E•øº.¶AI¢.TEL. noe-dek
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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA
ANA™KO¶H™H 447 °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ 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·ÌԇϷ˜, Z. ¶··‰ÔÔ‡ÏÔ˘-KÔ˘ÏÔ˘Ì‹
529 ƒ·‚‰ÔÌ˘fiÏ˘ÛË Û ·È‰› Ì ÔÍ›· Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Salmonella
™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘
●
TEYXO™ 6
●
ETO™ 2000
ISSN 0377-2551
470 ∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È Ì˘ÂÏÔ‰˘ÛÏ·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› ·ÈÌÔÔÈËÙÈÎÔ› ·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˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (rhG-CSF) ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›· ∫. ™·Ú·Ê›‰Ë˜, µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, Ã. ∞Á·Î›‰Ë˜, ¶. ¶··Î˘ÚȷΛ‰Ô˘, ∞. ∞ı·Ó·Û›Ô˘, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜
490 ¶Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÈÛ‹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 ∞ÈÌÔÂÚÈÙfiÓ·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›˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶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 ∏ ›‰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
Hellenic Paediatric Society
¡O∂ªµƒπO™-¢∂∫∂ªµƒπO™ 2000
●
TOMO™ 63
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TEYXO™ 6O
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¶AI¢IATPIKH TfiÌÔ˜ 63, T‡¯Ô˜ 6Ô ¡ÔÂÌ.-¢ÂÎ. 2000
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·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó·È 115 28
Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28
TËÏ:. (01) 7771 140 / 7771 663, Fax: 7758 354
Tel. (01) 7771 140 / 7771 663, Fax: 7758 354
EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∫. ª·Ï·Î¿ ¢È¢ı˘ÓÙ‹˜ : ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ : °. µ·ÚÏ¿Ì˘ : ¶. ∫·ÊÚ›ÙÛ· : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ : £. ∆ÛÈÏÈÁÈ¿ÓÓ˘ : ∫. ∆ÛÔ˘Ì¿Î·˜ : ™. ºˆÙfiÔ˘ÏÔ˜ : A. ÷Ù˙‹˜
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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
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Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: (01) 7771 140, Fax: 7758 354
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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
¶EPIEÃOMENA
CONTENTS ™ÂÏ.
O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜
vii
ANA™KO¶H™H
Page
Instructions for Authors
vii
REVIEW ARTICLE
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ 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˘¯ÚÔÓÔÔ‡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‰˘ÛÏ·Û›· ∞. ¶Ô˘ÚÙÛ›‰Ë˜
461
Aplastic syndromes and myelodysplasia 470
∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·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˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (rhG-CSF) ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿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˘, °. ∫ÚÂÌÂÓfiÔ˘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΋ ÂÈÛ‹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
∏ ›‰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·ÌԇϷ˜, Z. ¶··‰ÔÔ‡ÏÔ˘-KÔ˘ÏÔ˘Ì‹
524
™˘Ó¯›˙ÔÓÙ·È
A. Drougia, K.D. Kollios, I. Siondi, K. Tsampulas, Z. Papadopoulou-Couloumbis
524
Continued
iii
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·8
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
∞ÈÌÔÂÚÈÙfiÓ·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›˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶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 ÙÚÔÔÔÈËı›. ¶·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 ÂÈÛÙËÌÔÓÈ΋ ¤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 ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, ›ηÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘Â˜ 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΋˜ Âη›‰Â˘Û˘ Î·È ˘Á›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›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 EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi 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 ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. µ. ÀÔ‚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 ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· 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∫◊". ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹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 ÂÎÚÔÛÒˆÓ 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˘˜ ÂÈÙÚ¤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˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ 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 ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ÂÙ¿ (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 ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·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˘ÌÂÚÈÏ·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 ‰ÈÏfi ‰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 ÂȉÔÙ‹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˘.
vii
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
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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· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ 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 ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ 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 ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›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˘ÌÂÚ¿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˜ ÂÚÈÙÒÛÂȘ ¤¯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· ¯ÚËÛÈÌÔÔÈËıÔ‡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·Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤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˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ 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 ÂȉÔÙ‹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·Ô̤˜. 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 ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›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·Ô̤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ 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·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ 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·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·, ·ÚfiÓ Î·È Ì¤ÏÏÔÓ: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È-
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‰È·ÙÚÈ΋ 1996;59:272-279. Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi 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 ˘ÂÚÏÈȉ·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. Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract]. J Am Soc Nephrol 1991;2:562. Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701. 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˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡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 ÂÂÍ‹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 ÔÔ›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: - ÂÈÛÙÔÏ‹ ˘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 ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ¢¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¡ÙÔ˘ÓÙÔ˘Ï¿Î˘ π. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂڷ›· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ·È‰È¿ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.
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● ¶ÂÚ›ÏË„Ë: √ ¿ÓıÚˆÔ˜ ¿Ú¯ÈÛ οÔÙ 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 Ôԛ˜ ÚÔ‹Ïı·Ó. ∆ÔÓ ÙÂÏÂ˘Ù·›Ô ·ÈÒÓ· ÂÓÙ·ÙÈÎÔÔÈ‹ıËÎÂ Ë Î·ÏÏȤÚÁÂÈ· Ì ÂÈÏÔÁ‹ 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 ÂÈÏÂÁÌ¤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 ÔÔ›ÔÈ ÂÚȤ¯Ô˘Ó DNA 2-3 ÂÈı˘ÌËÙÒÓ ÁÔÓȉ›ˆÓ, ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯ÂÈ ÂÈÏÂÁ› Ù˘¯·›·. ∏ ·Ú·ÁˆÁ‹ ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤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· οÔÈÔ˘ 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˘˜ ÔÔ›Ô˘˜ Ù· 3/4 ˘ÔÛÈÙ›˙ÔÓÙ·È. O ÏËı˘ÛÌfi˜ Ù˘ Á˘ ı· ‰ÈÏ·ÛÈ·Ûı› Ù· ÂfiÌÂÓ· 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· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛˆÛÙ¿ Î·È Ó· ˘ËÚÂÙ› ÙËÓ ·ÓıÚˆfiÙËÙ·. ¶·È‰È·ÙÚÈ΋ 2000;63:447-459. §¤ÍÂȘ ÎÏÂȉȿ: ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ 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. °ÂˆfiÓÔ˜, π·ÙÚfi˜ ∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›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 ¿ÓıÚˆÔ˜ ·fi ÙfiÙ Ԣ ¿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 Ôԛ˜ 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 ÂÈ‚Ï·‚›˜, ·ÏÏ¿ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi Â›Ó·È ¯Ú‹ÛÈ̘ Î·È ˆÊ¤ÏÈ̘ ÛÙÔ Ê˘Ùfi Î·È ‰È·ÈˆÓ›˙ÔÓÙ·È ·Ó ÂÈÏÂÁÔ‡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 ¿ÓıÚˆÔÈ 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 ¿ÓıÚˆÔ˜ ¤¯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·ÌfiÎÈ Î·È Ô Î·Ófi˜, ¤ÁÈÓ·Ó ÁÓˆÛÙ¿ ÌÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë Ù˘
448
·ÌÂÚÈοÓÈ΢ Ë›ÚÔ˘, fiÔ˘ ·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 ¿ÓıÚˆÔ Ì›· ·Ó·Î¿Ï˘„Ë, fiÙÈ ‰ËÏ·‰‹ ÔÈ ÛfiÚÔÈ ÌÔÚÔ‡Ó Ó· Û·ÚÔ‡Ó Î·È Ó· ·Ú¿ÁÔ˘Ó Ê˘Ù·, fiÔ˘ Î·È fiÙ·Ó ·˘Ùfi˜ ‹ıÂÏÂ. ∞ÏÏ¿ Ë Û˘ÛÙËÌ·ÙÈ΋ ÁˆÚÁ›· ηٷӷÏÒÓÂÈ ÂÚÈÛÛfiÙÂÚË ÂÓ¤ÚÁÂÈ· ·’ fi,ÙÈ ·Ú¿ÁÂÈ. O ¿ÓıÚˆÔ˜ Ú¤ÂÈ Ó· ÂÚÁ·Ûı› ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÁÈ· Ó· ·Ú¿ÁÂÈ ÙÚfiÊÈÌ·, ·’ fi,ÙÈ ·Ó Ì¿˙¢ ηÚÔ‡˜ ·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 ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ (·-
∂ÈÎfiÓ· 1. O ‚·ÛÈÏÈ¿˜ Ù˘ ∂ÏÂ˘Û›Ó·˜ ∆ÚÈÙfiÏÂÌÔ˜ ¤Ï·‚ ·fi ÙËÓ ı¿ ¢‹ÌËÙÚ· ÛÙ¿¯˘· ÁÈ· Ó· ‰È‰¿ÍÂÈ ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙˆÓ ‰ËÌËÙÚÈ·ÎÒÓ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜.
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·15
¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·
ٿٷ), ÔÈ ÔÊı·ÏÌÔ› ÙÔ˘˜ ÌÔÚÔ‡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· ›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‡, ÙÚÔÔÔÈ‹ıËÎ·Ó ÂÍÂÏÈÎÙÈο Û ÔÚÈṲ̂ӷ Ê˘Ù¿. ÒÛÙ ӷ ·Ú¿ÁÔ˘Ó ÛfiÚÔ ·ÚıÂÓÔÁÂÓÂÙÈο (·Á·ÌÔÛÂÚÌ›·) .¯. ÔÚÙÔοÏÈ· ª¤ÚÏÈÓ. O ÂÁÁÂÓ‹˜ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Â›Ó·È Ô Û˘ÓËıÈṲ̂ÓÔ˜ ÙÚfiÔ˜ ·Ó··Ú·ÁˆÁ‹˜ ÙˆÓ ·ÓˆÙ¤ÚˆÓ Ê˘ÙÒÓ Î·Ù¿ ÙÔÓ ÔÔ›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 ÂÈÏÂÁ̤Ó˜ ÂÎÏÂÎÙ¤˜ ÔÈÎÈϛ˜ Ê˘ÙÒÓ Ô˘ ¤¯Ô˘Ó Ù· ÂÈı˘ÌËÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÁÈ· ÙÔ˘˜ ηٷӷψ٤˜. ™˘Á¯ÚfiÓˆ˜, ÌÂÈÒıËÎÂ Ë Î·ÏÏȤÚÁÂÈ· ·˘ÙÔÊ˘ÒÓ ÔÈÎÈÏÈÒÓ. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ê˘ÙÈΤ˜ ÔÚÌfiÓ˜ (ÁÈ‚‚ÂÚÈϛӘ) Ô˘ ÂÈÙ·¯‡ÓÔ˘Ó ÙËÓ ·‡ÍËÛË Î·È ÙËÓ ¿ÓıÈÛË, Î·È Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡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˘ ÂÈÎÔÓÈ¿˙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 ÂÎχÓÔÓÙ·È ·fi ÙÔ ¤‰·ÊÔ˜, ÂÓÒ Ù· Ê˘Ù¿ (ÏËÓ ÙˆÓ „˘¯·ÓıÒÓ) ‰ÂÓ ÌÔÚÔ‡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΋ ηٷÔϤÌËÛË ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Ì¤ıÔ‰Ô ·ÓÙÈÌÂÙÒÈÛ˘ ÌÂ-
∞ÙÌÔÛÊ·ÈÚÈÎfi ¿˙ˆÙÔ
µÈÔÌ˯·ÓÈ΋ ‰¤ÛÌ¢ÛË
µÈÔÏÔÁÈ΋ ‰¤ÛÌ¢ÛË ¡ÈÙÚÔÁfiÓ· ‚ÚÔ¯‹˜
∞¤ÚÈÔ ¿˙ˆÙÔ µÈÔÏÔÁÈΤ˜ ÂÎÎÚ›ÛÂȘ Î·È ÙÒÌ·Ù· ¡ÈÙÚÈο
¢¤ÛÌ¢ÛË ·fi ‚·ÎÙËÚ›‰È· Î·È Ì‡ÎËÙ˜
OÚÁ·ÓÈ΋ Ô˘Û›· Û ·ÔÛ‡ÓıÂÛË
¢¤ÛÌ¢ÛË ·ÂÚ›Ô˘ ·˙ÒÙÔ˘
∞Ì̈ÓÈÔÔ›ËÛË ∞ÒÏÂÈ· ÏfiÁˆ ¤ÎÏ˘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˜.
449
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™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 ¿ÓıÚˆÔ˜. ∫¿ı ¯ÚfiÓÔ ¯¿ÓÔÓÙ·È ‰Âο‰Â˜ ¯ÈÏÈ¿‰Â˜ ›‰Ë. ∏ ‚ÈÔÔÈÎÈÏfiÙËÙ·, ÚÔ˚fiÓ ÂͤÏÈ͢ ¯ÈÏÈ¿‰ˆÓ ÂÙÒÓ, ÌÂÈÒÓÂÙ·È Ì ·ÓÂͤÏÂÁÎÙÔ˘˜ Ú˘ıÌÔ‡˜. ÀÔÏ›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˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ηٷÔϤÌËÛË ÙˆÓ Â¯ıÚÒÓ Î·È ÙˆÓ ·ÛıÂÓÂÈÒÓ ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ, ÌÂٷʤÚÔÓÙ·È ÛÙËÓ ÙÚÔÊÈ΋ ·Ï˘Û›‰·. ™ÙÔ ÂÚÈ‚¿ÏÏÔÓ ·fi ÙËÓ ·‰È¿ÎÔË ¯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˜ ÂÈÙÒÛÂȘ ÛÙ· Ê˘Ù¿, Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ. ¶·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›Â‰Ô. ∂ÓÙ·ÙÈÎÔÔÈË̤ÓË ÂÎÙÚÔÊ‹ ˙ÒˆÓ Î·È ÂÈÙÒÛÂȘ ∆· ·ÓÙÈ‚ÈÔÙÈο ¯ÚËÛÈÌÔÔÈÔ‡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 ¿ÓıÚˆÔ. ∆· ˙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 ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 24 ÎÈÏ¿ ‚·ÓÎÔÌ˘Î›Ó˘ ·fi ÙÔÓ ¿ÓıÚˆÔ, ÂÓÒ 24.000 ÎÈÏ¿ ÙÔ˘ ›‰ÈÔ˘ ÁÏ˘ÎÔÂÙȉ›Ô˘ ·‚Ô·ÚΛÓË, ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÓ ÂÎÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ·ÓÙÈ‚ÈÔÙÈο ÛÙ· ˙Ò·, ·Ó·Ù‡ÛÛÔÓÙ·È ·ÓıÂÎÙÈÎÔ› ÏËı˘ÛÌÔ› Û·ÏÌÔӤϷ˜ Ô˘ ‰ÂÓ ÚÔηÏÔ‡Ó fï˜ Ù‡ÊÔ. ∏ ÊÏÔ˘ÔÚÔÎÈÓÔÏfiÓË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· Ô˘ÏÂÚÈο, ÁÈ· ·‡ÍËÛË Ù˘ ·fi‰ÔÛ˘ ÛÙÔ ÎÚ¤·˜. µÚ¤ıËÎÂ Î·Ì˘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·ÓıÚÒÔ˘˜ Ì ‰È¿ÚÚÔÈ·. ∏ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ Î·Ì˘ÏÔ‚·ÎÙËÚȉ›Ô˘ ÛÙËÓ ÎÈÓÔÏfiÓË, ‹Ù·Ó ¿ÁÓˆÛÙË ÛÙÔÓ ¿ÓıÚˆÔ, ÚÔ Ù˘ ¯Ú‹Ûˆ˜ Ù˘ ÎÈÓÔÏfiÓ˘, ÛÙËÓ ÂÎÙÚÔÊ‹ ÙˆÓ Ô˘ÏÂÚÈÎÒÓ. ™ÙËÓ ∂ӈ̤ÓË ∂˘ÚÒË Ë ¯Ú‹ÛË Ù˘ ·‚Ô·ÚΛÓ˘ ··ÁÔÚ‡ıËΠÙÔ 1997, ·ÏÏ¿ Ë Ù˘ÏÔÛ›ÓË Î·È Ë ‚ÈÚÁÈÓÈ·Ì˘Î›ÓË ·ÎfiÌË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È. O˘Û›Â˜ Ô˘ ÂÈÙÚ¤ÂÙ·È Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ·‡ÍËÛË ÙˆÓ ˙ÒˆÓ ÛÙËÓ ∂ӈ̤ÓË ∂˘ÚÒË, Â›Ó·È Ù· ÂÙȉÈο ·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 ¯ÚËÛÈÌÔÔÈÂ›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· ¯ÚËÛÈÌÔÔÈÔ‡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¿ ·˘ÙÔÁÔÓÈÌÔÔÈÔ‡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 ‰ÈÏ·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 ‰ÈÏ¿ÛÈÔ ·ÚÈıÌfi ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Î·È ‰ËÌÈÔ˘ÚÁ› ÌÈ· ηÈÓÔ‡ÚÁÈ· ÔÈÎÈÏ›· Ô˘ Â›Ó·È ÈηӋ Ó· ‰ÒÛÂÈ ·ÔÁfiÓÔ˘˜ (ÛfiÚÔ˘˜) 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 ÙÚÈÏÔÂȉ¤˜ ηÚÔ‡˙È ‰ÂÓ ¤¯ÂÈ ÛfiÚÔ˘˜ Î·È ‰›ÓÂÈ Î·Ï‡ÙÂÚË Û¿Úη. ∞ÚÎÂÙ¤˜ ÔÈÎÈϛ˜ ÌËÏÈ¿˜ Î·È ·¯Ï·‰È¿˜ Â›Ó·È ÙÚÈÏÔÂȉ›˜, Î·È ‰È·ÎÚ›ÓÔÓÙ·È ·fi ÙÔ˘˜ η΋˜ ÔÈfiÙËÙÔ˜ ÛfiÚÔ˘˜ ÙÔ˘˜. OÈ ÙÚÈÏÔÂȉ›˜ ηÚÔ› ¤¯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˜ ÂÌÔÚÈο ÔÈÎÈϛ˜ Ì·Ó¿Ó·˜ Â›Ó·È ÔÈ ÙÚÈÏÔÂȉ›˜. ∏ ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ÛfiÚˆÓ 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·ÌfiÎÈ. ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ô˘ Ô‰ËÁÔ‡Ó Û ¿ÓÈÛÔ ‰È·¯ˆÚÈÛÌfi. ™ÙÔÓ ˘Ú‹Ó· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÌÔÚ› 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 ‰ÈÏ·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 ‰ÈÏÔÂȉ‹ ˘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. ∏ ÂÈÙ˘¯›· 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 ÂÈ˙‹ÌȘ, ·ÏÏ¿ ÌÂÚÈΤ˜ ‚ÂÏÙÈÒÓÔ˘Ó ÙȘ ÔÈÎÈϛ˜ ÙˆÓ ˘·Ú¯fiÓÙˆÓ ÂȉÒÓ. O ¿ÓıÚˆÔ˜ ·Ó¿ ÙÔ˘˜ ·ÈÒÓ˜ ÂÈϤÁÂÈ Î·È Î·ÏÏÈÂÚÁ› ÙȘ ÔÈÎÈϛ˜ Ô˘ Â͢ËÚÂÙÔ‡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 Ôԛ˜ ¤¯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 ÂÈÌË΢Ṳ̂ÓÔ˜ ‚Ï·ÛÙfi˜ Î·È Ù· Ó·ڿ ʇÏÏ·. ∆· Ï¿¯·Ó· fiˆ˜ Â›Ó·È Û‹ÌÂÚ·, ¿Ú¯ÈÛ·Ó Ó· ηÏÏÈÂÚÁÔ‡ÓÙ·È ·fi ÙÔÓ 12Ô ·ÈÒÓ·, ÚÔÊ·ÓÒ˜ ÏfiÁˆ οÔÈ·˜ Ê˘ÛÈ΋˜ ÌÂÙ¿ÏÏ·Í˘. ∏ ÔÈÎÈÏ›· ÌÈ˙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 ÔÔ›· 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 ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ, ÁÈ·Ù› ÂÚȤ¯ÂÈ ¤Ó· ·ÏηÏÔÂȉ¤˜ Û ÌÂÁ¿ÏË ÔÛfiÙËÙ·, Ô˘ ‰›ÓÂÈ ÛÙ· ʇÏÏ· Î·È ÛÙÔ˘˜ ÛfiÚÔ˘˜ 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›· ›ÔÓË Î·È ÂÈÏÂÎÙÈ΋ 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 ÚˆÙÔÏ¿ÛÙ˜ Î·È ·ÔÚÚÔÊÔ‡Ó ÌÂÁ¿Ï· ÌfiÚÈ· ‹ ÌÔÚÔ‡Ó Ó· Û˘ÓÂÓˆıÔ‡Ó ‰‡Ô ·ÙÙ·Ú· (Û‡ÓÙËÍË ÚˆÙÔÏ·ÛÙÒÓ). ∂›Ó·È ‰˘Ó·Ù‹ Ë Û‡ÓÙËÍË ÚˆÙÔÏ·ÛÙÒÓ ·fi ‰È·ÊÔÚÂÙÈο ›‰Ë ‹ Î·È Á¤ÓË Î·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ۈ̷ÙÈÎÒÓ ˘‚Úȉ›ˆÓ. ŸÙ·Ó ηÏÏÈÂÚÁËıÔ‡Ó Û ηٿÏÏËÏÔ ıÚÂÙÈÎfi ‰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-
451
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·18
¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459
∫. ¶·ÓÙÛÈÒÙÔ˘
ÕÁÚÈÔ ÛÈÙ¿ÚÈ OÈ ÛfiÚÔÈ ·Ô¯ˆÚ›˙ÔÓÙ·È Â‡ÎÔÏ·
ÕÁÚÈÔ ÛÈÙ¿ÚÈ §Â›· ÂÈÊ¿ÓÂÈ· ∂‡ÎÔÏÔ˜ ·Ô¯ˆÚÈÛÌfi˜ ÛfiÚÔ˘
™fiÚÔ˜ ƒ¿¯Ë ∂ÍËÌÂڈ̤ÓÔ ÛÈÙ¿ÚÈ
∆Ú·¯Â›· ÂÈÊ¿ÓÂÈ· ∂ÍËÌÂڈ̤ÓÔ ÛÈÙ¿ÚÈ
¢‡ÛÎÔÏÔ˜ ·Ô¯ˆÚÈÛÌfi˜ ÛfiÚÔ˘
∂ÈÎfiÓ· 5. ∆Ô ¿ÁÚÈÔ ÛÈÙ¿ÚÈ Î·ÏÏÈÂÚÁ›ÙÔ fiÙ·Ó ÙÔ ·ÏÒÓÈÛÌ· ÁÈÓfiÙ·Ó Ì ڈÙfiÁÔÓ· ̤۷ Î·È Ô ÛfiÚÔ˜ ·Ô¯ˆÚÈ˙fiÙ·Ó Â‡ÎÔÏ· ·fi Ù· ¿Á·Ó·. ∆Ô ÂÍËÌÂڈ̤ÓÔ ÛÈÙ¿ÚÈ ÂÈϤ¯ıËΠÁÈ· ηÏÏȤÚÁÂÈ· fiÙ·Ó ÙÔ ·ÏÒÓÈÛÌ· ¿Ú¯ÈÛ ӷ Á›ÓÂÙ·È Ì˯·ÓÈο Î·È Ô ‰‡ÛÎÔÏÔ˜ ·Ô¯ˆÚÈÛÌfi˜ ÙÔ˘ ÛfiÚÔ˘ ·‡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· ¯ÚËÛÈÌÔÔÈÔ‡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· οÔÈÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÂÍ¿ÁÔÓÙ·È Î·È ÂÈÛ¿ÁÔÓÙ·È Û ·ÙÙ·Ú· ‰È·ÊÔÚÂÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Ì ·ÚÎÂÙ‹ ÂÈÙ˘¯›· Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ¤Ó·˜ Ó¤Ô˜ ÁÂÓÂÙÈο ÌÂÙ·ÏÏ·Á̤ÓÔ˜ (‹ ÙÚÔÔÔÈË̤ÓÔ˜) 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˘˜ ÛfiÚÔ˘˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ Ê˘ÙÒÓ. OÈ ÂÙ·Èڛ˜ Ô˘ ˆÏÔ‡Ó ÙÔ˘˜ ÛfiÚÔ˘˜ ‰È·ÁÔÓÈÎÒÓ Ê˘ÙÒÓ ÂϤÁ¯Ô˘Ó ÙËÓ ¿ÓıÈÛË Î·È ÙËÓ Î·ÚÔÊÔÚ›· 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 Ôԛ˜ 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¿ ¯ÚËÛÈÌÔÔÈÔ‡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˘ ÌÔÚÔ‡Û ӷ Îfi„ÂÈ ÙÔ ÌfiÚÈÔ ÙÔ˘ DNA ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÛËÌ›· (ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ). ∆· ÙÌ‹Ì·Ù· ÙÔ˘ DNA Ô˘ ÚÔ¤Î˘Ù·Ó ‹Ù·Ó ·ÚÎÂÙ¿ ÌÂÁ¿Ï· ÒÛÙ ӷ ÂÚȤ¯Ô˘Ó ÁÂÓÂÙÈΤ˜
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·19
¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459
ÏËÚÔÊÔڛ˜. ∏ ·Ó·Î¿Ï˘„Ë Ô‰‹ÁËÛ ÛÙË ‰˘Ó·ÙfiÙËÙ· Û¯ËÌ·ÙÈÛÌÔ‡ ÙÌËÌ¿ÙˆÓ DNA Ô˘ ÌÔÚÔ‡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‹ ÂÈı˘ÌËÙÒÓ ÁÔÓȉ›ˆÓ ÛÙ· ˙Ò· (‰È·ÁÔÓÈο ˙Ò·) ‹ Ì ‰ËÌÈÔ˘ÚÁ›· ÙÚÔÔÔÈËÌ¤ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (ÂÈÛ¿ÁÔÓÙ·È ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È·) ·Ú¿ÁÔÓÙ·È Û ÌÂÁ¿ÏË ÔÛfiÙËÙ· ˘„ËÏ‹˜ ηı·ÚfiÙËÙ·˜ ÔχÙÈÌ· ÚÔ˚fiÓÙ· fiˆ˜ ¤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΋ ıÂڷ›·. ø˜ ·Ú¿ÁÔÓÙ˜ ÌÂÙ·ÊÔÚ¿˜ ¯ÚËÛÈÌÔÔÈÔ‡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 ÙÔÔıÂÙÔ‡Ó Ù· ÂÈı˘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 ›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· ÏÈÔÛÒÌ·Ù· - fi¯È ÈÔ› ·ÏÏ¿ DNA ÂÂÓ‰˘Ì¤ÓÔ ÛÙ· ÏÈ›‰È· - ‰ÂÓ ÚÔηÏ› ÓfiÛÔ ·ÏÏ¿ ÌÂٷʤÚÂÈ ÁÔÓ›‰È· ÛÙ· ·ÙÙ·Ú·. ∆· ÙÔÔıÂÙ› Û ÌË ‰È·ÈÚÔ‡ÌÂÓ· ·ÙÙ·Ú· Î·È Ë ¤ÎÊÚ·Û‹ ÙÔ˘˜ ‰È·ÚΛ Ì·ÎÚÔ¯ÚfiÓÈ·. 1. ¶ÚÔ˚fiÓÙ· ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ÌÔÓÔ·ÙÙ·ÚÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜ ∆Ô ÂÈı˘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· ÔÔ›· ·Ú¿ÁÔ˘Ó Û ÂÌÔÚÈ΋ ÔÛfiÙËÙ· ÙÔ ÂÈı˘ÌËÙfi ÚÔ˚fiÓ. ∞fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘˜ ÌÔÓÔ·ÙÙ·ÚÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜, ·Ú¿ÁÂÙ·È ÙÔ ¤Ó˙˘ÌÔ ·-·Ì˘Ï¿ÛË Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ˙˘ıÔÔÈ›· Î·È ·ÚÙÔÔÈ›· ÁÈ· ÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿Û·ÛË ÙÔ˘ ·Ì‡ÏÔ˘ Û ÁÏ˘Îfi˙Ë, Ô˘
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ 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 ÙÚfiÔ ·Ú¿ÁÂÙ·È ÙÔ ¤Ó˙˘ÌÔ ËÎÙÈÓ¿ÛË, Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ˙‡ÌˆÛË ÙˆÓ ÛÙ·Ê˘ÏÈÒÓ, ÛÙËÓ ·Ú·ÁˆÁ‹ ¯˘ÌÒÓ ·fi ÊÚÔ‡Ù· Î·È ÛÙËÓ ÎÔÓÈÔÔ›ËÛË ÙˆÓ Î·ÚÒÓ 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˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ·ÚÙÔÔÈ›·, ÛÙËÓ ·Ï·ÓÙÔÔÈ›· Î·È ÛÙ· Á·Ï·ÎÙÔÎÔÌÈο ÚÔÈfiÓÙ·. OÈ ÚˆÙ½Ó˜ ‰È·ÛÒÓÙ·È Û ·ÌÈÓÔͤ· ÒÛÙ ÙÔ ÎÚ¤·˜, Ù· ·ÚÙÔÛ΢¿ÛÌ·Ù· Î·È Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· Á›ÓÔÓÙ·È Ï¤ÔÓ Â‡ÂÙ·. °È· ÙËÓ ·Ú·Û΢‹ ÙˆÓ Ù˘ÚÈÒÓ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ˘Ù›· Ô˘ Ï·Ì‚¿ÓÂÙ·È ·fi ÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Ó·ÚÒÓ ‚ÔÔÂȉÒÓ, ÌÂÙ¿ ÙË ÛÊ·Á‹ ÙÔ˘˜, ÂÂȉ‹ 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 ÙÚÔÔÔÈË̤ÓÔ˘˜ ˙˘ÌÔ̇ÎËÙ˜, ÔÈ ÔÔ›ÔÈ ·ÔÙÂÏÔ‡Ó Ï¤ÔÓ 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 ÙÚÔÔÔÈË̤ÓÔ˘˜ ˙˘ÌÔ̇ÎËÙ˜. 2. ¶ÚÔ˚fiÓÙ· ·fi ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ˙Ò· ∆Ô ÂÈı˘ÌËÙfi DNA ÂÈÛ¿ÁÂÙ·È Î·È ÂÓۈ̷ÙÒÓÂÙ·È ·Â˘ı›·˜ ÛÙÔ ¯ÚˆÌfiۈ̷ ÙÔ˘ ˙ˆÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ Ì ÌÈÎÚÔ¤ÓÂÛË. Œ¯Ô˘Ì ÌÂÁ·Ï‡ÙÂÚË ÂÈÙ˘¯›· fiÙ·Ó Ë ÌÈÎÚÔ¤ÓÂÛË Á›ÓÂÈ ÛÙÔ ˙˘ÁˆÙfi ·ÙÙ·ÚÔ, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ÁÔÓÈÌÔÔ›ËÛË ÙÔ˘ ˆ·Ú›Ô˘. °›ÓÂÙ·È ¤ÓÂÛË ·ÚÎÂÙÒÓ ÂηÙÔÌÌ˘Ú›ˆÓ ·ÓÙÈÁÚ¿ÊˆÓ ÙÔ˘ ÁÔÓȉ›Ô˘ ÛÙÔÓ ˘Ú‹Ó· ÙÔ˘ ÁÔÓÈÌÔÔÈË̤ÓÔ˘ 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· ÂfiÌÂÓ· ·ÙÙ·Ú· Î·È ˘¿Ú¯ÂÈ Û fiÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∞ÏÏ¿ Ë Ï¤ÔÓ 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 ÔÔ›Ô ÂÓۈ̷ÙÒÓÔÓÙ·È. OÈ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ÈÔ› ‰ÂÓ ¤¯Ô˘Ó ·ıÔÁfiÓ· ÁÔÓ›‰È· Î·È ¤¯Ô˘Ó Ù· ÂÈı˘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 ÌÔÚ› 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 ÙÚÔÔÔÈË̤ӷ ˙Ò· ÌÔÚÔ‡Ó Ó· ·Ú¿ÁÔ˘Ó ÔχÙÈ̘ Ê·Ú̷΢ÙÈΤ˜ Ô˘Û›Â˜ ÛÙÔ Á¿Ï· ÙÔ˘˜ ‹ Ù· Ô‡Ú· ÙÔ˘˜. ªÔÚ› Ó· ·Ú¿ÁÂÙ·È Á¿Ï· ¯ˆÚ›˜ ÙËÓ ÚˆÙ½ÓË Ô˘ ÚÔηÏ› ·ÏÏÂÚÁ›· ÛÙÔÓ ¿ÓıÚˆÔ, ‹ Á¿Ï· Ì ڈÙ½Ó˜ 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 ÂÈı˘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 ÂÈı˘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‡˜ ÛÎÔÔ‡˜. ŒÙÛÈ, ·Ú¿ÁÂÙ·È ·ÓıÚÒÈÓË ·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).
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¶Úfi‚·ÙÔ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ Û ÂÚÈÔ¯‹ ÛÙfi¯Ô
∂ÈÎfiÓ· 6. ∆ÚÔÔÔÈË̤ӷ 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 ·ÓıÚÒÈÓÔ 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‰ÈÎÔÔÈ› ÙËÓ ·ÓıÚÒÈÓË ·1-·ÓÙÈıÚ˘„›ÓË) ÂÈÛ¤Ú¯ÂÙ·È ÛÙ· ·ÙÙ·Ú· ÈÓÔ‚Ï·ÛÙÒÓ ÚÔ‚¿ÙÔ˘. ∆· ‰È·ÊÔÚÔÔÈË̤ӷ ·ٷڷ ÈÓÔ‚Ï·ÛÙÒÓ, ÚÔÙÈÌÒÓÙ·È ·fi Ù· ·‰È·ÊÔÚÔÔ›ËÙ· ·ÙÙ·Ú· ÙÔ˘ ÂÌ‚Ú˘ÔÓÈÎÔ‡ ÛÙ¤ÌÌ·ÙÔ˜, ÁÈ·Ù› ÌÔÚ› Ó· ÂÓÙÔÈÛı› 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· fiÔ˘ ı¤ÏÔ˘Ì ӷ ÂÎÊÚ¿˙ÂÙ·È Î·È Ë Í¤ÓË ÚˆÙ½ÓË. ∆Ô ÂÛˆÙÂÚÈÎfi ÚÈ‚fiۈ̷- ÛËÌÂ›Ô ÂÈÛfi‰Ô˘ (IRES), ÂÈÙÚ¤ÂÈ ÛÙÔ ·ÁÁÂÏÈÔÊfiÚÔ RNA Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙÔ Í¤ÓÔ ÁÔÓ›‰ÈÔ Ó· ÌÂÙ·ÊÚ¿˙ÂÙ·È Û ڈÙ½ÓË. ∆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 ÂÈÙ˘¯Ò˜ Ë ÂÈÛ·ÁˆÁ‹, ÂÎÊÚ¿˙ÂÙ·È ÙÔ Ó¤Ô ÁÔÓ›‰ÈÔ Î·È ÁÈ’ ·˘Ùfi ÌÔÚÔ‡Ó Ó· ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Û ıÚÂÙÈÎfi ˘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· ÂȂ‚·Èˆı› Ë ÂÈÙ˘¯‹˜ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ÂÚÈÔ¯‹ COL1A1. c) OÈ ˘Ú‹Ó˜ ·˘ÙÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÌÂÙ·ÊÔÚ¿ Û ˆ¿ÚÈ· ·fi Ù· ÔÔ›· ·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.
454
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·21
¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ 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˘˜ ÔÔ›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 ÙÚÔÔÔÈË̤ӷ 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˜, fiˆ˜ ·˘Í›ÓË Î·È Î˘ÙÔΛÓË Ô˘ ÚÔηÏÔ‡Ó ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡˜ fiÁÎÔ˘˜ (ηÚÎÈÓÒÌ·Ù·) ÙˆÓ Ê˘ÙÒÓ. ∞ÔÌ·ÎÚ‡ÓÔÓÙ·È Ù· ·ÓÂÈı‡ÌËÙ· ÁÔÓ›‰È· ·fi ÙÔÓ Èfi Î·È ÂΛ ÂÈÛ¿ÁÔÓÙ·È Ù· ÂÈı˘ÌËÙ¿ ÁÔÓ›‰È· (∂ÈÎfiÓ· 7). ∂Ó Û˘Ó¯›·, ÙÔ ÙÚÔÔÔÈË̤ÓÔ 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 ÂÈı˘ÌËÙfi ÁÔÓ›‰ÈÔ ÂÓۈ̷ÙÒÓÂÙ·È ÛÙÔ DNA ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È ¤ÙÛÈ ÂÈÙ˘Á-
EcoR1
EcoR1 D¡A §ÈÁ¿ÛË
Agrobacterium
∂ÈÎfiÓ· 7. ∆ÚfiÔ˜ ·Ú·ÁˆÁ‹˜ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘ Ê˘ÙÔ‡, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‚·ÎÙËÚ›‰ÈÔ ˆ˜ fi¯ËÌ· ÌÂÙ·ÊÔÚ¿˜.
455
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™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), ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë Ù¯ÓÔÏÔÁ›· particle-gum, fiÔ˘ ·fi Ù· ΢ÙÙ·ÚÈο ÙÔȯÒÌ·Ù· ÂÚÓÔ‡Ó ÌÈÎÚ¿ ÌÂÙ·ÏÏÈο ۈ̷ٛ‰È· Ì ÂÓۈ̷و̤ÓÔ ÙÔ DNA, Ù· ÔÔ›· ¤¯Ô˘Ó ÂÈÙ·¯˘ÓfiÌÂÓË Ù·¯‡ÙËÙ· ÌÂÚÈÎÒÓ ÂηÙÔÓÙ¿‰ˆÓ ̤ÙÚˆÓ ·Ó¿ ‰Â˘ÙÂÚfiÏÂÙÔ. ∏ ÂÈÙ˘¯‹˜ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ DNA ̤ۈ ÙÔ˘ ÈÔ‡ Agrobacterium Û ¤Ó· ·Ïfi Ê˘ÙÈÎfi ·ÙÙ·ÚÔ (ÚˆÙÔÏ¿ÛÙ˘) ÂÈϤÁÂÙ·È Î·È ÂÓ Û˘Ó¯›·, ·Ó·Ù‡ÛÛÂÙ·È Û ϋÚ˜ Ê˘Ùfi Û ηٿÏÏËÏÔ ıÚÂÙÈÎfi ˘ÏÈÎfi ÛÙ· ‰ÈÎÔÙ˘Ï‹‰ÔÓ· Ê˘Ù¿ (·Ù¿Ù˜, ÙÔÌ¿Ù·, ηÓfi˜, ‚·Ì‚¿ÎÈ) (15). ∂›Û˘, ·fi ÙÔ ÌÂÚ›Ûو̷ (ÎÔÚ˘Ê‹) ÂÓfi˜ ‰È·ÁÔÓÈÎÔ‡ Ê˘ÙÔ‡ ÌÔÚ› 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¤˜ ·ӷϋ„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 ÂÈı˘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 ÂÈı˘ÌËÙfi ÁÔÓ›‰ÈÔ ÂÓۈ̷ÙÒıËΠÛÙ· ÁÔÓ›‰È· ÙˆÓ Ê˘ÙÒÓ. ∆· ·ÓÙÈ‚ÈÔÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙ· Û˘ÛÙ‹Ì·Ù· Û‹Ì·ÓÛ˘, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ Î·Ù·ÔϤÌËÛË ÓfiÛˆÓ. ∆Ô ÁÔÓ›‰ÈÔ Î·ıÒ˜ Î·È ÙÔ ÚÔ˚fiÓ ÙÔ˘ (‰ËÏ·‰‹ ÙÔ ¤Ó˙˘ÌÔ Ô˘ ·ÂÓÂÚÁÔÔÈ› 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˜ ηϷÌÔÎÈÔ‡ Ô˘ ·Ó·Ù‡¯ıËΠ·fi ÙËÓ ÂÙ·ÈÚ›· Novartis ÂÚȤ¯ÂÈ ¤Ó· ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈÎÈÏÏ›ÓË. ªÈ· ·Ù¿Ù· Ô˘ ·Ó·Ù‡¯ıËΠ·fi ÙËÓ ÂÙ·ÈÚ›· Avebe ÂÚÈ›¯Â ¤Ó· ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈηۛÓË. ∆Ô Î·Ï·ÌfiÎÈ ÂÚfiÎÂÈÙÔ Ó· ¯ÚËÛÈÌÔÔÈËı› ·Î·Ù¤ÚÁ·ÛÙÔ, ÁÈ· ÙÚÔÊ‹ ˙ÒˆÓ Î·È ÙÔ ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ·ÓÙÔ¯‹ ÛÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi ‹Ù·Ó ˘fi ÙÔÓ ¤ÏÂÁ¯Ô ÂÓfi˜ ‚·ÎÙËÚÈ·ÎÔ‡ ˘ÔÎÈÓËÙ‹. ªÔÚ› 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˘ ·ÓıÚÒÔ˘, 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 ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿, ·ÓıÂÎÙÈο ÛÙ· ¤ÓÙÔÌ·, ·Ûı¤ÓÂȘ Î·È ˙È˙·ÓÈÔÎÙfiÓ· ∆Ô Ê˘Ùfi ηÓfi˜, 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˘ ηÓÔ‡, ‰ÂÓ ÚÔÛ‚¿ÏÏÂÙ·È
456
∫. ¶·ÓÙÛÈÒÙÔ˘
·fi ÙÔÓ Èfi ÙÔ˘ ̈۷˚ÎÔ‡ ÁÈ·Ù› Â›Ó·È Î·Ù¿ οÔÈÔÓ ÙÚfiÔ 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˘ ÂÓÂÚÁÔÔÂ›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 ÂÔ̤ӈ˜ ‰ÂÓ ÌÂÙ·‰›‰ÂÙ·È Û ¿ÏÏ· ·ÙÙ·Ú·. ∆· Ê˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡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 ηϷÌfiÎÈ ‰ÂÓ ÚÔÛ‚¿ÏÏÂÙ·È ·fi ÙÔ ¤ÓÙÔÌÔ ˘Ú·Ï›‰·. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ‰·ÛÈο ‰¤Ó‰Ú· Ì ·ÓÙÔ¯‹ Û ¯ıÚÔ‡˜ Î·È ·Ûı¤ÓÂȘ ı· ·Ó·Ù‡ÛÛÔÓÙ·È Ù·¯¤ˆ˜ Î·È ı· ηχÙÔ˘Ó ÁÚ‹ÁÔÚ· Á˘ÌÓ¿ ‚Ô˘Ó¿ Î·È ·ÔÙÂÊڈ̤ӷ ‰¿ÛË ÂÓÒ Ù· Ê˘ÛÈο ‰¤Ó‰Ú· ı¤ÏÔ˘Ó ‰ÈÏ¿ÛÈÔ Î·È Ï¤ÔÓ ¯ÚfiÓÔ ÁÈ· Ó· ·˘ÍËıÔ‡Ó. ∆Ô ˙È˙·ÓÈÔÎÙfiÓÔ glyphosate (ÂÌÔÚÈÎfi 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·ÌÔÎÈÔ‡ 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 ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿ Ì ‚ÂÏÙȈ̤ÓË ÂÌÔÚÈÎfiÙËÙ· ™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 ÂÈÙ˘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˜, ÂÈÙ˘Á¯¿ÓÂÙ·È (ÏfiÁˆ ÌÈÎÚ‹˜ ·‡ÍËÛ˘ ÙÔ˘ ·Ì‡ÏÔ˘) ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÈÍÒ‰Ô˘˜ ÛÙÔÓ ÙÔÌ·ÙÔÂÏÙ¤.
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·23
¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459
¶ÔÏÏÔ› ηÚÔ› ÂÓÒ ·ÔÙÂÏÔ‡Ó ÙË ‚¿ÛË Ù˘ ÙÚÔÊ‹˜ ÙˆÓ ˙ÒˆÓ, ¤¯Ô˘Ó ¯·ÌËÏ‹ ıÚÂÙÈ΋ ·Í›· ÏfiÁˆ ÌÈÎÚ‹˜ ·ÚÔ˘Û›·˜ ÔÚÈÛÌ¤ÓˆÓ ··Ú·›ÙËÙˆÓ ·ÌÈÓÔͤˆÓ. ∆· ·ÁÚÔÛÙÒ‰Ë (ÛÈÙ¿ÚÈ, ÎÚÈı¿ÚÈ, ηϷÌfiÎÈ 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·ÌfiÎÈ 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˘˜ ÂÌÏÔ˘Ù›˙ÂÙ·È Ì ·ÌÈÓÔͤ· Ô˘ ·˘Í¿ÓÂÈ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘˜. ªÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÁÔÓȉ›ˆÓ ÚˆÙÂ˚ÓÒÓ, ÏÔ‡ÛÈˆÓ ÛÙ· ÂÈı˘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·ÚÒÓ 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 ¿ÓıÚˆÔ Î·È Ë ÂÙ·ÈÚ›· ÛÙ·Ì¿ÙËÛ ÙËÓ ·Ú·ÁˆÁ‹ ÁÈ· Ó· ÌË ÌÂÈ ¤Ó· ηÈÓÔ‡ÚÁÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ ÙÚÔÊÈ΋ ·Ï˘Û›‰· ÙÔ˘ ·ÓıÚÒÔ˘. ∆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 fiˆ˜ 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 ·ÚÂÌÔ‰›˙Ô˘Ó ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ·ıËڈ̷و‰ÒÓ Ï·ÎÒÓ ÛÙ· ·ÁÁ›· Î·È ÂÏ·ÙÙÒÓÂÙ·È Ë Èı·ÓfiÙËÙ· ηډȷÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ·ÏÏ¿ ·ÚÂÌÔ‰›˙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 ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·
ÂÏ·ÛÙÈ΋ Î·È ÙÔ ÊÔ‡ÛΈ̷ ‰È·ÙËÚ›ٷÈ. ªÂ ÙÚÔÔÔ›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˘ ÂÂÍÂÚÁ·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. ∆· ÙÛȘ Ô˘ ·Ú·Û΢¿˙ÔÓÙ·È ·fi ÙÔ˘˜ ÎÔÓ‰‡ÏÔ˘˜ ·˘ÙÔ‡˜ ÂÌÊ·Ó›˙Ô˘Ó Î·Ù¿ ÙËÓ ÂÂÍÂÚÁ·Û›· ÙÔ˘˜ ¤ÓÙÔÓÔ ÛÎÔ‡ÚÔ ¯ÚÒÌ· Î·È ‰ÂÓ Â›Ó·È ÂÏ΢ÛÙÈο ÂÌÔÚÈο. ªÂ ÙËÓ ÙÚÔÔÔ›ËÛË ÙˆÓ Â˘·›ÛıËÙˆÓ ÛÙÔ „‡¯Ô˜ ÂÓ˙‡ÌˆÓ ·ÔʇÁÂÙ·È ÙÔ Ì·‡ÚÈÛÌ· Ù˘ ·Ù¿Ù·˜ ηٿ ÙËÓ ÂÂÍÂÚÁ·Û›· Û ÙÛȘ. O Ê˘ÙÈÎfi˜ ÈÛÙfi˜ Á›ÓÂÙ·È Î·Ê¤ fiÙ·Ó ÎÔ› ‹ ÍÂÊÏÔ˘‰ÈÛı›, Î·È ·ÔʇÁÂÙ·È Ì ÙË ¯Ú‹ÛË Û˘ÓÙËÚÈÎÒÓ fiˆ˜ 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΋ ÙÚÔÔÔ›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 ÌÔÚ› ÛÙÔ Ì¤ÏÏÔÓ Ó· ÌËÓ Â›Ó·È ‚Ï·‚ÂÚ¤˜ ÛÙËÓ ˘Á›· ·Ó Ù· Ê˘Ù¿ Ô˘ ÙȘ ÂÚȤ¯Ô˘Ó ÙÚÔÔÔÈËıÔ‡Ó ÁÂÓÂÙÈο. OÈ ÂÍÂÏ›ÍÂȘ Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ı· Ô‰ËÁ‹ÛÔ˘Ó Ì·ÎÚÔÚfiıÂÛÌ· ÛÙËÓ ·Ó¿Ù˘ÍË ÙÚÔÊÒÓ Ô˘ ‰ÂÓ ı· ÂÚȤ¯Ô˘Ó Ù· ·ÓÂÈı‡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·ÚÔ› 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˘ ηÚÔ‡ (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 ·ÚÂÌÔ‰ÈÛı› Ó· ‰Ú¿ÛÂÈ ·˘Ùfi ÙÔ ¤Ó˙˘ÌÔ, ı· ÂÈ‚Ú·ı˘Óı› ÙÔ Ì·Ï¿ÎˆÌ· ÙÔ˘ ηÚÔ‡, ÂÓÒ Ë ˆÚ›Ì·ÓÛË (¿ÚˆÌ·, ¯ÚÒÌ·) ı· Û˘Ó¯ÈÛı› ηÓÔÓÈο. ∏ ÓÙÔÌ¿Ù· ·˘-
457
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·24
¶∞π¢π∞∆ƒπ∫∏ 2000;63:447-459
∫. ¶·ÓÙÛÈÒÙÔ˘
Ù‹ Â›Ó·È ÁÓˆÛÙ‹ Ì ÙÔ fiÓÔÌ· FLAV SAVR Î·È Ë Î˘ÎÏÔÊÔÚ›· Ù˘ ÂÈÙÚ¤ÂÙ·È ÛÙȘ ∏¶∞ ·fi ÙÔ 1994. ∏ ÔÈÎÈÏ›· ·˘Ù‹ ʤÚÂÈ ÙÔ ÁÔÓ›‰ÈÔ (antisense) ·ÓÙÈÓÔËÌ·ÙÈÎfi, ÙÔ ÔÔ›Ô ·Ó·ÛÙ¤ÏÏÂÈ ÂÈ Ì·ÎÚfiÓ ÙËÓ ·Ú·ÁˆÁ‹ ÔÏ˘Á·Ï·ÎÙÔ˘ÚÔÓ¿Û˘, ¯ˆÚ›˜ Ó· ·ÚÂÌÔ‰›˙ÔÓÙ·È ÔÈ ¿ÏϘ ÏÂÈÙÔ˘ÚÁ›Â˜ Ù˘ ˆÚ›Ì·ÓÛ˘. ∆Ô ÁÔÓ›‰ÈÔ Ô˘ Ì·›ÓÂÈ ÂËÚ¿˙ÂÈ ÙÔÓ promoter ·ÓÙ›ÛÙÚÔÊ·. ¢ËÏ·‰‹ fiÙ·Ó ÙÔ ÁÔÓ›‰ÈÔ ·Ú¯›˙ÂÈ Ó· ÂÎÊÚ¿˙ÂÙ·È ÙÔ ·ÓÙÈÓÔËÌ·ÙÈÎfi ·ÚÂÌÔ‰›˙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 ¿ÓıÚˆÔÈ fï˜, ‰ÂÓ ÙÚÒÓ ˆÌ¤˜ ÙȘ ·Ù¿Ù˜ Î·È Ì ÙÔ Ì·Á›ÚÂ˘Ì· ·ÔÈÎÔ‰ÔÌÔ‡ÓÙ·È ÔÈ ÚˆÙ½Ó˜. ™˘ÓÂÒ˜, Ë ·Ù¿Ù· ‰ÂÓ ·ÔÙÂÏ› ηٿÏÏËÏË ÂÈÏÔÁ‹ 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 ÙÚÔÔÔÈË̤ӷ 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, fiˆ˜ ¯ÔϤڷ Î·È ‚·ÎÙËÚȷ΋ ‰È¿ÚÚÔÈ·, ÔÈ Ôԛ˜ ·ÔÙÂÏÔ‡Ó Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿ ÙˆÓ ¯ˆÚÒÓ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘. ∆· ‚·ÎÙËÚ›‰È· ·Ú¿ÁÔ˘Ó ÂÓÙÂÚÔÙÔ͛Ә ÛÙÔ ÏÂÙfi ¤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˘ÂÙ›‰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‰ÈÎÔÔÈ› ÙËÓ µ ˘ÔÔÌ¿‰· Ù˘ ÂÓÙÂÚÔÙÔ͛Ӣ Ù˘ E. coli, ÛÙÔ Ê˘Ùfi ·Ù¿Ù·. ™Ù· ÙÚÔÔÔÈË̤ӷ Ê˘Ù¿ Ë ˘ÔÔÌ¿‰· µ Û˘ÛÛˆÚ‡ıËΠÛÙÔ˘˜ ÎÔÓ‰‡ÏÔ˘˜. ¶ÔÓÙÈÎÔ› Ô˘ ¤Ê·Á·Ó ·˘Ù¤˜
∂ÈÊ˘Ï¿ÍÂȘ Î·È ÚÔÔÙÈΤ˜ ™ÙȘ ¯ÒÚ˜ Ù˘ ∂ӈ̤Ó˘ ∂˘ÚÒ˘ ˘¿Ú¯Ô˘Ó ÂÙÈΤÙ˜ ÛÙ· ÚÔÈfiÓÙ· Î·È ·Ó·Ê¤ÚÂÙ·È ·Ó ·˘Ù¿ Â›Ó·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ, 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 ÂÌÈÛÙÔÛ‡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 ÙÚÔÔÔÈË̤ӷ 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 ÙÚÔÔÔÈËÌ¤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 Ôԛ˜ 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 ÙÚÔÔÔÈË̤Ó˜ ηÏÏȤÚÁÂȘ. ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÂÊ·ÚÌfiÛıËÎ·Ó ÂÓÙ·ÙÈο Û˘ÛÙ‹Ì·Ù· ηÏÏȤÚÁÂÈ·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·˘Í·ÓfiÌÂÓ˘ ˙‹ÙËÛ˘ ÙÚÔÊÒÓ, ȉ›ˆ˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ (23). OÈ ı·̷ÙÈΤ˜ ·Ô‰fiÛÂȘ ÙˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ ÔÎÈÏÈÒÓ ÂÈÙ‡¯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 ·ÛÙÈÎÔÔ›ËÛË, ‰ÂÓ Û˘ÓÂȉËÙÔÔÈ› ‡ÎÔÏ· ηÓ›˜ fiÛÔ ÂÈÛÊ·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· ‰ÈÏ·ÛÈ·Ûı› ÛÙ· ÂfiÌÂÓ· 40-50 ¯ÚfiÓÈ·. ¶Ò˜ ı· ‰È·ÙÚ¤ÊÔÓÙ·È ÙfiÙ ÙfiÛÔÈ ¿ÓıÚˆÔÈ, fiÙ·Ó Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ÂÍ·ÛÊ·ÏÈÛı› ·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˘ ·ÓıÚÒÔ˘ 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· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ Ì ۈÛÙfi Î·È ·ÓıÚÒÈÓÔ ÙÚfiÔ. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ¤¯ÂÈ ·Ô‰Â›ÍÂÈ ÙËÓ ÙÂÚ¿ÛÙÈ· ·Ú·ÁˆÁÈ΋ Ù˘ ‰‡Ó·ÌË. ¶Ú¤ÂÈ Ë ‰‡Ó·ÌË ·˘Ù‹ Ó· ¯ÚËÛÈÌÔÔÈËı› ̤۷ Û fiÚÈ· ·ÛÊ·Ï‹ Î·È ËıÈο ·Ô‰ÂÎÙ¿ ·fi ÙËÓ ÎÔÈÓˆÓ›·, ¤ÙÛÈ ÒÛÙÂ Ë Ù¯ÓÔÏÔÁ›· Ó· ˘ËÚÂÙ› ÙÔÓ ¿ÓıÚˆÔ Î·È fi¯È Ô ¿ÓıÚˆÔ˜ ÙËÓ Ù¯ÓÔÏÔÁ›·.
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·
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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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● ¶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΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È ‰È·ÎÚ›ÓÂÙ·È Û ›ÎÙËÙË Î·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓË. OÈ Î˘ÚÈfiÙÂÚ˜ ·fi„ÂȘ Ô˘ ÂÈÎÚ·ÙÔ‡Ó Û‹ÌÂÚ· ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ›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· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú· (stem cells-SC) ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Û ¿ÏÏÔÙ ¿ÏÏÔ Â›Â‰Ô Ù˘ ‰È·ÊÔÔ›ËÛ‹˜ ÙÔ˘˜ (µÏ¿‚Ë Ù‡Ô˘ π Î·È ‚Ï¿‚Ë Ù‡Ô˘ ππ). °È· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ›ÎÙËÙ˘ ∞∞, ıˆÚËÙÈο ÂÓÔ¯ÔÔÈÂ›Ù·È ÚÔËÁËı›۷ ‚Ï·ÙÈ΋ ‰Ú¿ÛË Î¿ÔÈÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ‹ Â͈ÁÂÓÔ‡˜ ·Ú¿ÁÔÓÙ· › ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ 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 ÂÚÈÙÒÛˆÓ, ·ÎÔÏÔ˘ı› Ì›· ÈÛ¯˘Ú‹ ·˘ÙÔ·ÓfiÛÔ˘ Ù‡Ô˘ ·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Ë ÔÔ›· ÛÙÚ¤ÊÂÙ·È Î·Ù·ÛÙÚÔÊÈο ÂÓ·ÓÙ›ÔÓ ÙˆÓ È‰›ˆÓ ·˘ÙÔ‡ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (SC), ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ‰È·Ù·Ú·Á̤Ó˘ Î·È ·ÓÒÌ·Ï˘ ·ÓÔÛÔÔÈËÙÈ΋˜ ·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 ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ). O ÚfiÏÔ˜ Ô˘ η٤¯ÂÈ ÛÙËÓ fiÏË ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ ‰È·‰Èηۛ· Ù˘ ›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˘ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (΢ÙÙ¿ÚˆÓ ÛÙÚÒÌ·ÙÔ˜, ·Ó¿ÚÎÂÈ· ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÎÏ). ∏ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ·ÎÔÏÔ˘ı› Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÛÙËÓ ÏÂÈÔÓfiÙËÙ· fï˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ 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 ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È Ù· ÔÈΛϷ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÛÔÚ·‰Èο ‹ ÔÈÎÔÁÂÓ‹ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Ì ‹ ¯ˆÚ›˜ Ê˘ÛÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÂÎÚÔÛˆÂ›Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ ·Ó·ÈÌ›· Fanconi. OÈ ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Á¤ÓÂÛ˘ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ, Â›Ó·È ÔχÏÔÎÔÈ 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 ·ÈÌÔÔÈËÙÈÎÒÓ 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·ÛÎfiËÛ˘ ·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›· ›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˜, ∂̉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· ·Ó¿ÚÎÂÈ·˜ ª˘ÂÏÔ‡ ÙˆÓ OÛÙÒÓ (MO), Ù· ÔÔ›· ·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 ÂÎÚfiÛˆÔ ÙËÓ ·Ó¿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˜ AÏ·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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fiˆ˜ ·Ô‰fiıËΠ·fi ÙÔÓ Chauffard (2), ÚÔÎÂÈ̤ÓÔ˘ Ó· ¯·Ú·ÎÙËÚ›ÛÂÈ ÙËÓ ÎÏÈÓÈ΋ ·˘Ù‹ ÔÓÙfiÙËÙ·. O ÂÏÏËÓÈÎfi˜ Î·È ‰ÈÂıÓÒ˜ ¤ÎÙÔÙ ηıÈÂڈ̤ÓÔ˜ fiÚÔ˜, AÏ·ÛÙÈ΋ ·Ó·ÈÌ›·, ıˆÚÂ›Ù·È ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ ÂÙ˘ÌÔÏÔÁÈο, ·ÏÏ¿ Î·È ·ıÔÊ˘ÛÈÔÏÔÁÈο ÂÈÙ˘¯‹˜ ÁÈ·Ù› ÂÎÊÚ¿˙ÂÈ Â·ÎÚÈ‚Ò˜ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÂÈÎÚ·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 ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ÔÈΛÏÔ˘˜ ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ ÚÔηÏÔ‡Ó ·ÚÔ‰Èο ‹ ÌfiÓÈÌ· ‰È·Ù·Ú·¯‹ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ Ù˘ ·ÈÌÔÔ›ËÛ˘ (6). ∏ ηÙËÁÔÚ›· Ù˘ ›ÎÙËÙ˘ ∞∞ ηÙÂÍÔ¯‹Ó ÂÎÚÔÛˆÂ›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).
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469
∞. ∂›ÎÙËÙË ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· √ÚÈÛÌfi˜ ø˜ ›ÎÙËÙË ÔÚ›˙ÂÙ·È Ë ∞∞ Ë ÔÔ›· ·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· ›وۋ Ù˘ ÛÙȘ ∏¶∞ Î·È ÙËÓ ∂˘ÚÒË, ·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 Ԣ ·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˘ ∞∞, fiˆ˜ 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˘ ÂÎÚÔۈ› 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˘ ¤ÎÙˆÛ˘ Ù˘ ·ÈÌÔÔ›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˘ ¯ÚËÛÈÌÔÔÈ‹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˘ ·ÈÌÔÔ›ËÛ˘ Î·È ÙˆÓ ·ÔÎÏ›ÛÂˆÓ ‹ ·Ú·ÏÏ·ÁÒÓ Ù˘ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi (2,5,12). ™‡Ìʈӷ ÏÔÈfiÓ, Ì ÙÔ ÈÛ¯‡ÔÓ Û‹ÌÂÚ· ıˆÚËÙÈÎfi ÚfiÙ˘Ô Ù˘ ·ÈÌÔÔ›ËÛ˘, ¤Ó·˜ Ôχ ÌÈÎÚfi˜ ÌfiÓÔ ·ÚÈıÌfi˜ ·Ú¯¤ÁÔÓˆÓ ÌËÙÚÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, (Ù· ÔÔ›· 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 ·ÈÌÔÔÈËÙÈ΋ 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 ·ÈÌÔÔÈËÙÈÎÒÓ 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·ÊÔÚÔÔÈÔ‡ÌÂÓÔ˜ ÏËı˘ÛÌfi˜ ·ÈÌÔÔÈËÙÈÎÒÓ ·ÔÁfiÓˆÓ, Ù· ÔÔ›· ·ÎÔÏÔ˘ıÒÓÙ·˜ ¿ÓÙÔÙ ̛· ÛÔÊ‹ ÈÂÚ·Ú¯È΋ ÔÚÁ¿ÓˆÛË, ·ÔÙÂÏÔ‡Ó ÙÂÏÈο ÙÔÓ Û˘ÓÔÏÈÎfi ˙ˆÙÈÎfi ·ÈÌÔÔÈËÙÈÎfi ¯ÒÚÔ. ŸÛÔ ‰Â ·˘Í¿ÓÂÈ, ÌÂÙ¿ ·fi οı ̛وÛË, Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÙfiÛÔ ÙÔ ÔÛÔÛÙfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Â›Ó·È «Â˘·ÈÛıËÙÔÔÈË̤ӷ» ÁÈ· Ó· ˘·ÎÔ‡ÛÔ˘Ó ÛÙË ÌÂÙ¿‰ÔÛË ÂÓfi˜ Û‹Ì·ÙÔ˜, ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ù· ¢·ÈÛıËÙÔÔÈË̤ӷ ·˘Ù¿ ·ÙÙ·Ú· ‰¤¯ÔÓÙ·È ÈÔ Â‡ÎÔÏ· ÂÈÚÚÔ¤˜ ·fi ÂÓ‰ÔÁÂÓ›˜ ‹ Â͈ÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜ Î·È ˘fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ ¢ԉÒÓÂÙ·È Ë ÙÂÏÈ΋ ÙÔ˘˜ ‰È·ÊÔÚÔÔ›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˘ ÂÈÎÚ·ÙÔ‡Ó Û‹ÌÂÚ·, ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ›ÎÙËÙ˘ ∞∞, ·ÊÔÚÔ‡Ó: ·) ÙËÓ ÔÛÔÙÈ΋ ‹/Î·È ÔÈÔÙÈ΋ ‚Ï¿‚Ë ÙˆÓ SC, ‚) ÙË ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÈÎÚÔÂÚÈ‚¿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 ·Ô‰Â›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˘ ›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 ÛÔÚ·‰È΋ ·ÚÔ˘Û›· ·˘ÙfiÌ·Ù˘ ›·Û˘ Î·È Ù¤ÏÔ˜ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ıÂڷ¢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 Ï¤ÔÓ ·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 ÔÔ›Ô˜ ÛÙËÚ›˙ÂÈ ÔÏfiÎÏËÚÔ ÙÔ ÔÈÎÔ‰fiÌËÌ· Ù˘ ·ÈÌÔÔ›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 Ï¤ÔÓ ·ÒÚˆÓ ÌËÙÚÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˘ ‚·Ú‡ÙËÙ·˜ Î·È Û˘Ó‹ıˆ˜ Ë ÂÈÛ˘Ì‚·›ÓÔ˘Û· ‰È·Ù·Ú·¯‹ Â›Ó·È ÌË ·Ó·ÛÙÚ¤„ÈÌË Î·È ·Ó·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·ÊÔÚÔÔÈÔ‡ÌÂÓ· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ ‚¿Ûˆ˜ Ù˘ ˘Ú·Ì›‰·˜, Ù· ÔÔ›· 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·ÚÔÏ¿ÛÌ·ÙÔ˜, ÂÌÔ‰›˙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 ›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 ÛfiÚÔ˜», ÌÂÏÂÙ‹ıËΠÂÎÙÂٷ̤ӷ Î·È Ë Èı·Ó‹ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ªO ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ›ÎÙËÙ˘ ∞∞ (10,11,16,20,34). Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÔÏϷϤ˜ 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 ›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· fiÔ˘ ·ÙÙ·Ú· ÛÙÚÒÌ·ÙÔ˜ ·ÛıÂÓÒÓ Ì ∞∞, ˘ÂÛÙ‹ÚÈÍ·Ó ÈηÓÔÔÈËÙÈο ÙËÓ ·Ó¿Ù˘ÍË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ‰fiÙ˜,
464
™. ¶ÔÏ˘¯ÚÔÓÔÔ‡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 ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ù˘ ·ÚÔ˘Û›·˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ¤¯Ô˘Ó ›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 ·ÈÌÔÔÈËÙÈÎÒÓ ·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 ¿ÚÎÂÈ¿ ÙÔ˘˜, Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙÔ ıÂÙÈÎfi ÈÛÔ˙‡ÁÈÔ Ù˘ ·ÈÌÔÔ›ËÛ˘ Î·È ·ÓÙÈı¤Ùˆ˜ (37,38). ¶¤Ú·Ó Ù˘ ‰È·Ù‡ˆÛ˘ fiÏˆÓ ÙˆÓ ·ÓˆÙ¤Úˆ ıˆÚËÙÈÎÒÓ ÚÔÙ‡ˆÓ ·Ó¿Ù˘Í˘ Ù˘ ›ÎÙËÙ˘ ∞∞, Ë ·ÚÔ˘Û›· ÂÓfi˜ ˘ÔΛÌÂÓÔ˘ ÈÛ¯˘ÚÔ‡ ·˘ÙÔ·ÓfiÛÔ˘ Ì˯·ÓÈÛÌÔ‡ Ô˘ ÛÙÚ¤ÊÂÙ·È Î·Ù·ÛÙÚÔÊÈο ¤Ó·ÓÙÈ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙË (13,20,33). ª›· ÛÂÈÚ¿ ÎÏÈÓÈÎÒÓ ·Ú·ÙËÚ‹ÛˆÓ, Ô˘ ÂȂ‚·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’ ¤ÎÙ·ÛË ÙÔ˘ ıÂڷ¢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 ÔÔ›Ô˜ ·Ú¯Èο ˘Â‚Ï‹ıË 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˘˜ ¤ÎÏËÍË ÚÔ‹Á·Á ·˘Ùfi¯ıÔÓË ·ÈÌÔÔ›ËÛË (43). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ·Ô‰fiıËΠÛÙËÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ¯ËÌÂÈÔıÂڷ¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÚÔÂÙÔÈÌ·Û›·˜ ÛÙÔ ÔÔ›Ô Â›¯Â ˘Ô‚ÏËı› Ô ·ÛıÂÓ‹˜ (conditioning regimen), ÛÙ· Ï·›ÛÈ· Ù˘ ÂÈΛÌÂÓ˘ 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˘ ·ÈÌÔÔ›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 ÂÈϤÔÓ, ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi ÚÔ·Ú·Û΢·ÛÙÈÎfi Û¯‹Ì· (13,45-48). ™Ù·Ø Ï·›ÛÈ· Ù˘ Û˘ÓÔÏÈ΋˜ ηٷÛÙÔÏ‹˜/ηٷÛÙÚÔÊ‹˜ Ù˘ ·ÈÌÔÔ›ËÛ˘, ‰ÂÓ ·ÔÎÏ›ÂÙ·È Î·È Ë ¿ÌÂÛË Â·Ê‹ ÙˆÓ ∆ ΢ÙÙ·ÚÔÙÔÍÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì ٷ ·ÈÌÔÔÈËÙÈο «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
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:461-469
OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ˆ˜ ˘Â‡ı˘ÓÔÈ Ù˘ ˘ÚÔ‰fiÙËÛ˘ Ù˘ ‰È·‰Èηۛ·˜, Ë ÔÔ›· ÛÙÚ¤ÊÂÙ·È ÂÓ·ÓÙ›ÔÓ Ù˘ ·ÈÌÔÔ›ËÛ˘, Â›Ó·È ÔÏÏÔ›, Û ¯ÚfiÓÔ ¿ÌÂÛÔ ‹ ¤ÌÌÂÛÔ, Ì ÈÔ ÁÓˆÛÙÔ‡˜ ÙÔ˘˜ ÈÔ‡˜ Î·È Ù· Ê¿Ú̷η. ∏ ÙÂÏÈ΋ ›ıÂÛË ÙËÓ ÔÔ›· ‰¤¯ÔÓÙ·È Ù· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú·, ·fi Ù· ∆-΢ÙÙ·ÚÔÙÔÍÈο ÏÂÌÊÔ·ÙÙ·Ú· fiÙ·Ó ·˘Ù¿ ÚÔÛ‚ÏËıÔ‡Ó ·fi οÔÈÔ 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˘ ·ÓıÚÒÈÓÔ˘ ªO Î·È Ó· ÚÔηϤÛÔ˘Ó ‚Ï¿‚Ë Û ·˘Ù¿ ›Ù ¿ÌÂÛ·, ÚÔηÏÒÓÙ·˜ ÙÔÓ ı¿Ó·Ùfi ÙÔ˘˜ ‹ ¤ÌÌÂÛ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ 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 ÔÔ›ˆÓ ‰È¿ÊÔÚ˜ ÔÈÎÔÁ¤ÓÂȘ ÈÒÓ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ·Ó¿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· ÔÔ›· Û ·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· › ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·ÛÎÂ›Ù·È Ì¤Ûˆ ÙˆÓ ÂÓ‰È·Ì¤ÛˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙˆÓ Ê·Ú̿ΈÓ, ÔÈ ÔÔ›ÔÈ Û˘Ó‰¤ÔÓÙ·È Ì ÙȘ ÚˆÙ›Ó˜ Î·È ÙÔ DNA ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢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 ·ÈÌÔÔÈËÙÈο ·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˘ ›ÎÙËÙ˘ ∞∞. ™˘ÓÔÙÈο, ÔÈ ·ÏÏËÏÂȉڿÛÂȘ ÌÂٷ͇ ÌÂÙ·‚ÔÏÈÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ È‰ÈÔÛ˘ÛÙ·Ûȷ΋ ÙÔ˘˜ ‰Ú¿ÛË, Ë ÔÔ›· ÙÂÏÈο ηٷϋÁÂÈ ÛÂ Ì˘ÂÏÈ΋ ·Ó¿ÚÎÂÈ·, ·ÊÔÚ¿ ¿ÌÂÛË ÁÂÓÂÙÈ΋ ‹ ÌÂÙ·‚ÔÏÈ΋ ‚Ï¿‚Ë Ì ·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΋˜ ·Ó¿ÚÎÂÈ·˜ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (54-56). ∏ ÂÈÛ‹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 ÂȉڿÛÂˆÓ Â› Ù˘ ·ÈÌÔÔ›ËÛ˘, Ì ÙȘ Ôԛ˜ 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΋˜ ·Ó¿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 ·Ó·Ú΋ ‰È¿ÁÓˆÛË, ÛÙËÓ ÂÏÏÈ‹ ηٷÁÚ·Ê‹, ÛÙËÓ ÏËÌÌÂÏ‹ ·Ó·ÎÔ›ÓˆÛ‹ ÙÔ˘˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ÛÙËÓ Â˘Ú›· ‰È·ÛÔÚ¿ 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 ÔÔ›Ô ÙÂÏÈο Ê·›ÓÂÙ·È Ó· ÂÓ¤¯ÂÙ·È ÛÙËÓ ÚfiÎÏËÛË Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜ (54,55-58). 2. ∆Ô 5-10% ÙˆÓ ·ÛıÂÓÒÓ Ì ‰È·ÁÓˆṲ̂ÓË Â›ÎÙËÙË ∞∞ ÌÂÁ¿ÏˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Î·È ıÂڷ¢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 ∂˘ÚÒË ‰˘Ó·ÙfiÓ Ó· ·Ó¤Ú¯ÂÙ·È Û 1/300 (5,55,59). ∆· ÎÏ·ÛÈο Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿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 ∞∞ ÛÔÚ·‰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 ÂÈϤ¯ıËÎÂ Ë Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ, ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ·Ó·ÈÌ›·˜ Fanconi, ˆ˜ ÙÔ˘ ·ÚÈÔ˘ ÂÎÚÔÛÒÔ˘ ÌÂٷ͇ ÙˆÓ ÎÏËÚÔÓÔÌÔ‡ÌÂÓˆÓ Û˘Ó‰ÚfiÌˆÓ Ì˘ÂÏÈ΋˜ ·Ó¿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˘˜ ÂÈÛÙËÌÔÓÈ΋ ·Ó·˙‹ÙËÛË ÛÙ· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∂ȉÈÎfiÙÂÚ· ÛÙËÓ ·Ó·ÈÌ›· Fanconi ˘¿Ú¯Ô˘Ó ÂÓÙ˘ˆÛȷο ·ÔÙÂϤÛÌ·Ù· Ô˘ ÌÔÚÔ‡Ó Ó· ÂÂÓ‰˘ıÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÛÙË ‰È¿ÁÓˆÛË ·ÏÏ¿ Î·È ÛÙË ıÂڷ›· ÔχÏÔÎÔ˘ ·˘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 ˘ÔÏÂÈfiÌÂÓÔ ¯·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 ÚÔÛˆÂ›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 ˘fiÏÔÈÔÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÌÔӈ̤Ó˜ ‹ ÔÏϷϤ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒÓÂÙ·È ·Á΢ÙÙ·ÚÔÂÓ›· Ù˘ ÔÔ›·˜ ηٿ ηÓfiÓ· ÚÔËÁÂ›Ù·È ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÌÔӈ̤Ó˘ ıÚÔÌ‚ÔÂÓ›·˜ ‹ Ï¢ÎÔÂÓ›·˜. ™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. ∂ÈϤÔÓ, ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ F, ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ i, ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÂÚ˘ıÚÔÔÈËÙ›Ó˘ ÂÓÒ ·Ú¿ÏÏËÏ· Ê·›ÓÂÙ·È fiÙÈ Ë ÂÈ‚›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˘ıÚÔÔ›ËÛË Î·È ·Ó·Ú΋ Ì˘ÂÏÈ΋ ÏÂÈÙÔ˘ÚÁ›·. O Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ Â›Ó·È ÏÈ҉˘, ˘Ô΢ÙÙ·ÚÈÎfi˜ Ì ϛÁ· ·ÈÌÔÔÈËÙÈο ÛÙÔȯ›· Î·È Û¯ÂÙÈο ·˘ÍË̤ÓÔ ·ÚÈı-
466
™. ¶ÔÏ˘¯ÚÔÓÔÔ‡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 ÔÔ›· ·Ó·‰ÂÈÎÓ‡ÂÙ·È ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ· ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì ÎÏ·ÛÙÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ÌÈÙÔÌ˘Î›ÓË Î·È Ë ‰ÈÂÔ͢‚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˜. ∂ÈÚfiÛıÂÙ·, 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˘ ‹ ‰ÈÂÔ͢‚Ô˘Ù¤Ó˘ (DEB) ›ӷÈ: 1. π‰È·›ÙÂÚ· ÔχÙÈÌË ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË Ù˘ ÓfiÛÔ˘, fiÔ˘ ·˘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·, fiˆ˜ 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· ÔÔ›· 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 ‰ÈÏÔ‡˜ 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 ÔÔ›· ¤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 ıÂڷ¢ÙÈ΋ Ù˘ ·ÓÙÈÌÂÙÒÈÛË (·ÏÏÔÁÂÓ‹˜ ªªO, ÁÔÓȉȷ΋ ıÂڷ›·) (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˘ÌÏËڈ̷ÙÈÎÒÓ 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˘ÌÏËڈ̷ÙÈÎÒÓ 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 ÎψÓÔÔ›ËÛË 2 ·fi ·˘Ù¿, ÙˆÓ FAA Î·È FAC, Ô˘ fiˆ˜ Ê·›ÓÂÙ·È Â›Ó·È ·fi Ù· ÂÈÎÚ·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΋ ÂÓÙfiÈÛË 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˘ÌÏËڈ̷ÙÈÎfi ÙÚfiÔ fiÛÔÓ ·ÊÔÚ¿ ÙË ‚ÂÏÙ›ˆÛË ‹ ÙËÓ Â·Ó·ÊÔÚ¿ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÙˆÓ ÂȉÈÔÚıˆÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ DNA ÙˆÓ FA ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· Û˘ÁÎÂÎÚÈ̤ÓÔÈ Û˘Ó‰˘·ÛÌÔ› ÙÔ˘˜ in vitro Ó· ·ÔηıÈÛÙÔ‡Ó Ê˘ÛÈÔÏÔÁÈ΋ ·ÈÌÔÔ›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. Ÿˆ˜ 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). ∂ÈϤÔÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÁÂÓÈ΋˜ ʇÛˆ˜ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ‰ÂÓ ·ÔÙÂÏÔ‡Ó ¿ÌÂÛÔ Û˘ÛÙ·ÙÈÎfi ÙˆÓ ÂȉÈÔÚıˆÙÈÎÒÓ 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΋ ·ÈÌÔÔ›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˜ fiˆ˜ Ë IFN-Á (49) Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ (TNF), Ù· ·˘ÍË̤ӷ ›‰· ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È ÁÓˆ-
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ÛÙfi fiÙÈ Ô‰ËÁÔ‡Ó Û ηٷÛÙÔÏ‹ Ù˘ ·ÈÌÔÔ›ËÛ˘. ∂›Û˘, Ë ·Ó¢ÚÂı›۷ Û ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ IL-6 ÛÙËÓ ·Ó·ÈÌ›· Fanconi, Ê·›ÓÂÙ·È fiÙÈ Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·fiÙˆÛË ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÈÙ›ÓÔÓÙ·˜ ηْ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙÔÓ ‚·ıÌfi Ù˘ Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜ (49, 60-65). ™˘ÌÂÚ·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· ÂȉÈÔÚıÒÛÔ˘Ó ÙȘ ‚Ï¿‚˜ ÙÔ˘˜ ÛÂ Â›Â‰Ô DNA, ȉÈfiÙËÙ˜ ·fi ÙȘ Ôԛ˜ ÚÔ·ÙÔ˘Ó fi¯È ÌfiÓÔÓ ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÈÌÔÔ›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. 2. Introduction to aplastic anemia: History, differential diagnosis, and classification. In: Young NS, Alter BP (eds). Aplastic anemia acquired and inherited. W.B. Saunders Company; 1994. p. 3-11. 3. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶·È‰È·ÙÚÈ΋ 1993;56:38-47. 4. Fonseca R, Tefferi A. Practical aspects in the diagnosis and management of aplastic anemia. Am J Med Sci 1997;313:159-169. 5. Alter BP, Young NS. The Bone Marrow failure syndromes. In: Nathan DG, Orkin SH (eds). Nathan and Oski’s Hematology of Infancy and Childhood. 5th ed. W.B. Saunders Company; 1998. p. 237-335. 6. Freedman MH. Aplastic anemia in children: New concepts in etiology and therapy. Am. J Pediatr Hematol Oncol 1990;12:383-384. 7. Epidemiology of acquired aplastic anemia. In: Young NS, Alter BP (eds). Aplastic anemia acquired and inherited. W.B. Saunders Company; 1994. p. 24-31. 8. Liang R, Chan TK, Todd D. Childhood acute lymphoblastic leukemia and aplastic anaemia. Leukemia Lymphoma 1994;13:411-415. 9. Thierry SD, Richard P, Gluckman E. Long-term bone marrow culture in Fanconi’s anaemia. Br J Haematol 1993;83:554-559. 10. Marsh JC. Long-term bone marrow cultures in aplastic anaemia. Eur J Haematol 1996;60(Supp):75-79. 11. Marsch JCW, Chang J, Testa NG, Hows JM, Dexter TM. In vitro assessment of marrow «stem cell» and stromal cell function in aplastic anaemia. B J Haematol 1991;78:258-267. 12. Pathophysiology I: Stem cells, stroma, and growth factors. In: Young NS, Alter BP, eds. Aplastic anemia acquired and inherited. W.B. Saudners Company; 1994. p. 32-45. 13. Pathophysiology II: Immune suppression of hematopoiesis. In; Young NS, Alter BP, eds. Aplastic
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477
∞Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È Ì˘ÂÏÔ‰˘ÛÏ·Û›· ∞fiÛÙÔÏÔ˜ ¶Ô˘ÚÙÛ›‰Ë˜
● ¶ÂÚ›ÏË„Ë: ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞), Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (ª¢™), ÔÈ ÌÂÌÔӈ̤Ó˜ ΢ÙÙ·ÚÔÂӛ˜, ȉȷ›ÙÂÚ· ÔÈ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜, Î·È ÁÂÓÈο fiÏ· Ù· ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÛÙ· ÔÔ›· ¿Û¯ÂÈ ÚˆÙÔ·ıÒ˜ ÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ, ·ÔÙÂÏÔ‡Ó Ì›· ȉȷ›ÙÂÚË ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ, Ôχ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, Ù· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· Â›Ó·È Û¿ÓÈ· ÓfiÛÔ˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Á΢ÙÙ·ÚÔÂÓ›· 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 ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ ‰È¿ÁÓˆÛË Ù˘ ∞∞ ÂÈÙ˘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·ÚÔÂÓ›·. ™ÙËÓ ÚÔÛ¤ÁÁÈÛË Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ ›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‰˘ÛÏ·Û›·˜ ‹ ·ÎfiÌË Î·È Ï¢¯·ÈÌ›·˜. ∆· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Â›Ó·È ÎψÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË, ΢ÙÙ·ÚÔÂӛ˜ ÛÙÔ ·›Ì· Î·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂͤÏÈ͢ Û ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›·. ∏ ·Ó·ÛÎfiËÛË ·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 ÙÚÔÔÔÈË̤ÓË, ÚfiÛÊ·Ù·, ÌÔÚÊÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË. ¶·È‰È·ÙÚÈ΋ 2000;63:470-477. §¤ÍÂȘ ÎÏÂȉȿ: ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Ì˘ÂÏÔ‰˘ÛÏ·Û›·, Ì˘ÂÏÈ΋ ·Ó¿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‡»
470
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·471
¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477
∂ÈÛ·ÁˆÁ‹ ∏ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (∞∞), Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (ª¢™), ÔÈ ÌÂÌÔӈ̤Ó˜ ΢ÙÙ·ÚÔÂӛ˜, ȉȷ›ÙÂÚ· ÔÈ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜, Î·È ÁÂÓÈο fiÏ· Ù· ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÛÙ· ÔÔ›· ¿Û¯ÂÈ ÚˆÙÔ·ıÒ˜ ÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·ÙÙ·ÚÔ, ·ÔÙÂÏÔ‡Ó ÌÈ· ȉȷ›ÙÂÚË ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ, Ôχ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, Ù· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∏ ·Ó¿Ù˘ÍË Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ‚Ô‹ıËÛ ÛÙË ÌÂϤÙË Î·È Î·Ù·ÓfiËÛË ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ Ù˘ ·ÈÌÔÔ›ËÛ˘ Î·È ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘. ™ÙÔ ÌÔÓÙ¤ÏÔ ·˘Ùfi, ·fi ÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·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·ÊÔÚÔÔÈ‹ÛÂˆÓ Î·È ÔÏÏ·Ï·ÛÈ·ÛÌÒÓ, ηٷϋÁÔ˘Ó ÛÙËÓ ·Ú·ÁˆÁ‹ ÏÂÈÙÔ˘ÚÁÈο ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÒÚÈÌˆÓ Î˘ÙÙ¿ÚˆÓ ·ÔÁfiÓˆÓ Ù· ÔÔ›· 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 ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ù˘ ‰¤ÛÌ¢Û˘, Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ Î·È ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· Û ¤Ó· Ù¤ÏÂÈ· Ú˘ıÌÈ˙fiÌÂÓÔ ÌÈÎÚÔÂÚÈ‚¿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΋˜ ·Ó¿ÚÎÂÈ·˜ ·Ô‰›‰ÔÓÙ·È ÛÙÔ˘˜ ·Ú·Î¿Ùˆ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ● ·Ó¿ÚÎÂÈ· ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ ● ÂÏ¿¯ÈÛÙ˜ ÂȉڿÛÂȘ ÛÙÔ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ● ÂÍ¿ÓÙÏËÛË ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ∆· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Â›Ó·È Ì›· ÂÙÂÚÔÁÂÓ‹˜ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ Ì ‰È·ÊÔÚÂÙÈ΋ ·ıÔÊ˘ÛÈÔÏÔÁ›·. ∂ÚÁ·ÛÙËÚȷο ÂÌÊ·Ó›˙ÔÓÙ·È Û·Ó ·Á΢ÙÙ·ÚÔÂÓ›· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‹ ÌÂÌÔӈ̤Ó˜ ΢ÙÙ·ÚÔÂӛ˜ 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·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ .¯. Ô˘‰ÂÙÂÚÔÂӛ˜ (ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË ) - ‰Â˘ÙÂÚÔ·ıÒ˜ ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂڷ›·, ·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‰˘ÛÏ·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 ·Ó¿ÚÎÂÈ· ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘. ™Ù· ·Ï·ÛÙÈο Û‡Ó‰ÚÔÌ· Ë ·ÈÌÔÔ›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·ÚÔÂÓ›· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ Â‡ÚËÌ·. ™Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ¤¯Ô˘Ì ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ Î·È ÌÂÌÔӈ̤Ó˜ ‹ Û˘Ó‰˘·Ṳ̂Ó˜ ΢ÙÙ·ÚÔÂӛ˜ 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· ÔÔ›· ÔÊ›ÏÔÓÙ·È Û ηٷÛÙÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ¯ËÌÂÈÔıÂڷ›·, ·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˜ ·Ï·Û›Â˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¿ÁÓˆÛÙ˘, ˆ˜ › ÙÔ Ï›ÛÙÔÓ, ·ÈÙÈÔÏÔÁ›·˜ Ô˘ Û˘Ó‹ıˆ˜ ÂÍÂÏ›ÛÛÔÓÙ·È ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·Û›· ‹ ÔÍ›· Ï¢¯·ÈÌ›·. ¶·Á΢ÙÙ·ÚÔÂÓ›· ¢ÂÓ Â›Ó·È ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ·ÏÏ¿ ÙÚÈ¿‰· ¢ÚËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÔÈΛϷ ·›ÙÈ· (¶›Ó·Î·˜ 1). ∂ÎÊÚ¿˙ÂÙ·È Ì ÙË Ì›ˆÛË fiÏˆÓ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ● ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Ô˘ ÌÔÚ› 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˜ ‹ ˘ÔÏ·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·ÊÔÚÔÔ›ËÛ˘ ● ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›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 ÂÓÂÚÁÔÔÈË̤ӷ ·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·˜ ·ÈÌÔÔÈËÙÈ΋˜ ÛÂÈÚ¿˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ó·Ù‡ÛÛÂÙ·È ·Á΢ÙÙ·ÚÔÂÓ›· ÌÂ Û˘ÓÔ‰fi Ì˘ÂÏÈ΋ ˘ÔÏ·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·ÚÔÂÓ›·˜. ¡ÔÛ‹Ì·Ù· Ì ‰È‹ıËÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ● ªÂȈ̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ ∞Ï·ÛÙÈ΋ ‹ ˘ÔÏ·ÛÙÈ΋ ·Ó·ÈÌ›· ª˘ÂÏÔ‰˘ÛÏ·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‰˘ÛÏ·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: ÀÂÚÛÏËÓÈÛÌfi §ÔÈÌÒÍÂȘ fiˆ˜ ÈÒÛÂȘ, Kala-azar, ÎÂÁ¯ÚÔÂȉ‹ Ê˘Ì·Ù›ˆÛË ∞Ó¿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‚ÔÂÓ›·˜, Î·È Ï¢ÎÔÂÓ›·˜. ∫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›· ÛÏËÓÔÌÂÁ·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˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î·È ÏÂÌÊÔÔÈËÙÈÎÔ‡ 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˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù· Â›Ó·È ¿Ù˘· ‹ ÙÔ ‰Â›ÁÌ· Ì˘ÂÏÔ‡ Â›Ó·È ·Ó·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 ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ·Á΢ÙÙ·ÚÔÂÓ›·˜ 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·ÚÔÂÓ›· 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 ·ÈÌÔÔÈËÙÈÎÒÓ 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‚ÔÂÓ›·˜. OÈ ·ÛıÂÓ›˜ ηٿ ÙË ‰È¿ÁÓˆÛË Û˘Ó‹ıˆ˜ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ˘ÚÂÙfi, Ô‡Ù ‰ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ ‹ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ·Á΢ÙÙ·ÚÔÂÓ›·˜ ¯ˆÚ›˜ ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ·fi ͤӷ ·ÙÙ·Ú· Î·È ¯ˆÚ›˜ ÛÙÔȯ›· ‰˘ÛÌ˘ÂÏÔÔ›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‡, ÏÂÙÔÌÂÚ¤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·ÚÔÂÓ›·˜. ∏ ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· ›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‡ ÌÔÚ› 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· ÏÈÔ·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‰˘ÛÏ·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· ÔÔ›· ‚·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·ÚÔÂÓ›·, fiˆ˜ ‰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˘˜ fiˆ˜ Ó¢ÚÔ‚Ï¿Ûو̷, Û·ÚÎÒÌ·Ù· (Ì ·Ó·ÚÚfiÊËÛË Ì˘ÂÏÔ‡ Î·È ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·), - ÔÛÙÂÔ¤ÙÚˆÛË, ıËÛ·˘ÚÈÛÌÒÛÂȘ, ˘ÂÚÛÏËÓÈÛÌfi (Ì ·Ó·ÚÚfiÊËÛË Î·È ‚ÈÔ„›· Ì˘ÂÏÔ‡, ·Ô˘Û›· ÛÏËÓÔÌÂÁ·Ï›·˜), - Ì˘ÂÏÔÛÎÏ‹Ú˘ÓÛË, Ì˘ÂÏÔ˚ÓˆÛË (·Û‡ÓËı˜ ÙÔ "dry tap" ÛÙËÓ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, ÛÙËÓ ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· ›ÓˆÛË ·ÓÙ› ϛԘ),
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·473
¶∞π¢π∞∆ƒπ∫∏ 2000;63:470-477
- ·Ó¿ÚÎÂÈ· ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ ‚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·ÚÔÂÓ›· ·ÓÔÛÔÂÍ·ÚÙÒÌÂÓË (΢ÙÙ·ÚÔ‚ÚÈı‹˜ Ì˘ÂÏfi˜). ™ËÌ·ÓÙÈ΋ ‰˘ÛÎÔÏ›· ˘¿Ú¯ÂÈ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ∞∞ ·fi Ù· Ì˘ÂÏÔ‰˘ÛÏ·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˘ÂÏÔÔ›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˘ ÏÂÙÔÌÂÚÔ‡˜ 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 ıÂڷ¢ÙÈ΋ ÛËÌ·Û›·. ∆· ÎÚÈÙ‹ÚÈ· Ù˘ ‚·ÚÈ¿˜ ∞∞ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 3. ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ∆· ª¢™ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ·ÔÙÂÏÔ‡Ó ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÎψÓÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢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·ÚÔÂӛ˜, ÌË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÌÔÔ›ËÛË, ‰˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÌÈ·˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ 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 ¯ËÌÂÈÔıÂڷ›· ‹ ·ÎÙÈÓÔ‚ÔÏ›·. ∏ ÚfiÁÓˆÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·È‰ÈÒÓ Ì ª¢™ Â›Ó·È Î·Î‹ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ì ¯ËÌÂÈÔıÂڷ›· ‰›ÓÂÈ ÊÙˆ¯¿ ·ÔÙÂϤÛÌ·Ù·. ∏ ·ÏÏÔÁÂÓ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È Ë ıÂڷ›· ÂÎÏÔÁ‹˜. ¶ÂÚ›Ô˘ 30% ÙˆÓ ·È‰ÈÒÓ Ì ª¢™ Û¯ÂÙ›˙ÔÓÙ·È Ì ÚԉȷıÂÛÈΤ˜ ·ÓˆÌ·Ï›Â˜ fiˆ˜ ·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 ÔÔÈ·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˘Â˜ 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›· ·ÈÌÔÂÙ·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˘ıÚÔÔ›ËÛ˘ ¯ˆÚ›˜ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· ∂›Â‰· µ12 Î·È Ê˘ÏÏÈÎÔ‡ Ôͤˆ˜ Ê˘ÛÈÔÏÔÁÈο ‹ ·˘ÍË̤ӷ ∂Ú˘ıÚÔÔÈËÙ›ÓË ÔÚÔ‡ ·˘ÍË̤ÓË - ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ™ˆÛÙ‹ ÂÎÙ›ÌËÛË Ì ÔÛÙÂÔÌ˘ÂÏÈΤ˜ ‚ÈÔ„›Â˜ Û ÔÏϤ˜ ı¤ÛÂȘ ÀÔ΢ÙÙ·ÚÈÎfi˜ Ì˘ÂÏfi˜ Ì ·ÙÙ·Ú· ‰ÈÎÙ‡Ô˘, ϛԘ, 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˘ ˘ÔÏ·ÛÙÈÎÔ‡ Ì˘ÂÏÔ‰˘ÛÏ·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 ∞ÈÌÔÂÙ¿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· ∞∞ (˘ÔÏ·ÛÙÈ΋) ∫˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ 25-50% Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜, ·ÏÏ¿ Ì ÔÛÔÛÙfi ·ÈÌÔÔÈËÙÈÎÒÓ 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. ¢˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfïÓ. ™ÂÈÚ¿
¶ÂÚÈÊÂÚÈÎfi ·›Ì·
ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ
∂Ú˘ıÚ¿
ª·ÎÚÔ΢ÙÙ¿ÚˆÛË, ‰›ÌÔÚÊÔ˜ ÏËı˘ÛÌfi˜, Û·Ṳ̂ӷ ÂÚ˘ıÚ¿, ÔÏ˘¯ÚˆÌ·ÙÔÊÈÏ›·, ÒÚÈÌÔÈ ÂÚ˘ıÚÔ‚Ï¿ÛÙ˜
ÀÂÚÏ·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
ªÂÁ·Î·Ú˘Ô΢ÙÙ·ÚÈ΋
£ÚÔÌ‚ÔÂÓ›· °ÈÁ¿ÓÙÈ· ·ÈÌÔÂÙ¿ÏÈ·
∂Ï¿ÙÙˆÛË ÙˆÓ ÌÂÁ·Î·Ú˘Ô΢ÙÙ¿ÚˆÓ ªÈÎÚÔÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú·
ÛÙȘ ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Û ·ÛıÂÓ‹ Ì ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ·Ó·ÚÎÔ‡˜ ·ÈÌÔÔ›ËÛ˘, Ô˘ ÂΉËÏÒÓÂÙ·È Ì ·Ó·ÈÌ›·, Ô˘‰ÂÙÂÚÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· ‹ Û˘Ó‰˘·Ṳ̂Ó˜ ΢ÙÙ·ÚÔÂӛ˜. 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·ÚÔÂÓ›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Â›Ó·È Ë ¤Ó‰ÂÈÍË Ù˘ ·Ó·ÚÎÔ‡˜ ·ÈÌÔÔ›ËÛ˘. OÈ ‰˘ÛÏ·ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ÔÈΛϘ, ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ·ÈÌÔÔÈËÙÈΤ˜ 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‰˘ÛÏ·Û›·˜ ·fi ÌfiÓ˜ ÙÔ˘˜. ∞Ó¿ÚÎÂȘ ‚ÈÙ·Ì›Ó˘ µ12 Î·È Ê˘ÏÏÈÎÔ‡, ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ fiˆ˜ Ë HIV Ïԛ̈ÍË Î·È Ë ¤ÎıÂÛË Û ·ÓÙÈ‚ÈÔÙÈο, ¯ËÌÂÈÔıÂڷ¢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‰˘ÛÏ·Û›·˜. ∂ÎÙfi˜ ·fi ÙËÓ ·Ó‡ÚÂÛË ¯ÚˆÌÔÛˆÌÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ Û˘¯Ó¿ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·Û›· Î·È ÔÍ›· Ï¢¯·ÈÌ›·, Ë ·Ó‡ÚÂÛË ÔÔÈ·Û‰‹ÔÙ ›ÎÙËÙ˘ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ·ÓˆÌ·Ï›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ÎψÓÈ΋ ·ÈÌÔÔ›ËÛË Î·È Â›Ó·È ¤Ó‰ÂÈÍË Î·ÎÔ‹ıÂÈ·˜. ™Â Ì›· ÌÂÁ¿ÏË ÛÂÈÚ¿ Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·Ù· Î·È ·ÊÔÚÔ‡Û ·È‰È¿, ·Ó¢ڤıËÎ·Ó Î˘ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∆· 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‡ÌÏÔΘ ηڢÔÙ˘ÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÌÔÓÔۈ̛· 7, ÙÚÈۈ̛· 8 Î·È 21. ∆· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ÛÙ· ·È‰È¿ Â›Ó·È Û¿ÓÈ· Ì ÂÙ‹ÛÈ· ›وÛË 3-4 ÂÚÈÙÒÛÂȘ ·Ó¿ ÂηÙÔÌ̇ÚÈÔ Î·È Ë Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û‡Á¯˘ÛË, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÂÚÈÙÒÛÂˆÓ 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˜ ÙÚÔÔÔÈ‹ÛÂȘ. ™ÙËÓ Û˘Ó¤¯ÂÈ· ı· ·Ó·ÊÂÚıÔ‡Ó ÔÈ Û˘¯ÓfiÙÂÚ˜ ÌÔÚʤ˜ Ì˘ÂÏÔ‰˘ÛÏ·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·ÚÔÂÓ›· ‹ ÌÂÌÔӈ̤ÓË Î˘ÙÙ·ÚÔÂÓ›· (Û˘Ó‹ıˆ˜ ·Ó·ÈÌ›·). º˘ÛÈÔÏÔÁÈ΋ ‹ ·˘ÍË̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· Ì˘ÂÏÔ‡ Ì ‰˘ÛÏ·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˘ıÚÔÔÈËÙÈ΋˜ 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% (› ÙˆÓ ÂÌ˘Ú‹ÓˆÓ Î˘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· › ·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·ÚÔÂÓ›· ‰‡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˘ÂÏÔÔ›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‰˘ÛÏ·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 ¯ËÌÂÈÔıÂڷ›·. 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 ˘ÂÚÏ·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‰˘ÛÏ·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·ÙÔÛÏËÓÔÌÂÁ·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‡ÌÏÔΘ ¯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 ÂÈ‚›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 ˘ÂÚÏ·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˘, ÂÂȉ‹ 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·ÙÔÛÏËÓÔÌÂÁ·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˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ Ó¤Â˜ ηÙËÁÔڛ˜, ·ÏÏ¿ Î·È ÂΛӘ Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ÎÏ·ÛÈΤ˜ Ù·ÍÈÓÔÌ‹ÛÂȘ, fiˆ˜ Ù· ÔÈÎÔÁÂÓ‹ /ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ª¢™ Î·È Ù· ÚÔηÏÔ‡ÌÂÓ· ·fi ıÂڷ¢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) ∏·ÙÔÛÏËÓÔÌÂÁ·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˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ÌÔÓÔۈ̛· 7) ÀÂÚ¢·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 Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡, ÔÈ Ì˘ÂÏÔ‚Ï¿ÛÙ˜ ηٷÌÂÙÚÒÓÙ·È ˆ˜ ÔÛÔÛÙfi › fiÏˆÓ ÙˆÓ ÂÌ˘Ú‹ÓˆÓ Î˘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˜ ÂÚÈÙÒÛÂȘ 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). ÀÔ΢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 ˘ÔÏ·ÛÙÈ΋ Oª§ ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ΢ÙÙ·-
476
∞. ¶Ô˘ÚÙÛ›‰Ë˜
¶›Ó·Î·˜ 6. §ÂÙÔÌÂÚ‹˜ Ù·ÍÈÓfiÌËÛË ÙˆÓ ª¢™. ¶ÚˆÙÔ·ı‹ ª¢™ ™È‰ËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ∞ÓıÂÎÙÈ΋ ΢ÙÙÔÂÓ›· ™‡Ó‰ÚÔÌÔ ·ÒÏÂÈ·˜ Ì·ÎÚÔ‡ ÛΤÏÔ˘˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 5 (5q-) π‰ÈÔ·ı‹˜ Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË ª¢™ Ì ‰˘ÛÎÔÎÎÈÔÔ›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¸ÂÚÏ·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 ¯ËÌÂÈÔıÂڷ›· Ì ·Ï΢ÏÈÔ‡ÓÙ˜ ·Ú¿ÁÔÓÙ˜ Î·È ·Ó·ÛÙÔÏ›˜ Ù˘ ÙÔÔ˚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˘Â˜ ı¤ÛÂȘ, ÙËÓ ·Ó‡ÚÂÛË ÌÔÚÊÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ ‰˘ÛÌÂÁ·Î·Ú˘ÔÔ›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›· fiˆ˜ 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΋˜ ·Ó¿ÚÎÂÈ·˜ ¶·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·Ó¿ÚÎÂÈ·˜ fiˆ˜ ·Ó·ÈÌ›· Fanconi, Û‡Ó‰ÚÔÌÔ Shwachman, Û˘ÁÁÂÓ‹ Ô˘‰ÂÙÂÚÔÂÓ›· (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 ÂÚÈÙÒÛÂˆÓ 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˘‰ÂÙÂÚÔÂÓ›·˜ 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˘‰ÂÙÂÚÔÂÓ›· Î·È ıÂڷ›· Ì ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (G-CSF). ∆Ô ÂÚÒÙËÌ· Â›Ó·È Â¿Ó Ë Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· ıˆÚÂ›Ù·È ÚÔηÎÔ‹ı˘ ηٿÛÙ·ÛË ‹ Ë ·Ó¿Ù˘ÍË ª¢™ Î·È Oª§ ·Ô‰›‰ÂÙ·È ÛÙË ıÂڷ›·. ª¢™ Î·È ÏÔÈÌÒÍÂȘ ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ ‰˘Ó·ÙfiÓ, ÂÚÈÛÙ·Ûȷο, Ó· ÚÔηϤÛÔ˘Ó ÛÔ‚·Ú‹ ‰˘ÛÏ·Û›· ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÙˆÓ ÙÚÈÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ 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› fiˆ˜ Ô Èfi˜ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Î·È Ô ÂÚËÙÔ˚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›, fiˆ˜ Î·È Ô Èfi˜ Ù˘ ›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿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 ÂÈÏÔÁ‹ 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˘ ÙÔÔ˚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‰˘ÛÏ·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 ÃËÌÂÈÔıÂڷ›· ‹ ∞ÎÙÈÓÔıÂڷ›· ∆· ª¢™ Î·È ÔÈ Oª§ ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂڷ›· ‹ ·ÎÙÈÓÔıÂڷ›· ·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˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ ππ, ÂÓÔ¯ÔÔÈÔ‡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‰˘ÛÏ·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› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ª·Ú›· ªÔÛ¯fi‚Ë
● ¶ÂÚ›ÏË„Ë: OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÈÂÁ›ÚÔ˘Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ 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 ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ·ÚÁfiÙÂÚ· ÛÙËÓ ·Ó¿Î·Ì„Ë Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ ·ÈÌÔÔ›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 ıÂڷ›· ÂÎÏÔÁ‹˜, ·˘Í¿ÓÔÓÙ·˜ ı·̷ÙÈο Ù· ÔÛÔÛÙ¿ ÂÈ‚›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˘ ·ÈÌÔÔ›ËÛ˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Ó¿Î·Ì„Ë, ÂÚÈÛÛÔÙ¤ÚˆÓ Ù˘ ÌÈ·˜, ÛÂÈÚÒÓ. ™ÙÔ Û‡Ó‰ÚÔÌÔ Kostmann, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ô˘‰ÂÙÂÚÔÂÓ›·, Ë ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·‡ÍËÛ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›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 ¤ÎÙˆÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ Î·È Ë Û˘Ó˘¿Ú¯Ô˘Û· ıÚÔÌ‚ÔÂÓ›·. ∏ ¯ÔÚ‹ÁËÛË ÂÚ˘ıÚÔÔÈËÙ›Ó˘ Ì ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Ó¿Î·Ì„Ë Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈÚÒÓ. ∏ ÂÌÊ¿ÓÈÛË Ï¢¯·ÈÌÈÒÓ Î·È Ì˘ÂÏÔ‰˘ÛÏ·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, ÂÈÏÔΤ˜. 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΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·", ∞ı‹Ó·
478
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·479
¶∞π¢π∞∆ƒπ∫∏ 2000;63:478-482
OÈ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ 10Âٛ˜ Ì¿˜ ¯¿ÚÈÛ·Ó ÙËÓ ÎψÓÔÔ›ËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (HGF) Î·È ¯¿ÚȘ Û ·˘ÙÔ‡˜ ¿ÏÏ·ÍÂ Ë ıÂÒÚËÛË ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÈÂÁ›ÚÔ˘Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ (ÂÚ˘ıÚÔÔÈËÙ›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‚ÔÔÈËÙ›ÓË). OÈ ÈÓÙÂÚÏ¢ΛÓ˜ ‰ÚÔ˘Ó Û˘Ó‹ıˆ˜ Û ÚÒÈÌË Ê¿ÛË Ù˘ ·ÈÌÔÔ›ËÛ˘ ‹ Û˘ÓÂÚÁÈο Ì ¿ÏÏÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¶ÚfiÛÊ·Ù· ÎψÓÔÔÈ‹ıËÎ·Ó ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ÛÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·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˘, fiˆ˜ Ô ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (G-CSF), ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ (M-CSF), Ë ÂÚ˘ıÚÔÔÈËÙ›ÓË (EPO), Ë ıÚÔÌ‚ÔÔÈËÙ›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΋˜ ·Ó¿ÚÎÂÈ·˜, Ô G-CSF ‚Ô‹ıËÛ ÛËÌ·ÓÙÈο ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ ‹ ›ÎÙËÙË Ô˘‰ÂÙÂÚÔÂÓ›·, ÂÓÒ Ë ∆ƒO ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÌÂÙ¿ ¯ËÌÂÈÔıÂڷ›· ÛÂ Û˘Ì·Á›˜ ΢ڛˆ˜ fiÁÎÔ˘˜. 2. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ ÛÂÈÚ¤˜ (multilineage) ‹ ÚÒÈÌ˘ Ê¿Û˘ (early acting HGF), fiˆ˜ 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, fiˆ˜ Ô Stem cell factor (SCF) Î·È Ô Flt3 ligand. √ SCF ¯ÔÚËÁÔ‡ÌÂÓÔ˜ Ì·˙› Ì ÙËÓ EPO ‹ ÙÔÓ G-CSF ‰ÈÂÁ›ÚÂÈ Û ‰È·ÊÔÚÔÔ›ËÛË ÙËÓ ÂÚ˘ıÚ¿ ÛÂÈÚ¿, ÙËÓ ÎÔÎÎÈÒ‰Ë ·ÏÏ¿ ÂÈÚfiÛıÂÙ· Î·È Ù· ÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú·. 4. ™˘ÓÂÚÁÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ 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·ÊÔÚÔÔ›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‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ıÚÔÌ‚ÔÂÓ›·, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. OÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ·Ú¯Èο, ¯ÚËÛÈÌÔÔÈ‹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 ÈηÓÔÔÈ-
∞’ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙·
ËÙÈÎfi ÙÔ Â›Â‰Ô ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ, ÒÛÙ ӷ ÌÂȈı› Ô Î›Ó‰˘ÓÔ˜ ÙˆÓ ÏÔÈÌÒ͈Ó. ∞ÚÁfiÙÂÚ·, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘Ó‰˘·ÛÌÔ› ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó Û ‰È·ÊÔÚÂÙÈο ÛÙ¿‰È· Ù˘ ·ÈÌÔÔ›ËÛ˘, ÒÛÙ ӷ ÂÈÙ¢¯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 ÂÈ‚›ˆÛË, ·ÏÏ¿ ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó Û ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi Ï¢¯·ÈÌ›· ‹ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ 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˘ ¿Ô„˘ fiÙÈ Ë ÂÌÊ¿ÓÈÛË Ù˘ Ï¢¯·ÈÌ›·˜ ÌÔÚ› 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˜ ÂÈ‚›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›˜ ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∞Ï·ÛÙÈ΋ ·Ó·ÈÌ›· OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ·›˙Ô˘Ó Ôχ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÈ‚›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΋˜ ·ÈÌÔÔ›ËÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ∂Âȉ‹ ‰ÂÓ ÌÔÚÔ‡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˘˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÍ¿ÓÙÏËÛË Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ·ÈÌÔÔ›ËÛ˘, ÁÈ' ·˘Ùfi Ë ∂˘Úˆ·˚΋ ÔÌ¿‰· ªÂÙ·ÌfiÛ¯Â˘Û˘ Ù˘ ∞Ï·ÛÙÈ΋˜ ∞Ó·ÈÌ›·˜ ÚÔÙ›ÓÂÈ Ó· ÌËÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌfiÓÔÈ ÙÔ˘˜ Û ڈÙԉȿÁÓˆÛÙÔ˘˜ ·ÛıÂÓ›˜, ·ÊÔ‡ ‰ÂÓ ÌÔÚÔ‡Ó ·Ê' ·˘ÙÒÓ Ó· ˘ÂÚÓÈ΋ÛÔ˘Ó ÙÔ˘˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó Î·Ù·ÛÙÔÏ‹ Ù˘ ·ÈÌÔÔ›ËÛ˘. ∫·ÙfiÈÓ ÙÔ‡ÙÔ˘, Ë ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞∞, ‰È·ÎÚ›ÓÂÙ·È Û ÙÚÂȘ ‰È·ÊÔÚÂÙÈΤ˜ Ê¿ÛÂȘ: 1) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹, 2) ˆ˜ ıÂڷ›· ‰Â‡ÙÂÚ˘ ÂÈÏÔÁ‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο, 3) ˆ˜ ÂÈÚfiÛıÂÙË ·ÁˆÁ‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÛÔ‚·ÚÒÓ ÏÔÈÌÒ͈Ó. µÂ‚·›ˆ˜, ÛÙ· ·È‰È¿ Ì ∞∞ ıÂڷ›· 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 ıÂڷ›· ÚÒÙ˘ ÂÈÏÔÁ‹˜. ™ÙȘ ÂÚÈÙÒÛÂȘ, 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¿ ÂÈ‚›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 ÂÈ‚›ˆÛË ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ·ÁˆÁ‹˜ ÌfiÓÔ Ì ΢ÎÏÔÛÔÚ›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 ÂÈ‚›ˆÛË ·˘Í‹ıËΠÛÙËÓ ÔÌ¿‰· Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ Û 50% ÂÓÒ ÛÙËÓ ÔÌ¿‰· Ù˘ ALG 100%. ∂ÈϤÔÓ, ˘‹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 ·ÈÌÔÂÙ·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˘ÏÚ‰ÓÈ˙ÔÏfiÓË Î·È G-CSF. OÈ 33 ·ÛıÂÓ›˜ (82%) ·ÚÔ˘Û›·Û·Ó ·ÓÙ·fiÎÚÈÛË Î·È ÛÙȘ ÙÚÂȘ ÛÂÈÚ¤˜ ·ÈÌÔÔ›ËÛ˘. ∏ Û˘ÓÔÏÈ΋ ÂÈ‚›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˘˜, fiÔ˘ Û 84 ·ÛıÂÓ›˜ ›¯Â ¯ÔÚËÁËı› ÙÔ ›‰ÈÔ Û¯‹Ì· ·ÓÔÛÔηٷÛÙÔÏ‹˜ ¯ˆÚ›˜ G-CSF, Ë ÂÈ‚›ˆÛË ‹Ù·Ó 68% Î·È Ë ‰È·ÊÔÚ¿ ÛÙËÓ ÂÈ‚›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 ÂÈ‚›ˆÛ˘ Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ (CyA, ALG, Danasol) Î·È ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (G-CSF). º·›ÓÂÙ·È, ‰ËÏ·‰‹, fiÙÈ ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌÔÚÔ‡Ó Ó· Û˘ÓÂÈÛʤÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ, ·Ó ¯ÔÚËÁËıÔ‡Ó Ì·˙› Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹. ∏ ¯Ú‹ÛË ÌfiÓÔÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·ÔÙÂÏ› ıÂڷ›· ‰Â‡ÙÂÚ˘ ÂÈÏÔÁ‹˜ 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 ·ÈÌÔÔ›ËÛ˘. ªÂ ÙË ÛΤ„Ë ·˘Ù‹, ·Ú¯Èο ÙÔ ÂӉȷʤÚÔÓ ÛÙÚ¿ÊËΠ۠·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ Ù˘ Ì›·˜ ÛÂÈÚ¤˜, ‰ËÏ·‰‹ Û ·Ú¿ÁÔÓÙ˜ ÚÒÈÌ˘ Ê¿Û˘, fiˆ˜ 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 ÂȉȈÎfiÌÂÓË ·‡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 ·ÈÌÔÂÙ·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· ·ÈÌÔÂÙ¿ÏÈ·, ·ÏÏ¿ ‰ÂÓ ˘‹ÚÍ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ÂÚ˘ıÚ¿ ÛÂÈÚ¿. ∞Ó fï˜ Ë IL3 Û˘Ó‰˘·Ûı› Ì ÙÔÓ G-CSF, ÙfiÙ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ Û ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ¶ÚfiÛÊ·Ù·, ¿Ú¯ÈÛ·Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ÛÙÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi ·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‰˘ÛÏ·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 ÂÈÌ‹Î˘Ó ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ∞∞, ıˆÚÂ›Ù·È ·fi ·ÚÎÂÙÔ‡˜ fiÙÈ ÌÔÚ› 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‰˘ÛÏ·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‹ıËΠÚÔÁÚ·ÌÌ·ÙÈṲ̂ӷ Ì ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi ¤ÏÂÁ¯Ô, ÙÔ 7,7% ÙˆÓ ·ÛıÂÓÒÓ ·Ó¤Ù˘ÍÂ Ì˘ÂÏÔ‰˘ÛÏ·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 ›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˘‰ÂÙÂÚÔÂÓ›· ÛÙËÓ ÔÔ›· Ë ‰È·ÊÔÚÔÔ›ËÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ ÛÙ·Ì·Ù¿ ÛÙÔ Â›Â‰Ô ÙÔ˘ ÚÔÌ˘ÂÏÔ΢ÙÙ¿ÚÔ˘. OÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÌÈÎÚfi ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, ÌfiÏȘ 3,5 ¯ÚfiÓÈ· Î·È Î·Ù·Ï‹ÁÔ˘Ó, ΢ڛˆ˜, ·fi ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ. ∏ ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·‡ÍËÛ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›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·ÊÔÚÔÔ›ËÛ˘ Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜, ·Ú¯Èο, ıˆڋıËΠfiÙÈ ÔÊ›ÏÂÙ·È ÛÙËÓ ‡·ÚÍË ·ıÔÏÔÁÈÎÔ‡ ˘Ô‰Ô¯¤· ÙÔ˘ G-CSF ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Û˘ÁÎÏ›ÓÔ˘Ó Ï¤ÔÓ ˘¤Ú Ù˘ ¿Ô„˘ 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 ÎÔÎÎÈÔÔ›ËÛË, ‰ËÏ·‰‹ Û ·ıÔÏÔÁÈ΋ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÌËӇ̷ÙÔ˜ Ù˘ ÎÔÎÎÈÔÔ›ËÛ˘ ·fi ÙË ÌÂÌ‚Ú¿ÓË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÛÙÔÓ ˘Ú‹Ó·. ∂ȉÈÎfiÙÂÚ·, Ë JAK-2 ÂÚÈÔ¯‹ ÙÔ˘ ÚˆÙÔÏ¿ÛÌ·ÙÔ˜ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È ÂÓÂÚÁÔÔÈË̤ÓË Î·È Ì ·˘ÍË̤ÓË ·ÔÊÔÛÊˆÚ˘Ï›ˆÛË Û ۯ¤ÛË Ì ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ∆· ›‰· 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 ÂÈÏÔÁ‹˜ 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 ÂÚÈÙÒÛÂȘ 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˜. ∏ ÂÈÌ‹Î˘ÓÛË fï˜, ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ ¤ÊÂÚ ÛÙÔ Êˆ˜ ‰Â˘ÙÂÚÔÁÂÓ‹ ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë Ï¢¯·ÈÌ›· Î·È Ù· Ì˘ÂÏÔ‰˘ÛÏ·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·ÊÔÚÔÔÈËı› 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˘ ¿Ô„˘ fiÙÈ 1) Ë Ï¢¯·ÈÌ›· ÌÔÚ› 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 ÂÈ‚›ˆÛ˘ Î·È 3) ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÚÔ˘Ó ˆ˜ ÂÈÚfiÛıÂÙÔ ·›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˘ ÚˆÙÔÏ¿ÛÌ·ÙÔ˜ Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÎÔÎÎÈÔÔ›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¢ÎÔÂÓ›· Î·È ıÚÔÌ‚ÔÂÓ›· ÚÈÓ ÌÂÙ·¤ÛÂÈ Û ·Á΢ÙÙ·ÚÔÂÓ›·. ∆Ô Ì›˙ÔÓ Úfi‚ÏËÌ· ÁÈ· Ù· ·È‰È¿ Ì ·Ó·ÈÌ›· Fanconi ‰ÂÓ Â›Ó·È Ë ¯·ÌËÏ‹ ·ÈÌÔÛÊ·ÈÚ›ÓË, ·ÏÏ¿ Ë ¤ÎÙˆÛË Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ Î·È Ë Û˘Ó˘¿Ú¯Ô˘Û· ıÚÔÌ‚ÔÂÓ›·. ∏ Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÚ˘ıÚÔÔÈËÙ›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 ÂÈϤÔÓ Î·È ·‡ÍËÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘, ÂÓÒ 3/10 ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË Î·È ÛÙ· ·ÈÌÔÂÙ¿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 ÔÔ›· ˘Ê¤ıËΠÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ G-CSF. ∞ÒÙÂÚ˜ ÂÈÏÔΤ˜ ∫·›ÚÈÔ ÂÚÒÙËÌ· Â›Ó·È ·Ó Ë Ì·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÚÔηÏ› ¿ÏϘ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ ÂÎÙfi˜ ·fi ÙËÓ ÂӉ¯fiÌÂÓË ÚԉȿıÂÛË ÛÙË Ï¢¯·ÈÌ›·. ∞fi ÙË ¢ÈÂıÓ‹ ÔÌ¿‰· ηٷÁÚ·Ê‹˜ Ù˘ ‚·ÚÈ¿˜ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, 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 ÂÈÏÔΤ˜ ·fi ÙË ¯Ú‹ÛË ÙÔ˘˜. ∏ ÛÏËÓÔÌÂÁ·Ï›·, ·Ó Î·È ÚÔ¸‹Ú¯Â Û ÔÏÏÔ‡˜ ·ÛıÂÓ›˜, ·˘Í‹ıËΠÛÙÔ 49% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘Á-
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:478-482
ÁÂÓ‹ Ô˘‰ÂÙÂÚÔÂÓ›·. ¶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· ÔÛÙÂÔÂÓ›· ‹ ÔÛÙÂÔfiÚˆÛË. ™ÙËÓ ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚı›۷ ÌÂϤÙË, ÔÛÙÂÔfiÚˆÛË ·ÚÔ˘Û›·Û ÙÔ 14% ÙˆÓ ·ÛıÂÓÒÓ. ª˘ÂÏÔ‰˘ÛÏ·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˘‰ÂÙÂÚÔÂÓ›·˜, 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 ›‰·. ∂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 ·ÈÌÔÔÈËÙÈÎfi Û‡ÛÙËÌ·, Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Ï¢¯·ÈÌÔÁ¤ÓÂÛË. ∞ÊÔ‡ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ˘·ÚÎÙfi˜, ÛÎfiÈÌÔ 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΢ÙÙÔÂÓ›·, ‰ËÏ·‰‹ ÚÔÛ‚ÔÏ‹ Ì›·˜ ÌfiÓÔÓ ÛÂÈÚ¿˜, ÌÔÚ› Ó· ·Ó·ÛÙ›ÏÔ˘Ó ‹ ¤ÛÙˆ Ó· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙËÓ ÂͤÏÈÍË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Û ·Á΢ÙÙ·ÚÔÂÓ›·. ™‹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
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-10-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-11-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª. ªÔÛ¯fi‚Ë √ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, 115 27 ∞ı‹Ó·
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ª. ªÔÛ¯fi‚Ë
Party. Blood 1999;93:2191-2195. 2. Shao Z, Chu Y, Zhang Y, Chen G, Zheeng Y. Treatment of severe aplastic anemia with an immunosuppressive agent plus recombinant human granulocytemacrophage colony-stimulating factor and erythropoietin. Am J Hematol 1998;59:185-191. 3. Kojima S, Hibi S, Kosaka Y, Yamamoto M, Tsuchida M, Sugita K et al. Immunosuppressive therapy with antilymphocyte globulin (ALG), cyclosporine A (CyA), Danasol with or without G-CSF in children with aquired aplastic anemia (AA). Blood 1998;92(Suppl 1):158a. 4. Bacigalupo A, Broccia G, Corda G, Arcese W, Carotenuto M, Gallamini A et al. Antilymphocyte globulin, cyclosporin and granulocyte colony-stimulating factor in patients with acquired severe aplastic anemia (SAA): A pilot study of the EBMT SAA Working Party. Blood 1995;85:1348-1353. 5. Kojima S. Use of hematopoietic growth factors for treatment of aplastic anemia. Bone Marrow Transplant 1996;18(suppl 3):S36-S38. 6. Socie G, Henry-Amar M, Bacigalupo A, Hows J, Tichelli A, Ljungman P et al. Malignant tumors occurring after treatment of aplastic anemia. N Engl J Med 1993;329:1152-1157. 7. Sieff CA, Nathan DG, Clark SC. Hematopoietic growth factor receptors. In Nathan DG, Orkin SH, eds. Hematology of infancy and childhood. 5th ed. W.B. Saunders Company; 1998. p. 193-200. 8. Bonilla MA, Dale D, Zeidler C, Last L, Ruggeiro M, Davis M et al. Long-term safety of treatment with recombinant human granulocyte colony-stimulating factor (r-metHuGCSF) in patients with severe congenital neutropenias. Br J Haematol 1994;88:723-730. 9. Weinblatt WE, Scimeca P, James-Herry A, Sahdev I, Kochen J. Transformation of congenital neutropenia into monosomy 7 and acute nonlymphoblastic leukemia in a child treated with granulocyte colony-stimulating factor. J Pediatr 1995;126:263-265. 10. Kinsey SE, Bonilla MA, Boxer L, Brown S, Dale DC, Cham B et al. Long-term safety of Filgrastim (G-CSF) therapy for chronic neutropenias. Blood 1998;92(Suppl 1):379a.
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·483
¶∞π¢π∞∆ƒπ∫∏ 2000;63:483-489
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™
∂›‰Ú·ÛË ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (rhG-CSF) ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿ÏÈ· ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›· ∫ÔÛÌ¿˜ ™·Ú·Ê›‰Ë˜, µ·ÛÈÏÈ΋ ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, ÷ڿϷÌÔ˜ ∞Á·Î›‰Ë˜, ¶·Ó·ÁÈÒÙ· ¶··Î˘ÚȷΛ‰Ô˘, ∞ı·Ó¿ÛÈÔ˜ ∞ı·Ó·Û›Ô˘, °ÂÒÚÁÈÔ˜ ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ›‰Ú·Û˘ ÙÔ˘ rh-G-CSF ÛÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË (Hct), ÛÙÔÓ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÛÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·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˜ ·ÈÌÔÂÙ·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¿ ‹ ·ÈÌÔÂÙ¿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 ·ÈÌÔÂÙ·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‡ ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ·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). ∏ ıÂڷ¢ÙÈ΋ ¯ÔÚ‹ÁËÛË rhG-CSF Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ‰˘ÛÌÂÓÒ˜ ÙÔÓ Hct, ÙÔÓ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ Ô‡Ù ÙȘ ·Ó¿ÁΘ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. ¶·È‰È·ÙÚÈ΋ 2000;63:483-489. §¤ÍÂȘ ÎÏÂȉȿ: G-CSF, ·ÈÌ·ÙÔÎÚ›Ù˘, ·ÈÌÔÂÙ¿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΋ ∞.¶.£., πÔÎÚ¿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˘ÎÔÚˆÙ½ÓË 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 ·Ô‰Â›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 ÂÈÊ·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‹ ›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. £ÂˆÚËÙÈο, Ô G-CSF ÌÔÚ› 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¿ ÌÔÚ› Ó· ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ›‰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‡. Afi 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 Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È fiϘ ÔÈ Î˘ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ÙÔ˘ ·›Ì·ÙÔ˜ (5-7). ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ Û ÂÓ‹ÏÈΘ ‰ÂÓ ¤‰ÂÈÍ·Ó ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ rhG-CSF, ÛÙ· ÂÚ˘ıÚ¿ Î·È ·ÈÌÔÂÙ¿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΋ ›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (12-14). ŸÌˆ˜, Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ Î·È in vitro ÌÂÏÂÙÒÓ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔÂÍÔÊÏ‹ÛÔ˘Ó ÙËÓ in vivo ›‰Ú·ÛË Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·, Ë ÔÔ›· ÂÈϤÎÂÙ·È Û˘¯Ó¿ ·fi ·Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÂÓ›· (15). ∂ÈϤÔÓ, ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜ ·˘Í¿ÓÔÓÙ·È Ù· ›‰· Ï¿ÛÌ·ÙÔ˜ ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ fiˆ˜ 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 Ôԛ˜ ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ·ÈÌÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (13,18,19). ŒÙÛÈ ÏÔÈfiÓ, ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÂڷ¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ rhG-CSF ¿Óˆ ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›· ˘fiÎÂÈÙ·È ÛÙË Û˘ÓÂÚÁÈ΋ ‹ ·ÓÙ·ÁˆÓÈÛÙÈ΋ ·ÏÏËÏ›‰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›·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ ÙËÓ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ ηıÒ˜ Î·È ÛÙȘ ·Ó¿ÁΘ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·, ÂϤÁ¯ÔÓÙ·˜ ¤ÙÛÈ ¤ÌÌÂÛ· ÙËÓ Â›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÈÏÔÙÈ΋ ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ¢ڇÙÂÚ˘ ¤Ú¢ӷ˜ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ıÂڷ¢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 ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ
¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ ÛËÙÈÎÒÓ 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 (∞/∫) ∆ÚfiÔ˜ ÙÔÎÂÙÔ‡ (ÎÔÏÈÎfi˜/∫∆) ∞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, fiÔ˘ Ë ÛË„·ÈÌ›· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÙË Û˘Ì‚·ÙÈ΋ ·ÓÙÈÌÈÎÚԂȷ΋ Î·È ÁÂÓÈ΋ ˘ÔÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹. 2) OÌ¿‰· GCSF, fiÔ˘ 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 ÂÂÈÛfi‰È·, ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘) Ì·˙› Ì ‰˘Ô ‹ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ (Ô˘‰ÂÙÂÚÔÂÓ›· <1800/mm3, Û¯¤ÛË ·ÒÚˆÓ ÚÔ˜ ÔÏÈο Ô˘‰ÂÙÂÚfiÊÈÏ· >0,25, ıÚÔÌ‚ÔÂÓ›· <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 ÔÔ›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 ·ÈÌÔÂÙ·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˘ ‹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 ·ÈÌÔÂÙ·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· ÂfiÌÂÓ· ÛÙËÓ 1Ë,
¶›Ó·Î·˜ 2. ∆È̤˜ (à ± SD) ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (∞∞O), ·ÈÌ·ÙÔÎÚ›ÙË Î·È ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜ ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜ ÓÂÔÁÓÒÓ Ì ÛË„·ÈÌ›·.
∞∞O ∞ÈÌ·ÙÔÎÚ›Ù˘ (%) ∞ÚÈıÌfi˜ ·ÈÌÔÂÙ·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
AfiÏ˘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 ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ë ÌË ·Ú·ÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· Mann Whitney Î·È Ë ‰ÔÎÈÌ·Û›· Fischer (Fischer exact test), fiÔ˘ ¯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˜ ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ 10 ÚÒÙˆÓ ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜. ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÂÈÙÚÔ‹ 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 ÙÚfiÔ 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· ÔÔ›· Ë ¯ÔÚ‹ÁËÛË ‰ÈÂÎfiË. ∆· ·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 ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ·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 ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ 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 Ôԛ˜ ÂȉÂÈÓÒÓÔÓÙ·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˘‰ÂÙÂÚÔÂÓ›·˜ (15). ™ÙËÓ ÚÔÛ¿ıÂÈ· ÚfiÏ˄˘ ‹ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ·ÏÏ¿ Î·È ÔÚÈÛÌ¤ÓˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·˘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˘ÂÏÔÔ›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˘˜, fiˆ˜ Â›Ó·È Ë ÂÈÊ·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·˜ ıÂڷ›·˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ÛËÌ·Û›· ¤¯ÂÈ fi¯È ÌfiÓÔ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·ÏÏ¿ Î·È Ë ·ÛÊ¿ÏÂÈ·. OÈ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ô˘ ··Û¯ÔÏÔ‡Û·Ó ÙÔ˘˜ ÓÂÔÁÓÔÏfiÁÔ˘˜ ‹Ù·Ó ΢ڛˆ˜ Ë ÂÈ‚¿Ú˘ÓÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÏfiÁˆ Û˘ÛÛÒÚ¢Û˘ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ Ó‡ÌÔÓ˜ (23), Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂȉÂÈÓÒÛÂÈ ÙËÓ ‹‰Ë ÂÈ‚·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¿, fiˆ˜ ˘Ô‰fiÚÈ· ‹ ÂÓ‰ÔÊϤ‚È· ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË, Û ‰fiÛÂȘ Ô˘ ‰ÂÓ ÍÂÂÚÓÔ‡Ó Ù· 10 mcg/kg/H (2-4,22). ªÈ· ¿ÏÏË Èı·Ó‹ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· Â›Ó·È Ë ÂӉ¯Ô̤ÓË ‰˘ÛÌÂÓ‹˜ ›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÂÚ˘ıÚÒÓ Î·È ·ÈÌÔÂÙ·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·ÊÔÚÔÔ›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 ÌÔÚ› Ó· ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·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˘˜ ÔÔ›Ô˘˜ Ë ·ÛÊ¿ÏÂÈ· Â›Ó·È ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘Ô‚ÏËıÔ‡Ó Û ıÂڷ›· ‰È¤ÁÂÚÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ Ì rhG-CSF, ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ‰ÂÓ Â›¯Â ηÌÈ¿ ›‰Ú·ÛË ‹ ÚÔοÏÂÛ ·ÚÔ‰È΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (8,24). ∂›Û˘, Ë ıÂڷ¢ÙÈ΋ ¯ÔÚ‹ÁËÛË rhG-CSF Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ¯ËÌÂÈÔıÂڷ›· ‰ÂÓ ¤‰ÂÈÍ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›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˘ıÚÔÔ›ËÛ˘ Î·È ıÚÔÌ‚ÔÔ›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 ·ÈÌÔÂÙ·Ï›ˆÓ (13), ÂÓÒ Ë in vitro ÚÔÛı‹ÎË rhG-CSF Û ηÏÏȤÚÁÂȘ ÚÔ‰ÚÔÌÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ 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, ÂÂȉ‹ ÛÙ· ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ˘¿Ú¯ÂÈ ‹‰Ë ηٷÛÙÔÏ‹ Ù˘ ÂÚ˘ıÚ¿˜ Î·È ıÚÔÌ‚Ô΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜. ∂ÈϤÔÓ, 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 ·ÈÌÔÔÈËÙÈÎÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (GM-CSF), ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ‰ÚÔ˘Ó Û˘ÓÂÚÁÈο Ì ÙÔÓ G-CSF ÛÙËÓ ÂÚ˘ıÚÔÔ›ËÛË Î·È ıÚÔÌ‚ÔÔ›ËÛË (5,7,13,28). ∞Ó Î·È ÛÙȘ ÌÂϤÙ˜ ıÂڷ¢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˘ıÚÔÔ›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 ÂËÚ¿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˘ıÚÔÔ›ËÛ˘, ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰˘Ô ÔÌ¿‰ˆÓ ÛË„·ÈÌÈÎÒÓ ÓÂÔÁÓÒÓ. º·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ ‰ÂÓ ·ÛÎÂ›Ù·È ‰˘ÛÌÂÓ‹˜ ›‰Ú·ÛË ÛÙËÓ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÒÓ. ™¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ rhG-CSF ÛÙ· ·ÈÌÔÂÙ¿ÏÈ·, Û ÚÔËÁÔ‡ÌÂÓË ÎÏÈÓÈ΋ ÌÂϤÙË Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ÂÌÊ¿ÓÈÛË ıÚÔÌ‚ÔÂÓ›·˜, Ô˘ fï˜ ı· ÌÔÚÔ‡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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¶∞π¢π∞∆ƒπ∫∏ 2000;63:483-489
CSF ÛÙ· ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ ÓÂÔÁÓÒÓ. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙÔ ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÁÂÁÔÓfi˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÙȘ ‰ÈÔÚıˆÙÈΤ˜ ÌÂÙ·ÁÁ›ÛÂȘ ·ÈÌÔÂÙ·Ï›ˆÓ. øÛÙfiÛÔ, ˘‹Ú¯Â Û·Ê‹˜ Ù¿ÛË ÁÈ· Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÌÂÙ·ÁÁ›ÛÂˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙËÓ ÔÌ¿‰· G-CSF, Ë ÔÔ›· ˘Ô‰ÂÈÎÓ‡ÂÈ ÂӉ¯fiÌÂÓË Â˘ÓÔ˚΋ ›‰Ú·ÛË ÛÙË ıÚÔÌ‚ÔÔ›ËÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ıÂڷ¢ÙÈ΋ ¯ÔÚ‹ÁËÛË rhGCSF Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ‰˘ÛÌÂÓÒ˜ ÙÔÓ ·ÈÌ·ÙÔÎÚ›ÙË Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÒ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ ÂÚÈÔÚ›˙ÂÈ ÙȘ ·Ó¿ÁΘ ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ ·ÈÌÔÂÙ·Ï›ˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Demetri GD, Griffin JD. Granulocyte colony-stimulating factor and its receptor. Blood 1991;78:1061-1075. 2. Gillan ER, Christensen RD, Suen Y, Ellis R, van de Ven C, Cairo MS. A randomized, placebo-controlled trial of recombinant human granulocyte colony-stimulating factor administration in newborn infants with presumed sepsis: Significant induction of peripheral and bone marrow neutrophilia. Blood 1994;84:1427-1433. 3. Drossou-Agakidou V, Kanakoudi-Tsakalidou F, Sarafidis K, Taparkou A, Tsimouli V, Tsantali H, et al. Administration of recombinant human granulocyte-colony stimulating factor to septic neonates induces neutrophilia and enhances the neutrophil respiratory burst and beta2 integrin expression. Results of a randomized placebo controlled trial. Eur J Pediatr 1998;157:583-588. 4. Bedford Russell AR, Davies EG, Ball SE, Gordon-Smith E. Granulocyte-colony stimulating factor treatment for neonatal neutropenia. Arch Dis Child 1995;72:F53-F54. 5. Bodine DM, Crosier PS, Clark SC. Effects of hematopoietic growth factors on the survival of primitive stem cells in liquid suspension culture. Blood 1991;79:914-920. 6. Ikebuchi K, Ihle JN, Hirai Y, Wong GG, Clark SC, Ogawa M. Further studies of the target stem cells and the mechanism of stimulation by interleukin-1, interleukin-6, and granulocytecolony stimulating factor. Blood 1988;72:2007-2014. 7. McNiece IK, Langley KE, Zsebo KM. Recombinant human stem cell factor synergises with GM-CSF, G-CSF, IL-3 and EPO to stimulate human progenitor cells of the myeloid and erythroid lineages. Exp Hematol 1991;19:226-231. 8. Stroncek DF, Clay ME, Smith J, Ilstrup S, Oldham F, McCullough J. Changes in blood counts after the administration of granulocyte-colony stimulating factor and the collection of peripheral blood stem cells from healthy donors. Transfusion 1996;36:596-600. 9. Negrin RS, Stein R, Doherty K, Cornwell J, Vardiman J, Kranzt S, Greenberg PL. Maintenance treatment of the anemia of myelodysplastic syndromes with recombinant human granulocyte-colony stimulating factor and
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∫. ™·Ú·Ê›‰Ë˜ Î·È Û˘Ó.
erythropoietin: evidence for in vivo synergy. Blood 1996;87:4076-4081. 10. Negrin RS, Haeuber DH, Nagler A, Kobayashi Y, Donlon T, Vincent M, et al. Maintenance treatment of patients with myelodysplastic syndromes using recombinant human granulocyte-colony stimulating factor. Blood 1990;76:36-43. 11. Lee SM, Radford JA, Dobson L, Hug T, Ryder WD, Pettengell R, et al. Recombinant human granulocyte macrophage-colony stimulating factor (filgastim) following high dose chemotherapy and peripheral blood progenitor cell rescue in high-grade non Hodgkin’s lymphoma :clinical benefits at no extra cost. Br J Cancer 1998;77:1294-1299. 12. Calhoun DA, Li Y, Christensen RD. Effect of recombinant granulocyte-colony stimulating factor in newborn rats: modulation of granulopoiesis and thrombopoiesis. Pediatr Res1991;30:554-559. 14. Bungart B, Loeffler M, Goris H, Dontje B, Diehl V, Nijhof W. Differential effects of recombinant human granulocytecolony stimulating factor (rhG-CSF) on stem cells in marrow, spleen and peripheral blood in mice. Br J Haematol 1990;76:174-179. 15. Christensen RD, Shigeoka AO, Hill HR. Neutropenia and bone marrow exhaustion in human and experimental neonatal sepsis. Pediatr Res 1980;14:806-808. 16. ∫·Ó·ÎÔ‡‰Ë -∆۷ηϛ‰Ô˘ º, ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ, ™·Ú·Ê›‰Ë˜ ∫, ∆˙ÈÌÔ‡ÏË µ, ∫Ô„·¯Â›ÏË O, ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂȤ‰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˜ ∫. ∞ÓÔÛԷڤ̂·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 ·ÈÌÔÂÙ¿ÏÈ· ÛËÙÈÎÒÓ 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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¶∞π¢π∞∆ƒπ∫∏ 2000;63:490-498
¶Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÈÛ‹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: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËı› ÚÔÁÂÓÓËÙÈο Ë Û˘¯ÓfiÙËÙ· Ù˘ ‡ÚÂÛ˘ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (™∫) ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ̤ıÔ‰Ô ÂϤÁ¯Ô˘ ÙÔ Ï‹Ú˜ ÂÌ‚Ú˘˚Îfi ˯ÔηډÈÔÁÚ¿ÊËÌ· (∏Ã). ∂ϤÁıËÎ·Ó Ì ϋÚ˜ ∏à (2D+Doppler) 291 Ù˘¯·›· ÂÈÏÂÁ̤ӷ ¤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· ÂÈϤÔÓ 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˘ ˘Ô‰Â›¯ıËÎÂ Û˘Ó›· ÙˆÓ Î·Ú‰ÈÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∫·È ÔÈ 7 ΢‹ÛÂȘ Ì Ì›˙ÔÓ˜ ™∫ ‰ÈÂÎfiËÛ·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˘ ·˘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 ™∫ ÌÔÚ› 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 ÛÔ˘‰·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‹ ›وÛË ™∫ 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’ ¤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 ÛÎÔfi Ó· ÂÎÙÈÌ‹ÛÔ˘Ì ÙËÓ Â›ÙˆÛË ™∫ ÛÙ· ¤Ì‚Ú˘· - fiÙ·Ó ¯ÚËÛÈÌÔÔÈËı› 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 ϋÚ˜ 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˘ ÂÈϤ¯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 ‚-ÂȤ‰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˜ ‚- ÂȤ‰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˘ÌÂÚÈÏ¿‚·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 ϋÚË 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˜ ·ӷϷ̂·ÓfiÙ·Ó ÌÈ· ÒÚ· ÂÚ›Ô˘ ·ÚÁfiÙÂÚ· ÌÂÙ¿ ÂÏ·ÊÚ‡ Á‡̷ Ù˘ ÌËÙ¤Ú·˜, ÒÛÙ ӷ ÂÈÙ¢¯ı› ÎÈÓËÙÔÔ›ËÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È Â›Ù¢ÍË ı¤Û˘ ¢ÓÔ˚ÎfiÙÂÚ˘ ÁÈ· ÙËÓ ·ÂÈÎfiÓÈÛË. ∂› ·ÚÚ˘ıÌ›·˜ ‹ fiÔ˘ ··ÈÙÔ‡ÓÙÔ ·ÎÚȂ›˜ ÌÂÙÚ‹ÛÂȘ ÂÈÚfiÛıÂÙ· ÁÈÓfiÙ·Ó M-mode, ÂÓÒ Î·Ù¿ ηÓfiÓ· Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌÂÁÂıÒÓ ÁÈÓfiÙ·Ó Ì ۇÁÎÚÈÛË Î·Ù¿ ÙËÓ Î·ıÔÏÈο ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË Ú·ÎÙÈ΋ (3,8) .¯. ÎfiÏÔÈ 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 ·ÓÙÈÂÈÏËÙÈο, 1 ·ÓÙÈËÎÙÈÎfi) §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‚ÔÔ‰›· 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
17:43
™ÂÏ›‰·492
¶∞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 ÎfiÏÔ (RA). 7. ∆ÚÂȘ ·fi ÙȘ Ó¢ÌÔÓÈΤ˜ ÊϤ‚˜ (‚¤ÏË) Û˘Ó‰¤ÔÓÙ·È ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ (LA). 8. Doppler ·ÂÈÎfiÓÈÛË ÚÔ‹˜ ÛÙËÓ ·ÓÈÔ‡Û· ·ÔÚÙ‹ (¤Ì‚Ú˘Ô 20 ‚‰.). RA = ‰ÂÍÈfi˜ ÎfiÏÔ˜, RV = ‰ÂÍÈ¿ ÎÔÈÏ›·, LA = ·ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜, LV = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·, S = ÛÔÓ‰˘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·ÙÔÔÈÔ‡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 ÎfiÏÔÈ, Á) ·ÂÈÎÔÓ›˙ÔÓÙ·Ó 2 ÈÛÔÌÂÁ¤ıÂȘ Î·È ÈÛÔ‰‡Ó·Ì· Û˘ÛÒÌÂÓ˜ ÎÔÈϛ˜ Ì ÙËÓ ÚfiÛıÈ· Ó· ¤¯ÂÈ Ù· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰ÂÍÈ¿˜, ‰) ·ÂÈÎÔÓ›˙ÔÓÙ·Ó 2 Ê˘ÛÈÔÏÔÁÈ΋˜ ÂÌÊ¿ÓÈÛ˘ Î·È Î›ÓËÛ˘ ÎÔÏÔÎÔÈÏȷΤ˜ ‚·Ï‚›‰Â˜, Ô˘ Û˘Ó·ÓÙÔ‡Û·Ó ÙÔ ÌÂÛÔÎÔÏÈÎfi 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 ÔˆÛ‰‹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 ÎfiÏÔ (∂ÈÎ. ∞7), 5) Û fiϘ ÙȘ ·Ú·¿Óˆ ‰ÈۉȿÛٷ٘ ·ÂÈÎÔÓ›ÛÂȘ Ë ÚÔ‹, fiˆ˜ 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 ·ÍÈÔÈÛÙ›· 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‚ÏÂfiÙ·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 ·ӤÏÂÁ¯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˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. 2. ∞ÚÙËÚÈ·Îfi˜ ÎÔÚÌfi˜ (∆). ªÂ ‚¤ÏÔ˜ ÛËÌÂÈÒÓÂÙ·È ÌÂÁ¿ÏÔ ¤ÏÏÂÈÌÌ· ·Ó¿ÌÂÛ· ÛÙȘ ‰˘Ô ÎÔÈϛ˜ (V). 3. ÀÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·. ∞Ô˘Û›· ÎÔÈÏfiÙËÙ·˜ ÛÙË ı¤ÛË (LV), fiÔ˘ Ê˘ÛÈÔÏÔÁÈο ·ÂÈÎÔÓ›˙ÂÙ·È Ë ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·. ÷ڷÎÙËÚÈÛÙÈ΋ ΛÓËÛË – ÚÔ¤ÙÂÈ· ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ÚÔ˜ ÙÔÓ ‰ÂÍÈfi ÎfiÏÔ. 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‹ (∞) ÂÊÈÂ‡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 ÎfiÏÔ (RA). 8. ªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· (‚¤ÏÔ˜). (R = ‰ÂÍÈ¿ ÎÔÈÏ›·, L = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·.) (∂ÈÎ. 7 Î·È 8 ·fi ÙÔ ›‰ÈÔ ¤Ì‚Ú˘Ô). 9. ∫ÔÈÓfi ÎÔÏÔÎÔÈÏÈ·Îfi ηӿÏÈ. ŒÏÏÂÈÌÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ «ÛÙ·˘ÚÔ‡». ∫ÔÏÔÎÔÈÏȷΤ˜ ‚·Ï‚›‰Â˜ ÛÙÔ ›‰ÈÔ Â›Â‰Ô. (RA = ‰ÂÍÈfi˜ ÎfiÏÔ˜, 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 ÎfiÏÔ (SA). ™ÙÔ 11 ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰‡Ô ÎÔÈϛ˜ (V) Î·È ¤Ó· ÌÂÁ¿ÏÔ ·ÁÁÂ›Ô (∆). Ê·Ï›‰· › ‰È·ÎÔ‹˜ Ù˘ ·ËÛ˘ Î·È ÔÈ ÁÔÓ›˜ ÂÓËÌÂÚÒÓÔÓÙ·Ó ÏÂÙÔÌÂÚÒ˜ ÁÈ· Ù· ·Ó·ÙÔÌÈο ÚÔ‚Ï‹Ì·Ù· Î·È ÙȘ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ÂÈÙÒÛÂȘ 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˘ › 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 ˘ÔÏ·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΋ ÂÈÎÔÈÓˆÓ›· ÛÙÔ ¯ÒÚÔ ÂÈÛfi‰Ô˘. - 1 ¤Ì‚Ú˘Ô ¤ÏÏÂÈÌÌ· ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (∂ÈÎ. µ1) Ì ÛÔ‚·Ú‹ ·Ó¿ÚÎÂÈ· ÙÚÈÁÏÒ¯ÈÓ·˜. - 1 ¤Ì‚Ú˘Ô ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· (∂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 ۇÌÏÔÎË Î·Ú‰ÈÔ¿ıÂÈ· [˘ÔÏ·Û›· Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ Î·È ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘, ÌÂÁ¿ÏË ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì ÂÊ›Â˘ÛË
493
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™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΋ ÂÈÎÔÈÓˆÓ›· 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·. ∏ ›وÛË ™∫ ÛÙËÓ ÔÌ¿‰· ¯·ÌËÏÔ‡ Û˘ÁÎÚÈÙÈο Ì ·˘Ù‹Ó ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ Â›¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿, fiˆ˜ ¤‰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 ÂÈı˘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 ›Û˘ ÙÚÈۈ̛· 21. ∂ÚfiÎÂÈÙÔ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô Ì ÙÂÙÚ·ÏÔÁ›· Fallot Î·È ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· 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 ÂȂ‚·›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 ÔÔ›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΋ ÂÈÎÔÈÓˆÓ›·, Ô˘ ¤ÎÏÂÈÛ ÂÚ›Ô˘ ÙÔÓ 6Ô Ì‹Ó· Ù˘ ˙ˆ‹˜ ¯ˆÚ›˜ ÙÔ ·È‰› Ó· ¯ÚÂÈ·ÛÙ› ÔÔÈ·‰‹ÔÙ ·ÁˆÁ‹. ™˘˙‹ÙËÛË OÈ ™∫ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ¶·ÚfiÙÈ ÛÙȘ ÌÈÛ¤˜ ÂÚÈÙÒÛÂȘ 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 ÂÔ̤ӈ˜ 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 ÂÈÏÔÁÒÓ. Œ¯ÂÈ ‰Âȯı›, fiÙÈ Ë Ë¯ÔÁÚ·ÊÈ΋ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ÌÂÈ˙fiÓˆÓ Â͈ηډȷÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÌÔÚ› 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· ¤ÙÚ 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˘ÌÂÚ·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) fiÔ˘ Ë ¿ÌÂÛË ÓÂÔÁÓÔÏÔÁÈ΋ ÊÚÔÓÙ›‰· Â›Ó·È Ú·ÁÌ·ÙÈÎfiÙËÙ· ÁÈ· fiÏ· Ù· ÓÂÔÁÓ¿ Ì ™∫, ·ÓÂÍ¿ÚÙËÙ· ·Ó Ë ·ÓˆÌ·Ï›· ‰È·ÁÓÒÛıËΠÚÈÓ ‹ 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¿ ÂÔ̤ӈ˜, ÙË Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜, ˆ˜ ·fiÙÔÎÔ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÌÂÈ˙fiÓˆÓ ™∫, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙË ¯ÒÚ· Ì·˜, ı· ÌÔÚÔ‡Û ηÓ›˜ Ó· ÙËÓ Èı·ÓÔÏÔÁ‹ÛÂÈ ÈÛ¯˘Ú¿. ŒÙÛÈ, Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË .¯. ÌÂÙ¿ıÂÛ˘ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ı· ¤ÙÚ 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 ·ÓÙÈÌÂÙÒÈÛ˘. ∆· ‰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·˜ ¤ÏÂÍ·Ó ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË Ù˘ ηډÈÔ¿ıÂÈ·˜. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÚfiÎÂÈÙÔ 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 ÂÈ‚›ˆÛË ‰ÂÓ ÚÔ‹¯ıË Ì ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, fi¯È ÏfiÁˆ ·ÛÙÔ¯›·˜ Ù˘ ÌÂıfi‰Ô˘, ·ÏÏ¿ fiˆ˜ ¤¯ÂÈ ÛËÌÂȈı› ·fi ÙËÓ Allan (2), ÏfiÁˆ ÂÈÏÔÁ‹˜ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ‰È·ÎÔ‹. ™ÙËÓ ÚÔ·Ó·ÊÂÚı›۷ ÚˆÙÔÔÚȷ΋ 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·ÎfiÙÔ˘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 ÂȂ‚·ÈÒıËÎÂ. ¶·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ì ·ÙÚËÛ›· Ù˘ Ó¢ÌÔÓÈ΋˜ ÏfiÁˆ ‰È·ÎÔÒÓ Î˘‹ÛÂˆÓ ÂÌ‚Ú‡ˆÓ, ÛÙ· ÔÔ›· Ë ·Ú·¿Óˆ ¿ıËÛË Â›¯Â ‰È·ÁÓˆÛı› ˯ÔηډÈÔÁÚ·ÊÈο (9). ¶Èı·Ófiٷٷ ÏÔÈfiÓ, ÙÔ Î‡ÚÈÔ Â·ÎfiÏÔ˘ıÔ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙˆÓ ™∫ ı· Â›Ó·È Ë Ì›ˆÛË Ù˘ ›وÛ˘ ÙˆÓ ÌÂÈ˙fiÓˆÓ ™∫ ÛÙ· ÓÂÔÁÓ¿ ÏfiÁˆ ‰È·ÎÔÒÓ 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˘, fiˆ˜ 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˘ÌÂÚ¿ÛÌ·Ù· ÙÂÏÂ˘Ù·›ˆÓ ÌÂÏÂÙÒÓ Ù·˘Ù›˙ÔÓÙ·È Ì ÙËÓ ·Ú·Ù‹ÚËÛ‹ Ì·˜, fiÙÈ ÔÈ ™∫ ÌÔÚ› 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·˜ ÂÔ̤ӈ˜, 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 ÏÂÙÔÌÂÚ‹˜ ¤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 ÔˆÛ‰‹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 ÔÏϷϤ˜ ‰ÈۉȿÛٷ٘ ÙÔ̤˜ Î·È Doppler (pulsed + color), fiˆ˜ ¤ÁÈÓ ÛÙËÓ ÌÂϤÙË Ì·˜, ÌÂÁÈÛÙÔÔÈÔ‡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 ÂÈϤͷÌ ÙÔ ÚˆÙfiÎÔÏÏÔ ÂϤÁ¯Ô˘, Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› 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·ÁÓÒÛıËΠÚÔÁÂÓÓËÙÈο
(¢·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΋ ÂÈÎÔÈÓˆÓ›·, 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˘˜, ÌÔÚ› 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΋ ÂÈÎÔÈÓˆÓ›· ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÚfiÁÓˆÛË, fiˆ˜ Ê¿ÓËΠÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜ Î·È fiˆ˜ ¤¯ÂÈ ÙÔÓÈÛı› Û ·Ó¿ÏÔÁ˜ ÂÚÈÙÒÛÂȘ 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· ¯ÚËÛÈÌÔÔÈËı› 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˘ÙÔÈ΋, ˘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˜, fiˆ˜ ‰Â›¯ıËÎÂ Î·È ÛÙË ÌÂϤÙË Ì·˜, ÙÔ ÂÈÙ˘Á¯¿ÓÂÈ Ì ¢·ÈÛıËÛ›· Ô˘ ·ÁÁ›˙ÂÈ ÙÔ 100%. ™ÙË ÛÂÈÚ¿ Ì·˜ ‰È·ÁÓÒÛıËÎ·Ó Î·È ÔÈ 7 ηډÈÔ¿ıÂȘ, ÔÈ Ôԛ˜ ·Ó ÔÈ Î˘‹ÛÂȘ ÔÏÔÎÏËÚÒÓÔÓÙ·Ó ı· ··ÈÙÔ‡Û·Ó ·Ú¤Ì‚·ÛË. °È· ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ·Ï‹ıÂÈ· Ú¤ÂÈ ÂÓÙÔ‡ÙÔȘ Ó· ÛËÌÂȈı› fiÙÈ ¤¯Ô˘Ó ηٷÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÛÙÂÓˆÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ ‰ÂÓ ¤ÁÈÓ·Ó ÂÌÊ·Ó›˜ ·Ú¿ ÌfiÓÔ Î·Ù¿ ÙÔ 3Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ (24), fiˆ˜ ›Û˘ fiÙÈ Î·Ú‰È·ÎÔ› fiÁÎÔÈ ‹ Ì˘ÔηډÈÔ¿ıÂȘ ÌÔÚ› 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‡ (fiˆ˜ ·fi ÚÔÛˆÈΤ˜ ·ʤ˜ 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 ÔχÏÔÎÔ Î·È Ë ÁÂÓÈÎfiÙÂÚË ÛÙÚ·ÙËÁÈ΋ › 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 ÙÚfiÔ ‰ÂÓ ÂÌϤÎÔ˘Ì ÙÔ˘˜ ÁÔÓ›˜ Û ڷÎÙÈΤ˜ Ô˘ Û˘Ó¿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 ÂÈÙÚ¤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 ڷÎÙÈÎfi ›‰Ô, Èı·Ó‹ ·ÛÙÔ¯›· ·ÊÔÚ¿ ÙȘ ηډÈÔÏÔÁÈο ·Û‹Ì·ÓÙ˜ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜. ∏ ·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). Àfi ÙÔÓ fiÚÔ ÏÔÈfiÓ, fiÙÈ Ô ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È ·fi ÂȉÈÎÔ‡˜ (Ë Âη›‰Â˘ÛË Î·È ÂÌÂÈÚ›· ÙˆÓ ÔÔ›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), fiˆ˜ Î·È ÛÙË ÛÂÈÚ¿ Ì·˜ ‰Â›¯ıËÎÂ, fiÔ˘ Ô ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂȂ‚·›ˆÛ ϋڈ˜ ÙË ‰È¿ÁÓˆÛË Î·È ÛÙȘ 6 ÂÚÈÙÒÛÂȘ Ô˘ ÂϤÁ¯ıËηÓ. ∆ÂÏÂÈÒÓÔÓÙ·˜ Ì ÙÔ ÙÂÚ¿ÛÙÈÔ ı¤Ì· Ù˘ ·ÍÈÔÈÛÙ›·˜ 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˘ ÌÔÚ› Ó· ÌÂÈÒÓÔ˘Ó ÙËÓ ·ÍÈÔÈÛÙ›· 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 ÎÈÓËÙÔÔ›ËÛË ÎÏ, fiˆ˜ ÂÚÈÁÚ¿„·Ì ÛÙË ÌÂıÔ‰ÔÏÔÁ›· Î·È fiˆ˜ ¤¯ÂÈ ÂÊ·ÚÌÔÛı› ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (8). Ÿˆ˜ ÏÔÈfiÓ ‰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 ¤ÌÂÈÚÔÈ 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· ™∫, fiˆ˜ ·˘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˘
ÌÂÚÈÂÏ‹ÊıË Ë ·˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ·, ÙËÓ ÔÔ›· Ê·›ÓÂÙ·È fiÙÈ Ë ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· Ù›ÓÂÈ Ó· ·Ô‰Â¯ı› Û·Ó Ôχ ÈÛ¯˘Úfi ·Ú¿ÁÔÓÙ· ÁÈ· ™∫, ·ÊÔ‡ › ·ÚÔ˘Û›·˜ Ù˘ ÚÔÙ¿ıËΠ‰È·ÎÔÏÈÎfi ˯ÔηډÈÔÁÚ¿ÊËÌ· ‹‰Ë ·fi ÙËÓ 13Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ (26). ∞Ó Ô ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ Â›¯Â Û˘ÌÂÚÈÏËÊı› 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. ∏ ›وÛË ™∫ Î·È ‰Ë ÌÂÈ˙fiÓˆÓ ÛÙÔÓ ÏËı˘ÛÌfi ¯ˆÚ›˜ ηӤӷ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘, ¤ÊÙ·Û ÛÙË ÌÂϤÙË Ì·˜ ÙÔ 2,5%, ›وÛË Ô˘ ‰ÂÓ ¤¯ÂÈ Î·ÌÈ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·fi ÙËÓ ‰È·ÈÛÙˆı›۷ ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (2,1%), fiÔ˘ 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‡ıËΠ۠ÏËı˘ÛÌfi ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ Û ÁÂÚÌ·ÓÈ΋ ÌÂϤÙË ÙÔ˘ 1996 (8), Ô˘ ¤ÁÈÓ fiˆ˜ Î·È Ë ‰È΋ Ì·˜ ÛÂ Ù˘¯·›· ÂÈÏÂÁ̤Ó˜ ΢‹ÛÂȘ, η٤ÏËÍ·Ó ÛÙËÓ ›‰È· ‰È·›ÛÙˆÛË. ™ÙË ÌÂϤÙË Ì·˜ ÏÔÈfiÓ, fiˆ˜ Î·È Û ¿ÏϘ ÌÂÁ¿Ï˜ Î·È Î·Ï¿ ۯ‰ȷṲ̂Ó˜ ÛÂÈÚ¤˜ ·Ú·ÙËÚÂ›Ù·È ÂÓÙ˘ˆÛȷ΋ ›وÛË ™∫ 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%, ÙÚÈÏ¿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˜ οÔÈ· ·fi Ù· ¤Ì‚Ú˘· ı· η٤ÏËÁ·Ó ·ÚÁfiÙÂÚ· (ÚÈÓ ÙË Á¤ÓÓËÛË), ›Ûˆ˜ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·Ú·ÙËÚËı›۷ ‰È·ÊÔÚ¿ ›وÛ˘ ™∫ 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˘ ›وÛ˘ ÛÙ· ÓÂÔÁÓ¿ ÏfiÁˆ ÙˆÓ ÚÔ·Ó·ÊÂÚıÂÈÛÒÓ ‰È·ÎÔÒÓ Î˘‹ÛˆÓ. ™˘ÓÔ„›˙ÔÓÙ·˜ Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰È·ÈÛÙÒÓÔ˘ÌÂ: 1) ∏ ›وÛË ™∫ ÛÙ· ¤Ì‚Ú˘·, fiˆ˜ ·˘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) ∏ ›وÛË 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 ›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 ÂÚÈÙÒÛÂȘ ΢‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ô˘ ηٿ ÙËÓ ÂÌÂÈÚ›· 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· Âηȉ‡ÔÓÙ·È ÔÈ Á˘Ó·ÈÎÔÏfiÁÔÈ, ¤ÙÛÈ ÒÛÙ ӷ Â›Ó·È Û ı¤ÛË Ó· ÂϤÁ¯Ô˘Ó ·ÍÈfiÈÛÙ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙȘ 4 ÎÔÈÏfiÙËÙ˜ Î·È Ù· ÌÂÁ¿Ï· ·ÁÁ›·, ·Ú·¤ÌÔÓÙ·˜ 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˘˜ ÂÈÏÔÁ‹. 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.
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31. Shinebourne EA, Carvalho JS. Ethics of fetal echocardiography [editorial]. Cardiol Young 1996;6:261-263. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-02-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 20-11-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· ∆Ú¿·ÏË ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶ & ∞ ∫˘ÚÈ·ÎÔ‡» £Ë‚ÒÓ & §Â‚·‰Â›·˜ 115 27 ∞ı‹Ó·
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·˘Ùfi˜ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÛÊ·Ï‹˜ ‹ ÂÈÙ˘Á¯¿ÓÂÈ Ù·¯‡ÙÂÚË ÙÒÛË ÙÔ˘ ˘ÚÂÙÔ‡ ·’ fi,ÙÈ ÙÔ Î¿ı ·ÓÙÈ˘ÚÂÙÈÎfi ¯ˆÚÈÛÙ¿. ∂ÛÊ·Ï̤ÓË ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ÌÔÚ› Ó· ·Ô‚› ÂÈ˙‹ÌÈ·. ¶·ÚfiÏÔ Ô˘ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙË ÌÂϤÙË ·Ó¤ÊÂÚ·Ó fiÙÈ ·ÎÔÏÔ˘ıÔ‡Ó ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∞η‰ËÌ›·˜ ˆ˜ ‚¿ÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘ÚÂÙÔ‡, Ù¤ÙÔȘ Ô‰ËÁ›Â˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó. ∏ ·Ú·Ù‹ÚËÛË fiÙÈ Ë Ú·ÎÙÈ΋ ·˘Ù‹ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Û˘Ó‹ı˘ ÛÙÔ˘˜ Ó¤Ô˘˜ È·ÙÚÔ‡˜ ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ·ÓËÛ˘¯›· ÙÔ˘˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘ÚÂÙÔ‡. ª¤¯ÚÈ Ó· ÂÏÂÁ¯ıÔ‡Ó ÛˆÛÙ¿ ·˘Ù¤˜ ÔÈ ÌÂϤÙ˜ Î·È Ó· ÂÎÙÈÌËı› Ô Î›Ó‰˘ÓÔ˜ ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfi ·˘ÙÒÓ ÙˆÓ Ê·Ú̿ΈÓ, ÔÈ È·ÙÚÔ› Ú¤ÂÈ Ó· Â›Ó·È ÂÈÊ˘Ï·ÎÙÈÎÔ›.
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·ÌÔ˜ °. ÷Ù˙Ë·ı·Ó·Û›Ô˘, ÷ڿϷÌÔ˜ £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›ÏÈÔ˜ ¶·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 ıÂڷ›· Ì rhGH ÂËÚ¿˙ÂÙ·È ·fi ÙË ÁÔÓÂ˚΋ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ Ã, ÌÂÏÂÙ‹Û·Ì 33 EÏÏËÓfiÔ˘Ï· Ì ™∆ (18 Ì ηڢfiÙ˘Ô 45,Ã Î·È 15 Ì ̈۷˚ÎÈÛÌfi ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã) Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ‡˜ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÔ‡˜ ‰Â›ÎÙ˜ DXS 101 Î·È DXS 337 ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã. ¢ÂηÂÙ¿ ·fi Ù· ·È‰È¿ ·˘Ù¿ Û˘ÌÏ‹ÚˆÛ·Ó 2 ¤ÙË ıÂڷ›·˜ 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 ÂÚÈÙÒÛÂȘ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ‰È¢ÎÚ›ÓÈ˙·Ó ÙËÓ ÚԤϢÛË. ∆Ô ‡„Ô˜ ÙˆÓ ·È‰ÈÒÓ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ 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 ıÂڷ›·˜, ¯ˆÚ›˜ fï˜ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘˜. ∂ÈϤÔÓ, 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. ™˘ÌÂÚ·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 ÂËÚ¿˙ÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂڷ›·˜ 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΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∆Ì‹Ì· µÈÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌ›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 ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÔ›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 ™∆ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ 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 ÂÚÈÙÒÛÂˆÓ 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· ÂËÚ¿˙ÂÙ·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂڷ›·˜ 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· ÌÔÚÔ‡Û ÂӉ¯Ô̤ӈ˜ Ó· ÂËÚ¿ÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ıÂڷ¢ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ ıÂڷ›·˜ 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˘. ∂ÈϤÔÓ, Û 17 ·fi Ù· ·È‰È¿ ·˘Ù¿ Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯ÚfiÓÈ· ıÂڷ›·˜ Ì rhGH, ÂÍÂÙ¿Û·Ì ηٿ fiÛÔÓ Ë ·ÓÙ·fiÎÚÈÛË ÌÔÚ› 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). ∂ÈϤÔÓ, ÌÂÙÚ‹ıËΠÙÔ ‡„Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÚÔÛ‰ÈÔÚ›ÛıËÎÂ Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛ‹ ÙÔ˘ ÁÈ· οı ÁÔÓ¤· (Ht SDS), fiˆ˜ ›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·ÚfiÙˆÛË, ·˘¯ÂÓÈÎfi ÙÂÚ‡ÁÈÔ, ‚Ú·¯‡˜ ·˘¯¤Ó·˜, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÎÒÌ˘, ·ÓˆÌ·Ï›Â˜ ÒÙˆÓ, ÏÂÌÊÔ›‰ËÌ·, ‚Ú·¯‡ 4Ô ÌÂٷοÚÈÔ, 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 ıÂڷ›· Ì rhGH Û ‰fiÛË 0,7 IU/kg/‚‰, Ì ηıËÌÂÚÈÓ¤˜ ˘Ô‰fiÚȘ ÂÓ¤ÛÂȘ. ¢ÂηÂÙ¿ ·fi ·˘Ù¿, ËÏÈΛ·˜ 10,1±2,7 ÂÙÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Û˘ÌÏ‹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 ¯ÚËÛÈÌÔÔÈ‹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 ˘‚ÚȉÔÔ›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·, fiˆ˜ ¤¯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). ÃÚËÛÈÌÔÔÈÒÓÙ·˜ 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·ÙÔÔÈ‹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, fiˆ˜ ¤¯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 ÔÔ›Ô ·ÊÔ‡ ·ÔÍËÚ¿ÓıËΠ˘Ô‚Ï‹ıËΠ۠·˘ÙÔÚ·‰ÈÔÁÚ·Ê›· (20). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹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˘ ıÂڷ›·˜, ÙÔ ∏t SDS ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙÔ TH SDS, ηıÒ˜ Î·È ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ÛÙ· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ıÂڷ›·. ∞ÔÙÂϤÛÌ·Ù· ÃÚˆÌÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË (ηڢfiÙ˘Ô˜ Î·È FISH) OÏÈ΋ ÌÔÓÔۈ̛· à ‰È·ÈÛÙÒıËΠ۠18 ·fi ÙȘ 33 ·ÛıÂÓ›˜ (54,5%), ÂÓÒ ÛÙȘ ˘fiÏÔȘ 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·˘ÙÔÔ›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 Ôԛ˜ 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 ̛· ·ÓÙÈÚÔÛˆÂ˘ÙÈ΋ ÔÌ¿‰· 10 ·È‰ÈÒÓ Ì ™∆ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÁÔÓÔÙ‡Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› 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‹, ÂÂȉ‹ 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 ÌfiÚÂÛ ӷ ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ ÚԤϢÛË Ù˘ ÌÔÓÔۈ̛·˜ à Û 3 ÔÈÎÔÁ¤ÓÂȘ, ÂÂȉ‹ 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 ˘fiÏÔȘ 30 ÂÚÈÙÒÛÂȘ, 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 ÔÔ›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 ÂÚÈÙÒÛÂˆÓ 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. ∂ÈϤÔÓ, ‰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·ÚfiÙˆÛË ∞˘¯ÂÓÈÎfi ÙÂÚ‡ÁÈÔ µÚ·¯‡˜ ·˘¯¤Ó·˜ ÷ÌËÏ‹ ÚfiÛÊ˘ÛË ÎÒÌ˘ ∞ӈ̷ϛ˜ ÒÙˆÓ §ÂÌÊÔ›‰ËÌ· µÚ·¯‡ 4Ô ÌÂٷοÚÈÔ ¶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 ıÂڷ›· Ì rhGH ∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ Ht SDS/CA ÙˆÓ ·ÛıÂÓÒÓ, ÙÔ˘ Ht SDS ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ÙÔ˘ TH SDS, fiˆ˜ Î·È ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ¯ÚfiÓÔ˘ ıÂڷ›·˜ Ì rhGH, Û ۇÁÎÚÈÛË Ì ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ÚÈÓ ·fi ÙË ıÂڷ›·, ·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 ıÂڷ›·˜ 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˘ ıÂڷ›·˜ ·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˘ ıÂڷ›·˜ Ì rhGH, (¶›Ó·Î·˜ 4, ∂ÈÎfiÓ· 2), Ô ÔÔ›Ô˜ fï˜, ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙÔ˘˜. ™˘˙‹ÙËÛË ¶Ú·ÁÌ·ÙÔÔÈ‹Û·Ì ÌÔÚȷ΋ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ÁÔÓÂ˚΋˜ ÚÔ¤Ï¢Û˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à Û 33 ∂ÏÏËÓfiÔ˘Ï· Ì ™∆, Ì ÛÎÔfi Ó· ‰ÈÂÚ¢ӋÛÔ˘Ì ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‡„Ô˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ì rhGH, ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›·, ηıÒ˜ Î·È Ù· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹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 ıÂڷ›· 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 η̇Ϙ ·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˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (9-11,21). °È· Ó· ÂϤÁÍÔ˘ÌÂ Î·È Ù· 2 ÛΤÏË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ÂÈϤͷÌ 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). ∂ÈϤÔÓ, 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 ÂËÚ¿˙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· ıÂڷ›·˜ Ì rhGH. ∫·Ú˘fiÙ˘Ô˜
504
ƒ˘ıÌfi˜ ·‡ÍËÛ˘ (cm/¤ÙÔ˜) ¶ÚÔ ıÂڷ›·˜
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 ıÂڷ›·˜
1Ô˜ ÃÚfiÓÔ˜
2Ô˜ ÃÚfiÓÔ˜
∂ÈÎfiÓ· 2. ƒ˘ıÌfi˜ ·‡ÍËÛ˘ ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂڷ›·˜ 2 ÂÙÒÓ Ì rhGH Û ·È‰È¿ Ì ۇӉÚÔÌÔ Turner.
·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›· Ì rhGH, ‰ÂÓ ‚ڋηÌ η̛· ‰È·ÊÔÚ¿ ÛÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ¯ÚfiÓÔ˘ ıÂڷ›·˜ 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˘ ıÂڷ›·˜ Ú˘ıÌfi. ∂Í fiÛˆÓ ÁÓˆÚ›˙Ô˘ÌÂ, Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ Â›Ó·È Ù· ÚÒÙ· Ô˘ ··ÓÙÔ‡Ó ÛÙÔ ÂÚÒÙËÌ· ·˘Ùfi Û ‰ÈÂıÓ¤˜ ›‰Ô. ™˘ÌÂÚ·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 ÂËÚ¿˙ÂÈ ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›· 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· ÂÈÙ¢¯ı› ˘fi ıÂڷ›· Ì rhGH. ∞Ó·ÁÓˆÚ›ÛÂȘ ∏ ÂÚÁ·Û›· ·˘Ù‹ ÂȯÔÚËÁ‹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. 9. Connor JM, Loughlin SAR. Molecular genetics of Turner syndrome. Acta Paediatr Scand 1989;356(Suppl):77-80. 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.
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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. 14. Lyon AJ, Preece MA, Grant DB. Growth curve for girls with Turner syndrome. Arch Dis Child 1985;60:932-935. 15. Seabright M. A rapid banding technique for human chromosomes. Lancet 1971;2:971-972. 16. Pinkel D, Staume I, Gray JW. Cytogenetic analysis using quantitation high sensitive fluorescent hybridization. Proc Natl Acad Sci 1986;83:2934-2938. 17. Ausubel F, Brent R, Kingston RE. Short Protocols in
Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.
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›·˜: ÷ڿϷÌÔ˜ °. ÷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·ÎÔÔ‡ÏÔ˘ 180, 115 27 ∞ı‹Ó·
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518
∏ ›‰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·ÙÔÔÈ‹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˘ ›‰Ú·Û˘ ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ·˘ÙÒÓ ÛÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ÂȤ‰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˘ÌÏËÚÒıËΠ·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΢¿ÛÙËΠ›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 ÈηÓÔÔÈË̤Ó˜ ·fi ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜. ¢È·ÈÛÙÒıËΠ›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· µÚÂÊÔÓËÈÔÎÔÌ›·˜, ∆.∂.π. ∞ı‹Ó·˜ 1. ∫ÏÈÓÈÎfi˜ ·È‰Ô„˘¯ÔÏfiÁÔ˜, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜, ∆Ì‹Ì· µÚÂÊÔÓËÈÔÎÔÌ›·˜, ∆.∂.π. ∞ı‹Ó·˜ 2. ∫ÏÈÓÈ΋ ·È‰Ô„˘¯ÔÏfiÁÔ˜
507
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·508
¶∞π¢π∞∆ƒπ∫∏ 2000;63:507-518
∂ÈÛ·ÁˆÁ‹ ™‡Ìʈӷ Ì ÙÔ˘˜ ÂȉÈÎÔ‡˜, Ë ·¯˘Û·ÚΛ· ‰ÂÓ ·ÔÙÂÏ› „˘¯È΋ ‰È·Ù·Ú·¯‹, Â›Ó·È ˆÛÙfiÛÔ ¤Ó· ÔχÏÔÎÔ Úfi‚ÏËÌ·, ÙÔ ÔÔ›Ô ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÂÈÙÒÛÂȘ, fi¯È ÌfiÓÔ ÔÚÁ·ÓÈΤ˜ ·ÏÏ¿ Î·È „˘¯ÔÏÔÁÈΤ˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·¯˘Û·ÚΛ· ¤¯ÂÈ ÔÏϤ˜ ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ ÛÙËÓ ˘Á›· ÙÔ˘ ·ÓıÚÒÔ˘ fiˆ˜ ˘¤ÚÙ·ÛË, ηډȷΤ˜ ·ı‹ÛÂȘ Î.·. OÈ „˘¯ÔÏÔÁÈΤ˜ fï˜ ÂȉڿÛÂȘ 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‡ ÂȤ‰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¿ ÌÔÚ› Ó· Â›Ó·È ÔÈΛϷ. ™Â οÔȘ ÂÚÈÙÒÛÂȘ Ë ·¯˘Û·ÚΛ· ÌÔÚ› Ó· Â›Ó·È Û˘Ó¤ÂÈ· οÔÈÔ˘ ÔÚÁ·ÓÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ‹ Ó· ÂËÚ¿˙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· ÔÔ›· 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· ÔÔ›· ‰ÂÓ ıËÏ¿˙Ô˘Ó. OÈ ÂȉÈÎÔ› ÔÈ ÔÔ›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˘ÌÂÚÈÊÔÚ¿ 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 ÔÔ›· 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› ›Û˘, ˆ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ÔÈ ÁÔÓ›˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ Ê·ÁËÙfi ÁÈ· Ó· ÈηÓÔÔÈ‹ÛÔ˘Ó Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡ ‹ ÙÔ ¯ÚËÛÈÌÔÔÈÔ‡Ó ˆ˜ ·ÌÔÈ‚‹ fiÙ·Ó ÙÔ ·È‰› ÙÔ˘˜ Û˘ÌÂÚÈʤÚÂÙ·È Î·Ï¿, ÙfiÙ ÌÔÚ› 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 ÌÔÚ› 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 ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ∂ÏÏ‹ÓˆÓ ÁÔÓÈÒÓ Î·ıÒ˜ Î·È Ë ÂÈÌÔÓ‹ 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›˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, fiˆ˜ 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· ∂ÏÏËÓfiÔ˘Ï· ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ¯ıÚÔ‡˜ Ù˘ ˘Á›·˜ ÙÔ˘˜. ∆· ∂ÏÏËÓfiÔ˘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 ÂȂ‚·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˜ ›Û˘ Î·È ÙÔ˘ ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÚ¢ÓËÙÈÎÒÓ ÚÔÛ·ıÂÈÒÓ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ˆ˜ ÙÒÚ· (11). Ÿˆ˜ 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 ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹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˘ÌÂÚÈÊÔÚ¿˜ 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 ·ÏÏËÏ›‰Ú·Û˘. ª›· ·fi ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÂÈÙÒÛÂȘ 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˘ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ·ÏÏËÏ›‰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·ÙÔÔÈÂ›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 ÔÙÈ΋ 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 ÔÙÈ΋ 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˜ ÂÌÂÈڛ˜ Ô‰ËÁÔ‡Ó Û ¤Ó· ‚·ÛÈÎfi Û˘Ó·›ÛıËÌ· «ÂÚËÊ¿ÓÈ·˜» ‹ «ÓÙÚÔ‹˜», ÙÔ ÔÔ›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·, ÂÛˆÙÂÚÈÎÔÔÈÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÔÈ ·Í›Â˜ Î·È ÔÈ Î·ÓfiÓ˜ Ô˘ ÂÈ‚¿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 ÔÔ›Ô Ì¿ÏÈÛÙ· ÂÂȉ‹ Á›ÓÂÙ·È ·Ì¤Ûˆ˜ ÂÌÊ·Ó¤˜ ÛÙÔ ÎÔÈÓˆÓÈÎfi ÂÚ›Á˘ÚÔ, ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙȘ ÎÔÈÓˆÓÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ·Ó¿ÌÂÛ· ÛÙÔ ·¯‡Û·ÚÎÔ ¿ÙÔÌÔ Î·È ÛÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ (20). OÈ ·¯‡Û·ÚÎÔÈ ¿ÓıÚˆÔÈ 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·ÛÎfiËÛË 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 ˘fiÏÔȘ ‰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˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‰ÂÓ ÂËÚ¿˙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 ÏÔÈfiÓ fiÙÈ ÔÈ „˘¯ÔÏÔÁÈΤ˜ ÂȉڿÛÂȘ Ù˘ ·¯˘Û·ÚΛ·˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ›‰È˜ ‰ÈfiÙÈ ‰ÂÓ ‚ÈÒÓÔ˘Ó fiÏ· Ù· ·È‰È¿ ÙËÓ ·¯˘Û·ÚΛ· Ì ÙÔÓ ›‰ÈÔ ÙÚfiÔ. 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 ÂËÚ¿˙Ô˘Ó ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘. ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ù· ·È‰È¿ ÚÔ‚Ï¤Ô˘Ó ÛˆÛÙ¿ ÔȘ ı· Â›Ó·È ÔÈ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È fiÙÈ Ë ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘˜ ÂËÚ¿˙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 ÂËÚ¿˙ÂÙ·È ·fi ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô Ù· ·È‰È¿ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ·›ÙÈ· Ù˘ ·¯˘Û·ÚΛ·˜ ÙÔ˘˜ Î·È ÙȘ ÂȉڿÛÂȘ Ô˘ ¤¯ÂÈ ÛÙÔÓ ÙÚfiÔ 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· οÔÈÔ ·È‰› ÈÛÙ‡ÂÈ fiÙÈ Ù· ¿ÏÏ· ·È‰È¿ ‰ÂÓ ÙÔ ı¤ÏÔ˘Ó ÛÙËÓ ·Ú¤· ÙÔ˘˜ ÂÂȉ‹ 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 Âȉڿ 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¿ ÂËÚ¿˙ÂÙ·È ·fi ÙÔÓ ÙÚfiÔ 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 ÔÔ›· 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˘ ÂËÚ¿˙Ô˘Ó ÙȘ ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹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. EÈϤͷÌ ˆ˜ ÙfiÔ ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ ¤Ú¢ӷ˜ ÙËÓ ∞ı‹Ó· Î·È Ì›· ·گȷ΋ fiÏË ‰ÈfiÙÈ ı¤Ï·Ì ӷ ‰ÈÂÚ¢ӋÛÔ˘Ì ηٿ fiÛÔÓ Ô ÙfiÔ˜ ηٷÁˆÁ‹˜ Î·È ‰È·‚›ˆÛ˘ Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙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, fiˆ˜ 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 ÏÔÈfiÓ, ˙˘Á›ÛÙËÎ·Ó fiÏ· Ù· ·È‰È¿ Î·È Î·Ù·ÁÚ¿ÊËΠÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜. ∫·ÙfiÈÓ ˘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 ÔÔ›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‡, fiÔ˘ ÙÔ Ú·ÁÌ·ÙÈÎfi ‚¿ÚÔ˜ ‹Ù·Ó ηٿ 20% ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ȉ·ÓÈÎÔ‡ ‚¿ÚÔ˘˜, ‚) ·È‰È¿ Ì ηÓÔÓÈÎfi ‚¿ÚÔ˜, fiÔ˘ 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‡, fiÔ˘ 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˘ÌÏËÚÒÛÔ˘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 ηχÙÔ˘Ó ÙÔÌ›˜ fiˆ˜ 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 ·˘ÙÔÂÔ›ıËÛË. ∂›Û˘, ÁÈ· ÙË ÌÂϤÙË Ù˘ ‰ËÌÔÙÈÎfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÎÔÈÓˆÓÈfiÁÚ·ÌÌ· ∆Ô ÎÔÈÓˆÓÈfiÁÚ·ÌÌ·, ÂÌÓ¢ÛÙ‹˜ ÙÔ˘ ÔÔ›Ô˘ ‹Ù·Ó Ô J.L. Moreno (29), ·ÔÙÂÏ› ̤ÛÔ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÏÏËÏÂȉڿÛÂˆÓ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ·Ó¿ÌÂÛ· ÛÙ· ̤ÏË ÌÈ·˜ ÔÌ¿‰·˜, ÂÎÊÚ¿˙ÂÈ ‰ËÏ·‰‹, ÔÛÔÙÈο Î·È ÔÈÔÙÈο ÙȘ ÎÔÈÓˆÓÈΤ˜ ·ʤ˜ 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˘ÌÏËÚÒÛÔ˘Ó ¤Ó· Έ‰ÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. ∆Ô ÚÒÙÔ Ì¤ÚÔ˜ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÂÚÈÏ¿Ì‚·Ó ÔÚÈṲ̂ӷ ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ ·ÔÛÎÔÔ‡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, ÂÈÛÙÚ¿ÊËÎ·Ó Û˘ÌÏËڈ̤ӷ Ù· 140. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÛÙÔȯ›ˆÓ Ô˘ Û˘ÁÎÂÓÙÚÒıËηÓ, ·ÍÈÔÔÈ‹ıËÎ·Ó ·˘Ù¿ Ô˘ ·ÊÔÚÔ‡Û·Ó Û 140 ·È‰È¿, ÁÈ· Ù· ÔÔ›· ˘‹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 ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ‰Â›ÎÙ˘ Û˘Ó¿ÊÂÈ·˜ C, Ô ÔÔ›Ô˜ Â›Ó·È Î·Ù¿ÏÏËÏÔ˜ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ Û˘Ó¿ÊÂÈ·˜ ηÙËÁÔÚÈÎÒÓ ‰ÈÌÂÙ·‚ÏËÙÒÓ, ÛÙȘ Ôԛ˜ 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˜ ÂÚÈÙÒÛÂȘ, ¤¯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, fiÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÙÔ 86,7% ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· ÔÈ ÌËÙ¤Ú˜ ÙÔ˘˜ ıˆÚÔ‡Ó ˆ˜ ·È‰È¿ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜, ¤¯ÂÈ Î·ÓÔÓÈÎfi ‚¿ÚÔ˜, ÂÓÒ ÙÔ 51,7% ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· 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 ÏÔÈfiÓ, 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 fiÔÙ 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·ÙËÚԇ̠ÏÔÈfiÓ 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· ‚Ï¤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 ÈηÓÔÔ›ËÛ‹˜ ÙÔ˘˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› ÙÔ˘˜. µ·ıÌfi˜ ÈηÓÔÔ›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. ∂ÈϤÔÓ, 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· ÔÔ›· ·ÊÔÚÔ‡Ó ÛÙÔ ‚·ıÌfi ÈηÓÔÔ›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 ÂÚÈÙÒÛÂȘ fiÔ˘ 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 ÂÚÈÙÒÛÂȘ fiÔ˘ 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˜ ÈηÓÔÔ›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˜. Ÿˆ˜ 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 ÈηÓÔÔ›ËÛ‹˜ ÙÔ˘˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› ÙÔ˘˜. µ·ıÌfi˜ ÈηÓÔÔ›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 ÈηÓÔÔ›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˘ ȉÈfiÙÚÔÔ 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 ÙÚfiÔ ‰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 È¤˙ÂÈ ÙÔ ·È‰› Ó· Ê¿ÂÈ Â›Ù ¿ÌÂÛ·, ›Ù ¤ÌÌÂÛ· Ì ÙËÓ ˘fiÛ¯ÂÛË
οÔÈ·˜ ·ÓÙ·ÌÔÈ‚‹˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙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‡ ÂȤ‰Ô˘ (66,7%) ÔÈ Ôԛ˜ ÂÎÙÈÌÔ‡Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ı· ¤ÙÚˆÁ ÏÈÁfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi ·Ó ·ÊËÓfiÙ·Ó ÂχıÂÚÔ (¶›Ó·Î·˜ 10). ªÂÏÂÙ‹ıËΠ›Û˘, Ë ÂӉ¯fiÌÂÓË Â›‰Ú·ÛË ÙÔ˘ ʇÏÔ˘ ÙÔ˘ ·È‰ÈÔ‡ ηıÒ˜ Î·È ÙÔ˘ ÙfiÔ˘ 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˘ ÂȤ‰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 fiÔ˘ ‰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 ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ ÛÙÔ Ôχ ÌÈÎÚfi Î·È fi¯È ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ηıÒ˜ ›Û˘ Î·È ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›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 ÌÔÚ› Ó· ·ÔÙÂÏ› ¤Ó‰ÂÈÍË Ù˘ ÌÂÁ¿Ï˘ Û˘¯ÓfiÙËÙ·˜ Ì ÙËÓ ÔÔ›· 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 ›‰Ú·ÛË ÛÙË ‰È·ÙÚÔÊÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 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· ÔÔ›· ‹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 ÂÔ›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 ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜, (11), Û‡Ìʈӷ Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ∂ÏÏËÓ›‰Â˜ ÌËÙ¤Ú˜ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ˘ÂÚÚÔÛÙ·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 ÈηÓÔÔÈË̤Ó˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ηٷӷÏÒÓÂÈ Î·È ı· ÂÈı˘ÌÔ‡Û·Ó Ó· ÙÚÒÂÈ ÂÚÈÛÛfiÙÂÚÔ. ¶ÔÏϤ˜ ÌËÙ¤Ú˜ ¿ÏψÛÙ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ ·È‰› ÙÔ˘˜ ȉÈfiÙÚÔÔ ÛÙÔ Ê·ÁËÙfi fiÙ·Ó ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ Â›Ó·È ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡, ·Ú’fiÏÔ Ô˘, fiˆ˜ ›‰·ÌÂ, ‰ÂÓ ‚Ú¤ıËΠԇÙ ¤Ó· Ù¤ÙÔÈÔ ·È‰› ÛÙȘ 140 ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂÙ‹Û·ÌÂ. Ÿˆ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ, ·˘Ù¤˜ ÔÈ Ï·Óı·Ṳ̂Ó˜ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÌËÙ¤ÚˆÓ ÂËÚ¿˙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˘ÌÂÚÈÊÔÚ¿ 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 Ôԛ˜ fiˆ˜ ‰È·ÈÛÙÒÛ·ÌÂ, Û˘¯Ó¿ ·¤¯Ô˘Ó ηٿ Ôχ ·fi ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. ™˘ÓÂÒ˜, 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 fiˆ˜ 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 ÏÔÈfiÓ Èı·Ófi Ë ·ÓÙ›ÏË„‹ ÙÔ˘˜ ÁÈ· ÙÔ ‰ÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜ Ó· ·¤¯ÂÈ ·fi ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, fiˆ˜ ·¤¯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
›Û˘ Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙȘ ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ. OÈ ÌÂÙ·‚ÏËÙ¤˜ ÙȘ Ôԛ˜ ÌÂÏÂÙ‹Û·Ì ‹Ù·Ó Ë ËÏÈΛ· Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓÈÒÓ, Ô ÙfiÔ˜ ηٷÁˆÁ‹˜ Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ·È‰ÈÔ‡. ¢È·ÈÛÙÒÛ·Ì fï˜, fiÙÈ Î·Ì›· ·fi ·˘Ù¤˜ ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ‰ÂÓ Ê¿ÓËΠӷ ÂËÚ¿˙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 ·گ›·˜, ÔÈ ÌËÙ¤Ú˜ ·ÓÒÙÂÚÔ˘ ‹ ηÙÒÙÂÚÔ˘ ÌÔÚʈÙÈÎÔ‡ ÂȤ‰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 ÏÔÈfiÓ, fiÙÈ ÔÈ ·ÓÙÈÏ‹„ÂȘ Ô˘ ÔÈ ∂ÏÏËÓ›‰Â˜ ÌËÙ¤Ú˜ ‰È·ÌÔÚÊÒÓÔ˘Ó ÁÈ· ÙË ‰È·ÙÚÔÊ‹ Î·È ÔÈ Ôԛ˜ 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 ÙÚfiÔ ¯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 ÂÈÎÚ·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 ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÔÈ «ÛËÌ·ÓÙÈÎÔ› ¿ÏÏÔÈ» ‚Ï¤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˜ ÂÈÙÒÛÂȘ 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 ÔÔ›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˘, fiˆ˜ Ë ÁÓˆÛÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë Û‡ÁÎÚÈÛË ÙÔ˘ ·˘ÙÔ‡ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜. ∂Ô-
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̤ӈ˜, Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, Ë ¤ÏÏÂÈ„Ë Ú·ÏÈÛÙÈ΋˜ ·ÓÙ›Ï˄˘ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙËÓ ·¯˘Û·ÚΛ· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Â›Ó·È Èı·Ófi Ó· ¯¿ÛÂÈ ÙËÓ ÚÔÛٷ٢ÙÈ΋ Ù˘ ·Í›· ÁÈ· ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛË ÙÔ˘ ·È‰ÈÔ‡, ηıÒ˜ ÙÔ ·È‰› ¤¯ÂÈ Ï¤ÔÓ ÂÚÈÛÛfiÙÂÚ˜ ËÁ¤˜ ÏËÚÔÊÔÚÈÒÓ. £· ‹Ù·Ó ÏÔÈfiÓ ÚÔÙÈÌfiÙÂÚÔ Ó· ˘‹Ú¯Â ÂÍ·Ú¯‹˜ Ì›· Ú·ÏÈÛÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ηٿÛÙ·Û˘ Ô˘ ı· Ô‰ËÁÔ‡Û Û ¤ÁηÈÚË ·Ú¤Ì‚·ÛË Î·Ù¿ Ù˘ ·¯˘Û·ÚΛ·˜, ÚÔÙÔ‡ ÙÔ ·È‰› ¤ÚıÂÈ ·ÓÙÈÌ¤ÙˆÔ Ì ÙËÓ Â˘Ú‡ÙÂÚË ÎÔÈÓˆÓÈ΋ ÔÌ¿‰· Î·È ·Ó·ÁηÛÙ› Ó· Û˘ÓÂȉËÙÔÔÈ‹ÛÂÈ ·fiÙÔÌ· fiÙÈ ÔÈ ·ÓÙȉڿÛÂȘ Ô˘ ÚÔηÏ› ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ‰ÂÓ Â›Ó·È ·Ó¿ÏÔÁ˜ Ì ·˘Ù¤˜ ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ¿ÓÔ˘Ì ‚¤‚·È· fiÙÈ, Û‡Ìʈӷ Ì ÔÏϤ˜ ¤Ú¢Ó˜, Ù· ·¯‡Û·Úη ·È‰È¿ ‰ÂÓ ¤¯Ô˘Ó Û˘ÓÔÏÈο ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË ·ÏÏ¿ ·ÚÓËÙÈ΋ ÂÈÎfiÓ· ÌfiÓÔ ÁÈ· ÙËÓ Â͈ÙÂÚÈ΋ ÙÔ˘˜ ÂÌÊ¿ÓÈÛË (23). ∏ Îϛ̷η Ô˘ ¯ÚËÛÈÌÔÔÈ‹Û·Ì fï˜, ‰ÂÓ Â›¯Â ÙË ‰˘Ó·ÙfiÙËÙ· ·ÍÈÔÏfiÁËÛ˘ ·˘ÙÔ‡ ÙÔ˘ ÛÙÔÈ¯Â›Ô˘. ∂›Ó·È ÏÔÈfiÓ Ê·ÓÂÚfi fiÙÈ ÙfiÛÔ Ë ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚΛ·˜ fiÛÔ Î·È ÙÔ Â›Â‰Ô ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Û¯ÂÙ›˙ÔÓÙ·È Ì ̛· ÂӉȿÌÂÛË ÌÂÙ·‚ÏËÙ‹, ÙȘ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙÔ È‰·ÓÈÎfi ‚¿ÚÔ˜ Î·È ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡. ∞Ó¿ÏÔÁ· Ì ÙËÓ ÂÈÎfiÓ· Ô˘ ¤¯Ô˘Ó ÁÈ· ÙÔ ·È‰› ÙÔ˘˜ ÔÈ ÁÔÓ›˜ ÂÓ‰¤¯ÂÙ·È Ó· ÙÔ Ù·˝˙Ô˘Ó ÏÈÁfiÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔ. ∞Ó¿ÏÔÁ· Ì ٷ ÌËӇ̷ٷ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Ù· ·È‰È¿ ÂÓ‰¤¯ÂÙ·È Ó· ÙÚÒÓ ÂÚÈÛÛfiÙÂÚÔ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔ˘˜ ÈηÓÔÔÈ‹ÛÔ˘Ó, Î·È ¤ÙÛÈ ‰È·ÌÔÚÊÒÓÔ˘Ó Î·È Ù· ›‰È· ·ÚfiÌÔȘ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË ‰È·ÙÚÔÊ‹. ∆Ș ·ÓÙÈÏ‹„ÂȘ ·˘Ù¤˜ Â›Ó·È Ôχ Èı·Ófi Ó· ÙȘ ˘ÈÔıÂÙ‹ÛÔ˘Ó ˆ˜ ·˘ÚÈ·ÓÔ› ÂÓ‹ÏÈΘ Î·È Ó· ÙȘ ÌÂÙ·‰ÒÛÔ˘Ó Ì ÙÔÓ ›‰ÈÔ ÙÚfiÔ ÛÙ· ‰Èο ÙÔ˘˜ ·È‰È¿. ∂Ô̤ӈ˜, ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜, Ë ·Ú¤Ì‚·ÛË ı· Ú¤ÂÈ Î·Ù¿ ÙË ÁÓÒÌË Ì·˜ Ó· ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙȘ Û¯ÂÙÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÁÔÓÈÒÓ Î·È ÛÙËÓ ·ÏÏ·Á‹ ÙÔ˘˜. ÕÌÂÛ˜ ·ÚÂÌ‚¿ÛÂȘ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ Ì ÙË ÌÔÚÊ‹ ÂȉÈÎÒÓ ‰È·ÈÙÔÏÔÁ›ˆÓ, ¯ˆÚ›˜ ·Ú¿ÏÏËÏË ÚÔÛ¿ıÂÈ· ·ÏÏ·Á‹˜ ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ Â›Ó·È Û˘Ó‹ıˆ˜ ·Ó·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜. ™ÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË Û˘ÓÈÛÙÔ‡Ó ÚÔÛˆÚÈÓ¤˜ ÌfiÓÔ Ï‡ÛÂȘ ηıÒ˜ Â›Ó·È Èı·Ó‹ Ë Â·ÓÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∞ÓÙ›ıÂÙ·, ·Ó ÔÈ ÁÔÓ›˜ ‚ÔËıËıÔ‡Ó Ó· ·ÏÏ¿ÍÔ˘Ó ÙȘ ·ÓÙÈÏ‹„ÂȘ ÙÔ˘˜ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ Î·È Â›Ó·È Û ı¤ÛË Ó· ÂÎÙÈÌÔ‡Ó Ì Ú·ÏÈÛÌfi ÔÈÔ Â›Ó·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Û ۯ¤ÛË Ì ÙÔ È‰·ÓÈÎfi ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ‚¿ÚÔ˜, ÙfiÙ ÙÔ Úfi‚ÏËÌ· ÌÔÚ› Ó· ÚÔÏËÊı› Î·È ·˘Í¿ÓÔÓÙ·È Î·Ù¿ Ôχ ÔÈ Èı·ÓfiÙËÙ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘.
¶·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˘Ìو̷ÙÔÏÔÁ›· ·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΋ ıÂڷ›· Ì ˘ÂÚ‚·ÚÈÎfi Ô͢ÁfiÓÔ (∏µO) Î·È ÙËÓ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ˘ÔÛÙ‹ÚÈÍ‹ ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜. ¶·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 ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ∏ Û˘Ìو̷ÙÔÏÔÁ›· 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˘·ÈÛıËÙÔÔ›ËÛ˘ ÂΠ̤ÚÔ˘˜ ÙÔ˘ ÁÈ·ÙÚÔ‡, ȉ›ˆ˜ fiÙ·Ó Ï›ÂÈ ÙÔ Û·Ê¤˜ ÈÛÙÔÚÈÎfi ¤ÎıÂÛ˘ Û ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη. ∏ ıÂڷ›· 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˘Ìو̷ÙÔÏÔÁ›· ÔÍ›·˜ ‰ËÏËÙËÚ›·Û˘ Ì CO ·fi Ì·ÁοÏÈ Î·È ÂÈÛËÌ·›ÓÂÙ·È Ë Ôχ ηϋ ÙÔ˘ ¤Î‚·ÛË ÌÂÙ¿ ÙË ÓÔÛËÏ›· ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·1 2
ÙÈ΋˜ £Âڷ›·˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ Î·È ÙȘ ıÂڷ¢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˜ Âԯȷ΋ 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 ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÚÈÛÙ·Ûȷο Ì·ÁοÏÈ. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi Î·È ÏÔÈfi 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 ‰‡ÛÓÔÈ·, ¿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΋˜ £Âڷ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶ & ∞ ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· ∫ÏÈÓÈ΋ ÀÂÚ‚·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. ∏ ›ÁÔ˘Û· ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÛÙÔ ∫À ÙÔ˘ ÓËÛÈÔ‡ ‹Ù·Ó Ë ¯ÔÚ‹ÁËÛË O2 Î·È ‰È·˙¿Ì˘ ·fi ÙÔ ÔÚıfi ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË 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·ÂÚÔÔÚÈÎÒ˜, 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 ıÂڷ¢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‰› ÙÔÔıÂÙ‹ıËΠ۠ÂȉÈÎfi ı¿Ï·ÌÔ Î·È ÙÔ Û¯‹Ì· Ù˘ ıÂڷ›·˜ Ô˘ ·ÎÔÏÔ˘ı‹ıËΠ‹Ù·Ó: ¯ÔÚ‹ÁËÛË ∏µO ÛÙȘ 1,8 Atm ÁÈ· 40 ÏÂÙ¿ Î·È Î·ÙfiÈÓ ÛÙȘ 1,6 Atm ÁÈ· 60 ÏÂÙ¿. 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· ÂÒ‰˘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›·˙ ۷ÛÌÔ‡˜ ‹ ¿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), ‹È˜ 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˜ ÂÚÈÙÒÛÂȘ
∞¤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 ÂÈÛÓÔ‹˜ 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) fiˆ˜ Î·È Ì·ÎÚÔÌÔÚÈ·ÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË 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·¯¤˜ ·ӷfiψÛ˘ 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 ÂÈÏÔÎÒÓ. ∆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 ÙÚÔÔÓ›Ó˘ ‹Ù·Ó ·ÚÓËÙÈÎfi ·ÏÏ¿ ÙÔ ·È‰› ·ÚÔ˘Û›·Û ÂÂÈÛfi‰ÈÔ ÎÔÈÏÈ·ÎÒÓ ¤ÎÙ·ÎÙˆÓ Û˘ÛÙÔÏÒÓ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Ô˘ ˘Ô¯ÒÚËÛ ¯ˆÚ›˜ ıÂڷ¢ÙÈ΋ ·Ú¤Ì‚·ÛË. ∆ËÓ ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË Ì¤Ú· ÓÔÛËÏ›·˜ ÌÂٷʤÚıËΠÁÈ· ¿ÏϘ ‰‡Ô Û˘Ó‰ڛ˜ ∏µO. ∞ÔÛˆÏËÓÒıËΠÂÈÙ˘¯Ò˜ ÙËÓ ¤ÌÙË Ë̤ڷ ÓÔÛËÏ›·˜ Î·È Ù¤ıËΠ۠·ÚÔ¯‹ ˘ÁÚÔÔÈË̤ÓÔ˘ O2 40-60% Ì ̿Ûη. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÂÏ·ÊÚ¿ ÂËÚ·Ṳ̂ÓË ÙÔ ÚÒÙÔ ÂÈÎÔÛÈÙÂÙÚ¿ˆÚÔ. ◊Ù·Ó ÏËı·ÚÁÈÎfi ·ÏÏ¿ fiÙ·Ó ·Ê˘ÓÈ˙fiÙ·Ó Â›¯Â ηϋ ·ʋ 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·¯¤˜ ·ӷfiψÛ˘ 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 fiÔ˘ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË ÌÂÙ¿ ·fi 7 ̤Ú˜ ηٿ ÙȘ Ôԛ˜ ›¯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΋ ·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‹. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù· Î·È ·Ú·Ì¤ÓÔ˘Ó ·‰È¿ÁÓˆÛÙ˜. ™ËÌÂȈ٤ÔÓ fiÙÈ ÔÈ Î¿ÙÔÈÎÔÈ ÙˆÓ ÌÂÁ·ÏÔ˘fiÏÂˆÓ ¤¯Ô˘Ó ›‰· ηڂÔ͢·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbCO) ÛÙÔ ·›Ì· Ù˘ Ù¿Í˘ ÙÔ˘ 1-2% ÂÓÒ ÛÙÔ˘˜ ηÓÈÛÙ¤˜ Ù· ›‰· Â›Ó·È Ù˘ Ù¿Í˘ ÙÔ˘ 4% (2). ¶¤ÓÙ ‚·ÛÈÎÔ› Ì˯·ÓÈÛÌÔ› ÂÓÔ¯ÔÔÈÔ‡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 ÂÎÙfiÈÛË ÙÔ˘ O2 ·fi ÙÔ ÌfiÚÈÔ Ù˘ Hb Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿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· fiˆ˜ ›Û˘ Î·È Î·ı˘ÛÙÂÚË̤ÓË ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘Ìو̿وÓ, 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 ·ÎfiÏÔ˘ıÔ ÙËÓ ÈÛ¯·ÈÌ›· ÙˆÓ ÈÛÙÒÓ (2,4). Â) ™Â ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÒÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Ô˘ È-
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
ÛÙ‡ÂÙ·È fiÙÈ Â›Ó·È ·fiÙÔΘ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‚Ï¿‚˘ ·ӷÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓ ÌÂÙ¿ ·fi ÈÛ¯·ÈÌÈÎfi ÂÂÈÛfi‰ÈÔ (2,4). ∆· Û˘ÌÙÒÌ·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 Ôԛ˜ ‚Ú¤ıËÎÂ Ô ·ÛıÂÓ‹˜ (1,9). ∆· ÛËÌ›· Î·È Û˘ÌÙÒÌ·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 ›‰· Ù˘ HbCO ÛÙÔ ·›Ì· (2,9). ∏ Ùˆ¯‹ ·˘Ù‹ Û˘Û¯¤ÙÈÛË ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ¤ÎıÂÛ˘ ·ÏÏ¿ Î·È ÛÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÂÈÛÓÂfiÌÂÓÔ˘ ·¤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 ÂȤ‰ˆÓ Ù˘ HbCO Ì ÙË Û˘Ìو̷ÙÔÏÔÁ›· (2,7): 0-10% ∞Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ÂÎÙfi˜ ‹È·˜ ÎÂÊ·Ï·ÏÁ›·˜ 20% ∑¿ÏË, Ó·˘Ù›·, ÏÈÔı˘ÌÈ΋ Ù¿ÛË, Û˘ÌÙÒÌ·Ù· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜, ‹È· ‰‡ÛÓÔÈ· 30% OÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ 40% ™‡Á¯˘ÛË, ÏÈÔı˘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· ÌÔÚ› 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› fiˆ˜: ‰È·ÓÔËÙÈ΋ ¤ÎÙˆÛË, ·ÒÏÂÈ· ÌÓ‹Ì˘ (Û ÔÛÔÛÙfi ̤¯ÚÈ Î·È 43%), ‰È·Ù·Ú·¯¤˜ fiÚ·Û˘, ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ), Û˘ÌÙÒÌ·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˘ÌÙÒÌ·Ù· (2). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÁÓˆÛË, Ë ÈÔ ·ÍÈfiÈÛÙË ¤Ó‰ÂÈÍË ‰ËÏËÙËÚ›·Û˘ Â›Ó·È ÙÔ ÈÛÙÔÚÈÎfi Èı·Ó‹˜ ¤ÎıÂÛ˘ Û CO (2). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ HbCO ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î˘Ú›ˆ˜ ˆ˜ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ (3,9). ∞Ó ¤¯ÂÈ ·Ú¤ÏıÂÈ ÛËÌ·ÓÙÈÎfi˜ ¯ÚfiÓÔ˜ ·fi ÙÔ ·Ù‡¯ËÌ· ‹ ·Ó ¤¯ÂÈ ¯ÔÚËÁËı› 100% O2 Ù· ›‰· Ù˘ HbCO ÌÔÚ› Ó· Â›Ó·È ·Ú·Ï·ÓËÙÈο ¯·ÌËÏ¿. O ÎÏÈÓÈÎfi˜ ÌÔÚ› 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˜, ÂÂȉ‹ ˘ÔÏÔÁ›˙ÂÙ·È ·˘ÙfiÌ·Ù· ·fi ÙËÓ ÌÂÚÈ΋ ›ÂÛË ÙÔ˘ O2, Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·ÏÌÈ΋ Ô͢ÌÂÙÚ›· ›Û˘ Â›Ó·È ·Ó·ÎÚÈ‚‹˜ ÛÙË ‰ËÏËÙËÚ›·ÛË Ì CO, ‰ÈfiÙÈ Ë ∏bCO ·ÔÚÚÔÊ¿ ÙÔ Êˆ˜ ÛÙÔ ›‰ÈÔ Ì‹ÎÔ˜ ·̷ÙÔ˜ fiˆ˜ 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 ÔÔ›· ÎÈ ÂÌ›˜ ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘fiÓÔÈ· ‹ ÂȂ‚·ÈˆÌ¤ÓË ‰ËÏËÙËÚ›·ÛË Ì CO Ú¤ÂÈ Ó· Á›ÓÂÙ·È ∏∫° Î·È ·Ó Â›Ó·È ·ıÔÏÔÁÈÎfi (ÎÔÏÈ΋ Ù·¯˘Î·Ú‰›·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ST) ÙfiÙ ڤÂÈ 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 ·Ó·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˘ fiÔ˘ ÌÔÚ› Ó· ηٷÁÚ·ÊÔ‡Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· fiˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË Ó¤ÎÚˆÛË Ù˘ ˆ¯Ú¿˜ ÛÊ·›Ú·˜, ÙÔ˘ ÊÏÔÈÔ‡, ÙÔ˘ ÈfiηÌÔ˘ 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 و¯‹ 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 ÂÂÈÛfi‰ÈÔ, ÓfiÛÔ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ, ·ÚÚ˘ı̛˜ Î·È Ô ·ÛıÂÓ‹˜ ı· Ú¤ÂÈ Ó· ·ÔÌ·ÎÚ‡ÓÂÙ·È ·Ì¤Ûˆ˜ ·fi ÙÔÓ ÙfiÔ ¤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· ıÂڷ›· 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˘ ıÂڷ›·˜ Ì O2 Â›Ó·È Ó· ÌÂÁÈÛÙÔÔÈËı› ÙÔ ÎÏ¿ÛÌ· ÙÔ˘ O2 Ô˘ Â›Ó·È ‰È·Ï˘Ì¤ÓÔ ÛÙÔ Ï¿ÛÌ·. ∏ Ô͢ÁÔÓÔıÂڷ›· ı· Ú¤ÂÈ Ó· Û˘Ó¯›˙ÂÙ·È ÁÈ· ÙfiÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÒÛÙ ӷ ÚÔÏËÊıÔ‡Ó ÔÈ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ ·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). ∏ ıÂڷ›· Ì ∏µ√ Â›Ó·È Ë ‰È·ÏÂ›Ô˘Û· ÂÈÛÓÔ‹ O2 100% ˘fi ›ÂÛË ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÌÈ·˜ ·ÙÌfiÛÊ·ÈÚ·˜ (6,10). ŒÓ‰ÂÈÍË ÁÈ· ıÂڷ›· 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˘Ìو̷ÙÈÎÔ› ·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˘
522
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
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 ϋÚË ¤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˘ ·ӷÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓ. ∆Ô ∏µO ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ O2 Î·È ·ÔÙÚ¤ÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, Ô˘ ÚÔηÏÔ‡Ó ‚Ï¿‚Ë ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁ›ˆÓ. OÈ ‚Ï¿‚˜ ·ӷÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·ı˘ÛÙÂÚËÌ¤ÓˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ (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˘ ıÂڷ›·˜ Ì ∏µO ÂÈÙ˘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 ÂÈÏÔÎÒÓ ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ì ÙË ıÂڷ›· 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˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ ∫¡™ (ÎÒÌ· πππ Î·È ÛËÌ›· ·ÂÁÎÂÊ·ÏÈÛÌÔ‡) fiˆ˜ ›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΋˜ £Âڷ›·˜ 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 ÔÔ›· 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 ıÂڷ›· Ì ∏µO ÌÔÚ› Ó· Â›Ó·È Ôχ ÂÈÙ˘¯‹˜ 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˜ ÂÚÈÙÒÛÂȘ
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˜. O͢ÁÔÓÔıÂڷ›·. ∂ÓÙ·ÙÈ΋ £Âڷ›·, 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·ÌԇϷ˜2, Zˆ‹ ¶··‰ÔÔ‡ÏÔ˘-KÔ˘ÏÔ˘Ì‹1
● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÔÈÎÔÁÂÓ‹˜ ÂÚ›ÙˆÛË ÛÔÁÁÒ‰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 ÂÈÎÂÓÙÚÒÓÂÙ·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˘ ÛÔÁÁÒ‰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: ÛÔÁÁ҉˘ 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‹ OÛÔÁÁ҉˘ 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). ∏ ›وÛË Ù˘ ÓfiÛÔ˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹ ‰ÈfiÙÈ Ë ÓfiÛÔ˜ Â›Ó·È Û˘¯Ó¿ ·Û˘Ìو̷ÙÈ΋ ¤ˆ˜ fiÙÔ˘ ÂΉËψıÔ‡Ó Î¿ÔȘ ·fi ÙȘ ÂÈÏÔΤ˜ 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‹ ¶·ÓÂÈÛÙËÌ›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˜ ÂÚÈÙÒÛÂȘ Â›Ó·È ÛÔÚ·‰ÈΤ˜, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ Û ·‰¤ÏÊÈ· ηıÒ˜ Î·È Û 2-3 ÁÂÓȤ˜ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ fiÔ˘ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (4). OÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ fï˜, ·ÌÊÈÛ‚ËÙÔ‡Ó ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘.
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:524-528
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
¶›Ó·Î·˜ 1. EÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÛÙ· ‰‡Ô ·‰¤ÏÊÈ· Ì ÛÔÁÁÒ‰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˜ fiˆ˜ 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· ›‰· ·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 ÔÏϷϤ˜ 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 ›Û˘ Ê˘ÛÈÔÏÔÁÈÎfi. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ 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 ·ÌÊÔÙÂÚfiÏ¢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 ·ÌÊÔÙÂÚfiÏ¢ڷ Î·È Ï‹ÚˆÛ‹ ÙÔ˘˜ Ì ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi ˘ÏÈÎfi (ÁÚ·ÌÌÔÂȉ›˜ Ú·‚‰ÒÛÂȘ), ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÛÔÁÁÒ‰Ë ÓÂÊÚfi (EÈÎfiÓ· 1). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ Û˘¯Ó¿ ÂÂÈÛfi‰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˜ ÂÚÈÙÒÛÂȘ
∂ÈÎfiÓ· 2. YÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ fiÔ˘ ‰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›· fiÔ˘ 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· ·ÌÊÔÙÂÚfiÏ¢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 ¤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 ÂÂÈÛfi‰ÈÔ ÎÔÏÈÎÔ‡ ÙÔ˘ ÓÂÊÚÔ‡ ÁÈ· ÙÔ ÔÔ›Ô ÓÔÛËχÙËΠÛÙËÓ ∞Ï‚·Ó›· fiÔ˘ ‰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 ÂÂÈÛfi‰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˘ÚÔÔÈËÙÈÎÔ‡ 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˜ ·ÌÊÔÙÂÚfiÏ¢ڷ Ô˘ ÏËÚÔ‡ÓÙ·Ó Ì ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi ̤ÛÔ, ÂÈÎfiÓ· ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÙÔ˘ ÛÔÁÁÒ‰Ô˘˜ ÓÂÊÚÔ‡, ηıÒ˜ Î·È ˘ÔÙÔÓÈ΋ ‡ÂÏÔ ÛÙÔÓ ‰ÂÍÈfi ÓÂÊÚfi. ™˘˙‹ÙËÛË O ÛÔÁÁ҉˘ ÓÂÊÚfi˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÔÚ·‰Èο, ¤¯Ô˘Ó fï˜ ÂÚÈÁÚ·Ê› Î·È ÔÈÎÔÁ¤ÓÂȘ Ì ÚÔÛ‚ÔÏ‹ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÌÂÏÒÓ ÙÔ˘˜ (4). EÈϤÔÓ, ·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‚‹˜ ›وÛË Ù˘ ÓfiÛÔ˘ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÔÈÎÔÁ¤ÓÂÈ· ı· ÌÔÚÔ‡Û ӷ ÚÔÛ‰ÈÔÚÈÛÙ› Ì ԢÚÔÁÚ·ÊÈ΋ ÌÂϤÙË ÙˆÓ ˘ÔÏÔ›ˆÓ ÌÂÏÒÓ Ù˘. ∞˘Ùfi fï˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ ÂÂȉ‹ ‰È¤ÌÂÓ·Ó ÛÙËÓ ∞Ï‚·Ó›·. ™˘¯Ó¿ Ë ÓfiÛÔ˜ Â›Ó·È ·Û˘Ìو̷ÙÈ΋ Î·È ·Ú·ÙËÚÂ›Ù·È Û 1:200 (0,5%) ÌË ÂÈÏÂÁ̤Ó˜ 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 οÔÈ· ·fi ÙȘ ÂÈÏÔΤ˜ Ù˘ fiˆ˜ ÎÔÏÈÎfi˜ ÓÂÊÚÔ‡ (57%), Ì·ÎÚÔÛÎÔÈ΋ ·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 ‹È˜ ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘Ì‡ÎÓˆÛ˘ ÙˆÓ Ô‡ÚˆÓ ÔÊÂÈÏfiÌÂÓ˜ ΢ڛˆ˜ ÛÙËÓ ·ÚÔ˘Û›· ÓÂÊÚ·Û‚¤ÛÙˆÛ˘, ηıÒ˜ Î·È ‹È˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÍÈÓÔÔ›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˘ fiˆ˜ 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 ›‰· 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›·˜, ÌÔÚ› 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¯ÔÔÈËı› ‰È¿ÊÔÚÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ fiˆ˜: ·) 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‹ ·Ó¿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›·, fiÔ˘ ·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 ÂÚÈÙÒÛÂˆÓ ÚÔÛ‚¿ÏÏÔÓÙ·È Î·È ÔÈ ‰‡Ô ÓÂÊÚÔ›, ¯ˆ-
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
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¤˜ ÂÚÈÙÒÛÂȘ 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 ÂÚÈÙÒÛÂȘ 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· ÂÎÎÔÏÒÌ·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 ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ, 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΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ô˘ÚÔÏÔÈÌÒ͈Ó, Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Î·Ï‹ Î·È Ë ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ·Û˘Ó‹ı˘ (8-9). ¶·ÚfiÏ· ·˘Ù¿ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿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˘ ıÂڷ¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ 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. 2. Mayall GF. The incidence of medullary sponge kidney. Clin Radiol 1970;21:171-174. 3. Patriquin HB, O' Regan S. Medullary sponge kidney in childhood. ∞JR 1985;145:315-319. 4. Kuiper JJ. Medullary sponge kidney in three generations. N.Y.State J Med 1971;71:2665-2669. 5. Shultz PK, Strife JL, Strife CF, McDaniel JD. Hyperechoic renal medullary pyramids in infants and children. Radiology 1991;181:163-167. 6. Baldree LA, Stapleton FB. Uric acid metabolism in children. Pediatr Clin N Am 1990;37:391-418 7. Harris RE, Fuchs EF, Kaempf MJ. Medullary sponge kidney and congenital hemihypertrophy: case report and review of the literature. J Urol 1981;126:676-678. 8. Gardner KD. Medullary Sponge Kidney. In: Edelmann C, editor. Pediatric Kidney Disease. 2nd ed. Boston: Little, Brown and Co; 1992. p. 1641-1645.
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9. Yendt ER. Medullary sponge kidney and nephrolithiasis. N Engl J Med 1982;306:1106-1107. 10. Ginalski JM, Portmann L, Jaeger P. Does medullary sponge kidney cause nephrolithiasis? AJR 1990;155:299-302. 11. O' Neill M, Breslau NA, Pak CY. Metabolic evaluation of nephrolithiasis in patients with medullary sponge kidney.JAMA 1981;245:1233-1236. 12. Osther PJ, Hansen AB, Rohl HF. Renal acidification defects in medullary sponge kidney. Br J Urol 1988;61:392-394.
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
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‹ ¶·ÓÂÈÛÙËÌ›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· ‹ ηÎÔÔ›ËÛË; ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘: ™ÎÔfi˜ 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· ‹ ηÎÔÔ›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· ‹ ηÎÔÔ›ËÛË. ª¤ıÔ‰Ô˜:ŒÁÈÓ ·Ó·ÛÎfiËÛË 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‹˜. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ Î·ÙËÁÔÚÈÔÔ›ËÛË Ù˘ οΈÛ˘ ˆ˜ ÔÊÂÈÏfiÌÂÓ˘ Û ηÎÔÔ›ËÛË ‹ ·Ù‡¯ËÌ·. ∞ÔÙÂϤÛÌ·Ù·: ™ÙÔ 81% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÚfiÎÂÈÙÔ ÁÈ· ·Ù‡¯ËÌ· Î·È ÛÙÔ 19% ÁÈ· ηÎÔÔ›ËÛË. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Ì οΈÛË ·fi ·Ù‡¯ËÌ· ‹Ù·Ó 2,5 ¯ÚfiÓˆÓ Î·È ·fi ηÎÔÔ›ËÛË 0,7 ¯ÚfiÓˆÓ. √È ÌÂÁ·Ï‡ÙÂÚ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ Â›ÙˆÛË ‚Ú¤ıËÎ·Ó ÛÙ· ·ÎfiÏÔ˘ı·: ÀÔÛÎÏËÚ›‰ÈÔ ·È̿و̷: 10% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ·Ù‡¯ËÌ· Î·È 46% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›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 ηÎÔÔ›ËÛË. ∞ÈÌÔÚÚ·Á›Â˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜: 2% ÛÙ· ·È‰È¿ Ì ·Ù‡¯ËÌ· Î·È 33% ÛÙ· ·È‰È¿ Ì ηÎÔÔ›ËÛË. ∆Ú·˘Ì·ÙÈÛÌfi˜ ‰¤ÚÌ·ÙÔ˜ Û˘Ó˘‹Ú¯Â Û 16% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔÔ›ËÛË. ∆Ô 23% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·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 ÂÚÈÙÒÛÂˆÓ ·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¤ÚıËΠÙÒÛË, ÂÓÒ ÛÙÔ 24% ¤ÁÈÓ ·Ú·‰ÂÎÙ‹ Ë Î·ÎÔÔ›ËÛË. ∏ ıÓËÙfiÙËÙ· ‹Ù·Ó 13% ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ Î·ÎÔÔÈËÌ¤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 ηÎÔÔ›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 ηÎÔÔ›ËÛË ÁÈ· Ù· ÔÔ›· ·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‹. ™˘ÌÂÚ¿ÛÌ·Ù·: ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Î·ÎÒÛÂˆÓ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿ οو ÙˆÓ 6,5 ¯ÚfiÓˆÓ ÛÙȘ Ôԛ˜ ··ÈÙÂ›Ù·È ÂÈÛ·ÁˆÁ‹ Û ÓÔÛÔÎÔÌ›Ô, ÔÊ›ÏÔÓÙ·È Û ηÎÔÔ›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· ÛÏ¿¯Ó· Û˘Ó‰¤ÔÓÙ·È ÛËÌ·ÓÙÈο ÈÔ Û˘¯Ó¿ Ì ηÎÔÔ›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 ÌÔÚ› 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 ÔÔ›Ô ÂÌÊ¿ÓÈÛ ڷ‚‰ÔÌ˘fiÏ˘ÛË ÌÂ Û˘ÓÔ‰fi ‹È· ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜, ÛÙ· Ï·›ÛÈ· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ·fi Salmonella enteritidis. °›ÓÂÙ·È ·Ó·ÛÎfiËÛË 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 ÔÔ›· ÌÔÚ› Ó· ηٷϋÍÂÈ Û ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿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· ÂÓÙÔÈṲ̂ÓË ˘Ò‰Ë Û˘ÏÏÔÁ‹ (·fiÛÙËÌ·) Î·È ˆ˜ ‰ÂÓ Â›Ó·È ÂÌÊ·Ó‹˜ Ë ·ÚÔ˘Û›· οÔÈ·˜ ÙÔÈ΋˜ Ì˘˚΋˜ ‚Ï¿‚˘. ™‡Á¯ÚÔÓ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ Ë ·ÍÔÓÈ΋ Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ÌÔÚÔ‡Ó Ó· ·ÔÎÏ›ÛÔ˘Ó ÙËÓ ‡·ÚÍË ÙÔÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È Ì˘ÔÓ¤ÎÚˆÛ˘. ∆· ·›ÙÈ· ÌÔÚ› Ó· Â›Ó·È ÎÏËÚÔÓÔÌÈο, ȉÈÔ·ı‹ ‹
‰Â˘ÙÂÚÔ·ı‹. √È Ú·‚‰ÔÌ˘ÔχÛÂȘ Ô˘ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌÈÎfi ˘fiÛÙڈ̷, ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Ì ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∞Ó¿ÌÂÛ· ÛÙ· ·›ÙÈ· Ô˘ ÌÔÚÔ‡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˘ÌÈÂÛÙÈο-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˜ ÂÚÈÙÒÛÂȘ
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΋ ·ӷÚÚfiÊËÛË ÊˆÛÊfiÚÔ˘ ‹Ù·Ó ÂËÚ·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% ·ӷÚÚfiÊËÛË 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%, ·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 ÎÔÚ¿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 ÂÛÙÂÚÔÔÈË̤ÓË): Ê˘ÛÈÔÏÔÁÈ΋ ∞ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù·: Ê˘ÛÈÔÏÔÁÈο √ÏÈÎfi Û˘Ìϋڈ̷ Î·È C3, C4: Ê˘ÛÈÔÏÔÁÈο ∞ÓÙÈÛÒÌ·Ù· ÁÈ· ÏÂÙfiÛÂÈÚ· 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˜ › ·ÚÂÁ¯˘Ì·ÙÈ΋˜ ÂÈ‚¿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˜ ÂÚÈÙÒÛÂȘ
¶›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 ÂȂ‚·›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 ÔÔ›· ¤‰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 ÔÔ›ˆÓ Ë ·Ó¿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˘Ìو̷ÙÔÏÔÁ›·˜ (˘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) ¿ÓÔ‰Ô ÙˆÓ ÂÓ˙‡ÌˆÓ (CPK, LDH, AST) ÛÙ· Ê˘ÛÈÔÏÔÁÈο ›‰· (¶›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 ›‰· (οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘, ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘, ÛˆÏËÓ·Úȷ΋ ·ӷÚÚfiÊËÛË 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˜ ·Ó¿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· ÌÔÚ› 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 ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÓ˙˘ÌÈΤ˜ ·Ó¿ÚÎÂȘ ÛÙȘ ÌÂÙ·‚ÔÏÈΤ˜ Ô‰Ô‡˜ ·) ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ (¤ÏÏÂÈ„Ë Ì˘˚΋˜ ʈÛÊÔÚ˘Ï¿Û˘- ÓfiÛÔ˜ Mcardle Î·È ·Ó¿ÚÎÂÈ· ʈÛÊÔÊÚÔ˘ÎÙÔÎÈÓ¿Û˘) Î·È ‚) ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (‰È·Ù·Ú·¯‹ ‚- ÔÍ›‰ˆÛ˘, ÏfiÁˆ ·Ó¿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 ÔÔ›· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î˘ÙÙ·ÚfiÏ˘ÛË ÔÏϤ˜ ÊÔÚ¤˜ ÌÂÙ¿ ·fi ÙËÓ Â›‰Ú·ÛË ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ë ÓËÛÙ›·, Ë ¿ÛÎËÛË, ÙÔ „‡¯Ô˜, ÙÔ stress ÎÏ. ÕÏϘ ·ÚfiÌÔȘ ηٷÛÙ¿ÛÂȘ, ÙˆÓ ÔÔ›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
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
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 fiˆ˜ Ë ·ÌÊÔÙÂÚÈΛÓË µ (‰Â˘ÙÂÚÔ·ıÒ˜ ̤ۈ ηÏÈÔÂÓ›·˜) Î·È ÙÔ Ì˘Ô¯·Ï·ÚˆÙÈÎfi ÛÔ˘ÎÈÓÈÏÔ¯ÔÏ›ÓË.(1,2) ∏ ·Ó¿ÚÎÂÈ· ÙÔ˘ ÚÔÛÊÂÚÔ̤ÓÔ˘ Ô͢ÁfiÓÔ˘, fiˆ˜ ·˘Ù‹ ÂΉËÏÒÓÂÙ·È ÛÙËÓ ÔÚ›· ÂÈÏËÙÈÎÔ‡ status ηıÒ˜ Î·È Ë ÈÛ¯·ÈÌ›· ÌÂÙ¿ ·fi Û˘ÌÈÂÛÙÈο ÙÚ·‡Ì·Ù·, ·ÔÙÂÏÔ‡Ó ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘, ÂÓÒ ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯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 ÌÔÚÔ‡Ó Ó· ÂÈÏ·ÎÔ‡Ó ÛÙËÓ ÔÚ›· ÙÔ˘˜ Ì ڷ‚‰ÔÌ˘fiÏ˘ÛË. ∆· ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, Ù· ÔÔ›· ·ÊÔÚÔ‡Ó Û ÂÓ‹ÏÈÎÔ˘˜, ÂÓÔ¯ÔÔÈÔ‡Ó ÙÔÓ Èfi Ù˘ Áڛ˘ (∞ Î·È µ) ˆ˜ ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ. ¶Ú¿ÁÌ·ÙÈ, ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 59 ÂÚÈÙÒÛÂˆÓ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜, ÔÈ 25 (ÔÛÔÛÙfi 42%) ÚÔÎÏ‹ıËÎ·Ó ·fi ÈÔ‡˜ Ù˘ Áڛ˘. ∞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΋ ·Ó¿ÚÎÂÈ·. (2) ∞ÎÔÏÔ˘ıÔ‡Ó ÛÂ Û˘¯ÓfiÙËÙ· Ô Èfi˜ Ù˘ ›ÎÙËÙ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·Ó¿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¯ÔÔÈËı› ‰‡Ô, ·fi ÙÔ˘˜ ÔÔ›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˘ Áڛ˘ 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¿˜-¤ÚËÙ· ˙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› fiˆ˜ 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· ÂÓÂÚÁÔÔÈÔ‡Ó Ï˘ÛÔÛˆ-
532
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
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 ÔÔ›ÔÈ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÍ·ÈÌ›·, ·Ê˘‰¿ÙˆÛË, ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·ÏÏ¿ Î·È ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÌÈ·˜ ÂÈΛÌÂÓ˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘.(5,7-9). ¶Ú¤ÂÈ fï˜ Ó· ÙÔÓÈÛı›, ˆ˜ ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ·ÔÌÔÓˆı› Î·È Ù·˘ÙÔÔÈËı› οÔÈ· 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˘ ÛÂÈÚ·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›·, ÌÔÚ› Ó· ηٷϋÍÂÈ ÙÂÏÈο Û ÔÏÈÁÔ˘ÚÈ΋ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·.(2,6) ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ˆ˜ ÂÈÏÔ΋ Ïԛ̈͢ ·fi ›‰Ë Salmonella Â›Ó·È Û¿ÓÈ· Î·È ·˘Ùfi Û˘Ó¿ÁÂÙ·È ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Ë ÔÔ›· Û˘ÓÔÏÈο ·ÚÈıÌ› ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ.(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·ÎÚÔÛÎÔÈ΋˜ 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· ÂÈÛËÌ·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 ÂÚȤÏÂÍ 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˘ ÔÔ›·˜ 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΢„ οÔÈÔ˘ ‚·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 ÂÔ›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
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:529-533
ÔÈÔ ‚·ıÌfi ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, Ë ÔÔ›· Î·È ·ÔηٷÛÙ¿ıËΠÚÔԉ¢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 ÔÔ›ÔÈ Â·Ó‹Ïı·Ó ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÛÙËÓ ¤ÍÔ‰Ô Î·È Î·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ú·‚‰ÔÌ˘fiÏ˘ÛË ÛÙ· Ï·›ÛÈ· ‚·ÎÙËÚȷ΋˜ Ïԛ̈͢ Â›Ó·È ÌÂÓ Û¿ÓÈ· ˆ˜ ÂÈÏÔ΋, Â›Ó·È fï˜ ˘·ÚÎÙ‹. ™˘ÓÂÒ˜, ÂÈ‚¿ÏÏÂÙ·È Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú¿ÍË, ȉ›ˆ˜ ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÂËÚ·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 ÂÚÈÙÒÛÂȘ Ì ÛËÌ·ÓÙÈ΋ ÎÏÈÓÈ΋ ·Ù˘›· fiˆ˜ ·˘Ù‹ (·Ô˘Û›· Û˘ÌÙˆÌ¿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 ÂÈÏÔΤ˜ Ù˘, fiˆ˜ ÔÈ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Î·È Ë ·Ú¿Ï˘ÛË ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ ÌÔÚ› 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.
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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
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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˘ÌÂÚÈÏ·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˘ÌÙÒÌ·Ù· Î·È ÂÈÏÔΤ˜ 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˘ÌÙˆÌ¿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 ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˈÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ, ·Ô˘Û›· ·ÁÁÂÈ›Ùȉ·˜ Î·È ÂÚÈÊÂÚÈ΋ ˈÛÈÓÔÊÈÏ›· ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (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˜ ÚˆÙÔÂÚÈÁÚ¿ÊËΠ·fi ÙÔÓ Kaijser ÙÔ 1937. ∏ ›وۋ Ù˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹. ∆· Û˘ÌÙÒÌ·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 ÂÓÙfiÈÛË Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ ‰È‹ıËÛ˘ (ÔÈÛÔÊ¿ÁÔ˜, ÛÙÔÌ¿¯È, ÏÂÙfi, ·¯‡ ¤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˜ ÂÚÈÙÒÛÂȘ
·fi Û˘ÌÙÒÌ·Ù· ÊÏÂÁÌÔÓ‹˜, ÛÙË Ì˘˚΋ ÛÙÈ‚¿‰· ·fi Û˘ÌÙÒÌ·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 ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·fiÊÚ·ÍË (1). ∏ ‰È¿ÙÚËÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È Ô ÂÁÎÔÏ·ÛÌfi˜ ·ÔÙÂÏÔ‡Ó Û¿ÓȘ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ (3). ∞Ó Î·È ¿ÙÔÌ· fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚ÏËıÔ‡Ó, ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Û ÓÂÔÁÓ¿ (4,5,6) Î·È Î·Ì›· ·fi ·˘Ù¤˜ ‰ÂÓ ·ÚÔ˘Û›·Û οÔÈ· ÂÈÏÔ΋. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡, ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛÂ Û˘ÌÙÒÌ·Ù· ˈÛÈÓÔÊÈÏÈ΋˜ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ‹‰Ë ·fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜, ηıÒ˜ Î·È ‰‡Ô Û¿ÓȘ ÂÈÏÔΤ˜, ‰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˘ ÂÙÈÎÔ‡. °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˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó Á·ÛÙÚÔÏËÁÈÎÔ›. √ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ 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 ÔÔ›· ‰È·ÈÛÙÒıËΠÂÈÛÎÔÈο ÌÂÁ¿ÏË ‰È¿Ù·ÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∆Ô ‹·Ú Î·È Ù· ¯ÔÏËÊfiÚ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÙÔ ÏÂÙfi Î·È ÙÔ ·¯‡ ¤ÓÙÂÚÔ Û ÔÚıfiÙÔË ı¤ÛË ¯ˆÚ›˜ Ì·ÎÚÔÛÎÔÈο ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∫·Ù¿ ÙËÓ Â¤Ì‚·ÛË ÂϤÁ¯ıËÎÂ Ë ‚·ÙfiÙËÙ· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· ‰È· ÙÔ˘ ÔÔ›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 ÂÈÙ˘¯‹˜ 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 ÂfiÌÂÓ˜ Ë̤Ú˜ ‹Ù·Ó ›Û˘ ·ÓÂÈÙ˘¯Â›˜.
∂ÈÎfiÓ· 1. ∞fiÊÚ·ÍË ÛÙÔÓ ˘ÏˆÚfi ∆Ô ÓÂÔÁÓfi ÌÂٷʤÚıËΠÛÙÔ ÙÌ‹Ì· Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô Î·È ·ÓÙÈÌÂÙÒÈÛË. ∞fi ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÙÈÎÔ‡ ‰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˜ fiÔ˘ ‰Â ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆Ô ÙÔ›¯ˆÌ· ÙÔ˘ ˘ÏˆÚÔ‡ ·ÓÂϤÁ¯ıËΠ̠˘ÂÚ‹¯Ô˘˜ ‰‡Ô Ë̤Ú˜ ·ÚÁfiÙÂÚ·, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆı› ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘. ŒÁÈÓ ÂÓ‰ÔÛÎfiËÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ 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 ÔÔ›· ·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 ·ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ, Î˘Ì¿ÓıËÎ·Ó ·fi 13% ¤ˆ˜ 27% (·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ 1300-4000\mm3). ∆· ›‰· 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˜ ÂÚÈÙÒÛÂȘ
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˘Ìو̷ÙÈÎfi. √ ·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˘ÌÏËÚÒÌ·ÙÔ˜ ÛÙÔÓ ÔÚfi ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜, ‹Ù·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. ∏ ·1 ·ÓÙÈıÚ˘„›ÓË ÎÔÚ¿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· ÎfiÚ·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 Âȉ›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˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Î·È ˘‰Ú·ÂÚÈο ›‰·, ÂÓ‰ÂÈÎÙÈο ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢. ŒÁÈÓ ‰Â‡ÙÂÚË Ï··ÚÔÙÔÌ›· ÛÙËÓ ÔÔ›· ‰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 ÔÔ›· 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 ÌÂٿوÛ˘ 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˘Ìو̷ÙÔÏÔÁ›· Î·È ÙËÓ ÂÓÙfiÈÛË 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 Ôԛ˜ ‰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˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi, Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ·fiÊڷ͢ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÙËÓ ÂÚÈÊÂÚÈ΋ ˈÛÈÓÔÊÈÏ›·, Ù· ·˘ÍË̤ӷ ›‰· Ù˘ IgE ÛÙÔÓ ÔÚfi, ÙË ıÂÙÈ΋ ‰ÔÎÈÌ·Û›· Rast Û ڈÙ½ÓË Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Î·È Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÂÚ›ÙˆÛË ÌÔÚ› 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 ÂÈÏÔΤ˜, ‰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¤˜ ÂÈÏÔΤ˜. ∆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˘ÌÙÒÌ·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 ÂÚÈÙÒÛÂȘ ‰È¿ÙÚËÛ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û ·ÛıÂÓ›˜ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ÂÙ¿ Û ÂÓ‹ÏÈΘ Î·È Ù¤ÛÛÂÚȘ Û ·È‰È¿ (3,8,9). √ÎÙÒ ·fi ·˘Ù¤˜ ·ÊÔÚÔ‡Û·Ó ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ (Ó‹ÛÙȉ· ‹ ÂÈÏÂfi), Ì›· ÙÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ Î·È ‰‡Ô ÙÔ ·¯‡ ¤ÓÙÂÚÔ. ∏ ‰È¿ÙÚËÛË ÛÙÔÌ¿¯Ô˘ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ ÌÔÚ› Ó· ·Ô‰oı› ÛÙËÓ ËˆÛÈÓÔÊÈÏÈ΋ ÊÏÂÁÌÔÓÒ‰Ë ‰È‹ıËÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Ô˘ ÂӉ¯Ô̤ӈ˜ Ô‰‹ÁËÛ Û ·Ó¿Ù˘ÍË ÂÙÈÎÔ‡ ¤ÏÎÔ˘˜ ‹\Î·È ÛÙËÓ ·‡ÍËÛË Ù˘ ÂÓ‰Ô·˘ÏÈ΋˜ ›ÂÛ˘ ÏfiÁˆ Ù˘ ¿¯˘ÓÛ˘ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ˘ÏˆÚÔ‡. √ ÂÁÎÔÏ·ÛÌfi˜ ·ÔÙÂÏ› ›Û˘, ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ ÓfiÛÔ˘. ¢‡Ô ÂÚÈÙÒÛÂȘ 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 ÂÚÈÙÒÛÂˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÁÎÔÏ·ÛÌÔ‡ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÓÙfi˜ ÌÈ·˜ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (10). ∏ ·Ù˘›· ÙˆÓ Û˘ÌÙˆÌ¿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˘ ÏÂÙÔ‡ 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˘·ÈÛıËÙÔÔ›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˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ‚ÂÏÙÈÒÓÔÓÙ·È ‹ ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ÂÓÔ¯ÔÔÈÔ‡ÌÂÓ˘ ÙÚÔÊ‹˜ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ (2,9,11), ÂÓÒ Û ¿ÏÏÔ˘˜ ÔÈ ‰›·ÈÙ˜ ·ÔÎÏÂÈÛÌÔ‡ ‰ÂÓ ÂËÚ¿˙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¢·ÈÛıËÙÔÔ›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˘ÌÙÒÌ·Ù· ˘Ê¤ıËÎ·Ó ÌÂÙ¿ ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ·ÓÙÈÁfiÓÔ˘, Ë IgE ÙÔ˘ ÔÚÔ‡ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ·ӋÏı·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Î·È Ë ‰ÔÎÈÌ·Û›· Rast ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·ÚÓË-
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
ÙÈÎÔÔÈ‹ıËÎÂ. ∏ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙË Á¤ÓÓËÛË ÌÔÚ› Ó· ·Ô‰Ôı› Û ÂÓ‰ÔÌ‹ÙÚÈ· ¢·ÈÛıËÙÔÔ›ËÛË. ∏ ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, Ë ·ÓÙ·fiÎÚÈÛË ÛÙË ‰›·ÈÙ· ·ÔÎÏÂÈÛÌÔ‡ Ù˘ ˘Â‡ı˘Ó˘ ÙÚÔÊ‹˜ Î·È Ë ÌË Â˘·ÈÛıËÙÔÔ›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
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·538
¶∞π¢π∞∆ƒπ∫∏ 2000;63:538-541
∞ÈÌÔÂÚÈÙfiÓ·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 ÔÔ›Ô ·ÚÔ˘Û›·Û ·ÈÌÔÂÚÈÙfiÓ·ÈÔ ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆÔı‹Î˘. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜. ∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËΠÂÈÙ˘¯Ò˜ Ì ¯ÔÚ‹ÁËÛË Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Î·È ÎÚ˘Ô˚˙‹Ì·ÙÔ˜ ˆ˜ ıÂڷ›· ˘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 ÂÚÈÙÒÛÂȘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·ÁÎfiÛÌÈ· ‚È‚ÏÈÔÁÚ·Ê›·. øÛÙfiÛÔ, ·ÔÙÂÏ› ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÙËÓ ÔÔ›· ı· Ú¤ÂÈ Ó· ˘Ô„È¿˙ÂÙ·È Î·Ó›˜ Û ·Ó¿ÏÔÁË Û˘Ìو̷ÙÔÏÔÁ›·. ¶·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 ÂÂÈÛfi‰È· fiˆ˜ ÂÈÛÙ¿ÍÂȘ Î·È Ô˘ÏÔÚÚ·Á›Â˜, ¤ˆ˜ ÛÔ‚·Ú¤˜ ·ÈÌÔÚÚ·Á›Â˜, fiˆ˜ ·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 ÂÂÈÛfi‰È· Ù· ÔÔ›· 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 ÔÔ›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΋ ∞¶£, °¶¡£ πÔÎÚ¿ÙÂÈÔ
538
·Ó·Ê¤ÚÔÓÙ·È ‰‡Ô ÌfiÓÔÓ ·ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ (5,9). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 14 ÂÙÒÓ Ì ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ 30 kg Î·È ÁÓˆÛÙ‹ ÎÏËÚÔÓÔÌÈ΋ ·ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· ‰È·ÎÔÌ›ÛÙËΠÛÙËÓ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢ ·fi ¶ÂÚÈÊÂÚÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ÏfiÁˆ Èı·Ó‹˜ ÔÍ›·˜ ÎÔÈÏ›·˜. ∏ ·ÛıÂÓ‹˜ ·ÔÙÂÏ› ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÌÂÓÈο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ ÔÈ ÔÔ›ÔÈ ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙÔ˘˜ Û˘ÁÁ¤ÓÂÈ·. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ Ì ·Ó¿Ù˘ÍË ÌÂÁ¿ÏˆÓ ÎÂÊ·Ï·ÈÌ·ÙˆÌ¿ÙˆÓ Ï›Á˜ Ë̤Ú˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÁÈ· Ù· ÔÔ›· ÙÔ ÓÂÔÁÓfi ÓÔÛËχıËΠ۠¡ÔÛÔÎÔÌÂ›Ô Ù˘ £ÂÛÛ·ÏÔӛ΢. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™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 ÔÔ›Ô ‰È·ÈÛÙÒıËÎÂ: ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘ (PT) 39”/13”, ¯ÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ (·PTT) 120”/34”, ¯ÚfiÓÔ˜ ıÚÔÌ‚›Ó˘ 100”/25”, ¯ÚfiÓÔ˜ ÚÂÙÈÏ¿Û˘ 120”/20” Î·È Â›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›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›·˜. ∆· ÂfiÌÂÓ· ¯ÚfiÓÈ· Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÌÂÌÔӈ̤ӷ ÂÂÈÛfi‰È· Ô˘ÏÔÚÚ·Á›·˜ Î·È ÚÈÓÔÚÚ·Á›·˜, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÂȈ̷ÙÈÛÌfi ‹ ¯ÔÚ‹ÁËÛË ÈÓˆ‰ÔÁfiÓÔ˘ ÂÓ‰ÔÊÏ‚›ˆ˜, ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ÂÂÈÛÔ‰›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%, ·ÈÌÔÂÙ¿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 ÔÔ›Ô ÂȂ‚·ÈÒıËΠ̠·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÛÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËΠ›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 ÂÔ̤ÓË fï˜ ·ÚÔ˘Û›·Û ÂÈ-
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
∂ÈÎfiÓ· 1. ÀÂÚ˯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‹ıËΠÙÒÛË 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˘ ·ÈÌÔÂÚÈÙfiÓ·ÈÔ˘ ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Î·È ·ÔÊ·Û›ÛÙËΠ·Ú·ÎÔÏÔ‡ıËÛË Î·È Û˘ÓÙËÚËÙÈ΋ ıÂڷ›· ˘ÔηٿÛÙ·Û˘ ÙÔ˘ ÂÏÏ›ÔÓÙÔ˜ ·Ú¿ÁÔÓÙ· π Ù˘ ‹Í˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (ÈÓˆ‰ÔÁfiÓÔ˘). °È· ÙÔÓ ÛÎÔfi ·˘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˘ÌÙˆÌ¿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 ÔÔ›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 ıÂڷ›·. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô Ù˘ ·ÛıÂÓÔ‡˜ 3 ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·, Ë ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· ·ÚÔ˘Û›·˙ ۷ʋ ‚ÂÏÙ›ˆÛË Ì ϋÚË ·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 ÔÔ›· ÎÏËÚÔÓÔÌ›ٷÈ
539
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
™ÂÏ›‰·540
¶∞π¢π∞∆ƒπ∫∏ 2000;63:538-541
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
∂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. ÀÂÚ˯ÔÁÚ¿ÊËÌ· οو ÎÔÈÏ›·˜. ¶·ÚÔ˘Û›· ·ÚÎÂÙ‹˜ ÔÛfiÙËÙ·˜ ˘ÁÚÔ‡ (·›Ì·) ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ·.
Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (2,7). ∏ ˘Ô˚Óˆ‰ÔÁÔÓ·ÈÌ›· ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ ‰È·‰Ú¿ÌÂÈ Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈο Î·È Û¿ÓÈ· ÚÔηÏ› ‹È˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ÔÈ ÁÔÓ›˜ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ·Û˘Ìو̷ÙÈÎÔ› ÂÙÂÚÔ˙˘ÁÒÙ˜ Ì ›‰· ÈÓˆ‰ÔÁfiÓÔ˘ <50 mg/dl. ™ÙÔ˘˜ ÔÌÔ˙˘ÁÒÙ˜ ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó Û ‚·Ú‡ÙËÙ·, ÁÂÓÈο fï˜ Â›Ó·È ËÈfiÙÂÚ˜ Û˘ÁÎÚÈÙÈο Ì ·˘Ù¤˜ ÔÈ Ôԛ˜ ·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·, ÂÈÛÙ¿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 ÂÚÈÙÒÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¢ÈÂıÓ‹ µÈ‚ÏÈÔÁÚ·Ê›·. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚ¿ ÌÈ· 22¯ÚÔÓË Á˘Ó·›Î· Ë ÔÔ›· ·ÚÔ˘Û›·Û ÛÔ‚·Ú‹ ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›· ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆ¯ÚÔ‡ ÛˆÌ·Ù›Ô˘ Î·È Ë ÔÔ›· ˘Ô‚Ï‹ıËΠ۠ˆÔıËÎÂÎÙÔÌ‹ ηıÒ˜ Ë ·ÈÌÔÚÚ·Á›· ‰ÂÓ ÌfiÚÂÛ ӷ ÂÏÂÁ¯ı› Û˘ÓÙËÚËÙÈο (9). ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË ·ÊÔÚ¿ ÌÈ· 19¯ÚÔÓË ÎԤϷ, Ë ÔÔ›· ÂÌÊ¿ÓÈÛ ˘ÔÔÁηÈÌÈ΋ ηٷÏËÍ›· ÌÂÙ¿ ·fi Ú‹ÍË Î‡ÛÙ˘ ˆÔı‹Î˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÔ›·˜ ›Û˘ ··ÈÙ‹ıËΠ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË (5). ∏ ·ÓˆÙ¤Úˆ ·ÛıÂÓ‹˜ ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ıÂڷ›· Ì ·ÓÙÈÛ˘ÏÏËÙÈο ÂΉ‹ÏˆÛ ÂÓ‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠¯ÔÚ‹ÁËÛË ÎÚ˘Ô˚˙‹Ì·ÙÔ˜ Ì ·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 ıÂڷ›·˜ ˘ÔηٿÛÙ·Û˘ ÔÈ ¯ÚfiÓÔÈ ‹Í˘ ·ÔηٷÛÙ¿ıËÎ·Ó Î·È Ë ÙÈÌ‹ ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ·˘Í‹ıËΠ۠›‰· ¿Óˆ ·fi 50 mg/dl. ¢ÂÓ ÎÚ›ıËΠÛÎfiÈÌË Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ, ÚÔ˜ ÙÔ ·ÚfiÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ, ÏfiÁˆ ÙÔ˘ ÌÂÌÔӈ̤ÓÔ˘ ÂÂÈÛÔ‰›Ô˘ Î·È Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜ Ù˘ ·ÛıÂÓÔ‡˜. ™Â ÂÚ›ÙˆÛË Û˘Ó¯È˙fiÌÂÓ˘ ·ÈÌÔÚÚ·Á›·˜, Û ·ÚÔ˘Û›· ÛËÌ›ˆÓ ˘ÔÔÁηÈÌÈ΋˜ ηٷÏËÍ›·˜ ‹ Û ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÚÔÂÙÔÈÌ·Û›· Û˘ÓÈÛÙ¿Ù·È ¯ÔÚ‹ÁËÛË ÈÓˆ‰ÔÁfiÓÔ˘ (100 mg/kg) ‹ ˘ÔηٿÛÙ·ÙˆÓ ÒÛÙ ӷ ÂÈÙ¢¯ıÔ‡Ó Â›Â‰· 100mg/dl (2,5,9,11). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‹ÈˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ·ÚΛ Ë ¯ÔÚ‹ÁËÛË Â‡ÎÔÏ· ‰È·ı¤ÛÈÌˆÓ ÚÔ˚fiÓÙˆÓ, fiˆ˜ Â›Ó·È ÙÔ Ï¿ÛÌ·, ÙÔ ÊÚ¤ÛÎÔ Î·Ù„˘Á̤ÓÔ Ï¿ÛÌ· ‹ ÙÔ ÎÚ˘Ô˝˙ËÌ· (2,7). ∏ ıÂڷ›· ˘ÔηٿÛÙ·Û˘ Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Ì ÚÔÛÔ¯‹ ÏfiÁˆ ÙˆÓ ÂÌÊ·ÓÈ˙fiÌÂÓˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. ∞ӷʤÚÔÓÙ·È ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ (1,11,12), ‰ËÌÈÔ˘ÚÁ›· ·ÓÙÈÛˆÌ¿ÙˆÓ (7,13), ÂΉ‹ÏˆÛË ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (4,9) ηıÒ˜ Î·È ÌÂÙ¿‰ÔÛË ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ (11), fiˆ˜ Ë ÌÂÙ¿‰ÔÛË Ù˘ Ë·Ù›Ùȉ·˜ C Ë ÔÔ›· ·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 ıÂڷ›· 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‹ ÂÈÏÔ΋ Ë ÔÔ›· ÌÔÚ› Ó· ·Ô‚› ÌÔÈÚ·›· Î·È Ë ˘fiÓÔÈ· ·˘Ù‹˜ Ú¤ÂÈ Ó· Ù›ıÂÙ·È Û ·Ó¿ÏÔÁË Û˘Ìو̷ÙÔÏÔÁ›·.
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µÈ‚ÏÈÔÁÚ·Ê›· 1. Fried K, Kaufmann S. Congenital afibrinogenemia in 10 offsprings of uncle-niece marriages. Clin Genet 1980;18:223-227. 2. Hoffman R, Benz EJ, Shattil SJ, Furil B, Cohen HJ, Silberstein LE, eds. Quantitive and Qualitative
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Disorders of Fibrinogen. In: Hematology. Basic Principles and Practice. 2nd ed. Churchill Livingstone Inc; 1995. p. 1703-1717. 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. 4th ed, W.B. Saunders Company; 1993. p. 1605-1650. 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
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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. 12. Cohen N, Kaufman s, Pik A, Behar M, Weissgarten J, Modai D. Congenital afibrinogenemia: an unusual case. Isr J Sci 1985;373-376. 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·¯‹ 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˘ÌÂÚÈʤÚÂÙ·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 ÂȉËÌ›·. ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ¤¯ÂÈ ·Ó·Ù˘¯ı› ÌÂÁ·Ï‡ÙÂÚË ÂȉÂÍÈfiÙËÙ· 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˘˜ ÙÚfiÔ˘˜: ● ™·Ó ·ÚÔÚÌËÙÈ΋, ÊÙˆ¯¿ ·˘ÙÔÂÏÂÁ¯fiÌÂÓË Û˘ÌÂÚÈÊÔÚ¿, fiÔ˘ ÂÈÎÚ·Ù› Ë ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È Ë ·ÚÔÚÌËÙÈÎfiÙËÙ·. ● ™·Ó Úfi‚ÏËÌ· ÛÙË Û˘ÁΤÓÙÚˆÛË, ÛÙË ÌÓ‹ÌË Î·È ÛÙË Ì¿ıËÛË, fiÔ˘ ÂÈÎÚ·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˘ÌÂÚÈÊÔÚ¿, ‰˘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˘ÌÂÚÈÊÔÚ¿˜ Î·È Ù˘ Âη›‰Â˘Û‹˜ ÙÔ˘. ∂›Ó·È ·‰‡Ó·ÙÔ Ó· ·ÏÏ·¯ı› Ë ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË Ô˘ Û˘Ó‹ıˆ˜ ˘¿Ú¯ÂÈ, ·ÏÏ¿ Û›ÁÔ˘Ú· ÌÔÚ› Ó· Á›ÓÂÈ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÛÙÔ Û›ÙÈ Î·È ÛÙÔ Û¯ÔÏ›Ô, ÒÛÙ ӷ ‚ÔËıËı› ÙÔ ·È‰› Ó· Û˘ÌÂÚÈʤÚÂÙ·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.
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™˘Ì‚Ô˘Ï¤˜ ÁÈ· ¯ÂÈÚÈÛÌfi Û˘ÌÂÚÈÊÔÚ¿˜ - √ ÂÈÙ˘¯‹˜ ¯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˘. - ™˘ÌÂÚÈʤÚÂÙ·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 ÂÈı˘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˘˜. ÃÚËÛÈÌÔÔÈ›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˘Ó‹ ·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‰› ˘Â‡ı˘ÓÔ ÁÈ· ÙË ‰È΋ ÙÔ˘ Û˘ÌÂÚÈÊÔÚ¿. ªËÓ ·Ó·Ï·Ì‚¿ÓÂÙ ÙËÓ Â˘ı‡ÓË ÁÈ· ÙËÓ Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ Î·È ÌËÓ ÙÔ˘ ÂÈÙÚ¤ÂÙ ӷ ηÙËÁÔÚ› ¿ÏÏÔ˘˜ ÁÈ’ ·˘Ù‹Ó. - µÔËı›ÛÙ ÙÔ Ó· ηٷϿ‚ÂÈ fiÙÈ Ë ‰È΋ ÙÔ˘ ÂÈÏÔÁ‹ Û˘ÌÂÚÈÊÔÚ¿˜ Ô‰ËÁ› Û ÂÈÏÔÁ‹ ÙÈ̈ڛ·˜ ‹ ·ÓÙ·ÌÔÈ‚‹˜. ÃÚËÛÈÌÔÔÈ›ÛÙ ·Ï¤˜ ·ÓÙ·ÌÔÈ‚¤˜ ‹ ÙÈ̈ڛ˜ Ô˘ ÌÔÚÔ‡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˘ÌÂÚÈÊÔÚ¿ Â›Ó·È Î·Ïfi ÙÔ 95% ÙÔ˘ ¯ÚfiÓÔ˘. ∞ÓÙ·Ì›„Ù ·˘Ù‹ ÙË ıÂÙÈ΋ ÏÂ˘Ú¿, Û˘ÏÏ¿‚ÂÙ¤ ÙÔ Ó· Û˘ÌÂÚÈʤÚÂÙ·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 ÂÈÙ˘¯Ë̤ÓÔÈ ÁÔÓ›˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙËÓ ÛËÌ·Û›· Ó· ÂÈ̤ÓÔ˘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· ÂÈÙÚ¤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 ÂÈÙÚ¤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 ÂÈÎÔÈÓˆÓ›·˜ 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˘ ÌÔÚ› Ó· Û˘ÁÎÂÓÙÚˆı› ÁÈ· ÙËÓ ÌÂϤÙË ÛÙÔ Û›ÙÈ .¯. 1 ‹ 2 ÒÚ˜ ÌÂÙ¿ ·fi ÙËÓ ÂÈÛÙÚÔÊ‹ 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· ·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 ·Ú΋ ÚÔÛ¿ıÂÈ· Ë ‰Ô˘ÏÂÈ¿ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· ÙÂÏÂÈÒÛÂÈ, ·Ê‹ÛÙ ÙËÓ fiˆ˜ ›ӷÈ. - ªËÓ ··ÈÙ›ÙÂ Î·È ÎÚÈÙÈοÚÂÙÂ, ÁÈ·Ù› ·˘Ùfi ÌÔÚ› Ó· ÚÔÛ‚¿ÏÂÈ ÙÔÓ ‰¿ÛηÏÔ. ƒˆÙ‹ÛÙ Ҙ ÌÔÚ›Ù ӷ ‚ÔËı‹ÛÂÙÂ. - ªÂÚÈΤ˜ ÊÔÚ¤˜ ·Ó·ÚˆÙȤÛÙ ·Ó ÙÔ ·È‰› Û·˜ ı· Ú¤ÂÈ Ó· ·ӷϿ‚ÂÈ ÙËÓ Ù¿ÍË. ∫·ıÒ˜ Ô ÂÁΤʷÏÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Ì ¢∂¶À ˆÚÈÌ¿˙ÂÈ, ÔÏÏ¿ ·fi Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÁΤÓÙÚˆÛ˘, Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Ì¿ıËÛ˘ Á›ÓÔÓÙ·È
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¢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˘ ÓËÈ·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 ÂÈϤÔÓ ‚Ô‹ıÂÈ· ¯ÚÂÈ¿˙ÔÓÙ·È ÛÙÔ Û›ÙÈ. ∂Âȉ‹ Ë ¢∂¶À Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ Ì ÂȉÈΤ˜ Ì·ıËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ Ë ‰˘ÛÏÂÍ›·, ÔÏÏ¿ ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÈϤÔÓ ‚Ô‹ıÂÈ· ÛÙËÓ ·Ó¿ÁÓˆÛË, ÙËÓ ÁÚ·Ê‹, Ù· Ì·ıËÌ·ÙÈο Î·È ÙËÓ ÁÏÒÛÛ·. ŒÓ·˜ ȉȈÙÈÎfi˜ ‰¿ÛηÏÔ˜ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙËÓ ·˘ÙÔÂÔ›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 ÂÈϤÔÓ ‰È‰·Ûηϛ· Î·È ÛÙËÓ ÂÈÙ˘¯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. ªÔÚÔ‡Ó Ó· ÂÍÂÙ·ÛıÔ‡Ó ÚÔÊÔÚÈο ‹ Ó· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ. ∫¿ÔÈ· ·È‰È¿ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˘ÔÏÔÁÈÛÙ¤˜ Î·È ¿ÏÏ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ 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·˜ ÂÎÏ‹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· ÌÔÚ¤ÛÂÈ Ë ÂÙ·ÈÚ›· Ì·˜ Ó· ÂÎÏËÚÒÛÂÈ ÙÔ˘˜ ÛÎÔÔ‡˜ 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 ÂÈÛÙÔϤ˜ Ô˘ ÙÔ˘˜ ·Ë‡ı˘ÓÂ, ÙËÓ ÔÈÎÔÓÔÌÈ΋ ÙÔ˘˜ Ù·ÎÙÔÔ›ËÛË ÚÔÎÂÈ̤ÓÔ˘ Ë ∂Ù·ÈÚ›· Ì·˜ Ó· ÌÔÚ› ·˘ÙÔ‰‡Ó·ÌË Ó· ηχ„ÂÈ ÙȘ ‰·¿Ó˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ Î·È Ó· ÂȉÈÒÎÂÈ Ù˘ ÂÎÏ‹ÚˆÛË ÙˆÓ ÛÎÔÒÓ Ù˘. ∫‡ÚÈÔÈ ™˘Ó¿‰ÂÏÊÔÈ, ∆Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂.¶.∂. Û·˜ ηÏ› Ó· ·ÓÙ·ÔÎÚÈı›Ù ÛÙËÓ ¤ÎÎÏËÛË Ô˘ Û·˜ ·Ë‡ı˘Ó ̤ۈ ÙˆÓ ˆ˜ ¿Óˆ ÂÈÛÙÔÏÒÓ.
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:545
∂¶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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√ √ÈÎÔÓÔÌ›‰Ë˜ πˆ¿ÓÓ˘ √ÈÎÔÓfiÌÔ˘ ª·Ú›Ó·
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309 225,421 225 391 322 275 101,110, 538 314 534 507 319
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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
548
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30-05-03
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38 268,322
™ ™·‚‚¿Ï· ª·ÚÈ¿ÓÓ· ™¿‚‚·˜ ™¿‚‚·˜ ™·Ï·‚Ô‡Ú· ∞ÈηÙÂÚ›ÓË ™·Ú·Ê›‰Ë˜ ∫ÔÛÌ¿˜ ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞ÓÙÈÁfiÓË ™È·ÌÔ‡ÓÎË ª·Ú›· ™È·¤Ú· ¢‹ÌËÙÚ· ™È·¯·Ó›‰Ô˘ ∆¿ÓÈ· ™›‰ÂÚË µ·ÛÈÏÈ΋ ™ÈfiÓÙË ∂ÈÚ‹ÓË ™Î·Ú‰Ô‡ÙÛÔ˘ ∞ÁÁÂÏÈ΋ ™ÎÔÚ‰‹˜ ¡ÈÎfiÏ·Ô˜ ™Ô‡ÏË ∫ÏÂÔ¿ÙÚ· ™˘Ú›‰Ë˜ ¶·Ó·ÁÈÒÙ˘ ™Ù·ÛÈÓfi˜ ¶·Ó·ÁÈÒÙ˘ ™ÙÂÊ·Ó›‰Ë˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞ÓÙÈÁfiÓË ™˘ÚÈÔÔ‡ÏÔ˘ µ·ÛÈÏÈ΋ ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜ ™¯ÔÈÓ¿ÎË ∞ıËÓ¿
309 137,213 534 483 418 137 47 534 529 524 170 213 287 314 319 47 220 43 353 319
549
∆ ∆·¿ÎË °ÂˆÚÁ›· ∆˙¤ÙË ª·Ú›· ∆˙ËÙËÚ›‰Ô˘ ª·Ú›· ∆˙ˆÚÙ˙¿ÙÔ˘ °ÂˆÚÁ›· ∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘ ºˆÙÂÈÓ‹ ∆ÔÚÓ·Ú›Ù˘ ªÈ¯¿Ï˘ ∆Ú¿·ÏË ÃÚÈÛÙ›Ó· ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜ °ÂÒÚÁÈÔ˜ ∆۷ΛÚ˘ ∞Ó·ÛÙ¿ÛÈÔ˜ ∆Û·ÌԇϷ˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∆Û¿ÙÚ· πˆ¿ÓÓ· ∆ÛÂÁ΋ ÃÚÈÛÙ›Ó· ∆Û¤˙Ô˘ ∞Û·Û›· ∆ÛÂÎÔ˘Ú¿ £ÂÔÊ·Ó‹ ∆ÛÈ¿ÓÙ˘ πˆ¿ÓÓ˘ ∆Û›ÁÎÔ˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∆ÛÈÏÈ‚¿ÎÔ˜ ¢ËÌ‹ÙÚÈÔ˜ ∆ÛÈÏÈÌÈÁοÎË ∞Ì·Ï›· ∆Û›ÙÔ˘Ú· ™Ù¤ÏÏ· ∆ÛfiÏ·˜ °ÂÒÚÁÈÔ˜ ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ª·Ú›˙· ∆ÛÔ˘Ì¿Î·˜ ∫ˆÓÛÙÓÙ›ÓÔ˜
430 21 412 240 183 137,213 302, 490 529 34 524 167 339 21, 499 319 186 499 426,433 319 27,78,225, 542 236,426, 529 55 253,337,444
º º·Ï·˝Ó· µ›Î˘ ºÈÏÈ›‰Ë˜ º›ÏÈÔ˜ à ÷ڛÛË ª¿Úı· ÷ڛÛ˘ °ÈÒÚÁÔ˜ ÷ÚÈÙ¿ÓÙË ∞ÊÚÔ‰›ÙË Ã·ÛÈÒÙÔ˘-µÚ›ÙÛÈÔ˘ ª·Ú›· ÷Ù˙Ë·ı·Ó·Û›Ô˘ ÷ڿϷÌÔ˜ ÷Ù˙ËÁˆÚÁ›Ô˘ ÷ڿϷÌÔ˜ ÷Ù˙ˉ¿ÎË ∂Ï¢ıÂÚ›· ÷Ù˙ˉËÌԇϷ ∞Ó‰ÚÔÓ›ÎË Ã·Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜ ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡-™È‰ËÚÔÔ‡ÏÔ˘ ª·Ú›· Û˙· ∞ÛÛ¤Ì ÃÚÔ‡ÛÛÔ˜ °ÂÒÚÁÈÔ˜ æ æˆÌ¿ ∂ϤÓË
43 430
418 437 60 145 499 137 437 21 292,382 60,101,103 309 275
129
NOV.-DEC.2000(ÙÂÏÈÎfi N)
30-05-03
17:43
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:550-552
∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍˆÓ-ÎÏÂȉÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 63
1·-˘‰ÚÔÍ˘Ï¿ÛË Aids Candida albicans Coxsackie B C-ÂÙ›‰ÈÔ M. Avium Octreotide G-CSF ∞ ∞ÁÚÔ‚ÈÔÙ¯ÓÔÏÔÁ›· ÕÁ¯Ô˜ ∞‰È„›· ∞ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ∞ıËÚÔÛÎÏ‹Ú˘ÓÛË ∞ÈÌ·ÙÔÎÚ›Ù˘ ∞ÈÌÔÂÙ¿ÏÈ· ∞ÈÌÔÚÚ·Á›·, ÂÓ‰ÔÎÔÈÏȷ΋ ∞Ó·ÈÌ›· Fanconi ∞οÚ· ∞ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË ∞ÏÏ·ÓÙÈ΋ ÙÔÍ›ÓË ∞ÏÏÂÚÁÈ΋ Á·ÛÙÚÂÓÙÂÚÔ¿ıÂÈ· ∞Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ∞Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ∞Ó¿Ù˘ÍË ∞Ó¢ڢÛÌ·ÙÈ΋ ·ÛÙË ∞ÓÈÓˆ‰ÔÁÔÓ·ÈÌ›· ∞ÓÔÛԉȷÙÚÔÊ‹ ∞ÓÔÛÔηٷÛÙÔÏ‹ ∞ÓÙÈÂÈÏËÙÈο ∞ÓÙÈÏ¢ÎÔÙÚȤÓÈ· ∞ÓÙÈÏ‹„ÂȘ ÁÔÓ¤ˆÓ ∞ÓÙÈÌÂÙÒÈÛË ∞ÓÙÈ˘ÚÂÙÈο ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ∞Ï·ÛÙÈ΋ ·Ó·ÈÌ›· (›ÎÙËÙË Î·È ÎÏËÚÔÓÔÌÈ΋) ∞fiÊÚ·ÍË ÛÙÔÌ¿¯Ô˘ ∞ÚÁÈÓ›ÓË ‚·˙ÔÚÂÛÛ›ÓË ÕÛıÌ· ∞ÛÂÚÁ›ÏψÛË ÕÙ˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ∞˘ÍËÙÈ΋ ÔÚÌfiÓË ∞˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∞˘ÙÔÂÎÙ›ÌËÛË ∞˘ÙfiÌ·ÙË ‰È¿ÙÚËÛË ÛÙÔÌ¿¯Ô˘
426 50 309 38 129 50,314 47 483
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292 412 534 391 205 205 150 490 43 538
550
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30-05-03
17:43
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551
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30-05-03
17:43
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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 ÀÂÚ‚·ÚÈÎfi Ô͢ÁfiÓÔ ÀÂÚ˯ÔηډÈÔÁÚ·Ê›· ÀÂÚˆÛÌÔÙÈÎfiÙËÙ· ÀÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ÀÔıÚ„›· ÀÔÙÚÔ¤˜
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 ¶ÚÔÏËÙÈ΋˜ 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·Ó¿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˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ 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΋˜ ıÂڷ›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚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 ÏÂÙfi ·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˘ÙÂÚfiÏÂÙÔ ˘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