·Ï·ÛÙÈο Û‡Ó‰ÚÔÌ·, Ù· ÔÔ›· ÔÊ›ÏÔÓÙ·È Û ηٷÛÙÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ¯ËÌÂÈÔıÂÚ·›·, ·ÎÙÈÓÔ‚ÔÏ›·, ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÏÔÈÌÒÍÂȘ, Ê¿Ú̷η, ηٿÏË„Ë ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ͤӷ ÚÔ˜ ÙÔ Ì˘ÂÏfi ·ÙÙ·Ú·. ∆¤ÏÔ˜, ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÔÈ ·ÚÔ‰ÈΤ˜ ·Ϸۛ˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¿ÁÓˆÛÙ˘, ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ, ·ÈÙÈÔÏÔÁ›·˜ Ô˘ Û˘Ó‹ıˆ˜ ÂÍÂÏ›ÛÛÔÓÙ·È ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·Û›· ‹ ÔÍ›· Ï¢¯·ÈÌ›·. ¶·Á΢ÙÙ·ÚÔÂÓ›· ¢ÂÓ Â›Ó·È ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ·ÏÏ¿ ÙÚÈ¿‰· ¢ÚËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÔÈΛϷ ·›ÙÈ· (¶›Ó·Î·˜ 1). ∂ÎÊÚ¿˙ÂÙ·È Ì ÙË Ì›ˆÛË fiÏˆÓ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ● ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Ô˘ ÌÔÚ› Ó· Â›Ó·È È‰ÈÔ·ı‹˜ Î·È ÁÂÓÂÙÈο ηıÔÚÈṲ̂ÓË ‹ Ó· ÔÊ›ÏÂÙ·È Û ηٷÛÙÚÔÊ‹ ÙÔ˘ Ì˘ÂÏÈÎÔ‡ ÈÛÙÔ‡ ·fi ÙÔ͛Ә (·Î˘ÙÙ·ÚÈÎfi˜ ‹ ˘ÔÏ·ÛÙÈÎfi˜ Ì˘ÂÏfi˜), ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Ì˘ÂÏÈÎÔ‡ ÈÛÙÔ‡ ·fi ͤӷ ÚÔ˜ ÙÔÓ Ì˘ÂÏfi ηÎÔ‹ıË Î·È ÌË Î‡ÙÙ·Ú· ‹ Û ηٷÛÙÔÏ‹ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ Ì˘ÂÏÈ΋˜ ·‡ÍËÛ˘ Î·È ‰È·ÊÔÚÔÔ›ËÛ˘ ● ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË, Ì ΢ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ Ê˘ÛÈÔÏÔÁÈ΋ ‹ Î·È ·˘ÍË̤ÓË ÌÂÚÈΤ˜ ÊÔÚ¤˜ Î·È ¯ˆÚ›˜ ·ÓÒÌ·Ï· ·ÙÙ·Ú·, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ı¿Ó·ÙÔ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ‹ ·Ú·ÁˆÁ‹ ÌÂÈÔÓÂÎÙÔ‡ÓÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Ù·¯‡Ù·Ù· ·ÔÛ‡ÚÔÓÙ·È ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›·, ‹ ηٷÛÙÚÔÊ‹ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ù ·fi ÂÓÂÚÁÔÔÈË̤ӷ ·ÓÙÈÛÒÌ·Ù· ›Ù ÏfiÁˆ ÂÁÎψ‚ÈÛÌÔ‡ ÙÔ˘˜ ÛÙÔ ˘ÂÚÙÚÔÊÈÎfi Î·È ·ÓÙȉڷÛÙÈÎfi ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·Îfi Û‡ÛÙËÌ·. ªÂÚÈΤ˜ ÊÔÚ¤˜ ˘¿Ú¯ÂÈ ·Ú¯Èο, ÌÂÌÔӈ̤ÓË Î·Ù·ÛÙÔÏ‹ ÌÈ·˜ ·ÈÌÔÔÈËÙÈ΋˜ ÛÂÈÚ¿˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ó·Ù‡ÛÛÂÙ·È ·Á΢ÙÙ·ÚÔÂÓ›· ÌÂ Û˘ÓÔ‰fi Ì˘ÂÏÈ΋ ˘ÔÏ·Û›·.

471

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·472

¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

¶›Ó·Î·˜ 1. ∞Èٛ˜ ·Á΢ÙÙ·ÚÔÂÓ›·˜. ¡ÔÛ‹Ì·Ù· Ì ‰È‹ıËÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ● ªÂȈ̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ ∞Ï·ÛÙÈ΋ ‹ ˘ÔÏ·ÛÙÈ΋ ·Ó·ÈÌ›· ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Û˘Ó‹ıˆ˜ ·ÓıÂÎÙÈΤ˜ ·Ó·È̛˜ ¶ÚÔÏ¢¯·È̛˜ ªÂÚÈΤ˜ Ï¢¯·È̛˜ Î·È ÏÂÌÊÒÌ·Ù· ● º˘ÛÈÔÏÔÁÈ΋ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ¶·ÚÔ͢ÛÌÈ΋ Ó˘¯ÙÂÚÈÓ‹ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›· ª˘ÂÏÔ˝ÓˆÛË, Ì˘ÂÏfiÊıÈÛË √ÛÙÂo¤ÙÚˆÛË ªÂÚÈΤ˜ Ï¢¯·È̛˜ (·Ï¢¯·ÈÌÈ΋ ÌÔÚÊ‹) ¢È‹ıËÛË ·fi Ó¢ÚÔ‚Ï¿Ûو̷ Î.Ï.. ¢Â˘ÙÂÚÔ·ıÒ˜ ÛÂ: ÀÂÚÛÏËÓÈÛÌfi §ÔÈÌÒÍÂȘ fiˆ˜ ÈÒÛÂȘ, Kala-azar, ÎÂÁ¯ÚÔÂȉ‹ Ê˘Ì·Ù›ˆÛË ∞ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 ‹ Ê˘ÏÏÈÎÔ‡ Û ηÎÔ‹ıË ·Ó·ÈÌ›·, ÛÙ·ÙfiÚÚÔÈ· ª˘ÂÏÈ΋ ‰È‹ıËÛË ·fi Gaucher, Niemann-Pick ÎÏ. ™Ë„·ÈÌ›·, ‚ÚԢΤÏψÛË, ÌÂÚÈΤ˜ ·ÓıÂÎÙÈΤ˜ ·Ó·È̛˜, Ì˘ÎÔ‚·ÎÙËÚȉȷΤ˜ ÏÔÈÌÒÍÂȘ (ÂÓ›ÔÙÂ), Î·È ›Ûˆ˜ Ë È‰ÈÔ·ı‹˜ Ê·Ú̷΢ÙÈ΋ ˘ÂÚ¢·ÈÛıËÛ›· ∏ ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÔÈΛÏÂÈ Î·È Û˘¯Ó¿ Â›Ó·È ·Ú·Ï·ÓËÙÈ΋. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÍ·ÚÙÒÓÙ·È ·fi ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ·Ó·ÈÌ›·˜, ıÚÔÌ‚ÔÂÓ›·˜, Î·È Ï¢ÎÔÂÓ›·˜. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ·Ï¿ ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û˘¯Ó¿ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ Î·È Û˘Ó‹ıˆ˜ ÌÂÈÒÓÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ Èı·ÓÒÓ ‰È·ÁÓÒÛˆÓ. ŒÙÛÈ, Ë ·ÚÔ˘Û›· ÛÏËÓÔÌÂÁ·Ï›·˜ Â›Ó·È Û˘Ì‚·Ù‹ Ì ÔÏϤ˜ ·fi ÙȘ ·Èٛ˜ Ô˘ ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ›Ó·Î· 1, ·ÏÏ¿ ÂÛÙÈ¿˙ÂÈ ÙȘ ‰È·ÊÔÚԉȷÁÓˆÛÙÈΤ˜ Ì·˜ ÛΤ„ÂȘ ÛÙȘ ηÎÔ‹ıÂȘ ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î·È ÏÂÌÊÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· Î·È ‰ÈÔÁÎˆÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ï¢¯·ÈÌ›·˜, ÏÂÌÊÒÌ·ÙÔ˜ ‹ ¿ÏÏˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ¢˘ÛÎÔϛ˜ ÛÙË ‰È¿ÁÓˆÛË ÚÔ·ÙÔ˘Ó fiÙ·Ó Ù· Û˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù· Â›Ó·È ¿Ù˘· ‹ ÙÔ ‰Â›ÁÌ· Ì˘ÂÏÔ‡ Â›Ó·È ·ÓÂ·ÚΤ˜. ™˘Ó‹ıˆ˜ Ë ·Ó·ÚÚfiÊËÛË Ì˘ÂÏÔ‡ Î·È Ë ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· Û˘Á¯ÚfiÓˆ˜, ‚ÔËıÔ‡Ó ÛÙËÓ Â›Ï˘ÛË Ù¤ÙÔÈˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ∆¤ÏÔ˜, Ë ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ·Á΢ÙÙ·ÚÔÂÓ›·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ. ∞Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ªÂ ÙÔÓ fiÚÔ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞) Û‹ÌÂÚ· ÔÚ›˙ÂÙ·È Ë ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Á΢ÙÙ·ÚÔÂÓ›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ·fi Ì›ˆÛË ‹ ÂÍ·Ê¿ÓÈÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÙÔȯ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi, ÔÊÂÈÏfiÌÂÓË Û ÌÈ· ÔÛÔÙÈ΋ ‹ ÔÈÔÙÈ΋

472

∞. ¶Ô˘ÚÙÛ›‰Ë˜

‰È·Ù·Ú·¯‹ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ‰È‹ıËÛ˘ ·fi ηÎÔ‹ıË Î‡ÙÙ·Ú· ‹ ›ÓˆÛ˘. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË ‰Â›¯ÓÂÈ Û˘Ó‹ıˆ˜ ˆ¯ÚfiÙËÙ·, ·Ó¿ÏÔÁË Ì ÙÔ ‚·ıÌfi Ù˘ ·Ó·ÈÌ›·˜ Î·È ÂÙ¤¯ÂȘ ‹ Âί˘ÌÒÛÂȘ, ·Ó Î·È ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ·Ó¿ÏÔÁ˜ Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ıÚÔÌ‚ÔÂÓ›·˜. OÈ ·ÛıÂÓ›˜ ηٿ ÙË ‰È¿ÁÓˆÛË Û˘Ó‹ıˆ˜ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ˘ÚÂÙfi, Ô‡Ù ‰ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ ‹ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ·Á΢ÙÙ·ÚÔÂÓ›·˜ ¯ˆÚ›˜ ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ·fi ͤӷ ·ÙÙ·Ú· Î·È ¯ˆÚ›˜ ÛÙÔȯ›· ‰˘ÛÌ˘ÂÏÔÔ›ËÛ˘. ∏ ·Ó‡ÚÂÛË ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ ‹ Î·È ·ÒÚˆÓ ÌÔÚÊÒÓ Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· (Ï¢ÎÔÂÚ˘ıÚÔ‚Ï·ÛÙÈ΋ ·ÓÙ›‰Ú·ÛË) Â›Ó·È ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô Î·Ù¿ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ∞∞. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ·ÙÙ·Ú·, ·Ó·ÚÚfiÊËÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ó¿ÏÔÁ· Ì ٷ Â˘Ú‹Ì·Ù· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÙË ÌÔÚÊÔÏÔÁ›· ÙÔ˘ Ì˘ÂÏÔ‡, ÏÂÙÔÌÂÚ¤ÛÙÂÚÔ ¤ÏÂÁ¯Ô Ì ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜, ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÈÒÓ, ‰Â›ÎÙ˜ ·˘ÙÔ¿ÓÔÛˆÓ ‰È·Ù·Ú·¯ÒÓ, ·ÓÙÈÁfiÓ· ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ËÏÂÎÙÚÔÊfiÚËÛË Hb, ‰ÔÎÈÌ·Û›· Ham. ∏ ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Ë ÌÔÚÊÔÏÔÁ›· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Â›Ó·È ÔÈ ÂÍÂÙ¿ÛÂȘ Ô˘ ‚ÔËıÔ‡Ó ÛÙËÓ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·Ï·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Î·È Ù˘ Û˘ÓÔ‰Ô‡ ·Á΢ÙÙ·ÚÔÂÓ›·˜. ∏ ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· Â›Û˘, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ Î·È ÙÔÓ ·ÔÎÏÂÈÛÌfi ›ÓˆÛ˘ ‹ ηÎÔ‹ıÂÈ·˜. ∏ ·Ó·ÚÚfiÊËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÌÔÚ› Ó· ÌËÓ ·Ô‰ÒÛÂÈ ˘ÏÈÎfi ‹ Ó· ÂÚȤ¯ÂÈ ÂÏ¿¯ÈÛÙ· ·ÙÙ·Ú· Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ, ÂÓÒ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ ·ÙÙ·Ú· ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ (ȉȷ›ÙÂÚ· ÏÈÔ·ÙÙ·Ú·) Î·È ·ÚÎÂÙ¿ ÏÂÌÊÔ·ÙÙ·Ú· ‹ Î·È Ï·ÛÌ·ÙÔ·ÙÙ·Ú·. ∏ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋ ÌÂϤÙË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋. ∏ ·Ó‡ÚÂÛË ÎψÓÈ΋˜ ·ÓˆÌ·Ï›·˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜ Â›Ó·È ˘¤Ú Ù˘ ‰È¿ÁÓˆÛ˘ Ì˘ÂÏÔ‰˘ÛÏ·Û›·˜ ‹ ·ÎfiÌË Î·È Ï¢¯·ÈÌ›·˜. ™ÙÔÓ ›Ó·Î· 2 ·Ú·Ù›ıÂÓÙ·È Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È ÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÛÙ· ÔÔ›· ‚·Û›˙ÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ∞∞. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ∞∞ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi fiϘ ÙȘ ηٷÛÙ¿ÛÂȘ Ô˘ ÚÔηÏÔ‡Ó ·Á΢ÙÙ·ÚÔÂÓ›·, fiˆ˜ ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ·fi: - ÔÍ›· Ï¢¯·ÈÌ›· (Ì ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Ì˘ÂÏfiÁÚ·ÌÌ·), - ·Ï¢¯·ÈÌÈ΋ Ï¢¯·ÈÌ›·, ϤÌʈ̷, Û˘Ì·Á›˜ fiÁÎÔ˘˜ fiˆ˜ Ó¢ÚÔ‚Ï¿Ûو̷, Û·ÚÎÒÌ·Ù· (Ì ·Ó·ÚÚfiÊËÛË Ì˘ÂÏÔ‡ Î·È ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·), - ÔÛÙÂÔ¤ÙÚˆÛË, ıËÛ·˘ÚÈÛÌÒÛÂȘ, ˘ÂÚÛÏËÓÈÛÌfi (Ì ·Ó·ÚÚfiÊËÛË Î·È ‚ÈÔ„›· Ì˘ÂÏÔ‡, ·Ô˘Û›· ÛÏËÓÔÌÂÁ·Ï›·˜), - Ì˘ÂÏÔÛÎÏ‹Ú˘ÓÛË, Ì˘ÂÏÔ˚ÓˆÛË (·Û‡ÓËı˜ ÙÔ "dry tap" ÛÙËÓ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, ÛÙËÓ ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· ›ÓˆÛË ·ÓÙ› Ï›Ô˜),

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·473

¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

- ·ÓÂ¿ÚÎÂÈ· ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ ‚ÈÙ·Ì›Ó˘ µ12 ‹ Ê˘ÏÏÈÎÔ‡ ÔͤԘ (΢ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ ·˘ÍË̤ÓË), - ·ÚÔ͢ÛÌÈ΋ Ó˘¯ÙÂÚÈÓ‹ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›· (‰‡ÛÎÔÏË Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ‰ÔÎÈÌ·Û›· HAM ÚÈÓ ·fi ÌÂÙ¿ÁÁÈÛË, ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ÁÈ· GPI ÚˆÙ½ÓË) , - ·Á΢ÙÙ·ÚÔÂÓ›· ·ÓÔÛÔÂÍ·ÚÙÒÌÂÓË (΢ÙÙ·ÚÔ‚ÚÈı‹˜ Ì˘ÂÏfi˜). ™ËÌ·ÓÙÈ΋ ‰˘ÛÎÔÏ›· ˘¿Ú¯ÂÈ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ∞∞ ·fi Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Ì ÂÈÎfiÓ· ·ÓıÂÎÙÈ΋˜ ·Ó·ÈÌ›·˜ Î·È È‰È·›ÙÂÚ· fiÙ·Ó Û˘Óԉ‡ÔÓÙ·È ·fi ˘Ô΢ÙÙ·ÚÈÎfi Ì˘ÂÏfi (˘¿Ú¯Ô˘Ó ¤ÓÙÔÓ˜ ·ÏÏÔÈÒÛÂȘ ‰˘ÛÌ˘ÂÏÔÔ›ËÛ˘, ¯ÚˆÌÔÛˆÌÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·ıÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ in vitro ·ÔÈÎÈÒÓ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ Î·È Û˘¯Ó¿ ÂÌÊ¿ÓÈÛË ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ). ∞˘Ùfi ÙÔÓ›˙ÂÈ ÙËÓ ·Ó¿ÁÎË Û οı ÂÚ›ÙˆÛË Ù˘ ÏÂÙÔÌÂÚÔ‡˜ Ï‹„˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ù˘ ηϋ˜ ·ÍÈÔÏfiÁËÛ˘ fiÏˆÓ ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÙˆÓ ·Ú·ÎÏÈÓÈÎÒÓ ÂÍÂÙ¿ÛˆÓ. ªÂ ÙÔÓ Û˘ÁÎÂÚ·ÛÌfi fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ ÛÙÔȯ›ˆÓ Î·È Â˘ÚËÌ¿ÙˆÓ ÙÂÏÈο Ë ‰È¿ÁÓˆÛË Ù˘ ∞∞ Á›ÓÂÙ·È Û¯ÂÙÈο ‡ÎÔÏË. ∏ ‚·Ú‡ÙËÙ· Ù˘ ∞∞ ¤¯ÂÈ Ôχ ÌÂÁ¿ÏË ÚÔÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ÛËÌ·Û›·. ∆· ÎÚÈÙ‹ÚÈ· Ù˘ ‚·ÚÈ¿˜ ∞∞ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 3. ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ∆· ª¢™ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ·ÔÙÂÏÔ‡Ó ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÎψÓÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ Î·È ÙÔ ÔÛÔÛÙfi ÙÔ˘˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 10% fiÏˆÓ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ Î·ÎÔËıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ·ÓıÂÎÙÈΤ˜ ΢ÙÙ·ÚÔÂӛ˜, ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË, ‰˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÌÈ·˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÌÂÙ·ÙÚÔ‹˜ Û ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· (Oª§). ™˘Ó‹ıˆ˜ Â›Ó·È ÚˆÙÔ·ı‹ ÂÓÒ Ù· ‰Â˘ÙÂÚÔ·ı‹ Û¯ÂÙ›˙ÔÓÙ·È Ì ¯ËÌÂÈÔıÂÚ·›· ‹ ·ÎÙÈÓÔ‚ÔÏ›·. ∏ ÚfiÁÓˆÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·È‰ÈÒÓ Ì ª¢™ Â›Ó·È Î·Î‹ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ì ¯ËÌÂÈÔıÂÚ·›· ‰›ÓÂÈ ÊÙˆ¯¿ ·ÔÙÂϤÛÌ·Ù·. ∏ ·ÏÏÔÁÂÓ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È Ë ıÂÚ·›· ÂÎÏÔÁ‹˜. ¶ÂÚ›Ô˘ 30% ÙˆÓ ·È‰ÈÒÓ Ì ª¢™ Û¯ÂÙ›˙ÔÓÙ·È Ì ÚԉȷıÂÛÈΤ˜ ·ÓˆÌ·Ï›Â˜ fiˆ˜ ·Ó·ÈÌ›· Fanconi, Û‡Ó‰ÚÔÌÔ Schwachman, Û‡Ó‰ÚÔÌÔ Down, Ó¢ÚÔ˚ӈ̿وÛË (NF-1) Î·È ¿ÏϘ ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∏ ‰È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÔÔÈ·Û‰‹ÔÙ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÛˆÛÙ‹ ÌÂϤÙË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Ì Ôχ ηϤ˜ ¯ÚÒÛÂȘ, ̤ÙÚËÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ F ÚÈÓ ÙË ÌÂÙ¿ÁÁÈÛË, ÌÔÚÊÔÏÔÁ›· (¯ÚÒÛÂȘ Ûȉ‹ÚÔ˘) Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ÌÂϤÙË Û ‰Â›ÁÌ·Ù· ·fi ·Ó·ÚÚfiÊËÛË Ì˘ÂÏÔ‡ Î·È ÔÛÙÂÔÌ˘ÂÏÈΤ˜ ‚ÈÔ„›Â˜ ÁÈ· ·Ó·˙‹ÙËÛË ·ÚÔ˘Û›·˜ Û ¿Ù˘˜ ı¤ÛÂȘ ·ÒÚˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (ALIP). ∏ ‰È¿ÁÓˆÛË ÙˆÓ ª¢™ ÛÙËÚ›˙ÂÙ·È

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

¶›Ó·Î·˜ 2. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜.

- ¶ÂÚÈÊÂÚÈÎfi ·›Ì· ∞Ô˘Û›· ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ï¢ÎÔ΢ÙÙ¿ÚˆÓ º˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· ÂÚ˘ıÚÒÓ ‹ ÂÏ·ÊÚ¿ Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË (ÂÓ›ÔÙÂ) MCV Û˘¯Ó¿ ·˘ÍË̤ÓÔ (ÂÎÙfi˜ Â¿Ó ¤¯ÂÈ ÚÔËÁËı› ÌÂÙ¿ÁÁÈÛË) ¢ÈÎÙ˘ÔÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎfi˜ ‰Â›ÎÙ˘ ÂÏ·Ùو̤ÓÔ˜ ∏ ·ÚÔ˘Û›· Ó·ÚÒÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ·ÔÎÏ›ÂÈ ÙË ‰È¿ÁÓˆÛË ∏ ·‡ÍËÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ F Î·È ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ i ÙˆÓ ÂÚ˘ıÚÒÓ Â›Ó·È ‰Â›ÎÙ˘ ÂÌ‚Ú˘˚΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘ ¯ˆÚ›˜ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· ∂›‰· µ12 Î·È Ê˘ÏÏÈÎÔ‡ Ôͤˆ˜ Ê˘ÛÈÔÏÔÁÈο ‹ ·˘ÍË̤ӷ ∂Ú˘ıÚÔÔÈËÙ›ÓË ÔÚÔ‡ ·˘ÍË̤ÓË - ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ™ˆÛÙ‹ ÂÎÙ›ÌËÛË Ì ÔÛÙÂÔÌ˘ÂÏÈΤ˜ ‚ÈÔ„›Â˜ Û ÔÏϤ˜ ı¤ÛÂȘ ÀÔ΢ÙÙ·ÚÈÎfi˜ Ì˘ÂÏfi˜ Ì ·ÙÙ·Ú· ‰ÈÎÙ‡Ô˘, Ï›Ô˜, Ï·ÛÌ·ÙÔ·ÙÙ·Ú· Î·È ÏÂÌÊÔ·ÙÙ·Ú·. ¶ÔÛÔÛÙfi ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ >70% Û¯ÂÙ›˙ÂÙ·È Ì ‚·ÚÈ¿ ÚfiÁÓˆÛË ∞ÍÈÔÏfiÁËÛË Ù˘ ÔÌÔÈÔÁÂÓÔ‡˜ ‹ ÂÙÂÚÔÁÂÓÔ‡˜ Âڋ̈Û˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ ‡·ÚÍË Ù˘ ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ ‹ ÙÔ˘ ˘ÔÏ·ÛÙÈÎÔ‡ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ·ÓÙ›ÛÙÔȯ·.

¶›Ó·Î·˜ 3. µ·Ú‡ÙËÙ· ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜. ™Ô‚·Ú‹ ∞∞ ∞fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ <500/mm3 ∞ÈÌÔÂÙ¿ÏÈ· <20000/mm3 ¢ÈÎÙ˘ÔÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎfi˜ ‰Â›ÎÙ˘ <1% ∫˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ <25% Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ¶Ôχ ÛÔ‚·Ú‹ ∞∞ ŸÏ· Ù· ·ÓˆÙ¤Úˆ ·ÏÏ¿ ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ <200/mm3 ◊È· ‹ ̤ÙÚÈ· ∞∞ (˘ÔÏ·ÛÙÈ΋) ∫˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ 25-50% Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜, ·ÏÏ¿ Ì ÔÛÔÛÙfi ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î¿Ùˆ ·fi 30%

473

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·474

¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

∞. ¶Ô˘ÚÙÛ›‰Ë˜

¶›Ó·Î·˜ 4. ¢˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfïÓ. ™ÂÈÚ¿

¶ÂÚÈÊÂÚÈÎfi ·›Ì·

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∂Ú˘ıÚ¿

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ÀÂÚÏ·Û›· ÂÚ˘ıÚ¿˜, ۈ̿ ÙÈ· Howell-Jolly, ÔÏ˘‡ÚËÓ˜ Î·È ÌÂÁ·ÏÔ‚Ï·ÛÙÔÂȉ›˜ ÂÚ˘ıÚÔ‚Ï¿ÛÙ˜, ÂÚ˘ıÚÔ‚Ï¿ÛÙ˜ Ì ·ÓÒÌ·ÏÔ ˘Ú‹Ó·, ‰·ÎÙ˘ÏÈÔÂȉ›˜ ÛȉËÚÔ‚Ï¿ÛÙ˜

§Â˘ÎÔ΢ÙÙ·ÚÈ΋

∫ÔÎÎÈÔ·ÙÙ·Ú· Ì Ì›ˆÛË ‹ ¤ÏÏÂÈ„Ë ÎÔÎΛˆÛ˘ Î·È ÌÔÚÊÔÏÔÁ›· Pelger - Huet, ˘ÂÚηٿÙÌËÙ· Ô˘‰ÂÙÂÚfiÊÈÏ·, ÌÔÓÔ΢ÙÙ¿ÚˆÛË

∞‡ÍËÛË ÙˆÓ ·ÒÚˆÓ ÌÔÚÊÒÓ, ÂÏ¿ÙÙˆÛË Ù˘ ÎÔÎΛˆÛ˘, ‰È·Ù·Ú·¯¤˜ Ù˘ ¯ÚˆÌ·Ù›Ó˘ ÙÔ˘ ˘Ú‹Ó·, ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ‚Ï·ÛÙÒÓ ÌÂ Î·È ¯ˆÚ›˜ ÎÔÎΛ·, ·‡ÍËÛË ÚÔÌÔÓÔ΢ÙÙ¿ÚˆÓ

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∂Ï¿ÙÙˆÛË ÙˆÓ ÌÂÁ·Î·Ú˘Ô΢ÙÙ¿ÚˆÓ ªÈÎÚÔÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú·

ÛÙȘ ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Û ·ÛıÂÓ‹ Ì ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ·ÓÂ·ÚÎÔ‡˜ ·ÈÌÔÔ›ËÛ˘, Ô˘ ÂΉËÏÒÓÂÙ·È Ì ·Ó·ÈÌ›·, Ô˘‰ÂÙÂÚÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· ‹ Û˘Ó‰˘·Ṳ̂Ó˜ ΢ÙÙ·ÚÔÂӛ˜. O Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ Û˘Ó‹ıˆ˜ ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ·˘ÍË̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·Á΢ÙÙ·ÚÔÂÓ›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Â›Ó·È Ë ¤Ó‰ÂÈÍË Ù˘ ·ÓÂ·ÚÎÔ‡˜ ·ÈÌÔÔ›ËÛ˘. OÈ ‰˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ÔÈΛϘ, ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ·ÈÌÔÔÈËÙÈΤ˜ ÛÂÈÚ¤˜. OÈ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÂÓ Û˘ÓÙÔÌ›· ÛÙÔÓ ›Ó·Î· 4 ‰ÂÓ ÛÙÔȯÂÈÔıÂÙÔ‡Ó ÙË ‰È¿ÁÓˆÛË Ù˘ Ì˘ÂÏÔ‰˘ÛÏ·Û›·˜ ·fi ÌfiÓ˜ ÙÔ˘˜. ∞ÓÂ¿ÚÎÂȘ ‚ÈÙ·Ì›Ó˘ µ12 Î·È Ê˘ÏÏÈÎÔ‡, ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ fiˆ˜ Ë HIV Ïԛ̈ÍË Î·È Ë ¤ÎıÂÛË Û ·ÓÙÈ‚ÈÔÙÈο, ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·Èı·ÓfiÏË, ‚ÂÓ˙›ÓË Î·È ÌfiÏ˘‚‰Ô ÚÔηÏÔ‡Ó ·ÚfiÌÔȘ ·ÏÏÔÈÒÛÂȘ. ∆Ô Î·Ïfi ÈÛÙÔÚÈÎfi, Ë ÛˆÛÙ‹ Ê˘ÛÈ΋ ÂͤٷÛË Î·È Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚԉȷÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË. ∏ ÌÂϤÙË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÁÈ· ·Ó·˙‹ÙËÛË Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ıˆÚÂ›Ù·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÁÈ· ÙË ‰È·ÊÔÚԉȷÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË Î¿ıÂ Ì˘ÂÏÔ‰˘ÛÏ·Û›·˜. ∂ÎÙfi˜ ·fi ÙËÓ ·Ó‡ÚÂÛË ¯ÚˆÌÔÛˆÌÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ Û˘¯Ó¿ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·Û›· Î·È ÔÍ›· Ï¢¯·ÈÌ›·, Ë ·Ó‡ÚÂÛË ÔÔÈ·Û‰‹ÔÙ Â›ÎÙËÙ˘ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ·ÓˆÌ·Ï›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ÎψÓÈ΋ ·ÈÌÔÔ›ËÛË Î·È Â›Ó·È ¤Ó‰ÂÈÍË Î·ÎÔ‹ıÂÈ·˜. ™Â Ì›· ÌÂÁ¿ÏË ÛÂÈÚ¿ Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·Ù· Î·È ·ÊÔÚÔ‡Û ·È‰È¿, ·Ó¢ڤıËÎ·Ó Î˘ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∆· ÚˆÙÔ·ı‹ ª¢™ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÏÏ›„ÂȘ ¯ÚˆÌÔÛˆÌÈ·ÎÔ‡ ˘ÏÈÎÔ‡, ÂÓÒ Ù· ‰Â˘ÙÂÚÔ·ı‹ ¯·-

474

Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi Û‡ÌÏÔΘ ηڢÔÙ˘ÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÌÔÓÔۈ̛· 7, ÙÚÈۈ̛· 8 Î·È 21. ∆· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ÛÙ· ·È‰È¿ Â›Ó·È Û¿ÓÈ· Ì ÂÙ‹ÛÈ· Â›ÙˆÛË 3-4 ÂÚÈÙÒÛÂȘ ·Ó¿ ÂηÙÔÌ̇ÚÈÔ Î·È Ë Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û‡Á¯˘ÛË, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÂÚÈÙÒÛÂˆÓ ÛÙ· ‰È¿ÊÔÚ· ΤÓÙÚ·. ∏ ÌÔÚÊÔÏÔÁÈ΋ ηٿ FAB Ù·ÍÈÓfiÌËÛË Ô˘ ÚÔÙ¿ıËΠ·fi Ì›· ÔÌ¿‰· °¿ÏÏˆÓ (F), ∞ÌÂÚÈηÓÒÓ (A) Î·È ÕÁÁÏˆÓ (B) ·ÈÌ·ÙÔÏfiÁˆÓ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ, ·Ú·Ì¤ÓÂÈ Û ÈÛ¯‡ Î·È ÁÈ· Ù· ·È‰È¿ Ì ÂÏ¿¯ÈÛÙ˜ ÙÚÔÔÔÈ‹ÛÂȘ. ™ÙËÓ Û˘Ó¤¯ÂÈ· ı· ·Ó·ÊÂÚıÔ‡Ó ÔÈ Û˘¯ÓfiÙÂÚ˜ ÌÔÚʤ˜ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙ· ·È‰È¿ ηıÒ˜ Î·È Ù· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈο: ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ‹È· ·Á΢ÙÙ·ÚÔÂÓ›· ‹ ÌÂÌÔӈ̤ÓË Î˘ÙÙ·ÚÔÂÓ›· (Û˘Ó‹ıˆ˜ ·Ó·ÈÌ›·). º˘ÛÈÔÏÔÁÈ΋ ‹ ·˘ÍË̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ Ì ‰˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ Â›Ó·È <1% ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È <5% ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ∏ ‰È¿ÁÓˆÛË ÙÂÎÌËÚÈÒÓÂÙ·È Ôχ ‰‡ÛÎÔÏ·, Î·È fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ‰Â›ÎÙ˘ ÎψÓÈÎfiÙËÙ·˜, Á›ÓÂÙ·È ‰È· ·ÔÎÏÂÈÛÌÔ‡. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Á›ÓÂÈ ·fi Û˘ÁÁÂÓ›˜ ÌÔÚʤ˜ ‰˘ÛÂÚ˘ıÚÔÔÈËÙÈ΋˜ Î·È ÌÂÁ·ÏÔ‚Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜, Û¿ÓȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∂ȉÈο Û ‚Ú¤ÊË, ‰È¿ÊÔÚÔÈ ÏÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÌÈÌÔ‡ÓÙ·È ÙË ÌÔÚÊÔÏÔÁÈ΋ ÂÈÎfiÓ· Ù˘ ·ÓıÂÎÙÈ΋˜ ·Ó·ÈÌ›·˜. ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ‰·ÎÙ˘ÏÈÔÂȉ›˜ ÛȉËÚÔ‚Ï¿ÛÙ˜ ÿ‰È· ¯·Ú·ÎÙËÚÈÛÙÈο Ì ÙËÓ ·ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· ·ÏÏ¿ Ì ÔÛÔÛÙfi >15% (Â› ÙˆÓ ÂÌ˘Ú‹ÓˆÓ ΢ÙÙ¿ÚˆÓ) ÛȉËÚÔ‚Ï·ÛÙÒÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ∂›Ó·È

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·475

¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

ÙfiÛÔ Û¿ÓÈ· ÛÙ· ·È‰È¿ ÒÛÙ Û οı ٤ÙÔÈ· ÂÚ›ÙˆÛË Î·È È‰È·›ÙÂÚ· Â› ·ÚÔ˘Û›·˜ Ì·ÎÚÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È Ë ÂÓ·ÏÏ·ÎÙÈ΋ ‰È¿ÁÓˆÛË ÌÈÙÔ¯ÔÓ‰Úȷ΋˜ ΢ÙÙÔ¿ıÂÈ·˜. ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ÂÚ›ÛÛÂÈ· ‚Ï·ÛÙÒÓ ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ΢ÙÙ·ÚÔÂÓ›· ‰‡Ô ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ÛÂÈÚÒÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È Ì ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ <5% ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È 5-20% ÛÙÔÓ Ì˘ÂÏfi. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ‰˘ÛÌ˘ÂÏÔÔ›ËÛË Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ, ·ÏÏ¿ ΢ÚÈ·Ú¯Ô‡Ó ÔÈ ·ÏÏÔÈÒÛÂȘ Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜. ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ÂÚ›ÛÛÂÈ· ‚Ï·ÛÙÒÓ Û ÌÂÙ·Û¯ËÌ·ÙÈÛÌfi ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ >5% ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, 20-29% ‚Ï¿ÛÙ˜ ÛÙÔÓ Ì˘ÂÏfi ‹ ·ÚÔ˘Û›· ¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›· Ú·‚‰›ˆÓ Auer ÛÙ· ÚÔÁÔÓÈο ÎÔÎÎÈÔ·ÙÙ·Ú·. ∞ÔÙÂÏ› ȉȷ›ÙÂÚË ÔÌ¿‰· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚Ú·¯‡ ‰È¿ÛÙËÌ· Ì˘ÂÏÔ‰˘ÛÏ·Û›·˜ Î·È Ù·¯‡ÙÂÚË ÂͤÏÈÍË Û ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›·. ∏ ÛËÌ·Û›· Ù˘ ·ÚÔ˘Û›·˜ ÙˆÓ Ú·‚‰›ˆÓ Auer Â›Ó·È ˘fi Û˘Ó¯‹ ¤Ú¢ӷ, ·ÏÏ¿ ÌÂÚÈÎÔ› ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ·ÚÔ˘Û›· ÙÔ˘˜ Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ‡ÊÂÛ˘ ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂÚ·›·. ÃÚfiÓÈ· Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· OÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· >1000/mm3. ™˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Ì ·ÚÔ˘Û›· ·ÒÚˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ù˘ Ì˘ÂÏÈ΋˜ Î·È ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·. O Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ Â›Ó·È ¤ÓÙÔÓ· ΢ÙÙ·ÚÔ‚ÚÈı‹˜ Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË ˘ÂÚÏ·Û›· Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜, ÂÓÒ Ù· ÌÔÓÔ΢ÙÙ·ÚÔÂȉ‹ ÛÙÔȯ›· ‰ÂÓ Â›Ó·È ÙfiÛÔ ÂÌÊ·Ó‹ ˆ˜ ·Ó·Ì¤ÓÂÙ·È ·fi ÙËÓ ÂÈÎfiÓ· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∆Ô ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È <5% ÛÙÔ ·›Ì· Î·È Ì¤¯ÚÈ 20% ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™Ù· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·Û›·, Ë ÌÔÚÊÔÏÔÁ›· Ù˘ ¯ÚfiÓÈ·˜ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋˜ Ï¢¯·ÈÌ›·˜ ··ÓÙ¿Ù·È ˆ˜: - Ó·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· (ªª§), - ¯ÚfiÓÈ· Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· ˆ˜ ‰Â‡ÙÂÚË Î·ÎÔ‹ıÂÈ·. ∏ Ó·ÓÈÎÔ‡ Ù‡Ô˘ (·Ï·ÈfiÙÂÚ· ÁÓˆÛÙ‹ ˆ˜ Ó·ÓÈ΋ ¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›·) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙË ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, Û˘Ó‹ıˆ˜ οو ÙˆÓ 4 ¯ÚfiÓˆÓ, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Û˘¯Ó¿ ‰ÂÚÌ·ÙÈ΋ ‰È‹ıËÛË, Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, ÌÔÓÔ΢ÙÙ¿ÚˆÛË Î·È ·ÚÔ˘Û›· ·ÒÚˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·. 14% ÙˆÓ ·ÛıÂÓÒÓ ¤¯Ô˘Ó ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ Ó¢ÚÔ˚ӈ̿وÛ˘ Ù‡Ô˘ 1, ÂÓÒ 7% ¤¯Ô˘Ó ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ¶ÂÚ›Ô˘ 65% ÙˆÓ ·ÛıÂÓÒÓ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô, 25% ÂÌÊ·Ó›˙Ô˘Ó ÌÔÓÔۈ̛· 7 Î·È 10% Û‡ÌÏÔΘ ¯ÚˆÌÔÛˆÌȷΤ˜ ·ÓˆÌ·Ï›Â˜. ∏ ÓfiÛÔ˜ Ì ÌÔÓÔۈ̛· 7 ·Ó·Ê¤ÚÂÙ·È Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ ‚ÚÂÊÈ΋˜ ÌÔÓÔۈ̛·˜ 7. ∆· ÎÏÈÓÈο

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ë ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ì Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§ Î·È ÌÔÓÔۈ̛· 7 ‰ÂÓ ‰È·Ê¤ÚÂÈ ÂΛӢ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô. ∂ÓÙÔ‡ÙÔȘ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ÛËÌ·ÓÙÈο ¯·ÌËÏfi ·ÚÈıÌfi Ï¢ÎÒÓ, ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, ÌÂȈ̤ÓË Û¯¤ÛË Ì˘ÂÏÈ΋˜ ÚÔ˜ ÂÚ˘ıÚ¿ ÛÂÈÚ¿ Î·È ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ˈÛÈÓÔÊ›ÏˆÓ ÛÙÔÓ Ì˘ÂÏfi. ™ÙË ÌÔÓÔۈ̛· 7 Ù· ÂÚ˘ıÚÔ·ÙÙ·Ú· ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ Ì ̷ÎÚÔ΢ÙÙ¿ÚˆÛË Î·È Ë ·ÈÌÔÛÊ·ÈÚ›ÓË F Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÌfiÓÔ ÌÂÙÚ›ˆ˜ ·˘ÍË̤ÓË. ∞ÓÙÈı¤Ùˆ˜ Û ·È‰È¿ Ì Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô, ˘¿Ú¯ÂÈ Â˘Ú›· ‰È·Î‡Ì·ÓÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ F. ™ÙË Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§ Ù· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜, Û in vitro ηÏÏȤÚÁÂȘ, ÂΉËÏÒÓÔ˘Ó ˘¤ÚÌÂÙÚË ˘ÂÚÏ·Û›· Î·È ˘ÂÚ¢·ÈÛıËÛ›· ÛÙË ‰Ú¿ÛË ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ-Ì·ÎÚÔÊ¿ÁˆÓ (GM-CSF). ∏ ÌÂϤÙË ·˘Ù‹ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘, ÂÂȉ‹ Ë ÎÏÈÓÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ÂÈÎfiÓ· Ù˘ Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§ Û˘¯Ó¿ ÌÈÌÂ›Ù·È ÙËÓ ÂÈÎfiÓ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È ÏÔÈÌÒ͈Ó. ŸÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈÔ ·ıÔÁÓˆÌÔÓÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‹ ÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ·, Ë ‰È¿ÁÓˆÛË Ù˘ Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§ ÛÙËÚ›˙ÂÙ·È ÛÙ· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ›Ó·Î· 5. ™‡Ó‰ÚÔÌÔ ‚ÚÂÊÈ΋˜ ÌÔÓÔۈ̛·˜ 7 ¶ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ·È‰È¿ Ì ª¢™, ËÏÈΛ·˜ οو ÙˆÓ 4 ¯ÚfiÓˆÓ Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·ÓˆÌ·Ï›· ÙËÓ ÌÔÓÔۈ̛· 7. ∞ÊÔÚ¿ Û˘Ó‹ıˆ˜ ·ÁfiÚÈ· Ì ÂÌÊ·Ó‹ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ∏ Û¯¤ÛË Ì˘ÂÏÈ΋˜ ÚÔ˜ ÂÚ˘ıÚ¿ ÛÂÈÚ¿ Â›Ó·È ÌÂȈ̤ÓË, ÂÓÒ ·Ú·ÙËÚÂ›Ù·È Î·È ·‡ÍËÛË ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ∏ ·ÈÌÔÛÊ·ÈÚ›ÓË F Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÂÏ¿¯ÈÛÙ· ·˘ÍË̤ÓË. ∏ ηٿ FAB Ù·ÍÈÓfiÌËÛË ÙˆÓ ª¢™ ‚Ô‹ıËÛ ÛËÌ·ÓÙÈο ÛÙÔÓ Û¯Â‰È·ÛÌfi ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, ·ÏÏ¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÈ ÚfiÔ‰ÔÈ ÛÙËÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋, ·ÓÔÛÔÏÔÁ›· Î·È ÌÔÚȷ΋ ‚ÈÔÏÔÁ›· ÚÔÛ¤ÊÂÚ·Ó Ó¤Â˜ ‰˘Ó·ÙfiÙËÙ˜ ÛÙË ÌÂϤÙË ÙÔ˘˜. ∏ ηٷÓfiËÛË ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û ÔÚÈṲ̂Ó˜ ˘ÔÔÌ¿‰Â˜ ª¢™, Ô‰‹ÁËÛ Û ÌÈ· Ó¤· Ù·ÍÈÓfiÌËÛË Ô˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ Ó¤Â˜ ηÙËÁÔڛ˜, ·ÏÏ¿ Î·È ÂΛӘ Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ÎÏ·ÛÈΤ˜ Ù·ÍÈÓÔÌ‹ÛÂȘ, fiˆ˜ Ù· ÔÈÎÔÁÂÓ‹ /ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ª¢™ Î·È Ù· ÚÔηÏÔ‡ÌÂÓ· ·fi ıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰Â˘ÙÂÚÔ·ı‹ ª¢™ (¶›Ó·Î·˜ 6). ™Â ÔÚȷΤ˜ ηٷÛÙ¿ÛÂȘ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ª¢™ Î·È Oª§ Â›Ó·È ‰‡ÛÎÔÏË Î·È ‚·Û›˙ÂÙ·È ÛÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ. ¶ÚÒÙÔ ‚‹Ì· ·ÔÙÂÏ› Ë Î·Ù·Ì¤ÙÚËÛË ÙˆÓ ÂÌÌfiÚÊˆÓ ÛÙÔȯ›ˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ∂¿Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Â›Ó·È >50%, ÔÈ Ì˘ÂÏÔ‚Ï¿ÛÙ˜ ηٷÌÂÙÚÒÓÙ·È ˆ˜ ÔÛÔÛÙfi ÙˆÓ ÂÌ˘Ú‹ÓˆÓ ÌË ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ.

475

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·476

¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

¶›Ó·Î·˜ 5. ÷ڷÎÙËÚÈÛÙÈο Î·È ÎÚÈÙ‹ÚÈ· Ù˘ Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§. ●

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∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο (% ÙˆÓ ·ÛıÂÓÒÓ) ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· (>90%) §ÂÌÊ·‰ÂÓÔ¿ıÂÈ· (75%) ø¯ÚfiÙËÙ· (70%) ¶˘ÚÂÙfi˜ (60%) ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ· (40%) ∂Ï¿¯ÈÛÙ· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· (··ÈÙÔ‡ÓÙ·È Î·È Ù· ÙÚ›·) Ÿ¯È Ph+, fi¯È bcr-abl ¶ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ ÛÙÔÓ Ì˘ÂÏfi <20 % ªÔÓÔ·ÙÙ·Ú· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· >1000 mm3 ∫ÚÈÙ‹ÚÈ· ÔÚÈÛÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (··ÈÙÔ‡ÓÙ·È ÙÔ˘ Ï¿¯ÈÛÙÔÓ 2) ∞˘ÍË̤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË F ¶·ÚÔ˘Û›· ÚÔÁÔÓÈÎÒÓ Ì˘ÂÏÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ∞ÚÈıÌfi˜ Ï¢ÎÒÓ >10000/mm3 ∫ψÓÈ΋ ·ÓˆÌ·Ï›· (Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ÌÔÓÔۈ̛· 7) ÀÂÚ¢·ÈÛıËÛ›· ÛÙÔÓ ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ-Ì·ÎÚÔÊ¿ÁˆÓ (GM-CSF)

¶ÔÛÔÛÙfi >30% ˘ÔÛÙËÚ›˙ÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ Oª§. ∂¿Ó ÔÈ ÂÚ˘ıÚÔ‚Ï¿ÛÙ˜ ·ÔÙÂÏÔ‡Ó <50% ÙˆÓ ÂÌ˘Ú‹ÓˆÓ ΢ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡, ÔÈ Ì˘ÂÏÔ‚Ï¿ÛÙ˜ ηٷÌÂÙÚÒÓÙ·È ˆ˜ ÔÛÔÛÙfi Â› fiÏˆÓ ÙˆÓ ÂÌ˘Ú‹ÓˆÓ ΢ÙÙ¿ÚˆÓ Î·È ÔÛÔÛÙfi >30% Â›Ó·È ˘¤Ú Ù˘ Oª§. ∞Ó Î·È Ë ·ÓˆÙ¤Úˆ ÌÔÚÊÔÏÔÁÈ΋ ηٿٷÍË Ê·›ÓÂÙ·È ·Ï‹, Û˘¯Ó¿ Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÓÙÔÙ‹ÙˆÓ Â›Ó·È ‰‡ÛÎÔÏË. ™Â ÔÚȷΤ˜ ÂÚÈÙÒÛÂȘ Ì ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ ÂÏ¿¯ÈÛÙ· <30%, Ë Â·Ó¿ÏË„Ë Ù˘ ·Ó·ÚÚfiÊËÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ Î·È Ë ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· ÌÂÙ¿ ·fi 2-3 ‚‰ÔÌ¿‰Â˜ ‚ÔËı¿ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÚÔfi‰Ô˘ Ù˘ ÓfiÛÔ˘. ∆ÂÏÈο, Ù· ‚ÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Â›Ó·È ÛËÌ·ÓÙÈÎfiÙÂÚ· ÁÈ· ÙË ‰È¿ÎÚÈÛË Ù˘ Oª§ ·fi ÙÔ ª¢™ Û ۯ¤ÛË Ì ÙÔ fiÚÈÔ ÙÔ˘ 30% ÙˆÓ ‚Ï·ÛÙÒÓ. ¡fiÛÔ˜ Ì ‚Ï¿ÛÙ˜ <30%, ·ÏÏ¿ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋ ‹ ÌÔÚȷ΋ ·ÓˆÌ·Ï›· ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ù˘ de novo Oª§ ÂÎÏ·Ì‚¿ÓÂÙ·È ˆ˜ Oª§ Ì ¯·ÌËÏfi ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ Î·È Ú¤ÂÈ Ó· ıˆÚ›ٷÈ, ·ÏÏ¿ Î·È Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ˆ˜ Ù¤ÙÔÈ·. ÷ڷÎÙËÚÈÛÙÈΤ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ù˘ Oª§ ıˆÚÔ‡ÓÙ·È Ë t (8;21) (q22;q22), t (15;17) (q22;q12), inv (16) (p13q22) Î·È Ú¤ÂÈ Ó· ·Ó·˙ËÙÔ‡ÓÙ·È Î·È Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR). ÀÔ΢ÙÙ·ÚÈÎfi ª¢™ ™Ù· ·È‰È¿ ‰ÂÓ ˘¿Ú¯ÂÈ Û·Ê‹˜ ÔÚÈÛÌfi˜ ÙÔ˘ ˘Ô΢ÙÙ·ÚÈÎÔ‡ ª¢™. ∏ ÔÓÙfiÙËÙ· ·˘Ù‹ Ô˘ ·ÔÙÂÏ› ÙÔ 15% ÙˆÓ ª¢™ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‰È·¯ˆÚ›˙ÂÙ·È ·fi ÙËÓ ˘ÔÏ·ÛÙÈ΋ Oª§ ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ΢ÙÙ·-

476

∞. ¶Ô˘ÚÙÛ›‰Ë˜

¶›Ó·Î·˜ 6. §ÂÙÔÌÂÚ‹˜ Ù·ÍÈÓfiÌËÛË ÙˆÓ ª¢™. ¶ÚˆÙÔ·ı‹ ª¢™ ™È‰ËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ∞ÓıÂÎÙÈ΋ ΢ÙÙÔÂÓ›· ™‡Ó‰ÚÔÌÔ ·ÒÏÂÈ·˜ Ì·ÎÚÔ‡ ÛΤÏÔ˘˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 5 (5q-) π‰ÈÔ·ı‹˜ Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË ª¢™ Ì ‰˘ÛÎÔÎÎÈÔÔ›ËÛË Î·È ·ÒÏÂÈ· 17p ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ÂÚ›ÛÛÂÈ· ‚Ï·ÛÙÒÓ ∞ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ÂÚ›ÛÛÂÈ· ‚Ï·ÛÙÒÓ Û ÌÂÙ·Û¯ËÌ·ÙÈÛÌfi (ª¢™/√ª§) ª¢™ Ì ˘Ô΢ÙÙ·ÚÈÎfi Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (ÚÔÛˆÚÈÓ‹ ÔÓÙfiÙËÙ·) ● ª¢™ ÌÂ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÃÚfiÓÈ· Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·, ÂÓËÏ›ÎÔ˘ Ù‡Ô˘ ÃÚfiÓÈ· Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· ·È‰ÈÒÓ ™‡Ó‰ÚÔÌÔ ·ÓÒÌ·Ï˘ Û˘ÛÛÒÚ¢Û˘ ¯ÚˆÌ·Ù›Ó˘ ● ¢Â˘ÙÂÚÔ·ı‹ ª¢™ √ÊÂÈÏfiÌÂÓ· Û ¯ËÌÂÈÔıÂÚ·›· Ì ·Ï΢ÏÈÔ‡ÓÙ˜ ·Ú¿ÁÔÓÙ˜ Î·È ·Ó·ÛÙÔÏ›˜ Ù˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ ππ √ÊÂÈÏfiÌÂÓ· Û ÙÔÍÈ΋ ¤ÎıÂÛË Â·ÁÁÂÏÌ·ÙÈ΋ ‹ ÂÚÈ‚·ÏÏÔÓÙÈ΋ ● ª¢™ Ì ÎÏËÚÔÓÔÌÈ΋ ÚԉȿıÂÛË ª¢™ ÔÊÂÈÏfiÌÂÓ· ÛÙÔ Û‡Ó‰ÚÔÌÔ Â‡ıÚ·˘ÛÙˆÓ ¯ÚˆÌÔۈ̿وÓ, Û ¤ÌÊ˘Ù˜ ·ÓˆÌ·Ï›Â˜ (.¯.Û‡Ó‰ÚÔÌÔ Down, Shwachmann’s ) OÈÎÔÁÂÓ¤˜ ª¢™: ÔÈÎÔÁÂÓ‹˜ ÌÔÓÔۈ̛· 7, ÔÈÎÔÁÂÓ¤˜ ª¢™ ÂÓËÏ›ÎˆÓ ●

ÚÔ‚Ú›ıÂÈ·˜ ÙÔ˘ Ì˘ÂÏÔ‡ (<50%) Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ (>30%). O ‰È·¯ˆÚÈÛÌfi˜ Ù˘ fï˜ ·fi ÙËÓ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· Â›Ó·È Ôχ ‰‡ÛÎÔÏÔ˜ Î·È Á›ÓÂÙ·È ·fi ÙËÓ ·Ó‡ÚÂÛË ·ÒÚˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ¿Ù˘˜ ı¤ÛÂȘ, ÙËÓ ·Ó‡ÚÂÛË ÌÔÚÊÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ ‰˘ÛÌÂÁ·Î·Ú˘ÔÔ›ËÛ˘ Î·È ÙËÓ ·ÚÔ˘Û›· ÌÂÁ·Î·Ú˘Ô‚Ï·ÛÙÒÓ ÛÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô. ™Â Ì›· ÌÂÁ¿ÏË ÛÂÈÚ¿ ·ÛıÂÓÒÓ Ì ‚·ÚÈ¿ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, 4% ›¯·Ó ÎψÓÈ΋ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·ÓˆÌ·Ï›· fiˆ˜ ÌÔÓÔۈ̛· 7 ‹ ÙÚÈۈ̛· 8, ‰ËÏ·‰‹ ·ÚÈıÌËÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ª¢™. OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› Ï›ÁÔ˘˜ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ ‹ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ó¤Ù˘Í·Ó ÔÍ›· Ï¢¯·ÈÌ›·. ª¢™ Î·È Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ¶·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ fiˆ˜ ·Ó·ÈÌ›· Fanconi, Û‡Ó‰ÚÔÌÔ Shwachman, Û˘ÁÁÂÓ‹ Ô˘‰ÂÙÂÚÔÂÓ›· (Û‡Ó‰ÚÔÌÔ Kostmann), ·Ó·ÈÌ›· Diamond-Blackfan, Â›Ó·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ Oª§ Î·È ª¢™. ™Â ·ÛıÂÓ›˜ Ì ·Ó·ÈÌ›· Fanconi, Ï¢¯·ÈÌ›· ‹ ª¢™ ·Ó·Ù‡ÛÛÂÙ·È ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 40 ¯ÚfiÓˆÓ. ∫ψÓÈΤ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ¤¯Ô˘Ó ·Ó·-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·477

¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477

ÊÂÚı› ÛÙÔ 40% ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Î·È ˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· ÁÈ· ÙË ÛËÌ·Û›· ·˘Ù‹˜ Ù˘ ÎψÓÈÎfiÙËÙ·˜, ȉȷ›ÙÂÚ· Ù˘ ÌÔÓÔۈ̛·˜ 7, ηٿ fiÛÔÓ ·ÔÙÂÏ› ‰Â›ÎÙË Î·ÎÔ‹ıÂÈ·˜ ‹ fi¯È. ∏ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Û˘ÁÁÂÓÔ‡˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Ì˘ÂÏÔÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛı›. ÀÊ›ÛÙ·Ù·È ‰È¯ÔÁӈ̛· Û¯ÂÙÈο Ì ÙËÓ Â›ÙˆÛË ª¢™ ‹ Oª§ Û ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ıÂÚ·›· Ì ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (G-CSF). ∆Ô ÂÚÒÙËÌ· Â›Ó·È Â¿Ó Ë Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· ıˆÚÂ›Ù·È ÚÔηÎÔ‹ı˘ ηٿÛÙ·ÛË ‹ Ë ·Ó¿Ù˘ÍË ª¢™ Î·È Oª§ ·Ô‰›‰ÂÙ·È ÛÙË ıÂÚ·›·. ª¢™ Î·È ÏÔÈÌÒÍÂȘ ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ ‰˘Ó·ÙfiÓ, ÂÚÈÛÙ·Ûȷο, Ó· ÚÔηϤÛÔ˘Ó ÛÔ‚·Ú‹ ‰˘ÛÏ·Û›· ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÙˆÓ ÙÚÈÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ. ∂Ô̤ӈ˜, Ë ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË ª¢™ Â›Ó·È ‰‡ÛÎÔÏË Â› ·Ô˘Û›·˜ ·˘ÍË̤ÓÔ˘ ÔÛÔÛÙÔ‡ ‚Ï·ÛÙÒÓ, fiÙ·Ó ÔÈ ¯ÚˆÌÔÛˆÌÈΤ˜ ÌÂϤÙ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈΤ˜. ™˘Ó‹ıÂȘ ÈÔ› fiˆ˜ Ô Èfi˜ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Î·È Ô ÂÚËÙÔ˚fi˜ 6 ÚÔηÏÔ‡Ó ·ÏÏÔÈÒÛÂȘ Ô˘ ÌÈÌÔ‡ÓÙ·È ÙËÓ ·ÈÌ·ÙÔÏÔÁÈ΋ Î·È ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ó·ÓÈÎÔ‡ Ù‡Ô˘ ªª§. ∂›Û˘ ÔÈ ·Ú·¿Óˆ ÈÔ›, fiˆ˜ Î·È Ô Èfi˜ Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ Î·È Ô ·Ú‚Ô˚fi˜ µ19, ÚÔηÏÔ‡Ó ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ fiÌÔȘ Ì ÂΛӘ Ù˘ ·ÓıÂÎÙÈ΋˜ ·Ó·ÈÌ›·˜. √ÈÎÔÁÂÓ¤˜ ª¢™ ∆Ô ÔÈÎÔÁÂÓ¤˜ ª¢™ ··ÓÙ¿Ù·È ÂÚÈÛÙ·Ûȷο, ¯ˆÚ›˜ ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË Î·È Û˘Ó‰˘¿˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Ì ÌÔÓÔۈ̛· 7. ∞ÊÔÚ¿ Û˘Ó‹ıˆ˜ ÌfiÓÔ Ì›· ÁÂÓÈ¿ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Î·È ÁÈ’ ·˘Ùfi ¯ÚÂÈ¿˙ÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ‰ÔÙÒÓ Ì˘ÂÏÔ‡ ·fi ÙËÓ ›‰È· ÁÂÓÈ¿.

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

ı¤Ùˆ˜ ÔÈ Ï¢¯·È̛˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ˘˜ ·Ó·ÛÙÔÏ›˜ Ù˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ ππ ¤¯Ô˘Ó ‚Ú·¯Â›· Ï·Óı¿ÓÔ˘Û· ÂÚ›Ô‰Ô (·fi 1 ¤ˆ˜ 3 ¯ÚfiÓÈ·) Î·È ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈ΋ Ê¿ÛË ÛÙËÓ ·Ú¯‹. ™˘Ó‹ıˆ˜ ¤¯Ô˘Ó ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ù˘ 11q23 ı¤Û˘ ÛÙÔÓ Î·Ú˘fiÙ˘Ô. µÈ‚ÏÈÔÁÚ·Ê›· 1. Vlachos ∞, Lipton JM. Bone marrow failure in children.

Current opinion in Pediatrics 1996;8:33-41.

2. Williams D. Pancytopenia. Aplastic Anemia and Pure Cell Aplasia. In: Wintrobe’s Clinical Hematology, 10th ed.

Baltimore: Lippincott Williams & Wilkins. Inc; 1999. p.

1449-1484.

3. Guinan EC. Clinical aspects of aplastic anemia. Hematol Oncol Clin N Am 1997;11:1025-1037.

4. Young NS. Acquired Aplastic Anemia. JAMA 1999;282:271-278.

5. Passmore SJ, Hann IM. Paediatric myelodysplasia. Brit Med Bull 1996;52:778-786.

6. Emmanuel DP. Myelodysplasia and myeloproliferative disorders in childhood: An update. Brit J Hematol 1999;105:852-863.

7. Luna-Fineman S, Shannon K, Atwater S, Jeffrey D, Masterson M, Ortega J et al. Myelodysplastic and myeloproliferative disorders of childhood: A study of 167 patients. Blood 1999;93:459-466.

8. Mijovic A, Mufti G. The myelodysplastic syndromes: towards a functional classification. Blood Rev 1998;12:73-83.

9. EWOG MDS 98 study. Prospective study of the diagnosis and treatment of myelodysplastic syndrome in childhood. Coordinator Charlotte Niemeyer, University Kinderklinic, Freiburg, Germany.

ª¢™ ‰Â˘ÙÂÚÔ·ı¤˜ ÌÂÙ¿ ·fi ÃËÌÂÈÔıÂÚ·›· ‹ ∞ÎÙÈÓÔıÂÚ·›· ∆· ª¢™ Î·È ÔÈ Oª§ ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂÚ·›· ‹ ·ÎÙÈÓÔıÂÚ·›· ·ÔÙÂÏÔ‡Ó ÙÔ 10-15% ÙˆÓ Ó¤ˆÓ ‰È·ÁÓÒÛÂˆÓ Û ÂÓ‹ÏÈΘ. ™‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ, ÔÈ ·Ï΢ÏÈÔ‡ÓÙ˜ ·Ú¿ÁÔÓÙ˜ Î·È ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ ππ, ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË ‰Â˘ÙÂÚÔ·ıÒÓ Oª§. OÈ Ï¢¯·È̛˜ ·fi ·Ï΢ÏÈÔ‡ÓÙ˜ ·Ú¿ÁÔÓÙ˜ Û˘¯Ó¿ ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ Ì˘ÂÏÔ‰˘ÛÏ·Û›· ·Ú¯Èο, Û˘Ó‹ıˆ˜ Ì ¤ÏÏÂÈÌÌ· ¯ÚˆÌÔÛˆÌÈ·Îfi 5q ‹ 7q Î·È Ï·Óı¿ÓÔ˘Û· ÂÚ›Ô‰Ô 3-5 ¯ÚfiÓÈ·. ∞ÓÙÈ-

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-10-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-11-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞fiÛÙÔÏÔ˜ ¶Ô˘ÚÙÛ›‰Ë˜ ∞Ê·›·˜ 14, æ˘¯ÈÎfi 154 54

477

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·478

¶∞π¢π∞∆ƒπ∫∏ 2000;63:478-482

∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ª·Ú›· ªÔÛ¯fi‚Ë

● ¶ÂÚ›ÏË„Ë: OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÈÂÁ›ÚÔ˘Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·Ó¿ÏÔÁ· Ì ÙË ‰Ú¿ÛË ÙÔ˘˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ·Ú¿ÁÔÓÙ˜ ÙÂÏÈ΋˜ ‹ ÚÒÈÌ˘ Ê¿Û˘, Û ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ÛÙÔ ·Ú¯¤ÁÔÓÔ Î‡ÙÙ·ÚÔ ‹ ÛÂ Û˘ÓÂÚÁÈÎÔ‡˜. T· ·Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· ‰ÂÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ¤ÏÏÂÈ„Ë ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fï˜ Ë Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ Û˘ÓÂÈÛ¤ÊÂÚ ·Ú¯Èο ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ·ÚÁfiÙÂÚ· ÛÙËÓ ·Ó¿Î·Ì„Ë Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ ·ÈÌÔÔ›ËÛ˘. ™Â ·È‰È¿ Ì ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· Ô˘ ‰ÂÓ ¤¯Ô˘Ó Û˘Ì‚·Ùfi ‰fiÙË ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË, Ë ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì·˙› Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈο ·ÔÙÂÏ› ÙË ıÂÚ·›· ÂÎÏÔÁ‹˜, ·˘Í¿ÓÔÓÙ·˜ ı·̷ÙÈο Ù· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ·fi 50% ¤ˆ˜ 100% ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜. ™Â ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο, Ô Û˘Ó‰˘·ÛÌfi˜ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó Û ‰È·ÊÔÚÂÙÈΤ˜ Ê¿ÛÂȘ Ù˘ ·ÈÌÔÔ›ËÛ˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Ó¿Î·Ì„Ë, ÂÚÈÛÛÔÙ¤ÚˆÓ Ù˘ ÌÈ·˜, ÛÂÈÚÒÓ. ™ÙÔ Û‡Ó‰ÚÔÌÔ Kostmann, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ô˘‰ÂÙÂÚÔÂÓ›·, Ë ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·‡ÍËÛ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, ‚ÂÏÙ›ˆÛ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ì›ˆÛ ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÏÔÈÌÒ͈Ó. ∆Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ Úfi‚ÏËÌ· ÁÈ· Ù· ·È‰È¿ Ì ·Ó·ÈÌ›· Fanconi ‰ÂÓ Â›Ó·È Ë ¯·ÌËÏ‹ ·ÈÌÔÛÊ·ÈÚ›ÓË, ·ÏÏ¿ Ë ¤ÎÙˆÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ Î·È Ë Û˘Ó˘¿Ú¯Ô˘Û· ıÚÔÌ‚ÔÂÓ›·. ∏ ¯ÔÚ‹ÁËÛË ÂÚ˘ıÚÔÔÈËÙ›Ó˘ Ì ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Ó¿Î·Ì„Ë Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ. ∏ ÂÌÊ¿ÓÈÛË Ï¢¯·ÈÌÈÒÓ Î·È Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Ô˘ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÂӉ¯Ô̤ӈ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ¶·È‰È·ÙÚÈ΋ 2000;63:478-482. §¤ÍÂȘ ÎÏÂȉȿ: ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Û‡Ó‰ÚÔÌÔ Kostmann, ·Ó·ÈÌ›· Fanconi, ÂÈÏÔΤ˜.

M. Moschovi. Aplastic syndromes and hematopoietic growth factors. Paediatriki 2000;63:478-482. ● Abstract: Hematopoietic growth factors stimulate the differentiation and proliferation of the hematopoietic cells.

Depending on their function they are distinguished in lineage-specific factors, multilineage stem-cell factors and synergistic factors. Although aplastic syndromes are not characterized by the lack of growth factors nevertheless their exogenous administration was initially effective in the management of neutropenia and later in the recovery of all three cell lines. In children with aplastic anemia who don’t have a histocompatible donor for bone marrow transplantation, the use of growth factors in combination with immunosuppressive agents is the treatment of choice sinceit increases significantly the survival rates from 50% to 100% depending on the types of the immunosuppressives used. In patients who do not respond to immunosuppressives the combination of various growth factors, that act on a different phase of hemopoiesis may result in the recovery of more than one lineage. In Kostmann syndrome, characterized by neutropenia, the use of growth factor has increased the expected survival rate, improved the quality of patients’ life and reduced significantly the incidence and severity of infections. The major problem for children with Fanconi anemia is not only the low hemoglobin levels but also the decline in the number of granulocytes as well as the coexisting thrombocytopenia. The administration of erythropoietin plus granulocyte colony-stimulating factor (G-CSF) may cause a trilineage hematologic response. The appearance of leukemia or myelodysplastic syndromes following prolonged use of growth factors, is probably related to the genetic predisposition of the aplastic syndromes.

Key words: growth factors, aplastic anemia, Kostmann, Fanconi anemia.

OÁÎÔÏÔÁÈÎfi ÙÌ‹Ì· ∞' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·", ∞ı‹Ó·

478

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30-05-03

17:43

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:478-482

OÈ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ 10Âٛ˜ Ì¿˜ ¯¿ÚÈÛ·Ó ÙËÓ ÎψÓÔÔ›ËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (HGF) Î·È ¯¿ÚȘ Û ·˘ÙÔ‡˜ ¿ÏÏ·ÍÂ Ë ıÂÒÚËÛË ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÈÂÁ›ÚÔ˘Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ (ÂÚ˘ıÚÔÔÈËÙ›ÓË), Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜ (·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ, ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ‹ Î·È ÙˆÓ ‰‡Ô) Î·È ÙˆÓ ÌÂÁ·Î·Ú˘Ô΢ÙÙ¿ÚˆÓ (ıÚÔÌ‚ÔÔÈËÙ›ÓË). OÈ ÈÓÙÂÚÏ¢ΛÓ˜ ‰ÚÔ˘Ó Û˘Ó‹ıˆ˜ Û ÚÒÈÌË Ê¿ÛË Ù˘ ·ÈÌÔÔ›ËÛ˘ ‹ Û˘ÓÂÚÁÈο Ì ¿ÏÏÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¶ÚfiÛÊ·Ù· ÎψÓÔÔÈ‹ıËÎ·Ó ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ÛÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ. ªÂ ÎÚÈÙ‹ÚÈÔ ÙË ‰Ú¿ÛË ÙÔ˘˜, ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ηٷٿÛÛÔÓÙ·È Û 4 ÔÌ¿‰Â˜, ‰ËÏ·‰‹: 1. ¶·Ú¿ÁÔÓÙ˜ ÂȉÈÎÔ› ÁÈ· Ì›· ÛÂÈÚ¿ (lineagespecific factors) ‹ ÙÂÏÈ΋˜ Ê¿Û˘, fiˆ˜ Ô ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (G-CSF), ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ (M-CSF), Ë ÂÚ˘ıÚÔÔÈËÙ›ÓË (EPO), Ë ıÚÔÌ‚ÔÔÈËÙ›ÓË (TPO) Î·È Ë ÈÓÙÂÚÏ¢ΛÓË-5 (IL-5). ∞fi ·˘ÙÔ‡˜ Ë EPO ¤¯ÂÈ Î·Ù·ÍȈ̤ÓË ¯Ú‹ÛË ÛÙËÓ ·Ó·ÈÌ›· Ù˘ ÚÔˆÚfiÙËÙ·˜ Î·È Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Ô G-CSF ‚Ô‹ıËÛ ÛËÌ·ÓÙÈο ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ ‹ Â›ÎÙËÙË Ô˘‰ÂÙÂÚÔÂÓ›·, ÂÓÒ Ë ∆ƒO ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÌÂÙ¿ ¯ËÌÂÈÔıÂÚ·›· ÛÂ Û˘Ì·Á›˜ ΢ڛˆ˜ fiÁÎÔ˘˜.

2. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ ÛÂÈÚ¤˜ (multilineage) ‹ ÚÒÈÌ˘ Ê¿Û˘ (early acting HGF), fiˆ˜ Ë ÈÓÙÂÚÏ¢ΛÓË-3 (IL3) Î·È Ô ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ Î·È Ì·ÎÚÔÊ¿ÁˆÓ (GM-CSF).

3. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ÛÙÔ ·Ú¯¤ÁÔÓÔ Î‡ÙÙ·ÚÔ, fiˆ˜ Ô Stem cell factor (SCF) Î·È Ô Flt3 ligand. √ SCF ¯ÔÚËÁÔ‡ÌÂÓÔ˜ Ì·˙› Ì ÙËÓ EPO ‹ ÙÔÓ G-CSF ‰ÈÂÁ›ÚÂÈ Û ‰È·ÊÔÚÔÔ›ËÛË ÙËÓ ÂÚ˘ıÚ¿ ÛÂÈÚ¿, ÙËÓ ÎÔÎÎÈÒ‰Ë ·ÏÏ¿ ÂÈÚfiÛıÂÙ· Î·È Ù· ÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú·.

4. ™˘ÓÂÚÁÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ÈÓÙÂÚÏ¢ΛÓË1(IL-1), Ë ÈÓÙÂÚÏ¢ΛÓË-6(IL-6) Î·È Ë ÈÓÙÂÚÏ¢ΛÓË11(IL-11) Ô˘ ‰ÚÔ˘Ó Û˘ÓÂÚÁÈο Ì ¿ÏÏÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙË ‰È·ÊÔÚÔÔ›ËÛË Ù˘ ÛÂÈÚ¿˜. H IL-6 Î·È Ë IL-11 in vitro ¤¯Ô˘Ó ‰Ú¿ÛË ÛÙ· ÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú· Î·È Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ê¿Û˘ 1, fiÙ·Ó ¯ÔÚËÁ‹ıËÎ·Ó Û ·ÛıÂÓ›˜ ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ıÚÔÌ‚ÔÂÓ›·, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ.

OÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ·Ú¯Èο, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ì ÛÙfi¯Ô ÙËÓ ·‡ÍËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ¯ÔÚËÁ‹ıËÎ·Ó Â›Ù Û ۯ‹Ì·Ù· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ηٿ ÙË Ê¿ÛË Ù˘ Ïԛ̈͢ ‹ ÛÂ Û˘Ó¯‹ Ì·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÁÈ· Ó· ‰È·ÙËÚÂ›Ù·È ÈηÓÔÔÈ-

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

ËÙÈÎfi ÙÔ Â›Â‰Ô ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ, ÒÛÙ ӷ ÌÂȈı› Ô Î›Ó‰˘ÓÔ˜ ÙˆÓ ÏÔÈÌÒ͈Ó. ∞ÚÁfiÙÂÚ·, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘Ó‰˘·ÛÌÔ› ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó Û ‰È·ÊÔÚÂÙÈο ÛÙ¿‰È· Ù˘ ·ÈÌÔÔ›ËÛ˘, ÒÛÙ ӷ ÂÈÙ¢¯ı› ·Ó¿Î·Ì„Ë Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ. ∏ Ì·ÎÚfi¯ÚÔÓË ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙ· ·Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· ·‡ÍËÛ ÌÂÓ ÙËÓ ÂÈ‚›ˆÛË, ·ÏÏ¿ ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó Û ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi Ï¢¯·ÈÌ›· ‹ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ Ë ÌÔÓÔۈ̛· 7. ª¤¯ÚÈ Û‹ÌÂÚ·, ·Ú·Ì¤ÓÂÈ ·Ó·¿ÓÙËÙÔ ÙÔ ÂÚÒÙËÌ· ·Ó Ë Ï¢¯·ÈÌ›· ÔÊ›ÏÂÙ·È ÛÙË Ì·ÎÚfi¯ÚÔÓË ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‹ ÔÊ›ÏÂÙ·È ÛÙÔ ›‰ÈÔ ÙÔ ÓfiÛËÌ·. OÈ ·fi„ÂȘ ϤÔÓ Û˘ÁÎÏ›ÓÔ˘Ó ˘¤Ú Ù˘ ¿Ԅ˘ fiÙÈ Ë ÂÌÊ¿ÓÈÛË Ù˘ Ï¢¯·ÈÌ›·˜ ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙË ÁÂÓÂÙÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Î·È ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ·˘Í¿ÓÔ˘Ó ÙËÓ ‹‰Ë ˘¿Ú¯Ô˘Û· ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË. O ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ï·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ÚÈÓ ÙË ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ - ‹Ù·Ó ÂÚÈÔÚÈṲ̂ÓÔ˜, ÁÈ' ·˘Ùfi Ë Ï¢¯·ÈÌ›· ‰ÂÓ ÚÔÏ¿‚·ÈÓ ӷ ÂΉËψı›. ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ ı· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·Ó ÔÈ ·ÛıÂÓ›˜ ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∞Ï·ÛÙÈ΋ ·Ó·ÈÌ›· OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ·›˙Ô˘Ó Ôχ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞), ȉȷ›ÙÂÚ· ÛÙËÓ ÔÌ¿‰· ÂΛÓË Ô˘ ‰ÂÓ ¤¯ÂÈ Û˘Ì‚·Ùfi ‰fiÙË ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∏ ‰Ú¿ÛË ÙÔ˘˜ ÛÙËÚ›˙ÂÙ·È ÛÙË ‰È¤ÁÂÚÛË Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ·ÈÌÔÔ›ËÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ∂Âȉ‹ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ·‡ÍËÛË Ù˘ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ ÙÔ˘ Ì˘ÂÏÔ‡ ·Ó ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È ·fi ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹, Ë Ì·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÍ¿ÓÙÏËÛË Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ·ÈÌÔÔ›ËÛ˘, ÁÈ' ·˘Ùfi Ë ∂˘Úˆ·˚΋ ÔÌ¿‰· ªÂÙ·ÌfiÛ¯Â˘Û˘ Ù˘ ∞Ï·ÛÙÈ΋˜ ∞Ó·ÈÌ›·˜ ÚÔÙ›ÓÂÈ Ó· ÌËÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌfiÓÔÈ ÙÔ˘˜ Û ÚˆÙԉȿÁÓˆÛÙÔ˘˜ ·ÛıÂÓ›˜, ·ÊÔ‡ ‰ÂÓ ÌÔÚÔ‡Ó ·Ê' ·˘ÙÒÓ Ó· ˘ÂÚÓÈ΋ÛÔ˘Ó ÙÔ˘˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó Î·Ù·ÛÙÔÏ‹ Ù˘ ·ÈÌÔÔ›ËÛ˘. ∫·ÙfiÈÓ ÙÔ‡ÙÔ˘, Ë ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞∞, ‰È·ÎÚ›ÓÂÙ·È Û ÙÚÂȘ ‰È·ÊÔÚÂÙÈΤ˜ Ê¿ÛÂȘ: 1) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹, 2) ˆ˜ ıÂÚ·›· ‰Â‡ÙÂÚ˘ ÂÈÏÔÁ‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο, 3) ˆ˜ ÂÈÚfiÛıÂÙË ·ÁˆÁ‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÛÔ‚·ÚÒÓ ÏÔÈÌÒ͈Ó. µÂ‚·›ˆ˜, ÛÙ· ·È‰È¿ Ì ∞∞ ıÂÚ·›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·ÏÏ¿ ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Ì‚·Ùfi˜ ‰fiÙ˘, ÙfiÙÂ Ë ¯ÔÚ‹ÁËÛË ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë ıÂÚ·›· ÚÒÙ˘ ÂÈÏÔÁ‹˜. ™ÙȘ ÂÚÈÙÒÛÂȘ, fï˜, ·˘Ù¤˜ ·Ú·ÙËÚ›ٷÈ

479

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·480

¶∞π¢π∞∆ƒπ∫∏ 2000;63:478-482

˘„ËÏfi ÔÛÔÛÙfi ÚÒÈÌ˘ ıÓËÙfiÙËÙ·˜ ̤¯ÚÈ Ó· ·Ô‰ÒÛÂÈ Ë ·ÓÔÛÔηٷÛÙÔÏ‹. ∏ ÚÔÛı‹ÎË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÚÒÈÌË ıÓËÙfiÙËÙ· Î·È Û˘ÓÙÂÏ› ÛÙÔ Ó· ·˘ÍËıÔ‡Ó Ù· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘, ÚÔÊ˘Ï¿ÛÛÔÓÙ·˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ·fi ÙȘ ÏÔÈÌÒÍÂȘ Î·È ÙȘ ·ÈÌÔÚÚ·Á›Â˜ ÛÙÔ ÎÚ›ÛÈÌÔ ‰È¿ÛÙËÌ· ÙˆÓ ÚÒÙˆÓ 30-45 ËÌÂÚÒÓ. ™Â ÌÂϤÙË ÙÔ˘ 1998, Ë ÂÈ‚›ˆÛË ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ·ÁˆÁ‹˜ ÌfiÓÔ Ì ΢ÎÏÔÛÔÚ›ÓË (CyA) ‹Ù·Ó 37,5% ÂÓÒ ÌfiÓÔ Ì ·ÓÙÈÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ÛÊ·ÈÚ›ÓË (ALG) ‹Ù·Ó 54%. ŸÙ·Ó ÛÙËÓ ·ÁˆÁ‹ ·˘Ù‹ ÚÔÛÙ¤ıËÎ·Ó ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (GM-CSF Î·È EPO) Ë ÂÈ‚›ˆÛË ·˘Í‹ıËΠÛÙËÓ ÔÌ¿‰· Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ Û 50% ÂÓÒ ÛÙËÓ ÔÌ¿‰· Ù˘ ALG 100%. ∂ÈϤÔÓ, ˘‹ÚÍ ·ÓÙ·fiÎÚÈÛË Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ, ‰ËÏ·‰‹ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¤ÙÔ˘˜ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó ηÏfi Â›Â‰Ô ·ÈÌÔÛÊ·ÈÚ›Ó˘, ¢∂∫, ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. ¶ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË ·fi ÙËÓ πÙ·Ï›· ·Ó·Ê¤ÚÂÈ fiÙÈ Û 40 ÚˆÙԉȿÁÓˆÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞∞, ÂÓ‹ÏÈΘ Î·È ·È‰È¿ (̤ÛË ËÏÈΛ· ‰È¿ÁÓˆÛ˘:16 ¤ÙË) ¯ÔÚËÁ‹ıËΠ·ÓÔÛÔηٷÛÙÔÏ‹ Ì ALG, CyA, ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË Î·È G-CSF. OÈ 33 ·ÛıÂÓ›˜ (82%) ·ÚÔ˘Û›·Û·Ó ·ÓÙ·fiÎÚÈÛË Î·È ÛÙȘ ÙÚÂȘ ÛÂÈÚ¤˜ ·ÈÌÔÔ›ËÛ˘. ∏ Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË ‹Ù·Ó 92% Ì ‰È·Î‡Ì·ÓÛË 86% Î·È 100% ·Ó¿ÏÔÁ· Ì ÙÔÓ ·ÚÈıÌfi ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Ô˘ ›¯·Ó ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘. OÈ ÂÚ¢ÓËÙ¤˜ Û˘Ó¤ÎÚÈÓ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Ì ÚÔËÁÔ‡ÌÂÓË ÂÚÁ·Û›· ÙÔ˘˜, fiÔ˘ Û 84 ·ÛıÂÓ›˜ ›¯Â ¯ÔÚËÁËı› ÙÔ ›‰ÈÔ Û¯‹Ì· ·ÓÔÛÔηٷÛÙÔÏ‹˜ ¯ˆÚ›˜ G-CSF, Ë ÂÈ‚›ˆÛË ‹Ù·Ó 68% Î·È Ë ‰È·ÊÔÚ¿ ÛÙËÓ ÂÈ‚›ˆÛË, ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÌÂϤÙ˜, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ¶ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË ·fi ÙËÓ π·ˆÓ›· Û 111 ·È‰È¿ Ì ∞∞ ·Ó·Ê¤ÚÂÈ 100% ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ (CyA, ALG, Danasol) Î·È ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (G-CSF). º·›ÓÂÙ·È, ‰ËÏ·‰‹, fiÙÈ ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌÔÚÔ‡Ó Ó· Û˘ÓÂÈÛʤÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ, ·Ó ¯ÔÚËÁËıÔ‡Ó Ì·˙› Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹. ∏ ¯Ú‹ÛË ÌfiÓÔÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·ÔÙÂÏ› ıÂÚ·›· ‰Â‡ÙÂÚ˘ ÂÈÏÔÁ‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙËÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÎÈÓ‰˘ÓÂ‡Ô˘Ó ·fi ÏÔÈÌÒÍÂȘ ·ÏÏ¿ Î·È ·fi ·ÈÌÔÚÚ·Á›Â˜, ÙÔ ˙ËÙÔ‡ÌÂÓÔ Â›Ó·È Ë ·Ó¿Î·Ì„Ë fi¯È ÌfiÓÔ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÏÏ¿ Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ ·ÈÌÔÔ›ËÛ˘. ªÂ ÙË ÛΤ„Ë ·˘Ù‹, ·Ú¯Èο ÙÔ ÂӉȷʤÚÔÓ ÛÙÚ¿ÊËΠ۠·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ Ù˘ Ì›·˜ ÛÂÈÚ¤˜, ‰ËÏ·‰‹ Û ·Ú¿ÁÔÓÙ˜ ÚÒÈÌ˘ Ê¿Û˘, fiˆ˜ Ô GM-CSF Î·È Ë IL-3. ™Â 66 ·ÛıÂÓ›˜ Ô˘ ¯ÔÚËÁ‹ıËΠGM-CSF ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÁÈ·Ù› ·˘Í‹ıËÎ·Ó Ù· ˈÛÈ-

480

ª. ªÔÛ¯fi‚Ë

ÓfiÊÈÏ· Î·È Ù· ÌÔÓÔ·ÙÙ·Ú·, ·ÏÏ¿ Ë ÂȉȈÎfiÌÂÓË ·‡ÍËÛË ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ‹Ù·Ó ÌÈÎÚ‹. ø˜ ÚÔ˜ ÙËÓ ·ÓÙ·fiÎÚÈÛË ÙˆÓ ¿ÏÏˆÓ ‰‡Ô ÛÂÈÚÒÓ, ·fi ÙÔ˘˜ 66 ·ÛıÂÓ›˜ ÌfiÓÔÓ ÔÈ 3 ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ. ™Â 17 ·ÛıÂÓ›˜ Ô˘ ¯ÔÚËÁ‹ıËΠIL3, ÌfiÓÔÓ ÔÈ 6 ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ·, ÔÈ 2 Î·È ÛÙ· ·ÈÌÔÂÙ¿ÏÈ·, ·ÏÏ¿ ‰ÂÓ ˘‹ÚÍ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ÂÚ˘ıÚ¿ ÛÂÈÚ¿. ∞Ó fï˜ Ë IL3 Û˘Ó‰˘·Ûı› Ì ÙÔÓ G-CSF, ÙfiÙ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ Û ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ¶ÚfiÛÊ·Ù·, ¿Ú¯ÈÛ·Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ÛÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·Ú¿ÁÔÓÙ˜ ÙÂÏÈ΋˜ Ê¿Û˘.

O SCF Ê·›ÓÂÙ·È Ó· ˘fiÛ¯ÂÙ·È ÔÏÏ¿ Î·È ‚Ú›ÛÎÔÓÙ·È Û ÂͤÏÈÍË ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì G-CSF. ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ·Ï·ÈfiÙÂÚ· ÂıˆÚ›ÙÔ ÚÔÏ¢¯·ÈÌÈ΋ ηٿÛÙ·ÛË. ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ 3% ÙˆÓ ·È‰ÈÒÓ Ì ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ·Ó¤Ù˘ÛÛÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ Ï¢¯·ÈÌ›· Î·È Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ÌÂÙ¿‚·Û˘ ·fi ÙËÓ Ï‹ÚË ·Ï·Û›· ÛÙË Ï¢¯·ÈÌ›· ‹Ù·Ó 7 Ì‹Ó˜. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÂÚ›Ô˘ 100 ·ÛıÂÓ›˜ Ì ∞∞ Ô˘ ·Ó¤Ù˘Í·Ó Ï¢¯·ÈÌ›· Î·È ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ¤·ÈÚÓ·Ó ÌfiÓÔ ÌÂÙ·ÁÁ›ÛÂȘ, ÔÈ ÌÈÛÔ› ›¯·Ó ¿ÚÂÈ ÎÔÚÙÈÎÔÂȉ‹ Î·È ÌfiÓÔÓ 20 ·ÛıÂÓ›˜ ›¯·Ó ¿ÚÂÈ Û˘Ó‰˘·ÛÌfi ÎÔÚÙÈÎÔÂȉÒÓ Î·È ·Ó‰ÚÔÁfiÓˆÓ. ∏ ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÂÎÙfi˜ ·fi ÙÔ fiÙÈ ÂÈÌ‹Î˘Ó ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ∞∞, ıˆÚÂ›Ù·È ·fi ·ÚÎÂÙÔ‡˜ fiÙÈ ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ¤Ó· ÔÛÔÛÙfi Ï¢¯·ÈÌÈÒÓ. ¶·È‰È¿ Ì ∞∞ Ô˘ ‹Ú·Ó ·ÓÔÛÔηٷÛÙ·ÏÙÈο Î·È G-CSF, ·Ó¤Ù˘Í·Ó Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ÌÔÓÔۈ̛· 7 Û ÔÛÔÛÙfi 10,8% ÂÚ›Ô˘ 6 Ì‹Ó˜ ·fi ÙËÓ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÂÓÒ Û ÔÌ¿‰· ÂÓËÏ›ÎˆÓ Ì ∞∞ Ô˘ ÌÂÏÂÙ‹ıËΠÚÔÁÚ·ÌÌ·ÙÈṲ̂ӷ Ì ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi ¤ÏÂÁ¯Ô, ÙÔ 7,7% ÙˆÓ ·ÛıÂÓÒÓ ·Ó¤Ù˘ÍÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Î·È ÙÔ 17% ·Ó¤Ù˘Í ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÌÂ Û˘¯ÓfiÙÂÚË ÙË ÌÔÓÔۈ̛· 7. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó Â›Û˘, ÌÂÌÔӈ̤Ó˜ ·Ó·ÊÔÚ¤˜ ·Ó¿Ù˘Í˘ Ï¢¯·ÈÌ›·˜ ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË ¯Ú‹ÛË G-CSF. ™‡Ó‰ÚÔÌÔ Kostmann ∆Ô Û‡Ó‰ÚÔÌÔ Kostmann Â›Ó·È Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙËÓ ÔÔ›· Ë ‰È·ÊÔÚÔÔ›ËÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ ÛÙ·Ì·Ù¿ ÛÙÔ Â›Â‰Ô ÙÔ˘ ÚÔÌ˘ÂÏÔ΢ÙÙ¿ÚÔ˘. OÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÌÈÎÚfi ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, ÌfiÏȘ 3,5 ¯ÚfiÓÈ· Î·È Î·Ù·Ï‹ÁÔ˘Ó, ΢ڛˆ˜, ·fi ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ. ∏ ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·‡ÍËÛ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, ‚ÂÏÙ›ˆÛ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ì›ˆÛ ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ·, ·ÏÏ¿ Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÏÔÈÌÒ͈Ó. ∏ ·ÈÙÈÔÏÔÁ›· ÙÔ˘

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·481

¶∞π¢π∞∆ƒπ∫∏ 2000;63:478-482

Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹. ∏ ·‰˘Ó·Ì›· Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜, ·Ú¯Èο, ıˆڋıËΠfiÙÈ ÔÊ›ÏÂÙ·È ÛÙËÓ ‡·ÚÍË ·ıÔÏÔÁÈÎÔ‡ ˘Ô‰Ô¯¤· ÙÔ˘ G-CSF ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Û˘ÁÎÏ›ÓÔ˘Ó ϤÔÓ ˘¤Ú Ù˘ ¿Ԅ˘ fiÙÈ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ·ıÔÏÔÁÈÎfi ˘Ô‰Ô¯¤· ·ÏÏ¿ Û ·ıÔÏÔÁÈÎfi ÂÓ‰Ô΢ÙÙ¿ÚÈÔ Û‹Ì· Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÎÔÎÎÈÔÔ›ËÛË, ‰ËÏ·‰‹ Û ·ıÔÏÔÁÈ΋ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÌËӇ̷ÙÔ˜ Ù˘ ÎÔÎÎÈÔÔ›ËÛ˘ ·fi ÙË ÌÂÌ‚Ú¿ÓË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÛÙÔÓ ˘Ú‹Ó·. ∂ȉÈÎfiÙÂÚ·, Ë JAK-2 ÂÚÈÔ¯‹ ÙÔ˘ ÚˆÙÔÏ¿ÛÌ·ÙÔ˜ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È ÂÓÂÚÁÔÔÈË̤ÓË Î·È Ì ·˘ÍË̤ÓË ·ÔÊÔÛÊˆÚ˘Ï›ˆÛË Û ۯ¤ÛË Ì ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ∆· Â›‰· ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ ·›Ì· Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ‹ ·˘ÍË̤ӷ, ·Ú' fiÏ· ·˘Ù¿, ÔÈ ·ÛıÂÓ›˜ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Â͈ÁÂÓ‹ ¯ÔÚ‹ÁËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ.

O G-CSF Â›Ó·È Ô ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ ÂÈÏÔÁ‹˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Kostmann Î·È Ë ·ÓÙ·fiÎÚÈÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi 90%, ÂÓÒ Ô GM-CSF ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÁÈ·Ù› ·˘Í¿ÓÂÈ Î˘Ú›ˆ˜ Ù· ˈÛÈÓfiÊÈÏ· Î·È ÏÈÁfiÙÂÚÔ Ù· Ô˘‰ÂÙÂÚfiÊÈÏ·. ™Â ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ·fiÎÚÈÛË ÛÙÔÓ G-CSF, Ô Û˘Ó‰˘·ÛÌfi˜ G-CSF Î·È SCF Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·Ô‰ÔÙÈÎfi˜. ∏ ÂÈÌ‹Î˘ÓÛË fï˜, ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ ¤ÊÂÚ ÛÙÔ Êˆ˜ ‰Â˘ÙÂÚÔÁÂÓ‹ ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë Ï¢¯·ÈÌ›· Î·È Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ·. ∏ ·Ó¿Ù˘ÍË Ì˘ÂÏÔÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 10% ÙˆÓ ·Û¯fiÓÙˆÓ, fï˜ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› ·Ó Û˘Ó‰¤ÂÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‹ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÁÂÓÂÙÈ΋˜ ‚Ï¿‚˘ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. §fiÁˆ Ù˘ ·ıÔÁ¤ÓÂÈ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Kostmann, Ë ÎÔÎÎÈ҉˘ ÛÂÈÚ¿ ‰ÂÓ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‰È·ÊÔÚÔÔÈËı› Û ÒÚÈÌ· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È Ë Ì·ÎÚfi¯ÚÔÓË ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÂӉ¯Ô̤ӈ˜ Ó· ‰ÈÂÁ›ÚÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Úfi‰ÚÔÌˆÓ Ì˘ÂÏÈÎÒÓ ÌÔÚÊÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË Ì˘ÂÏÔÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜. ™Â ÌÂϤÙ˜ ·ÏÏ¿ Î·È Û ÌÂÌÔӈ̤Ó˜ ·Ó·ÊÔÚ¤˜, Ê·›ÓÂÙ·È fiÙÈ ·ÛıÂÓ›˜ Ì Û. Kostmann Ô˘ ¤·ÈÚÓ·Ó Ì·ÎÚÔ¯ÚfiÓÈ· G-CSF, ·Ó¤Ù˘Í·Ó ÌÔÓÔۈ̛· 7 Î·È ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· ÂÓÒ ·Ó·Ê¤ÚÔÓÙ·È Î·È ÙÚÂȘ ·ÛıÂÓ›˜ Ô˘ ·Ó¤Ù˘Í·Ó Ï¢¯·ÈÌ›· ¯ˆÚ›˜ Ó· ·›ÚÓÔ˘Ó G-CSF. ∞˘Ùfi Û˘ÁÎÏ›ÓÂÈ ˘¤Ú Ù˘ ¿Ԅ˘ fiÙÈ 1) Ë Ï¢¯·ÈÌ›· ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙË ÁÂÓÂÙÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, 2) ı· ‹Ù·Ó Û˘¯ÓfiÙÂÚË Î·È ¯ˆÚ›˜ ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·Ó ÔÈ ¿Û¯ÔÓÙ˜ ·fi Û. Kostmann ‰ÂÓ Â›¯·Ó ÙfiÛÔ ÌÈÎÚfi ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ Î·È 3) ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÚÔ˘Ó ˆ˜ ÂÈÚfiÛıÂÙÔ ·›ÙÈÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ Ï¢¯·ÈÌ›·˜. ∆Ô 20-25% ÙˆÓ ·Û¯fiÓÙˆÓ ·fi Û. Kostmann ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔÓ ˘Ô‰Ô¯¤· ÙÔ˘ G-CSF

∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·

Î·È ·Ú¯Èο ıˆڋıËΠfiÙÈ Ë ‡·ÚÍË ÌÂÙ·ÏÏ¿ÍÂˆÓ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË Î·ÎÔ‹ıÂÈ·˜. ¶ÚÔÛÂÎÙÈ΋ Î·È Ì·ÎÚfi¯ÚÔÓË fï˜ ¤Ú¢ӷ Ô‰‹ÁËÛ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÌÂÚÈΤ˜ ÊÔÚ¤˜ Ë ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ˘Ô‰Ô¯¤· Â›Ó·È ·ÚÔ‰ÈÎfi ÁÂÁÔÓfi˜, Û˘Ó˘¿Ú¯ÂÈ Ì ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ˘Ô‰Ô¯¤· ÛÙÔ ›‰ÈÔ Î‡ÙÙ·ÚÔ Î·È ‰ÂÓ Úԉȷı¤ÙÂÈ Û˘ÛÙËÌ·ÙÈο ۠Ϣ¯·ÈÌÔÁ¤ÓÂÛË. ∞ÓÙ›ıÂÙ·, ÙÔ ·ıÔÏÔÁÈÎfi ÂÓ‰Ô΢ÙÙ¿ÚÈÔ Û‹Ì· ÛÙË JAK-2 ÂÚÈÔ¯‹ ÙÔ˘ ÚˆÙÔÏ¿ÛÌ·ÙÔ˜ Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÎÔÎÎÈÔÔ›ËÛË Ê·›ÓÂÙ·È fiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙËÓ ÚԉȿıÂÛË ÁÈ· Ï¢¯·ÈÌÔÁ¤ÓÂÛË. ∞Ó·ÈÌ›· Fanconi ∏ ·Ó·ÈÌ›· Fanconi Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ̤ÙÚÈ· ‹ ÛÔ‚·Ú‹ Ï¢ÎÔÂÓ›· Î·È ıÚÔÌ‚ÔÂÓ›· ÚÈÓ ÌÂÙ·¤ÛÂÈ Û ·Á΢ÙÙ·ÚÔÂÓ›·. ∆Ô Ì›˙ÔÓ Úfi‚ÏËÌ· ÁÈ· Ù· ·È‰È¿ Ì ·Ó·ÈÌ›· Fanconi ‰ÂÓ Â›Ó·È Ë ¯·ÌËÏ‹ ·ÈÌÔÛÊ·ÈÚ›ÓË, ·ÏÏ¿ Ë ¤ÎÙˆÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ Î·È Ë Û˘Ó˘¿Ú¯Ô˘Û· ıÚÔÌ‚ÔÂÓ›·. ∏ Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÚ˘ıÚÔÔÈËÙ›Ó˘ ÌfiÓ˘, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·Ô‰›‰ÂÈ. O Gª-CSF, ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ Ô G-CSF, Ì·ÎÚÔ¯ÚfiÓÈ· ·Ô‰›‰Ô˘Ó ·ÎfiÌË Î·È Û ÌÈÎÚ¤˜ ‰fiÛÂȘ. ™Â 10 ·ÛıÂÓ›˜ Ì ·Ó·ÈÌ›· Fanconi Ô˘ ¯ÔÚËÁ‹ıËΠG-CSF, fiÏÔÈ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ, 4/10 ·ÚÔ˘Û›·Û·Ó ÂÈϤÔÓ Î·È ·‡ÍËÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘, ÂÓÒ 3/10 ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË Î·È ÛÙ· ·ÈÌÔÂÙ¿ÏÈ·. ∏ ¯Ú‹ÛË Ù˘ IL-3 ·ÚÔ˘ÛÈ¿˙ÂÈ, Û ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ, ηϿ ·ÔÙÂϤÛÌ·Ù·, ·ÏÏ¿ Û˘Óԉ‡ÂÙ·È ÎÈ ·fi ÔÏϤ˜ ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ Î·È ·˘Ùfi ÂÚÈÔÚ›˙ÂÈ ÙË ¯ÔÚ‹ÁËÛ‹ Ù˘. ∏ ·Ó·ÈÌ›· Fanconi ÌÂÙ·›ÙÂÈ Û Ï¢¯·ÈÌ›· Û ÔÛÔÛÙfi 10% ÎÈ ÂÎÙfi˜ ·fi ÙË ÁÓˆÛÙ‹ ¢ıÚ·˘ÛÙfiÙËÙ· ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙË ÓfiÛÔ, ÂÌÊ·Ó›˙ÔÓÙ·È ÎψÓÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· ÙÔ˘ Ì˘ÂÏÔ‡ Û ÔÛÔÛÙfi 3%. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÌÂÁ¿ÏË ÂÚ›Û΄Ë. ¢‡Ô ·fi ÙÔ˘˜ 10 ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó G-CSF ÁÈ· 3,5 ¯ÚfiÓÈ·, ·ÚÔ˘Û›·Û·Ó ÎψÓÈ΋ ·‡ÍËÛË ¯ÚˆÌÔۈ̿وÓ, Ë ÔÔ›· ˘Ê¤ıËΠÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ G-CSF. ∞ÒÙÂÚ˜ ÂÈÏÔΤ˜ ∫·›ÚÈÔ ÂÚÒÙËÌ· Â›Ó·È ·Ó Ë Ì·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÚÔηÏ› ¿ÏϘ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ ÂÎÙfi˜ ·fi ÙËÓ ÂӉ¯fiÌÂÓË ÚԉȿıÂÛË ÛÙË Ï¢¯·ÈÌ›·. ∞fi ÙË ¢ÈÂıÓ‹ ÔÌ¿‰· ηٷÁÚ·Ê‹˜ Ù˘ ‚·ÚÈ¿˜ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, ÌÂÏÂÙ‹ıËÎ·Ó 531 ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ‰È¿ÛÙËÌ· 10 ¯ÚfiÓˆÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÁÚ·ÊÔ‡Ó ÔÈ ÂÈÏÔΤ˜ ·fi ÙË ¯Ú‹ÛË ÙÔ˘˜. ∏ ÛÏËÓÔÌÂÁ·Ï›·, ·Ó Î·È ÚÔ¸‹Ú¯Â Û ÔÏÏÔ‡˜ ·ÛıÂÓ›˜, ·˘Í‹ıËΠÛÙÔ 49% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘Á-

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ÁÂÓ‹ Ô˘‰ÂÙÂÚÔÂÓ›·. ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·Ú·ÙÂٷ̤ÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÚÔηÏ› ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ‹ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ Ì ·ÔÙ¤ÏÂÛÌ· ÔÛÙÂÔÂÓ›· ‹ ÔÛÙÂÔfiÚˆÛË. ™ÙËÓ ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚı›۷ ÌÂϤÙË, ÔÛÙÂÔfiÚˆÛË ·ÚÔ˘Û›·Û ÙÔ 14% ÙˆÓ ·ÛıÂÓÒÓ. ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi ‹ Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· (Oª§) ·Ó¤Ù˘Í ÙÔ 11% Î·È ‹Ù·Ó fiÏ· ·È‰È¿ ·fi ÙËÓ ÔÌ¿‰· Ù˘ Û˘ÁÁÂÓÔ‡˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, ÂÓÒ Ù· ۈ̷ÙÔÌÂÙÚÈο 300 ·È‰ÈÒÓ (ËÏÈΛ·˜ 1 Ì‹Ó·-16 ¯ÚfiÓˆÓ) Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ‰È¿ÛÙËÌ· 10 ¯ÚfiÓˆÓ ‹Ù·Ó ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο Â›‰·. ∂Âȉ‹ Ë ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙ· Û‡Ó‰ÚÔÌ· ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ Â›Ó·È Ì·ÎÚÔ¯ÚfiÓÈ·, ˘¿Ú¯ÂÈ ¤ÓÙÔÓÔ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ Ì‹ˆ˜ Ë ·Ú·ÙÂٷ̤ÓË Î·È ÔÏϤ˜ ÊÔÚ¤˜ Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ ¯ÔÚ‹ÁËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ ‹‰Ë ·ıÔÏÔÁÈÎfi ·ÈÌÔÔÈËÙÈÎfi Û‡ÛÙËÌ·, Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Ï¢¯·ÈÌÔÁ¤ÓÂÛË. ∞ÊÔ‡ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ˘·ÚÎÙfi˜, ÛÎfiÈÌÔ Â›Ó·È Ó· ·Ú·ÎÔÏÔ˘ıԇ̠ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ Û˘¯ÓÔ‡˜ ¯ÚˆÌÔÛˆÌÈÎÔ‡˜ ÂϤÁ¯Ô˘˜. ÕÏÏÔ ÎÚ›ÛÈÌÔ ÂÚÒÙËÌ· Ô˘ ·Ó·Ê‡ÂÙ·È Â›Ó·È, ·Ó ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¯ÔÚËÁÔ‡ÌÂÓÔÈ ¤ÁηÈÚ· fiÙ·Ó ˘¿Ú¯ÂÈ ÌÔÓÔ΢ÙÙÔÂÓ›·, ‰ËÏ·‰‹ ÚÔÛ‚ÔÏ‹ Ì›·˜ ÌfiÓÔÓ ÛÂÈÚ¿˜, ÌÔÚ› Ó· ·Ó·ÛÙ›ÏÔ˘Ó ‹ ¤ÛÙˆ Ó· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙËÓ ÂͤÏÈÍË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Û ·Á΢ÙÙ·ÚÔÂÓ›·. ™‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ ·¿ÓÙËÛË, ·ÏÏ¿ ÂӉ¯Ô̤ӈ˜ ·˘Ùfi Î·È ÔÏÏ¿ ¿ÏÏ· ÂÚˆÙ‹Ì·Ù· Ó· ··ÓÙËıÔ‡Ó Û‡ÓÙÔÌ· ÚÔ˜ fiÊÂÏÔ˜ ÙˆÓ ·ÛıÂÓÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Marsh J, Schrezenmeier H, Marin P, Ilhan O, Ljungman P, McCann S et al. Prospective randomized multicenter study comparing cyclosporin alone versus the combination of antithymocyte globulin and cyclosporin for treatment of patients with non severe aplastic anemia: a report from the European Blood and Marrow Transplant (EBMT) Severe Aplastic anemia Working

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∂›‰Ú·ÛË ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (rhG-CSF) ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›· ∫ÔÛÌ¿˜ ™·Ú·Ê›‰Ë˜, µ·ÛÈÏÈ΋ ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, ÷ڿϷÌÔ˜ ∞Á·Î›‰Ë˜, ¶·Ó·ÁÈÒÙ· ¶··Î˘ÚȷΛ‰Ô˘, ∞ı·Ó¿ÛÈÔ˜ ∞ı·Ó·Û›Ô˘, °ÂÒÚÁÈÔ˜ ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ Â›‰Ú·Û˘ ÙÔ˘ rh-G-CSF ÛÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË (Hct), ÛÙÔÓ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÛÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·. ªÂÏÂÙ‹ıËÎ·Ó 86 ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ‚¤‚·ÈË ‹ Èı·Ó‹ ÛË„·ÈÌ›·. 48/86 ‹Ú·Ó rhG-CSF Û ‰fiÛË 10mcg/kg/H, À¢ ÁÈ· 3 Û˘Ó¯›˜ Ë̤Ú˜ (ÔÌ¿‰· G-CSF) Î·È 38/86 ‰ÂÓ ‹Ú·Ó rhG-CSF (ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ). ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ô Hct, Ô ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (∞∞O) ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜ Î·È ÙËÓ 1Ë, 3Ë Î·È 5Ë Ë̤ڷ ÌÂÙ¿. ∂›Û˘, ηٷÁÚ¿ÊËÎÂ Ô ·ÚÈıÌfi˜ ÙˆÓ ÌÂÙ·ÁÁ›ÛÂˆÓ Ì ÂÚ˘ıÚ¿ ‹ ·ÈÌÔÂÙ¿ÏÈ· ÙȘ ÚÒÙ˜ 10 Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜. ™ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜, ÔÈ ÔÌ¿‰Â˜ G-CSF Î·È Ì·ÚÙ‡ÚˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ˆ˜ ÚÔ˜ ÙÔÓ Hct (39,6%±10% vs 40,6%±8%), ÙÔÓ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ (116.000±110.000/mm3 vs 117.000±112.000/mm3) Î·È ÙÔÓ ∞∞O (5.130±3.367/mm3 vs 7.169±7.644/mm3). ™ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË, Ô ∞∞√ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ¿‰· G-CSF (p<0,001), Ô˘ ÙËÓ 3Ë Ë̤ڷ ›¯Â ∞∞O ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ·fi ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (p<0,001). ∫·ÌÈ¿ ·fi ÙȘ ‰˘Ô ÔÌ¿‰Â˜ ‰ÂÓ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ Hct Î·È ·ÚÈıÌÔ‡ ·ÈÌÔÂÙ·Ï›ˆÓ, Ô˘ ÔÈ ÙÈ̤˜ ÙÔ˘˜ ‹Ù·Ó ·ÚfiÌÔȘ ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜ Û fiÏÔ ÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘. ∂›Û˘, ‰ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÌÂÙ·ÁÁ›ÛÂˆÓ ÂÚ˘ıÚÒÓ (1,7±1,6 Î·È 1,9±1,8 ÛÙȘ ÔÌ¿‰Â˜ G-CSF Î·È Ì·ÚÙ‡ÚˆÓ, ·ÓÙ›ÛÙÔȯ·, p=0,7), Î·È ·ÈÌÔÂÙ·Ï›ˆÓ (1,0±1,5 Î·È 1,8±2,4 ÛÙȘ ÔÌ¿‰Â˜ G-CSF Î·È Ì·ÚÙ‡ÚˆÓ, ·ÓÙ›ÛÙÔȯ·, p=0,06). ∏ ıÂÚ·¢ÙÈ΋ ¯ÔÚ‹ÁËÛË rhG-CSF Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ‰˘ÛÌÂÓÒ˜ ÙÔÓ Hct, ÙÔÓ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ Ô‡Ù ÙȘ ·Ó¿ÁΘ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. ¶·È‰È·ÙÚÈ΋ 2000;63:483-489. §¤ÍÂȘ ÎÏÂȉȿ: G-CSF, ·ÈÌ·ÙÔÎÚ›Ù˘, ·ÈÌÔÂÙ¿ÏÈ·, ÌÂÙ·ÁÁ›ÛÂȘ, ÓÂÔÁÓ¿, ÛË„·ÈÌ›·. ∫. Sarafidis, V. Drossou-Agakidou, C. Agakidis, P. Papakyriakidou, A. Athanasiou, G. Kremenopoulos.

Effect of recombinant human granulocyte-colony stimulating factor (rhG-CSF) on red cells and platelets in septic neonates. Paediatriki 2000;63:483-489. ● Abstract: The aim of this study was to investigate the effect of rhG-CSF administration on hematocrit and platelet counts and on the number of transfusions in septic neonates. The study population consisted of 86 preterm neonates with proven or suspected sepsis. In 48/86 neonates rhG-CSF was administered at a dose of 10 mcg/kg/d subcutaneously for 3 consecutive days (G-CSF group), while 38/86 neonates did not receive any rhG-CSF (control group). The hematocrit (Hct), platelet and absolute neutrophil counts (ANC) were measured on days 0, 1, 3 and 5 of sepsis. In addition the number of red cell and platelet transfusions during the first 10 days was recorded. On day 0 of sepsis, the Hct (39.6%±10% vs 40,6%±8%), platelet counts (116000±110000/mm3 vs 117000±112000/mm3) and ANC (5130±3367/mm3 vs 7169±7644/mm3) did not differ significantly between the two groups. On follow-up, the ANC increased significantly in the G-CSF group (p<0.001) in which ANC values were significantly higher on day 3 than in the controls (p<0.001). Serial measurements of Hct and platelet counts were not significantly different between the two groups during the study period. No significant differences were observed in the number of red cell transfusions (1.7±1.6 and 1.9±1.8 in the G-CSF and control groups, respectively, p=0.7), and in platelet transfusions (1.0±1.5 and 1.8±2.4 in the G-CSF and control group respectively, p=0.06). Therapeutic administration of rhG-CSF to septic ¡ÂÔÁÓÔÏÔÁÈ΋ KÏÈÓÈ΋ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ °.¶.¡. £ÂÛ/ӛ΢

483

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·484

¶∞π¢π∞∆ƒπ∫∏ 2000;63:483-489

∫. ™·Ú·Ê›‰Ë˜ Î·È Û˘Ó.

neonates results in a significant increase of the ANC without having any significant effect on the hematocrit and platelet values or on the number of red blood cell and platelet transfusions.

Key words: G-CSF, hematocrit, platelets, transfusions, neonates, sepsis.

™˘ÓÙÔÌÔÁڷʛ˜: ∞∞O

·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚÔʛψÓ

CFUs-GEMM:

(Colony Forming Units-Granulocyte Erythrocyte Monocyte Megakaryocyte) ÌÈÎÙ¤˜ ·ÔÈ˘ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÌÂÁ·Î·Ú˘Ô΢ÙÙ¿ÚˆÓ

GM-CSF:

(Granulocyte Monocyte-Colony Stimulating Factor) ·Ú¿ÁÔÓÙ·˜ ‰È¤ÁÂÚÛ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ·ÔÈÎÈÒÓ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ Î·È ÌÔÓÔ΢ÙÙ¿ÚˆÓ

Hct:

·ÈÌ·ÙÔÎÚ›Ù˘

IL-6:

ÈÓÙÂÚÏ¢ΛÓË-6

IL-1‚:

ÈÓÙÂÚÏ¢ΛÓË-1‚

rhG-CSF:

recombinant human GranulocyteColony Stimulating Factor

TNF-·:

·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁΈÓ

∂ÈÛ·ÁˆÁ‹ O ·Ú¿ÁÔÓÙ·˜ ‰È¤ÁÂÚÛ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ·ÔÈÎÈÒÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (Granulocyte-Colony Stimulating Factor, G-CSF) Â›Ó·È ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi Ù· Ì·ÎÚÔÊ¿Á· Î·È ÚÔ¿ÁÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ÚÔ‰ÚÔÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi ηıÒ˜ Î·È ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÒÚÈÌˆÓ ÌÔÚÊÒÓ ÙÔ˘˜ ÛÙËÓ ÂÚÈʤÚÂÈ· (1). ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·ԉ›ÍÂÈ fiÙÈ Ë Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË rhG-CSF Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ÚÔηÏ› ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Ô˘‰ÂÙÂÚÔÊÈÏ›·, ÛÙÚÔÊ‹ ÙÔ˘ Ï¢ÎÔ΢ÙÙ·ÚÈÎÔ‡ Ù‡Ô˘ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿ (2). ¶·Ú¿ÏÏËÏ· ‰ÈÂÁ›ÚÂÈ ÙËÓ ÂÈÊ·ÓÂȷ΋ ¤ÎÊÚ·ÛË ÔÚÈÛÌ¤ÓˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, ÙÔÓ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ÔÍÂȉˆÙÈÎfi Ì˯·ÓÈÛÌfi Î·È ¿ÏϘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (2-4). øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂ÓÔÈ ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂӉ¯fiÌÂÓË ‰˘ÛÌÂÓ‹ Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. £ÂˆÚËÙÈο, Ô G-CSF ÌÔÚ› Ó· ·Û΋ÛÂÈ ‰˘Ô ‰È·ÌÂÙÚÈο ·ÓÙ›ıÂÙ˜ ‰Ú¿ÛÂȘ ÛÙȘ ‰˘Ô ·˘Ù¤˜ ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜. ∏ ÛÙÚÔÊ‹ Ù˘ ˆÚ›Ì·ÓÛ˘ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ÔÏ˘‰‡Ó·ÌÔ˘ ΢ÙÙ¿ÚÔ˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÚÔ˜ ÙËÓ ÎÔÎÎÒ‰Ë ÛÂÈÚ¿ ÌÔÚ› Ó· ¤¯ÂÈ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙËÓ ÂÚ˘ıÚ¿ Î·È ıÚÔÌ‚Ô΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿

484

ÏfiÁˆ ‰ËÌÈÔ˘ÚÁ›·˜ Ê·ÈÓÔ̤ÓÔ˘ ˘ÔÎÏÔ‹˜ Û ‚¿ÚÔ˜ ÙˆÓ ‰˘Ô ·˘ÙÒÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ ÙÔ˘ Ì˘ÂÏÔ‡. Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿ fï˜, Ô G-CSF ‰ÈÂÁ›ÚÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ÔÏ˘‰‡Ó·ÌˆÓ CFUs-GEMM (Colony Forming Units-Granulocyte Erythrocyte Monocyte Megakaryocyte), ·fi ÙȘ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È fiϘ ÔÈ Î˘ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ÙÔ˘ ·›Ì·ÙÔ˜ (5-7). ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ Û ÂÓ‹ÏÈΘ ‰ÂÓ ¤‰ÂÈÍ·Ó ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ rhG-CSF, ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· (8-11). ™Ù· ÓÂÔÁÓ¿ ˘¿Ú¯Ô˘Ó ÌfiÓÔ in vitro Î·È ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, Ô˘ ‰ÂÓ ‰Â›¯ÓÔ˘Ó Î¿ÔÈ· ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (12-14). ŸÌˆ˜, Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ Î·È in vitro ÌÂÏÂÙÒÓ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔÂÍÔÊÏ‹ÛÔ˘Ó ÙËÓ in vivo Â›‰Ú·ÛË Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·, Ë ÔÔ›· ÂÈϤÎÂÙ·È Û˘¯Ó¿ ·fi ·Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÂÓ›· (15). ∂ÈϤÔÓ, ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜ ·˘Í¿ÓÔÓÙ·È Ù· Â›‰· Ï¿ÛÌ·ÙÔ˜ ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ fiˆ˜ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-6 (IL-6), Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘1‚, ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁΈÓ-· (TNF-·) Î·È ÙÔ˘ ·Ú¿ÁÔÓÙ· ‰È¤ÁÂÚÛ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ·ÔÈÎÈÒÓ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ Î·È ÌÔÓÔ΢ÙÙ¿ÚˆÓ (GMCSF) (3,16,17), ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ·ÈÌÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (13,18,19). ŒÙÛÈ ÏÔÈfiÓ, ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ rhG-CSF ¿Óˆ ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›· ˘fiÎÂÈÙ·È ÛÙË Û˘ÓÂÚÁÈ΋ ‹ ·ÓÙ·ÁˆÓÈÛÙÈ΋ ·ÏÏËÏÂ›‰Ú·ÛË fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·ÁfiÓÙˆÓ Î·È Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓÈÛÙ› ÚÈÓ Î·ıÈÂÚˆı› Ë ¯Ú‹ÛË ÙÔ˘ rhGCSF Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ ÙËÓ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ ηıÒ˜ Î·È ÛÙȘ ·Ó¿ÁΘ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·, ÂϤÁ¯ÔÓÙ·˜ ¤ÙÛÈ ¤ÌÌÂÛ· ÙËÓ Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÈÏÔÙÈ΋ ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ¢ڇÙÂÚ˘ ¤Ú¢ӷ˜ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ rhG-CSF ÛÙÔÓ ·ÚÈıÌfi Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÓÂÔÁÓÈÎÒÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·È ÌÔÓÔ΢ÙÙ¿ÚˆÓ. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 86 ÓÂÔÁÓ¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ‚¤‚·ÈË ‹ Èı·Ó‹ ÛË„·ÈÌ›· ÛÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÙÔ˘˜ ÛÙË ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ∞.¶.£. ∆· ÓÂÔÁÓ¿ ¯ˆÚ›-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·485

¶∞π¢π∞∆ƒπ∫∏ 2000;63:483-489

∂›‰Ú·ÛË rhG-CSF ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ

¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ. √Ì¿‰· G-CSF ∞ÚÈıÌfi˜ ∏ÏÈΛ· ·ËÛ˘ (‚‰. x ± SD) µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g x ± SD) ∏ÏÈΛ· ¤Ó·Ú͢ ÛË„·ÈÌ›·˜ (ËÌ. x ± SD) º‡ÏÔ (∞/∫) ∆ÚfiÔ˜ ÙÔÎÂÙÔ‡ (ÎÔÏÈÎfi˜/∫∆) ∞ÛÊ˘Í›· (n) £ÓËÙfiÙËÙ· (%) ™∞¢ (n) £ÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ (n) Gram ıÂÙÈÎÔ› ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› (n) Gram ·ÚÓËÙÈÎÔ› ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› (n) ª‡ÎËÙ˜ (n)

48 31,6 ± 4,2 1671 ± 823 10,5 ± 9,5 25/23 26/22 9 10 26 40 17 19 4

√Ì¿‰· ª·ÚÙ‡ÚˆÓ 38 30,8 ± 3,1 1628 ± 690 10,9 ± 10,3 19/19 20/18 7 12 26 33 13 15 5

p ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™

∞/∫: ·ÁfiÚÈ·/ÎÔÚ›ÙÛÈ·, ∫∆: ηÈÛ·ÚÈ΋ ÙÔÌ‹, ™∞¢: Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ª™: ‰È·ÊÔÚ¿ ÌË ÛËÌ·ÓÙÈ΋ ÛÙ·ÙÈÛÙÈο

ÛÙËÎ·Ó Ù˘¯·›· Ì ‚¿ÛË ÙË ÛÂÈÚ¿ ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÙÌ‹Ì· Û ‰˘Ô ÔÌ¿‰Â˜: 1) OÌ¿‰· Ì·ÚÙ‡ÚˆÓ, fiÔ˘ Ë ÛË„·ÈÌ›· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÙË Û˘Ì‚·ÙÈ΋ ·ÓÙÈÌÈÎÚԂȷ΋ Î·È ÁÂÓÈ΋ ˘ÔÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹. 2) OÌ¿‰· GCSF, fiÔ˘ ÂÎÙfi˜ ·fi ÙË Û˘Ì‚·ÙÈ΋ ·ÁˆÁ‹ ¯ÔÚËÁ‹ıËΠrhG-CSF ˘Ô‰fiÚÈ· Û ‰fiÛË 10 mcg/kg ÙËÓ Ë̤ڷ ÁÈ· 3 Û˘Ó¯›˜ Ë̤Ú˜. ø˜ Èı·Ó‹ ÛË„·ÈÌ›· ¯·Ú·ÎÙËÚ›ÛÙËÎÂ Ë ‡·ÚÍË ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ÛË„·ÈÌ›·˜ (ÓˆıÚfiÙËÙ·, ˘ÔÙÔÓ›·, η΋ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›·, ·ÓÔ˚ο ÂÂÈÛfi‰È·, ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘) Ì·˙› Ì ‰˘Ô ‹ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ (Ô˘‰ÂÙÂÚÔÂÓ›· <1800/mm3, Û¯¤ÛË ·ÒÚˆÓ ÚÔ˜ ÔÏÈο Ô˘‰ÂÙÂÚfiÊÈÏ· >0,25, ıÚÔÌ‚ÔÂÓ›· <100.000/mm3 Î·È CRP>10 mg/L). ø˜ ‚¤‚·ÈË ÛË„·ÈÌ›· ÔÚ›ÛÙËÎÂ Ë ‡·ÚÍË ıÂÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·›Ì·ÙÔ˜. ∞fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi 20x103/mm3 ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜ ‹ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ‹Ù·Ó ¤Ó‰ÂÈÍË ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ÌÂϤÙË ‹ ‰È·ÎÔ‹˜ Ù˘ ¯ÔÚ‹ÁËÛ˘ rhG-CSF. OÈ ·Ô-

Ê¿ÛÂȘ ÁÈ· ÙË ÁÂÓÈ΋ ˘ÔÛÙËÚÈÎÙÈ΋ Î·È ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ Ï·Ì‚¿ÓÔÓÙ·Ó Î·È ÂÊ·ÚÌfi˙ÔÓÙ·Ó ·fi ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·ÙÚÔ‡˜, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÁÓÒÚÈ˙·Ó ÙÔ Û¯Â‰È·ÛÌfi Ù˘ ÌÂϤÙ˘. ∆· ÎÚÈÙ‹ÚÈ· ÌÂÙ¿ÁÁÈÛ˘ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ Î·ıÔÚ›˙ÔÓÙ·Ó ·fi ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·ÙÚÔ‡˜ ·Ó¿ÏÔÁ· Ì ÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÙË ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· Î·È ÙȘ ·Ó¿ÁΘ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È Ô͢ÁfiÓÔ. ŒÓ‰ÂÈÍË ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ·ÈÌÔÂÙ·Ï›ˆÓ ‹Ù·Ó Ë Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ οو ·fi 50.000/mm3. ø˜ ı¿Ó·ÙÔÈ Û˘Ó‰ÂfiÌÂÓÔÈ Ì ÙË Ïԛ̈ÍË ıˆڋıËÎ·Ó ÂΛÓÔÈ Ô˘ Â‹Ïı·Ó ̤۷ ÛÙȘ 10 ÚÒÙ˜ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜.

O ÂȉÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ¿Ì‚·Ó ̤ÙÚËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ï¢ÎÔ΢ÙÙ·ÚÈÎÔ‡ Ù‡Ô˘ Î·È Ì¤ÙÚËÛË ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ∆Ô ÚÒÙÔ ‰Â›ÁÌ· ·›Ì·ÙÔ˜ Ï·Ì‚·ÓfiÙ·Ó Ì ÙËÓ ÎÏÈÓÈ΋ ˘Ô„›· Ù˘ Ïԛ̈ÍË, ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË rhG-CSF ÛÙËÓ ÔÌ¿‰· G-CSF, (Ë̤ڷ 0) Î·È Ù· ÂfiÌÂÓ· ÛÙËÓ 1Ë,

¶›Ó·Î·˜ 2. ∆È̤˜ (à ± SD) ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (∞∞O), ·ÈÌ·ÙÔÎÚ›ÙË Î·È ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜ ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜ ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›·.

∞∞O ∞ÈÌ·ÙÔÎÚ›Ù˘ (%) ∞ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ (Ã103/mm3)

√Ì¿‰· G-CSF

√Ì¿‰· Ì·ÚÙ‡ÚˆÓ

p

5130 ± 3367 39,6 ± 10,3

7169 ± 7644 40,5 ± 8,1

ª™ ª™

116 ± 111

117 ± 112

ª™

ª™: ‰È·ÊÔÚ¿ ÌË ÛËÌ·ÓÙÈ΋ ÛÙ·ÙÈÛÙÈο

485

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·486

AfiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚfiÊÈψÓ/mm3

¶∞π¢π∞∆ƒπ∫∏ 2000;63:483-489

∫. ™·Ú·Ê›‰Ë˜ Î·È Û˘Ó.

18000 16000 14000 12000 10000 8000 6000 4000 2000 0

Ù·˜ ÙˆÓ ‰È·ÊÔÚÒÓ ÌÂٷ͇ ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ë ÌË ·Ú·ÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· Mann Whitney Î·È Ë ‰ÔÎÈÌ·Û›· Fischer (Fischer exact test), fiÔ˘ ¯ÚÂÈ·˙fiÙ·Ó. ∆¤ÏÔ˜, Ë ÛËÌ·ÓÙÈÎfiÙËÙ· ÙˆÓ ‰È·‰Ô¯ÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ÙÈÌÒÓ ÛÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÂÎÙÈÌ‹ıËΠ̠ÙËÓ Kruskal-Wallis ANOVA.

√Ì¿‰· G-CSF √Ì¿‰· Ì·ÚÙ‡0

1

2

3

4

5

6

∏ª∂ƒ∞ ™∏æ∞πªπ∞™

AÈÌ·ÙÔÎÚ›Ù˘ (%)

43 42 41 40 39 38 37 36 35 34

√Ì¿‰· G-CSF √Ì¿‰· Ì·ÚÙ‡-

0

1

2

3

4

5

∏ª∂ƒ∞ ™∏æ∞πªπ∞™

∞ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ /mm3

180000 160000 140000 120000 100000 80000

√Ì¿‰· G-CSF

60000 √Ì¿‰· Ì·ÚÙ‡-

40000 20000 0 0

1

2

3

4

5

∏ª∂ƒ∞ ™∏æ∞πªπ∞™

∂ÈÎfiÓ· 1. ¢È·‰Ô¯ÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË, ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜ ÓÂÔÁÓÒÓ ÛÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ Î·È ÙÔ ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· (SEM).

3Ë Î·È 5Ë Ë̤ڷ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ Ïԛ̈͢. ∂›Û˘, ÁÈÓfiÙ·Ó Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÌÂÙ·ÁÁ›ÛÂˆÓ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ 10 ÚÒÙˆÓ ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜. ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÂÈÙÚÔ‹ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Î·È Ï·Ì‚·ÓfiÙ·Ó ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ·fi ÙÔ˘˜ ÁÔÓ›˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· fiϘ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÔÈ Ì¤Û˜ ÙÈ̤˜, ÔÈ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ Î·È ÙÔ ÛÙ·ıÂÚfi ÛÊ¿ÏÌ·. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙË-

486

∞ÔÙÂϤÛÌ·Ù· ∞fi Ù· 86 ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· Ù· 48 ‹Ú·Ó rhGCSF Î·È ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· G-CSF Î·È Ù· ˘fiÏÔÈ· 38 ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ. OÈ ‰˘Ô ÔÌ¿‰Â˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· ·ËÛ˘ Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÙÔÓ ÙÚfiÔ ÙÔÎÂÙÔ‡, ÙÔ Ê‡ÏÔ Î·È ÙËÓ Ë̤ڷ ¤Ó·Ú͢ Ù˘ Ïԛ̈͢ (¶›Ó·Î·˜ 1). ∂›Û˘, ‰ÂÓ ˘‹Ú¯Â ÌÂٷ͇ ÙÔ˘˜ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÛËÌ·ÓÙÈÎfiÙÂÚˆÓ ÓÂÔÁÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (¶›Ó·Î·˜ 1). µ¤‚·ÈË ÛË„·ÈÌ›· ›¯·Ó 73 ÓÂÔÁÓ¿ (40/48 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ G-CSF Î·È 33/38 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ Ì·ÚÙ‡ÚˆÓ), ÂÓÒ Ù· ˘fiÏÔÈ· ›¯·Ó Èı·Ó‹ ÛË„·ÈÌ›·. ∆· ÌÈÎÚfi‚È· Ô˘ ·ÔÌÔÓÒıËÎ·Ó Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. ∏ ıÓËÙfiÙËÙ· ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜. ∞‡ÍËÛË ÙÔ˘ ∞∞O ¿Óˆ ·fi 20.000/mm3 ·ÚÔ˘Û›·Û·Ó 3 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ GCSF, 1 ÌÂÙ¿ ÙËÓ 1Ë ‰fiÛË Î·È 2 ÌÂÙ¿ ÙË 2Ë ‰fiÛË ÙÔ˘ G-CSF, ÛÙ· ÔÔ›· Ë ¯ÔÚ‹ÁËÛË ‰ÈÂÎfiË. ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2 Î·È ÙËÓ ÂÈÎfiÓ· 1. ™ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜ (Ë̤ڷ 0) Ô ∞∞O Ô ·ÈÌ·ÙÔÎÚ›Ù˘ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ıÚÔÌ‚Ô΢ÙÙ¿ÚˆÓ ‰Â ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ (¶›Ó·Î·˜ 2). ∫·Ù¿ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË, Ô ∞∞O ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ¿‰· G-CSF (p<0,001, Kruskal-Wallis ANOVA, ∂ÈÎfiÓ· 1), ·ÏÏ¿ fi¯È ÛÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ (∂ÈÎfiÓ· 1). OÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜ Û ηÌÈ¿ ·fi ÙȘ ‰˘Ô ÔÌ¿‰Â˜. ∏ Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ ¤‰ÂÈÍ fiÙÈ Ô ∞∞O ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· G-CSF ÙËÓ 3Ë Ë̤ڷ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ¯ÔÚ‹ÁËÛ˘ (p<0,0001, ‰ÔÎÈÌ·Û›· Mann-Whitney), ÂÓÒ Ô ·ÈÌ·ÙÔÎÚ›Ù˘ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ‰Â ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο Û fiÏÔ ÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ (∂ÈÎfiÓ· 1). ™ÙȘ ‰¤Î· ÚÒÙ˜ Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Ïԛ̈͢, Û ÌÂÙ¿ÁÁÈÛË ÂÚ˘ıÚÒÓ ˘Ô‚Ï‹ıËÎ·Ó 37/48 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ G-CSF Î·È 30/38 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ Ì·ÚÙ‡ÚˆÓ (p=0,43, ‰ÔÎÈÌ·Û›· Fischer) Î·È Û ÌÂÙ¿ÁÁÈÛË ·ÈÌÔÂÙ·Ï›ˆÓ 19/38 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ G-CSF Î·È 20/38 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ Ì·ÚÙ‡ÚˆÓ (p=0,28). O ̤ÛÔ˜ ·ÚÈıÌfi˜ ÌÂÙ·ÁÁ›ÛÂˆÓ ÂÚ˘ıÚÒÓ ‹Ù·Ó ·ÚfiÌÔÈÔ˜ ÛÙȘ ÔÌ¿‰Â˜ G-CSF Î·È Ì·ÚÙ‡ÚˆÓ (1,7±1,6 Î·È 1,9±1,8, ·ÓÙ›ÛÙÔȯ·, p=0,6). √ ·ÚÈıÌfi˜ ÌÂÙ·ÁÁ›ÛÂˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· G-CSF (1,0±1,5 ·Ó¿ ÓÂÔÁÓfi ηÈ

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

¶∞π¢π∞∆ƒπ∫∏ 2000;63:483-489

™ÂÏ›‰·487

∂›‰Ú·ÛË rhG-CSF ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ

1,8±2,4, ·ÓÙ›ÛÙÔȯ·) ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ‚ÚÈÛÎfiÙ·Ó ÛÙ· fiÚÈ· Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ (p=0,06, ‰ÔÎÈÌ·Û›· Mann-Whitney). ™˘˙‹ÙËÛË ™Ù· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÔÈΛϘ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÂȉÈÎÒÓ Î·È ÌË ÂȉÈÎÒÓ ·Ì˘ÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘˜, ÔÈ Ôԛ˜ ÂȉÂÈÓÒÓÔÓÙ·È ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜ (20,21). ªÈ· ‰È·Ù·Ú·¯‹ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ˘„ËÏ‹ ıÓËÙfiÙËÙ· Â›Ó·È Ë ÂÌÊ¿ÓÈÛË Ô˘‰ÂÙÂÚÔÂÓ›·˜ (15). ™ÙËÓ ÚÔÛ¿ıÂÈ· ÚfiÏ˄˘ ‹ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ·ÏÏ¿ Î·È ÔÚÈÛÌ¤ÓˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Î˘Ú›ˆ˜ ÙÔ˘ rhGCSF. ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ·¤‰ÂÈÍ·Ó fiÙÈ Ô rhG-CSF ÚÔ¿ÁÂÈ ÙË Ì˘ÂÏÔÔ›ËÛË Û fiÏ· Ù· ÛÙ¿‰È¿ Ù˘ ·˘Í¿ÓÔÓÙ·˜ ÙȘ ‰ÂÍ·ÌÂÓ¤˜ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È ·Ôı‹Î¢Û˘ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙÔ Ì˘ÂÏfi, ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·È ÚÔ¿ÁÂÈ ÔÚÈṲ̂Ó˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘˜, fiˆ˜ Â›Ó·È Ë ÂÈÊ·ÓÂȷ΋ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ Î·È Ô ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÔÍÂȉˆÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ (2-4,21,22). ∫·È ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË Â›Ó·È ÂÌÊ·Ó‹˜ Ë ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙËÓ ÔÌ¿‰· Ô˘ ‹Ú rhG-CSF. ŸÌˆ˜, ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÈ·˜ ıÂÚ·›·˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ÛËÌ·Û›· ¤¯ÂÈ fi¯È ÌfiÓÔ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·ÏÏ¿ Î·È Ë ·ÛÊ¿ÏÂÈ·. OÈ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ô˘ ··Û¯ÔÏÔ‡Û·Ó ÙÔ˘˜ ÓÂÔÁÓÔÏfiÁÔ˘˜ ‹Ù·Ó ΢ڛˆ˜ Ë ÂÈ‚¿Ú˘ÓÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÏfiÁˆ Û˘ÛÛÒÚ¢Û˘ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ Ó‡ÌÔÓ˜ (23), Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂȉÂÈÓÒÛÂÈ ÙËÓ ‹‰Ë ÂÈ‚·Ú˘Ì¤ÓË ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È Ó· ·˘Í‹ÛÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘. ª¤¯ÚÈ ÛÙÈÁÌ‹˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó Ù¤ÙÔÈ· ÚÔ‚Ï‹Ì·Ù· Û ÓÂÔÁÓ¿ Ô˘ ‹Ú·Ó rhG-CSF ÂÊfiÛÔÓ ¯ÔÚËÁÂ›Ù·È ·ÚÁ¿, fiˆ˜ ˘Ô‰fiÚÈ· ‹ ÂÓ‰ÔÊϤ‚È· ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË, Û ‰fiÛÂȘ Ô˘ ‰ÂÓ ÍÂÂÚÓÔ‡Ó Ù· 10 mcg/kg/H (2-4,22). ªÈ· ¿ÏÏË Èı·Ó‹ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· Â›Ó·È Ë ÂӉ¯Ô̤ÓË ‰˘ÛÌÂÓ‹˜ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. £ÂˆÚËÙÈο, Â›Ó·È Èı·Ófi Ë ‰È¤ÁÂÚÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ Ó· ÚÔηÏ› ÂÍ¿ÓÙÏËÛË ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ÔÏ˘‰‡Ó·ÌÔ˘ ΢ÙÙ¿ÚÔ˘ ·ÓÙ·ÁˆÓÈ˙fiÌÂÓË ÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘ ÚÔ˜ ÙËÓ ÂÚ˘ıÚ¿ Î·È ıÚÔÌ‚Ô΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿. ¶·Ú¿ÏÏËÏ· fï˜, Ë ‰ÈÂÁÂÚÙÈ΋ ‰Ú¿ÛË ÙÔ˘ rhG-CSF ÛÙȘ ÔÏ˘‰‡Ó·Ì˜ CFUs-GEMM ÌÔÚ› Ó· ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ (5-7). OÈ ·Ú¯ÈΤ˜ ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ‰ÂÓ ¤‰ˆÛ·Ó ÂӉ›ÍÂȘ ÂÍ¿ÓÙÏËÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ Ì ÙË ¯ÔÚ‹ÁËÛË

ÙÔ˘ rhG-CSF Û ÔÓÙ›ÎÈ· (14). ªÂϤÙ˜ Û ˘ÁÈ›˜ ÂÓ‹ÏÈΘ ‰fiÙ˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ·ÛÊ¿ÏÂÈ· Â›Ó·È ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘Ô‚ÏËıÔ‡Ó Û ıÂÚ·›· ‰È¤ÁÂÚÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ Ì rhG-CSF, ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ‰ÂÓ Â›¯Â ηÌÈ¿ Â›‰Ú·ÛË ‹ ÚÔοÏÂÛ ·ÚÔ‰È΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (8,24). ∂›Û˘, Ë ıÂÚ·¢ÙÈ΋ ¯ÔÚ‹ÁËÛË rhG-CSF Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ¯ËÌÂÈÔıÂÚ·›· ‰ÂÓ ¤‰ÂÈÍ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (9,11,25-28), ÂÓÒ ÔÈ Negrin Î·È Û˘Ó. (10) ‰È·›ÛÙˆÛ·Ó Ì›ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ. ™Ù· ÓÂÔÁÓ¿, ÔÈ Èı·ÓfiÙËÙ˜ ηٷÛÙÔÏ‹˜ Ù˘ ÂÚ˘ıÚÔÔ›ËÛ˘ Î·È ıÚÔÌ‚ÔÔ›ËÛ˘ Â›Ó·È ·˘ÍË̤Ó˜ ÏfiÁˆ ÙÔ˘ ÂÏ·Ùو̤ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÔÏ˘‰‡Ó·ÌˆÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ (29-31). ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ Û ÓÂÔÁ¤ÓÓËÙ· ÔÓÙ›ÎÈ· ‰ÂÓ ¤‰ÂÈÍ·Ó Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (13), ÂÓÒ Ë in vitro ÚÔÛı‹ÎË rhG-CSF Û ηÏÏȤÚÁÂȘ ÚÔ‰ÚÔÌÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÂÌ‚Ú˘˚Îfi Ì˘ÂÏfi Î·È ‹·Ú ηıÒ˜ Î·È ·fi ÔÌÊ¿ÏÈÔ ÏÒÚÔ ‰ÂÓ ÂÏ¿ÙÙˆÛ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ (12). ∆· ÂÈÚ·Ì·ÙÈο Î·È in vitro ‰Â‰Ô̤ӷ ‰ÂÓ ÚÔ‰Èο˙Ô˘Ó ÙËÓ in vivo ‰Ú¿ÛË ÙÔ˘ rhG-CSF, ÂÂȉ‹ ÛÙ· ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ˘¿Ú¯ÂÈ ‹‰Ë ηٷÛÙÔÏ‹ Ù˘ ÂÚ˘ıÚ¿˜ Î·È ıÚÔÌ‚Ô΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜. ∂ÈϤÔÓ, ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜ ·˘Í¿ÓÂÙ·È Ë ÂÓ‰ÔÁÂÓ‹˜ ·Ú·ÁˆÁ‹ ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ (IL-6) (16,22) Î·È ·ÈÌÔÔÈËÙÈÎÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (GM-CSF), ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ‰ÚÔ˘Ó Û˘ÓÂÚÁÈο Ì ÙÔÓ G-CSF ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (5,7,13,28). ∞Ó Î·È ÛÙȘ ÌÂϤÙ˜ ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ rhG-CSF ·Ó·Ê¤ÚÂÙ·È ÁÂÓÈο fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ (2,3), ‰ÂÓ ˘¿Ú¯Ô˘Ó ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ô˘ Ó· ÂÛÙÈ¿˙ÔÓÙ·È ÛÙËÓ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›·. ™ÙË ÌÂϤÙË Ì·˜, Ô ·ÈÌ·ÙÔÎÚ›Ù˘ Î·È Ô ·ÚÈıÌfi˜ ÌÂÙ·ÁÁ›ÛÂˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‰ÂÓ ÂËÚ¿ÛÙËΠ·fi ÙË ¯ÔÚ‹ÁËÛË G-CSF, ·ÊÔ‡ Û fiÏÔ ÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÔÈ ÙÈ̤˜ ÙˆÓ ‰˘Ô ·˘ÙÒÓ ·Ú·Ì¤ÙÚˆÓ, Ô˘ Û˘Ó‰˘·˙fiÌÂÓ˜ ‰›ÓÔ˘Ó ¤ÌÌÂÛ· ÙËÓ ÂÈÎfiÓ· Ù˘ ÂÚ˘ıÚÔÔ›ËÛ˘, ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ ÛË„·ÈÌÈÎÒÓ ÓÂÔÁÓÒÓ. º·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ ‰ÂÓ ·ÛÎÂ›Ù·È ‰˘ÛÌÂÓ‹˜ Â›‰Ú·ÛË ÛÙËÓ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÒÓ. ™¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙ· ·ÈÌÔÂÙ¿ÏÈ·, Û ÚÔËÁÔ‡ÌÂÓË ÎÏÈÓÈ΋ ÌÂϤÙË Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ÂÌÊ¿ÓÈÛË ıÚÔÌ‚ÔÂÓ›·˜, Ô˘ fï˜ ı· ÌÔÚÔ‡Û ӷ ÚÔÎÏËı› ·fi ÙËÓ ›‰È· ÙË ÛË„·ÈÌ›· (4). ¢ÂÓ ˘¿Ú¯Ô˘Ó ¿ÏϘ ·Ó·ÊÔÚ¤˜ ÁÈ· ÙËÓ Â›‰Ú·ÛË ÙÔ˘ rhG-

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CSF ÛÙ· ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÁÂÁÔÓfi˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÙȘ ‰ÈÔÚıˆÙÈΤ˜ ÌÂÙ·ÁÁ›ÛÂȘ ·ÈÌÔÂÙ·Ï›ˆÓ. øÛÙfiÛÔ, ˘‹Ú¯Â Û·Ê‹˜ Ù¿ÛË ÁÈ· Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÌÂÙ·ÁÁ›ÛÂˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙËÓ ÔÌ¿‰· G-CSF, Ë ÔÔ›· ˘Ô‰ÂÈÎÓ‡ÂÈ ÂӉ¯fiÌÂÓË Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÛÙË ıÚÔÌ‚ÔÔ›ËÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ıÂÚ·¢ÙÈ΋ ¯ÔÚ‹ÁËÛË rhGCSF Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ‰˘ÛÌÂÓÒ˜ ÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÒ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ ÂÚÈÔÚ›˙ÂÈ ÙȘ ·Ó¿ÁΘ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ·ÈÌÔÂÙ·Ï›ˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Demetri GD, Griffin JD. Granulocyte colony-stimulating factor and its receptor. Blood 1991;78:1061-1075.

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16. ∫·Ó·ÎÔ‡‰Ë -∆۷ηϛ‰Ô˘ º, ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ, ™·Ú·Ê›‰Ë˜ ∫, ∆˙ÈÌÔ‡ÏË µ, ∫Ô„·¯Â›ÏË O, ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-6, TNF-· Î·È IL-1‚ Î·È ¤Î‚·ÛË Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜. ¶·È‰È·ÙÚÈ΋ 1997;60:689-695.

17. de Bond ESJM, Martens A, van Raan J, Samson G, Fetter WPE, Okken A. Tumor necrosis factor-a, interleukin-1b, and interleukin-6 plasma levels in neonatal sepsis. Pediatr Res 1993;33:380-383.

18. Leary AG, Ikebuchi K, Hirai Y, Yang YC, Clark SC, Ogawa M. Synergism between interleukin-6 and interleukin-3 in supporting proliferation of human hematopoietic stem cells: comparison with interleukin-1 alpha. Blood 1988;6:1759-1763.

19. Quesenberry PJ, McGrath HE, Williams ME, Robinson BE, Deacon DH, Clark S,et al. Multifactor stimulation of megakaryocytopoiesis: effects of interleukin-6. Exp Hematol 1991;19:35-41.

20. Bektas S, Goetze B, Speer CP. Decreased adherence, chemotaxis and phagocytic activities of neutrophils from preterm neonates. Acta Pediatr Scand 1990;79:1031-1038.

21. Drossou V, Kanakoudi F, Tsimouli V, Sarafidis K Taparkou A, Bougiouklis D, et al. Impact of prematurity, stress and sepsis on the neutrophil respiratory burst activity of neonates. Biol Neonate 1997;72:201-209.

22. ™·Ú·Ê›‰Ë˜ ∫. ∞ÓÔÛÔ·Ú¤Ì‚·ÛË ÛÙË ÓÂÔÁÓÈ΋ ÛË„·ÈÌ›· [¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹] £ÂÛÛ·ÏÔÓ›ÎË: ∞¶£; 2000.

23. Lieschke GJ, Cebon J, Morstyn G. Characterization of the clinical effect after the first dose of bacterially synthesized recombinant human granulocyte macrophage-colony stimulating factor. Blood 1989;74:2634-2643.

24. LeBlanc R, Roy J, Demers C, Vu L, Cantin G. A

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∂›‰Ú·ÛË rhG-CSF ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ

prospective study of G-CSF effects on hemostasis in allogeneic blood stem cell donors. Bone Marrow Transplant 1999;23:991-996.

25. Geissler K, Koller E, Hubmann E, Niederwieser D, Hinterberger W, Geissler D, et al. Granulocyte-colonystimulating factor as an adjunct to induction chemotherapy for adult acute lymphoblastic leukemia-a randomized phase-III study. Blood 1997;90:590-596.

26. Mukai J, Shimizu E, Ogura T. Granulocyte-colony stimulating factor enhances the circulating hemopoietic progenitors in lung cancer patients treated with cisplastincontaining regimens. Jpn J Cancer Res 1992;83:476-453.

27. Koumakis G, Vassilomanolakis M, Barbounis V, Hatzichristou E, Demiri S, Plataniotis G, et al. Optimal timing (preemptive versus supportive) of granulocytecolony stimulating factor administration following highdose cyclophosphamide. Oncology 1999;56:28-35.

28. Recchia F, De Filippis S, Torchio P, Rea S, Guilino A,

Quaglino D, et al. Randomized trial of filgastim vs. sequential filgastim and molgramostim after doseintentified carboplatin, cyclophosphamide, and etoposide: a phase I pilot study. Am J Clin Oncol 1997;20:209-214.

29. Christensen RD, Liechty KW, Koening JM, Schibler KR, Ohls RK. Administration of erythropoietin to newborn rats results in diminished neutrophil production. Blood 1991;78:124-126.

30. De Haan, Loeffler M, Nijhof W. Long-term recombinant human granulocyte-colony stimulating factor (rhG-CSF) treatment severely depresses murine marrow erythropoiesis without causing anemia. Exp Hematol 1989;20:600-604.

31. Migliaccio AR, Migliaccio G. Human embryonic erythropoiesis: control mechanisms underlying progenitor differentiation in vitro. Dev Biol 1988;125:2074-2081.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-09-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 20-11-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: µ·ÛÈÏÈ΋ ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ °ÏËÓÔ‡ 28, 54352 £ÂÛÛ·ÏÔÓ›ÎË

489

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¶Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÈÛ‹Ì·ÓÛË Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È Ë Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ¤Î‚·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÃÚÈÛÙ›Ó· ∆Ú¿·ÏË, ∞Ó‰Ú¤·˜ ª·ÚÁÂÙ¿Î˘ ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËı› ÚÔÁÂÓÓËÙÈο Ë Û˘¯ÓfiÙËÙ· Ù˘ ‡ÚÂÛ˘ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (™∫) ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ̤ıÔ‰Ô ÂϤÁ¯Ô˘ ÙÔ Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· (∏Ã). ∂ϤÁıËÎ·Ó Ì Ï‹Ú˜ ∏à (2D+Doppler) 291 Ù˘¯·›· ÂÈÏÂÁ̤ӷ ¤Ì‚Ú˘· ËÏÈΛ·˜ 18-24 ‚‰ÔÌ¿‰ˆÓ. ∞Ó¿ÏÔÁ· Ì ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫ Ô ÏËı˘ÛÌfi˜ ¯ˆÚ›ÛÙËΠ۠2 ÔÌ¿‰Â˜: √Ì¿‰· ∞: 244 ¤Ì‚Ú˘· ¯ˆÚ›˜, Î·È ÔÌ¿‰· µ: 47 ¤Ì‚Ú˘· Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫. ¢È·ÈÛÙÒıËÎ·Ó 7 Ì›˙ÔÓ˜ ™∫ (2,4%): 6 ÛÙËÓ ÔÌ¿‰· ∞ (2,5%) Î·È 1 ÛÙËÓ ÔÌ¿‰· µ (2,1%). ªÂÙ¿ ÙË Á¤ÓÓËÛË ‰È·ÈÛÙÒıËΠÌÈ· ÂÈϤÔÓ ÂÏ¿ÛÛˆÓ ™∫. ¢ÂÓ ˘‹Ú¯·Ó „¢‰Ò˜ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· (¢·ÈÛıËÛ›· 87,5%, ÂȉÈÎfiÙËÙ· 100%). ™Â 2 ¤Ì‚Ú˘· ‰È·ÈÛÙÒıËÎ·Ó ¯ÚˆÌÔÛˆÌȷΤ˜ ·ÓˆÌ·Ï›Â˜ ÌÂÙ¿ ·fi ¯ÚˆÌÔÛˆÌÈ·Îfi ¤ÏÂÁ¯Ô Ô˘ ˘ԉ›¯ıËÎÂ Û˘ÓÂ›· ÙˆÓ Î·Ú‰ÈÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∫·È ÔÈ 7 ΢‹ÛÂȘ Ì Ì›˙ÔÓ˜ ™∫ ‰ÈÂÎfiËÛ·Ó. ∞fi ÙË ÌÂϤÙË Ì·˜ ÚÔ·ÙÂÈ: 1. ¶Ï‹Ú˜ ∏à ‰ÈηÈÔÏÔÁÂ›Ù·È Î·È ÛÙȘ ΢‹ÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. 2. √ ¤ÏÂÁ¯Ô˜ Â›Ó·È ÎÚ›ÛÈÌÔ˜ ÁÈ· ÙËÓ ·fiÊ·ÛË Û˘Ó¤¯ÈÛ˘ ‹ fi¯È Ù˘ ·ËÛ˘. 3. ∏ ·Í›· ÙÔ˘ ÂϤÁ¯Ô˘ Â·˘Í¿ÓÂÙ·È ·fi ÙËÓ ˘·ÚÎÙ‹ Û¯¤ÛË ÌÂٷ͇ ™∫ Î·È ·‰È¿ÁÓˆÛÙˆÓ ¯ÚˆÌÔÛˆÌÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ. ¶·È‰È·ÙÚÈ΋ 2000;63:490-498. §¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ·, ‰È·ÎÔ‹ ·ËÛ˘, ¯ÚˆÌÔÛˆÌȷ΋ ·Ó¿Ï˘ÛË.

C. Trapali, A. Margetakis. Detailed fetal echocardiography for the detection of congenital heart disorders and its impact on the outcome of pregnancy. Paediatriki 2000;63:490-498. ● Abstract: The aim of this study was to assess the prenatal detection of congenital heart disease (CHD) by the use of detailed fetal echocardiography (echo) in 291 unselected pregnancies of 18-24 weeks gestation. The fetal heart was evaluated by echo (2D+Doppler) in 244 fetuses without risk factors for CHD (group A) and in 47 fetuses with risk factors for CHD (group B). Seven cases of major CHD (2.4%) were detected: 6 in group A (2.5%) and 1 in group B (2.1%). Postnatal assessment revealed one more minor case of CHD. There were no false positive diagnoses (sensitivity 87.5%, specificity 100%). In all cases with CHD the pregnancies were terminated. In two of these cases chromosomal anomalies were detected following detailed chromosomal analysis. We conclude that: 1. detailed fetal echo is justified even in a low risk pregnancies 2. Fetal echo may assist the physician’s decision to terminate the pregnancy. 3. the importance of echo is further enhanced by the existing association between CHD and previously undiagnosed chromosomal abnormalities.

Key words: fetal echocardiography, termination of pregnancy, chromosomal analysis.

∂ÈÛ·ÁˆÁ‹ OÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ (™∫) ÌÂ Û˘¯ÓfiÙËÙ· 8 ÛÙȘ 1000 ÁÂÓÓ‹ÛÂȘ ˙ÒÓÙˆÓ (1) Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË Î·ÙËÁÔÚ›· ÙˆÓ ÛÔ‚·ÚÒÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Â˘ı˘ÓfiÌÂÓË Ì¿ÏÈÛÙ·, ÁÈ· ÂÚ›Ô˘ 35% ÙˆÓ ı·Ó¿ÙˆÓ ·fi Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ηٿ ÙÔÓ 1Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÓfi˜ ΢ÔÊÔÚÔ‡ÌÂÓÔ˘ ÂÌ‚Ú‡Ô˘ Ó· ¿Û¯ÂÈ ·fi ™∫ ÌÔÚ› Ó·

∫·Ú‰ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶ & ∞ ∫˘ÚÈ·ÎÔ‡»

490

·ÊÔÚÔ‡Ó ÙË ÌËÙ¤Ú· (۷ί·Ú҉˘ ‰È·‚‹Ù˘, ÓfiÛÔ˜ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, Ï‹„Ë Ê·Ú̿ΈÓ, ¤ÎıÂÛË Û ÙÂÚ·ÙÔÁfiÓ·, ÏÔÈÌÒÍÂȘ), ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (ÈÛÙÔÚÈÎfi ™∫) ‹ ÙÔ ›‰ÈÔ ÙÔ ¤Ì‚Ú˘Ô (Â͈ηډȷΤ˜ ·ÓˆÌ·Ï›Â˜, ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘, ·‡ÍËÛË ‹ ÂÏ¿ÙÙˆÛË ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡, ·ÚÚ˘ı̛˜) Î·È ÂÚÈÁÚ¿ÊÔÓÙ·È ˘fi ÙÔÓ ÁÂÓÈÎfi fiÚÔ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. ∏ ·ÚÔ˘Û›· ‹ ·Ô˘Û›· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÌÈ· ·ËÛË ˆ˜ ˘„ËÏÔ‡ ‹ ¯·-

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∂Ì‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· - ™ËÌ·Û›· ÙÔ˘ ÁÈ· ÙËÓ Î‡ËÛË

ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÓÙ›ÛÙÔȯ·, ÁÈ· ™∫. ¢È¿ÁÓˆÛË ‹ ·ÔÎÏÂÈÛÌfi˜ ™∫ Â›Ó·È ÂÊÈÎÙfi Ó· Á›ÓÂÈ Ì ˯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÂÚ›Ô˘ ·fi ÙË 18Ë Â‚‰ÔÌ¿‰· Ù˘ ΢‹Ûˆ˜. ∂ÓÙÔ‡ÙÔȘ, Ô Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ (2D+Doppler), Ô˘ Â›Ó·È Ë ÌfiÓË ˘„ËÏ‹˜ ·ÎÚȂ›·˜ ̤ıÔ‰Ô˜, ηٿ ηÓfiÓ· Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ ÛÙȘ ΢‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (2,3) ÁÈ·Ù› Â›Ó·È ¯ÚÔÓÔ‚fiÚÔ˜ Î·È ‰··ÓËÚfi˜ Î·È ÔÈ ÂȉÈο ÂÎ·È‰Â˘Ì¤ÓÔÈ ÛÙÔ ·ÓÙÈΛÌÂÓÔ ÁÈ·ÙÚÔ› Â›Ó·È Ôχ Ï›ÁÔÈ ÁÈ· Ó· ÂϤÁÍÔ˘Ó ÙÔ Û‡ÓÔÏÔ ÙˆÓ Î˘‹ÛÂˆÓ (4), ÌÂ Û˘Ó¤ÂÈ· ÔÈ ™∫ Ó· Â›Ó·È ÌÂٷ͇ ÙˆÓ ÛÔ˘‰·ÈfiÙÂÚˆÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ ‰ÂÓ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÛÙ· Ï·›ÛÈ· ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ (5). ∂ÓÈÛ¯‡ÔÓÙ·˜ Ù· ‹‰Ë ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù·, Ë ‚È‚ÏÈÔÁÚ·Ê›· ÙÂÏÂ˘Ù·›· ηٷÁÚ¿ÊÂÈ ˘„ËÏ‹ Â›ÙˆÛË ™∫ Û ΢‹ÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (6-8). ∞ÓÂÍ¿ÚÙËÙ· ÂÍ¿ÏÏÔ˘ ·fi Ù· ÌÂÁ¤ıË ÎfiÛÙÔ˘˜ ˆÊ¤ÏÂÈ·˜ (3), Ô˘ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËıÔ‡Ó, Ê·›ÓÂÙ·È fiÙÈ Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ™∫ Â›Ó·È Î·ıÔÚÈÛÙÈ΋ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (3,9) Î·È Î·Ù’ Â¤ÎÙ·ÛË ÙÔ ÂÚÒÙËÌ· «Û ÔȘ ΢‹ÛÂȘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ë¯ÔηډÈÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜», Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ··ÓÙËı›. ªÂ ÛÎÔfi Ó· ÂÎÙÈÌ‹ÛÔ˘Ì ÙËÓ Â›ÙˆÛË ™∫ ÛÙ· ¤Ì‚Ú˘· - fiÙ·Ó ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ̤ıÔ‰Ô˜ ÂϤÁ¯Ô˘ Ï‹Ú˜ ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È Î˘Ú›ˆ˜ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ - ÌÂÏÂÙ‹Û·ÌÂ Ù˘¯·›Ô ÏËı˘ÛÌfi ΢‹ÛÂˆÓ Ì Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· Û·Ó ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜. ∂›Û˘, ÂÎÙÈÌ‹Û·Ì ÛÙÔ ‰Â›ÁÌ· Ì·˜ ÙË Û¯¤ÛË Â›ÙˆÛ˘ - ¤Ó‰ÂÈ͢ Û˘Ó˘ÔÏÔÁ›˙ÔÓÙ·˜ ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 291 ¤Ì‚Ú˘· (287 ΢‹ÛÂȘ, ÔÈ 4 ‰›‰˘Ì˜), Ô˘ ÂÈϤ¯ıËÎ·Ó Ù˘¯·›· Ì ÌÔÓ·‰ÈÎfi ÎÚÈÙ‹ÚÈÔ ËÏÈΛ· ΢‹Ûˆ˜ ÌÂٷ͇ 18˘ Î·È 24˘ ‚‰ÔÌ¿‰·˜ (̤ÛË ËÏÈΛ· ÂϤÁ¯Ô˘ 20 ‚‰ÔÌ¿‰Â˜+ 4 Ë̤Ú˜), ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÙfiÛÔ Ë ·ÎÚ›‚ÂÈ· ÙÔ˘ ÂϤÁ¯Ô˘, fiÛÔ Î·È Ë ‰˘Ó·ÙfiÙËÙ· ¤ÁηÈÚ˘ ‰È·ÎÔ‹˜. ¶Ï‹Ú˜ ·ÙÔÌÈÎfi, ÔÈÎÔÁÂÓÂÈ·Îfi Î·È Ì·È¢ÙÈÎfi ÈÛÙÔÚÈÎfi ÂÏ‹ÊıË ·’ fiϘ ÙȘ ÂÁ΢ÌÔÓÔ‡Û˜. ŸÏ· Ù· ¤Ì‚Ú˘· ˘Ô‚Ï‹ıËÎ·Ó Û ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ‚-ÂÈ¤‰Ô˘ ·fi Á˘Ó·ÈÎÔÏfiÁÔ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÈÛÙˆı› Ë ·ÚÔ˘Û›· ‹ ·Ô˘Û›· Â͈ηډȷÎÒÓ ·ÓˆÌ·ÏÈÒÓ. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËı› Ë Û¯¤ÛË Â›ÙˆÛË ™∫ - ¤Ó‰ÂÈÍË ÁÈ· ¤ÏÂÁ¯Ô Ì ‚¿ÛË ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫, Ë ÔÌ¿‰· ÙˆÓ ÂÌ‚Ú‡ˆÓ ¯ˆÚ›ÛÙËΠ۠‰˘Ô ˘ÔÔÌ¿‰Â˜ (∞ Î·È µ) ·Ó·ÏfiÁˆ˜ ÙÔ˘ ·Ó ÙÔ ÈÛÙÔÚÈÎfi Î·È Ô ¤ÏÂÁ¯Ô˜ ‚- ÂÈ¤‰Ô˘ ·Ó›¯Ó¢·Ó (µ) ‹ fi¯È (∞) ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫. ™ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ÂÎÙfi˜ ·fi ÙÔ˘˜ ÎÏ·ÛÈο ıˆÚÔ‡ÌÂÓÔ˘˜, Û˘ÌÂÚÈÏ¿‚·Ì ÙÔ ÈÛÙÔÚÈÎfi ·˘ÍË̤Ó˘ ·˘¯ÂÓÈ΋˜ ‰È·Ê¿ÓÂÈ·˜, ÂÚ› ÙË 12Ë Â‚‰ÔÌ¿‰·, Ô˘

Û‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ (10) Â›Ó·È ÈÛ¯˘Úfi˜ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ ÙfiÛÔ ÁÈ· ™∫, fiÛÔ Î·È ÁÈ· ÙÚÈۈ̛· 21. ∞fi Ù· ¤Ì‚Ú˘·, 244 ‰ÂÓ Â›¯·Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ (ÔÌ¿‰· ∞), ÂÓÒ 47 ¤Ì‚Ú˘· ›¯·Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫ (ÔÌ¿‰· µ). (¶›Ó·Î·˜ 1). ™ÙË Û˘Ó¤¯ÂÈ·, fiÏ· Ù· ¤Ì‚Ú˘· ˘Ô‚Ï‹ıËÎ·Ó Û Ï‹ÚË Ë¯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ·fi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÛÙÔ ·ÓÙÈΛÌÂÓÔ ·È‰ÔηډÈÔÏfiÁÔ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËıÔ‡Ó Ë Â›ÙˆÛË ™∫ ÛÙ· ¤Ì‚Ú˘· Î·È Î˘Ú›ˆ˜ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÚÔÁÂÓÓËÙÈÎÒÓ ‰È·ÁÓÒÛÂˆÓ ™∫. O ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ÙÔÓ ‚È‚ÏÈÔÁÚ·ÊÈο ··ÈÙÔ‡ÌÂÓÔ ‰ÈۉȿÛÙ·ÙÔ ¤ÏÂÁ¯Ô (3,11) Ù˘ ÙÔÌ‹˜ 4 ÎÔÈÏÔًوÓ, Ù˘ Û‡Ó‰ÂÛ˘ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ÙÔ˘ ·ÔÚÙÈÎÔ‡ ÙfiÍÔ˘ Î·È ÙÔ˘ ÙfiÍÔ˘ ÙÔ˘ ‚ÔÙ·Ï›Ԣ, Ù˘ Û‡Ó‰ÂÛ˘ ÙˆÓ ÎÔ›ÏˆÓ Î·È ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ Î·ıÒ˜ Î·È ¤ÏÂÁ¯Ô Ù˘ ÚÔ‹˜ (Ù‡Ô˜, Ù·¯‡ÙËÙ·, ηÙ‡ı˘ÓÛË ÚÔ‹˜) Ì pulsed Î·È color Doppler (11) Û fiϘ ÙȘ ‰ÈۉȿÛٷ٘ ÙÔ̤˜. ™Â ÂÚ›ÙˆÛË Ùˆ¯‹˜ ·ÂÈÎfiÓÈÛ˘ ÏfiÁˆ ı¤Û˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘, Ô ¤ÏÂÁ¯Ô˜ Â·Ó·Ï·Ì‚·ÓfiÙ·Ó ÌÈ· ÒÚ· ÂÚ›Ô˘ ·ÚÁfiÙÂÚ· ÌÂÙ¿ ÂÏ·ÊÚ‡ Á‡̷ Ù˘ ÌËÙ¤Ú·˜, ÒÛÙ ӷ ÂÈÙ¢¯ı› ÎÈÓËÙÔÔ›ËÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È Â›Ù¢ÍË ı¤Û˘ ¢ÓÔ˚ÎfiÙÂÚ˘ ÁÈ· ÙËÓ ·ÂÈÎfiÓÈÛË. ∂› ·ÚÚ˘ıÌ›·˜ ‹ fiÔ˘ ··ÈÙÔ‡ÓÙÔ ·ÎÚȂ›˜ ÌÂÙÚ‹ÛÂȘ ÂÈÚfiÛıÂÙ· ÁÈÓfiÙ·Ó M-mode, ÂÓÒ Î·Ù¿ ηÓfiÓ· Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌÂÁÂıÒÓ ÁÈÓfiÙ·Ó Ì ۇÁÎÚÈÛË Î·Ù¿ ÙËÓ Î·ıÔÏÈο ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË Ú·ÎÙÈ΋ (3,8) .¯. ÎfiÏÔÈ ÌÂٷ͇ ÙÔ˘˜, ÎÔÈϛ˜ ÌÂٷ͇ ÙÔ˘˜ Î.Ô.Î.

OÈ ÌÂϤÙ˜ ¤ÁÈÓ·Ó Ì ÌÔÚÊÔÙÚÔ›˜ 3,5 Î·È 5 ¶›Ó·Î·˜ 1. ŒÌ‚Ú˘· Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫ (ÔÌ¿‰· µ) ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘

∞ÚÈıÌfi˜ ¶ÂÚÈÛÙ·ÙÈÎÒÓ

1. ∞fi ÙË ÌËÙ¤Ú· ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ∞Ô‚ÔϤ˜ 1Ô˘ ÙÚÈÌ‹ÓÔ˘ ¡fiÛÔ˜ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ §‹„Ë Ê·ÚÌ¿ÎˆÓ (2 ·ÓÙÈÂÈÏËÙÈο, 1 ·ÓÙÈËÎÙÈÎfi) §Ô›ÌˆÍË (ÂÚ˘ıÚ¿ 15Ë-20Ë Â‚‰ÔÌ¿‰·) 2. ∞fi ÙÔ ¤Ì‚Ú˘Ô ∞˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ· ∞ӈ̷ϛ˜ ÓÂÊÚÒÓ µÚ·¯‡ ÌËÚÈ·›Ô ∆Ú·¯ËÏÈÎfi ÙÂڿو̷ ƒ·È‚ÔÔ‰›· 3. ∞fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ¶·Ù¤Ú·˜ Ì ™∫ ¶ÚÔËÁÔ‡ÌÂÓÔ ·È‰› Ì ™∫ ¶ÚÔËÁÔ‡ÌÂÓÔ ·È‰› Ì ™∫ Î·È Down

15 1 4 1 4 3 2 18 3 6 1 1 7 14 1 9 4

491

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498

Ã. ∆Ú¿·ÏË, ∞. ª·ÚÁÂÙ¿Î˘

∂ÈÎfiÓ· ∞. º˘ÛÈÔÏÔÁÈ΋ ηډȿ ÂÌ‚Ú‡Ô˘: 1. ∆ÔÌ‹ 4 ÎÔÈÏÔًوÓ. ªÂ ‚¤ÏÔ˜ ÛËÌÂÈÒÓÂÙ·È ÙÔ ÚfiÛıÈÔ ıˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ·. 2. ∏ ·ÔÚÙ‹ (AO) Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›· (LV). 3. ∏ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· (PA) Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ‰ÂÍÈ¿ ÎÔÈÏ›· (RV). º˘ÛÈÔÏÔÁÈ΋ Û¯¤ÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ÌÂٷ͇ ÙÔ˘˜. 4. ∞ÔÚÙÈÎfi ÙfiÍÔ. ªÂ ‚¤ÏÔ˜ ÛËÌÂÈÒÓÔÓÙ·È Ù· ‚Ú·¯ÈÔÎÂÊ·ÏÈο ·ÁÁ›·. 5. ∆fiÍÔ ‚ÔÙ·Ï›Ԣ fiÚÔ˘. ¶¿Óˆ ‚¤ÏÔ˜ Ë Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·, οو ‚¤ÏÔ˜ Û‡Ó‰ÂÛË ÛÙËÓ ·ÔÚÙ‹. 6. ™‡Ó‰ÂÛË ÎÔ›ÏˆÓ ÊÏ‚ÒÓ (‚¤ÏË) ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ (RA). 7. ∆ÚÂȘ ·fi ÙȘ Ó¢ÌÔÓÈΤ˜ ÊϤ‚˜ (‚¤ÏË) Û˘Ó‰¤ÔÓÙ·È ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ (LA). 8. Doppler ·ÂÈÎfiÓÈÛË ÚÔ‹˜ ÛÙËÓ ·ÓÈÔ‡Û· ·ÔÚÙ‹ (¤Ì‚Ú˘Ô 20 ‚‰.). RA = ‰ÂÍÈfi˜ ÎfiÏÔ˜, RV = ‰ÂÍÈ¿ ÎÔÈÏ›·, LA = ·ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜, LV = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·, S = ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË, AO = ·ÔÚÙ‹, PA = Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·.

MHz (HP Sonos 1000) Î·È 5 Î·È 6 MHz (Toshiba) Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó Û ‚ÈÓÙÂÔηۤÙ˜. ∏¯ÔηډÈÔÁÚ·ÊÈ΋ ÌÂϤÙË, Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡Û·Ì ηٿ Ù· ·ÓˆÙ¤Úˆ ¯·Ú·ÎÙËÚ›˙·ÌÂ, ˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ ÂÊfiÛÔÓ: 1) Ë ‚·ÛÈ΋ ÙÔÌ‹ ÙˆÓ 4 ÎÔÈÏÔÙ‹ÙˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋, ‰ËÏ·‰‹: ·) Ë Î·Ú‰È¿ ÛÂ Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË Î·È Î·Ù¤¯Ô˘Û· ÏÈÁfiÙÂÚÔ ·fi ÙÔ 1/3 ÙÔ˘ ıÒڷη, ‚) ·ÂÈÎÔÓ›˙ÔÓÙ·Ó 2 ÈÛÔÌÂÁ¤ıÂȘ ÎfiÏÔÈ, Á) ·ÂÈÎÔÓ›˙ÔÓÙ·Ó 2 ÈÛÔÌÂÁ¤ıÂȘ Î·È ÈÛÔ‰‡Ó·Ì· Û˘ÛÒÌÂÓ˜ ÎÔÈϛ˜ Ì ÙËÓ ÚfiÛıÈ· Ó· ¤¯ÂÈ Ù· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰ÂÍÈ¿˜, ‰) ·ÂÈÎÔÓ›˙ÔÓÙ·Ó 2 Ê˘ÛÈÔÏÔÁÈ΋˜ ÂÌÊ¿ÓÈÛ˘ Î·È Î›ÓËÛ˘ ÎÔÏÔÎÔÈÏȷΤ˜ ‚·Ï‚›‰Â˜, Ô˘ Û˘Ó·ÓÙÔ‡Û·Ó ÙÔ ÌÂÛÔÎÔÏÈÎfi Î·È ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÛÙ·˘Úfi, Â) ÙÔ ˆÔÂȉ¤˜ ÙÚ‹Ì· ÂÏÂÁ¯fiÙ·Ó ·ÓÔÈÎÙfi Î·È Ë Î›ÓËÛË Ù˘ ‚·Ï‚›‰·˜ ÙÔ˘ ‹Ù·Ó ‰ÂÍÈÔ·ÚÈÛÙÂÚ‹, ÛÙ) ÙÔ ÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· ·ÂÈÎÔÓÈ˙fiÙ·Ó ·Î¤Ú·ÈÔ. (∂ÈÎ. ∞1), 2) Ô ¯ÒÚÔ˜ ÂÍfi‰Ô˘ ÙˆÓ ÎÔÈÏÈÒÓ Î·È Ë Û‡Ó‰ÂÛË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ·ÔÚÙ‹ ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ˆ˜ Ê˘ÛÈÔÏÔÁÈο Û˘Ó‰ÂfiÌÂÓË ÂÊfiÛÔÓ ·Ó·ÁÓˆÚÈ˙fiÙ·Ó ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ·ÁÁÂ›Ô Û˘Ó‰ÂfiÌÂÓÔ Ì ÙËÓ Ô›ÛıÈ· ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· (∂ÈÎ. ∞2). ∏ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ ÂÊfiÛÔÓ Û˘Ó‰ÂfiÙ·Ó Ì ÙËÓ ÚfiÛıÈ· ‰ÂÍÈ¿ ÎÔÈÏ›· Î·È ·ÂÈÎÔÓÈ˙fiÙ·Ó Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ ‰È¯·ÛÌfi˜ Ù˘ (∂ÈÎ. ∞3). ∏ ΛÓËÛË ÙˆÓ

492

‰˘Ô ‚·Ï‚›‰ˆÓ Î·È Ù· ÌÂÁ¤ıË fiÊÂÈÏ·Ó Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ηıÒ˜ Î·È Ë Û¯¤ÛË ÙˆÓ ›‰ÈˆÓ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ÛÙÔÓ ¯ÒÚÔ (∂ÈÎ. ∞3), 3) ÙÔ ·ÔÚÙÈÎfi ÙfiÍÔ ÔˆÛ‰‹ÔÙ Ì ٷ 3 ‚Ú·¯ÈÔÎÂÊ·ÏÈο ÂÏÂÁ¯fiÙ·Ó ·fi ÙÔÓ Ì·ÎÚfi ¿ÍÔÓ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ê˘ÛÈÔÏÔÁÈÎfi (∂ÈÎ. ∞4), ηıÒ˜ Î·È ÙÔ ÙfiÍÔ ÙÔ˘ ‚ÔÙ·Ï›Ԣ fiÚÔ˘ (∂ÈÎ. ∞5 ), 4) ÔÈ ÎԛϘ ÊϤ‚˜ Û˘Ó‰¤ÔÓÙ·Ó ÛÙÔ ‰ÂÍÈfi (∂ÈÎ. ∞6) Î·È ÔÈ Ó¢ÌÔÓÈΤ˜ ÊϤ‚˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ (∂ÈÎ. ∞7), 5) Û fiϘ ÙȘ ·Ú·¿Óˆ ‰ÈۉȿÛٷ٘ ·ÂÈÎÔÓ›ÛÂȘ Ë ÚÔ‹, fiˆ˜ ÂÏÂÁ¯fiÙ·Ó Ì ÙÔ Doppler, ‹Ù·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ (∂ÈÎ. ∞8), 6) Ô Ú˘ıÌfi˜ Î·È Ë Û˘¯ÓfiÙËÙ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ™Â fiÏ· Ù· ¤Ì‚Ú˘· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ÔÈ ÁÔÓ›˜ ÂÓËÌÂÚÒÓÔÓÙ·Ó ÁÈ· ÙÔ˘˜ ÌÈÎÚÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙËÓ ·ÍÈÔÈÛÙ›· Ù˘ ÌÂıfi‰Ô˘ Î·È ÁÈÓfiÙ·Ó Û‡ÛÙ·ÛË ÁÈ· ·È‰È·ÙÚÈ΋ ÂÎÙ›ÌËÛË ÙËÓ 1Ë Ë̤ڷ, ÙËÓ 1Ë Â‚‰ÔÌ¿‰· Î·È ÙÔÓ 1Ô Ì‹Ó· Ù˘ ˙ˆ‹˜. ¶Ï‹Ú˘ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ‚ÏÂfiÙ·Ó Û ÂÚ›ÙˆÛË ‰È·›ÛÙˆÛ˘ Ê˘Û‹Ì·ÙÔ˜ ‹ ¿ÏÏÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ¢ÈÓfiÙ·Ó ¤ÌÊ·ÛË ÛÙÔ fiÙÈ Ë Èı·ÓfiÙËÙ· ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È Ì¿ÏÈÛÙ· Ì›˙ÔÓÔ˜, ·fi ÙÔÓ ¯ÚfiÓÔ ÂϤÁ¯Ô˘ ˆ˜ ÙË Á¤ÓÓËÛË, ‹Ù·Ó Ôχ ÌÈÎÚ‹ Î·È ÔÈ ÁÔÓ›˜ ·ÔÙÚ¤ÔÓÙ·Ó ·fi ηډÈÔÏÔÁÈÎfi Â·Ó¤ÏÂÁ¯Ô ̤¯ÚÈ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ·ËÛ˘. ™Â fiÏ· Ù· ¤Ì‚Ú˘· Ì ·ıÔÏÔÁÈ΋ ÌÂϤÙË Û˘ÛÙ‹ıËΠηڢfiÙ˘Ô˜ ÌÂÙ¿ ·ÌÓÈÔΤÓÙËÛË ‹ ·fi ÙËÓ ÔÌ-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498

™ÂÏ›‰·493

∂Ì‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· - ™ËÌ·Û›· ÙÔ˘ ÁÈ· ÙËÓ Î‡ËÛË

∂ÈÎfiÓ· µ. ¶·ıÔÏÔÁÈΤ˜ ηډȤ˜. 1. ∞Ô˘Û›· ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. 2. ∞ÚÙËÚÈ·Îfi˜ ÎÔÚÌfi˜ (∆). ªÂ ‚¤ÏÔ˜ ÛËÌÂÈÒÓÂÙ·È ÌÂÁ¿ÏÔ ¤ÏÏÂÈÌÌ· ·Ó¿ÌÂÛ· ÛÙȘ ‰˘Ô ÎÔÈϛ˜ (V). 3. ÀÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·. ∞Ô˘Û›· ÎÔÈÏfiÙËÙ·˜ ÛÙË ı¤ÛË (LV), fiÔ˘ Ê˘ÛÈÔÏÔÁÈο ·ÂÈÎÔÓ›˙ÂÙ·È Ë ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·. ÷ڷÎÙËÚÈÛÙÈ΋ ΛÓËÛË – ÚÔ¤ÙÂÈ· ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ÚÔ˜ ÙÔÓ ‰ÂÍÈfi ÎfiÏÔ. 4,5. ∆ÂÙÚ·ÏÔÁ›· Fallot: ÃÒÚÔ˜ ÂÍfi‰Ô˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (RVOT), ‰·ÎÙ‡ÏÈÔ˜ Ó¢ÌÔÓÈ΋˜ (‚¤ÏË) Î·È Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· (PA). (™‡ÁÎÚÈÛË Ì ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÔÚÙ‹˜ ∂ÈÎ.

6). 6. ∆ÂÙÚ·ÏÔÁ›· Fallot: ∞ÔÚÙ‹ (∞) ÂÊÈÂ‡Ô˘Û· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. (R = ‰ÂÍÈ¿ ÎÔÈÏ›·, L = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·). 7. ∞ÓÒÌ·ÏË Û‡Ó‰ÂÛË (‚¤ÏÔ˜) Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ (PV) ÛÙÔ ‰ÂÍÈfi ÎfiÏÔ (RA). 8. ªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· (‚¤ÏÔ˜). (R = ‰ÂÍÈ¿ ÎÔÈÏ›·, L = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·.) (∂ÈÎ. 7 Î·È 8 ·fi ÙÔ ›‰ÈÔ ¤Ì‚Ú˘Ô). 9. ∫ÔÈÓfi ÎÔÏÔÎÔÈÏÈ·Îfi ηӿÏÈ. ŒÏÏÂÈÌÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ «ÛÙ·˘ÚÔ‡». ∫ÔÏÔÎÔÈÏȷΤ˜ ‚·Ï‚›‰Â˜ ÛÙÔ ›‰ÈÔ Â›‰Ô. (RA = ‰ÂÍÈfi˜ ÎfiÏÔ˜, RV = ‰ÂÍÈ¿ ÎÔÈÏ›·). 10,11. ∫·Ú‰È·Î‹ ÂÎÙÔ›· (ectopia cordis). µ = ÙÔ ÛÒÌ· ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∏ ηډȿ «ÎÔÏ˘Ì¿» ̤۷ ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi (∞). ™ÙÔ 10 ÛËÌÂÈÒÓÂÙ·È Ì ‚¤ÏÔ˜ ÎÔ›ÏË ÊϤ‚· Û˘Ó‰ÂfiÌÂÓË ÛÙÔÓ ÊÏ‚ÈÎfi ÎfiÏÔ (SA). ™ÙÔ 11 ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰‡Ô ÎÔÈϛ˜ (V) Î·È ¤Ó· ÌÂÁ¿ÏÔ ·ÁÁÂ›Ô (∆). Ê·Ï›‰· Â› ‰È·ÎÔ‹˜ Ù˘ ·ËÛ˘ Î·È ÔÈ ÁÔÓ›˜ ÂÓËÌÂÚÒÓÔÓÙ·Ó ÏÂÙÔÌÂÚÒ˜ ÁÈ· Ù· ·Ó·ÙÔÌÈο ÚÔ‚Ï‹Ì·Ù· Î·È ÙȘ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ÂÈÙÒÛÂȘ ÙÔ˘˜, ηıÒ˜ Î·È ÁÈ· ÙȘ Èı·ÓfiÙËÙ˜ ÂͤÏÈ͢ Ù˘ ¿ıËÛ˘ ηٿ ÙËÓ ÂÌ‚Ú˘˚΋ ˙ˆ‹ Î·È ÙȘ ‰˘Ó·ÙfiÙËÙ˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ú¤Ì‚·Û˘ Â› ÔÏÔÎÏ‹ÚˆÛ˘ Ù˘ ·ËÛ˘. ™Â fiϘ ÙȘ ‰È·ÎÔ¤˜ ·ËÛ˘ Û˘ÛÙ‹ıËΠ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ÂͤٷÛË Ù˘ ηډȿ˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙÔ Fisher’s exact test (x2 test). ∞ÔÙÂϤÛÌ·Ù· ™Â 7 ·fi Ù· 291 ¤Ì‚Ú˘· (ÔÛÔÛÙfi 2,4%) ‰È·ÈÛÙÒıËΠ™∫. ™ÙËÓ ÔÌ¿‰· ∞, 238 ¤Ì‚Ú˘· ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ÂÓÒ 6 ¤Ì‚Ú˘· (ÔÛÔÛÙfi 2,5%) ›¯·Ó ™∫, ˆ˜ ·ÎÔÏÔ‡ıˆ˜:

- 1 ¤Ì‚Ú˘Ô Û‡Ó‰ÚÔÌÔ ˘ÔÏ·ÛÙÈ΋˜ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ (∂ÈÎ. µ3).

- 1 ¤Ì‚Ú˘Ô ·ÚÙËÚÈ·Îfi ÎÔÚÌfi (∂ÈÎ. µ2).

- 1 ¤Ì‚Ú˘Ô ÙÂÙÚ·ÏÔÁ›· Fallot (∂ÈÎ. µ4,5,6) Î·È ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÛÙÔ ¯ÒÚÔ ÂÈÛfi‰Ô˘.

- 1 ¤Ì‚Ú˘Ô ¤ÏÏÂÈÌÌ· ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (∂ÈÎ. µ1) Ì ÛÔ‚·Ú‹ ·ÓÂ¿ÚÎÂÈ· ÙÚÈÁÏÒ¯ÈÓ·˜.

- 1 ¤Ì‚Ú˘Ô ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· (∂ÈÎ. µ8) Î·È ÌÂÚÈ΋ ·ÓÒÌ·ÏË Â΂ÔÏ‹ Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ (∂ÈÎ. µ7). ∏ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· ÂÏÂÁ¯fiÙ·Ó ÌÈÎÚfiÙÂÚË ·fi ÙËÓ ·ÔÚÙ‹ Î·È Û˘Ó˘ÔÏÔÁÈ˙fiÌÂÓ˘ Ù˘ ‰È¿Ù·Û˘ ÙˆÓ ‰ÂÍÈÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ÂÁ›ÚÔÓÙ·Ó ÂÚˆÙËÌ·ÙÈο ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ¿ıËÛ˘.

- 1 ¤Ì‚Ú˘Ô ÂÎÙÔ›· Ì ۇÌÏÔÎË Î·Ú‰ÈÔ¿ıÂÈ· [˘ÔÏ·Û›· Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ Î·È ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘, ÌÂÁ¿ÏË ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì ÂÊ›¢ÛË

493

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™ÂÏ›‰·494

¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498

ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÁÁ›Ԣ (∂ÈÎ. µ10,11), Ô˘ ¤‰ÈÓ ÙÔ˘˜ ÎÏ¿‰Ô˘˜ ÙÔ˘ ·ÔÚÙÈÎÔ‡ ÙfiÍÔ˘ Î·È Û˘Ó¤¯È˙ ˆ˜ ηÙÈÔ‡Û· ·ÔÚÙ‹, ÂÓÒ ‰ÂÓ ·ÂÈÎÔÓÈ˙fiÙ·Ó Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·]. ™ÙËÓ ÔÌ¿‰· µ, 46 ¤Ì‚Ú˘· ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ÂÓÒ 1 ¤Ì‚Ú˘Ô (ÔÛÔÛÙfi 2,1%) ›¯Â ™∫ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÛÙÔ ¯ÒÚÔ ÂÈÛfi‰Ô˘ ÙˆÓ ÎÔÈÏÈÒÓ (∂ÈÎ.µ9). ∆Ô ¤Ì‚Ú˘Ô ·˘Ùfi ‹Ù·Ó ¤Ó· ÂÎ ‰È‰‡ÌˆÓ Î·È Ô ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÙÔ Î·Ù¤Ù·Í ÛÙËÓ ÔÌ¿‰· µ ‹Ù·Ó ·˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ·. ∏ Â›ÙˆÛË ™∫ ÛÙËÓ ÔÌ¿‰· ¯·ÌËÏÔ‡ Û˘ÁÎÚÈÙÈο Ì ·˘Ù‹Ó ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ Â›¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿, fiˆ˜ ¤‰ÂÈÍÂ Ë ·Ó¿Ï˘ÛË Î·Ù¿ Fisher’s exact test (p=1). ™ÙÔ ¤Ì‚Ú˘Ô Ì ™∫ Ù˘ ÔÌ¿‰·˜ µ Ô ¯ÚˆÌÔÛˆÌÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÌÂÙ¿ ·ÌÓÈÔΤÓÙËÛË ¤‰ÂÈÍ ÙÚÈۈ̛· 21 Î·È Ë ‰È·ÎÔ‹ ·ËÛ˘, Ô˘ ˙‹ÙËÛ·Ó ÔÈ ÁÔÓ›˜ ¤ÁÈÓ ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏ· ÏfiÁˆ Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‰È‰‡ÌÔ˘. ¢È·ÎÔ‹ ·ËÛ˘ ¤ÁÈÓ ÌÂÙ¿ ·fi ÂÈı˘Ì›· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÁÈ· Ù· 6 ¤Ì‚Ú˘· Ù˘ ÔÌ¿‰·˜ ∞. ™Â ¤Ó· ·fi ·˘Ù¿ Ô ¯ÚˆÌÔÛˆÌÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·fi ÙËÓ ÔÌÊ·Ï›‰· ¤‰ÂÈÍ Â›Û˘ ÙÚÈۈ̛· 21. ∂ÚfiÎÂÈÙÔ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô Ì ÙÂÙÚ·ÏÔÁ›· Fallot Î·È ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÛÙÔ ¯ÒÚÔ ÂÈÛfi‰Ô˘. ŒÙÛÈ, Û 2 ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÌ‚Ú‡ˆÓ Ì ™∫ (ÔÛÔÛÙfi 28,5%) ‰È·ÈÛÙÒıËΠ¯ÚˆÌÔÛˆÌȷ΋ ·ÓˆÌ·Ï›·. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙ· 6 ·fi Ù· 7 ¤Ì‚Ú˘· Î·È ÂȂ‚·›ˆÛ ٷ Â˘Ú‹Ì·Ù¿ Ì·˜. ∞fi Ù· 284 ¤Ì‚Ú˘· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ηډȿ ÛÙÔÓ Ë¯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô, ¤ÁÈÓ ÌÈ· ‰È·ÎÔ‹ ·ËÛ˘ ÁÈ· Â͈ηډȷÎfi Úfi‚ÏËÌ· Î·È ÛËÌÂÈÒıËΠ¤Ó·˜ ı¿Ó·ÙÔ˜ ηٿ ÙËÓ ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡ ÏfiÁˆ Ì·È¢ÙÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜. ∞fi Ù· 282 ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó (ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÁÂÈ ÙÔÓ 28Ô Ì‹Ó· Î·È ÙÔ ÌÈÎÚfiÙÂÚÔ ÙÔÓ 3Ô Ì‹Ó· Ù˘ Â͈̋ÙÚÈ·˜ ˙ˆ‹˜) ‰È·ÈÛÙÒıËΠʇÛËÌ· ÙËÓ 1Ë Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜ Û ¤Ó· ·È‰›, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂϤÁ¯Ô˘. O ‰È·ıˆÚ·ÎÈÎfi˜ ˯ÔηډÈÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÌÈÎÚ‹ ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, Ô˘ ¤ÎÏÂÈÛ ÂÚ›Ô˘ ÙÔÓ 6Ô Ì‹Ó· Ù˘ ˙ˆ‹˜ ¯ˆÚ›˜ ÙÔ ·È‰› Ó· ¯ÚÂÈ·ÛÙ› ÔÔÈ·‰‹ÔÙ ·ÁˆÁ‹. ™˘˙‹ÙËÛË OÈ ™∫ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ¶·ÚfiÙÈ ÛÙȘ ÌÈÛ¤˜ ÂÚÈÙÒÛÂȘ ÙÔ Úfi‚ÏËÌ· Â›Ó·È ¤Ï·ÛÛÔÓ ‹ ‡ÎÔÏ· ‰ÈÔÚıÒÛÈÌÔ ¯ÂÈÚÔ˘ÚÁÈο, Ë ıÓËÛÈÌfiÙËÙ· ÏfiÁˆ ™∫ Â›Ó·È ˘„ËÏ‹ (12), ÂÓÒ ‰ÂÓ Â›Ó·È ‹ÛÛÔÓÔ˜ ÛËÌ·Û›·˜ ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ÔÈ Î·Ú‰ÈÔ·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜ Û˘Ó‰¤ÔÓÙ·È ÈÛ¯˘Ú¿ Ì ¿ÏϘ ·ÓˆÌ·Ï›Â˜ ȉ›ˆ˜ ‰Â ¯ÚˆÌÔÛˆÌȷΤ˜. ∂ÓÒ Ë ·ÈÙÈÔÏÔÁ›· ÙˆÓ ™∫ Â›Ó·È ·ÎfiÌ· ÂÓ ÔÏÏÔ›˜

494

Ã. ∆Ú¿·ÏË, ∞. ª·ÚÁÂÙ¿Î˘

¿ÁÓˆÛÙË Î·È ÂÔ̤ӈ˜ Ë ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë Â›Ó·È Â› ÙÔ˘ ·ÚfiÓÙÔ˜ ·Ó¤ÊÈÎÙË, ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ̤ۈ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È Ù˘ Û˘Ó·ÎfiÏÔ˘ı˘ ÚÔÛ·ÚÌÔÁ‹˜ ÙˆÓ ÂÈÏÔÁÒÓ. Œ¯ÂÈ ‰Âȯı›, fiÙÈ Ë Ë¯ÔÁÚ·ÊÈ΋ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ÌÂÈ˙fiÓˆÓ Â͈ηډȷÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· (13). ™ÂÈÚ¿ ÌÂÏÂÙÒÓ ÂÍ¿ÏÏÔ˘, ¤¯ÂÈ ‰Â›ÍÂÈ ÙËÓ ·Í›· ÙÔ˘ ˯ÔηډÈÔÁÚ·ÊÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ™∫ (5,14). ¶Èı·ÓÔÏÔÁ‹ıËΠfiÙÈ Ë ÂÌ‚Ú˘˚΋ ‰È¿ÁÓˆÛË ™∫ ı· Ì›ˆÓ ÙË ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ·fi ™∫, ·ÊÔ‡ ı· Â¤ÙÚÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ·ÁˆÁ‹˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË.

OÚÈṲ̂Ó˜ ·fi ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÌÂϤÙ˜ (15-17) ·ÌÊÈÛ‚ËÙÔ‡Ó ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ˯ÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜. ¶ÚÔ˜ ·ÔÊ˘Á‹ Ï·Óı·ÛÌ¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› ȉȷ›ÙÂÚ·, fiÙÈ ÔÈ ·Ú·¿Óˆ ÌÂϤÙ˜ ·ÊÔÚÔ‡Ó ÂÚÈÔ¯¤˜ ÙˆÓ ∏¶∞ (15,16) Î·È Ù˘ °ÂÚÌ·Ó›·˜ (17) fiÔ˘ Ë ¿ÌÂÛË ÓÂÔÁÓÔÏÔÁÈ΋ ÊÚÔÓÙ›‰· Â›Ó·È Ú·ÁÌ·ÙÈÎfiÙËÙ· ÁÈ· fiÏ· Ù· ÓÂÔÁÓ¿ Ì ™∫, ·ÓÂÍ¿ÚÙËÙ· ·Ó Ë ·ÓˆÌ·Ï›· ‰È·ÁÓÒÛıËΠÚÈÓ ‹ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∏ ÂÏÏËÓÈ΋ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÙfiÛÔ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰˘Ó·ÙfiÙËÙ· ¿ÌÂÛ˘ ‰È¿ÁÓˆÛ˘, fiÛÔ Î·È Ù˘ ÂÚ›ı·Ï„˘ ÙˆÓ ÓÂÔÁÓÒÓ Ì ™∫ ·¤¯ÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙˆÓ ∏¶∞ Î·È °ÂÚÌ·Ó›·˜. ŸÛÔÓ ·ÊÔÚ¿ ÂÔ̤ӈ˜, ÙË Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜, ˆ˜ ·fiÙÔÎÔ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÌÂÈ˙fiÓˆÓ ™∫, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙË ¯ÒÚ· Ì·˜, ı· ÌÔÚÔ‡Û ηÓ›˜ Ó· ÙËÓ Èı·ÓÔÏÔÁ‹ÛÂÈ ÈÛ¯˘Ú¿. ŒÙÛÈ, Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË .¯. ÌÂÙ¿ıÂÛ˘ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ı· Â¤ÙÚÂ ÙËÓ ¿ÌÂÛË, ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ‚·ÚÈ¿˜ ΢¿ÓˆÛ˘ Î·È ÔͤˆÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡, Ô˘ ÙfiÛÔ Û˘¯Ó¿ ‰˘ÛÙ˘¯Ò˜ ·Ú·ÙËÚÂ›Ù·È ÛÙË ¯ÒÚ· Ì·˜ ÏfiÁˆ ηı˘ÛÙÂÚË̤Ó˘ ‰È¿ÁÓˆÛ˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘. ∆· ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ Ì·˜, ¯ˆÚ›˜ ηıfiÏÔ˘ Ó· ·Ó·ÈÚÔ‡Ó Ù· ·Ú·¿Óˆ, ηٷÁÚ¿ÊÔ˘Ó ÌÈ·Ó ¿ÏÏË Ú·ÁÌ·ÙÈÎfiÙËÙ·. ŸÏÔÈ ÔÈ ÁÔÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜ Â¤ÏÂÍ·Ó ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË Ù˘ ηډÈÔ¿ıÂÈ·˜. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÚfiÎÂÈÙÔ ÁÈ· Ì›˙ÔÓ˜ ‹ ÛÔ‚·Ú¤˜ ηډÈÔ¿ıÂȘ Î·È ÛÙË ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú‹ ·fi ·˘Ù¤˜ ηıÔÚÈÛÙÈÎfi ÚfiÏÔ ¤·ÈÍÂ Ë ‰È·›ÛÙˆÛË ÙÚÈۈ̛·˜ 21. ŒÙÛÈ Ë ÂÈ‚›ˆÛË ‰ÂÓ ÚÔ‹¯ıË Ì ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, fi¯È ÏfiÁˆ ·ÛÙÔ¯›·˜ Ù˘ ÌÂıfi‰Ô˘, ·ÏÏ¿ fiˆ˜ ¤¯ÂÈ ÛËÌÂȈı› ·fi ÙËÓ Allan (2), ÏfiÁˆ ÂÈÏÔÁ‹˜ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ‰È·ÎÔ‹. ™ÙËÓ ÚÔ·Ó·ÊÂÚı›۷ ÚˆÙÔÔÚȷ΋ ÌÂϤÙË Ù˘ Allan Î·È Û˘Ó ÙÔ 1994, Û 1.006 ¤Ì‚Ú˘· Ì ™∫, ÔÈ ÂÚ¢ÓËÙ¤˜ ˘¤ıÂÛ·Ó fiÙÈ ·Ó Ë Ù¿ÛË ÙˆÓ ÁÔÓÈÒÓ Ó· ‰È·ÎfiÙÔ˘Ó ÙȘ ΢‹ÛÂȘ ÂÌ‚Ú‡ˆÓ Ì ™∫ Û˘Ó¯È˙fiÙ·Ó ı· ÁÂÓÓÈfiÙ·Ó ÌÈÎÚfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì Ì›˙ÔÓ˜

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498

™ÂÏ›‰·495

∂Ì‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· - ™ËÌ·Û›· ÙÔ˘ ÁÈ· ÙËÓ Î‡ËÛË

™∫. ¶ÚfiÛÊ·Ù· ÛÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Ë ·Ú·¿Óˆ ˘fiıÂÛË ÂȂ‚·ÈÒıËÎÂ. ¶·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ì ·ÙÚËÛ›· Ù˘ Ó¢ÌÔÓÈ΋˜ ÏfiÁˆ ‰È·ÎÔÒÓ Î˘‹ÛÂˆÓ ÂÌ‚Ú‡ˆÓ, ÛÙ· ÔÔ›· Ë ·Ú·¿Óˆ ¿ıËÛË Â›¯Â ‰È·ÁÓˆÛı› ˯ÔηډÈÔÁÚ·ÊÈο (9). ¶Èı·Ófiٷٷ ÏÔÈfiÓ, ÙÔ Î‡ÚÈÔ Â·ÎfiÏÔ˘ıÔ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙˆÓ ™∫ ı· Â›Ó·È Ë Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ ÌÂÈ˙fiÓˆÓ ™∫ ÛÙ· ÓÂÔÁÓ¿ ÏfiÁˆ ‰È·ÎÔÒÓ Î˘‹ÛˆÓ, ÁÂÁÔÓfi˜ Ô˘ Ê¿ÓËÎÂ Î·È ·fi ÙË ÌÂϤÙË Ì·˜. ∏ ÛËÌ·Û›· Ù˘ ÌÂıfi‰Ô˘ ‚‚·›ˆ˜, ‰ÂÓ ÂÍ·ÓÙÏÂ›Ù·È ÛÙÔ ·Ú·¿Óˆ. ™ÙË ÌÂϤÙË Ì·˜ Û 2 ·fi Ù· 7 ¤Ì‚Ú˘· Ì ™∫ (ÔÛÔÛÙfi 28,5%) ‰È·ÈÛÙÒıËΠ¯ÚˆÌÔÛˆÌȷ΋ ·ÓˆÌ·Ï›·. ¶·ÚfiÙÈ ÙÔ ¤Ó· ¤Ì‚Ú˘Ô Â›¯Â ·˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ· Ô˘, fiˆ˜ ÚԷӷʤÚıËÎÂ, ıˆÚÂ›Ù·È ÈÛ¯˘Úfi˜ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ ÙfiÛÔ ÁÈ· Û‡Ó‰ÚÔÌÔ Down fiÛÔ Î·È ÁÈ· ™∫, ÙÔ ‰Â‡ÙÂÚÔ ¤Ì‚Ú˘Ô ‰ÂÓ Â›¯Â η̛· ¤Ó‰ÂÈÍË ¯ÚˆÌÔÛˆÌȷ΋˜ ·ÓˆÌ·Ï›·˜ ̤¯ÚÈ ÙË ‰È·›ÛÙˆÛË Ù˘ ηډÈÔ¿ıÂÈ·˜. ∆· Û˘ÌÂÚ¿ÛÌ·Ù· ÙÂÏÂ˘Ù·›ˆÓ ÌÂÏÂÙÒÓ Ù·˘Ù›˙ÔÓÙ·È Ì ÙËÓ ·Ú·Ù‹ÚËÛ‹ Ì·˜, fiÙÈ ÔÈ ™∫ ÌÔÚ› Ó· Â›Ó·È Ë ÌfiÓË ¤Ó‰ÂÈÍË ¯ÚˆÌÔÛˆÌȷ΋˜ ·ÓˆÌ·Ï›·˜. ™Â ÏËı˘ÛÌfi 210 ÂÌ‚Ú‡ˆÓ Ì ™∫ ‰È·ÈÛÙÒıËÎ·Ó ¯ÚˆÌÔÛˆÌȷΤ˜ ·ÓˆÌ·Ï›Â˜ Û ÔÛÔÛÙfi 25% (18) Î·È ÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÓÈÛÙÔ‡Ó Î·Ú˘fiÙ˘Ô ÌÂÙ¿ ·ÌÓÈÔΤÓÙËÛË Û οı ¤Ì‚Ú˘Ô Ì ™∫. ∞fi ÙËÓ ÌÂϤÙË Ì·˜ ÂÔ̤ӈ˜, ηıÒ˜ Î·È ·fi Ù· ·Ú·¿Óˆ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÚÔ·ÙÂÈ ·Ó·ÌÊÈÛ‚‹ÙËÙË ·Í›· Ù˘ ÂÌ‚Ú˘˚΋˜ ‰È¿ÁÓˆÛ˘ ™∫ ÙfiÛÔ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ·ÔÊ¿ÛÂȘ ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ·ËÛ˘, fiÛÔ Î·È ˆ˜ ¤Ó‰ÂÈÍË ¯ÚˆÌÔÛˆÌÈ·ÎÔ‡ ÂϤÁ¯Ô˘. ¶·Ú¿ Ù·‡Ù·, Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÌfiÓÔ ÏÂÙÔÌÂÚ‹˜ ¤ÏÂÁ¯Ô˜ ·Ú¤¯ÂÈ ÙȘ ·Ú·¿Óˆ ‰˘Ó·ÙfiÙËÙ˜. ªÂÙ¿ ÙÔÓ ·Ú¯ÈÎfi ÂÓıÔ˘ÛÈ·ÛÌfi ÁÈ· ÙË ‰˘Ó·ÙfiÙËÙ· ¯Ú‹Û˘ ÌfiÓÔ Ù˘ ÙÔÌ‹˜ 4 ÎÔÈÏÔÙ‹ÙˆÓ Û·Ó screening test ÁÈ· ™∫, ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ (19,20) η٤‰ÂÈÍ·Ó fiÙÈ Ë ÔˆÛ‰‹ÔÙ ‚·ÛÈ΋ ·˘Ù‹ ÙÔÌ‹ ¤¯ÂÈ ¯·ÌËÏ‹ ¢·ÈÛıËÛ›· (4,5-40%) ÛÙËÓ ·Ó›¯Ó¢ÛË ·ÎfiÌ· Î·È ÌÂÈ˙fiÓˆÓ ™∫. O ¤ÏÂÁ¯Ô˜ Î·È ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· (21), ÂÓÒ ÔÈ ÔÏÏ·Ϥ˜ ‰ÈۉȿÛٷ٘ ÙÔ̤˜ Î·È Doppler (pulsed + color), fiˆ˜ ¤ÁÈÓ ÛÙËÓ ÌÂϤÙË Ì·˜, ÌÂÁÈÛÙÔÔÈÔ‡Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘ ÂϤÁ¯Ô˘, Ô˘ ·ÁÁ›˙ÂÈ ÙÔ 96% (2,11,22). ™ÙË ÌÂϤÙË Ì·˜, Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ı· ÎÚÈÓfiÙ·Ó È‰·ÓÈο Ì ˯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ÓÂÔÁÓÒÓ, Ô˘ ıˆڋıËÎ·Ó Ê˘ÛÈÔÏÔÁÈο ÛÙËÓ ÂÌ‚Ú˘˚΋ ˙ˆ‹. ¶Ú·ÎÙÈο οÙÈ Ù¤ÙÔÈÔ Û¿ÓÈ· Â›Ó·È ÂÊÈÎÙfi Û ¢Ú›· Îϛ̷η Î·È ÂÈϤͷÌ ÙÔ ÚˆÙfiÎÔÏÏÔ ÂϤÁ¯Ô˘, Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Û ·Ó¿ÏÔÁ˜ Ì ÙË ‰È΋ Ì·˜ ÌÂÁ¿Ï˜ ÛÂÈÚ¤˜ (8), ÂϤÁ¯ÔÓÙ·˜ ˯ÔηډÈÔÁÚ·ÊÈο ÌfiÓÔ ÓÂÔÁÓ¿ Ì ÎÏÈÓÈ΋ ˘Ô„›· ™∫, .¯. ʇÛËÌ·. ™ÙËÓ ÔÌ¿‰· ∞ ‰È·ÁÓÒÛıËÎ·Ó ÚÔÁÂÓÓËÙÈο 6 ·fi ÙȘ 7 ™∫ (¢·ÈÛıËÛ›· 85,7%), ÂÓÒ ÛÙËÓ ÔÌ¿‰· µ ˘‹ÚÍ ÌfiÓÔ ÌÈ· ™∫ Î·È ‰È·ÁÓÒÛıËΠÚÔÁÂÓÓËÙÈο

(¢·ÈÛıËÛ›· 100%). ŒÙÛÈ, ÛÙË ÌÂϤÙË Ì·˜ Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ‹Ù·Ó 87,5%, ·ÊÔ‡ ‰È·ÈÛÙÒıËÎ·Ó ÚÔÁÂÓÓËÙÈο 7 ·fi ÙȘ 8 ™∫. ∏ ÌÔÓ·‰È΋ ÌË ‰È·ÁÓˆÛı›۷ ™∫ ÛÙÔÓ ÏËı˘ÛÌfi Ì·˜ ·ÊÔÚÔ‡Û ÌÈ· ÌÈÎÚ‹ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, Ô˘ ÏfiÁˆ ÙÔ˘ ÔÚ›Ô˘ Ù˘ ‰È·ÎÚÈÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ ˘ÂÚ‹¯ˆÓ Î·È Ù˘ ËÏÈΛ·˜ ÂϤÁ¯Ô˘ ÙˆÓ ÂÌ‚Ú‡ˆÓ ‰ÂÓ Â›Ó·È ·Û‡ÓËı˜ Ó· ÌË ‰È·ÈÛÙÒÓÂÙ·È (23) Î·È Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ÂÚ›ÙˆÛË Ô˘ ÁÈ· ÙÔ˘˜ ·Ú·¿Óˆ Ù¯ÓÈÎÔ‡˜ ÏfiÁÔ˘˜, ÌÔÚ› Ó· ÌÂȈı› Ë Â˘·ÈÛıËÛ›· ÂÓfi˜ Ï‹ÚÔ˘˜ ˯ÔηډÈÔÁÚ·ÊÈÎÔ‡ ÂϤÁ¯Ô˘. O˘ÛÈ҉˜ Â›Ó·È Ó· ı˘Ì¿Ù·È ηÓ›˜, fiÙÈ Ë ÌÈÎÚ‹ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÚfiÁÓˆÛË, fiˆ˜ Ê¿ÓËΠÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜ Î·È fiˆ˜ ¤¯ÂÈ ÙÔÓÈÛı› Û ·Ó¿ÏÔÁ˜ ÂÚÈÙÒÛÂȘ ÌË ‰È·›ÛÙˆÛ˘ („¢‰Ò˜ ·ÚÓËÙÈο) ÂÏ·ÛÛfiÓˆÓ ™∫ (2). ∏ ÌË ·Ó›¯Ó¢ÛË ÂÏ¿ÛÛÔÓÔ˜ ÚÔ‚Ï‹Ì·ÙÔ˜ („¢‰Ò˜ ·ÚÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜), ı· ÂӉȤÊÂÚ ıˆÚËÙÈο ·fi ÙËÓ ¿Ô„Ë Ù˘ Û˘Û¯¤ÙÈÛ˘ ™∫ Î·È ¯ÚˆÌÔÛˆÌÈ·ÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜, ηٿ Ù· ÚÔ·Ó·ÊÂÚı¤ÓÙ·. µ¤‚·È·, ··›ÙËÛË Ó· ¯ÚËÛÈÌÔÔÈËı› ÙÔ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· Û·Ó ‰Â›ÎÙ˘ ¯ÚˆÌÔÛˆÌÈ·ÎÔ‡ ÂϤÁ¯Ô˘ Î·È Ì¿ÏÈÛÙ· Ì ¢·ÈÛıËÛ›· 100% ı· ‹Ù·Ó Ô˘ÙÔÈ΋, ˘ÂÚ‚ÔÏÈ΋ Î·È ¿‰ÈÎË ÁÈ· ÙÔÓ ÔÏÏ·Ï¿ ¯Ú‹ÛÈÌÔ ·˘ÙfiÓ ¤ÏÂÁ¯Ô.

OÏÔÎÏËÚÒÓÔÓÙ·˜ Ù· Ù˘ ¢·ÈÛıËÛ›·˜ ÙÔ˘ ÂϤÁ¯Ô˘ Ó· ÙÔÓ›ÛÔ˘Ì fiÙÈ Î·Ù·Ú¯‹Ó, ÙÔ ˙ËÙÔ‡ÌÂÓÔ Â›Ó·È ÙÔ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· Ó· ·ÓȯÓ‡ÂÈ fiϘ ÙȘ ηډÈÔ¿ıÂȘ Ô˘ ı· ··ÈÙÔ‡Û·Ó Î·Ú‰ÈÔÏÔÁÈ΋ ·Ú¤Ì‚·ÛË ¿ÏÏÔÙ ¿ÏÏ˘ ¤ÎÙ·Û˘. ∞˘Ùfi, Ë Ì¤ıÔ‰Ô˜, fiˆ˜ ‰Â›¯ıËÎÂ Î·È ÛÙË ÌÂϤÙË Ì·˜, ÙÔ ÂÈÙ˘Á¯¿ÓÂÈ Ì ¢·ÈÛıËÛ›· Ô˘ ·ÁÁ›˙ÂÈ ÙÔ 100%. ™ÙË ÛÂÈÚ¿ Ì·˜ ‰È·ÁÓÒÛıËÎ·Ó Î·È ÔÈ 7 ηډÈÔ¿ıÂȘ, ÔÈ Ôԛ˜ ·Ó ÔÈ Î˘‹ÛÂȘ ÔÏÔÎÏËÚÒÓÔÓÙ·Ó ı· ··ÈÙÔ‡Û·Ó ·Ú¤Ì‚·ÛË. °È· ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ·Ï‹ıÂÈ· Ú¤ÂÈ ÂÓÙÔ‡ÙÔȘ Ó· ÛËÌÂȈı› fiÙÈ ¤¯Ô˘Ó ηٷÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÛÙÂÓˆÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ ‰ÂÓ ¤ÁÈÓ·Ó ÂÌÊ·Ó›˜ ·Ú¿ ÌfiÓÔ Î·Ù¿ ÙÔ 3Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ (24), fiˆ˜ Â›Û˘ fiÙÈ Î·Ú‰È·ÎÔ› fiÁÎÔÈ ‹ Ì˘ÔηډÈÔ¿ıÂȘ ÌÔÚ› Ó· ·Ó·Ù˘¯ıÔ‡Ó ÌÂÙ¿ ÙËÓ 18Ë-22Ë Â‚‰ÔÌ¿‰·, Ô˘ Û˘Ó‹ıˆ˜ Á›ÓÔÓÙ·È ÔÈ ¤ÏÂÁ¯ÔÈ Ô‰ËÁÒÓÙ·˜ Û ‰È·ÁÓˆÛÙÈ΋ ·ÛÙÔ¯›· (23). ™Â ÔÚÈṲ̂ӷ ΤÓÙÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ (fiˆ˜ ·fi ÚÔÛˆÈΤ˜ Â·Ê¤˜ ÁÓˆÚ›˙Ô˘ÌÂ) ÂÍ·ÈÙ›·˜ ·˘ÙÒÓ ÙˆÓ Û·Ó›ˆÓ ÂÍ·ÈÚ¤ÛˆÓ, ÔÈ ÁÔÓ›˜ ÂÓËÌÂÚÒÓÔÓÙ·È ÂÓ˘fiÁÚ·Ê·, fiÙÈ ¤Ï·‚·Ó ÁÓÒÛË ÙˆÓ ÂÚÈÔÚÈÛÌÒÓ ÌÈ·˜ Ê˘ÛÈÔÏÔÁÈ΋˜ ÂÌ‚Ú˘˚΋˜ ÌÂϤÙ˘. ∆Ô ı¤Ì· Ù˘ ηٿ Ù· ·Ú·¿Óˆ ÂÓË̤ڈÛ˘ ÙˆÓ ÁÔÓÈÒÓ Â›Ó·È ÔχÏÔÎÔ Î·È Ë ÁÂÓÈÎfiÙÂÚË ÛÙÚ·ÙËÁÈ΋ Â› Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙˆÓ ™∫ ÛÙÔÓ ‰˘ÙÈÎfi ÎfiÛÌÔ Ô‡Ùˆ˜ ‹ ¿Ïψ˜ ‰ÂÓ Â›Ó·È ÂÓÈ·›· (23). ∂Ì›˜, Û¯ÂÙÈο Ì ÙËÓ ÂÓË̤ڈÛË, ·ÎÔÏÔ˘ıԇ̠ÙËÓ Ú·ÎÙÈ΋ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙË ÌÂıÔ‰ÔÏÔÁ›· Ì·˜ ıˆÚÒÓÙ·˜ fiÙÈ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ‰ÂÓ ÂÌϤÎÔ˘Ì ÙÔ˘˜ ÁÔÓ›˜ Û Ú·ÎÙÈΤ˜ Ô˘ Û˘ÓÂ¿ÁÔÓÙ·È ¿Á¯Ô˜ ‰˘Û·Ó¿-

495

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·496

¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498

ÏÔÁÔ Ì ÙÔ ÚÔÛ‰ÔÎÒÌÂÓÔ fiÊÂÏÔ˜. ∂‰Ò Ó· ˘ÂÓı˘Ì›ÛÔ˘Ì fiÙÈ Ë ‰È¿ÁÓˆÛË ·ÎfiÌ· Î·È Ì›˙ÔÓÔ˜ ÚÔ‚Ï‹Ì·ÙÔ˜ ÌÂÙ¿ ÙËÓ 25Ë Â‚‰ÔÌ¿‰·, ·ÊÂÓfi˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ‰È·ÎÔ‹ ÏfiÁˆ Ì·È¢ÙÈÎÒÓ Î·È ÓÔÌÈÎÒÓ ÏfiÁˆÓ, ·ÊÂÙ¤ÚÔ˘ Ë ÂÓ‰ÔÌ‹ÙÚÈ· ·Ú¤Ì‚·ÛË ÁÈ· ™∫ Â›Ó·È Û·ÓÈfiÙ·ÙË Î·È ÂÓ ÔÏÏÔ›˜ ÂÈÚ·Ì·ÙÈ΋. ∞fi Ù· ·Ú·¿Óˆ Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ·ÚfiÙÈ ˘¿Ú¯Ô˘Ó ÂÚÈÔÚÈÛÌÔ› ÛÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ (23), Û Ú·ÎÙÈÎfi Â›‰Ô, Èı·Ó‹ ·ÛÙÔ¯›· ·ÊÔÚ¿ ÙȘ ηډÈÔÏÔÁÈο ·Û‹Ì·ÓÙ˜ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜. ∏ ·Ú·ÌÔÓ‹ ÂÍ¿ÏÏÔ˘ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ·ÓÔÈÎÙÔ‡ ÙÔ˘ ˆÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ ‹ ÙÔ˘ ‚ÔÙ·Ï›Ԣ fiÚÔ˘ ‰ÂÓ Â›Ó·È Ê˘ÛÈο ‰˘Ó·ÙfiÓ Ó· ÚÔ‚ÏÂÊı› (·ÊÔ‡ ÔÈ ·Ú·¿Óˆ ‰Ô̤˜ ·ÔÙÂÏÔ‡Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ·Ó·ÙÔÌÈΤ˜ ‰È·ÊÔÚ¤˜ ÂÌ‚Ú‡ˆÓ ·È‰ÈÒÓ) ÚÔÊ·ÓÒ˜ fï˜, ‰ÂÓ Û˘ÓÈÛÙ¿ ·ÛÙÔ¯›· Ù˘ ÌÂıfi‰Ô˘, ·ÚfiÙÈ ıˆÚËÙÈο ·Ó·Ê¤ÚÂÙ·È ÛÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ Ù˘ ÌÂıfi‰Ô˘ (23). Àfi ÙÔÓ fiÚÔ ÏÔÈfiÓ, fiÙÈ Ô ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È ·fi ÂȉÈÎÔ‡˜ (Ë ÂÎ·›‰Â˘ÛË Î·È ÂÌÂÈÚ›· ÙˆÓ ÔÔ›ˆÓ ÂÚÈÁÚ¿ÊÔÓÙ·È ˆ˜ ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÂϤÁ¯Ô˘ (4,25)) Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È Ôχ ˘„ËÏ‹. ∏ ÂȉÈÎfiÙËÙ· Ù˘ ÂÍ¿ÏÏÔ˘ ÌfiÓÔ ÛÙ· ¯¤ÚÈ· ÙˆÓ ÂȉÈÎÒÓ ·ÁÁ›˙ÂÈ ÙÔ 100% (3,8), fiˆ˜ Î·È ÛÙË ÛÂÈÚ¿ Ì·˜ ‰Â›¯ıËÎÂ, fiÔ˘ Ô ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂȂ‚·›ˆÛ Ï‹Úˆ˜ ÙË ‰È¿ÁÓˆÛË Î·È ÛÙȘ 6 ÂÚÈÙÒÛÂȘ Ô˘ ÂϤÁ¯ıËηÓ. ∆ÂÏÂÈÒÓÔÓÙ·˜ Ì ÙÔ ÙÂÚ¿ÛÙÈÔ ı¤Ì· Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ˯ÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜, Ó· ÛËÌÂÈÒÛÔ˘Ì fiÙÈ Ë ·¯˘Û·ÚΛ· Ù˘ ÌËÙ¤Ú·˜ Î·È Ë ı¤ÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÌÔÚ› Ó· ÌÂÈÒÓÔ˘Ó ÙËÓ ·ÍÈÔÈÛÙ›· Ù˘ ÌÂıfi‰Ô˘ (23). ™ÙË ÛÂÈÚ¿ Ì·˜ ‰ÂÓ ·ÓÙÈÌÂÙˆ›Û·Ì Úfi‚ÏËÌ· Ì ·ıÔÏÔÁÈο ·¯‡Û·ÚΘ ÂÁ΢ÌÔÓÔ‡Û˜, ÂÓÒ Ù· ÚÔ‚Ï‹Ì·Ù· ı¤Û˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ χıËÎ·Ó Ì ÎÈÓËÙÔÔ›ËÛË ÎÏ, fiˆ˜ ÂÚÈÁÚ¿„·Ì ÛÙË ÌÂıÔ‰ÔÏÔÁ›· Î·È fiˆ˜ ¤¯ÂÈ ÂÊ·ÚÌÔÛı› ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (8). Ÿˆ˜ ÏÔÈfiÓ ‰È·ÈÛÙÒÛ·ÌÂ Î·È Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ÙÔ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È ˘„ËÏ‹˜ ·ÎÚȂ›·˜ ̤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ™∫, ÂÊfiÛÔÓ Á›ÓÂÙ·È ·fi ÂȉÈÎÔ‡˜. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ·ÎfiÌ· Î·È Û ·Ó·Ù˘Á̤Ó˜ È·ÙÚÈο ÎÔÈӈӛ˜ ÔÈ ¤ÌÂÈÚÔÈ ÂÍÂÙ·ÛÙ¤˜ Â›Ó·È Ï›ÁÔÈ, ÙÔ ÎfiÛÙÔ˜ ÂϤÁ¯Ô˘ ˘„ËÏfi (·ÚfiÏÔ Ô˘ ÙÔ ÈÛÔ˙‡ÁÈÔ ˆÊ¤ÏÂÈ·˜-ÎfiÛÙÔ˘˜ Â›Ó·È Ì¿ÏÏÔÓ ıÂÙÈÎfi (25)), ÂÓÒ Ë Â›ÙˆÛË ™∫ Û ÓÂÔÁÓ¿ ÂÚ› ÙÔ 1% ÚÔ·ÙÂÈ ÙÔ Â‡ÏÔÁÔ ÂÚÒÙËÌ·: «Û ÔȘ ΢‹ÛÂȘ Ó· Á›ÓÂÙ·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ·fi ÂȉÈÎÔ‡˜;». °È· ÌÂÁ¿ÏÔ ‰È¿ÛÙËÌ·, ÂÓ ÔÏÏÔ›˜, ·ÎÔÏÔ˘ı‹ıËÎÂ Ë Ú·ÎÙÈ΋ Ó· Á›ÓÂÙ·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÌfiÓÔ ÛÙȘ ΢‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫, fiˆ˜ ·˘Ù¤˜ ηıÔÚ›˙ÔÓÙ·È Ì ‚¿ÛË ÙËÓ ·Ó›¯Ó¢ÛË ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫. ™ÙË ÛÂÈÚ¿ Ì·˜ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û˘-

496

Ã. ∆Ú¿·ÏË, ∞. ª·ÚÁÂÙ¿Î˘

ÌÂÚÈÂÏ‹ÊıË Ë ·˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ·, ÙËÓ ÔÔ›· Ê·›ÓÂÙ·È fiÙÈ Ë ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· Ù›ÓÂÈ Ó· ·ԉ¯ı› Û·Ó Ôχ ÈÛ¯˘Úfi ·Ú¿ÁÔÓÙ· ÁÈ· ™∫, ·ÊÔ‡ Â› ·ÚÔ˘Û›·˜ Ù˘ ÚÔÙ¿ıËΠ‰È·ÎÔÏÈÎfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ‹‰Ë ·fi ÙËÓ 13Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ (26). ∞Ó Ô ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ Â›¯Â Û˘ÌÂÚÈÏËÊı› ÛÙË ÌÂϤÙË Ì·˜ ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫, Ë Â›ÙˆÛË ™∫ ÛÙËÓ ÔÌ¿‰· Ì·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ı· ‹Ù·Ó 0%. ∆Ô ÂÓÙ˘ˆÛÈ·ÎfiÙÂÚÔ Î·È Ô˘ÛÈ·ÛÙÈÎfiÙÂÚÔ fï˜ Û¯ÂÙÈÎfi ÛÙÔÈ¯Â›Ô Ô˘ η٤ÁÚ·„Â Ë ÌÂϤÙË Ì·˜ Â›Ó·È ¿ÏÏÔ. ∏ Â›ÙˆÛË ™∫ Î·È ‰Ë ÌÂÈ˙fiÓˆÓ ÛÙÔÓ ÏËı˘ÛÌfi ¯ˆÚ›˜ ηӤӷ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘, ¤ÊÙ·Û ÛÙË ÌÂϤÙË Ì·˜ ÙÔ 2,5%, Â›ÙˆÛË Ô˘ ‰ÂÓ ¤¯ÂÈ Î·ÌÈ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·fi ÙËÓ ‰È·ÈÛÙˆı›۷ ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (2,1%), fiÔ˘ ηٿ Ù· ÎÏ·ÛÈο ıˆÚÔ‡ÌÂÓ· ı· ·Ó·ÌÂÓfiÙ·Ó Ë ÌÂÁ¿ÏË Â›ÙˆÛË. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Û ÚfiÛÊ·ÙË Á·ÏÏÈ΋ ÛÂÈÚ¿ (6) Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ™∫ ·ÓȯÓ‡ıËΠ۠ÏËı˘ÛÌfi ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ Û ÁÂÚÌ·ÓÈ΋ ÌÂϤÙË ÙÔ˘ 1996 (8), Ô˘ ¤ÁÈÓ fiˆ˜ Î·È Ë ‰È΋ Ì·˜ ÛÂ Ù˘¯·›· ÂÈÏÂÁ̤Ó˜ ΢‹ÛÂȘ, η٤ÏËÍ·Ó ÛÙËÓ ›‰È· ‰È·›ÛÙˆÛË. ™ÙË ÌÂϤÙË Ì·˜ ÏÔÈfiÓ, fiˆ˜ Î·È Û ¿ÏϘ ÌÂÁ¿Ï˜ Î·È Î·Ï¿ ۯ‰ȷṲ̂Ó˜ ÛÂÈÚ¤˜ ·Ú·ÙËÚÂ›Ù·È ÂÓÙ˘ˆÛȷ΋ Â›ÙˆÛË ™∫ Û ¤Ì‚Ú˘· ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫. ∂Í¿ÏÏÔ˘, Ë Â›ÙˆÛË ™∫ ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ Ô˘ ÂϤÁÍ·Ì ‹Ù·Ó 2,4%, ÙÚÈÏ¿ÛÈ· ‰ËÏ·‰‹ Û ۯ¤ÛË Ì ÙËÓ ÎÏ·ÛÈο ·Ó·ÊÂÚfiÌÂÓË 0,8% Û ˙ÒÓÙ· ÓÂÔÁÓ¿. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ô ÏËı˘ÛÌfi˜ Ì·˜ ‹Ù·Ó 291 ¤Ì‚Ú˘· ÂӉ¯Ô̤ӈ˜ Ó· ·›˙ÂÈ ÚfiÏÔ, ·ÏÏ¿ ·˜ ÛËÌÂȈı› fiÙÈ Î·È Û ÌÂÁ·Ï‡ÙÂÚ˜ ÛÂÈÚ¤˜ ¤¯ÂÈ ‰È·ÈÛÙˆı› ·˘ÍË̤ÓË Â›ÙˆÛË ™∫ ÛÙ· ¤Ì‚Ú˘· (8). ∆Ô fiÙÈ Ë ÂÌ‚Ú˘˚΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Û¯ÂÙÈο ÚÒÈÌ· Î·È ÂӉ¯Ô̤ӈ˜ οÔÈ· ·fi Ù· ¤Ì‚Ú˘· ı· η٤ÏËÁ·Ó ·ÚÁfiÙÂÚ· (ÚÈÓ ÙË Á¤ÓÓËÛË), ›Ûˆ˜ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·Ú·ÙËÚËı›۷ ‰È·ÊÔÚ¿ Â›ÙˆÛ˘ ™∫ ÌÂٷ͇ ÂÌ‚Ú‡ˆÓ Î·È ÓÂÔÁÓÒÓ. ∆Ô ı¤Ì· ›Ûˆ˜ ‰È¢ÎÚÈÓÈÛı› ÛÙÔ Ì¤ÏÏÔÓ, ·Ó Î·È Ë Èı·ÓfiÙÂÚË ÂΉԯ‹ Â›Ó·È Ë ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚË ÂÏ¿ÙÙˆÛË Ù˘ Â›ÙˆÛ˘ ÛÙ· ÓÂÔÁÓ¿ ÏfiÁˆ ÙˆÓ ÚÔ·Ó·ÊÂÚıÂÈÛÒÓ ‰È·ÎÔÒÓ Î˘‹ÛˆÓ. ™˘ÓÔ„›˙ÔÓÙ·˜ Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰È·ÈÛÙÒÓÔ˘ÌÂ: 1) ∏ Â›ÙˆÛË ™∫ ÛÙ· ¤Ì‚Ú˘·, fiˆ˜ ·˘Ù¤˜ ·ÓȯÓ‡ÔÓÙ·È Ì ˯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Â›Ó·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Û ۯ¤ÛË Ì ÙËÓ Â›ÙˆÛË ™∫ ÛÙ· ÓÂÔÁÓ¿. 2) ∏ Â›ÙˆÛË Â›Ó·È ÂÍ›ÛÔ˘ ˘„ËÏ‹ Î·È Û ÏËı˘ÛÌfi ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™∫. 3) ∆Ô ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È ˘„ËÏ‹˜ ·ÎÚ›‚ÂÈ·˜ ̤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ™∫. ∏ ·Ó›¯Ó¢ÛË ÙˆÓ ÛÔ‚·ÚÒÓ ‹ ÌÂÈ˙fiÓˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ¤ÁÈÓ Ì ¢·ÈÛıËÛ›· 100% Î·È ·˘Ùfi Â›Ó·È ÚˆÙ›ÛÙˆ˜ ÙÔ ˙ËÙÔ‡ÌÂÓÔ Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ë ·Ó›¯Ó¢ÛË ÂÏ·ÛÛfiÓˆÓ Î·È ·˘ÙÔ˚ˆÌ¤ÓˆÓ ·ÓˆÌ·ÏÈÒÓ.

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498

™ÂÏ›‰·497

∂Ì‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· - ™ËÌ·Û›· ÙÔ˘ ÁÈ· ÙËÓ Î‡ËÛË

OÈ ‰È·ÁÓÒÛÂȘ ÛÙË ÌÂϤÙË Ì·˜ ˘‹ÚÍ·Ó Î·ıÔÚÈÛÙÈΤ˜ ÁÈ· ÙËÓ Ù‡¯Ë ÙˆÓ Î˘‹ÛÂˆÓ Ô‰ËÁÒÓÙ·˜ Û 2 ·ÚÈ· ·ÔÙÂϤÛÌ·Ù·: 1) ‰È·ÎÔ¤˜ ΢‹ÛˆÓ, 2) ·Ó›¯Ó¢ÛË ¯ÚˆÌÔÛˆÌȷ΋˜ ·ÓˆÌ·Ï›·˜, Ô˘ ÙÂÏÈο Ô‰‹ÁËÛ Â›Û˘ Û ‰È·ÎÔ‹ ΢‹Ûˆ˜. £ÂˆÚԇ̠ÂÍ¿ÏÏÔ˘ ÛËÌ·ÓÙÈ΋ ÙË ‰˘Ó·ÙfiÙËÙ· Ô˘ ·Ú¤¯ÂÈ ÌÈ· Ê˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË Ó· ηıËÛ˘¯¿˙Ô˘Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È È‰›ˆ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ ΢‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ô˘ ηٿ ÙËÓ ÂÌÂÈÚ›· Ì·˜ Û˘Óԉ‡ÔÓÙ·È ·fi ¿Á¯Ô˜. ∞fi ÙË ÌÂϤÙË Ì·˜ ÚÔ·ÙÂÈ ıˆÚËÙÈο ¤Ó‰ÂÈÍË ÁÈ· Ï‹ÚË ¤ÏÂÁ¯Ô Ì ˯ÔηډÈÔÁÚ¿ÊËÌ· fiÏˆÓ ÙˆÓ Î˘‹ÛˆÓ, ·ÊÔ‡ Ë Â›ÙˆÛË ™∫ Î·È ÛÙËÓ ÔÌ¿‰· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‹Ù·Ó ˘„ËÏ‹. ∂Âȉ‹ Ú·ÎÙÈο ·˘Ùfi Â›Ó·È ·Ó¤ÊÈÎÙÔ, ηٿ ÙËÓ ¿Ô„‹ Ì·˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÂÎ·È‰Â‡ÔÓÙ·È ÔÈ Á˘Ó·ÈÎÔÏfiÁÔÈ, ¤ÙÛÈ ÒÛÙ ӷ Â›Ó·È Û ı¤ÛË Ó· ÂϤÁ¯Ô˘Ó ·ÍÈfiÈÛÙ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙȘ 4 ÎÔÈÏfiÙËÙ˜ Î·È Ù· ÌÂÁ¿Ï· ·ÁÁ›·, ·Ú·¤ÌÔÓÙ·˜ Ù· ÚÔ‚Ï‹Ì·Ù· ÛÙÔ˘˜ ÂȉÈÎÔ‡˜. ∆ÂÏÂÈÒÓÔÓÙ·˜ Ó· ÛËÌÂÈÒÛÔ˘Ì fiÙÈ Ù· ËıÈο ÂÚˆÙËÌ·ÙÈο Ô˘ ÚÔ·ÙÔ˘Ó Û¯ÂÙÈο Ì ÙËÓ Ù‡¯Ë ÌÈ·˜ ·ËÛ˘ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË ™∫ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ··ÓÙËıÔ‡Ó. ™Ù· ı·˘Ì¿ÛÈ· Û¯ÂÙÈο editorials ÙÔ˘ Cardiology in the Young (27-31) ¤¯Ô˘Ó ηٷÙÂı› ÔÏϤ˜ ‰È·ÊÔÚÂÙÈΤ˜ ·fi„ÂȘ. £ÂˆÚԇ̠fiÙÈ Ì¤¯ÚȘ fiÙÔ˘ Ë ÚˆÙÔ·ı‹˜ ÚfiÏË„Ë Á›ÓÂÈ Ú·ÁÌ·ÙÈÎfiÙËÙ·, Ë ÌfiÓË ÂÊÈÎÙ‹ χÛË Â›Ó·È Ë Û·Ê‹˜ Î·È Ï‹Ú˘ ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓÈÒÓ, ÒÛÙ Û οı ÂÚ›ÙˆÛË Ó· οÓÔ˘Ó ÙË ‰È΋ ÙÔ˘˜ ÂÈÏÔÁ‹. µÈ‚ÏÈÔÁÚ·Ê›· 1. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56109 births: incidence and natural history.

Circulation 1971;43:323-332.

2. Allan LD, Sharland GK, Milburn A, Lockhart SM, Groves AM, Anderson RH et al. Prospective diagnosis of 1006 consecutive cases of congenital heart disease in the fetus.JACC 1994;23:1452-1458.

3. Wyllie J, Wren C, Hunter S. Screening for fetal heart malformations. Br Heart J 1994;71(suppl):20-27.

4. DeVore GR. Influence of prenatal diagnosis on congenital heart defects. Ann N Y Acad Sci 1998;847:46-52.

5. D’ Alton ME, DeCherney AH. Prenatal diagnosis. N Engl J Med 1993;328:114-120.

6. Schleich JM, Almange C. Fetal echocardiography (French).

Arch Pediatr 1998;5:1236-1245.

7. Sharland GK, Allan LD. Screening for congenital heart disease prenatally. Results of a 2 and ó year study in the South East Thames region. Br J Obstet Gynaecol 1992;99:220-225.

8. Stumpflen I, Stumpflen A, Wimmer M, Bernaschek G. Effect of detailed fetal echocardiography as part of routine prenatal ultrasonographic screening on detection of congenital heart disease. Lancet 1996;348:854-857.

9. Daubeney PEF, Sharland GK, Cook AC, Keeton BR, Anderson RH, Webber SA. Pulmonary atresia with intact ventricular septum. Impact of fetal echocardiography on incidence at birth and postnatal outcome. Circulation 1998;98:562-566.

10. Hyett JA, Perdy M, Sharland GK, Snijders RSM, Nicolaides KH. Increased nuchal translucency at 10-14 weeks of gestation as a marker for major cardiac defects.Ultrasound Obstet Gynecol 1997;10:242-246.

11. Allan L, Sharland G, Cook A. Color atlas of fetal cardiology.

Mosby Wolfe Publ 1994.

12. Fyler DC, Buckley LP, Hellenbrand WE, Cohn HE. Report of the New England Infant Cardiac Program. Pediatrics 1980;65:375-461.

13. Saari-Kemppainen A, Karjalainen O, Ylostalo P,Heinonen OP. Ultrasound screening and perinatal mortality: controlled trial of systematic one stage screening in pregnancy. Lancet 1990;336:387-391.

14. Allan LD, Crawford DC, Chita SK,Tynen MJ. Prenatal screening for congenital heart disease. BMJ1986;292:17171719.

15. Montana E, Khoury MJ, Cragan JD, Hiva Sharma, Pradir Dhar, Fyfe D. Trends and outcomes after prenatal diagnosis of congenital cardiac malformations by fetal echocardiography in a well defined birth population, Atlanta Georgia 1990-1994.

JACC 1996;28:1805-1809.

16. Copel JA, Tan AS, Kleinman CS. Does a prenatal diagnosis of congenital heart disease alter short term outcome? Ultrasound Obstet Gynecol 1997;10(4):237- 241.

17. Hofbeck M, Beinder E, Kirchgessner E, Buheitel G, Singer H. Perinatal management of children with prenatal diagnosis of congenital heart defects (German). ZGeburtshilfe Neonatol 1997;201(2):49-54.

18. Raymond FL, Simpson JM, Sharland GK, Mackie Ogilvie CM. Fetal echocardiography as a predictor of chromosomal abnormality. Lancet 1997;350:930.

19. Buskens E, Grobbee DE, Frohn Mulder IME, Stewart PA, Juttmann RE, Wladimiroff JW, Hess J. Efficacy of routine ultrasound screening for congenital heart disease in normal pregnancy. Circulation 1996;94:67-72.

20. Sinclair BG, Sandor GG, Farquharson DF. Effectiveness of primary level antenatal screening for severe congenital heart disease: a population based assessment. J Perinatol 1996;16(5):336-340.

21. Tegnander E, Eik-Nes SH, Johansen OJ, Linker DT.Prenatal detection of heart defects at the routine fetal examination at 18 weeks in a non selected population. Ultrasound Obstet Gynecol 1995; 5:372-380 22. Devore GR, Horenstein J, Siassi B, Platt LD. Fetal echocardiography VII: Doppler color flow mapping: a new technique for the diagnosis of congenital heart disease. Am J Obstet Gynecol 1987;156:1054-1064 23. Allan L. Congenital heart disease. Antenatal diagnosis of heart disease Heart 2000;83:367-370.

24. Yagel S, Weissman A, Rotstein Z et al. Congenital heart defects. Natural course and in utero development. Circulation 1997;96:550-555.

25. Rustico MA, Benettoni A, D’ Ottavio G, Maieron A, Fischer Tamaro I, Conoscenti G et al. Fetal heart screening in low risk pregnancies. Ultrasound in Obstetrics & Gynecology 1995;6(5):313-319.

26. Carvalho JS, Moscoso G, Ville Y. First-trimester transabdominal fetal echocardiography.

Lancet 1998;351:1023-1027.

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27. Anderson RH. Termination of pregnancy [editorial]. Cardiol Young 1996;6:255.

28. Squarcia U. Fetal diagnosis of congenital cardiac malformations - a challenge for physicians as well as parents [editorial]. Cardiol Young 1996;6:256-257.

29. Allan LA. Fetal diagnosis of congenital heart disease [editorial]. Cardiol Young 1996;6:258.

30. Sandor GS. Fetal diagnosis of congenital heart disease [editorial]. Cardiol Young 1996;6:259-260.

Ã. ∆Ú¿·ÏË, ∞. ª·ÚÁÂÙ¿Î˘

31. Shinebourne EA, Carvalho JS. Ethics of fetal echocardiography [editorial]. Cardiol Young 1996;6:261-263.

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Mayoral CE, Marino RV, Rosenfeld W, Greensher J Alternating Antipyretics: Is This an Alternative?

Pediatrics 2000 105: 1009-1012

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

™‡Ó‰ÚÔÌÔ Turner: ™˘Û¯¤ÙÈÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ Ù˘ ÌÔÓÔۈ̛·˜ à Ì ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·˘ÍËÙÈ΋ ÔÚÌfiÓË Ã·Ú¿Ï·ÌÔ˜ °. ÷Ù˙Ë·ı·Ó·Û›Ô˘, ÷ڿϷÌÔ˜ £ÂÔ‰ˆÚ›‰Ë˜, ∞Û·Û›· ∆Û¤˙Ô˘, ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∆Û›ÁÎÔ˜, ¢ËÌ‹ÙÚÈÔ˜ °Ô˘ÚÁÈÒÙ˘, ∂ÌÌ·ÓÔ˘‹Ï ∫·‚·˙·Ú¿Î˘, ÃÚÈÛÙ›Ó· ∫‡ÚÔ˘, ∞ÁÁÂÏÈ΋ °·ÏÏ¿, ∞ÁÁÂÏÈ΋ ¶·Û·Ú¿ÎË, º›ÏÈÔ˜ ¶·ÙÛ·Ï‹˜, ¡ÈÎfiÏ·Ô˜ ªÔÛ¯ÔÓ¿˜, ™ÔÊ›· ∫›ÙÛÈÔ˘

● ¶ÂÚ›ÏË„Ë: °È· Ó· ÂÍÂÙ¿ÛÔ˘Ì ηٿ fiÛÔÓ Ë ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ ∆urner (™∆) ηıÒ˜ Î·È Ë ·ÓÙ·fiÎÚÈÛ‹ ÙÔ˘˜ ÛÙË ıÂÚ·›· Ì rhGH ÂËÚ¿˙ÂÙ·È ·fi ÙË ÁÔÓÂ˚΋ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ Ã, ÌÂÏÂÙ‹Û·Ì 33 EÏÏËÓfiÔ˘Ï· Ì ™∆ (18 Ì ηڢfiÙ˘Ô 45,Ã Î·È 15 Ì ̈۷˚ÎÈÛÌfi ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã) Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ‡˜ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÔ‡˜ ‰Â›ÎÙ˜ DXS 101 Î·È DXS 337 ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã. ¢ÂηÂÙ¿ ·fi Ù· ·È‰È¿ ·˘Ù¿ Û˘ÌÏ‹ÚˆÛ·Ó 2 ¤ÙË ıÂÚ·›·˜ Ì rhGH (0,7 IU/kg/‚‰). H ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ÙÔ ‰È·ÙËÚËı¤Ó ¯ÚˆÌfiۈ̷ à ‹Ù·Ó ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ (Ãm) Û 15/30 ·È‰È¿ Î·È ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ (Ãp) Û 15/30, ÂÓÒ Û 3/33 ÂÚÈÙÒÛÂȘ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ‰È¢ÎÚ›ÓÈ˙·Ó ÙËÓ ÚԤϢÛË. ∆Ô ‡„Ô˜ ÙˆÓ ·È‰ÈÒÓ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì rhGH Û˘Û¯ÂÙÈ˙fiÙ·Ó ÛËÌ·ÓÙÈο Ì ÙÔ ‡„Ô˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ ‡„Ô˜ ÛÙfi¯Ô, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÚԤϢÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã. ∫·È ÛÙȘ 2 ÔÌ¿‰Â˜ (Ãm Î·È Xp) ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 2 ÂÙÒÓ ıÂÚ·›·˜, ¯ˆÚ›˜ fï˜ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘˜. ∂ÈϤÔÓ, Ë ·ÚÔ˘Û›· ÙÔ˘ Ãm ‹ Ãp ‰ÂÓ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ٷ ˘fiÏÔÈ· ÎÏÈÓÈο Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂϤÁ¯ıËηÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ·È‰ÈÒÓ Ì ™∆ Ô˘ ÌÂÏÂÙ‹Û·ÌÂ, ‰È·ÈÛÙÒÛ·Ì ‰È·Ù‹ÚËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ‹ ·ÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Û ›ÛÔ ÔÛÔÛÙfi Î·È ‰Â›Í·Ì fiÙÈ Ë ÁÔÓÂ˚΋ ÚԤϢÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ ·˘ÙÔ‡ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ Ì rhGH Ô‡ÙÂ Î·È ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:499-506. §¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Turner, ÁÔÓÂ˚΋ ÚԤϢÛË, Ê·ÈÓfiÙ˘Ô˜, ‚ÈÔÛ˘ÓıÂÙÈ΋ ·˘ÍËÙÈ΋ ÔÚÌfiÓË.

C.G. Hadjiathanasiou, C. Theodoridis, A. Tsezou, K. Tsigos, D. Gourgiotis, E. Kavazarakis, C. Kyrou, A. Galla, A. Pasparaki, P. Patsalis, N Moschonas, S. Kitsiou. Turner syndrome: Relationship between the parental origin of monosomy X and the response to rhGH therapy. Paediatriki 2000;63:499-506. ● Abstract: We performed a systematic clinical assessment as well as molecular studies in 33 Greek children with Turner syndrome (TS), (18 with 45, X and 15 with X-mosaicisms), and their parents in order to examine if there is a relationship between the parental origin of the retained X chromosome and the height attained after treatment with recombinant human growth hormone (rhGH). PCR analysis, using microsatellite markers on X chromosome (DXS 101 and DXS 337), revealed that the intact X was paternal (Xp) in 15/30 and maternal (Xm) in 15/30 children, while in 3/33 families the results were non-informative. There was no significant correlation between parental origin of the retained X and the clinical and ultrasonographic phenotypic features assessed.

In 17 of these children, who completed at least 2 years of rhGH therapy (0,7 IU/kg/wk), we found no differences between the Xm and Xp groups in regards to the degree of improvement of height velocity, which was ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡” ªÔÓ¿‰· °ÂÓÂÙÈ΋˜ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∆Ì‹Ì· µÈÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ Î·È πÓÛÙÈÙÔ‡ÙÔ ªÔÚȷ΋˜ µÈÔÏÔÁ›·˜ Î·È µÈÔÙ¯ÓÔÏÔÁ›·˜ ∫Ú‹Ù˘ ∆Ì‹Ì· ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ πÓÛÙÈÙÔ‡ÙÔ˘ ¡Â˘ÚÔÏÔÁ›·˜ Î·È °ÂÓÂÙÈ΋˜ ∫‡ÚÔ˘

499

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·500

¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.

significant in both groups. In conclusion, we observed no preferential loss of the paternal or maternal X chromosome in our patient population with TS. In addition, we found that the parental origin of the retained X chromosome does not influence the response to rhGH therapy or the frequency of the characteristic phenotypic manifestations of the syndrome.

Key words: Turner syndrome, parental origin, imprinting, phenotype, recombinant human growth hormone. ™˘ÓÙÔÌÔÁڷʛ˜: ™∆ = rhGH =

™‡Ó‰ÚÔÌÔ Turner recombinant human growth hormone = µÈÔÛ˘ÓıÂÙÈ΋ ·˘ÍËÙÈ΋ ÔÚÌfiÓË Ãm = ÃÚˆÌfiۈ̷ à ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ Ãp = ÃÚˆÌfiۈ̷ à ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ RFLPs = Restriction fragment length polymorphisms Ht SDS = ™Ù·ıÂÚ‹ ·fiÎÏÈÛË ÙÔ˘ ‡„Ô˘˜ CA = Chronological age = ÃÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ∆∏ = Target height = ⁄„Ô˜ ÛÙfi¯Ô˜ PCR = Polymerase chain reaction = ∞Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ FISH = Fluorescence in situ hybridization = in situ ˘‚ÚȉÈÛÌfi˜ Ì ÊıÔÚÈÛÌfi.

EÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Turner (™∆) Â›Ó·È Ì›· ·fi ÙȘ Û˘ÓËı¤ÛÙÂÚ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÌÂ Û˘¯ÓfiÙËÙ· 1/2500 - 1/3500 ÛÙ· ÓÂÔÁ¤ÓÓËÙ· ÎÔÚ›ÙÛÈ·. ¶ÂÚ›Ô˘ 50% ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ¤¯Ô˘Ó ηڢfiÙ˘Ô 45,Ã, ÂÓÒ Ù· ˘fiÏÔÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌˆÛ·˚ÎÈÛÌfi ‹ ¤¯Ô˘Ó ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· à ‹ À (1-3). ª›· ·fi ÙȘ ·ÚȘ ÂΉËÏÒÛÂȘ ÙÔ˘ ™∆ ·ÔÙÂÏ› ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÔ›Ô˘ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË ¯ÔÚ‹ÁËÛË ‚ÈÔÛ˘ÓıÂÙÈ΋˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (rhGH), Ì ÔÈΛÏË ·ÓÙ·fiÎÚÈÛË (4-8). ¢È¿ÊÔÚ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÚԤϢÛË ÙÔ˘ ‰È·ÙËÚËı¤ÓÙÔ˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã Â›Ó·È Û˘¯ÓfiÙÂÚ· ÌËÙÚÈ΋ (Ãm) ÛÙ· ‚ÈÒÛÈÌ· ÓÂÔÁ¤ÓÓËÙ· Ì ™∆ (9-11), ÂÓÒ ·ÓÙ›ıÂÙ· ‰È·Ù‹ÚËÛË ÙÔ˘ ·ÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à (Ãp) ·Ú·ÙËÚ‹ıËÎÂ Û˘¯ÓfiÙÂÚ· ÛÙ· ·Ô‚ÏËı¤ÓÙ· ¤Ì‚Ú˘· (12). Œ¯ÂÈ Â›Û˘ ÚÔÙ·ı› fiÙÈ Ë ÚԤϢÛË ÙÔ˘ ‰È·ÙËÚÔ˘Ì¤ÓÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ÛÙȘ ·ÛıÂÓ›˜ Ì ™∆ Èı·ÓfiÓ Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÔÚÈṲ̂ӷ ·fi Ù· Ê·ÈÓÔÙ˘Èο ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈο, ¯ˆÚ›˜ fï˜ ·˘Ùfi Ó· ·ÔÙÂÏ› ÛÙ·ıÂÚfi ‡ÚËÌ·. ¶ÚÒÙÔÈ ÔÈ Mathur Î·È Û˘Ó ÂÍ¤Ù·Û·Ó ÙËÓ Èı·ÓfiÙËÙ· ·˘Ù‹ Û 25 ·ÛıÂÓ›˜ Ì ™∆ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ RFLPs (restriction fragment length polymorphisms), ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó fï˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰È·Ù‹ÚËÛ·Ó ÙÔ Ãm ‹ ÙÔ Ãp fiÛÔÓ ·ÊÔÚ¿ ÙÔ ‚¿ÚÔ˜ Î·È Ì‹ÎÔ˜ Á¤ÓÓËÛ˘ Î·È ¿ÏϘ Ê˘ÛÈΤ˜, ·Ó·ÙÔÌÈΤ˜ Î·È Ê˘ÛÈÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ η٤ÁÚ·„·Ó (10). ¶·ÚÔÌÔ›ˆ˜, ÔÈ Lorda-Sanchez Î·È Û˘Ó ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÛËÌ·ÓÙÈΤ˜ Ê·ÈÓÔÙ˘ÈΤ˜ ‰È·-

500

ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ãm Î·È Ãp Û ÌÂϤÙË 40 ÂÚÈÙÒÛÂˆÓ Ì ™∆ (11). ∞ÓÙ›ıÂÙ·, ÔÈ Chu Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ηډȷÁÁÂÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ·˘¯ÂÓÈÎÔ‡ ÙÂÚ˘Á›Ô˘ Û ·ÛıÂÓ›˜ Ì ™∆ Ô˘ ‰È·Ù‹ÚËÛ·Ó ÙÔ Ãm (13). ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Ë ›‰È· ÔÌ¿‰· ·Ó¤ÊÂÚ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰È·ÙËÚÔ‡Ó ÙÔ ÌËÙÚÈÎfi ¯ÚˆÌfiۈ̷ à Ì ÙÔ ‡„Ô˜ Ù˘ ÌËÙ¤Ú·˜ (13). ∏ Èı·ÓfiÙËÙ· fï˜ Ó· ÂËÚ¿˙ÂÙ·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ Ì rhGH ÛÙÔ ™∆ ·fi ÙË ÁÔÓÂ˚΋ ÚԤϢÛË ÙÔ˘ ¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ à ‰ÂÓ ¤¯ÂÈ ÂÚ¢ÓËı› ̤¯ÚÈ Û‹ÌÂÚ·. ªÈ· Ù¤ÙÔÈ· Û˘Û¯¤ÙÈÛË ı· ÌÔÚÔ‡Û ÂӉ¯Ô̤ӈ˜ Ó· ÂËÚ¿ÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ ıÂÚ·›·˜ Ì rhGH ÛÙ· ·È‰È¿ ·˘Ù¿. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÚÔÛ‰ÈÔÚ›Û·Ì ÙË ÁÔÓÂ˚΋ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ à Û 33 ·È‰È¿ Ì ™∆ Î·È ÙËÓ Û˘Û¯ÂÙ›Û·Ì Ì ٷ ÎÏÈÓÈο Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∂ÈϤÔÓ, Û 17 ·fi Ù· ·È‰È¿ ·˘Ù¿ Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯ÚfiÓÈ· ıÂÚ·›·˜ Ì rhGH, ÂÍÂÙ¿Û·Ì ηٿ fiÛÔÓ Ë ·ÓÙ·fiÎÚÈÛË ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ Xm ‹ ÙÔ˘ Xp. ÀÏÈÎfi Î·È M¤ıÔ‰ÔÈ ∞ÛıÂÓ›˜ – ∫ÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË ªÂÏÂÙ‹Û·Ì 33 ·È‰È¿ Ì ™∆, ËÏÈΛ·˜ 4,7-15 ÂÙÒÓ (̤ÛË ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 9,8 ± 2,9 ¤ÙË), ÌÂÙ¿ ·fi Û˘ÁηٿıÂÛË ÙˆÓ ·È‰ÈÒÓ Î·È/‹ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÙ˘ ÂͤٷÛ˘ ηٷÁÚ¿ÊËΠÙÔ ‡„Ô˜ ÙˆÓ ·È‰ÈÒÓ Î·È ˘ÔÏÔÁ›ÛıËÎÂ Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛ‹ ÙÔ˘ (SDS) ÁÈ· ÙË ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· (Ht SDS/CA), Û‡Ìʈӷ Ì ٷ ‰È·ÁÚ¿ÌÌ·Ù· ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Ì ™∆ (14). ∂ÈϤÔÓ, ÌÂÙÚ‹ıËΠÙÔ ‡„Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÚÔÛ‰ÈÔÚ›ÛıËÎÂ Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛ‹ ÙÔ˘ ÁÈ· οı ÁÔÓ¤· (Ht SDS), fiˆ˜ Â›Û˘ Î·È Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÙÔ˘ ‡„Ô˘˜ ÛÙfi¯Ô˘ (Target Height, TH SDS). ∆·˘Ùfi¯ÚÔÓ·, ·ÍÈÔÏÔÁ‹Û·Ì ٷ ·ÎfiÏÔ˘ı· Ê·ÈÓÔÙ˘Èο Î·È ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ: ‚¿ÚÔ˜/Ì‹ÎÔ˜ Á¤ÓÓËÛ˘, ‰È¿ÚÎÂÈ· ·ËÛ˘, ‚ÏÂÊ·ÚfiÙˆÛË, ·˘¯ÂÓÈÎfi ÙÂÚ‡ÁÈÔ, ‚Ú·¯‡˜ ·˘¯¤Ó·˜, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÎÒÌ˘, ·ÓˆÌ·Ï›Â˜ ÒÙˆÓ, ÏÂÌÊÔ›‰ËÌ·, ‚Ú·¯‡ 4Ô ÌÂٷοÚÈÔ, ÈıÔÂȉ‹˜ ıÒڷη˜, ·˘ÍË̤ÓË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ıËÏÒÓ, ‚Ï·ÈÛÔ› ·ÁÎÒÓ˜, ÔÏÏ·ÏÔ› ÌÂÏ·Á¯ÚˆÌ·ÙÈÎÔ› Û›ÏÔÈ, ·ÚÔ˘Û›· Ù·ÈÓÈÔÂȉÒÓ ÁÔÓ¿‰ˆÓ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ/ ÓÂÊÚÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÌÂ

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·501

¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

ªÔÚȷ΋ ÁÂÓÂÙÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner

˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. ∆ÚÈ¿ÓÙ· ·fi Ù· ·È‰È¿ ÂÙ¤ıËÛ·Ó Û ıÂÚ·›· Ì rhGH Û ‰fiÛË 0,7 IU/kg/‚‰, Ì ηıËÌÂÚÈÓ¤˜ ˘Ô‰fiÚȘ ÂÓ¤ÛÂȘ. ¢ÂηÂÙ¿ ·fi ·˘Ù¿, ËÏÈΛ·˜ 10,1±2,7 ÂÙÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Û˘ÌÏ‹ÚˆÛ·Ó 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÙË ¯ÔÚ‹ÁËÛ˘ rhGH. ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ™Â fiϘ ÙȘ ·ÛıÂÓ›˜ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ¤ÁÈÓ ¯ÚˆÌÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË (ηڢfiÙ˘Ô˜), Û‡Ìʈӷ Ì ÙȘ ÎÏ·ÛÈΤ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ÌÂıfi‰Ô˘˜ Î·È ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ù¯ÓÈ΋ Û‹Ì·ÓÛ˘ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Giemsa banding (15). °È· ÙËÓ ·Ó›¯Ó¢ÛË ÌˆÛ·˚ÎÈÛÌÔ‡ ·Ó·Ï‡ıËÎ·Ó Û οı ·ÛıÂÓ‹ 50-100 ÌÂÙ·Ê¿ÛÂȘ. πn situ ˘‚ÚȉÈÛÌfi˜ Ì ÊıÔÚÈÛÌfi (fluorescence in situ hybridization, FISH) °È· ÙËÓ ·Ó›¯Ó¢ÛË ÌÈÎÚÔ̈۷˚ÎÈÛÌÔ‡ ¤ÁÈÓ ˘‚ÚȉÔÔ›ËÛË ÙˆÓ ÌÂÙ·Ê·ÛÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ì ÙÔ˘˜ ÎÂÓÙÚÔÌÂÚȉȷÎÔ‡˜ ·ÓȯÓÂ˘Ù¤˜ Ãpbam Î·È DYZ3 (Oncor), ÛÂÛËÌ·Ṳ̂ÓÔ˘˜ Ì ‚ÈÔÙ›ÓË, ÁÈ· Ù· ¯ÚˆÌÔÛÒÌ·Ù· Ã Î·È À ·ÓÙ›ÛÙÔȯ·, fiˆ˜ ¤¯ÂÈ ‹‰Ë ÂÚÈÁÚ·Ê› (16). ™Â οı ·ÛıÂÓ‹ Ù· Û‹Ì·Ù· ˘‚ÚȉÈÛÌÔ‡ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û 50 ηϿ ‰ÈÂÛ·Ṳ́Ó˜ ÌÂÙ·Ê¿ÛÂȘ. ªÔÚȷ΋ ·Ó¿Ï˘ÛË ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ·ÔÌÔÓÒÛ·Ì DNA ·fi 5 ml ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ (17). ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÂȉÈÎÔ‡˜ ÂÎÎÈÓËÙ¤˜ ÁÈ· 2 Ê˘ÏÔÛ‡Ó‰ÂÙÔ˘˜ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÔ‡˜ ‰Â›ÎÙ˜ ˘„ËÏÔ‡ ÔÏ˘ÌÔÚÊÈÛÌÔ‡, ÙÔ˘ DXS 101 Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Xq22 (̤ÁÈÛÙË ÂÙÂÚÔ˙˘ÁˆÙ›·: 0,90) Î·È ÙÔ˘ DXS 337 Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ãp11.3 - p11.23 (̤ÁÈÛÙË ÂÙÂÚÔ˙˘ÁˆÙ›·: 0,83), Ú·ÁÌ·ÙÔÔÈ‹Û·Ì ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (PCR) Û 10 ng DNA ·fi ÙÔ Î¿ı ¿ÙÔÌÔ ÛÂ Û˘ÓÔÏÈÎfi fiÁÎÔ 25 Ìl, fiˆ˜ ¤¯ÂÈ ‹‰Ë ÂÚÈÁÚ·Ê› (18,19). ™Â ο-

ı ·ÓÙ›‰Ú·ÛË PCR, ¤Ó·˜ ÂÎ ÙˆÓ 2 ÂÎÎÈÓËÙÒÓ Â›¯Â ÛËÌ·Óı› Ì 32P ÛÙÔ 5’ ¿ÎÚÔ ÙÔ˘. ∆· ÚÔ˚fiÓÙ· ÙˆÓ ·ÓÙȉڿÛÂˆÓ PCR ·Ó·Ï‡ıËÎ·Ó Û ‹Îو̷ ÔÏ˘·ÎÚ˘Ï·Ì›‰Ë˜ 6%, ÙÔ ÔÔ›Ô ·ÊÔ‡ ·ÔÍËÚ¿ÓıËΠ˘Ô‚Ï‹ıËΠ۠·˘ÙÔÚ·‰ÈÔÁÚ·Ê›· (20). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ·ÎfiÏÔ˘ı˜ ÌË ·Ú·ÌÂÙÚÈΤ˜ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ: - ∏ ‰ÔÎÈÌ·Û›· Kruscall-Wallis ÁÈ· ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Ì ٷ Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο.

- ∏ ‰ÔÎÈÌ·Û›· Mann-Whitney ÁÈ· ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ Ì ÙÔ ‚¿ÚÔ˜ /Ì‹ÎÔ˜ Á¤ÓÓËÛ˘ Î·È ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘.

- ∏ ‰ÔÎÈÌ·Û›· Wilcoxon signed ranks ÁÈ· ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ Ì ÙÔ Ht SDS/CA ÙˆÓ ·È‰ÈÒÓ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ÙÔ ∏t SDS ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙÔ TH SDS, ηıÒ˜ Î·È ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ÛÙ· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ıÂÚ·›·. ∞ÔÙÂϤÛÌ·Ù· ÃÚˆÌÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË (ηڢfiÙ˘Ô˜ Î·È FISH) OÏÈ΋ ÌÔÓÔۈ̛· à ‰È·ÈÛÙÒıËΠ۠18 ·fi ÙȘ 33 ·ÛıÂÓ›˜ (54,5%), ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 15 (45,5%) ‰È·ÈÛÙÒıËΠ̈۷˚ÎÈÛÌfi˜ [45,Ã/46,Ãà Û 3/33, 45,Ã/46,Ãr(X) Û 6/33 Î·È 45,X/46,Xi(Xq) Û 6/33]. ™Â η̛· ·fi ÙȘ ·ÛıÂÓ›˜ ‰ÂÓ ·ÓȯÓ‡ıËΠ̈۷˚ÎÈÛÌfi˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À. ªÔÚȷ΋ Ù·˘ÙÔÔ›ËÛË Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ ÙÔ˘ ‰È·ÙËÚËı¤ÓÙÔ˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Ì ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÔ‡˜ ‰Â›ÎÙ˜ (∂ÈÎ. 1) ∏ ÚԤϢÛË ÙÔ˘ ‰È·ÙËÚËı¤ÓÙÔ˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ÚÔÛ‰ÈÔÚ›ÛıËÎÂ Û˘ÁÎÚ›ÓÔÓÙ·˜ ÙË ‰È¿Ù·ÍË ÙˆÓ

¶›Ó·Î·˜ 1. °ÔÓÂ˚΋ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ à Û ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Turner*. ∫·Ú˘fiÙ˘Ô˜

∞ÛıÂÓ›˜ (n)

Xm

°ÔÓÂ˚΋ ¶ÚԤϢÛË Xp

OÏÈ΋ ÌÔÓÔۈ̛· X (45, X)

16

7 (43,8%)

9 (56,2%)

ªˆÛ·˚ÎÈÛÌfi˜ 45,X/46,XX 45,X/46, X, r (X) 45,X/46,X, i (Xq)

14

™‡ÓÔÏÔ

30

8 (57,1%) n=3 n=5 n=6

6 (42,9%) n=1 (7,1%) n=3 (21,4%) n=4 (28,6%)

15 (50%)

n=2 (14,3%) n=2 (14,3%) n=2 (14,3%) 15 (50%)

* ∞ÔÎÏ›ÛıËÎ·Ó 3 ÔÈÎÔÁ¤ÓÂȘ, ÛÙȘ Ôԛ˜ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ‹Ù·Ó ÏËÚÔÊÔÚȷο

501

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·502

¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ∞Ó¿Ï˘ÛË Ê·ÈÓÔÙ˘ÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Turner. º·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο

∂ÈÎfiÓ· 1. °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Û ̛· ·ÓÙÈÚÔÛˆ¢ÙÈ΋ ÔÌ¿‰· 10 ·È‰ÈÒÓ Ì ™∆ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÁÔÓÔÙ‡Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ô ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎfi˜ ‰Â›ÎÙ˘ DXS 101. F= ·Ù¤Ú·˜, ª = ªËÙ¤Ú·, D= ÎfiÚË. ¶·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÙÔ˘ ·ÎÙÈÓÔÁÚ·ÊÈÎÔ‡ film ·ÚÔ˘Û›·Û ¤Ó· ·ÛıÂÓ¤˜ Û‹Ì· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÏÏËÏ›Ô˘ ÙÔ˘ ·È‰ÈÔ‡ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ #4, ˘Ô‰ËÏÒÓÔÓÙ·˜ ÙËÓ ·ÚÔ˘Û›· ̈۷˚ÎÔ‡ Ê·ÈÓÔÙ‡Ô˘. ™ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· #10, ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÚÔ¤Ï¢Û˘ ÙÔ˘ ‰È·ÙËÚÔ‡ÌÂÓÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ÛÙËÓ ·ÛıÂÓ‹, ÂÂȉ‹ Î·È ÔÈ ‰‡Ô ÁÔÓ›˜ ÌÔÈÚ¿˙ÔÓÙ·Ó ¤Ó· ÎÔÈÓfi ·ÏÏ‹ÏÈÔ Ô˘ ÎÏËÚÔÓÔÌ‹ıËΠ·fi ÙÔ ·È‰›. ˙ˆÓÒÓ ÁÈ· ÙÔ Î¿ı ·ÏÏ‹ÏÈÔ ·fi ÙËÓ ·ÛıÂÓ‹ Î·È ÙÔ˘˜ ÁÔÓ›˜ Ù˘ (.¯. ÔÈÎÔÁ¤ÓÂÈ· #4, ∂ÈÎfiÓ· 1). O ηıÔÚÈÛÌfi˜ ÙÔ˘ ÁÔÓÔÙ‡Ô˘ ‰ÂÓ ÌfiÚÂÛ ӷ ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ à Û 3 ÔÈÎÔÁ¤ÓÂȘ, ÂÂȉ‹ Î·È ÔÈ 2 ÁÔÓ›˜ ÌÔÈÚ¿˙ÔÓÙ·Ó 1 ÎÔÈÓfi ·ÏÏ‹ÏÈÔ Ô˘ ÎÏËÚÔÓÔÌ‹ıËΠ·fi ÙÔ ·È‰› (.¯. ÔÈÎÔÁ¤ÓÂÈ· #10, ∂ÈÎfiÓ· 1). ∞fi ÙȘ ˘fiÏÔÈ˜ 30 ÂÚÈÙÒÛÂȘ, Û 15 ÎÔÚ›ÙÛÈ· ›¯Â ‰È·ÙËÚËı› ÙÔ ¯ÚˆÌfiۈ̷ Ãm (50%) Î·È Û 15 ÙÔ Xp (50%). ∂ȉÈÎfiÙÂÚ·, ·fi ÙȘ 16 ·ÛıÂÓ›˜ Ì ÔÏÈ΋ ÌÔÓÔۈ̛· à ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó ÏËÚÔÊÔÚȷο, ÙÔ ¯ÚˆÌfiۈ̷ Ãm ‰È·ÙËÚ‹ıËΠ۠7 (43,8%) Î·È ÙÔ Ãp Û 9 (56,2%) (¶›Ó·Î·˜ 1), ÂÓÒ ·fi ÙȘ 14 ·ÛıÂÓ›˜ Ì ̈۷˚ÎÈÛÌfi, Û 8 (57,1%) ÙÔ Xm Î·È Û 6 (42,9%) ÙÔ Xp. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÌÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌˆÛ·˚ÎÈÛÌÔ‡ ÙÔ Xm ‰È·ÙËÚ‹ıËΠ۠1/3 ÙˆÓ ·ÛıÂÓÒÓ Ì 45,Ã/46,ÃÃ, Û 3/5 Ì 45,Ã/46,Ãr(Ã) Î·È Û 4/6 Ì 45,Ã/46,Ãi(Ãq), ÂÓÒ ÙÔ Xp Û 2/3, 2/5 Î·È 2/6 ·ÓÙ›ÛÙÔȯ·. º·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ∆· Ê·ÈÓÔÙ˘Èο ÛÙÔȯ›· Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û οı ·ÛıÂÓ‹ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·ÚÔ˘Û›· ÙˆÓ ‰È·ÊfiÚˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ÛÙÔȯ›ˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ãm Î·È Ãp. ∂ÈϤÔÓ, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘ Î·È ÙÔ ‚¿ÚÔ˜ Î·È Ì‹ÎÔ˜ Á¤ÓÓËÛ˘ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Xm Î·È Ãp (3,0±0,6 kg Î·È 49,4±1,3 cm ¤Ó·ÓÙÈ 2,7±0,7 kg Î·È 48,3± 3,5 cm ·ÓÙ›ÛÙÔȯ·).

502

µÏÂÊ·ÚfiÙˆÛË ∞˘¯ÂÓÈÎfi ÙÂÚ‡ÁÈÔ µÚ·¯‡˜ ·˘¯¤Ó·˜ ÷ÌËÏ‹ ÚfiÛÊ˘ÛË ÎÒÌ˘ ∞ӈ̷ϛ˜ ÒÙˆÓ §ÂÌÊÔ›‰ËÌ· µÚ·¯‡ 4Ô ÌÂٷοÚÈÔ ¶ÈıÔÂȉ‹˜ ıÒڷη˜ ∞˘ÍË̤ÓË ·fiÛÙ·ÛË ıËÏÒÓ µÏ·ÈÛÔ› ·ÁÎÒÓ˜ ªÂÏ·Á¯ÚˆÌ·ÙÈÎÔ› Û›ÏÔÈ ∆·ÈÓÈÔÂȉ›˜ ÁÔÓ¿‰Â˜ (U/S) ∫·Ú‰È·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜ (U/S) ¡ÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜ (U/S)

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ Xm (n=15)

Xp (n=15)

3 3 7 8 7 2 3 8 10 10 5 13 2 4

3 4 9 12 9 0 4 7 10 6 8 14 3 7

∞ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›· Ì rhGH ∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ Ht SDS/CA ÙˆÓ ·ÛıÂÓÒÓ, ÙÔ˘ Ht SDS ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ÙÔ˘ TH SDS, fiˆ˜ Î·È ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ¯ÚfiÓÔ˘ ıÂÚ·›·˜ Ì rhGH, Û ۇÁÎÚÈÛË Ì ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ÚÈÓ ·fi ÙË ıÂÚ·›·, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 3 Î·È 4, ·ÓÙ›ÛÙÔȯ·. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ‡„Ô˜ ÙˆÓ ·È‰ÈÒÓ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ıÂÚ·›·˜ Ì rhGH, Î·È ÛÙȘ 2 ÔÌ¿‰Â˜ (Xm Î·È Xp) ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‡„Ô˜ Ù˘ ÌËÙ¤Ú·˜ (p=0,003 Î·È p=0,004 ·ÓÙ›ÛÙÔȯ·) ηıÒ˜ Î·È Ì ÙÔ ‡„Ô˜ ÛÙfi¯Ô (p=0,021 Î·È p=0,013 ·ÓÙ›ÛÙÔȯ·) (¶›Ó·Î·˜ 3). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ¯ÚfiÓÔ˘ ıÂÚ·›·˜ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ Î·È ÛÙȘ 2 ÔÌ¿‰Â˜ (Xm Î·È Xp), Û˘ÁÎÚÈÙÈο Ì ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔÓ ÙÂÏÂ˘Ù·›Ô ¯ÚfiÓÔ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì rhGH, (¶›Ó·Î·˜ 4, ∂ÈÎfiÓ· 2), Ô ÔÔ›Ô˜ fï˜, ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙÔ˘˜. ™˘˙‹ÙËÛË ¶Ú·ÁÌ·ÙÔÔÈ‹Û·Ì ÌÔÚȷ΋ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Û 33 ∂ÏÏËÓfiÔ˘Ï· Ì ™∆, Ì ÛÎÔfi Ó· ‰ÈÂÚ¢ӋÛÔ˘Ì ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‡„Ô˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì rhGH, ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›·, ηıÒ˜ Î·È Ù· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÔ‡˜ ‰Â›ÎÙ˜,

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·503

¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

ªÔÚȷ΋ ÁÂÓÂÙÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner

¶›Ó·Î·˜ 3. Ht SDS/CA ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Turner ÚÈÓ ·fi ÙË ıÂÚ·›· Ì rhGH, Ht SDS ÁÔÓ¤ˆÓ Î·È TH SDS: ™˘Û¯¤ÙÈÛË Ì ÙË ÁÔÓÂ˚΋ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ à °ÔÓÂ˚΋ ÚԤϢÛË ÌÔÓÔۈ̛·˜ Ã

∞ÛıÂÓ›˜ ªËÙ¤Ú·

¶·Ù¤Ú·˜

HtSDS

HtSDS

TH SDS

1,5 -0,3 1,2 -0,1 0,1 1,1 0,2 -0,5 0,6 1,3 -0,5 0,4 0,6 1,5 0,6

0,5 -1,9 -0,9 -1,6 -2,3 -0,4 -0,9 -1,7 -2,0 1,3 -1,5 -0,9 0,3 -0,4 -1,5

-0,7 -1,9 1,4 -1,5 0,8 -0,3 0,6 -2,6 -2,2 -0,7 0,3 -0,7 0,3 -0,3 -0,3

-0,2 -2,1 0,3 -1,6 -0,7 -0,4 -0,1 -2,3 -2,3 0,2 -0,6 -0,9 0,3 -0,4 -0,9

1,2 0,1 1,3 1,4 -0,2 -0,2 -0,6 0,4 0,7 -0,4 1,1 0,2 1,2 0,0 0,4

0,8 -1,2 0,8 0,3 -0,9 -2,0 -3,7 -0,4 0,5 -0,2 -0,4 0,2 0,8 -1,9 0,8

-1,5 -2,2 0,2 1,1 -1,5 1,1 -3,3 -2,2 -0,4 -0,3 -0,1 0,2 0,5 -0,7 0,0

-0,4 -1,9 0,5 0,7 -1,3 -0,4 -3,7 -1,4 0,0 -0,3 -0,3 0,2 0,6 -1,4 0,4

-0,7 0,5 0,7

-1,4 -1,3 -1,2

-2,2 -1,5 0,8

-2,0 -1,5 -0,2

Ht SDS/CA*

Xm

Xp

∞ηıfiÚÈÛÙË

°ÔÓ›˜

*™‡Ìʈӷ Ì ÙȘ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner

503

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·504

¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.

ÏfiÁˆ Ù˘ ˘„ËÏ‹˜ ¢·ÈÛıËÛ›·˜ ÙÔ˘˜, Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔ ¯·ÌËÏfi ‚·ıÌfi ÔÌÔ˙˘ÁˆÙ›·˜ Û ۇÁÎÚÈÛË Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ RFLPs Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (9-11,21). °È· Ó· ÂϤÁÍÔ˘ÌÂ Î·È Ù· 2 ÛΤÏË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ÂÈϤͷÌ ÙÔ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎfi ‰Â›ÎÙË DXS 101, Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Xq 22 Î·È ÙÔÓ DXS 337, Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Xp 11.3 - p 11.23. ™ÙÔÓ ÏËı˘ÛÌfi Ì·˜ Ì ™∆ ·Ú·ÙËÚ‹Û·Ì ›ÛË Û˘¯ÓfiÙËÙ· ÛÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Î·È ·ÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã, ÙfiÛÔ ÛÙ· ·È‰È¿ Ì ÔÏÈ΋ ÌÔÓÔۈ̛· à fiÛÔ Î·È Û ·˘Ù¿ Ì ̈۷˚ÎÈÛÌfi, ÂÓÒ ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Û˘Ó‹ıˆ˜ ˘ÂÚ›¯Â Ë ÌËÙÚÈ΋ ÚԤϢÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à (9-11). ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÔÈ Lorda-Sanchez Î·È Û˘Ó Î·È Mathur Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó ‰È·Ù‹ÚËÛË ÙÔ˘ Xm Û 77,8% Î·È 72% ·ÓÙ›ÛÙÔȯ· (10,11). ∂ÈϤÔÓ, ÔÈ Jacobs Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó fiÙÈ ÙÔ 74% ÙˆÓ ·ÛıÂÓÒÓ Ì 45,à ‰È·Ù‹ÚËÛ·Ó ÙÔ Xm, ÂÓÒ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ‹ ‰·ÎÙ˘ÏÈÔÂȉ‹ ¯ÚˆÌÔÛÒÌ·Ù· Ã Ë ÚԤϢÛË ·˘ÙÒÓ ‹Ù·Ó ·ÙÚÈ΋ (22). ∂›Ó·È

ÂӉȷʤÚÔÓ fiÙÈ ÛÙËÓ ›‰È· ÌÂϤÙË, ·È‰È¿ Ì i(Xq)s ·ÚÔ˘Û›·˙·Ó ÙȘ ›‰È˜ ÂÚ›Ô˘ Èı·ÓfiÙËÙ˜ Ó· ‰È·ÙËÚÔ‡Ó ÙÔ Xm ‹ ÙÔ Ãp (22). ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ÌfiÓ· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ™∆ Ô˘ ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÂËÚ¿˙ÔÓÙ·È ·fi ÙÔ ÁÂÓÂÙÈÎfi ·ÔÙ‡ˆÌ· (imprinting) ÂÚÈÔ¯ÒÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã Â›Ó·È ÔÈ Î·Ú‰È·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜, Ô ‚Ú·¯‡˜ ·˘¯¤Ó·˜ Î·È ÙÔ ‡„Ô˜, Ô˘ Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ Xm (13,23). ™ÙÔ ‰ÈÎfi Ì·˜ ÏËı˘ÛÌfi, fï˜, ‰ÂÓ ·Ú·ÙËÚ‹Û·ÌÂ Û˘Û¯¤ÙÈÛË ÙˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ·˘ÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ì ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ Xm, ÙÔ ‰Â ‡„Ô˜ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ Ì ™T Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ ‡„Ô˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ ‡„Ô˜ ÛÙfi¯Ô, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÚԤϢÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã. ∂›Û˘, ÛÂ Û˘Ìʈӛ· Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ‰ÂÓ ‰È·ÈÛÙÒÛ·ÌÂ Û˘Û¯¤ÙÈÛË ÙÔ˘ ‰È·ÙËÚËı¤ÓÙÔ˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Ì ٷ ˘fiÏÔÈ· ÎÏÈÓÈο Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ ÌÂÏÂÙ‹Û·Ì (10,11). ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ÂÚÒÙËÌ· Ù˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ Ù˘ ÌÔÓÔۈ̛·˜ à Ì ÙËÓ

¶›Ó·Î·˜ 4. ƒ˘ıÌfi˜ ·‡ÍËÛ˘ 17 ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ì rhGH. ∫·Ú˘fiÙ˘Ô˜

504

ƒ˘ıÌfi˜ ·‡ÍËÛ˘ (cm/¤ÙÔ˜) ¶ÚÔ ıÂÚ·›·˜

1Ô˜ ¯ÚfiÓÔ˜

2Ô˜ ¯ÚfiÓÔ˜

45,X

3,8

3,7

4,8

45,X

3,0

4,7

4,5

45,X

4,0

9,0

6,1

45,X

3,3

5,3

6,3

45,X

4,0

6,0

6,3

45,X

5,3

8,1

7,8

45,X

4,7

7,5

3,8

45,X

4,3

5,8

5,0

45,X

5,5

7,0

4,0

45,X/46,XX

3,5

6,6

4,5

45,X/46,XX

4,5

14,4

13,1

45,X/46,X r(X)

5,5

7,3

8,0

45,X/46,X, r(X)

2,9

5,6

7,0

45,X/46,X, r(X)

4,0

6,7

7,2

45,X/46,X, i(Xq)

3,5

4,0

4,8

45,X/46,X, i(Xq)

4,0

7,0

5,5

45,X/46,X, i(Xq)

4,0

5,5

5,7

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·505

¶∞π¢π∞∆ƒπ∫∏ 2000;63:499-506

ªÔÚȷ΋ ÁÂÓÂÙÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner

6,7±2,4

6,1±2,2

ƒ˘ıÌfi˜ ·‡ÍËÛ˘ (cm\¤ÙÔ˜)

8

6

4,1±0,8

p<0,001 p=0,001

4

2 n=17

0 ¶ÚÔ ıÂÚ·›·˜

1Ô˜ ÃÚfiÓÔ˜

2Ô˜ ÃÚfiÓÔ˜

∂ÈÎfiÓ· 2. ƒ˘ıÌfi˜ ·‡ÍËÛ˘ ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ 2 ÂÙÒÓ Ì rhGH Û ·È‰È¿ Ì ۇӉÚÔÌÔ Turner.

·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›· Ì rhGH, ‰ÂÓ ‚ڋηÌ η̛· ‰È·ÊÔÚ¿ ÛÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ¯ÚfiÓÔ˘ ıÂÚ·›·˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ãm Î·È Xp, ·ÚfiÏÔ Ô˘ Î·È ÛÙȘ 2 ÔÌ¿‰Â˜ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Û ۇÁÎÚÈÛË Ì ÙÔÓ ÚÔ Ù˘ ıÂÚ·›·˜ Ú˘ıÌfi. ∂Í fiÛˆÓ ÁÓˆÚ›˙Ô˘ÌÂ, Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ Â›Ó·È Ù· ÚÒÙ· Ô˘ ··ÓÙÔ‡Ó ÛÙÔ ÂÚÒÙËÌ· ·˘Ùfi Û ‰ÈÂıÓ¤˜ Â›‰Ô. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi 33 ·È‰ÈÒÓ Ì ™∆ ‰È·ÈÛÙÒÛ·Ì ‰È·Ù‹ÚËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ‹ ·ÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Û ›ÛÔ ÔÛÔÛÙfi Î·È ‰Â›Í·Ì fiÙÈ Ë ÁÔÓÂ˚΋ ÚԤϢÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ ·˘ÙÔ‡ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›· Ì rhGH ÁÈ· 2 ¤ÙË, Ô‡ÙÂ Î·È ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ¿ÏÏˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. £· ¤¯ÂÈ ÂӉȷʤÚÔÓ Ó· ÌÂÏÂÙËı› ·Ó Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ı· ÈÛ¯‡Ô˘Ó Î·È ÁÈ· ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, Ô˘ ı· ÂÈÙ¢¯ı› ˘fi ıÂÚ·›· Ì rhGH. ∞Ó·ÁÓˆÚ›ÛÂȘ ∏ ÂÚÁ·Û›· ·˘Ù‹ ÂȯÔÚËÁ‹ıËΠ·fi ÙË °ÂÓÈ΋ °Ú·ÌÌ·Ù›· ŒÚ¢ӷ˜ Î·È ∆¯ÓÔÏÔÁ›·˜ (PENED 95, 95 ED. 31 - 26).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Buckton KE. Incidence and some consequences of Xchromosome abnormalities in liveborn infants. In: Sandberg AA, ed. Cytogenetics of mammalian X chromosome. Part B. New York: Alan R. Liss, Inc; 1983. p. 7-22.

2. Hook EB, Warbuton D. The distribution of chromosomal genotypes associated with Turner’s syndrome: live birth prevalence rates and evidence for diminished foetal

mortality and severity in genotypes associated with structural X abnormalities or mosaicism. Hum Genet 1983;64:24-27.

3. Patsalis PC, Sismani C, Hadjimarkou MI, Kitsiou-Tzeli S, Tsezou A, Hadjiathanasiou CG et al. Detection and incidence of cryptic Y chromosome sequences in Turner syndrome patients. Clin Genet 1998;53:249-257.

4. Van den Broeck J, Massa GG, Attanasio A, Matranga A, Chaussain JL, Price DA et al. Final height after long-term growth hormone treatment in Turner syndrome. J Pediatr 1995;127:729-735.

5. Pasquino AM, Passeri F, Municchi G, Segni M, Pucarelli I, Larizza D et al. Final height in Turner syndrome patients treated with growth hormone. Horm Res 1996;46:269-272.

6. Rosenfeld RG, Attie KM, Frane J, Brasel JA, Burstein S, Cara JF et al. Growth hormone therapy of Turner syndrome: beneficial effect on adult height. J Pediatr 1998;132:319-324.

7. Sas TCJ, Muinck Keizer-Schrama de SMPF, Stijnen T, Teunenbroek van A, Hokken -koelega ACS, Waelkens JJJ et al. Final height in girls with Turner’s syndrome treated with once or twice daily growth hormone injections. Arch Dis Child 1999;80:36-41.

8. Hochberg Z, Zadik Z. Final height in young women with Turner syndrome after GH therapy: an open controlled study. Eur J Endocrinol 1999;141;218-224.

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10. Mathur A, Stekol L, Schatz D, MacLaren NK, Scott ML, Lippe B. The parental origin of the single X chromosome in Turner syndrome: lack of correlation with parental age or clinical phenotype. Am J Hum Genet 1991;48:682-686.

11. Lorda-Sanchez I, Binkert F, Maechler M, Schintzel A.

505

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Molecular study of 45,X conceptuses: correlation with clinical findings. Am J Med Genet 1992;42:487-490.

12. Jacobs PA, Betts PR, Cockwell AE, Crolla JA, Mackenzie MJ, Robinson DO et al. A cytogenetic and molecular reappraisal of a series of patients with Turner’s syndrome.

Ann Hum Genet 1990;54:209-223.

13. Chu CE, Donaldson MDS, Kelnar CJH, Smail PS, Greene SA, Paterson WF et al. Possible role of imprinting in the Turner phenotype. J Med Genet 1994;31:840-842.

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16. Pinkel D, Staume I, Gray JW. Cytogenetic analysis using quantitation high sensitive fluorescent hybridization. Proc Natl Acad Sci 1986;83:2934-2938.

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Molecular Biology. New York: Greene and Wiley Interscience; 1993. p. 55-59.

18. Barker DF, Ngyen K, Fain PR. Two simple repeat polymorphisms at DXS 337. Hum Mol Genet 1993;2:1507.

19. Allen RC, Belmont JW. Trinucleotide repeat polymorphism at DXS 101. Hum Mol Genet 1993;2:1508.

20. Sambrook J, Fritch EF, Maniatis T. In: Molecular Cloning: A Laboratory Manual. 2nd ed. New York: Cold Spring Harbor Laboratory Press; 1989.

21. Hassold T, Kumlin E, Takaesu N, Leppert M. Determination of the parental origin of sex chromosome monosomy using RFLP’s. Am J Hum Genet 1985;37:965-972.

22. Jacobs PA, Dalton P, James R, Mosse K, Power M, Robinson D, et al. Turner syndrome: a cytogenetic and molecular study. Ann Hum Genet 1997;61:471-483.

23. Chu CE, Connor JM. Molecular biology of Turner’s syndrome. Arch Dis Child 1995;72:285-286.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 27-06-00 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-10-00 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÷ڿϷÌÔ˜ °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ ¶·È‰›·ÙÚÔ˜ – ∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜ ∂ÈÌÂÏËÙ‹˜ ∞’ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡” ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 180, 115 27 ∞ı‹Ó·

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∏ Â›‰Ú·ÛË ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ ∂˘ı‡ÌÈÔ˜ ∫¿ÎÔ˘ÚÔ˜1, ∫·ÙÂÚ›Ó· ª·ÓÈ·‰¿ÎË2

● ¶ÂÚ›ÏË„Ë: ∏ ¤Ú¢ӷ ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠‰‡Ô ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ÛÙËÓ ∞ı‹Ó· Î·È Û ¤Ó·Ó ÛÙËÓ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË Ì ÙË Û˘ÌÌÂÙÔ¯‹ 140 ·È‰ÈÒÓ ËÏÈΛ·˜ 4-6 ÂÙÒÓ, ÙˆÓ ÌËÙ¤ÚˆÓ Î·È ÙˆÓ ·È‰·ÁˆÁÒÓ ÙÔ˘˜. O ÚÒÙÔ˜ ÛÙfi¯Ô˜ Ù˘ ¤Ú¢ӷ˜ ‹Ù·Ó Ë ÌÂϤÙË Ù˘ Û¯¤Û˘ ÌÂٷ͇ ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜. O ‰Â‡ÙÂÚÔ˜ ÛÙfi¯Ô˜ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Â›‰Ú·Û˘ ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ·˘ÙÒÓ ÛÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ÂÈ¤‰Ô˘ ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ. °È· ÙË ‰ÈÂÍ·ÁˆÁ‹ Ù˘ ¤Ú¢ӷ˜ ˘ÔÏÔÁ›ÛÙËΠÁÈ· οı ·È‰› Ë ‰È·ÊÔÚ¿ ÌÂٷ͇ Ú·ÁÌ·ÙÈÎÔ‡ Î·È È‰·ÓÈÎÔ‡ ‚¿ÚÔ˘˜, Û˘ÌÏËÚÒıËΠ·fi ÙȘ ·È‰·ÁˆÁÔ‡˜ Ë Îϛ̷η BASE ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘ (Coopersmith & Gilberts, 1982) ηıÒ˜ Î·È ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ Î·È Î·Ù·Û΢¿ÛÙËΠÂ›Û˘ Ô ÎÔÈÓˆÓÈÔÌÂÙÚÈÎfi˜ ›Ó·Î·˜ Ô˘ ¤‰ÂȯÓ ÙÔ Â›Â‰Ô ‰ËÌÔÙÈÎfiÙËÙ·˜ ÙÔ˘ οı ·È‰ÈÔ‡. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜, ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ÙËÓ Ù¿ÛË Ó· ıˆÚÔ‡Ó Ù· ·È‰È¿ ÙÔ˘˜ ˆ˜ ÈÔ ·‰‡Ó·Ù· ·’ fi,ÙÈ Ú·ÁÌ·ÙÈο ‹Ù·Ó Î·È Ó· ÌËÓ Â›Ó·È ÈηÓÔÔÈË̤Ó˜ ·fi ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜. ¢È·ÈÛÙÒıËΠÂ›Û˘ fiÙÈ ÔÈ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ·È‰ÈÒÓ Î·ıÔÚ›˙ÔÓÙ·Ó Î˘Ú›ˆ˜ ·fi ÙȘ ˘ÔÎÂÈÌÂÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È fi¯È ·fi ÙȘ Ú·ÁÌ·ÙÈΤ˜ ÙÔ˘˜ ·Ó¿ÁΘ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Â›Â‰Ô ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó Ô˘ÛÈÒ‰ÂȘ ‰È·ÊÔÚ¤˜ Û ۯ¤ÛË Ì ٷ ·È‰È¿ ηÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜. ∆Ô Â‡ÚËÌ· ·˘Ùfi ÂÍËÁÂ›Ù·È ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ ·ÏÏ¿ Î·È ÏfiÁˆ ÙˆÓ ÌË Ú·ÏÈÛÙÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ô˘Û›· ÌÂÙ¿‰ÔÛ˘ ·ÚÓËÙÈÎÒÓ ÌËÓ˘Ì¿ÙˆÓ ÛÙ· ·È‰È¿ Û¯ÂÙÈο Ì ÙËÓ ·¯˘Û·ÚΛ· ÙÔ˘˜. ¶·È‰È·ÙÚÈ΋ 2000;63:507-518. §¤ÍÂȘ ÎÏÂȉȿ: ·È‰È΋ ·¯˘Û·ÚΛ·, ·˘ÙÔÂÎÙ›ÌËÛË, ·ÓÙÈÏ‹„ÂȘ ÁÔÓ¤ˆÓ.

E. Kakouros, K. Maniadaki. The effect of parental attitudes on the presence of childhood obesity. Paediatriki 2000;63:507-518. ● Abstract: This research took place at two nursery schools in Athens and one in Alexandroupolis, with the participation of 140 preschoolers, aged 4-6 years, their mothers and their educators. Our first aim was to study the relationship between the mothers’ attitudes regarding the nutrition of children and the appearance of childhood obesity. Our second aim was to investigate the impact of these attitudes on the development of childrens’ selfesteem. For these aims, we first calculated the difference between the real and the ideal weight for every child. The childrens’ educators filled out the BASE inventory (Coopersmith & Gilberts, 1982) for the assessment of selfesteem level as well as a questionnaire relevant to their attitudes towards nutrition. Finally, we constructed a sociogram, which indicated the popularity of every child among his/her peers. Our results showed that mothers often considered their children as being slimmer than they actually were and were not satisfied by their child’s weight. Furthermore, no significant difference was found between the self-esteem level of overweight children as compared to that of their peers with normal weight. This result can be explained primarily by the young age of the children in the study as well as by the unrealistic attitudes of their mothers in regards to their weight, both of which contributed to the absence of negative messages transmitted to the children about their obesity.

Key words: childhood obesity, self-esteem, parental attitudes. ∆Ì‹Ì· µÚÂÊÔÓËÈÔÎÔÌ›·˜, ∆.∂.π. ∞ı‹Ó·˜ 1. ∫ÏÈÓÈÎfi˜ ·È‰Ô„˘¯ÔÏfiÁÔ˜, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜, ∆Ì‹Ì· µÚÂÊÔÓËÈÔÎÔÌ›·˜, ∆.∂.π. ∞ı‹Ó·˜ 2. ∫ÏÈÓÈ΋ ·È‰Ô„˘¯ÔÏfiÁÔ˜

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∂ÈÛ·ÁˆÁ‹ ™‡Ìʈӷ Ì ÙÔ˘˜ ÂȉÈÎÔ‡˜, Ë ·¯˘Û·ÚΛ· ‰ÂÓ ·ÔÙÂÏ› „˘¯È΋ ‰È·Ù·Ú·¯‹, Â›Ó·È ˆÛÙfiÛÔ ¤Ó· ÔχÏÔÎÔ Úfi‚ÏËÌ·, ÙÔ ÔÔ›Ô ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÂÈÙÒÛÂȘ, fi¯È ÌfiÓÔ ÔÚÁ·ÓÈΤ˜ ·ÏÏ¿ Î·È „˘¯ÔÏÔÁÈΤ˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·¯˘Û·ÚΛ· ¤¯ÂÈ ÔÏϤ˜ ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ ÛÙËÓ ˘Á›· ÙÔ˘ ·ÓıÚÒÔ˘ fiˆ˜ ˘¤ÚÙ·ÛË, ηډȷΤ˜ ·ı‹ÛÂȘ Î.·. OÈ „˘¯ÔÏÔÁÈΤ˜ fï˜ ÂȉڿÛÂȘ Ù˘ ·¯˘Û·ÚΛ·˜ Ê·›ÓÂÙ·È ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÛÔ‚·Ú¤˜ ·fi ÙȘ ÔÚÁ·ÓÈΤ˜ (1). ∏ ‡·ÚÍË ·˘ÙÔ‡ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ‰ÂÓ ÂÓÙÔ›˙ÂÙ·È ÌfiÓÔ ÛÙÔÓ ÎfiÛÌÔ ÙˆÓ ÂÓËÏ›ÎˆÓ ·ÏÏ¿ ·ÁÁ›˙ÂÈ Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Î·È ·È‰È¿ οı ËÏÈΛ·˜. ™‡Ìʈӷ Ì ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ·fi ¯ÒÚ˜ ÙÔ˘ ¢˘ÙÈÎÔ‡ ÎfiÛÌÔ˘, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë ·¯˘Û·ÚΛ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ 5-15% ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÛÙÔ 10-35% ÙˆÓ ÂÊ‹‚ˆÓ (2). ∂›Û˘, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ·˘ÍËÙÈÎÒÓ Ù¿ÛÂˆÓ ÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙÔÓ ·È‰ÈÎfi Î·È ÂÊË‚ÈÎfi ÏËı˘ÛÌfi (3). ™‡Ìʈӷ Ì ÂÎÙÈÌ‹ÛÂȘ ÙÔ˘ LeBow (4), ÙÔ 10-40% ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ∏¶∞, ÙÔ 5-15% ÛÙË µÚÂÙ·Ó›·, ÙÔ 8% ÛÙË ¢. °ÂÚÌ·Ó›· Î·È ÙÔ 5% ÛÙË °ÈÔ˘ÁÎÔÛÏ·‚›· Â›Ó·È ·¯‡Û·Úη. O LeBow ·Ú·ÙËÚ› ·ÎfiÌË ˆ˜ Ë ·¯˘Û·ÚΛ· ÂÌÊ·Ó›˙ÂÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Û ÔÈÎÔÁ¤ÓÂȘ ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ ÂÓÒ Ù· ·È‰È¿ ÙˆÓ Ôχ ÊÙˆ¯ÒÓ ÔÈÎÔÁÂÓÂÈÒÓ Ù›ÓÔ˘Ó Ó· ¤¯Ô˘Ó ‚¿ÚÔ˜ ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·›ÙÈ· Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜, ·˘Ù¿ ÌÔÚ› Ó· Â›Ó·È ÔÈΛϷ. ™Â οÔȘ ÂÚÈÙÒÛÂȘ Ë ·¯˘Û·ÚΛ· ÌÔÚ› Ó· Â›Ó·È Û˘Ó¤ÂÈ· οÔÈÔ˘ ÔÚÁ·ÓÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ‹ Ó· ÂËÚ¿˙ÂÙ·È ·fi ÎÏËÚÔÓÔÌÈ΋ ÚԉȿıÂÛË, Û˘¯ÓfiÙÂÚ· fï˜ Ë ·¯˘Û·ÚΛ· Û¯ÂÙ›˙ÂÙ·È Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜.

OÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ‰È·ÙÚÔÊ‹˜ Ô˘ Ô‰ËÁÔ‡Ó Û ·¯˘Û·ÚΛ· Û˘¯Ó¿ ·Ú¯›˙Ô˘Ó ·fi ÙȘ ÚÒÙ˜ ̤Ú˜ Ù˘ ˙ˆ‹˜. °È· ·Ú¿‰ÂÈÁÌ·, Ë ·Ó·ÛÊ·Ï‹˜ ÌËÙ¤Ú· Ô˘ ÂÚÌËÓ‡ÂÈ Î¿ı ÎÏ¿Ì· ÙÔ˘ ̈ÚÔ‡ Ù˘ Û·Ó Ó· ÚfiÎÂÈÙ·È ÁÈ· ÎÏ¿Ì· ›ӷ˜, ¿ıÂÏ¿ Ù˘ Û˘ÓËı›˙ÂÈ ÙÔ ·È‰› Ó· ηٷʇÁÂÈ ÛÙËÓ ÙÚÔÊ‹ οı ÊÔÚ¿ Ô˘ ¤¯ÂÈ ·Ó¿ÁÎË ·fi ·Ó·ÎÔ‡ÊÈÛË (5). ∂›Û˘, Û ÚfiÛÊ·Ù˜ ÂÚ¢ÓËÙÈΤ˜ ÙÔ˘˜ ÂÚÁ·Û›Â˜, ÙfiÛÔ ÔÈ Tulldahl Î·È Û˘ÓÂÚÁ¿Ù˜ (6) fiÛÔ Î·È ÔÈ Hediger Î·È Û˘ÓÂÚÁ¿Ù˜ (7) ‰È·ÈÛÙÒÓÔ˘Ó ˆ˜ Ù· ‚Ú¤ÊË Ù· ÔÔ›· ıËÏ¿˙Ô˘Ó ÁÈ· ÙÚÂȘ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì‹Ó˜ ¤¯Ô˘Ó Ôχ ÏÈÁfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· Á›ÓÔ˘Ó ·ÚÁfiÙÂÚ· ·¯‡Û·Úη Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ù· ÔÔ›· ‰ÂÓ ıËÏ¿˙Ô˘Ó.

OÈ ÂȉÈÎÔ› ÔÈ ÔÔ›ÔÈ ˘ÈÔıÂÙÔ‡Ó ÙË ıˆڛ· Ù˘ ÎÔÈÓˆÓÈ΋˜ Ì¿ıËÛ˘ ÙÔÓ›˙Ô˘Ó ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ô˘ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ·¯‡Û·ÚÎÔÈ ÁÔÓ›˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿. OÈ ÁÔÓ›˜ ·˘ÙÔ› ·ÔÙÂÏÔ‡Ó ÚfiÙ˘· Î·È ÂÓı·ÚÚ‡ÓÔ˘Ó ÙËÓ ·Ó¿ÏÔÁË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Û ۯ¤ÛË Ì ÙÔ Ê·ÁË-

508

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

Ùfi. OÈ Klesges Î·È Û˘Ó. (8) Û ¤ÚÂ˘Ó¿ ÙÔ˘˜ Ë ÔÔ›· ÛÙËÚÈ˙fiÙ·Ó ÛÙËÓ ·Ú·Ù‹ÚËÛË ·È‰ÈÒÓ ËÏÈΛ·˜ 30 ÌËÓÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ê·ÁËÙÔ‡, ‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÈ Ô‰ËÁ›Â˜ ÙˆÓ ÁÔÓÈÒÓ Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈο ÙfiÛÔ Ì ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘ Ô˘ ·ÊÈÂÚˆÓfiÙ·Ó ÛÙÔ Ê·ÁËÙfi fiÛÔ Î·È Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡. Œ¯ÂÈ ‚ÚÂı› Â›Û˘, ˆ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ÔÈ ÁÔÓ›˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ Ê·ÁËÙfi ÁÈ· Ó· ÈηÓÔÔÈ‹ÛÔ˘Ó Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡ ‹ ÙÔ ¯ÚËÛÈÌÔÔÈÔ‡Ó ˆ˜ ·ÌÔÈ‚‹ fiÙ·Ó ÙÔ ·È‰› ÙÔ˘˜ Û˘ÌÂÚÈʤÚÂÙ·È Î·Ï¿, ÙfiÙ ÌÔÚ› Ó· ‰È·Ù·Ú·¯ı› Ë ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó· Ú˘ıÌ›˙ÂÈ ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· ηٷӷÏÒÓÂÈ Î·È ·˘Ùfi ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÙÔ ·È‰› ÛÙËÓ ·¯˘Û·ÚΛ· (9). ¢È·ÈÛÙÒıËΠ·ÎfiÌË, ˆ˜ ¤Ó·˜ ·fi ÙÔ˘˜ ÈÔ ÛËÌ·ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·È‰È΋ ·¯˘Û·ÚΛ· Â›Ó·È Ë ‡·ÚÍË ·¯˘Û·ÚΛ·˜ ÛÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜ (10). OÈ Mamalakis Î·È Kafatos (11) ÂÎÙÈÌÔ‡Ó ˆ˜ Ë ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ∂ÏÏ‹ÓˆÓ ÁÔÓÈÒÓ Î·ıÒ˜ Î·È Ë ÂÈÌÔÓ‹ ÙÔ˘˜ Ó· Ù·˝˙Ô˘Ó Ù· ·È‰È¿ ÙÔ˘˜ ·ÎfiÌ· Î·È fiÙ·Ó ·˘Ù¿ ‰ÂÓ ÂÈÓÔ‡Ó, Â›Ó·È ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·È‰È΋ ·¯˘Û·ÚΛ·. ∆Ô Úfi‚ÏËÌ· Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ ÂÌÊ·Ó›˙ÂÙ·È È‰È·›ÙÂÚ· ¤ÓÙÔÓÔ ÛÙË ¯ÒÚ· Ì·˜. ¢ÈÂıÓ›˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, fiˆ˜ Ë ¤Ú¢ӷ Ô˘ ‰ÈÂÍ‹Á·Á ÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È Ë American Heart Foundation (12) ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ·¯˘Û·ÚΛ· ÛÙ· ∂ÏÏËÓfiÔ˘Ï· ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ¯ıÚÔ‡˜ Ù˘ ˘Á›·˜ ÙÔ˘˜. ∆· ∂ÏÏËÓfiÔ˘Ï· 13 ÂÙÒÓ ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È Î·Ù¿ ̤ÛÔÓ fiÚÔ ÈÔ ·¯‡Û·Úη ·fi ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ Û ¿ÏϘ ÂÊÙ¿ ¯ÒÚ˜ Î·È Ë ∂ÏÏ¿‰· ›¯Â ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ. ™Â ÌÈ· ÈÔ ÚfiÛÊ·ÙË ¤Ú¢ӷ Ô˘ ¤ÁÈÓ ÛÙËÓ ∫Ú‹ÙË ·fi ÙÔ˘˜ Mamalakis Î·È Û˘ÓÂÚÁ¿Ù˜ (13), ¤¯ÂÈ ÂȂ‚·Èˆı› ÙÔ ·Ú·¿Óˆ ‡ÚËÌ· ·ÊÔ‡ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ·È‰È¿ ÛÙËÓ ∂ÏÏ¿‰· Â›Ó·È Û ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ˘¤Ú‚·Ú· Û ۯ¤ÛË Ì ٷ ·È‰È¿ ÛÙËÓ ∞ÌÂÚÈ΋. ™ÙË ¯ÒÚ· Ì·˜ fï˜, Ê·›ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·¯˘Û·ÚΛ·˜ ÏfiÁˆ Ù˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÛÙÔ Û¯Â‰È·ÛÌfi, ÙÔ˘ ÌÈÎÚÔ‡ ‰Â›ÁÌ·ÙÔ˜ ηıÒ˜ Â›Û˘ Î·È ÙÔ˘ ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÚ¢ÓËÙÈÎÒÓ ÚÔÛ·ıÂÈÒÓ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ˆ˜ ÙÒÚ· (11). Ÿˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÂÓËϛΈÓ, ¤ÙÛÈ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·È‰ÈÒÓ, Ë ·¯˘Û·ÚΛ· ÂÎı¤ÙÂÈ ÙÔ ·È‰› Û ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ÔÚÁ·ÓÈÎÒÓ Î·È „˘¯ÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ™Â ÌÈ· ¤Ú¢ӷ ÙÔ˘ Banis Î·È ÙˆÓ Û˘ÓÂÚÁ·ÙÒÓ ÙÔ˘ (14), Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙÔ §Ô˜ ÕÓÙ˙ÂϘ, ÌÂÏÂÙ‹ıËÎÂ Ë „˘¯ÔÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹ 30 ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ù· ·¯‡Û·Úη ·È‰È¿ ›¯·Ó ÏÈÁfiÙÂÚ˜ ÎÔÈÓˆÓÈΤ˜

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·509

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

‰ÂÍÈfiÙËÙ˜, ÂÚÈÛÛfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÈÔ ·ÚÓËÙÈ΋ ÂÈÎfiÓ· ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘˜ ·fi ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∂›Û˘, ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÂÓÙÔ›ÛÙËΠÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·ÚÓËÙÈÎÒÓ ÌÔÚÊÒÓ ·ÏÏËÏÂ›‰Ú·Û˘. ª›· ·fi ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÂÈÙÒÛÂȘ Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜, Û‡Ìʈӷ Ì ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜, Â›Ó·È Ë ‰È·ÌfiÚʈÛË ¯·ÌËÏ‹˜ ·˘ÙÔÂÎÙ›ÌËÛ˘, ÏfiÁˆ Ù˘ ·ÚÓËÙÈ΋˜ ·Ó·ÙÚÔÊÔ‰fiÙËÛ˘ Ô˘ ‰¤¯ÂÙ·È ÙÔ ·È‰› ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ (15,16). ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ë ‰È·ÌfiÚʈÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÙÔ˘ ·ÙfiÌÔ˘ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ Î·È È‰È·›ÙÂÚ·, ·fi Ù· ÌËӇ̷ٿ Ô˘ ÔÈ ¿ÏÏÔÈ ÌÂÙ·‰›‰Ô˘Ó ÛÙÔ ¿ÙÔÌÔ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘ Î·È ·fi ÙË ÛËÌ·Û›· Ô˘ ÙÔ ¿ÙÔÌÔ ·Ô‰›‰ÂÈ Û ·˘Ù¿ Ù· ÌËӇ̷ٷ. ™‡Ìʈӷ Ì ÙÔÓ Mead (17), ÙÔ ·È‰› ‰È·ÌÔÚÊÒÓÂÈ ÙËÓ ·˘ÙÔÂÈÎfiÓ· ÙÔ˘ Ì·›ÓÔÓÙ·˜ ÛÙË ı¤ÛË ÙÔ˘ ¿ÏÏÔ˘ Î·È ·ÍÈÔÏÔÁÒÓÙ·˜ ÙÔÓ Â·˘Ùfi ÙÔ˘ Ì ‚¿ÛË ÙËÓ ·ÍÈÔÏfiÁËÛË Ô˘ ÈÛÙ‡ÂÈ fiÙÈ ı· ¤Î·ÓÂ Ô ¿ÏÏÔ˜ ÁÈ’ ·˘Ùfi. ∏ ‰È·‰Èηۛ· ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Û ‰‡Ô ÛÙ¿‰È·. ∆Ô ÚÒÙÔ ÛÙ¿‰ÈÔ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ‰È·ÌfiÚʈÛË ÛÙ¿ÛÂˆÓ ·¤Ó·ÓÙÈ ÛÙÔÓ Â·˘Ùfi ·fi ÙËÓ ÔÙÈ΋ ÁˆÓ›· ÙˆÓ «ÛËÌ·ÓÙÈÎÒÓ ¿Ïψӻ (ÔÈÎÔÁ¤ÓÂÈ·, Ê›ÏÔÈ Î.Ï.) ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ‰È·ÌfiÚʈÛË ÛÙ¿ÛÂˆÓ ·¤Ó·ÓÙÈ ÛÙÔÓ Â·˘Ùfi ·fi ÙËÓ ÔÙÈ΋ ÁˆÓ›· ¢ڇÙÂÚˆÓ ÎÔÈÓˆÓÈÎÒÓ ÔÌ¿‰ˆÓ. ™‡Ìʈӷ Ì ÙÔ˘˜ Pelham & Swann (18), Ë ‰È·ÌfiÚʈÛË Ù˘ ·˘ÙÔÂÈÎfiÓ·˜ ‚·Û›˙ÂÙ·È ·Ú¯Èο ÛÂ Û˘Ó·ÈÛıËÌ·ÙÈο ÛÙÔȯ›·, ‰ÈfiÙÈ ÙÔ ·È‰› ‰ÂÓ ¤¯ÂÈ ÙȘ ··ÈÙÔ‡ÌÂÓ˜ ÁÓˆÛÙÈΤ˜ ÈηÓfiÙËÙ˜ ÁÈ· Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔÓ Â·˘Ùfi ÙÔ˘. ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È fï˜ ·Ó ÙÔ ÂÚÈ‚¿ÏÏÔÓ ‰È¿ÎÂÈÙ·È ÊÈÏÈο ‹ ¯ıÚÈο ·¤Ó·ÓÙ› ÙÔ˘. ∞˘Ù¤˜ ÔÈ ÚÒÈ̘ ÎÔÈÓˆÓÈΤ˜ ÂÌÂÈڛ˜ Ô‰ËÁÔ‡Ó Û ¤Ó· ‚·ÛÈÎfi Û˘Ó·›ÛıËÌ· «ÂÚËÊ¿ÓÈ·˜» ‹ «ÓÙÚÔ‹˜», ÙÔ ÔÔ›Ô ·ÔÙÂÏ› ÙË ‚¿ÛË ÁÈ· ÙË ‰È·ÌfiÚʈÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘. ŸÛÔ ÙÔ ·È‰› ÌÂÁ·ÏÒÓÂÈ, ÌÂÁ·ÏÒÓÂÈ Ù·˘Ùfi¯ÚÔÓ· Î·È Ë ·fiÛÙ·ÛË ·Ó¿ÌÂÛ· ÛÙÔÓ Ú·ÁÌ·ÙÈÎfi Î·È ÙÔÓ È‰·ÓÈÎfi ·˘Ùfi ÙÔ˘ ÂÓÒ ·Ú¿ÏÏËÏ·, ÂÛˆÙÂÚÈÎÔÔÈÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÔÈ ·Í›Â˜ Î·È ÔÈ Î·ÓfiÓ˜ Ô˘ ÂÈ‚¿ÏÏÂÈ Ë ÎÔÈÓˆÓ›·, Ì ·ÔÙ¤ÏÂÛÌ· Ë ·ÍÈÔÏfiÁËÛË Ô˘ οÓÂÈ ÙÔ ·È‰› ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘ Ó· ‚·Û›˙ÂÙ·È ÛÙ·‰È·Î¿ Û fiÏÔ Î·È ÈÔ ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ· (19). ™‡Ìʈӷ Ì ٷ ·Ú·¿Óˆ, Á›ÓÂÙ·È Î·Ù·ÓÔËÙ‹ Ë ÂӉ¯fiÌÂÓË Û¯¤ÛË ÌÂٷ͇ ·¯˘Û·ÚΛ·˜ Î·È ¯·ÌËÏ‹˜ ·˘ÙÔÂÎÙ›ÌËÛ˘. H ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ¤Ó· ÎÔÈÓˆÓÈÎfi ÛÙ›ÁÌ·, ÙÔ ÔÔ›Ô Ì¿ÏÈÛÙ· ÂÂȉ‹ Á›ÓÂÙ·È ·Ì¤Ûˆ˜ ÂÌÊ·Ó¤˜ ÛÙÔ ÎÔÈÓˆÓÈÎfi ÂÚ›Á˘ÚÔ, ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙȘ ÎÔÈÓˆÓÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ·Ó¿ÌÂÛ· ÛÙÔ ·¯‡Û·ÚÎÔ ¿ÙÔÌÔ Î·È ÛÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ (20). OÈ ·¯‡Û·ÚÎÔÈ ¿ÓıÚˆÔÈ ÚÔηÏÔ‡Ó, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜, ÙȘ ·ÚÓËÙÈΤ˜ ·ÓÙȉڿÛÂȘ ÙˆÓ ¿ÏψÓ. ª¿ÏÈÛÙ· ÙÔ ÛÙ›ÁÌ· Ù˘ ·-

¶·È‰È΋ ·¯˘Û·ÚΛ·

¯˘Û·ÚΛ·˜ Â›Ó·È È‰È·›ÙÂÚ· ¤ÓÙÔÓÔ ÁÈ· ÙȘ Á˘Ó·›Î˜ ·fi ÙËÓ ÂÊ˂›· Î·È ÌÂÙ¿ (21). øÛÙfiÛÔ, Ù· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË Û¯¤ÛË ÌÂٷ͇ ·¯˘Û·ÚΛ·˜ Î·È ·˘ÙÔÂÎÙ›ÌËÛ˘ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Â›Ó·È Û˘Áί˘Ì¤Ó· Î·È Û˘¯Ó¿ ÚÔ¤Ú¯ÔÓÙ·È ·fi ¤Ú¢Ó˜ Ì ÌÂıÔ‰ÔÏÔÁÈΤ˜ ·‰˘Ó·Ì›Â˜ (22). ∏ ·Ó·ÛÎfiËÛË 25 Û˘Á¯ÚÔÓÈÎÒÓ ÂÚ¢ÓÒÓ ¤‰ÂÈÍ fiÙÈ ÌfiÓÔ ÔÈ 13 ·fi ·˘Ù¤˜ η٤ÏËÁ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ù· ·¯‡Û·Úη ·È‰È¿ ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË ·˘ÙÔÂÎÙ›ÌËÛË ·fi ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ ÙÔ˘˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‚¿ÚÔ˜ ÂÓÒ ÔÈ ˘fiÏÔÈ˜ ‰ÂÓ Î·Ù¤ÏËÁ·Ó Û ·ÚfiÌÔÈÔ Û˘Ì¤Ú·ÛÌ·. ª¿ÏÈÛÙ· ÙÔ ·Ú·¿Óˆ Û˘Ì¤Ú·ÛÌ· ·ÊÔÚÔ‡Û ΢ڛˆ˜ ÛÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· ÙˆÓ ÂÊ‹‚ˆÓ (13-18 ÂÙÒÓ) Î·È fi¯È ÛÙ· ÌÈÎÚfiÙÂÚ· ·È‰È¿ (22).

OÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ (23) Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‰ÂÓ ÂËÚ¿˙ÂÙ·È ÁÂÓÈο Ë ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ·ÏÏ¿ ÌfiÓÔ ÔÈ ‰È·ÛÙ¿ÛÂȘ Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Â͈ÙÂÚÈ΋ ÂÌÊ¿ÓÈÛË. º·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ ÔÈ „˘¯ÔÏÔÁÈΤ˜ ÂȉڿÛÂȘ Ù˘ ·¯˘Û·ÚΛ·˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ›‰È˜ ‰ÈfiÙÈ ‰ÂÓ ‚ÈÒÓÔ˘Ó fiÏ· Ù· ·È‰È¿ ÙËÓ ·¯˘Û·ÚΛ· Ì ÙÔÓ ›‰ÈÔ ÙÚfiÔ. OÈ Pierce & Wardle (24) ÌÂϤÙËÛ·Ó Î·Ù¿ fiÛÔÓ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡, Ë ÂÎÙ›ÌËÛË ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù· ÈÛÙ‡ˆ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÙȘ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÁÔÓÈÒÓ ÂËÚ¿˙Ô˘Ó ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘. ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ù· ·È‰È¿ ÚԂϤÔ˘Ó ÛˆÛÙ¿ ÔȘ ı· Â›Ó·È ÔÈ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È fiÙÈ Ë ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÂËÚ¿˙ÂÙ·È ÙfiÛÔ ·fi ·˘Ù¤˜ ÙȘ ÂÎÙÈÌ‹ÛÂȘ fiÛÔ Î·È ·fi Ù· ÈÛÙ‡ˆ ÙÔ˘˜ ÁÈ’ ·˘Ù¤˜ ÙȘ ÂÎÙÈÌ‹ÛÂȘ. ™Â Ì›· ¿ÏÏË ¤ÚÂ˘Ó¿ ÙÔ˘˜, ÔÈ ›‰ÈÔÈ Û˘ÁÁÚ·Ê›˜ (25) ‰È·›ÛÙˆÛ·Ó fiÙÈ Ë ·˘ÙÔÂÎÙ›ÌËÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÂËÚ¿˙ÂÙ·È ·fi ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô Ù· ·È‰È¿ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ·›ÙÈ· Ù˘ ·¯˘Û·ÚΛ·˜ ÙÔ˘˜ Î·È ÙȘ ÂȉڿÛÂȘ Ô˘ ¤¯ÂÈ ÛÙÔÓ ÙÚfiÔ Ô˘ Ù· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ¿ÏÏÔÈ. ∆· ·È‰È¿ Ô˘ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë ·¯˘Û·ÚΛ· ÙÔ˘˜ ÔÊ›ÏÂÙ·È Û ‰ÈÎfi ÙÔ˘˜ ÛÊ¿ÏÌ· (.¯. ÔÏ˘Ê·Á›· Î·È ÌÂȈ̤ÓË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË), ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË ·˘ÙÔÂÎÙ›ÌËÛË ·fi Ù· ·È‰È¿ Ô˘ ·Ô‰›‰Ô˘Ó ÙËÓ ·¯˘Û·ÚΛ· ÙÔ˘˜ Û Â͈ÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜ (.¯. ÚԉȿıÂÛË ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÔÚÁ·ÓÈ΋ ¿ıËÛË Î.Ï.). ∂›Û˘, ·Ó ÁÈ· ·Ú¿‰ÂÈÁÌ· οÔÈÔ ·È‰› ÈÛÙ‡ÂÈ fiÙÈ Ù· ¿ÏÏ· ·È‰È¿ ‰ÂÓ ÙÔ ı¤ÏÔ˘Ó ÛÙËÓ ·Ú¤· ÙÔ˘˜ ÂÂȉ‹ Â›Ó·È ·¯‡Û·ÚÎÔ, ÙfiÙ ·˘Ù‹ Ë ÂÓÙ‡ˆÛË ÙÔ Ô‰ËÁ› Û ÌÂȈ̤ÓË ·˘ÙÔÂÎÙ›ÌËÛË. ∞Ó fï˜ ¤Ó· ·¯‡Û·ÚÎÔ ·È‰› ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙËÓ ·¯˘Û·ÚΛ· ÙÔ˘ ˆ˜ Ì›· ηٿÛÙ·ÛË Ô˘ ÙÔ ÛÙÈÁÌ·Ù›˙ÂÈ, ÙfiÙÂ Ë ·¯˘Û·ÚΛ· ‰ÂÓ Âȉڿ ÛÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘. ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ, ˘Ôı¤ÙÔ˘Ì fiÙÈ ÙÔ Â›Â‰Ô ·˘ÙÔÂÎÙ›ÌËÛ˘ Î·È ‰ËÌÔÙÈÎfiÙËÙ·˜ ÙˆÓ ·¯‡-

509

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·510

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

ˆÁË

Û·ÚÎˆÓ ·È‰ÈÒÓ ‰ÂÓ ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ ·ÏÏ¿ ÂËÚ¿˙ÂÙ·È ·fi ÙÔÓ ÙÚfiÔ Ô˘ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙËÓ ·¯˘Û·ÚΛ· ÙÔ˘˜. ∆ËÓ ˘fiıÂÛË ·˘Ù‹ ıÂÏ‹Û·Ì ӷ ÂϤÁÍÔ˘Ì ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ, ÛÙËÓ ÔÔ›· ı¤Û·Ì ˆ˜ ÂȉÈÎfiÙÂÚÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜: ·) ∆Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ Î·È ÙË Û¯¤ÛË ÙÔ˘˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜, ‚) ∆Ë ÌÂϤÙË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙȘ ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙÔ ‰È¿ÛÙËÌ· ª·ÚÙ›Ô˘-ª·˝Ô˘ 1999 Û ‰‡Ô ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ÛÙËÓ ∞ı‹Ó· Î·È Û ¤Ó·Ó ·È‰ÈÎfi ÛÙ·ıÌfi ÛÙËÓ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË Ì ÙË Û˘ÌÌÂÙÔ¯‹ 200 ·È‰ÈÒÓ ËÏÈΛ·˜ 4-6 ÂÙÒÓ, ÙˆÓ ·È‰·ÁˆÁÒÓ Î·È ÙˆÓ ÌËÙ¤ÚˆÓ ÙˆÓ ·È‰ÈÒÓ. EÈϤͷÌ ˆ˜ ÙfiÔ ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ ¤Ú¢ӷ˜ ÙËÓ ∞ı‹Ó· Î·È Ì›· Â·Ú¯È·Î‹ fiÏË ‰ÈfiÙÈ ı¤Ï·Ì ӷ ‰ÈÂÚ¢ӋÛÔ˘Ì ηٿ fiÛÔÓ Ô ÙfiÔ˜ ηٷÁˆÁ‹˜ Î·È ‰È·‚›ˆÛ˘ Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙȘ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÁÔÓÈÒÓ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ. ªÈ· ·fi ÙȘ ÛËÌ·ÓÙÈΤ˜ ‰˘ÛÎÔϛ˜ ÔÏÏÒÓ ÂÚ¢ÓÒÓ Û¯ÂÙÈο Ì ÙËÓ ·¯˘Û·ÚΛ· Â›Ó·È Ô ÔÚÈÛÌfi˜ Ù˘. Œ¯Ô˘Ó ÚÔÙ·ı› ηٿ ηÈÚÔ‡˜ ‰È¿ÊÔÚÔÈ Ù‡ÔÈ, fiˆ˜ Ë Ì¤ÙÚËÛË ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (mass body index), ÂÌ›˜ fï˜ ÚÔÙÈÌ‹Û·Ì ÙÔÓ ·ÏÔ‡ÛÙÂÚÔ ÚÔÛ‰ÈÔÚÈÛÌfi ÁÈ· ÙËÓ ·‰Ú‹ ÂÎÙ›ÌËÛË Ù˘ ·¯˘Û·ÚΛ·˜ Ì ‚¿ÛË ÙÔ ÔÛÔÛÙfi ·fiÎÏÈÛ˘ ÌÂٷ͇ Ú·ÁÌ·ÙÈÎÔ‡ Î·È È‰·ÓÈÎÔ‡ ‚¿ÚÔ˘˜ (26). ™Â ÚÒÙË Ê¿ÛË ÏÔÈfiÓ, ˙˘Á›ÛÙËÎ·Ó fiÏ· Ù· ·È‰È¿ Î·È Î·Ù·ÁÚ¿ÊËΠÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜. ∫·ÙfiÈÓ ˘ÔÏÔÁ›ÛÙËΠÙÔ È‰·ÓÈÎfi ‚¿ÚÔ˜ ÙÔ˘ οı ·È‰ÈÔ‡ Ì ‚¿ÛË ÙÔÓ Ù‡Ô «ËÏÈΛ· Û ¯ÚfiÓÈ· x 2+8=‚¿ÚÔ˜ Û kg» (27) (Ô ÔÔ›Ô˜ ÈÛ¯‡ÂÈ ÁÈ· ·È‰È¿ ¤ˆ˜ 11 ÂÙÒÓ), Î·È ÛÙË Û˘Ó¤¯ÂÈ· ˘ÔÏÔÁ›ÛÙËÎÂ Ë ‰È·ÊÔÚ¿ ÌÂٷ͇ Ú·ÁÌ·ÙÈÎÔ‡ Î·È È‰·ÓÈÎÔ‡ ‚¿ÚÔ˘˜. ªÂ ‚¿ÛË ÙÔ ÔÛÔÛÙfi ·fiÎÏÈÛ˘ ÌÂٷ͇ Ú·ÁÌ·ÙÈÎÔ‡ Î·È È‰·ÓÈÎÔ‡ ‚¿ÚÔ˘˜, Ù· ·È‰È¿ ÙÔ˘ ‰Â›ÁÌ·Ùfi˜ Ì·˜ ηٷٿ¯ıËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜: ·) ·È‰È¿ Ì ‚¿ÚÔ˜ ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡, fiÔ˘ ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ‹Ù·Ó ηٿ 20% ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ȉ·ÓÈÎÔ‡ ‚¿ÚÔ˘˜, ‚) ·È‰È¿ Ì ηÓÔÓÈÎfi ‚¿ÚÔ˜, fiÔ˘ ÙÔ ÔÛÔÛÙfi ·fiÎÏÈÛ˘ ÌÂٷ͇ Ú·ÁÌ·ÙÈÎÔ‡ Î·È È‰·ÓÈÎÔ‡ ‚¿ÚÔ˘˜ Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ -19% ¤ˆ˜ +19%, Á) ·È‰È¿ Ì ‚¿ÚÔ˜ ˘„ËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡, fiÔ˘ ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ‹Ù·Ó ηٿ 20% ÙÔ˘Ï¿¯ÈÛÙÔÓ ˘„ËÏfiÙÂÚÔ ÙÔ˘ ȉ·ÓÈÎÔ‡ ‚¿ÚÔ˘˜. ™Â ‰Â‡ÙÂÚË Ê¿ÛË ˙ËÙ‹ıËΠ·fi ÙȘ ·È‰·ÁˆÁÔ‡˜

510

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

ÙˆÓ ·È‰ÈÒÓ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÁÈ· οı ·È‰› ÙËÓ Îϛ̷η BASE (28) ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘. ∏ Îϛ̷η BASE (Behavioral Academic Self Esteem) Â›Ó·È ÛÙ·ıÌÈṲ̂ÓË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË Û ¿ÙÔÌ· ËÏÈΛ·˜ 415 ÂÙÒÓ, ·ÔÙÂÏÂ›Ù·È ·fi 16 ÂÚˆÙ‹ÛÂȘ Î·È ·ÍÈÔÏÔÁ› ÙÔ Â›Â‰Ô ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Û¯ÔÏÈÎfi Ï·›ÛÈÔ. OÈ ÂÚˆÙ‹ÛÂȘ Ù˘ Îϛ̷η˜ BASE ηχÙÔ˘Ó ÙÔÌ›˜ fiˆ˜ ÙÔ Â›Â‰Ô ·Ó¿Ï˄˘ ÚˆÙÔ‚Ô˘ÏÈÒÓ, ÙËÓ ÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹, ÙËÓ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ ·ÔÙ˘¯›·, ÙÔ Â›Â‰Ô ·Ô‰Ô¯‹˜ ·fi ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ Î·È ÙËÓ ·˘ÙÔÂÔ›ıËÛË. ∂›Û˘, ÁÈ· ÙË ÌÂϤÙË Ù˘ ‰ËÌÔÙÈÎfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÎÔÈÓˆÓÈfiÁÚ·ÌÌ· ∆Ô ÎÔÈÓˆÓÈfiÁÚ·ÌÌ·, ÂÌÓ¢ÛÙ‹˜ ÙÔ˘ ÔÔ›Ô˘ ‹Ù·Ó Ô J.L. Moreno (29), ·ÔÙÂÏ› ̤ÛÔ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÏÏËÏÂȉڿÛÂˆÓ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ·Ó¿ÌÂÛ· ÛÙ· ̤ÏË ÌÈ·˜ ÔÌ¿‰·˜, ÂÎÊÚ¿˙ÂÈ ‰ËÏ·‰‹, ÔÛÔÙÈο Î·È ÔÈÔÙÈο ÙȘ ÎÔÈÓˆÓÈΤ˜ Â·Ê¤˜ Î·È ÙȘ Û¯¤ÛÂȘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È Û ÌÈ· ÎÔÈÓˆÓÈ΋ ÔÌ¿‰·. ™Ù· Ï·›ÛÈ· Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜, ÔÈ ·È‰·ÁˆÁÔ› ÚÒÙËÛ·Ó Î¿ı ·È‰› Ì ÔÈÔ ·fi Ù· ·È‰È¿ Ù˘ Ù¿Í˘ ÙÔ˘ οÓÂÈ ÂÚÈÛÛfiÙÂÚÔ ·Ú¤·. °È· ÙËÓ Î·Ù·Û΢‹ ÙÔ˘ ÎÔÈÓˆÓÈÔÌÂÙÚÈÎÔ‡ ›Ó·Î· ηٷÁÚ¿„·Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÚÔÙÈÌ‹ÛÂˆÓ Ô˘ ›¯Â Û˘ÁÎÂÓÙÚÒÛÂÈ Î¿ı ·È‰› Î·È ÛÙË Û˘Ó¤¯ÂÈ·, Ì ‚¿ÛË ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ··ÓÙ‹ÛˆÓ, ¯ˆÚ›Û·Ì ٷ ·È‰È¿ Û ÙÚÂȘ ÔÌ¿‰Â˜: ·) ·È‰È¿ Ì ¯·ÌËÏ‹ ‰ËÌÔÙÈÎfiÙËÙ· (0-1 ÚÔÙÈÌ‹ÛÂȘ), ‚) ·È‰È¿ Ì ̤ÙÚÈ· ‰ËÌÔÙÈÎfiÙËÙ· (2 ÚÔÙÈÌ‹ÛÂȘ), Á) ·È‰È¿ Ì ˘„ËÏ‹ ‰ËÌÔÙÈÎfiÙËÙ· (¿Óˆ ·fi 3 ÚÔÙÈÌ‹ÛÂȘ). ∆¤ÏÔ˜, ˙ËÙ‹ıËΠ·fi ÙȘ ÌËÙ¤Ú˜ ÙˆÓ ·È‰ÈÒÓ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ¤Ó· Έ‰ÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. ∆Ô ÚÒÙÔ Ì¤ÚÔ˜ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÂÚÈÏ¿Ì‚·Ó ÔÚÈṲ̂ӷ ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ ·ÔÛÎÔÔ‡Û ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ ÌËÙ¤ÚˆÓ Û¯ÂÙÈο Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÛÙË Û˘ÁΤÓÙÚˆÛË ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÁÔÓÈÒÓ Î·È ·È‰ÈÒÓ. ∞fi Ù· 200 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ‰È·ÓÂÌ‹ıËηÓ, ÂÈÛÙÚ¿ÊËÎ·Ó Û˘ÌÏËڈ̤ӷ Ù· 140. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÛÙÔȯ›ˆÓ Ô˘ Û˘ÁÎÂÓÙÚÒıËηÓ, ·ÍÈÔÔÈ‹ıËÎ·Ó ·˘Ù¿ Ô˘ ·ÊÔÚÔ‡Û·Ó Û 140 ·È‰È¿, ÁÈ· Ù· ÔÔ›· ˘‹Ú¯Â Ï‹Ú˘ ·ÍÈÔÏfiÁËÛË. O ̤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó Ù· 4,7 ¤ÙË (sd=0,74). ∞fi Ù· ·È‰È¿ ·˘Ù¿, Ù· 85 ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙËÓ ∞ı‹Ó· Î·È Ù· 55 ·fi ÙËÓ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË. ∂›Û˘ Ù· 62 ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù· 78 ÎÔÚ›ÙÛÈ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ, Ë ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ (70,7% ÙˆÓ ÌËÙ¤ÚˆÓ Î·È 62,9% ÙˆÓ ·Ù¤ÚˆÓ) ·Ó‹Î ÛÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· 31-40 ÂÙÒÓ. ∂›Û˘, ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÁÔÓÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‹Ù·Ó ·ÚÎÂÙ¿ ˘„ËÏfi ·ÊÔ‡ ¿Óˆ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ‹Ù·Ó ·fiÊÔÈÙÔÈ ·ÓÒÙÂÚ˘ ‹ ·ÓÒÙ·Ù˘ Û¯ÔÏ‹˜.

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·511

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

¶·È‰È΋ ·¯˘Û·ÚΛ·

¶›Ó·Î·˜ 1. ™‡ÁÎÚÈÛË ÌÂٷ͇ ÙÔ˘ Ú·ÁÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÎÙÈÌ‹ÛÂˆÓ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ. ¶Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ∂ÎÙ›ÌËÛË Ù˘ ÙÔ˘ ·È‰ÈÔ‡ ÌËÙ¤Ú·˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ % % ∫·ÓÔÓÈÎfi

50,7

82,9

À„ËÏfi

49,3

6,4

÷ÌËÏfi

0

10,7

C=0,26, p<0,01

∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Î·È ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ‰Â›ÎÙ˘ Û˘Ó¿ÊÂÈ·˜ C, Ô ÔÔ›Ô˜ Â›Ó·È Î·Ù¿ÏÏËÏÔ˜ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ Û˘Ó¿ÊÂÈ·˜ ηÙËÁÔÚÈÎÒÓ ‰ÈÌÂÙ·‚ÏËÙÒÓ, ÛÙȘ Ôԛ˜ Ë ÌÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÙ·‚ÏËÙ‹ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ‰‡Ô ηÙËÁÔڛ˜. ∞ÔÙÂϤÛÌ·Ù· ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·Ùfi˜ Ì·˜ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 49,3%, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ Ô‡Ù ¤Ó· ·È‰› Ì ‚¿ÚÔ˜ ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡ (¶›Ó·Î·˜ 1). øÛÙfiÛÔ, Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, ¤¯ÂÈ ÌÂÁ¿ÏË ·fiÎÏÈÛË ·fi ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. ™‡Ìʈӷ Ì ٷ ÛÙÔȯ›· ÙÔ˘ ¶›Ó·Î· 1, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 49,3%, ÌfiÓÔ ÙÔ 6,4% ÙˆÓ ÌËÙ¤ÚˆÓ ÂÎÙÈÌ¿ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È ·¯‡Û·ÚÎÔ. ∞ÓÙ›ıÂÙ·, ÙÔ 82,9% ÙˆÓ ÌËÙ¤ÚˆÓ ıˆÚ› fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ Î·ÓÔÓÈÎfi ‚¿ÚÔ˜ ÂÓÒ ÙÔ 10,7% ÂÎÙÈÌ¿ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ ¯·ÌËÏfiÙÂÚÔ ‚¿ÚÔ˜ ·fi ÙÔ Î·ÓÔÓÈÎfi.

OÈ ÂÛÊ·Ï̤Ó˜ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù·‰ÂÈ-

ÎÓ‡ÔÓÙ·È Î·È ·fi Ù· ÛÙÔȯ›· ÙÔ˘ ¶›Ó·Î· 2, fiÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÙÔ 86,7% ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· ÔÈ ÌËÙ¤Ú˜ ÙÔ˘˜ ıˆÚÔ‡Ó ˆ˜ ·È‰È¿ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜, ¤¯ÂÈ Î·ÓÔÓÈÎfi ‚¿ÚÔ˜, ÂÓÒ ÙÔ 51,7% ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· ÔÈ ÌËÙ¤Ú˜ ÙÔ˘˜ ıˆÚÔ‡Ó ˆ˜ ·È‰È¿ ηÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜, ¤¯ÂÈ ˘„ËÏfi ‚¿ÚÔ˜. ª¿ÏÈÛÙ· ÙÔ 13,3% ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÂÎÙÈÌ¿ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ ‚¿ÚÔ˜ ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡ ÂÓÒ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ ·È‰› Â›Ó·È ·¯‡Û·ÚÎÔ. ∂›Ó·È Ê·ÓÂÚfi ÏÔÈfiÓ, fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Ó¿ÊÂÈ· ·Ó¿ÌÂÛ· ÛÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜. ∏ Û‡ÁÎÚÈÛË ·Ó¿ÌÂÛ· ÛÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙÔ ‚¿ÚÔ˜ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘˜ (ÙÔ ‚¿ÚÔ˜ ÙˆÓ ÌËÙ¤ÚˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙȘ ˘ÔÎÂÈÌÂÓÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ›‰ÈˆÓ), ·Ó Î·È ‰ÂÓ ¤‰ÂÈÍ ˘„ËÏ‹ Û˘Ó¿ÊÂÈ·, ¤‰ÂÈÍ fï˜ Ì›· Ù¿ÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ÌËÙ¤ÚˆÓ Ó· ¤¯Ô˘Ó Î·È ·¯‡Û·Úη ·È‰È¿ Û ÔÛÔÛÙfi 54,8%. ∞ÓÙ›ıÂÙ·, ÌfiÓÔ ÙÔ 33,3% ÙˆÓ ·È‰ÈÒÓ Ì ÌËÙ¤Ú˜ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Â›Ó·È ·¯‡Û·Úη (¶›Ó·Î·˜ 3). ™ÙËÓ ÂÚÒÙËÛ‹ Ì·˜ «∆È ı· ¤Î·Ó ÙÔ ·È‰› Û·˜ ·Ó ·ÊËÓfiÙ·Ó ÂÓÙÂÏÒ˜ ÂχıÂÚÔ Ó· Ê¿ÂÈ fiÔÙ ı¤ÏÂÈ;», ÙÔ 57,9 % ÙˆÓ ÌËÙ¤ÚˆÓ ·¿ÓÙËÛ fiÙÈ ÙÔ ·È‰› ı· ¤ÙÚˆÁ ηÓÔÓÈ΋ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ ÂÓÒ ÙÔ 37,1% ·¿ÓÙËÛ fiÙÈ ÙÔ ·È‰› ı· ¤ÙÚˆÁ ÌÈÎÚfiÙÂÚË ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ ·fi ÙÔ Î·ÓÔÓÈÎfi (¶›Ó·Î·˜ 4). ¶·Ú·ÙËÚԇ̠ÏÔÈfiÓ fiÙÈ ¤Ó· ·ÚÎÂÙ¿ ˘„ËÏfi ÔÛÔÛÙfi ÌËÙ¤ÚˆÓ ıˆÚ› fiÙÈ ÙÔ ·È‰› ı· ˘ÔÛÈÙÈÛÙ› ·Ó ·ÊÂı› ÂχıÂÚÔ Ó· Ê¿ÂÈ fiÛÔ ÓÔÌ›˙ÂÈ ÙÔ ›‰ÈÔ fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È. ∞fi Ù· ÛÙÔȯ›· ÙÔ˘ ›‰ÈÔ˘ ›Ó·Î· ÚÔ·ÙÂÈ Â›Û˘ fiÙÈ ˘¿Ú¯ÂÈ ˘„ËÏ‹ Û˘Ó¿ÊÂÈ· (c=0,57, p<0,001) ·Ó¿ÌÂÛ· ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Ù˘ Î·È ÙËÓ ÂÎÙ›ÌËÛ‹ Ù˘ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› Ù˘ ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ. °È· ·Ú¿‰ÂÈÁÌ· ‚ϤÔ˘Ì fiÙÈ ÙÔ 86,7% ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ ÌÈÎÚfiÙÂÚÔ ‚¿ÚÔ˜ ·fi ÙÔ Î·ÓÔÓÈÎfi ÈÛÙ‡ÂÈ fiÙÈ ·Ó ·˘Ùfi ·ÊÂı› ÂχıÂÚÔ, ı· Ê¿ÂÈ ÏÈÁfiÙÂÚÔ ·’ fiÛÔ Ú¤ÂÈ. øÛÙfiÛÔ, ·Ó ÌÂÏÂÙ‹ÛÔ˘Ì ÙË Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ

¶›Ó·Î·˜ 2. ∏ ÂÎÙ›ÌËÛË ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡. ¶Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ·È‰ÈÔ‡ (¡=140) ∂ÎÙ›ÌËÛË ÁÈ·

÷ÌËÏfi ‚¿ÚÔ˜

∫·ÓÔÓÈÎfi ‚¿ÚÔ˜

∫·ÓÔÓÈÎfi ‚¿ÚÔ˜

ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡

%

%

%

÷ÌËÏfi

0

86,7

13,3

∫·ÓÔÓÈÎfi

0

48,3

51,7

À„ËÏfi

0

22,2

77,8

™‡ÓÔÏÔ

0

50,7

49,3

C=0,26, p<0,01

511

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·512

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

¶›Ó·Î·˜ 3. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. µ¿ÚÔ˜ ·È‰ÈÔ‡ (¡=140) µ¿ÚÔ˜ ÌËÙ¤Ú·˜ ÷ÌËÏfi ∫·ÓÔÓÈÎfi À„ËÏfi ™‡ÓÔÏÔ

÷ÌËÏfi ‚¿ÚÔ˜ % 0 0 0

∫·ÓÔÓÈÎfi ‚¿ÚÔ˜ % 66,7 52,6 45,2

0

À„ËÏfi ‚¿ÚÔ˜ % 33,3 47,4 54,8

50,7

49,3

C=0,08, p>0,01

¶›Ó·Î·˜ 4. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› ÙÔ˘˜ ·Ó ·ÊËÓfiÙ·Ó ÂÓÙÂÏÒ˜ ÂχıÂÚÔ. ∂ÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› Ù˘ (¡=140) ∂ÎÙ›ÌËÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÷ÌËÏfi ∫·ÓÔÓÈÎfi À„ËÏfi ™‡ÓÔÏÔ

ªÂÁ·Ï‡ÙÂÚË ·fi ÙÔ Î·ÓÔÓÈÎfi % 0 1,7 55,6 5

ªÈÎÚfiÙÂÚË ·fi ÙÔ Î·ÓÔÓÈÎfi % 86,7 33,6 0

∫·ÓÔÓÈ΋

37,1

57,9

% 13,3 64,7 44,4

C=0,57, p<0,001

¶›Ó·Î·˜ 5. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› ÙÔ˘˜ ·Ó ·ÊËÓfiÙ·Ó ÂÓÙÂÏÒ˜ ÂχıÂÚÔ. ∂ÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› Ù˘ (¡=140) ¶Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÷ÌËÏfi ∫·ÓÔÓÈÎfi À„ËÏfi ™‡ÓÔÏÔ C=0,15, p>0,01

512

ªÂÁ·Ï‡ÙÂÚË ·fi ÙÔ Î·ÓÔÓÈÎfi % 0 2,8 7,2 5

ªÈÎÚfiÙÂÚË ·fi ÙÔ Î·ÓÔÓÈÎfi % 0 43,7 30,4

∫·ÓÔÓÈ΋

37,1

57,9

% 0 53,5 62,3

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·513

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

¶·È‰È΋ ·¯˘Û·ÚΛ·

¶›Ó·Î·˜ 6. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙÔ ‚·ıÌfi ÈηÓÔÔ›ËÛ‹˜ ÙÔ˘˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› ÙÔ˘˜. µ·ıÌfi˜ ÈηÓÔÔ›ËÛ˘ Ù˘ ÌËÙ¤Ú·˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› Ù˘ (¡=140) ∂ÎÙ›ÌËÛË ÁÈ· ÙÔ ‚¿ÚÔ˜

£· ‹ıÂÏ· Ó· ÙÚÒÂÈ

£· ‹ıÂÏ· Ó· ÙÚÒÂÈ

ÂÚÈÛÛfiÙÂÚÔ

ÏÈÁfiÙÂÚÔ

%

%

%

÷ÌËÏfi

73,3

13,3

13,3

∫·ÓÔÓÈÎfi

20,7

0

79,3

À„ËÏfi

0

66,7

33,3

™‡ÓÔÏÔ

25

5,7

69,3

ÙÔ˘ ·È‰ÈÔ‡

∂›Ì·È ¢¯·ÚÈÛÙË̤ÓË

C=0,63, p<0,001

Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› Ù˘ ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ, ÙfiÙ ı· ‰È·ÈÛÙÒÛÔ˘Ì fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Ó¿ÊÂÈ· (¶›Ó·Î·˜ 5). ∆Ô 62,3% ÙˆÓ ÌËÙ¤ÚˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÈÛÙ‡ÂÈ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ı· ¤ÙÚˆÁ ηÓÔÓÈο ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ ÂÓÒ ÙÔ 30,4% ÈÛÙ‡ÂÈ fiÙÈ ÙÔ ·È‰› ı· ¤ÙÚˆÁ ÏÈÁfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi. ∂ÈϤÔÓ, ÙÔ 43,7% ÙˆÓ ÌËÙ¤ÚˆÓ ·È‰ÈÒÓ Ì ηÓÔÓÈÎfi ‚¿ÚÔ˜ ÈÛÙ‡ÂÈ Â›Û˘, fiÙÈ ·Ó ‰ÈÓfiÙ·Ó ÛÙÔ ·È‰› Ë ÚˆÙÔ‚Ô˘Ï›·, ı· ¤ÙÚˆÁ ÏÈÁfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi. º·›ÓÂÙ·È ‰ËÏ·‰‹, fiÙÈ Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ ˘ÔÎÂÈÌÂÓÈ΋ ÙÔ˘˜ ÂÎÙ›ÌËÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È fi¯È Ì ÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘ ‚¿ÚÔ˜. ¶·ÚfiÌÔÈ· Â›Ó·È Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛÙÔȯ›ˆÓ ÙˆÓ ÈÓ¿ÎˆÓ 6 Î·È 7 Ù· ÔÔ›· ·ÊÔÚÔ‡Ó ÛÙÔ ‚·ıÌfi ÈηÓÔÔ›ËÛ˘ ÙˆÓ ÌËÙ¤ÚˆÓ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ

ÙÔ ·È‰› ÙÔ˘˜ ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡. ∫·Ù·Ú¯‹Ó, Ê·›ÓÂÙ·È fiÙÈ ÙÔ 25% ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·Ùfi˜ Ì·˜ ı· ‹ıÂÏ ÙÔ ·È‰› ÙÔ˘˜ Ó· ÙÚÒÂÈ ÂÚÈÛÛfiÙÂÚÔ. º·›ÓÂÙ·È Â›Û˘, fiÙÈ ÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ÔÈ ÌËÙ¤Ú˜ ÂÎÙÈÌÔ‡Ó fiÙÈ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ¯·ÌËÏfi, ı· ‹ıÂÏ·Ó ÙÔ ·È‰› Ó· ÙÚÒÂÈ ÂÚÈÛÛfiÙÂÚÔ Û ÔÛÔÛÙfi 73,3%, ÂÓÒ ÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ÂÎÙÈÌÔ‡Ó fiÙÈ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ˘„ËÏfi, ı· ‹ıÂÏ·Ó ÙÔ ·È‰› Ó· ÙÚÒÂÈ ÏÈÁfiÙÂÚÔ, Û ÔÛÔÛÙfi 66,7% (¶›Ó·Î·˜ 6). ∫·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË fï˜, Ô ‚·ıÌfi˜ ÈηÓÔÔ›ËÛ˘ Ù˘ ÌËÙ¤Ú·˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› Ù˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ˘ÔÎÂÈÌÂÓÈ΋ Ù˘ ÂÎÙ›ÌËÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È fi¯È Ì ÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘ ‚¿ÚÔ˜. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 7, ÙÔ 33,8% ÙˆÓ ÌËÙ¤ÚˆÓ ·È‰ÈÒÓ Ì ηÓÔÓÈÎfi ‚¿ÚÔ˜ ı· ‹ıÂÏ ӷ ÙÚÒÂÈ ÂÚÈÛÛfiÙÂÚÔ ÙÔ ·È‰› ÙÔ˘˜, ÂÓÒ ÙÔ 78,3% ÙˆÓ ÌËÙ¤ÚˆÓ

¶›Ó·Î·˜ 7. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙÔ ‚·ıÌfi ÈηÓÔÔ›ËÛ‹˜ ÙÔ˘˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› ÙÔ˘˜. µ·ıÌfi˜ ÈηÓÔÔ›ËÛ˘ Ù˘ ÌËÙ¤Ú·˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› Ù˘ (¡=140) ∂ÎÙ›ÌËÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÷ÌËÏfi

£· ‹ıÂÏ· Ó· ÙÚÒÂÈ

£· ‹ıÂÏ· Ó· ÙÚÒÂÈ

ÂÚÈÛÛfiÙÂÚÔ

ÏÈÁfiÙÂÚÔ

%

%

∂›Ì·È ¢¯·ÚÈÛÙË̤ÓË %

0

0

0

∫·ÓÔÓÈÎfi

33,8

5,6

60,6

À„ËÏfi

15,9

5,8

78,3

™‡ÓÔÏÔ

25

5,7

69,3

C=0,20, p<0,05

513

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·514

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

¶›Ó·Î·˜ 8. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ȉÈÔÙÚÔ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Ê·ÁËÙfi. ™˘¯ÓfiÙËÙ· ȉÈÔÙÚÔ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Ê·ÁËÙfi (¡=140) ÷ÌËÏfi ∫·ÓÔÓÈÎfi À„ËÏfi

33,3 5,2 0

46,7 45,7 11,1

13,3 44 33,3

6,7 5,2 55,6

™‡ÓÔÏÔ

7,9

43,6

40

8,6

C=0,49, p<0,001

·È‰ÈÒÓ Ì ˘„ËÏfi ‚¿ÚÔ˜, ‰ËÏÒÓÂÈ ÈηÓÔÔ›ËÛË ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› ÙÔ˘˜. ª¿ÏÈÛÙ· ÙÔ 15,9% ÙˆÓ ÌËÙ¤ÚˆÓ ·È‰ÈÒÓ Ì ˘„ËÏfi ‚¿ÚÔ˜ ı· ‹ıÂÏ ÙÔ ·È‰› ÙÔ˘˜ Ó· ÙÚÒÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ. ∏ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Â›Û˘ Î·È Ì ÙÔ Î·Ù¿ fiÛÔÓ ıˆÚ› ÙÔ ·È‰› Ù˘ ȉÈfiÙÚÔÔ ÛÙÔ Ê·ÁËÙfi. ∆Ô 33,3% ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ÂÎÙÈÌÔ‡Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ¤¯Ô˘Ó ¯·ÌËÏfi ‚¿ÚÔ˜, Ù· ıˆÚ› ¿ÓÙ· ȉÈfiÙÚÔ· ÛÙÔ Ê·ÁËÙfi ÂÓÒ ÙÔ 55,6% ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ÂÎÙÈÌÔ‡Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ¤¯Ô˘Ó ˘„ËÏfi ‚¿ÚÔ˜, ‰ÂÓ Ù· ıˆÚÔ‡Ó ÔÙ¤ ȉÈfiÙÚÔ· ÛÙÔ Ê·ÁËÙfi (¶›Ó·Î·˜ 8). ∞ÓٛʷÛË ÛËÌÂÈÒÓÂÙ·È fï˜ Î·È ·Ó¿ÌÂÛ· ÛÙȘ ıˆÚËÙÈΤ˜ ·fi„ÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙȘ Ú·ÎÙÈΤ˜ Ô˘ ÔÈ ›‰È˜ ·ÎÔÏÔ˘ıÔ‡Ó. °È· ·Ú¿‰ÂÈÁÌ·, ÂÓÒ ÙÔ 89,3% ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÈÛÙ‡ÂÈ fiÙÈ ¤Ó· ·È‰› Ú¤ÂÈ Ó· ÙÚÒÂÈ fiÛÔ ı¤ÏÂÈ ÙÔ ›‰ÈÔ Î·È fi¯È fiÛÔ ı¤ÏÂÈ Ë ÌËÙ¤Ú· ÙÔ˘, ÙÔ 38,5% ÙˆÓ ÌËÙ¤ÚˆÓ Ȥ˙ÂÈ ÙÔ ·È‰› Ó· Ê¿ÂÈ Â›Ù ¿ÌÂÛ·, ›Ù ¤ÌÌÂÛ· Ì ÙËÓ ˘fiÛ¯ÂÛË

οÔÈ·˜ ·ÓÙ·ÌÔÈ‚‹˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙȘ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, Ë ¤ÚÂ˘Ó¿ Ì·˜ ¤‰ÂÈÍ fiÙÈ Ë ËÏÈΛ· Î·È ÙÔ ÌÔÚʈÙÈÎfi ÙÔ˘˜ Â›Â‰Ô ·›˙Ô˘Ó Î¿ÔÈÔ ÚfiÏÔ, fi¯È fï˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi. ™‡Ìʈӷ Ì ÙÔÓ ¶›Ó·Î· 9, ÔÈ ÌËÙ¤Ú˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ (¿Óˆ ÙˆÓ 41 ÂÙÒÓ) ÈÛÙÂ‡Ô˘Ó Û ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi (50%) fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ı· ¤ÙÚˆÁ ÏÈÁfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ. ∂›Û˘, ˘„ËÏfiÙÂÚÔ Â›Ó·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌËÙ¤ÚˆÓ ¯·ÌËÏfiÙÂÚÔ˘ ÌÔÚʈÙÈÎÔ‡ ÂÈ¤‰Ô˘ (66,7%) ÔÈ Ôԛ˜ ÂÎÙÈÌÔ‡Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ı· ¤ÙÚˆÁ ÏÈÁfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ (¶›Ó·Î·˜ 10). ªÂÏÂÙ‹ıËΠÂ›Û˘, Ë ÂӉ¯fiÌÂÓË Â›‰Ú·ÛË ÙÔ˘ ʇÏÔ˘ ÙÔ˘ ·È‰ÈÔ‡ ηıÒ˜ Î·È ÙÔ˘ ÙfiÔ˘ ηٷÁˆÁ‹˜ ÛÙȘ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ, fï˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ŒÓ·˜ ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜ ‹Ù·Ó Î·È Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙˆÓ ·È‰ÈÒÓ Û ۯ¤ÛË Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜ ‰ÂÓ ¤‰ÂÈÍ·Ó Û˘Ó¿ÊÂÈ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÌÂÙ·‚ÏËÙÒÓ (¶›Ó·Î·˜ 11). ¶·ÚfiÌÔÈ· Â›Ó·È Î·È Ù· ÛÙÔȯ›· ÙÔ˘ ¶›Ó·Î· 12 fiÔ˘ ‰ÂÓ ‰È·Ê·›ÓÂÙ·È Û˘Ó¿ÊÂÈ· ÌÂٷ͇ ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ Î·È Ù˘ ÎÔÈÓˆÓÈÔÌÂÙÚÈ΋˜ ÙÔ˘˜ ı¤Û˘. ™˘˙‹ÙËÛË ∫·Ù¿ ÙËÓ ÂÎÙ›ÌËÛ‹ Ì·˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ô˘ ‚Ú¤ıËΠÛÙÔ ‰Â›ÁÌ· Ì·˜ (49,3%) Â›Ó·È È‰È·›ÙÂÚ· ˘„ËÏfi. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ ÛÙÔ Ôχ ÌÈÎÚfi Î·È fi¯È ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ηıÒ˜ Â›Û˘ Î·È ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›ÔÓ ÔÚ›ÛÙËÎÂ Ë ·¯˘Û·ÚΛ· ÛÙËÓ ¤ÚÂ˘Ó¿ Ì·˜. øÛÙfiÛÔ,

¶›Ó·Î·˜ 9. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· ÙÔ˘˜ Î·È ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› ÙÔ˘˜ ·Ó ·ÊËÓfiÙ·Ó ÂÓÙÂÏÒ˜ ÂχıÂÚÔ. ∂ÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› Ù˘ (¡=140) ∏ÏÈΛ· ÌËÙ¤Ú·˜

ªÂÁ·Ï‡ÙÂÚË ·fi

ªÈÎÚfiÙÂÚË ·fi

ÙÔ Î·ÓÔÓÈÎfi

ÙÔ Î·ÓÔÓÈÎfi

%

%

21-30 ÂÙÒÓ

3,4

27,6

69

31-40 ÂÙÒÓ

5,1

38,4

56,6

¿Óˆ ÙˆÓ 41 ÂÙÒÓ

8,3

50

41,7

37,1

57,9

™‡ÓÔÏÔ C=0,14, p>0,01

514

5

∫·ÓÔÓÈ΋ %

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·515

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

¶·È‰È΋ ·¯˘Û·ÚΛ·

¶›Ó·Î·˜ 10. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙÔ ÌÔÚʈÙÈÎfi ÙÔ˘˜ Â›Â‰Ô Î·È ÙËÓ ÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› ÙÔ˘˜ ·Ó ·ÊËÓfiÙ·Ó ÂÓÙÂÏÒ˜ ÂχıÂÚÔ. ∂ÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ı· ¤ÙÚˆÁ ÙÔ ·È‰› Ù˘ (¡=140) ªÔÚʈÙÈÎfi Â›Â‰Ô ÌËÙ¤Ú·˜

ªÂÁ·Ï‡ÙÂÚË ·fi

ªÈÎÚfiÙÂÚË ·fi

ÙÔ Î·ÓÔÓÈÎfi

ÙÔ Î·ÓÔÓÈÎfi

%

%

%

0

66,7

33,3

6,8

25,5

67,7

3,8

44,9

51,3

5

37,1

57,9

∞fiÊÔÈÙÔ˜ ¢ËÌÔÙÈÎÔ‡ ∞fiÊÔÈÙÔ˜ °˘ÌÓ/§˘Î›Ԣ

∫·ÓÔÓÈ΋

∞fiÊÔÈÙÔ˜ ∞ÓÒÙÂÚ˘/ ∞ÓÒÙ·Ù˘ ™¯ÔÏ‹˜ ™‡ÓÔÏÔ C=0,25, p>0,01

ÙÔ ÔÛÔÛÙfi ·˘Ùfi ÌÔÚ› Ó· ·ÔÙÂÏ› ¤Ó‰ÂÈÍË Ù˘ ÌÂÁ¿Ï˘ Û˘¯ÓfiÙËÙ·˜ Ì ÙËÓ ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Ë ·È‰È΋ ·¯˘Û·ÚΛ· ÛÙË ¯ÒÚ· Ì·˜. ª¤Û· fï˜ ·fi Ù· ÛÙÔȯ›· Ù˘ ¤Ú¢ӷ˜ ·˘Ù‹˜, Ì·˜ ÚÔ‚ÏËÌ·Ù›˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÔÈ ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ Î·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜. ∏ ÌÂÁ¿ÏË ·fiÎÏÈÛË Ô˘ ‰È·ÈÛÙÒÛ·Ì ·Ó¿ÌÂÛ· ÛÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÛÙȘ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÁÈ’ ·˘Ùfi ‰ÂÓ Ê·›ÓÂÙ·È Ù˘¯·›· ·ÏÏ¿ ·ÓÙ·Ó·ÎÏ¿ ÔÚÈṲ̂Ó˜ ‚·ÛÈΤ˜ ·ÓÙÈÏ‹„ÂȘ Î·È ÚÔÛ‰Ô˘ ÙˆÓ ∂ÏÏËÓ›‰ˆÓ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó Â›‰Ú·ÛË ÛÙË ‰È·ÙÚÔÊÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ. ™‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· Ô˘ ÔÚ›Û·ÌÂ, ÙÔ 49,3% ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ηٷٷÛÛfiÙ·Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ. øÛÙfiÛÔ, ÌfiÓÔ ÙÔ 6,4% ÙˆÓ ÌËÙ¤ÚˆÓ ¯·Ú·ÎÙ‹ÚÈÛ ÙÔ ·È‰› ÙÔ˘˜ ˆ˜ ·¯‡Û·ÚÎÔ. ∂›Û˘, Ù· ÌÈÛ¿ ÂÚ›Ô˘ ·fi Ù· ·È‰È¿ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜ ˆ˜ ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜, ‹Ù·Ó ·¯‡Û·Úη. À‹Ú¯Â

Ì¿ÏÈÛÙ· Î·È ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·È‰ÈÒÓ (13,3%) Ù· ÔÔ›· ‹Ù·Ó ·¯‡Û·Úη ·ÏÏ¿ ÔÈ ÌËÙ¤Ú˜ ÙÔ˘˜ Ù· ¯·Ú·ÎÙ‹ÚÈ˙·Ó ˆ˜ ·È‰È¿ Ì ‚¿ÚÔ˜ ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi. ∫·Ù¿ ÙËÓ ¿Ô„‹ Ì·˜, ·˘Ù‹ Ë ¤ÏÏÂÈ„Ë Ú·ÏÈÛÙÈ΋˜ ÂÎÙ›ÌËÛ˘ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Û¯ÂÙ›˙ÂÙ·È ÌÂٷ͇ ¿ÏψÓ, Ì ÙËÓ ÂÔ›ıËÛË ÔÚÈÛÌ¤ÓˆÓ ÌËÙ¤ÚˆÓ fiÙÈ ·Ó ÙÔ ·È‰› ·ÊÂı› ÂχıÂÚÔ ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÔÛfiÙËÙ·˜ Ê·ÁËÙÔ‡ Ô˘ ı· ηٷӷÏÒÛÂÈ, ÙfiÙ ı· ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó· Ê¿ÂÈ ÏÈÁfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi. ∫·Ù¿ Û˘Ó¤ÂÈ·, ÔÏϤ˜ ÌËÙ¤Ú˜ Ȥ˙Ô˘Ó ÙÔ ·È‰› Ó· Ê¿ÂÈ fiÛÔ ÎÚ›ÓÔ˘Ó ÔÈ ›‰È˜ ··Ú·›ÙËÙÔ, ·Ó Î·È ıˆÚËÙÈο ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ¤Ó· ·È‰› Ú¤ÂÈ Ó· ÙÚÒÂÈ fiÛÔ ı¤ÏÂÈ ÙÔ ›‰ÈÔ. ∏ ›ÂÛË ·˘Ù‹ ·ÛÎÂ›Ù·È Â›Ù ¿ÌÂÛ· ›Ù ¤ÌÌÂÛ·, Ì ÙËÓ ˘fiÛ¯ÂÛË Î¿ÔÈ·˜ ·ÌÔÈ‚‹˜ ÛÙÔ ·È‰›. ∆Ô Â‡ÚËÌ· ·˘Ùfi ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜, (11), Û‡Ìʈӷ Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ∂ÏÏËÓ›‰Â˜ ÌËÙ¤Ú˜ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ˘ÂÚÚÔÛÙ·ÙÂ‡Ô˘Ó Ù· ·È‰È¿ ÙÔ˘˜ Î·È Ó· Â›Ó·È ·ÚÎÂÙ¿ ÈÂÛÙÈΤ˜ Û¯ÂÙÈο Ì ÙÔ Ê·ÁËÙfi.

¶›Ó·Î·˜ 11. ∫·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙÔ Â›Â‰Ô ·˘ÙÔÂÎÙ›ÌËÛ‹˜ ÙÔ˘˜.

¶›Ó·Î·˜ 12. ∫·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙËÓ ÎÔÈÓˆÓÈÔÌÂÙÚÈ΋ ÙÔ˘˜ ı¤ÛË.

∂›Â‰Ô ·˘ÙÔÂÎÙ›ÌËÛ˘ ·È‰ÈÔ‡ (¡=140) µ¿ÚÔ˜ ·È‰ÈÔ‡

÷ÌËÏfi

ª¤ÙÚÈÔ

À„ËÏfi

%

%

%

∫·ÓÔÓÈÎfi

18,8

62,4

18,8

À„ËÏfi

17,2

65,6

17,2

∫ÔÈÓˆÓÈÔÌÂÙÚÈ΋ ı¤ÛË ·È‰ÈÔ‡ (¡=140) µ¿ÚÔ˜ ·È‰ÈÔ‡

÷ÌËÏfi

ª¤ÙÚÈÔ

À„ËÏfi

%

%

%

∫·ÓÔÓÈÎfi

77,5

8,5

14,1

À„ËÏfi

72,5

8,7

18,8

÷ÌËÏfi

0

0

0

÷ÌËÏfi

0

0

0

™‡ÓÔÏÔ

18,1

63,8

18,1

™‡ÓÔÏÔ

75

8,6

16,4

C=0,03, p>0,01

C=0,06, p>0,01

515

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·516

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

∞ÎfiÌ· fï˜, ÎÈ ·˘Ù‹ Ë ·ÓÙ›ÏË„Ë, fiÙÈ ‰ËÏ·‰‹ ÙÔ ·È‰› ‰ÂÓ Â›Ó·È Û ı¤ÛË Ó· ηıÔÚ›ÛÂÈ ÌfiÓÔ ÙÔ˘ ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ Ú¤ÂÈ Ó· ηٷӷÏÒÛÂÈ, ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙËÓ ˘ÔÎÂÈÌÂÓÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È fi¯È Ì ÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘ ‚¿ÚÔ˜. ∂Ô̤ӈ˜, fiÙ·Ó ÔÈ ÌËÙ¤Ú˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È Ôχ ·‰‡Ó·ÙÔ, ÙfiÙ ÂÎÙÈÌÔ‡Ó fiÙÈ ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó· ÙÚÒÂÈ ÏÈÁfiÙÂÚÔ ·’ fiÛÔ Ú¤ÂÈ, ·ÎfiÌ· Î·È ·Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ ·È‰› ¤¯ÂÈ Î·ÓÔÓÈÎfi ‚¿ÚÔ˜ ‹ Â›Ó·È ·¯‡Û·ÚÎÔ. OÌÔ›ˆ˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡, ÔÈ ÌËÙ¤Ú˜ Ô˘ ÂÎÙÈÌÔ‡Ó fiÙÈ ·˘Ùfi Â›Ó·È Ôχ ·‰‡Ó·ÙÔ, ‰ÂÓ Â›Ó·È ÈηÓÔÔÈË̤Ó˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ηٷӷÏÒÓÂÈ Î·È ı· ÂÈı˘ÌÔ‡Û·Ó Ó· ÙÚÒÂÈ ÂÚÈÛÛfiÙÂÚÔ. ¶ÔÏϤ˜ ÌËÙ¤Ú˜ ¿ÏψÛÙ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ ·È‰› ÙÔ˘˜ ȉÈfiÙÚÔÔ ÛÙÔ Ê·ÁËÙfi fiÙ·Ó ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ Â›Ó·È ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡, ·Ú’fiÏÔ Ô˘, fiˆ˜ ›‰·ÌÂ, ‰ÂÓ ‚Ú¤ıËΠԇÙ ¤Ó· Ù¤ÙÔÈÔ ·È‰› ÛÙȘ 140 ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂÙ‹Û·ÌÂ. Ÿˆ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ, ·˘Ù¤˜ ÔÈ Ï·Óı·Ṳ̂Ó˜ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÙfiÛÔ ÙˆÓ ›‰ÈˆÓ fiÛÔ Î·È ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È Î·ıÔÚ›˙Ô˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘˜ ·¤Ó·ÓÙÈ ÛÙÔ ·È‰› Û ۯ¤ÛË Ì ÙÔ Ê·ÁËÙfi. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜, ÙÔ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ‰›ÓÔ˘Ó ÔÈ ÌËÙ¤Ú˜ ÛÙ· ·È‰È¿ ÙÔ˘˜ Â›Ó·È ÔÈ ˘ÔÎÂÈÌÂÓÈΤ˜ ÙÔ˘˜ ÂÎÙÈÌ‹ÛÂȘ ÁÈ· ÙÔ È‰·ÓÈÎfi ‚¿ÚÔ˜, ÔÈ Ôԛ˜ fiˆ˜ ‰È·ÈÛÙÒÛ·ÌÂ, Û˘¯Ó¿ ·¤¯Ô˘Ó ηٿ Ôχ ·fi ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. ™˘ÓÂÒ˜, ÔÏÏ¿ ·È‰È¿ Ȥ˙ÔÓÙ·È Ó· ηٷӷÏÒÛÔ˘Ó ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ ·fi ·˘Ù‹ Ô˘ Ú·ÁÌ·ÙÈο ¯ÚÂÈ¿˙ÔÓÙ·È Ì ·ÔÙ¤ÏÂÛÌ· Ó· Á›ÓÔÓÙ·È ˘¤Ú‚·Ú·. ™‡Ìʈӷ Ì ٷ ‰Â‰Ô̤ӷ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ (4,10) ı· ÂÚÈ̤ӷÌ ӷ ‰È·ÈÛÙÒÛÔ˘Ì ÌÂÁ·Ï‡ÙÂÚË Û˘Ó¿ÊÂÈ· ·Ó¿ÌÂÛ· ÛÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ ‚¿ÚÔ˜ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜ ¤‰ÂÈÍ·Ó ‚¤‚·È· Ì›· Ù¿ÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ÌËÙ¤ÚˆÓ Ó· ¤¯Ô˘Ó ·¯‡Û·Úη ·È‰È¿, ‰ÂÓ ¤‰ÂÈÍ·Ó fï˜ ˘„ËÏ‹ Û˘Ó¿ÊÂÈ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÌÂÙ·‚ÏËÙÒÓ. ¶Ú¤ÂÈ ˆÛÙfiÛÔ Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ì fiÙÈ ‰ÂÓ ˘‹ÚÍ ·ÓÙÈÎÂÈÌÂÓÈ΋ ̤ÙÚËÛË ÙÔ˘ ‚¿ÚÔ˘˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ˘ÔÏÔÁÈÛÌfi˜ Ù˘ ·fiÎÏÈÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ Ù˘ ·fi ÙÔ È‰·ÓÈÎfi fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·È‰ÈÒÓ. ∞ÓÙ›ıÂÙ·, ÔÈ ÌËÙ¤Ú˜ ·ÍÈÔÏfiÁËÛ·Ó ÌfiÓ˜ ÙÔ˘˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ ··ÓÙÒÓÙ·˜ Û ÂÚÒÙËÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ô˘ ÙÔ˘˜ ¯ÔÚËÁ‹ıËÎÂ. ∂›Ó·È ÏÔÈfiÓ Èı·Ófi Ë ·ÓÙ›ÏË„‹ ÙÔ˘˜ ÁÈ· ÙÔ ‰ÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜ Ó· ·¤¯ÂÈ ·fi ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, fiˆ˜ ·¤¯ÂÈ Î·È Ë ·ÓÙ›ÏË„‹ ÙÔ˘˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ∂Ô̤ӈ˜, ÔÏϤ˜ ·fi ÙȘ ÌËÙ¤Ú˜ Ô˘ ÂÎÙÈÌÔ‡Ó fiÙÈ ¤¯Ô˘Ó ηÓÔÓÈÎfi ‚¿ÚÔ˜, ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È Î·È ÔÈ ›‰È˜ ·¯‡Û·ÚΘ. ŒÓ·˜ ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜ ‹Ù·Ó

516

∂. ∫¿ÎÔ˘ÚÔ˜, ∫. ª·ÓÈ·‰¿ÎË

Â›Û˘ Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙȘ ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ. OÈ ÌÂÙ·‚ÏËÙ¤˜ ÙȘ Ôԛ˜ ÌÂÏÂÙ‹Û·Ì ‹Ù·Ó Ë ËÏÈΛ· Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓÈÒÓ, Ô ÙfiÔ˜ ηٷÁˆÁ‹˜ Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ·È‰ÈÔ‡. ¢È·ÈÛÙÒÛ·Ì fï˜, fiÙÈ Î·Ì›· ·fi ·˘Ù¤˜ ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ‰ÂÓ Ê¿ÓËΠӷ ÂËÚ¿˙ÂÈ È‰È·›ÙÂÚ· ÙȘ ·ÓÙÈÏ‹„ÂȘ ·˘Ù¤˜. ∆fiÛÔ ÔÈ ÓÂÒÙÂÚ˜ fiÛÔ Î·È ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ Û ËÏÈΛ· ÌËÙ¤Ú˜, ÔÈ ÌËÙ¤Ú˜ Ù˘ ∞ı‹Ó·˜ Î·È ·˘Ù¤˜ ÙȘ Â·Ú¯›·˜, ÔÈ ÌËÙ¤Ú˜ ·ÓÒÙÂÚÔ˘ ‹ ηÙÒÙÂÚÔ˘ ÌÔÚʈÙÈÎÔ‡ ÂÈ¤‰Ô˘ Î·È ÔÈ ÌËÙ¤Ú˜ ·ÁÔÚÈÒÓ ‹ ÎÔÚÈÙÛÈÒÓ ·ÚÔ˘Û›·˙·Ó ÙȘ ›‰È˜ ÂÚ›Ô˘ Èı·ÓfiÙËÙ˜ Ó· ‰È·ÌÔÚÊÒÛÔ˘Ó Ï·Óı·Ṳ̂Ó˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È Ó· ÂÓı·ÚÚ‡ÓÔ˘Ó ·Ó¿ÏÔÁ˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ. º·›ÓÂÙ·È ÏÔÈfiÓ, fiÙÈ ÔÈ ·ÓÙÈÏ‹„ÂȘ Ô˘ ÔÈ ∂ÏÏËÓ›‰Â˜ ÌËÙ¤Ú˜ ‰È·ÌÔÚÊÒÓÔ˘Ó ÁÈ· ÙË ‰È·ÙÚÔÊ‹ Î·È ÔÈ Ôԛ˜ ηıÔÚ›˙Ô˘Ó ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ›‰ÈˆÓ Î·È ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ÁÂÓÓÈÔ‡ÓÙ·È Î·È ·Ó·Ù‡ÛÛÔÓÙ·È Ì¤Û· ·fi Ù· ‹ıË Î·È ÙȘ ·Ú·‰fiÛÂȘ Ù˘ ÂÏÏËÓÈ΋˜ ÎÔÈÓˆÓ›·˜. ∞ÎfiÌ· Î·È ÔÈ ÓÂÒÙÂÚ˜ Î·È ÈÔ ÌÔÚʈ̤Ó˜ ÌËÙ¤Ú˜ Ê·›ÓÂÙ·È Ó· ÌËÓ ¤¯Ô˘Ó ÍÂʇÁÂÈ ·fi ÙȘ ·ÓÙÈÏ‹„ÂȘ ·Ï·ÈfiÙÂÚˆÓ ÁÂÓÂÒÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ Î·È ÙÔÓ ÙÚfiÔ ¯ÂÈÚÈÛÌÔ‡ ÙˆÓ ·È‰ÈÒÓ Û¯ÂÙÈο Ì ·˘Ù‹. ∏ ¿Ô„Ë fiÙÈ ¤Ó· ·¯‡Û·ÚÎÔ ·È‰› ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ˘Á›·˜ Î·È Â˘ÚˆÛÙ›·˜ Â›Ó·È ·ÎfiÌ· ‚·ıÈ¿ ÚÈ˙ˆÌ¤ÓË ÛÙȘ ·ÓÙÈÏ‹„ÂȘ ÔÏÏÒÓ ∂ÏÏËÓ›‰ˆÓ ÌËÙ¤ÚˆÓ. ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓË Ë ¤ÏÏÂÈ„Ë Û˘Ó¿ÊÂÈ·˜ Ô˘ ‰È·ÈÛÙÒÛ·Ì ÌÂٷ͇ ‚¿ÚÔ˘˜ Î·È ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙˆÓ ·È‰ÈÒÓ. ™‡Ìʈӷ Ì ÙȘ ÂÈÎÚ·Ù¤ÛÙÂÚ˜ ıˆڛ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘, Ë ÂÈÎfiÓ· Ô˘ ‰È·ÌÔÚÊÒÓÂÈ ÙÔ ·È‰› ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘ ‚·Û›˙ÂÙ·È ·Ú¯Èο ÛÂ Û˘Ó·ÈÛıËÌ·ÙÈο ÛÙÔȯ›· Î·È Û˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÔÈ «ÛËÌ·ÓÙÈÎÔ› ¿ÏÏÔÈ» ‚ϤÔ˘Ó ÙÔ ·È‰› (17,18). ∂›Û˘, ηٿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ‰ÂÓ ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ ·ÎfiÌ· Ô‡ÙÂ Ë ‰È·‰Èηۛ· Ù˘ Û‡ÁÎÚÈÛ˘ ÙÔ˘ ·˘ÙÔ‡ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ (30) Ô‡ÙÂ Ë ‰È·‰Èηۛ· Ù˘ Û‡ÁÎÚÈÛ˘ ÌÂٷ͇ Ú·ÁÌ·ÙÈÎÔ‡ Î·È È‰·ÓÈÎÔ‡ ·˘ÙÔ‡ (19). ∂Ô̤ӈ˜, ÔÈ ÁÔÓ›˜ Ô˘ ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ·È‰È¿ ÙÔ˘˜ ˆ˜ ·¯‡Û·Úη, ‰ÂÓ ÙÔ˘˜ ÌÂÙ·‰›‰Ô˘Ó ·ÚÓËÙÈο ÌËӇ̷ٷ ˆ˜ ÚÔ˜ ÙË ÛˆÌ·ÙÈ΋ ÙÔ˘˜ ÂÈÎfiÓ· ¤ÙÛÈ ÒÛÙ ӷ ˘¿Ú¯Ô˘Ó ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙÔ Â›Â‰Ô Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ‹˜ ÙÔ˘˜. ∆Ô Û˘Ì¤Ú·ÛÌ· ·˘Ùfi ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÙËÓ ¿Ô„Ë ÙÔ˘ Crocker Î·È ÙˆÓ Û˘ÓÂÚÁ·ÙÒÓ ÙÔ˘ (20), ÔÈ ÔÔ›ÔÈ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ ÛÙ›ÁÌ· ‰ÂÓ ÚÔ¤Ú¯ÂÙ·È ·fi Ù· ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ÂÓfi˜ ·ÙfiÌÔ˘ ·ÏÏ¿ ·fi ÙȘ ·ÓÙȉڿÛÂȘ ÙˆÓ ¿ÏÏˆÓ Û ·˘Ù¿ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο. øÛÙfiÛÔ, ηıÒ˜ ÙÔ ·È‰› ÌÂÁ·ÏÒÓÂÈ, ·ÚÂÌ‚·›ÓÔ˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÛÙË ‰È·ÌfiÚʈÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘, fiˆ˜ Ë ÁÓˆÛÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë Û‡ÁÎÚÈÛË ÙÔ˘ ·˘ÙÔ‡ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜. ∂Ô-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·517

¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518

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¶·È‰È΋ ·¯˘Û·ÚΛ·

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B·ÚÈ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Û ·È‰› ÏfiÁˆ ‰ËÏËÙËÚ›·Û˘ Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη ª·Ú›· ∫·ÙÛ¿Ú·1, ∫ÏÂÔÓ›ÎË ¶·¿˙ÔÁÏÔ˘1, µ·Û›ÏÂÈÔ˜ ∑·¯·ÚÈ¿‰Ë˜2, πˆ¿ÓÓ˘ ¶··‰¿ÙÔ˜1 ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ 6 ¯ÚfiÓˆÓ Ì ‚·ÚÈ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Î·È Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi ÏfiÁˆ ‰ËÏËÙËÚ›·Û˘ Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη (CO) ·fi Ì·ÁοÏÈ. ∂ÈÛËÌ·›ÓÂÙ·È Ë Ôχ ηϋ ¤Î‚·Û‹ ÙÔ˘ ÌÂÙ¿ ÙË Û˘ÓÔÏÈ΋ ıÂÚ·›· Ì ˘ÂÚ‚·ÚÈÎfi Ô͢ÁfiÓÔ (∏µO) Î·È ÙËÓ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ˘ÔÛÙ‹ÚÈÍ‹ ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜. ¶·È‰È·ÙÚÈ΋ 2000;63:519-523. §¤ÍÂȘ ÎÏÂȉȿ: ‰ËÏËÙËÚ›·ÛË Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη, ˘ÂÚ‚·ÚÈÎfi Ô͢ÁfiÓÔ.

M. Katsara, K. Papazoglou, V. Zachariadis, I. Papadatos. Severe neurological dysfunction in a child due to acute intoxication by carbon monoxide. Paediatriki 2000;63:519-523. ● Abstract: This is a case of a 6 year-old boy who suffered acute intoxication by carbon monoxide (CO) produced by a woodstove. He presented with severe neurologic dysfunction and myocardial injury. We underline the very good outcome after specialized support in the Intensive Care Unit and treatment with Hyperbaric Oxygen (HBO).

Key words: carbon monoxide poisoning, hyperbaric oxygen therapy.

∂ÈÛ·ÁˆÁ‹ ∏ ‰ËÏËÙËÚ›·ÛË Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη (CO) ·ÔÙÂÏ› Û·ÓÈfiÙÂÚÔ ·›ÙÈÔ ·Ù˘¯‹Ì·ÙÔ˜ ÛÙËÓ ∂ÏÏ¿‰· Û ۯ¤ÛË Ì ¿ÏϘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ∏ Û˘Ìو̷ÙÔÏÔÁ›· Â›Ó·È ÌË ÂȉÈ΋ Î·È Î˘Ì·›ÓÂÙ·È ·fi ‹È· Î·È ·Ì‚Ï˯ڋ ¤ˆ˜ ‚·Ú‡Ù·ÙË, Ô˘ ı¤ÙÂÈ Û ΛӉ˘ÓÔ ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∏ ‰È¿ÁÓˆÛË ··ÈÙ› ˘„ËÏfi ‰Â›ÎÙË Â˘·ÈÛıËÙÔÔ›ËÛ˘ ÂΠ̤ÚÔ˘˜ ÙÔ˘ ÁÈ·ÙÚÔ‡, ȉ›ˆ˜ fiÙ·Ó Ï›ÂÈ ÙÔ Û·Ê¤˜ ÈÛÙÔÚÈÎfi ¤ÎıÂÛ˘ Û ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη. ∏ ıÂÚ·›· Ì ˘ÂÚ‚·ÚÈÎfi Ô͢ÁfiÓÔ (∏µO), ¿ÏÏÔÙ ·ÌÊÈÏÂÁfiÌÂÓË Î·È ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓË, Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ÛËÌ·ÓÙÈÎfiÙ·ÙÔ ÚfiÏÔ ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜, ȉȷ›ÙÂÚ· fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ÙȘ ÚÒÙ˜ ¤ÍÈ ÒÚ˜ ·fi ÙÔ Û˘Ì‚¿Ó. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ¤ÍÈ ¯ÚfiÓˆÓ Ì ‚·ÚÈ¿ Û˘Ìو̷ÙÔÏÔÁ›· ÔÍ›·˜ ‰ËÏËÙËÚ›·Û˘ Ì CO ·fi Ì·ÁοÏÈ Î·È ÂÈÛËÌ·›ÓÂÙ·È Ë Ôχ ηϋ ÙÔ˘ ¤Î‚·ÛË ÌÂÙ¿ ÙË ÓÔÛËÏ›· ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·1 2

ÙÈ΋˜ £ÂÚ·›·˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ Î·È ÙȘ ıÂÚ·¢ÙÈΤ˜ Û˘Ó‰ڛ˜ Ì ∏µO. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 6 ¯ÚfiÓˆÓ, ·È‰› ÌËÙ¤Ú·˜ ∞Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ Ô˘ ˙ÂÈ Û ÓËÛ› Ù˘ ∂ÏÏ¿‰·˜ Î·È ÂÚÁ¿˙ÂÙ·È ˆ˜ Âԯȷ΋ ÂÚÁ¿ÙÚÈ·. O ·Ù¤Ú·˜ ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ‰ÂÓ ˙ÂÈ ÎÔÓÙ¿ ÙÔ˘˜, Â›Ó·È ŒÏÏËÓ·˜ ηٷÁfiÌÂÓÔ˜ ·fi ÙÔ ÓËÛ›. O ¯ÒÚÔ˜ ‰È·ÌÔÓ‹˜ ÌËÙ¤Ú·˜ Î·È ·È‰ÈÔ‡ ‹Ù·Ó ¤Ó· ÌfiÓÔ ‰ˆÌ¿ÙÈÔ, ÁÈ· ı¤ÚÌ·ÓÛË ‰Â ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÚÈÛÙ·Ûȷο Ì·ÁοÏÈ. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi Î·È ÏÔÈfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÂχıÂÚÔ. ∆Ô ·ÁfiÚÈ Ì·˙› Ì ÙË ÌËÙ¤Ú· ÙÔ˘ ÚÔÛÎÔÌ›ÛÙËΠ·fi Ê›ÏÔ˘˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ ÙÔ˘ ÓËÛÈÔ‡. ∆Ô ·È‰› ‹Ù·Ó Û Έ̷ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË Ì ‰‡ÛÓÔÈ·, ¿ÚÚ˘ıÌË ·Ó·ÓÔ‹, ΢¿ÓˆÛË Î·È Û·ÛÌÔ‡˜. ◊Ù·Ó ·ÈÌÔ‰˘Ó·ÌÈο ÛÙ·ıÂÚfi. ∏ ÌËÙ¤Ú· ÌÂٷʤÚıËΠÛÂ Û˘Á¯˘ÙÈ΋ ηٿÛÙ·ÛË Î·È Ó¢ÚÔÌ˘˚΋

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶ & ∞ ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· ∫ÏÈÓÈ΋ ÀÂÚ‚·ÚÈ΋˜ Î·È ∫·Ù·‰˘ÙÈ΋˜ π·ÙÚÈ΋˜, ¡·˘ÙÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ

519

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·520

¶∞π¢π∞∆ƒπ∫∏ 2000;63:519-523

·‰˘Ó·Ì›·. ∞fi ÙÔ ÈÛÙÔÚÈÎfi ‰È·ÈÛÙÒıËΠfiÙÈ fiÏÔ ÙÔ ÚÔËÁÔ‡ÌÂÓÔ ‚Ú¿‰˘, ÌËÙ¤Ú· Î·È ·È‰› ÎÔÈÌ‹ıËÎ·Ó ÛÙÔ ‰ˆÌ¿ÙÈÔ Ì ·Ó·Ì̤ÓÔ Ì·ÁοÏÈ. ∏ Â›ÁÔ˘Û· ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÛÙÔ ∫À ÙÔ˘ ÓËÛÈÔ‡ ‹Ù·Ó Ë ¯ÔÚ‹ÁËÛË O2 Î·È ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û·ÛÌÒÓ. ∆Ô ∏∫° ¤‰ÂÈÍ ÛÔ‚·Ú¿ ÛËÌ›· ÈÛ¯·ÈÌ›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. ŒÁÈÓ ¿ÌÂÛ· Û˘ÓÂÓÓfiËÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ Ì ÙÔ ∂∫∞µ ∞ıËÓÒÓ Î·È Ô ·ÛıÂÓ‹˜ ÌÂٷʤÚıËΠ·ÂÚÔÔÚÈÎÒ˜, ÌÂ Û˘Ó¯‹ ¯ÔÚ‹ÁËÛË O2 100% Ì ̿Ûη, ÛÙÔ ¡·˘ÙÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ Ô˘ ‰È·ı¤ÙÂÈ ı¿Ï·ÌÔ ·Ô›ÂÛ˘ ÁÈ· ÙËÓ ¿ÌÂÛË ¤Ó·ÚÍË ıÂÚ·¢ÙÈ΋˜ Û˘Ó‰ڛ·˜ ∏µO. O ·ÛıÂÓ‹˜ ¤Êı·Û ÂΛ Ì ‚·ÚÈ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹. ◊Ù·Ó Û ÎÒÌ· πππ, ›¯Â Ì˘‰Ú›·ÛË ¯ˆÚ›˜ ·ÓÙ›‰Ú·ÛË ÛÙÔ Êˆ˜ Î·È ·ÚÔ˘Û›·˙ ÛËÌ›· ·ÂÁÎÂÊ·ÏÈÛÌÔ‡.

O ¿ÌÂÛÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ÂÏ‹ÊıË ÂΛ ¤‰ÂÈÍÂ: ·¤ÚÈ· ·›Ì·ÙÔ˜ PH: 7,37, PO2: 54,8 mmHg, PCO2: 25,7 mmHg SBE: -10. O ÂÓ˙˘ÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ LDH: 615 IU/L, CPK: 4230 IU/L, SGOT: 1735 IU/L, SGPT: 27 IU/L Û˘ÓËÁÔÚÔ‡Û ÁÈ· ‚·ÚÈ¿ ÈÛ¯·ÈÌ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÏfiÁˆ Ù˘ ‰ËÏËÙËÚ›·Û˘ Ì CO. ∆Ô ·È‰› ÙÔÔıÂÙ‹ıËΠ۠ÂȉÈÎfi ı¿Ï·ÌÔ Î·È ÙÔ Û¯‹Ì· Ù˘ ıÂÚ·›·˜ Ô˘ ·ÎÔÏÔ˘ı‹ıËΠ‹Ù·Ó: ¯ÔÚ‹ÁËÛË ∏µO ÛÙȘ 1,8 Atm ÁÈ· 40 ÏÂÙ¿ Î·È Î·ÙfiÈÓ ÛÙȘ 1,6 Atm ÁÈ· 60 ÏÂÙ¿. ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ Û˘Ó‰ڛ·˜ Ë Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ ‚ÂÏÙÈÒıËÎÂ: ÔÈ ÎfiÚ˜ ‹Ù·Ó ̤ÛÔ˘ ÌÂÁ¤ıÔ˘˜ Ì ·ÓÙ›‰Ú·ÛË ÛÙÔ Êˆ˜ Î·È Ô ·ÛıÂÓ‹˜ ·ÓÙȉÚÔ‡Û ÛÙ· ÂÒ‰˘Ó· ÂÚÂı›ÛÌ·Ù·. ∞̤ۈ˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ Û˘Ó‰ڛ·˜ ¤ÁÈÓÂ Û˘ÓÂÓÓfiËÛË Ì ÙË ªÔÓ¿‰· Ì·˜ Î·È Ô ·ÛıÂÓ‹˜ ÌÂٷʤÚıËÎÂ Û˘Óԉ›· ÁÈ·ÙÚÔ‡ ÛÙÔ ÙÌ‹Ì· Ì·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙË ª∂£ ‹Ù·Ó Û ÎÒÌ· ππ Î·È Â›¯Â Îϛ̷η °Ï·ÛÎ҂˘ 8. ¢ÂÓ ·ÚÔ˘Û›·˙ Û·ÛÌÔ‡˜ ‹ ¿ÏϘ ·ÓÒ̷Ϙ ÎÈÓ‹ÛÂȘ. OÈ ÎfiÚ˜ ·Ú¤ÌÂÓ·Ó Ì ·ÓÙ›‰Ú·ÛË ÛÙÔ Êˆ˜ ·ÏÏ¿ ÙÔ ·È‰› ÂÌÊ¿ÓÈ˙ ÛËÌÂ›Ô ‰‡ÔÓÙÔ˜ ËÏ›Ô˘. ◊Ù·Ó ·ÈÌÔ‰˘Ó·ÌÈο ÛÙ·ıÂÚfi, ›¯Â ÛʇÍÂȘ 140/min, ∞¶ 122/62 mmHg. OÈ Î·Ú‰È·ÎÔ› ÙfiÓÔÈ ‹Ù·Ó ¢ÎÚÈÓ›˜, ¯ˆÚ›˜ ʇÛËÌ·. ∂›¯Â Ù·¯‡ÓÔÈ· (40 ·Ó·Ó./min), ‹Ș ÂÈÛÔÏΤ˜ Î·È ÌÂȈ̤ÓÔ ·Ó·Ó¢ÛÙÈÎfi „Èı‡ÚÈÛÌ· ‰ÂÍÈ¿ ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Î˘¿ÓˆÛË. ∂›¯Â ÂÏ·Ùو̤ÓË ‰ÈÔ‡ÚËÛË ÏfiÁˆ ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ˘ÁÚÒÓ. ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÂÈÛfi‰Ô˘ ‹Ù·Ó: Na: 139 mEq/L, K: 4,7 mEq/L, Cl: 110 mEq/L, O˘Ú›·: 78 mg/dl, ∫Ú·ÙÈÓ›ÓË: 0,8 mg/dl, °Ï˘Îfi˙Ë: 98 mg/dl, Ca: 7,7 mg/dl, PO4: 7,9 mg/dl, Mg: 3,7 mg/dl, O˘ÚÈÎfi Ô͇: 8,3 mg/dl, ∞Ì˘Ï¿ÛË: 122 IU/L, §Â˘ÎÒÌ·Ù· ÔÏÈο: 4,9 g/dl, ·Ï‚Ô˘Ì›Ó˜: 3,1 g/dl, CPR: 63 mg/L, SGOT: 81 IU/L, SGPT: 19 IU/L, CPK: 2000 IU/L, LDH: 560 IU/L. Hct: 32%, Hb: 10,1 g%, §Â˘Î¿: 18.600 /mm3 ¶ÔÏ˘ÌÊ: 87%, Aª∆: 356.000/mm3.

520

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

∞¤ÚÈ· ·›Ì·ÙÔ˜ PH: 7,33, PO2: 72 mmHg, PCO2: 22,3 mmHg, HCO3: 12 mEq/L, SBE:-8 Hb Sat: 98,3%.

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Û ÂȉÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ Ù˘ ηڂÔ͢·ÈÌÔÛÊ·ÈÚ›Ó˘ ÛÙÔ ·›Ì· ¤‰ÂÈÍÂ: HbCO 0,6%. ™ÙËÓ ·/· ıÒڷη ˘‹Ú¯Â ÛΛ·ÛË ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ Î·È ‰ÂÍÈÔ‡ ¿Óˆ-̤ÛÔ˘ ÏÔ‚Ô‡: ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ô˘ Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ÂÈÛÚfiÊËÛË, ·ÏÏ¿ Î·È Èı·ÓfiÓ ÁÈ· Ó¢ÌÔÓ›Ùȉ· ÏfiÁˆ ÂÈÛÓÔ‹˜ CO. §fiÁˆ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ô˘ ‹Ù·Ó Û˘Ó‰˘·ÛÌfi˜ ‚·ÚÈ¿˜ Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ (ÎÒÌ·ÙÔ˜ ππ Î·È ÛËÌÂ›Ô ‰‡ÔÓÙÔ˜ ËÏ›Ô˘, ÂÓ‰ÂÈÎÙÈÎfi ÂÁÎÂÊ·ÏÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜), ·Ú·Ì¤ÓÔ˘Û·˜ ÔͤˆÛ˘ Î·È ˘ÔÍ·ÈÌ›·˜ ÙÔ ·È‰› ‰È·ÛˆÏËÓÒıËΠ¿ÌÂÛ·. ∆¤ıËΠ۠Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi ˘fi ηٷÛÙÔÏ‹, ¿Ú¯ÈÛ ¯ÔÚ‹ÁËÛË Ì·ÓÈÙfiÏ˘ (0,25 g/kg x 6 IV) fiˆ˜ Î·È Ì·ÎÚÔÌÔÚÈ·ÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ Ô˘ ··ÓÙ¿Ù·È ÛÙË ‚·ÚÈ¿ ‰ËÏËÙËÚ›·ÛË Ì CO ÏfiÁˆ ‰È¿¯˘Ù˘ ‚Ï¿‚˘ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ Î·È ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ¤ÁÈÓ 8 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ·Ú¿ Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÂÁÎÂÊ·ÏÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜. ∆· ∏∫° ÂÈÛfi‰Ô˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ ¤‰ÂÈÍ·Ó ÈÛ¯·ÈÌ›· ÙÔ˘ οو Ï¿ÁÈÔ˘ ÙÔȯÒÌ·ÙÔ˜ Î·È ‰È·Ù·Ú·¯¤˜ Â·Ó·fiψÛ˘ Û fiϘ ÙȘ ··ÁˆÁ¤˜. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډ›·˜ ¤‰ÂÈÍ ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ· Î·È ‹È· ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜. ªÂ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ¯ÔÚËÁ‹ıËÎ·Ó ÈÓfiÙÚÔ· ÁÈ· ¤ÓÙ Ë̤Ú˜. ∆Ë ‰Â‡ÙÂÚË Ì¤Ú· ÓÔÛËÏ›·˜ ¤ÁÈÓ ‰Â‡ÙÂÚË Û˘Ó‰ڛ· ∏µO ·Ú¿ ÙË ¯·ÌËÏ‹ ηڂÔ͢·ÈÌÔÛÊ·ÈÚ›ÓË ÛÙÔ ·›Ì·. O ÏfiÁÔ˜ ‹Ù·Ó Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ‰ÂÛÌÂ˘Ì¤ÓÔ˘ CO ·fi ÙËÓ Ì˘ÔÛÊ·ÈÚ›ÓË, Ë ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ηıÒ˜ Î·È Ë ·ÔÊ˘Á‹ ·ÒÙÂÚˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ. ∆ËÓ ÙÚ›ÙË Ì¤Ú· ÓÔÛËÏ›·˜ ˘‹ÚÍ ‚ÂÏÙ›ˆÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÈÛ¯·ÈÌ›·˜ ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ CPK ‹Ù·Ó 535 IU/L Î·È ÙÔ ÎÏ¿ÛÌ· CKMB ‹Ù·Ó 28 IU/L, Ë LDH ‹Ù·Ó 430 IU/L. ∆Ô ÙÂÛÙ ÙÚÔÔÓ›Ó˘ ‹Ù·Ó ·ÚÓËÙÈÎfi ·ÏÏ¿ ÙÔ ·È‰› ·ÚÔ˘Û›·Û ÂÂÈÛfi‰ÈÔ ÎÔÈÏÈ·ÎÒÓ ¤ÎÙ·ÎÙˆÓ Û˘ÛÙÔÏÒÓ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Ô˘ ˘Ô¯ÒÚËÛ ¯ˆÚ›˜ ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË. ∆ËÓ ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË Ì¤Ú· ÓÔÛËÏ›·˜ ÌÂٷʤÚıËΠÁÈ· ¿ÏϘ ‰‡Ô Û˘Ó‰ڛ˜ ∏µO. ∞ÔÛˆÏËÓÒıËΠÂÈÙ˘¯Ò˜ ÙËÓ ¤ÌÙË Ë̤ڷ ÓÔÛËÏ›·˜ Î·È Ù¤ıËΠ۠·ÚÔ¯‹ ˘ÁÚÔÔÈË̤ÓÔ˘ O2 40-60% Ì ̿Ûη. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÂÏ·ÊÚ¿ ÂËÚ·Ṳ̂ÓË ÙÔ ÚÒÙÔ ÂÈÎÔÛÈÙÂÙÚ¿ˆÚÔ. ◊Ù·Ó ÏËı·ÚÁÈÎfi ·ÏÏ¿ fiÙ·Ó ·Ê˘ÓÈ˙fiÙ·Ó Â›¯Â ηϋ Â·Ê‹ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ ¯ˆÚ›˜ ÂÛÙȷο ÛËÌ›·. ∂›Û˘ ÎÏ‹ıËΠ·È‰Ô„˘¯›·ÙÚÔ˜, Û˘ÓÂÚÁ¿Ù˘ Ù˘ ªÔÓ¿‰·˜, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Î·È ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡. ∏ Û˘ÓÔÏÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÙÔ˘ ÂͤٷÛË ‹Ù·Ó ηϋ. ∆Ô Â›Â‰Ô ÙˆÓ ·ÓÒÙÂÚˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÎÚ›ıËÎÂ Ê˘ÛÈÔ-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·521

¶∞π¢π∞∆ƒπ∫∏ 2000;63:519-523

ÏÔÁÈÎfi, Ì ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·›ÛıËÛ˘ ÙÔ˘ ¯ÒÚÔ˘, ÙÔ˘ ¯ÚfiÓÔ˘, Ù˘ ÌÓ‹Ì˘, ÙˆÓ Ì·ıËÌ·ÙÈÎÒÓ ˘ÔÏÔÁÈÛÌÒÓ Î·È Ù˘ ·Ó¿ÁÓˆÛ˘. ∂Í‹Ïı ·fi ÙË ªÔÓ¿‰· Ì·˜ ÙËÓ ¤Ó·ÙË Ë̤ڷ ÓÔÛËÏ›·˜, Ì ÛÙ·ıÂÚ¿ ‚ÂÏÙÈÔ‡ÌÂÓ· Â˘Ú‹Ì·Ù· ·fi ÙÔ ∏∫° Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډ›·˜. ¶·Ú¤ÌÂÓ·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ Â·Ó·fiψÛ˘ ÛÙȘ οو-Ï¿ÁȘ ··ÁˆÁ¤˜, ÂÓÒ ˘‹Ú¯Â ÛÙ·ıÂÚ‹ ‚ÂÏÙ›ˆÛË ÛÙȘ ‰È·ÛÙ¿ÛÂȘ Î·È ÙË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ. ¢È·ÎÔÌ›ÛÙËΠ۠¶·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ ·fi fiÔ˘ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË ÌÂÙ¿ ·fi 7 ̤Ú˜ ηٿ ÙȘ Ôԛ˜ ›¯Â ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ηډȷ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜. ŒÓ· Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ›¯Â Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ ∏∫°. ™˘ÛÙ‹ıËΠηډÈÔÏÔÁÈ΋ Â·ÓÂͤٷÛË ÌÂÙ¿ ·fi ÂÍ¿ÌËÓÔ. ™˘˙‹ÙËÛË ∆Ô CO Â›Ó·È ¿¯ÚˆÌÔ, ¿ÔÛÌÔ ÙÔÍÈÎfi ·¤ÚÈÔ, ÚÔ˚fiÓ ·ÙÂÏÔ‡˜ η‡Ûˆ˜ ÙÔ˘ ¿Óıڷη. ∫ÔÈÓ¤˜ ËÁ¤˜ CO Â›Ó·È Ù· ·¤ÚÈ· ÂÍ¿ÙÌÈÛ˘ ·˘ÙÔÎÈÓ‹ÙˆÓ, Ô Î·Ófi˜ ·fi ˘ÚηÁȤ˜, Ô Î·Ófi˜ ÙÔ˘ ÙÛÈÁ¿ÚÔ˘, ÙÔ Ì·ÁοÏÈ, ‰È·Ï˘ÙÈο ‚·ÊÒÓ Ô˘ ÂÚȤ¯Ô˘Ó ¯ÏˆÚÈÔ‡¯Ô ÌÂı˘Ï¤ÓÈÔ (1). ∏ ·ÎÚÈ‚‹˜ Û˘¯ÓfiÙËÙ· Ù˘ ‰ËÏËÙËÚ›·Û˘ ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù· Î·È ·Ú·Ì¤ÓÔ˘Ó ·‰È¿ÁÓˆÛÙ˜. ™ËÌÂȈ٤ÔÓ fiÙÈ ÔÈ Î¿ÙÔÈÎÔÈ ÙˆÓ ÌÂÁ·ÏÔ˘fiÏÂˆÓ ¤¯Ô˘Ó Â›‰· ηڂÔ͢·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbCO) ÛÙÔ ·›Ì· Ù˘ Ù¿Í˘ ÙÔ˘ 1-2% ÂÓÒ ÛÙÔ˘˜ ηÓÈÛÙ¤˜ Ù· Â›‰· Â›Ó·È Ù˘ Ù¿Í˘ ÙÔ˘ 4% (2). ¶¤ÓÙ ‚·ÛÈÎÔ› Ì˯·ÓÈÛÌÔ› ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÙÔÍÈÎfiÙËÙ· ÙÔ˘ CO: ·) ∆Ô ·¤ÚÈÔ CO ¤¯ÂÈ Û˘ÁÁ¤ÓÂÈ· Ì ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË 200-500 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ÂΛӢ ÙÔ˘ O2 Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÎÙfiÈÛË ÙÔ˘ O2 ·fi ÙÔ ÌfiÚÈÔ Ù˘ Hb Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ Û ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ˘ÔÍ›· ÙˆÓ ÈÛÙÒÓ (1,2,4). ‚) ¢Â‡ÙÂÚÔ˜ Ì˯·ÓÈÛÌfi˜ ÙÔÍÈÎfiÙËÙ·˜ Â›Ó·È Ë Î˘ÙÙ·ÚÈ΋ ·ÛÊ˘Í›·, Ì ·Ó·ÛÙÔÏ‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ ÛÙÔ Â›Â‰Ô ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘ (1,2). Á) ∏ ÙÔÍÈÎfiÙËÙ· ÙÔ˘ CO ·˘Í¿ÓÂÈ ÏfiÁˆ Ù˘ Û‡Ó‰ÂÛ‹˜ ÙÔ˘ Ì ÙËÓ ÛÎÂÏÂÙÈ΋ ·ÏÏ¿ Î·È ÙËÓ Î·Ú‰È·Î‹ Ì˘ÔÛÊ·ÈÚ›ÓË Ô˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó· ·Ú·ÙËÚÔ‡ÓÙ·È ·Ú·ÙÂٷ̤ӷ ÙÔÍÈο Ê·ÈÓfiÌÂÓ· fiˆ˜ Â›Û˘ Î·È Î·ı˘ÛÙÂÚË̤ÓË ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘Ìو̿وÓ, ÂÍ·ÈÙ›·˜ Ù˘ ·ÚÁfiÙÂÚ˘ ·Ô‰¤ÛÌ¢Û˘ ÙÔ˘ CO ·fi ÙËÓ Ì˘ÔÛÊ·ÈÚ›ÓË Û ۯ¤ÛË Ì ÙËÓ ·Ô‰¤ÛÌ¢ÛË ÙÔ˘ ·fi ÙËÓ Hb, ÏfiÁˆ ˘„ËÏfiÙÂÚ˘ Û˘ÁÁ¤ÓÂÈ·˜ (2,4). ‰) ∆Ô CO ÚÔηÏ› ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈԉȷÛÙÔÏ‹ Î·È ˘fiÙ·ÛË Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ÈÛ¯·ÈÌ›· ÙˆÓ ÈÛÙÒÓ (2,4). Â) ™Â ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÒÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Ô˘ È-

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

ÛÙ‡ÂÙ·È fiÙÈ Â›Ó·È ·fiÙÔΘ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‚Ï¿‚˘ Â·Ó·ÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓ ÌÂÙ¿ ·fi ÈÛ¯·ÈÌÈÎfi ÂÂÈÛfi‰ÈÔ (2,4). ∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÔÍ›·˜ ‰ËÏËÙËÚ›·Û˘ Ì CO Â›Ó·È Û˘Ó‹ıˆ˜ ¿Ù˘·. °È’ ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ Ë ‰È¿ÁÓˆÛË ‰È¢ÎÔχÓÂÙ·È ·fi ÙȘ Û˘Óı‹Î˜ ÛÙȘ Ôԛ˜ ‚Ú¤ıËÎÂ Ô ·ÛıÂÓ‹˜ (1,9). ∆· ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù·, ÂȉÈο ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ηıÒ˜ Î·È Ë ÚfiÁÓˆÛË Ù˘ ÔÍ›·˜ ‰ËÏËÙËÚ›·Û˘ ·Ú·‰fi͈˜, Û¯ÂÙ›˙ÔÓÙ·È Û ÌÈÎÚfi ‚·ıÌfi Ì ٷ Â›‰· Ù˘ HbCO ÛÙÔ ·›Ì· (2,9). ∏ Ùˆ¯‹ ·˘Ù‹ Û˘Û¯¤ÙÈÛË ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ¤ÎıÂÛ˘ ·ÏÏ¿ Î·È ÛÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÂÈÛÓÂfiÌÂÓÔ˘ ·¤Ú· ÛÙÔ ‰ËÏËÙËÚÈ҉˜ ·¤ÚÈÔ, ÛÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÛÙÔÓ ¯ÚfiÓÔ Ô˘ ¤¯ÂÈ ·Ú¤ÏıÂÈ ·fi ÙËÓ ¤ÎıÂÛË ÛÙÔ CO ̤¯ÚÈ ÙËÓ ¤Ï¢ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô. µÈ‚ÏÈÔÁÚ·ÊÈο ¤¯ÂÈ ·Ó·ÊÂÚı› Ë ·Ú·Î¿Ùˆ ·‰Ú‹ Û˘Û¯¤ÙÈÛË ÂÈ¤‰ˆÓ Ù˘ HbCO Ì ÙË Û˘Ìو̷ÙÔÏÔÁ›· (2,7): 0-10% ∞Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ÂÎÙfi˜ ‹È·˜ ÎÂÊ·Ï·ÏÁ›·˜ 20% ∑¿ÏË, Ó·˘Ù›·, ÏÈÔı˘ÌÈ΋ Ù¿ÛË, Û˘ÌÙÒÌ·Ù· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜, ‹È· ‰‡ÛÓÔÈ· 30% OÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ 40% ™‡Á¯˘ÛË, ÏÈÔı˘Ì›· >50% ™·ÛÌÔ›, ÎÒÌ·, ·ÚÚ˘ı̛˜, ÈÛ¯·ÈÌ›· ÙÔ˘ Ì˘Ôηډ›Ô˘, ·Ó·ÎÔ‹ Î·È ı¿Ó·ÙÔ˜ ¡Â˘ÚÔ„˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù· ÌÔÚ› Ó· ·Ó·Ù˘¯ıÔ‡Ó "‡Ô˘Ï·" ̤۷ Û ÂÚ›Ô‰Ô Â‚‰ÔÌ¿‰ˆÓ ‹ ÌËÓÒÓ ·fi ÙËÓ ÔÍ›· ‰ËÏËÙËÚ›·ÛË (1). ªÂÁ¿ÏË ÔÈÎÈÏ›· Ó¢ÚÔÏÔÁÈÎÒÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ¤¯ÂÈ ·Ó·ÊÂÚı› fiˆ˜: ‰È·ÓÔËÙÈ΋ ¤ÎÙˆÛË, ·ÒÏÂÈ· ÌÓ‹Ì˘ (Û ÔÛÔÛÙfi ̤¯ÚÈ Î·È 43%), ‰È·Ù·Ú·¯¤˜ fiÚ·Û˘, ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ), Û˘ÌÙÒÌ·Ù· Ù‡Ô˘ ÓfiÛÔ˘ Parkinson, ÌfiÓÈÌË Ê˘ÙÈ΋ ηٿÛÙ·ÛË (2). ª¤¯ÚÈ Î·È 10% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· (2). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÁÓˆÛË, Ë ÈÔ ·ÍÈfiÈÛÙË ¤Ó‰ÂÈÍË ‰ËÏËÙËÚ›·Û˘ Â›Ó·È ÙÔ ÈÛÙÔÚÈÎfi Èı·Ó‹˜ ¤ÎıÂÛ˘ Û CO (2). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ HbCO ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î˘Ú›ˆ˜ ˆ˜ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ (3,9). ∞Ó ¤¯ÂÈ ·Ú¤ÏıÂÈ ÛËÌ·ÓÙÈÎfi˜ ¯ÚfiÓÔ˜ ·fi ÙÔ ·Ù‡¯ËÌ· ‹ ·Ó ¤¯ÂÈ ¯ÔÚËÁËı› 100% O2 Ù· Â›‰· Ù˘ HbCO ÌÔÚ› Ó· Â›Ó·È ·Ú·Ï·ÓËÙÈο ¯·ÌËÏ¿. O ÎÏÈÓÈÎfi˜ ÌÔÚ› ÂÛÊ·Ï̤ӷ Ó· ·ÔÎÏ›ÛÂÈ ÙË ‰ËÏËÙËÚ›·ÛË Ì CO, ‰ÈfiÙÈ Ô ÎÔÚÂÛÌfi˜ Ù˘ Hb ÛÙ· ·¤ÚÈ· ·›Ì·ÙÔ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÂȉ‹ ˘ÔÏÔÁ›˙ÂÙ·È ·˘ÙfiÌ·Ù· ·fi ÙËÓ ÌÂÚÈ΋ ›ÂÛË ÙÔ˘ O2, Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·ÏÌÈ΋ Ô͢ÌÂÙÚ›· Â›Û˘ Â›Ó·È ·Ó·ÎÚÈ‚‹˜ ÛÙË ‰ËÏËÙËÚ›·ÛË Ì CO, ‰ÈfiÙÈ Ë ∏bCO ·ÔÚÚÔÊ¿ ÙÔ Êˆ˜ ÛÙÔ ›‰ÈÔ Ì‹ÎÔ˜ ·̷ÙÔ˜ fiˆ˜ Î·È Ë Ô͢·ÈÌÔÛÊ·ÈÚ›ÓË. ™Â ÛËÌ·-

521

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·522

¶∞π¢π∞∆ƒπ∫∏ 2000;63:519-523

ÓÙÈ΋ ˘ÎÓfiÙËÙ· HbCO ¯ÚÂÈ¿˙ÂÙ·È ÂȉÈ΋ Ô͢ÌÂÙÚ›· ÁÈ· Ó· ÌÂÙÚËı› Ô ·ÎÚÈ‚‹˜ ÎÔÚÂÛÌfi˜ Ù˘ Hb (7), ̤ıÔ‰Ô ÙËÓ ÔÔ›· ÎÈ ÂÌ›˜ ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘fiÓÔÈ· ‹ ÂȂ‚·ÈˆÌ¤ÓË ‰ËÏËÙËÚ›·ÛË Ì CO Ú¤ÂÈ Ó· Á›ÓÂÙ·È ∏∫° Î·È ·Ó Â›Ó·È ·ıÔÏÔÁÈÎfi (ÎÔÏÈ΋ Ù·¯˘Î·Ú‰›·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ST) ÙfiÙ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔÈ ÚÔÛ‰ÈÔÚÈÛÌÔ› CPK, LDH Î·È Ô ·ÛıÂÓ‹˜ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÛÙÂÓ¿. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Ì ÂȉÈο „˘¯ÔÌÂÙÚÈο ÙÂÛÙ, ‰ÈfiÙÈ Ô ·‰Úfi˜ ¤ÏÂÁ¯Ô˜ ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ ÙÔ˘ ÛÙÔ ¯ÒÚÔ, ¯ÚfiÓÔ, ÂÚÈ‚¿ÏÏÔÓ, Â›Ó·È ·ÓÂ·Ú΋˜ Û ÂÚ›ÙˆÛË ‰È·Ù·Ú·¯‹˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ (2,3,5). ∂›Û˘ ÔÈ ·ÛıÂÓ›˜ Ì Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ì CT ‹ MRI ÂÁÎÂÊ¿ÏÔ˘ fiÔ˘ ÌÔÚ› Ó· ηٷÁÚ·ÊÔ‡Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· fiˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË Ó¤ÎÚˆÛË Ù˘ ˆ¯Ú¿˜ ÛÊ·›Ú·˜, ÙÔ˘ ÊÏÔÈÔ‡, ÙÔ˘ ÈfiηÌÔ˘ Î·È Ù˘ Ê·È¿˜ Ô˘Û›·˜ (2,4). ∏ ·ÚÔ˘Û›· ‚Ï·‚ÒÓ ÛÙË Ï¢΋ Ô˘Û›· ÈÔ Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì Ùˆ¯‹ ÚfiÁÓˆÛË (4). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ‰ËÏËÙËÚ›·Û˘ Ì CO, fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ Â·ÚΤ˜ ÈÛÙÔÚÈÎfi ¤ÎıÂÛ˘, ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È¿ÊÔÚ˜ ÈÒÛÂȘ, ÙÚÔÊÈ΋ ‰ËÏËÙËÚ›·ÛË, ηٿıÏÈ„Ë, ·ÚÔ‰ÈÎfi ÈÛ¯·ÈÌÈÎfi ÂÂÈÛfi‰ÈÔ, ÓfiÛÔ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ, ·ÚÚ˘ı̛˜ Î·È Ô ·ÛıÂÓ‹˜ ı· Ú¤ÂÈ Ó· ·ÔÌ·ÎÚ‡ÓÂÙ·È ·Ì¤Ûˆ˜ ·fi ÙÔÓ ÙfiÔ ¤ÎıÂÛ˘ ÛÙÔ ‰ËÏËÙËÚÈ҉˜ ·¤ÚÈÔ Î·È Ó· ¯ÔÚËÁÂ›Ù·È O2 100% Ì ̿Ûη ÂÊ·ÚÌÔṲ̂ÓË Î·Ï¿. ∞Ó Ô ·ÛıÂÓ‹˜ ¤¯ÂÈ ·ÒÏÂÈ· ·ÈÛı‹ÛÂˆÓ ı· Ú¤ÂÈ Ó· ‰È·ÛˆÏËÓÒÓÂÙ·È ¿ÌÂÛ· Î·È Ó· Ù›ıÂÙ·È Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi. ∏ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì·˜, ·fi ÙÔ ∫À ÁÈ· ıÂÚ·›· Ì ∏µ√ ÛÙËÓ ∞ı‹Ó· ı· ÁÈÓfiÙ·Ó Ì ÌÂÁ·Ï‡ÙÂÚË ·ÛÊ¿ÏÂÈ· ·Ó Ô ·ÛıÂÓ‹˜ ‹Ù·Ó ‰È·ÛˆÏËӈ̤ÓÔ˜ Î·È Û Ì˯·ÓÈÎfi ˘ÂÚ·ÂÚÈÛÌfi.

O ÛÙfi¯Ô˜ Ù˘ ıÂÚ·›·˜ Ì O2 Â›Ó·È Ó· ÌÂÁÈÛÙÔÔÈËı› ÙÔ ÎÏ¿ÛÌ· ÙÔ˘ O2 Ô˘ Â›Ó·È ‰È·Ï˘Ì¤ÓÔ ÛÙÔ Ï¿ÛÌ·. ∏ Ô͢ÁÔÓÔıÂÚ·›· ı· Ú¤ÂÈ Ó· Û˘Ó¯›˙ÂÙ·È ÁÈ· ÙfiÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÒÛÙ ӷ ÚÔÏËÊıÔ‡Ó ÔÈ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ ·fi ÙËÓ ·Ô‰¤ÛÌ¢ÛË Ù˘ ηڂÔÍ˘Ì˘ÔÛÊ·ÈÚ›Ó˘. ¢˘ÛÙ˘¯Ò˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ηıÔÚÈṲ̂Ó˜ Ô‰ËÁ›Â˜ ÁÈ· ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚÔÓÈÎÔ‡ ·˘ÙÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ (2). ∏ ıÂÚ·›· Ì ∏µ√ Â›Ó·È Ë ‰È·Ï›Ô˘Û· ÂÈÛÓÔ‹ O2 100% ˘fi ›ÂÛË ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÌÈ·˜ ·ÙÌfiÛÊ·ÈÚ·˜ (6,10). ŒÓ‰ÂÈÍË ÁÈ· ıÂÚ·›· Ì ∏µO ¤¯Ô˘Ó ÔÈ ·ÛıÂÓ›˜ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È Ì ÈÛÙÔÚÈÎfi ·ÒÏÂÈ·˜ Û˘Ó›‰ËÛ˘ ‹ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ù·Í›·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ „˘¯ÈÛÌÔ‡ ‹ ıÂÙÈΤ˜ „˘¯ÔÌÂÙÚÈΤ˜ ‰ÔÎÈ̷ۛ˜, fiÓÔ ÛÙÔ ÛÙ‹ıÔ˜, ÂӉ›ÍÂȘ ÈÛ¯·ÈÌ›·˜ ÛÙÔ ∏∫°, ˘fiÙ·ÛË, ¤ÁÎ˘Â˜ Á˘Ó·›Î˜, ‹ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ·Û˘Ìو̷ÙÈÎÔ› ·ÏÏ¿ ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ÛËÌ·ÓÙÈ΋˜ ‹/Î·È ·Ú·ÙÂٷ̤Ó˘ ¤ÎıÂÛ˘ ÛÙÔ CO (1,2,9).

OÈ Ì˯·ÓÈÛÌÔ› ‰Ú¿Û˘ ÙÔ˘ ∏µO ÛÙË ‰ËÏËÙËÚ›·ÛË Ì CO ›ӷÈ: 1) ™˘Ì‚¿ÏÏÂÈ ÛÙË ÁÚËÁÔÚfiÙÂÚË ·Ô‰¤ÛÌ¢ÛË ÙÔ˘

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CO ·fi ÙÔ ÌfiÚÈÔ Ù˘ Hb. O ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Ù˘ HbCO Â›Ó·È 4-5 ÒÚ˜ ÁÈ· ¤Ó· ¿ÙÔÌÔ Ô˘ ·Ó·Ó¤ÂÈ ‹ÚÂÌ· Û ·¤Ú· ‰ˆÌ·Ù›Ô˘. O ¯ÚfiÓÔ˜ ·˘Ùfi˜ ÌÂÈÒÓÂÙ·È ÛÙ· 80 min Ì ÙË ¯ÔÚ‹ÁËÛË O2 100% Î·È Û 20-23 min Ì ÙË ¯ÔÚ‹ÁËÛË ∏µO ÛÙȘ 2,5-3 Atm. ™ÙȘ 3 Atm Ë ÔÛfiÙËÙ· ÙÔ˘ O2 Ô˘ ‰È·Ï‡ÂÙ·È ÛÙÔ Ï¿ÛÌ· Â›Ó·È ÈηӋ Ó· ‰È·ÙËÚ‹ÛÂÈ ÙÔÓ ÔÚÁ·ÓÈÛÌfi ÂÓ ˙ˆ‹ ·ÎfiÌ· Î·È Ì Ï‹ÚË ¤ÏÏÂÈ„Ë ÏÂÈÙÔ˘ÚÁÈ΋˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (2,6,9,10).

2) ¶ÚÔηÏ› Û‡Û·ÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛ˘ Î·È ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ (2,6,9).

3) ¶ÚÔÛٷهÂÈ ·fi ÙËÓ ÔÍÂȉˆÙÈ΋ ‚Ï¿‚Ë Ô˘ Û˘Ì‚·›ÓÂÈ ÛÙ· ·ÙÙ·Ú· ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË ÛÙÔ CO, ηٿ ÙË Ê¿ÛË Ù˘ Â·Ó·ÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓ. ∆Ô ∏µO ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ O2 Î·È ·ÔÙÚ¤ÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, Ô˘ ÚÔηÏÔ‡Ó ‚Ï¿‚Ë ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁ›ˆÓ. OÈ ‚Ï¿‚˜ Â·Ó·ÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·ı˘ÛÙÂÚËÌ¤ÓˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ (2,4,6,8).

4) ∂›Û˘, ·˘Í¿ÓÂÈ ÙËÓ ·Ô‰¤ÛÌ¢ÛË ÙÔ˘ CO ·fi ÙÔ Î˘Ùfi¯ÚˆÌ· P450 Î·È ÙËÓ ÔÍÂȉ¿ÛË ·3 Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜. ŒÙÛÈ ·ÔÙÚ¤ÂÈ ÙËÓ ·ÓÔÍ›· ÛÙÔ Â›Â‰Ô ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘ (2,6,9,10). ∆Ô Ì¤ÁÈÛÙÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ıÂÚ·›·˜ Ì ∏µO ÂÈÙ˘Á¯¿ÓÂÙ·È fiÙ·Ó ÔÈ Û˘Ó‰ڛ˜ Á›ÓÔÓÙ·È ÙȘ ÚÒÙ˜ ¤ÍÈ ÒÚ˜ ·fi ÙÔ Û˘Ì‚¿Ó Î·È Û ›ÂÛË ¯ÔÚ‹ÁËÛ˘ ÂÓÙfi˜ ÙÔ˘ ÂȉÈÎÔ‡ ı·Ï¿ÌÔ˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 Atm (2,4,9). ∏ ÂÌÊ¿ÓÈÛË Î·ı˘ÛÙÂÚËÌ¤ÓˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ì ÙË ıÂÚ·›· Ì ∏µO, ·ÎfiÌË Î·È fiÙ·Ó ·˘Ù‹ ¯ÔÚËÁËı› Ôχ ·ÚÁfiÙÂÚ· ·fi ÙȘ ¤ÍÈ ÚÒÙ˜ ÒÚ˜ ·fi ÙÔ Û˘Ì‚¿Ó (4). ∏ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊËΠ·ÊÔÚ¿ ·ÛıÂÓ‹ ¿ÚÚÂÓ Ì ÛÔ‚·Ú‹ ‰ËÏËÙËÚ›·ÛË Ì CO Ô˘ ·ÚÔ˘Û›·Û ‚·Ú‡Ù·ÙË Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ ∫¡™ (ÎÒÌ· πππ Î·È ÛËÌ›· ·ÂÁÎÂÊ·ÏÈÛÌÔ‡) fiˆ˜ Â›Û˘ Î·È ÛËÌ›· ÈÛ¯·ÈÌ›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. OÈ Û˘Ó‰ڛ˜ Ì ∏µO Î·È Ë ÓÔÛËÏ›· ÙÔ˘ ÛÙËÓ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Ì·˜, ›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó· ÂͤÏıÂÈ Ô ·ÛıÂÓ‹˜ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ·ÏÏ¿ Ì ¤Ó·Ó ‚·ıÌfi ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, Ë ÔÔ›· ÛÙ·‰È·Î¿ ·ÔηٷÛÙ¿ıËÎÂ. ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ì·˜ ·ÔÙÂÏ› ÌÂÌÔӈ̤ÓË ÂÚ›ÙˆÛË ‰ËÏËÙËÚ›·Û˘ Ì CO ·fi Ì·ÁοÏÈ, Ô˘ ‰ËÏÒÓÂÈ fiÙÈ Ë ÔÓÙfiÙËÙ· ÂÍ·ÎÔÏÔ˘ı› Ó· ˘Ê›ÛÙ·Ù·È ÛÙË ¯ÒÚ· Ì·˜ ·Ú¿ ÙËÓ ‚ÂÏÙ›ˆÛË ÙˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Û˘ÓıËÎÒÓ. ∂›Û˘, ÂÓÈÛ¯‡ÂÙ·È Ë ¿Ô„Ë fiÙÈ Ë ıÂÚ·›· Ì ∏µO ÌÔÚ› Ó· Â›Ó·È Ôχ ÂÈÙ˘¯‹˜ ÛÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Meredith T, Vale A. Carbon monoxide poisoning. Brit Med J 1988;296:77-78.

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2. Varon J, Marik P. Carbon Monoxide Poisoning, Int J Emerg Intens Care Med 1997; Vol 1 N2: http://www.ispub.com/journals/ IJEICM/Vol1N2/CO.htm.

Updated July 10, 1997.

3. Frances- Cramer. Department of Respiratory Care, UIHC, Carbon Monoxide Poisoning, http://www.uihc.uiowa.edu/ pubinfo/respcare/carbon2.htm.

4. Thom S, Keim L. Carbon Monoxide Poisoning: A review epidemiology, pathophysiology, clinical findings and treatment options including hyperbaric therapy. Clin Toxicol 1989;27:141-156.

5. Myers R, Britten J. Are arterial blood gases of value in treatment decisions for carbon monoxide poisoning? Crit Care Med 1989;17:139-142.

6. Grim SP, Gottlieb JL, Boddie A, Batson E. Hyperbaric Oxygen Therapy, JAMA 1990;263:2216(5).

7. Spurrier E, Spear R, Munster A. Burns, Inhalational Injury and Electrical Injury. In: Rogers, M, Helfaer M,

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

eds. Handbook of Pediatric Intensive Care. Third Edition, Williams & Wilkins; 1999: p. 825-829.

8. Thom S. Experimental carbon monoxide -mediated brain lipid peroxidation and the effects of oxygen therapy, Ann Emerg Med 1988;17:403.

9. °ÎÈÒÓ˘ ¢, ªÔ˘ÛÙ¿ÎË ª. ∏ ¯Ú‹ÛË ÙÔ˘ ˘ÂÚ‚·ÚÈÎÔ‡ ÛÙËÓ È·ÙÚÈ΋ Ú¿ÍË, ¶·È‰È·ÙÚÈ΋ 1999;62:279-286.

10. ƒÔ‡ÛÔ˜. O͢ÁÔÓÔıÂÚ·›·. ∂ÓÙ·ÙÈ΋ £ÂÚ·›·, π·ÙÚÈΤ˜ ∂ΉfiÛÂȘ ¶·Û¯·Ï›‰Ë˜; 1997. ÛÂÏ. 348-350.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-04-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-10-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ∫·ÙÛ¿Ú· ¢ÈÛÙfiÌÔ˘ 9, ∑ˆÁÚ¿ÊÔ˘ ∞ı‹Ó·, 15772

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™ÔÁÁ҉˘ ÓÂÊÚfi˜ Û ‰‡Ô ·‰¤ÏÊÈ· KˆÓÛÙ·ÓÙ›ÓÔ˜ KÔÏÏÈfi˜1, AÈηÙÂÚ›ÓË ¢ÚÔ‡ÁÈ·1, EÈÚ‹ÓË ™ÈfiÓÙË1, KˆÓÛÙ·ÓÙ›ÓÔ˜ TÛ·ÌԇϷ˜2, Zˆ‹ ¶··‰ÔÔ‡ÏÔ˘-KÔ˘ÏÔ˘Ì‹1

● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÔÈÎÔÁÂÓ‹˜ ÂÚ›ÙˆÛË ÛÔÁÁÒ‰Ô˘˜ ÓÂÊÚÔ‡ Î·È ÓÂÊÚ·Û‚¤ÛÙˆÛ˘ Û ¿ÚÚÂÓ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 13 ÌËÓÒÓ Î·È ÛÙËÓ ·‰ÂÏÊ‹ ÙÔ˘ ËÏÈΛ·˜ 11 ÂÙÒÓ ¯ˆÚ›˜ Ó· Û˘Ó˘¿Ú¯ÂÈ ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›· ‹ ¿ÏÏË ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹. ∆Ô ÂӉȷʤÚÔÓ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙË Û·ÓÈfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙ· ·È‰È¿, ÛÙÔÓ ·Û˘Ó‹ıÈÛÙÔ ÔÈÎÔÁÂÓ‹ ¯·Ú·ÎÙ‹Ú· Ù˘, ηıÒ˜ Î·È Ù˘È΋ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ÛÙËÓ ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›·. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜, Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ÛÔÁÁÒ‰Ô˘˜ ÓÂÊÚÔ‡ Ì ·ÌÈÁ‹ Ô˘ÚÈ΋ ÏÈı›·ÛË ·ÔÙÂÏ›, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Û¿ÓÈ· ÂΉ‹ÏˆÛË ÛÙ· ·È‰È¿ Ô˘ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ‚È‚ÏÈÔÁÚ·Ê›·. ¶·È‰È·ÙÚÈ΋ 2000;63:524-528. §¤ÍÂȘ ÎÏÂȉȿ: ÛÔÁÁ҉˘ ÓÂÊÚfi˜, ÓÂÊÚ·Û‚¤ÛÙˆÛË, Ô˘ÚÈ΋ ÓÂÊÚÔÏÈı›·ÛË.

K.D. Kollios, A. Drougia, I. Siondi, K. Tsampulas, Z.L. Papadopoulou. Medullary sponge kidney in two siblings. Paediatriki 2000;63:524-528. ● Abstract: Two siblings, a male infant aged 13 months and his sister aged 11 years, with medullary sponge kidney and nephrocalcinosis, are described. There was no associated hypercalciuria or other metabolic disease. The interest of these two cases lies in the rarity of the disease presentation in childhood, its unusual familial occurrence, and its characteristic urographic pattern. In the case of the male infant, the association of medullary sponge kidney with pure uric acid lithiasis is, in contrast to adults, an unusual finding in childhood not previously reported in the literature.

Key words: medullary sponge kidney, nephrocalcinosis, uric acid lithiasis.

∂ÈÛ·ÁˆÁ‹ OÛÔÁÁ҉˘ ÓÂÊÚfi˜ (™¡) Â›Ó·È ÌÈ· Û˘ÁÁÂÓ‹˜ ·Ó·ÙÔÌÈ΋ ·ÓˆÌ·Ï›· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È¿Ù·ÛË ÙˆÓ ÙÂÏÈÎÒÓ ÙÌËÌ¿ÙˆÓ ÙˆÓ ·ıÚÔÈÛÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ˘Ú·Ì›‰ˆÓ Î·È ÙˆÓ ÓÂÊÚÈÎÒÓ ıËÏÒÓ. ¶ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔÓ Lenarduzzi ÙÔ 1938, ÂÓÒ Ë ÔÓÔÌ·Û›· Î·È Ù· ÎÏÈÓÈο, ·ÎÙÈÓÔÏÔÁÈο Î·È ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ ÔÚ›ÛÙËÎ·Ó ·fi ÙÔ˘˜ Cacchi Î·È Ricci ÙÔ 1948 (1). ∏ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹ ‰ÈfiÙÈ Ë ÓfiÛÔ˜ Â›Ó·È Û˘¯Ó¿ ·Û˘Ìو̷ÙÈ΋ ¤ˆ˜ fiÙÔ˘ ÂΉËψıÔ‡Ó Î¿ÔȘ ·fi ÙȘ ÂÈÏÔΤ˜ Ù˘, ¤¯ÂÈ fï˜ ˘ÔÏÔÁÈÛı› fiÙÈ Â›Ó·È 1:20.000 (2). ∂ΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜

1

¶·È‰ÔÓÂÊÚÔÏÔÁÈ΋ KÏÈÓÈ΋, 2 EÚÁ·ÛÙ‹ÚÈÔ AÎÙÈÓÔÏÔÁ›·˜, I·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ, Iˆ¿ÓÓÈÓ·

524

ÙËÓ 3Ë-5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ Ì ›ÛË Û˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ‰‡Ô ʇψÓ. ∏ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ·ÚÎÂÙ¿ Û¿ÓÈ· (3-5). ∏ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Â›Ó·È ¿ÁÓˆÛÙË ·Ó Î·È ·ÚÎÂÙÔ› Û˘ÁÁÚ·Ê›˜ ÙË ıˆÚÔ‡Ó ˆ˜ ÌÈ· Û˘ÁÁÂÓ‹ ·ÓˆÌ·Ï›· ÙˆÓ ÓÂÊÚÈÎÒÓ ˘Ú·Ì›‰ˆÓ Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ ÙÔ˘ ÓÂÊÚÔ‡. ªÔÏÔÓfiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È ÛÔÚ·‰ÈΤ˜, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ Û ·‰¤ÏÊÈ· ηıÒ˜ Î·È Û 2-3 ÁÂÓȤ˜ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ fiÔ˘ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (4). OÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ fï˜, ·ÌÊÈÛ‚ËÙÔ‡Ó ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘.

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·525

¶∞π¢π∞∆ƒπ∫∏ 2000;63:524-528

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

¶›Ó·Î·˜ 1. EÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÛÙ· ‰‡Ô ·‰¤ÏÊÈ· Ì ÛÔÁÁÒ‰Ë ÓÂÊÚfi.

EÚÁ·ÛÙËÚÈ·Îfi˜ 1Ë ¶ÂÚ›ÙˆÛË 2Ë ¶ÂÚ›ÙˆÛË ¤ÏÂÁ¯Ô˜ 13 ÌËÓÒÓ 3 ó ÂÙÒÓ 11 ÂÙÒÓ EÍÂÙ¿ÛÂȘ ·›Ì·ÙÔ˜ pH HCO3(mEq/L) O˘Ú›· (mg/dl) KÚ·ÙÈÓ›ÓË (mg/dl) Ca (mg/dl) P (mg/dl) O˘ÚÈÎfi Ô͇ (mg/dl)

7,39 22,6 23 0,5 10,1 3,8 5,2

7,3 23,8 24 0,6 9,6 4,4 4,5

7,35/7,39 26,2/27,5 25 0,7 10,2 4,5 4,5

EÍÂÙ¿ÛÂȘ Ô‡ÚˆÓ pH FeNa (%) FeK (%) FeMg (%) TmP/GFR (mg/dl GFR) UCa/UCr ratio (mg/mg) OÍ·ÏÈο (mg/1,73m2) O˘ÚÈÎfi Ô͇ (mg/dl GFR)

5,0/5,5 0,6 18 0,02 19 (‚) 0,72/0,88 (Á)

5,5 0,95 14,2 4,9/6,4 0,03 40 (‚) 0,72/0,75 (Á)

5,0/5,5 0,97 8,7/13,3 8,2 4,6 (·) 0,02 36 (‚) 0,32 (Á)

(·) º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ >4mg/dl GFR (‚) º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ <45mg/1,73m2 (Á) º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ <0,56 mg/dl GFR

¶ÂÚÈÁÚ·Ê‹ ÚÒÙ˘ ÂÚ›ÙˆÛ˘ ÕÚÚÂÓ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 13 ÌËÓÒÓ ·Ú·¤ÌÊıËΠ·fi ÓÔÛÔÎÔÌÂ›Ô Ù˘ ∞Ï‚·Ó›·˜ ÁÈ· ‰ÈÂÚ‡ÓËÛË ÓÂÊÚÔÏÈı›·Û˘. ∏ ‰È¿ÁÓˆÛ‹ Ù˘ ›¯Â ÙÂı› Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Î·Ù¿ ÙË ÓÔÛËÏ›· ÙÔ˘ ÏfiÁˆ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â ÂχıÂÚÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ·ÚÓËÙÈÎfi ÁÈ· ÓÂÊÚÈΤ˜ ·ı‹ÛÂȘ. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‚Ú¤ıËÎÂ: µ™: 9 Kg (25Ë ∂£), ª™: 75 cm (>50Ë ∂£) Î·È ·ÚÙËÚȷ΋ ›ÂÛË 90/50 mmHg. H ÏÔÈ‹ ηٿ Û˘ÛÙ‹Ì·Ù· ÂͤٷÛË ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ fiˆ˜ ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜, ∆∫∂, CRP, ۿί·ÚÔ, Ô˘Ú›·, ÎÚ·ÙÈÓ›ÓË, ËÏÂÎÙÚÔχÙ˜ ÔÚÔ‡, ·¤ÚÈ· ·›Ì·ÙÔ˜, Ca, P, Mg, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Î·È Ô˘ÚÈÎfi Ô͇ ÔÚÔ‡ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. T· Â›‰· ·Ú·ıÔÚÌfiÓ˘ ÛÙÔÓ ÔÚfi Î·È ÔÈ ÌÂÙ·‚Ôϛ٘ Ù˘ ‚ÈÙ·Ì›Ó˘ D ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. H ̤ÙÚËÛË Ù˘ ·¤ÎÎÚÈÛ˘ ·Û‚ÂÛÙ›Ô˘ (UCa/UCr), ÔÍ·ÏÈÎÒÓ, Î·È Ë ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘, Î·Ï›Ô˘ Î·È ÊˆÛÊfiÚÔ˘ ÛÂ Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ 24ÒÚÔ˘ Ì ηıÂÙ‹Ú· Folley ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. H ·¤ÎÎÚÈÛË ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ‹Ù·Ó ·˘ÍË̤ÓË fiÙ·Ó ˘ÔÏÔÁ›ÛÙËΠ۠100ml οı·ÚÛ˘ ÎÚ·ÙÈÓ›Ó˘ [(UUA x SCr)/UCr] (6) (¶›Ó·Î·˜ 1). ∆Ô pH ÙˆÓ Ô‡ÚˆÓ Û ÔÏÏ·Ϥ˜ ÌÂÙÚ‹ÛÂȘ Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ 5,0-5,5 Î·È ÔÈ Î·ÏÏȤÚÁÂȘ ÙˆÓ Ô‡ÚˆÓ ‹Ù·Ó ÛÙ›Ú˜. ∏ οı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È Ë ‰ÈÔ‡ÚËÛË

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∆Ô ·ÌÈÓfiÁÚ·ÌÌ· Ô‡ÚˆÓ ‹Ù·Ó Â›Û˘ Ê˘ÛÈÔÏÔÁÈÎfi.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ÂÚÈÏ¿Ì‚·Ó ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÓÂÊÚÒÓ-Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Î·È ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›·. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ‰ÂÓ ·Ó¤‰ÂÈÍ ÏÈı›·ÛË Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜ ÓÂÊÚÒÓ Ì ·˘ÍË̤ÓË Ë¯ÔÁ¤ÓÂÈ· ÙˆÓ ÓÂÊÚÈÎÒÓ ˘Ú·Ì›‰ˆÓ ·ÌÊÔÙÂÚfiÏ¢ڷ, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÓÂÊÚ·Û‚¤ÛÙˆÛË. ∏ ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›· ¤‰ÂÈÍ ‰È¿Ù·ÛË ÙˆÓ ·ıÚÔÈÛÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÓÂÊÚÈÎÒÓ ˘Ú·Ì›‰ˆÓ ·ÌÊÔÙÂÚfiÏ¢ڷ Î·È Ï‹ÚˆÛ‹ ÙÔ˘˜ Ì ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi ˘ÏÈÎfi (ÁÚ·ÌÌÔÂȉ›˜ Ú·‚‰ÒÛÂȘ), ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÛÔÁÁÒ‰Ë ÓÂÊÚfi (EÈÎfiÓ· 1). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ Û˘¯Ó¿ ÂÂÈÛfi‰È· ·Ô‚ÔÏ‹˜ ÌÈÎÚÒÓ Ï›ıˆÓ ηٿ ÙËÓ Ô‡ÚËÛË. ∏ ·Ó¿Ï˘Û‹ ÙÔ˘˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ˘¤Ú˘ıÚ˘ Ê·ÛÌ·ÙÔÁÚ·Ê›·˜ ¤‰ÂÈÍ ·ÌÈÁ‹ Û‡ÛÙ·ÛË ·fi Ô˘ÚÈÎfi Ô͇. ∞ÓÙÈÌÂÙˆ›ÛÙËΠ̠¿ÊıÔÓË Ï‹„Ë ˘ÁÚÒÓ Î·È ¯ÔÚ‹ÁËÛË ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ. ªÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·ÎÔÏÔ‡ıËÛ ÌÂÛԉȿÛÙËÌ· 2,5 ¯ÚfiÓˆÓ ¯ˆÚ›˜ È·ÙÚÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË, ÂÓÒ Û˘Ó¤¯È˙ ÙËÓ ·Ô‚ÔÏ‹ ÌÈÎÚÒÓ Ï›ıˆÓ ηٿ ÙËÓ Ô‡ÚËÛË. ∂·Ó‹Ïı Û ËÏÈΛ· 3,5 ÂÙÒÓ Ì ÙËÓ Â˘Î·ÈÚ›· Ù˘ ·Ú·ÔÌ‹˜ Ù˘ 11¯ÚÔÓ˘ ·‰ÂÏÊ‹˜ ÙÔ˘ ÁÈ· ‰ÈÂÚ‡ÓËÛË ÓÂÊÚ·Û‚¤ÛÙˆÛ˘ Î·È ÓÂÊÚÔÏÈı›·Û˘. ∏ ÎÏÈÓÈ΋ Âͤ-

525

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·526

¶∞π¢π∞∆ƒπ∫∏ 2000;63:524-528

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

∂ÈÎfiÓ· 2. YÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ fiÔ˘ ‰È·ÈÛÙÒÓÂÙ·È ˘ÂÚ˯ÔÁ¤ÓÂÈ· Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÓÂÊÚ·Û‚¤ÛÙˆÛË (2Ë ÂÚ›ÙˆÛË).

∂ÈÎfiÓ· 1. EÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›· fiÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÓÂÊÚÈÎÒÓ ıËÏÒÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÁÚ·ÌÌÔÂȉ›˜ Ú·‚‰ÒÛÂȘ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘ ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡ ̤۷ ÛÙ· ‰È·ÙÂٷ̤ӷ ·ıÚÔÈÛÙÈο ÛˆÏËÓ¿ÚÈ· ·ÌÊÔÙÂÚfiÏ¢ڷ (ÂÈÎfiÓ· «‚Ô‡ÚÙÛ·˜») (1Ë ÂÚ›ÙˆÛË). Ù·ÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÛÙË ‰Â‡ÙÂÚË ÓÔÛËÏ›· ÂÓÒ Ô ÌÂÙ·‚ÔÏÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÓÂÊÚÔÏÈı›·Û˘ ¤‰ÂÈÍ ·ıÔÏÔÁÈ΋ ·¤ÎÎÚÈÛË Ô˘ÚÈÎÔ‡ Ôͤˆ˜ Û 2/5 ÌÂÙÚ‹ÛÂȘ (¶›Ó·Î·˜ 1). ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙˆÓ ÓÂÊÚÒÓ ‰ÂÓ ¤‰ÂÈÍ Â¤ÎÙ·ÛË Ù˘ ÓÂÊÚ·Û‚¤ÛÙˆÛ˘. ∏ οı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ ·Ú¤ÌÂÈÓÂ Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·Ó¿Ï˘ÛË ÙˆÓ Ï›ıˆÓ ¤‰ÂÈÍ ¿ÏÈ ·ÌÈÁ‹ Û‡ÛÙ·ÛË ·fi Ô˘ÚÈÎfi Ô͇. ¶ÂÚÈÁÚ·Ê‹ ‰Â‡ÙÂÚ˘ ÂÚ›ÙˆÛ˘ ∏ 11¯ÚÔÓË ·‰ÂÏÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ›¯Â ÂÌÊ·Ó›ÛÂÈ ÂÂÈÛfi‰ÈÔ ÎÔÏÈÎÔ‡ ÙÔ˘ ÓÂÊÚÔ‡ ÁÈ· ÙÔ ÔÔ›Ô ÓÔÛËχÙËΠÛÙËÓ ∞Ï‚·Ó›· fiÔ˘ ‰È·ÈÛÙÒıËΠÓÂÊÚ·Û‚¤ÛÙˆÛË Î·È ÓÂÊÚÔÏÈı›·ÛË Î·È ·Ú·¤ÌÊıËΠÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô. ∂›¯Â ÂχıÂÚÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Î·È ‰ÂÓ ·Ó¤ÊÂÚ ÂÂÈÛfi‰È· ·Ô‚ÔÏ‹˜ Ï›ıˆÓ. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‚Ú¤ıËÎÂ: µ™: 26 Kg (10Ë ∂£), ª™: 133 cm (10Ë ∂£) Î·È ·ÚÙËÚȷ΋ ›ÂÛË 105/65 mmHg. ∏ ÏÔÈ‹ Û˘ÛÙËÌ·ÙÈ΋ ÂͤٷÛË ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ‚ÈÔ¯ËÌÈÎfi˜ Î·È ÌÂÙ·‚ÔÏÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·ÈÙ›· Ù˘ ÓÂÊÚÔÏÈı›·Û˘ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È Ë Î¿ı·ÚÛË

526

Ù˘ ÎÚ·ÙÈÓ›Ó˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ÂÚȤϷ‚ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÓÂÊÚÒÓ-Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Î·È ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›·. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ·Ó¤‰ÂÈÍ ÏÈı›·ÛË ·ÚÈÛÙÂÚÔ‡ ÓÂÊÚÔ‡ Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ·˘ÍË̤ÓË Ë¯ÔÁ¤ÓÂÈ· Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ Î·È ÙˆÓ ‰˘Ô ÓÂÊÚÒÓ, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÓÂÊÚ·Û‚¤ÛÙˆÛË (∂ÈÎfiÓ· 2). ™ÙËÓ ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›· ·Ú·ÙËÚ‹ıËÎ·Ó Î˘ÛÙÈÎÔ› Û¯ËÌ·ÙÈÛÌÔ› Û fiϘ ÙȘ ÓÂÊÚÈΤ˜ ˘Ú·Ì›‰Â˜ ·ÌÊÔÙÂÚfiÏ¢ڷ Ô˘ ÏËÚÔ‡ÓÙ·Ó Ì ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi ̤ÛÔ, ÂÈÎfiÓ· ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÙÔ˘ ÛÔÁÁÒ‰Ô˘˜ ÓÂÊÚÔ‡, ηıÒ˜ Î·È ˘ÔÙÔÓÈ΋ ‡ÂÏÔ ÛÙÔÓ ‰ÂÍÈfi ÓÂÊÚfi. ™˘˙‹ÙËÛË O ÛÔÁÁ҉˘ ÓÂÊÚfi˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÔÚ·‰Èο, ¤¯Ô˘Ó fï˜ ÂÚÈÁÚ·Ê› Î·È ÔÈÎÔÁ¤ÓÂȘ Ì ÚÔÛ‚ÔÏ‹ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÌÂÏÒÓ ÙÔ˘˜ (4).

EÈϤÔÓ, ·Ó·Ê¤ÚÂÙ·È Û˘Ó‡·ÚÍË Ì ¿ÏϘ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜, ÌÂ Û˘¯ÓfiÙÂÚË ÙË Û˘ÁÁÂÓ‹ ËÌÈ˘ÂÚÙÚÔÊ›· (7). ∏ ·ÚÔ‡Û· ÌÂϤÙË ·Ô‰ÂÈÎÓ‡ÂÈ ¤ÌÌÂÛ· Èı·Ó‹ ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ Û ‰‡Ô ̤ÏË ÌÈ·˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ·ÎÚÈ‚‹˜ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÔÈÎÔÁ¤ÓÂÈ· ı· ÌÔÚÔ‡Û ӷ ÚÔÛ‰ÈÔÚÈÛÙ› Ì ԢÚÔÁÚ·ÊÈ΋ ÌÂϤÙË ÙˆÓ ˘ÔÏÔ›ˆÓ ÌÂÏÒÓ Ù˘. ∞˘Ùfi fï˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ ÂÂȉ‹ ‰È¤ÌÂÓ·Ó ÛÙËÓ ∞Ï‚·Ó›·. ™˘¯Ó¿ Ë ÓfiÛÔ˜ Â›Ó·È ·Û˘Ìو̷ÙÈ΋ Î·È ·Ú·ÙËÚÂ›Ù·È Û 1:200 (0,5%) ÌË ÂÈÏÂÁ̤Ó˜ ÂÓ‰ÔÊϤ‚Ș ˘ÂÏÔÁڷʛ˜ (2). ™ÙËÓ ·Ú¯È΋ ÂÌÊ¿ÓÈÛ‹ Ù˘ Ë Ófi-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·527

¶∞π¢π∞∆ƒπ∫∏ 2000;63:524-528

ÛÔ˜ ÂΉËÏÒÓÂÙ·È Ì οÔÈ· ·fi ÙȘ ÂÈÏÔΤ˜ Ù˘ fiˆ˜ ÎÔÏÈÎfi˜ ÓÂÊÚÔ‡ (57%), Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· (15-20%) Î·È Ô˘ÚÔÏÔÈÌÒÍÂȘ (15-20%) (8). ¶ÂÚ›Ô˘ ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÓÂÊÚ·Û‚¤ÛÙˆÛË. O ™¡ ·ÔÙÂÏ› ÙËÓ ÙÚ›ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÓÂÊÚ·Û‚¤ÛÙˆÛ˘ Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ÂÓÒ ·ÓÙ›ıÂÙ· ÛÙ· ·È‰È¿ Ô ™¡ Â›Ó·È ¤Ó· Û¿ÓÈÔ ·›ÙÈÔ ÓÂÊÚ·Û‚¤ÛÙˆÛ˘ (5,9). ∏ ÓfiÛÔ˜ Úԉȷı¤ÙÂÈ Û ÓÂÊÚÔÏÈı›·ÛË, Û˘Ó‹ıˆ˜ ÔÍ·ÏÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘, ÌÂ Û˘¯Ó‹ ·Ô‚ÔÏ‹ ÌÈÎÚÒÓ Ï›ıˆÓ (8-10). ªÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹, ȉȷ›ÙÂÚ· ȉÈÔ·ı‹˜ ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›· ·ÔÚÚÔÊËÙÈÎÔ‡ Ù‡Ô˘, ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ Ì ™¡ Î·È ÓÂÊÚÔÏÈı›·ÛË (10). ™˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ‹Ș ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘Ì‡ÎÓˆÛ˘ ÙˆÓ Ô‡ÚˆÓ ÔÊÂÈÏfiÌÂÓ˜ ΢ڛˆ˜ ÛÙËÓ ·ÚÔ˘Û›· ÓÂÊÚ·Û‚¤ÛÙˆÛ˘, ηıÒ˜ Î·È ‹Ș ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÍÈÓÔÔ›ËÛ˘ ÙˆÓ Ô‡ÚˆÓ, ȉȷ›ÙÂÚ· ·ÙÂÏ‹˜ ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË Ù‡Ô˘ 1, ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÛÔ‚·Ú‹˜ Û˘ÛÙËÌ·ÙÈ΋˜ ÔͤˆÛ˘ (11-12). ¶ÂÚ›ÙˆÛË ·ÌÈÁÔ‡˜ Ô˘ÚÈ΋˜ ÏÈı›·Û˘ fiˆ˜ ÛÙÔ ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜, ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÌÂÙ·‚ÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜, ‰ÂÓ ·Ó¢ڤıË ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ŒÓ·˜ ·fi ÙÔ˘˜ ηıÔÚÈÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· Ï›ıˆÓ ·fi Ô˘ÚÈÎfi Ô͇ Û ·ÛıÂÓ›˜ ÌÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· Ô˘ÚÈÎÔ‡ Ôͤˆ˜ ÛÙÔ Ï¿ÛÌ· Î·È Ì ‹ ¯ˆÚ›˜ Ô˘ÚÈÎÔ˙Ô˘Ú›·, Â›Ó·È ÙÔ ¯·ÌËÏfi pH Ô‡ÚˆÓ Ô˘ ¢ÓÔ› ÙÔÓ ˘ÂÚÎÔÚÂÛÌfi ÙˆÓ Ô‡ÚˆÓ Ì ÙË ÌÔÚÊ‹ ¿Ó˘‰ÚÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ, Ô˘ ‰ÂÓ «‰È›ÛٷٷȻ (dissociation constant Ô˘ÚÈÎÔ‡ ÔͤԘ=5,47), Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÎÚ˘ÛÙ¿ÏÏˆÓ (13). ™ÙÔÓ ·ÛıÂÓ‹ Ì·˜ (1Ë ÂÚ›ÙˆÛË), Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ™¡ Î·È ÙÔ˘ ÛÙ·ıÂÚ¿ ¯·ÌËÏÔ‡ pH ÙˆÓ Ô‡ÚˆÓ (<5,5) ηıÒ˜ Î·È Ù˘ ·Ó‡ÚÂÛ˘ Ô˘ÚÈÎÔ˙Ô˘Ú›·˜, ÌÔÚ› Ó· ‰ÈηÈÔÏÔÁ‹ÛÂÈ ÙËÓ Ô˘ÚÈ΋ ÏÈı›·ÛË. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓÂÊÚÔÏÈı›·Û˘ Û ·ÛıÂÓ›˜ Ì ™¡ Î·È ¯ˆÚ›˜ ˘ÂÚ·Û‚ÂÛÙÔ˘Ú›· Â›Ó·È ·ÎfiÌË ·‰È¢ÎÚ›ÓÈÛÙË. Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ‰È¿ÊÔÚÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ fiˆ˜: ·) ÛÙ¿ÛË ÙˆÓ Ô‡ÚˆÓ ‹ ·Ú·ÙÂٷ̤ÓÔ˜ ¯ÚfiÓÔ˜ ÚÔ‹˜ ÙˆÓ Ô‡ÚˆÓ ÛÙ· ‰È·ÙÂٷ̤ӷ ·ıÚÔÈÛÙÈο ÛˆÏËÓ¿ÚÈ· Ì ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÛÛÒÚ¢ÛË ÔÍ·ÏÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘, ‚) Èı·Ó‹ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÎÚ˘ÛÙ¿ÏÏˆÓ ÔÍ·ÏÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ Î·È Á) ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ̤¯ÚÈ Û‹ÌÂÚ· Â›Ó·È ¿ÁÓˆÛÙÔÈ. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™¡ Á›ÓÂÙ·È Ì ÙËÓ ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›·, fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ‰È¿Ù·ÛË ÙˆÓ ·ıÚÔÈÛÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Î·È ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡ ̤۷ ÛÙ· ‰È·ÙÂٷ̤ӷ ·ıÚÔÈÛÙÈο ÛˆÏËÓ¿ÚÈ· ÙˆÓ ÓÂÊÚÈÎÒÓ ıËÏÒÓ. ∏ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÈ ÓÂÊÚÈΤ˜ ıËϤ˜ Ì ÙËÓ ·ÚÔ˘Û›· ÁÚ·Ì̈ÙÒÓ ‹ ÛÊ·ÈÚÈÎÒÓ ÂÓ·ÔıÂÌ¿ÙˆÓ ¤¯ÂÈ ·ÚÔÌÔÈ·ÛÙ› Ì «‚Ô‡ÚÙÛ·», «·ÓıÔ‰¤ÛÌË» ‹ «ÙÛ·Ì› ÛÙ·Ê˘ÏÈÒÓ» (8). ™ÙÔ 60-80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÔÛ‚¿ÏÏÔÓÙ·È Î·È ÔÈ ‰‡Ô ÓÂÊÚÔ›, ¯ˆ-

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

Ú›˜ fï˜ Ó· Â›Ó·È ··Ú·›ÙËÙË Ë Û˘ÌÌÂÙÚÈ΋ ÚÔÛ‚ÔÏ‹. ∆Ô Ì¤ÁÂıÔ˜ ÙˆÓ ÓÂÊÚÒÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ‹ ÂÏ·ÊÚ¿ ·˘ÍË̤ÓÔ (30%). ∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂͤٷÛË ‰Â›¯ÓÂÈ ÙËÓ ·ÚÔ˘Û›· ÓÂÊÚ·Û‚¤ÛÙˆÛ˘ ‹ ·˘ÍË̤Ó˘ ˯ÔÁ¤ÓÂÈ·˜ ÙˆÓ ÓÂÊÚÈÎÒÓ ˘Ú·Ì›‰ˆÓ, ·ÏÏ¿ Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ Ë ÂÈÎfiÓ· ‰ÂÓ Â›Ó·È ·ıÔÁÓˆÌÔÓÈ΋ Î·È Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ¿ÏÏ· ÓÔÛ‹Ì·Ù· Â›Ó·È ‰‡ÛÎÔÏË. ∏ ‰È·ÁÓˆÛÙÈ΋ ·Í›· Ù˘ ·ÍÔÓÈ΋˜ Î·È Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ‰ÂÓ ˘ÂÚÙÂÚ› ·˘Ù‹˜ Ù˘ ÂÓ‰ÔÊϤ‚È·˜ ˘ÂÏÔÁÚ·Ê›·˜. ™ÙȘ ÂÚÈÙÒÛÂȘ Ï‹ÚÔ˘˜ ·ÎÙÈÓÔÏÔÁÈ΋˜ ÂΉ‹ÏˆÛ˘ Ù˘ ÓfiÛÔ˘ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi Úfi‚ÏËÌ·. ∞ÓÙ›ıÂÙ·, fiÙ·Ó ÔÈ ‚Ï¿‚˜ Â›Ó·È ÂÏ¿¯ÈÛÙ˜ Î·È ÂÚÈÔÚ›˙ÔÓÙ·È Û ÌÈ· ‹ Ï›Á˜ ÓÂÊÚÈΤ˜ ˘Ú·Ì›‰Â˜, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÂÎÎÔÏÒÌ·Ù· ÙˆÓ Î·Ï‡ÎˆÓ, ÙË Ê˘Ì·Ù›ˆÛË ÙˆÓ ÓÂÊÚÒÓ, ÙË Ó¤ÎÚˆÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ıËÏÒÓ Î·È ¿ÏÏ· ·›ÙÈ· ÓÂÊÚ·Û‚¤ÛÙˆÛ˘ (8). ªÂ ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ, Î·È È‰È·›ÙÂÚ· Ì ÙË ¯ÔÚ‹ÁËÛË ıÂÈ·˙ȉÒÓ ‹ ·ÓfiÚÁ·ÓˆÓ ʈÛÊÔÚÈÎÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë Û¯ËÌ·ÙÈÛÌÔ‡ Ï›ıˆÓ Î·È Ì ÙËÓ ¿ÌÂÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ô˘ÚÔÏÔÈÌÒ͈Ó, Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Î·Ï‹ Î·È Ë ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ·Û˘Ó‹ı˘ (8-9). ¶·ÚfiÏ· ·˘Ù¿ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ΢ڛˆ˜ Û ÂÓ‹ÏÈΘ ·ÏÏ¿ ·ÎfiÌË Î·È Û ·È‰È¿, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ¯ÚfiÓÈ·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜, ‰È¿ÌÂÛ˘ ÓÂÊÚ›Ùȉ·˜ Î·È ÓÂÊÚÔÏÈı›·Û˘. ∏ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ ™¡ ·Ú¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘ Ù˘ ÓfiÛÔ˘ Î·È Ù˘ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ Ù˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Cacchi R, Ricci V. Sopra una rara e forse ancora non descritta affezione cistica delle piramidi renali, "Rene a spugna". Atti Soc Ital Urol 1948;5:59-63.

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EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

13. Pak CYC. Urolithiasis. In: Schrier RW, Gottschalk CW, editors. Diseases of the kidney. 5th edition. Boston: Little, Brown and Co; 1993. p. 729-741.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-03-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-08-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: KˆÓÛÙ·ÓÙ›ÓÔ˜ ¢. KÔÏÏÈfi˜ ¶·È‰È·ÙÚÈ΋ NÂÊÚÔÏÔÁ›·, TÔ̤·˜ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ I·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ, 451 10 Iˆ¿ÓÓÈÓ·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∫·ÎÒÛÂȘ Ù˘ ÎÂÊ·Ï‹˜ ÛÙ· ·È‰È¿. ∞Ù‡¯ËÌ· ‹ ηÎÔÔ›ËÛË; ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËı› Ë ·Ó·ÏÔÁ›· ÛÙËÓ Â›ÙˆÛË ÙˆÓ Î·ÎÒÛÂˆÓ Ù˘ ÎÂÊ·Ï‹˜ Ô˘ ÔÊ›ÏÔÓÙ·È Û ·Ù‡¯ËÌ· ‹ ηÎÔÔ›ËÛË Û ·È‰È¿ οو ÙˆÓ 6,5 ¯ÚfiÓˆÓ, Ó· ηٷÁÚ·Ê› Ô Ù‡Ô˜ Ù˘ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ ·Ó¿ÏÔÁ· Ì ÙÔÓ Ì˯·ÓÈÛÌfi ÚfiÎÏËÛ˘ Î·È Ó· ÂÎÙÈÌËı› Ë Èı·ÓfiÙËÙ· ÔÈ Î·ÎÒÛÂȘ Ó· ÔÊ›ÏÔÓÙ·È Û ·Ù‡¯ËÌ· ‹ ηÎÔÔ›ËÛË. ª¤ıÔ‰Ô˜:ŒÁÈÓ ·Ó·ÛÎfiËÛË ÙˆÓ È·ÙÚÈÎÒÓ ÈÛÙÔÚÈÎÒÓ 287 ·È‰ÈÒÓ Ì οΈÛË Ù˘ ÎÂÊ·Ï‹˜ ËÏÈΛ·˜ 1 ‚‰ÔÌ¿‰·˜ - 6,5 ¯ÚfiÓˆÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó Û ÌÂÁ¿ÏÔ ¶·È‰È·ÙÚÈÎfi ÓÔÛÔÎÔÌÂ›Ô ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1986 ̤¯ÚÈ ÙÔÓ ¢ÂΤ̂ÚÈÔ 1991. ¶ÂÚÈÂÏ‹ÊıËÛ·Ó ·ÛıÂÓ›˜ Ì ‰È·ÁÓÒÛÂȘ: οٷÁÌ· ÎÚ·Ó›Ô˘, ‰È¿ÛÂÈÛË, ˘·Ú·¯ÓÔÂȉ‹˜ ·ÈÌÔÚÚ·Á›·, ·È̿و̷, ıÏ¿ÛË ‹ ÁÚ·ÌÌÔÂȉ‹˜ Ú‹ÍË Î·È ÎÏÂÈÛÙfi ÙÚ·‡Ì· ÎÂÊ·Ï‹˜. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ Î·ÙËÁÔÚÈÔÔ›ËÛË Ù˘ οΈÛ˘ ˆ˜ ÔÊÂÈÏfiÌÂÓ˘ Û ηÎÔÔ›ËÛË ‹ ·Ù‡¯ËÌ·. ∞ÔÙÂϤÛÌ·Ù·: ™ÙÔ 81% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÚfiÎÂÈÙÔ ÁÈ· ·Ù‡¯ËÌ· Î·È ÛÙÔ 19% ÁÈ· ηÎÔÔ›ËÛË. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Ì οΈÛË ·fi ·Ù‡¯ËÌ· ‹Ù·Ó 2,5 ¯ÚfiÓˆÓ Î·È ·fi ηÎÔÔ›ËÛË 0,7 ¯ÚfiÓˆÓ. √È ÌÂÁ·Ï‡ÙÂÚ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ Â›ÙˆÛË ‚Ú¤ıËÎ·Ó ÛÙ· ·ÎfiÏÔ˘ı·: ÀÔÛÎÏËÚ›‰ÈÔ ·È̿و̷: 10% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ·Ù‡¯ËÌ· Î·È 46% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›ËÛË. À·Ú·¯ÓÔÂȉ‹˜ ·ÈÌÔÚÚ·Á›·: 8% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ·Ù‡¯ËÌ· Î·È 31% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›ËÛË. ∞ÈÌÔÚÚ·Á›Â˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜: 2% ÛÙ· ·È‰È¿ Ì ·Ù‡¯ËÌ· Î·È 33% ÛÙ· ·È‰È¿ Ì ηÎÔÔ›ËÛË. ∆Ú·˘Ì·ÙÈÛÌfi˜ ‰¤ÚÌ·ÙÔ˜ Û˘Ó˘‹Ú¯Â Û 16% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›ËÛË. ∆Ô 23% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·fi ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÔÊ›ÏÔÓÙ·Ó Û ·˘ÙÔÎÈÓËÙÈÛÙÈÎfi ‰˘ÛÙ‡¯ËÌ·, ÙÔ 58% Û ÙÒÛË, ÙÔ 2% Û˘Ó¤‚ËÛ·Ó ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ·È¯ÓȉÈÔ‡ ÂÓÒ ÁÈ· Ù· ˘fiÏÔÈ· ÔÈ ÏËÚÔÊÔڛ˜ ‹Ù·Ó ÂÏÏÈ›˜. ™ÙÔ 56% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·fi ÙËÓ Î·ÙËÁÔÚ›· Ù˘ ηÎÔ-

528

Ô›ËÛ˘ ‰ÂÓ ˘‹Ú¯Â ÈÛÙÔÚÈÎfi Ô˘ Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ Î¿ÎˆÛË Ô‡Ù ÈÛÙÔÚÈÎfi ·˘ÙÔÎÈÓËÙÈÛÙÈÎÔ‡ ‰˘ÛÙ˘¯‹Ì·ÙÔ˜. ™ÙÔ 17% ·Ó·Ê¤ÚıËΠÙÒÛË, ÂÓÒ ÛÙÔ 24% ¤ÁÈÓ ·Ú·‰ÂÎÙ‹ Ë Î·ÎÔÔ›ËÛË. ∏ ıÓËÙfiÙËÙ· ‹Ù·Ó 13% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ Î·ÎÔÔÈËÌ¤ÓˆÓ ·È‰ÈÒÓ Î·È 2% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ·Ù‡¯ËÌ·. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ‹Ù·Ó 9,5 Ë̤Ú˜ ÁÈ· ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›ËÛË Î·È 3 Ë̤Ú˜ ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ·Ù‡¯ËÌ·. ™ÙȘ ÙÒÛÂȘ ·fi ‡„Ô˜ οو ÙˆÓ 1,2 ̤ÙÚˆÓ, ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ·Ù‡¯ËÌ· 8% ›¯·Ó ˘ÔÛÎÏËÚ›‰ÈÔ ·È̿و̷, 2% ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›· Î·È Î·Ó¤Ó· ‰ÂÓ Â›¯Â ·ÈÌÔÚÚ·Á›Â˜ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹, ÂÓÒ ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›ËÛË ÁÈ· Ù· ÔÔ›· ·Ó·Ê¤ÚÂÙ·È ÙÒÛË ·fi ‡„Ô˜ οو ÙˆÓ 1,2 ̤ÙÚˆÓ 8% ›¯·Ó ˘ÔÛÎÏËÚ›‰ÈÔ ·È̿و̷, 38% ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›· Î·È 25% ›¯·Ó ·ÈÌÔÚÚ·Á›Â˜ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹. ™˘ÌÂÚ¿ÛÌ·Ù·: ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Î·ÎÒÛÂˆÓ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿ οو ÙˆÓ 6,5 ¯ÚfiÓˆÓ ÛÙȘ Ôԛ˜ ··ÈÙÂ›Ù·È ÂÈÛ·ÁˆÁ‹ Û ÓÔÛÔÎÔÌ›Ô, ÔÊ›ÏÔÓÙ·È Û ηÎÔÔ›ËÛË. ∆Ô ˘ÔÛÎÏËÚ›‰ÈÔ ·È̿و̷ ‹ ˘·Ú·¯ÓÔÂȉ‹˜ ·ÈÌÔÚÚ·Á›·, ÔÈ ·ÈÌÔÚÚ·Á›Â˜ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹ Î·È ÔÈ Û˘ÓÔ‰Ô› ηÎÒÛÂȘ ÛÙÔ ‰¤ÚÌ·, Ù· ÔÛÙ¿ Î·È Ù· ÛÏ¿¯Ó· Û˘Ó‰¤ÔÓÙ·È ÛËÌ·ÓÙÈο ÈÔ Û˘¯Ó¿ Ì ηÎÔÔ›ËÛË ·Ú¿ Ì ·Ù‡¯ËÌ·.

Reece RM, Sege R Childhood Head Injuries. Accidental Or Inflicted?

Arch Pediatr Adolesc Med 2000;154(I): 11-15

¢Ú. ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ £. ∆ÛÔ˘Ì¿Î·˜ ¶·È‰›·ÙÚÔ˜ – ¢È¢ı˘ÓÙ‹˜ ∂™À ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ ∞ÙÙÈ΋˜

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·529

¶∞π¢π∞∆ƒπ∫∏ 2000;63:529-533

ƒ·‚‰ÔÌ˘fiÏ˘ÛË Û ·È‰› Ì ÔÍ›· Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Salmonella °ÂÒÚÁÈÔ˜ ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, °ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜, ¶·Ú·Û΢‹ ∑ÒÛË, ¢ÈÔÓ‡ÛÈÔ˜ ∫·Ú·Î·˚‰fi˜, πˆ¿ÓÓ˘ ∫·Ú·Ì·ÓÙ˙¿Ó˘, µ·ÛÈÏÈ΋ ™›‰ÂÚË, ÃÚ›ÛÙÔ˜ ∫·Ú‹˜ ● ¶ÂÚ›ÏË„Ë: ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ÌÔÚ› Ó· Â›Ó·È Â·ÎfiÏÔ˘ıÔ ÙÚ·‡Ì·ÙÔ˜, ÈÛ¯·ÈÌ›·˜, ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÌÂÙ·‚ÔÏÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, Ï‹„˘ Ê·ÚÌ¿ÎˆÓ Î·ıÒ˜ Î·È ÌÈ·˜ ÔÈÎÈÏ›·˜ ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ 10 ÂÙÒÓ, ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛ ڷ‚‰ÔÌ˘fiÏ˘ÛË ÌÂ Û˘ÓÔ‰fi ‹È· ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜, ÛÙ· Ï·›ÛÈ· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ·fi Salmonella enteritidis. °›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È Û˘˙ËÙÔ‡ÓÙ·È Ù· ‰È·ÊÔÚԉȷÁÓˆÛÙÈο ÚÔ‚Ï‹Ì·Ù· Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:529-533. §¤ÍÂȘ ÎÏÂȉȿ: Ú·‚‰ÔÌ˘fiÏ˘ÛË, Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›·, Û·ÏÌÔÓ¤ÏÏ·.

G. Triantafyllidis, G. Tsolas, P. Zosi, D. Karakaidos, I. Karamantzanis, V. Sideri, C. Karis. Rhabdomyolysis associated with Salmonella gastrointestinal infection. Paediatriki 2000;63:529-533. ● Abstract: Rhabdomyolysis can be provoked by trauma, ischemia, electrolyte disturbances, drugs, inborn errors of metabolism and a wide variety of infectious causes. We report the case of a 10 year old boy who developed rhabdomyolysis associated with a transient reduction of renal function during the course of gastroenteritis with Salmonella enteritidis. A review of the literature as well as the diagnostic difficulties are discussed. ∫ey words: rhabdomyolysis, myoglobinuria, Salmonella.

∂ÈÛ·ÁˆÁ‹ ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ÔÊ›ÏÂÙ·È ÛÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ (ÁÚ·Ì̈ÙÒÓ Ì˘˚ÎÒÓ ÈÓÒÓ) Î·È ·ÂÏ¢ı¤ÚˆÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ ÛÙÔ Ï¿ÛÌ· (1). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓ ÂÓ˙‡ÌˆÓ (ÎÚ·ÙÈÓÔʈÛÊÔÎÈÓ¿ÛË, ·Ï‰ÔÏ¿ÛË) ÛÙÔ ·›Ì· Î·È Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›· (ÛÎÔÙÂÈÓfi¯ÚÔ· Ô‡Ú·), Ë ÔÔ›· ÌÔÚ› Ó· ηٷϋÍÂÈ Û ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∏ ÔÓÙfiÙËÙ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ‰È·ÊÔÚԉȷÁÓˆÛı› ·fi ÂΛÓË Ù˘ ˘ÔÌ˘ÔÛ›Ùȉ·˜ Î·È Ó· ÙÔÓÈÛı› fiÙÈ ‰ÂÓ ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÂÓÙÔÈṲ̂ÓË ˘Ò‰Ë Û˘ÏÏÔÁ‹ (·fiÛÙËÌ·) Î·È ˆ˜ ‰ÂÓ Â›Ó·È ÂÌÊ·Ó‹˜ Ë ·ÚÔ˘Û›· οÔÈ·˜ ÙÔÈ΋˜ Ì˘˚΋˜ ‚Ï¿‚˘. ™‡Á¯ÚÔÓ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ Ë ·ÍÔÓÈ΋ Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ÌÔÚÔ‡Ó Ó· ·ÔÎÏ›ÛÔ˘Ó ÙËÓ ‡·ÚÍË ÙÔÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È Ì˘ÔÓ¤ÎÚˆÛ˘. ∆· ·›ÙÈ· ÌÔÚ› Ó· Â›Ó·È ÎÏËÚÔÓÔÌÈο, ȉÈÔ·ı‹ ‹

‰Â˘ÙÂÚÔ·ı‹. √È Ú·‚‰ÔÌ˘ÔχÛÂȘ Ô˘ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌÈÎfi ˘fiÛÙڈ̷, ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Ì ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∞Ó¿ÌÂÛ· ÛÙ· ·›ÙÈ· Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Ú·‚‰ÔÌ˘fiÏ˘ÛË, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· (‰È·Ù·Ú·¯¤˜ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ˘‰·Ù·ÓıڿΈÓ, ‚-ÔÍ›‰ˆÛ˘ ÏÈ·ÚÒÓ ÔͤˆÓ), Û˘ÌÈÂÛÙÈο-ÈÛ¯·ÈÌÈο ÙÚ·‡Ì·Ù·, ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ›, ÙÔ͛Ә (·Èı·ÓfiÏË, ËÚˆ›ÓË), Ê¿Ú̷η (·ÌÊÔÙÂÚÈΛÓË µ) Î·È Ù¤ÏÔ˜ ÏÔÈÌÒ‰Ë ·›ÙÈ· (2). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Ú·‚‰ÔÌ˘fiÏ˘Û˘, Û ·ÁfiÚÈ ËÏÈΛ·˜ 10 ÂÙÒÓ ÛÙ· Ï·›ÛÈ· ‚·ÎÙËÚȉȷ΋˜ Ïԛ̈͢ (Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Salmonella). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 10 ¯ÚfiÓˆÓ, ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ‰ÈfiÙÈ ·fi 48ˆÚÔ˘ ·ÚÔ˘Û›·Û ˘ÚÂÙfi ̤¯ÚÈ

¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜ – ¶ÂÈÚ·È¿ «ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈ӻ, ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋

529

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·530

¶∞π¢π∞∆ƒπ∫∏ 2000;63:529-533

40oC, ηٷ‚ÔÏ‹ ‰˘Ó¿ÌˆÓ, Â̤ÙÔ˘˜ (5-6 ËÌÂÚËÛ›ˆ˜ Ú¿ÛÈÓÔ˘ ¯ÚÒÌ·ÙÔ˜) Î·È ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ (4-5 ËÌÂÚËÛ›ˆ˜ ˘‰·Ú›˜, ‚ÏÂÓÓÒ‰ÂȘ ¯ˆÚ›˜ ÚfiÛÌÈÍË ·›Ì·ÙÔ˜). ∂›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› ÂÓÙ·ÌÂÏÔ‡˜ ÔÈÎÔÁ¤ÓÂÈ·˜. √È ÁÔÓ›˜ ÙÔ˘ ‰ÂÓ Â›Ó·È Û˘ÁÁÂÓ›˜ ÌÂٷ͇ ÙÔ˘˜, ÂÓÒ ÙfiÛÔ Ë ÌËÙ¤Ú·, fiÛÔ Î·È Ô ·Ù¤Ú·˜ Â›Ó·È Ê·ÈÓÔÙ˘Èο ˘ÁÈ›˜. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ÂÎÙfi˜ ·fi ÙËÓ Î·Ù·‚ÔÏ‹, ‹È· ·Ê˘‰¿ÙˆÛË (4-5%), ̤ÙÚÈ· ÍËÚfiÙËÙ· ÙÔ˘ ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ê˘ÛÈÔÏÔÁÈ΋ Û·ÚÁ‹ ‰¤ÚÌ·ÙÔ˜, Ù›ÔÙ ÙÔ ·ıÔÏÔÁÈÎfi ‰ÂÓ ‰È·ÈÛÙÒıËΠ·fi Ù· ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù·. ∫·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÛÙËÓ ÎÏÈÓÈ΋, Ë ıÂÚÌÔÎÚ·Û›· ‹Ù·Ó 37oC, ÂÓÒ Ù· ˙ˆÙÈο ÙÔ˘ ÛËÌ›· ›¯·Ó ˆ˜ ÂÍ‹˜: ·Ó·ÓÔ¤˜ 25/min, ÛʇÍÂȘ 98/min, ∞.¶. 108/78 mmHg Û ‡ÙÈ·

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

ı¤ÛË. ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹Ù·Ó 31 kgr (ÛÙËÓ 50‹ ÂηÙÔÛÙÈ·›· ı¤ÛË), ÂÓÒ Ù· ˘fiÏÔÈ· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›· ‚Ú›ÛÎÔÓÙ·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ÙÈ̤˜.(ÌÂٷ͇ 50-75˘ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘). ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÁÂÓÈ΋ ·›Ì·ÙÔ˜, Ca, Î·È ÙÔ ÈÔÓÙfiÁÚ·ÌÌ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∞ÓÙ›ıÂÙ·, Ë ÁÂÓÈ΋ Ô‡ÚˆÓ, Ô˘Ú›·, ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡, οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘, ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘ (FENa) ηıÒ˜ Î·È ÛˆÏËÓ·Úȷ΋ Â·Ó·ÚÚfiÊËÛË ÊˆÛÊfiÚÔ˘ ‹Ù·Ó ÂËÚ·Ṳ̂Ó˜. ∞Ó·Ï˘ÙÈο Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. ∏ ÂÌÊ¿ÓÈÛË Ù˘ ·›Ì˘ ÛÙË ÁÂÓÈ΋ Ô‡ÚˆÓ Ô‰‹ÁËÛ ÙË ‰È·ÁÓˆÛÙÈ΋ Ì·˜ ÛΤ„Ë ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô. ∏ Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›· Ô˘ ·ÚÔ˘Û›·ÛÂ Ô ·ÛıÂÓ‹˜ Ì·˜, ·ÔÙ¤ÏÂÛ ÙÔ Ô‰ËÁfi ‡ÚËÌ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ. °ÂÓÈ΋ ·›Ì·ÙÔ˜: Hb: 13,4 g/dL, MCV: 80 fl, MCH: 28pg, Ht: 41,7%, §Â˘Î¿: 5800/mmÑ (¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·: 75%), §ÂÌÊÔ·ÙÙ·Ú·: 19% ªÂÁ¿Ï· ÌÔÓÔ‡ÚËÓ·: 6%, ∞ª¶: 240000/ÌL,∆∫∂: 75 mm/h BÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜: ÁÏ˘Îfi˙Ë: 104 mg/dL CRP: 241 mg/L, Na+: 136 mEq/L, K+: 4,3mEq/L, Ca++: 9,5 mg/dL, P: 2,3 mg/dL Ô˘Ú›·: 110 mg/dL, ÎÚ·ÙÈÓ›ÓË: 2,6 mg/dL. CPK: 7787U/L, LDH: 484 U/L, ·Ï‰ÔÏ¿ÛË oÚÔ‡: 72 U/L AST: 150 U/L, ALT: 50U/L, ¯ÔÏËÛÙÂÚfiÏË: 240 mg/dl, HDL: 72 mg/dl LDL: 159 mg/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È·: 43 mg/dl ApoA1: 169%, Lp(a): 57 mg/dl OÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË: 0,8 mg/dL G6PD: Ê˘ÛÈÔÏÔÁÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ª˘ÔÛÊ·ÈÚ›ÓË Ô‡ÚˆÓ: 2570 Ìg/L (Ê.Ù.<5Ìg/L) ¢Â›ÎÙ˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜: 2Ô 24ˆÚÔ: V Ô‡ÚˆÓ 350 ml 3Ô 24ˆÚÔ: V Ô‡ÚˆÓ 550 ml, οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ 36 ml/min/1,73 mÇ, ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘ (FENa):1,6% Â·Ó·ÚÚfiÊËÛË ƒ: 68%.

10Ô 24ˆÚÔ: V Ô‡ÚˆÓ 800 ml,Cl(cr): 77 ml/ /min/1,73 mÇ.

12Ô 24ˆÚÔ: V o‡ÚˆÓ 1250 ml, Cl(cr): 97 ml/ /min/1,73 mÇ, FENa:0,1%, Â·Ó.P:80%.

A¤ÚÈ· ·›Ì·ÙÔ˜: pH:7,42, PCO2: 32 mmHg, PO2: 112 mmHg, SBC: 24 mmol/L, HCO3: 23mmol/L, EB: -1,8 mmol/L

530

°ÂÓÈ΋ Ô‡ÚˆÓ: pH: fiÍÈÓÔ, ∂µ :1030, §Â‡ÎˆÌ·:+, A›ÌË:+++,Û¿ÓÈ· ÂÚ˘ıÚ¿, Û¿ÓÈ· ˘ÔÛÊ·›ÚÈ· ∫·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ (3): Salmonella enteritidis ∞ÌÈÓfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜: Ê˘ÛÈÔÏÔÁÈÎfi ∞ÌÈÓfiÁÚ·ÌÌ· Ô‡ÚˆÓ: Ê˘ÛÈÔÏÔÁÈÎfi √ÚÁ·ÓÈο Ôͤ· Ô‡ÚˆÓ: Ê˘ÛÈÔÏÔÁÈο ∫·ÚÓÈÙ›ÓË ·›Ì·ÙÔ˜ (ÔÏÈ΋ Î·È ÂÛÙÂÚÔÔÈË̤ÓË): Ê˘ÛÈÔÏÔÁÈ΋ ∞ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù·: Ê˘ÛÈÔÏÔÁÈο √ÏÈÎfi Û˘Ìϋڈ̷ Î·È C3, C4: Ê˘ÛÈÔÏÔÁÈο ∞ÓÙÈÛÒÌ·Ù· ÁÈ· ÏÂÙfiÛÂÈÚ· Î·È ÈÔ‡˜ (∂cho Î·È Coxsackie): ·ÚÓËÙÈο ∏∫°: Ê˘ÛÈÔÏÔÁÈÎfi U/S ÓÂÊÚÒÓ: Ê˘ÛÈÔÏÔÁÈΤ˜ ‰È·ÛÙ¿ÛÂȘ ¯ˆÚ›˜ ÛËÌ›· ·ÔÊÚ·ÎÙÈ΋˜ Ô˘ÚÔ¿ıÂÈ·˜, Ì ‰È¿¯˘ÙË ·‡ÍËÛË Ù˘ ˯ÔÁ¤ÓÂÈ·˜ ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ ÓÂÊÚÒÓ Î·È ÔÚ·Ù¤˜ ıËϤ˜ Î·È ˘Ú·Ì›‰Â˜, ˆ˜ Â› ·ÚÂÁ¯˘Ì·ÙÈ΋˜ ÂÈ‚¿Ú˘ÓÛ˘ ÙˆÓ ÔÚÁ¿ÓˆÓ.

DMSA ÓÂÊÚÒÓ (15 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô): Ê˘ÛÈÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ ÓÂÊÚÒÓ.

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·531

¶∞π¢π∞∆ƒπ∫∏ 2000;63:529-533

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

¶›Ó·Î·˜ 2. ∂ͤÏÈÍË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÓ˙‡ÌˆÓ Î·È Ì˘ÔÛÊ·ÈÚ›Ó˘.

ª˘ÔÛÊ·ÈÚ›ÓË (Ô‡ÚˆÓ) CPK LDH ∞ωÔÏ¿ÛË ÔÚÔ‡ AST ALT √˘Ú›· ∫Ú·ÙÈÓ›ÓË

º˘ÛÈÔÏÔÁÈΤ˜ ∆È̤˜

∂›ÛÔ‰Ô˜

ŒÍÔ‰Ô˜

<5 Ìg/L 18-80 U/L 120-270 U/L <7,6 U/L 3-35 U/L 1-30 U/L 10-30 mg/dl 0,3-0,7 mg/dl

2570 Ìg/L 7787 U/L 484 U/L 72 U/L 150 U/L 50 U/L 110 mg/dl 2,6 mg/dl

<5 Ìg/L 46 U/L 130 U/L 6,1 U/L 33 U/L 22 U/L 39 mg/dl 0,9 mg/dl

Ú·‚‰ÔÌ˘fiÏ˘Û˘. °È· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÍ·ÎÚ›‚ˆÛË ÙÔ˘ ·ÈÙ›Ô˘ Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘, ¤ÁÈÓ ‚ÈÔ„›· Ì˘fi˜, Ë ÔÔ›· ¤‰ÂÈÍ ÂÈÎfiÓ· Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ì˘fi˜ Ì ηϋ ·Ú¯ÈÙÂÎÙÔÓÈ΋ Î·È ·Ô˘Û›· ÊÏÂÁÌÔÓˆ‰ÒÓ ‹ ÓÂÎÚˆÙÈÎÒÓ ÛÙÔȯ›ˆÓ. ¢ÂÓ ÂÛÙ¿ÏË ‰Â›ÁÌ· Ì˘fi˜ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ì˘˚ÎÒÓ ÓfiÛˆÓ ÁÈ· ÚÔÛ‰ÈÔÚÈÛÌfi fiÏˆÓ ÙˆÓ ÂÓ˙‡ÌˆÓ (¶›Ó·Î·˜ 3) ÙˆÓ ÔÔ›ˆÓ Ë ·ÓÂ¿ÚÎÂÈ· ÚÔηÏ› Ú·‚‰ÔÌ˘fiÏ˘ÛË ÁÈ·Ù› Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, ¿Ú¯ÈÛ·Ó Ó· ‚ÂÏÙÈÒÓÔÓÙ·È ÔÈ ÙÈ̤˜ ÙˆÓ Ì˘˚ÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ·Ô‰fiıËÎ·Ó Û·Ó ‰Â˘ÙÂÚÔ·ı›˜ ÂΉËÏÒÛÂȘ ÏfiÁˆ Ù˘ Ïԛ̈͢. ∆Ô ·È‰›, ηٿ ÙËÓ Â›ÛÔ‰Ô ÛÙËÓ ÎÏÈÓÈ΋, ·ÓÙÈÌÂÙˆ›ÛıËΠ̠·ÚÂÓÙÂÚÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ (·ÔηٿÛÙ·ÛË ÂÏÏ›ÌÌ·ÙÔ˜ Î·È ÙÚÂ¯Ô˘ÛÒÓ ·ˆÏÂÈÒÓ Î·ıÒ˜ Î·È ·˘ÍË̤ÓË ·ÚÔ¯‹ ˘ÁÚÒÓ Û˘ÓÙ‹ÚËÛ˘), Ì ÛÙfi¯Ô ÙËÓ Â›Ù¢ÍË Ù˘ Ù·¯‡ÙÂÚ˘ ·Ô‚ÔÏ‹˜ Ù˘ Ì˘ÔÛÊ·ÈÚ›Ó˘. ∏ ̤ÁÈÛÙË ÙÈÌ‹ Ù˘ CPK, ÂÓÓ¤· ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ¤Êı·Û ÙȘ 8.120 U/L. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·Ú·ÙËÚ‹ıËΠÛÙ·‰È·Î‹ ‡ÊÂÛË Ù˘ Á·ÛÙÚÂÓÙÂÚÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ (˘Ô¯ÒÚËÛË Â̤وÓ, ‰È·ÚÚÔ˚ÎÒÓ ÎÂÓÒÛˆÓ), ̤¯ÚÈ Ï‹ÚÔ˘˜ ÂÍ¿ÏÂÈ„‹˜ Ù˘. ∆·˘Ùfi¯ÚÔÓË Ì ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, ˘‹ÚÍÂ Î·È Ë ·ÔηٿÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, Ì ÙË ÛÙ·‰È·Î‹ (ÂÓÙfi˜ ‰¤Î· ËÌÂÚÒÓ) Â¿ÓÔ‰Ô ÙˆÓ ÂÓ˙‡ÌˆÓ (CPK, LDH, AST) ÛÙ· Ê˘ÛÈÔÏÔÁÈο Â›‰· (¶›Ó·Î·˜ 2). µ·ıÌÈ·›·, Ù¤ÏÔ˜, ‹Ù·Ó Î·È Ë Â·Ó·ÊÔÚ¿ ÙˆÓ ‰È·Ù·Ú·ÁÌ¤ÓˆÓ ‰ÂÈÎÙÒÓ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· (οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘, ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘, ÛˆÏËÓ·Úȷ΋ Â·Ó·ÚÚfiÊËÛË ÊˆÛÊfiÚÔ˘, fiÁÎÔ˜ Ô‡ÚˆÓ) (¶›Ó·Î·˜ 1). ∆Ô ·È‰›, ÌÂÙ¿ ·fi ‰ˆ‰Âη‹ÌÂÚË ·Ú·ÌÔÓ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÂÍ‹Ïı Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË Ì ۷ʋ ‚ÂÏÙ›ˆÛË. ∏ ÂͤÏÈÍË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 2. ™·Ú¿ÓÙ· Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓÔ‡˜, Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ Â·Ó¤ÏÂÁ¯Ô, Ë Î¿ı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ ‹Ù·Ó 117 ml/min/1,73 mÇ, Ë ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘ (FENa: 0,3%), Î·È Ë Â·Ó·ÚÚfiÊËÛË ÊˆÛÊfiÚÔ˘ 92%.

¶›Ó·Î·˜ 3. ∂Ó˙˘ÌÈΤ˜ ·ÓÂ¿ÚÎÂȘ Ô˘ ÚÔηÏÔ‡Ó Ú·‚‰ÔÌ˘fiÏ˘ÛË. ·) ∫·ÚÓÈÙ›ÓË ·ÏÌÈÙÔ˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË ‚) ºˆÛÊÔÚ˘Ï¿ÛË Á) ºˆÛÊÔÊÚÔ˘ÎÙÔÎÈÓ¿ÛË ‰) ºˆÛÊÔÂÍÔ˚ÛÔÌÂÚ¿ÛË Â) ºˆÛÊÔÁÏ˘ÎÂÚÈÓÈ΋ ÎÈÓ¿ÛË ÛÙ) ºˆÛÊÔÁÏ˘ÎÂÚÈÓÈ΋ ÌÔ˘Ù¿ÛË ˙) °·Ï·ÎÙÈ΋ ·Ê˘‰ÚÔÁÔÓ¿ÛË

™˘˙‹ÙËÛË ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ÔÊ›ÏÂÙ·È ÛÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ (ÁÚ·Ì̈ÙÒÓ Ì˘˚ÎÒÓ ÈÓÒÓ), ÌÂ Û˘ÓÔ‰fi ·‡ÍËÛË ÙˆÓ ÂÓ˙‡ÌˆÓ (ÎÚ·ÙÈÓÔʈÛÊÔÎÈÓ¿ÛË, ·Ï‰ÔÏ¿ÛË) ÛÙÔ ·›Ì· Î·È Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›· (1,2). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÛÎÔÙÂÈÓfi¯ÚÔ· Ô‡Ú·, Ì˘·ÏÁ›Â˜ Î·È Ì˘˚΋ ˘ÔÙÔÓ›·. ∆· ·›ÙÈ· ÌÔÚ› Ó· Â›Ó·È ÎÏËÚÔÓÔÌÈο, ȉÈÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹. ªÂٷ͇ ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ÚÔηÏÔ‡Ó Ú·‚‰ÔÌ˘fiÏ˘ÛË Î·È ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Ì ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÓ˙˘ÌÈΤ˜ ·ÓÂ¿ÚÎÂȘ ÛÙȘ ÌÂÙ·‚ÔÏÈΤ˜ Ô‰Ô‡˜ ·) ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ (¤ÏÏÂÈ„Ë Ì˘˚΋˜ ʈÛÊÔÚ˘Ï¿Û˘- ÓfiÛÔ˜ Mcardle Î·È ·ÓÂ¿ÚÎÂÈ· ʈÛÊÔÊÚÔ˘ÎÙÔÎÈÓ¿Û˘) Î·È ‚) ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (‰È·Ù·Ú·¯‹ ‚- ÔÍ›‰ˆÛ˘, ÏfiÁˆ ·ÓÂ¿ÚÎÂÈ·˜ ÙÚ·ÓÛÊÂÚ·ÛÒÓ Ù˘ ·ÏÌÈÙÔ˘ÏÔηÚÓÈÙ›Ó˘) (¶›Ó·Î·˜ 3). ∆ÂÏÈ΋ ηٿÏËÍË ·˘ÙÒÓ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Â›Ó·È Ë ÂÏÏÈ‹˜ ·Ú·ÁˆÁ‹ ATP, Ë ÔÔ›· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î˘ÙÙ·ÚfiÏ˘ÛË ÔÏϤ˜ ÊÔÚ¤˜ ÌÂÙ¿ ·fi ÙËÓ Â›‰Ú·ÛË ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ë ÓËÛÙ›·, Ë ¿ÛÎËÛË, ÙÔ „‡¯Ô˜, ÙÔ stress ÎÏ. ÕÏϘ ·ÚfiÌÔȘ ηٷÛÙ¿ÛÂȘ, ÙˆÓ ÔÔ›ˆÓ Ë ·ıÔÁ¤ÓÂÈ· ÂÍ·ÎÔÏÔ˘ı› Ó· ÌËÓ Â›Ó·È Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓË, Â›Ó·È Ë Î·ÎÔ‹ı˘ ˘ÂÚıÂÚÌ›· Î·È Ë ÔÈÎÔÁÂÓ‹˜ ˘ÔηÏÈ·ÈÌÈ΋ ÂÚÈÔ‰È΋ ·Ú¿Ï˘ÛË. (1,2) ™ÙȘ ÙÔ͛Ә Ô˘ ÚÔηÏÔ‡Ó Ú·‚‰ÔÌ˘fiÏ˘ÛË, Û˘-

531

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17:43

™ÂÏ›‰·532

¶∞π¢π∞∆ƒπ∫∏ 2000;63:529-533

ÁηٷϤÁÔÓÙ·È Ë ·Èı·ÓfiÏË (̤ۈ ¿ÌÂÛ˘ ÌÈÙÔ¯ÔÓ‰Úȷ΋˜ ‚Ï¿‚˘ Î·È Î·Ù·Ó¿ÏˆÛ˘ Ì˘˚΋˜ ·Ê˘‰ÚÔÁÔÓ¿Û˘ ÙÔ˘ ÓÈÎÔÙÈÓ¿ÌÈÓÔ-‰ÈÓÔ˘ÎÏÂÔÙȉ›Ô˘ (NADH), Ë ËÚˆ›ÓË (¿ÌÂÛË ÙÔÍÈ΋ ‰Ú¿ÛË ÛÙÔ Ì˘˚Îfi ÈÛÙfi), ηıÒ˜ Î·È Ê¿Ú̷η fiˆ˜ Ë ·ÌÊÔÙÂÚÈΛÓË µ (‰Â˘ÙÂÚÔ·ıÒ˜ ̤ۈ ηÏÈÔÂÓ›·˜) Î·È ÙÔ Ì˘Ô¯·Ï·ÚˆÙÈÎfi ÛÔ˘ÎÈÓÈÏÔ¯ÔÏ›ÓË.(1,2) ∏ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÚÔÛÊÂÚÔ̤ÓÔ˘ Ô͢ÁfiÓÔ˘, fiˆ˜ ·˘Ù‹ ÂΉËÏÒÓÂÙ·È ÛÙËÓ ÔÚ›· ÂÈÏËÙÈÎÔ‡ status ηıÒ˜ Î·È Ë ÈÛ¯·ÈÌ›· ÌÂÙ¿ ·fi Û˘ÌÈÂÛÙÈο ÙÚ·‡Ì·Ù·, ·ÔÙÂÏÔ‡Ó ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘, ÂÓÒ ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË ‰È·‰ÚÔÌ‹ ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ (‰ÂÚÌ·ÙÔÌ˘ÔÛ›Ùȉ·) Î·È ¿ÏÏˆÓ ÚÔԉ¢ÙÈο ÂÎÊ˘ÏÈÛÙÈÎÒÓ Ì˘˚ÎÒÓ ·ı‹ÛÂˆÓ (1-3). ∞ÚÎÂÙ¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÌÔÚÔ‡Ó Ó· ÂÈÏ·ÎÔ‡Ó ÛÙËÓ ÔÚ›· ÙÔ˘˜ Ì ڷ‚‰ÔÌ˘fiÏ˘ÛË. ∆· ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, Ù· ÔÔ›· ·ÊÔÚÔ‡Ó Û ÂÓ‹ÏÈÎÔ˘˜, ÂÓÔ¯ÔÔÈÔ‡Ó ÙÔÓ Èfi Ù˘ ÁÚ›˘ (∞ Î·È µ) ˆ˜ ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ. ¶Ú¿ÁÌ·ÙÈ, ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 59 ÂÚÈÙÒÛÂˆÓ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜, ÔÈ 25 (ÔÛÔÛÙfi 42%) ÚÔÎÏ‹ıËÎ·Ó ·fi ÈÔ‡˜ Ù˘ ÁÚ›˘. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Û˘, Â›Ó·È ÙÔ fiÙÈ ÙÔ 44% ·fi ·˘Ù¤˜ ¯ÚÂÈ¿ÛÙËÎ·Ó ÙÂÏÈο ·ÈÌÔ‰È¿Ï˘ÛË ÏfiÁˆ ηٿÏËÍ‹˜ ÙÔ˘˜ Û ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. (2) ∞ÎÔÏÔ˘ıÔ‡Ó ÛÂ Û˘¯ÓfiÙËÙ· Ô Èfi˜ Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (∏πV), ÂÓÙÂÚÔ˚Ô› (΢ڛˆ˜ ›‰Ë Coxsackie), Î·È Ô Èfi˜ Epstein-Barr.(3-6) ∞Ó Î·È Ô ·ÎÚÈ‚‹˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ·fi ÈÔ‡˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ˜, ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ‰‡Ô, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ¤Ó·˜ ·ÊÔÚ¿ ÛÙËÓ ¿ÌÂÛË ÈÔÁÂÓ‹ ÚÔÛ‚ÔÏ‹ ÙˆÓ Ì˘ÒÓ Î·È Ô ¿ÏÏÔ˜ ÛÙËÓ ·Ú·ÁˆÁ‹ ÙÔ͛Ӣ. ™ÙÔȯ›· Ô˘ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ÚÒÙË ÂΉԯ‹, Â›Ó·È Ë ¤ÓÙÔÓË ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË ·˘ÙÒÓ Î·ıÒ˜ Î·È Ë ·ÚÔ˘Û›· ÂÁÎÏ›ÛÙˆÓ ÛÙËÓ ‚ÈÔ„›· Ì˘fi˜. √ Èfi˜ Ù˘ ÁÚ›˘ µ Ì¿ÏÈÛÙ·, ¤¯ÂÈ ·ÔÌÔÓˆı› Ì ÂȉÈΤ˜ Ù¯ÓÈΤ˜, ÂÓÒ Ë ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (PCR), ¤¯ÂÈ ÚfiÛÊ·Ù· ÂÓÙÔ›ÛÂÈ DNA ÙÔ˘ ÈÔ‡ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú· Û ‰Â›ÁÌ·Ù· Ì˘fi˜, ·ÛıÂÓÒÓ Ì ڷ‚‰ÔÌ˘fiÏ˘ÛË.(3) ™ÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ ·ÈÙÈÒÓ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ‚·ÎÙËÚȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·Ù¿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜, ›‰Ë Legionella, Streptococcus (S. pneumoniae, group B streptococcus, S. pyogenes) ηıÒ˜ Î·È Â›‰Ë Salmonella). ∏ Legionella ÚÔηÏ› χÛË ÙˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ Èı·Ófiٷٷ ̤ۈ ·ÂÏ¢ı¤ÚˆÛ˘ ÌÈ·˜ Â͈ÙÔ͛Ӣ. ªÈÎÚÔÔÚÁ·ÓÈÛÌÔ› fiˆ˜ Ô Streptococcus Î·È Ë Salmonella Ê·›ÓÂÙ·È ˆ˜ ÂÈÛ‚¿ÏÏÔ˘Ó ¿ÌÂÛ· ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi, ÂÏ·ÙÙÒÓÔ˘Ó fï˜ ·Ú¿ÏÏËÏ· ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÔÍÂȉˆÙÈÎÒÓ Î·ıÒ˜ Î·È ÂÓ˙‡ÌˆÓ Ù˘ ÁÏ˘ÎÔÏ˘ÙÈ΋˜ Ô‰Ô‡ ÙˆÓ ÛÎÂÏÂÙÈÎÒÓ Ì˘ÒÓ Î·È Ù·˘Ùfi¯ÚÔÓ· ÂÓÂÚÁÔÔÈÔ‡Ó Ï˘ÛÔÛˆ-

532

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

ÌÈο ¤Ó˙˘Ì·.(3,7) ∂Ó·ÏÏ·ÎÙÈο, ·Ó·Ê¤ÚÂÙ·È Î·È Ë ¤ÎÏ˘ÛË ÂÓ‰ÔÙÔÍÈÓÒÓ ·fi ›‰Ë Salmonella ˆ˜ ·ÈÙ›· Ì˘ÔÓ¤ÎÚˆÛ˘. √È ÂÓ‰ÔÙÔ͛Ә ·˘Ù¤˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÍ·ÈÌ›·, ·Ê˘‰¿ÙˆÛË, ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·ÏÏ¿ Î·È ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÌÈ·˜ ÂÈΛÌÂÓ˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘.(5,7-9). ¶Ú¤ÂÈ fï˜ Ó· ÙÔÓÈÛı›, ˆ˜ ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ·ÔÌÔÓˆı› Î·È Ù·˘ÙÔÔÈËı› οÔÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÙÔÍ›ÓË.(2) ∏ ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ì˘fiÏ˘ÛË, ÚÔ·ÙÂÈ ·fi ÌÈ· ÔÈÎÈÏ›· ·Ú·ÁfiÓÙˆÓ. ∏ Ì˘ÔÛÊ·ÈÚ›ÓË ·ÔÊÚ¿ÛÛÂÈ Ù· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· Î·È Â›Ó·È ¿ÌÂÛ· ÙÔÍÈ΋ ¿Óˆ Û ·˘Ù¿. ∏ ÈÛ¯·ÈÌ›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÊÏÔÈÔ‡ ηıÒ˜ Î·È Ë ÂÏ¿ÙÙˆÛË Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ ·ÔÙÂÏÔ‡Ó ÚfiÛıÂÙÔ˘˜ ‚Ï·ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÂÓÒ Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ÚÔ·Ó·ÊÂÚıÂÈÛÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ì ÙËÓ ˘ÔÁηÈÌ›·, ÌÔÚ› Ó· ηٷϋÍÂÈ ÙÂÏÈο Û ÔÏÈÁÔ˘ÚÈ΋ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·.(2,6) ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ˆ˜ ÂÈÏÔ΋ Ïԛ̈͢ ·fi ›‰Ë Salmonella Â›Ó·È Û¿ÓÈ· Î·È ·˘Ùfi Û˘Ó¿ÁÂÙ·È ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Ë ÔÔ›· Û˘ÓÔÏÈο ·ÚÈıÌ› ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ.(1,3) ∏ ‰È¿ÁÓˆÛË Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ ˘ÔÛÙËÚ›¯ıËΠ·fi ÙËÓ ·‡ÍËÛË ÙˆÓ Ì˘˚ÎÒÓ ÂÓ˙‡ÌˆÓ (CPK, LDH) Î·È ÙËÓ ·Ó›¯Ó¢ÛË Ì˘ÔÛÊ·ÈÚ›Ó˘ ÛÙ· Ô‡Ú·. °È· ÙËÓ ÂÌÊ¿ÓÈÛË Ì·ÎÚÔÛÎÔÈ΋˜ Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›·˜ ··ÈÙÂ›Ù·È Ë Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ 1-5% Ù˘ Ì¿˙·˜ ÙˆÓ ÁÚ·Ì̈ÙÒÓ Ì˘˚ÎÒÓ ÈÓÒÓ (2,4,5,10,11). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊËΠı· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› Ë ·Ó·ÓÙÈÛÙÔȯ›· ÌÂٷ͇ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∏ ‹È· ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ·Ê˘‰¿ÙˆÛ˘ ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙȘ ˘„ËϤ˜ ÙÈ̤˜ Ô˘Ú›·˜ Î·È ÎÚ·ÙÈÓ›Ó˘ (110 mg/dL Î·È 2,6 mg/dL ·ÓÙ›ÛÙÔȯ·) Ô˘ ηٷÁÚ¿ÊËηÓ, ÂÓÒ Ë Â‡ÚÂÛË ·ÚÎÂÙ‹˜ ÔÛfiÙËÙ·˜ ·›Ì˘ ÛÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ Ô‡ÚˆÓ ÂÚȤÏÂÍ ÂÚ·ÈÙ¤Úˆ ÙËÓ Î·Ù¿ÛÙ·ÛË. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ: ·) Ë ·ÚÔ˘Û›· ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ ¿ÌÂÛÔ ·Ú·Û··ÛÌ· ÙˆÓ Ô‡ÚˆÓ ‹Ù·Ó Û¿ÓÈ· Î·È ‚) Ë ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÂÈÎfiÓ· ‰ÂÓ ÂÌÊ¿ÓÈÛ ÛÙÔȯ›· Ô˘ Ó· Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ·ÈÌfiÏ˘Û˘, ¤Î·Ó ··Ú·›ÙËÙË ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Èı·ÓfiÙËÙ·˜ Ó· Â›Ó·È Ë Ì˘ÔÛÊ·ÈÚ›ÓË Î·È fi¯È Ë ·ÈÌÔÛÊ·ÈÚ›ÓË, Ë ¯ËÌÈ΋ ¤ÓˆÛË Ù˘ ÔÔ›·˜ Û˘ÛÙ·ÙÈÎfi ·ÔÙÂÏ› Ë ·›ÌË. ∞ÍÈÔÛËÌ›ˆÙÔ ·ÎfiÌË Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‰ÂÓ ÚԤ΢„ οÔÈÔ˘ ‚·ıÌÔ‡ ¢·ÈÛıËÛ›· ηٿ ÙËÓ „ËÏ¿ÊËÛË ÙˆÓ Ì˘˚ÎÒÓ ÔÌ¿‰ˆÓ. ∏ Û·Ê‹˜ Ì›ˆÛË Ù˘ ÙÈÌ‹˜ Ù˘ οı·ÚÛ˘ Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÛÙËÓ Â›ÛÔ‰Ô (36 ml/min/1,73 mÇ), ÂÓÈÛ¯‡ÂÈ ÙËÓ ÂÔ›ıËÛË fiÙÈ Ë ·˘ÍË̤ÓË ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÛÙÔÓ ÔÚfi ‰ÂÓ ÔÊ›ÏÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ ·˘ÍË̤ÓÔ Ì˘˚Îfi ηٷ‚ÔÏÈÛÌfi, ·ÏÏ¿ Î·È Û ο-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·533

¶∞π¢π∞∆ƒπ∫∏ 2000;63:529-533

ÔÈÔ ‚·ıÌfi ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Ë ÔÔ›· Î·È ·ÔηٷÛÙ¿ıËΠÚÔԉ¢ÙÈο. ¶ÚfiÛıÂÙ˜ ÂӉ›ÍÂȘ ·Ú¯fiÌÂÓ˘ ÛˆÏËÓ·Úȷ΋˜ ‚Ï¿‚˘ ·ÔÙ¤ÏÂÛ·Ó Ë ·˘ÍË̤ÓË ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘ ηıÒ˜ Î·È Ë ÌÂȈ̤ÓË Â·Ó·ÚÚfiÊËÛË ÊˆÛÊfiÚÔ˘ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ʈÛÊfiÚÔ˘ ·›Ì·ÙÔ˜ ÛÙËÓ Â›ÛÔ‰Ô, ‰Â›ÎÙ˜ ÔÈ ÔÔ›ÔÈ Â·Ó‹Ïı·Ó ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÛÙËÓ ¤ÍÔ‰Ô Î·È Î·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ú·‚‰ÔÌ˘fiÏ˘ÛË ÛÙ· Ï·›ÛÈ· ‚·ÎÙËÚȷ΋˜ Ïԛ̈͢ Â›Ó·È ÌÂÓ Û¿ÓÈ· ˆ˜ ÂÈÏÔ΋, Â›Ó·È fï˜ ˘·ÚÎÙ‹. ™˘ÓÂÒ˜, ÂÈ‚¿ÏÏÂÙ·È Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú¿ÍË, ȉ›ˆ˜ ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÂËÚ·Ṳ̂ÓÔÈ ‰Â›ÎÙ˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∂ÎÙfi˜ ·˘ÙÔ‡, Ë ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ ·˘Ù‹˜ ÛÙԯ‡ÂÈ ÛÙÔ Ó· ηٷ‰Â›ÍÂÈ ÙË ÛËÌ·Û›· Ù˘ Û¯ÔÏ·ÛÙÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ¢ÚËÌ¿ÙˆÓ ·ÏÒÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ, ȉ›ˆ˜ Ì¿ÏÈÛÙ· Û ÂÚÈÙÒÛÂȘ Ì ÛËÌ·ÓÙÈ΋ ÎÏÈÓÈ΋ ·Ù˘›· fiˆ˜ ·˘Ù‹ (·Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ·fi ÙÔ Ì˘ÔÛÎÂÏÂÙÈÎfi Î·È Ó¢ÚÈÎfi Û‡ÛÙËÌ·). ∏ ‰È¿ÁÓˆÛË Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Â›Ó·È ·Ó·Áη›·, ÁÈ·Ù› ÔÈ ÂÈÏÔΤ˜ Ù˘, fiˆ˜ ÔÈ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Ë ·Ú¿Ï˘ÛË ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙÔ ı¿Ó·ÙÔ. ™ÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË, Ë ÂͤÏÈÍË ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ηϋ. ∞fi ÙÔ Ù¤Ù·ÚÙÔ ÂÈÎÔÛÈÙÂÙÚ¿ˆÚÔ ¿Ú¯ÈÛ ÛÙ·‰È·Î‹ ‚ÂÏÙ›ˆÛË Î·È ÂÍ‹Ïı ÌÂÙ¿ ·fi ‰Ò‰Âη Ë̤Ú˜ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Cabow PA, Kaheny WD, Kellher SP. The spectrum of rhabdomyolysis. Medicine 1982;61:141-152.

2. Robotham J, Haddow J. Rhabdomyolysis and myoglobinuria in childhood. Pediatr Clin N Am 1976;23:279-301.

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

3. Singh U, Scheld WM. Infectious Etiologies of Rhabdomyolysis: Three case reports and review. Clin Infect Dis 1996;22:642-649.

4. Foulkes W, Rees J, Sewry C. Influenza A and rhabdomyolysis. J Infect 1990;21:303-304.

5. Tanaka T, Takad T, Takagi D, Takeyama N, Kitazawa Y. Acute renal failure due to rhabdomyolysis associated with echovirus 9 infection. A case report and review of literature. Jpn J Med 1989;28:237-242.

6. Collaros J, Mayo J, Martinez E, Soledad Blanco M. Muscle infections caused by Salmonella species: case report and review. Clin Infect Dis 1999;29:673-677.

7. Sion M, Hatzitolios A,Toulis E, Kounanis A, Prokopidis D. Rhabdomyolysis and acute renal failure associated with Salmonella enteritidis bacteremia. Nephrol Dial Transplant 1998;13:532.

8. Valdes M, Vinets C, Marco T, Gonzalez JL. Rhabdomyolysis associated with Salmonella enteritidis infection. An Med Interna 1990;M7:164-165.

9. Vargas V, Accarino A, Monteagudo A, and Pigram C. Rhabdomyolysis infection by Salmonella enteritidis. Med Clin 1985;85:815.

10. Lacarde C, Peyronnet P, Denis F, Benzakour M, Leroux Robert C. Salmonella bonaviensis, Salmonellosis rhabdomyolysis and acute renal failure. Nephron 1989;53:179-180.

11. Campistol JM, Perez Villa F, Montoliou J, Moreno A, Revert Ll. Rhabdomyolysis and acute renal failure associated with Salmonella enteritidis infection. J Hosp Infect 1989;14:267-268.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-05-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫·Ú‹˜ ÃÚ›ÛÙÔ˜ ¶·È‰›·ÙÚÔ˜ - ¢È¢ı˘ÓÙ‹˜, ∑·Î‡ÓıÔ˘ 2, ÷ϿӉÚÈ

533

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·534

¶∞π¢π∞∆ƒπ∫∏ 2000;63:534-537

∏ˆÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Û ÓÂÔÁÓfi ∆¿ÓÈ· ™È·¯·Ó›‰Ô˘1, ∂ϤÓË ª¿Ó‰˘Ï·1, ∫·ÙÂÚ›Ó· ™·Ï·‚Ô‡Ú·1, ¢ËÌ‹ÙÚ˘ ¢ËÌËÙÚÈ¿‰Ë˜2, Catherine Van-Vliet3, ¢ËÌ‹ÙÚ˘ ∞Ó·ÁÓˆÛÙ¿Î˘1

● ¶ÂÚ›ÏË„Ë: ∏ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Â›Ó·È ÓfiÛËÌ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˈÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ. ∏ ÓfiÛÔ˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙ· ÓÔÛ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ˘ÂÚ¢·ÈÛıËÛ›· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û ÙÚÔʤ˜ Î·È ‰È·ÎÚ›ÓÂÙ·È Û ·ÏÏÂÚÁÈ΋ ˈÛÈÓÔÊÈÏÈ΋ ÔÈÛÔÊ·Á›Ùȉ·, Á·ÛÙÚ›Ùȉ· ‹ Á·ÛÙÚÔÂÓÙÂÚÔÎÔÏ›Ùȉ· ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚÈÔ¯‹ Ô˘ ¤¯ÂÈ ÚÔÛ‚ÏËı›. ∏ ˈÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË, ‰È¿ÙÚËÛË ‹ ÂÁÎÔÏ·ÛÌfi. ∏ ÓfiÛÔ˜ Â›Ó·È Û¿ÓÈ· Û ÓÂÔÁÓ¿. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ô˘ ÂÌÊ¿ÓÈÛÂ Û˘ÌÙÒÌ·Ù· Î·È ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ ·fi ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜. ™ÙÔ ÓÂÔÁÓfi Ë ÓfiÛÔ˜ ÂΉËÏÒıËΠ̠·fiÊÚ·ÍË ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ‰È¿ÙÚËÛË ÙÔ˘ ˘ÏˆÚÈÎÔ‡ ¿ÓÙÚÔ˘ Î·È ÂÈÏÂÔÂÈÏÂ˚Îfi ÂÁÎÔÏ·ÛÌfi. ∏ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙË Á¤ÓÓËÛË Î·ıÈÛÙ¿ Ôχ Èı·Ó‹ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:534-537. §¤ÍÂȘ ÎÏÂȉȿ: ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ·ÏÏÂÚÁÈ΋ Á·ÛÙÚÂÓÙÂÚÔ¿ıÂÈ·, ·fiÊÚ·ÍË ÛÙÔÌ¿¯Ô˘, ‰È¿ÙÚËÛË, ÂÁÎÔÏ·ÛÌfi˜, ÓÂÔÁÓfi.

T. Siahanidou, H. Mandyla, K. Salavoura, D. Dimitriadis, C. Van-Vliet, D. Anagnostakis. Eosinophilic gastroenteritis in a neonate. Paediatriki 2000;63:534-537. ● ∞bstract: Eosinophilic gastroenteritis is a disease characterized by eosinophilic infiltration of the gastrointestinal tract. It is included in the food-related gastrointestinal hypersensitivity disorders and is further distinguished into allergic eosinophilic esophagitis, allergic eosinophilic gastritis or gastroenterocolitis, according to the affected anatomical region. Gastrointestinal obstruction, perforation or intussusception may occur due to the eosinophilic infiltration of the gastrointestinal tract. The disease is rare in neonates. A case of a neonate who presented symptoms and complications of eosinophilic gastroenteritis from the early days of life is described. In this neonate the disease evolved with gastric outlet obstruction, perforation of the antrum and ileoileic intussusception. The onset of symptoms shortly after birth may suggest an intrauterine onset of the disease.

Key words: eosinophilic gastroenteritis, allergic gastroenteropathy, gastric outlet obstruction, perforation, intussusception, neonate. ∂ÈÛ·ÁˆÁ‹ ∏ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Â›Ó·È ÓfiÛÔ˜ Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˈÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ, ·Ô˘Û›· ·ÁÁÂÈ›Ùȉ·˜ Î·È ÂÚÈÊÂÚÈ΋ ˈÛÈÓÔÊÈÏ›· ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (1). ¶ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ Ó¤Ô Û¯‹Ì· Ù·ÍÈÓfiÌËÛ˘ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Û ÙÚÔʤ˜ (1). ∏

ÓfiÛÔ˜ ÚˆÙÔÂÚÈÁÚ¿ÊËΠ·fi ÙÔÓ Kaijser ÙÔ 1937. ∏ Â›ÙˆÛ‹ Ù˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹. ∆· Û˘ÌÙÒÌ·Ù· ÔÈΛÏÏÔ˘Ó Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÛÙÈ‚¿‰· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ Ô˘ ¤¯ÂÈ ÚÔÛ‚ÏËı› (‚ÏÂÓÓÔÁfiÓÔ˜, Ì˘˚΋ ÛÙÈ‚¿‰·, ÔÚÔÁfiÓÔ˜) Î·È ÙËÓ ÂÓÙfiÈÛË Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ ‰È‹ıËÛ˘ (ÔÈÛÔÊ¿ÁÔ˜, ÛÙÔÌ¿¯È, ÏÂÙfi, ·¯‡ ¤ÓÙÂÚÔ). ∏ ˘ÂÚÔ¯‹ Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ ‰È‹ıËÛ˘ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ Û˘Óԉ‡ÂÙ·È

1. ∆Ì‹Ì· ¡ÂÔÁÓÒÓ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·Ó\Ì›Ô˘ ∞ıËÓÒÓ 2. A’ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·» 3. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∆Ì‹Ì· ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·»

534

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·535

¶∞π¢π∞∆ƒπ∫∏ 2000;63:534-537

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

·fi Û˘ÌÙÒÌ·Ù· ÊÏÂÁÌÔÓ‹˜, ÛÙË Ì˘˚΋ ÛÙÈ‚¿‰· ·fi Û˘ÌÙÒÌ·Ù· ·fiÊڷ͢ Î·È ÛÙÔÓ ÔÚÔÁfiÓÔ ·fi ·ÛΛÙË (2). ∏ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ·ÏÏÂÚÁÈ΋ ˈÛÈÓÔÊÈÏÈ΋ ÔÈÛÔÊ·Á›Ùȉ·, Á·ÛÙÚ›Ùȉ· ‹ Á·ÛÙÚÔÂÓÙÂÚÔÎÔÏ›Ùȉ· ·Ó¿ÏÔÁ· Ì ÙËÓ ·Ó·ÙÔÌÈ΋ ÂÚÈÔ¯‹ Ô˘ ¤¯ÂÈ ÚÔÛ‚ÏËı› (1). ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙËÓ ËˆÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚ›Ùȉ· ‹ Á·ÛÙÚÔÂÓÙÂÚÔÎÔÏ›Ùȉ· Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·fiÊÚ·ÍË (1). ∏ ‰È¿ÙÚËÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È Ô ÂÁÎÔÏ·ÛÌfi˜ ·ÔÙÂÏÔ‡Ó Û¿ÓȘ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ (3). ∞Ó Î·È ¿ÙÔÌ· fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚ÏËıÔ‡Ó, ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Û ÓÂÔÁÓ¿ (4,5,6) Î·È Î·Ì›· ·fi ·˘Ù¤˜ ‰ÂÓ ·ÚÔ˘Û›·Û οÔÈ· ÂÈÏÔ΋. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡, ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛÂ Û˘ÌÙÒÌ·Ù· ˈÛÈÓÔÊÈÏÈ΋˜ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ‹‰Ë ·fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜, ηıÒ˜ Î·È ‰‡Ô Û¿ÓȘ ÂÈÏÔΤ˜, ‰ËÏ·‰‹ ‰È¿ÙÚËÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÂÈÏÂÔÂÈÏÂ˚Îfi ÂÁÎÔÏ·ÛÌfi. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¡ÂÔÁÓfi ËÏÈΛ·˜ 25 ËÌÂÚÒÓ ÌÂٷʤÚıËΠÛÙÔ ÙÌ‹Ì· Ì·˜ Ì ÂÈÎfiÓ· ·fiÊڷ͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡. °ÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ 3200 g. ∆Ô Apgar score ·Ó·Ê¤ÚÂÙ·È 8 ÛÙÔ 1’ Î·È 10 ÛÙ· 5’. ∞fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜ ÂÌÊ¿ÓÈÛ Â̤ÙÔ˘˜ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, ¯ˆÚ›˜ ÚfiÛÌÂÈÍË ¯ÔÏ‹˜, ÌÂÚÈÎÔ› ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó Á·ÛÙÚÔÏËÁÈÎÔ›. √ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË Á·ÛÙÚÔÁÚ·Ê›Ó˘ ¤‰ÂÈÍ ÌÂÁ¿ÏË ‰È¿Ù·ÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ·‰˘Ó·Ì›· ‰Èfi‰Ô˘ ÙÔ˘ ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ·fi ÙÔÓ ˘ÏˆÚfi ÛÙÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ. ∆Ô ÓÂÔÁÓfi Û ËÏÈΛ· ÙÚÈÒÓ ËÌÂÚÒÓ ˘Ô‚Ï‹ıËΠ۠ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÙÔÌ›·, ηٿ ÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËΠÂÈÛÎÔÈο ÌÂÁ¿ÏË ‰È¿Ù·ÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∆Ô ‹·Ú Î·È Ù· ¯ÔÏËÊfiÚ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÙÔ ÏÂÙfi Î·È ÙÔ ·¯‡ ¤ÓÙÂÚÔ Û ÔÚıfiÙÔË ı¤ÛË ¯ˆÚ›˜ Ì·ÎÚÔÛÎÔÈο ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∫·Ù¿ ÙËÓ Â¤Ì‚·ÛË ÂϤÁ¯ıËÎÂ Ë ‚·ÙfiÙËÙ· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· ‰È· ÙÔ˘ ÔÔ›Ô˘ ¤ÁÈÓ ¤Á¯˘ÛË ÛÙÔ ÛÙÔÌ¿¯È ÙÔ˘ ÓÂÔÁÓÔ‡, ·Ú¯Èο ·¤Ú· Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡, Ô˘ ¤Ú·Û·Ó ̤¯ÚÈ ÙË Ó‹ÛÙȉ·. ∆¤ÏÔ˜, ÚÔˆı‹ıËÎÂ Î·È Ô ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ‰È· ÙÔ˘ ˘ÏˆÚÔ‡ ̤¯ÚÈ ÙË Ó‹ÛÙȉ· ¯ˆÚ›˜ ÂÌÊ·Ó¤˜ ÎÒÏ˘Ì·. ¢ÂÓ Ï‹ÊıËÎ·Ó ‚ÈÔ„›Â˜. ªÂÙÂÁ¯ÂÈÚËÙÈο ÛÙÔ ÓÂÔÁÓfi ¯ÔÚËÁ‹ıËΠ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹. ∆ËÓ 3Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Û›ÙÈÛ˘ Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· Ô˘ ‰ÂÓ ‹Ù·Ó ÂÈÙ˘¯‹˜ ÏfiÁˆ ·‰˘Ó·Ì›·˜ ΤӈÛ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (‰‡Ô ÒÚ˜ ÌÂÙ¿ ÙË Û›ÙÈÛË ·Ó·ÚÚÔÊfiÙ·Ó ·fi ÙÔÓ Î·ıÂÙ‹Ú· ۯ‰fiÓ fiÏË Ë ÔÛfiÙËÙ· ÙÔ˘ Á¿Ï·ÎÙÔ˜ Ô˘ ›¯Â ¯ÔÚËÁËı›). ∂·ÓÂÈÏËÌ̤Ó˜ ÚÔÛ¿ıÂȘ Û›ÙÈÛ˘ ÙȘ ÂfiÌÂÓ˜ Ë̤Ú˜ ‹Ù·Ó Â›Û˘ ·ÓÂÈÙ˘¯Â›˜.

∂ÈÎfiÓ· 1. ∞fiÊÚ·ÍË ÛÙÔÓ ˘ÏˆÚfi ∆Ô ÓÂÔÁÓfi ÌÂٷʤÚıËΠÛÙÔ ÙÌ‹Ì· Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô Î·È ·ÓÙÈÌÂÙÒÈÛË. ∞fi ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÙÈÎÔ‡ ‰È·ÈÛÙÒıËΠηı˘ÛÙ¤ÚËÛË Ù˘ ‰È¤Ï¢Û˘ ÙÔ˘ ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ·fi ÙÔÓ ˘ÏˆÚfi ÛÙÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ (ÂÈÎfiÓ· 1), ˘ÏˆÚfiÛ·ÛÌÔ˜ Î·È ‰˘ÛÎÈÓËÛ›· ÙÔ˘ ¿ÓÙÚÔ˘, ÂÓÒ ÂÈÎÔÛÈÙ¤ÛÛÂÚȘ ÒÚ˜ ·ÚÁfiÙÂÚ· ·Ú¤ÌÂÓ ·ÎfiÌ· ÔÛfiÙËÙ· ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ÛÙÔ ÛÙÔÌ¿¯È. ™ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘ ‰È·ÈÛÙÒıËΠ¿¯˘ÓÛË ÙÔ˘ Ì˘fi˜ ÙÔ˘ ˘ÏˆÚÔ‡ (¿¯Ô˜ ˘ÏˆÚÈÎÔ‡ Ì˘fi˜ 3 mm, Ê˘ÛÈÔÏ. ÙÈÌ‹ <2 mm). ∂ϤÁ¯ıËÎ·Ó Ì ˘ÂÚ‹¯Ô˘˜ Ù· ˘fiÏÔÈ· ÂÓ‰ÔÎÔÈÏȷο fiÚÁ·Ó· Î·È ¤ÁÈÓ ‚·ÚÈÔ‡¯Ô˜ ˘ÔÎÏ˘ÛÌfi˜ fiÔ˘ ‰Â ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆Ô ÙÔ›¯ˆÌ· ÙÔ˘ ˘ÏˆÚÔ‡ Â·ÓÂϤÁ¯ıËΠ̠˘ÂÚ‹¯Ô˘˜ ‰‡Ô Ë̤Ú˜ ·ÚÁfiÙÂÚ·, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆı› ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘. ŒÁÈÓ ÂÓ‰ÔÛÎfiËÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ Î·È Ï‹ÊıËÎ·Ó ‚ÈÔ„›Â˜ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘, Ô˘ ¤‰ÂÈÍ·Ó ‰È‹ıËÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ·fi ¿ÊıÔÓ· ˈÛÈÓfiÊÈÏ· (∂ÈÎfiÓ· 2), ÂÓÒ ÔÈ Ï¿¯Ó˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ¢Â ‰È·ÈÛÙÒıËÎ·Ó ¤ÁÎÏÂÈÛÙ· ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚Ô‡ (CMV). ∂›Û˘, ¤ÁÈÓ ‰È·ÙÔȯˆÌ·ÙÈ΋ ‚ÈÔ„›· ÔÚıÔ‡ ÛÙËÓ ÔÔ›· ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó Ê˘ÛÈÔÏÔÁÈο Á·ÁÁÏȷο ·ÙÙ·Ú·, ÂÓÒ ÛÙÔ ¯fiÚÈÔ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ‚Ú¤ıËÎ·Ó Â›Û˘ ¿ÊıÔÓ· ˈÛÈÓfiÊÈÏ·. ∆· ˈÛÈÓfiÊÈÏ· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, Û Â·ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ, Î˘Ì¿ÓıËÎ·Ó ·fi 13% ¤ˆ˜ 27% (·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ 1300-4000\mm3). ∆· Â›‰· Ù˘ IgE ÛÙÔÓ ÔÚfi ‹Ù·Ó 22 IU\mL (Ê˘Û. ÙÈÌ. 1-12 IU\mL) Î·È Ë ‰ÔÎÈÌ·Û›· Rast ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ‚Ú¤ıËΠıÂÙÈ΋

535

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·536

¶∞π¢π∞∆ƒπ∫∏ 2000;63:534-537

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

ÁfiÓÔ˘, Ù˘ ˘Ô‚ÏÂÓÓÔÁfiÓÈ·˜ Î·È Ù˘ Ì˘˚΋˜ ÛÙÈ‚¿‰·˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ¿ÓÙÚÔ˘. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹. ™˘Ó¯›ÛÙËÎÂ Ë ÛÙÔȯÂȷ΋ ‰›·ÈÙ· Î·È ÔÈ ¤ÌÂÙÔÈ ÛÙ·‰È·Î¿ ˘Ô¯ÒÚËÛ·Ó. ∂Í‹Ïı ÌÂÙ¿ ·fi ‰‡Ô Ì‹Ó˜ ÓÔÛËÏ›·˜ Û˘ÓÔÏÈο, Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ì ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ 4100 g. ŒÎÙÔÙÂ, ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘ÛÙËÌ·ÙÈο, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ Â›Ó·È ˘·ÚÎÙfi˜. ™‹ÌÂÚ·, Û ËÏÈΛ· ÂÓfi˜ ¤ÙÔ˘˜, ÙÔ ‚Ú¤ÊÔ˜ Â›Ó·È Î·Ï¿ ·Ó·Ù˘Á̤ÓÔ Î·È ·Û˘Ìو̷ÙÈÎfi. √ ·ÚÈıÌfi˜ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ·›Ì·ÙÔ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜, Ë ÔÏÈ΋ IgE ÙÔ˘ oÚÔ‡ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 2 IU\mL Î·È Ë ‰ÔÎÈÌ·Û›· Rast ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ηıÒ˜ Î·È Û ¿ÏÏ· ÙÚÔÊÈο ·ÓÙÈÁfiÓ· (ÊÚÔ‡Ù·, ·˘Áfi, „¿ÚÈ, ‰ËÌËÙÚȷο) Â›Ó·È ·ÚÓËÙÈ΋. ∂ÈÎfiÓ· 2. µÈÔ„›· Á·ÛÙÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Ì ·ÚÔ˘Û›· ·˘ÍË̤ÓÔ˘ ·ÚÈıÌÔ‡ ˈÛÈÓfiÊÈÏˆÓ ÛÙÔ ¯fiÚÈÔ (∞ÈÌ·ÙÔÍ˘Ï›ÓË-∏ˆÛ›ÓË, x 400). (Ù¿ÍË 2). ∏ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÔÈ ËÏÂÎÙÚÔχÙ˜ Î·È Ù· Ï¢ÎÒÌ·Ù· ÔÚÔ‡, Ë Ë·ÙÈ΋ Î·È Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÔÈ ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ IgG, IgA, IgM Î·È Ù· ÎÏ¿ÛÌ·Ù· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÛÙÔÓ ÔÚfi ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜, ‹Ù·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. ∏ ·1 ·ÓÙÈıÚ˘„›ÓË ÎÔÚ¿ÓˆÓ ‹Ù·Ó 0,26 mg\ml (Ê˘Û. ÙÈÌ‹<0,8 mg\ml) Î·È Ë ‰ÔÎÈÌ·Û›· ·Ó›¯Ó¢Û˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ ÛÙ· ÎfiÚ·Ó· (Mayer) ‹Ù·Ó ıÂÙÈ΋ (++). √ Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· CMV ÛÙÔÓ ÔÚfi ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘ ‰ÂÓ ‹Ù·Ó ÂÓ‰ÂÈÎÙÈÎfi˜ Ïԛ̈͢. ™ÙÔ ÓÂÔÁÓfi ¯ÔÚËÁ‹ıËΠÛÙÔȯÂȷ΋ ‰›·ÈÙ· (Á¿Ï· Nutri-Junior) Û ÌÈÎÚ¤˜, ÛÙ·‰È·Î¿ ·˘Í·ÓfiÌÂÓ˜ ÔÛfiÙËÙ˜. ∆Ë 12Ë Ë̤ڷ ÓÔÛËÏ›·˜ (ÙÚÂȘ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ÛÙÔȯÂȷ΋˜ ‰›·ÈÙ·˜) ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û Âȉ›ӈÛË Ù˘ ÁÂÓÈ΋˜ ÙÔ˘ ηٿÛÙ·Û˘, ¯ÔÏÒ‰ÂȘ Â̤ÙÔ˘˜ Î·È ¤ÓÙÔÓÔ ÌÂÙˆÚÈÛÌfi ÎÔÈÏÈ¿˜. ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏÈ¿˜ Û fiÚıÈ· ı¤ÛË ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÙÂٷ̤Ó˜ ÂÓÙÂÚÈΤ˜ ¤ÏÈΘ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Î·È ˘‰Ú·ÂÚÈο Â›‰·, ÂÓ‰ÂÈÎÙÈο ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢. ŒÁÈÓ ‰Â‡ÙÂÚË Ï··ÚÔÙÔÌ›· ÛÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËηÓ: 1) ™ËÌ·ÓÙÈ΋ ‰È¿Ù·ÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ™ÙÔ ÚfiÛıÈÔ ÙÔ›¯ˆÌ· ÙÔ˘ ÚÔ˘ÏˆÚÈÎÔ‡ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ˘‹Ú¯Â ÂÚÈÔ¯‹ ‰È·Ì¤ÙÚÔ˘ 3 cm, Ì ÂÎÛËÌ·Ṳ̂ÓË ·ÙÚÔÊ›·, Ë ÔÔ›· Û˘ÌÊ˘fiÙ·Ó Ôχ ÛÙÂÚ¿ Ì ÙÔ ‰ÂÍÈfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜. ∆Ô Â‡ÚËÌ· ‹Ù·Ó Û˘Ì‚·Ùfi ÌÂ Î·Ï˘Ì̤ÓË ‰È¿ÙÚËÛË ÙÔ˘ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. 2) ∂ÈÏÂÔÂÈÏÂ˚Îfi˜ ÂÁÎÔÏ·ÛÌfi˜ Ì‹ÎÔ˘˜ 7 cm ÛÙÔ ÛËÌÂ›Ô ÌÂÙ¿ÙˆÛ˘ Ù˘ Ó‹ÛÙȉ·˜ ÛÙÔÓ ÂÈÏÂfi. ŒÁÈÓ ·Ó¿Ù·ÍË ÙÔ˘ ÂÁÎÔÏ·ÛÌÔ‡ Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË Ù˘ ‰È¿ÙÚËÛ˘ ÙÔ˘ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∆Ô ÂÁÎÔÏ·Ûı¤Ó ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‹Ù·Ó ‚ÈÒÛÈÌÔ. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÂÌ·¯›ˆÓ Á·ÛÙÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ·fi ÙËÓ ÂÚÈÔ¯‹ Ù˘ ‰È¿ÙÚËÛ˘ ¤‰ÂÈÍ ˈÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ ‚ÏÂÓÓÔ-

536

™˘˙‹ÙËÛË √È Á·ÛÙÚÂÓÙÂÚÈΤ˜ ·ı‹ÛÂȘ ‚ÚÂÊÒÓ Î·È ·È‰ÈÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Û ÙÚÔʤ˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÚfiÛÊ·Ù· Ì ‚¿ÛË ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, ÙË Û˘Ìو̷ÙÔÏÔÁ›· Î·È ÙËÓ ÂÓÙfiÈÛË Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜ (1). ™ÙËÓ Ù·ÍÈÓfiÌËÛË ÂÚÈÏ‹ÊıËηÓ: ·) ¢È·Ù·Ú·¯¤˜ ̤ۈ IgE (Á·ÛÙÚÂÓÙÂÚÈ΋ ·Ó·Ê˘Ï·Í›·, ÛÙÔÌ·ÙÔÊ·Ú˘ÁÁÈÎfi Û‡Ó‰ÚÔÌÔ), ‚) ¢È·Ù·Ú·¯¤˜ ÛÙȘ Ôԛ˜ ‰ÂÓ Û˘ÌÌÂÙ¤¯ÂÈ Ë IgE (ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÚˆÎÙÔÎÔÏ›Ùȉ·, ÂÓÙÂÚÔ¿ıÂÈ· ·fi ÚˆÙ½ÓË ÙÚÔÊ‹˜, ÎÔÈÏÈÔοÎË) Î·È Á) ªÈÎÙ¤˜ ‰È·Ù·Ú·¯¤˜ Ì ‹ ¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ Ù˘ IgE (·ÏÏÂÚÁÈ΋ ˈÛÈÓÔÊÈÏÈ΋ ÔÈÛÔÊ·Á›Ùȉ·, ·ÏÏÂÚÁÈ΋ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚ›Ùȉ·, ·ÏÏÂÚÁÈ΋ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÔÂÓÙÂÚÔÎÔÏ›Ùȉ·). ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Ô˘ ÂÚÈÁÚ¿ÊËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ‚·Û›ÛÙËΠÛÙ· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi, Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ·fiÊڷ͢ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÙËÓ ÂÚÈÊÂÚÈ΋ ˈÛÈÓÔÊÈÏ›·, Ù· ·˘ÍË̤ӷ Â›‰· Ù˘ IgE ÛÙÔÓ ÔÚfi, ÙË ıÂÙÈ΋ ‰ÔÎÈÌ·Û›· Rast Û ÚˆÙ½ÓË Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Î·È Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÂÚ›ÙˆÛË ÌÔÚ› Ó· ¯·Ú·ÎÙËÚÈÛÙ› ˆ˜ ·ÏÏÂÚÁÈ΋ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÔÂÓÙÂÚÔÎÔÏ›Ùȉ· Ì ‚¿ÛË ÙËÓ Î·Ù·ÓÔÌ‹ Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ ‰È‹ıËÛ˘ Û ¿ÓÙÚÔ, ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ Î·È ·¯‡ ¤ÓÙÂÚÔ (1). ∆Ô ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛ ·fiÊÚ·ÍË ÛÙÔÌ¿¯Ô˘, Ô˘ ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ηıÒ˜ Î·È ‰‡Ô Û¿ÓȘ ÂÈÏÔΤ˜, ‰È¿ÙÚËÛË ÛÙÔÌ¿¯Ô˘ Î·È ÂÈÏÂÔÂÈÏÂ˚Îfi ÂÁÎÔÏ·ÛÌfi. ∞’ fiÛÔ ÁÓˆÚ›˙Ô˘Ì ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê›, ̤¯ÚÈ Û‹ÌÂÚ·, ¿ÏÏÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ Ë ÓfiÛÔ˜ Ó· ÍÂÎÈÓ¿ ·fi ÙË Á¤ÓÓËÛË Î·È ÚfiÛıÂÙ· Ó· ÂÌÊ·Ó›˙ÂÈ ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜. ∆Ô ¿ÓÙÚÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ·ÔÙÂÏ› ÙÔ fiÚÁ·ÓÔ «ÛÙfi¯Ô» ÛÙË ÓfiÛÔ (7). ∏ ‰È‹ıËÛ‹ ÙÔ˘ ·fi ˈÛÈÓfiÊÈÏ· Î·È ÙÔ Ô›‰ËÌ· ·fi ÙË Û˘ÓÔ‰fi ÊÏÂÁÌÔÓ‹ Û˘¯Ó¿ ÚÔηÏÔ‡Ó Û˘ÌÙÒÌ·Ù· ·fiÊڷ͢. ªÔÏÔÓfiÙÈ Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ¿ÓÙÚÔ˘ Â›Ó·È Û˘¯Ó‹, ‰È¿ÙÚËÛË ÛÙÔÌ¿-

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·537

¶∞π¢π∞∆ƒπ∫∏ 2000;63:534-537

¯Ô˘, ·’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ̤¯ÚÈ Û‹ÌÂÚ·. Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› 11 ÂÚÈÙÒÛÂȘ ‰È¿ÙÚËÛ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û ·ÛıÂÓ›˜ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ÂÙ¿ Û ÂÓ‹ÏÈΘ Î·È Ù¤ÛÛÂÚȘ Û ·È‰È¿ (3,8,9). √ÎÙÒ ·fi ·˘Ù¤˜ ·ÊÔÚÔ‡Û·Ó ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ (Ó‹ÛÙȉ· ‹ ÂÈÏÂfi), Ì›· ÙÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ Î·È ‰‡Ô ÙÔ ·¯‡ ¤ÓÙÂÚÔ. ∏ ‰È¿ÙÚËÛË ÛÙÔÌ¿¯Ô˘ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ ÌÔÚ› Ó· ·Ô‰oı› ÛÙËÓ ËˆÛÈÓÔÊÈÏÈ΋ ÊÏÂÁÌÔÓÒ‰Ë ‰È‹ıËÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Ô˘ ÂӉ¯Ô̤ӈ˜ Ô‰‹ÁËÛ Û ·Ó¿Ù˘ÍË ÂÙÈÎÔ‡ ¤ÏÎÔ˘˜ ‹\Î·È ÛÙËÓ ·‡ÍËÛË Ù˘ ÂÓ‰Ô·˘ÏÈ΋˜ ›ÂÛ˘ ÏfiÁˆ Ù˘ ¿¯˘ÓÛ˘ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ˘ÏˆÚÔ‡. √ ÂÁÎÔÏ·ÛÌfi˜ ·ÔÙÂÏ› Â›Û˘, ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ ÓfiÛÔ˘. ¢‡Ô ÂÚÈÙÒÛÂȘ ÂÁÎÔÏ·ÛÌÔ‡ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ̤¯ÚÈ Û‹ÌÂÚ· Î·È ÌfiÓÔÓ Ë Ì›· ·fi ·˘Ù¤˜ ·Ó·Ê¤ÚÂÙ·È Û ·È‰› (3). ∂›Ó·È ·›ı·ÓÔ Ô ÂÁÎÔÏ·ÛÌfi˜ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ Ó· Û˘Ó‰¤ÂÙ·È Ì ÙË Ï··ÚÔÙÔÌ›· Ô˘ ¤ÁÈÓ ÙËÓ 3Ë Ë̤ڷ ˙ˆ‹˜ (34 Ë̤Ú˜ ÚÈÓ) ηıÒ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÁÎÔÏ·ÛÌÔ‡ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÓÙfi˜ ÌÈ·˜ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (10). ∏ ·Ù˘›· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ÂÁÎÔÏ·ÛÌÔ‡ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ ·Ô‰›‰ÂÙ·È ÛÙË ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ Î·È ÛÙËÓ ˘„ËÏ‹ ı¤ÛË ÙÔ˘ ÂÁÎÔÏ·Ûı¤ÓÙÔ˜ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∞Ó Î·È ‰ÂÓ Ï‹ÊıËÎ·Ó ‚ÈÔ„›Â˜ ·fi ÙËÓ ÂÚÈÔ¯‹ (‰ÈfiÙÈ Ë ·Ó¿Ù·ÍË ¤ÁÈÓ Ì ¯ÂÈÚÈÛÌÔ‡˜) ÈÛÙ‡ԢÌ fiÙÈ Ô ÂÁÎÔÏ·ÛÌfi˜ ÔÊ›ÏÂÙ·È Û ˈÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. ™’ ·˘Ùfi Û˘ÓËÁÔÚ› Ë ‰È·›ÛÙˆÛË ËˆÛÈÓÔÊÈÏÈ΋˜ ‰È‹ıËÛ˘ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ˘ Î·È ÙÔ˘ ÔÚıÔ‡ Ô˘ ˘Ô‰ËÏÒÓÂÈ Î·ıÔÏÈ΋ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ (1). ™Â ·ÛıÂÓ›˜ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Û˘¯Ó¿ ‰È·ÈÛÙÒÓÂÙ·È Â˘·ÈÛıËÙÔÔ›ËÛË Ì¤Ûˆ IgE Û ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ·. øÛÙfiÛÔ, Ô ·ÓÔÛÔ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛı› Ï‹Úˆ˜ ̤¯ÚÈ Û‹ÌÂÚ·. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ‚ÂÏÙÈÒÓÔÓÙ·È ‹ ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ÂÓÔ¯ÔÔÈÔ‡ÌÂÓ˘ ÙÚÔÊ‹˜ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ (2,9,11), ÂÓÒ Û ¿ÏÏÔ˘˜ ÔÈ ‰›·ÈÙ˜ ·ÔÎÏÂÈÛÌÔ‡ ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (12), Èı·ÓfiÓ ‰ÈfiÙÈ Î·È ¿ÏÏ· ÙÚÔÊÈο ·ÓÙÈÁfiÓ· ÚÔηÏÔ‡Ó ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ì¤Ûˆ ÌË IgE Ì˯·ÓÈÛÌÔ‡. ∏ ·ÓÙ·fiÎÚÈÛË ÛÙË ‰›·ÈÙ· Â›Ó·È Û˘Ó‹ıˆ˜ ¿ÚÈÛÙË Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ ‰‡Ô ¯ÚfiÓˆÓ (1). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊËÎÂ, ‰È·ÈÛÙÒıËΠ¢·ÈÛıËÙÔÔ›ËÛË ÛÙËÓ ÚˆÙ½ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜. ∏ ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ì ÙË ÓfiÛÔ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ Â›Ó·È ÚÔÊ·Ó‹˜ ηıÒ˜ Ù· Û˘ÌÙÒÌ·Ù· ˘Ê¤ıËÎ·Ó ÌÂÙ¿ ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ˘‡ı˘ÓÔ˘ ·ÓÙÈÁfiÓÔ˘, Ë IgE ÙÔ˘ ÔÚÔ‡ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Â·Ó‹Ïı·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Î·È Ë ‰ÔÎÈÌ·Û›· Rast ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·ÚÓË-

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

ÙÈÎÔÔÈ‹ıËÎÂ. ∏ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙË Á¤ÓÓËÛË ÌÔÚ› Ó· ·Ô‰Ôı› Û ÂÓ‰ÔÌ‹ÙÚÈ· ¢·ÈÛıËÙÔÔ›ËÛË. ∏ ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, Ë ·ÓÙ·fiÎÚÈÛË ÛÙË ‰›·ÈÙ· ·ÔÎÏÂÈÛÌÔ‡ Ù˘ ˘‡ı˘Ó˘ ÙÚÔÊ‹˜ Î·È Ë ÌË Â˘·ÈÛıËÙÔÔ›ËÛ‹ ÙÔ˘ Û ¿ÏÏ· ÙÚÔÊÈο ·ÓÙÈÁfiÓ· ·ÔÙÂÏÔ‡Ó ÛÙÔȯ›· Ô˘ Ì·˜ ηıÈÛÙÔ‡Ó ·ÈÛÈfi‰ÔÍÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ÚfiÁÓˆÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Sampson HA, Anderson JA. Summary and recommendations: Classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr 2000;30:S87-S94.

2. Whitington PF, Whitington GL. Eosinophilic gastroenteritis in childhood. J Pediatr Gastroenterol Nutr 1988;7:379-385.

3. Hoefer RA, Ziegler MM, Koop CE, Schnaufer L. Surgical manifestations of eosinophilic gastroenteritis in the pediatric patient. J Pediatr Surg 1977;12:955-962.

4. Vanderplas Y, Quenon M, Renders F, Dab I, Loeb H. Milk-sensitive eosinophilic gastroenteritis in a 10-day-old boy. Eur J Pediatr 1990;149:244-245.

5. Hummer-Ehret BH, Rohrshneider WK, OleszczukRaschke K, Darge K, Nutzenadel W, Troger J. Eosinophilic gastroenteritis mimicking idiopathic hypertrophic pyloric stenosis. Pediatr Radiol 1998;28:711-713.

6. Blankenberg FG, Parker BR, Sibley E, Kerner JA. Evolving asymmetric hypertrophic pyloric stenosis associated with histologic evidence of eosinophilic gastroenteritis. Pediatr Radiol 1995;25:310-311.

7. Blackshaw AJ, Levison DA. Eosinophilic infiltrates of the gastrointestinal tract. J Clin Pathol 1986;39:1-7.

8. Deslandres C, Russo P, Gould P, Hardy P. Perforated duodenal ulcer in a pediatric patient with eosinophilic gastroenteritis. Can J Gastroenterol 1997;11:208-212.

9. Agertoft A, Husby S, Host A. Intestinal perforation in a two-year-old child with eosinophilic gastroenteritis. Acta Paediatr Scand 1991;80:389-391.

10. Ein SH, Ferguson JM. Intussusception – the forgotten postoperative obstruction. Arch Dis Child 1982;57:788-790.

11. Justinich C, Katz A, Gurbindo C, Lepage G, Chad Z, Bouthillier L, et al. Elemental diet improves steroid dependent eosinophilic gastroenteritis and reverses growth failure. J Pediatr Gastroenterol Nutr 1996;23:81-85.

12. Katz AJ, Twarog GJ, Zeiger RS, Falchuk ZM. Milksensitive and eosinophilic gastroenteropathy: Similar clinical features with contrasting mechanisms and clinical course. J Allergy Clin Immunol 1984;74:72-78.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-02-00 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 16-10-00 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: T¿ÓÈ· ™È·¯·Ó›‰Ô˘ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó\Ì›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·» £Ë‚ÒÓ & §Â‚·‰Â›·˜, 11527

537

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:538-541

∞ÈÌÔÂÚÈÙfiÓ·ÈÔ ÌÂÙ¿ ·fi Ú‹ÍË ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Û ·ÛıÂÓ‹ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· ªÈÚ¿ÓÙ· ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿, ∞ÊÚÔ‰›ÙË ∫Ô‡ÛË, ª·Ú›Ó· OÈÎÔÓfiÌÔ˘, ¢ËÌ‹ÙÚ˘ ¶·˘Ï›‰Ë˜, ∞ÈηÙÂÚ›ÓË ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘ ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ‰ÂηÙÂÙÚ¿¯ÚÔÓÔ˘ ÎÔÚÈÙÛÈÔ‡ Ì ÁÓˆÛÙ‹ ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›·, ÙÔ ÔÔ›Ô ·ÚÔ˘Û›·Û ·ÈÌÔÂÚÈÙfiÓ·ÈÔ ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆÔı‹Î˘. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜. ∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËΠÂÈÙ˘¯Ò˜ Ì ¯ÔÚ‹ÁËÛË Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Î·È ÎÚ˘Ô˚˙‹Ì·ÙÔ˜ ˆ˜ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· π Ù˘ ‹Íˆ˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (ÈÓˆ‰ÔÁfiÓÔ˘). A˘Ù‹ Ë ·ÈÌÔÚÚ·ÁÈ΋ ÂΉ‹ÏˆÛË Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· Î·È ÌfiÓÔ ‰‡Ô ·ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·ÁÎfiÛÌÈ· ‚È‚ÏÈÔÁÚ·Ê›·. øÛÙfiÛÔ, ·ÔÙÂÏ› ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÙËÓ ÔÔ›· ı· Ú¤ÂÈ Ó· ˘Ô„È¿˙ÂÙ·È Î·Ó›˜ Û ·Ó¿ÏÔÁË Û˘Ìو̷ÙÔÏÔÁ›·. ¶·È‰È·ÙÚÈ΋ 2000;63:538-541. §¤ÍÂȘ ÎÏÂȉȿ: ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›·, ·ÛÙË ˆÔı‹Î˘, ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›·.

M. Athanasiou-Metaxa, A. Koussi, M. Economou, D. Pavlidis, E. Malaka-Zafiriou. Intra-abdominal hemorrhage due to a ruptured corpus luteum cyst in a girl with congenital afibrinogenemia. Paediatriki 2000;63:538-541. ● Abstract: This is a case report of a 14 year old patient with congenital afibrinogenemia and intra-abdominal bleeding due to ruptured ovarian cyst. Diagnosis was confirmed by abdominal ultrasonography and computed tomography scans. Such a complication is extremely rare and only two similar cases have been reported.

Physicians caring for patients with afibrinogenemia should bear in mind this potentially fatal complication.

Key words: afibrinogenemia, ovarian cyst, intra-abdominal bleeding.

∂ÈÛ·ÁˆÁ‹ ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· ·ÔÙÂÏ› Û¿ÓÈ· ‰È·Ù·Ú·¯‹ Ù˘ ‹Í˘ ÌÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ 2 ·Ó¿ 1.000.000 ÁÂÓÓ‹ÛÂȘ (1). ∏ ‚·Ú‡ÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÔÈΛÏÏÂÈ ·fi ‹È· ·ÈÌÔÚÚ·ÁÈο ÂÂÈÛfi‰È· fiˆ˜ ÂÈÛÙ¿ÍÂȘ Î·È Ô˘ÏÔÚÚ·Á›Â˜, ¤ˆ˜ ÛÔ‚·Ú¤˜ ·ÈÌÔÚÚ·Á›Â˜, fiˆ˜ ·fi ÙÔÓ ÔÌÊ¿ÏÈÔ ÏÒÚÔ ÛÙ· ÓÂÔÁÓ¿ (2-4) ‹ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· (5,6). ™·ÓÈfiÙÂÚ· ·Ú·ÙËÚÔ‡ÓÙ·È ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È· Ù· ÔÔ›· Â›Ó·È ‰˘Ó·Ùfi Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙÔ ı¿Ó·ÙÔ (7,8). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ‰ÂηÙÂÙÚ¿¯ÚÔÓÔ˘ ÎÔÚÈÙÛÈÔ‡ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›·, ÙÔ ÔÔ›Ô ·ÚÔ˘Û›·Û ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›· ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘. ∞fi ÙËÓ ÚÔÛÈÙ‹ Û ̷˜ ‚È‚ÏÈÔÁÚ·Ê›·,

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£, °¶¡£ πÔÎÚ¿ÙÂÈÔ

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™ÂÏ›‰·539

¶∞π¢π∞∆ƒπ∫∏ 2000;63:538-541

ÈÛÙÔÚÈÎfi ÁÈ· ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· Û ̤ÏÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ù˘ ·ÛıÂÓÔ‡˜, ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‹Í˘ ·fi ÙÔÓ ÔÔ›Ô ‰È·ÈÛÙÒıËÎÂ: ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘ (PT) 39”/13”, ¯ÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ (·PTT) 120”/34”, ¯ÚfiÓÔ˜ ıÚÔÌ‚›Ó˘ 100”/25”, ¯ÚfiÓÔ˜ ÚÂÙÈÏ¿Û˘ 120”/20” Î·È Â›‰· ÈÓˆ‰ÔÁfiÓÔ˘ 0 mg/dl (ÊÙ=200-450 mg/dl). ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÙˆÓ ÁÔÓ¤ˆÓ ‰È·ÈÛÙÒıËÎ·Ó Â›‰· ÈÓˆ‰ÔÁfiÓÔ˘ ÛÙÔÓ ·Ù¤Ú· 50 mg/dl Î·È ÛÙË ÌËÙ¤Ú· 45 mg/dl. ªÂ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ Ù¤ıËΠÛÙËÓ ·ÛıÂÓ‹ Ë ‰È¿ÁÓˆÛË Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›·˜. ∆· ÂfiÌÂÓ· ¯ÚfiÓÈ· Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÌÂÌÔӈ̤ӷ ÂÂÈÛfi‰È· Ô˘ÏÔÚÚ·Á›·˜ Î·È ÚÈÓÔÚÚ·Á›·˜, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÂÈˆÌ·ÙÈÛÌfi ‹ ¯ÔÚ‹ÁËÛË ÈÓˆ‰ÔÁfiÓÔ˘ ÂÓ‰ÔÊÏ‚›ˆ˜, ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Û οı ÂÚ›ÙˆÛË. ™Â ËÏÈΛ· 11 ÂÙÒÓ, 7 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÌÌ‹ÓÔ˘ Ú‡Ûˆ˜, Ë ·ÛıÂÓ‹˜ ÓÔÛËχıËΠÛÙËÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÏfiÁˆ ÌËÓÔÚÚ·Á›·˜ Î·È ÌÂı·ÈÌÔÚÚ·ÁÈ΋˜ ·Ó·ÈÌ›·˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ë ·ÈÌÔÛÊ·ÈÚ›ÓË (∏b) ‹Ù·Ó 6,2 g/dl, Ô ·ÈÌ·ÙÔÎÚ›Ù˘ (Ht) 18% ÂÓÒ ‚Ú¤ıËÎ·Ó ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ C ¯ˆÚ›˜ ˘ÂÚÙÚ·ÓÛ·ÌÈÓ·Û·ÈÌ›·. ∏ ·ÛıÂÓ‹˜ ÛÙËÓ ÔÍ›· Ê¿ÛË ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠¯ÔÚ‹ÁËÛË ÎÚ˘Ô˚˙‹Ì·ÙÔ˜ Î·È Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ÔÈÛÙÚÔÁfiÓˆÓ Î·È ÚÔÁÂÛÙÂÚfiÓ˘ ÁÈ· 3 Ì‹Ó˜ Ì ·ÎfiÏÔ˘ıË Ú‡ıÌÈÛË Ù˘ ¤ÌÌËÓ˘ Ú‡Û˘. ŒÎÙÔÙÂ Ë ·ÛıÂÓ‹˜ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÛÙÔ ∂͈ÙÂÚÈÎfi ¶·È‰Ô·ÈÌ·ÙÔÏÔÁÈÎfi π·ÙÚÂ›Ô ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù·. ∫·Ù¿ ÙËÓ ÚfiÛÊ·ÙË ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÎÔÈÏȷο ¿ÏÁË, Â̤ÙÔ˘˜ Î·È ¯·ÌËÏ‹ ˘ÚÂÙÈ΋ ΛÓËÛË ·fi 24ÒÚÔ˘. µÚÈÛÎfiÙ·Ó ÛÙË Ì¤ÛË ÂÚ›Ô˘ ÙÔ˘ ηٷ̋ÓÈÔ˘ ·ÎÏÔ˘. ∞fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÌÂÙˆÚÈÛÌfi˜ ÎÔÈÏ›·˜ Î·È Â˘·ÈÛıËÛ›· ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈ͠ϢÎÔ΢ÙÙ¿ÚˆÛË Ì ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË (§= 24.100/mm3 Ì ¶=90%), Hb 13,4 g/dl, Ht 39,3%, ·ÈÌÔÂÙ¿ÏÈ· 388.000/mm3, ÌË ÚÔÛ‰ÈÔÚ›ÛÈ̘ ÙÈ̤˜ PT Î·È ·PTT ηıÒ˜ Î·È ÌË ·ÓȯÓ‡ÛÈÌÔ ÈÓˆ‰ÔÁfiÓÔ. O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ ·ÔÎ¿Ï˘„ ·ÛÙË ‰ÂÍÈ¿˜ ˆÔı‹Î˘ ‰ÂÍÈ¿ (∂ÈÎfiÓ· 1), ‡ÚËÌ· ÙÔ ÔÔ›Ô ÂȂ‚·ÈÒıËΠ̠·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÛÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËΠÂ›Û˘ ÌÈÎÚ‹ ÔÛfiÙËÙ· ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÁÚÔ‡ Û‡ÛÙÔȯ· (EÈÎfiÓ· 2). §fiÁˆ ·Ô˘Û›·˜ Ôͤˆ˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ Ë ·ÛıÂÓ‹˜ ‰È·ÎÔÌ›ÛÙËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ·‡ÚÂÙË, ÂÏ·ÊÚÒ˜ ˆ¯Ú‹ Î·È ·ÚÔ˘Û›·˙ ‹È· ÎÔÈÏȷο ¿ÏÁË. ∆ËÓ ÚÒÙË Ë̤ڷ ÓÔÛËÏ›·˜ ·Ú¤ÌÂÈÓ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÙËÓ ÂÔ̤ÓË fï˜ ·ÚÔ˘Û›·Û ÂÈ-

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

∂ÈÎfiÓ· 1. ÀÂÚ˯ÔÁÚ¿ÊËÌ· οو ÎÔÈÏ›·˜. ™ÙË ‰ÂÍÈ¿ ˆÔı‹ÎË ·ÂÈÎÔÓ›˙ÂÙ·È Î‡ÛÙË ÌÂÁ¤ıÔ˘˜ 4,66x3,14 cm ¯ˆÚ›˜ ÂÛˆÙÂÚÈΤ˜ ·ÓÙ·Ó·ÎÏ¿ÛÂȘ Î·È ‰È·ÊÚ·ÁÌ¿ÙÈ·. ‰Â›ÓˆÛË Ì ¤ÓÙÔÓ· ÎÔÈÏȷο ¿ÏÁË, Â̤ÙÔ˘˜ Î·È ¤ÓÙÔÓË Â˘·ÈÛıËÛ›· ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ. ¶·Ú·ÙËÚ‹ıËΠÙÒÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (∏b= 8,8 g/dl) Ì ˙ˆÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÛÙ·ıÂÚ¤˜. ¡¤Ô˜ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¤‰ÂÈÍ ·‡ÍËÛË Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ˘ÁÚÔ‡ ÛÙËÓ ÂÏ¿ÛÛÔÓ· ‡ÂÏÔ. ŒÁÈÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È Á˘Ó·ÈÎÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË Ù˘ ·ÛıÂÓÔ‡˜ Î·È Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ ·ÈÌÔÂÚÈÙfiÓ·ÈÔ˘ ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Î·È ·ÔÊ·Û›ÛÙËΠ·Ú·ÎÔÏÔ‡ıËÛË Î·È Û˘ÓÙËÚËÙÈ΋ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ ÙÔ˘ ÂÏÏ›ÔÓÙÔ˜ ·Ú¿ÁÔÓÙ· π Ù˘ ‹Í˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (ÈÓˆ‰ÔÁfiÓÔ˘). °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ¯ÔÚËÁ‹ıËÎ·Ó 12 ÌÔÓ¿‰Â˜ ÎÚ˘Ô˚˙‹Ì·ÙÔ˜ (4 ÌÔÓ¿‰Â˜/10 kg) (10) ηıÒ˜ Î·È 3 ÌÔÓ¿‰Â˜ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ ÁÈ· ÙË ‰ÈfiÚıˆÛË Ù˘ ·Ó·ÈÌ›·˜. ∆ËÓ 3Ë Ë̤ڷ ÓÔÛËÏ›·˜ Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ÂχıÂÚË Û˘ÌÙˆÌ¿ÙˆÓ Ì ٷ˘Ùfi¯ÚÔÓË ¿ÓÔ‰Ô ÙˆÓ ÙÈÌÒÓ Hb Î·È Ht (Û 11,3 g/dl Î·È 34% ·ÓÙ›ÛÙÔȯ·), ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ (Û 58 mg/dl) ηıÒ˜ Î·È ‰ÈfiÚıˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‹Í˘ (ƒ∆= 12”/14”, ·ƒ∆∆= 30”/28”). O Ó¤Ô˜ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ Ô ÔÔ›Ô˜ ¤ÁÈÓ ÙËÓ 6Ë Ë̤ڷ ÓÔÛËÏ›·˜ ¤‰ÂÈÍ Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ·ÛÙ˘ Ì ·Ú·ÌÔÓ‹ ÔÛfiÙËÙ·˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÁÚÔ‡ ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ· (∂ÈÎfiÓ· 3). ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÔÚÌÔÓÈÎÔ‡ ÂϤÁ¯Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙËÓ 7Ë Ë̤ڷ ÓÔÛËÏ›·˜ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ¯ˆÚ›˜ η̛· ÂÚ·ÈÙ¤Úˆ ıÂÚ·›·. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô Ù˘ ·ÛıÂÓÔ‡˜ 3 ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·, Ë ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· ·ÚÔ˘Û›·˙ ۷ʋ ‚ÂÏÙ›ˆÛË Ì Ï‹ÚË ·Ô˘Û›· ÂχıÂÚÔ˘ ˘ÁÚÔ‡ ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ·. ∆ÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘, Ë ·ÛıÂÓ‹˜ ·Ú·Ì¤ÓÂÈ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË ¯ˆÚ›˜ ÂÚ·ÈÙ¤Úˆ ÚÔ‚Ï‹Ì·Ù·. ™˘˙‹ÙËÛË ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· Â›Ó·È ÌÈ· Û¿ÓÈ· ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌfiÛÙ·Û˘ Ë ÔÔ›· ÎÏËÚÔÓÔÌ›ٷÈ

539

NOV.-DEC.2000(ÙÂÏÈÎfi N)

30-05-03

17:43

™ÂÏ›‰·540

¶∞π¢π∞∆ƒπ∫∏ 2000;63:538-541

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· οو ÎÔÈÏ›·˜. ¶·ÚÔ˘Û›· ΢ÛÙÈÎÔ‡ ÌÔÚÊÒÌ·ÙÔ˜ ‰ÂÍÈ¿˜ ˆÔı‹Î˘ Î·È ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÁÚÔ‡ Û‡ÛÙÔȯ·.

∂ÈÎfiÓ· 3. ÀÂÚ˯ÔÁÚ¿ÊËÌ· οو ÎÔÈÏ›·˜. ¶·ÚÔ˘Û›· ·ÚÎÂÙ‹˜ ÔÛfiÙËÙ·˜ ˘ÁÚÔ‡ (·›Ì·) ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ·.

Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (2,7). ∏ ˘Ô˚Óˆ‰ÔÁÔÓ·ÈÌ›· ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ ‰È·‰Ú¿ÌÂÈ Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈο Î·È Û¿ÓÈ· ÚÔηÏ› ‹Ș ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ÔÈ ÁÔÓ›˜ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ·Û˘Ìو̷ÙÈÎÔ› ÂÙÂÚÔ˙˘ÁÒÙ˜ Ì Â›‰· ÈÓˆ‰ÔÁfiÓÔ˘ <50 mg/dl. ™ÙÔ˘˜ ÔÌÔ˙˘ÁÒÙ˜ ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó Û ‚·Ú‡ÙËÙ·, ÁÂÓÈο fï˜ Â›Ó·È ËÈfiÙÂÚ˜ Û˘ÁÎÚÈÙÈο Ì ·˘Ù¤˜ ÔÈ Ôԛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ÎÏ·ÛÈο ·ÈÌÔÚÚÔÊÈÏÈο Û‡Ó‰ÚÔÌ· (7). ™˘Ó‹ıˆ˜, Ë ÚÒÙË ÂΉ‹ÏˆÛË ·Ú·ÙËÚÂ›Ù·È Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Ì ·ÈÌÔÚÚ·Á›· ·fi ÙÔÓ ÔÌÊ¿ÏÈÔ ÏÒÚÔ Û ÔÛÔÛÙfi ¤ˆ˜ 85% (2,4,7), ÂÓÒ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ·Ú·ÙËÚÔ‡ÓÙ·È ·˘ÙfiÌ·Ù· ‹ ÌÂÙ¿ ÙÚ·˘Ì·ÙÈÛÌfi ·ÈÌ·ÙÒÌ·Ù·, ÂÈÛÙ¿ÍÂȘ, Ô˘ÏÔÚÚ·Á›Â˜ Î·È ÌËÓÔÚÚ·Á›Â˜ Û ÔÛÔÛÙfi ¿Óˆ ÙÔ˘ 70% (2,4,7). ∏ ÂÌÊ¿ÓÈÛË ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆÔı‹Î˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· Î·È ÌfiÓÔ ‰‡Ô ·ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¢ÈÂıÓ‹ µÈ‚ÏÈÔÁÚ·Ê›·. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚ¿ ÌÈ· 22¯ÚÔÓË Á˘Ó·›Î· Ë ÔÔ›· ·ÚÔ˘Û›·Û ÛÔ‚·Ú‹ ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›· ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Î·È Ë ÔÔ›· ˘Ô‚Ï‹ıËΠ۠ˆÔıËÎÂÎÙÔÌ‹ ηıÒ˜ Ë ·ÈÌÔÚÚ·Á›· ‰ÂÓ ÌfiÚÂÛ ӷ ÂÏÂÁ¯ı› Û˘ÓÙËÚËÙÈο (9). ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË ·ÊÔÚ¿ ÌÈ· 19¯ÚÔÓË ÎÔ¤Ï·, Ë ÔÔ›· ÂÌÊ¿ÓÈÛ ˘ÔÔÁηÈÌÈ΋ ηٷÏËÍ›· ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆÔı‹Î˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÔ›·˜ Â›Û˘ ··ÈÙ‹ıËΠ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË (5). ∏ ·ÓˆÙ¤Úˆ ·ÛıÂÓ‹˜ ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ì ·ÓÙÈÛ˘ÏÏËÙÈο ÂΉ‹ÏˆÛ ÂÓ‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠¯ÔÚ‹ÁËÛË ÎÚ˘Ô˚˙‹Ì·ÙÔ˜ Ì Â·ÎfiÏÔ˘ıË ÂÌÊ¿ÓÈÛË Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜ Èı·ÓÒ˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÚÔÌ‚ÔÁfiÓÔ˘ ‰Ú¿Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ (8). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ Ë ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠÌfiÓÔ Û˘ÓÙËÚËÙÈο ¯ˆÚ›˜ Ó· ··ÈÙËı› ¯ÂÈÚÔ˘ÚÁÈ΋

·Ú¤Ì‚·ÛË. ªÂ ÙË ¯ÔÚ‹ÁËÛË ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘ ÔÈ ¯ÚfiÓÔÈ ‹Í˘ ·ÔηٷÛÙ¿ıËÎ·Ó Î·È Ë ÙÈÌ‹ ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ·˘Í‹ıËΠ۠Â›‰· ¿Óˆ ·fi 50 mg/dl. ¢ÂÓ ÎÚ›ıËΠÛÎfiÈÌË Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ, ÚÔ˜ ÙÔ ·ÚfiÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ, ÏfiÁˆ ÙÔ˘ ÌÂÌÔӈ̤ÓÔ˘ ÂÂÈÛÔ‰›Ô˘ Î·È Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜ Ù˘ ·ÛıÂÓÔ‡˜. ™Â ÂÚ›ÙˆÛË Û˘Ó¯È˙fiÌÂÓ˘ ·ÈÌÔÚÚ·Á›·˜, Û ·ÚÔ˘Û›· ÛËÌ›ˆÓ ˘ÔÔÁηÈÌÈ΋˜ ηٷÏËÍ›·˜ ‹ Û ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÚÔÂÙÔÈÌ·Û›· Û˘ÓÈÛÙ¿Ù·È ¯ÔÚ‹ÁËÛË ÈÓˆ‰ÔÁfiÓÔ˘ (100 mg/kg) ‹ ˘ÔηٿÛÙ·ÙˆÓ ÒÛÙ ӷ ÂÈÙ¢¯ıÔ‡Ó Â›‰· 100mg/dl (2,5,9,11). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‹ÈˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ·ÚΛ Ë ¯ÔÚ‹ÁËÛË Â‡ÎÔÏ· ‰È·ı¤ÛÈÌˆÓ ÚÔ˚fiÓÙˆÓ, fiˆ˜ Â›Ó·È ÙÔ Ï¿ÛÌ·, ÙÔ ÊÚ¤ÛÎÔ Î·Ù„˘Á̤ÓÔ Ï¿ÛÌ· ‹ ÙÔ ÎÚ˘Ô˝˙ËÌ· (2,7). ∏ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Ì ÚÔÛÔ¯‹ ÏfiÁˆ ÙˆÓ ÂÌÊ·ÓÈ˙fiÌÂÓˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. ∞ӷʤÚÔÓÙ·È ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ (1,11,12), ‰ËÌÈÔ˘ÚÁ›· ·ÓÙÈÛˆÌ¿ÙˆÓ (7,13), ÂΉ‹ÏˆÛË ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (4,9) ηıÒ˜ Î·È ÌÂÙ¿‰ÔÛË ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ (11), fiˆ˜ Ë ÌÂÙ¿‰ÔÛË Ù˘ Ë·Ù›Ùȉ·˜ C Ë ÔÔ›· ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÛıÂÓ‹ Ì·˜. ™Â οı ÂÚ›ÙˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ù·ÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ¯ÚfiÓˆÓ ‹Í˘ Î·È Ë ıÂÚ·›· Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È. ∏ ÂÌÊ¿ÓÈÛË ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆÔı‹Î˘ Â›Ó·È Û¿ÓÈ· ÂΉ‹ÏˆÛË Û ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›·, ˆÛÙfiÛÔ ·ÔÙÂÏ› ÌÈ· ÛÔ‚·Ú‹ ÂÈÏÔ΋ Ë ÔÔ›· ÌÔÚ› Ó· ·Ԃ› ÌÔÈÚ·›· Î·È Ë ˘fiÓÔÈ· ·˘Ù‹˜ Ú¤ÂÈ Ó· Ù›ıÂÙ·È Û ·Ó¿ÏÔÁË Û˘Ìو̷ÙÔÏÔÁ›·.

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2. Hoffman R, Benz EJ, Shattil SJ, Furil B, Cohen HJ, Silberstein LE, eds. Quantitive and Qualitative

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Mc Donagh J, Carrej N, Lee MH. Disfibrinogenemia and other disorders of fibrinogen structure and function. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds.

Hemostasis and Thrombosis. Basic Principles and Clinical Practice. Philadelphia: J.B. Lippincott Company; 1994. p. 314-334.

Lak M, Keihani M, Elahi F, Peyvandi F, Manucci PM. Bleeding and thrombosis in 55 patients with inherited afibrinogenemia. Br J Haematol 1999;107:204-206.

Henselmans JML, Meijer K, Haaxma R, Hew J, Van Der Meer J. Recurrent spontaneous intracerebral hemorrhage in a congenitally afibrinogenemic patient.

Stroke 1999;30:2479-2482.

Menart C, Sprunck N, Duhaut P, Pinede L, Demolombue-Rague S, Negrier C. Recurrent spontaneous intracerebral hematoma in a patient with afibrinogenemia. Thromb Haemost 1998;79:241-242.

Nathan DG, Oski FA, eds. Hemostasis: Diseases of the fluid phase. In: Hematology of Infancy and Childhood.

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Roberts HR, Brigham MD. Other coagulation factor deficiencies. In:Loscalzo J, Shafer AL, eds. Thrombosis and Hemorrhage. 2nd ed. William and Wilkins; Baltimore: 1998. p. 773-802.

Schnider D, Bukofski I, Kaufman S, Sadovsky G, Caspi

EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ

E. Severe ovarian hemorrhage in congenital agibrinogenemia. Acta Obstet Gynecol Scand 1981;60:431.

10. Tura S. Coagulopatie congenite non emofiliche. A: Lezioni di ematologia. Societa Editrice Esulapio, Bologna, 1991;555-557.

11. Shima M, Tanaka I, Sawamoto Y, Kanehiro H, Matsuo N, Nishimura A, Giddings J, Yoshioka A. Successful treatment of two brothers with congenital afibrinogenemia for splenic rupture using heat- and solvent detergent-treated fibrinogen concentrates. J Pediatr ∏ematol Oncol 1997:19:462-465.

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13. De Vries A, Rosenberg T, Kochwa S, Bross JHL. Precipitating afibrinogen antibody appearing after fibrinogen infusions in a patient with congenital afibrinogenemia. Am J Med 1961;30:486-494.

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¢È·Ù·Ú·¯‹ ∂ÏÏÂÈÌÌ·ÙÈ΋˜ ¶ÚÔÛÔ¯‹˜ Ì ‹ ¯ˆÚ›˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶À) ™Ù¤ÏÏ· ∆Û›ÙÔ˘Ú·

∏ ‰È·Ù·Ú·¯‹ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ‹ ¯ˆÚ›˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶À) ·Ó·Ê¤ÚÂÙ·È Û ÌÈ· ÌÈÎÚ‹ ‰È·ÊÔÚ¿ ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ·, ¤Ó· ¤Í˘ÓÔ ·È‰› Ó· ·ÔÙ˘Á¯¿ÓÂÈ ÛÙÔ Û¯ÔÏÂ›Ô Î·È Ó· Û˘ÌÂÚÈʤÚÂÙ·È ¿Û¯ËÌ· ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤¯ÂÈ Î·Ï‹ ÁÔÓÈ΋ ÊÚÔÓÙ›‰·. ªÂ fiÏÔ ÙÔ ÚfiÛÊ·ÙÔ ÂӉȷʤÚÔÓ Ô˘ ¤¯ÂÈ ·Ó·Ù˘¯ı› ÁÈ· ÙË ¢∂¶À ı· ÓfiÌÈ˙ ηÓ›˜ fiÙÈ ¤¯ÂÈ ÍÂÛ¿ÛÂÈ ÂȉËÌ›·. ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ¤¯ÂÈ ·Ó·Ù˘¯ı› ÌÂÁ·Ï‡ÙÂÚË ÂȉÂÍÈfiÙËÙ· ÛÙË ‰È¿ÁÓˆÛË ÌÈ·˜ Ú·ÁÌ·ÙÈ΋˜ ηٿÛÙ·Û˘ Ô˘ ·ÏÈfiÙÂÚ· ·ÁÓÔ›ÙÔ. ∏ ¢∂¶À ·ÊÔÚ¿ 2 Ì 5% ÙˆÓ ·È‰ÈÒÓ Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ÙÚfiÔ˘˜: ● ™·Ó ·ÚÔÚÌËÙÈ΋, ÊÙˆ¯¿ ·˘ÙÔÂÏÂÁ¯fiÌÂÓË Û˘ÌÂÚÈÊÔÚ¿, fiÔ˘ ÂÈÎÚ·Ù› Ë ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È Ë ·ÚÔÚÌËÙÈÎfiÙËÙ·. ● ™·Ó Úfi‚ÏËÌ· ÛÙË Û˘ÁΤÓÙÚˆÛË, ÛÙË ÌÓ‹ÌË Î·È ÛÙË Ì¿ıËÛË, fiÔ˘ ÂÈÎÚ·Ù› Ë ÂÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹ Î·È Ë Ì·ıËÛȷ΋ ‰˘ÛÎÔÏ›·. ● ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ¤¯Ô˘Ó ¤Ó· Ì›ÁÌ· Î·È ÙˆÓ ‰‡Ô Ù‡ˆÓ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ·ÚÔÚÌËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ‰˘ÛÎÔϛ˜ ÛÙË Û˘ÁΤÓÙÚˆÛË Î·È ÛÙË Ì¿ıËÛË. ∏ ¢∂¶À ÚÔηÏÂ›Ù·È ·fi ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÛÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÂÁΤʷÏÔ. ∆Ô Ì¤ÁÂıÔ˜ Ù˘ ‰È·Ù·Ú·¯‹˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ·fi ÙÔÓ ¯ÂÈÚÈÛÌfi Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Ù˘ ÂÎ·›‰Â˘Û‹˜ ÙÔ˘. ∂›Ó·È ·‰‡Ó·ÙÔ Ó· ·ÏÏ·¯ı› Ë ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË Ô˘ Û˘Ó‹ıˆ˜ ˘¿Ú¯ÂÈ, ·ÏÏ¿ Û›ÁÔ˘Ú· ÌÔÚ› Ó· Á›ÓÂÈ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÛÙÔ Û›ÙÈ Î·È ÛÙÔ Û¯ÔÏ›Ô, ÒÛÙ ӷ ‚ÔËıËı› ÙÔ ·È‰› Ó· Û˘ÌÂÚÈʤÚÂÙ·È ÛˆÛÙ¿ Î·È Ó· ·Ó·Ù‡ÍÂÈ ÙÔ Ì¤ÁÈÛÙÔ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÙÔ˘. ÷ڷÎÙËÚÈÛÙÈο ÙÔ˘ ·È‰ÈÔ‡ Ì ¢∂¶À - ¶ÂÈÚ¿˙ÂÈ Ù· ¿ÓÙ·, ÛÙÚÈÊÔÁ˘Ú›˙ÂÈ, οÓÂÈ Ó¢ÚÈΤ˜ ÎÈÓ‹ÛÂȘ.

- ∂›Ó·È ·Ó‹Û˘¯Ô, ¯¿ÓÂÈ ÙÔÓ ¯ÚfiÓÔ ÙÔ˘.

- ¢‡ÛÎÔÏ· ÚÔÛ·ÚÌfi˙ÂÙ·È Û Ӥ˜ ηٷÛÙ¿ÛÂȘ.

- ∞ÚÁ› Ó· ηٷϿ‚ÂÈ Ô‰ËÁ›Â˜.

- •Â¯Ó¿ Ù· ‚È‚Ï›· ‹ Ù· ÙÂÙÚ¿‰È· ÌÂϤÙ˘.

- •Â¯Ó¿ Ù· ÌËӇ̷ٷ Ô˘ ÛÙ¤ÏÓÂÈ ÙÔ Û¯ÔÏÂ›Ô ÛÙÔ Û›ÙÈ.

- ¢˘ÛÎÔχÂÙ·È Ó· ÍÂÎÈÓ‹ÛÂÈ ÙË ‰Ô˘ÏÂÈ¿ Ô˘ Ú¤ÂÈ Ó· οÓÂÈ.

- ÃÚÂÈ¿˙ÂÙ·È ·˘ÛÙËÚ‹ ‰ÔÌ‹ ÁÈ· ÙË ÌÂϤÙË.

- ∞Ê·ÈÚÂ›Ù·È Â‡ÎÔÏ·, ̤ÓÂÈ ›Ûˆ, ¯¿ÓÂÈ ÙÔ ÂӉȷʤÚÔÓ.

- ∞ÓÙȉڿ ˘ÂÚ‚ÔÏÈο ÛÙ· ÂÈÚ¿ÁÌ·Ù· ÙˆÓ Û˘ÓÔÌËϛΈÓ. ª∏¡ •∂á∞∆∂! ∞ÎfiÌË ÎÈ ·Ó ÙÔ ·È‰› Û·˜ ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· Ô˘ ÚԷӷʤÚıËÎ·Ó ÛÙËÓ ∂ÈÛ·ÁˆÁ‹, Ë ÙÂÏÈ΋ ‰È¿ÁÓˆÛË Ù˘ ¢∂¶À ı· Á›ÓÂÈ ·fi ÙÔÓ ÂȉÈÎfi (ÂÎ·È‰Â˘ÙÈÎfi „˘¯ÔÏfiÁÔ ‹ ·È‰›·ÙÚÔ) Î·È fi¯È ·fi ÂÛ¿˜ ÙÔ˘˜ ›‰ÈÔ˘˜ ‹ ÙÔÓ ‰¿ÛηÏÔ.

¶·È‰›·ÙÚÔ˜ – π·ÙÚfi˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ ¢È¢ı‡ÓÙÚÈ· ∆Ì‹Ì·ÙÔ˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & ∞. ∫˘ÚÈ·ÎÔ‡"

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:542-544

™ÂÏ›‰·543

¶Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜

™˘Ì‚Ô˘Ï¤˜ ÁÈ· ¯ÂÈÚÈÛÌfi Û˘ÌÂÚÈÊÔÚ¿˜ - √ ÂÈÙ˘¯‹˜ ¯ÂÈÚÈÛÌfi˜ ÙÔ˘ ·È‰ÈÔ‡ Ì ¢∂¶À ÂÚÈÏ·Ì‚¿ÓÂÈ ˙ˆ‹ Ì ÚfiÁÚ·ÌÌ·, ·ÓÙ·ÌÔÈ‚‹ οı ηÏÔ‡ Î·È ˘Ô¯ÒÚËÛË Û ÂÚ›ÙˆÛË ·ÓÙÈ·Ú¿ıÂÛ˘.

- ™˘ÌÂÚÈʤÚÂÙ·È Î·Ï‡ÙÂÚ· fiÙ·Ó ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙÔ ›‰ÈÔ Î·ıËÌÂÚÈÓfi ÚfiÁÚ·ÌÌ·.

- £˘ÌËı›Ù fiÙÈ fiÙ·Ó ÔÈ ‰‡Ô ÁÔÓ›˜ Û˘ÓÂÚÁ·ÛıÔ‡Ó ÌÂٷ͇ ÙÔ˘˜ ¿Óˆ Û ¤Ó· ÚfiÁÚ·ÌÌ· Â›Ó·È ÏÈÁfiÙÂÚÔ Èı·Ófi Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó Î·È ÂΛÓÔÈ ·ÚÔÚÌËÙÈο ‹ ·Ú¿ÏÔÁ·.

- ªËÓ ÍÈÊÔÌ·¯Â›Ù Ì ÙÔ ·È‰› Ì ¢∂¶À Î·È ·˘Í¿ÓÂÙ ÙËÓ ·ÓÙÈ·Ú¿ıÂÛË. ∞˘Ùfi ÚÔηÏ› ÌÈ· ‰È·Ì¿¯Ë ÂÈı˘ÌÈÒÓ, ‰‡Ô ¤Í·ÏÏ· ÛÙÚ·Ùfi‰·, ·ÓÙ›ıÂÛË, ÌÓËÛÈηΛ· Î·È Î·Ù·ÛÙÚÔÊ‹ Ù˘ Û¯¤Û˘.

- ªË ‰È·Ú·ÁÌ·Ù‡ÂÛÙÂ, ÌËÓ ÂÎÓ¢ڛ˙ÂÛÙÂ, ÌËÓ ·Ó‚¿˙ÂÙ ÙÔ˘˜ ÙfiÓÔ˘˜. ÃÚËÛÈÌÔÔÈ›ÛÙ ÂÏÂÁ¯fiÌÂÓË ÊˆÓ‹, ¯ˆÚ›˜ Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË.

- ∞Ó·Ù‡ÍÙ ηÓfiÓ˜ Î·È Û˘Ó¤ÂÈ·. ∆Ô ·È‰› Ì ¢∂¶À ·ÓÙȉڿ ηχÙÂÚ· fiÙ·Ó Î·Ù·Ï·‚·›ÓÂÈ ÙÔ˘˜ ηÓfiÓ˜, ÁÓˆÚ›˙ÂÈ Ù· fiÚÈ· Î·È ÂÚÈ̤ÓÂÈ Û˘ÓÂ‹ Â·ÎfiÏÔ˘ı·. ŒÓ· ÌÈÎÚfi ÏÔÁÈÎfi Ï·›ÛÈÔ Î·ÓfiÓˆÓ, ı· Ú¤ÂÈ Ó· ¤¯ÂÈ ÙÂı› ÚÔËÁÔ˘Ì¤Óˆ˜, Û ÛÙÈÁ̤˜ ËÚÂÌ›·˜ Î·È fi¯È Û ÛÙÈÁ̤˜ ¤Í·„˘. √È Î·ÓfiÓ˜ ·˘ÙÔ› ¯ÚÂÈ¿˙ÂÙ·È Ó· Â›Ó·È Ï›ÁÔÈ, Ù›ÌÈÔÈ Î·È ÍÂοı·ÚÔÈ.

- ¢ÒÛÙ ÛÙÔÓ Â·˘Ùfi Û·˜ ¯ÚfiÓÔ ÁÈ· Ó· ¯ÂÈÚÈÛÙ› ÙËÓ Î·Ù¿ÛÙ·ÛË: - ¢ËÏÒÛÙ ÙÔ˘˜ ηÓfiÓ˜ - ªÂÙÚ‹ÛÙ ̤¯ÚÈ ÙÔ ÙÚ›· - ∫¿ÓÙ ‰È¿ÏÂÈÌÌ· - ¢ÒÛÙ ÂÓ·ÏÏ·ÎÙÈΤ˜ χÛÂȘ - ∫¿ÓÙ ÙÔ ·È‰› ˘‡ı˘ÓÔ ÁÈ· ÙË ‰È΋ ÙÔ˘ Û˘ÌÂÚÈÊÔÚ¿. ªËÓ ·Ó·Ï·Ì‚¿ÓÂÙ ÙËÓ Â˘ı‡ÓË ÁÈ· ÙËÓ Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ Î·È ÌËÓ ÙÔ˘ ÂÈÙÚ¤ÂÙ ӷ ηÙËÁÔÚ› ¿ÏÏÔ˘˜ ÁÈ’ ·˘Ù‹Ó.

- µÔËı›ÛÙ ÙÔ Ó· ηٷϿ‚ÂÈ fiÙÈ Ë ‰È΋ ÙÔ˘ ÂÈÏÔÁ‹ Û˘ÌÂÚÈÊÔÚ¿˜ Ô‰ËÁ› Û ÂÈÏÔÁ‹ ÙÈ̈ڛ·˜ ‹ ·ÓÙ·ÌÔÈ‚‹˜. ÃÚËÛÈÌÔÔÈ›ÛÙ ·Ϥ˜ ·ÓÙ·ÌÔÈ‚¤˜ ‹ ÙÈ̈ڛ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌÔÛıÔ‡Ó ¿ÌÂÛ· Î·È ÌËÓ ·Ó·‚¿ÏÂÙÂ. Ÿ„È̘ ÙÈ̈ڛ˜ ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈΤ˜.

- £˘ÌËı›Ù fiÙÈ ·ÎfiÌ· Î·È ÙÔ ·È‰› Ì ÙË ¯ÂÈÚfiÙÂÚË Û˘ÌÂÚÈÊÔÚ¿ Â›Ó·È Î·Ïfi ÙÔ 95% ÙÔ˘ ¯ÚfiÓÔ˘. ∞ÓÙ·Ì›„Ù ·˘Ù‹ ÙË ıÂÙÈ΋ ÏÂ˘Ú¿, Û˘ÏÏ¿‚ÂÙ¤ ÙÔ Ó· Û˘ÌÂÚÈʤÚÂÙ·È ÛˆÛÙ¿. ¶ÚÔÛ·ı›ÛÙ ·ÚÁ¿ Î·È ÛÙ·ıÂÚ¿. √È ·ÏÏ·Á¤˜ ı· Á›ÓÔ˘Ó ·ÏÏ¿ ÌËÓ ÂÚÈ̤ÓÂÙ ¿Ú· ÔÏÏ¿ ÙfiÛÔ Û‡ÓÙÔÌ·.

- ªËÓ Í¯ӿÙ fiÙÈ ÔÈ ÂÈÙ˘¯Ë̤ÓÔÈ ÁÔÓ›˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙËÓ ÛËÌ·Û›· Ó· ÂÈ̤ÓÔ˘Ó ÌfiÓÔ ÁÈ· ÛËÌ·ÓÙÈο ı¤Ì·Ù· Î·È Ó· ˘Ô¯ˆÚÔ‡Ó ÛÙ· ·Û‹Ì·ÓÙ·. ™˘Ì‚Ô˘Ï¤˜ ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ Û¯ÔÏÈ΋˜ ·fi‰ÔÛ˘ - ªÂÙ¿ ·fi ÌÈ· ‰‡ÛÎÔÏË Ì¤Ú· ÛÙÔ Û¯ÔÏ›Ô, ÙÔ ÙÂÏÂ˘Ù·›Ô Ú¿ÁÌ· Ô˘ ı¤ÏÂÈ ÙÔ ·È‰› Ì ¢∂¶À Â›Ó·È ÂÚÈÛÛfiÙÂÚË ÌÂϤÙË ÛÙÔ Û›ÙÈ. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÂÁηٷÛÙ·ı› ÛÙ· ÚÒÙ· Û¯ÔÏÈο ¯ÚfiÓÈ· Ë Û˘Ó‹ıÂÈ· Ù˘ ÌÂϤÙ˘ ÛÙÔ Û›ÙÈ. ∫·ıÔÚ›ÛÙÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ¯ÚfiÓÔ ÌÂϤÙ˘ Ô˘ ı· ÂÈÙÚ¤ÂÈ ÍÂÎÔ‡Ú·ÛË ÌÂÙ¿ ÙÔ Û¯ÔÏ›Ô, ·ÏÏ¿ fi¯È ‰È¿‚·ÛÌ· ̤¯ÚÈ ·ÚÁ¿ ÙÔ ‚Ú¿‰˘ fiÙ·Ó ÙÔ ·È‰› Â›Ó·È Ôχ ÎÔ˘Ú·Ṳ̂ÓÔ.

- ∏ ÌÂϤÙË ÛÙÔ Û›ÙÈ ·ÊÔÚ¿ ΢ڛˆ˜ ÙÔ Û¯ÔÏÂ›Ô Î·È ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ó· ηٷÛÙÚ¤ÊÂÈ ÙȘ Û¯¤ÛÂȘ ÁÔÓÈÔ‡ – ·È‰ÈÔ‡. ¶ÔÏϤ˜ ÊÔÚ¤˜ ÙÔ ·È‰› ͯӿ Ù· ‚È‚Ï›· ‹ ÙȘ ÛËÌÂÈÒÛÂȘ ÙÔ˘ ÛÙÔ Û¯ÔÏÂ›Ô ‹ ‰ÂÓ ÚÔÏ·‚·›ÓÂÈ Ó· ÁÚ¿„ÂÈ ÔȘ Â›Ó·È ÔÈ ˘Ô¯ÚÂÒÛÂȘ ÙÔ˘ ÁÈ· ÙÔ Û›ÙÈ. ¢Â‡ÙÂÚ· ‚È‚Ï›· ÛÙÔ Û›ÙÈ ‹ ¤Ó· ÙÂÙÚ¿‰ÈÔ ÂÈÎÔÈÓˆÓ›·˜ ÌÂٷ͇ ‰·ÛοÏÔ˘ Î·È ·È‰ÈÔ‡ ÂӉ¯Ô̤ӈ˜ Ó· ¤Ï˘Ó ÙÔ Úfi‚ÏËÌ·.

- ª·˙› Ì ÙÔ ·È‰› Û·˜ ·ÔÊ·Û›ÛÙ ÔÈÔ˜ Â›Ó·È Ô Î·Ï‡ÙÂÚÔ˜ ¯ÚfiÓÔ˜ Ô˘ ÌÔÚ› Ó· Û˘ÁÎÂÓÙÚˆı› ÁÈ· ÙËÓ ÌÂϤÙË ÛÙÔ Û›ÙÈ .¯. 1 ‹ 2 ÒÚ˜ ÌÂÙ¿ ·fi ÙËÓ ÂÈÛÙÚÔÊ‹ ÛÙÔ Û›ÙÈ. ¢ËÌÈÔ˘ÚÁ›ÛÙ ÌÈ· ÛÙ·ıÂÚ‹ ÁˆÓÈ¿ ÁÈ· ÌÂϤÙË Ì ηÏfi ʈÙÈÛÌfi, ¯ˆÚ›˜ ÙËÏÂfiÚ·ÛË Î·È Ì fi,ÙÈ ÙÔ˘ ¯ÚÂÈ¿˙ÂÙ·È ÎÔÓÙ¿ ÙÔ˘. ¢È·ÈÚ¤ÛÙ ÙÔÓ ¯ÚfiÓÔ ÌÂϤÙ˘ ·Ó¿ÏÔÁ· Ì ÙÔÓ ¯ÚfiÓÔ Û˘ÁΤÓÙÚˆÛ˘ ÙÔ˘ ·È‰ÈÔ‡ .¯. ÌÈÛ‹ ÒÚ· ÌÂϤÙ˘, ÌÂÙ¿ ¤Ó· ÌÈÎÚfi ‰È¿ÏÂÈÌÌ· Î·È ÌÂÙ¿ ¿ÏÈ ÌÂϤÙË. √ ÂÓıÔ˘ÛÈ·ÛÌfi˜ ÙÔ˘ ·È‰ÈÔ‡ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÂӉȷʤÚÔÓ Î·È ÙËÓ ˘ÔÛÙ‹ÚÈÍË Ô˘ ‰Â›¯ÓÔ˘Ó ÔÈ ÁÔÓ›˜ ·fi ÙË ÌÈÎÚ‹ ÙÔ˘ ËÏÈΛ·. µÔ‹ıÂÈ·, ÂÓı¿ÚÚ˘ÓÛË, ¤ÏÂÁ¯Ô˜, ‰È·ıÂÛÈÌfiÙËÙ· ÁÈ· Û˘˙‹ÙËÛË, ÙÂÏÈο ‰›ÓÔ˘Ó Î·Ïfi ·ÔÙ¤ÏÂÛÌ·.

- ŸÙ·Ó ÙÔ ·È‰› ¤¯ÂÈ Î¿ÓÂÈ ÙËÓ Î·Ï‡ÙÂÚË ‰È·¯Â›ÚÈÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÙÔ˘, ı· Ú¤ÂÈ Ó· Â·ÈÓÂ›Ù·È ÁÈ· fiÙÈ ¤¯ÂÈ Î·Ù·Ê¤ÚÂÈ Î·È fi¯È Ó· ÙÈ̈ÚÂ›Ù·È ÁÈ· ·˘Ùfi Ô˘ ‰ÂÓ ÚfiÏ·‚ ӷ ÔÏÔÎÏËÚÒÛÂÈ. ∞Ó ÌÂÙ¿ ·fi Â·Ú΋ ÚÔÛ¿ıÂÈ· Ë ‰Ô˘ÏÂÈ¿ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· ÙÂÏÂÈÒÛÂÈ, ·Ê‹ÛÙ ÙËÓ fiˆ˜ ›ӷÈ.

- ªËÓ ··ÈÙ›ÙÂ Î·È ÎÚÈÙÈοÚÂÙÂ, ÁÈ·Ù› ·˘Ùfi ÌÔÚ› Ó· ÚÔÛ‚¿ÏÂÈ ÙÔÓ ‰¿ÛηÏÔ. ƒˆÙ‹ÛÙ Ò˜ ÌÔÚ›Ù ӷ ‚ÔËı‹ÛÂÙÂ.

- ªÂÚÈΤ˜ ÊÔÚ¤˜ ·Ó·ÚˆÙȤÛÙ ·Ó ÙÔ ·È‰› Û·˜ ı· Ú¤ÂÈ Ó· Â·Ó·Ï¿‚ÂÈ ÙËÓ Ù¿ÍË. ∫·ıÒ˜ Ô ÂÁΤʷÏÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Ì ¢∂¶À ˆÚÈÌ¿˙ÂÈ, ÔÏÏ¿ ·fi Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÁΤÓÙÚˆÛ˘, Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Ì¿ıËÛ˘ Á›ÓÔÓÙ·È

543

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:542-544

¶Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜

¢ÎÔÏfiÙÂÚ·. °È’ ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ ÌÂÚÈο ·È‰È¿ Ó· ·ÎÔÏÔ˘ıÔ‡Ó ÛÙÔ Û¯ÔÏÂ›Ô ·ÚÁfiÙÂÚÔ Ú˘ıÌfi. ∂¿Ó Ô ‰¿ÛηÏÔ˜ ÙÔ˘ ÓËÈ·ÁˆÁ›Ԣ ÚÔÙ›ÓÂÈ Ó· ·Ú·Ì›ÓÂÈ ÙÔ ·È‰› ÌÈ· ¯ÚÔÓÈ¿ ·ÎfiÌ·, ηÏfi Â›Ó·È Ó· ÙÔÓ ·ÎÔ‡ÛÂÙÂ.

- ™˘¯Ó¿ ÁÂÓÓÈ¤Ù·È ÙÔ ÂÚÒÙËÌ· fiÛË ÂÈϤÔÓ ‚Ô‹ıÂÈ· ¯ÚÂÈ¿˙ÔÓÙ·È ÛÙÔ Û›ÙÈ. ∂Âȉ‹ Ë ¢∂¶À Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ Ì ÂȉÈΤ˜ Ì·ıËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ Ë ‰˘ÛÏÂÍ›·, ÔÏÏ¿ ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÈϤÔÓ ‚Ô‹ıÂÈ· ÛÙËÓ ·Ó¿ÁÓˆÛË, ÙËÓ ÁÚ·Ê‹, Ù· Ì·ıËÌ·ÙÈο Î·È ÙËÓ ÁÏÒÛÛ·. ŒÓ·˜ ȉȈÙÈÎfi˜ ‰¿ÛηÏÔ˜ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙËÓ ·˘ÙÔÂÔ›ıËÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ¤Ó·˜ ÚÔ˜ ¤Ó·Ó Â›Ó·È ·Ô‰ÔÙÈ΋. £˘ÌËı›Ù fï˜, fiÙÈ ‰ÂÓ Â›Ó·È ˘ÁȤ˜ Ó· Û·Ù·ÏÈ¤Ù·È fiÏÔ˜ Ô ¯ÚfiÓÔ˜ Ì ÂÛÙ›·ÛË Û ÂÚÈÔ¯¤˜ ·‰˘Ó·Ì›·˜, ¯ÚÂÈ¿˙ÂÙ·È ÌÈ· ÈÛÔÚÚÔ›· ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ ¯ÚfiÓÔ˘ ·Ó¿ÌÂÛ· ÛÙËÓ ÂÈϤÔÓ ‰È‰·Ûηϛ· Î·È ÛÙËÓ ÂÈÙ˘¯Ë̤ÓË ··Û¯fiÏËÛË Ì ¿ÏÏ· ÂӉȷʤÚÔÓÙ· (·ıÏËÙÈÛÌfi, ÌÔ˘ÛÈ΋, ÂχıÂÚÔ ·È¯Ó›‰È, ¯ÔÚfi).

- ŸÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÂȉÈΤ˜ Ì·ıËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ÓfiÌÈÌÔ Ó· ¤¯Ô˘Ó ÂȉÈ΋ ÌÂÙ·¯Â›ÚÈÛË, ȉȷ›ÙÂÚ· ÛÙȘ ÂÍÂÙ¿ÛÂȘ. ªÔÚÔ‡Ó Ó· ÂÍÂÙ·ÛıÔ‡Ó ÚÔÊÔÚÈο ‹ Ó· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ. ∫¿ÔÈ· ·È‰È¿ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˘ÔÏÔÁÈÛÙ¤˜ Î·È ¿ÏÏ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ì·ÁÓËÙfiʈÓÔ.

- ÃÙ›ÛÙ ¿Óˆ ÛÙȘ ‰˘Ó·ÙfiÙËÙ˜, ÙË ‰ËÌÈÔ˘ÚÁÈÎfiÙËÙ· Î·È Ù· ıÂÙÈο ÙÔ˘˜ ÛÙÔȯ›·. ∞˘Ù¿ Ù· ·È‰È¿ ¤¯Ô˘Ó ÔÏÏ¿ ÌÔÓ·‰Èο ٷϤÓÙ·. ∫·ÏÏÈÂÚÁ›ÛÙ ÙȘ ÈηÓfiÙËÙ¤˜ ÙÔ˘˜ Î·È ı· Û·˜ ÂÎÏ‹ÍÔ˘Ó ·ÚÁfiÙÂÚ· ÛÙË ˙ˆ‹. µÈ‚ÏÈÔÁÚ·Ê›· 1. Barkley RA. Attention deficit hyperactivity disorder. A handbook for diagnosis and treatment. New York: Guilford Press; 1990.

2. Cantwell DP. Attention deficit disorder. A review of the past 10 years. J Am Acad Child Adolesc Phychiat 1996;35:978-987.

3. Denckla MB. Biological correlates of learning and attention: what is relevant to learning disability and attention-deficit hyperactivity disorder? J Developm Behav Pediatr 1996;17:114-119.

4. Rosenberg PB. Attention deficit. Pediatr Neurol 1991;7:397-405.

5. Shaywitz BA, Fletcher JM, Shaywitz SE. Defining and classifying learning disabilities and attention-deficit/hyperactivity disorder. J Child Neurol 1995;10 (Suppl 1):S50-7.

∞Ó·ÎÔ›ÓˆÛË ¶ÚÔ˜ fiÏ· Ù· ̤ÏË Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜

∫‡ÚÈÔÈ ™˘Ó¿‰ÂÏÊÔÈ, °È· Ó· ÌÔÚ¤ÛÂÈ Ë ÂÙ·ÈÚ›· Ì·˜ Ó· ÂÎÏËÚÒÛÂÈ ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ Î·È Ó· ηχ„ÂÈ ÙȘ ·Ó¿ÁΘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ fiÚÔ˘˜ ·fi ÙȘ Û˘Ó‰ÚÔ̤˜ ÙˆÓ ÌÂÏÒÓ Ù˘. ∏ ·ÓÂÍ·ÚÙËÛ›· Î·È Ë ·˘ÙÔÓÔÌ›· Ù˘ ¤¯Ô˘Ó Û·Ó ·˘ÙÔÓfiËÙË ÚÔ¸fiıÂÛË ÙËÓ ÔÈÎÔÓÔÌÈ΋ ·ÓÂÍ·ÚÙËÛ›· Ù˘ Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÙÔ ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›˜ (∂.¶.∂.) Ì ÁÚ·Ù‹ ˘fiÌÓËÛ‹ ÙÔ˘, ˙‹ÙËÛ ·fi Ù· ̤ÏË ÙÔ˘, Ì ÂÈÛÙÔϤ˜ Ô˘ ÙÔ˘˜ ·ˇı˘ÓÂ, ÙËÓ ÔÈÎÔÓÔÌÈ΋ ÙÔ˘˜ Ù·ÎÙÔÔ›ËÛË ÚÔÎÂÈ̤ÓÔ˘ Ë ∂Ù·ÈÚ›· Ì·˜ Ó· ÌÔÚ› ·˘ÙÔ‰‡Ó·ÌË Ó· ηχ„ÂÈ ÙȘ ‰·¿Ó˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ Î·È Ó· ÂȉÈÒÎÂÈ Ù˘ ÂÎÏ‹ÚˆÛË ÙˆÓ ÛÎÔÒÓ Ù˘. ∫‡ÚÈÔÈ ™˘Ó¿‰ÂÏÊÔÈ, ∆Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂.¶.∂. Û·˜ ηÏ› Ó· ·ÓÙ·ÔÎÚÈı›Ù ÛÙËÓ ¤ÎÎÏËÛË Ô˘ Û·˜ ·ˇı˘Ó ̤ۈ ÙˆÓ ˆ˜ ¿Óˆ ÂÈÛÙÔÏÒÓ.

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∂¶π™∆√§∂™ ∂ÈÛÙÔÏ‹ ÚÔ˜ ÙË ™‡ÓÙ·ÍË Dear Editor: I was deeply moved by the short note by Dr Christina Tsegi, which was published recently in "Paediatriki" (2000;63:339). I am one of the expatriates, trained by the late Professor Choremis, who have fond memories of those "old days". Certainly the first meeting of the Hellenic Pediatric Society in Thessaloniki in 1961 is unforgettable, being my first public presentation of a paper in front of an audience that I admired, respected and craved for their approval. Professors Choremis and Matsaniotis were there, as well as Drs Kassimos, Zannou, Danelatou-Athanassiadou and many others that I will not mention, not for lack of fond memories but only because the list would be too long. And, of course, I do not forget Drs Tsegi and Mavrou who have been very special to me; they introduced me to the laboratory technique that I used to measure serum SGOT and SGPT activity levels in diphtheritic myocarditis, which was the subject of my presentation at that first meeting. Deep in the darkened small rooms of the old Korgialenion building I spent many long nights in front of the spectrophotometer which Dr Tsegi had introduced me to, in the lonely company of Sultana who was near by, incubating throat cultures from the same children with diphtheria.

Memories of my past at "Agia Sophia" are constantly with me, perhaps more so as I grow older, because I know that it was there that I acquired the discipline, enthusiasm and love of knowledge that shaped my future.

I left a few months after that first meeting in Thessaloniki. Many years have gone by… Yet nothing is more dear to me than remembering the "on call" rooms I shared in sequence with Yannis Karpouzas, Christos Kattamis, Yannis Messaritakis and Haralambos Katerelos, all great academic teachers in later years. There are so many precious moments that I remember, so many old friends that touched my life.

I regret I can not express all this in my mother tongue. Yet feelings are the same in any language.

Sincerely, John C. Leonidas, M.D. Professor of Radiology and Pediatrics Albert Einstein College of Medicine New York, NY, USA

∞¿ÓÙËÛË Ù˘ ™‡ÓÙ·Í˘ Dear Professor Leonidas On behalf of the Editorial Board of "Paediatriki" I would like to thank you for your wonderful and touching letter to the Editor. I want to assure you that it will be published in full in the November-December issue of the journal.

We think of you very warmly an do hope that you will continue to communicate to us your suggestions, remarks and critical judgement regarding the contents and appearance of our journal which we plan to improve in the near future (January 2001). Our aim is to succeed in incorporating "Paediatriki" in the Index Medicus and hopefully, some day, get it listed in the SCI - Journal Citation Reports.

We wish you all the best, Sincerely yours Zoe Papadopoulou-Couloumbis, M.D Editor P.S. We would greatly appreciate your contribution to "Paediatriki" by writing (in English) an Editorial or a Review article on a subject of your choice.

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∂˘¯·ÚÈÛٛ˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ Ù˘ «¶·È‰È·ÙÚÈ΋˜» ∏ ¢È‡ı˘ÓÛË Î·È Ù· ̤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ¢¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ «¶∞π¢π∞∆ƒπ∫∏» Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ ›ڷ Î·È ÙÔ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜, ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2000.

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¶ ¶¿ÓÔ˘ ¡ÈÎfiÏ·Ô˜ ¶·ÓÙÂÏÈ¿‰Ë˜ ÃÚ‹ÛÙÔ˜ ¶·ÓÙÛÈÒÙÔ˘ ∫˘Ú·ÙÛԇϷ ¶··‚·ÛÈÏ›Ԣ µ·Û›ÏÂÈÔ˜ ¶··‚·ÛÈÏ›Ԣ ∫˘ÚÈ¿ÎÔ˜ ¶··ÁˆÚÁ›Ô˘ £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··ÁÚËÁÔÚ›Ô˘-£ÂÔ‰ˆÚ›‰Ô˘ ª·Ú›· ¶··‰¿ÎË ª·Ú›Ó·

430 50 38 322 150 302, 490 236 421 150 47 287,309,421 47 50 391 478 499 375 220 412 167 440 191 150 27 292,356,382

292,382 27 6 163 156 322 243

440 38,412 447 440 440 60 55 87 330

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38 268,322

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309 137,213 534 483 418 137 47 534 529 524 170 213 287 314 319 47 220 43 353 319

549

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43 430

418 437 60 145 499 137 437 21 292,382 60,101,103 309 275

129

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426 50 309 38 129 50,314 47 483

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π πÏ·Ú¿ πÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· πÛÙÈÔ΢ÙÙ¿ÚˆÛË

150,231 322 418

∫ ∫·ÎÔ‹ıË ÓÔÛ‹Ì·Ù· ∫·ÏÔ‹ı˘ ÔÛÙÈÎfi˜ fiÁÎÔ˜ ÙÔ˘ ÎÚ·Ó›Ô˘ ∫·ÚΛÓÔ˜ ∫·Ù¿ıÏÈ„Ë ∫·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ ∫·Ù·ÏËÍ›· ∫·Ù·ÛÙÔÏ‹ ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ∫ÂÊ·Ï·ÏÁ›· ∫ÂÊ·Ï·ÏÁ›· Ù¿Ûˆ˜ ∫Ï›‰· ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ∫ÔÎÎÈÒÌ·Ù· ‹·ÙÔ˜ ∫Ú›ÛÈÌË ÓfiÛÔ˜ ∫‡ËÛË - ‰È·ÎÔ‹ ∫‡ÚÔ˜ ∫‡ÛÙË ˆÔı‹Î˘ ∫˘ÛÙÈ΋ ›ÓˆÛË ∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ ∫˘ÙÙ·ÚÔÂӛ˜

121 236 101 225 292 382 145 326 197 205 440 38 9 292,356 490 137 538 322 326 101

551

§ §ÂÌÊ·‰ÂÓ›Ùȉ· §ÂÙ›ÓË §ÔÈÌÒÍÂȘ §Ô›ÌˆÍË ·fi ª˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜

314 213 101 43

ª ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ªÂÙ·‚ÔÏÈ΋ ÔͤˆÛË ªÂÙ·ÁÁ›ÛÂȘ ªÂÙ·ÏÏ¿ÍÂȘ ªËÓÈÁÁ›Ùȉ· ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ªÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ªÔÚÊ·›· ª˘ÂÏÈ΋ ·ÓÂ¿ÚÎÂÈ· ª˘ÂÏÔ‰˘ÛÏ·Û›· ª˘ÔηډÈÔ¿ıÂÈ· ª˘ÔÛÊ·ÈÚÈÓÔ˘Ú›·

326 319 34 483 421 382 382 231 292 433 470 470 101 529

¡ ¡·˚ÛÛ¤ÚÈ· ÌËÓÈÁÁ›Ùȉ·˜ ¡ÂÔÁÓ¿, ÓÂÔÁÓfi ¡ÂÔÁÓÈÎfi ÂÍ¿ÓıËÌ· ¡ÂÊÚÔÏÈı›·ÛË ¡ÂÊÚ·Û‚¤ÛÙˆÛË ¡ÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ¡fiÛÔ˜ Pompe ¡Ô˘ÎÏÂÔÙ›‰È·

382 34,156,302,483,534 418 524 524 47 421 243

√ √ÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ √Í›· ·ÁÎÚ·ٛÙȉ· √ÚÌfiÓ˜ ÂÙÈÎÔ‡ √˘ÚÈ΋ ÓÂÊÚÔÏÈı›·ÛË

356 47 408 524

¶ ¶·ÁÎÚ·ÙÈο ¤Ó˙˘Ì· 322 ¶·È‰›, ·È‰È¿ 367 ¶·È‰È¿ 27,137,145,391 ¶·È‰È·ÙÚÈ΋ ‚ÚÔÁ¯ÔÛÎfiËÛË 375 ¶·È‰›·ÙÚÔÈ 225 ¶·È‰È΋ ËÏÈΛ· 121,330,461 ¶·È‰È΋ ·¯˘Û·ÚΛ· 507 ¶·Ú¿ÁÔÓÙ˜ ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ 447 ¶·Ú¿ÁÔÓÙ˜ ‹Íˆ˜ 287 ¶·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜ 9 ¶¿ÚÂÛË ÚÔÛˆÈÎÔ‡ 43

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:550-552

¶·¯˘Û·ÚΛ· ¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ¶Ó¢ÌÔÓ›· ¶Ó¢ÌÔÓÔ¿ıÂÈ· ¶ÔÏ›Ù˘ ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ¶ÚÔÁÚ¿ÌÌ·Ù· ÂÌ‚ÔÏÈ·ÛÌÒÓ ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ¶ÚÔʇϷÍË ¶ÚfiˆÚ· ‰›‰˘Ì· ÓÂÔÁÓ¿ ¶ÚfiˆÚÔ ÓÂÔÁÓfi ¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ƒ ƒ·‚‰ÔÌ˘fiÏ˘ÛË ƒ·¯›Ùȉ· ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ‚ÈÙ·Ì›ÓË D- Ù‡Ô˘ I ƒÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË ™ ™·ÏÌÔÓ¤ÏÏ· ™Ë„·ÈÌ›· ™›ÙÈÛË ÓÂÔÁÓÒÓ ™ÎÏËÚfi‰ÂÚÌ· ™·ÛÙÈÎfiÙËÙ· ™ÔÁÁ҉˘ ÓÂÊÚfi˜ ™˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ· ™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· ™˘ÁÁÂÓ‹˜ „¢‰¿ÚıÚˆÛË ™‡Ó‰ÚÔÌÔ Gilbert ™‡Ó‰ÚÔÌÔ Kostmann ™‡Ó‰ÚÔÌÔ Turner ™ˆÏËÓ·Úȷ΋ ÔͤˆÛË

137,213,507 408 231 101 97 220 150 391 170 437 437 170

529 426 292

529 483 408 433 412 524 156 55 440 21 478 278,499 34

∆ ∆ÂÏÈÎfi ·Ó¿ÛÙËÌ· ∆¯ÓÈΤ˜ ¯·Ï¿ÚˆÛ˘

278 205

À ÀÂÚ‚·ÚÈÎfi Ô͢ÁfiÓÔ ÀÂÚ˯ÔηډÈÔÁÚ·Ê›· ÀÂÚˆÛÌÔÙÈÎfiÙËÙ· ÀÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ÀÔıÚ„›· ÀÔÙÚÔ¤˜

519 319 430 220 356 170

º º·ÈÓfiÙ˘Ô˜ 21,499 º¿Ú̷η ËÌÈÎÚ·Ó›·˜ 205 ºÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ 121 º‡ÏÔ 213 º˘Û·ÏȉԂϷÙȉ҉˜ ÓÂÔÁÓÈÎfi ÂÍ¿ÓıËÌ· 418 à ÿÛÌ· ·ÓÈfiÓÙˆÓ ÃÂÈÚÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ÃÈÙÔÙÚÈÔ˙ȉ¿ÛË ÃÚfiÓÈ· ˘ÂÚÓ·ÙÚÈ·ÈÌ›· ÃÚˆÌÔÛˆÌȷ΋ ·Ó¿Ï˘ÛË Ã˘ÏÔ˘Ú›·

34 440 309 430 496 163

552

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30-05-03

17:43

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¶PO™EXH ™YNE¢PIA 19-21 π·ÓÔ˘·Ú›Ô˘

1Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ ¶ÏËÚÔÊÔڛ˜: ∆Ô˘Ú. & ™˘Ó ¢π∫∆À√/∂æπ§√¡ ∆ËÏ.: 01 7254 360-2 Fax: 01 7454 363 e-mail: epsilonB@hol.gr

Holiday Inn, ∞ı‹Ó·

2-4 ºÂ‚ÚÔ˘·Ú›Ô˘

First World Congress on the Fetal Origins of Adult Disease ¶ÏËÚÔÊÔڛ˜: Ms Alifiya Motiwala Tel.: +91 22 651 6439 Fax: +91 22 6516438 e-mail: mrcssc@vsnl.com website: www.sneha-india.org

Bombay, India

10-11 ºÂ‚ÚÔ˘·Ú›Ô˘

International Symposium on the West Syndrome and Related Infantile Epileptic Encephalopathies (ISWS) ¶ÏËÚÔÊÔڛ˜: Yukio Fukuyama Secretariat, ISWS C/o Child Neurology Institute Samban-cho TY Plaza, SFL 24 Samban-cho, Chiyoda-Ku Tokyo 102-0075 Japan Tel.: +81 3 3238 1580 Fax: +81 3 3238 1502 e-mail: yfukuyam@sc4.so-net.ne.jp

Tokyo, Japan

8-10 ª·ÚÙ›Ô˘

4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ ¶ÏËÚÔÊÔڛ˜: ∂æπ§√¡ ∆ËÏ.: 01 7254 360-2 Fax: 01 7254 363 e-mail: epsilonb@hol.gr

Holiday Inn, ∞ı‹Ó·

26-28 ª·ÚÙ›Ô˘

European Society for Pediatric Infectious Diseases (ESPID) Secretariat: PO Box 50006 Tel Aviv 61500, Israel Tel.: +972 3 5140000 Fax: +972 3 51 40077 e-mail: espid2001@kenes.com website: http://www.kenes.com/espid2001

Eilat, Israel

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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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™˘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 )

xiii

Combining prefixes T G M k h da d c m Ì n p f a