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

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¶AI¢IATPIKH TOMO™ 63 TEYXO™ 4 ETO™ 2000 E§§HNIKH ¶AI¢IATPIKH ETAIPEIA ISSN 0377-2551 πOÀ§πO™-∞À°OÀ™∆O™ 2000 TOMO™ 63 TEYXO™ 4 O PAEDIATRIKI Hellenic Paediatric Society AºIEPøMA: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000 H ÓÂÔÁÓÔÏÔÁ›· ÛÙËÓ ·Ó·ÙÔÏ‹ Ù˘ ÙÚ›Ù˘ ¯ÈÏÈÂÙ›·˜ M. •¿ÓıÔ˘ H Ïԛ̈ÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ÛÙ· ·È‰È¿ E. PÒÌ·-°È·ÓÓ›ÎÔ˘ H ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜ °. KÔÙÙ·Ú›‰Ë AP£PO ™YNTA•H™ H ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ› M.A. M·ÁÈ¿ÎÔ˘, °.¶. XÚÔ‡ÛÛÔ˜ ANA™KO¶H™H ™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË: ¢ÈηÈÔÏÔÁÂ›Ù·È ·ÎfiÌË Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜; X. K·Ó·Î¿-Gantenbein EPEYNHTIKE™ EP°A™IE™ E›Â‰· ·Ú·ÁfivÙˆv ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂv›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜" K. ™o‡ÏË, E. ¶Ï·ÙoÎo‡ÎË, E. ¶··ÎˆvÛÙ·vÙ›vo˘, E. MȯÂϷοÎË, ™. AÚÒvË ¶ÚˆÙfiÎÔÏÏÔ ¤ÁηÈÚ˘ ÂÏÂÁ¯fiÌÂÓ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿ °. MÚÈ·ÛÔ‡Ï˘, N. Z¿‚Ú·˜, M. N·ÚÏ›ÔÁÏÔ˘, A. X·Ù˙‹˜ ¢È·ÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÛÙ· ÓÂÔÁÓ¿: ÂÎÙ›ÌËÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ A.E. M·ÚÁÂÙ¿Î˘, X. TÚ¿·ÏË, ¢. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜, °. °ÚËÁÔÚÈ¿‰Ô˘, N. I·Îˆ‚›‰Ô˘, °. KÔ˘Ú¿Î˘, H. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜ E›Â‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ·fi Candida albicans I. §·Ì·‰·Ú›‰Ë˜, E. ¢ËÌËÙÚ›Ô˘, M. £ÂÔ‰ˆÚ¿ÎË, A. X›˙·, M. ™·‚‚¿Ï·, E. MȯÂϷοÎË §ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Û ·È‰È¿ ¶. ™˘Ú›‰Ë˜, E. M·ÏÙ¤˙Ô˘, ¢. K·ÊÂÙ˙‹˜ BPAXEIA ¢HMO™IEY™H EÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Û ‚Ú¤ÊË A. TÛÈÏÈÌÈÁοÎË, A. M·ÓÔ˘Ú¿, £. TÛÂÎÔ˘Ú¿, B. AÁÁÂÏ¿ÎÔ˘, A. ™¯ÔÈÓ¿ÎË, ¶. ™Ù·ÛÈÓfi˜, §. ¶ÏÔ˘Ì›‰Ë˜ EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™ IÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· Û ·ÛıÂÓ‹ Ì ΢ÛÙÈ΋ ›ÓˆÛË ™. NÙÔ˘ÓÙÔ˘Ó¿Î˘, A. ZËÛÔ‡ÏË, A. §Ô˘Ú›‰·, E. PÒÌ·-°È·ÓÓ›ÎÔ˘, N. M·ÓˆÏ¿ÎË Ÿ„ÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi: ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘, M. Z·Ú›ÊË, I. OÈÎÔÓÔÌ›‰Ë˜, A. •˘ÔÏ˘Ù¿-Z·¯·ÚÈ¿‰Ë ™YNEXIZOMENH EK¶AI¢EY™H AÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙ· ·È‰È¿ M.°. ¶··‰¿ÎË, I. ™. K·ÛηڤÏ˘ ¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY TÚÔ¯·›· ·Ù˘¯‹Ì·Ù· - O‰ËÁ›Â˜ ÚfiÏ˄˘ K.£. TÛÔ˘Ì¿Î·˜ I™TOPIA TH™ E§§HNIKH™ ¶AI¢IATPIKH™ ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ- ¶ÔÚ›· 39 ÂÙÒÓ X. TÛÂÁ΋ E¶π™∆O§Œ˜ ¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ £. ¶ÂÚÚ¿Î˘ ¶.¢. §··ÙÛ¿Ó˘ ¡. ª·ÙÛ·ÓÈÒÙ˘ ¶AI¢IATPIKH ENHMEPø™∏ ∂. µ·Ï¿ÛÛË-∞‰¿Ì ¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ· ™˘ÓÙÔÌÔÁڷʛ˜ 265 268 272 275 278 287 292 302 309 314 319 322 326 330 337 339 342 347

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Τριμηνιαία έκδοση της Ελληνικής Παιδιατρικής Εταιρείας

Transcript of Παιδιατρική | Τόμος 63 • Τεύχος 4 • Ιούλιος - Αύγουστος...

Page 1: Παιδιατρική | Τόμος 63 • Τεύχος 4 • Ιούλιος - Αύγουστος 2000

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

ISSN 0377-2551

πOÀ§πO™-∞À°OÀ™∆O™ 2000 ● TOMO™ 63 ● TEYXO™ 4O

PAEDIATRIKI Hellenic Paediatric Society

AºIEPøMA: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

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

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

H ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓÌ ·Ó·Ëڛ˜°. KÔÙÙ·Ú›‰Ë

AP£PO ™YNTA•H™H ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner:™‡Á¯ÚÔÓ˜ ·fi„ÂȘ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ›M.A. M·ÁÈ¿ÎÔ˘, °.¶. XÚÔ‡ÛÛÔ˜

ANA™KO¶H™H™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË: ¢ÈηÈÔÏÔÁ›ٷȷÎfiÌË Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜;X. K·Ó·Î¿-Gantenbein

EPEYNHTIKE™ EP°A™IE™E›Â‰· ·Ú·ÁfivÙˆv ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂv›˜Ì Á·Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜" K. ™o‡ÏË, E. ¶Ï·ÙoÎo‡ÎË, E. ¶··ÎˆvÛÙ·vÙ›vo˘,E. MȯÂϷοÎË, ™. AÚÒvË

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

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

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

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

BPAXEIA ¢HMO™IEY™HEÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜Û ‚Ú¤ÊËA. TÛÈÏÈÌÈÁοÎË, A. M·ÓÔ˘Ú¿, £. TÛÂÎÔ˘Ú¿, B. AÁÁÂÏ¿ÎÔ˘,A. ™¯ÔÈÓ¿ÎË, ¶. ™Ù·ÛÈÓfi˜, §. ¶ÏÔ˘Ì›‰Ë˜

EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™IÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· Û ·ÛıÂÓ‹ Ì ΢ÛÙÈ΋ ›ÓˆÛË™. NÙÔ˘ÓÙÔ˘Ó¿Î˘, A. ZËÛÔ‡ÏË, A. §Ô˘Ú›‰·, E. PÒÌ·-°È·ÓÓ›ÎÔ˘,N. M·ÓˆÏ¿ÎË

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

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

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Page 2: Παιδιατρική | Τόμος 63 • Τεύχος 4 • Ιούλιος - Αύγουστος 2000

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EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹¶Úfi‰ÚÔ˜ : A. KˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜¢È¢ı˘ÓÙ‹˜ : E. B·Ï¿ÛÛË-A‰¿ÌM¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

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Bimonthly PublicationThe Official Journal of the Hellenic Paediatric Society

PublisherK. Griveas

Owner©Hellenic Paediatric SocietyMichalakopoulou 92Athens 115 28Tel. (01) 7771 140 / 7771 663, Fax: 7758 354

Scientific Editorial BoardPresident : A. KonstadopoulosEditor : E. Valassi-AdamMembers : F. Athanassiadou-Piperopoulou

: M. Athanassiou-Metaxa: S. Andronikou: S. Kitsiou-Tzeli: S. Nakou : T. Panagiotopoulos: A. Syrigou-Papavassiliou: K. Priftis: G. Syrogiannopoulos: S. Tsitoura

English EditingS. Nakou

Statistics ConsultantE. Sarafidou

TfiÌÔ˜ 63, T‡¯Ô˜ 4Ô Io˘Ï-∞˘Á. 2000

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

Consultants, Paediatric SubspecialtySocietiesS. Grafacos Haematology-OncologyE. Roma GastroenterologyV. Spilioti EndocrinologyV. Thanopoulos CardiologyE. Petridou Social PaediatricsM. Xanthou NeonatologyK. Stefanidis NephrologyL. Papagianouli PaedodonticsA. Papavassiliou NeurologyJ. Tsanakas Pneumonology

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EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 10000 ‰Ú¯.EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 5000 ‰Ú¯.

πSSN 0377-2551

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdP. Tsaldari 3, Marousi 151 22Tel.: 61 43 501-4-5, Fax: 61 31 365

Annual SubscriptionAll foreign countries: US $ 30

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Page 3: Παιδιατρική | Τόμος 63 • Τεύχος 4 • Ιούλιος - Αύγουστος 2000

AºIEPøMA: YÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000H ÓÂÔÁÓÔÏÔÁ›· ÛÙËÓ ·Ó·ÙÔÏ‹ Ù˘ ÙÚ›Ù˘ ¯ÈÏÈÂÙ›·˜M. •¿ÓıÔ˘ 265

H Ïԛ̈ÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ÛÙ· ·È‰È¿E. PÒÌ·-°È·ÓÓ›ÎÔ˘ 268

H ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜°. KÔÙÙ·Ú›‰Ë 272

AP£PO ™YNTA•H™H ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner:™‡Á¯ÚÔÓ˜ ·fi„ÂȘ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ›M.A. M·ÁÈ¿ÎÔ˘, °.¶. XÚÔ‡ÛÛÔ˜ 275

ANA™KO¶H™H™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË: ¢ÈηÈÔÏÔÁ›ٷȷÎfiÌË Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜;X. K·Ó·Î¿-Gantenbein 278

EPEYNHTIKE™ EP°A™IE™E›Â‰· ·Ú·ÁfivÙˆv ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂv›˜ Ì Á·-Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜" K. ™o‡ÏË, E. ¶Ï·ÙoÎo‡ÎË, E. ¶··ÎˆvÛÙ·vÙ›vo˘,E. MȯÂϷοÎË, ™. AÚÒvË 287

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

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

E›Â‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂÌ˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ·fi Candida albicansI. §·Ì·‰·Ú›‰Ë˜, E. ¢ËÌËÙÚ›Ô˘, M. £ÂÔ‰ˆÚ¿ÎË,A. X›˙·, M. ™·‚‚¿Ï·, E. MȯÂϷοÎË 309

§ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Û ·È‰È¿¶. ™˘Ú›‰Ë˜, E. M·ÏÙ¤˙Ô˘, ¢. K·ÊÂÙ˙‹˜ 314

SPECIAL SERIES: Children's Health 2000Neonatology at the dawn of the third millenium M. Xanthou 265

Helicobacter pylori infection in children E. Roma-Yiannikou 268

The family and care of the child with disabilityY. Kottaridi 272

EDITORIALThe use of growth hormone in the treatment of shortstature in Turner syndromeM.A. Magiakou, G.P. Chroussos 275

REVIEW ARTICLETurner syndrome and growth hormone: Is the initialenthusiasm justified?C. Kanaka-Gantenbein 278

ORIGINAL PAPERSHaemostatic factors in patients withgalactosaemia on soybean dietK. Schulpis, E. Platokouki, E. Papakonstantinou,E. Michelakakis, S. Aroni 287

Optimized enteral feeding in critically ill children;a prospective study in a paediatric intensive care unitG. Briassoulis, N. Zavras, M. Narlioglou, T. Hatzis 292

Transoesophageal pacing in neonates: Estimation ofthe appropriate site of minimum pacing thresholdA. Margetakis, C.Trapali, D. Georgakopoulos,G. Grigoriadou, N. Iakovidou, G. Kourakis,H Dellagrammaticas 302

Chitotriosidase levels in Candida albicans infectionJ. Labadaridis, E. Dimitriou, M. Theodoraki,A. Hiza, M. Savala, H. Michelakakis 309

Non-tuberculous mycobacterial lymphadenitis in childrenP. Spyridis, H. Maltezou, D. Kafetzis 314

¶ E P I E Ã O M E N A C O N T E N T S

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA HELLENIC PAEDIATRIC SOCIETY

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BPAXEIA ¢HMO™IEY™HEÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ÂÈÎÔÈÓˆÓ›·˜ Û ‚Ú¤ÊËA. TÛÈÏÈÌÈÁοÎË, A. M·ÓÔ˘Ú¿, £. TÛÂÎÔ˘Ú¿, B. AÁÁÂÏ¿ÎÔ˘,A. ™¯ÔÈÓ¿ÎË, ¶. ™Ù·ÛÈÓfi˜, §. ¶ÏÔ˘Ì›‰Ë˜ 319

EN¢IAºEPOY™E™ ¶EPI¶Tø™EI™IÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· Û ·ÛıÂÓ‹ Ì ΢ÛÙÈ΋ ›ÓˆÛË™. NÙÔ˘ÓÙÔ˘Ó¿Î˘, A. ZËÛÔ‡ÏË, A. §Ô˘Ú›‰·,E. PÒÌ·-°È·ÓÓ›ÎÔ˘, N. M·ÓˆÏ¿ÎË 322

Ÿ„ÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi:ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘, M. Z·Ú›ÊË,I. OÈÎÔÓÔÌ›‰Ë˜, A. •˘ÔÏ˘Ù¿-Z·¯·ÚÈ¿‰Ë 326

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

¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY TÚÔ¯·›· ·Ù˘¯‹Ì·Ù· - O‰ËÁ›Â˜ ¶ÚfiÏ˄˘K.£. TÛÔ˘Ì¿Î·˜ 337

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

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

¶∞π¢π∞∆ƒπ∫∏ E¡∏ª∂ƒø™∏ 347∂. µ·Ï¿ÛÛË-∞‰¿Ì

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

™˘ÓÙÔÌÔÁڷʛ˜

SHORT REPORTA study of ventricular septal defects inthe first year of life A. Tsilimingaki, A. Manoura, T. Tsekoura, V. Agelakou,A. Schoinaki, P. Stasinos, L. Ploumidis 319

CASE REPORTSFibrosing colonopathy in cystic fibrosisS. Doudounakis, A. Zissouli, A. Lourida,E. Roma-Giannicou, N. Manolaki 322

Late intrauterine cytomegalovirus infection:clinical and imaging findingsO. Papadaki-Papandreou, M. Zarifi, I. Oikonomidis,A. Xypolyta-Zachariadi 326

CONTINUING MEDICAL EDUCATIONGastroÔesophageal reflux in children: methodsof radiological evaluationM. Papadaki, I. Kaskarelis 330

PAEDIATRICIAN'S PRACTICALADVICE TO PARENTSK.T. Tsoumakas 337

HISTORY OF HELLENIC PAEDIATRICSC. Tsegi 339

LETTERS 342

PAEDIATRIC NEWS 347

Forthcoming meetings

Abbreviations

Page™ÂÏ.

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¶¶AAII¢¢IIAATTPPIIKKHHTfiÌÔ˜ 63, T‡¯Ô˜ 4Ô πÔ‡Ï.-∞˘Á. 2000

E§§HNIKH ¶AI¢IATPIKH ETAIPEIA HELLENIC PAEDIATRIC SOCIETY

PPAAEEDDIIAATTRRIIKKIIVolume 63, No. 4, Jul-Aug 2000

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H ¶AI¢IATPIKH Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛËÎ·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ (E ¶ E ).

Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ·) ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ‚) ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ·È‰È¿ÙÚˆÓÛ ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ÔÈÎÔÁ¤ÓÂÈ·˜ ηıÒ˜ Î·È Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Á) ÙË ‰È¢-ÎfiÏ˘ÓÛË Ù˘ ‰È·Î›ÓËÛ˘ ÙˆÓ È‰ÂÒÓ Î·È Ù˘ ·Ó¿Ù˘Í˘Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Â‰›Ô Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ‰) ÙËÓÚfiÔ‰Ô Ù˘ ÂÏÏËÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ ̤ۈ Ù˘ ÎÚÈÙÈ΋˜·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÎÂÈÌ¤ÓˆÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ· ‰ËÌÔ-Û›Â˘ÛË Â) ÙËÓ ÂÓı¿ÚÚ˘ÓÛË Î·È Î·ÏÏȤÚÁÂÈ· Ù˘ ÂÈÛÙË-ÌÔÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ·

°È· ÙÔÓ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË: ¿ÚıÚ·Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘-ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ,›ηÈÚ· ı¤Ì·Ù·,¿ÚıÚ· ÂȉÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜, ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜, ÎÏÈ-ÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ, Ú·ÎÙÈο ı¤Ì·Ù·, ÁÂÓÈο ı¤Ì·Ù·Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛËÙ˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘ Î·È ˘Á›·˜, Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁ-Á˘ÏÔ‡ ÙÚ·Â˙ÈÔ‡, ÎÏÈÓÈÎÔ·ıÔÏÔÁÈΤ˜ Û˘˙ËÙ‹ÛÂȘ, ÛÂÌÈ-Ó¿ÚÈ·, Û˘ÌfiÛÈ·, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈ-Τ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ¿ÚıÚ· Û˘Ó¯È-˙fiÌÂÓ˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡-ÓÙ·ÍË, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙËÌÔÓÈ΋ ÂȉËÛÂÔÁÚ·Ê›· fiˆ˜ÂÓË̤ڈÛË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Û˘Ó‰ڛˆÓ, Û˘ÌÔÛ›ˆÓ ηÈÁÈ· ‰Ú·ÛÙËÚÈfiÙËÙ˜ Û¯ÂÙÈΤ˜ Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡.

OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰Ë-ÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi ¶AI¢IATPIKH ·ÔÛÙ¤ÏÏÔÓÙ·ÈÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 9211528 Aı‹Ó·

H ¶AI¢IATPIKH ·ÎÔÏÔ˘ı› ÙȘ KÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ÁÈ· XÂÈÚfiÁÚ·Ê· Ô˘ YÔ‚¿ÏÏÔÓÙ·È Û BÈÔ˚·ÙÚÈο ¶Â-ÚÈÔ‰Èο Ô˘ ‰È·ÌÔÚÊÒıËÎ·Ó ·fi ÙËÓ ICMJE(International Committee of Medical Journal Editors.Uniform Requirements for Manuscripts Submitted toBiomedical Journals. N Eng J Med 1997;337:309-315,http://jama.ama-assn.org/info/auinst-req.htlm)

ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ô˘ Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·-Ê›˜, ÛÙËÓ ÔÔ›·:·) ÂÚÈÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈο Ë Û˘Ì‚ÔÏ‹ ÂοÛÙÔ˘ ÙˆÓ

Û˘ÁÁڷʤˆÓ (ۯ‰ȷÛÌfi˜, ·Ó¿Ï˘ÛË, ÂÚÌËÓ›· ¢ÚË-Ì¿ÙˆÓ,Û˘ÏÏÔÁ‹ ‰Â‰Ô̤ӈÓ, Û˘ÁÁÚ·Ê‹ ÂÚÁ·Û›·˜,·Ó·ÌfiÚʈÛË ÎÂÈ̤ÓÔ˘),

‚) ‰ËÏÒÓÂÙ·È fiÙÈ fiÏÔÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó Î·È ÌÔ-ÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙÔ ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË Î›ÌÂÓÔ‹ ÙÌ‹Ì· ÙÔ˘,

Á) ‰ËÏÒÓÂÙ·È Ë ÚԤϢÛË Ù˘ ¯ÚËÌ·ÙÔ‰fiÙËÛ˘ ÁÈ· ÙË

Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›· (£· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Ù¤ÏÔ˜Ù˘ ÂÚÁ·Û›·˜),

‰) ‰ËÏÒÓÂÙ·È ·Ó ÔÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó οÔÈ· ÔÈÎÔÓÔÌÈ-΋ Û¯¤ÛË Ì ÂÙ·ÈÚ›· ‹ ÔÚÁ·ÓÈÛÌfi Ô˘ ¤¯ÂÈ ÔÈÎÔÓÔÌÈ-Îfi ÂӉȷʤÚÔÓ ÁÈ· Ù· Â˘Ú‹Ì·Ù· ‹ ÙȘ ·fi„ÂȘ ÙÔ˘Û˘ÁÁڷʤ· (·˘Ùfi ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘-ÓÙ·ÎÙÒÓ ·ÏÏ¿ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÁÓˆÛÙfi ÛÙÔ˘˜ ·Ó·-ÁÓÒÛÙ˜),

Â) ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔ-ÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢Ù› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔEÏÏËÓÈÎfi ÂÚÈÔ‰ÈÎfi.

H ¶AI¢IATPIKH ÂÓı·ÚÚ‡ÓÂÈ ÙËÓ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓÔ˘ ¤¯Ô˘Ó ‹‰Ë ‰ËÌÔÛÈ¢Ù› ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ÛÂÍÂÓfiÁψÛÛ· ÂÚÈÔ‰Èο Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÔÈ Û˘Á-ÁÚ·Ê›˜ Û˘Ó˘Ô‚¿ÏÏÔ˘Ó ÊˆÙÔ·ÓÙ›ÁÚ·ÊÔ Ù˘ ÍÂÓfi-ÁψÛÛ˘ ‰ËÌÔÛ›Â˘Û˘ Î·È ÙËÓ ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛËÙÔ˘ ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ ÙÔ˘ ÍÂÓfiÁψÛÛÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¶AI¢IATPIKH Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ-΋ ‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·-ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ¢È¢ı˘ÓÙ‹ Ù˘ E.™.E.

ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó Û‡Ì-ʈӷ Ì ÙË ‰È·Î‹Ú˘ÍË ÙÔ˘ EÏÛ›ÓÎÈ ÙÔ˘ 1975 fiˆ˜ ·Ó·-ıˆڋıËΠÙÔ 1983, Î·È Û‡Ìʈӷ Ì ÙË ™‡Ì‚·ÛË ÁÈ· Ù·¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡.

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

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·-ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓEÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi‰ÈÛΤٷ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο,ÛËÌÂ›Ô ÚÔ˜ ÛËÌ›Ô, ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË-̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘Ó¿ÁÂÙ·È Ó¤·˘Ô‚ÔÏ‹.

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰Â-ÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈ-ÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔ-Áڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

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

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O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜

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™‡ÓÙ·ÍË ÙˆÓ ÂÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ

ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·-ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤-ıÔ˘˜ A4 (22X28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢-Ú¤˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË:ÛÂÏ›‰· Ù›ÙÏÔ˘, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο,ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹-ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·-Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘-ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈÓ· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡-ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘. H ¤ÎÙ·-ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ·ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 Î·È ÁÈ· Ù· ›ηÈÚ·ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈ-Τ˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜,ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ ηÈÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:- ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) Î·È ÙÔ ‚Ú·¯‡ Ù›ÙÏÔ (<5 Ϥ-

ÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ

ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹-

ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤Ï-ÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó··Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒ-Ù˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ,

- ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁÚ·-ʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂȘH ÂÚ›ÏË„Ë ÙˆÓ ÂÚ¢ÓËÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó·

Â›Ó·È ‰ÔÌË̤ÓË. N· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ·) ÙÔ˘˜ ÛÙfi¯Ô˘˜,‚) ÙË ÌÂıÔ‰ÔÏÔÁ›·, Á) Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ηȉ) Û¯fiÏÈ· ‹ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈÓ· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·Á-ÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤ-ˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤-ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈ-Îfi. ¶ÂÚ›ÏË„Ë ‰ÂÓ ¤¯Ô˘Ó ÔÈ Ô‰ËÁ›Â˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈ-ÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë. K¿-Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈ-ÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ Ô˘ ı· ¯ÚËÛÈÌÔÔÈË-ıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

K›ÌÂÓÔOÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹,

˘ÏÈÎfi Î·È ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈ-Û·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘

¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È-‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜.H ÂÚÈÁÚ·Ê‹ ÙÔ˘ ˘ÏÈÎÔ‡ Î·È ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· ›-Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T··ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ·Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘-ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛË-Ì·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤ-ÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·Áˆ-Á‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË.OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛËÌ ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤-Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘Á-ÁڷʤˆÓ ÙÔ˘˜.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓOÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó·

ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional - ™˘Ì‚·ÙÈÎfi)™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA ÙÔ˘ 1986 (255:2329-2339).

™˘ÓÙÔÌÔÁڷʛ˜OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜

‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂ-ÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘-¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘-ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂ-ÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ

‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤Ó-ıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó·˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢-ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂÓ-‰È·Ê¤ÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈ-‡ÛÂȘ. H ·Ó·ÊÔÚ¿ ÂÏÏËÓÈÎÒÓ ‰ËÌÔÛȇÛÂˆÓ ıˆÚ›ٷȷ·Ú·›ÙËÙË.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·ÈÛ‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ National Library ofMedicine (H¶A) Î·È Ù˘ International Committee ofMedical Journal Editors (N Eng J Med 1997;337:309-315,http://jama.ama-assn.org/info/auinst-req.htlm). OÈÛ˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛËÙÔ Index Medicus (List of Journals Indexed in IndexMedicus http://www.nlm.nih.gov).

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¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶ÂÚÈÔ‰ÈοAÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ,

·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔȤÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:™ÙÂÊ·Ó›‰Ë˜ A, KÔÚÈÙÛÈ¿‰Ë˜ ™, Mȯ·‹Ï B, AÓ‰ÚÔ˘Ï·-

ο΢ ºA. O˘ÚÔ‰˘Ó·ÌÈο Â˘Ú‹Ì·Ù· Û ·ÛıÂÓ›˜ Ì ·-ÏȤ˜ ‚·Ï‚›‰Â˜ Ù˘ ÔÈÛı›·˜ Ô˘Ú‹ıÚ·˜. AÚ¯ EÏÏ I·ÙÚ1988;15:448-455.

Vega KJ, Pina I, Krevsky B. Heart transplantation isassociated with an increased risk for pancreatobiliarydisease. Ann Intern Med 1996;124:980-983.

™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:Llach F. Parathyroidectomy in chronic renal failure:

Indications, surgical approach and the use of calcitriol.Kidney Int 1990; 38 (29 suppl):S62-S68.

XˆÚ›˜ Û˘ÁÁڷʤ·:Coffee drinking and cancer of the pancreas

[editorial]. BMJ 1981;283:628.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:§ÂΤ· B, M·ÎԇϷ X, M·ÙÛ·ÓÈÒÙ˘ N. ¢È·ÓÔÛÔÎÔ-

ÌÂȷΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·. TÈ˘Ô‰ÂÈÎÓ‡Ô˘Ó; ¶ÂÚÈÏ. 78, 26Ô ¶·ÓÂÏ. ¶·È‰. ™˘Ó. Iˆ¿ÓÓÈ-Ó· 28-29 M·˚Ô˘ 1988.

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

II. BÈ‚Ï›·KÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô:Schuster V. Renal clearance. In: Seldin DW, Giebich

G, eds. The kidney: physiology and pathophysiology.2nd ed. New York: Raven Press, 1992:943-978.

™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:M·Ú¿ÙÔ˘-AÏÈÚ¿ÓÙË §. OÈÎÔÁ¤ÓÂÈ· ÛÙËÓ Aı‹Ó·: OÈ-

ÎÔÁÂÓÂȷο ÚfiÙ˘· Î·È Û˘˙˘ÁÈΤ˜ Ú·ÎÙÈΤ˜. Aı‹Ó·:EıÓÈÎfi K¤ÓÙÚÔ KÔÈÓˆÓÈÎÒÓ EÚ¢ÓÒÓ 1995.

¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ:Bauer AW. The two definitions of bacterial resistance.

In: Smith AJ, Rogers CA, eds. Proceedings of the ThirdInternational Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy,1963:484-500.

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹:MÂÓ¤ÙÔ˘-M·Ú·ÓÙ›‰Ô˘ A. XÚËÛÈÌÔÔ›ËÛË ÔÏÏ·-

ÏÒÓ ÂȉÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÙÒÛÂ-ˆÓ Ù˘ ÌÔÏ˘‚‰È¿Ûˆ˜ ÛÙÔ K.N.™. ·È‰ÈÒÓ (¢È‰·ÎÙ. ¢È·-ÙÚ.). Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ 1988.

ÕÚıÚ· Û ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹:Morse SS. Factors in the emergence of infectious

diseases.Emerg Infect Dis [serial online]1995 Jan-Mar[cited 1996 June 5];1(1):[24 screens]. Available from:URL: http://www.cdc.gov/ncidod/EID/eid.htm

¶›Ó·Î˜ Î·È ÂÈÎfiÓ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô

ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔÏ¿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‡˜ ÌÂÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿ÙˆÌ¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂ-Ù˜ ÁÚ·Ì̤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·,ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £·Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·-ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™˘ÛÙ‹ÓÂÙ·È ÛÙ· Û¯‹Ì·Ù· Ó··ÔʇÁÔÓÙ·È ÔÈ ÛÎÈ¿ÛÂȘ ÛÙÔ ÊfiÓÙÔ Î·È ÙÔ Î›ÌÂÓÔ Ì¤-Û· ÛÙËÓ ÂÈÎfiÓ·. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó·ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔfiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈ-ÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È ËÙ·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔ-ÓÙ·È ÔÓÔÌ·ÛÙÈο.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈÂÚÈÏ·Ì‚¿ÓÂÈ:

- ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜- ‰‹ÏˆÛË fiÙÈ ‰ÂÓ ¤¯ÂÈ ˘Ô‚ÏËı› Û˘Á¯ÚfiÓˆ˜ Û ¿ÏÏÔ

EÏÏËÓÈÎfi ÂÚÈÔ‰ÈÎfi Î·È ‰ÂÓ ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈ¢Ù›. - ·Ó¿Ù˘Ô Î·È ÂÈÛÙÔÏ‹ ¤ÁÎÚÈÛ˘ ÙÔ˘ ‰È¢ı˘ÓÙ‹ Û‡-

ÓÙ·Í˘ Û ÂÚ›ÙˆÛË Ô˘ ¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› Û ÍÂÓfi-ÁψÛÛÔ ÂÚÈÔ‰ÈÎfi

- 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜- ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜- fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈ-

ÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·Ï-

ÏËÏÔÁÚ·Ê›·- ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi

‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈ-

ÛÙ‹ ÛÂÏ›‰·)- ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈ-

ÏÔ‡Ó- ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜

Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó- Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆ-

ÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

ix

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265

¶∞π¢π∞∆ƒπ∫∏ 2000;63:265-267

H ÚfiÔ‰Ô˜ ÛÙËÓ ÓÔÛËÏ›· ÙˆÓ ÓÂÔÁÓÒÓ ·ÔÙÂÏ› ¤Ó· ·fi Ù· ÈÔ ÛËÌ·ÓÙÈο ÂÈÙ‡ÁÌ·Ù· ÙÔ˘ 20Ô‡ ·ÈÒÓ·.M¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ· ÚfiˆÚ· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ıˆÚÔ‡ÓÙ·Ó ·˘Ù¿ Ì B°<2500ÁÚ.Î·È ·fi ·˘Ù¿ ÙÔ

70% ¤ı·ÈÓ·Ó. TÔ 1900 Ô Pierre Budin ÛÙÔ ¶·Ú›ÛÈ Î·Ù·Û··Û ÙËÓ ÚÒÙË ıÂÚÌÔÎÔÈÙ›‰· Î·È ÂÈÛ‹Á·Á ÙÔ Ï‡-ÛÈÌÔ ÙˆÓ ¯ÂÚÈÒÓ ÚÈÓ ·fi ÙËÓ Â·Ê‹ Ì ÙÔ ÓÂÔÁ¤ÓÓËÙÔ. M ·˘Ù¿ Î·È ÌfiÓÔ Ù· ̤ÙÚ· ÌÂÈÒıËÎÂ Ë ıÓËÛÈÌfiÙËÙ·ÙˆÓ ÓÂÔÁÓÒÓ Ì B°<2500 ÁÚ. ÂÚ›Ô˘ ÛÙÔ 20%.

K·Ù¿ ÙÔ ÚÒÙÔ ‹ÌÈÛ˘ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, Ù›ÔÙ ÛËÌ·ÓÙÈÎfi ‰ÂÓ Û˘Ó¤‚Ë. K·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ‹ÌÈÛ˘ ÛËÌÂÈÒÓÂÙ·ÈÌÈ· Ú·ÁÌ·ÙÈ΋ ·ӿÛÙ·ÛË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔÒÚˆÓ Î·È ‚·ÚÈ¿ ¿ÚÚˆÛÙˆÓ ÓÂÔÁÓÒÓ. TÔ ÌÂÁ¿ÏÔ ÂÓ-‰È·Ê¤ÚÔÓ ¿Ú¯ÈÛ Á‡Úˆ ÛÙ· 1950, fiÙ·Ó ÔÈ ÂÚ¢ÓËÙ¤˜ ÛÙÚ¿ÊËÎ·Ó ÛÙË ÌÂϤÙË Ù˘ Ê˘ÛÈÔÏÔÁ›·˜ Î·È Ê˘ÛÈÔ·ıÔ-ÏÔÁ›·˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡. OÈ ÁÓÒÛÂȘ ·˘Ù¤˜, Ì·˙› Ì ÙËÓ ÌÂÁ¿ÏË Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô Ô˘ ¿ÓıÈ˙Â›Û˘ ÂΛÓË ÙËÓ ÂÔ¯‹, Ô‰‹ÁËÛ ÛÙËÓ ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ÚÒÙˆÓ MÔÓ¿‰ˆÓ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓÛÙËÓ ‰ÂηÂÙ›· 1960-1970. ŒÙÛÈ, ÂÓÒ Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ Ôχ ÌÈÎÚÒÓ ÚÔÒÚˆÓ Ì B°<1200 ÁÚ. ÚÈÓ ·fi ÙÔ1970 ‹Ù·Ó Á‡Úˆ ÛÙÔ 80% ÌÂÙ¿ ÙÔ 1980 ¤ÂÛ ÛÙÔ 20%. ™Â ·˘Ùfi, ÂÎÙfi˜ ·fi ÙȘ MÔÓ¿‰Â˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›-·˜ Û˘Ó¤‚·Ï·Ó ÛËÌ·ÓÙÈο Î·È Ó¤Â˜ ıÂڷ¢ÙÈΤ˜ ̤ıÔ‰ÔÈ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ.

¶ÚÈÓ ·fi ÙÔ 1970 ÙÔ I‰ÈÔ·ı¤˜ ™‡Ó‰ÚÔÌÔ AÓ·Ó¢ÛÙÈ΋˜ ¢˘Û¯¤ÚÂÈ·˜ (I™A¢) ·ÔÙÂÏÔ‡Û ÙËÓ Î˘ÚÈfiÙÂÚË·ÈÙ›· ı·Ó¿ÙÔ˘ Ù˘ ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘. H ·Ó·Î¿Ï˘„Ë Î·È ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·(Surfactant) ÂÏ¿ÙÙˆÛ ÙËÓ ıÓËÛÈÌfiÙËÙ· ÙÔ˘ I™A¢ ηٿ 40% Î·È ÙȘ ÂÈÏÔΤ˜ ÙÔ˘ ηٿ 60% (1). TÂÏÂ˘Ù·›· Û˘-ÓÈÛÙ¿Ù·È Ô ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁˆÓ Ó· ‰›‰ÂÙ·È fi¯È ÌfiÓÔ ıÂڷ¢ÙÈο, ·ÏÏ¿ Î·È ÚÔÊ˘Ï·ÎÙÈο Û ÓÂÔ-Á¤ÓÓËÙ· Ì ËÏÈΛ· ΢‹Ûˆ˜ <32 ‚‰ÔÌ¿‰ˆÓ Ù· ÔÔ›· ηٿ ÙËÓ ·Ó¿ÓË„Ë ¯ÚÂÈ¿˙ÔÓÙ·È ‰È·ÛˆÏ‹ÓˆÛË (2). O Û˘Ó-‰˘·ÛÌfi˜ ¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÛÙË ÌËÙ¤Ú· ÚÔ ÙÔ˘ ÙÔÎÂÙÔ‡ Î·È ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·ÛÙ· ÓÂÔÁÓ¿ ʤÚÓÂÈ Ù· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· (3).

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

H ÓÂoÁÓÔÏÔÁ›· ÛÙËÓ ·Ó·ÙÔÏ‹ Ù˘ ÙÚ›Ù˘ ¯ÈÏÈÂÙ›·˜

M·ÚȤÙÙ· •¿ÓıÔ˘

M. Xanthou. Neonatology at the dawn of the third millenium. Paediatriki 2000;63:265-267.● Abstract: During the second half of the 20th century impressive progress was made in neonatology basedon knowledge that was gained from research on the fetus and the newborn. With the help of the technologicalrevolution which occurred at the same time, the first neonatal intensive care units were created. The neonatalmorbidity and mortality rates fell dramatically during the following years and today 80% of the babies ofBW<1000g survive, and only 8-15% of them develop major handicaps. The reduction of neonatal morbidity andmortality was due in part to the new methods of treatment and prophylaxis which were applied, including theadministration of surfactant and high frequency ventilation to babies suffering from respiratory distresssyndrome, the administration of i.v. lg and growth factors to increase neonatal host defense mechanismsagainst infections, and total parenteral nutrition. A second factor in improved survival comprises the improvedmethods of diagnosis. Today with the new methods of imaging and with the help of molecular biology,congenital illness can be diagnosed very early and even at the beginning of intrauterine life. Thirdly there hasbeen improvement in the quality and organization of perinatal care. In Greece perinatal mortality has decreasedconsiderably during the last 20 years, and this is of added importance as the birth rate during the same timeperiod has been decreasing.

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

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ÛÒ˙Ô˘Ó ÓÂÔÁÓ¿ Ù· ÔÔ›· ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙÔÓ Û˘Ó‹ıË ·ÂÚÈÛÌfi(4).H ¯Ú‹ÛË ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (NO) Ì·˜ ÚÔÛʤÚÂÈ ¿ÌÂÛË Î·È ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ó¢ÌÔÓÈ-

΋˜ ˘¤ÚÙ·Û˘. H ıÂڷ›· Ì ˘„›Û˘¯ÓÔ Ù·Ï·ÓÙˆÛÈÎfi ·ÂÚÈÛÌfi Î·È Û˘Á¯ÚfiÓˆ˜ ÂÈÛÓÔ‹ NO, ‰›‰ÂÈ Ù· ηχÙÂ-Ú· ·ÔÙÂϤÛÌ·Ù· Û ‚·ÚȤ˜ Ó¢ÌÔÓÈΤ˜ ˘ÂÚÙ¿ÛÂȘ (5).

T¤ÏÔ˜, Ë Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË Ì¤Ûˆ ÌÂÌ‚Ú¿Ó˘ (ECMO) Â›Ó·È Ë ÙÂÏÂ˘Ù·›· ̤ıÔ‰Ô˜ Ë ÔÔ›· ¯ÚËÛÈÌÔ-ÔÈÂ›Ù·È fiÙ·Ó ¤¯Ô˘Ó ·ÔÙ‡¯ÂÈ fiϘ ÔÈ ÚÔ·Ó·ÊÂÚı›Û˜ ̤ıÔ‰ÔÈ, Ì ηϿ ·ÔÙÂϤÛÌ·Ù· ΢ڛˆ˜ fiÙ·Ó ·ÊÔÚ¿ÓÂÔÁ¤ÓÓËÙ· Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 2000 ÁÚ. (6).

™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ì›ˆÛË Ù˘ ˘„ËÏ‹˜ ÓÂÔÁÓÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÔÊ›ÏÔÓÙ·È Û ÛÔ-‚·Ú¤˜ ÓÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ ¤¯Ô˘Ó ·›ÍÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÈ ÓÂÒÙÂÚ˜ ̤ıÔ‰ÔÈ ÂÓ›Û¯˘Û˘ ÙˆÓ ·ÓÔÛÔ‚ÈÔ-ÏÔÁÈÎÒÓ ·Ì˘ÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ ÓÂÔÁÓÔ‡. OÈ ÏÔÈÌÒÍÂȘ ·ÎfiÌË Î·È Û‹ÌÂÚ· ·ÔÙÂÏÔ‡Ó Ì›· ·fi ÙȘ ·ÚȘ·Èٛ˜ ÓÂÔÁÓÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Î·È È‰È·›ÙÂÚ· ÛÙȘ ˘fi ·Ó¿Ù˘ÍË ¯ÒÚ˜ Î·È ÛÙȘ MÔÓ¿‰Â˜EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ. T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¯ÔÚËÁÔ‡ÓÙ·È Û ÓÂÔÁ¤ÓÓËÙ· ÂÓ‰ÔÊϤ‚Ș ·ÓÔÛÔÛÊ·ÈÚ›-Ó˜ Î·È ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ·ÈÌÔÔÈËÙÈÎÔ› ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ì ÛÎÔfi ÙËÓ ÂÓ›Û¯˘ÛË ÙˆÓ ·Ì˘ÓÙÈÎÒÓ ÙÔ˘˜ ÌË-¯·ÓÈÛÌÒÓ.

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

OÈ ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (G-CSF Î·È GM-CSF) ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓÏ¢ÎÔ΢ÙÙ¿ÚˆÓ ·ÏÏ¿ Î·È ÛÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘˜ (8).

ŒÙÛÈ ÔÈ ÂÓ‰ÔÊϤ‚Ș ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ηıÒ˜ Î·È ÔÈ ·ÈÌÔÔÈËÙÈÎÔ› ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ fiÙ·Ó ‰›‰ÔÓÙ·È ıÂ-ڷ¢ÙÈο Û ÓÂÔÁÓÈΤ˜ ÛË„·È̛˜ ‹ ÚÔÊ˘Ï·ÎÙÈο ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ÏÔÈÌÒÍÂˆÓ ¤¯Ô˘Ó ‰ÒÛÂÈ Ôχ ÂÓ-ı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (7,8).

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

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

H ÌË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÌÂÙ¤ÂÈÙ· ·Ó·ËÚÈÒÓ ÔÊ›ÏÂÙ·È, ÂÎÙfi˜ ·fi ÙË ¯Ú‹ÛË ÙˆÓ Ó¤ˆÓ ıÂڷ¢ÙÈÎÒÓÛ¯ËÌ¿ÙˆÓ, ÛÙËÓ ÔÚÁ¿ÓˆÛË Î·È ‚ÂÏÙ›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜. ™ÙË ¯ÒÚ· Ì·˜ ηٿ ÙËÓ 15ÂÙ›· 1983-1998 Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ˘Ô‰ÈÏ·ÛÈ¿ÛÙËÎÂ Î·È ¤ÊÙ·Û ÛÙÔ 10,5% (13). TÔ ÂӉȷʤÚÔÓ Î·È Ë ÂÓ·-Û¯fiÏËÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ ·ÓÙÈηÙÔÙÚ›˙ÂÙ·È ÙfiÛÔ ÛÙÔ Ï‹ıÔ˜ ÙˆÓ ÂÏÏËÓÈÎÒÓ ‰ËÌÔÛȇÛÂˆÓ Ô˘ Û¯Â-Ù›˙ÔÓÙ·È Ì ÓÂÔÁÓ¿ ÛÙÔÓ ‰ÈÂıÓ‹ Î·È ÂÏÏËÓÈÎfi È·ÙÚÈÎfi Ù‡Ô (ÌfiÓÔ ÛÙ· ·È‰È·ÙÚÈο ÂÚÈÔ‰Èο, ÛÙË B¿ÛË EÏÏËÓÈ-΋˜ BÈ‚ÏÈÔÁÚ·Ê›·˜ "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡" ·Ó·Ê¤ÚÔÓÙ·È 80 ‰ËÌÔÛȇÛÂȘ) fiÛÔ Î·È ·fi ÙÔ ÁÂÁÔÓfi˜ Ù˘ ·Ó·ÁÓÒ-ÚÈÛ˘ ·fi ÙËÓ ¶ÔÏÈÙ›· ÂÍÂȉ›Î¢Û˘ ÙˆÓ ·È‰È¿ÙÚˆÓ Â› ‰ÈÂÙ›· ÛÙËÓ ÂÓÙ·ÙÈ΋ ÓÔÛËÏ›· ÓÂÔÁÓÒÓ. T¤ÏÔ˜, Ë Ì›-ˆÛË ÙˆÓ ·Ó·ËÚÈÒÓ ÔÊ›ÏÂÙ·È ·ÎfiÌË ÛÙËÓ ¤ÁηÈÚË, Û˘¯Ó¿ ÂÓ‰ÔÌ‹ÙÚÈ·, ‰È¿ÁÓˆÛË ÓfiÛˆÓ, Ì ÙËÓ ‚Ô‹ıÂÈ· ÙˆÓÓ¤ˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ ηıÒ˜ Î·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÂıfi‰ˆÓ ÚfiÏ˄˘ ÓÔ-ÛËÚÒÓ Î·Ù·ÛÙ¿ÛˆÓ, fiˆ˜ ÂÁÎÂÊ·ÏÈÎÒÓ ‚Ï·‚ÒÓ, ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜, ·Ó·ÈÌÈÒÓ ÎÏ.

ŒÙÛÈ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ˘ÔÍÈ΋˜ ÈÛ¯·ÈÌÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜, ¤¯Ô˘Ó ‰Ôı› Û ÓÂ-ÔÁÓ¿ Ì ·ÛÊ˘Í›· Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ıÂÈÈÎfi Ì·ÁÓ‹ÛÈÔ, ‚ÈÙ·Ì›ÓË E Î·È ÙÒÚ· ÙÂÏÂ˘Ù·›· ·ÏÏÔÔ˘ÚÈÓfiÏË Î·È ÈÓ‰Ô-ÌÂı·Î›ÓË (14). OÈ ¤Ú¢Ó˜ ÛÙÔÓ ÙÔ̤· ·˘Ùfi Û˘Ó¯›˙ÔÓÙ·È.

°È· ÙËÓ ÚÔʇϷÍË Ù˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ Û ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓÂÔÁ¤ÓÓËÙ· ‰›‰ÔÓÙ·È ÚÔÊ˘Ï·ÎÙÈο ÔÈ ‚Èٷ̛Ә A Î·È E (15). H ¯ÔÚ‹ÁËÛË ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ ·˘ÙÒÓ Ì·˙› Ì ÙËÓ ÎÚ˘ÔıÂڷ›·Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÎÙ›ÓˆÓ Laser ¤¯Ô˘Ó ÂÏ·ÙÙÒÛÂÈ ÙËÓ Ù‡ÊψÛË.

T¤ÏÔ˜, ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ·Ó·ÈÌ›·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û‹ÌÂÚ· Ë ·Ó·Û˘Ó‰˘·Ṳ̂ÓËÂÚ˘ıÚÔÔÈËÙ›ÓË Ë ÔÔ›· ¤¯ÂÈ ÂÏ·ÙÙÒÛÂÈ ÛËÌ·ÓÙÈο ÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜ ·ÎfiÌË Î·È Û ‚·ÚÈ¿ ¿Û¯ÔÓÙ·ÚfiˆÚ· (16).

¶∞π¢π∞∆ƒπ∫∏ 2000;63:265-267 M. •¿ÓıÔ˘

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:265-267 ∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

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

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

E›ÏÔÁÔ˜H Ì¿¯Ë ÁÈ· ÙËÓ ÂÈ‚›ˆÛË Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÂͤÏÈÍË ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ Û˘Ó¯›˙ÂÙ·È Î·È Î·Ù¿ ÙËÓ ÙÚ›ÙË ¯È-

ÏÈÂÙ›· Î·È ·ÔÎÙ¿ ·ÎfiÌË ÈÔ ÌÂÁ¿ÏË ÛËÌ·Û›· ·Ó Ï¿‚Ô˘Ì ˘fi„Ë Ì·˜ fiÙÈ ÔÈ ÁÂÓÓ‹ÛÂȘ ÛÙËÓ ¯ÒÚ· Ì·˜ ·fi150.000 ÚÈÓ 20 ¯ÚfiÓÈ·, ¤¯Ô˘Ó η٤ÏıÂÈ Û‹ÌÂÚ· ÛÙȘ 98.000.

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

O 20fi˜ ·ÈÒÓ·˜ ʇÁÂÈ Î·È ·Ó·Ù¤ÏÏÂÈ Ô 21Ô˜, Ô ÔÔ›Ô˜ Ì ÙȘ ÂÈÙ‡ÍÂȘ Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÙ¯ÓÔÏÔÁ›·˜, Ì·˜ ˘fi-Û¯ÂÙ·È ı·‡Ì·Ù· Ô˘ Â›Ó·È ‰‡ÛÎÔÏÔ ·ÎfiÌË Î·È Ó· Ù· Û˘ÏÏ¿‚Ô˘ÌÂ, fiˆ˜ ÙË ıÂڷ›· ·ÓÈ¿ÙˆÓ ÓfiÛˆÓ Ì ÙËÓ ·ÓÙÈ-ηٿÛÙ·ÛË ·ıÔÏÔÁÈÎÒÓ ÁÔÓȉ›ˆÓ, ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓıÚˆ›ÓˆÓ ÔÚÁ¿ÓˆÓ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È... ‰È·ÎÔ¤˜ ÛÙÔÓÕÚË! ÕÚ·Á ÙÈ ı·‡Ì·Ù· Ó· Ì·˜ ÂÈÊ˘Ï¿ÛÛÂÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÙfiÛÔ ÌÈÎÚÒÓ Î·È Â˘·›ÛıËÙˆÓ ÓÂÔÁÓÒÓ;

BÈ‚ÏÈÔÁÚ·Ê›·1. Morley CJ. Systematic review of prophylactic versus rescue surfactant. Arch Dis Child 1997;77:F70-F4.2. Renie JM, Bokhari SA. Recent advances in neonatology. Arch Dis Child Fetal Neonatal 1990;81:F1-F4.3. Jobe AH, Mitchell BR, Gunkel JH. Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant

on preterm infants. Am J Obstet Gynecol 1993;168:508-513.4. Clark RH, Yoder BA, Sell MS. Prospective randomized comparison of high frequency oscillation and conventional ventilation

in candidates for extra-corporeal membrane oxygenation. J Ped 1994;124:447-454.5. Kinsella JP, Truog WE, Walsh WF. Randomized, multicenter trial of inhaled nitric oxide and high frequency oscillatory ventilation

in severe persistent pulmonary hypertension of the newborn. J Ped 1997;131:55-62.6. Collaborative ECMO Trial Group. UK Collaborative randomized trial of neonatal extracorporeal membrane oxygenation. Lancet

1996; 348: 75-82.7. Seth T, Cairo MS. The role of cytokines in the prevention and treatment of neonatal sepsis. In: Neonatal hematology and

Immunology III. Bellanti JA, Bracci R, Prindull G, Xanthou M, eds. Excepta Medica, International Congress Series 1131.Amsterdam: Elsevier 1997:49-53.

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

9. Fletcher A, ed. Neonatology: Pathophysiology and Management of the Newborn. 4rth ed. Nutrition 1994;24:343-348.10. The Victorian infant collaborative study group. Improved outcome in the 1990s for infants weighing 500-999gr at birth. Arch Dis

Child 1997;77:91-94.11. Battin M, Ling E, Whitfield MF, Mackinnon M, Effer SB. Has the outcome for extremely low gestational age (ELGA) infants

improved following recent advances in neonatal intensive care? Amer J Perinat 1998;8:469-477.12. O'Shea TM, Klinepeter KL, Goldstein DJ. Survival and developmental disability in infants with B.W. of 501 to 800gr born

between 1979 and 1994. Ped 1997;100:982-986.13. M·ÎԇϷ X. ¶ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·, 2000. 14. Vannucci RC, Perlman JM. Interventions for perinatal hypoxic-ischemic encephalopathy. Ped 1997;100:1004-1014.15. Papagaroufalis C, Spyropoulos G, Stamocosta E, Megreli C, Xanthou M. A trial of Vitamin A supplementation for the prevention

of retinopathy of prematurity in very low birth weight infants. In: Koppe JG, Eskes TKAB, van Geijn HP, Wiesenhaan PF, RuysJH, eds. Care, Concern and Cure in Perinatal Medicine: Proceedings of the XIIIth European Congress of Perinatal Medicine,Amsterdam, The Netherlands, May 1992. Lancs, England: The Parthenon Publishing Group 1993:187-193.

16. Obladen M, Maier RF. Recombinant human erythropoietin: A therapeutic option in anemia of prematurity. Xanthou M, BracciL, Prindull G, eds. In: Neonatal Haematology and Immunology II. Excepta Medica International Congress Series 1038.Amsterdam: Elsevier, 1993: 99-110.

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EÏ¢ıÂÚ›· PÒÌ·-°È·ÓÓ›ÎÔ˘

TÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ (H. pylori) ·Ó·Î·Ï‡ÊıËÎÂ Ù˘¯·›· Û ηÏÏȤÚÁÂÈ· ÈÛÙÔ‡ ·fi ÙÔ ˘ÏˆÚÈÎfi¿ÓÙÚÔ ÚÈÓ 18 ¯ÚfiÓÈ·. ŒÎÙÔÙÂ, ·ÎÔÏÔ‡ıËÛ·Ó ¯ÈÏÈ¿‰Â˜ ÌÂϤÙ˜ Ô˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó ·Ê' ÂÓfi˜ ÙËÓ ·ÁÎfiÛÌÈ· η-Ù·ÓÔÌ‹ Ù˘ Ïԛ̈͢ Î·È ·Ê' ÂÙ¤ÚÔ˘ ÙËÓ ·ıÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔÓ ¿ÓıÚˆÔ.(1)

EȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ Ïԛ̈͢ Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË ÙˆÓ Û˘ÓıË-ÎÒÓ ˘ÁÈÂÈÓ‹˜ Î·È ·˘Í¿ÓÂÙ·È ·Ú¿ÏÏËÏ· Ì ÙËÓ ËÏÈΛ· (1-3). EӉȷʤÚÔÓ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÌÂÁ¿ÏÔ ÔÛÔ-ÛÙfi ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ Á˘ Ë Ïԛ̈ÍË ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ùfi Û˘Ì‚¿ÏÏÂÈ fi¯È Ìfi-ÓÔ ÛÙË ÓÔÛËÚfiÙËÙ· ÛÙ· ·È‰È¿ ·ÏÏ¿ Î·È Èı·ÓfiÓ Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÛÔ‚·ÚfiÙÂÚ˜ ÂÈÙÒÛÂȘ ÌÂÙ¿ ·fi Ì·ÎÚÔ-¯ÚfiÓÈ· ·Ú·ÌÔÓ‹ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔ ÛÙÔÌ¿¯È, ηٿ ÙËÓ ÂÓ‹ÏÈÎÔ ‰ËÏ·‰‹ ˙ˆ‹. H Û˘¯ÓfiÙËÙ· Ù˘ Ïԛ̈͢ ÛÙËӷȉÈ΋ ËÏÈΛ· ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Î˘Ì·›ÓÂÙ·È ·fi 6 ¤ˆ˜ 15%, ÂÓÒ ÛÙȘ ˘fi ·Ó¿Ù˘ÍË ÂÚ›Ô˘ ÙÔ 80%ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ̤¯ÚÈ Ù· 15 ¯ÚfiÓÈ· ¤¯ÂÈ ÌÔÏ˘Óı›. ™ÙËÓ EÏÏ¿‰· ÔÈ ÌÂϤÙ˜ Â›Ó·È Ï›Á˜. H Û˘¯ÓfiÙËÙ·ÛÙ· ·Û˘Ìو̷ÙÈο ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi 15 ¤ˆ˜ 40%, ÂÓÒ ÙÔ ÔÛÔÛÙfi Â›Ó·È ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· Û˘-Ìو̷ÙÈο ·È‰È¿. TÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰È·ÁÓÒÛıËÎ·Ó ÈÛÙÔÏÔÁÈο ÛÙËÓ A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·-ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Ì Ïԛ̈ÍË ·fi H. pylori ˘ÂÚ‚·›ÓÂÈ Ù· 400. H Û˘¯ÓfiÙËÙ· ÛÙËÓ ÂÊ˂›· ·Ó¤Ú¯ÂÙ·È ÛÙÔ 60% ÙˆÓ ·È‰ÈÒÓ Ô˘ Á·ÛÙÚÔÛÎÔÔ‡ÓÙ·È.(3)

AÓ Î·È ·ÎfiÌ· Û˘˙ËÙÂ›Ù·È Ô ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ H. pylori- ÈÔ Èı·Ó‹ Ê·›ÓÂÙ·È Ë ÌÂÙ¿‰ÔÛË Ì ÙË ÛÙÔÌ·-ÙÈ΋ Î·È ÛÙÔÌ·ÙÔÚˆÎÙÈ΋ Ô‰fi - ÂÓÙÔ‡ÙÔȘ, Â›Ó·È Û·Ê¤˜ fiÙÈ Ë Â·Ê‹ Ì ÌÔÏ˘Ṳ̂ӷ ¿ÙÔÌ· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ηÈÔ Û˘Á¯ÚˆÙÈÛÌfi˜ Û ȉڇ̷ٷ ¢ÓÔÔ‡Ó ÙËÓ ÌÂÙ¿‰ÔÛ‹ ÙÔ˘. ¶Ú¿ÁÌ·ÙÈ, ÛÙËÓ A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈ-ÛÙËÌ›Ô˘ AıËÓÒÓ ÌÂÏÂÙ‹ıËÎ·Ó Ì Á·ÛÙÚÔÛÎfiËÛË Ù· ̤ÏË ÔÈÎÔÁÂÓÂÈÒÓ 41 ·È‰ÈÒÓ Ì Á·ÛÙÚ›Ùȉ· ·fi H. pyloriÎ·È ‚Ú¤ıËÎ·Ó ÌÔÏ˘Ṳ̂ӷ Û ÔÛÔÛÙfi 90%, ÂÓÒ Û οı ÔÈÎÔÁ¤ÓÂÈ· ˘‹Ú¯Â ¤Ó· ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤ÏÔ˜ ÌÔÏ˘Ṳ̂-ÓÔ(4). ™¯ÂÙÈο Ì ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ Ïԛ̈͢ Ê·›ÓÂÙ·È fiÙÈ ÌÔÚ› Ó· Á›ÓÂÈ ·˘ÙfiÌ·ÙË ›·ÛË Î·È ÌÂϤÙ˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ‚Ú¤ÊË Ô˘ ÌÔχÓıËÎ·Ó ·fi H. pylori Û˘¯Ó¿ ··ÏÏ¿ÛÛÔÓÙ·È ·ÚÁfiÙÂÚ· ·fi ·˘Ùfi.(5) ™ÙËÓ ÏÂÈÔÓfi-ÙËÙ· fï˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ı· ÂÁηٷÛÙ·ı› ÙÔ ÌÈÎÚfi‚ÈÔ ÛÙÔ ÛÙÔÌ¿¯È, ·Ó ‰ÂÓ ˘¿ÚÍÂÈ ·-ڤ̂·ÛË, ı· Ì›ÓÂÈ ‰È· ‚›Ô˘. H Ïԛ̈ÍË ÚÔηÏ› ÈÛÙÔÏÔÁÈ΋ ‚Ï¿‚Ë Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÔÍ›· Á·ÛÙÚ›ÙÈ-‰· Î·È Û˘Óԉ‡ÂÙ·È ·fi ·¯ÏˆÚ˘‰Ú›·, Î·È ÌÂÙ·›ÙÂÈ Û ¯ÚfiÓÈ· ÂÓÂÚÁfi Á·ÛÙÚ›Ùȉ·. H ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹ ÚÔ-ηÏ› ÛÙË Û˘Ó¤¯ÂÈ· ‚Ï¿‚Ë ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Ì ·ÔÙ¤ÏÂÛÌ· ·ÙÚÔÊ›· Î·È ˘Ô¯ÏˆÚ˘‰Ú›·, ÂÓÒ ¿Ï-ÏÔÙÂ Ë Ïԛ̈ÍË ÚÔηÏ› ÂÈÏÔΤ˜ fiˆ˜ ÂÙÈÎfi ¤ÏÎÔ˜ Î·È Î·ÚΛÓÔ ÛÙÔÌ¿¯Ô˘.

E. Roma-Yiannikou. Helicobacter pylori infection in children. Paediatriki 2000;63:268-271.● Abstract: Helicobacter pylori infection is common among the adult population and its incidence in the paediatricpopulation increases with age ranging between 5 and 80% in the developed and the developing world respectively.It is responsible for human diseases such as gastritis and peptic ulcer and there is evidence that early infection inchildhood predisposes to atrophic gastritis and gastric cancer in adulthood. Symptomatic children should beinvestigated by gastroscopy for the isolation of H. pylori, and H. pylori positive children treated with effective shortregimes for 7-10 days consisting of proton pump inhibitors, combined with two antibiotics such as amoxicillin,clarithromycin or metronidazole, according to the sensitivity test of the gastric culture. Large-scale screening of allasymptomatic children is impossible due to the large numbers of infected children, increased antibiotic resistanceand high rates of treatment failure. Prevention of H. pylori infection by improving hygienic status and probably bythe use of the appropriate vaccine will diminish infection and its consequent morbidity in children and adults.

Key words: Helicobacter pylori, therapeutic regimes, cancer.

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™Â ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙÔ˘ ÏËı˘ÛÌÔ‡ Ë Ïԛ̈ÍË Â›Ó·È ·Û˘Ìو̷ÙÈ΋.(1) EÚ¢ÓËÙ¤˜ Ô˘ ÂÈÚ·Ì·ÙÈοÌfiÏ˘Ó·Ó ÙÔ˘˜ ·˘ÙÔ‡˜ ÙÔ˘˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÚÔηÏ› ÔÍ›· Ïԛ̈ÍË Ì ¯ÚfiÓÔ ÂÒ·Û˘ 1 ¤ˆ˜7 Ë̤Ú˜, Ô˘ ÂΉËÏÒÓÂÙ·È Ì ÂÈÁ·ÛÙÚ·ÏÁ›·, Ó·˘Ù›·, ηÎÔ˘¯›· Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ Â̤ÙÔ˘˜. T· Û˘ÌÙÒÌ·Ù·ÂΉËÏÒÓÔÓÙ·È Û ÔÛÔÛÙfi 50% ÙˆÓ ÂÓËÏ›ÎˆÓ Ô˘ ÌÔχÓıËηÓ, ÂÓÒ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë Û˘¯ÓfiÙËÙ· Ù˘ ÎÏÈÓÈ-΋˜ ÂΉ‹ÏˆÛ˘ Ù˘ Ïԛ̈͢ ÛÙ· ·È‰È¿. ™Ù· ·È‰È¿ ÙÔ H. pylori ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· Á·ÛÙÚ›Ùȉ·˜ Ô˘ÌÔÚ› Ó· ÚÔ‚¿ÏÂÈ Ì ¯ÚfiÓÈ· ÎÔÈÏȷο ¿ÏÁË, Â›Ó·È ˘Â‡ı˘ÓÔ ÁÈ· ÙÔ ÂÙÈÎfi ¤ÏÎÔ˜ (ÛÙ· ÌÈÛ¿ ÂÚ›Ô˘ ·È‰È¿Ì ¤ÏÎÔ˜ Û˘Ó˘¿Ú¯ÂÈ H. pylori) (1,3,6,7), Û¿ÓÈ· ÁÈ· ˘ÂÚÙÚÔÊÈ΋ Á·ÛÙÚÂÓÙÂÚÔ¿ıÂÈ· Î·È ˘ÔÚˆÙÂ˚Ó·ÈÌ›·, ·È-Ì·Ù¤ÌÂÛË, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· Î·È Á·ÛÙÚÈÎfi ϤÌʈ̷ (›Ó·Î·˜ 1). ŸÛÔÓ ·ÊÔÚ¿ Ù· ÎÔÈÏȷο ¿ÏÁË Â›Ó·È ·Ì-ÊÈÏÂÁfiÌÂÓÔ Î·Ù¿ fiÛÔÓ Â˘ı‡ÓÂÙ·È ÙÔ H. pylori, ÂÓÒ ÌÔÏ˘Ṳ̂ӷ ·È‰È¿ ‰ÂÓ ·Ó¤ÊÂÚ·Ó ÎÔÈÏȷο ¿ÏÁË Û˘¯ÓfiÙÂ-Ú· ·fi ¿ÏÏ· Ô˘ ‰ÂÓ Â›¯·Ó ÌÔÏ˘Óı›. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ì·˜, ·fi Ù· 396 ·È‰È¿ Ì ¯ÚfiÓÈ· ÎÔÈÏȷο ¿ÏÁËÔ˘ Á·ÛÙÚÔÛÎÔ‹ıËηÓ, ÌfiÓÔ 28,5% ›¯·Ó Ïԛ̈ÍË ·fi H. pylori.(6)

Y¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ H. pylori ¢ı‡ÓÂÙ·È ÁÈ· Â͈ÂÓÙÂÚÈΤ˜ ÂΉËÏÒÛÂȘ, ‰ËÏ·‰‹ Û˘Ì-ÌÂÙÔ¯‹ ·fi ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· Ì ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘, Ê·ÈÓfiÌÂÓÔ Raynaud, ËÌÈ-ÎÚ·Ó›·, ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· fiˆ˜ ȉÈÔ·ı‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ, ·˘ÙÔ¿ÓÔÛÔ ı˘ÚÂÔÂȉԿıÂÈ· (ı˘ÚÂÔÂÈ-‰›Ùȉ·, ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi), ‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ fiˆ˜ ¯ÚfiÓÈ· ÎÓ›‰ˆÛË Î·È ·ÎÌ‹ roseaca Î·È Ù¤ÏÔ˜ Ë·ÙÈÎ‹Û˘ÌÌÂÙÔ¯‹ Ì Èı·Ó‹ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜ Û ÎÈÚÚˆÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ηıÒ˜ ›Û˘ Î·È ¯Úfi-ÓÈ· ¯ÔÏÔ΢ÛÙ›Ùȉ· 1 (›Ó·Î·˜ 2). H ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· ·ÔÙÂÏ› Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ Ïԛ̈͢, ÂÓÒ Ë Î·ı˘-ÛÙ¤ÚËÛË ÛÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Ì¿ÏÏÔÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ̄ ·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙˆÓ ·È‰ÈÒÓ ·-Ú¿ Ì ÙËÓ ¿ÌÂÛË Â›‰Ú·ÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙËÓ ÛˆÌ·ÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·È‰ÈÔ‡. °È· ÙȘ ÂΉËÏÒÛÂȘ ÂÎÙfi˜ ÂÙÈ-ÎÔ‡ ̤ÓÂÈ Ó· ‰È¢ÎÚÈÓÈÛı› ·Ó Ë Ïԛ̈ÍË Â›Ó·È Ë ·ÈÙ›· ‹ Û˘Ì‚¿ÏÏÔ˘Ó ÎÈ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜.

ŸÛÔÓ ·ÊÔÚ¿ ÙË ‰È¿ÁÓˆÛË, Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ÔÈΛϘ ̤ıÔ‰ÔÈ (›Ó·Î·˜ 3). H ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ·Ú·Ì¤-ÓÂÈ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ Î·È ÙÔ CLO test ¤¯ÂÈ Â˘·ÈÛıËÛ›· ÂÚ›Ô˘ 90%.(1,3,7) H ηÏÏȤÚÁÂÈ· ÈÛÙÔ‡ ·ÔÙÂÏ› ÙËÓÈÔ ÂȉÈ΋ ̤ıÔ‰Ô ·ÏÏ¿ Ë Â˘·ÈÛıËÛ›· Ù˘ ‰È·Ê¤ÚÂÈ ÛÙ· ‰È¿ÊÔÚ· ÂÚÁ·ÛÙ‹ÚÈ·. TÔ ÌÂÁ¿ÏÔ Ù˘ ÏÂÔÓ¤ÎÙËÌ· ›-Ó·È fiÙÈ ÂϤÁ¯ÂÙ·È Ë Â˘·ÈÛıËÛ›· ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Î·È ¤ÙÛÈ Á›ÓÂÙ·È Ë ÛˆÛÙ‹ ÂÈÏÔÁ‹ ÙÔ˘˜ ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈ-ÎÚÔ‚›Ô˘. H PCR ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÙÂÎÌËÚȈı› Û·Ó Ì¤ıÔ‰Ô˜ ÚÔ˘Ù›Ó·˜, ·ÏÏ¿ ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂϤÁ¯Ô˘ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Î·È ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂÒÓ ÙÔ˘. ŸÛÔÓ ·ÊÔÚ¿ Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ H. pylori Ù· IgG

¶∞π¢π∞∆ƒπ∫∏ 2000;63:268-271 ∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

¶›Ó·Î·˜ 1.

™˘ÌÙÒÌ·Ù·

* ÎÔÈÏȷο ¿ÏÁË

* ·ÈÌ·Ù¤ÌÂÛË

* ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·

* ˘ÔÚˆÙÂ˚Ó·ÈÌ›·

* ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘

¶›Ó·Î·˜ 3.

¢È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi H. pylori

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

¶›Ó·Î·˜ 2.

EΉËÏÒÛÂȘ Ù˘ Ïԛ̈͢ ·fi H. pylori ÂÎÙfi˜

ÂÙÈÎÔ‡

* ηډȷÁÁÂȷ΋ ÓfiÛÔ˜

* Ê·ÈÓfiÌÂÓÔ Raynaud

* ËÌÈÎÚ·Ó›·

* ·˘ÙÔ·ÓÔÛ›·

* ‰ÂÚÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·

* ·ı‹ÛÂȘ ÙÔ˘ ‹·ÙÔ˜

¶›Ó·Î·˜ 4.

NÔÛ‹Ì·Ù· ÙÔ˘ ÂÙÈÎÔ‡ ·fi Ïԛ̈ÍË Ì H.pylori

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

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Â›Ó·È ÈÔ ·ÍÈfiÈÛÙ· Û˘ÁÎÚÈÙÈο Ì ٷ IgA Î·È Ù· IgM, ·ÏÏ¿ Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿, Â›Ó·È ÌÈÎÚ‹(̤¯ÚÈ 60%) Î·È ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ¿ÓÙÔÙ ÙËÓ ÂÓÂÚÁfi Ïԛ̈ÍË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÌÔÚ› Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙÔÓÔÚfi ̤¯ÚÈ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ·fi ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘.(1,7) EÔ̤ӈ˜, ‰ÂÓ ÂӉ›ÎÓ˘Ù·È Ë ¤Ó·ÚÍË ıÂÚ·-›·˜ ÌfiÓÔ Ì ÙËÓ ·Ó‡ÚÂÛË ıÂÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi. ™ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ë ‰ÔÎÈÌ·Û›· ÂÎÓÔ‹˜ Ù˘ Ô˘Ú›·˜¤¯ÂÈ ÙÂÎÌËÚȈı› Û·Ó ·ÍÈfiÈÛÙË ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ ÂϤÁ¯Ô˘ Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÛÙÔÓ Á·-ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ ·ÏÏ¿ ÛÙ· ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ·ÍÈÔÈÛÙ›·˜ Ù˘ ÌÂıfi‰Ô˘.(8,9) MÈ··Ï‹, ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ Ì ÈηÓÔÔÈËÙÈ΋ ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· Â›Ó·È Ë ·Ó·˙‹ÙËÛË ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ H.pylori ÛÙ· ÎfiÚ·Ó·. OÈ ÌÂϤÙ˜ Â›Ó·È Ï›Á˜ ·ÎfiÌË Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ¤Ú¢ӷ Ô˘ Á›ÓÂÙ·È ÛÙÔ ÌÈÎÚÔ-‚ÈÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ·›‰ˆÓ "AÁ›· ™ÔÊ›·" Û ۇÁÎÚÈÛË Ì ÙËÓ ÈÛÙÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ÂÓı·Ú-Ú˘ÓÙÈο. AÎfiÌË ÈÔ ÚfiÛÊ·ÙË Â›Ó·È ·Ó·˙‹ÙËÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙ· Ô‡Ú·, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó·ÎfiÌË ÙÂÎÌËÚȈ̤Ó˜ ÌÂϤÙ˜. H Â˘Úˆ·˚΋ ÔÌ¿‰· ÌÂϤÙ˘ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ¤¯ÂÈ Î·ÈË A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ·˘Ù‹ ÙËÓ ÂÔ¯‹ ‰ÈÂÍ¿ÁÂÈ ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋ Û˘ÁÎÚÈÙÈ΋ ÌÂ-ϤÙË fiÏˆÓ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· Ó· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙÔ ı¤Ì· ·˘Ùfi.

AÓ ˘¿Ú¯Ô˘Ó Û‹ÌÂÚ· ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢ ÛÙÔÓ ÂÓ‹ÏÈη, ·˘ÙÔ› Á›ÓÔÓÙ·È Ô-χ ÂÚÈÛÛfiÙÂÚÔÈ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ·È‰›. K·È ·˘Ùfi Â›Ó·È Â‡ÏÔÁÔ ·Ó ·Ó·ÏÔÁÈÛı› ηÓ›˜ fiÙÈ Ë ıÂڷ›· ÛÙԷȉ› ¤¯ÂÈ ¿ÌÂÛÔ ÛÙfi¯Ô ÙËÓ ÂÎÚ›˙ˆÛË Î·È ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·ÒÙÂÚÔ ÛÙfi¯Ô ÙËÓ ÚfiÏË„Ë ÙˆÓÂÈÏÔÎÒÓ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹(1) (›Ó·Î·˜ 4)

¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛı› ÙÔ ·È‰› Ì Ïԛ̈ÍË ·fi H. pylori ı· Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘fi„Ë ÔÈ È‰È·ÈÙÂÚfi-ÙËÙ˜ ÙÔ˘ ·È‰ÈÔ‡, ‰ËÏ·‰‹ ÙÔ fiÙÈ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È -ȉȷ›ÙÂÚ· ÛÙË ‚ÚÂÊÈ΋- ˘¿Ú¯ÂÈ Û ·ÚÎÂÙfi ÔÛÔÛÙfi·˘ÙfiÌ·ÙË ›·ÛË, Ë ·Ó·ÍÈÔÈÛÙ›· ÙˆÓ ÌË ÂÂÌ‚·ÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È Ë ÌË Î·Ï‹ -ÚÔ˜ ÙÔ ·ÚfiÓ- ÙÂÎ-ÌËÚ›ˆÛ‹ ÙÔ˘˜, Î·È Ù¤ÏÔ˜ ÙÔ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ.(10-12)

EÚˆÙ‹Ì·Ù· ÏÔÈfiÓ Ô˘ ··Û¯ÔÏÔ‡Ó ÚÈÓ Û˘ÛÙËı› ıÂڷ›· Û ¤Ó· ·È‰› ›ӷÈ: ·) ·Ó ˘¿Ú¯Ô˘Ó Û˘Ì-ÙÒ-Ì·Ù·, ‚) ·Ó ı· ÎÈÓ‰˘Ó‡ÛÂÈ Ú·ÁÌ·ÙÈο ·fi ηÚΛÓÔ ÛÙÔÌ¿¯Ô˘ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ ÂÊfiÛÔÓ ‰ÂÓ ÂÈÙ¢¯ı› ÂÎÚ›-˙ˆÛË, Á) Ì‹ˆ˜ ·Ó·Ù˘¯ıÔ‡Ó ·ÓıÂÎÙÈο ÛÙÂϤ¯Ë, ‰) Ì‹ˆ˜ Ë ÂÎÚ›˙ˆÛË ‰È·Ù·Ú¿ÍÂÈ ÙÔ ÔÈÎÔÛ‡ÛÙËÌ· ÙÔ˘ ÛÙÔ-Ì¿¯Ô˘ ÚÔηÏÒÓÙ·˜ ¤ÙÛÈ ¿ÏÏ· ÓÔÛ‹Ì·Ù· fiˆ˜ ·ÏÈÓ‰ÚÔÌÈ΋ ÓfiÛÔ. E›Ó·È ȉȷ›ÙÂÚ· ‰‡ÛÎÔÏÔ Ó· ··ÓÙ‹ÛÂÈ Î·-Ó›˜ ÛÙ· ÈÔ ¿Óˆ ÂÚˆÙ‹Ì·Ù·. H E˘Úˆ·˚΋ ÔÌ¿‰· ÂÚÁ·Û›·˜ ÁÈ· ÙË Ïԛ̈ÍË Ì H. pylori ÛÙ· ·È‰È¿ η٤ÏË-Í fiÙÈ Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÁÈ· Ïԛ̈ÍË ·fi H. pylori οı ·È‰› Ô˘ ¤¯ÂÈ Û˘ÌÙÒÌ·Ù·.(7) EΛÓÔ fï˜, Ô˘ÚÔηÏ› ‰˘ÛÎÔÏ›· Â›Ó·È fiÙÈ ÛÙ· ·È‰È¿ Â›Ó·È ··Ú·›ÙËÙË Ë Á·ÛÙÚÔÛÎfiËÛË ÁÈ·Ù› ‰ÂÓ ˘¿Ú¯ÂÈ ·ÍÈfiÈÛÙË ÌËÂÂÌ‚·ÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÂͤٷÛË.

ŸÛÔÓ ·ÊÔÚ¿ Ù· ıÂڷ¢ÙÈο Û¯‹Ì·Ù·, ˘¿Ú¯ÂÈ ÔÌÔÈfiÙËÙ· Ì ·˘Ù¿ ÙˆÓ ÂÓËϛΈÓ. ¢ËÏ·‰‹, ·Ó·˙ËÙÔ‡ÓÙ·È ·Ï¿,¢¤ÏÈÎÙ·, ·ÔÙÂÏÂÛÌ·ÙÈο Î·È ¯ˆÚ›˜ ·ÚÂÓ¤ÚÁÂȘ ıÂڷ¢ÙÈο Û¯‹Ì·Ù·, ¤ÙÛÈ ÒÛÙ ÙÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ Ó·Êı¿ÛÂÈ 90%.(12,13) ¢˘ÛÙ˘¯Ò˜, ÛÙ· ·È‰È¿ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÓÙ· ηϋ Û˘ÌÌfiÚʈÛË, ˘¿Ú¯Ô˘Ó ·ÓıÂÎÙÈο ÛÙÂϤ¯ËÎ·È ÙÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ Û˘¯Ó¿ Â›Ó·È ¯·ÌËÏfi ·ÎfiÌË Î·È Ì ٷ ›‰È· Û¯‹Ì·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÔÈ ÂÓ‹ÏÈΘ. £·Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ÔÙ¤ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ¤Ó· ÌfiÓÔ ·ÓÙÈ‚ÈÔÙÈÎfi, ÁÈ·Ù› ·Ó·Ù‡ÛÛÂÙ·È ·ÓıÂÎÙÈÎfiÙËÙ·. ™Ù· ·È‰È¿ ‰Ô-ÎÈÌ¿ÛıËÎ·Ó Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ıÂڷ¢ÙÈο Û¯‹Ì·Ù· ̤¯ÚÈ 6 ‚‰ÔÌ¿‰Â˜. TÔ ÔÛÔÛÙfi ÂÎÚ›˙ˆÛ˘ ÛÙÔÓ Â·Ó¤ÏÂÁ-¯Ô Ì Á·ÛÙÚÔÛÎfiËÛË ·Ó¿ÏÔÁ· Ì ٷ ıÂڷ¢ÙÈο Û¯‹Ì·Ù· Î˘Ì¿ÓıËΠ·fi 70 ¤ˆ˜ 80%. T· ‰‡Ô ÙÂÏÂ˘Ù·›· ¯Úfi-ÓÈ· ¯ÔÚËÁÔ‡ÓÙ·È Ù· ‚Ú·¯¤· Û¯‹Ì·Ù·, ‰È¿ÚÎÂÈ·˜ 7 ¤ˆ˜ 10 ËÌÂÚÒÓ(13,14). T· ÚÔÙÂÈÓfiÌÂÓ· ıÂڷ¢ÙÈο Û¯‹Ì·Ù·Â›Ó·È ·Ó·ÛÙÔÏ›˜ Ù˘ ·ÓÙÏ›·˜ ÚˆÙÔÓ›Ô˘ (omeprazole, lanzoprazole ÎÙÏ.) Î·È Û˘Ó‰˘·ÛÌfi˜ ‰‡Ô ·ÓÙÈ‚ÈÔÙÈÎÒÓ (ÎÏ·-Ú˘ıÚÔÌ˘Î›ÓË, ·ÌÔ͢ÎÈÏÏ›ÓË, ÌÂÙÚÔÓȉ·˙fiÏË). E¿Ó ‰ÂÓ ÂÈÙ¢¯ı› ÂÎÚ›˙ˆÛË ÚÔÛÙ›ıÂÙ·È ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ Û¯‹Ì·Î·È ‚ÈÛÌÔ‡ıÈÔ (Denol). ŸÌˆ˜, ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ·ÔÙ˘¯›·˜ ÂÎÚ›˙ˆÛ˘ ÙÔ˘ H. pylori ÛÙ· ·È‰È¿, Ë ·Ó¿Ù˘ÍË ·ÓÙÔ-¯‹˜, Î·È Ô ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÔÏ˘ÛÌ¤ÓˆÓ ·È‰ÈÒÓ ÛÙÔÓ Ï·Ó‹ÙË Î·ıÈÛÙÔ‡Ó ·Ó¤ÊÈÎÙË ÙË Ì·˙È΋ ıÂڷ›· ÂÎÚ›˙ˆÛ˘ÙÔ˘ H. pylori ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi. ŒÓ· ÂÌ‚fiÏÈÔ ·ÔÙÂÏ› ÙË ÌÔÓ·‰È΋ ÂÏ›‰· ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ÂÍ·Ê¿ÓÈÛËÙ˘ Ïԛ̈͢, Ú·ÎÙÈ΋ Ô˘ ÂÊ·ÚÌfiÛıËÎÂ Î·È ¤Ù˘¯Â ÙËÓ ÂÍ·Ê¿ÓÈÛË ÔÏÏÒÓ ¿ÏÏˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ(15).

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:268-271 ∂. PÒÌ·-°È·ÓÓ›ÎÔ˘

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:268-271 ∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

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

E›ÏÔÁÔ˜MÂÙ¿ ÙÔÓ ˘ÂÚ‚¿ÏÏÔÓÙ· ˙‹ÏÔ ÁÈ· ÙËÓ ÂÍ·Ê¿ÓÈÛË ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ·fi ÙÔ Á·ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Û ÔÏ-

ÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ ÂÈÎÚ·Ù› ÛÎÂÙÈÎÈÛÌfi˜ ·Ó ÙÂÏÈο ¤¯ÂÈ ¤Ó‰ÂÈÍË Ë ÂÎÚ›˙ˆÛË. ¶·Ú·Ù‹ÚËÛ·Ó ‰ËÏ·‰‹, fiÙÈ ÂÓ‹ÏÈΘÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H. pylori ·ÚÔ˘Û›·Û·Ó Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÂÓÒ ÙÂÏÂ˘Ù·›· ·˘Í‹ıËÎÂ Ô Î·Ú-ΛÓÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÂÓÈÛ¯‡ÂÈ ÙËÓ ¿Ô„Ë fiÙÈ ›Ûˆ˜ ÙÔ H. pylori ÚÔÛٷهÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛËÁ·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. AÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÚÔ‚ÏËÌ·ÙÈÛÌfi ÚÔηÏ› Ù· ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ· Ë¿Ô„Ë ÌÂÚÈÎÒÓ ÂÚ¢ÓËÙÒÓ Ô˘ ı¤ÙÔ˘Ó ÛÔ‚·Ú¿ ÙËÓ Èı·ÓfiÙËÙ· fiÙÈ ÙÔ H. pylori ›Ûˆ˜ ·ÔÙÂÏ› Ê˘ÛÈÔÏÔÁÈ΋ ¯Ïˆ-Ú›‰· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ fiÙÈ ›Ûˆ˜ Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙÔÓ ÍÂÓÈÛÙ‹. O Ó¤Ô˜ ·˘Ùfi˜ ÛÎÂÙÈÎÈÛÌfi˜ ¤Ú-¯ÂÙ·È ·ÎÚÈ‚Ò˜ ÙË ÛÙÈÁÌ‹ Ô˘ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ ı¤Ì· ÙÂÏÈο ¤¯Ô˘Ó ÂÈÛı› ÁÈ· ÙȘ ÛÔ‚·Ú¤˜ÂÈÙÒÛÂȘ ÛÙËÓ ˘Á›· ·fi ÙË Ïԛ̈ÍË ·˘Ù‹. ŸÌˆ˜, ·fi fiÏÔ˘˜ ÔÌÔÏÔÁÂ›Ù·È fiÙÈ Ë ·Ó·Î¿Ï˘„Ë ÙÔ˘ H. pylori Î·È ËÛ˘Û¯¤ÙÈÛ‹ ÙÔ˘ Ì ÙË Á·ÛÙÚ›Ùȉ·, ÙÔ ¤ÏÎÔ˜, ÙÔ Á·ÛÙÚÈÎfi ηÚΛÓÔ Î·È ÙÔ MALT-ϤÌʈ̷ ·ÔÙÂÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂ-ÚË ÚfiÔ‰Ô Ù˘ Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜ Ù· ÙÂÏÂ˘Ù·›· 50 ¯ÚfiÓÈ·. H ÁÓÒÛË ·˘Ù‹ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÍ·Ê·ÓÈÛıÔ‡ÓÓfiÛÔÈ Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ¯ÈÏÈ¿‰Â˜ ı·Ó¿ÙÔ˘˜ οı ¯ÚfiÓÔ.(1,7)

TÂÏÈο, ‰ÂÓ Â›Ó·È ·ÎfiÌË ‚¤‚·ÈÔ ·Ó Ë ‰È·Ù·Ú·¯‹ ·˘Ù‹ Ù˘ Û˘Ì‚›ˆÛ˘ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚԇ̠ÙÔÓ ÍÂÓÈÛÙ‹, Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙË ıÂڷ›· ÂÎÚ›˙ˆÛ˘ ÙÔ˘, ¤¯ÂÈ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ. ¶ÚÔ˜ ÙÔ ·ÚfiÓfï˜, ÂÈÎÚ·Ù› Ë ¿Ô„Ë ˘¤Ú Ù˘ ¯ÚËÛÈÌÔÔ›ËÛ˘ ÚÔÏËÙÈÎÒÓ Ì¤ÛˆÓ ÁÈ· ÙË Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘Ïԛ̈͢ ·fi ÙÔ ÌÈÎÚfi‚ÈÔ ·˘Ùfi.

BÈ‚ÏÈÔÁÚ·Ê›·1. Koletzko S, Ashorn M. The year in Helicobacter pylori. Paediatrics. Current opinion in Gastroenterology (Supplement 1)

1998;14:S 57-S63. 2. Barden PK. Epidemiological features of Helicobacter pylori infection in developing countries. Clin Infect Dis 1997;25:973-978.3. Roma-Giannikou, Panayiotou J, Vanvliet C, Charissiadou A, Anasi H, Pangali A, Matsaniotis N. Helicobacter pylori in Greek

children with upper gastrointestinal symptoms. Hellenic J Gastroenterol 1993;6:251-259.4. Roma-Giannikou E, Balatsos B, Panayiotou J, Van-Vliet C, Papaliodi J, Charissiadou A, Siahanidou T, Skandalis N. Intrafamilial

spread of Helicobacter pylori. Hellenic J Gastroenter 1999;12:96-100.5. Xia HH, Talley NJ. Natural acquisition and spontaneous elimination of Helicobacter pylori infection: clinical implications. Am J

Gastroenterol 1997;92:1780-1787.6. Roma E, Panayiotou J, Kafritsa P, Vanvliet C, Giannoulia A, Constantopoulos A. Upper gastrointestinal disease, Helicobacter

Pylori and recurrent abdominal pain. Acta Paediatr 1999;88:1-4.7. Drum B, Koletzko S, Oderda G. Helicobacter pylori Infection in Children: A concensus statement. J P Gastr Nutr 2000;30:207-213.8. Kindermann A, Demmelmair H, Koletzko B, Wiebecke B, Koletzko S. Diagnostic value and errors of the 13C- urea breath test

in children. Gut 1997;41(Suppl.):A67.9. Jones NL, Bourke B, Sherman PM. Breath testing for Helicobacter pylori infection in children: a breath of fresh air? (editorial,

comment) J Pediatr 1997;131:791-793.10. Abdel RS, Nahata MC. Guidelines for the treatment of Helicobacter pylori in the pediatric population. Ann Pharmacother

1997;32-1247-1249.11. Oderda G. Cure of Helicobacter pylori in children. Helicobacter 1997;2(Suppl1):S73-76.12. Walsh D, Goggin N, Rowland M, Durnin M, Moriatri S, Drumm B. One week treatment for Helicobacter pylori infection. Arch Dis

Child 1997;76:352-355.13. Blecker U, Gold Bd. Treatment of Helicobacter pylori infection; a review. Pediatr Infect Dis J 1997;16:391-399.14. Berquist W. New, Improved Helicobacter pylori eradication therapy in children. J Ped Gastroent Nutr 1998;26:360-362.15. Czinn S. What is the role for vaccination in Helicobacter pylori? Gastroenterol 1997;113:S149-S153.16. Mentis A, Roma E, Pangalis A, Katsigiannakis E. Susceptibilities of Helicobacter pylori strains isolated from children with

gastritis to selected antibiotics. J Antimicrob Chemother 1999;44:720-22.

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

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

Aӷʤڈ ÔÚÈṲ̂Ó˜ ‰È·ÈÛÙÒÛÂȘ Î·È ·Ú·ÙËÚ‹ÛÂȘ ·fi ÂÎ ‚·ı¤ˆÓ Û˘ÓÂÓÙ‡ÍÂȘ Ì ÔÈÎÔÁ¤ÓÂȘ ·È‰ÈÒÓÌ ÎÈÓËÙÈ΋, ·ÈÛıËÙËÚȷ΋, ÓÔËÙÈ΋ ·Ó·ËÚ›·. OÈ Û˘ÓÂÓÙ‡ÍÂȘ ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÌÈ·˜ ¢ڇÙÂÚ˘ ÌÂϤ-Ù˘ Ô˘ ¤ÁÈÓ ÛÙÔ Ï·›ÛÈÔ ÂÓfi˜ ‰È·ÎÚ·ÙÈÎÔ‡ ÂÚ¢ÓËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂٷ͇ ÌÂÛÔÁÂÈ·ÎÒÓ ¯ˆÚÒÓ Ì Τ-ÓÙÚÔ Û˘ÓÙÔÓÈÛÌÔ‡ ÙÔ EıÓÈÎfi IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ Î·È I·ÙÚÈ΋˜ ŒÚ¢ӷ˜ ÛÙÔ ¶·Ú›ÛÈ (INSERM).

ŒÓ· ·fi Ù· ÚÒÙ· ÛËÌ·ÓÙÈο Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ·Ó·‰‡ıËΠ·fi ÙȘ Û˘ÓÂÓÙ‡ÍÂȘ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜fiÙÈ,ÛÙË ¯ÒÚ· Ì·˜, ›Ûˆ˜ Î·È ÂÏÏ›„ÂÈ ÔÚÁ·ÓˆÌ¤ÓˆÓ ˘Ô‰ÔÌÒÓ, Â›Ó·È Ô ÔÈÎÔÁÂÓÂÈ·Îfi˜ ıÂÛÌfi˜ ·˘Ùfi˜ Ô˘ Û¯Â-‰fiÓ ·ÔÎÏÂÈÛÙÈο ¤¯ÂÈ ÂÈÊÔÚÙÈÛı› Ì ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜. °È· ÙȘ ÔÈÎÔÁ¤ÓÂȘ ·˘Ù¤˜ ËÂÌÂÈÚ›· Ì ÙËÓ ·Ó·ËÚ›· Â›Ó·È ¤Ó· ‚·Ú‡ ÊÔÚÙ›Ô Ô˘ ÛËÎÒÓÂÈ Ë ÔÈÎÔÁ¤ÓÂÈ·, ΢ڛˆ˜ Ë ÌËÙ¤Ú·, ¯ˆÚ›˜ ÏËÚÔ-ÊfiÚËÛË, ηıÔ‰‹ÁËÛË ‹ ÛÙ‹ÚÈÍË ·fi ÙÔ ÎÚ¿ÙÔ˜ ‹ ÙËÓ ÎÔÈÓˆÓ›·.

EÂȉ‹ Ë ÎÔÈÓˆÓ›· Â›Ó·È ‰ÔÌË̤ÓË ¤ÙÛÈ ÒÛÙ ӷ ÈηÓÔÔÈ› ÚˆÙ·Ú¯Èο ÙȘ ·Ó¿ÁΘ ÙˆÓ ˘ÁÈÒÓ ·ÙfïÓ, Ë·Ó·ËÚ›· Â›Ó·È ‰··ÓËÚ‹. TÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘ ÎfiÛÙÔ˘˜ - ÔÈÎÔÓÔÌÈÎÔ‡ Î·È „˘¯ÔÎÔÈÓˆÓÈÎÔ‡ - Ô˘ ·ÓÙÈ-ÌÂÙˆ›˙Ô˘Ó ÔÈ ÔÈÎÔÁ¤ÓÂȘ ÂÈ‚¿ÏÏÂÙ·È ÎÔÈÓˆÓÈο Î·È ‰ÂÓ Â›Ó·È ÂÁÁÂÓ¤˜ ÛÙË Ê‡ÛË Ù˘ ·Ó·ËÚ›·˜. TÔ ÔÈÎÔÓÔÌÈ-Îfi ‚¿ÚÔ˜ ÚÔ·ÙÂÈ ·fi ÙÔ fiÙÈ ÁÂÓÈο, ÔÈ ÁÔÓ›˜ Î·È fi¯È Ë ÎÔÈÓˆÓ›· ·Ó·Ì¤ÓÂÙ·È Ó· ÏËÚÒÛÔ˘Ó ÙȘ ˘¤ÚÔÁΘ‰·¿Ó˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙȘ ÂȉÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡. ¶·ÚÔÌÔ›ˆ˜, ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙÔ˘ „˘¯ÔÎÔÈÓˆ-ÓÈÎÔ‡ ÊÔÚÙ›Ô˘ Ô˘ ˆ̛˙ÔÓÙ·È ÔÈ ÁÔÓ›˜ ÙÔ‡˜ ÂÈ‚¿ÏÏÂÙ·È ÂÂȉ‹ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÔÈ Î·Ù¿ÏÏËϘ ˘ÔÛÙËÚÈÎÙÈ-Τ˜ ˘ËÚÂۛ˜ fiˆ˜ ηÙ' Ô›ÎÔÓ ÊÚÔÓÙ›‰·, ÏËÚÔÊfiÚËÛË Û¯ÂÙÈο Ì ÙË ‰È¿ÁÓˆÛË, ÙËÓ ·ÁˆÁ‹ Î·È ÙË ıÂڷ›·,ηıÒ˜ Î·È ÂÎ·È‰Â˘ÙÈο Î·È ÌÔÚʈÙÈο ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· ÙÔ ·È‰›. O ÛÙÈÁÌ·ÙÈÛÌfi˜ Ù˘ ·Ó·ËÚ›·˜ ·fi ÙËÓ ÎÔÈ-ÓˆÓ›· Î·È Ù· ÚfiÙ˘· Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ·˘ÙfiÓ ÙÔÓ ÛÙÈÁÌ·ÙÈÛÌfi ›Û˘ ÂÌÔ‰›˙Ô˘Ó ÙȘ ÔÈ-ÎÔÁ¤ÓÂȘ Ó· ¤¯Ô˘Ó ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ÙÚfiÔ ˙ˆ‹˜.

ŸÌˆ˜, Î·È ÙÔ ÔÈÎÔÓÔÌÈÎfi Î·È ÙÔ „˘¯ÔÎÔÈÓˆÓÈÎfi ÎfiÛÙÔ˜ ·ÓÙÈÛÙ·ıÌ›˙ÔÓÙ·È, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÚÈÎÒ˜, Ì ÔʤÏËÔ˘ ·ÔÚÚ¤Ô˘Ó ·fi ·˘ÍË̤ÓË Û˘ÓÂȉËÙÔÔ›ËÛË, ·fi ‚ÂÏÙȈ̤Ó˜ ÈηÓfiÙËÙ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Î·È ·fi ÙËÓ ·Ó¿-ÁÎË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÁÈ· ÂÓۈ̿وÛË Î·È ÎÔÈÓˆÓÈ΋ ¤ÓÙ·ÍË Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ÂÌÂÈÚ›· Ù˘ ·Ó·ËÚ›·˜.¶ÔÏÏ¿ ·fi Ù· ¤ÍÔ‰· Ù˘ ·Ó·ËÚ›·˜ Ô˘ ʤÚÂÈ Ë ÔÈÎÔÁ¤ÓÂÈ· ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂȈıÔ‡Ó Ì ÌÈ· ÂÓÙÔÓfiÙÂÚˢÔÛÙËÚÈÎÙÈ΋ ·ÓÙ·fiÎÚÈÛË ÂΠ̤ÚÔ˘˜ Ù˘ ÎÔÈÓˆÓ›·˜.

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:272-274

272

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

°›ÙÛ· KÔÙÙ·Ú›‰Ë

Y. Kottaridi. The family and care of the child with disability. Paediatriki 2000;63:272-274.● Abstract: In the Greek context, the care of the child with disability is undertaken mainly by the family withinadequate information and support from the community and the state. Parents complain about negativeattitudes on the part of society, social and physical barriers and problems of communication and relationshipswith health professionals, as well as about delays in detection and intervention. They meet the needs of the childto the best of their ability, but they are very concerned about the future of the child when they are gone, as thefamily unit is gradually loosening its bonds and its traditional function is changing.

Key words: disability, special needs.

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ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙË ‰˘ÛÎÔÏÂ‡Ô˘Ó Ó· ΢ÚÈ·Ú¯‹ÛÂÈ ¿Óˆ Û ·˘Ù‹Ó Î·È Ó· ÙËÓ ÂϤÁÍÂÈ. M ÙËÓ ÚfiÔ‰Ô ÛÙËÓ È·-ÙÚÈ΋ Ù¯ÓÔÏÔÁ›·, Ù· ·Ó¿ËÚ· ·È‰È¿ ˙Ô˘Ó ˆ˜ ÙËÓ ÂÊ˂›· ·ÏÏ¿ Î·È Ôχ ÂÚÈÛÛfiÙÂÚÔ, ˆ˜ ÂÓ‹ÏÈΘ. A˘Ùfi ÙÔıÂÙÈÎfi ÁÂÁÔÓfi˜ ‰ËÌÈÔ˘ÚÁ› ÚfiÛıÂÙ· „˘¯ÔÎÔÈÓˆÓÈο ‚¿ÚË Ô˘ ˆ̛˙ÔÓÙ·È Î˘Ú›ˆ˜ ÔÈ ÔÈÎÔÁ¤ÓÂȘ.

ŒÓ· ‰Â‡ÙÂÚÔ ÛËÌ·ÓÙÈÎfi Û˘Ì¤Ú·ÛÌ· Â›Ó·È fiÙÈ Ë ÎÔÈÓ‹ ÁÓÒÌË ÙÔÔıÂÙÂ›Ù·È ˘¤Ú Ù˘ ‡·Ú͢ Î·È ÂÓ›Û¯˘-Û˘ ÙÔ˘ KÚ¿ÙÔ˘˜ ¶ÚfiÓÔÈ·˜, Ì ÛÔ‚·ÚfiÙÂÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·Ú¤Ì‚·ÛË Û fiÏ· Ù· ›‰·. OÈ ÁÔ-Ó›˜ ·Â˘ı‡ÓÔ˘Ó "ÛÎÏËÚ‹" ÎÚÈÙÈ΋ ÛÙËÓ ˘Ô‚¿ıÌÈÛË ÙˆÓ ÚÔÓÔÈ·ÎÒÓ Ï¢ÚÒÓ ÙÔ˘ ÎÚ¿ÙÔ˘˜, ·ÈÛı·ÓfiÌÂÓÔȤÓÙÔÓ· ÙËÓ ·Ó·ÛÊ¿ÏÂÈ· Ù˘ ·ÁÔÚ¿˜ Î·È Ù˘ ·ıÂÛÌÔÔ›ËÙ˘ ÎÔÈÓˆÓ›·˜.

ŒÓ· ÙÚ›ÙÔ Â‡ÚËÌ· Â›Ó·È fiÙÈ Ô ‚·ıÌfi˜ ÂÓË̤ڈÛ˘ Ù˘ ÂÏÏËÓÈ΋˜ ÎÔÈÓˆÓ›·˜ ÁÈ· Ù· ˙ËÙ‹Ì·Ù· Ù˘ ·Ó·ËÚ›·˜ÂÌÊ·Ó›˙ÂÙ·È ¯·ÌËÏfi˜. EÍ·ÈÙ›·˜ Ù˘ ¿ÁÓÔÈ·˜ Î·È Ù˘ ÂÏÏÈÔ‡˜ ÏËÚÔÊfiÚËÛ˘, ·Ó·Ù‡ÛÛÔÓÙ·È ÚÔηٷϋ„ÂȘ,·ÚÓËÙÈΤ˜ ÛÙ¿ÛÂȘ Î·È ‰È·ı¤ÛÂȘ ÌÂ Û˘Ó¤ÂÈ· ÙË ‰È¿ÎÚÈÛË, ÙË ÌË ·Ô‰Ô¯‹, ÙËÓ ÂÚÈıˆÚÈÔÔ›ËÛË Î·È ÙÔÓ ÛÙÈÁ-Ì·ÙÈÛÌfi Ô˘ ‰˘ÛÎÔÏÂ‡Ô˘Ó ÙËÓ ÔÚı‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·Ó·ËÚ›·˜, ·ÎfiÌË Î·È ·fi ÙËÓ ›‰È· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ™Ë-Ì·ÓÙÈÎfi Â›Ó·È Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ÎÔÈÓˆÓÈ΋ ·Ô‰Ô¯‹ ÂËÚ¿˙ÂÙ·È Î·È ·fi ÙËÓ ÙÔÔı¤ÙËÛË ÙˆÓ ÁÔÓÈÒÓ ·¤Ó·-ÓÙÈ ÛÙÔ Úfi‚ÏËÌ·. ™˘¯Ó¿ ÔÈ ÁÔÓ›˜ ÚÔ‚¿ÏÏÔ˘Ó ÛÙËÓ ÎÔÈÓˆÓ›· ·˘Ùfi Ô˘ ÊÔ‚Ô‡ÓÙ·È, fiÙÈ ‰ËÏ·‰‹ ÙÔ˘˜ Ï˘Ô‡-ÓÙ·È, ÂÂȉ‹ ·˘ÙÔ› ÔÈ ›‰ÈÔÈ Ï˘Ô‡ÓÙ·È ÙÔÓ Â·˘Ùfi ÙÔ˘˜. ÕÚ·, Ë ÌË ·Ô‰Ô¯‹ Û˘¯Ó¿ ÍÂÎÈÓ¿ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ÁÔÓ›˜. ŒÙÛÈ, ηٷϋÁÔ˘Ì ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·Ó·ËÚ›· Â›Ó·È ¤Ó· ÁÂÁÔÓfi˜, ÂÓÒ Ë ÌÂÈÔÓÂÍ›· ÁÈ· ÙËÓ ·Ó·-ËÚ›· ηٷÛ΢¿˙ÂÙ·È ·Ú¯Èο ·fi ÙËÓ ›‰È· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.

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

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

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

OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ì ·Ó·Ëڛ˜ ¤¯Ô˘Ó ÌÂÚÈΤ˜ ÎÔÈÓ¤˜ ·Ó¿ÁΘ:- TËÓ ·Ó¿ÁÎË Ó· ¤¯Ô˘Ó ·ÎÚÈ‚‹ ÏËÚÔÊfiÚËÛË Á‡Úˆ ·fi ÙË Ê‡ÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘ ·È‰ÈÔ‡.- TËÓ ·Ó¿ÁÎË Ó· ‰Â¯ÙÔ‡Ó ˘ÔÛÙ‹ÚÈÍË, Û˘Ì‚Ô˘Ï‹ Î·È Âη›‰Â˘ÛË Ì ÛÎÔfi Ó· ÈηÓÔÔÈÔ‡Ó ÙȘ ··ÈÙ‹ÛÂȘ

ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹.- TËÓ ·Ó¿ÁÎË ˘ËÚÂÛÈÒÓ Ô˘ Ó· ·ÚÌfi˙Ô˘Ó ÛÙÔ ·È‰› ÙÔ˘˜, Î·È Ù¤ÏÔ˜,- TËÓ ·Ó¿ÁÎË Ó· ÛÎÂÊıÔ‡Ó ÙËÓ Â˘‰ÔΛÌËÛË fiÏˆÓ ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜.ŸÌˆ˜, fiˆ˜ Ê¿ÓËΠ·fi ÙËÓ ¤Ú¢ӷ ·˘Ù‹, ÔÈ ÔÈÎÔÁ¤ÓÂȘ Ì ·Ó¿ËÚÔ ·È‰› ÛÙË ¯ÒÚ· Ì·˜ ÓÔÈÒıÔ˘Ó Ìfi-

Ó˜ Î·È ·‚Ô‹ıËÙ˜ ÛÙÔÓ ·ÁÒÓ· ÙÔ˘˜. OÈ ÁÔÓ›˜ ‰È·Ù˘ÒÓÔ˘Ó Ù· ·Ú¿ÔÓ¿ ÙÔ˘˜ ¤ÌÌÂÛ· ‹ ¿ÌÂÛ· Î·È Ì ‰È·-ÊÔÚÂÙÈ΋ ¤ÓÙ·ÛË Î·È Û˘¯ÓfiÙËÙ·. ¶·Ú·ÔÓÔ‡ÓÙ·È:

- ÁÈ· ·ÚÓËÙÈ΋ ÛÙ¿ÛË ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÎÔÈÓˆÓ›·˜, - ÁÈ· ÎÔÈÓˆÓÈο Î·È Ê˘ÛÈο ÂÌfi‰È·, - ÁÈ· ·Ó·Ú΋ ÏËÚÔÊfiÚËÛË,- ÁÈ· ·Ó·Ú΋ ÂÈÛÙËÌÔÓÈ΋ ηıÔ‰‹ÁËÛË Î·È ˘ÔÛÙ‹ÚÈÍË, - ÁÈ· ÚÔ‚Ï‹Ì·Ù· ÂÈÎÔÈÓˆÓ›·˜ Î·È Û¯¤ÛÂˆÓ Ì ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙÔ˘˜ ¿ÏÏÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, - ÁÈ· ÌË ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·Ú¤Ì‚·ÛË,

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- ÁÈ· ·Ó·Ú΋ ÂÍÂȉÈÎÂ˘Ì¤ÓË ÊÚÔÓÙ›‰·, - ÁÈ· ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ ηٿÏÏËÏÔ˘ ÁÈ· ÔÏÈÛÙÈ΋ ÊÚÔÓÙ›‰· Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË „˘-

¯ÔÏÔÁÈÎÒÓ, ÎÔÈÓˆÓÈÎÒÓ, ·Ó·Ù˘ÍÈ·ÎÒÓ ·Ó·ÁÎÒÓ, „˘¯·ÁˆÁ›·˜ Î·È ·È‰Â›·˜, - ÁÈ· ¤ÏÏÂÈ„Ë ˘ËÚÂÛÈÒÓ ÊÚÔÓÙ›‰·˜ ÛÙÔ Û›ÙÈ.ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·Ó·Ê¤ÚÔ˘Ó Â›Ó·È ÙÔ ÎÚ¿ÙÔ˜ ÁÚ·ÊÂÈÔÎÚ·Ù›·˜ Ô˘ ¤¯Ô˘Ó Ó· ·ÓÙÈ-

ÌÂÙˆ›ÛÔ˘Ó, ÙÔ ÔÔ›Ô ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ·ÔÙÂÏ› ÌÈ· ÂÓÙÂÏÒ˜ ·Ú·ÓÔ˚΋ ηٿÛÙ·ÛË.TÔ˘˜ ··Û¯ÔÏ› Ôχ ÙÔ Ì¤ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡ fiÙ·Ó ÔÈ ›‰ÈÔÈ Ï›„Ô˘Ó, ηıÒ˜ ÔÈ ÔÈÎÔÁÂÓÂÈ·ÎÔ› ‰ÂÛÌÔ› ¯·Ï·-

ÚÒÓÔ˘Ó Î·È Ë ·Ú·‰ÔÛȷ΋ ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ·ÏÏ¿˙ÂÈ. ZËÙÔ‡Ó ÙË ‰Ú·ÛÙËÚÈÔÔ›ËÛË ÙÔ˘ ÎÚ¿ÙÔ˘˜ ÁÈ·Ó· ηχ„ÂÈ ÙȘ ·˘Í·ÓfiÌÂÓ˜ ·Ó¿ÁΘ Ô˘ Û‹ÌÂÚ· ˆ̛˙ÂÙ·È Ë ›‰È· Ë ÔÈÎÔÁ¤ÓÂÈ·.

E›ÏÔÁÔ˜ H ‰˘Ó·ÙfiÙËÙ· Ó· ÂÈÙ‡¯ÂÈ Î·Ó›˜ ÈηÓÔÔÈËÙÈ΋ ÔÈfiÙËÙ· ˙ˆ‹˜ οو ·fi ÙȘ ȤÛÂȘ Î·È ÙȘ ·‚‚·ÈfiÙË-

Ù˜ Ô˘ ÚÔηÏ› Ë ·Ó·ËÚ›· Â›Ó·È ÌÈ· ÙÂÚ¿ÛÙÈ· ÚfiÎÏËÛË. H ÂÌÂÈÚ›· οı ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ÌÔÓ·‰È΋ ηȉÂÓ ÌÔÚ› Ó· ÂÚÈÔÚÈÛÙ› Û ¤Ó·Ó ÎÏÈÓÈÎfi Ù‡Ô. ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ˙ËÙ‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ÚÔ‚ÏÂÊıÔ‡ÓÎ·È Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ Ô˘·Û¯ÔÏÔ‡ÓÙ·È Ì ÙË ÊÚÔÓÙ›‰· Ù˘ ·Ó·ËÚ›·˜. °È' ·˘ÙfiÓ ÙÔ ÛÎÔfi, ‰ÂÓ ·ÚÎÔ‡Ó ÔÈ ÁÓÒÛÂȘ Î·È ÔÈ Î·Ï¤˜ ‰È·-ı¤ÛÂȘ. XÚÂÈ¿˙ÔÓÙ·È ÔÏÈÙÈΤ˜ ˘Á›·˜ Î·È ÚfiÓÔÈ·˜ Î·È ÚˆÙÔ‚Ô˘Ï›Â˜ ÁÈ· ÚÔÁÚ¿ÌÌ·Ù· Ô˘ Ó· ¤¯Ô˘Ó ˆ˜Â›ÎÂÓÙÚÔ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:272-274 °. KÔÙÙ·Ú›‰Ë

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

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TÔ Û‡Ó‰ÚÔÌÔ Turner, Ô˘ Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ¯ÚˆÌÔ-ÛˆÌÈ΋ ·ÓˆÌ·Ï›· ÛÙ· ÎÔÚ›ÙÛÈ·, ·ÚÈıÌ› Û‹ÌÂÚ·ÂηÙÔÓÙ¿‰Â˜ ¯ÈÏÈ¿‰Â˜ ¿Û¯Ô˘Û˜ Û ÔÏfiÎÏËÚÔ ÙÔÓÎfiÛÌÔ. YÔÏÔÁ›˙ÂÙ·È fiÙÈ Ô ÛËÌÂÚÈÓfi˜ ·ÚÈıÌfi˜ ·ÛıÂ-ÓÒÓ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ÛÙȘ Hӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘AÌÂÚÈ΋˜ Â›Ó·È 75.000.TȘ ÚÒÙ˜ ‰ÂηÂٛ˜ ÌÂÙ¿ ÙËÓ ÂÚÈÁÚ·Ê‹ ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ (1938), fiˆ˜ ‹Ù·Ó Ê˘ÛÈÎfi, ÔÈ ÂÈÛÙ‹ÌÔÓ˜ÚÔÛ¿ıËÛ·Ó Ó· ··ÓÙ‹ÛÔ˘Ó ‚·ÛÈο ÂÚˆÙËÌ·ÙÈοۯÂÙÈο Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙËÓ ÁÂÓÂÙÈ΋ Î·È ÙËıÂڷ›· ÙÔ˘. TȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ÙÔ Û.Turner ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÂÎÙÂٷ̤Ó˘¤Ú¢ӷ˜ ‰È·ÊfiÚˆÓ È·ÙÚÈÎÒÓ ÔÌ¿‰ˆÓ (¶·È‰È¿ÙÚˆÓ -EÓ‰ÔÎÚÈÓÔÏfiÁˆÓ - ¶·ıÔÏfiÁˆÓ - æ˘¯È¿ÙÚˆÓ - M·È¢-Ù‹ÚˆÓ), Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¤¯Ô˘Ó ÛËÌÂȈı› ÙÂÚ¿-ÛÙȘ ÚfiÔ‰ÔÈ ÛÙËÓ Î·Ù·ÓfiËÛË Î·È ·ÓÙÈÌÂÙÒÈÛ‹ÙÔ˘. ™‹ÌÂÚ·, ·ÛıÂÓ›˜ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÌÔ-ÚÔ‡Ó Ó· Â›Ó·È ˘ÁÈ‹, Â˘Ù˘¯‹ Î·È ·Ú·ÁˆÁÈο ̤ÏË Ù˘ÎÔÈÓˆÓ›·˜, Î·È ÛÙfi¯Ô˜ Â›Ó·È Ó· Ï˘ı› ηٿ ÙÔ ‰˘Ó·-ÙfiÓ Î·È ÙÔ ·Ú·ÌÈÎÚfi Úfi‚ÏËÌ· Ô˘ ÙȘ ··Û¯ÔÏ›.A˜ ÌË Í¯Óԇ̠fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰È¿ÊÔڷΤÓÙÚ· Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘ ·Ó·Ê¤ÚÔ˘ÓÂÈÙ˘¯Â›˜ ΢‹ÛÂȘ ÌÂÙ¿ ÂÌʇÙ¢ÛË ˆ·Ú›ˆÓ Û Ô-ÛÔÛÙfi 50-60% Û Á˘Ó·›Î˜ Ì Û. Turner (1,2). H ¤ÁηÈÚË Î·È ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·-ÛÙ‹Ì·ÙÔ˜, Ô˘ ··ÓÙ¿ Û ÔÛÔÛÙfi 95-100%, ›ӷÈÂȂ‚ÏË̤ÓË ÛÙÔ Ï·›ÛÈÔ Ù˘ ÚÔÛ¿ıÂÈ·˜ Ù˘

‚ÂÏÙ›ˆÛ˘ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ. H ÚÔÛ¿ıÂÈ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘-Ó¯‹ ˘ÔÛÙËÚÈÎÙÈ΋ ·ʋ ÙˆÓ ıÂÚ·fiÓÙˆÓ ·È‰›·-ÙÚˆÓ-ÂÓ‰ÔÎÚÈÓÔÏfiÁˆÓ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙȘ ·ÛıÂ-Ó›˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹,ÛˆÛÙ‹ ÏËÚÔÊfiÚËÛË Î·È Âη›‰Â˘ÛË ·ÌÊÔÙ¤ÚˆÓ,‰È·ÎÚÈÙÈÎfi ¯ÂÈÚÈÛÌfi ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ÂÊË‚È΋˜ËÏÈΛ·˜, Î·È ‚·ıÌÈ·›· ηıÔ‰‹ÁËÛË Î·È ‰È·Û‡Ó‰ÂÛËÙˆÓ ·ÛıÂÓÒÓ Ì ÔÌ¿‰· I·ÙÚÒÓ EÓËϛΈÓ. H ·Ó·Û˘Ó‰˘·Ṳ̂ÓË ·˘ÍËÙÈ΋ ÔÚÌfiÓË (GH), Ô˘·ÔÙÂÏ› ÙËÓ ÌfiÓË Ô˘ÛÈ·ÛÙÈ΋ ıÂڷ¢ÙÈ΋ ÂÈÏÔ-Á‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜,¿Ú¯ÈÛ ӷ ÂÊ·ÚÌfi˙ÂÙ·È Û ·È‰È¿ Ì Û. Turner ·fiÙÔ 1985. T· ÚÒÙ· ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÂڷ›·˜‹Ù·Ó ÂÏȉÔÊfiÚ· (3). EÓÙÔ‡ÙÔȘ, Û˘Ó Ùˆ ¯ÚfiÓˆ,·ÚÎÂÙ¿ ΤÓÙÚ· ·Ó¤ÊÂÚ·Ó ÌË ı·̷ÙÈ΋ ‚ÂÏÙ›ˆÛËÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, Î·È ¤ÙÛÈ, ¿Ú¯ÈÛ·Ó Ó·ÂÁ›ÚÔÓÙ·È ÂÚˆÙËÌ·ÙÈο Û¯ÂÙÈο Ì ÙË Û¯¤ÛË Îfi-ÛÙÔ˘˜-ÔʤÏÔ˘˜ Ù˘ ÂÓ ÏfiÁˆ ıÂڷ›·˜, ‰Â‰Ô̤-Ó˘ Ù˘ Ì·ÎÚÔ¯ÚÔÓÈfiÙËÙ¿˜ Ù˘ Î·È ÙÔ˘ ˘„ËÏfiÙ·-ÙÔ˘ ÎfiÛÙÔ˘˜ Ù˘. OÈ ÂÈÛÙ‹ÌÔÓ˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·ÈÌ ÙÔ ı¤Ì· ‰È·¯ˆÚ›˙ÔÓÙ·È Û‹ÌÂÚ· ÛÙÔ˘˜ ÂÓıÔ˘-ÛÈÒ‰ÂȘ ˘ÔÛÙËÚÈÎÙ¤˜ Ù˘ ıÂڷ›·˜ Ì GH ηÈÛÙÔ˘˜ ÛÎÂÙÈÎÈÛÙ¤˜, Î·È ÙÔ ¯¿ÛÌ· ÌÂٷ͇ ÙÔ˘˜ Ê·›-ÓÂÙ·È Û˘Ó¯Ҙ Ó· ÌÂÁ·ÏÒÓÂÈ. OÈ ÌÂÓ ÚÒÙÔÈ ˘Ô-ÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÛÙÂÚËıÔ‡Ó ÔÈ·ÛıÂÓ›˜ ÌÈ· ıÂڷ›· Ì ÔÏÏ¿ ÔʤÏË Î·È ¯ˆÚ›˜

Aƒ£ƒO ™À¡∆∞•∏™

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

M·Ú›·-AÏÂÍ¿Ó‰Ú· M·ÁÈ¿ÎÔ˘1, °ÂÒÚÁÈÔ˜ ¶. XÚÔ‡ÛÔ˜2

1 B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ2 A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

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

a modest average gain of between 4 and 7 cm. SinceGH treatment is parenteral, of long duration andexpensive, considerable thought and commitment onthe part of the physician, the patient and her parentsis required.

∫ey words: Turner syndrome, GH treatment, finalheight.

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ÎÈÓ‰‡ÓÔ˘˜, ÔÈ ‰Â ‰Â‡ÙÂÚÔÈ fiÙÈ ÛÔ‚·Úfi fiÊÂÏÔ˜ (ˆ˜ÚÔ˜ ÙËÓ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜) ‰ÂÓ¤¯ÂÈ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ·Ô‰Âȯı› (2,4-6).H ‰ËÌÔÛ›Â˘ÛË ·Ó·ÛÎfiËÛ˘ Ù˘ Û¯ÂÙÈ΋˜ Ì ÙÔ ı¤-Ì· ‚È‚ÏÈÔÁÚ·Ê›·˜ Û ·˘Ùfi ÙÔ Ù‡¯Ô˜ Ù˘ "¶·È‰È·-ÙÚÈ΋˜" (X.K·Ó·Î¿ -Gantenbein, ÛÂÏ. ) Ì·˜ ‰›‰ÂÈfiϘ ÙȘ ÏÂÙÔ̤ÚÂȘ ÙˆÓ Ì¤¯ÚÈ ÙÒÚ· ‰ËÌÔÛÈÂ˘Ì¤-ÓˆÓ ÂÚ¢ÓÒÓ. Afi ÙËÓ Ôχ ÂÌÂÚÈÛٷو̤ÓË ·˘Ù‹·Ó·ÛÎfiËÛË, Ë /Ô ¶·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ·ÓÙÏ‹ÛÂÈÙ· ÂÍ‹˜ ‚·ÛÈο Û˘ÌÂÚ¿ÛÌ·Ù·:1. ™Â ·ÁÎfiÛÌÈÔ Â›Â‰Ô, ‰ÂÓ ıˆÚÔ‡ÓÙ·È ÈηÓÔ-

ÔÈËÙÈο Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂڷ›·˜ Ì GHÛÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ·ÛıÂÓÒÓ ÌÂÛ. Turner (·Ó·ÊÂÚfiÌÂÓÔ Ì¤ÛÔ Î¤Ú‰Ô˜ ÛÙÔ ÙÂÏÈÎfi·Ó¿ÛÙËÌ· Ù˘ ٿ͈˜ ÙˆÓ 4-7 ÂηÙÔÛÙÒÓ, ‰È·Î˘-Ì¿ÓÛÂȘ ÌÂٷ͇ ÙˆÓ ÌÂÏÂÙÒÓ ·fi 0-10 ÂηÙÔÛÙ¿). 2. ¶·Ú¿ ÙÔÓ ÌÂÁ¿ÏÔ ÚÔ‚ÏËÌ·ÙÈÛÌfi Î·È ÙË Ì›ˆÛË

ÙÔ˘ ·Ú¯ÈÎÔ‡ ÂÓıÔ˘ÛÈ·ÛÌÔ‡, ·Ú·Ì¤ÓÂÈ ·Ó·ÌÊÈÛ‚‹-ÙËÙÔ ÁÂÁÔÓfi˜ fiÙÈ ıÂڷ›· Ì GH ‚ÂÏÙÈÒÓÂÈ ÛËÌ·-ÓÙÈο ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·, Î·È ¤¯ÂÈ Â˘ÓÔ˚ο ·ÔÙÂ-ϤÛÌ·Ù· ÛÙÔ ÏÈȉ·ÈÌÈÎfi profile Î·È ÛÙËÓ „˘¯ÔÏÔÁ›·ÙˆÓ ·ÛıÂÓÒÓ (7-9). 3. Afi ÙȘ ̤¯ÚÈ ÙÒÚ· ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ Î·È ÙÔÓÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÂÏÂÙÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÂͤÏÈÍˉȷÈÛÙÒÓÂÙ·È, Ôχ ÛˆÛÙ¿ ηٿ ÙË ÁÓÒÌË Ì·˜, fiÙÈÔÈ ·Ó¿ ÙÔÓ ÎfiÛÌÔ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ Ê·›ÓÔÓÙ·È ‰È·ÙÂıÂÈ-̤ÓÔÈ Ó· "·ÔÚÚ›„Ô˘Ó" ÙËÓ ¯Ú‹ÛË Ù˘ GH ÛÙÔ Û.Turner, ·Ú¿ ÌfiÓÔÓ ·Ó ·Ô‰Âȯı› fiÙÈ Ë Û¯¤ÛË Îfi-ÛÙÔ˘˜-ÔʤÏÔ˘˜ Â›Ó·È ·ÚÓËÙÈ΋. ŒÙÛÈ, Û‹ÌÂÚ· ÂÚ¢-ÓÒÓÙ·È fiÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂË-Ú¿ÛÔ˘Ó ÙËÓ ¤Î‚·ÛË Ù˘ ıÂڷ›·˜ Ì GH, fiˆ˜.¯. ·) ÙÔ ‰˘Ó·ÌÈÎfi ·Ó¿Ù˘Í˘ ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ (·Ó ‰ËÏ·‰‹ ˆÊÂÏÔ‡ÓÙ·È·fi ÙË ıÂڷ›· ÂÚÈÛÛfiÙÂÚÔ ÔÈ ÎÔÓÙfiÙÂÚ˜ ‹ ÔÈ„ËÏfiÙÂÚ˜ ·ÛıÂÓ›˜ ‹ ÙÈ ÚfiÏÔ ·›˙ÂÈ ÙÔ ÎÏËÚÔÓÔÌÈ-Îfi ‰˘Ó·ÌÈÎfi ÁÈ· ÙÔ ‡„Ô˜), ‚) Ë ÂӉ‰ÂÈÁ̤ÓË ¯ÚÔ-ÓÔÏÔÁÈ΋ Î·È ÔÛÙÈ΋ ËÏÈΛ· ÂÓ¿Ú͈˜ Ù˘ ıÂڷ›-·˜, Á) Ë ÌÔÚÊ‹ ηڢÔÙ‡Ô˘, ‰) Ù· ›‰· Ù˘ ÂÓ-‰ÔÁÂÓÔ‡˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, Â) Ë ÂӉ‰ÂÈÁ̤ÓˉfiÛË, Û˘¯ÓfiÙËÙ· Î·È ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜, ÛÙ) ÔÛ˘Ó‰˘·ÛÌfi˜ Ì ¿ÏÏ· Ê¿Ú̷η (ÔÍ·Ó‰ÚÔÏfiÓË), ˙) ËÂӉ‰ÂÈÁ̤ÓË ËÏÈΛ· ÔÈÛÙÚÔÁÔÓÈ΋˜ ˘ÔηٿÛÙ·-Û˘. Afi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÓ ÏfiÁˆ ÂÚ¢ÓÒÓÂÏ›˙Ô˘Ì fiÙÈ Û‡ÓÙÔÌ· ı· ˘¿ÚÍÔ˘Ó ÙÂÏÈο Û˘ÌÂ-Ú¿ÛÌ·Ù· ÁÈ· ÙËÓ "¿ÚÈÛÙË" Â›Ï˘ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·-ÙÔ˜ ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙȘ ·ÛıÂÓ›˜ Ì Û.Turner.¶ÚÈÓ Û·˜ ηٷı¤ÛÔ˘Ì ÙËÓ ÚÔÛˆÈ΋ Ì·˜ ¿Ô„ËÛÙÔ ÂÚÒÙËÌ· "E›ÛÙ ˘¤Ú Ù˘ ıÂڷ›·˜ Ì GH ÛÙÔÛ. Turner;", ÂÈÙÚ¤„Ù ̷˜ Ó· ÂÍËÁ‹ÛÔ˘Ì ÙÔ ÁÈ·Ù›Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂڷ›·˜ Ì GH ÛÙÔ ÙÂÏÈÎfi·Ó¿ÛÙËÌ· ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ Ó· Á›ÓÔ˘Ó ÈηÓÔÔÈËÙÈο.¶ÚÒÙÔÓ, ‰ÈfiÙÈ ÛÙÔ Û. Turner ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÓÂ-¿ÚÎÂÈ· Ù˘ GH Ì ÙËÓ "ÎÏ·ÛÈ΋" ¤ÓÓÔÈ· ÙÔ˘ fiÚÔ˘,·ÏÏ¿ Ë ·ÈÙ›· ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÔÏ˘-·Ú·ÁÔÓÙÈ΋ (X. K·Ó·Î¿-Gantenbein, ÛÂÏ. 278-286).§fiÁˆ ·ÎÚÈ‚Ò˜ Ù˘ ·ÈÙ›·˜ ·˘Ù‹˜, ÙÔ Ì¤ÛÔ ·Ó¿ÛÙËÌ··ÛıÂÓÒÓ Ì Û. Turner Ô˘ ‰ÂÓ ¤Ï·‚·Ó ÔÚÌÔÓÈ΋ ıÂ-ڷ›· Â›Ó·È 3,1 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ οو ·fi ÙÔÓ

̤ÛÔ fiÚÔ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÓËÏ›ÎˆÓ (10). H "·ÒÏÂÈ·"·˘ÙÒÓ ÙˆÓ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘ ‡„Ô˘˜ Á›ÓÂ-Ù·È ÂÓ Ì¤ÚÂÈ Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹ (ÏfiÁˆ ÌÈÎÚ‹˜ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ ·‡ÍËÛ˘ Ù· ·È‰È¿ ÌÂÛ. Turner ÁÂÓÓÈÔ‡ÓÙ·È Ì ̋ÎÔ˜ ÌÂȈ̤ÓÔ Î·Ù¿ 0,6ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ), ÂÚ›Ô˘ 1,4 ÛÙ·ıÂÚ¤˜ ·Ô-ÎÏ›ÛÂȘ ¯¿ÓÔÓÙ·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ, ÂÓÒÔ ÌÂȈ̤ÓÔ˜ ÂÙ‹ÛÈÔ˜ Ú˘ıÌfi˜ ·‡ÍËÛ˘ ÌÂÙ¿ ·˘Ù‹ÙËÓ ËÏÈΛ· Î·È Ë ¤ÏÏÂÈ„Ë ÙÔ˘ "growth spurt" ηٿ ÙËÓÂÊ˂›· Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ÙÔ˘‡„Ô˘˜. H ¯ÔÚ‹ÁËÛË GH (Û ‰fiÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿25% ·Ú·¿Óˆ ·fi ÙË ‰fiÛË ˘ÔηٿÛÙ·Û˘ Ô˘¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ˘ÔÊ˘Ûȷ΋ ·Ó¿ÚÎÂÈ·)ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÓ Ì¤ÚÂÈ ÛÙËÓ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂ-ÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ Û›ÁÔ˘Ú·, ‰ÂÓ ÌÔÚ› Ó·"·Ú¤Ì‚ÂÈ" ÛÙËÓ ·ÒÏÂÈ· ÙˆÓ 2 ÛÙ·ıÂÚÒÓ ·ÔÎÏ›-ÛÂˆÓ ÙÔ˘ ‡„Ô˘˜, Ô˘ ¯¿ıËÎ·Ó Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ18 ÌËÓÒÓ.M fiϘ ÙȘ ÂÈÊ˘Ï¿ÍÂȘ Ô˘ ÚԷӷʤÚıËηÓ, ηÈÂÓ ·Ó·ÌÔÓ‹ ÙˆÓ ÙÂÏÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Ù˘ ·-ÁÎfiÛÌÈ·˜ ¤Ú¢ӷ˜, ÈÛÙ‡ԢÌ fiÙÈ Ú¤ÂÈ Ó· ·ÎÔ-ÏÔ˘ıËıÔ‡Ó ÔÈ ÙÂÏÂ˘Ù·›Â˜ ›ÛË̘ Ô‰ËÁ›Â˜ Ù˘AÌÂÚÈηÓÈ΋˜ Aη‰ËÌ›·˜ ¶·È‰È¿ÙÚˆÓ (1997), Ô˘ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ Û. Turner ÛÙȘ ÂӉ›ÍÂȘ ¯ÔÚËÁ‹ÛÂ-ˆ˜ GH (11).H ıÂڷ›· Ì GH ‰ÂÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÚÈÓ ÙËÓËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ, Ë ÂӉ‰ÂÈÁ̤ÓË ‰fiÛË Â›Ó·È 0,7-0,9IU/kg/‚‰ÔÌ¿‰· (20-30 IU/m2/‚‰ÔÌ¿‰·) › 6 Ë̤-Ú˜/‚‰ÔÌ¿‰·, Î·È Ë ÛˆÛÙfiÙÂÚË ËÏÈΛ· ÔÈÛÙÚÔÁÔÓÈ-΋˜ ˘ÔηٿÛÙ·Û˘ Â›Ó·È Ù· 13 ¤ÙË (2).H ¿Ô„‹ Ì·˜ Â›Ó·È fiÙÈ Ë ¯Ú‹ÛË Ù˘ GH ÛÙÔ Û.Turner ı· Ú¤ÂÈ Ó· Û˘˙ËÙÂ›Ù·È ‰ÈÂÍÔ‰Èο Û·Ó ıÂÚ·-¢ÙÈ΋ ÂÈÏÔÁ‹ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙȘ ·ÛıÂÓ›˜, ˉ ·fiÊ·ÛË ÁÈ· ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ ‰ÂÓ ı· Ú¤-ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÂÛ¢Ṳ̂ӷ Î·È ˘fi Û˘Óı‹Î˜"¿Á¯Ô˘˜" ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÔÓ¤ˆÓ, ÂÊfiÛÔÓ Â›Ó·ÈÁÓˆÛÙfi fiÙÈ Î·ı˘ÛÙ¤ÚËÛË ¤Ó·Ú͢ Ù˘ ıÂڷ›·˜ÁÈ· ÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ‰ÂÓ ·ÏÏ¿˙ÂÈ Ù· ·ÔÙÂϤÛÌ·Ù·.OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ ·ÔÊ·Û›˙Ô˘Ó, ÌÂÙ¿ ÛˆÛÙ‹ÂÓË̤ڈÛË, Ó· ˘Ô‚¿ÏÔ˘Ó Ù· ·È‰È¿ ÙÔ˘˜ ÛÙË ıÂ-ڷ›· Ì ÙÔ ÛÎÂÙÈÎfi fiÙÈ Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ “ο-ÓÔ˘Ó fi,ÙÈ Á›ÓÂÙ·È Î·Ï‡ÙÂÚÔ ÁÈ· ÙÔ ·È‰› ÙÔ˘˜”. £Âˆ-Úԇ̠·ÎfiÌË, fiÙÈ ·ÛıÂÓ›˜ Ì ÈηÓÔÔÈËÙÈÎfi ·Ó¿-ÛÙËÌ· ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘Ô‚ÏËıÔ‡Ó Û ıÂڷ›·Ì GH.

BÈ‚ÏÈÔÁÚ·Ê›·

1. Turner HH. A syndrome of infantilism, congenital webbedneck and cubitus valgus. Endocrinology 1938;28:566-574.

2. Saenger P. Turner's syndrome: Current concepts. NEJM1996;335(23):1749-1754.

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

4. Donaldson MD. Growth hormone therapy in Turnersyndrome: Current uncertainties and future strategies.Horm Res 1997;48 (Suppl 5):35-44.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:275-277 M. A. M·ÁÈ¿ÎÔ˘, °. ÃÚÔ‡ÛÔ˜

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

6. Donaldson MDC. Unresolved problems in the treatment ofshort stature for Turner syndrome. International GrowthMonitor 1998;8:2-9.

7. Sylven L, Hagenfeldt K, Ringertz H. Impact of hormonalreplacement therapy on bone mineral density in womenwith Turner syndrome. In: Albertsson-Wikland K, RankeMB, eds. Turner syndrome in a life span perspective:Research and clinical aspects. Amsterdam: ElsevierScience BV, 1995:241-248.

8. Lanes R, Gunczler P, Palacios A, Villaroel O. Serum lipids,lipoprotein lp(a) and plasminogen activator inhibitor-1 inpatients with Turner's syndrome before and duringgrowth hormone and estrogen therapy. Fertil Steril1997;68:473-477.

9. Lagrou K, Xhrouet-Heinrichs D, Heinrichs C, Graen M,Chanoine JP, Malvaux P et al. Age-related perception ofstature, acceptance of therapy and psychosocialfunctioning in human growth hormone-treated girls withTurner's syndrome. J Clin Endocrinol Metab1998;83:1494-1501.

10. Ranke MB, Pfluger H, Rosendahl W, Stubbe P, Enders H,Bierich JR et al. Turner syndrome: spontaneous growth in150 cases and review of the literature. Eur J Pediatr1983;141:81-88.

11. American Academy of Pediatrics. Committee on Bioethicsand Committee on Drugs: Considerations related to theuse of recombinant human growth hormone in children.Pediatrics 1997;99:122-129.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:275-277 ™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË

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

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

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

H ˘ÔΛÌÂÓË ¯ÚˆÌÔÛˆÌȷ΋ ·ÓˆÌ·Ï›· ›ӷÈ

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

XÚÈÛÙ›Ó· K·Ó·Î¿ - Gantenbein

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

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Turner, ·˘ÍËÙÈ΋ ÔÚÌfiÓË, ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·.

C. Kanaka-Gantenbein. Turner syndrome and growth hormone: Is the initial enthusiasm justified?Paediatriki 2000;63:278-286.● Abstract: This paper summarizes data published on the final height of growth hormone (GH) treated girlswith Turner syndrome, with emphasis on meta-analysis of the published data. Turner syndrome is a commongenetic disorder, with a frequency of 1 case in 2,000-2,500 live newborn females. Extremely severe shortstature, with a final height of 20 cm shorter than the average for the female population is observed in 95-100%of girls with Turner syndrome. Human growth hormone (hGH) is used worldwide for the treatment of these girls.Recent data on final height with hGH therapy reveal an average benefit of about 6 cm over the projected adultheight, with a wide variation within studies, ranging from 0 to 10 cm, along with improvement in the bonedensity. Prognostic factors influencing the outcome are the chronological age and bone age delay at initiationof treatment, the karyotype and the parental height, while other factors such as dose, frequency and durationof hGH administration or levels of endogenous GH secretion do not seem to play a major role. Prospectivestudies are under way which aim to elucidate the ideal age for oestrogen substitution and oxandrolone therapy.

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

ANA™KO¶∏™∏

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

K‡ÚÈ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈοTÔ ™‡Ó‰ÚÔÌÔ Turner ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi

·Ó¿ÛÙËÌ·, ˘ÔÁÔÓ·‰ÈÛÌfi, ·˘¯ÂÓÈÎfi ÙÂÚ‡ÁÈÔ, ‚Ï·È-ÛÔ‡˜ ·ÁÎÒÓ˜, ÏÂÌÊÔ›‰ËÌ· ¯ÂÈÚÒÓ Î·È Ô‰ÒÓ Î·Ù¿ÙË Á¤ÓÓËÛË, Ï·Ù‡ ıÒڷη Ì ÌÂÁ¿ÏË ·fiÛÙ·ÛË ıË-ÏÒÓ Î·È ÂÈÛ¤¯Ô˘Û˜ ıËϤ˜, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË Ì·Ï-ÏÈÒÓ, Ó‡¯È· "‰›ÎËÓ ÛÊ˘Úfi˜" (ongles en marteau),ÌÏ ÛÎÏËÚÔ‡˜ (blue sclera), ÎÏ (2-4). EÈϤÔÓ,··ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜.¯. ÛÙ¤ÓˆÛË ÙÔ˘ ÈÛıÌÔ‡ Ù˘ ·ÔÚÙ‹˜, ·ÓˆÌ·Ï›Â˜ ÙÔ˘Ô˘ÚÔÔÈËÙÈÎÔ‡ (ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜, ‰ÈÏfi ·Ô¯Â-Ù¢ÙÈÎfi Û‡ÛÙËÌ·), ‚·ÚËÎÔ˝· (2,5,6) Î·È ·˘ÙÔ¿ÓÔÛ·ÓÔÛ‹Ì·Ù· (7,8).

¶Úfi‚ÏËÌ· ·Ó¿Ù˘Í˘TÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ·Ó¢ڛÛÎÂÙ·È Û ¿Óˆ ÙˆÓ

90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘ ™˘Ó‰ÚfiÌÔ˘ (9), Ì ·Ô-Ù¤ÏÂÛÌ· Ù· ÎÔÚ›ÙÛÈ· ·˘Ù¿ Ó· ηٷϋÁÔ˘Ó, ¯ˆÚ›˜ ıÂ-ڷ›·, Û fiÏ· Ù· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘, ηٿ ̤ÛÔÓ fiÚÔ20 ÂηÙÔÛÙ¿ ÎÔÓÙ‡ÙÂÚ· ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ Á˘Ó·ÈÎÒÓÙÔ˘ ÂοÛÙÔÙ ÏËı˘ÛÌÔ‡ (10-12).

Afi ÓˆÚ›˜ ·Ó·˙ËÙ‹ıËÎ·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ Ó·ÂËÚ¿˙Ô˘Ó ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, .¯. Ô Î·Ú˘fiÙ˘Ô˜,Ë ¤Ó·ÚÍË ÂÊ˂›·˜ ‹ fi¯È, ÙÔ Ì¤ÛÔ ÁÔÓÂ˚Îfi ‡„Ô˜ ÎÏ.(10-12).

NÂfiÙÂÚ˜ ÌÂϤÙ˜ η٤‰ÂÈÍ·Ó ÙËÓ Â›‰Ú·ÛË ÙԢηڢÔÙ‡Ô˘ ÛÙÔ ·Ó¿ÛÙËÌ· (13). AÛıÂÓ›˜ Ì ηڢfi-Ù˘Ô 46,X,I(Xq) ηٷϋÁÔ˘Ó Û ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂ-ÚÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÂÓÒ ·ÛıÂÓ›˜ Ì ηڢfiÙ˘Ô45,XO/46,XY ‹ Ì ηڢfiÙ˘Ô 46,X, del (Xq) ·ÚÔ˘-ÛÈ¿˙Ô˘Ó Î·Ï‡ÙÂÚÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. EÈϤÔÓ, ·ÛıÂ-Ó›˜ Ì ‰Èۈ̛· ÙÔ˘ ‚Ú·¯¤Ô˜ ÛΤÏÔ˘˜ ÙÔ˘ ¯ÚˆÌÔ-ÛÒÌ·ÙÔ˜ X (Xp) ηٷϋÁÔ˘Ó ÛËÌ·ÓÙÈο „ËÏfiÙÂÚ˜·fi ·ÛıÂÓ›˜ Ì ÌÔÓÔۈ̛· ÙÔ˘ Xp.

TÔ Ì¤ÛÔ ÁÔÓÂ˚Îfi ‡„Ô˜ ÂËÚ¿˙ÂÈ Â›Û˘ ÙÔ ÙÂÏÈ-Îfi ·Ó¿ÛÙËÌ· ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ, fiˆ˜ Î·È ÛÙËÓÂÚ›ÙˆÛË ˘ÁÈÒÓ ·È‰ÈÒÓ (12,14,15).

EÈϤÔÓ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, .¯. ˘Ôı˘ÚÂ-ÔÂȉÈÛÌfi˜ ÛÙ· Ï·›ÛÈ· ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto ‹ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ηٷÛÙ¿ÛÂȘ Ô˘··ÓÙÒÓÙ·È Û¯ÂÙÈο Û˘¯Ó¿ ÛÙÔ ™‡Ó‰ÚÔÌÔ, ÌÔÚÔ‡ÓÓ· ÂËÚ¿ÛÔ˘Ó ·ÚÓËÙÈο ÙËÓ ·Ó¿Ù˘ÍË (8), ÂÓÒ ·˘-ÙfiÌ·ÙË ÂÌÊ¿ÓÈÛË ÂÊ˂›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ηχÙÂÚÔÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (14).

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

ÛÙËÌ· Î·È ‚Ú›ÛÎÂÙ·È ÛÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔ-ÛÒÌ·ÙÔ˜ X, ·›˙ÂÈ ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ, ÂÓÒ ÂÈϤÔÓ·Ú¿ÁÔÓÙ˜ fiˆ˜ ‡·ÚÍË ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ¿ÍÔÓ·GH-IGFI Î·È ÛÎÂÏÂÙÈ΋˜ ‰˘ÛÏ·Û›·˜ Û˘Ì‚¿ÏÏÔ˘Ó›Û˘ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· (17).

§fiÁˆ ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ηٷÛ΢¿-ÛÙËÎ·Ó ÂȉÈΤ˜ η̇Ϙ ·Ó¿Ù˘Í˘ ÙˆÓ ÎÔÚÈÙÛÈÒÓÌ ÙÔ ™‡Ó‰ÚÔÌÔ Û ‰È¿ÊÔÚ˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜(10). ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ÚԂϤ„ÂȘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹-Ì·ÙÔ˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ, ¤ÁÈÓ ÂÌÊ·Ó‹˜ Ë ‰˘-ÛÎÔÏ›· ÂÊ·ÚÌÔÁ‹˜ ÚԂϤ„ÂˆÓ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ¯ÚË-ÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ÚԂϤ„ÂȘ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·ÈÛÙÔÓ ˘ÁÈ‹ ÏËı˘ÛÌfi (18). ŒÙÛÈ, ÔÈ Lyon et al. (19)ÚfiÙÂÈÓ·Ó fiÙÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·˘-ÙÒÓ ÌÔÚ› Ó· ÚÔ‚ÏÂÊı› ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ·È‰ÈÔ‡Û ÌÈ· ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ÌÂÙ¿·fi ÚÔ¤ÎÙ·ÛË ÙÔ˘ ‰Â‰Ô̤ÓÔ˘ ‡„Ô˘˜ ÛÙËÓ ÂÓ‹ÏÈÎË˙ˆ‹, ¿Óˆ ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ η̇Ϙ ‡„Ô˘˜ ÙÔ˘ÂοÛÙÔÙ ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ, ‚·ÛÈ˙fiÌÂÓÔÈÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ·˘Ù¿ ‰ÂÓ ı· ·ÚÔ˘ÛÈ¿-ÛÔ˘Ó ÙÔ ¿ÏÌ· Û ‡„Ô˜ Ô˘ Ê˘ÛÈÔÏÔÁÈο ÂÈÙ˘Á¯¿ÓÂ-Ù·È Î·Ù¿ ÙËÓ ÂÊ˂›· (pubertal growth spurt). ŒÙÛÈÚԤ΢„Â Ô fiÚÔ˜ ÙÔ˘ "ÚÔ‚·ÏÏfiÌÂÓÔ˘ ÙÂÏÈÎÔ‡ ·Ó·-ÛÙ‹Ì·ÙÔ˜"= projected adult height: PAH) Ô ÔÔ›Ô˜ıˆÚÂ›Ù·È Ë ÈÔ ¤Á΢ÚË Ì¤ıÔ‰Ô˜ Úfi‚Ï„˘ ÙÔ˘ ÙÂ-ÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙÔ ™‡Ó‰ÚÔÌÔ Turner (20-22).

TÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ¤ÛÙÚ„ ·fi ÓˆÚ›˜ ÙÔ ÂÓ-‰È·Ê¤ÚÔÓ ÙˆÓ ÂÓ‰ÔÎÚÈÓÔÏfiÁˆÓ Û ‰˘Ó·ÙfiÙËÙ˜ ıÂ-ڷ¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘.

AÚ¯Èο ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ıÂڷ›˜ Ì ‚¿ÛË·Ó·‚ÔÏÈο Û΢¿ÛÌ·Ù·, Ì ·ÚÈÔ ÂÎÚfiÛˆÔ ÙËÓÔÍ·Ó‰ÚÔÏfiÓË Î·ıÒ˜ Î·È ¯ÔÚ‹ÁËÛË ·Èı˘Ó˘Ï-ÔÈÛÙÚ·-‰ÈfiÏ˘, Ù· ÔÔ›· ¤ÊÂÚ·Ó ÌfiÓÔ ÌÈÎÚ‹ ‚ÂÏÙ›ˆÛË ÙÔ˘ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ (23).

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

TÂÏÈÎfi AÓ¿ÛÙËÌ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ú·Ó ·˘ÍËÙÈ΋ÔÚÌfiÓË

MfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘‹ÚÍ·Ó Ï¤ÔÓ ‰Â‰Ô-̤ӷ, fi¯È ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ÙÂÏÈÎÔ‡ ‡„Ô˘˜, ·ÏÏ¿ÙÔ˘ Ú·ÁÌ·ÙÈÎÔ‡ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ™‡Ó‰ÚÔÌÔ Ô˘ ‹Ú·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË, Î·È Ô ·Ú¯È-Îfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜ ¿Ú¯ÈÛ ϤÔÓ Ó· ÌÂÙÚÈ¿˙ÂÙ·È.

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

™˘ÓÙÔÌÔÁڷʛ˜hGH = human Growth Hormone = ·ÓıÚÒÈÓË A˘ÍËÙÈ΋

OÚÌfiÓËIGF I = Insulin-like Growth factor I = ™ˆÌ·ÙỔ›ÓË C

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

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

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

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

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

EÚÁ·Û›· AÛıÂÓ›˜ XH ¤Ó·Ú͢ ¢fiÛË hGH OÍ·Ó‰ÚÔÏfiÓË EE ng/kg/d, TA PAH Lyon ŸÊÂÏÔ˜(n) (ŒÙË) IU/Kg/week mg/Kg/day XH cm cm cm

Werther n=18 11(7-14) 1,2 +EE 5Ì/d, XH:11 147,3 ± 5,6 143,6 ± 4,2 3,7A˘ÛÙÚ·Ï›·, 1995 n=15 11(7-14) 1,2+ placebo 5Ì/d, XH:13 148,1 ± 4,5 142,6 ± 4,7 5,4

(2yrs), + EE

Takano, n=12 10,3 ± 2,4 0,5 XH>13 145,1 ± 4,7 137 8,1I·ˆÓ›·, 1995 n=16 9,3 ± 2,6 1,0 144,0 ± 2,2 137 7,0

Pasquino, n=18 0,5, then 1,0 100→200 147,6 142,2 5,0IÙ·Ï›·, 1996 Ctrl=18 XH= 15,7

Rochiccioli, n=117 12,9 ± 2,0 0,7- 0,9 0,05-0,1 147,7 141-142 5,0-6,0 °·ÏÏ›·, 1995 n=24

Nilsson, I(n=13) 12,3 ±1,7 Ox(1yr), II or III 0,05-0,1 100 151,0 ± 6,7 143,6 ± 4,9 7,4™Ô˘Ë‰›·, 1996 II(n=17) 12,1 ±1,7 Ox+GH 0,7 154,2 ± 6,6 145,7 ± 5,1 8,5

III(n=15) 12,3 ±2,1 Ox+GH0,7+EE 151,1 ± 4,6 148,1 ± 6,2 3,0

Haeusler, n=20 11,8±2,4 0,4-0,6 0,0625 50 152,9±3,5 143,7±4,0 9,2A˘ÛÙÚ›·, 1996 (7,3-16,4) 16,3±1,7

V. den Broeck n=56 12,9 0,5-1,2 50-125 150,7±4,9 147,8 2,95 ¯ÒÚ˜, 1995 XH=14,5

Massa n=45 0,85 100 152,3±5,3 147-149,7 2,6-5,3OÏÏ·Ó‰›·, 1995 XH>12

Ranke, KIGS, n=82 12,0 0,7 XH=13,6 n=31 149,6 142,4 7,21995 (10,3-14,7) (0,5-0,9) n=31 XH=13,8 (141-155,4)

Plotnick H¶A, n=622 10,1±3,6 1,0 148,3±5,6 141,9±6,2 6,41998

Rosenfeld, n=17 9,1±2,1 0,8 XH:15,2±0,9 150,4±5,5 142,0±5,9 8,4H¶A,1998 n=43 9,7±2,5 0,8+Ox 0,0625 XH:14,9±0,9 152,1±5,9 141,8±5,9 10,3

Ctrl=25(R) 9,1±1,7 - XH:15,8±1,8 144,2±6,0 144,2±5,6 -

Hochberg, n=25 10,7±1,4 0,8 XH:13,2±1,0 147,3±4,9 142,6±5,2 4,7±2,9IÛÚ·‹Ï,1998 Ctrl=24(M) 10,7±1,4 - XH:13,2±1,0 142,9±5,1 143,5±4,2

Stephure, n=41 11,1±1,5 1,0 XH:13 146,1±6,5 6,3±1,1K·Ó·‰¿˜,1998 Ctrl=29(M) 11,3±1,4 XH:13 141,4±4,7 vs.controls

Quigley, H¶A, n=83 11,5±2,2 0,9 148,9±6,7 143,6±5,8 5,4 ±2,21998

™˘ÓÔÏÈο 6,07 cm

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ÔÚÌfiÓ˘, ÙÔ Â‡ÚÔ˜ fï˜ ÙÔ˘ ÔʤÏÔ˘˜ Û ÂηÙÔÛÙ¿(cm) ·fi ÙË ıÂڷ›· ‹Ù·Ó Ôχ ÌÂÁ¿ÏÔ, ÙfiÛÔ ·fiÂÚÁ·Û›· Û ÂÚÁ·Û›· (Î˘Ì·ÈÓfiÌÂÓÔ ·fi 2,6 ¤ˆ˜ 10cm), fiÛÔ Î·È ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·ÛıÂÓÒÓ Ù˘ ÂοÛÙÔÙ ÂÚÁ·Û›·˜. H ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂ-ڷ›·˜ Ì hGH ‹Ù·Ó Û¯ÂÙÈο ÚÔ¯ˆÚË̤ÓË (9,1-13,1 ÂÙÒÓ) Î·È ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· Ù· ̤ÙÚÈ··ÔÙÂϤÛÌ·Ù· Ù˘ ıÂڷ›·˜, ÏfiÁˆ ·Ú·ÌÔÓ‹˜ ÌÈ-ÎÚÔ‡ ‰˘Ó·ÌÈÎÔ‡ ‡„Ô˘˜. ™Â ·Ó¿ÏÔÁ· Û˘ÌÂÚ¿ÛÌ·-Ù· η٤ÏËÍÂ Î·È Ë ·Ó·ÛÎfiËÛË ÙÔ˘ Haeusler (17),Ô˘ ·Ó¤Ï˘Û ٷ ‰ÈÂıÓ‹ ‰Â‰Ô̤ӷ ¯ÔÚ‹ÁËÛ˘ hGHÛ ‰fiÛÂȘ 0.5-1.2 IU/Kg/‚‰ÔÌ¿‰· Ì ‹ ¯ˆÚ›˜ ÔÍ·Ó-‰ÚÔÏfiÓË.

M›· ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙËÓ AÌÂÚÈ΋ (21) Ô˘·Ó¤Ï˘Û ٷ ‰Â‰Ô̤ӷ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔÔ˘ ÂÚÈÏ‹ÊıËÎ·Ó ÛÙËÓ EıÓÈ΋ MÂϤÙË ·Ó¿Ù˘Í˘ÌÂÙ¿ ¯ÔÚ‹ÁËÛË A˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ù˘ Genentech,η٤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË hGH ¤ÊÂÚ ‚ÂÏÙ›ˆÛËÙÔ˘ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ù˘ ٿ͈˜ ÙˆÓ6,4±4,9 cm.

EÈÚÔÛı¤Ùˆ˜, Ë Ì·ÎÚÔ¯ÚfiÓÈ·, ÔÏ˘ÎÂÓÙÚÈ΋,ÚÔ‰ÚÔÌÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË Ù˘ AÌÂÚÈ΋˜ÙˆÓ Rosenfeld Î·È Û˘Ó. Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·-Ù· (22) ‰Â›¯ÓÂÈ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·-ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ìfi-Ó˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÔÍ·Ó‰ÚÔÏfiÓË. H ÂÚÁ·Û›··˘Ù‹ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ Â›Ó·È ÚÔ‰ÚÔÌÈ΋ ÌÂ-Ù¿ ·fi Û˘ÓÔÏÈÎfi ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ 12 ÂÙÒÓÎ·È ÂÚÈÏ·Ì‚¿ÓÂÈ ‰Â‰Ô̤ӷ ÎÔÚÈÙÛÈÒÓ Ô˘ ¤Ï·‚·ÓıÂڷ›· Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ (4,7-12,4 ÂÙÒÓ, ̤-ÛË ËÏÈΛ· 9,3 ÂÙÒÓ) ·' fi,ÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ‰Ë-ÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜. M ‚¿ÛË ÙËÓ ÌÂϤÙË ·˘Ù‹,Ù· ÎÔÚ›ÙÛÈ· Ô˘ ¤Ï·‚·Ó ÌfiÓÔ ·˘ÍËÙÈ΋ ÔÚÌfiÓˤÊı·Û·Ó ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· 8,4±4,5 cm ÌÂÁ·Ï‡ÙÂÚÔÙÔ˘ ÚÔ‚·ÏÏfiÌÂÓÔ˘, ·˘Ù¿ Ô˘ ¤Ï·‚·Ó Û˘Ó‰˘·ÛÌfiA˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È ÔÍ·Ó‰ÚÔÏfiÓ˘ ¤Êı·Û·Ó ÙÂ-ÏÈÎfi ·Ó¿ÛÙËÌ· 10,3± 4,7 cm ·ÓÒÙÂÚÔ ÙÔ˘ ·Ó·ÌÂÓfi-ÌÂÓÔ˘, ÂÓÒ ÈÛÙÔÚÈ΋ ÔÌ¿‰· Û˘ÁÎÚ›Ûˆ˜, fiÌÔÈ· ·fiÏÂ˘Ú¿˜ ËÏÈΛ·˜, ̤ÛÔ˘ ÁÔÓÂ˚ÎÔ‡ ‡„Ô˘˜, ‡„Ô˘˜

¤Ó·Ú͢ Î·È Î·Ú˘ÔÙ‡Ô˘ η٤ÏËÁ Û ÙÂÏÈÎfi ·Ó¿-ÛÙËÌ· fiÌÔÈÔ Ì ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ.

¢‡Ô ÂÚÁ·Û›Â˜ Ô˘ ‰ÂÓ ¤‰ÂÈÍ·Ó ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÂ-ÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ÔÚÌfiÓ˘ ›ӷÈ, Ë ÂÚÁ·Û›· ÙˆÓ Taback Î·È Û˘Ó. ·fiÙÔÓ K·Ó·‰¿ (34), Î·È Ë ÙˆÓ Chu Î·È Û˘Ó. ·fi ÙË ™ÎÔ-Ù›· (35). ™‡Ìʈӷ Ì ÙËÓ ÚÒÙË, ÙÔ ÚÔ‚·ÏÏfiÌÂÓÔÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ›¯Â ˘ÔÏÔÁÈÛÙ› ·ÚÎÂÙ¿ „ËÏ¿,148 cm, ÒÛÙÂ Ë ¯ÔÚ‹ÁËÛË hGH Ó· ÌËÓ Ê·›ÓÂÙ·È Ó·ÂÈʤÚÂÈ ÂÈϤÔÓ fiÊÂÏÔ˜ (34). ™ÙËÓ ÂÚÁ·Û›· ÙˆÓChu Î·È Û˘Ó. (35), ·ÓÙÈı¤Ùˆ˜, ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·ÓA˘ÍËÙÈ΋ ÔÚÌfiÓË Ì ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·-›·˜ 12,5 ¤ÙË (‡ÚÔ˜ 9,7-16,8 ¤ÙË), ¤Êı·Û·Ó ̤ÛÔÙÂÏÈÎfi ·Ó¿ÛÙËÌ· 142,6 cm, fiÌÔÈÔ Ì ÙÔ ·Ó·ÌÂÓfiÌÂ-ÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ 142,0 cm. TÔ ÁÂÁÔÓfi˜ fï˜fiÙÈ ÛÙËÓ ÂÚÁ·Û›· ·˘Ù‹ Ë ¯ÔÚ‹ÁËÛË hGH ¿Ú¯ÈÛ ÛÂÚÔ¯ˆÚË̤ÓË ËÏÈΛ·, ›Ûˆ˜ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ·Ô˘Û›· ΤډԢ˜ ·fi ÙË ıÂڷ›·.

M›· ·ÎfiÌË ÂÚÁ·Û›· Ô‡ ‰Â›¯ÓÂÈ ·Ô˘Û›· ‚ÂÏÙ›ˆ-Û˘ ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·˘-ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ¯ÒÚ· Ì·˜ (36).H ÂÚÁ·Û›· ·˘Ù‹ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ ÂÚÈÏ·Ì‚¿-ÓÂÈ Ù·˘Ùfi¯ÚÔÓË ÔÌ¿‰· ÂϤÁ¯Ô˘, Ë ÔÔ›· ‰ÂÓ ¤Ï·‚ÂhGH ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ˆ˜ ÂÎÙÔ‡ÙÔ˘ ·ÔʇÁÂÈ Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÂÎÙ›ÌËÛ˘ ÙÔ˘

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286 ™‡Ó‰ÚÔÌÔ Turner Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË

281

¶›Ó·Î·˜ 1‚. ™˘ÓÔÏÈ΋ ·Ú¿ıÂÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ηٷ‰ÂÈÎÓ‡Ô˘Ó Î¤Ú‰Ô˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿-ÛÙËÌ· ÎÔÚÈÙÛÈÒÓ Ì ™‡Ó‰ÚÔÌÔ Turner Ô˘ ¤Ï·‚·Ó ·˘ÍËÙÈ΋ ÔÚÌfiÓË. ∞ӷʤÚÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ ± ™Ù·ıÂÚ¤˜∞ÔÎÏ›ÛÂȘ (SD=standard deviation).EÚÁ·Û›· AÛıÂÓ›˜ XH ¤Ó·Ú͢ ¢fiÛË hGH OÍ·Ó‰ÚÔÏfiÓË EE ng/kg/d, TA PAH Lyon ŸÊÂÏÔ˜

(n) (ŒÙË) IU/Kg/week mg/Kg/day XH cm cm cm

Taback, K·Ó·‰¿˜, n=17 12,4 0,9 125-500 148,0 148,2 0,21996 XH:13,3 N.S.

Chu, ™ÎˆÙ›·, n=26 12,5 0,9 50 142,6 142,0 0,6 1997 XH:12,8 N.S.

Dacou, EÏÏ¿‰·, n=35 12,0±1,8 0,7± 0,2 XH:15,6±1,3 146,1 ± 6,6 N.S.

1998 Ctrl=27(M) 12,4±3,3 - XH:14,2±1,8 144,0 ± 6,1

EÂÍËÁ‹ÛÂȘ Û˘ÓÙÌ‹ÛÂˆÓ ÈӿΈÓn= AÚÈıÌfi˜ ·ÛıÂÓÒÓ XH ¤Ó·Ú͢= XÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ¤Ó·Ú͢¢fiÛË hGH= ¢fiÛË A˘ÍËÙÈ΋˜ OÚÌfiÓ˘IU/Kg/wk=¢ÈÂıÓ›˜ MÔÓ¿‰Â˜/ XÈÏÈfiÁÚ·ÌÌÔ ‚¿ÚÔ˘˜/

‚‰ÔÌ¿‰·Ctrl= Controls: ÔÌ¿‰· ÂϤÁ¯Ô˘R= restrospective: ·Ó·‰ÚÔÌÈ΋ ÔÌ¿‰· ÂϤÁ¯Ô˘ M= matched: ÔÌ¿‰· ÂϤÁ¯Ô˘, fiÌÔÈ· Ì ÙÔ˘˜ ·ÛıÂÓ›˜EE= Ethinyl-estradiol= AÈı˘Ó˘Ï/ÔÈÛÙÚ·‰ÈfiÏË TA= TÂÏÈÎfi AÓ¿ÛÙËÌ·PAH= Projected adult height: ÚÔ‚·ÏfiÌÂÓÔ ÙÂÏÈÎfi

·Ó¿ÛÙËÌ·NS= ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi

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

MÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·H ÌÂÁ¿ÏË ÏËıÒÚ· ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ Î·È Ù·

·ÓÙÈÎÚÔ˘fiÌÂÓ· ÔÏϤ˜ ÊÔÚ¤˜ ·ÔÙÂϤÛÌ·Ù· ¤Î·-Ó·Ó ÂÌÊ·Ó‹ Ù· ÌÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· οı ÂÚ-Á·Û›·˜ Î·È ÙË ‰˘ÛÎÔÏ›· Û‡ÁÎÚÈÛ˘ ÙˆÓ Û˘ÌÂÚ·-ÛÌ¿ÙˆÓ ÙÔ˘˜.

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

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

AÎfiÌË, ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÌÂÁ¿ÏË ÏÂÈÔÓfi-ÙËÙ· ÙˆÓ ÂÚÁ·ÛÈÒÓ ·ÊÔÚ¿ ·Ó·‰ÚÔÌÈΤ˜ ÌÂϤÙ˜, ÔÈÔԛ˜ ÂÎ ÙÔ˘ ۯ‰ȷÛÌÔ‡ ÙÔ˘˜ ‰ÂÓ Â›Ó·È Ù˘¯·ÈÔÔÈ-Ë̤Ó˜ Î·È ÂÌÂÚȤ¯Ô˘Ó Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÌÈ·˜ ·Ó·-‰ÚÔÌÈ΋˜ ·Ó¿Ï˘Û˘ ·ÔÙÂÏÂÛÌ¿ÙˆÓ.

EÈϤÔÓ, ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÙfiÛÔ Ù˘

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

M›· ÚfiÛıÂÙË ÔÈÎÈÏÔÌÔÚÊ›· ÛÙË ıÂڷ¢ÙÈ΋·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ ÔÏϤ˜ ÔÌ¿‰Â˜ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÔÍ·Ó‰ÚÔ-ÏfiÓË ·Ú¿ÏÏËÏ· ‹ fi¯È Ì ÙË ¯ÔÚ‹ÁËÛË A·˘ÍËÙÈ΋˜ÔÚÌfiÓ˘.

E›Û˘, Ô ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Ù˘ ¯ÔÚ‹ÁËÛ˘ hGHÌ ‹ ¯ˆÚ›˜ ÔÍ·Ó‰ÚÔÏfiÓË ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ÛÙȘ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜ ·Ó·-Ï‡Ô˘Ó ‰Â‰Ô̤ӷ ÎÔÚÈÙÛÈÒÓ Ì ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Û ۯÂÙÈο ÚÔ¯ˆÚË̤ÓË ËÏÈΛ·(12 ÂÙÒÓ), Ì ·ÔÙ¤ÏÂÛÌ· Ù· ÂÚÈıÒÚÈ· ÁÈ· ‚ÂÏÙ›ˆ-ÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Ó· Â›Ó·È Ï¤ÔÓ ÂÚÈÔÚÈ-Ṳ̂ӷ Î·È Ó· ¢ı‡ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÁÈ¿ ÙËÓ·‰˘Ó·Ì›· ηٿ‰ÂÈ͢ ÔʤÏÔ˘˜ ·fi ÙË ıÂڷ›·(27,35,36).

ŒÓ· ÂÈÚfiÛıÂÙÔ Úfi‚ÏËÌ· ÛÙËÓ ·ÍÈÔÏfiÁËÛËÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÁ·ÛÈÒÓ Â›Ó·ÈÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÚÔÛı‹ÎË ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ (·Èı˘-Ó˘Ï-ÔÈÛÙÚ·‰ÈfiÏ˘) Á›ÓÂÙ·È Û ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘ÛÙȘ ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜ (22,27,35,36,38).

¶·Ú¿ Ù· ÌÂıÔ‰ÔÏÔÁÈο ·˘Ù¿ ÚÔ‚Ï‹Ì·Ù·, Ë ÌÂ-Ù·-·Ó¿Ï˘ÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÛÎÔfi¤¯ÂÈ Ó· ··ÓÙ‹ÛÂÈ ÛÙ· η›ÚÈ· ÂÚˆÙ‹Ì·Ù·:

XÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘:- ¶fiÙÂ Â›Ó·È Ë È‰·ÓÈ΋ ËÏÈΛ· ¤Ó·Ú͢;- ¶ÔÈ· Â›Ó·È Ë È‰·ÓÈ΋ Î·È ·ÛÊ·Ï‹˜ ‰fiÛË Î·È

Û˘¯ÓfiÙËÙ· ¯ÔÚ‹ÁËÛ˘;- M ‹ ¯ˆÚ›˜ ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘; - ¶ÔÈ· Â›Ó·È Ë Â›ÙˆÛË ÛÙËÓ ÔÛÙÈ΋ ËÏÈΛ·;- Y¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ù˘ ·¿ÓÙËÛ˘ Ù˘ ÂÓ‰ÔÁÂ-

ÓÔ‡˜ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰˘Ó·ÌÈΤ˜ ‰ÔÎÈ̷ۛ˜ÚfiÎÏËÛ˘ Ù˘ Î·È ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛ˘·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘;

- Y¿Ú¯ÂÈ Â›‰Ú·ÛË ÙÔ˘ ηڢÔÙ‡Ô˘ ÛÙËÓ ·ÓÙ·-fiÎÚÈÛË ıÂڷ›·˜ Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË;

¢È¿ÊÔÚÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ‰ÂÓ ‚ڋηÓÛ˘Û¯¤ÙÈÛË ÌÂٷ͇ ËÏÈΛ·˜ ¤Ó·Ú͢ Ù˘ ıÂڷ›·˜Î·È ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ (17,27,29,32,36). AÍ›˙ÂÈfï˜ Ó· ÛËÌÂȈı› fiÙÈ fiϘ ÔÈ ·ÛıÂÓ›˜ Ô‡ ¤Êı·-Û·Ó ÙÔ ÙÂÏÈÎfi ÙÔ˘˜ ·Ó¿ÛÙËÌ· ¿Ú¯ÈÛ·Ó ıÂڷ›· Û¯Â-ÙÈο ·ÚÁ¿ (9 -12 ¤ÙË), ÔÏϤ˜ ÊÔÚ¤˜ Ì¿ÏÈÛÙ· Û ËÏÈ-Λ· 16 ÂÙÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ·ÚÎÂÙfi ‰˘Ó·ÌÈÎfi ‡„Ô˘˜Ó· ¤¯ÂÈ ‹‰Ë ¯·ı›, ÒÛÙ ٷ Û˘ÌÂÚ¿ÛÌ·Ù· Ó· ÌËÓÌÔÚÔ‡Ó Ó· ÁÂÓÈ΢ıÔ‡Ó ÁÈ· ÙË ¯ÔÚ‹ÁËÛË Û ÈÔ ÌÈ-ÎÚ¤˜ ËÏÈ˘. ™ÙËÓ ÂÚÁ·Û›· ÙÔ˘ Plotnick Î·È Û˘Ó. (21)Ê·›ÓÂÙ·È fiÙÈ ÎÔÚ›ÙÛÈ· Ô˘ ¿Ú¯ÈÛ·Ó ıÂڷ›· Ì hGHÛ Ó·ÚfiÙÂÚË ËÏÈΛ· ›¯·Ó ηχÙÂÚË ‚ÂÏÙ›ˆÛË ÙÔ˘·Ó·ÛÙ‹Ì·ÙÔ˜ ÙÔ˘˜ (21). E›Û˘, ÔÈ Rosenfeld ηÈÛ˘Ó. (22) Î·È Ranke Î·È Û˘Ó. (38) ÂȂ‚·ÈÒÓÔ˘Ó Ù·Î·Ï‡ÙÂÚ· ·ÔÙÂϤÛÌ·Ù·, fiÙ·Ó Ë ıÂڷ›· ·Ú¯›˙ÂÈ

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286 X. K·Ó·Î¿ - Gantenbein

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

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

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

H ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓËÂËÚ¿˙ÂÈ ıÂÙÈο ÙËÓ ¤Î‚·ÛË Î·Ù¿ ÔÚÈṲ̂ÓÔ˘˜ ÂÚ¢-ÓËÙ¤˜ (21), ÂÓÒ Î·Ù¿ ¿ÏÏÔ˘˜ ‰ÂÓ ÙËÓ ÂËÚ¿˙ÂÈ(32,36,37).

ŒÓ·˜ ÂÚ·ÈÙ¤Úˆ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ÌÂÏÂÙ‹ıËÎÂ Â›Ó·È Ë Â›‰Ú·ÛË ÙÔ˘ ‚·ıÌÔ‡ ÙÔ˘ ¯·ÌË-ÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ¤Ó·ÚÍË ÛÙÔ Î¤Ú‰Ô˜ ·fiÙË ıÂڷ›·. ŸÛÔ ÂÓÙÔÓfiÙÂÚÔ ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙË̷ηٿ ÙËÓ ¤Ó·ÚÍË ıÂڷ›·˜, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔΤډԘ Ù˘ ¯ÔÚ‹ÁËÛ˘ hGH (21,25) Î·È fiÛÔ „ËÏfi-ÙÂÚÔ ÙÔ ÎÔÚ›ÙÛÈ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Ùfi-ÛÔ Î·Ï‡ÙÂÚÔ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (38).

H ›وÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ÛÙËÓ ˆÚ›Ì·ÓÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ ·ÔÙ¤ÏÂÛ ı¤-Ì· ·ÌÊÈÏÂÁoÌ¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. OÈ Joss et al.(26) ÂͤÊÚ·Û·Ó ·ÓËÛ˘¯›Â˜ fiÙÈ ÂÓˆÚ›˜ ¤Ó·ÚÍË ¯Ô-Ú‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ì ‹ ¯ˆÚ›˜ ÔÍ·Ó‰ÚÔ-ÏfiÓË ÂÈÙ·¯‡ÓÂÈ ‰˘Û·Ó¿ÏÔÁ· ÙËÓ ÔÛÙÈ΋ ËÏÈΛ·, Ì·ÔÙ¤ÏÂÛÌ· ·ÒÏÂÈ· ‰˘Ó·ÌÈÎÔ‡ ÙÂÏÈÎÔ‡ ‡„Ô˘˜,¤ÙÛÈ ÒÛÙ ÚfiÙÂÈÓ·Ó Ë ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ hGH Ó·ÌËÓ Á›ÓÂÙ·È ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 9 ÂÙÒÓ, ÂÓÒ ¿ÏÏÔÈÂÚ¢ÓËÙ¤˜ (17,22,27) ‰ÂÓ ÂȂ‚·›ˆÛ·Ó ÙÔ˘˜ Êfi-‚Ô˘˜ ·˘ÙÔ‡˜.

¶¿ÓÙˆ˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ Ô ‚·ıÌfi˜ ηı˘ÛÙ¤ÚË-Û˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ ηٿ ÙËÓ ¤Ó·ÚÍË hGH, ÙfiÛÔÌÂÁ·Ï‡ÙÂÚÔ ÙÔ Î¤Ú‰Ô˜ ·fi ÙËÓ ıÂڷ›· (21,25).

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

ŒÓ·˜ ÂÈϤÔÓ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÌÂÏÂÙ‹ıËΠ›-Ó·È Ô Î·Ú˘fiÙ˘Ô˜. KÔÚ›ÙÛÈ· Ì ηڢfiÙ˘Ô ÈÛÔ¯Úˆ-ÌÔÛÒÌ·ÙÔ˜ Â›Ó·È ÈÔ ÎÔÓÙ¿ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·-χÙÂÚÔ ‚·ıÌfi ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ ·fi ÙËÓ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (25).

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, ÙÔ Ì¤ÛÔ ÁÔÓÂ˚Îfi ‡„Ô˜ ·ÔÙÂ-Ï› ¤Ó· ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›-˙Ô˘Ó ÙÔ ·Ó¿ÛÙËÌ· ÎÔÚÈÙÛÈÔ‡ Ì ÙÔ ™‡Ó‰ÚÔÌÔ Î·È Ê·›-ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ ıÂڷ›·˜(15,36,38). K·Ù¿ ÔÚÈṲ̂ÓÔ˘˜ Ì¿ÏÈÛÙ· ÂÚ¢ÓËÙ¤˜, ÙÔ‡„Ô˜ Ù˘ ÌËÙ¤Ú·˜ ·ÔÙÂÏ› ÈÛ¯˘ÚfiÙÂÚÔ ÚÔÁÓˆÛÙÈ-Îfi ·Ú¿ÁÔÓÙ· ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ·Ù¤Ú· (36).

AÛÊ¿ÏÂÈ·/ ¶·ÚÂÓ¤ÚÁÂȘ, ÂÈϤÔÓ ÔʤÏË Ù˘ ·˘-ÍËÙÈ΋˜ ÔÚÌfiÓ˘

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

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

M ‹ ¯ˆÚ›˜ ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘Afi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÚÁ·ÛÈÒÓ ˘¿Ú¯Ô˘Ó ÈÛ¯˘Ú¤˜

ÂӉ›ÍÂȘ fiÙÈ Ë ÚÔÛı‹ÎË ÔÍ·Ó‰ÚÔÏfiÓ˘ ÛÙË ıÂÚ·-›· Ì hGH ÂÈʤÚÂÈ ÂÈϤÔÓ fiÊÂÏÔ˜ ÛÙÔ ÙÂÏÈÎfi·Ó¿ÛÙËÌ· (17,22,26), ¤ÙÛÈ ÒÛÙ ӷ ÚÔÙ›ÓÂÙ·È Ô Û˘Ó-‰˘·ÛÌfi˜ ·˘Ùfi˜ Û·Ó Î·Ï‡ÙÂÚË ıÂڷ¢ÙÈ΋ ·Ú¤Ì-‚·ÛË ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÚÔÛʤÚÂÈ ÂÈϤÔÓ ÙÔ ÏÂÔÓ¤-ÎÙËÌ· ÂÓfi˜ ηχÙÂÚÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ·È‰È-΋ ËÏÈΛ· Ô‡ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ „˘¯ÔÏÔÁÈο Ù· ÎÔ-Ú›ÙÛÈ· ·˘Ù¿ Î·È Ó· ÂÈÙÚ¤„ÂÈ ÙËÓ ÚÔÛı‹ÎË ÔÈÛÙÚÔ-ÁfiÓˆÓ Û ÌÈÎÚfiÙÂÚË ËÏÈΛ·, Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ı·‰Ú¿ÛÔ˘Ó Â˘ÓÔ˚ο ÛÙË „˘¯ÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙˆÓÎÔÚÈÙÛÈÒÓ ·˘ÙÒÓ Î·È ÛÙËÓ ÂÏ¿ÙÙˆÛË Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ù˘ ÔÛÙÂÔfiÚˆÛ˘ (22,27,39-42).Y¿Ú¯Ô˘Ó οÔÈÔÈ ÂÓ‰ÔÈ·ÛÌÔ› ÛÙË ¯ÔÚ‹ÁËÛË Ù˘ ÛÂÓ·ڋ ËÏÈΛ·, ÏfiÁˆ Ù˘ Èı·ÓfiÙËÙ·˜ ÛËÌ·ÓÙÈ΋˜ÚÔfi‰Ô˘ Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ Ô˘ ı· ÂÈʤÚÂÈ ÂÏ¿Ù-ÙˆÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ (26), ÔÈ ÔÔ›ÔÈfï˜ ‰ÂÓ ÂȂ‚·ÈÒÓÔÓÙ·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜(22). AÓÂÈı‡ÌËÙ˜ ‰Ú¿ÛÂȘ Ù˘ ÔÍ·Ó‰ÚÔÏfiÓ˘fiˆ˜, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÎÏÂÈÙÔÚ›‰·˜ ‹ ηȂ¿ı˘ÓÛË Ù˘ ʈӋ˜, Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ·fi ÙË

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286 ™‡Ó‰ÚÔÌÔ Turner Î·È A˘ÍËÙÈ΋ ÔÚÌfiÓË

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¯Ú‹ÛË „ËÏÒÓ ‰fiÛˆÓ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂÌÊ·Ó›˙ÔÓÙ·ÈÛ ‰fiÛË 0,05-0,0625 mg/kg/Ë̤ڷ (22,27,38). £Âˆ-ÚÂ›Ù·È Û·Ó ·ÛÊ·Ï‹˜ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂڷ›·˜Ì ÔÍ·Ó‰ÚÔÏfiÓË Ë ËÏÈΛ· ÙˆÓ 8-9 ÂÙÒÓ, fiÙ·Ó Ê˘ÛÈÔ-ÏÔÁÈο ·Ó·Ì¤ÓÂÙ·È ¤Ó·ÚÍË ·‰ÚÂÓ·Ú¯‹˜ (26,27).

¶fiÙ ڤÂÈ Ó· ÚÔÛÙÂı› ÌÈÎÚ‹ ‰fiÛË ÔÈÛÙÚÔÁfi-ÓˆÓ ÁÈ· ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓÙÔ˘ ʇÏÔ˘;

Y¿Ú¯ÂÈ ÁÂÓÈο Ô Êfi‚Ô˜ fiÙÈ ÂÓˆÚ›˜ ÚÔÛı‹ÎË ÔÈÛÙÚÔÁfiÓˆÓ ı· ÂÈʤÚÂÈ ÂÈÙ¿¯˘ÓÛË Ù˘ ÔÛÙÈ΋˜ËÏÈΛ·˜ Ì ‰˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙË-Ì· (14,17,27,36) ÂÓÒ Î·ı˘ÛÙ¤ÚËÛË ˘ÔηٿÛÙ·Û˘Ì ÔÈÛÙÚÔÁfiÓ· Û ¤Ó· ™‡Ó‰ÚÔÌÔ Ô‡ Û˘Óԉ‡ÂÙ·È·fi ÙÔ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· Ù˘ ÔÛÙÂÔfiÚˆÛ˘ÚÔ‚ÏËÌ·Ù›˙ÂÈ (22,27,32,39-42).

E›Û˘, ηı˘ÛÙ¤ÚËÛË ÚfiÎÏËÛ˘ ÂÊ˂›·˜ η-Ù·Ï‹ÁÂÈ Û ·ÒÏÂÈ· ÙÔ˘ ΤډԢ˜ Û ‡„Ô˜ (loss ofpubertal growth spurt) fiˆ˜ ¤‰ÂÈÍÂ Ë ·Ó·‰ÚÔÌÈ΋ ÌÂ-ϤÙË ÙˆÓ Shah Î·È Û˘Ó. (37) Î·È Ù· ‰Â‰Ô̤ӷ Ù˘ ÂÚ-Á·Û›·˜ ÙˆÓ Hochberg Î·È Û˘Ó. (32) ηٷ‰ÂÈÎÓ‡Ô˘ÓfiÙÈ Ë ËÏÈΛ· ÚÔÛı‹Î˘ ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ ‰ÂÓ Ê·›ÓÂ-Ù·È Ó· ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ¤Î‚·ÛË Ù˘ ıÂÚ·-›·˜ Ì hGH, ˘ÔÛÙËÚ›˙ÔÓÙ·˜ fiÙÈ ˘ÔηٿÛÙ·ÛËÌ ÔÈÛÙÚÔÁfiÓ· ‰ÂÓ Ú¤ÂÈ Ó· ηı˘ÛÙÂÚ› ¤Ú·Ó Ù˘ËÏÈΛ·˜ ÙˆÓ 13-14 ÂÙÒÓ (27,32).

ŒÙÛÈ, Â›Ó·È Ì¿ÏÏÔÓ ·Ô‰ÂÎÙfi fiÙÈ ÚÔÛı‹ÎË ÔÈ-ÛÙÚÔÁfiÓˆÓ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÚÈÓ ÙËÓ ËÏÈΛ·ÙˆÓ 12 ÂÙÒÓ Î·È ‰ÂÓ ı· Ú¤ÂÈ Ó· ηı˘ÛÙÂÚ› ÔχÌÂÙ¿ Ù· 13-14 ¤ÙË Î·È fiÙÈ ·ÛÊ·Ï‹˜ ‰fiÛË ¤Ó·Ú͢ ıÂ-ˆÚÔ‡ÓÙ·È Ù· 50ng/Kg/Ë̤ڷ ·Èı˘Ó˘Ï-ÔÈÛÙÚ·‰ÈfiÏ˘(27,32,42).

MÈ· ÂıÓÈ΋ ÚÔ‰ÚÔÌÈ΋ ÌÂϤÙË Ô˘ ¿Ú¯ÈÛ ‹‰ËÛÙÔ Hӈ̤ÓÔ B·Û›ÏÂÈÔ ÌÂ Ù˘¯·ÈÔÔ›ËÛË ÙˆÓ ÎÔÚÈ-ÙÛÈÒÓ Ì ÙÔ ™‡Ó‰ÚÔÌÔ ˘fi hGH ÁÈ· Ó· Ï¿‚Ô˘Ó ÔÈ-ÛÙÚÔÁfiÓ· Û ËÏÈ˘ 12 ‹ 14 ÂÙÒÓ, ÛÎÔfi ¤¯ÂÈ ·ÎÚÈ-‚Ò˜ Ó· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙËÓ È‰·ÓÈ΋ ËÏÈΛ· ¤Ó·Ú͢ÔÈÛÙÚÔÁÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ (27).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ıÂڷ›· Ì ·˘ÍËÙÈ΋ ÔÚÌfi-ÓË ÎÔÚÈÙÛÈÒÓ Ì ™‡Ó‰ÚÔÌÔ Turner, Û ‰fiÛÂȘ 0,7-0,9IU/Kg/week Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ÂÈʤÚÂÈ Î·Ù¿ ̤ÛÔfiÚÔ, ¤Ó· Û˘ÓÔÏÈÎfi ΤډԘ Ù˘ ٿ͈˜ ÙˆÓ 6,07 Âη-ÙÔÛÙÒÓ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·.

ø˜ ·ÛÊ·Ï‹˜ Î·È Î·Ù¿ÏÏËÏË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ıÂڷ›·˜ ıˆÚÂ›Ù·È Ë ËÏÈΛ· ÙˆÓ 6 -8 ÂÙÒÓ, ÂÓÒ ¯Ô-Ú‹ÁËÛË Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ÌÂ-ϤÙ˘.

OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ¤Î‚·ÛË Ù˘ıÂڷ›·˜ ›ӷÈ:

- TÔ ‡„Ô˜ ηٿ ÙËÓ ¤Ó·ÚÍË- H ÔÛÙÈ΋ ËÏÈΛ· ηٿ ÙËÓ ¤Ó·ÚÍË- O ηڢfiÙ˘Ô˜- TÔ ÁÔÓÂ˚Îfi ‡„Ô˜

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

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

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

40. Bachrach LK. Osteopenia in Turner girls. In: Albertsson-Wikland K, Ranke MB, eds. Turner syndrome in a life span

¶∞π¢π∞∆ƒπ∫∏ 2000;63:278-286 ™‡Ó‰ÚÔÌÔ Turner Î·È A˘ÍËÙÈ΋ ÔÚÌfiÓË

285

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286

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-04-1999HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢Ú. XÚÈÛÙ›Ó· K·Ó·Î¿ - Gantenbein¶·È‰›·ÙÚÔ˜- ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏfiÁÔ˜ - §¤ÎÙÔÚ·˜ ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁ›·˜T˘ÌÊÚËÛÙÔ‡ 52 - 15234 X·Ï¿Ó‰ÚÈ, Aı‹Ó·

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

41. Sylven L, Hagenfeldt K, Ringertz H. Impact of hormonalreplacement therapy on bone mineral density in womenwith Turner syndrome. In: Albertsson-Wikland K, RankeMB, eds. Turner syndrome in a life span perspective:Research and clinical aspects. Amsterdam: ElsevierScience BV, 1995:241-248.

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

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291

287

E›Â‰· ·Ú·ÁfiÓÙˆÓ ·ÈÌfiÛÙ·Û˘ Û ·ÛıÂÓ›˜Ì Á·Ï·ÎÙo˙·ÈÌ›· ˘fi ‰›·ÈÙ· Ì "Á¿Ï· ÛfiÁÈ·˜"

KÏÂo¿ÙÚ· ™o‡ÏË1, EϤÓË ¶Ï·ÙoÎo‡ÎË2, E˘¿ÁÁÂÏo˜ ¶··ÎˆÓÛÙ·ÓÙ›Óo˘1,EϤÓË MȯÂϷοÎË1, ™oÊ›· AÚÒÓË2

● ¶ÂÚ›ÏË„Ë: TÚÂȘ Ù‡oÈ ‰È·Ù·Ú·¯ÒÓ Ù˘ Á·Ï·ÎÙo˙·ÈÌ›·˜ ¤¯o˘Ó ÂÚÈÁÚ·Ê› oÈ oo›oÈ ·ÓÙ·oÎÚ›ÓoÓÙ·È ÛÙË ıÂ-ڷ¢ÙÈ΋ ‰È·ÈÙËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ì Úo˚fiÓÙ· ÂχıÂÚ· Ï·ÎÙfi˙˘/Á·Ï·ÎÙfi˙˘ Ì ·ÚÈo ·ÓÙÈÚfiÛˆfi Ùo˘˜ Ù·Úo˚fiÓÙ· ÛfiÁÈ·˜ ηٿ ÙË ÓÂoÁÓÈ΋ Î·È ‚ÚÂÊÈ΋ ËÏÈΛ·. E›Ó·È ÁÓˆÛÙfi fiÙÈ oÈ Ê˘ÙÈΤ˜ ÚˆÙ½Ó˜, fiˆ˜ oÈ ÚoÂÚ-¯fiÌÂÓ˜ ·fi ÛfiÁÈ· o˘ ÂÌÂÚȤ¯ÂÈ ÈÛoÊÏ·‚oÓoÂȉ‹, ‚oËıo‡Ó ÛÙËÓ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯oÏËÛÙÂÚfiÏ˘.AÎfiÌË ¤¯o˘Ó ·Ú·ÙËÚËı› ÌÂȈ̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ·Ú·ÁfiÓÙˆÓ VII, Ù˘ ÈÓˆ‰oÁoÓoÏ˘ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜, Ù˘ ÚˆÙ½Ó˘ C (PC) Î·È Ù˘ AÓÙÈıÚoÌ‚›Ó˘ III (ATIII) ÛÂ Ê˘ÙoÊ¿Áo˘˜. MÂÏÂÙ‹Û·Ì ÙfiÛo ÙȘ ·Ú·Ì¤ÙÚo˘˜Ù˘ ‹Íˆ˜ fiÛo Î·È Ù· ÏÈ›‰È· Û oÚfi 18 ·ÛıÂÓÒÓ (ËÏÈΛ· ‰È¿ÁÓˆÛ˘ 8,5±3,5 Ë̤Ú˜), oÈ 15 ¤·Û¯·Ó ·fi ÎÏ·Û-ÛÈ΋ Á·Ï·ÎÙo˙·ÈÌ›· Î·È oÈ 3 ·fi ·Ó¿ÚÎÂÈ· ÂÈÌÂÚ¿Û˘, ËÏÈΛ·˜ 3,2+0,2 ÌËÓÒÓ. H ¯oÚ‹ÁËÛË Ùo˘ Û΢¿ÛÌ·Ùo˜Ù˘ ÛfiÁÈ·˜ ¿Ú¯ÈÛ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ‰È¿ÁÓˆÛË Î·È Ùo˘˜ Û˘ÁÎÚ›Ó·Ì Ì ÂΛÓo˘˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ·ÚfiÌoÈ·˜ ËÏÈ-Λ·˜. H ¯oÏËÛÙÂÚfiÏË, Ë ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈoÚˆÙ½Ó˘ (LDL) Î·È Ë ·oÏÈoÚˆÙ½ÓË B ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈ-ο ¯·ÌËÏfiÙÂÚ˜ Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì Ùo˘˜ Ì¿ÚÙ˘Ú˜. E›Û˘ ¯·ÌËÏfiÙÂÚ· ‚Ú¤ıËÎ·Ó Ù· ›‰· ÙˆÓ ·Ú·ÁfiÓوӋ͈˜ II, VII, IX, X Î·È PC. £ÂˆÚo‡Ì fiÙÈ Ù· ¯·ÌËÏ¿ ›‰· ÏÈȉ›ˆÓ ÙˆÓ Á·Ï·ÎÙo˙·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ Ì·˜ Â›Ó·È˘Â‡ı˘Ó· ÙfiÛo ÁÈ· ÙËÓ ·oÚÚfiÊËÛË, fiÛo Î·È ÁÈ· ÙË ÌÂÙ·ÊoÚ¿ Ù˘ BÈÙ·Ì›Ó˘ K ÛÙoÓ Ùfio Û‡ÓıÂÛ˘ ÙˆÓ ·-Ú·ÁfiÓÙˆÓ ‹Íˆ˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, oÈ Á·Ï·ÎÙo˙·ÈÌÈÎo› ·ÛıÂÓ›˜ ˘fi ‰›·ÈÙ· Ì Úo˚fiÓÙ· ÛfiÁÈ·˜ ·Úo˘ÛÈ¿˙o˘ÓÌÂÙ·‚oϤ˜ ÙˆÓ ÏÈȉ›ˆÓ Ùo˘˜ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ·ÚfiÌoȘ Ì ÂΛӘ ÙˆÓ Ê˘ÙoÊ¿ÁˆÓ. ¶·È‰È·ÙÚÈ΋2000;63:287-291.

§¤ÍÂȘ ÎÏÂȉȿ: Á·Ï·ÎÙo˙·ÈÌ›·, ·Ú¿ÁoÓÙ˜ ‹Íˆ˜, ‰›·ÈÙ· Ì ÛfiÁÈ·.

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

Key words: galactosaemia, haemostatic factors, soybean diet.

1 IÓÛÙÈÙo‡Ùo YÁ›·˜ Ùo˘ ¶·È‰Èo‡ NoÛoÎoÌ›o ¶·›‰ˆÓ "AÁ›· ™oÊ›·" 11527 Aı‹Ó·2 MoÓ¿‰· AÈÌfiÛÙ·Û˘, AÈÌoÚÚoÊÈÏ›·˜ NoÛoÎoÌ›o ¶·›‰ˆÓ "AÁ›· ™oÊ›·" 11527 Aı‹Ó·

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

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EÈÛ·ÁˆÁ‹H Á·Ï·ÎÙo˙·ÈÌ›· Â›Ó·È Ì›· ÎÏËÚoÓoÌÈ΋ ‰È·Ù·-

Ú·¯‹ Ùo˘ ÌÂÙ·‚oÏÈÛÌo‡ Ùo˘ ˘‰·Ù¿ÓıÚ·Îo˜ Á·Ï·-ÎÙfi˙Ë. TÚÂȘ Â›Ó·È oÈ Ù‡oÈ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ o˘ Â-ÚÈÁÚ¿ÊoÓÙ·È ·Ó¿ÏoÁ· Ì ÙËÓ ·ÈÙÈoÏoÁ›· Ùo˘˜: ·) HÚoÂÚ¯fiÌÂÓË ·fi ·Ó¿ÚÎÂÈ· Ùo˘ ÂÓ˙‡Ìo˘ ÂÈÌÂ-Ú¿ÛË Ù˘ o˘Úȉ˘ÏÈ΋˜ ‰ÈʈÛÊoÚÈ΋˜ Á·Ï·ÎÙfi˙˘,o˘ ¤¯ÂÈ ˆ˜ ·oÙ¤ÏÂÛÌ· ÙË ÌÂȈ̤ÓË ÌÂÙ·ÙÚo‹Ù˘ Á·Ï·ÎÙfi˙˘ Û ÁÏ˘Îfi˙Ë, ‚) H ·Ó¿ÚÎÂÈ· Ù˘o˘Úȉ˘ÏÈ΋˜ ÙÚ·ÓÛÊÂÚ¿Û˘ Ù˘ ʈÛÊoÚÈ΋˜-1-Á·Ï·ÎÙfi˙˘ (ÎÏ·ÛÈ΋ Á·Ï·ÎÙo˙·ÈÌ›·) Î·È Á) H ·ÓÂ-¿ÚÎÂÈ· Ù˘ Á·Ï·ÎÙoÎÈÓ¿Û˘ o˘ ηٷχÂÈ ÙËÓ·ÓÙ›‰Ú·ÛË ·Ú·ÁˆÁ‹˜ ʈÛÊoÚÈ΋˜-1-Á·Ï·ÎÙfi˙˘·fi Á·Ï·ÎÙfi˙Ë. H ÌÂÁ·Ï‡ÙÂÚË oÛfiÙËÙ· Ù˘ÚoÂÚ¯fiÌÂÓ˘ ·fi ÙȘ ÙÚoʤ˜ Á·Ï·ÎÙfi˙˘ Úo¤Ú-¯ÂÙ·È ·fi ÙoÓ ˘‰·Ù¿Óıڷη Ï·ÎÙfi˙Ë, ¤Ó· ‰˘Û·Î-¯·Ú›ÙË o˘ ÂÌÂÚȤ¯ÂÙ·È Î˘Ú›ˆ˜ ÛÙo Á¿Ï· Î·È˘‰ÚoχÂÙ·È Û Á·Ï·ÎÙfi˙Ë Î·È ÁÏ˘Îfi˙Ë Ì ÙËÓ ‰Ú¿-ÛË Ù˘ ÂÓÙÂÚÈ΋˜ Ï·ÎÙ¿Û˘, Ë oo›· ¤¯ÂÈ Ê˘-ÛÈoÏoÁÈ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ÛÙo˘˜ ·ÛıÂÓ›˜ Ì Á·Ï·-ÎÙo˙·ÈÌ›· (1-3). MoÓ·‰È΋ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈ-ÛË Ù˘ ÓfiÛo˘ Â›Ó·È Ë ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ ·fi ÙËÓoo›· ·o˘ÛÈ¿˙o˘Ó oÈ ˘‰·Ù¿ÓıڷΘ Ï·ÎÙfi˙Ë/Á·-Ï·ÎÙfi˙Ë. ™˘ÓÂÒ˜ Ùo ÚoÛÊÂÚfiÌÂÓo Ïo‡ÛÈoÛÙo˘˜ Úo·Ó·ÊÂÚfiÌÂÓo˘˜ ˘‰·Ù¿ÓıڷΘ Á¿Ï·,·ÓÙÈηı›ÛÙ·Ù·È ÛÙo˘˜ ¿Û¯oÓÙ˜ ·fi ¿ÏÏo ÚoÂÚ-¯fiÌÂÓo ·fi ÚˆÙ½ÓË ÛfiÁÈ·˜ Î·È Ùo oo›o ‰ÂÓ Â-ÚȤ¯ÂÈ Á·Ï·ÎÙfi˙Ë/Ï·ÎÙfi˙Ë.

Œ¯ÂÈ ·o‰Âȯı›, ·fi oÏÏÒÓ ÂÙÒÓ, fiÙÈ Ë Úfi-ÛÏË„Ë ÚˆÙ½Ó˘ Â›Ó·È ·fi Ùo˘˜ ϤoÓ ÛËÌ·-ÓÙÈÎo‡˜ ‰È·ÈÙËÙÈÎo‡˜ ·Ú¿ÁoÓÙ˜ o˘ ÂËÚ¿˙o˘ÓÙo ÌÂÙ·‚oÏÈÛÌfi Ù˘ XoÏËÛÙÂÚfiÏ˘ (XoÏ). EȉÈÎfiÙÂ-Ú·, fiÛoÓ ·ÊoÚ¿ ÛÙo ›‰o˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ, Ë ¯oÚ‹-ÁËÛË ÚˆÙ½Ó˘ Ê˘ÙÈ΋˜ Úo¤Ï¢Û˘ Û ۇÁÎÚÈÛËÌ ÂΛÓË Ù˘ ˙ˆÈ΋˜ Úo¤Ï¢Û˘ ¤¯ÂÈ ˆ˜ ·oÙ¤ÏÂ-ÛÌ· ÙË Ì›ˆÛË ÙˆÓ ˘„ËÏÒÓ ÂȤ‰ˆÓ Ù˘ XoÏ. OÈϤoÓ ÁÓˆÛÙ¤˜ ÌÂϤÙ˜ ·ÊoÚo‡Ó ÛÙËÓ Î·˙½ÓË Î·ÈÙË ÛfiÁÈ·. H ‰Ú¿ÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ Â›Ó·È ÁÓˆÛÙfi fiÙȤ¯ÂÈ ·ÍÈfiÏoÁo ˘o¯oÏËÛÙÂÚÈÓ·ÈÌÈÎfi ·oÙ¤ÏÂÛÌ·(4,5). H ›‰Ú·ÛË ·˘Ùo‡ Ùo˘ ›‰o˘˜ ‰È·ÙÚoÊ‹˜ÛÙo˘˜ ·Ú¿ÁoÓÙ˜ Ù˘ ‹Íˆ˜ o˘ ÂÍ·ÚÙÒÓÙ·È·fi ÙË ÏÈo‰È·Ï˘Ù‹ ‚ÈÙ·Ì›ÓË K ÂÓ‰¤¯ÂÙ·È Ó· ›ӷÈÛËÌ·ÓÙÈ΋.

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

Û˘Ó. (6), oÈ Miller Î·È Û˘Ó. (7) ·¤‰ÂÈÍ·Ó Û ÌÈ· Û‡-ÓÙoÌË ÌÂϤÙË Ùo˘˜ fiÙÈ Â¿Ó Ùo ηıËÌÂÚÈÓfi ‰È·ÈÙoÏfi-ÁÈo ÂÌÂÚȤ¯ÂÈ 80% Ï›o˜ ·˘Í¿ÓoÓÙ·È Ù· ›‰·Ùo˘ ·Ú¿ÁoÓÙ· ‹Íˆ˜ VII ÛÙo ·›Ì·, ÂÓÒ Ù· Ïo‡-ÛÈ· Û ˘‰·Ù¿ÓıڷΘ ‰È·ÈÙoÏfiÁÈ· ¤¯o˘Ó ·oÙ¤ÏÂ-ÛÌ· ÙËÓ Ì›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ VII, VIIIÎ·È X ·ÏÏ¿ ·˘Í¿Óo˘Ó ÙËÓ ÈÓˆ‰oÁÔÓÔÏ˘ÙÈ΋ ‰Ú·ÛÙË-ÚÈfiÙËÙ· (8).

¶ÚoÛ¿ıÂÈ· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ÂÎÙÈ-ÌËıo‡Ó Ù· ›‰· ·Ú·Ì¤ÙÚˆÓ Ù˘ ·ÈÌfiÛÙ·Û˘ ÛÂÁ·Ï·ÎÙo˙·ÈÌÈÎo‡˜ ·ÛıÂÓ›˜ o˘ ‰È·ÙÚ¤ÊoÓÙ·È ·o-ÎÏÂÈÛÙÈο Ì "Á¿Ï·" ÛfiÁÈ·˜.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291 K. ™o‡ÏË Î·È Û˘Ó.

288

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

¶·Ú¿ÁÔÓÙ˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ PN=15 (N=38)

TT (%) 16,15 15,4 NS±3,43 ±1,04

PT (%) 11,98 11,43 NS±0,66 ±0,45

APTT (%) 30,42 27,96 (NS)±7,86 ±3,15

I (%) 248,3 278,1 NS±63,6 ±12,4

II (%) 85,7 94,8 0.012±9,1 ±10,2

VII (U/dl) 81,7 95,4 0.006±16,6 ±15,2

VIII (%) 106,0 109,2 (NS)±28,7 25,8

X (%) 81,3 98,4 0.01±16,2 ±12,8

IX (U/dl) 74,1 84,0 0.016±20,7 ±22,67

ATIII (%) 36,82 33,25 NS±2,01 ±3,85

Plg (%) 96,9 92,8 NS±15,3 ± 20,5

PC (%) 72,9 92,0 0.0001±28,1 ±11,5

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

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YÏÈÎfi Î·È M¤ıÔ‰ÔÈ¢ÂηoÎÙÒ (18) ·ÛıÂÓ›˜ Ì Á·Ï·ÎÙo˙·ÈÌ›·, ̤-

Û˘ ËÏÈΛ·˜ ‰È¿ÁÓˆÛ˘ 8,5±3,5 ËÌÂÚÒÓ, o˘ Ù¤ıË-Î·Ó Û ‰›·ÈÙ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ‰È¿ÁÓˆÛ‹ Ùo˘˜, ·fiÙo˘˜ oo›o˘˜ oÈ 15 ¤·Û¯·Ó ·fi ÙËÓ ÎÏ·ÛÈ΋ÌoÚÊ‹ Ù˘ ÓfiÛo˘ Î·È oÈ ˘fiÏoÈoÈ 3 ·fi ·Ó¿Ú-ÎÂÈ· Ù˘ ÂÈÌÂÚ¿Û˘, Ì ̤ÛË ËÏÈΛ· 3,2+0,8 ÌË-ÓÒÓ, ¤Ï·‚·Ó ̤Úo˜ ÛÙË ÌÂϤÙË Ì·˜. TÚÈ¿ÓÙ· oÎÙÒ(38) ˘ÁÈ‹ ‚Ú¤ÊË ·ÚfiÌoÈ·˜ ËÏÈΛ·˜, Ù· oo›· ‰È·-ÙÚ¤ÊoÓÙo Ì ÎoÓÈooÈË̤Óo Á¿Ï·, ·oÙ¤ÏÂÛ·Ó ÙËÓoÌ¿‰· Ì·ÚÙ‡ÚˆÓ. OÈ ·ÛıÂÓ›˜ ÙÚ¤ÊoÓÙ·È Ì ÂȉÈÎfi"Á¿Ï·" ·fi ÛfiÁÈ· (Izomil), ÂχıÂÚo Á·Ï·-ÎÙfi˙˘/Ï·ÎÙfi˙˘. To "Á¿Ï·" ·˘Ùfi ÂÚȤ¯ÂÈ2,1g/100ml ÚˆÙ½ÓË, 6,9 gr/100 ml ˘‰·Ù¿ÓıÚ·ÎÂ˜Î·È 2,69g/100ml Ï›o˜. OÈ Ì¿ÚÙ˘Ú˜ ‰È·ÙÚ¤ÊoÓÙ·ÓÌ Á¿Ï· ÎoÓÈooÈË̤Óo Ùo oo›o ÂÚÈ›¯Â 3,4g/100ml ÚˆÙ½ÓË, 4,8g/100ml ˘‰·Ù¿ÓıڷΘ ηÈ4,7g/100ml Ï›o˜. H ‚ÈÙ·Ì›ÓË K ÂÌÂÚȤ¯ÂÙo Û ˘-ÎÓfiÙËÙ· 10Ìg/100ml Î·È ÛÙ· ‰‡o Á¿Ï·Ù·.

TfiÛo oÈ ·ÛıÂÓ›˜ fiÛo Î·È oÈ Ì¿ÚÙ˘Ú˜ ·Ú¤ÌÂÈ-Ó·Ó ÓËÛÙÈÎo› › 5 ÒÚ˜ ÚÈÓ ÙËÓ ·ÈÌoÏË„›· (5,0 ml)ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÙˆÓ ·Ú·-ÁfiÓÙˆÓ ‹Íˆ˜ Î·È ÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÛÙoÓoÚfi Ùo˘˜.

·) ¶·Ú¿ÁoÓÙ˜ ‹Íˆ˜O ¯ÚfiÓo˜ ÚoıÚoÌ‚›Ó˘ (PT), o ¯ÚfiÓo˜ ÂÓÂÚ-

Áoo›ËÛ˘ ıÚoÌ‚oÏ·ÛÙ›Ó˘ (APTT), o ¯ÚfiÓo˜ıÚoÌ‚›Ó˘ (TT), Ùo ÈÓˆ‰oÁfiÓo (I), oÈ ·Ú¿ÁoÓÙ˜II, VII, VIII, IX, X, Î·È Ùo Ï·ÛÌÈÓoÁfiÓo (Plg) ÌÂÙÚ‹-ıËÎ·Ó ÛÙo Ï¿ÛÌ· ÌÂÙ¿ ·fi ÚoÛı‹ÎË ÎÈÙÚÈÎo‡Ó·ÙÚ›o˘, ¯ÚËÛÈÌooÈÒÓÙ·˜ ÂȉÈÎfi Ì˯¿ÓËÌ· (RA,Organon Teknika) Ì ·ÓÙȉڷÛÙ‹ÚÈ· Ù˘ AKZO. H·ÓoÛo‰È¿¯˘ÛË (Berling Hoechst) Î·È Ë Ì¤ıo‰o˜Elisa ¯ÚËÛÈÌooÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙˆÓ ATIII (·ÓÙÈıÚoÌ‚›ÓË πππ) Î·È PC (Úˆ-Ù½ÓË C).

‚) §ÈȉÈoÁÚ¿ÌÌ·Ù·ŸÏoÈ oÈ oÚo› Ê˘Ï¿¯ÙËÎ·Ó Û ‚·ıÈ¿ ηٿ„˘ÍË ¤ˆ˜

fiÙo˘ ÌÂÙÚËıo‡Ó Ì ÂȉÈÎfi Kit-test Î·È ·Ó·Ï˘Ù‹ BA-500.OÈ ÛÙ·ÙÈÛÙÈΤ˜ ·Ó·Ï‡ÛÂȘ o˘ ·ÊoÚo‡Û·Ó ÙfiÛo

ÛÙ· ›‰· ÙˆÓ ÏÈȉ›ˆÓ fiÛo Î·È ÛÙo˘˜ ·Ú¿ÁoÓÙ˜‹Íˆ˜ ÌÂٷ͇ ÙˆÓ oÌ¿‰ˆÓ ¤ÁÈÓ·Ó Ì Ùo Student's t-test. TÈ̤˜ p<0,05 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-Τ˜. H ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ¯ÚËÛÈÌooÈ‹ıËΠÁÈ· ÙËÓ·Ó‡ÚÂÛË Û˘Û¯ÂÙ›ÛÂˆÓ ÌÂٷ͇ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜, Ë ÙÈÌ‹r>±0,60 ıˆڋıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋.

∞ÔÙÂϤÛÌ·Ù·T· Ë·ÙÈο ¤Ó˙˘Ì· ¢ڤıËÛ·Ó ÛÂ Ê˘ÛÈoÏoÁÈο ›-

‰· ÙfiÛo ÛÙo˘˜ ·ÛıÂÓ›˜ fiÛo Î·È ÛÙo˘˜ Ì¿ÚÙ˘Ú˜.¶·Ú¿ÁoÓÙ˜ ‹Íˆ˜: OÈ ·Ú¿ÁoÓÙ˜ ‹Íˆ˜

·Úo˘ÛÈ¿˙oÓÙ·È ÛÙoÓ ¶›Ó·Î· 1. ¶·ÚfiÏo o˘ oÈ ·-Ú¿ÁoÓÙ˜ ‹Û·Ó ̤۷ ÛÙ· Ê˘ÛÈoÏoÁÈο fiÚÈ·, oÈ ·-Ú¿ÁoÓÙ˜ II, VII, IX, X Î·È PC ¢ڤıËÎ·Ó ÌÂȈ̤ÓoÈÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Û˘ÁÎÚÈÓfiÌÂÓoÈ, Ì ÂΛÓo˘˜ÙˆÓ Ì·ÚÙ‡ÚˆÓ.

§È›‰È·: ™ÙoÓ ¶›Ó·Î· 2 ·Úo˘Û›·˙oÓÙ·È Ë Ì¤ÛË ÙÈ-Ì‹ Î·È Ë ÛÙ·ıÂÚ¿ ·fiÎÏÈÛË ÙˆÓ ÏÈȉ›ˆÓ ÛÙoÓ oÚfiÙˆÓ ·ÛıÂÓÒÓ Ì·˜. OÈ ÙÈ̤˜ ÙˆÓ XoÏ, Ë LDL Î·È ËAoB ‹Û·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ Û˘ÁÎÚÈÓfiÌÂӘ̠ÂΛӘ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. AÓÙ›ıÂÙ·, Ù· ÙÚÈÁÏ˘ÎÂÚ›-‰È· ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜ ‹Û·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ·ÂÓÒ ÛÙ· ›‰· Ù˘ HDL ‰ÂÓ ·Ú·ÙËÚ‹ıËΉȷÊoÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ.

™ÙoÓ ¶›Ó·Î· 3 ÂÌÊ·Ó›˙oÓÙ·È oÈ Û˘Û¯ÂÙ›ÛÂȘÌÂٷ͇ ÙˆÓ ·ÈÌoÛÙ·ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÙˆÓ ÏÈȉ›ˆÓ.

™˘˙‹ÙËÛ˶oÏϤ˜ ÂÚÁ·Û›Â˜ ¤¯o˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÚfiÛÏË„Ë

ÚˆÙÂ˚ÓÒÓ ÚoÂÚ¯oÌ¤ÓˆÓ ·fi ÛfiÁÈ· ¤¯ÂÈ Â˘ÂÚÁÂ-ÙÈο ·oÙÂϤÛÌ·Ù· ˆ˜ Úo˜ ÙËÓ ÚfiÏË„Ë Ù˘ ·Ú-ÙËÚÈoÛÎÏ‹Ú˘ÓÛ˘ ÌÂÈÒÓoÓÙ·˜ ÙfiÛo Ù· ›‰· Ù˘

¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291 ¶·Ú¿ÁÔÓÙ˜ ·ÈÌfiÛÙ·Û˘ ÛÙË Á·Ï·ÎÙÔ˙·ÈÌ›·

289

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

XoÏ 143,8 181,0 0,0001±28,4 ±12,1

TÚÈÁÏ 126,6 100,1 0,001±49,7 ±10,6

HDL 42,0 45,0 0,079±12,9 ±5,6 (NS)

LDL 80,8 118,0 0,0001±27,1 ±6,7

VLDL 24,9 15,6 0,0001±9,6 ±5,6

Ao A1 130,6 101,1 0,0001±27,7 ±21,3

Ao B 50,5 71,3 0,0001±13,0 ±4,1

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

JULY-AUG.2000 30-05-03 13:24 ™ÂÏ›‰·289

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

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

ÂÍ·ÚÙˆÌ¤ÓˆÓ ·fi ÙËÓ ‚ÈÙ·Ì›ÓË K ·Ú·ÁfiÓÙˆÓ ·È-ÌfiÛÙ·Û˘ (II, VII, IX, X, PC) Î·È ÙˆÓ ÏÈȉ›ˆÓ (XoÏ,TÚÈÁÏ, LDL Î·È AoB) o˘ ·Ú·ÙËÚ‹ıËΠÛÙo˘˜Á·Ï·ÎÙo˙·ÈÌÈÎo‡˜ ·ÛıÂÓ›˜ Ì·˜ ˘fi ‰›·ÈÙ·(14,15).

™˘ÌÂÚ·ÛÌ·ÙÈο, oÈ Á·Ï·ÎÙo˙·ÈÌÈÎo› ·ÛıÂÓ›˜˘fi ‰›·ÈÙ· Ì ÛfiÁÈ· ÂÌÊ·Ó›˙o˘Ó ÌÂÙ·‚oϤ˜ ÛÙȘ Û˘-ÁÎÂÓÙÚÒÛÂȘ ÙfiÛo ÙˆÓ ÏÈȉ›ˆÓ fiÛo Î·È ÙˆÓ ·Ú·Áfi-ÓÙˆÓ ‹Íˆ˜, ·ÚfiÌoȘ Ì ÙȘ ·Ú·ÙËÚo‡ÌÂÓ˜ÛÙo˘˜ Ê˘ÙoÊ¿Áo˘˜.

BÈ‚ÏÈÔÁÚ·Ê›·1. Segal S. Disorders of galactose metabolism. In: Scriver

CR, Beadet AI, Sly W, eds. The metabolic and molecularbasis of inherited disease: London: MTP, 1995:967-990.

2. Schweitzer S, Shin NS, Jacobs C, Broedehl J. Longtermoutcome in 134 patients with galactosemia. Eur J Pediatr1993;152:36-43.

3. Francis D. Galactosemia. In: Diets for sick children.London: Blackwell Scientific Publications, 1986:386-396.

4. Karasawa T, Tanaka M, Uemura T, Osanai T. Anti-atherogenicity of soybean protein. Ann NY Acad Sci1992;676:202-214.

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

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

7. Miller FJ, Martin JC, Webster J. Association betweendietary fat intake and plasma factor VII coagulant activity.Atherosclerosis 1986;60:269-277.

8. Masarei J, Rouse J, Lynch W, Robertson K. Effects of alacto-ovo vegetarian diet on serum concentrations ofcholesterol, triglyceride, HDL, apoprotein B, and Lp (a).Am J Clin Nutr 1984;40:468-479.

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

10. Fehily AM, Millbank JE, Yarnell JWG, Hayes TM. Dietarydeterminants of lipoproteins, total cholesterol, viscosity,fibrinogen and blood pressure. Am J Clin Nutr1982;36:890-918.

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291 K. ™o‡ÏË Î·È Û˘Ó.

290

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

XoÏ TÚÈÁÏ HDL LDL VLDL Ao B Ao A

II +0,71 * * * * * *

VII +0,70 +0,81 * +0,72 * +0,76 *

IX * * * 0,68 * * *

X * +0,80 * * +0,80 * *

PC +0,61 * * * * +0,61 *

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:287-291 ¶·Ú¿ÁÔÓÙ˜ ·ÈÌfiÛÙ·Û˘ ÛÙË Á·Ï·ÎÙÔ˙·ÈÌ›·

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12. Pan Wen Harn, Chia Jung Chin, Chin-Tou Shew.Hemostatic factors and blood lipids in young Buddhistvegetarians and omnivores. Am J Clin Nutr 1993;58:354-359.

13. Merskey C, Nossel HL. Blood coagulation after theingestion of saturated and unsaturated fats. Lancet1997;i:806-810.

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

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

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-08-1999HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-04-2000

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ÏÂÔ¿ÙÚ· ™Ô‡ÏËπÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, °Ô˘‰›, ∞ı‹Ó·

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301

292

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

°ÂÒÚÁÈÔ˜ MÚÈ·ÛÔ‡Ï˘, NÈÎfiÏ·Ô˜ Z¿‚Ú·˜, M·Ú›· N·ÚÏ›ÔÁÏÔ˘, AÓ·ÛÙ¿ÛÈÔ˜ X·Ù˙‹˜

● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ηٷÁÚ¿„ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÂÓfi˜ ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈ-Ú˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ (E°™) ÛÙËÓ ÔÍ›· Ê¿ÛË ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘ Û ·È‰È¿ Ô˘ ÂÈÛ¿ÁÔÓÙ·È Û ÌÔÓ¿‰· ÂÓÙ·-ÙÈ΋˜ ıÂڷ›·˜ (ME£). ™ÙË ÌÂϤÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 36 ·ÛıÂÓ›˜, ËÏÈΛ·˜ 2 ¤ˆ˜ 204 ÌËÓÒÓ Ì ÛÔ‚·Ú¤˜ ·-ı‹ÛÂȘ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÛË„·ÈÌ›·˜, ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎÒÓ Î·ÎÒÛˆÓÎ·È ÂÁη˘Ì¿ÙˆÓ. H ËÌÂÚ‹ÛÈ· ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë (¶) Û˘Û¯ÂÙ›ÛıËΠ̠ÙÔÓ ÚÔ‚ÏÂfiÌÂÓÔ ‚·ÛÈÎfi ÌÂÙ·‚ÔÏÈ-ÛÌfi (¶BM), ÙËÓ ÚÔ‚ÏÂfiÌÂÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ (¶KE) Î·È ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, Û‡Ìʈӷ Ì ٷ Û˘-ÛÙ‹Ì·Ù· ·ÍÈÔÏfiÁËÛ˘ PRISM Î·È TISS. H £¶ ÚÔÛ¤ÁÁÈÛ ÛËÌ·ÓÙÈο ÙÔÓ ¶BM ÙÔ 2Ô 24-ˆÚÔ ÓÔÛËÏ›·˜(46,4±3 vs 45±1,4 kcal/kg/day) Î·È ÙËÓ ¶KE ÙÔ 5Ô 24-ˆÚÔ (71±4,7 vs 74,8±12,7 kcal/kg/day). TÔ Û‡ÓÔÏÔ ÙˆÓˆÚÒÓ ¯ˆÚ›˜ Û›ÙÈÛË (1,4% ÙÔ˘ Û˘ÓfiÏÔ˘ ˆÚÒÓ Û›ÙÈÛ˘) Û¯ÂÙ›ÛıËΠÛËÌ·ÓÙÈο Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘(p<0,001) Î·È ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ‰È·Ù·Ú·Á̤ÓË ·ÓÔ¯‹ Ù˘ Û›ÙÈÛ˘ ·ÏÏ¿ Ì ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· (ÚÔÛ¿-ıÂÈ· ·ÔۈϋӈÛ˘). ™Â ÁÚ·ÌÌÈ΋ ·Ó¿Ï˘ÛË ÔÏÏ·Ï‹˜ ·ÏÈÓ‰ÚfiÌËÛ˘, ·ÚÓËÙÈο ÛÙË ÂÊ·ÚÌÔÁ‹ Ù˘ E°™ Û˘-Ó¤‚·Ï·Ó ·ÓÂÍ¿ÚÙËÙ· Ë Î·Î‹ ÙÂÏÈ΋ ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘ (p<0,0001) Î·È ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· TISS. Y„ËÏ¿ Ì˘Ô-ηډȷο ÎÏ¿ÛÌ·Ù· (EF 66% vs 32%, p<0,0001 ‹ SF 35% vs 19%, p=0,001) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓÛ¯ÂÙ›ÛıËÎ·Ó Ì ÂÈÙ˘¯›· Ù˘ E°™. MfiÓÔ ¤Ó· 5,6% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·Û ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›·, ‰È¿Ú-ÚÔȘ ‹ ¯ÚÂÈ¿ÛıËΠ·ÁˆÁ‹ Ì ÛÈÛ·Ú›‰Ë ÏfiÁˆ ÌË ÚÔÒıËÛ˘ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘. H ıÓËÛÈÌfiÙËÙ·‹Ù·Ó 5,6%. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË ÌÂ Î¿Ï˘„Ë ÙˆÓ ‚·ÛÈÎÒÓ ÌÂÙ·‚ÔÏÈÎÒÓ ·Ó·ÁÎÒÓ Ì ÂÈ-‰È΋ Ï‹ÚË ˘ÁÚ‹ ÙÚÔÊ‹ Â›Ó·È ÂÊÈÎÙ‹, ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ¿ÌÂÛË ÌÂÙ·ÎÚÈÙÈ΋ (post-stress) η-Ù¿ÛÙ·ÛË Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿ Ô˘ ÓÔÛËχÔÓÙ·È Û ME£. H ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ E°™ Ì ÙË Ì˘ÔηÚ-‰È·Î‹ Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿. ¶·È‰È·ÙÚÈ΋ 2000;63:292-301.

§¤ÍÂȘ ÎÏÂȉȿ: ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË, ÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË, ηٷӿψÛË ÂÓ¤ÚÁÂÈ·˜, ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·-›·˜, Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ·, ÎÚ›ÛÈÌË ÓfiÛÔ˜.

G. Briassoulis, N. Zavras, M. Narlioglou, T. Hatzis. Optimized enteral feeding in critically ill children; aprospective study in a paediatric intensive care unit. Paediatriki 2000;63:292-301.● Abstract: The aim of this study was to investigate the feasibility, adequacy and efficacy of early intragastricfeeding (EGF) in critically ill children. In the study 36 critically ill children received EGF through a naso-gastric tubefrom day 1 (energy intake equal to 1/2, 1, 5/4, 6/4 and 6/4 of the predicted basal metabolic rate (PBMR) on days 1to 5, respectively). Severity of illness was assessed by the PRISM Score, the TISS and indices of organ failure.Predicted energy expenditure (PEE), PBMR, and caloric intake (CI) were calculated using recommended formulae.EF and SF were measured by echocardiography on day 1. The early success rate was 94.4% and predicted lateenteral feeding success accurately (p=0.005). CI approached PBMR on the 2nd day (46.4±3 vs 45±1.4kcal/kg/day) and PEE on the 5th day (71±4.7 vs 74.8±12.7 kcal/kg/day). Non-feeding hours (1.4% of the totalfeeding hours) correlated to the PRISM (p<0.001), while transient withholding EGF was not primarily due to feedingintolerance (extubation). Multivariate stepwise regression analysis showed that poor outcome and high TISScorrelated with failure of EGF (p<0.0001). Patients who succeeded EGF had significantly higher EF (66% vs 32%,p<0.0001) or SF (35% vs 19%, p=0.001) than those who failed. Most patients tolerated EGF well; only 5.6%

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

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EÈÛ·ÁˆÁ‹H ·ÔÙ˘¯›· ÛÙËÓ ¿ÌÂÛË ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜

‰È·ÙÚÔÊ‹˜ Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿ Ô‰ËÁ› Û˘-¯Ó¿ ÛÙËÓ ¯ÔÚ‹ÁËÛË O¶¢ Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ Î›Ó‰˘-ÓÔ Ù˘ ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙËÙ·˜, ıÓËÛÈÌfiÙËÙ·˜, ÙËÌË ÈÛfiÚÚÔË Û›ÙÈÛË Î·È ·ÎfiÌË ÙÔ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜(1). §fiÁˆ Ù˘ Û˘¯Ó¿ ÂËÚ·Ṳ̂Ó˘ ÎÈÓËÙÈÎfiÙËÙ·˜ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÚÈÔÚÈÛÌÔ‡ Ù˘O¶¢, ÙÂÏÂ˘Ù·›· Û ÔÏϤ˜ ME£ ÂÊ·ÚÌfi˙ÂÙ·È Ë ‰È·-˘ÏˆÚÈ΋ ‹ ÓËÛÙȉÈ΋ ̤ıÔ‰Ô˜ Û›ÙÈÛ˘. ŒÙÛÈ ÔÈ Â-ÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ¤ÁηÈÚˤӷÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Û ÂÓ‹ÏÈΘ ·Ó·-ʤÚÔÓÙ·È ÛÙË ¯Ú‹ÛË Á·ÛÙÚÔÛÙÔÌ›·˜ ‹ ÓËÛÙȉÔÛÙÔ-Ì›·˜ (2). Ÿˆ˜ fï˜, Î·È Ë ÂÊ·ÚÌÔÁ‹ Ù˘ O¶¢ Û˘-Û¯ÂÙ›˙ÂÙ·È Ì ÂËÚ·Ṳ̂ÓË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Á·ÛÙÚÂ-ÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡, ¤ÙÛÈ Î·È Ë ÓËÛÙȉÈ΋ Û›ÙÈÛË Û˘Ó-‰¤ÂÙ·È Ì ÙË ÌË Ê˘ÛÈÔÏÔÁÈ΋ Ú·ÎÙÈ΋ Ù˘ ·Ú¿Î·Ì-„˘ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ‚ÏÂÓÔÁfiÓÔ˘, ÙÔ˘ Ù˘ ‰È¤ÁÂÚÛË˜ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ Î·È Ù˘ ÔÛ̈ڇıÌÈ-Û˘ Ô˘ ÚÔÛʤÚÂÈ.

BÈÔÏÔÁÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ, ›Û˘ ÂÓÈÛ¯‡Ô˘ÓÙËÓ ¿Ô„Ë Ù˘ ÂÈÏÔÁ‹˜ Ù˘ ‰È·Á·ÛÙÚÈ΋˜ Ô‰Ô‡ Û›-ÙÈÛ˘ ÙˆÓ ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ. E›Ó·È ÁÓˆÛÙfifiÙÈ ÔÈ Á·ÛÙÚÈΤ˜ ÂÎÎÚ›ÛÂȘ, Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔÓ Î˘-ÚÈfiÙÂÚÔ ·ÓÙÈ‚·ÎÙËÚȉȷÎfi Ì˯·ÓÈÛÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘,ÌÂÈÒÓÔÓÙ·È fiÙ·Ó Ë ÙÚÔÊ‹ ·ÂÏ¢ıÂÚÒÓÂÙ·È ÛÙÔ ‰ˆ-‰Âη‰¿ÎÙ˘ÏÔ (3). EÈÚfiÛıÂÙ·, Ë Û›ÙÈÛË Ì¤Ûˆ ÚÈÓÔ-Á·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· Â›Ó·È Â‡ÎÔÏË, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÈ-‰È΋ Ù¯ÓÈ΋ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ηıÂÙ‹Ú· ηÈÛ˘ÁÎÚÈÙÈο, ¤¯ÂÈ ÙÔ ¯·ÌËÏfiÙÂÚÔ ÎfiÛÙÔ˜. H ¤ÁηÈÚËÂÓÙÂÚÈ΋ Û›ÙÈÛË ·Ô‰Â›¯ıËΠ¢ÂÚÁÂÙÈ΋ Û ÂÓ‹ÏÈΘ·ÛıÂÓ›˜ Ì ÂÁη‡Ì·Ù· (4), ‹ ÌÂÙÂÁ¯ÂÈÚËÙÈο (5).EÓÙÔ‡ÙÔȘ, Ë ·ÛÊ¿ÏÂÈ· Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·¤ÓÔ˜ ¤ÁηÈÚÔ˘ ÂÈıÂÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÚÈÓÔÁ·ÛÙÚÈ΋˜Û›ÙÈÛ˘ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È-‰È¿ (¤Ú¢ӷ ÛÙÔ MEDLINE). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÍÂÙ¿ÛË ÙËÓ ˘fiıÂÛË fiÙÈ Ë E°™ η-Ù¿ ÙË ‰¿ÚÎÂÈ· ÛÔ‚·Ú‹˜ ¿ıËÛ˘ Â›Ó·È ÂÊÈÎÙ‹ ηȷÛÊ·Ï‹˜ Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈAÛıÂÓ›˜

™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó 36 ÎÚ›ÛÈÌ· ¿ÚÚˆ-ÛÙ· ·È‰È¿ Ô˘ ˘ÔÛÙËÚ›˙ÔÓÙ·Ó Ì Ì˯·ÓÈÎfi ·ÂÚÈ-ÛÌfi. °È· Ó· ÂÚÈÏËÊıÔ‡Ó ÛÙË ÌÂϤÙË, ÔÈ ·ÛıÂÓ›˜

¤Ú ӷ ÏËÚÔ‡Ó Ù· ·ÎfiÏÔ˘ı· ÎÚÈÙ‹ÚÈ·: ·) ·Ó·-ÌÂÓfiÌÂÓË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙË ME£>5 Ë̤-Ú˜, ‚) ·Ó·ÌÂÓfiÌÂÓË ‰È¿ÚÎÂÈ· Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡>3 Ë̤Ú˜, Á) ·Ô˘Û›· ÓÂÊÚÈ΋˜ ‹ Ë·ÙÈ΋˜ ÓfiÛÔ˘,‰) ÈÛÙÔÚÈÎfi ÂχıÂÚÔ ¯ÚfiÓÈ·˜ Á·ÛÙÚÂÓÙÂÚÈ΋˜ Ófi-ÛÔ˘, Â) ¤Ó·ÚÍË ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ ÙȘ ÚÒÙ˜ 12ÒÚ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹.

¶ÚˆÙfiÎÔÏÏÔ Û›ÙÈÛ˘¶Ï‹Ú˘ ˘ÁÚ‹ ÙÚÔÊ‹ (Nutrison Pediatric ÁÈ·

·È‰È¿ οو ÙˆÓ 10 ÂÙÒÓ, Nutrison Standard ÁÈ··È‰È¿ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ) ¯ÔÚËÁ›ÙÔ Ì¤Ûˆ ÚÈÓÔÁ·-ÛÙÚÈÎÔ‡ ۈϋӷ ̤۷ ÛÙȘ 12 ÚÒÙ˜ ÒÚ˜ ·fiÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙË ME£. TÔ ˆÚÈ·›Ô ÔÛfi ˘ÔÏÔ-ÁÔ˙fiÙ·Ó Û‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ, Ì ÛÙfi¯ÔÓ· Êı¿ÛÂÈ ÙÔÓ ¶BM ÛÙÔ 2Ô 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜Î·È Ó· ÙÔÓ ˘Âڂ› ηٿ 50% ÙȘ ÂfiÌÂÓ˜ Ë̤-Ú˜, Î·È ÂÓÒ Ô ·ÛıÂÓ‹˜ ·Ú¤ÌÂÓ Û ηٿÛÙ·ÛËstress (ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ›ÛË Ì ÙÔ 1/2, 1, 5/4,6/4 Î·È 6/4 ÙÔ˘ ¶BM ‰È·‰Ô¯Èο ÙȘ Ë̤Ú˜ 1-5).K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ E°™, ÔÈ ·ÛıÂÓ›˜ Ì ÚÔ-‚Ï‹Ì·Ù· ÛÙËÓ ÚÔÒıËÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÂÎÙÈÌÒ-ÓÙ·Ó ÁÈ· ÙÔ Â›Â‰Ô Ù˘ ηٷÛÙÔÏ‹˜ Î·È Ù˘ ·-Ú¿Ï˘Û˘, Î·È ·Ó ˘‹Ú¯Â Úfi‚ÏËÌ·, ·ÓÙÈÌÂÙˆ›˙Ô-ÓÙ·Ó Ì ¯ÔÚ‹ÁËÛË ÛÈÛ·Ú›‰Ë˜ (2 mg/kg/8ˆÚÔ)ÁÈ· 48 ÒÚ˜.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301 EÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Û ·È‰È¿ Û ME£

293

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

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

™˘ÓÙÔÌÔÁڷʛ˜

O¶¢ OÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹

ME£ MÔÓ¿‰· EÓÙ·ÙÈ΋˜ £Âڷ›·˜

¶BM ¶ÚÔ‚ÏÂfiÌÂÓÔ˜ ‚·ÛÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜

E°™ ŒÁηÈÚË ÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË

SIRS ™‡Ó‰ÚÔÌÔ Û˘ÛÙËÌ·ÙÈ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜

·¿ÓÙËÛ˘

PRISM Pediatric Risk of Mortality

TISS Therapeutic Intervention Scoring System

MOSF ¶ÔÏ˘ÔÚÁ·ÓÈ΋ ·Ó¿ÚÎÂÈ·

¶KE ¶ÚÔ‚ÏÂfiÌÂÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜

£¶ £ÂÚÌȉÈ΋ ÚfiÛÏË„Ë

™HA ™˘ÓÈÛÙÒÌÂÓ˜ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ

A£¶ AÓ·ÌÂÓfiÌÂÓË ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë

EF KÏ¿ÛÌ· ÂÍÒıËÛ˘

SF KÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘

JULY-AUG.2000 30-05-03 13:24 ™ÂÏ›‰·293

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™˘ÏÏÔÁ‹ ‰Â‰Ô̤ӈÓOÈ ·ÛıÂÓ›˜ Ù·ÍÈÓÔÌÔ‡ÓÙ·Ó a priori ÛÙȘ ·ÎfiÏÔ˘ı˜

‰È·ÁÓˆÛÙÈΤ˜ ηÙËÁÔڛ˜: ÛË„·ÈÌ›· / ÌËÓÈÁÁ›Ùȉ·, ÎÚ·-ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË, ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·, Ó¢-ÚÔÌ˘˚΋ ¿ıËÛË Î·È ÂÁη‡Ì·Ù·. ™Ë„·ÈÌ›·, ÛËÙÈ΋ η-Ù·ÏËÍ›· Î·È SIRS ÔÚ›ÛıËÎ·Ó Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÔÌÔ-ʈӛ·˜ Ù˘ AÌÂÚÈοÓÈ΢ EÙ·ÈÚ›·˜ £ˆÚ·ÎÔ¯ÂÈÚÔ˘Ú-ÁÒÓ Î·È Ù˘ EÙ·ÈÚ›·˜ EÓÙ·ÙÈ΋˜ £Âڷ›·˜ (6). H ÂÎÙ›-ÌËÛË Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ¿ıËÛ˘ ÁÈÓfiÙ·Ó Ì ‚¿ÛËÙÔ PRISM score (7), ÙÔ TISS ÙÚÔÔÔÈË̤ÓÔ ÁÈ· Ù· ·È-‰È¿ (8), Î·È ÙÔ˘˜ ‰Â›ÎÙ˜ ÔÚÁ·ÓÈ΋˜ ·Ó¿ÚÎÂÈ·˜. HMOSF ÔÚ›ÛıËΠ̠ٷ ÎÚÈÙ‹ÚÈ· ÙˆÓ Wilkinson Î·È Û˘Ó(9). O ¶BM ˘ÔÏÔÁÈ˙fiÙ·Ó Ì ‚¿ÛË ÙȘ ÂÍÈÛÒÛÂȘ ÙˆÓSchofield (10) Î·È Harris-Benedict (11). AÎÔÏÔ‡ıˆ˜,ÔÏÏ·Ï·ÛÈ·˙fiÙ·Ó Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‰ÈfiÚıˆÛ˘fiˆ˜ ÚÔÙ¿ıËÎ·Ó ·fi ÙÔÓ Seashore (12) ÁÈ· Ó· ÂÎÙÈ-ÌËı› Ë ¶KE. H £¶ ˘ÔÏÔÁÈ˙fiÙ·Ó Î·ıËÌÂÚÈÓ¿ ·fi ÙȘοÚÙ˜ ÓÔÛËÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ. OÈ ™HA ˘ÔÏÔÁ›˙ÔÓÙ·Ó·fi ÙÔ˘˜ ›Ó·Î˜ ÙÔ˘ ÂıÓÈÎÔ‡ Û˘Ì‚Ô˘Ï›Ô˘ ¤Ú¢ӷ˜ ÛÂı¤Ì·Ù· ÙÚÔÊ›ÌˆÓ Î·È Û›ÙÈÛ˘ ÙˆÓ H¶A (13). T· ÎÏ¿-ÛÌ·Ù· Ì˘Ôηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ SF Î·È EF ˘Ô-ÏÔÁ›˙ÔÓÙ·Ó Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ÛÙË ME£Â·ÓÂÈÏËÌ̤ӷ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÎÚ›ÛÈÌ˘ Ófi-ÛÔ˘. TÔ ̆ ÂÚ˯ÔÁÚ¿ÊËÌ· ÁÈÓfiÙ·Ó ‰›Ï· ÛÙËÓ ÎÏ›ÓË ÙÔ˘·ÛıÂÓÔ‡˜ Ì ÙÔ Ultramark 8 Ultrasound System,Advanced Technology Laboratory, Squibb, Washington,¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˯ԂÔÏ›˜ 3 Î·È 5 MHz, Î·È ÔÈ Î·Ù·-Áڷʛۘ ÙÈ̤˜ ÙÔ˘ ÚÒÙÔ˘ 24ˆÚÔ˘ ÂÚÈÂÏ‹ÊıËÛ·ÓÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ù˘ ÌÂϤÙ˘. H ÔÛfiÙËÙ· ÙÔ˘Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜, ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ηÈÁ·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÓÔÛÔÎÔÌÂȷ΋˜Ó¢ÌÔÓ›·˜ Î·È ÔÈ ÂÈÏÔΤ˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi(¤ÌÂÙÔÈ, ‰È¿ÚÚÔȘ) ÛËÌÂÈÒÓÔÓÙ·Ó Î·ı' fiÏË ÙË ‰È¿ÚÎÂÈ·Ù˘ ÌÂϤÙ˘. EÈÙ˘¯‹˜ ıˆڋıËÎÂ Ë Û›ÙÈÛË Ô˘ ÔÏÔ-ÎÏËÚÒıËΠۇÌʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘¤ÛÙˆ Ì ÌÈÎÚ¤˜ ·ÚÔ‰ÈΤ˜ ·ÔÎÏ›ÛÂȘ ÙˆÓ Î·Ï˘ÙfiÌÂ-ÓˆÓ ¤Ó·ÓÙÈ ÙˆÓ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓˆÓ ıÂÚÌ›‰ˆÓ. AÔ-Ù˘¯›· Ù˘ Û›ÙÈÛ˘ ıˆڋıËÎÂ Ë ‰È·ÎÔ‹ ÂÊ·ÚÌÔÁ‹˜

ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ Î·È Ë ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ ÌË Û˘-ÓÙ·ÁÔÁÚ¿ÊËÛË ÙˆÓ ˘ÔÏÔÁÈÛıÂÈÛÒÓ ıÂÚÌ›‰ˆÓ ‚¿ÛÂÈÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘. E›Û˘, Ô ÙÚfiÔ˜ Û›ÙÈÛ˘ Î·È Ë £¶Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô Î·Ù·ÁÚ¿ÊÔÓÙ·Ó Î·È Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂÙȘ ·ÓÙ›ÛÙÔȯ˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘.

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛËT· Ê˘ÛÈÔÏÔÁÈÎÒ˜ ηٷÓÂÌË̤ӷ ‰Â‰Ô̤ӷ ·-

ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û·Ó Ì¤ÛË ÙÈÌ‹±sem, ÂÓÒ Ù· ÌË Ê˘ÛÈÔ-ÏÔÁÈÎÒ˜ ηٷÓÂÌË̤ӷ ‰Â‰Ô̤ӷ ‰›ÓÔÓÙ·È Û·Ó ‰È¿-ÌÂÛË ÙÈÌ‹ Î·È Â‡ÚÔ˜ ÙÈÌÒÓ. H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛˤÁÈÓ Ì ÙÔ two-tailed t-test ÁÈ· Ù· Ê˘ÛÈÔÏÔÁÈÎÒ˜ η-Ù·ÓÂÌË̤ӷ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË Î·Ù¿ Levene ÁÈ· ÙËÓÈÛfiÙËÙ· ÙˆÓ ·ÓÙÈı¤ÙˆÓ ‹ Ì ÙË Mann-Whitney U -Wilcoxon ηٿٷÍË sum W test ÁÈ· Ù· ÌË Ê˘ÛÈÔÏÔÁÈ-ο ηٷÓÂÌË̤ӷ ‰Â‰Ô̤ӷ. TÈ̤˜ Èı·ÓfiÙËÙ·˜<0,05 Ì ٷ two-tailed tests ıˆڋıËÎ·Ó ÛËÌ·ÓÙÈ-Τ˜. ŸÙ·Ó ˘ÔÏÔÁÈ˙fiÙ·Ó Ë ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ÙfiÙ¯ÚËÛÈÌÔÔÈ›ÙÔ Ë Î·Ù¿ Pearson ·Ó¿Ï˘ÛË. H ‰ÔÎÈÌ·-Û›· ηٿ Fisher ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ Î·ÙËÁÔÚ›·ÙˆÓ ‰Â‰Ô̤ӈÓ. H ÔÏ˘·Ú·ÁÔÓÙȷ΋ ·Ó¿Ï˘ÛË ·-ÏÈÓ‰ÚfiÌËÛ˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· Ó· ·Ó·Ï‡ÛÂÈ ÙËÓÛ˘Ì‚ÔÏ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÎÏÈÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÙË˜Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ÙËÓ ·ÓıÚˆÔÌÂ-ÙÚ›· Î·È ÙËÓ ÛÔ‚·ÚfiÙËÙ· ÙˆÓ ÙÈÌÒÓ Ù˘ ¿ıËÛ˘ ÛÂÛ¯¤ÛË Ì ÙË ÌÂÙ·‚ÔÏ‹ ÛÙË ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ.ŸÏ˜ ÔÈ ·Ó·Ï‡ÛÂȘ ¤ÁÈÓ·Ó Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ™Ù·ÙÈ-ÛÙÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· ÙȘ KÔÈÓˆÓÈΤ˜ EÈÛً̘(SPSS) ÁÈ· Windows, ¤Î‰ÔÛË 8.0.

AÔÙÂϤÛÌ·Ù·KÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301 °. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

294

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

MÂÙ·‚ÏËÙ¤˜ M¤Û˱SEM ¢È¿ÌÂÛË ÙÈÌ‹ EÏ¿¯ÈÛÙË M¤ÁÈÛÙËM ÙÈÌ‹ Ë Ë

HÏÈΛ· (Ì‹Ó˜) 54,8±9,1 42 2,0 - 204B¿ÚÔ˜ (kg) 21±1,9 18 3,6 - 50PRISM 11,1±1,4 9,0 2,0 - 47,0TISS 27±1,8 25,0 9,0 - 56,0¶Èı·ÓfiÙËÙ· ı·Ó¿ÙÔ˘Ì ÙËÓ Îϛ̷η PRISM (%) 11±0,09 4,0 0,00 - 99EF (%) 65±1,8 68 33 - 77SF (%) 34±1,2 35 16 - 46

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

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›¯·Ó ÛË„·ÈÌ›·,12 (33,3%) ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈ-ÛË, 6 (16,7%) ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·, 3 (8,3%)Ó¢ÚÔÌ˘˚΋ ÓfiÛÔ Î·È 5 (13,9%) ÂÁη‡Ì·Ù·. H ‰È¿Ú-ÎÂÈ· ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ‹Ù·Ó 5±0,7 Ë̤Ú˜(‡ÚÔ˜ 1-16 Ë̤Ú˜), ÂÓÒ Ë Ì¤ÛË ·Ú·ÌÔÓ‹ ÛÙËME£ ‹Ù·Ó 9,8±1,3 Ë̤Ú˜ (‡ÚÔ˜ 1-46 Ë̤Ú˜). HÛ¯¤ÛË ·ÁÔÚÈÒÓ/ÎÔÚÈÙÛÈÒÓ ‹Ù·Ó 1,3:1. ¢‡Ô ·ÛıÂÓ›˜(5,6%) η٤ÏËÍ·Ó (ÌË ·Ó·ÛÙÚ¤„ÈÌË ÛËÙÈ΋ ηٷ-ÏËÍ›·). K·Ù¿ ÙË 1Ë Ì¤Ú· Ù˘ ÌÂϤÙ˘ 30,6% ÙˆÓ·ÛıÂÓÒÓ ‹Ù·Ó Û ΛӉ˘ÓÔ ÁÈ· Ì›ˆÛË ÙˆÓ ·ÔıÂÌ¿-ÙˆÓ Ï›Ô˘˜ Î·È 25% ÁÈ· Ì›ˆÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓÚˆÙ›Ó˘ Û‡Ìʈӷ Ì ÙÔ˘˜ Frisancho (14), RyanÎ·È Martinez (15). EÈϤÔÓ, 16,7% ‹Ù·Ó Û ΛӉ˘ÓÔÁÈ· ¯ÚfiÓÈ· Î·È 22,2% ÁÈ· ÔÍ›· ÚˆÙÂ˚ÓÈ΋ ÂÓÂÚÁÂÈ·-΋ ˘ÔıÚ„›· Û‡Ìʈӷ Ì ÙË ÛÙ·‰ÈÔÔ›ËÛË Î·Ù¿Waterlow ( ). ™˘ÓÔÏÈο, ÙÔ 16,7% ›¯Â ‹‰Ë ÌÂȈ̤ӷ·Ôı¤Ì·Ù· Ï›Ô˘˜ ‹ ÚˆÙ›Ó˘ Î·È 5,5% ‹Ù·Ó ‹‰Ë Û¯ÚfiÓÈ· ‹ ÔÍ›· ÚˆÙÂ˚ÓÈ΋ ÂÓÂÚÁÂȷ΋ ˘ÔıÚ„›·.

™¯¤ÛË ÌÂٷ͇ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ Î·È ·Ó·ÌÂÓfiÌÂ-Ó˘ ÂÓÂÚÁÂȷ΋˜ ηٷӿψÛ˘

K·Ù¿ ÙËÓ 1Ë Ì¤Ú·, Ë £¶ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfi-ÙÂÚË ·fi ÙÔÓ ¶BM, ¶KE Î·È ™HA. H £¶ ÏËÛ›·ÛÂÙËÓ ¶BM ηٿ ÙË ‰Â‡ÙÂÚË Ì¤Ú· (46,4±3 vs 45±1,4kcal/kg/Ë̤ڷ) Î·È ÙËÓ ¶KE ÙËÓ 5Ë Ì¤Ú· (71±4,7 vs74,8±12,7 kcal/kg/Ë̤ڷ). K·Ù¿ ÙËÓ 5Ë Ì¤Ú·, Ë £¶Í¤ڷÛ ÙÔÓ ¶BM ÛËÌ·ÓÙÈο (71±4,7 vs 45±1,4kcal/kg/Ë̤ڷ, p<0,0001), ˘ÂÚ‚·›ÓÔÓÙ·˜ ÙËÓ ·Ó·-ÌÂÓfiÌÂÓË (expected) £¶ (A£¶) ηٿ ÙËÓ 5Ë Ì¤Ú·(71±4,7 vs 67,9±2,1 kcal/kg/Ë̤ڷ) (EÈÎfiÓ· 1). ¢È·-ÊÔÚ¤˜ ÌÂٷ͇ £¶ (·Ú·ÙËÚËı›۷) Î·È A£¶ (·Ó·-ÌÂÓfiÌÂÓË), ÙˆÓ ÚÔ‚ÏÂfiÌÂÓˆÓ ÙÈÌÒÓ ıÂÚÌȉÈ΋˜Î·Ù·Ó¿ÏˆÛ˘, ηıÒ˜ Î·È ÙˆÓ Û˘ÓÈÛÙÒÌÂÓˆÓ ÂÓÂÚ-ÁÂÈ·ÎÒÓ ‰··ÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. MfiÓÔ ÔÈηٿ ˙‡ÁË ‰È·ÊÔÚ¤˜ ÌÂٷ͇ £¶ Î·È ™HA ‰È¤ÊÂÚ·ÓÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ì ·ÚÓËÙÈ΋ Û¯¤ÛË Î·Ù¿ ÙÔ Ù¤-

ÏÔ˜ ÙÔ˘ E°™ ÚˆÙÔÎfiÏÏÔ˘. TË 2Ë Ì¤Ú· Ë ‰È·ÊÔÚ¿¶£-¶BM ‹Ù·Ó ·ÚÓËÙÈ΋ Û ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi ÙÔ˘˜ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ (58%), ÂÓÒ Î·Ù¿ ÙËÓ 5Ë Ì¤Ú· Ë ‰È·-ÊÔÚ¿ ÌÂٷ͇ ¶£-¶BM ‹Ù·Ó <0 ÌfiÓÔ Û ÔÛÔÛÙfi8,3% Î·È >0 Û ÔÛÔÛÙfi 91,7% ÙˆÓ ·ÛıÂÓÒÓ.

™˘Û¯¤ÙÈÛË ÌÂٷ͇ £¶ Î·È ÎÏÈÓÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ M¤¯ÚÈ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ E°™, Ë

£¶ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Î·È·ıÔÏÔÁÈÎÒÓ ·ÛıÂÓÒÓ (69,9±5,0 vs 79,2±5,3kcal/kg/Ë̤ڷ, p=0,5) ‹ Û ·ÛıÂÓ›˜ Ì ‹ ¯ˆÚ›˜ ıÂ-ÙÈÎfi ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi (66±5,3 vs 72±5,3

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301 EÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Û ·È‰È¿ Û ME£

295

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

Paired Samples Test ¢È·ÊÔÚ¤˜ ηٿ ˙‡ÁË

M¤ÛË ÙÈÌ‹ ± SEM 95% ŸÚÈ· ·ÍÈÔÈÛÙ›·˜

X·ÌËÏfiÙÂÚ· Y„ËÏfiÙÂÚ·

™HA - £¶ (kcal/kg/Ë̤ڷ) 17,8 ± 4,4 * 8,8 26,8¶KE - £¶ (kcal/kg/Ë̤ڷ) 3,8 ± 11,7 -19,8 27,5 ¶BM - £¶ (kcal/kg/Ë̤ڷ) -25,9 ± 4,1 * -34,4 -17,4 A£¶ - £¶ (kcal/kg/Ë̤ڷ) -3,3 ± 3,9 -11,4 4,8

* p <0,0001

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

EÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË Ù˘ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘(£¶) Ì ÙȘ ÚÔ‚ÏÂÊı›Û˜ ÙÈ̤˜ ‚·ÛÈÎÔ‡ ÌÂÙ·‚ÔÏÈ-ÛÌÔ‡ (¶BM), ηٷӷψı›۷˜ ÂÓ¤ÚÁÂÈ·˜ (¶KE), Û˘ÓÈ-ÛÙÒÌÂÓˆÓ ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ (™HA) Î·È ·Ó·ÌÂÓfiÌÂ-Ó˘ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ (A£¶) ÙËÓ 5Ë Ë̤ڷ ÂÓfi˜ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈÚ˘ ÚÈÓÔÁ·ÛÙÚÈ΋˜ Û›ÙÈÛ˘ (E°™)Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿.

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

E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ ÂÓÂÚÁÂȷ΋˜ ÚfiÛÏ˄˘ E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ

A£¶-£¶ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ì‹ ¯ˆÚ›˜ MOSF (p<0,0001) ‹ ÛËÙÈ΋ ηٷÏËÍ›·(p<0,0001) ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ÌÂϤÙ˘(EÈÎfiÓ· 3). AÓÙ›ıÂÙ·, ·ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ وӉȷÊÔÚÒÓ A£¶-£¶ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ì ‹ ¯ˆÚ›˜ SIRS (p=0,6).

™¯¤ÛË ÌÂٷ͇ £¶ Î·È Ê·Ú̿ΈÓH £¶ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ·ÛıÂÓÒÓ

Ô˘ ÂÏ¿Ì‚·Ó·Ó ‹ fi¯È ÔÈÔÂȉ‹ (67,9±5,9 vs 78±6,9kcal/kg/Ë̤ڷ, p=0,3) ‹ ·ÁÁÂÈÔ‰Ú·ÛÙÈο Ê¿Ú̷η(63,2±10,8 vs 73,5±5,0 kcal/kg/Ë̤ڷ, p=0,4). AÓÙ›-ıÂÙ·, ·ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó Ó¢ÚÔÌ˘˚ÎÔ‡˜ ·Ô-ÎÏÂÈÛÙ¤˜ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË £¶ Û ۯ¤ÛËÌ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ·Ú¿Ï˘ÛË(65,8±4,9 vs 93,8±7,9 kcal/kg/Ë̤ڷ, p<0,02). H‰È·ÊÔÚ¿ ·˘Ù‹ ·ÓÙ·Ó·ÎÏÔ‡Û ·ÓÙ›ÛÙÔÈ¯Ë ÛËÌ·ÓÙÈ΋‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ· ηٿÙË ‰È¿ÚÎÂÈ· Ù˘ E°™ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (6±2,3vs 0±0 ml/ÒÚ·, p=0,015). ¶·ÚfiÌÔÈ·, ·ÛıÂÓ›˜ Ô˘ÂÏ¿Ì‚·Ó·Ó ÔÈÔÂȉ‹ ¿ÊËÓ·Ó ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ·Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜ Û˘ÁÎÚÈÙÈο Ì ÂΛÓÔ˘˜Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ÔÈÔÂȉ‹ (7,2±2,7 vs 0,2±0,1ml/ÒÚ·, p=0,018). AÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ‹ fi¯È ·Á-

ÁÂÈÔ‰Ú·ÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ˆ˜ ÚÔ˜ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ ˘ÔÏ›ÌÌ·ÙÔ˜ (6,9 vs 4,3 ml/ÒÚ·,p=0,6).

E°™: ÂÈÙ˘¯›·-·ÔÙ˘¯›·H ¿ÌÂÛË ÂÈÙ˘¯›· ¤Êı·Û ÙÔ ÔÛÔÛÙfi 94,4%,

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301 °. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

296

EÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË Ì˘Ôηډȷ΋˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜Î·È Û˘ÓÔÏÈÎÔ‡ ÚÔÛÏ·Ì‚·ÓfiÌÂÓÔ˘ ÔÛÔ‡ Û›ÙÈÛ˘.

EÈÎfiÓ· 3. E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ‰È·ÊÔ-ÚÒÓ A£¶-£¶ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ì ‹ ¯ˆÚ›˜ MOSF(¿Óˆ) ‹ ÛËÙÈ΋ ηٷÏËÍ›· (οو) ηٿ ÙËÓ ÚÒÙË‚‰ÔÌ¿‰· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ¤ÁηÈÚ˘ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘.

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Û‡ÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤ÊÂÚ·Ó Û ¤Ú·˜ ÙÔÚˆÙfiÎÔÏÏÔ (EÈÎfiÓ· 4). TÔ ¿ıÚÔÈÛÌ· ÙˆÓ ˆÚÒÓ ¯ˆ-Ú›˜ Û›ÙÈÛË ·ÓÙÈÛÙÔȯԇÛ ÛÙÔ 1,4% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡·ÚÈıÌÔ‡ ˆÚÒÓ Û›ÙÈÛ˘, ·ÓÙÈÛÙÔȯÒÓÙ·˜ Û 3,6±1,7ÒÚ˜ (0-60) ÁÈ· οı ·ÛıÂÓ‹ Û fiÏË ÙËÓ ‰È¿ÚÎÂÈ·Ù˘ ÌÂϤÙ˘. OÈ ÒÚ˜ ·˘Ù¤˜ ‰È·ÎÔ‹˜ Ù˘ Û›ÙÈÛ˘ۯÂÙ›˙ÔÓÙ·Ó ıÂÙÈο ÚÔ˜ ÙȘ ÙÈ̤˜ ÙˆÓ PRISM, TISS,Î·È ·ÚÓËÙÈο Ì ÙÔ EF (r=-0,32, p=0,007) ‹ SF (r=-0,37, p=0,002). ™Â ÔÏ˘·Ú·ÁÔÓÙȷ΋ ·Ó¿Ï˘ÛË ·-ÏÈÓ‰ÚfiÌËÛ˘, ÌfiÓÔ Ë ÂÈ‚›ˆÛË (r2=0,62, p<0,0001)Î·È ÙÔ TISS (r2=-3, p<0,02) Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ·ÓÂÍ¿Ú-ÙËÙ· Ì ÙË ‰È·ÊÔÚ¿ £¶-¶BM.

E°™ -ÂÈÏÔΤ˜OÈ ·ÛıÂÓ›˜ ·Ó¤¯ıËÎ·Ó ÙËÓ E°™ Ôχ ηϿ. H Û˘-

¯ÓfiÙËÙ· ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙË Û›ÙÈÛËÌ ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· ‹Ù·Ó ÌÈÎÚ‹ (13,9%).¢È¿ÚÚÔÈ· (5,6%) Î·È ÂËÚ·Ṳ̂ÓË Á·ÛÙÚÈ΋ ΤӈÛË(8,3%) ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì ‚Ú·¯‡¯ÚÔÓË Ì›ˆÛËÙ˘ Û›ÙÈÛ˘. H ·ÚÔ‰È΋ ‰È·ÎÔ‹ Ù˘ E°™ ‰ÂÓ ÔÊÂÈ-ÏfiÙ·Ó ÛÙË ÌË ·ÓÔ¯‹ Ù˘ Û›ÙÈÛ˘ ΢ڛˆ˜, ·ÏÏ¿ ÛÙËÓÚÔ·ÈÚÂÙÈ΋ ‰È·ÎÔ‹ Ù˘ ÁÈ· ÙËÓ ·ÔۈϋӈÛË. Mfi-ÓÔ ¤Ó·˜ ·ÛıÂÓ‹˜ ›¯Â ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Á·ÛÙÚÈÎԇηٿ ÙËÓ 5Ë Ì¤Ú· (Klebsiella) Î·È ‰‡Ô ·Ó¤Ù˘Í·Ó ÓÔ-ÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›·, ÂÓÒ 12 ·ÛıÂÓ›˜ (33.3%) ›-¯·Ó ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜. TÚÂȘ ·ÛıÂÓ›˜ ıÂ-ڷ‡ıËÎ·Ó Ì ÂÈÙ˘¯›· Ì ¯ÔÚ‹ÁËÛË ÛÈÛ·Ú›‰Ë˜ÏfiÁˆ ηı˘ÛÙÂÚË̤Ó˘ Á·ÛÙÚÈ΋˜ ΤӈÛ˘. Ÿ„ÈÌ·ÚÔ‚Ï‹Ì·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË Û›ÙÈÛË, Ì ‰È·ÎÔ‹Ù˘ Û›ÙÈÛ˘ ÁÈ· ÏÈÁfiÙÂÚÔ ·fi 1 Ë̤ڷ, ÂÚÈÂÏ¿Ì‚·-Ó·Ó ÙȘ ‰È¿ÚÚÔȘ (5,6%) Î·È ÙË Á·ÛÙÚÔ¿ÚÂÛË

(5,6%) Û 4 ·ÛıÂÓ›˜ Ì ÛËÙÈ΋ ηٷÏËÍ›·. MfiÓÔ 2·ÛıÂÓ›˜ ¯ÚÂÈ¿ÛıËÎ·Ó O¶¢ ÌÂÙ¿ ·fi ÙË Û˘ÌÏ‹Úˆ-ÛË Ù˘ E°™ ÂÓÒ 21 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ (58,3%)ÂÍ‹Ïı·Ó Û˘Ó¯›˙ÔÓÙ·˜ ÙË Û›ÙÈÛË Ì ÚÈÓÔÁ·ÛÙÚÈÎfi η-ıÂÙ‹Ú·. H ıÓËÙfiÙËÙ· ÛÙË ME£ (5,6%) ‹Ù·Ó ÛËÌ·ÓÙÈ-ο ¯·ÌËÏfiÙÂÚË ÁÈ· ÙËÓ ÔÌ¿‰· Ì ÂÈÙ˘¯Ë̤ÓË ÙÂÏÈ΋ۛÙÈÛË Û ۇÁÎÚÈÛË Ì ÂΛÓË Ù˘ ÔÌ¿‰·˜ Ô˘ ·¤-Ù˘¯Â Ó· ÔÏÔÎÏËÚÒÛÂÈ ÙÔ ÚˆÙfiÎÔÏÏÔ (p<0,002), Î·È‹Ù·Ó ¯·ÌËÏfiÙÂÚË ·fi ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ·fi ÙË ‚·-Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ (PRISM) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹(12±0,3).

™˘˙‹ÙËÛËEÏ¿¯ÈÛÙ˜ ÌÂϤÙ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔ-

ÓÙ·È ÛÙȘ ıÂÚÌȉÈΤ˜ ·Ó¿ÁΘ ÙˆÓ ‚·Ú¤ˆ˜ ·Û¯fi-ÓÙˆÓ ·È‰ÈÒÓ ÛÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘.™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰Â›¯ıËΠfiÙÈ ÔÈ ÂÓÂÚÁÂȷΤ˜·Ó¿ÁΘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÚԂϤÔÓÙ·È ¯ÚËÛÈÌÔ-ÔÈÒÓÙ·˜ ÙȘ ™HA ‹ ÂȉÈΤ˜ ÂÍÈÛÒÛÂȘ ˘ÂÚÂÎÙÈÌÔ‡ÓÙËÓ Ú·ÁÌ·ÙÈο ‰··ÓfiÌÂÓË ÂÓ¤ÚÁÂÈ· ÛÙË Ê¿ÛË ÙÔ˘stress. H ÌÂÙÚËı›۷ ÂÓ¤ÚÁÂÈ· ÛÙË Ê¿ÛË ÙÔ˘ stress‚Ú¤ıËΠӷ ÚÔÛÂÁÁ›˙ÂÈ ÙÔÓ ¶BM (17) ÂÓÒ ÔÈ ˘ÔÏÔ-ÁÈÛÌÔ› ¶KE ¤¯Ô˘Ó ‰Âȯı› ÙÂÏ›ˆ˜ ·Î·Ù¿ÏÏËÏÔÈ ÁÈ·˘ÔÏÔÁÈÛÌfi Ù˘ ıÂÚÌȉÈ΋˜ Î¿Ï˘„˘ ÙˆÓ ·ÛıÂÓÒÓ·˘ÙÒÓ (18). AÙ˘¯Ò˜, ÔÈ ÚÔÙÂÈÓfiÌÂÓ˜ ËÌÂÚ‹ÛȘ·Ó¿ÁΘ Û ·È‰È¿ Û stress ¤¯Ô˘Ó ‚·ÛÈÛı› Û ÌÂ-ϤÙ˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Û ˘ÁÈ‹, ¯ˆÚ›˜ stress ¿ÙÔÌ·(19,20), Ô‰ËÁÒÓÙ·˜ ÔÏϤ˜ ÊÔÚ¤˜ Û ˘ÂÚÛ›ÙÈÛË(21). H ˘ÂÚÛ›ÙÈÛË, fï˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·-ÚÂÓ¤ÚÁÂȘ, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÚÔηÏÔ‡ÌÂÓ˘·fi ÙË Û›ÙÈÛË ıÂÚÌÔÁ¤ÓÂÛË, Ù˘ ·˘ÍË̤Ó˘ ·Ú·-ÁˆÁ‹˜ CO2, Î·È ÙË ÏÈÒ‰Ë ÂÓ·fiıÂÛË ÛÙÔ ‹·Ú (22).T·˘Ùfi¯ÚÔÓ·, ÌÂϤÙ˜ ‚Ú·¯‡¯ÚÔÓ˘ ‹ ·Ó·ÚÎÔ‡˜ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ (23) ·¤Ù˘¯·Ó Ó· ‰Â›ÍÔ˘Ó ÔÔÈÔ-‰‹ÔÙ ¢ÓÔ˚Îfi ·ÔÙ¤ÏÂÛÌ· Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ˜·ÛıÂÓ›˜. AÓÙ›ıÂÙ·, ¤Ú¢ӷ Û ·ÛıÂÓ›˜ Ì ÎÚ·ÓÈÔÂ-ÁÎÂÊ·ÏÈ΋ οΈÛË ¤‰ÂÈÍ·Ó fiÙÈ Ë ·Ó·Ú΋˜ ıÂÚÌȉÈ-΋ Î¿Ï˘„Ë Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· ηÈıÓËÙfiÙËÙ·.

™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÔÈ ÂÓÂÚÁÂȷΤ˜ ·Ó¿ÁÎÂ˜ÙˆÓ ·ÛıÂÓÒÓ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ Ê¿ÛË Ù˘ ÓfiÛÔ˘.™Â ÚfiÛÊ·ÙË ÌÂϤÙË, ÛÙËÓ ÔÔ›· Ë Î·Ù·Ó¿ÏˆÛËÂÓ¤ÚÁÂÈ·˜ ÚÔÔÛ‰ÈÔÚ›ÛıËΠ۠‰È¿ÊÔÚ· ÛÙ¿‰È·ÔÍ›·˜ ÓfiÛÔ˘, Ë ÌÂÙÚËı›۷ ÂÓ¤ÚÁÂÈ· ÌÂÈÒıËΠÛË-Ì·ÓÙÈο ÛÙË Ê¿ÛË Ù˘ ÛËÙÈ΋˜ ηٷÏËÍ›·˜, ÂÓÒ¤Êı·Û ÛÙȘ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘·Ó¿Î·Ì„˘ ·fi ÙË ÛË„·ÈÌ›· (24). ¶ÚfiÛıÂÙ˜ ÌÂϤ-Ù˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô ˘ÂÚÌÂÙ·‚ÔÏÈÛÌfi˜ ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ ‰ÂÓ Â›Ó·È ÙfiÛÔ Û˘-¯Ófi˜ Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙ· ·È‰È¿ (25-26) Î·È ÓÂÔÁÓ¿(27) fiˆ˜ ›¯Â ÚÔËÁÔ‡ÌÂÓ· ˘ÔÙÂı›. EÔ̤ӈ˜, ÔΛӉ˘ÓÔ˜ ·fi ˘ÂÚÛ›ÙÈÛË Î·È ÌÂÙ·‚ÔÏÈ΋ ÂÈ‚¿Ú˘Ó-ÛË ÙÔ˘ ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜(28). ŒÙÛÈ, Û‡Ìʈӷ Ì ÙÔ Û¯Â‰È·ÛÌfi ÙÔ˘ ·ÚfiÓÙÔ˜

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301 EÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Û ·È‰È¿ Û ME£

297

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

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ÚˆÙÔÎfiÏÏÔ˘, Ë E°™ ‚Ô‹ıËÛ ӷ Î·Ï˘Êı› Ô ¶BMηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ Î·È Ë¶KE ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·Ó¿ÚÚˆÛ˘, fiˆ˜ ·˘Ù‹ÚÔÛ‰ÈÔÚÈ˙fiÙ·Ó ·fi ÙËÓ ÚÔÛ¿ıÂÈ· ·Ô‰¤ÛÌ¢-Û˘ ·fi ÙÔÓ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi. H ¿ÌÂÛË ÂÈÙ˘¯›·‹Ù·Ó 94,4%, ÚԂϤÔÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· ÙËÓ fi„ÈÌËÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì ·ÛÊ¿ÏÂÈ· (97,1%). AÔÙÂϤÛÌ·Ù·Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Á·ÛÙÚÈ΋ Ô‰fi˜ Â›Ó·È Ì›· ÂÊÈÎÙ‹ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÛÙËÓ ·ÚÂÓÙÂÚÈ΋ Î·È ÂÓÙÂÚÈ΋ Û›-ÙÈÛË ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‚·ÚÈ¿˜ ÓfiÛÔ˘. T·Â˘Ú‹Ì·Ù· ·˘Ù¿ Â›Ó·È Â˘ÓÔ˚ÎfiÙÂÚ· ·fi ÂΛӷ ÌÂÏÂ-ÙÒÓ Û ME£ ÂÓËÏ›ÎˆÓ fiÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÌfiÓÔ ÛÂ75% ÂÈÙ˘Á¯¿ÓÂÙ·È ÈηÓÔÔÈËÙÈ΋ Û›ÙÈÛË (29). ¶·Úfi-ÌÔÈ·, Û ÌÂϤÙË Ì ÚÒÈÌË Û›ÙÈÛË Û ÂÓ‹ÏÈΘ, ÌfiÓÔÙÔ 42% ¤Ù˘¯Â ÈηÓÔÔÈËÙÈ΋ Û›ÙÈÛË ÙËÓ 5Ë Ì¤Ú·(30). H ÚÒÈÌË Û›ÙÈÛË fï˜, Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋,ηıÒ˜ ÌÂÈÒÓÂÈ ÙËÓ ˘ÂÚηٷ‚ÔÏÈ΋ ·¿ÓÙËÛË ÛÙÔstress, Ë ‰Â ¯Ú‹ÛË ÛÈÙÈÛÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Â˘ÓÔ›ȉȷ›ÙÂÚ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË,ÙÔ 94% ÙˆÓ ·È‰ÈÒÓ Ì stress ¤Ù˘¯Â Ï‹ÚË Û›ÙÈÛË̤۷ Û 4 Ë̤Ú˜ ÌÂÙ¿ ÙÔ stress. To ‡ÚËÌ· ·˘Ùfi ›-Ó·È ·ÚfiÌÔÈÔ Ì ÙȘ ·Ú·ÙËÚ‹ÛÂȘ Û ÂÓ‹ÏÈΘ Ô˘˘Ô‚Ï‹ıËÎ·Ó Û Ì›˙ÔÓ· ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Î·ÈÛÈÙ›ÛÙËÎ·Ó ÚÔÁÚ·ÌÌ·ÙÈṲ̂ӷ ÂÓÙÂÚÈο ¤ˆ˜ ÙËÓ 4ËÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ‰Â›¯ıËΠ̛· ÛËÌ·ÓÙÈÎ‹Û˘Û¯¤ÙÈÛË Ù˘ ·ÔÙ˘¯›·˜ ÛÙËÓ ·ÓÔ¯‹ Ù˘ E°™ Ì ÙË‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, fiˆ˜ ÂÎÙÈÌ‹ıËΠ̠ٷ Û˘ÛÙ‹-Ì·Ù· PRISM Î·È TISS, Î·È Î˘Ú›ˆ˜ Ì ٷ ÎÏ¿ÛÌ·Ù·‚Ú¿¯˘ÓÛ˘ Î·È ÂÍÒıËÛ˘ Ù˘ ηډȷ΋˜ Û˘ÛÙ·ÏÙÈ-ÎfiÙËÙ·˜. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË, Ë ÌÂÙÚËı›۷ η-ٷӿψÛË ÂÓ¤ÚÁÂÈ·˜ ‚Ú¤ıËΠÛËÌ·ÓÙÈο ÌÂȈ̤ÓËÛ ·ÛıÂÓ›˜ Ì ÛË„·ÈÌ›·, Î·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ Û·ÛıÂÓ›˜ Ì ÛËÙÈÎfi shock, ÂÓÒ ·ÓÙ›ıÂÙ· Ë Î·Ù·Ó¿-ψÛË ÂÓ¤ÚÁÂÈ·˜ ·˘Í‹ıËΠÌfiÓÔ ÌÂÙ¿ ÙËÓ ·Ó¿ÚÚˆÛË·fi ÙË ÛË„·ÈÌ›·. ŒÙÛÈ, ‰Â›¯ıËΠÌÈ· ·Ó·ÏÔÁÈ΋ Û˘-Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÛË„·ÈÌ›·˜ ηÈÙ˘ ηٷӿψÛ˘ ÂÓ¤ÚÁÂÈ·˜ (24). ŸÌˆ˜, ÛÙËÓ ·-ÚÔ‡Û· ÌÂϤÙË, Â›Ó·È Ë ÚÒÙË ÊÔÚ¿ Ô˘ ‰Â›¯ÓÂÙ·È Ì›··ÚfiÌÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ÚÒÈ-Ì˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ÌÂȈ̤Ó˘ ηډȷ΋˜ Û˘-ÛÙ·ÏÙÈÎfiÙËÙ·˜ Û ÎÚ›ÛÈÌ· ¿ÚÚˆÛÙÔ˘˜ ·ÛıÂÓ›˜ ‚·-Ú¤ˆ˜ (MEDLINE). H ·Ú΋˜ ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙËÛÏ·¯ÓÈ΋ ΢ÎÏÔÊÔÚ›· ‰È·ÛÊ·Ï›˙ÂÙ·È fi¯È ÌfiÓÔ ·fiÙËÓ ÈηÓÔÔÈËÙÈ΋ Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙÔ˘ Ì˘Ôηډ›Ô˘,·ÏÏ¿ Î·È ·fi ÙËÓ Û˘Ó¯‹ ‰È¤ÁÂÚÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡‚ÏÂÓÓÔÁfiÓÔ˘ ·fi ÙËÓ E°™. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë E°™ ‰ÈÂ-Á›ÚÂÈ ÙËÓ ›‰È· ÙË ıÚÂÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ÂÓÙÂÚÈ-ÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, ·ÔÙÚ¤ÔÓÙ·˜ ηÙ' ¤ÎÙ·ÛË ÙËÓ·ÙÚÔÊ›· ÙÔ˘ Î·È Â˘ÓÔÒÓÙ·˜ ÙËÓ ·Ó¿ÎÙËÛË Ù˘ ÏÂÈ-ÙÔ˘ÚÁÈÎfiÙËÙ¿˜ ÙÔ˘ (31). B¤‚·È·, Û ηٷÛÙ¿ÛÂȘ ÌÂÈ-ˆÌ¤ÓÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡, fiˆ˜ Û ηٷÛÙ¿ÛÂȘ ‚·-ÚÈ¿˜ ÛËÙÈ΋˜ ηٷÏËÍ›·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È·fi ÛËÌ·ÓÙÈο ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙÔ˘ Ì˘Ô-

ηډ›Ô˘, Ë ÛÏ·¯ÓÈ΋ ·ÈÌ¿ÙˆÛË ·Ú·Ì¤ÓÂÈ Û Ôχ¯·ÌËÏ¿ ›‰·. K·È ·˘Ùfi ·Ú¿ ÙËÓ ·Ó·ÌÊÈÛ‚‹ÙËÙˉȤÁÂÚÛË Ù˘ ÂÓÙÂÚÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ̤ۈ ÙË˜Û˘Ó¯ԇ˜ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘. EȂ‚·›ˆÛË Ù˘ ˘fi-ıÂÛ˘ ·˘Ù‹˜ ·ÔÙÂÏ› ÙÔ Â‡ÚËÌ· fiÙÈ ÛÙËÓ ·ÚÔ‡Û·¤Ú¢ӷ Ë ·ÔÙ˘¯›· Ù˘ E°™ ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ ÛÙËÌË ·ÓÙÈÛÙÚÂÙ‹ ÛËÙÈ΋ ηٷÏËÍ›·. A˘Ùfi Û˘Ìʈӛ̠ٷ ·ÔÙÂϤÛÌ·Ù· ÌÂϤÙ˘ Ô˘ ¤ÁÈÓ Û ·È‰È¿ ÌÂÛÔ‚·Ú¿ ÂÁη‡Ì·Ù·, ÛÙ· ÔÔ›· Ë ÌË ·ÓÔ¯‹ Ù˘ ÂÓÙÂ-ÚÈ΋˜ Û›ÙÈÛ˘ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ÂΉ‹ÏˆÛË ÛË„·È-Ì›·˜ Î·È ·‡ÍËÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ (32).

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

T· ‚·ÚÈ¿ ¿Û¯ÔÓÙ· ·È‰È¿ Û’ ·˘Ù‹ ÙË ÌÂϤÙË ·Ó¤-¯ÙËÎ·Ó Î·Ï¿ ÙËÓ E°™, ηıÒ˜ ÙÔ 86% ÙˆÓ ·ÛıÂÓÒÓ‰ÂÓ Â›¯Â ‰˘ÛÎÔÏ›· ÛÙËÓ ÚÔÒıËÛË Ù˘ Û›ÙÈÛ˘. TÔ‡ڋ̷ ·˘Ùfi Â›Ó·È ·ÚfiÌÔÈÔ Ì ÚÔËÁÔ‡ÌÂÓË ÂÌÂÈ-Ú›· Ô˘ ›¯Â ‰Â›ÍÂÈ fiÙÈ ÙÔ 80-90% ÙˆÓ ‚·ÚÈ¿ ·Û¯fi-ÓÙˆÓ ÂÓËÏ›ÎˆÓ ·Ó¤¯ÔÓÙ·È ÙËÓ ÂÓÙÂÚÈ΋ Û›ÙÈÛË ÙȘÚÒÙ˜ ̤Ú˜ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ·ÚÔ˘Û›· ‹ fi¯È ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ. T· Úfi‰ÚÔÌ· ¢ڋ-Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¤ÁηÈÚË Á·ÛÙÚÈ-΋ Û›ÙÈÛË Â›Ó·È ÂÊÈÎÙ‹ Û ‰È¿ÊÔÚ˜ ·ı‹ÛÂȘ fiÔ˘··ÈÙÂ›Ù·È Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜. ™Â ÚfiÛÊ·ÙË ÌÂϤ-ÙË ‰Â›¯ıËΠ›Û˘, fiÙÈ Ë ¤ÁηÈÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË Â›-Ó·È ‰˘Ó·Ù‹ ·ÎfiÌË Î·È Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ì ÔÍ›··ÁÎÚ·ٛÙȉ· (37). ™Â ÌÂϤÙ˜ Û ·È‰È¿, ÚfiÛÊ·ÙˤÚ¢ӷ ÂȂ‚·›ˆÛ ÙËÓ ·ÛÊ·Ï‹ ¯ÔÚ‹ÁËÛË ÂÓÙÂÚÈ-΋˜ Û›ÙÈÛ˘ Û ·È‰È¿ Û Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË(38). B¤‚·È·, Ë ÛÔ‚·Ú‹ ÓfiÛËÛË ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ·ÚÓËÙÈο ÙË Á·ÛÙÚÂÓÙÂÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (39). AÓ Î·È ÔÈÙÚ¤¯Ô˘Û˜ ·fi„ÂȘ ÁÈ· ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÙÔ˘˜˘Â‡ı˘ÓÔ˘˜ ÁÈ· ÙËÓ Á·ÛÙÚÈ΋ ΤӈÛË Â›Ó·È ÂÚÈÔÚÈ-Ṳ̂Ó˜, Â›Ó·È Ê·ÓÂÚfi fiÙÈ Ë Á·ÛÙÚÔ¿ÚÂÛË ÍÂÎÈÓ¿·fi ¤Ó· Ê¿ÛÌ· ÎÈÓËÙÈÎÒÓ ‰˘ÛÏÂÈÙÔ˘ÚÁÈÒÓ (40). H ·˘ÍË̤ÓË ÂÓ‰ÔÎÚ¿ÓÈ· ›ÂÛË, ÔÈ Î˘ÙÔΛÓ˜ Ô ·Ú¿-ÁˆÓ ·ÂÏ¢ı¤ÚˆÛ˘ Ù˘ ÎÔÚÙÈÎÔÙÚÔ›Ó˘, Ù· ÔÈÔ-

¶∞π¢π∞∆ƒπ∫∏ 2000;63:292-301 °. MÚÈ·ÛÔ‡Ï˘ Î·È Û˘Ó.

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Âȉ‹ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÛÎÔ‡ÓοÔÈ· ›‰Ú·ÛË. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ ·ÛıÂÓ›˜Ô˘ ÂÏ¿Ì‚·Ó·Ó Ó¢ÚÔÌ˘˚ÎÔ‡˜ ·ÔÎÏÂÈÛÙ¤˜ ˘ÔÏ›-ÔÓÙ·Ó Ù˘ ÚÔ‚ÏÂfiÌÂÓ˘ £¶ ÏfiÁˆ ÙÔ˘ ÌÂÁ·Ï‡ÙÂ-ÚÔ˘ ÔÛÔ‡ Á·ÛÙÚÈÎÔ‡ ˘ÔÏ›ÌÌ·ÙÔ˜. T· ÔÈÔÂȉ‹Ê·›ÓÂÙ·È Â›Û˘ Ó· ·ÛÎÔ‡Ó ·ÚÓËÙÈ΋ ›‰Ú·ÛË ÛÙËÓÁ·ÛÙÚÈ΋ ΤӈÛË. ™Â ¿ÏÏË ÌÂϤÙË, Ë Û˘¯ÓfiÙËÙ· ÙˆÓÁ·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÈÏÔÎÒÓ ‹Ù·Ó ›Û˘ ¯·ÌËÏ‹ ÌÂ-ٷ͇ ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ Ì ÂÁη‡Ì·Ù· Ô˘ ÛÈÙ›˙Ô-ÓÙ·Ó Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· (41). AÚÔÛ‰fiÎËÙ·,ÌÂÁ·Ï‡ÙÂÚË ‹Ù·Ó Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓÂÈÏÔÎÒÓ ÌÂٷ͇ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ Ô˘ÛÈÙ›˙ÔÓÙ·Ó Ì ÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ‰È·˘ÏˆÚÈο (42).KÔÈÏȷ΋ ‰È¿Ù·ÛË, ÌÂÁ¿ÏÔ Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ·(17%), Î·È ‰È¿ÚÚÔÈ· (9,7%) ‹Ù·Ó ÔÈ Î˘ÚÈfiÙÂÚ˜ ÂÈ-ÏÔΤ˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹.

™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜, Ë ‰È¿ÚÚÔÈ· ·ÓÙÈÌÂÙˆÈ˙fiÙ·ÓÌ ÚÔÛˆÚÈÓ‹ ÌfiÓÔ Ì›ˆÛË Ù˘ Û›ÙÈÛ˘, ÂÓÒ Ë ¯ÔÚ‹-ÁËÛË ÛÈÛ·Ú›‰Ë˜ ‚ÂÏÙ›ˆÓ ·ÔÙÂÏÂÛÌ·ÙÈο ÙË Á·-ÛÙÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ·. H ÛÈÛ·Ú›‰Ë ¤¯ÂÈ ‰Âȯı› fiÙÈ‚ÂÏÙÈÒÓÂÈ ÙËÓ Á·ÛÙÚÈ΋ ΤӈÛË Ú˘ıÌ›˙ÔÓÙ·˜ ÙË Û¯¤-ÛË ÌÂٷ͇ ÙˆÓ Û˘Û¿ÛÂˆÓ ÙÔ˘ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ˘ ηÈÙÔ˘ ¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, Î·È ·˘Í¿ÓÔÓÙ·˜ ÙÔÓ ·ÚÈı-Ìfi ÙˆÓ Û˘ÛÙÔÏÒÓ ÙÔ˘ ¿ÓÙÚÔ˘ (43). EÍ¿ÏÏÔ˘, Ë ÓË-ÛÙ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰È¿ÚÚÔÈ·˜ ·Ú·Ù›ÓÂÈ ÙËӉȿÚÎÂÈ· Ù˘ ·˘ÍË̤Ó˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÛÙ· ÌÂÁ¿-Ï· ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÌfiÚÈ· ÁÏ˘Îfi˙˘, ÂÓÒ Ë Û˘Ó¤¯È-ÛË Ù˘ ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ¢ÓÔ› ÙË ÁÚËÁÔÚfiÙÂÚË·Ó¿Ï·ÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ (60). A˘Ù‹ Î·È ¿ÏϘ ÌÂ-ϤÙ˜ ‰›ÓÔ˘Ó ¤ÌÊ·ÛË ÛÙËÓ ÂÍ¿ÚÙËÛË Ù˘ Á·ÛÙÚÂÓÙÂ-ÚÈ΋˜ Ô‰Ô‡ ·fi ÙȘ ÂÓ‰Ô·˘ÏÈΤ˜ ıÚÂÙÈΤ˜ Ô˘Û›Â˜ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ·Ó·Î·Ù·Û΢‹ ÙÔ˘ ÂÓÙÂÚÈ-ÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. EÈÚfiÛıÂÙ·, ÔÏϷϤ˜ ÎÏÈÓÈΤ˜ÌÂϤÙ˜ ¤¯Ô˘Ó ÂȂ‚·ÈÒÛÂÈ fiÙÈ Ë ¿ÌÂÛË Û›ÙÈÛË, Û‰ȿÊÔÚ· ‰È·ÚÚÔ˚ο Û‡Ó‰ÚÔÌ·, Û˘Ó‰¤ÂÙ·È Ì ηχÙÂ-ÚË ¤Î‚·ÛË, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ Ófi-ÛÔ˘ (44), Ù˘ ·Ó¿ÎÙËÛ˘ ‚¿ÚÔ˘˜ Î·È ‚ÂÏÙ›ˆÛ˘ Ù˘ηٿÛÙ·Û˘ ıÚ¤„˘ (45). A˘Ùfi ÂÓÈÛ¯‡ÂÙ·È Î·È ·fiÙȘ ÙÂÏÂ˘Ù·›Â˜ Ô‰ËÁ›Â˜ Ù˘ AÌÂÚÈοÓÈ΢ ¶·È‰È·ÙÚÈ-΋˜ EÙ·ÈÚ›·˜ ÁÈ· ÙÔ ·È‰› ¯ˆÚ›˜ stress, Ë ÔÔ›· ÂÈ-‰ÔÎÈÌ¿˙ÂÈ ÙËÓ ¿ÌÂÛË Û›ÙÈÛË Ì ·Ó¿ÏÔÁË ÁÈ· ÙËÓ ËÏÈ-Λ· ‰È·ÙÚÔÊ‹, ÛËÌÂÈÒÓÔÓÙ·˜ fiÙÈ ·˘Ù‹ Ë Ú·ÎÙÈ΋ ‰ÂÓ¯ÂÈÚÔÙÂÚ‡ÂÈ ÙË ‰È¿ÚÚÔÈ·, ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙȘ ÎÂ-ÓÒÛÂȘ, Ó· ‚Ú·¯‡ÓÂÈ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ Î·È Ó·‚ÂÏÙÈÒÛÂÈ ÙË ıÚ¤„Ë (46). E˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜‰Â›¯ÓÔ˘Ó Â›Û˘, fiÙÈ Î·È Û ηٿÛÙ·ÛË ‚·ÚÈ¿˜ Ófi-ÛÔ˘, ÙÔ ·È‰› Ì ÙË ‰È¿ÚÚÔÈ· ‹ ÙËÓ Î·ı˘ÛÙ¤ÚËÛË Ù˘Á·ÛÙÚÈ΋˜ ΤӈÛ˘ ı· Ú¤ÂÈ Ó· Û˘Ó¯›˙ÂÈ Ó· ÛÈÙ›˙Â-Ù·È, ·Ó Î·È Û ÌÈÎÚfiÙÂÚÔ Ú˘ıÌfi ·ÚÔ‰Èο.

MfiÓÔ 2 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ·¤Ù˘¯·Ó ÛÙËÓÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘, Î·È ˘ÔÛÙËÚ›¯ıË-Î·Ó Ì O¶¢. A˘Ùfi ÙÔ ÔÛÔÛÙfi Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fiÙÔ 9,7% ÌÈ·˜ ÌÂϤÙ˘ Ì ÂÓÙÂÚÈ΋ Û›ÙÈÛË, ÛÙËÓ ÔÔ›·Ë ÂÓÙÂÚÈ΋ Û›ÙÈÛË ‰ÈÂÎfiË. ¶ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹ Ù˘

Û›ÙÈÛ˘ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ‰ÂÓ ÔÊÂÈ-ÏfiÙ·Ó ÛÙË ÌË ·ÓÔ¯‹ Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘, ·ÏÏ¿ÛÙËÓ ÂÎÏÂÎÙÈ΋ ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹ ÏfiÁˆ ·Ôۈϋ-ÓˆÛ˘. ¶·ÚfiÏÔ Ô˘ ÙÔ ÚˆÙfiÎÔÏÏÔ Ù˘ E°™ ηıfi-ÚÈ˙Â Û˘ÁÎÂÎÚÈ̤ÓÔ ıÂÚÌȉÈÎfi ÛÙfi¯Ô, ÔÈ ÒÚ˜ ¯ˆÚ›˜Û›ÙÈÛË Ù˘ ÚÔÛˆÚÈÓ‹˜ ‰È·ÎÔ‹˜ ‰ÂÓ ·Ó·ÏËÚÒÓÔ-ÓÙ·Ó ¿ÓÙÔÙ (81,8 %). TÔ Â‡ÚËÌ· ·˘Ùfi ÙÔÓ›˙ÂÈ ÙËÓ·Ó·ÁηÈfiÙËÙ· Ù˘ ¯Ú‹Û˘ ÂÓfi˜ ηٿÏÏËÏ· ۯ‰ȷ-Ṳ̂ÓÔ˘ ÚˆÙÔÎfiÏÏÔ˘, Ì ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔÚÔÛˆÈÎfi, ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ¯ÂÈÚÈÛÌÒÓ Î·Ù¿ÙË Û›ÙÈÛË. M ÂÈÌÔÓ‹ (‰È·ÎÔ‹ Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈ-Û˘ ÌfiÓÔ fiÙ·Ó Ë ÔÛfiÙËÙ· ÙÔ˘ ˘ÔÏ›ÌÌ·ÙÔ˜ ÍÂ-ÂÚÓÔ‡Û ÙËÓ Û›ÙÈÛË ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 12ÒÚÔ˘) ηÈÏÔÁÈ΋ ¯ÔÚ‹ÁËÛË ÚÔÎÈÓËÙÈÎÒÓ Ô˘ÛÈÒÓ, Ë ·Ó·ÏÔÁ›·ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó ÌfiÓÔ ÂÓÙÂÚÈ΋ Û›-ÙÈÛË ·˘Í‹ıËΠÛËÌ·ÓÙÈο ·fi 48,5 Û 91% (47).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Û˘Ó¯‹˜ 24-ˆÚË ÚÈÓÔÁ·ÛÙÚÈ-΋ Û›ÙÈÛË ·ÔÙÂÏ› ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ̤-ıÔ‰Ô ÁÈ· ÙËÓ ÂÈÙ˘¯‹ Î¿Ï˘„Ë ÙˆÓ ıÂÚÌȉÈÎÒÓ ·Ó·-ÁÎÒÓ Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘ ıÚÂÙÈ΋˜ ηٿÛÙ·Û˘·È‰ÈÒÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ÎÚ›ÛÈÌ˘ ÓfiÛÔ˘. H ¤ÁηÈÚËÚÈÓÔÁ·ÛÙÚÈ΋ Û›ÙÈÛË ·Ô‰Â›¯ıËΠÂÊ·ÚÌfiÛÈÌË Û‰ȿÊÔÚ˜ ·ı‹ÛÂȘ, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÛË„·È-Ì›·˜ Î·È Ù˘ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋˜ οΈÛ˘, Î·È Î·Ï¿·ÓÂÎÙ‹ ÛÙ· ÂÚÈÛÛfiÙÂÚ· ‚·ÚÈ¿ ¿Û¯ÔÓÙ· ·È‰È¿. HÛ˘Û¯¤ÙÈÛË Ù˘ ›ÌÔÓ˘ ¯·ÌËÏ‹˜ Ì˘Ôηډȷ΋˜ Û˘-ÛÙ·ÏÙÈÎfiÙËÙ·˜ (ÌË ·ÓÙÈÚÚÔÔ‡ÌÂÓË Î·Ù·ÏËÍ›·) ÌÂÙËÓ ·ÓÂÈÙ˘¯‹ ¤Î‚·ÛË ÂÓfi˜ ÂÈıÂÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘, ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿.

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¢ÈÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÛÙ· ÓÂÔÁÓ¿: EÎÙ›ÌËÛËÙ˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡

AÓ‰Ú¤·˜ E. M·ÚÁÂÙ¿Î˘1, XÚÈÛÙ›Ó· TÚ¿·ÏË1, ¢ËÌ‹ÙÚ˘ °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜1, °ÂˆÚÁ›·°ÚËÁÔÚÈ¿‰Ô˘1, NÈÎÔϤٷ I·Îˆ‚›‰Ô˘2, °ÂÒÚÁÈÔ˜ KÔ˘Ú¿Î˘2, HÚ·ÎÏ‹˜ ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜2

● ¶ÂÚ›ÏË„Ë: H ‰ÈÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË Î·È ËÏÂÎÙÚÔηډÈÔÁÚ·Ê›· ¤¯ÂÈ ÛÔ˘‰·›· ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂڷ¢-ÙÈ΋ ÛËÌ·Û›· ÛÙ· ÓÂÔÁÓ¿. H ÌÂϤÙË ·˘Ù‹ ÂÎÙÈÌ¿ ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·-ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ Û 26 ÓÂÔÁÓ¿ ËÏÈΛ·˜ ·fi 2 ̤¯ÚÈ 16 ËÌÂÚÒÓ, ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· (15 ÓÂÔÁÓ¿) ‹ Ê˘ÛÈÔÏÔ-ÁÈ΋ ηډȿ (11 ÓÂÔÁÓ¿) Î·È ·ÚÚ˘ı̛˜. XÚËÛÈÌÔÔÈ‹ıËΠ‰ÈÔÏÈÎfi ÔÈÛÔÊ¿ÁÂÈÔ ËÏÂÎÙÚfi‰ÈÔ 6 Fr Ì ‰È·ÔÏÈÎfi ‰È¿-ÛÙËÌ· 20 mm Î·È Ë ‰È¤ÁÂÚÛË ¤ÁÈÓ ηٿ ÙË ‰È¿ÚÎÂÈ· ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ Ì ÚÔÁÚ·ÌÌ·ÙÈ˙fiÌÂÓÔ ‰ÈÂÁ¤ÚÙË, ̉ȿÚÎÂÈ· ÂÚÂı›ÛÌ·ÙÔ˜ 10 msec Î·È Ì ‰˘Ó·ÙfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÛÙ·ıÂÚÔ‡, ÙÂÙÚ¿ÁˆÓÔ˘ Ú‡̷ÙÔ˜ Ì ¤ÓÙ·ÛË ·fi 0-20 mA. O ̤ÛÔ˜ ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ ‹Ù·Ó 8,39 mA (‰È·Î‡Ì·ÓÛË 7-10 mA), ÙÔ Ì¤ÛÔ ‡„Ô˜ ÙÔ˘ ‰ÈÔÏÈ-ÎÔ‡ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ‹Ù·Ó 0,57 mV (‰È·Î‡Ì·ÓÛË 0,45-0,65 mV). TÔ Ì¤ÛÔ ‚¿ıÔ˜ ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯È-ÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ‹Ù·Ó 12,93 cm (‰È·Î‡Ì·ÓÛË 11-14,5 cm), Ô ÂÏ¿¯ÈÛÙÔ˜ Ô˘‰fi˜ ·ÓȯÓ¢fiÙ·Ó 0,5 cm Âη-Ù¤ÚˆıÂÓ ÙÔ˘ ̤ÛÔ˘ ‚¿ıÔ˘˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· (ÚÈÓÔÁ·ÛÙÚÈο) Î·È Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡(r=0,59). TÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ËÏÂÎÙÚfiÁÚ·ÌÌ· ›¯Â Ôχ ÈÛ¯˘Ú‹ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔ Ô˘‰fi (r=-0,95)ÛÙË ı¤ÛË ·Ó›¯Ó¢Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡. ¢ÂÓ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ Û η̛· ·Ú¿ÌÂÙÚÔ ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓÌÂ Û˘ÁÁÂÓ‹ Î·È ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·. ™Ù· ÓÂÔÁÓ¿, Ô ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ‚¿ıÔ˘˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ÔÈÛÔ-Ê¿ÁÂÈÔ˘ ηıÂÙ‹Ú· Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ı¤Û˘ Ô˘ ηٷÁÚ¿ÊÂÙ·È ÙÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ËÏÂÎÙÚfiÁÚ·ÌÌ· ›ӷÈÚÔÙÈÌfiÙÂÚÔ˜ ·fi ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ì ‚¿ÛË ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈ΋ 2000;63:302-308.

§¤ÍÂȘ ÎÏÂȉȿ: ‰ÈÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË, ÓÂÔÁÓfi, ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜.

A. Margetakis, C. Trapali, D. Georgakopoulos, G. Grigoriadou, N. Iakovidou, G. Kourakis, H.Dellagrammaticas. Transoesophageal pacing in neonates: Estimation of the appropriate site of minimumpacing threshold. Paediatriki 2000;63:302-308.● Abstract: Transoesophageal pacing and electrocardiography have important diagnostic and therapeuticuses in the neonate. This study evaluated the depth of esophageal insertion in minimizing transoesophagealatrial pacing threshold in 26 neonates aged 2 to 16 days with congenital heart disease (15) or normal heart (11)and arrhythmias. A 6 Fr oesophageal electrode with interelectrode spacing of 20 mm was used. Stimulation wasperformed during sinus rhythm with a programmable stimulator capable of delivering a constant-current,square-wave of 0-20 mA, with pulse width of 10 msec. The average minimal pacing threshold was 8.39 mA(range 7 to 10). The average maximum bipolar atrial electrogram amplitude was 0.57 mA (range 0.45 to 0.65).The average depth of catheter insertion in the site of minimal pacing threshold was 12.93 cm (range 11 to 14.5),it occurred within 0.5 cm bilaterally, and was correlated with patient height (r=0.59). The maximum bipolar atrialelectrogram was highly negatively correlated with the minimum pacing threshold (r=-0.95) in the site of minimalthreshold. There was no difference between neonates with and without congenital heart disease. In neonates,the estimation of catheter insertion depth using the maximum atrial electrogram amplitude is preferable to thatfor using the patient's height, and is critical for minimizing pacing threshold.

Key words: transoesophageal atrial pacing, neonate, threshold.

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

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EÈÛ·ÁˆÁ‹T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Á›ÓÔÓÙ·È ÚÔÛ¿ıÂȘ ÁÈ· Ó·

ÙÂÎÌËÚȈıÔ‡Ó ÔÈ ÂȉÈΤ˜ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈΤ˜ ‰È·-ÁÓÒÛÂȘ Û ÓÂÔÁÓ¿ Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡. TÔ¤Ó·˘ÛÌ·, ηٿ ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜, ÔÊ›ÏÂÙ·È ÛÙËÓ‚ÂÏÙ›ˆÛË Ù˘ ηٷÓfiËÛ˘ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ú˘ı-ÌÔ‡ Î·È ÛÙË ‰È¿ıÂÛË ÏËıÒÚ·˜ Ê·Ú̿ΈÓ, ‚ËÌ·ÙÔ-‰ÔÙÒÓ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Ù¯ÓÈÎÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛË ÙÔ˘˜. A˘Ù¤˜ ÔÈ ıÂڷ¢ÙÈΤ˜ Î·È ‰È·ÁÓˆÛÙÈΤ˜Ù¯ÓÈΤ˜ ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó Â‡ÎÔÏ· ηÈ·ÚÎÒ˜ Û ÓÂÔÁÓ¿ Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡,fiÙ·Ó ‰Ôı› ÚÔÛÔ¯‹ Û ÌÂÚÈΤ˜ ÏÂÙÔ̤ÚÂȘ.

H ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ·Ô-ÙÂÏ› Ì›· ·fi ÙȘ ·ÚȘ Û˘ÓÈÛÙÒÛ˜ ÂÈÙ˘¯Ô‡˜ ‚ËÌ·-ÙÔ‰fiÙËÛ˘, ·ÊÔ‡ Ì ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÌÔÚ› Ó·ÂÈÙ¢¯ı› ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ·ÊÂÓfi˜,Î·È ·ÊÂÙ¤ÚÔ˘ Ó· ·ÔÊ¢¯ı› ÙÔ ·›ÛıËÌ· η‡ÛÔ˘ ‹ÂÏ·ÊÚÔ‡ fiÓÔ˘ Ô˘ ÚÔηÏ›ٷÈ, fiÙ·Ó Ë ¤ÓÙ·ÛË ÙÔ˘‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ú‡̷ÙÔ˜ ÍÂÂÚ¿ÛÂÈ Ù· 15 mA(1).

™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‰ÈÔÈÛÔ-Ê¿ÁÂÈÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ÛÙ· ÓÂÔÁÓ¿ Î·È Ë Û¯¤-ÛË ÙÔ˘ Ì‹ÎÔ˘˜ ÛÒÌ·ÙÔ˜ ÚÔ˜ ÙÔ ‚¿ıÔ˜ ÙÔÔı¤ÙË-Û˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ ËÏÂÎÙÚÔ‰›Ô˘.¶·ÚfiÌÔÈ· ÌÂϤÙË ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛÈ¢Ù›ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, ÂÓÒ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔ-ÁÚ·Ê›·, ·' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ›ÛÙÔȯËÌÂϤÙË Ô˘ Ó· ·Ó·Ê¤ÚÂÙ·È ·ÔÎÏÂÈÛÙÈο Û ÓÂÔÁÓ¿.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈTÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 26 ÓÂÔÁÓ¿ (12

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

AÓ·ÈÛıËÛ›·-ηٷÛÙÔÏ‹H ÌÂϤÙË Û fiÏ· Ù· ÓÂÔÁÓ¿ ¤ÁÈÓ ÛÙËÓ ÎÏ›ÓË ÙÔ˘˜.

™Â ηӤӷ ‰ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·Ó·ÈÛıËÛ›·. ™Â ‰‡ÔÏfiÁˆ ¤ÓÙÔÓ˘ ·ÓËÛ˘¯›·˜ ¯ÔÚËÁ‹ıËΠ¯ÏˆÚ¿ÏË (50mg /Kg POs).

HÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ηٷÁڷʤ˜XÚËÛÈÌÔÔÈ‹ıËΠÎÔÈÓfi˜ ÙÚÈηӷÏÈÎfi˜ ËÏÂÎÙÚÔ-

ηډÈÔÁÚ¿ÊÔ˜ (Mac PC Marquet) ÁÈ· ÙËÓ Ù·˘Ùfi¯ÚÔ-ÓË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜Î·È ÙˆÓ V1, V2 ‹ D2, Ì ʛÏÙÚÔ ÛÙ· 40 Hz. H ηٷ-ÁÚ·Ê‹ ÁÈÓfiÙ·Ó Ì ٷ¯‡ÙËÙ· ¯·ÚÙÈÔ‡ 25 Î·È 50mm/sec Î·È Â˘·ÈÛıËÛ›· 20mm/mV.

BËÌ·ÙÔ‰fiÙ˘/Stimulator™Â fiϘ ÙȘ ÌÂϤÙ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠÔÏ˘ÚÔ-

ÁÚ·ÌÌ·ÙÈ˙fiÌÂÓÔ˜ ‰ÈÂÁ¤ÚÙ˘ (FIAB programmablestimulator model 8817). H ‰ÈÔÈÛÔÊ¿ÁÂÈ· ‰È¤ÁÂÚÛË ÁÈ-ÓfiÙ·Ó Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÛÙ·ıÂÚÔ‡ Î·È ÙÂÙÚ¿Áˆ-Ó˘ ÌÔÚÊ‹˜ Ú‡̷ÙÔ˜, ‰È¿ÚÎÂÈ·˜ 10 msec (Pulsewidth).

T¯ÓÈ΋ ÔÈÛÔÊ¿ÁÂÈ·˜ ηٷÁÚ·Ê‹˜ Î·È ‰È¤ÁÂÚÛ˘: ™Â fiϘ ÙȘ ÌÂϤÙ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠ¢ΛÓËÙÔ,

Ì·Ï·Îfi Î·È ·ÚÈıÌË̤ÓÔ ‰ÈÔÏÈÎfi ‚ËÌ·ÙÔ‰ÔÙÈÎfi ËÏÂ-ÎÙÚfi‰ÈÔ ÛÈÏÈÎfiÓ˘ 6 Fr (FIAB mod. 25125E ESOKID2) Ì ‰È·ÔÏÈÎfi ‰È¿ÛÙËÌ· 20 mm. TÔ ËÏÂÎÙÚfi‰ÈÔ ÂÈ-Û‹¯ıË ·fi ÙÔ ÚÒıˆÓ· ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ Ô˘ ÂÈ-Û¿ÁÂÙ·È ¤Ó·˜ ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ Ì ·Ú¯ÈÎfi‚¿ıÔ˜ Ù· 16 ÂηÙÔÛÙ¿. H ·fiÛÙ·ÛË ·˘Ù‹ ÛËÌÂÈÒ-ıËΠ¿Óˆ ÛÙÔ ËÏÂÎÙÚfi‰ÈÔ Î·È ·ÓÙÈÛÙÔȯԇÛ ÛÙËÓ·fiÛÙ·ÛË ÚÒıˆÓ·˜-¿ˆ ¿ÎÚÔ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘(distal). ™ÙË ı¤ÛË ·˘Ù‹ ηٷÁÚ¿ÊÔÓÙ·Ó Î·È ÊÈÏÙÚ¿-ÚÔÓÙ·Ó ÛÙ· 40 Hz Ù· ‰ÈÔÏÈο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù·.MÂÙÚÔ‡Û·Ì ÙÔ peak-to-peak ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈ-Ô˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ ÚÔÂÚ¯fiÙ·Ó·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÊÏ‚ÔÎÔÌ‚È΋ ÂÓÂÚÁÔÔ›ËÛË(EÈÎfiÓ· 1). ™ÙË ı¤ÛË ·˘Ù‹ ¯ÔÚËÁÔ‡Û·Ì ̛· ÛÂÈÚ¿ÂÚÂıÈÛÌ¿ÙˆÓ Ì ̋ÎÔ˜ ·ÎÏÔ˘ 80% ·˘ÙÔ‡ ÙÔ˘ ÊÏÂ-‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡, ·Ú¯›˙ÔÓÙ·˜ ·fi Ù· 16 mA ηÈÌÂÈÒÓÔÓÙ·˜ Û˘Ó¯Ҙ ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ Ú‡̷ÙÔ˜(amplitude) ηٿ 1 mA ̤¯ÚȘ fiÙÔ˘ Ó· ÌË "Û˘ÏÏ·Ì-‚¿ÓÂÙ·È" Ô ÎfiÏÔ˜ (EÈÎfiÓ· 1). H ÂÏ¿¯ÈÛÙË ··ÈÙÔ‡-ÌÂÓË ¤ÓÙ·ÛË Ë ÔÔ›· ‰È¤ÁÂÈÚ ÙÔÓ ÎfiÏÔ ÔÚ›ÛÙËÎÂÛ·Ó "Ô ÙÔÈÎfi˜ ‰ÈÔÈÛÔÊ¿ÁÂÈÔ˜ Ô˘‰fi˜". K¿ı ‚ËÌ·-ÙÔ‰ÔÙÈ΋ ÚÔÛ¿ıÂÈ· ηٷÁÚ·ÊfiÙ·Ó ÛÙÔÓ ËÏÂÎÙÚÔ-ηډÈÔÁÚ¿ÊÔ.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308 OÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜

303

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

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™ÙË Û˘Ó¤¯ÂÈ· ÌÂÙ·ÎÈÓÔ‡Û·Ì ÙÔÓ Î·ıÂÙ‹Ú· Ì ¤Ï-ÍË (Û·Ó "„¿ÚÂÌ·") ηٿ 0,5 cm Î·È Â·Ó·Ï·Ì‚¿Ó·ÌÂÙȘ ηٷÁڷʤ˜, ÙȘ ÌÂÙÚ‹ÛÂȘ Î·È ÙȘ ‚ËÌ·ÙÔ‰ÔÙ‹-ÛÂȘ ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ, fiˆ˜ ·Ú¯Èο ·Ó·Ê¤ÚıËÎÂ,ÁÈ· οı Ӥ· ı¤ÛË Î·È Ë ÌÂϤÙË ÙÂÚÌ·ÙÈ˙fiÙ·Ó ÌÂÙ¿ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ÛÙÔ ‚¿ıÔ˜ ÙˆÓ 9 ÂηÙÔÛÙÒÓ. ™Â ÂÚ›ÙˆÛË Ô˘ ··È-Ù›ÙÔ ¤ÓÙ·ÛË Ú‡̷ÙÔ˜ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 16 mA, ıˆ-Ú‹ıËΠfiÙÈ Ô Ô˘‰fi˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙˆÓ 16 mA.

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË·) XÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÁÚ·ÌÌÈ΋ ·ÏÈÓ‰ÚfiÌËÛË

(linear regression), ÁÈ· Ó· ÂÎÙÈÌËı› 1) Ë Û¯¤ÛË ÌÂÙ·-͇ ÙÔ˘ Ì‹ÎÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘ ËÏÂ-ÎÙÚÔ‰›Ô˘ ÛÙË ı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ ‰È¤ÁÂÚÛË˜Î·È 2) Ë Û¯¤ÛË ÌÂٷ͇ ÙˆÓ Ì¤ÛˆÓ ÙÔÈÎÒÓ ‚ËÌ·ÙÔ-‰ÔÙÈÎÒÓ Ô˘‰ÒÓ Ì ÙÔ Ì¤ÛÔ ÂÏ¿¯ÈÛÙÔ ÙÔÈÎfi voltage.

‚) XÚËÛÈÌÔÔÈ‹ıËÎÂ Ô Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘(correlation coefficients) ÁÈ· Ó· ÂÎÙÈÌËı› Ë Û¯¤ÛË ÌÂ-ٷ͇ ÙÔ˘ Ì‹ÎÔ˘˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ ¤Ó·ÓÙÈ

ÙÔ˘ ̤ÁÈÛÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎԇ¿ÚÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡.

Á) XÚËÛÈÌÔÔÈ‹ıËΠÙÔ Student t-test ÁÈ· Ó· ÂÏÂÁ-¯ı› Â¿Ó ÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ ¿Ú-Ì·ÙÔ˜ Î·È Ô ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜, ‰È·Ê¤-ÚÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙË ı¤ÛË (‚¿ıÔ˜ ÙÔÔı¤ÙËÛ˘) ÙÔ˘ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ .

AÔÙÂϤÛÌ·Ù·T· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›·, ÙÔ ‚¿ıÔ˜ ÙÔÔı¤-

ÙËÛ˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔ‰›Ô˘, Ô ÂÏ¿¯ÈÛÙÔ˜‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ Î·È ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ ÎÔÏÈÎÔ‡ ¿ÚÌ·ÙÔ˜ Ê·›ÓÔÓÙ·ÈÛÙÔÓ ›Ó·Î· 1.

¶·ÚÔ˘Û›· ‹ fi¯È ·Ó·ÙÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜ Ù˘ ηډȿ˜H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË (Student t-test) ‰ÂÓ ¤‰ÂÈÍÂ

η̛· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ Ì‹ÎÔ˜, ÛÙÔ ‚¿ÚÔ˜,ÛÙÔ ‚¿ıÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ ÛÙË ı¤ÛËÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡, ÛÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔ-

¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308 A. M·ÚÁÂÙ¿Î˘ Î·È Û˘Ó.

304

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

NÂÔÁÓfi HÏÈΛ· µ¿ÚÔ˜ M‹ÎÔ˜ B·ı-K·ı O˘‰fi˜ ⁄„Ô˜ A(Ë̤Ú˜) (g ) (cm) (mA) (mV)

1 2 2350 42 13 7 0,552 5 3000 48 14 8 0,63 10 3100 46 14 8 0,64 8 2200 39 11 7 0,55 3 2150 39 12 9 0,55

6 4 4150 46 14 10 0,67 2 3000 45 13 7 0,68 16 2860 41 12,5 8 0,69 11 3200 46 13,5 8 0,5

10 14 2680 41 14 10 0,6

11 5 3010 44 14,5 10 0,512 9 2800 39 12,5 9 0,613 3 2700 39 13 10 0,614 5 1900 39 13,5 9 0,6515 7 4200 48 14 7 0,6

16 2 2680 44 13 8 0,617 6 4100 50 13,5 8 0,5518 8 2200 43 12 9 0,619 10 3100 43 13 8 0,620 4 1800 37 11,5 8 0,6

21 3 2000 37 12 9 0,522 5 1750 38 11,5 10 0,4523 4 3400 46 13 8 0,524 9 2650 42 12,5 7 0,525 15 4100 49 12 8 0,626 7 3000 47 14 8 0,6

Min 2 1750 37 11 7 0,45Max 16 4200 50 14,5 10 0,65Mean 6,96 2858,21 43,04 12,93 8,39 0,57SD 4,27 754,90 4,08 1,01 1,05 0,06Median 5,5 2829,107 43 13 8 0,6

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

B¿ıÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ηıÂÙ‹Ú·™Â οı ·ÛıÂÓ‹ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ÙÔÈÎÔ› ÂÏ¿-

¯ÈÛÙÔÈ Ô˘‰Ô› Î·È ÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· οı ı¤ÛË ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘.™Â ¤Ó· ·ÛıÂÓ‹ Ù˘ ÌÂϤÙ˘ Ì·˜ (ÓÂÔÁÓfi 16), Ì ÙË‚ËÌ·ÙÔ‰fiÙËÛË ÚÔÎÏ‹ıËΠۇ۷ÛË ÙÔ˘ ·ÚÈÛÙÂ-ÚÔ‡ ‚Ú·¯›ÔÓ·, Èı·ÓÒ˜ ÏfiÁˆ ‰È¤ÁÂÚÛ˘ ÙÔ˘ ‚Ú·¯ÈÔ-Ó›Ô˘ ϤÁÌ·ÙÔ˜, Û ¤Ó· ¿ÏÏÔ ÚÔÎÏ‹ıËΠ(ÓÂÔÁÓfi14) Û‡Û·ÛË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™ÙÔ ›‰ÈÔ ÓÂÔÁÓfiÚÔÎÏ‹ıËΠÎÔÈÏȷ΋ ‰È¤ÁÂÚÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘‚ËÌ·ÙÔ‰fiÙËÛ˘ Ì ÌÔÓ‹ÚË ÚÒÈÌË ‚ËÌ·ÙÔ‰ÔÙÈÎ‹Û˘ÛÙÔÏ‹ (EÈÎfiÓ· 2).

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

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308 OÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜

305

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

∂ÈÎfiÓ· 3. B¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ÛÙË ı¤ÛËÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ Û ۯ¤ÛË Ì ÙÔ Ì‹ÎÔ˜ ÙˆÓ ÓÂÔ-ÁÓÒÓ. H ÁÚ·ÌÌ‹ ·˘Ù‹ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙËÓ ÂÍ›-ÛˆÛË ÁÚ·ÌÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (linear regression)y=11,17+2,45x, fiÔ˘ y=ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ηÈx=ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ÌÂÙÚË̤ÓÔ ·fiÙÔ ÚÒıˆÓ·.

∂ÈÎfiÓ· 4. O ̤ÛÔ˜ ÙÔÈÎfi˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ (·ÎÏÔÈ) Î·È ÙÔ Ì¤ÛÔ Ì¤ÁÈÛÙÔ ÔÈÛÔÊ¿ÁÂÈÔ ÎÔÏÈÎfi¤·ÚÌ· (ÙÚ›ÁˆÓ·) Û ۯ¤ÛË Ì ÙÔ ‚¿ıÔ˜ ÂÈÛfi‰Ô˘ ÙԢηıÂÙ‹Ú· Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜. Hı¤ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ۯ‰fiÓ Û˘-Ì›ÙÂÈ Ì ÙË ı¤ÛË ÙÔ˘ ̤ÁÈÛÙÔ˘ ÎÔÏÈÎÔ‡ ¿ÚÌ·ÙÔ˜.

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

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™˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜,˘‹Ú¯Â ۯ‰fiÓ ·fiÏ˘ÙË ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË (linearregression) (r=-0,95065 p=0,000) ÙÔ˘ ̤ÁÈÛÙÔ˘ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ ¿ÚÌ·ÙÔ˜ Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔ ‚ËÌ·-ÙÔ‰ÔÙÈÎfi Ô˘‰fi ÛÙȘ ı¤ÛÂȘ ·fi 11 ¤ˆ˜ 15 ÂηÙÔÛÙ¿.K·Ù¿ ̤ÛÔÓ fiÚÔ, Ë ı¤ÛË ÛÙËÓ ÔÔ›· ηٷÁÚ·ÊfiÙ·ÓÙÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfi ¤·ÚÌ· (mean 0,57±0,06 mV)·Â›¯Â 0,5 cm Âη٤ڈıÂÓ ÙÔ˘ ̤ÛÔ˘ ‚¿ıÔ˘˜(12,94±0,94 cm) ÛÙÔ ÔÔ›Ô ‰È·ÈÛÙˆÓfiÙ·Ó Ô ÂÏ¿¯È-ÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ (8,38±1,02 mA). ŸÙ·Ó ËÛ˘Û¯¤ÙÈÛË Ô˘‰Ô‡/ÎÔÏÈÎÔ‡ ¿ÚÌ·ÙÔ˜ ¤ÁÈÓ ÛÙȘ‰‡Ô ÈÔ ÂӉȷʤÚÔ˘Û˜ ˘ÔÔÌ¿‰Â˜ ‚¿ıÔ˘˜ ÙÔ˘ η-ıÂÙ‹Ú· (11-13cm Î·È 13-15cm), ‰È·ÈÛÙÒıËΠfiÙÈ ËÛ˘Û¯¤ÙÈÛË ÛÙËÓ ÚÒÙË ÔÌ¿‰· ‹Ù·Ó Û¯ÂÙÈο ÌÈÎÚfi-ÙÂÚË (r=-0,93189 p=0,000) Û˘ÁÎÚÈÙÈο Ì ÙËÓ ‰Â‡-ÙÂÚË (r=-0,99624 p=0,000).

H Û‡ÁÎÚÈÛË ÙÔ˘ ÙÔÈÎÔ‡ ‡„Ô˘˜ ÙÔ˘ ÎÔÏÈÎÔ‡ËÏÂÎÙÚÔÁÚ¿Ì·ÙÔ˜ Ì ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ (Studentt-test) ¤‰ÂÈÍ fiÙÈ:

·) ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÌÂٷ͇ 12,5 cm Î·È 13cm ‚¿ıÔ˘˜ (t-value=-1,48 p=0,153), 13cm Î·È 13,5cm (t-value=1,36 p=0,185), Î·È 12,5 cm Î·È 13,5 cm (t-value=-0,09 p=0,927).

‚) Y‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÂfiϘ ÙȘ ˘fiÏÔȘ ı¤ÛÂȘ ÂϤÁ¯Ô˘ (p<0,01).

Á) ¢ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ÛÙ· Û˘ÌÌÂÙÚÈο, ˆ˜ ÚÔ˜ ÙÔ Ì¤ÛÔ ‚¿ıÔ˜ (13 cm),˙‡ÁË ÂϤÁ¯Ô˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: Z‡ÁÔ˜ 12-14 cm (t-value=0,05 p=0,957)

11,5-14,5 cm (t-value=1,14 p=0,264)11-15 cm (t-value=2,17 p=0,04)

H Û‡ÁÎÚÈÛË ÙˆÓ ÙÔÈÎÒÓ Ô˘‰ÒÓ Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔÔ˘‰fi (Student t-test) ¤‰ÂÈÍ fiÙÈ:

·) ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÌÂٷ͇ 12,5 cm Î·È 13cm ‚¿ıÔ˘˜ (t-value=-1,94 p=0,064), 13 cm Î·È 13,5cm (t-value=-0,8 p=0,430), Î·È 12,5 cm Î·È 13,5 cm(t-value=0,62 p=0,538). EÔ̤ӈ˜, ÙÔ "·Ú¿ı˘ÚÔ"ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ Â›Ó·È 1 ÂηÙÔ-ÛÙfi.

‚) Y‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÂfiϘ ÙȘ ˘fiÏÔȘ ı¤ÛÂȘ ÂϤÁ¯Ô˘ (p<0,05)

Á) ¢ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ÛÙ· Û˘ÌÌÂÙÚÈο, ˆ˜ ÚÔ˜ ÙÔ Ì¤ÛÔ ‚¿ıÔ˜ (13 cm),˙‡ÁË ÂϤÁ¯Ô˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: Z‡ÁÔ˜ 12-14 cm (t-value=0,04 p=0,970)

11,5-14,5 cm (t-value=0 p=1,000)11-15 cm (t-value=-0,44 p=0,662)

™˘˙‹ÙËÛËŒ¯ÂÈ ˘¿ÚÍÂÈ ·fi Ôχ ·Ï·È¿ ÌÂÁ¿ÏÔ ÂӉȷʤ-

ÚÔÓ ÁÈ· ÙÔÓ ÔÈÛÔÊ¿ÁÔ Û·Ó Ì›· Â͈ηډȷ΋ ı¤ÛË Î·-Ù·ÁÚ·Ê‹˜ ÙÔ˘ HK°, ·ÏÏ¿ Ë ‚ËÌ·ÙÔ‰fiÙËÛË Ù˘ ηÚ-‰È¿˜ ·fi ÙË ı¤ÛË ·˘Ù‹ ¤¯ÂÈ ·ÔÎÙ‹ÛÂÈ ÂӉȷʤÚÔÓ

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

H ÎÏÈÓÈ΋ ¤Ú¢ӷ Î·È ·Ô‰Ô¯‹ Ù˘ ÔÈÛÔÊ¿ÁÂÈ·˜‚ËÌ·ÙÔ‰fiÙËÛ˘ ‹Ù·Ó ‚Ú·‰Â›· ÂÍ·ÈÙ›·˜ Ù˘ ÂÚÈÔÚÈ-Ṳ̂Ó˘ ·Ô‰Ô¯‹˜ ÙˆÓ ·Ú¯ÈÎÒÓ ÌÂÏÂÙÒÓ. O Benson(9) ÙÔÓ›˙ÂÈ fiÙÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ÂÚÂı›ÛÌ·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ÎÚ›ÛÈÌÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÁÈ·ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË. T· ¯·Ú·ÎÙËÚÈ-ÛÙÈο ÙÔ˘ Ô˘‰Ô‡ ‰È¤ÁÂÚÛ˘ ·Ó·Ï‡ÔÓÙ·È Ì ÙËÓ Î·-̇ÏË ¤ÓÙ·Û˘-‰È¿ÚÎÂÈ·˜ (strength-duration curve).H ÌÔÚÊ‹ Ù˘ η̇Ï˘ ¤¯ÂÈ ÌÂÏÂÙËı› Û ‚·ÛÈÎfiÂ›Â‰Ô Î·È ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÌÈ· ÁÚ·ÌÌÈ΋ ÌÂÌ‚Ú¿ÓËÛ ¤Ó·Ó ÈÛÙfi Ì ·Ï‹ ÁˆÌÂÙÚ›·, ··ÈÙÂ›Ù·È Ì›· ÛÙ·-ıÂÚ‹ ÌÂÙ·‚ÔÏ‹ Û ¤Ó· ÛÙ·ıÂÚfi ÛËÌÂ›Ô Ù˘ ÌÂÌ‚Ú¿-Ó˘ ÒÛÙ ӷ Á›ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‰È¤ÁÂÚÛË. M ÙËÓÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË ÂÊ·ÚÌfi˙ÂÙ·È ¤Ó· ‰›ÔÂÚÂıÈÛÌ¿ÙˆÓ Û ÌÈ· ÁÚ·ÌÌÈ΋ ÌÂÌ‚Ú¿ÓË Î·È ·fi ıÂ-ˆÚËÙÈ΋ ¿Ô„Ë, Ô ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ı· ‹Ù·Ó¤Ó·˜ ‚Ú·¯‡˜ ·ÏÏ¿ Ì ÌÂÁ¿ÏÔ ‡„Ô˜ (¤ÓÙ·ÛË), ÂÚÂıÈ-ÛÌfi˜. ŸÌˆ˜, Ë ÂÈÏÔÁ‹ ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ¤ÓÙ·Û˘ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‰˘ÛÊÔÚ›· Ô˘ ÌÔÚ› Ó· ÚÔη-ϤÛÂÈ ÛÙÔÓ ·ÛıÂÓ‹. TÔ Ì¤ÁÂıÔ˜ Ù˘ ηډȿ˜ (Ë ·-ÚÔ˘Û›· ‹ fi¯È Ì˘Ôηډȷ΋˜ ˘ÂÚÙÚÔÊ›·˜) ÌÔÚ› Ó·Â›Ó·È ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁˆÓ Ô˘ ÂËÚ¿˙ÂÈ ÙËÓÂÈÙ˘¯›· Ù˘ ‚ËÌ·ÙÔ‰fiÙËÛ˘.

T· ÔÈÛÔÊ¿ÁÂÈ· ÎÔÏÈο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù· ηٷ-ÁÚ¿ÊÔÓÙ·È Û οÔÈ· ·fiÛÙ·ÛË ·fi ÙËÓ Î·Ú‰È¿ ηÈÂÔ̤ӈ˜ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Ì›· Û‡ÓıÂÛË ÔÏÏÒÓ‰ÈÂÁÂÚÙÈÎÒÓ Î˘Ì¿ÙˆÓ. OÈ ·Ó·ÙÔÌÈÎÔ› Î·È ËÏÂÎÙÚÔÊ˘-ÛÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ÎÔÏÈ΋˜ Ì¿˙·˜ (̤ÁÂ-ıÔ˜) Î·È Ë ÂÁÁ‡ÙËÙ· ÚÔ˜ ÙÔ ÎÔÏÈÎfi Ì˘ÔοډÈÔ Ô˘ÚÔÛ‰ÈÔÚ›˙Ô˘Ó Ù· ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈο ¯·Ú·ÎÙË-ÚÈÛÙÈο Û ‰È·ÊÔÚÂÙÈΤ˜ ı¤ÛÂȘ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ‰ÂÓ¤¯Ô˘Ó ÙÂÎÌËÚȈı› Ï‹Úˆ˜. AÓ Î·È Ë ÂÁÁ‡ÙËÙ· ÙˆÓ ÔÈ-ÛÔÊ¿ÁÂÈˆÓ ËÏÂÎÙÚÔ‰›ˆÓ ¤¯ÂÈ ·Ô‰Âȯı› ·ÎÙÈÓÔÁÚ·-ÊÈο, Ë ¤ÎÙ·ÛË ÛÙËÓ ÔÔ›· Ù· ÔÈÛÔÊ¿ÁÂÈ· ËÏÂÎÙÚÔ-ÁÚ¿ÌÌ·Ù· ·ÓÙ·Ó·ÎÏÔ‡Ó ÙËÓ "·ÚÈÛÙÂÚ‹ ÎÔÏÈ΋ ‰Ú·-ÛÙËÚÈfiÙËÙ·" ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓË. ™ÙȘ ı¤ÛÂÈ˜Ô˘ ÂÍÂÙ¿Û·ÌÂ, ÂÓÒ Ë ÁˆÌÂÙÚÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ηډȿ˜ Î·È ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Â›Ó·È ÔχÏÔÎË, ÂÓÙÔ‡-ÙÔȘ, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰Â›¯ÓÔ˘Ó fiÙÈË ÔÏ˘ÏÔÎfiÙËÙ· ÙˆÓ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ Âȉڿ-ÛÂˆÓ ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙÔ˘ ÎfiÏÔ˘ Î·È Ë ÂÁÁ‡ÙËÙ·ÚÔ˜ ÙÔÓ ÔÈÛÔÊ¿ÁÔ, ÔÌ·ÏÔÔÈÔ‡ÓÙ·È ·fi ÙÔ Ì¤ÁÂıÔ˜ÙÔ˘ ·ÛıÂÓÔ‡˜, ·ÊÔ‡ ÙÔ Ì¤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜, ÙÔ ‚ËÌ·ÙÔ‰ÔÙÈÎfi ·Ú¿ı˘ÚÔ Î·ÈÔ ÂÏ¿¯ÈÛÙÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜, ‰ÂÓ Û˘Û¯ÂÙ›˙Ô-ÓÙ·È Ì ÙÔ Ì‹ÎÔ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜.

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308 A. M·ÚÁÂÙ¿Î˘ Î·È Û˘Ó.

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™Â ÌÂϤÙË ÙÔ˘ Benson et al (9), Ô˘ ·ÊÔÚÔ‡ÛÂ30 ·ÛıÂÓ›˜ ËÏÈΛ·˜ ·fi 1 Ë̤ڷ˜ ̤¯ÚÈ 77 ÂÙÒÓ(ÙÚ›· ÓÂÔÁÓ¿) ‰È·ÈÛÙÒÓÂÙ·È ˘„ËÏ‹ ıÂÙÈ΋ Û˘Û¯¤ÙÈ-ÛË (r=0,987 p<0,001) ÌÂٷ͇ ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Î·È ÙÔ˘ ‚¿ıÔ˘˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂ-ÎÙÚÔ‰›Ô˘. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û ·Ô-ÎÏÂÈÛÙÈο ÓÂÔÁÓ¿, Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÌÂ-Ù·‚ÏËÙÒÓ ‹Ù·Ó ÌÂÓ ıÂÙÈ΋, ·ÏÏ¿ fi¯È ÙfiÛÔ ÈÛ¯˘Ú‹(r=0,594 p<0,001) fï˜, ‰È·ÈÛÙÒÓÂÙ·È ÈÛ¯˘ÚfiÙ·-ÙË ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË (r=-0,95065 p=0,000) ÌÂÙ·-͇ ÂÏ¿¯ÈÛÙÔ˘ Ô˘‰Ô‡ Î·È Ì¤ÁÈÛÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÔÈÛÔ-Ê¿ÁÂÈÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜. £Âˆ-Úԇ̠ÂÔ̤ӈ˜, fiÙÈ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÓÂÔÁÓ¿, Ë ı¤-ÛË ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ·ÓÙÈÛÙÔÈ-¯Â› Ôχ ηχÙÂÚ· ÛÙË ı¤ÛË Ô˘ ηٷÁÚ¿ÊÂÙ·È ÙÔ̤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ·-Ú¿ ÛÙË ı¤ÛË Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·fi ÙÔ ‡„Ô˜ ÙÔ˘·ÛıÂÓÔ‡˜. EÓÙÔ‡ÙÔȘ, Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘ ‡„Ô˘˜ÙÔ˘ ·ÛıÂÓÔ‡˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿-¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ı· ÌÔÚÔ‡Û ӷ ›ӷÈÔχÙÈÌË ÁÈ· ÙËÓ Â›ÁÔ˘Û· ÔÈÛÔÊ¿ÁÂÈ· ËÏÂÎÙÚÈ΋·Ó¿Ù·ÍË, ÂÂȉ‹ Ë ÂÓÙfiÈÛË Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯È-ÛÙÔ˘ Ô˘‰Ô‡ Ì ‚¿ÛË ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ËÏÂÎÙÚÔÁÚ¿Ì-Ì·ÙÔ˜ ÌÔÚ› Ó· Â›Ó·È ‰‡ÛÎÔÏË ÂÍ·ÈÙ›·˜ Ù˘ "ÌË-ÊÏ‚ÔÎÔÌ‚È΋˜" ÂÈÎfiÓ·˜ Ù˘ ÎÔÏÈ΋˜ ‰È¤ÁÂÚÛË˜Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙËÓ Ù·¯˘Î·Ú‰›· (4,9). ™‡Ìʈ-Ó· Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ Î·È ÚÔ-ÎÂÈ̤ÓÔ˘ ÁÈ· Ù· ÓÂÔÁÓ¿, ÚÔÙ›ÓÔ˘Ì ÙË ¯ÚËÛÈÌÔ-Ô›ËÛË Ù˘ η̇Ï˘ Ô˘ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ· 3,·ÓÂÍ¿ÚÙËÙ· ·Ó ÙÔ ÓÂÔÁÓfi ¿Û¯ÂÈ ‹ fi¯È ·fi Û˘ÁÁÂ-Ó‹ ηډÈÔ¿ıÂÈ·. ¶Ú·ÎÙÈο, ÚÔÙ›ÓÔ˘Ì ÙËÓ ·Ú¯È-΋ ÚÈÓÔÁ·ÛÙÚÈ΋ ›ÛÔ‰Ô ÙÔ˘ ηıÂÙ‹Ú· Û ‚¿ıÔ˜ 13ÂηÙÔÛÙÒÓ (mean±SD - 12,94±0,94 ÂηÙÔÛÙ¿) ηÈÛÙË Û˘Ó¤¯ÂÈ· ÌÂٷΛÓËÛË ÙÔ˘ ηıÂÙ‹Ú· ηٿ 0,5ÂηÙÔÛÙfi ¿Óˆ ‹ οو ·fi ÙË ı¤ÛË ·˘Ù‹ (‚ËÌ·ÙÔ-‰ÔÙÈÎfi ·Ú¿ı˘ÚÔ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘-‰Ô‡) ̤¯ÚȘ fiÙÔ˘ ηٷÁÚ·Ê› ÙÔ Ì¤ÁÈÛÙÔ ÎÔÏÈÎfiËÏÂÎÙÚfiÁÚ·ÌÌ·. EȉÈÎfiÙÂÚ·, Ì ‚¿ÛË Ù· ÛÙÔȯ›·Ù˘ ÌÂϤÙ˘ Ì·˜, ıˆÚԇ̠fiÙÈ Ë ÚÔÒıËÛË Î·Ù¿0,5 ÂÎ. ÙÔ˘ ηıÂÙ‹Ú· ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ·Ó· "Û˘Ó·ÓÙ‹ÛÂÈ" ÙÔÓ ÂÏ¿¯ÈÛÙÔ Ô˘‰fi (r=-0,99624p=0,000) ·' fi,ÙÈ ¤¯ÂÈ Ë ·fiÛ˘ÚÛË ÙÔ˘ ηٿ ÙËÓ›‰È· ·fiÛÙ·ÛË (r=-0,93189 p=0,000). M ÙÔÓ ¯ÂÈÚÈ-ÛÌfi ·˘Ùfi ÈÛÙ‡ԢÌ fiÙÈ ı· ÂÚÈÔÚÈÛÙ› ‰Ú·ÛÙÈÎ¿Ô ¯ÚfiÓÔ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ı¤Û˘ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘‚ËÌ·ÙÔ‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ı· ÂÏ·¯È-ÛÙÔÔÈËı› Ô ¯ÚfiÓÔ˜ Ù˘ ÔÈÛÔÊ¿ÁÂÈ·˜ ËÏÂÎÙÚÔÊ˘-ÛÈÔÏÔÁÈ΋˜ ÌÂϤÙ˘.

T¤ÏÔ˜, ÂÂȉ‹ ˘¿Ú¯ÂÈ ÂÏ¿¯ÈÛÙË ˆÊ¤ÏÂÈ· ·fi Ù˯ڋÛË Ú‡̷ÙÔ˜ Ì ‰È¿ÚÎÂÈ· >10 ms(9) (pulsewidth), ıˆÚԇ̠fiÙÈ ·˘Ùfi ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ìfi-ÓÔ Û ÂÚÈÙÒÛÂȘ Ô˘ Ô Ô˘‰fi˜ ÍÂÂÚÓ¿ Ù· 14 mA,fiÚÈÔ ¤Ú·Ó ÙÔ˘ ÔÔ›Ô˘ ÚÔηÏÂ›Ù·È ·›ÛıËÌ· ÂÏ·-ÊÚÔ‡ ÔÈÛıÔÛÙÂÚÓÈÎÔ‡ η‡ÛÔ˘ ‹ fiÓÔ˘.

AÓ·ÊÔÚÈο Ì ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ ÌÂıfi‰Ô˘, ‰ÂÓ¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› η̛· ÛÔ‚·Ú‹ fi„ÈÌË ÂÈÏÔ΋. OMcNally (10) ¤‰ˆÛ 20 shocks ÙˆÓ 200 J ¤Î·ÛÙÔÛÙÔÓ ÔÈÛÔÊ¿ÁÔ 6 ÛÎ‡ÏˆÓ Î·È 15 shocks ÙˆÓ 60 J ÛÂ8 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËΠη̛·‚Ï¿‚Ë. A˘Ù¿ Ù· ÂÓÂÚÁÂȷο ›‰· Â›Ó·È ÛËÌ·ÓÙÈοÌÂÁ·Ï‡ÙÂÚ· ·fi ÂΛӷ Ô˘ ‰›ÓÔÓÙ·È ÁÈ· ÙËÓ ÔÈÛÔ-Ê¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË. O Montoyo (2) ˘¤‚·Ï ÛÂÔÈÛÔÊ·ÁÔÛÎfiËÛË 6 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi ÔÈ-ÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË Î·È ‰ÂÓ ‚ڋΠη̛· ·Óˆ-Ì·Ï›·. ™Â Ì›· ÂÚ›ÙˆÛË, Ë ·˘ÙÔ„›· ÌÂÙ¿ ·fi Û˘ÓÂ-¯‹ ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË 60 ˆÚÒÓ, ·ÔÎ¿Ï˘„ÂÌÂÚÈΤ˜ ÂÚÈÔ¯¤˜ ‹È·˜ Ó¤ÎÚˆÛ˘ ÂΠȤÛˆ˜, fiˆ˜·˘Ù¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ÚÈ-ÓÔÁ·ÛÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ÚÔ˘Ù›Ó·˜.

OÌÔ›ˆ˜, ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÔ‚·Ú¤˜ ¿ÌÂÛ˜ÂÈÏÔΤ˜ Ù˘ ÔÈÛÔÊ¿ÁÂÈ·˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘. ™ÙȘ·Ú·¿Óˆ ÌÂϤÙ˜, Ë ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ˘ÚÔ-‰fiÙËÛ ·Ô‰Â‰ÂÈÁ̤ӷ ÚÔ¸¿Ú¯Ô˘Û· ÎÔÈÏȷ΋ Ù·-¯˘Î·Ú‰›· Û ‰‡Ô ·ÛıÂÓ›˜ Î·È ‰È¤ÁÂÚÛË ÙÔ˘ ÊÚÂÓÈ-ÎÔ‡ Û ¤Ó· ·fi 65 ·ÛıÂÓ›˜. ™Â 4/38 ·ÛıÂÓ›˜ Ì¢ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ÚÔÎÏ‹ıËΠÎÔÏÈ΋ Ì·Ú-Ì·Ú˘Á‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÔÛ¿ıÂÈ·˜ ·Ó¿Ù·-͢ Ù˘ Û ÊÏ‚ÔÎÔÌ‚ÈÎfi Ú˘ıÌfi. ¢È¤ÁÂÚÛË ÙÔ˘ ‚Ú·-¯ÈÔÓ›Ô˘ ϤÁÌ·ÙÔ˜ Û˘Ó¤‚Ë Û ¤Ó· ‚Ú¤ÊÔ˜ ηٿ ÙˉȿÚÎÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛ˘ ÛÙËÓ ÂÁÁ‡˜ ÂÚÈÔ¯‹ ÙÔ˘ÔÈÛÔÊ¿ÁÔ˘. AÓÙ›ıÂÙ· ÚÔ˜ ÙËÓ ‰È·ÊϤ‚È· ‚ËÌ·ÙÔ‰fi-ÙËÛË, Ë ÔÈÛÔÊ¿ÁÂÈ· ‚ËÌ·ÙÔ‰fiÙËÛË ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È·ÎÙÈÓÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ·ÔʇÁÔÓÙ·ÈfiϘ ÔÈ ÂÈÏÔΤ˜ Ô˘ ·ÊÔÚÔ‡Ó Ù· ·ÁÁ›·.

™˘ÌÂÚ¿ÛÌ·Ù· T· ·ÚÈ· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ Â›Ó·È fiÙÈ

ÛÙ· ÓÂÔÁÓ¿: 1) ‰ÂÓ ‰È·ÈÛÙÒıËΠη̛· ‰È·ÊÔÚ¿ ÛÙÔ‚¿ıÔ˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘, ÛÙÔÓ ÂÏ¿¯ÈÛÙÔ‚ËÌ·ÙÔ‰ÔÙÈÎfi Ô˘‰fi Î·È ÛÙÔ ‡„Ô˜ ÙÔ˘ ÊÏ‚ÔÎÔÌ‚È-ÎÔ‡ ÔÈÛÔÊ¿ÁÂÈÔ˘ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂٷ͇ ÙˆÓ ÓÂ-ÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È ·˘ÙÒÓ Ì ·Ó·-ÙÔÌÈο Ê˘ÛÈÔÏÔÁÈ΋ ηډȿ, 2) ÙÔ È‰·ÓÈÎfi ‚¿ıÔ˜ ÂÈ-Û·ÁˆÁ‹˜ ÙÔ˘ ηıÂÙ‹Ú· ÌÔÚ› Ó· ÂÎÙÈÌËı› ηٿ ·-ÚÈÔ ÏfiÁÔ ·fi ÙË ı¤ÛË ÛÙËÓ ÔÔ›· ηٷÁÚ¿ÊÂÙ·È ÙÔ̤ÁÈÛÙÔ ‡„Ô˜ ÙÔ˘ ÎÔÏÈÎÔ‡ ËÏÂÎÙÚÔÁÚ¿ÌÌ·ÙÔ˜ η-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ Î·È ÏÈÁfi-ÙÂÚÔ ·fi ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, 3) Ô ÂÏ¿¯ÈÛÙÔ˜ ‰È-ÔÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜ ·Ú·ÙËÚÂ›Ù·È Û·fiÛÙ·ÛË 0,5 ÂηÙÔÛÙ¿ Âη٤ڈıÂÓ Ù˘ ı¤Û˘ ÙÔ˘Ì¤ÁÈÛÙÔ˘ ÔÈÛÔÊ¿ÁÂÈÔ˘ ÎÔÏÈÎÔ‡ ¿ÚÌ·ÙÔ˜ (mean±SD: 12,93±1,01 cm) Î·È 4) Ô Ù·¯‡˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù˘ ı¤Û˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÂÏ¿¯ÈÛÙÔ˘ ‚ËÌ·ÙÔ-‰ÔÙÈÎÔ‡ Ô˘‰Ô‡ ı· ÂÏ·ÙÙÒÛÂÈ ‰Ú·ÛÙÈο ÙÔ ¯ÚfiÓÔ Ù˘ÌÂϤÙ˘, ı· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘‚ËÌ·ÙÔ‰fiÙËÛ˘ Î·È ı· ÂÚÈÔÚ›ÛÂÈ ÙȘ fiÔȘ Èı·-Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (ÔÈÛıÔÛÙÂÚÓÈÎfi˜ fi-ÓÔ˜-η‡ÛÔ˜).

¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308 OÈÛÔÊ¿ÁÂÈÔ˜ ‚ËÌ·ÙÔ‰ÔÙÈÎfi˜ Ô˘‰fi˜

307

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:302-308 A. M·ÚÁÂÙ¿Î˘ Î·È Û˘Ó.

308

BÈ‚ÏÈÔÁÚ·Ê›·

1. Benson W Jr: Transesophageal electrocardiography andcardiac pacing:state of art. Circulation 1987;75(SupplIII):86-90.

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

3. Sterz H, Prager H, Koller H. Transesophageal rapidstimulation of the left atrium in atrial tachycardia. Z Kardiol1978:67:136-138.

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

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

6. Benson DW Jr, Dunnlgan A, Sterba R, Bend}U DG. Atrialpacing from the esophagus in diagnosis andmanagement of tachycardia and palpitations. J Pediatr1983;102:40-46.

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

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

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

10. McNally EM, Meyer EC, Langendorf R. Electivecountershock in unanesthetized patients with use of anesophageal electrode. Circulation 33:124, 1966.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-02-2000HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000

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

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313

309

EÈÛ·ÁˆÁ‹H Û˘¯ÓfiÙËÙ· ÙˆÓ Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙȘ

MÔÓ¿‰Â˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ (MENN)¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌÂ Û˘-¯ÓfiÙÂÚ˜ ÙȘ ÏÔÈÌÒÍÂȘ ·fi Candida albicans (1,2).T· ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ηÓÙÈÓÙ›·Û˘ ÛÙ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó·Ô‰Ôı› ÛÙËÓ Î·ı˘ÛÙ¤ÚËÛË Ù˘ ‰È¿ÁÓˆÛ˘ ·ÏÏ¿

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

H ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È ¤Ó· Úfi-ÛÊ·Ù· ·Ó·ÁÓˆÚÈṲ̂ÓÔ ¤Ó˙˘ÌÔ Ô˘ ·Ó‹ÎÂÈ, Ì ‚¿ÛË

E›Â‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ‰‡Ô ÓÂÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈ΋Ïԛ̈ÍË ·fi Candida albicans

Iˆ¿ÓÓ˘ §·Ì·‰·Ú›‰Ë˜1, E˘·ÁÁÂÏ›· ¢ËÌËÙÚ›Ô˘2, M¿Úı· £ÂÔ‰ˆÚ¿ÎË1, AÛÛÂÌ X›˙·1,M·ÚÈ¿ÓÓ· ™·‚‚¿Ï·3, EϤÓË MȯÂϷοÎË2

1 NÂÔÁÓÔÏÔÁÈÎfi TÌ‹Ì· ¶°N N›Î·È·˜, ¶ÂÈÚ·È¿˜2 ¢/ÓÛË EÓ˙˘ÌÔÏÔÁ›·˜ Î·È K˘ÙÙ·ÚÈ΋˜ §ÂÈÙÔ˘ÚÁ›·˜, IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, Aı‹Ó·3 MÈÎÚÔ‚ÈÔÏÔÁÈÎfi TÌ‹Ì· ¶°N N›Î·È·˜, ¶ÂÈÚ·È¿˜

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

§¤ÍÂȘ ÎÏÂȉȿ: Candida albicans, ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË.

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

Key words: Candida albicans, chitotriosidase.

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ÙËÓ ÔÌÔÏÔÁ›· ÛÙËÓ ·ÏÏËÏÔ˘¯›· ·ÌÈÓÔͤˆÓ, ÛÙË ÌÂ-Á¿ÏË ÔÈÎÔÁ¤ÓÂÈ· 18 ÙˆÓ ÁÏ˘ÎÔ˙˘ÏÔ-˘‰ÚÔÏ·ÛÒÓ (4).™ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·˘Ù‹ ·Ó‹ÎÔ˘Ó ÔÏϤ˜ ÔÌÔÂȉ›˜ ˆ˜ÚÔ˜ ÙË ‰ÔÌ‹ ÙÔ˘˜ ÚˆÙ½Ó˜ Ô˘ ·Ó¢ڛÛÎÔÓÙ·ÈÛ ¤Ó· Â˘Ú‡Ù·ÙÔ Ê¿ÛÌ· ÔÚÁ·ÓÈÛÌÒÓ (.¯. ‚·ÎÙ‹-ÚÈ·, ̇ÎËÙ˜, Ê˘Ù¿, ¤ÓÙÔÌ·, ıËÏ·ÛÙÈο Î.·.) ηÈÔ˘ ‰È·Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· η-Ù·Ï‡Ô˘Ó ÙË ‰È¿Û·ÛË Ù˘ ¯ÈÙ›Ó˘ (5,6). H ·ÓıÚÒÈ-ÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Â›Ó·È Ë ÌÔÓ·‰È΋ ̤¯ÚÈ ÙÒÚ·ÚˆÙÂ˚ÓË ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜ Ì·ԉ‰ÂÈÁ̤ÓË ¯ÈÙÈÓÔÏ˘ÙÈ΋ ‰Ú¿ÛË, Â›Ó·È ‰ËÏ·‰‹Ì›· ¯ÈÙÈÓ¿ÛË (7,8). ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙȘ ‚ÈÔÏÔÁÈΤ˜ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ ¯ÈÙÈÓ·ÛÒÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·ÈË ¿Ì˘Ó· ¤Ó·ÓÙÈ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Ô˘ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓË, fiˆ˜ Â›Ó·È ÔÈ Ì‡ÎËÙ˜ (9), ÛÙËÓ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹Û·Ì ÙË Û˘ÌÂÚÈÊÔÚ¿Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ Û ÓÂÔÁÓ¿ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ Ì˘-ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË ÔÊÂÈÏfiÌÂÓË Û Candidaalbicans. M¤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜, Ô˘ ·ÔÙÂÏ› ÙËÓÚÒÙË ‰ÈÂıÓÒ˜ ÌÂϤÙË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Ù˘ ¯ÈÙÔ-ÙÚÈÔ˙ȉ¿Û˘ ÛÂ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÛÙÔÓ ¿Ó-ıÚˆÔ, ‰ËÌÔÛȇıËΠÛÙÔÓ ‰ÈÂıÓ‹ Ù‡Ô (10).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈAÛıÂÓ‹˜ A: ¶ÚfiÎÂÈÙ·È ÁÈ· ¿ÚÚÂÓ ÓÂÔÁÓfi Ô˘

ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3870 gÌÂÙ¿ ·fi ÂÚÁÒ‰Ë ÙÔÎÂÙfi. NÔÛËχıËΠÛÙËMENN, ÏfiÁˆ ÂÚÈÁÂÓÓËÙÈ΋˜ ·ÛÊ˘Í›·˜ - ÂÈÛÚfiÊË-Û˘ Ì˘ÎˆÓ›Ô˘, Î·È ¯ÚÂÈ¿ÛıËΠÌ˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈ-ÍË Ù˘ ·Ó·ÓÔ‹˜. TÔ ÓÂÔÁÓfi Û ËÏÈΛ· 24 ËÌÂÚÒÓÂÍ‹Ïı ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·-ÛË. ¢¤Î· Ë̤Ú˜ ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ÂÈÛ‹¯ıË ÂÎ Ó¤-Ô˘ ÏfiÁˆ ¿ÚÓËÛ˘ Ï‹„˘ ÙÚÔÊ‹˜, ˘ÚÂÙÔ‡ Î·È Â˘Â-ÚÂıÈÛÙfiÙËÙ·˜. §ÂÙÔÌÂÚ‹˜ ÂÚÈÁÚ·Ê‹ ÙÔ˘ ÎÏÈÓÈÎÔ‡ÈÛÙÔÚÈÎÔ‡ ¤ÁÈÓ ÛÙÔ ¢ÂÏÙ›Ô Ù˘ A' ¶·È‰È·ÙÚÈ΋˜ KÏÈ-ÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ (11). H ¯ÈÙÔÙÚÈÔ˙È-‰¿ÛË ÌÂÙÚ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ Û ‰Â›ÁÌ· Ï¿-ÛÌ·ÙÔ˜ ÙË 15Ë Ë̤ڷ Ù˘ ‰Â‡ÙÂÚ˘ ÓÔÛËÏ›·˜fiÙ·Ó ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ‹Ù·Ó ıÂÙÈ-Τ˜ ÁÈ· Candida albicans. MÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó Â›Û˘Û ‰È·‰Ô¯Èο ‰Â›ÁÌ·Ù· Ï¿ÛÌ·ÙÔ˜ Î·È Ô‡ÚˆÓ (II-V)(¶›Ó·Î·˜ 1) Ô˘ ÂÏ‹ÊıËÛ·Ó ÛÙË Û˘Ó¤¯ÂÈ· ·Ó¿Â‚‰ÔÌ¿‰· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜. ™ÙÔ Ù¤-ÏÔ˜ Ù˘ ·Ú·¿Óˆ ¯ÚÔÓÈ΋˜ ÂÚÈfi‰Ô˘ ÔÈ Î·ÏÏȤÚ-ÁÂȘ ÙÚÈÒÓ ‰È·‰Ô¯ÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ Ô‡ÚˆÓ ‹Ù·ÓÛÙ›Ú˜.

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

ıËÎÂ, ÛÙ·ıÂÚÔÔÈ‹ıËÎÂ Î·È ÌÂٷʤÚıËΠÛÙË MÔ-Ó¿‰· Ì·˜ ÙË 2Ë ÒÚ· ˙ˆ‹˜. AÚ¯Èο ÙÔ ÓÂÔÁÓfi ·-ÚÔ˘Û›·Û ¤ÓÙÔÓÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤-ÚÂÈ·˜, ̋Π۠Ì˯·ÓÈ΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈ-ÍË, ÙÔ˘ ¯ÔÚËÁ‹ıËÎ·Ó ÙÚÂȘ ‰fiÛÂȘ Â͈ÁÂÓÔ‡˜ ÂÈ-Ê·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (surfactant), ÓÙÔ·Ì›-ÓË ÂÓÒ ·Ú¿ÏÏËÏ· ¯ÔÚËÁ‹ıËΠ·ÌÈÎÈÏÏ›ÓË Î·È ÓÂ-ÙÈÏÌÈΛÓË.

TÔÔıÂÙ‹ıËΠ·ÚÙËÚÈ·Îfi˜ ÔÌÊ·ÏÈÎfi˜ ηıÂÙ‹-Ú·˜ Î·È ÂÚÈÊÂÚÈ΋ ÁÚ·ÌÌ‹. EÌÊ¿ÓÈÛ ÛËÌ·ÓÙÈÎfi ·È-ÌÔ‰˘Ó·ÌÈÎfi ‚ÔÙ¿ÏÂÈÔ Î·È ÙÔ˘ ¯ÔÚËÁ‹ıËÎ·Ó ·Ú¯ÈοÊÔ˘ÚÔÛÂÌ›‰Ë Î·È ‰ÈÁÔÍ›ÓË Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÈÓ‰ÔÌÂ-ı·Î›ÓË.

TËÓ 11Ë Ë̤ڷ ˙ˆ‹˜ ÂÓÒ ‹Ù·Ó ·ÎfiÌË Û Ì˯·ÓÈ-΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË, ·ÚÔ˘Û›·Û Âȉ›-ÓˆÛË Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ïԛ̈͢ (§Â˘Î¿=5140mm3, AÈÌÔÂÙ¿ÏÈ·=6000 mm3, CRP=314 mg/L) ηÈÙÚÔÔÔÈ‹ıËΠÙÔ Û¯‹Ì· Ù˘ ·ÓÙÈ‚›ˆÛ˘ Û ·ÌÈη-Û›ÓË Î·È ÙÂ˚ÎÔÏ·Ó›ÓË ÁÈ· ÙËÓ Î¿Ï˘„Ë ÙˆÓ gram (-)Î·È ÁÈ· ÙÔ ÂӉ¯fiÌÂÓÔ Ïԛ̈͢ ·fi ÂȉÂÚÌÈÎfiÛÙ·Ê˘ÏfiÎÔÎÎÔ ·ÓÙ›ÛÙÔȯ·. YÔÛÙËÚ›¯ıËΠ·ÎfiÌËÌ ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ (Sandaglobulin) ηÈÊÚ¤ÛÎÔ˘ ηÙ„˘Á̤ÓÔ˘ Ï¿ÛÌ·ÙÔ˜. ¶·Ú¿ ÙËÓ ·Áˆ-Á‹ ÙÔ ÓÂÔÁÓfi η٤ÏËÍ Ì ÂÈÎfiÓ· ÛËÙÈÎÔ‡ shock ÙË13Ë Ë̤ڷ ˙ˆ‹˜.

™ÙȘ ηÏÏȤÚÁÂȘ (Ï‹„Ë 11Ë Ë̤ڷ) ·›Ì·ÙÔ˜,ÙÚ·¯ÂÈÔۈϋӷ Î·È ÔÌÊ·ÏÈÎÔ‡ ηıÂÙ‹Ú· ·Ó·Ù‡-¯ıËΠCandida albicans. T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‚¤-‚·È· Ù· Ï¿‚·Ì ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ÓÂÔÁÓÔ‡, ÁÈ' ·˘-Ùfi Î·È ‰ÂÓ ¯ÔÚËÁ‹ıËΠ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹.

MÂÙÚ‹ÛÂȘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ¤ÁÈÓ·Ó Û ‰Â›ÁÌ·Ù··›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Ô˘ ÂÏ‹ÊıËÛ·Ó ÙËÓ 1Ë, 7Ë Î·È ÙË13Ë Ë̤ڷ ˙ˆ‹˜.

H ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÌÂÙÚ‹ıËΠ̠ÙÔ ÊıÔÚ›˙ÔÓ˘fiÛÙڈ̷ ÌÂı˘ÏÔ˘ÌÂÏÏÈÊÂÚ‡Ï-‚-D-NN’N’’-ÙÚÈ·-ÎÂÙ˘ÏÔÙÚÈfi˙Ë ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ÙˆÓ ·ÛıÂ-ÓÒÓ Û‡Ìʈӷ Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Hollak Î·È Û˘Ó.(12). TËÓ ·Ó¿ ‚‰ÔÌ¿‰· Ï‹„Ë ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÙËÓÂÈϤͷÌÂ Û·Ó ¤Ó· ÏÔÁÈÎfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·-ÎÔÏÔ‡ıËÛ˘ Ù˘ ÔÚ›·˜ Ù˘ Ïԛ̈͢ Î·È Ù˘·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ›· ÌÈ· Î·È Â›Ó·È Ë ÚÒÙËÌÂϤÙË Ô˘ Á›ÓÂÙ·È ‰ÈÂıÓÒ˜ ¿Óˆ ÛÙÔ ı¤Ì· ·˘Ùfi.¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ˘¿Ú-¯Ô˘Ó ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ ÁÈ· Ù· ›‰· Ù˘ ¯ÈÙÔÙÚÈÔ-˙ȉ¿Û˘ Û ÓÂÔÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó 10 ÓÂÔÁÓ¿ ·ÓÙ›-ÛÙÔȯ˘ ËÏÈΛ·˜ ˆ˜ Ì¿ÚÙ˘Ú˜.

AÔÙÂϤÛÌ·Ù· ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ·˘ÍË̤ӷ ›-

‰· ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘, Û ۇÁÎÚÈÛË ÌÂ Ê˘ÛÈÔÏÔÁÈοÓÂÔÁÓ¿ Ù˘ ›‰È·˜ ËÏÈΛ·˜, ‚Ú¤ıËÎ·Ó ÛÙ· ·Ú¯Èο ‰Â›Á-Ì·Ù· Î·È È‰È·›ÙÂÚ· ÛÙ· Ô‡Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜ A. ™ÙˉȿÚÎÂÈ· Ù˘ ıÂڷ›·˜ Ù· ›‰· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈ-ÒıËÎ·Ó ÙfiÛÔ ÛÙÔ Ï¿ÛÌ· fiÛ· Î·È ÛÙ· Ô‡Ú·.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313 π. §·Ì·‰·Ú›‰Ë˜ Î·È Û˘Ó.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313 ∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Û Ïԛ̈ÍË Candida albicans

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

AÓÙ›ıÂÙ· ÛÙÔÓ ·ÛıÂÓ‹ B, ÛÙ· ·Ú¯Èο ‰Â›ÁÌ·Ù·,Ù· ›‰· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‹Ù·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·(¶›Ó·Î·˜ 1). A‡ÍËÛË ·Ú·ÙËÚ‹ıËΠÛÙÔ 2Ô ‰Â›ÁÌ·,Ì ÙË Ï‹„Ë ÙÔ˘ ÔÔ›Ô˘ ÙÔ ÓÂÔÁÓfi ·Ó¤Ù˘Í ÎÏÈÓÈ΋ÂÈÎfiÓ· Î·È ‰Â›ÎÙ˜ Ïԛ̈͢, Ô˘ fiˆ˜ ·Ô‰Â›¯ıË-Π۠ηÏÏȤÚÁÂȘ Ô˘ ÂÏ‹ÊıËÛ·Ó ÙËÓ ›‰È· ¯ÚÔÓÈ-΋ ÛÙÈÁÌ‹, ÔÊ›ÏÂÙÔ Û Candida albicans. ¶ÂÚ·ÈÙ¤-Úˆ ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ·-Ú·ÙËÚ‹ıËΠÛÙÔ 3Ô ‰Â›ÁÌ· Ô˘ ÂÏ‹ÊıË ÙË 13Ë Ë̤-Ú· ˙ˆ‹˜.

™˘˙‹ÙËÛËH ¯ÈÙ›ÓË Â›Ó·È ¤Ó· ÁÚ·ÌÌÈÎfi ÔÏ˘ÌÂÚ¤˜, ·ÔÙÂ-

ÏÔ‡ÌÂÓÔ ·fi ÌÔÓ¿‰Â˜ N-·ÎÂÙ˘ÏÔ-ÁÏ˘ÎÔ˙·Ì›ÓË˜Û˘Ó‰Â‰Â̤Ó˜ Ì ‚-1,4 ‰ÂÛÌÔ‡˜. E›Ó·È ·fi Ù· Ϥ-ÔÓ ‰È·‰Â‰Ô̤ӷ ÔÏ˘ÌÂÚ‹ ÛÙË Ê‡ÛË Î·È ·ÔÙÂÏ›‰ÔÌÈÎfi ˘ÏÈÎfi ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÙÔȯˆÌ¿ÙˆÓ ÔÏÏÒÓÔÚÁ·ÓÈÛÌÒÓ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ Ì˘Î‹-ÙˆÓ (13). H ·ÔÈÎÔ‰fiÌËÛ‹ Ù˘ Á›ÓÂÙ·È Ì ÙË ‰Ú¿Ûˢ‰ÚÔÏ·ÛÒÓ ÛÙȘ Ôԛ˜ Û˘ÁηٷϤÁÂÙ·È Î·È Ë ÔÌ¿-‰· ÙˆÓ ¯ÈÙÈÓ·ÛÒÓ, ÂÓ˙‡ÌˆÓ Ô˘ ¤¯Ô˘Ó ·Ó¢ÚÂı›ÙfiÛÔ Û ÔÚÁ·ÓÈÛÌÔ‡˜ Î·È Â›‰Ë Ô˘ ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓËfiÛÔ Î·È Û ¿ÏÏÔ˘˜ Ô˘ ‰ÂÓ ÙËÓ ÂÚȤ¯Ô˘Ó (9,14,15).™Â ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·Ó‹ÎÂÈ Î·È Ë ÚfiÛÊ·Ù· ·Ó·ÁÓˆ-ÚÈṲ̂ÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË ÙÔ˘ ·ÓıÚÒÔ˘. OÈ ‚ÈÔÏÔÁÈ-Τ˜ ‰Ú¿ÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ô‰Ôı› ÛÙȘ ¯ÈÙÈÓ¿Û˜¤¯Ô˘Ó Û¯¤ÛË Ì ÙË ÌÔÚÊÔÁ¤ÓÂÛË, ÙË ıÚ¤„Ë ÙˆÓ ÔÚ-

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

O ‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ Ù˘ ·ÓıÚÒÈÓ˘ ¯ÈÙÔÙÚÈÔ˙È-‰¿Û˘ ‰ÈÂÚÂ˘Ó¿Ù·È. Y¿Ú¯Ô˘Ó fï˜ ÔÏÏ¿ ÛÙÔȯ›·Ô˘ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë ˆ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÌÂ-Ù¤¯ÂÈ ÛÙËÓ ¿Ì˘Ó· ¤Ó·ÓÙÈ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈ-ÛÌÒÓ, fiˆ˜ ÔÈ Ì‡ÎËÙ˜, Ô˘ ÂÚȤ¯Ô˘Ó ¯ÈÙ›ÓË.

T· Ì·ÎÚÔÊ¿Á· Ô˘ ·ÔÙÂÏÔ‡Ó ¤Ó·Ó ·fi ÙÔ˘˜ÚÒÙÔ˘˜ Î·È Î˘ÚÈfiÙÂÚÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ¿Ì˘Ó·˜¤Ó·ÓÙÈ ÙˆÓ Ì˘Î‹ÙˆÓ (19), Â›Ó·È Û˘Á¯ÚfiÓˆ˜ Ë Î‡ÚÈ·ËÁ‹ ¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘, Ë ÔÔ›· ›Ù ·ÂÎÎÚ›ÓÂÙ·ÈÂÍˆÎ˘ÙÙ·ÚÈο ›Ù ԉËÁÂ›Ù·È ÛÙ· Ï˘ÛÈۈ̿ÙÈ· ÙԢ΢ÙÙ¿ÚÔ˘. XÈÙÈÓÔÏ˘ÙÈ΋ ‰Ú¿ÛË ¤¯Ô˘Ó Î·È ÔÈ ‰‡ÔÌÔÚʤ˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ‰È·Ê¤ÚÔ˘Ó fï˜ ˆ˜ ÚÔ˜ÙÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙËÓ ÈηÓfiÙËÙ· ÚfiÛ‰Â-Û˘ ¯ÈÙ›Ó˘. ŒÙÛÈ ÌfiÓÔ Ë ÂÍˆÎ˘ÙÙ·ÚÈο ¢ÚÈÛÎfiÌÂ-ÓË ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Ì ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 50kDa, ¤Ó·ÓÙÈ39kDa ÙÔ˘ ÂÓ‰ÔÏ˘ÛÈÛˆÌÈ·ÎÔ‡ ÂÓ˙‡ÌÔ˘, ÂÚȤ¯ÂÈÌ›· ·ÏÏËÏÔ˘¯›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 49 ·ÌÈÓÔͤˆÓ ÛÙÔ ·Ó-ıÚ·ÎÈÎfi ¿ÎÚÔ Ù˘ Ô˘ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓÚfiÛ‰ÂÛË Ù˘ ¯ÈÙ›Ó˘ (12,20). A˘ÍË̤ÓË ·Ú·ÁˆÁ‹¯ÈÙÔÙÚÈÔ˙ȉ¿Û˘ ·fi Ù· Ì·ÎÚÔÊ¿Á· ¤¯ÂÈ ·Ú·ÙË-ÚËı› ÛÙË ÓfiÛÔ Gaucher (11), ÛÙȘ ·ıËÚÔÌ·ÙÈΤ˜Ï¿Î˜ (21) Î·È ÈÔ ÚfiÛÊ·Ù· Û ÈÓ‰Èο ¯ÔÈÚ›‰È·Ô˘ ›¯·Ó ÌÔÏ˘Óı› Ì AÛ¤ÚÁÈÏÏÔ (Aspergillusfumigatus) (22).

EÈϤÔÓ, ÂÒ·ÛË ÌÔÓÔ·ÙÙ·ÚˆÓ ÌÔÚÊÒÓCandida albicans Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ 50kDa ¤Ó˙˘ÌÔ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ï‡ÛË ÙˆÓ Ì˘Î‹ÙˆÓ Î·È Ë ÂÓ-‰ÔÂÚÈÙÔÓ·˚΋ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ Û ÔÓÙ›ÎÈ· ÌÂ Û˘ÛÙË-Ì·ÙÈ΋ ÌfiÏ˘ÓÛË ·fi Candida albicans ‹ Aspergillus ›-¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ı·̷ÙÈ΋ ·Ó¿ÚÚˆÛ‹ ÙÔ˘˜ (23).

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

XÈÙÚÔÙÚÈÔ˙ȉ¿ÛË

H̤ڷ ¢Â›ÁÌ· ¶Ï¿ÛÌ· O‡Ú· §Â˘Î¿ TKE CRPNÔÛËÏ›·˜ (nmoles/ml/hr) (nmoles/mg /mm3 (mm/1h) (mg/L)

ÎÚ·ÙÈÓ./hr)

AÛıÂÓ‹˜ A 15Ë I 88 - 22670 84 ++22Ë II 105 440 13430 - ++29Ë III 80 67 11000 - 6036Ë IV 57 4 9200 -43Ë V 53 0 -

AÛıÂÓ‹˜ B 1Ë π 40 34 21610 <27Ë ππ 123 808 20200 <2

13Ë πππ - 3275 5140 314

º˘ÛÈÔÏÔÁÈΤ˜ 25-52 0-30 3-9TÈ̤˜ n=10 n=10

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

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

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

Clin Perinatol. 1991;18:263-280.2. Nichols JM, Yuen KY, Tan AYC: Systemic fungal infections

in neonates. Br J Hosp Med 1993;49:420-424.3. Leibovitz E, Luster-Reicher A, Amitai M, Moligner S.

Systemic candidal infections associated with the use ofperipheral venous catheters in neonates: A 9 yearexperience. Clin Infec Dis 1992;14:485-491.

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

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

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

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

7. Den Tandt WR, Scharp S, Overdijk B. Evaluation of thehydrolysis of methylumbelliferyl-tetra-N-acetyl chioto-tetraoside by various glucosidases. A comparative study.Int J Biochem 1993;25:113-119.

8. Overdijk B, van Steijn GJ. Human serum contains achitinase: identification of an enzyme, formerly describedas 4-methylumbelliferyl-tetra-N-acetylchitotetraosidehydrolase (MU-TCACT). Glycobiology 1994;4:797-803.

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

10. Labadaridis J, Dimitriou E, Costalos C, et al. Serialchitotriosidase activity estimations in neonatal systemiccandidiasis. Acta Paediatrica 1998;87:605-606.

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

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

13. Mulisch M. Chitin in protistan organisms. Eur J Protistol1993;29:1-18.

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

15. Gooday GW. Diversity of roles for chitinases in nature. In:Zakaria MB, Nudna WMW, Abdullah MP eds. Chitin andchitosan - the versatile environmentally friendly modernmaterials. Pangi, Penerbit University KebangsaanMalaysia 1995:191-202.

16. Shahabudin M, Kaslow DC. Chitinase: a novel target forblocking parasite transmission? Parasitol Today1993;9:252-258.

17. Schlein Y, Jacobson RL, Shlomai J. Chitinase secreted byLeishmania functions in the sandfly vector. Proc R Soc B1991;245:121-26.

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

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

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

21. Boot RG, van Archterberg TA, van Aken BE, Renkema GH,Jacobs MJ, Aerts JM et al. Strong induction of membersof the chitinase family of proteins in atherosclerosis:Chitotriosidase and human cartilage hp-39 expressed inlesion macrophages. Arterioscler Thromb Vasc Biol1999;19:687-694.

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313 π. §·Ì·‰·Ú›‰Ë˜ Î·È Û˘Ó.

312

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:309-313 ∏ ¯ÈÙÔÙÚÈÔ˙ȉ¿ÛË Û Ïԛ̈ÍË Candida albicans

313

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

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

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

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-03-2000HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢Ú. EϤÓË MȯÂϷοÎËIÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡NÔÛ/ÌÂ›Ô ¶·›‰ˆÓ "H AÁ›· ™ÔÊ›·", Aı‹Ó· 11527

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EÈÛ·ÁˆÁ‹T· ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (A.M.) Â›Ó·È ıÂÙÈÎÔ› η-

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

ÛÙÔÓ ¿ÓıÚˆÔ, ·fi ÙËÓ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÓÒÙÂÚÔ˘·Ó·Ó¢ÛÙÈÎÔ‡ (΢ڛˆ˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÙÔ˘ ÙÚ·¯‹-ÏÔ˘), ̤¯ÚÈ ÙËÓ ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ‰È·ÛÔÚ¿ ÛÂÔÏÏ¿ fiÚÁ·Ó·, Û ¿ÙÔÌ· Ì ·ÓÔÛÔηٷÛÙÔÏ‹. H ÙÂ-ÏÂ˘Ù·›· ‰È·ÈÛÙÒÓÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Úfi-ÛÊ·Ù·, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÚfiÛÊÔÚÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÙÔÔÔ›Ô ·Ó·Ù‡ÛÛÂÙ·È Û ¿ÙÔÌ· Ì AIDS ‹ Û ÂÚÈ-ÙÒÛÂȘ ηٷÛÙÔÏ‹˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜ ·fi ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· (1,2).

¶∞π¢π∞∆ƒπ∫∏ 2000;63:314-318

314

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

¶·Ó·ÁÈÒÙ˘ ™˘Ú›‰Ë˜, EϤÓË M·ÏÙ¤˙Ô˘, ¢ËÌ‹ÙÚÈÔ˜ K·ÊÂÙ˙‹˜

● ¶ÂÚ›ÏË„Ë: ™ÙËÓ ·Ó·‰ÚÔÌÈ΋ ·˘Ù‹ ÌÂϤÙË ÂÍÂÙ¿ÛıËÎ·Ó Ù· ÎÏÈÓÈο Î·È ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ηıÒ˜ Î·È Ë·ÓÙÈÌÂÙÒÈÛË Î·È Ë ¤Î‚·ÛË ·È‰ÈÒÓ Ì Ïԛ̈ÍË ·fi ÕÙ˘· M˘ÎÔ‚·ÎÙËÚ›‰È· (A.M.). MÂÏÂÙ‹ıËÎ·Ó Ù· ÈÛÙÔÚÈο 52 ·È-‰ÈÒÓ ËÏÈΛ·˜ 0-14 ÂÙÒÓ Ù· ÔÔ›· ÓÔÛËχıËÎ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1982-1997 Ì Ïԛ̈ÍË ·fi AM ηٿ ÙÔ ‰Â‡ÙÂÚÔ ‹ÌÈÛ˘ Ù˘ ÌÂϤÙ˘ ‰È·ÁÓÒÛıËÎ·Ó 40 ·ÛıÂÓ›˜ (76,5%). Afi ÙÔ˘˜ 52 ·ÛıÂ-Ó›˜ ÔÈ 47 ›¯·Ó ÂÈÔÏ‹˜ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÙÚÂȘ Ó¢ÌÔÓÈ΋ Î·È ‰‡Ô ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ. TÔ M. Avium ‹Ù·Ó ÙÔ Î·ÙÂÍÔ-¯‹Ó A.M. ÌÂٷ͇ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ. H ÔÚ›· ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ηıÒ˜ Î·È ÙÔ ÙÂÏÈÎfi ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·‹Ù·Ó ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤ÓÔ Ì ÙÔ ¯ÚfiÓÔ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÔηٿÛÙ·Û˘. OÈ ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈ΋ ÓfiÛÔ Â›¯·Ó Ôχ η-Ï‹ ÔÚ›· Ì ÙË ¯ÔÚ‹ÁËÛË 3-4 ·ÓÙÈÊ˘Ì·ÙÈÎÒÓ Ê·Ú̿ΈÓ, ÂÓÒ ÔÈ ‰‡Ô ·ÛıÂÓ›˜ Ì ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ Î·Ù¤ÏËÍ·Ó Ì¤Û·ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ·Ú¿ ÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. ¶·È‰È·ÙÚÈ΋ 2000;63:314-318.

§¤ÍÂȘ ÎÏÂȉȿ: ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ÏÂÌÊ·‰ÂÓ›Ùȉ·, M. Avium.

P. Spyridis, H. Maltezou, D. Kafetzis. Non-tuberculous mycobacterial lymphadenitis in children. Paediatriki2000;63:314-318.● Abstract: A study was made to review the clinical and epidemiological features, management and outcomeassociated with the development of non-tuberculous mycobacterial (NTM) infection in children. The medicalrecords of all children aged 0-14 years with NTM infection diagnosed at the P. and A. Kyriakou Children'sHospital between January 1982 and December 1997 were reviewed. During the study period 52 such childrenwere identified, in 76.5% of whom the diagnosis was made during the second half of the period studied. Ofthe 52 patients, 47 had lymphadenitis, 3 pulmonary and 2 disseminated disease. Mycobacterium aviumcomplex was the predominant isolate in these cases. Satisfactory aesthetic results were achieved when totalexcision of the affected lymph nodes was perfomed within one month of the onset of NTM lymphadenitis. Theoutcome was good for the 3 patients with pulmonary disease, but the 2 patients with the disseminated formdied. In conclusion NTM infection in children is being diagnosed in increasing frequency during the lastdecade. Prompt total excision of the involved lymph nodes is indicated for an optimal outcome.

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

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

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™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÚÈÁÚ·ÊÔ‡Ó Ù· ÎÏÈ-ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, ËıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·ıÒ˜ Î·È Ë ¤Î‚·ÛË ·È-‰ÈÒÓ Ì Ïԛ̈ÍË ·fi A.M.

YÏÈÎfi Î·È Ì¤ıÔ‰Ô˜TÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó ·ÛıÂÓ›˜ ÙÔ˘

NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡", ËÏÈΛ·˜ 0-14 ÂÙÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÁÓÒÛıËΠÏԛ̈ÍË ·fiA.M. ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1982-1997.

™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ·ÛıÂÓ›˜ Ì ·ÔÌfi-ÓˆÛË A.M. Û ηٿÏÏËÏÔ ‰Â›ÁÌ· ·fi ÙÔ ÓÔÛÔ‡Ó Û‡-ÛÙËÌ· ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ· Û ˘ÏÈÎfi Lowenstein-Jensen ‹ Ì ÙË Ú·‰ÈÔÌÂÙÚÈ΋ ̤ıÔ‰Ô BACTEC. ™ÙȘÂÚÈÙÒÛÂȘ fiÔ˘ ‰ÂÓ ·ÔÌÔÓÒıËΠA.M., Ë ‰È¿ÁÓˆ-ÛË Ù˘ Ïԛ̈͢ ·fi A.M. ÛÙËÚ›¯ıËΠÛÙËÓ ÈÛÙÔÏÔ-ÁÈ΋ ÂÈÎfiÓ· Ë ÔÔ›· ‹Ù·Ó Û˘Ì‚·Ù‹ Ì Ïԛ̈ÍË ·fiÌ˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ì ٷ˘Ùfi¯ÚÔÓË ¤ÏÏÂÈ„Ë Â·Ê‹˜ ÌÂÂÓ‹ÏÈη Ê˘Ì·ÙÈÎfi, ·ÚÓËÙÈ΋ ‹ ·ÌÊ›‚ÔÏË Ê˘Ì·ÙÈÓÔ·-ÓÙ›‰Ú·ÛË Mantoux, ·Ô˘Û›· ÚfiÛÊ·ÙÔ˘ ÂÌ‚ÔÏÈ·-ÛÌÔ‡ Ì BCG, Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·-η. T· ·ÓˆÙ¤Úˆ Ô‰ËÁÔ‡Ó Ì ·ÚÎÂÙ‹ ·ÛÊ¿ÏÂÈ· ÛÙˉȿÁÓˆÛË Ïԛ̈͢ ·fi A.M.

AÔÙÂϤÛÌ·Ù·K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ηٷÁÚ¿ÊËÎ·Ó Û˘-

ÓÔÏÈο 52 ·È‰È¿ (26 ·ÁfiÚÈ·) Ì Ïԛ̈ÍË ·fi A.M. OÈÂÈ̤ÚÔ˘˜ ‰È·ÁÓÒÛÂȘ ÂÚÈÂÏ¿Ì‚·Ó·Ó: ÂÈÔÏ‹˜ÏÂÌÊ·‰ÂÓ›Ùȉ· (47 ·È‰È¿), Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ (3 ·È-‰È¿), Î·È ‰È¿¯˘ÙË Ïԛ̈ÍË (2 ·È‰È¿). ™˘ÓÔÏÈο, 12·È‰È¿ (23%) ‰È·ÁÓÒÛıËÎ·Ó ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1982-89 Î·È Ù· ˘fiÏÔÈ· 40 (77%) ÛÙÔ ‰Â‡ÙÂÚÔ ‹ÌÈÛ˘ Ù˘ÌÂϤÙ˘, 1991-1997 (∂ÈÎfiÓ· 1). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙËÓÂԯȷ΋ ηٷÓÔÌ‹, ÙÔ 41% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ¿ÓÈÛÂÙ· ÚÒÙ· ÛËÌ›· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ηٿÙËÓ ÕÓÔÈÍË. Afi ÙÔ ÈÛÙÔÚÈÎfi ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ÚÔ-·ÙÔ˘Ó ·ÛÊ·Ï‹ ÛÙÔȯ›· ÁÈ· ÙËÓ ËÁ‹ ÌfiÏ˘ÓÛ˘ ÛÂ

Â›Â‰Ô ÔÈÎÔÁ¤ÓÂÈ·˜, ¤ÎıÂÛË Û ˙Ò·, ‰È·ÈÙËÙÈΤ˜ Û˘-Ó‹ıÂȘ ‹ Ù·Í›‰È· Û ÂÚÈÔ¯¤˜ ÂÓ‰ËÌÈΤ˜ ÁÈ· A.M.

H ̤ÛË ËÏÈΛ· ÙˆÓ 47 ·ÛıÂÓÒÓ Ì ÂÈÔÏ‹˜ ÏÂÌ-Ê·‰ÂÓ›Ùȉ· ·fi A.M. ‹Ù·Ó Ù· 3 ¤ÙË (4 Ì‹Ó˜ - 10 ¤ÙË).H ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‰È·ÈÛÙÒıËΠηٿ ̤-ÛÔÓ fiÚÔ 30 Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔ-ÛÔÎÔÌÂ›Ô (1 Ë̤ڷ - 2 ¯ÚfiÓÈ·). £ÂÚÌÔÎÚ·Û›· 38o-38,5oC ‰È·ÈÛÙÒıËΠ۠٤ÛÛÂÚȘ ·ÛıÂÓ›˜ ηٿ ÙËÓ¤Ó·ÚÍË Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‹ Ï›ÁÔ ·Ú-ÁfiÙÂÚ· (1Ë-12Ë Ë̤ڷ). EÌÂÈÚÈ΋ ıÂڷ›·, ΢ڛˆ˜Ì ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈο ·ÓÙÈ‚ÈÔÙÈο, ¤Ï·‚·Ó 20/47·ÛıÂÓ›˜ (43%), ¯ˆÚ›˜ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË, ÂÓÒ ÌÂÙËÓ ˘Ô„›· Ïԛ̈͢ ·fi M. Ê˘Ì·Ù›ˆÛ˘ 9/47·ÛıÂÓ›˜ (19%) ¤Ï·‚·Ó ·fi ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·-ÙÚÔ‡˜ ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹. ∏ ·ÁˆÁ‹ ÂÚÈÂÏ¿Ì‚·ÓÂÈÛÔÓÈ·˙›‰Ë Î·È ÚÈÊ·ÌÈΛÓË, ¯ˆÚ›˜ ˘Ô¯ÒÚËÛË Ù˘ÏÂÌÊ·‰ÂÓÈ΋˜ ‰ÈfiÁΈÛ˘. H ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹¯ÔÚËÁ‹ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·fi 12 Ë̤Ú˜¤ˆ˜ 12 Ì‹Ó˜ Ì ̤ÛË ‰È¿ÚÎÂÈ· 60 Ë̤Ú˜ ÚÈÓ ·fiÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô.

ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi A.M.‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù·‹ ÎÏÈÓÈο Â˘Ú‹Ì·Ù·. T· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓÏÂÌÊ·‰¤ÓˆÓ ηٿ ÙËÓ ÚÔۤϢÛË ÛÙÔ ÓÔÛÔÎÔÌ›Ô,ÂÚȤ¯ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1, ÂÓÒ Ë ·Ó·ÙÔÌÈ΋ ı¤ÛËÛÙÔÓ ›Ó·Î· 2. TÔ Ì¤ÛÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ‹Ù·Ó 3x3 cm (1,5x1,5 ¤ˆ˜ 5x8 cm). ¢ÂÓ ‰È·ÈÛÙÒıË-Π‰ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ Û ¿ÏÏË ı¤ÛË ÏËÓ Ù˘·Ú¯È΋˜ ÚÔÛ‚ÔÏ‹˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Â-ÚÈÂÏ¿Ì‚·Ó ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜, C-·ÓÙȉÚÒÛ·ÚˆÙ½ÓË, TKE, ¤ÏÂÁ¯Ô Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηÈÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· ÈÔ‡˜, Bartonella henselae

¶∞π¢π∞∆ƒπ∫∏ 2000;63:314-318 §ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·

315

¶›Ó·Î·˜ 1. KÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÚÔÛ‚Â-‚ÏËÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ (NÔ, %).

™ÎÏËÚfi˜ - ÎÈÓËÙfi˜ 21 (45)K·ıËψ̤ÓÔ˜ 13 (28)M·Ï·Îfi˜ (Z˘Ì҉˘) 12 (26)EÚ˘ıÚfiÙËÙ· 11 (23)KÏ˘‰·ÛÌfi˜ 5 (11)£ÂÚÌfi˜ 2 (4)™˘Ú›ÁÁÈÔ 3 (6)¶ÔÏÏ·Ï‹ ·˘ÙfiÌ·ÙË Ú‹ÍË 1 (2)

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

YÔÁÓ¿ıÈÔÈ 24 (51)¶ÚfiÛıÈÔÈ ÙÚ·¯ËÏÈÎÔ› 15 (32)¶ÚÔˆÙÈ·›ÔÈ 4 (9)BÔ˘‚ˆÓÈÎÔ› 2 (4)O›ÛıÈÔÈ ÙÚ·¯ËÏÈÎÔ› 1 (2)M·Û¯·ÏÈ·›ÔÈ 1 (2)

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

7

6

5

4

3

2

1

0

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

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Î·È Toxoplasma gondii Î·È ‹Ù·Ó ·ÚÓËÙÈÎfi˜.ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi A.M.

˘Ô‚Ï‹ıËÎ·Ó ÛÂ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË ÌÂ Ê˘Ì·Ù›ÓËLot 5180A πÓÛÙÈÙÔ‡ÙÔ˘ Pasteur-Merieux. TÔ Ì¤ÁÂıÔ˜Ù˘ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·Û˘ Î˘Ì¿ÓıËΠ·fi 0-15 ¯ÈÏ.Ì ̤ÛË ÙÈÌ‹ Ù· 7 ¯ÈÏ. H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈ΋ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ.

OÈ ·ÛıÂÓ›˜ Ì ÏÂÌÊ·‰ÂÓ›Ùȉ· ˘Ô‚Ï‹ıËÎ·Ó Û¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó ÔÏÈ΋·Ê·›ÚÂÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Û 40 ·ÛıÂÓ›˜, ·ÚÔ-¯¤Ù¢ÛË ·ÔÛÙËÌ·ÙÔÔÈËı¤ÓÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Û¤ÓÙ ·ÛıÂÓ›˜ Î·È Î·ı·ÚÈÛÌfi Î·È Ó·ÚÔÔ›ËÛË Â›·˘ÙfiÌ·Ù˘ ڋ͢ ‹ ·Ó¿Ù˘Í˘ Û˘ÚÈÁÁ›Ô˘, Û ‰‡Ô.H ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠηٿ̤ÛÔ fiÚÔ Û 36 Ë̤Ú˜ ·fi ÙËÓ ·Ú¯È΋ ÂÌÊ¿ÓÈÛËÙ˘ ‰ÈfiÁΈÛ˘ (6 Ë̤Ú˜ - 2 ¯ÚfiÓÈ·). IÛÙÔÏÔÁÈ΋ÂͤٷÛË ˘ÏÈÎÔ‡ ÏÂÌÊ·‰¤ÓÔ˜ ¤ÁÈÓ Û 42 ·fi ÙÔ˘˜47 ¯ÂÈÚÔ˘ÚÁËı¤ÓÙ˜ ·ÛıÂÓ›˜, fiÔ˘ ¢ڤıËÛ·Ó ·Ï-ÏÔÈÒÛÂȘ ¯ÚfiÓÈ·˜ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÊÏÂÁÌÔÓ‹˜ ηÈÓÂÎÚÒÛÂȘ Û˘Ì‚·Ù¤˜ Ì Ïԛ̈ÍË ·fi Ì˘ÎÔ‚·ÎÙËÚ›-

‰È·. K·ÏÏȤÚÁÂÈ· ÁÈ· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ¤ÁÈÓ Û 45·ÛıÂÓ›˜ Î·È ·¤‚Ë ıÂÙÈ΋ Û 40. AÔÌÔÓÒıËΠM.Avium complex Û 33 ·ÛıÂÓ›˜ Î·È M. Kansasii ÛÂÙÚÂȘ. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 4 ·ÛıÂÓ›˜ ‰ÂÓ Ù˘ÔÔÈ‹-ıËΠÙÔ ¿Ù˘Ô Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ. H ‰È¿ÁÓˆÛË Ù˘ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·Ô‰Â›-¯ıËΠÌÈÎÚÔ‚ÈÔÏÔÁÈο Û 40 ·ÛıÂÓ›˜ ÂÓÒ ÛÙÔ˘˜˘fiÏÔÈÔ˘˜ ÂÙ¿ ÛÙËÚ›¯ıËΠÛÙË Û˘Ì‚·Ù‹ ÌÂ Ì˘-ÎÔ‚·ÎÙËÚȉȷ΋ Ïԛ̈ÍË ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ÙËÓ ÌÈÎÚfiÙÂÚË ·fi 10 ¯ÈÏ. Ê˘Ì·ÙÈÓÔ·ÓÙ›-‰Ú·ÛË, ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÙËÓ¤ÏÏÂÈ„Ë Â·Ê‹˜ Ì ÂÓ‹ÏÈη Ê˘Ì·ÙÈÎfi Î·È Ù¤ÏÔ˜, ÙËÓ·ÔηٿÛÙ·ÛË ¯ˆÚ›˜ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÊ˘Ì·ÙÈÎÒÓÊ·Ú̿ΈÓ.

™ÙÔ˘˜ 13 ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·Û·Ó Ê˘Ì·ÙÈÓÔ·-ÓÙ›‰Ú·ÛË ¿Óˆ ÙˆÓ 10 ¯ÈÏ. Ë ‰È¿ÁÓˆÛË Ù˘ ÏÂÌÊ·‰Â-Ó›Ùȉ·˜ ·fi A.M. ÂȂ‚·ÈÒıËΠÌÈÎÚÔ‚ÈÔÏÔÁÈο. EÓ·Ó·ÌÔÓ‹ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ηÏÏȤÚÁÂÈ·˜ ÙˆÓÏÂÌÊ·‰¤ÓˆÓ, ¯ÔÚËÁ‹ıËΠ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ ËÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó IÛÔÓÈ·˙›‰Ë Î·È PÈÊ·ÌÈΛÓË, ÛÂ14 ·ÛıÂÓ›˜. ¢‡Ô ·ÛıÂÓ›˜ Ì M. Avium complex ηȤӷ˜ ·ÛıÂÓ‹˜ Ì M. Kansasii ¤Ï·‚·Ó ÙËÓ ·ÓˆÙ¤ÚˆıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· 9 Ì‹Ó˜ Î·È 12 Ì‹Ó˜ ·ÓÙ›-ÛÙÔȯ· ¯ˆÚ›˜ ·ÔÙ¤ÏÂÛÌ·, ÚÈÓ ÚÔÛ¤ÏıÔ˘Ó ÛÙÔ ÓÔ-ÛÔÎÔÌ›Ô.

H ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ÏÂÌÊ·‰ÂÓ›ÙÈ-‰· ·fi A.M. ‰È‹ÚÎÂÛ ·fi 6 Ì‹Ó˜ ¤ˆ˜ 2 ¤ÙË ÌÂÙ¿ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË. K·Ó›˜ ‰ÂÓ ÂÌÊ¿ÓÈÛ ÏÂÌ-Ê·‰ÂÓ›Ùȉ· Û ı¤ÛË ¿ÏÏË ÂÎÙfi˜ Ù˘ ·Ú¯È΋˜, Û ¤-ÓÙ fï˜ ·ÛıÂÓ›˜ ¯ÚÂÈ¿ÛÙËΠӷ Á›ÓÂÈ Î·È ‰Â‡ÙÂÚ˯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Â›Ù ‰ÈfiÙÈ ‰ÂÓ Â›¯Â Á›ÓÂÈ ·Ê·›-ÚÂÛË fiÏˆÓ ÙˆÓ ÚÔÛ‚ÏËı¤ÓÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (4·ÛıÂÓ›˜) ›Ù ÁÈ·Ù› ·Ó·Ù‡¯ıËΠÏÂÌÊ·‰ÂÓ›Ùȉ· ÛÙËÁÂÈÙÓÈ¿˙Ô˘Û· ÂÚÈÔ¯‹ ÚÔ˜ ÙËÓ ·Ú¯È΋ (1 ·ÛıÂÓ‹˜).H ‰Â‡ÙÂÚË Â¤Ì‚·ÛË ¤ÁÈÓ 3-4 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÚÒ-ÙË. ™Â 43/47 ·ÛıÂÓ›˜ ÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙËı¤ÛË Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘ ‹Ù·Ó Ôχ ηÏfi,ÂÓÒ Ù¤ÛÛÂÚȘ ·ÛıÂÓ›˜ ·Ó¤Ù˘Í·Ó ‰‡ÛÌÔÚÊË Ô˘Ï‹(¯ËÏÔÂȉ¤˜) Î·È ÔÈ ÙÚÂȘ ·fi ·˘ÙÔ‡˜ ¯ÚÂÈ¿ÛıËΠӷ·ÔηٷÛÙ·ıÔ‡Ó Ì ·ÈÛıËÙÈ΋ ¤̂·ÛË. O ̤ÛÔ˜¯ÚfiÓÔ˜ Ù˘ ·ÈÛıËÙÈ΋˜ ·˘Ù‹˜ ·ÔηٿÛÙ·Û˘ ‹Ù·Ó5 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË.

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:314-318 ¶. ™˘Ú›‰Ë˜ Î·È Û˘Ó.

316

EÈÎfiÓ· 3. ¶·ÚÔ¯¤Ù¢ÛË ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ÂԇψÛËηٿ ‰Â‡ÙÂÚÔ ÛÎÔfi.

EÈÎfiÓ· 2. A˘ÙfiÌ·ÙË Ú‹ÍË Î·È ·Ó¿Ù˘ÍË ¯ËÏÔÂȉԇ˜.

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complex Î·È ÛÙÔ˘˜ 3 ·ÛıÂÓ›˜. K·Ó¤Ó·˜ ‰ÂÓ ¤Ï·‚ ÂÈ-‰È΋ ·ÁˆÁ‹ ηٿ A.M. ŒÓ·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘-ÙÔ‡˜ ‰ÂÓ Â·Ó‹Ïı ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË. OÈ ¿ÏÏÔÈ 2·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ·˘ÙfiÌ·ÙË ÎÏÈÓÈ΋ Î·È ·ÎÙÈÓÔ-ÏÔÁÈ΋ ›·ÛË. MÂÙ¿ ·fi 2 Î·È 8 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛË˜Â›Ó·È ˘ÁÈ›˜ Î·È ÂχıÂÚÔÈ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·ÎÙÈÓÔÏÔ-ÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘Ì‚·ÙÒÓ Ì Ïԛ̈ÍË ·fi A.M.

T· 2 ·È‰È¿ Ì ‰È¿¯˘ÙË Ïԛ̈ÍË ·fi A.M. (ËÏÈ-Λ·˜ 7 Î·È 11 ÂÙÒÓ) ¤·Û¯·Ó ·fi Û‡Ó‰ÚÔÌÔ EvansÎ·È AIDS, ·ÓÙ›ÛÙÔȯ·. E›¯·Ó ˘ÚÂÙÈ΋ ΛÓËÛË ¤ˆ˜39,0oC ÁÈ· ¤Ó· Ì‹Ó·, ÂÓÒ ¤Ó·˜ ·fi ·˘ÙÔ‡˜ ÂÌÊ¿ÓÈ˙‰ȿ¯˘Ù· ÎÔÈÏȷο ¿ÏÁË. K·È ÔÈ 2 ·ÛıÂÓ›˜ ›¯·Ó Ë·-ÙÔÛÏËÓÔÌÂÁ·Ï›·. ŒÓ·˜ ·fi ·˘ÙÔ‡˜ ˘Ô‚Ï‹ıËΠÛÂÁ·ÛÙÚÔÛÎfiËÛË Ë ÔÔ›· ¤‰ÂÈÍ ‰È¿¯˘Ù˜ ‚Ï¿‚˜ η-Ù¿ Ì‹ÎÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ‰ˆ-‰Âη‰·ÎÙ‡ÏÔ˘. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ¤‰ÂÈÍ·Ó M.Avium complex Î·È ÛÙÔ˘˜ 2 ·ÛıÂÓ›˜. E›Û˘, ·Ô-ÌÔÓÒıËΠ۠˘ÏÈÎfi ·fi ÙÔÓ ÔÈÛÔÊ¿ÁÔ (1 ·ÛıÂÓ‹˜),ÙÔ ÛÏ‹Ó· (1), Î·È ÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (1). K·È ÔÈ 2·ÛıÂÓ›˜ ¤Ï·‚·Ó ÔχÌËÓË ·ÁˆÁ‹ Ì 3 ‹ 4 Ê¿ÚÌ·-η Ì ‰Ú¿ÛË Î·Ù¿ ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ ·˘ÙÔ‡, Â-ÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘, fï˜ ‰ÂÓ ·-ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË. K·È ÔÈ 2 ·ÛıÂÓ›˜ Ì ‰È¿¯˘ÙËÏԛ̈ÍË ·fi A.M. η٤ÏËÍ·Ó Ì¤Û· Û 1 ¤ÙÔ˜ ·fi ÙˉȿÁÓˆÛ‹ Ù˘.

™˘˙‹ÙËÛËT· A.M. ‰È·‚ÈÔ‡Ó ÛÙÔ Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·Ó-

ıÚÒÔ˘. H ÌfiÏ˘ÓÛË ÙÔ˘ ·ÓıÚÒÔ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂÙËÓ ¤ÎıÂÛË Û ÛÎfiÓË Ë ÔÔ›· ÂÚȤ¯ÂÈ A.M. ‹ Ì η-Ù¿ÔÛË ‹ Î·È ¿ÌÂÛÔ ÂÌ‚ÔÏÈ·ÛÌfi ÛÙÔ ‰¤ÚÌ· (1,3).

H ÂÌÊ¿ÓÈÛË ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ fï˜ ÂÍ·ÚÙ¿-Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ÍÂÓÈ-ÛÙ‹ ¤Ó·ÓÙÈ Ù˘ ÌfiÏ˘ÓÛ˘ ·fi A.M. ™Ù· ·È‰È¿, Ë ÏÂÌ-Ê·‰ÂÓ›Ùȉ· ÙˆÓ ÂÈÔÏ‹˜ ÏÂÌÊ·‰¤ÓˆÓ ·ÔÙÂÏ› ÙËÓ·ÚÈ· ÂΉ‹ÏˆÛË, ȉȷ›ÙÂÚ· ÛÙȘ ËÏÈ˘ οو ÙˆÓ 5ÂÙÒÓ (5). H Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË Ù˘ ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ÙËÓ ÕÓÔÈÍË Ë ÔÔ›· ‰È·ÈÛÙÒıËΠÛÙË ÌÂϤÙË Ì·˜,

·ÔÙÂÏ› ‡ÚËÌ· ÙÔ ÔÔ›Ô ¤¯ÂÈ ·Ó·ÊÂÚı› Î·È Û ¿Ï-ÏË ÌÂϤÙË (6). O ¯ÚfiÓÔ˜ Ô ÔÔ›Ô˜ ÌÂÛÔÏ·‚› ÌÂٷ͇Ù˘ ÌfiÏ˘ÓÛ˘ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ ÎÏÈÓÈÎÒÓ ÂΉËÏÒ-ÛÂˆÓ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜, Â›Ó·È ÏÔÁÈÎfi fï˜ Ó· ˘Ô-ı¤ÛÂÈ Î·Ó›˜ fiÙÈ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÌÔχÓ-ÛÂˆÓ Û˘Ì‚·›ÓÂÈ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹Ó˜, fiÔ˘ Ù· ·È-‰È¿ ¤Ú¯ÔÓÙ·È Û ÛÙÂÓfiÙÂÚË Â·Ê‹ Ì ÙÔ Ê˘ÛÈÎfi Â-ÚÈ‚¿ÏÏÔÓ (¯ÒÌ·, ÓÂÚfi).

H ÊÏÂÁÌÔÓ‹ ÙˆÓ ÂÈÔÏ‹˜ ÏÂÌÊ·‰¤ÓˆÓ ¤¯ÂÈ ˘Ô-Í›· ‹ ¯ÚfiÓÈ· ÔÚ›· Î·È ÚfiÁÓˆÛË Î·Ï‹, Ë ÔÔ›·fï˜ ÌÔÚ› Ó· ηٷϋÍÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›· Û˘ÚÈÁÁ›-Ô˘ Â¿Ó ‰ÂÓ Á›ÓÂÈ ¤ÁηÈÚ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË (5).™ÙË ÌÂϤÙË Ì·˜, ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÛıËÙÈ-ο ηÎfi ·ÔÙ¤ÏÂÛÌ· ·ÊÔÚÔ‡Û·Ó ÂÚÈÙÒÛÂȘ fiÔ˘Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Î·ı˘ÛÙ¤ÚËÛ ¤ÓÙ ̋Ó˜ηٿ ̤ÛÔ fiÚÔ ·fi ÙËÓ ·Ú¯È΋ ÂÌÊ¿ÓÈÛË Ù˘ ÏÂÌÊ·-‰ÂÓÈ΋˜ ‰ÈfiÁΈÛ˘. AÓÙ›ıÂÙ·, ÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂ-ÛÌ· ‹Ù·Ó Ôχ ηÏfi fiÙ·Ó Ë ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó ¿ÌÂ-ÛË Î·È ¿ÓÙˆ˜ fi¯È ¤Ú·Ó ÙÔ˘ ÂÓfi˜ ÌËÓfi˜.

Afi ÙË ÌÂϤÙË Ì·˜ Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ fiÙ·Ó ˘¿Ú-¯Ô˘Ó ÛÔ‚·Ú¤˜ ˘Ô„›Â˜ fiÙÈ ÙÔ ·›ÙÈÔ Ù˘ ÏÂÌÊ·‰ÂÓ›ÙÈ-‰·˜ Â›Ó·È Ù· A.M., Â›Ó·È ÂÈÙ·ÎÙÈ΋ Ë ¯ÂÈÚÔ˘ÚÁÈ΋·Ê·›ÚÂÛË ÙfiÛÔ ÙˆÓ ÂÌÊ·ÓÒ˜ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÏÂÌ-Ê·‰¤ÓˆÓ, fiÛÔ Î·È ÙˆÓ ‡ÔÙˆÓ ¤ÚÈÍ Ù˘ ‚Ï¿‚˘. HÚfiÛÊ·ÙË ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÓÂÒÙÂÚˆÓ Ì·ÎÚÔÏȉÒÓ ˆ˜ÂÓ·ÏÏ·ÎÙÈ΋ ıÂڷ›· ¤Ó·ÓÙÈ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ê·›-ÚÂÛ˘ Â›Ó·È ÂÏȉÔÊfiÚÔ˜, ‰ÂÓ ˘¿Ú¯ÂÈ fï˜ ·Ú-΋˜ ÂÌÂÈÚ›· (7,8). E›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ù· Û˘Ó‹ıË ·ÓÙÈ-Ê˘Ì·ÙÈο Ê¿Ú̷η, fiˆ˜ Ê·›ÓÂÙ·È Î·È ·fi ÙË ÌÂϤ-ÙË Ì·˜, ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙËÓ ÔÚ›· ÙˆÓ ÏÂÌÊ·‰ÂÓ›-ÙȉˆÓ ·fi A.M.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ÌfiÓÔ ÔÈÏÂÌÊ·‰ÂÓ›Ùȉ˜ ÔÈ Ôԛ˜ ÌÈÎÚÔ‚ÈÔÏÔÁÈο ‹ ÈÛÙÔÏÔÁÈ-ο ·Ô‰Â›¯ıËΠfiÙÈ ÔÊ›ÏÔÓÙ·È Û A.M., Ê·›ÓÂÙ·Èfï˜ fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË.E›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Ù· ÙÚ›· ٤ٷÚÙ· ÙˆÓ ÂÚÈÙÒ-ÛÂˆÓ Î·ÙÂÁÚ¿ÊËÛ·Ó Î·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‹ÌÈÛ˘Ù˘ ÌÂϤÙ˘ Ì·˜. AÍÈÔÛËÌ›ˆÙË ·‡ÍËÛË ÏÔÈÌÒ͈ӷfi A.M. ‰È·ÈÛÙÒÓÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, fiˆ˜Ê·›ÓÂÙ·È Î·È ·fi ÌÂϤÙ˜ Û ¿ÏϘ ¯ÒÚ˜. A˘Ù‹ Ë·‡ÍËÛË ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛËÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ·Ó·˙‹ÙËÛË ÏÔÈÌÒÍÂˆÓ Ô˘ÔÊ›ÏÔÓÙ·È Û A.M., fï˜ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ú¤ÂÈ Ó··›˙ÂÈ Â›Û˘ Ë ·˘ÍË̤ÓË ÏÔÈÌÔÁfiÓÔ˜ ÈηÓfiÙËÙ· ÙˆÓA.M. Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ηıÒ˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ÌÂÙ·‚ÔϤ˜ (5,9,10). O ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÂÚÈÙÒ-ÛÂˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û M. Avium complex ¤Ó·ÓÙÈÙˆÓ ¿ÏÏˆÓ Ì˘ÎÔ‚·ÎÙËÚȉ›ˆÓ Î·È Î˘Ú›ˆ˜ ÙÔ˘ M.Scrufolaceum ÙfiÛÔ ÛÙË ‰È΋ Ì·˜ fiÛÔ Î·È Û ¿ÏϘÌÂϤÙ˜, ÙÔÓ›˙ÂÈ ÙȘ ÔÈÎÔÏÔÁÈΤ˜ ·˘Ù¤˜ ÌÂÙ·‚ÔϤ˜(4,6).

™Ù· ·È‰È¿ Ë Ó¢ÌÔÓÈ΋ ÂÓÙfiÈÛË Ïԛ̈͢ ·fiA.M. Â›Ó·È Û¿ÓÈ· ÂÎÙfi˜ ·fi ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fiÈÓÒ‰Ë Î˘ÛÙÈ΋ ÓfiÛÔ. TÔ M. Avium complex Î·È ÙÔ M.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:314-318 §ÔÈÌÒÍÂȘ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·

317

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

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

H ‰È¿¯˘ÙË Ïԛ̈ÍË ·fi A.M. Û˘Ó·ÓÙ¿Ù·È ÔχۿÓÈ· ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ·ÎfiÌË Î·È Û ·È‰È¿Ì ‚·ÚÈ¿ ·ÓÔÛÔηٷÛÙÔÏ‹, fiˆ˜ Ë ‚·ÚÈ¿ Û˘Ó‰˘·-Ṳ̂ÓË ·ÓÔÛÔ·Ó¿ÚÎÂÈ· Î·È Î·ÎÔ‹ıÂȘ ˘fi ¯ËÌÂÈÔ-ıÂڷ›·. TÔÓ›˙ÂÙ·È ¿ÓÙˆ˜, fiÙÈ Ë ·ÔÌfiÓˆÛË ÙÔ˘Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ ·fi ÛÙ›Ú˜ ÂÚÈÔ¯¤˜, fiˆ˜ ÔÌ˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ ·›Ì·, Â›Ó·È ‰È·ÁÓˆÛÙÈΤ˜(12). ¶·Ú¿ ÙË ¯ÔÚ‹ÁËÛË ÔÏÏ·ÏÒÓ Î·È Ì·ÎÚÔ¯Úfi-ÓÈˆÓ ıÂڷ¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ, Ë ÚfiÁÓˆÛË Â›Ó·È ‰˘-ÛÌÂÓ¤ÛÙ·ÙË Î·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ·ÚÈıÌËÙÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ·ÓÔÛÔÏÔÁÈ΋ ¿ÚÎÂÈ·ÙˆÓ ·ÛıÂÓÒÓ (2,12). OÈ ‰˘Ô ÂÚÈÙÒÛÂȘ ‰È¿¯˘Ù˘ÓfiÛÔ˘ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ÊÔÚÔ‡Û·Ó ‚·ÚÈ¿ ·ÓÔ-ÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿ Ù· ÔÔ›· η٤ÏËÍ·Ó Ì¤Û· Û¤ӷ ¤ÙÔ˜ ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘.

™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ÏÔÈÌÒÍÂȘ ·È‰ÈÒÓ ·fi A.M.·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙËÓ ÙÂÏ¢-Ù·›· ‰ÂηÂÙ›·, ÌÂ Û˘ÓËı¤ÛÙÂÚË ÂÓÙfiÈÛË ÙÔ˘˜ ÂÈÔ-Ï‹˜ ÏÂÌÊ·‰¤Ó˜. OÚÈÛÙÈ΋ χÛË ÛÙÔ Úfi‚ÏËÌ· ÂÈ-Ù˘Á¯¿ÓÂÙ·È Ì ¤ÁηÈÚË ÔÏÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛËÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ, Ë ÔÔ›· Ú¤ÂÈÓ· Á›ÓÂÙ·È ÂÓÙfi˜ ÙÔ˘ ÚÒÙÔ˘ ÌËÓfi˜ ·fi ÙËÓ ¤Ó·ÚÍËÙ˘ ÏÂÌÊ·‰ÂÓÈ΋˜ ÚÔÛ‚ÔÏ‹˜. H ηı˘ÛÙ¤ÚËÛË ÛÙˉȿÁÓˆÛË Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ô‰ËÁ› ÛÙˉËÌÈÔ˘ÚÁ›· „˘¯ÚÒÓ ·ÔÛÙËÌ¿ÙˆÓ, ·˘ÙÔÌ¿ÙˆÓ Ú‹ÍÂ-ˆÓ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È Ù¤ÏÔ˜ ÛÙË ‰ËÌÈÔ˘ÚÁ›·Â›ÌÔÓˆÓ Û˘ÚÈÁÁ›ˆÓ Î·È ‰‡ÛÌÔÚÊˆÓ Ô˘ÏÒÓ. ™Â ·È‰È¿Ì Ó¢ÌÔÓÈ΋ ÂÓÙfiÈÛË Ù· ÔÔ›· Â›Ó·È Û ηϋ ÎÏÈÓÈ-΋ ηٿÛÙ·ÛË, Ë ÎÏÈÓÈ΋ Î·È ·ÎÙÈÓÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡-ıËÛ‹ ÙÔ˘˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÙË Ï‡ÛË. ÿÛˆ˜ ·Ô-‰Âȯı› fiÙÈ ÔÈ ÓÂfiÙÂÚ˜ Ì·ÎÚÔÏ›‰Â˜ Â›Ó·È ¯Ú‹ÛÈ̘. HÂÌÊ¿ÓÈÛË ‰È¿¯˘Ù˘ ÓfiÛÔ˘ Û ·È‰È¿ Ì ·ÓÔÛÔηٷ-ÛÙÔÏ‹ ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË.

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associated diseases. Am Rev Resp Dis 1979;119:107-59.2. Lincoln EM, Gilbert LA. Disease in children due to

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3. Pattz EF, Swensen SJ, Erasmus J. Pulmonarymanifestations of nontuberculous mycobacterium. RadiolClin North Am 1995;33:719-29.

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7. Tessier MH, Amoric JC, Mechinaud F, Dubesset D, LitouxP, Stalder JF. Clarithromycin for atypical mycobacteriallymphadenitis in non-immunocompromised children.Lancet 1994;344:1778.

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

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

10. Romanus V, Hallander HO, Wahlen P, Olinder - NielsenAM, Magnusson PH, Juhlin I. Atypical mycobacteria inextrapulmonary disease among children. Incidence inSweden from 1969 through 1990, related to changingBCG - vaccination coverage. Tubercle Lung Dis1995;76:300-10.

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

12. Stone A, Schelonka R, Drehner D, Ascher D.Disseminated M. avium complex in non-humanimmunodeficiency virus-infected pediatric patients.Pediatr Infect Dis J 1992;11:960-964.

™ËÌ›ˆÛË: M¤ÚÔ˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ¤¯ÂÈ ‰ËÌÔ-ÛÈ¢ı› ÛÙÔ ÂÚÈÔ‰ÈÎfi Pediatr Infect Dis J1999;18:968-70.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:314-318 ¶. ™˘Ú›‰Ë˜ Î·È Û˘Ó.

318

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 25-10-1999HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙ˘ ™˘Ú›‰Ë˜, E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜B’ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. Î·È A. K˘ÚÈ·ÎÔ‡"£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, 115 27, Aı‹Ó·

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H ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ·ÓÙÈÚÔۈ‡ÂÈ ÙÔ20-30% ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È, Ì ÂÍ·›-ÚÂÛË ÙË ‰ÈÁÏÒ¯ÈÓ·-·ÔÚÙÈ΋ ‚·Ï‚›‰·, Â›Ó·È Ë ÈÔ Û˘-¯Ó‹ Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·.(1-6) AӷʤÚÔÓÙ·È 1,5-3,5 ÂÚÈÙÒÛÂȘ ÛÙ· 1000 ˙ÒÓÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿Î·È 4,5-7 ÛÙ· 1000 ÚfiˆÚ·.(1,7) øÛÙfiÛÔ, Ë Û˘¯Ófi-ÙËÙ¿ Ù˘ ÌÂÈÒÓÂÙ·È Û 1 ÛÙ· 1000 ·È‰È¿ Û¯ÔÏÈ΋˜ËÏÈΛ·˜ Î·È 0,5 Û 1000 ÂÓ‹ÏÈΘ.(2) H ÚÔԉ¢ÙÈ΋·˘Ù‹ Ì›ˆÛË ·ÓÙ·Ó·ÎÏ¿ ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ ¿ıË-

Û˘ ·ÊÔ‡ ·Ú·ÙËÚÂ›Ù·È ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË Ù˘ÂÈÎÔÈÓˆÓ›·˜ ÛÙÔ 25-50%, ÂÓÒ ÔÈ ÌÈÎÚ¤˜ ÌÂÛÔÎÔÈÏÈ·-Τ˜ ÂÈÎÔÈӈӛ˜ Û˘ÁÎÏ›ÓÔ˘Ó ·˘ÙfiÌ·Ù· Û ÔÛÔÛÙfiÔ˘ ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 80%. (1,3,4,7-11) H ÏÂÈÔÓfiÙËÙ·ÙˆÓ ·˘ÙfiÌ·ÙˆÓ Û˘ÁÎÏ›ÛÂˆÓ Û˘Ì‚·›ÓÂÈ ÛÙ· ‰‡ÔÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ Î·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 8¯ÚfiÓˆÓ, ¤¯ÂÈ ÂÈÙÂÏÂÛÙ› ÙÔ 90% ÙˆÓ Û˘ÁÎÏ›ÛÂ-ˆÓ.(1,2,8) H ˯ÔηډÈÔÁÚ·Ê›· ‰‡Ô ‰È·ÛÙ¿ÛÂˆÓ ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÙÔ ·ÏÌÈÎfi Î·È Û˘Ó¯¤˜ Doppler ˯Ô-

¶∞π¢π∞∆ƒπ∫∏ 2000;63:319-321

319

EÌÂÈÚ›· ·fi ÂÚÈÙÒÛÂȘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜Û ‚Ú¤ÊË

AÌ·Ï›· TÛÈÏÈÌÈÁοÎË, AÓÙˆÓ›· M·ÓÔ˘Ú¿, £ÂÔÊ·Ó‹ TÛÂÎÔ˘Ú¿, B·ÛÈÏÈ΋ AÁÁÂÏ¿ÎÔ˘,AıËÓ¿ ™¯ÔÈÓ¿ÎË, ¶·Ó·ÁÈÒÙ˘ ™Ù·ÛÈÓfi˜, §¿ÌÚÔ˜ ¶ÏÔ˘Ì›‰Ë˜

● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜, Ë ÌÂϤ-ÙË Ù˘ ÂͤÏÈ͢ ÙÔ˘˜ Î·È Ë ıÂڷ¢ÙÈ΋ ÙÔ˘˜ ·ÓÙÈÌÂÙÒÈÛË ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜. YÏÈÎfi Ù˘ ÌÂ-ϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 48 ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ÌÈÎÚfiÙÂÚ· ÙÔ˘ ¤ÙÔ˘˜, Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÛÂÌÈ· ‰ÈÂÙ›·, Î·È ÛÙ· ÔÔ›· ‰È·ÈÛÙÒıËΠÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Û·Ó ÌÔÓ‹Ú˘ ηډȷ΋ ‚Ï¿‚Ë. H ‰È¿ÁÓˆÛË ¤ÁÈÓÂÌ ˯ÔηډÈÔÁÚ¿ÊËÌ· M-mode, ‰‡Ô ‰È·ÛÙ¿ÛÂˆÓ Î·È ¤Á¯ÚˆÌÔ Doppler. ¢È·ÈÛÙÒıËΠfiÙÈ 41 ‚Ú¤ÊË (85,5%) ›¯·ÓÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘, 6 ‚Ú¤ÊË (12,5%) ›¯·Ó ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë Î·È 1 ‚Ú¤ÊÔ˜ (2%) ›¯Â ˘Ô-Ó¢ÌÔÓÈ΋ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·Ú·ÙËÚ‹ıËΠ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË ÛÂ20 ‚Ú¤ÊË (41,6%) Ì ÌÈÎÚ‹ Ì˘˚΋ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. K·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ·ÚÔ˘Û›·Û·Ó 5 ‚Ú¤ÊË (10,4%)Î·È 3 ‚Ú¤ÊË (6,2%) Ì ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË. ™˘ÌÂÚ·-ÛÌ·ÙÈο, Ë Ì˘˚΋ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚË ·fi ÙËÓ ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë. A˘Ùfi Â›Ó·È ÙÔ ·ÔÙ¤-ÏÂÛÌ· Ù˘ ÂÓÙfiÈÛ˘ ÙˆÓ ÌÈÎÚÒÓ Ì˘˚ÎÒÓ ÌÂÛÔÎÔÈÏÈ·ÎÒÓ ÂÈÎÔÈÓˆÓÈÒÓ Ì ÙËÓ Â˘Ú›· ¯Ú‹ÛË Ù˘ ˘ÂÚ˯ÔηډÈÔ-ÁÚ·Ê›·˜ ÛÙÔÓ ¤ÏÂÁ¯Ô ‚ÚÂÊÒÓ Ì Èı·Ó‹ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·. ¶·È‰È·ÙÚÈ΋ 2000;63:319-321.

§¤ÍÂȘ ÎÏÂȉȿ: ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, ˘ÂÚ˯ÔηډÈÔÁÚ·Ê›·, ‚ÚÂÊÈ΋ ËÏÈΛ·.

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

Key words: ventricular septal defect, echocardiography, infants.

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

µP∞XEIA ¢HMO™π∂À™H

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ηډÈÔÁÚ¿ÊËÌ· Î·È ÙÔ ¤Á¯ÚˆÌÔ Doppler ¤¯Ô˘Ó η-ıÈÂÚˆı› ˆ˜ ̤ıÔ‰Ô˜ ‰È¿ÁÓˆÛ˘ Î·È ÂÓÙfiÈÛ˘ Ù˘ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆÓ›·˜, ·ÏÏ¿ Î·È ˆ˜ ̤ÛÔ ÂÎÙ›-ÌËÛ˘ ÙˆÓ ·ÈÌÔ‰˘Ó·ÌÈÎÒÓ Û˘ÓÂÂÈÒÓ, ÌÂÙÂÁ¯ÂÈÚËÙÈ-΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Î·ıÒ˜ Î·È ÂÓÙfi-ÈÛ˘ Ù˘¯fiÓ ÂÈÏÔÎÒÓ Ù˘ ÌÂÛÔÎÔÈÏȷ΋˜ ÂÈÎÔÈÓˆ-Ó›·˜. (3,12,13)

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÂÈÚ›· ‰˘Ô ÂÙÒÓ ·fi 48 ÂÚÈ-ÙÒÛÂȘ ‚ÚÂÊÒÓ Ô˘ ‰È·ÁÓÒÛÙËÎ·Ó Î·È ·Ú·ÎÔÏÔ˘-ı‹ıËÎ·Ó ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÙÔ˘ BÂÓÈ˙¤-ÏÂÈÔ˘ °ÂÓÈÎÔ‡ NÔÛÔÎÔÌ›Ԣ KÚ‹Ù˘.

YÏÈÎfi Î·È Ì¤ıÔ‰Ô˜YÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó Ù· 48 ÓÂÔÁÓ¿ ηÈ

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

H ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ‚ÚÂÊÒÓ Û˘Ó¯›ÛÙËΠ̤-¯ÚÈ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ-‹˜. ŸÏ· Ù· ‚Ú¤ÊË Â·ÓÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ·È‰ÔηÚ-‰ÈÔÏÔÁÈÎfi È·ÙÚ›Ô, Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜, ·Ó¿-ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ¿ıËÛ‹˜ÙÔ˘˜. £ÂˆÚ‹ıËΠfiÙÈ Â‹Ïı ·˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛËÙ˘ ÂÈÎÔÈÓˆÓ›·˜ fiÙ·Ó ÙÔ Ê‡ÛËÌ· ‰ÂÓ ‹Ù·Ó È· ·ÎÔ˘-ÛÙfi. H Û‡ÁÎÏÂÈÛË ÂȂ‚·ÈÒıËΠ˘ÂÚ˯ÔÁÚ·ÊÈο.MfiÓÔ Ù¤ÛÛÂÚ· ·fi Ù· 48 ‚Ú¤ÊË, ¯ÚÂÈ¿ÛÙËΠӷ ·-Ú·ÂÌÊıÔ‡Ó Û ·È‰ÔηډÈÔÏÔÁÈÎfi ΤÓÙÚÔ Ù˘ Aı‹-Ó·˜, fiÔ˘ Ù· 3 ˘Ô‚Ï‹ıËÎ·Ó Û ηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋¤̂·ÛË.

AÔÙÂϤÛÌ·Ù·Afi Ù· 48 ‚Ú¤ÊË Ì ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·,

ÛÙ· 24 (50%) Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË

ÙˆÓ 4 ‚‰ÔÌ¿‰ˆÓ, Ì ̤ÛË ËÏÈΛ· 9 Ë̤Ú˜. ™Ù· ˘fi-ÏÔÈ· 24, ¤ÁÈÓ Û ËÏÈΛ· ·fi 1 ¤ˆ˜ 12 ÌËÓÒÓ, Ì ̤-ÛË ËÏÈΛ· 4,5 Ì‹Ó˜. ¢È·ÈÛÙÒıËΠfiÙÈ 41 ‚Ú¤ÊË(85,5%) ›¯·Ó ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡-Ô˘, 6 ‚Ú¤ÊË (12,5%) ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏÈ·-΋ ÂÈÎÔÈÓˆÓ›· Î·È 1 ‚Ú¤ÊÔ˜ (2%) ˘Ô·ÚÙËÚȷ΋(˘ÔÓ¢ÌÔÓÈ΋). ŒÏÏÂÈÌÌ· ÂÈÛfi‰Ô˘ ‰ÂÓ ‰È·ÈÛÙÒ-ıËΠ۠ηӤӷ ·fi Ù· ‚Ú¤ÊË. Afi Ù· 41 ‚Ú¤ÊË ÌÂÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘, Ù· 40 ›¯·ÓÌÈÎÚ¿ Î·È Ôχ ÌÈÎÚ¿ ÂÏÏ›ÌÌ·Ù· Î·È 1 ›¯Â ̤ÙÚÈÔ˘ÌÂÁ¤ıÔ˘˜ ¤ÏÏÂÈÌÌ·. T· 6 ‚Ú¤ÊË Ì ÙȘ ÂÚÈÌÂÌ‚Ú·-ÓÒ‰ÂȘ ÌÂÛÔÎÔÈÏȷΤ˜ ÂÈÎÔÈӈӛ˜ Î·È ÙÔ 1 ‚Ú¤ÊԘ̠ÙËÓ ˘Ô·ÚÙËÚȷ΋ ÂÈÎÔÈÓˆÓ›· ›¯·Ó ̤ÙÚÈÔ˘ ηÈÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÂÏÏ›ÌÌ·Ù·.

A˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË ·Ú·ÙËÚ‹ıËΠ۠20 ·È‰È¿(41,6%), fiÏ· Ì ÌÈÎÚ‹ ‹ Ôχ ÌÈÎÚ‹ Ì˘˚ÎÔ‡ Ù‡Ô˘ ÌÂ-ÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. K·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ·-ÚÔ˘Û›·Û·Ó 5 ‚Ú¤ÊË (10,4%), ·fi Ù· ÔÔ›· 1 ›¯Â Ì˘-˚ÎÔ‡ Ù‡Ô˘ ¤ÏÏÂÈÌÌ· Î·È 4 ÂÚÈÌÂÌ‚Ú·Ó҉˜. T·‚Ú¤ÊË ·˘Ù¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ¯ÔÚ‹ÁËÛË ‰ÈÁÔÍ›-Ó˘, ÊÔ˘ÚÔÛÂÌ›‰Ë˜ Î·È Î·ÙÔÚ›Ï˘ ηٿ ÂÚ›Ùˆ-ÛË. TÚ›· ·fi Ù· ‚Ú¤ÊË ·˘Ù¿ (6,2%) ÙÔ˘ Û˘ÓfiÏÔ˘) ÌÂÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ¯ÚÂÈ¿-ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË, Ù· 2 ÏfiÁˆ ÌË ·ÓÙÈÚ-ÚÔÔ‡ÌÂÓ˘ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È ÙÔ 1 ÏfiÁˆÛÔ‚·Ú‹˜ ˘ÔÓ¢ÌÔÓÈ΋˜ ÛÙ¤ÓˆÛ˘.

™˘˙‹ÙËÛËTÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· ÌÔÚ› Ó· ¯ˆÚÈÛÙ›

Û ÌÂÌ‚Ú·Ó҉˜ Î·È ÛÂ Ì˘˚Îfi, Ì ÙÚÂȘ Û˘ÓÈÛÙÒÛ˜:ÙÔ Ì˘˚Îfi ‰È¿ÊÚ·ÁÌ· ÂÈÛfi‰Ô˘, ÙÔ ‰ÔÎȉ҉˜ ‰È¿-ÊÚ·ÁÌ· Î·È ÙÔ ‰È¿ÊÚ·ÁÌ· ÂÍfi‰Ô˘.(2,11) OÈ ÌÂÛÔÎÔÈ-ÏȷΤ˜ ÂÈÎÔÈӈӛ˜ (MKE) Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÎÔÓÙ¿ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÌ‚Ú·ÓÒ‰Ô˘˜ ‰È·ÊÚ¿ÁÌ·ÙÔ˜,οو ·fi ÙËÓ ·ÔÚÙÈ΋ ‚·Ï‚›‰·, ÔÓÔÌ¿˙ÔÓÙ·È ÂÚÈ-ÌÂÌ‚Ú·ÓÒ‰ÂȘ Î·È Â›Ó·È Û˘Ó‹ıˆ˜ ÌÔÓ‹ÚÂȘ. ŸÙ·Ó ÙÔ¤ÏÏÂÈÌÌ· ÂÚÈ‚¿ÏÏÂÙ·È ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ·fi Ù· Ì˘˚Î¿Û˘ÛÙ·ÙÈο ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ÚfiÎÂÈÙ·È ÁÈ· ÌÂÛÔ-ÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì˘˚ÎÔ‡ Ù‡Ô˘. ŸÙ·Ó Ï›ÂÈ ÙÂ-Ï›ˆ˜ ÙÔ ‰È¿ÊÚ·ÁÌ· ÂÍfi‰Ô˘ Î·È ÙÔ ¤ÏÏÂÈÌÌ· ‚Ú›ÛÎÂ-Ù·È ·ÎÚÈ‚Ò˜ οو ·fi ÙËÓ Ó¢ÌÔÓÈ΋ Î·È ÙËÓ ·ÔÚÙÈ-΋ ‚·Ï‚›‰·, Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÔÓÔÌ¿˙ÂÙ·È˘Ô·ÚÙËÚȷ΋. TÔ ¤ÏÏÂÈÌÌ· Ô˘ ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fiÙË ‰È·ÊÚ·ÁÌ·ÙÈ΋ Áψ¯›Ó· Ù˘ ÙÚÈÁÏÒ¯ÈÓ·˜ ‚·Ï‚›-‰·˜ Î·È ›Ûˆ Î·È Î¿Ùˆ ·fi Ù· ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÂÏ-Ï›ÌÌ·Ù·, ÔÓÔÌ¿˙ÂÙ·È ¤ÏÏÂÈÌÌ· ÂÈÛfi‰Ô˘.(1,2,11,12)

™ÙË ÌÂϤÙË Ì·˜, ÔÈ ÂÚÈÌÂÌ‚Ú·ÓÒ‰ÂȘ MKE ·ÓÙÈ-ÚÔÛˆÂ‡Ô˘Ó ÌfiÓÔ ÙÔ 12,5%, ÂÓÒ ÙÔ 85,5% ·ÔÙÂ-ÏÔ‡Ó ÔÈ Ì˘˚ÎÔ‡ Ù‡Ô˘ MKE. T· ÔÛÔÛÙ¿ ·˘Ù¿ Û˘Ì-ʈÓÔ‡Ó Ì ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, fiÔ˘ Û˘¯ÓfiÙÂÚÂ˜Â›Ó·È ÔÈ Ì˘˚ÎÔ‡ Ù‡Ô˘ MKE ÌÂ Û˘¯ÓfiÙËÙ· 51-85%.(3-5,14)

K·Ó¤Ó· ·fi Ù· ‚Ú¤ÊË ÌÂ Ì˘˚ÎÔ‡ Ù‡Ô˘ ¤ÏÏÂÈÌÌ·‰ÂÓ ¯ÚÂÈ¿ÛÙËΠ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË Î·È ÌfiÓÔ 1

¶∞π¢π∞∆ƒπ∫∏ 2000;63:319-321 A. TÛÈÏÈÌÈÁοÎË Î·È Û˘Ó.

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·fi Ù· 41 ·ÚÔ˘Û›·Û ÛËÌ›· ηډȷ΋˜ ·Ó¿Ú-ÎÂÈ·˜. AÓÙ›ıÂÙ·, ·fi Ù· 6 ·È‰È¿ Ì ÂÚÈÌÂÌ‚Ú·ÓÒ‰ËMKE, Ù· 4 ·ÚÔ˘Û›·Û·Ó ÛËÌ›· ÌË ·Ó·Ù·ÛÛfiÌÂÓ˘ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Ù· 3 ·fi ·˘Ù¿ ·ÓÙÈÌÂÙˆ-›ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈο.

™ÙÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘, ·Ú·ÙËÚ‹ıËη˘ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË Û 20 ‚Ú¤ÊË Ì ÌÈÎÚ¤˜, Ì˘˚ÎÔ‡Ù‡Ô˘ MKE (48,8% ÙˆÓ Ì˘˚ÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ), ÛÙˉȿÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜. ™Â ·Ó¿ÏÔÁ˜ ÂÚ-Á·Û›Â˜ ÙÔ ÔÛÔÛÙfi Î˘Ì·›ÓÂÙ·È ·fi 43% ̤¯ÚÈ84%.(3-5,7,15) Afi ÙȘ ÂÚÈÌÂÌ‚Ú·ÓÒ‰ÂȘ ÌÂÛÔÎÔÈ-ÏȷΤ˜ ÂÈÎÔÈӈӛ˜, Û η̛· ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·˘-ÙfiÌ·ÙË Û‡ÁÎÏÂÈÛË.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì˘˚ÎÔ‡ Ù‡Ô˘ ÌÂÛÔÎÔÈÏȷ΋ÂÈÎÔÈÓˆÓ›· ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Èı·ÓfiÙËÙ· ·˘ÙfiÌ·Ù˘ۇÁÎÏÂÈÛ˘ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜ Î·È Â›Ó·È ÔÏ‡Û˘¯ÓfiÙÂÚË Ù˘ ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ô˘˜. H ÚfiÁÓˆÛË ÁÈ·ÙËÓ Ì˘˚ÎÔ‡ Ù‡Ô˘ ÂÈÎÔÈÓˆÓ›· Â›Ó·È Î·Ï‡ÙÂÚË, fi¯È Ìfi-ÓÔ ˆ˜ ÚÔ˜ ÙËÓ Èı·ÓfiÙËÙ· ·˘ÙfiÌ·Ù˘ Û‡ÁÎÏÂÈÛ˘·ÏÏ¿ Î·È ÙË Û·ÓÈfiÙËÙ· ·Ó¿Ù˘Í˘ ηډȷ΋˜ ·ÓÂ-¿ÚÎÂÈ·˜.

BÈ‚ÏÈÔÁÚ·Ê›·1. Graham T, Gutgesell H. Ventricular Septal Defects In:

Emmanouilidis GC, Allen HD, Riemenschneider TA,Gutgesell HP eds. Heart disease in infants, children andadolescents. 5th ed. Baltimore: Williams & Wilkins1995:724-726.

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

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

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

first year of life. Am J Cardiol 1992;70:364-366.5. Meberg A, Otterstad JE, Froland G, Sorland S, Nitter-

Hauge S. Increasing incidence of ventricular septal defectcaused by improved detection rate. Acta Paediatr 1994,83(6):653-657.

6. Backer C, Winters R, Zales V, Takami H, Muster A, BensonW, Mavroudis C. Restrictive ventricular septal defect: howsmall is too small to close? Ann Thorac Surg1993;56:1014-1019.

7. Moe D, Guntheroth W. Spontaneous closure ofuncomplicated ventricular septal defect. Am J Cardiol1987;60:674-678.

8. Shirali G, O'Brian Smith, Geva T. Quantitation ofechocardiographic predictors of outcome in infants withisolated ventricular septal defect. Am Heart J1995;130:1228-1235.

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

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

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

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

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

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

15. Hiraishi S, Agata Y, Nowatari M, Oguchi K, Misawa H,Hirota H et al. Incidence and natural course of trabecularventricular septal defect: Two-dimensional echocardio-graphy and color Doppler flow imaging study. J Pediatr1992;120:409-415.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:319-321 MÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·

321

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-10-1999HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-04-2000

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: AÌ·Ï›· TÛÈÏÈÌÈÁοÎËHÚÔ‰fiÙÔ˘ 214, N¤· AÏÈηÚÓ·ÛÛfi˜HÚ¿ÎÏÂÈÔ KÚ‹Ù˘, 71 601

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EÈÛ·ÁˆÁ‹ H ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ÂÚÈÁÚ¿ÊËΠˆ˜ ÓÔÛÔÏÔ-

ÁÈ΋ ÔÓÙfiÙËÙ· ÙÔ 1994 Û ·ÛıÂÓ›˜ Ì ΢ÛÙÈ΋ ›ÓˆÛË,Ô˘ ¤·ÈÚÓ·Ó ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ-˙‡ÌˆÓ ÁÈ· ‰È¿ÛÙËÌ· ϤÔÓ ÙˆÓ 12-15 ÌËÓÒÓ (1). H ÎÔ-ÏÔÓÔ¿ıÂÈ· ÂÌÊ·Ó›ÛıËΠÌÂÙ¿ ÙËÓ Î˘ÎÏÔÊÔÚ›· ηȯڋÛË Û΢·ÛÌ¿ÙˆÓ Ì ÌÂÁ¿ÏË ÂÚÈÂÎÙÈÎfiÙËÙ·

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:322-325

322

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

™Ù·‡ÚÔ˜ NÙÔ˘ÓÙÔ˘Ó¿Î˘1, AÓ·ÛÙ·Û›· ZËÛÔ‡ÏË1, Aı·Ó·Û›· §Ô˘Ú›‰·2,EÏ¢ıÂÚ›· PÒÌ·-°È·ÓÓ›ÎÔ˘2, N›Ó· M·ÓˆÏ¿ÎË2

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

§¤ÍÂȘ ÎÏÂȉȿ: ΢ÛÙÈ΋ ›ÓˆÛË, ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ·, ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·.

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

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

1 TÌ‹Ì· IÓÔ΢ÛÙÈ΋˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"2 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

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‰È·ÊÔÚÂÙÈ΋ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·(3). H ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Û˘Ó›ÛٷٷÈ, ΢ڛˆ˜, Û ÂÂÈ-Ûfi‰È· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢ Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ·Ù˘ ¿¯˘ÓÛ˘ Î·È ÛÙ¤ÓˆÛ˘ ÙÔ˘ ·˘ÏÔ‡ ÙÔ˘ ·¯¤Ô˜ÂÓÙ¤ÚÔ˘. X·Ú·ÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ·Î·È Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· (4,5). °È· ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛ‹ Ù˘, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ··ÈÙ‹ıË-Π¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (ÂÓÙÂÚÂÎÙÔÌ‹) (6).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ΢ÛÙÈ΋›ÓˆÛË Î·È ÈÓÒ‰Ë ÎÔÏÔÓÔ¿ıÂÈ· Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÏ‹„Ë ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘H ·ÛıÂÓ‹˜, ËÏÈΛ·˜ Û‹ÌÂÚ· 9 ¯ÚfiÓˆÓ, ÁÂÓÓ‹ıËÎÂ

ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ 3.200 gr. ¶·ÚÔ˘-Û›·Û ÓÂÔÁÓÈÎfi ›ÎÙÂÚÔ Î·È ı‹Ï·Û ÁÈ· 1 Ì‹Ó·. ™Â ËÏÈ-Λ· 1ó ÌËÓfi˜ ÂÙ¤ıË Ë ÎÏÈÓÈ΋ ˘Ô„›· Ù˘ ΢ÛÙÈ΋˜›ÓˆÛ˘ ÏfiÁˆ ÔÏÏÒÓ, ÌÂÁ¿ÏˆÓ, ‰‡ÛÔÛ̈Ó, ÏÈ·ÚÒÓÎÂÓÒÛˆÓ, ÏËÌÌÂÏÔ‡˜ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜ Î·È Â›-ÌÔÓÔ˘ ‚‹¯· ·fi ÙË Á¤ÓÓËÛË. H ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒ-ıËΠ̠ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ¯ÏˆÚÈÔ‡¯ˆÓ ÛÙÔÓȉÚÒÙ· Ì ÙË Ì¤ıÔ‰Ô Gibson - Cooke (95 mEq/L) Û‰‡Ô ͯˆÚÈÛÙ¤˜ ÌÂÙÚ‹ÛÂȘ. MÂÙ¿ ÙË ‰È¿ÁÓˆÛË ¿Ú¯È-Û ıÂڷ›· ˘ÔηٿÛÙ·Û˘ Ì ·ÁÎÚ·ÙÈο ¤Ó˙˘-Ì· Î·È ‚Èٷ̛Ә, Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË Ù˘ ·ÛıÂÓÔ‡˜‚ÂÏÙÈÒıËÎÂ Î·È Ë ÂͤÏÈÍ‹ Ù˘, ·fi ÏÂ˘Ú¿˜ ۈ̷ÙÈ-΋˜ ·Ó¿Ù˘Í˘, ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋.

™Â ËÏÈΛ· 13 ÌËÓÒÓ Î·È 4ó ¯ÚfiÓˆÓ ÓÔÛËχıË-ΠÁÈ· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·. ™Â ËÏÈΛ· 3 ¯ÚfiÓˆÓ Ô ·Ó·-Ó¢ÛÙÈÎfi˜ ‚ÏÂÓÓÔÁfiÓÔ˜ ·ÔÈΛÛıËΠ·fi „¢‰Ô-ÌÔÓ¿‰·. Afi ÙËÓ ËÏÈΛ· ÙˆÓ 17 ÌËÓÒÓ Ì¤¯ÚÈ 5ó¯ÚfiÓˆÓ, ·ÚÔ˘Û›·Û 6 ÂÂÈÛfi‰È· ·ÔÊÚ·ÎÙÈÎÔ‡ÂÈÏÂÔ‡, Ô˘ ¯·Ú·ÎÙËÚ›ÛıËÎ·Ó ˆ˜ ÈÛÔ‰‡Ó·ÌÔ ÂÈÏÂ-Ô‡ ·fi ÌËÎÒÓÈÔ (Distal intestinal obstructionsyndrome - DIOS). ŸÏ· ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙË-ÚËÙÈο. T· ¤ÓÙ ÙÂÏÂ˘Ù·›· Û˘Ó¤‚ËÛ·Ó ÙÔ ÙÂÏ¢-Ù·›Ô ÂÍ¿ÌËÓÔ. K·Ù¿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÂÈÛfi‰ÈÔ ÂÓÙÂ-ÚÈ΋˜ ·fiÊڷ͢, ˘‹Ú¯Â ›ÌÔÓÔ ÎÔÈÏÈ·Îfi ¿Ï-ÁÔ˜, ÌÂÙˆÚÈÛÌfi˜ ÎÔÈÏ›·˜, ·˘ÍË̤ÓÔÈ ÂÓÙÂÚÈÎÔ›‹¯ÔÈ Î·È, ÂÈϤÔÓ, ÚÔÛÙ¤ıËΠÂÈÛÎÔÈο ÂÌÊ·-Ó‹˜ ÂÚÈÛÙ·ÏÙÈÛÌfi˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ŒÙÛÈ, ‚¿ÛÂÈ ÙˆÓÛ˘¯ÓÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙˆÓ ¤ÓÙÔÓˆÓ Î·È Â›ÌÔÓˆÓÛ˘Ìو̿وÓ, ÂÙ¤ıË Ë ˘Ô„›· Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔ-ÓÔ¿ıÂÈ·˜. ™Â ‚·ÚÈÔ‡¯Ô ˘ÔÎÏ˘ÛÌfi Ì Á·ÛÙÚÔ-ÁÚ·Ê›ÓË ·ÂÈÎÔÓ›ÛıËΠÓËÌ·ÙÔÂȉ‹˜ ÛÙ¤ÓˆÛË ÙÔ˘ÙÂÏÈÎÔ‡ ÂÈÏÂÔ‡ Ì ÚÔÛÙÂÓˆÙÈ΋ ‰È¿Ù·ÛË, ÂÓÒ ÙÔ‰ÂÍÈfi ÎfiÏÔÓ, ·fi ÙËÓ ÎÔÏÈ΋ η̋ ̤¯ÚÈ ÙÔ Ù˘-ÊÏfi, ‹Ù·Ó ÚÈÎÓfi Î·È ·Ú·ÌÔÚʈ̤ÓÔ (EÈÎfiÓ· 1).AÎÔÏÔ‡ıËÛ ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÙÔÌ›· ηٿ ÙËÓÔÔ›· ‰È·ÈÛÙÒıËΠ¤ÓÙÔÓË ÂÚ˘ıÚfiÙËÙ· Ì ÂÈÎfiÓ·ÊÏÂÁÌÔÓ‹˜ Î·È ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÙÂÏÈ-ÎÔ‡ ÂÈÏÂÔ‡, ÙÔ˘ Ù˘ÊÏÔ‡ Î·È ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘,Ô˘ ¤‰ÈÓ ÙËÓ ÂÓÙ‡ˆÛË ÓfiÛÔ˘ Crohn, ÏfiÁˆ Ù˘ÔÔ›·˜ Ë Ï‹„Ë ‚ÈÔ„›·˜ ÂÁ΢ÌÔÓÔ‡Û ÙÔÓ Î›Ó‰˘ÓÔ

‰ËÌÈÔ˘ÚÁ›·˜ Û˘ÚÈÁÁ›ˆÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ‰ÂÓ ÂÏ‹-ÊıËÛ·Ó ‚ÈÔ„›Â˜ ·fi ÙÔ ¤ÓÙÂÚÔ. TȘ ›‰È˜ Ì·ÎÚÔ-ÛÎÔÈο ·ÏÏÔÈÒÛÂȘ ·ÚÔ˘Û›·˙Â Ë ÛΈÏËÎÔÂȉ‹˜·fiÊ˘ÛË, Ë ÔÔ›· Î·È ·Ê·ÈÚ¤ıËÎÂ. TÔ ‹·Ú ›¯ÂÔ˙Ò‰Ë ÂÌÊ¿ÓÈÛË Î·È ÂÏ‹ÊıË ‰Â›ÁÌ· ÁÈ· ÈÛÙÔÏÔÁÈ-΋ ÂͤٷÛË.

¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈο, Ë ÛΈÏËÎÔÂȉ‹˜ ‰ÂÓ ·-ÚÔ˘Û›·˙ ·ÍÈfiÏÔÁ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ ÂÎÙfi˜·fi ÙËÓ ·ÚÔ˘Û›· ˘ÎÓ‹˜ ‚ϤÓÓ˘ Î·È ¿ÊıÔÓˆÓ Ëˆ-ÛÈÓÔÊ›ÏˆÓ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ. T· Á·ÁÁÏȷο ·ÙÙ·Ú·‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. H ÈÛÙÔÏÔÁÈ΋ ·˘Ù‹ ÂÈÎfiÓ· ·¤-ÎÏÂÈ ÙË ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘. TÔ ‹·Ú ·-ÚÔ˘Û›·˙ ‰È‡ڢÓÛË ÙˆÓ ˘Ï·›ˆÓ ‰È·ÛÙËÌ¿ÙˆÓ Î·ÈÂÚȯÔÏ·ÁÁÂÈ›Ùȉ·, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ·ÓÙ›‰Ú·ÛË·fi Ù· ¯ÔÏËÊfiÚ· ÛÙ· Ï·›ÛÈ· Ù˘ ΢ÛÙÈ΋˜ ›ÓˆÛ˘.

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

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:322-325

323

EÈÎfiÓ· 1. ¡ËÌ·ÙÔÂȉ‹˜ ÛÙ¤ÓˆÛË ÙÔ˘ ÂÈÏÂÔ‡ Ì ÚÔ-ÛÙÂÓˆÙÈ΋ ‰È¿Ù·ÛË.

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

EÎÙfi˜ ·fi ‰‡Ô ·ÎfiÌË ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú¿ ÂÂÈÛfi-‰È· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢, Û ËÏÈΛ· 7ó Î·È 8 ¯Úfi-ÓˆÓ, Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙËÚËÙÈο, ÙÔ ·È‰› ›-¯Â ÂÚÈÔ‰Èο ‹È· ÂÓԯϋ̷ٷ ·fi ÙÔ ÂÙÈÎfi, ·Ô-Ù¤ÏÂÛÌ· Ù˘ ÂÓÙÂÚÈ΋˜ ÛÙ¤ÓˆÛ˘. E·Ó·¯ÔÚËÁ‹ıË-ηÓ, ÛÙ·‰È·Î¿, ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì· Û ÌÈÎÚ¤˜ ‰fi-ÛÂȘ, ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÈηÓÔÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È Ó· ÂÈÙ¢¯ı› ηϋ ıÚ¤„Ë.

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

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

™˘˙‹ÙËÛËO fiÚÔ˜ ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ·Ô‰›‰ÂÈ ÙÔÓ Ù‡Ô

Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ÎfiÏÔ˘, Ô˘ ÂÚÈÁÚ¿ÊËΠÁÈ·ÚÒÙË ÊÔÚ¿ Û ·È‰È¿ Ì ΢ÛÙÈ΋ ›ÓˆÛË ÙÔ 1994 (1).ŒÎÙÔÙÂ, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚ›Ô˘ 80 ÂÚÈÙÒÛÂȘ,Û ËÏÈ˘ Ô˘ Î˘Ì·›ÓÔÓÙ·È ·fi 9 ÌËÓÒÓ Ì¤¯ÚÈ 13¯ÚfiÓˆÓ, ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ ‰ÂÓ ¤¯Ô˘Ó ÂȂ‚·È-ˆı› ÈÛÙÔÏÔÁÈο, ·ÏÏ¿ ÌfiÓÔ ‚¿ÛÂÈ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfi-Ó·˜ Î·È ÙÔ˘ ·ÎÙÈÓÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ (2,3). ™Ù¤ÓˆÛËÙÔ˘ ÂÓÙ¤ÚÔ˘ ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ÛÙÔ ·ÚÂÏıfiÓ ÛÂÂÓ‹ÏÈΘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË Î·È ¿ÏÏˆÓ Ê·Ú̿ΈÓ,fiˆ˜ Â›Ó·È Ù· ‰ÈÔ˘ÚËÙÈο , Î·È Ù· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈ-ÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η.

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

T· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿-ıÂÈ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÌÔÈfiÙËÙ˜ Ì ۇӉÚÔÌÔ ÈÛÔ-‰‡Ó·ÌÔ ÂÈÏÂÔ‡ ·fi ÌËÎÒÓÈÔ Ô˘ Û˘Ó·ÓÙ¿Ù·È ÛÙÔ 10-30% ÙˆÓ ·ÛıÂÓÒÓ Ì ΢ÛÙÈ΋ ›ÓˆÛË Î·È ÔÊ›ÏÂÙ·ÈÛÙËÓ ·ÚÔ˘Û›· ·¯‡ÚÚ¢ÛÙ˘ ÂÓÙÂÚÈ΋˜ ‚ϤÓÓË˜Î·È ÂÓÛÊ‹ÓˆÛË ÎÔÚ¿ÓˆÓ, ·ÏÏ¿ ‰ÂÓ Û˘Óԉ‡ÂÙ·È Ì¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ‹ ÛÙ¤ÓˆÛË ÙÔ˘ ·˘ÏÔ‡ ÙÔ˘ÂÓÙ¤ÚÔ˘. E›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË(distal intestinal obstruction syndrome, DIOS) ÚÔ-‚¿ÏÏÂÈ ÌÂ Û˘ÌÙÒÌ·Ù· fiˆ˜ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÌÂÙˆ-ÚÈÛÌfi, ‰˘ÛÎÔÈÏÈfiÙËÙ·, ÛÙ·ÛÈÌfiÙËÙ· ‹ ·ÒÏÂÈ· ‚¿-ÚÔ˘˜. H ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ÚÔÛ‚¿ÏÏÂÈ ÙÔ ÎfiÏÔÓηÈ, ȉȷ›ÙÂÚ·, ÙÔ Ù˘ÊÏfi Î·È ÙÔ ·ÓÈfiÓ, ÂÓÒ Û ϛÁ˜ÂÚÈÙÒÛÂȘ Ë ÚÔÛ‚ÔÏ‹ ·ÊÔÚ¿ Î·È ÛÙÔÓ ÙÂÏÈÎfi ÂÈ-ÏÂfi (5). ¶·ıÔÁÓˆÌÔÓÈο ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·Ô-ÙÂÏÔ‡Ó Ë ˘Ô‚ÏÂÓÓÔÁfiÓÈ· ›ÓˆÛË Ì ¤ÎÙ·ÛË Î·ÈÛÙÔ Ì˘˚Îfi ¯ÈÙÒÓ·, ÙÔ Ô›‰ËÌ· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ë‰È‹ıËÛË ·fi ˈÛÈÓfiÊÈÏ· Î·È Ì·ÛÙÔ·ÙÙ·Ú· (5).

Afi ÙȘ ÚÒÙ˜ ·Ú·ÙËÚ‹ÛÂȘ Èı·ÓÔÏÔÁ‹ıËÎÂοÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÎÔÏÔÓÔ¿ıÂÈ·˜ ηÈÙ˘ ¯ÔÚ‹ÁËÛ˘ ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ·ÁÎÚ·ÙÈÎÒÓ

¶∞π¢π∞∆ƒπ∫∏ 2000;63:322-325 ™. NÙÔ˘ÓÙÔ˘Ó¿Î˘ Î·È Û˘Ó.

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ÂÓ˙‡ÌˆÓ (1,7). K·È ·˘Ùfi Û˘Ì‚·›ÓÂÈ Â˘ÎÔÏfiÙÂÚ· Ì Ù˯ڋÛË Û΢·ÛÌ¿ÙˆÓ ÌÂÁ¿Ï˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·. OÈ Smyth Î·È Û˘Ó. (1995) ‚Ú‹-Î·Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÎÔÏÔÓÔ¿ıÂÈ· ¤·ÈÚÓ·Ó, ηٿ̤ÛÔ fiÚÔ, ¿Óˆ ·fi 46.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ,Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë Ì¤-ÛË ÚfiÛÏË„Ë ÏÈ¿Û˘ ‰ÂÓ ÍÂÂÚÓÔ‡Û ÙȘ 21.000 UIÏÈ¿Û˘/Kg/Ë̤ڷ. T· Â˘Ú‹Ì·Ù¿ ÙÔ˘˜ ¤‰ÂÈÍ·Ó fiÙÈ ËÛ˘Û¯¤ÙÈÛË Ù˘ ÎÔÏÔÓÔ¿ıÂÈ·˜ Ì ÙËÓ ÔÛfiÙËÙ· ÙˆÓ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ‹Ù·Ó ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË ÌÂÛ¯ÂÙÈÎfi ΛӉ˘ÓÔ 8,0 Û ۇÁÎÚÈÛË Ì ÙË ¯Ú‹ÛË ˘·-ÎÙÈÎÒÓ, ÁÈ· ÙËÓ ÔÔ›· Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ‹Ù·Ó ÌfiÓÔ2,4 (7). ™Â ¿ÏÏË ÌÂϤÙË, Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ˘ÔÏÔ-Á›ÛıËΠ۠8,4 ÁÈ· ÔÛfiÙËÙ˜ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡-ÌˆÓ >25.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ Î·È 64 ÁÈ· ÔÛfi-ÙËÙ˜ >50.000 UI ÏÈ¿Û˘/Kg/Ë̤ڷ (8).

O ·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ ÚfiÎÏËÛ˘ Ù˘ ‚Ï¿‚˘‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔ˜. EÓÔ¯ÔÔÈÂ›Ù·È ËÙÔÍÈ΋ ‰Ú¿ÛË ÙˆÓ ÌÂÁ¿ÏˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ·ÁÎÚÂ-·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ηıÒ˜Î·È ÙˆÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ (ÔÏ˘ÌÂÚ‹) ÙÔ˘ ÂÚÈ‚Ï‹Ì·-ÙÔ˜ ÙˆÓ ÌÈÎÚÔ‰ÈÛΛˆÓ Î·È ÙˆÓ ÌÈÎÚÔÛÊ·ÈÚȉ›ˆÓ Ô˘ÂÚȤ¯ÔÓÙ·È ÛÙËÓ Î¿„Ô˘Ï·. EÂȉ‹ Ù· ·È‰È¿ Ì ΢-ÛÙÈ΋ ›ÓˆÛË ¤¯Ô˘Ó ÈÔ ¯·ÌËÏfi PH ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ·Ú·ÁˆÁ‹˜ ·ÁÎÚ·ÙÈÎÒÓ˘ÁÚÒÓ, ηı˘ÛÙÂÚ› Ë ‰È¿Ï˘ÛË ÙÔ˘ ÂÚÈ‚Ï‹Ì·ÙÔ˜ ηȤÙÛÈ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·ÁÎÚ·-ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ÏÂÙÔ‡ÂÓÙ¤ÚÔ˘, ‹ ·ÎfiÌË Î·È ÙÔ ·¯‡, ÂÚÈÔ¯¤˜, ‰ËÏ·‰‹, Ô˘‰ÂÓ Â›Ó·È ·Ó·ÙÔÌÈο ÚÔÂÙÔÈÌ·Ṳ̂Ó˜ Ó· ÙȘ ‰Â¯ıÔ‡ÓÎ·È Ó· ÙȘ ·Ó¯ıÔ‡Ó. ™ÙËÓ ÚfiÎÏËÛË Ù˘ ÂÓÙÂÚÈ΋˜‚Ï¿‚˘ Èı·ÓfiÓ Ó· Û˘Ì‚¿ÏÏÔ˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔ-ÓÙ˜, fiˆ˜ Ë Î·ı˘ÛÙÂÚË̤ÓË ‰›Ô‰Ô˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ÂÚȯÔ̤ÓÔ˘, Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ ·Ú·ÙÂٷ̤-ÓË Â·Ê‹ Ì ÙÔ ‚ÏÂÓÓÔÁfiÓÔ, ‹ Ù· ÂÂÈÛfi‰È· ÂÓÙÂÚÈ΋˜ÛÙ¿Û˘ ‹ ·fiÊڷ͢ Ô˘ ÂÈϤÎÔ˘Ó ÙËÓ Î˘ÛÙÈ΋›ÓˆÛË. ™Â ÂÈÚ·Ì·ÙÈο ÚfiÙ˘·, ¤¯ÂÈ ‰È·ÈÛÙˆı› ÙÔ-ÍÈ΋ ‰Ú¿ÛË ÛÙÔ ¤ÓÙÂÚÔ ÙˆÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ Ô˘ ÂÚÈ-‚¿ÏÏÔ˘Ó Ù· ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·, fiˆ˜ ÙÔ Âı˘Ï-·ÎÚ‡-ÏÈÔ (Panzytrat, Pancrease HL, Nutrizyme 22), ‰ÂÓ Â›Ó·È,fï˜ ·ÓÙ›ÛÙÔÈ¯Ë Ì ·˘Ù‹ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔÓ ¿Ó-ıÚˆÔ (3). AÓÙ›ıÂÙ·, ÙÔ Êı·ÏÈÎfi (Creon) ıˆÚ›ٷÈÈÔ ·ÛʷϤ˜, ÂÂȉ‹, Èı·ÓÒ˜, ‰È·Ï‡ÂÙ·È Û ¯·ÌËÏfi-ÙÂÚÔ PH Î·È ÂÏ¢ıÂÚÒÓÂÙ·È Ù·¯‡ÙÂÚ· Û ·ÓÒÙÂÚÔÙÌ‹Ì· ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ (3,10). H ˘fiıÂÛË Ó·ÂÌϤÎÂÙ·È Î·È ·˘ÙÔ¿ÓÔÛÔ˜ Ì˯·ÓÈÛÌfi˜ ‹ Ó· Â›Ó·È ·-ıÔÏÔÁÈÎfi˜ Ô Ì˯·ÓÈÛÌfi˜ Ô˘ Ú˘ıÌ›˙ÂÈ ÙË Û‡ÓıÂÛËÎÔÏÏ·ÁfiÓÔ˘ ·fi ÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· ‰ÂÓ Ê·›ÓÂÙ·È Ó·Û˘ÁÎÂÓÙÚÒÓÂÈ ÔÏϤ˜ Èı·ÓfiÙËÙ˜ (9).

H ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÈÓÒ‰Ô˘˜ ÎÔÏÔÓÔ¿ıÂÈ·˜,ÛÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛË˜ÙˆÓ ÂÓ˙‡ÌˆÓ. H ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ÂÓÙÂÚÂÎÙÔÌ‹Û˘ÓÈÛÙ¿Ù·È ÛÙȘ ÂÚÈÙÒÛÂȘ ÂÈÌÔÓ‹˜ Ù˘ ÎÏÈÓÈ΋˜Û˘Ìو̷ÙÔÏÔÁ›·˜ Î·È ‡·Ú͢ ÛÔ‚·Ú‹˜ ÛÙ¤ÓˆÛ˘

ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È ı· Ú¤ÂÈÓ· ÂÚÈÔÚ›˙ÂÙ·È, fiÛÔÓ Â›Ó·È ‰˘Ó·ÙfiÓ, ÛÙÔ ÚÔÛ‚Â-‚ÏË̤ÓÔ ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘ (4,6). H ÚfiÏË„Ë Ù˘ÓfiÛÔ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Û‡Ìʈӷ Ì ÙËÓ EÈÙÚÔ‹ I·-ÙÚÈ΋˜ AÛÊ¿ÏÂÈ·˜ - Committee on the Safety ofMedicine (NԤ̂ÚÈÔ˜ 1995) - Ì ÙËÓ ·ÔÊ˘Á‹ ¯ÔÚ‹-ÁËÛ˘ Û΢·ÛÌ¿ÙˆÓ Ù· ÔÔ›· ÂÚȤ¯Ô˘Ó ÌÂÁ¿Ï˜‰fiÛÂȘ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Û ·ÛıÂÓ›˜ Ì ΢ÛÙÈ-΋ ›ÓˆÛË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ¯ÚfiÓˆÓ. H ËÌÂ-Ú‹ÛÈ· ‰fiÛË ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ ÙȘ 10.000UI/Kg/Ë̤ڷ Î·È Ù· ¤Ó˙˘Ì· ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡-ÓÙ·È Ì ȷÙÚÈ΋ Û˘ÓÙ·Á‹ (10).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÈÓ҉˘ ÎÔÏÔÓÔ¿ıÂÈ· ·ÔÙÂ-Ï› Ì›· Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ ıÂڷ›·˜ Ù˘ ΢ÛÙÈ΋˜›ÓˆÛ˘ ·fi ÌÂÁ¿Ï˜ ‰fiÛÂȘ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ,Ë ÔÔ›· ¤¯ÂÈ ·ÌÊ›‚ÔÏË ÚfiÁÓˆÛË. H ÙÚÔÔÔ›ËÛËÙ˘ ‰ÔÛÔÏÔÁ›·˜ ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ıˆÚ›-Ù·È Ô ÌfiÓÔ˜ ÙÚfiÔ˜ ÚfiÏ˄˘.

BÈ‚ÏÈÔÁÚ·Ê›·1. Smyth RL, Van Velzen D, Smyth AR, Lloyd DA, Heaf DP.

Strictures of ascending colon in cystic fibrosis and highstrength pancreatic enzymes. Lancet 1994;343:85-86.

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

3. Littlewood JM. Update on intestinal strictures. JR Soc Med1999;92 (suppl 37): S41-S49.

4. Borowitz DS, Grand RJ, Durie PR and the CF ConsensusCommittee. Use of pancreatic enzyme supplements forpatients with cystic fibrosis in the context of fibrosingcolonopathy. J Pediatr 1995;127:681-684.

5. Hasler WL. Pancreatic enzymes and colonic strictures withcystic fibrosis: A case- control study. Selected summaries.Gastroenterology 1998;114:609-612.

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

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

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

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

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

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O˘Ú·Ó›· ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘1, ª·Ú›· ∑·Ú›ÊË2, πˆ¿ÓÓ˘ OÈÎÔÓÔÌ›‰Ë˜3,∞ÛË̛ӷ •˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë1

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ2 ∆Ì‹Ì· ∞ÍÔÓÈÎÒÓ ∆ÔÌÔÁÚ¿ÊˆÓ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”3 ∞ÈÌ·ÙÔÏÔÁÈÎfi ÙÌ‹Ì·, ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

● ¶ÂÚ›ÏË„Ë: H ÚÒÈÌË ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û˘Ó‹ıˆ˜ Ô‰ËÁ› Û ‚·ÚÈ¿ Ó¢ÚÔÏÔÁÈο ÂÏÏ›Ì-Ì·Ù· Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· Î·È Ù˘Èο Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·: ÂÓ‰ÔÂÁÎÂÊ·ÏÈΤ˜ ·ÚÂÁ¯˘Ì·ÙÈΤ˜·ÔÙÈÙ·ÓÒÛÂȘ, ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Ó¢ÚÒÓˆÓ (·Á˘Ú›· - ·¯˘Á˘Ú›· - ÔÏ˘ÌÈÎÚÔÁ˘Ú›·), ‰È·Ù·Ú·¯¤˜ÛÙËÓ Ì˘ÂϛӈÛË, ·Ú·ÎÔÈÏȷΤ˜ ·ÛÙÂȘ, ‰È¿Ù·ÛË ÙˆÓ Ï·Á›ˆÓ ÎÔÈÏÈÒÓ Î·È ˘ÔÏ·Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜.AÓÙ›ıÂÙ·, Ë fi„ÈÌË Ïԛ̈ÍË Û ÚÔ¯ˆÚË̤ÓË ÂÁ΢ÌÔÛ‡ÓË ¤¯ÂÈ ËÈfiÙÂÚ˜ ÂΉËÏÒÛÂȘ Ì ÌÈÎÚÔÎÂÊ·Ï›·, ‚·ÚËÎÔ˝·Î·È ÂÏ·ÊÚ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡, 3 ÂÙÒÓ Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚË-ÎÔ˝· ÁÈ· ÙËÓ ÔÔ›· ÙÔÔıÂÙ‹ıËΠÎÔ¯ÏÈ·Îfi ÂÌʇÙÂ˘Ì·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ηϋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È ÂÚ›ÌÂ-ÙÚÔ ÎÂÊ·Ï‹˜ ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· (47 ÂÎ., 5Ë ÂηÙÔÛÙÈ·›· ı¤ÛË). ™Ù· Ï·›ÛÈ· ÙÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ÂϤÁ¯Ô˘ ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ÎÔ¯ÏÈ·ÎÔ‡ ÂÌÊ˘Ù‡̷ÙÔ˜ ˘Ô‚Ï‹ıËΠ۠·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·ÂÁÎÂÊ¿ÏÔ˘ Î·È ÏÈıÔÂȉÒÓ ÔÛÙÒÓ. ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú·ÙËÚ‹ıËÎÂ Û˘ÌÌÂÙÚÈο ˘fi˘ÎÓË ·ÂÈÎfiÓÈÛË Ù˘Ï¢΋˜ Ô˘Û›·˜ ΢ڛˆ˜ ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ ËÌȈԉÒÓ Î¤ÓÙÚˆÓ ·ÌÊÔÙÂÚfiÏ¢ڷ, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·ÂÈÎfiÓÈ-ÛË ÙÔ˘ ˘ÔÏÔ›Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜ Î·È ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÂÁÎÂÊ¿-ÏÔ˘. ™ÙËÓ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó·‰Â›¯ıËÎ·Ó Û˘ÌÌÂÙÚÈΤ˜ ÂÛٛ˜ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ Ì ·Û·Ê‹ fiÚÈ· ÛÙËÓ ÂÓÙˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁÌ·ÙÈÎÒÓ, ÌÂوȷ›ˆÓ Î·È ÎÚÔÙ·ÊÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿Ì ÌË ÂȉÈ΋ Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·. K·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜ Ë ·ÂÈÎfiÓÈÛË ÙˆÓ ·Ó·ÙÔÌÈÎÒÓ ÌÔÚ›ˆÓ ÙˆÓ ÏÈıÔÂȉÒÓÔÛÙÒÓ Î·È ÙˆÓ ·ÎÔ˘ÛÙÈÎÒÓ ÓÂ‡ÚˆÓ ˘‹ÚÍÂ Ê˘ÛÈÔÏÔÁÈ΋. H ·ÛıÂÓ‹˜ ·˘Ù‹ Ô˘ ÓÔÛËχÙËΠÁÈ· Ïԛ̈ÍË ·fi ΢Ù-Ù·ÚÔÌÂÁ·ÏÔ˚fi ÛÙËÓ ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, Èı·ÓÔÏÔÁԇ̠fiÙÈ ÓfiÛËÛ ÛÙÔ 3Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Ì ·ÔÙ¤ÏÂ-ÛÌ· ‹È· ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Î·È ÂÚÈÔÚÈṲ̂ӷ ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·. ¶·È‰È·ÙÚÈ΋ 2000;63:326-329.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË, ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜, ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·.

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

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

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EÈÛ·ÁˆÁ‹H Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi

(CMV) Â›Ó·È Ë Ï¤ÔÓ Û˘¯Ó‹ ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ÙˆÓÓÂÔÁÓÒÓ Î·È Û˘Ì‚·›ÓÂÈ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 1%.(1-3)MfiÓÔ 10% ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Â›Ó·È Û˘-Ìو̷ÙÈο ηٿ ÙË Á¤ÓÓËÛË.(1) T· ϤÔÓ ¤Î‰ËÏ·ÛËÌ›· Â›Ó·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ·Ù¤¯ÂÈ-˜(50%).(1) B·ÚÈ¿ Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·ÚÔ˘-ÛÈ¿˙ÂÈ ÙÔ 55% ÙˆÓ ·ÛıÂÓÒÓ, ËÈfiÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜·ÓˆÌ·Ï›Â˜ ÙÔ 31%, ÂÓÒ ‚·ÚËÎÔ˝· ·Ú·ÙËÚÂ›Ù·È ÛÂ27% ÂÚ›Ô˘ (1,2). H ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È ÌÂÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÈÔ‡ ÛÙ· Ô‡Ú· ‹ ÙÔÓ Û›ÂÏÔ Î·Ù¿ÙȘ 4 ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ˙ˆ‹˜, Ì ٷ ÂȉÈο IgM·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi Î·È ÙÂÏÂ˘Ù·›· Ì ÙË Ì¤ıÔ‰ÔPCR. MÂÙ¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Ë ‰È¿ÁÓˆÛË Ù˘ ÂÓ-‰ÔÌ‹ÙÚÈ·˜ Ïԛ̈͢ Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË Î·È ‚·Û›˙Â-Ù·È ÛÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ·. M ÙËÓ Î·ÏÏȤÚÁÂÈ·ÙÔ˘ ÈÔ‡ Î·È ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓÓ· ηıÔÚÈÛÙ› Ô ·ÎÚÈ‚‹˜ ¯ÚfiÓÔ˜ ÚÔÛ‚ÔÏ‹˜ ·fi ÙÔÓÈfi ηٿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ‹ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô.

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

AÓÙ›ıÂÙ· Ë fi„ÈÌË Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fiηٿ Ù· ÙÂÏÂ˘Ù·›· ÛÙ¿‰È· Ù˘ ΢‹Ûˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÈËÈfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË, ÁÈ’ ·˘Ùfi Î·È Ù· ÎÚÈÙ‹ÚÈ·ÁÈ· ÙË ‰È¿ÁÓˆÛË ‰ÂÓ Â›Ó·È Û·Ê‹ Î·È Ù· ‚È‚ÏÈÔÁÚ·ÊÈ-ο ‰Â‰Ô̤ӷ Ùˆ¯¿(5).

¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ÎÏÈÓÈ-΋ ÂÈÎfiÓ· Î·È Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Û˘Ì‚·-Ù¿ Ì Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ηٿ ÙÔ ÙÂÏ¢-Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛˆ˜KÔÚ›ÙÛÈ ËÏÈΛ·˜ 3 ÂÙÒÓ ÚÔÛ‹Ïı ÁÈ· Ó¢ÚÔÏÔÁÈ-

΋ ÂÎÙ›ÌËÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘Ô‚ÏËı› Û ¤̂·-ÛË ÙÔÔı¤ÙËÛ˘ ÎÔ¯ÏÈ·ÎÔ‡ ÂÌÊ˘Ù‡̷ÙÔ˜ ÏfiÁˆ ‚·-ÚÂÈ¿˜ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ·˜ ‚·ÚËÎÔ˝·˜ ÁÓˆÛÙ‹˜ ·fiËÏÈΛ·˜ 4 ÌËÓÒÓ.

¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› ˘ÁÈÒÓ ÌË Û˘ÁÁÂÓÒÓÁÔÓ¤ˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÂÁ΢ÌÔÛ‡ÓË Î·È ÙÔÎÂÙfi ηȂ¿ÚÔ˜ Á¤ÓÓËÛ˘ 2.850 Kg. NÔÛËχÙËΠ۠ÓÂÔÁÓÔ-ÏÔÁÈÎfi ÙÌ‹Ì· ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, fiÔ˘‰È·ÁÓÒÛıËΠÏԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Ì ıÂÙÈ-ο IgM ·ÓÙÈÛÒÌ·Ù·. ™Â ËÏÈΛ· 4 ÌËÓÒÓ ‰È·ÈÛÙÒıËÎÂ

‚·ÚËÎÔ˝·, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛıËΠ·Ú¯Èο Ì ·ÎÔ˘-ÛÙÈο Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÚÔÛÙ¤ıËÎÂ Î·È ·ÁˆÁ‹ ÏfiÁÔ˘,¯ˆÚ›˜ fï˜ Ô˘ÛÈ·ÛÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÏfiÁÔ˘, ·Ó Î·È Ë„˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ˘‹ÚÍ ÔÌ·Ï‹.ŒÙÛÈ, Û ËÏÈΛ· 3 ÂÙÒÓ ·ÔÊ·Û›ÛÙËÎÂ Ë ÙÔÔı¤ÙËÛËÎÔ¯ÏÈ·ÎÔ‡ ÂÌÊ˘Ù‡̷ÙÔ˜ ÁÈ· ÚÈ˙ÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈ-ÛË Ù˘ ‚·ÚËÎÔ˝·˜ ÛÙÔ ·ÎÔÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ÓÔÛÔ-ÎÔÌ›Ԣ Ì·˜. Afi ÙËÓ ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›-ÌËÛË ‰ÂÓ ÚԤ΢„ ·ıÔÏÔÁÈÎfi ‡ÚËÌ·. TÔ ·È‰› ›-¯Â ηϋ ÂÈÎÔÈÓˆÓ›· ‹Ù·Ó fï˜ ȉȷ›ÙÂÚ· ˘ÂÚÎÈÓËÙÈ-Îfi Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÙÔ˘ (47 ÂÎ.) ·ÓÙÈÛÙÔÈ-¯Ô‡Û ÛÙËÓ 5Ë ÂηÙÔÛÙÈ·›· ı¤ÛË.

™Ù· Ï·›ÛÈ· ÙÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÁÈ·ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ÂÌÊ˘Ù‡̷ÙÔ˜, ÙÔ ·È‰› ˘Ô-‚Ï‹ıËΠ›Û˘ Û ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·-Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÏÈıÔÂȉÒÓ ÔÛÙÒÓ.

™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú·ÙËÚ‹ıËÎÂ Û˘ÌÌÂ-ÙÚÈο ˘fi˘ÎÓË ·ÂÈÎfiÓÈÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜ ΢-Ú›ˆ˜ ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ ËÌȈÔÂȉÒÓ Î¤ÓÙÚˆÓ·ÌÊÔÙÂÚfiÏ¢ڷ, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·ÂÈÎfiÓÈÛË ÙÔ˘˘ÔÏÔ›Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Ù˘ ·ÚÂ-ÁÎÂÊ·Ï›‰Ô˜ Î·È ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘.

™ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó·‰Â›¯ıËÎ·Ó Û˘ÌÌÂ-ÙÚÈΤ˜ ÂÛٛ˜ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ Ì ·Û·Ê‹ fiÚÈ·ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁÌ·ÙÈÎÒÓ, ÌÂ-وȷ›ˆÓ Î·È ÎÚÔÙ·ÊÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ‡-ÚËÌ· Û˘Ì‚·Ùfi Ì ÌË ÂȉÈ΋ Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·.

¶∞π¢π∞∆ƒπ∫∏ 2000;63:326-329

327

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

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

Afi ÙÔÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô: ‚˘ıfi˜ Ê˘ÛÈÔÏÔÁÈÎfi˜,Ï˘ÛÔÛˆÌȷο ¤Ó˙˘Ì· Ê˘ÛÈÔÏÔÁÈο, ÏÈ·Ú¿ Ôͤ· Ì·-ÎÚ¿˜ ·Ï‡ÛÔ˘ Î·È Ê˘Ù·ÓÈÎfi Ô͇ Ê˘ÛÈÔÏÔÁÈο. E›Û˘,ÙÔ ·ÌÈÓfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Î·È Ù· ÔÚÁ·ÓÈοÔͤ· Ô‡ÚˆÓ ‚Ú¤ıËÎ·Ó Ê˘ÛÈÔÏÔÁÈο.

™˘˙‹ÙËÛËH Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Â›Ó·È Ë Û˘¯Ófi-

ÙÂÚË ·fi ÙȘ Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. TfiÛÔ Ë ÎÏÈÓÈ΋ ÂÈ-ÎfiÓ· fiÛÔ Î·È Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÔÈΛÏÏÔ˘Ó·Ó·ÏfiÁˆ˜ ÙÔ˘ ‚·ıÌÔ‡ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔÛ‚ÔÏ‹˜·fi ÙÔÓ Èfi.

ŸÙ·Ó Ë Ïԛ̈ÍË Û˘Ì‚Â› ÛÙÔ ÚÒÙÔ ‹ ÛÙÔ ‰Â‡-ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ ÔÈ ‚Ï¿‚˜ ·fi ÙÔ KN™ÙÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È ÛÔ‚·Ú¤˜ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÈ-ÎÚÔÎÂÊ·Ï›·, ‰È·Ù·Ú·¯¤˜ ÌÂÙ·Ó¿ÛÙ¢Û˘ ÙˆÓ Ó¢-ÚÒÓˆÓ (·Á˘Ú›·, ·¯˘Á˘Ú›·, ÔÏ˘ÌÈÎÚÔÁ˘Ú›·, ÂÙÂ-ÚÔÙԛ˜), ÂÚÈÎÔÈÏȷΤ˜ ·ÔÙÈÙ·ÓÒÛÂȘ, ˘‰Ú·ÓÂ-

ÁÎÂÊ·Ï›· ‹ ÔÚÂÁÎÂÊ·Ï›· Î·È Û·ÓÈfiÙÂÚ· ‰È¿Ù·ÛËÙÔ˘ Ï·Á›Ô˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ·ÚÔ˘Û›·‰È·ÊÚ·ÁÌ·Ù›ˆÓ ÂÓÙfi˜ ·˘ÙÔ‡. E›Û˘, Â›Ó·È ‰˘Ó·ÙfiÓÓ· Û˘Ó˘¿Ú¯Ô˘Ó ·ÙÚÔÊ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ˘ÔÏ·-Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜, ˘ÔÂÂÓ‰˘Ì·ÙÈΤ˜ ·-ÛÂȘ ÙËÓ Ï¢΋ Ô˘Û›·, ΢ڛˆ˜ ·Ú¿ Ù· ÈÓȷο Τڷ-Ù·, ‰È·Ù·Ú·¯¤˜ Ù˘ Ì˘ÂϛӈÛ˘, Ï¢ÎÔ̷ϷΛ· ηÈ΢ÛÙÈ΋ ÂÁÎÂÊ·ÏÔ̷ϷΛ·. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ÂÎÙfi˜ ÙˆÓ ·ÔÙÈÙ·ÓÒÛÂˆÓ ·ÂÈÎÔÓ›˙ÔÓÙ·È Î˘Ú›ˆ˜Ì ÙËÓ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. H ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·-Ê›· ·Ó·‰ÂÈÎÓ‡ÂÈ ÙȘ ·ÔÙÈÙ·ÓÒÛÂȘ, ·ÏÏ¿ ·ÚÔ˘-ÛÈ¿˙ÂÈ ÌÈÎÚfiÙÂÚË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ·fi ÙËÌ·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÙËÓ ·Ó¿‰ÂÈÍË ÙˆÓ ˘ÔÏÔ›-ˆÓ ·ÏÏÔÈÒÛˆÓ. TÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÌÔÚ› ›-Û˘ Ó· ·Ôηχ„ÂÈ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ·Ó ηȷÚÔ˘ÛÈ¿˙ÂÈ ¯·ÌËÏfiÙÂÚË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙË-Ù· ·fi ÙË Ì·ÁÓËÙÈ΋ Î·È ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·-Ê›·.(4,6)

OÈ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ·ÔÙÈÙ·ÓÒÛÂȘ ÙÔ˘ ÂÁÎÂÊ¿-ÏÔ˘ Â›Ó·È Â‡ÚËÌ· Ù˘ÈÎfi Ïԛ̈͢ ·fi ΢ÙÙ·ÚÔÌÂ-Á·ÏÔ˚fi, ·ÏÏ¿ fi¯È ·ıÔÁÓˆÌÔÓÈÎfi. Œ¯Ô˘Ó ·Ó·ÊÂÚı›ÛÙÔ 40% ÂÚ›Ô˘ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Î·È·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘Î·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·. H ÂÁÁÂÓ‹˜ ·‰˘Ó·Ì›·Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ó· ·Ó·‰Â›ÍÂÈ ÙȘ ·Ô-ÙÈÙ·ÓÒÛÂȘ Â›Ó·È ÁÓˆÛÙ‹. OÈ ·ÔÙÈÙ·ÓÒÛÂȘ ¯·Ú·-ÎÙËÚÈÛÙÈο ÂÓÙÔ›˙ÔÓÙ·È ÂÚÈÎÔÈÏȷο, ·ÏÏ¿ ÌÔÚ››Û˘ Ó· ˘¿Ú¯Ô˘Ó ÙfiÛÔ ÛÙÔÓ ÊÏÔÈfi Î·È ÛÙËÓ ˘Ô-ÊÏÔÈÒ‰Ë ÌÔ›Ú· Ù˘ Ï¢΋˜ Ô˘Û›·˜ fiÛÔ Î·È ÛÙ· ‚·-ÛÈο Á¿ÁÁÏÈ·.

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

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

¶∞π¢π∞∆ƒπ∫∏ 2000;63:326-329 O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

328

EÈÎfiÓ· 2. ™˘ÌÌÂÙÚÈΤ˜ ÂÛٛ˜ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ Ì·۷ʋ fiÚÈ· ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁ-Ì·ÙÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·Ú¿ Ù· ÈÓȷο Τڷ-Ù·. ¶·ÚfiÌÔȘ ·ÏÏÔÈÒÛÂȘ ·ÂÈÎÔÓ›ÛıËÎ·Ó Î·È ÛÙËÓÂÓ Ùˆ ‚¿ıÂÈ Ô˘Û›· ÙˆÓ ÌÂوȷ›ˆÓ Î·È ÎÚÔÙ·ÊÈÎÒÓÏÔ‚ÒÓ ¿Ìʈ.

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K·Ù¿ ÙfiÔ˘˜ ÔÈ Û˘ÚÚ¤Ô˘Û˜ ·ÔÌ˘ÂÏÈÓˆÙÈΤ˜,ÌË ÂÍÂÏÈÛÛfiÌÂÓ˜ ÂÛٛ˜ ÛÙË Ï¢΋ Ô˘Û›·, Ô˘·Ô‰›‰ÔÓÙ·È ÛÂ Ô˘Ï¤˜ ÁÏÔ›ˆÛ˘, fiˆ˜ ·Ó·‰ÂÈ-ÎÓ‡ÔÓÙ·È Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ηıÒ˜ ηȿÏÏ· ¿Ù˘· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈ-ÁÚ·Ê› Û ÂÚÈÙÒÛÂȘ Ïԛ̈͢ Ì ΢ÙÙ·ÚÔÌÂÁ·-ÏÔ˚fi, ·fi ÙÔ˘˜ Sugita et al(9) Î·È Alonso et al(10)·ÓÙ›ÛÙÔȯ·. OÈ Steinlin et al (6) ÂÚȤÁÚ·Ê·Ó ÙÔ1966 ÂÙ¿ ·È‰È¿ Ì ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο ¢-Ú‹Ì·Ù· ·Ó¿ÏÔÁ· Ì ·˘Ù¿ Ù˘ ÌÈÎÚ‹˜ ·ÛıÂÓÔ‡˜Ì·˜, Èı·ÓÔÏÔÁÒÓÙ·˜ fi„ÈÌË Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔ-ÌÂÁ·ÏÔ˚fi.

M·ÎÚÔ¯ÚfiÓÈÔÈ Â·Ó¤ÏÂÁ¯ÔÈ ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÎÂÈ-̤ÓÔ˘ Ó· ·ÔÎÏÂÈÛı› Ù˘¯fiÓ ÂÍÂÏÈÎÙÈÎfiÙËÙ· ÙˆÓ ÎÏÈ-ÓÈÎÒÓ Î·È ÂÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. Œ¯ÂÈ ¿ÓÙˆ˜·Ó·ÊÂÚı› ÚÔԉ¢ÙÈ΋ ‚·ÚËÎÔ˝· Û ·È‰È¿ Ì ·Û˘-Ìو̷ÙÈ΋ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi(11),ÚÔԉ¢ÙÈ΋ ˘ÔÂÂÓ‰˘Ì·ÙÈ΋ Ó¤ÎÚˆÛË ÌÂÙ¿ ÙËÁ¤ÓÓËÛË(12) ÛÂ Û˘ÁÁÂÓ‹ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·-ÏÔ˚fi Î·È Ù¤ÏÔ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ‚·ÚÂÈ¿ ÂÍÂÏÈÎÙÈ΋ÂÁÎÂÊ·ÏÈ΋ ·ÙÚÔÊ›· Û ·È‰› Ì ÂÚÈÁÂÓÓËÙÈ΋ ÏÔ›-̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi(13).

™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ Ë ·ıÔÏÔÁÈ΋ ·ÂÈÎfiÓÈÛËÙ˘ Ï¢΋˜ Ô˘Û›·˜, Ô˘ Â›Ó·È Â‡ÚËÌ· ÌË ÂȉÈÎfi, ηÈË ·Ô˘Û›· ¿ÏÏˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ¢ÚËÌ¿ÙˆÓ, Û˘Ì‚·ÙÒÓ Ì ÚÒÈÌË Ïԛ̈ÍË ·fi ΢Ù-Ù·ÚÔÌÂÁ·ÏÔ˚fi fiˆ˜ ÚԷӷʤÚıËÎ·Ó ÛÂ Û˘Ó‰˘·-ÛÌfi Ì ÙËÓ ‹È·, ·ÏÏ¿ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfi-Ó· Ù˘ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ·˜ ‚·ÚËÎÔ˝·˜, Ù˘ ˘ÂÚÎÈÓË-ÙÈÎfiÙËÙ·˜ Î·È Ù˘ ÌÈÎÚ‹˜ ÂÚÈ̤ÙÚÔ˘ Ù˘ ÎÂÊ·Ï‹˜Ô˘ Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÚÔÛ‚ÔÏ‹ ·fiÙÔ Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û˘Ó¤‚Ë fi„ÈÌ· Î·È Ì¿ÏÈÛÙ· ηٿÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ Î·È Ë ÂÈÙ˘¯‹˜ ¯ÂÈ-ÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚·ÚËÎÔ˝·˜ Ì ÎÔ¯ÏÈ·ÎfiÂÌʇÙÂ˘Ì· ÛÙÔ ·ÎÔÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ NÔÛÔÎÔÌÂ›Ô˘Ì·˜ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÏfiÁÔ˘˜ ·ÚÔ˘Û›·Û˘ Ù˘ÂÚÁ·Û›·˜ Ì·˜.

BÈ‚ÏÈÔÁÚ·Ê›·1. Dobbins JG, Stewart JA, Demmler GJ. Surveillance of

congenital cytomegalovirus disease, 1990-1991.Collaborating Registry Group MMWR CDC Surveill Summ1992;41:35-39.

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

3. Yair D, Gull I, Peyser MR, Lessing JB. Congenitalcytomegalovirus infection. Eur J Obstet Gynecol ReprodBiol 1995;63:7-16.

4. Barkovich AJ, Lindau CE. Congenital cytomegalovirusinfection of the brain: Imaging analysis and embryologicalconsiderations. AJNR 1994;15:703-704.

5. Boech C, Issakainen J, Kewitz G, Kikinis R, Martin E,Boltshause E. Magnetic resonance imaging of the brain incongenital cytomegalocirus infection. Pediatr Radiol1989;19:91-93.

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

7. Barnes PD, Poussaint TY, Burrows PE. Imaging ofpediatric central nervous system infections. PediatricNeuroradiology 1994;4:367-391.

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

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

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

11. Williamson WD, Demmler GJ, Percy AK, Catlin FI.Progressice hearing loss in infants with asymptomaticcongenital cytomegalovirus infection. Pediatrics1992;90:862-866.

12. Bale JF, Sato Y, Eisert D. Progressive postnatalsubependymal necrosis in an infant with congenitalcytomegalovirus infection. Pediatr Neurol 1986;2:367.

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

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-04-1999HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2000

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: O. ¶··‰¿ÎË-¶··Ó‰Ú¤Ô˘∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, °Ô˘‰› 115 27

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1 AÎÙÈÓԉȷÁÓˆÛÙÈÎfi TÌ‹Ì· °.¶.N. ¶·›‰ˆÓ AıËÓÒÓ "AÁ›· ™ÔÊ›·"2 AÎÙÈÓԉȷÁÓˆÛÙÈÎfi TÌ‹Ì· ¶.°.N.A. "O E˘·ÁÁÂÏÈÛÌfi˜”

¶∞π¢π∞∆ƒπ∫∏ 2000;63:330-336

330

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

M·Ú›Ó· °. ¶··‰¿ÎË1, Iˆ¿ÓÓ˘ ™. K·ÛηڤÏ˘2

● ¶ÂÚ›ÏË„Ë: O fiÚÔ˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) Â›Ó·È ÂÚÈÁÚ·ÊÈÎfi˜ Î·È ·Ó·Ê¤ÚÂÙ·È Û οı "¯ˆ-Ú›˜ ÚÔÛ¿ıÂÈ·" ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÂÓÙfi˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. H ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂ-Ú‡ÓËÛË Ù˘ °O¶ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ‰ÔÎÈÌ·Û›· Bernstein, ÙËÓ ‰ÔÎÈÌ·Û›· Tuttle, ÙËÓ pH/ÌÂÙÚ›·, ÙÔ ÛÈÓıËÚÔÁÚ¿-ÊËÌ·, ÙËÓ Ì·ÓÔÌÂÙÚ›·, ÙËÓ ÂÓ‰ÔÛÎfiËÛË, ÙÔ ‚·ÚÈÔ‡¯Ô Á‡̷ (B°) Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (U/S). H ·ÚÔ‡Û· ÌÂ-ϤÙË Â›Ó·È ÂÎÙÂÓ‹˜ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÛÙÔ ı¤Ì· Ù˘ °O¶ ÛÙ· ·È‰È¿, Û¯ÂÙÈο Ì ÙÔ˘˜ ÙÚfiÔ˘˜ ·ÂÈ-ÎÔÓÈÛÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ‹˜ Ù˘. K‡ÚÈÔ˜ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì B° Â›Ó·È Ë ‰È·›ÛÙˆÛË ‹ Ô ·ÔÎÏÂÈÛÌfi˜ ·Ó¿ÚÎÂÈ-·˜ ÙÔ˘ ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Î·È ÙˆÓ ·‰ÚÒÓ ÌÔÚÊÒÓ ÔÈÛÔÊ·Á›Ùȉ·˜, ÂÓÒ Û˘Ó‹ıˆ˜ ÌÂÏÂÙ¿Ù·È ÙÔ Û‡ÓÔÏÔÙÔ˘ ·ÓÒÙÂÚÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H ¢·ÈÛıËÛ›· Î˘Ì·›ÓÂÙ·È ·fi 20-73% (Ì.Ô. 35%) Î·È Ë ÂȉÈÎfiÙËÙ· Â-Ú› ÙÔ 30% ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ. TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì Tc99m ıˆÚÂ›Ù·È Ì¤ıÔ‰Ô˜ ÏÈÁfiÙÂÚÔ Â˘·›ÛıË-ÙË ÙÔ˘ B°, ¯Ú‹ÛÈÌË fï˜ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ·˘ÙÔηı¿ÚÛˆ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. TÔ ÛÈÓıËÚÔÁÚ¿-ÊËÌ· ¤¯ÂÈ Î·ÙÂÍÔ¯‹Ó ¤Ó‰ÂÈÍË fiÔ˘ Ë °O¶ ÂΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfiÈı·Ó‹˜ ÂÈÛÚÔÊ‹Ûˆ˜ ÛÙÔ˘˜ Ó‡ÌÔÓ˜, Û ÂÚÈÙÒÛÂȘ ηı˘ÛÙÂÚË̤Ó˘ Á·ÛÙÚÈ΋˜ ΤӈÛ˘ Î·È ·Ó·ÁˆÁ‹˜ ÌËÔÍ›ÓÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘. TÔ U/S ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ °O¶ Î·È Ù˘ ÔÈÛÔÊ·Á›ÙÈ-‰·˜ ˆÛÙfiÛÔ, ÌÔÚ› Ó· ÌÂÏÂÙËıÔ‡Ó ÏÂÙÔÌÂÚÒ˜ Ë ·Ó·ÙÔÌ›· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ Û˘Ì-‚ÔÏ‹˜. £· ÌÔÚÔ‡Û ӷ Û˘ÛÙËı› ˆ˜ screening test Û ÎÏÈÓÈο ˘fiÙÔ˘˜ ÁÈ· °O¶ ·ÛıÂÓ›˜ Î·È Ì¿ÏÈÛÙ· ËÏÈΛ·˜Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ, Ì ‹ ¯ˆÚ›˜ Ù·˘Ùfi¯ÚÔÓË ÂÊ·ÚÌÔÁ‹ pH/ÌÂÙÚ›·˜. TÔ U/S ˆ˜ ÌfiÓË Ì¤ıÔ‰Ô˜ ˘ÔÏ›ÂÙ·È Û ·ÎÚ›-‚ÂÈ· Ù˘ pH/ÌÂÙÚ›·˜ Î·È ¤¯ÂÈ ÙËÓ ›‰È· Ì ÙÔ B° ÂȉÈÎfiÙËÙ· (30%). ¶·È‰È·ÙÚÈ΋ 2000;63:330-336.

§¤ÍÂȘ ÎÏÂȉȿ: Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ·È‰È΋ ËÏÈΛ·, ·ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË.

M. Papadaki, I. Kaskarelis. GastroÔesophageal reflux in children: methods of radiological evaluation.Paediatriki 2000;63:330-336.● Abstract: GastroÔesophageal reflux (GER) is the passage of gastric contents into the lower oesophagus andthe term usually refers to symptomatic GER with or without histological oesophageal abnormalities. Variousdiagnostic tests are available for the assessment of the patient with suspected GER; the Bernstein test, the Tuttletest, intraoesophageal pH monitoring, gastric scintigraphy, oesophageal manometry, endoscopy, uppergastrointestinal (GI) barium studies and ultrasonography. The main aims of upper GI barium studies in examiningchildren with suspected GER are to assess the adequacy of the antireflux mechanism and to detect grossmorphological changes of reflux oesophagitis and possible upper gastrointestinal tract anatomical abnormalities.The sensitivity of barium studies varies between 20% and 73% and the specificity is estimated at 30% ofsymptomatic patients. Gastric scintigraphy is probably less sensitive than upper GI barium studies, although it isuseful for evaluating oesophageal function and clearance. and is indicated primarily for evaluating infants withsuspected aspiration, delayed gastric emptying and nonacid reflux. Ultrasonography (US) permits only poorassessment of the severity of GER and oesophagitis but it provides unique morphological information about thegastrooesophageal junction. US evaluation is almost as specific as upper GI barium studies for demonstratingGER in children but less accurate than oesophageal pH monitoring. It could be used as a screening test, coupledor not to pH analysis, in patients at risk, especially those under the age of 5 years.

Key words: gastroÔesophageal reflux, childhood, radiological evaluation.

™À¡∂Ãπ∑Oª∂¡∏ ∂∫¶∞π¢∂À™∏

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EÈÛ·ÁˆÁ‹ O fiÚÔ˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶)

Â›Ó·È ÂÚÈÁÚ·ÊÈÎfi˜ Î·È ·Ó·Ê¤ÚÂÙ·È Û οı "¯ˆÚ›˜ÚÔÛ¿ıÂÈ·" ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ Â-ÚȯÔ̤ÓÔ˘ ÂÓÙfi˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘.(1) O ÂÈÔÏ·-ÛÌfi˜ (fï˜ ÛÙËÓ ·ıÔÏÔÁ›· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·Ó¤Ú-¯ÂÙ·È ÛÙÔ 75% Ì prevalence) Ù˘ °O¶ ÛÙÔ ÁÂÓÈÎfiÏËı˘ÛÌfi ÂÎÙÈÌ¿Ù·È ÛÙÔ 2-5% (2), Ë Û˘Ì‚ÔÏ‹ ÙË˜Û˘¯Ó¤˜, ·Ù˘¯Ò˜, ηٷ¯Ú‹ÛÂȘ Î·È ÛÙË ‰È¿ÁÓˆÛË Î·ÈÛÙË ıÂڷ›· Ù˘.

AÓ Î·È Ë ·ÓÙ›ÏË„Ë ÁÈ· ÙË °O¶ ¿Ú¯ÈÛ ӷ ·Ó·-Ù‡ÛÛÂÙ·È ÛÙË ‰ÂηÂÙ›· ÙÔ˘ 1930, Û˘¯ÓfiÙÂÚË ·Ó·-ÊÔÚ¿ Û ·˘Ù‹Ó ·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ Î·Ù¿ Ù· ÙÂÏ¢-Ù·›· 15-20 ¯ÚfiÓÈ·(3). A˘Ùfi, ÚÔÊ·ÓÒ˜, Û¯ÂÙ›˙ÂÙ·ÈÎ·È Ì ÙȘ Û‡Á¯ÚÔÓ˜ ηÏÏ›ÙÂÚ˜ ‰È·ÁÓˆÛÙÈΤ˜ ÙÂ-¯ÓÈΤ˜ ·ÏÏ¿ Î·È Ì ÙËÓ ·˘ÍË̤ÓË ÂÓË̤ڈÛË - ÂÙÔÈ-ÌfiÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÁÈ·ÙÚÒÓ.

¶·ıÔÊ˘ÛÈÔÏÔÁ›·◊‰Ë ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1950 Ë ·ıÔÊ˘ÛÈÔÏÔ-

Á›· Ù˘ °O¶ ›¯Â Û˘Û¯ÂÙÈÛı› Ì ÙÔ ÌÂȈ̤ÓÔ ÙfiÓÔ(¯·Ï·ÚfiÙËÙ·) ÙÔ˘ ηÙÒÙÂÚÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÛÊÈÁÎÙ‹-Ú· (KO™) Ô ÔÔ›Ô˜ ıˆÚÂ›Ù·È ˆ˜ Ô Î˘ÚÈfiÙÂÚÔ˜ÊÚ·ÁÌfi˜ ÚÔÛÙ·Û›·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·fi ÙÔ fiÍÈÓÔÂÚȯfiÌÂÓÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘.(3,4)

™ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ÌÔÓÙ¤ÏÔ Ô ÔÈÛÔÊ¿ÁÔ˜ ÛÙÔÛ‡ÓÔÏfi ÙÔ˘ ÏÂÈÙÔ˘ÚÁ› ˆ˜ ÚÔˆıËÙÈ΋ ·ÓÙÏ›·, ÔÛÙfiÌ·¯Ô˜ ˆ˜ ·Ôı‹ÎË ÂÓÒ Ô KO™ ˆ˜ ‚·Ï‚›‰· ÌÔ-Ó‹˜ ηÙ¢ı‡ÓÛˆ˜. ¶ÏËÌÌÂÏ‹˜ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘KO™, Û˘ÓÂÈÎÔ˘ÚÔ‡ÌÂÓË ÂӉ¯Ô̤ӈ˜ ·fi ¿ÏÏÔ˘˜·Ú¿ÁÔÓÙ˜ (·ÚÔ˘Û›· ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘, ·˘ÍË-̤ÓË ÔÛfiÙËÙ· Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, ·˘ÍË̤-ÓË ÂÓ‰ÔÎÔÈÏȷ΋ ›ÂÛË, ηı˘ÛÙÂÚË̤ÓË Î¤ÓˆÛËÛÙÔÌ¿¯Ô˘, ÌÂȈ̤ÓË ·ÓÙÔ¯‹ ÔÈÛÔÊ·ÁÈÎÔ‡ ÂÈıËÏ›-Ô˘, ÌË Ê˘ÛÈÔÏÔÁÈ΋ ÎÈÓËÙÈÎfiÙËÙ· - ·˘ÙÔοı·ÚÛËÔÈÛÔÊ¿ÁÔ˘ Î.¿.) Ô‰ËÁ› ÛÙËÓ ·Ó·ÁˆÁ‹ Î·È Ù· ·-ÎfiÏÔ˘ı¿ Ù˘ (3-5). O KO™ ‰È·ÙËÚÂ›Ù·È Û ÙÔÓÈ΋ۇ۷ÛË Û ÂÚ›Ô‰Ô ËÚÂÌ›·˜ Î·È ¯·Ï·ÚÔ‡Ù·È ÚÔ˜ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÂÚÈÛÙ·ÏÙÈÎÔ‡ ·̷ÙÔ˜ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙË ‰›Ô‰Ô ÙÔ˘ ‚ψÌÔ‡(6). O Û˘-ÓÙÔÓÈÛÌfi˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ Î·Ù¿ÏÏËÏË Ó‡ڈ-ÛË Ù˘ ÂÚÈÔ¯‹˜ ÂÎ ÙˆÓ ˆÓ ԢΠ¿Ó¢ ÁÈ· ÙË ÏÂÈ-ÙÔ˘ÚÁ›· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. TÔ ÁÂÁÔÓfi˜ fiÙÈ Ë °O¶ ›-Ó·È Û˘¯ÓfiÙÂÚË ÛÙÔ˘˜ 2 ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜ (1:300¤ˆ˜ 1:1000)(4) ηıÒ˜ Î·È ÛÙÔ 10% ÂÚ›Ô˘ وӷȉÈÒÓ Ì Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (ÓÔËÙÈ΋˘ÛÙ¤ÚËÛË, Ù¤ÙÚ·- ‹ ËÌÈ·ÚÂÙÈ΋ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿-Ï˘ÛË ÎÏ)(5,7) ·Ô‰›‰ÂÙ·È Û ·Ó·ÙÔÌÈ΋ Î·È ÏÂÈ-ÙÔ˘ÚÁÈ΋ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ Ó¢ÚÔÌ˯·ÓÈÛÌÔ‡ ÚÔ-ÛÙ·Û›·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. (1) EÈϤÔÓ, Ë ÔÛfiÙËÙ·ÔÍ›ÓÔ˘ ÂÎÎÚ›Ûˆ˜ › ÎÂÓÔ‡ ÛÙÔÌ¿¯Ô˘ Â›Ó·È Ë ›‰È·Ì ÙÔ˘ ÂÓËÏ›ÎÔ˘ (30Mmol/Kgr/ÒÚ·), Ë ¯ˆÚËÙÈÎfiÙË-Ù· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÌÈÎÚfiÙÂÚË(4) ÂÓÒ Î·È ÙÔ ÂÓ‰Ô-ÎÔÈÏÈ·Îfi ÙÌ‹Ì· (ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·ÚÂ-

Ìfi‰ÈÛË ·ÏÈÓ‰ÚÔÌ‹Ûˆ˜) Â›Ó·È Û˘ÁÎÚÈÙÈο ‚Ú·¯‡-ÙÂÚÔ ·fi ·˘Ùfi ÙÔ˘ ÂÓËÏ›ÎÔ˘.(1) TÔ Ì‹ÎÔ˜ ÙÔ˘ ÔÈ-ÛÔÊ¿ÁÔ˘ ·˘Í¿ÓÂÈ Ì ÙËÓ ·‡ÍËÛË Î·È ‰È¿Ï·ÛË ÙÔ˘·È‰ÈÔ‡ Î·È ·˘Ùfi Èı·ÓÒ˜ ÂÍËÁ› ÙËÓ ·˘ÙfiÌ·ÙˇÊÂÛË ÙˆÓ ·Ó·ÁˆÁÒÓ ÌÂÙ¿ ÙÔ 18Ô Ì‹Ó·.(8) T¤ÏÔ˜,¤¯ÂÈ ÂÚÈÁÚ·Ê› °O¶ Ì ·˘ÍË̤ÓÔ ÙfiÓÔ KO™ ËÈfi-ÙÂÚ˘ ¿ÓÙˆ˜ ‰È·‰ÚÔÌ‹˜(9) ÂÓÒ ÚfiÛÊ·Ù˜ ÌÂϤ-Ù˜ Û˘Ó‰˘¿˙Ô˘Ó ·ÈÙÈÔÏÔÁÈο ÙË °O¶ Ì ·ÏÏÂÚÁ›·ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜.(10)

KÏÈÓÈ΋ ÂÈÎfiÓ·T· ΢ÚÈfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Ù˘ °O¶ Û˘ÓÔ„›˙Ô-

ÓÙ·È ÛÙÔÓ ›Ó·Î· 1. H °O¶ ÌÔÚ› Ó· ÚÔηϤÛÂȉȷٷڷ¯¤˜ Ù˘ ·Ó¿Ù˘Í˘, ÂÈÏÔΤ˜ ·fi ÙÔ Â-ÙÈÎfi Û‡ÛÙËÌ· (ÙÂÚˉfiÓ·, ÔÈÛÔÊ·Á›Ùȉ·, Ô˘ÏÒ‰ËÛÙ¤ÓˆÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ÔÈÛÔÊ¿ÁÔ Barrett, ÂÓ‰ÔÔÈ-ÛÔÊ·ÁÈÎÔ‡˜ Ôχԉ˜), ·fi ÙÔ Î·Ú‰ÈÔ·Ó·Ó¢-ÛÙÈÎfi Û‡ÛÙËÌ· (˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ, ·ÓÙÈ-‰Ú·ÛÙÈ΋ ÓfiÛÔ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, ·ÛıÌ·ÙÈ΋‚ÚÔÁ¯›Ùȉ·, ¿ÓÔÈ·, ‚Ú·‰˘Î·Ú‰›·, ÛÈÁÌfi, Ï·Ú˘ÁÁÈ-Îfi ÎÔÎΛˆÌ· Î.¿.) ÂÓÒ Ë Û¯¤ÛË Ù˘ Ì ÙÔ Û‡Ó‰ÚÔÌÔ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ (SIDS) ·Ú·Ì¤ÓÂÈ·ÌÊÈÏÂÁfiÌÂÓË(4,7).

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ °O¶H ÏÂÙÔÌÂÚ‹˜ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÚÔÛÂ-

ÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ÔÙÂÏÔ‡Ó, ÛÙ·¯¤ÚÈ· ÙÔ˘ ¤ÌÂÈÚÔ˘ ÁÈ·ÙÚÔ‡, ÙÔ ÚÒÙÔ Î·È Î·Ï‡ÙÂÚԉȷÁÓˆÛÙÈÎfi ÂÚÁ·Ï›Ô. ∂ÓÙÔ‡ÙÔȘ, ÁÈ· ÙË ‰È¿ÁÓˆÛË,Â›Ó·È ··Ú·›ÙËÙË Ë ÂÚÁ·ÛÙËÚȷ΋ Û˘Ó‰ÚÔÌ‹ ÔÈ Î˘-ÚÈfiÙÂÚÔÈ ÂÎÚfiÛˆÔÈ Ù˘ ÔÔ›·˜ ηٷÁÚ¿ÊÔÓÙ·ÈÛÙÔÓ ›Ó·Î· 2.

¶›Ó·Î·˜ 1. T· ΢ÚÈfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Ù˘ °O¶.

1. ŒÌÂÙÔÈ - ·Ó·ÁˆÁ¤˜2. ¢˘ÛÊ·Á›·3. EÈÁ¿ÛÙÚÈÔ ‹ ÔÈÛıÔÛÙÂÚÓÈÎfi ¿ÏÁÔ˜

Ù‡Ô˘ ÛÙËı¿Á¯Ë˜4. OÈÛıÔÛÙÂÚÓÈÎfi˜ η‡ÛÔ˜5. EÚ˘Á¤˜, ÌÂÙ·ÁÂ˘Ì·ÙÈÎfi ·›ÛıËÌ· ÏËÚÒÛˆ˜6. AÓÔÚÂÍ›· Èı·ÓÒ˜ ÏfiÁˆ ¿ÏÁÔ˘˜

ηٿ ÙËÓ Î·Ù¿ÔÛË (odynophagia)7. MËڢηÛÌfi˜8. AÓ·ÈÌ›· ÛȉËÚÔÂÓÈ΋9. AÈÌ·Ù¤ÌÂÛË - ̤ϷÈÓ·

10. AÒÏÂÈ· ‚¿ÚÔ˘˜ - η΋ ıÚ¤„Ë11. E˘ÂÚÂıÈÛÙfiÙËÙ· - ¿Ù˘ÔÈ ÎÔÏÈÎÔ›12. ¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘13. XÚfiÓÈ· ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù·14. ™‡Ó‰ÚÔÌÔ Sandifer (ÔÈÛıfiÙÔÓÔ˜,

ÌË Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË ÎÂÊ·Ï‹˜)

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

H ‰ÔÎÈÌ·Û›· Bernstein ™˘Ó›ÛÙ·Ù·È Û ÙÔÔı¤ÙËÛË Î·ıÂÙ‹Ú· ̤¯ÚÈ ÙÔ˘

̤ÛÔ˘ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Î·È ÂÓ·ÏÏ·ÛÛfiÌÂÓ˜ ÂÁ¯‡ÛÂÈ˜Ê˘ÛÈÔÏÔÁÈÎÔ‡ - ÔÍ›ÓÔ˘ ‰È·Ï‡Ì·ÙÔ˜ Ì ٷ˘Ùfi¯ÚÔÓË·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ë ‰Â ÂÌÂÈÚ›·ÛÙ· ·È‰È¿ Â›Ó·È Ìˉ·ÌÈÓ‹ (7). ™‹ÌÂÚ· ϤÔÓ Ë ‰ÔÎÈ-Ì·Û›· Bernstein ‰ÂÓ ¯ÚËÛÈÌÔÔÈ›ٷÈ.

H ‰ÔÎÈÌ·Û›· Tuttle E›Ó·È Ë ÂÏÂÁ¯fiÌÂÓË, ÌÂÙ¿ ¯ÔÚ‹ÁËÛË ¯˘ÌÔ‡ Ì‹-

ÏÔ˘, pH/ÌÂÙÚ›· Ì ÌÂÁ·Ï‡ÙÂÚË ›Ûˆ˜ ¢·ÈÛıËÛ›· ηÈÔχ ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ˘ı‹Ûˆ˜ ·fi fiÙÈ Ë‰ÔÎÈÌ·Û›· Berstein (7). T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘‰ÔÎÈÌ·Û›·˜ Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏÔ Ó· ÂÚÌËÓ¢ıÔ‡ÓÎ·È ‰ÂÓ Â›Ó·È ·ÍÈfiÈÛÙ·.

H pH/ÌÂÙÚ›· °ÂÓÈο ıˆÚÂ›Ù·È ˆ˜ Ë Î·Ï‡ÙÂÚË ÂÚÁ·ÛÙËÚȷ΋

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

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

TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì Tc99m ıˆÚÂ›Ù·È Ì¤ıÔ-

‰Ô˜ ÏÈÁfiÙÂÚÔ Â˘·›ÛıËÙË, ¯Ú‹ÛÈÌË fï˜ ÛÙËÓ ÂÎÙ›ÌË-ÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ·˘ÙÔηı¿ÚÛˆ˜ ÙÔ˘ ÔÈÛÔÊ¿-ÁÔ˘ (13) ηıÒ˜ Î·È Û ÂÚÈÙÒÛÂȘ ·Ó·ÁˆÁ‹˜ ¯ÔÏ‹˜‹ ·¯ÏˆÚ˘‰Ú›·˜ fiÔ˘ Ë PH/ÌÂÙÚ›· ÌÔÚ› Ó· ‰ÒÛÂÈ„Â˘‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·.(12) EÈÙÚ¤ÂÈ Â›Û˘ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ Ú˘ıÌÔ‡ Á·ÛÙÚÈ΋˜ ÎÂÓÒÛˆ˜, ÛË-Ì·ÓÙÈ΋˜ ·Ú·Ì¤ÙÚÔ˘ ÛÙË ÌÂϤÙË Ù˘ °O¶, ÙÔÓÂÓÙÔÈÛÌfi Ó¢ÌÔÓÈÎÒÓ ÂÈÛÚÔÊ‹ÛˆÓ(6) ηÈ, ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ÔÈÛÔÊ·ÁÈ΋ Ì·ÓÔÌÂÙÚ›·, ÙËÓ ·Ó›¯Ó¢ÛËÂÚÈÙÒÛÂˆÓ °O¶ Ì ‰È·Ù·Ú·¯‹ Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ÂÙÈÎÔ‡.(1) ø˜ ·Ú·Ù‹ÚËÛË fï˜,ÂÎÙ›ÓÂÙ·È Û ÂÚÈÔÚÈṲ̂ÓÔ ¯ÚfiÓÔ, ·Ó··Ú¿ÁÂٷȉ‡ÛÎÔÏ·, ‰ÂÓ ÚÔÛ‰ÈÔÚ›˙ÂÈ Ì ·ÎÚ›‚ÂÈ· ÙËÓ ÔÛfiÙË-Ù· ·Ó·ÁˆÁ‹˜ Î·È Î·ıfiÏÔ˘ ÙȘ Ù˘¯fiÓ ·Ó·ÙÔÌÈΤ˜ ·Óˆ-̷ϛ˜.(6) E›Ó·È ̤ıÔ‰Ô˜ ¿ÓÂÙË ÁÈ· ÙÔÓ ¿ÚÚˆÛÙÔ Î·È¯·ÌËÏ‹˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ (¯·ÌËÏfiÙÂÚ˘ ·fi ÂΛ-Ó˘ ÙÔ˘ B°)(6,14) Î·È ¤¯ÂÈ Î·ÙÂÍÔ¯‹Ó ¤Ó‰ÂÈÍË fiÔ˘ Ë°O¶ ÂΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢-ÛÙÈÎfi ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi Èı·Ó‹˜ ÂÈÛÚÔÊ‹Ûˆ˜ÛÙÔ˘˜ Ó‡ÌÔÓ˜. H ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÔÈΛ-ÏÂÈ Â˘Ú¤ˆ˜ ·Ó¿ÌÂÛ· ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Î·È Î˘-Ì·›ÓÂÙ·È ·fi 14-90% (Ì.Ô. 65%).(13)

H Ì·ÓÔÌÂÙÚ›· H Ì·ÓÔÌÂÙÚ›· ·Ú¿ ÙÔ fiÙÈ ıˆڋıËΠ̤ıÔ‰Ô˜

"ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË" Ì ‰˘Ó·ÙfiÙËÙ˜ ηٷÁÚ·Ê‹˜ÌÂÙ·‚ÔÏÒÓ ÛÙÔ ‚·ÛÈÎfi ÙfiÓÔ ÙÔ˘ KO™, ·Â‰Â›¯ıË ÙÂ-ÏÈÎÒ˜ ÌÈÎÚ‹˜ ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜, Û˘Ó‰˘·˙fiÌÂÓË Û·-ÓÈfiÙÂÚ· Ì ¿ÏϘ ‰ÔÎÈ̷ۛ˜ Î·È ·Ú·Ì¤ÓÔ˘Û·, ΢-Ú›ˆ˜, ˆ˜ ÂÚÁ·ÏÂ›Ô ¤Ú¢ӷ˜.(6)

H ÂÓ‰ÔÛÎfiËÛË H ÂÓ‰ÔÛÎfiËÛË, Ì ٷ˘Ùfi¯ÚÔÓË Î·Ù¿ ηÓfiÓ·

‚ÈÔ„›·,(15) ÏËÚÔÊÔÚ› ÁÈ· ÙËÓ ‡·ÚÍË ‹ fi¯È ÔÈÛÔ-Ê·Á›Ùȉ·˜ Î·È ÙË ÛÔ‚·ÚfiÙËÙ¿ Ù˘ ηıÒ˜ Î·È ÁÈ· ÙËÁÚ·ÌÌ‹ ÌÂÙ·ÙÒÛˆ˜ ÙÔ˘ Ï·ÎÒ‰Ô˘˜ ÂÈıËÏ›Ô˘ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÛÙÔ Î˘ÏÈÓ‰ÚÈÎfi ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (ÔÈÛÔ-Ê¿ÁÔ˜ Barrett).(8) MÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ‰È¿ÁÓˆ-ÛË ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ Î·È ÁÂÓÈÎÒ˜ ıˆÚÂ›Ù·È ··-Ú·›ÙËÙË Û ÛÔ‚·Ú¤˜, ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ.

H ÌÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ H ÌÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ (B°) ıˆÚÂ›Ù·È Ì¤ıÔ-

‰Ô˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÚÔÛÈÙ‹ Î·È ÊıËÓ‹. ™˘Ó‹ıˆ˜ ‰ÂÓÂÚÈÔÚ›˙ÂÙ·È ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ ·ÏÏ¿ ·ÊÔÚ¿ ÙÔ Û‡ÓÔÏÔÙÔ˘ ·ÓˆÙ¤ÚÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ (¤ˆ˜ ÙÔ Û‡Ó‰ÂÛÌÔ ÙÔ˘

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

EÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË

1. ¢ÔÎÈÌ·Û›· Bernstein2. ¢ÔÎÈÌ·Û›· Tuttle3. 24-ˆÚË ÂÓ‰ÔÔÈÛÔÊ·ÁÈ΋ PH/ÌÂÙÚ›·4. OÈÛÔÊ·ÁÔÁ·ÛÙÚÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·

Ì Ó¢ÌÔÓÈÎfi monitoring5. OÈÛÔÊ·ÁÔÁ·ÛÙÚÈ΋ Ì·ÓÔÌÂÙÚ›·6. EÓ‰ÔÛÎfiËÛË - ‚ÈÔ„›· ÔÈÛÔÊ¿ÁÔ˘7. B·ÚÈÔ‡¯Ô ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·

(‚·ÚÈÔ‡¯Ô Á‡̷ - B°)8. YÂÚ˯ÔÁÚ¿ÊËÌ· (UltraSound - U/S)

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333

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

K·Ù¿ ÙËÓ ÌÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ ·Ú¤¯ÔÓÙ·È›Û˘ ÏËÚÔÊÔڛ˜ ˆ˜ ÚÔ˜ ÙËÓ ‡·ÚÍË ‹ fi¯È ‰È·-ÊÚ·ÁÌ·ÙÔ΋Ï˘ (ÂÈÎfiÓ· 1), ÙÔ Ì¤ÁÂıÔ˜ ˘¿Ú¯Ô˘Û·˜‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘, ÙËÓ ‡·ÚÍË ÔÈÛÔÊ·ÁÈ΋˜ ÛÙÂÓÒ-Ûˆ˜ (‚·ıÌfi˜-¤ÎÙ·ÛË), ‰È·Ù·Ú·¯ÒÓ Ù˘ ÎÈÓËÙÈÎfiÙË-Ù·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ηı˘ÛÙÂÚË̤Ó˘ Á·ÛÙÚÈ΋˜ ÎÂ-ÓÒÛˆ˜ (antral dyskinesia) Î·È ÂÈÛÚÔÊ‹Ûˆ˜ ÛÙÔ ·Ó·-Ó¢ÛÙÈÎfi. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ B°ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ Á·ÛÙÚÈ΋˜ ÎÂÓÒÛˆ˜ Â›Ó·È ÂÚÈÔ-ÚÈṲ̂ÓË Î·ıÒ˜ ÙÔ ‚¿ÚÈÔ Â›Ó·È Ô˘Û›· ·‰Ú·Ó‹˜ ηÈ, ˆ˜ÂÎ ÙÔ‡ÙÔ˘, ‰ÂÓ ÂÓÂÚÁÔÔÈ› ÙÔ˘˜ ‰ˆ‰Âη‰·ÎÙ˘ÏÈÎÔ‡˜˘Ô‰Ô¯Â›˜ Ô˘ ÙË Ú˘ıÌ›˙Ô˘Ó (8). Œ¯ÂÈ ÚÔÙ·ı› Ù·ÍÈ-ÓfiÌËÛË ÛÙË ÌÂϤÙË Ù˘ °O¶ Ì B° ·Ó·ÏfiÁˆ˜ ÙÔ˘ ÂÈ-¤‰Ô˘ ·Ó·ÁˆÁ‹˜, ·fi 1 (·Ó·ÁˆÁ‹ ÛÙÔ ÂÓ‰ÔÎÔÈÏÈ·ÎfiÙÌ‹Ì· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘) ̤¯ÚÈ 5 (·Ó·ÁˆÁ‹ Ì ÂÈÛÚfiÊË-ÛË)(16), ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ fï˜ ÎÏÈÓÈÎÔ› ‰ÂÓ ıˆÚÔ‡Ó·Ó·Áη›· ÌÈ· Ù¤ÙÔÈ· ÔÛÔÙÈ΋ ‰È·‚¿ıÌÈÛË ·ÊÔ‡ ÙÔ‡„Ô˜ Ù˘ ·Ó·ÁˆÁ‹˜ ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ô‡Ù Ì ÙË ‚·-Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, Ô‡Ù Ì ٷ PH/ÌÂÙÚÈο Â˘Ú‹Ì·Ù·,Ô‡Ù Ì ÙË ıÂڷ¢ÙÈ΋ ·¿ÓÙËÛË.(12,16)

H ÌÂϤÙË Ì B° Û˘Ó¿ÁÂÙ·È ¤ÎıÂÛË ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Û ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·. K·ıÒ˜ Ô ·Ô‰ÂÎÙfi˜¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎÔ‹Ûˆ˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙˆÓ ÂÓÙÔÈ-ÛÌfi ÂÚÈÛÙ·ÛÈ·ÎÒÓ °O¶ ‹ ¿ÏÏˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Ìfi-ÓÔ ˘fi ÔÚÈṲ̂Ó˜ Û˘Óı‹Î˜ (.¯. ÌfiÓÔ Û fiÚıÈ· ÛÙ¿-ÛË, ÌfiÓÔ ÙË Ó‡¯Ù· ‹ ÌfiÓÔ Û ηٿÛÙ·ÛË ÓËÛÙ›·˜) Ë¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÌÂÈÒÓÂÙ·È Î·È Ë ·Í›· Ù˘,ȉ›ˆ˜ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ Ù¯ÓÈÎÒÓ, Û˘˙ËÙ›-Ù·È.(15,17) ™Â ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜ Ë Â˘·ÈÛıËÛ›· ΢-Ì·›ÓÂÙ·È ·fi 20-73% (Ì.fi. 35%) Î·È Ë ÂȉÈÎfiÙËÙ· ÂÚ›ÙÔ 30% ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ.(12,15) ™ÙԄ¢‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Û˘Ì‚¿ÏÏÂÈ Ë ¯ÔÚ‹ÁË-ÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ‚·Ú›Ô˘ ÛÙÔ ‰Â „¢‰Ò˜ ıÂÙÈÎfiÔÈ ÎÚ·˘Á¤˜, Ë ¿ÛÎËÛË È¤Ûˆ˜ ÛÙÔ ÎÔÈÏÈ·Îfi ÙÔ›¯ˆÌ·,Ë ¯·ÌËÏfiÙÂÚË ı¤ÛË Ù˘ ÎÂÊ·Ï‹˜ Î·È Ô ˘ÂÚ‚¿ÏψÓ˙‹ÏÔ˜ ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÌÈÎÚÔ·Ó·ÁˆÁÒÓ (12). TÔ B°ÏÔÈfiÓ Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ÔÛfiÙËÙ· Û˘Ó‹ıÔ˘˜Á‡̷ÙÔ˜ Î·È Ì ÙÔÓ ·ÛıÂÓ‹, ηٿ ÙÔ ‰˘Ó·ÙfiÓ, ‹ÚÂÌÔ.TÔ ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· ıˆÚÂ›Ù·È ıÂÙÈÎfi fiÙ·Ó ·Ú·ÙË-ÚËıÔ‡Ó ‹ 2 ·Ó·ÁˆÁ¤˜ ÛÙÔ Û‡ÓÙÔÌÔ ¯ÚfiÓÔ ÂÍÂÙ¿Ûˆ˜‹ 1 ·Ó·ÁˆÁ‹ Ì ۷ʋ fï˜ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ Î¿-ı·ÚÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·fi ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi(12). ¶ÚÒ-ÈÌË ÎÚÈÎÔÊ·Ú˘ÁÁÈ΋ Û‡Û·ÛË ÌÂÙ¿ ÙȘ ÚÒÙ˜ ηٷ-

fiÛÂȘ ‚·Ú›Ô˘, ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· °O¶.(18)XÂÈÚÈÛÌÔ› ÚfiÎÏËÛ˘ (provocative maneuvers),

fiÙ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÊ·ÚÌÔÛıÔ‡Ó, ÂÈÙÚ¤Ô˘ÓÌÂÓ ÙË Û‡ÏÏË„Ë ÂÚÈÛÛÔÙ¤ÚˆÓ ·Ó·ÁˆÁÒÓ, ·˘Í¿-ÓÔ˘Ó ‰ËÏ·‰‹ ÙËÓ Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘, ÌÂÈÒ-ÓÔ˘Ó fï˜ ÙËÓ ÂȉÈÎfiÙËÙ¿ Ù˘.(15) ¶ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÙÔ ‚‹¯·, ÙË ‰ÔÎÈÌ·Û›· Valsava, ÙË ÌÂÙ·‚ÔÏ‹ ı¤ÛÂ-ˆ˜ ·fi ‡ÙÈ· Û ‰ÂÍÈ¿ Ï¿ÁÈ· Î·È ÙË ‰ÔÎÈÌ·Û›·water siphon. ™Â ÌÂϤÙË ÙˆÓ J Keith-Thompson etal.(11) ÂÓÒ Ë ·˘ÙfiÌ·ÙË ·Ó·ÁˆÁ‹ Ì B° ·Â‰Â›¯ıËıÂÙÈ΋ ÛÙÔ 26% ÙˆÓ Â›Û˘ ıÂÙÈÎÒÓ ÛÙËÓ PH/ÌÂ-ÙÚ›·, ÂÚÈÙÒÛˆÓ, Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·Ú·¿-Óˆ ¯ÂÈÚÈÛÌÒÓ ÙÔ ÔÛÔÛÙfi ·˘Í‹ıËΠÛÙÔ 70% ·Îfi-ÌË Î·È Û ÂÚÈÙÒÛÂȘ (Û·ÓÈfiÙÂÚ·) ·ÚÓËÙÈΤ˜ÛÙËÓ PH/ÌÂÙÚ›· (11).

¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÙÔ B°, ·ÚfiÙÈ ıˆÚ›ٷÈ̤ıÔ‰Ô˜ ·ÛÊ·Ï‹˜, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÓÙȉڿ-ÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜ Û ¿ÙÔÌ· Ì ÛÔ‚·Ú‹ ÙÚÔÊÈ΋·ÏÏÂÚÁ›· ÛÙ· ÔÔ›· Ú¤ÂÈ Ó· ÚÔÙÈÌ¿Ù·È ÙÔ Î·ı·ÚfiıÂÈÈÎfi ‚¿ÚÈÔ(18). TÔ B° ¤¯ÂÈ Î·ÙÂÍÔ¯‹Ó ¤Ó‰ÂÈÍË ÛÙË‚ÚÂÊÈ΋ ËÏÈΛ·, fiÙ·Ó Ë °O¶ Â›Ó·È ÌÂÁ¿ÏË ÁÈ· ÙÔÓ·ÔÎÏÂÈÛÌfi Û˘ÁÁÂÓÔ‡˜ ·Ó·ÙÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜.

EÈÎfiÓ· 1. MÂϤÙË Ì ‚·ÚÈÔ‡¯Ô Á‡̷ Û ·È‰› ËÏÈ-Λ·˜ 2 ÂÙÒÓ: ÔÏÈÛı·›ÓÔ˘Û· ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË. ¢È‡-Ú˘ÓÛË ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÙÚ‹Ì·ÙÔ˜ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜(‚¤ÏÔ˜) ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÔÔ›Ô˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÂÚÈÛ-ÛfiÙÂÚ˜ ·fi ÙÚÂȘ Á·ÛÙÚÈΤ˜ Ù˘¯¤˜ Ó· ·Ó¤Ú¯ÔÓÙ·ÈÚÔ˜ ÙÔÓ ıˆÚ·ÎÈÎfi ÔÈÛÔÊ¿ÁÔ.

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O ˘ÂÚ˯ÔÙÔÌÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜O ˘ÂÚ˯ÔÙÔÌÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ (UltraSound-

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

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

YÂÚ˯ÔÙÔÌÔÁÚ·ÊÈο, ¤Ó· ÂÂÈÛfi‰ÈÔ °O¶ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi (22): ·) ‰È¿ÓÔÈÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÛÊÈÁÎÙ‹Ú· ‚) ·Ï›Ó‰ÚÔÌË Î›ÓËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘

ÛÙÔÓ "¿ˆ" ÔÈÛÔÊ¿ÁÔ (∂ÈÎfiÓ· 2)Á) οı·ÚÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Ì ÂÚÈÛÙ·ÏÙÈΤ˜ ÎÈÓ‹ÛÂȘ ‰) ÎÏ›ÛÈÌÔ ÙÔ˘ ÛÊÈÁÎÙ‹Ú·. ™ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ‰ÂÓ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì-‚¿ÓÔÓÙ·È ÂÂÈÛfi‰È· ·Ï›Ó‰ÚÔÌ˘ ΛÓËÛ˘ ·¤Ú·, Ù·ÔÔ›· ıˆÚÔ‡ÓÙ·È Ê˘ÛÈÔÏÔÁÈο (22).

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

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

M ÙÔ U/S ÌÔÚÔ‡Ó Ó· ÌÂÏÂÙËıÔ‡Ó ÏÂÙÔÌÂÚÒ˜Ë ·Ó·ÙÔÌ›· Î·È ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·-ÁÈ΋˜ Û˘Ì‚ÔÏ‹˜ - ÂÚÈÔ¯‹˜ ÎÚ›ÛÈÌ˘ ÁÈ· ÙË °O¶ - ηÈÛ˘ÁÎÂÎÚÈ̤ӷ: 1. O ÙfiÓÔ˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ KO™,2. TÔ Ì‹ÎÔ˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Î·È Ë ÁˆÓ›·His Ô˘ ÂÓÂÚÁÔÔÈ› ÙÔ Ì˯·ÓÈÛÌfi Ù˘ ‚·Ï‚›‰·˜ÂϤÁ¯Ô˘ (check valve) ηٿ ÙË ‰È¿Ù·ÛË ÙÔ˘ Á·ÛÙÚÈ-ÎÔ‡ ıfiÏÔ˘. E‰Ò Ë ÌÔÚÊÔÏÔÁÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ÌÂ-ϤÙË Ì U/S, fiÙ·Ó Á›ÓÂÙ·È ÚÔÛÂÎÙÈο Î·È Î¿Ùˆ ·fi·˘ÛÙËÚ¿ ηıÔÚÈṲ̂Ó˜ ÎÏÈÓÈΤ˜ Û˘Óı‹Î˜, ˘ÂÚ¤¯ÂÈ.OÈ Û˘Óı‹Î˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ˘fi„Ë ÙËÊ¿ÛË Ù˘ ·Ó·ÓÔ‹˜, ÙË Á·ÛÙÚÈ΋ ÏËÚfiÙËÙ· Î·È ÙËÓÂÓ‰ÔÎÔÈÏȷ΋ ›ÂÛË(8). ™˘ÓÈÛÙ¿Ù·È ÏÔÈfiÓ ÙÔ U/S Ó·Á›ÓÂÙ·È ÌÂÙ¿ ÙÔ Á‡̷, Ì ÙÔ ·È‰› ‹ÚÂÌÔ Î·È Ì ÚÔÛ-‰ÈÔÚÈÛÌfi Ì¤ÛˆÓ ÙÈÌÒÓ ÌÂٷ͇ ÂÈÛÓÔ‹˜ Î·È ÂÎ-ÓÔ‹˜(8). TÔ optimum ·Ó·ÙÔÌÈÎfi Ì‹ÎÔ˜ ÙÔ˘ ÛÊÈÁÎÙ‹-Ú· Ô˘ ı· ÂÈÙÚ¤„ÂÈ ÂÈÙ˘¯‹ ·ÓÙÈÚÚfiËÛË ·˘ÍË̤-Ó˘ ÂÓ‰ÔÎÔÈÏȷ΋˜ ȤÛˆ˜ ›ӷÈ, ηٿ ÙÔ˘˜ DeMeester et al (28), ÌÂٷ͇ 20-25mm ÂÓÒ Ù· ·ÓÙ›ÛÙÔÈ-¯· U/S-Ì‹ÎË, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È Á·ÛÙÚÈÎÒÓ Ù˘-¯ÒÓ, Â›Ó·È 25-30mm. ™ËÌÂȈ٤ÔÓ fiÙÈ Ë ÂÎÙ›ÌËÛË ÙÔ˘Ì‹ÎÔ˘˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘ Ì ¿ÏϘ ÙÂ-¯ÓÈΤ˜ (PH/ÌÂÙÚ›·, Ì·ÓÔÌÂÙÚ›·, ÛÈÓıËÚÔÁÚ¿ÊËÌ·)Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·˘Ù¤˜ ·ÂÈ-ÎÔÓ›˙Ô˘Ó ÌfiÓÔ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ¿Ô„Ë Ù˘ ·Ó·ÁˆÁ‹˜(8). EÍ·ÈÙ›·˜ ·ÎÚÈ‚Ò˜ Ù˘ ¢·ÈÛıËÛ›·˜ ·˘Ù‹˜ ÙÔ˘U/S, ÌÂÚÈÎÔ› Û˘ÓÈÛÙÔ‡Ó Ë ÌÂϤÙË Ì B° Ó· ÂÚÈÔÚ›˙Â-Ù·È ÛÙ· ·È‰È¿ ÂΛӷ Ô˘, ·Ú¿ ÙÔ ·ÚÓËÙÈÎfi U/S ÂÍ·-ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· (29,30).3. H ÈηÓfiÙËÙ· ÙˆÓ ÛÎÂÏÒÓ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ó·Û˘ÁÎÚ·ÙÔ‡Ó ÛÙË ı¤ÛË ÙÔ˘ ÙÔÓ ÂÓ‰ÔÎÔÈÏÈ·Îfi ÔÈÛÔÊ¿-ÁÔ ÂÌÔ‰›˙ÔÓÙ·˜ ÙË ‰ÈÔÏ›ÛıËÛ‹ ÙÔ˘ ÚÔ˜ ÙÔ ıÒÚ·-η (17). TÔ U/S Â›Ó·È ÈÔ Â˘·›ÛıËÙÔ ·fi ÙÔ B° ÛÙˉȿÁÓˆÛË ÌÈÎÚÒÓ ‰È·ÊÚ·ÁÌ·ÙÔÎËÏÒÓ (8). AÔ˘Û›··ÂÈÎÔÓ›Ûˆ˜ Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ Û˘Ì‚ÔÏ‹˜,‚Ú·¯‡˜ ÂÓ‰ÔÎÔÈÏÈ·Îfi˜ ÔÈÛÔÊ¿ÁÔ˜, ·˘ÍË̤ÓË ‰È¿ÌÂ-ÙÚÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÛÙÔ Á·ÛÙÚÈÎfi ¿ÎÚÔ ÙÔ˘ ηȷÓÒÌ·ÏË ÁˆÓ›· ÙÔ˘ His ıˆÚÔ‡ÓÙ·È ÛÙÔȯ›· ÂÓ‰ÂÈ-ÎÙÈο ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ (∂ÈÎfiÓ· 3· & ∂ÈÎfiÓ· 3‚). H ·ÎÚÈ‚‹˜ ÂÎÙ›ÌËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ¤Ú·ÙÔ˜ ÙÔ˘

¶∞π¢π∞∆ƒπ∫∏ 2000;63:330-336 M. ¶··‰¿ÎË, π. ™. ∫·ÛηڤÏ˘

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

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:330-336 ∞ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË

335

ÔÈÛÔÊ·ÁÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Â›Ó·È ··Ú·›ÙËÙË ‰ÈfiÙÈ ÔȉȷÊÚ·ÁÌ·ÙÔ΋Ϙ Â›Ó·È Û˘¯Ó¿ Ìˉ·ÌÈÓ¤˜. ™Â ÓÂÔ-ÁÓ¿ Î·È ÌÈÎÚ¿ ‚Ú¤ÊË Î‹Ï˜ ¤ˆ˜ Î·È 5 mm ‰ÂÓ Û·Ó›-˙Ô˘Ó Î·È ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ·ÒÏÂÈ· ÙÔ˘ 1/4 ÙÔ˘ ÎÔÈ-ÏÈ·ÎÔ‡ ÔÈÛÔÊ¿ÁÔ˘. TÔ U/S ÂÈÙÚ¤ÂÈ ‰È·›ÛÙˆÛË‚Ú·¯‡ÓÛˆ˜ ̤¯ÚÈ Î·È 2 mm ÁÂÁÔÓfi˜ Ô‡ ÂÍËÁ› ÙˉȷÁÓˆÛÙÈ΋ ˘ÂÚÔ¯‹ ÙÔ˘ › ÙÔ˘ B° ÛÙȘ ÌÈÎÚ¤˜‰È·ÊÚ·ÁÌ·ÙÔ΋Ϙ (8). ¢ÂÓ Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ·Ú·-‚ϤÂÙ·È Ë ·Í›· ÙÔ˘ U/S ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Á·ÛÙÚÈ΋˜ÂÍfi‰Ô˘ ÁÈ· ηٷÎÚ¿ÙËÛË ‹ ·fiÊÚ·ÍË.

5. ™˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂıfi‰ˆÓÁÈ· ÙËÓ ‰È¿ÁÓˆÛË Ù˘ °O¶ EӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜

ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Ù¯ÓÈÎÒÓ. M standard ÙËÓpH/ÌÂÙÚ›·, Ë Â˘·ÈÛıËÛ›· ÙÔ˘ U/S Êı¿ÓÂÈ ÙÔ 95% ηÈË ÂȉÈÎfiÙËÙ¿ ÙÔ˘ ÙÔ 58%. OÙ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÈÓ‰ÚÔ-Ì‹ÛÂȘ ıˆÚËıÔ‡Ó ·ıÔÏÔÁÈΤ˜ ¤ÛÙˆ Î·È ·Ó Â›Ó·È·Û˘Ìو̷ÙÈΤ˜, ÙfiÙÂ Î·È Ë ÂȉÈÎfiÙËÙ· ÙÔ˘ U/S ‚ÂÏ-

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

6. ™˘ÌÂÚ¿ÛÌ·Ù·°ÂÓÈο, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙËÓ Û¯ÂÙÈ΋ ‚È‚ÏÈÔ-ÁÚ·Ê›·:● NÂÔÁÓ¿ Î·È ‚Ú¤ÊË Ì¤¯ÚÈ 2 ÌËÓÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó

Â̤ÙÔ˘˜ ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ˘. ™ÙËÓËÏÈΛ· ·˘Ù‹ ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ÛˆÛÙ‹ Ï‹„Ë ÙÔ˘ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÚÔÛÂÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË ÂÓÒ ËÂÚÁ·ÛÙËÚȷ΋ Û˘Ó‰ÚÔÌ‹, ÂÊfiÛÔÓ ÎÚÈı› ··Ú·›ÙË-ÙË, Û˘Ó‹ıˆ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ U/S, ÙËÓ PH/ÌÂÙÚ›·Î·È, Û·ÓÈfiÙÂÚ· ÙÔ B°.

● ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‚ÚÂÊÒÓ ËÏÈΛ·˜ 2-12 ÌËÓÒÓÂÌÊ·Ó›˙ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÏÂÈÙÔ˘ÚÁÈ΋ °O¶. E¿Ó Ë·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‰ÂÓ Û˘-ÓÈÛÙ¿Ù·È Ë ÂÊ·ÚÌÔÁ‹ ÂÂÌ‚·ÙÈÎÒÓ Ù¯ÓÈÎÒÓ ‹ ‰ÔÎÈ-Ì·ÛÈÒÓ Ì ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·. TÔ U/S ı· ÌÔ-ÚÔ‡Û ӷ Û˘ÛÙËı› Û·Ó screening test Û ÎÏÈÓÈο‡ÔÙÔ˘˜ ÁÈ· °O¶ ·ÛıÂÓ›˜. E¿Ó ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋˘Ô„›· fiÙÈ Ë °O¶ Â›Ó·È ‰Â˘ÙÂÚÔ·ı‹˜, Û˘ÓÈÛٿٷÈË ‰ÈÂÍ·ÁˆÁ‹ U/S ‹/Î·È B°.

● H °O¶ Ô˘ ·Ú·Ù›ÓÂÙ·È ¤Ú· ·fi ÙÔÓ 18Ô Ì‹Ó·Ù˘ ˙ˆ‹˜ Û˘¯Ó¿ ηٷϋÁÂÈ ¯ÚfiÓÈÔ Úfi‚ÏËÌ·, ·Ó¿-ÏÔÁÔ Ì ÙË ÓfiÛÔ ÙˆÓ ÂÓËϛΈÓ. H °O¶ Ù˘ ·È‰È΋˜ËÏÈΛ·˜, ȉ›ˆ˜ Â¿Ó Ë ¤Ó·ÚÍË Ù˘ ÂÓÙÔ›˙ÂÙ·È ÌÂÙ¿ÙÔÓ 12Ô Ì‹Ó· Ù˘ ˙ˆ‹˜, ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡-ÓËÛ˘. H ÂÈÏÔÁ‹ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓÂÍ·ÚÙ¿Ù·È ·fi Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜.

OÔÈ·‰‹ÔÙ ̤ıÔ‰Ô˜ ‹ Û˘Ó‰˘·ÛÌfi˜ ÌÂıfi‰ˆÓÎ·È ·Ó ÂÈÏÂÁ› ÁÈ· ÙËÓ ‰È¿ÁÓˆÛË Ù˘ °O¶ ÛÙ· ·È‰È¿‰ÂÓ Ú¤ÂÈ Ó· ÏËÛÌÔÓÂ›Ù·È fiÙÈ:

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

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·) TÔ ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ÚˆÙfiÎÔÏÏÔ ¤Ú¢ӷ˜ ¤¯ÂÈ ÌÂ-Á¿ÏË ÛËÌ·Û›· ÁÈ· Ù· ·ÔÙÂϤÛÌ·Ù¿ Ù˘. ‚) H ÂÌÂÈÚ›· ÙÔ˘ ÂÍÂÙ¿˙ÔÓÙÔ˜ ÂËÚ¿˙ÂÈ Â˘ı¤ˆ˜ ηÈÙËÓ Â˘·ÈÛıËÛ›· Î·È ÙËÓ ÂȉÈÎfiÙËÙ· fiÏˆÓ ÙˆÓ ÂÚÁ·-ÛÙËÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ Î·È ‰Ë ÙˆÓ Î˘ÚÈÔÙ¤ÚˆÓ (pH/ÌÂ-ÙÚ›·˜, B°, U/S) Î·È Á) K·Ì›· ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ‰ÂÓ Â‰Ú·ÈÒÓÂٷȯˆÚ›˜ ÙË Û‡ÌÚ·ÍË ÙÔ˘ ¤ÌÂÈÚÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ ÔÔÔ›Ô˜ ı· ÚÔÛʤÚÂÈ Î·È ÙËÓ ·ÍÈfiÈÛÙË ÎÏÈÓÈ΋ ÂÈÎfi-Ó· Î·È ÙËÓ ex juventibus ÙÂÏÈ΋ ÙÂÎÌËÚ›ˆÛË.

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baby won't eat. J Pediatr 1994; 125:103-109. 2. Vandenplas Y. Gastroesophageal reflux in children. Scand

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:330-336 M. ¶··‰¿ÎË, π. ™. ∫·ÛηڤÏ˘

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TÔ ·È‰› ÌÔÚ› Ó· ‚ÚÂı› ˆ˜ ı‡Ì· ÙÚÔ¯·›Ô˘, ›Ù ˆ˜ Â˙fi˜ ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜, ›Ù ˆ˜ ÂÈ‚¿Ù˘ ÌÂÙ·ÊÔÚÈÎԇ̤ÛÔ˘ ‹ Î·È ·ÎfiÌ· ˆ˜ Ô‰ËÏ¿Ù˘ Î·È ÛÙËÓ ÂÊ˂›· ˆ˜ Ô‰ËÁfi˜.

A. TÔ ·È‰› Â˙fi˜ ¶·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 9 ÂÙÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ΢ÎÏÔÊÔÚÔ‡Ó ÌfiÓ· ÙÔ˘˜, ¯ˆÚ›˜ ÂÈÙ‹ÚËÛË. MÂÙ¿ Ù· 9 ¯ÚfiÓÈ·

ÌfiÓÔ ÌÂÙ¿ ·fi ηϋ Âη›‰Â˘ÛË ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ Î·È ÂÍÔÈΛˆÛË Ì ÙË ‰È·‰ÚÔÌ‹ ÌÔÚÔ‡Ó Ó· ΢ÎÏÔÊÔÚÔ‡Ó Ìfi-Ó· ÙÔ˘˜. ¶·È‰È¿ ¿Óˆ ÙˆÓ 12 ¯ÚfiÓˆÓ ÌÔÚÔ‡Ó Ó· Û˘ÌÂÚÈʤÚÔÓÙ·È ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ ÛˆÛÙ¿ fiˆ˜ Î·È ÔÈ ÂÓ‹ÏÈÎÔÈ.

B. TÔ ·È‰› ÂÈ‚¿Ù˘ - °È· ÙËÓ ·ÛÊ·Ï‹ ÌÂÙ·ÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂ÓÔÈ ‚·ÛÈÎÔ› ηÓfiÓ˜: - ¶ÔÙ¤ Ù· ·È‰È¿ ÛÙÔ ÌÚÔÛÙÈÓfi οıÈÛÌ· (ÂȉÈο ·Ó ˘¿Ú¯ÂÈ ·ÂÚfiÛ·ÎÔ˜), ¿ÓÙÔÙ ÛÙÔ ›Ûˆ. AÎfiÌ· Î·È ÛÂ

ÂÏ·ÊÚÈ¿ Û‡ÁÎÚÔ˘ÛË ‹ Û ·fiÙÔÌÔ ÊÚÂÓ¿ÚÈÛÌ· ÙÔ ·È‰› ÎÈÓ‰˘Ó‡ÂÈ Ó· ÎÙ˘‹ÛÂÈ ÛÙÔ Ù·ÌÏfi ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘.¶ÔÙ¤ ÛÙÔ ÔÚÙ-ÌÂ̤, ÛÙ· ÁfiÓ·Ù· ‹ ÛÙËÓ ·ÁηÏÈ¿ οÔÈÔ˘. Œ¯ÂÈ ‚ÚÂı› ˆ˜ ÙÔ 90% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÓÂ-Ï¿ÎËÛ·Ó Û ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· Î·È ÎÚ·ÙÔ‡Û·Ó ·È‰È¿ ÛÙËÓ ·ÁηÏÈ¿ ÙÔ˘˜ Î·È ÛÒıËηÓ, ÛÒıËÎ·Ó ÂÂȉ‹ ÙÔ ·È-‰› ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ·Û›‰·.

- TÔ ·È‰› ¿ÓÙÔÙ ÛÙÔ ÂȉÈÎfi οıÈÛÌ· ·ÛÊ·Ï›·˜, Ì ÙËÓ ÂȉÈ΋ ˙ÒÓË ·ÛÊ·Ï›·˜, ÔÙ¤ 2 ·È‰È¿ Ì·˙› Û ÌÈ·˙ÒÓË ·ÛÊ·Ï›·˜. M ÙËÓ ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ·È‰ÈÎÒÓ Î·ıÈÛÌ¿ÙˆÓ ÔÈ ı¿Ó·ÙÔÈ ·fi ÙÚÔ¯·›· ı· ÌÔÚÔ‡Û·Ó Ó·ÌÂȈıÔ‡Ó Î·Ù¿ 70% Î·È ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ηٿ 67%. ŸÌˆ˜, ·fi ÙÔ˘˜ ÁÔÓ›˜ Ô˘ ̤ÓÔ˘Ó ÛÙËÓ Aı‹Ó· Î·È ¤¯Ô˘Ó·˘ÙÔΛÓËÙÔ, ÌfiÓÔ ÙÔ 58% ·ÁÔÚ¿˙Ô˘Ó ·È‰Èο ηı›ÛÌ·Ù· ·˘ÙÔÎÈÓ‹ÙÔ˘ Î·È ÛÙËÓ Â·Ú¯›· ÙÔ 32%, ÂÓÒ ‰˘ÛÙ˘¯Ò˜ÌfiÓÔ ÙÔ 0,5-1% ·ÁÔÚ¿˙Ô˘Ó ÙÔ ÙÂÏÂ˘Ù·›ˆÓ ÚԉȷÁÚ·ÊÒÓ Î¿ıÈÛÌ· ·ÛÊ·Ï›·˜ Ô˘ Â›Ó·È ÂȉÈÎfi ÁÈ· ÙÔ ‚¿ÚÔ˜, ÙËÓËÏÈΛ·, ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ·Ú¤¯ÂÈ ÈηÓÔÔÈËÙÈ΋ ÚÔÛÙ·Û›·. T· ηı›ÛÌ·Ù· ·˘Ù¿ ʤÚÔ˘Ó ÙÔ Û‹Ì· ECE R4403 ÛÙË Û˘Û΢·Û›·. Y¿Ú¯Ô˘Ó ·) ηı›ÛÌ·Ù· ÛÙÚ·Ì̤ӷ ÚÔ˜ Ù· ›Ûˆ ÁÈ· ·È‰È¿ Ì ‚¿ÚÔ˜ ˆ˜ 10 ÎÈÏ¿, ‚) η-ı›ÛÌ·Ù· ‰ÈÏ‹˜ ηÙ‡ı˘ÓÛ˘ ÁÈ· ·È‰È¿ Ì ‚¿ÚÔ˜ ˆ˜ 20 ÎÈÏ¿, Á) ηı›ÛÌ·Ù· ÛÙÚ·Ì̤ӷ ÚÔ˜ Ù· ÂÌÚfi˜ ÁÈ· ·È-‰È¿ ‚¿ÚÔ˘˜ 10-25 ÎÈÏ¿ Î·È ‰) ·Ó˘„ˆÙÈο ηı›ÛÌ·Ù· ÁÈ· ·È‰È¿ ‚¿ÚÔ˘˜ 15-35 ÎÈÏ¿. H ˙ÒÓË ·ÛÊ·Ï›·˜ Î·È ÛÙ·›Ûˆ ηı›ÛÌ·Ù· ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÌÂÈÒÓÂÈ ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ ηٿ 22% Î·È ÙÔ˘˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ηٿ 50%. H ˙ÒÓË·ÛÊ·Ï›·˜ ıˆÚÂ›Ù·È Î·Ù¿ÏÏËÏË fiÙ·Ó ÙÔ ‰È·ÁÒÓÈÔ ÙÌ‹Ì· Ù˘ ÂÚÓ¿ ·fi ÙÔ Ì¤ÛÔ ÂÚ›Ô˘ Ù˘ ·fiÛÙ·Û˘ ÌÂ-ٷ͇ ÙÔ˘ ¿ÎÚÔ˘ ÙÔ˘ ÒÌÔ˘ Î·È ÙÔ˘ Ï·ÈÌÔ‡.

- ¶ÔÙ¤ Ù· ·È‰È¿ ÛÙÔ ·˘ÙÔΛÓËÙÔ Ì ÂÈΛӉ˘Ó· ·È¯Ó›‰È·. (EÈΛӉ˘ÓÔ Â›Ó·È Î¿ı ·È¯Ó›‰È Ô˘ Îfi‚ÂÈ, Û¯›˙ÂÈ ‹Î·Ù·›ÓÂÙ·È).

- OÈ fiÚÙ˜ ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘ Ú¤ÂÈ Ó· ·ÛÊ·Ï›˙ÔÓÙ·È ·' ¤Íˆ. ¶ÔÏÏ¿ ·È‰È¿ ÙÚ·˘Ì·Ù›˙ÔÓÙ·È ‹ Î·È ÛÎÔÙÒ-ÓÔÓÙ·È ¤ÊÙÔÓÙ·˜ ¤Íˆ ·fi ÙËÓ fiÚÙ· ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘ Ô˘ ·ÓÔ›ÁÂÈ ·fiÙÔÌ· Û ÛÙÚÔÊ‹ ‹ fiÙ·Ó ·›˙Ô˘Ó Ì ÙËÓfiÚÙ· ¯ˆÚ›˜ Ó· ÊÔÚÔ‡Ó ˙ÒÓË.

¶ƒ∞∫∆π∫∂™ O¢∏°π∂™ ∆OY ¶∞π¢π∞∆ƒOÀ

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°. TÔ ·È‰› Ô‰ËÏ¿Ù˘ TÔ ·È‰› ˆ˜ Ô‰ËÏ¿Ù˘ Ú¤ÂÈ Ó· Û˘ÌÂÚÈʤÚÂÙ·È È· fiˆ˜ Ô Ô‰ËÁfi˜ Ô¯‹Ì·ÙÔ˜. T· ̤ÙÚ· Ô˘ ı· ÙÔ˘ ÂÍ·-

ÛÊ·Ï›ÛÔ˘Ó ÈηÓÔÔÈËÙÈ΋ ÚÔÛÙ·Û›· ›ӷÈ: - ηϋ Âη›‰Â˘ÛË, ˆÚÈÌfiÙËÙ·, ·˘ÍË̤ÓÔ ·›ÛıËÌ· ¢ı‡Ó˘. Ÿ¯È ·ÚÔÚÌËÙÈÎfiÙËÙ· Î·È ÂÚÈÊÚfiÓËÛË ÙÔ˘

ÎÈÓ‰‡ÓÔ˘. - ¿ÚÈÛÙË ÁÓÒÛË ÙˆÓ ÂÓÓÔÈÒÓ ÙˆÓ ÛËÌ¿ÙˆÓ Î·È ÙˆÓ ‚·ÛÈÎÒÓ Î·ÓfiÓˆÓ Ô‰È΋˜ ΢ÎÏÔÊÔÚ›·˜. - ÊÚÔÓÙ›‰· ÁÈ· ÙËÓ Î·Ï‹ Û˘ÓÙ‹ÚËÛË ÙÔ˘ Ô‰ËÏ¿ÙÔ˘ Î·È Ù·ÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜. - ··ÁfiÚ¢ÛË ¯Ú‹Û˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ.- ·ÔÊ˘Á‹ ΢ÎÏÔÊÔÚ›·˜ Û ÔÏ˘Û‡¯Ó·ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ Î·È ¯ÚËÛÈÌÔÔ›ËÛË ¿ÓÙÔÙ Ù˘ ‰ÂÍÈ¿˜ "ψڛ‰·˜"

ÙˆÓ ‰ÚfïÓ.

¶·È‰È·ÙÚÈÎfi TÌ‹Ì· NÔÛÔÎÔÌ›Ԣ KAT

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338

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I™∆Oƒπ∞ ∆∏™ ∂§§∏¡π∫∏™ ¶∞π¢π∞∆ƒπ∫∏™

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

EΛÓË ÙË ¯ÚÔÓÈ¿ Û˘ÌÏËÚÒıËÎ·Ó 30 ¯ÚfiÓÈ· ·fi ÙËÓ ›‰Ú˘ÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ (E¶E)Î·È ÙÔ ¢.™. Ô˘ ÙÔ ·ÔÙÂÏÔ‡Û·Ó ÔÈ N›Î·˜ ZÂÚ‚fi˜ ¶Úfi‰ÚÔ˜, KˆÓ/ÓÔ˜ XˆÚ¤Ì˘ ∞ÓÙÈÚfi‰ÚÔ˜, ™ÔÊÔÎÏ‹˜ X·-Ù˙ˉ¿Î˘ Î·È ¢ËÌ‹ÙÚ˘ §È·Î¿ÎÔ˜ °Ú·ÌÌ·Ù›˜, Iˆ¿ÓÓ˘ AÏ·Ì¿Ó˘ T·Ì›·˜, B·Û›ÏÂÈÔ˜ KˆÓÛÙ·ÓÙÈÓ›‰Ë˜, ™‡ÚÔ˜¢ÔÍÈ¿‰Ë˜ Î·È KˆÓ/ÓÔ˜ ¶·‰È·Ù¤Ï˘ M¤ÏË, Û ÌÈ· Û˘Ó‰ڛ·Û‹ ÙÔ˘ ¤Î·Ó ·ÔÏÔÁÈÛÌfi ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ù˘E¶E ·˘Ù¿ Ù· 30 ¯ÚfiÓÈ· Ô˘ ¤Ú·Û·Ó ·fi ÙËÓ ›‰Ú˘Û‹ Ù˘.

™Â ·˘Ùfi ÙÔ ÛËÌÂ›Ô ·Í›˙ÂÈ Ó· ·Ó·Ê¤ÚÔ˘Ì ÙÔ ¯ÚÔÓÈÎfi ›‰Ú˘Û˘ Ù˘ E¶E.(1) H E¶E ȉڇıËΠÛÙȘ 25.2.1931Ì ڈÙÔ‚Ô˘Ï›· ÙÔ˘ ·Â›ÌÓËÛÙÔ˘ ηıËÁËÙ‹ Ù˘ ¶·È‰È·ÙÚÈ΋˜ °ÂˆÚÁ›Ô˘ M·Îο, Ô ÔÔ›Ô˜ ˘‹ÚÍÂ Î·È Ô ÚÒÙÔ˜¶Úfi‰ÚÔ˜ ÙÔ˘ ¢.™. Ù˘. T· È‰Ú˘ÙÈο ̤ÏË ·ÔÙÂÏÔ‡Û·Ó Î·È ¿ÏÏÔÈ 25 ‰È·ÎÂÎÚÈ̤ÓÔÈ ·È‰›·ÙÚÔÈ Ù˘ ÂÔ¯‹˜ ÂΛ-Ó˘.(2) Ÿˆ˜ ·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔ ÚÒÙÔ K·Ù·ÛÙ·ÙÈÎfi Ù˘ EÙ·ÈÚ›·˜ ÛÎÔfi˜ ‹Ù·Ó "Ë ÚÔ·ÁˆÁ‹ Ù˘ ·È‰È·ÙÚÈ-΋˜ ηıfiÏÔ˘ Î·È Ë ÛÙÂÓˆÙ¤Ú· Û˘Ó·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÂȉÈÎÒ˜ ÙÔÓ ÎÏ¿‰ÔÓ ÙÔ‡ÙÔÓ Ù˘ È·ÙÚÈ΋˜ ·ÛÎÔ‡ÓÙˆÓ È·-ÙÚÒÓ".(3)

T· ÚÒÙ· 30 ¯ÚfiÓÈ· ˙ˆ‹˜ Ù˘ E¶E ˘‹ÚÍ·Ó ·Ô‰ÔÙÈο Î·È ÙfiÛÔ Ù· ¢.™. Ì ÚÔ¤‰ÚÔ˘˜ Âͤ¯Ô˘Û˜ Î·È ‰È·-ÎÂÎÚÈ̤Ó˜ ÌÔÚʤ˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ fiÛÔ Î·È ÔÈ ·È‰›·ÙÚÔÈ Ì¤ÏË ÂÍÂÙ¤ÏÂÛ·Ó Ï‹Úˆ˜ ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘˜ ÒÛÙÂ"Ë ¶·È‰È·ÙÚÈ΋ Ó· ¤¯ÂÈ ÂÈ‚ÏËı› ˆ˜ ÂȉÈÎfiÙ˘, ˆ˜ ÎÏ¿‰Ô˜ ÂÚ‡Ó˘ ÔÏÏ¿ ÚÔÛÊ¤ÚˆÓ ÂȘ ÙËÓ EÏÏËÓÈÎ‹Ó ÂÈ-ÛÙ‹ÌËÓ Î·È ˆ˜ ¿ÁÁÂÏÌ·, Ô‡ÙÈÓÔ˜ Ë ÎÔÈÓˆÓÈ΋ ·ÔÛÙÔÏ‹ Î·È Ë ÚÔÛÊÔÚ¿ ·fi È·ÙÚÔÎÔÈÓˆÓÈ΋˜ ÏÂ˘Ú¿˜, Ùfi-ÛÔÓ ‰È· ÙËÓ ÚÔÏËÙÈÎ‹Ó È·ÙÚÈÎ‹Ó fiÛÔÓ ‰È· ÙËÓ ÚÔÛÙ·Û›·Ó ÙÔ˘ ·È‰ÈÔ‡ ÁÂÓÈÎÒÙÂÚÔÓ, ·Ú' Ô˘‰ÂÓfi˜ Ó· ·ÌÊÈ-Û‚ËًٷÈ".

™ÙË Û˘Ó‰ڛ·ÛË Ù˘ E¶E ÙÔ 1961 ÙÔ ¢.™. ·ÚfiÏÔ Ô˘ ¤ÌÂÈÓ ÈηÓÔÔÈË̤ÓÔ ·fi ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘E¶E ηٿ Ù· 30 ¯ÚfiÓÈ· Ô˘ ¤Ú·Û·Ó, ‰È·›ÛÙˆÛ fiÙÈ ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ·ÊÔÚÔ‡Û·Ó ÌfiÓÔ ÙÔ˘˜¶·È‰È¿ÙÚÔ˘˜ Ù˘ Aı‹Ó·˜ Î·È ı· ¤Ú ӷ ‚ÚÂı› ÙÚfiÔ˜ ÒÛÙ ӷ ·Â˘ı‡ÓÔÓÙ·È Î·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ fiÏ˘Ù˘ ¯ÒÚ·˜. ™ÙËÓ ÂfiÌÂÓË Û˘Ó‰ڛ·ÛË ÙÔ˘ ¢.™. ÌÂÙ¿ ·fi ÚfiÙ·ÛË ÙÔ˘ AÓÙÈÚÔ¤‰ÚÔ˘ Ù˘ E¶E, ÙÔ˘ ·Â›ÌÓË-ÛÙÔ˘ K·ıËÁËÙ‹ KˆÓÛÙ·ÓÙ›ÓÔ˘ XˆÚ¤ÌË, Ë ÔÔ›· ¤ÁÈÓ ÔÌfiʈӷ ·Ô‰ÂÎÙ‹ ·ÔÊ·Û›ÛÙËÎÂ: Ì›· ÊÔÚ¿ ÙÔ ¯ÚfiÓÔÓ· Á›ÓÂÙ·È Ì›· ÂΉ‹ÏˆÛË Ù˘ EÙ·ÈÚ›·˜ Û ‰È¿ÊÔÚ˜ fiÏÂȘ Ù˘ EÏÏ¿‰·˜ Ô˘ ı· ‰›ÓÂÈ ·ÊÔÚÌ‹ ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜Ù˘ ÂÚÈʤÚÂÈ·˜ Ó· ‰Ú·ÛÙËÚÈÔÔÈËıÔ‡Ó, Ó· ·ÔÎÙ‹ÛÔ˘Ó Ó¤Â˜ ÁÓÒÛÂȘ, Ó· ·ÓÙ·ÏÏ¿ÍÔ˘Ó ·fi„ÂȘ, Ó· Û˘Ó·-ÓÙËıÔ‡Ó Ì ʛÏÔ˘˜ Î·È Ó· Û˘ÛÊȯıÔ‡Ó ÔÈ ÌÂٷ͇ ÙÔ˘˜ Û¯¤ÛÂȘ.(4) ŒÙÛÈ Î·ıÈÂÚÒıËΠÙÔ ™¿‚‚·ÙÔ ·fiÁÂ˘Ì·Î·È Ë K˘Úȷ΋ Ù˘ ¶ÂÓÙËÎÔÛÙ‹˜ ˆ˜ ÂÙ‹ÛÈ· ÂÈÛÙËÌÔÓÈ΋ ÂΉ‹ÏˆÛË ÛÙËÓ ÂÚÈʤÚÂÈ·, ·Ú¯‹˜ ÁÂÓÔ̤Ó˘ ·fi ÙË£ÂÛÛ·ÏÔÓ›ÎË. ∫·È ÙÔ fiÓÔÌ· ·˘Ù‹˜ "¶·È‰È·ÙÚÈη› H̤ڷÈ".

Ÿˆ˜ ·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔ 1Ô ÚfiÁÚ·ÌÌ· "AÈ ¶·È‰È·ÙÚÈη› HÌ¤Ú·È ÔÚÁ·ÓÔ‡ÓÙ·È ÙÔ ÚÒÙÔÓ Î·Ù¿ ÙËÓ 27ËÓ Î·È28ËÓ M·˝Ô˘ 1961 ÂÓ £ÂÛÛ·ÏÔÓ›ÎË ˘fi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ÂÓ ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· ÌÂÙ¿ Ù˘EÓÒÛˆ˜ ¶·È‰È¿ÙÚˆÓ £ÂÛÛ·ÏÔӛ΢". H ÂΉ‹ÏˆÛË ÂÙ¤ıË ˘fi ÙËÓ ·ÈÁ›‰· ÙÈÌËÙÈ΋˜ ÂÈÙÚÔ‹˜ ÂÍ ÂÎÚÔÛÒˆÓ¶ÓÂ˘Ì·ÙÈÎÒÓ I‰Ú˘Ì¿ÙˆÓ Ù˘ £ÂÛÛ·ÏÔӛ΢, ‰ËÏ. ÙÔ˘ ¶Ú˘Ù¿Óˆ˜ ÙÔ˘ AÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·-ÏÔӛ΢ °ÂˆÚÁ›Ô˘ B¿Ú‚ÔÁÏË, ÙÔ˘ KÔÛÌ‹ÙÔÚÔ˜ Ù˘ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ NÈÎÔÏ¿Ô˘ K·‚·˙·Ú¿ÎË Î·È ÙÔ˘ ¶ÚÔ¤‰ÚÔ˘Ù˘ I·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ £ÂÛÛ·ÏÔӛ΢ E˘ÛÙ·ı›Ô˘ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘. ø˜ ¯ÒÚÔ˜ Û˘Ó‰ÚÈ¿ÛÂˆÓ ·Ú¯ˆÚ‹ıËÙÔ ·ÌÊÈı¤·ÙÚÔ ÙÔ˘ XËÌ›Ԣ ÙÔ˘ AÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢.(5)

"AÈ ¶·È‰È·ÙÚÈη› H̤ڷÈ" ¤Î·Ó·Ó ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘˜ ‰ÂÈÏ¿ - ‰ÂÈÏ¿ Î·È Ì ÛÎÂÙÈÎÈÛÌfi. ŒÁÈÓ·Ó 3 Û˘Ó‰ÚÈ¿ÛÂÈ˜Î·È ·Ó·ÎÔÈÓÒıËÎ·Ó 33 ÂÚÁ·Û›Â˜ ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Û·Ó fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ™Â ¿ÏÏË ·›ıÔ˘Û·

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

XÚÈÛÙ›Ó· TÛÂÁ΋

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

O ·ÔÏÔÁÈÛÌfi˜ ·fi ÙȘ ¶ÚÒÙ˜ ¶·È‰È·ÙÚÈΤ˜ H̤Ú˜ ͤڷÛ ÙȘ ÚԂϤ„ÂȘ fiψÓ, Ë Û˘ÌÌÂÙÔ¯‹ ‹Ù·ÓÌÂÁ¿ÏË Î·È ·fi fiÏË ÙËÓ EÏÏ¿‰· ·ÎfiÌË Î·È ·fi ÙËÓ KÚ‹ÙË. AÛÊ·ÏÒ˜ Ú¤ÂÈ Ó· ˘ÔÏÔÁ›ÛÔ˘ÌÂ Î·È ÙȘ ‰˘ÛÎÔ-ϛ˜ Ô˘ ˘‹Ú¯·Ó ÛÙË ÌÂÙ·ÊÔÚ¿ ·fi ÙfiÛÔ Ì·ÎÚÈÓ¤˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜. H ·ÙÌfiÛÊ·ÈÚ· Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıË-Π‹Ù·Ó Ôχ ˙ÂÛÙ‹ Î·È ÊÈÏÈ΋ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ηıÈÂÚˆıÔ‡Ó Î·È Ó· Á›ÓÔ˘Ó Ï¤ÔÓ ıÂÛÌfi˜.(6)

AÎÔÏÔ‡ıËÛ·Ó Ë ¶¿ÙÚ·, ÙÔ HÚ¿ÎÏÂÈÔ KÚ‹Ù˘, Ù· Iˆ¿ÓÓÈÓ·, Ô BfiÏÔ˜. H Û˘ÌÌÂÙÔ¯‹ οı ¯ÚfiÓÔ ‹Ù·Ó ÌÂÁ·-χÙÂÚË Î·È ÙÔ Úfi‚ÏËÌ· Ô˘ ·ÓÙÈÌÂÙÒÈ˙·Ó ÔÈ ÔÚÁ·ÓˆÙ¤˜ ‹Ù·Ó Ó· ‚ÚÂıÔ‡Ó Î·Ù¿ÏÏËϘ ·›ıÔ˘Û˜ ÁÈ· ™˘ÓÂ-‰ÚÈ¿ÛÂȘ Î·È ÍÂÓԉԯ›· ÁÈ· ‰È·ÌÔÓ‹.(7) TËÓ ÂÔ¯‹ ÂΛÓË Ù· ÍÂÓԉԯ›· ‹Ù·Ó Ï›Á·, Ì ˘ÔÙ˘Ò‰ÂȘ ·Ó¤ÛÂÈ˜Î·È Ù· ÌÔÓ·‰Èο ηϿ ‹Ù·Ó ÁÈ· ÙÔÓ K·ıËÁËÙ‹, YÊËÁËÙ¤˜ Î·È ÁÂÓÈÎÒ˜ ÙÔ˘˜ ÌÂÁ·Ï‡ÙÂÚÔ˘˜. OÈ ÓÂÒÙÂÚÔÈ Û˘Ó‹-ıˆ˜ ̤ӷÌ Û 3˘ ηÙËÁÔÚ›·˜ Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ Ì·˜ ÊÈÏÔÍÂÓÔ‡Û·Ó Û˘Ó¿‰ÂÏÊÔÈ ÛÙ· Û›ÙÈ· ÙÔ˘˜.

TÔ 1967 ÛÙËÓ K·‚¿Ï· ÔÈ ¤ÎÙ˜ "¶·È‰È·ÙÚÈΤ˜ H̤Ú˜" ‹Ù·Ó ͯˆÚÈÛÙ¤˜ ·ÊÔ‡ ÂÚfiÎÂÈÙÔ Ó· ·ÔÓÂÌËıÔ‡ÓÁÈ· ÚÒÙË ÊÔÚ¿ Ù· "XˆÚ¤ÌÂÈ· Œ·ıÏ·" Ô˘ ·ıÏÔıÂÙ‹ıËÎ·Ó ·fi ÙËÓ E¶E ÛÙË ÌÓ‹ÌË ÙÔ˘ ‰·ÛοÏÔ˘ KˆÓÛÙ·-ÓÙ›ÓÔ˘ XˆÚ¤ÌË Ô˘ ¤Ê˘Á ͷÊÓÈο ÙÔ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 1966. TÔ ¤·ıÏÔ ·ÔÙÂÏÔ‡Û·Ó 3 ‚Ú·‚›· (A, B Î·È °)ÚˆÙfiÙ˘ˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ÂÎÚ›ÓÔÓÙÔ ·fi ÂÈÙÚÔ‹, ÛÙËÓ ÔÔ›· ÂÎÙfi˜ ÙˆÓ EÏÏ‹ÓˆÓ Û˘ÌÌÂÙ›¯·Ó Î·È 2 ‰È·-ÎÂÎÚÈ̤ÓÔÈ Í¤ÓÔÈ Î·ıËÁËÙ¤˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ™ÙË ÌÓ‹ÌË ÙÔ˘ ηıÈÂÚÒıËΠ›Û˘ Î·È Ì›· ÔÌÈÏ›· ·fi ͤÓÔ Î·-ıËÁËÙ‹. H ÚÒÙË ¤ÁÈÓ ·fi ÙÔÓ K·ıËÁËÙ‹ Ù˘ 2˘ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ BÔ˘‰·¤-ÛÙ˘ E. Körpel-Froni˘s. ŒÁÈÓ·Ó 8 Û˘Ó‰ÚÈ¿ÛÂȘ Ô˘ ÂÚÈÏ¿Ì‚·Ó·Ó 3 ÂÈÛËÁ‹ÛÂȘ ·Ó·ÎÔÈÓÒıËηÓ, 94 ÂÚÁ·Û›Â˜Â› fiÏˆÓ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ıÂÌ¿ÙˆÓ Î·È ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó 17 ·Ó·ÚÙË̤Ó˜ ·Ó·ÎÔÈÓÒÛÂȘ

TÔ 1971 ÔÈ "¶·È‰È·ÙÚÈΤ˜ H̤Ú˜" Û˘ÌÏ‹ÚˆÛ·Ó ÙËÓ ÚÒÙË 10ÂÙ›· ÙÔ˘˜ Î·È ÙÔ ¢.™. Ù˘ E.¶.E. Ì ¶Úfi‰ÚÔÙÔÓ K·ıËÁËÙ‹ NÈÎfiÏ·Ô M·ÙÛ·ÓÈÒÙË ·ÔÊ¿ÛÈÛ ӷ ÙÔ˘˜ ‰ÒÛÂÈ ·ÓËÁ˘ÚÈ΋ ÌÔÚÊ‹. K¿ÏÂÛ 14 ‰È·ÎÂÎÚÈ̤ÓÔ˘˜Í¤ÓÔ˘˜ ÔÌÈÏËÙ¤˜ Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó Ì ÂÈÛËÁ‹ÛÂȘ Î·È ÛÙÚÔÁÁ˘Ï¿ ÙÚ·¤˙È·. MÂٷ͇ ·˘ÙÒÓ ·Ó·Ê¤ÚÔ˘Ì ÙÔ˘˜Î·ıËÁËÙ¤˜ J. Dogramaci K·ıËÁËÙ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ ÕÁ΢ڷ˜ Î·È ¶Úfi‰ÚÔ Ù˘ ¢ÈÂıÓÔ‡˜ ¶·È‰È·ÙÚÈ΋˜ŒÓˆÛ˘, ÙÔÓ S. Krugman ·fi ÙËÓ N.Y., ÙÔÓ A. Prader ·fi ÙË Z˘Ú›¯Ë, ÙÔÓ A. Sabin ·fi ÙÔ IÛÚ·‹Ï, ÙÔÓ G. Mathé·fi ÙÔ ¶·Ú›ÛÈ Î·È ¿ÏÏÔ˘˜. TËÓ ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË KˆÓ. XˆÚ¤ÌË ¤Î·ÓÂ Ô Nillo Halman, K·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ÛÙÔ ¶·Ó/ÌÈÔ ÙÔ˘ EÏÛ›ÓÎÈ Ì ı¤Ì· "Heredity of Kidney diseases". Œ‰Ú· Ù˘ ÂΉ‹ÏˆÛ˘ ‹Ù·Ó Ë Aı‹Ó· ÛÙËÓ ¶¿-ÓÙÂÈÔ AÓˆÙ¿ÙË ™¯ÔÏ‹ ¶ÔÏÈÙÈÎÒÓ EÈÛÙËÌÒÓ. H ÂÈÙ˘¯›· ‹Ù·Ó ¿Ó¢ ÚÔËÁÔ˘Ì¤ÓÔ˘, Ë Û˘ÌÌÂÙÔ¯‹ ÙfiÛÔ ÙˆÓ ·È-‰È¿ÙÚˆÓ fiÛÔ Î·È È·ÙÚÒÓ fiÏˆÓ ÙˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ ·È‰› ‹Ù·Ó Ôχ ÌÂÁ¿ÏË. TÔ ÚfiÁÚ·Ì-Ì· ÂÚÈÏ¿Ì‚·Ó 3 ÂÈÛËÁ‹ÛÂȘ, 2 ÛÙÚÔÁÁ˘Ï¿ ÙÚ·¤˙È·, 72 ·Ó·ÎÔÈÓÒÛÂȘ EÏÏ‹ÓˆÓ Î·È Í¤ÓˆÓ ÔÌËÏËÙÒÓ. ◊Ù·ÓϤÔÓ ÔÊı·ÏÌÔÊ·Ó‹˜ Ë ÂÈÙ˘¯›· ÙÔ˘ ıÂÛÌÔ‡ ·Ó ·Ó·ÏÔÁÈÛıԇ̠fiÙÈ ÛÙȘ ÚÒÙ˜ ¶·È‰È·ÙÚÈΤ˜ H̤Ú˜ ¤ÁÈÓ·Ó3 Û˘Ó‰ÚÈ¿ÛÂȘ ÛÙȘ Ôԛ˜ ·Ó·ÎÔÈÓÒıËÎ·Ó 33 ÂÚÁ·Û›Â˜ Î·È ÌÂÙ¿ 10 ¯ÚfiÓÈ· 15 Û˘Ó‰ÚÈ¿ÛÂȘ Ì 3 ÂÈÛËÁ‹ÛÂȘ,2 ÛÙÚÔÁÁ˘Ï¿ ÙÚ·¤˙È· Î·È 76 ·Ó·ÎÔÈÓÒÛÂȘ.

K¿ı ¯ÚfiÓÔ "AÈ ¶·È‰È·ÙÚÈη› H̤ڷÈ" ›¯·Ó fiÏÔ Î·È ÌÂÁ·Ï‡ÙÂÚË Û˘ÌÌÂÙÔ¯‹. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ÙÔ ¢.™. Ù˘E¶E ÙÔ 1973 ·ÔÊ¿ÛÈÛ ˆ˜ ‹Ù·Ó ηÈÚfi˜ Ó· ıˆÚËı› È· ˆ˜ ™˘Ó¤‰ÚÈÔ Î·È ÌÂÙÔÓÔÌ¿ÛÙËÎ·Ó Û "¶·ÓÂÏÏ‹ÓÈÔ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ".(8) ŒÙÛÈ, ÙÔ 1973 ¤ÁÈÓ ÛÙË §Â˘ÎˆÛ›· ÛÙËÓ K‡ÚÔ ÙÔ 11Ô "¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘-Ó¤‰ÚÈÔ" ÌÂ Û˘ÌÌÂÙÔ¯‹ ÂÎÙfi˜ ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È È·ÙÚÒÓ fiÏˆÓ ÙˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ·È‰›. H ÂÈÙ˘¯›· Ô˘ ͤڷÛ ÙȘ ÚԂϤ„ÂȘ fiÏˆÓ ‰Èη›ˆÛ ÙË ÌÂÙÔÓÔÌ·Û›· Û "¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤-‰ÚÈÔ".

AÎÔÏÔ˘ıÔ‡Ó Î·È ¿ÏÈ ‰È·‰Ô¯Èο ‰È¿ÊÔÚ˜ fiÏÂȘ Î·È ÓËÛÈ¿ Ù˘ ¯ÒÚ·˜ ÁÈ· Ó· Í·Ó·Á˘Ú›ÛÔ˘Ì ÛÙË £ÂÛÛ·-ÏÔÓ›ÎË ÛÙÔ 28Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÙÔ 1990 ÛÙÔ ÍÂÓÔ‰Ô¯Â›Ô "M·Î‰ÔÓ›· ¶·ÏÏ¿˜".

H ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË KˆÓ. XˆÚ¤ÌË ¤ÁÈÓ ·fi ÙÔÓ ŒÏÏËÓ· K·ıËÁËÙ‹ ÛÙÔ National Institute of Health ÛÙȘ H¶AÎ. °ÂÒÚÁÈÔ XÚÔ‡ÛÔ, Ô ÔÔ›Ô˜ ÚfiÛÊ·Ù· ÂÍÂϤÁË K·ıËÁËÙ‹˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙÔ ¶·Ó/ÌÈÔ AıËÓÒÓ. TÔ ı¤Ì· Ô˘ ·Ó¤Ù˘Í ‹Ù·Ó "KÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ·ÂÏ¢ıÂÚˆÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ù˘ ÎÔÚÙÈÎÔÙÚÔ›Ó˘(CRH)". ™ÙÔ ÚfiÁÚ·ÌÌ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó 2 EÈÛËÁ‹ÛÂȘ, 1 ™ÙÚÔÁÁ˘Ïfi TÚ·¤˙È, 168 AÓ·ÎÔÈÓÒÛÂȘ Î·È 53 ·Ó·Ú-ÙË̤Ó˜ ·Ó·ÎÔÈÓÒÛÂȘ.

£· ‹ıÂÏ· Ó· ·Ó·Ê¤Úˆ fiÙÈ ÎÈ ¿ÏÏÔÈ ŒÏÏËÓ˜ È·ÙÚÔ› ÔÈ ÔÔ›ÔÈ ÛÔ‡‰·Û·Ó ÛÙË ¯ÒÚ· Ì·˜ ‹Ú·Ó ÙËÓ ÂȉÈÎfi-ÙËÙ· Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘ K. XˆÚ¤ÌË Î·È ¤¯Ô˘Ó ‰È·Ú¤„ÂÈ ÛÙÔ Â͈ÙÂÚÈÎfi, ¤¯Ô˘Ó ÚÔÛÎÏËı› ÁÈ·ÙËÓ Î·ıÈÂڈ̤ÓË ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË ÙÔ˘ ‰¿ÛηÏÔ˘ ÙÔ˘˜ fiˆ˜:

TÔ 1982 ÛÙÔ 20Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÛÙË X·ÏÎȉÈ΋, Ô Î. °È¿ÓÓ˘ §ÂˆÓ›‰·˜, K·ıËÁËÙ‹˜ Ù˘

¶∞π¢π∞∆ƒπ∫∏ 2000;63:339-341 ÃÚÈÛÙ›Ó· ∆ÛÂÁ΋

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:339-341

341

¶·È‰È·ÙÚÈ΋˜ AÎÙÈÓÔÏÔÁ›·˜ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Tufts ÙˆÓ H¶A Ì ı¤Ì·: O ·ÎÙÈÓÔÏfiÁÔ˜ Û·Ó Û‡Ì‚Ô˘ÏÔ˜ ÙÔ˘ ÎÏÈ-ÓÈÎÔ‡ ¶·È‰È¿ÙÚÔ˘.

TÔ 1983 ÛÙÔ 21Ô ÛÙËÓ Kˆ, Ë Î. E‡· ¶··Ì·Ùı·È¿ÎË-Lester, K·ıËÁ‹ÙÚÈ· Ù˘ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ÛÙÔ ¶·ÓÂ-ÈÛÙ‹ÌÈÔ McGill ÙÔ˘ K·Ó·‰¿, Ì ı¤Ì·: A˘ÙÔÎÙÔӛ˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜.

TÔ 1985 ÛÙÔ 23Ô ÛÙËÓ EÚÌÈfiÓË, Ë Î. ™Ù¤ÏÏ· Z·¯·ÚÈÔ˘‰¿ÎË-Van Praagh, K·ıËÁ‹ÙÚÈ· Ù˘ ¶·È‰È΋˜ K·Ú‰ÈÔ-ÏÔÁ›·˜ ÛÙÔ ¶·È‰È·ÙÚÈÎfi NÔÛÔÎÔÌÂ›Ô Ù˘ BÔÛÙÒÓ˘, Ì ı¤Ì·: º˘ÛÈÔÏÔÁÈ΋ Î·È ·ıÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÂ-ÛÔÎÔÏÈÎÔ‡ Î·È ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ù˘ ηډȿ˜ ÙÔ˘ ·ÓıÚÒÔ˘.

TÔ 1998 ÛÙÔ 36Ô ÛÙËÓ ¶¿ÊÔ Ù˘ K‡ÚÔ˘, Ë Î. M·Ú›· ¢ÂÏË‚ÔÚÈ¿- ¶··‰ÔÔ‡ÏÔ˘ ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈ-΋˜ Î·È º˘ÛÈÔÏÔÁ›·˜ ÛÙË ºÈÏ·‰¤ÏÊÈ· ÙˆÓ ∏.¶.∞.

Afi ÙÔ 28Ô ™˘Ó¤‰ÚÈÔ Ô˘ ¤ÁÈÓ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË, Ô ·ÚÈıÌfi˜ ÙˆÓ Û˘Ó¤‰ÚˆÓ ·˘Í‹ıËΠÙfiÛÔ ÒÛÙ ϤÔÓÌfiÓÔ Û fiÏÂȘ Ô˘ ‰È·ı¤ÙÔ˘Ó ÙË ÛˆÛÙ‹ ˘Ô‰ÔÌ‹ ÁÈ· Ó· ÊÈÏÔÍÂÓ‹ÛÔ˘Ó ¤Ó· ÙfiÛÔ ÌÂÁ¿ÏÔ Ï‹ıÔ˜ ÌÔÚ› Ó·Ú·ÁÌ·ÙÔÔÈËı› ÙÔ ™˘Ó¤‰ÚÈÔ Ì·˜. A˜ ÌËÓ Í¯ӿÌ fiÙÈ ÏfiÁˆ ÂÔ¯‹˜ Î·È ÙÔ˘ ÂÔÚÙ·ÛÙÈÎÔ‡ ÙÚÈË̤ÚÔ˘ Ë ÏÂÈÔ-ÓfiÙ˘ ÙˆÓ Û˘Ó¤‰ÚˆÓ Û˘Óԉ‡ÔÓÙ·È Î·È ·fi ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜.(9)

ŒÙÛÈ, ·ÎÔÏÔ˘ıËÛ·Ó ÙÔ HÚ¿ÎÏÂÈÔ KÚ‹Ù˘, Ë §ÂÌÂÛfi˜ K‡ÚÔ˘, Ë X·ÏÎȉÈ΋, Ë K¤Ú΢ڷ, Ë §‹ÌÓÔ˜, Ë Pfi‰Ô˜Î·È ¿ÏÈ ÙÔ HÚ¿ÎÏÂÈÔ Î·È Ë ¶¿ÊÔ˜ K‡ÚÔ˘.

TÔ ™˘Ó¤‰ÚÈÔ Â‰Ò Î·È ÌÂÚÈο ¯ÚfiÓÈ· ·Ú¯›˙ÂÈ ·fi ÙËÓ ¶·Ú·Û΢‹ ÙÔ ·fiÁÂ˘Ì· ̤¯ÚÈ ÙËÓ K˘Úȷ΋ ÙÔ ‚Ú¿‰˘.K·È ÊÙ¿ÓÔ˘Ì ÛÙÔ 37Ô Ì ÛÂÈÚ¿ Î·È ¿ÏÈ ·fi ÂΛ Ô˘ ·Ú¯›Û·ÌÂ, ÙË £ÂÛÛ·ÏÔÓ›ÎË, ÛÙÔ ÍÂÓÔ‰Ô¯Â›Ô "M·ÎÂ-

‰ÔÓ›· ¶·ÏÏ¿˜" Î·È Ì ·˘Ùfi ÎÏ›ÓÂÈ Ë ÙÂÏÂ˘Ù·›· ¯ÚÔÓÈ¿ ÙÔ˘ ·ÈÒÓ·.H ¤Ó·ÚÍË ÙÔ˘ ™˘Ó‰ڛԢ ¤ÁÈÓ Ì ÙËÓ ÔÌÈÏ›· ÙÔ˘ Aη‰ËÌ·˚ÎÔ‡ Î·È OÌfiÙÈÌÔ˘ K·ıËÁËÙ‹ Ù˘ ¶·È‰È·ÙÚÈ΋˜

NÈÎÔÏ¿Ô˘ M·ÙÛ·ÓÈÒÙË Ì ı¤Ì· "BÈÔ˚·ÙÚÈ΋ Î·È HıÈ΋". H ÔÌÈÏ›· ÛÙË ÌÓ‹ÌË KˆÓ. XˆÚ¤ÌË ¤ÁÈÓ ·fi ÙÔÓ K·ıË-ÁËÙ‹ Bush, Reader and Honorary Consultant in Pediatric Respiratory Medicine Ì ı¤Ì· "The child with verydifficult asthma. ªechanisms and managment". Y‹Ú¯·Ó ¿ÏÏÔÈ ‰‡Ô ͤÓÔÈ ÚÔÛÎÂÎÏË̤ÓÔÈ ÔÌÈÏËÙ¤˜ Ô˘ ·Ó¤-Ù˘Í·Ó ı¤Ì·Ù· Ù˘ ÂȉÈÎfiÙËÙ¿˜ ÙÔ˘˜. ŒÁÈÓ·Ó 2 ™ÙÚÔÁÁ˘Ï¿ TÚ·¤˙È·, 6 EÈÛËÁ‹ÛÂȘ, 3 ¢ÔÚ˘ÊÔÚÈο ™˘ÌfiÛÈ·,98 ·Ó·ÎÔÈÓÒÛÂȘ Î·È Û˘˙ËÙ‹ıËÎ·Ó 286 ·Ó·ÚÙË̤Ó˜ ·Ó·ÎÔÈÓÒÛÂȘ.

H Û˘ÌÌÂÙÔ¯‹ ‹Ù·Ó Ôχ ÌÂÁ¿ÏË, ÂÚ›Ô˘ 1500 Û‡Ó‰ÚÔÈ Ô˘ Û˘ÌÌÂÙ›¯·Ó Ô˘ÛÈ·ÛÙÈο Ì ÂÚˆÙ‹ÛÂȘ ηÈÛ¯fiÏÈ· ÛÙȘ 30 Û˘Ó‰ÚÈ¿ÛÂȘ Î·È ¤‰ˆÛ·Ó Ì›· ·ÓËÁ˘ÚÈ΋ fi„Ë ÛÙÔ ™˘Ó¤‰ÚÈfi Ì·˜, ÙÔ ™˘Ó¤‰ÚÈÔ ÙÔ˘ 1999.

TÂÏÂÈÒÓÔÓÙ·˜ ·˘Ù‹ ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ó·‰ÚÔÌ‹ ı· ‹ıÂÏ· Ó· ÙÔÓ›Ûˆ fiÙÈ fiÏÔÈ Ì·˜ ›̷ÛÙ ‚¤‚·ÈÔÈ fiÙÈ Ô ıÂ-ÛÌfi˜ ·˘Ùfi˜ Ô˘ ¿Ú¯ÈÛ ‰ÂÈÏ¿ - ‰ÂÈÏ¿ ˆ˜ "¶·È‰È·ÙÚÈη› H̤ڷÈ" Î·È ÂÍÂÏ›¯ıËΠÛÈÁ¿ - ÛÈÁ¿ Û ¤Ó· ·fi Ù· ÌÂ-Á·Ï‡ÙÂÚ·, ÔÏ˘ÏËı¤ÛÙÂÚ· Î·È ·ÍÈfiÏÔÁ· I·ÙÚÈο ™˘Ó¤‰ÚÈ· ı· Û˘Ó¯›ÛÂÈ ÙËÓ ›‰È· ÔÚ›· Î·È Û fiÏË ÙË ‰È·-‰ÚÔÌ‹ ÙÔ˘ 21Ô˘ ·ÈÒÓ·.

BÈ‚ÏÈÔÁÚ·Ê›·1. ¶Ô˘Ï¿ÎÔ˘-PÂÌÂÏ¿ÎÔ˘ ŒÊË, ¶Ú›ÊÙ˘ K. ¶ÂÓ‹ÓÙ· ¯ÚfiÓÈ· "¶·È‰È·ÙÚÈ΋" (ÈÛÙÔÚÈÎÔ› ÛÙ·ıÌÔ› ÛÙËÓ ÔÚ›· ÌÈÛÔ‡ ·ÈÒÓ·)

¶·È‰È·ÙÚÈ΋ 1997;60:474-487.2. M·ÚÙÛfiη˜ ™X. T· ÂÓ‹ÓÙ· ¯ÚfiÓÈ· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. ¶·È‰È·ÙÚÈ΋ 1981;44:377-378.3. M·ÚÙÛfiη˜ ™X. Nˆ٤ڷ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋. Aگ›· E¶E, 1972;35:479-482.4. ™¯fiÏÈ· Î·È ·fi„ÂȘ. AÈ ¶·È‰È·ÙÚÈη› HÌ¤Ú·È £ÂÛÛ·ÏÔӛ΢. Aگ›· E¶E 1961;24:53-54.5. ¶·È‰È·ÙÚÈη› HÌ¤Ú·È £ÂÛÛ·ÏÔӛ΢. ¶ÚÔÛÊÒÓËÛË ¶ÚÔ¤‰ÚÔ˘ Ù˘ E¶E N›Î· ZÂÚ‚Ô‡ ηٿ ÙËÓ EÓ·ÚÎÙ‹ÚÈÔ TÂÏÂÙ‹, £ÂÛÛ·-

ÏÔÓ›ÎË 5-6 IÔ˘Ó›Ô˘ 1961.6. ¶·È‰È·ÙÚÈη› Âȉ‹ÛÂȘ ·fi ÙËÓ EÏÏ¿‰· Î·È ÙÔ E͈ÙÂÚÈÎfi. Aگ›· E¶E 1961;24:107-108.7. Z¿ÓÓÔ˘-M·ÚÈÔϤ· §. ™Î¤„ÂȘ Î·È ÂÓÙ˘ÒÛÂȘ. ¶·È‰È·ÙÚÈ΋ 1974;37:413-416.8. ¶·È‰È·ÙÚÈη› Eȉ‹ÛÂȘ ·fi ÙËÓ EÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi. ¶ÂÚ·Á̤ӷ ¢.™. Ù˘ ¯ÚÔÓÈ΋˜ ÂÚÈfi‰Ô˘ 1964-1965. Aگ›· E¶E

1972;35:582-584.9. ¶ÚÔÛÊÒÓËÛË ÙÔ˘ ¶ÚÔ¤‰ÚÔ˘ Ù˘ E¶E I. MÂÛÛ·ÚÈÙ¿ÎË. 28Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. ¶·È‰È·ÙÚÈ΋ 1990;53:251-252.

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AÙÂÏ›˜ ·Ó·ÊÔÚ¤˜ ÛÙÔ˘˜ ·Ú¯·›Ô˘˜ ÎÏ·ÛÈÎÔ‡˜ È·ÙÚÔ‡˜

™Â ÔÚÈṲ̂Ó˜ ÂÚÁ·Û›Â˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¶AI¢IATPIKH ÙfiÌÔ˜ 63, Ù‡¯Ô˜ 2, M·ÚÙ›Ô˘ - AÚÈÏ›Ô˘ 2000, ÂÓÒÁ›ÓÔÓÙ·È ·Ó·ÊÔÚ¤˜ Û ·Ú¯·›Ô˘˜ ŒÏÏËÓ˜ È·ÙÚÔ‡˜, ı· ‹ıÂÏ· Ó· ÂÈÛËÌ¿Óˆ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û¯ÂÙÈ΋ ·Ú·-ÔÌ‹ ÛÙ· ÂÏÏËÓÈο ΛÌÂÓ¿ ÙÔ˘˜, ·ÏÏ¿ ·ÓÙ›ıÂÙ· ÔÈ ·Ú·Ô̤˜ Â›Ó·È Û ͤÓ˜ ÂÚÁ·Û›Â˜.

™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ Û˘ÁÁÚ·Ê›˜ ÙÔ˘ ¿ÚıÚÔ˘ "¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ¯˘ÏÔ˘Ú›·", ÛÂÏ. 163-166, ‰›ÓÔ˘Ó ÙË ÛË-Ì·ÓÙÈ΋ ÏËÚÔÊÔÚ›· ˆ˜ "ÁÈ· ÚÒÙË ÊÔÚ¿ Ô IÔÎÚ¿Ù˘ ·Ó·ÁÓÒÚÈÛÂ Î·È ÂÚȤÁÚ·„ ÙË ÓfiÛÔ". K·È ÂÓÒ ı·ÂÚ›ÌÂÓ ηÓ›˜ Ó· ‰ÂÈ ÙËÓ ·Ó·ÊÔÚ¿ ÛÙËÓ IÔÎÚ·ÙÈ΋ ™˘ÏÏÔÁ‹, ›Ûˆ˜ Î·È Ì ÙËÓ ·Ú¿ıÂÛË Û¯ÂÙÈÎÒÓ ÊÚ¿ÛÂ-ˆÓ, ÔÈ Û˘ÁÁÚ·Ê›˜ ·Ú·¤ÌÔ˘Ó Û ‰‡Ô ͤÓ˜ ÂÚÁ·Û›Â˜. MÈ· Î·È ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο ÏÂÍÈο-¢ÚÂÙ‹ÚÈ· Ù˘IÔÎÚ·ÙÈ΋˜ ™˘ÏÏÔÁ‹˜, ÓÔÌ›˙ˆ fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ ı· ‰˘ÛÎÔÏ¢fiÓÙÔ˘Û·Ó Ó· ¤‚ÚÈÛÎ·Ó ÙȘ ÊÚ¿ÛÂȘ "Ô‡-ÚËÛ Ï›ÔÓ, ÂÏ·È҉˜ Ô˘Ï‡" Î·È "Ô‡ÚËÛÂÓ ÂÏ·È҉˜", ÔÈ Ôԛ˜ Â›Ó·È ·fi ÙÔ "EȉËÌÈÒÓ ÙÔ ÚÒÙÔÓ, 13, ¿ÚÚˆ-ÛÙÔ˜ ‰ˆ‰¤Î·ÙÔ˜" Î·È ÙÔ "EȉËÌÈÒÓ ÙÔ ÙÚ›ÙÔÓ. ÕÚÚˆÛÙÔ˜ ÂÎηȉ¤Î·ÙÔ˜" ·ÓÙ›ÛÙÔȯ·.

E›Û˘, ÔÈ Û˘ÁÁÚ·Ê›˜ ÙÔ˘ ¿ÚıÚÔ˘ "H ‚·ÛÈ΋ ÂÎÎÚÈÙÈ΋ Âʉڛ· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘‰È·‚‹ÙË Ù‡Ô˘ 1", ÛÂÏ. 129-136, ÛËÌÂÈÒÓÔ˘Ó ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ¿ÚıÚÔ˘ ÙÔ˘˜ fiÙÈ "...Ô Û·Î¯·Ú҉˘ ‰È·‚‹ÙË˜Â›Ó·È ÁÓˆÛÙfi˜ ÁÈ· ÂÚÈÛÛfiÙÂÚ· ·fi 2000 ¯ÚfiÓÈ·..." ·Ú·¤ÌÔÓÙ·˜ fï˜, Û ͤÓÔ ¿ÚıÚÔ. B‚·›ˆ˜, Î·È ·˘-Ùfi ÙÔ ¿ÚıÚÔ ı· ÙÔ ÌÓËÌÔÓ‡ÛÔ˘Ó, ·ÏÏ¿ ηχÙÂÚ· ı· ‹Ù·Ó Ó· ›¯·Ó ÚÒÙ· ·Ó·Ê¤ÚÂÈ ÙÔ "¶ÂÚ› ‰È·‚ËÙ¤ˆ" ·fiÙÔ ¤ÚÁÔ ÙÔ˘ AÚÂÙ·›Ô˘, "¶ÂÚ› ·ÈÙ›ˆÓ Î·È ÛËÌ›ˆÓ ¯ÚÔÓ›ˆÓ ·ıÒÓ" B, II. A˜ ÛËÌÂȈı› fiÙÈ Ù· ¿·ÓÙ· ÙÔ˘ AÚÂ-Ù·›Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó Û ‰‡Ô ÙfiÌÔ˘˜, Ì ÙÔ ·Ú¯·›Ô ΛÌÂÓÔ Î·È ·Ú¿ÏÏËÏ· Ì ÙË ÓÂÔÂÏÏËÓÈ΋ ÌÂÙ¿ÊÚ·ÛË, ·fiÙȘ ÂΉfiÛÂȘ K¿ÎÙÔ˜.

T¤ÏÔ˜, ÛÙÔ ¿ÚıÚÔ "H ÈÛÙÔÚ›· Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜. EÈÙ‡ÁÌ·Ù· Î·È ÛÎȤ˜ ÙÔ˘ ¯ı˜ - ÚÔÛ‰Ô˘ Ù˘ ·‡-ÚÈÔÓ", ÛÂÏ. 93-96, ÌÓËÌÔÓ‡ÂÙ·È ˆ˜ IÔÎÚ¿ÙÂÈÔ˜ ·Ú¯‹ ÙÔ "¶ÚÔÏ·Ì‚¿ÓÂÈÓ Î·È Ô˘¯› ıÂڷ‡ÂÈÓ", ¯ˆÚ›˜ ˆÛÙfi-ÛÔ Ó· ·Ó·Ê¤ÚÂÙ·È Ë ·Ú·ÔÌ‹ ÙÔ˘ ¤ÚÁÔ˘, ÛÙÔ ÔÔ›Ô Î·Ù·¯ˆÚ›˙ÂÙ·È ·˘Ù‹ Ë Ú‹ÛË. ™Ù· ¢ÚÂÙ‹ÚÈ· fï˜,Ù˘ IÔÎÚ·ÙÈ΋˜ ™˘ÏÏÔÁ‹˜, ·fi fiÛÔ ‰ÈÂÚ¢ӋıËÎ·Ó ‰ÂÓ ÂÓÙÔ›ÛÙËÎÂ Ë ·Ó·ÊÂÚfiÌÂÓË Ú‹ÛË. ¶Èı·ÓfiÓ, ËÛ˘ÁÁڷʇ˜ ı· ‹ıÂÏ ӷ ÌÓËÌÔÓ‡ÛÂÈ ÙË Ú‹ÛË "ˆÊÂϤÂÈÓ ‹ ÌË ‚Ï¿ÙÂÈÓ", Ô˘ Â›Ó·È ·fi ÙÔ "EȉËÌÈÒÓ ÙÔÚÒÙÔÓ" II, 5.

™˘ÓÔ„›˙ÔÓÙ·˜, ÓÔÌ›˙ˆ fiÙÈ Î·Ïfi ı· Â›Ó·È ÔÈ Û˘ÁÁÚ·Ê›˜ fiÙ·Ó ı· ı¤ÏÔ˘Ó Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ˘˜ ·Ú¯·›Ô˘˜ŒÏÏËÓ˜ È·ÙÚÔ‡˜, Ó· ÌÓËÌÔÓÂ‡Ô˘Ó ÚÒÙ· ÙËÓ ÂÏÏËÓÈ΋ ËÁ‹ ÙˆÓ ÎÂÈÌ¤ÓˆÓ ÙÔ˘˜, ÙËÓ ÔÔ›· ‡ÎÔÏ· ÌÔÚÔ‡ÓÓ· ·Ó·˙ËÙ‹ÛÔ˘Ó Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ó· ·Ú·ı¤ÙÔ˘Ó ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Í¤ÓË.

M ÙÈÌ‹¢ËÌ‹ÙÚÈÔ˜ K·Ú·ÌÂÚfiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜¢È‰¿ÎÙˆÚ IÛÙÔÚ›·˜ Ù˘ I·ÙÚÈ΋˜

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O˘Î Â’ ¿ÚÙˆ ÌfiÓÔÓ ˙‹ÛÂÙ·È ¿ÓıÚˆÔ˜...

Y¿Ú¯Ô˘Ó ÔÏÏÔ› Û˘Ó¿‰ÂÏÊÔÈ ÌÂٷ̷͇˜, ÔÈ ÔÔ›ÔÈ ÂÎÙfi˜ ·fi ÙÔ ÌÂÚ¿ÎÈ Ù˘ I·-ÙÚÈ΋˜ ÂȉÈÎfiÙËÙ·˜ ¤¯Ô˘Ó Î·È ÙÔ ÂӉȷʤ-ÚÔÓ ÙÔ˘˜ ÛÙËÓ Ù¤¯ÓË, ÛÙË ÌÔ˘ÛÈ΋, ÛÙ·ÁÚ¿ÌÌ·Ù·, ÛÙÔÓ ·ıÏËÙÈÛÌfi. M ÙËÓ È‰Èfi-ÙËÙ· ÙÔ˘ ·˘ÙÔ‰‡ÙË-ʈÙÔÁÚ¿ÊÔ˘, ı· ÌÔ˘ÂÈÙÚ¤„ÂÙ ӷ ÌÔÈÚ·ÛÙÒ Ì·˙› Û·˜ (·Ó ÙÂ-ÏÈο ‰ËÌÔÛȇÛÂÙ ¤Á¯ÚˆÌ˜ ÙȘ ʈÙÔ-Áڷʛ˜ Ô˘ ÙÚ¿‚ËÍ· ÙËÓ 25.05.2000ÛÙÔÓ ¶·Á·ÛËÙÈÎfi) ÙË ı¤· ÂÓfi˜ ˘Ôı·-Ï¿ÛÛÈÔ˘ Î·È ÂÓfi˜ ·Ú·ı·Ï¿ÛÛÈÔ˘ ÙÔ›-Ô˘, ÚÈÓ ÍÂÛ¿ÛÂÈ ¤Ó· ÙÔÈÎfi ÌÔ˘Ú›ÓÈ.M·ÚÙ˘ÚÔ‡Ó fiÙÈ Ë ·ÙÚ›‰· Ì·˜, ·fi ·fi-„ˆ˜ ÔÈÎÔÏÔÁ›·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ, ¤¯ÂÈ ·Îfi-ÌË ÔÏÏ¿ Ó· ÚÔÛʤÚÂÈ Î·È ÛÙÔ Ì¤ÏÏÔÓ,·ÚΛ Ó· ·Ó·ıÚ¤„Ô˘Ì ٷ ·È‰È¿ Î·È ˆ˜ÔÈÎÔÏfiÁÔ˘˜. M ·ÊÔÚÌ‹ ·˘Ù‹ ÙË ‰ËÌÔÛ›-¢ÛË, ›Ûˆ˜ ÎÚ›ÓÂÙ fiÙÈ ÁÈ· Ó· ÁÓˆÚÈÛÙÔ‡-Ì ηχÙÂÚ· ÌÂٷ͇ Ì·˜, Û οı Ù‡¯Ô˜·Ó·ÁÚ¿ÊÂÙÂ Î·È ¤Ó· Û¯fiÏÈÔ ÁÈ· Ù· ÂӉȷ-ʤÚÔÓÙ· ÙˆÓ Û˘Ó·‰¤ÏÊˆÓ ÛÙËÓ Ù¤¯ÓË.Y¿Ú¯Ô˘Ó Î·È ÔÏÏÔ› Î·È Ì ÔÏÏ¿ ÂӉȷ-ʤÚÔÓÙ·.

MÂ Û˘Ó·‰ÂÏÊÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜£Âfi‰ˆÚÔ˜ ¶ÂÚÚ¿Î˘

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¶·È‰È¿ ∞Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ÛÙ· ¡ÔÛÔÎÔÌ›·

K˘Ú›Â˜ Î·È Î‡ÚÈÔÈ Ù˘ ™‡ÓÙ·Í˘,

™ÙÔ ÙÚ›ÙÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ "¶AI¢IATPIKH" Î·È ÛÙÔ ÎÂÊ¿Ï·ÈÔ "¶AI¢IATPIKH ENHMEPø™H" ·Ó·Ê¤-ÚÂÙ·È Ô ÏfiÁÔ˜ Ô˘ ‰ËÌÔÛȇıËΠÛÙÔ ÂÚÈÔ‰ÈÎfi Ë ÂȉËÌ›· ÈÏ·Ú¿˜ ÛÙËÓ AÏ‚·Ó›· ·fi ÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÙÔ˘NÔÛÔÎÔÌ›Ԣ "MËÙ¤Ú· TÂÚ¤˙·" ÙˆÓ TÈÚ¿ÓˆÓ (1). EÈÛËÌ·›ÓÂÙ·È fiÙÈ "™ÙËÓ ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙË-Ì›Ô˘ Iˆ·ÓÓ›ÓˆÓ ‹‰Ë ·fi ÙËÓ ÂÓÙ·ÂÙ›· 1991-1994 Ù· ·È‰È¿ AÏ‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ Î¿Ï˘Ù·Ó 16% ÙÔ˘ Û˘Ófi-ÏÔ˘ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ" (1). TÔ ÛÙÔÈ¯Â›Ô ·˘Ùfi Â›Ó·È ·Ôχو˜ ·Ó·ÎÚÈ‚¤˜, Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Â͈ڷÁÌ·ÙÈÎfi. §fiÁˆ Ù˘ Ì·ÎÚ¿˜ ÌÔ˘ ıËÙ›·˜ ˆ˜ ‰È¢ı˘ÓÙ‹ Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙˆÓ Iˆ·ÓÓ›ÓˆÓ ·fiÙÔ 1979 ̤¯ÚÈ ÙÔ 1997 ı· Ú¤ÂÈ Ó· Û·˜ ÂÓËÌÂÚÒÛˆ fiÙÈ ·fi Ù· ÛÙÔȯ›· Ù˘ ÎÏÈÓÈ΋˜ ÚÔ·ÙÂÈ fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·È‰ÈÒÓ AÏ‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ηٿ ̤ÛÔ fiÚÔ ÌfiÏȘ ÏËÛ›·˙ ÙÔ 7% οı ¯ÚfiÓÔ. ¶ÚÔÙ¿ÛÛÔÓÙ·˜ ÙË ÏÔÁÈ΋ ÙˆÓ ·ÚÈıÌÒÓ ı· Ú¤ÂÈ Ó· Ï¿‚ÂÙ ˘fi„Ë Û·˜ fiÙÈ ·fi 1-1-1990 ̤¯ÚÈ 31-12-1995 ÓÔÛËχıËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ 24.534 ·È‰È¿. EÏÏËÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜ 22.823 (93,03%) Î·È AÏ‚·ÓÈ-΋˜ ηٷÁˆÁ‹˜ 1.711 (6,97%) (2).

T· ÛÙÔȯ›· ‚Ú›ÛÎÔÓÙ·È ÛÙË ‰È¿ıÂÛË fiÛˆÓ ÂÈı˘ÌÔ‡Ó Ó· Ù· ÌÂÏÂÙ‹ÛÔ˘Ó ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÌÔÚÔ‡Ó Ó· Ù··Ó·˙ËÙ‹ÛÔ˘Ó ÛÙËÓ ·È‰È·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ÛÙË °Ú·ÌÌ·Ù›· Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜,ÛÙ· ÂÚ·Á̤ӷ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ NÔÛÔÎÔÌ›Ԣ Iˆ·ÓÓ›ÓˆÓ ·ÏÏ¿ Î·È ÛÙÔÓ AıËÓ·˚Îfi Ù‡Ô (3) fiÔ˘ ‰Ë-ÌÔÛȇÙËÎÂ Û˘ÁÎÚÔÙË̤ÓË ÂÈÎfiÓ· Ù˘ Èı·Á¤ÓÂÈ·˜ ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·È‰ÈÒÓ ·fi ÙÔÓ ÁÚ¿ÊÔÓÙ·, ÏfiÁˆ ÙÔ˘ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ÏÔÁÈ΋ ÙˆÓ ·ÚÈıÌÒÓ Â›¯Â Î·È ÙfiÙ ηÎÔÔÈËı› ·fi ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙˆÓ AıËÓÒÓ Ì ÙË ‰Ë-ÌÔÛ›Â˘ÛË ¿ÚıÚÔ˘ ÛÙËÓ ¤ÁÎÚÈÙË ÂÊËÌÂÚ›‰· K·ıËÌÂÚÈÓ‹ (4) ˘fi ÙÔÓ Â͈ڷÁÌ·ÙÈÎfi fiÛÔ Î·È ÍÂÓfiÊÔ‚Ô Ù›ÙÏÔ"¶·ÓÂÈÛÙËÌȷ΋ KÏÈÓÈ΋ ÁÈ·... AÏ‚·Ó¿ÎÈ·"!

TÔ ˆ˜ ¿Óˆ ¿ÚıÚÔ ÛÙËÓ K·ıËÌÂÚÈÓ‹ ÛÙËÚ›¯ıËΠ۠ÛÙÔȯ›· Ô˘ Û˘Ó¤Ù·Í ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙˆÓ AıËÓÒÓ,Ë ÔÔ›· ‰ÂÓ ÂÚ‡ÓËÛ ÂÈÙfiÔ˘ ÙÔ ı¤Ì·, ‰ÂÓ Î·ÙfiÙ¢Û ÙÔ˘˜ ¯ÒÚÔ˘˜, ‰ÂÓ Â›‰Â ȉ›ÔȘ fiÌÌ·ÛÈ ÙËÓ Î·Ù¿ÛÙ·-ÛË, fï˜ ›¯Â ÙËÓ ÙfiÏÌË Ó· ·ÔÊ·Óı› ÂÍ ·ÔÛÙ¿Ûˆ˜. ¢˘ÛÙ˘¯Ò˜ Ë ‰ËÌÔÛÈÔÁÚ¿ÊÔ˜ Î. N. K·Ú·ÌÔ‡˙Ë Ô˘Û˘Ó¤Ù·Í ÙÔ ¿ÚıÚÔ ‰ÂÓ ˙‹ÙËÛ ÙË ÁÓÒÌË ÙˆÓ Â¯fiÓÙˆÓ ÙfiÙ ÙËÓ Â˘ı‡ÓË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ¶·ÓÂÈÛÙËÌÈ·-΋˜ KÏÈÓÈ΋˜ ÙˆÓ Iˆ·ÓÓ›ÓˆÓ, ÒÛÙ ӷ ¤¯ÂÈ ÙË ¯·Ú¿ ÙÔ˘ ·ÓÙÈÏfiÁÔ˘, ·ÏÏ¿ ÂÏ·ÊÚ¿ ÙË Î·Ú‰›·, ·Ó·Î‹Ú˘Í ÙËÓÎÏÈÓÈ΋ domaine reservé ÙˆÓ ·Ï‚·ÓÔ·›‰ˆÓ (4). E˘Ù˘¯Ò˜, Ë Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰È¤„¢Û ·ÌÊÔÙ¤ÚÔ˘˜ (2).

T· ÛÙÔȯ›· Ô˘ ·Ó·Ê¤ÚÔ˘Ó Ù· ÂÈÛÙËÌÔÓÈο, ȉ›ˆ˜ Ù· È·ÙÚÈο ÂÚÈÔ‰Èο Î·È Î˘Ú›ˆ˜ ÙÔ ÓÔ‡ÌÂÚÔ Ú¤ÂÈÓ· ÂϤÁ¯ÂÙ·È Â·ÚÎÒ˜ Î·È Â·ÓÂÈÏËÌ̤ӷ ÁÈ· Ó· ÏËÛÈ¿˙ÂÈ ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, ÒÛÙ ÔȉȷÚıÚˆÙÈΤ˜ ·ÏÏ·Á¤˜ Ó· Â›Ó·È Â‡ÛÙԯ˜, ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ Î·È Ó· ‰›ÓÔ˘Ó Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ· Î·È fi¯È Ó· ‰Ë-ÌÈÔ˘ÚÁÔ‡Ó ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÏÈÓÈÎÒÓ, ȉ›ˆ˜ Ù˘ ·گ›·˜.

°È· ÌÈ· ÊÔÚ¿ ·ÎfiÌË ·Ô‰Â›¯ıËΠfiÙÈ Ë ÌÂÙÚÈÔ¿ıÂÈ·, Ë Û‡ÓÂÛË Î·È Ô ÚÔÛÂÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÛÙÔȯ›-ˆÓ ·ÔÙÂÏÔ‡Ó fiÏÔ ÛÙ· ¯¤ÚÈ· fiÛˆÓ ÂÈı˘ÌÔ‡Ó Ú·ÁÌ·ÙÈο Ó· Ï˘ıÔ‡Ó Ù· ÚÔ‚Ï‹Ì·Ù·.

M ÙÈÌ‹¶¤ÙÚÔ˜ ¢. §··ÙÛ¿Ó˘OÌ. K·ıËÁËÙ‹˜ - ¢È¢ı˘ÓÙ‹˜ ¶·Ó/΋˜ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙˆÓ Iˆ·ÓÓ›ÓˆÓ (1979-1997)

BÈ‚ÏÈÔÁÚ·Ê›·1. H ™‡ÓÙ·ÍË. ¶AI¢IATPIKH ENHMEPø™H. ¶·È‰È·ÙÚÈ΋ 2000;63:254-261.2. °·Ï·Ó¿Î˘ E., KÚ¿ÏÏ˘ N., NÙÔ‡ÚÔ˜ £., E˘·ÁÁÂÏ›‰Ô˘ E., AÓ‰ÚÔÓ›ÎÔ˘ ™., ™È·ÌÔÔ‡ÏÔ˘ A. NÔÛËÏ›· ·È‰ÈÒÓ ·Ï‚·ÓÈ΋˜

˘ËÎÔfiÙËÙ·˜: Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÚÔ‚Ï‹Ì·Ù·, ÚÔÔÙÈΤ˜. ¶·È‰È·ÙÚÈ΋ 1998;61:276-286.3. §··ÙÛ¿Ó˘ ¶. ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ Iˆ·ÓÓ›ÓˆÓ. KA£HMEPINH -°PAMMATA 20 I·ÓÔ˘·Ú›Ô˘ 1996.4. K·Ú·ÌÔ‡˙Ë N. ¶·ÓÂÈÛÙËÌȷ΋ KÏÈÓÈ΋ ÁÈ·... AÏ‚·Ó¿ÎÈ·. KA£HMEPINH 4 I·ÓÔ˘·Ú›Ô˘ 1996.

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¶·È‰È¿ ∞Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ÛÙ· ¡ÔÛÔÎÔÌ›·A¿ÓÙËÛË ·fi ÙË ™‡ÓÙ·ÍË

E›Ó·È Ôχ ÎÔϷ΢ÙÈÎfi ÁÈ· ÙËÓ ¶AI¢IATPIKH Ó· ‰È·‚¿˙ÂÈ Ô ¶¤ÙÚÔ˜ §··ÙÛ¿Ó˘ ·ÎfiÌË Î·È ÙËÓ ¶·È‰È·-ÙÚÈ΋ EÓË̤ڈÛË Î·È ·ÎfiÌË ÎÔϷ΢ÙÈÎfiÙÂÚÔ Ó· Ì·›ÓÂÈ ÛÙÔÓ ÎfiÔ Ó· ÛÙ›ÏÂÈ ÂÈÛÙÔÏ‹. E˘¯·ÚÈÛÙÔ‡ÌÂ.

H ÏËÚÔÊÔÚ›· ÁÈ· ÙÔ 16% ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÂÚÁ·Û›· ÙˆÓ ¶. §··ÙÛ¿ÓË, I. ¶··Â˘ÛÙ·ı›Ô˘, X. ¶ÂÙÛÔ‡ÎË, M. T˙Ô‡ÊË, E. °·Ï·Ó¿ÎË. "NÔÛÔÎÔÌÂȷ΋ ÂÚ›ı·Ï„Ë ·È‰ÈÒÓ AÏ‚·ÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜" 33Ô ¶·ÓÂÏÏ. ¶·È‰ ™˘Ó 1995, AA257 fiÔ˘ ÁÚ¿ÊÂÙ·È: "™ÙËÓ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›-Ô˘ Iˆ·ÓÓ›ÓˆÓ ÔÈ ÂÈÛ·ÁˆÁ¤˜ ÙˆÓ ·È‰ÈÒÓ AÏ‚·ÓÈ΋˜ ˘ËÎÔfiÙËÙ·˜ ¤ÊÙ·Û·Ó Î·Ù¿ ÙËÓ ÙÂÙÚ·ÂÙ›· 1991-1994 ÙȘ1.516 (16% ÙÔ˘ Û˘ÓfiÏÔ˘ ÂÈÛ·ÁˆÁÒÓ Ù˘ KÏÈÓÈ΋˜)".

OÈ ÂȉËÌÈÔÏÔÁÈΤ˜ Û¯¤ÛÂȘ Ì ÙÔÓ AÏ‚·ÓÈÎfi ÏËı˘ÛÌfi ÂȂ‚·ÈÒÓÔÓÙ·È ·fi Ù· ÛÙÔȯ›· Ô˘ ‰›ÓÂÈ Ô Î. §··ÙÛ¿Ó˘. ¢ÂÓ ·Ó·ÈÚÔ‡ÓÙ·È ·Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙ· ÓÔÛÔÎÔÌ›· Â›Ó·È 6% ·ÓÙ› 16% Ô˘ ˘Ô-ÏfiÁÈ˙ ·Ï·ÈfiÙÂÚ·. AÏÏ¿, ÁÈ·Ù› ÔÈ ÚÔÛ‚ÏËÙÈΤ˜ ‰˘Ô ÙÂÏÂ˘Ù·›Â˜ ·Ú¿ÁÚ·ÊÔÈ; £· ‹Ù·Ó ¿‰ÈΘ ·ÎfiÌË ÎÈ ·Ó ›¯·Ì ·ÓÙÈÁÚ¿„ÂÈ Ï¿ıÔ˜ ÙÔ ÓÔ‡ÌÂÚÔ. H ˘ÔÁÚ¿ÊÔ˘Û· Â›Ó·È ‚·ı‡Ù·Ù· ¢ÁÓÒÌˆÓ ÁÈ· ÙȘ ÂÔÈÎÔ‰ÔÌËÙÈΤ˜ ηÙÛ¿‰Â˜ ÙÔ˘ ÂÈÛÙÔÏÔÁÚ¿ÊÔ˘ Ô˘ ‰È·ÌfiÚÊˆÛ·Ó ÙËÓ ÎÏÈÓÈ΋ Ù˘ ÛΤ„Ë ÛÙËÓ ·Ú¯‹ Ù˘ ÛÙ·‰ÈÔ‰ÚÔÌ›·˜ Ù˘.AÏÏ¿ Ó· ηÙËÁÔÚÂ›Ù·È ÁÈ· ¤ÏÏÂÈ„Ë ÛÔ‚·ÚfiÙËÙ·˜ Î·È ¤ÏÏÂÈ„Ë Â·ÚÎÔ‡˜ ÂϤÁ¯Ô˘ ÙˆÓ ÁÚ·ÙÒÓ Ù˘, ‰ÂÓ ÙÔ ·Í›˙ÂÈ. K·È ÙËÓ ·›ÚÓÂÈ ÙÔ ·Ú¿ÔÓÔ...

°È· ÙËÓ E.™.E.EϤÓË B·Ï¿ÛÛË-A‰¿Ì

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X·ÚÙÔÁÚ¿ÊËÛË ÁÔÓȉÈÒÌ·ÙÔ˜ Î·È ˘Á›·

K¿ı ÛÙ·ıÌfi˜ ÂÈÛÙËÌÔÓÈ΋˜ ÚÔfi‰Ô˘ Â›Ó·È ¿ÍÈÔ˜ ÂÔÚÙ·ÛÌÔ‡. AÚΛ ÙÔ Â›Ù¢ÁÌ· Ó· ÂÚÌËÓ‡ÂÙ·È ÛˆÛÙ¿Î·È Ó· ÌËÓ ‰ËÌÈÔ˘ÚÁ› Â͈ڷÁÌ·ÙÈΤ˜ ÚÔÛ‰Ô˘, fiˆ˜ ‰˘ÛÙ˘¯Ò˜ Û˘Ó¤‚Ë ÙËÓ Â‚‰ÔÌ¿‰· ·˘Ù‹ - NÈ΋ıË-Î·Ó ÔÈ ·ÚÚÒÛÙȘ, ÓÈ΋ıËΠÙÔ Á‹Ú·˜ - ÕÂÈÚ˜ Û˘ÓÂÓÙ‡ÍÂȘ Ì ÛÔ‚·ÚÔ‡˜ Î·È ÏÈÁfiÙÂÚÔ ÛÔ‚·ÚÔ‡˜ ÂÈÛÙ‹-ÌÔÓ˜. £· ¤Ú fï˜, ÚˆÙ›ÛÙˆ˜ Ó· ÂÚˆÙËı› Ô Î·ıËÁËÙ‹˜ Î. ºÒÙ˘ K·Ê¿ÙÔ˜, °ÂÓÈÎfi˜ ¢È¢ı˘ÓÙ‹˜ ÙÔ˘E˘Úˆ·˚ÎÔ‡ K¤ÓÙÚÔ˘ MÔÚȷ΋˜ BÈÔÏÔÁ›·˜ Ô˘ ‰Ú‡ÂÈ ÛÙË X·˚‰ÂÏ‚¤ÚÁË Î·È Û˘ÓÙÔÓ›˙ÂÈ Ù· ÈÔ ÛËÌ·ÓÙÈο Τ-ÓÙÚ· ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ ÙˆÓ ÎÚ·ÙÒÓ ÌÂÏÒÓ Ù˘ E˘Úˆ·˚΋˜ ŒÓˆÛ˘. TÔÓ ·ÚÂÏıfiÓÙ· M¿ÚÙÈÔ, fiÙ·Ó ÙÔ˘·ÔÓÂÌ‹ıËΠÙÔ AÚÈÛÙÂ›Ô Ù˘ Aη‰ËÌ›·˜, ÌÔ˘ › ¯·Ú·ÎÙËÚÈÛÙÈο: AÓ ¯ÚÂÈ¿ÛıËÎ·Ó 10 ÂÚ›Ô˘ ¯ÚfiÓÈ· ÁÈ·ÙË ¯·ÚÙÔÁÚ¿ÊËÛË ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ı· ¯ÚÂÈ·Ûı› ÂӉ¯Ô̤ӈ˜ ¤Ó·˜ ·ÈÒÓ·˜ ÁÈ· ÙËÓ ·ÎÚÈ‚‹·ÔÎ¿Ï˘„Ë Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘.

AÛÊ·ÏÒ˜ ı· ˆÊÂÏËı› - Û ÌÈÎÚ‹ Îϛ̷η - Ë È·ÙÚÈ΋ ·fi Ù· Û˘ÓÙÂÏÔ‡ÌÂÓ· ÂÚ¢ÓËÙÈο ÂÈÙ‡ÁÌ·Ù· ÌÂ-Ù¿ 10 ÂÚ›Ô˘ ¯ÚfiÓÈ·. OÈ Û˘¯ÓÔ› Î·È ˘ÂÚ‚ÔÏÈÎÔ› ÂÔÚÙ·ÛÌÔ› ÁÈ· ÙȘ ÂÈÙÂÏÔ‡ÌÂÓ˜ È·ÙÚÔ‚ÈÔÏÔÁÈΤ˜ ÚÔfi‰Ô˘˜Ì·˜ ·Ú·Û‡ÚÔ˘Ó ¤Íˆ ·fi ÙË ˙¤Ô˘Û· Ú·ÁÌ·ÙÈÎfiÙËÙ· Ô˘ ‰È‰¿ÛÎÂÈ fiÙÈ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ Û‡ÌÌ·¯Ô˜ Ù˘ ˘Á›-·˜ Ì·˜ Â›Ó·È Ë ·˘ÙÔÊÚÔÓÙ›‰·. ŸÏÔÈ ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÔÈ ÌÂÁ¿ÏÔÈ Â¯ıÚÔ› Ù˘ ˘Á›·˜ Ì·˜ Â›Ó·È ÙÔ Î¿ÓÈÛÌ·, Ë ·-¯˘Û·ÚΛ·, Ë Î·ıÈÛÙÈ΋ ˙ˆ‹, ÙÔ ¿Á¯Ô˜, Ë ·˘ÙÔηٷÛÙÚÔÊÈ΋ ÙÚÔ¯·›· Û˘ÌÂÚÈÊÔÚ¿ Î·È Ù· Û˘Ó·Ê‹. H ·ÔÊ˘-Á‹ ÙÔ˘˜ Û˘ÓÂÈÛʤÚÂÈ ÛÙË Ì·ÎÚÔË̤Ú¢ÛË Î·È ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Ì·˜ ‰ÂηϿÛÈ· ·fi ÙËÓ È·ÙÚÈ΋. °È· ӷˆÊÂÏËıԇ̠·fi Ù· ÌÂÏÏÔÓÙÈο È·ÙÚÈο ı·‡Ì·Ù· Ú¤ÂÈ ÚÒÙÔÓ Ó· ˘¿Ú¯Ô˘ÌÂ Î·È ‰Â‡ÙÂÚÔ Ó· ÌËÓ ¤¯Ô˘-Ì ÂÈÙÚ¤„ÂÈ Ó· ˘ÔÛÙ› Ë ˘Á›· Ì·˜ ·Ó·ÓfiÚıˆÙ˜ ‚Ï¿‚˜.

H ÌÂÁ·Ï‡ÙÂÚË ÚfiÔ‰Ô˜ Ù˘ Û‡Á¯ÚÔÓ˘ È·ÙÚÈ΋˜ Î·È Ë ÌÂÁ·Ï‡ÙÂÚË Û˘ÓÂÈÛÊÔÚ¿ Ù˘ ÛÙËÓ ˘Á›· Ì·˜ ›ӷÈË Û˘ÓÂȉËÙÔÔ›ËÛË Ù˘ ·Í›·˜ Ù˘ ·˘ÙÔÊÚÔÓÙ›‰·˜.

K·ıËÁËÙ‹˜ N. M·ÙÛ·ÓÈÒÙ˘°ÂÓÈÎfi˜ °Ú·ÌÌ·Ù‡˜ Ù˘ Aη‰ËÌ›·˜ AıËÓÒÓ

AÓ·‰ËÌÔÛ›Â˘ÛË ·fi ÙËÓ K·ıËÌÂÚÈÓ‹

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∞fi ÙËÓ ∂. µ·Ï¿ÛÛË-∞‰¿Ì

AÏÏ·Á‹ ™‡ÓÙ·Í˘H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Û˘ÌÏ‹ÚˆÛ ‰‡Ô ¯ÚfiÓÈ· ‰Ô˘ÏÂÈ¿˜ ÛÙËÓ ¶AI¢IATPIKHÎ·È ı· ·Ú·‰ÒÛÂÈ Ù· ·Ú¯Â›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÛÙÔÓ Ó¤Ô ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ™˘Ó¤‰ÚÈÔ ÔfiÙ·ӷϷ̂¿ÓÂÈ Î·È ÙÔ Ó¤Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. TÔ 5Ô Ù‡¯Ô˜ ÙÔ˘ 2000ı· ‰ÈÂÎÂڷȈı› ·fi ÙËÓ ÂfiÌÂÓË E.™.E. ÂÓÒ Ë ÚÒËÓ... ı· οÓÂÈ ¿ÓÂÙ· ÙȘ ‰È·ÎÔ¤˜ Ù˘!

H ¶AI¢IATPIKH ·Ó¤Î·ıÂÓ ÛÙËÚÈ˙fiÙ·Ó ÛÙÔÓ "·ÙÚȈÙÈÛÌfi ÙˆÓ Û˘ÓÙ·ÎÙÒÓ Ù˘" Î·È ‰ÂÓ Ù· ηٷʤÚÓÂÈ ÎÈ¿ÛÎËÌ·, ·ÏÏ¿ ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Ó¯›˙ÂÙ·È. ™ÙȘ ÚԉȷÁڷʤ˜ ÂÓfi˜ Û‡Á¯ÚÔÓÔ˘, ¤ÁÎÚÈÙÔ˘ ÂÈÛÙË-ÌÔÓÈÎÔ‡ ÂÚÈÔ‰ÈÎÔ‡ Î·È ÛÙ· ÎÚÈÙ‹ÚÈ· ·ÍÈÔÏfiÁËÛ‹˜ ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·Ù·ÛÙ·ÙÈÎfi Î·È Î·ÓÔÓÈÛÌfi˜ ÏÂÈÙÔ˘Ú-Á›·˜. H ·ÚÔ‡Û· E.™.E. ¤¯ÂÈ Î·Ù·ı¤ÛÂÈ ¤Ó· Û¯¤‰ÈÔ Î·ÓÔÓÈÛÌÔ‡ ÏÂÈÙÔ˘ÚÁ›·˜ Ì·˙› Ì ÚÔÙ¿ÛÂȘ ÁÈ· ÙÚÔÔÔÈ‹-ÛÂȘ Ô˘ ¤ÁÈÓ·Ó ·fi Ù· ̤ÏË Ù˘ Î·È ·fi ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘ (£. K·Ú¿ıÈÔ, N. M·Óˆ-Ï¿ÎË, ™. X·˚‰¿, X. M·ÚÙÛfiη) ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘Ì‚Ô˘Ï‡ÙËÎÂ. EÏ›˙Ô˘Ì ÙÔ ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ E.¶.E.Ó· ÙÔ ÂÂÍÂÚÁ·ÛÙ› fiÛÔ ÓÔÌ›˙ÂÈ fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È Î·È Ó· ηϤÛÂÈ Û‡ÓÙÔÌ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Û ηٷÛÙ·ÙÈ΋ ÁÂ-ÓÈ΋ Û˘Ó¤Ï¢ÛË ÁÈ· Ó· Ù·ÎÙÔÔÈËı› ÙÔ ı¤Ì·.

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N¤ÔÈ Î·ıËÁËÙ¤˜ ·È‰È·ÙÚÈ΋˜Afi Ù· Ôχ ¢¯¿ÚÈÛÙ· ·È‰È·ÙÚÈο Ó¤·: ÂÍÂÏ›¯ÙËÎ·Ó Û ηıËÁËÙ¤˜ ÚÒÙ˘ ‚·ıÌ›‰·˜ ÔÈ Û˘Ó¿‰ÂÏÊÔÈ: A. Kˆ-

ÛÙ·ÓÙfiÔ˘ÏÔ˜, A. ¢¿ÎÔ˘-BÔ˘ÙÂÙ¿ÎË, £. K·Ú¿ıÈÔ˜, º. K·Ó·ÎÔ‡‰Ë- T۷ηϛ‰Ô˘. E›Ó·È fiÏÔÈ ÁÓˆÛÙÔ› ÛÙÔ˘˜ ·Ó·-ÁÓÒÛÙ˜ Ù˘ ¶AI¢IATPIKH™ ÎÈ Ô ÂÏÏËÓÈÎfi˜ ·È‰È·ÙÚÈÎfi˜ Ù‡Ô˜ ÙÔ˘˜ ÔÊ›ÏÂÈ ÔÏÏ¿. TÔÓ ¤¯Ô˘Ó ˘ÔÛÙËÚ›ÍÂÈ fi¯ÈÌfiÓÔ ˆ˜ Û˘ÁÁÚ·Ê›˜ ·ÏÏ¿ Î·È ˆ˜ ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘, Û˘ÓÙ¿ÎÙ˜ Î·È ÎÚÈÙ¤˜. £ÂÚÌfiٷٷ Û˘Á¯·ÚËÙ‹ÚÈ·!

O ηıËÁËÙ‹˜ °. XÚÔ‡ÛÔ˜ Ô˘ ÂÍÂϤÁË ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1999 ¤¯ÂÈ Ï·ÌÂÚ‹ ·ÚÔ˘Û›· ÛÙÔÓ Í¤ÓÔ ÂÈÛÙËÌÔÓÈÎfiÙ‡Ô ·ÏÏ¿ fi¯È ÛÙÔÓ ÂÏÏËÓÈÎfi, ·È‰È·ÙÚÈÎfi. AÓÙ·ÔÎÚ›ıËΠÚfiı˘Ì· ÛÙËÓ ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ-‹˜ Ó· ÁÚ¿„ÂÈ ¤Ó· ¿ÚıÚÔ Û‡ÓÙ·Í˘ ÁÈ· ÙËÓ ¶AI¢IATPIKH (ÛÂÏ. 275-277 ). K·Ï‹ ·Ú¯‹!

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K¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛˆÓAfi ÙÔ˘˜ ¢¯¿ÚÈÛÙÔ˘˜ ÛÙ·ıÌÔ‡˜ Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜: ÙÔ K¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ Û˘ÌÏ‹ÚˆÛ 25

¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜. T· ÁÈfiÚÙ·Û Û ÌÈ· Ôχ ÛÂÌÓ‹ ÂÔÚÙ·ÛÙÈ΋ ÂΉ‹ÏˆÛË fiÔ˘ ·ÚÎÂÙÔ› ÔÌÈÏËÙ¤˜ ·Ó·Ê¤Ú-ıËÎ·Ó ÛÙÔ Ò˜ ÍÂΛÓËÛ ÙÔ K¤ÓÙÚÔ. H ˘Ê˘Ô˘ÚÁfi˜ YÁ›·˜ ΢ڛ· XÚÈÛÙ¿ÎË ˘ÔÛ¯¤ıËΠÌÂÏÏÔÓÙÈ΋ ˘ÔÛÙ‹-ÚÈÍË ÙÔ˘ ¤ÚÁÔ˘ ÙÔ˘ K¤ÓÙÚÔ˘ (˘Ô˘ÚÁfi˜ ›ӷÈ, ÌÔÚ› Ú¿ÁÌ·ÙÈ Ó· ÙÔ ˘ÔÛÙËÚ›ÍÂÈ). AӷʤÚıËΠ›Û˘ ÛÙËÓ˘ÔÛÙ‹ÚÈÍË Ô˘ ¤¯ÂÈ ‰Â¯ı› Ë ›‰È· ·fi ÙÔ K¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ ˆ˜ ·ÁÁÂÏÌ·Ù›·˜ ˘Á›·˜ Î·È Â˘¯·Ú›ÛÙËÛÂÁÈ’ ·˘Ù‹Ó. ¶ÈÛÙ‡ˆ fiÙÈ ÔÈ Â˘¯·ÚÈÛٛ˜ Ù˘ ÂÎÊÚ¿˙Ô˘Ó fiÏÔ ÙÔÓ ·È‰È·ÙÚÈÎfi ÎfiÛÌÔ. E˘¯·ÚÈÛÙÔ‡ÌÂ, Û˘Ó¿‰ÂÏÊÔÈÙÔ˘ K¤ÓÙÚÔ˘ ¢ËÏËÙËÚÈ¿ÛˆÓ.

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EÓËÌÂÚˆÙÈÎfi˜ ·ÔÏÔÁÈÛÌfi˜H ˘ÔÁÚ¿ÊÔ˘Û· ¤Ï·‚ ¤Ó· ÂÓËÌÂÚˆÙÈÎfi ‰ÂÏÙ›Ô Ù˘ MÔÓ¿‰·˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ NÂÔÁÓÒÓ NÔÛÔÎÔÌ›-

Ô˘ I·ÛÒ. EÓÙ˘ˆÛÈ¿˙ÂÈ ÙÔ fiÙÈ Ô ÚfiÏÔÁÔ˜ ‰ÂÓ ˘ÔÁÚ¿ÊÂÙ·È ÌfiÓÔ ·fi ÙÔÓ ‰È¢ı˘ÓÙ‹ ·ÏÏ¿ ·fi ÙÔ˘˜ 8 ÁÈ·ÙÚÔ‡˜Ù˘ MÔÓ¿‰·˜ Î·È ÙȘ 2 ÚÔ˚ÛÙ¿ÌÂÓ˜. EÓÙ˘ˆÛÈ¿˙ÂÈ Â›Û˘, ÙÔ fiÙÈ Ë ÂÈ‚›ˆÛË ÙˆÓ ÌÈÎÚÒÓ ÚÔÒÚˆÓ (<1500ÁÚ) ¤¯ÂÈ Êı¿ÛÂÈ ·ÈÛ›ˆ˜ ÛÙÔ 90%. OÈ ·ÔÏÔÁÈÛÌÔ› Û˘Ó‹ıˆ˜ ·Ô‚Ï¤Ô˘Ó ÛÙËÓ ÚÔ‚ÔÏ‹ ÙÔ˘ ¤ÚÁÔ˘ ÙˆÓ ÂÚÁ·-˙fiÌÂÓˆÓ. ™ÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË, ÙÔ ˘ÏÈÎfi Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Â›Ó·È ÏËÚÔÊÔÚÈ·Îfi Î·È ÂӉȷʤÚÔÓ. £·‹Ù·Ó ηϋ ȉ¤· Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ÛÙÔȯ›· ·fi ÙÔ˘˜ ·ÔÏÔÁÈÛÌÔ‡˜ Î·È ¿ÏÏˆÓ ÌÔÓ¿‰ˆÓ.

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¶AI¢IATPIK∏ ∂¡∏ª∂ƒø™∏

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BÈ‚ÏÈÔÁÚ·ÊÈ΋ ÂÓË̤ڈÛË

K¿ı ‰Ú·ÛÙËÚÈfiÙËÙ· ·È‰È¿ÙÚˆÓ Ô˘ ÍÂʇÁÂÈ ·fi ÙÔÓ ‚ÈÔ˚·ÙÚÈÎfi ˘Ú‹Ó· Ù˘ ¶·È‰È·ÙÚÈ΋˜, ÂÎ ÙˆÓ Ú·Á-Ì¿ÙˆÓ ·ÁÓÔÂ›Ù·È ·fi ÙÔÓ ÂÚÈÔ‰ÈÎfi ·È‰È·ÙÚÈÎfi Ù‡Ô. EӉȷʤÚÔ˘Û· ‰Ô˘ÏÂÈ¿ Û˘Ó·‰¤ÏÊˆÓ ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ,ÁÈ· ÂÈÎÔÈÓˆÓ›·, ÁÈ· Ù· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡, ÁÈ· ÓÔÌÔıÂÛ›·, ÁÈ· ÈÛÙÔÚ›· Ù˘ È·ÙÚÈ΋˜, ‰ËÌÔÛȇÂÙ·È Û˘Ó‹-ıˆ˜ Û ÌË È·ÙÚÈÎfi Ù‡Ô ‹ ΢ÎÏÔÊÔÚ› ˆ˜ ÌÔÓÔÁÚ·Ê›·. ¢ÂÓ Î·Ù·ÏÔÁÔÁÚ·ÊÂ›Ù·È ·fi ÙËÓ IATPOTEK(www.mednet.gr) Ô‡Ù ·fi ÙËÓ IPI™ (www.ich.gr) ÎÈ ¤ÙÛÈ Î·Ó›˜ Ì·˜ ‰ÂÓ ¤¯ÂÈ ÚfiÛ‚·ÛË Û' ·˘Ù‹Ó. E›Ó·È Îڛ̷!Ÿ¯È ÌfiÓÔ ÁÈ·Ù› ·˘Ù¿ Ù· ‰›· ‰›ÓÔ˘Ó ÌÈ· ¿ÏÏË ıÂÒÚËÛË, ȉȷ›ÙÂÚ· ¯Ú‹ÛÈÌË ÛÙËÓ ¿ÛÎËÛË Ù˘ ·È‰È·ÙÚÈ΋˜ ·Ï-Ï¿, Û˘¯Ó¿ Î·È ÁÈ· ÔÏÏÔ‡˜, Ë ·Ó¿ÁÓˆÛ‹ ÙÔ˘˜ Â›Ó·È Î·È ÌÈ· ¢¯·Ú›ÛÙËÛË. "T¤ÚÔ˘Ó ¿Ì· Î·È ‰È‰¿ÛÎÔ˘Ó"!

TÔ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÚÔÁÚ·ÌÌ·Ù›˙ÂÈ, ÂÎÙfi˜ ·fi ÙȘ ‰ËÌÔÛȇÛÂȘ ÛÙÔÓ È·ÙÚÈÎfi Ù‡Ô Î·È ÙȘ·Ó·ÎÔÈÓÒÛÂȘ ÛÂ Û˘Ó¤‰ÚÈ· Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡, Ó· ηٷÏÔÁÔÁÚ·Ê› ›Û˘ Û¯ÂÙÈο ‚È-‚Ï›· Î·È ÌÔÓÔÁڷʛ˜. H ·Ó·˙‹ÙËÛ‹ ÙÔ˘˜ ‰ÂÓ Â›Ó·È Î·ıfiÏÔ˘ ‡ÎÔÏË. °È’ ·˘Ùfi, Ôχ ı· ‚ÔËıÔ‡Û ·Ó οıÂ Û˘Á-Áڷʤ·˜ ¤ÛÙÂÏÓ ÛÙÔ I.Y.¶. ¤Ó· ·ÓÙ›Ù˘Ô Ù˘ ÂÚÁ·Û›·˜ ÙÔ˘ ÁÈ· ηٷÏÔÁÔÁÚ¿ÊËÛË.

O Û˘Ó¿‰ÂÏÊÔ˜ ·È‰›·ÙÚÔ˜ ¢. K·Ú·ÌÂÚfiÔ˘ÏÔ˜, ‰È‰¿ÎÙˆÚ Ù˘ IÛÙÔÚ›·˜ Ù˘ I·ÙÚÈ΋˜ ›¯Â ÙËÓ Î·ÏÔÛ‡ÓËÓ· ÛÙ›ÏÂÈ ÛÙË ™‡ÓÙ·ÍË ÌÂÚÈΤ˜ ·fi ÙȘ ‰ËÌÔÛȇÛÂȘ ÙÔ˘. AӷʤÚÔ˘Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜:

1. O È·ÙÚfi˜ M·ÓÔ˘‹Ï ™·Ú‹˜ TÂÓ¤‰ÈÔ˜ (1778-1802) Î·È ÙÔ ‰È·ÊˆÙÈÛÙÈÎfi ÙÔ˘ ¤ÚÁÔ, ™Ù·ÌÔ‡Ï˘, Aı‹Ó· 1999.

2. Iˆ¿ÓÓ˘ NÈÎÔÏ›‰Ë˜ Î·È Anton Stoerck Ù·‡ÙÈÛË ÙÔ˘ ÎÂÈ̤ÓÔ˘ ÙÔ˘ ‚È‚Ï›Ô˘ "EÚÌËÓ›· ÂÚ› ÙÔ˘ Ò˜ Ú¤ÂÈ Ó·ıÂڷ‡ÂÙ·È ÙÔ Á·ÏÏÈÎfiÓ ¿ıÔ˜, ‹ÁÔ˘Ó Ë Ì·Ï·ÊÚ¿ÓÙ˙·" BȤÓÓË 1794. Aı‹Ó· 1999.

3. H ·Ô‰Ô¯‹ Ù˘ Â˘Úˆ·˚΋˜ È·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘ ̤ۈ ÙˆÓ È·ÙÚÈÎÒÓ ‚È‚Ï›ˆÓ Ù˘ ÚÔÂÂÓ·ÛÙ·ÙÈ΋˜ ÂÚÈfi-‰Ô˘. ¶Ú·ÎÙÈο "H ÂÈÛÙËÌÔÓÈ΋ ÛΤ„Ë ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ 18Ô˜-19Ô˜ ·ÈÒÓ·˜" Aı‹Ó· 1998, 331-346.

4. H È·ÙÚÈ΋ ÛΤ„Ë Ì¤Û· ·fi Ù· ‚È‚Ï›· Ê˘ÛÈ΋˜ Ù˘ ÚÔ·ӷÛÙ·ÙÈ΋˜ ÂÚÈfi‰Ô˘. ¶Ú·ÎÙÈο "OÈ ÂÈÛً̘ ÛÙÔÓEÏÏËÓÈÎfi ¯ÒÚÔ" K¤ÓÙÚÔ NÂÔÂÏÏËÓÈÎÒÓ ∂Ú¢ÓÒÓ E.I.E., Aı‹Ó· 1997,223-248.

5. ŒÓ· ·‚È‚ÏÈÔÁÚ¿ÊËÙÔ Î›ÌÂÓÔ ÙÔ˘ 1815 ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ·fi ÙËÓ ·ÓÒÏË. °ÂˆÚÁ›Ô˘ KÔ˙¿ÎË T˘¿Ï‰Ô˘:"¶ÂÚ› ÙÔ˘ ηı·ÚÈÛÌÔ‡ ÙÔ˘ ·¤ÚÔ˜ ‰È· ÙÔ˘ ·ÏÈÎÔ‡ ÔͤԘ" EΉfiÛÂȘ ™Ù·ÌÔ‡Ï˘, Aı‹Ó· - ¶ÂÈÚ·È¿˜ 1994.

6. H ¶ÚÒÙË IÛÙÔÚ›· Ù˘ I·ÙÚÈ΋˜ ÛÙËÓ EÏÏËÓÈ΋ °ÏÒÛÛ·. ¶·Ú¿ÚÙËÌ·: KˆÛÙ·ÓÙ›ÓÔ˘ Mȯ·‹Ï, ™˘ÓÔÙÈ΋ IÛÙÔÚ›·Ù˘ I·ÙÚÈ΋˜, BȤÓÓË 1794. EΉfiÛÂȘ ™Ù·ÌÔ‡Ï˘, Aı‹Ó· - ¶ÂÈÚ·È¿˜,1994.

***

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§Â‡ÎˆÌ· ˙ˆ‹˜

Aӷηχ„·Ì ÙË ı·˘Ì¿ÛÈ· ¤Î‰ÔÛË "§Â‡ÎˆÌ· ˙ˆ‹˜” ºˆÙÔÁÚ·ÊÈΤ˜ ·Ó·ÌÓ‹ÛÂȘ ·fi ÙÔ ¢ËÌÔÙÈÎfi BÚÂÊÔ-ÎÔÌÂ›Ô AıËÓÒÓ 1947-1950, EΉfiÛÂȘ "ENTO™".

E˘¯·ÚÈÛÙԇ̠ÙÔÓ ÂΉfiÙË Î. £.§. º·ÛÔ˘Ï¿ Ô˘ ¤ÙÚ„ ӷ ‰ËÌÔÛÈ¢ÙÔ‡Ó ÛÙËÓ ¶AI¢IATPIKH οÔȘʈÙÔÁڷʛ˜ Î·È ÙÔ ·Ú·Î¿Ùˆ ÂÓËÌÂÚˆÙÈÎfi ÛËÌ›ˆÌ·.

TÔ ¢ËÌÔÙÈÎfi BÚÂÊÔÎÔÌÂ›Ô Ù˘ Aı‹Ó·˜ ȉڇıËΠÙÔ 1874, Ì ÛÎÔfi ÙËÓ ÂÚ›ı·Ï„Ë Î·È Û˘ÓÙ‹ÚËÛË ÙˆÓÂÁηٷÏÂÏÂÈÌÌ¤ÓˆÓ ‹ ÔÚÊ·ÓÒÓ ÓÂÔÁÓÒÓ. K·Ù¿ ̤ÛÔÓ fiÚÔ ‰‡Ô ‚Ú¤ÊË ÙËÓ Ë̤ڷ ÂÈÛ¿ÁÔÓÙ·Ó ÛÙÔ ÊÈÏ·ÓıÚˆ-ÈÎfi ·˘Ùfi ›‰Ú˘Ì· ÙËÓ ÂÚ›Ô‰Ô 1947-1950. ŒÓ· Û‡ÓÔÏÔ 230 ·È‰ÈÒÓ, ÔÏÏ¿ ·fi Ù· ÔÔ›· ÍÂÂÚÓÔ‡Ó Ù· ‰‡Ô¤ÙË Î·È ˘ÔÛÙËÚ›¯ıËÎ·Ó ÙËÓ ÎÚ›ÛÈÌË ·˘Ù‹ ÂÚ›Ô‰Ô ·fi ÙËÓ ÔÚÁ¿ÓˆÛË UNRRA ÙÔ˘ OHE Î·È ÙÔÓ ÂıÂÏÔÓÙÈÎfi ÂÏ-ÏËÓÈÎfi ÔÚÁ·ÓÈÛÌfi ÿ‰Ú˘Ì· ÁÈ· ÙË ™ˆÙËÚ›· ÙÔ˘ ¶·È‰ÈÔ‡.

H BԇϷ ¶··˚ˆ¿ÓÓÔ˘ (1898-1990), ÌÈ· ·fi ÙȘ ÎÔÚ˘Ê·›Â˜ EÏÏËÓ›‰Â˜ ʈÙÔÁÚ¿ÊÔ˘˜, ·Ó·Ï·Ì‚¿ÓÂÈ Ó···ı·Ó·Ù›ÛÂÈ Ì ÙÔ Ê·Îfi Ù˘ ÙÔ BÚÂÊÔÎÔÌÂ›Ô ÁÈ· ÏÔÁ·ÚÈ·ÛÌfi Ù˘ UNRRA. ™·Ú¿ÓÙ· ÔÎÙÒ ¯ÚfiÓÈ· ÌÂÙ¿, ÙÔ1998, ȉڇÂÙ·È ÛÙËÓ Aı‹Ó· ÙÔ K¤ÓÙÚÔ EÚ¢ÓÒÓ "P›˙˜", ÌÈ· ÂÙ·ÈÚ›· ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· Ô˘ ¤¯ÂȈ˜ ÛÎÔfi ÙËÓ ·Ó·˙‹ÙËÛË ÙˆÓ Ê˘ÛÈÎÒÓ ÁÔÓÈÒÓ ÙˆÓ ˘ÈÔıÂÙËÌ¤ÓˆÓ ·È‰ÈÒÓ Ì¤Û· ·fi ÙË ‰ˆÚÂ¿Ó ÂÓË̤ڈÛË Î¿-ı ÂӉȷÊÂÚfiÌÂÓÔ˘ Î·È ÙË Û˘ÛÙËÌ·ÙÈ΋ ·Ó·˙‹ÙËÛË ÛÙ· ·Ú¯Â›· ‚ÚÂÊÔÎÔÌ›ˆÓ, ÔÚÊ·ÓÔÙÚÔÊ›ˆÓ ‹ ¿ÏψÓÈ‰Ú˘Ì¿ÙˆÓ, ÛÙËÓ EÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi.

TÔ K¤ÓÙÚÔ ·ÔÊ·Û›˙ÂÈ Ó· ÂΉÒÛÂÈ ÙÔÓ ·ÓÂÎÙ›ÌËÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ıËÛ·˘Úfi Ù˘ B. ¶··˚ˆ¿ÓÓÔ˘ Ô˘ ·fiÙÔ 1978 Ê˘Ï¿ÛÛÂÙ·È ÛÙÔ MÔ˘ÛÂ›Ô MÂÓ¿ÎË, Ì "ÛÎÔfi Ó· ʤÚÂÈ ÛÙÔ Êˆ˜ ͯ·Ṳ̂Ó˜ ÂÈÎfiÓ˜ ·fi ÙÔ ÛÎÏËÚfi·ÚÂÏıfiÓ".

TÔ ÔÏ˘ÙÂϤ˜ ¿ÏÌÔ˘Ì ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚÈ¿ÓÙ· ÔÎÙÒ ·ÛÚfiÌ·˘Ú˜ ʈÙÔÁڷʛ˜ Î·È Î˘ÎÏÔÊfiÚËÛ Û Â-ÚÈÔÚÈṲ̂ÓÔ - Û˘ÏÏÂÎÙÈÎfi - ·ÚÈıÌfi ·ÓÙÈÙ‡ˆÓ, Ô˘ ʤÚÔ˘Ó ÙËÓ ˘ÔÁÚ·Ê‹ Î·È ÙË ÛÊÚ·Á›‰· ÙÔ˘ K¤ÓÙÚÔ˘ EÚ¢-ÓÒÓ "P›˙˜". T· ¤ÛÔ‰· ·fi ÙËÓ ÒÏËÛË ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ ı· Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ‰‡ÛÎÔÏÔ˘ ηÈÔÏ˘‰¿·ÓÔ˘ ¤ÚÁÔ˘ ÙÔ˘ K¤ÓÙÚÔ˘.

TÔ "§Â‡ÎˆÌ· ˙ˆ‹˜" Ô˘ ΢ÎÏÔÊfiÚËÛ Ì ÙËÓ Â˘ÁÂÓÈ΋ ÚÔÛÊÔÚ¿ ÙÔ˘ MÔ˘Û›Ԣ MÂÓ¿ÎË, ΢ÎÏÔÊÔÚ› Ì·ڿÏÏËÏË ÌÂÙ¿ÊÚ·ÛË ÛÙ· AÁÁÏÈο. ¢È·Ù›ıÂÙ·È ·fi ÙÔ K¤ÓÙÚÔ EÚ¢ÓÒÓ "P›˙˜" (0945-414493) Î·È ÙȘ ÂΉfi-ÛÂȘ "ENTO™".

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ªˆÚfi ÛÙËÓ ÎÔ‡ÓÈ· ÎÔÈÌ¿Ù·È

ºˆÙÔÁÚ·ÊÈΤ˜ ·Ó·ÌÓ‹ÛÂȘ ·fi ÙÔ ¢ËÌÔÙÈÎfi µÚÂÊÔÎÔÌÂ›Ô ∞ıËÓÒÓ 1947-1950

"BÚÂÊÔ‰fi¯Ô˜. ∞fi ÙË “ªÂÁ¿ÏË ∂ÏÏËÓÈ΋∂Á΢ÎÏÔ·›‰ÂÈ·”. KÈ‚ÒÙÈÔÓ Â˘ÌÂÁ¤ı˜ ‰˘-Ó¿ÌÂÓÔÓ Ó· ¯ˆÚ› ¤ˆ˜ ‰‡Ô ‚Ú¤ÊË ÂÍËψ-̤ӷ. TÔ ÙÔÈÔ‡ÙÔÓ ÂÓÙÔȯ›˙ÂÙ·È ·Ú¿ ÙËÓÂÍÒı˘Ú·Ó ÙˆÓ ‚ÚÂÊÔÎÔÌ›ˆÓ ÚÔ˜ ÙÔÓÛÎÔfiÓ Ó· ÂÎÙ›ıÂÓÙ·È ÂÓ ·˘ÙÒ ÎÚ˘Ê¿ Ù· ‰È'¤Ó· ÔÈÔÓ‰‹ÔÙ ÏfiÁÔÓ ·ÔÚÚÈÙfiÌÂÓ· ‹ÂÁηٷÏÂÈfiÌÂÓ· ÓÂÔÁÓ¿ ‹ ‚Ú¤ÊË. ø˜ ‰Â‹ıÂÏÂÓ ·ÔÙÂı› ÂΛ ÙÔ ·È‰›ÔÓ ·˘ÙfiÌ·-ÙÔ˜ ËÏÂÎÙÚÈÎfi˜ ÎÒ‰ˆÓ ·ÁÁ¤ÏÏÂÈ ÙËÓ Ú¿ÍÈÓÙ·‡ÙËÓ Ù˘ ÂÁηٷÏ›„ˆ˜".

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π·ÙÚÈ΋ ÂͤٷÛË ÌˆÚÒÓ. ∂Î ÙÔ˘ π·ÙÚÈÎÔ‡ÔÚ›ÛÌ·ÙÔ˜: £‹Ï˘, 25 ËÌÂÚÒÓ, 2700 ÁÚ·Ì.£¿Ó·ÙÔ˜ ·fi ·ÙÚÔÊ›· ‹·ÙÔ˜

ªˆÚfi ·ÊË̤ÓÔ ÛÙ· ÛηÏÈ¿

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°˘Ó·›Î· Ì ̈Úfi, ÙÔ ÎÚ·Ù¿ ÛÊÈÎÙ¿. ÎÈ fï˜ı· ÙÔ ÂÁηٷÏ›„ÂÈ

"¶·È‰È¿, ı‡Ì·Ù· ÙÔ˘ ÔϤÌÔ˘, ·fi οı Áˆ-ÓÈ¿ Ù˘ ∂ÏÏ¿‰·˜ ÌÂٷʤÚÔÓÙ·È Û π‰Ú‡Ì·Ù·

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¶PO™EXH ™YNE¢PIA

™Â٤̂ÚÈÔ˜ 20001-3 ™ÂÙÂÌ‚Ú›Ô˘™¿ÌÔ˜5Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ¶·È‰È¿ÙÚˆÓ∞Ó·ÙÔÏÈ΋˜ ª·Î‰ÔÓ›·˜ & £Ú¿Î˘™˘Ó‰ÈÔÚÁ¿ÓˆÛË: ¢ËÌÔÎÚ›ÙÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £Ú¿Î˘¶·ÓÂÈÛÙ‹ÌÈÔ ∞ÈÁ·›Ô˘¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ∫‡ÚÔ˘•ÂÓÔ‰Ô¯Â›Ô Doryssa Bay, ¶˘ı·ÁfiÚÂÈÔ ™¿ÌÔ˘OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›·Minerva Fairs & Congresses,TËÏ.: 01 3217 456 Fax: 01 3220 595e-mail: [email protected]

30 ™ÂÙÂÌ‚Ú›Ô˘ 2000∞ı‹Ó·14Ô ™ÂÌÈÓ¿ÚÈÔ E›ÁÔ˘Û·˜ Î·È EÓÙ·ÙÈ΋˜¶·È‰È·ÙÚÈ΋˜ £¤Ì·: “AÓ·Ó¢ÛÙÈÎfi ™‡ÛÙËÌ· Î·È EÓÙ·ÙÈ΋£Âڷ›·”OÚÁ¿ÓˆÛË: MÔÓ¿‰· EÓÙ·ÙÈ΋˜ £Âڷ›·˜ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ AıËÓÒÓ “¶. & A. K˘ÚÈ·ÎÔ‡”AÌÊÈı¤·ÙÚÔ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ AıËÓÒÓ “¶. & A.K˘ÚÈ·ÎÔ‡”¶ÏËÚÔÊÔڛ˜: Î. °ÂˆÚÁ›· ™È‰ÂÚ‹TËÏ. 77 98 033

OÎÙÒ‚ÚÈÔ˜ 20004-6 OÎÙˆ‚Ú›Ô˘Portoroz, Slovenia26th Annual Congress of the Union of Middle-Eastern& Mediterranean Paediatric SocietiesInformation: Dr Ivan VidmarDivision for Paediatric Surgery & Intensive Care 1525 Ljubljana - SloveniaFax: 0038661-1301714OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›·C&C International A.E.TËÏ.: 01 68 89 100 Fax: 01 68 44 777e-mail: [email protected]

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™YNTOMO°PAºIE™ - (Abbreviations)

AÁÁÏÈÎÔ› fiÚÔÈacquired immunodeficiencysyndromeadenosine 5mono-, di-,triphosphateadenosine triphosphatasecaloriecerebrospinal fluidcentral nervous systemcentimetercoenzyme Acubic centimetersquare centimetercyclic AMPdegree(s) CelsiusC-reactive proteindeoxyribonucleic acidelectrocardiogramelectroencephalogramenzyme-linked immunoabsorbentassayerythrocyte sedimentation rateethylenediaminetetracetategramhaematocrithaemoglobin(human) histocompatibilityleucocyte antigenimmunoglobulinintensive care unitinternational Unitintramuscularintraperitonealintravenousliterlogarithmmolemolecular weightmean corpuscular haemoglobinmean corpuscular volumemessenger RNAmeterminutenumber newtonnot significantosmolepercent polymerase chain reactionpotentia hydrogeniicarbon dioxide pressureoxygen pressureprobability

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·ÂηÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi·ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓˉÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›Ù˘·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚οÂÓ‰ÔÂÚÈÙÔÓ·˚οÂÓ‰ÔÊϤ‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚԘ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ̤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA̤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔ› ÙÔȘ ÂηÙfi·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁΤÓÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈ΋ Ù¿ÛË CO2ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘Èı·ÓfiÙËÙ·

™˘ÓÙÔÌÔÁڷʛ˜AIDS

AMP, ADP, ATP

ATPasecalCSF ‹ ENYCNS ‹ ∫¡™cmCoAcmÑcm2

cAMPÆCCRPDNAECG ‹ ∏∫°EEG ‹ ∏∂°ELISA

ESR ‹ ∆∫∂EDTAgHctHbHLA

IgICU ‹ ª∂£IUi.m. ‹ ∂.ª.i.p. ‹ ∂.¶.i.v. ‹ ∂.º.LlogmolªW ‹ MBMCHMCVmRNAmminnNNS ‹ ª™Ôsm%PCRpHPCO2PO2p

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xiii

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

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

Combining prefixes

TGMkhdadcmÌnpfa

p.o.RIARNARDSsecs.c. ‹ À.¢.SDSEU

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

tera- (1012)giga- (109)mega-(106)kilo- (103)hecto(102)deca (101)deci (10-1)centi- (10-2)milli(10-3)micro (10-5)nano (10-9)pico (10-12) femto (10-15)atto (10-18)

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