Παιδιατρική | Τόμος 67 • Τεύχος 4 • Ιούλιος - Αύγουστος 2004

COVER July August 04

07-10-04

13:55

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ISSN 0377-2551

ETO™ 2004

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πÔ‡Ï ÈÔ˜ - ∞ ‡ Á Ô ˘ Û Ù Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 4

∏ ·Ó·‰˘fiÌÂÓË ·ÂÈÏ‹ Ù˘ ‚ÈÔÏÔÁÈ΋˜ Î·È ¯ËÌÈ΋˜ ÙÚÔÌÔÎÚ·Ù›·˜ Î·È ÔÈ Èı·Ó¤˜ ÂÈÙÒÛÂȘ Ù˘ ÛÙ· ·È‰È¿

REVIEW ARTICLES 225

µ. ∆Û·ÁÚ‹˜, º. ∆˙ÈÊ‹, ∞. ∫ÈÙÛÔÔ‡ÏÔ˘, ª. µ·ÛÈÏÂÈ¿‰Ë˜, π. ¡Ù¿ÌÔ˜

∫·Ù¿ıÏÈ„Ë ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∞ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÛÙËÓ ·È‰È΋ ËÏÈΛ·

V. Tsagris, F. Tzifi, A. Kitsopoulou, M. Vasileiadis, I. Ntampos 241

254

AWARD-WINNING ARTICLE 261

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ORIGINAL ARTICLES 268

X. ÷Ù˙ËÁˆÚÁ›Ô˘, ª. ÷Ù˙ËȈ¿ÓÓÔ˘, ª. ∆ÔÚÓ·Ú›Ù˘, ∞. °È·ÁÎÔ˘Ï‹, ∂. ∫ˆÓÛÙ·ÓÙ›ÓÔ˘, µ. ¡Â¿Ú¯Ô˘, ™. ™¿‚‚·˜

The effect of aerobic exercise on risk factors for chronic disease in 10-12 year-old children in Cyprus C. Chadjigeorgiou, M. Chadjiioannou, M. Tornaritis, A. Giagkouli, E. Konstantinou, B. Nearchou, S. Savvas

274

º. ¡ÈÎÔÏ¿Ô˘, º. ∫·Î·‚¿, ∫. ¶·¿˙ÔÁÏÔ˘, π. ¶··‰¿ÙÔ˜

Epidemiologic aspects of childhood injuries in a Paediatric Intensive Care Unit F. Nikolaou, F. Kakava, K. Papazoglou, J. Papadatos

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ µÚ¤ÊÔ˜ Ì ‚·ÚÈ¿ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›·

Rb-1 gene mutations as prognostic factors in childhood malignancies E.-A. Markaki, H. Dimitriou, M. Tsopanomichalou, E. Stiakaki, D. Spadidos, M. Kalmanti

∂.-∞. ª·ÚοÎË, ∂. ¢ËÌËÙÚ›Ô˘, ª. ∆ÛÔ·ÓÔÌ›¯·ÏÔ˘, ∂. ™ÙÂȷοÎË, ¢. ™·ÓÙ›‰Ô˜, M. ∫·ÏÌ·ÓÙ‹

∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û ¶·È‰È·ÙÚÈ΋ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜

Strokes in childhood D. I. Zafeiriou, M. Ikonomou

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞

∂›‰Ú·ÛË Ù˘ ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ Û ·È‰È¿ Ù˘ ∫‡ÚÔ˘ ËÏÈΛ·˜ 10-12 ÂÙÒÓ

Childhood depression H. Lazaratou, D. C. Anagnostopoulos

¢. π. ∑·ÊÂÈÚ›Ô˘, ª. OÈÎÔÓfiÌÔ˘

OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Rb-1 ˆ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÛÙ· ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

The emerging threat of biological and chemical terrorism and its potential implications for children

CASE REPORTS 281

An infant with severe staphylococcal pneumonia

º. ∫·Î·‚¿, ™. ™Ù¤ÊÔ˜, ∞. ¶ÚÂ˙ÂÚ¿ÎÔ˘, ∞. ¢·Ú˙¤ÓÙ·˜, ∞. µ·ÛÈÏfiÔ˘ÏÔ˜

F. Kakava, S. Stefos, A. Prezerakou, A. Darzentas, A. Vasilopoulos

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

Continuation of table of contents inside title page

Greek Paediatric Society July - August 200 4 ñ V o l u m e 6 7 ñ No 4

July August 04

07-10-04

13:51

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I Ô ‡ Ï È Ô ˜ - ∞ ‡ Á Ô ˘ Û Ù Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 4

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Aspergillus niger Û ‰‡Ô Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿

Continuation of table of contents

287

I. Labadaridis, A. Velegraki, M. Theodoraki, E. Dimitriou, H. Michelakakis

π. §·Ì·‰·Ú›‰Ë˜, ∞. µÂÏÂÁÚ¿ÎË, ª. £ÂÔ‰ˆÚ¿ÎË, ∂. ¢ËÌËÙÚ›Ô˘, ∂. ªÈ¯ÂϷοÎË

SPECIAL ARTICLE

∂π¢π∫O ∞ƒ£ƒO ∆· ‰ÈηÈÒÌ·Ù· Ù˘ ·ÙÚÈ΋˜ ÂÍÔ˘Û›·˜ Â› ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰· ∫. ∆·Ì¿ÎË, £. ∆·Ì¿Î˘

Aspergillus niger in two very low birth weight neonates

293

The rights of paternal authority over newborn infants in ancient Greece ∫. Tabaki, T. Tabakis

Hellenic Paediatric Society

Hellenic Paediatric Society

Greek Paediatric Society ™˘Ó¯›˙ÔÓÙ·È

Continued

Greek Paediatric Society J u l y - ∞ u g u s t 200 4 ñ V o l u m e 6 7 ñ No 4

July August 04

07-10-04

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π Ô ‡ Ï È Ô ˜ - ∞ ‡ Á Ô ˘ Û Ù Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 4

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

298

NEWS FROM THE INTERNET

∞Ó·ÎÔ›ÓˆÛË

300

Announcement

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xiii

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xix

Abbreviations

Hellenic Paediatric Society

Hellenic Paediatric Society

Greek Paediatric Society

Greek Paediatric Society J u l y - A u g u s t 200 4 ñ V o l u m e 6 7 ñ No 4

July August 04

07-10-04

13:51

™ÂÏ›‰·7

I Ô ‡ Ï È Ô ˜ - ∞ ‡ Á Ô ˘ Û Ù Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 4

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

Bimonthly Publication The Official Journal of the Greek 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 Greek 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‹˜ ™‡ÓÙ·Í˘ : ™. ÷˚‰¿˜ ∞Ó·Ï. ¢È¢ı. ™‡ÓÙ·Í˘ : ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË : ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë Ã. ∫ÒÛÙ·ÏÔ˜ °. ªÚÈ·ÛÔ‡Ï˘ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ¶··‰ÔÔ‡ÏÔ˘ ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË

Scientific Editorial Board President : A. Constantopoulos Editor : S. Haidas Assistant Editor : C. Stefanidis Members : H. Antonopoulou A. Vazeou-Gerasimidi G. Varlamis ∂. Katsarou-Pectasides Greek Paediatric Society Ch. Costalos Greek Paediatric Society G. Briasoulis N. Papadopoulos ∞. Papadopoulou M. Tsolia-Pasparaki

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜

Publishing Coordinator

Hellenic Paediatric Society

Hellenic Paediatric Society

E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ∞ÚÙ¤ÌȉԘ 3, 151 25 M·ÚÔ‡ÛÈ TËÏ.: 210 87 78 810 Fax: 210 87 78 822

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜:

40 € 20 €

Greek Editing I. Karavranou

SCIENTIFIC PUBLICATIONS Ltd Artemidos 3, Marousi Hellenic Paediatric Society 151 25 Tel.: 210 87 78 810 Fax: 210 87 78 822

Annual Subscription All foreign countries: US $ 50

Greek Paediatric Society J u l y - ∞ u g u s t 200 4 ñ V o l u m e 6 7 ñ No 4

πSSN 0377-2551 i

July August 04

07-10-04

13:51

™ÂÏ›‰·11

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·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿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.

vii

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¶·È‰È·ÙÚÈ΋ 2004;67:225-240

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Paediatriki 2004;67:225-240

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∏ ·Ó·‰˘fiÌÂÓË ·ÂÈÏ‹ Ù˘ ‚ÈÔÏÔÁÈ΋˜ Î·È ¯ËÌÈ΋˜ ÙÚÔÌÔÎÚ·Ù›·˜ Î·È ÔÈ Èı·Ó¤˜ ÂÈÙÒÛÂȘ Ù˘ ÛÙ· ·È‰È¿ µ. ∆Û·ÁÚ‹˜1, º. ∆˙ÈÊ‹1, ∞. ∫ÈÙÛÔÔ‡ÏÔ˘1, ª. µ·ÛÈÏÂÈ¿‰Ë˜1, π. ¡Ù¿ÌÔ˜2

The emerging threat of biological and chemical terrorism and its potential implications for children V. Tsagris1, F. Tzifi1, A. Kitsopoulou1, M. Vasileiadis1, I. Ntampos2

¶ÂÚ›ÏË„Ë: ªÂÙ¿ Ù· ÙÚ·ÁÈο ÁÂÁÔÓfiÙ· Ù˘ 11˘ ™ÂÙÂÌ‚Ú›Ô˘ Î·È ÙȘ ÂÈı¤ÛÂȘ Ì ¿Óıڷη ̤ۈ Ù·¯˘‰ÚÔÌ›Ԣ ÛÙȘ ∏¶∞ ÙÔ 2001, ¤Ó· ÂÎÙÂٷ̤ÓÔ ÙÚÔÌÔÎÚ·ÙÈÎfi ¯Ù‡ËÌ· Ì ‚ÈÔÏÔÁÈο ‹ ¯ËÌÈο fiÏ· ıˆÚÂ›Ù·È Ì›· fi¯È ÙfiÛÔ ·ÔÌ·ÎÚ˘Ṳ̂ÓË Èı·ÓfiÙËÙ·. ∏ Ù¤ÏÂÛË ÙˆÓ OÏ˘ÌÈ·ÎÒÓ ∞ÁÒÓˆÓ ÙÔ Î·ÏÔη›ÚÈ ÙÔ˘ 2004 ÛÙË ¯ÒÚ· Ì·˜, ÙËÓ Î·ıÈÛÙ¿ ¤Ó·Ó Èı·Ófi ηÈ, ‰˘ÛÙ˘¯Ò˜, ¢¿ÏˆÙÔ ÛÙfi¯Ô. ¶ÔȘ ı· ‹Ù·Ó ÔÈ Û˘Ó¤ÂȘ ÂÓfi˜ ÙÚÔÌÔÎÚ·ÙÈÎÔ‡ ¯Ù˘‹Ì·ÙÔ˜ Ì ·È‰È¿-ı‡Ì·Ù· ˆ˜ “·Ú¿Ï¢ÚË ·ÒÏÂÈ·”; ¶ÔÈÔÈ Â›Ó·È ÔÈ Â͈ÙÈÎÔ› Î·È ·Û˘Ó‹ıÈÛÙÔÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹Ú˜ Ô˘ ı· ÎÏËıÔ‡Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÔÈ ·È‰›·ÙÚÔÈ, Èı·ÓÒ˜ ÚÈÓ ·fi fiÏÔ˘˜ ÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜; °È·Ù› Ù· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó È‰ÈÔÌÔÚʛ˜ Î·È ÔȘ Â›Ó·È ÔÈ ··Ú·›ÙËÙ˜ ·ÚÂÌ‚¿ÛÂȘ; ∆È Â›‰Ô˘˜ ÚfiÔ‰Ô ¤¯ÂÈ ÂÈʤÚÂÈ, ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ, Ë ·ÁÎfiÛÌÈ· ÂÌÊ¿ÓÈÛË “˘ÛÙÂÚ›·˜” Û¯ÂÙÈο Ì ÙÔ ı¤Ì·; ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂȯÂÈÚÂ›Ù·È Ë ·Ó‡ÚÂÛË ··ÓÙ‹ÛÂˆÓ ÙˆÓ ·Ú·¿Óˆ ÂÚˆÙËÌ¿ÙˆÓ.

Abstract: In the aftermath of the September 11th attack and the anthrax mail bomb episodes in the USA, a widespread and devastating terrorist act with biological or chemical weapons, is no longer considered to be only a remote probability. In Greece, the organization of the Olympic Games of 2004 poses the possibility of a terrorist threat. What would be the implications of a biochemical attack involving children as “collateral damage”? What are the uncommon and exotic clinical findings that paediatricians, playing a pivotal role amongst health care professionals, will be called upon to recognize? In what ways are children different from adults and what interventions would be necessary?

Have there been any recent advances in the care and management of children as a result of the worldwide “hysteria” with regards to the subject of terrorism? This review attempts to provide answers to these questions.

§¤ÍÂȘ ÎÏÂȉȿ: ‚ÈÔÙÚÔÌÔÎÚ·Ù›·, ‚ÈÔÏÔÁÈο, ¯ËÌÈο, fiÏ·, ·È‰È¿.

Key words: bioterrorism, biological, chemical, warfare, children.

∂ÈÛ·ÁˆÁ‹ ∆Ô ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi Â›ıÂÛ˘ Ì ‚ÈÔÏÔÁÈο fiÏ· ηٷÁÚ¿ÊÂÙ·È ÙÔ 184 .Ã., fiÙ·Ó Ô ÛÙfiÏÔ˜ Ù˘ ∫·Ú¯Ë‰fiÓ·˜, ˘fi ÙËÓ ·Ú¯ËÁ›· ÙÔ˘ ∞ÓÓ›‚·, Û˘Ó¤ÙÚÈ„Â ÙÔÓ ·ÓÙ›·ÏÔ ÛÙfiÏÔ Ù˘ ¶ÂÚÁ¿ÌÔ˘ ÂÎÙÔ͇ÔÓÙ·˜ ‹ÏÈÓ· ÛÎÂ‡Ë Ô˘ ÂÚÈ›¯·Ó ÂÚÂÙ¿. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ªÂÛ·›ˆÓ·, Ë ÂÎÙfiÍ¢ÛË ÈÛÙÒÓ ˙ÒˆÓ ÌÔÏ˘ÛÌ¤ÓˆÓ ·fi ·ÓÒÏË Î·Ù¿ ÙˆÓ ÔÏÈÔÚÎËÌ¤ÓˆÓ ·ÔÙÂÏÔ‡ÛÂ Û˘Ó‹ıË Ù·ÎÙÈ΋ ÙˆÓ ÔÏÈÔÚÎËÙÒÓ fiψÓ, Ú·ÎÙÈ΋ Ô˘ ÚÔηÏÔ‡Û ÛËÌ·ÓÙÈΤ˜ ·Ò-

ÏÂȘ ·fi ÙËÓ ·Ó‰ËÌ›· Ô˘ ·ÎÔÏÔ˘ıÔ‡ÛÂ, ·ÏÏ¿ ΢ڛˆ˜ ηٷÚڿΈÛË ÙÔ˘ ËıÈÎÔ‡ (1). ∏ ·ÂÏ¢ı¤ÚˆÛË, ·fi ÙÚÔÌÔÎÚ·ÙÈ΋ ÔÚÁ¿ÓˆÛË, ÙÔ˘ ·ÂÚ›Ô˘ sarin ÛÙÔÓ ˘fiÁÂÈÔ ÛȉËÚfi‰ÚÔÌÔ ÙÔ˘ ∆fiÎÈÔ, ÙÔ 1995 (2), ÂÛÙ›·Û ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ ÂӉȷʤÚÔÓ Ù˘ ·ÁÎfiÛÌÈ·˜ ÎÔÈÓ‹˜ ÁÓÒÌ˘ ÛÙË ˙ÔÊÂÚ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ· Ù˘ Â›ıÂÛ˘ Ì ¯ËÌÈο ‹ ‚ÈÔÏÔÁÈο fiÏ·. ∏ ·ÔÎ¿Ï˘„Ë, ·fi ÙÔ OÌÔÛÔӉȷÎfi °Ú·ÊÂ›Ô ∂Ú¢ÓÒÓ ÙˆÓ ∏¶∞, ۯ‰›Ô˘ ÁÈ· ·ÂÏ¢ı¤ÚˆÛË ·ÂÚ›Ô˘ ¯ÏˆÚ›Ó˘ ÛÙÔ ıÂÌ·ÙÈÎfi ¿ÚÎÔ

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, “£ÚÈ¿ÛÈÔ” ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∂ÏÂ˘Û›Ó·˜ 2 ∫ÏÈÓÈ΋ º˘ÛÈ΋˜ π·ÙÚÈ΋˜ Î·È ∞ÔηٿÛÙ·Û˘, “£ÚÈ¿ÛÈÔ” ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∂ÏÂ˘Û›Ó·˜

1 Paediatric Clinic, “Thriasio” General Hospital of Elefsina 2 Clinic of Physical Medicine and Rehabilitation, “Thriasio” General Hospital of Elefsina

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Ù˘ ¡Ù›ÛÓ¸ϷÓÙ ÛÙËÓ ∫·ÏÈÊfiÚÓÈ·, Ù· ÙÚ·ÁÈο ÁÂÁÔÓfiÙ· Ù˘ 11˘ ™ÂÙÂÌ‚Ú›Ô˘ ÙÔ˘ 2001 ÛÙȘ ∏¶∞ Î·È Ë Â·ÎfiÏÔ˘ıË ‰È·ÛÔÚ¿ - ̤ۈ Ù·¯˘‰ÚÔÌ›Ԣ - ‚·Î›ÏÔ˘ ÙÔ˘ ¿Óıڷη, ηıÈÛÙÔ‡Ó ÙËÓ Èı·ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ·È‰ÈÒÓ, ÌÂÙ¿ ·fi ¯ËÌÈ΋ ‹ ‚ÈÔÏÔÁÈ΋ Â›ıÂÛË, ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈ΋ (3). ¶·Ú¿ ÙËÓ ÚÔÛ¿ıÂÈ·, Û ‰ÈÂıÓ¤˜ Â›‰Ô, ÂϤÁ¯Ô˘ Ù˘ ·Ú·ÁˆÁ‹˜ ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓ Î·È ¯ËÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (™‡ÓÔ‰Ô˜ ÁÈ· ÙÔÓ ŒÏÂÁ¯Ô µÈÔÏÔÁÈÎÒÓ Î·È ∆ÔÍÈÎÒÓ ŸψÓ, 1972), ÂÍ·ÎÔÏÔ˘ıÔ‡Ó ·˘Ù¿ Ó· ·Ó·Ù‡ÛÛÔÓÙ·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Û ‰È¿ÊÔÚ· ÛËÌ›· ÙÔ˘ ÎfiÛÌÔ˘, ηıÒ˜ Ù· ̤۷ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· Ó· “·ÍÈÔÔÈËıÔ‡Ó” ·˘ÙÔ› ÔÈ ·Ú¿ÁÔÓÙ˜ Î·È Ó· ÌÂÙ·ÙÚ·Ô‡Ó Û fiÏ· Ì·˙È΋˜ ηٷÛÙÚÔÊ‹˜, Â›Ó·È ÂÍ·ÈÚÂÙÈο ·Ï¿ ηÈ, ΢ڛˆ˜, ¢ڤˆ˜ ‰È·ı¤ÛÈÌ·. ∆· ˘ÏÈο ·Ú·ÁˆÁ‹˜ Â›Ó·È ÊıËÓ¿ Î·È ÔÈ Ù¯ÓÈΤ˜ ·Ôı‹Î¢Û˘ ·ÏÔ˘ÛÙÂ˘Ì¤Ó˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ‰‡ÛÎÔÏÔ˜ Ô ÂÓÙÔÈÛÌfi˜ ÙfiÛÔ ÙˆÓ ¯ÒÚˆÓ ·Ú·ÁˆÁ‹˜ fiÛÔ Î·È ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ, ηıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ̤ıÔ‰ÔÈ ·Ó›¯Ó¢Û˘. ªÂ ÙÔÓ Ú˘ıÌfi ÂͤÏÈ͢ Ù˘ ˘¿Ú¯Ô˘Û·˜ Ù¯ÓÔÏÔÁ›·˜, ·Ó·Ì¤ÓÂÙ·È fiÙÈ ı· ··ÈÙËı› ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÂÓÙ·ÂÙ›· ·ÎfiÌË ÁÈ· Ó· ·Ó·Ù˘¯ıÔ‡Ó Ì¤ıÔ‰ÔÈ ¿ÌÂÛÔ˘ ÂÓÙÔÈÛÌÔ‡ ‚ÈÔÏÔÁÈÎÒÓ ‹ ¯ËÌÈÎÒÓ fiÏˆÓ (4-6). ª›· ‰ËÌÔÛ›Â˘ÛË Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜ (WHO, www.who.int) ÙÔ˘ 1970 ÂÚÈÁÚ¿ÊÂÈ Ì ÁÏ·Ê˘ÚfiÙËÙ· (Û ÂÔ¯‹ Ô˘ Ë ‚ÈÔ¯ËÌÈ΋ ·ÂÈÏ‹ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ˆ˜ ÛÙÚ·ÙËÁÈ΋ ÂÈÏÔÁ‹ ÂÚÈÛÛfiÙÂÚÔ ÙˆÓ Î˘‚ÂÚÓ‹ÛˆÓ, ·Ú¿ ÙˆÓ ÙÚÔÌÔÎÚ·ÙÈÎÒÓ ÔÚÁ·ÓÒÛˆÓ) (7) ÙȘ ‰˘ÓËÙÈο ÙÚ·ÁÈΤ˜ ÂÈÙÒÛÂȘ ÂÓfi˜ ‚ÈÔÏÔÁÈÎÔ‡ ¯Ù˘‹Ì·ÙÔ˜. ÀÔÏÔÁ›ÛÙËΠfiÙÈ ·Ó 50 kg ·ÂÚÈÔÔÈËÌ¤ÓˆÓ ÛfiÚˆÓ ‚·Î›ÏÔ˘ ÙÔ˘ ¿Óıڷη ·ÂÏ¢ıÂÚÒÓÔÓÙ·Ó ·fi ·ÂÚÔÏ¿ÓÔ Û ·fiÛÙ·ÛË 2 ¯ÏÌ. ·fi ·ÛÙÈÎfi ΤÓÙÚÔ Ì ÏËı˘ÛÌfi 500.000 ηÙԛΈÓ, ı· ‰È·Û›ÚÔÓÙ·Ó Û ·fiÛÙ·ÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ 20 ¯ÏÌ. Î·È ı· ÚÔηÏÔ‡Û·Ó ÙÔÓ ı¿Ó·ÙÔ ‹ ÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË 220.000 ·ÓıÚÒˆÓ. ∞Ó Ô ‚ÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ë francisella tularensis, Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ ı· ‹Ù·Ó 155.000 ¿ÙÔÌ·. ™ÙË ¯ÒÚ· Ì·˜, ÙÔ ÂӉ¯fiÌÂÓÔ Ì›·˜ ‚ÈÔÏÔÁÈ΋˜ ‹ ¯ËÌÈ΋˜ ·ÂÈÏ‹˜ ·ÔÎÙ¿ ÂÍ·ÈÚÂÙÈÎfi ÂӉȷʤÚÔÓ, ÏfiÁˆ Ù˘ ÂÈΛÌÂÓ˘ Ù¤ÏÂÛ˘ ÙˆÓ OÏ˘ÌÈ·ÎÒÓ ∞ÁÒÓˆÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ȉڇıËΠÚfiÛÊ·Ù· Ë OÏ˘Ìȷ΋ ÀÁÂÈÔÓÔÌÈ΋ ªÔÓ¿‰·, Ë ÔÔ›· ÙÂÏ› ˘fi ÙËÓ ÂÔÙ›· ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ∂ıÓÈ΋˜ ÕÌ˘Ó·˜ Î·È ·ÚÈıÌ› ÚÔÛˆÈÎfi 850 ·ÙfiÌˆÓ (ÚÔÛÂÁÁ›˙ÔÓÙ·˜ ÙÔ Ì¤ÁÂıÔ˜ Ù·ÍÈ·Ú¯›·˜) (8). ∏ ÌÔÓ¿‰· ·˘Ù‹ ı· ·ÔÙÂϤÛÂÈ ÙÔÓ ϤÔÓ ‰˘Ó·ÌÈÎfi ‚Ú·¯›ÔÓ· Û ÂÚ›ÙˆÛË Ù˘ÊÏÔ‡ ¯Ù˘‹Ì·ÙÔ˜ Î·È ÚԂϤÂÙ·È Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Î·È Ó· ÛÙÂϯÒÛÂÈ ÛÙ·ıÂÚÔ‡˜ Î·È ÎÈÓËÙÔ‡˜ ˘ÁÂÈÔÓÔÌÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ Ù˘ ÚˆÙÂ‡Ô˘Û·˜, Ó· ÂÍÔÏÈÛÙ› Ì ·ÛıÂÓÔ-

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ÊfiÚ· ÔÏÏ·ÏÒÓ Ù‡ˆÓ Î·È Ó· ÔÚÁ·ÓÒÛÂÈ ÔÌ¿‰Â˜ ·ÓÙÈÌÂÙÒÈÛ˘ ˘ÚËÓÈ΋˜, ‚ÈÔÏÔÁÈ΋˜ Î·È ¯ËÌÈ΋˜ (¶µÃ) ÚÔÛ‚ÔÏ‹˜. °È· ÚÒÙË ÊÔÚ¿, ÛÙÔ 401 °ÂÓÈÎfi ™ÙÚ·ÙȈÙÈÎfi ¡ÔÛÔÎÔÌ›Ô, ‰ËÌÈÔ˘ÚÁ‹ıËΠÙ¤Ú˘Á· ‚ÈÔÚÔÛÙ·Û›·˜ ÁÈ· ÂÚÈÛÙ·ÙÈο ˘„ËÏ‹˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜, ÂÓÒ ÛËÌ·ÓÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ó·Ù‡ÛÛÂÈ Î·È Ë ™¯ÔÏ‹ ¶˘ÚËÓÈ΋˜ µÈÔÏÔÁÈ΋˜ Î·È ÃËÌÈ΋˜ ÕÌ˘Ó·˜ Ù˘ ¶ÔÏÂÌÈ΋˜ ∞ÂÚÔÔÚ›·˜ (™.¶.À.µ.π.Ã.∞.), ÛÙȘ ÂÁηٷÛÙ¿ÛÂȘ ÙÔ˘ 251 °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∞ÂÚÔÔÚ›·˜. ∂›Û˘, Ì ·ÊÔÚÌ‹ ÙËÓ ·ÁÎfiÛÌÈ· ÎÈÓËÙÔÔ›ËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂȉËÌ›·˜ ÙÔ˘ SARS, ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó Û °ÂÓÈο ¡ÔÛÔÎÔÌ›· Ù˘ ∞ÙÙÈ΋˜, ı¿Ï·ÌÔÈ Ì ÂÍÔÏÈÛÌfi ·ÚÓËÙÈ΋˜ ›ÂÛ˘ Î·È ·˘ÙfiÓÔÌÔ ÂÍ·ÂÚÈÛÌfi. ™ÙËÓ OÏ˘Ìȷ΋ ÀÁÂÈÔÓÔÌÈ΋ ªÔÓ¿‰· ·Ó·Ì¤ÓÂÙ·È Ó· ÂÎ·È‰Â˘ÙÔ‡Ó Î·È Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ·ÛÙ˘ÓÔÌÈÎÔ›, ˘ÚÔÛ‚¤ÛÙ˜, ÓÔÛËÏÂ˘Ù¤˜, È·ÙÚÔ› ‰È·ÊfiÚˆÓ ÂȉÈÎÔًوÓ, ηıÒ˜ Î·È ˘¿ÏÏËÏÔÈ ÊÔÚ¤ˆÓ Ô˘ ÂÌϤÎÔÓÙ·È ÛÙÔ˘˜ ÙÔÌ›˜ ·ÛÊ¿ÏÂÈ·˜ Î·È ˘Á›·˜. ∞Ó¿ÏÔÁË ÌÔÓ¿‰· ·ÓÙÈÌÂÙÒÈÛ˘ ‚ÈÔÏÔÁÈ΋˜ ‹ ¯ËÌÈ΋˜ ·ÂÈÏ‹˜ ·Ó·Ù‡ÛÛÂÈ Î·È ÙÔ ¶˘ÚÔÛ‚ÂÛÙÈÎfi ™ÒÌ·. øÛÙfiÛÔ, ‰È·Ê·›ÓÂÙ·È Ë ‡·ÚÍË ÛËÌ·ÓÙÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ ÛÙÔÓ ·Ú¯ÈÎfi ÛÙÚ·ÙËÁÈÎfi ۯ‰ȷÛÌfi, ηıÒ˜ ‰ÂÓ ÂÏ‹ÊıËÛ·Ó ˘’ fi„ÈÓ ÔÈ È‰ÈÔÌÔÚʛ˜ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, Ô ÔÔ›Ô˜ ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛ‚ÏËı› ‰˘Û·Ó¿ÏÔÁ· Û ÂÚ›ÙˆÛË Â›ıÂÛ˘. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙ· OÏ˘Ìȷο ¡ÔÛÔÎÔÌ›· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ‰‡Ô ¡ÔÛÔÎÔÌ›· ¶·›‰ˆÓ Ù˘ ∞ı‹Ó·˜, ÛÙËÓ OÏ˘Ìȷ΋ ÀÁÂÈÔÓÔÌÈ΋ ªÔÓ¿‰· ‰ÂÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ·È‰›·ÙÚÔÈ, ÂÓÒ ÛÙÔÓ Û¯Â‰È·ÛÌfi ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂӉ¯fiÌÂÓ˘ ‚ÈÔ¯ËÌÈ΋˜ ·ÂÈÏ‹˜ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·Ì›· ¶·È‰È·ÙÚÈ΋ ªÔÓ¿‰· Ù˘ ∞ÙÙÈ΋˜. °È·Ù› Ù· ·È‰È¿ ÎÈÓ‰˘ÓÂ‡Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ; ™Â ÂÚ›ÙˆÛË ·ÂÏ¢ı¤ÚˆÛ˘ ‚ÈÔÏÔÁÈÎÒÓ ‹ ¯ËÌÈÎÒÓ fiψÓ, Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ı· ÌÔÚÔ‡Û ӷ Ï¿‚ÂÈ ‰˘Û·Ó¿ÏÔÁ· ÌÂÁ¿Ï˜ ‰È·ÛÙ¿ÛÂȘ, ÂÍ·ÈÙ›·˜ Ì›·˜ ÛÂÈÚ¿˜ ·Ú·ÁfiÓÙˆÓ Î·È Ì˯·ÓÈÛÌÒÓ Ô˘ ‰È·ÊÔÚÔÔÈÔ‡Ó Ù· ·È‰È¿-ı‡Ì·Ù· ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓÔ Î·Ù¿ ÏÂÙfi ·ÂÚÈÛÌfi, Ì ·ÔÙ¤ÏÂÛÌ· Ë ·ÔÚÚfiÊËÛË ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· ¯ËÌÈÎÒÓ ·ÂÚ›ˆÓ, fiˆ˜ ÙÔ sarin Î·È Ë Ê·ÈÓÙ·Ó‡ÏË, ‹ ·ÂÚÈÔÔÈËÌ¤ÓˆÓ ‚ÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ô ¿Óıڷη˜, Ó· Â›Ó·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∂ÈϤÔÓ, ·¤ÚÈ· fiˆ˜ Ë ¯ÏˆÚ›ÓË Î·È ÙÔ sarin ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙË Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÎÔÓÙ¿ ÛÙÔ ¤‰·ÊÔ˜, ‰ËÏ·‰‹ ÏËÛȤÛÙÂÚ· ÛÙËÓ ·Ó·Ó¢ÛÙÈ΋ ˙ÒÓË ÌÈÎÚÒÓ ·È‰ÈÒÓ. ∏ ÌÂÁ·Ï‡ÙÂÚË ‰È·ÂÚ·ÙfiÙËÙ· Î·È Ë ÌÂȈ̤ÓË ÎÂÚ·ÙÈÓÔÔ›ËÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË

July August 04

07-10-04

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¶·È‰È·ÙÚÈ΋ 2004;67:225-240

ÌÂÁ·Ï‡ÙÂÚË ¤ÎıÂÛË Û ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÔÚÚÔÊÒÓÙ·È ‰È·‰ÂÚÌÈο, fiˆ˜ ÊÏ˘ÎÙ·ÈÓÔÁfiÓ· Î·È ‰È·‚ÚˆÙÈο. O ·˘ÍË̤ÓÔ˜ ÏfiÁÔ˜ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÚÔ˜ ÙË Ì¿˙· ÛÒÌ·ÙÔ˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÛËÌ·ÓÙÈ΋ ˘ÔıÂÚÌ›·, Â¿Ó Ë ÚÔÛ¿ıÂÈ· ·ÔÌ¿ÎÚ˘ÓÛ˘ ÙÔ˘ ‚Ï·ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (Û˘Ó‹ıˆ˜ Ì ÂÎÙfiÍ¢ÛË ÓÂÚÔ‡ ˘fi ›ÂÛË) ‰ÂÓ Ï¿‚ÂÈ ¯ÒÚ· Û ÂÏÂÁ¯fiÌÂÓÔ ÂÚÈ‚¿ÏÏÔÓ, Ì ¯Ú‹ÛË ıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ. ∏ Èı·ÓfiÙËÙ· ·Ê˘‰¿ÙˆÛ˘ ‹ Î·È Î·Ù·ÏËÍ›·˜ Â›Ó·È ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ·È‰È¿, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÚÔηÏÔ‡Ó Û˘Ó¯›˜ Â̤ÙÔ˘˜ ‹ ‰È¿ÚÚÔȘ. ∂ÈϤÔÓ, ÔÈ ÎÈÓËÙÈΤ˜ ȉÈÔÌÔÚʛ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ηıÈÛÙÔ‡Ó ‰‡ÛÎÔÏË ÙË ‰È·Ê˘Á‹ ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔÓ ¯ÒÚÔ Ù˘ ·ÂÈÏ‹˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ·fi ÚÔÛˆÈÎfi Ô˘ ¯ÚËÛÈÌÔÔÈ› ÚÔÛٷ٢ÙÈÎfi ÂÍÔÏÈÛÌfi, Ô ÔÔ›Ô˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÛÙËÓ ÂÚ›ÙˆÛË Ù¤ÙÔÈˆÓ ÁÂÁÔÓfiÙˆÓ, ÌÔÚ› Ó· ·Ô‰Âȯı› ȉȷ›ÙÂÚ· ‰‡ÛÎÔÏË. O ÚÔÛٷ٢ÙÈÎfi˜ ÂÍÔÏÈÛÌfi˜ Â›Ó·È È‰È·›ÙÂÚ· ÔÁÎ҉˘ Î·È ‰‡Û¯ÚËÛÙÔ˜, ÂÓÒ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Êfi‚Ô Û ÌÈÎÚ¿ ·È‰È¿, ¤¯ÔÓÙ·˜ Û·Ó Û˘Ó¤ÂÈ· ÙË ‰˘ÛÎÔÏ›· ÛÙËÓ ÂÎÙ¤ÏÂÛË È·ÙÚÈÎÒÓ Ú¿ÍÂˆÓ (∂ÈÎfiÓ· 1). ∆¤ÏÔ˜, ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ ·Ú·ÁfiÓÙˆÓ, ·ÓÙ›‰ÔÙˆÓ Î·È Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ Ô˘ Â›Ó·È Èı·Ófi Ó· ¯ÚÂÈ·ÛÙ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó, ‰ÂÓ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ÔÙ¤ Û ·È‰È¿ ‹ ·ÓÙÂӉ›ÎÓ˘Ù·È Ë ¯Ú‹ÛË ÙÔ˘˜ Û ·˘Ù¿, ÂÓÒ ÁÈ· οÔÈ· ¿ÏÏ· ‰ÂÓ ¤¯Ô˘Ó ÔÚÈÛÙ› ·ÛÊ·Ï›˜ ‹ ıÂÚ·¢ÙÈΤ˜ ‰fiÛÂȘ (9-13). µπO§O°π∫OI ¶∞ƒA°O¡∆∂™ ∆Ô 2000, ÙÔ ∫¤ÓÙÚÔ ∂ϤÁ¯Ô˘ Î·È ¶ÚfiÏ˄˘ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∏¶∞ (CDC, www.cdc.gov) Û˘ÁÎÚfiÙËÛ ÔÌ¿‰· ÂÚÁ·Û›·˜, Ì ÛÎÔfi Ó· ηıÔÚÈÛÙÔ‡Ó ÔÈ ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›· Î·È ·ÛÊ¿ÏÂÈ·

∂ÈÎfiÓ· 1. ∆Ô ÚÔÛˆÈÎfi Ô˘ ÂÌϤÎÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‚ÈÔÏÔÁÈ΋˜ ‹ ¯ËÌÈ΋˜ Â›ıÂÛ˘ ı· Ú¤ÂÈ ˘Ô¯ÚˆÙÈο Ó· ʤÚÂÈ ÚÔÛٷ٢ÙÈÎfi ÂÍÔÏÈÛÌfi (¶ËÁ‹: ¶˘ÚÔÛ‚ÂÛÙÈÎfi ™ÒÌ· ∂ÏÏ¿‰·˜, ·fi ¿ÛÎËÛË ÙÔ˘ ™ÒÌ·ÙÔ˜).

Paediatriki 2004;67:225-240

(14,15). ªÂ ‚¿ÛË Û˘ÁÎÂÎÚÈ̤ӷ ÎÚÈÙ‹ÚÈ·, fiˆ˜ Ë Â˘ÎÔÏ›· ‰È·ÛÔÚ¿˜ Î·È ÌÂÙ¿‰ÔÛ˘ ·fi ¿ÙÔÌÔ Û ¿ÙÔÌÔ, Ë ıÓËÙfiÙËÙ· Î·È Ë Â›ÙˆÛË ÛÙË ¢ËÌfiÛÈ· ÀÁ›·, Ë ÈηÓfiÙËÙ· ÚfiÎÏËÛ˘ ·ÓÈÎÔ‡ Î·È ÎÔÈÓˆÓÈ΋˜ ·Ó·Ù·Ú·¯‹˜ Î·È Ë ·Ó·ÁηÈfiÙËÙ· ·Ó¿Ï˄˘ ÂȉÈ΋˜ ‰Ú¿Û˘ ·fi ÙȘ ˘ÁÂÈÔÓÔÌÈΤ˜ ·Ú¯¤˜, ÔÈ ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û 3 ηÙËÁÔڛ˜ (A, B Î·È C). ø˜ ϤÔÓ ÂÈΛӉ˘ÓÔÈ (ηÙËÁÔÚ›· ∞) ıˆڋıËÎ·Ó Ô ¿Óıڷη˜, Ë Â˘ÏÔÁÈ¿, Ë ·ÓÒÏË, Ë ÙÔ˘Ï·Ú·ÈÌ›·, Ë ·ÏÏ·ÓÙ›·ÛË Î·È ÔÈ ÈÔÁÂÓ›˜ ·ÈÌÔÚÚ·ÁÈÎÔ› ˘ÚÂÙÔ›. ™ÙËÓ Î·ÙËÁÔÚ›· µ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÔÙÂÏÔ‡Ó ‹ÛÛÔÓÔ˜ ÛËÌ·Û›·˜ ·ÂÈÏ‹, ÂÓÒ ÛÙËÓ Î·ÙËÁÔÚ›· C Ù·ÍÈÓÔÌ‹ıËÎ·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÔÙÂϤÛÔ˘Ó ÛËÌ·ÓÙÈ΋ ·ÂÈÏ‹ ÛÙÔ Ì¤ÏÏÔÓ (¶›Ó·Î·˜ 1). ™ÙÔÓ ¶›Ó·Î· 2 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹Ú˜, ÔÈ ÚÔÙÂÈÓfiÌÂÓÔÈ ÙÚfiÔÈ ·ÔÌfiÓˆÛ˘ Î·È ÚÔʇϷ͢, Ë ÌÂıÔ‰ÔÏÔÁ›· ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Î·È ÔÈ ıÂÚ·¢ÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ηÙËÁÔÚ›·˜ ∞. ∂ÈÛËÌ·›ÓÂÙ·È Ë ÂÈÏÔÁ‹ ÙˆÓ ÎÈÓÔÏÔÓÒÓ Î·È ÙˆÓ ÙÂÙڷ΢ÎÏÈÓÒÓ ˆ˜ ıÂÚ·›· ÚÒÙ˘ ÂÎÏÔÁ‹˜ ÛÙË ıÂÚ·›· Î·È ¯ËÌÂÈÔÚÔʇϷÍË ·È‰ÈÒÓ Ì ¿Óıڷη, ·ÓÒÏË Î·È ÙÔ˘Ï·Ú·ÈÌ›·. ∞Ó Î·È ÛÙÔ ·ÚÂÏıfiÓ ˘‹ÚÍ·Ó ÛËÌ·ÓÙÈΤ˜ ÂÈÊ˘Ï¿ÍÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ¯Ú‹ÛË ÙÔ˘˜ Û ·È‰È¿, ÚfiÛÊ·Ù·, ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·Ó·ÊÔÚÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÚÔÙ›ÓÂÈ ÙË ¯Ú‹ÛË ¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ‚ÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ù¿ CDC (ÚÔÛ·ÚÌÔÁ‹ Ì ‚¿ÛË ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ 6, 14, URL: www.bt.cdc.gov) ∫·ÙËÁÔÚ›· ∞ I. ÕÓıڷη˜ II. ¶·ÓÒÏË III. ∂˘ÏÔÁÈ¿ IV. ∆Ô˘Ï·Ú·ÈÌ›· V. ∞ÏÏ·ÓÙ›·ÛË VI. πÔÁÂÓ›˜ ·ÈÌÔÚÚ·ÁÈÎÔ› ˘ÚÂÙÔ› (Ebola, Marburg, Lassa, Machupo Î.¿.) ∫·ÙËÁÔÚ›· µ I. µÚԢΤÏψÛË II. ∆ÔÍ›ÓË ∂ ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ perfrigens III. ∆ÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ (›‰Ë salmonella, shigella, Escherichia coli O157:∏7) IV. ª¿ÏÏ˘ (burkholderia mallei) V. ªÂÏÏÈÔ›‰ˆÛË (burkholderia pseudomallei) VI. æÈÙٿΈÛË VII. ¶˘ÚÂÙfi˜ Q VIII. ∆ÔÍ›ÓË ricin (ÚÈΛÓË) IX. ™Ù·Ê˘ÏÔÎÔÎÎÈ΋ ÂÓÙÂÚÔÙÔÍ›ÓË µ X. ƒÈÎÂÙÛÈÒÛÂȘ (rickettsia prowazekii) XI. πÔÁÂÓ›˜ ÂÁÎÂÊ·Ï›Ùȉ˜ (›ÂÈÔ˜ ÂÁÎÂÊ·Ï›Ùȉ· µÂÓÂ˙Ô˘¤Ï·˜, ·Ó·ÙÔÏÈ΋ ›ÂÈÔ˜ ÂÁÎÂÊ·Ï›Ùȉ·, ‰˘ÙÈ΋ ›ÂÈÔ˜ ÂÁÎÂÊ·Ï›Ùȉ·) XII. À‰·ÙÔÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜ (.¯. vibrio cholerae, cryptosporidium parvum) ∫·ÙËÁÔÚ›· C I. ∞Ó·‰˘fiÌÂÓ˜ ·ÂÈϤ˜, fiˆ˜ Èfi˜ Nipah Î·È hantavirus

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™˘Ó‹ıÂȘ

∞ÂÚÔÁÂÓÒ˜, ̤ۈ ÛÙ·ÁÔÓȉ›ˆÓ, ̤ۈ Â·Ê‹˜

ª¤Ûˆ ÛÙ·ÁÔÓȉ›ˆÓ, ̤¯ÚÈ ÙËÓ 3Ë Ë̤ڷ ıÂÚ·›·˜

™˘Ó‹ıÂȘ ̤ıÔ‰ÔÈ, ÌË Â·Ê‹ Ì ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜

¶Ó¢ÌÔÓÈ΋ ÌÔÚÊ‹: ¶˘ÚÂÙfi˜ Ì ·ÈÊÓ›‰È· ¤Ó·ÚÍË, ı·Ó·ÙËÊfiÚ· Ó¢ÌÔÓ›· (·/· ıÒڷη: ‰ÈËı‹ÛÂȘ Î·È ˘Ï·›· ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·) ∆˘ÊÔÂȉ‹˜ ÌÔÚÊ‹: ¶˘ÚÂÙfi˜, ηÎԉȷıÂÛ›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜

™ÈÚÔÊÏÔÍ·Û›ÓË [10-15 mg/kg (max 500 mg) PO x 2/24 h, x 60 Ë̤Ú˜] ‹ ¢Ô͢΢ÎÏ›ÓË [2,5 mg/kg (max 100 mg) PO x 2/24 h x 60 Ë̤Ú˜] ‹ ∞ÌÔ͢ÎÈÏÏ›ÓË [80 mg/kg/24 h: 3, PO, ·Ó ÙÔ Û٤ϯԘ ·Ô‰Âȯı› ¢·›ÛıËÙÔ] ∂Ì‚fiÏÈÔ (¤ÁÎÚÈÛË ·fi FDA ÌfiÓÔ ÁÈ· ËÏÈ˘ 18-65 ÂÙÒÓ, ‰È·Ù›ıÂÙ·È ÌfiÓÔ ÁÈ· ÛÙÚ·ÙȈÙÈ΋ ¯Ú‹ÛË)

ÃËÌÂÈÔÚÔʇϷÍË**

™ÙÚÂÙÔÌ˘Î›ÓË [30 mg/kg/24 h: ¢Ô͢΢ÎÏ›ÓË [2,2 mg/kg (max 100 mg) 2, πª x 10-14 Ë̤Ú˜] ‹ PO x 2/24 h x 14 Ë̤Ú˜] ‹ °ÂÓÙ·Ì˘Î›ÓË [2,5 mg/kg IV x ™ÈÚÔÊÏÔÍ·Û›ÓË [15 mg/kg (max 500 3/24 h] x 10-14 Ë̤Ú˜ ‹ mg) PO x 2/24 h x 14 Ë̤Ú˜] ™ÈÚÔÊÏÔÍ·Û›ÓË*** ∂Ì‚fiÏÈÔ Ì ˙ÒÓÙ˜ ÂÍ·ÛıÂÓË̤ÓÔ˘˜ [10-15 mg/kg (max 500 mg) ÔÚÁ·ÓÈÛÌÔ‡˜, ÛÙÔ ÛÙ¿‰ÈÔ ·ÍÈÔÏfiÁËÛ˘ πV x 2/24 h x 10-14 Ë̤Ú˜] ‹ ¢Ô͢΢ÎÏ›ÓË [2,2 mg/kg (max 100 mg) IV x 2/24 h x 10-14 Ë̤Ú˜] ‹ ÃψڷÌÊ·ÈÓÈÎfiÏË [15 mg/kg (max 1 g) IV x 4/24 h x 10-14 Ë̤Ú˜] (ΛӉ˘ÓÔ˜ ˘ÔÙÚÔÒÓ ÁÈ· Ù· ÙÂÏÂ˘Ù·›· 2 Û΢¿ÛÌ·Ù·)

∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÓÙfi˜ 4 ËÌÂÚÒÓ ·fi ÙËÓ ¤ÎıÂÛË ∂ȉÈ΋ ·ÓÔÛÔÛÊ·ÈÚ›ÓË Û ÂÈÏÔΤ˜ ·fi ÙÔ ÂÌ‚fiÏÈÔ Î·È ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜, 0,6 mL/kg IM ÂÓÙfi˜ 3 ËÌÂÚÒÓ ·fi ÙËÓ ¤ÎıÂÛË

™ÙÚÂÙÔÌ˘Î›ÓË [30 mg/kg/24 h: ¢Ô͢΢ÎÏ›ÓË [2,2 mg/kg (max 100 mg) 2, πª x 10 Ë̤Ú˜] PO x 2/24 h x 10 Ë̤Ú˜] ‹ °ÂÓÙ·Ì˘Î›ÓË [2,5 mg/kg IV x ™ÈÚÔÊÏÔÍ·Û›ÓË [20 mg/kg (max 500 3/24 h] ‹ mg) PO x 2/24 h x 10 Ë̤Ú˜] ‹ ¢Ô͢΢ÎÏ›ÓË [2,2 mg/kg ÃψڷÌÊ·ÈÓÈÎfiÏË [25 mg/kg (max 1 g) (max 100 mg) IV x 2/24 h] ‹ PO x 4/24 h x 10 Ë̤Ú˜] ™ÈÚÔÊÏÔÍ·Û›ÓË*** ∂Ì‚fiÏÈÔ [10-15 mg/kg (max 500 mg) πV x 2/24] ‹ ÃψڷÌÊ·ÈÓÈÎfiÏË [15 mg/kg (max 1 g) IV x 4/24 h] (Û ÂÚ›ÙˆÛË ÌËÓÈÁÁ›Ùȉ·˜ ‹ ΢ÎÏÔÊÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜)

™ÈÚÔÊÏÔÍ·Û›ÓË*** [10-15 mg/kg (max 500 mg) πV x 2/24 h] ‹ ¢Ô͢΢ÎÏ›ÓË**** [2,2 mg/kg (max 100 mg) IV x 2/24 h] ‹ (ÂÓÈÎÈÏ›ÓË G Î·È ÛÙÚÂÙÔÌ˘Î›ÓË) ∂Ì‚fiÏÈÔ ·Ó Â›Ó·È ‰È·ı¤ÛÈÌÔ

£ÂÚ·›·

¶Úfi‰ÚÔÌÔ ÂÌ‡ÚÂÙÔ ÛÙ¿‰ÈÔ, ÀÔÛÙËÚÈÎÙÈ΋ ıÂÚ·›· ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ¤Îı˘ÛË Àfi ·Ó¿Ù˘ÍË# ÎËÏȉÔÊ˘Û·ÏÈ‰Ò‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜, ΢ڛˆ˜ ηٿ ÙÔ ÚfiÛˆÔ Î·È ¿ÎÚ·

∂Ì‡ÚÂÙÔ Û‡Ó‰ÚÔÌÔ Ì ٷ¯Â›· ÂͤÏÈÍË Û ı·Ó·ÙËÊfiÚÔ Ó¢ÌÔÓ›· Ì ·ÈÌfiÙ˘ÛË, ¢∂¶, ÛË„·ÈÌ›·

∞Ó·Ó¢ÛÙÈ΋ Ô‰fi˜: ∂Ì‡ÚÂÙÔ Û‡Ó‰ÚÔÌÔ Ì ٷ¯Â›· ÂͤÏÈÍË Û ÌÂÛÔıˆÚ¿ÎÈÔ, ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÚÔÛ‚ÔÏ‹ ÌÂÛÔıˆÚ·Î›Ô˘ (·/· ıÒڷη ± ‰ÈËı‹ÛÂȘ, ‰È‡ڢÓÛË ÌÂÛÔıˆÚ·Î›Ô˘, Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹), ÛË„·ÈÌ›·, ηٷÏËÍ›·, ÌËÓÈÁÁ›Ùȉ· ¢ÂÚÌ·ÙÈ΋ Ô‰fi˜: O˙›‰È· Ô˘ ÂÍÂÏ›ÛÛÔÓÙ·È Û ÊχÎÙ·ÈÓ˜, ¤ÏÎË Î·È, ÙÂÏÈο, Û ̷‡ÚË ÂÛ¯¿Ú· Û˘Óԉ¢fiÌÂÓË ·fi ÙÔÈÎfi Ô›‰ËÌ·

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

¶·È‰È·ÙÚÈ΋ 2004;67:225-240

∫·ÏÏȤÚÁÂÈ·, ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ (Û˘ÁÎfiÏÏËÛË) Î·È ¤ÏÂÁ¯Ô˜ Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û ·›Ì·, Ù‡ÂÏ·, ‰Â›ÁÌ·Ù· ÈÛÙÒÓ Î·È ÔÚfi

∫·ÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹ ‚Ï·‚ÒÓ

7-17 Ë̤Ú˜

∂˘ÏÔÁÈ¿ (Èfi˜ ¢ÏÔÁÈ¿˜)

∫·ÏÏȤÚÁÂÈ· ‹ ¯ÚÒÛË Gram ·›Ì·ÙÔ˜, ∂¡À, Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, Ì˘ÂÏÔ‡, ˘ÏÈÎÔ‡ ‰ÂÚÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ, ·ÓÔÛÔÊıÔÚÈÛÌfi˜, ELISA, PCR

∞ÔÌfiÓˆÛËÚÔʇϷÍË*

13:52

∫·ÏÏȤÚÁÂÈ·, ¯ÚÒÛË Gram ‹ Wright-Giemsa (ÂÈÎfiÓ· ‰›ÎËÓ ÈÓ¤˙·˜), Ag- ELISA (·Ó›¯Ó¢ÛË F1 η„ȉÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘), Ab-ELISA, IFA Û ·›Ì·, Ù‡ÂÏ·, ÏÂÌÊ·‰ÂÓÈÎfi ÈÛÙfi

1-5 Ë̤Ú˜ (Èı·ÓÒ˜ ¤ˆ˜ Î·È 60 Ë̤Ú˜)

ÕÓıڷη˜ (bacillus anthracis)

¢È¿ÁÓˆÛË

07-10-04

¶·ÓÒÏË 2-3 Ë̤Ú˜ (Àersinia pestis)

ÃÚfiÓÔ˜ ÂÒ·Û˘

¶·Ú¿ÁÔÓÙ·˜

¶›Ó·Î·˜ 2. µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ηÙËÁÔÚ›·˜ ∞: ÚÔÙÂÈÓfiÌÂÓ˜ ‰È·ÁÓˆÛÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ, ·ÔÌfiÓˆÛË Î·È ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ (ÚÔÛ·ÚÌÔÁ‹ Ì ‚¿ÛË ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ 3,4,6,9,13,19,20,32,54,55,57,63)

July August 04 ™ÂÏ›‰·228

Paediatriki 2004;67:225-240

1-5 Ë̤Ú˜

∞ÂÚÔÁÂÓÒ˜, ̤ۈ ÛÙ·ÁÔÓȉ›ˆÓ, ̤ۈ Â·Ê‹˜

™˘Ó‹ıÂȘ

¶Úfi‰ÚÔÌÔ ÂÌ‡ÚÂÙÔ ÛÙ¿‰ÈÔ, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ηٷÏËÍ›·, ÔÚʇڷ Î·È ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË

ÀÔÛÙËÚÈÎÙÈ΋ ıÂÚ·›· ƒÈÌ·‚ÈÚ›ÓË (Û ·ÚÂÓ·˚Ô‡˜) 30 mg/kg IV ·Ú¯Èο Î·È ÌÂÙ¿ 15 mg/kg x 4/24 h x 4 Ë̤Ú˜ Î·È ÌÂÙ¿ 7,5 mg/kg x 3/24 h x 6 Ë̤Ú˜

∞˘ÚÂÍ›·, ηÙÈÔ‡Û· ¯·Ï·Ú‹ ™Â Ï‹„Ë ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·Ú¿Ï˘ÛË, ¿ÚÂÛË ÎÚ·ÓÈ·ÎÒÓ Ó‡ڈÓ,ÚfiÎÏËÛË ¤ÌÂÙÔ˘, Á·ÛÙÚÈÎfi˜ ·Ó¤·ÊË ·ÈÛıËÙÈÎfiÙËÙ· Î·È ‰È·‡ÁÂÈ·, ηıÂÙ‹Ú·˜, ηı·ÚÙÈο ı¿Ó·ÙÔ˜ ·fi ·Ú¿Ï˘ÛË Î·È ˘ÔÎÏ˘ÛÌfi˜ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ ÀÔÛÙ‹ÚÈÍË ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ∞ÓÙÈÙÔÍ›ÓË ##

∂Ì‚fiÏÈ· Û ÛÙ¿‰ÈÔ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙÔ USAMRIID ÁÈ· ÙÔÓ ˘ÚÂÙfi Ù˘ ÎÔÈÏ¿‰·˜ Rift, Ù˘ ∞ÚÁÂÓÙÈÓ‹˜ Î·È Ù˘ µÔÏÈ‚›·˜

∫·Ì›· (Ë ·ÓÙÈÙÔÍ›ÓË ‰ÂÓ ¯ÔÚËÁÂ›Ù·È Û ·Û˘Ìو̷ÙÈο ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·ÏÒ˜ ÂÎÙÂı›)

13:52

* ∞ÔÌfiÓˆÛË-ÚÔÊ˘Ï¿ÍÂȘ: ™˘Ó‹ıÂȘ: ¶Ï‡ÛÈÌÔ ¯ÂÚÈÒÓ, Ì¿Ûη, ÚÔÛٷ٢ÙÈο Á˘·ÏÈ¿, ˘‰·ÙÔÛÙÂÁ‹ Á¿ÓÙÈ· (ÌË ·ÔÛÙÂÈڈ̤ӷ), ηٿÏÏËÏÔ˜ ¯ÂÈÚÈÛÌfi˜ ÂȉÒÓ Î·ıËÌÂÚÈÓ‹˜ ¯Ú‹Û˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ (ÈÌ·ÙÈÛÌfi˜, ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù·, ÛÎÔ˘›‰È·), ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ÁÈ· ·ÔÊ˘Á‹ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Ì ·È¯ÌËÚ¿ ·ÓÙÈΛÌÂÓ·. ∞ÂÚÔÁÂÓÒ˜ ÌÂÙ·‰È‰fiÌÂÓ·: ™˘Ó‹ıÂȘ Î·È ÂÈϤÔÓ ·ÔÌÔӈ̤ÓÔ ‰ˆÌ¿ÙÈÔ ·ÚÓËÙÈ΋˜ ›ÂÛ˘ Ì Â͈ÙÂÚÈÎfi ÂÍ·ÂÚÈÛÌfi ‹ ·Ó·Î˘ÎÏÔ‡ÌÂÓÔ ·¤Ú· ̤ۈ Ê›ÏÙÚÔ˘ HEPA, ¯Ú‹ÛË ·Ó·Ó¢ÛÙÈÎÒÓ Û˘Û΢ÒÓ Ï‹ÚÔ˘˜ Î¿Ï˘„˘ Î·È ·ÔÌfiÓˆÛ˘ ·fi ÙÔ ÚÔÛˆÈÎfi. ª¤Ûˆ ÛÙ·ÁÔÓȉ›ˆÓ: ™˘Ó‹ıÂȘ Î·È ÂÈϤÔÓ ·ÔÌÔӈ̤ÓÔ ‰ˆÌ¿ÙÈÔ, ¯Ú‹ÛË Û˘Ó‹ıÔ˘˜ Ì¿Ûη˜ Û ·fiÛÙ·ÛË 1 ̤ÙÚÔ˘ ·fi ÙÔÓ ·ÛıÂÓ‹. ª¤Ûˆ Â·Ê‹˜: ™˘Ó‹ıÂȘ Î·È ÂÈϤÔÓ ·ÔÌÔӈ̤ÓÔ ‰ˆÌ¿ÙÈÔ, ¯Ú‹ÛË Á·ÓÙÈÒÓ Î·È χÛÈÌÔ ¯ÂÚÈÒÓ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛ‹ ÙÔ˘˜, ¯Ú‹ÛË ÚÔÛٷ٢ÙÈÎÒÓ ÂÓ‰˘Ì¿ÙˆÓ Ô˘ Ú¤ÂÈ Ó· ·Ê·ÈÚÔ‡ÓÙ·È ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·ÛıÂÓÔ‡˜. (¶ÚÔÛ·ÚÌÔÁ‹ ·fi American Academy of Pediatrics. Infection control for hospitalized children. In: Pickering LK, editor. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed.

Elk Grove Village (IL). American Academy of Pediatrics; 2000. p. 127-137) ** ∏ ¯ËÌÂÈÔÚÔʇϷÍË Ú¤ÂÈ Ó· ÍÂÎÈÓ‹ÛÂÈ ÌfiÓÔ ÌÂÙ¿ ·fi Ô‰ËÁ›Â˜ ÙˆÓ ·ÚÌfi‰ÈˆÓ ‰ËÌfiÛÈˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ ÊÔÚ¤ˆÓ. ∏ ‰È¿ÚÎÂÈ· Ù˘ ÚÔʇϷ͢ ‰ÂÓ ¤¯ÂÈ Î·ıÔÚÈÛÙ› ÁÈ· ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜. *** ∏ ÛÈÚÔÊÏÔÍ·Û›ÓË ‰ÂÓ Â›Ó·È ÂÁÎÂÎÚÈ̤ÓË ·fi ÙÔ FDA ÁÈ· ¿ÙÔÌ· ËÏÈΛ·˜ <18 ÂÙÒÓ, ·ÏÏ¿ ÂӉ›ÎÓ˘Ù·È Û ÏÔÈÌÒÍÂȘ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹. ∫·Ù¿ ÙËÓ ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ ÙÔ ÊıÈÓfiˆÚÔ ÙÔ˘ 2001, ÙÔ FDA ÛÙȘ ∏¶∞ Û˘Ó¤ÛÙËÛÂ, ÁÈ· ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÌÔÚÊ‹, ÂÈϤÔÓ ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‹ ‰‡Ô ·ÓÙÈ‚ÈÔÙÈÎÒÓ ·fi Ù· ·Ú·Î¿Ùˆ: ÚÈÊ·Ì˘Î›ÓË, ‚·ÓÎÔÌ˘Î›ÓË, ÂÓÈÎÈÏ›ÓË ‹ ·ÌÈÎÈÏÏ›ÓË, ÎÏÈÓ‰·Ì˘Î›ÓË, ÈÌÈÂÓ¤ÌË Î·È ÎÏ·ÚÈıÚÔÌ˘Î›ÓË. ªÔÓÔıÂÚ·›· Ì ÛÈÚÔÊÏÔÍ·Û›ÓË ‹ ‰Ô͢΢ÎÏ›ÓË Û˘ÓÂÛÙ‹ıË ÛÙȘ ‹Ș ‰ÂÚÌ·ÙÈΤ˜ ÌÔÚʤ˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë ÂÓÈÎÈÏ›ÓË G, ·Ó Î·È ·ÔÙÂÏ› ÙÔ Ê¿ÚÌ·ÎÔ ÚÒÙ˘ ÂÎÏÔÁ‹˜ ÁÈ· ÙË Ê˘ÛÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, ı· Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È ˆ˜ Ù¤ÙÔÈÔ ÛÙËÓ ÂÚ›ÙˆÛË ¯Ú‹Û˘ ÙÔ˘ B anthracis ˆ˜ fiÏÔ˘, ÏfiÁˆ Èı·Ó‹˜ ·Ó¿Ù˘Í˘ ·ÓıÂÎÙÈÎfiÙËÙ·˜. ∏ Èı·Ó‹ ·Ó¿Ù˘ÍË ‚-Ï·ÎÙ·Ì·ÛÒÓ Î·ıÈÛÙ¿ ·Î·Ù¿ÏÏËÏË ÙË ¯Ú‹ÛË ÂÓÈÎÈÏ›Ó˘ ‹ ·ÌÈÎÈÏÏ›Ó˘ ˆ˜ ÌÔÓÔıÂÚ·›·. **** OÈ ÙÂÙڷ΢ÎϛӘ ·ÓÙÂӉ›ÎÓ˘ÓÙ·È Û ·È‰È¿ ËÏÈΛ·˜ <8 ÂÙÒÓ, ·ÏÏ¿ Ë ıÂÚ·›· Â›Ó·È ‰ÈηÈÔÏÔÁË̤ÓË Û ÂÈÏÂÁ̤Ó˜ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ. ## ™ÙȘ ∏¶∞ Â›Ó·È ‰È·ı¤ÛÈ̘ Ë ›ÂÈÔ˜ ÙÚȉ‡Ó·ÌË ·ÓÙÈÙÔÍ›ÓË ÙÔ˘ CDC (ÔÚfiÙ˘ÔÈ ∞, µ Î·È ∂, 1 ÊÈ·Ï›‰ÈÔ (10 ml) IV), Ë ›ÂÈÔ˜ ÂÙ·‰‡Ó·ÌË ·ÓÙÈÙÔÍ›ÓË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÕÌ˘Ó·˜ (A-G) Î·È Ë ÂÓÙ·‰‡Ó·ÌË (∞-∂) ·ÓÔÛÔÛÊ·ÈÚ›ÓË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Ù˘ ∫·ÏÈÊfiÚÓÈ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚ÚÂÊÈ΋˜ ·ÏÏ·ÓÙ›·Û˘ (Ù· ÙÂÏÂ˘Ù·›· 2 Û΢¿ÛÌ·Ù· Â›Ó·È ·ÎfiÌ· Û ÂÚ¢ÓËÙÈÎfi ÛÙ¿‰ÈÔ). # ∆Ô π·ÙÚÈÎfi ∂Ú¢ÓËÙÈÎfi πÓÛÙÈÙÔ‡ÙÔ §ÔÈ̈‰ÒÓ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∞ÌÂÚÈηÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ (USAMRIID) ‰ÈÂÚÂ˘Ó¿ ÙË ¯Ú‹ÛË Î·ÙËÁÔÚÈÒÓ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ Ù˘ ¢ÏÔÁÈ¿˜. ∆¤ÛÛÂÚ· Û΢¿ÛÌ·Ù· ‚Ú›ÛÎÔÓÙ·È Û ÂÍÂÏÈÁ̤ÓÔ ÛÙ¿‰ÈÔ ‰ÔÎÈÌÒÓ (·‰ÂÊÔ‚›ÚË, ‰ÈÈ‚ÔÍ›ÏË, ÛȉÔÊÔ‚›ÚË Î·È ÚÈÌ·‚ÈÚ›ÓË). ∫·Ó¤Ó·, ÏËÓ Ù˘ ÚÈÌ·‚ÈÚ›Ó˘, ‰ÂÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Û ·È‰È¿.

∞ÔÌfiÓˆÛË ÈÔ‡ Ì AgELISA, RT-PCR, ·Ó‡ÚÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Ì Ab-ELISA, Û ‚ÈÔÏÔÁÈο ˘ÏÈο

∞Ó·˙‹ÙËÛË ÙÔ͛Ӣ ÛÙÔÓ ÔÚfi Â¿Ó <3 Ë̤Ú˜ ·fi ÙËÓ ¤ÎıÂÛË, ηÏÏȤÚÁÂÈ·, ·Ó·˙‹ÙËÛË ÙÔ͛Ӣ Û ÎfiÚ·Ó· ‹ Á·ÛÙÚÈΤ˜ ÂÎÎÚ›ÛÂȘ, ¤ÏÂÁ¯Ô˜ Ó¢ÚÈ΋˜ ·ÁˆÁÈÌfiÙËÙ·˜, ‚ÈÔÏÔÁÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Û ÔÓÙ›ÎÈ·

07-10-04

πÔÁÂÓ›˜ 4-21 Ë̤Ú˜ ·ÈÌÔÚÚ·ÁÈÎÔ› ˘ÚÂÙÔ› (·ÚÂÓ·˚Ô›, fiˆ˜ ˘ÚÂÙfi˜ Lassa, ÊÈÏÔ˚Ô› fiˆ˜ Ebola, Marburg Î.¿.)

∞ÏÏ·ÓÙ›·ÛË (ÙÔÍ›ÓË ÙÔ˘ clostiridium botulinum)

July August 04 ™ÂÏ›‰·229

¶·È‰È·ÙÚÈ΋ 2004;67:225-240 Paediatriki 2004;67:225-240

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July August 04

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¶·È‰È·ÙÚÈ΋ 2004;67:225-240

ÙÔ˘˜ Û ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ ·È‰È·ÙÚÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (16,17). ™Â ÂÚ›ÙˆÛË ‚ÈÔÏÔÁÈ΋˜ Â›ıÂÛ˘, ÔÈ ÂӉ¯fiÌÂÓ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi ÙË ¯Ú‹ÛË ÙÔ˘˜ ·ÔÙÂÏÔ‡Ó ı¤Ì· ‹ÛÛÔÓÔ˜ ÛËÌ·Û›·˜ Û ۯ¤ÛË Ì ÙË ÓÔÛËÚfiÙËÙ·, ıÓËÙfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë ·ÂÈÏ‹. ¶ÚfiÛÊ·Ù·, ÙÔ FDA ÂÓ¤ÎÚÈÓ ÙË ¯Ú‹ÛË ÛÈÚÔÊÏÔÍ·Û›Ó˘ Î·È ‰Ô͢΢ÎÏ›Ó˘ ˆ˜ ıÂÚ·›· Î·È ¯ËÌÂÈÔÚÔʇϷÍË Û ·È‰È¿ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÙÔÓ ‚¿ÎÈÏÔ ÙÔ˘ ¿Óıڷη ̤ۈ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ Ô‰Ô‡ (18). ∞ÎÔÏÔ˘ı› ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ηÙËÁÔÚ›·˜ ∞ ηٿ CDC, ηıÒ˜ Î·È Û ¤Ó·Ó ·Ú¿ÁÔÓÙ· Ù˘ ηÙËÁÔÚ›·˜ µ Ô˘ ··Û¯fiÏËÛ ÚfiÛÊ·Ù· ÙË ‰ËÌÔÛÈfiÙËÙ·. µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ηÙËÁÔÚ›·˜ ∞ ÕÓıڷη˜ O ¿Óıڷη˜ ÚÔηÏÂ›Ù·È ·fi ÙÔÓ Gram(+) ‚¿ÎÈÏÔ ÙÔ˘ ¿Óıڷη, Ô ÔÔ›Ô˜ Â›Ó·È ÈηÓfi˜, ˘fi ÙË ÌÔÚÊ‹ ÛfiÚÔ˘, Ó· ÂÈ‚ÈÒÛÂÈ ÁÈ· ·Û˘Ó‹ıÈÛÙ· ÌÂÁ¿Ï· ‰È·ÛÙ‹Ì·Ù·. ÷ڷÎÙËÚÈÛÙÈο, ÛfiÚÔÈ Ô˘ ·ÂÏ¢ıÂÚÒıËÎ·Ó ÁÈ· ÂÚ¢ÓËÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Û ‚Ú·¯ÔÓËÛ›‰· ÙˆÓ ·ÎÙÒÓ Ù˘ ™ÎˆÙ›·˜ ÙË ‰ÂηÂÙ›· ÙÔ˘ ’50, ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÓȯÓ‡ÔÓÙ·È ¤ˆ˜ Û‹ÌÂÚ·. ∏ Ê˘ÛÈ΋ ÓfiÛÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰ÂÚÌ·ÙÈ΋, Á·ÛÙÚÂÓÙÂÚÈ΋ Î·È ·Ó·Ó¢ÛÙÈ΋ ÌÔÚÊ‹. OÈ ¯·Ú·ÎÙ‹Ú˜ ÙˆÓ ÛfiÚˆÓ ¿Óıڷη ÙÔ˘˜ ηıÈÛÙÔ‡Ó È‰·ÓÈÎÔ‡˜ ÁÈ· ÌÂÙ·ÊÔÚ¿ ̤ۈ ÙÔ˘ ·¤Ú·. ∏ ‰È·ÛÔÚ¿ ÙÔ˘˜ Û ÂÍ·ÈÚÂÙÈο ÌÂÁ¿Ï˜ ·ÔÛÙ¿ÛÂȘ Ì ¢ÓÔ˚Τ˜ ·ÙÌÔÛÊ·ÈÚÈΤ˜ Û˘Óı‹Î˜, Ë ·ÓıÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ ÛÙȘ ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ ÂȉڿÛÂȘ Î·È Ë ·˘ÍË̤ÓË ıÓËÙfiÙËÙ· Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÌÔÚÊ‹˜ ÙÔ‡˜ ηıÈÛÙÔ‡Ó ÂÍ·ÈÚÂÙÈÎfi ÙÚÔÌÔÎÚ·ÙÈÎfi fiÏÔ (19-22). OÈ ÂÈı¤ÛÂȘ ̤ۈ Ù·¯˘‰ÚÔÌ›Ԣ, ÙÔ ÊıÈÓfiˆÚÔ ÙÔ˘ 2001 ÛÙȘ ∏¶∞, ÚÔοÏÂÛ·Ó 22 ‚‚·ÈˆÌ¤Ó· ‹ ‡ÔÙ· ÎÚÔ‡ÛÌ·Ù·, 5 ÂÎ ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó ı·Ó·ÙËÊfiÚ· (23). øÛÙfiÛÔ, ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈΤ˜ ‹Ù·Ó ÔÈ ·Ú¿Ï¢Ú˜ Û˘Ó¤ÂȘ Ù˘ Â›ıÂÛ˘. O ·ÓÈÎfi˜ Ô˘ ÚÔÎÏ‹ıËΠԉ‹ÁËÛ Û ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙË ˙‹ÙËÛË È·ÙÚÈÎÒÓ ˘ËÚÂÛÈÒÓ. ÃËÌÂÈÔÚÔʇϷÍË ¯ÔÚËÁ‹ıËΠ۠ÂÚÈÛÛfiÙÂÚ· ·fi 30.000 ¿ÙÔÌ·, ÂÓÒ ÌfiÓÔ ÁÈ· ÙÔ ÎÙ‹ÚÈÔ Ù˘ °ÂÚÔ˘Û›·˜ ÛÙËÓ Washington, Ë ·Ôχ̷ÓÛË ‰È‹ÚÎÂÛ ̋Ó˜ Î·È ÎfiÛÙÈÛ 23 ÂηÙÔÌ̇ÚÈ· ‰ÔÏ¿ÚÈ·. ∏ ·Ó·Ó¢ÛÙÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ·ÔÙÂÏ› ÙËÓ ϤÔÓ ÂÈΛӉ˘ÓË. ∆· ı·Ó·ÙËÊfiÚ· ÎÚÔ‡ÛÌ·Ù· ÛÙȘ ∏¶∞ ·ÊÔÚÔ‡Û·Ó ·ÔÎÏÂÈÛÙÈο Û ·˘Ù‹ ÙË ÌÔÚÊ‹, ÂÓÒ Û ·ÂÏ¢ı¤ÚˆÛË ¿Óıڷη ÏfiÁˆ ·Ù˘¯‹Ì·ÙÔ˜ Û ÛÙÚ·ÙȈÙÈ΋ ÂÁηٿÛÙ·ÛË Ù˘ ÚÒËÓ ∂™™¢, ÙÔ 1979, 66 ·fi Ù· 77 ÎÚÔ‡ÛÌ·Ù· ˘‹ÚÍ·Ó ı·Ó·ÙËÊfiÚ· (24). ªÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ÔÈ ÛfiÚÔÈ ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È ·fi Ù· ΢„ÂÏȉÈο Ì·ÎÚÔÊ¿Á·. ∞ÎÔÏÔ˘ı› Ë ·Ó¿Ù˘ÍË ÙˆÓ ‚·Î›ÏˆÓ ηÈ

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Ë ·ÂÏ¢ı¤ÚˆÛË ÙÔÍÈÓÒÓ ÛÙÔ˘˜ ÏÂÌÊ·‰¤Ó˜ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘, Ë ÔÔ›· ÚÔηÏ› ·ÈÌÔÚÚ·ÁÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È ÛË„·ÈÌ›·. O B. anthracis ·Ú¿ÁÂÈ ‰‡Ô ÚˆÙÂ˚ÓÈΤ˜ ÙÔ͛Ә, ÙËÓ ÔȉËÌ·ÙÔÍ›ÓË Î·È ÙË ÓÂÎÚÔÙÔÍ›ÓË. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ê¿Ú̷η Ù· ÔÔ›· ·ÚÂÌÔ‰›˙Ô˘Ó ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ ·fi Ù· ÚÈ‚ÔÛÒÌ·Ù· (fiˆ˜ ÔÈ Ì·ÎÚÔÏ›‰Â˜ Î·È Ë ÎÏÈÓ‰·Ì˘Î›ÓË) ıˆÚËÙÈο ÏÂÔÓÂÎÙÔ‡Ó. ∆· Û˘ÌÙÒÌ·Ù· ÍÂÎÈÓÔ‡Ó 1-6 Ë̤Ú˜ ·fi ÙËÓ ¤ÎıÂÛË, ·Ó Î·È ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›Ô‰Ô˜ ÂÒ·Û˘ ·ÚÎÂÙÒÓ Â‚‰ÔÌ¿‰ˆÓ. ∏ ÓfiÛÔ˜, ·Ú¯Èο, ÚÔ‚¿ÏÏÂÈ ˆ˜ ÌË ÂȉÈÎfi ÂÌ‡ÚÂÙÔ ÓfiÛËÌ·, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ˘ÚÂÙfi, Ì˘·ÏÁ›·, ÎÂÊ·Ï·ÏÁ›· Î·È ‚‹¯·. ∏ ·Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘Ì‚·ÙÒÓ Ì ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (ηٷÚÚÔ‹, Ê·Ú˘ÁÁ·ÏÁ›·, ÂÈÂÊ˘Î›Ùȉ·, ÂͤڢıÚ· ·Ú›ÛıÌÈ·) Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, ÌÂÛÔÏ·‚› ‰È¿ÛÙËÌ· ‡ÊÂÛ˘, ÙÔ ÔÔ›Ô ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ù·¯Â›· Âȉ›ӈÛË, Ì ˘„ËÏfi ˘ÚÂÙfi, ΢¿ÓˆÛË, ‰‡ÛÓÔÈ· Î·È Î·Ù·ÏËÍ›·. ™Â ÔÛÔÛÙfi 50%, Ë ÓfiÛÔ˜ Û˘Óԉ‡ÂÙ·È ·fi ·ÈÌÔÚÚ·ÁÈ΋ ÌËÓÈÁÁ›Ùȉ·. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ ·ÔηχÙÔ˘Ó ‰È¿Ù·ÛË ÌÂÛÔıˆÚ·Î›Ô˘, ÂÎÛÂÛËÌ·Ṳ̂ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÌÂÛÔıˆÚ·Î›Ô˘ ηÈ, ·ÚÎÂÙ¿ Û˘¯Ó¿, Ó¢ÌÔÓÈΤ˜ ‰ÈËı‹ÛÂȘ Î·È Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹. ™Â ·˘Ùfi ÙÔ ÛÙ¿‰ÈÔ, ¯ÚÒÛË Gram Û Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ôηχ„ÂÈ ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi. ∏ ¤ÁηÈÚË ¤Ó·ÚÍË Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È ÎÂÊ·Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜. ∂¿Ó Ë ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ ηı˘ÛÙÂÚ‹ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 48 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË, Ë ıÓËÙfiÙËÙ· ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 95%. ∏ ‰ÂÚÌ·ÙÈ΋ ÌÔÚÊ‹ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂÙ¿ ·fi ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙÔ ‰¤ÚÌ·, ̤ۈ χÛˆ˜ Ù˘ Û˘Ó¤¯ÂÈ¿˜ ÙÔ˘. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂÌÊ¿ÓÈÛË ÎËÏ›‰·˜ ÛÙÔ ÛËÌÂ›Ô ÙÔ˘ ÂÓÔÊı·ÏÌÈÛÌÔ‡, Ë ÔÔ›· ÌÂÙ·ÙÚ¤ÂÙ·È ÛÙ·‰È·Î¿ Û ‚Ï·Ù›‰·, ¤ÏÎÔ˜ ηÈ, ÙÂÏÈο, ÛÙËÓ Ù˘È΋ ÁÈ· ÙË ÓfiÛÔ Ì·‡ÚË ÂÛ¯¿Ú·. ∏ ‚Ï¿‚Ë ÂÚÈ‚¿ÏÏÂÙ·È ·fi Ô›‰ËÌ· ÙˆÓ ÁÂÈÙÔÓÈÎÒÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ¯ˆÚ›˜ ˆÛÙfiÛÔ Û˘ÓÔ‰fi ¢·ÈÛıËÛ›·, ‚ÔËıÒÓÙ·˜ ¤ÙÛÈ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÙË Û˘Ó‹ıË Î˘ÙÙ·Ú›Ùȉ·. ªÂ ÙËÓ ¤Ó·ÚÍË Ù˘ ηٿÏÏËÏ˘ ·ÁˆÁ‹˜, Ë ıÓËÙfiÙËÙ· Ù˘ ÌÔÚÊ‹˜ ·˘Ù‹˜ ·Ú·Ì¤ÓÂÈ ÂÚÈÔÚÈṲ̂ÓË. ∆Ô ÌÔÓ·‰ÈÎfi ·È‰È·ÙÚÈÎfi ÂÚÈÛÙ·ÙÈÎfi ηٿ ÙËÓ Â›ıÂÛË ÙÔ˘ 2001 ÛÙȘ ∏¶∞, ·ÊÔÚÔ‡Û Û ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 7 ÌËÓÒÓ, ÙÔ ÔÔ›Ô ·Ó¤Ù˘Í ¿Óıڷη ηٿ ÙÔ ¿Óˆ ¿ÎÚÔ (25). ∏ ‰ÂÚÌ·ÙÈ΋ ‚Ï¿‚Ë ıˆڋıËΠ·Ú¯Èο ‰‹ÁÌ· ·Ú¿¯Ó˘, ÂÓÒ - ηٿ ÙËÓ ÂͤÏÈÍ‹ Ù˘ - Ë ÓfiÛÔ˜ Û˘Óԉ‡ÙËΠ·fi ·ÈÌfiÏ˘ÛË, ıÚÔÌ‚ÔÂÓ›· Î·È ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ηٷ‰ÂÈÎÓ‡ÔÓÙ·˜ ÙË ‰È·ÊÔÚÂÙÈ΋ ÔÚ›· Ù˘

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¶·È‰È·ÙÚÈ΋ 2004;67:225-240

Ê˘ÛÈ΋˜ ÈÛÙÔÚ›·˜ Ù˘ ÓfiÛÔ˘ ÛÙ· ·È‰È¿ Î·È ÂȂ‚·ÈÒÓÔÓÙ·˜ ÙȘ ·Ú¯ÈΤ˜ ˘Ôı¤ÛÂȘ ÁÈ· ÙËÓ È‰ÈÔÌÔÚÊ›· ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Û ÂÚ›ÙˆÛË ‚ÈÔÏÔÁÈ΋˜ Â›ıÂÛ˘. ¶·ÓÒÏË ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ µ’ ¶·ÁÎÔÛÌ›Ô˘ ¶ÔϤÌÔ˘, Ë π·ˆÓ›· ‰ÈÂÚ‡ÓËÛ ÙË ¯Ú‹ÛË Ù˘ ·ÓÒÏ˘ ˆ˜ ‚ÈÔÏÔÁÈÎfi fiÏÔ, ÂÓÒ ÔÈ ∏¶∞ ‰ÈÂÍ‹Á·Á·Ó ·Ó¿ÏÔÁ· ÂÈÚ¿Ì·Ù· ηٿ ÙË ‰ÂηÂÙ›· ÙÔ˘ ’50, ÛÙÔ Ï·›ÛÈÔ ·Ó¿Ù˘Í˘ ÙÔ˘ ‰ÈÎÔ‡ ÙÔ˘˜ ÂÈıÂÙÈÎÔ‡ ‚ÈÔÏÔÁÈÎÔ‡ ÔÏÔÛÙ·Û›Ô˘ (26). ¶ÚfiÎÂÈÙ·È ÁÈ· ˙ˆÔ·ÓıÚˆÔÓfiÛÔ. ∂›Ó·È ÓfiÛËÌ· ÙˆÓ ÙÚˆÎÙÈÎÒÓ, ÔÓÙÈÎÒÓ Î˘Ú›ˆ˜, ÂÓÒ ÌfiÓÔ ‰Â˘ÙÂÚÔÁÂÓÒ˜ ÚÔÛ‚¿ÏÏÂÈ ÙÔÓ ¿ÓıÚˆÔ. ∞›ÙÈÔ Â›Ó·È Ë ÀÂÚÛ›ÓÈ· Ù˘ ·ÓÒÏÔ˘˜, ¤Ó· Gram(-) ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ÌÈÎÚfi‚ÈÔ. ∏ ÈηÓfiÙËÙ¿ ÙÔ˘ Ó· ÂÈ‚ÈÒÓÂÈ ÂÓÙfi˜ ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ˘Ô‚ÔËı¿ ÙË ‰È·ÛÔÚ¿ ÙÔ˘ ÌÂÙ¿ ·fi ÂÈÛÓÔ‹ ‹ ÂÓÔÊı·ÏÌÈÛÌfi (27). ∏ Ê˘ÛÈ΋ ÓfiÛÔ˜ ÌÔÚ› Ó· Ï¿‚ÂÈ Ó¢ÌÔÓÈ΋ (Â›Ó·È Ë Èı·ÓfiÙÂÚË ÌÔÚÊ‹ ÂÌÊ¿ÓÈÛ˘ Û ÂÚ›ÙˆÛË ‚ÈÔÏÔÁÈ΋˜ ·ÂÈÏ‹˜), ‚Ô˘‚ˆÓÈ΋ ‹ Î·È ÛË„·ÈÌÈ΋ ÌÔÚÊ‹. ÷ڷÎÙËÚÈÛÙÈÎfi Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ÂÍ·ÈÚÂÙÈο ˘„ËÏ‹ ıÓËÙfiÙËÙ·, Ë ÔÔ›· ·ÁÁ›˙ÂÈ ÙÔ 100% ÛÙËÓ Ó¢ÌÔÓÈ΋ ÌÔÚÊ‹, ÂÓÒ ÙÔ 50-75% ÛÙË ‚Ô˘‚ˆÓÈ΋. ∏ ıÂÚ·›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ÙȘ ÚÒÙ˜ 24 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. ∏ ¯ËÌÂÈÔÚÔʇϷÍË ı· Ú¤ÂÈ Ó· ¯ÔÚËÁËı› ÛÙ· ·Û˘Ìو̷ÙÈο ÂÓ ‰˘Ó¿ÌÂÈ ı‡Ì·Ù· Ù˘ ‚ÈÔÏÔÁÈ΋˜ Â›ıÂÛ˘, fiˆ˜ Î·È ÛÙ· ¿ÙÔÌ· ÙÔ˘ ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì Ó¢ÌÔÓÈ΋ ÌÔÚÊ‹. ∂Ì‚fiÏÈÔ, Û ÂÚÈÔÚÈṲ̂Ó˜ ÔÛfiÙËÙ˜, ‰È·ı¤ÙÔ˘Ó ÔÈ ŒÓÔϘ ¢˘Ó¿ÌÂȘ ÙˆÓ ∏¶∞, ÙÔ ÔÔ›Ô ÂÚÈÏ·Ì‚¿ÓÂÈ ÓÂÎڈ̤Ó˜ ˘ÂÚÛ›ÓȘ, ÂÓÒ ¤¯ÂÈ Î·Ù·Û΢·ÛÙ› Î·È ÂÌ‚fiÏÈÔ Ì ˙ÒÛ˜ ÂÍ·ÛıÂÓË̤Ó˜. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ ¤Ó·ÓÙÈ Ù˘ Ó¢ÌÔÓÈ΋˜ ÌÔÚÊ‹˜ ·ÌÊÈÛ‚ËÙÂ›Ù·È (28). ∂˘ÏÔÁÈ¿ ∞ÔÙÂÏ› ÙÚ·ÁÈ΋ ÂÈÚˆÓ›· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ó Î·È Ë Â˘ÏÔÁÈ¿ ÎËÚ‡¯ıËΠÂÎÚÈ˙ˆı›۷ ÓfiÛÔ˜ ÙÔ 1980 ·fi ÙËÓ ¶OÀ, 20 ¯ÚfiÓÈ· ÌÂÙ¿, ÔÈ ˘ÁÂÈÔÓÔÌÈΤ˜ ·Ú¯¤˜ ÙˆÓ ∏¶∞ Î·È Ù˘ ª. µÚÂÙ·Ó›·˜ ÚÔ‚·›ÓÔ˘Ó Û ̷˙ÈΤ˜ ·Ú·ÁÁÂϛ˜ ÂÌ‚ÔÏ›ˆÓ (29) ¤Ó·ÓÙÈ ÂÓfi˜ ‚ÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ ‰È·‚È› ϤÔÓ ÌfiÓÔ Û ÂÚÁ·ÛÙËÚÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. ∏ ¢ÏÔÁÈ¿ - ¤Ï·‚ ÙÔ fiÓÔÌ¿ Ù˘ ηْ ¢ÊËÌÈÛÌfi - ÚÔοÏÂÛ Èı·Ófiٷٷ ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ı·Ó¿ÙÔ˘˜ ·fi ÔÔÈ·‰‹ÔÙ ¿ÏÏË ÓfiÛÔ ÛÙÔ ·ÚÂÏıfiÓ. ∆Ô ·›ÙÈfi Ù˘ Â›Ó·È Ô ÔÌÒÓ˘ÌÔ˜ Èfi˜, Ô ÔÔ›Ô˜ ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ÌÂÁ·Ï‡ÙÂÚÔ˘˜ Û ̤ÁÂıÔ˜ DNA ÈÔ‡˜. ¶ÚfiÛÊ·Ù·, ÂÎÊÚ¿ÛÙËÎ·Ó Êfi‚ÔÈ - Û ·Ó·ÊÔÚ¤˜ ÛÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ·ÏÏ¿ Î·È ÌË ÂȉÈÎfi ∆‡Ô - Û¯ÂÙÈο Ì ÙËÓ Èı·ÓfiÙËÙ· Ó· ‰È·Ù›ıÂÙ·È Ô Èfi˜ Ù˘ ¢ÏÔÁÈ¿˜ ÚÔ˜ ¯Ú‹ÛË Û ‰È¿ÊÔÚ˜ ÙÚÔÌÔÎÚ·ÙÈΤ˜ ÔÚ-

Paediatriki 2004;67:225-240

Á·ÓÒÛÂȘ ·Ó¿ ÙÔÓ ÎfiÛÌÔ. ∞ÚÎÂÙÔ› ·Ú¿ÁÔÓÙ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔ Ó· ·ÔÙÂÏ› Ô Èfi˜ ¤Ó· ÂÏ΢ÛÙÈÎfi fiÏÔ: Ë ·ÓÔÛ›· Ô˘ ÂÍ·ÛÊ·Ï›˙ÂÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ (3-5 ¤ÙË), Ë ÂÓÂÚÁËÙÈ΋ ·ÓÔÛÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ‰È·ÎÔ› ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ ’70, Ù· ·ÁÎfiÛÌÈ· ·Ôı¤Ì·Ù· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÂÚÈÔÚÈṲ̂ӷ, Ë ÌÂÙ·‰ÔÙÈÎfiÙËÙ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ˘„ËÏ‹ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌË ıÂÚ·›·. ∆Ô π·ÙÚÈÎfi ∂Ú¢ÓËÙÈÎfi πÓÛÙÈÙÔ‡ÙÔ §ÔÈ̈‰ÒÓ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∞ÌÂÚÈηÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ (USAMRIID, www.usamriid.army.mil) ‰ÈÂÚÂ˘Ó¿ ÙË ¯Ú‹ÛË Î·ÙËÁÔÚÈÒÓ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ Ù˘ ¢ÏÔÁÈ¿˜. ∆¤ÛÛÂÚ· Û΢¿ÛÌ·Ù· ‚Ú›ÛÎÔÓÙ·È Û ÂÍÂÏÈÁ̤ÓÔ ÛÙ¿‰ÈÔ ‰ÔÎÈÌÒÓ (·‰ÂÊÔ‚›ÚË, ‰ÈÈ‚ÔÍ›ÏË, ÛȉÔÊÔ‚›ÚË Î·È ÚÈÌ·‚ÈÚ›ÓË). øÛÙfiÛÔ, ηӤӷ, ÏËÓ Ù˘ ÚÈÌ·‚ÈÚ›Ó˘, ‰ÂÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Û ·È‰È¿. º˘ÛÈÎfi˜ ÍÂÓÈÛÙ‹˜ ÙÔ˘ ÈÔ‡ Â›Ó·È Ô ¿ÓıÚˆÔ˜. ¢ÂÓ ˘¿Ú¯Ô˘Ó ˘ÁÈ›˜ ÌÈÎÚÔ‚ÈÔÊfiÚÔÈ. ∏ ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ Á›ÓÂÙ·È Ì ÛÙ·ÁÔÓ›‰È·, ·ÂÚÔÁÂÓÒ˜ ηÈ, Û·ÓÈfiÙÂÚ·, ̤ۈ ÙˆÓ ÂÊÂÏΛ‰ˆÓ, ÌÔÏ˘ÛÌ¤ÓˆÓ ÎÏÈÓÔÛÎÂ·ÛÌ¿ÙˆÓ, ·ÓÙÈÎÂÈÌ¤ÓˆÓ ‹ ÎÔÓÈÔÚÙÔ‡. ¶‡ÏË ÂÈÛfi‰Ô˘ ·ÔÙÂÏ› ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· ηÈ, Û·ÓÈfiÙÂÚ·, ÙÔ ‰¤ÚÌ·. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÛÙ·‰›Ô˘ ÂÒ·Û˘, Ô Èfi˜ ·Ó··Ú¿ÁÂÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, Ô‰ËÁÒÓÙ·˜ Û ÚˆÙÔ·ı‹ È·ÈÌ›·. ªÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË ÛÙÔÓ ÛÏ‹Ó· Î·È ÙÔ ‹·Ú, ·ÎÔÏÔ˘ı› ÙÔ ÛÙ¿‰ÈÔ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ È·ÈÌ›·˜ Ô˘ Ô‰ËÁ› ÙÂÏÈο ÛÙËÓ ÎÏ·ÛÈ΋ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∏ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ ·Ú¯›˙ÂÈ Î·Ù¿ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ È·ÈÌ›·˜, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ˘ÚÂÙfi, Ú›ÁË, ¤ÌÂÙÔ, ÎÂÊ·Ï·ÏÁ›·, Ú·¯È·ÏÁ›· Î·È ÂÎÛÂÛËÌ·Ṳ̂ÓË Î·ÎԉȷıÂÛ›·. ∆Ô ÎÏ·ÛÈÎfi ÂÍ¿ÓıËÌ· ÂÌÊ·Ó›˙ÂÙ·È 2-4 Ë̤Ú˜ ·ÚÁfiÙÂÚ·, ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi ÎËÏ›‰Â˜ Ô˘ ÂÎı‡ÔÓÙ·È Û˘ÌÌÂÙÚÈο ÛÙÔ ÚfiÛˆÔ Î·È Ù· ¿ÎÚ·, ÔÈ Ôԛ˜ ÂÍÂÏ›ÛÛÔÓÙ·È ÛÂ Ê˘Û·Ï›‰Â˜ ηÈ, ÙÂÏÈο, Û ÂÊÂÏΛ‰Â˜. ∫·ıÒ˜ ÔÈ ÂÊÂÏΛ‰Â˜ ·Ô›ÙÔ˘Ó, ηٷÏ›Ô˘Ó ‰‡ÛÌÔÚʘ, ·ԯڈ̷ÙÈṲ̂Ó˜ Ô˘Ï¤˜. ∏ Û˘ÌÌÂÙÚÈ΋ ¤Îı˘ÛË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ Û ÚfiÛˆÔ Î·È ¿ÎÚ· Î·È Ë Ê˘ÁfiÎÂÓÙÚÔ˜ ÂÍ¿ψۋ ÙÔ˘, ‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ¿ÏÏ· ÂÍ·ÓıËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë ·ÓÂÌÔ‚ÏÔÁÈ¿, Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÂÓÙÚÔÌfiÏÔ Î·Ù·ÓÔÌ‹ (30). ∏ ıÓËÙfiÙËÙ· Ù˘ ÓfiÛÔ˘ ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 30%, ·ԉȉfiÌÂÓË Û ·ÚÙËÚȷ΋ ˘fiÙ·ÛË, ηٷÏËÍ›· Î·È ÓfiÛÔ ·fi ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù·. ∏ ÚfiÁÓˆÛË Â›Ó·È ‚·Ú‡ÙÂÚË Û ¢·ı›˜ ÔÌ¿‰Â˜ ÙÔ˘ ÏËı˘ÛÌÔ‡, ηıÒ˜ Î·È ÛÙËÓ ·ÈÌÔÚÚ·ÁÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È, ÈÛÙÔÚÈο, ‰‡Ô ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘: Ë “Ì›˙ˆÓ” Î·È Ë “ÂÏ¿ÛÛˆÓ”.

O ‰·Ì·ÏÈÛÌfi˜ Â›Ó·È ÙÔ ÚÒÙÔ ÂÌ‚fiÏÈÔ Ô˘ ·Ó·Î·Ï‡ÊıËΠ(ÙÔ 1798 ·fi ÙÔÓ Jenner) ηÈ, Ì¿ÏÈÛÙ·, Û ÂÔ¯‹ Ô˘ Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó

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¶·È‰È·ÙÚÈ΋ 2004;67:225-240

¿ÁÓˆÛÙÔ˜. OÈ ÈÔ› Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÂÌ‚ÔÏ›Ô˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÎÛÙÚ·Ù›·˜ ÂÎÚ›˙ˆÛ˘ ÙˆÓ ÂÚ·ÛÌ¤ÓˆÓ ‰ÂηÂÙÈÒÓ, ·Ó‹Î·Ó ÛÙÔ Û٤ϯԘ Lister Elstree ÁÈ· ÙËÓ ∂˘ÚÒË Î·È ÛÙÔ Û٤ϯԘ NYCBH (New York City Board of Health) ÁÈ· ÙȘ ∏¶∞ Î·È ÙÔÓ ∫·Ó·‰¿. ∆· ÂÌ‚fiÏÈ· ÂÚÈÂÏ¿Ì‚·Ó·Ó ˙ÒÓÙ· Èfi Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ orthopoxvirus Ô˘ ÌÔÈ¿˙ÂÈ, ·fi ·ÓÙÈÁÔÓÈ΋ ¿Ô„Ë, Ì ÙÔÓ Èfi Ù˘ ¢ÏÔÁÈ¿˜. øÛÙfiÛÔ, Ë ‰È·‰Èηۛ· ·Ú·ÁˆÁ‹˜ (ÌfiÏ˘ÓÛË ÌÔÛ¯·ÚÈÒÓ Î·È ÚÔ‚¿ÙˆÓ Î·È Û˘ÏÏÔÁ‹ ÙÔ˘ ÊÏ˘ÎÙ·ÈÓÒ‰Ô˘˜ ˘ÏÈÎÔ‡) ‰ÂÓ ÏËÚÔ› ÙȘ Û‡Á¯ÚÔÓ˜ ··ÈÙ‹ÛÂȘ. ™‹ÌÂÚ·, Ù· ÂÌ‚fiÏÈ· Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fi ÂͤÏÈÍË ·fi ÙȘ ∞ÌÂÚÈηÓÈΤ˜ ŒÓÔϘ ¢˘Ó¿ÌÂȘ, ·Ó·Ù‡ÛÛÔÓÙ·È Û ηÏÏȤÚÁÂÈ· ÈÛÙÔ‡, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ¤¯Ô˘Ó Ï¿‚ÂÈ ¿‰ÂÈ· ΢ÎÏÔÊÔÚ›·˜. ŒÙÛÈ, ÔÈ ·ÚÌfi‰È˜ ˘ËÚÂۛ˜ ÙˆÓ ∏¶∞ Î·È Ù˘ ª. µÚÂÙ·Ó›·˜ ηٷʇÁÔ˘Ó ÂÎ Ó¤Ô˘ ÛÙ· ·Ï·ÈÔ‡ Ù‡Ô˘ ÂÌ‚fiÏÈ·. [¶ÚfiÛÊ·Ù·, ÙÔ ı¤Ì· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ Ù˘ ¢ÏÔÁÈ¿˜ ÚÔÛ›Ï΢Û ÙÔ ¤ÓÙÔÓÔ ÂӉȷʤÚÔÓ ÌÂÚ›‰·˜ ÙÔ˘ ∆‡Ô˘ Î·È Ù˘ ÎÔÈÓ‹˜ ÁÓÒÌ˘ ÛÙË ª. µÚÂÙ·Ó›·, fi¯È fï˜ ÁÈ· ÏfiÁÔ˘˜ ÂÈÛÙËÌÔÓÈÎÔ‡˜ (31). ∏ ·fiÊ·ÛË ÁÈ· ÚÔÌ‹ıÂÈ· ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÂÌ‚ÔÏ›Ô˘ ηٿ Ù˘ ¢ÏÔÁÈ¿˜, ÂÏ‹ÊıË ˘fi ηıÂÛÙÒ˜ Ì˘ÛÙÈÎfiÙËÙ·˜ Î·È ÂÈÛÎÈ¿ÛÙËΠ·fi ÙËÓ ·ÔÎ¿Ï˘„Ë fiÙÈ Ô ÂÈÎÂÊ·Ï‹˜ Ù˘ ÚÔÌËı‡ÙÚÈ·˜ ÂÙ·ÈÚ›·˜ ÚÔÛ¤ÊÂÚ ÛËÌ·ÓÙÈ΋ ÔÈÎÔÓÔÌÈ΋ ÂÓ›Û¯˘ÛË ÛÙÔ Î˘‚ÂÚÓÒÓ ÎfiÌÌ· ÙˆÓ ∂ÚÁ·ÙÈÎÒÓ, Ï›ÁÔ ÚÈÓ ÙËÓ ˘ÔÁÚ·Ê‹ Ù˘ Û˘Ìʈӛ·˜. ∏ ‚ÚÂÙ·ÓÈ΋ Ì˘ÛÙÈÎfiÙËÙ· ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙËÓ ÚÔÛ¤ÁÁÈÛË Ù˘ ·ÌÂÚÈηÓÈ΋˜ ΢‚¤ÚÓËÛ˘, Ë ÔÔ›· ÚÔ΋ڢÍ ·ÓÔÈÎÙfi ÌÂÈÔ‰ÔÙÈÎfi ‰È·ÁˆÓÈÛÌfi.] °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ·ÓÔÛÔηÙÂÛÙ·Ï̤ӈÓ, ¯ÔÚËÁÂ›Ù·È ÂȉÈ΋ ·ÓÔÛÔÛÊ·ÈÚ›ÓË (VIG) (0,6 ml/kg IM) Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 3 ËÌÂÚÒÓ ·fi ÙËÓ Èı·Ó‹ ¤ÎıÂÛË ÛÙÔÓ Èfi. ∏ ÂÚÈÔÚÈṲ̂ÓË ‰È·ıÂÛÈÌfiÙËÙ·, ÙfiÛÔ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ fiÛÔ Î·È Ù˘ VIG, ÂÁ›ÚÂÈ ·ÓËÛ˘¯›Â˜, ˆÛÙfiÛÔ ·Ó·Ì¤ÓÂÙ·È Û‡ÓÙÔÌ· Ó· ¯ÔÚËÁËı› ¿‰ÂÈ· ΢ÎÏÔÊÔÚ›·˜ ÛÙÔ ˘fi ÂͤÏÈÍË ÂÌ‚fiÏÈÔ. ¶ÚfiÛÊ·Ù˜ ·Ó·ÊÔÚ¤˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ, Û ·Ú·›ˆÛË 1:10, ÙÔ ˘¿Ú¯ÔÓ ÂÌ‚fiÏÈÔ ‰È·ÙËÚ› ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ (32). ™‹ÌÂÚ·, Ë ÂÌÊ¿ÓÈÛË ·ÎfiÌ· Î·È ÂÓfi˜ ÂÚÈÛÙ·ÙÈÎÔ‡ ¢ÏÔÁÈ¿˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ, ·ÔÙÂÏ› ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÁ΢ÌÔÓ› ÛÔ‚·ÚfiÙ·ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. OÈ ··Ú·›ÙËÙ˜ ÚÔÊ˘Ï¿ÍÂȘ Î·È ÔÈ ÂÓ‰ÂÈÎÓ˘fiÌÂÓ˜ ̤ıÔ‰ÔÈ ·ÔÌfiÓˆÛ˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ¿ÌÂÛ·.

OÈ Â·Ê¤˜ Ú¤ÂÈ Ó· ‚Ú›ÛÎÔÓÙ·È ˘fi ÛÙÂÓ‹ ÂÈÙ‹ÚËÛË ÁÈ· ‰È¿ÛÙËÌ· 17 ËÌÂÚÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ‡ÔÙË Â·Ê‹. ™¯Â‰fiÓ ÛÙÔ Û‡ÓÔÏfi Ù˘, Ë ·ÁÎfiÛÌÈ· ÂÚ¢ÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ ·Ó·Ù‡ÛÛÂÙ·È Û‹ÌÂÚ·

232

Paediatriki 2004;67:225-240

Û¯ÂÙÈο Ì ÙËÓ Â˘ÏÔÁÈ¿, ·ÔÙÂÏ› ‰È·‚·ıÌÈṲ̂ÓË, ÛÙÚ·ÙȈÙÈ΋ ˘fiıÂÛË. ∆Ô˘Ï·Ú·ÈÌ›· ∏ francisella tularensis, Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ù˘ ÙÔ˘Ï·Ú·ÈÌ›·˜, Â›Ó·È ¤Ó·˜ ÌÈÎÚfi˜, ·Î›ÓËÙÔ˜, ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˜ Gram(-) ÎÔÎÎÔ‚¿ÎÈÏÔ˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ˙ˆÔÓfiÛÔ, ÂÓÒ Ô ¿ÓıÚˆÔ˜ ÚÔÛ‚¿ÏÏÂÙ·È, ˘fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ̤ۈ ÂÓÔÊı·ÏÌÈÛÌÔ‡ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹ ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ Ì ·›Ì· ‹ ÌÔÏ˘Ṳ̂ÓÔ˘˜ ÈÛÙÔ‡˜ ·Û¯fiÓÙˆÓ ˙ÒˆÓ (Û˘Ó‹ıˆ˜ ÎÔ˘Ó¤ÏÈ· ‹ Ï·ÁÔ›) ‹ ‰‹ÁÌ·Ù· ·Ú·ÛÈÙÈÎÒÓ ÂÓÙfïÓ. ªfiÏ˘ÓÛË Ì¤Ûˆ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‹ Á·ÛÙÚÂÓÙÂÚÈ΋˜ Ô‰Ô‡ ›ӷÈ, Â›Û˘, ÂÊÈÎÙ‹. ∏ ·Ó·Ó¢ÛÙÈ΋ ¤ÎıÂÛË Ì¤Ûˆ ·ÂÚÔÛfiÏ˘ (Û ÂӉ¯fiÌÂÓË Â›ıÂÛË) ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙËÓ Ù˘ÊÔÂȉÈ΋ ÙÔ˘Ï·Ú·ÈÌ›·, ÌÂ Û˘ÓÔ‰fi ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ¿Ù˘Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ˘ÚÂÙfi, ηÎԉȷıÂÛ›· Î·È ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜. ∏ ıÓËÙfiÙËÙ· Ù˘ ÌË ıÂÚ·¢ı›۷˜ Ù˘ÊÔÂȉÈ΋˜ ÌÔÚÊ‹˜ ·Ó¤Ú¯ÂÙ·È Û 35%. O ÔÚÁ·ÓÈÛÌfi˜ ÌÔÚ› Ó· ÂÈ‚ÈÒÛÂÈ ÁÈ· ‚‰ÔÌ¿‰Â˜ ÛÙÔ ¯ÒÌ·, ÙÔ ÓÂÚfi Î·È ÙÔ˘˜ ÈÛÙÔ‡˜ ‹ ·ÎfiÌ· Î·È ¯ÚfiÓÈ· Û ηÙ„˘Á̤ÓÔ ÎÚ¤·˜. ∂ÍÂÏ›¯ıËΠˆ˜ ‚ÈÔÏÔÁÈÎfi fiÏÔ ·fi ÙȘ ∏¶∞ Ì ÙË ÌÔÚÊ‹ ·ÂÚÔÛfiÏ˘, ηٿ ÙË ‰È¿ÚÎÂÈ· ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÈıÂÙÈÎÔ‡ ‚ÈÔÏÔÁÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙˆÓ ‰ÂηÂÙÈÒÓ ’50 Î·È ’60. ∏ ÙÔ˘Ï·Ú·ÈÌ›· ‰ÂÓ Â›Ó·È ÌÂÙ·‰ÔÙÈ΋ Î·È ÈÛ¯‡Ô˘Ó ÔÈ Û˘Ó‹ıÂȘ Ô‰ËÁ›Â˜ ÚÔʇϷ͢ Î·È ·ÔÌfiÓˆÛ˘ (33-36). ∞ÏÏ·ÓÙ›·ÛË OÊ›ÏÂÙ·È Û Ó¢ÚÔÙÔÍ›ÓË Ô˘ ·Ú¿ÁÂÈ ˘fi ·Ó·ÂÚfi‚Ș Û˘Óı‹Î˜ Ô Gram(+) ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ÎψÛÙËÚ›‰ÈÔ Ù˘ ·ÏÏ·ÓÙ›·Û˘ (clostiridium botulinum). OÚÔÏÔÁÈο, ‰È·ÎÚ›ÓÔÓÙ·È 7 ·ÓÙÈÁÔÓÈÎÔ› Ù‡ÔÈ Ù˘ ÙÔ͛Ӣ, ∞ ¤ˆ˜ G. OÈ Ó¢ÚÔÙÔ͛Ә ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó ÙȘ ÈÛ¯˘ÚfiÙÂÚ˜ ÙÔ͛Ә Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›, Ì lethal dose 50 (ÁÈ· ÙËÓ ÙÔÍ›ÓË ∞) 0,001 Ìg/kg [̤ÛË ı·Ó·ÙËÊfiÚÔ˜ ‰fiÛË (lethal dose 50): Ë ‰fiÛË Ô˘ Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜ ÁÈ· ÙÔ 50% ÙˆÓ ÂÈÚ·Ì·Ùfi˙ˆˆÓ Ù˘ ÌÂÏÂÙÔ‡ÌÂÓ˘ ÔÌ¿‰·˜]. ŒÓ· mg Â›Ó·È ÈηÓfi Ó· ÊÔÓ‡ÛÂÈ 20.000 ÔÓÙÈÎÔ‡˜. ∏ Â͈ÙÔÍ›ÓË Î·Ù·ÛÙÚ¤ÊÂÙ·È ÛÙÔ˘˜ 80ÔC ÁÈ· 30 ÏÂÙ¿ ‹ ÛÙÔ˘˜ 100ÔC ÁÈ· 10 ÏÂÙ¿. ¢Ú· ÛÙȘ ÂÚÈÊÂÚÈΤ˜ ¯ÔÏÈÓÂÚÁÈΤ˜ ÚÔÛ˘Ó·ÙÈΤ˜ Ó¢ÚÈΤ˜ ·ÔÏ‹ÍÂȘ, ΢ڛˆ˜ ÛÙË Ó¢ÚÔÌ˘˚΋ Û‡Ó·„Ë, ·ÚÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘ Î·È ÚÔηÏÒÓÙ·˜ ÁÂÓÈÎÂ˘Ì¤ÓË, Û˘ÌÌÂÙÚÈ΋ ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ¤ÎıÂÛË ÛÙË Ó¢ÚÔÙÔÍ›ÓË ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ, Û ‰È¿ÛÙËÌ· Ï›ÁˆÓ ˆÚÒÓ ¤ˆ˜ ËÌÂÚÒÓ. ◊È· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ·‰˘Ó·Ì›·, ‰Èψ›·, ‚ÏÂÊ·ÚfiÙˆÛË, ‰˘Û·ÚıÚ›·, ‰˘ÛηٷÔÛ›·, ·‰˘Ó·Ì›· ‚¿‰ÈÛ˘ ηÈ, ÙÂÏÈο, ı¿Ó·ÙÔ ÏfiÁˆ ¤ÎÙˆÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ

July August 04

07-10-04

13:52

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¶·È‰È·ÙÚÈ΋ 2004;67:225-240

Ì˘ÒÓ. O ·ÛıÂÓ‹˜ ‰È·ÙËÚ› Ê˘ÛÈÔÏÔÁÈ΋ ·ÈÛıËÙÈÎfiÙËÙ· Î·È ÓÂ˘Ì·ÙÈ΋ ‰È·‡ÁÂÈ·. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ¿‚ÂÈ ÙË Ì˘·Ûı¤ÓÂÈ· gravis Î·È ÙÔ Û‡Ó‰ÚÔÌÔ GuillainBarre. ∏ ˘ÔÛÙËÚÈÎÙÈ΋ ıÂÚ·›· Èı·ÓfiÓ ··ÈÙ› Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜, Ô˘ ÌÔÚ› Ó· ‰È·ÚΤÛÂÈ ·ÎfiÌË Î·È Ì‹Ó˜. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ηıÈÛÙ¿ ȉȷ›ÙÂÚ· ÚÔ‚ÏËÌ·ÙÈ΋ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ Û ÂÚ›ÙˆÛË Ì·˙ÈÎÒÓ ÎÚÔ˘ÛÌ¿ÙˆÓ. ™ÙȘ ∏¶∞ Â›Ó·È ‰È·ı¤ÛÈ̘ Ë ›ÂÈÔ˜ ÙÚȉ‡Ó·ÌË ·ÓÙÈÙÔÍ›ÓË ÙÔ˘ CDC (ÔÚfiÙ˘ÔÈ ∞, µ Î·È ∂, 1 ÊÈ·Ï›‰ÈÔ ÙˆÓ 10 ml IV), Ë ›ÂÈÔ˜ ÂÙ·‰‡Ó·ÌË ·ÓÙÈÙÔÍ›ÓË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÕÌ˘Ó·˜ (ÔÚfiÙ˘ÔÈ A ¤ˆ˜ G), Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÔÔ›·˜ Û ·ÓıÚÒÔ˘˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, ηıÒ˜ Î·È Ë ÂÓÙ·‰‡Ó·ÌË (ÔÚfiÙ˘ÔÈ ∞-∂) ·ÓÔÛÔÛÊ·ÈÚ›ÓË Ù˘ ¢È‡ı˘ÓÛ˘ ÀÁ›·˜ Ù˘ ∫·ÏÈÊfiÚÓÈ·, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚ÚÂÊÈ΋˜ ·ÏÏ·ÓÙ›·Û˘, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÛÙ¿‰ÈÔ ÎÏÈÓÈÎÒÓ ‰ÔÎÈÌÒÓ (37,38). πÔÁÂÓ›˜ ·ÈÌÔÚÚ·ÁÈÎÔ› ˘ÚÂÙÔ› ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û Ïԛ̈ÍË ·fi ÚÈ‚Ô˚Ô‡˜ (RNA ÈÔ‡˜). ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ÂÌÊ¿ÓÈÛË ÔÍ›·˜ ÂÌ‡ÚÂÙ˘ Û˘Ó‰ÚÔÌ‹˜, Û˘Óԉ¢fiÌÂÓ˘ ·fi ηÎԉȷıÂÛ›·, ÛËÌ›· ·˘ÍË̤Ó˘ ·ÁÁÂȷ΋˜ ‰È·ÂÚ·ÙfiÙËÙ·˜ Î·È Î˘ÎÏÔÊÔÚÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∞ÈÌÔÚÚ·Á›· ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ÂÌÊ·Ó›˙ÂÙ·È Û¿ÓÈ·, ·Ó Î·È Ë ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË Â›Ó·È Û˘¯Ó‹, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ‚Ï¿‚˘ ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘. ªÂÙ·‰›‰ÔÓÙ·È ÛÙÔÓ ¿ÓıÚˆÔ ÌÂÙ¿ ·fi Â·Ê‹ Ì ÌÔÏ˘Ṳ̂ӷ ˙Ò· ‹ ·ÚıÚfiÔ‰·, Ë ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ ÙˆÓ ÔÔ›ˆÓ ηıÔÚ›˙ÂÈ Û˘¯Ó¿ ÙË ÁˆÁÚ·ÊÈ΋ ÂÓÙfiÈÛË Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ ÔÓÔÌ·ÙÔÏÔÁ›· Ù˘. ¶ÚfiÛÊ·Ù˜ ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂÙ·‚ÔϤ˜ ¤¯Ô˘Ó ÚÔηϤÛÂÈ ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÓıÚÒÈÓˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ. OÈ ÈÔÁÂÓ›˜ ·˘ÙÔ› ·Ú¿ÁÔÓÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏ‹ ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ˘fi ÌÔÚÊ‹ ·ÂÚÔÛfiÏ˘, Û˘Ó‰˘¿˙Ô˘Ó ˘„ËÏ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ· Î·È Ë ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ Û ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ ÙÔ˘˜ ηıÈÛÙ¿ ÈÛ¯˘Úfi ‚ÈÔÏÔÁÈÎfi fiÏÔ. πÔ› ·fi ÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ Arenaviridae, Bunyaviridae, Filoviridae Î·È Flaviviridae ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ˘˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ™ÙÔ˘˜ Arenaviridae (·ÚÂÓ·˚Ô‡˜) Û˘ÁηٷϤÁÔÓÙ·È Ô Èfi˜ ÙÔ˘ ˘ÚÂÙÔ‡ Lassa (Èfi˜ Lassa) (39,40) Î·È ÔÈ ÈÔ› ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÚÂÙÔ‡ Ù˘ ∞ÚÁÂÓÙÈÓ‹˜, Ù˘ µÔÏÈ‚›·˜, Ù˘ µÂÓÂ˙Ô˘¤Ï·˜ Î·È Ù˘ µÚ·˙ÈÏ›·˜ (ÈÔ› Junin, Machupo, Guanarito Î·È Sabia, ·ÓÙ›ÛÙÔȯ·) (41-46). ™ÙÔ˘˜ Bunyaviridae Û˘ÁηٷϤÁÂÙ·È Ô Èfi˜ ÙÔ˘ ˘ÚÂÙÔ‡ Ù˘ ÎÔÈÏ¿‰·˜ Rift (47), ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÂȉËÌ›·˜ ÛÙËÓ ∞ÊÚÈ΋ Ô˘ Û˘Ó‰¤ıËΠ̠·Û˘Ó‹ıÈÛÙË ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÎÔ˘ÓÔ˘ÈÒÓ ÛÙËÓ ÂÚÈÔ¯‹, Ô Èfi˜ ÙÔ˘ ˘ÚÂÙÔ‡ ÙÔ˘ ∫ÔÓÁÎfi Î·È Ù˘

Paediatriki 2004;67:225-240

∫ÚÈÌ·›·˜ (48) Î·È Ô hantavirus Ô˘ ÌÂÙ·‰›‰ÂÙ·È ·fi ÙÚˆÎÙÈο, Ô ÔÔ›Ô˜ ˆÛÙfiÛÔ ‰ÂÓ ÚÔÛʤÚÂÙ·È ÁÈ· ·Ó¿Ù˘ÍË ‚ÈÔÏÔÁÈÎÔ‡ fiÏÔ˘, ÏfiÁˆ Ù˘ Ùˆ¯‹˜ ·Ó··Ú·ÁˆÁ‹˜ ÙÔ˘ Û ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ (49).

OÈ Filoviridae (ÊÈÏÔ˚Ô›) ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ˘˜ ÈÔ‡˜ ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÚÂÙÔ‡ Ebola Î·È ÙÔÓ Èfi Ù˘ ÓfiÛÔ˘ Marburg (50-53). OÈ ÈÔ› ·˘ÙÔ› ‚Ú¤ıËÎ·Ó ÛÙÔ Â›ÎÂÓÙÚÔ Ù˘ ‰ËÌÔÛÈfiÙËÙ·˜ ÏfiÁˆ Ù˘ ÚfiÎÏËÛ˘ ÂÎÚËÎÙÈÎÒÓ - ·ÏÏ¿, Ù·˘Ùfi¯ÚÔÓ·, ÂÚÈÔÚÈÛÌ¤ÓˆÓ ÁˆÁÚ·ÊÈο - ÂȉËÌÈÒÓ. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ÈÔ‡ Ebola, ÔÈ ÂȉËÌÈΤ˜ ÂÍ¿ÚÛÂȘ ÛÙÔ ∑·˝Ú Î·È ÙÔ ™Ô˘‰¿Ó, ÙÔ 1976, Û˘Óԉ‡ÙËÎ·Ó ·fi ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ 92% Î·È 53%, ·ÓÙ›ÛÙÔȯ·. øÛÙfiÛÔ, Ë Î·Ù¿ÛÙ·ÛË ÂȉÂÈÓÒıËΠ·fi ÙËÓ Â·Ó·¯ÚËÛÈÌÔÔ›ËÛË Û˘Ú›ÁÁˆÓ, ‚ÂÏÔÓÒÓ Î·È ÏÔÈÔ‡ ÓÔÛÔÎÔÌÂÈ·ÎÔ‡ ÂÍÔÏÈÛÌÔ‡.

OÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹Ú˜ Ù˘ Û˘Ó‰ÚÔÌ‹˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈ΋˜ ‚Ï¿‚˘ Î·È ÌÂÙ·‚ÔÏÒÓ Ù˘ ·ÁÁÂȷ΋˜ ‰È·ÂÚ·ÙfiÙËÙ·˜. ∆· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Â›Ó·È ÌË ÂȉÈο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÚÂÙfi, Ì˘·ÏÁ›· Î·È Î·ÎԉȷıÂÛ›·. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË ·ÔηχÙÂÈ ¤ÓÂÛË ÂÈÂÊ˘ÎfiÙˆÓ, ‹È· ˘fiÙ·ÛË, ÂÚ‡ıËÌ· ÚÔÛÒÔ˘ Î·È ÂÙ¯ÂÈÒ‰ÂȘ ‚Ï¿‚˜. ™ÙËÓ Ï‹ÚË ¤ÎÊÚ·Û‹ Ù˘, Ë Û˘Ó‰ÚÔÌ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈÎÂ˘Ì¤ÓË ·ÈÌÔÚÚ·Á›· ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ, Ë·ÙÈ΋ ‚Ï¿‚Ë, ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ó¢ÚÈÎÔ‡, ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Î·Ù·ÏËÍ›·, ÂÓÒ Ô ·ÛıÂÓ‹˜ ηٷϋÁÂÈ ·fi ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ·. øÛÙfiÛÔ, Û˘ÁÎÂÎÚÈ̤Ó˜ ÌÔÚʤ˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÚÂÙÔ‡ ‰È·ÙËÚÔ‡Ó Î¿ÔÈ· ÌÔÚÊ‹ ÂÙÂÚÔÁ¤ÓÂÈ·˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ô ˘ÚÂÙfi˜ Lassa, ÛÙÔÓ ÔÔ›Ô Ë ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË Î·È ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Â›Ó·È Û¿ÓȘ, Û ·ÓÙ›ıÂÛË Ì ٷ Û‡Ó‰ÚÔÌ· Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔ˘˜ ·ÚÂÓ·˚Ô‡˜ Ù˘ ¡. ∞ÌÂÚÈ΋˜, fiÔ˘ ÔÈ ÂÈÏÔΤ˜ ·˘Ù¤˜ Â›Ó·È Û˘ÓËıÈṲ̂Ó˜. OÈ ÊÈÏÔ˚Ô› Marburg Î·È Ebola ÚÔηÏÔ‡Ó Û˘¯Ó¿ ÂÎÛÂÛËÌ·Ṳ̂ӷ ÎËÏȉԂϷÙÈ‰Ò‰Ë ÂÍ·Óı‹Ì·Ù· Î·È Î·Ù·Ï‹ÁÔ˘Ó Û ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË (¢∂¶). ∏ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Î˘Ú›ˆ˜ Û˘Ìو̷ÙÈ΋, ÂÓÒ È‰È·›ÙÂÚË ÊÚÔÓÙ›‰· ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÁÈ· ÙË Ì›ˆÛË ÙˆÓ ¯ÂÈÚÈÛÌÒÓ Î·È ÙˆÓ È·ÙÚÈÎÒÓ Ú¿ÍÂˆÓ ÛÙÔ˘˜ ·fiÏ˘Ù· ··Ú·›ÙËÙÔ˘˜, ÏfiÁˆ Ù˘ ·ÁÁÂȷ΋˜ ¢ıÚ·˘ÛÙfiÙËÙ·˜. ¢È¯ÔÁӈ̛· ÂÈÎÚ·Ù› ÛÙÔ ı¤Ì· Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÈÏÔÎÒÓ, Ì ÂÈÎÚ·ÙÔ‡Û· ÙËÓ ¿Ô„Ë Ù˘ ÌË ·Ú¤Ì‚·Û˘ Û ‹Ș, ÌË ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹, ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ. OÈ ‰Â˘ÙÂÚÔ·ı›˜ ÏÔÈÌÒÍÂȘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Î·È Ó· ¯ÔÚËÁÂ›Ù·È Ë·Ú›ÓË Û ÂÚÁ·ÛÙËÚȷο ÂȂ‚·ÈˆÌ¤Ó˜ ÌÔÚʤ˜ ¢∂¶. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘fiÙ·Û˘ Î·È Ù˘ ηٷÏËÍ›·˜ Û˘¯Ó¿ ÂÁ΢ÌÔÓ› ÎÈÓ‰‡ÓÔ˘˜, ηıÒ˜ Ë ·˘ÍË̤ÓË ·ÁÁÂȷ΋ ‰È·ÂÚ·ÙfiÙËÙ· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ٷ¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓÔ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·. ∏

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·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ·ÚÂÓ·˚Ô‡˜ Ì ÚÈÌ·‚ÈÚ›ÓË Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Â¿Ó ·Ú¯›ÛÂÈ ÂÓÙfi˜ 7 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ˘ÚÂÙÔ‡ Ù˘ ∞ÚÁÂÓÙÈÓ‹˜ Î·È Ù˘ µÔÏÈ‚›·˜, ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ì ÂÈÙ˘¯›· Ë ¯ÔÚ‹ÁËÛË Ï¿ÛÌ·ÙÔ˜ ·ÛıÂÓÔ‡˜ Û ·Ó¿ÚÚˆÛË, ÂÊfiÛÔÓ Ë ıÂÚ·›· ·Ú¯›ÛÂÈ ÂÓÙfi˜ 8 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. ∆¤ÏÔ˜, ÂÌ‚fiÏÈ· ‚Ú›ÛÎÔÓÙ·È Û ÛÙ¿‰ÈÔ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙÔ USAMRIID ÁÈ· ÙÔ˘˜ ÈÔ‡˜ ÙÔ˘ ˘ÚÂÙÔ‡ Ù˘ ÎÔÈÏ¿‰·˜ Rift, Ù˘ ∞ÚÁÂÓÙÈÓ‹˜ Î·È Ù˘ µÔÏÈ‚›·˜ (54,55). µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ηÙËÁÔÚ›·˜ µ ƒÈΛÓË (ricin) ∏ ÙÔÍ›ÓË ÚÈΛÓË Â›Ó·È ÚÔ˚fiÓ ÙÔ˘ ÔÏÈÁÔÂÙÔ‡˜ ÔÒ‰Ô˘˜ Ê˘ÙÔ‡ ΛÎȘ (Ô) ‹ Ú›ÎÈÓÔ˜ (Ricinus communis), ·fi ÙÔ ÔÔ›Ô ·Ú¿ÁÂÙ·È ÙÔ Î·ÛÙÔڤϷÈÔ Î·È ÙÔ ÔÔ›Ô Â˘‰ÔÎÈÌ› ÙfiÛÔ ÛÙË ¯ÒÚ· Ì·˜ fiÛÔ Î·È ·ÁÎfiÛÌÈ·. ¶ÚfiÛÊ·Ù·, ˘‹ÚÍ·Ó ·Ó·ÊÔÚ¤˜ ÛÙ· ¢ÈÂıÓ‹ ª¤Û· ∂ÓË̤ڈÛ˘ Û¯ÂÙÈο Ì ÙËÓ ·Ó·Î¿Ï˘„Ë Î·È Î·Ù¿Û¯ÂÛË ·fi ÙȘ ∞Ú¯¤˜ ∞ÛÊ·Ï›·˜, ÛËÌ·ÓÙÈÎÒÓ ÔÛÔÙ‹ÙˆÓ ÚÈΛÓ˘ ÛÙËÓ πÙ·Ï›· Î·È ÙË ª. µÚÂÙ·Ó›·, ÔÈ Ôԛ˜ ÚÔÔÚ›˙ÔÓÙ·Ó ÁÈ· ÙÚÔÌÔÎÚ·ÙÈ΋ ¯Ú‹ÛË (56,57). ∏ ÚÈΛÓË ÌÔÚ› Ó· ·Ú·¯ı› ‡ÎÔÏ· Î·È Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜. ªÔÚ› Ó· ‰È·Û·Ú› Ì ÙË ÌÔÚÊ‹ ·ÂÚÔÛfiÏ˘ Î·È Ó· ÂÈÛ¤ÏıÂÈ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi ‹, ̤ۈ ÌÔÏ˘Ṳ̂Ó˘ ÙÚÔÊ‹˜ ‹ ‡‰·ÙÔ˜, Ó· ÚÔÛ‚¿ÏÏÂÈ ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi. ∏ ‰ËÏËÙËÚ›·ÛË ÌÔÚ› Ó· ·Ԃ› ÌÔÈÚ·›·, ηıÒ˜ ‰ÂÓ ‰È·Ù›ıÂÙ·È ıÂÚ·›· ‹ ·ÓÙ›‰ÔÙÔ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ·Ï¿ ˘ÔÛÙËÚÈÎÙÈ΋. ∂ÈÛÂÚ¯fiÌÂÓË ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi, Ë ÚÈΛÓË ÚÔηÏ› ·‰˘Ó·Ì›·, ˘ÚÂÙfi, ‚‹¯·, ‚ÚÔÁ¯fiÛ·ÛÌÔ Î·È, ÙÂÏÈο, Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·. O ·ÛıÂÓ‹˜ ηٷϋÁÂÈ ÂÓÙfi˜ 3 ËÌÂÚÒÓ. ŸÙ·Ó Ë ‡ÏË ÂÈÛfi‰Ô˘ Â›Ó·È ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÓÙÂÚÈ΋ ·ÈÌÔÚÚ·Á›· Î·È ÔÏ˘ÔÚÁ·ÓÈ΋ ·ÓÂ¿ÚÎÂÈ·. Ã∏ªπ∫Oπ ¶∞ƒA°O¡∆∂™ ∏ ÚÒÙË, ÂÎÙÂٷ̤Ó˘ Îϛ̷η˜, ¯Ú‹ÛË ¯ËÌÈÎÒÓ fiÏˆÓ ¤Ï·‚ ¯ÒÚ· ηٿ ÙÔÓ ∞’ ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ÚÔηÏÒÓÙ·˜ ÂηÙfî˜ ı˘Ì¿ÙˆÓ. ™ÙȘ Ë̤Ú˜ Ì·˜, Ë ÚÒÙË Â›ıÂÛË ·fi ÙÚÔÌÔÎÚ·ÙÈ΋ ÔÚÁ¿ÓˆÛË ¤ÁÈÓ ÙÔ 1995, Ì ÙË ¯Ú‹ÛË ÙÔ˘ ·ÂÚ›Ô˘ sarin ÛÙÔÓ ˘fiÁÂÈÔ ÛȉËÚfi‰ÚÔÌÔ ÙÔ˘ ∆fiÎÈÔ (2). OÈ ÙÔÍÈΤ˜ ÂȉڿÛÂȘ ·fi ÙË ¯Ú‹ÛË ¯ËÌÈÎÒÓ fiÏˆÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔÈΤ˜ ‚Ï¿‚˜ ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÙÔ ‰¤ÚÌ·, ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ Î·È ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ηıÒ˜ Î·È Û˘ÛÙËÌ·ÙÈΤ˜ ‚Ï¿‚˜, ÏfiÁˆ ·ÔÚÚfiÊËÛ˘ ÙÔ˘ ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi ‹ ÙÔ ‰¤ÚÌ·.

OÈ ÁÂÓÈΤ˜ ·Ú¯¤˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ı˘Ì¿ÙˆÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ú¯È΋ ·ÍÈÔÏfiÁËÛË Î·È ‰È·ÏÔÁ‹

234

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(triage) ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡, ¤Ó·ÚÍË Î·Ú‰ÈÔÓ¢ÌÔÓÈ΋˜ ·Ó·˙ˆÔÁfiÓËÛ˘ - ·Ó ··ÈÙÂ›Ù·È - Î·È ·Ôχ̷ÓÛË, ·fi ÚÔÛˆÈÎfi Ô˘ ʤÚÂÈ ÙÔÓ Î·Ù¿ÏÏËÏÔ ÂÍÔÏÈÛÌfi (57,58). ∏ ‰È·‰Èηۛ· Ù˘ ·Ôχ̷ÓÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Ï‹ÚË ·Ê·›ÚÂÛË ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜, Ì›· ·Ï‹ ÂÓ¤ÚÁÂÈ· Ô˘ Â›Ó·È ÈηӋ Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌfiÏ˘ÓÛ˘ ηٿ 80-90%, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ·ÎÔÏÔ˘ı› ÛÙ¿‰ÈÔ ÂÚ·ÈÙ¤Úˆ ·Ôχ̷ÓÛ˘ (59). °È· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¤ÎıÂÛË Û ·ÙÌÔ‡˜, ··ÈÙÂ›Ù·È ÂÈϤÔÓ ÌfiÓÔ χÛÈÌÔ ÎÂÊ·Ï‹˜. ∞ÓÙ›ıÂÙ·, ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¤ÎıÂÛË Û ˘ÁÚ¿, ··ÈÙÂ›Ù·È Ï‹Ú˘ ‰È·‰Èηۛ· ·Ôχ̷ÓÛ˘, Ë ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÂÈ χÛÈÌÔ ‰¤ÚÌ·ÙÔ˜ Î·È ÎÂÊ·Ï‹˜, Ì ‹ÈÔ ÙÚfiÔ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Û·Ô‡ÓÈ Î·È ¿ÊıÔÓÔ ÓÂÚfi, ͤÏ˘Ì· ÙˆÓ ÔÊı·ÏÌÒÓ Ì ¿ÊıÔÓÔ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi Î·È ÚÔÛÂÎÙÈ΋ ‰È·¯Â›ÚÈÛË ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ Î·È ÙˆÓ ÚÔÛˆÈÎÒÓ ·ÓÙÈÎÂÈ̤ӈÓ, Ù· ÔÔ›· ı· Ú¤ÂÈ Ó· ÙÔÔıÂÙÔ‡ÓÙ·È Û ÂȉÈÎÔ‡˜ Û¿ÎÔ˘˜. OÚÈṲ̂Ó˜ ˘ÁÂÈÔÓÔÌÈΤ˜ ·Ú¯¤˜ Û˘ÓÈÛÙÔ‡Ó χÛÈÌÔ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ì ‰È¿Ï˘Ì· ˘ԯψÚÈÒ‰Ô˘˜ Ó·ÙÚ›Ô˘ 0,48% (‰È¿Ï˘Ì· ¯ÏˆÚ›Ó˘ ÙÔ˘ ÂÌÔÚ›Ô˘), ˆÛÙfiÛÔ, ¤¯Ô˘Ó ÂÎÊÚ·ÛÙ› ÂÈÊ˘Ï¿ÍÂȘ, ηıÒ˜ Ô ‰ÂÚÌ·ÙÈÎfi˜ ÂÚÂıÈÛÌfi˜ Ô˘ ÚÔηÏÂ›Ù·È ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, ÙËÓ ·ÔÚÚfiÊËÛË ÙÔ˘ ‚Ï·ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∂ÈϤÔÓ, Ë ÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ÙÔ˘ Û ·È‰È¿ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. ∏ ‰È·¯Â›ÚÈÛË ÙˆÓ ı˘Ì¿ÙˆÓ ÂÁ΢ÌÔÓ› ÛËÌ·ÓÙÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ ÂÌÏÂÎfiÌÂÓÔ ÚÔÛˆÈÎfi, ÙÔ ÔÔ›Ô ı· Ú¤ÂÈ ˘Ô¯ÚˆÙÈο Ó· ʤÚÂÈ ÚÔÛٷ٢ÙÈÎfi ÂÍÔÏÈÛÌfi. π‰·ÓÈο, Ë ·Ú¯È΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ı˘Ì¿ÙˆÓ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È Û ÚÔÂÈÏÂÁ̤ÓÔ˘˜ ¯ÒÚÔ˘˜, fiÔ˘ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÔÈ ··ÈÙÔ‡ÌÂÓ˜ ÁÈ· ÙËÓ ÂÚ›ÛÙ·ÛË ÂȉÈΤ˜ ÌÔÓ¿‰Â˜. ™ÙÔÓ ¶›Ó·Î· 3 ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ‚·ÛÈÎÔ› ¯·Ú·ÎÙ‹Ú˜, Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Î·È ÔÈ ÚÔÙÂÈÓfiÌÂÓÔÈ ÙÚfiÔÈ ·ÓÙÈÌÂÙÒÈÛ˘ ÁÈ· ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ¯ËÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¶·Ú¿ÁÔÓÙ˜ ÓÂ‡ÚˆÓ ¶ÚfiÎÂÈÙ·È ÁÈ· ÔÚÁ·ÓÔʈÛÊÔÚÈο Û˘ÌϤÁÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó ·Ó·ÛÙÔÏ‹ Ù˘ ·ÎÂÙ˘ÏÔ¯ÔÏÈÓÂÛÙÂÚ¿Û˘, ηٿ ÙÚfiÔ ·ÚfiÌÔÈÔ Ì ·˘ÙfiÓ ÙˆÓ ÔÚÁ·ÓÔʈÛÊÔÚÈÎÒÓ ÂÓÙÔÌÔÎÙfiÓˆÓ. Àfi ·˘Ùfi ÙÔ Ú›ÛÌ·, ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ¯ËÌÈÎfi fiÏÔ Ì ÙÔ ÔÔ›Ô Â›Ó·È ϤÔÓ ÂÍÔÈÎÂȈ̤ÓÔ˜ Ô Û‡Á¯ÚÔÓÔ˜ ·È‰›·ÙÚÔ˜. ∏ ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Î·ı›ÛÙ·Ù·È ÌË ·Ó·ÛÙÚ¤„ÈÌË Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ì›· ‰È·‰Èηۛ· Ô˘ Â›Ó·È ÁÓˆÛÙ‹ Î·È ˆ˜ “Á‹Ú·ÓÛË”. ∏ ηÙËÁÔÚ›· ÂÚÈÏ·Ì‚¿ÓÂÈ 10 ·Ú¿ÁÔÓÙ˜ (¶›Ó·Î·˜ 3), ÔÈ ÔÔ›ÔÈ ÚÔηÏÔ‡Ó ÙÔÍÈÎfiÙËÙ· ̤ۈ ÂÈÛÓÔ‹˜, ηٿÔÛ˘ Î·È ‰ÂÚÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ (ÙÔ ÙÂÏÂ˘Ù·›Ô ÂȉÈο ÁÈ· ÙÔÓ VX ‹ Venom X) (60). ∏ Â›‰Ú·ÛË ÛÙËÓ ·ÎÂÙ˘ÏÔ¯ÔÏÈÓÂÛÙÂÚ¿ÛË ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÛÛÒÚ¢ÛË ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘ ÛÙȘ Ó¢ÚÈΤ˜ Û˘Ó¿„ÂȘ,

July August 04

07-10-04

13:52

™ÂÏ›‰·235

¶·È‰È·ÙÚÈ΋ 2004;67:225-240

Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘ ÚÔηÏ› ‰È¤ÁÂÚÛË ÙÔ˘ ¯ÔÏÈÓÂÚÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡. ∆Ô ¯ÔÏÈÓÂÚÁÈÎfi Û‡Ó‰ÚÔÌÔ ‰È·ÎÚ›ÓÂÙ·È Û 3 ÌÔÚʤ˜: ÙËÓ ÎÂÓÙÚÈ΋ (·ÊÔÚ¿ ÛÙÔ ∫¡™), ÙË ÓÈÎÔÙÈÓÈ΋ (·ÊÔÚ¿ ÛÙË Ó¢ÚÔÌ˘˚΋ Û‡Ó·„Ë Î·È ÛÙ· Û˘Ì·ıËÙÈο Á¿ÁÁÏÈ·) Î·È ÙË ÌÔ˘ÛηÚÈÓÈ΋ (·ÊÔÚ¿ ÛÙȘ Ï›˜ Ì˘˚Τ˜ ›Ó˜ Î·È ÛÙÔ˘˜ Â͈ÎÚÈÓ›˜ ·‰¤Ó˜). OÈ ÎÂÓÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘, ÂÍÂÏÈÛÛfiÌÂÓË ÛÙ·‰È·Î¿ Û ϋı·ÚÁÔ Î·È ÎÒÌ·, ·Ù·Í›·, Û·ÛÌÔ‡˜ Î·È ·Ó·Ó¢ÛÙÈ΋ ηٷÛÙÔÏ‹. ∏ ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Ó¢ÚÔÌ˘˚ÎÒÓ Û˘Ó¿„ÂˆÓ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙȘ ÓÈÎÔÙÈÓÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ô‰ËÁ› ÛÂ Ì˘˚Τ˜ ‰ÂÛÌȉÒÛÂȘ Î·È ·‰˘Ó·Ì›·, Ô˘ ÂÍÂÏ›ÛÛÂÙ·È Û ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË, ÂÓÒ ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ÚÔηÏÔ‡Ó Ù·¯˘Î·Ú‰›·, ˘¤ÚÙ·ÛË Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ (˘ÂÚÁÏ˘Î·ÈÌ›·, ˘ÔηÏÈ·ÈÌ›· Î·È ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË). OÈ ÌÔ˘ÛηÚÈÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÚÔηÏÔ‡Ó ÔÊı·ÏÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ (̇ÛË, ıfiψÛË fiÚ·Û˘, ‰·ÎÚ‡ÚÚÔÈ·, ÔÊı·ÏÌÈÎfi ¿ÏÁÔ˜), ·Ó·Ó¢ÛÙÈΤ˜ (ηٷÚÚÔ‹, ‚ÚÔÁ¯fiÛ·ÛÌÔ, ·‡ÍËÛË ‚ÚÔÁ¯ÈÎÒÓ ÂÎÎÚ›ÛˆÓ, ‰‡ÛÓÔÈ·, ΢¿ÓˆÛË), ηډȷÁÁÂȷΤ˜ (‚Ú·‰˘Î·Ú‰›·, ˘fiÙ·ÛË, ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi), ‰ÂÚÌ·ÙÈΤ˜ (ÂÚ‡ıËÌ·, ÂÊ›‰ÚˆÛË), Á·ÛÙÚÂÓÙÂÚÈΤ˜ (ÛÈÂÏfiÚÚÔÈ·, Ó·˘Ù›·, ¤ÌÂÙÔ, ‰È¿ÚÚÔÈ· ÂÍÂÏÈÛÛfiÌÂÓË Û ·ÎÚ¿ÙÂÈ· ÎÔÚ¿ÓˆÓ, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜) Î·È Ô˘ÚÔÁÂÓÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (·ÎÚ¿ÙÂÈ· Ô‡ÚˆÓ, Û˘¯ÓÔ˘Ú›·). ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi, ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÂÈ¤‰ˆÓ ·ÎÂÙ˘ÏÔ¯ÔÏÈÓÂÛÙÂÚ¿Û˘ ÛÙÔ Ï¿ÛÌ· Î·È Ù· ÂÚ˘ıÚÔ·ÙÙ·Ú·. OÈ ‚·ÛÈΤ˜ ·Ú¯¤˜ ·Ôχ̷ÓÛ˘ Î·È ıÂÚ·›·˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 (61,62). ºÏ˘ÎÙ·ÈÓÔÁfiÓ· O ·ÚÈÔ˜ fiÁÎÔ˜ ÙˆÓ ·Ó·ÊÔÚÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙË ÌÔ˘ÛÙ¿Ú‰·, ¤Ó· ΢ÙÙ·ÚÈÎfi ‰ËÏËÙ‹ÚÈÔ Ô˘ ‰Ú· ·Ï΢ÏÈÒÓÔÓÙ·˜ ÙÔ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ DNA. ∂ÎÙfi˜ ·fi ÙÔÓ ∞’ Î·È µ’ ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ÙÔ ·¤ÚÈÔ ÌÔ˘ÛÙ¿Ú‰·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Î·È ÛÙÔÓ fiÏÂÌÔ πÚ¿Ó-πÚ¿Î ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80. ª›· ÌÂϤÙË 14 ·È‰ÈÒÓ-ı˘Ì¿ÙˆÓ ·fi ÙÔ πÚ¿Ó, ÂȂ‚·›ˆÛ ÙË ıˆڛ· ÁÈ· ‚·Ú‡ÙÂÚË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Û ÂÚ›ÙˆÛË ‚ÈÔ¯ËÌÈ΋˜ Â›ıÂÛ˘ (63-65). ¶Ó¢ÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∏ ¯ÏˆÚ›ÓË Î·È ÙÔ ÊˆÛÁ¤ÓÈÔ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ÂÈıÂÙÈο fiÏ· ÛÙÔÓ ∞’ ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ÂÓÒ Û‹ÌÂÚ· ‚Ú›ÛÎÔ˘Ó ·ÚÎÂÙ¤˜ ‚ÈÔÌ˯·ÓÈΤ˜ ÂÊ·ÚÌÔÁ¤˜. ∏ ¯ÏˆÚ›ÓË, ¤Ó· ·ÔÏ˘Ì·ÓÙÈÎfi Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙÔ fiÛÈÌÔ ‡‰ˆÚ Î·È ÙȘ ÈÛ›Ó˜, Û¯ËÌ·Ù›˙ÂÈ ÛÙË Ê˘ÛÈ΋ ÙÔ˘ ÌÔÚÊ‹ ˘ÎÓfi ÎÈÙÚÈÓÔÚ¿ÛÈÓÔ ·¤ÚÈÔ, ÙÔ ÔÔ›Ô ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË Ì¤ÁÈÛÙË ˘ÎÓfiÙËÙ¿ ÙÔ˘ ÎÔÓÙ¿ ÛÙÔ ¤‰·ÊÔ˜ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Â›Ó·È È‰È·›ÙÂÚ· ÂÈΛӉ˘ÓÔ ÁÈ· Ù· ÌÈÎÚ¿ ·È‰È¿.

Paediatriki 2004;67:225-240

∆Ô Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· ÂÌÊ·Ó›˙ÂÙ·È Û¯ÂÙÈο ÚÒÈÌ· (Û 2-4 ÒÚ˜ Û ÛÔ‚·Ú‹ ¤ÎıÂÛË ‹ ·ÎfiÌ· Î·È Û 3060 ÏÂÙ¿ Û ÛÔ‚·ÚfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ). ∆Ô ÊˆÛÁ¤ÓÈÔ ·ÔÙÂÏ› ȉȷ›ÙÂÚ· ‡Ô˘ÏÔ fiÏÔ, ηıÒ˜ ¤¯ÂÈ Û¯ÂÙÈο ¢¯¿ÚÈÛÙË ÔÛÌ‹ (‰›ÎËÓ ÊÚÂÛÎÔÎÔ˘ÚÂ̤Ó˘ ¯Ïfi˘) Î·È Û ‹È· ¤ˆ˜ ̤ÙÚÈ· ÚÔÛ‚ÔÏ‹ ÙÔ ı‡Ì· ·Ú·Ì¤ÓÂÈ ·Ú¯Èο ·Û˘Ìو̷ÙÈÎfi, ·Ú·Ù›ÓÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ¯ÚfiÓÔ ¤ÎıÂÛ˘. ∏ ÂÌÊ¿ÓÈÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ·Ú¯›˙ÂÈ Û 4-6 ÒÚ˜ ·fi ÙËÓ ¤ÎıÂÛË ‹ ·ÎfiÌ· Î·È Û 24 ÒÚ˜ Û ËÈfiÙÂÚ˜ ÚÔÛ‚ÔϤ˜ (63,66). ∆Ô ˘‰ÚÔ΢¿ÓÈÔ (ÁÓˆÛÙ‹ ·fi ÙËÓ ·Ú¯·ÈfiÙËÙ· ÙÔÍÈ΋ Ô˘Û›·) ¤¯ÂÈ ÂÚÈÔÚÈṲ̂Ó˜ ‰˘Ó·ÙfiÙËÙ˜ ÂÊ·ÚÌÔÁ‹˜ ˆ˜ ¯ËÌÈÎfi fiÏÔ, ÏfiÁˆ Ù˘ ȉÈfiÙËÙ¿˜ ÙÔ˘ Ó· ‰È·Û¿Ù·È ÁÚ‹ÁÔÚ· ÛÙÔÓ ·ÙÌÔÛÊ·ÈÚÈÎfi ·¤Ú· Î·È Ù˘ ÌÂȈ̤Ó˘ ıÓËÙfiÙËÙ·˜ Ô˘ ÚÔηÏ›, Û ۯ¤ÛË Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ó‡ڈÓ. øÛÙfiÛÔ, Â¿Ó ·ÂÏ¢ıÂÚˆı› Û ÎÏÂÈÛÙfi ¯ÒÚÔ, ÌÔÚ› Ó· ¤¯ÂÈ Î·Ù·ÛÙÚÔÊÈΤ˜ Û˘Ó¤ÂȘ. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙËÓ Ï‹ÚË ¤ÎÊÚ·Û‹ Ù˘, Â›Ó·È ‚·Ú‡Ù·ÙË. ∏ ıÂÚ·›· ‚·Û›˙ÂÙ·È ÛÙË Ï‹„Ë ˘ÔÛÙËÚÈÎÙÈÎÒÓ Ì¤ÙÚˆÓ Î·È ÛÙË ¯ÔÚ‹ÁËÛË ÓÈÙÚÒ‰Ô˘˜ Ó·ÙÚ›Ô˘ (NaNO2), ÙÔ ÔÔ›Ô ÚÔηÏ› Û¯ËÌ·ÙÈÛÌfi ÌÂı·ÈÌÔÛÊ·ÈÚ›Ó˘, Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘, ÏfiÁˆ ˘„ËÏ‹˜ ¯ËÌÈ΋˜ Û˘ÁÁ¤ÓÂÈ·˜ Ì ÙÔ ˘‰ÚÔ΢¿ÓÈÔ, ÙÔ ·ÚÂÎÙÔ›˙ÂÈ ·fi ÙË Û‡Ó‰ÂÛ‹ ÙÔ˘ Ì ÙËÓ Î˘ÙÔ¯ÚˆÌÈ΋ ÔÍÂȉ¿ÛË. ∏ ·È‰È·ÙÚÈ΋ ‰fiÛË Î·ıÔÚ›˙ÂÙ·È ·fi ÙÔ ‚¿ÚÔ˜ Î·È ·fi ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (¶›Ó·Î·˜ 3). ∆Ô ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ ıÂÚ·›·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ıÂÈÔıÂÈÈÎÔ‡ Ó·ÙÚ›Ô˘ 25% (Na2S2O3), ÙÔ ÔÔ›Ô ÌÂÙ·ÙÚ¤ÂÈ ÙÔ ˘‰ÚÔ΢¿ÓÈÔ ÛÙÔ ÏÈÁfiÙÂÚÔ ÙÔÍÈÎfi Î·È ˘‰·ÙÔ‰È·Ï˘Ùfi ıÂÈÔ΢¿ÓÈÔ. ∆· ‰‡Ô ÚÔ·Ó·ÊÂÚfiÌÂÓ· Û΢¿ÛÌ·Ù· ‰È·Ù›ıÂÓÙ·È ·fi ÙȘ ÀÁÂÈÔÓÔÌÈΤ˜ ∞Ú¯¤˜ ÙˆÓ ∏¶∞ ÛÂ Û˘Û΢·Û›· ¤ÙÔÈÌË ÚÔ˜ ¯Ú‹ÛË. ™ÙËÓ ∂˘ÚÒË, ÚÔÙ›ÓÔÓÙ·È ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋ ·ÁˆÁ‹ Ê¿Ú̷η fiˆ˜ Ë ˘‰ÚÔ͢ÎÔ‚·Ï·Ì›ÓË (Ë ÔÔ›· Ê·›ÓÂÙ·È Ó· ÏÂÔÓÂÎÙ› ÏfiÁˆ Ù˘ ¯·ÌËÏ‹˜ ÙÔÍÈÎfiÙËÙ¿˜ Ù˘) Î·È Ù· ¿Ï·Ù· ÎÔ‚·ÏÙ›Ô˘, ÂÓÒ Û΢¿ÛÌ·Ù· fiˆ˜ ÔÈ ·Ï‰Â˛‰Â˜ Î·È ·Ú¿ÁˆÁ· ·ÌÈÓÔÊ·ÈÓ˘ÏÔÎÂÙfiÓ˘ ‚Ú›ÛÎÔÓÙ·È Û ÛÙ¿‰ÈÔ ÎÏÈÓÈÎÒÓ ‰ÔÎÈÌÒÓ (67). ¢·ÎÚ˘ÁfiÓ· ∫˘ÚÈfiÙÂÚÔÈ ÂÎÚfiÛˆÔÈ Â›Ó·È Ù· ·¤ÚÈ· CS, CN (‹ Mace®) Î·È ÙÔ ÛÚ¤È ÈÂÚÈÔ‡ (ÂÚȤ¯ÂÈ Î·„·˚ΛÓË) (¶›Ó·Î·˜ 3). ∞‰Ú·ÓÔÔÈËÙÈο - ·Ú·ÈÛıËÛÈÔÁfiÓ· ™ÙËÓ Î·ÙËÁÔÚ›· ·Ó‹ÎÔ˘Ó Ô˘Û›Â˜ fiˆ˜ ÙÔ LSD, ÔÈ Î·ÓÓ·‚ÈÓfiϘ, ÔÈ Ê·ÈÓÔıÂÈ·˙›Ó˜ Î·È Ë Ê·ÈÓÙ·Ó‡ÏË, Ì›· Ô˘Û›· ÁÓˆÛÙ‹ ·fi ÙË ¯Ú‹ÛË Ù˘ ˆ˜ ·Ó·ÈÛıËÙÈÎfi. ∏ Ê·ÈÓÙ·Ó‡ÏË, ¤Ó· Û˘ÓıÂÙÈÎfi ÔÈÔÂȉ¤˜, ·Ó‹ÎÂÈ ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‚ÈÔÚ˘ıÌÈÛÙÒÓ, ¤¯ÔÓÙ·˜ ÙËÓ ÈηÓfiÙËÙ· Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ó· ηٷÛÙ¤ÏÏÂÈ, ÌÂٷ͇ ¿ÏψÓ, ÙËÓ ·Ó·ÓÔ‹. ¶ÚfiÛÊ·Ù· ·¤ÎÙËÛÂ

235

236 ∆ÔÍÈÎfiÙËÙ· ∞Ó·ÛÙÔÏ‹ ·ÓÙȯÔÏÈÓÂÛÙÂÚ¿Û˘: ÌÔ˘ÛηÚÈÓÈ΋, ÓÈÎÔÙÈÓÈ΋ ‰Ú¿ÛË Î·È Â›‰Ú·ÛË ÛÙÔ ∫¡™

∞Ï΢ÏÈÔ‡ÓÙ· (ÌÔ˘ÛÙ¿Ú‰·) ∞ÚÛÂÓÈÎfi (Lewisite)

∞Ï΢ÏÈÔ‡ÓÙ· ∞ÂÏ¢ı¤ÚˆÛË HCl Î·È ÂχıÂÚˆÓ ÚÈ˙ÒÓ O2 ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi À‰ÚÔ΢¿ÓÈÔ: ∞Ó·ÛÙÔÏ‹ ΢ÙÔ¯ÚˆÌÈ΋˜ ÔÍÂȉ¿Û˘, ΢ÙÙ·ÚÈ΋ ·ÓÔÍ›· Î·È Á·Ï·ÎÙÈ΋ ÔͤˆÛË

¶·Ú¿ÁÔÓÙ·˜

¶·Ú¿ÁÔÓÙ˜ Ó‡ڈÓ: Tabun (GA), ΢ÎÏÔÂ͢ÏÈÔ‡¯Ô sarin (GF), soman (GD), sarin (GB), GE, VE, VG, V-gas, VM, VX

ºÏ˘ÎÙ·ÈÓÔÁfiÓ·: ∞ÂÛÙ·Á̤ÓË ÌÔ˘ÛÙ¿Ú‰· (HD), Lewisite (L), ·¤ÚÈÔ ÌÔ˘ÛÙ¿Ú‰·˜ (H), ·˙ˆÙÔ‡¯Ô˜ ÌÔ˘ÛÙ¿Ú‰· (HN-1, 2, 3), ÔÍ›ÌË ÊˆÛÁÂÓ›Ô˘ (CX), ·Èı˘Ï‰È¯ÏˆÚÔ·ÚÛÂÓÈÎfi (ED), Lewisite 1, 2, 3 (L1, 2, 3), ÌÂı˘Ï‰È¯ÏˆÚÔ·ÚÛÂÓÈÎfi (MD), ÌÔ˘ÛÙ¿Ú‰·/ Lewisite (HL), ÌÔ˘ÛÙ¿Ú‰·/ ∆, Ê·ÈÓԉȯψÚÔ·ÚÛÂÓÈÎfi (PD), ÌÔ˘ÛÙ¿Ú‰· Sesqui

¶Ó¢ÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙ˜: ÃψڛÓË (CL), ‰ÈʈÛÁ¤ÓÈÔ (DP), ˘‰ÚÔ΢¿ÓÈÔ (HCN), ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (¡O), ÊıÔÚÈÔ˚ÛÔ‚Ô˘Ù˘ÏÔÎÂÙfiÓË (ƒ∏πµ), ʈÛÁ¤ÓÈÔ (CG), ÎfiÎÎÈÓÔ˜ ʈÛÊfiÚÔ˜ (RP), ıÂÈÈÎfi ÙÚÈÔÍÂȉԯψÚÔıÂÈ˚Îfi Ô͇ (FS), ÙÂÊÏfiÓ Î·È ˘ÂÚÊıÔÚÈÔ˚ÛÔ‚Ô˘Ù˘ÏÔÎÂÙfiÓË (PHIB), ÙÂÙÚ·¯ÏˆÚÈÔ‡¯Ô ÙÈÙ¿ÓÈÔ (FM), ÔÍ›‰ÈÔ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘ (HC)

§ÂÙ¿: ÚÔÛ‚ÔÏ‹ ÔÊı·ÏÌÒÓ, Ê¿Ú˘ÁÁ·, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ flÚ˜: Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· À‰ÚÔ΢¿ÓÈÔ: ¢Â˘ÙÂÚfiÏÂÙ·

∫·ı·Úfi˜ ·¤Ú·˜ ¶Ï‡ÛÈÌÔ ‰¤ÚÌ·ÙÔ˜ Ì ÓÂÚfi

£ÂÈÔıÂÈÈÎfi Ó¿ÙÚÈÔ 25% (Na2S2O3 25%): 1,65 ml/kg (max 50 ml)

™˘Ìو̷ÙÈ΋ °È· ÙË ¯ÏˆÚ›ÓË: ÂÈÛÓÔ¤˜ Ì ÓÂÊÂÏÔÔÈËÙ‹ ‰ÈÙÙ·ÓıÚ·ÎÈÎÔ‡ Ó·ÙÚ›Ô˘ (NaHCO3) 3,75% (ÛÙËÓ ∂ÏÏ¿‰· ‰È·Ù›ıÂÙ·È 4%) °È· ÙÔ ˘‰ÚÔ΢¿ÓÈÔ: ∫·Ú‰ÈÔÓ¢ÌÔÓÈ΋ ·Ó·˙ˆÔÁfiÓËÛË ¢ÈÙÙ·ÓıÚÈÎfi Ó¿ÙÚÈÔ Û ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË ¡ÈÙÚ҉˜ Ó¿ÙÚÈÔ (NaNO2) 3% ¢fiÛË (Û ml/kg) ∏b Û g/dl 0,27 10 0,33 12 0,39 14 (max 10 ml)

™˘Ìو̷ÙÈ΋ GCSF (Granulocyte Colony Stimulating Factor) Û ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ fi„ÈÌ˘ Ï¢ÎÔÂÓ›·˜ ·fi ÌÔ˘ÛÙ¿Ú‰· BAL 3 mg/kg IM οı 4-6 ÒÚ˜ ÁÈ· Ù· Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù· ÙÔ˘ Lewisite Û ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ

∫·Ú‰ÈÔÓ¢ÌÔÓÈ΋ ·Ó·˙ˆÔÁfiÓËÛË ∞ÙÚÔ›ÓË: 0,05 mg/kg IV, IM* (min 0,1 mg, max 5 mg), Â·Ó¿ÏË„Ë Î¿ı 2-5 min PRN Û ‚ÚÔÁ¯fiÛ·ÛÌÔ, ·˘ÍË̤Ó˜ ÂÎÎÚ›ÛÂȘ ¶Ú·ÏȉÔÍ›ÌË: 25 mg/kg IV, IM** (max 1 g IV, 2 g IM), Â·Ó¿ÏË„Ë Û 30-60 min PRN, ÌÂÙ¿ οı 1 ÒÚ· ÁÈ· 1 ‹ 2 ‰fiÛÂȘ Ì 0,2 mg/kg PRN, Û Â›ÌÔÓË ·‰˘Ó·Ì›· ‹ ˘„ËϤ˜ ··ÈÙ‹ÛÂȘ ·ÙÚÔ›Ó˘ ™Â ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ ÔÍ›ÌË HI-6 Î·È ·ÎÂÙ˘ÏÔ¯ÔÏÈÓÂÛÙÂÚ¿ÛË ÂÌ‚Ú‡Ô˘ ‚ÔÔÂȉÒÓ ¢È·˙Â¿ÌË: 0,3 mg/kg IV (max 10 mg) §ÔÚ·˙Â¿ÌË: 0,1 mg/kg IV, IM (max 4 mg) ªÈ‰·˙ÔÏ¿ÌË: 0,2 mg/kg (max 10 mg) IM PRN Û Û·ÛÌÔ‡˜ ‹ ÛÔ‚·Ú‹ ¤ÎıÂÛË

∞ÓÙÈÌÂÙÒÈÛË

¶·È‰È·ÙÚÈ΋ 2004;67:225-240

À‰ÚÔ΢¿ÓÈÔ: ∆·¯‡ÓÔÈ·, ÎÒÌ·, Û·ÛÌÔ›, ¿ÓÔÈ·, ηډȷ΋ ·Ó·ÎÔ‹

ºÏÂÁÌÔÓ‹ ÔÊı·ÏÌÒÓ, Ê¿Ú˘ÁÁ· (ÂȉÈο Ë ¯ÏˆÚ›ÓË), ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (ÂȉÈο ÙÔ ÊˆÛÁ¤ÓÈÔ)

∞Ê·›ÚÂÛË ÚÔ‡¯ˆÓ, ÚÔÛÂÎÙÈÎfi, ·ÏÏ¿ Ï‹Ú˜, χÛÈÌÔ ‰¤ÚÌ·ÙÔ˜ Î·È Ì·ÏÏÈÒÓ Ì ۷Ô‡ÓÈ Î·È ÓÂÚfi, ͤÏ˘Ì· ÔÊı·ÏÌÒÓ Ì NaCl 0,9% (·ÔÙÂÏÂÛÌ·ÙÈÎfi ÌfiÓÔ Â¿Ó ÂÊ·ÚÌÔÛÙ› ¿ÌÂÛ·)

∞ÙÌÔ›: ∫·ı·Úfi˜ ·¤Ú·˜, ·Ê·›ÚÂÛË ÚÔ‡¯ˆÓ, χÛÈÌÔ Ì·ÏÏÈÒÓ ÀÁÚ¿: ∞Ê·›ÚÂÛË ÚÔ‡¯ˆÓ, ÚÔÛÂÎÙÈÎfi, ·ÏÏ¿ Ï‹Ú˜, χÛÈÌÔ ‰¤ÚÌ·ÙÔ˜ Î·È Ì·ÏÏÈÒÓ Ì ۷Ô‡ÓÈ Î·È ÓÂÚfi, ͤÏ˘Ì· ÔÊı·ÏÌÒÓ Ì NaCl 0,9%

∞Ôχ̷ÓÛË

13:52

flÚ˜ ÕÌÂÛÔ ¿ÏÁÔ˜ ÛÙÔ Lewisite

∞ÙÌÔ›: ‰Â˘ÙÂÚfiÏÂÙ· ÀÁÚ¿: ÏÂÙ¿-ÒÚ˜

ŒÓ·ÚÍË

07-10-04

¢ÂÚÌ·ÙÈο ÂÚ˘ı‹Ì·Ù· Î·È ‚Ï·Ù›‰Â˜, ÊÏÂÁÌÔÓ‹ ÔÊı·ÏÌÒÓ Î·È ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ÕÏÁË ÛÙÔ Lewisite. ¶Èı·Ó‹ fi„ÈÌË ÂÌÊ¿ÓÈÛË Î·ÚΛÓÔ˘ Ó¢ÌfiÓˆÓ Î·È Ï¢ÎÔÂÓ›·˜ ÛÙË ÌÔ˘ÛÙ¿Ú‰·

∞ÙÌÔ›: ̇ÛË, ηٷÚÚÔ‹, ‰‡ÛÓÔÈ· ÀÁÚ¿: ¤ÌÂÙÔÈ ∫·È Ù· ‰‡Ô: ÎÒÌ·, ·Ú¿Ï˘ÛË, Û·ÛÌÔ›, ¿ÓÔÈ·

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

¶›Ó·Î·˜ 3. ÃËÌÈÎÔ› ·Ú¿ÁÔÓÙ˜: ÚÔÙÂÈÓfiÌÂÓ˜ ‰È·ÁÓˆÛÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ, ·ÔÌfiÓˆÛË Î·È ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ (ÚÔÛ·ÚÌÔÁ‹ Ì ‚¿ÛË ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ 9,14,57-60,62,63, URL: www.bt.cdc.gov)

July August 04 ™ÂÏ›‰·236

Paediatriki 2004;67:225-240

July August 04

07-10-04

13:52

™ÂÏ›‰·237

Paediatriki 2004;67:225-240

* ∏ ÂÓ‰ÔÔÛÙÈ΋ ¤Á¯˘ÛË ıˆÚÂ›Ù·È ÂÍ›ÛÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Ì ÙËÓ ÂÓ‰ÔÊϤ‚È·. ∏ ¯ÔÚ‹ÁËÛË ·ÙÚÔ›Ó˘ ÌÔÚ› Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÓ‰ÔÙÚ·¯Âȷο ‹ ̤ۈ ÓÂÊÂÏÔÔ›ËÛ˘. ∂›Û˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ̤ۈ ÓÂÊÂÏÔÔÈËÙ‹ ÙÔ ‚ÚˆÌÈÔ‡¯Ô ÈÚ·ÙÚfiÈÔ. ** °È· IV ¯ÔÚ‹ÁËÛË Á›ÓÂÙ·È ·Ó·Û‡ÛÙ·ÛË Ù˘ Ú·ÏȉÔÍ›Ì˘ Û ‰È¿Ï˘Ì· 50 mg/ml (1 g Û 20 ml water for injection) Î·È Ë ÙÂÏÈ΋ ‰fiÛË ¯ÔÚËÁÂ›Ù·È ÛÙ¿Á‰ËÓ IV Û ‰È¿ÛÙËÌ· 30 min ‹ ÌÔÚ› Ó· ¯ÔÚËÁËı› ÌÂ Û˘Ó¯‹ ¤Á¯˘ÛË (‰fiÛË ÊfiÚÙÈÛ˘ 25 mg/kg Û 30 min Î·È ÛÙË Û˘Ó¤¯ÂÈ· 10 mg/kg/h). ∏ ÂÌÂÈÚ›· Ô˘ ¤¯ÂÈ ·ÔÎÙËı› ·fi ÙȘ ‰ËÏËÙËÚÈ¿ÛÂȘ ·È‰ÈÒÓ Ì ÔÚÁ·ÓÔʈÛÊÔÚÈο ÂÓÙÔÌÔÎÙfiÓ·, ηٷ‰ÂÈÎÓ‡ÂÈ ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Û ·È‰È¿ ÙË ¯Ú‹ÛË Ù˘ Û˘Ó¯ԇ˜ ¤Á¯˘Û˘ Ú·ÏȉÔÍ›Ì˘ (62). °È· πª ¯ÔÚ‹ÁËÛË Á›ÓÂÙ·È ·Ó·Û‡ÛÙ·ÛË Û ‰È¿Ï˘Ì· 300 mg/ml (1 g Û 3 ml water for injection). ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÔÈ ∞ÌÂÚÈηÓÈΤ˜ ŒÓÔϘ ¢˘Ó¿ÌÂȘ ‰È·ı¤ÙÔ˘Ó autoinjectors ·ÙÚÔ›Ó˘ Î·È Ú·ÏȉÔÍ›Ì˘, Ù· ÔÔ›·, ·Ó Î·È ÛÙÂÚÔ‡ÓÙ·È ¤ÁÎÚÈÛ˘ ÁÈ· ·È‰È·ÙÚÈ΋ ¯Ú‹ÛË, ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Û ÂÚÈÙÒÛÂȘ Ì·˙ÈÎÒÓ Î·Ù·ÛÙÚÔÊÒÓ, fiÔ˘ Ë ˙ˆ‹ ·È‰ÈÒÓ ÎÈÓ‰˘Ó‡ÂÈ ¿ÌÂÛ· Î·È Â›Ó·È ‰˘Û¯ÂÚ‹˜ Ë ÂÓ‰ÔÊϤ‚È· ÚfiÛ‚·ÛË Î·È Ô ·ÎÚÈ‚‹˜ ˘ÔÏÔÁÈÛÌfi˜ ‰fiÛÂˆÓ (63).

™˘Ìو̷ÙÈ΋ ¡·ÏÔÍfiÓË ∫·ı·Úfi˜ ·¤Ú·˜ ¢Â˘ÙÂÚfiÏÂÙ· ™˘ÓıÂÙÈο ÔÈÔÂȉ‹ µÈÔÚ˘ıÌÈÛÙ¤˜ ∫·Ù·ÛÙÔÏ‹ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ∞‰Ú·ÓÔÔÈËÙÈο: º·ÈÓÙ·Ó‡ÏË, ηÓÓ·‚ÈÓfiϘ, LSD

∫·Ù·ÛÙÔÏ‹ ·Ó·Ó¢ÛÙÈÎÔ‡ ΤÓÙÚÔ˘

∞ÂÏ¢ı¤ÚˆÛË Ó¢ÚÔÂÙȉÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ P ∞Ï΢ÏÈÔ‡ÓÙ· ¢·ÎÚ˘ÁfiÓ·: µÚˆÌÔ‚ÂÓ˙˘ÏÔ¸‰ÚÔ΢¿ÓÈÔ (CA), ¯ÏˆÚÔ·ÎÂÙ˘ÏÔÊ·ÈÓfiÏË (CN-Mace®), ¯ÏˆÚÔÈÎÚ›ÓË (PS), CNB (CN Ì ÙÂÙÚ·¯ÏˆÚÈÔ‡¯Ô ¿Óıڷη), CNC (CN Ì ¯ÏˆÚÔÊfiÚÌÈÔ), CNS (CN Ì ¯ÏˆÚÔÈÎÚ›ÓË Î·È ¯ÏˆÚÔÊfiÚÌÈÔ), CR, CS, η„·˚ΛÓË (ÛÚ¤È ÈÂÚÈÔ‡)

¢·ÎÚ‡ÚÚÔÈ·, ÔÊı·ÏÌÈÎfi ¿ÏÁÔ˜, ‚ÏÂÊ·ÚfiÛ·ÛÌÔ˜, ÊÏÂÁÌÔÓ‹ ÚÈÓfi˜ Î·È Ê¿Ú˘ÁÁ· ∞Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· (Û¿ÓÈ·)

¢Â˘ÙÂÚfiÏÂÙ·

∫·ı·Úfi˜ ·¤Ú·˜, ͤÏ˘Ì· ÔÊı·ÏÌÒÓ Ì NaCl 0,9%

™˘Ìو̷ÙÈ΋ ∞ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ÎÔÏχÚÈ·

¶·È‰È·ÙÚÈ΋ 2004;67:225-240

‰ËÌÔÛÈfiÙËÙ·, ‡ÛÙÂÚ· ·fi ÙË ¯Ú‹ÛË Ù˘ ÛÙË ÁÓˆÛÙ‹ - Î·È Ì ÙÚ·ÁÈ΋ ηٿÏËÍË - ˘fiıÂÛË ÔÌËÚ›·˜ ÙÔ˘ ∫Ú·ÙÈÎÔ‡ £Â¿ÙÚÔ˘ Ù˘ ªfiÛ¯·˜. ∏ ÛËÌ·Û›· Ù˘ ÂȉËÌÈÔÏÔÁÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ∞Ó Î·È Ë Èı·ÓfiÙËÙ· Ì›·˜ ‚ÈÔ¯ËÌÈ΋˜ Â›ıÂÛ˘ Â›Ó·È ¿ÁÓˆÛÙË Î·È Ë ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ ·ÁÁ›˙ÂÈ Ù· fiÚÈ· (ηٿ ÂÚÈÙÒÛÂȘ) ˘ÛÙÂÚ›·˜, ÔÏÏÔ› ÈÛÙÂ‡Ô˘Ó fiÙÈ Ô ‰˘ÙÈÎfi˜ ÎfiÛÌÔ˜ ·Ú·Ì¤ÓÂÈ ÂÍ·ÈÚÂÙÈο ¢¿ÏˆÙÔ˜. ∞˘Ùfi ÈÛ¯‡ÂÈ È‰È·›ÙÂÚ· ÁÈ· ÙÔ˘˜ ·ÏÔ‡˜ Ôϛ٘, ηıÒ˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó ÙËÓ ÂÎ·›‰Â˘ÛË, ÙËÓ ÂÙÔÈÌfiÙËÙ· Î·È Ù· ̤۷ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÚÔÛÙ·Û›· ÙÔ˘˜. ∞ÔÙÂÏ› ÙÚ·ÁÈ΋ ÂÈÚˆÓ›· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ¿ÓıÚˆÔÈ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÈÔ Â˘·›ÛıËÙÔ Î·È, Û˘¯Ó¿, ·ÔÎÏÂÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· ·Ó›¯Ó¢Û˘ Ì›·˜ ‚ÈÔ¯ËÌÈ΋˜ ·ÂÈÏ‹˜. Èڛ˜ ÚÔËÁÔ‡ÌÂÓË ÁÓÒÛË Ù˘ Â›ıÂÛ˘, ÙËÓ ÚÒÙË ¤Ó‰ÂÈÍË Ì›·˜ ÂÈÙ˘¯Ë̤Ó˘ ÚÔÛ‚ÔÏ‹˜ Û˘¯Ó¿ ·ÔÙÂÏ› Ë ÏËÌÌ˘Ú›‰· ·ÛıÂÓÒÓ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È ÁÈ· È·ÙÚÈ΋ ‚Ô‹ıÂÈ·, ÂÌÊ·Ó›˙ÔÓÙ·˜ ·ÚfiÌÔÈ· Î·È Â͈ÙÈο Û˘ÌÙÒÌ·Ù· (68-70). ª›· ÛÔ‚·Ú‹ ÂȉËÌÈÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ÂȉËÌÈ΋˜ ¤Í·ÚÛ˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ·Ó ÙÔ ·›ÙÈÔ Â›Ó·È Ê˘ÛÈÎfi ‹ Ù¯ÓËÙfi, ı· ‚ÔËı‹ÛÂÈ ÙÔ ˘ÁÂÈÔÓÔÌÈÎfi ÚÔÛˆÈÎfi Ó· ÂÓÙÔ›ÛÂÈ ÙÔÓ ˘‡ı˘ÓÔ ·Ú¿ÁÔÓÙ· Î·È Ó· ÂÎÎÈÓ‹ÛÂÈ ÙȘ ··Ú·›ÙËÙ˜ ·ÚÂÌ‚¿ÛÂȘ (5). ∆Ô CDC, ·fi ÙÔ 1951, ›‰Ú˘Û ÙËÓ ÀËÚÂÛ›· ∂ȉËÌÈÔÏÔÁÈÎÒÓ ¶ÏËÚÔÊÔÚÈÒÓ (ÙÔ ÂÈÛÙËÌÔÓÈÎfi ·Ó¿ÏÔÁÔ Ù˘ CIA ÛÙËÓ ÂÔ¯‹ ÙÔ˘ æ˘¯ÚÔ‡ ¶ÔϤÌÔ˘), Ì ÛÎÔfi ÙËÓ ÂÎ·›‰Â˘ÛË ÂȉËÌÈÔÏfiÁˆÓ ÁÈ· ÙÔ ÂӉ¯fiÌÂÓÔ ‚ÈÔ¯ËÌÈ΋˜ Â›ıÂÛ˘. ∏ ηٷÁÚ·Ê‹ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÚÔÛ‚Ï‹ıËηÓ, ÙˆÓ Èı·ÓÒÓ ÙÚfiˆÓ ¤ÎıÂÛ˘, ÙˆÓ ÚÔÁÂÓ¤ÛÙÂÚˆÓ Î·È ÌÂÙ·ÁÂÓ¤ÛÙÂÚˆÓ Â·ÊÒÓ, ÙˆÓ ÛËÌ›ˆÓ Î·È Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ÓfiÛÔ˘, ηıÒ˜ Î·È Ë Ù·¯Â›· ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÈÙ›Ô˘, ‰È·ÈÛÙÒıËΠfiÙÈ ‚ÔËıÔ‡Ó ÛËÌ·ÓÙÈο ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ Î·È È·ÙÚÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ (71-73). øÛÙfiÛÔ, ÙÔ ÎÚ›ÛÈÌÔ ÂÚÒÙËÌ· ·Ú·Ì¤ÓÂÈ: Ò˜ ı· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ (Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÔÈ ·È‰›·ÙÚÔÈ) ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÎÚÔÛˆÔ‡Ó ÙÔ ÚÒÙÔ Î‡Ì· ı˘Ì¿ÙˆÓ Ì›·˜ Â›ıÂÛ˘; ∆Ú›· ÎÚ›ÛÈÌ· ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ı· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·Ó·ÁÓÒÚÈÛË: ·) Ô ÂȉËÌÈÎfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ, ‚) ÙÔ ÎÔÈÓfi ÈÛÙÔÚÈÎfi ¤ÎıÂÛ˘ Î·È Á) Ë Â͈ÙÈ΋ ÎÏÈÓÈ΋ ·ÚÔ˘Û›·ÛË Ù˘ ÓfiÛÔ˘. ŒÓ·˜ ·ÚÔÛ‰fiÎËÙ· ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ô˘ ·ÛıÂÓÔ‡Ó, ‰˘Û·Ó¿ÏÔÁÔ˜ Ì ÙËÓ ÂÔ¯‹, ı· Ú¤ÂÈ Ó· ÂÁ›ÚÂÈ ˘Ô„›Â˜. πÛÙÔÚÈÎfi ÁˆÁÚ·ÊÈ΋˜ ‰È·Û‡Ó‰ÂÛ˘ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‹ ˘Ô„›· ÎÔÈÓÔ‡ ÙÚfiÔ˘ ¤ÎıÂÛ˘, fiˆ˜ ¤ÎÚËÍË ‹ ·ÚÔ˘Û›· Û‡ÓÓÂÊÔ˘ ·ÂÚ›Ô˘, ı· Ú¤ÂÈ Ó· ÚÔηϤÛÔ˘Ó Û˘Ó·ÁÂÚÌfi. ∞Û˘Ó‹ıÈÛÙÔÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹Ú˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÂÎÙÂٷ̤Ó˜ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜

237

July August 04

07-10-04

13:52

™ÂÏ›‰·238

¶·È‰È·ÙÚÈ΋ 2004;67:225-240

Paediatriki 2004;67:225-240

¶›Ó·Î·˜ 4. ¶ÚÒÈ̘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ‚ÈÔÏÔÁÈÎÔ‡˜-¯ËÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ∂ΉËÏÒÛÂȘ ∞Ó·Ó¢ÛÙÈΤ˜ ∂ÈÎfiÓ· “ÁÚ›˘” º·Ú˘ÁÁ›Ùȉ· ¢‡ÛÓÔÈ· Î·È ÛÈÁÌfi˜ ¶Ó¢ÌÔÓ›Ùȉ· µÚÔÁ¯fiÛ·ÛÌÔ˜ ¢ÂÚÌ·ÙÔÏÔÁÈΤ˜ ºÏ‡ÎÙ·ÈÓ˜, ÂÙ¤¯ÂȘ, ÔÚʇڷ ŒÏÎË ¢È·‚ÚˆÙÈΤ˜ ‚Ï¿‚˜ ‹ ÂÁη‡Ì·Ù· ∫·Ú‰È·ÁÁÂȷΤ˜ ∫·Ù·ÏËÍ›· µÚ·‰˘·ÚÚ˘ı̛˜ ¡Â˘ÚÔÏÔÁÈΤ˜ ¶ÂÚÈÊÂÚÈΤ˜ ∞‰˘Ó·Ì›·, ˘ÔÙÔÓ›· ¢ÂÛÌȉÒÛÂȘ ∫ÂÓÙÚÈΤ˜ ∞¿ıÂÈ·, ·ÔÚÔÛ·Ó·ÙÔÏÈÛÌfi˜, ÎÒÌ· ™·ÛÌÔ› ªËÓÈÁÁ›Ùȉ· ¡ÂÊÚÈΤ˜ OÏÈÁÔ˘Ú›· °·ÛÙÚÂÓÙÂÚÈΤ˜ ∞Ó·ˉÒÛ· ¢·ÈÛıËÛ›· ∞ÈÌ·Ù¤ÌÂÛË, ̤ϷÈÓ˜ ÎÂÓÒÛÂȘ ¢È¿ÚÚÔÈ·

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* ¶ÚÔÛ·ÚÌÔÁ‹ ·fi: Chemical-biological terrorism and its impact on children: a subject review. American Academy of Pediatrics. Committee on Environmental Health and Committee on Infectious Diseases. Pediatrics 2000;105:662-670

Û˘Ó‰˘·˙fiÌÂÓ˜ Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ‰ÂÓ ı· Ú¤ÂÈ, Â›Û˘, Ó· ·ÁÓÔËıÔ‡Ó.

O ¶›Ó·Î·˜ 4, fiÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÚÒÈ̘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ‚ÈÔÏÔÁÈÎÔ‡˜ ‹ ¯ËÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÌÔÚ› Ó· ·Ô‰Âȯı› ¯Ú‹ÛÈÌÔ ‚Ô‹ıËÌ· Û ̛· Ù¤ÙÔÈ· ÂÚ›ÙˆÛË. ™ÙË ¯ÒÚ· Ì·˜, Ë Â˘·ÈÛıËÛ›· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ÛÙ· ı¤Ì·Ù· ÊÚÔÓÙ›‰·˜ Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡, ηıÈÛÙ¿ ÂÍ·ÈÚÂÙÈο Èı·Ófi ÙÔ ÂӉ¯fiÌÂÓÔ Ó· ·ÔÙÂϤÛÔ˘Ó ÔÈ ·È‰›·ÙÚÔÈ ÙÔ˘˜ ÚÒÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ Ô˘ ı· ‚ÚÂıÔ‡Ó ·ÓÙÈ̤وÔÈ - Î·È Èı·ÓÒ˜ ·ÚÔÂÙԛ̷ÛÙÔÈ - Ì ÙÔ ·Ú¯ÈÎfi ·̷ ı˘Ì¿ÙˆÓ. ∏ Â·ÁÚ‡ÓËÛ‹ Ì·˜, ·ÏÏ¿ Î·È Ë ¿ÌÂÛË - ·ÎfiÌ· Î·È ·Ó Ë ‰È¿ÁÓˆÛË Â›Ó·È ÂÈÛÊ·Ï‹˜ - ·Ó·ÊÔÚ¿ ÙˆÓ ‡ÔÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÛÙȘ ·ÚÌfi‰È˜ ÀËÚÂۛ˜, ıˆÚÂ›Ù·È ÎÂÊ·Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË Ù˘ Â›ÙˆÛ˘ Ì›·˜ ‚ÈÔ¯ËÌÈ΋˜ Â›ıÂÛ˘ ÛÙ· ·È‰È¿. µÈ‚ÏÈÔÁÚ·Ê›· 1. Christopher GW, Cieslak TJ, Pavlin JA, Eitzen EM Jr. Biological warfare. A historical perspective. JAMA 1997;278: 412-417.

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∫·Ù¿ıÏÈ„Ë ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∂. §·˙·Ú¿ÙÔ˘, ¢. ∫. ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ˜

Childhood depression H. Lazaratou, D. C. Anagnostopoulos

¶ÂÚ›ÏË„Ë: ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ·Ó·ÛÎÔ› ÙË ‚È‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈο Ì ÙË ÓÔÛÔÏÔÁÈ΋ ı¤ÛË Ù˘ ηٿıÏȄ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∏ ηٿıÏÈ„Ë Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ¿ÚÁËÛ ӷ ·Ó·ÁÓˆÚÈÛÙ› Û·Ó ·˘ÙfiÓÔÌË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·. OÈ Û‡Á¯ÚÔÓ˜ ÌÂϤÙ˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹ Ì ΛӉ˘ÓÔ ¯ÚÔÓÈfiÙËÙ·˜ ‹ ˘ÔÙÚÔÒÓ Ô˘ ÂËÚ¿˙ÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË ˙ˆ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ÎÏÈÓÈ΋ Ù˘ ÂÈÎfiÓ· ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ·Ó·Ù˘Íȷ΋ Ê¿ÛË ÛÙËÓ ÔÔ›· ‚Ú›ÛÎÂÙ·È ÙÔ ·È‰›. ∏ ηٷıÏÈÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÂÎÊÚ¿˙ÂÙ·È Ì ۈ̷ÙÈο Û˘ÌÙÒÌ·Ù· Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÏÈÁfiÙÂÚÔ Ì ÏÂÎÙÈΤ˜ ‰È·Ù˘ÒÛÂȘ ÙÔ˘ ηٷıÏÈÙÈÎÔ‡ Û˘Ó·ÈÛı‹Ì·ÙÔ˜. ∞Á¯Ò‰ÂȘ ‰È·Ù·Ú·¯¤˜, Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜ Û˘ÓÔ‰Â‡Ô˘Ó Û˘¯Ó¿ ÙËÓ ·È‰È΋ ηٿıÏÈ„Ë. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. ∏ ÁÂÓÂÙÈ΋ ÂÈ‚¿Ú˘ÓÛË ¤¯ÂÈ ·Ô‰Âȯı› Î·È Ù· ·È‰È¿ ηٷıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜. ∞ÚÓËÙÈο ÁÂÁÔÓfiÙ· ˙ˆ‹˜ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Û˘¯Ó¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ∏ ÁÓˆÛȷ΋ ÚÔÛ¤ÁÁÈÛË ÌÂÏÂÙ¿ ÙȘ ÛËÌ·ÓÙÈΤ˜ ÁÓˆÛȷΤ˜ ‰È·ÛÙÚ‚ÏÒÛÂȘ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙË ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË Î·È ÛÙËÓ ¤ÓÙÔÓË ·˘ÙÔÎÚÈÙÈ΋ ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ. ∏ „˘¯Ô‰˘Ó·ÌÈ΋ ηٷÓfiËÛË ‚·Û›˙ÂÙ·È ÛÙË ÌÂϤÙË ÙˆÓ „˘¯ÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Ô˘ ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È ÁÈ· Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÙËÓ ·ÒÏÂÈ·. ∏ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ηٿıÏȄ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ „˘¯ÔıÂÚ·›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÙˆÓ ÁÔÓ¤ˆÓ. º·ÚÌ·ÎÔıÂÚ·›· ¯ÔÚËÁÂ›Ù·È ÛÙȘ ÛÔ‚·ÚfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ. ∂ÓÒ Ù· ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο ‰ÂÓ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·fi Ù· placebo, Ù· ÓÂfiÙÂÚ˘ ÁÂÓÈ¿˜ ·ÓÙÈηٷıÏÈÙÈο ˘fiÛ¯ÔÓÙ·È

Abstract: This is a review of the current literature on the nosological status of childhood depression.

Child depression has been recognized as a separate clinical entity since the 1970s. Recent studies have shown that it is a very serious disorder, which involves the risk of perpetuation or relapse, and it has a great impact on the child’s functioning, as well as on the life of the whole family. Clinical features vary according to the developmental phase of the child. Depressive symptomatology is expressed in somatic symptoms and conduct problems rather than by verbal formulation concerning the depressive feelings. The usual comorbid conditions of child depression are anxiety disorders, learning disorders and conduct disorders. The aetiology of child depression is multi-factorial. The genetic factor is implicated in the children of depressed parents, which puts these children in a higher risk status for the development of the disorder. Negative life events often herald the onset of a depressive episode. Cognitive approaches have studied the role of major cognitive distortions such as self-criticism and low selfesteem in depressed children. The psychodynamic approach has been based on the study of those psychic mechanisms involved in confrontation of loss. Therapeutic procedures involve child psychotherapy and parental counselling, along with drug therapy in serious cases. While tricyclic antidepressants proved to be no more effective than placebo, the new generation anti-depressants (SSRI) are more promising. There is a need for the development of more appropriate early intervention strategies targeted at primary detection and treatment.

ÀËÚÂÛ›· æ˘¯È΋˜ ÀÁ›·˜ ¶·È‰ÈÒÓ Î·È ∂Ê‹‚ˆÓ, ∫ÔÈÓÔÙÈÎfi ∫¤ÓÙÚÔ æ˘¯È΋˜ ÀÁÈÂÈÓ‹˜ µ‡ÚˆÓ· - ∫·ÈÛ·ÚÈ·Ó‹, æ˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ∞ı‹Ó·

Children’s and Adolescents’ Mental Health Service, Community Center for Mental Health of Vyronas - Kaissariani, Psychiatric Clinic of Athens University, Athens

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¶·È‰È·ÙÚÈ΋ 2004;67:241-253

Paediatriki 2004;67:241-253

ÂÚÈÛÛfiÙÂÚ·. ¢È·ÈÛÙÒÓÂÙ·È Ë ·Ó¿ÁÎË ·Ó¿Ù˘Í˘ ÛËÌ·ÓÙÈÎfiÙÂÚˆÓ ÚÔÏËÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ, Ì ÛÎÔfi ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË, ·ÓÙÈÌÂÙÒÈÛË, ·ÏÏ¿ Î·È ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË Ù˘ ·È‰È΋˜ ηٿıÏȄ˘. §¤ÍÂȘ ÎÏÂȉȿ: ηٿıÏÈ„Ë Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ıÂÚ·›·, ÚfiÏË„Ë.

Key words: childhood depression, treatment, prevention.

∂ÈÛ·ÁˆÁ‹ ∏ ηٿıÏÈ„Ë Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÌÂÏÂÙËı› ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÏfiÁˆ Ù˘ ·‰˘Ó·Ì›·˜ ÙÔ˘ ·È‰ÈÔ‡ Ó· ÂÎÊÚ¿ÛÂÈ Ì ÏfiÁÈ· Ù· Û˘Ó·ÈÛı‹Ì·Ù· ıÏ›„˘, ·ÂÏÈÛ›·˜ Î·È ·fiÁÓˆÛ˘. ∏ ηٷıÏÈÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÂÎÊÚ¿˙ÂÙ·È Î˘Ú›ˆ˜ Ì ۈ̷ÙÈο Û˘ÌÙÒÌ·Ù· (ÎÔÈÏȷο ¿ÏÁË, ÎÂÊ·Ï·ÏÁ›Â˜, ·ÓÔÚÂÍ›·, ·¸Ó›·) Î·È ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (¢ÂÚÂıÈÛÙfiÙËÙ·, ÂÈıÂÙÈÎfiÙËÙ·, ·ÒÏÂÈ· ÂӉȷʤÚÔÓÙÔ˜, ·fiÛ˘ÚÛË). £ÂˆÚÂ›Ù·È Ì›· Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·Ù·Ú·¯‹, Ì ۷ʋ ÁÂÓÂÙÈ΋ ÂÈ‚¿Ú˘ÓÛË, Ô˘ ÚÔηÏ› ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ. ∂›Ó·È Ì›· ηٿÛÙ·ÛË Ô˘ ‡ÎÔÏ· ·Ú·ÁÓˆÚ›˙ÂÙ·È, ηıÒ˜ Ù· ηٷıÏÈÙÈο ·È‰È¿ ‰ÂÓ ·Ú·ÔÓÈÔ‡ÓÙ·È Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘˜ Â›Ó·È ÌÂȈ̤Ó˘ ¤ÓÙ·Û˘. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· Á›ÓÂÙ·È Ì›· ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂȉËÌÈÔÏÔÁ›·, ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙËÓ ·ÈÙÈÔÏÔÁ›·, ÙËÓ ÚfiÁÓˆÛË Î·È ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ηٿıÏȄ˘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ¶·Ú’ fiÏÔ Ô˘ ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó ÔÈ ÌÂϤÙ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È fi¯È ÛÙËÓ ÂÊ˂›·, ıˆڋıËΠÛÎfiÈÌÔ Ó· Á›ÓÂÈ ÂÚÈÔÚÈÛÌfi˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ËÏÈÎÈ·Îfi Ê¿ÛÌ·. ∏ ÂÊ˂›· ·ÔÙÂÏ› Ì›· ÂÍÂÏÈÎÙÈ΋ ‰ÈÂÚÁ·Û›· ÛÙË ˙ˆ‹ ÙÔ˘ ·ÙfiÌÔ˘ Ô˘ Û˘¯Ó¿ ÂÚÈÁÚ¿ÊÂÙ·È Ì fiÚÔ˘˜ Ô˘ ı· Ù·›ÚÈ·˙·Ó ÁÈ· ÙËÓ ÂÚÈÁÚ·Ê‹ ÂÓfi˜ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘.

O ¤ÊË‚Ô˜ Â›Ó·È ·Ó·ÁηṲ̂ÓÔ˜ Ó· ·Ô¯ˆÚÈÛÙ› Û˘Ì‚ÔÏÈο ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, Ó· ‰È·Îfi„ÂÈ ÙÔ˘˜ ‰ÂÛÌÔ‡˜ Ì·˙› ÙÔ˘˜ Î·È Ó· ·ÔÌ·ÎÚ˘Óı› ·fi ÙÔÓ ·Ú¿‰ÂÈÛÔ ÙˆÓ ·È‰ÈÎÒÓ ÙÔ˘ ¯ÚfiÓˆÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÌfiÓÔ˜ ÙÔ˘ Ì›· Ó¤· Ú·ÁÌ·ÙÈÎfiÙËÙ·. ∞˘Ù‹ Ë ‰ÈÂÚÁ·Û›· ‰È·ÎÔ‹˜ ÙˆÓ ‰ÂÛÌÒÓ Î·È ·ÒÏÂÈ·˜ ÙÔ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘ ¤¯ÂÈ ·ÎÚÈ‚Ò˜ Ù· ›‰È· ÛÙ¿‰È·, fiˆ˜ Ë ‰ÈÂÚÁ·Û›· ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ı·Ó¿ÙÔ˘ ÂÓfi˜ ·Á·Ë̤ÓÔ˘ ÚÔÛÒÔ˘. ¶ÚÔ·ÙÂÈ, ¤ÙÛÈ, ÙÔ ÂÚÒÙËÌ· ·Ó Î·È fiÙÂ Ë Î·Ù¿ıÏÈ„Ë ·ÔÙÂÏ› Ì›· Ê˘ÛÈÔÏÔÁÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÂÊ˂›·˜ ‹ ÂÓÙ¿ÛÛÂÙ·È Û ·ıÔÏÔÁÈο Ï·›ÛÈ· Î·È ·ÔÙÂÏ› „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹.

∏ ηٿıÏÈ„Ë ÛÙËÓ ÂÊ˂›· ı¤ÙÂÈ ÛÔ‚·Ú¿ ‰È·ÊÔÚԉȷÁÓˆÛÙÈο ÚÔ‚Ï‹Ì·Ù·, Ë ‰Â ÎÏÈÓÈ΋ Ù˘ ÂÈÎfiÓ· Â›Ó·È ÏËÛȤÛÙÂÚË ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ηٿıÏȄ˘ ÙˆÓ ÂÓËÏ›ÎˆÓ ·Ú¿ ÙˆÓ ·È‰ÈÒÓ. ª›· ¿ÏÏË ·Ó·ÛÎfiËÛË ÙˆÓ ›‰ÈˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ Î·Ù¿ıÏÈ„Ë ÛÙËÓ ÂÊ˂›· ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈ¢ı› (1).

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πÛÙÔÚÈ΋ ·Ó·‰ÚÔÌ‹ ∏ ·È‰È΋ ηٿıÏÈ„Ë ¿ÚÁËÛ ӷ ·Ó·ÁÓˆÚÈÛÙ› Û·Ó ·˘ÙfiÓÔÌË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·. À‹ÚÍ ̛· ¤ÓÙÔÓË ‰È·Ì¿¯Ë ηٿ fiÛÔ ‹Ù·Ó ·Ó·Ù˘Íȷο Û˘Ì‚·Ùfi ÁÈ· Ù· ·È‰È¿ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ù¿ıÏÈ„Ë, ‚·ÛÈ˙fiÌÂÓË ÛÙËÓ ÎÔÈÓ‹ ·Ú·‰Ô¯‹ fiÙÈ Ë ·È‰È΋ ËÏÈΛ· Â›Ó·È Ë ÈÔ ¯·ÚÔ‡ÌÂÓË Î·È Â˘¯¿ÚÈÛÙË ÂÚ›Ô‰Ô˜ Ù˘ ·ÓıÚÒÈÓ˘ ˙ˆ‹˜. ∏ „˘¯·Ó·Ï˘ÙÈ΋ ÚÔÛ¤ÁÁÈÛË, Â›Û˘, ıˆÚÒÓÙ·˜ fiÙÈ ÛÙÔÓ Ì˯·ÓÈÛÌfi Á¤ÓÂÛ˘ Ù˘ ÌÂÏ·Á¯ÔÏ›·˜ Û˘ÌÌÂÙ¤¯ÂÈ ¤Ó· Û·‰ÈÛÙÈÎfi ˘ÂÚÂÁÒ, ·ÚÓ‹ıËΠÙËÓ ‡·ÚÍ‹ Ù˘ ÛÙ· ·È‰È¿, Ù· ÔÔ›· ‰ÂÓ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ ·ÎfiÌË ÙÔ ˘ÂÚÂÁÒ.

O Kraepelin, ·Ó¿ÌÂÛ· Û 900 ÂÚÈÙÒÛÂȘ ÌÂÏ·Á¯ÔÏ›·˜ ÂÓËϛΈÓ, ‰ÂÓ ‚ڋΠ·Ú¿ ÌfiÓÔ Ù¤ÛÛÂÚȘ fiÔ˘ ÔÈ ÂΉËÏÒÛÂȘ ¿Ú¯ÈÛ·Ó ÚÈÓ ÙËÓ ÂÊ˂›·, ·ÏÏ¿ fi¯È ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ (2).

O L. Kanner, ÛÙÔ ‚È‚Ï›Ô Ù˘ ·È‰Ô„˘¯È·ÙÚÈ΋˜ ÙÔ 1937, ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÈ ÙËÓ ·È‰È΋ ηٿıÏÈ„Ë Û·Ó ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·. ∞ӷʤÚÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ï¿ıÔ˜ ‰È¿ÁÓˆÛË Î·È fiÙÈ Ë ÌÂÏ·Á¯ÔÏ›· Â›Ó·È Ì›· ÓfiÛÔ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ (3). ∏ ÎÏÈÓÈ΋ Ú·ÎÙÈ΋, fï˜, ·ԉ›ÎӢ ÙËÓ ·ÚÔ˘Û›· ηٷıÏÈÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ ÛÙ· ·È‰È¿. ™ÙËÓ ·Ú¯‹ ÌÂÏÂÙ‹ıËÎÂ Û·Ó “ÎÂÎ·Ï˘Ì̤ÓË Î·Ù¿ıÏÈ„Ë” (masked depression) ÏfiÁˆ Ù˘ ÚÔÂÍ¿Ú¯Ô˘Û·˜ ۈ̷ÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ (ÎÔÈÏȷο ¿ÏÁË, ÎÂÊ·Ï·ÏÁ›Â˜, ·¸Ó›·, ·ÓÔÚÂÍ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜). ™ÙË Û˘Ó¤¯ÂÈ·, ·Ó·ÁÓˆÚ›ÛÙËΠÙÔ Î·Ù·ıÏÈÙÈÎfi Û˘Ó·›ÛıËÌ· Î·È ÔÈ ÂΉËÏÒÛÂȘ ÙÔ˘, ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÛÙ¿‰ÈÔ ÙÔ˘ ·È‰ÈÔ‡. ∏ ·È‰È΋ ηٿıÏÈ„Ë ·Ó·ÁÓˆÚ›ÛÙËΠÂ›ÛËÌ· Û·Ó ·˘ÙfiÓÔÌË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ÙÔ 1976 ÛÙÔ 4Ô ™˘Ó¤‰ÚÈÔ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ ¶·È‰Ô„˘¯È¿ÙÚˆÓ ÛÙË ™ÙÔίfiÏÌË.

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∆·ÍÈÓfiÌËÛË ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ∏ ηٿıÏÈ„Ë Â›Ó·È ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ ÓfiÛÔ˘˜ Î·È ÚÔηÏ› ÛËÌ·ÓÙÈΤ˜ ‰˘ÛÎÔϛ˜ ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ÛÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ· Î·È ÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·ÙfiÌÔ˘. °È· ÙË ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜, ı· ‹Ù·Ó ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÈ ¤Ó·˜ ‚·ÛÈÎfi˜ ‰È·¯ˆÚÈÛÌfi˜ ·Ó¿ÌÂÛ· ÛÙËÓ ¤ÓÓÔÈ· Ù˘ ıÏ›„˘ Î·È ÛÙËÓ ¤ÓÓÔÈ· Ù˘ ηٿıÏȄ˘ (4). £Ï›„Ë Â›Ó·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi Î·È ·Ó·ÌÂÓfiÌÂÓÔ Û˘Ó·›ÛıËÌ·, Ô˘ ÂÎχÂÙ·È Î¿Ùˆ ·fi ÔÚÈṲ̂Ó˜ „˘¯ÔÙÚ·˘Ì·ÙÈΤ˜ Û˘Óı‹Î˜. ŒÓ· ÈÛ¯˘Úfi „˘¯ÔÙÚ·˘Ì·ÙÈÎfi ÁÂÁÔÓfi˜, fiˆ˜ Â›Ó·È Ë ·ÒÏÂÈ· ÂÓfi˜ ·Á·Ë̤ÓÔ˘ ÚÔÛÒÔ˘, Ë ‰È¿„¢ÛË Ì›·˜ ÛËÌ·ÓÙÈ΋˜ ÚÔÛ‰ÔΛ·˜, Ë ÎÔÈÓˆÓÈ΋ ‹ Â·ÁÁÂÏÌ·ÙÈ΋ ˘Ô‚¿ıÌÈÛË ‹ ·ÎfiÌË Î·È Ë ·ÒÏÂÈ· ˘ÏÈÎÒÓ ·Á·ıÒÓ, Â›Ó·È Ê˘ÛÈÎfi Ó· ÚÔηÏ› ıÏ›„Ë. ™Â ·ÓÙ›ıÂÛË Ì ÙË ıÏ›„Ë, Ë Î·Ù¿ıÏÈ„Ë Â›Ó·È ¤Ó· ·ıÔÏÔÁÈÎfi Û˘Ó·›ÛıËÌ·, ‰ËÏ·‰‹ ›Ù ÌË ·Ó·ÌÂÓfiÌÂÓÔ, ›Ù ˘ÂÚ‚ÔÏÈÎfi Û ¤ÓÙ·ÛË ‹ ‰È¿ÚÎÂÈ·.

OÈ ÚÔÛ¿ıÂȘ ηٿٷ͢ Ù˘ ηٿıÏȄ˘ ¯ÚÔÓÔÏÔÁÔ‡ÓÙ·È ·fi ÙÔÓ 4Ô ·ÈÒÓ· .Ã., fiÙ·Ó Ô πÔÎÚ¿Ù˘ ‰ËÌÈÔ‡ÚÁËÛ ÙÔ˘˜ fiÚÔ˘˜ “ÌÂÏ·Á¯ÔÏ›·” (Ì·‡ÚË ¯ÔÏ‹) Î·È “Ì·Ó›·” (ÙڤϷ) (5). ∆· Û‡Á¯ÚÔÓ· Û˘ÛÙ‹Ì·Ù· Ù·ÍÈÓfiÌËÛ˘, DSM-IV Î·È ICD-10, ‰È·¯ˆÚ›˙Ô˘Ó ÙÔ˘˜ fiÚÔ˘˜ “ÂÂÈÛfi‰ÈÔ” Î·È “‰È·Ù·Ú·¯‹”. ∆Ô ÂÂÈÛfi‰ÈÔ Â›Ó·È Ì›· ÂÚ›Ô‰Ô˜ Ô˘ ‰È·ÚΛ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ‚‰ÔÌ¿‰Â˜, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÎÂÙ¿ Û˘ÌÙÒÌ·Ù· ÁÈ· ÙËÓ Ï‹ÚˆÛË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ. ª›· ·fi ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ‰È·ÎÚ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ‰È¿ıÂÛ˘ Â›Ó·È Ô ‰È·¯ˆÚÈÛÌfi˜ Û ÌÔÓÔÔÏÈ΋ Î·È ‰ÈÔÏÈ΋ ηÙËÁÔÚ›·. OÈ ÌÔÓÔÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‰È¿ıÂÛ˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ηٷıÏÈÙÈο Û˘ÌÙÒÌ·Ù· ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ·ıÔÏÔÁÈο ·˘ÍË̤Ó˘ ‰È¿ıÂÛ˘. ™ÙȘ ‰ÈÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‰È¿ıÂÛ˘, Ë Î·Ù¿ıÏÈ„Ë ÂÓ·ÏÏ¿ÛÛÂÙ·È ‹ Û˘Ó‰˘¿˙ÂÙ·È Ì ̷ӛ· ‹ ˘ÔÌ·Ó›·. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌfiÓÔ ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì·Ó›· (ÌÔÓÔÔÏÈ΋ Ì·Ó›·) ‰›ÓÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ‰ÈÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜ Ù˘ ‰È¿ıÂÛ˘, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÙÂÏÈο ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ¤Ó· ÂÂÈÛfi‰ÈÔ Î·Ù¿ıÏȄ˘. ∏ Ì›˙ˆÓ ηٷıÏÈÙÈ΋ ‰È·Ù·Ú·¯‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ηٷıÏÈÙÈο ÂÂÈÛfi‰È·, ¯ˆÚ›˜ Ì·Ó›· ‹ ˘ÔÌ·Ó›·. ∆· ηٷıÏÈÙÈο Û‡Ó‰ÚÔÌ· Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ۈ̷ÙÈΤ˜ ÓfiÛÔ˘˜ Î·È ·fi Ê¿Ú̷η ‹ „˘¯Ô‰Ú·ÛÙÈΤ˜ Ô˘Û›Â˜ ‰ÂÓ ıˆÚÔ‡ÓÙ·È ÚˆÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‰È¿ıÂÛ˘ Î·È ‰ÂÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ Ì›˙ˆÓ ηٷıÏÈÙÈ΋ ‰È·Ù·Ú·¯‹. ∏ ‰˘Ûı˘ÌÈ΋ ‰È·Ù·Ú·¯‹ Û˘ÌÂÚÈÏ‹ÊıËΠÛÙÔ

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DSM-III ÁÈ· Ó· ‰ËÏÒÛÂÈ Ì›· ¯ÚfiÓÈ· ηٿıÏÈ„Ë Ô˘ Â›Ó·È ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú‹ ·fi ÙË Ì›˙ÔÓ· ηٿıÏÈ„Ë. ∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ‰˘Ûı˘ÌÈ΋˜ ‰È·Ù·Ú·¯‹˜ Â›Ó·È Ì›· ¯ÚÔÓ›ˆ˜ ηٷıÏÈÙÈ΋ ‰È¿ıÂÛË, Ë ÔÔ›· ˘¿Ú¯ÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ Ë̤ڷ˜ Î·È ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Ë̤Ú˜ Û ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ÂÙÒÓ. ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ¿ ÙÔ Ì›˙ÔÓ Î·Ù·ıÏÈÙÈÎfi ÂÂÈÛfi‰ÈÔ Î·È ÙË ‰˘Ûı˘Ì›· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ηıÒ˜ ·˘Ù¤˜ ÔÈ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ Û˘Ó·ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ·. ∏ ‰ÈÔÏÈ΋ ‰È·Ù·Ú·¯‹ Û˘Ó·ÓÙ¿Ù·È Ôχ Û¿ÓÈ· Î·È ÂÎÊÚ¿˙ÂÙ·È Î˘Ú›ˆ˜ Ì „˘¯ˆÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ∆· Û˘ÛÙ‹Ì·Ù· Ù·ÍÈÓfiÌËÛ˘ ÛÙ¿ıËÎ·Ó ·Ì‹¯·Ó· ÛÙÔÓ ÔÚÈÛÌfi ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙËÓ ·È‰È΋ ηٿıÏÈ„Ë. ™ÙËÓ Ù¤Ù·ÚÙË ·Ó·ıÂÒÚËÛË ÙÔ˘ ¢È·ÁÓˆÛÙÈÎÔ‡ Î·È ™Ù·ÙÈÛÙÈÎÔ‡ ∂Á¯ÂÈÚȉ›Ô˘ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ æ˘¯È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ (DSM-IV), Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ ·È‰È΋ ηٿıÏÈ„Ë ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‰È·Ù·Ú·¯¤˜ Ù˘ ‰È¿ıÂÛ˘ Î·È fi¯È ÛÙȘ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘Ó‹ıˆ˜ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ηٿ ÙË ‚ÚÂÊÈ΋-·È‰È΋ ‹ ÂÊË‚È΋ ËÏÈΛ· (¶›Ó·Î˜ 1 Î·È 2). πÛ¯‡Ô˘Ó Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ηٿıÏȄ˘ ÂÓËÏ›ÎˆÓ Ì ÌÈÎÚ¤˜ ‰È¢ÎÚÈÓ›ÛÂȘ, fiˆ˜ .¯. “Ë ‰È¿ıÂÛË ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÔÚ› Ó· Â›Ó·È Â˘ÂÚ¤ıÈÛÙË ‰È¿ıÂÛË” ‹ “ÛËÌ·ÓÙÈ΋ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÛÙ· ·È‰È¿: Ï¿‚ÂÙ ˘’ fi„ÈÓ ÙËÓ ·ÔÙ˘¯›· ÛÙËÓ ÚfiÛÏË„Ë ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘ ‚¿ÚÔ˘˜”. ∞·Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Ì›˙ÔÓÔ˜ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Â›Ó·È Ë ‰˘ÛÊÔÚÈ΋ ‰È¿ıÂÛË ‹ Ë ·ÒÏÂÈ· ¢¯·Ú›ÛÙËÛ˘ ‹ ÂӉȷʤÚÔÓÙÔ˜ Î·È ¤Ó· Û‡Ìو̷ ·fi ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ÙÔÌ›˜ ÏÂÈÙÔ˘ÚÁ›·˜: fiÚÂÍËÊ·ÁËÙfi, ‡ÓÔ˜, „˘¯ÔÎÈÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∞·ÈÙÂ›Ù·È Ë ÂΉ‹ÏˆÛË ¤ÓÙÂ Û˘ÌÙˆÌ¿ÙˆÓ Â› ‰‡Ô ‚‰ÔÌ¿‰Â˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ. ∞fi ÙËÓ ÎÏÈÓÈ΋ ÂÌÂÈÚ›·, fï˜, ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÛÔ ‰‡ÛÎÔÏË Â›Ó·È Ë ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÊÔÚ›·˜ ÛÙ· ·È‰È¿ Î·È fiÙÈ Ô ¯ÚfiÓÔ˜ ÙˆÓ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ Â›Ó·È ·ÚÎÂÙ¿ ÌÂÁ¿ÏÔ˜ Î·È ·Ú·¤ÌÂÈ Û ·ÓÙȉڷÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·È‰ÈÔ‡ ·¤Ó·ÓÙÈ Û „˘¯ÔÈÂÛÙÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ‚ÈÒÓÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‹ ÛÙÔ Â˘Ú‡ÙÂÚÔ ÂÚÈ‚¿ÏÏÔÓ (6). ¶·ÚfiÌÔȘ ‰˘ÛÎÔϛ˜ ‰È·ÈÛÙÒÓÔÓÙ·È ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ICD-10. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù· ÁÂÓÈο ÎÚÈÙ‹ÚÈ· ‰È·Ù·Ú·¯‹˜ Ù˘ ‰È¿ıÂÛ˘ (F30-39) Ì ‰È¢ÎÚÈÓ›ÛÂȘ fiˆ˜: “ÌË Ù˘ÈΤ˜ ÂÈÎfiÓ˜ Â›Ó·È È‰È·›ÙÂÚ· Û˘¯Ó¤˜ ηٿ ÙËÓ ÂÊ˂›·”. ™ÙÔ ÎÂÊ¿Ï·ÈÔ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ì ¤Ó·ÚÍË Û˘Ó‹ıˆ˜ ηٿ ÙËÓ ·È‰È΋ Î·È ÙËÓ ÂÊË‚È΋ ËÏÈΛ· ·Ó‹ÎÂÈ Ë ‰È·Ù·Ú·¯‹ Ù˘ ‰È·ÁˆÁ‹˜ ηٷıÏÈÙÈÎÔ‡ Ù‡Ô˘

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Paediatriki 2004;67:241-253

¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ì›˙ÔÓÔ˜ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Û‡Ìʈӷ Ì ÙÔ DSM-IV ∞. ¶¤ÓÙ ‹ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·ÎfiÏÔ˘ı· Û˘ÌÙÒÌ·Ù· ‹Ù·Ó ·ÚfiÓÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ›‰È·˜ ÂÚÈfi‰Ô˘ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ Î·È ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Ì›· ·ÏÏ·Á‹ ÛÙËÓ ÚÔËÁÔ‡ÌÂÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·. ∆Ô˘Ï¿¯ÈÛÙÔÓ ÙÔ ¤Ó· ·fi Ù· Û˘ÌÙÒÌ·Ù· Â›Ó·È Â›Ù (1) ηٷıÏÈÙÈ΋ ‰È¿ıÂÛË Â›Ù (2) ·ÒÏÂÈ· ÂӉȷʤÚÔÓÙÔ˜ ‹ ¢¯·Ú›ÛÙËÛ˘ 1. ∫·Ù·ıÏÈÙÈ΋ ‰È¿ıÂÛË ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ Ë̤ڷ˜ ™ËÌ›ˆÛË: ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÔÚ› Ó· Â›Ó·È Â˘ÂÚ¤ıÈÛÙË ‰È¿ıÂÛË 2. ŒÓÙÔÓË ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂӉȷʤÚÔÓÙÔ˜ ‹ Ù˘ ¢¯·Ú›ÛÙËÛ˘ Û fiϘ ‹ ۯ‰fiÓ fiϘ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ Ë̤ڷ˜ 3. ™ËÌ·ÓÙÈ΋ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ - ÂÓÒ ‰ÂÓ Â›Ó·È Û ‰›·ÈÙ· - ‹ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ (.¯. ÌÂÙ·‚ÔÏ‹ ¿Óˆ ·fi 5% ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ¤Ó· Ì‹Ó·) ‹ ÂÏ¿ÙÙˆÛË ‹ ·‡ÍËÛË Ù˘ fiÚÂ͢ ™ËÌ›ˆÛË: ™Ù· ·È‰È¿ Ï¿‚ÂÙ ˘’ fi„ÈÓ ÙËÓ ·ÔÙ˘¯›· ÛÙËÓ ÚfiÛÏË„Ë ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘ ‚¿ÚÔ˘˜ 4. ∞¸Ó›· ‹ ˘ÂÚ˘Ó›· 5. æ˘¯ÔÎÈÓËÙÈ΋ ‰È¤ÁÂÚÛË ‹ ÂÈ‚Ú¿‰˘ÓÛË 6. ∫fiˆÛË ‹ ·ÒÏÂÈ· Ù˘ ÂÓÂÚÁËÙÈÎfiÙËÙ·˜ 7. ∞ÈÛı‹Ì·Ù· ·Ó·ÍÈfiÙËÙ·˜ ‹ ˘¤ÚÌÂÙÚ˘ ‹ ·ÚfiÛÊÔÚ˘ ÂÓÔ¯‹˜ (fi¯È ·ÏÒ˜ ·˘ÙÔÌÔÌÊ‹ ‹ ÂÓÔ¯‹ ÂÂȉ‹ Â›Ó·È ·ÛıÂÓ‹˜) 8. ∂Ï·Ùو̤ÓË ÈηÓfiÙËÙ· Ó· ÛÎÂÊı› ‹ Ó· Û˘ÁÎÂÓÙÚˆı›, ‹ ·Ó·ÔÊ·ÛÈÛÙÈÎfiÙËÙ· 9. ∂·ÓÂÚ¯fiÌÂÓ˜ ÛΤ„ÂȘ ı·Ó¿ÙÔ˘ (fi¯È ÌfiÓÔ Êfi‚Ô˜ ı·Ó¿ÙÔ˘), Â·ÓÂÚ¯fiÌÂÓÔ˜ ·˘ÙÔÎÙÔÓÈÎfi˜ ȉ·ÛÌfi˜ ¯ˆÚ›˜ Û˘ÁÎÂÎÚÈ̤ÓÔ Û¯¤‰ÈÔ ‹ Ì›· ·fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜ ‹ ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ Û¯¤‰ÈÔ Ó· ·˘ÙÔÎÙÔÓ‹ÛÂÈ µ. ∆· Û˘ÌÙÒÌ·Ù· ÚÔηÏÔ‡Ó ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ ÂÓfi¯ÏËÛË ‹ ¤ÎÙˆÛË Ù˘ ÎÔÈÓˆÓÈ΋˜, Â·ÁÁÂÏÌ·ÙÈ΋˜ ‹ ¿ÏÏˆÓ ÛËÌ·ÓÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ °. ∆· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÔÊ›ÏÔÓÙ·È ÛÙȘ ¿ÌÂÛ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ Ì›·˜ Ô˘Û›·˜ (.¯. Ô˘Û›· ηٿ¯ÚËÛ˘, Ê¿Ú̷η) ‹ ÁÂÓÈ΋˜ ۈ̷ÙÈ΋˜ ηٿÛÙ·Û˘ (.¯. ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜) ¢. ∆· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÂÍËÁÔ‡ÓÙ·È Î·Ï‡ÙÂÚ· Ì ¤ÓıÔ˜, ‰ËÏ·‰‹ Ì ÙËÓ ·ÒÏÂÈ· ·Á·Ë̤ÓÔ˘ ÚÔÛÒÔ˘

¶›Ó·Î·˜ 2. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ‰˘Ûı˘ÌÈ΋˜ ‰È·Ù·Ú·¯‹˜ Û‡Ìʈӷ Ì ÙÔ DSM-IV ∞. ∫·Ù·ıÏÈÙÈ΋ ‰È¿ıÂÛË ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ Ë̤ڷ˜, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Ë̤Ú˜, fiˆ˜ Ê·›ÓÂÙ·È Â›Ù ·fi ÙËÓ ˘ÔÎÂÈÌÂÓÈ΋ ÂÎÙ›ÌËÛË Â›Ù Ì ÙËÓ ·Ú·Ù‹ÚËÛË ÙˆÓ ¿ÏψÓ, ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ¯ÚfiÓÈ· ™ËÌ›ˆÛË: ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÔÚ› Ó· Â›Ó·È Â˘ÂÚ¤ıÈÛÙË ‰È¿ıÂÛË Î·È Ë ‰È¿ÚÎÂÈ· Ú¤ÂÈ Ó· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·˜ ¯ÚfiÓÔ˜ µ. ¶·ÚÔ˘Û›·, fiÙ·Ó ˘¿Ú¯ÂÈ Î·Ù·ıÏÈÙÈ΋ ‰È¿ıÂÛË, ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·fi Ù· ·ÎfiÏÔ˘ı·: 1. ªÂȈ̤ÓË fiÚÂÍË ‹ ˘ÂÚÊ·Á›· 2. ∞¸Ó›· ‹ ˘ÂÚ˘Ó›· 3. ÷ÌËÏ‹ ÂÓÂÚÁËÙÈÎfiÙËÙ· ‹ ÎfiˆÛË 4. ÷ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË 5. ºÙˆ¯‹ Û˘ÁΤÓÙÚˆÛË ‹ ‰˘ÛÎÔÏ›· Ï‹„˘ ·ÔÊ¿ÛÂˆÓ 6. ∞ÈÛı‹Ì·Ù· ·ÂÏÈÛ›·˜ °. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¯ÚÔÓÈ΋˜ ÂÚÈfi‰Ô˘ ÙˆÓ 2 ¯ÚfiÓˆÓ (¤Ó·˜ ¯ÚfiÓÔ˜ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜) Ù˘ ‰È·Ù·Ú·¯‹˜, ÙÔ ¿ÙÔÌÔ ‰ÂÓ ‹Ù·Ó ÔÙ¤ ÂχıÂÚÔ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ ÎÚÈÙËÚ›ˆÓ ∞ Î·È µ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 2 Ì‹Ó˜ ÙË ÊÔÚ¿ ¢. ¢ÂÓ ˘‹ÚÍ ·ÚÔ˘Û›· Ì›˙ÔÓÔ˜ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 2 ¯ÚfiÓˆÓ Ù˘ ‰È·Ù·Ú·¯‹˜ (¤Ó·˜ ¯ÚfiÓÔ˜ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜) ∂. ∆· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÔÊ›ÏÔÓÙ·È ÛÙȘ ¿ÌÂÛ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ Ì›·˜ Ô˘Û›·˜ (.¯. Ô˘Û›· ηٿ¯ÚËÛ˘, Ê¿Ú̷η) ‹ ÁÂÓÈ΋˜ ۈ̷ÙÈ΋˜ ηٿÛÙ·Û˘ (.¯. ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜) ™∆. ∆· Û˘ÌÙÒÌ·Ù· ÚÔηÏÔ‡Ó ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ ÂÓfi¯ÏËÛË ‹ ¤ÎÙˆÛË Ù˘ ÎÔÈÓˆÓÈ΋˜, Â·ÁÁÂÏÌ·ÙÈ΋˜ ‹ ¿ÏÏˆÓ ÛËÌ·ÓÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜

(F92.0). ¶ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ Â›ÌÔÓÔ Î·È ¤ÓÙÔÓÔ Î·Ù·ıÏÈÙÈÎfi Û˘Ó·›ÛıËÌ· Ô˘ ÂΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· fiˆ˜ ˘ÂÚ‚ÔÏÈ΋ ÁÎÚ›ÓÈ·, ·ÒÏÂÈ· ÂӉȷʤÚÔÓÙÔ˜ Î·È Â˘¯·Ú›ÛÙËÛ˘ Ô˘ ÚÔÛʤÚÔ˘Ó ÔÈ Û˘ÓËıÈṲ̂Ó˜ ·Û¯Ôϛ˜, ·˘ÙÔÌÔÌÊ‹ Î·È ·ÂÏÈÛ›·. ¶Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘Ó‡·ÚÍË ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘ Î·È fiÚÂ͢ (7).

H Á·ÏÏÈ΋ Ù·ÍÈÓfiÌËÛË ÙˆÓ „˘¯ÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘, ÈÛÙ‹ ÛÙÔÓ „˘¯·Ó·Ï˘ÙÈÎfi ÚÔÛ·Ó·ÙÔÏÈÛÌfi, ηٷٿÛÛÂÈ ÙËÓ Î·Ù¿ıÏÈ„Ë ·Ó¿ÏÔÁ· Ì ÙÔ ‰ÔÌÈÎfi ˘fi‚·ıÚÔ, Û ¤ÓÙ ‰È·ÊÔÚÂÙÈΤ˜ ηÙËÁÔڛ˜: „‡¯ˆÛË (1.06 ‰˘Ûı˘ÌÈΤ˜ „˘¯ÒÛÂȘ), Ó‡ڈÛË (2.05 ÓÂ˘ÚˆÙÈ΋ ηٿıÏÈ„Ë), ·ıÔÏÔÁ›· Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ (3.05 ηٿıÏÈ„Ë Ô˘

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Û¯ÂÙ›˙ÂÙ·È Ì ·ıÔÏÔÁ›· ÚÔÛˆÈÎfiÙËÙ·˜), ·ÓÙȉڷÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (4.00 ·ÓÙȉڷÛÙÈ΋ ηٿıÏÈ„Ë) Î·È ·Ú·ÏÏ·Á‹ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (9. 01 ·ÚÔ‰È΋ ηٿıÏÈ„Ë) (8). ∂ȉËÌÈÔÏÔÁ›· ∏ Â›ÙˆÛË Ù˘ ηٿıÏȄ˘ ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È, ·Ó¿ÏÔÁ· Ì ÙȘ ÌÂϤÙ˜, ·fi 0,4% ¤ˆ˜ 2,5% (9,10). ∆Ô ÔÛÔÛÙfi ·˘Ùfi ·˘Í¿ÓÂÈ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ 1 ÛÙ· 5 ·È‰È¿ Ô˘ ·Ú·¤ÌÔÓÙ·È Û „˘¯È·ÙÚÈο ÙÌ‹Ì·Ù·, ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ù·ıÏÈÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· (11).

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¶·È‰È·ÙÚÈ΋ 2004;67:241-253

ÕÏϘ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÛÔÛÙfi 7% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙÔ ÁÂÓÈÎfi ÓÔÛÔÎÔÌÂ›Ô Î·È 40% ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ÎÂÊ·Ï·ÏÁ›· ›¯·Ó ηٿıÏÈ„Ë (12,13). ™Ù· ·È‰È¿, Ë Ì›˙ˆÓ ηٷıÏÈÙÈ΋ ‰È·Ù·Ú·¯‹ ÂΉËÏÒÓÂÙ·È Û ÂÚ›Ô˘ ›‰È· ·Ó·ÏÔÁ›· Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ fiÔ˘ ˘ÂÚÙÂÚÔ‡Ó ÔÈ Á˘Ó·›Î˜ (14). ŒÚ¢Ó˜ Û ÎÏÈÓÈÎÔ‡˜ Î·È ÌË ÎÏÈÓÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ¤‰ÂÈÍ·Ó fiÙÈ Ù· ¿ÙÔÌ· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·Ù¿ıÏÈ„Ë Î·È fiÙÈ Ë ‰È·Ù·Ú·¯‹ ÂΉËÏÒÓÂÙ·È Û fiÏÔ Î·È ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ (15,16). ∞˘Ù‹ Ë ‰È·›ÛÙˆÛË ·ÊÔÚ¿ Û ÂÏ·ÊÚ¤˜ Î·È Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ηٷıÏ›„ÂȘ Î·È fi¯È ÛÙË Ì›˙ÔÓ· ‰È·Ù·Ú·¯‹ (17). ∞Ô‰›‰ÂÙ·È ‰Â ÂÚÈÛÛfiÙÂÚÔ Û ·‡ÍËÛË ÙˆÓ ÛÙÚÂÛÔÁfiÓˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ Û˘ÓıËÎÒÓ Î·È ÏÈÁfiÙÂÚÔ Û ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (18). ™Â Ì›· ÚfiÛÊ·ÙË ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ÛÙËÓ ∂ÏÏ¿‰·, ÔÛÔÛÙfi 11,5% ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 10-17 ÂÙÒÓ ·ÍÈÔÏÔÁ‹ıËΠˆ˜ Û‡ÓÔÏÔ ·ÙfiÌˆÓ Ì ˘„ËÏ‹ ·ÚÔ˘Û›· ηٷıÏÈÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜. ¶·Ú·ÙËÚ‹ıËÎ·Ó ÂÈ‚·Ú˘Ì¤Ó˜ ÔÈ ÂÚÈÙÒÛÂȘ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ˆ˜ ÚÔ˜ ÙËÓ ·ÚÔ˘Û›· Î·È ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙÔ Û˘ÓÔÏÈÎfi ‰Â›ÁÌ· (19). ∆· ·ÚÓËÙÈο ÁÓˆÛÙÈο Û¯‹Ì·Ù· Î·È Ë ¯·ÌËÏ‹ ÂÈÎfiÓ· ·˘ÙÔ‡ ‰È·ÊÔÚÔÔ›ËÛ·Ó ÛËÌ·ÓÙÈο Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ˘„ËÏ‹ ·ÚÔ˘Û›· ηٷıÏÈÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜. ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ·È‰È΋˜ ηٿıÏȄ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰È·ÊÔÚ¤˜ ·fi ÂΛÓË ÙˆÓ ÂÓËϛΈÓ. ∏ ÏÂÎÙÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ıÏ›„˘, ·fiÁÓˆÛ˘ ‹ ·ÂÏÈÛ›·˜ Û¿ÓÈ· Û˘Ó·ÓÙ¿Ù·È ÛÙ· ·È‰È¿. ªÂÏ·Á¯ÔÏÈο ‹ „˘¯ˆÙÈο Û˘ÌÙÒÌ·Ù·, ˘ÔÏÂÈÌÌ·ÙÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ Î·È ·˘ÙÔÎÙÔӛ˜ Û˘Ó·ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· fiÛÔ ·˘Í¿ÓÂÈ Ë ËÏÈΛ·. ∞ÓÙ›ıÂÙ·, ÙÔ ¿Á¯Ô˜ ÙÔ˘ ·Ô¯ˆÚÈÛÌÔ‡, ÊÔ‚›Â˜, ۈ̷ÙÈο Û˘ÌÙÒÌ·Ù· Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∞ÎfiÌË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ηٿıÏȄ˘ ·ÏÏ¿˙ÂÈ ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÛÙ¿‰ÈÔ ÙÔ˘ ·È‰ÈÔ‡ (20).

O R. Spitz, Ì ÙȘ ¤Ú¢Ӥ˜ ÙÔ˘ ÛÙ· ÔÚÊ·ÓÔÙÚÔÊ›· ÌÂÙ¿ ÙÔÓ µ’ ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ¤‰ÂÈÍ fiÙÈ ¤Ó· ‚Ú¤ÊÔ˜ ÌÔÚ› Ó· ¤¯ÂÈ ·ÈÛı‹Ì·Ù· χ˘ Î·È Ó· ˙‹ÛÂÈ Ì›· Ú·ÁÌ·ÙÈο ηٷıÏÈÙÈ΋ ÂÌÂÈÚ›· Û˘Óԉ¢fiÌÂÓË ·fi ¤ÓÙÔÓË „˘¯ÔÎÈÓËÙÈ΋ ÂÈ‚Ú¿‰˘ÓÛË. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, fiˆ˜ ÙËÓ ÂÚȤÁÚ·„Â Ô Spitz, ÛÂ

Paediatriki 2004;67:241-253

¤Ó· ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 6-8 ÌËÓÒÓ Ô˘ ¯ˆÚ›˙ÂÙ·È ·fi ÙË ÌËÙ¤Ú· ÙÔ˘, ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈ΋ ·¿ıÂÈ·, ¿ÚÓËÛË Â·Ê‹˜, ·‰È·ÊÔÚ›· ÚÔ˜ ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ·ÓÔÚÂÍ›· Î·È ·¸Ó›·. ∂¿Ó ‚ÚÂı› ¤Ó· ÌËÙÚÈÎfi ˘ÔηٿÛÙ·ÙÔ ·Ó¿ÌÂÛ· ÛÙÔÓ 3Ô-5Ô Ì‹Ó· ·fi ÙÔÓ ·Ô¯ˆÚÈÛÌfi, Ë ÂÈÎfiÓ· Ù˘ ηٿıÏȄ˘ ÂÍ·Ê·Ó›˙ÂÙ·È ÚÔԉ¢ÙÈο. ¢È·ÊÔÚÂÙÈο, ÂÍÂÏ›ÛÛÂÙ·È Û ̛· ηٿÛÙ·ÛË Ê˘ÛÈÎÔ‡ Î·È „˘¯ÈÎÔ‡ Ì·Ú·ÛÌÔ‡. O Spitz ÙËÓ ÔÓfiÌ·Û ·Ó·ÎÏËÙÈ΋ ηٿıÏÈ„Ë Î·È ¤ÛÙÚ„ ÙËÓ ÚÔÛÔ¯‹ ÛÙȘ „˘¯Ôۈ̷ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ηٿıÏȄ˘ ÛÙËÓ ·Ú¯‹ Ù˘ ˙ˆ‹˜ (21). ™‹ÌÂÚ·, ‰Â¯fiÌ·ÛÙ fiÙÈ Ë ‚ÚÂÊÈ΋ ηٿıÏÈ„Ë ÂΉËÏÒÓÂÙ·È ÌÂ: ·) Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÙÔÓ›·: ÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ ÂÍ·ÛΛ ÙȘ ·ÈÛıËÙËÚȷΤ˜ ÙÔ˘ ÈηÓfiÙËÙ˜, ‰ÂÓ ¤¯ÂÈ ‰È¿ıÂÛË Ó· ÎÔÈÙ¿ÂÈ, Ó· ·ÎÔ‡ÂÈ, Ó· Ì˘Ú›˙ÂÈ, Ó· ÎÈÓ›ٷÈ, Ó· ÁÓˆÚ›˙ÂÈ, Ó· ÏÂÈÙÔ˘ÚÁ› Î·È Ó· ÚÔԉ‡ÂÈ, ‚) ÌÂȈ̤Ó˜ ÎÈÓËÙÈΤ˜ ÚˆÙÔ‚Ô˘Ï›Â˜, ÊÙˆ¯‹ ÌÈÌÈ΋, ÌÔÓÔÙÔÓ›·, Ù¿ÛË ÁÈ· Â·Ó¿ÏË„Ë ÙˆÓ È‰›ˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È Á) ÊÙˆ¯‹ ·ÏÏËÏÂȉڷÛÙÈ΋ Û¯¤ÛË Ì ÙË ÌËÙ¤Ú·, Ì›ˆÛË ÙˆÓ ÚˆÙÔ‚Ô˘ÏÈÒÓ ·ÏÏ¿ Î·È ÙˆÓ ··ÓÙ‹ÛÂˆÓ ÛÙȘ ÚÔÙÚÔ¤˜, ·ÔÙ˘¯›· ÂÈÎÔÈÓˆÓ›·˜. ∏ ‚ÚÂÊÈ΋ ηٿıÏÈ„Ë, Û‡Ìʈӷ Ì „˘¯·Ó·Ï˘Ù¤˜ Û˘ÁÁÚ·Ê›˜, ıˆÚÂ›Ù·È ¤Ó·˜ ·ÚÈÔ˜ ·Ú¿ÁÔÓÙ·˜ „˘¯Ôۈ̷ÙÈ΋˜ ·Ô‰ÈÔÚÁ¿ÓˆÛ˘ (22). OÓÔÌ¿˙ÂÙ·È “ÎÚ‡·” ηٿıÏÈ„Ë ‹ “Û‡Ó‰ÚÔÌÔ ÙÔ˘ ¿‰ÂÈÔ˘” Î·È ÂÎÊÚ¿˙ÂÈ ÙËÓ ¤ÏÏÂÈ„Ë ÛÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ¤Ó‰ÂÈ·, ÙËÓ ·‰È·ÊÔÚ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘ Î·È ÙÔÓ Â͈ÙÂÚÈÎfi ÎfiÛÌÔ Ô˘ ÙÔ ÂÚÈ‚¿ÏÏÂÈ. ™ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ΢ÚÈ·Ú¯Ô‡Ó ÔÈ ÂΉËÏÒÛÂȘ „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈ΋˜ ·Ó·ÛÙÔÏ‹˜. ∏ ·‰È·ÊÔÚ›·, Ë ·¿ıÂÈ·, Ë ÌË ÂΉ‹ÏˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ÂΠ̤ÚÔ˘˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ÌË Û˘ÌÌÂÙÔ¯‹ ÛÙÔ ·È¯Ó›‰È ·ÔÙÂÏÔ‡Ó ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ηٿıÏȄ˘. ™Â ·˘Ù‹ ÙËÓ ËÏÈΛ· ÌÔÚ› Ó· ÂΉËψıÔ‡Ó ‰È¿ÊÔÚ˜ ÊÔ‚›Â˜ Î·È ¿Á¯Ô˜ ·Ô¯ˆÚÈÛÌÔ‡. ¶·Ú·ÙËÚÔ‡ÓÙ·È, Â›Û˘, ۈ̷ÙÈο Û˘ÌÙÒÌ·Ù· (ÎÔÈÏÈ·ÎÔ› fiÓÔÈ), ‰È·Ù·Ú·¯¤˜ ‰È·ÙÚÔÊ‹˜ (·ÓÔÚÂÍ›·, ¿ÚÓËÛË ÙÚÔÊ‹˜) Î·È ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ (·¸Ó›·, Ó˘¯ÙÂÚÈÓÔ› ÂÊÈ¿ÏÙ˜). ¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎË ÚÔÛ·ÚÌÔÁ‹˜ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÙÔ˘ DSM-IV, ÁÈ·Ù› Ù· ˘¿Ú¯ÔÓÙ· ÎÚÈÙ‹ÚÈ· ·ÔÙ˘Á¯¿ÓÔ˘Ó Ó· Ù·˘ÙÔÔÈ‹ÛÔ˘Ó ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÎÏÈÓÈÎÒÓ ÂÚÈÙÒÛÂˆÓ Ù˘ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ (23). ™ÙË Û¯ÔÏÈ΋ ËÏÈΛ·, Ë Î·Ù¿ıÏÈ„Ë ‰È·ÁÈÁÓÒÛÎÂÙ·È Î˘Ú›ˆ˜ Û·Ó ·ÏÏ·Á‹ Û˘ÌÂÚÈÊÔÚ¿˜, Ì›ˆÛË Ù˘ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘, ‰È·ÎÔ‹ ÙˆÓ Û¯¤ÛÂˆÓ ÌÂ Û˘ÓÔÌËÏ›ÎÔ˘˜, ·ÒÏÂÈ· Ù˘ ¢¯·Ú›ÛÙËÛ˘ ÙÔ˘ ·È¯ÓȉÈÔ‡ ‹ ·ÔÌfiÓˆÛË. ∆· ·È‰È¿ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜ ÌÔÚÔ‡Ó Ó· ÂÎÊÚ¿ÛÔ˘Ó ÂÛÈÌÈÛÙÈΤ˜ ÛΤ„ÂȘ Î·È È‰¤Â˜ ·˘ÙÔ-˘ÔÙ›ÌËÛ˘ Î·È ·˘ÙÔÌÔÌÊ‹˜.

OÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙË ‰È·ÓÔËÙÈ΋ ·Ó·ÛÙÔÏ‹, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È ÌÂ

245

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07-10-04

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¶·È‰È·ÙÚÈ΋ 2004;67:241-253

ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÎÚ›Û˘, ·ÒÏÂÈ· Û˘ÁΤÓÙÚˆÛ˘ Î·È ÚÔÛÔ¯‹˜, ÊÙˆ¯‹ Ê·ÓÙ·Û›· Î·È ÚÔ‚Ï‹Ì·Ù· ÌÓ‹Ì˘. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È, Â›Û˘, ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂ Ê˘ÛÈ΋ ·‰˘Ó·Ì›· (ÙÔ ·È‰› ÎÔ˘Ú¿˙ÂÙ·È Â‡ÎÔÏ·), ¿ÚÓËÛË Û˘ÌÌÂÙÔ¯‹˜ Û ÔÌ·‰Èο ·È¯Ó›‰È· Î·È ‰˘ÛÎÔÏ›· ÂÎÙ¤ÏÂÛ˘ ηıËÎfiÓÙˆÓ Ô˘ ÙÔ˘ ÂÈ‚¿ÏÏÔÓÙ·È. ∆· ۈ̷ÙÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ ˙¿ÏË, ÎÂÊ·Ï·ÏÁ›·, ËÌÈÎڷӛ˜ Î·È ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ (·¸Ó›·, ÂÊÈ¿ÏÙ˜) Î·È ‰È·ÙÚÔÊ‹˜ (·ÓÔÚÂÍ›·, ÊÔ‚›Â˜ ÙÚÔʛ̈Ó), Â›Ó·È Û˘Ó‹ıˆ˜ ·ÚfiÓÙ·. ∆Ô ·È‰› ‰Â›¯ÓÂÈ Ï˘Ë̤ÓÔ, ‰˘ÛÙ˘¯ÈṲ̂ÓÔ. ∆›ÔÙ· ‰ÂÓ ÙÔ Â˘¯·ÚÈÛÙ› Î·È ‰ÂÓ Î·Ù·Ê¤ÚÓÂÈ Ù›ÔÙ·. ¶ÈÛÙ‡ÂÈ fiÙÈ ‰ÂÓ ÙÔ ·Á·Ô‡Ó Î·È ‰ÂÓ ÙÔ ı¤ÏÔ˘Ó. Œ¯ÂÈ Ì›· ÊÙˆ¯‹ ÌÈÌÈ΋, Ì ‚ϤÌÌ· ¯ˆÚ›˜ ¤ÎÊÚ·ÛË Î·È ÌÔÓfiÙÔÓË ÊˆÓ‹. ™Â ·˘Ù‹ ÙËÓ ËÏÈΛ· ÌÔÚ› Ó· ÂÎÊÚ·ÛÙÔ‡Ó È‰¤Â˜ ·˘ÙÔÎÙÔÓ›·˜, ·ÏÏ¿ ÔÈ ·fiÂÈÚ˜ Â›Ó·È Û·ÓÈfiÙÂÚ˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ÂÊ˂›·. ™˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÂÎÚ‹ÍÂȘ ÔÚÁ‹˜, Ó¢ÚÈÎfiÙËÙ·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÚÔÎÏËÙÈÎfiÙËÙ· Î·È ·Ó˘·ÎÔ‹. OÈ ı˘ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚ› Ó· ¤¯Ô˘Ó ¯·Ú·ÎÙ‹Ú· ΢ÎÏÈÎfi, Ì ÁÚ‹ÁÔÚ˜ ÂÓ·ÏÏ·Á¤˜ ·ÎfiÌË Î·È Ì¤Û· ÛÙËÓ ›‰È· Ë̤ڷ. ∏ ·Ó·ÛÙÔÏ‹ ÌÂ Û˘Ó·›ÛıËÌ· ‚·ı‡ ηٷıÏÈÙÈÎfi ÌÂÙ·ÙÚ¤ÂÙ·È Û ‰È¤ÁÂÚÛË Â˘ÊÔÚÈÎÔ‡ Ù‡Ô˘.

OÈ Williamson Î·È Û˘Ó, ·fi ¤Ó· ÌÂÁ¿ÏÔ ‰Â›ÁÌ· 1046 ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ‰È¿ÁÓˆÛË Ì›˙ÔÓÔ˜ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ‚Ú‹Î·Ó ¿Ù˘Ë Î·Ù·ıÏÈÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·. ∆· ¿Ù˘· Û˘ÌÙÒÌ·Ù· Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ‹Ù·Ó Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÛÙ¿ıÂÈ· (40,9%), ·˘ÍË̤ÓË fiÚÂÍË ÁÈ· Ê·ÁËÙfi (13,6%), ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (11,6%), ˘ÂÚ˘Ó›· (21,8%) Î·È „˘¯ÔÎÈÓËÙÈ΋ ÂÈ‚Ú¿‰˘ÓÛË (10,7%) (24). ™˘ÓÓÔÛËÚfiÙËÙ· ∫ÏÈÓÈΤ˜ Î·È ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ηٷıÏÈÙÈÎÒÓ ·È‰ÈÒÓ (4070%) ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘ÓÔ‰Ô‡˜ „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ (25,26).

OÈ Î˘ÚÈfiÙÂÚ˜ Û˘ÓÓÔÛËÚ¤˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘Ó·ÓÙÒÓÙ·È Â›Ó·È Ë ‰˘Ûı˘ÌÈ΋ ‰È·Ù·Ú·¯‹, Ë ·Á¯Ò‰Ë˜ ‰È·Ù·Ú·¯‹ Ì ΢ڛ·Ú¯Ô ÙÔ ¿Á¯Ô˜ ÙÔ˘ ·Ô¯ˆÚÈÛÌÔ‡ (30-80%) Î·È Ë ‰È·Ù·Ú·¯‹ Ù˘ ‰È·ÁˆÁ‹˜ (10-80%). ŸÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Ë ‰˘Ûı˘ÌÈ΋ ‰È·Ù·Ú·¯‹, Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ “‰ÈÏ‹˜ ηٿıÏȄ˘” Î·È ÂÈ‚·Ú‡ÓÂÙ·È Ë ÚfiÁÓˆÛË, ÙfiÛÔ ·Ó·ÊÔÚÈο Ì ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙËÓ ÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹ Î·È ÙȘ ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ (25). ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚ› Ó· ·Ó·Ù˘¯ıÔ‡Ó Û·Ó ÂÈÏÔ΋ Ù˘ ηٿıÏȄ˘ Î·È Ó· ·Ú·Ì›ÓÔ˘Ó ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛ‹ Ù˘. ∏ ηٿıÏÈ„Ë,

246

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Â›Û˘, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË Û˘ÓÓÔÛËÚfiÙËÙ· Ì ÙȘ Ì·ıËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜ (60-80%) (27). °ÂÓÈο, Ë Û˘ÓÓÔÛËÚfiÙËÙ· Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ˘ÔÙÚÔ¤˜, ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, ÙȘ ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜, ÙËÓ ·¿ÓÙËÛË ÛÙË ıÂÚ·›· Î·È ÙË ¯Ú‹ÛË ˘ËÚÂÛÈÒÓ „˘¯È΋˜ ˘Á›·˜. ∞ÈÙÈÔÏÔÁ›· ∞. °ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ªÂϤÙ˜ Û ÏËı˘ÛÌfi ‰È‰‡ÌˆÓ Î·È ˘ÈÔıÂÙËÌ¤ÓˆÓ ·È‰ÈÒÓ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÔÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 50% Ù˘ ÔÈÎÈÏfiÙËÙ·˜ (ÌÂÙ·‚ÏËÙfiÙËÙ·˜) ÛÙË ÌÂÙ¿‰ÔÛË ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. º·›ÓÂÙ·È, Â›Û˘, fiÙÈ Ù· ¿ÙÔÌ· Ì ÁÂÓÂÙÈ΋ ÂÈ‚¿Ú˘ÓÛË Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Â˘·›ÛıËÙ· ÛÙȘ ÂȉڿÛÂȘ ÂÓfi˜ ·ÓÙ›ÍÔÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ (28).

OÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ Â›Ó·È ·˘Ù¤˜ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ·È‰È¿ ηٷıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ. ∫·Ù¿ıÏÈ„Ë ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ì ΛӉ˘ÓÔ Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 13% ¤ˆ˜ 70% (29,30). OÈ ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ ·Ó¤Ú¯ÔÓÙ·È Û 7,8% ÛÙ· ·È‰È¿ ηٷıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋, Û ۇÁÎÚÈÛË Ì 1,4% ÛÙ· ·È‰È¿ ÌË Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ (31). º·›ÓÂÙ·È fiÙÈ Ô Ù‡Ô˜ Ù˘ ÁÔÓÈ΋˜ ηٿıÏȄ˘ ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∏ ‡·ÚÍË ‰ÈÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜, Ë ÚÒÈÌË ËÏÈΛ· ¤Ó·Ú͢ Î·È ÔÈ ˘ÔÙÚÔ¤˜ ÙˆÓ ÁÔÓ¤ˆÓ Û˘Ó‰¤ÔÓÙ·È Ì ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· Ù· ·È‰È¿ (32,33). ∂›Û˘, ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ‰È·ÙÚ¤¯Ô˘Ó Ù· ·È‰È¿ fiÙ·Ó ÓÔÛÔ‡Ó Î·È ÔÈ ‰‡Ô ÁÔÓ›˜ (34). ∆Ô Î·Ù·ıÏÈÙÈÎfi ÂÂÈÛfi‰ÈÔ ‰È·ÚΛ ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ·È‰È¿ ηٷıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó Î·Ù¿ ̤ÛÔ fiÚÔ 54 ‚‰ÔÌ¿‰Â˜ ÁÈ· Ó· ·ÔıÂÚ·¢ÙÔ‡Ó, ÂÓÒ ·È‰È¿ Ù˘ ›‰È·˜ ËÏÈΛ·˜ ÌË Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ›¯·Ó ̤ÛÔ fiÚÔ 23 ‚‰ÔÌ¿‰Â˜ ıÂÚ·›·˜ (35). º·›ÓÂÙ·È fiÙÈ Ë ÁÔÓÈ΋ ηٿıÏÈ„Ë ·›˙ÂÈ ÚfiÏÔ Î·È ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ ÛÙ· ·È‰È¿. ∂ÎÙfi˜ ·fi ÙȘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜, Ù· ·È‰È¿ ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ·fi fiÏÔ ÙÔ Ê¿ÛÌ· Ù˘ ·È‰Ô„˘¯È·ÙÚÈ΋˜. ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, ‰È·Ù·Ú·¯‹ Ù˘ ‰È·ÁˆÁ‹˜, ‰È¿Û·ÛË ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ‰È·Ù·Ú·¯¤˜ Ù˘ ÚÔÛ·ÚÌÔÁ‹˜, ·ıÔÏÔÁ›· Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜, ηıÒ˜ Î·È ÂÍ¿ÚÙËÛË ·fi ·ÏÎÔfiÏ Î·È Ó·ÚΈÙÈο ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· Â˘Ú‹Ì·Ù· ÙˆÓ ÌÂÏÂÙÒÓ (36,37). µ. OÈÎÔÁÂÓÂÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ ∂ÎÙfi˜ ·fi ÙË ÁÂÓÂÙÈ΋ ÂÈ‚¿Ú˘ÓÛË, ÔÈ ÔÈÎÔÁ¤ÓÂȘ ηٷıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÂÓÙÔÓfiÙÂÚ˜ Û˘ÁÎÚÔ‡ÛÂȘ, ÂÚÈÛÛfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù·

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ÂÈÎÔÈÓˆÓ›·˜, ÌÂȈ̤ÓË ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ, ÌÈÎÚfiÙÂÚË ˘ÔÛÙ‹ÚÈÍË ÚÔ˜ Ù· ̤ÏË ÙÔ˘˜ Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·È‰È΋˜ ηÎÔÔ›ËÛ˘ (37). ∞˘Ù¿ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÙÂÏÔ‡Ó ÂÚÈ‚·ÏÏÔÓÙÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ‰È·Ù·Ú·¯‹˜ ÛÙ· ·È‰È¿. ª›· ÂÏÏËÓÈ΋ ¤Ú¢ӷ ÂÍÂÙ¿˙ÂÈ Ù· „˘¯ÔÎÔÈÓˆÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ηٷıÏÈÙÈÎÒÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÁÂÓÈÎÔ‡ ÓÔÛÔÎÔÌ›Ԣ. ™Â Û‡ÁÎÚÈÛË Ì ÙȘ ÔÈÎÔÁ¤ÓÂȘ ·È‰ÈÒÓ, ÁÈ· Ù· ÔÔ›· ›¯Â Á›ÓÂÈ ¿ÏÏÔ˘ ›‰Ô˘˜ „˘¯È·ÙÚÈ΋ ‰È¿ÁÓˆÛË, ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·È‰ÈÒÓ Ì ηٿıÏÈ„Ë ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ı¿Ó·ÙÔ˜ ÂÓfi˜ ÁÔÓ¤·, ı¿Ó·ÙÔ˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ‰È·˙‡ÁÈÔ Î·È ·Ú¿ÁÔÓÙ˜ ÂÓ‰ÂÈÎÙÈÎÔ› ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·ÎÔ‡ „˘¯ÔÎÔÈÓˆÓÈÎÔ‡ stress, fiˆ˜ ‚ÈÒÌ·Ù· ·ÒÏÂÈ·˜, ·ÂÈÏ‹ ·ÒÏÂÈ·˜, ·fiÚÚÈ„Ë Î·È „˘¯È΋ ‰È·Ù·Ú·¯‹ ÁÔÓ¤ˆÓ (38).

OÈ Ì˯·ÓÈÛÌÔ› Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ·ÓÙ›ÍÔ˜ ÔÈÎÔÁÂÓÂȷΤ˜ Û˘Óı‹Î˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·Ó¿Ù˘ÍË Î·Ù¿ıÏȄ˘ ‰ÂÓ Â›Ó·È ÁÓˆÛÙÔ›. ŒÓ·˜ Èı·Ófi˜ Ì˯·ÓÈÛÌfi˜ Â›Ó·È fiÙÈ ‰È·Ù·Ú·Á̤Ó˜ ÚÒÈ̘ ·ÏÏËÏÂȉڿÛÂȘ ÌÂٷ͇ ÌËÙ¤Ú·˜ Î·È ·È‰ÈÔ‡ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÙÔ ·È‰› Ó· ·Ó·Ù‡ÍÂÈ ÙÚfiÔ˘˜ ‰È·¯Â›ÚÈÛ˘ ÙÔ˘ stress Ô˘ Úԉȷı¤ÙÔ˘Ó ÁÈ· ηٿıÏÈ„Ë.

OÈ ÁÔÓ›˜ ‰È‰¿ÛÎÔ˘Ó ÛÙ· ·È‰È¿ ÙÔ˘˜ Ó· ·ÔÛ‡ÚÔÓÙ·È fiÙ·Ó ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ¤Ó· ‰‡ÛÎÔÏÔ Î·ı‹ÎÔÓ Î·È ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÌÂıfi‰Ô˘˜ ÚÔÛ·ÚÌÔÁ‹˜ ÁÈ· Ó· Ú˘ıÌ›˙Ô˘Ó Ù· ·ÚÓËÙÈο Û˘Ó·ÈÛı‹Ì·Ù·. ¶Ú¤ÂÈ, Â›Û˘, Ó· ÙÔÓÈÛÙ› fiÙÈ Ù· ηٷıÏÈÙÈο ·È‰È¿ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ÂÈ‚·Ú‡ÓÔ˘Ó ÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ηٿıÏȄ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ‹ ‰ËÌÈÔ˘ÚÁÔ‡Ó Û˘ÁÎÚÔ‡ÛÂȘ Û ̛· ÔÈÎÔÁ¤ÓÂÈ·, Ë ÔÔ›· ηٿ Ù· ¿ÏÏ· ÏÂÈÙÔ˘ÚÁ› Ê˘ÛÈÔÏÔÁÈο. ∏ ·È‰È΋ ηٿıÏÈ„Ë ¤¯ÂÈ Û˘Ó‰Âı› Ì ·ÚÓËÙÈο ÁÂÁÔÓfiÙ· ˙ˆ‹˜, ΢ڛˆ˜ ·ÒÏÂȘ. ∆¤ÙÔÈ· ÁÂÁÔÓfiÙ·, fiˆ˜ ‰È·˙‡ÁÈÔ, ·ÔÛÙ¤ÚËÛË, ı¿Ó·ÙÔ˜, ·˘ÙÔÎÙÔÓ›· - ÌfiÓ· ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (.¯. ¤ÏÏÂÈ„Ë ˘ÔÛÙ‹ÚÈ͢) ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ÙËÓ ¤Ó·ÚÍË Ù˘ ηٿıÏȄ˘. ™ÙȘ ÂÚÈÙÒÛÂȘ ı·Ó¿ÙÔ˘ ‹ ·˘ÙÔÎÙÔÓ›·˜, Ô Î›Ó‰˘ÓÔ˜ ηٿıÏȄ˘ Â›Ó·È ·Ó¿ÏÔÁÔ˜ Ì ÙÔ fiÛÔ ÎÔÓÙÈÓfi ‹Ù·Ó ÙÔ ·ÔÏÂÛı¤Ó ÚfiÛˆÔ Î·È ÙË ‚È·ÈfiÙËÙ· Ù˘ ¤ÎıÂÛ˘ ÛÙÔ ÁÂÁÔÓfi˜. ∂›Û˘, ÛÔ‚·Ú¿ ÛÙÚÂÛÔÁfiÓ· ÁÂÁÔÓfiÙ·, fiˆ˜ ‰˘ÛÎÔϛ˜ ÛÙȘ Û¯¤ÛÂȘ Ì ÙÔ˘˜ Ê›ÏÔ˘˜ ‹ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û¯ÔÏ›Ô, ·Ó¢ڛÛÎÔÓÙ·È ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘ Ù˘ ¤Ó·Ú͢ Ô˘ ÚÔËÁÂ›Ù·È Ù˘ ηٿıÏȄ˘ (39). °. °ÓˆÛȷ΋ ÚÔÛ¤ÁÁÈÛË ∏ ÌÂϤÙË Ù˘ ÁÓˆÛȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Î·Ù·-

Paediatriki 2004;67:241-253

ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ ¤‰ÂÈÍ fiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË, ¤ÓÙÔÓË ·˘ÙÔÎÚÈÙÈ΋, ÛËÌ·ÓÙÈΤ˜ ÁÓˆÛȷΤ˜ ‰È·ÛÙÚ‚ÏÒÛÂȘ Î·È ·›ÛıËÌ· ¤ÏÏÂȄ˘ ÂϤÁ¯Ô˘ Û ·ÚÓËÙÈο ÁÂÁÔÓfiÙ· (40). ∆· ηٷıÏÈÙÈο ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ ·›ÛıËÌ· ÙÔ˘ ·‚Ô‹ıËÙÔ˘ Î·È ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ·Ô‰›‰Ô˘Ó Û Â͈ÙÂÚÈÎÔ‡˜ ÌË ÂÏÂÁ¯fiÌÂÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜. OÈ ÎÔÈÓˆÓÈΤ˜ ‰ÂÍÈfiÙËÙ˜ Â›Ó·È ÊÙˆ¯¤˜ Î·È ‰˘ÛÎÔχÔÓÙ·È ÛÙȘ Û¯¤ÛÂȘ Ì ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ (41). ∆· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·ÚÓËÙÈÎfi ÙÚfiÔ Ó· ÂÚÌËÓÂ‡Ô˘Ó Î·È Ó· ‰È·Ú·ÁÌ·Ù‡ÔÓÙ·È Ì ÙÔ stress ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÎÏËıÔ‡Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÛÙÚÂÛÔÁfiÓ· ÁÂÁÔÓfiÙ·, fiˆ˜ η΋ Û¯ÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ‹ ·fiÚÚÈ„Ë ·fi Û˘ÓÔÌËÏ›ÎÔ˘˜ - Â›Ó·È Û ˘„ËÏfi ΛӉ˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó Î·Ù¿ıÏÈ„Ë. ™˘˙ËÙÂ›Ù·È Â¿Ó ·˘Ùfi˜ Ô ÁÓˆÛÈ·Îfi˜ ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Â›Ó·È ¤Ó· ‰ÔÌÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ ‹ Â¿Ó ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌfiÓÔ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ª›· ÚfiÛÊ·ÙË ¤Ú¢ӷ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ÁÓˆÛÈ·Îfi ÌÔÓÙ¤ÏÔ Ô˘ Û˘Ó‰¤ÂÈ ÙÔ Ù˘¯·›Ô, ÙȘ ÈηÓfiÙËÙ˜ Î·È ÙÔÓ ¤ÏÂÁ¯Ô Ì ÙËÓ Î·Ù¿ıÏÈ„Ë. ™Â Ì›· ·Ó·Ù˘Íȷ΋ ÚÔÛ¤ÁÁÈÛË, ·˘Ùfi ÙÔ ÌÔÓÙ¤ÏÔ Ê·›ÓÂÙ·È Ó· ÏÂÈÙÔ˘ÚÁ› ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÂÊ˂›·, fiÔ˘ ˘¿Ú¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÈηÓfiÙËÙ˜ ·Ê·ÈÚÂÙÈ΋˜ ÛΤ„˘, ·Ú¿ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ø˜ ¤ÏÂÁ¯Ô˜ ÔÚ›˙ÂÙ·È Ë ÈηÓfiÙËÙ· Ó· ·Ú·¯ı› ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ·ÔÙ¤ÏÂÛÌ·, ÂÓÒ Û˘Ó‰¤ÂÙ·È Î·È Ì ‰‡Ô ÂÈÚfiÛıÂÙÔ˘˜ ·Ú¿ÁÔÓÙ˜: ÙËÓ ¤Î‚·ÛË ÙÔ˘ Ù˘¯·›Ô˘ Î·È ÙȘ ÚÔÛˆÈΤ˜ ÈηÓfiÙËÙ˜ (42). ¶ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ·ÎfiÌË Î·È ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ù· ηٷıÏÈÙÈο ·È‰È¿ ›¯·Ó ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË, Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘ ·ÔÙÂÏÔ‡Û ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ (43). ¢. æ˘¯·Ó·Ï˘ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ™‡Ìʈӷ Ì ÙȘ ·fi„ÂȘ ÙÔ˘ Freud (1917) Î·È ÙÔ˘ Abraham (1927), ÛÙÔ Â›ÎÂÓÙÚÔ Ù˘ ÌÂÏ·Á¯ÔÏÈ΋˜ Û˘Ó›‰ËÛ˘ Â›Ó·È Ë ÂÈıÂÙÈÎfiÙËÙ·, Ë ÔÔ›· ÂÓÂÚÁÔÔÈÂ›Ù·È ·fi Ì›· Ú·ÁÌ·ÙÈ΋ ‹ Ê·ÓÙ·ÛÙÈ΋ ·ÒÏÂÈ· ·ÓÙÈÎÂÈ̤ÓÔ˘ (44,45). ∏ ÂÈıÂÙÈÎfiÙËÙ· ÌÂÙ·ÛÙÚ¤ÊÂÙ·È Û ηٷÛÙÚÂÙÈ΋ ·˘ÙÔÌÔÌÊ‹ Ô˘ Ï‹ÙÙÂÈ ÙÔ ›‰ÈÔ ÙÔ ¿ÙÔÌÔ. ¶ÚÔ¸Ôı¤ÙÂÈ ÙË Û‡ÁÎÚÔ˘ÛË ÙÔ˘ Û·‰ÈÛÙÈÎÔ‡ ˘ÂÚÂÁÒ Î·È ÙÔ˘ ·˘ÙÔ‡, Ô ÔÔ›Ô˜ ¤¯ÂÈ Ù·˘ÙÈÛÙ› Ì ÙÔ ¯·Ì¤ÓÔ ·ÓÙÈΛÌÂÓÔ. ™Ù· ·È‰È¿, fï˜, Ë ·Ó¿Ù˘ÍË ÙÔ˘ ˘ÂÚÂÁÒ ·ÚÁ› Ó· ÔÏÔÎÏËÚˆı›. ∂Ô̤ӈ˜, ‰ÂÓ ÌÔÚԇ̠ӷ ÌÈÏ¿Ì ÁÈ· ÌÂÏ·Á¯ÔÏ›·. ∏ ÂÚÈÁÚ·Ê‹ Ù˘ ·Ó·ÎÏËÙÈ΋˜ ηٿıÏȄ˘ ·fi ÙÔÓ Spitz ÙÔÔı¤ÙËÛ ÙËÓ ·ÒÏÂÈ· Ù˘ ÌËÙ¤Ú·˜ ˆ˜ ÎÂÓÙÚÈÎfi ˘Ú‹Ó· Ù˘ ηٿıÏȄ˘. O Spitz ˘ÔÛÙ‹ÚÈÍ fiÙÈ Ô ·Ô¯ˆÚÈÛÌfi˜ Â›Ó·È Ì›· ÂÈıÂÙÈ΋ Ú¿ÍË

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Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ›‰ÈÔ ÙÔ ·ÓÙÈΛÌÂÓÔ ·Á¿˘, Ô˘ ·ÎfiÌË Â›Ó·È ¤Ó· Â͈ÙÂÚÈÎfi ·ÓÙÈΛÌÂÓÔ. ∏ ¤ÓÓÔÈ· Ù˘ ·ÒÏÂÈ·˜ ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÛÂ Ê˘ÛÈ΋ ·Ô˘Û›· Ù˘ ÌËÙ¤Ú·˜, ·ÏÏ¿ Û οı ηٿÛÙ·ÛË ··Ú·›ÙËÙË ÁÈ· ÙËÓ „˘¯ÔÏÔÁÈ΋ ÈÛÔÚÚÔ›· ÙÔ˘ ·ÙfiÌÔ˘ (46). ∞fi ÙȘ „˘¯·Ó·Ï‡ÛÂȘ ÂÓËÏ›ÎˆÓ Î·Ù·ıÏÈÙÈÎÒÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ¿ÓÙ· Ì›· ÚÒÈÌË ÂÌÂÈÚ›· ·ÒÏÂÈ·˜, ›Ù ·˘Ù‹ Â›Ó·È Ú·ÁÌ·ÙÈ΋ ›Ù ʷÓÙ·ÛȈÛÈ΋. ™ÙËÓ ·È‰È΋ ËÏÈΛ·, Ë ÌË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ‰È·ıÂÛÈÌfiÙËÙ· Ù˘ ÌËÙ¤Ú·˜ ‚ÈÒÓÂÙ·È Û·Ó ·ÒÏÂÈ·. ∏ ‰È·ıÂÛÈÌfiÙËÙ· Î·È Ë ··ÓÙËÙÈÎfiÙËÙ· Ù˘ ÌËÙ¤Ú·˜ ·ÔÙÂÏÔ‡Ó Ù· ‰‡Ô ··Ú·›ÙËÙ· ÛÙÔȯ›· ÁÈ· Ì›· Û¯¤ÛË ·ÛÊ·Ï‹ Î·È ÛÙ·ıÂÚ‹. ªÂ ‚¿ÛË ·˘Ù‹ ÙË Û¯¤ÛË, ÙÔ ·È‰› ı· ·Ó·Ù‡ÍÂÈ ÙÔ ·›ÛıËÌ· ÂÌÈÛÙÔÛ‡Ó˘ ÙÔ˘ ·˘ÙÔ‡ ÙÔ˘. ŸÙ·Ó Ë ÌËÙ¤Ú· ‰ÂÓ ˘¿Ú¯ÂÈ ‹ ‰ÂÓ ··ÓÙ¿, ÙÔ ·È‰› ‚ÈÒÓÂÈ Ì›· ‰ÈÂÚÁ·Û›· ¤ÓıÔ˘˜, Ù· ÛÙ¿‰È· Ù˘ ÔÔ›·˜ ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ J. Bowlby (1973) (47). O ·Ô¯ˆÚÈÛÌfi˜ Â›Ó·È Ì›· Ú·ÁÌ·ÙÈ΋ ·ÒÏÂÈ· Ô˘ ÚÔηÏ› ·ÂÏÈÛ›·. ∏ ·ÂÈÏ‹ Ù˘ ·ÒÏÂÈ·˜ ÚÔηÏ› ¿Á¯Ô˜. ∆Ô ·È‰› ·ÓÙȉڿ ÛÙËÓ ·ÒÏÂÈ· Ì ̛· ›‰È· ÛÂÈÚ¿ Û˘ÌÂÚÈÊÔÚÒÓ: ·) ∞ÂÏÈÛ›·: ÎÏ·›ÂÈ Î·È ÚÔÛ·ı› Ó· Í·Ó·‚Ú› ÙÔ ¯·Ì¤ÓÔ ·ÓÙÈΛÌÂÓÔ. ‚) ∞Ôı¿ÚÚ˘ÓÛË: ÂÓ·ÏÏ·Á‹ χ˘ Î·È ı˘ÌÔ‡, ‰È·ÈÛÙÒÓÂÈ ÙËÓ ·ÔÙ˘¯›· ÛÙÔ Ó· Â·Ó·Ê¤ÚÂÈ ÙË ÌËÙ¤Ú· ÙÔ˘ Î·È Ì¤ÓÂÈ ¤ÎÏËÎÙÔ. Á) ∞Ô‰¤ÛÌ¢ÛË: ÂÁηٷÏ›ÂÈ ÙÂÏ›ˆ˜ ÙË ‰ÈÂΉ›ÎËÛË. ∏ „˘¯Ô·ıÔÏÔÁÈ΋ ÔÚÁ¿ÓˆÛË ÙÔ˘ ·È‰ÈÔ‡ Úԉȷı¤ÙÂÈ ÁÈ· Ì›· ÛÙ·ıÂÚ‹ ˘ÔΛÌÂÓË Î·Ù·ıÏÈÙÈ΋ ı¤ÛË, Ô˘ ‡ÎÔÏ· ˘ÚÔ‰ÔÙÂ›Ù·È ·fi Ì›· ·ÒÏÂÈ· ‹ ÙËÓ ·ÂÈÏ‹ ·ÒÏÂÈ·˜ ÙÔ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘. À¿Ú¯Ô˘Ó ¿ÓÙ· ·ÈÛı‹Ì·Ù· ˘ÔÙ›ÌËÛ˘ Î·È ÂÓÔ¯‹˜. ∆Ô ·È‰› ηٷÏÔÁ›˙ÂÈ ÛÙÔÓ Â·˘Ùfi ÙÔ˘ ÙȘ Ú¿ÍÂȘ Î·È Ù· Û˘Ó·ÈÛı‹Ì·Ù· Ô˘ ÚÔηÏÔ‡Ó Î·Ù¿ ÙË ÁÓÒÌË ÙÔ˘ ÙËÓ ÂÁηٿÏÂÈ„‹ ÙÔ˘ ·fi ÙÔ ·ÓÙÈΛÌÂÓÔ. OÈ Ó·ÚÎÈÛÛÈÛÙÈΤ˜ ÂÏÏ›„ÂȘ Â›Ó·È ÛËÌ·ÓÙÈΤ˜, ‰ËÏ·‰‹ ˘ÔÏ›ÂÙ·È Ë Ê˘ÛÈÔÏÔÁÈ΋ Î·È ··Ú·›ÙËÙË ·Á¿Ë ÁÈ· ÙÔÓ Â·˘Ùfi. ∆Ô ·È‰› Â›Ó·È ˘Ô¯Úˆ̤ÓÔ Ó· οÓÂÈ Û¯¤ÛÂȘ ·Ó·ÎÏËÙÈΤ˜, ‰ËÏ·‰‹ Ó· ·ÎÔ˘Ì¿, Ó· ÛÙËÚ›˙ÂÙ·È ÛÙÔ ·ÓÙÈΛÌÂÓÔ ·fi ÙÔ ÔÔ›Ô ÂÚÈ̤ÓÂÈ ·ıËÙÈο ÙËÓ ÈηÓÔÔ›ËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘. ∆Ô Î·Ù·ıÏÈÙÈÎfi ¿Á¯Ô˜ ‡ÎÔÏ· ÚÔηÏÂ›Ù·È Û ·˘Ùfi ÙÔ ·È‰›, ·¤Ó·ÓÙÈ ÛÙËÓ Èı·Ó‹ ÂÁηٿÏÂÈ„Ë ·fi ÙÔ ·ÓÙÈΛÌÂÓÔ. ∂. µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∆· ηٷıÏÈÙÈο ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÏ·Ùو̤ÓË ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, Ô˘ Èı·ÓfiÓ ÔÊ›ÏÂÙ·È Û ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÂÓÙÚÈÎÒÓ ÓÔÚ·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ (48). OÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ÌÈÏÔ‡Ó ÁÈ· ˘ÂÚ¤ÎÎÚÈÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfi-

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Ó˘ ÛÙ· ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (49), ·ÏÏ¿ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ Â·Ó·Ï‹ÊıËÎ·Ó Û ÓÂfiÙÂÚ˜ ¤Ú¢Ó˜ (50). ∆· ηٷıÏÈÙÈο ·È‰È¿ ¤¯Ô˘Ó, Â›Û˘, ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· ÛÙÔ test Ù˘ ‰ÂÍ·ÌÂı·˙fiÓ˘ ·’ fi,ÙÈ ÔÈ ¤ÊË‚ÔÈ (58% Î·È 44%, ·ÓÙ›ÛÙÔȯ·) (51). ∞Ó Î·È Û˘¯Ó¿ ˘¿Ú¯Ô˘Ó ·Ú¿ÔÓ· ÁÈ· ÚÔ‚Ï‹Ì·Ù· ‡ÓÔ˘ ÛÙ· ηٷıÏÈÙÈο ·È‰È¿, ÔÈ ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ∏∂° ηٷÁڷʤ˜ ‰ÂÓ ‚Ú‹Î·Ó ‰È·Ù·Ú·¯¤˜ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ÂÓËÏ›ÎˆÓ (52). ªfiÓÔ Ì›· ¤Ú¢ӷ ·Ó¤ÊÂÚ ÂÏ·Ùو̤ÓË REM latency Î·È ·˘ÍË̤ÓÔ ¯ÚfiÓÔ Â¤Ï¢Û˘ ‡ÓÔ˘ Û ¤Ó· ‰Â›ÁÌ· ÓÔÛËÏ¢fiÌÂÓˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ (53). ¶ÚfiÁÓˆÛË ∏ ̤ÛË ‰È¿ÚÎÂÈ· ÂÓfi˜ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ÛÙ· ·È‰È¿ Â›Ó·È 7-9 Ì‹Ó˜. ¶ÂÚ›Ô˘ 90% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ¤¯ÂÈ È·ı› Ï‹Úˆ˜ ÌÂÙ¿ ·fi 1,5 ¤ˆ˜ 2 ¤ÙË, ÂÓÒ 6-10% Ù›ÓÂÈ ÚÔ˜ ÙË ¯ÚÔÓÈfiÙËÙ·. ∞fi fiϘ ÙȘ ¤Ú¢Ó˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ë Ì›˙ˆÓ ηٷıÏÈÙÈ΋ ‰È·Ù·Ú·¯‹ Â›Ó·È Ì›· ˘ÔÙÚÔÈ¿˙Ô˘Û· ‰È·Ù·Ú·¯‹ Ì 40% Èı·ÓfiÙËÙ˜ ˘ÔÙÚÔ‹˜ ÛÙ· 2 ¯ÚfiÓÈ· Î·È 70% ÛÙ· 5 ¯ÚfiÓÈ· (54,55). ∆· ηٷıÏÈÙÈο ·È‰È¿ Ô˘ ˙Ô˘Ó ÛÂ Û˘ÁÎÚÔ˘ÛÈ·Îfi ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜ ·fi ÂΛӷ Ô˘ ˙Ô˘Ó Û ÔÈÎÔÁ¤ÓÂȘ ¯ˆÚ›˜ Û˘ÁÎÚÔ‡ÛÂȘ (56). ∏ ·È‰È΋ ηٿıÏÈ„Ë Â›Ó·È Û˘Ó‰Â‰Â̤ÓË Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·˘ÙÔÎÙÔÓÈÎÒÓ Û˘ÌÂÚÈÊÔÚÒÓ Î·È ¯Ú‹ÛË ·ÏÎÔfiÏ Î·È ¿ÏÏˆÓ Ô˘ÛÈÒÓ ÛÙËÓ ÂÊ˂›· Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (57,58). ¶ÚÔÔÙÈΤ˜ ÌÂϤÙ˜, Â›Û˘, ‰Â›¯ÓÔ˘Ó fiÙÈ Î·È ÌÂÙ¿ ÙËÓ ›·ÛË, Ù· ηٷıÏÈÙÈο ·È‰È¿ Û˘Ó¯›˙Ô˘Ó Ó· ¤¯Ô˘Ó ·ÚÓËÙÈΤ˜ Áӈۛ˜, ‰˘ÛÎÔϛ˜ ÛÙȘ ‰È·ÚÔÛˆÈΤ˜ Û¯¤ÛÂȘ, ÌÂȈ̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ·˘ÍË̤ÓË ¯Ú‹ÛË Î·ÓÔ‡, ·˘ÍË̤ӷ ۈ̷ÙÈο ÚÔ‚Ï‹Ì·Ù· Î·È ÚÒÈ̘ ÂÁ΢ÌÔÛ‡Ó˜ (59). ∆¤ÏÔ˜, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ÂÁηٿÛÙ·Û˘ ÌÔÓÔÔÏÈ΋˜ ‹ ‰ÈÔÏÈ΋˜ Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ ‰È·Ù·Ú·¯‹˜. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ì›· Ù¤ÙÔÈ· ÂͤÏÈÍË Â›Ó·È Ë ÌÈÎÚ‹ ËÏÈΛ· ¤Ó·Ú͢ ÙÔ˘ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰ÈÔÏÈ΋˜ ‹ ¿ÏÏ˘ Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ Î·È Ë Û˘Ó‡·ÚÍË „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ‹ „˘¯ˆÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ (60). °È· ÙËÓ M. Covacs, Ë ·È‰È΋ ηٿıÏÈ„Ë ¤¯ÂÈ ÂÚ›Ô˘ ÙËÓ ›‰È· ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ÙËÓ Î·Ù¿ıÏÈ„Ë ÂÓËϛΈÓ, ·ÏÏ¿ ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË (61). ∞Ó Î·È Ë ›·ÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Â›Ó·È Û¯ÂÙÈο Ù·¯‡ÙÂÚË ÛÙ· ·È‰È¿ ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ Û ۯÂÙÈο Û‡ÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∂›Û˘, Ô Î›Ó‰˘ÓÔ˜ ÂÁηٿÛÙ·Û˘ ‰ÈÔÏÈ΋˜

July August 04

07-10-04

13:52

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‰È·Ù·Ú·¯‹˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙËÓ Î·Ù¿ıÏÈ„Ë Ì ¤Ó·ÚÍË ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·’ fi,ÙÈ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∆· ηٷıÏÈÙÈο ·È‰È¿ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‰ÈÔÏÈ΋ ‰È·Ù·Ú·¯‹ Û ÔÛÔÛÙfi 20-30% ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ (ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Â›Ó·È 10%). ∞Ô‰ÂÈÎÓ‡ÂÙ·È, ¤ÙÛÈ, Ë ÛËÌ·Û›· Ù˘ ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘, Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Î·È Ù˘ ·Ó¿Ù˘Í˘ ÚÔÏËÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ. £ÂÚ·›· OÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔÈ ÙÚfiÔÈ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ·È‰È΋˜ ηٿıÏȄ˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ë „˘¯ÔıÂÚ·›· Î·È Ë Ê·ÚÌ·ÎÔıÂÚ·›· ‹ Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘˜. ∏ ÂÈÏÔÁ‹ ÙÔ˘ Ï·ÈÛ›Ô˘ (Â͈ÙÂÚÈÎfi˜ ·ÛıÂÓ‹˜, ÓÔÛÔÎÔÌÂ›Ô Ë̤ڷ˜, ÓÔÛËÏ›·) ı· ÂÍ·ÚÙËı› ·fi ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜, ÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ˘ÔÛÙ‹ÚÈÍË, Ù· ΛÓËÙÚ· Î·È ÙË Û˘ÌÌfiÚʈÛË ÚÔ˜ ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ıÂÚ·›·. ∏ „˘¯ÔıÂÚ·›· Ê·›ÓÂÙ·È Ó· Â›Ó·È Î·Ù¿ÏÏËÏË ÁÈ· ÂÏ·ÊÚÈ¿˜ Î·È Ì¤Û˘ ‚·Ú‡ÙËÙ·˜ ÌÔÚʤ˜ ηٿıÏȄ˘. ™ÎÔfi˜ Ù˘ „˘¯ÔıÂÚ·›·˜ Â›Ó·È Ó· Ì¿ıÂÈ ÙÔ ·È‰› Ó· Û˘Ó·ÏÏ¿ÛÛÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚ· Ì ÛÙÚÂÛÔÁfiÓ˜ ηٷÛÙ¿ÛÂȘ, Ó· ‚ÂÏÙÈÒÛÂÈ ÙȘ ÎÔÈÓˆÓÈΤ˜ ‰ÂÍÈfiÙËÙ˜ Î·È ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘, Ó· ηٷÓÔ‹ÛÂÈ Î·Ï‡ÙÂÚ· ÙÔÓ Â·˘Ùfi ÙÔ˘ Î·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÔÈÎÔÁÂÓÂȷο, ÎÔÈÓˆÓÈο Î·È Ì·ıËÛȷο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙËÓ Î·Ù¿ıÏÈ„Ë. ™Â οı „˘¯ÔıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ··ÈÙÂ›Ù·È Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÁÔÓ¤ˆÓ ¤¯ÂÈ ÛÎÔfi Ó· ‚ÔËı‹ÛÂÈ Ó· ηٷÓÔ‹ÛÔ˘Ó ÔÈ ÁÔÓ›˜ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘ (.¯. Ó· ÌËÓ ·Ô‰›‰Ô˘Ó ÙË Ì·ıËÛȷ΋ ÙÔ˘ ·ÔÙ˘¯›· ÛÙËÓ ÙÂÌÂÏÈ¿). ∞˘Ùfi ı· ‰È¢ÎÔχÓÂÈ ÙÔÓ Û¯Â‰È·ÛÌfi Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Î·È ı· ‚ÔËı‹ÛÂÈ Ó· ÂÁηٷÛÙ·ı› Ë ıÂÚ·¢ÙÈ΋ Û˘ÌÌ·¯›· Ì ÙÔ ·È‰›. ™˘¯Ó¿, Ë ·Ó·ÁÓÒÚÈÛË Ù˘ ηٿıÏȄ˘ ÙÔ˘ ·È‰ÈÔ‡ ‚ÔËı¿ÂÈ ÙÔ˘˜ ÁÔÓ›˜ Ó· ·Ó·Î·Ï‡„Ô˘Ó Ù· ‰Èο ÙÔ˘˜ ηٷıÏÈÙÈο Û˘ÌÙÒÌ·Ù· Î·È Ó· ˙ËÙ‹ÛÔ˘Ó ‚Ô‹ıÂÈ· ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘˜. ÕÏϘ ÊÔÚ¤˜, Ë ˘ÂÚÚÔÛÙ·Û›· Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ·ÓËÛ˘¯›· ÙˆÓ ÁÔÓ¤ˆÓ ÚÔηÏÔ‡Ó ÌÂÁ·Ï‡ÙÂÚÔ ¿Á¯Ô˜, ÂÓÔ¯¤˜ Î·È ÂÈıÂÙÈÎfiÙËÙ· ÛÙÔ ·È‰›. OÈ ‰È·Ù·Ú·Á̤Ó˜ ÂÓ‰ÔÔÈÎÔÁÂÓÂȷΤ˜ Û¯¤ÛÂȘ ÌÔÚ› Ó· ÚÔËÁÔ‡ÓÙ·È ‹ Ó· ¤ÔÓÙ·È ÙÔ˘ ηٷıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ∏ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜, Û οı ÂÚ›ÙˆÛË, ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·ÙÔÌÈ΋ Î·È ÔÈÎÔÁÂÓÂȷ΋ ÏÂÈÙÔ˘ÚÁ›·, Û˘ÓÙÂÏ› ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ıÂÚ·›·˜ Î·È ‰Ú· ÚÔÏËÙÈο ÁÈ· ÙȘ ˘ÔÙÚÔ¤˜. °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ηٿıÏȄ˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Ë ÁÓˆÛȷ΋, Ë Û˘ÌÂÚÈÊÂÚÔ-

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ÏÔÁÈ΋, Ë „˘¯Ô‰˘Ó·ÌÈ΋ Î·È Ë ÔÈÎÔÁÂÓÂȷ΋ ‹ ‰È·ÚÔÛˆÈ΋ „˘¯ÔıÂÚ·›·. OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ıÂÚ·ÂÈÒÓ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ÎÏÈÓÈ΋ ÂÌÂÈÚ›·. OÈ Ritvo Î·È Papilsky ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÌÂÙ·-·Ó¿Ï˘ÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚ¢ÓËÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë „˘¯ÔıÂÚ·›· Ù˘ ·È‰È΋˜ ηٿıÏȄ˘ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·¢ÙÈ΋ ̤ıÔ‰Ô˜ (62). ¢˘ÛÙ˘¯Ò˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·Ú΋ Î·È ·ÍÈfiÈÛÙ· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ Ô˘ Ó· Û˘ÁÎÚ›ÓÔ˘Ó Î·È Ó· ‰Â›¯ÓÔ˘Ó ÙËÓ ˘ÂÚÔ¯‹ Ù˘ Ì›·˜ ÌÔÚÊ‹˜ „˘¯ÔıÂÚ·›·˜ ¤Ó·ÓÙÈ Ù˘ ¿ÏÏ˘ (.¯. ÁÓˆÛȷ΋ ÚÔ˜ „˘¯·Ó·Ï˘ÙÈ΋) (63). ¶·Ú¿ Ù·‡Ù·, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ÁÓˆÛȷ΋ „˘¯ÔıÂÚ·›· ¤¯ÂÈ Ù·¯‡ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· (64,65). ŸÏ˜, fï˜, ÔÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ‰È·ÈÛÙÒÓÔ˘Ó ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ Î·È Û˘ÌÂÚ·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË Û˘Ó¤¯ÈÛ˘ Ù˘ ıÂÚ·›·˜ (64). ªÂ ÙËÓ „˘¯Ô‰˘Ó·ÌÈ΋ „˘¯ÔıÂÚ·›·, ÙÔ ·È‰› ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÂÈÎfiÓ· Ô˘ ¤¯ÂÈ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘, Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Ù· Û˘Ó·ÈÛı‹Ì·Ù¿ ÙÔ˘, Ó· Û˘Ó·Ó·ÛÙÚ¤ÊÂÙ·È Ì ۈÛÙfiÙÂÚÔ ÙÚfiÔ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ Î·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÂÛˆÙÂÚÈΤ˜ ‹ Â͈ÙÂÚÈΤ˜ Û˘ÁÎÚÔ‡ÛÂȘ. ∏ „˘¯Ô‰˘Ó·ÌÈ΋ ıÂÚ·›·, fï˜, Â›Ó·È Ì·ÎÚÔ¯ÚfiÓÈ· Î·È Ë Ú·ÁÌ·ÙÔÔ›ËÛ‹ Ù˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘ÛÎÔϛ˜. ∏ ·Ó·ÛÙÔÏ‹ Î·È ÙÔ ÌÏÔοÚÈÛÌ· ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ ÛÙ· ηٷıÏÈÙÈο ·È‰È¿ ··ÁÔÚÂ‡Ô˘Ó ÙË ÁÚ‹ÁÔÚË ÂÁηٿÛÙ·ÛË Ù˘ ÌÂÙ·‚È‚·ÛÙÈ΋˜ Û¯¤Û˘. ŸÙ·Ó ÍÂÂÚ·ÛÙÔ‡Ó Ù· ÚÒÙ· ÂÌfi‰È·, ÙÔ ·È‰› ÂÎÊÚ¿˙ÂÈ ¤ÓÙÔÓ˜ Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·Ó¿ÁΘ Î·È Êfi‚Ô ·fiÚÚȄ˘. À¿Ú¯Ô˘Ó Ï›Á˜ ÌÂϤÙ˜ ÁÈ· ÙË Ê·ÚÌ·ÎÔÏÔÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ηٿıÏȄ˘ ÛÙ· ·È‰È¿. ¢ÂÔÓÙÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ¯Ú‹Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ‰˘ÛÎÔϛ˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ ÂÚ¢ÓÒÓ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÔÈ ˘¿Ú¯Ô˘Û˜ ¤Ú¢Ó˜ Ó· Â›Ó·È ·ÓÔȯ٤˜ ηÈ, ¿Ú·, ÏÈÁfiÙÂÚÔ ·ÍÈfiÈÛÙ˜ Î·È Ó· ¤¯Ô˘Ó ÔÏÏ¿ ÌÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ∂›Û˘, ÙÔ ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙË ‚Ú·¯˘¯ÚfiÓÈ· ¯Ú‹ÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È ·ÁÓÔ› ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙȘ ·ÚÂÓ¤ÚÁÂȤ˜ ÙÔ˘˜ (66). ∞fi ÙȘ ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ Ù· ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο ‰ÂÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈο ·’ fi,ÙÈ Ù· placebo ÛÙËÓ ·È‰È΋ ηٿıÏÈ„Ë. ¶Èı·Ó¤˜ ÂÍËÁ‹ÛÂȘ ·ÊÔÚÔ‡Ó ÛÙË ÌË Ï‹ÚË ·Ó¿Ù˘ÍË ÙÔ˘ ÓÔÚ·‰ÚÂÓÂÚÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿ ‹ ÛÙÔÓ Ù·¯‡ÙÂÚÔ Ë·ÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi Ô˘ Ô‰ËÁ› ÛÙË ÁÚ‹ÁÔÚË ·Ô‚ÔÏ‹ Ù˘ Ê·Ú̷΢ÙÈ΋˜ Ô˘Û›·˜ (67).

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ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ù· ÓÂfiÙÂÚ˘ ÁÂÓÈ¿˜ ·ÓÙÈηٷıÏÈÙÈο, ÔÈ ·Ó·ÛÙÔÏ›˜ Â·Ó·ÚfiÛÏ˄˘ Ù˘ ÛÂÚÔÙÔÓ›Ó˘, ¤¯Ô˘Ó ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù·. ª›· ‰ÈÏ‹ Ù˘ÊÏ‹ ÌÂϤÙË 8 ‚‰ÔÌ¿‰ˆÓ Û ¤Ó· ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ηٿıÏÈ„Ë ‰Â›¯ÓÂÈ ÛËÌ·ÓÙÈο ÔÛÔÛÙ¿ ‚ÂÏÙ›ˆÛ˘ Ì ÊÏÔ˘ÔÍÂÙ›ÓË ¤Ó·ÓÙÈ ÙÔ˘ placebo (58% Î·È 32%, ·ÓÙ›ÛÙÔȯ·) (68). ∏ ¯Ú‹ÛË ÙÔ˘˜ ¢ÓÔÂ›Ù·È Î·È ·fi ÙÔÓ ÈÛ¯˘ÚÈÛÌfi fiÙÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ∂›Ó·È ·ÎÚÈ‚¤˜ fiÙÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙȘ ›‰È˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ì ٷ ·Ï·ÈfiÙÂÚ· ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο. øÛÙfiÛÔ, Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·Ú΋ ‰Â‰Ô̤ӷ ÁÈ· ÙÔ ·Ó ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¿ÏÏÔ˘ ›‰Ô˘˜ ·ÚÂÓ¤ÚÁÂȘ ηÈ, ȉȷ›ÙÂÚ·, ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ (66). ∏ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È΋˜ Î·È ∂ÊË‚È΋˜ æ˘¯È·ÙÚÈ΋˜, ÛÙȘ Ô‰ËÁ›Â˜ Ù˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ηٿıÏȄ˘, ÌÂٷ͇ ¿ÏψÓ, ·Ó·Ê¤ÚÂÈ: “…µ·ÛÈ˙fiÌÂÓÔÈ ÛÙË Ì¤¯ÚÈ Û‹ÌÂÚ· ÁÓˆÛÙ‹ ‚È‚ÏÈÔÁÚ·Ê›· Î·È ÎÂÎÙË̤ÓË ÎÏÈÓÈ΋ ÂÌÂÈÚ›·, Ë „˘¯ÔıÂÚ·›· Â›Ó·È Ë ıÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ηٿıÏȄ˘. ¶·Ú’ fiÏ· ·˘Ù¿, Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ÂÍÂÙ¿˙ÂÙ·È ÁÈ· ÂΛÓÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì „˘¯ˆÛÈ΋ ηٿıÏÈ„Ë, ‰ÈÔÏÈ΋ ‰È·Ù·Ú·¯‹, ÂÈ̤ÓÔ˘Û· ‚·ÚÈ¿ ηٿıÏÈ„Ë Î·È ÁÈ· ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ „˘¯ÔıÂÚ·›· ÌÂÙ¿ ·fi ¤Á΢ÚË Î·È Â·Ú΋ ÛÔ‚·Ú‹ ÚÔÛ¿ıÂÈ·…” (69). ™Â οı ÂÚ›ÙˆÛË, Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ηٿıÏȄ˘ ‰ÂÓ ÌÔÚ› Ó· ·ÔÙÂÏ› ·Ï‹ ÚÔÛ·ÚÌÔÁ‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ÌÔÓÙ¤ÏˆÓ ÙˆÓ ÂÓËϛΈÓ. O ıÂÚ·¢ÙÈÎfi˜ ۯ‰ȷÛÌfi˜ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ - ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ - Î·È ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ·Ú¿ÁÔÓÙ˜: ·) ÙË Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÒÓ Î·È Û˘ÓÓÔÛËÚfiÙËÙ·˜, ‚) ÙË ÌÂȈ̤ÓË Û¯ÔÏÈ΋ Â›‰ÔÛË Î·È ÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹, Á) ÙËÓ ÔÈfiÙËÙ· ÙˆÓ Û¯¤ÛÂˆÓ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙË Û˘¯Ó‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ‰) ÙË Û˘Ó‡·ÚÍË ÛÔ‚·ÚÒÓ ·Ú·ÁfiÓÙˆÓ stress. ¶ÚfiÏË„Ë ∞Ó Î·È Ë ·È‰È΋ ηٿıÏÈ„Ë ÌÔÚ› Ó· ·Ô‰Âȯı› Ì›· ¯ÚfiÓÈ· ˘ÔÙÚÔÈ¿˙Ô˘Û· ‰È·Ù·Ú·¯‹ Î·È Ó· ¤¯ÂÈ ÛÔ‚·Ú¤˜ Û˘Ó¤ÂȘ ÛÙË ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Â›Ó·È Ï›Á˜ ÔÈ ¤Ú¢Ó˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ÚfiÏË„‹ Ù˘. °ÂÓÈο, Â›Ó·È ·Ô‰ÂÎÙfi fiÙÈ ÁÈ· ÙËÓ ˘ÁÈ‹ „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Î·Ïfi Ó· ·ÔʇÁÔÓÙ·È ÔÈ ÚÒÈÌÔÈ ·Ô¯ˆÚÈÛÌÔ› (.¯. Ì·ÎÚÔ¯ÚfiÓÈ· ·Ô˘Û›· Ù˘ ÌËÙ¤Ú·˜, Ù·Í›‰È·, ÓÔÛËÏ›·). ™ÙËÓ ÂÚ›ÙˆÛË ı·Ó¿ÙÔ˘ Ù˘ ÌËÙ¤Ú·˜, ÔÈ

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ÊÚÔÓÙ›‰Â˜ Ú¤ÂÈ Ó· ·Ú¤¯ÔÓÙ·È ·fi ¤Ó· ¿ÏÏÔ ÛÙ·ıÂÚfi ÚfiÛˆÔ Î·È Ó· ÌËÓ ˘¿Ú¯ÂÈ Û˘¯Ó‹ ÂÓ·ÏÏ·Á‹ Ï·ÈÛ›Ô˘ ‰È·ÌÔÓ‹˜.

OÈ ÂÚÁ·Û›Â˜ ÙÔ˘ Spitz η٤‰ÂÈÍ·Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÁÈ· Â¿ÚÎÂÈ·, ·ÏÏ¿ Î·È ÁÈ· ÌÔÓÈÌfiÙËÙ·, ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÙˆÓ È‰Ú˘Ì¿ÙˆÓ ·È‰È΋˜ ̤ÚÈÌÓ·˜. ∞˘Ù¤˜ ÔÈ Û˘Óı‹Î˜ ‰ÚÔ˘Ó ÚÔÏËÙÈο ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ·Ó·ÎÏËÙÈ΋˜ ηٿıÏȄ˘.

OÚÈṲ̂Ó˜ ÚÔÏËÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› Ì ·ÚÈÔ ÛÎÔfi ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË „˘¯ÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙ· ·È‰È¿ ηٷıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ. OÈ Keitner Î·È Miller ÚÔÙ›ÓÔ˘Ó ˘ÔÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ ÛÙÔ˘˜ ÁÔÓ›˜ (70). O La Roche ıˆÚ› fiÙÈ Ë ·Ú¤Ì‚·ÛË Ú¤ÂÈ Ó· ·ÊÔÚ¿ Û fiÏ· Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (71). OÈ Beardslee Î·È Û˘Ó ÚÔÙ›ÓÔ˘Ó ÚÔÏËÙÈ΋ „˘¯ÔıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ÁÈ· Ó· ‚ÔËı‹ÛÂÈ ÙÔ ·È‰› Ó· Û˘Ó‰È·ÏÏ·Á› Ì ÙȘ ‰˘ÛÎÔϛ˜ Ô˘ ÚÔηÏÔ‡Ó ÔÈ Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘ (72). µÚ·¯Â›Â˜ ÔÈÎÔÁÂÓÂȷΤ˜ „˘¯Ô-ÂÎ·È‰Â˘ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Ê·›ÓÂÙ·È, Â›Û˘, Ó· ÂÏ·ÙÙÒÓÔ˘Ó ÙȘ Û˘Ó¤ÂȘ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÁÔÓ¤ˆÓ ηÈ, ηٿ Û˘Ó¤ÂÈ·, ÙÔÓ Î›Ó‰˘ÓÔ ÓfiÛËÛ˘ ÙˆÓ ·È‰ÈÒÓ (73). ªÂÁ¿ÏË ÚÔÏËÙÈ΋ ÛËÌ·Û›· ¤¯ÂÈ Ë ·Ó›¯Ó¢ÛË ÛÙËÓ ÎÔÈÓfiÙËÙ· ·È‰ÈÒÓ Ô˘ Â›Ó·È Èı·Ófi Ó· ·Ó·Ù‡ÍÔ˘Ó Î·Ù¿ıÏÈ„Ë. ∆· ·È‰È¿ Ì ‰˘Ûı˘Ì›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ì›˙ÔÓÔ˜ ηٿıÏȄ˘ 2-3 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‰˘Ûı˘Ì›·˜ (74). ŒÚ¢Ó˜ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ì ˘ÔÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘ ¤‰ÂÈÍ·Ó fiÙÈ ÔÌ¿‰Â˜ ÁÓˆÛȷ΋˜ Û˘ÌÂÚÈÊÂÚÔÏÔÁÈ΋˜ ıÂÚ·›·˜ ÌÔÚ› Ó· ÚÔÊ˘Ï¿ÍÔ˘Ó ·fi ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÁÈ· ÂÚ›Ô‰Ô ¤ˆ˜ 24 ÌËÓÒÓ (75).

OÈ Mesman Î·È Koot ‰È·ÈÛÙÒÓÔ˘Ó, Û ¤Ó· ‰Â›ÁÌ· 274 ·È‰ÈÒÓ ËÏÈΛ·˜ 10-11 ÂÙÒÓ, fiÙÈ ÔÈ ‰¿ÛηÏÔÈ ·Ó·ÁÓÒÚÈ˙·Ó ÈÔ Â‡ÎÔÏ· ·’ fi,ÙÈ ÔÈ ÁÔÓ›˜ ÙȘ ÂÛˆÙÂÚÈÎÂ˘Ì¤Ó˜ ‰È·Ù·Ú·¯¤˜ ÏfiÁˆ ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ Î·È Ì·ıËÛÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ù· ·È‰È¿ Ì ¿Á¯Ô˜ ‹ ηٿıÏÈ„Ë (76).

OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó fiÙÈ ÙÔ Û¯ÔÏÂ›Ô ÚÔÛʤÚÂÙ·È ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ηٿıÏȄ˘ Î·È ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ·Ó¿Ù˘Í˘ ÂÓfi˜ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘, ÂȉÈο ۯ‰ȷṲ̂ÓÔ˘ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË - ·fi ÙÔ˘˜ ‰·ÛοÏÔ˘˜ - ·È‰ÈÒÓ Ì ηٷıÏÈÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·.

OÈ ›‰ÈÔÈ Û˘ÁÁÚ·Ê›˜ ‰È·ÈÛÙÒÓÔ˘Ó ÙËÓ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÔÚÈÛÌ¤ÓˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÂÈÛËÌ¿ÓıËÎ·Ó ·fi ·È‰·ÁˆÁÔ‡˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (·È‰› Ï˘Ë̤ÓÔ, ‰˘ÛÙ˘¯ÈṲ̂ÓÔ, ÌÔÓ·¯ÈÎfi, Ì ·ÈÛı‹Ì·Ù· ÂÓÔ¯‹˜). ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ Û˘Ó‰¤ıËÎ·Ó Ì ÙË ‰È¿ÁÓˆÛË Ù˘ ηٿıÏȄ˘ 6 ¯ÚfiÓÈ·

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·ÚÁfiÙÂÚ·. ∂›Û˘, ÚÔÁÓˆÛÙÈ΋ ·Í›· Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó οÔÈ· ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Ô˘ ·Ú·ÙËÚÔ‡Ó ÔÈ ·È‰·ÁˆÁÔ› Î·È ·ÊÔÚÔ‡Ó ÛÙËÓ ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ (Û˘ÌÂÚÈÊÔÚ¿ ·ÓÒÚÈÌË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘, Ôχ ÂÍ·ÚÙË̤ÓÔ, ·‰¤ÍÈÔ). ∂Ȃ‚·ÈÒÓÂÙ·È, ¤ÙÛÈ, Ë ·Ú·Ù‹ÚËÛË fiÙÈ Ë Î·Ù¿ıÏÈ„Ë Û˘Ó‰¤ÂÙ·È Ì ¤ÏÏÂÈ„Ë ÎÔÈÓˆÓÈÎÒÓ ÈηÓÔًوÓ, ·fiÚÚÈ„Ë ·fi Û˘ÓÔÌËÏ›ÎÔ˘˜ Î·È ÎÔÈÓˆÓÈ΋ ·fiÛ˘ÚÛË (77). ∂Ô̤ӈ˜, Â›Ó·È ÛËÌ·ÓÙÈ΋ Ë ‚Ô‹ıÂÈ· ÙˆÓ ·È‰·ÁˆÁÒÓ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ηٿıÏȄ˘. ∏ ÚÒÈÌË ·Ó›¯Ó¢ÛË ÚÔÛٷهÂÈ ÙÔ ·È‰› ·fi ÙȘ Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ Ù˘ ηٿıÏȄ˘ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË Û¯ÔÏÈ΋ Â›‰ÔÛË, ÙȘ Û¯¤ÛÂȘ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ Î·È ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ·˘ÙÔÎÙÔÓ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‹ ÙËÓ ÂÊ˂›·. ™˘ÌÂÚ¿ÛÌ·Ù· ∞fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ê·›ÓÂÙ·È fiÙÈ Ë Î·Ù¿ıÏÈ„Ë ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·ÔÙÂÏ› ¤Ó· ÛÔ‚·Úfi Î·È Û¯ÂÙÈο Û˘¯Ófi Úfi‚ÏËÌ·. ÃÚ‹˙ÂÈ ¿ÌÂÛ˘ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘, ÙfiÛÔ ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ fiÛÔ Î·È ÁÈ· ÙË Ì›ˆÛË ÙˆÓ ˘ÔÙÚÔÒÓ ‹ Ù˘ ÂÁηٿÛÙ·Û˘ Ù˘ ·ıÔÏÔÁ›·˜ Ô˘ ı· Û˘Óԉ‡ÂÈ ÙÔ ·È‰› ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ™ÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, ·Ó Î·È Ù· ÔÛÔÛÙ¿ ·È‰È΋˜ ηٿıÏȄ˘ Â›Ó·È ·ÚÎÂÙ¿ ˘„ËÏ¿, Â›Ó·È ÁÂÓÈο ·Ú·‰ÂÎÙfi fiÙÈ ÔÈ ·Ú·ÔÌ¤˜ ÛÙȘ ˘ËÚÂۛ˜ „˘¯È΋˜ ˘Á›·˜ Â›Ó·È ÌÂȈ̤Ó˜. ∞˘Ùfi ·Ô‰›‰ÂÙ·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ·ÊÂÓfi˜ ÛÙË ‰˘ÛÎÔÏ›· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ Ó· ·Ú·ÙËÚ‹ÛÔ˘Ó ÙȘ ÂÛˆÙÂÚÈÎÂ˘Ì¤Ó˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·È‰ÈÒÓ, ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ ·ÓÙ›ÛÙ·ÛË ÙˆÓ ÁÔÓ¤ˆÓ Ó· ‰Â¯ıÔ‡Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ Î·Ù¿ıÏÈ„Ë, ‰È·Ù·Ú·¯‹ Û˘Ó‰ÂfiÌÂÓË Ì ·ÚÓËÙÈο ÁÂÁÔÓfiÙ· ˙ˆ‹˜, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ.

OÊ›ÏÔ˘ÌÂ, Â›Û˘, Ó· ·Ú·ÙËÚ‹ÛÔ˘Ì fiÙÈ ÙȘ ›‰È˜ ·ÓÙÈÛÙ¿ÛÂȘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È Â·ÁÁÂÏ̷ٛ˜ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ Ô˘ ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ÙÔ ·È‰›. ¶ÚÔ·ÙÂÈ, ¤ÙÛÈ, Ë ·Ó¿ÁÎË ÏËÚÔÊfiÚËÛ˘ Î·È Â˘·ÈÛıËÙÔÔ›ËÛ‹˜ ÙÔ˘˜. O ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚÔÛ¿ıÂÈ· Ó· Á›ÓÂÈ Â˘Ú‡ÙÂÚ· ·Ô‰ÂÎÙfi fiÙÈ Ù· “Ï˘Ë̤ӷ Î·È ‰˘ÛÙ˘¯ÈṲ̂ӷ” ·È‰È¿ ¤¯Ô˘Ó ‰Èη›ˆÌ· Î·È ÌÔÚÔ‡Ó Ó· ˆÊÂÏËıÔ‡Ó ·fi ÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. §·˙·Ú¿ÙÔ˘ ∂, ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ˜ ¢∫. ∂Ê˂›· Î·È Î·Ù¿ıÏÈ„Ë. ∞گ›· ∂ÏÏËÓÈ΋˜ π·ÙÚÈ΋˜ 2001;18:466-474.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-06-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 19-12-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË §·˙·Ú¿ÙÔ˘ ¢‹ÏÔ˘ 14, ∫·ÈÛ·ÚÈ·Ó‹, ∆.∫. 161 21, ∞ı‹Ó· E-mail: danagnos@otenet.gr

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∞ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¢. π. ∑·ÊÂÈÚ›Ô˘, ª. OÈÎÔÓfiÌÔ˘

Strokes in childhood D. I. Zafeiriou, M. Ikonomou

¶ÂÚ›ÏË„Ë: ∏ ÂÎÙÂٷ̤ÓË ¤Ú¢ӷ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ Û¯ÂÙÈο Ì ÙËÓ ÂΉ‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿, ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ Û ÂÚÈÔÚÈÛÌfi Ù˘ ·Ï·ÈfiÙÂÚ˘ ‰È¿ÁÓˆÛ˘ ÙÔ˘ “ȉÈÔ·ıÔ‡˜” ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘. øÛÙfiÛÔ, Ë Û·Ê‹˜ ·ÈÙ›· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÚÈÙÒÛˆÓ. ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿ ÔÈΛÏÏÂÈ, ‰È·Ê¤ÚÔÓÙ·˜ ÛËÌ·ÓÙÈο ·fi ·˘Ù‹ ÙˆÓ ÂÓËϛΈÓ. ™Â ÔÛÔÛÙfi 25%, Ù· ¤ÌÊÚ·ÎÙ· ÛÙ· ·È‰È¿ ıˆÚÔ‡ÓÙ·È È‰ÈÔ·ı‹, ·ÊÔ‡ ‰ÂÓ ÌÔÚ› Ó· ηıÔÚÈÛÙ› Û˘ÁÎÂÎÚÈ̤ÓÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ∆· ηډÈÔÂÌ‚ÔÏÈο ¤ÌÊÚ·ÎÙ· ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 1/3 ¤ˆ˜ 1/5 fiÏˆÓ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿, ÌÂ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙȘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ. ∞fi Ù· ·ÁÁÂȷο ·›ÙÈ· ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, Ô ·ÚÙËÚÈ·Îfi˜ ‰È·¯ˆÚÈÛÌfi˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿. ∏ ÓfiÛÔ˜ Moyamoya ÌÔÚ› Ó· Â›Ó·È È‰ÈÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜, ˆ˜ ‡ÚËÌ· Ô˘ Û˘Óԉ‡ÂÈ ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Â›Ó·È Ë Ó¢ÚÔ˚ӈ̿وÛË, ÙÔ Û‡Ó‰ÚÔÌÔ Down Î·È Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜. ∏ ÙÂÏÂ˘Ù·›· ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, Ô Î›Ó‰˘ÓÔ˜ ÂΉ‹ÏˆÛ˘ ÙÔ˘ ÔÔ›Ô˘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È 200-400 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۇÁÎÚÈÛË Ì ÙÔÓ ˘fiÏÔÈÔ ·È‰ÈÎfi ÏËı˘ÛÌfi. ∆¤ÏÔ˜, ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ·È‰È΋ Î·È ÓÂÔÁÓÈ΋ ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ÔÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ Úԉȷı¤ÙÔ˘Ó Û ‰È·Ù·Ú·¯‹ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‹Í˘, Ì ÛÙÚÔÊ‹ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÈÛÔÚÚÔ›·˜ Ù˘ ·ÈÌfiÛÙ·Û˘ ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ ıÚfiÌ‚ˆÛ˘. øÛÙfiÛÔ, ··ÈÙÔ‡ÓÙ·È ÌÂÁ¿Ï˜ ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ ÁÈ· Ó· ηıÔÚÈÛÙÔ‡Ó Ì ۷ʋÓÂÈ· ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, Ë ‚¤ÏÙÈÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ·ÍÈÔÏfiÁËÛË

Abstract: The extensive research that has been conducted on childhood stroke during recent years has led to a significant increase in the diagnosis of specific aetiologic factors. The aetiology differs from that of adults, and in 25% of cases it is still considered idiopathic. Cardiovascular causes and especially congenital heart disease, account for 1/3 to 1/5 of ischaemic childhood stroke incidents and a significant number of cases are due to arterial dissection. Moyamoya disease can be either idiopathic or secondary ÙÔ various disorders, such as neurofibromatosis type I, Down syndrome and sickle cell disease. Sickling is one of the most frequent causes, with a risk estimated to be 200-400 times higher than that in the general population.

Further important causes of stroke are the prothrombotic disorders, which are characterized by disturbed haemostasis and a shift towards thrombosis. These disorders can be either inherited or acquired after an infection, drug use or liver or renal disease; their overall incidence varies from 1050% according to different series. Regarding preceding infections, of special interest is the association with the varicella-zoster virus, which typically results in basal ganglia infarcts. Large multicentre studies are still needed, in order to make an accurate estimate of risk factors and to formulate therapeutic interventions and provide long-term follow-up of this multifactorial disorder.

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘, £ÂÛÛ·ÏÔÓ›ÎË

1st Paediatric Clinic of Aristotelion University, Thessaloniki

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Paediatriki 2004;67:254-260

Ù˘ ¤Î‚·Û˘ Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·˘Ù‹˜ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. §¤ÍÂȘ ÎÏÂȉȿ: ¤ÌÊÚ·ÎÙÔ, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ·È‰È¿, ·ÈÙÈÔÏÔÁ›·, ÚfiÁÓˆÛË.

Key words: stroke, children, etiology, prognosis, therapy.

∂ÈÛ·ÁˆÁ‹ ø˜ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ ÔÚ›˙ÂÙ·È Ë “Ù·¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓË ÂΉ‹ÏˆÛË ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ÂÛÙȷ΋˜ ‹ ÁÂÓÈÎÂ˘Ì¤Ó˘ ‰È·Ù·Ú·¯‹˜ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ì ‰È¿ÚÎÂÈ· ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 24 ˆÚÒÓ ‹ Ì Â·ÎfiÏÔ˘ıÔ ÙÔÓ ı¿Ó·ÙÔ, ¯ˆÚ›˜ ¿ÏÏË ÂÌÊ·Ó‹ ·ÈÙ›· ÏËÓ Ù˘ ·ÁÁÂȷ΋˜ ÚÔ¤Ï¢Û˘ ·˘ÙÔ‡” (1). ∏ ÂΉ‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ··ÓÙ¿Ù·È ÙfiÛÔ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, fiÛÔ ıˆÚÔ‡ÓÙ·Ó ·ÏÈfiÙÂÚ·, ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ ÊÙ¿ÓÂÈ ÙȘ 7 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 (2,3), ÂÓÒ Ë ·Ó·ÊÂÚfiÌÂÓË Â›ÙˆÛË ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Â›Ó·È ÂÚ›Ô˘ 1/4000 ÁÂÓÓ‹ÛÂȘ ·Ó¿ ¤ÙÔ˜ (4). ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÚfiÁÓˆÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿ Â›Ó·È Û·ÊÒ˜ ηχÙÂÚË Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ηıÒ˜ Î·È Î›Ó‰˘ÓÔ˜ Â·ÓÂΉ‹ÏˆÛ˘ ÂÌÊÚ¿ÎÙÔ˘.

ÊÚ¿ÎÙÔ˘, ÂÓÒ ·˘Ù¤˜ Ô˘ Ô‰ËÁÔ‡Ó Û ÔÏ˘ÂÚ˘ıÚ·ÈÌ›· (΢·ÓˆÙÈΤ˜) ÂÓ‰¤¯ÂÙ·È Ó· ÚÔηϤÛÔ˘Ó ÊÏ‚È΋ ıÚfiÌ‚ˆÛË (5). ∫·Ú‰ÈÔ¿ıÂȘ Û¯ÂÙÈ˙fiÌÂÓ˜, Â›Û˘, Ì ÙËÓ ÂΉ‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Â›Ó·È ÔÈ Â›ÎÙËÙ˜ ‚·Ï‚ȉÔ¿ıÂȘ ÚÂ˘Ì·ÙÈ΋˜, ÏÔÈÌÒ‰Ô˘˜, ÊÏÂÁÌÔÓÒ‰Ô˘˜, Ì˘ÍˆÌ·ÙÒ‰Ô˘˜, ÂÎÊ˘ÏÈÛÙÈ΋˜ ‹ ÙÚ·˘Ì·ÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, ÔÈ ·ı‹ÛÂȘ ÙÔ˘ ÂÓ‰Ôηډ›Ô˘ Î·È ÙÔ˘ Ì˘Ôηډ›Ô˘, ηıÒ˜ Î·È ÔÈ Î·Ú‰È·ÎÔ› fiÁÎÔÈ (5). ∞fi Ù· ·ÁÁÂȷο ·›ÙÈ· ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, Ô ·ÚÙËÚÈ·Îfi˜ ‰È·¯ˆÚÈÛÌfi˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ (5,6). O ‰È·¯ˆÚÈÛÌfi˜ Â͈ÎÚ¿ÓÈˆÓ ‹ ÂÓ‰ÔÎÚ¿ÓÈˆÓ ÙÌËÌ¿ÙˆÓ ÙˆÓ Î·ÚˆÙ›‰ˆÓ Î·È ÙˆÓ ÛÔÓ‰˘ÏÔ‚·ÛÈÎÒÓ ·ÚÙËÚÈÒÓ ÌÔÚ› Ó· Û˘Ì‚Â› ·˘ÙfiÌ·Ù· ‹ ‰Â˘ÙÂÚÔ·ıÒ˜, ›Ù ˆ˜ Â·ÎfiÏÔ˘ıÔ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ›Ù Û ·ÚÔ˘Û›· ˘ÔΛÌÂÓ˘ ·ÁÁÂÈÔ¿ıÂÈ·˜. ∏ ÓfiÛÔ˜ Moyamoya (ªªD) ·ÔÙÂÏ› ·ÁÁÂÈÔ¿ıÂÈ· ÔÚÈ˙fiÌÂÓË ·fi ȉȷ›ÙÂÚ· ·ÁÁÂÈÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· Î·È ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi Ì›· ‚Ú·‰¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓË ÛÙ¤ÓˆÛË Î·È ·fiÊÚ·ÍË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ Ù˘ ‚¿Ûˆ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∏ MMD ÌÔÚ› Ó· Â›Ó·È È‰ÈÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜, ˆ˜ ‡ÚËÌ· Ô˘ Û˘Óԉ‡ÂÈ ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Â›Ó·È Ë Ó¢ÚÔ˚ӈ̿وÛË, ÙÔ Û‡Ó‰ÚÔÌÔ Down Î·È Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜ (9,10). §fiÁˆ Ù˘ Èı·Ó‹˜ Û˘Ó‡·Ú͢ ÛÙÂÓÒÛÂˆÓ ÛÙ· ÌÂÁ¿Ï· ·ÁÁ›· Ù˘ ηډȿ˜ Î·È ÙˆÓ ÓÂÊÚÒÓ, Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÛıÂÓÒÓ Ú¤ÂÈ Ó· ÛÙÚ¤ÊÂÙ·È Î·È ÚÔ˜ ·˘Ù‹ ÙËÓ Î·Ù‡ı˘ÓÛË. ∂›Û˘, Â›Ó·È ··Ú·›ÙËÙÔ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÏÂÙÔÌÂÚ‹˜ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÈÌfiÛÙ·Û˘, ηıÒ˜ Ë ÓfiÛÔ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·ÓÂ¿ÚÎÂÈ· ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÚˆÙÂ˚ÓÒÓ S Î·È C, ·ÚÔ˘Û›· FV Leiden Î.¿. (11).

OÈ ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙ· ·È‰È¿ (12). OÈ ·ÚÙËÚÈÔÊÏ‚ÈΤ˜ ÂÈÎÔÈӈӛ˜ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÌË ÙÚ·˘Ì·ÙÈ΋˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜ Î·È Ë ˘fiÓÔÈ· ‡·ÚÍ‹˜ ÙÔ˘˜ ı· Ú¤ÂÈ Ó· Ù›ıÂÙ·È ¿ÓÙÔÙ Û ÂÚÈÙÒÛÂȘ ·ÓÂÍ‹ÁËÙÔ˘ ·ÚÂÁ¯˘Ì·ÙÈÎÔ‡ ·ÈÌ·ÙÒÌ·ÙÔ˜. º·›ÓÂÙ·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·ÈÌÔÚÚ·Á›·˜ Ì›·˜ ÚÔËÁÔ˘Ì¤Óˆ˜ ÌË Ú˯ı›۷˜ ·ÚÙËÚÈÔÊÏ‚È΋˜ ÂÈÎÔÈÓˆÓ›·˜ Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁÔ˜ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘, Ì Èı·ÓfiÙËÙ· Ó¤·˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙÔÓ ÂfiÌÂÓÔ ¯ÚfiÓÔ 2-6% (5,13). ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ù· ·Ó¢ڇÛÌ·Ù· ‰ÂÓ ·ÔÙÂÏÔ‡Ó Û˘¯Ó‹

∞ÈÙÈÔÏÔÁ›· Î·È ·ıÔÁ¤ÓÂÈ· ∆· ¤ÌÊÚ·ÎÙ· ·ÊÔÚÔ‡Ó Û ·fiÊÚ·ÍË ·ÚÙËÚÈ·ÎÒÓ ‹ ÊÏ‚ÈÎÒÓ ÎÏ¿‰ˆÓ. ∆· ·ÚÙËÚȷο ¤ÌÊÚ·ÎÙ· ‰È·ÎÚ›ÓÔÓÙ·È Û ÈÛ¯·ÈÌÈο, Ù· ÔÔ›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÌ‚ÔÏ‹˜ ‹ ıÚfiÌ‚ˆÛ˘ Î·È Û ·ÈÌÔÚÚ·ÁÈο ‹ ˆ¯Ú¿. ∆· ÊÏ‚Èο ¤ÌÊÚ·ÎÙ· ·Ú·ÙËÚÔ‡ÓÙ·È Û·ÓÈfiÙÂÚ·, ¿ÓÙ· ˆ˜ ·ÔÙ¤ÏÂÛÌ· ıÚfiÌ‚ˆÛ˘. ™ÙÔÓ ÔÚÈÛÌfi ÙˆÓ ÂÌÊÚ¿ÎÙˆÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È, Â›Û˘, ÔÈ ÂÚÈÙÒÛÂȘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ‹ ˘·Ú·¯ÓÔÂȉԇ˜ ·ÈÌÔÚÚ·Á›·˜ (5). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿ ÔÈΛÏÏÂÈ, ‰È·Ê¤ÚÔÓÙ·˜ ÛËÌ·ÓÙÈο ·fi ÂΛÓË ÙˆÓ ÂÓËϛΈÓ, ηıÒ˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ˘¤ÚÙ·ÛË, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ÙÔ Î¿ÓÈÛÌ· Î·È Ë Î·Ù¿¯ÚËÛË ·ÏÎÔfiÏ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ™Â ÔÛÔÛÙfi 25%, Ù· ¤ÌÊÚ·ÎÙ· ÛÙ· ·È‰È¿ ıˆÚÔ‡ÓÙ·È È‰ÈÔ·ı‹, ηıÒ˜ ‰ÂÓ ÌÔÚ› Ó· ηıÔÚÈÛÙ› Û˘ÁÎÂÎÚÈ̤ÓÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (7). OÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ηٷÛÙ¿ÛÂȘ Ô˘ Úԉȷı¤ÙÔ˘Ó ÛÙËÓ ÂΉ‹ÏˆÛË ·ÚÙËÚÈ·ÎÔ‡ Î·È ÊÏ‚ÈÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Ê·›ÓÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 1 Î·È 2, ·ÓÙ›ÛÙÔȯ·. ∆· ηډÈÔÂÌ‚ÔÏÈο ¤ÌÊÚ·ÎÙ· Ê·›ÓÂÙ·È fiÙÈ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 1/3 ¤ˆ˜ 1/5 fiÏˆÓ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿, ÌÂ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙȘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ (™∫) (8). OÈ ™∫, ÔÈ Ôԛ˜ Û˘Óԉ‡ÔÓÙ·È ·fi ·Ó·ÈÌ›·, ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ·ÚÙËÚÈ·ÎÔ‡ ÂÌ-

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¶·È‰È·ÙÚÈ΋ 2004;67:254-260

Paediatriki 2004;67:254-260

¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÚÙËÚÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·

¶›Ó·Î·˜ 2. ∞›ÙÈ· ÊÏ‚ÈÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·

∫·Ú‰È·Î¿ ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂȘ ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜ ™ËÙÈ΋ ÂÓ‰Ôηډ›Ùȉ· ª˘Ôηډ›Ùȉ·-Ì˘ÔηډÈÔ¿ıÂȘ µ·Ï‚ȉÔ¿ıÂȘ ŸÁÎÔÈ (̷͈̇) ∞ÁÁÂȷο ¡fiÛÔ˜ Moyamoya πÓÔÌ˘˚΋ ‰˘ÛÏ·Û›· ¡Â˘ÚÔ˚ӈ̿وÛË ¢È·¯ˆÚÈÛÌfi˜ ηڈٛ‰·˜ ∞ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ ∞ÁÁÂÈ›Ùȉ· (™.∂.§., Ô˙҉˘ ÔÏ˘·ÚÙËÚ›Ùȉ·, ÓfiÛÔ˜ Kawasaki, ·ÏÏÂÚÁÈ΋ ÔÚʇڷ) ∞ÈÌ·ÙÔÏÔÁÈο ¢ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜ ¶ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· π.£.¶. ∞ÈÌÔÚÚÔÊÈÏ›· ∞ÓÂ¿ÚÎÂÈ· ÚˆÙ½Ó˘ C ∞ÓÂ¿ÚÎÂÈ· ÚˆÙ½Ó˘ S ∞ÓÂ¿ÚÎÂÈ· ·ÓÙÈıÚÔÌ‚›Ó˘ πππ ∞ÓÂ¿ÚÎÂÈ· Ï·ÛÌÈÓÔÁfiÓÔ˘ ªÂÙ¿ÏÏ·ÍË F II G20210A ªÂÙ¿ÏÏ·ÍË FV Leiden ªÂÙ¿ÏÏ·ÍË MTHFR ∞ÓÙÈʈÛÊÔÏÈȉÈÎfi Û‡Ó‰ÚÔÌÔ ªÂÙ·‚ÔÏÈο OÌÔ΢ÛÙÈÓÔ˘Ú›· §ÔÈÌÒ‰Ë πfi˜ ·ÓÂÌ¢ÏÔÁÈ¿˜ HIV ª˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ ÃϷ̇‰È· ªÔÚ¤ÏÈ· ∂ÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ∞ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ º·Ú̷΢ÙÈο ∫Ôη˝ÓË ™˘Ì·ıËÙÈÎÔÌÈÌËÙÈο ∆Ú·‡Ì· ∞ÎÙÈÓÔ‚ÔÏ›· π‰ÈÔ·ı¤˜ ¤ÌÊÚ·ÎÙÔ

∫·Ú‰È·Î¿ ™˘ÁÁÂÓ‹˜ ΢·ÓˆÙÈ΋ ηډÈÔ¿ıÂÈ· ™˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ∞ÈÌ·ÙÔÏÔÁÈο ¶ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· ∞ÓÂ¿ÚÎÂÈ· ·ÓÙÈıÚÔÌ‚›Ó˘ πππ ∞ÓÂ¿ÚÎÂÈ· Ï·ÛÌÈÓÔÁfiÓÔ˘ ∞ÓÂ¿ÚÎÂÈ· ÚˆÙ½Ó˘ C ∞ÓÂ¿ÚÎÂÈ· ÚˆÙ½Ó˘ S ªÂÙ¿ÏÏ·ÍË F II 20210∞ ªÂÙ¿ÏÏ·ÍË FV Leiden ªÂÙ¿ÏÏ·ÍË MTHFR ∞ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· §ÔÈÌÒ‰Ë øÙ›Ùȉ·-Ì·ÛÙÔÂȉ›Ùȉ· ¶·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· ªËÓÈÁÁ›Ùȉ· ∆Ú·‡Ì· ∞Ê˘‰¿ÙˆÛË ¡ÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ∫·ıÂÙËÚÈ·ÛÌfi˜

·ÈÙ›· ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿. ¶ÔÛÔÛÙfi ÂÚ›Ô˘ 1-2% ·˘ÙÒÓ Î·ı›ÛÙ·Ù·È Û˘Ìو̷ÙÈÎfi ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ Û˘¯ÓfiÙÂÚ· ·Ú·ÙËÚÔ‡ÓÙ·È Û ·È‰È¿ Ì ÛÙ¤ÓˆÛË ÙÔ˘ ÈÛıÌÔ‡ Ù˘ ·ÔÚÙ‹˜ ‹ ÔÏ˘Î˘ÛÙÈ΋ ÓfiÛÔ ÙˆÓ ÓÂÊÚÒÓ (4,13). ∏ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜ (SCD) ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, Ô Î›Ó‰˘ÓÔ˜ ÂΉ‹ÏˆÛ˘ ÙÔ˘ ÔÔ›Ô˘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È 200-400 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ Ì SCD Û ۇÁÎÚÈÛË Ì ÙÔÓ ˘fiÏÔÈÔ ·È‰ÈÎfi ÏËı˘ÛÌfi (4). ∞ӷʤÚÂÙ·È fiÙÈ Ù· ¤ÌÊÚ·ÎÙ· ·Ú·ÙËÚÔ‡ÓÙ·È Û˘ÓËı¤ÛÙÂÚ· ÚÈÓ ÙÔ 10Ô ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ (14). øÛÙfiÛÔ, ·fi fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì SCD, ÙÔ

256

1/10 ı· ÂΉËÏÒÛÂÈ Û˘Ìو̷ÙÈÎfi ¤ÌÊÚ·ÎÙÔ Ì¤¯ÚÈ ÙÔ 20fi ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜, ÂÓÒ ÙÔ 1/5 ÛȈËÏfi ¤ÌÊÚ·ÎÙÔ ÛÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ· (15). ™ËÌ·ÓÙÈÎfi ·›ÙÈÔ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ·È‰È΋ Î·È ÓÂÔÁÓÈ΋ ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ÔÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È·Ù·Ú·¯‹ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‹Í˘, Ì ÛÙÚÔÊ‹ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ Ù˘ ·ÈÌfiÛÙ·Û˘ ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ ıÚfiÌ‚ˆÛ˘. ∏ ÂΉ‹ÏˆÛË ÂÌÊÚ¿ÎÙÔ˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·ÓÂ¿ÚÎÂÈ· Ù˘ ÚˆÙ½Ó˘ C, Ù˘ ÚˆÙ½Ó˘ S, Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ πππ Î·È ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, Ì ÙËÓ ·ÚÔ˘Û›· ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· V Leiden, Ù˘ ÚÔıÚÔÌ‚›Ó˘ G20210A ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ methylenetetrahydrofolate dehydrogenase (MTHFR), ηıÒ˜ Î·È Ì ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈʈÛÊÔÏÈȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (16,17).

OÈ ÚÔıÚÔÌ‚ˆÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚ› Ó· Â›Ó·È ÎÏËÚÔÓÔÌÈΤ˜ ‹ Â›ÎÙËÙ˜, Û˘Ó‹ıˆ˜ Â·ÎfiÏÔ˘ıÔ ÏÔÈÌÒ͈Ó, ¯Ú‹Û˘ Ê·ÚÌ¿ÎˆÓ Î·È Ë·ÙÈ΋˜ ‹ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ (5). H Û˘ÓÔÏÈ΋ Â›ÙˆÛË ÙˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û ·È‰È¿ Ì ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· ÔÈΛÏÏÂÈ Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·fi 1050% (17-19). ∂ÎÙfi˜ ·fi ÙË ÌÂÙ¿ÏÏ·ÍË MTHFR, Ë ÔÔ›· Ô‰ËÁ› Û ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÌÔ΢ÛÙ½Ó˘, ˘ÂÚÔÌÔ΢ÛÙÈÓ·ÈÌ›· ÌÔÚ› Ó· ·Ú·ÙËÚËı› ÛÙÔ Ï·›ÛÈÔ Ù˘ ÔÌÔ΢ÛÙÈÓÔ˘Ú›·˜, Ì›·˜ ÌÂÙ·‚ÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÓÂ·Ú΋ ‰Ú¿ÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ cystathionine ‚-synthase, ‹ ˆ˜ Â·ÎfiÏÔ˘ıÔ ‰È·ÙÚÔÊÈ΋˜ ¤ÏÏÂȄ˘ Ê˘ÏÈÎÔ‡ ÔͤԘ Î·È ‚ÈÙ·Ì›Ó˘ µ6 ‹ µ12 (20-22). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÏÔÈÌÒÍÂȘ, ÔÈΛÏÔÈ ÈÔÁÂÓ›˜

July August 04

07-10-04

13:52

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¶·È‰È·ÙÚÈ΋ 2004;67:254-260

Î·È ‚·ÎÙËÚÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙÔ Ï·›ÛÈÔ ÂΉ‹ÏˆÛ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, Û ÔÛÔÛÙfi Ô˘ ÍÂÂÚÓ¿ ÙÔ 30% (23) ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ. øÛÙfiÛÔ, Ë Û·Ê‹˜ Û˘Û¯¤ÙÈÛË ·ÈÙ›Ô˘·ÔÙÂϤÛÌ·ÙÔ˜ Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏË. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜, Ô ÔÔ›Ô˜ Ù˘Èο ÚÔηÏ› ¤ÌÊÚ·ÎÙÔ ÂÓÙÔÈṲ̂ÓÔ ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ· (24,25). ∞Ó Î·È Ô Ì˯·ÓÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, Èı·ÓÔÏÔÁÂ›Ù·È Ë ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ¿ÌÂÛË ‰È›ۉ˘ÛË ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ë ·ÚÂÌ‚ÔÏ‹ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÁÁÂȷ΋˜ ·¿ÓÙËÛ˘, ηıÒ˜ Î·È Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÚˆÙÂ˚ÓÒÓ C, S Î·È Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ πππ (24,26). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂΉ‹ÏˆÛË ÊÏ‚ÈÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, ΢ڛˆ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂȘ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙËÓ ÎÂÊ·Ï‹ Î·È ÙÔÓ ÙÚ¿¯ËÏÔ, fiˆ˜ Ë ÔÍ›· ̤ÛË ˆÙ›Ùȉ· Î·È Ë Ì·ÛÙÔÂȉ›Ùȉ· Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ıÚfiÌ‚ˆÛË ÙÔ˘ ÂÈÌ‹ÎÔ˘˜ ÎfiÏÔ˘, ηıÒ˜ Î·È ÔÈ ÏÔÈÌÒÍÂȘ ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ Ô˘ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ıÚfiÌ‚ˆÛË ÙÔ˘ ÛËÚ·ÁÁÒ‰Ô˘˜ ÎfiÏÔ˘ (3,27). ¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ∆˘Èο, Û ÂÚÈÙÒÛÂȘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ‰È·ÈÛÙÒÓÂÙ·È ÎÏÈÓÈο ËÌÈ¿ÚÂÛË, Ë ÔÔ›· Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÈÛıËÙÈÎfiÙËÙ·˜ ‹ Ù˘ fiÚ·Û˘ (28). ∫ÂÊ·Ï·ÏÁ›· ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ Û ÂÚÈÙÒÛÂȘ ·ÚÙËÚÈ·ÎÔ‡ ‰È·¯ˆÚÈÛÌÔ‡ ‹ ÊÏ‚ÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ (29,30), ÂÓÒ Û·ÛÌÔ› ÂΉËÏÒÓÔÓÙ·È Û ÂÚÈÙÒÛÂȘ ÊÏ‚ÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, ȉȷ›ÙÂÚ· ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (30). ¢È·Ù·Ú·¯‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ (31), ÌÂÁ¿ÏˆÓ ÂÌÊÚ¿ÎÙˆÓ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ (32) ‹ ÂÌÊÚ¿ÎÙˆÓ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ (33). ™ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÂÁÎÂÊ·ÏÈÎÔ› fiÁÎÔÈ, Ù· ÙÚ·˘Ì·ÙÈο ÂÈÛÎÏËÚ›‰È· Î·È ˘ÔÛÎÏËÚ›‰È· ·ÈÌ·ÙÒÌ·Ù·, ÔÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÈ ·ÔÌ˘ÂÏÈÓˆÙÈΤ˜ ÓfiÛÔÈ Î·È Ë ËÌÈÎÚ·Ó›· (28). ¶·Ï·ÈfiÙÂÚ·, ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, ÔÈ ·ÛıÂÓ›˜ ˘Ô‚¿ÏÏÔÓÙ·Ó ÛÂ Û˘Ì‚·ÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›·. øÛÙfiÛÔ, Û‹ÌÂÚ· ÂÊ·ÚÌfi˙ÔÓÙ·È ÌË ÂÂÌ‚·ÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI), Ë Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (MRA) Î·È Ë ˘ÂÚ˯ÔÁÚ·Ê›· Doppler, Ë ÔÔ›· ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Î·È Û·Ó ÂͤٷÛË screening Û ÏËı˘ÛÌÔ‡˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Â›Ó·È ÔÈ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈÎÔ› ·ÛıÂÓ›˜ (28,34). ™Â ÂÚ›ÙˆÛË Ô˘ ·˘Ù¤˜ ÔÈ Ì¤ıÔ‰ÔÈ ÂͤٷÛ˘ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈ̘, ··ÈÙÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÈÌÔÚÚ·Á›·˜. ∏ Û˘Ì‚·ÙÈ΋ ·ÁÁÂÈÔ-

Paediatriki 2004;67:254-260

ÁÚ·Ê›· ÙÂÏÂ›Ù·È Û˘Ó‹ıˆ˜ Û ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ, ›Ù ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÚÙËÚÈÔÊÏ‚È΋˜ ÂÈÎÔÈÓˆÓ›·˜, ·Ó¢ڇÛÌ·ÙÔ˜ ‹ ÓfiÛÔ˘ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ, ȉȷ›ÙÂÚ· Û ÂÚÈÙÒÛÂȘ Ô˘ Ë MRA Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÌË ‰È·ÁÓˆÛÙÈ΋, ›Ù Û ÂÚÈÙÒÛÂȘ ÂÓ‰ÂÈÎÙÈΤ˜ ÓfiÛÔ˘ Moyamoya ÁÈ· ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â¤Ì‚·Û˘ (28). °È· ÙË ‰È·›ÛÙˆÛË Ù˘ ˘ÔΛÌÂÓ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÚfiÁÓˆÛ˘ Î·È Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ··ÈÙÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÍÂÙ¿ÛÂˆÓ (¶›Ó·Î·˜ 3), ÔÈ Ôԛ˜, ˆÛÙfiÛÔ, ı· ·Ôηχ„Ô˘Ó ÙËÓ ·ÎÚÈ‚‹ ·ÈÙ›· Û ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÙÒÛˆÓ. £ÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ÔÍ›· ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ıÚÔÌ‚fiÏ˘ÛË, ÛÙ· ·È‰È¿ Ë ¯Ú‹ÛË ÙÔ˘ tissue plasminogen activator (t-PA) ‰ÂÓ ¤¯ÂÈ ˘ÈÔıÂÙËı›. ∞ÎfiÌË Î·È ·Ó ¤Ó· ·È‰› ÚÔÛÎÔÌÈÛÙ› ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÙÔ ÎÚ›ÛÈÌÔ ‰È¿ÛÙËÌ· ÙˆÓ ÙÚÈÒÓ ÚÒÙˆÓ ˆÚÒÓ ·fi ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘, Ë Û·ÓÈfiÙËÙ¿ ÙÔ˘, Ë ¯·ÌËÏ‹ ‰È·ÁÓˆÛÙÈ΋ ÂȉÈÎfiÙËÙ· Ù˘ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Î·È ÙÔ Â‡ÚÔ˜ ÙˆÓ Èı·ÓÒÓ ‰È·ÁÓÒÛÂˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¤¯Ô˘Ó, Û˘Ó‹ıˆ˜, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·ı˘ÛÙ¤ÚËÛË Ù˘ ‰È¿ÁÓˆÛ˘ (28,35). ∂Í¿ÏÏÔ˘, ηıÒ˜ Ë ıÓËÙfiÙËÙ· Â›Ó·È ¯·ÌËÏfiÙÂÚË Î·È Ë ÚfiÁÓˆÛË Û·ÊÒ˜ ηχÙÂÚË Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë ¯Ú‹ÛË ÙÔ˘ t-PA ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ‰ÈηÈÔÏÔÁË̤ÓË, Ì ÂÍ·›ÚÂÛË ›Ûˆ˜ οÔȘ ÂÚÈÙÒÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ ÔÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, ÔÈ ÔÔ›ÔÈ ÂΉËÏÒÓÔ˘Ó ¤ÌÊÚ·ÎÙÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋˜ ÓÔÛËÏ›·˜. ∏ ¤ÎÙ·ÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ Î·È Ë ÎÏÈÓÈ΋ ¤Î‚·ÛË ¤¯ÂÈ Ê·Ó› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ıÂÚÌÔÎÚ·Û›· ÛÒÌ·ÙÔ˜ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ ËÌÂÚÒÓ ÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ (36). Èڛ˜ ·˘Ùfi Ó· ¤¯ÂÈ ·ÈÙÈÔÏÔÁÈο ÙÂÎÌËÚȈı›, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ‰È·Ù‹ÚËÛË Ù˘ ıÂÚÌÔÎÚ·Û›·˜ <37ÔC ·ÔÙÂÏ› ·˘Ù‹ ÙË ÛÙÈÁÌ‹, Ô˘ÛÈ·ÛÙÈο, ÙÔ ÌfiÓÔ ‰È·ı¤ÛÈÌÔ Ì¤ÙÚÔ “Ó¢ÚÔÚÔÛÙ·Û›·˜”. ∂ÊfiÛÔÓ ÙÂı› Ë ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË, Ë ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÙÔÌÈ·ÂÙ·È ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË. ŒÙÛÈ, ÔÈ ·ÛıÂÓ›˜ Ì ·ÈÌÔÚÚ·ÁÈο ¤ÌÊÚ·ÎÙ· ‹ ÌÂÁ¿Ï· ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ¿ÌÂÛË Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (28,32), ÂÓÒ ÔÈ ·ÛıÂÓ›˜ Ì ·ÚÙËÚÈ·Îfi ‰È·¯ˆÚÈÛÌfi, ÊÏ‚È΋ ıÚfiÌ‚ˆÛË ‹ ÚÔıÚÔÌ‚ˆÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ¯Ú‹˙Ô˘Ó ·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜, ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÚÒÈÌ˘ Â·ÓÂΉ‹ÏˆÛ˘ ÂÌÊÚ¿ÎÙÔ˘ (5,17,38). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ÂӉ›ÎÓ˘Ù·È Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË Ë·Ú›Ó˘ ηÈ, ·ÎÔÏÔ‡ıˆ˜, ˆ˜ ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›·, Ë

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¶·È‰È·ÙÚÈ΋ 2004;67:254-260

Paediatriki 2004;67:254-260

¶›Ó·Î·˜ 3. ¢ÈÂÚ‡ÓËÛË ·ÈÙÈÔÏÔÁ›·˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ñ MRI, MRA - Ì ÛÎÔfi Ù· ÂÍ‹˜: ·ÔÎÏÂÈÛÌfi ·ÈÌÔÚÚ·Á›·˜, ·ÔÎÏÂÈÛÌfi ·ÚÙËÚÈ·ÎÔ‡ ‰È·¯ˆÚÈÛÌÔ‡, ηıÔÚÈÛÌfi ·Ó·ÙÔÌ›·˜ ÂÍ·ÁÒÓÔ˘ ÙÔ˘ Willis Î·È ·ÁÁ›ˆÓ ÙÔ˘ ·˘¯¤Ó·, ηıÔÚÈÛÌfi ı¤Û˘ Î·È ¤ÎÙ·Û˘ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ñ CT - ÁÈ· ·ÔÎÏÂÈÛÌfi ·ÈÌÔÚÚ·Á›·˜, ÂÊfiÛÔÓ Ô MR ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌÔ˜ ñ ™˘Ì‚·ÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· - Û ÂÚ›ÙˆÛË ·ÈÌÔÚÚ·Á›·˜ ¯ˆÚ›˜ ·ÚÔ˘Û›· ‰È·Ù·Ú·¯‹˜ ‹Í˘ ‹ ÂÊfiÛÔÓ Ô MR ¤ÏÂÁ¯Ô˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ™Â ÂÚ›ÙˆÛË ·ÈÌÔÚÚ·Á›·˜ ñ µ·ÛÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Í˘-·ÈÌÔÂÙ·Ï›ˆÓ ñ ™˘Ì‚·ÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ËÎÙÈÎfi ¤ÏÂÁ¯Ô ™Â ÂÚ›ÙˆÛË ÂÌÊÚ¿ÎÙÔ˘ ·ÁÁÂȷ΋˜ ηٷÓÔÌ‹˜ ηÈ/‹ ·ÁÁÂÈÔÂÁÎÂÊ·ÏÈ΋˜ ÓfiÛÔ˘ ñ ÀÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ñ °ÂÓÈ΋ ·›Ì·ÙÔ˜ - ∆∫∂ ñ ∏ÏÂÎÙÚÔÊfiÚËÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ ñ ¶·Ú¿ÁÔÓÙ·˜ von Willebrand (vWF), F VIII, F XII ñ ŒÏÂÁ¯Ô˜ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ: ÚˆÙ½ÓË C, ÚˆÙ½ÓË S, ·ÓÙÈıÚÔÌ‚›ÓË πππ, Ï·ÛÌÈÓÔÁfiÓÔ, Û˘Ó-·Ú¿ÁˆÓ Ë·Ú›Ó˘ ππ, FV Leiden - ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÚˆÙ½ÓË C, ÁÔÓ›‰ÈÔ ÚÔıÚÔÌ‚›Ó˘ 20210, ÁÔÓ›‰ÈÔ MTHFR, ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘, ·ÓÙÈηډÈÔÏÈÈÓÈο ·ÓÙÈÛÒÌ·Ù·), anti-‚2GPI ñ OÌÔ΢ÛÙ½ÓË - Ê˘ÏÏÈÎfi Ô͇, ‚ÈÙ·Ì›ÓË µ12 ñ ÃÔÏËÛÙÂÚfiÏË, ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÏÈÔÚˆÙ½ÓË Lp(a) ñ ŒÏÂÁ¯Ô˜ Èı·Ó‹˜ Ïԛ̈͢ (ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: mycoplasma, chlamydia, helicobacter, borrelia) ñ ŒÏÂÁ¯Ô˜ ÔÚÔ‡ Î·È ∂¡À ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ·ÓÂÌ¢ÏÔÁÈ¿˜ ™Â ÂÚ›ÙˆÛË ÂÌÊÚ¿ÎÙÔ˘ ÙÔ˘ ÛÔÓ‰˘ÏÔ‚·ÛÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ñ ∞ÎÙÈÓÔÁÚ·Ê›· ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘

¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘ ÁÈ· ‰È¿ÛÙËÌ· 3-6 ÌËÓÒÓ, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ÈÛ¯·ÈÌÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ Û˘ÓÈÛÙ¿Ù·È Ë ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ¯·ÌËÏÒÓ ‰fiÛÂˆÓ ·ÛÈÚ›Ó˘ (1 mg/kg) (28,39). ªÂ ÛÎÔfi ÙËÓ ÚÔʇϷÍË ·fi Ó¤· ˘ÔÙÚÔ‹ Û ÂÚÈÙÒÛÂȘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ÓfiÛÔ˘, ÂÈ‚¿ÏÏÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ ¯ÚfiÓÈÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÙ·ÁÁ›ÛÂˆÓ (40,41), ÂÓÒ Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ Moyamoya - ·ÓÂÍ·Úًو˜ Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙÔ·ı›˜ ‹ ‰Â˘ÙÂÚÔ·ı›˜ ÂÚÈÙÒÛÂȘ - Û˘ÓÈÛÙ¿Ù·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â·Ó·ÁÁ›ˆÛË (42,43). ∆¤ÏÔ˜, Û ·ÛıÂÓ›˜ Ì ˘ÂÚÔÌÔ΢ÛÙÈÓ·ÈÌ›·, fiˆ˜ Â›Ó·È ÔÈ ÔÌÔ˙˘ÁÒÙ˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ MTHFR, Û˘ÛÙ‹ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ‚ÈÙ·ÌÈÓÒÓ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ µ Î·È Ê˘ÏÏÈÎfi Ô͇ (21). ¶ÚfiÁÓˆÛË ¶·Ï·ÈfiÙÂÚ·, οı ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ Î·Ù¿ ÙËÓ ·È‰È΋ ËÏÈΛ· ıˆÚÔ‡ÓÙ·Ó È‰ÈÔ·ı¤˜, ηϋ˜ ÚfiÁÓˆÛ˘ Î·È ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â·ÓÂΉ‹ÏˆÛ˘. ∂›Ó·È, ϤÔÓ, ÁÓˆÛÙfi fiÙÈ ÙÔ Â‡ÚÔ˜ ÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¤Ó· Ù¤ÙÔÈÔ ÂÂÈÛfi‰ÈÔ Â›Ó·È Ôχ ÌÂÁ¿ÏÔ Î·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ıÓËÙfiÙËÙ·˜ Î·È ˘ÔÙÚÔ‹˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· (44). ™Â Ì›· ÌÂÁ¿ÏË ÌÂϤÙË, Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó 402 ·È‰È¿ Ì ·ÚÙËÚÈ·Îfi ÈÛ¯·ÈÌÈÎfi ¤ÌÊÚ·ÎÙÔ Î·È 160 ·È‰È¿ Ì ÊÏ‚È΋ ıÚfiÌ‚ˆÛË, ‰È·ÈÛÙÒıËΠıÓËÙfiÙËÙ· Û ÔÛÔÛÙfi 12%, ·ÚÔ˘Û›· Ó¢ÚÔÏÔÁÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ ηٿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô Û ÔÛÔÛÙfi 61% Î·È ÂΉ‹ÏˆÛË Ó¤Ô˘ ÂÌÊÚ¿ÎÙÔ˘ Û ÔÛÔÛÙfi 21,6% ÙˆÓ ·ÛıÂÓÒÓ (45). °ÂÓÈο, Ê·›ÓÂÙ·È fiÙÈ Ë

258

ÂÓÙfiÈÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ÛÙË Ì¤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· Ì ¤ÎÙ·ÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙÔ 10% ÙÔ˘ ÂÓ‰ÔÎÚ¿ÓÈÔ˘ fiÁÎÔ˘, Ë ·ÚÔ˘Û›· Û·ÛÌÒÓ Î·È Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ ηٿ ÙËÓ ¤Ó·ÚÍË Û¯ÂÙ›˙ÔÓÙ·È Ì ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË (46-49). ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂÏÔ‡Ó, ·ÎfiÌË, Ë ÌÈÎÚ‹ ËÏÈΛ· ÂΉ‹ÏˆÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ë ·ÚÔ˘Û›· ËÌÈ¿ÚÂÛ˘ Ô˘ ÂÈ̤ÓÂÈ ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÂÓfi˜ Ì‹Ó·, Ë ÊÏÔÈÈ΋ - Û˘ÁÎÚÈÙÈο Ì ÙËÓ ˘ÔÊÏÔÈÈ΋ - ÂÓÙfiÈÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘, ηıÒ˜ Î·È Ë ·ÌÊÔÙÂÚfiÏ¢ÚË ·ÔÊÚ·ÎÙÈ΋ ÓfiÛÔ˜ (50-52). ∏ Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÂÓfi˜ ÂÌÊÚ¿ÎÙÔ˘, Ë ÔÔ›· ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ ˘ÔΛÌÂÓË ·ÈÙ›·, ·Ó·Ê¤ÚÂÙ·È Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 20-40% (44,45,53). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÂÎÙÂٷ̤ÓË ¤Ú¢ӷ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ Û¯ÂÙÈο Ì ÙËÓ ÂΉ‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ Û ÂÚÈÔÚÈÛÌfi Ù˘ ·Ï·ÈfiÙÂÚ˘ ‰È¿ÁÓˆÛ˘ ÙÔ˘ “ȉÈÔ·ıÔ‡˜” ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘. øÛÙfiÛÔ, Ë Û·Ê‹˜ ·ÈÙ›· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÚÈÙÒÛˆÓ. ∞·ÈÙÔ‡ÓÙ·È, ·ÎfiÌË, ÌÂÁ¿Ï˜ ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ ÁÈ· Ó· ηıÔÚÈÛÙÔ‡Ó Ì ۷ʋÓÂÈ· ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, Ë ‚¤ÏÙÈÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ¤Î‚·Û˘ Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·˘Ù‹˜ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM, Schroll M. Stroke incidence, case fatality, and mortality in the WHO MONICA Project. World Health Organization

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-07-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 30-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ËÌ‹ÙÚÈÔ˜ π. ∑·ÊÂÈÚ›Ô˘ ∂ÁÓ·Ù›·˜ 106, ∆.∫. 546 22, £ÂÛÛ·ÏÔÓ›ÎË E-mail: jeff@med.auth.gr

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Paediatriki 2004;67:261-267

AWARD-WINNING ARTICLE

OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Rb-1 ˆ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÛÙ· ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜* ∂.-∞. ª·ÚοÎË, ∂. ¢ËÌËÙÚ›Ô˘, ª. ∆ÛÔ·ÓÔÌ›¯·ÏÔ˘, ∂. ™ÙÂȷοÎË, ¢. ™·ÓÙ›‰Ô˜, M. ∫·ÏÌ·ÓÙ‹

Rb-1 gene mutations as prognostic factors in childhood malignancies* E.-A. Markaki, H. Dimitriou, M. Tsopanomichalou, E. Stiakaki, D. Spadidos, M. Kalmanti

¶ÂÚ›ÏË„Ë: ∆Ô ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Rb-1 Â›Ó·È ÔÁÎÔηٷÛÙ·ÏÙÈÎfi ÁÔÓ›‰ÈÔ, ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈ› ÁÈ· Ì›· ˘ÚËÓÈ΋ ʈÛÊÔÚˆÙ½ÓË 110 Kb. ¢Ú· ˆ˜ Ú˘ıÌÈÛÙ‹˜ ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘ Î·È ÂÌÔ‰›˙ÂÈ ÙË ÌÂÙ¿‚·ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË G0/G1 ÛÙËÓ S Ê¿ÛË ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘. ∂ÎÊÚ¿˙ÂÙ·È Ê˘ÛÈÔÏÔÁÈο ÛÙ· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú·. ∞‰Ú·ÓÔÔÈÂ›Ù·È Ì ··Ï›„ÂȘ Î·È ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜, Û˘¯ÓfiÙÂÚ· fï˜ Ì ÌÂÙ·ÏÏ¿ÍÂȘ, Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÛÙ· ÂÍfiÓÈ· 20-24. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ·ÔÙ‡ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ Rb-1 ÁÔÓ›‰ÈÔ˘ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi Ï¢¯·ÈÌ›· Î·È Ó¢ÚÔ‚Ï¿Ûو̷ Î·È Ë ÂͤٷÛË Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ¯ÚËÛÈÌÔÔ›ËÛ‹˜ ÙÔ˘ ˆ˜ ÚÔÁÓˆÛÙÈÎÔ‡ ‰Â›ÎÙË. ªÂÏÂÙ‹ıËÎ·Ó ÂȯڛÛÌ·Ù· Ì˘ÂÏÔ‡, Ù˘ ÂÚÈfi‰Ô˘ 1992-1997, ·fi ÙÔ ·Ú¯Â›Ô Ù˘ ∫ÏÈÓÈ΋˜, 26 ·È‰ÈÒÓ Ì Ï¢¯·ÈÌ›· ÛÙËÓ ÚˆÙԉȿÁÓˆÛË (18 O§§, 8 Oª§) Î·È 4 ·È‰ÈÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷. ∆· ÂÍfiÓÈ· 20, 21 Î·È 22 ÂÓÈÛ¯‡ıËÎ·Ó Ì ÙË ¯Ú‹ÛË Ù˘ Ù¯ÓÈ΋˜ PCR. °È· ÙËÓ ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÂÊ·ÚÌfiÛÙËΠ̤ıÔ‰Ô˜ ·Ó¿Ï˘Û˘ ÛÙÂÚÂԉȷÌfiÚʈÛ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÌÔÓ‹˜ ·Ï˘Û›‰·˜ (SSCP) Î·È ÂÙÂÚÔ‰›ÎψÓ˘ ·Ó¿Ï˘Û˘ (heteroduplex). ∆Ô ·ÏÏÔȈ̤ÓÔ ÚfiÙ˘Ô Ô˘ ·ÓȯÓ‡ÙËΠ̠ÙËÓ SSCP ·Ó¿Ï˘ÛË ·ÊÔÚÔ‡Û ÛÙÔÓ ›‰ÈÔ Ù‡Ô ÌÂÙ¿ÏÏ·Í˘. ™ÙȘ O§§ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÂÍfiÓÈÔ 20 Û ÔÛÔÛÙfi 11,11%, ÛÙÔ ÂÍfiÓÈÔ 21 Û ÔÛÔÛÙfi 5,56% Î·È ÛÙÔ ÂÍfiÓÈÔ 22 Û ÔÛÔÛÙfi 22,22%. ªÂÙ¿ÏÏ·ÍË ·ÓȯÓ‡ıËΠ۠25% ÙˆÓ ·ÛıÂÓÒÓ Ì Oª§, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ÂÈÙ‡¯ıËΠ‡ÊÂÛË Î·È ÛÙÔ 25% ·˘ÙÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ÛÙ·‰›Ô˘ IV Ì ‰È‹ıËÛË Ì˘ÂÏÔ‡. ŸÏ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ·È‰È¿ Ì ÂӉȿÌÂÛÔ˘˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÔÍ›· Ï¢¯·ÈÌ›·, Ù· ÔÔ›· ›ÙÂ

Abstract: Rb-1 is a tumour suppressor gene located in the 13q14 chromosome region and comprising of 27 exons. The Rb-1 gene codes for a 110 KD product, which is a nuclear phosphoprotein acting as a cell cycle regulator and blocking the transition of normal cells from G0/G1 into the S phase of the cycle, and it is normally expressed in haematopoietic cells. It is inactivated by deletions but more often by mutations. Point mutations may affect most of the exons, but predominantly exons 20-24. In haematopoietic malignancies, deletions or rearrangements of the Rb-1 gene have been reported in 5 to 10% of acute leukemias in adults.

The aim of this study was to correlate the Rb-1 gene mutations with the prognosis and progression of childhood acute leukemia and neuroblastoma.

Archival bone marrow slides, dating from 1992 to 1997, from 26 children with leukemia [18 acute lyphocytic leukemia (ALL) and 8 acute myeloid leukemia (AML)] and 4 children with neuroblastoma were studied. Exons 20, 21 and 22 were amplified using the PCR technique, resulting in products of 350 bp, 518 bp and 363 bp respectively. SSCP and heteroduplex analysis were performed to detect mutations. In exon 20 two ALL samples (11.11%), in exon 21 one of the ALL samples (5.56%) and in exon 22 four ALL samples (22.22%), had altered conformation. All but one of these patients were classified as high risk leukemias, who either relapsed or never achieved remission. Two of the AML patients who did not achieve remission and one of the neuroblastoma cases with concomitant bone marrow infiltration also showed altered conformation. The SSCP and heteroduplex analysis

*∞’ “ÈڤÌÂÈÔ” Œ·ıÏÔ 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2000

*1st “Choremio” Award 38th Panhellenic Paediatric Meeting, 2000

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ

Paediatric Clinic of Hematology-Oncology, Medical School of University of Crete, Heraklion

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Paediatriki 2004;67:261-267

ÂÌÊ¿ÓÈÛ·Ó Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ Â›Ù¢ÍË ‡ÊÂÛ˘ ‹ ˘ÔÙÚÔ›·Û·Ó. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ Rb-1 ÁÔÓȉ›Ô˘ ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÛÙȘ Ï¢¯·È̛˜ ÙˆÓ ·È‰ÈÒÓ, ÂÓÒ Ë ·Ó›¯ÓÂ˘Û‹ ÙÔ˘˜ ÌÔÚ› Ó· ÙÚÔÔÔÈ‹ÛÂÈ ‹ Ó· ÂÓÙ·ÙÈÎÔÔÈ‹ÛÂÈ ÙËÓ ·Ú¯È΋ ıÂÚ·›·. ™ÙÔ˘˜ Û˘Ì·Á›˜ fiÁÎÔ˘˜ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ‰Â›ÎÙË ÂÈıÂÙÈÎfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘.

showed that all but one, who did not belong to the high risk group, had the same altered conformation.

The exception may represent a leaky mutation.

These data suggest that the Rb-1 gene could possibly be used as a prognostic factor in acute leukemia of childhood, and be an indication for intensification of chemotherapy. In solid tumours with bone marrow involvement it could play a role as a marker of aggressive disease.

§¤ÍÂȘ ÎÏÂȉȿ: Rb-1 ÁÔÓ›‰ÈÔ, ÚfiÁÓˆÛË, ÔÍ›· Ï¢¯·ÈÌ›·, Ó¢ÚÔ‚Ï¿Ûو̷, ·È‰È΋ ËÏÈΛ·.

Key words: Rb-1 gene, prognosis, acute leukemia, neuroblastoma, childhood.

∂ÈÛ·ÁˆÁ‹ ∏ ηÚÎÈÓÈ΋ ÂÍ·ÏÏ·Á‹ ÂÓfi˜ ·ÙÙ·ÚÔ˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ÔÏ˘ÛÙ·‰È·Î‹˜ ‰È·‰Èηۛ·˜, ηٿ ÙËÓ ÔÔ›· ÔÏÏ·ÏÔ› ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙË ÌÂÙ¿‚·ÛË ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·Ó¿Ù˘Í˘, Û ̛· ηٿÛÙ·ÛË ·ÒÏÂÈ·˜ ÙÔ˘ ÂϤÁ¯Ô˘ (1). ∆· ÁÔÓ›‰È· Ô˘ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·‡ÍËÛ˘ Î·È ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘, ηٷٿÛÛÔÓÙ·È Û ‰‡Ô ‚·ÛÈΤ˜ ηÙËÁÔڛ˜, ÛÙ· ÔÁÎÔÁÔÓ›‰È· Î·È ÛÙ· ÔÁÎÔηٷÛÙ·ÏÙÈο ÁÔÓ›‰È· (2). ∆· ÔÁÎÔηٷÛÙ·ÏÙÈο ÁÔÓ›‰È· ·ÔÙÂÏÔ‡Ó Ì›· ηÙËÁÔÚ›· ÁÔÓȉ›ˆÓ Ô˘ Ô‰ËÁÔ‡Ó Û ηÚÎÈÓÔÁ¤ÓÂÛË fiÙ·Ó ¯¿ÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘˜, ‰ËÏ·‰‹ Ù· ÁÔÓ›‰È· ·˘Ù¿ Ê˘ÛÈÔÏÔÁÈο ‰ÚÔ˘Ó ˆ˜ ·ÚÓËÙÈÎÔ› Ú˘ıÌÈÛÙ¤˜ ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘, Ì ÙËÓ ¤ÓÓÔÈ· Ù˘ ·Ó·ÛÙÔÏ‹˜ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ ΢ÙÙ¿ÚÔ˘ (3,4). OÈ ÌÂϤÙ˜ Û˘Û¯¤ÙÈÛ˘ ÔÁÎÔÁÔÓȉ›ˆÓ Î·È Î·ÚΛÓÔ˘ ¿Ú¯ÈÛ·Ó ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1970, ·ÏÏ¿ ÌfiÏȘ ÙÔ 1982 Ù·˘ÙÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÔÁÎÔηٷÛÙ·ÏÙÈÎfi ÁÔÓ›‰ÈÔ Û ÎÏËÚÔÓÔÌÈÎfi ÚÂÙÈÓÔ‚Ï¿Ûو̷ Î·È ÔÓÔÌ¿ÛÙËΠÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÁÈ· ÙÔ ÚÂÙÈÓÔ‚Ï¿Ûو̷ (Rb-1) (5,6). ∏ Ù·˘ÙÔÔ›ËÛË ·˘ÙÔ‡ ÙÔ˘ ÁÔÓȉ›Ô˘ ÂÚÌ‹Ó¢Û ÁÈ· ÚÒÙË ÊÔÚ¿ ÙË ÌÔÚȷ΋ ‚¿ÛË ÙÔ˘ ÎÏËÚÔÓÔÌÈÎÔ‡ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜, Ì ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·‰Ú·ÓÔÔ›ËÛ˘ Î·È ÙˆÓ ‰‡Ô ·ÏÏËÏfiÌÔÚÊˆÓ ÙÔ˘ ÁÔÓȉ›Ô˘ (7). ¶ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÁÔÓ›‰ÈÔ ·˘Ùfi ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 13q14, ·ÔÙÂÏÂ›Ù·È ·fi 27 ÂÍfiÓÈ· Ô˘ ηٷϷ̂¿ÓÔ˘Ó 180 Kb ÛÙÔ ·ÓıÚÒÈÓÔ ÁÔÓȉ›ˆÌ·, ÂÓÒ ÙÔ ÌÂÙ·ÁÚ·ÊÈÎfi ÙÔ˘ RNA, 4,8 Kb, Έ‰ÈÎÔÔÈ› ÁÈ· Ì›· ˘ÚËÓÈ΋ ʈÛÊÔÚˆÙ½ÓË, ÙËÓ p105 (8,9) (∂ÈÎfiÓ· 1). ∏ p105 Ú˘ıÌ›˙ÂÈ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ·ÎÏÔ ·Ó¿ÏÔÁ· Ì ÙË ÊˆÛÊÔÚ˘Ï›ˆÛ‹ Ù˘ (10). ∆Ô Î‡ÙÙ·ÚÔ ‰ÂÓ ‰È·ÈÚÂ›Ù·È fiÛÔ Ë ÚˆÙ½ÓË Â›Ó·È ˘ÔʈÛÊÔÚ˘ÏȈ̤ÓË Î·È Û ۇÌÏÔÎÔ Ì ÙÔÓ Î˘ÚÈfiÙÂÚÔ ÌÂÙ·ÁÚ·ÊÈÎfi ·Ú¿ÁÔÓÙ· E2F (11). ªÂ ÙË ÊˆÛÊÔÚ˘Ï›ˆÛË Ù˘ p105 ·fi ÙËÓ D/CDK4,6 ·ÂÏ¢ıÂÚÒÓÂÙ·È Ô E2F, ÚÔÛ‰¤ÓÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ·ÏÏËÏÔ˘¯›· ÙÔ˘ DNA, ÂÓÂÚÁÔÔÈ› Ù· ÚˆÙÔÔÁÎÔÁÔÓ›‰È· myc, cdc-2 Î·È ÙËÓ DNA ÔÏ˘ÌÂÚ¿ÛË

ÁÈ· Ó· ·Ú¯›ÛÂÈ Ë ·ÓÙÈÁÚ·Ê‹ (12). ¶·Ú¿ÏÏËÏ·, Ë ˘ÂÚʈÛÊÔÚ˘ÏȈ̤ÓË ÚˆÙ½ÓË pppp-pRb ÚÔÛ‰¤ÓÂÙ·È Û ηıÔÚÈṲ̂ÓË ·ÏÏËÏÔ˘¯›· ÙÔ˘ DNA Î·È ÂÓÂÚÁÔÔÈ› ÙËÓ RNA ÔÏ˘ÌÂÚ¿ÛË ÁÈ· Ó· ·Ú¯›ÛÂÈ Ë ÌÂÙ·ÁÚ·Ê‹ (∂ÈÎfiÓ· 2). OÈ ÔÁÎÔÚˆÙ½Ó˜ ÙˆÓ ÈÒÓ SV40 (T ·ÓÙÈÁfiÓÔ), ÙÔ˘ ·‰ÂÓÔ˚Ô‡ (∂π∞) Î·È ÙÔ˘ HPV16 (E7 ·ÓÙÈÁfiÓÔ˘) Û˘Ó‰¤ÔÓÙ·È ÂÎÏÂÎÙÈο Ì ÙËÓ pRb Î·È ÙËÓ ·‰Ú·ÓÔÔÈÔ‡Ó, ¯ˆÚ›˜ ‰ËÏ·‰‹ Ó· ··ÈÙÂ›Ù·È ÊˆÛÊÔÚ˘Ï›ˆÛË, ÂÓÒ ÂχıÂÚÔ˜ Ô E2F ÚÔηÏ› ·ÓÂͤÏÂÁÎÙÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1315). ∏ pRb, ÂÎÙfi˜ ·fi ÙÔÓ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ Ù˘ ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Û˘ÌÌÂÙ¤¯ÂÈ Î·È ÛÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘˜ (16). ∆Ô ÁÔÓ›‰ÈÔ Rb-1 ÂÎÊÚ¿˙ÂÙ·È Û fiÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜. ∏ ·‰Ú·ÓÔÔ›ËÛ‹ ÙÔ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ Ì ÌÂÙ·ÏÏ¿ÍÂȘ (mutations), ·ÏÏ¿ Î·È Ì ··Ï›„ÂȘ (deletions) Î·È ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜ (rearrangements) (17). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ, ÂÓÒ ıˆÚËÙÈο ÌÔÚÔ‡Ó Ó· Û˘Ì‚Ô‡Ó ÛÙ· ÂÚÈÛÛfiÙÂÚ· ÂÍfiÓÈ·, ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ 90% ÛÙ· ÂÍfiÓÈ· 20-24 (18,19). ŒÓ·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ Û ÂÓ‹ÏÈΘ ÌÂ Û˘Ì·Á›˜ fiÁÎÔ˘˜, fiˆ˜ ÔÛÙÂÔÛ¿ÚΈ̷, ÌÈÎÚÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ·, ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ÚÔÛÙ¿ÙË, Ù˘ ·ÛÙ˘, ηıÒ˜ Î·È ˘„ËÏ‹˜ ηÎÔ‹ıÂÈ·˜ NHL, ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Ë ·‰Ú·ÓÔÔ›ËÛË ÙÔ˘ ÁÔÓȉ›Ô˘ ·˘ÙÔ‡ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÚfiÁÓˆÛË (20-25). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ, ÔÈ ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÊÔÚÔ‡Ó ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÚˆÙ½Ó˘ p105 Û ÏÂÌÊÔ‚Ï·ÛÙÈΤ˜ Î·È Ì˘ÂÏÔÁÂÓ›˜ Ï¢¯·È̛˜ ÂÓËϛΈÓ, ÛÙȘ Ôԛ˜ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Ë ÂÏ¿ÙÙˆÛË ‹ Ë ·Ô˘Û›· ¤ÎÊÚ·Û˘ Ù˘ ÚˆÙ½Ó˘ p105 ÌÔÚ› Ó· ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË (26-30). ¶ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ·‰Ú·ÓÔÔ›ËÛ˘ ÙÔ˘ Rb-1 Ì ··Ï›„ÂȘ ‹ ·Ó·‰È·Ù¿ÍÂȘ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÌÔÚÔ‡Ó Ó· Û˘Ì‚Ô‡Ó Û ÔÛÔÛÙfi 5-10% ÛÙȘ Oª§ (31) Î·È O§§ (32) ÂÓËϛΈÓ, ηıÒ˜ Î·È ÛÙȘ ê§ ηٿ ÙË ‚Ï·ÛÙÈ΋ ÎÚ›ÛË (33). ªÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÌÂÙ¿ÏÏ·ÍË ·˘ÙÔ‡ ÙÔ˘ ÁÔÓȉ›Ô˘ Â›Ó·È ÂÏ¿¯ÈÛÙ˜ Î·È ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙȘ ¯ÚfiÓȘ ÏÂÌÊÔ‚Ï·ÛÙÈΤ˜ Ï¢¯·È̛˜ ÙˆÓ ÂÓËÏ›ÎˆÓ (34).

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1

Paediatriki 2004;67:261-267

9

27

ª G0

∂ÎÎÈÓËÙ‹˜ ÙÔ˘ RB1 ¶ÚˆÙ½ÓË pRB 105 kDa NH2

mRNA 4,7 kb ¶ÂÚÈÔ¯‹ ‰ËÌÈÔ˘ÚÁ›·˜ ÔÏÈÁÔÌÂÚÒÓ

PP

DNA

P P P P

΢ÎÏ›ÓË D, E CDK4/CDK6 pRBp

P: £¤ÛÂȘ ʈÛÊÔÚ˘Ï›ˆÛ˘

pRBpp

∂ÈÎfiÓ· 1. ¢ÔÌ‹ Î·È ÔÚÁ¿ÓˆÛË ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 Î·È Ù˘ ÚˆÙ½Ó˘ ÙÔ˘ [ÙÚÔÔÔÈË̤ÓÔ ·fi Rahman J (40)].

™ÙËÓ ÔÍ›· Ï¢¯·ÈÌ›· ÙˆÓ ·È‰ÈÒÓ, ·Ú¿ ÙÔ˘˜ ÁÓˆÛÙÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·ÊÂÓfi˜ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ¤¯ÂÈ ¤Î‚·ÛË ÌË Û˘Ì‚·Ù‹ Ì ÙËÓ ·Ú¯È΋ ÚfiÁÓˆÛË, ·ÊÂÙ¤ÚÔ˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÔÚÈ·ÎÔ› ‰Â›ÎÙ˜ ηٿ ÙË ‰È¿ÁÓˆÛË, ÔÈ ÔÔ›ÔÈ Ó· ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ıˆڋıËΠfiÙÈ Ë ÌÂϤÙË Ù˘ ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ Rb-1 ÁÔÓȉ›Ô˘ Û ·˘Ù‹ ÙËÓ ·ÈÌ·ÙÔÏÔÁÈ΋ ηÎÔ‹ıÂÈ· ÙˆÓ ·È‰ÈÒÓ, Ô˘ Â›Ó·È ÙfiÛÔ Ë Û˘¯ÓfiÙÂÚË fiÛÔ Î·È ·˘Ù‹ Ì ÂÍ·ÈÚÂÙÈ΋ ÚfiÁÓˆÛË, ÌÔÚ› Ó· Û˘ÓÂÈÛʤÚÂÈ fi¯È ÌfiÓÔ ÛÙËÓ ÚfiÁÓˆÛË Î·È ÙÚÔÔÔ›ËÛË Ù˘ ıÂÚ·›·˜, ·ÏÏ¿ Î·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó ÂȯڛÛÌ·Ù· Ì˘ÂÏÔ‡, Ì ‹ ¯ˆÚ›˜ ¯ÚÒÛË, ·fi ÙÔ ·Ú¯Â›Ô Ù˘ ∫ÏÈÓÈ΋˜ Ù˘ ÂÚÈfi‰Ô˘ 1992-1997, 26 ·È‰ÈÒÓ Ì ÔÍ›· Ï¢¯·ÈÌ›· ÛÙËÓ ÚˆÙԉȿÁÓˆÛË (18 ·È‰È¿ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Î·È 8 Ì ÔÍ›· Ì˘ÂÏÔÁÂÓ‹), ηıÒ˜ Î·È 4 Ì Ó¢ÚÔ‚Ï¿Ûو̷. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì O§§, 13 ‹Ù·Ó ·ÁfiÚÈ· Î·È 5 ‹Ù·Ó ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 3 ÌËÓÒÓ ¤ˆ˜ 15,5 ÂÙÒÓ. ªÂ ‚¿ÛË ÙÔ ÚˆÙfiÎÔÏÏÔ BFM-ALL, ¤Ó·˜ ·ÛıÂÓ‹˜ ·Ó‹Î ÛÙËÓ ÔÌ¿‰· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, 7 ·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· ÂӉȿÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·Ó‹Î·Ó 10 ·ÛıÂÓ›˜. ∆Ú›· ·È‰È¿, Ô˘ ·Ú¯Èο ›¯·Ó ηٷٷÁ› ÛÙËÓ ÔÌ¿‰· ÂӉȿÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘, ÛÙËÓ ÔÚ›· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÏfiÁˆ Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘. ∞fi ·˘Ù¿, ¤Ó· ·ÚÔ˘Û›·Û ˘ÔÙÚÔ‹ ÛÙÔ ∫¡™ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È Î·Ù¤ÏËÍÂ. ∆Ô ‰Â‡ÙÂÚÔ ·È‰› ·ÚÔ˘Û›·Û ˘ÔÙÚÔ‹ ÛÙÔÓ Ì˘ÂÏfi 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ıÂÚ·›·˜. ÀÔ‚Ï‹ıËΠ۠ªªO ·fi ÙÔÓ ·fiÏ˘Ù· ÈÛÙÔÛ˘Ì‚·Ùfi ·‰ÂÚÊfi ÙÔ˘. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ªªO, ·ÚÔ˘Û›·Û ˘ÔÙÚÔ‹ ÛÙÔ ∫¡™ Î·È ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™ÙÔ ÙÚ›ÙÔ ·È‰› ‰ÂÓ Â›¯Â ÂÈÙ¢¯ı› ‡ÊÂÛË ÙËÓ 33Ë Ë̤ڷ Ù˘ ıÂÚ·›·˜ ÂÊfi‰Ô˘. ∏ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì Oª§ ÂÚÈÂÏ¿Ì‚·Ó 6 ÎÔÚ›ÙÛÈ· Î·È 2 ·ÁfiÚÈ·. ∞fi ·˘Ù¿, ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 10,5 ÂÙÒÓ Ô˘ ˘Ô‚Ï‹ıËΠ۠ªªO Â›Ó·È ÂχıÂÚÔ ÓfiÛÔ˘ 4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙË ªªO Î·È ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 14 ÂÙÒÓ ÛÙËÓ ÚˆÙԉȿÁÓˆÛË Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠÌÂ Û˘Ì‚·ÙÈ΋ ¯ËÌÂÈÔıÂÚ·›·, Â›Ó·È Â›-

G1 (ÚÒÈÌË)

pRD

¶ÂÚÈÔ¯‹ ¶ÂÚÈÔ¯‹ ʷΤÏÔ˘ ÚfiÛ‰ÂÛ˘ DNA COOH

P P PP P P

∂2F G2

pRBpppp S

G1 (fi„ÈÌË)

∂ÈÎfiÓ· 2. ¢È·ÁÚ·ÌÌ·ÙÈ΋ ·Ó··Ú¿ÛÙ·ÛË Ù˘ ʈÛÊÔÚ˘Ï›ˆÛ˘ Ù˘ pRb ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘ [ÙÚÔÔÔÈË̤ÓÔ ·fi Rahman J (40)]. Û˘ ÂχıÂÚÔ ÓfiÛÔ˘ 5 ¯ÚfiÓÈ· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂÚ·›·˜. ∏ ÔÌ¿‰· ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÂÚÈÂÏ¿Ì‚·Ó 4 ·È‰È¿, 2 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 3 ÌËÓÒÓ ¤ˆ˜ 2,5 ÂÙÒÓ. ∆ÚÂȘ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ›¯·Ó ÓfiÛÔ ÛÙ·‰›Ô˘ 4 (1 Ì ‰È‹ıËÛË Ì˘ÂÏÔ‡) Î·È Ô Ù¤Ù·ÚÙÔ˜ ÛÙ·‰›Ô˘ 4 S. ∂ί‡ÏÈÛË ÙÔ˘ DN∞ ∏ Âί‡ÏÈÛË ÙÔ˘ DNA Ú·ÁÌ·ÙÔÔÈ‹ıËΠ·fi Ù· ÂȯڛÛÌ·Ù· ÙÔ˘ Ì˘ÂÏÔ‡. ∆· ͤÛÌ·Ù· ÙˆÓ ÂȯÚÈÛÌ¿ÙˆÓ ÌÂٷʤÚÔÓÙ·È Û ۈÏËÓ¿ÚÈ· eppendorf. ¶ÚÔÛÙ›ıÂÙ·È ÚˆÙÂ˚Ó¿ÛË ∫ Î·È 400 Ìl ‰È·Ï‡Ì·ÙÔ˜ χÛ˘ (100 mM NaCl, 10 Mm Tris-HCL, pH 8, 25 mM EDTA, 0,5% SDS Î·È 100 Ìg/ml ÚˆÙÂ˚Ó¿ÛË ∫). ∆· ‰Â›ÁÌ·Ù· Âˆ¿˙ÔÓÙ·È ÛÙÔ˘˜ 37ÔC ÁÈ· 24 ÒÚ˜. ∏ ·ÔÌ¿ÎÚ˘ÓÛË Ù˘ ÚˆÙÂ˚Ó¿Û˘ ∫ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂÙ¿ ·fi Âί‡ÏÈÛË Ì ʷÈÓfiÏË-¯ÏˆÚÔÊfiÚÌÈÔ. ™ÙËÓ ˘‰·ÙÈ΋ Ê¿ÛË, ÚÔÛÙ›ıÂÓÙ·È 1/20 ÙÔ˘ fiÁÎÔ˘ 5 ª NaCl Î·È 2,5 fiÁÎÔÈ „˘¯Ú‹˜ (-20ÔC) ·fiÏ˘Ù˘ ·Èı·ÓfiÏ˘ ÁÈ· ÙËÓ Î·Ù·ÎÚ‹ÌÓÈÛË ÙÔ˘ DNA. ∆Ô DNA Â·Ó·ÎÙ¿Ù·È ÌÂ Ê˘ÁÔΤÓÙÚËÛË ÛÙȘ 13.000 ÛÙÚÔʤ˜ ÁÈ· 15 ÏÂÙ¿ ÛÙÔ˘˜ 4ÔC, ÂÎχÂÙ·È Ì „˘¯Ú‹ ·Èı·ÓfiÏË 70%, ·Ê‹ÓÂÙ·È Ó· ÛÙÂÁÓÒÛÂÈ Î·È Â·Ó·‰È·Ï‡ÂÙ·È Û 50 Ìl ·ÔÛÙ·Á̤ÓÔ˘ ‡‰·ÙÔ˜. ¶·Ú·Ì¤ÓÂÈ ÛÙÔ˘˜ 4ÔC ÁÈ· 24 ÒÚ˜ Î·È Î·ÙfiÈÓ Ê˘Ï¿ÛÛÂÙ·È ÛÙÔ˘˜ -20ÔC. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙÔ˘ DNA Á›ÓÂÙ·È Ì ʈÙo̤ÙÚËÛË ÛÙ· 260 nm. ∞Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË Ì ÔÏ˘ÌÂÚ¿ÛË (PCR) ∞fi ÙÔ Âί˘ÏÈṲ̂ÓÔ DNA οı ‰Â›ÁÌ·ÙÔ˜, 0,5 Ìl ˘Ê›ÛÙ·Ù·È ÂÓ˙˘ÌÈ΋ ÂÓ›Û¯˘ÛË Û ÙÂÏÈÎfi fiÁÎÔ 50 Ìl (35). ∏ ·ÓÙ›‰Ú·ÛË ÂÚÈÏ·Ì‚¿ÓÂÈ 5 Ìl Ú˘ıÌÈÛÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜, 200 ̪ dNTPs, 1,25 U Taq ÔÏ˘ÌÂÚ¿ÛË Î·È 0,5 Ìm ·fi οı ÂÎÎÈÓËÙ‹ (primer), Ë ·ÏÏËÏÔ˘¯›· ÙˆÓ ÔÔ›ˆÓ Û˘ÓÙ¤ıËΠۇÌʈӷ Ì ÙÔ˘˜ Hogg Î·È Û˘Ó (36).

OÈ primers ÁÈ· ÙÔ ÂÍfiÓÈÔ 23 ۯ‰ȿÛÙËÎ·Ó ÂÍ·Ú¯‹˜ ‚¿ÛÂÈ Ù˘ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 23 ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 ·fi ÙË ÁÔÓȉȷ΋ ÙÚ¿Â˙· (gene bank). ∞ÎÔÏÔ˘ıÔ‡Ó 35 ·ÎÏÔÈ ÂÓ›Û¯˘Û˘ ˘fi ÙȘ ÂÍ‹˜ Û˘Óı‹Î˜: ÛÙ¿‰ÈÔ ·ԉȿٷ͢ (template denaturation) Ì ıÂÚÌÔÎÚ·Û›· 96ÔC ÁÈ· 0,5 min, ÛÙ¿‰ÈÔ ·Ó·‰È¿Ù·Í˘ (primer annealing) Ì ıÂÚÌÔÎÚ·Û›·

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¶·È‰È·ÙÚÈ΋ 2004;67:261-267

ηٿÏÏËÏË ÁÈ· ÙÔ Î¿ı ˙¢Á¿ÚÈ ÂÎÎÈÓËÙÒÓ (ÂÍfiÓÈÔ 20 ÛÙÔ˘˜ 60ÔC, ÂÍfiÓÈÔ 21 ÛÙÔ˘˜ 58ÔC Î·È ÂÍfiÓÈÔ 22 ÛÙÔ˘˜ 62ÔC) Î·È ÛÙ¿‰ÈÔ ÂÈÌ‹Î˘ÓÛ˘ (primer extension) ÛÙÔ˘˜ 72ÔC ÁÈ· 1 min. ∆Ô Ì‹ÎÔ˜ ÙˆÓ ÂÓÈÛ¯˘Ì¤ÓˆÓ ÙÌËÌ¿ÙˆÓ Â›Ó·È 350, 518 Î·È 363 ‚¿ÛÂȘ (bp) ÁÈ· Ù· ÂÍfiÓÈ· 20, 21 Î·È 22, ·ÓÙ›ÛÙÔȯ·. ª¤ÚÔ˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR ·Ó·Ï‡ÂÙ·È Û ‹Îو̷ ·Á·Úfi˙˘ 2% Ì ¯ÚÒÛË ‚ÚˆÌÈÔ‡¯Ô˘ ·Èıȉ›Ô˘ Î·È ÂÎÙ›ıÂÙ·È Û ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›·, ÒÛÙ ӷ ‰È·ÈÛÙˆı› Ë ÂÈı˘ÌËÙ‹ ÂÓ›Û¯˘ÛË ÙˆÓ 350 bp, 518 bp Î·È 363 bp (∂ÈÎfiÓ˜ 3-6).

SSCP ·Ó¿Ï˘ÛË - Heteroduplex °È· ÙËÓ ·Ó›¯Ó¢ÛË ÌÂÙ·ÏϿ͈Ó, ÂÊ·ÚÌfi˙ÂÙ·È Ë ·Ó¿Ï˘ÛË ÛÙÂÚÂԉȷÌfiÚʈÛ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÌÔÓ‹˜ ·Ï˘Û›‰·˜ (single stand conformational polymorphism analysis - SSCP) (37): 5 Ìl ·fi οı PCR ÚÔ˚fiÓ ·Ó·ÌÂÈÁÓ‡ÂÙ·È Ì 10 Ìl ·ԉȷٷÎÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ (¡aO∏ 10 mª, 2 ÌM EDTA, 95%

Paediatriki 2004;67:261-267

ÊÔÚÌ·Ì›‰Ë, 0,05% ‚ÚˆÌÔÊ·ÈÓfiÏË Î·È 0,05% ΢·ÓÔ‡ ÙÔ˘ Í˘Ï¤ÓÈÔ˘). ∞ԉȿٷÍË (denaturation) ÙÔ˘ DNA ÛÙÔ˘˜ 95ÔC ÁÈ· 5 min, ¿ÌÂÛË ÙÔÔı¤ÙËÛË ÙˆÓ eppendorfs ÛÙÔÓ ¿ÁÔ Î·È ¿ÌÂÛË ËÏÂÎÙÚÔÊfiÚËÛË Û 10% ‹Îو̷ ÔÏ˘·ÎÚÈÏ·Ìȉ›Ô˘ 37,5/1 acrylamide/bisacrylamide. °È· ÙËÓ ÂÙÂÚÔ‰›ÎψÓË ·Ó¿Ï˘ÛË (Heteroduplex), Ù· PCR ÚÔ˚fiÓÙ· ·ԉȷٿÛÛÔÓÙ·È ÛÙÔ˘˜ 95ÔC ÁÈ· 10 min Î·È ËÏÂÎÙÚÔÊÔÚÔ‡ÓÙ·È Û ‹Îو̷ ÔÏ˘·ÎÚÈÏ·Ìȉ›Ô˘ 10% Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ Û 260 V ÁÈ· 4 ÒÚ˜. ∆Ô ÚÔ˚fiÓ ÙÔ˘ ÂÍÔÓ›Ô˘ 21, ÏfiÁˆ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘, ÁÈ· Ó· ÌÔÚ¤ÛÂÈ Ó· ˘ÔÛÙ› SSCP ·Ó¿Ï˘ÛË, ˘Ô‚¿ÏÏÂÙ·È Û ¤„Ë Ì ÙÔ Î·Ù¿ÏÏËÏÔ ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ NdeI, ÛÙÔ˘˜ 37ÔC ÁÈ· 10 ÒÚ˜, ‰›ÓÔÓÙ·˜ ‰‡Ô ˘ÔÚÔ˚fiÓÙ· 180/338 bp.

OÈ ·Ï˘Û›‰Â˜ ÙÔ˘ DNA Ô˘ ʤÚÔ˘Ó ÌÂÙ¿ÏÏ·ÍË, ˘‚Úȉ›˙ÔÓÙ·È Ì ·ÏÏÔȈ̤ÓÔ ÚfiÙ˘Ô Û ۯ¤ÛË Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜.

OÈ SSCP Î·È Heteroduplex ·Ó·Ï‡ÛÂȘ (∂ÈÎfiÓ· 7) ¤ÁÈÓ·Ó ÂȘ ‰ÈÏÔ‡Ó Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi ‰‡Ô ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÂÚ¢ÓËÙ¤˜, ÒÛÙ ӷ ·ÔÎÏÂÈÛÙ› Ë Èı·ÓfiÙËÙ· Ù· ·ÏÏÔȈ̤ӷ ÚfiÙ˘· ˘‚ÚȉÈÛÌÔ‡ Ó· ·ÊÔÚÔ‡Ó Û ÛÊ¿ÏÌ·Ù· Ù¯ÓÈ΋˜.

∞ÔÙÂϤÛÌ·Ù· ∞ÏÏÔȈ̤ÓÔ ÚfiÙ˘Ô ·Ú·ÙËÚ‹ıËΠÛÙÔ ÂÍfiÓÈÔ 20 Û 2 ·È‰È¿ Ì O§§ (11%), ÛÙÔ ÂÍfiÓÈÔ 21 Û 1

∂ÈÎfiÓ· 3. ∞ÓÙÈÚÔÛˆ¢ÙÈ΋ ʈÙÔÁÚ·Ê›· ·Ó¿Ï˘Û˘ ÚÔ˚fiÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 20 ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 Û Á¤ÏË ·Á·Úfi˙˘ Ì ¯ÚÒÛË Ì ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ∆Ô ‚¤ÏÔ˜ ·ÓÙÈÛÙÔȯ› ÛÙË ı¤ÛË ÙˆÓ 350 ˙¢ÁÒÓ ‚¿ÛÂˆÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR. Lader 123 bp, ‰ËÏ·‰‹ οı ˙ÒÓË ÙÔ˘ ·ÓÙÈÛÙÔȯ› Û 123 ˙‡ÁË ‚¿ÛÂˆÓ (bp).

∂ÈÎfiÓ· 4. ∞ÓÙÈÚÔÛˆ¢ÙÈ΋ ʈÙÔÁÚ·Ê›· ·Ó¿Ï˘Û˘ ÚÔ˚fiÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 21 ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 Û Á¤ÏË ·Á·Úfi˙˘ Ì ¯ÚÒÛË Ì ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ∆Ô ‚¤ÏÔ˜ ·ÓÙÈÛÙÔȯ› ÛÙË ı¤ÛË ÙˆÓ 518 ˙¢ÁÒÓ ‚¿ÛÂˆÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR. Lader 123 bp.

264

∂ÈÎfiÓ· 5. ∞ÓÙÈÚÔÛˆ¢ÙÈ΋ ʈÙÔÁÚ·Ê›· ·Ó¿Ï˘Û˘ ÚÔ˚fiÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 21 ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 Û Á¤ÏË ·Á·Úfi˙˘ Ì ¯ÚÒÛË Ì ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ, ηÙfiÈÓ ¤„˘ ÙÔ˘ Ì ÙÔ ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ Nde. ∆· ‚¤ÏË ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙË ı¤ÛË ÙˆÓ 180 Î·È 338 bp ÙˆÓ ‰‡Ô ˘ÔÚÔ˚fiÓÙˆÓ Ù˘ ¤„˘.

∂ÈÎfiÓ· 6. ∞ÓÙÈÚÔÛˆ¢ÙÈ΋ ʈÙÔÁÚ·Ê›· ·Ó¿Ï˘Û˘ ÚÔ˚fiÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 22 ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 Û Á¤ÏË ·Á·Úfi˙˘ Ì ¯ÚÒÛË Ì ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ∆Ô ‚¤ÏÔ˜ ·ÓÙÈÛÙÔȯ› ÛÙË ı¤ÛË ÙˆÓ 363 ˙¢ÁÒÓ ‚¿ÛÂˆÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR. Lader 123 bp.

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¶›Ó·Î·˜ 1. ªÂÙ·ÏÏ¿ÍÂȘ ÛÙ· ÂÍfiÓÈ· 20, 21, 22 ÙÔ˘ Rb-1 ÁÔÓȉ›Ô˘ Û ·È‰È¿ ̠Ϣ¯·ÈÌ›· Î·È Ó¢ÚÔ‚Ï¿Ûو̷ ∂ÍfiÓÈ·

O§§

Oª§

¡Â˘ÚÔ‚Ï¿Ûو̷

20 21 22 ™‡ÓÔÏÔ

2/18 (11%) 1/18 (6%) 4/18 (22%) 7/18 (39%)

0/8 0/8 2/8 (25%) 2/8 (25%)

0/4 0/4 1/4 (25%) 1/4 (25%)

¶›Ó·Î·˜ 2. ™˘Û¯¤ÙÈÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ Ì ÙË ÛÙ·‰ÈÔÔ›ËÛË Ù˘ ÓfiÛÔ˘

∂ÈÎfiÓ· 7. ∞ÓÙÈÚÔÛˆ¢ÙÈ΋ ʈÙÔÁÚ·Ê›· ·Ó¿Ï˘Û˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÌÔÓfiÎψÓ˘ ·Ï˘Û›‰·˜ (SSCP) Î·È ÂÙÂÚÔ‰ÈÌÂÚÒÓ (Heteroduplex). OÈ ·Ï˘Û›‰Â˜ ÙÔ˘ DNA Ô˘ ¤¯Ô˘Ó ·ԉȷٷ¯ı›, ˘‚Úȉ›˙Ô˘Ó Ì ·ÏÏÔȈ̤ÓÔ ÚfiÙ˘Ô (‰Â›ÁÌ· ¡Ô 23), ÁÂÁÔÓfi˜ Ô˘ Â›Ó·È ÂÌÊ·Ó¤˜ ηٿ ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË Û Á¤ÏË ÔÏ˘·ÎÚ˘Ï·Ìȉ›Ô˘ ÌÂÙ¿ ·fi ¯ÚÒÛË Ì ÓÈÙÚÈÎfi ¿ÚÁ˘ÚÔ.

·È‰› Ì O§§ (65%), ÛÙÔ ÂÍfiÓÈÔ 22 Û 4 ·È‰È¿ Ì O§§ (22,22%), Û 2 ·È‰È¿ Ì Oª§ (25%) Î·È Û 1 ·È‰› Ì Ó¢ÚÔ‚Ï¿Ûو̷ (25%) (¶›Ó·Î·˜ 1). ™ËÌÂÈÒÓÂÙ·È, Â›Û˘, fiÙÈ Û ¤Ó·Ó ·ÛıÂÓ‹ Ì Oª§, ‰Â˘ÙÂÚÔÁÂÓ‹ ÌÂÙ¿ ·fi ıÂÚ·›· Ì ÂÙÔÔÛ›‰Ë ÁÈ· ÔÛÙÂÔÛ¿ÚΈ̷, ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ÂÓÈÛ¯˘ı› ÙÔ ÂÍfiÓÈÔ 20, ÂÓ‰ÂÈÎÙÈÎfi Èı·Ó‹˜ ·¿ÏÂÈ„‹˜ ÙÔ˘ (deletion). ™˘ÓÔÏÈο ·ÓȯÓ‡ıËÎ·Ó 7 ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙȘ ÔÍ›˜ ÏÂÌÊÔ‚Ï·ÛÙÈΤ˜, 2 ÛÙȘ Ì˘ÂÏÔÁÂÓ›˜ Î·È 1 ÌÂÙ¿ÏÏ·ÍË ÛÙÔ Ó¢ÚÔ‚Ï¿Ûو̷. ™˘Û¯ÂÙ›˙ÔÓÙ·˜ ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ Ì ÙÔ ÛÙ¿‰ÈÔ-ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘ Ù˘ ÓfiÛÔ˘, ÔÈ 6 ·fi ÙȘ 7 ÔÍ›˜ ÏÂÌÊÔ‚Ï·ÛÙÈΤ˜ Ï¢¯·È̛˜ ·Ú·ÙËÚÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ ÔÌ¿‰· ÂӉȿÌÂÛÔ˘-˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2). ™ÙËÓ ÔÌ¿‰· ÙˆÓ ÔÍÂÈÒÓ Ì˘ÂÏÔÁÂÓÒÓ Ï¢¯·ÈÌÈÒÓ, fiϘ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ·ÓȯÓ‡ıËÎ·Ó Û ·ÛıÂÓ›˜ Ô˘ η٤ÏËÍ·Ó. ™ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷, Ë ÌÂÙ¿ÏÏ·ÍË Ô˘ ·ÓȯÓ‡ıËΠ·ÊÔÚÔ‡Û ÛÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ì ‰È‹ıËÛË Ì˘ÂÏÔ‡, ÙÔ ÔÔ›Ô Î·Ù¤ÏËÍ (¶›Ó·Î·˜ 3). ™˘˙‹ÙËÛË ∏ Ï¢¯·ÈÌÔÁ¤ÓÂÛË ·ÔÙÂÏ› ÔχÏÔÎË ‰È·‰Èηۛ·, Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓÒÌ·ÏÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ÎÏÒÓÔ˘, Ô ÔÔ›Ô˜ ¤¯ÂÈ ·ÔϤÛÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ÂϤÁ¯ÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi, ̤ۈ ÔÏÏ·ÏÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÙfiÛÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÔÁÎÔÁÔÓȉ›ˆÓ fiÛÔ Î·È ÛÙËÓ ·‰Ú·ÓÔÔ›ËÛË ÙˆÓ ÔÁÎÔηٷÛÙ·ÏÙÈÎÒÓ ÁÔÓȉ›ˆÓ (38). ∏ ÚˆÙ½ÓË ÙÔ˘ Rb-1 ·ÔÙÂÏ› ¤Ó·Ó ·ÚÈÔ ÛËÌ·ÙÔ‰fiÙË ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘.

OÍ›˜ Ï¢¯·È̛˜

™Ù·ıÂÚÔ‡ ÎÈÓ‰‡ÓÔ˘

∂ӉȿÌÂÛÔ˘-˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

O§§ (7) Oª§ (2)

1

6 2 ªÂ ‰È‹ıËÛË Ì˘ÂÏÔ‡ 1

¡Â˘ÚÔ‚Ï¿Ûو̷ (1)

Èڛ˜ ‰È‹ıËÛË Ì˘ÂÏÔ‡ 0

¶›Ó·Î·˜ 3. ™˘Û¯¤ÙÈÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ Ì ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ™Ù¿‰ÈÔ ÓfiÛÔ˘

¢È¿ÁÓˆÛË

÷ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 1 (1+) O§§ ∂ӉȿÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ 7 (2+) O§§ À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 10 (4+) O§§ 8 (2+) Oª§

ÀÔÙÚÔ‹ ⁄ÊÂÛË (-) 2+

1+ 2+

(n+) ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÔÌ¿‰· Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙ· ÂÍfiÓÈ· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È Ë ÂÚ·ÈÙ¤Úˆ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ ÙÔ˘˜

∆· ÂÍfiÓÈ· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙÔ ÙÌ‹Ì· Ù˘ ÚˆÙ½Ó˘ Ô˘ ÚÔÛ‰¤ÓÂÙ·È ÛÙÔ DNA, ·ÏÏ¿ Î·È Ô˘ ‰ÂÛÌÂ‡Ô˘Ó ÙÔÓ Î·ıÔÚÈÛÙÈÎfi ÌÂÙ·ÁÚ·ÊÈÎfi ·Ú¿ÁÔÓÙ· E2F, Â›Ó·È Ù· ÂÍfiÓÈ· 20-23 (39). ™˘ÓÂÒ˜, ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ Û ·˘Ù¿ Ù· ÂÍfiÓÈ· Ô‰ËÁÔ‡Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ì›·˜ ÌÂÙ·ÏÏ·Á̤Ó˘ ÚˆÙ½Ó˘, Ë ÔÔ›· Â›Ó·È ÂÏ·Ùو̷ÙÈ΋ ÛÙË ÊˆÛÊÔÚ˘Ï›ˆÛË, ·ÏÏ¿ Î·È ÛÙËÓ ˘ÚËÓÈ΋ ÚfiÛ‰ÂÛ‹ Ù˘, Â›Ó·È ÙÂÏÈο, ‰ËÏ·‰‹, Ì›· ÌË ÏÂÈÙÔ˘ÚÁÈ΋ ÚˆÙ½ÓË. ∏ ÂÏ·Ùو̷ÙÈ΋ ¤ÎÊÚ·ÛË Ù˘ pRb ÌÔÚ› Ó· Û˘ÓÂ¿ÁÂÙ·È Â›Ù ·ÓÂͤÏÂÁÎÙÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÏfiÁˆ ·Ú¤Ì‚·Û˘ ÛÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ Ì›· ηÎÔ‹ıË ÌÂÙ·ÙÚÔ‹, ›Ù de novo ·fiÎÙËÛË ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1, Ì ·ÔÙ¤ÏÂÛÌ· ¿ÚÛË Ù˘ ·Ó·ÛÙ·ÏÙÈ΋˜ ‰Ú¿Û˘ ÙÔ˘ ÁÔÓȉ›Ô˘ ·˘ÙÔ‡ ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ϤÔÓ ÂÈıÂÙÈ΋ ÓfiÛÔ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ·Ó›¯Ó¢ÛË ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ Rb-1 ÛÙË Û˘¯ÓfiÙÂÚË Î·ÎÔ‹ıÂÈ· ÙˆÓ ·È‰ÈÒÓ, Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË. ªÂÙ·ÏÏ¿ÍÂȘ ÛÙ· ÂÍfiÓÈ· 20, 21 Î·È 22 ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 ·ÓȯÓ‡ıËÎ·Ó ÛÙÔ 35% ÙˆÓ ·È‰ÈÒÓ Ì ÔÍ›· Ï¢¯·ÈÌ›·. ™Â ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 50%, ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ·ÊÔÚÔ‡Û·Ó Û ·È‰È¿ Ì ·Ú¯Èο ‰˘ÛÌÂÓ›˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‹

265

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ÌÂÙ¤ÂÈÙ· ‰˘ÛÌÂÓ‹ ÔÚ›·. ™Â fiÏ· Ù· ·È‰È¿ Ô˘ ˘ÔÙÚÔ›·Û·Ó ‹ ÂÌÊ¿ÓÈÛ·Ó Î·ı˘ÛÙ¤ÚËÛË ‡ÊÂÛ˘, ·ÓȯÓ‡ıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ. ∞fi ÙȘ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ Ô˘ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿ÏÏ·ÍË, fiϘ - ÏËÓ Ì›·˜ - ·ÊÔÚÔ‡Û·Ó Û ·ÛıÂÓ›˜ ÔÌ¿‰·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ŸÏ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ Ô˘ ·ÓȯÓ‡ıËÎ·Ó Û ·È‰È¿ Ì Oª§, ·ÊÔÚÔ‡Û·Ó Û Ï¢¯·È̛˜ ÛÙȘ Ôԛ˜ ‰ÂÓ ÂÈÙ‡¯ıËΠ‡ÊÂÛË. ∏ ÌÂÙ¿ÏÏ·ÍË Ô˘ ·ÓȯÓ‡ıËΠÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷, ·ÊÔÚÔ‡Û Û fiÁÎÔ Ì ٷ˘Ùfi¯ÚÔÓË ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ Ê·›ÓÂÙ·È, Ì ‚¿ÛË ÙËÓ SSCP ·Ó¿Ï˘ÛË, fiÙÈ ·˘Ù¤˜ ¤¯Ô˘Ó Û˘Ì‚Â› ÛÙËÓ ›‰È· ·ÏÏËÏÔ˘¯›·, ·ÊÔ‡ ÂÌÊ·Ó›˙Ô˘Ó ÙÔ ›‰ÈÔ ·ÏÏÔȈ̤ÓÔ ÚfiÙ˘Ô. µ¿ÛÂÈ ·˘ÙÒÓ ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ ‰Â‰Ô̤ӈÓ, Ë ·Ó›¯Ó¢ÛË ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ Rb-1 ÚÔÙ›ÓÂÙ·È Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ¤Ó·˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÛÙȘ ÔÍ›˜ Ï¢¯·È̛˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙÔ Ó¢ÚÔ‚Ï¿Ûو̷ Î·È ˆ˜ ‰Â›ÎÙ˘ ÁÈ· ·Ó›¯Ó¢ÛË ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘, ȉȷ›ÙÂÚ· ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ԉ›¯ıËΠfiÙÈ Ë ·ÚÔ˘Û›· ÌÂÙ·ÏÏ·Á̤ÓÔ˘ Rb-1 ÁÔÓȉ›Ô˘ Û ÂÚÈÙÒÛÂȘ O§§ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌÔÚ› Ó· ¯·Ú·ÎÙËÚ›ÛÂÈ ÙË ÓfiÛÔ Û·Ó ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Ì ÚÔÔÙÈ΋ ÙËÓ ÂÓÙ·ÙÈÎÔÔ›ËÛË Ù˘ ıÂÚ·›·˜ ηÈ, ‚¤‚·È·, Ó· ·ÔÙÂϤÛÂÈ ‰Â›ÎÙË ·Ó›¯Ó¢Û˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘, ÂÊfiÛÔÓ ·ÓȯÓ¢ı› ÛÙËÓ ÚˆÙԉȿÁÓˆÛË. ∞˘Ùfi ÙÔ ÌÂÙ·ÏÏ·Á̤ÓÔ ÁÔÓ›‰ÈÔ Ê·›ÓÂÙ·È fiÙÈ ÂÓ¤¯ÂÙ·È Î·È ÛÂ Û˘Ì·Á›˜ fiÁÎÔ˘˜ Ì ÌÂÙ¿ÛÙ·ÛË ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, fiˆ˜ ‰È·ÈÛÙÒıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÛÙȘ ÂÚÈÙÒÛÂȘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙ·‰›Ô˘ 4. ™‡Ìʈӷ Ì ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, ÚÔÙ›ÓÂÙ·È Ë ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ Rb-1 ˆ˜ ÚÔÁÓˆÛÙÈÎÔ‡ ‰Â›ÎÙË Î·È ˆ˜ ‰Â›ÎÙË ÌÂϤÙ˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ ÛÙȘ ÔÍ›˜ Ï¢¯·È̛˜ ÙˆÓ ·È‰ÈÒÓ, ·ÏÏ¿ Î·È Û fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ Î·ÎÔËıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ȉȷ›ÙÂÚ· Û ·˘Ù¤˜ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ì ÛÎÔfi ÙËÓ ·ÍÈÔÔ›ËÛ‹ ÙÔ˘ ˆ˜ ‰Â›ÎÙË ÂÈıÂÙÈÎfiÙËÙ·˜ Û˘Ì·ÁÒÓ fiÁΈÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Vogelstein B, Kinzler KW. The multistep nature of cancer.

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¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ∫·ÏÌ·ÓÙ‹ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: pedhem@med.uoc.gr

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2004;67:268-273

ORIGINAL ARTICLE

∂›‰Ú·ÛË Ù˘ ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ Û ·È‰È¿ Ù˘ ∫‡ÚÔ˘ ËÏÈΛ·˜ 10-12 ÂÙÒÓ X. ÷Ù˙ËÁˆÚÁ›Ô˘, ª. ÷Ù˙ËȈ¿ÓÓÔ˘, ª. ∆ÔÚÓ·Ú›Ù˘, ∞. °È·ÁÎÔ˘Ï‹, ∂. ∫ˆÓÛÙ·ÓÙ›ÓÔ˘, µ. ¡Â¿Ú¯Ô˘, ™. ™¿‚‚·˜

The effect of aerobic exercise on risk factors for chronic disease in 10-12 year-old children in Cyprus C. Chadjigeorgiou, M. Chadjiioannou, M. Tornaritis, A. Giagkouli, E. Konstantinou, B. Nearchou, S. Savvas

¶ÂÚ›ÏË„Ë: ™ÙËÓ ∫‡ÚÔ, fiˆ˜ Î·È Û fiϘ ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·È‰È¿ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· Ù· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜. OÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› Û˘Ó‹ıˆ˜ ·Ú·Ì¤ÓÔ˘Ó Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÌÂ Û˘Ó¤ÂÈ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıËڈ̿وÛË, ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Ù˘ ηډȿ˜ Î·È ÌÂÚÈΤ˜ ÌÔÚʤ˜ ηÚΛÓÔ˘. ∏ ηıÈÛÙÈ΋ ˙ˆ‹ Î·È Ë Î·Î‹ ‰È·ÙÚÔÊ‹ Â›Ó·È ÔÈ Î˘ÚÈfiÙÂÚÔÈ ÏfiÁÔÈ Ô˘ ‰ËÌÈÔ‡ÚÁËÛ·Ó ·˘Ù‹ ÙËÓ ÂÈÎfiÓ·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ Ù˘ ›‰È·˜ ÁˆÁÚ·ÊÈ΋˜ ÂÚÈÔ¯‹˜ ÁÈ· 15 Ì‹Ó˜: Ì›· ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ Ô˘ ·ÛÎÔ‡ÓÙ·Ó 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Â› 1-1,5 ÒÚ· οı ÊÔÚ¿ Î·È Ì›· ÔÌ¿‰· ·È‰ÈÒÓ Ô˘ ‰ÂÓ ·ÛÎÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο. ŒÁÈÓ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜, ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ (‚¿ÚÔ˜, ‡„Ô˜ Î·È ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ηıÒ˜ Î·È Ì¤ÙÚËÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÙÚÈΤʷÏÔ˘ Ì˘fi˜). ŒÁÈÓ ¤ÏÂÁ¯Ô˜ Ù˘ ·ıÏËÙÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ Euro fit test ÛÙËÓ ·Ú¯‹ Î·È 15 Ì‹Ó˜ ÌÂÙ¿ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘. OÈ Ô‰ËÏ¿Ù˜ (·ÁfiÚÈ·) ›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›‰· TC (158,16/169,93, p=0,042) Î·È LDL-C (79,36/97,5, p<0,001) Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ô˘ ‰ÂÓ ·ÛÎÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο. ∞ÎfiÌË, ÔÈ Ô‰ËÏ¿Ù˜ (ÎÔÚ›ÙÛÈ·) ›¯·Ó ηχÙÂÚË ·fi‰ÔÛË ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (4,68/3,42, p=0,042). º·›ÓÂÙ·È fiÙÈ Ë Â˘ÂÚÁÂÙÈ΋ ÁÈ· ÙËÓ ˘Á›· Â›‰Ú·ÛË Ù˘ ¿ıÏËÛ˘, ÂÊfiÛÔÓ Û˘Ó¯ÈÛÙ›, Èı·Ófiٷٷ ı· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Ù˘ ηډȿ˜ Î·È ¿ÏÏ· ÛÔ‚·Ú¿ ÓÔÛ‹Ì·Ù· ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

Abstract: In Cyprus there is a high prevalence among children of risk factors for chronic diseases.

These factors tend to persist into adulthood and increase the risk for hypertension, heart disease, cancer and other conditions. Reduced levels of physical activity and an unbalanced diet are the main reasons for this trend. This study followed two groups of 10-12 year-old children in a suburban area of the district of Nicosia for 15 months. Group µ consisted of regular cyclists and group ∞ of children who do not exercise regularly. Testing was made at the beginning and after 15 months of observation. Blood lipids and glucose were measured and the ratios: TC/HDL-C and TC/LDL-C were estimated. Weight (kg) and height (m) were measured and the body mass index (BMI) was calculated. The triceps skin fold was measured in mm. The physical level of the two groups was examined with four exercises of the Euro Fit Test (abdominals, flexibility, long jump and 20 m multistage shuttle run test). The cyclists (boys) had lower levels of TC (158.16/169.93, p=0.042) and LDL-C (79.36/97.5, p<0.001) than the group A children who do not exercise regularly. The cyclists (girls) had better results at 20 m test stage (4.68/3.42, p=0.042) than group ∞ children. These findings suggest that in children exercise improves the risk factors for chronic diseases of adulthood.

§¤ÍÂȘ ÎÏÂȉȿ: ¿ıÏËÛË, ·È‰È¿, ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜.

Key words: exercise, children, chronic diseases.

™˘ÓÙÔÌÔÁڷʛ˜ ™¡∫

™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ηډȿ˜

∂Î·È‰Â˘ÙÈÎfi Î·È ∂Ú¢ÓËÙÈÎfi ÿ‰Ú˘Ì· “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡”, §Â˘ÎˆÛ›·, ∫‡ÚÔ˜

268

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¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÕÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ·

Research and Educational Programme “Child’s Health”, Nicosia, Cyprus

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∫O∞ TC LDL-C HDL-C TG W H ¢ª™ ¢¶∆ ∂™∂∞¶ WHO CDC

∫˘ÚÈ·Îfi˜ OÚÁ·ÓÈÛÌfi˜ ∞ıÏËÙÈÛÌÔ‡ OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Ã·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏË À„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏË ∆ÚÈÁÏ˘ÎÂÚ›‰È· ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ¶ÂÚÈʤÚÂÈ· ÁÏÔ˘ÙÔ‡ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈΤʷÏÔ˘ Ì˘fi˜ ∂ıÓÈÎfi ™‡ÛÙËÌ· ∂͈ÙÂÚÈ΋˜ ∞ÍÈÔÏfiÁËÛ˘ ¶ÔÈfiÙËÙ·˜ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ ∫¤ÓÙÚÔ ∂ϤÁ¯Ô˘ ∞ÛıÂÓÂÈÒÓ (∏¶∞)

∂ÈÛ·ÁˆÁ‹ ∞fi ÙËÓ ·È‰È΋ ËÏÈΛ· ·ÓȯÓ‡ÔÓÙ·È ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜, fiˆ˜ ˘ÂÚÏÈȉ·ÈÌ›·, ·¯˘Û·ÚΛ· Î·È ÂÏÏÈ‹˜ ۈ̷ÙÈ΋ ¿ÛÎËÛË, Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È (111). ŸÛÔ ÂÚÈÛÛfiÙÂÚÔÈ Â›Ó·È ÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÙfiÛÔ ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ·ıËڈ̿وÛË, ηıÒ˜ Î·È ÔÈ ‚Ï¿‚˜ ÛÙ· ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· Ù˘ ηډȿ˜ (7-10). ™ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ·Ó·ÊÔÚ¤˜ ÂÎÙ›ÌËÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙ· ∂ÏÏËÓfiÔ˘Ï·, ΢ڛˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ˘ÂÚÏÈȉ·ÈÌ›·, ÙËÓ ·¯˘Û·ÚΛ· Î·È ÙËÓ Î·Î‹ ‰È·ÙÚÔÊ‹ (5-9). ∏ ·¯˘Û·ÚΛ· ÚÔηÏ› ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, ÙfiÛÔ ¿ÌÂÛ· („˘¯ÔÏÔÁÈο, ‹È· ÔÚıÔ·È‰Èο Î.Ï.) fiÛÔ Î·È ÚÔ‚Ï‹Ì·Ù· Ì ̷ÎÚÔ¯ÚfiÓȘ ÂÈÙÒÛÂȘ (·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÔÏ˘Î˘ÛÙÈΤ˜ ˆÔı‹Î˜ ÛÙ· ÎÔÚ›ÙÛÈ·, ˘¤ÚÙ·ÛË, Ó˘¯ÙÂÚÈÓ‹ ¿ÓÔÈ·, ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ ππ, ·ıËڈ̿وÛË Î·È ÌÂÙ¿ÙˆÛË Û ·¯˘Û·ÚΛ· ÙˆÓ ÂÓËϛΈÓ) (11-14). ™Ù· ·È‰È¿ Ù˘ ∫‡ÚÔ˘, ÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· Ù· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯ÓÔ›, Û‡Ìʈӷ Ì ÌÂϤÙ˜ Û ·È‰È¿ ËÏÈΛ·˜ 6-18 ÂÙÒÓ (5,6,13-15). ∏ ¿ıÏËÛË ¤¯ÂÈ ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ ÛÙËÓ ÚfiÏË„Ë ÓÔÛËÌ¿ÙˆÓ Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ıˆÚÂ›Ù·È Ôχ ÛËÌ·ÓÙÈÎfi Ó· Ì¿ıÔ˘Ó Ù· ·È‰È¿ Ó· ·ıÏÔ‡ÓÙ·È ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ó· ÁÓˆÚ›˙Ô˘Ó Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Ô˘ ÚÔÛʤÚÂÈ Ë ¿ÛÎËÛË (1621). ¢˘ÛÙ˘¯Ò˜, Ë ÂÁηٿÏÂÈ„Ë Ù˘ ˘·›ıÚÔ˘ Î·È Ë ·ÛÙÈÎÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡, Ë ÙËÏÂfiÚ·ÛË, ÔÈ ËÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ Î·È Ù· ËÏÂÎÙÚÔÓÈο ·È¯Ó›‰È· Ô˘ ¤¯Ô˘Ó ÂÈÛ¯ˆÚ‹ÛÂÈ ÛÙË ˙ˆ‹ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Û‹ÌÂÚ·, ¤¯Ô˘Ó ÂÚÈÔÚ›ÛÂÈ Î·Ù¿ Ôχ ÙËÓ ·ıÏËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ (6,13,14,17-24). ∏ ÌÂϤÙË ·˘Ù‹ ۯ‰ȿÛÙËΠ·fi ÙÔ ÚfiÁÚ·ÌÌ· “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡”, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ÔÌÔÛÔÓ‰›· Ô‰ËÏ·Û›·˜ ÙÔ˘ ∫˘ÚÈ·ÎÔ‡ OÚÁ·ÓÈÛÌÔ‡ ∞ıÏËÙÈÛÌÔ‡ (∫O∞). ™ÎÔfi˜ Ù˘ ‹Ù·Ó Ó· ÌÂÏÂÙ‹ÛÂÈ ÙËÓ Â›‰Ú·ÛË Ù˘ ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ Î·È Û˘ÁÎÂÎÚÈ-

Paediatriki 2004;67:268-273

̤ӷ Ù˘ Ô‰ËÏ·Û›·˜ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ Û ·È‰È¿ Î·È Ó· ÂÍ·Á¿ÁÂÈ Û˘ÌÂÚ¿ÛÌ·Ù· Ù· ÔÔ›· Ó· ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·fi ÙÔÓ ∫O∞ Î·È Ù· ÀÔ˘ÚÁ›· ÀÁ›·˜ Î·È ¶·È‰Â›·˜-¶ÔÏÈÙÈÛÌÔ‡, ÚÔÎÂÈ̤ÓÔ˘ Ó· ¯·Ú·¯ıÔ‡Ó ·ÚÂÌ‚¿ÛÂȘ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Î·ÎÒÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ ÙˆÓ Ó¤ˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆o ÚfiÁÚ·ÌÌ· “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡”, Ô˘ ÙÂÏ› ˘fi ÙËÓ ·ÈÁ›‰· ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ¯ÚËÌ·ÙÔ‰ÔÙÂ›Ù·È ·fi ÙËÓ Î˘‚¤ÚÓËÛË Î·È ÙË §·˚΋ ÙÚ¿Â˙·, ÌÂϤÙËÛ - ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ÔÌÔÛÔÓ‰›· Ô‰ËÏ·Û›·˜ ÙÔ˘ ∫O∞ - ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÁÈ· 15 Ì‹Ó˜ (π·ÓÔ˘¿ÚÈÔ˜ 2000 ¤ˆ˜ ª¿ÚÙÈÔ˜ 2001). ∏ ÔÌ¿‰· ∞ ÂÚÈÂÏ¿Ì‚·Ó ·È‰È¿ (72 ·ÁfiÚÈ· Î·È 62 ÎÔÚ›ÙÛÈ·) Ô˘ ÊÔÈÙÔ‡Û·Ó ÛÙË ™Ù’ Ù¿ÍË ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ, ËÏÈΛ·˜ 10-12 ÂÙÒÓ, Ù· ÔÔ›· ‰ÂÓ ·ıÏÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο, ÂÓÒ Ë ÔÌ¿‰· µ ÂÚÈÂÏ¿Ì‚·Ó 40 ·È‰È¿ (25 ·ÁfiÚÈ· Î·È 15 ÎÔÚ›ÙÛÈ·), Ù· ÔÔ›· ÍÂΛÓËÛ·Ó Ô‰ËÏ·Û›· Û ËÏÈΛ· 10-12 ÂÙÒÓ. ∫·È ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ‰‹ÌÔ˘˜ Ù˘ Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜, ·fi Ì›· ËÌÈ·ÛÙÈ΋, ¤ÓÙÔÓ· ·Ó·Ù˘ÛÛfiÌÂÓË, ÂÚÈÔ¯‹ ÎÔÓÙ¿ ÛÙË §Â˘ÎˆÛ›·. ™ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÂÊ·ÚÌfiÛÙËΠÙÔ ›‰ÈÔ ÚˆÙfiÎÔÏÏÔ ÂÚÁ·Û›·˜, ÙfiÛÔ ÛÙËÓ ·Ú¯‹ fiÛÔ Î·È ÌÂÙ¿ ·fi ÂÚ›Ô˘ 15 Ì‹Ó˜ Î·È ÂÚÈÂÏ¿Ì‚·ÓÂ: ·) ∫ÏÈÓÈ΋ ÂͤٷÛË Î·È Ì¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ·ÓÙÈ‚Ú¿¯ÈÔ Ì ˘‰Ú·ÚÁ˘ÚÈÎfi Ì·ÓfiÌÂÙÚÔ. °›ÓÔÓÙ·Ó 3 ÌÂÙÚ‹ÛÂȘ Î·È Î·Ù·ÁÚ·ÊfiÙ·Ó Ô 1Ô˜, 2Ô˜ Î·È 5Ô˜ ‹¯Ô˜ ηٿ Korothof. ∆Ô ·È‰› ‚ÚÈÛÎfiÙ·Ó Û ηıÈÛÙ‹ ı¤ÛË Î·È Ë ÂÚȯÂÈÚ›‰· Î¿Ï˘Ù ٷ 2/3 ÙÔ˘ ·ÓÙÈ‚Ú·¯›Ô˘. §·Ì‚·ÓfiÙ·Ó Ë Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÙÚÈÒÓ ÌÂÙÚ‹ÛˆÓ. ‚) ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ [‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (kg), ‡„Ô˜ ÛÒÌ·ÙÔ˜ (m), ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ (mm) ÙÚÈΤʷÏÔ˘ Î·È ‰ÈΤʷÏÔ˘ Ì˘fi˜, Ï·ÁÔÓ›Ô˘, ˆÌÔÏ¿Ù˘, ÂÚ›ÌÂÙÚÔ˜ ‚Ú·¯›ÔÓ·, ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (W) Î·È ÂÚÈʤÚÂÈ· (H)]. °ÈÓfiÙ·Ó ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ Û¯¤ÛÂˆÓ W/H Î·È ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) (¢ª™ = ‚¿ÚÔ˜ (kg)/‡„Ô˜ (m)2. ∆Ô ‚¿ÚÔ˜ ÌÂÙÚ‹ıËΠ۠˙˘Á·ÚÈ¿ SECA ·ÎÚȂ›·˜ ±0,5 kg, Ì ÙÔ ·È‰› ÂÏ·ÊÚ¿ ÓÙ˘Ì¤ÓÔ, ‰›¯ˆ˜ ·Ô‡ÙÛÈ·, ÂÓÒ ÙÔ ‡„Ô˜ Ì ÊÔÚËÙfi ÌÂÙ·ÏÏÈÎfi ·Ó·ÛÙËÌfiÌÂÙÚÔ SECA, ÚÔÛ·ÚÌÔṲ̂ÓÔ Û Â›Â‰Ô ÙÔ›¯Ô. OÈ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ÌÂÙÚ‹ıËÎ·Ó Ì ‰ÂÚÌ·ÙÔÙ˘¯fiÌÂÙÚÔ Jammar, ·fi ÙÔÓ ›‰ÈÔ ¿ÓÙÔÙ ÂÚ¢ÓËÙ‹, Ì ·ÎÚ›‚ÂÈ· ¯ÈÏÈÔÛÙÔ‡. Á) ∞ÈÌÔÏË„›·, ÁÈ· ̤ÙÚËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ (TC), Ù˘ LDL-C, Ù˘ HDL-C, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG) Î·È Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜, ηıÒ˜ Î·È ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ (FBC). ∏ ·ÈÌÔÏË„›· ÁÈÓfiÙ·Ó ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›·, ·fi ÙË ÌÂÛÔ‚·ÛÈÏÈ΋ - ηٿ ηÓfiÓ· - ÊϤ‚·, Ì ۈÏËÓ¿ÚÈ· ÎÂÓÔ‡ (vacutainer). §·Ì‚·ÓfiÙ·Ó ¤Ó· ‰Â›ÁÌ· 4-5 ml ·›Ì·ÙÔ˜ Ì ·ÓÙÈËÎÙÈÎfi EDTA ÁÈ· ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ó·Ï‡ÛÂȘ Î·È 5 ml ·›Ì·ÙÔ˜ Û ۈÏËÓ¿ÚÈÔ ‰›¯ˆ˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ. ∆· ‰Â›ÁÌ·Ù· ÙÔÔıÂÙÔ‡ÓÙ·Ó Û ÊÔÚËÙfi „˘ÁÂ›Ô Ì ·ÁÔ·ÛÙÂȘ Î·È ÌÂٷʤÚÔÓÙ·Ó ÛÙÔ ÃËÌÂ›Ô ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ̤۷ Û 2-3 ÒÚ˜. OÈ ÂÍÂÙ¿ÛÂȘ

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¶·È‰È·ÙÚÈ΋ 2004;67:268-273

Paediatriki 2004;67:268-273

Á›ÓÔÓÙ·Ó ÙËÓ ›‰È· Ë̤ڷ Û ·Ó·Ï˘Ù‹ HITACHI 717 Ù˘ Boeringer Mannheim. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ TC Î·È ÙˆÓ TG ÁÈÓfiÙ·Ó Ì ÂÓ˙˘ÌÈ΋ ¯ÚˆÌ·ÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô Î·È Ù˘ HDL-C Ì ¿ÌÂÛË Ì¤ÙÚËÛË Ì ÔÏ˘ÌÂÚ‹. H LDL-C ÚÔÛ‰ÈÔÚÈ˙fiÙ·Ó ¤ÌÌÂÛ·, ‚¿ÛÂÈ ÙÔ˘ Ù‡Ô˘ ÙÔ˘ Freidewald LDL-C = TC-(HDLC+TG/5). ∆o ÂÚÁ·ÛÙ‹ÚÈÔ ¤¯ÂÈ ÙfiÛÔ ÂÛˆÙÂÚÈÎfi (local, boeringer) fiÛÔ Î·È Â͈ÙÂÚÈÎfi ¤ÏÂÁ¯Ô ÔÈfiÙËÙ·˜, Ì ÚÔÙ˘ÔÔ›ËÛË Ù˘ Murex, ÙÔ˘ International EOAS Ù˘ WHO Î·È ÙÔ˘ ∂™∂∞¶ (∂ıÓÈÎfi ™‡ÛÙËÌ· ∂͈ÙÂÚÈ΋˜ ∞ÍÈÔÏfiÁËÛ˘ ¶ÔÈfiÙËÙ·˜ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙËÓ ÎÏÈÓÈ΋ ¯ËÌ›· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ∂˘·ÁÁÂÏÈÛÌfi˜, ∞ı‹Ó·). ‰) ŒÏÂÁ¯Ô Ù˘ ·ıÏËÙÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ Ì ٤ÛÛÂÚȘ ·Û΋ÛÂȘ ÙÔ˘ Euro fit test: i) ‰ÔÎÈÌ·Û›· ‰›ψÛ˘ ·fi ‰ڷ›· ı¤ÛË, ii) ·Ó·‰ÈÏÒÛÂȘ ·fi ‡ÙÈ· ηٿÎÏÈÛË (ÎÔÈÏÈ·ÎÔ›), iii) ¿ÏÌ· ÂȘ Ì‹ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ· (∞ªÃº) Î·È iv) ‰ÔÎÈÌ·Û›· ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ (¶∆∞) ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ. ∆Ô ¶∆∞ ıˆÚÂ›Ù·È Î·Ïfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ¤ÌÌÂÛË ·ÍÈÔÏfiÁËÛË Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ (27). ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ÔÌ¿‰Â˜ ÙˆÓ 5 ·ÙfiÌˆÓ Î·È ÎÏ‹ıËÎ·Ó Ó· ‰È·Ó‡ÛÔ˘Ó Ì›· ·fiÛÙ·ÛË 20 ̤ÙÚˆÓ ÌÂ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓË Ù·¯‡ÙËÙ·, ‚¿ÛÂÈ ÂÓfi˜ ˯ËÙÈÎÔ‡ ÌËӇ̷ÙÔ˜ Ô˘ ‹Ù·Ó ÚÔÙ˘ÔÔÈË̤ÓÔ Û „ËÊÈ·Îfi ‰›ÛÎÔ Ô˘ ·Ó¤ÊÂÚÂ Î·È ÙÔ ÛÙ¿‰ÈÔ Ô˘ ¤Êı·Û ÙÔ ·È‰›. ∆· ·È‰È¿ ηٷٿ¯ÙËÎ·Ó Û Îϛ̷η, ÙËÓ ÔÔ›· ÂÙÔ›Ì·Û·Ó Û ∂ÏÏËÓfiÔ˘Ï· ÔÈ °ÂˆÚÁÈ¿‰Ë˜ Î·È ∫ÏÂÈÛÔ‡Ú·˜, ÙÔ 1990 (27). ∆· ·ÔÙÂϤÛÌ·Ù· ‰fiıËÎ·Ó ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Û ÚÔÛˆÈÎfi Ê¿ÎÂÏÔ, ÛÙÔ Ï·›ÛÈÔ ÂÓËÌÂÚˆÙÈ΋˜ ‰È¿ÏÂ͢ ÛÙÔ Û¯ÔÏÂ›Ô ÙˆÓ ·È‰ÈÒÓ. ™ÙË ‰È¿ÏÂÍË ÂÂÍËÁ‹ıËÎ·Ó Ù· ÛÙÔȯ›· Î·È ··ÓÙ‹ıËÎ·Ó Û¯ÂÙÈΤ˜ ÂÚˆÙ‹ÛÂȘ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ Ì˯·ÓÔÁÚ¿ÊËÛË ÙˆÓ ÛÙÔȯ›ˆÓ ¤ÁÈÓ ÛÙÔ ÚfiÁÚ·ÌÌ· Epi Info 6 (CDC, USA, WHO) Î·È Ù· ÛÙÔȯ›· ÌÂٷʤÚıËηÓ

ÁÈ· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÛÙ· ÚÔÁÚ¿ÌÌ·Ù· EXCEL Î·È SPSS. ŒÁÈÓ ·Ó¿Ï˘ÛË Î·Ù¿ Mann-Whitney ÁÈ· Ó· ˘ÔÏÔÁÈÛÙ› Ë ÙÈÌ‹ p. ∆È̤˜ p<0,05 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔ˘˜ ¶›Ó·Î˜ 1 Î·È 2 ηٷÁÚ¿ÊÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ. ∏ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ - Î·È ÛÙÔ˘˜ ‰‡Ô ÂϤÁ¯Ô˘˜ Ô˘ ¤ÁÈÓ·Ó - ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋, ÙfiÛÔ ÛÙÔ˘˜ Ô‰ËÏ¿Ù˜ fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∫·Ù¿ ÙÔÓ ‰Â‡ÙÂÚÔ ¤ÏÂÁ¯Ô, Ô ¢ª™ ‰ÂÓ ‰È¤ÊÂÚ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ·. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ë ÂÚÈʤÚÂÈ· ̤Û˘ (W) ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙÔ˘˜ Ô‰ËÏ¿Ù˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ¯ˆÚ›˜ fï˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿. ∏ Â›‰Ú·ÛË Ù˘ ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ ÛÙËÓ ·ıÏËÙÈ΋ ηٿÛÙ·ÛË ÙˆÓ ·È‰ÈÒÓ Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 3 Î·È 4. ∂›Ó·È ÂÌÊ·Ó‹ Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ¿ıÏËÛ˘ ÛÙÔ˘˜ Ô‰ËÏ¿Ù˜, ·ÊÔ‡ Ë ·fi‰ÔÛË ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜ Û fiϘ ۯ‰fiÓ ÙȘ ·Û΋ÛÂȘ ‹Ù·Ó ηχÙÂÚË, Ì ÙË ÛËÌ·ÓÙÈÎfiÙÂÚË ¿ÛÎËÛË - ÙÔ ¶∆∞ - Ó· ÏËÛÈ¿˙ÂÈ Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË (0,08 ÛÙ· ·ÁfiÚÈ· Î·È 0,042 ÛÙ· ÎÔÚ›ÙÛÈ·). O ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ-Ô‰ËÏ·ÙÒÓ ‹Ù·Ó Û¯ÂÙÈο ÌÈÎÚfi˜. ∆· ·ÁfiÚÈ· Ô‰ËÏ¿Ù˜ ›¯·Ó ηχÙÂÚ˜ ÂȉfiÛÂȘ ÛÙËÓ Â˘Ï˘ÁÈÛ›· Î·È ÙÔ˘˜ ÎÔÈÏÈ·ÎÔ‡˜ (‰ÈÏÒÛÂȘ ·fi ‡ÙÈ· ηٿÎÏÈÛË) Û ۇÁÎÚÈÛË Ì ٷ Û˘ÓÔÌ‹ÏÈο ÙÔ˘˜ ·ÁfiÚÈ·. ∞ÎfiÌË, ÛÙËÓ ›‰È· ¿ÛÎËÛË (‰ÈÏÒÛÂȘ ·fi ‡ÙÈ· ηٿÎÏÈÛË), Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ηχÙÂÚ· Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·, ›Ù ·˘Ù¿ ¤Î·Ó·Ó Ô‰ËÏ·Û›· ›Ù fi¯È.

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈο ÛÙÔȯ›· ÙˆÓ ÎÔÚÈÙÛÈÒÓ

∏ÏÈΛ· µ¿ÚÔ˜ ⁄„Ô˜ ¢ª™ ¶ÂÚÈʤÚÂÈ· ̤Û˘ ¢¶∆

n

¶Ô‰ËÏ¿Ù˜ ª∆

™∞

n

OÌ¿‰· ÂϤÁ¯Ô˘ ª∆

™∞

14 14 14 14 13 13

12,01 51,92 154,52 21,58 66,77 16,85

0,928 9,59 7,82 2,069 2,069 3,52

63 63 63 63 63 63

11,79 47,19 148,88* 21,06 70,20 16,04

0,344 11,90 8,44 4,07 4,07 5,46

* ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,027

¶›Ó·Î·˜ 2. ™ˆÌ·ÙÔÌÂÙÚÈο ÛÙÔȯ›· ÙˆÓ ·ÁÔÚÈÒÓ. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û η̛· ·Ú¿ÌÂÙÚÔ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ

∏ÏÈΛ· µ¿ÚÔ˜ ⁄„Ô˜ ¢ª™ ¶ÂÚÈʤÚÂÈ· ̤Û˘ ¢¶∆

270

n

¶Ô‰ËÏ¿Ù˜ ª∆

™∞

n

OÌ¿‰· ÂϤÁ¯Ô˘ ª∆

™∞

25 25 25 25 24 25

11,39 44,28 147,75 20,07 68,27 15,84

1,13 11,56 8,66 3,82 9,49 5,31

73 72 72 72 71 72

11,66 44,47 147,33 20,31 71,65 14,59

0,46 11,23 7,08 4,12 11,27 4,84

July August 04

07-10-04

13:52

™ÂÏ›‰·271

¶·È‰È·ÙÚÈ΋ 2004;67:268-273

Paediatriki 2004;67:268-273

¶›Ó·Î·˜ 3. ∞ÔÙÂϤÛÌ·Ù· ·ıÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙ· ÎÔÚ›ÙÛÈ·

∂˘Ï˘ÁÈÛ›· ∞ªÃº ∫ÔÈÏÈ·ÎÔ› ¶∆∞

n

¶Ô‰ËÏ¿Ù˜ ª∆

™∞

n

OÌ¿‰· ÂϤÁ¯Ô˘ ª∆

™∞

8 8 8 8

21 144,12 20,50 4,68

7,34 13,15 3,46 1,83

63 63 61 62

16 136,39 18,96 3,42*

7,11 25,5 3,86 1,59

* ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,042

¶›Ó·Î·˜ 4. ∞ÔÙÂϤÛÌ·Ù· ·ıÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙ· ·ÁfiÚÈ·

∂˘Ï˘ÁÈÛ›· ∞ªÃº ∫ÔÈÏÈ·ÎÔ› ¶∆∞

n

¶Ô‰ËÏ¿Ù˜ ª∆

™∞

n

OÌ¿‰· ÂϤÁ¯Ô˘ ª∆

™∞

14 16 16 16

20,78 157,62 17,25 5,78

7,20 20,05 4,58 2,12

73 72 72 72

11,72* 149,58 21,50* 4,83**

6,80 20,19 4,14 1,81

* ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p<0,001 ** ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,08

™ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔ ·›Ì·, ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜, ÔÈ Ôԛ˜ Ê·›ÓÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 5 Î·È 6. ™ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô, ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó Ô˘ÛÈ·ÛÙÈΤ˜ ‰È·ÊÔÚ¤˜. øÛÙfiÛÔ, ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ Û 15 Ì‹Ó˜ ÂÚ›Ô˘, Ë TC Î·È LDL-C ÙˆÓ Ô‰ËÏ·ÙÒÓ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙ· ·ÁfiÚÈ·. ∏ ·ÈÌÔÛÊ·ÈÚ›ÓË ·›Ì·ÙÔ˜ Î·È Ë ÁÏ˘Îfi˙Ë ÓËÛÙ›·˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Î·È ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (26). ™˘˙‹ÙËÛË OÈ Â˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ ÛÙÔ˘˜ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ ‹Ù·Ó Ê·ÓÂÚ¤˜ ÛÙ· ·È‰È¿ Ô˘ ·ıÏÔ‡ÓÙ·Ó Ù·ÎÙÈο. ∆· ·ÁfiÚÈ· Ô˘ ·ıÏÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο ›¯·Ó ηχÙÂÚÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï ·fi ÙÔ˘˜ ÌË ·ıÏÔ‡ÌÂÓÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ ÙÔ˘˜. ∂›¯·Ó ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ TC Î·È LDL-C Î·È ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ HDL-C Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· Ô˘ ‰ÂÓ Á˘ÌÓ¿˙ÔÓÙ·Ó. ∞ÎfiÌË, ›¯·Ó Â·Ú΋ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË. ∂Âȉ‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ô‰ËÏ·ÙÒÓ ‰ÂÓ ‹Ù·Ó ÌÂÁ¿ÏÔ˜, Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÎÔÚÈÙÛÈÒÓ ‰ÂÓ ‰Â›¯ÓÔ˘Ó ÙfiÛÔ ÂÌÊ·Ó›˜ ‰È·ÊÔÚ¤˜ fiÛÔ ÛÙ· ·ÁfiÚÈ·.

OÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÛÙÔ ¶∆∞, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ·, Ê·ÓÂÚÒÓÔ˘Ó ÙËÓ Î·Ï‡ÙÂÚË Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ ÙˆÓ Ô‰ËÏ·ÙÒÓ Û ۯ¤ÛË Ì ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘˜ (22).

OÈ Î·Ï‡ÙÂÚ˜ ÂȉfiÛÂȘ ÛÙËÓ Â˘Ï˘ÁÈÛ›· Î·È ÛÙȘ ·Ó·‰ÈÏÒÛÂȘ ·fi ‡ÙÈ· ηٿÎÏÈÛË ÛÙ· ·ÁfiÚÈ· Ê·-

ÓÂÚÒÓÔ˘Ó Î·Ï‡ÙÂÚË ÛˆÌ·ÙÈ΋ ‰È¿Ï·ÛË ÛÙ· ·È‰È¿ Ô˘ ·ıÏÔ‡ÓÙ·È Ì ·ÂÚfi‚È· ¿ÛÎËÛË.

OÈ ÏÈÔÚˆÙ½Ó˜ Î·È È‰È·›ÙÂÚ· Ë TC Î·È Ë LDLC ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Û ÈÔ ¯·ÌËÏ¿ Â›‰· ÛÙÔ˘˜ Ô‰ËÏ¿Ù˜ (·ÁfiÚÈ·). ∞˘Ùfi ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙËÓ ÚfiÏË„Ë Ù˘ ·ıËڈ̿وÛ˘. ∞ÊÔ‡ ¤¯ÂÈ ·Ô‰Âȯı› Ë ‡·ÚÍË ·ıËڈ̷ÙÈÎÒÓ ÈÓȉ›ˆÓ ·fi ÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ·, Ë ÚfiÏË„Ë ı· Ú¤ÂÈ Ó· ÍÂÎÈÓ‹ÛÂÈ ·fi Ù· ·È‰È¿ ÁÈ· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· (21-26). ∂ÏÏÈ‹˜ ¿ıÏËÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫‡ÚÔ˘ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi, ·ÊÔ‡ - Û‡Ìʈӷ Ì ·ÔÙÂϤÛÌ·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ - ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ¤¯ÂÈ ¯·ÌËÏ‹ ¤ˆ˜ Ôχ ¯·ÌËÏ‹ ·fi‰ÔÛË ÛÙÔ ¶∆∞ (24,26). ªfiÓÔ ÙÔ 20% ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ Ôχ ηϤ˜ ‹ ¿ÚÈÛÙ˜ ÂȉfiÛÂȘ ÛÙÔ ¶∆∞, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 30% η٤¯ÂÈ Ì¤ÙÚȘ ı¤ÛÂȘ (24). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ÈÛ¯‡Ô˘Ó Î·È ÁÈ· ÙȘ ·ÛÙÈΤ˜ Î·È ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ∫‡ÚÔ˘, Ì ÌfiÓË ‰È·ÊÔÚ¿ ÙË ÌÈÎÚ‹ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È‰ÈÒÓ Ì Ôχ ηϋ ·fi‰ÔÛË (25%) ÌfiÓÔ ÛÙ· ·ÁfiÚÈ· ÙˆÓ ·ÁÚÔÙÈÎÒÓ ‰ÈÓÒÓ ÂÚÈÔ¯ÒÓ (24). ¶·ÚfiÌÔÈ· ηٿÛÙ·ÛË ·Ú·ÙËÚÂ›Ù·È ÛÙ· Á˘ÌÓ¿ÛÈ· Î·È Ù· χÎÂÈ·, Ì ÌÈÎÚ‹ ‚ÂÏÙ›ˆÛË ÛÙ· ·ÁfiÚÈ· ÛÙË ‰ÔÎÈÌ·Û›· ÙÔ˘ ¶∆∞ Î·È ÛÙÔ ¿ÏÌ· ÂȘ Ì‹ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ· (23,24). ∏ ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ô˘ ·ÛÎÔ‡ÓÙ·È Ù· ·È‰È¿, ÙfiÛÔ ÛÙÔ Û¯ÔÏÂ›Ô fiÛÔ Î·È ÛÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ ÙÔ˘˜, ı· Ú¤ÂÈ Ó· ·˘ÍËı›. ∏ ¿ÛÎËÛË ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ ı· Ú¤ÂÈ Ó· Â·ÓÂÍÂÙ·ÛÙ› Î·È Ó· ÙÂı› Û ÈÔ ÛˆÛÙ¤˜ ‚¿ÛÂȘ.

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Paediatriki 2004;67:268-273

¶›Ó·Î·˜ 5. ∞ÔÙÂϤÛÌ·Ù· ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ Î·È ‚ÈÔ¯ËÌÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙ· ÎÔÚ›ÙÛÈ·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û η̛· ·Ú¿ÌÂÙÚÔ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ

TC HDL-C LDL-C TG LDL/HDL GLUCOSE HGB

n

¶Ô‰ËÏ¿Ù˜ ª∆

™∞

n

OÌ¿‰· ÂϤÁ¯Ô˘ ª∆

™∞

14 14 14 14 14 14 14

169,78 59,57 96,35 69,28 1,69 81,57 13,00

16,91 11,54 16,14 16,14 0,51 10,45 0,70

63 63 63 63 63 63 63

164,31 55,53 90,57 99,66 1,70 85,07 12,56

31,20 12,59 26,00 103,49 0,58 8,50 1,03

¶›Ó·Î·˜ 6. ∞ÔÙÂϤÛÌ·Ù· ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ Î·È ‚ÈÔ¯ËÌÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙ· ·ÁfiÚÈ·

TC HDL-C LDL-C TG LDL/HDL GLUCOSE HGB

n

¶Ô‰ËÏ¿Ù˜ ª∆

™∞

n

OÌ¿‰· ÂϤÁ¯Ô˘ ª∆

™∞

25 25 25 25 25 25 25

158,16 64,64 79,36 71,00 1,41 83,20 12,52

20,68 19,80 17,70 43,90 0,45 5,82 1,02

72 72 72 72 72 72 72

169,93* 60,68 97,50** 72,00 1,66 83,73 12,59

25,16 11,02 21,49 86,05 0,47 6,43 0,96

* ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,042 ** ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p<0,001

∏ Û˘Û¯¤ÙÈÛË Ù˘ ¤ÓÙ·Û˘, Ù˘ ‰È¿ÚÎÂÈ·˜ Î·È ÙÔ˘ ›‰Ô˘˜ Ù˘ ¿ÛÎËÛ˘ Ì ٷ ¢ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù· Ô˘ ¤¯ÂÈ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˘ Î·È ·ÍÈÔÏfiÁËÛ˘. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ٷ ˘Ô˘ÚÁ›· ÀÁ›·˜ Î·È ¶·È‰Â›·˜-¶ÔÏÈÙÈÛÌÔ‡ ÁÈ· ÙË Û˘ÓÂÚÁ·Û›· Ì ÙÔ ÚfiÁÚ·ÌÌ¿ Ì·˜, ηıÒ˜ Î·È ÙË ‰È‡ı˘ÓÛË Î·È ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ÃËÌ›Ԣ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ. ∂›Û˘, ¢¯·ÚÈÛÙԇ̠ÙÔÓ ∫O∞ ηÈ, ȉȷ›ÙÂÚ·, ÙËÓ ∞η‰ËÌ›· Î·È ÙÔ˘˜ ÚÔÔÓËÙ¤˜ Ô‰ËÏ·Û›·˜ Î. ∞ÓÙÚ¤· ∫ˆÓÛÙ·ÓÙ›ÓÔ˘, Î. ™ˆÙ‹ÚË ª·‡ÚÔ Î·È Î. ¢ËÌ‹ÙÚË ∫·‰‹ ÁÈ· ÙËÓ ÂÓÂÚÁfi Û˘ÌÌÂÙÔ¯‹ Î·È ‚Ô‹ıÂÈ¿ ÙÔ˘˜ ÛÙËÓ ÂÎÙ¤ÏÂÛË Ù˘ ¤Ú¢ӷ˜, ηıÒ˜ Î·È ÙÔ˘˜ ÁÔÓ›˜ Î·È Ù· ·È‰È¿ Ô˘ Ì·˜ ÂÌÈÛÙ‡ÙËÎ·Ó Î·È Û˘ÌÌÂÙ›¯·Ó Û ·˘Ù‹ ÙË ÌÂϤÙË.

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2. Manios Y, Kafatos A, Mamalakis G. Physical activity of 6 year old children: validation of two proxy reports. Pediatr Exerc Sci 1998;10:176-188.

3. American Academy of Pediatrics. Committee on Nutrition.

Cholesterol in childhood. Pediatrics 1998;101:141-147.

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5. ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›Ù˘ ª, ∫ˆÓÛÙ·ÓÙ›ÓÔ˘ ∂, ÷Ù˙ËȈ¿ÓÓÔ˘ ª, °È·ÓÎÔ˘Ï‹ ∞. ŒÏÂÁ¯Ô˜ ÂÈ¤‰Ô˘ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·¯˘Û·ÚΛ·˜ Û 1132 ·È‰È¿ Ù˘ ™Ù’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜. ¶·È‰È·ÙÚÈ΋ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ 1998;10:238-244.

6. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›Ù˘ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚·, ™, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 2001;64:595-603.

7. Maffeis C, Talamini G, Tato L. Influence of diet, physical activity and parents’ obesity on children's adiposity: a fouryear longitudinal study. Int J Obes Relat Metab Disord 1998;22:758-764.

8. ∫·‚·˙·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.

9. ∫·Ê¿ÙÔ˜ ∞, Christakis G, Hsia SL, Cassady J, ¶·Ó·ÁȈٷÎfiÔ˘ÏÔ˜ °. §È›‰È· ÔÚÔ‡ Û 1010 ·È‰È¿ Ù˘ ∞ı‹Ó·˜ 1014 ¯ÚÔÓÒÓ. π·ÙÚÈ΋ 1980;38:283-290.

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Cholesterol in childhood. Pediatrics 1998;101:141-147.

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13. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›Ù˘ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∏ ·¯˘Û·ÚΛ· Û ·È‰È¿

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ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ·. ¶·È‰È·ÙÚÈ΋ 2000;63:137-144.

14. Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Tafouna P, Kafatos A. Reference growth curves for Cypriot children 6 to 17 years of age. Obes Res 2001;9:754-762.

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23. ™¿‚‚· ™, ∆ÔÚÓ·Ú›Ù˘ ª, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ∫Ô˘Ú›‰Ë˜ °, ™È·ÌÔ‡ÓÎË ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚· ª. ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÔÏÏ·ÏÒÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ¶·È‰È·ÙÚÈ΋ 1999;62:468-473.

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26. ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›Ù˘ ª, ∫ˆÓÛÙ·ÓÙ›ÓÔ˘ ∂. ∫·Ù¿ÛÙ·ÛË ‰È·ÙÚÔÊ‹˜ Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË ·›Ì·ÙÔ˜ Û 1130 ·È‰È¿ ™Ù’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜. ¶·È‰ ∂ÓË̤ڈÛË ∫‡ÚÔ˜ 1999;3:6-21.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-09-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 16-07-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÷ڿϷÌÔ˜ ÷Ù˙ËÁˆÚÁ›Ô˘ ™Ù·˘ÚÔ‡ 56, ™ÙÚfi‚ÔÏÔ˜ 2035 §Â˘ÎˆÛ›·, ∫‡ÚÔ˜ E-mail: c.chadjigeorgiou@cytanet.com.cy

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ORIGINAL ARTICLE

∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û ¶·È‰È·ÙÚÈ΋ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ º. ¡ÈÎÔÏ¿Ô˘, º. ∫·Î·‚¿, ∫. ¶·¿˙ÔÁÏÔ˘, π. ¶··‰¿ÙÔ˜

Epidemiologic aspects of childhood injuries in a Paediatric Intensive Care Unit F. Nikolaou, F. Kakava, K. Papazoglou, J. Papadatos

¶ÂÚ›ÏË„Ë: ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙË ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ ÙˆÓ ·È‰ÈÒÓ ÛÙ· ÙÌ‹Ì·Ù· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·È ÙËÓ ÚÒÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂÙ¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û ·È‰È¿ ËÏÈΛ·˜ 0-14 ÂÙÒÓ Ô˘ ÓÔÛËχıËÎ·Ó Û ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ (ª∂£). ¶ÚfiÎÂÈÙ·È ÁÈ· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ 394 ·È‰È¿, Ù· ÔÔ›· ÓÔÛËχÙËÎ·Ó ÛÙË ª∂£ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰ÂηÂÙ›·˜ 1991-2000. ∆Ô ·Ù‡¯ËÌ· ˆ˜ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ‰ÈÂÚ¢ӋıËΠ۠ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ, ÙËÓ ËÏÈΛ·, ÙËÓ ÂÙ‹ÛÈ· Î·È ÙËÓ Âԯȷ΋ ηٷÓÔÌ‹, ÙËÓ ·ÈÙÈÔÏÔÁ›· Î·È ÙËÓ ÚÔηÏÔ‡ÌÂÓË Î¿ÎˆÛË, ÙË ıÓËÙfiÙËÙ· Î·È ÙË ÓÔÛËÚfiÙËÙ·. ∆· ·Ù˘¯‹Ì·Ù· Î¿Ï˘Ù·Ó ÙÔ 19,4% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙË ª∂£ ÌÂ Û˘¯ÓfiÙËÙ· ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÙÔ Î·ÏÔη›ÚÈ. ∏ ·Ó·ÏÔÁ›· ·ÁÔÚÈÒÓ/ÎÔÚÈÙÛÈÒÓ ‹Ù·Ó 1,75:1. ™˘¯ÓfiÙÂÚ· ‹Ù·Ó Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· (46,2%), Ô˘ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ Û˘Ó¤‚ËÛ·Ó Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ·, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÙÒÛÂȘ (32,2%), ÔÈ ‰ËÏËÙËÚÈ¿ÛÂȘ (5,8%), Ù· ÂÁη‡Ì·Ù· (5,8%), Ë ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ (2,6%) Î·È Ô ÓÈÁÌfi˜ (1,7%). ∫¿ÎˆÛË ÂÓfi˜ ·Ó·ÙÔÌÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËΠ۠264 ·È‰È¿, ‰‡Ô ·Ó·ÙÔÌÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Û 99 Î·È ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Û 31 ·È‰È¿. ∏ ÚˆÙÔÁÂÓ‹˜ οΈÛË ·ÊÔÚÔ‡Û Û ÔÛÔÛÙfi 69,8% ÙÔ ∫¡™ Î·È ·ԉ›¯ıËÎÂ Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ¤Î‚·ÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô, Ï‹Ú˘ ›·ÛË ·Ú·ÙËÚ‹ıËΠÛÙÔ 60,7% Î·È ˘ÔÏÂÈÌÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹, Ô˘ ÂÎÙÈÌ‹ıËΠ̠ÙËÓ ∫ϛ̷η ¶ÚfiÁÓˆÛ˘ Ù˘ °Ï·ÛÎ҂˘, ÛÙÔ 26,1% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ıÓËÙfiÙËÙ· ·Ó‹Ïı Û 13,2% Î·È ·ÊÔÚÔ‡Û ΢ڛˆ˜ Û ·È‰È¿ Ô˘ ‰È·ÎÔÌ›ÛÙËÎ·Ó ·fi

Abstract: Accident related injuries are the second leading cause of emergency room visits and the leading cause of child death beyond the newborn period. The aim of this retrospective study was to investigate the epidemiology of the injured paediatric population aged 0-14 years treated in the Paediatric Intensive Care Unit (PICU). During the period 19912000, out of a total of 2027 admissions to the PICU at the “P. & A. Kyriakou” Children’s Hospital, 394 admissions (251 boys, 143 girls) were due to injury.

The gender, age, annual and seasonal distribution, the cause of accident, the resulting injury, the morbidity and the mortality were studied. The percentage of admissions to PICU as a result of injury was 19.4%. The highest frequency was observed in summer. There was a prevalence of males in a ratio of 1.75:1. Traffic accidents were the most frequent cause of injury (46.2%) mainly for preschool and school age children, followed by falls (32.2%), poisonings (5.8%), burns (5.8%), foreign body ingestion (2.5%) and drowning (1.7%). One anatomic system was injured in 264 children, two anatomic systems in 99 and three or more in 31 children. The central nervous system (CNS) was most commonly the primary injured system (69.8%) and CNS injuries were the principal determinant of outcome. On discharge, 60.7% of the children were cured and 26.1% had neurological disabilities that were assessed according to the Glasgow Outcome Scale. The mortality rate was 13.2%. The highest mortality rate was related to children who were transferred from district hospitals. In conclusion, the increasing frequency of childhood injuries and the number of deaths and neurological disabilities demonstrate that the acute care of injured children begins before the time of injury, with prevention, is

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Intensive Care Unit, “P. & A. Kyriakou” Children’s Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2004;67:274-280

Paediatriki 2004;67:274-280

Â·Ú¯È·Î¿ ÓÔÛÔÎÔÌ›·. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ú·ÙËÚÔ‡ÌÂÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ Î·È ˘ÔÏÂÈÌÌ·ÙÈ΋˜ Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó fiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ ·Ú¯›˙ÂÈ Ì ÙËÓ ÚfiÏË„Ë, Û˘Ó¯›˙ÂÙ·È Ì ÙËÓ ·ÚÔ¯‹ ÊÚÔÓÙ›‰·˜ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Û ÓÔÛÔÎÔÌÂ›Ô Î·È ÔÏÔÎÏËÚÒÓÂÙ·È Û ΤÓÙÚÔ ·ÔηٿÛÙ·Û˘.

continued during the prehospital and hospital care and is completed by the discharge from hospital to home or to a rehabilitation centre.

§¤ÍÂȘ ÎÏÂȉȿ: ·Ù˘¯‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ·È‰ÈÎfi ÙÚ·‡Ì·, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ, Û˘ÛÙ‹Ì·Ù· ÌÂÙ·ÊÔÚ¿˜.

Key words: childhood injuries, paediatric multiple trauma, head injury, paediatric transfer.

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276

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70 Ë Û¯ÂÙÈ΋ Ì ·˘Ù‹ ÚÔηÏÔ‡ÌÂÓË Î¿ÎˆÛË, Ù· ÎÏÈÓÈο ‰Â‰Ô̤ӷ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Î·È ÓÔÛËÏ›· ÙˆÓ ·È‰ÈÒÓ ÛÙË ª∂£, Ë ÓÔÛËÚfiÙËÙ· Î·È Ë ıÓËÙfiÙËÙ·. ∏ ÓÔÛËÚfiÙËÙ· ÂÎÙÈÌ‹ıËΠ۠ۯ¤ÛË Ì ÙËÓ ‡·ÚÍË ˘ÔÏÂÈÌÌ·ÙÈ΋˜ Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË ª∂£. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ٤ÛÛÂÚȘ ‚·ÛÈΤ˜ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ: ‚ÚÂÊÈ΋ ËÏÈΛ· (0-1 ¤ÙÔ˘˜), ÓËȷ΋ ËÏÈΛ· (1-4 ÂÙÒÓ), ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (4-6 ÂÙÒÓ) Î·È Û¯ÔÏÈ΋ ËÏÈΛ· (6-14 ÂÙÒÓ). ∏ ηٷÓÔÌ‹ ¤ÁÈÓ ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ ÁÈ· οı ÔÌ¿‰· ËÏÈÎÈÒÓ Í¯ˆÚÈÛÙ¿, ·ÏÏ¿ Î·È ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ. ∆· ·Ù˘¯‹Ì·Ù·, ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘˜, Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ÙÒÛÂȘ, ÂÁη‡Ì·Ù·, ‰ËÏËÙËÚÈ¿ÛÂȘ, ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜, ÓÈÁÌfi Î·È ‰È¿ÊÔÚ· ¿ÏÏ· ·Ù˘¯‹Ì·Ù·. ∫·Ù·ÁÚ¿ÊËÎ·Ó ÁÈ· οı ·È‰› ͯˆÚÈÛÙ¿ Ë ·ÈÙ›· ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ Î·È Ë Î¿ÎˆÛË Ô˘ ÚÔÎÏ‹ıËΠ·fi ·˘Ùfi, ηıÒ˜ Î·È ÛÙÔȯ›· ·fi ÙËÓ ÚÒÙË ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ª∂£, fiˆ˜ Ë ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·ÓÔ‹˜, Ë ÚÔËÁËı›۷ Â›ÁÔ˘Û· ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·Ú¯È΋˜ ·ÓÙÈÌÂÙÒÈÛ˘, Ë ‡·ÚÍË ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ηٷÏËÍ›·˜, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂÈ¤‰Ô˘ Ù˘ Û˘Ó›‰ËÛ˘ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ó·ÙÔÌÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Ô˘ ¤·Û¯·Ó. ∫·Ù·ÁÚ¿ÊËηÓ, Â›Û˘, Ù· ˘ÔÛÙËÚÈÎÙÈο ̤ÙÚ· Ô˘ ··ÈÙ‹ıËηÓ, ‰ËÏ·‰‹ Ô Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, Ë Â›ÁÔ˘Û· ÌÂÙ¿ÁÁÈÛË ‹ Ë ¯ÔÚ‹ÁËÛË ÈÓÔÙÚfiˆÓ Ê·Ú̿ΈÓ, ηıÒ˜ Î·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, fiÔ˘ ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ ̤ۈ ˘ÔÏÔÁÈÛÙ‹, Ì ÙÔ Û‡ÛÙËÌ· Microsoft Excel.

∫ÔÚ›ÙÛÈ·

72

60 50 40

39

30

31 25

20 15

10 0

7 7 0-1

12

1-4 4-6 ∏ÏÈΛ· (¤ÙË)

6-14

∂ÈÎfiÓ· 5. ∫·Ù·ÓÔÌ‹ ηٿ ʇÏÔ Î·È ËÏÈΛ·.

ÛfiÙÂÚÔ ÂÈÚÚÂ‹ ÛÙ· ·Ù˘¯‹Ì·Ù· Û ۯ¤ÛË Ì ٷ ÎÔÚ›ÙÛÈ·, ÌÂÙ¿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ∏ ÂÙ‹ÛÈ· ηٷÓÔÌ‹ ¤‰ÂÈÍ ̛· Û¯ÂÙÈο ÛÙ·ıÂÚ‹ ÔÚ›·, ·ÓÙ›ıÂÙ· Ì ÙËÓ Âԯȷ΋, fiÔ˘ ÙÔ 1/3 ÂÚ›Ô˘ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÚÔÎÏ‹ıËΠÙÔ˘˜ ηÏÔηÈÚÈÓÔ‡˜ Ì‹Ó˜ (33,25%). ∞ÎÔÏÔ˘ıÔ‡Ó Ë ¿ÓÔÈÍË (23,85%) Î·È ÙÔ ÊıÈÓfiˆÚÔ (23,35%) ÛÙËÓ ›‰È· ÂÚ›Ô˘ ·Ó·ÏÔÁ›·. ∏ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ·Ù˘¯ËÌ¿ÙˆÓ ·Ú·ÙËÚ‹ıËΠηٿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜ (19,55%) (∂ÈÎfiÓ· 6). ™ÙËÓ ∂ÈÎfiÓ· 7 ·ÂÈÎÔÓ›˙ÂÙ·È Ë Î·Ù·ÓÔÌ‹ Û˘¯ÓÔÙ‹ÙˆÓ ÙˆÓ 394 ·Ù˘¯ËÌ¿ÙˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÈÙ›·. ¶·Ú·ÙËÚÂ›Ù·È fiÙÈ Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ηχÙÔ˘Ó ÙÔ 46,2% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ, ÔÈ ÙÒÛÂȘ ÙÔ 32,2%, ÔÈ ‰ËÏËÙËÚÈ¿ÛÂȘ ÙÔ 5,8%, Ù· ÂÁη‡Ì·Ù· ÙÔ 5,8%, Ë ÂÈÛÚfiÊËÛË Í¤ÓˆÓ ÛˆÌ¿ÙˆÓ ÙÔ 2,6% Î·È Ô ÓÈÁÌfi˜ ÙÔ 1,7%. ™ÙÔ 60,5% ÙˆÓ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ, Ù· ·È‰È¿ ‹Ù·Ó ÂÈ‚¿Ù˜ ·˘ÙÔÎÈÓ‹ÙÔ˘, ÛÙÔ 26,9% ‹Ù·Ó Â˙Ô› Ô˘ ·Ú·Û‡ÚıËÎ·Ó ·fi ‰ÈÂÚ¯fiÌÂÓÔ fi¯ËÌ· Î·È ÛÙÔ 12,6% Ô‰ËÁÔ‡Û·Ó Ô‰‹Ï·ÙÔ Ô˘ ÂÎÙÚ¿ËÎ Ù˘ ÔÚ›·˜ ÙÔ˘. ∆· ÂÁη‡Ì·Ù· Î·È Ë Î·Ù¿ÔÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ‹Ù·Ó Ù· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ·Ù˘¯‹Ì·ÙÔ˜ ÛÙË ‚ÚÂÊÈ΋

July August 04

07-10-04

13:52

™ÂÏ›‰·277

¶·È‰È·ÙÚÈ΋ 2004;67:274-280

¶ÔÛÔÛÙfi ÂÈÛ·ÁˆÁÒÓ (%)

35

33,25

30 25 20 15

Paediatriki 2004;67:274-280

23,85

23,35

ÕÓÔÈÍË

∫·ÏÔη›ÚÈ ºıÈÓfiˆÚÔ

19,55

10 5 0 ÃÂÈÌÒÓ·˜

∂ÈÎfiÓ· 6. ∂ԯȷ΋ ηٷÓÔÌ‹ ·Ù˘¯ËÌ¿ÙˆÓ.

ÕÏÏ· ·›ÙÈ· 5,6% ¶ÓÈÁÌfi˜ 1,7% •¤ÓÔ ÛÒÌ· 2,6% ∂Áη‡Ì·Ù· 5,8% ¢ËÏËÙËÚÈ¿ÛÂȘ 5,8%

¶ÙÒÛÂȘ 32,2%

∂È‚¿Ù˜ 60,5% ∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù· 46,2%

¶Â˙Ô› 26,9%

Û‡ÛÙËÌ· ηٿ Êı›ÓÔ˘Û· ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜ ‹Ù·Ó ÙÔ Ì˘ÔÛÎÂÏÂÙÈÎfi, ÙÔ ÂÙÈÎfi, ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. ∫·Ù¿ ÙË ÓÔÛËÏ›· ÙÔ˘˜ ÛÙË ª∂£, 85 ·È‰È¿ ˘Ô‚Ï‹ıËÎ·Ó Û Â›ÁÔ˘Û· ‹ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, ÙÔ Â›‰Ô˜ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÔÔ›ˆÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ™Â ¤ÓÙ ÂÚÈÙÒÛÂȘ ··ÈÙ‹ıËΠ‚ÚÔÁ¯ÔÛÎfiËÛË ÁÈ· ÙËÓ ·Ê·›ÚÂÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ·fi ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜. ∂Ó‰ÔÓÔÛÔÎÔÌÂȷ΋ Ïԛ̈ÍË ÂΉËÏÒıËΠÛÙÔ 4,06% ÙˆÓ ·ÛıÂÓÒÓ Î·È ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ Û ÛÙÂϤ¯Ë ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘, „¢‰ÔÌÔÓ¿‰·˜ Î·È ÂÓÙÂÚÔ‚·ÎÙËÚȉ›Ô˘. ∫·Ù·ÁÚ¿ÊËηÓ, Â›Û˘, ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ Û˘ÌÊ˘ÙÈÎÔ‡ ÂÈÏÂÔ‡, ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋˜ ·ÁÎÚ·ٛÙȉ·˜, ‰È·‡ËÛ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ Î·È ‚·ÚÔÙÚ·‡Ì·ÙÔ˜. O ‰È¿ÌÂÛÔ˜ (median) ¯ÚfiÓÔ˜ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ÓÔÛËÏ›·˜ ÛÙË ª∂£ ·Ó‹Ïı Û 3 Î·È 5 Ë̤Ú˜, ·ÓÙ›ÛÙÔȯ·. ∏ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ·ÔÙ˘ÒÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 9. ¶Ï‹Ú˘ ›·ÛË ·Ú·ÙËÚ‹ıËΠÛÙÔ 60,7% Î·È ˘ÔÏÂÈÌÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ ÛÙÔ 26,1%. ∏ ‡·ÚÍË ˘ÔÏÂÈÌÌ·ÙÈ΋˜ Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ ÂÎÙÈÌ‹ıËΠηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∂£ Î·È Û‡Ìʈӷ Ì ÙËÓ ∫ϛ̷η ¶ÚfiÁÓˆÛ˘ Ù˘ °Ï·ÛÎ҂˘ (6). ∏ ıÓËÙfiÙËÙ· ·Ó‹Ïı ÛÙÔ 13,2%. ∏ ΢ڛ· ·ÈÙ›· ı·Ó¿ÙÔ˘

¶Ô‰ËÏ¿Ù˜ 12,6%

∂ÈÎfiÓ· 7. ∞Ù˘¯‹Ì·Ù· ηٿ ·ÈÙ›· Î·È Û˘¯ÓfiÙËÙ·.

ËÏÈΛ·. ™ÙË ÓËȷ΋ ËÏÈΛ·, ÙËÓ ÚÒÙË ı¤ÛË Î·Ù›¯·Ó ÔÈ Î·ÎÒÛÂȘ ÌÂÙ¿ ·fi ÙÒÛË. ∆· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ¢ı‡ÓÔÓÙ·Ó ÁÈ· ÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û ·È‰È¿ Ù˘ ÚÔÛ¯ÔÏÈ΋˜ Î·È Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÙÒÛÂȘ. ™Â 169 ·Ù˘¯‹Ì·Ù· (42,9%), Ë ÚÒÙË ÂÎÙ›ÌËÛË ¤ÁÈÓ Û ÓÔÛÔÎÔÌÂ›Ô ÂÓËϛΈÓ, ΢ڛˆ˜ Ù˘ Â·Ú¯›·˜. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, Ù· 253 (64,2%) ˘Ô‚Ï‹ıËÎ·Ó Û Â›ÁÔ˘Û· ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË Ô˘ ÂÎÙÂϤÛÙËΠÛÙÔ ÚÒÙÔ Î¤ÓÙÚÔ ˘Ô‰Ô¯‹˜. ∂‚‰ÔÌ‹ÓÙ· ‰‡Ô ·È‰È¿, ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙË ª∂£, ‚Ú›ÛÎÔÓÙ·Ó Û ηٿÛÙ·ÛË ÔÏÈÁ·ÈÌÈ΋˜ ηٷÏËÍ›·˜ Î·È ˘Ô‚Ï‹ıËÎ·Ó Û Â›ÁÔ˘Û· ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜. ™Â 53 ·fi ·˘Ù¿ ¯ÔÚËÁ‹ıËÎ·Ó ÂÈϤÔÓ Î·È ÈÓÔÙÚfi· Ê¿Ú̷η. ∏ Û˘¯ÓfiÙËÙ· ÚˆÙÔ·ıÔ‡˜ ÚÔÛ‚ÔÏ‹˜ ·Ó¿ ·Ó·ÙÔÌÈÎfi Û‡ÛÙËÌ· Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 8. ∆Ô ∫¡™ ηٷϷ̂¿ÓÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi (69,8%) Î·È ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ÌÔÓ‹Ú˘ οΈÛË ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛˆÓ. ¶ÚÔÛ‚ÔÏ‹ ÂÓfi˜ Û˘ÛÙ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËΠ۠264 ·ÛıÂÓ›˜, ‰‡Ô Û˘ÛÙËÌ¿ÙˆÓ Û 99 Î·È ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Û 31 ·ÛıÂÓ›˜. ™ÙÔ˘˜ 99 ·ÛıÂÓ›˜ Ô˘ Ë Î¿ÎˆÛË ·ÊÔÚÔ‡Û Û ‰‡Ô Û˘ÛÙ‹Ì·Ù·, ÙÔ ‰Â‡ÙÂÚÔ ·Ó·ÙÔÌÈÎfi

∫·Ú‰È·ÁÁÂÈ·Îfi ¶ÂÙÈÎfi 1,5% 4,5% ∂Áη‡Ì·Ù· 5,8% ª˘ÔÛÎÂÏÂÙÈÎfi 6,9%

O˘ÚÔÔÈËÙÈÎfi 1,2% K¿ÎˆÛË ÔÊı·ÏÌÒÓ 1,2%

AÓ·Ó¢ÛÙÈÎfi 9,4% K.N.™.

69,8% ∂ÈÎfiÓ· 8. ™˘¯ÓfiÙËÙ· ÚˆÙÔÁÂÓÔ‡˜ ÚÔÛ‚ÔÏ‹˜ ·Ó¿ Û‡ÛÙËÌ· (N=394). ¶›Ó·Î·˜ 1. ÃÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ∂¤Ì‚·ÛË ¶·ÚÔ¯¤Ù¢ÛË ÂÓ‰ÔÂÁÎÂÊ·ÏÈÎÔ‡ ·ÈÌ·ÙÒÌ·ÙÔ˜ ™˘ÚÚ·Ê‹ ÛÏËÓfi˜ ÛÏËÓÂÎÙÔÌ‹ ¡ÂÊÚÂÎÙÔÌ‹ ™˘ÚÚ·Ê‹ ڋ͢ ÂÓÙ¤ÚÔ˘ ™˘ÚÚ·Ê‹ ڋ͢ ‹·ÙÔ˜ ÃÂÈÚÔ˘ÚÁÈ΋ ·Ó¿Ù·ÍË Î·Ù·ÁÌ¿ÙˆÓ ÃÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ ÂÁη˘Ì¿ÙˆÓ

∂›ÁÔ˘Û·

¶ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË

39

11 4 3 5 15 8

277

July August 04

07-10-04

13:52

™ÂÏ›‰·278

¶·È‰È·ÙÚÈ΋ 2004;67:274-280

Paediatriki 2004;67:274-280

£¿Ó·ÙÔÈ 13,2%

ÀÔÏÂÈÌÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÓfiÛÔ˜ 26,1%

ÿ·ÛË 60,7%

∂ÈÎfiÓ· 9. ŒÎ‚·ÛË ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ.

‹Ù·Ó ÔÈ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ (∫∂∫). OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ (36/52) ÛËÌÂÈÒıËÎ·Ó Û ·È‰È¿ Ô˘ ‰È·ÎÔÌ›ÛÙËÎ·Ó ·fi ÙËÓ Â·Ú¯›·. ™˘˙‹ÙËÛË ∆· ·Ù˘¯‹Ì·Ù· ÛÙ· ·È‰È¿ Î·È È‰È·›ÙÂÚ· ÙÔ ÙÚ·‡Ì·, ·ÔÙÂÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ›Ûˆ˜ ÚfiÎÏËÛË ÁÈ· ÙȘ ª∂£. OÈ ÙÚ·˘Ì·ÙÈΤ˜ ηÎÒÛÂȘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÔ 50% ÙˆÓ ı·Ó¿ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 1-14 ÂÙÒÓ Î·È ·ÔÙÂÏÔ‡Ó, ÌÂÙ¿ ÙȘ ÏÔÈÌÒÍÂȘ, ÙË ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ ÛÙ· ∆Ì‹Ì·Ù· ∂ÂÈÁfiÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ (∆∂¶). ™ÙȘ ∏¶∞, ÔÈ ÌÂÙ·ÊÔÚ¤˜ ÛÙ· ∂͈ÙÂÚÈο π·ÙÚ›· (∂π) ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ, ·ÏÏ¿ Î·È ÛÙ· ȉȈÙÈο È·ÙÚ›·, ÌÂÙ¿ ·fi ·Ù‡¯ËÌ· ηٷϷ̂¿ÓÔ˘Ó ÙÔ 34,4% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÌÂÙ·ÊÔÚÒÓ (∆∂¶: 13,2%, ∂π: 2,6%, ȉȈÙÈο È·ÙÚ›·: 18,7%) (3). ™ÙËÓ ›‰È· ¯ÒÚ·, ·fi Ù· ÛÙÔȯ›· Ô˘ ηٷÁÚ¿ÊËÎ·Ó ÙÔ 2000 ÛÙÔ “Annual Summary of Vital Statistics”, Á›ÓÂÙ·È Ì›· ·Ó·‰ÚÔÌ‹ ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ∏¶∞ ηٿ ÙÔÓ ÂÚ·Ṳ̂ÓÔ ·ÈÒÓ· Î·È ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ıÓËÙfiÙËÙ· ·fi ÏÔÈÌÒÍÂȘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ÙÔ 1900 ‹Ù·Ó 61,6%, ÂÓÒ ÙÔ 1998 ÂÏ·ÙÙÒıËΠÛÙÔ 2%. ∆Ô 1900, Ë ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ı·Ó¿ÙˆÓ ·fi ·Ù˘¯‹Ì·Ù· ·ÓÂÚ¯fiÙ·Ó Û 6,3% ÙˆÓ ı·Ó¿ÙˆÓ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÂÓÒ ÙÔ 1998 ·˘Í‹ıËΠ۠43,9%, ÔÈ ÌÈÛÔ› ÂÎ ÙˆÓ ÔÔ›ˆÓ ·Ô‰fiıËÎ·Ó Û ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· (7). ∆· ÛÙÔȯ›· ·˘Ù¿ ·ÔÙ˘ÒÓÔ˘Ó ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ‰Â›¯ÓÔ˘Ó fiÙÈ, ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ÙÔ ÙÚ·‡Ì· Ù›ÓÂÈ Ó· Ï¿‚ÂÈ ÙË ÌÔÚÊ‹ ÂȉËÌÈ΋˜ ÓfiÛÔ˘, Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÔ›·˜ ··ÈÙ› ÙË Ï‹„Ë ¿ÌÂÛˆÓ Ì¤ÙÚˆÓ. ∆· ̤ÙÚ· ·˘Ù¿ ÎÈÓÔ‡ÓÙ·È Û ÙÚÂȘ ¿ÍÔÓ˜: ÂÎ·›‰Â˘ÛË, Ù¯ÓÔÏÔÁ›· Î·È ÓÔÌÔıÂÛ›· (ÁÓˆÛÙÔ› ˆ˜ ∂∂∂ ·fi Ù· ·Ú¯Èο ÙˆÓ ·ÁÁÏÈÎÒÓ Ï¤ÍÂˆÓ education, engineering Î·È law enforcement) (8). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÛÙÔ ÔÔ›Ô ÂÌϤÎÂÙ·È ÙÔ ·È‰› ˆ˜ Â˙fi˜ ‹ ÂÈ‚¿Ù˘, Û˘ÁÎÂÓÙÚÒÓÂÈ Ù· ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Û˘ÁÎÚÈÙÈο Ì fiϘ ÙȘ ¿ÏϘ ·Èٛ˜ ·Ù˘¯‹Ì·ÙÔ˜. ∆· Â˘Ú‹Ì·Ù· ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Û‡Ìʈӷ Ì ÂΛӷ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ (1,2,9,10), η›ÙÔÈ ·Ó·Ê¤ÚÔÓÙ·È Û ÔÌ¿‰· ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ. °ÂÓÈο, ˘¿Ú¯ÂÈ ‰˘ÛÎÔÏ›· ˘ÔÏÔÁÈÛÌÔ‡ Ù˘ ·Ó·ÏÔÁ›·˜ ÙÔ˘ ‚·Ú¤Ô˜ ÙÚ·‡Ì·-

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ÙÔ˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂٷʤÚÔÓÙ·È ÛÙ· ÓÔÛÔÎÔÌ›·. ™‡Ìʈӷ Ì ̛· ÌÂϤÙË Ô˘ ‰ËÌÔÛȇÙËΠÚfiÛÊ·Ù·, Ë ÔÔ›· Û˘ÁÎÂÓÙÚÒÓÂÈ ÛÙÔȯ›· ·fi 50 ΤÓÙÚ· ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ISS (injury severity score) >24 ·Ó¤Ú¯ÂÙ·È Û 6,5% (2). ∆· ·È‰È¿ ·˘Ù¿ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÏËı˘ÛÌfi ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ Ô˘ ÓÔÛËχÔÓÙ·È Û ª∂£. °È· ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Â˘ı‡ÓÔÓÙ·È ÔÈ Ô‰ËÁÔ› (ÂÏÏÈ‹˜ ÂÎ·›‰Â˘ÛË, ·‰˘Ó·Ì›· Ù‹ÚËÛ˘ ÙˆÓ Î·ÓfiÓˆÓ Ô‰È΋˜ ΢ÎÏÔÊÔÚ›·˜, ηٷӿψÛË ·ÏÎÔfiÏ), Ë ¤ÏÏÂÈ„Ë Ì¤ÙÚˆÓ ÚÔÛÙ·Û›·˜ ÙÔ˘ ·È‰ÈÔ‡-ÂÈ‚¿ÙË Ì¤Û· ÛÙÔ ·˘ÙÔΛÓËÙÔ (ηٿÏÏËÏË ı¤ÛË, ¯Ú‹ÛË ·È‰ÈÎÒÓ Î·ıÈÛÌ¿ÙˆÓ, ˙ÒÓË ÚÔÛ·ÚÌÔṲ̂ÓË ÛÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡) Î·È Ù¤ÏÔ˜ Ë ¤ÏÏÂÈ„Ë ·ÛÊ¿ÏÂÈ·˜ ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ (10-12). ™Â fiϘ ÙȘ ËÏÈ˘, ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Û fi,ÙÈ ·ÊÔÚ¿ Ù· ·Ù˘¯‹Ì·Ù·. ∏ ÎÚ›ÛÈÌË ËÏÈΛ· ÁÈ· Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë Û¯ÔÏÈ΋. ∞ÓÙ›ıÂÙ·, ÛÙ· ·È‰È¿ Ù˘ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÔÈ ÙÒÛÂȘ ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ·fi ·Ù˘¯‹Ì·Ù· (13). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÈηÈÔÏÔÁÂ›Ù·È ·fi ÙËÓ ·˘ÍË̤ÓË ÂÚȤÚÁÂÈ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙË Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈΛ·, ÙËÓ ˘ÂÚÎÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÓË›ˆÓ, ·ÏÏ¿ Î·È ·fi ÙËÓ Èı·Ó‹ ·Ì¤ÏÂÈ· ÙˆÓ ÁÔÓ¤ˆÓ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi οΈÛ˘ η٤Ϸ‚ ÙÔ ∫¡™. ∞˘Ùfi ·ÔÙÂÏ› ı¤ÛË ÔÌÔʈӛ·˜ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ·È‰ÈÎfi ÙÚ·‡Ì·. ∏ ‡·ÚÍË ‚·ÚÈ¿˜ ∫∂∫ ÛÙÔ ÙÚ·‡Ì· ‰ÂηÏ·ÛÈ¿˙ÂÈ ÙË ıÓËÙfiÙËÙ· Î·È ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ·Ú¿ÁÔÓÙ· Ù˘ ÚfiÁÓˆÛ˘ (9). ∏ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË ÛÙ· ·È‰È¿ ¤¯ÂÈ ÙË ÌÔÚÊ‹ ‰È¿¯˘Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ (ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ·, ‰È¿¯˘ÙË ·ÈÌÔÚÚ·ÁÈ΋ ıÏ¿ÛË). ∆· ÂÓ‰ÔÂÁÎÂÊ·ÏÈο, ηıÒ˜ Î·È Ù· ÂÈÛÎÏËÚ›‰È· Î·È ˘ÔÛÎÏËÚ›‰È· ·ÈÌ·ÙÒÌ·Ù· ‰ÂÓ Â›Ó·È Û˘¯Ó¿. ™˘¯ÓfiÙÂÚ· ··ÓÙ¿Ù·È ÙÔ ˘ÔÛÎÏËÚ›‰ÈÔ ·È̿و̷ Ô˘ ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ÔÈ Ì‹ÓÈÁÁ˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÏÂÙ¤˜ Î·È Â‡ıÚ·˘ÛÙ˜. O ΛӉ˘ÓÔ˜ ÁÈ· ÂÈÛÎÏËÚ›‰ÈÔ ·È̿و̷ ·˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È Û¿ÓÈ· ··ÓÙ¿Ù·È Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 4 ÂÙÒÓ (9).

O ·ÚÈıÌfi˜ ÙˆÓ ıˆÚ·ÎÈÎÒÓ Î·ÎÒÛˆÓ, Ì ÙËÓ ¤ÓÓÔÈ· Ù˘ ÌÂÌÔӈ̤Ó˘ οΈÛ˘, ˘‹ÚÍ ÌÈÎÚfi˜. °ÂÓÈο, ÔÈ ÌÔÓ‹ÚÂȘ ıˆÚ·ÎÈΤ˜ ηÎÒÛÂȘ Â›Ó·È Û¿ÓȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯Ô˘Ó Ì ∫∂∫ Î·È Î¿ÎˆÛË ÎÔÈÏ›·˜. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÔÊ›ÏÔÓÙ·È Û ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Î·È ÙÒÛÂȘ. OÈ ÂÚÈÛÛfiÙÂÚ˜ Â›Ó·È ÎÏÂÈÛÙ¤˜ ηÎÒÛÂȘ Ô˘ Û˘Ó‹ıˆ˜ ˘ÔÂÎÙÈÌÔ‡ÓÙ·È, ÁÈ·Ù› Ë ÂÏ·ÛÙÈÎfiÙËÙ· ÙˆÓ

July August 04

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¶·È‰È·ÙÚÈ΋ 2004;67:274-280

Ï¢ÚÒÓ Î·È Ë ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÛÙ· ·È‰È¿ ÙȘ ηıÈÛÙÔ‡Ó ÎÏÈÓÈο ÌË ÂÌÊ·Ó›˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ‰ÂÓ ·ÔÎÏ›ÂÙ·È Ë ‡·ÚÍË Ó¢ÌÔıÒڷη, ·ÈÌÔıÒڷη ‹ Ó¢ÌÔÓÈ΋˜ ıÏ¿Û˘ Â› ·Ô˘Û›·˜ ·ÎÙÈÓÔÏÔÁÈο ÂÌÊ·ÓÔ‡˜ ηٿÁÌ·ÙÔ˜ Ï¢ÚÒÓ. ∏ ıÓËÙfiÙËÙ· ÏfiÁˆ ıˆÚ·ÎÈÎÒÓ Î·ÎÒÛÂˆÓ Â›Ó·È ÌÈÎÚ‹, ·ÓÂÚ¯fiÌÂÓË Û ÔÛÔÛÙfi ÂÚ›Ô˘ 3% Î·È ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙË Û˘Ó‡·ÚÍË Î¿ÎˆÛ˘ ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ, fiˆ˜ ÙÔ˘ ∫¡™ Î·È ÙÔ˘ ÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (9).

OÈ ÂÓ‰ÔÎÔÈÏȷΤ˜ ηÎÒÛÂȘ ‰ÂÓ Â›Ó·È Û¿ÓȘ ÛÙ· ·È‰È¿. ∏ ·ÙÂÏ‹˜ ÔÛÙÂÔÔ›ËÛË ÙˆÓ Ï¢ÚÒÓ Î·È ÙÔ ÌÈÎÚfi ̤ÁÂıÔ˜ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÎÔÈÏfiÙËÙ·˜ Û˘ÁÎÚÈÙÈο Ì ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ ÚÔÛʤÚÔ˘Ó ÌÈÎÚ‹ ÚÔÛÙ·Û›· ÛÙÔ ‹·Ú, ÙÔÓ ÛÏ‹Ó· Î·È ÙÔ˘˜ ÓÂÊÚÔ‡˜, Ù· ÔÔ›· Â›Ó·È Â˘ÚfiÛ‚ÏËÙ· Û οΈÛË. ™˘Ó‹ıˆ˜ ÂΉËÏÒÓÔÓÙ·È ˆ˜ ˘Ôο„ÈÔ ·È̿و̷ ÙÔ˘ ‹·ÙÔ˜, ÙÔ˘ ÛÏËÓfi˜ Î·È ÙˆÓ ÓÂÊÚÒÓ. OÈ ‚·ÚȤ˜ ηÎÒÛÂȘ ÙˆÓ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ, fiˆ˜ Ú‹ÍÂȘ ‹ ÌÂÁ¿Ï˜ ıÏ¿ÛÂȘ, Â›Ó·È Û¿ÓȘ. ∏ ıÓËÙfiÙËÙ· ÏfiÁˆ ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ Î·ÎÒÛÂˆÓ Â›Ó·È Â›Û˘ Û˘Ó¿ÚÙËÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÛÙÔ ÙÚ·‡Ì· οΈÛ˘ ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ ‹ Û˘ÛÙËÌ¿ÙˆÓ. π‰È·›ÙÂÚË ÛËÌ·Û›· ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Ú‹ÍË ÛÏËÓfi˜, ‰ÈfiÙÈ Ë ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ·ÛÏËÓ›· ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ÂΉ‹ÏˆÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÌÂÙ¿ ÛÏËÓÂÎÙÔÌ‹ ÔÍ›·˜ ÎÂÚ·˘ÓÔ‚fiÏÔ˘ Û‹„˘. ∏ ÂΉ‹ÏˆÛË ÔÏÈÁ·ÈÌÈ΋˜ ηٷÏËÍ›·˜ Â› ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÂÈ‚·Ú‡ÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÚfiÁÓˆÛË. ∏ ÌÂÁ¿ÏË ·ÒÏÂÈ· ·›Ì·ÙÔ˜, Ë ·Ú·ÙÂÈÓfiÌÂÓË ˘fiÙ·ÛË Î·È Ë Â·ÎfiÏÔ˘ıË ÂÏ¿ÙÙˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ‰Â˘ÙÂÚÔ·ı‹ ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë Î·È ˘ÔÍ·ÈÌÈ΋, ÈÛ¯·ÈÌÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ 36 ·fi ÙÔ˘˜ 52 ı·Ó¿ÙÔ˘˜ (69,2%) Û˘Ó¤‚ËÛ·Ó Û ·È‰È¿ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ·Ú¯Èο Û Â·Ú¯È·Î¿ ÓÔÛÔÎÔÌ›·. ∫¿ÔÈÔÈ ·fi ·˘ÙÔ‡˜ ı· ÌÔÚÔ‡Û·Ó ›Ûˆ˜ Ó· ÚÔÏËÊıÔ‡Ó, Â¿Ó Ë ·ÓÙÈÌÂÙÒÈÛË ¿Ú¯È˙ ÛÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ ·fi ÔÌ¿‰· ÂÍÂȉÈÎÂ˘Ì¤ÓË ÛÙËÓ Â›ÁÔ˘Û· È·ÙÚÈ΋ Î·È Û˘Ó¯È˙fiÙ·Ó Ì ÙËÓ Ù·¯Â›· Î·È ·ÛÊ·Ï‹ ‰È·ÎÔÌȉ‹ ÙÔ˘ ÙÚ·˘Ì·Ù›· ÛÙÔ Î·Ù¿ÏÏËÏÔ Î¤ÓÙÚÔ, Ì ‰›ÎÙ˘Ô ÌÂÙ·ÊÔÚ¿˜ ÛÙÂϯˆÌ¤ÓÔ ·fi ¤ÌÂÈÚÔ˘˜ ÂÓÙ·ÙÈÎÔÏfiÁÔ˘˜ Î·È Û‡Á¯ÚÔÓÔ ÂÍÔÏÈÛÌfi. ∏ ÛËÌ·Û›· Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ Û ÓÔÛÔÎÔÌÂ›Ô ÙÔÓ›˙ÂÙ·È Û ÔÏϤ˜ ÌÂϤÙ˜. ∂Ó‰ÂÈÎÙÈο, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ıÓËÙfiÙËÙ· ·È‰ÈÒÓ Ì ‚·ÚÈ¿ ∫∂∫ Ô˘ ÌÂٷʤÚÔÓÙ·È ¿ÌÂÛ· ·fi ÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ Û ΤÓÙÚÔ Î·Ù¿ÏÏËÏÔ Ó· Ù· ·ÓÙÈÌÂÙˆ›ÛÂÈ, ·Ó¤Ú¯ÂÙ·È Û 26,8%, ÂÓÒ ·˘Í¿ÓÂÙ·È Û 50% fiÙ·Ó ·ÚÂÌ‚¿ÏÏÂÙ·È ÂӉȿÌÂÛÔ˜ ÛÙ·ıÌfi˜ (14-16). ∏ ·ÛÊ·Ï‹˜ ÌÂÙ·ÊÔÚ¿ Û ¯ÚfiÓÔ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 4 ˆÚÒÓ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÚfiÁÓˆÛË Î·È ·ÔÙÂÏ› ÙÔÓ ÎÔÚÌfi ÂÓfi˜ ÔÚÁ·ÓˆÌ¤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ·ÊÔÚ¿˜

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(17). ¶·Ú·Ì¤ÓÂÈ ÎÏ·ÛÈ΋ Ë ÌÂϤÙË ÙÔ˘ Trunkey Ô˘ ·¤‰ÂÈÍÂ, ÚÈÓ ·fi 20 ¯ÚfiÓÈ·, fiÙÈ Ë ÚÒÙË ÒÚ· ÌÂÙ¿ ÙÔ ·Ù‡¯ËÌ·, Ë ·ÔηÏÔ‡ÌÂÓË “¯Ú˘Û‹ ÒÚ·”, Â›Ó·È Î·ıÔÚÈÛÙÈ΋ ÁÈ· ÙËÓ ¤Î‚·ÛË ÙÔ˘ ÙÚ·˘Ì·Ù›·: “O ÛˆÛÙfi˜ ·ÛıÂÓ‹˜, ÛÙÔ ÛˆÛÙfi ÓÔÛÔÎÔÌ›Ô, ÙË ÛˆÛÙ‹ ÒÚ·” (18). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÚÔ‡Û· ÌÂϤÙË ÚÔÛÂÁÁ›˙ÂÈ ÙËÓ È‰È·›ÙÂÚË ÔÌ¿‰· ·È‰ÈÒÓ Ì ÙÚ·‡Ì· ÌÂÁ¿Ï˘ ‚·Ú‡ÙËÙ·˜. ∆Ô 1/4 ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∂£, ·ÚÔ˘Û›·˙ ˘ÔÏÂÈÌÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Î·È ÓÔÛËχÙËΠÛÙË ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÁÈ· ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚfiÓÔ. ŒÓ· ÔÛÔÛÙfi ÌÂٷʤÚıËΠÛÙÔ Û›ÙÈ Ì ԉËÁ›Â˜ ÁÈ· ÎÈÓËÙÈ΋ Ê˘ÛÈÎÔıÂÚ·›· Î·È ÊÚÔÓÙ›‰·. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ÙÔ ÙÚ·‡Ì· ¤¯ÂÈ ÂȉڿÛÂȘ fi¯È ÌfiÓÔ ÛÙÔ ›‰ÈÔ ÙÔ ·È‰›, ·ÏÏ¿ Î·È ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, ÛÙÔ˘˜ Ê›ÏÔ˘˜ Î·È ÛÙÔÓ Â˘Ú‡ÙÂÚÔ ÎÔÈÓˆÓÈÎfi ÙÔ˘ ÂÚ›Á˘ÚÔ. ™Â ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË, ÚÔÂÚ¯fiÌÂÓË ·fi ÙË µÔÛÙÒÓË, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ Ì ÛÔ‚·Úfi ÙÚ·‡Ì· Ô˘ ÓÔÛËχÔÓÙ·È Û ª∂£, ¯ÚÂÈ¿˙ÂÙ·È ÂȉÈÎfi Û¯ÔÏ›Ô. ∆· 2/3 ÙˆÓ ·‰ÂÏÊÒÓ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ·Ó·Ù‡ÛÛÔ˘Ó ·ÚÁfiÙÂÚ· ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û¯ÔÏ›Ô, ÂÓÒ ÙÔ 1/3 ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ·ÓÙÈÌÂÙˆ›˙ÂÈ ÚÔ‚Ï‹Ì·Ù· ÛÙË Û¯¤ÛË ÙÔ˘˜ (19). ∆· ·Ú·¿Óˆ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó ÙËÓ ‡·ÚÍË Ù˘ “ÎÚ˘Ì̤Ó˘ ÓÔÛËÚfiÙËÙ·˜” ÙÔ˘ ‚·ÚÈ¿ ÙÚ·˘Ì·ÙÈṲ̂ÓÔ˘ ·È‰ÈÔ‡, Ë ÔÔ›· ÌÔÚ› Ó· Ê·Ó› ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ı·Ó¿ÙˆÓ Î·È ˘ÔÏÂÈÌÌ·ÙÈ΋˜ Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎË ‰ËÌÈÔ˘ÚÁ›·˜ ÂÓfi˜ ÔÚıÔÏÔÁÈο ÔÚÁ·ÓˆÌ¤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜. O ۯ‰ȷÛÌfi˜ ÂÓfi˜ Ù¤ÙÔÈÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÔÌ¿‰· ÙÚ·‡Ì·ÙÔ˜, Û‡ÛÙËÌ· ·ÛÊ·ÏÔ‡˜ Î·È ÁÚ‹ÁÔÚ˘ ÌÂÙ·ÊÔÚ¿˜ Û ªÔÓ¿‰· ∆Ú·‡Ì·ÙÔ˜ Ì ‰˘Ó·ÙfiÙËÙ· Û˘ÓÔÏÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ÙÚ·˘Ì·ÙÈṲ̂ÓÔ˘ ·È‰ÈÔ‡ Î·È ÂȉÈÎfi ∫¤ÓÙÚÔ ∞ÔηٿÛÙ·Û˘ Ì ÛÙfi¯Ô ÙËÓ ÎÔÈÓˆÓÈ΋ Â·Ó¤ÓÙ·ÍË ÙÔ˘ ·È‰ÈÔ‡. µÈ‚ÏÈÔÁÚ·Ê›· 1. Paar O, Kasperk R. The significance of multiple trauma in children. Eur J Pediatr Surg 1992;2:345-347.

2. Cooper A, Barlow B, Davidson L, Relethford J, O’ Meara J, Mottley L. Epidemiology of pediatric trauma: importance of population-based statistics. J Pediatr Surg 1992;27:149-154.

3. Hambidge SJ, Davidson AJ, Gonzales R, Steiner JF. Epidemiology of pediatric injury-related primary care office visits in the United States. Pediatrics 2002;109:559-565.

4. Ramsay S. Child-injury deaths rates. Do international comparisons help? Lancet 2001;357:454.

5. World Health Organization. World Health Statistics (annual). Geneva: WHO; 1980-1984.

6. Robertson CM, Joffe AR, Moore AJ, Watt JM. Neurodevelopmental outcome of young pediatric intensive care

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survivors of serious brain injury. Pediatr Crit Care Med 2002;3:345-350.

7. Guyer B, Freedman MA, Strobino DM, Sondik EJ. Annual summary of vital statistics: trends in the health of Americans during the 20th century. Pediatrics 2000;106:1307-1317.

8. Dowd MD, Keenan HT, Bratton SL. Epidemiology and prevention of childhood injuries. Crit Care Med 2002;30 (11 Suppl):S385-S392.

9. Sanchez JI, Paidas CN. Childhood trauma. Now and in the new millennium. Surg Clin North Am 1999;79:1503-1535.

10. Rivara FP, Aitken M. Prevention of injuries to children and adolescents. Adv Pediatr 1998;45:37-72.

11. Halman SI, Chipman M, Parkin PC, Wright JG. Are seat belt restraints as effective in school age children as in adults? A prospective crash study. BMJ 2002;324:1123-1128.

12. Rivara FP. Pediatric injury control in 1999: where do we go from here? Pediatrics 1999;103:883-888.

13. Wang MY, Kim KA, Griffith PM, Summers S, McComb JG, Levy ML et al. Injuries from falls in the pediatric population: an analysis of 729 cases. J Pediatr Surg 2001;36:1528-1534.

14. Hall JR, Reyes HM, Meller JL, Loeff DS, Dembek R. The outcome for children with blunt trauma is best at a pediatric trauma center. J Pediatr Surg 1996;31:72-77.

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15. Johnson DL, Krishnamurthy S. Send severely head-injured children to a pediatric trauma center. Pediatr Neurosurg 1996;25:309-314.

16. Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 2000;49:237-245.

17. Ammon AA, Fath JJ, Brautigan M, Mehta R, Matthews J. Transferring patients to a pediatric trauma center: the transferring hospital’s perspective. Pediatr Emerg Care 2000;16:332-334.

18. Cales RH, Trunkey DD. Preventable trauma deaths. A review of trauma care systems development. JAMA 1985;254:1059-1063.

19. Harris BH, Schwaitzberg SD, Seman TM, Herrmann C. The hidden morbidity of pediatric trauma. J Pediatr Surg 1989;24:103-106. ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-04-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ºÈÏÈ›· ¡ÈÎÔÏ¿Ô˘ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” T.K.115 23, ∞ı‹Ó·

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Paediatriki 2004;67:281-286

CASE REPORT

µÚ¤ÊÔ˜ Ì ‚·ÚÈ¿ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›· º. ∫·Î·‚¿, ™. ™Ù¤ÊÔ˜, ∞. ¶ÚÂ˙ÂÚ¿ÎÔ˘, ∞. ¢·Ú˙¤ÓÙ·˜, ∞. µ·ÛÈÏfiÔ˘ÏÔ˜

An infant with severe staphylococcal pneumonia F. Kakava, S. Stefos, A. Prezerakou, A. Darzentas, A. Vasilopoulos

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜, ËÏÈΛ·˜ 5 ÌËÓÒÓ, Ì ÈÛÙÔÚÈÎfi ·ÛıÌ·ÙÈÎÒÓ ÎÚ›ÛˆÓ, ÙÔ ÔÔ›Ô ÚÔÛÎÔÌ›ÛÙËΠ̠ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ïԛ̈͢ Î·È ‚·ÚÈ¿˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ÚÔÂÍ¿Ú¯ÔÓ Û‡Ìو̷ Ù˘ ÔÔ›·˜ ‹Ù·Ó Ô ¤ÓÙÔÓÔ˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˜. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ıÂÛ ÙËÓ ˘Ô„›· ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜. ∏ ÓfiÛÔ˜ ‰È¤‰Ú·Ì ‚·Ú¤ˆ˜, Ì ÙËÓ ÂΉ‹ÏˆÛË ˘ÔıÒڷη Î·È Ó¢ÌÔıÒڷη. ™ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ·ÔÌÔÓÒıËΠ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜. ∏ ıÂÚ·›· Û˘ÌÂÚȤϷ‚ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ˘ÔıÒڷη Î·È Ó¢ÌÔıÒڷη, ·ÓÙÈ‚ÈÔÙÈο Î·È ÈÛ¯˘Ú‹ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹. ¶·Ú¿ ÙË ‚·Ú‡Ù·ÙË ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘, Ë ¤Î‚·ÛË ‹Ù·Ó ηϋ.

Abstract: The case is described of a 5 month-old boy with a history of asthma who was admitted to hospital with clinical signs of infection and respiratory distress. Diffuse wheezes were auscultated on lung examination. The chest X-ray was suggestive of Staphylococcal pneumonia. The child developed severe pneumonia with pneumothorax and empyema. Staphylococcus aureus was isolated from the pleural fluid.

Treatment included mechanical ventilation, drainage of the pleural effusion, iv antibiotics and antiasthmatic drugs. The patient had a very good outcome despite the severe course of the disease.

§¤ÍÂȘ ÎÏÂȉȿ: ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›·, ˘ÔıÒڷη˜, Ó¢ÌÔıÒڷη˜, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜.

Key words: staphylococcal pneumonia, empyema, pneumothorax, wheezes.

∂ÈÛ·ÁˆÁ‹ ∏ Ó¢ÌÔÓ›· ·Ú·Ì¤ÓÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜, ·ÏÏ¿ Î·È ıÓËÛÈÌfiÙËÙ·˜, ÛÙ· ·È‰È¿, ΢ڛˆ˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜. ∆Ô Â›‰Ô˜ ÙÔ˘ ·ıÔÁfiÓÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ÚÔηÏ› ÙËÓ Ó¢ÌÔÓ›· ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ËÏÈΛ·, ÙËÓ ÂÔ¯‹, ·ÏÏ¿ Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (1-3). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ Ó¢ÌÔÓÈÒÓ ÂÌÊ·Ó›˙ÂÙ·È Û ËÏÈ˘ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 7 ÂÙÒÓ, Ì ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Ó· ÂΉËÏÒÓÂÙ·È ÌÂٷ͇ ÙˆÓ 2 Î·È 4 ÂÙÒÓ (7). ™ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, Ë ıÓËÙfiÙËÙ· Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È ¯·ÌËÏ‹, ÂÓÒ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 10% (3). ∏ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›· Û˘Ó‹ıˆ˜ ÂÍÂÏ›ÛÛÂÙ·È ‚·Ú¤ˆ˜, ÂÓÒ ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂÚ· Ù· ‚Ú¤-

ÊË Î·È Ù· ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿ (1,7). ™˘¯Ó¿, Û˘Ó‰˘¿˙ÂÙ·È Ì ÓÂ˘Ì·ÙÔ΋Ϙ, Ó¢ÌÔıÒڷη, ˘ÔıÒڷη Î·È ·ÔÛÙ‹Ì·Ù·, Ô˘ ıˆÚÔ‡ÓÙ·È, ˆÛÙfiÛÔ, ̤ÚÔ˜ Ù˘ ÓfiÛÔ˘ Î·È fi¯È ÂÈÏÔΤ˜.

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Intensive Care Unit, “P. & A. Kyriakou” Children’s Hospital, Athens

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ ËÏÈΛ·˜ 5 ÌËÓÒÓ, Ì ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›·, ηıÒ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ Ë ‚·Ú‡Ù·ÙË ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘, Ë ÂΉ‹ÏˆÛË fiÏÔ˘ ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙˆÓ ÂÈÏÔÎÒÓ Ù˘, Ë ·Ó¿ÁÎË ÁÈ· Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È Ë Î·Ï‹ ÙÂÏÈ΋ ¤Î‚·ÛË, ·Ú¿ ÙË ‚·Ú‡ÙËÙ¿ Ù˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ¿ÚÚÂÓ ‚Ú¤ÊÔ˜, ÙÔ ÔÔ›Ô ÂÈÛ‹¯ıË Û ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ, ÁÈ·Ù› ·fi 48ÒÚÔ˘ ›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ˘ÚÂÙfi (38,5ÔC), ‚‹¯· Î·È ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·.

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¶·È‰È·ÙÚÈ΋ 2004;67:281-286

Paediatriki 2004;67:281-286

∂›Ó·È ÙÔ Ù¤Ù·ÚÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔ ÔÔ›Ô ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË ‰›‰˘ÌË Î‡ËÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ™ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ (·Ù¤Ú·˜ Î·È ‰‡Ô ·‰¤ÏÊÈ·), ÂÓÒ ÙÔ ›‰ÈÔ ÙÔ ·È‰› ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ‰‡Ô ÂÂÈÛfi‰È· ·ÛıÌ·ÙÈ΋˜ ÎÚ›Û˘, ÁÈ· Ù· ÔÔ›· ›¯Â ÓÔÛËÏ¢Ù› Û ËÏÈΛ· 3,5 Î·È 4 ÌËÓÒÓ Î·È Â›¯Â ÙÂı› Û ·ÁˆÁ‹ Ì ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο. ∆Ô ‚Ú¤ÊÔ˜, ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ‹Ù·Ó Û ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, Ù·¯‡ÓÔÈ·, ÁÔÁÁ˘ÛÌfi, ÂÚÈÛÙÔÌ·ÙÈ΋ ΢¿ÓˆÛË Î·È ·ÁÁÂÈÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ‡ÎÓˆÛË ‰ÂÍÈÔ‡ ¿Óˆ ÏÔ‚Ô‡ (¢∞§) ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη (∂ÈÎfiÓ· 1). O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ·˘ÍË̤ÓÔ˘˜ ‰Â›ÎÙ˜ Ïԛ̈͢: CRP: 86 mg/L, WBC: 57.000/mm3 (GR: 75% Ì ÙÔÍÈ΋ ÎÔÎΛˆÛË). ∆· ·¤ÚÈ· ·›Ì·ÙÔ˜ Ì ¯ÔÚ‹ÁËÛË O2 40% ¤‰ÂÈÍ·Ó pH: 7,19, pO2: 170 mmHg, pCO2: 53 mmHg Î·È HCO3-: 20. ∆Ô ‚Ú¤ÊÔ˜ Ù¤ıËΠ۠·ÁˆÁ‹ Ì ‰ÈÎÏÔÍ·ÎÈÎÏ›ÓË Î·È ÎÂÊÔÙ·Í›ÌË. §›Á˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÌÂٷʤÚıËΠÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ÂÂȉ‹ ·ÚÔ˘Û›·Û Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ÙÔ˘ ÂÈÎfiÓ·˜ Î·È Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ª∂£ ¤‰ÂÈÍ ıÂÚÌÔÎÚ·Û›· 38,2ÔC, ·ÁÁÂÈÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‰¤ÚÌ·ÙÔ˜, ÁÔÁÁ˘ÛÌfi, ∞¶: 106/53 mmHg, Ù·¯‡ÓÔÈ· (80 ·Ó·ÓÔ¤˜/min), Ù·¯˘Î·Ú‰›· (190/min), ÂÈÛÔÏΤ˜ ¢¤Ó‰ÔÙˆÓ ÛËÌ›ˆÓ ÙÔ˘ ıÒڷη, ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ Î·È ÂÚÈÛÙÔÌ·ÙÈ΋ ΢¿ÓˆÛË.

∞ÎÚÔ·ÛÙÈÎÒ˜, ¤ÁÈÓ ʷÓÂÚ‹ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ηٿ ÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ Î·È Ë ·Ú¿Ù·ÛË ÂÎÓÔ‹˜ Ì ÍËÚÔ‡˜ ÚfiÁ¯Ô˘˜ (Û˘Ú›ÙÙÔÓÙ˜). ∆· ·¤ÚÈ· ·›Ì·ÙÔ˜ Ì ¯ÔÚ‹ÁËÛË O2 60% ¤‰ÂÈÍ·Ó pH: 7,33, pO2: 61 mmHg, pCO2: 41 mmHg Î·È HCO3-: 21. ∏ ıÂÚ·›· ÛÙË ª∂£ ÂÚÈÂÏ¿Ì‚·Ó ÙË ¯ÔÚ‹ÁËÛË O2, ÙËÓ ÂÓ‰ÔÊϤ‚È· ÂÓ˘‰¿ÙˆÛË, ÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ (ÙÂïÎÔÏ·Ó›ÓË) Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ (Û·Ï‚Ô˘Ù·ÌfiÏË Û ÂÈÛÓÔ¤˜ ·Ó¿ ÌÈÛ‹ ¤ˆ˜ Ì›· ÒÚ·, ‚ÚÔÌÈÔ‡¯Ô ÈÚ·ÙÚfiÈÔ Î·È ÎÔÚÙÈ˙fiÓË). ∆Ô ‚Ú¤ÊÔ˜, ÙȘ ÂfiÌÂÓ˜ 10 ÒÚ˜ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ÛÙË ª∂£, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ·ÚÔ˘Û›·ÛÂ Î˘Ì·ÈÓfiÌÂÓË ÂÈÎfiÓ·, Ì ÚÔÂÍ¿Ú¯ÔÓ, fï˜, Û‡Ìو̷ ÙÔÓ ‚ÚÔÁ¯fiÛ·ÛÌÔ Î·È ÙËÓ Ù·¯‡ÓÔÈ·. ¢Ò‰Âη ÒÚ˜ ÂÚ›Ô˘ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙË ª∂£, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û ÔÍ›· Âȉ›ӈÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ (·Ó·Ó¢ÛÙÈ΋ ·Ó·ÎÔ‹). ¢È·ÛˆÏËÓÒıËΠ·Ì¤Ûˆ˜ Î·È Ù¤ıËΠ۠Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi (ª∞). ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ÂÎÙÂٷ̤ÓÔ Ó¢ÌÔıÒڷη ‰ÂÍÈ¿, Ô ÔÔ›Ô˜ ·ÚÔ¯ÂÙ‡ÙËΠ̠ۈϋӷ ıˆÚ·ÎÔÛÙÔÌ›·˜ (·¤ÚÈ· ·›Ì·ÙÔ˜ Û ª∞ ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÛˆÏ‹Ó· ıˆÚ·ÎÔÛÙÔÌ›·˜ pH: 7,09, pO2: 93 mmHg, pCO2: 97 mmHg, HCO3-: 26) (∂ÈÎfiÓ· 2). ∏ ·ÎÙÈÓÔÁÚ·Ê›· Ô˘ ¤ÁÈÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ۈϋӷ ıˆÚ·ÎÔÛÙÔÌ›·˜, ¤‰ÂÈÍ ÌÂÁ¿ÏË Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ, ÙÔ ÔÔ›Ô, fï˜, ‰ÂÓ ·ÚÔ¯¤ÙÂ˘Â Ô ÛˆÏ‹Ó·˜ ıˆÚ·ÎÔÛÙÔÌ›·˜ (∂ÈÎfiÓ· 3). ∆ÔÔıÂÙ‹ıËΠ‰Â‡ÙÂÚÔ˜ ۈϋӷ˜, ̤ۈ ÙÔ˘ ÔÔ›Ô˘ ·ÚÔ¯ÂÙ‡ÙËÎ·Ó ÂÚÈÛÛfiÙÂÚ· ·fi 300 ml

∂ÈÎfiÓ· 1. ¶‡ÎÓˆÛË ‰ÂÍÈÔ‡ ¿Óˆ ÏÔ‚Ô‡ Ì ·ÚÔ˘Û›· ÓÂ˘Ì·ÙÔ΋Ï˘ (ÙfiÍÔ).

∂ÈÎfiÓ· 2. ∂ÎÙÂٷ̤ÓÔ˜ Ó¢ÌÔıÒڷη˜ ‰ÂÍÈ¿ Ì ·ÚÂÎÙfiÈÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÛÎÈ¿˜ ·ÚÈÛÙÂÚ¿ Î·È ‡ÎÓˆÛË ‰ÂÍÈÔ‡ ¿Óˆ ÏÔ‚Ô‡.

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˘Ò‰Ô˘˜ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÔÔ›Ô˘ ·Ó·Ù‡¯ıËΠStaphylococcus aureus (·ÓıÂÎÙÈÎfi ÛÙËÓ ÔÍ·ÎÈÏÏ›ÓË Î·È Â˘·›ÛıËÙÔ ÛÙËÓ ÙÂ˚ÎÔÏ·Ó›ÓË Î·È ‚·ÓÎÔÌ˘Î›ÓË). ªÂÙ¿ ÙËÓ ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, ·ÎÙÈÓÔÁÚ·ÊÈο, Ô ‰ÂÍÈfi˜ Ó‡ÌÔÓ·˜ Â·ÓÂÙ‡¯ıËÎÂ, ·ÚÔ˘Û›·˙ fï˜ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ ÛÙÔÓ ‰ÂÍÈfi ̤ÛÔ, ‰ÂÍÈfi ¿Óˆ Î·È ‰ÂÍÈfi οو ÏÔ‚fi (∂ÈÎfiÓ· 4). ∂ÓfiÛˆ ÙÔ ‚Ú¤ÊÔ˜ ‹Ù·Ó Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È Ì ÙÔÓ ‰ÂÍÈfi Ó‡ÌÔÓ· Ó· ¤¯ÂÈ ÂÎÙ˘¯ı›, ÙÔ ÚÔÂÍ¿Ú¯ÔÓ Û‡Ìو̷ ‹Ù·Ó Ô ¤ÓÙÔÓÔ˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ Î·È Ë ÛÔ‚·Ú‹ ˘ÂÚηÓ›· (·¤ÚÈ· ·›Ì·ÙÔ˜ pH: 7,18, pO2: 93 mmHg, pCO2: 91 mmHg, HCO3-: 32). ∏ ·ÁˆÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Î·È Ù˘ ˘ÂÚηÓ›·˜ ÂÚÈÂÏ¿Ì‚·Ó ÙË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ (2 mg/kg/24 h), ÙË Û˘Ó¯‹ ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË Û·Ï‚Ô˘Ù·ÌfiÏ˘ (‰fiÛË 24 Á/kg/min) Î·È ÙÔÓ ˘ÂÚ·ÂÚÈÛÌfi ̤ۈ ·Ó·Ó¢ÛÙ‹Ú·. ∆· ‰‡Ô ÚÒÙ· 24ˆÚ·, ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, Ô ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ ‹Ù·Ó Â›ÌÔÓÔ˜ Î·È ·ÓıÂÎÙÈÎfi˜ ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹.

OÈ ÙÈ̤˜ Ù˘ ƒaCO2 Î˘Ì¿ÓıËÎ·Ó ·fi 50 mmHg ¤ˆ˜ 194 mmHg, ÂÓÒ Ë ƒaO2 ‰È·ÙËÚ‹ıËΠÛÙ·ıÂÚ¿ Û Â›‰· ¿Óˆ ·fi 90 mmHg. ∏ ÌÂÁ·Ï‡ÙÂÚË ¤Í·ÚÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Î·È Ë ·ÓÒÙÂÚË ÙÈÌ‹ Ù˘ PaCO2 (194 mmHg) (·¤ÚÈ· ·›Ì·ÙÔ˜ pH: 6,92, pO2: 92 mmHg, pCO2: 194 mmHg, HCO3-: 30) ·Ú·ÙËÚ‹ıËÎ·Ó 40 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÙË ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊÏ‚›ˆ˜ 2 ‰fiÛÂˆÓ MgSO4 (20 mg/kg/‰fiÛË), Ì ÌÂÛԉȿÛÙËÌ· ¯ÔÚ‹ÁËÛ˘ ÙȘ 2 ÒÚ˜. ™ÙȘ ÂfiÌÂÓ˜ ÒÚ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ MgSO4, ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ÙÒÛË Ù˘ ÙÈÌ‹˜ Ù˘ PaCO2 (·¤-

∂ÈÎfiÓ· 3. ªÂÁ¿ÏË Û˘ÏÏÔÁ‹ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ÛÙÔ ‰ÂÍ› ËÌÈıˆÚ¿ÎÈÔ.

Paediatriki 2004;67:281-286

ÚÈ· ·›Ì·ÙÔ˜ pH: 7,42, pO2: 99 mmHg, pCO2: 52 mmHg, HCO3-: 40). ªÂÙ¿ ·fi 48 ÒÚ˜ ÓÔÛËÏ›·˜ ÛÙË ª∂£, Ô ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ Î·È Ë ˘ÂÚηÓ›· ˘Ô¯ÒÚËÛ·Ó ÛËÌ·ÓÙÈο (ÙÈ̤˜ pCO2: 38-60 mmHg). ∏ ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË Ù˘ Û·Ï‚Ô˘Ù·ÌfiÏ˘ ‰È·ÎfiËÎÂ Î·È Ë ·ÁˆÁ‹ Û˘Ó¯›ÛÙËΠ̠ÙË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘, ·ÌÈÓÔÊ˘ÏÏ›Ó˘ ÛÂ Û˘Ó¯‹ ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË Î·È ÂÈÛÓÔÒÓ Û·Ï‚Ô˘Ù·ÌfiÏ˘ Î·È ‚ÚÔÌÈÔ‡¯Ô˘ ÈÚ·ÙÚfiÈÔ˘ ̤ۈ ÙÔ˘ ·Ó·Ó¢ÛÙ‹Ú·. ∏ ˘Ô¯ÒÚËÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Û˘Ó¤ÂÛ ¯ÚÔÓÈο Ì ÙËÓ ‡ÊÂÛË Ù˘ Ïԛ̈͢. O ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛ ÛÙȘ 48 ÒÚ˜ Î·È ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û ÙÒÛË Ù˘ CRP (43 mg/L). ∆Ô ‚Ú¤ÊÔ˜ ·Ú¤ÌÂÈÓ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi 16 Ë̤Ú˜, ÂÓÒ Ô ÛˆÏ‹Ó·˜ ıˆÚ·ÎÔÛÙÔÌ›·˜ ·Ú¤ÌÂÈÓ Â› 30 Ë̤Ú˜. ∆Ë 12Ë, 20‹ Î·È 23Ë Ë̤ڷ ÓÔÛËÏ›·˜ ÛÙË ª∂£, ÂÌÊ¿ÓÈÛ Ӥ· ‰È·Ê˘Á‹ Î·È Û˘ÏÏÔÁ‹ ·¤Ú· ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ, Ë ÔÔ›· ·ÚÔ¯ÂÙ‡ÙËÎÂ, ÂÓÒ ÙË 12Ë Ë̤ڷ ·ÚÔ˘Û›·ÛÂ Î·È ˘Ô‰fiÚÈÔ ÂÌʇÛËÌ· ıÒڷη-ÙÚ·¯‹ÏÔ˘ Ô˘ ˘Ô¯ÒÚËÛ ÛÙ·‰È·Î¿ Û 4-5 Ë̤Ú˜ (∂ÈÎfiÓ· 5). ∆Ô ‚Ú¤ÊÔ˜ ÓÔÛËχÙËΠÁÈ· 26 Ë̤Ú˜ ÛÙË ª∂£ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, ÁÈ· ¿ÏϘ 8 Ë̤Ú˜ Û ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋. ∂Í‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Ì Â¿ÚÎÂÈ· ·Ó·Ó¢ÛÙÈÎÔ‡, ‰ËÏ·‰‹ ¯ˆÚ›˜ ‰‡ÛÓÔÈ·, ·Ó·ÓÔ¤˜ 35-40/min Î·È Ê˘ÛÈÔÏÔÁÈÎfi ·Ó·Ó¢ÛÙÈÎfi „Èı‡ÚÈÛÌ·, ¯ˆÚ›˜ ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛ˘ O2 (∂ÈÎfiÓ· 6). ¢ÂÓ ‰È·ÈÛÙÒıËΠοÔÈ· Â›ÙˆÛË ·fi ÙË ‚·ÚÈ¿ ÔͤˆÛË (pH: 6,91) Î·È ˘ÂÚηÓ›· (PaCO2: 194 mmHg) Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Î·Ù¿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘.

∂ÈÎfiÓ· 4. ¶·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ ÛÙÔÓ ‰ÂÍÈfi ̤ÛÔ, οو Î·È ¿Óˆ ÏÔ‚fi ÌÂÙ¿ ÙËÓ ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡. ¶·ÚÔ˘Û›· ۈϋӷ ıˆÚ·ÎÔÛÙÔÌ›·˜.

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∂ÈÎfiÓ· 5. ÀÔ‰fiÚÈÔ ÂÌʇÛËÌ· ıÒڷη Î·È ÙÚ·¯‹ÏÔ˘.

™˘˙‹ÙËÛË ∏ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›· ¤¯ÂÈ ˆ˜ ·›ÙÈÔ ÙÔÓ ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ. ™˘Ó‹ıˆ˜ ÂÍÂÏ›ÛÛÂÙ·È ‚·Ú¤ˆ˜ Î·È Ù·¯¤ˆ˜. ∂›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ ·fi ÙËÓ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ Î·È ÙËÓ ÈÔÁÂÓ‹ Ó¢ÌÔÓ›·. ¢È·ÎÚ›ÓÔÓÙ·È ‰‡Ô ÌÔÚʤ˜: Ë ÚˆÙÔ·ı‹˜ Ô˘ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ Î·È ÚÔηÏÂ›Ù·È Ì ÙËÓ Â›ÛÔ‰Ô Î·È ÚÔÛ‚ÔÏ‹ ÙˆÓ Ó¢ÌfiÓˆÓ ·fi ÙÔ ÌÈÎÚfi‚ÈÔ Ì¤Ûˆ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ Ô‰Ô‡ Î·È Ë ‰Â˘ÙÂÚÔ·ı‹˜ Ô˘ ÔÊ›ÏÂÙ·È Û ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔÚ¿ ηٿ ÙË ‰È·‰ÚÔÌ‹ ÂÓ‰Ôηډ›Ùȉ·˜ ‹ ÛË„·ÈÌ›·˜, ÂÓÒ Û˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯ÂÈ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ ÂÛÙ›· ÛÙÔ ‰¤ÚÌ· ‹ ÛÙ· ̷Ϸο ÌfiÚÈ·. ∏ ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓ›· ÚÔÛ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ ·È‰È¿, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÚÔËÁÔ˘Ì¤Óˆ˜ ˘ÁÈ‹, ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ ÛÙ· 3/4 ÙˆÓ ÂÚÈÙÒÛÂˆÓ (1,3). ÕÏÏÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ Â›Ó·È ÔÈ ¯ÚfiÓȘ Ó¢ÌÔÓÈΤ˜ ÓfiÛÔÈ (ÈÓÔ΢ÛÙÈ΋), Ë ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ÔÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È Ë ·ÚÔ˘Û›· ͤÓÔ˘ ÛÒÌ·ÙÔ˜ (1,7). πÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ·‰ÂÓÔ˚Ô‡˜ Î·È Î˘Ú›ˆ˜ ·fi ÙÔÓ Èfi Ù˘ ÁÚ›˘, ÚÔηÏÔ‡Ó Ì›· ÂÔ¯È΋ ÎÔڇʈÛË ÛÙË Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ (ÌÂٷ͇ OÎÙˆ‚Ú›Ô˘ Î·È ª·˝Ô˘), Èı·Ófiٷٷ ̤ۈ ÙÚÔÔÔ›ËÛ˘ ÙˆÓ ÙÔÈÎÒÓ ·Ì˘ÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (2,6,7). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ ÛÙËÓ Ù˘È΋ Ù˘ ÌÔÚÊ‹, Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È ÌÂÙ¿ ·fi Ì›· ‹È· Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÚÂÙfi, ‚‹¯·, Ù·¯‡ÓÔÈ· Î·È ÁÔÁÁ˘ÛÌfi. ™˘¯Ó¤˜ Â›Ó·È ÔÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜. ¶Ôχ Û‡ÓÙÔÌ· ·ÎÔÏÔ˘ı› Ï‹ı·ÚÁÔ˜ Î·È ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ì ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ, ÂÈÛÔÏ΋ ÌÂÛÔχÚÈˆÓ ‰È·ÛÙËÌ¿ÙˆÓ Î·È Î˘¿ÓˆÛË. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ηı›ÛÙ·Ù·È ‰Ú·Ì·ÙÈ΋ fiÙ·Ó ÂΉËÏÒÓÔÓÙ·È ÔÈ ÂÈÏÔΤ˜ (˘ÔÓ¢ÌÔıÒڷη˜) Î·È ÂÁηı›ÛÙ·Ù·È ϤÔÓ ‚·ÚÈ¿

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∂ÈÎfiÓ· 6. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ηٿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·È‰ÈÔ‡.

·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· Û˘Ó‹ıˆ˜ ··ÈÙ› Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ Ù·˘ÙÔÔÈËı› ‚·Ú‡Ù·ÙË ÌÔÚÊ‹ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ Û ·È‰È¿, Ë ÓÂÎÚˆÙÈ΋ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi shock, Ï¢ÎÔÂÓ›·, ·ÈÌfiÙ˘ÛË Î·È ˘„ËÏ‹ ıÓËÙfiÙËÙ·. ¶ÚÔηÏÂ›Ù·È ·fi ÛÙÂϤ¯Ë ÙÔ˘ ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘ Ô˘ ·Ú¿ÁÔ˘Ó ÙË Ï¢ÎÔÙÔÍ›ÓË Panton-Valentine (8). ™Ù· ÓÂÔÁÓ¿ Î·È ÛÙ· ‚Ú¤ÊË, Ë ÂͤÏÈÍË Ù˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ Â›Ó·È Ú·Á‰·›· Î·È Û˘Ó‰˘¿˙ÂÙ·È Ì ˘„ËÏ‹ ıÓËÙfiÙËÙ· ̤۷ Û ϛÁ˜ ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. ∏ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ Ó· ‰Â›¯ÓÂÈ ‰È¿Û·ÚÙ˜ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈΤ˜ ‰ÈËı‹ÛÂȘ, Û˘Ó‹ıˆ˜ ÂÙÂÚfiÏ¢Ú˜. ∂ÓÙfi˜ ˆÚÒÓ, ÔÈ ‚Ï¿‚˜ ÂÍÂÏ›ÛÛÔÓÙ·È Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ˘ÎÓÒÛÂȘ, ÓÂ˘Ì·ÙÔ΋Ϙ, Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ‹ ·˘ÙfiÌ·ÙÔ˜ Ó¢ÌÔıÒڷη˜. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ÚÒÙË ·ÎÙÈÓÔÁÚ·Ê›· ¤‰ÂÈÍ ‡ÎÓˆÛË ‰ÂÍÈÔ‡ οو ÏÔ‚Ô‡ (¢∫§) Ì ·ÚÔ˘Û›· ÓÂ˘Ì·ÙÔ΋Ï˘. ƒ·Á‰·›·, ÂÓÙfi˜ 10 ˆÚÒÓ, ÙfiÛÔ Ë ÎÏÈÓÈ΋ fiÛÔ Î·È Ë ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ ÂȉÂÈÓÒıËηÓ, Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙfiÌ·ÙÔ˘ Ó¢ÌÔıÒڷη Î·È Ï¢ÚÈÙÈ΋˜ Û˘ÏÏÔÁ‹˜. ∏ ·ÚÔ˘Û›· ÓÂ˘Ì·ÙÔÎËÏÒÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ Ù˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜, fi¯È fï˜ ·ıÔÁÓˆÌÔÓÈ΋. ∂ÌÊ·Ó›˙ÔÓÙ·È Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 50%. ™˘¯Ó¿, ·ÏÏ¿˙Ô˘Ó Û ̤ÁÂıÔ˜ Î·È ·ÚÈıÌfi. ∂›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ó¤ÎÚˆÛ˘ ΢„ÂÏ›‰ˆÓ Î·È ‚ÚÔÁ¯ÈÔÏ›ˆÓ. ∞ÎÙÈÓÔÏÔÁÈο, ÌÔÚ› Ó· ·Ú·Ì¤ÓÔ˘Ó ·ÎfiÌË Î·È Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ıÂÚ·›·˜. OÈ Ï¢ÚÈÙÈΤ˜ Û˘ÏÏÔÁ¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÂ

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ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 70%, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‰Â ̤ÚÔ˜ ÂÍ ·˘ÙÒÓ ÂÌÊ·Ó›˙ÂÙ·È ÓˆÚ›˜ ηٿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘.

OÈ Rebhan Î·È Edwards ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÛÔÛÙfi 59% ÂÎ ÙˆÓ 329 ·ÛıÂÓÒÓ Ì ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›· ÂÌÊ¿ÓÈ˙ Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ÛÙËÓ ÚÒÙË ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηÈ, ÂÈϤÔÓ, ÔÛÔÛÙfi 19% ·ÚÔ˘Û›·˙ ÛÙË Û˘Ó¤¯ÂÈ· (4). OÈ Haggerty Î·È Hendren ‰È·ÈÛÙÒÓÔ˘Ó fiÙÈ ÙÔ 71% ÙˆÓ ·ÛıÂÓÒÓ Â›¯Â Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ηٿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (5). ¶ÓÂ˘Ì·ÙÔ΋Ϙ Î·È Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó Î·È ¿ÏϘ ‚·ÎÙËÚȷΤ˜ Ó¢ÌÔӛ˜ (Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, ÎÏÂÌÛȤÏÏ·, ·ÈÌfiÊÈÏÏÔ˜), ·ÏÏ¿ Î·È ÙÔ Ó¢ÌÔÓÈÎfi ·fiÛÙËÌ· ÌÂÙ¿ ·fi ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ÌÔÚ› Ó· ‰ÒÛÂÈ ·ÚfiÌÔÈ· ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ·.

O ·˘ÙfiÌ·ÙÔ˜ Ó¢ÌÔıÒڷη˜ ÂÌÊ·Ó›˙ÂÙ·È Û ÔÛÔÛÙfi 25-50% ÙˆÓ ÂÚÈÙÒÛˆÓ. OÈ Haggerty Î·È Hendren ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÙÔ 42% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·Û ·˘Ù‹ ÙËÓ ÂÈÏÔ΋ (5). ∏ Ú‹ÍË ÙˆÓ ÓÂ˘Ì·ÙÔÎËÏÒÓ Â›Ó·È ¤Ó·˜ ÂÎ ÙˆÓ ‰‡Ô Ì˯·ÓÈÛÌÒÓ ÚfiÎÏËÛ˘ Ó¢ÌÔıÒڷη. O ¿ÏÏÔ˜ Â›Ó·È Ë ‰ËÌÈÔ˘ÚÁ›· ‚ÚÔÁ¯ÔÏ¢ÚÈÙÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘. ∏ ÂÁηٿÛÙ·ÛË ·˘ÙfiÌ·ÙÔ˘ Ó¢ÌÔıÒڷη Û˘Ó‹ıˆ˜ ÚÔηÏ› ·ÈÊÓ›‰È· Âȉ›ӈÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Î˘ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÌÔÚ› Ó· Á›ÓÂÈ ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ Î·È ¯Ú‹˙ÂÈ Â›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛ˘. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ô ·˘ÙfiÌ·ÙÔ˜ Ó¢ÌÔıÒڷη˜ ‹Ù·Ó Ë ·ÈÙ›· Ù˘ ·ÈÊÓ›‰È·˜, ÔÍ›·˜ Âȉ›ӈÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ (·Ó·Ó¢ÛÙÈ΋ ·Ó·ÎÔ‹) Ô˘ Û˘Ó¤‚Ë 10 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙË ª∂£ Î·È Â¤‚·Ï ÙËÓ Â›ÁÔ˘Û· ‰È·ÛˆÏ‹ÓˆÛË Ù˘ ÙÚ·¯Â›·˜, ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ Ó¢ÌÔıÒڷη. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Ó¢ÌÔıÒڷη Û ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰˘ÛÎÔϛ˜ ÏfiÁˆ Ù˘ ÂÊ·ÚÌÔÁ‹˜ ıÂÙÈ΋˜ ›ÂÛ˘ ̤ۈ ÙÔ˘ ·Ó·Ó¢ÛÙ‹Ú·. ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ·ÚÔ˘Û›·Û ·ÚÎÂÙ¤˜ ˘ÔÙÚÔ¤˜ ÙÔ˘ Ó¢ÌÔıÒڷη, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó˘¿Ú¯ÔÓÙÔ˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ ··ÈÙ‹ıËÎ·Ó ˘„ËϤ˜ ÂÈÛÓ¢ÛÙÈΤ˜ ȤÛÂȘ ÁÈ· ÙÔÓ ·ÂÚÈÛÌfi ÙÔ˘. ∏ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË MgSO4 ÌÔÚ› Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ‚·ÚÈ¿˜ ·ÛıÌ·ÙÈ΋˜ ÎÚ›Û˘. À¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ÙfiÛÔ Û ·È‰È¿ fiÛÔ Î·È Û ÂÓ‹ÏÈΘ (9,10). ∏ ‰È¿ÁÓˆÛË Ù˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, ÙÔ˘ ·›Ì·ÙÔ˜ (fiˆ˜ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË) - Ë ÔÔ›· Û˘Ó‹ıˆ˜ Â›Ó·È ·ÚÓËÙÈ΋ - ‹ ÛÙÔ ˘ÏÈÎfi ÙˆÓ ‚ÚÔÁ¯Ô·Ó·ÚÚÔÊ‹ÛˆÓ. ∏ ·ÔÌfiÓˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔ

Paediatriki 2004;67:281-286

ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ¤ÎÏ˘Ì· ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈ΋. ∆Ô Ï¢ÚÈÙÈÎfi ˘ÁÚfi Â›Ó·È ÂÍȉڈ̷ÙÈÎfi. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›· ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ÌfiÓÔ ÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹, ·ÏÏ¿ Î·È ÙËÓ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ, ȉȷ›ÙÂÚ· ÙÔ˘ Ó¢ÌÔıÒڷη Î·È ÙˆÓ Ï¢ÚÈÙÈÎÒÓ Û˘ÏÏÔÁÒÓ, ÔÈ Ôԛ˜ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ··ÈÙÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡. OÈ Ï¢ÚÈÙÈΤ˜ Û˘ÏÏÔÁ¤˜ Ú¤ÂÈ ¿ÓÙ· Ó· ·ÚÔ¯ÂÙ‡ÔÓÙ·È Ì ¢ڇ ۈϋӷ ıˆÚ·ÎÔÛÙÔÌ›·˜, ·ÊÔ‡ ·˘Ùfi ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ Èı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘. ∏ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Â›Ó·È ‚Ú·‰Â›·. O ˘ÚÂÙfi˜ ÌÔÚ› Ó· ÂÈ̤ÓÂÈ ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ Ù˘ Ì›·˜ ‚‰ÔÌ¿‰·˜ (ÛÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi Ô ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛ Û 48 ÒÚ˜). ∏ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· Û˘Ó¯›˙ÂÙ·È ÁÈ· ‰È¿ÛÙËÌ· 3-4 ‚‰ÔÌ¿‰ˆÓ, ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘. ∆Ô ·Ú¯ÈÎfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ÎÂÊ·ÏÔÛÔÚ›ÓË ÙÚ›Ù˘ ÁÂÓÈ¿˜ Î·È Ì›· ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ ËÌÈÛ˘ÓıÂÙÈ΋ ÂÓÈÎÈÏ›ÓË (ÂÓÈÎÈÏÈÓ¿ÛË ·ÓıÂÎÙÈ΋), fiˆ˜ Ë ÔÍ·ÎÈÏÏ›ÓË. ¢Â‰Ô̤Ó˘, fï˜, Ù˘ ‚·Ú‡ÙËÙ·˜ Î·È Ù˘ Ù·¯Â›·˜ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Î·È Ù˘ Èı·ÓfiÙËÙ·˜ Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ Ó· Â›Ó·È ·ÓıÂÎÙÈÎfi˜ ÛÙË ÌÂıÈÎÈÏÏ›ÓË (MRSA), Ë ÔÍ·ÎÈÏÏ›ÓË ı· Ú¤ÂÈ Ó· ·ÓÙÈηı›ÛÙ·Ù·È Ì ÙÂ˚ÎÔÏ·Ó›ÓË ‹ ‚·ÓÎÔÌ˘Î›ÓË. ∏ ·ÔÊÏÔ›ˆÛË Ù˘ ˘Â˙ÔΈÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ‰ÂÓ ıˆÚÂ›Ù·È Û‹ÌÂÚ· ··Ú·›ÙËÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë Ì·ÎÚÔÚfiıÂÛÌË ÚfiÁÓˆÛË Â›Ó·È Ôχ ηϋ, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ï‹Ú˘ ·ÔηٿÛÙ·ÛË ÙˆÓ ·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ ÚÔηÏ› Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ Â›Ó·È Î·ı˘ÛÙÂÚË̤ÓË. ™Â ‰‡Ô ÌÂÁ¿Ï˜ ÛÂÈÚ¤˜ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÛÙÔÓ Ó‡ÌÔÓ·, Ë ‰Â ıÓËÙfiÙËÙ· Ù˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ ·Ó¤Ú¯ÂÙ·È Û 10% (3). ∂Âȉ‹ Ë ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›· Â›Ó·È Ì›· ‚·ÚÈ¿ Î·È Ù·¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓË ÓfiÛÔ˜, ı· Ú¤ÂÈ ¿ÓÙ· Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Î¿ı ·È‰ÈÔ‡ Ì ˘ÚÂÙfi Î·È ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. µÈ‚ÏÈÔÁÚ·Ê›· 1. ª·ÙÛ·ÓÈÒÙ˘ ¡™, ∫·Ú¿ıÈÔ˜ £∂ Î·È Û˘Ó. ™Ù·Ê˘ÏÔÎÔÎÎÈ΋ Ó¢ÌÔÓ›·. ¶·È‰È·ÙÚÈ΋; 1994. ∆fiÌÔ˜ 3. ÛÂÏ. 1431-1432.

2. Behrman RE, Kliegman RM, Arvin AM. Staphylococcal pneumonia. Nelson Textbook of Pediatrics. 15th ed.

Philadelphia: WB Saunders; 1996. p. 719-720.

3. Melish ME, Campbell KA. Coagulase-positive staphylococcal infections. Textbook of Pediatric Infectious Diseases. 4th ed. Philadelphia: WB Saunders; 1998. p.

1048-1050.

4. Rebhan AW, Edwards HE. Staphylococcal pneumonia: a review of 329 cases. Can Med Assoc J 1960;82:513-517.

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5. Hendren WH 3rd, Haggerty RJ. Staphylococcic pneumonia in infancy and childhood. Analysis of 75 cases. J Am Med Assoc 1958;168:6-16.

6. Jain A, Ben-Ami T, Daum RS. Staphylococcal infections in children: part 2. Pediatr Rev 1999;20:219-227.

7. Mahabee-Gittens EM. Pediatric pneumonia. Clin Pediatr Emerg Med 2002;3:200-214.

8. Gillet Y, Issartel B, Vanhems P, Lina G, Vandenesch F, Etienne J et al. Severe staphylococcal pneumonia in children. Arch Pediatr 2001;8 (Suppl 4):S742-S746.

9. Okayama H, Okayama M, Aikawa T, Sasaki M, Takishima T. Treatment of status asthmaticus with intravenous magnesium sulfate. J Asthma 1991;28:11-17.

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10. Pabon H, Monem G, Kissoon N. Safety and efficacy of magnesium sulfate infusions in children with status asthmaticus. Pediatr Emerg Care 1994;10:200-203.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-09-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ºÂÏ›ÙÛÈ· ∫·Î·‚¿ ∞ı. º›ÏÈÔ˘ 3, ¡¤· ºÈÏÔı¤Ë, ∆.∫. 115 24, ∞ı‹Ó·

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Paediatriki 2004;67:287-292

CASE REPORT

Aspergillus niger Û ‰‡Ô Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ π. §·Ì·‰·Ú›‰Ë˜1, ∞. µÂÏÂÁÚ¿ÎË2, ª. £ÂÔ‰ˆÚ¿ÎË1, ∂. ¢ËÌËÙÚ›Ô˘3, ∂. ªÈ¯ÂϷοÎË3

Aspergillus niger in two very low birth weight neonates I. Labadaridis1, A. Velegraki2, M. Theodoraki1, E. Dimitriou3, H. Michelakakis3

¶ÂÚ›ÏË„Ë: ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÒÓ (∞ Î·È µ) Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ÛÙÔ ·›Ì· ÙˆÓ ÔÔ›ˆÓ ·ÓȯÓ‡ıËÎÂ Î·È Ù·˘ÙÔÔÈ‹ıËΠAspergillus niger Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÂıfi‰ˆÓ ·Ó›¯Ó¢Û˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (PCR) Î·È Ì¤ÙÚËÛ˘ ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ̇ÎËÙ·. ™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË, Ë ıÂÙÈ΋ PCR Û˘Óԉ¢fiÙ·Ó ·fi ·˘ÍË̤ÓÔ Ù›ÙÏÔ ·ÓÙÈÁfiÓˆÓ Î·È ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË, ÂÓÒ ÙÔ ÓÂÔÁÓfi η٤ÏËÍ Ì ÛËÙÈÎfi shock. ∞ÓÙ›ıÂÙ·, ÛÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ë ıÂÙÈ΋ PCR Û˘Óԉ¢fiÙ·Ó ·fi Ê˘ÛÈÔÏÔÁÈÎfi Ù›ÙÏÔ ·ÓÙÈÁfiÓˆÓ Î·È ‹È· ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ô˘ ‚ÂÏÙÈÒıËΠ¯ˆÚ›˜ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜. ∂ÈϤÔÓ, Ì›· ‰Â‡ÙÂÚË PCR ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË, ¤Ó· ¤Ó˙˘ÌÔ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÂÓÂÚÁÔÔÈË̤ӷ Ì·ÎÚÔÊ¿Á· Î·È ·˘Í¿ÓÂÙ·È ÛÙȘ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ, ·˘Í‹ıËΠÛÙ· Ô‡Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ ∞ ÌfiÓÔ ÙË 14Ë Ë̤ڷ ˙ˆ‹˜, ÂÓÒ ÛÙÔ ÓÂÔÁÓfi µ ‚Ú¤ıËÎ·Ó ·˘ÍË̤ӷ Â›‰· ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ·fi ÙËÓ 1Ë Ë̤ڷ ˙ˆ‹˜. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂıfi‰ˆÓ, ‰È·‰Ô¯ÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È Ë Û˘ÓÂÎÙ›ÌËÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Â›Ó·È ÂÍ·ÈÚÂÙÈ΋˜ ÛËÌ·Û›·˜ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛˆÓ. ∏ ‰È·ÊÔÚÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÛÙ· ‰‡Ô ÓÂÔÁÓ¿ Èı·ÓfiÓ ˘Ô‰ËÏÒÓÂÈ ‰È·ÊÔÚÔÔ›ËÛË ˆ˜ ÚÔ˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÙÔ˘˜.

Abstract: The cases of two very low birth weight neonates (A and B) are presented in which Aspergillus niger was identified through the detection of the DNA of the fungus by PCR, and the quantitation of its antigen titer. In neonate A, the positive PCR was associated with an elevated antigen titer and a severe clinical condition that deteriorated and culminated in death from septic shock. In neonate B, the positive PCR was associated with a normal antigen titer and a mild clinical condition that improved without antifungal treatment. A second PCR test was normal.

Chitotriosidase, an enzyme that increases during fungal infection and is produced by activated macrophages, increased in the urine of neonate A only on the 14th day of life. On the other hand, increased levels were found in both plasma and urine of neonate B from the 1st day of life. The results of this study show the importance of applying different methods and serial analyses as well as the need to interpret the results in combination with the clinical picture in the diagnosis of aspergillosis. The difference in the behaviour of chitotriosidase in the two neonates is possibly related to a different state of activation of their macrophages.

§¤ÍÂȘ ÎÏÂȉȿ: ∞spergillus niger, PCR, Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ, ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË.

Key words: Aspergillus niger, PCR, antigen titer, chitotriosidase.

∂ÈÛ·ÁˆÁ‹ OÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ¤¯Ô˘Ó ·Ó·‰Âȯı›, ÙÂÏÂ˘Ù·›·, Û ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙË-

Ù·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙȘ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ÓÂÔÁÓÒÓ (ª∂¡N). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 2-5% ÙˆÓ ÓÂÔÁÓÒÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ı·

1 ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜, ¶ÂÈÚ·È¿˜ 2 ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ª˘ÎËÙÈ¿ÛˆÓ, π·ÙÚÈ΋ ™¯ÔÏ‹, ∞ı‹Ó· 3 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó·

1 Intensive Care Unit of Neonates, General Hospital of Nikaia, Piraeus 2 Mycology Reference Laboratory, Medical School, Athens 3 Institute of Child Health, Athens

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·Ó·Ù‡ÍÂÈ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, ÂÓÒ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÏÔÈÌÒÍÂȘ ÔÊ›ÏÔÓÙ·È Û ‰È·ÊÔÚÂÙÈο ›‰Ë Candida (1-3). ∞ÓÙ›ıÂÙ·, ÔÈ ·ÛÂÚÁÈÏÏÒÛÂȘ ÛÙ· ÓÂÔÁÓ¿ Â›Ó·È Û¿ÓȘ Î·È ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ó·ÎÔÈÓˆı› ·ÊÔÚÔ‡Ó Û Aspergillus fumigatus Î·È flavus, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÌfiÓÔ Ù¤ÛÛÂÚ· ÂÚÈÛÙ·ÙÈο Aspergillus niger (3-7). ∏ ¤ÁηÈÚË Î·È ¤Á΢ÚË ‰È¿ÁÓˆÛË ÙˆÓ Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ. π‰È·›ÙÂÚ·, Ë ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ ·ÔÙÂÏ›, ·ÎfiÌ· Î·È Û‹ÌÂÚ·, ÛËÌ·ÓÙÈ΋ ÚfiÎÏËÛË Î·È Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ë ‰È¿ÁÓˆÛË Ù¤ıËΠÌÂÙ¿ ı¿Ó·ÙÔÓ (3-6). ¶ÚfiÛÊ·Ù·, ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜ ÂÌÏÔ˘Ù›ÛÙËÎ·Ó Ì ÌÂıfi‰Ô˘˜ ·Ó›¯Ó¢Û˘ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ - PCR) Î·È Ì ÌÂıfi‰Ô˘˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Î·È ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ̇ÎËÙ·. OÈ Ù¯ÓÈΤ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ‹‰Ë ÂÊ·ÚÌÔÛÙ› Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ (8,9). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÂÚÈÙÒÛÂȘ ‰‡Ô ÓÂÔÁÓÒÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ÛÙ· ÔÔ›· ·ÓȯÓ‡ıËÎÂ Î·È Ù·˘ÙÔÔÈ‹ıËΠAspergillus niger Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ÌÂıfi‰ˆÓ. ∂ÈϤÔÓ, Ù· ÓÂÔÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó Ì ÌÂÙÚ‹ÛÂȘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘, ÂÓfi˜ ÂÓ˙‡ÌÔ˘ ÙÔ ÔÔ›Ô ·˘Í¿ÓÂÙ·È ÛÙȘ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ (10,11). ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚ›ÙˆÛË ÚÒÙË ¶ÚfiˆÚÔ ÓÂÔÁÓfi (ÓÂÔÁÓfi ∞), ËÏÈΛ·˜ ·ËÛ˘ 25 ‚‰ÔÌ¿‰ˆÓ, ÁÂÓÓ‹ıËΠÛÙÔ Û›ÙÈ Ì ÎÔÏÈÎfi ÙÔÎÂÙfi Î·È Ì µ° 830 g. ∞̤ۈ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÌÂٷʤÚıËΠÛÙË ª∂¡¡ Ì ˘ÔıÂÚÌ›· (<35ÔC) Î·È ‚Ú·‰˘Î·Ú‰›·. ŒÁÈÓ ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÓË„Ë, ‰È·ÛˆÏ‹ÓˆÛË Î·È ¯ÔÚ‹ÁËÛË ·‰ÚÂÓ·Ï›Ó˘ ÂÓ‰ÔÙÚ·¯Âȷο, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ILCOR. ∆¤ıËΠ۠Ì˯·ÓÈ΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË, ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Î·È ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ (Amplicilline + Netilmicin), ÂÓÒ ¯ÔÚËÁ‹ıËΠ‰‡Ô ÊÔÚ¤˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÏfiÁˆ ™∞¢. ∆ËÓ 4Ë Ë̤ڷ ˙ˆ‹˜ ÂÌÊ¿ÓÈÛ ˘ÂÚÁÏ˘Î·ÈÌ›·, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘. ∆ËÓ 8Ë Ë̤ڷ ˙ˆ‹˜, ÏfiÁˆ ˘ÂÚÁÏ˘Î·ÈÌÈÒÓ Î·È ÓˆıÚfiÙËÙ·˜, ¤ÁÈÓ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ïԛ̈͢. ∆Ë 10Ë Ë̤ڷ ˙ˆ‹˜, ÏfiÁˆ ÌË ÈηÓÔÔÈËÙÈ΋˜ ‚ÂÏÙ›ˆÛ˘ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙˆÓ ·˘ÍËÌ¤ÓˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (20.500 Î.Î.¯), ÙÚÔÔÔÈ‹ıËΠÙÔ Û¯‹Ì· ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û Amikacin + Teicoplanine. ∆ËÓ 11Ë Ë̤ڷ ˙ˆ‹˜, ÙÔ ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛ Âȉ›ӈÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ì ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ÛÙÔÓ

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·Ó·Ó¢ÛÙ‹Ú· Î·È ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÂÓ‰ÂÈÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·˜. ∆Ë 12Ë Ë̤ڷ ˙ˆ‹˜ ¤ÁÈÓ ÁÓˆÛÙ‹ Ë ·Ó¿Ù˘ÍË Ì˘Î‹ÙˆÓ Û ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Ù˘ 8˘ Ë̤ڷ˜, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÌfiÚÂÛ·Ó Ó· Ù·˘ÙÔÔÈËıÔ‡Ó Î·È ¯ÔÚËÁ‹ıËΠ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹ Ì Amphotericin B Liposome + Flucytosine, ÂÓÒ ·Ú¿ÏÏËÏ· ‰È·ÎfiËÎÂ Ë ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹. ∆Ô ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ÛÙ·‰È·Î‹ Âȉ›ӈÛË Ù˘ ÁÂÓÈ΋˜ ÙÔ˘ ηٿÛÙ·Û˘, ÂÌÊ·Ó›˙ÔÓÙ·˜ ˘ÚÂÙfi, Ôȉ‹Ì·Ù·, ˘fiÙ·ÛË, ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Û Ô͢ÁfiÓÔ Î·È ‚Ú·‰˘Î·Ú‰›·. ÃÔÚËÁ‹ıËÎ·Ó Ï¿ÛÌ· (FFP) Î·È ÈÓfiÙÚÔ·. ∫·Ù¤ÏËÍ ÙË 14Ë Ë̤ڷ ˙ˆ‹˜ Ì ÂÈÎfiÓ· ÛË„·ÈÌÈÎÔ‡ shock. ∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÌÂÙÚ‹ıËΠ۠‰Â›ÁÌ· Ï¿ÛÌ·ÙÔ˜ Î·È Ô‡ÚˆÓ ÙË 2Ë, 10Ë Î·È 14Ë Ë̤ڷ ˙ˆ‹˜ (¶›Ó·Î·˜ 1). ¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË ¶ÚfiˆÚÔ ÓÂÔÁÓfi (ÓÂÔÁÓfi µ), ËÏÈΛ·˜ ·ËÛ˘ 27 ‚‰ÔÌ¿‰ˆÓ, ÁÂÓÓ‹ıËΠ̠ÎÔÏÈÎfi ÙÔÎÂÙfi Î·È µ° 850 g (ÛÙË ÌËÙ¤Ú· ›¯·Ó ¯ÔÚËÁËı› ÙÚÂȘ ·ÎÏÔÈ ÛÙÂÚÔÂȉÒÓ). ∆Ô ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞Ú¯Èο, ¯ÔÚËÁ‹ıËΠO2 Û Hood ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, ¯ÚËÛÈÌÔÔÈ‹ıËΠÚÈÓÈÎfi CPAP. ∫·ıÂÙËÚÈ¿ÛÙËÎ·Ó Ù· ÔÌÊ·ÏÈο ·ÁÁ›· Î·È ÙÔÔıÂÙ‹ıËΠ‰È·‰ÂÚÌÈÎfi˜ ÊÏ‚ÔηıÂÙ‹Ú·˜ ÂÚÈÊÂÚÈο. ∆Ô ÓÂÔÁÓfi Ù¤ıËΠ۠ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Ì Theophylline, Ampicilline + Netilmicin. ∆ËÓ 7Ë Ë̤ڷ ˙ˆ‹˜ ¿Ú¯ÈÛ ÛÙ·‰È·Î‹ Û›ÙÈÛË, Ì ÛÙ·ıÂÚ‹ ‚ÂÏÙ›ˆÛË Ù˘ ÁÂÓÈ΋˜ ÙÔ˘ ηٿÛÙ·Û˘. ∆ËÓ 21Ë Ë̤ڷ ˙ˆ‹˜ ÂÌÊ¿ÓÈÛ ˘ÚÂÙfi, ·ÁÁÂÈÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÓˆıÚfiÙËÙ· Î·È ˘fiÏÂÈÌÌ· ÛÙË Û›ÙÈÛË. ∂Ï‹ÊıË Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ Ïԛ̈͢ Î·È ¯ÔÚËÁ‹ıËΠAmikacin + Cefotaxime, Ô˘ ÙÚÔÔÔÈ‹ıËÎÂ, ÛÙË Û˘Ó¤¯ÂÈ·, Û Amikacin + Teicoplanine ÏfiÁˆ ÙÔ˘ ·ÓÙÈ‚ÈÔÁÚ¿ÌÌ·ÙÔ˜, ηıÒ˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ·Ó·Ù‡¯ıËΠStaphylococcus epidermidis. ∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÌÂÙÚ‹ıËΠ۠‰Â›ÁÌ· Ï¿ÛÌ·ÙÔ˜ Î·È Ô‡ÚˆÓ ÙËÓ 1Ë Ë̤ڷ ˙ˆ‹˜ ηÈ, ‰È·‰Ô¯Èο, ÙËÓ 21Ë, 24Ë, 36Ë Î·È 55Ë Ë̤ڷ ˙ˆ‹˜ (¶›Ó·Î·˜ 1). ∏ ·ÚÔ˘Û›· ÙÔ˘ Aspergillus niger Î·È ÛÙ· ‰‡Ô ÓÂÔÁÓ¿ ·ÓȯÓ‡ıËÎÂ Î·È Ù·˘ÙÔÔÈ‹ıËΠ̠PCR (∂ÈÎfiÓ· 1), ÂÓÒ ÂϤÁ¯ıËÎÂ Î·È Ô Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ, ÛÙÔ ÓÂÔÁÓfi ∞ ÙËÓ Ë̤ڷ ı·Ó¿ÙÔ˘ Î·È ÛÙÔ ÓÂÔÁÓfi µ ÙËÓ 27Ë Ë̤ڷ ˙ˆ‹˜ (¶›Ó·Î·˜ 1). ™ÙÔ ÓÂÔÁÓfi µ, ÏfiÁˆ Ù˘ ÛÙ·ıÂÚ‹˜ Î·È Î·Ï‹˜ ÂͤÏÈÍ‹˜ ÙÔ˘, ‰ÂÓ ¯ÔÚËÁ‹ıËΠ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹. O Â·Ó¤ÏÂÁ¯Ô˜ Ù˘ PCR ÙËÓ 55Ë Ë̤ڷ ˙ˆ‹˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∂Í‹Ïı Û ηϋ ηٿÛÙ·ÛË ÙËÓ 82Ë Ë̤ڷ ˙ˆ‹˜. ∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÌÂÙÚ‹ıËΠ̠ÙÔ ÊıÔÚ›˙ÔÓ ˘fiÛÙڈ̷ ÌÂı˘ÏÔ˘ÌÂÏÏÈÊÂÚ˘Ï-‚-d-N,N’,N’’-

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¶·È‰È·ÙÚÈ΋ 2004;67:287-292

Paediatriki 2004;67:287-292

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÛÙ· ÓÂÔÁÓ¿ ∞ Î·È µ H̤ڷ ˙ˆ‹˜

ÃÈÙÔÙÚÈÔ˙ȉ¿ÛË ¶Ï¿ÛÌ· O‡Ú· (nmoles/ (nmoles/mg/ ml/h) ÎÚ·Ù./h)

PCR (OÏÈÎfi ·›Ì·)

∆›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ (ng/ml)

¡ÂÔÁÓfi ∞ (∏°: 25 ‚‰ÔÌ¿‰Â˜, µ°: 830 g) ™Ù›ڷ

2Ë

12

-

7Ë

6

80

-

-

12Ë

-

-

£ÂÙÈÎfi ÁÈ· Aspergillus niger

5,4

14Ë

32

210

1Ë

205

21Ë

102

250 (5Ë Ë̤ڷ) -

27Ë

76

437

36Ë

153

16 (40‹ Ë̤ڷ)

55Ë

65

7 (57Ë Ë̤ڷ) 0-70 n=10

º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜

25-70 n=10

∫·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜

ª‡ÎËÙ˜ (‰ÂÓ Ù·˘ÙÔÔÈ‹ıËηÓ) ™Ù›ڷ

§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·/ ∞ÈÌÔÂÙ¿ÏÈ·

CRP (mg/dl)

ENY

21.100/ 313.000

4,8

-

5

16.100/ 142.000

24.900/ 29.000 ¡ÂÔÁÓfi µ (∏°: 27 ‚‰ÔÌ¿‰Â˜, µ°: 850 g) ™Ù›ڷ -

-

™Ù›ڷ

£ÂÙÈÎfi ÁÈ· Aspergillus niger -

0,85

Staphylococcus epidermidis

-

™Ù›ڷ Î/· Ô‡ÚˆÓ: ÛÙ›ڷ

∞ÚÓËÙÈÎfi <0,8

ÙÚÈ·ÎÂÙ˘ÏÔ¯ÈÙÔÙÚÈfi˙Ë ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ÙˆÓ ÓÂÔÁÓÒÓ, Û‡Ìʈӷ Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Hollak Î·È Û˘Ó (12).

O Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÂϤÁ¯ıËΠ̠Platelia Aspergillus (Biorad). ∆Ô DNA ·ÔÌÔÓÒıËΠۇÌʈӷ Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Velegraki Î·È Û˘Ó (13). O ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙÔ˘ DNA ¤ÁÈÓ Ì ÙË ¯Ú‹ÛË ÙˆÓ ·Ú·Î¿Ùˆ ÂÎÎÈÓËÙÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·ÛÂÚÁÈÏÏÔ„›Ó˘ ÙÔ˘ Aspergillus fumigatus: Pep 1 5’-TAGACAUUGGCACCACCCTC’-3’ Pep 22 5’-CTATGCCTGAGGGGCGAA-3’.

OÈ Û˘Óı‹Î˜ ÙÔ˘ PCR ‹Ù·Ó ·˘Ù¤˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ·fi ÙÔ˘˜ Kambouris Î·È Û˘Ó (14) Î·È ÔÈ ÂÚÈÔÚÈÛÙÈÎÔ› ¯¿ÚÙ˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘ PCR ¤ÁÈÓ·Ó Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÂÚÈÔÚÈÛÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ MspI. ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ ‰‡Ô ÓÂÔÁÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È ÛÙËÓ ∂ÈÎfiÓ· 1. ™˘˙‹ÙËÛË £ÂÙÈ΋ ηÏÏȤÚÁÂÈ· ÁÈ· ̇ÎËÙ˜, ¯ˆÚ›˜ fï˜ Ù·˘ÙÔÔ›ËÛË, ˘‹Ú¯Â ÌfiÓÔ ÛÙÔ ÓÂÔÁÓfi ∞, ÙËÓ 8Ë Ë̤ڷ ˙ˆ‹˜. ∏ ¯Ú‹ÛË PCR ‹Ù·Ó ηıÔÚÈÛÙÈ΋ ÁÈ·

6.179/ 192.000 7.800/ Î.Ê.

6.500/ 330.000

165

∫: 50 Î.Î.¯. §: 80 mg/dl ™: 120 mg/dl Î/·: ™Ù›ڷ

130 <2 <2 <2

5.990/ 320.000

8,6

9.500/ 486.000

2,3 3-9

ÙËÓ ·Ó›¯Ó¢ÛË Î·È ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Aspergillus niger. O ̇ÎËÙ·˜ ‚Ú¤ıËΠÛÙ· ÓÂÔÁÓ¿ ∞ Î·È µ ÙË 12Ë Î·È ÙËÓ 27Ë Ë̤ڷ ˙ˆ‹˜, ·ÓÙ›ÛÙÔȯ·. ™ÙÔ ÓÂÔÁÓfi ∞, Ë ‚·ÚÈ¿ ÂÈÎfiÓ· Ïԛ̈͢ Û˘Ó‰˘·˙fiÙ·Ó fi¯È ÌfiÓÔ Ì ÙË ıÂÙÈ΋ ·ÈÌÔηÏÏȤÚÁÂÈ· Î·È ÙË ıÂÙÈ΋ PCR, ·ÏÏ¿ Î·È Ì ·˘ÍË̤ÓÔ Ù›ÙÏÔ ·ÓÙÈÁfiÓˆÓ. ∏ Ú·Á‰·›· Âȉ›ӈÛË Î·È Ô ı¿Ó·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ‰ÂÓ Â¤ÙÚ„·Ó ÙËÓ Â·Ó¿ÏË„Ë Ù˘ PCR Î·È ÙË ‰Â‡ÙÂÚË Ì¤ÙÚËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ. ∞ÓÙ›ıÂÙ·, ÛÙÔ ÓÂÔÁÓfi µ, ÙÔ ÔÔ›Ô ‚ÂÏÙÈÒıËΠ¯ˆÚ›˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹, Ô Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·È ‰ÂÓ ˘‹ÚÍ ηÏÏȤÚÁÂÈ· ıÂÙÈ΋ ÁÈ· ̇ÎËÙ˜. ∂ÈϤÔÓ, Ì›· ‰Â‡ÙÂÚË PCR, 22 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÚÒÙË, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∞‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÛÙÔ ÓÂÔÁÓfi ∞ ‚Ú¤ıËΠÌfiÓÔ ÛÙ· Ô‡Ú·, ÙË 14Ë Ë̤ڷ ˙ˆ‹˜. ∞ÓÙ›ıÂÙ·, Ù· Â›‰· Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ µ ‹Ù·Ó ·˘ÍË̤ӷ ·fi ÙËÓ 1Ë Ë̤ڷ ˙ˆ‹˜ Î·È ÔÌ·ÏÔÔÈ‹ıËÎ·Ó ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ ÙÔ˘, ·Ú¿ÏÏËÏ· Ì ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÙÔ˘ ÂÈÎfiÓ·˜.

OÈ ·Û¤ÚÁÈÏÏÔÈ Â›Ó·È ·fi ÙÔ˘˜ ϤÔÓ ‰È·‰Â‰Ô̤ÓÔ˘˜ ̇ÎËÙ˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ™ÙÔ Á¤ÓÔ˜ ·˘Ùfi Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚ· ·fi 600 ›‰Ë

289

July August 04

07-10-04

13:52

™ÂÏ›‰·290

¶·È‰È·ÙÚÈ΋ 2004;67:287-292

∂ÈÎfiÓ· 1. ∂Ó‰ÂÈÎÙÈÎÔ› ÂÚÈÔÚÈÛÙÈÎÔ› ¯¿ÚÙ˜ ÚÔ˚fiÓÙˆÓ ÂÓ›Û¯˘Û˘ (RFLP’s) ·fi ηı·Ú¤˜ ηÏÏȤÚÁÂȘ Î·È ÎÏÈÓÈο ‰Â›ÁÌ·Ù·: ¶ÚÔ˚fiÓÙ· ÂÚÈÔÚÈÛÙÈÎÒÓ ¤„ÂˆÓ ƒ∂ƒ 1/22 Aspergillus sp. Û ‹Îو̷ ·Á·Úfi˙˘ 3%. ¢È·‰ÚÔÌ‹: 1) flavus (ηı·Úfi ηÏÏȤÚÁËÌ·), 2) A. niger (ηı·Úfi ηÏÏȤÚÁËÌ·), 3) ∞. fumigatus (ηı·Úfi ηÏÏȤÚÁËÌ·), 4) ∞. parasiticus (ηı·Úfi ηÏÏȤÚÁËÌ·), 5) ∞. niger (·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÌË ÂȉÈΤ˜ ˙ÒÓ˜ fiÙ·Ó ÂÓÈÛ¯‡ÂÙ·È DNA Aspergillus spp. ·fi ‚ÈÔÏÔÁÈο ˘ÁÚ¿ ÙˆÓ ·ÛıÂÓÒÓ), 6) ¢Â›ÎÙ˘ ÌÔÚÈ·ÎÒÓ ÌÂÁÂıÒÓ pBR322XMsp I.

Û·ÚÔÊ˘ÙÈÎÒÓ Î·È, Û˘Ó‹ıˆ˜, ÌË ·ıÔÁfiÓˆÓ Ì˘Î‹ÙˆÓ, ÔÎÙÒ ·fi Ù· ÔÔ›· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÏÔÈÌÒÍÂȘ ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ›‰Ë Aspergillus fumigatus Î·È flavus ıˆÚÔ‡ÓÙ·È Ù· ϤÔÓ ·ıÔÁfiÓ· (15). ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ·ÛÂÚÁÈÏÏÒÛÂˆÓ ·Ú·ÙËÚÂ›Ù·È Û ηÚÎÈÓÔ·ı›˜ Î·È ·ÛıÂÓ›˜ Ì Â›ÎÙËÙ˜ Î·È ÁÂÓÂÙÈΤ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ÏÔÈÌÒÍÂȘ ·˘Ù¤˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÛÔ‚·Ú¤˜ Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ı·Ó·ÙËÊfiÚ˜ (16,17). ¶·Ú’ fiÏÔ Ô˘ ÔÈ ÏÔÈÌÒÍÂȘ ·fi ̇ÎËÙ˜ ¤¯Ô˘Ó ·Ó·‰Âȯı› Û ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙË ÓÔÛËÏ›· ÓÂÔÁÓÒÓ Û ÂÓÙ·ÙÈΤ˜ ÌÔÓ¿‰Â˜, Ù· ÂÚÈÛÙ·ÙÈο ·ÛÂÚÁÈÏÏÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ Â›Ó·È Ôχ Ï›Á· (2,3,18). ∆· ÂÚÈÛÛfiÙÂÚ· ·ÊÔÚÔ‡Û·Ó ÛÙ· ›‰Ë Aspergillus fumigatus Î·È flavus, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÌfiÓÔ 4 ÂÚÈÙÒÛÂȘ Ì Aspergillus niger, Ì›· ·fi ÙȘ Ôԛ˜ ·ÊÔÚÔ‡Û Û ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË Î·È ı¿Ó·ÙÔ (4,5). ™ÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ Groll Î·È Û˘Ó (3) ÂÚÈÁÚ¿ÊÔÓÙ·È 44 ÂÚÈÛÙ·ÙÈο ·ÛÂÚÁÈÏÏÒÛˆÓ, Û ·È‰È¿ ËÏÈΛ·˜ 0-90 ËÌÂÚÒÓ ˙ˆ‹˜, 14 ·fi Ù· ÔÔ›· ›¯·Ó ‰È¿¯˘ÙË ·ÛÂÚÁ›ÏψÛË, 11 ÚˆÙÔÁÂÓ‹ ‰ÂÚÌ·ÙÈ΋, 10 ‰ÈÂÈÛ‰˘ÙÈ΋ Ó¢ÌÔÓÈ΋ Î·È 9 ›¯·Ó ·ÛÂÚÁ›ÏψÛË ÂÓÙÔÈṲ̂ÓË ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î.¿. ∏ Ïԛ̈ÍË ‹Ù·Ó ı·Ó·ÙËÊfiÚ· ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ‰ÂÓ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ıÂÚ·¢ÙÈο. ∞ÓÙ›ıÂÙ·, ÙÔ 73% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¤Ù˘¯·Ó ¤ÁηÈÚ˘ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÂÈ‚›ˆÛÂ. ∫·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ Â›Ó·È, ‚‚·›ˆ˜, Ë ¤ÁηÈÚË Î·È ¤Á΢ÚË ‰È¿ÁÓˆÛ‹ ÙÔ˘˜, Ô˘ ·ÎfiÌË Î·È Û‹ÌÂÚ· ·Ú·Ì¤ÓÂÈ Ì›· ÚfiÎÏËÛË.

290

Paediatriki 2004;67:287-292

OÈ Î·ÏÏȤÚÁÂȘ ·fi ÛÙ›ڷ ‚ÈÔÏÔÁÈο ˘ÏÈο Î·È Ë ÈÛÙÔÏÔÁÈ΋/ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‚ÈÔ„ÈÒÓ ·fi ÌÔÏ˘Ṳ̂ÓÔ˘˜ ÈÛÙÔ‡˜, Â›Ó·È ÔÈ Ì¤ıÔ‰ÔÈ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ ·ԉ‰ÂÈÁ̤ÓË ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ (19). øÛÙfiÛÔ, ÛÙËÓ Ú¿ÍË Î·È ÔÈ ‰‡Ô ̤ıÔ‰ÔÈ ÂÌÊ·Ó›˙Ô˘Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·. OÈ Î·ÏÏȤÚÁÂȘ ¤¯Ô˘Ó ÂÍ·ÈÚÂÙÈο ¯·ÌËÏ‹ ¢·ÈÛıËÛ›·. ¶·Ú·ÙËÚÂ›Ù·È ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· Ï·Óı·ÛÌ¤ÓˆÓ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÚÁ‹ ·Ó¿Ù˘ÍË ÙˆÓ ·ÛÂÚÁ›ÏÏˆÓ (20), ·ÏÏ¿ Î·È ÛÙËÓ Ù·¯Â›· οı·ÚÛË ÙˆÓ Ì˘Î‹ÙˆÓ ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›· (17). ∂ÈϤÔÓ, ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ‰ÂÓ ÛËÌ·›ÓÔ˘Ó Î·Ù’ ·Ó¿ÁÎË ÓfiÛÔ, ‰ÈfiÙÈ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Â›Ù Û ·ÔÈÎÈÛÌfi ÙÔ˘ ·ÛıÂÓÔ‡˜, fiˆ˜ ¤¯ÂÈ ·Ú·ÙËÚËı› Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜, ›Ù Û ÂÈÌÔχÓÛÂȘ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∏ Ï‹„Ë ‚ÈÔ„›·˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË Â›Ó·È ÂÊÈÎÙ‹ ÌfiÓÔ Û οÔȘ Û¿ÓȘ ÂÚÈÙÒÛÂȘ ·ÛÂÚÁ›ÏψÛ˘, Ì ÂΉËÏÒÛÂȘ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È Û ‡ÎÔÏ· ÚÔÛ‚¿ÛÈÌÔ˘˜ ÈÛÙÔ‡˜, ¤ÙÛÈ ÒÛÙ ӷ ÌËÓ ÂÈ‚·Ú‡ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ∂ÈϤÔÓ, Ë ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‰ÂÓ Â›Ó·È ¿ÓÙ· ·ÍÈfiÈÛÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·ÚÎÂÙÔ› ÓËÌ·ÙÔÂȉ›˜ ̇ÎËÙ˜ ¤¯Ô˘Ó ·ÚfiÌÔÈ· ÌÔÚÊÔÏÔÁ›· Ì ·˘Ù‹ ÙˆÓ ·ÛÂÚÁ›ÏÏˆÓ (9,17). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÛÙȘ ‰È·ÁÓˆÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ ¤¯ÂÈ ÚÔÛÙÂı› Ë ·Ó›¯Ó¢ÛË ·ÓÙÈÁfiÓˆÓ Î·È ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ̇ÎËÙ·. 梉Ҙ ıÂÙÈο Î·È „¢‰Ò˜ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ó ·Ó·ÊÂÚı› Ì ÙËÓ ÚÒÙË Ì¤ıÔ‰Ô Î·È „¢‰Ò˜ ıÂÙÈο Ì ÙË ‰Â‡ÙÂÚË. ¶ÚfiÛÊ·Ù·, Â›Û˘, ¤¯ÂÈ ·Ó·Ù˘¯ı› ̤ıÔ‰Ô˜ ·Ó›¯Ó¢Û˘ Î·È Ì¤ÙÚËÛ˘ ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ Ì ¯Ú‹ÛË ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ô˘ ¤¯ÂÈ Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· >90%. ¶ÚÔÙÂÈÓfiÌÂÓÔ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ ˆ˜ ıÂÙÈÎfi, Â›Ó·È Ë ‡·ÚÍË ‰‡Ô ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ٛÙÏÔ >1,5 OD (21,22). ∆· „¢‰Ò˜ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Ì ÙȘ ÌÂıfi‰Ô˘˜ PCR ıˆÚÂ›Ù·È fiÙÈ ‰ÂÓ ÔÊ›ÏÔÓÙ·È Û ÂÈÌÔχÓÛÂȘ. ∞ÓÙ›ıÂÙ·, ıˆÚÂ›Ù·È Èı·Ófi fiÙÈ ·ÓÙ·Ó·ÎÏÔ‡Ó ·ÔÈÎÈÛÌfi ‹/Î·È ·ÚÔ‰È΋ ·ÚÔ˘Û›· Ì˘Î‹ÙˆÓ ÛÙÔ ·›Ì· ÙˆÓ ·ÛıÂÓÒÓ (9).

OÈ ÂÚÈÔÚÈÛÌÔ› Î·È ÔÈ ‰˘Ó·ÙfiÙËÙ˜ ÙˆÓ ·Ú·¿Óˆ ÌÂıfi‰ˆÓ Ê·›ÓÔÓÙ·È ÛÙ· ÂÚÈÛÙ·ÙÈο Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, Ù· ÔÔ›· Î·È ·ÔÙÂÏÔ‡Ó, fiÛÔ Â›Ó·È ÁÓˆÛÙfi, ÙȘ ÚÒÙ˜ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÁÈ· ·ÛÂÚÁ›ÏψÛË Ì PCR. ™ÙÔ ÓÂÔÁÓfi ∞ ˘‹Ú¯Â ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ÁÈ· ̇ÎËÙ˜ Ô˘, fï˜, ‰ÂÓ ÌfiÚÂÛ·Ó Ó· Ù·˘ÙÔÔÈËıÔ‡Ó Î·Ù¿ ÙËÓ ·ÔÌfiÓˆÛË. O Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ ‹Ù·Ó Û·ÊÒ˜ ·ıÔÏÔÁÈÎfi˜ Î·È Ë PCR ıÂÙÈ΋, Ô‰ËÁÒÓÙ·˜ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË Aspergillus niger. ∏ ηٿÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó ‚·ÚÈ¿, ÂÍÂÏ›¯ıËΠٷ¯¤ˆ˜ Î·È ‰ÂÓ Â¤ÙÚ„ ÙË Ï‹„Ë Ó¤ˆÓ ‰ÂÈÁÌ¿ÙˆÓ.

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∞ÓÙ›ıÂÙ·, ÛÙÔ ÓÂÔÁÓfi µ, ÙÔ ÌfiÓÔ Â‡ÚËÌ· ‹Ù·Ó ¤Ó· ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· PCR Ô˘, fï˜, ‹Ù·Ó ·ÚÓËÙÈÎfi Û ¤Ó· ‰Â‡ÙÂÚÔ ‰Â›ÁÌ·. ∂ÈϤÔÓ, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û˘Ó‰˘¿˙ÔÓÙ·Ó Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û·ÊÒ˜ ËÈfiÙÂÚË ÙÔ˘ ÓÂÔÁÓÔ‡ ∞, ÂÓÒ Ë Î·Ù¿ÛÙ·Û‹ ÙÔ˘ ‚ÂÏÙÈÒıËΠ¯ˆÚ›˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ıÂÚ·›·. OÈ Û˘Óı‹Î˜ Ï‹„˘ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Î·È Ù˘ PCR οÓÔ˘Ó È‰È·›ÙÂÚ· Èı·Ófi ÙÔ ÁÂÁÔÓfi˜ ÙÔ ·Ú¯ÈÎfi ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ÔÊ›ÏÂÙ·È Û ÂÈÌfiÏ˘ÓÛË, ·ÏÏ¿ Ó· ·ÓÙ·Ó·ÎÏ¿ ·ÔÈÎÈÛÌfi ‹/Î·È ·ÚÔ‰È΋ ·ÚÔ˘Û›· ÙÔ˘ ̇ÎËÙ·, fiˆ˜ ¤¯ÂÈ ÚÔÙ·ı› Î·È ÛÙÔ ·ÚÂÏıfiÓ (9). º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È ‰È·‰Ô¯ÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È Ë Û˘ÓÂÎÙ›ÌËÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Â›Ó·È ÂÍ·ÈÚÂÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛˆÓ. ∏ ·ÓıÚÒÈÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Â›Ó·È ¤Ó· ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚÈṲ̂ÓÔ ¤Ó˙˘ÌÔ Ì ¯ÈÙÈÓÔÏ˘ÙÈ΋ ‰Ú¿ÛË, Ô˘ ·Ú¿ÁÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ·fi ÂÓÂÚÁÔÔÈË̤ӷ Ì·ÎÚÔÊ¿Á·. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ‚Ú¤ıËΠ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ÓÂÔÁÓ¿, ÚÈÓ Î·È ÛÙË ‰È¿ÁÓˆÛË Ïԛ̈͢ ·fi Candida albicans. ∆· Â›‰· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒıËÎ·Ó ‹ ·˘Í‹ıËÎ·Ó ·Ú¿ÏÏËÏ· Ì ÙËÓ ÎÏÈÓÈ΋ ÔÚ›· ÙˆÓ ·ÛıÂÓÒÓ (10,11). ∞‡ÍËÛË Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘, Ô˘ fï˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÙˆÓ ·˘Í‹ÛÂˆÓ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÏÔÈÌÒÍÂȘ ·fi Candida albicans ·ÓÙ›ÛÙÔȯ˘ ‚·Ú‡ÙËÙ·˜ (11), ·Ú·ÙËÚ‹ıËΠÛÙÔ ÓÂÔÁÓfi ∞ ÌfiÓÔ ÙË 14Ë Ë̤ڷ ˙ˆ‹˜. ∞ÓÙ›ıÂÙ·, ÙÔ ÓÂÔÁÓfi µ, Ô˘ ‰ÂÓ ·Ó¤Ù˘Í Ïԛ̈ÍË, ›¯Â ·˘ÍË̤ӷ Â›‰· ·fi ÙËÓ 1Ë Ë̤ڷ ˙ˆ‹˜. ∆· Ì·ÎÚÔÊ¿Á· ¤¯Ô˘Ó ‚·ÛÈÎfi ÚfiÏÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢ ·fi ·Û¤ÚÁÈÏÏÔ, ·ÊÔ‡ Ê·ÁÔ΢ÙÙ·ÚÒÓÔ˘Ó Î·È Î·Ù·ÛÙÚ¤ÊÔ˘Ó ÙÔ˘˜ ÛfiÚÔ˘˜ ÙˆÓ Ì˘Î‹ÙˆÓ, ·ÔÙÚ¤ÔÓÙ·˜ ÙË ‚Ï¿ÛÙËÛ‹ ÙÔ˘˜ (23). ∂ÈϤÔÓ, Ù· Ì·ÎÚÔÊ¿Á· ·ÔÙÂÏÔ‡Ó ÛÙfi¯Ô Ù˘ ‰Ú¿Û˘ ÙÔÍÈÎÒÓ ÚÔ˚fiÓÙˆÓ Ô˘ ·Ú¿ÁÔ˘Ó Î˘Ú›ˆ˜ ÔÈ Aspergillus fumigatus Î·È niger, ‰È·‰Èηۛ· Ô˘ Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÛÙË ÏÔÈÌÔÁfiÓÔ ‰Ú¿ÛË ÙˆÓ Ì˘Î‹ÙˆÓ (24). ∏ ‰È·ÊÔÚÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ÛÙ· ‰‡Ô ÓÂÔÁÓ¿ ˘Ô‰ËÏÒÓÂÈ ‰È·ÊÔÚÔÔ›ËÛË ˆ˜ ÚÔ˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÙÔ˘˜. ∆· ·›ÙÈ· ·˘Ù‹˜ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ ‰ÂÓ Â›Ó·È Û·Ê‹. ∆Ô ÓÂÔÁÓfi ∞ ÁÂÓÓ‹ıËΠÛÙÔ Û›ÙÈ Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ÁÈ· ÙËÓ Î‡ËÛË Î·È ÙÔÓ ÙÔÎÂÙfi. ¶·Ú’ fiÏ· ·˘Ù¿, Â›Ó·È Èı·Ófi Ë ‰È·ÊÔÚÔÔ›ËÛË ·˘Ù‹ Ó· ˘‹ÚÍ ηıÔÚÈÛÙÈ΋ ÛÙË ÏÔÈÌÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘ ̇ÎËÙ·, ÌÂ Û˘Ó¤ÂÈ· ‰È¿¯˘ÙË Ïԛ̈ÍË ÛÙÔ ÓÂÔÁÓfi ∞. µÈ‚ÏÈÔÁÚ·Ê›· 1. Ng PC. Systemic fungal infections in neonates. Arch Dis Child 1994;71:F130-F135.

2. Bendel CM, Hostetter MK. Systemic candidiasis and other

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3. Groll AH, Jaeger G, Allendorf A, Herrmann G, Schloesser R, von Loewenich V. Invasive pulmonary aspergillosis in a critically ill neonate: case report and review of invasive aspergillosis during the first 3 months of life. Clin Infect Dis 1998;27:437-452.

4. Rowen JL, Correa AG, Sokol DM, Hawkins HK, Levy ML, Edwards MS. Invasive aspergillosis in neonates: report of five cases and literature review. Pediatr Infect Dis J 1992; 11:576-582.

5. Rowen JL, Atkins JT, Levy ML, Baer SC, Baker CJ. Invasive fungal dermatitis in the ≤1000-gram neonate. Pediatrics 1995;95:682-687.

6. Bruyere A, Bourgeois J, Cochat P, Bethenod M. Entérocolite ulcero-nécrotique néonatale et aspergillose. Pediatrie 1983;38:185-189.

7. Ben Rejeb A, Boubaker S, Turki I, Massaoudi L, Chibani M, Khouja H. Placental aspergillosis: myth or reality? Apropos of a case with fetal death in utero. J Gynecol Obstet Biol Reprod 1993;22:85-89.

8. Muller FM, Trusen A, Weig M. Clinical manifestations and diagnosis of invasive aspergillosis in immunocompromised children. Eur J Pediatr 2002;161:563-574.

9. Buchheidt D, Baust C, Skladny H, Ritter J, Suedhoff T, Baldus M et al. Detection of Aspergillus species in blood and bronchoalveolar lavage samples from immunocompromised patients by means of 2-step polymerase chain reaction: clinical results. Clin Infect Dis 2001;33:428-435.

10. §·Ì·‰·Ú›‰Ë˜ π, ¢ËÌËÙÚ›Ô˘ ∂, £ÂÔ‰ˆÚ¿ÎË ª, Û˙· ∞, ™·‚‚¿Ï· ª, ªÈ¯ÂϷοÎË ∂. ∂›‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ·fi Candida albicans. ¶·È‰È·ÙÚÈ΋ 2000;63:309-313.

11. Labadaridis I, Dimitriou E, Theodoraki M, Mermiri D, Sawaqed U, Velegrakis A et al. Chitotriosidase in neonatal fungal infections. J Perin Med 2001;29:255.

12. Hollak CE, van Weely S, van Oers MH, Aerts JM. Marked elevation of plasma chitotriosidase activity. A novel hallmark of Gaucher disease. J Clin Invest 1994;93:1288-1292.

13. Velegraki A, Kambouris M, Kostourou A, Chalevelakis G, Legakis NJ. Rapid extraction of fungal DNA from clinical samples for PCR amplification. Med Mycol 1999;37:69-73.

14. Kambouris ME, Reichard U, Legakis NJ, Velegraki A. Sequences from the aspergillopepsin PEP gene of Aspergillus fumigatus: evidence on their use in selective PCR identification of Aspergillus species in infected clinical samples. FEMS Immunol Med Microbiol 1999;25:255-264.

15. Schwartz DA, Jacquette M, Chawla HS. Disseminated neonatal aspergillosis: report of a fatal case and analysis of risk factors. Pediatr Infect Dis J 1988;7:349-353.

16. Abbasi S, Shenep JL, Hughes WT, Flynn PM. Aspergillosis in children with cancer. A 34-year experience. Clin Infect Dis 1999;29:1210-1219.

17. Muller FM, Groll AH, Walsh TJ. Current approaches to diagnosis and treatment of fungal infections in children infected with human immunodeficiency virus. Eur J Pediatr 1999;158:187-199.

18. Singer S, Singer D, Ruchel R, Mergeryan H, Schmidt U, Harms K. Outbreak of systemic aspergillosis in a neonatal

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-05-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ªÈ¯ÂϷοÎË ¢È‡ı˘ÓÛË ∂Ó˙˘ÌÔÏÔÁ›·˜ Î·È ∫˘ÙÙ·ÚÈ΋˜ §ÂÈÙÔ˘ÚÁ›·˜ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ E-mail: inchildh@otenet.gr

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∂π¢π∫O ∞ƒ£ƒO

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SPECIAL ARTICLE

∆· ‰ÈηÈÒÌ·Ù· Ù˘ ·ÙÚÈ΋˜ ÂÍÔ˘Û›·˜ Â› ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰· ∫. ∆·Ì¿ÎË1, £. ∆·Ì¿Î˘2

The rights of paternal authority over newborn infants in ancient Greece ∫. Tabaki1, T. Tabakis2

¶ÂÚ›ÏË„Ë: O ÂÚ¯ÔÌfi˜ ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ÛÙÔÓ ·Ú¯·›Ô ÂÏÏËÓÈÎfi Ô›ÎÔ ‹Ù·Ó οÙÈ ·Ú·¿Óˆ ·fi ¢ÚfiÛ‰ÂÎÙÔ˜. ∆Ô Ì¤ÁÂıÔ˜, fï˜, Ù˘ ̤Û˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ˘·ÁÔÚ¢fiÙ·Ó Î˘Ú›ˆ˜ ·fi ÔÈÎÔÓÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ŒÓ·˜ ÁÈÔ˜ ηÈ, ›Ûˆ˜, Ì›· ı˘Á·Ù¤Ú· ‹Ù·Ó ÙÔ È‰·ÓÈÎfi Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∆· ‰ÈηÈÒÌ·Ù· Ù˘ ·ÙÚÈ΋˜ ÂÍÔ˘Û›·˜, fiˆ˜ ‰È·ÁÚ¿ÊÔÓÙ·È ÙËÓ ÂÔ¯‹ ÂΛÓË, ÂÚÈÂÏ¿Ì‚·Ó·Ó: ·) £·Ó¿ÙˆÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘. O ·Ù¤Ú·˜ Ê·Ó¤ÚˆÓ ÙËÓ ÚfiıÂÛ‹ ÙÔ˘ Ó· ÂÓÙ¿ÍÂÈ ÙÔ ÓÂÔÁ¤ÓÓËÙÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÙÂÏÂÙ‹˜ ÙˆÓ ∞ÌÊȉÚÔÌ›ˆÓ. OÈ ŒÏÏËÓ˜ Û‡˙˘ÁÔÈ ÏfiÁˆ ÊÙÒ¯ÂÈ·˜, ÂÁˆÈÛÌÔ‡ ‹ ‡ÎÔÏ˘ ÈηÓÔÔ›ËÛ˘ ÙˆÓ ÛÂÍÔ˘·ÏÈÎÒÓ ÙÔ˘˜ ÂÓÛÙ›ÎÙˆÓ ÂÎÙfi˜ ÙÔ˘ ÛÈÙÈÔ‡, ÊÔ‚Ô‡ÓÙ·Ó Ó· ·Ó·ıÚ¤„Ô˘Ó ÔÏÏ¿ Ù¤ÎÓ·, ÂÓÒ Ë ·ÙÚÈ΋ ÎÏËÚÔÓÔÌÈ¿ ÌÂȈÓfiÙ·Ó ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ. ‚) ¶ÒÏËÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘. O ·Ù¤Ú·˜ ›¯Â ‰Èη›ˆÌ· fi¯È ÌfiÓÔ Ó· Ô˘Ï‹ÛÂÈ ÙÔ ·È‰› ÙÔ˘, ·ÏÏ¿ ·ÎfiÌË Î·È Ó· ÙÔ ˘ÔıË·ÛÂÈ. Á) ŒÎıÂÛË. ∏ ÂÁηٿÏÂÈ„Ë ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ‹Ù·Ó ¤Ó· Ê·ÈÓfiÌÂÓÔ Û‡ÓËı˜, ·Ó Î·È ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ¤ÎıÂÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ Ú¤ÂÈ Ó· ·ÊÔÚÔ‡Û Û ÂÍÒÁ·Ì·, Ófiı·, ·È‰È¿ ‰Ô‡ÏˆÓ, ÂÙ·›ÚˆÓ Î·È ÈÂÚfi‰Ô˘ÏˆÓ. O ÂÂÚ¯fiÌÂÓÔ˜ ÃÚÈÛÙÈ·ÓÈÛÌfi˜, Ì ÙËÓ ¤ÌÊ·ÛË Ô˘ ¤‰ˆÛ ÛÙËÓ ÈÂÚfiÙËÙ· Ù˘ ˙ˆ‹˜, ‹Úı Û ·ÓÙ›ıÂÛË Ì ·˘Ù¤˜ ÙȘ Ú·ÎÙÈΤ˜ ÙÔ˘ ·ÚÂÏıfiÓÙÔ˜. ¶¤Ú·Û·Ó ÔÏÏÔ› ·ÈÒÓ˜ ÁÈ· Ó· ηٷ¯ˆÚËıÔ‡Ó ÓÔÌÈο ÔÈ ·ÙÚÈ·Ú¯ÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ¤Ó·ÓÙÈ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ·È‰ÈÒÓ.

Abstract: In the ancient Greek home the arrival of an infant was more than welcome. The number of members in an average family was mainly determined by economic factors. One son, and perhaps a daughter, was considered the ideal number of children in a family, and the father’s authority determined the fate of the children. The major rights of paternal authority exercised during that period of history were: a) Execution. The father showed his intention to accept the newborn infant into his family during a ceremony called “Amfidromia”. Many Greek husbands, due to poverty, egoism or ease of satisfaction of their sexual instincts outside their home, were reluctant to raise a large number of children. Another reason was that paternal inheritance was becoming less. Infanticide was an accepted practice. b) Sale. The father had the right not only to sell his child but also to use it for purposes of mortgage. c) Exposure. Abandonment of infants was rather a common practice, although the greatest proportion of abandoned babies may have been illegitimate or adopted, servants’ or even prostitutes’ babies. The advent of Christianity, due to the emphasis that religion placed on the sanctity of life, contradicted all such practices of the past. Many centuries were to pass before paternal attitudes towards infants became legalized.

§¤ÍÂȘ ÎÏÂȉȿ: ∞Ú¯·›· ∂ÏÏ¿‰·, ·ÙÚÈο ‰ÈηÈÒÌ·Ù·, ÂÁηٿÏÂÈ„Ë, ‚ÚÂÊÔÎÙÔÓ›·.

Key words: Ancient Greece, paternal rights, abandonment, infanticide.

∏ ·È‰È΋ ÈÛÙÔÚ›· ·Ú¯›˙ÂÈ Ì ¤Ó·Ó ‚·ı‡ ‡ÓÔ Ô˘ ‰È‹ÚÎÂÛ ·ÈÒÓ˜ Î·È ·fi ÙÔÓ ÔÔ›Ô ÌfiÏȘ ÙÒÚ· ·Ú¯›Û·Ì ӷ ͢Ó¿ÌÂ. OÈ ÁÓÒÛÂȘ Ì·˜ Â›Ó·È Û¯Â‰fiÓ ·Ó‡·ÚÎÙ˜ Î·È ıˆÚÂ›Ù·È Ôχ Èı·Ófi fiÙÈ Ù· ÓÂÔ-

Á¤ÓÓËÙ· ‰ÔÏÔÊÔÓÔ‡ÓÙ·Ó, ı˘ÛÈ¿˙ÔÓÙ·Ó, ÂÁηٷÏ›ÔÓÙ·Ó, ˘ÈÔıÂÙÔ‡ÓÙ·Ó, ÙÚÔÌÔÎÚ·ÙÔ‡ÓÙ·Ó, ͢ÏÔÎÔÔ‡ÓÙ·Ó, ·ÔÏ·ÓÔ‡ÓÙ·Ó ÛÂÍÔ˘·ÏÈο ηÈ, ÁÂÓÈο, ηÎÔÔÈÔ‡ÓÙ·Ó.

1 ™¯ÔÏ‹ ∫·ÏÒÓ ∆¯ÓÒÓ, ∆Ì‹Ì· ªÔ˘ÛÈÎÒÓ ™Ô˘‰ÒÓ, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ 2 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ª.∂.¡. ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏ˘

1 School of Fine Arts, Faculty of Musical Studies, Aristotelion University, Thessaloniki 2 Department of Neonatology, Intensive Care Unit, University Hospital of Alexandroupolis

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∆Ô ·È‰›, ÛÙÔ˘˜ ÚˆÙfiÁÔÓÔ˘˜ Ï·Ô‡˜, ‰ÂÓ Â›¯Â ‰ÈηÈÒÌ·Ù·, ‰ÂÓ ˘ÔÏÔÁÈ˙fiÙ·Ó ˆ˜ ·˘ı‡·ÚÎÙÔ ¿ÙÔÌÔ. Œˆ˜ οÔÈ· ÂÔ¯‹, ‹Ù·Ó ¿ÁÓˆÛÙÔ˜ ·ÎfiÌË Î·È Ô Ê˘ÛÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ ¿Ó‰Ú· ÛÙËÓ ·Ó··Ú·ÁˆÁ‹. ∏ Á¤ÓÓËÛË ÂÈÙ˘Á¯·ÓfiÙ·Ó Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ ÓÂ˘Ì¿ÙˆÓ Î·È, ¤ÙÛÈ, Ô ÚfiÏÔ˜ ÙÔ˘ ·Ù¤Ú· ‹Ù·Ó ͤÓÔ˜. ∆· ·È‰È¿ ·Ó‹Î·Ó ÛÙË ÌËÙ¤Ú· Î·È ÛÙÔ Á¤ÓÔ˜ Ù˘. ŸÙ·Ó ηٷÓÔ‹ıËÎÂ Ë ·fiÚÚÔÈ· Ù˘ ÛÂÍÔ˘·ÏÈ΋˜ Ú¿Í˘, ÙfiÙÂ Ë ı¤ÛË ÙÔ˘ ¿Ó‰Ú· ¿ÏÏ·ÍÂ Î·È ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë ·ÙÚÈ·Ú¯È΋ ÔÈÎÔÁ¤ÓÂÈ·. ™Â ·˘Ù‹, Ù· ·È‰È¿ ·Ó‹Î·Ó ÛÙÔÓ ·Ù¤Ú·, Ô ÔÔ›Ô˜ Ôχ Û˘¯Ó¿ ›¯Â ‰Èη›ˆÌ· ˙ˆ‹˜ ‹ ı·Ó¿ÙÔ˘. ∆Ô ·È‰› ›¯Â ÌÈÎÚfiÙÂÚË ·Í›· ·fi ¤Ó· ·ÓÙÈΛÌÂÓÔ ‹ ¤Ó· ˙ÒÔ (1). ∏ Û‡Á¯ÚÔÓË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ¤¯ÂÈ ·Û¯ÔÏËı› ȉȷ›ÙÂÚ· Ì ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì·. ∂›Ó·È ۯ‰fiÓ ¿ÁÓˆÛÙÔ ÔÈ· ‹Ù·Ó Ë ı¤ÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘, ÚÔ¿ÓÙˆÓ fiÙ·Ó ‹Ù·Ó Á¤ÓÔ˘˜ ıËÏ˘ÎÔ‡, ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. OÈ ËÁ¤˜ Ô˘ ˘¿Ú¯Ô˘Ó ‰ÂÓ Â›Ó·È ·ÚÎÂÙ¤˜ ÁÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙ› ÙÔ ÛÙ›ÁÌ· ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘. ∏ ·Ú¯·›· ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ÂÈı˘ÌÔ‡Û ӷ ·ÔÎÙ‹ÛÂÈ ÔˆÛ‰‹ÔÙ ¤Ó·Ó ÁÈÔ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ Ô›ÎÔ˘ ‹, ÙÔ Ôχ, ¤Ó·Ó ÁÈÔ Î·È Ì›· ÎfiÚË. ¶›ÛÙ¢·Ó fiÙÈ Ô ÁÈÔ˜ ‰È·ÈÒÓÈ˙ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ˘ÂÚ¿ÛÈ˙ ÙËÓ ‡·ÚÍ‹ Ù˘, ÙfiÛÔ ÛÙÔ ‰›Ô Ù˘ Ì¿¯Ë˜ fiÛÔ Î·È ÛÙËÓ ·ÁÔÚ¿. OÈ ı˘Á·Ù¤Ú˜ Û˘ÓÂ¿ÁÔÓÙ·Ó ÂÚÈÛÛfiÙÂÚ˜ ¢ı‡Ó˜ (Úԛη, ‰È·Ê‡Ï·ÍË ·ÁÓfiÙËÙ·˜ Î.Ï.).

OÈ ÔÏϤ˜ ÁÂÓÓ‹ÛÂȘ, ÂÓÒ ÛÙËÓ fiÏË-ÌËÙ¤Ú· ıˆÚÔ‡ÓÙ·Ó Ì¿ÛÙÈÁ· Î·È Î›Ó‰˘ÓÔ˜, ÛÙËÓ ·ÔÈΛ· ıˆÚÔ‡ÓÙ·Ó ÂÈÙ·ÎÙÈ΋ ·Ó¿ÁÎË. ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ ·ÔÙÂÏÔ‡Û ÂÁÁ‡ËÛË ÁÈ· ÙÔ Ì¤ÏÏÔÓ. ∞ÓÙÈηÙÔÙÚ›˙ÔÓÙ·˜ ÙÔ Ó‡̷ Ù˘ ÂÔ¯‹˜ ÙÔ˘, Ô ¶Ï¿ÙˆÓ ·Ó·Ê¤ÚÂÈ: “¶·›‰ˆÓ ‰Â ÈηÓfiÙ˘ ·ÎÚÈ‚‹˜ ¿ÚÚËÓ Î·È ı‹ÏÂÈ· ¤ÛÙˆ Ùˆ Ófï”, ‰ËÏ·‰‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·fi ÙÔÓ ÓfiÌÔ Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È ·ÚÎÂÙfi˜ ·˜ Â›Ó·È ¤Ó· ·ÁfiÚÈ Î·È ¤Ó· ÎÔÚ›ÙÛÈ (¡fiÌÔÈ, 1∞ 930d). ™Â ¿ÏÏÔ ÙÔ˘ ¤ÚÁÔ Î·È, Û˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔÓ “∫ÚÈÙ›·” ÁÚ¿ÊÂÈ ÁÈ· ÙȘ ÎÚ˘Ê¤˜, ·ÓÂÎÏ‹ÚˆÙ˜ ÂÈı˘Ì›Â˜ ÙÔ˘: “O ÚÔÛÙ¿Ù˘ Ù˘ ∞ÙÏ·ÓÙ›‰·˜, Ô ıÂfi˜ ¶ÔÛÂȉÒÓ·˜, Ì ÙË ıÓËÙ‹ ∫ÏÂÈÙÒ ·¤ÎÙËÛ·Ó ‰¤Î· ÁÈÔ˘˜” (2,3).

OÈ ÂÏÏËÓÈÎÔ› Á¿ÌÔÈ ‰ÂÓ ‹Ù·Ó ηıfiÏÔ˘ ÁfiÓÈÌÔÈ, ÁÈ· ‰‡Ô ÏfiÁÔ˘˜: ·) Ô Û‡˙˘ÁÔ˜ ÈηÓÔÔÈÔ‡Û ‡ÎÔÏ· Ù· ÛÂÍÔ˘·ÏÈο ÙÔ˘ ¤ÓÛÙÈÎÙ· Î·È ¤Íˆ ·fi ÙÔ Û›ÙÈ Î·È ‚) ÔÈ ŒÏÏËÓ˜ ÊÔ‚Ô‡ÓÙ·Ó ÏfiÁˆ ÊÙÒ¯ÂÈ·˜ Î·È ÂÁˆÈÛÌÔ‡ Ó· ¤¯Ô˘Ó Î·È Ó¤· ̤ÏË Ó· ·Ó·ıÚ¤„Ô˘Ó. ∞ÎfiÌË, ›ÛÙ¢·Ó fiÙÈ Ë ·ÙÚÈ΋ ÎÏËÚÔÓÔÌÈ¿ ı· ¤ÚÂ ӷ ÌÔÈÚ·ÛÙ› Û ÔÏÏÔ‡˜ ÎÏËÚÔÓfiÌÔ˘˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ÌÂÚ›‰ÈÔ Ó· ÌÂÈÒÓÂÙ·È Û˘Ó¯Ҙ. ÷ڷÎÙËÚÈÛÙÈο Û˘ÁÎÏ›ÓÔ˘Û˜ Â›Ó·È ÔÈ ·fi„ÂȘ ÔÏÏÒÓ Û˘ÁÁڷʤˆÓ Ù˘ ÂÔ¯‹˜ ÂΛӢ Ì ÎÔÚ˘Ê·›· ÂΛÓË ÙÔ˘ ∏Û›Ô‰Ô˘: “ŒÓ· ·È‰›, ·ÁfiÚÈ, Â›Ó·È ·ÚÎÂÙfi ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·”. ¶ÚÔÙÈÌÔ‡Û “·ÎfiÌË Î·È

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Ó· ÛÎÔÙˆı› Û οÔÈÔÓ fiÏÂÌÔ, ·fi ÙÔÓ Î›Ó‰˘ÓÔ Ó· ÌÔÈÚ·ÛÙ› Ë ÔÈÎÔÁÂÓÂȷ΋ ÂÚÈÔ˘Û›· Û ÂÚÈÛÛfiÙÂÚ· ·È‰È¿” (ŒÚÁ· Î·È ∏̤ڷÈ, 375-385). ™ÙËÓ ∞ı‹Ó·, fiÏÔÈ ÔÈ ÓfiÌÈÌÔÈ ÁÈÔÈ ÎÏËÚÔÓÔÌÔ‡Û·Ó ÙË ÁË Û ›Û· ÌÂÚ›‰È·. ŒÙÛÈ, ÌÂÙ¿ ·fi ·ÏÏÂ¿ÏÏËϘ ‰È·ÈÚ¤ÛÂȘ, Ë ÔÈÎÔÁÂÓÂȷ΋ ÂÚÈÔ˘Û›· ηٷÌÂÚÈ˙fiÙ·Ó Û ٤ÙÔÈÔ ‚·ıÌfi, ÒÛÙ οı ÎÏËÚÔÓfiÌÔ˜ η٤ÏËÁ Ì ¤Ó· ÌÈÎÚfi ÎÔÌÌ¿ÙÈ Á˘, ÙÔ ÔÔ›Ô Ì ‰˘ÛÎÔÏ›· Î¿Ï˘Ù ÙȘ ‚ÈÔÙÈΤ˜ ÙÔ˘ ·Ó¿ÁΘ (4). ™‡Ìʈӷ, fï˜, Ì ÙÔÓ Â‚Ú·˚Îfi ÓfiÌÔ, ÌfiÓÔ Ô ÚÒÙÔ˜ ÁÈÔ˜ ÎÏËÚÔÓÔÌ› ÙËÓ ÂÚÈÔ˘Û›· (5). ∆Ô ÓÂÔÁ¤ÓÓËÙÔ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰· ‹Ù·Ó Ï‹Úˆ˜ ÂÍ·ÚÙË̤ÓÔ ·fi ÙÔÓ ·Ù¤Ú· ÙÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·ÔÊ·Û›˙ÂÈ ÂΛÓÔ˜ ·Ó ı· ¤ÌÂÓ ‹ fi¯È ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. O ·Ù¤Ú·˜ Ê·Ó¤ÚˆÓ ÙËÓ ÚfiıÂÛ‹ ÙÔ˘ Ó· ÙÔ ÂÓÙ¿ÍÂÈ Û ·˘Ù‹, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÙÂÏÂÙ‹˜ ÙˆÓ ∞ÌÊȉÚÔÌ›ˆÓ, Ë ÔÔ›· ‰ÈÂÍ·ÁfiÙ·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛË. O ·Ù¤Ú·˜, Ì ÙË ‚¿ÙÈÛË, ÙÔ ·Ó·ÁÓÒÚÈ˙ ϤÔÓ ˆ˜ ÓfiÌÈÌÔ ·fiÁÔÓÔ. ™ÙÔ Ï·›ÛÈÔ Ù˘ ÂÔÚÙ‹˜ ÙˆÓ ∞ÌÊȉÚÔÌ›ˆÓ, Ë ÙÔÔı¤ÙËÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ÁË, ‰›Ï· ÛÙËÓ ÂÛÙ›·, ̤۷ ÛÙÔÓ Î‡ÎÏÔ Ô˘ ¯·Ú¿¯ıËΠ̠ÙÔ ÈÂÚÔ˘ÚÁÈÎfi ÙÚ¤ÍÈÌÔ Á‡Úˆ ·fi ·˘Ù‹, ·›ÚÓÂÈ ÙËÓ ·Í›· Ì›·˜ ‰ÔÎÈÌ·Û›·˜ ÓÔÌÈÌÔÔ›ËÛ˘ (6). ∆· ‰ÈηÈÒÌ·Ù· Ù˘ ·ÙÚÈ΋˜ ÂÍÔ˘Û›·˜, fiˆ˜ ‰È·ÁÚ¿ÊÔÓÙ·È ÛÙÔ ‰›Î·ÈÔ Ù˘ ÂÔ¯‹˜, ‹Ù·Ó: ·) £·Ó¿ÙˆÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ™ÙËÓ ÂÏÏËÓÈ΋ Ì˘ıÔÏÔÁ›·, Û˘Ó·ÓÙ¿Ù·È Û˘¯Ó¿ Ë Ú¿ÍË Ù˘ ·È‰ÔÎÙÔÓ›·˜. O O˘Ú·Ófi˜ ‚˘ı›˙ÂÈ Ù· Ù¤ÎÓ· ÙÔ˘ ÛÙ· ¤Áηٷ Ù˘ Á˘ (∏ÛÈfi‰Ô˘ £ÂÔÁÔÓ›· 154-160). O ∫ÚfiÓÔ˜ ηٷ‚ÚÔ¯ı›˙ÂÈ fiÛ· ¤Ú¯ÔÓÙ·È Ó· ·Ó··˘ıÔ‡Ó ÛÙ· ÁfiÓ·Ù¿ ÙÔ˘ (§Ô˘ÎÈ·ÓÔ‡ ¶ÂÚ› £˘ÛÈÒÓ 5). O ◊Ê·ÈÛÙÔ˜ ηٷÎÚËÌÓ›˙ÂÙ·È ·fi ÙÔÓ ŸÏ˘ÌÔ ·fi ÙÔÓ ¢›· ‹ ÙËÓ ◊Ú·, ÁÈ·Ù› Â›Ó·È ‰‡ÛÌÔÚÊÔ˜. O §¿ÈÔ˜ ‰È·Ù¿ÛÛÂÈ Ó· ÂÍ·ÁÓÈÛÙ› Ô ÁÈÔ˜ Ô˘ ÁÂÓÓ‹ıËΠ·fi ÙËÓ πÔοÛÙË, ÂÓÒ Ô ¶ÂÚÛ‡˜ Ú›¯ÓÂÙ·È ÛÙË ı¿Ï·ÛÛ· ·fi ÙÔÓ ·Ô‡ ÙÔ˘. ™ÙËÓ Ú·ÁÌ·ÙÈ΋ πÛÙÔÚ›· ÛËÌÂÈÒÓÂÙ·È fiÙÈ Ô ÕÙÙ·ÏÔ˜, Ô ‚·ÛÈÏÈ¿˜ Ù˘ ¶ÂÚÁ¿ÌÔ˘ Î·È Û‡˙˘ÁÔ˜ Ù˘ ™ÙÚ·ÙÔӛ΢, ¯‹Ú·˜ ÙÔ˘ ·‰ÂÏÊÔ‡ ÙÔ˘, ı·Ó·ÙÒÓÂÈ fiÏ· Ù· Ù¤ÎÓ· ÙÔ˘ ÌfiÏȘ ÁÂÓÓÈÔ‡ÓÙ·È, ·fi ·‰ÂÏÊÈ΋ ·Á¿Ë, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌËÓ ÊÔ‚¿Ù·È Ô ·ÓÈ„Èfi˜ ÙÔ˘ ·fi ÂӉ¯fiÌÂÓÔ ·ÓÙ·ÁˆÓÈÛÌfi ÛÙË ‚·ÛÈÏ›· (§˘Û. 16, ¶ÏÔ˘Ù¿Ú¯Ô˘ §˘ÎÔ‡ÚÁÔ˜ 16). ™ÙË ™¿ÚÙË, ÙÔ ÎÚ¿ÙÔ˜ ··ÁfiÚ¢ ÚËÙ¿ ÛÙÔÓ ·Ù¤Ú· Ó· ·Ó·ıÚ¤„ÂÈ ‰‡ÛÌÔÚÊÔ ‹ ·ÛıÂÓ¤˜ ÓÂÔÁÓfi. ∏ ı·Ó¿ÙˆÛË ÛÙË ™¿ÚÙË Â›¯Â ¯·Ú·ÎÙ‹Ú· ÎÔÈÓˆÓÈÎfi, ÂÈ‚·ÏÏfiÙ·Ó ÁÈ· Â͢Á›·ÓÛË Ù˘ ÎÔÈÓˆÓ›·˜, fiˆ˜ ÛÙËÓ ∫·Ú¯Ë‰fiÓ· Î·È Â›¯Â ıÚËÛ΢ÙÈÎfi ¯·Ú·ÎÙ‹Ú·. ∂Λ, ı·Ó¿ÙˆÓ·Ó Ù· ÚˆÙfiÙÔη ·ÁfiÚÈ·. ™ÙË ™¿ÚÙË, Û‡Ìʈӷ Ì ÙÔ˘˜ ¡fiÌÔ˘˜ ÙÔ˘ §˘ÎÔ‡ÚÁÔ˘, Ô ·Ù¤Ú·˜ ‹Ù·Ó ˘Ô¯Úˆ̤ÓÔ˜ Ó· ÚÔÛÎÔÌ›ÛÂÈ ÙÔ ·È‰› ÙÔ˘ ÛÙÔ˘˜ Á¤ÚÔÓÙ˜ Ù˘ Ê˘Ï‹˜ ÁÈ· Ó·

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¶·È‰È·ÙÚÈ΋ 2004;67:293-297

ÙÔ ÂÍÂÙ¿ÛÔ˘Ó. ∞Ó ·˘Ùfi ·ÚÔ˘Û›·˙Â Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ‹ ‹Ù·Ó ·ÛıÂÓÈÎfi, ÙÔ ÂÙÔ‡Û·Ó Û ̛· ·fiÙÔÌË ¯·Ú¿‰Ú· ÙÔ˘ ∆·¸Á¤ÙÔ˘, ÙÔ˘˜ ∞Ôı¤Ù˜ (¶ÏÔ˘Ù¿Ú¯Ô˘ §˘ÎÔ‡ÚÁÔ˜ 16). ∆fiÛÔ Ô ∞ÚÈÛÙÔÙ¤Ï˘ fiÛÔ Î·È Ô ‰¿ÛηÏfi˜ ÙÔ˘, Ô ¶Ï¿ÙˆÓ, ˙ËÙÔ‡Û·Ó ÙË ‰È¿ ÓfiÌÔ˘ ¤ÎıÂÛË ÛÙË ÊˆÙÈ¿ ÂÎÂ›ÓˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ›¯·Ó ÔÏÏ·Ϥ˜ ‰˘ÛÌÔÚʛ˜. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ë ÂÈÛÙËÌÔÓÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÎÂÊ·Ï·›Ô˘ ÙÂÚ·ÙÔÁ¤ÓÂÛË ¤ÁÈÓ ·fi ÙÔÓ ∞ÚÈÛÙÔÙ¤ÏË Î·È ÙÔÓ πÔÎÚ¿ÙË. ª¤¯ÚÈ ÙfiÙÂ, ΢ÚÈ·Ú¯Ô‡ÛÂ Ë ‰ÂÈÛȉ·ÈÌÔÓ›· Î·È Ë Ì·Á›· (7).

O ¶Ôχ‚ÈÔ˜ ıˆÚÔ‡Û ηٿڷ Ó· ı·Ó·ÙÒÓÔÓÙ·È Ù· ÓÂÔÁ¤ÓÓËÙ·, ηıÒ˜ ÛÙËÓ ÂÔ¯‹ ÙÔ˘ Ë ∂ÏÏ¿‰· ˘¤ÊÂÚ ·fi ¤ÏÏÂÈ„Ë ·È‰ÈÒÓ, ‰ËÏ·‰‹ ˘ÔÁÂÓÓËÙÈÎfiÙËÙ·. ∏ ı·Ó¿ÙˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡, Ë ÔÔ›· Û˘Ó¤‚·ÈÓ Û¿ÓÈ· fiÙ·Ó ·˘Ùfi ‹Ù·Ó ÚˆÙfiÙÔÎÔ ·ÁfiÚÈ, ‹Ù·Ó Ì›· Ú¿ÍË ¯ˆÚ›˜ ÛËÌ·Û›·, ηıÒ˜ ÙÔ ·È‰› ‰ÂÓ ·Ó‹Î ·ÎfiÌË ÛÙÔ ÎÔÈÓˆÓÈÎfi Û‡ÓÔÏÔ. ¢ÂÓ Â›¯·Ó Á›ÓÂÈ ÔÈ Î·ıÔÚÈṲ̂Ó˜ ÈÂÚÔÙÂÏÂÛٛ˜ Ô˘ ÙÔ˘ ‰›ÓÔ˘Ó, ÙÔ˘Ï¿¯ÈÛÙÔÓ, ÙËÓ ·Ú¯‹ οÔÈ·˜ ÚÔÛˆÈÎfiÙËÙ·˜. ∂ȉÈÎfiÙÂÚ·, Ì¿ÏÈÛÙ·, ·ÊÔ‡ ‰ÂÓ ¤¯ÂÈ Ï¿‚ÂÈ fiÓÔÌ·, ‰ÂÓ ¤¯ÂÈ Ú·ÁÌ·ÙÈ΋ ‡·ÚÍË. O ı¿Ó·Ùfi˜ ÙÔ˘ ÚÔÛ‚¿ÏÏÂÈ ÌfiÓÔÓ Ù· Ê˘ÛÈο Û˘Ó·ÈÛı‹Ì·Ù·. ¢ÂÓ ÛÎfiÙˆÓ·Ó ÙÔ ÓÂÔÁÓfi Ô˘ ‰ÂÓ ‹ıÂÏ·Ó Ó· ·Ó·ıÚ¤„Ô˘Ó, ·ÏÏ¿ ÙÔ ¿ÊËÓ·Ó ¤Íˆ, ̤۷ Û ¤Ó· ‰Ô¯Â›Ô ‹ Û ̛· ¯‡ÙÚ· ·fi ¿ÚÁÈÏÔ fiÔ˘ ı· ÁÈÓfiÙ·Ó Ô Ù¿ÊÔ˜ ÙÔ˘ (∞ÚÈÛÙÔÊ¿ÓË £ÂÛÌÔÊÔÚÈ¿˙Ô˘Û˜ 505-509, µ¿ÙÚ·¯ÔÈ 1190). ∏ ‚ÚÂÊÔÎÙÔÓ›·, fï˜, ‹ Ô ı¿Ó·ÙÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ˘ Û ËÏÈΛ· ·È‰ÈÔ‡ ‰ÂÓ ·ÔÙÂÏ› ÂÏ·ÊÚ˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· Î·È ‰ÂÓ ÂÌÔ‰›˙ÂÈ Ó· ¯·Ú·ÎÙËÚÈÛÙ› Ë Ú¿ÍË ˆ˜ ÎÔÈÓfi˜ ÊfiÓÔ˜. ∏ ÚÔ‚ÏÂfiÌÂÓË ÔÈÓ‹ ·fi ÙÔÓ ÓfiÌÔ ˘Ô¯ÚÂÒÓÂÈ ÙÔÓ ‰Ú¿ÛÙË Ó· ·˘ÙÔÂÍÔÚÈÛÙ›, ÂÓÒ ÙÔ˘ ··ÁÔÚ‡ÂÈ Î·È Ó· ·Ú·ÛÙ› ÛÙËÓ Îˉ›· ÙÔ˘ ı‡Ì·Ùfi˜ ÙÔ˘ (8). O ¶Ï¿ÙˆÓ ÛÙÔ˘˜ “¡fiÌÔ˘˜” ÙÔ˘ ÂÈ‚¿ÏÏÂÈ ÛÙÔÓ ¤ÓÔ¯Ô ·Ù¤Ú· ‹ ÌËÙ¤Ú· - ÂÎÙfi˜ ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ - ÙËÓ ˘Ô¯ÚˆÙÈ΋ ‰È¿Ï˘ÛË ÙÔ˘ Á¿ÌÔ˘ Î·È ÙËÓ ·ÒÏÂÈ· οı ‰ÈηÈÒÌ·ÙÔ˜ ¿Óˆ ÛÙ· Ù¤ÎÓ· Ô˘ ˙Ô˘Ó. ∂¿Ó ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡ Â¤ÊÂÚ ÔÔÈÔÛ‰‹ÔÙ ¿ÏÏÔ˜, Ë Ú¿ÍË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó, Â›Û˘, ˆ˜ ÊfiÓÔ˜. ∏ ı·Ó¿ÙˆÛË ÙÔ˘ ·È‰ÈÔ‡, ˆÛÙfiÛÔ, .¯. Ë ı˘Û›· Ù˘ πÊÈÁ¤ÓÂÈ·˜, ıˆÚÂ›Ù·È Î¿ÙÈ ·Úˆ¯Ë̤ÓÔ, fiˆ˜ Ì·˜ ÏËÚÔÊÔÚ› Î·È Ô Ú‹ÙÔÚ·˜ ∞ÈÛ¯›Ó˘, ÌË Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ ÛÙÔ˘˜ ¯ÚfiÓÔ˘˜ ÙÔ˘ (∫·Ù¿ ∆ÈÌ¿Ú¯Ô˘ 182). ™ÙÔ ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙÔÓ ™fiψӷ, ‰ÂÓ Û˘Ó·ÓÙ¿Ù·È Î·Ó¤Ó· ÂÚÈÛÙ·ÙÈÎfi ı·Ó¿ÙˆÛ˘. µ¤‚·È·, fiÏ· ·˘Ù¿ ›Û¯˘·Ó ÁÈ· ÙÔ˘˜ ÂχıÂÚÔ˘˜ Ôϛ٘. °È· ÙÔ˘˜ ‰Ô‡ÏÔ˘˜, Ù· Ú¿ÁÌ·Ù· ‹Ù·Ó ÙÂÏ›ˆ˜ ‰È·ÊÔÚÂÙÈο. ∫¿ı ‰Ô˘ÏÔÎÙ‹Ù˘ ‹Ù·Ó ÂχıÂÚÔ˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÓÂÔÁÓÔ‡ ·fi ‰Ô‡-

Paediatriki 2004;67:293-297

ÏË ÙÔ˘, Ó· ÙÔ ÛÎÔÙÒÛÂÈ Î·È Ó· ÙÔ ÂÎı¤ÛÂÈ, Ú¿ÁÌ· Ô˘ Û˘Ó¤‚·ÈÓ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜. ∏ ÁÓÒÌË ÙÔ˘ ·Ù¤Ú· ‰Ô‡ÏÔ˘ ‹Ù·Ó ·Ó‡·ÚÎÙË. ◊Ù·Ó Ôχ ÈÔ Û˘ÌʤÚÔÓ Ó· ·ÁÔÚ¿˙ÂÙ·È ‰Ô‡ÏÔ˜ ÈηÓfi˜ ÁÈ· οı ÂÚÁ·Û›· ·fi ÙÔ Ó· ·Ó·ÙÚ¤ÊÔÓÙ·È Ù· ·È‰È¿ ÙˆÓ ‰Ô‡ÏˆÓ (6). ∂¿Ó ÏËÊı› ˘’ fi„ÈÓ fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ‰Ô‡ÏˆÓ ÛÙËÓ ∞ÙÙÈ΋ ÙÔ 300 .X., Û‡Ìʈӷ Ì ÙȘ ËÁ¤˜, ‹Ù·Ó 400.000, ÂÓÒ ÔÈ ÂχıÂÚÔÈ ∞ıËÓ·›ÔÈ Ôϛ٘ ·Ó¤Ú¯ÔÓÙ·Ó ÌfiÏȘ Û 21.000, Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ı·Ó¿ÙˆÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ ‹ Ù˘ ¤ÎıÂÛ˘ ‹Ù·Ó ·ÚÎÂÙ¿ Û‡ÓËı˜ (14). ‚) ¶ÒÏËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ O ·Ù¤Ú·˜ ›¯Â ÙÔ ‰Èη›ˆÌ· fi¯È ÌfiÓÔ Ó· Ô˘Ï‹ÛÂÈ ÙÔ ·È‰› ÙÔ˘, ·ÏÏ¿ ·ÎfiÌË Î·È Ó· ÙÔ ˘ÔıË·ÛÂÈ. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·Ó·Ê¤ÚÂÙ·È ·fi ÔÏÏÔ‡˜ Û˘ÁÁÚ·Ê›˜, fiˆ˜ Ô ¶ÏÔ‡Ù·Ú¯Ô˜: “... ¶ÔÏÏÔ› ‰Â ·›‰·˜ ȉ›Ô˘˜ ËÓ·Áο˙ÔÓÙÔ ˆÏ›Ó... Ô˘‰Â›˜ Á·Ú ÓfiÌÔ˜ ÂÎÒÏ˘ÂÓ” (™fiÏˆÓ 13,5). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ˘Ôı‹Î¢Û˘ ·Ó·Ê¤ÚÂÙ·È Ô πÛÔÎÚ¿Ù˘ ÛÙÔ ¤ÚÁÔ ÙÔ˘ ¶Ï·Ù·˚Îfi˜ 14,48. µ¤‚·È·, fiÏ· ·˘Ù¿ Û˘Ó¤‚·ÈÓ·Ó Ôχ ÚÈÓ ÙËÓ ÂÔ¯‹ ÙÔ˘ ™fiψӷ, ηıÒ˜ ·˘Ùfi˜ ‹Ù·Ó Ô˘ Ù· ηًÚÁËÛ ‰È¿ ÓfiÌÔ˘, ÂÓÒ Â¤ÙÚ„ ÌfiÓÔ ÙËÓ ÒÏËÛË ÎÔÚÈÙÛÈÒÓ, fiÙ·Ó ÔÈ ÌËÙ¤Ú˜ ›¯·Ó Û˘Ó¿„ÂÈ ÂÍÒÁ·Ì˜ Û¯¤ÛÂȘ Ì ͤÓÔ˘˜ ¿Ó‰Ú˜.

O ª¤Ó·Ó‰ÚÔ˜ ÁÚ¿ÊÂÈ fiÙÈ ÌÂٷ͇ ÙˆÓ £Ú·ÎÒÓ ›Û¯˘Â Ë ÔÏ˘Á·Ì›·, ÁÂÁÔÓfi˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Û ‰ËÌÔÁÚ·ÊÈο ÚÔ‚Ï‹Ì·Ù· Ì ȉÈfiÙ˘˜ ÎÔÈÓˆÓÈΤ˜ ÚÔÂÎÙ¿ÛÂȘ (.¯. ıÚ‹ÓÔÈ Î·Ù¿ ÙË Á¤ÓÓËÛË ÙˆÓ ·È‰ÈÒÓ, ¯·Ú¤˜ Î·È ¯ÔÚÔ› fiÙ·Ó Î¿ÔÈÔ˜ ¤ı·ÈÓÂ, ÒÏËÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ). øÛÙfiÛÔ, Ù· ·È‰È¿ ˆÏÔ‡ÓÙ·È Î·È Û‹ÌÂÚ· (˘ÈÔıÂÛ›·). ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ›Û¯˘Â Î·È ÛÙËÓ ·Ú¯·ÈfiÙËÙ·. O ÚˆÙ·Ú¯ÈÎfi˜ ÛÎÔfi˜ Ù˘ ˘ÈÔıÂÛ›·˜ ‹Ù·Ó Ë ·ÚÔ¯‹ ÓfiÌÈÌ˘ Ô‰Ô‡ ÁÈ· ÙË ‰È·ÈÒÓÈÛË Ì›·˜ ¿ÎÏËÚ˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È fi¯È Ë ·ÚÔ¯‹ ÁÔÓÈ΋˜ ÚÔÛÙ·Û›·˜ Û ¤Ó· ·È‰› Ô˘ Û ‰È·ÊÔÚÂÙÈ΋ ÂÚ›ÙˆÛË ı· ›¯Â ÛÙÂÚËı›. ∏ Ú¿ÍË ·˘Ù‹ ‹Ù·Ó ÁÓˆÛÙ‹ Û fiÏË ÙËÓ ÂÏÏËÓÈ΋ ÂÈÎÚ¿ÙÂÈ· Î·È ÂÊ·ÚÌÔ˙fiÙ·Ó Û˘ÛÙËÌ·ÙÈο ÛÙÔ˘˜ ÂχıÂÚÔ˘˜ Ôϛ٘. ∞Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˘ÈÔıÂÛ›·˜ ÁÂÓÓÈfiÙ·Ó ·ÁfiÚÈ, Ë ˘ÈÔıÂÛ›· ÚÔ¯ˆÚÔ‡ÛÂ, ¯ˆÚ›˜ fï˜ Ô ˘ÈÔıÂÙË̤ÓÔ˜ Ó· ·ÔÏ·Ì‚¿ÓÂÈ ÎÏËÚÔÓÔÌÈÎÒÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ (9,10). Á) ŒÎıÂÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ O ·Ù¤Ú·˜ ‹ οÔÈÔ˜ ÂÎÚfiÛˆfi˜ ÙÔ˘, .¯. ‰Ô‡ÏÔ˜, ÌÔÚÔ‡Û ӷ ÂÁηٷÏ›„ÂÈ ÙÔ ÓÂÔÁ¤ÓÓËÙfi ÙÔ˘, ¯ˆÚ›˜ Ó· ÂӉȷʤÚÂÙ·È ÁÈ· ÙËÓ Î·Ù¿ÏËÍ‹ ÙÔ˘. ∞˘Ùfi ÁÈÓfiÙ·Ó ÂÂȉ‹ ‰ÂÓ ıˆÚÔ‡ÓÙ·Ó ÛÎfiÈÌË Ë ·Ó·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ, .¯. Ë ÂÚ›ÙˆÛË ¤ÎıÂÛ˘ ÙÔ˘ Oȉ›Ô‰·. ¶Ï›ÛÙ· ·Ú·‰Â›ÁÌ·Ù· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ˘˜ Έ̈‰ÈÔÁÚ¿ÊÔ˘˜ Ù˘ ÂÔ¯‹˜ ÂΛӢ, Ì ÚÒÙÔ ÙÔÓ ∞ÚÈÛÙÔÊ¿ÓË. ∞Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÌÂÛ˜ Ì·ÚÙ˘Ú›Â˜ ÁÈ· ÙËÓ Ú·ÎÙÈ΋ Ù˘ ¤ÎıÂÛ˘ ÛÙË ÓÔÌÔıÂÛ›· Ù˘ ÂÔ¯‹˜,

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ÂÎÙfi˜ ·fi ·Ó·ÊÔÚ¤˜ ÛÙÔ ‰Èη›ˆÌ· Ù˘ ÌËÙ¤Ú·˜ Ó· ÂÎı¤ÛÂÈ Ë ›‰È· ÙÔ ·È‰› ·Ó ‹Ù·Ó ¯ˆÚÈṲ̂ÓË Î·È ·Ó Ô ÚÒËÓ ¿Ó‰Ú·˜ ‰ÂÓ ÙÔ ·Ó·ÁÓÒÚÈ˙ (10), ÂÓÙÔ‡ÙÔȘ, ÙÔ ÁÂÁÔÓfi˜ ÂȂ‚·ÈÒÓÂÙ·È ¤ÌÌÂÛ· ÛÙË ÏÔÁÔÙ¯ӛ·, ÙË Ì˘ıÔÏÔÁ›· ‹ ·ÎfiÌË Î·È ÛÙËÓ ·ÏÏËÏÔÁÚ·Ê›·. ŒÙÛÈ, ÛÙ· ı·ÙÚÈο ¤ÚÁ·, ›Ù ÚfiÎÂÈÙ·È ÁÈ· Έ̈‰›Â˜ ÙÔ˘ ∞ÚÈÛÙÔÊ¿ÓË, ›Ù ÁÈ· ÙÚ·Áˆ‰›Â˜ ÙÔ˘ ∂˘ÚÈ›‰Ë, Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ô ·Ù¤Ú·˜ Ó· ÂÎı¤ÙÂÈ ÙÔ ·È‰› ÙÔ˘, ÂÓÒ ·˘Ù‹ Ë Ú¿ÍË ıˆÚÂ›Ù·È ˆ˜ οÙÈ ·fiÏ˘Ù· Ê˘ÛÈÔÏÔÁÈÎfi. ™ÙËÓ ÂÏÏËÓÈ΋ Ì˘ıÔÏÔÁ›·, Û˘¯Ó¿, ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂȘ ¤ÎıÂÛ˘ ·Ó¿ÌÂÛ· ÙfiÛÔ ÛÙÔ˘˜ ıÂÔ‡˜ fiÛÔ Î·È ÛÙÔ˘˜ ‹ÚˆÂ˜. ∞fi ÙÔÓ ¢›· ̤¯ÚÈ ÙÔÓ Oȉ›Ô‰·, ÔÏÏÔ› ÂÎÙ¤ıËÎ·Ó ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ ‹, Â¿Ó ‹Ù·Ó ıÓËÙÔ›, ·Ê¤ıËÎ·Ó ·fi ÙÔÓ ·Ù¤Ú· ÙÔ˘˜ Ó· Âı¿ÓÔ˘Ó (∞ÚÈÛÙÔÊ¿ÓË µ¿ÙÚ·¯ÔÈ 1190-6). ∆¤ÏÔ˜, Û‡Ìʈӷ Ì ¤Ó· ÁÚ¿ÌÌ· Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÂÏÏËÓÈÛÙÈ΋ ÂÔ¯‹, ¤Ó·˜ ¿Ó‰Ú·˜ Û˘Ì‚Ô˘Ï‡ÂÈ ÙË Á˘Ó·›Î· ÙÔ˘: “™Â ÚÔÙÚ¤ˆ Î·È Û ÂÎÏÈ·ÚÒ Ó· Â›Û·È ÚÔÛÂÎÙÈ΋ Ì ÙÔ ·È‰›... ·Ó Â›Ó·È ·ÚÛÂÓÈÎfi ¿ÊËÛ¤ ÙÔ Ó· ˙‹ÛÂÈ, ·Ó Â›Ó·È ıËÏ˘Îfi ¿ÊËÛ¤ ÙÔ ¤ÎıÂÙÔ” (4,12). ∂ÍÂÙ¿˙ÔÓÙ·˜ ÙËÓ Ú·ÎÙÈ΋ Ù˘ ¤ÎıÂÛ˘ ·fi Ì›· ÁÂÓÈÎfiÙÂÚË ıÂÒÚËÛË, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë fiÚıÈ· ÛÙ¿ÛË ‰ÂÓ ¤¯ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ù˘ ÔÚÈ˙fiÓÙÈ·˜ ı¤Û˘, Ô˘ ·Ú·‰›ÓÂÈ ÂÓÙÂÏÒ˜ ÙÔÓ ¿ÓıÚˆÔ ÛÙȘ ¯ıfiÓȘ ‰˘Ó¿ÌÂȘ. °È’ ·˘Ùfi, ·ÎfiÌË Î·È fiÙ·Ó ÂÎı¤ÙÔ˘Ó ¤Ó· ÓÂÔÁ¤ÓÓËÙÔ, ‰ÂÓ ÙÔ ÂÁηٷÏ›Ô˘Ó ÛÙË ÁË. ∏ ¤ÎıÂÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ Û˘Óԉ¢fiÙ·Ó ¿ÓÙ· ·fi ÙË Ï¿Úӷη, ÙÔ Ï›ÎÓÔ ‹ ÙË ¯‡ÙÚ·. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ªˆ¸Û‹ ‹Ù·Ó ¤Ó· ηϿıÈ. ªÂ ÙËÓ Ú¿ÍË ·˘Ù‹, Ë ÂÁηٿÏÂÈ„Ë ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ÁÈÓfiÙ·Ó ·Ó·ÁηÛÙÈο Û ÂÚËÌÈÎfi ̤ÚÔ˜, Ì ÙËÓ ÂÏ›‰· fiÙÈ ı· ÂÈ˙‹ÛÂÈ (13).

O ÛÔ˘‰·›Ô˜ ÌÂÏÂÙËÙ‹˜ Ù˘ ·Ú¯·ÈfiÙËÙ·˜ R. Flacieliere ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ ÛÙ›Ú˜ Á˘Ó·›Î˜ Û˘¯Ó¿ ÂÚÈÌ¿˙¢·Ó οÔÈÔ ¤ÎıÂÙÔ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÈηÓÔÔÈ‹ÛÔ˘Ó ÙË Ï·¯Ù¿Ú· ÙÔ˘˜ ÁÈ· ·È‰›. ¶·Ú›ÛÙ·Ó·Ó ÙȘ ÂÁ΢ÌÔÓÔ‡Û˜ ÁÈ· Ó· ÍÂÁÂÏ¿ÛÔ˘Ó ÙÔÓ Û‡˙˘ÁÔ, ‰›ÓÔÓÙ¿˜ ÙÔ˘ ÙÔÓ ÁÈÔ Ô˘ ÂÈı˘ÌÔ‡Û (11). ∏ ·fiıÂÛË ‹Ù·Ó οÙÈ ÂÓÙÂÏÒ˜ ‰È·ÊÔÚÂÙÈÎfi. ∂ÓÒ ÛÙËÓ ¤ÎıÂÛË ÔÈ ÏfiÁÔÈ ‹Ù·Ó ÎÔÈÓˆÓÈÎÔ›, ÛÙËÓ ·fiıÂÛË ‹Ù·Ó ıÚËÛ΢ÙÈÎÔ›. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, ÂÈÏÂÁfiÙ·Ó ÂÚËÌÈ΋ ÙÔÔıÂÛ›·, Ì ÛÎÔfi ÙÔÓ ¯·Ìfi ÙÔ˘ ÓÂÔÁÓÔ‡. ™ÙÔÓ “ÿˆÓ·” ÙÔ˘ ∂˘ÚÈ›‰Ë ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÂÁη٤ÏÂÈ„·Ó ÙÔÓ ÿˆÓ· Û ̛· ÂÚËÌÈ΋ ÛËÏÈ¿ (1494), “ÙÔÓ ¤‰ˆÛ·Ó ÙÚÔÊ‹ ÛÙ· Ô˘ÏÈ¿” (504505) Î·È “ÙÔÓ ÂÁη٤ÏÂÈ„·Ó ÛÙ· ıËÚ›·” (951). ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÓıÚˆÔÎÙÔÓ›· ‹Ù·Ó ÙÔ ÛÔ‚·ÚfiÙÂÚÔ ·‰›ÎËÌ· ÁÈ· ÙËÓ ·Ú¯·›· ÂÏÏËÓÈ΋ fiÏË, ÔÈ ‰ËÌfiÛÈÔÈ ·ÍȈ̷ÙÔ‡¯ÔÈ ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ˘Ô‚¿ÏÔ˘Ó Ì‹Ó˘ÛË Î·Ù¿ ÙÔ˘ ‰ÔÏÔÊfiÓÔ˘. ∞˘Ùfi ÁÈÓfiÙ·Ó ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘ ı‡Ì·ÙÔ˜. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ¤ÎıÂÛ˘, ÔÈ Û˘ÁÁÂÓ›˜ ÙÔ˘ ·È‰ÈÔ‡ ¤ÚÂ ӷ ηٷÁÁ›ÏÔ˘Ó ÙËÓ Ú¿ÍË. ¶Ú¤ÂÈ ·ÎfiÌË

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Ó· ÛËÌÂȈı› fiÙÈ Ô ÁÈÔ˜ ÌÔÚÔ‡Û ӷ ˙ËÙ‹ÛÂÈ ·fi ÙÔ ‰ÈηÛÙ‹ÚÈÔ, Ì ÙËÓ ˘ÔΛÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ·Ó ‹Ù·Ó ·Ó‹ÏÈÎÔ˜, Ó· ˘Ô¯ÚÂÒÛÂÈ ÙÔÓ ·Ù¤Ú· ÙÔ˘ Ó· ÙÔÓ ÂÓÙ¿ÍÂÈ ÛÙË Ê˘Ï‹ ˆ˜ ÁÈÔ ÙÔ˘ Î·È ÛÙËÓ fiÏË fiÙ·Ó ÂÓËÏÈÎȈı› (8-10). ∂ÎÙfi˜ ·fi ÙËÓ ∂ÏÏ¿‰·, ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ¤ÎıÂÛ˘ ‹Ù·Ó Û‡ÓËı˜ ÛÙËÓ ∞›Á˘ÙÔ Î·È ÙË ƒÒÌË. ™ÙË ƒÒÌË, ÙÔ ‰Èη›ˆÌ· Ù˘ ¤ÎıÂÛ˘ ÙˆÓ ·È‰ÈÒÓ Û‹Ì·ÈÓ Ú·ÎÙÈο ÙÔ ‰Èη›ˆÌ· ÙÔ˘ ·Ù¤Ú· Ó· ÂÎı¤ÙÂÈ ÙËÓ ÎfiÚË ÙÔ˘. ∞ÎfiÌ· Î·È ÔÈ ÊÙˆ¯fiÙÂÚÔÈ, Û¿ÓÈ· ¿ÊËÓ·Ó ¤ÎıÂÙÔ ¤Ó·Ó ÁÈÔ, ÁÈ·Ù› Ô ÁÈÔ˜ ÌÔÚÔ‡Û ÚÈÓ ·ÎfiÌË ÂÓËÏÈÎȈı› - Ó· ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘. ∏ ÎfiÚË, ·ÓÙ›ıÂÙ·, ÌÔÚÔ‡Û ›Ûˆ˜ Ó· ‚ÔËı‹ÛÂÈ ÛÙÔ ÓÔÈÎÔ΢ÚÈfi ¤ˆ˜ fiÙÔ˘ ·ÓÙÚ¢Ù›. ∆fiÙÂ, ¤ÚÂ ӷ ÚÔÈÎÈÛÙ›, ‰ËÏ·‰‹ Ó· ·ÔÚÚÔÊ‹ÛÂÈ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ Ù˘ ÔÈÎÔÁÂÓÂȷ΋˜ ÂÚÈÔ˘Û›·˜. ∞ÓÙ›ıÂÙ·, ÔÈ ∂‚Ú·›ÔÈ, fiˆ˜ Ì·˜ ÏËÚÔÊÔÚ› Ô º›ÏˆÓ, ·Ó Î·È ‰ÂÓ ÂȉÔΛ̷˙·Ó ÙË Á¤ÓÓËÛË ÎÔÚÈÙÛÈÔ‡, ‰ÂÓ ÙÔ ÂͤıÂÙ·Ó (º›ÏˆÓÔ˜ π, ÃÃV, 119). ¶Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ·Ó·ÊÂÚı› Î·È Ë ÛÙ·‰È·ÎÒ˜ ·˘Í·ÓfiÌÂÓË Â›‰Ú·ÛË ÙˆÓ ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ, Ù˘ “Ó¤·˜ ËıÈ΋˜”, ÛÙÔ È·ÙÚÈÎfi Â¿ÁÁÂÏÌ·-ÏÂÈÙÔ‡ÚÁËÌ·. O ÃÚÈÛÙÈ·ÓÈÛÌfi˜, Ì ÙËÓ ¤ÌÊ·ÛË Ô˘ ¤‰ˆÛ ÛÙËÓ ÈÂÚfiÙËÙ· Ù˘ ˙ˆ‹˜, ‹Úı Û ·ÓÙ›ıÂÛË Ì ·˘Ù¤˜ ÙȘ Ú·ÎÙÈΤ˜ ÙÔ˘ ·ÚÂÏıfiÓÙÔ˜. OÈ ·Ù¤Ú˜ Ù˘ ÂÎÎÏËÛ›·˜ ‹Ù·Ó ȉȷ›ÙÂÚ· ¢·›ÛıËÙÔÈ ·¤Ó·ÓÙÈ ÛÙȘ ·Á·ÓÈÛÙÈΤ˜ ·˘Ù¤˜ Ú¿ÍÂȘ Î·È ÚÔÛ¿ıËÛ·Ó Ó· ÚÔÛٷ٤„Ô˘Ó Ì οı ÙÚfiÔ ÙÔ ÓÂÔÁ¤ÓÓËÙÔ. OÈ ÃÚÈÛÙÈ·ÓÔ› Û˘ÁÁÚ·Ê›˜ Û˘¯Ó¿ ·¤‰È‰·Ó ÙËÓ Î·ÙËÁÔÚ›· Ù˘ ·ÓıÚˆÔÎÙÔÓ›·˜ Û ·˘ÙÔ‡˜ Ô˘ η٤ÛÙÚÂÊ·Ó ÙÔÓ “ηÚfi Ù˘ ÎÔÈÏÈ¿˜”. ¶¤Ú·Û·Ó ÔÏÏÔ› ·ÈÒÓ˜ ÁÈ· Ó· ηÙÔ¯˘ÚˆıÔ‡Ó ÓÔÌÈο ÔÈ ¯ÚÈÛÙÈ·ÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ ÁÈ· ÙË ı·Ó¿ÙˆÛË, ÙËÓ ÒÏËÛË ‹ ÙËÓ ¤ÎıÂÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘. OÈ Î·ÈÚÔ› Î·È ÔÈ ›‰ÈÔÈ ÔÈ ¿ÓıÚˆÔÈ ‰È·ÌÔÚÊÒÓÔ˘Ó ÙȘ Û˘Óı‹Î˜. Ÿ,ÙÈ Ï¿‚ÂÈ ¤Ó· ·È‰›, οÔÈ· ̤ڷ ı· ÙÔ ÂÈÛÙÚ¤„ÂÈ. Ÿ,ÙÈ ÛÙÂÚËı›, ı· ÙÔ ÛÙÂÚ‹ÛÂÈ Î·È ·˘Ùfi Ì ÙË ÛÂÈÚ¿ ÙÔ˘. ∆Ô Î·Îfi Ô˘ ¤¯ÂÈ ˘ÔÛÙ›, ÌÔÚ› Ó· ÙÔ Â·Ó·Ï¿‚ÂÈ. ∞ÏÏ¿, Â¿Ó ÁÂÌ›ÛÂÈ Ë Ó·ڋ „˘¯‹ ÙÔ˘ Ì ÙËÓ ÓÔ‹ Ù˘ ÂÏ¢ıÂÚ›·˜, Ù˘ ‰‡Ó·Ì˘ Î·È Ù˘ ÁÓÒÛ˘, ÙfiÙ ÌÔÚ› Ó· ·ÚÌÂÓ›ÛÂÈ Î·È Ó· Ì¿ıÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙȘ ı‡ÂÏϘ Ù˘ ˙ˆ‹˜. °È·Ù›, Û‡Ìʈӷ Ì ÙË ª·Ú›· §·Ì·‰·Ú›‰Ô˘-¶fiıÔ˘ ÛÙÔ ‚È‚Ï›Ô Ù˘ “°Ú¿ÌÌ· ÛÙÔÓ ÁÈÔ ÌÔ˘ ÎÈ ¤Ó· ¿ÛÙÚÔ”: “¡· ı˘Ì¿Û·È ¿ÓÙ· ÙÔ ı·‡Ì· fiÙÈ ÁÂÓÓ‹ıËΘ! ∫È ·Ó ÔÈ Î·ÈÚÔ› Ì·˜ Â›Ó·È ·Ó¿ÍÈÔÈ ÁÈ· ¤Ó· Ù¤ÙÔÈÔ ı·‡Ì·, ÌËÓ Í¯¿ÛÂȘ ÔÙ¤ ˆ˜ ÙÔ˘˜ ηÈÚÔ‡˜ ÙÔ˘˜ ÊÙÈ¿¯ÓÔ˘Ó ¿ÓıÚˆÔÈ Î·È ¿ÓıÚˆÔÈ ÙÔ˘˜ ·ÏÏ¿˙Ô˘Ó”. µÈ‚ÏÈÔÁÚ·Ê›· 1. ∆·Ì¿Î˘ £∫. ∆Ô ·È‰› ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1996;43:31-36.

2. Faure P. ∏ ηıËÌÂÚÈÓ‹ ˙ˆ‹ ÛÙȘ ÂÏÏËÓÈΤ˜ ·ÔÈ˘. ∂Ή. ¢. ¡. ¶··‰‹Ì·: ∞ı‹Ó·; 1998. ÛÂÏ. 49, 180.

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3. ∆·Ì¿Î˘ £∫. ∆Ô ·È‰› ÛÙȘ ·Ú¯·›Â˜ ÂÏÏËÓÈΤ˜ ·ÔÈ˘. ¶·È‰È·ÙÚÈ΋ 1996;59:297-302.

4. §·ÌÚÔÔ‡ÏÔ˘ µ. ∆Ô ‰›Î·ÈÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ∂Ή. ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; 1990.

5. ∫·˚Ì¿ÎË ¢µ. OÈ ıÂÛÌÔ› Ù˘ ¶·Ï·È¿˜ ¢È·ı‹Î˘. ∂Ή. Sinbo; 1995. ÛÂÏ. 90.

6. Kolobova ∫ª, Ozereckaja EL. ∏ ηıËÌÂÚÈÓ‹ ˙ˆ‹ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ∂Ή. ¢. ¡. ¶··‰‹Ì·: ∞ı‹Ó·; 1993. ÛÂÏ. 84, 117, 146.

7. ÷ÚÔÎfiÔ˜ ™. ∆Ô ·È‰› Î·È Ô ∞ÚÈÛÙÔÙ¤Ï˘. ¶·È‰È·ÙÚÈ΋ 1979; 42:402-417.

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10. Harrison ARW. The law of Athens. Oxford: Clarendon Press; 1968. p. 71.

11. Flacieliere R. O ‰ËÌfiÛÈÔ˜ Î·È È‰ÈˆÙÈÎfi˜ ‚›Ô˜ ÙˆÓ ·Ú¯·›ˆÓ EÏÏ‹ÓˆÓ. ∞ı‹Ó·: ∂Ή. ¢. ¡. ¶··‰‹Ì·; 1970. ÛÂÏ. 65.

12. ∆·Ì¿Î˘ £∫. ∆Ô ·È‰› ·fi ÙË ‚ÚÂÊÈ΋ ˆ˜ ÙË Û¯ÔÏÈ΋ ËÏÈΛ· ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1998;45:51-56.

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14. ∆˙ÈÚÔÔ‡ÏÔ˘-∂˘ÛÙ·ı›Ô˘ A. ∏ ·Ï‹ıÂÈ· ÁÈ· ÙË ‰Ô˘Ï›· ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ∂ÏÏËÓÈ΋ AÁˆÁ‹ 2002;14/67:5-17.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 19-02-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: £Ú·Û‡‚Ô˘ÏÔ˜ ∆·Ì¿Î˘ §. ¢ËÌÔÎÚ·Ù›·˜ 368, ∆.∫. 681 00, ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË

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∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™ ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜ ∆Ô “∞ÓÔȯÙfi ¶·ÓÂÈÛÙ‹ÌÈÔ” Ù˘ ¶·È‰È·ÙÚÈ΋˜! - http://www.abp.org/abpfr1024.htm ∆Ô ÚˆÙÔÔÚÈ·Îfi ÛÙÔÈ¯Â›Ô Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ÙÔ˘ American Board of Pediatrics Â›Ó·È Ë ‰˘Ó·ÙfiÙËÙ· Û˘Ó¯È˙fiÌÂÓ˘ ÂÎ·›‰Â˘Û˘ Î·È ÂÎÌ¿ıËÛ˘ ̤ۈ ‰ÈÎÙ‡Ô˘, Ë ÔÔ›· ÈÛÙÔÔÈÂ›Ù·È Â›ÛËÌ· Ì ¢›ψ̷-¶ÈÛÙÔÔÈËÙÈÎfi °ÓÒÛ˘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋. ™Ùfi¯Ô˜ ÙÔ˘ American Board of Pediatrics Â›Ó·È Ë ÚÔÒıËÛË Ù˘ ·È‰È·ÙÚÈ΋˜ ıˆڛ·˜ Î·È ¤Ú¢ӷ˜ ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ·, Ì ÙËÓ ·Ú¿ÏÏËÏË ·ÍÈÔÏfiÁËÛË ÙˆÓ ÈηÓÔًوÓ, ÙˆÓ ‰ÂÍÈÔÙ‹ÙˆÓ Î·È Ù˘ ÂÌÂÈÚ›·˜ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Û fiϘ ÙȘ ˘ÔÂȉÈÎfiÙËÙ¤˜ Ù˘. ∆Ô ÚfiÁÚ·ÌÌ· ÂÎÌ¿ıËÛ˘ ·ÎÔÏÔ˘ı› ÛÂÈÚ¿ ÂÍÂÙ¿ÛÂˆÓ Û ˘ÔÂȉÈÎfiÙËÙ˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜, fiˆ˜ ÛÙË Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›·, ÙËÓ ·ÈÌ·ÙÔÏÔÁ›·, ÙËÓ ÂÓ‰ÔÎÚÈÓÔÏÔÁ›· Î·È ÙË Ó¢ÚÔÏÔÁ›·. ∏ ·Ú¿‰ÔÛË ÙˆÓ Ì·ıËÌ¿ÙˆÓ Á›ÓÂÙ·È ËÏÂÎÙÚÔÓÈο - ̤ۈ Internet - Î·È ÔÏÔÎÏËÚÒÓÂÙ·È ·fi ÂÍÂÙ¿ÛÂȘ ·ÍÈÔÏfiÁËÛ˘, ÏÂÈÙÔ˘ÚÁÒÓÙ·˜ ¤ÙÛÈ ˆ˜ “∞ÓÔȯÙfi ¶·ÓÂÈÛÙ‹ÌÈÔ” Ù˘ ¶·È‰È·ÙÚÈ΋˜. ∂ÎÙfi˜ ·fi Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂÎÌ¿ıËÛ˘, ÙÔ American Board of Pediatrics ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ™˘Ó¯È˙fiÌÂÓ˘ π·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘ ̤۷ ·fi ÂȉÈÎÂ˘Ì¤Ó· Û¯¤‰È· ‰Ú¿Û˘ Î·È ÌÂϤÙ˜ ‰È¿ÚÎÂÈ·˜ ÙÚÈÒÓ ÂÙÒÓ. ªÔÓÙ¤ÚÓ· ÛÙÔÓ Û¯Â‰È·ÛÌfi Ù˘, Ì ÏÂÈÙÔ˘ÚÁÈ΋ Î·È Â˘ÎÚÈÓ‹ ÏÔ‹ÁËÛË, Ë ÈÛÙÔÛÂÏ›‰· ÙÔ˘ American Board of Pediatrics ÚÔÛʤÚÂÈ, Â›Û˘, ÏÔ‡ÛÈÔ ˘ÏÈÎfi ·fi Û¯ÂÙÈÎÔ‡˜ Û˘Ó‰¤ÛÌÔ˘˜, ηχÙÔÓÙ·˜ ÙÔ Â˘Ú‡ Ê¿ÛÌ· Ù˘ ¶·È‰È·ÙÚÈ΋˜.

Ambulatory Pediatric Association - ™ÙËÓ ˘ËÚÂÛ›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘! http://www.ambpeds.org/site/index.htm ™Ùfi¯Ô˜ ÙÔ˘ Ambulatory Pediatric Association Â›Ó·È Ë ·ÚÔ¯‹ ¯Ú‹ÛÈÌˆÓ Û˘Ì‚Ô˘ÏÒÓ Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË Î·È Ë „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÂÊ‹‚ˆÓ ·ÏÏ¿ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÁÂÓÈÎfiÙÂÚ·, Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ˘Á›· Î·È ÛÙËÓ ÔÌ·Ï‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘. ∂ȉÈÎÂ˘Ì¤ÓÔÈ ÂÈÛÙ‹ÌÔÓ˜ ·fi ÙÔÓ ¯ÒÚÔ Ù˘ ∞η‰ËÌ·˚΋˜ ¶·È‰È·ÙÚÈ΋˜ ÚÔÛʤÚÔ˘Ó ÙȘ ÁÓÒÛÂȘ Î·È ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜, ÙfiÛÔ ÛÂ Û˘Ó‹ıÂȘ fiÛÔ Î·È Û ÂÚÈÙÒÛÂȘ ¤ÎÙ·ÎÙ˘ ·Ó¿Á΢ Ô˘ ÚÔ·ÙÔ˘Ó ÛÙÔ Ï·›ÛÈÔ Ù˘ ¶·È‰È·ÙÚÈ΋˜, ̤۷ ·fi ÂÌÂÚÈÛٷو̤ÓË ¤Ú¢ӷ, ÚÔÛʤÚÔÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· Î·È ˘ËÚÂۛ˜ ÚÔÛÙ·Û›·˜ ÙˆÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ.

O ۯ‰ȷÛÌfi˜ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ÙÔ˘ Ambulatory Pediatric Association Â›Ó·È Î·Ïfi˜ Î·È Â‡¯ÚËÛÙÔ˜, ¯ˆÚ›˜ ȉȷ›ÙÂÚ˜ ÂÎÏ‹ÍÂȘ, Ì ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ÏÔ‹ÁËÛË ÛÙȘ ‚·ÛÈΤ˜ ηÙËÁÔڛ˜ ÙˆÓ È·ÙÚÈÎÒÓ websites. ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Î·ÙËÁÔÚ›· “¶ÚÔÛÊÔÚ¿ ∂ÚÁ·Û›·˜”, ÂÓÒ - ÂÎÙfi˜ ·fi ÙȘ Û¯ÂÙÈΤ˜ ÂΉfiÛÂȘ - ÙÔ Ambulatory Pediatric Association ÚÔÛʤÚÂÈ Î·È ˘ÔÙÚÔʛ˜ Û ӤԢ˜ ÂÈÛÙ‹ÌÔÓ˜ ÁÈ· ÙËÓ ÚÔÒıËÛË Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û¯ÂÙÈÎfi ÂÈÛÙËÌÔÓÈÎfi ‰›Ô.

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ª›· Û‡Á¯ÚÔÓË ËÏÂÎÙÚÔÓÈ΋ ‚È‚ÏÈÔı‹ÎË ÁÈ· ÙËÓ ¶·È‰È·ÙÚÈ΋! http://www.vh.org/pediatric/index.html ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÈÛÙ‹ÌÔÓ˜ ·È‰›·ÙÚÔÈ ÂӉȷʤÚÔÓÙ·È ÁÈ· ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË Û¯ÂÙÈο Ì ÙȘ ÓÂfiÙÂÚ˜ ÂÍÂÏ›ÍÂȘ ÛÙÔÓ ÙÔ̤· Ù˘ Û‡Á¯ÚÔÓ˘ ¶·È‰È·ÙÚÈ΋˜. ¶·Ú¿ÏÏËÏ·, ·ÚÈÔ Ì¤ÏËÌ· ÙˆÓ ÁÔÓ¤ˆÓ Â›Ó·È Ë ·Ó·˙‹ÙËÛË Ì›·˜ ηχÙÂÚ˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜, ÙfiÛÔ ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ fiÛÔ Î·È ÁÈ· Ù· ·È‰È¿ ÙÔ˘˜. ∆Ô ÚÒÙÔ “∂ÈÎÔÓÈÎfi ¶·È‰ÈÎfi ¡ÔÛÔÎÔÌ›Ԕ ‰ËÌÈÔ˘ÚÁ‹ıËΠÁÈ· Ó· ηχ„ÂÈ ·˘Ù¤˜ ·ÎÚÈ‚Ò˜ ÙȘ ·Ó¿ÁΘ, ÚÔÛʤÚÔÓÙ·˜ Ì›· ¢Ú›· Áο̷ ÏËÚÔÊÔÚÈÒÓ Î·È Û˘Ì‚Ô˘ÏÒÓ Ì¤Û· ·fi ÙË ÏÂÈÙÔ˘ÚÁ›· ÏÔ‡ÛÈ·˜ ËÏÂÎÙÚÔÓÈ΋˜ ‚È‚ÏÈÔı‹Î˘ Û¯ÂÙÈο Ì ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜, ηıÒ˜ Î·È ÛˆÌ·ÙÈ΋˜ Î·È „˘¯È΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘. ∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ Children’s Virtual Hospital ·Ó‹ÎÂÈ ÛÙÔÓ Â˘Ú‡ÙÂÚÔ ‰ÈÎÙ˘·Îfi ÙfiÔ Virtual Hospital, Ô ÔÔ›Ô˜ ‰ËÌÈÔ˘ÚÁ‹ıËΠ·fi ÙÔ ÂÚ¢ÓËÙÈÎfi È·ÙÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ ∞˚fi‚· Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÏÔ‡ÛÈÔ ˘ÏÈÎfi Û ı¤Ì·Ù· ÁÂÓÈ΋˜ È·ÙÚÈ΋˜. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÏÂÈÙÔ˘ÚÁ› Î·È ÙÌ‹Ì· ÌÂÙ·ÊÚ¿ÛÂˆÓ Û 5 ÁÏÒÛÛ˜.

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∞¡∞∫Oπ¡ø™∏

ANNOUNCEMENT

µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 42Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, Ô˘ ¤Ï·‚ ¯ÒÚ· ÛÙȘ 28-30 ª·˝Ô˘ 2004 ÛÙÔ ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘, ·ÔÓÂÌ‹ıËÎ·Ó Ù· ·ÎfiÏÔ˘ı· ‚Ú·‚›·:

∞’ Ãøƒ∂ª∂πO ∂¶∞£§O “™˘¯Ó¿ ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Û ·È‰È¿ ÌÂ Ê˘ÏÂÙÈÎfi ̈۷˚ÎÈÛÌfi: ¤Ó·˜ Èı·Ófi˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡” Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, ∫. ™ÈÛÌ¿ÓË, ∫. ∆Û›ÁÎÔ˜, ∞. °·ÏÏ¿, ¡. ™ÎÔÚ‰‹˜, ∑. ∫ÔÛÌ·˝‰Ô˘, º. ¶·ÙÛ¿Ï˘, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∆Ì‹Ì· ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ¡Â˘ÚÔÏÔÁ›·˜ Î·È °ÂÓÂÙÈ΋˜ ∫‡ÚÔ˘ ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁÈ΋ ªÔÓ¿‰· ª·Î¿ÚÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ∆Ì‹Ì· °ÂÓÂÙÈ΋˜, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”

µ’ Ãøƒ∂ª∂πO ∂¶∞£§O “∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ‰ÈÂÚ‡ÓËÛË 50 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Williams ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi” ™. ∞̤ÓÙ·, Ã. ™ÔÊÔÎÏ¤Ô˘˜, ∞. ∫ÔÏȷϤÍË, §. £ˆÌ·˝‰Ô˘, ∞. ª·‡ÚÔ˘, ™. ∫›ÙÛÈÔ˘, ∂. ∫·Ó·‚¿Î˘, ∂. ºÚ˘Û›Ú· ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

“∂›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ ˘ÔÏËı˘ÛÌÔ‡˜ ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ ÓÂÔÁÓÒÓ ÌË ·ÙÔÈÎÒÓ ÁÔÓ¤ˆÓ” µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, µ. ∆˙ÈÌÔ‡ÏË, Ã. ¡Ô‡ÙÛÈ·, ∞. ∆·¿ÚÎÔ˘, ¶. ª·˘Ú›‰Ë˜, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜, º. ∫·Ó·ÎÔ‡‰Ë-∆۷ηϛ‰Ô˘ ∞’ ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢

µƒ∞µ∂πO ∫Oπ¡ø¡π∫∏™ ¶∞π¢π∞∆ƒπ∫∏™ “¶ÚfiÁÚ·ÌÌ· ÚÔÛÙ·Û›·˜ Ù˘ ˘Á›·˜ ∆ÛÈÁÁ·ÓÔ·›‰ˆÓ” ¶. ™˘Ú›‰Ë˜, ∞. ∞ÙÙÈÏ¿ÎÔ˜, ¢. ¢ÔÁ¿Ó˘, ª. §·Ú›Ô˘, ª. ÷ÓÙ·Ú¿Ó, ∫. ∞ϤÛÙ·˜, ∂. ™ˆÙËÚÔÔ‡ÏÔ˘, ¢. ¶ÂÂÏ¿Û˘, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· °ÂÓÈ΋ °Ú·ÌÌ·Ù›· ¶ÚfiÓÔÈ·˜

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¶PO™EXH ™YNE¢PIA 13-16 OÎÙˆ‚Ú›Ô˘ 2004

XIX European Congress of Perinatal Medicine •ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔڛ˜: C&C International S.A. ∆ËÏ.: +30 210 68 89 100 Fax: +30 210 68 44 777 E-mail: perinatal2004@cnc.gr Website: www.perinatal2004.gr

∞ı‹Ó·

6-7 ¡ÔÂÌ‚Ú›Ô˘ 2004

24Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ™ÂÌÈÓ¿ÚÈÔ ¶·È‰È·ÙÚÈ΋˜ ∞›ıÔ˘Û· £Â¿ÙÚÔ˘ ∫ÔÏÂÁ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∆ËÏ.: +30 210 77 93 000 E-mail: ppk@otenet.gr

∞ı‹Ó·

11-14 ¡ÔÂÌ‚Ú›Ô˘ 2004

14Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ™˘Ó¤‰ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ Î·È π·ÙÚÈ΋˜ ∞ÂÈÎfiÓÈÛ˘ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ∞ÌÊÈı¤·ÙÚÔ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 77 11 673 Fax: +30 210 77 11 289 E-mail: info@prctravel.gr

13-14 ¡ÔÂÌ‚Ú›Ô˘ 2004

4Ë ∏ÌÂÚ›‰· Ù˘ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ (¶·Ú¿ÚÙËÌ· £ÂÛÛ·Ï›·˜) Î·È 1Ë ∏ÌÂÚ›‰· Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∆ÚÈÎ¿ÏˆÓ ¶ÓÂ˘Ì·ÙÈÎfi ∫¤ÓÙÚÔ ¢‹ÌÔ˘ ∆ÚÈη›ˆÓ ¶ÏËÚÔÊÔڛ˜: ∞Ó·ÛÙ·Û›Ô˘ ∞Ó·ÛÙ·Û›· ∆ËÏ.: 6937 676725, 24210 35574 ∞ÁÔÚ›ÙÛ· ™ÔÊ›· ∆ËÏ.: 24310 23652 (ÂÛˆÙ. 162) E-mail: anaskatsiar20t@hotmail.com ¶ÏËÚÔÊÔڛ˜ ÁÈ· ‰È·ÌÔÓ‹: ∫ˆÓ/ÓÔ˜ OÈÎÔÓfiÌÔ˘ ∆ËÏ.: 24310 79680 Fax: 24310 79682

∆ڛηϷ

22-23 ¡ÔÂÌ‚Ú›Ô˘ 2004

4th European Conference on Paediatric Asthma & Allergy ¶ÏËÚÔÊÔڛ˜: Tania Unsworth ∆ËÏ.: +44 2 075 016 747 Fax: +44 2 079 788 322 E-mail: tania@markallengroup.com

Amsterdam, Netherlands

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3Ë ∏ÌÂÚ›‰· ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¢ÂÚÌ·ÙÔÏÔÁ›·˜ ∞ÌÊÈı¤·ÙÚÔ ¶ÔÏÂÌÈÎÔ‡ ªÔ˘Û›Ԣ ¶ÏËÚÔÊÔڛ˜: ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ∆ËÏ.: +30 210 67 55 437 Fax: +30 210 67 45 117 E-mail: kakst@otenet.gr

∞ı‹Ó·

2-5 ¢ÂÎÂÌ‚Ú›Ô˘ 2004

13Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶Ó¢ÌÔÓÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ ™˘Ó‰ÚÈ·Îfi Î·È ¶ÔÏÈÙÈÛÙÈÎfi ∫¤ÓÙÚÔ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ¶ÏËÚÔÊÔڛ˜: Frei S.A. Travel-Congress ∆ËÏ.: +30 210 32 15 600 Fax: +30 210 32 19 296 E-mail: info@frei.gr Website: www.frei.gr

¶¿ÙÚ·

8-11 ¢ÂÎÂÌ‚Ú›Ô˘ 2004

6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜ ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ÓÔÛÔÏÔÁ›·˜ •ÂÓÔ‰Ô¯Â›Ô Electra Palace ¶ÏËÚÔÊÔڛ˜: ¢π∞™∆∞™∏ Travel ∆ËÏ.: +30 2310 88 92 44-5 Fax: +30 2310 88 92 46 E-mail: diastasi@diastasitravel.gr

£ÂÛÛ·ÏÔÓ›ÎË

5-7 ª·˝Ô˘ 2005

8th Congress of the European Society of Paediatric Dermatology Hilton Budapest Congress Center ¶ÏËÚÔÊÔڛ˜: Convention Budapest Ltd ∆ËÏ.: (361) 2990 184-6 Fax: (361) 2990 187 E-mail: zspapp@convention.hu kbagdi@convention.hu Website: www.convention.hu

Budapest, Hungary

4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005

ESPGHAN Summer School on Nutrition “Research Challenges in Clinical Nutrition” European Society for Paediatric Gastroenterology, Hepatology and Nutrition Eden Beach Hotel Club ¶ÏËÚÔÊÔڛ˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 77 26 355, 6945 29 30 71 E-mail: papadop5@otenet.gr

∞Ó¿‚˘ÛÛÔ˜

11-15 ™ÂÙÂÌ‚Ú›Ô˘ 2005

29th UMEMPS - Union of Middle Eastern and Mediterranean Pediatric Societies Congress ¶ÏËÚÔÊÔڛ˜: Pynar Aytac ∆ËÏ.: 90 2 163 473 535 Fax: 90 2 163 477 850 E-mail: paytac@symcon.com.tr

Istanbul, Turkey

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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

xx

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