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COVER May-June 03

03-06-03

16:52

™ÂÏ›‰·1

ISSN 0377-2551

ETO™ 2003

ª¿ÈÔ˜ - πÔ‡Ó ÈÔ˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 3

∞¡∞™∫O¶∏™∂π™ OÚÁ·ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ì „˘¯È·ÙÚÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÛÙ· ·È‰È¿: Ë ‰ÈÂÚ‡ÓËÛË ·fi ÙÔÓ ·È‰›·ÙÚÔ

REVIEW ARTICLES 167

D. Protagoras-Lianos

∂Ӊ›ÍÂȘ ÂÎÙ¤ÏÂÛ˘ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Ù˘ ·Ó·ÓÔ‹˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·

176

ª. ªÔ˘ÛÙ¿ÎË

M. Moustaki

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ∂͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜

ORIGINAL ARTICLES 185

∂. ∫·Ú·ÓÙ·Ó¿, ™. ∫ˆÛÙ·Ú›‰Ô˘, ∞. ∫·Ï·ÓÙ˙‹˜, ∞. °È·ÓÓÔ‡ÏÈ·

ºÔÚ›· Neisseria meningitidis Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜: ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ

Indications for pulmonary function testing in childhood

Extrapulmonary symptoms of Mycoplasma pneumoniae infections E. Karantana, S. Kostaridou, A. Kalantzis, A. Giannoulia

188

π. ¶·˘ÏÔÔ‡ÏÔ˘, ∂. ∞ÏÂÍ¿Ó‰ÚÔ˘, °. ¢·›ÎÔ˜, ∂. ¶ÂÙÚ›‰Ô˘, ∞. ¶¿ÁηÏË, ª. £ÂÔ‰ˆÚ›‰Ô˘, µ. ™˘ÚÈÔÔ‡ÏÔ˘

Neisseria meningitidis carriage in schoolchildren: risk factors and characteristics of isolated strains I. Pavlopoulou, E. Alexandrou, G. Daikos, E. Petridou, A. Pangalis, M. Theodoridou, V. Syriopoulou

¶AI¢IATPIKH

TOMO™ 66

TEYXO™ 3

¡. ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡

Organic disorders with psychiatric symptomatology in children: investigation by the paediatrician

§ÂÌÊÒÌ·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∂ÌÂÈÚ›· 10 ¯ÚfiÓˆÓ

195

º. ∞ı·Ó·ÛÈ¿‰Ô˘, £. ∆Ú·ÁÈ·ÓÓ›‰Ë˜, £. ¶··ÁˆÚÁ›Ô˘, µ. ∫·ÏÔ‡ÙÛË, ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡, ª. ™Ù¿ÌÔ˘, ¢. ∫·ÙÚÈÔ‡

§È›‰È· Î·È ÏÈÔÚˆÙ½Ó˜ ÔÚÔ‡ ·È‰ÈÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η

Lymphomas in childhood. Ten years’ experience F. Athanassiadou, T. Tragiannidis, T. Papageorgiou, V. Kaloutsi, M. Hatzistilianou, M. Stamou, D. Katriou

202

Serum lipids and lipoproteins in epileptic children receiving antiepileptic drugs

∫. ∞. µÔ‡‰Ú˘, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ª. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘, ™. ¢‹ÌÔ˘, ∂. ∞. µ·ÁÈ¿ÎÔ˘

K. Voudris, A. Skardoutsou, M. Servitzoglou, S. Dimou, E. Vagiakou

∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

Continuation of table of contents inside title page

May - June 2 0 0 3 . V o l u m e 6 6 . N o 3


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™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

CASE REPORTS

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ™‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÛÙÔÓ ‡ÓÔ Û˘Óԉ¢fiÌÂÓÔ ·fi Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË

208

E. Alexopoulos, A. Kaditis, V. Mikraki, E. Kostadima, N. Skenteris, K. Gourgoulianis

∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ∞. ∫·‰›Ù˘, µ. ªÈÎÚ¿ÎË, ∂. ∫ˆÛÙ·‰‹Ì·, ¡. ™ÎÂÓÙ¤Ú˘, ∫. °Ô˘ÚÁÔ˘ÏÈ¿Ó˘

∂ÙÂÚfiÏ¢ÚË ‰È·Ï›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÚÔ¤¯ÔÓ Û‡Ìو̷ ¯ÚfiÓÈ·˜ ÈÁÌÔÚ›Ùȉ·˜

211

215

CURRENT ISSUES

∂¶π∫∞πƒ∞ £∂ª∞∆∞ 223

SPECIAL ARTICLE

∂π¢π∫O ∞ƒ£ƒO 232

™˘Ó¯›˙ÔÓÙ·È

A case of diabetes mellitus presented in the journal “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”, 1814 D. Karaberopoulos

¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

Probiotics, prebiotics, synbiotics: recent data I. Charoniti, M. Mavrokosta, E. Kokori

π. ÷ڈӛÙË, ª. ª·˘ÚfiΈÛÙ·, ∂. ∫fiÎÔÚË

¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” ÙÔ˘ 1814

Clinical heterogeneity in facioscapulohumeral muscular dystrophy (FSHMD). Report of two cases and review of the literature H. Fryssira, S. Amenta, K. Kekou, S. Youroukos, P. Manta, C. Metaxotou

E. ºÚ˘Û›Ú·, ™. ∞̤ÓÙ·, ∫. ∫¤ÎÔ˘, ™. °ÈÔ˘ÚÔ‡ÎÔ˜, ¶. ª·ÓÙ¿, ∞. ªÂٷ͈ÙÔ‡

¶ÚÔ‚ÈÔÙÈο, Ú‚ÈÔÙÈο, Û˘Ì‚ÈÔÙÈο: ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ

Unilateral intermittent blepharoptosis as an urgent symptom of chronic sinusitis G. Pardalos, S. Mouskou, D. Zafiriou, V. Aivazis

°. ¶·Ú‰·Ïfi˜, ™. ªÔ‡ÛÎÔ˘, ¢. ∑·ÊÂÈÚ›Ô˘, µ. ∞˚‚¿˙˘

∫ÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· (FSHMD). ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜

Obstructive sleep apnoea syndrome accompanied by nocturnal enuresis

236

NEWS FROM THE INTERNET

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™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

LITERATURE ABSTRACTS

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞ ∞ÓÙÈ‚ÈÔÙÈο ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ ÛÙ· ·È‰È¿

194

Glasziou PP, Del Mar CB, Sanders SL, Hayem M Greek translation: F. Hantzi

Glasziou PP, Del Mar CB, Sanders SL, Hayem M ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ºˆÙÂÈÓ‹ ÷ÓÙ˙‹

¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ η΋˜ ¤Î‚·Û˘ Î·È ÔʤÏË ·fi Ù· ·ÓÙÈ‚ÈÔÙÈο Û ·È‰È¿ Ì ÔÍ›· ̤ÛË ˆÙ›Ùȉ·

Antibiotics for acute otitis media in children

201

Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomized trial Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I Greek translation: F. Hantzi

Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ºˆÙÂÈÓ‹ ÷ÓÙ˙‹

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xi

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xv

Abbreviations

May - June 2 0 0 3 . V o l u m e 6 6 . N o 3


May-June 03

03-06-03

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M¿ÈÔ˜ - πÔ‡Ó ÈÔ˜ 2003

. ∆fiÌÔ˜

66

. ∆‡¯Ô˜

3

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

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

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

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

TËÏ.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Tel.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¢È¢ı˘ÓÙ‹˜ : ™. ÷˚‰¿˜ M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : °. µ·ÚÏ¿Ì˘ : ª. ∏Ï›· : π. ¶··‰¿ÙÔ˜ : ¡. ¶··‰fiÔ˘ÏÔ˜ : ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ : ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ : ∫. ™ÙÂÊ·Ó›‰Ë˜ : ª. ∆ÛÔÏÈ¿ : ™. ºˆÙfiÔ˘ÏÔ˜

Scientific President Editor Members

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘

Manuscript Editing

EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘

English Editing S. Nakou

∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 ∞ı‹Ó·È 115 28 ∆ËÏ: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜

Publishing Coordinator

E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶. ∆۷ω¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 210-61 41 360-5 Fax: 210-61 41 366

SCIENTIFIC PUBLICATIONS Ltd P. Tsaldari 3, Marousi 151 22 Tel.: 210-61 41 360-5 Fax: 210-61 41 366

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹

40

EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜:

20

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Editorial Board : A. Constantopoulos : S. Haidas : F. Athanassiadou-Piperopoulou : G. Varlamis : M. Ilia : I. Papadatos : N. Papadopoulos : S. Polychronopoulou : K. Prountzou-Kassiou : C. Stefanidis : M. Tsolia : S. Fotopoulos

Greek Editing I. Karavranou

Annual Subscription All foreign countries: US $ 50

M a y - J u n e 2 0 0 3 .V o l u m e 6 6 .N o 3

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O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜). 2. ∞Ó·ÛÎÔ‹ÛÂȘ. 3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜. 4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜. 5. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ. 6. ∂›Î·ÈÚ· ı¤Ì·Ù·. 7. £¤Ì·Ù· ÂÎ·›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜. 8. ∫ÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ. 9. ™‡ÓÙÔÌ· Ó¤·. 10. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. 11. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË. 12. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. 13. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ Î·ıÒ˜ Î·È ¿ÚıÚ· Ì Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·Ûı› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì Â›Î·ÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚË-

Á›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934 http://jama.ama-assn.org/info/auinst_req.html OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·��ÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜. T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ. T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜

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A4 (21x29.7 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘. H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ‚. ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. Á. ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ‰. ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™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˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ Û ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë. K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ. K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-

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ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ì ÏÂÙÔ̤ÚÂȘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜. TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ. BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÛÙȘ ÂÈÛÙÔϤ˜. H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov).


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¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”. T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279. Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: ÷ڷϷÌ›‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199. 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. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂÚ·›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979. Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. ¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο. ¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜. 2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜. 3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜. 4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰. fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢). 9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó. 11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó. 12. ∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

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Paediatriki 2003;66:167-175

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OÚÁ·ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ì „˘¯È·ÙÚÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÛÙ· ·È‰È¿: Ë ‰ÈÂÚ‡ÓËÛË ·fi ÙÔÓ ·È‰›·ÙÚÔ ¡. ¶ÚˆÙ·ÁfiÚ· - §È·ÓÔ‡

Organic disorders with psychiatric symptomatology in children: investigation by the paediatrician D. Protagoras - Lianos

¶ÂÚ›ÏË„Ë: ∏ ‰È¿ÁÓˆÛË Ù˘ ˘ÔΛÌÂÓ˘ ÔÚÁ·ÓÈ΋˜ ÓfiÛÔ˘ ÛÙÔ ·È‰› Ì „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ÛÙËÚ›˙ÂÙ·È ÛÙË ‰ÈÂÍÔ‰È΋ „˘¯È·ÙÚÈ΋ Î·È ·È‰È·ÙÚÈ΋ ÂͤٷÛË. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂȉÈο „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· Î·È ÔÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â˘Ú‡ Ê¿ÛÌ· ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜. ¶·È‰È¿ Ì ÔÚÁ·ÓÈο ÓÔÛ‹Ì·Ù· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È ÈÔ ÂÈÚÚÂ‹ Û ‰˘ÛÌÂÓ›˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÛÙȘ ÙÔÍÈΤ˜ ·ÚÂÓ¤ÚÁÂȘ „˘¯ÔÙÚfiˆÓ Ê·Ú̿ΈÓ. ∆Ô ·ÚfiÓ ¿ÚıÚÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ó·ÛÎfiËÛË ÙˆÓ ÔÚÁ·ÓÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì „˘¯È·ÙÚÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÛÙ· ·È‰È¿, ηıÒ˜ Î·È ÙˆÓ ÛËÌ·ÓÙÈÎÒÓ ÛÙÔȯ›ˆÓ Ù˘ ·È‰È·ÙÚÈ΋˜ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘.

Abstract: The diagnosis of underlying organic disease in children with psychiatric symptoms is based on a thorough psychiatric and paediatric examination. In most cases, there are no specific psychiatric symptoms and the patients may present with a wide range of behavioural disorders. Children with organic brain disease are more susceptible both to unfavourable environmental factors and to the toxic side effects of psychotropic medications. This article presents a review of organic diseases in children which may present with psychiatric symptoms and outlines the significant elements of the paediatric clinical examination.

§¤ÍÂȘ ÎÏÂȉȿ: ÔÚÁ·ÓÈ΋ „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹, ÌÂÙ·‚ÔÏÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Ó¢ÚÔ„˘¯È·ÙÚÈ΋, Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈο.

Key words: organic psychiatric disorder, metabolic encephalopathy, neuropsychiatry, neurodegenerative disorder.

∂ÈÛ·ÁˆÁ‹ ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ù¿ ηÈÚÔ‡˜ ‰È·Ù·Ú·¯¤˜ Û˘Ó·ÈÛıËÌ¿ÙˆÓ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (1). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Ù· ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ‹È·, ÂÓÒ Û·ÓÈfiÙÂÚ· ÏËÚÔ‡Ó Ù· Ù˘Èο ÎÚÈÙ‹ÚÈ· ÁÈ· ¿Á¯Ô˜, ηٿıÏÈ„Ë, ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜ ‹ „‡¯ˆÛË (2). ŸÙ·Ó ÔÈ ÁÔÓ›˜ ·Ú·ÙËÚ‹ÛÔ˘Ó ÛÙÔ ·È‰› ÙÔ˘˜ ·ÏÏ·Á‹ ÚÔÛˆÈÎfiÙËÙ·˜, Ë ÔÔ›· ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙË Û¯ÔÏÈ΋ Â›‰ÔÛË, ÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ ‹ ÙËÓ ·˘ÙÔÂ͢ËÚ¤ÙËÛ‹ ÙÔ˘, Û˘¯Ó¿ ·¢ı‡ÓÔÓÙ·È ÚÒÙ· ÛÙÔÓ ·È‰›·ÙÚÔ. ¶ÔÏÏ¿ ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ Î·È ÂÊË‚È΋˜ ËÏÈΛ·˜ Û˘Óԉ‡ÔÓÙ·È ·fi „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù·. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ÙÔ ·È‰› ·ÚÔ˘ÛÈ¿˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÔÚÁ·ÓÈ΋˜ ÓfiÛÔ˘. ™·ÓÈfiÙÂÚ·, fï˜, Ù· „˘¯È·ÙÚÈο Û˘-

ÌÙÒÌ·Ù· ÌÔÚ› Ó· ÚÔËÁËıÔ‡Ó ÙˆÓ ¿ÏÏˆÓ Î·Ù¿ ÔÏÏÔ‡˜ Ì‹Ó˜ ‹ ¯ÚfiÓÈ· (3-7). O Goodman (5) ·Ú·ÏÏËÏ›˙ÂÈ ÙËÓ „˘¯È΋ ‰È·Ù·Ú·¯‹ Ì ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹ (∏À). ŸÙ·Ó Ô ∏À ‰˘ÛÏÂÈÙÔ˘ÚÁ›, ˘¿Ú¯Ô˘Ó ÙÚÂȘ Èı·Ó¤˜ ÂÍËÁ‹ÛÂȘ: ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛˆÛÙ¿, ÂÚȤ¯ÂÈ ÂÏ·Ùو̷ÙÈÎfi ÚfiÁÚ·ÌÌ· ‹ ˘¿Ú¯ÂÈ ‚Ï¿‚Ë ÛÙ· ËÏÂÎÙÚÔÓÈο ΢ÎÏÒÌ·Ù¿ ÙÔ˘. ∆ÚÂȘ ·ÚfiÌÔȘ ÂÚÌËÓ›˜, ÌÂÌÔӈ̤Ó˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi, Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ Û ÂÚ›ÙˆÛË „˘¯È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙÔ ·È‰›: ÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÂÈ‚¿ÏÏÂÈ ÛÙÔ ·È‰› ··ÈÙ‹ÛÂȘ Ô˘ ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ ‰˘Ó·ÙfiÙËÙ¤˜ ÙÔ˘, ¤¯ÂÈ ‰È‰·¯Ù› ‰˘ÛÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ ÙÚfiÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ˘¿Ú¯ÂÈ ÔÚÁ·ÓÈ΋ ‚Ï¿‚Ë ÙˆÓ Ó¢ÚÒÓˆÓ. ™‡Ìʈӷ Ì ÙÔ “¢È·ÁÓˆÛÙÈÎfi ™Ù·ÙÈÛÙÈÎfi ∂Á¯ÂÈÚ›‰ÈÔ IV” Ù˘ ∞ÌÂÚÈηÓÈ΋˜ æ˘¯È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜

∞’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1st Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens

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(DSM IV), Ë ‰È¿ÁÓˆÛË ÔÚÁ·ÓÈÎÔ‡ „˘¯È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÌÔÚ› Ó· ÙÂı› fiÙ·Ó ˘¿Ú¯Ô˘Ó “·ԉ›ÍÂȘ ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË, ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‹ ÙÔ ÈÛÙÔÚÈÎfi ÁÈ· ÂȉÈÎfi ÔÚÁ·ÓÈÎfi ·Ú¿ÁÔÓÙ·, Ô ÔÔ›Ô˜ ÎÚ›ÓÂÙ·È fiÙÈ ¤¯ÂÈ ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË Ì ÙË ‰È·Ù·Ú·¯‹” (8). ™Ù· Ï·›ÛÈ· ÂȉËÌÈÔÏÔÁÈ΋˜ ÌÂϤÙ˘ ÛÙËÓ ∞ÁÁÏ›·, Û ÏÈÁfiÙÂÚÔ ·fi 10% ÙˆÓ ·È‰ÈÒÓ Ì „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ÓÔËÙÈÎfi ËÏ›ÎÔ ‚Ú¤ıËΠÔÚÁ·ÓÈ΋ ‚Ï¿‚Ë ÂÁÎÂÊ¿ÏÔ˘ (5). ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, Ë Î·Ù¿ÏÏËÏË È·ÙÚÈ΋ ·ÁˆÁ‹ Î·È Ë ·Ú·ÔÌ‹ Û ÂȉÈÎÔ‡˜ ÂÓ‰¤¯ÂÙ·È Ó· ·ÔÙÚ¤„ÂÈ ‹ Ó· ÌÂÙÚÈ¿ÛÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ·Ûı¤ÓÂÈ·˜. ∞ÎfiÌË Î·È fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂÚ·›·, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋, ÂÓË̤ڈÛË ÁÈ· ÙËÓ ÚfiÁÓˆÛË Î·È Î·Ù¿ÏÏËÏË „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË. ™ÙË ÌÂϤÙË ·˘Ù‹ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÔÚÁ·ÓÈΤ˜ ·Èٛ˜ „˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, Ù· ÛÙÔȯ›· ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, Ù˘ ·ÓÙÈÎÂÈÌÂÓÈ΋˜ ÂͤٷÛ˘, ηıÒ˜ Î·È ÔÈ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Ô˘ Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌÔ‡ÓÙ·È, ÚÔÎÂÈ̤ÓÔ˘ Ó· Ô‰ËÁËı› Ô ·È‰›·ÙÚÔ˜ ÛÙËÓ ÔÚı‹ ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. OÚÁ·ÓÈΤ˜ ·Èٛ˜ „˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ∞. ∂Ó‰ÔÁÂÓ‹ ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· ™Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿, ÙÔ ÁÂÓÂÙÈο ηıÔÚÈṲ̂ÓÔ ¤ÏÏÂÈÌÌ· ÂÓ˙‡ÌÔ˘ Ô‰ËÁ› ÛÂ Û˘ÛÛÒÚ¢ÛË ·ıÔÏÔÁÈÎÒÓ ÚÔ˚fiÓÙˆÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ‹ Ê˘ÛÈÔÏÔÁÈÎÒÓ Ô˘ÛÈÒÓ Û ·ıÔÏÔÁÈ΋ Û˘ÁΤÓÙÚˆÛË ÛÙÔ˘˜ ÈÛÙÔ‡˜. ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ˘fiÛÙڈ̷ ÁÈ· „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ÛÙÔÓ ·ÛıÂÓ‹ (3-7). ∏ οı ̛· ÓfiÛÔ˜ Â›Ó·È Û¿ÓÈ·, ·ÏÏ¿ Ë ·ıÚÔÈÛÙÈ΋ ÙÔ˘˜ Û˘¯ÓfiÙËÙ· ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1:2000 (9). OÈ ‚·ÚȤ˜ ÌÔÚʤ˜ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙË ‚ÚÂÊÈ΋ ‹ ÓËȷ΋ ËÏÈΛ· Ì Ï‹ÚË ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ™Â ¿ÙÔÌ· Ì ÌÂÚÈ΋ ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘ ‹ Û ı‹Ï· ÊÔÚ›˜ Ê˘ÏÔÛ‡Ó‰ÂÙˆÓ ÓÔÛËÌ¿ÙˆÓ, ÌÔÚ› Ó· ÂΉËψıÔ‡Ó ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ·, ÙËÓ ÂÊ˂›· ‹ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∆fiÙÂ, Ù· Û˘ÌÙÒÌ·Ù· Û˘¯Ó¿ Â›Ó·È ‹È· ‹ ÚÔηÏÔ‡ÓÙ·È ÌfiÓÔ Û ηٷÛÙ¿ÛÂȘ ÌÂÙ·‚ÔÏÈ΋˜ ·ÔÚÚ‡ıÌÈÛ˘, fiˆ˜ ˘ÚÂÙfi˜, ÓËÛÙ›·, ÏÔÈÌÒÍÂȘ ‹ ηٷӿψÛË ÌË ·ÓÂÎÙÒÓ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ. ∆· „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· ˘ÂÚÈÛ¯‡Ô˘Ó ‹ Ó· ÚÔËÁÔ‡ÓÙ·È ÙˆÓ ¿ÏÏˆÓ Î·È, ÙfiÙÂ, Ë ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Û¯ÂÚ‹˜. OÈ ÈÔ Û˘¯Ó¤˜ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È Ë Â˘ÂÚÂıÈÛÙfiÙËÙ·, Ë ‰È¤ÁÂÚÛË, Ë ÂÈıÂÙÈÎfiÙËÙ· Î·È Ë ·ÚÔÚÌËÙÈÎfiÙËÙ· ‹, ·ÓÙÈı¤Ùˆ˜, Ë ·Ê‡ÛÈÎË ·ıËÙÈÎfiÙËÙ·. ∂Ó›ÔÙÂ, ˘¿Ú¯ÂÈ ÂÈÎfiÓ· „‡¯ˆÛ˘ (3-7,10-12). ™ÙÔ ÓÔËÙÈÎfi ÙÔ̤·, ÙÔ ·È‰› ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓÔ ¤ÏÏÂÈÌÌ· ÚÔ-

168

Paediatriki 2003;66:167-175

ÛÔ¯‹˜, ¤ÎÙˆÛË ÌÓ‹Ì˘, ÌÂȈ̤ÓÔ ÏÂÍÈÏfiÁÈÔ, ηÎfi ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÛÙÔ ¯ÒÚÔ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∆· Û˘ÌÙÒÌ·Ù· ÂÓ‰¤¯ÂÙ·È Ó· ÂÚÌËÓ¢ÙÔ‡Ó ·Ú¯Èο ˆ˜ ·Ϥ˜ ‰È·Ù·Ú·¯¤˜ ÚÔÛÔ¯‹˜ ‹ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜. ™Â ·È‰È¿ Ì ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, Ë ‰È·Ù·Ú·¯‹ Û˘ÌÂÚÈÊÔÚ¿˜ Û˘¯Ó¿ ·Ô‰›‰ÂÙ·È ÛÙÔ ÁÓˆÛÙÈÎfi ¤ÏÏÂÈÌÌ·. ∂Ó›ÔÙÂ, ÔÈ ÚÒÙ˜ ÂΉËÏÒÛÂȘ Â›Ó·È ÔÍ›˜, Ì ηٿıÏÈ„Ë ‹ „‡¯ˆÛË. ™Â ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, ÔÈ ·ÛıÂÓ›˜ ÓÔÛËχÔÓÙ·È ·Ú¯Èο Û „˘¯È·ÙÚÈο ÙÌ‹Ì·Ù· (13). ™Ù· ÂÈ̤ÚÔ˘˜ ÓÔÛ‹Ì·Ù·, ÔÚÈṲ̂ӷ „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ··ÓÙÒÓÙ·È ÈÔ Û˘¯Ó¿, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂȉÈÎÔ› Ê·ÈÓfiÙ˘ÔÈ Û˘ÌÂÚÈÊÔÚ¿˜ (4). ¶·Ú¿ÏÏËÏ· Ì ÙȘ ÚÔԉ¢ÙÈΤ˜ ·ÏÏ·Á¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ, Ë ÛËÌ·ÓÙÈÎfiÙÂÚË ¤Ó‰ÂÈÍË Èı·ÓÔ‡ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË Ó¢ÚÔÏÔÁÈÎÒÓ Û˘Ìو̿وÓ, fiˆ˜ ‰È·Ù·Ú·¯¤˜ ÔÌÈÏ›·˜ (‰˘Û·ÚıÚ›·, ·ÏÏ·Á‹ ¯ÚÔÈ¿˜ Ù˘ ʈӋ˜, ÙÚ·˘ÏÈÛÌfi˜), ÙÚfiÌÔ˜ ¯ÂÚÈÒÓ, ¤ÎÙˆÛË fiÚ·Û˘ ‹ ·ÎÔ‹˜, ·ıÔÏÔÁÈο ˘Ú·ÌȉÈο ‹ Â͈˘Ú·ÌȉÈο ÛËÌ›· (3-7,10-12). ™ÙË Û˘Ó¤¯ÂÈ· ·Ó·Ê¤ÚÔÓÙ·È Ù· Û˘¯ÓfiÙÂÚ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÂÊ‹‚Ô˘˜. °È· ÙËÓ ÂÚÈÁÚ·Ê‹ Ù˘ Ï‹ÚÔ˘˜ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜, Ô ·Ó·ÁÓÒÛÙ˘ ÌÔÚ› Ó· ·Ó·ÙÚ¤ÍÂÈ ÛÙË Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· (3,6,7,9). ÀÂÚ·Ì̈ÓÈ·ÈÌ›·: ∏ ÈÔ Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ Â›Ó·È ÙÔ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¤ÏÏÂÈÌÌ· ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ Ù˘ ÔÚÓÈı›Ó˘. ∫ÔÚ›ÙÛÈ· ÊÔÚ›˜ Î·È ·ÁfiÚÈ· Ì ˘ÔÏÂÈÌÌ·ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÓ˙‡ÌÔ˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÔÍ›˜, ‰È·Ï›Ô˘Û˜ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÏÔÈÌÒÍÂȘ ‹ ηٷӿψÛË ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ Ï¢ÎÒÌ·ÙÔ˜ (46,9,13,14). GM2 Á·ÁÁÏÈÔÛ›‰ˆÛË, ÌÔÚÊ‹ Ó·ÓÈ΋ ‹ ÂÓËϛΈÓ: OÈ „˘¯È·ÙÚÈΤ˜ ÂΉËÏÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Â˘ÂÚÂıÈÛÙfiÙËÙ· Î·È ÂÈıÂÙÈÎfiÙËÙ·, ηٿıÏÈ„Ë ‹ ÓÔËÙÈ΋ ¤ÎÙˆÛË (4-6,9). ¡fiÛÔ˜ Nieman-Pick Ù‡Ô˘ C: ∏ ·È‰È΋ ÌÔÚÊ‹ ÂΉËÏÒÓÂÙ·È Ì ¤ÎÙˆÛË Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘ Î·È Ó¢ÚÔÏÔÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, Ë ÔÔ›· ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· ‰ÂÓ ˘¿Ú¯ÂÈ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ (4-6,9). ¡fiÛÔ˜ Wilson: ∆· 2/3 ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙Ô˘Ó „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÂÓÒ ÛÙÔ 1/5 ÙˆÓ ·ÛıÂÓÒÓ ·ÔÙÂÏÔ‡Ó ÙÔ ÌÔÓ·‰ÈÎfi ·Ú¯ÈÎfi Û‡Ìو̷. ¶ÔÏÏÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÓÔÛËÏ¢Ù› Û „˘¯È·ÙÚÈο ÙÌ‹Ì·Ù· ÚÈÓ ‰È·ÁÓˆÛÙ› Ë ÓfiÛÔ˜. ∆· ÈÔ Û˘¯Ó¿ ÚÔ‚Ï‹Ì·Ù· Â›Ó·È Ë Â˘ÂÚÂıÈÛÙfiÙËÙ· Î·È Ë ÂÈıÂÙÈÎfiÙËÙ·, Ë Î·Ù¿ıÏÈ„Ë Î·È Ë ÓÔËÙÈ΋ ¤ÎÙˆÛË (4,15,16). OÌÔ΢ÛÙÈÓÔ˘Ú›·: OÈ ÌÈÛÔ› ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó


May-June 03

03-06-03

16:55

™ÂÏ›‰·169

¶·È‰È·ÙÚÈ΋ 2003;66:167-175

„˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù·. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯ÂÈ Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ ۈ̷ÙÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ Î·È ‹È· ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË (4-6). ¡fiÛÔ˜ Sanfilippo: OÈ Ù‡ÔÈ µ Î·È C ¤¯Ô˘Ó ‹È· ÔÚ›· Î·È Û˘¯Ó¿ ÂΉËÏÒÓÔÓÙ·È ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ· Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÈıÂÙÈÎfiÙËÙ· Î·È ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘. ∆· ·‰Ú¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ ÂÓ›ÔÙÂ Â›Ó·È ‰È·ÎÚÈÙÈο Î·È Ù· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ· (4-6). ∫ËÚÔÂȉ‹˜ ÏÈÔÊÔ˘ÛΛӈÛË: ∏ ÓfiÛÔ˜ Batten Ì ÓÔËÙÈ΋ ¤ÎÙˆÛË Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ Û ËÏÈΛ· 6 ÂÙÒÓ. ∏ ÔÙÈ΋ Ô͇ÙËÙ· ÂËÚ¿˙ÂÙ·È ÓˆÚ›˜ ÛÙËÓ ÔÚ›· (4). ¡fiÛÔ˜ Tay Sachs: ∏ ÓfiÛÔ˜ ÌÔÚ› Ó· ÂΉËψı› Û ¿ÙÔÌ· fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ. 懯ˆÛË ·Ó·Ê¤ÚÂÙ·È Û 30-50% ·ÛıÂÓÒÓ Ì ÙÔÓ Ù‡Ô ÂÓËϛΈÓ, Ô ÔÔ›Ô˜ ÌÔÚ› Ó· ·Ú¯›˙ÂÈ ÛÙËÓ ÂÊ˂›·. ™˘¯Ó¿ Ù›ıÂÙ·È Ï·Óı·Ṳ̂ÓË ‰È¿ÁÓˆÛË Û¯È˙ÔÊÚ¤ÓÈ·˜ (4-6,17). º˘ÏÔÛ‡Ó‰ÂÙË ·‰ÚÂÓÔÏ¢ÎÔ‰˘ÛÙÚÔÊ›· (∞§¢): ∂›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ (1:20.000 ÁÂÓÓ‹ÛÂȘ), Ë ÔÔ›· Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È Û ·ÁfiÚÈ· ËÏÈΛ·˜ 610 ÂÙÒÓ. ∏ ÌÔÚÊ‹ Ì ¤Ó·ÚÍË ÛÙËÓ ÂÊ˂›· ¤¯ÂÈ ÈÔ ‹È· ÔÚ›·. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÂ¿ÚÎÂÈ· ÂÈÓÂÊÚȉ›ˆÓ, Ó¢ÚÔÏÔÁÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ηÈ, Û ÔÛÔÛÙfi 56%, „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù·. ∏ „‡¯ˆÛË ÌÔÚ› Ó· ÚÔËÁËı› ÙˆÓ ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÔÏÏÔ‡˜ Ì‹Ó˜. ∞Ó·‰ÚÔÌÈο, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ∞§¢ Ù‡Ô˘ ÂÓËÏ›ÎˆÓ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ·ÏÏ·Á‹ Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ Î·È ÔÈ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‹ ÙËÓ ÂÊ˂›· Î·È ·Ô‰fiıËÎ·Ó Û ¿ÏÏ· ·›ÙÈ·. ™Ù· 2/3 ÙˆÓ ·ÛıÂÓÒÓ ‰È·ÈÛÙÒÓÂÙ·È ‚ÈÔ¯ËÌÈο ·ÓÂ¿ÚÎÂÈ· ÂÈÓÂÊÚȉ›ˆÓ, ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó ¿ÓÙ· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· (4,18). OÍ›· ‰È·Ï›Ô˘Û· ÔÚÊ˘Ú›·: ∞ÔÙÂÏ› Û¿ÓÈ· ‰È·Ù·Ú·¯‹ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÔÚÊ˘ÚÈÓÒÓ, Ë ÔÔ›· ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÎÔÚ›ÙÛÈ·. ¶·ÚÔ˘ÛÈ¿˙ÂÈ Ôͤ· ÂÂÈÛfi‰È· „‡¯ˆÛ˘, Ì ÈÛÙÔÚÈÎfi Û˘¯ÓÒÓ ·ÓÂÍ‹ÁËÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ (4). ªÂÙ·¯ÚˆÌ·ÙÈ΋ Ï¢ÎÔ‰˘ÛÙÚÔÊ›·: ∏ Ó·ÓÈ΋ ÌÂÙ·¯ÚˆÌ·ÙÈ΋ Ï¢ÎÔ‰˘ÛÙÚÔÊ›· ÂÌÊ·Ó›˙ÂÙ·È Û ËÏÈΛ· 6-10 ÂÙÒÓ, Ì ÓÔËÙÈ΋ ¤ÎÙˆÛË, Ì›ˆÛË Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘ Î·È ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿. ¡Â˘ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ (4,9). µ. ¢È·Ù·Ú·¯¤˜ ÂÓ‰ÔÎÚÈÓÒÓ ·‰¤ÓˆÓ ™˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘. ¡ÔÛ‹Ì·Ù· ı˘ÚÂÔÂȉԇ˜: ∞ÛıÂÓ›˜ Ì ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡Á¯˘ÛË, ¿Á¯Ô˜ ‹ Î·È „‡¯ˆÛË. ™ÙÔÓ ˘Ôı˘ÚÂÔÂȉÈÛÌfi ··ÓÙ¿Ù·È ‚Ú·‰˘„˘¯ÈÛÌfi˜ Î·È ÂÓ›ÔÙ ηٿıÏÈ„Ë (7,10). ∂ÓÙÔ‡ÙÔȘ, Ë Û˘¯ÓfiÙËÙ· ÓÔÛËÌ¿ÙˆÓ ı˘ÚÂÔÂȉԇ˜ ‰ÂÓ Â›Ó·È ·˘ÍË̤ÓË ÛÙÔÓ „˘¯È·ÙÚÈÎfi ÏËı˘ÛÌfi. °È·

Paediatriki 2003;66:167-175

ÙÔ ÏfiÁÔ ·˘Ùfi, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ ıˆÚÔ‡Ó ·Ó·Áη›Ô ÙÔÓ Û¯ÂÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ·Ô˘Û›· ÎÏÈÓÈ΋˜ ˘Ô„›·˜, ÂÓÒ ¿ÏÏÔÈ ÙÔÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘ÛÙËÌ·ÙÈο (19,20). ÕÙÔÌ· Ì ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉ›Ùȉ·, Û˘Ó‹ıˆ˜ Û ηٿÛÙ·ÛË Â˘ı˘ÚÂÔÂȉÈÛÌÔ‡, ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹ ÛÙ· Ï·›ÛÈ· ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ Hashimoto, Ë ÔÔ›· ·Ô‰›‰ÂÙ·È Û ‚Ï¿‚Ë Ó¢ÚÒÓˆÓ Ì ·˘ÙÔ¿ÓÔÛÔ Ì˯·ÓÈÛÌfi. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÁÚ¿ÊÔÓÙ·È ‰¤Î· ÂÚÈÙÒÛÂȘ ıËϤˆÓ, ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ·ÚÔ˘Û›·˙·Ó Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ Û·ÛÌÔ‡˜, ÂÓÒ fiϘ ›¯·Ó ÛÙËÓ ÔÚ›· ·ıÔÏÔÁÈÎfi ∏∂° Î·È ·˘ÍË̤ÓÔ Ï‡Έ̷ ÛÙÔ ∂¡À. ∏ ‰È·Ù·Ú·¯‹ ·˘Ù‹ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Û ·ÁˆÁ‹ Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (21-24). ¡fiÛÔ˜ Cushing: ™˘Ó‹ıˆ˜ ˘¿Ú¯Ô˘Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÛËÌ›· ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Â˘ÂÚÂıÈÛÙfiÙËÙ·, ηٿıÏÈ„Ë Î·È Â‡ÎÔÏË ÎfiˆÛË (7). ÀÂÚÚÔÏ·ÎÙÈÓ·ÈÌ›·: ∂ÎÙfi˜ ·fi Ù· Ê˘ÛÈο Û˘ÌÙÒÌ·Ù· (Á˘Ó·ÈÎÔÌ·ÛÙ›·, Á·Ï·ÎÙfiÚÚÔÈ·), ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ¿Á¯Ô˜, ηٿıÏÈ„Ë Î·È ÂÈıÂÙÈÎfiÙËÙ· (25). ÀÂÚ·Ó‰ÚÔÁÔÓÈÛÌfi˜: O ˘ÂÚ·Ó‰ÚÔÁÔÓÈÛÌfi˜ ÛÙ· ı‹Ï· ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ı‡ÌÔ˘ ‹ Ì ÂΉ‹ÏˆÛË Û¯È˙ÔÊÚ¤ÓÂÈ·˜ Û ÓÂfiÙÂÚË ËÏÈΛ· (›‰È·˜ Ì ·˘Ù‹ ÙˆÓ ·ÁÔÚÈÒÓ). Œ¯ÂÈ ÛËÌÂȈı› ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ·fi ÔÚÌÔÓÈ΋ ·ÁˆÁ‹ Ì ·ÓÙÈÛ˘ÏÏËÙÈο (26,27). ¢È·Ù·Ú·¯¤˜ ·Ú·ı˘ÚÂÔÂȉÒÓ ·‰¤ÓˆÓ: ∏ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· Û¯ÂÙ›˙ÂÙ·È Ì ÔÍ›· Û‡Á¯˘ÛË ‹ ¯ÚfiÓȘ ·ÏÏ·Á¤˜ ÚÔÛˆÈÎfiÙËÙ·˜, ‰˘ÛÎÔϛ˜ Û˘ÁΤÓÙÚˆÛ˘ Î·È ¤ÏÏÂÈ„Ë ÚˆÙÔ‚Ô˘Ï›·˜, Ô˘ ·Ó·ÛÙÚ¤ÊÔÓÙ·È Ì ÙË ‰ÈfiÚıˆÛË Ù˘ ËÏÂÎÙÚÔÏ˘ÙÈ΋˜ ‰È·Ù·Ú·¯‹˜. ∏ ˘Ô·Û‚ÂÛÙÈ·ÈÌ›· ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÂÈ ÔÍ›· Û‡Á¯˘ÛË (·ÎfiÌË Î·È ·Ô˘Û›· ÙÂÙ·Ó›·˜), Â¿Ó Ë ÙÒÛË ÙˆÓ ÂÈ¤‰ˆÓ ·Û‚ÂÛÙ›Ô˘ Â›Ó·È ·fiÙÔÌË. ∏ ‚·ıÌÈ·›· ÙÒÛË ÚÔηÏ› ÈÔ ‹Ș ·ÏÏ·Á¤˜ ÚÔÛˆÈÎfiÙËÙ·˜ Î·È ÁÓˆÛÙÈο ÂÏÏ›ÌÌ·Ù·, Ù· ÔÔ›· ‰ÂÓ ·Ôηı›ÛÙ·ÓÙ·È ¿ÓÙ· ÌÂÙ¿ ·fi ÙËÓ Â·Ó·ÊÔÚ¿ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÈ¤‰ˆÓ (10). °. ∫¿ÎˆÛË ÎÂÊ·Ï‹˜ (28-30) ∏ ÂÌÊ¿ÓÈÛË „˘¯È·ÙÚÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ ·fi οΈÛË Ù˘ ÎÂÊ·Ï‹˜ ÂÍ·ÚÙ¿Ù·È ·fi ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ‚·Ú‡ÙËÙ· Ù˘ οΈÛ˘ Â›Ó·È Ô Î‡ÚÈÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙÔ Û˘Ì‚¿Ó, ÂÓÒ ·È‰È¿ Ì ‚·Ú‡ÙÂÚ˜ ηÎÒÛÂȘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È ÈÔ ÓˆÚ›˜. ™ÙËÓ ÔÍ›· ÂÚ›Ô‰Ô ·Ó¿ÚÚˆÛ˘ ÌÔÚ› Ó· ÂΉËÏÒÓÂÙ·È ¿Á¯Ô˜ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, ηٿıÏÈ„Ë (‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ Î·È fiÚÂ͢, ·¿ıÂÈ·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÂÓÔ¯¤˜,

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·˘ÙÔÎÙÔÓÈÎfi˜ ȉ·ÛÌfi˜). ªÂÙ¿, ÙÔ Ê¿ÛÌ· Èı·ÓÒÓ ·ÏÏ·ÁÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ Î˘Ì·›ÓÂÙ·È ·fi ‹È· ÎÔÈÓˆÓÈ΋ ·‰È·ÎÚÈÛ›· ¤ˆ˜ ‚›·È˜ ÂÈı¤ÛÂȘ. ¶ÂÚÈÁÚ¿ÊÂÙ·È ‰È·ÎÚÈÙfi Û‡Ó‰ÚÔÌÔ ·ÚfiÌÔÈÔ Ì ÙÔ “Û‡Ó‰ÚÔÌÔ ÌÂÙˆÈ·›Ô˘ ÏÔ‚Ô‡”, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÚÔÚÌËÙÈÎfiÙËÙ·, Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ÂÎÚ‹ÍÂȘ Î·È ·ÒÏÂÈ· ÎÔÈÓˆÓÈÎÒÓ ·Ó·ÛÙÔÏÒÓ (.¯. Á‰‡ÓÂÙ·È ‹ ·˘Ó·Ó›˙ÂÙ·È ‰ËÌÔÛ›ˆ˜). ∆· ı‡Ì·Ù· οΈÛ˘ ÎÂÊ·Ï‹˜ ‰ËÏÒÓÔ˘Ó ÈÔ Û˘¯Ó¿ ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË, ÌÔÓ·ÍÈ¿ Î·È ‰˘ÛÎÔϛ˜ ÚÔÛ·ÚÌÔÁ‹˜, Û ۇÁÎÚÈÛË Ì ̿ÚÙ˘Ú˜. ∂Ó›ÔÙÂ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÌÙÒÌ·Ù· ÂÓ·ÓÙȈÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ ‹ ‰È·Ù·Ú·¯‹˜ Ù˘ ‰È·ÁˆÁ‹˜. ∏ ÚÔ¸¿Ú¯Ô˘Û· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ‹ ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜ Úԉȷı¤ÙÂÈ ÁÈ· ·Ù˘¯‹Ì·Ù· Î·È ÌÔÚ› Ó· ÂȉÂÈÓˆı› ÌÂÙ¿ ·fi ·˘Ù¿. ∆Ô ıÂÙÈÎfi ÈÛÙÔÚÈÎfi „˘¯È·ÙÚÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Â›Û˘ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÚÔ‚ÏËÌ¿ÙˆÓ. ªÂÙ¿ ·fi ¤ÍÈ Ì‹Ó˜ ÌÂÈÒÓÂÙ·È Ë Û¯ÂÙÈ΋ ÛËÌ·Û›· Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ οΈÛ˘ Î·È ·˘Í¿ÓÂÈ Ô ÚfiÏÔ˜ ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∏ Û¯¤ÛË ‰ÂÓ Â›Ó·È ·Ï‹, ‰ÈfiÙÈ ÔÈ ·ÏÏ·Á¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Û ·È‰·ÁˆÁÈο ÛÊ¿ÏÌ·Ù· (.¯. ˘ÂÚÚÔÛÙ·Û›·). ¶ÚÔÔÙÈ΋ ÌÂϤÙË ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 60% ÙˆÓ ·È‰ÈÒÓ Ì ÚÔ¸¿Ú¯ÔÓÙ· ÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ Û 14% ÙˆÓ ·È‰ÈÒÓ ·fi ÂÚÈ‚¿ÏÏÔÓ ÂχıÂÚÔ Ù¤ÙÔÈˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ (5). ¢. ŸÁÎÔÈ ÂÁÎÂÊ¿ÏÔ˘ (7,10,31,32) æ˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ÂΉËÏÒÓÔÓÙ·È ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ Ì fiÁÎÔ ÂÁÎÂÊ¿ÏÔ˘, ·ÏÏ¿ Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÔÓÙ·È ·fi ¿ÏÏ· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›·. OÈ fiÁÎÔÈ ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì „˘¯ˆÛÈο Û˘ÌÙÒÌ·Ù·, ÂÓÒ ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ÏÔ‚Ô‡ ÌÔÚ› ·Ú¯Èο Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÏÏ·Á‹ ÚÔÛˆÈÎfiÙËÙ·˜, ÁÓˆÛÙÈο ÂÏÏ›ÌÌ·Ù· Î·È ·Ú·Í›·. ∏ ηٿıÏÈ„Ë ÌÔÚ› Ó· Û˘Óԉ‡ÂÈ Î¿ı ¯ÚfiÓÈÔ ÓfiÛËÌ·, ÂȉÈο fiÙ·Ó ˘¿Ú¯ÂÈ ·›ÛıËÌ· ηÎÔ˘¯›·˜ Î·È ¤ÎÙˆÛË ÏÂÈÙÔ˘ÚÁ›·˜. ŸÙ·Ó Ù· Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘ Û˘Óԉ‡ÔÓÙ·È ·fi ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÎÂÊ·Ï·ÏÁ›Â˜ Î·È Â̤ÙÔ˘˜ ¯ˆÚ›˜ ¿ÏÏ· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi, Û˘ÓÈÛÙ¿Ù·È Ó¢ÚÔÏÔÁÈ΋ Î·È Èı·ÓÒ˜ Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈ΋ ÂͤٷÛË. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÙÒÛÂȘ ηı˘ÛÙÂÚË̤Ó˘ ‰È¿ÁÓˆÛ˘ fiÁÎÔ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ Û ·È‰È¿ ÌÂ Û˘ÓÔ‰¿ „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· Î·È ‰˘ÛÎÔϛ˜ ÛÙË Û¯ÔÏÈ΋ Â›‰ÔÛË ‹ ÌÂ Û˘ÌÙÒÌ·Ù· Ô˘ ÂÛÊ·Ï̤ӷ ·Ô‰fiıËÎ·Ó Û „˘¯ÔÏÔÁÈο ·›ÙÈ·, fiˆ˜ ȉÈfiÌÔÚÊË ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ¿ÏÁË ÛÙ· ¿ÎÚ·. ŸÙ·Ó Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË (ÂÓ›ÔÙ Ì ηı˘ÛÙ¤ÚËÛË ÌËÓÒÓ ‹ ÂÙÒÓ), ›¯Â ·Ó·Ù˘¯ı› Ë Ï‹Ú˘ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘. ŒÙÛÈ, ÙÔÓ›˙ÂÙ·È Ë ·Ó·ÁηÈfiÙËÙ· ÂÚÈÔ‰È΋˜ Â·ÓÂͤٷÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ (33).

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∂. ∂ÈÏË„›· (7,10,34) ŸÙ·Ó ÙÔ ·È‰› ·ÚÔ˘ÛÈ¿˙ÂÈ Ôͤ· ÂÂÈÛfi‰È· ÔÚÁ‹˜ ‹ ·ÓÈÎÔ‡, Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Ë Èı·ÓfiÙËÙ· ÂÈÏË„›·˜ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Î·È ÛÙË ÌÂÙ·ÎÚÈÙÈ΋ Ê¿ÛË, ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘ Â›Ó·È ‰È·Ù·Ú·Á̤ÓÔ, Ë ‚›·ÈË Û˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ÛÙÂÚÂfiÙ˘Ë Î·È ¿ÛÎÔË, ÂÓÒ Û˘Ó‹ıˆ˜ ·ÎÔÏÔ˘ı› ˘ÓËÏ›· Î·È ·ÌÓËÛ›· ÙÔ˘ Û˘Ì‚¿ÓÙÔ˜. ∏ ÂÈÏÂÁ̤ÓË ÂÛÙȷ΋ ÂÈÏË„›· ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ÏÔ‚Ô‡ ÌÔÚ› Ó· ÂΉËÏÒÓÂÙ·È Ì ÂÈʈӋ̷ٷ Î·È ÔÈΛϘ ·ıÔÏÔÁÈΤ˜ ÎÈÓ‹ÛÂȘ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÎÏ·ÛÈÎfi ¯·Ú·ÎÙ‹Ú· Û·ÛÌÒÓ. ™Â ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ˆ˜ ·ÚÂÓ¤ÚÁÂÈ· ÙˆÓ Ê·Ú̿ΈÓ. ™Ù. °ÂÓÂÙÈο Û‡Ó‰ÚÔÌ· ŸÙ·Ó Ë „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Û˘Ó˘¿Ú¯ÂÈ Ì „˘¯È·ÙÚÈÎfi Úfi‚ÏËÌ·, Ë Û˘¯ÓfiÙËÙ· ΢ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·È 3%, Êı¿ÓÔÓÙ·˜ ÙÔ 10% Û ÂÚÈÙÒÛÂȘ ÚÒÈÌ˘ Û¯È˙ÔÊÚ¤ÓÂÈ·˜ (35,36). ∏ ‰È¿ÁÓˆÛË Ù˘ ÁÂÓÂÙÈ΋˜ ·��ˆÌ·Ï›·˜ ÂÈÙÚ¤ÂÈ ÛÙÔÓ ·È‰›·ÙÚÔ Ó· ÂÎÙÈÌ‹ÛÂÈ ÙÔ ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ·È‰ÈÔ‡, Ó· ÂϤÁÍÂÈ ÁÈ· Û˘ÓÔ‰¿ ÚÔ‚Ï‹Ì·Ù·, Ó· ÚԂϤ„ÂÈ ÙËÓ ÔÚ›· ηÈ, Èı·ÓÒ˜, Ó· ‰È·ÁÓÒÛÂÈ ËÈfiÙÂÚ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ Û ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∆· ÈÔ Û˘¯Ó¿ ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ· Ì ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È Ù· ·ÎfiÏÔ˘ı· (35,37,38): ™‡Ó‰ÚÔÌÔ Down: ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Û ÌÈÎÚ‹ ËÏÈΛ·, ÏfiÁˆ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡ ۈ̷ÙÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘. ™Â Û‡ÁÎÚÈÛË Ì ¿ÏÏ· ·È‰È¿ Ì ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, Â›Ó·È ÈÔ ÎÔÈÓˆÓÈο, ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓ ı‡ÌÔ˘ Î·È „‡¯ˆÛ˘, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈÔ Û˘¯Ó¿ Û‡Ó‰ÚÔÌÔ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜. ™‡Ó‰ÚÔÌÔ Â‡ıÚ·˘ÛÙÔ˘ Ã: ∂›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÈ΋ ·ÈÙ›· ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ (1:1250 ÁÂÓÓ‹ÛÂȘ ·ÚÚ¤ÓˆÓ). ¡ÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, Ë ‚·Ú‡ÙËÙ· Ù˘ ÔÔ›·˜ ÔÈΛÏÏÂÈ, ˘¿Ú¯ÂÈ Û fiÏÔ˘˜ ÙÔ˘˜ ¿ÚÚÂÓ˜ Î·È ÛÙ· ÌÈÛ¿ ÂÙÂÚfi˙˘Á· ı‹Ï·. º·ÈÓÔÙ˘Èο, Ù· ·ÁfiÚÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·Ï·ÚfiÙËÙ· ·ÚıÚÒÛˆÓ, ÌÂÁ¿ÏÔ˘˜ fiÚ¯ÂȘ, ÌÂÁ¿ÏË ÁÓ¿ıÔ Î·È Âͤ¯ÔÓÙ· ·ÊÙÈ¿. ∏ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·ÛıÂÓÒÓ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÊÙˆ¯‹ ‚ÏÂÌÌ·ÙÈ΋ Â·Ê‹, ·ÔÊ˘Á‹ ÎÔÈÓˆÓÈÎÒÓ Â·ÊÒÓ, ÛÙÂÚÂÔÙ˘›Â˜, ÂÌÌÔÓ¤˜, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ÂÎÚ‹ÍÂȘ ı˘ÌÔ‡. ™‡Ó‰ÚÔÌÔ Williams: ∆· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆ›Ô, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Î·È ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·. Œ¯Ô˘Ó ηϿ ·ÓÂÙ˘Á̤ÓÔ ÂÎÊÚ·ÛÙÈÎfi ÏfiÁÔ, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ¿Á¯Ô˜.


May-June 03

03-06-03

16:55

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¶·È‰È·ÙÚÈ΋ 2003;66:167-175

™‡Ó‰ÚÔÌÔ Prader-Willi: O ÎÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ·¯˘Û·ÚΛ·, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÎÚ˘„ÔÚ¯›·, ˘ÔÏ·ÛÙÈο ÁÂÓÓËÙÈο fiÚÁ·Ó·, ÌÈÎÚ¿ ¯¤ÚÈ· Î·È fi‰È·. ™ÙÔ ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ˘ÔÙÔÓ›· ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ÔÏ˘Ê·Á›· ·fi ÙË ÓËȷ΋ ËÏÈΛ· Î·È Î·ı˘ÛÙ¤ÚËÛË „˘¯ÔÎÈÓËÙÈ΋˜ ·Ó¿Ù˘Í˘. ∆· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Prader-Willi ¤¯Ô˘Ó ÔÚȷ΋ ‹ ‹ÈÔ˘ ‚·ıÌÔ‡ ¯·ÌËÏ‹ ÓÔËÌÔÛ‡ÓË. ∆· ÈÔ Û˘¯Ó¿ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â›Ó·È ÂÌÌÔÓ¤˜, ΢ڛˆ˜ Ì ÙÔ Ê·ÁËÙfi, ηıÒ˜ Î·È ÂÂÈÛfi‰È· ÂÈıÂÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. ™‡Ó‰ÚÔÌÔ Turner: ∏ ÌÂÚÈ΋ ‹ Ï‹Ú˘ ¤ÏÏÂÈ„Ë ÂÓfi˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à ÂΉËÏÒÓÂÙ·È Ì ÙÔÓ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô: ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ȉÈfiÌÔÚÊÔ ÚÔÛˆ›Ô, ÙÂÚ‡ÁÈÔ ÙÚ·¯‹ÏÔ˘, Ê·Ú‰‡˜ ıÒڷη˜ Î·È ÎÔÓÙfi ٤ٷÚÙÔ ÌÂٷοÚÈÔ. ∏ ÓÔËÌÔÛ‡ÓË Â›Ó·È Û˘Ó‹ıˆ˜ ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·, ·ÏÏ¿ ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Â›Ó·È Û˘¯Ó¤˜. ¶ÔÏϤ˜ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ù¿ıÏÈ„Ë, ¿Á¯Ô˜ Î·È ‰˘ÛÎÔÏ›· ÛÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ. ∞ÁfiÚÈ· Ì ηڢfiÙ˘Ô ÃÃÀ ‹ Û‡Ó‰ÚÔÌÔ Klinefelter: ∂›Ó·È „ËÏÔ›, Ì ‰˘Û·Ó¿ÏÔÁ· Ì·ÎÚÈ¿ fi‰È·, ÌÈÎÚÔ‡˜ fiÚ¯ÂȘ Î·È Á˘Ó·ÈÎÔÌ·ÛÙ›·. ¶ÔÏÏÔ› ¤¯Ô˘Ó ¯·ÌËÏfi ÏÂÎÙÈÎfi ËÏ›ÎÔ ÓÔËÌÔÛ‡Ó˘ Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ ·Ó¿ÁÓˆÛË. ∂›Ó·È ·ıËÙÈÎÔ› ÛÙȘ Û¯¤ÛÂȘ ÌÂ Û˘ÓÔÌËÏ›ÎÔ˘˜, ÔÈ ÔÔ›ÔÈ Û˘¯Ó¿ ÙÔ˘˜ ÂÈÙ›ıÂÓÙ·È. ∞ÁfiÚÈ· Ì ηڢfiÙ˘Ô ÃÀÀ: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi „ËÏfi ·Ó¿ÛÙËÌ· Î·È ¤ÓÙÔÓË ·ÎÌ‹ ηٿ ÙËÓ ÂÊ˂›·. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÏfiÁÔ˘, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ÂÓÒ ÛÙËÓ ÂÊ˂›· ÌÔÚ› Ó· ‰È·ÁÓˆÛÙ› ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜. ¶·È‰È¿ Ì Ó¢ÚÔ˚ӈ̿وÛË: Œ¯Ô˘Ó ÓÔËÌÔÛ‡ÓË ÛÙ· ¯·ÌËÏ¿ Ê˘ÛÈÔÏÔÁÈο fiÚÈ·, ÂÓÒ Ù· ÌÈÛ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È ‰È·Ù·Ú·¯‹ ÚÔÛÔ¯‹˜. ∑. §ÔÈÌÒÍÂȘ OÈ ·ÎfiÏÔ˘ı˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ∫¡™ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó ·Ú¯Èο Ì „˘¯ÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ (7,10,39). ÀÔÍ›· ÛÎÏËÚ˘ÓÙÈ΋ ·ÓÂÁÎÂÊ·Ï›Ùȉ·: ¶ÚfiÎÂÈÙ·È ÁÈ· Ï·Óı¿ÓÔ˘Û·, ÚÔԉ¢ÙÈ΋ ÊÏÂÁÌÔÓ‹ Ô˘ ·ÎÔÏÔ˘ı› ÙËÓ ÈÏ·Ú¿ ‹ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ηٿ Ù˘ ÈÏ·Ú¿˜. ∂ΉËÏÒÓÂÙ·È Ì ·¸Ó›·, ÂÓ·ÓÙȈÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ÂÎÚ‹ÍÂȘ ı˘ÌÔ‡ Î·È ·Ú·ÈÛı‹ÛÂȘ. ¡Â˘ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ Û·ÛÌÔ› Î·È ·Ù·Í›·, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÚÁfiÙÂÚ· ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ∂ÚËÙÈ΋ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ·: ∫·Ù¿ ÙÔ Ô͇ ÂÂÈÛfi‰ÈÔ, Ù· 9/10 ÙˆÓ ·ÛıÂÓÒÓ ¤¯Ô˘Ó ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, ·Ú·ÈÛı‹ÛÂȘ ‹ „‡¯ˆÛË. ™˘Ó‹ıˆ˜ ˘¿Ú¯ÂÈ ˘ÚÂÙfi˜, Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ∂ÈÏÔΤ˜ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜: ª›· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ ÂÈÏÔΤ˜ Â›Ó·È Ë ·ÒÏÂÈ· ·ÎÔ‹˜, Ë ÔÔ›· ÂÓ‰¤¯ÂÙ·È Ó· ÂΉËψı› Ì ‰È·Ù·Ú·¯¤˜ ÔÌÈ-

Paediatriki 2003;66:167-175

Ï›·˜ Î·È Û˘ÌÂÚÈÊÔÚ¿˜. ªÂÚÈΤ˜ ‚‰ÔÌ¿‰Â˜ ‹ Î·È Ì‹Ó˜ ÌÂÙ¿ ÙË ÓfiÛÔ, ÔÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÁÓˆÛÙÈο ÂÏÏ›ÌÌ·Ù·. °ÂÓÈο, fï˜, Ë ÚfiÁÓˆÛË Â›Ó·È Â˘ÓÔ˚΋ ÛÙ· ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ™‡Ó‰ÚÔÌÔ ¯ÚfiÓÈ·˜ ÎfiˆÛ˘: ™˘Ó‹ıˆ˜ ·Ú¯›˙ÂÈ Ì ÔÍ›· Ïԛ̈ÍË (ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË ‹ ÁÚ›Ë). ∞ÎÔÏÔ˘ı› ·›ÛıËÌ· ÎfiˆÛ˘ Î·È ÌÂȈ̤Ó˘ ·ÓÙÔ¯‹˜, Ô˘ ÂÌÔ‰›˙ÂÈ ÙȘ ηÓÔÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ‰È·ÚΛ >6 Ì‹Ó˜. ™˘Óԉ‡ÂÙ·È ·fi ÔÏÏ·Ï¿ Û˘ÌÙÒÌ·Ù· Î·È Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Â¿Ó ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ∫¤ÓÙÚÔ˘ ∂ϤÁ¯Ô˘ Î·È ¶ÚfiÏ˄˘ ∞ÛıÂÓÂÈÒÓ ÙˆÓ ∏¶∞ (40). OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ¿Û¯Ô˘Ó ·fi ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ (·¸Ó›· ‹ ˘ÓËÏ›·), ‰˘ÛÎÔÏ›· Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ÚÔÛÔ¯‹˜ ‹ ¤¯Ô˘Ó fiÏ· Ù· Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘ (Û ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ·fi ¿ÙÔÌ· Ì ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë Î˘ÛÙÈ΋ ›ÓˆÛË). ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿Ó Ù· „˘¯Èο ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ·ÈÙ›· ‹ Â›ÙˆÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ Â¿Ó ˘¿Ú¯ÂÈ ÎÔÈÓfi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ™‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (AIDS): ¶·È‰È¿ Ì AIDS Î·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ÌÓ‹Ì˘ Î·È ÚÔÛÔ¯‹˜, ·fiÛ˘ÚÛË Î·È ·˘ÍË̤ÓË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÌÂÙ·‚ÏËÙfiÙËÙ·. ∏. ∞˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (7,41) ¶·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙfiÎÔÎÎÔ (Pediatric autoimmune neuropsychiatric disorders associated with streptococcus - PANDAS): ∂ΉËÏÒÓÂÙ·È Ì ȉÂÔ„˘¯·Ó·ÁηÛÙÈ΋ ‰È·Ù·Ú·¯‹. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ·ÔÙÂÏÔ‡Ó: ·) Ë ·ÚÔ˘Û›· ȉÂÔ„˘¯·Ó·ÁηÛÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ ‹ ÙÈÎ, ‚) Ë ¤Ó·ÚÍË ÌÂٷ͇ ËÏÈΛ·˜ 3 ÂÙÒÓ Î·È ÂÊ˂›·˜, Á) Ë ·ÈÊÓ›‰È· ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ, Ë ÔÚ›· Ì ˘Ê¤ÛÂȘ Î·È ‰Ú·Ì·ÙÈΤ˜ ÂÍ¿ÚÛÂȘ, ‰) Ë ¯ÚÔÓÔÏÔÁÈ΋ Û¯¤ÛË ÙˆÓ ÂÍ¿ÚÛÂˆÓ Ì ÙË ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË Î·È Â) Ù· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤Í·ÚÛ˘ (ÙÈÎ, ¯ÔÚ›·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·). ∞fi ÌÂϤÙ˜ Ì ÌÈÎÚÔ‡˜ ·ÚÈıÌÔ‡˜ ·ÛıÂÓÒÓ ÚÔ·ÙÂÈ fiÙÈ ÂÚ›Ô˘ 10% ÙˆÓ ·È‰ÈÒÓ Ì ȉÂÔÏË„›Â˜ Î·È „˘¯·Ó·ÁηÛÌÔ‡˜ ÌÔÚ› Ó· ¿Û¯ÂÈ ·fi PANDAS. ™˘ÓÈÛÙ¿Ù·È ÚÔʇϷÍË Ì ÂÓÈÎÈÏ›ÓË, fiˆ˜ ÌÂÙ¿ ·fi ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÎfiÌË ÏËÚÔÊÔڛ˜ ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛË. ∂Ú˘ıËÌ·Ù҉˘ χÎÔ˜: ¶·È‰È¿ Ì ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ Ô˘ ¤¯ÂÈ ÚÔÛ‚¿ÏÂÈ ÙÔ ∫¡™ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÔÍ›· Û‡Á¯˘ÛË ‹ „‡¯ˆÛË, ÚÔÙÔ‡ ÂÌÊ·ÓÈÛÙÔ‡Ó Ù· ¿ÏÏ· Ó¢ÚÔÏÔÁÈο Î·È Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ (42,43). £. ∆ÔÍÈο ·›ÙÈ· (12,32) º·ÚÌ·ÎÔÏÔÁÈο ·›ÙÈ·: ¶ÔÏÏ¿ Ê¿Ú̷η ÌÔÚ›

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03-06-03

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¶·È‰È·ÙÚÈ΋ 2003;66:167-175

Ó· ÚÔηϤÛÔ˘Ó „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ˆ˜ ·ÚÂÓ¤ÚÁÂÈ¿ ÙÔ˘˜ ‹ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛÙ¤ÚËÛ˘. ∞fi ÙËÓ ·È‰È·ÙÚÈ΋ Ê·ÚÌ·ÎÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ·ÓÙȯÔÏÈÓÂÚÁÈο, ·ÓÙÈÂÈÏËÙÈο, ‚·Ú‚ÈÙÔ˘ÚÈο, ‚ÂÓ˙ԉȷ˙Â›Ó˜, ·ÓÙ·ÁˆÓÈÛÙ¤˜ ‚-˘Ô‰Ô¯¤ˆÓ, ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ÈÛÔÓÈ·˙›‰Ë, ÌÂÙÚÔÓȉ·˙fiÏË, ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË Î·È ¿ÏÏ·. ∫·Ù¿¯ÚËÛË Ô˘ÛÈÒÓ: ™Â ÂÊ‹‚Ô˘˜ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ·, Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ¯Ú‹ÛË ··ÁÔÚÂ˘Ì¤ÓˆÓ Ô˘ÛÈÒÓ. ŸÙ·Ó Ô ¯Ú‹ÛÙ˘ ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ Ô˘Û›·˜, ·˘Í¿ÓÂÈ Ë Èı·ÓfiÙËÙ· Ó· ˘¿Ú¯ÂÈ ÚˆÙÔ·ı¤˜ „˘¯È·ÙÚÈÎfi Úfi‚ÏËÌ·. ∏ ÂıÈÛÙÈ΋ Ô˘Û›· ‰Ú· ˆ˜ ÚÔÎÏËÙÈÎfi˜ Î·È ÂÈ‚·Ú˘ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. π. ¡Â˘ÚÔ·Ó·Ù˘ÍÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ ∏ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ „˘¯È·ÙÚÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È 2-3 ÊÔÚ¤˜ ·˘ÍË̤ÓË Û ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ¯·ÌËÏfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹/Î·È ÂÚÈÁÂÓÓËÙÈΤ˜ ÂÈÏÔΤ˜, fiˆ˜ Ë ·ÓÔÍ›· (44). ∏ ̤ÛË ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ Û ·È‰È¿ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ· Â›Ó·È ¯·ÌËÏfiÙÂÚË Û ۇÁÎÚÈÛË Ì ̿ÚÙ˘Ú˜ (45). ∂›Û˘, ÛÙËÓ ·ÂÈÎfiÓÈÛË ÂÁÎÂÊ¿ÏÔ˘ ·Ú·ÙËÚÂ›Ù·È ÈÔ Û˘¯Ó¿ ‰È‡ڢÓÛË ÎÔÈÏÈÒÓ Û ۯÈ˙ÔÊÚÂÓÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ÂÚÈÁÂÓÓËÙÈÎÒÓ ÂÈÏÔÎÒÓ (46). ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ì ‚‚·ÚË̤ÓÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù· Î·È ¤ÙÛÈ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Ë ·ÈÙÈÔÏÔÁ›· ÙÔ˘˜ ÔÊ›ÏÂÙ·È Û ·ÏÏËÏÂ›‰Ú·ÛË ‚Ï¿‚˘ ÙÔ˘ ∫¡™ Ì ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (47,48). ∏ ¯Ú‹ÛË ÔÈÓÔÓ‡̷ÙÔ˜, ÓÈÎÔÙ›Ó˘, οÓÓ·‚˘, ÎÔη˝Ó˘ ‹ ·ÓÙÈηٷıÏÈÙÈÎÒÓ, ·ÓÙÈÂÈÏËÙÈÎÒÓ Î·È ·ÓÙÈ„˘¯ˆÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·fi ÙË ÌËÙ¤Ú· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓ Ù˘ „˘¯ÔÎÈÓËÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙÔ ·È‰›. OÈ ÌÂϤÙ˜ ¤¯Ô˘Ó Ï¿‚ÂÈ ˘’ fi„ÈÓ ÙÔ˘˜ ÔÏÏÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ˘¿Ú¯Ô˘Ó Û ٤ÙÔȘ ÂÚÈÙÒÛÂȘ (49). ™ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·È‰ÈÒÓ Ì „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È ÈÔ Û˘¯Ó¿ ·ÔÎÏ›ÛÂȘ ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË, ΢ڛˆ˜ ηı˘ÛÙ¤ÚËÛË ÛÙË ‚¿‰ÈÛË Î·È ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ ÏfiÁÔ˘. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ‰È·Ù·Ú·Á̤ÓË ·Ó¿Ù˘ÍË ÙÔ˘ ∫¡™ ı· ÌÔÚÔ‡Û ӷ ·ÔÙÂÏ› ÎÔÈÓfi ˘fiÛÙڈ̷ ÁÈ· Ù· ‰‡Ô Ê·ÈÓfiÌÂÓ· (48,50). OÈ ÂÏ¿ÛÛÔÓ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È Ê˘ÛÈο ÂÏÏ›ÌÌ·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÛÔÛÙfi <4% ÙÔ˘ ÏËı˘ÛÌÔ‡. ¶·Ú·‰Â›ÁÌ·Ù· ·˘ÙÒÓ Â›Ó·È Ô ˘ÂÚÙÂÏÔÚÈÛÌfi˜, Ë ÌÔÓ‹Ú˘ Ù˘¯‹ Ù˘ ·Ï¿Ì˘, Ë ıÔψً ˘ÂÚÒ· Î.Ï. ™Â ·È‰È¿ Ì ÔÈΛϷ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹, ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜, „‡¯ˆÛË), ÔÈ ÂÏ¿ÛÛÔÓ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ··ÓÙÒ-

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ÓÙ·È ���ÈÔ Û˘¯Ó¿ Û ۇÁÎÚÈÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (51,52). ™Â ÚÔÔÙÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Û ˘„ËÏfi ΛӉ˘ÓÔ ÁÈ· „˘¯È·ÙÚÈ΋ ÓfiÛÔ (ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÚÔ‚ÏËÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ), Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ „˘¯È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙËÓ ÂÊ˂›· ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÛÙ· ·È‰È¿ Ì ≥2 ÂÏ¿ÛÛÔÓ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (52). ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ·˘Ù¤˜ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ‰È·ÎÚÈÙÈΤ˜ ·Ó·Ù˘ÍȷΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ∫¡™ Ô˘ Úԉȷı¤ÙÔ˘Ó, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÁÈ· „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·. ∫ÏÈÓÈ΋ ·È‰È·ÙÚÈ΋ ÂͤٷÛË πÛÙÔÚÈÎfi ∆· ·ÎfiÏÔ˘ı· ÛÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ Èı·Ó‹ ‡·ÚÍË ÔÚÁ·ÓÈ΋˜ ‰È·Ù·Ú·¯‹˜ (3-7,9-11): ·) ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜, ÌÂÙ·‚ÔÏÈο ‹ ¿ÏÏ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù·, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, Û·ÛÌÔ›, ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜, ı¿Ó·ÙÔÈ Û ·È‰È΋ ËÏÈΛ·, ·ÈÌÔÌÈÍ›·, „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·), ‚) ÌËÙ¤Ú· Ì AIDS, Á) ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi (ÂÈÏÔΤ˜ ·ËÛ˘, ÙÔÎÂÙÔ‡, ÂÚÈÁÂÓÓËÙÈ΋˜ ÂÚÈfi‰Ô˘, ÚÔˆÚfiÙËÙ·), ‰) „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË (ηı˘ÛÙÂÚ‹ÛÂȘ, ÂȉÈο ÛÙÔ ‚¿‰ÈÛÌ·, ÏfiÁÔ˘ Î·È ÛÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ·, ¿Ù˘Ë ·Ó¿Ù˘ÍË), Â) ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi (¤ÓÙÔÓÔÈ ¤ÌÂÙÔÈ ‹ ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ ÚÔηÏÔ‡ÌÂÓ· Â·ÓÂÈÏËÌ̤ӈ˜ ·fi ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ, ÓËÛÙ›· ‹ ‰È·ÈÙËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·Û˘Ó‹ıÈÛÙË ÔÛÌ‹ ۈ̷ÙÈÎÒÓ ÂÎÎÚ›ÛˆÓ, Û·ÛÌÔ› ‹ ¿ÏÏ· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·) Î·È ÛÙ) ÁÂÓÈÎfi Â›Â‰Ô ÏÂÈÙÔ˘ÚÁ›·˜ (˘ÓËÏ›· ‹ ·¸Ó›·, ÚÔԉ¢ÙÈ΋ ·ÒÏÂÈ· ‰ÂÍÈÔÙ‹ÙˆÓ ·˘ÙÔÂ͢ËÚ¤ÙËÛ˘, ·fiÛ·ÛË ÚÔÛÔ¯‹˜, ¤ÎÙˆÛË ÌÓ‹Ì˘, ÌÂȈ̤ÓÔ ÏÂÍÈÏfiÁÈÔ Ì Â·ÎfiÏÔ˘ıË Ì›ˆÛË Ù˘ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘, ηÎfi˜ ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÛÙÔ ¯ÒÚÔ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈ΋ ‰È·Ù·Ú·¯‹, ‰È·Ù·Ú·¯¤˜ ÔÌÈÏ›·˜ - ‰˘Û·ÚıÚ›·, ·ÏÏ·Á‹ ¯ÚÔÈ¿˜ Ù˘ ʈӋ˜, ÙÚ·˘ÏÈÛÌfi˜, ¤ÎÙˆÛË fiÚ·Û˘ ‹ ·ÎÔ‹˜). ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÛÙ· ·ÌÈÁÒ˜ „˘¯È·ÙÚÈο ÓÔÛ‹Ì·Ù·, Ë Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ÂËÚ¿˙ÂÈ ‰˘ÛÌÂÓÒ˜ ÙË Û¯ÔÏÈ΋ ÚfiÔ‰fi ÙÔ˘, ·ÏÏ¿ ·˘Ùfi Û˘Ó‹ıˆ˜ ‰ÂÓ ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÎÙˆÛË ÙˆÓ ‰ÂÍÈÔÙ‹ÙˆÓ Î·ı’ ·˘Ù‹ (·Ó¿ÁÓˆÛË, ÁÚ·Ê‹, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜), fiˆ˜ ÛÙȘ ÔÚÁ·ÓÈΤ˜ „˘¯ÒÛÂȘ. ∞ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ∆· ·ÎfiÏÔ˘ı· ÛËÌ›· ÌÔÚ› Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ‡·ÚÍË ÔÚÁ·ÓÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ (3-7,911,51,52): ·) ۈ̷ÙÔÌÂÙÚÈο (ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ÁÈ· ·Ó¿ÛÙËÌ· Î·È ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜), ‚) ȉÈfiÌÔÚÊÔ ÚÔÛˆ›Ô, Á) ‰ÈfiÁΈÛË ı˘ÚÂÔÂȉԇ˜, ‰) ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË (‰·ÎÙ‡ÏÈÔ˜ Kaiser Fleischer, ÂӉ›ÍÂȘ ·˘ÍË̤Ó˘ ÂÓ‰ÔÎÚ·Óȷ΋˜ ›ÂÛ˘ ÛÙË ‚˘ıÔÛÎfiËÛË, ¤ÎÙˆÛË ÔÙÈ΋˜ Ô͇ÙËÙ·˜, Ì›ˆÛË ÔÙÈÎÒÓ ‰›ˆÓ, ÔÈΛϘ


May-June 03

03-06-03

16:55

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·ıÔÁÓˆÌÔÓÈΤ˜ ·ÏÏÔÈÒÛÂȘ Û ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·), Â) ΢ÎÏÔÊÔÚÈÎfi (‰È·Ù·Ú·¯¤˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ûʇ͈Ó), ÛÙ) ÎÔÈÏÈ¿ (‰ÈfiÁΈÛË ‹·ÙÔ˜ ‹ ÛÏËÓfi˜), ˙) Â͈ÙÂÚÈο ÁÂÓÓËÙÈο fiÚÁ·Ó· (‰È·Ù·Ú·¯‹ ÛÂÍÔ˘·ÏÈ΋˜ ˆÚ›Ì·ÓÛ˘), Ë) ·ÓˆÌ·Ï›Â˜ ÛÎÂÏÂÙÔ‡ ‹ ‰¤ÚÌ·ÙÔ˜, ı) ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË (‚¿‰ÈÛÌ·, ÈÛÔÚÚÔ›·, Û˘ÓÙÔÓÈÛÌfi˜, ÂÁÎÂÊ·ÏÈΤ˜ Û˘˙˘Á›Â˜, ÏfiÁÔ˜/ÔÌÈÏ›·, ·ÎÔ‹, Ì˘˚΋ ÈÛ¯‡˜, Ì˘˚Îfi˜ ÙfiÓÔ˜, ·ÎÔ‡ÛȘ ÎÈÓ‹ÛÂȘ-ÙÚfiÌÔ˜, ‰˘ÛÎÈÓËÛ›·, ·ıÔÏÔÁÈο ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο, ·ÈÛıËÙÈÎfiÙËÙ·-ÂÏ¿ÛÛÔÓ· Ó¢ÚÔÏÔÁÈο ÛËÌ›·) Î·È È) Ì›˙ÔÓ˜ ‹ ÂÏ¿ÛÛÔÓ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·Ϥ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· ·Ó›¯Ó¢ÛË ÓÔÛËÌ¿ÙˆÓ Û ¿ÙÔÌ· ¯ˆÚ›˜ ÔÚÁ·ÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Î·È ‰È·ÁÓˆÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÎÏÈÓÈ΋ ˘Ô„›· (3-7,9-11,55). ·) ∞ÓȯÓ¢ÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ: °ÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, ÁÂÓÈ΋ Ô‡ÚˆÓ, ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜, ÈÔÓÙfiÁÚ·ÌÌ·, Ô˘ÚÈÎfi Ô͇, Ô˘Ú›· Î·È ÎÚ·ÙÈÓ›ÓË, ÂÍÂÙ¿ÛÂȘ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÏÈ›‰È·, CPK (54-56), ÂÍÂÙ¿ÛÂȘ ÏÂÈÙÔ˘ÚÁ›·˜ ı˘ÚÂÔÂȉԇ˜. ‚) ¢È·ÁÓˆÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ÔÈ Ôԛ˜ ‰ÈÂÓÂÚÁÔ‡ÓÙ·È ·Ó¿ÏÔÁ· Ì ٷ ÎÏÈÓÈο ÛÙÔȯ›·. i) ÃÚˆÌÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË Î·È ÂͤٷÛË ÁÈ· ‡ıÚ·˘ÛÙÔ Ã Û ÂÚÈÙÒÛÂȘ Ì æ∫∫, ·ıÔÁÓˆÌÔÓÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ê·ÈÓfiÙ˘Ô Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ii) ∫˘ÙÙ·ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, fiÙ·Ó ˘¿Ú¯Ô˘Ó Ê˘ÛÈο Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ‹/Î·È æ∫∫. iii) ∂ͤٷÛË ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ÁÈ· ÙÔÍÈΤ˜ Ô˘Û›Â˜, fiÔ˘ ÂӉ›ÎÓ˘Ù·È. iv) ŒÏÂÁ¯Ô˜ ÁÈ· Ó¢ÚÔÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜: ·›Ì· (p∏, ·Ì̈ӛ·, ·ÌÈÓÔͤ·, Á·Ï·ÎÙÈÎfi Ô͇, ˘ÚÔÛÙ·Ê˘ÏÈÎfi Ô͇, ηÚÓÈÙ›ÓË, ÏÈ·Ú¿ Ôͤ· Ôχ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘, ÛÂÚÔ˘ÏÔÏ·ÛÌ›ÓË), o‡Ú·: (ÔÚÁ·ÓÈο Ôͤ·, ·ÌÈÓÔͤ·, ‚ÂÓÓÔÔÏ˘Û·Î¯·Ú›Ù˜, ÔÏÈÁÔ۷ί·Ú›Ù˜, ¯·ÏÎfi˜). v) ∆· ·Ú·¿Óˆ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÈÔ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÂÍÂÙ¿ÛÂȘ, fiˆ˜ ÂÍÂÙ¿ÛÂȘ ∂¡À (57), ÂÓ˙˘Ì·ÙÈΤ˜ ÌÂϤÙ˜ ‰ÂÈÁÌ¿ÙˆÓ ·fi ‚ÈÔ„›·, ·Ó¿Ï˘ÛË DNA. Á) ¡Â˘ÚÔ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜: ∂Ӊ›ÎÓ˘ÓÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó Ó¢ÚÔÏÔÁÈο ÛËÌ›· ‹ ˘Ô„›· ÂÎÊ˘ÏÈÛÙÈ΋˜ ÓfiÛÔ˘ (19,58,59). ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÚÔÛʤÚÂÈ ÂÚÈÛÛfiÙÂÚ· ·fi ÙËÓ ˘ÔÏÔÁÈÛÙÈ΋, ÂȉÈο ÁÈ· ÓÔÛ‹Ì·Ù· Ù˘ Ï¢΋˜ Ô˘Û›·˜ Î·È fiÁÎÔ˘˜. ™ÙËÓ ·È‰È΋ Û¯È˙ÔÊÚ¤ÓÂÈ· ‰È·ÈÛÙÒÓÂÙ·È ÚÔԉ¢ÙÈ΋ ‰È‡ڢÓÛË ÎÔÈÏÈÒÓ Î·È Ì›ˆÛË ÔÏÈÎÔ‡ fiÁÎÔ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∞ÛıÂÓ›˜ Ì Ó¢ÚÔÁÂÓ‹ ·ÓÔÚÂÍ›· ¤¯Ô˘Ó Ì›ˆÛË Ê·È¿˜ Î·È Ï¢΋˜ Ô˘Û›·˜, Ë

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ÔÔ›· ·Ôηı›ÛÙ·Ù·È ÌfiÓÔ ÌÂÚÈÎÒ˜ ÌÂÙ¿ ·fi ÙËÓ ·Ó¿ÎÙËÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜. OÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ PET, SPECT, MRS, Â›Ó·È ·ÎfiÌË Î˘Ú›ˆ˜ ÂÚ¢ÓËÙÈο ÂÚÁ·Ï›·. ‰) ∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (60): ∆Ô ∏∂° Â›Ó·È ‰È·ÁÓˆÛÙÈÎfi Û ÂÚÈÙÒÛÂȘ ÂÈÏË„›·˜. ™Â ÔÚÁ·ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∫¡™, ÔÈ ÂȉÈΤ˜ ‹ ÌË-ÂȉÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÌÔÚ› Ó· ÚÔÛʤÚÔ˘Ó ÂÈÚfiÛıÂÙ˜ ÏËÚÔÊÔڛ˜. ∫ÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ ŸÙ·Ó ‰È·ÈÛÙÒÓÔ˘Ì ÙËÓ ‡·ÚÍË ÔÚÁ·ÓÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜, ‰ÂÓ ÌÔÚԇ̠¿ÓÙ· Ó· ˘Ôı¤ÛÔ˘Ì fiÙÈ ·˘Ùfi ¢ı‡ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο ÁÈ· ÙËÓ „˘¯È·ÙÚÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·. ∏ ÔÚ›· ÙÔ˘ ·È‰ÈÔ‡ ÂËÚ¿˙ÂÙ·È Î·È ·fi ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. À¿Ú¯Ô˘Ó ‰‡Ô ÌÔÓ٤Ϸ ÂÚÌËÓ›·˜ (5). ™‡Ìʈӷ Ì ÙÔ ¤Ó·, ÙÔ ÔÚÁ·ÓÈÎfi ÓfiÛËÌ· ηıÈÛÙ¿ ÙÔ ·È‰› ÈÔ ÂÈÚÚÂ¤˜ ·ÎfiÌË Û ÎÔÈÓ¿ ‰˘ÛÌÂÓ‹ ÎÔÈÓˆÓÈο Û˘Ì‚¿ÓÙ·. ∂Ô̤ӈ˜, Ì ۈÛÙ‹ ÂÚÈ‚·ÏÏÔÓÙÈ΋ ˘ÔÛÙ‹ÚÈÍË, ÌÔÚ› Ó· ·ÔÙÚ·Ô‡Ó, Û οÔÈÔ ‚·ıÌfi, Ù· „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·. ™‡Ìʈӷ Ì ÙÔ ¿ÏÏÔ ÌÔÓÙ¤ÏÔ, ÔÈ ‚ÈÔÏÔÁÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ Î·È Ù· „˘¯ÔÏÔÁÈο Ê·ÈÓfiÌÂÓ· ÂÍÂÏ›ÛÛÔÓÙ·È ·ÓÂÍ¿ÚÙËÙ·. ÕÚ·, ÌÂÚÈο ¿ÙÔÌ· Ì ÔÚÁ·ÓÈÎfi Úfi‚ÏËÌ· ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó „˘¯Ô·ıÔÏÔÁ›·, ·ÎfiÌË Î·È Î¿Ùˆ ·fi ÙȘ ÈÔ Â˘ÓÔ˚Τ˜ ÎÔÈÓˆÓÈΤ˜ Û˘Óı‹Î˜. ªÂ ·˘Ù‹ ÙËÓ ÚÔÛ¤ÁÁÈÛË, ·ÔʇÁÔ˘Ì ÙËÓ ÂÓÔ¯ÔÔ›ËÛË ÙˆÓ ‹‰Ë Ù·Ï·ÈˆÚËÌ¤ÓˆÓ ÁÔÓ¤ˆÓ. À¿Ú¯ÂÈ Î·È Ì›· ÙÚ›ÙË ÚÔÛ¤ÁÁÈÛË, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· ÔÚÈṲ̂ӷ ¿ÙÔÌ· Ì ÔÚÁ·ÓÈ΋ ‰È·Ù·Ú·¯‹ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·È „˘¯È΋ ‰È·Ù·Ú·¯‹ ÔÚÁ·ÓÈο ÚÔηıÔÚÈṲ̂ÓË. £· ˘ÔÛÙÔ‡Ó fï˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ ÂȉڿÛÂȘ, ÔÈ Ôԛ˜ Â›Ó·È Î·Ïfi Ó· ÚÔÛ¯ıÔ‡Ó, Ô‡Ùˆ˜ ÒÛÙ ӷ ÂÏ·¯ÈÛÙÔÔÈËıÔ‡Ó ÔÈ Èı·ÓfiÙËÙ˜ ¯ÚfiÓÈ·˜ „˘¯Ô·ıÔÏÔÁ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ô ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ·›ÍÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó›¯Ó¢ÛË „˘¯ÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘, ÛÙË ‰È¿ÁÓˆÛË Èı·Ó‹˜ ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ ˆ˜ ̤ÏÔ˜ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜. ∂Âȉ‹ Û˘¯Ó¿ ˘¿Ú¯ÂÈ ‰È·¯ÚÔÓÈ΋ ÌÂÙ·‚ÏËÙfiÙËÙ· Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜, ÂÈÛËÌ·›ÓÂÙ·È Ë ·Ó·ÁηÈfiÙËÙ· Û˘ÛÙËÌ·ÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È Â·ÓÂͤٷÛ˘ ÙÔ˘ ·ÛıÂÓ‹. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙÒ ÙÔÓ Î‡ÚÈÔ ¢ËÌ‹ÙÚË µ·˚fiÔ˘ÏÔ Î·È ÙËÓ Î˘Ú›· ∂‡Ë ∆ÛÂÏ·Ï›‰Ô˘-µ·˚ÔÔ‡ÏÔ˘ ÁÈ· ÙȘ ¯Ú‹ÛÈ̘ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. £ˆÌ·˝‰Ô˘ §, ™Ù¤ÓÔ˘ ∞, °ÚÈ‚¿ÎË ª, ª·ÎԇϷ Ã. ∞Ó›¯Ó¢ÛË ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ ·fi ÙÔÓ ·È‰›·ÙÚÔ [ÂÚ›ÏË„Ë]. 2Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜

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38. O’Brien G, Yule W. Behavioural phenotypes. London: Mac Keith Press; 1995. 39. Pontrelli L, Pavlakis S, Krilov LR. Neurobehavioral manifestations and sequelae of HIV and other infections. Child Adolesc Psychiatr Clin N Am 1999;8:869-878. 40. Wright JB, Beverley DW. Chronic fatigue syndrome. Arch Dis Child 1998;79:368-374. 41. Trifiletti RR, Packard AM. Immune mechanisms in pediatric neuropsychiatric disorders. Tourette’s syndrome, OCD, and PANDAS. Child Adolesc Psychiatr Clin N Am 1999;8:767776. 42. Turkel SB, Miller JH, Reiff A. Case series: neuropsychiatric symptoms with pediatric systemic lupus erythematosus. J Am Acad Child Adolesc Psychiatry 2001;40:482-485. 43. Silber TJ, Chatoor I, White PH. Psychiatric manifestations of systemic lupus erythematosus in children and adolescents. A review. Clin Pediatr 1984;23:331-335. 44. Cannon TD, Rosso IM, Hollister JM, Bearden CE, Sanchez LE, Hadley T. ∞ prospective cohort study of genetic and perinatal influences in the etiology of schizophrenia. Schizophr Bull 2000;26:351-366. 45. Kunugi H, Takei N, Murray RM, Saito K, Nanko S. Small head circumference at birth in schizophrenia. Schizophr Res 1996;20:165-170. 46. Fannon D, Tennakoon L, Sumich A, O’Ceallaigh S, Doku V, Chitnis X et al. Third ventricle enlargement and developmental delay in first-episode psychosis: preliminary findings. Br J Psychiatry 2000;177:354-359. 47. Hultman CM, Sparen P, Takei N, Murray RM, Cnattingius S. Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study. BMJ 1999;318:421-426. 48. Murray RM, Lewis SW. Is schizophrenia a neurodevelopmental disorder? BMJ 1987;295:681-682. 49. Walker A, Rosenberg M, Balaban-Gil K. Neurodevelopmental and neurobehavioral sequelae of selected substances of abuse and psychiatric medications in utero. Child Adolesc Psychiatr Clin N Am 1999;8:845-868. 50. Jones P, Rodgers B, Murray R, Marmot M. Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 1994;344:1398-1402.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-10-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-03-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÙÔÏfiÚ˜ ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡ ∞’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & §ÂÈ‚·‰Â›·˜, ∆.∫. 115 28, ∞ı‹Ó·

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∞¡∞™∫O¶∏™∏

Paediatriki 2003;66:176-184

REVIEW ARTICLE

∂Ӊ›ÍÂȘ ÂÎÙ¤ÏÂÛ˘ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Ù˘ ·Ó·ÓÔ‹˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ª. ªÔ˘ÛÙ¿ÎË

Indications for pulmonary function testing in childhood M. Moustaki

¶ÂÚ›ÏË„Ë: OÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ù˘ ·Ó·ÓÔ‹˜ ·ÔÙÂÏÔ‡Ó ÔχÙÈÌ· ÂÚÁ·Ï›· ÂÎÙ›ÌËÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÊÂÓfi˜ ÌÂÓ ·ÛıÂÓÒÓ Ì ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù·, ·ÊÂÙ¤ÚÔ˘ ‰Â ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡ Ì ÛÎÔfi ÙËÓ ÂÍ·ÁˆÁ‹ ÂȉËÌÈÔÏÔÁÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ¯Ú‹ÛÈÌˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Ì¤ÙÚˆÓ ÚfiÏ˄˘. OÈ ‰ÔÎÈ̷ۛ˜ ·Ó·ÓÔ‹˜ Ô˘ Û˘ÓËı¤ÛÙÂÚ· ÂӉ›ÎÓ˘ÓÙ·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙ· ·È‰È¿ ›ӷÈ, ηٿ Êı›ÓÔ˘Û· ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜, Ë ÛÈÚÔ̤ÙÚËÛË, Ë Ì¤ÙÚËÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ fiÁÎˆÓ Î·È ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ÏËı˘ÛÌÔÁÚ·Ê›·˜ ‹ Ù˘ ‰È¿¯˘Û˘, Ë ‰È¿¯˘ÛË ÙÔ˘ CO Î·È ÙÔ ÂÎÓÂfiÌÂÓÔ ¡O. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÂӉ›ÍÂȘ ÂÎÙ¤ÏÂÛ˘ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ·˘ÙÒÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Î·È ÁÈ· ÙË ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ.

Abstract: Pulmonary function testing is a valuable tool for the assessment of respiratory function of children being evaluated for either diagnostic or epidemiological purposes, aiming to establish the disease diagnosis or meaningful preventive measures respectively. The lung function tests most commonly used, in descending order of frequency, are: spirometry, measurement of lung volumes and capacities by using body plethysmography or gas dilution techniques, carbon monoxide diffusing capacity and exhaled nitric oxide measurement. The purpose of this review is to describe the indications for the above mentioned tests in childhood for the categorization, staging and monitoring of lung disease.

§¤ÍÂȘ ÎÏÂȉȿ: Ó¢ÌÔÓÈΤ˜ ‰ÔÎÈ̷ۛ˜, Ó¢ÌÔÓÈÎÔ› fiÁÎÔÈ, ÛÈÚÔ̤ÙÚËÛË, ‰È¿¯˘ÛË CO, ÂÎÓÂfiÌÂÓÔ ¡O.

Key words: lung function testing, lung volumes, spirometry, carbon monoxide diffusing capacity, exhaled NO.

∂ÈÛ·ÁˆÁ‹ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ, ÔÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ù˘ ·Ó·ÓÔ‹˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·Ï¿ ̤ıÔ‰Ô ÌÂϤÙ˘ Ù˘ Ê˘ÛÈÔÏÔÁ›·˜ Ù˘ ·Ó·ÓÔ‹˜, ·ÏÏ¿ Î·È ÂÚÁ·ÏÂ›Ô ÂÎÙ›ÌËÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÊÂÓfi˜ ÌÂÓ ·ÛıÂÓÒÓ Ì ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù·, ·ÊÂÙ¤ÚÔ˘ ‰Â ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ÂȉËÌÈÔÏÔÁÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ¯Ú‹ÛÈÌˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Ì¤ÙÚˆÓ ÚfiÏ˄˘. ∏ ‰˘Ó·ÙfiÙËÙ· ÂÎÙ¤ÏÂÛ˘ ηϋ˜ ÔÈfiÙËÙ·˜ ·Ó·Ó¢ÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ ÙˆÓ ∂ÈÛÙËÌÔÓÈÎÒÓ ¶Ó¢ÌÔÓÔÏÔÁÈÎÒÓ

∂Ù·ÈÚÂÈÒÓ, ÚÔ¸Ôı¤ÙÂÈ ÙËÓ Î·Ï‹ Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡, Ë ÔÔ›· Ê·›ÓÂÙ·È fiÙÈ ÁÈ· ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ‰˘Ó·Ù‹ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ (1,2). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂÛÙÈ¿˙ÂÙ·È ÛÙȘ ÂӉ›ÍÂȘ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÛÙ· ·È‰È¿ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜, ηıÒ˜ Û ÌÈÎÚfiÙÂÚ· ·È‰È¿ Â›Ó·È ÂÊÈÎÙ‹ Ë ÂÎÙ¤ÏÂÛË ÔÚÈÛÌ¤ÓˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Î·È Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Á›ÓÂÙ·È ÛÙ· Ï·›ÛÈ· ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ. ∏ ‰ÈÂÓ¤ÚÁÂÈ· ÛËÌ·ÓÙÈÎÔ‡ ·ÚÈıÌÔ‡ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Û ·È‰È¿, ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›·, η٤ÛÙËÛ ‰˘Ó·Ù‹ ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ· ÙȘ ÂӉ›ÍÂȘ ÂÎÙ¤ÏÂÛ˘ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Ù˘ ·Ó·ÓÔ‹˜

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

2nd Paediatric Department of University of Athens “P. & A. Kyriakou” Children’s Hospital, Athens

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ÛÙ· ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ›Ù ·fi ÚˆÙÔ·ı‹ ·Ó·Ó¢ÛÙÈο ÓÔÛ‹Ì·Ù·, ›Ù ·fi ÓÔÛ‹Ì·Ù· Ô˘ ‰Â˘ÙÂÚÔ·ıÒ˜ ÂËÚ¿˙Ô˘Ó ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·. OÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ù˘ ·Ó·ÓÔ‹˜ ÂӉ›ÎÓ˘ÓÙ·È ÁÈ· ÏfiÁÔ˘˜: ·) ‰È·ÁÓˆÛÙÈÎÔ‡˜ (¯·Ú·ÎÙËÚÈÛÌfi˜ Ù˘ Ê˘ÛÈÔÏÔÁ›·˜ Ù˘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘, ÂÓ›Û¯˘ÛË ‹ ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË, ÔÛÔÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ·ÍÈÔÏfiÁËÛË Ù˘ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ‰È·ÁÓˆÛÙÈÎÒÓ ‹ ıÂÚ·¢ÙÈÎÒÓ ÂÂÌ‚·ÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È ·Ó·ÁηÈfiÙËÙ· ¯ÔÚ‹ÁËÛ˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜), ‚) ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ (·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘, ÂÎÙ›ÌËÛË Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙËÓ ·ÁˆÁ‹, ηıÔÚÈÛÌfi˜ Ù˘ ‰È¿ÚÎÂÈ·˜ Î·È ÙÔ˘ ›‰Ô˘˜ Ù˘ ·ÁˆÁ‹˜) Î·È Á) ÂȉËÌÈÔÏÔÁÈÎÔ‡˜ (ÂÎÙ›ÌËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, Ì ÛÎÔfi ÙËÓ ÂÊ·ÚÌÔÁ‹ ̤ÙÚˆÓ ÚfiÏ˄˘). ∂Ӊ›ÍÂȘ ÛÈÚÔ̤ÙÚËÛ˘ °È· ÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ ÂӉ›ÍÂˆÓ ˘ÂÓı˘Ì›˙ÂÙ·È fiÙÈ Ë ÛÈÚÔ̤ÙÚËÛË Î·Ù·ÁÚ¿ÊÂÈ ÙÔÓ fiÁÎÔ ÙÔ˘ ·¤Ú· Ô˘ ÂÈÛÓ¤ÂÈ Î·È ÂÎÓ¤ÂÈ ÙÔ ¿ÙÔÌÔ Û ۯ¤ÛË Ì ÙÔ ¯ÚfiÓÔ. OÈ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ·Ú¿ÌÂÙÚÔÈ Â›Ó·È (3,4): ·) Ë ‚›·ÈË ˙ˆÙÈ΋ ¯ˆÚËÙÈÎfiÙËÙ· (FVC), Ô˘ ÈÛÔ‰˘Ó·Ì› Ì ÙÔÓ fiÁÎÔ ÙÔ˘ ·¤Ú· ÙÔÓ ÔÔ›Ô ÙÔ ÂÍÂÙ·˙fiÌÂÓÔ ¿ÙÔÌÔ ÂÎÓ¤ÂÈ, ·ÊÔ‡ ¤¯ÂÈ ÚÔËÁËı› Ë ÈÔ ‚·ıÈ¿ ÂÈÛÓÔ‹, ‚) Ô ‚›·È· ÂÎÓÂfiÌÂÓÔ˜ fiÁÎÔ˜ ÙÔ ÚÒÙÔ ‰Â˘ÙÂÚfiÏÂÙÔ Ù˘ ÂÎÓÔ‹˜ (FEV1), Á) Ô ÏfiÁÔ˜ FEV1/FVC. ∏ ·Ú¿ÌÂÙÚÔ˜ ·˘Ù‹ ÂÎÊÚ¿˙ÂÈ ÙÔ ÏfiÁÔ ÙÔ˘ fiÁÎÔ˘ Ô˘ ÂÎÓ¤ÂÙ·È ÙÔ ÚÒÙÔ ‰Â˘ÙÂÚfiÏÂÙÔ Ù˘ ÂÎÓ¢ÛÙÈ΋˜ ÚÔÛ¿ıÂÈ·˜ ÚÔ˜ ÙÔÓ fiÁÎÔ Ô˘ ÂÎÓ¤ÂÙ·È ÛÙÔ Û‡ÓÔÏÔ Ù˘ ÚÔÛ¿ıÂÈ·˜. ™Ù· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ·Ó·Ì¤ÓÂÙ·È fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ˘ fiÁÎÔ˘ ÂÎÓ¤ÂÙ·È ‚›·È· ÙÔ ÚÒÙÔ ‰Â˘ÙÂÚfiÏÂÙÔ Ù˘ ÂÎÓÔ‹˜, ‰) Ë ÂÎÓ¢ÛÙÈ΋ ÚÔ‹ Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·Ù¿ ÙËÓ ÂÎÓÔ‹ ÙÔ˘ 25-75% ÙÔ˘ fiÁÎÔ˘ Ù˘ ˙ˆÙÈ΋˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ Î·È Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ Ù˘ ‚·ÙfiÙËÙ·˜ ÙˆÓ ÌÈÎÚÒÓ ·ÂÚ·ÁˆÁÒÓ Î·È Â) Ë Ì¤ÁÈÛÙË ÂÎÓ¢ÛÙÈ΋ ÚÔ‹ Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙË Ì¤ÁÈÛÙË ÙÈÌ‹ Ù˘ ÚÔ‹˜ ηٿ ÙËÓ ÂÎÓÔ‹, Ë ÔÔ›· ÌÂÙÚ¿Ù·È Î·È Ì ÙÔ ·Ïfi ÚÔfiÌÂÙÚÔ. ∞Ó Ë ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, fiˆ˜ ÂÎÙÈÌ¿Ù·È ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÛÈÚÔ̤ÙÚËÛ˘, ‰ÂÓ Â›Ó·È ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ - ÁÈ· ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË - ÔÚ›ˆÓ, ÙfiÙ ٷ Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·Ù¿ Ì Ó¢ÌÔÓÔ¿ıÂÈ· ·ÔÊÚ·ÎÙÈÎÔ‡, ÂÚÈÔÚÈÛÙÈÎÔ‡ ‹ ÌÈÎÙÔ‡ Ù‡Ô˘. ∏ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ì›ˆÛË ÙˆÓ ÚÔÒÓ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ì›ˆÛË Ù˘ FVC, Ì ·ÔÙ¤ÏÂÛÌ· Ô ÏfiÁÔ˜ FEV1/FVC Ó· ˘ÔÏ›ÂÙ·È ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡, ÌÂ Û˘ÓÔ‰fi ·‡ÍËÛË Ù˘ ÎԛϷÓÛ˘ ÙÔ˘ ÙÂÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ ηÌ‡Ï˘ ÚÔ‹˜-fiÁÎÔ˘ (∂ÈÎfiÓ˜ 1, 2, 3). ∏ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

Paediatriki 2003;66:176-184

·fi ·Ó¿ÏÔÁË Ì›ˆÛË Ù˘ ÚÔ‹˜ Û ۯ¤ÛË Ì ÙÔÓ fiÁÎÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ô ÏfiÁÔ˜ FEV1/FVC Ó· ·Ú·Ì¤ÓÂÈ Ê˘ÛÈÔÏÔÁÈÎfi˜ ‹ Î·È ·˘ÍË̤ÓÔ˜ (∂ÈÎfiÓ· 4). ∏ ÌÈÎÙÔ‡ Ù‡Ô˘ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ì›ˆÛË ÚÔ‹˜ Î·È fiÁÎÔ˘, Û ·Ó·ÏÔÁ›· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÔÈÔ ÛÙÔÈ¯Â›Ô ˘ÂÚ¤¯ÂÈ (ÙÔ ·ÔÊÚ·ÎÙÈÎfi ‹ ÙÔ ÂÚÈÔÚÈÛÙÈÎfi). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Â› ˘Ô„›·˜ ÌÈÎÙÔ‡ Ù‡Ô˘ ÓÔÛ‹Ì·ÙÔ˜ Û˘ÓÈÛÙ¿Ù·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ì ÏËı˘ÛÌÔÁÚ·Ê›·, fiˆ˜ ÂÚÈÁÚ¿ÊÂÙ·È ·Ú·Î¿Ùˆ ÛÙË Û¯ÂÙÈ΋ ÂÓfiÙËÙ·. π‰È·›ÙÂÚË Â›Ó·È Ë Û˘Ì‚ÔÏ‹ Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ ÛÙ· ·È‰È¿ Ì ¿ÛıÌ·. ™Ù· ·È‰È¿ ·˘Ù¿, Ë ÛÈÚÔ̤ÙÚËÛË Â›Ó·È ·Ó¿ÏÔÁ˘ ÛËÌ·Û›·˜ Ì ÙË Ì¤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ ‹ ÙÔ˘ ۷ί¿ÚÔ˘ Û ‰È·‚ËÙÈÎÔ‡˜. ∏ ÛÈÚÔ̤ÙÚËÛË ‰ÂÓ ı¤ÙÂÈ Ê˘ÛÈο ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿ ηٷ‰ÂÈÎÓ‡ÂÈ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·ÔÊÚ·ÎÙÈ΋ ‹ ÂÚÈÔÚÈÛÙÈ΋ ÓfiÛÔ. ™ÙÔ ¿ÛıÌ· ·Ú·ÙËÚÂ›Ù·È ÌÂȈ̤ÓÔ˜ FEV1, Ô ÏfiÁÔ˜ FEV1/FVC Î·È Ë ÚÔ‹ ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÂÚ·ÁˆÁÔ‡˜ (FEF 25-75%). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ÛÈÚÔ̤ÙÚËÛË Û˘ÓÈÛÙ¿Ù·È Û fiÏ· Ù· ·È‰È¿ Ì ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ‹/Î·È ÛËÌÂÈÔÏÔÁ›· ¿ÛıÌ·ÙÔ˜. π‰È·›ÙÂÚË Â›Ó·È Ë Û˘Ì‚ÔÏ‹ Ù˘ Û ·È‰È¿ Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù·, fiˆ˜ .¯. Â›ÌÔÓÔ ‚‹¯·. ∞Ó Û ¤Ó· ·È‰› Ì ˘Ô„›· ¿ÛıÌ·ÙÔ˜ Ë ÛÈÚÔ̤ÙÚËÛË Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÂÚÈÔÚÈÛÙÈ΋˜ ÓfiÛÔ˘ (ÌÂȈ̤ÓÔ˜ FEV1, ÌÂȈ̤ÓË FVC Î·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ÏfiÁÔ˜ FEV1/FVC), Û˘ÓÈÛÙ¿Ù·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ Ó¢ÌfiÓˆÓ Ì ÏËı˘ÛÌÔÁÚ·Ê›·, ‰ÔÎÈ̷ۛ˜ ÚfiÎÏËÛ˘, ‰È¿¯˘ÛË, ηıÒ˜ Î·È ÁÂÓÈÎfiÙÂÚÔ˜ ¤ÏÂÁ¯Ô˜ (‰ÔÎÈÌ·Û›· ȉÚÒÙ·, ·ÂÈÎÔÓÈÛÙÈÎfi˜ Flow

8 6 4 2 0 -2 -4 -6 -1

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∂ÈÎfiÓ· 1. º˘ÛÈÔÏÔÁÈ΋ ηÌ‡ÏË ÚÔ‹˜-fiÁÎÔ˘ ηٿ ÙËÓ ÂÎÓÔ‹ Î·È ÙËÓ ÂÈÛÓÔ‹.

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Volume ∂ÈÎfiÓ· 2. ∂ÎÓ¢ÛÙÈ΋ ηÌ‡ÏË ÚÔ‹˜-fiÁÎÔ˘ Ì ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ·fiÊÚ·ÍË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ó¿ÏÔÁÔ˘ ‚·ıÌÔ‡ ÎԛϷÓÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ ÂÎÓ¢ÛÙÈ΋˜ ηÌ‡Ï˘. ∂ÈÛÓ¢ÛÙÈ΋ ηÌ‡ÏË Ê˘ÛÈÔÏÔÁÈ΋.

¤ÏÂÁ¯Ô˜ Ó¢ÌfiÓˆÓ Î.Ï.) ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË. ™Â ·È‰È¿ Ì ˘Ô„›· ¿ÛıÌ·ÙÔ˜ Î·È ÛÈÚÔÌÂÙÚÈ΋ ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ·ÔÊÚ·ÎÙÈ΋ ÓfiÛÔ, Û˘ÓÈÛÙ¿Ù·È ÁÈ· ÂȂ‚·›ˆÛË - Ë ‰ÔÎÈÌ·Û›· ·Ó·ÛÙÚ„ÈÌfiÙËÙ·˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÔ‡ (5). ∞‡ÍËÛË Î·Ù¿ 12% ÙÔ˘ FEV1, 20 ÏÂÙ¿ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Û·Ï‚Ô˘Ù·ÌfiÏ˘ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂȂ‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË, ηıÒ˜ Î·È ÙËÓ ·ÓÙ·fiÎÚÈÛ‹ Ù˘ ÛÙÔ˘˜ ‚2 ‰ÈÂÁ¤ÚÙ˜. ∏ ·‡ÍËÛË ÙÔ˘ FEV1 Â›Ó·È Ë Û˘¯ÓfiÙÂÚ· ·ÍÈÔÏÔÁÔ‡ÌÂÓË ÌÂÙ·‚ÔÏ‹ ηٿ ÙË ‰ÔÎÈÌ·Û›· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÔ‡. ªÔÚ›, Â›Û˘, Ó· ·ÍÈÔÏÔÁËı› ·‡ÍËÛË Ù˘ PEFR ηٿ 12-15% ‹ Ù˘ FEF25-75% ηٿ 25-30%, ·Ó Î·È ÂȉÈο Ë ÙÂÏÂ˘Ù·›· ‰ÂÓ ·ÔÙÂÏ› ·ÍÈfiÈÛÙÔ ‰Â›ÎÙË ÔÍ›·˜ ÌÂÙ·‚ÔÏ‹˜ ηıÒ˜ ÂËÚ¿˙ÂÙ·È ·fi ÙȘ Û˘ÓÔ‰¤˜ ÌÂÙ·‚ÔϤ˜ Ù˘ FVC (6). ∏ ‰ÔÎÈÌ·Û›· ·ÓÙÈÛÙÚÂÙfiÙËÙ·˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙ· ·È‰È¿ Ì ¿ÛıÌ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¤ÓÙÔÓ· Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹, Ë ÂÍ¿ÏÂÈ„Ë Ù˘ ÔÔ›·˜ ÂȂ‚·ÈÒÓÂÈ ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÁˆÁ‹, ηıÈÛÙÒÓÙ·˜ ÂÚÈÙÙ‹ ÛÙË Ê¿ÛË ·˘Ù‹ ÙË ÛÈÚÔ̤ÙÚËÛË. ™Â ·È‰È¿ Ì ÈÛÙÔÚÈÎfi ÂÓ‰ÂÈÎÙÈÎfi ¿ÛıÌ·ÙÔ˜, ·ÏÏ¿ Ê˘ÛÈÔÏÔÁÈ΋ ÛÈÚÔ̤ÙÚËÛË, Û˘ÓÈÛÙ¿Ù·È Ë ÂÎÙ¤-

178

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4

Volume ∂ÈÎfiÓ· 3. ∂ÎÓ¢ÛÙÈ΋ ηÌ‡ÏË ÚÔ‹˜-fiÁÎÔ˘ Ì ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ·fiÊÚ·ÍË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ó¿ÏÔÁÔ˘ ‚·ıÌÔ‡ ÎԛϷÓÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ ÂÎÓ¢ÛÙÈ΋˜ ηÌ‡Ï˘. ∂ÈÛÓ¢ÛÙÈ΋ ηÌ‡ÏË Ê˘ÛÈÔÏÔÁÈ΋.

ÏÂÛË ÛÈÚÔ̤ÙÚËÛ˘ ÌÂÙ¿ ·fi ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ (7,8), ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÂÌÂÈÚÈ΋˜ ıÂÚ·›·˜. ∫·Ù¿ ÙË ‰ÔÎÈÌ·Û›· ·˘Ù‹, Á›ÓÂÙ·È ÛÈÚÔ̤ÙÚËÛË ‰È·‰Ô¯Èο ÚÈÓ Î·È ÌÂÙ¿ ·fi ÂÈÛÓÔ‹ ÈÛÙ·Ì›Ó˘ ‹ ÌÂÙ·¯ÔÏ›Ó˘. ∆· ·È‰È¿ Ì ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· ·ÂÚ·ÁˆÁÒÓ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÚÔÁ¯fiÛ·ÛÌÔ Î·È ÙÒÛË ÙÔ˘ FEV1 ηٿ 20% ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË 225 ÌÔÓ¿‰ˆÓ ÌÂÙ·¯ÔÏ›Ó˘. ∏ ÌÂÙ·‚ÔÏ‹ Ùo˘ FEV1 Â›Ó·È Ô Û˘¯ÓfiÙÂÚ· ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˜ ‰Â›ÎÙ˘ ηٿ ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘. ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ Ë ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÙÂÏÂ˘Ù·›· Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ηıÒ˜ ÔÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ·ÚÔ‰Èο ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· ÙˆÓ ·ÂÚ·ÁˆÁÒÓ (8,9). ™Â ·È‰È¿ ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· ¿ÛıÌ·ÙÔ˜ ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘, Û˘ÓÈÛÙ¿Ù·È Ë ÂÎÙ¤ÏÂÛË ‰ÔÎÈÌ·Û›·˜ ¿ÛÎËÛ˘ Ì ÙË ¯Ú‹ÛË ÂÚÁÔÌÂÙÚÈÎÔ‡ Ô‰ËÏ¿ÙÔ˘ ‹ ‰È·‰ÚfiÌÔ˘. °È· ÙËÓ ÂÎÙ¤ÏÂÛË Ù˘ ‰ÔÎÈÌ·Û›·˜ ·˘Ù‹˜ ··ÈÙÂ›Ù·È ¿ÛÎËÛË ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· 6 ÏÂÙ¿, Û ڢıÌfi Ô˘ Ó· ÚÔηÏ› ·‡ÍËÛË ÙˆÓ ÛʇÍÂˆÓ Û 80% ÙÔ˘ ̤ÁÈÛÙÔ˘ - ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ - ηډȷÎÔ‡ Ú˘ıÌÔ‡. ∏ ̤ÁÈÛÙË ÙÒÛË ÙÔ˘ FEV1


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Volume ∂ÈÎfiÓ· 4. ∏ ÂÎÓ¢ÛÙÈ΋ ηÌ‡ÏË ÂÚÈÔÚÈÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Â›Ó·È ÌÈÎÚfiÙÂÚË Û ̤ÁÂıÔ˜ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ê˘ÛÈÔÏÔÁÈ΋, ¯ˆÚ›˜ fï˜ Ó· ÂËÚ¿˙ÂÙ·È ÙÔ Û¯‹Ì· Ù˘.

·Ú·ÙËÚÂ›Ù·È 5-15 ÏÂÙ¿ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ¿ÛÎËÛ˘. ¶ÙÒÛË ÙÔ˘ FEV1 >15% Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ¿ÛıÌ·ÙÔ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË (4). ™ËÌ·ÓÙÈÎfi˜ Â›Ó·È Ô ÚfiÏÔ˜ Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ∏ ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÛÈÚÔ̤ÙÚËÛË Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤ÁηÈÚË ‰È·›ÛÙˆÛË Âȉ›ӈÛ˘ ‹ ‚ÂÏÙ›ˆÛ˘ Ù˘ ÓfiÛÔ˘ Î·È ÙÚÔÔÔ›ËÛ˘ Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜, ·ÏÏ¿ Î·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÚfiÛÊ·ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹. ∏ ÂÎÙ¤ÏÂÛË ÛÈÚÔ̤ÙÚËÛ˘ ÂÚÈÔ‰Èο, Ì ÛÎÔfi ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÓfiÛÔ˘ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÙËÓ ·Ó¿ÏÔÁË ÙÚÔÔÔ›ËÛË Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜, ÂÈ‚¿ÏÏÂÙ·È Î·È ÛÙ· ·È‰È¿ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ. ∏ ÛÈÚÔ̤ÙÚËÛË ‰È¢ÎÔχÓÂÈ ÙË Ï‹„Ë ÛˆÛÙÒÓ ıÂÚ·¢ÙÈÎÒÓ ·ÔÊ¿ÛÂˆÓ ÙfiÛÔ Û ÂÚÈfi‰Ô˘˜ ¤Í·ÚÛ˘ Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜, fiÛÔ Î·È Î·Ù¿ ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ ÂÚÈÔ‰ÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ. ™Ù· ÚÒÈÌ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, ÔÈ ·ÓˆÌ·Ï›Â˜ ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÂÚ·ÁˆÁÔ‡˜ (10) Î·È ·ÎÔÏÔ˘ı› Ì›ˆÛË ÙÔ˘ ÏfiÁÔ˘ FEV1/FVC. ŸÌˆ˜, ηٿ ÙËÓ ÂͤÏÈÍË Î·È ÙËÓ ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘, Ô ÏfiÁÔ˜ FEV1/FVC

Â·Ó¤Ú¯ÂÙ·È ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‹ Î·È ·˘Í¿ÓÂÙ·È, ‰ÈfiÙÈ ÔÈ ÈÓÒ‰ÂȘ ÌÂÙ·‚ÔϤ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· ÚÔÛı¤ÙÔ˘Ó ¯·Ú·ÎÙËÚÈÛÙÈο ÂÚÈÔÚÈÛÙÈ΋˜ ÓfiÛÔ˘ ÛÙËÓ ·Ú¯Èο ÂÎÊÚ·˙fiÌÂÓË ˆ˜ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ. ∏ ÂÎÙ¤ÏÂÛË Ù˘ ‰ÔÎÈÌ·Û›·˜ ‰È¢ÎÔχÓÂÈ ÙËÓ ·Ó›¯Ó¢ÛË ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı· ˆÊÂÏËıÔ‡Ó ·fi ÙË Ï‹„Ë ÂÈÛÓÂfiÌÂÓˆÓ ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÒÓ (11). ™Â ·È‰È¿ Ì ‚ÚÔÁ¯ÂÎٷۛ˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÈÙÈÔÏÔÁ›·, Û˘ÓÈÛÙ¿Ù·È Ë ÂÚÈÔ‰È΋ ÂÎÙ›ÌËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÛÈÚÔ̤ÙÚËÛË. ™Ù· ·Ú¯Èο ÛÙ¿‰È·, ÂȉÈο fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÂÓÙÔÈṲ̂Ó˜ ‚ÚÔÁ¯ÂÎٷۛ˜, Ë ÛÈÚÔ̤ÙÚËÛË Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ (12). ™Â Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘, ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙÔ˘ FEV1 Î·È ÙÔ˘ ÏfiÁÔ˘ FEV1/FVC, ÌÂÙ·‚ÔϤ˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î·È ·fi ÙÒÛË ÙÔ˘ FVC Â¿Ó ‰ÂÓ ÂÈÙ¢¯ı› ÈηÓÔÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜. ™ÈÚÔ̤ÙÚËÛË Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Î·È Û ·È‰È¿ Ì ‰È¿ÌÂÛË Ó¢ÌÔÓÔ¿ıÂÈ· (13), ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô Ù˘. ™˘Ó‹ıˆ˜, ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙÔ˘ ÏfiÁÔ˘ FEV1/FVC Î·È ÙÔ˘ ÏfiÁÔ˘ FEF2575%/∆LC Û ·ÛıÂÓ›˜ Ô˘ Â›Ó·È ‰˘Ó·Ù‹ Ë Ì¤ÙÚËÛË Ù˘ ÔÏÈ΋˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ Ì ÏËı˘ÛÌÔÁÚ·Ê›·. ∂ÈÛËÌ·›ÓÂÙ·È, fï˜, fiÙÈ ‰ÂÓ ·ÔÙÂÏ› ÏÂÈÙÔ˘ÚÁÈ΋ ‰ÔÎÈÌ·Û›· ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ÂÓ›Û¯˘ÛË Ù˘ ‰È¿ÁÓˆÛ˘ ‹ ÁÈ· ÙË ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰È¿ÌÂÛË Ó¢ÌÔÓÔ¿ıÂÈ·, ÔÈ ÔÔ›ÔÈ, ·ÓÙ›ıÂÙ·, ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Û˘¯Ó¿ Ì ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ‰È¿¯˘Û˘ ÙÔ˘ CO (DLCO). ™ÈÚÔ̤ÙÚËÛË Û˘ÓÈÛٿٷÈ, Â›Û˘, Û ·ÛıÂÓ›˜ ÌÂ Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· Ô˘ ÂÈÓ¤ÌÔÓÙ·È ÚˆÙÔ·ıÒ˜ ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÓfiÛÔÈ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ (14,15). ™Â ·˘ÙÔ‡˜, Ë ÛÈÚÔ̤ÙÚËÛË ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ Ó· ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο ÓfiÛÔ˘ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘. ∂Âȉ‹ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ÚÔÛ‚¿ÏÏÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ Ô ‰È¿ÌÂÛÔ˜ ÈÛÙfi˜, ÂͤٷÛË ÂÎÏÔÁ‹˜ ηٿ ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ÔÙÂÏ› Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ‰È¿¯˘Û˘ ÙÔ˘ CO (DLCO) (14,15). OÈ ÂӉ›ÍÂȘ ÛÈÚÔ̤ÙÚËÛ˘ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù˜ Û ·ÛıÂÓ›˜ Ì ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ ÔÈ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ ·ÊÔÚÔ‡Ó ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ∆· ‰Â‰Ô̤ӷ, fï˜, Ô˘ ˘¿Ú¯Ô˘Ó ·fi ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı· ‰ÈηÈÔÏÔÁÔ‡Û·Ó ÙËÓ ÂÎÙ¤ÏÂÛË Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ Û ·ÛıÂÓ›˜ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· (16,17), ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (18), ÛÎÔÏ›ˆÛË (19) Î·È ·¯˘Û·ÚΛ· (20). ™Â ·È‰È¿ Ì ÛÔ‚·Ú‹ ÛÎÔÏ›ˆÛË (>50Ô), ȉÈÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹, ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ fiÁÎÔ˘, Ë ÔÔ›· Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ‚·ıÌÔ‡ ΢ÚÙfiÙËÙ·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ∞ÔÙ¤ÏÂÛÌ· Ù˘ Ì›ˆÛ˘ ÙÔ˘ fiÁÎÔ˘ Â›Ó·È Î·È Ë Ì›ˆÛË ÙˆÓ ÚÔÒÓ, ÔÈ ÙÈ̤˜ ÙˆÓ ÔÔ›ˆÓ, fï˜,

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·Ó ‰ÈÔÚıˆıÔ‡Ó ˆ˜ ÚÔ˜ ÙÔÓ fiÁÎÔ ÙˆÓ Ó¢ÌfiÓˆÓ, Â›Ó·È Ê˘ÛÈÔÏÔÁÈΤ˜. ∂›Ó·È, Â›Û˘, ÁÓˆÛÙfi fiÙÈ ÂÓ‹ÏÈΘ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ Ó¢ÌÔÓÔ¿ıÂÈ· Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÛÈÚÔ̤ÙÚËÛ˘. ∏ ÂÈ‚¿Ú˘ÓÛË ·˘Ù‹ ·Ô‰›‰ÂÙ·È ·ÊÂÓfi˜ ÌÂÓ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¢ÌÔÓÈ΋˜ ›ÓˆÛ˘ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÂÂÈÛÔ‰›ˆÓ ÔͤԘ ıˆÚ·ÎÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ˘ÔÙÚÔÈ·˙Ô˘ÛÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ·ÁÁÂÈ·ÎÒÓ ÂÌÊÚ¿ÎÙˆÓ, ·ÊÂÙ¤ÚÔ˘ ‰Â ÛÙËÓ ˘ÔÏÂÈfiÌÂÓË ·Ó¿Ù˘ÍË ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Û ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· ¤‰ÂÈÍ·Ó ·ÔÙÂϤÛÌ·Ù· ÛÈÚÔ̤ÙÚËÛ˘ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ Û 40%, Ì ·ÓÙÈÛÙÚÂÙfiÙËÙ· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÔ‡ Û 80% ÂÚ›Ô˘ ÂÍ ·˘ÙÒÓ. ∞Ó Î·È Ù· ̤¯ÚÈ ÛÙÈÁÌ‹˜ ‰Â‰Ô̤ӷ Â›Ó·È ÂÚÈÔÚÈṲ̂ӷ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, Ì ‰Â‰Ô̤ÓË ÙËÓ ·ÏfiÙËÙ· ÂÎÙ¤ÏÂÛ˘ Ù˘ ÛÈÚÔ̤ÙÚËÛ˘, ı· ‹Ù·Ó ÛÎfiÈÌË Ë ÂÚÈÔ‰È΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Ì ÛÈÚÔ̤ÙÚËÛË Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ‰È¿¯˘Û˘ CO (DLCO) Û ·˘Ù¿ ÌÂ Â˘Ú‹Ì·Ù· Ó¢ÌÔÓÔ¿ıÂÈ·˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘. ∆· ‰Â‰Ô̤ӷ Â›Ó·È ÈÔ ÂÚÈÔÚÈṲ̂ӷ Û ·ÛıÂÓ›˜ Ì Ì›˙ÔÓ· ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ηıÒ˜ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ (21) Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÌÈÎÚ‹ ÂÈ‚¿Ú˘ÓÛË ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ Î·È Û ÌÈÎÚfi ·ÚÈıÌfi ·È‰ÈÒÓ fiÔ˘ ÌÂÏÂÙ‹ıËÎÂ Ë Â›‰Ú·ÛË Ù˘ ¤ÎÙ˘Í˘ ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘ ÌÂÙ¿ ·fi ÌÂÙ¿ÁÁÈÛË ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ‰ÈÔ˘ÚËÙÈÎÔ‡ (22). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÛÈÚÔ̤ÙÚËÛË Û ·È‰È¿ Ì Ì›˙ÔÓ· ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ÛÙËÓ ·ÚÔ‡Û· Ê¿ÛË ÌÔÚ› Ó· Á›ÓÂÈ ÌfiÓÔ ÛÙ· Ï·›ÛÈ· ÎÏÈÓÈ΋˜ ¤Ú¢ӷ˜. ∆· ϤÔÓ ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ÂÌÊ¿ÓÈÛ˘ Ó¢ÌÔÓÔ¿ıÂÈ·˜ Û˘ÓËı¤ÛÙÂÚ· ÂÚÈÔÚÈÛÙÈÎÔ‡ Î·È Û·ÓÈfiÙÂÚ· ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ - ÛÙ· ·È‰È¿ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, fiÙ·Ó ·˘Ù‹ Á›ÓÂÙ·È Û ÙÂÏÈο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ (18,23). ∞˘Ù‹ Ë ·˘ÍËÙÈ΋ Ù¿ÛË Û˘Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ηٿ ÙÔ ÔÔ›Ô ¤ÁÈÓÂ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË, Û˘Û¯¤ÙÈÛË Ô˘ ·Ó¿ÁÂÈ ÛÙËÓ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ÛÙ· ·È‰È¿ ·˘Ù¿ ÏfiÁˆ Ù˘ ÚÔËÁËı›۷˜ ¯ÔÚ‹ÁËÛ˘ ÙÔÍÈÎÒÓ Ê·Ú̿ΈÓ. ¶·ÚfiÙÈ Ù· Â˘Ú‹Ì·Ù· ·fi ÙË ÛÈÚÔ̤ÙÚËÛË ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È ·fi ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, Ê·›ÓÂÙ·È fiÙÈ Ë ÂÚÈÔ‰È΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÛÈÚÔ̤ÙÚËÛË ı· ‚ÔËı‹ÛÂÈ ÛÙË Ï‹„Ë ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· ·ÔÊ˘Á‹ ÂÚ·ÈÙ¤Úˆ ÂÈ‚¿Ú˘ÓÛ˘.

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™ËÌ·ÓÙÈ΋ Â›Ó·È Ë Û˘Ì‚ÔÏ‹ Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ Î·È Û ÂÚÈÙÒÛÂȘ ˘Ô„›·˜ ·fiÊڷ͢ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (24). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈÛÙ¿Ù·È Ë Î·Ù·ÁÚ·Ê‹ Î·È Ù˘ ÂÈÛÓ¢ÛÙÈ΋˜ ηÌ‡Ï˘ ÚÔ‹˜ fiÁÎÔ˘ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Á›ÓÂÙ·È ÛÈÚÔ̤ÙÚËÛË ÁÈ· ÚÒÙË ÊÔÚ¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Û˘¯Ó¤˜ ÎÏÈÓÈΤ˜ ÂÎÊÚ¿ÛÂȘ Ù˘ ·fiÊڷ͢ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Â›Ó·È Ô ‚‹¯·˜ ‹ Ë Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹, Û˘ÌÙÒÌ·Ù· fï˜ Ô˘ Â›Ó·È ÂÓ‰ÂÈÎÙÈο Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜. ™Â ÂÚ›ÙˆÛË ·fiÊڷ͢ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, ·Ó¿ÏÔÁ· Ì ÙÔ Â›Â‰Ô Ù˘ ·fiÊڷ͢, ÙÚÔÔÔÈÂ›Ù·È ÙÔ Û¯‹Ì· Ù˘ ÂÈÛÓ¢ÛÙÈ΋˜ ‹ Î·È Ù˘ ÂÎÓ¢ÛÙÈ΋˜ ηÌ‡Ï˘ ÚÔ‹˜ fiÁÎÔ˘ (∂ÈÎfiÓ˜ 5, 6). ∂Ӊ›ÍÂȘ ÏËı˘ÛÌÔÁÚ·Ê›·˜ ∏ ÏËı˘ÛÌÔÁÚ·Ê›· ÂÈÙÚ¤ÂÈ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ fiÁÎˆÓ (RV, ERV, TV, IRV) Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ (∆LC, VC, FRC, IC), ÂÓÒ Ì ÙË ÛÈÚÔ̤ÙÚËÛË Â›Ó·È ÂÊÈÎÙ‹ ÌfiÓÔ Ë Ì¤ÙÚËÛË Ù˘ VC Î·È ÙˆÓ ˘ԉȷÈÚ¤ÛÂˆÓ Ù˘ ERV, TV, IRV Î·È IC (25) (∂ÈÎfiÓ· 7). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ˘fiÏÔÈˆÓ ÙÚÈÒÓ ÌÂÁÂıÒÓ (RV, FRC, TLC) ÚÔ¸Ôı¤ÙÂÈ ÙË Ì¤ÙÚËÛË ÙÔ˘ RV (˘ÔÏÂÈfiÌÂÓÔ˘ fiÁÎÔ˘), Ô ÔÔ›Ô˜ ‰ÂÓ ÂÎÓ¤ÂÙ·È ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ηÈ, ÂÔ̤ӈ˜, ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ì ÙË ÛÈÚÔ̤ÙÚËÛË. ∏ ÂÎÙ¤ÏÂÛË ÏËı˘ÛÌÔÁÚ·Ê›·˜ Û˘Ó‹ıˆ˜ Â›Ó·È ‰˘Ó·Ù‹ Û ·È‰È¿ ËÏÈΛ·˜ >8 ÂÙÒÓ, ¯ˆÚ›˜ ÙÔ fiÚÈÔ ·˘Ùfi Ó· Â›Ó·È ·fiÏ˘ÙÔ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ‰˘Ó·ÙfiÙËÙ· ÂÎÙ¤ÏÂÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ‰ÔÎÈÌ·Û›·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ Ô‰ËÁÈÒÓ. ™Â ·ÓÙ›ıÂÛË, fï˜, Ì ÙË ÛÈÚÔ̤ÙÚËÛË, ‰ÂÓ ·ÔÙÂÏ› ÂͤٷÛË ÚÔ˘Ù›Ó·˜ Û ·ÛıÂÓ›˜ Ì ·Ó·Ó¢ÛÙÈο ÓÔÛ‹Ì·Ù·. ∞ÓÙ›ıÂÙ·, ÂӉ›ÎÓ˘Ù·È Û ÂÈÏÂÁ̤ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈ ÚÔËÁËı› ÛÈÚÔ̤ÙÚËÛË Î·È ··ÈÙÂ›Ù·È ÏÂÙÔÌÂÚ¤ÛÙÂÚË ÛÙ·‰ÈÔÔ›ËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ‹ ۷ʤÛÙÂÚË ‰È¿ÁÓˆÛ‹ Ù˘ fiÙ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ ‰ÂÓ Â›Ó·È Ì ۷ʋÓÂÈ· ÂÓÈÛ¯˘ÙÈο Ù˘ ‰È¿ÁÓˆÛ˘ Ô˘ ¤¯ÂÈ ÙÂı› Ì ٷ ÎÏÈÓÈο Î·È Ù· ˘fiÏÔÈ· ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ·. ∆¤ÙÔȘ ÂÚÈÙÒÛÂȘ Û˘Ó·ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· Û ·ÛıÂÓ›˜ Ì ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ·Ó·Ó¢ÛÙÈο ÓÔÛ‹Ì·Ù· Î·È Û ·˘ÙÔ‡˜ Ì ÌÈÎÙÔ‡ Ù‡Ô˘ ÚÔ‚Ï‹Ì·Ù· (ÂÚÈÔÚÈÛÙÈÎÔ‡ Î·È ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘). °ÂÓÈο, Ë ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ (ÚˆÙÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ì›ˆÛË ÙfiÛÔ Ù˘ VC Ô˘ ηٷÁÚ¿ÊÂÙ·È Ì ÙË ÛÈÚÔ̤ÙÚËÛË, fiÛÔ Î·È Ù˘ TLC Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Ì ÙËÓ ÏËı˘ÛÌÔÁÚ·Ê›·. ∞Ó¿ÏÔÁ·, fï˜, Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, Ô ¤Ó·˜ ‰Â›ÎÙ˘ ÌÔÚ› Ó· ˘ÂÚÙÂÚ› ÙÔ˘ ¿ÏÏÔ˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Û ·ÛıÂÓ›˜ ÌÂ


May-June 03

03-06-03

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∂ÈÎfiÓ· 5. ∂È‰ˆÌ¤ÓË ÂÈÛÓ¢ÛÙÈ΋ ηÌ‡ÏË ÌÂ Û˘ÓÔ‰fi Ê˘ÛÈÔÏÔÁÈ΋ ÂÎÓ¢ÛÙÈ΋ ηÌ‡ÏË ÚÔ‹˜-fiÁÎÔ˘, ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÂÙ·‚·ÏÏfiÌÂÓ˘ Â͈ıˆÚ·ÎÈ΋˜ ·fiÊڷ͢ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (.¯. ‰ÈfiÁΈÛË ı˘ÚÂÔÂȉԇ˜, ·Ú¿Ï˘ÛË ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ).

˘Ô„›· ÓÔÛ‹Ì·ÙÔ˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ¯ˆÚ›˜ Û·Ê‹ Â˘Ú‹Ì·Ù· ·fi ÙË ÛÈÚÔ̤ÙÚËÛË, Û˘ÓÈÛÙ¿Ù·È Ë ÏÂÙÔÌÂÚ¤ÛÙÂÚË Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ fiÁÎˆÓ Î·È ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ Ì ÏËı˘ÛÌÔÁÚ·Ê›·. ™Â ·ÛıÂÓ›˜ Ì ÌÈÎÙÔ‡ Ù‡Ô˘ ÚÔ‚Ï‹Ì·Ù· (·ÔÊÚ·ÎÙÈÎÔ‡ Î·È ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘) Â›Ó·È ‰˘Ó·ÙfiÓ Ì ÙË ÛÈÚÔ̤ÙÚËÛË Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Û·ÊÒ˜ ÙÔ ·ÔÊÚ·ÎÙÈÎfi Úfi‚ÏËÌ·, ÂÓÒ ÙÔ ÂÚÈÔÚÈÛÙÈÎfi ÛÙÔÈ¯Â›Ô Ù˘ ÓfiÛÔ˘ Ó· ÌËÓ ·ÔηχÙÂÙ·È. ™Â ·ÛıÂÓ›˜ Ô˘ ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ˘Ô„›· Û˘Ó‡·Ú͢ Î·È ÂÚÈÔÚÈÛÙÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ TLC ı· ‰È¢ÎÔχÓÂÈ ÙË ‰ÈÂÚ‡ÓËÛË ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ı· ·ÍÈÔÏÔÁËıÔ‡Ó fi¯È ÌfiÓÔ ÔÈ ·ıÔÏÔÁÈο ¯·ÌËϤ˜ ÙÈ̤˜, ·ÏÏ¿ Î·È ÔÈ ÌË ·Ó·ÌÂÓfiÌÂÓ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÁÈ· ·ÛıÂÓ‹ Ì ·ÔÎÏÂÈÛÙÈο ·ÔÊÚ·ÎÙÈ΋ ÓfiÛÔ (25) (¶›Ó·Î·˜ 1). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ FRC, ÂÎÙfi˜ ·fi ÙËÓ ÏËı˘ÛÌÔÁÚ·Ê›·, ÌÔÚ› Ó· Á›ÓÂÈ Î·È Ì ÙË Ì¤ıÔ‰Ô ‰È¿Ï˘Û˘ ÙˆÓ ·ÂÚ›ˆÓ ËÏ›Ô˘ ‹ ·˙ÒÙÔ˘ (multiple-breath gas dilution). ∂ÈÛËÌ·›ÓÂÙ·È, ˆÛÙfiÛÔ, fiÙÈ Û ·ÛıÂÓ›˜ Ì ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÓfiÛÔ ˘ÔÂÎÙÈÌ¿Ù·È Ë FRC, ‰ÈfiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÚÈÔÚ›˙ÂÙ·È ÛÙȘ ÂÚÈÔ¯¤˜ ÙˆÓ Ó¢ÌfiÓˆÓ Ô˘ Â›Ó·È Û Â·Ê‹ Ì ÙÔ ÛÙfiÌ· Î·È ‰ÂÓ ˘ÔÏÔÁ›˙ÂÙ·È Ô fiÁÎÔ˜ ÙÔ˘ ·¤Ú· Ô˘ Â›Ó·È ÂÁÎψ‚ÈṲ̂ÓÔ˜ (26).

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∂ÈÎfiÓ· 6. ∂È‰ˆÌ¤ÓË ÂÈÛÓ¢ÛÙÈ΋ Î·È ÂÎÓ¢ÛÙÈ΋ ηÌ‡ÏË ÚÔ‹˜-fiÁÎÔ˘, ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙ·ıÂÚ‹˜ ·fiÊڷ͢ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (.¯. ÛÙ¤ÓˆÛË ÙÚ·¯Â›·˜).

∂Ӊ›ÍÂȘ ‰È¿¯˘Û˘ CO O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ‰È¿¯˘Û˘ ·Ú¤¯ÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ Ô͢ÁfiÓÔ˘ ·fi ÙËÓ Î˘„ÂÏ›‰· ÛÙ· Ó¢ÌÔÓÈο ÙÚȯÔÂȉ‹. °È· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Ô˘ ·Ú¤¯ÂÈ Ë ‰È¿¯˘ÛË ÙÔ˘ CO ηÈ, ÂÔ̤ӈ˜, ÙˆÓ ÂӉ›ÍÂÒÓ Ù˘, ˘ÂÓı˘Ì›˙ÂÙ·È Ë Â͛ۈÛË ÙˆÓ Roughton Î·È Forster (27) ÁÈ· ÙË ‰È¿¯˘ÛË: 1/DLCO = 1/Dm + 1/ıVc. H ·Ú¿ÌÂÙÚÔ˜ Dm Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÙÔ ¿¯Ô˜ Ù˘ ΢„ÂÏȉÈ΋˜ ÙÚȯÔÂȉÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÙÔ ¿¯Ô˜ Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙÔ ¿¯Ô˜ Ù˘ ÛÙÈ‚¿‰·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ÙË Ê˘ÛÈ΋ ‰È·¯˘ÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ CO ‰È·Ì¤ÛÔ˘ Ù˘ ΢„ÂÏȉÈ΋˜ ÙÚȯÔÂȉÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÂÚ˘ıÚÔ‡ ·ÈÌÔÛÊ·ÈÚ›Ô˘ Î·È ÙÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ÙÔ˘ ÂÚ˘ıÚÔ‡ ·ÈÌÔÛÊ·ÈÚ›Ô˘. ∏ ·Ú¿ÌÂÙÚÔ˜ ı Â›Ó·È Ô Û˘ÓÙÂÏÂÛÙ‹˜ Ù˘ ¯ËÌÈ΋˜ Û˘ÁÁ¤ÓÂÈ·˜ ÙÔ˘ CO Ì ÙËÓ Hb Î·È Vc Â›Ó·È Ô fiÁÎÔ˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙ· Ó¢ÌÔÓÈο ÙÚȯÔÂȉ‹. ∞fi ÙËÓ ·Ú·¿Óˆ Â͛ۈÛË Â›Ó·È Ê·ÓÂÚ¿ Ù· ·ÎfiÏÔ˘ı· (28-31): ÓÔÛ‹Ì·Ù· Ô˘ ÚÔηÏÔ‡Ó Ì›ˆÛË Ù˘ ·Ú·Ì¤ÙÚÔ˘ Dm, fiˆ˜ Ë Ó¢ÌÔÓÈ΋ ›ÓˆÛË, Ô‰ËÁÔ‡Ó ÛÂ Û˘ÓÔ‰fi Ì›ˆÛË Ù˘ DLCO. ∏ ·Ú¿ÌÂÙÚÔ˜ ı

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ª¤ÁÈÛÙË ÂÈÛÓÔ‹

IRV IC TLC

◊ÚÂÌË ÂÈÛÓÔ‹ VC TV ◊ÚÂÌË ÂÎÓÔ‹ ERV

FRC ª¤ÁÈÛÙË ÂÎÓÔ‹ RV

RV

∂ÈÎfiÓ· 7. ¶Ó¢ÌÔÓÈÎÔ› fiÁÎÔÈ Î·È ·ÓÙ›ÛÙÔȯ˜ ¯ˆÚËÙÈÎfiÙËÙ˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ì ÙËÓ ÏËı˘ÛÌÔÁÚ·Ê›·.

ÂËÚ¿˙ÂÙ·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ı¤ÛÂˆÓ ‰¤ÛÌ¢Û˘ Î·È ·fi ÙÔÓ ·ÓÙ·ÁˆÓÈÛÌfi O2 Î·È CO ÁÈ· ÙË Û‡Ó‰ÂÛ‹ ÙÔ˘˜ Ì ÙȘ ı¤ÛÂȘ ·˘Ù¤˜. ∏ DLCO ·Ó·Ì¤ÓÂÙ·È ÌÂȈ̤ÓË fiÙ·Ó ÔÈ ı¤ÛÂȘ ‰¤ÛÌ¢Û˘ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜, fiˆ˜ Û ÂÚ›ÙˆÛË ·Ó·ÈÌ›·˜, ηıÒ˜ Î·È fiÙ·Ó ÌÂÈÒÓÂÙ·È Ë Û˘ÁÁ¤ÓÂÈ· ÙÔ˘ O2 ÚÔ˜ ÙȘ ı¤ÛÂȘ ‰¤ÛÌ¢Û˘ ÏfiÁˆ ¯·ÌËÏ‹˜ ›ÂÛ˘, fiˆ˜ .¯. Û ÌÂÁ¿ÏÔ ˘„fiÌÂÙÚÔ. ∏ Ì›ˆÛË, Â›Û˘, ÙÔ˘ ÙÚȯÔÂȉÈÎÔ‡ fiÁÎÔ˘ ·›Ì·ÙÔ˜ Vc, Ë ÔÔ›· Û˘Ì‚·›ÓÂÈ .¯. Û Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹, ÂÌʇÛËÌ· ‹ ›ÓˆÛË ÏfiÁˆ ·fiÊڷ͢ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ, ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÓÔ‰fi ÂÏ¿ÙÙˆÛË ÙÔ˘ DLCO. ∏ ·Ú·¿Óˆ Â͛ۈÛË, Â›Û˘, ÂÍËÁ› ·Ó¿ÏÔÁ· ÙËÓ ·‡ÍËÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, Û ÓÔÛ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÂÓ‰Ô΢„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›·, fiˆ˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ‹ ÎÔÎÎȈ̿وÛË Wegener, ηıÒ˜ Î·È Û ÓÔÛ‹Ì·Ù· Ì ·˘ÍË̤ÓË ÚÔ‹ ·›Ì·ÙÔ˜ ÛÙËÓ Ó¢ÌÔÓÈ΋ ΢ÎÏÔÊÔÚ›·, fiˆ˜ Û ‰È·Ê˘Á‹ ·›Ì·ÙÔ˜ ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ ÛÙË ‰ÂÍÈ¿ ΢ÎÏÔÊÔÚ›·. ∞fi Ù· ·ÓˆÙ¤Úˆ Á›ÓÂÙ·È Ê·ÓÂÚfi fiÙÈ Ë ÂÎÙ¤ÏÂÛË Ù˘ ���ÔÎÈÌ·Û›·˜ ÁÈ· ηٷÁÚ·Ê‹ Ù˘ DLCO ÂӉ›ÎÓ˘Ù·È Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ÂΉËψı› Ó¢ÌÔÓÈ΋ ›ÓˆÛË ‹ Ì›ˆÛË ÙÔ˘ ÙÚȯÔÂȉÈÎÔ‡ fiÁÎÔ˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ‰ÔÎÈÌ·Û›· ‰È¿¯˘Û˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Û ·ÛıÂÓ›˜ ÌÂ

182

˘Ô„›· ‰È¿ÌÂÛ˘ Ó¢ÌÔÓÔ¿ıÂÈ·˜. ∏ Ì›ˆÛË Ù˘ DLCO ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·ÔÙÂÏ› ȉȷ›ÙÂÚ· ÚÒÈÌÔ Â‡ÚËÌ· Ô˘ ÚÔËÁÂ›Ù·È Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ Î·È ÙˆÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ (32). ™Â ÂÓ‹ÏÈΘ, Ì¿ÏÈÛÙ·, ÌÂÚÈÎÔ› Û˘ÓÈÛÙÔ‡Ó ÙËÓ ÂÎÙ¤ÏÂÛË ‚ÈÔ„›·˜ Ó‡ÌÔÓ· Û ·ÛıÂÓ›˜ Ì ‰‡ÛÓÔÈ· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη fiÙ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ·ÔÊÚ·ÎÙÈ΋˜ ÓfiÛÔ˘ Î·È Ë DLCO Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi ÙÔ 50% ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡. °È· Ù· ·È‰È¿ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ›ÛÙÔÈ¯Ë Û‡ÛÙ·ÛË. O ÚÔÛ‰ÈÔÚÈÛÌfi˜, fï˜, Ù˘ DLCO Â›Ó·È ··Ú·›ÙËÙÔ˜ Î·È ÛÙ· ·È‰È¿ Ì ˘Ô„›· ‰È¿ÌÂÛ˘ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘. ™˘ÓÈÛٿٷÈ, Â›Û˘, Ë ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘ Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ DLCO, ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ ÔÔ›·˜ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ ÁÈ· ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜. ªÂ ‚¿ÛË Ù· ‰Â‰Ô̤ӷ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë DLCO Â›Ó·È ÛÎfiÈÌÔ Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Î·È ÛÙ· ·È‰È¿ Ì ۷ÚÎÔ›‰ˆÛË (33), ·ÎfiÌË Î·È Û ·˘Ù¿ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔ ÛÙ¿‰ÈÔ π, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·ÎÙÈÓÔÏÔÁÈο ·fi Ê˘ÛÈÔÏÔÁÈÎfi Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Î·È Û˘ÓÔ‰fi ˘Ï·›· ·‰ÂÓ›Ùȉ·. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ DLCO ¤¯ÂÈ, Â›Û˘, ı¤ÛË Î·È Û ·È‰È¿ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ


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¶›Ó·Î·˜ 1. ∞ÍÈÔÏfiÁËÛË ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÏËı˘ÛÌÔÁÚ·Ê›·˜

VC TLC

∞ÔÊÚ·ÎÙÈ΋

¶ÂÚÈÔÚÈÛÙÈ΋

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ÔÛÙÒÓ, ȉȷ›ÙÂÚ· fiÙ·Ó ·˘Ù‹ ¤ÁÈÓ Û ÙÂÏÈο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, ηıÒ˜ Î·È Û ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·. ∂Ӊ›ÍÂȘ ̤ÙÚËÛ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O ∆Ô ÂÓ‰ÔÁÂÓ¤˜ ¡O ·Ú¿ÁÂÙ·È ·fi ÙËÓ L-·ÚÁÈÓ›ÓË Ì ÙË ‰Ú¿ÛË ÙÚÈÒÓ ÈÛÔÌÂÚÒÓ ÙˆÓ Û˘ÓıÂÙ·ÛÒÓ ÙÔ˘ ¡O (¡OS). ∆Ô ÈÛÔÌÂÚ¤˜ ¡OS2 Ê·›ÓÂÙ·È fiÙÈ Â¿ÁÂÙ·È ·fi ÙȘ ΢ÙÔΛÓ˜ (34) Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙË ÊÏÂÁÌÔÓÒ‰Ë ‰È·‰Èηۛ· ηÈ, ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÊÏÂÁÌÔÓ‹ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ. °È· ÚÒÙË ÊÔÚ¿ ÙÔ 1991, ÔÈ Gustafsson Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ¡O ÛÙËÓ ·ÓıÚÒÈÓË ·Ó·ÓÔ‹ (35). ŒÎÙÔÙÂ, ·ÚÎÂÙÔ› ÂÚ¢ÓËÙ¤˜ ·Ú·Ù‹ÚËÛ·Ó ˘„ËÏ¿ Â›‰· ¡O Û ·ÛıÂÓ›˜ Ì ¿ÛıÌ· (36-38). ™ÙË Ì¤ÙÚËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O, ·Ú¯Èο, ‰fiıËΠȉȷ›ÙÂÚË ÛËÌ·Û›· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¿ÛıÌ·, ‰ÈfiÙÈ ÂÓÒ Ë ÛÈÚÔ̤ÙÚËÛË ·ÔÙÂÏ› ‰Â›ÎÙË Ù˘ ·fiÊڷ͢ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ë Ì¤ÙÚËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O ·ÔÙÂÏ› ‰Â›ÎÙË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ë ÔÔ›· ÛÙ· ·Ú¯Èο ÛÙ¿‰È· ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ¯ˆÚ›˜ Û˘ÓÔ‰fi ·fiÊÚ·ÍË. ∆· Â›‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ‹ ¯·ÌËÏ¿ Û ÌË ·ÛıÌ·ÙÈο ·È‰È¿ Ì ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ Ó¢ÌÔÓÈ΋ ÓfiÛÔ, fiˆ˜ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Î·È Û‡Ó‰ÚÔÌÔ ‰˘ÛΛÓËÙˆÓ ÎÚÔÛÛÒÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë Ì¤ÙÚËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O ÂӉ›ÎÓ˘Ù·È Û ·È‰È¿ Ì ˘Ô„›· ¿ÛıÌ·ÙÔ˜, ÚÈÓ ÙËÓ ¤Ó·ÚÍË ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÁˆÁ‹˜, fiÙ·Ó ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· ÁÈ· ÙË ‰È¿ÁÓˆÛË. ∞ÓÙ›ıÂÙ·, fï˜, ·Ú¿ ÙÔÓ ·Ú¯ÈÎfi ÂÓıÔ˘ÛÈ·ÛÌfi, Ù· Â›‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó Î·Ù¿ÏÏËÏÔ ‰Â›ÎÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ·È‰ÈÒÓ Ì ¿ÛıÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÂÈÛÓÂfiÌÂÓ· ‹ Û˘ÛÙËÌ·ÙÈÎÒ˜ ¯ÔÚËÁÔ‡ÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ™‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, ‰È·ÈÛÙÒıËΠfiÙÈ Ù· Â›‰· ÂÎÓÂfiÌÂÓÔ˘ ¡O ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÈηÓÔÔÈËÙÈο Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ (˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· ·ÂÚ·ÁˆÁÒÓ ÌÂÙ¿ ·fi ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ÌÂÙ·¯ÔÏ›ÓË ‹ ÈÛÙ·Ì›ÓË, ˈÛÈÓfiÊÈÏ· Ù˘¤ÏˆÓ) ÛÙÔ˘˜ ·ÛıÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ·ÛÊ·Ï‹˜ ‰Â›ÎÙ˘ Ì›ˆÛ˘ Ù˘ ‰fiÛ˘ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Ê·ÚÌ¿ÎˆÓ Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ÂÏÂÁ¯ı› Ù· Û˘ÌÙÒÌ·Ù·. ªÂ Ù· ̤¯ÚÈ Û‹ÌÂÚ· ‰Â‰Ô̤ӷ ‰ÂÓ Â›Ó·È, Â›Û˘, ÂÊÈÎÙfi Ó· ‰È·ÊÔÚԉȷÁÓˆÛÙ› ÙÔ ·ÙÔÈÎfi ·fi ÙÔ ÌË ·ÙÔÈÎfi ¿ÛıÌ· Ì ‚¿ÛË Ù· Â›‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O.

™Â ÂÚÈÔÚÈṲ̂ÓÔ, fï˜, ·ÚÈıÌfi ÌÂÏÂÙÒÓ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ, ‰È·ÈÛÙÒıËÎ·Ó ˘„ËÏfiÙÂÚ· Â›‰· ÂÎÓÂfiÌÂÓÔ˘ ¡O ÛÙÔ˘˜ ·ÙÔÈÎÔ‡˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ÌË ·ÙÔÈÎÔ‡˜ ·ÛıÂÓ›˜. ∂Ô̤ӈ˜, Â›Ó·È Èı·ÓfiÓ ÛÙÔ Ì¤ÏÏÔÓ ÙÔ ÂÎÓÂfiÌÂÓÔ ¡O Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ê·ÈÓÔÙ‡ˆÓ ÙÔ˘ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ (39). ∆· Â›‰· ÙÔ˘ ÚÈÓÈÎÔ‡ ¡O Â›Ó·È Û˘Ó‹ıˆ˜ ·˘ÍË̤ӷ Û ·ÛıÂÓ›˜ Ì ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· (39). ∞ÓÙ›ıÂÙ·, ¯·ÌËÏ¿ Â›‰· ÚÈÓÈÎÔ‡ ¡O ·Ú·ÙËÚÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÎÚÔÛÛÒÓ, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Î·È ÔÍ›· ‹ ¯ÚfiÓÈ· ÈÁÌÔÚ›Ùȉ·. ™Â ·ÛıÂÓ›˜ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ‹ ‰˘ÛΛÓËÙÔ˘˜ ÎÚÔÛÛÔ‡˜ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ¯·ÌËÏ¿ Â›‰· ÚÈÓÈÎÔ‡ ¡O Î·È fiÙ·Ó ÔÈ ·Ú·ÚÚ›ÓÈÔÈ ÎfiÏÔÈ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎÔ›, ÌÂ Û˘Ó¤ÂÈ· Ù· ¯·ÌËÏ¿ Â›‰· Ó· ÌËÓ ÌÔÚÔ‡Ó Ó· ·Ô‰ÔıÔ‡Ó ÛÂ Û˘Ó˘¿Ú¯Ô˘Û· ·fiÊÚ·ÍË ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ Î·È Û˘ÓÔ‰fi ÈÁÌÔÚ›Ùȉ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, ˘¿Ú¯ÂÈ ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ ÂÈ¤‰ˆÓ Ì ·˘Ù¿ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÙfiÛÔ Û ˘ÁÈ‹ ¿ÙÔÌ·, fiÛÔ Î·È Û ¿ÏϘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ. ∞ÓÙ›ıÂÙ·, ·ÚfiÌÔÈ· ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ Ì ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ Î·È ¿ÏÏˆÓ ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ ‹ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfïÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ù· Â›‰· ÙÔ˘ ÚÈÓÈÎÔ‡ ¡O ·ÔÙÂÏÔ‡Ó ·ÚÎÂÙ¿ ÈηÓÔÔÈËÙÈÎfi ‰Â›ÎÙË ‰È·ÏÔÁ‹˜ (40) ÙˆÓ ·È‰ÈÒÓ Ì ÎÏÈÓÈ΋ ˘Ô„›· Ù˘ ÓfiÛÔ˘, ÛÙ· ÔÔ›· ı· ··ÈÙËı› ÂÓ‰Âϯ¤ÛÙÂÚÔ˜ ¤ÏÂÁ¯Ô˜ Ì ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ Î·È ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÛÈÚÔ̤ÙÚËÛË ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚ· ÂÓ‰ÂÈÎÓ˘fiÌÂÓË ÂͤٷÛË Û ·È‰È¿ Ì ÓÔÛ‹Ì·Ù· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÛÙ· ÔÔ›· ··ÈÙÂ›Ù·È Ë ÂÎÙ›ÌËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ™Â ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·È‰ÈÒÓ ··ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ÏÂÈÙÔ˘ÚÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ·Ó·ÓÔ‹˜ Ì ÂÎÙ›ÌËÛË Ù˘ ‰È·¯˘ÙÈ΋˜ ÈηÓfiÙËÙ·˜ Ù˘ ΢„ÂÏȉÔÙÚȯÔÂȉÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ‹ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ fiÁÎˆÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ¯ˆÚËÙÈÎÔًوÓ. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÚÈÓÈÎÔ‡ ¡O ·ÔÙÂÏ› ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ‰È·ÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ˘Ô„›· ‰˘ÛΛÓËÙˆÓ ÎÚÔÛÛÒÓ, ÂÓÒ ÙÔ ÂÎÓÂfiÌÂÓÔ ¡O ÁÈ· ÎÏÈÓÈÎÔ‡˜ ÏfiÁÔ˘˜ Û˘ÓÈÛÙ¿Ù·È Û ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÛÈÚÔ̤ÙÚËÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. American Thoracic Society. Standardization of spirometry: 1994 update. Am Rev Respir Dis 1994;143:1215-1223. 2. ∫·ÙÛ·Ú‰‹˜ Ã. §ÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ó¢ÌfiÓˆÓ ÛÙ· ·È‰È¿. ¶ÓÂ‡ÌˆÓ 1987;1:82-89. 3. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144:1202-1218.

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∂͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ ∂. ∫·Ú·ÓÙ·Ó¿1, ™. ∫ˆÛÙ·Ú›‰Ô˘2, ∞. ∫·Ï·ÓÙ˙‹˜3, ∞. °È·ÓÓÔ‡ÏÈ·2

Extrapulmonary symptoms of Mycoplasma pneumoniae infections E. Karantana1, S. Kostaridou2, A. Kalantzis3, A. Giannoulia2

¶ÂÚ›ÏË„Ë: ∫·Ù·ÁÚ¿ÊÔÓÙ·È 114 ÂÚÈÙÒÛÂȘ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, ÂÎ ÙˆÓ ÔÔ›ˆÓ 31 Ì Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ, Ì ‹ ¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ∞Ó·ÊÂÚfiÌ·ÛÙ Û 10 ÂÚÈÙÒÛÂȘ Ì ÂΉËÏÒÛÂȘ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, Û 6 Ì ‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ, 5 Ì ÂΉËÏÒÛÂȘ ·fi ÙÔ Ì˘ÔÛÎÂÏÂÙÈÎfi Û‡ÛÙËÌ·, 4 Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ηÈ, Ù¤ÏÔ˜, Û 6 ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ ∫¡™. ∏ ‰È¿ÁÓˆÛË Ù¤ıËΠ̠ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi IgG Î·È IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡. £ÂÚ·›· ¤Ï·‚·Ó ÔÈ 20 ·fi ÙÔ˘˜ 31 ·ÛıÂÓ›˜, Ë ÔÚ›· ÙˆÓ ÔÔ›ˆÓ ÂÍÂÏ›¯ıËΠÔÌ·Ï¿.

Abstract: This is a presentation of 114 cases of Mycoplasma pneumoniae infection, 31 of which had extrapulmonary symptoms, with or without respiratory tract involvement. These include 10 cases with gastrointestinal tract symptoms, 6 with skin involvement, 5 with symptoms related to muscles and joints, 4 of blood anomalies and 6 cases with central nervous system symptoms. The diagnosis was established using immunofluorescence techniques. Treatment was administered to 20 of the 31 patients and the course of the disease was satisfactory.

§¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, Ì˘ÂÏ›Ùȉ·, ·ÚıÚ›Ùȉ·, ÂÍ¿ÓıËÌ·, ·ÁÁÂÈ›Ùȉ·.

Key words: Mycoplasma pneumoniae infection, myelitis, arthropathy, brainstem syndrome, exanthem, vasculitis.

∂ÈÛ·ÁˆÁ‹ OÈ Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ·ÔÙÂÏÔ‡Ó ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ, ȉȷ›ÙÂÚ· fiÙ·Ó ·Ô˘ÛÈ¿˙Ô˘Ó Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ÂÓÒ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈۈ̿وÓ. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Ïԛ̈͢ ‰È·ÎÚ›ÓÔÓÙ·È Û ·˘Ù¤˜ ·fi ÙÔ ·ÓÒÙÂÚÔ Î·È Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi, ηıÒ˜ Î·È Û ÂΛӘ Ô˘ ÂÌϤÎÔ˘Ó ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·. ∞fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, Ë Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË ÌÔÚ› Ó· ÂΉËψı› ˆ˜ Ê·Ú˘ÁÁ›ÙȘ, ÔÍ›· ̤ÛË ˆÙ›ÙȘ, ·Ì˘Á‰·Ï›ÙȘ, ÂÓÒ ·fi ÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi, ÂÎÙfi˜ ·fi ÙËÓ Ó¢ÌÔÓ›· Ô˘ Â›Ó·È Î·È Ë ÛËÌ·ÓÙÈÎfiÙÂÚË ÂΉ‹ÏˆÛË, ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙ› ˆ˜

Ï·Ú˘ÁÁÔÙÚ·¯ÂÔ‚ÚÔÁ¯›ÙȘ, ‚ÚÔÁ¯›ÙȘ ‹ ‚ÚÔÁ¯ÈÔÏ›ÙȘ (1). OÈ Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È ·Û˘Ó‹ıÈÛÙ˜, ¯ˆÚ›˜ Ó· Â›Ó·È ‰˘Ó·Ùfi Ó· ηıÔÚÈÛÙ› ÙÔ ·ÎÚÈ‚¤˜ ÔÛÔÛÙfi Î·È ÙÔ ÎÏÈÓÈÎfi ‡ÚÔ˜ ·˘ÙÒÓ. Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜, Û˘Ó‰ÚfiÌÔ˘ StevensJohnson, ÂÚÈηډ›Ùȉ·˜, Ì˘Ôηډ›Ùȉ·˜, Ë·Ù›Ùȉ·˜, ÂÁÎÂÊ·Ï›Ùȉ·˜, ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ·˜ Î·È Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (2).

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶.°.¡. “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ ¡›Î·È·-¶ÂÈÚ·È¿˜ 2 A’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 O˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶.°.¡. “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1996 ¤ˆ˜ ÙÔÓ ¢ÂΤ̂ÚÈÔ 1997, ηÙÂÁÚ¿ÊËÛ·Ó 114 ÂÚÈÙÒÛÂȘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢, 31 ÂÎ ÙˆÓ ÔÔ›ˆÓ (25,4%) Ì Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ (∂ÈÎfiÓ· 1). ™Â 16 ·fi ·˘Ù¤˜ ÙȘ 31 1 Paediatric Clinic of “Agios Panteleimon” General Hospital, Nikea-Piraeus 2 1st Paediatric Clinic of Athens University, “Agia Sophia” Children’s Hospital, Athens 3 Urology Clinic of “G. Gennimatas” General Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2003;66:185-187

Paediatriki 2003;66:185-187

ÂÚÈÙÒÛÂȘ, ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 9 Ì‹Ó˜ ¤ˆ˜ 12 ¤ÙË (̤ÛË ËÏÈΛ·: 6 ¤ÙË), ÂÓÒ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ, 15 ·ÛıÂÓ›˜ ‹Ù·Ó ¿ÚÚÂÓ˜ Î·È 16 ı‹ÏÂȘ. OÈ Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›ÛÙËÎ·Ó 1-30 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ, ‰ËÏ·‰‹ ̤۷ ÛÙÔ ‰È¿ÛÙËÌ· ÙˆÓ ÚÒÙˆÓ 20 ËÌÂÚÒÓ, ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Î·È ÌÂÙ¿ ·fi ·˘Ù‹Ó. ∞ÊÔÚÔ‡Û·Ó ‰Â: ·) Û ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· Û 10 ÂÚÈÙÒÛÂȘ (8,7%) (΢ڛˆ˜ Ó·˘Ù›·, ¤ÌÂÙÔ, ‰È¿ÚÚÔÈ· Î·È ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜). ŒÓ· ·È‰› ÂÌÊ¿ÓÈÛ ·ÈÌ·Ù¤ÌÂÛË, ÂÓÒ Û ‰‡Ô ‰È·ÈÛÙÒıËΠ‹È· ÙÚ·ÓÛ·ÌÈÓ·ÈÌ›· (ÙÈ̤˜ SGPT: 100-200 u/dl). ‚) Û ‰ÂÚÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Û 6 ÂÚÈÙÒÛÂȘ (5,3%) (Ù‡Ô˘ ÂÏ¿ÛÛÔÓÔ˜ ÔχÌÔÚÊÔ˘ ÂÚ˘ı‹Ì·ÙÔ˜ Û 2 ·È‰È¿ Î·È Û‡Ó‰ÚÔÌÔ Stevens-Johnson Û 3 ·È‰È¿). ™Â Ì›· ÂÚ›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Stevens-Johnson ÛËÌÂÈÒıËÎ·Ó ÙÚÂȘ ˘ÔÙÚÔ¤˜ ÌÈÎÚfiÙÂÚ˘ ‚·Ú‡ÙËÙ·˜ ·fi ÙËÓ ·Ú¯È΋, ÔÈ Ôԛ˜ ·ÚÔ˘Û›·Û·Ó ‡ÊÂÛË ÌÂÙ¿ ·fi ÔÏÈÁÔ‹ÌÂÚË per os ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘. Á) Û ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Û 4 ÂÚÈÙÒÛÂȘ (3,5%). ◊È· ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· ·ÚÔ˘ÛÈ¿ÛÙËΠ۠¤Ó· ·È‰› ¯ˆÚ›˜ Ó· Û˘Óԉ‡ÂÙ·È ·fi ‚·ÚÈ¿ Ó¢ÌÔÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢, ÂÓÒ ÔÈ „˘¯ÚÔÛ˘ÁÎÔÏÏËÙ›Ó˜ ‹Ù·Ó ıÂÙÈΤ˜. £ÚÔÌ‚ÔÂÓ›· ÂΉËÏÒıËΠ۠‰‡Ô ÂÚÈÙÒÛÂȘ (·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ: 5000 Îί Î·È 7000 Îί). ŒÓ· ·È‰› ÂÌÊ¿ÓÈÛ ÂÙ¤¯ÂȘ, Âί˘ÌÒÛÂȘ, ÚÈÓÔÚÚ·Á›· Î·È Ô˘ÏÔÚÚ·Á›·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÎÚ›ıËΠ·Ó·Áη›· Ë ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘. ∂›Û˘, ÛËÌÂÈÒıËÎÂ Î·È Ì›· ÂÚ›ÙˆÛË ‚·ÚÈ¿˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚfiÊÈψÓ: 400), Ô˘ fï˜ ‰ÂÓ ÂÓÂÏ¿ÎË ·fi οÔÈ· Ïԛ̈ÍË. ™ÙȘ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ÂÚÈÙÒÛÂȘ ¤ÁÈÓ Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜, ηıÒ˜ Î·È ¤ÏÂÁ¯Ô˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÒÛÙ ӷ ·ÔÎÏÂÈÛÙÔ‡Ó ÓÔÛ‹Ì·Ù· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÚfiÌÔÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ‰) ÛÂ Ì˘ÔÛÎÂÏÂÙÈΤ˜ ÂΉËÏÒÛÂȘ Û 5 ÂÚÈÙÒÛÂȘ (4,4%) (·ÚıÚ›Ùȉ· Û 2 ·È‰È¿, ·ÚıÚ·ÏÁ›Â˜ Û 1 Î·È Ì˘ÔÛ›Ùȉ· Û 2 ·È‰È¿). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÚÔ˜ ·ÔÎÏÂÈÛÌfi ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ. ∂Ï‹ÊıËÛ·Ó ∞¡∞, RA-TEST, Anti DNA, pANCA, ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ Î·È ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Î·Ú‰ÈÔÏÈ›Ó˘ IgG-IgM, fiÔ˘ Ù· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈο.

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™‡ÓÔÏÔ ÂÚÈÙÒÛÂˆÓ ∂͈Ó¢ÌÔÓÈΤ˜ Ì˘ÎÔÏ·ÛÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ∂ÈÎfiÓ· 1. ™˘ÁÎÂÓÙÚˆÙÈ΋ ·Ó¿Ï˘ÛË Â͈Ó¢ÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜.

186

Â) Û Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Û 6 ÂÚÈÙÒÛÂȘ (5,3%). ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ ‰‡Ô ÂÙÒÓ, ·ÚÔ˘Û›·Û ¿ÚÂÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ηıÒ˜ Î·È ¿ÚÂÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ˘. ∂›¯Â ÚÔËÁËı›, ÚÔ ‰ÂηÂÓıË̤ÚÔ˘, Ó¢ÌÔÓ›· ÂÓÙÔÈṲ̂ÓË ÛÙÔÓ ·ÚÈÛÙÂÚfi οو ÏÔ‚fi. ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÓÙÔ›ÛÙËΠ¤ÌÊÚ·ÎÙÔ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ (ÊÏÔÈfi˜ Î·È Ï¢΋ Ô˘Û›· Ù˘ ‰ÂÍÈ¿˜ ‚ÚÂÁÌ·ÙÈ΋˜ ¯ÒÚ·˜). ∂Ï‹ÊıËÛ·Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Î·Ú‰ÈÔÏÈ›Ó˘ Î·È ‹Ù·Ó ·ÚÓËÙÈο. ŒÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ‰ÂÓ ¤ÁÈÓÂ. ™Â Ì›· ÂÚ›ÙˆÛË ÂΉËÏÒıËΠÂÁÎÂÊ·Ï›Ùȉ· Ì ‰‡Ô ÂÂÈÛfi‰È· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ, ·‰˘Ó·Ì›· Î·È ‰˘Û¯ÚËÛÙ›· ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ˘. ™ÙÔ ∂¡À ‚Ú¤ıËÎ·Ó Î‡ÙÙ·Ú· 23 Îί, χΈ̷ 17 mg/dl Î·È Û¿Î¯·ÚÔ 59 mg/dl. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ¤‰ÂÈÍ ÙÚÂȘ ˘¤Ú˘ÎÓ˜ ÂÛٛ˜ ÛÙÔ ‰ÂÍÈfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ, ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, ÔÈ Ôԛ˜ ·Ô‰fiıËÎ·Ó Û ‚Ï¿‚˜ ÏfiÁˆ ·ÁÁÂÈ›Ùȉ·˜. OÈ ¿ÏϘ Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Û·Ó Û ·È‰È¿ Ì ·ÈıÔ˘ÛÈ·›· Ó¢ڛÙȉ·, ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÈÏ›ÁÁÔ˘, Ì›· ÂÚ›ÙˆÛË Û˘Ó‰ÚfiÌÔ˘ Guilain-Barre Î·È Ì›· ÂÚ›ÙˆÛË ·ÚÂÁÎÂÊ·ÏÈÙȉÈ΋˜ ·Ù·Í›·˜. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ ‰ÂÓ ˘‹ÚÍ·Ó Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· (¶›Ó·Î·˜ 1). ∏ ‰È¿ÁÓˆÛË Ù˘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ Ù¤ıËΠ̠ÙË Ì¤ıÔ‰Ô ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Ì ¤ÏÂÁ¯Ô IgG Î·È πgM ·ÓÙÈۈ̿وÓ, Ì ÙÂÙÚ·Ï·ÛÈ·ÛÌfi ‹ ˘ÔÙÂÙÚ·Ï·ÛÈ·ÛÌfi ÙÔ˘ Ù›ÙÏÔ˘ ÌÂٷ͇ ÔÍ›·˜ Ê¿Û˘ Î·È ·Ó¿ÚÚˆÛ˘ ‹ Ù›ÙÏÔ >1/512. ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, Ë Ì¤ÛË ÙÈÌ‹ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‹Ù·Ó Ã=12.200 Îί. ™ÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›·, Ô Ù‡Ô˜ ‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜, ÂÓÒ Ë ∆∫∂ ‹Ù·Ó Ã=36,7 mm (5-73 mm) Î·È Ë CRP Ã=37,1 mg/l (3,2-258 mg/l). ™ÙÔ 64% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÔËÁ‹ıËΠ‹ Û˘Ó˘‹ÚÍ Ó¢ÌÔÓ›· ‹ ·ÎfiÌ· ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· Ïԛ̈͢ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. £ÂÚ·›· ¯ÔÚËÁ‹ıËΠ۠20 ·ÛıÂÓ›˜ (71%), ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ Ì ÎÏ·ÚÈıÚÔÌ˘Î›ÓË. ∏ ÔÚ›· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ÔÌ·Ï‹, ·Ú¿ ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ‚Ú·‰Â›· ·Ó¿ÚÚˆÛË (2,3) Î·È ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi Ï‹ÚË ·ÔηٿÛÙ·ÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ Û˘ÛÙËÌ¿ÙˆÓ, ¯ˆÚ›˜ ÛÙÔȯ›· ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓfiÛÔ˘. ŒÓÙÂη ·fi ÙÔ˘˜ 31 ·ÛıÂÓ›˜ ›¯·Ó Ï¿‚ÂÈ ·ÁˆÁ‹ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÁÈ· ‰È¿ÛÙËÌ· ÂÚ›Ô˘ 5-7 ËÌÂÚÒÓ.

™˘˙‹ÙËÛË ™ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙˆÓ Â͈Ó¢ÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÂÌϤÎÔÓÙ·È ÔÏÏ·ÏÔ› Ì˯·ÓÈÛÌÔ›, fiˆ˜ Â¤ÎÙ·ÛË Ù˘ ÌfiÏ˘ÓÛ˘, ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ Î·È È‰ÈfiÙ˘Ë ·ÓÔÛȷ΋ ·¿ÓÙËÛË ÙÔ˘ ÍÂÓÈÛÙ‹ (4). OÈ ÂΉËÏÒÛÂȘ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ÙfiÛÔ Û˘¯Ó¤˜. ™˘Ì‚·›ÓÔ˘Ó 1-21 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ, ÂÓÒ Û ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ ÚÔËÁÂ›Ù·È Ïԛ̈ÍË ÙÔ˘ ·��·Ó¢ÛÙÈÎÔ‡ (3). ∏ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ·fi ÙÔ ∫¡™, fiˆ˜ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙȘ (5) (Ô˘ Â›Ó·È Î·È Ë ÈÔ Û˘¯Ó‹), ÂÁοÚÛÈ· Ì˘ÂÏ›ÙȘ ‹ Ó¢ڛÙȘ (6), Û‡Ó‰ÚÔÌÔ ·Ó¿ÏÔÁÔ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, Û‡Ó‰ÚÔÌÔ Guilain-Barre, „‡¯ˆÛË Î·È ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ, ·ÓÙÈÛÙÔȯ› Û ÔÛÔÛÙfi 0,1% ÙˆÓ ÓÔÛÔ‡ÓÙˆÓ, ·ÏÏ¿ Î·È Ì¤¯ÚÈ 7%


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¶›Ó·Î·˜ 1. ¶ÔÛÔÛÙÈ·›· ·Ó¿Ï˘ÛË Â͈Ó¢ÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ °·ÛÙÚÂÓÙÂÚÈΤ˜ ÂΉËÏÒÛÂȘ 10/114 (8,7%) (·ÏÏËÏÔÂÈÎ¿Ï˘„Ë Û˘ÌÙˆÌ¿ÙˆÓ ) ¡·˘Ù›·-¤ÌÂÙÔÈ 6/114 ¢È¿ÚÚÔȘ 4/114 ∫ÔÈÏÈ·Îfi ¿ÏÁÔ˜ 4/114 ∞ÈÌ·Ù¤ÌÂÛË 1/114 ∏·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· 2/114 ¢ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ 6/114 (5,3%) ¶ÔχÌÔÚÊÔ ÂÚ‡ıËÌ· 2/114 Stevens-Johnson 3/114 ∞ÈÌÔÚÚ·ÁÈÎfi ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· 1/114 ∞ÈÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ 4/114 (3,5%) ∞ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· 1/114 £ÚÔÌ‚ÔÂÓ›· 2/114 O˘‰ÂÙÂÚÔÂÓ›· 1/114 ª˘ÔÛÎÂÏÂÙÈΤ˜ ÂΉËÏÒÛÂȘ 5/114 (4,4%) ∞ÚıÚ›Ùȉ· 2/114 ∞ÚıÚ·ÏÁ›Â˜ 1/114 ª˘ÔÛ›ÙȘ 1/114 ¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ 6/114 (5,3%) ŒÌÊÚ·ÎÙÔ Ì¤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ 1/114 ∂ÁÎÂÊ·Ï›ÙȘ 1/114 ∞ÈıÔ˘ÛÈ·›· Ó¢ڛÙȘ 2/114 Guilain-Barre 1/114 ¶·ÚÂÁÎÂÊ·ÏÈÙȉÈ΋ ·Ù·Í›· 1/114

ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ Ì Ó¢ÌÔÓÈ΋ ÓfiÛÔ. ∏ ıÓËÙfiÙËÙ· ¤¯ÂÈ ÂÎÙÈÌËı› Û 10%. ™Â fiÛÔ˘˜ ÂÈ‚ÈÒÛÔ˘Ó, Ë ·ÔηٿÛÙ·ÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È ‚Ú·‰Â›· Î·È ÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‚·ÚÈ¿ ˘ÔÏÂÈÌÌ·ÙÈ΋ ÓfiÛÔ (7,8), ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÈÛ¯‡ÂÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ηıÒ˜ Ë ÔÚ›· ÙÔ˘˜ ‹Ù·Ó ÔÌ·Ï‹ Î·È Ë ·Ó¿ÚÚˆÛË Ï‹Ú˘, ¯ˆÚ›˜ ÛÙÔȯ›· ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓfiÛÔ˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·, Ì˘·ÏÁ›Â˜ Î·È ·ÚıÚ·ÏÁ›Â˜ ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ (15-45%), Û‡Ìʈӷ Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ηıÒ˜ Î·È ÛËÌ›· ¿Ù˘˘ ·ÚıÚ›Ùȉ·˜ (ÌÔÓÔ·ÚıÚ›ÙȘ ‹ ÌÂÙ·Ó·ÛÙ¢ÙÈ΋ ·ÚıÚ›ÙȘ ‹ ÔÏ˘·ÚıÚ›ÙȘ Ì ÚÔÛ‚ÔÏ‹ ÌÂÁ¿ÏˆÓ ·ÚıÚÒÛˆÓ) (9-10). OÈ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Û˘Ó‹ıˆ˜ Â›Ó·È ‹Ș, Ì ÈÔ ÛËÌ·ÓÙÈ΋ ÙËÓ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, Ì ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ „˘¯ÚÔÛ˘ÁÎÔÏÏËÙÈÓÒÓ, ıÂÙÈ΋ Coomps Î·È ·‡ÍËÛË ÙˆÓ ¢∂∫. §ÈÁfiÙÂÚÔ Û˘¯Ó¤˜ Â›Ó·È Ë Ì˘ÂÏÈ΋ ·Ï·Û›·, Ë ıÚÔÌ‚ÔÂÓ›· ηÈ, ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·, Ë ‰È¿¯˘ÙË ÂÓ‰Ô·ÁÁÂȷ΋ ‹ÍË. ¢‡Ô ÌÔÚʤ˜ ‰ÂÚÌ·ÙÈÎÒÓ ÂΉËÏÒÛÂˆÓ Û˘Ó‰˘¿˙ÔÓÙ·È Ì Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜: ÙÔ ÔχÌÔÚÊÔ ÂÚ‡ıËÌ· Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Stevens-Johnson, ÂÓÒ Û‡Ìʈӷ Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ‹Ș ‰ÂÚÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ÌÔÚ› Ó· ÊÙ¿ÛÔ˘Ó ÙÔ 30% Û ·ÛıÂÓ›˜ Ì ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, Ë Û˘Ìو̷ÙÔÏÔÁ›· Â›Ó·È ËÈfiÙÂÚË, Ì Â̤ÙÔ˘˜, ‰È¿ÚÚÔȘ Î·È ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÂÓÒ Û¿ÓÈ· ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Û˘ÌÙÒÌ·Ù· ·ÁÎÚ·ÙÈ΋˜ Î·È Ë·ÙÈ-

Paediatriki 2003;66:185-187

΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, ηıÒ˜ Î·È ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ÂÙÈÎfi. ∆¤ÏÔ˜, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂΉËÏÒÛÂȘ ·fi Ù· ÓÂÊÚ¿, Ì ÙË ÌÔÚÊ‹ ‰È¿ÌÂÛ˘ ÓÂÊÚ›Ùȉ·˜ ‹ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜, ηıÒ˜ Î·È ÂÚÈÙÒÛÂȘ ·ÚÔ‰È΋˜ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ÙÂÏÂ˘Ù·›·, ÌÔÚ› Ó· ÂÚÌËÓ‡ÛÂÈ ÙË Ì·ÎÚ¿ ÂÚ›Ô‰Ô ·Ú·ÌÔÓ‹˜ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi ÌÂÙ¿ ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘Ìو̿وÓ, ηıÒ˜ Î·È ÙËÓ ·˘ÍË̤ÓË Èı·ÓfiÙËÙ·, Ù·˘Ùfi¯ÚÔÓ· ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿, Ïԛ̈͢ ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÈÔ‡˜ Î·È ‚·ÎÙËÚ›‰È· (11). µÈ‚ÏÈÔÁÚ·Ê›· 1. Stevens D, Swift PG, Johnston PG, Kearney PJ, Corner BD, Burman D. Mycoplasma pneumoniae infections in children. Arch Dis Child 1978;53:38-42. 2. Cassell GH, Cole BC. Mycoplasmas as agents of human disease. N Engl J Med 1981;304:80-89. 3. Lehtokoski-Lehtiniemi E, Koskiniemi ML. Mycoplasma pneumoniae encephalitis: a severe entity in children. Pediatr Infect Dis J 1989;8:651-653. 4. Tjhie JH, van Kuppeveld FJ, Roosendaal R, Melchers WJ, Gordijn R, MacLaren DM et al. Direct PCR enables detection of Mycoplasma pneumoniae in patients with respiratory tract infections. J Clin Microbiol 1994;32:11-16. 5. Koskiniemi M, Rautonen J, Lehtokoski-Lehtiniemi E, Vaheri A. Epidemiology of encephalitis in children: a 20-year survey. Ann Neurol 1993;29:492-497. 6. Mills RW, Schoolfield L. Acute transverse myelitis associated with Mycoplasma pneumoniae infection: a case report and review of the literature. Pediatr Infect Dis J 1992;11:228-231. 7. Nishimura M, Saida T, Kuroki S, Kawabata T, Obayashi H, Saida K et al. Post-infectious encephalitis with antigalactocerebroside antibody subsequent to Mycoplasma pneumoniae infection. J Neurol Sci 1996;140:91-95. 8. Pellegrini M, O’Brien TJ, Hoy J, Sedal L. Mycoplasma pneumoniae infection associated with an acute brainstem syndrome. Acta Neurol Scand 1996;93:203-206. 9. Perez C, Mendoza H, Hernandez R, Valcayo A, Guarch R. Leukocytoclastic vasculitis and polyarthritis associated with Mycoplasma pneumoniae infection. Clin Infect Dis 1997;25:154-155. 10. Cimolai N, Malleson P, Thomas E, Middleton PJ. Mycoplasma pneumoniae associated arthropathy: confirmation of the association by determination of the antipolypeptide IgM response. J Rheumatol 1989;16:1150-1152. 11. Liakopoulou-Tsisipi T. §ÔÈÌÒÍÂȘ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ¶·È‰È·ÙÚÈΤ˜ £ÂÚ·¢ÙÈΤ˜ ∂ÓËÌÂÚÒÛÂȘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ 1995;1:47-51. ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-09-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-01-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ∫·Ú·ÓÙ·Ó¿ ∞Á. ¢ËÌ‹ÙÚÈÔ˘ 28, ∆.∫. 166 73, µÔ‡Ï· - ∞ÙÙÈ΋˜ E-mail: ankalant@otenet.gr

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Paediatriki 2003;66:188-194

ORIGINAL ARTICLE

ºÔÚ›· Neisseria meningitidis Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜: ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ π. ¶·˘ÏÔÔ‡ÏÔ˘1, ∂. ∞ÏÂÍ¿Ó‰ÚÔ˘2, °. ¢·›ÎÔ˜3, ∂. ¶ÂÙÚ›‰Ô˘2, ∞. ¶¿ÁηÏË2, ª. £ÂÔ‰ˆÚ›‰Ô˘1, µ. ™˘ÚÈÔÔ‡ÏÔ˘1

Neisseria meningitidis carriage in schoolchildren: risk factors and characteristics of isolated strains I. Pavlopoulou1, E. Alexandrou2, G. Daikos3, E. Petridou2, A. Pangalis2, M. Theodoridou1, V. Syriopoulou1

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Ù˘ Â›ÙˆÛ˘ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ù˘ ÊÔÚ›·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ηıÒ˜ Î·È Ë ÂÚÈÁÚ·Ê‹ ÙˆÓ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ. ∂Ï‹ÊıËÛ·Ó Î·ÏÏȤÚÁÂȘ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ·fi 554 ·È‰È¿ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ‰ËÌÔÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ Ù˘ ∞ı‹Ó·˜, ËÏÈΛ·˜ 2-19 ÂÙÒÓ. ¶ÚÔËÁÔ˘Ì¤Óˆ˜ Û˘ÌÏËÚÒıËΠ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·ÊÔÚÔ‡Û Û ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÊÔÚ›·. ∏ ¢·ÈÛıËÛ›· ÙˆÓ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ Û ÎÔÈÓ¿ ·ÓÙÈÌÈÎÚԂȷο ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ÙË Ì¤ıÔ‰Ô E-test, Ë Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ Û ÔÚÔ-ÔÌ¿‰Â˜ ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠̤ıÔ‰Ô Û˘ÁÎfiÏÏËÛ˘, ÂÓÒ Ë ÁÂÓÂÙÈ΋ ÙÔ˘˜ Û˘ÁÁ¤ÓÂÈ· Ì ËÏÂÎÙÚÔÊfiÚËÛË ·ÏÏfiÌÂÓÔ˘ ‰›Ô˘ (PFGE). °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ·Î¤ÙÔ STATA. N. meningitidis ·ÔÌÔÓÒıËΠ·fi ÙÔÓ Ê¿Ú˘ÁÁ· 22 ·È‰ÈÒÓ (3,97%). ∏ ÏÂÈÔ„ËÊ›· ·Ó‹Î ÛÙȘ ÔÚÔ-ÔÌ¿‰Â˜ C (31,8%) Î·È B (22,7%). ŸÏ· Ù· ÛÙÂϤ¯Ë ‚Ú¤ıËÎ·Ó Â˘·›ÛıËÙ· ÛÙËÓ ÎÂÊÙÚÈ·ÍfiÓË, ÚÈÊ·ÌÈΛÓË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË, 5 ‚Ú¤ıËÎ·Ó ÌÂÙÚ›ˆ˜ ¢·›ÛıËÙ· ÛÙËÓ ÂÓÈÎÈÏ›ÓË (22,7%) Î·È 1 ·ÚÔ˘Û›·Û Ï‹ÚË ·ÓÙÔ¯‹ ÛÙËÓ ÎÔÙÚÈÌÔÍ·˙fiÏË (4,5%). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË 16 ÛÙÂϯÒÓ Ì PFGE ·ÔÎ¿Ï˘„ 6 ‰È·ÊÔÚÂÙÈΤ˜ ÂÈÎfiÓ˜ ËÏÂÎÙÚÔÊfiÚËÛ˘. ™ÙÔ ›‰ÈÔ Û¯ÔÏÂ›Ô ·Ú·ÙËÚ‹ıËÎÂ Û˘ÁΤÓÙÚˆÛË ·È‰ÈÒÓ Ì ›‰È· PFGE ÂÈÎfiÓ·, ÂÓÒ ÛÙÔÓ ›‰ÈÔ ÎÏÒÓÔ ‚Ú¤ıËÎ·Ó ÛÙÂϤ¯Ë ·fi ‰È·ÊÔÚÂÙÈΤ˜ ÔÚÔ-ÔÌ¿‰Â˜. ™ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË, Ë ÌfiÓË ÌÂÙ·‚ÏËÙ‹ Ô˘ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÙË ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ‹Ù·Ó Ë ËÏÈΛ·

Abstract: The aim of this study was to determine the prevalence of carriage of N. meningitidis strains in Greek schoolchildren and to identify associated risk factors. Oropharyngeal swabs were cultivated from a total of 554 children aged 2 to 19 years attending nurseries and primary and secondary schools in Athens. A questionnaire with questions including parameters possibly associated with meningococcal carriage was completed by the children’s parents. Susceptibilities of the isolates to antimicrobial agents were determined by E-test. Isolate serogrouping was performed by slide agglutination and their relatedness was tested by pulsed field gel electrophoresis (PFGE). Data were analyzed using the statistical package STATA. Twenty-two (3.97%) children were identified as meningococcal carriers. The majority of isolates belonged to serogroups C (31.8%) and B (22.7%). All were sensitive to ceftriaxone, rifampicin and chloramphenicol, one was resistant to cotrimoxazole (4.5%) and 5 intermediately resistant to penicillin (22.7%). DNA analysis of 16 isolates revealed 6 distinct PFGE patterns. Clusters with an identical PFGE pattern were noted in the same school. More than one serogroup were included in the same clonal group. On multivariate logistic regression analysis, age >12 years was the only variable to remain independently associated with the carrier state (OR: 7.96; 95% CI: 2.24-28.33; p<0.001). In conclusion, the N. meningitidis carriage rate among Greek schoochildren increases with age.

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ∞’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, “§·˚Îfi” °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∞ı‹Ó·

1 1st Paediatric Clinic of University of Athens “Agia Sophia” Children’s Hospital, Athens 2 Microbiological Laboratory “Agia Sophia” Children’s Hospital, Athens 3 1st Academic Clinic of Pathology, University of Athens “Laiko” General Hospital, Athens

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Paediatriki 2003;66:188-194

¿Óˆ ÙˆÓ 12 ÂÙÒÓ (OR: 7,96, 95% CI: 2,24-28,33, p<0,001). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ·, ÂÓÒ ÔÈ Û˘¯ÓfiÙÂÚ˜ ÔÚÔ-ÔÌ¿‰Â˜ ÛÙËÓ ·ÙÚ›‰· Ì·˜ Â›Ó·È ÔÈ C Î·È µ. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÛÙÔÓ ›‰ÈÔ ÎÏÒÓÔ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ÔÚÔ-ÔÌ¿‰Â˜ ˘Ô‰ËÏÒÓÂÈ fiÙÈ, οو ·fi ÙËÓ ›ÂÛË ÂÈÏÔÁ‹˜, Á›ÓÔÓÙ·È ÌÂÙ·ÙÚÔ¤˜ ÛÙ· ˘‡ı˘Ó· ÁÈ· ÙȘ ÔÚÔ-ÔÌ¿‰Â˜ ÁÔÓ›‰È·. ∆· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ÌÔÚ› Ó· ¯ÚËÛÈ̇ÛÔ˘Ó ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ÙÔ Û˘Ó‰Â‰Â̤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÛÙË ¯ÒÚ· Ì·˜.

The predominant serogroups in our geographic region are C and B. The inclusion of more than one serogroup within the same clonal group suggests switching of capsular genes. These findings have implications for future immunization with conjugate vaccines.

§¤ÍÂȘ ÎÏÂȉȿ: ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ·È‰È¿, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘.

Key words: meningococcal carriage, schoolchildren, risk factors.

∂ÈÛ·ÁˆÁ‹ ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ·Ú·Ì¤ÓÂÈ ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙ· ·È‰È¿, ·Ú¿ ÙȘ ‚ÂÏÙȈ̤Ó˜ ÌÂıfi‰Ô˘˜ ÂÚÁ·ÛÙËÚȷ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ıÂÚ·›·˜. ∏ Û˘Ó‹ı˘ ËÁ‹ ‰È·ÛÔÚ¿˜ Ù˘ Ïԛ̈͢ Â›Ó·È ÔÈ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜. ∏ Â›ÙˆÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÊÔÚ›·˜ ÔÈΛÏÏÂÈ. ∂›Ó·È ¯·ÌËÏ‹ ÛÙ· ÌÈÎÚ¿ ·È‰È¿ (<2%), ˘„ËÏfiÙÂÚË ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ (5-15%) Î·È ·ÚÎÂÙ¿ ˘„ËÏ‹ Û ¿ÙÔÌ· Ô˘ ‰È·‚ÈÔ‡Ó ÛÂ Û˘Óı‹Î˜ Û˘Á¯ÚˆÙÈÛÌÔ‡, fiˆ˜ ȉڇ̷ٷ Î·È ÛÙÚ·Ùfi‰· (~50%) (1-3). ∏ ÊÔÚ›· N. meningitidis ‰Ú· ·ÓÔÛÔÔÈËÙÈο, Ì ·Ô��¤ÏÂÛÌ·, ‰‡Ô ÂÚ›Ô˘ ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ·ÙfiÌÔ˘, Ó· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ÔÚfi ÂȉÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÔÚÔ-ÔÌ¿‰·˜. ø˜ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÊÔÚ›·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Ë ÚÔËÁËı›۷ ÈÔÁÂÓ‹˜ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙÔ ÂÓÂÚÁËÙÈÎfi ‹ ·ıËÙÈÎfi οÓÈÛÌ·, ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ Î·È ÙÔ ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô (2,4,5). ™‡Ìʈӷ Ì ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, fiÙ·Ó ÙÔ ÔÛÔÛÙfi ÊÔÚ›·˜ ·fi Û˘ÁÎÂÎÚÈ̤ÓË ÔÚÔ-ÔÌ¿‰· ˘Âڂ› ÙÔ 20% Û ̛· ÎÔÈÓfiÙËÙ·, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ÂȉËÌ›·˜, Û˘Ó‹ıˆ˜ ·fi ÙËÓ ›‰È· ÔÚÔ-ÔÌ¿‰·. ŒÌÊ·ÛË, fï˜, ı· Ú¤ÂÈ Ó· ‰Ôı› ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÏϤ˜ ÂȉË̛˜ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ηٷÁÚ¿ÊÔÓÙ·È fi¯È Û ÂÚÈfi‰Ô˘˜ ˘„ËÏ‹˜ ÊÔÚ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡, ·ÏÏ¿ fiÙ·Ó ˘¿Ú¯ÂÈ Ù·¯Â›· ·‡ÍËÛË ÙÔ˘ Ú˘ıÌÔ‡ Ù˘ Û ¿ÙÔÌ· Ô˘ ‰ÂÓ ‹Ù·Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ·ÔÈÎÈṲ̂ӷ ηÈ, ηٿ Û˘Ó¤ÂÈ·, ‰ÂÓ Â›¯·Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ˘‡ı˘Ó˘ ÁÈ· ÙËÓ ÂȉËÌ›· ÔÚÔ-ÔÌ¿‰·˜ (6). ™ÙËÓ ∂ÏÏ¿‰·, Ë N. meningitidis Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙ· ·È‰È¿, Ì ˘ÔÏÔÁÈ˙fiÌÂÓË Ì¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË 7,5 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ·È‰È¿ ËÏÈΛ·˜ <14 ÂÙÒÓ, ÛÙËÓ Â-

ÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ (7). ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·ÊÔÚ¿ Û ·È‰È¿ ËÏÈΛ·˜ 2-5 ÂÙÒÓ, ÂÓÒ Ì›· ¿ÏÏË ÔÌ¿‰· Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È Û˘¯Ó¿ Â›Ó·È ÔÈ ¤ÊË‚ÔÈ (8). ∞fi ÙÔ 1995 ¤¯ÂÈ ÛËÌÂȈı› Ì›· Û˘Ó¯È˙fiÌÂÓË ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘, ÔÊÂÈÏfiÌÂÓ˘ ΢ڛˆ˜ ÛÙËÓ ÔÚÔ-ÔÌ¿‰· µ, ÂÓÒ ÙÔ 1997 Ë ÔÚÔ-ÔÌ¿‰· Ô˘ ·ÔÌÔÓˆÓfiÙ·Ó Û˘¯ÓfiÙÂÚ· ‹Ù·Ó Ë C. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ô ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ µ ·ÔÌÔÓÒÓÂÙ·È ÛÙÔ 58% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙËÓ ·ÙÚ›‰· Ì·˜. ∏ ·‡ÍËÛË ·˘Ù‹ Ù˘ Â›ÙˆÛ˘ ÔÊ›ÏÂÙ·È ÂÓ Ì¤ÚÂÈ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ηٷÁÚ·Ê‹˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ªËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ·ÏÏ¿ Î·È ÛÙËÓ Â›ÛÔ‰Ô Ó¤ˆÓ ÛÙÂϯÒÓ ÛÙË ¯ÒÚ· Ì·˜, ·Ú¯Èο Ì ʷÈÓfiÙ˘Ô C:2a:P1.2.P1.5 (ÎÏÒÓÔ˜ ET-37) Î·È ÚfiÛÊ·Ù· Ì ʷÈÓfiÙ˘Ô B:2a:P1.2 (ÎÏÒÓÔ˜ ET-15) (9,10). ™Â ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, Ô˘ ·ÊÔÚÔ‡Û·Ó Û ÛÙÚ·ÙÈÒÙ˜, ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÌÂÙ·Ó¿ÛÙ˜, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÔÛÔÛÙ¿ ÊÔÚ›·˜ 25%, 5,8% Î·È 13%, ·ÓÙ›ÛÙÔȯ· (11,12). ª¤¯ÚÈ ÚfiÛÊ·Ù·, Ë ÛÙÚ·ÙËÁÈ΋ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÂÚÈÂÏ¿Ì‚·Ó ÂÌ‚ÔÏÈ·ÛÌfi Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÌ¿‰ˆÓ-ÛÙfi¯ˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÛÙȘ ηٿ ÙfiÔ˘˜ ÂȉË̛˜, ηıÒ˜ Î·È ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ÛÙÚ·ÙȈÙÒÓ Ì ÙÔ ‰È·ı¤ÛÈÌÔ ÛÙË ¯ÒÚ· Ì·˜ ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ ¤Ó·ÓÙÈ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ A+C. ∂ÓÙÔ‡ÙÔȘ, Ë Â˘Ú›· ·Ô‰Ô¯‹ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰È¿ÙÚˆÓ, ·ÏÏ¿ Î·È ÙˆÓ ÁÔÓ¤ˆÓ, ÙÔ˘ Ó¤Ô˘ Û˘˙¢Á̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ C, ÙÔ ÔÔ›Ô Î˘ÎÏÔÊfiÚËÛ ÛÙË ¯ÒÚ· Ì·˜ ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2001, Ô‰‹ÁËÛ ÛÙËÓ ÔÏÔ¤Ó· ·˘Í·ÓfiÌÂÓË ›ÂÛË ÛÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ Ó· ÂÚÈÏËÊı› ÙÔ ÂÌ‚fiÏÈÔ ·˘Ùfi ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ, ·Ú¿ ÙÔ ˘„ËÏfi ÙÔ˘ ÎfiÛÙÔ˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Â›ÙˆÛ˘ Ù˘ ÊÔÚ›·˜ N. meningitidis Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜, ηıÒ˜ Î·È Ë ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘

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¶·È‰È·ÙÚÈ΋ 2003;66:188-194

Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÊÔÚ›·. ∂›Û˘, ÂÚÈÁÚ¿ÊÔÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ Î·È Û˘˙ËÙÂ›Ù·È Ë Èı·Ó‹ ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ì·˜ ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ÙÔ Û˘Ó‰Â‰Â̤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÛÙË ¯ÒÚ· Ì·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó Û˘ÓÔÏÈο 580 ·È‰È¿ ËÏÈΛ·˜ 2-19 ÂÙÒÓ, Ù· ÔÔ›· ‹Ù·Ó Ì·ıËÙ¤˜ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ‰ËÌÔÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ΤÓÙÚÔ˘ Ù˘ ∞ı‹Ó·˜. ™ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ Ì·ıËÙÒÓ ·ÔÛÙ¿ÏıËΠÂÓËÌÂÚˆÙÈÎfi ÛËÌ›ˆÌ·, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ˙ËÙ‹ıËΠ·fi ·˘ÙÔ‡˜ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·Ó ÂÚˆÙ‹ÛÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó Û ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÙˆÓ ·È‰ÈÒÓ, fiˆ˜ ËÏÈΛ·, ʇÏÔ, ÂıÓÈÎfiÙËÙ·, ηıÒ˜ Î·È ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÚÔËÁËı›۷ ÈÔÁÂÓ‹ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ Ì‹Ó·, οÓÈÛÌ· Î·È ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ, ‰Â›ÎÙË ‰È·‚›ˆÛ˘ (·ÚÈıÌfi˜ ·ÙfiÌˆÓ ÛÙÔ Û›ÙÈ, ·ÚÈıÌfi˜ ‰ˆÌ·Ù›ˆÓ ÛÈÙÈÔ‡), ÌËÙÚÈÎfi ıËÏ·ÛÌfi Î·È ÂÌ‚ÔÏÈ·ÛÌfi Ì ÔÏ˘Û·Î¯·ÚȉÈÎfi ‹ Û˘Ó‰Â‰Â̤ÓÔ ·ÓÙÈÌËÓÈÁÁÈÙȉÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ. ∂Ï‹ÊıËÛ·Ó Î·ÏÏȤÚÁÂȘ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ ÛÙȘ Ù¿ÍÂȘ ÙÔ˘˜, ·fi ÙÔÓ ›‰ÈÔ È·ÙÚfi, ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙÔÓ ¡Ô¤Ì‚ÚÈÔ 2000 ¤ˆ˜ ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ 2001. ∞ÔÌfiÓˆÛË ÌÈÎÚÔ‚›Ô˘: ∆· ‰Â›ÁÌ·Ù· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜, Ù· ÔÔ›· Ï·Ì‚¿ÓÔÓÙ·Ó Ì ‚·Ì‚·ÎÔÊfiÚÔ ÛÙÂÈÏÂfi, ηÏÏÈÂÚÁÔ‡ÓÙ·Ó Û ÛÔÎÔÏ·ÙÔ‡¯Ô ¿Á·Ú ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ‚·ÓÎÔÌ˘Î›ÓË, ÎÔÏÈÌ˘Î›ÓË Î·È ÓÂÔÌ˘Î›ÓË (VCN). ∆· ÙÚ˘‚Ï›· Ô Âˆ¿˙ÔÓÙ·Ó ÛÙÔ˘˜ 35 C Û 5% CO2 ÁÈ· 2 Ë̤Ú˜ Î·È Ë Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÁÈÓfiÙ·Ó Ì ÙȘ Û˘Ó‹ıÂȘ ÌÈÎÚÔ‚ÈÔÏÔÁÈΤ˜ Ù¯ÓÈΤ˜. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ¢·ÈÛıËÛ›·˜ (MIC) ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÛÙËÓ ÂÓÈÎÈÏ›ÓË, ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË, ÚÈÊ·ÌÈΛÓË, ÎÂÊÙÚÈ·ÍfiÓË Î·È ÙÚÈÌÂıÔÚ›ÌË/ ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË ÁÈÓfiÙ·Ó Ì ÙË Ì¤ıÔ‰Ô ∂-test Û Mueller-Hinton ¿Á·Ú Ì 5% HB. ∆· ÛÙÂϤ¯Ë ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·ÓıÂÎÙÈο, ÌÂÙÚ›ˆ˜ ¢·›ÛıËÙ· Î·È Â˘·›ÛıËÙ· ÛÙËÓ ÂÓÈÎÈÏ›ÓË, Â¿Ó Ë MIC ‹Ù·Ó ≥1 Ìg/ml, 0,125-0,5 Ìg/ml Î·È <0,125 Ìg/ml, ·ÓÙ›ÛÙÔȯ·. ∞ÓıÂÎÙÈο ÛÙËÓ ÎÔÙÚÈÌÔÍ·˙fiÏË, ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË Î·È ÚÈÊ·ÌÈΛÓË ÔÚ›ÛÙËÎ·Ó Ù· ÛÙÂϤ¯Ë Ì MIC ≥2 Ìg/ml, ≥2 Ìg/ml Î·È ≥4 Ìg/ml, ·ÓÙ›ÛÙÔȯ· (13). ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÔÚÔ-ÔÌ¿‰·˜: ∏ ηٿٷÍË ÙˆÓ ÛÙÂϯÒÓ Û ÔÚÔ-ÔÌ¿‰Â˜ A, B, C, D, Y Î·È W135 ÁÈÓfiÙ·Ó Ì ÌÔÓÔ- ‹ ÔÏ˘ÎψÓÈÎÔ‡˜ ÔÚÔ‡˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ Û˘ÁÎfiÏÏËÛ˘, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹ (Biotec Laboratories Ltd, Suffolk, United Kingdom). ™ÙȘ ·ÔÈ˘ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÁÈÓfiÙ·Ó ·Ó·Î·ÏÏȤÚÁÂÈ· Î·È ÌÂÙ¿ Ù· ÛÙÂϤ¯Ë Ê˘Ï¿ÛÛÔÓÙ·Ó ÛÙÔ˘˜ -70ÔC ̤¯ÚÈ Ó· Á›ÓÂÈ Ë ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË. ∏ÏÂÎÙÚÔÊfiÚËÛË ·ÏÏfiÌÂÓÔ˘ ‰›Ô˘: ∏ ÁÂÓÂÙÈ΋ Û˘ÁÁ¤ÓÂÈ· ÙˆÓ ÛÙÂϯÒÓ ÂÍÂÙ¿ÛÙËΠ̠ËÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ‰›Ô ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÙ¿ ·fi ηٿÙÌËÛË Ì ÙȘ ÂÚÈÔÚÈÛÙÈΤ˜ ÂÓ‰ÔÓÔ˘ÎÏ¿Û˜ NotI Î·È SfiI, fiˆ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÚÔËÁÔ‡ÌÂÓ· (14). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ∏ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙÔ˘

190

Paediatriki 2003;66:188-194

ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ STATA. ∏ Û˘Û¯¤ÙÈÛË Î·ıÂÓfi˜ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ͯˆÚÈÛÙ¿ Û ۯ¤ÛË Ì ÙË ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ¤ÁÈÓ Ì ÙÔ ¯2. O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ Ó· Â›Ó·È Î·Ó›˜ ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÁÈ· ηı¤Ó· ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ͯˆÚÈÛÙ¿, ˘ÔÏÔÁ›ÛÙËΠ̠ÌÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. OÈ ÌÂÙ·‚ÏËÙ¤˜ ÂΛӘ Ô˘ ÛÙË ÌÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ‚Ú¤ıËΠӷ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ 10%, ·Ó·Ï‡ıËÎ·Ó ÂÚ·ÈÙ¤Úˆ Ì ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘.

∞ÔÙÂϤÛÌ·Ù· º·Ú˘ÁÁÈÎfi Â›¯ÚÈÛÌ· ÂÏ‹ÊıË ·fi 554 Ì·ıËÙ¤˜ (Û ۇÓÔÏÔ 580 ·È‰ÈÒÓ) ËÏÈΛ·˜ 2-19 ÂÙÒÓ (̤ÛË ËÏÈΛ·: 10 ¤ÙË, SD: ±4 ¤ÙË), ÔÈ ÔÔ›ÔÈ Â¤ÛÙÚ„·Ó Û˘ÌÏËڈ̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜: 95,5%). ¶ÔÛÔÛÙfi 3,97% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì·ıËÙÒÓ (22/554) ‚Ú¤ıËΠӷ Â›Ó·È ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘. ∞fi Ù· 349 ·È‰È¿ ËÏÈΛ·˜ <12 ÂÙÒÓ, ÌfiÓÔ 3 ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È ÊÔÚ›˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ (0,86%). ªÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ, ÙÔ ÔÛÔÛÙfi Ù˘ ÊÔÚ›·˜ ·˘Í‹ıËΠÛËÌ·ÓÙÈο Û 9,27% (19/205, p<0,0001). ∆· ÔÛÔÛÙ¿ ÊÔÚ›·˜ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο (13/272 ·ÁfiÚÈ· Î·È 9/282 ÎÔÚ›ÙÛÈ· ÊÔÚ›˜) (¶›Ó·Î·˜ 1). ∏ ÚÔËÁËı›۷ ÈÔÁÂÓ‹˜ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Ë ÚfiÛÊ·ÙË Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‚Ú¤ıËÎ·Ó Ó· Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙË ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ (p=0,004 Î·È p=0,06, ·ÓÙ›ÛÙÔȯ·). ∆· ·È‰È¿ Ì ·˘ÍË̤ÓÔ ‰Â›ÎÙË ‰È·‚›ˆÛ˘ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ÊÔÚ›˜ (p=0,064). ∏ ÊÔÚ›· N. meningitidis ‰ÂÓ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ·ıËÙÈÎfi οÓÈÛÌ·, ÙËÓ ÂıÓÈÎfiÙËÙ·, ÙÔ ıËÏ·ÛÌfi ‹ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ì ÔÏ˘Û·Î¯·ÚȉÈÎfi A+C ‹ ÌÂ Û˘Ó‰Â‰Â̤ÓÔ C ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘. ∆Ô ÔÛÔÛÙfi ÊÔÚ›·˜ ‚Ú¤ıËΠ¯·ÌËÏfiÙÂÚÔ Û ·È‰È¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ›¯·Ó ·ÓÂÈÛÙËÌȷ΋ ÌfiÚʈÛË, Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿ ÂÎÂ›ÓˆÓ Ô˘ ‰ÂÓ Â›¯·Ó (p=0,049). O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (OR), ηıÂÓfi˜ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ͯˆÚÈÛÙ¿, Ù˘ Èı·ÓfiÙËÙ·˜ ¶›Ó·Î·˜ 1. ºÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ÂıÓÈÎfiÙËÙ· ªÂÙ·‚ÏËÙ‹

ºÔÚ›· (¡·È/fi¯È)

%

p

3/346 19/186

0,89 9,2

<0,0001

∏ÏÈΛ· ≤12¤ÙË >12¤ÙË º‡ÏÔ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ∂ıÓÈÎfiÙËÙ· ŒÏÏËÓ·˜ ∞ÏÏÔ‰·fi˜

13/259 9/273

4,7 3,1

0,339

20/491 2/41

3,9 4,6

0,812

™‡ÓÔÏÔ

22/532

3,97


May-June 03

03-06-03

16:55

™ÂÏ›‰·191

¶·È‰È·ÙÚÈ΋ 2003;66:188-194

Paediatriki 2003;66:188-194

Ó· Â›Ó·È ¤Ó· ·È‰› ÊÔÚ¤·˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË, ÌfiÓÔ Ë ËÏÈΛ· ·Ú¤ÌÂÈÓ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘. ŒÙÛÈ, Ë ËÏÈΛ· ¿Óˆ ÙˆÓ 12 ÂÙÒÓ ‚Ú¤ıËΠӷ ·˘Í¿ÓÂÈ, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 8 ÊÔÚ¤˜, ÙËÓ Èı·ÓfiÙËÙ· Ó· Â›Ó·È ¤Ó· ·È‰› ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, Û˘ÁÎÚÈÙÈο Ì ¤Ó· ·È‰› ËÏÈΛ·˜ <12 ÂÙÒÓ (¶›Ó·Î·˜ 3). ŸÏ· Ù· ÛÙÂϤ¯Ë ‚Ú¤ıËÎ·Ó Â˘·›ÛıËÙ· ÛÙËÓ ÎÂÊÙÚÈ·ÍfiÓË, ÙË ÚÈÊ·ÌÈΛÓË Î·È ÙË ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË. ªfiÓÔ 1 Û٤ϯԘ ‚Ú¤ıËΠ·ÓıÂÎÙÈÎfi ÛÙËÓ ÎÔÙÚÈÌÔÍ·˙fiÏË (4,5%) Î·È 5 ̤ÙÚÈ· ¢·›ÛıËÙ· ÛÙËÓ ÂÓÈÎÈÏ›ÓË (22,7%). ∞fi Ù· ·ÔÌÔÓˆı¤ÓÙ· ÛÙÂϤ¯Ë, 1 ·Ó‹Î ÛÙËÓ ÔÚÔ-ÔÌ¿‰· ∞ (4,5%), 5 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· µ (22,7%), 7 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C (31,8%), 1 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· D (4,5%) Î·È 3 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· W135 (13,7%). ¶¤ÓÙ ÛÙÂϤ¯Ë (22,7%) ‹Ù·Ó ÌË Ù˘ÔÔÈ‹ÛÈÌ·. ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË 16 ÛÙÂϯÒÓ Ì ËÏÂÎÙÚÔÊfiÚËÛË ·ÏÏfiÌÂÓÔ˘ ‰›Ô˘ ·ÔÎ¿Ï˘„ 6 ‰È·ÊÔÚÂÙÈΤ˜ ÂÈÎfiÓ˜ ËÏÂÎÙÚÔÊfiÚËÛ˘. OÎÙÒ ·fi Ù· ÛÙÂϤ¯Ë ›¯·Ó fiÌÔÈ· ÂÈÎfiÓ· Î·È Î·Ù·Ù¿¯ÙËÎ·Ó ÛÙËÓ ÔÌ¿‰· a, 2 ÛÙÂϤ¯Ë ÛÙËÓ ÔÌ¿‰· b, 2 ÛÙÂϤ¯Ë ÛÙËÓ ÔÌ¿‰· c Î·È 2 ÛÙÂϤ¯Ë ÛÙËÓ ÔÌ¿‰· d. ∆· ˘fiÏÔÈ· 2 ÛÙÂϤ¯Ë ›¯·Ó ÙÔ Î·ı¤Ó· ‰È·ÊÔÚÂÙÈΤ˜ ËÏÂÎÙÚÔÊÔÚËÙÈΤ˜ ÂÈÎfiÓ˜ Ô˘ ‰ÂÓ ¤ÌÔÈ·˙·Ó Ô‡Ù ÌÂٷ͇ ÙÔ˘˜, Ô‡Ù Ì η̛· ·fi ÙȘ ÚÔËÁÔ‡ÌÂÓ˜. ∆¤ÛÛÂÚ· ·fi Ù· ÛÙÂϤ¯Ë ‰ÂÓ ‹Ù·Ó ˙ˆÓÙ·Ó¿ ÙË ÛÙÈÁÌ‹ Ù˘ ÁÂÓÂÙÈ΋˜ ·Ó¿Ï˘Û˘ Î·È 2 ‰ÂÓ ¤‰ˆÛ·Ó η̛· ËÏÂÎÙÚÔÊÔÚËÙÈ΋ ÂÈÎfiÓ· (¶›Ó·Î·˜ 4). ∆· ÛÙÂϤ¯Ë ÙˆÓ ÊÔÚ¤ˆÓ Û˘ÁÎÚ›ıËÎ·Ó Ì 4 ÛÙÂϤ¯Ë ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ (2 ·Ó‹Î·Ó ÛÙË ÔÚÔ-ÔÌ¿‰· µ Î·È 2 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C), Ù˘¯·›· ÂÈÏÂÁ̤ӷ, Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ·È‰ÈÒÓ Ì ÌËÓÈÁÁ›Ùȉ·, Ù· ÔÔ›· ÓÔÛËχıËÎ·Ó ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÓÔÛÔÎÔÌÂ›Ô Î·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô. £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ÛÙÂϤ¯Ë ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ó‹Î·Ó ÛÙȘ ÔÚÔ-ÔÌ¿‰Â˜ B Î·È C, ›¯·Ó Ù· ›‰È· ‰·ÎÙ˘ÏÈο ·ÔÙ˘ÒÌ·Ù· Ì ٷ ÛÙÂϤ¯Ë ÙˆÓ

ÊÔÚ¤ˆÓ Ô˘ ·Ó‹Î·Ó ÛÙȘ ÔÌ¿‰Â˜ ËÏÂÎÙÚÔÊfiÚËÛ˘ a Î·È b, ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 1). ™˘˙‹ÙËÛË ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·Ú¤¯Ô˘Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ηıÒ˜ Î·È ÁÈ· Ù· ÁÔÓÔÙ˘Èο Î·È Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÛÙÂϯÒÓ Neisseria meningitidis ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹. O ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÊÔÚ¤ˆÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Î·È ÙÔ Û¯ÂÙÈο ÌÈÎÚfi ̤ÁÂıÔ˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ Ô˘ ÌÂÏÂÙ‹ıËÎÂ, ÂÚÈÔÚ›˙Ô˘Ó ÙË ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÛÙË ¯¿Ú·ÍË ÛÙÚ·ÙËÁÈ΋˜ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Ì‚ÔÏÈ·ÛÌÔ‡. ¶·Ú’ fiÏ· ·˘Ù¿, ·Ó Û˘Ó‰˘·ÛÙÔ‡Ó ÌÂ Â˘Ú‹Ì·Ù· ·fi ¿ÏϘ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜, ÌÔÚ› Ó· Â›Ó·È ¯Ú‹ÛÈÌ· ÛÙË Ï‹„Ë ·fiÊ·Û˘ Û¯ÂÙÈο Ì ÙÔ Ì·˙ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÔÚÈÛÌ¤ÓˆÓ Â˘·ıÒÓ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡ Ì ÙÔ Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ÙÔ ÔÔ›Ô Î˘ÎÏÔÊÔÚ› ÛÙËÓ ∂ÏÏ¿‰· Â‰Ò Î·È ¤Ó· ¯ÚfiÓÔ. O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ÊÔÚ›·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Û ‰È·ÊÔÚÂÙÈΤ˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ Û ̛· ‰Â‰Ô̤ÓË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Â›Ó·È ‰‡ÛÎÔÏÔ˜, ‰ÈfiÙÈ ÌÔÚ› Ó· ÂËÚ·ÛÙ› ·fi ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ¿ÙÔÌÔ, ÙÔ ‚·ÎÙËÚ›‰ÈÔ Î·È ÙËÓ Ù¯ÓÈ΋ Ù˘ ‰ÂÈÁÌ·ÙÔÏË„›·˜. ∏ ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÛÙȘ ∏.¶.∞ Î·È ÛÙȘ ÌË ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜ ·Ó·Ê¤ÚÂÙ·È ÌÂٷ͇ 5-10% (14). ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÊÔÚ›·˜ (5-15%) ‚Ú›ÛÎÂÙ·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ, ÂÓÒ ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ·Ú·ÙËÚÂ›Ù·È ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ (50/100.000) Î·È ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· (5/100.000) (3). ∞fi ÙÔ˘˜ 554 Ì·ıËÙ¤˜ Ô˘ ÙÂÏÈο ¤Ï·‚·Ó ̤ÚÔ˜ ÛÙË ÌÂϤÙË Ì·˜, ÙÔ 3,97% ‚Ú¤ıËΠӷ Â›Ó·È ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘,

¶›Ó·Î·˜ 2. ºÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘: ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ªÂÙ·‚ÏËÙ‹

ºÔÚ›· ¡·È Ÿ¯È

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜)

∏ÏÈΛ· >12 ¤ÙË ∞ÏÏÔ‰·fi˜ ¶ÚÔËÁËı›۷ Ïԛ̈ÍË §‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ¢Â›ÎÙ˘ Û˘ÁηÙÔ›ÎËÛ˘ >1 ∫¿ÓÈÛÌ· (¤Ó·˜ ÁÔÓ¤·˜) ∫¿ÓÈÛÌ· (Î·È ÔÈ ‰‡Ô ÁÔÓ›˜) ªfiÚʈÛË ¶·Ó/ÌÈÔ (¤Ó·˜ ÁÔÓ¤·˜) ¶·Ó/ÌÈÔ (Î·È ÔÈ ‰‡Ô ÁÔÓ›˜) £ËÏ·ÛÌfi˜ ≥3 Ì‹Ó˜ <3 Ì‹Ó˜ ∂Ì‚ÔÏÈ·ÛÌfi˜

19 2 4 1 15 11 7

186 41 263 112 248 190 166

4 2

131 150

0,48 (0,16-1,46) 0,21 (0,47-0,92)

0,196 0,039

10 7 3

184 244 42

1,13 (0,37-3,39) 0,60 (0,19-1,92) 1,84 (0,52-6,48)

0,827 0,387 0,341

11,78 1,20 0,23 0,18 2,45 2,55 1,86

(3,44-40,32) (0,27-5,30) (0,08-0,68) (0,24-1,34) (0,98-6,12) (0,80-8,15) (0,53-6,45)

p <0,0001 0,812 0,008 0,094 0,054 0,115 0,331

191


May-June 03

03-06-03

16:55

™ÂÏ›‰·192

¶·È‰È·ÙÚÈ΋ 2003;66:188-194

Paediatriki 2003;66:188-194

¶›Ó·Î·˜ 3. ºÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜: ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ªÂÙ·‚ÏËÙ‹

¢ÈÔÚıˆÌ¤ÓÔ˜ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜

95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜

p

7,96 0,45 0,46 1,29

2,24-28,33 0,13-1,58 0,049-4,38 0,48-3,46

0,001 0,214 0,500 0,614

0,68 0,42

0,21-2,23 0,09-1,98

0,528 0,275

∏ÏÈΛ· >12 ¤ÙË ¶ÚÔËÁËı›۷ ÈÔÁÂÓ‹˜ Ïԛ̈ÍË ¶ÚfiÛÊ·ÙË Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ¢Â›ÎÙ˘ Û˘ÁηÙÔ›ÎËÛ˘ >1 ªfiÚʈÛË ÁÔÓ¤ˆÓ ¶·ÓÂÈÛÙ‹ÌÈÔ (¤Ó·˜ ÁÔÓ¤·˜) ¶·ÓÂÈÛÙ‹ÌÈÔ (Î·È ÔÈ ‰‡Ô ÁÔÓ›˜)

¶›Ó·Î·˜ 4. OÚÔ-ÔÌ¿‰Â˜ Î·È ÂÈÎfiÓ˜ ËÏÂÎÙÚÔÊfiÚËÛ˘ ÙˆÓ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ∞/· ÛÙÂϤ¯Ô˘˜

OÌ¿‰· ËÏÂÎÙÚÔÊfiÚËÛ˘

OÚÔ -ÔÌ¿‰·

™¯ÔÏÂ›Ô (Ù¿ÍË)

1 5 17 18 19 11 21 22

a a a a a a a a

NG C C B C NG C B

9 10

b b

D C

™3 (∆7) ™3 (∆7)

6 20

c c

NG W135

™3 (∆8) ™3 (c8)

4 8

d d

W135 A

™3 (∆9) ™3 (∆10)

2 3

DP DP

B W135

™2 (∆1) ™3 (∆11)

13 14 15 16

ND ND ND ND

NG C B B

™3 (∆12) ™3 (∆9) ™3 (∆13) ™3 (∆4)

7 12

ND ND

C NG

™3 (∆10) ™2 (∆1)

™2 ™3 ™3 ™3 ™3 ™3 ™3 ™3

(∆1) (∆2) (∆3) (∆2) (∆4) (∆3) (∆5) (∆6)

NG: ÌË ÔÌ·‰ÔÔÈÔ‡ÌÂÓÔ DP: ͯˆÚÈÛÙ‹ ËÏÂÎÙÚÔÊÔÚËÙÈ΋ ÂÈÎfiÓ· ND: ‰ÂÓ ¤ÁÈÓÂ

ÔÛÔÛÙfi ÂÏ·ÊÚ¿ ¯·ÌËÏfiÙÂÚÔ ·fi ÂΛÓÔ Ô˘ ›¯Â ·Ó·ÊÂÚı› Û ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙËÓ ∂ÏÏ¿‰· (11). ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ËÏÈΛ·, Ô ˘„ËÏfi˜ ‰Â›ÎÙ˘ Û˘ÁηÙÔ›ÎËÛ˘, ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ Î·È Ë ÚÔËÁÔ‡ÌÂÓË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÊÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Î·È ÛÙËÓ ∂ÏÏ¿‰·, fiˆ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Î·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ·fi ÙË µfiÚÂÈ· ∂˘ÚÒË (14,15). ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Ë ÚÔËÁËı›۷ ÈÔÁÂÓ‹˜ Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙË ÊÔÚ›·, ÂÓÒ Ë Û˘Û¯¤ÙÈÛË Ì ÙÔ ·ıËÙÈÎfi οÓÈÛÌ· ‰ÂÓ ÂȂ‚·ÈÒıËÎÂ,

192

fiˆ˜ Û ¿ÏϘ ÌÂϤÙ˜ (11). O ÚÔËÁËı›˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì ÔÏ˘Û·Î¯·ÚȉÈÎfi A+C ‹ Û˘Ó‰˘·Ṳ̂ÓÔ C ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ‰ÂÓ Ê¿ÓËΠӷ ÂËÚ¿˙ÂÈ ÙË ÊÔÚ›·. ∞Í›˙ÂÈ, fï˜, Ó· ÛËÌÂȈı› fiÙÈ ÙÔ Û˘ÓÔÏÈÎfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹Ù·Ó ¯·ÌËÏfi (8,1%). O ÌfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·Ú¤ÌÂÈÓ ӷ Û¯ÂÙ›˙ÂÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ì ÙË ÊÔÚ›· Î·È ÛÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË, ‹Ù·Ó Ë ËÏÈΛ· ¿Óˆ ÙˆÓ 12 ÂÙÒÓ. O ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂϯÒÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Ô˘ ÂÍÂÙ¿ÛÙËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÔ¯‹ ÛÙËÓ ÂÓÈÎÈÏ›ÓË ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÛÙÂϯÒÓ Ù˘ ÌÂϤÙ˘ Ô˘ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÂӉȿÌÂÛË ·ÓÙÔ¯‹ ÛÙËÓ ÂÓÈÎÈÏ›ÓË (22,7%) ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÂΛÓÔ Ô˘ ¤¯ÂÈ ·Ó·ÊÂÚı› Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ›‰È· ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹ (∆. ∆˙·Ó·Î¿ÎË, ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ªËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·ÓÙÔ¯‹˜ ÛÙËÓ ÂÓÈÎÈÏ›ÓË ÙˆÓ ÛÙÂϯÒÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Èı·ÓfiÓ Ó· ·ÔÙÂÏ› ˘ÂÚÂÎÙ›ÌËÛË Î·È Ó· ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ 3 ·fi Ù· 5 ÛÙÂϤ¯Ë Ì ÂӉȿÌÂÛË ·ÓÙÔ¯‹ ›¯·Ó Ù·˘ÙfiÛËÌË ËÏÂÎÙÚÔÊÔÚËÙÈ΋ ÂÈÎfiÓ· Î·È ·ÔÌÔÓÒıËÎ·Ó ·fi Ì·ıËÙ¤˜ ÙÔ˘ ›‰ÈÔ˘ Û¯ÔÏ›Ԣ, ÁÂÁÔÓfi˜ Ô˘ Èı·ÓÔÏÔÁ› ‰È·ÛÔÚ¿ ÙÔ˘ ›‰ÈÔ˘ ·ÓıÂÎÙÈÎÔ‡ ÎÏÒÓÔ˘ ·fi ·È‰› Û ·È‰›. ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÛÙÂϯÒÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·Ó‹Î ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C (31,8%) Î·È B (22,7%). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË Ì ËÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ‰›Ô ¤‰ÂÈÍ ÔÈÎÈÏÔÌÔÚÊ›· ÌÂٷ͇ ÙˆÓ ÛÙÂϯÒÓ, ·Ú’ fiÏÔ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ Û˘ÁΤÓÙÚˆÛË ÛÙÂϯÒÓ Ì ٷ˘ÙfiÛËÌË ÂÈÎfiÓ· ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ¤Ó· ·fi Ù· Û¯ÔÏ›·. ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ÛÙÔÓ ›‰ÈÔ ÎÏÒÓÔ ·Ú·ÙËÚ‹ıËÎ·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ÔÚÔ-ÔÌ¿‰Â˜, ÁÂÁÔÓfi˜ Ô˘ Èı·ÓfiÓ ˘Ô‰ËÏÒÓÂÈ ÌÂÙ·ÙÚÔ¤˜ ÛÙ· ˘‡ı˘Ó· ÁÈ· ÙȘ ÔÚÔ-ÔÌ¿‰Â˜ ÁÔÓ›‰È·. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ 3 ·fi ÙÔ˘˜ ÊÔÚ›˜ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ Ì ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘. ™Â 2 ·fi Ù· 3 ÛÙÂϤ¯Ë ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ (ÛÙÂϤ¯Ë 9 Î·È 22) (¶›Ó·Î·˜ 4), Ë ÌÂÙ·ÙÚÔ‹ ÙˆÓ ÁÔÓȉ›ˆÓ Â›Ó·È Èı·Ófi Ó· ¤ÁÈÓ ηÙfiÈÓ ›ÂÛ˘ ÂÈÏÔÁ‹˜ ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∏ ÌÂÙ·ÙÚÔ‹ ÙˆÓ


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727.5 679,0 630,5 585,0 533,5 485,0 436,5 388,0 339,5 291,0 242,5 194,0 145,5 97,0 48,5 ∂ÈÎfiÓ· 1. ∏ÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ‰›Ô (PFGE) ÌÂÙ¿ ·fi ηٿÙÌËÛË Ì ÙËÓ ÂÚÈÔÚÈÛÙÈ΋ ÂÓ‰ÔÓÔ˘ÎÏ¿ÛË Sfi I ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ 9 ÛÙÂϯÒÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘. Ï, lambda ladder, ÛًϘ 1,2,3,5 Î·È 6: ·ÓÙÈÚÔÛˆ¢ÙÈο ÛÙÂϤ¯Ë ·fi ÊÔÚ›˜ Ì ÂÈÎfiÓ· ËÏÂÎÙÚÔÊfiÚËÛ˘ Ô˘ ·Ó‹ÎÂÈ ÛÙȘ ÔÌ¿‰Â˜ c, d, b, c Î·È a, ·ÓÙ›ÛÙÔȯ· (¶›Ó·Î·˜ 4). ™Ù‹Ï˜ 4, 7, 8 Î·È 9: Ù˘¯·›· ÂÈÏÂÁ̤ӷ ÛÙÂϤ¯Ë ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ·, ηٿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô. ¡· ÛËÌÂȈı› fiÙÈ Ù· ÛÙÂϤ¯Ë ÙˆÓ ·È‰ÈÒÓ Ì ÌËÓÈÁÁ›Ùȉ· Î·È ÙˆÓ ÊÔÚ¤ˆÓ ¤¯Ô˘Ó Ù·˘ÙfiÛËÌÔ ‰·ÎÙ˘ÏÈÎfi ·ÔÙ‡ˆÌ· (ÛًϘ 3, 4, 9 Î·È ÛًϘ 6, 7, 8). ∆· ÛÙÂϤ¯Ë ·fi ÙȘ ÛًϘ 3, 4 Î·È 9 ·Ó‹ÎÔ˘Ó ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C, ÂÓÒ Ù· ÛÙÂϤ¯Ë ·fi ÙȘ ÛًϘ 6, 7 Î·È 8 ·Ó‹ÎÔ˘Ó ÛÙËÓ ÔÚÔ-ÔÌ¿‰· B.

˘‡ı˘ÓˆÓ ÁÈ· ÙȘ ÔÚÔ-ÔÌ¿‰Â˜ ÁÔÓȉ›ˆÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Î·È ÛÙÔ ·ÚÂÏıfiÓ, ·Ú’ fiÏÔ Ô˘ Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ ·˘ÙÔ‡ ‰ÂÓ Â›Ó·È ·Ôχو˜ ÁÓˆÛÙ‹ (16). ∂›Ó·È ¿ÓÙˆ˜ Èı·Ófi, Ì ÙËÓ ·˘ÍË̤ÓË ·ÓÔÛ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ Ô˘ ı· ÂÈÙ‡¯ÂÈ Ô Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜, Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ·ÚfiÌÔÈÔÈ Ì˯·ÓÈÛÌÔ› ‰È·Ê˘Á‹˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÏÔÁ‹ ÛÙÂϯÒÓ Ô˘ ı· ·ÔÈΛÛÔ˘Ó Î·È ÌÔÚ› Ó· ÚÔÎÏËıÔ‡Ó ÂȉË̛˜ ·fi ÔÚfiÙ˘Ô˘˜ Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· ˘¿Ú¯ÔÓÙ· ÂÌ‚fiÏÈ·. ∂ÈϤÔÓ, ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÚÔ·ÙÂÈ fiÙÈ ÔÈ ÔÚÔ-ÔÌ¿‰Â˜ Ô˘ Û˘¯ÓfiÙÂÚ· ·ÔÈΛ˙Ô˘Ó ÙÔ Ê¿Ú˘ÁÁ· Â›Ó·È ›‰È˜ Ì ÙȘ ÔÚÔ-ÔÌ¿‰Â˜ Ô˘ ÚÔηÏÔ‡Ó ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ ÛÙËÓ ∂ÏÏ¿‰· (9,10). ∂ÈÚfiÛıÂÙ·, Ù· ÛÙÂϤ¯Ë ÙˆÓ ·ÛıÂÓÒÓ ‚Ú¤ıËÎ·Ó ÁÂÓÂÙÈο Ù·˘ÙfiÛËÌ· Ì ÛÙÂϤ¯Ë ÊÔÚ¤ˆÓ. ŒÙÛÈ, ÂÊfiÛÔÓ Ë Î‡ÚÈ· ËÁ‹ ÌÂÙ¿‰ÔÛ˘ ·ıÔÁfiÓˆÓ ÛÙÂϯÒÓ Â›Ó·È ÔÈ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜, Ì ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÊÔÚ›·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο Ë Û˘¯ÓfiÙËÙ· ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔʇϷ͢ ÁÈ· ÙËÓ ÂÍ¿ÏÂÈ„Ë Ù˘ ÊÔÚ›·˜ ‰ÂÓ ·ÔÙÂÏ› ¿ÓÙ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÙÚfiÔ ÚfiÏË-

„˘ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘. Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Ù· Û˘Ó‰Â‰Â̤ӷ ÂÌ‚fiÏÈ· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÊÔÚÂ���·˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ C (16,17). ∂¿Ó ÏËÊı› ˘’ fi„ÈÓ fiÙÈ Ë ÔÚÔÔÌ¿‰· C ·ÓÙÈÚÔÛˆ‡ÂÈ ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙfiÛÔ Ù˘ ÊÔÚ›·˜, fiÛÔ Î·È Ù˘ ÓfiÛÔ˘, Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·Ó·Ì¤ÓÂÙ·È Ó· ÌÂÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ Â›ÙˆÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÛÙËÓ ∂ÏÏ¿‰·. ∏ ·Ô˘Û›· ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÁÈ· fiϘ ÙȘ ÔÌ¿‰Â˜ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÂÈ‚¿ÏÏÂÈ ÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ‰˘Ó·ÌÈ΋˜ Ù˘ ÊÔÚ›·˜, ·ÏÏ¿ Î·È Ù˘ ÓfiÛÔ˘, Ì ÛÎÔfi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ÚfiÏË„Ë. ∂ÈϤÔÓ, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ˘¿Ú¯ÂÈ Û˘Ó¯‹˜ ÂȉËÌÈÔÏÔÁÈ΋ ÂÈÙ‹ÚËÛË ÙˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ÛÙËÓ ∂ÏÏ¿‰·, Ì ÛÎÔfi ÙË ‰È·ÌfiÚʈÛË ÛÙÚ·ÙËÁÈ΋˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ٷ ‹‰Ë ˘¿Ú¯ÔÓÙ· ÂÌ‚fiÏÈ·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Caugant DA, Hoiby EA, Rosenqvist E, Froholm LO, Selander RK. Transmission of Neisseria meningitidis among asymptomatic military recruits and antibody analysis. Epidemiol Infect 1992;109:241-253. 2. Stephens DS. Uncloaking the meningococcus: dynamics of carriage and disease. Lancet 1999;353:941-943. 3. Cartwright K. Meningococcal carriage and disease. In: Cartwright K, editor. Meningococcal disease. 1st edition. Chichester, UK: John Wiley and Sons; 1995. p. 114-146. 4. Stuart JM, Cartwright KA, Robinson PM, Noah ND. Effect of smoking on meningococcal carriage. Lancet 1989;2:723725. 5. Caugant DA, Hoiby EA, Magnus P, Scheel O, Hoel T, Bjune G et al. Asymptomatic carriage of Neisseria meningitidis in a randomly sampled population. J Clin Microbiol 1994;32:323-330. 6. Apicella MA. Neisseria meningitidis. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 5th edition. London: Churchill Livingstone; 2000. p. 2228-2241. 7. Tsolia M, Theodoridou M, Tzanakaki G, Kalabalikis P, Vrani E, Mostrou G et al. A population-based multicenter study of invasive meningococcal disease in children in the area of Athens. The 18th Annual Meeting of the European Society for Paediatric Infectious Diseases; 2000 May 3-5; Noordwijk, The Netherlands: 2000. abstr. 0-6. 8. Theodoridou M, Pavlopoulou ID, Stamatiadis D, Mostrou G, Pangalis A, Papaevangelou V et al. Acute bacterial meningitis in Greek children: a 15-year overview. The 18th Annual Meeting of the European Society for Paediatric Infectious Diseases; 2000 May 3-5; Noordwijk, The Netherlands: 2000. abstr. 55. 9. ∂ȉËÌÈÔÏÔÁÈÎfi ¢ÂÏÙ›Ô §ÔÈ̈‰ÒÓ ¡ÔÛËÌ¿ÙˆÓ ∂ÏÏ¿‰Ô˜. ªËÓÈ·›· ŒÎ‰ÔÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¶·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¶·Ú¤Ì‚·Û˘ (∂∫∂¶∞¶) ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ ¶ÚfiÓÔÈ·˜ 1999;2:81-82.

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10. Kremastinou J, Tzanakaki G, Kansouzidou A, Pagalis A, Danielides V, Kouppari G et al. Recent emergence of serogroup C meningococcal disease in Greece. FEMS Immunol Med Microbiol 1999;23:49-55. 11. Kremastinou J, Blackwell C, Tzanakaki G, Kallergi C, Elton R, Weir D. Parental smoking and carriage of Neisseria meningitidis among Greek schoolchildren. Scand J Infect Dis 1994;26:719-723. 12. Kremastinou J, Tzanakaki G, Velonakis E, Voyiatzi A, Nickolaou A, Elton RA et al. Carriage of Neisseria meningitides and Neisseria lactamica among ethnic Greek schoolchildren from Russian immigrant families in Athens. FEMS Immunol Med Microbiol 1999;23:13-20. 13. Breakpoints in in-vitro antibiotic sensitivity testing. Report by a working party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 1988;21:701-710. 14. Broome CV. The carrier state: Neisseria meningitidis. J Antimicrob Chemother 1986;18 (Suppl A):S25-S34.

15. Fitzpatrick PE, Salmon RL, Hunter PR, Roberts RJ, Palmer SR. Risk factors for carriage of Neisseria meningitidis during an outbreak in Wales. Emerg Infect Dis 2000;6:65-69. 16. Ala’Aldeen DA, Neal KR, Ait-Tahar K, Nguyen-Van-Tam JS, English A, Falla TJ et al. Dynamics of meningococcal longterm carriage among university students and their implications for mass vaccination. J Clin Microbiol 2000;38:2311-2316. 17. Zhang Q, Choo S, Everard J, Jennings R, Finn A. Mucosal immune responses to meningococcal group C conjugate and group A and C polysaccharide vaccines in adolescents. Infect Immun 2000;68:2692-2697. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-08-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-02-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆ¿ÓÓ· ¶·˘ÏÔÔ‡ÏÔ˘ ºÂȉ›Ô˘ 25, ∆.∫. 155 62, ÃÔÏ·ÚÁfi˜, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∞ÓÙÈ‚ÈÔÙÈο ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ ÛÙ· ·È‰È¿1 ™ÎÔfi˜: ∏ ÔÍ›· ̤ÛË ˆÙ›Ùȉ· Â›Ó·È Ì›· ·fi ÙȘ ÈÔ ÎÔÈÓ¤˜ ÓfiÛÔ˘˜ Ù˘ ‚ÚÂÊÈ΋˜ Î·È ·È‰È΋˜ ËÏÈΛ·˜. ∏ ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ ÔÈΛÏÏÂÈ ·fi 31% ÛÙËÓ OÏÏ·Ó‰›· ¤ˆ˜ 98% ÛÙȘ ∏¶∞ Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·. O ÛÎÔfi˜ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ë ·ÔÙ›ÌËÛË ÙˆÓ Û˘ÓÂÂÈÒÓ Ù˘ ¯Ú‹Û˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ·È‰È¿ Ì ÔÍ›· ̤ÛË ˆÙ›Ùȉ·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÍÂÙ¿ÛÙËÎ·Ó ÂÓ‰ÂϯҘ ÙÔ Cochrane Controlled Trials Register, ÙÔ Medline, ÙÔ Index Medicus (ÚÔ ÙÔ˘ 1965) Î·È ÔÈ Î·Ù¿ÏÔÁÔÈ ÙˆÓ ·Ó·ÊÔÚÒÓ ÙˆÓ ¿ÚıÚˆÓ ·fi ÙÔ 1958 ¤ˆ˜ ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2000. ∫ÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ·ÔÙ¤ÏÂÛ·Ó Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ ·È‰ÈÒÓ Ì ÔÍ›· ̤ÛË ˆÙ›Ùȉ·, ÛÙȘ Ôԛ˜ Û˘ÁÎÚ›ıËÎ·Ó ·ÓÙÈÌÈÎÚԂȷο Ê¿Ú̷η Ì placebo. ∞fi ÙÚÂȘ ·ÓÂÍ¿ÚÙËÙÔ˘˜ ÎÚÈÙ¤˜, ÂÎÙÈÌ‹ıËÎÂ Ë ÔÈfiÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ‰ÔÎÈÌÒÓ Î·È ÂÍ‹¯ıËÛ·Ó ÏËÚÔÊÔڛ˜. ∞ÔÙÂϤÛÌ·Ù·: ¢¤Î· ÌÂϤÙ˜ ‹Ù·Ó ηٿÏÏËϘ, ·ÏÏ¿ ÌfiÓÔ ÂÙ¿ ÌÂϤÙ˜ ÌÂ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi 2202 ·È‰ÈÒÓ, ÂÚÈ›¯·Ó ÛËÌ›· ¤Î‚·Û˘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·Ó ÛÙÔÓ ›‰ÈÔ ÙÔÓ ·ÛıÂÓ‹. ∏ ÔÈfiÙËÙ· Ù˘ ÌÂıÔ‰ÔÏÔÁ›·˜ ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ‹Ù·Ó ÁÂÓÈο ˘„ËÏ‹. ŸÏ˜ ÔÈ ÌÂϤÙ˜ ‹Ù·Ó ·fi ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ™‡Ìʈӷ Ì ÙȘ ÌÂϤÙ˜, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÂÍ·Ûı¤ÓËÛË ÙÔ˘ fiÓÔ˘ Û 24 ÒÚ˜, ÛÙÔ 28% (95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜: 15% ¤ˆ˜ 38%) ˘‹ÚÍ ÂÍ·Ûı¤ÓËÛË ÙÔ˘ fiÓÔ˘ Û 2-7 Ë̤Ú˜. ∂ÊfiÛÔÓ ÙÔ 80% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ı· ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ‡ÊÂÛË ·˘ÙfiÌ·Ù· ̤¯ÚÈ ·˘Ùfi ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ì ‚¿ÛË Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ Û˘ÓÂ¿ÁÂÙ·È fiÙÈ Ë ·fiÏ˘ÙË ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÓÔ˘ ı· ·ÊÔÚ¿ ÛÙÔ 5% ‹ fiÙÈ Â-

194

Ú›Ô˘ 17 ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ì ·ÓÙÈ‚ÈÔÙÈο ÚÔÎÂÈ̤ÓÔ˘ Ó· ÚÔÏËÊı› Û 1 ·È‰› Ë ÂÈÌÔÓ‹ ÙÔ˘ fiÓÔ˘ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 2 Ë̤Ú˜. ¢ÂÓ ‰È·ÈÛÙÒıËΠη̛· Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ÚÔ‚Ï‹Ì·Ù· ·ÎÔ‹˜ Ô˘ ÚÔÎÏ‹ıËÎ·Ó ·fi ÙËÓ ÔÍ›· ̤ÛË ˆÙ›Ùȉ·, fiˆ˜ ηٷÁÚ¿ÊËΠ·fi ÙËÓ Â·ÎfiÏÔ˘ıË Ù˘Ì·ÓÔÌÂÙÚ›·. øÛÙfiÛÔ, ·ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠‰‡Ô ÌfiÓÔ ÌÂϤÙ˜ Î·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ‹Ù·Ó ÂÏÏÈ‹˜. ™ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Ï›Á˜ ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜: Ì›· ÌfiÓÔ ÂÚ›ÙˆÛË Ì·ÛÙÔÂȉ›Ùȉ·˜, Ô˘ ÂÌÊ·Ó›ÛÙËΠÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏ›Ó˘. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÓÙÈ‚ÈÔÙÈο ÚÔÛʤÚÔ˘Ó ÌÈÎÚfi fiÊÂÏÔ˜ ÛÙËÓ ÔÍ›· ̤ÛË ˆÙ›Ùȉ· ÛÙ· ·È‰È¿. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·˘ÙfiÌ·Ù· ‡ÊÂÛË, ÙÔ fiÊÂÏÔ˜ ı· Ú¤ÂÈ Ó· Û˘ÁÎÚÈı› Ì ÙȘ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ∏ ıÂÚ·›· Ì ·ÓÙÈ‚ÈÔÙÈο ÌÔÚ› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ì›ˆÛË Ù˘ Èı·ÓfiÙËÙ·˜ Ì·ÛÙÔÂȉ›Ùȉ·˜ Û ÏËı˘ÛÌÔ‡˜ Ô˘ ·˘Ù‹ Â›Ó·È Û˘¯ÓfiÙÂÚË.

1 Glasziou PP, Del Mar CB, Sanders SL, Hayem M Antibiotics for acute otitis media in children The Cochrane Library, Issue 4, 2002. Oxford: Update Software

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ORIGINAL ARTICLE

§ÂÌÊÒÌ·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∂ÌÂÈÚ›· 10 ¯ÚfiÓˆÓ º. ∞ı·Ó·ÛÈ¿‰Ô˘1, £. ∆Ú·ÁÈ·ÓÓ›‰Ë˜1, £. ¶··ÁˆÚÁ›Ô˘1, µ. ∫·ÏÔ‡ÙÛË2, ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1, ª. ™Ù¿ÌÔ˘1, ¢. ∫·ÙÚÈÔ‡1

Lymphomas in childhood. Ten years’ experience F. Athanassiadou1, T. Tragiannidis1, T. Papageorgiou1, V. Kaloutsi2, M. Hatzistilianou1, M. Stamou1, D. Katriou1

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ÎÏÈÓÈ΋ ·ÚÔ˘Û›·ÛË Î·È Ù· ıÂÚ·¢ÙÈο ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ·È‰ÈÒÓ Ì Hodgkin (HD) Î·È ÌË Hodgkin ϤÌʈ̷ (NHL) Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÎÏÈÓÈ΋ ÙË ‰ÂηÂÙ›· 1992-2002. ÀÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 38 ·È‰È¿ ËÏÈΛ·˜ 2 ¤ˆ˜ 15 ¯ÚfiÓˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ٷ ÚˆÙfiÎÔÏÏ· LSA2-L2, BFM Î·È ÙÔ ˘‚ÚȉÈÎfi ÚˆÙfiÎÔÏÏÔ COPP/ABVD. °È· οı ·È‰› ¤ÁÈÓ ηٷÁÚ·Ê‹ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜, ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ ÂχıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË Û ÚÒÙË ‡ÊÂÛË (event free survival - EFS) Î·È Ë Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ (overall survival - OS) ˘ÔÏÔÁ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Kaplan-Meier. ∞fi Ù· 38 ·È‰È¿, 16 (42,1%) Ù·ÍÈÓÔÌ‹ıËÎ·Ó ˆ˜ HD, ÂÓÒ 22 ·È‰È¿ (57,9%) ˆ˜ NHL. ∆· 27 ‹Ù·Ó ·ÁfiÚÈ· (71,1%) Î·È Ù· 11 ÎÔÚ›ÙÛÈ· (28,9%). ∏ ̤ÛË ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 9 ¯ÚfiÓÈ· (9±6,04). ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÚԤ΢„·Ó Ù· ÂÍ‹˜: 26 ·fi Ù· 38 ·È‰È¿ ›¯·Ó ·ÚÈıÌfi Ï¢ÎÒÓ <10.000/mm3 (68,4%), 28/38 Hb >10 g/dL (73,7%), 10/38 LDH >1000 U/L (26,3%) Î·È 7/38 ›¯·Ó ∆∫∂ >100 mm (18,4%). ∞fi Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ηٷÁÚ¿ÊËΠ˘ÚÂÙfi˜ Û ÔÛÔÛÙfi 39,5%, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÛÙÔ 42,1% Î·È Ó˘¯ÙÂÚÈÓÔ› ȉÚÒÙ˜ ÛÙÔ 26,3% ÙˆÓ ·È‰ÈÒÓ. ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· (>3 cm) ›¯Â ÙÔ 36,8%, ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÙÔ 76,3%, ‰ÈfiÁΈÛË ÙˆÓ ·‰¤ÓˆÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÙÔ 73,7% Î·È ÙˆÓ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ÙÔ 26,3%. ∏ ηٷÓÔÌ‹ ηٿ ÛÙ¿‰È· ‹Ù·Ó Ë ÂÍ‹˜: ÛÙÔ ÛÙ¿‰ÈÔ I ·Ó‹Î ÙÔ 7,9% (3 ·È‰È¿), ÛÙÔ II ÙÔ 52,6% (20 ·È‰È¿), ÛÙÔ III ÙÔ 31,6% (12 ·È‰È¿) Î·È ÛÙÔ IV ÙÔ 7,9%

Abstract: This is a study of children with Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL), admitted to the paediatric clinic during the period 1992-2002. The study includes 38 children aged between 2 and 15 years with lymphoma, treated with the protocols LSA2-L2, BFM and COPP/ABVD. The sex of the children and age at diagnosis, clinical and laboratory data at admission and the findings on radiological and histological investigation were evaluated. Event free survival (EFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Sixteen of the 38 children (42.1%) were diagnosed as HD and 22 (57.9%) as NHL. Twentyseven children (71.1%) were males and 11 (28.9%) females, and their mean age at admission was 9 years (9±6.04). Laboratory findings at admission showed that 68.4% had WBC <10.000/mm3, 73.7% had Hb >10 g/dL, 26.3% had LDH >1000 U/L and 18.4% had ESR >100 mm. Fever was documented in 39.5%, weight loss in 42.1% and night sweats in 26.3%. Hepatosplenomegaly (>3 cm) was found in 36.8%, and cervical, mediastinal, and retroperitoneal lymphadenopathy in 76.3%, 73.7% and 26.3% respectively. The disease was staged at: stage I 7.9%, stage II 52.6%, stage III 31.6% and stage IV 7.9%. Half of the children with HD were aged >10 years while 72.7% with NHL were aged between 5 and 10 years. Boys constituted 77.3% of the children with NHL and 62.5% of those with HD. Fever was present in 56.3% of those with HD and 27.3% of those with NHL. EFS at the first remission was 77.05% (±6.58%) and OS 91.27% (±4.36%). EFS in correlation to the type of lymphoma was 71.79% (±11.58%) for HD and 79.6% (±8.02%) for

1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ 2 ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢

1 2nd Paediatric Clinic of Aristotelion University, Thessaloniki 2 Laboratory of Clinical Pathology of Aristotelion University, Thessaloniki

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(3 ·È‰È¿). ∆· ÌÈÛ¿ ·È‰È¿ Ì HD (50%) ‹Ù·Ó ËÏÈΛ·˜ >10 ¯ÚfiÓˆÓ, ÂÓÒ ÙÔ 72,7% ÙˆÓ NHL ‹Ù·Ó ËÏÈΛ·˜ 5-10 ¯ÚfiÓˆÓ. ∆Ô 77,3% ÙˆÓ NHL ‹Ù·Ó ·ÁfiÚÈ·, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ HD ‹Ù·Ó 62,5%. ¶˘ÚÂÙfi ›¯Â ÙÔ 56,3% ÙˆÓ HD, ¤Ó·ÓÙÈ 27,3% ÙˆÓ NHL. ªÂ ̤ÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù· 4,8 ¤ÙË, Ë EFS Û ÚÒÙË ‡ÊÂÛË Â›Ó·È 77,05% (±6,58%) ��·È Ë OS 91,27% (±4,36%). ∏ ·Ó¿Ï˘ÛË Ù˘ Èı·ÓfiÙËÙ·˜ EFS Û ۯ¤ÛË Ì ÙÔÓ Ù‡Ô ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Â›Ó·È 71,79% (±11,58%) ÁÈ· Ù· ·È‰È¿ Ì HD, ¤Ó·ÓÙÈ 79,6% (±8,02%) ÁÈ· ÂΛӷ Ì NHL. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 16 ·È‰ÈÒÓ Ì HD Î·È ÙˆÓ 22 Ì NHL, ˘ÔÙÚÔ›·Û·Ó 5 Î·È 5 ·È‰È¿, ·ÓÙ›ÛÙÔȯ·. ∞fi ·˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ÚÔ·ÙÂÈ fiÙÈ Ë OS Î·È Ë EFS, Ì ٷ Û‡Á¯ÚÔÓ· ıÂÚ·¢ÙÈο ÚˆÙfiÎÔÏÏ·, ηٷÁÚ¿ÊËÎ·Ó Û Ï‹ÚË ·ÓÙÈÛÙÔȯ›· Ì ٷ ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ. ™˘ÁÎÚÈÙÈο ÚÔ·ÙÂÈ Î·Ï‡ÙÂÚË ¤Î‚·ÛË ÁÈ· Ù· ·È‰È¿ Ì NHL, Ô˘ ÔÊ›ÏÂÙ·È Èı·ÓfiÓ ÛÙËÓ ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÂÈ‚¿ÏÏÔ˘Ó ÙËÓ ¤ÁηÈÚË ÚÔۤϢÛË, ‰È¿ÁÓˆÛË Î·È ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË.

NHL. Relapses occurred in 5/16 and 5/22 children with HD and NHL respectively. In conclusion, the OS and EFS in this group of children were equivalent to those treated with modern chemotherapy protocols reported in the international bibliography. Comparing HD and NHL, better outcome for children with NHL was noted, possibly due to more timely admission, diagnosis and start of treatment.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ Hodgkin, ÌË Hodgkin ϤÌʈ̷, ÂÈ‚›ˆÛË ÂχıÂÚË ÓfiÛÔ˘, ·È‰È΋ ËÏÈΛ·.

Key words: Hodgkin disease, non-Hodgkin lymphoma, event free survival, childhood.

∂ÈÛ·ÁˆÁ‹ ∆· ÏÂÌÊÒÌ·Ù· ·ÔÙÂÏÔ‡Ó ÙÔ ÙÚ›ÙÔ Î·Ù¿ Û˘¯ÓfiÙËÙ· ηÎfiËı˜ ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌÂÙ¿ ÙËÓ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· Î·È ÙÔ˘˜ ÚˆÙÔ·ı›˜ fiÁÎÔ˘˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·ÓÙÈÚÔÛˆ‡ÔÓÙ·˜ ÂÚ›Ô˘ ÙÔ 10-15% ÙˆÓ Î·ÎÔËıÂÈÒÓ (1). ¢È·ÎÚ›ÓÔÓÙ·È ÛÙ· ÌË Hodgkin ÏÂÌÊÒÌ·Ù· (NHL) Î·È ÛÙ· Hodgkin ÏÂÌÊÒÌ·Ù· (HD). ∆· NHL ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· Û ۯ¤ÛË Ì ٷ HD ÛÙËÓ ·È‰È΋ ËÏÈΛ· (·Ó·ÏÔÁ›· 3/2), ÂÓÒ Ë Î·Ù·ÓÔÌ‹ ÛÙ· ‰‡Ô ʇϷ Â›Ó·È 3:1 Ì ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ (1-3). ∆· NHL ·ÔÙÂÏÔ‡Ó Î·ÎfiËı˜ ÓfiÛËÌ· ÙÔ˘ ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡ (ÏÂÌÊ·‰¤Ó˜ ‹ Â͈ÏÂÌÊ·‰ÂÓÈο fiÚÁ·Ó·). ∞ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÚ›Ô˘ ÙÔ 7-10% ÙˆÓ Î·ÎÔ‹ıˆÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (2,4,5). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ NHL Â›Ó·È ˘„ËÏfiÙÂÚË ÛÙËÓ ∞ÊÚÈ΋, ÁÂÁÔÓfi˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Burkitt ÛÙËÓ ÂÚÈÔ¯‹, ÙÔ ÔÔ›Ô Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙÔÓ Èfi Epstein-Barr (EBV) Û ÔÛÔÛÙfi ¤ˆ˜ Î·È 95% (2,4,6). ∞ÓÙ›ıÂÙ·, ÛÙËÓ ∂˘ÚÒË Î·È ÛÙË µfiÚÂÈ· ∞ÌÂÚÈ΋, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ NHL Â›Ó·È ∆ ‹ µ (ÌË Burkitt) ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È ÌfiÓÔ ÙÔ 10-15% ʤÚÂÈ ÙÔ Á¤ÓˆÌ· ÙÔ˘ EBV (5). °ÂÓÂÙÈÎÔ› ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÙˆÓ NHL Â›Ó·È ÔÈ ÎÏËÚÔÓÔÌÈΤ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Wiskott-Aldrich, Ë ·Ù·Í›· ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Î·È ÙÔ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ, ηıÒ˜ Î·È ÔÈ Â›ÎÙËÙ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ, fiˆ˜ Ë ·ÓÔ-

ÛÔηٷÛÙÔÏ‹ Ô˘ ·ÎÔÏÔ˘ı› ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ‹ ÙÔ˘ ‹·ÙÔ˜ (1,2). ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘Ó ÛÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ NHL Â›Ó·È Ë ·ÎÙÈÓÔ‚ÔÏ›· Î·È ÔÚÈṲ̂ÓÔÈ ÈÔ› fiˆ˜ Ô EBV Î·È Ô Èfi˜ Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV). ∏ ÓfiÛÔ˜ ÙÔ˘ Hodgkin ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔԉ¢ÙÈ΋, ·ÓÒ‰˘ÓË ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ, Û˘¯ÓfiÙÂÚ· Ù˘ ÙÚ·¯ËÏÈ΋˜ ¯ÒÚ·˜. ∏ ÓfiÛÔ˜ ·Ú¯Èο ÚÔÛ‚¿ÏÏÂÈ ¤Ó· ÌÔÓ‹ÚË ÏÂÌÊ·‰¤Ó· ‹ ÔÌ¿‰· ÏÂÌÊ·‰¤ÓˆÓ, ÂÓÒ Û ÚÔ¯ˆÚË̤ÓÔ ÛÙ¿‰ÈÔ ÌÔÚ› Ó· ÂÈÓ¤ÌÂÙ·È Î·È fiÚÁ·Ó·. ∏ ηÌ‡ÏË Û˘¯ÓfiÙËÙ·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ·È¯Ì‹ Û ËÏÈΛ· 15-35 ÂÙÒÓ Î·È Ì›· ‰Â‡ÙÂÚË Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (>50 ¯ÚfiÓÈ·) (1,4,7). ™ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ÂÓ¤¯ÔÓÙ·È ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÂÓÒ ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Û ¿ÙÔÌ· Ì ÓÔÛ‹Ì·Ù· fiˆ˜ Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ (™∂§), Ë ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ· Î·È Ë ·Ù·Í›· ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (1,7,8). ∂›Û˘, Ô EBV ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ HD, ·ÊÔ‡ ÌÂϤÙ˜ ·¤‰ÂÈÍ·Ó ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ EBV ÛÙ· ·ÙÙ·Ú· ReedSternberg Ì ÌÔÚȷΤ˜ Ù¯ÓÈΤ˜ (PCR), Û ÔÛÔÛÙfi Ô˘ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 60% ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ·Ú·Û΢·ÛÌ¿ÙˆÓ ·È‰ÈÒÓ Ì HD.

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ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÀÏÈÎfi Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 38 ·È‰È¿ ËÏÈΛ·˜ 2-15 ÂÙÒÓ Ì ϤÌʈ̷, Ù· ÔÔ›· ÓÔÛËχÙËÎ·Ó ÛÙË µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ∞.¶.£. ÙÔ ¯ÚÔÓÈÎfi


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‰È¿ÛÙËÌ· ·fi ÙÔÓ πÔ‡ÏÈÔ 1992 ˆ˜ ÙÔÓ πÔ‡ÏÈÔ 2002 Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ٷ ÚˆÙfiÎÔÏÏ· LSA2-L2, BFM Î·È ÙÔ ˘‚ÚȉÈÎfi COPP/ABVD. °È· οı ·È‰› ¤ÁÈÓ ηٷÁÚ·Ê‹ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜, ÙˆÓ ÎÏÈÓÈÎÒÓ (Ë·ÙÔÌÂÁ·Ï›·, ÛÏËÓÔÌÂÁ·Ï›·, ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ‰ÈfiÁΈÛË ·‰¤ÓˆÓ ÌÂÛÔıˆÚ·Î›Ô˘/ÎÔÈÏ›·˜, ˘ÚÂÙfi˜, Ó˘ÎÙÂÚÈÓÔ› ȉÚÒÙ˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜) Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ (ÁÂÓÈ΋ ·›Ì·ÙÔ˜, Á·Ï·ÎÙÈ΋ ‰Â¸‰ÚÔÁÂÓ¿ÛË, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË, ∆∫∂, ÊÂÚÚÈÙ›ÓË) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ηıÒ˜ Î·È Ù˘ ÈÛÙÔÏÔÁÈ΋˜ ÂͤٷÛ˘ Î·È ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ ÛÙ·‰ÈÔÔ›ËÛË Ù˘ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤ÁÈÓ Ì ٷ ÎÚÈÙ‹ÚÈ· Ann Arbor ÁÈ· Ù· ·È‰È¿ ÛÙ· ÔÔ›· ‰È·ÁÓÒÛÙËΠHD, ÂÓÒ Ì ٷ ÎÚÈÙ‹ÚÈ· Murphy ÁÈ· ÂΛӷ Ì NHL. ∏ ÂχıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË Û ÚÒÙË ‡ÊÂÛË (event free survival EFS) Î·È Ë Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ (overall survival OS) ˘ÔÏÔÁ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Kaplan-Meier, Ì ̤ÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù· 4,8 ¤ÙË Î·È Û˘Û¯ÂÙ›ÛÙËÎ·Ó Ì ÙȘ ÎÏÈÓÈΤ˜ Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ηٷÁÚ¿ÊËηÓ. ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· Î·È ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS.

∞ÔÙÂϤÛÌ·Ù· ∞fi Ù· 38 ·È‰È¿ Ô˘ ÓÔÛËχÙËηÓ, 16 (42,1%) Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÙËÓ HD, ÂÓÒ 22 (57,9%) ÛÙ· NHL. ∆· 27 (71,1%) ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù· 11 (28,9%) ÎÔÚ›ÙÛÈ·. ∏ ̤ÛË ËÏÈΛ· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó 9 ¯ÚfiÓÈ· (9±6,04). ∆Ô 60,5% ÙˆÓ ·È‰ÈÒÓ Â›¯Â ËÏÈΛ· 5-10 ¯ÚfiÓˆÓ Î·È ÙÔ 31,5% ›¯Â ËÏÈΛ· >10 ¯ÚfiÓˆÓ. ∞fi ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Ì ÙËÓ ËÏÈΛ· ÚԤ΢„ fiÙÈ ÛÙËÓ HD ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ Â›¯Â ËÏÈΛ· >10 ¯ÚfiÓˆÓ Î·È ÙÔ 43,8% 5-10 ¯ÚfiÓˆÓ, ÂÓÒ ÛÙ· NHL ÙÔ 18,2% ‹Ù·Ó ËÏÈΛ·˜ >10 ¯ÚfiÓˆÓ Î·È ÙÔ 72,7% 5-10 ¯ÚfiÓˆÓ. ∞fi Ù· ·È‰È¿ Ì HD, ÙÔ 62,5% ‹Ù·Ó ·ÁfiÚÈ· (10 ·È‰È¿), ÂÓÒ ÛÙ· ·È‰È¿ Ì NHL ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 77,3% (17 ·È‰È¿). ∞fi Ù· 38 ·È‰È¿, ÙÔ 68,4% (26 ·È‰È¿) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ›¯Â ·ÚÈıÌfi Ï¢ÎÒÓ <10.000/mm3 Î·È ÙÔ 23,7% 10.000-25.000/mm3. ∏ ÙÈÌ‹ Ù˘ Hb ÛÙÔ 73,7% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó >10 g/dL Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙÔ 71,1% ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 100.000-450.000/mm3, ÂÓÒ ÛÙÔ 10,5% ‹Ù·Ó >450.000/mm3. ∞˘ÍË̤ÓË LDH >1000 U/L ›¯Â ÙÔ 26,3%, ÊÂÚÚÈÙ›ÓË >150 ng/dl ÙÔ 23,7% Î·È ALP >250 U/L ÙÔ 63,2% ÙˆÓ ·È‰ÈÒÓ. ∞fi Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ 36,8% (10 ·È‰È¿) ÂÌÊ¿ÓÈ˙ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· (>3 cm), ÙÔ 76,3% (29 ·È‰È¿) ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÙÔ 73,7% (28 ·È‰È¿) ‰ÈÔÁΈ̤ÓÔ˘˜ ÏÂÌÊ·‰¤Ó˜ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È ÙÔ 26,3% (10 ·È‰È¿) ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÔ‡˜. ¶˘ÚÂÙfi ·ÚÔ˘Û›·˙ ÙÔ 39,5% (15 ·È‰È¿), ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÙÔ 42,1% (16 ·È‰È¿) Î·È Ó˘ÎÙÂÚÈÓÔ‡˜ ȉÚÒÙ˜ ÙÔ 26,3% ÙˆÓ ·È‰ÈÒÓ. ™‡Ìʈӷ Ì ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË, 12 ·fi Ù· 16 ·È‰È¿, ÛÙ· ÔÔ›· Ë ‰È¿ÁÓˆÛË ‹Ù·Ó HD, Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÙÔÓ Ù‡Ô Ù˘ Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛ˘

Paediatriki 2003;66:195-201

(75%) Î·È 4 Û ÂΛÓÔÓ Ù˘ ÌÈÎÙ‹˜ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ (25%). ∞fi Ù· ·È‰È¿ Ì NHL, ÙÔ 54,5% (12 ·È‰È¿) Ù·ÍÈÓÔÌ‹ıËΠÛÙ· ÏÂÌÊÔ‚Ï·ÛÙÈο ÏÂÌÊÒÌ·Ù·, ÙÔ 41% ÛÙ· ·‰È·ÊÔÚÔÔ›ËÙ· (·fi ÌÈÎÚ¿ ·ÙÙ·Ú· ¯ˆÚ›˜ ÂÓÙÔÌ‹) Burkitt/ÌË Burkitt, ÂÓÒ, Ù¤ÏÔ˜, 1 ·È‰› Ì Ki-1 ϤÌʈ̷ Ù·ÍÈÓÔÌ‹ıËΠÛÙ· ·ÓÔÛÔ‚Ï·ÛÙÈο ‹ ÈÛÙÈÔ΢ÙÙ·ÚÈο (ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 4,5%) (∂ÈÎfiÓ· 1). ∏ ηٷÓÔÌ‹ ηٿ ÛÙ¿‰ÈÔ ‹Ù·Ó Ë ÂÍ‹˜: ÛÙ¿‰ÈÔ I 7,9% (3 ·È‰È¿), ÛÙ¿‰ÈÔ II 52,6% (20 ·È‰È¿), ÛÙ¿‰ÈÔ III 31,6% (12 ·È‰È¿) Î·È ÛÙ¿‰ÈÔ IV 7,9% (3 ·È‰È¿). ∞fi ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢ÎÒÓ ‰ÂÓ ÚԤ΢„ η̛· Ô˘ÛÈ·ÛÙÈ΋ ‰È·ÊÔÚ¿, ·ÊÔ‡ ÙÔ 68,8% ÙˆÓ ·È‰ÈÒÓ Ì HD ›¯Â ·ÚÈıÌfi <10.000/mm3, ¤Ó·ÓÙÈ ÔÛÔÛÙÔ‡ 68,2% ÙˆÓ ·È‰ÈÒÓ Ì NHL. ∞ÓÙ›ıÂÙ·, ·Ó·ÈÌ›· (Hb <10 g/dL) ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ Ì NHL, ·ÊÔ‡ ‚Ú¤ıËΠÛÙÔ 36,4% (8 ·È‰È¿) Ì NHL, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì HD ‹Ù·Ó 12,5% (2 ·È‰È¿). ∞˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ (>450.000/mm3) ‚Ú¤ıËΠ۠4 ·È‰È¿ Ì HD (25%), ÂÓÒ Û ηӤӷ ·È‰› Ì NHL. ∏ ÙÈÌ‹ Ù˘ LDH ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‚Ú¤ıËΠӷ ¤¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ٷ NHL, ·ÊÔ‡ 9 ·È‰È¿ Ì NHL (40,9%) ·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ (>1000 U/L). ∞ÓÙ›ıÂÙ·, Ë ∆∫∂ Ê·›ÓÂÙ·È fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ·‡ÍËÛË (>100 mm) Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ Ì HD, ·ÊÔ‡ ‹Ù·Ó ·˘ÍË̤ÓË ÛÙÔ 31,3% ·˘ÙÒÓ, ¤Ó·ÓÙÈ ÔÛÔÛÙÔ‡ 9,1% ÙˆÓ ·È‰ÈÒÓ Ì NHL. ∏ ÙÈÌ‹ Ù˘ ALP ‹Ù·Ó ·˘ÍË̤ÓË ÛÙÔ 68,8% ÙˆÓ ·È‰ÈÒÓ Ì HD, ¤Ó·ÓÙÈ 59,1% ÙˆÓ ·È‰ÈÒÓ Ì NHL (¶›Ó·Î·˜ 1). ∞fi Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÚԤ΢„ fiÙÈ ˘ÚÂÙfi ›¯Â ÙÔ 56,3% (9 ·È‰È¿) ÙˆÓ ·È‰ÈÒÓ Ì HD Î·È ÙÔ 60

54,5

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∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Î·È Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ Ù‡ˆÓ ÙˆÓ NHL.

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¶·È‰È·ÙÚÈ΋ 2003;66:195-201

Paediatriki 2003;66:195-201

27,3% ÂÎÂ›ÓˆÓ Ì NHL (6 ·È‰È¿). ¡˘ÎÙÂÚÈÓÔ‡˜ ȉÚÒÙ˜ ·ÚÔ˘Û›·˙·Ó 5 ·È‰È¿ ·fi οı ÔÌ¿‰·. ∞ÒÏÂÈ· ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ·ÚÔ˘Û›·˙ ÙÔ 37,5% Ì HD (6 ·È‰È¿) Î·È ÙÔ 45,5% Ì NHL (10 ·È‰È¿). ™˘ÌÌÂÙÔ¯‹ ÙˆÓ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ·ÚÔ˘Û›·˙ ÙÔ 25% Ì HD (4 ·È‰È¿), ¤Ó·ÓÙÈ 27,3% Ì NHL (6 ·È‰È¿). ∆Ú·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ›¯Â ÙÔ 75% Ì HD (12 ·È‰È¿), ¤Ó·ÓÙÈ 77,3% ÙˆÓ ·È‰ÈÒÓ Ì NHL (17 ·È‰È¿). ™˘ÌÌÂÙÔ¯‹ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‚Ú¤ıËΠÛÙÔ 93,8% ÙˆÓ ·È‰ÈÒÓ Ì HD (15 ·È‰È¿), ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì NHL ‹Ù·Ó 59,1% (13 ·È‰È¿) (¶›Ó·Î·˜ 2). ∆· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ٷ ÚˆÙfiÎÔÏÏ· LSA2-L2, BFM Î·È ÙÔ ˘‚ÚȉÈÎfi ÚˆÙfiÎÔÏÏÔ COPP/ABVD, ·Ó¿ÏÔÁ· Ì ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô. ∞fi Ù· 38 ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ¯ËÌÂÈÔıÂÚ·›·, 10 (26,3%) ˘ÔÙÚÔ›·Û·Ó ÂÎ ÙˆÓ ÔÔ›ˆÓ 5 Ì HD (29,4%) Î·È 5 Ì NHL (23,8%), ÂÓÒ Î·Ù¤ÏËÍ·Ó 4 ·È‰È¿ ÂÎ ÙˆÓ ÔÔ›ˆÓ 3 Ì NHL (13,6%). ∞fi ·˘Ù¿, 2 η٤ÏËÍ·Ó Î·Ù¿ ÙË Ê¿ÛË Ù˘ Û˘ÓÙ‹ÚËÛ˘ Î·È 1 ÛÙË Ê¿ÛË ÂÊfi‰Ô˘ Ù˘ ıÂÚ·›·˜. ∞fi Ù· ·È‰È¿ Ì HD, η٤ÏËÍ 1 ÌÂÙ¿ ·fi ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÏfiÁˆ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË. ∏ ÂÎÙ›ÌËÛË Ù˘ Û˘ÓÔÏÈ΋˜ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ (overall survival) Î·È Ù˘ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ ÓfiÛÔ Û ÚÒÙË ‡ÊÂÛË (event-free survival) ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ÙË Ì¤ıÔ‰Ô Kaplan-Meier, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙÔ˘ ÛÙ·ıÂÚÔ‡ ÛÊ¿ÏÌ·ÙÔ˜ (standard error) Î·È 95% ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ·ÍÈÔÈÛÙ›·˜ (confidence interval). ∏ ÂÈ‚›ˆÛË ¯ˆÚ›˜ ÓfiÛÔ Û ÚÒÙË ‡ÊÂÛË ˘ÔÏÔÁ›ÛÙËΠ·fi ÙËÓ ËÌÂÚÔÌËÓ›· Ù˘ ‰È¿ÁÓˆÛ˘ ̤¯ÚÈ ÙËÓ ËÌÂÚÔÌËÓ›· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠ˘ÔÙÚÔ‹, ·ÔÙ˘¯›· Ï‹ÚÔ˘˜ ‡ÊÂÛ˘, ı¿Ó·ÙÔ˜ ‹ ·Ó¿Ù˘ÍË ‰Â‡ÙÂÚÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜. ∏ EFS Û ÚÒÙË ‡ÊÂÛË Â›Ó·È 77,05% (±6,58%) Î·È Ë OS 91,27% (±4,36%). ∏ ·Ó¿Ï˘ÛË Ù˘ Èı·ÓfiÙËÙ·˜ EFS Û ۯ¤ÛË Ì ÙÔÓ Ù‡Ô ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ ‹Ù·Ó 71,79% (±11,58%) ÁÈ· ÙËÓ HD, ¤Ó·ÓÙÈ 79,6% (±8,02%) ÁÈ· Ù· ·È‰È¿ Ì NHL. ∏ Èı·ÓfiÙËÙ· EFS Ì ‚¿ÛË ÙËÓ ËÏÈΛ· ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ ËÏÈΛ·˜ <10 ¯ÚfiÓˆÓ ‹Ù·Ó

79,78% (±7,9%), ÂÓÒ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ËÏÈΛ· >10 ¤ÙË ‹Ù·Ó 82,39% (±11,22%), ‰È·ÊÔÚ¿ Ô˘ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. H EFS ›¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙË ‰È¿ÁÓˆÛË Î·È ‹Ù·Ó 95,12% (±4,73%) ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ π Î·È II ÛÙ·‰›Ô˘, ÂÓÒ ÌÂȈÓfiÙ·Ó ÛÙÔ 50% (±26,87%) ÁÈ· ÂΛÓÔ˘˜ πππ Î·È IV ÛÙ·‰›Ô˘. ∏ Èı·ÓfiÙËÙ· EFS ÙˆÓ ·È‰ÈÒÓ Ì ‹ ¯ˆÚ›˜ ˘ÚÂÙfi ‹Ù·Ó 67,46 (±11,49%) Î·È 83,35% (±7,52%) ·ÓÙ›ÛÙÔȯ·, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,01). ∂›Û˘, Ë Èı·ÓfiÙËÙ· EFS ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ‹ ¯ˆÚ›˜ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ‹Ù·Ó 60,73% (±10,95%) Î·È 90,59% (±6,31%) ·ÓÙ›ÛÙÔȯ·, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,01). ∞fi Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÚԤ΢„ fiÙÈ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯·ÌËÏ¿ ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· Ë EFS ‹Ù·Ó 87,9% (±6,53%), ÂÓÒ ÁÈ· ÂΛÓÔ˘˜ Ì ·˘ÍË̤ӷ ‹Ù·Ó 63,11% (±13,85%), ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ ÁÈ· ÙËÓ ÙÈÌ‹ Ù˘ Hb, fiÔ˘ ·Ú·ÙËÚ‹Û·Ì fiÙÈ Ë EFS ‹Ù·Ó 56,3% (±15,94%) ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯·ÌËÏ‹ Hb Î·È ¤ÊÙ·Ó ÛÙÔ 83,74% (±6,53%) ÁÈ· ÂΛÓÔ˘˜ Ì Hb >10 g/dL, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,01). ∆¤ÏÔ˜, Ë Èı·ÓfiÙËÙ· EFS ÛÙ· ·È‰È¿ Ì ‹ ¯ˆÚ›˜ ÛÏËÓÔÌÂÁ·Ï›· ‹Ù·Ó 51,53% (±11,79%) Î·È 95,59% (±4,31%) ·ÓÙ›ÛÙÔȯ·, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ø˜ ÚÔ˜ ÙËÓ Â›ÙˆÛË ÙÔ˘ ÈÛÙÔÏÔÁÈÎÔ‡ Ù‡Ô˘ ÙˆÓ ·È‰ÈÒÓ Ì NHL ÛÙËÓ ÚfiÁÓˆÛË, ÙÔ ÏÂÌÊÔ‚Ï·ÛÙÈÎfi ϤÌʈ̷ ›¯Â ÙËÓ Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË Ì Èı·ÓfiÙËÙ· EFS 92,8% (±6,83%), ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÁÈ· Ù· ·È‰È¿ Ì ·‰È·ÊÔÚÔÔ›ËÙÔ Ï¤Ìʈ̷ ‹Ù·Ó 63% (±20,31%). ∞fi Ù· ·È‰È¿ Ì HD, ηχÙÂÚË ÚfiÁÓˆÛË Â›¯·Ó ÂΛӷ Ì ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô Ù˘ Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛ˘, fiÔ˘ Ë EFS ‹Ù·Ó 78,25% (±13,32%), ÂÓÒ ÛÙÔÓ Ù‡Ô Ù˘ ÌÈÎÙ‹˜ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ ÙÔ ÔÛÔÛÙfi ‹Ù·Ó 59,75% (±20,46%). ™˘˙‹ÙËÛË ∆· ÏÂÌÊÒÌ·Ù· Hodgkin Î·È ÌË, ·ÔÙÂÏÔ‡Ó ‰È·ÊÔÚÂÙÈΤ˜ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, Ì ‰È·ÊÔÚÂÙÈ΋ ÎÏÈÓÈ΋ Î·È ‚ÈÔÏÔÁÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ‰È·ÊÔÚÂÙÈ΋

¶›Ó·Î·˜ 1. ¢È·ÊÔÚ¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÙ· ·È‰È¿ Ì HD Î·È NHL 3

HD NHL

WBC <10.000/mm

Hb >10 g/dL

PLT >450.000/mm3

LDH >1000 U/L

∆∫∂ >100 mm

ALP >250 U/L

68,8% 68,2%

87,5% 63,6%

25% 0

7% 40,9%

31,3% 9,1%

68,8% 59,1%

¶›Ó·Î·˜ 2. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ì HD Î·È NHL

HD NHL

198

¶˘ÚÂÙfi˜

∞ÒÏÂÈ· ‚¿ÚÔ˘˜

π‰ÚÒÙ˜

∆Ú·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·

56,3% 27,3%

37,5% 45,5%

31% 22%

75% 77,3%


May-June 03

03-06-03

16:55

™ÂÏ›‰·199

¶·È‰È·ÙÚÈ΋ 2003;66:195-201

΢ÙÙ·ÚÈ΋ ÚԤϢÛË, ÂÓÙfiÈÛË Î·È ·ÚÔ˘Û›· ΢ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ (¶›Ó·Î·˜ 3). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ NHL ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÚˆÙÔ·ı‹ ÂÓÙfiÈÛ‹ ÙÔ˘˜. ∂ÌÊ·Ó›˙ÔÓÙ·È Ì ÔÈΛϘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Û˘¯Ó¿ Ë ÓfiÛÔ˜ Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓË Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·ÊÔ‡ Ù· NHL ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ‰È¿¯˘Ù· Î·È ˘„ËÏ‹˜ ηÎÔ‹ıÂÈ·˜ (1,4). ™˘¯Ó¤˜ Â›Ó·È Â›Û˘ Î·È ÔÈ ·ÔÌ·ÎÚ˘Ṳ̂Ó˜ ÌÂÙ·ÛÙ¿ÛÂȘ. ¶ÂÚ›Ô˘ ÙÔ 50% ÙˆÓ NHL ÛÙ· ·È‰È¿ Â›Ó·È ∆-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Â›Ó·È 5% (9). ∏ ηٷÓÔÌ‹ ÙˆÓ NHL ÛÙ· ·È‰È¿ Ì ‚¿ÛË ÙÔÓ ÈÛÙÔÏÔÁÈÎfi ÙÔ˘˜ Ù‡Ô Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 4. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÓÙfiÈÛ˘ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Î·È ÛÙËÓ ÎÔÈÏÈ¿ Â›Ó·È ÂÚ›Ô˘ Ù·˘ÙfiÛËÌË (30-40%) Î·È ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô (2,5,9). ™Â ·È‰È¿ Ì ÏÂÌÊÔ‚Ï·ÛÙÈÎfi ϤÌʈ̷ (΢ڛˆ˜ ∆-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘), Ë ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ Ì¿˙· ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 50-70%, ÂÓÒ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ·Ó‹Ïı ÛÙÔ 75%, Ì ٷ˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ÙÚ·¯ËÏÈ΋˜ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ (2,10). ∞ÓÙ›ıÂÙ·, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·‰È·ÊÔÚÔÔ›ËÙÔ NHL (Burkitt/non Burkitt) ‹ µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ Â›Ó·È Û˘¯ÓfiÙÂÚË Ë ·Ó‡ÚÂÛË ÎÔÈÏȷ΋˜ Ì¿˙·˜ (7090%) Î·È ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ÂÁÎÔÏ·ÛÌÔ‡ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ >6 ¯ÚfiÓˆÓ (9-11). ÕÏϘ Û·ÓÈfiÙÂÚ˜ ÚˆÙÔ·ı›˜ ÂÓÙÔ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔ ‰¤ÚÌ· Î·È Ô ˘Ô‰fiÚÈÔ˜ ÈÛÙfi˜, Ô ı˘ÚÂÔÂȉ‹˜ ·‰¤Ó·˜, ÔÈ ÓÂÊÚÔ›, ÂÓÒ ÌÔÚ› Ó· Û˘Ó˘¿Ú¯ÂÈ Î·È ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (2,12,13). ∞ÓÙ›ıÂÙ·, ÛÙËÓ HD Ë Û˘¯ÓfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ·ÓÒ‰˘ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 75-90% Î·È ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙÔ˘˜ ÙÚ·¯ËÏÈÎÔ‡˜ ÏÂÌÊ·‰¤Ó˜ ÛÙÔ 6080%, ÂÓÒ ·fi Ù· ‰Â‰Ô̤ӷ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ·Ó‹Ïı ÛÙÔ 76,5%. OÈ ·‰¤Ó˜ Â›Ó·È ·ÓÒ‰˘ÓÔÈ, ˘fiÛÎÏËÚÔÈ, ‰ÂÓ Û˘ÌʇÔÓÙ·È Ì ÙÔ˘˜ Á‡Úˆ ÈÛÙÔ‡˜ Î·È ‰ÂÓ ÊÏÂÁÌ·›ÓÔ˘Ó (8,14). ¢ÈfiÁΈÛË ÙˆÓ ·‰¤ÓˆÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 60% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ (ÙÔ ÔÛÔÛÙfi ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó 88,2%, ÂÓÒ ÁÈ· Ù· NHL 61,9%). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, ÔÈ Ì¿˙˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ›ÂÛË ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ‹ Ù˘ ¿Óˆ ÎÔ›Ï˘ ÊϤ‚·˜ Î·È Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ·. O ÛÏ‹Ó·˜ ‚Ú›ÛÎÂÙ·È ‰ÈÔÁΈ̤ÓÔ˜ Û ÔÛÔÛÙfi 6070% Î·È ÙÔ ‹·Ú ÛÙÔ 20-40% (8,14,15). ∆Ô ‚·ÛÈÎfi ‰È·ÁÓˆÛÙÈÎfi ÈÛÙÔÏÔÁÈÎfi ‡ÚËÌ· Â›Ó·È Ë ·Ó‡ÚÂÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Reed-Sternberg, Ù· ÔÔ›· Â›Ó·È ÌÂÁ¿Ï· ·ÙÙ·Ú· Ì ‰‡Ô ˘Ú‹Ó˜. OÈ ÈÛÙÔ·ıÔÏÔÁÈÎÔ› Ù‡ÔÈ Ù˘ ÓfiÛÔ˘ ÙÔ˘ Hodgkin, ηıÒ˜ Î·È Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ÛÙ· ·È‰È¿ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5.

Paediatriki 2003;66:195-201

ªÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ÁÂÓÈο Û˘ÌÙÒÌ·Ù· fiˆ˜ ˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ >10% ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ, ȉÚÒÙ˜, ·‰˘Ó·Ì›· Î·È Î·Ù·‚ÔÏ‹. ∂›Ó·È, fï˜, Û˘¯ÓfiÙÂÚ· ÛÙËÓ HD, ·ÊÔ‡ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ 30% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Û˘ÌʈÓ› Ì ٷ ‰Â‰Ô̤ӷ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ·ÊÔ‡ Ù· ·Ú·¿Óˆ Û˘ÌÙÒÌ·Ù· ‚Ú¤ıËÎ·Ó Û ÔÛÔÛÙfi Ô˘ Î˘Ì¿ÓıËΠ·fi 30-50%. O ··Ú·›ÙËÙÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÓÂÊÚÈ΋˜ Î·È Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· Î·È ÙËÓ ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·, ÙËÓ Î˘ÙÙ·ÚÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ∂¡À, ÙËÓ ·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È ÙÔÓ ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô (1,4,8). ™Ù· ÏÂÌÊÒÌ·Ù· Â›Ó·È Û˘¯ÓfiÙÂÚË Ë Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Î·È Ë ·Ó·ÈÌ›· Î·È Û¿ÓÈ· Û˘Ó˘¿Ú¯ÂÈ ıÚÔÌ‚ÔÂÓ›· (16). ∆· ‰Â‰Ô̤ӷ ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘, ÂÊfiÛÔÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Â›¯Â ÙÔ 31,6% (WBC >10.000/mm3) Î·È ·Ó·ÈÌ›· ÙÔ 26,3% ÙˆÓ ·È‰ÈÒÓ. ∆Ô ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ ÙˆÓ NHL Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙÔ ÛÙ¿‰ÈÔ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ·fi ÙÔ ÚˆÙfiÎÔÏÏÔ ıÂÚ·›·˜ Î·È Î˘Ì·›ÓÂÙ·È ·fi 50-80%, ÂÓÒ Ë EFS ·fi 75-90% ¶›Ó·Î·˜ 3. ¢È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ HD Î·È Ù˘ NHL HD ¶ÚԤϢÛË Î˘ÙÙ¿ÚˆÓ ∂ÓÙÔÈṲ̂ÓË ÓfiÛÔ˜ ∂¤ÎÙ·ÛË Ù˘ ÓfiÛÔ˘ ªÂÛÔıˆÚ¿ÎÈÔ ∫ÔÈÏ›· ™˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ÃÚˆÌÔÛˆÌÈΤ˜ ÌÂÙ·ı¤ÛÂȘ

NHL

∞‰È¢ÎÚ›ÓÈÛÙË µ ‹ ∆-·ÙÙ·Ú· ™˘¯Ó¿ ™¿ÓÈ· ∂ȯÒÚÈÔ˘˜ ∞ÔÌ·ÎÚ˘Ṳ̂ÓÔ˘˜ ™˘¯Ó¿ ™¿ÓÈ· ™¿ÓÈ· ™˘¯Ó¿ ™˘¯Ó¿

™¿ÓÈ·

Ÿ¯È

™˘¯Ó¿

¶›Ó·Î·˜ 4. IÛÙÔÏÔÁÈÎÔ› Ù‡ÔÈ Î·È Û˘¯ÓfiÙËÙ· ÙˆÓ NHL πÛÙÔÏÔÁÈÎfi˜ Ù‡Ô˜

¢Â›ÎÙ˘

™˘¯ÓfiÙËÙ·

§ÂÌÊÔ‚Ï·ÛÙÈÎfi πÛÙÈÔ΢ÙÙ·ÚÈÎfi ∞‰È·ÊÔÚÔÔ›ËÙÔ (Burkitt, ÌË Burkitt) ÕÏÏ·

∆ ·ÙÙ·ÚÔ, ¿ˆÚÔ ÚÔ µ µ, ÌË ∆, ÌË µ ·ÙÙ·ÚÔ

30-40% 10-15%

µ ·ÙÙ·ÚÔ

40-50% 5%

¶›Ó·Î·˜ 5. πÛÙÔÏÔÁÈÎÔ› Ù‡ÔÈ Î·È Û˘¯ÓfiÙËÙ· Ù˘ HD πÛÙÔÏÔÁÈÎfi˜ Ù‡Ô˜ §ÂÌÊÔ΢ÙÙ·ÚÈÎfi˜ Ù‡Ô˜ O˙҉˘ ÛÎÏËÚ˘ÓÙÈÎfi˜ ªÈÎÙ‹˜ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ §ÂÌÊÔÂÓÈÎfi˜

™˘¯ÓfiÙËÙ· 5-15% 40-60% 15-30% <5%

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03-06-03

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¶·È‰È·ÙÚÈ΋ 2003;66:195-201

(2,3,17). OÈ ˘ÔÙÚÔ¤˜ Â›Ó·È ÚÒÈ̘ ÛÙ· B-NHL, ÂÓÒ ·ÓÙ›ıÂÙ· fi„È̘ ÛÙ· T-NHL (1). ™Ù· ·È‰È¿ Ì HD, Ë Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 8095% Î·È Ë EFS ·fi 70-90% (3,18,19). ∞fi Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ ÚԤ΢„ fiÙÈ Ë EFS Û ÚÒÙË ‡ÊÂÛË ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ 38 ·È‰ÈÒÓ Ì ϤÌʈ̷ Â›Ó·È 77,05% (±6,58%) Î·È Ë OS 91,27% (±4,36%). ∏ ·Ó¿Ï˘ÛË Ù˘ Èı·ÓfiÙËÙ·˜ EFS Û ۯ¤ÛË Ì ÙÔÓ Ù‡Ô ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Â›Ó·È 71,79% (±11,58%) ÁÈ· ÙËÓ HD, ¤Ó·ÓÙÈ 79,6% (±8,02%) ÁÈ· Ù· NHL, ÁÂÁÔÓfi˜ Ô˘ ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÌfiÓÔ ˆ˜ ÚÔ˜ Ù· ÏÂÌÊÒÌ·Ù· Hodgkin. ∏ η΋ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ì HD Î·È Ë ¯·ÌËÏfiÙÂÚË - Û ۯ¤ÛË Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›· - EFS ÔÊ›ÏÔÓÙ·È ÛÙÔ ÚÔ¯ˆÚË̤ÓÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ηٿ ÙË ‰È¿ÁÓˆÛË. ∂›Ó·È ÁÓˆÛÙfi, ÂÍ¿ÏÏÔ˘, fiÙÈ ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÁÓˆÛË ·ÔÙÂÏ› ÙÔÓ ÛÔ˘‰·ÈfiÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË, Û‡Ìʈӷ Ì ٷ ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Î·È Û˘ÌʈÓ› ·fiÏ˘Ù· Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ·ÊÔ‡ ÚԤ΢„ fiÙÈ Ë EFS fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 95,12% (±4,73%) ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ I Î·È II ÛÙ·‰›Ô˘, ÂÓÒ ÌÂȈÓfiÙ·Ó ÛÙÔ 50% (±26,87%) ÁÈ· ÂΛÓÔ˘˜ πππ Î·È IV ÛÙ·‰›Ô˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÚÔ·ÙÂÈ fiÙÈ Ì ٷ Û‡Á¯ÚÔÓ· ıÂÚ·¢ÙÈο ÚˆÙfiÎÔÏÏ· Ë OS Î·È Ë EFS ηٷÁÚ¿ÊËÎ·Ó Û Ï‹ÚË ·ÓÙÈÛÙÔȯ›· Ì ٷ ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÂÓÒ ÛËÌ·ÓÙÈÎfi Â›Ó·È Â›Û˘ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ú·ÙËÚÂ›Ù·È Î·Ï‡ÙÂÚË ¤Î‚·ÛË ÁÈ· Ù· ·È‰È¿ Ì NHL. ∞˘Ùfi ÔÊ›ÏÂÙ·È Èı·ÓÒ˜ ÛÙËÓ ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÂÈ‚¿ÏÏÔ˘Ó ÙËÓ ¤ÁηÈÚË ÚÔۤϢÛË, ‰È¿ÁÓˆÛË Î·È ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, Û ·ÓÙ›ıÂÛË Ì ٷ ·È‰È¿ Ì HD, Ù· ÔÔ›· ηٿ ÙË ‰È¿ÁÓˆÛË Â›Ó·È ˘„ËÏÔ‡ ÛÙ·‰›Ô˘. ™˘ÓÂÒ˜, ·ÔÙÂÏ› ‚·ÛÈÎfi ̤ÏËÌ· Î·È Â˘ı‡ÓË ÙˆÓ ·È‰È¿ÙÚˆÓ ·ÈÌ·ÙÔÏfiÁˆÓ, Ô˘ Â›Ó·È Î·È ˘‡ı˘ÓÔÈ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, Ó· ÂÈÛËÌ¿ÓÔ˘Ó ÙËÓ ·Í›· Ù˘ ¤ÁηÈÚ˘ ·Ú·ÔÌ‹˜ ·È‰ÈÒÓ Ì ‰ÈÔÁΈ̤ÓÔ˘˜ ÏÂÌÊ·‰¤Ó˜ ‹ ÌÂ Û˘ÌÙÒÌ·Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ Û ÂȉÈΤ˜ ·È‰È·ÙÚÈΤ˜ ÌÔÓ¿‰Â˜, ·ÊÔ‡ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ηٿ ÙË ‰È¿ÁÓˆÛË ·ÔÙÂÏ› ÙÔ ÎÚ›ÛÈÌÔ ÛËÌÂ›Ô ÁÈ· ÙËÓ Â˘ÓÔ˚΋ ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Lanzkowsky P. Pediatric haematology and oncology. 3rd ed. New York: University Press; 2000. 2. Shad A, Magrath I. Malignant non-Hodgkin’s lymphoma in children. In: Pizzo PA, Poplack DG, editors. Principles and practices of pediatric oncology. Philadelphia: LippincottRaven; 1997. p. 545-587. 3. Zhao G, Boysen CD, Brown EF, Hassanein KM, Holmes FF,

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19.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-10-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-02-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: º·Ó‹ ∞ı·Ó·ÛÈ¿‰Ô˘ ™Ù. ∫˘ÚȷΛ‰Ë 1, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ η΋˜ ¤Î‚·Û˘ Î·È ÔʤÏË ·fi Ù· ·ÓÙÈ‚ÈÔÙÈο Û ·È‰È¿ Ì ÔÍ›· ̤ÛË ˆÙ›Ùȉ·1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙ› ÔÈ· ·fi Ù· ·È‰È¿ Ì ÔÍ›· ̤ÛË ˆÙ›Ùȉ· ¤¯Ô˘Ó ΛӉ˘ÓÔ Î·Î‹˜ ¤Î‚·Û˘ Î·È Ó· ÂÎÙÈÌËı› Û ·˘Ù¿ Ë ˆÊ¤ÏÂÈ· ·fi Ù· ·ÓÙÈ‚ÈÔÙÈο. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‰Â˘ÙÂÚÔÁÂÓ‹˜ ·Ó¿Ï˘ÛË ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÂÏÂÁ¯fiÌÂÓˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ. ∏ ÌÂϤÙË ‰ÈÂÍ‹¯ıË ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÂÚ›ı·Ï„Ë. ™˘ÌÌÂÙ›¯·Ó 315 ·È‰È¿ ËÏÈΛ·˜ 6 ÌËÓÒÓ ¤ˆ˜ 10 ÂÙÒÓ, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠ·ÓÙÈ‚ÈÔÙÈÎfi, ¿ÌÂÛ· ‹ ηı˘ÛÙÂÚË̤ӷ (Ï‹„Ë ÌÂÙ¿ ·fi 72 ÒÚ˜, Â¿Ó ‹Ù·Ó ··Ú·›ÙËÙÔ). ¶ÚÔÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ‚Ú·¯˘ÚfiıÂÛÌ˘ ¤Î‚·Û˘ ·ÔÙ¤ÏÂÛÂ Ë ÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›Ô˘ ·ÓËÛ˘¯›·˜ ‹ Ó˘¯ÙÂÚÈÓ‹˜ ·Ó·ÛٿوÛ˘ ¤ˆ˜ ÙÚÂȘ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÁÈ·ÙÚfi. ∞ÔÙÂϤÛÌ·Ù·: ∏ ÂΉ‹ÏˆÛË ·ÓËÛ˘¯›·˜ ̤¯ÚÈ ÙËÓ ÙÚ›ÙË Ë̤ڷ ‹Ù·Ó ÈÔ Èı·Ó‹ ÛÙ· ·È‰È¿ Ô˘ ÙËÓ ÚÒÙË Ë̤ڷ ÂÌÊ¿ÓÈ˙·Ó ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜: 4,5, 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜: 2,3 ¤ˆ˜ 9,0), Â̤ÙÔ˘˜ (2,6, 1,3 ¤ˆ˜ 5,0) Î·È ‚‹¯· (2,0, 1,1 ¤ˆ˜ 3,8). ∏ ÂÌÊ¿ÓÈÛË Ó˘¯ÙÂÚÈÓ‹˜ ·Ó·ÛٿوÛ˘ ̤¯ÚÈ ÙËÓ ÙÚ›ÙË Ë̤ڷ ‹Ù·Ó ÈÔ Èı·Ó‹ ÛÙ· ·È‰È¿ Ì ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· (2,4, 1,2 ¤ˆ˜ 4,8), Â̤ÙÔ˘˜ (2,1, 1,1 ¤ˆ˜ 4,0), ‚‹¯· (2,3, 1,3 ¤ˆ˜ 4,2) Î·È ˆÙfiÚÚÔÈ· (2,1, 1,2 ¤ˆ˜ 3,9). ™Ù· ·È‰È¿ Ì ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· ‹ Â̤ÙÔ˘˜, Ë ÂΉ‹ÏˆÛË ·ÓËÛ˘¯›·˜ ̤¯ÚÈ ÙËÓ ÙÚ›ÙË Ë̤ڷ ‹Ù·Ó ÏÈÁfiÙÂÚÔ Èı·Ó‹ ÌÂÙ¿ ·fi ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ (32% ÛÙËÓ ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ¤Ó·ÓÙÈ 53% ÛÙËÓ Î·ı˘ÛÙÂÚË̤ÓË, ¯2=4,0 (p=0,045) (¯ÚÂÈ¿ÛÙËΠӷ ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó 5 ·È‰È¿). ∞Ó¿ÏÔÁ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Î·È ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·Ó·ÛٿوÛË Î·-

2 Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜ (26% ¤Ó·ÓÙÈ 59%, ¯ =9,3 (p=0,002) (¯ÚÂÈ¿ÛÙËΠӷ ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó 3 ·È‰È¿). ™Ù· ·È‰È¿ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· ‹ Â̤ÙÔ˘˜, Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰ÂÓ ‰È·ÊÔÚÔÔ›ËÛ ÛËÌ·ÓÙÈο ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÓËÛ˘¯›·˜ (15% ¤Ó·ÓÙÈ 19%, ¯2=0,74, p=0,39) ‹ Ó˘¯ÙÂÚÈÓ‹˜ ·Ó·ÛٿوÛ˘ ̤¯ÚÈ ÙËÓ ÙÚ›ÙË Ë̤ڷ (20% ¤Ó·ÓÙÈ 27%, ¯2=1,6, p=0,20). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘‹Ú¯Â ÂÈÚfiÛıÂÙ· ‚‹¯·˜, Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰ÂÓ ‚ÂÏÙ›ˆÛÂ, Â›Û˘, ÛËÌ·ÓÙÈο ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ¿ÛÌ·Ù·: ™Ù· ·È‰È¿ Ì ̤ÛË ˆÙ›Ùȉ·, ¯ˆÚ›˜ fï˜ ˘ÚÂÙfi ‹ Â̤ÙÔ˘˜, Ë ıÂÚ·›· Ì ·ÓÙÈ‚ÈÔÙÈο ÚÔÛ¤ÊÂÚ ÌÈÎÚfi fiÊÂÏÔ˜. ∂›Û˘, Ë Èı·ÓfiÙËÙ· η΋˜ ¤Î‚·Û˘ Ù˘ ÓfiÛÔ˘ Û ·˘Ù¿ Ù· ·È‰È¿ ‹Ù·Ó ÌÈÎÚ‹.

1 Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomized trial BMJ 2002;325:22

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ORIGINAL ARTICLE

§È›‰È· Î·È ÏÈÔÚˆÙ½Ó˜ ÔÚÔ‡ ·È‰ÈÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ∫. ∞. µÔ‡‰Ú˘1, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘2, ª. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘2, ™. ¢‹ÌÔ˘3, ∂. ∞. µ·ÁÈ¿ÎÔ˘4

Serum lipids and lipoproteins in epileptic children receiving antiepileptic drugs K. Voudris1, A. Skardoutsou2, M. Servitzoglou2, S. Dimou3, E. Vagiakou4

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·Ó›¯Ó¢ÛË ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ÂÈÏËÙÈÎÒÓ ·È‰ÈÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ¯ÚfiÓÈ· ÌÔÓÔıÂÚ·›· Ì ٷ ·ÓÙÈÂÈÏËÙÈο ʿ̷η ηڂ·Ì·˙Â›ÓË, ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‹ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË. ™Â Û‡ÁÎÚÈÛË ÌÂ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì¿ÚÙ˘Ú˜, ·˘ÍË̤ӷ Â›‰· ÛÙÔÓ ÔÚfi Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ (TC), Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ (HDL-C) Î·È ¯·ÌËÏ‹˜ (LDL-C) ˘ÎÓfiÙËÙ·˜ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ∞-π (ApoA-I) Î·È µ (ApoB) ‰È·ÈÛÙÒıËÎ·Ó ÌfiÓÔ ÛÙ· ·È‰È¿ Ô˘ ÂÏ¿Ì‚·Ó·Ó ηڂ·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÂÓÒ ‰ÂÓ ‚Ú¤ıËΠÌÂÙ·‚ÔÏ‹ ÛÙ· Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (∆G) Î·È Ù˘ ÏÈÔÚˆÙ½Ó˘ a [Lp(a)] Û η̛· ·fi ÙȘ ÔÌ¿‰Â˜. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ Î·È Ù˘ ‰È¿ÚÎÂÈ·˜ ıÂÚ·›·˜ ·ÊÂÓfi˜, Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔÓ ÔÚfi ·ÊÂÙ¤ÚÔ˘. OÈ ‰È·Ù·Ú·¯¤˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›·, Ù· ÔÔ›· Â›Ó·È Û ¯ÚfiÓÈ· ÌÔÓÔıÂÚ·›· Ì ٷ ÌÂÏÂÙËı¤ÓÙ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η.

Abstract: The aim of this study was to evaluate changes in serum lipids, lipoproteins and apolipoproteins in children with epilepsy on longterm antiepileptic drug monotherapy with carbamazepine, sodium valproate, or phenobarbital. In comparison to controls taking no medication, significantly increased levels of serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) were found in children receiving carbamazepine and phenobarbital, but not in those on sodium valproate. No group showed significantly increased levels of serum triglycerides (TG) or lipoprotein a [Lp(a)]. The changes in the serum lipids profile did not correlate with either drug plasma concentrations or the duration of treatment. The possibility of such changes must be considered in all children with epilepsy on long-term antiepileptic drug monotherapy with carbamazepine and phenobarbital.

§¤ÍÂȘ ÎÏÂȉȿ: ÏÈ›‰È·, ÏÈÔÚˆÙ½Ó˜, ·ÔÏÈÔÚˆÙ½Ó˜, ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ·È‰È΋ ÂÈÏË„›·.

Key words: lipids, lipoproteins, apolipoproteins, antiepileptic drugs, epilepsy.

™˘ÓÙÔÌÔÁڷʛ˜ TC ∆G HDL-C LDL-C

OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ∆ÚÈÁÏ˘ÎÂÚ›‰È· ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ

1 ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 3 µÈÔ¯ËÌÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 4 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶. °. ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

202

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¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ∞ÔÏÈÔÚˆÙ½ÓË ∞-π ∞ÔÏÈÔÚˆÙ½ÓË µ §ÈÔÚˆÙ½ÓË a ªË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

1 Neurology Department, “P. & A. Kyriakou” Children’s Hospital, Athens 2 2nd Paediatric Clinic of University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens 3 Department of Biochemistry, “P. & A. Kyriakou” Children’s Hospital, Athens 4 Department of Microbiology, “G. Gennimatas” Peripheral General Hospital, Athens


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∂ÈÛ·ÁˆÁ‹ ªÂÙ·‚ÔϤ˜ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ Û ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ¤¯Ô˘Ó ‰È·ÈÛÙˆı› Û ‰È¿ÊÔÚ˜ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ (1-11). ™˘¯Ó¿, ÔÈ ·ÛıÂÓ›˜ ÂÏ¿Ì‚·Ó·Ó Ù·˘Ùfi¯ÚÔÓ· ÔÏÏ¿ ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Î·È Ë ÂӉ¯fiÌÂÓË Â›‰Ú·ÛË ÌÂÌÔӈ̤ÓÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ÂÏÂÁ¯ı›. OÈ ÌÂϤÙ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ΢ڛˆ˜ Û ÂÓ‹ÏÈΘ, ·ÏÏ¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·ÚfiÌÔȘ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› Î·È ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Ó ÛÙ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Ù˘ ÌÂϤÙ˘ Ì·˜, Ì ·Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ·ÏÏ¿ Î·È ÌÂٷ͇ ‰È·ÊfiÚˆÓ Ï·ÒÓ Î·È ‰È·ÊÔÚÂÙÈÎÒÓ ÏËı˘ÛÌÒÓ (12). Œ¯ÂÈ ·Ó·ÊÂÚı›, Â›Û˘, fiÙÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÔÈÔÙÈ΋ Î·È ÔÛÔÙÈ΋ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡ (10). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰È·›ÛÙˆÛË Èı·Ó‹˜ Â›‰Ú·Û˘ Ù˘ ¯ÚfiÓÈ·˜ ÌÔÓÔıÂÚ·›·˜ Ì ٷ Û˘¯ÓfiÙÂÚ· ¯ÔÚËÁÔ‡ÌÂÓ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η (ηڂ·Ì·˙Â›ÓË, ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‹ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË) ÛÙ· Â›‰· ÔÚÔ‡ Ù˘ TC, ÙˆÓ ∆G, Ù˘ HDL-C, Ù˘ LDL-C, Ù˘ ApoA-I, Ù˘ ApoB Î·È Ù˘ Lp(a) ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· ÛÙË ¯ÒÚ· Ì·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 151 ÂÈÏËÙÈο ·È‰È¿, Ù· ÔÔ›· ¯ˆÚ›ÛÙËÎ·Ó Û 3 ÔÌ¿‰·˜ ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Ô˘ ÂÏ¿Ì‚·Ó·Ó. ∂Í‹ÓÙ· ¤ÓÙ ·È‰È¿ (32 ·ÁfiÚÈ·, 33 ÎÔÚ›ÙÛÈ·) ‹Ù·Ó Û ÌÔÓÔıÂÚ·›· Ì ηڂ·Ì·˙Â›ÓË, 48 (22 ·ÁfiÚÈ·, 26 ÎÔÚ›ÙÛÈ·) Ì ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È 38 (18 ·ÁfiÚÈ·, 20 ÎÔÚ›ÙÛÈ·) Ì ʷÈÓÔ‚·Ú‚ÈÙ¿ÏË. ∏ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó ηڂ·Ì·˙Â›ÓË ‹Ù·Ó ÌÂٷ͇ 2 Î·È 13,5 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈΛ·: 8,5 ¤ÙË), ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ 2 ¤ˆ˜ 14 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈΛ·: 8,8 ¤ÙË) Î·È ÂÎÂ›ÓˆÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÂٷ͇ 6 ÌËÓÒÓ Î·È 4 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈΛ·: 2,4 ¤ÙË). ŸÏ· Ù· ·È‰È¿ ˘Ô‚Ï‹ıËÎ·Ó Û Ï‹ÚË ÎÏÈÓÈ΋ ÂͤٷÛË, ÂÓÒ ÂÏ‹ÊıË ·fi ÙÔ˘˜ ÁÔÓ›˜ Ï‹Ú˜ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∞ÔÎÏ›ÛÙËÎÂ Ë ·ÚÔ˘Û›· ¿ÏÏÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Ë Ï‹„Ë ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ Î·È Ë ‡·ÚÍË ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÚÒÈÌ˘ ·ıËڈ̿وÛ˘. ŸÏ· Ù· ·È‰È¿ ‚Ú›ÛÎÔÓÙ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 6 Ì‹Ó˜ ÛÙËÓ ›‰È· ·ÓÙÈÂÈÏËÙÈ΋ Ê·Ú̷΢ÙÈ΋ ÌÔÓÔıÂÚ·›·. ™Â fiÏ· Ù· ·È‰È¿ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ ÔÚfi Ù· Â›‰· Ù˘ TC Î·È ÙˆÓ TG. ™Â 76 ·È‰È¿, ·fi Ù· ÔÔ›· 28 (13 ·ÁfiÚÈ·, 15 ÎÔÚ›ÙÛÈ·) ÂÏ¿Ì‚·Ó·Ó ηڂ·Ì·˙Â›ÓË, 24 (12 ·ÁfiÚÈ·, 12 ÎÔÚ›ÙÛÈ·) ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È 24 (11 ·ÁfiÚÈ·, 13 ÎÔÚ›ÙÛÈ·) Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· Â›‰· Ù˘ LDL-C, HDL-C Î·È Lp(a) Î·È Û 85 ·È‰È¿, ·fi Ù· ÔÔ›· 32 (16

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·ÁfiÚÈ·, 16 ÎÔÚ›ÙÛÈ·) ‹Ù·Ó Û ÌÔÓÔıÂÚ·›· Ì ηڂ·Ì·˙Â›ÓË, 28 (13 ·ÁfiÚÈ·, 15 ÎÔÚ›ÙÛÈ·) Ì ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È 25 (12 ·ÁfiÚÈ·, 13 ÎÔÚ›ÙÛÈ·) Ì ʷÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ù· Â›‰· Apo∞-I Î·È Apoµ. ∆· Â˘Ú‹Ì·Ù· Û˘ÁÎÚ›ıËÎ·Ó Ì ÂΛӷ ˘ÁÈÒÓ ·È‰ÈÒÓ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘. ∆· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜, Ù· ÔÔ›· ÂÏ‹ÊıËÛ·Ó ÚˆÈÓ‹ ÒÚ· ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›·, Ê˘Ï¿ÛÛÔÓÙ·Ó ÌÂÙ¿ ÙÔ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡ Û ıÂÚÌÔÎÚ·Û›· -40ÔC Î·È ÔÈ ÌÂÙÚ‹ÛÂȘ Á›ÓÔÓÙ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÒÙˆÓ Â‚‰ÔÌ¿‰ˆÓ ·fi ÙËÓ ·ÈÌÔÏË„›·. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ¤ÁÈÓ Ì ÂÓ˙˘ÌÈ΋ ¯ÚˆÌ·ÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô Û ·Ó·Ï˘Ù‹ Hitachi 704 Û ıÂÚÌÔÎÚ·Û›· 30ÔC Î·È Ì ÔÚfiÙ˘Ô˘˜ Ù˘ Boehringer Mannheim. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ HDL-C ¤ÁÈÓ ÛÙÔ ˘ÂÚΛÌÂÓÔ ÛÙÚÒÌ· ÌÂÙ¿ ·fi ηٷÎÚ‹ÌÓÈÛË ÙˆÓ VLDL Î·È LDL-C Ì ʈÛÊÔÚÔ‚ÔÏÊÚ·ÌÈÎfi Ô͇ Î·È Ì·ÁÓ‹ÛÈÔ Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ApoA-I Î·È ApoB ¤ÁÈÓ Ì ·ÓÔÛÔıÔψÛÈÌÂÙÚÈ΋ ̤ıÔ‰Ô SPIA (Serum Protein Immunoassay). ∏ Lp(a) ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ, Â›Û˘, Ì ·ÓÔÛÔıÔψÛÈÌÂÙÚÈ΋ ̤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÓÂÊÂÏfiÌÂÙÚÔ Behring. ∏ Û˘ÁΤÓÙÚˆÛË Ù˘ LDL-C ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔÓ Ù‡Ô ÙˆÓ Friedwald Î·È Û˘Ó. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ t (t-test) Î·È Mann Whitney Î·È ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ηٿ Pearson Î·È Spearman. ∆È̤˜ p<0,05 ıˆڋıËÎ·Ó ˆ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.

∞ÔÙÂϤÛÌ·Ù· ∆· Â›‰· ÛÙÔÓ ÔÚfi ÙˆÓ TC, LDL-C Î·È HDL-C ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Û ۇÁÎÚÈÛË Ì ÂΛӷ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÌfiÓÔ ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ ˘fi ·ÁˆÁ‹ Ì ηڂ·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË (¶›Ó·Î˜ 1 Î·È 2) (∂ÈÎfiÓ˜ 1 Î·È 2). ∞ÓÙ›ıÂÙ·, ÛÙ· Â›‰· ÙˆÓ TG ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û η̛· ·fi ÙȘ ÔÌ¿‰Â˜. ∆· Â›‰· Ù˘ Lp(a) ÛÙÔÓ ÔÚfi ·˘Í‹ıËÎ·Ó Û fiϘ ÙȘ ÔÌ¿‰Â˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∆· Â›‰· Ù˘ Apo∞-I Î·È Apoµ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÌfiÓÔ ÛÙ· ·È‰È¿ Ô˘ ÂÏ¿Ì‚·Ó·Ó ηڂ·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË (¶›Ó·Î·˜ 3) (∂ÈÎfiÓ· 3). ¢ÂÓ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ·ÓˆÙ¤Úˆ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ, ÌÔÏÔÓfiÙÈ ÔÈ Ì¤Û˜ ÙÈ̤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÔÚÔ‡ ÙˆÓ TC, LDLC, HDL-C, Apo∞-I Î·È Apoµ ‹Ù·Ó ÈÔ ·˘ÍË̤Ó˜ ÛÙ· ·ÁfiÚÈ· ÛÙËÓ ÔÌ¿‰· Ù˘ ηڂ·Ì·˙Â›Ó˘ Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÙËÓ ÔÌ¿‰· Ù˘ Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘. ™Â η̛· ·fi ÙȘ ÔÌ¿‰Â˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ ıÂÚ·›·˜ ·ÊÂÓfi˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔ ·›Ì· ·ÊÂÙ¤ÚÔ˘. ™˘˙‹ÙËÛË OÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ıˆÚÔ‡ÓÙ·È ˆ˜ ·ÚÈÔÈ

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·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ·ıËڈ̿وÛ˘ ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, Ù· ˘„ËÏ¿ Â›‰· TC Î·È LDL-C Û¯ÂÙ›˙ÔÓÙ·È ıÂÙÈο Ì ÙÔÓ Î›Ó‰˘ÓÔ ·ıËڈ̿وÛ˘, ÂÓÒ Ù· ˘„ËÏ¿ Â›‰· HDL-C ·ÚÓËÙÈο (13). Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ TC Î·È Ù˘ LDL-C Î·È Ë ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDLC ÛÙÔÓ ÔÚfi ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ˘Ô¯ÒÚËÛË Ù˘ ·ıËڈ̿وÛ˘ Î·È Û ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ Î·È Ù˘ ÓÔÛËÚfiÙËÙ·˜ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ ·›Ì·, ÌÔÏÔÓfiÙÈ Ù· Â˘Ú‹Ì·Ù· ÔÈΛÏÏÔ˘Ó Î·È Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ Â›Ó·È ·ÓÙÈÊ·ÙÈο (1-11). ∏ ·È‰È΋ ÂÈÏË„›· ··ÈÙ› Û˘¯Ó¿ Ì·ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹ Ì ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÌÂÌÔӈ̤ӷ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi. ∏ ηڂ·Ì·˙Â›ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘.

∞‡ÍËÛË Ù˘ TC, Ù˘ HDL-C Î·È Ù˘ LDL-C ÛÙÔÓ ÔÚfi Û ·ÛıÂÓ›˜ Ì ÂÈÏË„›· ˘fi ıÂÚ·›· Ì ηڂ·Ì·˙Â›ÓË, fiˆ˜ ‚Ú¤ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ¤¯ÂÈ ‰È·ÈÛÙˆı› Î·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (4,8). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ù· Â›‰· ÙˆÓ TG ‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÛÙ· ·È‰È¿ Ì ϋ„Ë Î·Ú‚·Ì·˙Â›Ó˘, fiˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚı› Î·È ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (2,11). ∏ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ë ÔÔ›· ¤¯ÂÈ ·ÚfiÌÔȘ Â·ÁˆÁÈΤ˜ ȉÈfiÙËÙ˜ Ì ÙËÓ Î·Ú‚·Ì·˙Â›ÓË, ÚÔηÏ› ·ÚfiÌÔȘ ‰È·Ù·Ú·¯¤˜ ÛÙ· ÏÈ›‰È· Î·È ÛÙȘ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ ÔÚÔ‡ (1,2,4). ∆· ‰Â‰Ô̤ӷ ÁÈ· ÙÔÓ ·ıÔÁÂÓÂÙÈÎfi Ì˯·ÓÈÛÌfi ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ·˘ÙÒÓ ‰ÂÓ Â›Ó·È ÙÂÏ›ˆ˜ ÍÂοı·Ú·. ∏ ηڂ·Ì·˙Â›ÓË Î·È Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È Â¿ÁÔÓÙ·˜ Ù· Ë·ÙÈο ÌÈÎÚÔÛˆÌȷο ¤Ó˙˘Ì· Î·È ÚÔηÏÔ‡Ó ÌÂÙ·‚ÔϤ˜ ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ¯ÔÏÈÎÒÓ ÔͤˆÓ, Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ÙˆÓ ÏÈȉ›ˆÓ, Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È ¿ÏÏˆÓ Â͈ÁÂÓÒÓ Ê·Ú̿ΈÓ

¶›Ó·Î·˜ 1. ∂›‰· TC Î·È TG ÔÚÔ‡ Û ·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜ º¿Ú̷η ñ ∫·Ú‚·Ì·˙Â›ÓË ª¿ÚÙ˘Ú˜ ñ µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ª¿ÚÙ˘Ú˜ ñ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ª¿ÚÙ˘Ú˜

∞ÚÈıÌfi˜ ·È‰ÈÒÓ

TC (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

TG (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

65 71 48 70 38 56

211,7±33,8 152,2±33,9 158,3±35,2 151,8±34,9 201,7±25,9 148,1±29,1

<0,01

108,5±37,0 104,8±42,9 96,5±42,5 105,1±42,3 87,8±32,6 84,1±37,2

ª™

ª™ <0,01

ª™ ª™

250

200 ÃÔÏËÛÙÂÚfiÏË (mg/dl) 150

∆ÚÈÁÏÈÎÂÚ›‰È· (mg/dl)

100

50

0

Â›ÓË ˜1 Ù˘Ú ·Ì·˙ ª¿Ú K·Ú‚

ÚÔ˚Îfi µ·Ï ÈÔ Ó¿ÙÚ

Ë ˜2 ˜3 ‚ÈÙ¿Ï Ù˘ÚÂ Ù˘Ú Ԃ·Ú ª¿Ú ª¿Ú º·ÈÓ

∂ÈÎfiÓ· 1. ª¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ TC Î·È ÙˆÓ TG Û fiϘ ÙȘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜.

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¶›Ó·Î·˜ 2. ∂›‰· HDL-C, LDL-C Î·È Lp(a) ÔÚÔ‡ Û ·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜ º¿Ú̷η

∞ÚÈıÌfi˜ ·È‰ÈÒÓ

ñ ∫·Ú‚·Ì·˙Â›ÓË ª¿ÚÙ˘Ú˜ ñ µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ª¿ÚÙ˘Ú˜ ñ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ª¿ÚÙ˘Ú˜

28 42 24 40 24 36

HDL-C (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

LDL-C (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

Lp(a) (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

61,2±13,2 51,3±15,7 51,1±11,5 51,8±15,3 54,5±13,0 43,0±15,1

<0,01

125,1±25,2 108,8±28,1 98,4±18,1 109,2±28,4 124,0±32,6 104,5±27,2

<0,05

17,8±20,1 14,8±17,3 17,6±18,2 15,1±17,5 18,5±18,1 12,3±22,0

ª™

ª™ <0,01

ª™ <0,05

ª™ ª™

140 120 HDL-C (mg/dl)

100 80

LDL-C (mg/dl)

60 Lp(a) (mg/dl) 40 20 10

Â›ÓË ·Ì·˙ K·Ú‚

˜1 Ù˘Ú ª¿Ú

ÚÔ˚Îfi µ·Ï ÈÔ Ó¿ÙÚ

˜2 Ù˘Ú ª¿Ú

Ë ‚ÈÙ¿Ï Ô‚·Ú º·ÈÓ

˜3 Ù˘Ú ª¿Ú

∂ÈÎfiÓ· 2. ª¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL-C, LDL-C Î·È Lp(a) Û fiϘ ÙȘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜.

Ô˘ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ·fi Ù· ¤Ó˙˘Ì· ·˘Ù¿. ∆· ·ÓÙÈÂÈÏËÙÈο ·˘Ù¿ Ê¿Ú̷η ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙË ¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ¿ÏÏ· ÏÈ›‰È· ÛÙȘ ı¤ÛÂȘ Û‡Ó‰ÂÛ˘ Ì ÙÔ Ë·ÙÈÎfi ΢ÙÙfi¯ÚˆÌ· ƒ450, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘˜ (8,9). O Ì˯·ÓÈÛÌfi˜ ·˘Ùfi˜, fï˜, ‰ÂÓ ıˆÚÂ›Ù·È ·ÚÎÂÙfi˜ ÁÈ· Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ·‡ÍËÛË ÙˆÓ ÏÈȉ›ˆÓ, ·ÊÔ‡ ¿ÏÏ· Ê¿Ú̷η, fiˆ˜ Ë ÚÈÊ·ÌÈΛÓË Ô˘ Â›Ó·È ÂÓ˙˘ÌÈÎfi˜ Â·ÁˆÁ¤·˜, ‰ÂÓ ÚÔηÏÔ‡Ó ·Ó¿ÏÔÁË ·‡ÍËÛË. ÕÏÏÔ ¤Ó˙˘ÌÔ Ô˘ Â¿ÁÂÙ·È ·fi Ù· ·ÓÙÈÂÈÏËÙÈο Â›Ó·È ÙÔ ˘‰ÚÔ͢ÌÂı˘Ï-ÁÏÔ˘Ù·Ú˘ÏÔ Û˘Ó¤Ó˙˘ÌÔ ∞, Ô˘ ηٷχÂÈ ÙË Û‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∏ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È Ë Î·Ú‚·Ì·˙Â›ÓË ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ·‡ÍËÛË - ¤ˆ˜ Î·È ‰ÈÏ·ÛÈ·ÛÌfi - ÙÔ˘ Ë·ÙÈÎÔ‡ ˘‰ÚÔ͢ÌÂı˘Ï-ÁÏÔ˘Ù·Ú˘ÏÔ Û˘ÓÂÓ˙‡ÌÔ˘ ∞, ηٷϋÁÔÓÙ·˜ Û ·˘ÍË̤ÓË Û‡ÓıÂÛË ¯ÔÏËÛÙÂÚfiÏ˘. ÕÏÏÔ˜ Ì˯·ÓÈÛÌfi˜, Ô˘ ›Ûˆ˜ ı· ÌÔÚÔ‡Û ӷ ÂÍËÁ‹ÛÂÈ ÙȘ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ÏÈȉ›ˆÓ Û ÂÚÈÙÒÛÂȘ ¯ÔÚ‹ÁËÛ˘ Ê·ÚÌ¿ÎˆÓ Ì Â·ÁˆÁÈ΋ ‰Ú¿ÛË, fiˆ˜ Â›Ó·È Ë Î·Ú‚·Ì·˙Â›ÓË Î·È Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Â›Ó·È ÔÈ ÔÚÌÔÓÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ ÙË ¯ÚfiÓÈ· ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹. ∏ Ì›ˆÛË Ù˘ Âχ-

ıÂÚ˘ ı˘ÚÔ͛Ӣ Î·È Ù˘ ıÂÈÈ΋˜ ‰Â¸‰ÚÔÂÈ·Ó‰ÚÔÛÙÂÚfiÓ˘ Â›Ó·È ·fi ÙȘ ΢ÚÈfiÙÂÚ˜ ÔÚÌÔÓÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ÂÓ˙˘ÌÈ΋ Â·ÁˆÁ‹. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÔÚÌÔÓÒÓ ·˘ÙÒÓ Û˘Ó‰¤ÔÓÙ·È Ì ·˘ÍË̤ÓË ÛÙ¿ıÌË ÏÈȉ›ˆÓ ÛÙÔÓ ÔÚfi. Ÿˆ˜ ‚Ú¤ıËΠÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û·, fiÛÔ Î·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‰ÂÓ ÌÂÙ·‚¿ÏÏÂÈ Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔÓ ÔÚfi (2,4,7,9,11). ∞˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‰ÂÓ ¤¯ÂÈ Â·ÁˆÁÈΤ˜ ȉÈfiÙËÙ˜ Î·È Ë Î‡ÚÈ· Ô‰fi˜ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ Â›Ó·È Ë Û‡˙¢͋ ÙÔ˘ Ì ÙÔ ÁÏ˘ÎÔ˘ÚÔÓÈÎfi Ô͇ Î·È Ë ‚-ÔÍ›‰ˆÛË. £· Ú¤ÂÈ Ó· ÛËÌÂȈı›, fï˜, fiÙÈ Û¿ÓÈ· ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È, ΢ڛˆ˜, Ù˘ TC, ÙˆÓ TG Î·È Ù˘ LDL-C, Ì ·‰È¢ÎÚ›ÓÈÛÙÔ Ì˯·ÓÈÛÌfi (8). ∆· ˘„ËÏ¿ Â›‰· Lp(a) ıˆÚÔ‡ÓÙ·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÁ¤ÓÂÛ˘ Î·È ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ÂÂȉ‹ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ·fiÊÚ·ÍË ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ ÂÍ·ÈÙ›·˜

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¶›Ó·Î·˜ 3. ∂›‰· ApoA-I Î·È ApoB ÔÚÔ‡ Û ·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜ º¿Ú̷η ñ ∫·Ú‚·Ì·˙Â›ÓË ª¿ÚÙ˘Ú˜ ñ µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ª¿ÚÙ˘Ú˜ ñ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ª¿ÚÙ˘Ú˜

∞ÚÈıÌfi˜ ·È‰ÈÒÓ

ApoA-I (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

ApoB (mg/dl) (ª¤ÛË ÙÈÌ‹)

p

32 35 28 34 25 26

192,1±27,2 131,2±43,9 142,9±39,2 131,7±42,9 156,9±27,7 128,1±39,3

<0,01

101,3±27,7 74,8±17,9 84,5± 26,1 75,2±17,4 99,7±23,61 72,2±17,2

<0,01

ª™ <0,01

ª™ <0,01

250

200

150

ApoA-I (mg/dl)

100

ApoB (mg/dl)

50

0 Â›ÓË ·Ì·˙ ‚ Ú · K

˜1 Ù˘Ú ª¿Ú

ÚÔ˚Îfi µ·Ï ÈÔ Ó¿ÙÚ

˜2 Ù˘Ú ª¿Ú

Ë ‚ÈÙ¿Ï Ô‚·Ú º·ÈÓ

˜3 Ù˘Ú ª¿Ú

∂ÈÎfiÓ· 3. ª¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ApoA-I Î·È ApoB Û fiϘ ÙȘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜.

ÙˆÓ ·ÓÙÈÈÓˆ‰ÔÏ˘ÙÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ·Ó Î·È Ë Lp(a) ·˘Í¿ÓÂÙ·È Û fiϘ ÙȘ ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÙ·È Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi Â›‰Ô. À¿Ú¯Ô˘Ó ÌfiÓÔ ‰‡Ô ÚÔËÁÔ‡ÌÂÓ˜ ·ÚfiÌÔȘ ÌÂϤÙ˜. ™ÙËÓ ÚÒÙË ÌÂϤÙË ‰ÂÓ ‚Ú¤ıËΠӷ ÂËÚ¿˙ÔÓÙ·È Ù· Â›‰· Ù˘ Lp(a) (8), ÂÓÒ ÛÙË ‰Â‡ÙÂÚË ÌÂϤÙË ‚Ú¤ıËΠ·˘ÍË̤ÓË Û fiϘ ÙȘ ÔÌ¿‰Â˜, ÌÔÏÔÓfiÙÈ Ë ·‡ÍËÛË ·˘Ù‹ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÌfiÓÔ ÛÙ· ·È‰È¿ Ì ϋ„Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ (11). ∏ Â·ÁˆÁ‹ ÙˆÓ Ë·ÙÈÎÒÓ ÌÈÎÚÔÛˆÌÈ·ÎÒÓ ÂÓ˙‡ÌˆÓ ·fi ÙËÓ Î·Ú‚·Ì·˙Â›ÓË Î·È ÙËÓ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÔÚ› Ó· ıˆÚËı› ˘‡ı˘ÓË ÁÈ· ÙËÓ ·‡ÍËÛË ·˘Ù‹ (9), ·ÏÏ¿ Â›Ó·È ¿ÁÓˆÛÙÔ˜ Ô Ì˯·ÓÈÛÌfi˜ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ Lp(a) Ì ÙË Ï‹„Ë ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ Ó·ÙÚ›Ô˘. ¶ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ Ì ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ ÂӉ¯Ô̤ӈ˜ ı· ‰ÒÛÔ˘Ó ·¿ÓÙËÛË Û ·˘Ùfi ÙÔ ÂÚÒÙËÌ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· Â›‰· ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ, ˘¿Ú¯Ô˘Ó ÌfiÓÔ Ï›Á˜ ÌÂϤÙ˜ (1,7,11). ªÔÏÔ-

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ÓfiÙÈ Ù· Â›‰· Ù˘ HDL-C Î·È Ù˘ LDL-C ÛÙÔÓ ÔÚfi Û˘¯Ó¿ ·Ó·Ê¤ÚÔÓÙ·È ·˘ÍË̤ӷ Û ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó Â·ÁˆÁÈο ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÔÈ ApoA-I Î·È ApoB, Ô˘ ·ÔÙÂÏÔ‡Ó Î·È ÙȘ ·ÚȘ ÚˆÙ½Ó˜ ÙˆÓ HDL-C Î·È HDL-C ·ÓÙ›ÛÙÔȯ·, Û¿ÓÈ· ‚Ú›ÛÎÔÓÙ·È ÂËÚ·Ṳ̂Ó˜, fiˆ˜ ‰È·ÈÛÙÒıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË (1). ∂›Ó·È Èı·Ófi Ë Â·ÁˆÁ‹ ÙˆÓ ÌÈÎÚÔÛˆÌÈ·ÎÒÓ ÂÓ˙‡ÌˆÓ ·fi ÙËÓ Î·Ú‚·Ì·˙Â›ÓË Î·È ÙË Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Ó· ÚÔηÏ› ·˘ÍË̤ÓË Ë·ÙÈ΋ Û‡ÓıÂÛË Ù˘ ApoA-I Î·È ApoB. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ù· ¿ÙÔÌ· Ì ¯ÚfiÓÈ· ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ ¤¯Ô˘Ó ÁÂÓÈο ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (14). ∫·ıÒ˜ ÈÛÙ‡ÂÙ·È fiÙÈ Ù· ·˘ÍË̤ӷ Â›‰· Ù˘ HDL-C ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (13), Ë ·Ó·ÊÂÚfiÌÂÓË ÌÂȈ̤ÓË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ Û ÂÈÏËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ Û ·‡ÍËÛË Ù˘ HDL-C (4,8). ŸÌˆ˜, Ë ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ ıˆÚ› fiÙÈ Ù· ·˘ÍË̤ӷ Ëϛη TC/HDL-C Î·È LDL-C/HDL-C ›ӷÈ


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ÂÚÈÛÛfiÙÂÚÔ ÂÓ‰ÂÈÎÙÈο ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÁ¤ÓÂÛ˘ (5). ™Â ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, Ë ·‡ÍËÛË Ù˘ HDL-C ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi Ù·˘Ùfi¯ÚÔÓË ·‡ÍËÛË Ù˘ TC Î·È Ù˘ LDL-C ηÈ, ¤ÙÛÈ, Ù· Ëϛη TC/HDL Î·È LDL-C/HDLC Ó· ·Ú·Ì¤ÓÔ˘Ó ·ÌÂÙ¿‚ÏËÙ·. ∞˘ÍË̤ӷ Ëϛη TC/HDL-C Î·È LDL-C/HDL-C Û ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Î·Ú‚·Ì·˙Â›ÓË (7,9), ·ÏÏ¿ Î·È ÌÂȈ̤ӷ Ëϛη TC/HDL-C ÁÂÓÈο Û ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ¤¯Ô˘Ó ·Ó·ÊÂÚı› (14). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ·ÓˆÙ¤Úˆ ËÏ›ÎˆÓ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ Ó·ÙÚ›Ô˘, Ù· ‰Â‰Ô̤ӷ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È ·ÓÙÈÊ·ÙÈο (4,7). £· Ú¤ÂÈ Ó· ÛËÌÂȈı›, Â›Û˘, fiÙÈ Û ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ÚÔηÏÔ‡Ó ÌfiÓÔ ‚Ú·¯˘ÚfiıÂÛ̘ ÌÂÙ·‚ÔϤ˜ Î·È ÔÈ ÌÂÙ·‚ÔϤ˜ ·˘Ù¤˜ ·Ôηı›ÛÙ·ÓÙ·È ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ (8). ªÔÏÔÓfiÙÈ ÌÂÚÈÎÔ› ÂÚ¢ÓËÙ¤˜ Û˘ÓÈÛÙÔ‡Ó ‰›·ÈÙ· Ùˆ¯‹ Û ¯ÔÏËÛÙÂÚfiÏË Û ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó Î·Ú‚·Ì·˙Â›ÓË, Ù· ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ ‰ÂÓ ·Ú¤¯Ô˘Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Î›Ó‰˘ÓÔ ·ıËÚÔÁ¤ÓÂÛ˘ ÛÙ· ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÈο Ê¿Ú̷η Î·È ··ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙË ÙÔ˘ ı¤Ì·ÙÔ˜ (2,8). ™˘ÌÂÚ·ÛÌ·ÙÈο, ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ·ÚÔ‡Û· ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÌÔÓÔıÂÚ·›·˜ Ì ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, Ì ηڂ·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ÂÈÏËÙÈÎÒÓ ·È‰ÈÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜, ÌÔÏÔÓfiÙÈ ÙÔ Â›‰Ô˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ‰È·Ê¤ÚÂÈ ·fi ¿ÏϘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜. £· Ú¤ÂÈ, fï˜, Ó· ÙÔÓÈÛÙ› fiÙÈ ÁÈ· Ó· Á›ÓÂÈ ·ÓÙÈÏËÙfi˜ Ô ÚfiÏÔ˜ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ Ù˘¯fiÓ ÌÂÏÏÔÓÙÈ΋ ·Ó¿Ù˘ÍË ·ıËڈ̿وÛ˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Û ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi, ·ÏÏ¿ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË. ™˘¯Ófi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ Î·È ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜ ¯ÚÂÈ¿˙ÔÓÙ·È Î˘Ú›ˆ˜ Ù· ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Ì ηڂ·Ì·˙Â›ÓË ‹ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È Ù· ÔÔ›· ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ıËÚÔÁ¤ÓÂÛ˘, fiˆ˜ Â›Ó·È ·˘Ù¿ Ì ‰È·Ù·Ú·¯¤˜ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ‹ Ì ÂÈ‚·Ú˘Ì¤ÓÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ıËڈ̿وÛ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Reddy MN. Effect of anticonvulsant drugs on plasma total cholesterol, high-density lipoprotein cholesterol, and

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apolipoproteins A and B in children with epilepsy. Proc Soc Exp Biol Med 1985;180:359-363. Franzoni E, Govoni M, D’Addato S, Gualandi S, Sangiorgi Z, Descovich GC et al. Total cholesterol, high-density lipoprotein cholesterol and triglycerides in children receiving antiepileptic drugs. Epilepsia 1992;33:932-935. Brown DW, Ketter TA, Crumlish J, Post RM. Carbamazepine-induced increases in total serum cholesterol: clinical and theoretical implications. J Clin Psychopharmacol 1992;12:431-437. Eiris JM, Lojo S, Del Rio MC, Novo I, Bravo M, Pavon P et al. Effects of long-term treatment with antiepileptic drugs on serum lipid levels in children with epilepsy. Neurology 1995;45:1155-1157. Isojarvi JI, Pakarinen AJ, Myllyla VV. Serum lipid levels during carbamazepine medication. A prospective study. Arch Neurol 1993;50:590-593. Yalcin E, Hassanzadeh A, Mawlud K. The effects of longterm anticonvulsive treatment on serum lipid profile. Acta Paediatr Jpn 1997;39:342-345. Sozuer DT, Atakil D, Dogu O, Baybas S, Arpaci B. Serum lipids in epileptic children treated with carbamazepine and valproate. Eur J Pediatr 1997;156:565-567. Verrotti A, Basciani F, Domizio S, Sabatino G, Morgese G, Chiarelli F. Serum lipids and lipoproteins in patients treated with antiepileptic drugs. Pediatr Neurol 1998;19:364-367. Demircioglu S, Soylu A, Dirik E. Carbamazepine and valproic acid: effects on the serum lipids and liver functions in children. Pediatr Neurol 2000;23:142-146. Papacostas S. Oxcarbazepine versus carbamazepine treatment and induction of serum lipid abnormalities. J Child Neurol 2000;15:138-140. Aynaci FM, Orhan F, Orem A, Yildirmis S, Gedik Y. Effect of antiepileptic drugs on plasma lipoprotein (a) and other lipid levels in childhood. J Child Neurol 2001;16:367-369. ∫·‚·˙·Ú¿Î˘ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-÷Ù˙Ë·ÚÁ˘ÚÔ‡ ¢, ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Û ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1998;61:148-160. American Academy of Pediatrics Committee on Nutrition. Statement on cholesterol. Pediatrics 1992;90:469-473. Muuronen A, Kaste M, Nikkila EA, Tolppanen EM. Mortality from ischaemic heart disease among patients using anticonvulsive drugs: a case-control study. BMJ 1985;291:1481-1483.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-07-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-03-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰Ú˘ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: kvoudris@otenet.gr

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CASE REPORT

™‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÛÙÔÓ ‡ÓÔ Û˘Óԉ¢fiÌÂÓÔ ·fi Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ∞. ∫·‰›Ù˘, µ. ªÈÎÚ¿ÎË, ∂. ∫ˆÛÙ·‰‹Ì·, ¡. ™ÎÂÓÙ¤Ú˘, ∫. °Ô˘ÚÁÔ˘ÏÈ¿Ó˘

Obstructive sleep apnoea syndrome accompanied by nocturnal enuresis E. Alexopoulos, A. Kaditis, V. Mikraki, E. Kostadima, N. Skenteris, K. Gourgoulianis

¶ÂÚ›ÏË„Ë: ∏ Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ıˆÚÂ›Ù·È ÂÈÏÔ΋ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘, ÂÂȉ‹ Û˘¯Ó¿ ˘Ô¯ˆÚ› ÌÂÙ¿ ·fi ·Ì˘Á‰·ÏÂÎÙÔÌ‹ Î·È ·‰ÂÓÔÂȉÂÎÙÔÌ‹, ÔÈ Ôԛ˜ ·ÔÛÎÔÔ‡Ó ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ‚·ÙfiÙËÙ·˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡. øÛÙfiÛÔ, ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ̤¯ÚÈ Û‹ÌÂÚ· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ë ˘Ô¯ÒÚËÛË Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Èı·ÓÔÏÔÁ‹ıËΠ·fi ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È ‰ÂÓ ÙÂÎÌËÚÈÒıËΠ̠ÔÏ˘Î·Ù·ÁÚ·ÊÈ΋ ÌÂϤÙË ‡ÓÔ˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ì˘Á‰·ÏÂÎÙÔÌ‹/·‰ÂÓÔÂȉÂÎÙÔÌ‹. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 9 ÂÙÒÓ Ì ÈÛÙÔÚÈÎfi ηı’ ¤ÍÈÓ ÚÔ¯·ÏËÙÔ‡ Î·È ÚˆÙÔ·ıÔ‡˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘, Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ÔÔ›Ô˘ ˘Ô¯ÒÚËÛ·Ó ÌÂÙ¿ ·fi Û˘Ó‰˘·Ṳ̂ÓË ·Ì˘Á‰·ÏÂÎÙÔÌ‹ Î·È ·‰ÂÓÔÂȉÂÎÙÔÌ‹. ¶ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ Ô˘ ¤ÁÈÓ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ·Ó¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ. ∂Í·ÈÙ›·˜ Ù˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ Ù˘ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ Ì ÙȘ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ, ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È Û fiÏ· Ù· ·È‰È¿ Ô˘ ÚÔÛÎÔÌ›˙ÔÓÙ·È ÁÈ· ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂÓÔ‡ÚËÛ˘. £ÂÚ·›· Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ˘Ô¯ÒÚËÛË Ù˘ ÂÓÔ‡ÚËÛ˘.

Abstract: A causative link between nocturnal enuresis and obstructive sleep apnoea (OSA) in children has been suggested, since bedwetting frequently improves or resolves completely after adenotonsillectomy for the relief of upper airway obstruction. However, in the patients reported in the paediatric literature, the improvement of sleepdisordered breathing was not assessed by comparing preoperative and postoperative polysomnography findings. This is a report of a child with a long history of snoring and primary nocturnal enuresis whose symptoms ceased following adenotonsillectomy for OSA. Polysomnograms performed before and after the surgical procedure demonstrated appreciable improvement in the sleep pattern. Since nocturnal enuresis has been associated with sleepdisordered breathing, questions regarding respiratory symptoms during sleep should be asked in children undergoing an evaluation for bedwetting. Treatment of OSA may contribute to resolution of enuresis.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘, ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ, Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, ·Ì˘Á‰·ÏÂÎÙÔÌ‹, ·‰ÂÓÔÂȉÂÎÙÔÌ‹.

Key words: obstructive sleep apnoea syndrome, sleep disordered breathing, nocturnal enuresis, adenoidectomy, tonsillectomy.

™˘ÓÙÔÌÔÁڷʛ˜ ™∞∞À

™‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘

¶·È‰È·ÙÚÈ΋ Î·È ¶Ó¢ÌÔÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·Ï›·˜ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈÎfi π·ÙÚÂ›Ô Î·È ∂ÚÁ·ÛÙ‹ÚÈÔ ªÂϤÙ˘ ¢È·Ù·Ú·¯ÒÓ Ù˘ ∞Ó·ÓÔ‹˜ ÛÙÔÓ ⁄ÓÔ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô §¿ÚÈÛ·˜

208

Pediatric and Respiratory Medicine Clinic of University of Thessalia Department of Pediatric Respiratory Medicine and Laboratory for the Study of Sleep and Breathing Disorders, University Hospital of Larissa


May-June 03

03-06-03

16:55

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¶·È‰È·ÙÚÈ΋ 2003;66:208-210

∂ÈÛ·ÁˆÁ‹ Œ¯ÂÈ ‰È·Ù˘ˆı› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ë ¿Ô„Ë fiÙÈ Î¿ÔȘ ÂÚÈÙÒÛÂȘ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ ·ÔÙÂÏÔ‡Ó ÂÈÏÔ΋ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘ (1,2). ∏ ı¤ÛË ·˘Ù‹, fï˜, ‰ÂÓ ÛÙËÚ›˙ÂÙ·È Û ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, ·ÏÏ¿ ÛÙË ‚ÂÏÙ›ˆÛË ‹ Î·È Ï‹ÚË ˘Ô¯ÒÚËÛË Ù˘ ÂÓÔ‡ÚËÛ˘ ÌÂÙ¿ ÙË ıÂÚ·›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘ (™∞∞À) (3-5). øÛÙfiÛÔ, ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ̤¯ÚÈ Û‹ÌÂÚ· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ÔÏ˘Î·Ù·ÁÚ·ÊÈ΋ ÌÂϤÙË ‡ÓÔ˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ì˘Á‰·ÏÂÎÙÔÌ‹/·‰ÂÓÔÂȉÂÎÙÔÌ‹, ÂÓÒ Ë ˘Ô¯ÒÚËÛË ÙÔ˘ ™∞∞À Èı·ÓÔÏÔÁ‹ıËΠ·fi ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·È‰ÈÔ‡ Ì ÚÔ¯·ÏËÙfi, ·Ó‹Û˘¯Ô ‡ÓÔ, ™∞∞À Î·È ÚˆÙÔ·ı‹ Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ÔÔ›Ô˘ Î·È Ù· Â˘Ú‹Ì·Ù· Ù˘ ÔÏ˘Î·Ù·ÁÚ·ÊÈ΋˜ ÌÂϤÙ˘ ‚ÂÏÙÈÒıËÎ·Ó ÌÂÙ¿ ÙË Û˘Ó‰˘·Ṳ̂ÓË ·Ì˘Á‰·ÏÂÎÙÔÌ‹/ ·‰ÂÓÔÂȉÂÎÙÔÌ‹. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 9 ÂÙÒÓ ÚÔÛÎÔÌ›ÛÙËΠÛÙÔ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi È·ÙÚ›Ô, ηıÒ˜ ·ÚÔ˘Û›·˙ ÚˆÙÔ·ı‹ Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË Û¯Â‰fiÓ Î¿ı ‚Ú¿‰˘. OÈ ÁÔÓ›˜ ·Ó¤ÊÂÚ·Ó ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3,5 ÂÙÒÓ. ∆· Û˘ÌÙÒÌ·Ù· ÂÚÈÂÏ¿Ì‚·Ó·Ó ˘ÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ·Ó·ÓÔ‹ ·fi ÙÔ ÛÙfiÌ· ÙfiÛÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ fiÛÔ Î·È Î·Ù¿ ÙËÓ ÂÁÚ‹ÁÔÚÛË, ˯ËÚfi ÚÔ¯·ÏËÙfi οı ‚Ú¿‰˘ Î·È ¿ÓÔȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ¶ÚfiÛÊ·ÙË ÚÔÛ¿ıÂÈ· ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ Ì ÙÚÔÔÔ›ËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ‰ÂÓ Â›¯Â ·ÔÙ¤ÏÂÛÌ·. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ ‰È·ÈÛÙÒıËÎ·Ó ÛÙÔÌ·ÙÈ΋ ·Ó·ÓÔ‹ Î·È ˘ÂÚÙÚÔÊÈΤ˜ ·Ì˘Á‰·Ï¤˜ Ô˘ ·¤ÊÚ·ÛÛ·Ó Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. ¶Ï¿ÁÈ· ·ÎÙÈÓÔÁÚ·Ê›· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· Ì ÙÔ ÛÙfiÌ· ·ÓÔÈÎÙfi ·Ó¤‰ÂÈÍ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ ˘ÂÚÙÚÔÊ›· ÙˆÓ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ, ÂÓÒ Ô ˘fiÏÔÈÔ˜ ÎÏÈÓÈÎfi˜ Î·È ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·¤ÎÏÂÈÛ ¿ÏÏ· ÔÚÁ·ÓÈο ·›ÙÈ· ÛÙ· ÔÔ›· ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› Ë ÂÓÔ‡ÚËÛË. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ Ì ˘ÔÏÔÁÈÛÙÈÎfi Û‡ÛÙËÌ· (Alice 4, Respironics, Mariette, GA), ÛÙËÓ ÔÔ›· ηٷÁÚ¿ÊËÎÂ Ë ÚÔ‹ ÙÔ˘ ·¤Ú· ·fi ÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ·, ÔÈ ÎÈÓ‹ÛÂȘ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ Î·È ÎÔÈÏÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ô ÎÔÚÂÛÌfi˜ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ, Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· Î·È Ë ·ÏÏ·Á‹ Ù˘ ı¤Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∂ÈϤÔÓ, ¤ÁÈÓÂ Î·È ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ηٷÁÚ·Ê‹ ÁÈ· ÛÙ·‰ÈÔÔ›ËÛË ÙÔ˘ ‡ÓÔ˘. ø˜

Paediatriki 2003;66:208-210

·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘ ÔÚ›ÛÙËÎÂ Ë ‰È·ÎÔ‹ Ù˘ ÚÔ‹˜ ÙÔ˘ ·¤Ú· ·fi ÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ· ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·Ó·Ó¢ÛÙÈÎÒÓ Î‡ÎψÓ, Ì ٷ˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ ÎÈÓ‹ÛÂˆÓ Ù˘ ÎÔÈÏÈ¿˜. ø˜ ·ÔÊÚ·ÎÙÈ΋ ˘fiÓÔÈ· ıˆڋıËÎÂ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 50% Ù˘ ÚÔ‹˜ ÙÔ˘ ·¤Ú· ·fi ÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ·, Ì ٷ˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ·Ú¿‰Ô͢ ·Ó·ÓÔ‹˜ Î·È ·ÔÎÔÚÂÛÌfi Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 4% (6). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆Ô ·È‰› ˘Ô‚Ï‹ıËΠ۠·Ì˘Á‰·ÏÂÎÙÔÌ‹ Î·È ·‰ÂÓÔÂȉÂÎÙÔÌ‹. ∏ ˘ÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ Î·È ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ¿ÓÔȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ˘Ô¯ÒÚËÛ·Ó Ï‹Úˆ˜, ÂÓÒ ÙÔ ÚÔ¯·ÏËÙfi ‚ÂÏÙÈÒıËΠÛËÌ·ÓÙÈο. ∆Ô ·È‰› ·ÚÔ˘Û›·Û ÌfiÓÔ ÙÚ›· ÂÂÈÛfi‰È· Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ ÛÙȘ ÚÒÙ˜ ‰‡Ô ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È Â›Ó·È ÂχıÂÚÔ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 18 Ì‹Ó˜. ŒÁÈÓ Ӥ· ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ 6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ™˘˙‹ÙËÛË ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ Û ·È‰È¿ Ì ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÛÙÔÓ ‡ÓÔ ·Ó·Ê¤ÚÔ˘Ó ÂÚÈÙÒÛÂȘ Ì ӢÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË (2,3). OÈ Swift Î·È Û˘Ó ·Ó¤ÊÂÚ·Ó 3 ·È‰È¿ Ì ™∞∞À Î·È ÂÓÔ‡ÚËÛË, ÛÙÔ ¤Ó· ·fi Ù· ÔÔ›· Ë ÂÓÔ‡ÚËÛË ˘Ô¯ÒÚËÛ ÌÂÙÂÁ¯ÂÈÚËÙÈο (4). ª›· ÈÔ Û˘ÛÙËÌ·ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ù˘ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ Î·È Ù˘ ·fiÊڷ͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡ ¤¯ÂÈ ·ÚÔ˘ÛÈ·ÛÙ› ·fi ÙÔ˘˜ Weider Î·È Û˘Ó (5). ¶ÂÚÈÁÚ¿ÊÔ˘Ó ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜ ·fi 115 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 3-19 ÂÙÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·Ì˘Á‰·ÏÂÎÙÔÌ‹ ‹ ·‰ÂÓÔÂȉÂÎÙÔÌ‹ Ì ÔÈΛϘ ÂӉ›ÍÂȘ. ¶·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ó˘ÎÙÒÓ Ì ÂÓÔ˘ÚËÙÈο ÂÂÈÛfi‰È· ηٿ 66% ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È Î·Ù¿ 76% ¤ÍÈ Ì‹Ó˜ ÌÂÙ¿. ™Â 3 ·fi Ù· 11 ·È‰È¿ Ô˘ ¶›Ó·Î·˜ 1. ∞ÔÙÂϤÛÌ·Ù· ÔÏ˘Î·Ù·ÁÚ·ÊÈÎÒÓ ÌÂÏÂÙÒÓ ¶ÚÈÓ ÙËÓ ªÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Â¤Ì‚·ÛË ™‡ÓÔÏÔ ·ÓÔÈÒÓ ™‡ÓÔÏÔ ˘ÔÓÔÈÒÓ ™‡ÓÔÏÔ ·ÔÎÔÚÂÛÌÒÓ >4% ∞π (‰Â›ÎÙ˘ ·ÓÔÈÒÓ) ∞∏π (‰Â›ÎÙ˘ ·ÓÔÈÒÓ-˘ÔÓÔÈÒÓ) DI (‰Â›ÎÙ˘ ·ÔÎÔÚÂÛÌÒÓ) ∂Ï¿¯ÈÛÙÔ SaO2 ÃÚfiÓÔ˜ ‡ÓÔ˘ Ì SaO2 <95% ÃÚfiÓÔ˜ ‡ÓÔ˘ Ì SaO2 <90% ÃÚfiÓÔ˜ ‡ÓÔ˘ Ì SaO2 <85%

12 41 57 1,5/ÒÚ· 6,6/ÒÚ· 7,1/ÒÚ· 82% 32 min 6 min 0,5 min

4 7 12 0,5/ÒÚ· 1,5/ÒÚ· 1,6/ÒÚ· 93% 1,5 min 0 min 0 min

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¤ÁÈÓ ÔÏ˘Î·Ù·ÁÚ·ÊÈ΋ ÌÂϤÙË ‡ÓÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈο ‚Ú¤ıËΠ™∞∞À. ∏ ÂÓÔ‡ÚËÛË ˘Ô¯ÒÚËÛÂ Î·È ÛÙ· 3 ·È‰È¿ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË. ∏ ˘¤ÚÌÂÙÚË ·Ú·ÁˆÁ‹ Ô‡ÚˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ¤¯ÂÈ ÚÔÙ·ı› ˆ˜ ¤Ó·˜ ·fi ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ (8). ∆· ÂÂÈÛfi‰È· Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÚÓËÙÈ΋ ÂÓ‰ÔıˆÚ·ÎÈ΋ ›ÂÛË, ·˘ÍË̤ÓË ÊÏ‚È΋ ÂÈÛÙÚÔÊ‹, ‰È¿Ù·ÛË ÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘ Î·È ¤ÎÎÚÈÛË ÎÔÏÈÎÔ‡ Ó·ÙÚÈÔ‰ÈÔ˘ÚËÙÈÎÔ‡ ÂÙȉ›Ô˘. ∏ ˘ÔÍ·ÈÌ›· Ô˘ Û˘¯Ó¿ Û˘Óԉ‡ÂÈ ÙȘ ¿ÓÔȘ, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÁÁÂÈÔÛ‡Û·ÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ Î·È ÌÔÚ› Â›Û˘ Ó· Ô‰ËÁ‹ÛÂÈ Û ‰È¿Ù·ÛË ÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘. ∆Ô ÎÔÏÈÎfi Ó·ÙÚÈÔ‰ÈÔ˘ÚËÙÈÎfi ÂÙ›‰ÈÔ Â˘Ô‰ÒÓÂÈ ÙËÓ ·Ô‚ÔÏ‹ Ó·ÙÚ›Ô˘ ·fi ÙÔÓ ÓÂÊÚfi Î·È ·˘Í¿ÓÂÈ ÙÔÓ fiÁÎÔ ÙˆÓ Ô‡ÚˆÓ (9,10). ÀÔ¯ÒÚËÛË Ù˘ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙ· ·È‰È¿ Ì ‰È·Ï›Ô˘Û· ·fiÊÚ·ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÌÂÙ¿ ·fi ıÂÚ·›· Ì ÚÈÓÈÎfi ÂÎӤʈ̷ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ (11) Î·È ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ì ™∞∞À ÌÂÙ¿ ·fi ÂÊ·ÚÌÔÁ‹ Û˘Ó¯ԇ˜ ıÂÙÈ΋˜ ›ÂÛ˘ ·fi ÙË Ì‡ÙË (nasal CPAP) (12). OÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ‰ÂÓ Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Ù˘ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘. ŸÙ·Ó fï˜ ˘¿Ú¯Ô˘Ó, ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· Ô˘ Û˘Ó‹ıˆ˜ ÌÔÚ› ‡ÎÔÏ· Ó· ‰ÈÔÚıˆı›. §ÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi ÁÈ· Ù˘¯fiÓ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ·fi fiÏ· Ù· ·È‰È¿ Ô˘ ÚÔÛÎÔÌ›˙ÔÓÙ·È ÁÈ· ·ÓÙÈÌÂÙÒÈÛË Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛ˘ Î·È ÂÊfiÛÔÓ ÚÔ·ÙÔ˘Ó ÂӉ›ÍÂȘ Èı·ÓÔ‡ ™∞∞À, ı· Ú¤ÂÈ Ó· ÙÂÎÌËÚÈÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË Ì ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË Î·È Ó· ·ÎÔÏÔ˘ı› ıÂÚ·›·. ∏ ‚ÂÏÙ›ˆÛË ÙÔ˘ ™∞∞À Û˘¯Ó¿ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ˘Ô¯ÒÚËÛË Ù˘ ÂÓÔ‡ÚËÛ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. American Academy of Pediatrics, Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea

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syndrome. Pediatrics 2002;109:704-712. 2. Guilleminault C, Winkle R, Korobkin R, Simmons B. Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr 1982;139:165-171. 3. Richardson MA, Seid AB, Cotton RT, Benton C, Kramer M. Evaluation of tonsils and adenoids in sleep apnea syndrome. Laryngoscope 1980;90:1106-1110. 4. Swift AC. Upper airway obstruction, sleep disturbance and adenotonsillectomy in children. J Laryngol Otol 1988;102:419-422. 5. Weider DJ, Sateia MJ, West RP. Nocturnal enuresis in children with upper airway obstruction. Otolaryngol Head Neck Surg 1991;105:427-432. 6. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996;153:866-878. 7. Goh DY, Galster P, Marcus CL. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med 2000;162:682-686. 8. Neveus T, Lackgren G, Tuvemo T, Hetta J, Hjalmas K, Stenberg A. Enuresis - background and treatment. Scand J Urol Nephrol 2000;206 (Suppl):S1-S44. 9. Krieger J, Follenius M, Sforza E, Brandenberger G, Peter JD. Effects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patients with obstructive sleep apnoea. Clin Sci 1991;80:443-449. 10. Warley AR, Stradling JR. Abnormal diurnal variation in salt and water excretion in patients with obstructive sleep apnoea. Clin Sci 1988;74:183-185. 11. Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995;95:355-364. 12. Kramer NR, Bonitati AE, Millman RP. Enuresis and obstructive sleep apnea in adults. Chest 1998;114:634-637.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-10-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-03-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ∞ÏÂÍfiÔ˘ÏÔ˜ ÃÚ˘ÛÔÛÙfiÌÔ˘ ™Ì‡ÚÓ˘ 2, ¶ÂÚÈÔ¯‹ ™Ù·ıÌÔ‡ ∆.∫. 412 23, §¿ÚÈÛ· E-mail: ealexop@yahoo.com


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Paediatriki 2003;66:211-214

CASE REPORT

∂ÙÂÚfiÏ¢ÚË ‰È·Ï›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÚÔ¤¯ÔÓ Û‡Ìو̷ ¯ÚfiÓÈ·˜ ÈÁÌÔÚ›Ùȉ·˜ °. ¶·Ú‰��Ïfi˜, ™. ªÔ‡ÛÎÔ˘, ¢. ∑·ÊÂÈÚ›Ô˘, µ. ∞˚‚¿˙˘

Unilateral intermittent blepharoptosis as an urgent symptom of chronic sinusitis G. Pardalos, S. Mouskou, D. Zafiriou, V. Aivazis

¶ÂÚ›ÏË„Ë: H Â›ÎÙËÙË ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ÛÙ· ·È‰È¿ ¯ÚÂÈ¿˙ÂÙ·È ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË, ÁÈ·Ù› Û˘Ó‹ıˆ˜ ‰ËÏÒÓÂÈ ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂ȉÈÎfiÙÂÚ·, Ë ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÚÔ¤¯ÔÓ Û‡Ìو̷ ÂÈÏÔ΋˜ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜, ·Ó Î·È Û¿ÓÈ· ÛÙ· ·È‰È¿, Ú¤ÂÈ ¿ÓÙÔÙ ӷ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ÁÈ·Ù› Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂÏ› ÚÒÈÌÔ Û‡Ìو̷ ÔÍ›·˜ ÊÏÂÁÌÔÓ‹˜ ‹ ÌÂÌÔӈ̤ÓÔ Û‡Ìو̷ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 13 ÂÙÒÓ Ì ÂÙÂÚfiÏ¢ÚË ‰È·Ï›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿, ÏfiÁˆ Â¤ÎÙ·Û˘ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ ÛÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ Î·È ›ÂÛ˘ ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ Ó‡ÚÔ˘ Ô˘ Ó¢ÚÒÓÂÈ ÂÎÏÂÎÙÈο ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘.

Abstract: Acquired blepharoptosis in childhood demands special attention because it usually indicates a potentially serious neurologic disorder. In particular, blepharoptosis as an urgent symptom of complicated sinusitis, although rare in children, must be included in the differential diagnosis because it may constitute an early sign of acute inflammation or an isolated sign of chronic inflammation of the orbit. The case is reported of a 13-year-old girl with unilateral intermittent blepharoptosis of the left upper lid due to intraorbital extension of chronic sinusitis with pressure on the oculomotor nerve branch which supplies only the inferior levator palpebrae muscle.

§¤ÍÂȘ ÎÏÂȉȿ: ‚ÏÂÊ·ÚfiÙˆÛË, ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·, ¿ÚÂÛË ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘.

Key words: blepharoptosis, sinusitis, paresis of the inferior levator palpebrae muscle.

∂ÈÛ·ÁˆÁ‹ ∏ ÔÍ›· ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· ·ÔÙÂÏ› Û˘¯Ófi Úfi‚ÏËÌ· ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi οÔÈÔ ÂÂÈÛfi‰ÈÔ ÔÍ›·˜ ÚÈÓ›Ùȉ·˜ ÈÔÁÂÓÔ‡˜ ‹ ·ÏÏÂÚÁÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜. ∏ ¯ÚfiÓÈ· ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· Â›Ó·È Û·ÓÈfiÙÂÚË Î·È ‰ËÏÒÓÂÈ Û˘Ó‹ıˆ˜ ÙËÓ ‡·ÚÍË ÙÔÈ΋˜ (·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, ·Ó·ÙÔÌÈ΋ ·ÓˆÌ·Ï›· ÚÈÓÔÊ¿Ú˘ÁÁ· Î.¿.) ‹ ÁÂÓÈÎÂ˘Ì¤Ó˘ ‰È·Ù·Ú·¯‹˜ (‰˘ÛÎÈÓËÛ›· ÎÚÔÛÛÒÓ, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Î.¿.), Ë ÔÔ›· ‰È¢ÎÔχÓÂÈ ÙËÓ ÂÈÌÔÓ‹ Ù˘ ÊÏÂÁÌÔÓ‹˜ (1). OÈ ÂÈÏÔΤ˜ ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ›ÙȉˆÓ Â›Ó·È Û¯ÂÙÈο Û¿ÓȘ, ·ÏÏ¿ Ë ·ÚÔ˘Û›· ÙÔ˘˜ Î·È È‰›ˆ˜ Ë Â¤ÎÙ·ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÂÓ‰ÔÎÚ·Óȷο, ÌÔÚ› Ó· Â›Ó·È ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ (1-3). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·È‰ÈÔ‡ Ì ÂÙÂ-

ÚfiÏ¢ÚË ‰È·Ï›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿ ÏfiÁˆ Â¤ÎÙ·Û˘ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ ÛÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ Î·È ›ÂÛ˘ ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ Ó‡ÚÔ˘ Ô˘ Ó¢ÚÒÓÂÈ ÂÎÏÂÎÙÈο ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘. ∏ ÂÈÏÔ΋ ·˘Ù‹ Â›Ó·È Û¿ÓÈ· (4-6), ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿ (7). ¢ÂÓ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙȘ Û˘Ó‹ıÂȘ ÂÈÏÔΤ˜ ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ›ÙȉˆÓ (1-3) Î·È ·Ó·Ê¤ÚÂÙ·È ÌfiÓÔ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ‚ÏÂÊ·ÚfiÙˆÛ˘ ˆ˜ Û¿ÓÈÔ ·›ÙÈÔ ÚfiÎÏËÛ‹˜ Ù˘ (8,9).

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. “πÔÎÚ¿ÙÂÈÔ” °.¶.¡. £ÂÛÛ·ÏÔӛ΢

1st Paediatric Clinic of Aristotelion University “Ippokration” General Hospital, Thessaloniki

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 13 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ÂÙÂÚfiÏ¢Ú˘ ‰È·Ï›Ô˘Û·˜ ‚ÏÂÊ·ÚfiÙˆÛ˘ ·ÚÈÛÙÂÚ¿ ·fi ÂÓıË̤ÚÔ˘.

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∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ, ÂÓÒ ·fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·ÍÈÔÛËÌ›ˆÙË ‹Ù·Ó Ë ·Ó·ÊÔÚ¿ 4 ÂÂÈÛÔ‰›ˆÓ ÈÁÌÔÚ›Ùȉ·˜ ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ. ∆· ÂÂÈÛfi‰È· ·˘Ù¿ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÚÈÓÈ΋ Û˘ÌÊfiÚËÛË Î·È ÌÂÙˆÈ·›· ÎÂÊ·Ï·ÏÁ›·. ∏ ‰È¿ÁÓˆÛË Ù˘ ÈÁÌÔÚ›Ùȉ·˜ ¿Ìʈ ÂȂ‚·ÈÒıËΠ·ÎÙÈÓÔÏÔÁÈο ÛÙ· 3 ·fi Ù· 4 ÂÂÈÛfi‰È·. ÃÔÚËÁ‹ıËΠ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ per os ÁÈ· 10 Ë̤Ú˜ Î·È ÙȘ Ù¤ÛÛÂÚȘ ÊÔÚ¤˜, Ì ‰È·ÊÔÚÂÙÈÎfi οı ÊÔÚ¿ ·ÓÙÈ‚ÈÔÙÈÎfi Î·È ÚfiÛηÈÚË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿وÓ. ∞ӷʤÚÂÙ·È, Â›Û˘, fiÙÈ Ì ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÈÁÌÔÚ›Ùȉ·˜ ηٿ Ù· ‰‡Ô ÙÂÏÂ˘Ù·›· ÂÂÈÛfi‰È·, ·ÚÔ˘ÛÈ¿ÛÙËÎÂ Î·È ÂÙÂÚfiÏ¢ÚË ‰È·Ï›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿, Ë ÔÔ›· ÂÈÙÂÈÓfiÙ·Ó Ì ÙËÓ ÚfiÔ‰Ô Ù˘ Ë̤ڷ˜ Î·È ‚ÂÏÙȈÓfiÙ·Ó ‹ ÂÍ·ÏÂÈÊfiÙ·Ó Ì ÙËÓ Î·Ù¿ÎÏÈÛË. ∆Ô Û‡Ìو̷ ·˘Ùfi ‰È‹ÚÎÂÛ ϛÁ˜ Ë̤Ú˜ Î·È ÙȘ ‰‡Ô ÊÔÚ¤˜ Î·È ·Ô‰fiıËΠÛÙËÓ ÈÁÌÔÚ›Ùȉ·, ÁÈ·Ù› ÂÍ·Ï›ÊıËΠÏ‹Úˆ˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜. ∏ ·ÛıÂÓ‹˜ ‹Ù·Ó Û ηϋ ηٿÛÙ·ÛË ÌÂÙ¿ ÙÔ ÙÂÏÂ˘Ù·›Ô, ÚÔ ‰ÈÌ‹ÓÔ˘, ÂÂÈÛfi‰ÈÔ ÈÁÌÔÚ›Ùȉ·˜, ·Ó ÂÍ·ÈÚ¤ÛÔ˘Ì οÔȘ ÂÍ¿ÚÛÂȘ ‹È·˜ ÚÈÓÈ΋˜ Û˘ÌÊfiÚËÛ˘ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Â˘Î·ÈÚȷο Ì ÙÔÈο ·ÔÛ˘ÌÊÔÚËÙÈο. ¶¤ÓÙ Ë̤Ú˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ Ù˘ ·ÚÔ˘ÛÈ¿ÛÙËΠͷӿ ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿ Ì ٷ ›‰È· ‰È·Ï›ÔÓÙ· ¯·Ú·ÎÙËÚÈÛÙÈο Â›Ù·Û˘ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ Ë̤ڷ˜ Î·È ˘Ô¯ÒÚËÛ˘ Ì ÙËÓ Î·Ù¿ÎÏÈÛË, ·ÏÏ¿ ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ¿ÏÏˆÓ Û˘Ìو̿وÓ, fiˆ˜ ηٷÚÚÔ‹˜, ¤ÓÙÔÓ˘ ÚÈÓÈ΋˜ Û˘ÌÊfiÚËÛ˘, ÎÂÊ·Ï·ÏÁ›·˜ ‹ ˘ÚÂÙÔ‡. ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·Ó, Â›Û˘, ¿ÏÏ· ÔÊı·ÏÌÈο ÂÓԯϋ̷ٷ, fiˆ˜ fiÓÔ˜, ÂÚ˘ıÚfiÙËÙ·, ‰·ÎÚ‡ÚÚÔÈ·, ‰Èψ›· ‹ ÚfiÛÊ·ÙÔ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍ ̛· Ê˘ÛÈÔÏÔÁÈ΋, ηٿ Ù· ¿ÏÏ·, ¤ÊË‚Ë Ì ηϋ ·Ó¿Ù˘ÍË, ıÚ¤„Ë Î·È ÁÂÓÈ΋ ηٿÛÙ·ÛË. ¶·Ú·ÙËÚ‹ıËΠÙÒÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ÂÚ›Ô˘ 5 mm, ¯ˆÚ›˜ Ô›‰ËÌ·, ÂÚ˘ıÚfiÙËÙ· ‹ ¿ÏÁÔ˜. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ÙˆÓ ÔÊı·ÏÌÔÎÈÓËÙÈÎÒÓ ÓÂ‡ÚˆÓ ¤‰ÂÈÍ ¿ÚÂÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ‚ÏÂÊ¿ÚÔ˘ Ô˘ Ó¢ÚÒÓÂÙ·È ·fi ÎÏ¿‰Ô ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Ì‡Â˜ Ô˘ Ó¢ÚÒÓÔÓÙ·È ÙfiÛÔ ·fi ¿ÏÏÔ˘˜ ÎÏ¿‰Ô˘˜ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ (¤Ûˆ, ¿Óˆ Î·È Î¿Ùˆ ÔÚıfi˜, οو ÏÔÍfi˜, ÛÊÈÁÎÙ‹Ú·˜ Ù˘ ÎfiÚ˘ Î·È ·ÎÙÈÓˆÙfi˜ Ì˘˜), fiÛÔ Î·È ·fi ÙÔ ÙÚÔ¯ÈÏÈ·Îfi (¿Óˆ ÏÔÍfi˜) Î·È ÙÔ ··ÁˆÁfi (¤Íˆ ÔÚıfi˜) ¢ڤıËÛ·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›. º˘ÛÈÔÏÔÁÈο ‹Ù·Ó Ù· Â˘Ú‹Ì·Ù· Î·È ·fi ÙËÓ ˘fiÏÔÈË Ó¢ÚÔÏÔÁÈ΋ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË, fiˆ˜ Â›Û˘ Î·È ·fi ÙËÓ ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·, ÏËÓ Ù˘ ·ÚÔ˘Û›·˜ ‹È·˜ ÔÈÛıÔÚÈÓÈ΋˜ ¤ÎÎÚÈÛ˘ Ô˘ Û˘ÓËÁÔÚÔ‡Û ˘¤Ú Ù˘ ÈÁÌÔÚ›Ùȉ·˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ

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Ï‹ÚË ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfi, ÔÚÔÏÔÁÈÎfi, ·ÓÔÛÔÏÔÁÈÎfi, ·ÏÏÂÚÁÈÔÏÔÁÈÎfi Î·È Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·È Ë Mantoux ‹Ù·Ó ·ÚÓËÙÈ΋. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÏËÓ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·ÎÔ˜, ÂÚÈÔÚ›ÛÙËΠÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ ÁÈ· ηχÙÂÚË Â˘ÎÚ›ÓÂÈ·. ∏ ÙÂÏÂ˘Ù·›· ¤‰ÂÈÍ ÊÏÂÁÌÔÓ‹ fiÏˆÓ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎÔÈÏÔًوÓ, ȉȷ›ÙÂÚ· ÙˆÓ ËıÌÔÂȉÒÓ Î˘„ÂÏÒÓ, Ì ÂÈÎfiÓ· ·Ó·Î·Ù·Û΢‹˜ ÙÔ˘ ÔÛÙÔ‡ (bone remodeling), Ô˘ ·ÔÙÂÏ› ÂÓ‰ÂÈÎÙÈÎfi ‡ÚËÌ· ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ (∂ÈÎfiÓ· 1). ∂ÈϤÔÓ, ·Ú·ÙËÚ‹ıËΠ›ÂÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¤Ûˆ ÔÚıÔ‡ ÔÊı·ÏÌÈÎÔ‡ Ì˘fi˜ ÂÍ·ÈÙ›·˜ Ù˘ ÂÓÙÔÓfiÙÂÚ˘ ÊÏÂÁÌÔÓ‹˜ ÚÔ˜ ÙÔ ¤Ûˆ ÙÔ›¯ˆÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ (∂ÈÎfiÓ· 2). ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù· Ù˘ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎÔÈÏÔÙ‹ÙˆÓ Ì Â¤ÎÙ·ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÛÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ ·ÈÙ›ˆÓ ‚ÏÂÊ·ÚfiÙˆÛ˘ (ÙÚ·‡Ì·, fiÁÎÔÈ, Ì˘·Ûı¤ÓÂÈ·, Û. Horner), ÂÓ›Û¯˘Û·Ó ÙËÓ ·Ú¯È΋ ˘fiÓÔÈ· Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ÏfiÁˆ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÈÛÙÒÓ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ Î·È ›ÂÛ˘ ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ Ó‡ÚÔ˘ Ô˘ Ó¢ÚÒÓÂÈ ÙÔÓ ÂÓ ÏfiÁˆ Ì˘. ŒÙÛÈ, Ë ·ÛıÂÓ‹˜ Ù¤ıËΠ۠ÂÓ‰ÔÊϤ‚È· ·ÁˆÁ‹ Ì ÎÏÈÓ‰·Ì˘Î›ÓË ÁÈ· 7 Ë̤Ú˜, ·ÓÙÈ-ÈÛÙ·ÌÈÓÈ΋ ·ÁˆÁ‹ per os Î·È ÚÈÓÈΤ˜ ÂÓÛÙ·Ï¿ÍÂȘ ·ÔÛ˘ÌÊÔÚËÙÈÎÒÓ. ∆ÚÂȘ Ë̤Ú˜ ÌÂÙ¿ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜, Ë ‚ÏÂÊ·ÚfiÙˆÛË ˘Ô¯ÒÚËÛ Ï‹Úˆ˜ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙËÓ 8Ë Ë̤ڷ Ì ԉËÁ›Â˜ ÁÈ· Û˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ per os ÁÈ· 7 ·ÎfiÌË Ë̤Ú˜. ™ÙÔÓ Ù·ÎÙÈÎfi Â·Ó¤ÏÂÁ¯Ô ÌÂÙ¿ ·fi 2, 4 Î·È 6 Ì‹Ó˜, Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ÙÂÏ›ˆ˜ ηϿ, ¯ˆÚ›˜ ηӤӷ ÂÂÈÛfi‰ÈÔ ‚ÏÂÊ·ÚfiÙˆÛ˘ ‹ ¿ÏÏ· Û˘ÌÙÒÌ·Ù·. ™˘˙‹ÙËÛË ∏ Â›ÎÙËÙË ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, ·Ó Î·È Û¿ÓÈ· ÛÙ· ·È‰È¿, ··ÈÙ› ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË, ÁÈ·Ù› ‰ËÏÒÓÂÈ Ó¢ÚÈ΋ ‹/Î·È Ì˘˚΋ ÔÊı·ÏÌÔÎÈÓËÙÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÂÓ‰ÔÎÚ·ÓȷΤ˜ ‹ ÂÓ‰ÔÎÔÁ¯ÈΤ˜ ‚Ï¿‚˜ (ÙÚ·‡Ì·, ÊÏÂÁÌÔÓ‹, fiÁÎÔÈ), Ì˘Ô¿ıÂȘ (‚·ÚÈ¿ Ì˘·Ûı¤ÓÂÈ·, Ì˘ÔÛ›Ùȉ·) ‹ ¿ÏϘ ηٷÛÙ¿ÛÂȘ (Û. Horner, ·ÏÏ·ÓÙ›·ÛË, ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·) (8,9). ∏ ÂÙÂÚfiÏ¢ÚË ‰È·Ï›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ·ÛıÂÓÔ‡˜, Ì ÙÔ ÂÈ‚·Ú˘Ì¤ÓÔ ÚfiÛÊ·ÙÔ ÈÛÙÔÚÈÎfi ÙˆÓ Û˘¯ÓÒÓ ÈÁÌÔÚ›ÙȉˆÓ ηÈ, ȉȷ›ÙÂÚ·, Ë ·ÚÔ˘Û›· ·ÚfiÌÔÈ·˜ ÛËÌÂÈÔÏÔÁ›·˜ ηٿ ÙË ‰È·‰ÚÔÌ‹ ÙˆÓ ‰‡Ô ÙÂÏÂ˘Ù·›ˆÓ ÂÂÈÛÔ‰›ˆÓ ÈÁÌÔÚ›Ùȉ·˜ Ô˘ ˘Ô¯ÒÚËÛ Ì ÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ ıÂÚ·›·, ¤ıÂÙ·Ó ÙËÓ ˘fiÓÔÈ· Â¤ÎÙ·Û˘ Ù˘ ·Ú·ÚÚ›ÓÈ·˜


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¶·È‰È·ÙÚÈ΋ 2003;66:211-214

Paediatriki 2003;66:211-214

∂ÈÎfiÓ· 1. MRI ÂÁÎÂÊ¿ÏÔ˘, ∆1 ·ÎÔÏÔ˘ı›· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÛÎÈ·ÛÙÈÎÔ‡: ÊÏÂÁÌÔÓ‹ ·ÌÊfiÙÂÚˆÓ ÙˆÓ ËıÌÔÂȉÒÓ Î˘„ÂÏÒÓ ÛÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô Ì ÂÈÎfiÓ· ·Ó·Î·Ù·Û΢‹˜ ÙÔ˘ ÔÛÙÔ‡ (bone remodeling).

∂ÈÎfiÓ· 2. MRI ÂÁÎÂÊ¿ÏÔ˘, ∆2 ·ÎÔÏÔ˘ı›·: ›ÂÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¤Ûˆ ÔÚıÔ‡ ÔÊı·ÏÌÈÎÔ‡ Ì˘fi˜ ÏfiÁˆ Ù˘ ¤ÓÙÔÓ˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ËıÌÔÂȉÒÓ Î˘„ÂÏÒÓ ÚÔ˜ ÙÔ ¤Ûˆ ÙÔ›¯ˆÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘.

ÊÏÂÁÌÔÓ‹˜ ÚÔ˜ ÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô Î·È ÙËÓ ÚfiÎÏËÛË ‚ÏÂÊ·ÚfiÙˆÛ˘. ∏ ˘fiÓÔÈ· Ù˘ ÂÓ‰ÔÎÔÁ¯È΋˜ ‚Ï¿‚˘ ÂÓÈÛ¯‡ıËΠ·fi ÙÔ Â‡ÚËÌ· Ù˘ ÌÂÌÔӈ̤Ó˘ ¿ÚÂÛ˘ ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, ÁÈ·Ù› Ô Ì˘˜ ·˘Ùfi˜ Ó¢ÚÒÓÂÙ·È ·fi ÙÔÓ ¿Óˆ ÎÏ¿‰Ô ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ Ó‡ÚÔ˘ Ô˘ ÔÚ‡ÂÙ·È ÂÍ·Ú¯‹˜ ÂÓÙfi˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘. ∆· ˘fiÏÔÈ· ÔÊı·ÏÌÔÎÈÓËÙÈο Ó‡ڷ ‹Ù·Ó ·ÓÂËÚ¤·ÛÙ·, fiˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ ‹Ù·Ó Î·È Ë ÏÔÈ‹ Ó¢ÚÔÏÔÁÈ΋ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË. ∞ÚÓËÙÈÎfi ÛËÌÂ›Ô ·ÔÙ¤ÏÂÛÂ Ë ·Ô˘Û›· ¤ÓÙÔÓ˘ ÎÏÈÓÈ΋˜ ÛËÌÂÈÔÏÔÁ›·˜ Î·È Â˘ÚËÌ¿ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ���Ùȉ·˜, ÏËÓ Ì›·˜ ‹È·˜ ÔÈÛıÔÚÚÈÓÈ΋˜ ¤ÎÎÚÈÛ˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ‰ÈÂÓÂÚÁ‹ıËΠÏËÚ¤ÛÙÂÚÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ÂÛÙÈ¿ÛÙËΠ΢ڛˆ˜ ÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ ÁÈ· ηχÙÂÚË Â˘ÎÚ›ÓÂÈ·. ∆· Â˘Ú‹Ì·Ù· Ù˘ ¯ÚfiÓÈ·˜ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜ Ì Â¤ÎÙ·ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÛÙÔ˘˜ ÔÊı·ÏÌÈÎÔ‡˜ ÎfiÁ¯Ô˘˜, Ô˘ ‹Ù·Ó ÂÓÙÔÓfiÙÂÚË ·ÚÈÛÙÂÚ¿, ÂÓ›Û¯˘Û·Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ÏfiÁˆ ÂÓ‰ÔÎÔÁ¯È΋˜ ÊÏÂÁÌÔÓ‹˜ Î·È Ë ‰È¿ÁÓˆÛË ÙÂÎÌËÚÈÒıËΠ·fi ÙËÓ ˘Ô¯ÒÚËÛË Ù˘ ‚ÏÂÊ·ÚfiÙˆÛ˘ ۯ‰fiÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Î·È ÙË ÌË Â·ÓÂÌÊ¿ÓÈÛ‹ Ù˘ ÁÈ· 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·ÔıÂÚ·›·. OÈ ÂÈÏÔΤ˜ ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ›ÙȉˆÓ Â›Ó·È Û¯ÂÙÈο Û¿ÓȘ Û‹ÌÂÚ·, ÏfiÁˆ Ù˘ ¢Ú›·˜ ¯Ú‹Û˘ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ∏ ·ÚÔ˘Û›· ÙÔ˘˜, fï˜, ÌÔÚ› Ó· Â›Ó·È ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂ-

ÓÔ‡˜. OÈ ÛÔ‚·ÚfiÙÂÚ˜ ÂÈÏÔΤ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ Â¤ÎÙ·ÛË Ù˘ ·Ú·ÚÚ›ÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÚÔ˜ ÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô (΢ÙÙ·Ú›Ùȉ·, ÚfiÙˆÛË ÙÔ˘ ‚ÔÏ‚Ô‡, Ó¢ڛÙȉ· ÙÔ˘ ÔÙÈÎÔ‡ Ó‡ÚÔ˘), ÙËÓ ÂÓ‰ÔÎÚ¿ÓÈ· ÎÔÈÏfiÙËÙ· (ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·, ıÚfiÌ‚ˆÛË ÙÔ˘ ÛËÚ·ÁÁÒ‰Ô˘˜ ÎfiÏÔ˘, ÌËÓÈÁÁ›Ùȉ·) Î·È Ù· ÔÛÙ¿ Ù˘ ÂÚÈÔ¯‹˜ (ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·, ˘ÔÂÚÈÔÛÙÈÎfi ·fiÛÙËÌ·) (1-3). ∏ ÂÍ¿ψÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Á›ÓÂÙ·È Â›Ù Ì ÙËÓ ·¢ı›·˜ ‰È¿‚ÚˆÛË ÙÔ˘ ÔÛÙÔ‡, ›Ù ‰È·Ì¤ÛÔ˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÔÛÙÔ‡ (3,10). ∏ ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÂÈÏÔ΋ Ù˘ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜ ÏfiÁˆ Â¤ÎÙ·Û˘ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÂÓ‰ÔÎÔÁ¯Èο Â›Ó·È Û¿ÓÈ· Î·È ÔÊ›ÏÂÙ·È Û ¿ÚÂÛË ‹ ·Ú¿Ï˘ÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, Ô ÔÔ›Ô˜ Ó¢ÚÒÓÂÙ·È ·fi ÙÔÓ ¿Óˆ ÎÏ¿‰Ô ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ Ó‡ÚÔ˘ (4-7). ∏ ÔÚ›· ÙÔ˘ Ó‡ÚÔ˘ ·˘ÙÔ‡ Â›Ó·È ÂÍ·Ú¯‹˜ ÂÓ‰ÔÎÔÁ¯È΋ Î·È Ó¢ÚÒÓÂÈ ÂÈϤÔÓ Î·È ÙÔÓ ¿Óˆ ÔÚıfi Ì˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÚÒÙ· ‰›‰ÂÈ ÎÏ¿‰Ô˘˜ Ô˘ Ó¢ÚÒÓÔ˘Ó ÙÔÓ ¿Óˆ ÔÚıfi Ì˘, ÛÙË Û˘Ó¤¯ÂÈ· ÔÚ‡ÂÙ·È Î¿Ùˆ ·fi ·˘ÙfiÓ Î·È, ·ÎÔÏÔ˘ıÒÓÙ·˜ ·Á·ÏË ÔÚ›·, Êı¿ÓÂÈ Ì¤¯ÚÈ ÈÔ ¿Óˆ ·fi ÙÔÓ ¿Óˆ ÔÚıfi Ì˘ fiÔ˘ Î·È ‰›ÓÂÈ ÙÔ˘˜ ÙÂÏÈÎÔ‡˜ ÎÏ¿‰Ô˘˜ Ô˘ Ó¢ÚÒÓÔ˘Ó ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘. O ÎÏ¿‰Ô˜ ·˘Ùfi˜, ‰ËÏ·‰‹, ‚Ú›ÛÎÂÙ·È ÂÚÈÔÚÈṲ̂ÓÔ˜ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÔÊı·ÏÌÔÎÈÓËÙÈÎÔ‡˜ Ì˘˜. ∞˘Ù¤˜ ÔÈ ÛÙÂÓ¤˜ ·Ó·ÙÔÌÈΤ˜ Û¯¤ÛÂȘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÚÒÈÌÔ ÂÁÎψ‚ÈÛÌfi ÙÔ˘ Ó‡ÚÔ˘ Û ÂÚ›ÙˆÛË ÂÓ‰ÔÎÔÁ¯È΋˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÂÍÔ›‰ËÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ Ì˘ÒÓ. ∆ÂÏÈÎfi

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·ÔÙ¤ÏÂÛÌ· ÙˆÓ ÈÂÛÙÈÎÒÓ Â› ÙÔ˘ Ó‡ÚÔ˘ ‰˘Ó¿ÌÂˆÓ Â›Ó·È Ë ¿ÚÂÛË ‹ ·Ú¿Ï˘ÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ Î·È Ë ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ (7). ™ÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ‚Ú¤ıËΠ·ÚfiÌÔÈ· ÂÚ›ÙˆÛË, ÂÓÒ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÂÏ¿¯ÈÛÙ˜ ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ ·Ó¿ÏÔÁ˜ ÙÔ˘ ·ÚfiÓÙÔ˜ ÂÚÈÛÙ·ÙÈÎÔ‡ Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ (4,6). ™Â Ì›· ÂÎÙÂÓ‹ ÌÂϤÙË 113 ÂÓ‹ÏÈÎˆÓ ·ÛıÂÓÒÓ Ì ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÎfiÁ¯Ô˘ ÏfiÁˆ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜, ‰È·ÈÛÙÒıËÎ·Ó ÌfiÓÔ 3 ÂÚÈÙÒÛÂȘ ÌÂÌÔӈ̤Ó˘ ‚ÏÂÊ·ÚfiÙˆÛ˘ (5). ∂Ú¢ÓÒÓÙ·˜ ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ‚Ú¤ıËΠ·ÚfiÌÔÈ· ÂÚ›ÙˆÛË ‰ËÌÔÛÈÂ˘Ì¤ÓË Ô˘ Ó· ·ÊÔÚ¿ Û ·È‰È¿, ÂÓÒ ‚Ú¤ıËΠ̛· ÌfiÓÔ ‰ËÌÔÛ›Â˘ÛË ÌÂÌÔӈ̤ÓÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Ô˘ ·ÊÔÚÔ‡Û Û ¤ÊË‚Ô. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ·ÚÔ˘Û›·˙ ‹Ù·Ó ·ÚfiÌÔÈ· Ì ÂΛÓË Ù˘ ·ÚÔ‡Û·˜ ·ÛıÂÓÔ‡˜, ÏËÓ fï˜ Ë ‚ÏÂÊ·ÚfiÙˆÛ‹ ÙÔ˘ ‹Ù·Ó ÌfiÓÈÌË Î·È ÚÔ›¯Â Ô ¤ÓÙÔÓÔ˜ ÔÊı·ÏÌÈÎfi˜ fiÓÔ˜ (7). ∏ ·¿ÓÙËÛË ÛÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ·˘ÙÔ‡ ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂÈÙ˘¯‹˜ (7), fiˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, ÂÓÒ ·¤Ù˘¯Â Û 2 ÂÚÈÙÒÛÂȘ ÂÓËÏ›ÎˆÓ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ ‰È¿ÓÔÈÍË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ·Ú·ÚÚ›ÓÈÔ˘ ÎfiÏÔ˘ Ì ÈηÓÔÔÈËÙÈο, ÙÂÏÈÎÒ˜, ·ÔÙÂϤÛÌ·Ù· (4,6). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ë ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÚÔ¤¯ÔÓ Û‡Ìو̷ ÂÈÏÔ΋˜ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜, ·Ó Î·È Û¿ÓÈ· ÛÙ· ·È‰È¿, Ú¤ÂÈ ¿ÓÙÔÙ ӷ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ÁÈ·Ù› Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂÏ› ÚÒÈÌÔ Û‡Ìو̷ ÔÍ›·˜ ÊÏÂÁÌÔÓ‹˜ ‹ ÌÂÌÔӈ̤ÓÔ Û‡Ìو̷ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘. ∞˘Ùfi ÚÔ·ÙÂÈ ·fi ÙȘ ÛÙÂÓ¤˜ ·Ó·ÙÔÌÈΤ˜ Û¯¤ÛÂȘ Ù˘ ÔÚ›·˜ ÙÔ˘ Ó‡ÚÔ˘ Ô˘ Ó¢ÚÒÓÂÈ ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÔÊı·ÏÌÔÎÈÓËÙÈÎÒÓ Ì˘ÒÓ Î·È ÙÔÓ ÚÒÈÌÔ ÂÁÎψ‚ÈÛÌfi ÙÔ˘ Û ÂÚ›ÙˆÛË ÂÓ‰ÔÎÔÁ¯È΋˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÂÍÔ›‰ËÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ Ì˘ÒÓ. ∞˘Ù¤˜ ÔÈ ÈÂÛÙÈΤ˜ ‰˘Ó¿ÌÂȘ Â› ÙÔ˘ Ó‡ÚÔ˘ ¤¯Ô˘Ó Û·Ó Â·-

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ÎfiÏÔ˘ıÔ ÙËÓ ¿ÚÂÛË ‹ ·Ú¿Ï˘ÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ Î·È ÙËÓ ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË. ∏ Û˘Ó‰˘·Ṳ̂ÓË ıÂÚ·›· Ù˘ ÈÁÌÔÚ›Ùȉ·˜ Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Nash D, Wald E. Sinusitis. Pediatr Rev 2001;22:111-117. 2. Wagenmann M, Naclerio RM. Complications of sinusitis. J Allergy Clin Immunol 1992;90:552-554. 3. Stankiewicz JA, Newell DJ, Park AH. Complications of inflammatory diseases of the sinuses. Otolaryngol Clin North Am 1993;26:639-655. 4. Stefanis L, Przedborski S. Isolated palsy of the superior branch of the oculomotor nerve due to chronic erosive sphenoid sinusitis. J Clin Neuroophthalmol 1993;13:229231. 5. Pogosov VS, Akopian RG, Davudov KhSh, El’kun GB. Rhinogenous inflammatory diseases of the orbit. Vestn Otorinolaringol 1996;14-17. 6. Chotmongkol V, Chainunsamit S. Superior branch palsy of the oculomotor nerve caused by acute sphenoid sinusitis. J Med Assoc Thai 1999;82:410-413. 7. Coker SB, Ros SP. Ptosis associated with sinusitis. Pediatr Neurol 1996;14:62-63. 8. Weiss AH. The swollen and droopy eyelid. Signs of systemic disease. Pediatr Clin North Am 1993;40:789-804. 9. Olitsky SE, Nelson LB. Abnormalities of the lids: ptosis. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders Co; 2000. p. 1909. 10. Jabor MA, Amedee RG. Orbital complications of sinusitis. J La State Med Soc 1997;149:105-108.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-11-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-03-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÚËÁfiÚ˘ ¶·Ú‰·Ïfi˜ §‡ÙÚ· 3, ∆.∫. 546 40, £ÂÛÛ·ÏÔÓ›ÎË E-mail: pargr@med.auth.gr


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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2003;66:215-222

CASE REPORT

∫ÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· (FSHMD). ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ E. ºÚ˘Û›Ú·1, ™. ∞̤ÓÙ·1, ∫. ∫¤ÎÔ˘1, ™. °ÈÔ˘ÚÔ‡ÎÔ˜2, ¶. ª·ÓÙ¿3, ∞. ªÂٷ͈ÙÔ‡1

Clinical heterogeneity in facioscapulohumeral muscular dystrophy (FSHMD). Report of two cases and review of the literature H. Fryssira1, S. Amenta1, K. Kekou1, S. Youroukos2, P. Manta3, C. Metaxotou1

¶ÂÚ›ÏË„Ë: ∏ ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· (FSHMD) Â›Ó·È Ì›· Ì˘Ô¿ıÂÈ· Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ÙÚfiÔ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Û‡ÌÌÂÙÚË, ÚÔԉ¢ÙÈ΋ ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘, Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Î·È ÙˆÓ ¿Óˆ ¿ÎÚˆÓ. ∏ ÓfiÛÔ˜ ÔÊ›ÏÂÙ·È ÛÙÔ 95% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û ÂÏÏ›„ÂȘ ÙˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ D4Z4 ÛÙËÓ ÂÚÈÔ¯‹ q35 ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 4. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ Ì˘˚΋ ·‰˘Ó·Ì›· Î·È ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û Ôχ ÌÈÎÚ‹ ËÏÈΛ·, ÛÙȘ Ôԛ˜ Û˘Ó˘‹Ú¯Â ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ‚·ÚËÎÔ˝·, ˆ˜ ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂȘ ‚·Ú¤ˆ˜ Ê·ÈÓÔÙ‡Ô˘. ∫·È ÛÙȘ ‰‡Ô ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ, Ë ÌÔÚȷ΋ ·Ó¿Ï˘ÛË DNA ÂȂ‚·›ˆÛ ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË.

Abstract: Facioscapulohumeral muscular dystrophy (FSHMD) is a myopathy which is transmitted by autosomal dominant inheritance. It is characterized clinically by asymmetric and progressive weakness of the facial, shoulder-girdle and upper arm muscles. The disease is caused by the size reduction of a polymorphic repeat array D4Z4 on locus 4q35. ∆wo cases of children are presented with severe early onset muscular weakness, co-existing mental retardation and deafness which represent an unusual side of the disease spectrum. In both cases the clinical diagnosis was confirmed by molecular analysis.

§¤ÍÂȘ ÎÏÂȉȿ: ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›·, ÌÔÚȷ΋ ‰È¿ÁÓˆÛË, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, ‚·ÚËÎÔ˝·.

Key words: FSHMD, molecular diagnosis, mental retardation, deafness.

™˘ÓÙÔÌÔÁڷʛ˜

∂ÈÛ·ÁˆÁ‹ ∏ ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· (FSHMD, OMIM 158900) ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘Ùoۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È Â›Ó·È Ë ÙÚ›ÙË ÈÔ Û˘¯Ó‹ Ì˘Ô¿ıÂÈ·. ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ ˘ÔÏÔÁ›˙ÂÙ·È Û 1 ·Ó¿ 20.000, ÂÓÒ Ë ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Â›Ó·È 90% ÛÙËÓ ËÏÈΛ· ÙˆÓ 20 ¯ÚfiÓˆÓ (1,2). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÚÔԉ¢ÙÈ΋, ·Û‡ÌÌÂÙÚË ·‰˘Ó·Ì›· Î·È ·ÙÚÔÊ›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘, Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Î·È ÙˆÓ ¿Óˆ ¿ÎÚˆÓ, fiˆ˜ ¿ÏψÛÙ ʷ›ÓÂÙ·È ·fi ÙËÓ ÔÓÔÌ·Û›· Ù˘ (3,4). ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ÚÔÛ‚¿ÏÏÔÓÙ·È Î·È ÔÈ

FSHMD OMIM DNA ∫¡™ ∏∫° ∏ª° CPK ∫b AvrII BlnI EcoRI

}

¶ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· On line Mendelian inheritance in man ¢ÂÔ͢ÚÈ‚ÔÓÔ˘ÎÏÂ˚Îfi Ô͇ ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ∏ÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ∏ÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ∫Ú·ÙÈÓÔʈÛÊÔÚÈ΋ ÎÈÓ¿ÛË ∫ÈÏÔ‚¿ÛÂȘ ¶ÂÚÈÔÚÈÛÙÈο ¤Ó˙˘Ì·

1 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÈڤÌÂÈÔ ∂Ú¢ÓËÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 A’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ¡Â˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, “∞ÈÁÈÓ‹ÙÂÈÔ” ¡ÔÛÔÎÔÌ›Ô, ∞ı‹Ó·

1 Medical Genetics, Athens University, “Aghia Sophia” Children’s Hospital, Choremio Research Laboratory, ∞thens 2 1st Paediatric Department of Athens University, “Aghia Sophia” Children’s Hospital, Athens 3 Neurology Department of Athens University, “Aeginition” Hospital, Athens

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ÎÔÈÏÈ·ÎÔ›, ÔÈ ÂÎÙ›ÓÔÓÙ˜ Ù· οو ¿ÎÚ· Î·È ÔÈ Ì‡Â˜ Ù˘ ˘ÂÏÈ΋˜ ˙ÒÓ˘. À¿Ú¯ÂÈ ·ÍÈÔÛËÌ›ˆÙË ÎÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ·ÎfiÌ· Î·È ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (5). ∆Ô 1990, Ë ˘‡ı˘ÓË ÂÚÈÔ¯‹ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ¯·ÚÙÔÁÚ·Ê‹ıËΠÌÂÙ¿ ·fi ·Ó¿Ï˘ÛË Û‡Ó‰ÂÛ˘ ÛÙËÓ ˘ÔÙÂÏÔÌÂÚÈ΋ ÂÚÈÔ¯‹ ÙˆÓ Ì·ÎÚÒÓ ÛÎÂÏÒÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 4 (4q35), fiÔ˘ Ô ·ÓȯÓÂ˘Ù‹˜ p13∂-11 ·Ó·ÁÓˆÚ›˙ÂÈ ¤Ó· ȉȷ›ÙÂÚ· ÔÏ˘ÌÔÚÊÈÎfi ıÚ·‡ÛÌ· ∂coRI (6-9). ∏ ‰È¿ÁÓˆÛË, Û‹ÌÂÚ·, ÂȂ‚·ÈÒÓÂÙ·È ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ÌÔÚȷ΋ ·Ó¿Ï˘ÛË DNA. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ËÏÈΛ·˜ 10 Î·È 15 ¯ÚfiÓˆÓ ·ÓÙ›ÛÙÔȯ·, Ì ·Û˘Ó‹ıÈÛÙË ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ FSHMD Î·È ÚÒÈÌË ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. ™ÎÔfi˜ Ù˘ ÂÚÈÁÚ·Ê‹˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·˘ÙÒÓ Â›Ó·È ·ÊÂÓfi˜ ÌÂÓ Ó· ÙÔÓ›ÛÂÈ ÙÔ Â˘Ú‡ÙÂÚÔ ÎÏÈÓÈÎfi Ê¿ÛÌ· Ù˘ FSHMD, ȉ›ˆ˜ fiÙ·Ó Ë ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È Û Ôχ ÌÈÎÚ‹ ËÏÈΛ·, ·ÊÂÙ¤ÚÔ˘ ‰Â Ó· ‰Â›ÍÂÈ ÙË ÌÂÁ¿ÏË Û˘Ì‚ÔÏ‹ Ù˘ ÌÔÚȷ΋˜ ÁÂÓÂÙÈ΋˜ ÛÙË ‰È¿ÁÓˆÛË, ÛÙËÓ ÚÔÛ˘Ìو̷ÙÈ΋ ·Ó›¯Ó¢ÛË ÊÔÚ¤ˆÓ Î·È ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚ›ÙˆÛË ÚÒÙË ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 10 ¯ÚfiÓˆÓ ÚÔÛ‹Ïı ÁÈ· ¤ÏÂÁ¯Ô ‚·ÚÈ¿˜ ÓÔËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ Î·È ·‰˘Ó·Ì›·˜ ÛÙË ‚¿‰ÈÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ÌË Û˘ÁÁÂÓÒÓ ÌÂٷ͇ ÙÔ˘˜. ™ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ¤Ó·˜ ‰Â‡ÙÂÚÔ˜ ÂÍ¿‰ÂÏÊÔ˜ ·fi ÙÔÓ ·Ù¤Ú· Ì ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ¤Ó·˜ ı›Ԙ Ô˘ ›¯Â ÂÌÊ·Ó›ÛÂÈ Û·ÛÌÔ‡˜ Î·È Î·ı˘ÛÙ¤ÚËÛË ÏfiÁÔ˘. °ÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓË Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ Èۯȷ΋˜ ÚÔ‚ÔÏ‹˜ Î·È Ë ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ·Ó·ÊÂÚfiÙ·Ó ÂχıÂÚË. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ‹Ù·Ó 3250 g. ◊‰Ë ·fi ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ·Ú·ÙËÚ‹ıËΠ··ı¤˜ ÚÔÛˆÂ›Ô Î·È ˘ÔÙÔÓ›·. ™Â ËÏÈΛ· 20 ÌËÓÒÓ ÂÈÛ‹¯ıË ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÏfiÁˆ ÛÔ‚·Ú‹˜ ηı˘ÛÙ¤ÚËÛ˘ ÛÙ· ÛÙ¿‰È· ·Ó·Ù˘Íȷ΋˜ ÂͤÏÈ͢ - οıÈÛ Û ËÏÈΛ· 12 ÌËÓÒÓ, ÂÚ¿ÙËÛ Û ËÏÈΛ· 20 ÌËÓÒÓ Î·È ‰ÂÓ Â›¯Â ·ÎfiÌ· ·Ó·Ù‡ÍÂÈ ÏfiÁÔ Î·È ÎÔÈÓˆÓÈÎfiÙËÙ·. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠfiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ¤Ó· ·È‰› ˘ÔÙÔÓÈÎfi Ì ··ı¤˜ ÚÔÛˆÂ›Ô Ô˘ ‰ÂÓ ¯·ÌÔÁÂÏÔ‡Û ‡ÎÔÏ·, ¤ÎÏ·ÈÁ ¯ˆÚ›˜ Ó· Û˘ÛÒÓÙ·È ÔÈ Ì‡Â˜ ÙÔ˘ ÚÔÛÒÔ˘ Î·È Â›¯Â ÛÈÂÏfiÚÚÔÈ·. ¢ÂÓ Â›¯Â ÈÓȉÈÛÌÔ‡˜ ÁÏÒÛÛ·˜. ∆· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ÂÎχÔÓÙ·Ó Ê˘ÛÈÔÏÔÁÈο. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ (·ÈÌ·ÙÔÏÔÁÈÎfi˜, ‚ÈÔ¯ËÌÈÎfi˜, ÌÂÙ·‚ÔÏÈÎfi˜, ·ÓÔÛÔÏÔÁÈÎfi˜) ‹Ù·Ó ÌË ‰È·ÁÓˆÛÙÈÎfi˜, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë CPK Î·È Ë ·Ï‰ÔÏ¿ÛË ‹Ù·Ó ÂÏ·ÊÚÒ˜ ·˘ÍË̤Ó˜. ∏ ÌÂϤÙË ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ‚˘ıÔÛÎfiËÛË, Ë ˘ÔÏÔÁÈÛÙÈ-

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΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ ·ÎÔfiÁÚ·ÌÌ· ÂχıÂÚÔ˘ ‰›Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ™Â ËÏÈΛ· 5 ¯ÚfiÓˆÓ ÂÚ›Ô˘ ¤ÁÈÓ Â·Ó¤ÏÂÁ¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡. ∂Í·ÎÔÏÔ˘ıÔ‡Û ӷ ÂÌÊ·Ó›˙ÂÈ ‚·ÚÈ¿ ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›·, ȉȷ›ÙÂÚ· ÛÙÔ˘˜ Ì˘˜ ÙÔ˘ ÚÔÛÒÔ˘ Î·È Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘. À‹Ú¯·Ó, Â›Û˘, ÛÈÙÈÛÙÈο ÚÔ‚Ï‹Ì·Ù· ÏfiÁˆ ‰˘ÛÎÔÏÈÒÓ ÛÙËÓ Î·Ù¿ÔÛË. ¢ÂÓ ÌÈÏÔ‡Û ÈηÓÔÔÈËÙÈο (¤ÏÂÁ 10-12 ϤÍÂȘ). ∂›¯Â ÂȉÂÈÓÔ‡ÌÂÓË ‰˘ÛÎÔÏ›· ÛÙË ‚¿‰ÈÛË Î·È ÏfiÚ‰ˆÛË ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ∂›¯Â, Â›Û˘, ·Ú¯›ÛÂÈ Ó· ·Ú·ÙËÚÂ›Ù·È ·‰˘Ó·Ì›· ·Ó¿‚·Û˘ Îϛ̷η˜ Î·È ‚¿‰ÈÛË ÛÙȘ ̇Ù˜ ÙˆÓ Ô‰ÈÒÓ. ™ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹Ù·Ó ÛÙËÓ 75Ë ∂.£. Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÛÙËÓ 50Ë ∂.£. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ ‰¤ÚÌ·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Ì˘ÔÙÔÓÈÎfi Ê·ÈÓfiÌÂÓÔ, Ô‡Ù ÙÚfiÌÔ˜, ˘‹Ú¯Â fï˜ ÂÁÁ‡˜ Î·È ¿ˆ ÁÂÓÈÎÂ˘Ì¤ÓË Ì˘˚΋ ·‰˘Ó·Ì›·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÎÙfi˜ Ù˘ CPK Ô˘ ‹Ù·Ó 900 U/l (º.∆. ̤¯ÚÈ 140) Î·È Ù˘ ·Ï‰ÔÏ¿Û˘ Ô˘ ‹Ù·Ó 35 U/l (º.∆. ̤¯ÚÈ 16). ∏ ÙÈÌ‹ Ù˘ ηÚÓÈÙ›Ó˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. O ÔÊı·ÏÌÔÏÔÁÈÎfi˜ Î·È ·ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· Â›Ó·È ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ‚ÈÔ„›· ‰ÂÏÙÔÂȉԇ˜ ·ÔÎ¿Ï˘„ ‹Ș, ÌË ‰È·ÁÓˆÛÙÈΤ˜ ÈÛÙÔ·ıÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ì˘Ô·ıËÙÈÎÔ‡ Ù‡Ô˘. ™ÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ·Ú·ÙËÚ‹ıËÎ·Ó ‹Ș ·ÏÏÔÈÒÛÂȘ Ì˘Ô·ıËÙÈ΋˜ ‰ÈÂÚÁ·Û›·˜. ∏ Ù·¯‡ÙËÙ· ·ÁˆÁ‹˜ ÓÂ‡ÚˆÓ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. µ¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Î¿ÔÈ·˜ ÌÔÚÊ‹˜ Ì˘Ô¿ıÂÈ·˜ Ì·˙› Ì ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ô˘ ı· ÌÔÚÔ‡Û ӷ Á›ÓÂÈ ÏfiÁˆ Ù˘ Û˘Ó‡·Ú͢ Ì˘Ô¿ıÂÈ·˜ Ì ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Ù·Ó ÌÂٷ͇ Û˘ÁÁÂÓÔ‡˜ Ì˘˚΋˜ ‰˘ÛÙÚÔÊ›·˜ Î·È ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ‰È·ÁÓÒÛÂȘ Ô˘ ‰ÂÓ ÂȂ‚·ÈÒıËÎ·Ó ·fi Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÎÏÈÓÈ΋ ÂͤٷÛË, Û ËÏÈΛ· 10 ÂÙÒÓ, ›¯Â ÂÎÛÂÛËÌ·Ṳ̂ÓË Âȉ›ӈÛË Ù˘ ÎÈÓËÙÈ΋˜ Î·È ÓÔËÙÈ΋˜ ÂͤÏÈ͢. ◊Ù·Ó Î·ıËψ̤ÓË Û ·Ó·ËÚÈÎfi ·Ì·Í›‰ÈÔ Î·È Â›¯Â ¤Î‰ËÏË ÏfiÚ‰ˆÛË Î·È Î˘ÊÔÛÎÔÏ›ˆÛË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Ì ÚÔ‚ÔÏ‹ Ù˘ ˆÌÔÏ¿Ù˘. ∆Ô ÛÙfiÌ· ·Ú¤ÌÂÓ ·ÓÔÈÎÙfi Ì ÛÈÂÏfiÚÚÔÈ· Î·È ‰ÂÓ ÂÈÎÔÈÓˆÓÔ‡Û Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ (∂ÈÎfiÓ˜ 1 Î·È 2). ¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË ∞ÁfiÚÈ ËÏÈΛ·˜ 15 ¯ÚfiÓˆÓ ÚÔÛ‹Ïı ÏfiÁˆ Ì˘˚΋˜ ·‰˘Ó·Ì›·˜, ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ Î·È ‚·ÚËÎÔ˝·˜. ◊Ù·Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∆Ô ‰Â‡ÙÂÚÔ ·È‰› ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi


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·Ó·ÊÂÚfiÙ·Ó ÂχıÂÚÔ. °ÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ·ÓÒÌ·Ï˘ ı¤Û˘, ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË, ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÔ›·˜ Ë ÌËÙ¤Ú· ‰ÂÓ ÓfiÛËÛÂ, ‰ÂÓ ÂÎÙ¤ıËΠ۠ÂÌ‚Ú˘ÔÙÔÍÈο Ê¿Ú̷η ‹ ÛËÌ·ÓÙÈ΋ ‰fiÛË ·ÎÙÈÓÔ‚ÔÏ›·˜. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ‹Ù·Ó 3 kg. ∏ ÎÈÓËÙÈ΋ ÙÔ˘ ÂͤÏÈÍË ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ - οıÈÛ Û ËÏÈΛ· 7 ÌËÓÒÓ Î·È ÂÚ¿ÙËÛ Û ËÏÈΛ· 14 ÌËÓÒÓ. ™ÙËÓ ËÏÈΛ· ÙˆÓ 2 ¯ÚfiÓˆÓ, ‹Ù·Ó ‹Û˘¯Ô ·È‰›, Ì ÌÂÁ¿ÏÔ ·ÚÓËÙÈÛÌfi Î·È ‰ÂÓ Â›¯Â ·Ó¿Ù˘ÍË ÙÔ˘ ÏfiÁÔ˘. ™Â ·ÎÔfiÁÚ·ÌÌ· Ô˘ ¤ÁÈÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 4 ¯ÚfiÓˆÓ, ‚Ú¤ıËΠÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ‚·ÚËÎÔ˝· ·ÌÊÔÙÂÚfiÏ¢ڷ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓ ÙfiÙ Ì ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfi, ÌÂÙ·‚ÔÏÈÎfi, ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ∏∂° Î·È Î·Ú˘fiÙ˘Ô ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ÙÈÌ‹ Ù˘ CPK Î˘Ì·ÈÓfiÙ·Ó ·fi 240-460 U/l. ∆Ô ·È‰› ¿Ú¯ÈÛ ÚfiÁÚ·ÌÌ· ÂȉÈ΋˜ ·ÁˆÁ‹˜ Î·È ÏÔÁÔıÂÚ·›·˜ ÏfiÁˆ Ù˘ ‚·ÚËÎÔ˝·˜ Î·È Ù˘ ÂÓÙÔÓfiÙ·Ù˘ ‰˘Û·ÚıÚ›·˜. ™ÙËÓ ËÏÈΛ· ÙˆÓ 10 ¯ÚfiÓˆÓ, ÚÔÛÙ¤ıËΠÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‰˘ÛÎÔÏ›· ÛÙË ‚¿‰ÈÛË, ·‰˘Ó·Ì›· ·Ó¿‚·Û˘ Îϛ̷η˜ Î·È ·Ó¤ÁÂÚÛ˘ ·fi ÙËÓ Î·ıÈÛÙ‹ ÛÙËÓ fiÚıÈ· ı¤ÛË. ∆· ÙÂÏÂ˘Ù·›· 3 ¯ÚfiÓÈ· ›¯Â ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘, ȉ›ˆ˜ ÙÔ˘ ÏfiÁÔ˘ (·Ú¿ ÙË ÏÔÁÔıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË) Î·È Ù˘ ‚¿‰ÈÛ˘. ∂›Û˘, ¿Ú¯ÈÛ ӷ ÂÌÊ·Ó›˙ÂÈ Î·È ‰˘ÛÎÔÏ›· ÛÙË Ì¿ÛËÛË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ÂÎÙfi˜ ·fi ÙË ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ÙË ‚·ÚËÎÔ˝·, ·Ú·ÙËÚ‹ıËΠÌÂÁ¿ÏË ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘, ¤ÏÏÂÈ„Ë ¤ÎÊÚ·Û˘ Ì ÙÒÛË ÙÔ˘ οو ¯Â›ÏÔ˘˜ Î·È ÛÈÂÏfiÚÚÔÈ·. À‹Ú¯Â ·ÙÚÔÊ›· Î·È ÛËÌ·ÓÙÈ΋ ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Î·È ËÈfiÙÂÚË

∂ÈÎfiÓ· 1. O ·ÛıÂÓ‹˜ Ù˘ ÚÒÙ˘ ÂÚ›ÙˆÛ˘ ηıËψ̤ÓÔ˜ Û ·Ó·ËÚÈ΋ ηڤÎÏ·. ∂›Ó·È ¤Î‰ËÏË Ë Î˘ÊÔÛÎÔÏ›ˆÛË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È Ë ÚÔ¤ÙÂÈ· Ù˘ ˆÌÔÏ¿Ù˘.

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ÙˆÓ Ì˘ÒÓ Ù˘ ˘ÂÏÈ΋˜ ˙ÒÓ˘ Î·È ÙˆÓ Ì˘ÒÓ ÙˆÓ ¿ÎÚˆÓ. ¶·Ú·ÙËÚ‹ıËΠ„¢‰Ô¸ÂÚÙÚÔÊ›· ÙˆÓ Á·ÛÙÚÔÎÓËÌÈÒÓ, ·ÏÏ¿ Î·È ·ÍÈÔÛËÌ›ˆÙË ÏfiÚ‰ˆÛË Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È ·Û‡ÌÌÂÙÚË ÙÂÚ˘ÁÔÂȉ‹˜ ˆÌÔÏ¿ÙË (∂ÈÎfiÓ˜ 3 Î·È 4). ∞fi ÙËÓ ˘fiÏÔÈË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, Ù· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ÂÎχÔÓÙ·Ó Ê˘ÛÈÔÏÔÁÈο. O ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ CPK. ∆Ô ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ‰È¿¯˘Ù˜ ·ÏÏÔÈÒÛÂȘ Ì˘Ô·ıËÙÈÎÔ‡ Ù‡Ô˘. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ë ÂÏ·ÊÚÒ˜ ·˘ÍË̤ÓË CPK Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú Ù˘ ÚÔÛˆÔ-ˆÌÔ‚Ú·¯ÈÔÓ›Ô˘ Ì˘˚΋˜ ‰˘ÛÙÚÔÊ›·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÔÚȷ΋ ·Ó¿Ï˘ÛË ∏ ‰È¿ÁÓˆÛË Î·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ ÚÔÛˆÔ-ˆÌÔ‚Ú·¯ÈÔÓ›Ô˘ Ì˘˚΋˜ ‰˘ÛÙÚÔÊ›·˜ ÂȂ‚·ÈÒıËΠÂÚÁ·ÛÙËÚȷο Ì ÌÔÚȷ΋ ·Ó¿Ï˘ÛË DNA. ∞ÔÌÔÓÒıËΠDNA ·fi ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÙˆÓ ·ÛıÂÓÒÓ Î·È ÌÂÏÂÙ‹ıËΠ̠ÙËÓ Ù¯ÓÈ΋ Southern blotting, ÌÂÙ¿ ·fi ‰ÈÏ‹ ÂÒ·ÛË Ì ٷ ÂÚÈÔÚÈÛÙÈο ¤Ó˙˘Ì· EcoRI Î·È ∞vrII. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi ‰È·ÈÛÙÒıËÎÂ Â¿Ó ÔÈ ÂÏÏ›„ÂȘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹ 4q35 Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÓfiÛËÌ· ‹ ·fi Ì›· ÔÌfiÏÔÁË ÂÚÈÔ¯‹ ÛÙÔ ¯ÚˆÌfiۈ̷ 10 (10q26), ÙÔ ÔÔ›Ô ‰ÂÓ Û˘Óԉ‡ÂÙ·È Ì ·ıÔÏÔÁÈÎfi Ê·ÈÓfiÙ˘Ô. °È· ÙÔÓ ˘‚ÚȉÈÛÌfi ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ·ÓȯÓÂ˘Ù‹˜ p13∂11 (ÚÔÛÊÔÚ¿ ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ Sylvius Lab, Leiden). ∏ Û‹Ì·ÓÛË ¤ÁÈÓ Ì ÌË Ú·‰ÈÂÓÂÚÁfi ÙÚfiÔ Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ Û‡ÛÙËÌ· Û‹Ì·ÓÛ˘ Î·È ·Ó›¯Ó¢Û˘ Ì ‰ÈÁÔÍÈÁÂÓ›ÓË (Roche). ∆· ·ÔÙÂϤÛÌ·Ù· Î·È ÛÙÔ˘˜ ‰‡Ô ·ÛıÂÓ›˜ ¤‰ÂÈÍ·Ó ÙÔ ›‰ÈÔ ıÚ·‡ÛÌ·, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 5. ¢ËÏ·‰‹, ·Ú·ÙËÚ‹ıËΠfiÙÈ ˘‹Ú¯Â ıÚ·‡ÛÌ· ÂÚ›Ô˘ 7 kb ÌÂÙ¿ ·fi ‰ÈÏ‹ ÂÒ·ÛË Ì ٷ ¤Ó˙˘Ì· EcoRI Î·È ∞vrII.

∂ÈÎfiÓ· 2. O ·ÛıÂÓ‹˜ Ù˘ ÚÒÙ˘ ÂÚ›ÙˆÛ˘ Ì ·ÓÔȯÙfi ÛÙfiÌ· Î·È ÛÈÂÏfiÚÚÔÈ·.

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∂ÈÎfiÓ˜ 3 Î·È 4. ¢Â‡ÙÂÚË ÂÚ›ÙˆÛË. º·›ÓÔÓÙ·È Ù· ·ÎÔ˘ÛÙÈο ‚·ÚËÎÔ˝·˜, Ë ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘ Î·È Ë ·Û‡ÌÌÂÙÚË ÙÂÚ˘ÁÔÂȉ‹˜ ˆÌÔÏ¿ÙË.

™˘˙‹ÙËÛË ∏ FSHMD ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÁÂÓÂÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ·. ∏ ÂÙÂÚÔÁ¤ÓÂÈ· Â›Ó·È ¤Î‰ËÏË ·ÎfiÌ· Î·È ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (5,10). ∞ӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚ›ÙˆÛË ÌÔÓÔ˙˘ÁˆÙÈÎÒÓ ‰È‰‡ÌˆÓ Ì ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ¤ÎÊÚ·ÛË (1). ¶·Ú¿ ÙȘ ÚÔÛ¿ıÂȘ ‰ÂÓ ¤¯ÂÈ ·ÔÌÔÓˆı› ̤¯ÚÈ Û‹ÌÂÚ· ÙÔ ˘‡ı˘ÓÔ ÁÈ· ÙË ÓfiÛÔ ÁÔÓ›‰ÈÔ (9,11,12). ™ÙÔ 95% ÙˆÓ ·Û¯fiÓÙˆÓ ·ÓȯÓ‡ÔÓÙ·È ÂÏÏ›„ÂȘ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ, Ô˘ ÔÓÔÌ¿˙ÔÓÙ·È D4Z4 Î·È ¤¯Ô˘Ó ̤ÁÂıÔ˜ 3,3 kb (13). §fiÁˆ ÙˆÓ ÂÏÏ›„ˆÓ, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·Ó·Î·Ù·Ù¿ÍÂȘ ÛÙËÓ ÙÂÏÔÌÂÚÈ΋ ÂÚÈÔ¯‹ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 4. A˘Ù¤˜ ¤¯Ô˘Ó ˆ˜ Û˘Ó¤ÂÈ· ÌÂÙ·‚ÔÏ‹ ¤ÎÊÚ·Û˘ Î·È ·ÏÏ·Á‹ ÛÙË ÌÂÙ·ÁÚ·ÊÈ΋ ÈηÓfiÙËÙ· ÁÂÈÙÔÓÈÎÒÓ ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ ÁÔÓȉ›ˆÓ Ì ÙÔ Ì˯·ÓÈÛÌfi Ù˘ “Â›‰Ú·Û˘ ı¤Û˘” (positional effect). ∞˘Ùfi ıˆÚÂ›Ù·È Û‹ÌÂÚ· Ô Èı·ÓfiÙÂÚÔ˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ FSHMD (6-9,14). ∏ ·Ó›¯Ó¢ÛË ÙˆÓ ÂÏÏ›„ÂˆÓ Á›ÓÂÙ·È Ì ÙËÓ Ù¯ÓÈ΋ ÙÔ˘ Southern blot, Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÂÚÈÔÚÈÛÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ EcoRI Î·È ÙÔ˘ ·ÓȯÓÂ˘Ù‹ p13-11 (5). ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·ÓȯÓ‡ÂÙ·È ıÚ·‡ÛÌ· ≤35 kb, ÂÓÒ ÛÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÏËı˘ÛÌfi ·˘Ùfi ÙÔ ıÚ·‡ÛÌ· ÔÈΛÏÏÂÈ Û ̤ÁÂıÔ˜ ·fi 35 kb ̤¯ÚÈ 300 kb (15). ªÂ ÙÔÓ ›‰ÈÔ ÙÚfiÔ, ·ÓȯÓ‡ÔÓÙ·È ÔÌfiÏÔÁ˜ ·ÏÏËÏÔ˘¯›Â˜ ÂÎÙfi˜ ·fi ÙÔ ¯ÚˆÌfiۈ̷ 4 Î·È ÛÙÔ ¯ÚˆÌfiۈ̷ 10, ÁÂÁÔÓfi˜ Ô˘ ÛÙÔ ·ÚÂÏıfiÓ ‰ËÌÈÔ˘ÚÁÔ‡Û ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· (13). ŒÓ· ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ, ÙÔ BlnI (‹

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AvRII), ·Ó·ÁÓˆÚ›˙ÂÈ ·ÔÎÏÂÈÛÙÈο ÙÔ ÙÌ‹Ì· ÌfiÓÔ ÛÙÔ ¯ÚˆÌfiۈ̷ 10 Î·È fi¯È ÛÙÔ 4. ŒÙÛÈ, ‰ÈÏ‹ ÂÒ·ÛË Ì ٷ ‰‡Ô ÂÚÈÔÚÈÛÙÈο ¤Ó˙˘Ì· (∂coRI-BlnI ‹ AvrII) ÂÈÙÚ¤ÂÈ ÙÔÓ ‰È·¯ˆÚÈÛÌfi Î·È ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ıÚ·‡ÛÌ·ÙÔ˜ ÛÙÔ ¯ÚˆÌfiۈ̷ 4, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·ÍÈÔÈÛÙ›· Ù˘ ·Ó¿Ï˘Û˘ (9,19). ªÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë Ù˘ ÌÔÚȷ΋˜ ‚Ï¿‚˘, ¤¯Ô˘Ó Á›ÓÂÈ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ÁÈ· ÙÔ Û˘Û¯ÂÙÈÛÌfi ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ıÚ·‡ÛÌ·ÙÔ˜ Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ (16,17). Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ fiÛÔ ÈÔ ÌÈÎÚfi Â›Ó·È ÙÔ ıÚ·‡ÛÌ·, ‰ËÏ·‰‹ ÌÂÁ¿Ï˜ ÂÏÏ›„ÂȘ, ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Û˘Ó‰¤ÔÓÙ·È Ì ‚·Ú‡ÙÂÚÔ Ê·ÈÓfiÙ˘Ô Î·È Û˘ÌÌÂÙÔ¯‹ ·fi ÙÔ ∫¡™ (18). OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó‹ıˆ˜ ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ÂÈÏË„›·. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË Û˘ÁÁÂÓ‹ ·ÁÂÓÂÛ›· ÙˆÓ ÚÔÛˆÈÎÒÓ Ó‡ڈÓ, ÙË ÓˆÙÈ·›· Ì˘˚΋ ·ÙÚÔÊ›·, ÙËÓ ÔÏ˘Ì˘ÔÛ›Ùȉ·, ÙË ˙ˆÓÈ·›· Ì˘˚΋ ‰˘ÛÙÚÔÊ›·, ÙË Ì˘˚΋ ‰˘ÛÙÚÔÊ›· Ù‡Ô˘ Becker, ÙȘ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ Ì˘Ô¿ıÂȘ, ÙÔ Û‡Ó‰ÚÔÌÔ Moebius Î·È ÙË Û˘ÁÁÂÓ‹ Ì˘ÔÙÔÓÈ΋ ‰˘ÛÙÚÔÊ›· (3,5). ∫·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È, Ë ‰È¿ÁÓˆÛË ‚·Û›ÛÙËΠÙfiÛÔ ÛÙ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, fiÛÔ Î·È ÛÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË, fiÔ˘ ·ÓȯÓ‡ıËΠÙÔ ÌÈÎÚfiÙÂÚÔ ıÚ·‡ÛÌ· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (7,5 kb). ∞˘Ùfi Û˘ÌʈÓ› Ì ÙË ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Î·È ÙËÓ ÚÒÈÌË ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ (4,9,17,19,20). ∏ ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÔÈΛÏÏÂÈ. ∏ ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ ηٿ


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17 kb 15 kb

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6 kb ∂ÈÎfiÓ· 5. ∞Ó›¯Ó¢ÛË: ·) ıÚ·‡ÛÌ·ÙÔ˜ ÂÚ›Ô˘ 10 kb ÌÂÙ¿ ·fi ÂÒ·ÛË Ì ÙÔ ¤Ó˙˘ÌÔ ∂coRI (∂) Î·È ‚) ıÚ·‡ÛÌ·ÙÔ˜ ÂÚ›Ô˘ 7 kb ÌÂÙ¿ ·fi ‰ÈÏ‹ ÂÒ·ÛË Ì ٷ ¤Ó˙˘Ì· ∂coRI/AvrII (E/A) ÛÙÔ ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi. ∫ϛ̷η ÌÂÁ¤ıÔ˘˜ 1:1 kb ladder (BRL), Îϛ̷η ÌÂÁ¤ıÔ˘˜ 2:Ï Cut mix (Biolabs).

ÙÔ Ù¤ÏÔ˜ Ù˘ ÚÒÙ˘ ‹ ÛÙË ‰Â‡ÙÂÚË ‰ÂηÂÙ›· ˙ˆ‹˜. ™Â ÔÛÔÛÙfi 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ FSHªD, Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ÚÒÙË ÂÓÙ·ÂÙ›· Î·È Û˘Ó‹ıˆ˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ Î·ÈÓÔ‡ÚÈ· ÌÂÙ¿ÏÏ·ÍË Î·È ‚·Ú‡ÙÂÚË ÓfiÛËÛË (4,5). ∏ ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ‹Ù·Ó ÚÈÓ ÙÔ˘˜ 20 Ì‹Ó˜ ˙ˆ‹˜, ÂÓÒ ÛÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË ‹Ù·Ó Ù· 3 ¯ÚfiÓÈ·. ∫·È Ù· ‰‡Ô ÂÚÈÛÙ·ÙÈο Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ™Â ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ, Ë ÓfiÛËÛË Ê·›ÓÂÙ·È Ó· Â›Ó·È ÂÏ·ÊÚ‡ÙÂÚË. ™Â ·È‰È¿ Ì ÚÔÛˆÈ΋ ‰ÈÏËÁ›· (·‰˘Ó·Ì›· Ó· ÛÊ˘Ú›ÍÔ˘Ó, ÂÍ·Ê¿-

ÓÈÛË ÚÈÓÔ¯ÂÈÏÈÎÒÓ ·˘Ï¿ÎˆÓ, ·‰˘Ó·Ì›· Û‡ÁÎÏÂÈÛ˘ ‚ÏÂÊ¿ÚˆÓ Î·È, ÁÂÓÈÎfiÙÂÚ·, ·‰˘Ó·Ì›· ¤ÎÊÚ·Û˘ ÚÔÛÒÔ˘), Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È ÌÔÚȷ΋ ·Ó¿Ï˘ÛË DNA ÁÈ· FSHMD (5). ∆· Û˘ÌÙÒÌ·Ù· ·Ú¯›˙Ô˘Ó Û˘Ó‹ıˆ˜ Ì ·‰˘Ó·Ì›· Î·È ·ÙÚÔÊ›· ÙˆÓ Ì˘ÒÓ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Î·È ÙÔ˘ ÚÔÛÒÔ˘ Î·È ÌÔÚ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Ì˘ÒÓ Ù˘ ˘ÂÏÈ΋˜ ˙ÒÓ˘. ∞Ó, fï˜, Ë ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Á›ÓÂÈ ·fi ÙÔ˘˜ ̇˜ Ù˘ ˘ÂÏÈ΋˜ ˙ÒÓ˘, ı· Ú¤ÂÈ Ó· ÙÂı› ˘fi ·ÌÊÈÛ‚‹ÙËÛË Ë ‰È¿ÁÓˆÛË Ù˘ FSHMD (2). ŸÙ·Ó ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÚÔÛˆÈ΋ ‰ÈÏËÁ›·, Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌfiÓÔ ·Ó ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ¿Û¯ÔÓÙ· ̤ÏË ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘ (4). ¢ÂÓ ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ Ì·ÛËÙ‹Ú˜, ÔÈ ÔÊı·ÏÌÔÎÈÓËÙÈÎÔ›, ÔÈ ÁψÛÛÈÎÔ› Î·È ÔÈ Ê·Ú˘ÁÁÈÎÔ› ̇˜. ∏ ·‰˘Ó·Ì›· ÙÔ˘ ÚÔÛÒÔ˘ ÌÔÚ› Ó· Â›Ó·È Ôχ ÂÏ·ÊÚÈ¿ Î·È Ó· ·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ Ì›· ÌÈÎÚ‹ ·Û˘ÌÌÂÙÚ›· ÛÙËÓ ¤ÎÊÚ·ÛË. O ÈÔ ÛÔ‚·Ú¿ ÚÔۂ‚ÏË̤ÓÔ˜ Ì˘˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ô ˆÌÔÏ·ÙÈ·›Ô˜, ÁÂÁÔÓfi˜ Ô˘ Ô‰ËÁ› ÛÙȘ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÙÂÚ˘ÁÔÂȉ›˜ ˆÌÔÏ¿Ù˜, Ô˘ ‹Ù·Ó ÂÌÊ·Ó›˜ Î·È ÛÙ· ‰‡Ô ÂÚÈÛÙ·ÙÈο Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∞ÎÔÏÔ˘ıÔ‡Ó, Û ÛÂÈÚ¿ ÚÔÛ‚ÔÏ‹˜, Ô Ì›˙ˆÓ ıˆÚ·ÎÈÎfi˜ Î·È Ô ‰ÂÏÙÔÂȉ‹˜ (2,5). ∏ ·Û˘ÌÌÂÙÚ›· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ Ì˘ÒÓ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Â›Ó·È Î·ÓfiÓ·˜ Î·È Û˘Ó‹ıˆ˜ ÚÔÛ‚¿ÏÏÂÙ·È ÚÒÙ· ÙÔ ‰ÂÍÈfi ÙÌ‹Ì·. ™˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ·Û˘ÌÌÂÙÚ›· Î·È ÛÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘. ∏ Û˘ÌÌÂÙÚÈ΋ ·‰˘Ó·Ì›· Î·È ·ÙÚÔÊ›· ÛÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È ·Û˘Ó‹ı˘ Î·È ··ÈÙÂ›Ù·È ÌÂÁ¿ÏË ÚÔÛÔ¯‹ ÚÈÓ ÙÂı› Ë ‰È¿ÁÓˆÛË Ù˘ FSHMD (4). ∏ ÓfiÛÔ˜ ¤¯ÂÈ ·Ó·fiÊ¢ÎÙ· ÂÍÂÏÈÎÙÈÎfi ¯·Ú·ÎÙ‹Ú·, Ì ڢıÌfi Ô˘ ÔÈΛÏÏÂÈ Î·È Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁÔ˜ Ù˘ ËÏÈΛ·˜ ¤Ó·Ú͢ ÙˆÓ Û˘Ìو̿وÓ. ™¿ÓÈ·, ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó ÂÚ›Ô‰ÔÈ ÛÙ·ÛÈÌfiÙËÙ·˜. ∫·Ù¿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ ÎÔÈÏÈ·ÎÔ› Î·È ÔÈ ÂÎÙ›ÓÔÓÙ˜ ÙÔÓ ¿ÎÚÔ fi‰· ̇˜ (2). ∞‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ Ù˘ ˘¤ÏÔ˘ Î·È ÙˆÓ ¿Óˆ ¿ÎÚˆÓ ÌÔÚ› Ó· Û˘Ì‚Â› Û ÔÔÈ·‰‹ÔÙ ÛÙÈÁÌ‹, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·‰˘Ó·Ì›·˜ ÙˆÓ Ì˘ÒÓ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘. ™˘Û¿ÛÂȘ Î·È „¢‰Ô¸ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÒÓ Ù˘ Á·ÛÙÚÔÎÓËÌ›·˜ ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó, ÂÓÒ ÛÔ‚·Ú¤˜ Î·È ÁÂÓÈÎÂ˘Ì¤Ó˜ Û˘Áο̄ÂȘ ·ÔÎÏÂ›Ô˘Ó ÙË ‰È¿ÁÓˆÛË. ∏ „¢‰Ô¸ÂÚÙÚÔÊ›· Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔÓ ‰Â‡ÙÂÚÔ ·ÛıÂÓ‹ Ù˘ ÌÂϤÙ˘, ˘Ô‰ËÏÒÓÂÈ fiÙÈ ·˘Ùfi Â›Ó·È Û‡ÓËı˜, ȉ›ˆ˜ fiÙ·Ó Ë FSHMD ·Ú¯›˙ÂÈ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ‰ÂÓ Ú¤ÂÈ Ó· Û˘Á¯¤ÂÙ·È Ì ÙË Ì˘˚΋ ‰˘ÛÙÚÔÊ›· Ù‡Ô˘ Becker (21). °ÂÓÈÎÒ˜, Ë FSHMD ‰ÂÓ ÚÔÛ‚¿ÏÏÂÈ ÙÔÓ Î·Ú‰È·Îfi Ì˘. ª˘ÔηډÈÔ¿ıÂÈ· ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Û η̛· ÌÂϤÙË fiÔ˘ Á›ÓÂÙ·È Û˘Û¯¤ÙÈÛË Ê·ÈÓfiÙ˘Ô˘-ÁÔÓfiÙ˘Ô˘ Î·È ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·Ó‹ÎÂÈ ÛÙ· ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· Ù˘

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ÓfiÛÔ˘. ™Â ÌÈÎÚfi ÔÛÔÛÙfi (5%) ÌÔÚ› Ó· ÚÔÎÏËıÔ‡Ó ‰È·Ù·Ú·¯¤˜ ·ÁˆÁÈÌfiÙËÙ·˜ ‹ ·ÚÚ˘ı̛˜ (22). ¢ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ Ì˘˚΋˜ ·‰˘Ó·Ì›·˜ Î·È Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜. ¶·Ú’ fiÏ· ·˘Ù¿, Û˘ÓÈÛÙ¿Ù·È ÂÙ‹ÛÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ∏∫°. ∫·È ÔÈ ‰‡Ô ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ Â›¯·Ó Â˘Ú‹Ì·Ù· ·fi ÙÔ Î˘ÎÏÔÊÔÚÈÎfi. ¶·Ú·ÙËÚÂ›Ù·È ‚·ÚËÎÔ˝· Ó¢ÚÔ·ÈÛıËÙËÚÈ·ÎÔ‡ Ù‡Ô˘, Ë ÔÔ›· ÌÔÚ› Ó· ÂÂÎÙ·ı› Û fiϘ ÙȘ Û˘¯ÓfiÙËÙ˜ Î·È Â›Ó·È ÂÍÂÏÈÎÙÈ΋. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ‚·ÚËÎÔ˝·˜, Ë ÔÔ›· ÌÔÚ› Ó· ÂÎÏËÊı› Ï·Óı·Ṳ̂ӷ ˆ˜ ¯·ÌËÏfi ÓÔËÙÈÎfi Â›‰Ô, ˘¿Ú¯ÂÈ Î·ı˘ÛÙ¤ÚËÛË, fiˆ˜ Ê¿ÓËÎÂ Î·È ÛÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË. ∞ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û οı ÂÚ›ÙˆÛË FSHMD Ô˘ ‰È·ÁÈÁÓÒÛÎÂÙ·È ÛÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ· (5). OÈ Brouwer Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ‚·ÚËÎÔ˝·, ȉ›ˆ˜ ÛÙȘ ˘„ËϤ˜ Û˘¯ÓfiÙËÙ˜, ·Ú·ÙËÚÂ›Ù·È Û¯Â‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì FSHMD (23). ¶ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ ‚·ÚËÎÔ˝·˜ Û ÂÚÈÙÒÛÂȘ FSHMD Ì ¤Ó·ÚÍË ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ‰ÂÓ Â›Ó·È Û˘¯ÓfiÙÂÚË ·fi ÂΛÓË ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∏ ËÏÈΛ· ¤Ó·Ú͢, Ë ‰È¿ÚÎÂÈ· Î·È Ë ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, Ô ‚·ıÌfi˜ Ù˘ Ì˘˚΋˜ ·‰˘Ó·Ì›·˜ ÙÔ˘ ÚÔÛÒÔ˘, ·ÏÏ¿ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ıÚ·‡ÛÌ·ÙÔ˜ ‰ÂÓ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ‚·ıÌfi Ù˘ ‚·ÚËÎÔ˝·˜ (24). ∞ÌÊÈ‚ÏËÛÙÚÔÂȉÈ΋ ·ÁÁÂÈÔ¿ıÂÈ· Ì ÙÚȯÔÂȉÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ÌÈÎÚÔ·Ó¢ڇÛÌ·Ù· Î·È ·ÔÊÚ¿ÍÂȘ ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ (ÓfiÛÔ˜ Coats) ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙËÓ FSHMD (25). OÈ Shapiro Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì·˙› Ì ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ÛÙ· ˘fiÏÔÈ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ı· ÌÔÚÔ‡Û ӷ Â›Ó·È ¯Ú‹ÛÈÌ· ˆ˜ ÚÔ˜ ÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË (26). ∂Âȉ‹ Ë ÓfiÛÔ˜ Coats ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·, ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË Ë ·Ú·ÎÔÏÔ‡ıËÛË Ì ‚˘ıÔÛÎfiËÛË. ∏ ÚÒÈÌË ‰È¿ÁÓˆÛ‹ Ù˘ ÌÔÚ› ÛÙ· ·Ú¯fiÌÂÓ· ÛÙ¿‰È· Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘, Ì ÎÚ˘ÔËÍ›· Î·È ÊˆÙÔËÍ›· ÙˆÓ ‰È¢ڢÛÌ¤ÓˆÓ ·ÁÁ›ˆÓ. ∂Âȉ‹ Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÎÔ‹ Î·È ÙËÓ fiÚ·ÛË ‰ÂÓ Â›Ó·È ÛÙ·ıÂÚ¿, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÚÔÛ˘Ìو̷ÙÈÎfi ¤ÏÂÁ¯Ô, ȉ›ˆ˜ Â› ·Ô˘Û›·˜ Ì˘˚΋˜ ·‰˘Ó·Ì›·˜ (9). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì FSHMD, ÁÂÓÈο, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÓÂ˘Ì·ÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ Â›Ó·È ÂÚ›Ô˘ 2% Î·È Û¿ÓÈ· Û˘Óԉ‡ÂÙ·È ·fi ÂÈÏË„›· (18,27,28). ™ÙÔ˘˜ ¿Û¯ÔÓÙ˜, fï˜, Ì ÚÒÈÌË ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÓÂ˘Ì·ÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 20%. ™ÙÔ ÔÛÔÛÙfi ·˘Ùfi ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈ ‰‡Ô ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È. ∂ÂÈÛfi‰È· Û·ÛÌÒÓ ‰ÂÓ ¤¯Ô˘Ó ̤¯ÚÈ ÙÒÚ· ·Ú·ÙËÚËı› ÛÙÔ˘˜ ‰‡Ô ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘.

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∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ù· Â›‰· Ù˘ CPK Î˘Ì·›ÓÔÓÙ·È ·fi Ê˘ÛÈÔÏÔÁÈο ¤ˆ˜ ·˘ÍË̤ӷ. ¶·Ú’ fiÏ· ·˘Ù¿, Û¿ÓÈ· ÊÙ¿ÓÔ˘Ó ÙÔ ÂÓÙ·Ï¿ÛÈÔ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÙÈÌ‹˜. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛÙÔ‡Ó ¿ÏÏ· Ó¢ÚÔÌ˘˚ο ÓÔÛ‹Ì·Ù·. ∏ ̤ÙÚËÛË Ù˘ CPK Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Û·Ó ÚÔÛ˘Ìو̷ÙÈÎfi test. ™˘Ó‹ıˆ˜ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ì ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È Ë ÙÈÌ‹ Ù˘ ÌÂÈÒÓÂÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ (2). ∆Ô ∏ª° Û˘¯Ó¿ ‰Â›¯ÓÂÈ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Î·È ¯·ÌËÏÔ‡ ‡ÚÔ˘˜ ÔÏ˘Ê·ÛÈο ‰˘Ó·ÌÈο. ∏ ÎÈÓËÙÈ΋ Î·È Ë ·ÈÛıËÙÈ΋ ·ÁˆÁÈÌfiÙËÙ· ÙˆÓ ÓÂ‡ÚˆÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ (2). ∆Ô ∏ª° Î·È ÛÙ· ‰‡Ô ·È‰È¿ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ·ıÔÏÔÁÈÎfi. ∏ ‚ÈÔ„›· Ì˘fi˜ Â›Ó·È ÂȂ‚ÏË̤ÓË, ·ÏÏ¿ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ÌÂ Â˘Ú‹Ì·Ù· Û˘¯Ó¿ ÌË ÂȉÈο, Û˘Ó‹ıˆ˜ Ì˘Ô·ıËÙÈÎÔ‡ Ù‡Ô˘. ¶·Ú·ÙËÚÂ›Ù·È ÌÂÁ¿ÏË ‰È·ÊÔÚÔÔ›ËÛË ÛÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ, Ì ÂÓ‰Ô·ÙÙˆÛË ÙˆÓ ˘Ú‹ÓˆÓ Î·È ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÂÓ‰ÂÈÎÙÈ΋ Ì˘Ô¿ıÂÈ·˜. ºÏÂÁÌÔÓÒ‰Ë ÌÔÓÔ˘ÚËÓÈο ·ÙÙ·Ú· ‰È·ÈÛÙÒÓÔÓÙ·È Û ·È‰È¿ ËÏÈΛ·˜ <2 ¯ÚfiÓˆÓ (2). ∞Ó¢ڛÛÎÔÓÙ·È ÔÏϤ˜ ˘ÂÚÙÚÔÊÈΤ˜, fiˆ˜ Î·È ·ÙÚÔÊÈΤ˜, ÌÈÎÚ¤˜, ÁˆÓÈÒ‰ÂȘ Ì˘˚Τ˜ ›Ó˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Û‡Á¯˘ÛË Ì ‚Ï¿‚Ë Ó¢ÚÔÁÂÓÔ‡˜ Ù‡Ô˘. À¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ ·ÛıÂÓÒÓ Ì ӈÙÈ·›· Ì˘˚΋ ·ÙÚÔÊ›· Ù‡Ô˘ FSHªD, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ÔÔ›ˆÓ ÔÌÔÈ¿˙ÂÈ ÙfiÛÔ Ì ÙËÓ ÂÈÎfiÓ· ÙˆÓ ·Û¯fiÓÙˆÓ Ì FSHMD, Ô˘ ‰ËÌÈÔ˘ÚÁ› ·ÌÊÈ‚ÔÏ›· ÁÈ· ÙÔ ·Ó ÔÈ ‰‡Ô ÔÓÙfiÙËÙ˜ Â›Ó·È ‰È·ÊÔÚÂÙÈΤ˜. ¶ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ ¤‰ÂÈÍ·Ó fiÙÈ ·Ú·ÙËÚÂ›Ù·È ÛˆÌ·ÙÈÎfi˜ ̈۷˚ÎÈÛÌfi˜ ÛÙÔ 40% ÙˆÓ ÂÚÈÙÒÛˆÓ, ›Ù ÛÙÔ˘˜ ·ÛıÂÓ›˜ ›Ù ÛÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜ ÁÔÓ›˜ (29). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ, ÔÛÔÛÙfi 10-20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›˙ÂÈ ·‰˘Ó·Ì›· ‚¿‰ÈÛ˘ Û ËÏÈΛ· ÂÚ›Ô˘ 40 ÂÙÒÓ Î·È Î·Ù·Ï‹ÁÂÈ Û ·Ó·ËÚÈ΋ ηڤÎÏ·. ¶ÚÔÛ˘Ìو̷ÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ‰È·ÁÓˆÛÙÔ‡Ó Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ· Î·È ·ÔÙÂÏÔ‡Ó ÙÔ 30% ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÂÚÈÙÒÛÂˆÓ (2,4,5,17). º·›ÓÂÙ·È fiÙÈ Ë ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÔÁfiÓÔ˘˜ Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÚfiÌÔÈ· Ì ÙÔÓ ¿Û¯ÔÓÙ· ÁÔÓ¤·. ¢ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› ·Ó ÛÙÔ ÓfiÛËÌ· ·Ú·ÙËÚÂ›Ù·È ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ “Â›Û¢Û˘ ‹ ÚÒÈÌ˘ ¤ÎÊÚ·Û˘” Û οı ÂfiÌÂÓË ÁÂÓÈ¿ (30). ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÁÂÓÈο ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÔÓÙ·È Ë ÂÈ‚›ˆÛË Î·È Ë ·Ó··Ú·ÁˆÁ‹ (2,3), ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛË Û ‰‡Ô ÔÈÎÔÁ¤ÓÂȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÔÊÂÈÏfiÌÂÓË ÛÙËÓ FSHMD (31,32). Ÿˆ˜ Î·È Û ¿ÏÏÔ˘˜ Ù‡Ô˘˜ Ì˘˚΋˜ ‰˘ÛÙÚÔÊ›·˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂÚ·›·. ™˘ÓÈÛٿٷÈ


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¿ÛÎËÛË ¯ˆÚ›˜ ˘ÂÚ‚ÔÏ‹ ηÈ, ÂȉÈÎfiÙÂÚ·, ·ÔÊ˘Á‹ ·Û΋ÛÂˆÓ ÙÔ˘ Ù‡Ô˘ body building (2). ™‹ÌÂÚ· ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÚÔÛ˘Ìو̷ÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ Southern blot ·Ó¿Ï˘ÛË, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔÓ ·ÓȯÓÂ˘Ù‹ p13-11, ‰ËÌÈÔ‡ÚÁËÛ ¤Ó·Ó ·ÍÈfiÏÔÁÔ ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ FSHMD. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ıÚ·‡ÛÌ· ÌÈÎÚfiÙÂÚÔ ·fi 35 kb, ·˘Ùfi˜ Ô ¤ÏÂÁ¯Ô˜ ¤¯ÂÈ Â˘·ÈÛıËÛ›· ÂÚ›Ô˘ 95%, ÂÓÒ Ë ÂÍÂȉ›Î¢ÛË ÏËÛÈ¿˙ÂÈ ÙÔ 100% (19). Œ¯ÂÈ ‚ÔËı‹ÛÂÈ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Î·È ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ·Û¯fiÓÙˆÓ ÌÂÙ¿ ·fi ¯ÚfiÓÈ· ·ÌÊ›‚ÔÏ˘ ‰È¿ÁÓˆÛ˘. ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Û ÔÈÎÔÁ¤ÓÂȘ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi FSHMD, ·Ú¿ ÙȘ ·ÓÙÈÌÂÙˆÈ˙fiÌÂÓ˜ Ú·ÎÙÈΤ˜ ‰˘ÛÎÔϛ˜ (33). ªÂ ȉȷ›ÙÂÚÔ ÂӉȷʤÚÔÓ ·Ó·Ì¤ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÚÔÛ¿ıÂÈ· ·ÔÌfiÓˆÛ˘ Î·È ÎψÓÔÔ›ËÛ˘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ FSHMD Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ‰Ú¿Û˘ ÙÔ˘. ∞˘Ùfi ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ·ıÔÁÂÓÂÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Ù˘ ÓfiÛÔ˘ Î·È ı· ÂÓÈÛ¯‡ÛÂÈ ÙËÓ ·ÍÈÔÈÛÙ›· Ù˘ ÌÔÚȷ΋˜ ‰È¿ÁÓˆÛ˘ (9). µÈ‚ÏÈÔÁÚ·Ê›· 1. Tawil R, Storvick D, Feasby TE, Weiffenbach B, Griggs RC. Extreme variability of expression in monozygotic twins with FSH muscular dystrophy. Neurology 1993;43:345-348. 2. Lunt PW, Harper PS. Genetic counselling in facioscapulohumeral muscular dystrophy. J Med Genet 1991;28:655-664. 3. Eggers S, Zatz M. How the magnitude of clinical severity and recurrence risk affects reproductive decisions in adult males with different forms of progressive muscular dystrophy. J Med Genet 1998;35:189-195. 4. Padberg GW, Lunt PW, Koch M, Fardeau M. Diagnostic criteria for facioscapulohumeral muscular dystrophy. Neuromuscul Disord 1991;1:231-234. 5. Jardine PE, Koch MC, Lunt PW, Maynard J, Bathke KD, Harper PS et al. De novo facioscapulohumeral muscular dystrophy defined by DNA probe p13E-11(D4F104S1). Arch Dis Child 1994;71:221-227. 6. Wijmenga C, Frants RR, Brouwer OF, Moerer P, Weber JL, Padberg GW. Location of facioscapulohumeral muscular dystrophy gene on chromosome 4. Lancet 1990;336:651653. 7. Upadhyaya M, Lunt PW, Sarfarazi M, Broadhead W, Daniels J, Owen M et al. DNA marker applicable to presymptomatic and prenatal diagnosis of facioscapulohumeral disease. Lancet 1990;336:1320-1321. 8. Wijmenga C, Padberg GW, Moerer P, Wiegant J, Liem L, Brouwer OF et al. Mapping of facioscapulohumeral muscular dystrophy gene to chromosome 4q35-qter by multipoint linkage analysis and in situ hybridization. Genomics 1991;9:570-575. 9. Upadhyaya M, Lunt PW, Sarfarazi M, Broadhead W, Daniels J, Owen M et al. A closely linked DNA marker for facioscapulohumeral disease on chromosome 4q. J Med

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Genet 1991;28:665-671. 10. Padberg GW, Frants RR, Brouwer OF, Wijmenga C, Bakker E, Sandkuijl LA. Facioscapulohumeral muscular dystrophy in the Dutch population. Muscle Nerve 1995;2:S81-S84. 11. Ding H, Beckers MC, Plaisance S, Marynen P, Collen D, Belayew A. Characterization of a double homeodomain protein (DUX1) encoded by a cDNA homologous to 3.3 kb dispersed repeated elements. Hum Mol Genet 1998;7:1681-1694. 12. van Deutekom JC, Lemmers RJ, Grewal PK, van Geel M, Romberg S, Dauwerse HG et al. Identification of the first gene (FRG1) from the FSHD region on human chromosome 4q35. Hum Mol Genet 1996;5:581-590. 13. Lemmers RJ, van der Maarel SM, van Deutekom JC, van der Wielen MJ, Deidda G, Dauwerse HG et al. Inter- and intrachromosomal sub-telomeric rearrangements on 4q35: implications for facioscapulohumeral muscular dystrophy (FSHD) aetiology and diagnosis. Hum Mol Genet 1998;7:1207-1214. 14. Sarfarazi M, Wijmenga C, Upadhyaya M, Weiffenbach B, Hyser C, Mathews K et al. Regional mapping of facioscapulohumeral muscular dystrophy gene on 4q35: combined analysis of an international consortium. Am J Hum Genet 1992;51:396-403. 15. Bakker E, Van der Wielen MJ, Voorhoeve E, Ippel PF, Padberg GW, Frants RR et al. Diagnostic, predictive, and prenatal testing for facioscapulohumeral muscular dystrophy: diagnostic approach for sporadic and familial cases. J Med Genet 1996;33:29-35. 16. Ricci E, Galluzzi G, Deidda G, Cacurri S, Colantoni L, Merico B et al. Progress in the molecular diagnosis of facioscapulohumeral muscular dystrophy and correlation between the number of KpnI repeats at the 4q35 locus and clinical phenotype. Ann Neurol 1999;45:751-757. 17. Lunt PW, Jardine PE, Koch MC, Maynard J, Osborn M, Williams M et al. Correlation between fragment size at D4F104S1 and age at onset or at wheelchair use, with a possible generational effect, accounts for much phenotypic variation in 4q35-facioscapulohumeral muscular dystrophy (FSHD). Hum Mol Genet 1995;4:951-958. 18. Funakoshi M, Goto K, Arahata K. Epilepsy and mental retardation in a subset of early onset 4q35facioscapulohumeral muscular dystrophy. Neurology 1998;50:1791-1794. 19. Upadhyaya M, Maynard J, Rogers MT, Lunt PW, Jardine P, Ravine D et al. Improved molecular diagnosis of facioscapulohumeral muscular dystrophy (FSHD): validation of the differential double digestion for FSHD. J Med Genet 1997;34:476-479. 20. Van Deutekom JC, Wijmenga C, van Tienhoven EA, Gruter AM, Hewitt JE, Padberg GW et al. FSHD associated DNA rearrangements are due to deletions of integral copies of a 3.2 kb tandemly repeated unit. Hum Mol Genet 1993;2:2037-2042. 21. Reardon W, Temple IK, Harwood G, Baraitser M. Atypical facioscapulohumeral muscular dystrophy - a counselling dilemma. Clin Genet 1991;39:172-177. 22. Laforet P, de Toma C, Eymard B, Becane HM, Jeanpierre M,

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facioscapulohumeral muscular dystrophy: frequent somatic mosaicism, sex-dependent phenotype, and the role of mitotic transchromosomal repeat interaction between chromosomes 4 and 10. Am J Hum Genet 2000;66:26-35. Tawil R, Forrester J, Griggs RC, Mendell J, Kissel J, McDermott M et al. Evidence for anticipation and association of deletion size with severity in facioscapulohumeral muscular dystrophy. The FSH-DY Group. Ann Neurol 1996;39:744-748. Bailey RO, Marzulo DC, Hans MB. Infantile facioscapulohumeral muscular dystrophy: new observations. Acta Neurol Scand 1986;74:51-58. McGarry J, Garg B, Silbert S. Death in childhood due to facioscapulohumeral dystrophy. Acta Neurol Scand 1983;68:61-63. Upadhyaya M, MacDonald M, Ravine D. Prenatal diagnosis for facioscapulohumeral muscular dystrophy (FSHD). Prenat Diagn 1999;19:959-965.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-09-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-03-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ŒÏÂÓ· ºÚ˘Û›Ú· ª·ÎÚ˘Ó›ÙÛ·˜ 16, ∆.∫. 115 22, ∞ÌÂÏfiÎËÔÈ, ∞ı‹Ó· E-mail: efrysira@cc.uoa.gr


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CURRENT ISSUES

¶ÚÔ‚ÈÔÙÈο, Ú‚ÈÔÙÈο, Û˘Ì‚ÈÔÙÈο: ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ π. ÷ڈӛÙË, ª. ª·˘ÚfiΈÛÙ·, ∂. ∫fiÎÔÚË

Probiotics, prebiotics, synbiotics: recent data I. Charoniti, M. Mavrokosta, E. Kokori

¶ÂÚ›ÏË„Ë: ∏ ·ÓıÚÒÈÓË ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È·Ù‹ÚËÛË Î·È ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜. ∏ ÙÚÔÔÔ›ËÛ‹ Ù˘ Û ̛· ¢ÓÔ˚ÎfiÙÂÚË ÁÈ· ÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi Û‡ÛÙ·ÛË ¤¯ÂÈ ÂÈÎÂÓÙÚÒÛÂÈ ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ˘Á›·˜. ∏ ÌÂÙ·‚ÔÏ‹ Ù˘ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ›Ù Ì ÙË ¯ÔÚ‹ÁËÛË ˙ÒÓÙˆÓ ‚·ÎÙËÚ›ˆÓ, ÌÂÙ·‚ÔÏÈο ÂÓÂÚÁÒÓ, Ô˘ ÌÔÚÔ‡Ó Ó· Êı¿ÓÔ˘Ó ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ ·Ó·ÏÏÔ›ˆÙ· ·fi ÙË ‰Ú¿ÛË ÙˆÓ ÂÓ˙‡ÌˆÓ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ (ÚÔ‚ÈÔÙÈο), ›Ù Ì ÙË ¯ÔÚ‹ÁËÛË ÌË ÂÙÒÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Ô˘ ·ÔÙÂÏÔ‡Ó ÂÎÏÂÎÙÈÎfi ˘fiÛÙڈ̷ ÁÈ· Û˘ÁÎÂÎÚÈ̤ӷ ›‰Ë ‚·ÎÙËÚ›ˆÓ Ì ȉÈfiÙËÙ˜ ˆÊ¤ÏÈ̘ ÁÈ· ÙÔÓ ÍÂÓÈÛÙ‹ (Ú‚ÈÔÙÈο), ›Ù ٤ÏÔ˜ Ì ÙË Û˘Ó‰˘·Ṳ̂ÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·Ú·¿Óˆ (Û˘Ì‚ÈÔÙÈο). ∏ ÙÚÔÔÔ›ËÛË Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜ ‚Ú›ÛÎÂÈ ÂÊ·ÚÌÔÁ‹ Û ÔÏϤ˜ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù·, fiˆ˜ Û ‰È·ÚÚÔ˚ο Û‡Ó‰ÚÔÌ· ÔÈΛÏ˘ ·ÈÙÈÔÏÔÁ›·˜, ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔ˘˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È Î·Ù·ÛÙ¿ÛÂȘ Ì ˘ÂÚ·Ó¿Ù˘ÍË ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘.

Abstract: Human gut microflora play a significant role in the maintenance and promotion of the health of the host and scientists in the field of health have shown great interest in modifying gut microflora towards a more beneficial composition. Alteration of the gut microflora can be achieved by the ingestion of either live, metabolically active bacteria able to reach the colon intact through the action of the small intestine enzymes (probiotics), nondigestible carbohydrates which act as substrates to a limited number of bacteria beneficial to the host (prebiotics), or a combination of pro- and prebiotics (synbiotics). Modification of gut microflora has been applied with encouraging results in several clinical conditions such as various diarrhoeal illnesses, inflammatory bowel disease and conditions associated with bacterial overgrowth.

§¤ÍÂȘ ÎÏÂȉȿ: ÚÔ‚ÈÔÙÈο, Ú‚ÈÔÙÈο, Û˘Ì‚ÈÔÙÈο.

Key words: probiotics, prebiotics, synbiotics.

∂ÈÛ·ÁˆÁ‹ ∏ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ™ÙȘ ˆÊ¤ÏÈ̘ ÏÂÈÙÔ˘ÚÁ›Â˜ Ù˘ ·Ó‹ÎÔ˘Ó Ë ·ÚÂÌfi‰ÈÛË ·Ó¿Ù˘Í˘ ‚Ï·‚ÂÚÒÓ ‚·ÎÙËÚȉ›ˆÓ, Ë Û˘ÌÌÂÙÔ¯‹ Û ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, Ë Û˘Ì‚ÔÏ‹ ÛÙË Ì›ˆÛË ÂÓÙÂÚÈ΋˜ ‰È¿Ù·Û˘ ÏfiÁˆ ·ÂÚ›ˆÓ, Ë ‚ÂÏÙ›ˆÛË Ù˘ ¤„˘ Î·È Ù˘ ·ÔÚÚfiÊËÛ˘ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, ηıÒ˜ Î·È Ë Û‡ÓıÂÛË ‚ÈÙ·ÌÈÓÒÓ (1). ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ÛÙÔÓ ¿ÓıÚˆÔ ÂÚÈÔÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ, ÙÔ ÔÔ›Ô ·ÔÈΛ˙ÂÙ·È Ì ÂÚÈÛÛfiÙÂÚ· ·fi 1012 ·ÂÚfi‚È· Î·È ˘Ô¯ÚˆÙÈο ·Ó·ÂÚfi‚È· Gram(-)

Î·È Gram(+) ‚·ÎÙ‹ÚÈ· ·Ó¿ ÁÚ·ÌÌ¿ÚÈÔ ÂÓÙÂÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘. ∞fi Ù· 400 ›‰Ë Ô˘ Û˘Ì‚ÈÒÓÔ˘Ó, Ù· 30-40 ·ÔÙÂÏÔ‡Ó ÙÔ 99% Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜. ∆· ·Ó·ÂÚfi‚È· ˘ÂÚÙÂÚÔ‡Ó Î·Ù¿ Ôχ ÙˆÓ ·ÂÚfi‚ÈˆÓ (ÁÈ· οı 1000 ·Ó·ÂÚfi‚È· ·ÓÙÈÛÙÔȯ› 1 ·ÂÚfi‚ÈÔ ‚·ÎÙ‹ÚÈÔ) (2). ™Ù· ÂÈÎÚ·ÙÔ‡ÓÙ· ·Ó·ÂÚfi‚È· ›‰Ë ·Ó‹ÎÔ˘Ó Ù· Bacteroides spp, bifidobacteria, propionibacteria Î·È clostridia. ªÂٷ͇ ÙˆÓ ·ÂÚfi‚ÈˆÓ Î˘ÚÈ·Ú¯Ô‡Ó Ù· enterobacteria Î·È Î˘Ú›ˆ˜ Ù· escherichia coli Î·È enterococci (2). O ·ÔÈÎÈÛÌfi˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·Ú¯›˙ÂÈ ÙȘ ÚÒÙ˜ ÒÚ˜ Ù˘ ˙ˆ‹˜, ·fi ÙËÓ Î·Ù¿ÔÛË ÎÔÏÈÎÒÓ ˘ÁÚÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÙÔÎÂÙÔ‡ Ì ‚·ÎÙ‹ÚÈ· ÙÔ˘

A’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, ∫Ú‹ÙË

1st Paediatric Clinic Venizelion General Hospital of Heraklion, Crete

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ÎfiÏÔ˘ Î·È Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÂÚÈÔ¯‹˜ Ù˘ ÌËÙ¤Ú·˜ ‹ ·fi ‚·ÎÙ‹ÚÈ· ÙÔ˘ ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Û ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ (2,3). ∂ÎÙfi˜ ·fi ÙÔÓ Ù‡Ô ÙÔ˘ ÙÔÎÂÙÔ‡, ÚfiÏÔ ÛÙË Û‡ÛÙ·ÛË Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜ ¤¯ÂÈ Î·È Ë Û›ÙÈÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ (4). ™Â ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË, ΢ÚÈ·Ú¯Ô‡Ó Ù· bifidobacteria. ™Â ‚Ú¤ÊË Ô˘ ÛÈÙ›˙ÔÓÙ·È Ì Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹, Ë ÌÈÎÚԯψڛ‰· Â›Ó·È ÈÔ ÂÚ›ÏÔÎË, ·ÔÙÂÏÔ‡ÌÂÓË ·fi bifidobacteria, ‚·ÎÙËÚÈÔÂȉ‹, ÎψÛÙËÚ›‰È· Î·È ÛÙÚÂÙfiÎÔÎÎÔ˘˜ (5,6). OÈ ‰È·ÊÔÚ¤˜ Ô˘ ˘¿Ú¯Ô˘Ó Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ Á·ÛÙÚ›Ùȉ·˜ ÛÙ· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË. §›Á· ÂÈϤÔÓ ‚·ÎÙ‹ÚÈ· ÚÔÛÙ›ıÂÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂfiÌÂÓˆÓ ‰‡Ô ¯ÚfiÓˆÓ Ù˘ ˙ˆ‹˜, ÒÛÙÂ Ë ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ·˘Ù‹ Ó· ÔÌÔÈ¿˙ÂÈ Ì ÂΛÓË ÙÔ˘ ÂÓËÏ›ÎÔ˘ (7). ∆Ô ÔÈÎÔÛ‡ÛÙËÌ· ÙÔ˘ ÂÓÙ¤ÚÔ˘, οو ·fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ‰È·ÙËÚÂ›Ù·È Û¯ÂÙÈο ÛÙ·ıÂÚfi ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÓıÚÒÔ˘ (7). O ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ‚·ÎÙËÚ›ˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙË ‰È·Ù‹ÚËÛË Î·È ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› ·fi ·ÚÎÂÙ¿ ·ÏÈ¿. ∆Ô ÂӉȷʤÚÔÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ·fi ÓˆÚ›˜ ÛÙÚ¿ÊËΠ۠ÚÔÛ¿ıÂȘ ÙÚÔÔÔ›ËÛ˘ Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜, ÒÛÙ ӷ ·˘ÍËı› Ô ·ÚÈıÌfi˜ ‹ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÔÌ¿‰ˆÓ ‚·ÎÙËÚ›ˆÓ Ì ȉÈfiÙËÙ˜ Ô˘ ¢ÓÔÔ‡Ó ÙËÓ ˘Á›·. ™Â ·˘Ùfi ÙÔ ÛËÌÂ›Ô ÂÈÛ¿ÁÂÙ·È Ë È‰¤· ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, ÙˆÓ Ú‚ÈÔÙÈÎÒÓ Î·È ÙˆÓ Û˘Ì‚ÈÔÙÈÎÒÓ, Ô˘ Â›Ó·È ÁÓˆÛÙ¿ ˆ˜ ÚfiÛıÂÙ· ÙÚÔÊÒÓ. ¶ÚÔ‚ÈÔÙÈο ∆· ÚÔ‚ÈÔÙÈο Â›Ó·È ‰È·ÙÚÔÊÈο Û˘ÌÏËÚÒÌ·Ù· ·fi ˙ÒÓÙ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ·ÛÎÔ‡Ó ˆÊ¤ÏÈÌË ‰Ú¿ÛË ÛÙÔÓ ÍÂÓÈÛÙ‹, ÌÂÙ·‚¿ÏÏÔÓÙ·˜ ÙË Û‡ÛÙ·ÛË Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÌÈÎÚԯψڛ‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (8). °È· Ó· ıˆÚËı› ¤Ó·˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ fiÙÈ ·Ó‹ÎÂÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, Ú¤ÂÈ Ó· ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. OÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÚÔ‚ÈÔÙÈο Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ¶ÚfiÎÂÈÙ·È Î˘Ú›ˆ˜ ÁÈ· Á·Ï·ÎÙÔ‚¿ÎÈÏÏÔ˘˜ Î·È bifidobacteria Ô˘ Û˘Ó‹ıˆ˜ ·Ú¿ÁÔ˘Ó Î·Ù¿ ÙË ˙‡ÌˆÛ‹ ÙÔ˘˜ Á·Ï·ÎÙÈÎfi Ô͇. ∆Ô ·Ô¶›Ó·Î·˜ 1. ∫ÚÈÙ‹ÚÈ· ÚÔ‚ÈÔÙÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÌÏËÚˆÌ¿ÙˆÓ ∆· ÚÔ‚ÈÔÙÈο Ú¤ÂÈ: ñ Ó· ·ÛÎÔ‡Ó ˆÊ¤ÏÈÌË ‰Ú¿ÛË ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ñ Ó· ÌËÓ Â›Ó·È ÙÔÍÈο Î·È ·ıÔÁfiÓ· ñ Ó· ÂÚȤ¯Ô˘Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi ‚ÈÒÛÈÌˆÓ Î˘ÙÙ¿ÚˆÓ ñ Ó· ‰È·ÙËÚÔ‡Ó ÙȘ ȉÈfiÙËÙ¤˜ ÙÔ˘˜ ηٿ ÙȘ ‰È·‰Èηۛ˜ ·Ôı‹Î¢Û˘, ‰È·Ù‹ÚËÛ˘ Î·È ¯Ú‹Û˘ ñ Ó· Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ó··Ú·¯ıÔ‡Ó Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ (‚ÈÔÌ˯·ÓÈ΋ ·Ó··Ú·ÁˆÁ‹)

224

Paediatriki 2003;66:223-231

Ù¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ÙÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Û٤ϯԘ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Ô˘ ¯ÔÚËÁÂ›Ù·È (9). ™ÙȘ ȉÈfiÙËÙ¤˜ ÙÔ˘˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È: ·) Ë ·‡ÍËÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙȘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÂÙÈÎÔ‡, ‚) Ë ‰È¤ÁÂÚÛË Ù˘ ·ÓÔÛ›·˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, Á) Ë ‰È·Ù‹ÚËÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂÚ·›·˜, ‰) Ë ‚ÂÏÙ›ˆÛË Ù˘ ¤„˘ Î·È Â) Ë ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ‰˘Û·ÓÂÍ›·˜ ÛÙË Ï·ÎÙfi˙Ë. ¶Èı·Ó¿ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ ·Ì̈ӛ·˜ ÛÙÔ ·›Ì· Î·È ÛÙË Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ Î·ÎÔËıÂÈÒÓ ÙÔ˘ ÂÙÈÎÔ‡ (10). O ·ÚÈÔ˜ Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ıˆÚÂ›Ù·È Ô “·ÓÙ·ÁˆÓÈÛÙÈÎfi˜ ·ÔÎÏÂÈÛÌfi˜” (10). O fiÚÔ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÙË ‰È·‰Èηۛ· ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È, ̤ۈ ·˘Ù‹˜, ÙËÓ ·ÚÂÌfi‰ÈÛË Ù˘ ÚÔÛÎfiÏÏËÛ˘ ¿ÏÏˆÓ ‚·ÎÙËÚ›ˆÓ, Èı·Ó¿ ·ıÔÁfiÓˆÓ, ÏfiÁˆ ηٿÏ˄˘ ÙˆÓ ı¤ÛÂˆÓ ÚÔÛÎfiÏÏËÛ˘. ÕÏÏÔÈ Ì˯·ÓÈÛÌÔ› ‰Ú¿Û˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ‚·ÎÙËÚÈÔÎÙfiÓˆÓ Ô˘ÛÈÒÓ (11) Î·È ÙËÓ ÂÓ›Û¯˘ÛË ‹ ÙÚÔÔÔ›ËÛË Ù˘ ·ÓÔÛ›·˜ ÙÔ˘ ÍÂÓÈÛÙ‹ (·Ú·ÁˆÁ‹ ·ÓÙÈۈ̿وÓ, ÂÓÂÚÁÔÔ›ËÛË ·ÓÙȉڿÛÂˆÓ Î·ı˘ÛÙÂÚË̤Ó˘ ˘ÂÚ¢·ÈÛıËÛ›·˜, Â›Ù·ÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Ê·ÁÔ΢ÙÙ¿ÚˆÓ, ‰È¤ÁÂÚÛË Ù˘ ·Ú·ÁˆÁ‹˜ ÈÓÙÂÚÊÂÚfiÓ˘, IL-1a Î·È TNF-a) (12). ∆· bifidobacteria Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÔ‡Ó ÙË ‰Ú¿ÛË ÙÔ˘˜ ̤ۈ ·Ú·ÁˆÁ‹˜ Ô˘ÛÈÒÓ ·Ó·ÛÙ·ÏÙÈÎÒÓ Ù˘ ·Ó¿Ù˘Í˘ ¿ÏÏˆÓ ‚·ÎÙËÚ›ˆÓ, ·ÏÏ¿ Î·È Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ ÈÛ¯˘ÚÒÓ ÔͤˆÓ, Ù· ÔÔ›· ·ÛÎÔ‡Ó ÙË ‚·ÎÙËÚÈÔÎÙfiÓÔ ¶›Ó·Î·˜ 2. ™˘Ó‹ıË ÚÔ‚ÈÔÙÈο Lactobacilli L. acidophilus L. casei L. deibrueckii subsp. bulgrius L. reuteri L. cellobiosus L. curvarus L. fermentum L. plantarum Gram positive cocci Lactococcus lactis subsp. cremoris Streptococcus salivaris subsp. thermophilus Enterococcus faecium S. diaacetylactis S. intermedius Bifidobacteria B. bifidum B. adolescentis B. animalis B. infantis B. longum B. thermophilum


May-June 03

03-06-03

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‰Ú¿ÛË ÙÔ˘˜ ̤ۈ Ì›ˆÛ˘ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ pH (13). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙȘ Á·ÛÙÚÂÓÙÂÚ›Ùȉ˜, Ù· ÚÔ‚ÈÔÙÈο Ê·›ÓÂÙ·È fiÙÈ ÌÔÚ› Ó· ÌÂÈÒÛÔ˘Ó ÙË ‰È¿ÚÎÂÈ· Î·È ÙË ‚·Ú‡ÙËÙ· ·˘ÙÒÓ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‹ ·ÎfiÌË Î·È Ó· ÚÔÏ¿‚Ô˘Ó ÙËÓ ÂΉ‹ÏˆÛ‹ ÙÔ˘˜. ™˘ÁÎÂÎÚÈ̤ӷ, Û ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯ÂÈ ·Ô‰ÂȯÙ› Ô ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ Lactobacillus rhamnosus GG ÛÙË ıÂÙÈ΋ ¤Î‚·ÛË Ù˘ ‰È¿ÚÚÔÈ·˜ ·fi Èfi Rota ÛÙ· ‚Ú¤ÊË (1417). ™Â Ì›· ÚfiÛÊ·ÙË, ÌÂÁ¿ÏË ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ∂˘ÚÒË Î·È ¤Ï·‚·Ó ̤ÚÔ˜ ·È‰È¿ ËÏÈΛ·˜ ·fi 1-36 ÌËÓÒÓ Ì ÔÍ›· ‰È¿ÚÚÔÈ·, ¯ÔÚËÁ‹ıËΠÎÔÈÓfi ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘Ì· Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘Ì· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì Lactobacillus rhamnosus GG. ™Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ÙÔ ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì Lactobacillus rhamnosus GG ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘Ì· Î·È ÂȉÈο Û ·˘Ù¿ Ô˘ ¤·Û¯·Ó ·fi Ïԛ̈ÍË ·fi Èfi Rota, Ë ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÈÒıËΠÛËÌ·ÓÙÈο (58±28 ÒÚ˜ ÛÙ· ·È‰È¿ Ì ÙÔ ÂÌÏÔ˘ÙÈṲ̂ÓÔ ‰È¿Ï˘Ì· Î·È 76±36 ÒÚ˜ ÛÙ· ·È‰È¿ Ì ÙÔ ÎÔÈÓfi ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘Ì·) (18,19). O Lactobacillus GG Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ Î·È ÙÔ Ú˘ıÌfi ·Ô‚ÔÏ‹˜ ÙÔ˘ ÈÔ‡ Rota ÛÙ· ÎfiÚ·Ó· ηÈ, ¿Ú·, fiÙÈ ÂÚÈÔÚ›˙ÂÈ ÙË ÌÂÙ¿‰ÔÛ‹ ÙÔ˘ (20). ™Â ¿ÏϘ ÌÂϤÙ˜, fiÔ˘ ÙÔ ·›ÙÈÔ ÙˆÓ ‰È·ÚÚÔÈÒÓ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È, ÚÔ‚ÈÔÙÈο Ô˘ ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È, ÂÎÙfi˜ ÙÔ˘ Lactobacillus rhamnosus GG, Ô Enterococcus faecium SF68 (21), Ô Saccharomyces boulardii (22) Î·È Ô Lactobacillus reuteri (20). O Lactobacillus acidophilus Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ Á·ÛÙÚÂÓÙÂÚ›ÙȉˆÓ (23). À¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ Û˘Û¯ÂÙ›˙Ô˘Ó ÙË ¯ÔÚ‹ÁËÛË ÚÔ‚ÈÔÙÈÎÔ‡ Ì ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ‰È¿ÚÚÔÈ·˜ ÙˆÓ Ù·ÍȉȈÙÒÓ (24,25), ηıÒ˜ Î·È ÙËÓ ÂÎÚ›˙ˆÛË ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ fiˆ˜ Ë Salmonella Î·È ÙÔ Campylobacter ·fi ÙÔ ¤ÓÙÂÚÔ ¯ÚfiÓÈˆÓ ÊÔÚ¤ˆÓ (26,27). ∏ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÂÓÙÂÚ›Ùȉ· ·fi Cl. difficile Ê·›ÓÂÙ·È, Â›Û˘, Ó· ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙË ¯ÔÚ‹ÁËÛË Ï·ÎÙÔ‚¿ÎÈÏÏˆÓ (28). ∞ÔÙÂÏÂÛÌ·ÙÈο ÚÔ‚ÈÔÙÈο ÛÙËÓ ÚfiÏË„Ë Ù˘ ‰È¿ÚÚÔÈ·˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ٷ ·ÓÙÈ‚ÈÔÙÈο ıˆÚÔ‡ÓÙ·È Ô Lactobacillus rhamnosus GG Î·È Ô Saccharomyces boulardii (29). ™Â ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ·È‰È¿ Ô˘ ÂÏ¿Ì‚·Ó·Ó ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë ¯ÔÚ‹ÁËÛË Lactobacillus rhamnosus GG Ì›ˆÛ ÙËÓ Â›ÙˆÛË ÙˆÓ ¯·Ï·ÚÒÓ ÎÂÓÒÛÂˆÓ ·fi 42% Û 17% (30). ∏ ¯ÔÚ‹ÁËÛË ÚÔ‚ÈÔÙÈÎÒÓ ¤¯ÂÈ ÂÚÈÔÚÈṲ̂ӷ ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H. Pylori, ·Ú’ fiÏÔ Ô˘ Û in vitro ÌÂϤÙ˜ ¤¯ÂÈ ‰È·ÈÛÙˆı› ·ÓÙ·ÁˆÓÈÛÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ H. Pylori Î·È ÛÙÂϯÒÓ Lactobacillus (31).

Paediatriki 2003;66:223-231

∆· ÚÔ‚ÈÔÙÈο ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› Ì ÂÈÙ˘¯›· Û ÂÓËÏ›ÎÔ˘˜ ÛÙË ıÂÚ·›· Ù˘ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ ·fi ÌÂıÔÙÚÂÍ¿ÙË (32), Ù˘ ·ÎÙÈÓÈ΋˜ ÂÓÙÂÚ›Ùȉ·˜ (33) Î·È ÛÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ¯ÚfiÓÈ·˜ ‰È¿ÚÚÔÈ·˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ AIDS (34). º·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó ¢ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È Û ÓÂÔÁÓ¿ ¿Û¯ÔÓÙ· ·fi ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· Î·È ·ÏÏÂÚÁÈ΋ ÎÔÏ›Ùȉ·, ηıÒ˜ Î·È Û ·È‰È¿ Ì ΢ÛÙÈ΋ ›ÓˆÛË (35). ™Â fi,ÙÈ ¤¯ÂÈ Û¯¤ÛË Ì ÙË ¯Ú‹ÛË ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔ˘˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ù· ·ÔÙÂϤÛÌ·Ù· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÎÂÙfi ÂӉȷʤÚÔÓ. OÈ Ï·ÎÙÔ‚¿ÎÈÏÏÔÈ Ê·›ÓÂÙ·È fiÙÈ ·Ó·ÎÔ˘Ê›˙Ô˘Ó fi¯È ÌfiÓÔ ·fi ÙȘ ÂÓÙÂÚÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ˘ÂÚ·Ó¿Ù˘ÍË ‚·ÎÙËÚ›ˆÓ, ·ÏÏ¿ Î·È ·fi ÙȘ Â͈ÂÓÙÂÚÈΤ˜ ÂÈÏÔΤ˜, fiˆ˜ Ë ·ÚıÚ›Ùȉ· (35,36). ∏ ¯ÔÚ‹ÁËÛË Saccharomyces boulardii Û ·È‰È¿ Ì ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ ÂÓÂÚÁfi ÓfiÛÔ Crohn ¤Ù˘¯Â ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ô˘ ‰ÂÓ ¤Ï·‚·Ó ÚÔ‚ÈÔÙÈÎfi (37). ∆· ÚÔ‚ÈÔÙÈο Ê·›ÓÂÙ·È Ó· Â›Ó·È ÙÔ ›‰ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο Ì ÙË ÌÂÛ·Ï·˙›ÓË ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ‡ÊÂÛ˘ ÛÙË ÓfiÛÔ Crohn Î·È ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ (38). ™Â fi,ÙÈ ¤¯ÂÈ Û¯¤ÛË Ì ÙË ‰˘Û·ÓÂÍ›· ÛÙË Ï·ÎÙfi˙Ë, Ô Lactobacillus acidophilus Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ Ù· Û˘ÌÙÒÌ·Ù·, ̤ۈ ·Ú·ÁˆÁ‹˜ ‚-Á·Ï·ÎÙÔÛȉ¿Û˘ (39). ∆· ÚÔ‚ÈÔÙÈο ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Ì ÂÈÙ˘¯›· ÛÙËÓ ÚfiÏË„Ë, ·ÏÏ¿ Î·È ÛÙË ıÂÚ·›· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓfiÛˆÓ (40). ∏ ‰Ú¿ÛË ÙÔ˘˜ ÔÈΛÏÏÂÈ. ∂ÓÈÛ¯‡Ô˘Ó ÙÔÓ ‚ÏÂÓÓÔÁfiÓÈÔ ÊÚ·ÁÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ (41) Î·È ·ÓÙÈÛÙÚ¤ÊÔ˘Ó ÙËÓ ·˘ÍË̤ÓË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô˘ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿ Û ·ÛıÂÓ›˜ Ì ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· (42). ∂›Û˘, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ÂȉÈ΋, ÂÈÙÂÏÔ‡ÌÂÓË Ì¤Ûˆ IgA, ·¿ÓÙËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô˘ Û˘¯Ó¿ Â›Ó·È ÂÏÏÂÈÌÌ·ÙÈ΋ ÛÙÔ˘˜ ·Ú·¿Óˆ ·ÛıÂÓ›˜ (42). ∆¤ÏÔ˜, ÌÂÈÒÓÔ˘Ó ÙËÓ ÚÔηÏÔ‡ÌÂÓË ·fi ÙËÓ ·ÏÏÂÚÁ›· ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË, ̤ۈ ·Ú·ÁˆÁ‹˜ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ, fiˆ˜ Ë ÈÓÙÂÚÏ¢ΛÓË 10 Î·È Ô ÌÂÙ·ÙÚÂÙÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‚ (41). O˘ÛÈ·ÛÙÈο, Ù· ÚÔ‚ÈÔÙÈο ·ÔÙÚ¤Ô˘Ó ÙËÓ ÂÁηٿÛÙ·ÛË ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ Ù‡Ô˘ 2 (TH2) Î·È ‰È·‰Ú·Ì·Ù›˙Ô˘Ó Ú˘ıÌÈÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ÙÔÈ΋, ·ÏÏ¿ Î·È ÙË Û˘ÛÙË��·ÙÈ΋ ÂΉ‹ÏˆÛË ÊÏÂÁÌÔÓ‹˜ ÏfiÁˆ ¤ÎıÂÛ˘ Û ·ÏÏÂÚÁÈÔÁfiÓ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ (43). ™ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Ù· ·Ú·¿Óˆ ·Ô‰ÂÈÎÓ‡ÔÓÙ·È Ì¤Û· ·fi ÌÂϤÙ˜, fiÔ˘ Ë ¯ÔÚ‹ÁËÛË ÚÔ‚ÈÔÙÈÎÒÓ Û ÂÁ·Ԣ˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ·ËÛ˘ Î·È Û ÓÂÔÁÓ¿ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Ì›ˆÛ ÛËÌ·ÓÙÈο ÙËÓ ÂΉ‹ÏˆÛË ·ÙÔ›·˜ (44). O ÚfiÏÔ˜ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ÙÂÎÌËÚȈ̤ÓÔ˜, ·ÏÏ¿ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÙËÓ

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¢ÓÔ˚΋ Â›‰Ú·Û‹ ÙÔ˘˜, ȉȷ›ÙÂÚ· ÛÙ· Â›‰· Ù˘ LDL (45). ∆· ÚÔ‚ÈÔÙÈο Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÔ˘Ó ÙË ‚ÈԉȷıÂÛÈÌfiÙËÙ· ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ÙÔ˘ Ì·ÁÓËÛ›Ô˘ fiÙ·Ó ÚÔÛÙ›ıÂÓÙ·È Û Á¿Ï·Ù·. ∂›Û˘, ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ·Ú·ÁˆÁ‹ ‚ÈÙ·ÌÈÓÒÓ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ µ Î·È ÙÔ˘ Ê˘ÏÏÈÎÔ‡ ÔͤԘ (46). O Lactobacillus GG ¤¯ÂÈ Î·Ù·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÛÙË ‚·ÎÙËÚȷ΋ ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∏ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ¤¯ÂÈ Û˘Ó‰Âı› Ì ÌÂȈ̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ÂÓ˙‡ÌˆÓ ‚-ÁÏ˘ÎÔ˘ÚÔÛȉ¿‰Ë˜, ‚-ÁÏ˘ÎÔÓȉ¿Û˘, ÓÈÙÚÔÚ‰ԢÎÙ¿Û˘ Î·È ·˙ˆÙÔÚ‰ԢÎÙ¿Û˘, Ù· ÔÔ›· ıˆÚÂ›Ù·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È¤ÁÂÚÛË ÚÔηÚÎÈÓÔÁfiÓˆÓ Ô˘ÛÈÒÓ ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ. ∂›Û˘, Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì Ì›ˆÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ Î·È Ô‰ËÁÔ‡Ó Û ηÚÎÈÓÔÁ¤ÓÂÛË (46). ∏ ¯Ú‹ÛË ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÎfiÛÌÔ, Û ·È‰È¿ Ì ‰È·ÚÚÔ˚ο Û‡Ó‰ÚÔÌ·, ˆ˜ ̤ÚÔ˜ ÙˆÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ, ›Ûˆ˜ ÚÔÛʤÚÂÈ ÔχÙÈÌË ‚Ô‹ıÂÈ· Û ·˘Ùfi ÙÔ ÙÂÚ¿ÛÙÈÔ Úfi‚ÏËÌ· Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜. ◊‰Ë, ÛÙȘ Û˘ÛÙ¿ÛÂȘ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜ (WHO) ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ¯Ú‹Û˘ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ¯Ú‹ÛË ÚÔ‚ÈÔÙÈÎÒÓ fiˆ˜ ÔÈ Lactobacilli rhamnosus Î·È plantarum. ∆· ÚÔ‚ÈÔÙÈο ÚÔÛÙ›ıÂÓÙ·È Û Á¿Ï·Ù·, ‰È¿ÊÔÚ· ›‰Ë ÁÈ·Ô˘ÚÙÈÔ‡, Ù˘ÚÈ¿, ÚÔÊ‹Ì·Ù· Î·È ·ÁˆÙ¿. ™ÙËÓ π·ˆÓ›·, ÚˆÙÔfiÚÔ ¯ÒÚ· ÛÙËÓ ·Ú·Û΢‹ ÔÚÁ·ÓÈÎÒÓ ÚÔ˚fiÓÙˆÓ, ÁÈ· Ó· ıˆÚËı› οÔÈÔ ÚÔ˚fiÓ ÚÔ‚ÈÔÙÈ΋ ÙÚÔÊ‹, ı· Ú¤ÂÈ Ó· ÂÚȤ¯ÂÈ ˙ˆÓÙ·ÓÔ‡˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Û ÔÛfiÙËÙ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 107/g ‹ ml ÚÔ˚fiÓÙÔ˜ (47). ¶·Ú·Ì¤ÓÂÈ, fï˜, ·‰È¢ÎÚ›ÓÈÛÙÔ ·ÎfiÌË ÙÔ ÂÏ¿¯ÈÛÙÔ ÔÛfi ÙˆÓ ÚÔÛÙÈı¤ÌÂÓˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, ηıÒ˜ Î·È Ô È‰·ÓÈÎfi˜ ¯ÚfiÓÔ˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜, ÒÛÙ ӷ ˘¿ÚÍÂÈ Â˘ÂÚÁÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. ™‹ÌÂÚ·, Ù›ÓÂÈ Ó· ÂÈÎÚ·Ù‹ÛÂÈ Ë ¿Ô„Ë fiÙÈ Û˘ÁΤÓÙÚˆÛË ÌÈÎÚfiÙÂÚË ·fi 105 ˙ˆÓÙ·ÓÒÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ·Ó¿ g ‹ ml ÚÔ˚fiÓÙÔ˜ ‰ÂÓ Â›Ó·È ÈηӋ Ó· ·Ú¿ÁÂÈ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ·Ó Î·È Ë È‰·ÓÈ΋ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ÚÔ‚ÈÔÙÈÎÔ‡ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Û٤ϯԘ Ô˘ ¯ÚËÛÈÌÔÔÈ›ٷÈ, ηıÒ˜ Î·È Ì ÙÔ Â›‰Ô˜ Ù˘ ÙÚÔÊ‹˜ ÛÙËÓ ÔÔ›· ÂÓۈ̷ÙÒÓÂÙ·È (47). ™ÙÔ ÂÌfiÚÈÔ Î˘ÎÏÔÊÔÚÔ‡Ó Ì ÙË ÌÔÚÊ‹ ÛÎfiÓ˘, ÔÏÙÔ‡, Ù·ÌϤٷ˜, ο„Ô˘Ï·˜, ˘ÁÚÔ‡ ÂӷȈڋ̷ÙÔ˜ Î·È ÛÚ¤È. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú‡Ù·Ù· ÛÙËÓ ÎÙËÓÔÙÚÔÊ›·, ·ÏÏ¿ ÛÙ·‰È·Î¿ ηıÈÂÚÒÓÔÓÙ·È Î·È ˆ˜ Û˘ÌÏËÚÒÌ·Ù· ÛÙËÓ ·ÓıÚÒÈÓË ‰È·ÙÚÔÊ‹. ¶¿ÓÙˆ˜, ¯ÚÂÈ¿˙ÔÓÙ·È ·ÎfiÌË ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÁÂÓÈ΢ٛ Ë ¯Ú‹ÛË ÙÔ˘˜ ˆ˜ ·ÛÊ·Ï‹ ‰È·ÙÚÔÊÈο Û˘ÌÏËÚÒÌ·Ù·. ¶ÚÔ‚Ï‹Ì·Ù· ËÁ¿˙Ô˘Ó ·fi ÙËÓ ·ÓÔÌÔÈÔÌÔÚÊ›· ÙˆÓ ÌÂÏÂÙÒÓ, ·fi ÙÔ ÁÂÁÔ-

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Ófi˜ fiÙÈ Û˘¯Ó¿ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÓÙÔÈÛÙÔ‡Ó ÔÈ ÏËı˘ÛÌÔ› ÙˆÓ Â͈ÁÂÓÒ˜ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, ÏfiÁˆ ‡·Ú͢ ›‰ÈˆÓ ‹ ·Ú·Ï‹ÛÈˆÓ ÂÓ‰ÔÁÂÓÒÓ ÏËı˘ÛÌÒÓ, ηıÒ˜ Î·È ·fi ÙÔ fiÙÈ ·Ô‚¿ÏÏÔÓÙ·È Ù·¯‡Ù·Ù· ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi (̤۷ Û ÂÚ›Ô˘ Ô¯ÙÒ Ë̤Ú˜ ¤ˆ˜ Ï›Á˜ ‚‰ÔÌ¿‰Â˜) ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜. ∆· ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙËÓ Î·Ù¿ÔÛË ˙ÒÓÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, ˘ÂÚÛÎÂÏ›˙Ô˘Ó Û οÔÈÔ ‚·ıÌfi Ù· Ú‚ÈÔÙÈο, Ô˘Û›Â˜ ÌË ˙ÒÛ˜, ÔÈ Ôԛ˜ ·ÔÙÂÏÔ‡Ó ˘fiÛÙڈ̷ ÁÈ· ÙËÓ ˘ÂÚ·Ó¿Ù˘ÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô˘ ‹‰Ë ˘¿Ú¯Ô˘Ó ÛÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È ·ÛÎÔ‡Ó Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË. ¶Ú‚ÈÔÙÈο ™˘ÛÙ·ÙÈο ÙˆÓ ÙÚÔÊÒÓ, fiˆ˜ Ê˘ÙÈΤ˜ ›Ó˜, Û‡ÓıÂÙ˜ ÚˆÙ½Ó˜, ÌË ÂÙÔ› ˘‰·Ù¿ÓıڷΘ (ÔÏÈÁÔÎ·È ÔÏ˘Û·Î¯·Ú›Ù˜) Î·È ÔÚÈṲ̂ӷ ÏÈ›‰È·, Ô˘ ‰ÂÓ ˘fiÎÂÈÓÙ·È Û ÂÓ˙˘ÌÈ΋ ‰È¿Û·ÛË ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ Î·È Êı¿ÓÔ˘Ó ·Ó·ÏÏÔ›ˆÙ· ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ıÚ¤„Ë ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘. ∞ӷʤÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ “ÙÚÔÊ‹ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘”. ∏ “ÙÚÔÊ‹ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” ·ÔÙÂÏ› ˘fiÛÙڈ̷ ÁÈ· Ù· ‚·ÎÙËÚ›‰È· ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘, Ù· ÔÔ›· ‰È·ÛÒÓÙ·˜ ÙËÓ, ÙÚÔÊÔ‰ÔÙÔ‡Ó ÙÔÓ ÔÚÁ·ÓÈÛÌfi Ì ··Ú·›ÙËÙ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο Î·È ÂÓ¤ÚÁÂÈ·. ™˘ÓÈÛÙ¿Ù·È Ó· ·Ú¤¯ÂÙ·È ÙÔ 10% ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ıÂÚÌ›‰ˆÓ Î·È ÙÔ 20% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ fiÁÎÔ˘ Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰È·ÙÚÔÊ‹˜ Ì ÙË ÌÔÚÊ‹ “Ù˘ ÙÚÔÊ‹˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” (48). ∆· ÂÚÈÛÛfiÙÂÚ· Û˘ÛÙ·ÙÈο “Ù˘ ÙÚÔÊ‹˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” ·ÔÙÂÏÔ‡Ó ˘fiÛÙڈ̷ ÌË ÂȉÈ΋˜ ˙‡ÌˆÛ˘ ·fi ‰È·ÊÔÚÂÙÈο ›‰Ë ‚·ÎÙËÚ›ˆÓ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ·˘ÏÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÂÓ›ÔÙÂ Î·È ·ıÔÁfiÓˆÓ ÛÙÂϯÒÓ. ™˘ÛÙ·ÙÈο “Ù˘ ÙÚÔÊ‹˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” Ô˘ ·ÔÙÂÏÔ‡Ó ·ÔÎÏÂÈÛÙÈÎfi ˘fiÛÙڈ̷ ÂȉÈ΋˜ ÂÓ˙˘ÌÈ΋˜ ‰È¿Û·Û˘ ·fi ˆÊ¤ÏÈÌ· ÁÈ· ÙÔÓ ÔÚÁ·ÓÈÛÌfi ‚·ÎÙ‹ÚÈ·, fiˆ˜ lactobacilli Î·È bifidobacteria, ηٷٿÛÛÔÓÙ·È ÛÙ· Ú‚ÈÔÙÈο. ∆· Ú‚ÈÔÙÈο Â›Ó·È ÌË ÂÙÒÌÂÓ· ÙÚÔÊÈο Û˘ÛÙ·ÙÈο Ô˘ ÂËÚ¿˙Ô˘Ó Â˘ÂÚÁÂÙÈο ÙÔÓ ÍÂÓÈÛÙ‹, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ·‡ÍËÛË Î·È ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÂÎÏÂÎÙÈο ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ “ˆÊ¤ÏÈ̈Ӕ ‚·ÎÙËÚ›ˆÓ Ô˘ ‹‰Ë ·ÔÈÎÔ‡Ó ÙÔ ¤ÓÙÂÚÔ, Û˘ÓÙÂÏÒÓÙ·˜ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÍÂÓÈÛÙ‹ (49). ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÚfiÎÂÈÙ·È ÁÈ· ˘‰·Ù¿ÓıڷΘ ÌÈÎÚ‹˜ ·Ï˘Û›‰·˜ Ô˘ ‰ÂÓ ‰È·ÛÒÓÙ·È ·fi Ù· ¤Ó˙˘Ì· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È ÂΛӷ Ù˘ „ËÎÙÚÔÂȉԇ˜ ·Ú˘Ê‹˜ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ηÏÔ‡ÓÙ·È ÌË ÂÙÔ› ÔÏÈÁÔ۷ί·Ú›Ù˜ (50). °È· Ó· ¯·Ú·ÎÙËÚÈÛÙ›, ÂÔ̤ӈ˜, ¤Ó· Û˘ÛÙ·ÙÈÎfi


May-June 03

03-06-03

16:55

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Ù˘ ÙÚÔÊ‹˜ ˆ˜ Ú‚ÈÔÙÈÎfi ı· Ú¤ÂÈ: ·) Ó· ÌËÓ ˘‰ÚÔχÂÙ·È, Ô‡Ù ӷ ·ÔÚÚÔÊ¿Ù·È ·fi ÙÔ ·ÓÒÙÂÚÔ ÙÌ‹Ì· ÙÔ˘ ÂÙÈÎÔ‡, ‚) Ó· ·ÔÙÂÏ› ÂÎÏÂÎÙÈÎfi ˘fiÛÙڈ̷ ÁÈ· ÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ‚·ÎÙËÚ›ˆÓ Ô˘ ¤¯Ô˘Ó ¢ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÛÙÔÓ ÍÂÓÈÛÙ‹ Î·È Á) Ó· ÌÔÚ› Ó· ÌÂÙ·‚¿ÏÂÈ ÙË ÌÈÎÚԯψڛ‰· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÚÔ˜ Ì›· ÏÂÔÓÂÎÙÈÎfiÙÂÚË, ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ÍÂÓÈÛÙ‹, Û‡ÛÙ·ÛË (10,48,49). ∞·ÓÙÒÓÙ·È ÛÙÔ ÎÚÂÌ̇‰È, ÙËÓ ·ÁÎÈÓ¿Ú·, Ù· Û·Ú¿ÁÁÈ·, Ù· Ú·‰›ÎÈ· Î·È ÛÙË Ì·Ó¿Ó·. OÈ È‰ÈfiÙËÙ¤˜ ÙÔ˘˜ ÂÍ·ÚÙÒÓÙ·È ·fi ÙË ¯ËÌÈ΋ ÙÔ˘˜ ‰ÔÌ‹, ÙÔ ÌÔÚÈ·Îfi ÙÔ˘˜ ‚¿ÚÔ˜ Î·È ·fi ÙÔ ÔÛÔÛÙfi ÌÔÓÔ۷ί·ÚÈÙÒÓ Î·È ‰È۷ί·ÚÈÙÒÓ Ô˘ ÂÚȤ¯Ô˘Ó (10). ∏ ¢ÓÔ˚΋ ÁÈ· ÙÔÓ ÍÂÓÈÛÙ‹ ‰Ú¿ÛË ÙÔ˘˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ÚÔ·ÁˆÁ‹˜ Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ˆÊ¤ÏÈÌˆÓ ‚·ÎÙËÚ›ˆÓ, ̤ۈ ‰Ú·ÛÙËÚÈÔÔ›ËÛ˘ ·˘ÙÒÓ ‹ ̤ۈ Û˘Ó‰˘·ÛÌÔ‡ ÙˆÓ ·Ú·¿Óˆ ‰Ú¿ÛˆÓ. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ¤Ú¢Ó˜ ÁÈ· Ù· Ú‚ÈÔÙÈο ηÙ¢ı‡ÓÔÓÙ·È ÚÔ˜ ÙËÓ ·Ó¿Ù˘ÍË Ô˘ÛÈÒÓ Ô˘ ·ÔÙÂÏÔ‡Ó ˘fiÛÙڈ̷ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Ô˘ ·Ú¿ÁÔ˘Ó Á·Ï·ÎÙÈÎfi Ô͇, ÏfiÁˆ ÙˆÓ Â˘ÂÚÁÂÙÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ Ô˘ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ·˘ÙÔ› ÁÈ· ÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi. ¶·Ú’ fiÏ· ·˘Ù¿, ›Ûˆ˜ οÔȘ ÌÂÏÏÔÓÙÈΤ˜ ÌÂϤÙ˜ Ó· Û˘ÌÂÚÈÏ¿‚Ô˘Ó Î·È Ô˘Û›Â˜ Ô˘ ı· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÚÂÌfi‰ÈÛË Ù˘ ·Ó¿Ù˘Í˘ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ. ŒÓ· Ù¤ÙÔÈÔ ·Ú¿‰ÂÈÁÌ· ·ÔÙÂÏ› Ë Ô˘Û›· cellobiose, Ë ÔÔ›· ·ԉ›¯ÙËΠfiÙÈ ÌÂÈÒÓÂÈ ÙË ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË Ù˘ Listeria monocytoges (51). ∆· Û˘Ó‹ıË Ú‚ÈÔÙÈο Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. OÈ ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ ·ÔÙÂÏÔ‡Ó Ì›· ÌÂÁ¿ÏË Î·ÙËÁÔÚ›· Ê˘ÛÈÎÒÓ ÔÏÈÁÔ۷ί·ÚÈÙÒÓ. ¶ÚfiÎÂÈÙ·È ÁÈ· ÔÏÈÁÔÌÂÚ‹ Ù˘ ÊÚÔ˘ÎÙfi˙˘ Ô˘, ·Ó¿ÏÔÁ· Ì ÙÔÓ ‚·ıÌfi ÔÏ˘ÌÂÚÈÛÌÔ‡ ÙÔ˘˜, ‰È·ÎÚ›ÓÔÓÙ·È ÛÙËÓ ÈÓÔ˘Ï›ÓË (‚·ıÌfi˜ ÔÏ˘ÌÂÚÈÛÌÔ‡ 2-60) Î·È ÛÙËÓ ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë (̤ÛÔ˜ ‚·ıÌfi˜ ÔÏ˘ÌÂÚÈÛÌÔ‡ 4) (52,53). ∞fi ÔÏϤ˜ ÌÂϤÙ˜ ¤¯ÂÈ ÙÂÎÌËÚȈı› fiÙÈ Ë ÈÓÔ˘Ï›ÓË Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi Ù· Ú·‰›ÎÈ·, ·˘Í¿ÓÂÈ ÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ bifidobacteria Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÌË Â˘ÓÔ˚ÎÒÓ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ ‚·ÎÙËÚ›ˆÓ (52-55). OÈ ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ Â›Ó·È Ù· ϤÔÓ ÌÂÏÂÙË̤ӷ ˆ˜ Û‹ÌÂÚ· Ú‚ÈÔÙÈο. ∞ÔÙÂÏÔ‡Ó ÂȉÈÎfi ˘fiÛÙڈ̷ ÁÈ· Ù· bifidobacteria, Ù· ÔÔ›· fiÙ·Ó ˙˘ÌÒÓÔ˘Ó ÙÔ˘˜ ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜, ÙÔ Î¿ÓÔ˘Ó Û ‚¿ÚÔ˜ ÙˆÓ bacteroides, clostridia Î·È coliforms. ∞˘Ùfi ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi Ù· ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ ηÏÏÈÂÚÁÂÈÒÓ ÙˆÓ Gibson Î·È Wang (55), ÔÈ ÔÔ›ÔÈ Î·ÏÏȤÚÁËÛ·Ó, ÛÂ Û˘Óı‹Î˜ ÂÏÂÁ¯fiÌÂÓÔ˘ pH, bifidobacterium infantis, e. coli Î·È c. perfingens, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ˘fiÛÙڈ̷ ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë. ∆Ô bifidobacterium infantis ·Ó·Ù‡¯ıËΠ۠‚¿ÚÔ˜

Paediatriki 2003;66:223-231

¶›Ó·Î·˜ 3. ™˘Ó‹ıË Ú‚ÈÔÙÈο ºÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ [ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë, ÈÓÔ˘Ï›ÓË Î·È Û˘ÓıÂÙÈÎÔ› ˘‰·Ù¿ÓıڷΘ (Neosugar)] °·Ï·ÎÙÔÔÏÈ۷ί·Ú›Ù˜ §·ÎÙÔ˘Ïfi˙Ë §·ÎÙÈÙfiÏË

ÙˆÓ ˘ÔÏÔ›ˆÓ. ∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ in vitro ÌÂÏÂÙÒÓ ÙˆÓ ·Ú·¿Óˆ ÂÚ¢ÓËÙÒÓ Â·ÏËı‡ÙËÎ·Ó ·fi in vivo ÌÂϤÙ˜ (56). ∏ ÂȉÈÎfiÙËÙ· ·˘Ù‹ ÙˆÓ bifidobacteria ÚÔ˜ ÙÔ˘˜ ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ ÈÛÙ‡ÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È ÛÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· ·Ú¿ÁÔ˘Ó ‚-ÊÚÔ˘ÎÙÔÛȉ¿ÛË. ∏ ·Ó·ÛÙÔÏ‹ Ù˘ ·Ó¿Ù˘Í˘ ‚·ÎÙËÚ›ˆÓ, fiˆ˜ clostridia, e. coli Î·È ÔÏÏÒÓ ¿ÏÏˆÓ ÂÓÙÂÚÔ·ıÔÁfiÓˆÓ, fiˆ˜ listeria, shigella, salmonella Î·È v. Cholerae, ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÂÏ¢ı¤ÚˆÛË ‚·ÎÙËÚÈÔÎÙfiÓˆÓ Ô˘ÛÈÒÓ ·fi Ù· bifidobacteria (57,58). ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ ·ÔÙÂÏÔ‡Ó ÂȉÈÎfi ˘fiÛÙڈ̷ ÁÈ· ÙËÓ ÂÎÏÂÎÙÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ bifidobacteria ¤¯ÂÈ ·Ô‰ÂȯÙ› Î·È ·fi ¿ÏϘ ÌÂϤÙ˜, fiÔ˘ ˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜, fiÙ·Ó ÂÏ¿Ì‚·Ó·Ó 3x5 g ÊÚÔ˘ÎÙÔÔÏÈ۷ί·ÚÈÙÒÓ ·Ó¿ Ë̤ڷ, ·‡ÍËÛ·Ó Ù· bifidobacteria ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ ·fi 6% ¤ˆ˜ 22%. ™Â ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË (59) ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ‚ÚÂÊÒÓ Ì ̛ÁÌ· Á·Ï·ÎÙÔ- Î·È ÊÚÔ˘ÎÙÔÔÏÈ۷ί·ÚÈÙÒÓ Â˘ÓÔ› ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ bifidobacteria Î·È ÙˆÓ lactobacilli, Ì ÙÚfiÔ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ Î·È ¯ˆÚ›˜ ·ÚÂÓ¤ÚÁÂȘ. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÙÔÓÈÛÙ› fiÙÈ ÌÂϤÙ˜ Û ÂÓ‹ÏÈΘ (60,61), ·ÏÏ¿ Î·È Û ÂÈÚ·Ì·Ùfi˙ˆ· (62,63) Û˘ÁÎÏ›ÓÔ˘Ó ÛÙÔ fiÙÈ Ë ·Ó¿Ù˘ÍË ÙˆÓ bifidobacteria Â›Ó·È ·Ó¿ÏÔÁË Ù˘ ÚÔ¸¿Ú¯Ô˘Û·˜ Û˘ÁΤÓÙÚˆÛ˘ bifidobacteria ÛÙÔ ¤ÓÙÂÚÔ, ÂÓÒ fiÙ·Ó ·˘Ù¿ ·Ô˘ÛÈ¿˙Ô˘Ó ·fi ÙËÓ ·Ú¯È΋ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·, Ë Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË Ú‚ÈÔÙÈÎÒÓ Â›Ó·È ÂÓÙÂÏÒ˜ ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋. OÈ ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÔ‡Ó Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÛÙËÓ ·ÔÚÚfiÊËÛË ÈfiÓÙˆÓ fiˆ˜ Ô Û›‰ËÚÔ˜, ÙÔ ·Û‚¤ÛÙÈÔ Î·È ÙÔ Ì·ÁÓ‹ÛÈÔ, ̤ۈ Ù˘ ·Ú·ÁˆÁ‹˜ - ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ˙˘ÌÈ΋˜ ÙÔ˘˜ ˙‡ÌˆÛ˘ - ÏÈ·ÚÒÓ ÔͤˆÓ ‚Ú·¯Â›·˜ ·Ï‡ÛÔ˘ Î·È Á·Ï·ÎÙÈÎÔ‡ ÔͤԘ. º·›ÓÂÙ·È, Â›Û˘, fiÙÈ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎÔ› ÛÙË Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÔÚÔ‡, ÛÙË Ì›ˆÛË ÂÓ·fiıÂÛ˘ Ï›Ô˘˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜ Î·È ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ, ÏfiÁˆ Èı·ÓÒ˜ Ù˘ ÙÚÔÔÔ›ËÛ˘ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ Ï›Ô˘˜. OÈ ·Ú·¿Óˆ ıˆڛ˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ÙÂÎÌËÚ›ˆÛË. ¶¿ÓÙˆ˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙfiÛÔ Ë ÈÓÔ˘Ï›ÓË, fiÛÔ Î·È Ë ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙȘ ‚ÈÔÌ˯·Ó›Â˜ ÙÚÔÊ›ÌˆÓ Â˘Ú‡Ù·Ù·. ∏ ¯Ú‹ÛË ÙÔ˘˜

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Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙˆÓ ÙÚÔÊÒÓ Û ‰È·ÈÙËÙÈΤ˜ ›Ó˜, ÛÙË Ì›ˆÛË Ù˘ ıÂÚÌȉÈ΋˜ ·Í›·˜ ÙÔ˘˜ Î·È ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ó· ·˘Í¿ÓÔ˘Ó ÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ ˆÊ¤ÏÈÌˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔ ¤ÓÙÂÚÔ ·˘ÙÒÓ Ô˘ ηٷӷÏÒÓÔ˘Ó ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÙÚÔʤ˜. ∏ ηٷӿψÛË ÔÏÈÁÔÊÚÔ˘ÎÙfi˙˘ Û˘ÓÙÂÏ› Î·È ÛÙËÓ Î·Ï‡ÙÂÚË ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹, ηıÒ˜ ÈÛÙ‡ÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙËÓ ÙÂÚˉfiÓ·. ª›· ¿ÏÏË ÛËÌ·ÓÙÈ΋ ÔÌ¿‰· ÔÏÈÁÔ۷ί·ÚÈÙÒÓ Â›Ó·È ÔÈ Á·Ï·ÎÙÔÔÏÈ۷ί·Ú›Ù˜. OÈ Á·Ï·ÎÙÔÔÏÈ۷ί·Ú›Ù˜ Ê˘ÛÈÔÏÔÁÈο ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È Û ·˘ÙÔ‡˜ ·Ô‰›‰ÂÙ·È Ë ‰È·ÊÔÚÂÙÈ΋ ¯ÏˆÚ›‰· ÙÔ˘ ÂÙÈÎÔ‡ ÙˆÓ ıËÏ·˙fiÓÙˆÓ ‚ÚÂÊÒÓ (64). ™‹ÌÂÚ·, Â›Ó·È ‰˘Ó·Ù‹ Î·È Ë ‚ÈÔÌ˯·ÓÈ΋ ·Ú·Û΢‹ ÙÔ˘˜. OÈ ÔÏÈÁÔ۷ί·Ú›Ù˜ Î·È ÔÈ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıڷΘ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ·ÔÙÂÏÔ‡Ó ÙÔ ÙÚ›ÙÔ Û ÔÛfiÙËÙ· ÛÙÂÚÂfi Û˘ÛÙ·ÙÈÎfi ÙÔ˘, ÌÂÙ¿ ÙÔ Ï›Ô˜ Î·È ÙË Ï·ÎÙfi˙Ë (65). ∏ Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÛÙÔ ‡·Ú ·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ Û 22 g/L Î·È ÛÙÔ ÒÚÈÌÔ Á¿Ï· Û 12 g/L (65). OÈ ÔÏÈÁÔ۷ί·Ú›Ù˜ Â›Ó·È Û‡ÓıÂÙ· ۿί·Ú· Âӈ̤ӷ Ì ÌfiÚÈ· Ï·ÎÙfi˙˘ ÛÙÔ ·Ó·ÁˆÁÈÎfi ÙÔ˘˜ ¿ÎÚÔ Î·È ÌfiÚÈ· ÊÔ˘Îfi˙˘ ‹ ÛÈ·ÏÈÎÔ‡ ÔͤԘ ÛÙÔ ÌË ·Ó·ÁˆÁÈÎfi ÙÔ˘˜ ¿ÎÚÔ. OÈ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıڷΘ Â›Ó·È Î·È ·˘ÙÔ› Û‡ÓıÂÙ· ۿί·Ú·, Ô˘ fï˜ Â›Ó·È Âӈ̤ӷ Ì ÚˆÙ½Ó˜, ÏÈ›‰È· ‹ ¿ÏÏ· ÌfiÚÈ·, Û ‰Ô̤˜ Ô˘ ηÏÔ‡ÓÙ·È ÁÏ˘ÎÔÚˆÙ½Ó˜, ÁÏ˘ÎÔÏÈ›‰È·, ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿Ó˜, ‚ÏÂÓÓ›Ó˜ (mucins) Î.¿. Œ¯ÂÈ ·Ô‰ÂȯÙ› fiÙÈ ÔÈ ÔÏÈÁÔ۷ί·Ú›Ù˜ Î·È ÔÈ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıڷΘ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÚfiÏÔ˘˜ ÎÏÂȉȿ ÛÙËÓ ¿Ì˘Ó· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ÂÓ·ÓÙ›ÔÓ ·ıÔÁfiÓˆÓ ‚·ÎÙËÚ›ˆÓ, ÈÒÓ Î·È ·Ú·Û›ÙˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ‚·ÎÙ‹ÚÈ· Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ÂÓÙÂÚÈÎfi ·˘Ïfi ÁÈ· Ó· ·Û΋ÛÔ˘Ó ÙËÓ ·ıÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘˜ ı· Ú¤ÂÈ Ó· ÚÔÛÎÔÏÏËıÔ‡Ó ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ. ∏ ÚÔÛÎfiÏÏËÛË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Û ı¤ÛÂȘ˘ԉԯ›˜ ÙˆÓ ÏÂÎÙÈÓÒÓ ÙˆÓ ‚·ÎÙËÚ›ˆÓ. ∞˘Ù¤˜ ÔÈ ı¤ÛÂȘ-˘ԉԯ›˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û˘Ó›ÛÙ·ÓÙ·È ·fi ÁÏ˘ÎÔÚˆÙ½Ó˜ Î·È ÁÏ˘ÎÔÏÈ›‰È· Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÙˆÓ ÔÔ›ˆÓ ÙÔ ÔÏÈÁÔ۷ί·ÚÈÎfi ÙÌ‹Ì· ÚÔ¤¯ÂÈ Ì¤Û· ÛÙÔÓ ÂÓÙÂÚÈÎfi ·˘Ïfi. OÈ ÔÏÈÁÔ۷ί·Ú›Ù˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ·ÔÙÂÏÔ‡Ó ÔÌfiÏÔÁ˜ ‰Ô̤˜ ÙˆÓ ÔÏÈÁÔ۷ί·ÚÈÙÒÓ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ÕÚ·, ÌÔÚÔ‡Ó Ó· Û˘Ó‰¤ÔÓÙ·È Ì ٷ ‚·ÎÙ‹ÚÈ· Î·È Ó· ÂÌÔ‰›˙Ô˘Ó Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ ÙË Û‡Ó‰ÂÛË ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. ∞ÔÙÂÏÔ‡Ó, ηٿ Ì›· ¤ÓÓÔÈ·, ‰fiψ̷ ÙˆÓ ‚·ÎÙËÚ›ˆÓ, ÒÛÙ ӷ ·Ó·¯·ÈÙ›˙ÂÙ·È Ë ·ıÔÁfiÓÔ˜ ‰Ú¿ÛË ÙÔ˘˜. ªÂ ÙÔÓ ·Ú·¿Óˆ ÙÚfiÔ ¤¯ÂÈ ·Ô‰ÂȯÙ› fiÙÈ ·Ó·ÛÙ¤ÏÏÂÙ·È Ë ‰Ú¿ÛË ÙÔ˘ ÂÓÙÂÚÔÙÔÍÈÓÔÁfiÓÔ˘ (66) Î·È ÙÔ˘ ÂÓÙÂÚÔ·ÈÌÔÚÚ·ÁÈÎÔ‡ e. coli (67), ÙÔ˘ v. cholerae (66), ÙÔ˘ streptococcus pneumoniae (68),

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ÙÔ˘ haemophilus influenzae (68), Ù˘ shigella dysenteriae (69), ÙÔ˘ clostridium difficile (70) Î·È ÙÔ˘ campylobacter jejuni (71), ÂÓÒ Ë ¤Ú¢ӷ ÔÏÔ¤Ó· Î·È ·Ó·‰ÂÈÎÓ‡ÂÈ Ó¤· ·ıÔÁfiÓ·, Ë ‰Ú¿ÛË ÙˆÓ ÔÔ›ˆÓ ·Ó·ÛÙ¤ÏÏÂÙ·È ·fi ÙÔ˘˜ ÔÏÈÁÔ۷ί·Ú›Ù˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜. ªÂ ·ÚfiÌÔÈÔ ÙÚfiÔ ·Ó·ÛÙ¤ÏÏÂÙ·È Ë ‰Ú¿ÛË ÙÔ˘ ÈÔ‡ Rota, ̤ۈ Ì›·˜ ÁÏ˘ÎÔÚˆÙ½Ó˘, Ù˘ Ï·ÎÙÔÚÔÛÎÔÏÏËÙ›Ó˘ (72). OÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÔÏÈÁÔ۷ί·ÚÈÙÒÓ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÌÂÙ·‚¿ÏÏÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ›‰ÈÔ˘ Á‡̷ÙÔ˜ (73) ηÈ, Â›Û˘, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË (73). ∆Ô ÌËÙÚÈÎfi Á¿Ï· Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ¤¯ÂÈ ‰È·ÊÔÚÂÙÈ΋ Û‡ÛÙ·ÛË ÔÏÈÁÔ۷ί·ÚÈÙÒÓ ·fi ÂΛÓË ÙˆÓ ÂfiÌÂÓˆÓ ÌËÓÒÓ (74). °›ÓÂÙ·È Ê·ÓÂÚfi fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÚÔÛٷهÂÈ ·fi ÏÔÈÌÒÍÂȘ ·fi Ôχ ÓˆÚ›˜, ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, fiÙ·Ó ÔÈ ¿ÏÏÔÈ Ì˯·ÓÈÛÌÔ› ¿Ì˘Ó·˜ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·Ù˘¯ı› Û ÈηÓÔÔÈËÙÈÎfi ‚·ıÌfi. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ηٷ‚¿ÏÏÔÓÙ·È ÚÔÛ¿ıÂȘ ·Ú·Û΢‹˜ Ú‚ÈÔÙÈÎÒÓ Ì ۇÛÙ·ÛË ·ÚfiÌÔÈ· Ì ·˘Ù‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ·ÊÔ‡ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙˆÓ Á·Ï¿ÙˆÓ Ì Ú‚ÈÔÙÈο ¤¯ÂÈ ·Ú¯›ÛÂÈ Ó· Á›ÓÂÙ·È Ú¿ÍË. ∏ ¯Ú‹ÛË, fï˜, ÙˆÓ Ú‚ÈÔÙÈÎÒÓ ÂÂÎÙ›ÓÂÙ·È Î·È ¤Ú· ·fi Ù· ‚ÚÂÊÈο Á¿Ï·Ù·. ∫¿ı ¯ÚfiÓÔ ·Ú¿ÁÔÓÙ·È, Ì ÂÓ˙˘Ì·ÙÈΤ˜ ‰È·‰Èηۛ˜, ÔÏÏ¿ Ó¤· Ú‚ÈÔÙÈο. °È· Ó· ηٷٷ¯ı› ÛÙ· Ú‚ÈÔÙÈο Ì›· ‚ÈÔÌ˯·ÓÈο ·Ú·ÁfiÌÂÓË Ô˘Û›·, ı· Ú¤ÂÈ Ó· ÂΉËÏÒÓÂÈ Î·Ï‹ Û˘Û¯¤ÙÈÛË ÙˆÓ in vitro Î·È in vivo ȉÈÔÙ‹ÙˆÓ Ù˘ Î·È Ó· ÏËÚÔ› Ì›· ÛÂÈÚ¿ ·fi ÎÚÈÙ‹ÚÈ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi οı Ӥ· ˘Ô„‹ÊÈ· Ô˘Û›· Ó· ÂϤÁ¯ÂÙ·È Î·È Û ÌÂϤÙ˜ Û ·ÓıÚÒÔ˘˜. ¢Ò‰Âη ηÙËÁÔڛ˜ Ô˘ÛÈÒÓ Ì Ú‚ÈÔÙÈΤ˜ ȉÈfiÙËÙ˜ ¤¯Ô˘Ó ·Ú·¯ı› ‚ÈÔÌ˯·ÓÈο. OÈ Ô˘Û›Â˜ ·˘Ù¤˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. OÈ ÂÚÈÛÛfiÙÂÚ˜ Û˘ÓÙ›ıÂÓÙ·È ·fi ·ÏÔ‡˜ ˘‰·Ù¿ÓıڷΘ, fiˆ˜ Ë ÛÔ˘ÎÚfi˙Ë Î·È Ë Ï·ÎÙfi˙Ë ‹ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÏÂÁ¯fiÌÂÓË ˘‰ÚfiÏ˘ÛË ·Ì‡ÏÔ˘ ‹ ¿ÏÏˆÓ ÔÏ˘Û·Î¯·ÚÈÙÒÓ (67). ∏ Ï·ÎÙfi˙Ë ·ÔÙÂÏ› ÚÒÙË ‡ÏË ÁÈ· ÙËÓ ·Ú·Û΢‹ ÙˆÓ Á·Ï·ÎÙÔÔÏÈ۷ί·ÚÈÙÒÓ, Ù˘ Ï·ÎÙÔ˘Ïfi˙˘ Î·È Ù˘ Ï·ÎÙÔÛÔ˘ÎÚfi˙˘. ∆· Ú‚ÈÔÙÈο ÌÔÚÔ‡Ó Ó· ÂÓۈ̷وıÔ‡Ó Û ÚÔÊ‹Ì·Ù·, ÁÏ˘Î›ÛÌ·Ù·, Ì·ÚÌÂÏ¿‰Â˜, ·ÁˆÙ¿, ÛÔÎÔÏ¿Ù˜, ˙˘Ì·ÚÈο, Û¿ÏÙÛ˜ Î·È Û Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· (67). OÈ ÏËı˘ÛÌÔ› Ô˘ Ê·›ÓÂÙ·È fiÙÈ ˆÊÂÏÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙË ¯Ú‹ÛË ÙˆÓ Ú‚ÈÔÙÈÎÒÓ Â›Ó·È ·˘ÙÔ› Ì ÚÔ¸¿Ú¯Ô˘Û˜ ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ bifidobacteria ÛÙÔÓ ·˘Ïfi ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ËÏÈÎȈ̤ÓÔ˘˜, ·ÛıÂÓ›˜ Ì ‰È¿ÚÚÔÈ· ·fi Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ·ÛıÂÓ›˜ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÚfiˆÚ· ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ


May-June 03

03-06-03

16:55

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¶›Ó·Î·˜ 4. ∫·ÙËÁÔڛ˜ Ô˘ÛÈÒÓ Ì Ú‚ÈÔÙÈΤ˜ ȉÈfiÙËÙ˜ Ô˘ ¤¯Ô˘Ó ·Ú·¯ı› ‚ÈÔÌ˯·ÓÈο °·Ï·ÎÙÔÔÏÈÁÔ۷ί·Ú›Ù˜ §·ÎÙÔ˘Ïfi˙Ë §·ÎÙÔÛÔ˘ÎÚfi˙Ë ºÚÔ˘ÎÙÔÔÏÈÁÔ۷ί·Ú›Ù˜ ¶·Ï·ÙÈÓfi˙Ë - ÔÏÈÁÔ۷ί·Ú›Ù˜ °Ï˘ÎÔ˙˘ÏÔÛÔ˘ÎÚfi˙Ë ª·ÏÙÔÔÏÈÁÔ۷ί·Ú›Ù˜ πÛÔÌ·ÏÙÔÔÏÈÁÔ۷ί·Ú›Ù˜ ∫˘ÎÏÔ‰ÂÍÙÚ›Ó˜ °ÂÓÙÈÔÔÏÈÁÔ۷ί·Ú›Ù˜ OÏÈÁÔ۷ί·Ú›Ù˜ ÙÔ˘ ηÚÔ‡ Ù˘ ÛfiÁÈ·˜ •˘ÏÔÔÏÈÁÔ۷ί·Ú›Ù˜

ÂΉ‹ÏˆÛ˘ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜. ¶¿ÓÙˆ˜, fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È Ì ÙËÓ ÚfiÛÏË„Ë ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, ÙÔ Â˘ÂÚÁÂÙÈÎfi ÙÔ˘˜ ·ÔÙ¤ÏÂÛÌ· ۯ‰fiÓ ÂÍ·ÓÙÏÂ›Ù·È ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ Ï‹„˘ ÙÔ˘˜. ™Â Â·ÓÂÈÏËÌ̤Ó˜ ÌÂϤÙ˜ ¤¯ÂÈ ·Ô‰ÂȯÙ› fiÙÈ ÔÈ ÏËı˘ÛÌÔ› ÙˆÓ bifidobacteria Â·Ó¤Ú¯ÔÓÙ·È ÛÙ· ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ Â›‰· Û 7-8 Ë̤Ú˜ ¤ˆ˜ 3-4 ‚‰ÔÌ¿‰Â˜. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂÁÈÛÙÔÔÈËı› Ë Â˘ÓÔ˚΋ ‰Ú¿ÛË ÚÔ‚ÈÔÙÈÎÒÓ Î·È Ú‚ÈÔÙÈÎÒÓ, ÔÈ ÂÚ¢ÓËÙ¤˜ ÂÍÂÙ¿˙Ô˘Ó ÙË Û˘Ó‰˘·Ṳ̂ÓË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜. ∞fi ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÌÂٷ͇ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ¤¯Ô˘Ó ÚÔ·„ÂÈ Ù· Û˘Ì‚ÈÔÙÈο. ™˘Ì‚ÈÔÙÈο ¶Ú‚ÈÔÙÈο Î·È ÚÔ‚ÈÔÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi. ∆· ˙ˆÓÙ·Ó¿ ÌÈÎÚԂȷο ÚfiÛıÂÙ· (ÚÔ‚ÈÔÙÈο) ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂȉÈο Û˘ÛÙ·ÙÈο (Ú‚ÈÔÙÈο) ÁÈ· ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜ (3,10). ∆· Û˘Ó‹ıË ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Û˘Ì‚ÈÔÙÈο Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5. O Û˘Ó‰˘·ÛÌfi˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ÚÔ‚ÈÔÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Î·È ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÏÂÔÓÂÎÙ‹Ì·Ù· ÛÙÔÓ ÍÂÓÈÛÙ‹ Ô˘ ÚÔÛʤÚÔ˘Ó ÙfiÛÔ Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ fiÛÔ Î·È Ù· Ú‚ÈÔÙÈο. ™˘ÁÎÂÎÚÈ̤ӷ, Ô Û˘Ó‰˘·ÛÌfi˜ Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ˙ÒÓÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙ· ‰È·ÙÚÔÊÈο Û˘ÌÏËÚÒÌ·Ù·, Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ·Ú¿Ù·ÛË ÛÙË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ ÙÔ˘˜. ∂›Û˘, ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‚·ÎÙËÚ›ˆÓ Ô˘ Êı¿ÓÔ˘Ó ˙ˆÓÙ·Ó¿ ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‹‰Ë ˘·Ú¯fiÓÙˆÓ Û˘Ì‚ÈÔÙÈÎÒÓ ‚·ÎÙËÚ›ˆÓ. ∂ÓÂÚÁÔÔÈ› ÌÂÙ·‚ÔÏÈο Ù· Â͈ÁÂÓÒ˜ ¯ÔÚËÁÔ‡ÌÂÓ·, ·ÏÏ¿ Î·È Ù· ‚·ÎÙ‹ÚÈ· Ô˘ ÚÔ¸¿Ú¯Ô˘Ó ˆ˜ ÙÌ‹Ì· Ù˘ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ‰Ú¿ÛË ÎÚ›ÓÂÙ·È ˆ˜ Ë ϤÔÓ ÛËÌ·ÓÙÈ΋, ηıÒ˜ ÌfiÓÔ Ù· ÂÓÂÚÁ¿ ÌÂÙ·‚ÔÏÈο ‚·ÎÙ‹ÚÈ· ÌÔÚÔ‡Ó Ó· ·Û΋ÛÔ˘Ó ˆÊ¤ÏÈÌË ‰Ú¿ÛË ÛÙÔÓ ÍÂÓÈÛÙ‹. ™˘Ì‚ÈÔÙÈο ˘¿Ú¯Ô˘Ó ΢ڛˆ˜ Û ·Ú¿ÁˆÁ· Á¿Ï·ÎÙÔ˜ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ˙‡ÌˆÛË.

Paediatriki 2003;66:223-231

¶›Ó·Î·˜ 5. ™˘Ó‹ıË Û˘Ì‚ÈÔÙÈο Bifidobacteria Î·È ÊÚÔ˘ÎÙÔÔÏÈ۷ί·Ú›Ù˜ Lactobacilli Î·È Ï·ÎÙÈÙfiÏË Bifidobacteria Î·È Á·Ï·ÎÙÔÔÏÈ۷ί·Ú›Ù˜

™˘ÌÂÚ¿ÛÌ·Ù· ™ÙȘ Ë̤Ú˜ Ì·˜ ‰›ÓÂÙ·È ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚË ÛËÌ·Û›· ÛÙË Û‡ÛÙ·ÛË Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜. ∏ ηٿÏÏËÏË ÙÚÔÔÔ›ËÛ‹ Ù˘ ÌÔÚ› Ó· ·ÔʤÚÂÈ Â˘ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ˘Á›·. OÈ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ Î·È Ú·ÎÙÈΤ˜ ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·. ∞˘Ùfi ÌÔÚ› Ó· ÂÈÙ¢¯ı› ›Ù Ì ÙËÓ ÚfiÛÏË„Ë Î·Ù¿ÏÏËÏˆÓ ˙ÒÓÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (ÚÔ‚ÈÔÙÈο), ›Ù Ì ÙËÓ ÚfiÛÏË„Ë ÂȉÈÎÒÓ Ô˘ÛÈÒÓ Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔ ÌÂÙ·‚ÔÏÈÎfi ÙÔ˘˜ ˘fiÛÙڈ̷ (Ú‚ÈÔÙÈο) ‹, Ù¤ÏÔ˜, Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·Ú·¿Óˆ (Û˘Ì‚ÈÔÙÈο). ŸÏ˜ ÔÈ ·Ú·¿Óˆ Ô˘Û›Â˜ Î·È ÂȉÈο Ù· Û˘Ì‚ÈÔÙÈο ÌÔÚÔ‡Ó Ó· ·Û΋ÛÔ˘Ó Â˘ÓÔ˚΋ ‰Ú¿ÛË ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, fiˆ˜ ‰È¿ÊÔÚ· ‰È·ÚÚÔ˚ο Û‡Ó‰ÚÔÌ·, ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È Î·Ù·ÛÙ¿ÛÂȘ fiÔ˘ Ë ˘ÂÚ·Ó¿Ù˘ÍË ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜ Â›Ó·È ‰˘ÓËÙÈο ÂÈΛӉ˘ÓË (ÂÎÙÂٷ̤ӷ ÂÁη‡Ì·Ù·, ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi stress, ÌÂÙ·ÌÔۯ‡ÛÂȘ ÔÚÁ¿ÓˆÓ, Û‡Ó‰ÚÔÌÔ ‚Ú·¯¤Ô˜ ÂÓÙ¤ÚÔ˘) (57). ∏ ·ÚˆÁ‹ Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Â›Ó·È ÔχÙÈÌË ÛÙËÓ ÙÂÎÌËÚ›ˆÛË ÙˆÓ ·ÏÏ·ÁÒÓ Ô˘ ÂÈʤÚÂÈ Ë ¯Ú‹ÛË ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ Ô˘ÛÈÒÓ ÛÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ÙÔ˘ ·ÓıÚÒÔ˘. ∏ ÚfiÔ‰fi˜ Ù˘ Ì Ӥ˜ ÌÔÚȷΤ˜ Ù¯ÓÈΤ˜ ı· ·ÓÔ›ÍÂÈ Èı·Ó¿ ÙÔÓ ‰ÚfiÌÔ Ù˘ ¢Ú›·˜ ¯Ú‹Û˘ ÙÔ˘˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Hill MJ. The normal gut bacterial flora. In: Hill MJ, editor. Role of gut bacteria in human toxicology and pharmacology. London: Taylor and Francis; 1995. p. 3-17. 2. Nord CE, Kager L. The normal flora of the gastrointestinal tract. Neth J Med 1984;27:249-252. 3. Mandar R, Mikelsaar M. Transmission of mother’s microflora to the newborn at birth. Biol Neonate 1996;69:30-35. 4. Orrhage ∫, Nord CE. Factors controlling the bacterial colonization of the intestine in breastfed infants. Acta Paediatr 1999;88 (Suppl):S47-S57. 5. Lundequist B, Nord CE, Winberg J. The composition of the faecal microflora in breastfed and bottle fed infants from birth to eight weeks. Acta Paediatr Scand 1985;74:45-51. 6. Kleessen B, Bunke H, Tovar K, Noack J, Sawatzki G. Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants. Acta Paediatr 1995;84:1347-1356. 7. Midtvedt AC, Carlstedt-Duke B, Midtvedt T. Establishment of a mucin-degrading intestinal microflora during the first two years of human life. J Pediatr Gastroenterol Nutr 1994;18:321-326.

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Pediatr Gastroenterol Nutr 2000;30:217-219. 62. Catala I, Butel MJ, Bensaada M, Popot F, Tessedre AC, Rimbault A et al. Oligofructose contributes to the protective role of bifidobacteria in experimental necrotising enterocolitis in quails. J Med Microbiol 1999;48:89-94. 63. Howard MD, Gordon DT, Pace LW, Garleb KA, Kerley MS. Effects of dietary supplementation with fructooligosaccharides on colonic microbiota populations and epithelial cell proliferation in neonatal pigs. J Pediatr Gastroenterol Nutr 1995;21:297-303. 64. Kunz C, Rudloff S. Biological functions of oligosaccharides in human milk. Acta Paediatr 1993;82:903-912. 65. Newburg DS, Neubauer SH. Carbohydrates in milk. In: Jensen RG, ed. Handbook of Milk Composition. San Diego: Academic Press; 1995. p. 273-349. 66. Holmgren J. Comparison of the tissue receptors for Vibrio cholerae and Escherichia coli enterotoxins by means of gangliosides and natural cholera toxoid. Infect Immun 1973;8:851-859. 67. Ashkenazi S, Newburg DS, Cleary TG. The effect of human milk on the adherence of enterohemorrhagic E. coli to rabbit intestinal cells. Adv Exp Med Biol 1991;310:173-177. 68. Andersson B, Porras O, Hanson LA, Lagergard T, SvanborgEden C. Inhibition of attachment of Streptococcus pneumoniae and Haemophilus influenzae by human milk and receptor oligosaccharides. J Infect Dis 1986;153:232-237. 69. Lindberg AA, Brown JE, Stromberg N, Westling-Ryd M, Schultz JE, Karlsson KA. Identification of the carbohydrate receptor for Shiga toxin produced by Shigella dysenteriae type 1. J Biol Chem 1987;262:1779-1785. 70. Clark GF, Krivan HC, Wilkins TD, Smith DF. Toxin A from Clostridium difficile binds to rabbit erythrocyte glycolipidis with terminal Gal alpha 1-3Gal beta 1-4GlcNAc sequences. Arch Biochem Biophys 1987;257:217-229. 71. Cervantes LE, Newburg DS, Ruiz-Palacios GM. ∞1-2 fucosylated chains (H-2 and Lewisb) are the main human receptor analogues for Campylobacter. Pediatr Res 1995;37:171A. 72. Newburg DS, Peterson JA, Ruiz-Palacios GM, Matson DO, Morrow AL, Shults J et al. Role of human-milk lactadherin in protection against symptomatic rotavirus infection. Lancet 1998;351:1160-1164. 73. Viverge D, Grimmonprez L, Cassanas G, Bardet L, Solere M. Diurnal variations and within the feed in lactose and oligosaccharides of human milk. Ann Nutr Metab 1986;30:196-209. 74. Coppa GV, Gabrielli O, Pierani P, Catassi C, Carlucci A, Giorgi PL. Changes in carbohydrate composition in human milk over 4 months of lactation. Pediatrics 1993;91:637-641.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-02-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 20-03-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆ¿ÓÓ· ÷ڈӛÙË A’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, ∫Ú‹ÙË

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¶·È‰È·ÙÚÈ΋ 2003;66:232-235

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Paediatriki 2003;66:232-235

SPECIAL ARTICLE

¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” ÙÔ˘ 1814 ¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜

A case of diabetes mellitus presented in the journal “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”, 1814 D. Karaberopoulos

¶ÂÚ›ÏË„Ë: ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ·fi ÙÔÓ È·ÙÚfi πˆ¿ÓÓË ∞Û¿ÓË (17901850) ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” (µÈ¤ÓÓË 1814, ÛÂÏ. 117-123). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë Î·Ù¿ÛÙ·ÛË Ó¤Ô˘ ËÏÈΛ·˜ 14 ÂÙÒÓ Î·È Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ Û‡Á¯ÚÔÓ˜ ÁÓÒÛÂȘ ÁÈ· ÙË ÓfiÛÔ. ø˜ ıÂÚ·›· ÚÔÙ›ÓÂÙ·È ÏÂ˘ÎˆÌ·ÙÔ‡¯Ô˜ ‰›·ÈÙ· Î·È ¯ÔÚ‹ÁËÛË ÊˆÛÊfiÚÔ˘, Ì›· Ó¤· ÚfiÙ·ÛË ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜. ™ÙÔ ¿ÚıÚÔ ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ÂÏÏËÓÈ΋ È·ÙÚÈ΋ ÔÚÔÏÔÁ›· Ô fiÚÔ˜ “۷ί·Ú҉˘ ‰È·‚‹Ù˘”.

Abstract: A case of diabetes mellitus was presented by doctor John Assanis (1790-1850) in the journal “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” (Wien 1814, p. 117123). The condition of a fourteen year-old adolescent is described and updated information for the disease is recorded. A new proposal for treatment is recommended, consisting of a protein diet and phosphorus as medication. In the article the term “diabetes mellitus” is introduced into the Greek medical terminology.

§¤ÍÂȘ ÎÏÂȉȿ: ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ¡ÂÔÂÏÏËÓÈÎfi˜ ¢È·ÊˆÙÈÛÌfi˜, ʈÛÊfiÚÔ˜.

Key words: diabetes mellitus, Enlightenment, phosphorus.

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, Ô˘ ‰ËÌÔÛȇıËΠÙÔ 1814 ÛÙÔ ·ÍÈfiÏÔÁÔ ÚÔÂ·Ó·ÛÙ·ÙÈÎfi ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”. ∆Ô ÂÚÈÔ‰ÈÎfi ·˘Ùfi, ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ ¿ÚıÚˆÓ, ÂÚÈÂÏ¿Ì‚·ÓÂ Î·È È·ÙÚÈο ı¤Ì·Ù·, ‰ÈfiÙÈ ‰ÂÓ Î˘ÎÏÔÊÔÚÔ‡Û·Ó, ηٿ ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙÔ˘ ÂΉfiÙË ÙÔ˘, ÂÏÏËÓÈο È·ÙÚÈο ÂÚÈÔ‰Èο, fiˆ˜ Û˘Ó¤‚·ÈÓ ÛÙȘ Â˘Úˆ·˚Τ˜ ÁÏÒÛÛ˜ (1). ™˘ÁÁڷʤ·˜ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ¿ÚıÚÔ˘ ‹Ù·Ó Ô ÂÎ ∫ÂÊ·ÏÏËÓ›·˜ ηٷÁfiÌÂÓÔ˜ È·ÙÚfi˜ πˆ¿ÓÓ˘ ∞Û¿Ó˘ (2) (1790-1850), Ô ÔÔ›Ô˜ ÛÔ‡‰·Û π·ÙÚÈ΋ Î·È ª·ıËÌ·ÙÈο ÛÙËÓ ¶¿‰Ô‚·, ÙË µÈ¤ÓÓË Î·È ÙÔ ¶·Ú›ÛÈ Î·È Â›¯Â ‰ËÌÔÛȇÛÂÈ Â›Û˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” (3) ¿ÚıÚÔ Ì ٛÙÏÔ “∞¿ÓÙËÛȘ ÂȘ ÙËÓ ÂÚ› ÙÔ˘ µÚÔÓÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÚÒÙËÛÈÓ”, ÙÔ ÔÔ›Ô ·Ó·ÊÂÚfiÙ·Ó ÛÙÔ ıÂÚ·¢ÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÕÁÁÏÔ˘ È·ÙÚÔ‡ John Brown (1735-1788). ∂›Û˘, ›¯Â ÌÂÙ·ÊÚ¿ÛÂÈ ·fi ÙËÓ ÈÙ·ÏÈ΋ ÁÏÒÛÛ· ÙÔ ‚È‚Ï›Ô ÁÈ· ÙÔ˘˜ ÂÚÈÔ‰ÈÎÔ‡˜ ˘ÚÂÙÔ‡˜, fiˆ˜ ÔÓÔÌ·˙fiÙ·Ó ÙfiÙÂ Ë ÂÏÔÓÔÛ›·, Ì ٛÙÏÔ: “¶ÂÚ› ÙÔ˘ ·ÚÌԉȈ٤ÚÔ˘ ÙÚfiÔ˘ ÂȘ ÙÔ Ó· ÂÌÔ‰›˙ˆÓÙ·È ·È ˘ÔÛÙÚÔÊ·› ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ ˘ÚÂÙÒÓ ·ÊÔ‡ ‹‰Ë ÎÔÒÛÈ Ì ÙËÓ Î›Ó·Ó

‰È·ÙÚÈ‚‹ ¶¤ÙÚÔ˘ ƒÔ˘‚›ÓÔ˘. ªÂÙ·ÊÚ·Ûı›۷ ÂÎ ÙÔ˘ πÙ·ÏÈÎÔ‡ ˘fi πˆ¿ÓÓË ∞Û¿ÓË. ∂Ó ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂÈ, ÂÎ Ù˘ ∆˘ÔÁÚ·Ê›·˜ ∫. ∞. ∫ÔÏÔÓ¤ÏÏÔ˘, 1841”. ∂ÈϤÔÓ, Ô È·ÙÚfi˜ ¡ÈÎfiÏ·Ô˜ ¶›ÎÎÔÏÔ˜ (1792-1865), ηıËÁËÙ‹˜ ÛÙËÓ πfiÓÈÔ ∞η‰ËÌ›·, ·ÊȤڈÛ ÛÙÔÓ πˆ¿ÓÓË ∞Û¿ÓË ÙÔ ‚È‚Ï›Ô Ô˘ ÌÂÙ¤ÊÚ·ÛÂ Î·È Âͤ‰ˆÛ ÛÙËÓ ∫¤Ú΢ڷ ÙÔ 1824 “ƒÂÓ¿ÙÔ˘ ∫·ÚÙÂÛ›Ô˘, §fiÁÔ˜ ÂÚ› ÌÂıfi‰Ô˘ ÙÔ˘ Ô‰ËÁÂ›Ó Î·ÏÒ˜ ÙÔÓ ÓÔ‡Ó Î·È ˙ËÙÂ›Ó ÙËÓ ·Ï‹ıÂÈ·Ó ÂȘ Ù·˜ ÂÈÛÙ‹Ì·˜”. O πˆ¿ÓÓ˘ ∞Û¿Ó˘ ·ÛÎÔ‡Û ÙËÓ È·ÙÚÈ΋ ÛÙÔ π¿ÛÈÔ Ù˘ ªÔω·‚›·˜ Î·È ¤ÛÙÂÈÏ ÛÙÔÓ ÕÓıÈÌÔ °·˙‹, ÂΉfiÙË ÙÔ˘ ÚÔÂ·Ó·ÛÙ·ÙÈÎÔ‡ ÂÚÈÔ‰ÈÎÔ‡ “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”, ÙÔ ¿ÚıÚÔ Û¯ÂÙÈο Ì ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÂ Ó¤Ô ËÏÈΛ·˜ 14 ÂÙÒÓ Î·È ÙȘ Ӥ˜ ıÂÚ·¢ÙÈΤ˜ ÙÔ˘ ÚÔÛ¿ıÂȘ (4). ™ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ ÙÔ˘ ¿ÚıÚÔ˘, Ô πˆ¿ÓÓ˘ ∞Û¿Ó˘ ·Ú·ı¤ÙÂÈ ÙȘ Û‡Á¯ÚÔÓ˜ ÁÓÒÛÂȘ ÁÈ· ÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ‰›‰ÔÓÙ·˜ Ì¿ÏÈÛÙ· Î·È ÙÔÓ ÔÚÈÛÌfi ÙÔ˘: “¢È·‚‹Ù˘ ϤÁÂÙ·È ·Ú¿ ÙˆÓ ÓÔÛÔÏfiÁˆÓ Ë ˘ÂÚ‚ÔÏÈ΋ ¤ÎÚ˘ÛȘ Ô‡ÚÔ˘˜, ÌÂÙ¿ ‰›„˘ ·Û‚¤ÛÙÔ˘, Ôڤ͈˜ ·Ï‹ÛÙÔ˘, Î·È Ì·Ú·ÛÌÔ‡”. ™ËÌÂÈÒÓÂÈ fiÙÈ ÙÔ 1778 ·Ó·Î·Ï‡ÊıËΠ·fi ÙÔÓ “∫·ÓϤȔ

¢ÈÂıÓ¤˜ πÔÎÚ¿ÙÂÈÔ ÿ‰Ú˘Ì· Ù˘ ∫ˆ, ∞ı‹Ó·

International Hippocratic Foundation of Kos, Athens

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(William Cullen, 1710-1790) ÛÙ· Ô‡Ú· ÙˆÓ ‰È·‚ËÙÈÎÒÓ “Ë ÂÌÂÚȯÔ̤ÓË Û¿Î¯·ÚȘ” Î·È fiÙÈ ÙÔ 1803 Ë “ÂÓÙÂÏÂÛÙ¤Ú· ·Ó¿Ï˘ÛȘ ÙÔ˘ Ô‡ÚÔ˘˜ ÙˆÓ ‰È·‚ËÙÈÎÒÓ” ¤‰ÂÈÍ ˆ˜ “‰ÂÓ ˘¿Ú¯ÂÈ Ô˘Ú›· Ì‹Ù ԢÚÈÎfiÓ Ô͇”. ∞ÎfiÌË, ·Ó·Ê¤ÚÂÈ fiÙÈ “ÔÈ Î‡ÚÈÔÈ ∆ÂÓ¿Ú Î·È ¢Ô˘Ô˘¸ÙÚ¤Ó ¤Î·Ì·Ó Ó¤·˜ Û˘˙ËÙ‹ÛÂȘ Î·È ÂÍÂÙ¿ÛÂȘ ÂȘ ÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙËÓ” (5) Î·È ÁÈ· Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ “˙ˆÙÈ΋˜ ‰È·›Ù˘”, ‰ËÏ. ˙ˆÈ΋˜, fiˆ˜ ·ÔηÏÂ›Ù·È Ë ÏÂ˘ÎˆÌ·ÙÔ‡¯Ô˜. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ Ô fiÚÔ˜ “۷ί·Ú҉˘ ‰È·‚‹Ù˘” ηٷÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ÂÏÏËÓÈ΋ È·ÙÚÈ΋ ÔÚÔÏÔÁ›· Èı·ÓfiÓ ÂΛÓË ÙËÓ ÂÔ¯‹ (1814). O ∞Û¿Ó˘ ÛËÌÂÈÒÓÂÈ fiÙÈ “fiÙ·Ó ÔÈ ‰È·‚ËÙÈÎÔ› ÙÚÒÁˆÛÈ ÌfiÓÔÓ ˙ˆÙÈο (˙ˆÈο) Ê·ÁËÙ¿, ÙÔ Ô‡ÚÔ˜ ·˘ÙÒÓ ÂÓÙfi˜ ÔÏ›ÁÔÓ ÌÂÙ·ÏÏ¿ÙÙÂÈ ÙËÓ Â·˘ÙÔ‡ ʇÛÈÓ”. ™¯ÂÙÈο Ì ÙËÓ ·ÈÙ›· ÙÔ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, ·Ó·Ê¤ÚÂÈ ÙËÓ ˘fiıÂÛË ÙÔ˘ ∂Ú¿ÛÌÔ˘ ¢·Ú‚›ÓÔ˘ (Erasmus Darwin, 1731-1802), ·Ù¤Ú· ÙÔ˘ ÁÓˆÛÙÔ‡ Ê˘ÛÈÔ‰›ÊË Ù˘ ÂÍÂϛ͈˜ ÙˆÓ ÂȉÒÓ ∫·ÚfiÏÔ˘ ¢·Ú‚›ÓÔ˘, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ÔÊ›ÏÂÙ·È ÛÙËÓ “ÔÈÛıfi‰ÚÔÌÔÓ Î›ÓËÛÈÓ ÙˆÓ ¯˘ÏÔÊfiÚˆÓ ·ÁÁ›ˆÓ”. øÛÙfiÛÔ, Ô ∞Û¿Ó˘ ‰È·Ù˘ÒÓÂÈ Î·È ÙË ‰È΋ ÙÔ˘ ¿Ô„Ë ÛËÌÂÈÒÓÔÓÙ·˜ Û¯ÂÙÈο fiÙÈ “ÂȘ Â̤ fï˜ Ê·›ÓÂÙ·È Â˘ÛÙÔ¯ÒÙÂÚÔÓ ÙÔ Ó· ˘ÔÙÂı› Ë ·ÙÔÓ›· Î·È Ù¤ÏÔ˜ Ë ÂÓÙÂÏ‹˜ ·Ú·Ï˘Û›· ÙˆÓ ¯˘ÏÔÊfiÚˆÓ ·ÁÁ›ˆÓ, ÂÓÒ Ù· Ï˘ÌÊ·ÙÈο ÙÔ˘ Ô˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÁÁ›· ·˘Í¿ÓÔ˘ÛÈÓ ÙËÓ ÂÓ¤ÚÁÂÈ·Ó ·˘ÙÒÓ” (6). O fiÚÔ˜ “¯˘ÏÔÊfiÚ·” ·ÁÁ›· Â›Ó·È ÁÈ· Ù· ÌÂÛÂÓÙÂÚÈο ÏÂÌÊ·ÁÁ›·, ÂÍ Ô˘ Î·È Ô fiÚÔ˜ “¯˘ÏÔÊfiÚÔ˜ ‰ÂÍ·ÌÂÓ‹” Ô˘ ·Ú¤ÌÂÈÓÂ. ∞ÎfiÌË, ·Ó·Ê¤ÚÂÈ fiÙÈ Ê¿ÚÌ·ÎÔ Û ·˘Ù‹ ÙËÓ “·Ú·Ï˘Û›·Ó” ÙˆÓ ¯˘ÏÔÊfiÚˆÓ ·ÁÁ›ˆÓ Â›Ó·È ϤÔÓ Ô ÊˆÛÊfiÚÔ˜, ÁÈ’ ·˘Ùfi ÙÔÓ›˙ÂÈ Ì ¤ÌÊ·ÛË fiÙÈ “‰¤Ó Ú¤ÂÈ ϤÔÓ Ó· ·ÂÏÈ˙fiÌÂı·”. ∫·È Û˘ÌÏËÚÒÓÂÈ fiÙÈ “fiÛÙȘ ÂÈı˘Ì› Ï›ÔÓ·˜ ȉ¤·˜ Ù˘ Ù ÂÚÈÁÚ·Ê‹˜ Î·È ıÂÚ·›·˜ ¿¯ÚÈ ÙÔ˘ Ó‡Ó Ì·Ù·›ˆ˜ ÂÓÂÚÁÔ˘Ì¤Ó˘, ·˜ ·Ó·ÁÓÒÛÂÈ ÙÔÓ ¶¤ÙÚÔ ºÚ¿ÓÎ Î·È Ù·˜ ÌÔÓÔÁÚ·Ê›·˜”. ∞˜ ÛËÌÂȈı› fiÙÈ Ô “¶¤ÙÚÔ˜ ºÚ¿ÓΔ (Peter Frank, 1745-1821), ÂÎÙfi˜ ÙˆÓ ¿ÏψÓ, fiÚÈÛ ÙÔ 1794 ÙÔÓ ¿ÔÈÔ ‰È·‚‹ÙË Î·È ¤ÁÚ·„ ̛· ÔχÙÔÌË Ú·ÁÌ·Ù›· ÛÙË ıÂÚ·¢ÙÈ΋ “De curandis hominum morbis epitome”, Ô˘ ¿Ú¯ÈÛ ӷ ÂΉ›‰ÂÙ·È ÙÔ 1792 Î·È Û˘Ó¯›ÛÙËΠ̤¯ÚÈ ÙÔ 1821 (7). ∂›Ó·È Èı·Ófi Ô ∞Û¿Ó˘ Ó· ÂÓÓÔ› ·˘Ù‹ Ì ÙÔÓ fiÚÔ “ÌÔÓÔÁÚ·Ê›·”. ™ËÌÂÈÒÓÔ˘Ì fiÙÈ ÛÙÔ ‚È‚Ï›Ô ÙÔ˘ Fourcroy AF, Ô˘ ÌÂÙ¤ÊÚ·ÛÂ Ô £ÂÔ‰fiÛÈÔ˜ ∏ÏÈ¿‰Ë˜, ÌÓËÌÔÓ‡ÔÓÙ·È ÔÈ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘ Peter Frank ÁÈ· ÙË ÁÏ˘ÎÈ¿ Á‡ÛË ÙˆÓ Ô‡ÚˆÓ ÙˆÓ ‰È·‚ËÙÈÎÒÓ (8). ™‡Ìʈӷ Ì ÙÔÓ ¡ÈÎ. ∫ˆÛÙ‹, Ô ÊˆÛÊfiÚÔ˜ ·fi ÙÔ 1751 ¿Ú¯ÈÛ ӷ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÛˆÙÂÚÈÎÒ˜ ˆ˜ Ê¿ÚÌ·ÎÔ Û ‰È¿ÊÔÚ˜ ·ı‹ÛÂȘ (9). O ∞Ó·ÛÙ¿ÛÈÔ˜ °ÂˆÚÁÈ¿‰Ë˜ ·Ó·Ê¤ÚÂÈ fiÙÈ Ô ‰È·‚‹Ù˘ ÔÓÔÌ¿˙ÂÙ·È Î·Ù¿ ÙÔÓ ∞ϤͷӉÚÔÓ ∆Ú·ÏÏÈ·-

Paediatriki 2003;66:232-235

ÓfiÓ “‰È¿ÚÚÔÈ· ÂȘ Ô‡Ú·, Î·È ¿ıÔ˜ ‰›„·ÎÔÓ Î·È ‡‰ÂÚÔ˜ ›˜ ·Ì›‰·” (10). ª¿ÏÈÛÙ·, Ô ÙÂÏÂ˘Ù·›Ô˜ fiÚÔ˜ “‡‰ÂÚÔ˜ ÂȘ ·Ì›‰·” ÌÓËÌÔÓ‡ÂÙ·È Î·È ·fi ÙÔÓ £ˆÌ¿ ª·Ó‰·Î¿ÛË ÙÔ 1757 (11). ¶ÚÒÙË ÂÚÈÁÚ·Ê‹ Ù˘ ÓÔÛÔÏÔÁÈ΋˜ ÔÓÙfiÙËÙ·˜ ÙÔ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ¤¯ÂÈ Á›ÓÂÈ ·fi ÙÔÓ È·ÙÚfi ∞ÚÂÙ·›Ô, Ô ÔÔ›Ô˜ ÂÈϤÔÓ ÂÍËÁ› fiÙÈ ‰fiıËΠÛÙËÓ ¿ıËÛË ·˘Ù‹ Ô fiÚÔ˜ “‰È·‚‹Ù˘” ·fi ÙÔ Ú‹Ì· ‰È·‚·›Óˆ (12). ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ Î›ÌÂÓÔ Û ÓÂÔÂÏÏËÓÈ΋ ·fi‰ÔÛË ¤¯ÂÈ ˆ˜ ·ÎÔÏÔ‡ıˆ˜: “ŸÙ·Ó Ë ¤ÓÙÔÓË ·˘Ù‹ ·›ÛıËÛË (ÏËÚfiÙËÙ·˜) Êı¿ÛÂÈ ÛÙÔ ¿ÎÚÔ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ ·ÛÙˆ˜, ÔÈ ·ÛıÂÓ›˜ ·Ì¤Ûˆ˜ Ô˘ÚÔ‡Ó. °È’ ·˘Ùfi ÙÔÓ ÏfiÁÔ ÔÓÔÌ¿ÛıËΠ‰È·‚‹Ù˘ Ë ¿ıËÛË, ÂÂȉ‹ ÌÔÈ¿˙ÂÈ Ì ‰È·‚‹ÙË, ηı’ fiÙÈ Ù· ˘ÁÚ¿ ‰ÂÓ ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ ÛÒÌ· ·Ú¿ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ ·ÓıÚÒÈÓÔ ÛÒÌ· ˆ˜ ‰È·‚¿ıÚË (Îϛ̷η, ÛοϷ) ̤ۈ Ù˘ ÔÔ›·˜ ÂͤگÔÓÙ·È”. ™ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜ ÙÔ˘, Ô È·ÙÚfi˜ ∞Û¿Ó˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi, “ÙËÓ πÛÙÔÚ›· Ù˘ π·ÙÚÈ΋˜ ÂÈÛΤ„ˆ˜” fiˆ˜ ÙÔ ·ÔηÏ›, ÂÓfi˜ Ó¤Ô˘ ËÏÈΛ·˜ 14 ÂÙÒÓ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ∞ӷʤÚÂÈ fi,ÙÈ Â›¯Â ÚÔËÁËı› ÚÈÓ ·Ó·Ï¿‚ÂÈ ÙË ıÂÚ·›· ÙÔ˘ ·ÛıÂÓÔ‡˜. ™ËÌÂÈÒÓÂÈ fiÙÈ Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ‰È·‚‹ÙË ¿Ú¯ÈÛ·Ó ·ÈÊÓȉ›ˆ˜ ÚÈÓ ·fi Ù¤ÛÛÂÚȘ Ì‹Ó˜, ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1813, Ì “Û˘Ó¯›˜ ÏÂÈÔı˘Ì›·˜ Î·È ÎÒÏÈη˜”. °È· ‰‡Ô Ì‹Ó˜ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó ·fi È·ÙÚÔ‡˜, ÔÈ ÔÔ›ÔÈ ÙÔ˘ ¤‰ÈÓ·Ó “·ÓıÂÏÌÈÓÙÈο” Ê¿Ú̷η “ÂÂȉ‹ ÂÓfiÌÈ˙ÔÓ ÙÔ ¿ıÔ˜ ÛΈÏÈÎ҉˜, Ï‹Ó Ì·Ù·›ˆ˜ ηıfiÙÈ Ì‹Ù ¤ÏÌȘ ÔÙ¤ ÂÊ¿ÓË, Ì‹Ù ٷÈÓ›·”. ∫·È Û˘Ó¯›˙ÂÈ Ô ∞Û¿Ó˘ fiÙÈ “ÌÂÙ¿ Ù·‡Ù· ¿Ú¯ÈÛ·Ó Ù· ÙÔ˘ ‰È·‚‹ÙÔ˘ ÛËÌ›·” Î·È fiÙÈ ¤Î·Ó ·Ó¿Ï˘ÛË ÙˆÓ Ô‡ÚˆÓ Î·È ‰È·›ÛÙˆÛ ÙËÓ ‡·ÚÍË Ù˘ ۷ί·ÚÔ˘Ú›·˜, “Ë ÙÔ˘ Ô‡ÚÔ˘˜ ·Ó¿Ï˘ÛȘ ·¤‰ÂÈÍ ÙËÓ Û¿Î¯·ÚÈÓ ¿ÊıÔÓÔÓ”. ∂ÈÛËÌ·›ÓÂÈ fiÙÈ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó “fiÏ· Ù· È·ÙÚÈο fiÛ· ̤¯ÚÈ ÙÔ‡‰Â Ë Ù¤¯ÓË ˘·ÁÔÚ‡ÂÈ”. ª¿ÏÈÛÙ·, ˘ÔÁÚ·ÌÌ›˙ÂÈ fiÙÈ ÔÈ ÁÔÓ›˜ ·¢ı‡ÓıËÎ·Ó Î·È ÛÙÔ˘˜ È·ÙÚÔ‡˜ Ù˘ µÈ¤ÓÓ˘, ÔÈ ÔÔ›ÔÈ ‰˘ÛÙ˘¯Ò˜ ıÂÒÚËÛ·Ó ·ıÂÚ¿¢ÙË ÙË ÓfiÛÔ Ì ·ÔÙ¤ÏÂÛÌ·, fiˆ˜ Á›ÓÂÙ·È ÛÙȘ ·Ó›·Ù˜ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ÁÔÓ›˜ ÚÔÛÙÚ¤¯Ô˘Ó ÛÙÔ˘˜ ÁfiËÙ˜ Î·È ÛÙȘ Ì·Á›˜, Î·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ “ηٿ ÙÔ Û‡ÓËı˜, Ë ·Ó›Û¯˘ÚÔ˜ π·ÙÚÈ΋ ·Ú¯ÒÚËÛ ÙË ÁÔËÙ›·. ∫·È Ô Ù·Ï·›ˆÚÔ˜ Ó¤Ô˜ ˘¤ÂÛÂÓ ÂȘ Ù·˜ ¯Â›Ú·˜ ÙˆÓ ÁÚ·˚‰›ˆÓ Î·È Ù˘ Ì·Á›·˜ ·˘ÙÒÓ”. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÚÈÁÚ¿ÊÂÈ ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ Ó¤Ô˘ Î·È Ù· Â˘Ú‹Ì·Ù· ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË, fiÔ˘ ·Ú·Ù‹ÚËÛ “·ÙÚÔÊ›· ÔÏÔÌÂÏ‹˜, ‰¤ÚÌ· ÍËÚfiÓ, ÛÎÏËÚfiÓ Î·È Ú˘Ùȉ҉˜ ÂÍ Ô‡ ¤ÈÙ Ì ÙËÓ ÙÚÈ‚‹Ó ·Ï¢Ú҉˘ ÎfiÓȘ, Ë ÁÏÒÛÛ·, Ô Ê¿Ú˘ÁÍ, fiÏË Ë ÌÂÌ‚Ú¿ÓË ÍËÚÔÙ¿ÙË, ‰›„· Î·È ›ӷ Û˘Ó¯‹˜ Î·È ·‰È¿ÎÔÔ˜. ∆Ô ¯ÚÒÌ· ˘fiÏ¢ÎÔÓ Î·È ÁÏ˘Î‡, Ô ÛÊ˘ÁÌfi˜ Ù·¯‡˜”. ∏ ÔÛfiÙËÙ· ÙˆÓ Ô‡ÚˆÓ ÁÚ¿ÊÂÈ fiÙÈ ‹Ù·Ó 24 Ï›ÙÚ·, ÙÚÈÏ¿ÛÈ· ·’ fi,ÙÈ ¤ÈÓÂ. ∏ ÎÔÈÏÈ¿ ‹Ù·Ó “ÊÔ˘ÛΈ̤ÓË”

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Ì “·‰˘Ó·Ì›· ÛÙ· ¿ÎÚ·” Î·È Â›¯Â ‰˘ÛÎÔÈÏÈfiÙËÙ· Î·È ÛÎÏËÚ¿ ÎfiÚ·Ó· “Âͤ‚·ÈÓÔÓ ‰È¿ ÙÔ˘ ÎÏ˘ÛÙËÚ›Ô˘”. ¶ÚÔÛı¤ÙÂÈ fiÙÈ Û˘ÁÎÏ‹ıËΠȷÙÚÈÎfi Û˘Ì‚Ô‡ÏÈÔ, Ô˘ ÙÔ ·ÔηÏ› “π·ÙÚÈ΋ Û˘Ó¤Ï¢ÛȘ”, ÛÙÔ ÔÔ›Ô ÚfiÙÂÈÓÂ, ÛÙËÚÈ˙fiÌÂÓÔ˜ “ÛÙËÓ ÂÈηۛ·Ó” ÂÓfi˜ ÊËÌÈṲ̂ÓÔ˘ È·ÙÚÔ‡ Ù˘ ¶·˘˝·˜, Ó· ‰ÔÎÈÌ·ÛÙ› ÛÙÔÓ ·ÛıÂÓ‹ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, “ÂÛˆÙÂÚÈÎÒ˜”, ¤Ó· Ó¤Ô Ê¿ÚÌ·ÎÔ, “Ô ÊˆÛÊfiÚÔ˜” “·Ó·Ï˘fiÌÂÓÔ˜ ÂȘ ÙÔÓ ıÂÈÈÎfiÓ ·Èı¤Ú·”. H ıÂÚ·›· ı· Û˘Óԉ‡ÂÙ·È Ì ۯÂÙÈ΋ ˙ˆÈ΋ ‰›·ÈÙ· Î·È ı· ÚÔÛʤÚÂÙ·È ˆ˜ “ηıËÌÂÚÈÓfiÓ ÔÙfiÓ ÙÔ ˘‰ÚfiÁ·ÏÔÓ”, ‰ÈfiÙÈ fiˆ˜ ÛËÌÂÈÒÓÂÈ “ηٿ ÙËÓ ÂÌ‹Ó ÂÈηۛ·Ó Ë ÙˆÓ ÎÂÓˆÙÈÎÒÓ Î·Ù¿¯ÚËÛȘ Ó· ¤ÚÚÈ„Â Ù· ıÚÂÙÈο ·ÁÁ›· ÂȘ ·ÙÔÓ›·Ó”. ∏ Ó¤· ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ ÙÔ˘ Ó·ÓÈÎÔ‡ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ì ÙÔÓ ÊˆÛÊfiÚÔ ‰È‹ÚÎÂÛ 2 Î·È ϤÔÓ Ì‹Ó˜ (15 ∞ÚÈÏ›Ô˘ 1814 ¤ˆ˜ 24 πÔ˘Ó›Ô˘ 1814), ÂÓÒ ·Ú¿ÏÏËÏ· Û˘Óԉ¢fiÙ·Ó ·fi ÙÚÈ„›Ì·Ù· ÙÔ˘ Ï›Ô˘˜ ‰È¿ Ó· ·Ú·ÎˆÏ˘ı› Ô Â͈ÙÂÚÈÎfi˜ “ÂÎÚÔÊÈÛÌfi˜”, Ë ¿‰ËÏÔ˜ ‰È·ÓÔ‹. π‰È·›ÙÂÚ· ÙÔÓ›˙ÂÈ fiÙÈ Û˘Ó¤ÛÙËÛ ÙË “Á·Ï·ÎÙÔÙÚÔÊ›·”, ÂÂȉ‹ Ô Ó·Úfi˜ ·ÛıÂÓ‹˜ ›¯Â ·ÈÛı·Óı› ÎÔÚÂÛÌfi ·fi ÙÔ ÎÚ¤·˜. ™ËÌÂÈÒÓÂÈ fiÙÈ Ì ÙË Û˘ÁÎÂÎÚÈ̤ÓË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ Ô ·ÛıÂÓ‹˜ ÙÔ˘ ›¯Â ¿ÚÂÈ ‚¿ÚÔ˜, Ë ÔÛfiÙËÙ· ÙˆÓ Ô‡ÚˆÓ ÌÂȈÓfiÙ·Ó, ÙÔ ¯ÚÒÌ· Î·È Ë ÔÛÌ‹ ÙˆÓ Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈ΋, “Ë fiÚÂÍȘ Î·È Ë ‰›„· ÌÂÙÚȈٿÙË. ∆Ô ‰¤ÚÌ· Ì·Ï·ÎfiÓ, Ï›ÔÓ. ∂Ó›ÔÙ ›‰ÚˆÓ ÂȘ fiÏÔÓ ÙÔ ÛÒÌ·” Î·È fiÙÈ Â›¯Â “·¯‡ÓË ÙfiÛÔÓ fiÛÔÓ ‹ÙÔÓ Úfi Ù˘ ÓfiÛÔ˘”. ∆¤ÏÔ˜, ÂÚÈÁÚ¿ÊÂÈ ÙËÓ Î·Ù¿ÏËÍË ÙÔ˘ ·ÛıÂÓ‹, Ô˘ Û˘Ó¤‚Ë (ÙÔÓ πÔ‡ÏÈÔ ÙÔ˘ 1814) ηٿ ÙË ‰È·ÌÔÓ‹ ÙÔ˘ ÛÙËÓ ÂÍÔ¯‹. ∞ӷʤÚÂÈ fiÙÈ Ô Ó·Úfi˜ ·ÛıÂÓ‹˜ “ÂÛ˘Á¯›ÛıË ‰È¿ ÙËÓ ‰›·ÈÙ¿Ó ÙÔ˘ Ì ÙËÓ ÌËÙ¤Ú· ÙÔ˘, ÒÛÙ ‰ÂÓ ‹ıÂÏ ηْ Ô˘‰¤Ó· ÙÚfiÔÓ Ó· ηٷÂÈÛı› Ó· Ê¿ÁË Ì‹Ù ӷ ›Ë ‰‡Ô ÔÏÔÎÏ‹ÚÔ˘˜ Ë̤ڷ˜” Î·È ·Ú·‚·›ÓÔÓÙ·˜ ÙË ‰›·ÈÙ· Ô˘ ÙÔ˘ ›¯Â Û˘ÛÙËı›, ·ÚÔ˘Û›·ÛÂ Û˘Ó¯›˜ Â̤ÙÔ˘˜ Î·È ÎÔÈÏȷο ¿ÏÁË. ∆ËÓ ÙÚ›ÙË Ë̤ڷ ÙˆÓ ÛÔ‚·ÚÒÓ Û˘Ìو̿وÓ, fiÙ·Ó ÚÔÛÎÏ‹ıËÎÂ Ô È·ÙÚfi˜ ∞Û¿Ó˘, ›¯·Ó ·Ú¯›ÛÂÈ ‹‰Ë, fiˆ˜ ÁÚ¿ÊÂÈ, Ù· ÛËÌ›· ÙÔ˘ ı·Ó¿ÙÔ˘. øÛÙfiÛÔ, ·Ú·ÙËÚ› fiÙÈ “ÙÔ ÂÚ›ÂÚÁÔÓ Â›Ó·È fiÙÈ ÂȘ ·˘Ù¿˜ Ù·˜ ÙÚ›˜ ÙÂÏÂ˘Ù·›·˜ Ë̤ڷ˜ ÙÔ Ô‡ÚÔ˜ ‹ÙÔÓ ÂȘ ÂÏ·¯›ÛÙËÓ ÔÛfiÙËÙ·, ÂÚ˘ıÚfiÓ Î·È Ì ÔÛÌ‹Ó ‚·Ú›·Ó ·Ì̈ÓÈ·ÎÔ‡”. ∫·È ηٷϋÁÂÈ ˆ˜, ·Ó Î·È ‹ıÂÏ ӷ οÓÂÈ ÓÂÎÚÔÙÔÌ‹ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÂÚÈÙÒÛˆ˜, ÙËÓ ·¤Ê˘Á “ÁÓˆÚ›˙ˆÓ ÙËÓ ÎÔÈÓ‹Ó ‰ÂÈÛȉ·ÈÌÔÓ›·Ó Î·È ·¤¯ıÂÈ·Ó” ÙÔ˘ Ï·Ô‡ ÚÔ˜ ÙȘ ÓÂÎÚÔÙÔ̤˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÁÈ· ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÏϤ˜ Ê·Ú̷΢ÙÈΤ˜ Ô˘Û›Â˜, Ô˘ ηٷÁÚ¿ÊÔÓÙ·È Î·È Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚ· ‚È‚Ï›·, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ·fi ÙÔÓ ¢ÈÔÓ‡ÛÈÔ ¶‡ÚÚÔ (13), Ô ÔÔ›Ô˜ ÂÈϤÔÓ ·Ú·ı¤ÙÂÈ Î·È Û¯ÂÙÈÎfi ∞ÊÔÚÈÛÌfi ÙÔ˘ πÔ-

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ÎÚ¿ÙÔ˘˜ (ÙÌ‹Ì· 4ÔÓ, 83) “°ÈÁÓÒÌÂÓÔÓ Ôχ Ô‡ÚÔ˜ ÙËÓ Ó‡ÎÙ·, ‰ËÏÔ› ÌÈÎÚ¿Ó ÙËÓ ˘Ô¯ÒÚËÛÈÓ”, Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙÔ ·Ú¯·›Ô ΛÌÂÓÔ “O‡ÚËÛȘ Ó‡ÎÙˆÚ ÔÏÏ‹ ÁÈÓÔ̤ÓË, ÛÌÈÎÚ‹Ó ÙËÓ ˘Ô¯ÒÚËÛÈÓ ÛËÌ·›ÓÂÈ” Î·È Èı·ÓfiÓ Ó· ·Ó·Ê¤ÚÂÙ·È ÛÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË. OÌÔ›ˆ˜, Ô §. ¢. ÃÚ‹ÛÙÔ‚ÈÙ˙ ÛÙ· “¡¤· Ê¿Ú̷η” ÁÈ· ÙÔÓ ‰È·‚‹ÙË ·Ó·ÁÚ¿ÊÂÈ Ù· ·ÎfiÏÔ˘ı·: “Ȉ‰ÔÊfiÚÌÈÔÓ, „›ÓË, ÂÙfiÓ·È, Ó¿ÙÚÈÔÓ ÛÂÈÚ·˚ÎfiÓ, Ó·Ú‰ÈÎfi˜ „¢‰¿ÚÁ˘ÚÔ˜, Ô͇ Á·Ï·ÎÙÈÎfiÓ, ıÂÈ҉˜ ·Û‚¤ÛÙÈÔÓ” (14). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙÔ Î›ÌÂÓÔ ÙÔ˘ È·ÙÚÔ‡ πˆ¿ÓÓË ∞Û¿ÓË Î·Ù·¯ˆÚ›˙ÂÙ·È Ë Û˘Ìو̷ÙÔÏÔÁ›· ÙÔ˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÂ Ó¤Ô ËÏÈΛ·˜ 14 ÂÙÒÓ, Ë ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ Ì ÏÂ˘ÎˆÌ·ÙÔ‡¯Ô ÙÚÔÊ‹ Î·È Ì›· ÚÔÛ¿ıÂÈ· ıÂÚ·¢ÙÈ΋˜ ‰ÔÎÈÌ‹˜ ÂÓfi˜ Ó¤Ô˘ Ê·ÚÌ¿ÎÔ˘, ÙÔÓ “ʈÛÊfiÚÔÓ, ·ÏÂÍÈÊ¿ÚÌ·ÎÔÓ Ù˘ ÊÚÈÎÒ‰Ô˘˜ Î·È ·ÓÈ¿ÙÔ˘ ۯ‰fiÓ ÓfiÛÔ˘, ÙÔ˘ ‰È·‚‹ÙÔ˘”. ∞ÎfiÌË, Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” ηٷÁÚ¿ÊÔÓÙ·È Û‡Á¯ÚÔÓ˜ ÂÈÛÙËÌÔÓÈΤ˜ È·ÙÚÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ·Ó·ÁÓˆÛÙÒÓ ÙÔ˘, Û ̛· ÂÚ›Ô‰Ô Ô˘ ‰ÂÓ Î˘ÎÏÔÊÔÚÔ‡Û ÂȉÈÎfi ÂÏÏËÓÈÎfi È·ÙÚÈÎfi ÂÚÈÔ‰ÈÎfi. ∆¤ÏÔ˜, Û ·˘Ù‹ ÙËÓ ÂÚÁ·Û›· ÙÔ˘ È·ÙÚÔ‡ πˆ¿ÓÓË ∞Û¿ÓË ·Ó·ÁÚ¿ÊÔÓÙ·È, ›Ûˆ˜ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙÔ ÓÂÔÂÏÏËÓÈÎfi ÏÂÍÈÏfiÁÈÔ, ÔÈ fiÚÔÈ “۷ί·Ú҉˘ ‰È·‚‹Ù˘”, “‰È·‚ËÙÈÎfi˜” Î·È “ÌÔÓÔÁÚ·Ê›·”, ÔÈ ÔÔ›ÔÈ, ˆÛÙfiÛÔ, ·Ô‰›‰ÔÓÙ·È Ì¤¯ÚÈ ÙÒÚ· Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚ· ‚È‚Ï›· (15). µÈ‚ÏÈÔÁÚ·Ê›· Î·È ™ËÌÂÈÒÛÂȘ 1. ∂ÚÌ‹˜ Ô §fiÁÈÔ˜. ∂Ó µÈ¤ÓÓË, ÂÎ Ù˘ Ù˘ÔÁÚ·Ê›·˜ ÙÔ˘ πˆ. µ·ÚıÔÏ. ∆˙‚ÂΛԢ, 1817, Â·Ó·Ù‡ˆÛË ∂Ù·ÈÚ›· ∂ÏÏËÓÈÎÔ‡ §ÔÁÔÙ¯ÓÈÎÔ‡ ∞Ú¯Â›Ô˘, ∞ı‹Ó·; 1989. ÛÂÏ. 578: “ …ÂÂȉ‹ ·ÎfiÌË ‰ÂÓ ÂÊı¿Û·ÌÂÓ ÂȘ ÙÔÓ ‚·ıÌfiÓ ÂΛÓÔÓ Ù˘ ·È‰Â›·˜, ηı fiÓ ÂÌÔÚÔ‡ÌÂÓ Ó· ¤¯ˆÌÂÓ ÂοÛÙ˘ ÂÈÛÙ‹Ì˘ ȉ›·Ó ÂÊËÌÂÚ›‰·Ó, ˆ˜ ¤¯Ô˘ÛÈ Ù· ÛÔÊ¿ Ù˘ ‰˘ÙÈ΋˜ ∂˘ÚÒ˘ ¤ıÓË, ·Ó·Áη˙fiÌÂı· Ó· ÂΉ›‰ˆÌÂÓ ‰È· ÙÔ˘ §.[ÔÁ›Ô˘] ∂.[ÚÌÔ‡] ·Ó fi,ÙÈ ‹ıÂÏ ʤÚÂÈ ˆÊ¤ÏÂÈ·Ó ÂȘ ÙÔ Á¤ÓÔ˜…”. 2. ∆ÛÈÙÛ¤Ï˘ ∏. ∫ÂÊ·ÏÏËÓȷο Û‡ÌÌÈÎÙ·. ∆fiÌÔ˜ ∞’: ∞ı‹Ó·; 1904. ÛÂÏ. 33-34. 3. ∂ÚÌ‹˜ Ô §fiÁÈÔ˜. µÈ¤ÓÓË; 1811, ÛÂÏ. 91-95, 111-118. ∂ӉȷʤÚÔÓ ¤¯ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ ÛÙÔ ¿ÚıÚÔ ·˘Ùfi ηٷÁÚ¿ÊÂÙ·È Ô fiÚÔ˜ “‰ÈÂÁÂÚÛÈÌfiÙ˘” Î·È ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ÂÏÏËÓÈ΋ ÔÚÔÏÔÁ›·. µÏ. ™ÙÂÊ. ∫Ô˘Ì·ÓÔ‡‰Ë˜. ™˘Ó·ÁˆÁ‹ Ó¤ˆÓ Ϥ͈Ó. ∞ı‹Ó·; 1900. ∞Ó·Ù‡ˆÛË ∂ÚÌ‹˜: ∞ı‹Ó·; 1980. ÛÂÏ. 288. 4. ∂ÚÌ‹˜ Ô §fiÁÈÔ˜. µÈ¤ÓÓË; 1814. ÛÂÏ. 117-123. 5. O Thenar Luis (1777-1857) ‹Ù·Ó °¿ÏÏÔ˜ ¯ËÌÈÎfi˜ Î·È Ê·ÚÌ·ÎÔÔÈfi˜ Î·È Ô Dupuytren Guillaume (1777-1835) ‰È¿ÛËÌÔ˜ °¿ÏÏÔ˜ ¯ÂÈÚÔ˘ÚÁfi˜, Ô˘ ÌÂٷ͇ ¿ÏÏˆÓ ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ô ÚÒÙÔ˜ Ô˘ ıÂÚ¿¢Û ·Ó‡ڢÛÌ· Î·È Â›Ó·È ÁÓˆÛÙfi˜ Î·È ·fi ÙÔ Î¿Ù·ÁÌ· ¡Ù˘Ô˘˚ÙÚ¤Ó, Ô˘ ÂÚȤÁÚ·„ ÙÔ 1812. µÏ. ∂ÌÌ·ÓÔ˘‹Ï ∂. πÛÙÔÚ›· Ù˘ º·Ú̷΢ÙÈ΋˜. ∞ı‹Ó·È; 1948. ÛÂÏ. 415 Î·È Garrison F. An Introduction to the


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Paediatriki 2003;66:236-238

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

∂π™∞°ø°π∫O ™∏ª∂πøª∞ ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡

∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Ì¿˜ ¤¯ÂÈ ÛËÌ·‰¤„ÂÈ fiÏÔ˘˜ ÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ Î·È ·ÔÙÂÏ› ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙÔ˘˜ Ó¤Ô˘˜ ·È‰È¿ÙÚÔ˘˜. Œ¯ÂÈ ÙË ‰‡Ó·ÌË ÙÔ˘ ÎÏ·ÛÈÎÔ‡ Î·È ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÙÔ˘ ÛÙÔ Ó¤Ô. ™Â ·˘Ùfi ÙÔ Ù‡¯Ô˜ ÂÁηÈÓÈ¿˙Ô˘Ì ̛· Ó¤· ÛÂÏ›‰· Ô˘ ϤÁÂÙ·È “¡¤· ·fi ÙÔ ¢È·‰›ÎÙ˘Ô”. ∂›Ó·È Ì›· ÛÂÏ›‰· Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂӉȷʤÚÔÓÙ· Ó¤· Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ÌÂϤÙ˜ ÂÓÙÂÏÒ˜ ÚfiÛÊ·Ù˜, ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÚÈÓ ·ÎfiÌË ‰ËÌÔÛÈ¢ıÔ‡Ó ÛÙ· ·ÓÙ›ÛÙÔȯ· ÂÚÈÔ‰Èο. £· ÂÚÈÏ·Ì‚¿ÓÂÈ, Â›Û˘, ÏËÚÔÊÔڛ˜ ÁÈ· ÈÛÙÔÛÂÏ›‰Â˜ Î·È ËÏÂÎÙÚÔÓÈΤ˜ ‰È¢ı‡ÓÛÂȘ Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ ¶·È‰È·ÙÚÈ΋. ∏ ÂÈ̤ÏÂÈ· Ù˘ ÛÂÏ›‰·˜ ı· Â›Ó·È Â˘ı‡ÓË ÙˆÓ: ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ (¶·È‰È¿ÙÚÔ˘), ¡›ÎÔ˘ ¶··‰fiÔ˘ÏÔ˘ (∞ÏÏÂÚÁÈÔÏfiÁÔ˘) Î·È ª·Ú›·˜ ∏Ï›· (¶·È‰È¿ÙÚÔ˘-°·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˘). ™˘ÓÂÚÁ¿Ù˜ Ù˘ ÛÂÏ›‰·˜ ı· Â›Ó·È Î·È ·È‰›·ÙÚÔÈ Ì ȉȷ›ÙÂÚÔ ÂӉȷʤÚÔÓ ÁÈ· ÙÔ ‰È·‰›ÎÙ˘Ô. ∞˘Ù‹ ÙËÓ ÂÔ¯‹, ÙÔ ÂӉȷʤÚÔÓ fiÏÔ˘ ÙÔ˘ ÎfiÛÌÔ˘ Â›Ó·È ÛÙÚ·Ì̤ÓÔ ÛÙËÓ ÂȉËÌ›· ÙÔ˘ ™Ô‚·ÚÔ‡ OͤԘ ∞Ó·Ó¢ÛÙÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘ (™O∞™). ™Â ·˘Ùfi ÙÔ Ù‡¯Ô˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ì ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ. £ÂˆÚÔ‡ÌÂ, fï˜, ¯Ú¤Ô˜ Ì·˜ ÚÈÓ ¿Ì ÛÙȘ ÏËÚÔÊÔڛ˜, Ó· ·ÔÙ›ÛÔ˘Ì ÊfiÚÔ ÙÈÌ‹˜ ÛÙÔÓ π·ÙÚfi-ÕÓıÚˆÔ Carlo Urbani. O Carlo Urbani ‹Ù·Ó 46 ÂÙÒÓ Î·È ·Ù¤Ú·˜ 3 ·È‰ÈÒÓ. ◊Ù·Ó ÂȉÈÎfi˜ ÛÙ· ÌÂÙ·‰ÔÙÈο ÓÔÛ‹Ì·Ù· Î·È ¤ı·Ó ÛÙȘ 29 ª·ÚÙ›Ô˘ 2003 ÛÙÔ ∞ÓfiÈ, fiÔ˘ ÂÚÁ·˙fiÙ·Ó Û·Ó ÂÎÚfiÛˆÔ˜ ÙÔ˘ WHO Û ÚÔÁÚ¿ÌÌ·Ù· ‰ËÌfiÛÈ·˜ ˘Á›·˜. O Carlo Urbani ‹Ù·Ó Ô ÚÒÙÔ˜ ÁÈ·ÙÚfi˜ Ô˘ ·Ú·Ù‹ÚËÛ ÙËÓ È‰È·ÈÙÂÚfiÙËÙ· Ù˘ Ó¤·˜ ·Ûı¤ÓÂÈ·˜ Û ¤Ó·Ó ∞ÌÂÚÈηÓfi ÂȯÂÈÚËÌ·Ù›·, Û ¡ÔÛÔÎÔÌÂ›Ô ÙÔ˘ ∞ÓfiÈ. ÿÚË Û ·˘Ù‹ ÙËÓ ÚÒÈÌË ·Ó·ÁÓÒÚÈÛË Ù˘ ÓfiÛÔ˘, ÂÓÂÚÁÔÔÈ‹ıËΠÔχ ÁÚ‹ÁÔÚ· Ô ·ÁÎfiÛÌÈÔ˜ Ì˯·ÓÈÛÌfi˜ ÂÈÙ‹ÚËÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÏËÊıÔ‡Ó ¤ÁηÈÚ· ̤ÙÚ· ·Ó·ÎÔ‹˜ Ù˘ ÂÍ¿ψÛ˘ Ù˘ ÓfiÛÔ˘ Î·È Ë ÂȉËÌ›· ÛÙÔ ∞ÓfiÈ ÙÒÚ· Ó· ÂϤÁ¯ÂÙ·È. O Carlo Urbani ‹Ú ÙÔ Ù˘¯›Ô Ù˘ π·ÙÚÈ΋˜ ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ ∞ÁÎfiÓ· ÛÙËÓ πÙ·Ï›· Î·È ¤Î·Ó ÌÂÙ·Ù˘¯È·Î¤˜ ÛÔ˘‰¤˜ ÛÙËÓ ÂÏÔÓÔÛ›· Î·È Ù· ·Ú·ÛÈÙÈο ÓÔÛ‹Ì·Ù·. ◊Ù·Ó ÂȉÈÎfi˜ ÙÚÔÈÎÒÓ ÓfiÛˆÓ ÛÙ· ·È‰È¿. ∂›Û˘, ‹Ù·Ó ¶Úfi‰ÚÔ˜ ÙˆÓ “°È·ÙÚÒÓ ¯ˆÚ›˜ Û‡ÓÔÚ·” Ù˘ πÙ·Ï›·˜. O ı¿Ó·Ùfi˜ ÙÔ˘ Û˘ÁÎÏfiÓÈÛ ÙËÓ ·ÁÎfiÛÌÈ· È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ· Î·È Â·Ó¤ÊÂÚ ÛÙË Û˘Ó›‰ËÛË fiÏˆÓ Ì·˜ ·Í›Â˜ Ô˘ Ú¤ÂÈ Ó· ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔÓ ÁÈ·ÙÚfi: ÚÔۋψÛË ÛÙÔ Î·ı‹ÎÔÓ, ·ÓȉÈÔÙ¤ÏÂÈ·, ·˘ÙÔı˘Û›·, ·ÓıÚˆÈÛÌfi˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· “Ú¿ÍË ÙÔ˘ ‰Ú¿Ì·ÙÔ˜” ÚÔÛ¤ÊÂÚ ÙËÓ ˘¤ÚÙ·ÙË ı˘Û›·: ∆∏ ∑ø∏ ∆OÀ. ∆Ë ÛËÌÂÚÈÓ‹ ÂÔ¯‹, ·ÁÎfiÛÌÈ·, ¤¯Ô˘Ó ÂÎÏ›„ÂÈ ÔÈ ËÁ¤Ù˜ Î·È Ù· ÚfiÙ˘· Û fiÏ· Ù· Â›‰·. O Carlo Urbani Â›Ó·È Ô ÈÔ Û‡Á¯ÚÔÓÔ˜ “º¿ÚÔ˜” Û fiÏË ÂΛÓË ÙË ÛÂÈÚ¿ ÙˆÓ ·ÓıÚÒˆÓ Ù˘ πÛÙÔÚ›·˜ Ù˘ π·ÙÚÈ΋˜ Ô˘ ʈٛ˙Ô˘Ó ÙÔ ‰‡Û‚·ÙÔ ÌÔÓÔ¿ÙÈ ÙÔ˘ ∞ÓıÚˆÈÛÌÔ‡. ¢ÂÓ ı· ͯ·ÛÙ› ÔÙ¤ ÁÈ·Ù›, ÁÈ· Ó· ı˘ÌËıÔ‡ÌÂ Î·È ÙÔÓ ÔÈËÙ‹, “fiÏÔ ÙÔ ÛÎÔÙ¿‰È ÙÔ˘ ÎfiÛÌÔ˘ ‰ÂÓ ÌÔÚ› Ó· Û‚‹ÛÂÈ ÙÔ Êˆ˜ ÂÓfi˜ ÌÈÎÚÔ‡ ÎÂÚÈÔ‡”. ¶fiÛÔ Ì¿ÏÏÔÓ ÂÓfi˜ “º¿ÚÔ˘”.

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¶·È‰È·ÙÚÈ΋ 2003;66:236-238

Paediatriki 2003;66:236-238

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

¡∂∞ ™Ô‚·Úfi O͇ ∞Ó·Ó¢ÛÙÈÎfi ™‡Ó‰ÚÔÌÔ (™O∞™) - Severe Acute Respiratory Syndrome (SARS) ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∆Ô ™Ô‚·Úfi O͇ ∞Ó·Ó¢ÛÙÈÎfi ™‡Ó‰ÚÔÌÔ (Severe Acute Respiratory Syndrome - SARS) ÚˆÙÔÂÌÊ·Ó›ÛÙËΠÛÙËÓ ∫›Ó· ÚÈÓ ·fi Ï›ÁÔ˘˜ Ì‹Ó˜. Œ¯Ô˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ ÚÔÛ‚ÏËı› ÙÔ˘Ï¿¯ÈÛÙÔÓ 2600 ¿ÙÔÌ·, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÚ›Ô˘ 100 ¤¯Ô˘Ó Âı¿ÓÂÈ. ¶˘Ú‹Ó˜ Ù˘ ÂȉËÌ›·˜ Â›Ó·È Ë ∫›Ó·, ÙÔ ÃÔÓÁÎ-∫ÔÓÁÎ, Ë ™ÈÁηÔ‡ÚË Î·È ÙÔ µÈÂÙÓ¿Ì, ·ÏÏ¿ ¤Ó·˜ ‰Â‡ÙÂÚÔ˜ ı‡Ï·Î·˜ ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁËı› ÛÙÔÓ ∫·Ó·‰¿ Î·È ÛÙȘ ∏.¶.∞. ·fi ¿ÙÔÌ· Ô˘ ÚÔÛ‚Ï‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù·ÍȉÈÒÓ ÛÙËÓ Õˆ ∞Ó·ÙÔÏ‹. ∆Ô Û‡Ó‰ÚÔÌÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ú¯Èο ˘„ËÏfi ˘ÚÂÙfi Î·È ÁÂÓÈο Û˘ÌÙÒÌ·Ù· (Ì˘·ÏÁ›Â˜, ÎÂÊ·Ï·ÏÁ›·, ηÎÔ˘¯›·), ÁÈ· Ó· ÂÌÊ·Ó›ÛÂÈ 2-7 Ë̤Ú˜ ·ÚÁfiÙÂÚ· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ΢ڛˆ˜ ÍËÚfi ‚‹¯· Î·È ÛÙ·‰È·Î¿ ÂȉÂÈÓÔ‡ÌÂÓË ‰‡ÛÓÔÈ· Ô˘ ÌÔÚ› Ó· ÊÙ¿ÛÂÈ Ì¤¯ÚÈ ÙÔ ÛËÌÂ›Ô Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. O ¯ÚfiÓÔ˜ ÂÒ·Û˘ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· Â›Ó·È 2-10 Ë̤Ú˜. O ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘ Ê·›ÓÂÙ·È Ó· Á›ÓÂÙ·È Ì ÛÙ·ÁÔÓ›‰È·, ¯ÚÂÈ¿˙ÂÙ·È fï˜ Û¯ÂÙÈο ÛÙÂÓ‹ Â·Ê‹ Ì ÙÔÓ ·ÛıÂÓ‹: Â›Ó·È ÛËÌ·ÓÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤¯ÂÈ ÓÔÛ‹ÛÂÈ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ È·ÙÚÒÓ Ô˘ ÓÔÛ‹Ï¢·Ó ¿Û¯ÔÓÙ˜ ·fi SARS. ∆Ô ·›ÙÈÔ Ù˘ ÓfiÛÔ˘ ÌÔÈ¿˙ÂÈ Ó· Â›Ó·È ¤Ó·˜ Ó¤Ô˜ Èfi˜ ÎÔÚfiÓ·, ·Ó Î·È Û˘Û¯ÂÙ›ÛÂȘ ¤¯Ô˘Ó Á›ÓÂÈ Î·È Ì ÌÂÙ·Ó¢ÌÔÓÔ˚fi Î·È ·Ú·Ì˘ÍÔ˚fi. °›ÓÔÓÙ·È ÌÂÁ¿Ï˜ ÚÔÛ¿ıÂȘ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ‰È·ÁÓˆÛÙÈÎÔ‡ ÙÂÛÙ, ·Ú¿ÏÏËÏ· Ì ÙËÓ ÂȂ‚·›ˆÛË ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∏ ıÂÚ·›· Â›Ó·È ·ÏÒ˜ ˘ÔÛÙËÚÈÎÙÈ΋. ∏ ¶OÀ Û˘ÛÙ‹ÓÂÈ ÙËÓ ·ÔÊ˘Á‹ Ù·ÍȉÈÒÓ ÚÔ˜ ÙȘ ÂÚÈÔ¯¤˜ Ô˘ ¤¯Ô˘Ó ÏËÁ›.

ŒÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∏ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈ΋˜ ıÂÚ·›·˜ ÁÈ· ÙÔ ¿ÛıÌ· Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈο ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ¯ÔÚ‹ÁËÛË. ∞Ó Î·È ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÛÙÔ ·ÚÂÏıfiÓ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ‰˘Ó·ÙfiÙËÙ· ‚ÂÏÙ›ˆÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙ· ·È‰È¿ Ì ÙË ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË ÙÔ˘ ¯ÚfiÓÔ˘ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, Ë ÌÂϤÙË START, Ù˘ ÔÔ›·˜ ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ ‰ËÌÔÛȇıËΠÛÙȘ 29-03-2003 ÛÙÔ Lancet, ·ÔÙÂÏ› ÙË ÌÂÁ·Ï‡ÙÂÚË Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË Û¯ÂÙÈο Ì ÙË ıÂÚ·›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 7000 ·ÛıÂÓ›˜, fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ START ¤‰ÂÈÍ·Ó fiÙÈ ¿ÙÔÌ· Ì ‹ÈÔ Â›ÌÔÓÔ ¿ÛıÌ·, Ô˘ ›¯Â ‰È·ÁÓˆÛÙ› ÏÈÁfiÙÂÚÔ ·fi 2 ¯ÚfiÓÈ· Î·È ¤Ï·‚·Ó ‚Ô˘‰ÂÛÔÓ›‰Ë ÂÈϤÔÓ ¿ÏÏˆÓ ıÂÚ·ÂÈÒÓ, ›¯·Ó ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Û fiϘ ۯ‰fiÓ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. º·›ÓÂÙ·È fiÙÈ Ù· ÚÒÙ· ¯ÚfiÓÈ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Â›Ó·È Ôχ ÛËÌ·ÓÙÈο ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ‰›ÓÂÈ ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ· ÛÙÔ ÚfiÏÔ ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘. Lancet 2003;361:1071-1076

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¶·È‰È·ÙÚÈ΋ 2003;66:236-238

Paediatriki 2003;66:236-238

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

µÚ·¯‡ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· Ë·Ù›Ùȉ· µ ÛÙ· ·È‰È¿ ¢‹ÌËÙÚ· §È·ÓÔ‡, ¶·È‰›·ÙÚÔ˜

∆˘¯·ÈÔÔÈË̤ÓË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ¤Ó· “‚Ú·¯‡” Û¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ Ë·Ù›Ùȉ·˜ µ (3 ‰fiÛÂȘ Û ¯ÚfiÓÔ 0, 10 Î·È 21 Ë̤Ú˜) ‰ËÌÈÔ˘ÚÁ› ÚÔÛٷ٢ÙÈο ·ÓÙÈÛÒÌ·Ù· (antiHBs) Ù·¯‡ÙÂÚ· ·’ fiÙÈ ÙÔ ÎÏ·ÛÈÎfi Û¯‹Ì· (3 ‰fiÛÂȘ Û ¯ÚfiÓÔ 0, 1 Î·È 6 Ì‹Ó˜), ÂÓÒ Ô ‚·ıÌfi˜ ·ÓÔÛÔÏÔÁÈ΋˜ ÚÔÛÙ·Û›·˜ Î·È ÛÙ· ‰‡Ô Û¯‹Ì·Ù· Â›Ó·È Ô ›‰ÈÔ˜ ÌÂÙ¿ ·fi 1 ¯ÚfiÓÔ. ™˘ÓÂÒ˜, ÙÔ ‚Ú·¯‡ ·˘Ùfi Û¯‹Ì· ı· ÌÔÚÔ‡Û ӷ ¯ÔÚËÁËı› Û ·È‰È¿ Ô˘ ÚfiÎÂÈÙ·È Ó· Ù·Íȉ¤„Ô˘Ó Û ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜ Î·È ‰ÂÓ Â›¯·Ó Â·Ú΋ ¯ÚfiÓÔ ÁÈ· Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ ÎÏ·ÛÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹ ÚfiÎÂÈÙ·È Ó· Ï¿‚Ô˘Ó ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Î·È ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜. Pediatr Int 2002;44:663-665

∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ - www.aap.org ∏ ÈÛÙÔÛÂÏ›‰· Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ ·ÔÙÂÏ› ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÈÔ ÚfiÛÊ·Ù· ·È‰È·ÙÚÈο Ó¤·, ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ٷ ÚÔÙÂÈÓfiÌÂÓ· Û¯‹Ì·Ù· ÂÌ‚ÔÏÈ·ÛÌÒÓ, ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ‰È¿ÊÔÚ˜ ÂÎÛÙÚ·Ù›˜ Ô˘ ÔÚÁ·ÓÒÓÂÈ Ë ∞η‰ËÌ›·, ‰ÂÏÙ›· Ù‡Ô˘, ÏËÚÔÊÔڛ˜ ÁÈ· ÁÔÓ›˜, ÂȉÈΤ˜ ÂΉfiÛÂȘ Î·È ¿ÏÏ·. ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÔÈ Ô‰ËÁ›Â˜ Â›Ó·È ÏÈÙ¤˜, Û˘ÁÎÂÎÚÈ̤Ó˜ Î·È ‰ÔÌË̤Ó˜, ¤ÙÛÈ ÒÛÙ ÌÔÚ› ηÓ›˜ ‡ÎÔÏ· Ó· ÙȘ ÌÂٷʤÚÂÈ, ·ÊÔ‡ ÙȘ ÌÂÙ·ÊÚ¿ÛÂÈ, ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘ Ú·ÎÙÈ΋. °È· ÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜, ˘¿Ú¯Ô˘Ó ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ¢ηÈڛ˜ ·Ó‡ÚÂÛ˘ ÂÚÁ·Û›·˜ ÛÙȘ ∏.¶.∞., ˘ÔÙÚÔʛ˜ Î.Ï. ¶·Ú¤¯ÔÓÙ·È, Â›Û˘, ‰ˆÚÂ¿Ó Ì·ı‹Ì·Ù· Û˘Ó¯È˙fiÌÂÓ˘ ·È‰È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘ on-line, links ÁÈ· Ù· ÂÚÈÔ‰Èο Ù˘ ∞η‰ËÌ›·˜, fiˆ˜ ÙÔ Pediatrics Î·È ÙÔ Pediatrics in Review Î·È ÔÏÏ¿ ¿ÏÏ·. ∞Í›˙ÂÈ Ó· ÙÔ ÂÚÈÏ¿‚ÂÙ ÛÙ· favorites! PediatricLinx.com - www.pediatriclinx.com °È· fiÛÔ˘˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ̤ÓÔ˘Ó ›Ûˆ Ô‡Ù ̛· ‚‰ÔÌ¿‰· ÛÙËÓ ÂÓË̤ڈۋ ÙÔ˘˜, ÙÔ PediatricLinx ›Ûˆ˜ Ó· ·ÔÙÂÏ› ÙËÓ È‰·ÓÈ΋ χÛË. ∏ ÔÌ¿‰· ·˘Ù‹˜ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ·Ô‰ÂÏÙÈÒÓÂÈ ÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ ·È‰È·ÙÚÈ΋˜ Î·È Û¯ÂÙÈ˙fiÌÂÓˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È ·Ú·ı¤ÙÂÈ ÙÔÓ Ù›ÙÏÔ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·, Ì ڢıÌfi ·Ó·Ó¤ˆÛ˘ 2-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. ŒÙÛÈ, ÌÔÚ› ηÓ›˜ Ó· Ú›¯ÓÂÈ Ì›· Ì·ÙÈ¿ ÛÙÔÓ ÙÂÚ¿ÛÙÈÔ ·˘Ùfi fiÁÎÔ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Î·È, Â¿Ó Î¿ÙÈ ÙÔÓ ÂӉȷʤÚÂÈ È‰È·›ÙÂÚ·, Ó· Û˘Ó‰¤ÂÙ·È Ì ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÂÚÈÔ‰ÈÎÔ‡, fiÔ˘ ˘¿Ú¯ÂÈ Ë Ï‹Ú˘ ÂÚ›ÏË„Ë Î·È, ›Ù ‰ˆÚÂ¿Ó Â›Ù ̤ۈ Û˘Ó‰ÚÔÌ‹˜, ÙÔ Ï‹Ú˜ ¿ÚıÚÔ. ¢›ÓÂÙ·È, Â›Û˘, Ë ‰˘Ó·ÙfiÙËÙ· Ó· ÁÚ·ÊÙ› οÔÈÔ˜ Û˘Ó‰ÚÔÌËÙ‹˜ ÛÙÔ newsletter ·˘ÙÔ‡ ÙÔ˘ ÙfiÔ˘, ÔfiÙ fiϘ ÔÈ ·Ú·¿Óˆ ÏËÚÔÊÔڛ˜ ηٷÊı¿ÓÔ˘Ó Ì ÙÔ ËÏÂÎÙÚÔÓÈÎfi Ù·¯˘‰ÚÔÌ›Ô. ¶ÚÔÛÔ¯‹! O ÙfiÔ˜ ·˘Ùfi˜ ·¢ı‡ÓÂÙ·È ÛÙÔ˘˜ ·ÔÊ·ÛÈṲ̂ÓÔ˘˜ Î·È ‰È„·Ṳ̂ÓÔ˘˜ ÁÈ· ÁÓÒÛË Û˘Ó·‰¤ÏÊÔ˘˜.

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¶PO™EXH ™YNE¢PIA

30 ª·˝Ô˘ 2003

5Ë ∏ÌÂÚ›‰· ¶·È‰È·ÙÚÈ΋˜ ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ “Oͤ· Î·È ÃÚfiÓÈ· ¡Â˘ÚÔÏÔÁÈο ¶ÚÔ‚Ï‹Ì·Ù·” ÈڤÌÂÈÔ ∂Ú¢ÓËÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ¶ÏËÚÔÊÔڛ˜: ∞Ó·ÛÙ¿ÛÈÔ˜ ÷Ù˙‹˜ ª.∂.£. ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∆ËÏ. & fax: 210-74 88 686

∞ı‹Ó·

8-12 πÔ˘Ó›Ô˘ 2003

15th European Immunology Congress ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ÓÔÛÔÏÔÁ›·˜ ¶ÏËÚÔÊÔڛ˜: Amphitrion Holidays ∆ËÏ.: +3 210-900 6000 Fax: +3 210-9249 836 E-mail: congress@amphitrion.gr

ƒfi‰Ô˜

12-14 πÔ˘Ó›Ô˘ 2003

“2nd Caring in the skies” ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +3 210-7499 300 Fax: +3 210-7705 752 E-mail: siav@triaenatours.gr

∞ı‹Ó·

12-15 πÔ˘Ó›Ô˘ 2003

8th Congress of the European Hematology Association ¶ÏËÚÔÊÔڛ˜: Eurocongres Conference Management Tel.: +31 20 679 3411 Fax: +31 20 673 7306 E-mail: eha2003@eurocongres.com

Lyon, France

13-15 πÔ˘Ó›Ô˘ 2003

41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: C & C International S.A. ∆ËÏ.: 210 - 68 89 100 Fax: 210 - 68 44 777 E-mail: pediatric2003@cnc.gr

ƒfi‰Ô˜

16-17 πÔ˘Ó›Ô˘ 2003

2nd International Medical and Genetic Congress on Schwachman Diamond Syndrome ¶ÏËÚÔÊÔڛ˜: ¢Ú ∂ϤÓË æÈ¿¯Ô˘-Leonard E-mail: epsiachou@hotmail.com

Toronto, Canada

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12-18 πÔ˘Ï›Ô˘ 2003

Ãπà Congress of the International Society on Thrombosis and Haemostasis ¶ÏËÚÔÊÔڛ˜: Concorde Services Tel.: +44 20 8743 3106 Fax: +44 20 8743 1010 E-mail: isth-programme@concorde-uk.com

Birmingham, UK

12-13 ™ÂÙÂÌ‚Ú›Ô˘ 2003

Erasmus Workshop on Molecular Therapeutics in Acute Leukemia ¶ÏËÚÔÊÔڛ˜: Erasmus Workshop Leukemia Tel.: +31 (0)10 4087669 Fax: +31 (0)10 4089462 E-mail: info@emco.fgg.eur.nl Website: www.eur.nl/fgg/emco

Rotterdam, The Netherlands

18-21 ™ÂÙÂÌ‚Ú›Ô˘ 2003

28th UMEMPS Congress Secretariat: Dr S. Afif - Pr. M. Oumlil Tel. & Fax: +212 22 22 6386 E-mail: smpcasa@wanadoo.net.ma

Marrakech, Morocco

20-23 ¡ÔÂÌ‚Ú›Ô˘ 2003

14th European Congress on Pediatric and Neonatal Intensive Care Astir Palace Hotel ¶ÏËÚÔÊÔڛ˜: ZITA Congress E-mail: grasimosk@zita-congress.gr

∞ı‹Ó·

10-13 πÔ˘Ó›Ô˘ 2004

9th Congress of the European Geneva, Hematology Association Switzerland ¶ÏËÚÔÊÔڛ˜: Eurocongres Conference Management Tel.: +31 20 679 3411 Fax: +31 20 673 7306 E-mail: eha2004@eurocongres.com Website: www.eurocongres.com/eha2004

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™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º. L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

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™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE U

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9

6

3

2

1

-1

-2

-3

-6

-9

-12

-15

-18

xvi

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


Παιδιατρική | Τόμος 66 • Τεύχος 3 • Μάιος - Ιούνιος 2003