Παιδιατρική | Τόμος 64 • Τεύχος 1 • Ιανουάριος -...

ISSN 0377-2551

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ANA™KO¶H™∂π™√ÍÂ›· ‰È¿ÚÚÔÈ·∫. ™È·Ê¿Î·˜, π. ¶·Ó·ÁÈÒÙÔ˘-∞ÁÁÂÏ·ÎÔÔ‡ÏÔ˘

∏ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·∞. ∏Ï›·˜

™À¡∂Ãπ∑√ª∂¡∏ ¶∞π¢π∞∆ƒπ∫∏ ∂∫¶∞π¢∂À™∏™À¡¢ƒ√ª∞ ªÀ∂§π∫∏™ ∞¡∂¶∞ƒ∫∂π∞™™˘ÁÁÂÓÂ›˜ √˘‰ÂÙÂÚÔÂÓ›Â˜Õ. ∫·Ú·ÎfiÏË

£ÚÔÌ‚ÔÂÓ›Â˜ ÔÊÂÈÏfiÌÂÓÂ˜ ÛÂ ·ÓÂ·ÚÎ‹ ·Ú·ÁˆÁ‹ ·ÈÌÔÂÙ·Ï›ˆÓ∂. ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘

∞ÌÈÁ‹˜ ·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜µ. ∫›ÙÚ·

∞ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ıÂÚ·Â›· ÛÂ ·È‰È¿ ÌÂ ‚·ÚÈ¿ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·π.¶. ¶·Ó·ÁÈÒÙÔ˘

ªÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªª√) ÛÂ·È‰È¿ ÌÂ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜¢. ¶ÂÙÚfiÔ˘ÏÔ˜

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™£ÂÚ·Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· ÛÙËÓ ÔÍÂ›·‰È¿ÚÚÔÈ· Î·È ·Ó·ÛÙ·ÏÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ¡. ™ÎÂÓÙ¤ÚË˜, ¡. ™Ô‡ÎÈ·˜, ∂. ∫ˆÛÙ·‰‹Ì·, ™. Ã·˚‰¿˜

EDITORIALFactors affecting intrauterine lung growthT. Tsiligiannis

REVIEW ARTICLESAcute diarrheaC. Siafakas, J. Panayiotou-Angelakopoulou

Nocturnal enuresis in childrenA. Elias

CONTINUING MEDICAL EDUCATIONTHE BONE MARROW FAILURE SYNDROMESCongenital neutropenias∞. Karakoli

Thrombocytopenias resulting from deficientplatelet productionH. Platokouki-Komitopoulou

Pure red cell aplasia of childhoodV. Kitra

Immunosuppressive therapy in children withsevere aplastic anemiaJ.P. Panagiotou

Bone marrow transplantation in children withbone marrow failure syndromesD. Petropoulos

ORIGINAL PAPERSOral rehydration therapy for acute diarrhea and factors that inhibit its application E. Alexopoulos, N. Skenteris, N. Soukias,E. Kostadima, S. Haidas

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∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙËÂÛˆÙÂÚÈÎ‹ ÛÂÏ›‰·

E•øº.¶AI¢IATP.TEL TE§O™ 17-10-01 15:38 ™ÂÏ›‰· 1

∂›Â‰· §ÈÔÚˆÙÂ˝ÓË˜ (·) ÛÂ 3298 ∂ÏÏËÓfiÔ˘Ï·,ËÏÈÎ›·˜ 6-14 ÂÙÒÓ∫. ™Ô‡ÏË, °.∞. ∫·Ú›Î·˜, ™. °·‚Ú›ÏË

∆ÔÈÎ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ·ÁˆÁ‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›ÙÈ‰·˜¶. ™Ù·ÌÔ‡ÏË˜, Ã. ÃÚ˘Û·ÓıfiÔ˘ÏÔ˜, ª. ∂ÌÔÚÈ¿‰Ô˘, ¡. ∆Û¤Ë˜, ∂. °ÂˆÚÁÈ¿‰Ô˘, ¡. ª·ÁÎÏ·‚¤Ú·˜

∂›Â‰· ‚ÈÙ·ÌÈÓÒÓ ∞ Î·È ∂ ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË ÛÂ ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ÌÂ ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì· Î·È ÏÈÔ‰È·Ï˘Ù¤˜ ‚ÈÙ·Ì›ÓÂ˜™. ¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË, ∞. °·ÏÏ‹-∆ÛÈÓÔÔ‡ÏÔ˘, ¡. ƒÔ˘ÌÈ¤˜, ∫. ∆ÂÓÙ˙›‰Ô˘, ª. •ÂÊÙ¤ÚË

∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™“∫ÚÂÌ¿ÌÂÓÔ˜” ÛÏ‹Ó·˜ ÛÂ ÎÔÚ›ÙÛÈ 7 ÂÙÒÓ ∫. Ã·˚‰ÔÔ‡ÏÔ˘, ª. ™Ù¿ÌÔ˘-∆ÛÈ·Ú¿˙Ë, º. ∞ı·Ó·ÛÈ¿‰Ô˘, ∫. ∫Ô‡ÛÎÔ˘Ú·˜, ∞. ∞ÓÙˆÓÈ¿‰Ë˜

∫ÏËÚÔÓÔÌÈÎ‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ·ÈÌÔÂÙ·Ï›ˆÓ (ÁÈÁ·ÓÙÈ·›·) Ô˘ ÂÎ‰ËÏÒıËÎÂÛ·Ó “„Â˘‰ÔıÚÔÌ‚ÔÂÓ›·” ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ∂. Ã·Ù˙Ë·ÓÙÂÏ‹˜, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿, Ã. ∆Û¿ÓÙ·ÏË, ∫. ∞‚Ú·Ì›‰Ô˘, ¢. ∑·ÌÔ‡ÏË, ¡. °ÔÌ¿ÎË˜

ŒÏÏÂÈ„Ë ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ C6 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜Î·È ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ª. £ÂÔ‰ˆÚ›‰Ô˘, ª. πˆ¿ÓÓÔ˘, °. ªÔÛÙÚÔ‡, ∞. °ÂÚÌÂÓ‹˜

¶ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· ÌÂ ·Ú¯ÈÎÒ˜ Ê˘ÛÈÔ-ÏÔÁÈÎfi ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÛÂ ÌË ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔ ¿ÚÚˆÛÙÔ∞. Ã·Ù˙Ë·Ó·Á‹˜, ª. ™È‰ÂÚ¿

Serum Lipoprotein (a) concentration in 3298healthy school aged Greek childrenK.H. Schulpis, G.A. Karikas, S. Gavrili

Topical anti-inflammatory therapy in the management of acute laryngotracheitisP. Stamoulis, C. Chryssanthopoulos, M. Emporiadou, N. Tsepis, E. Georgiadou, N. Maglaveras

Serum vitamin A and E levels in cystic fibrosis patients supplemented with pancreatic enzymes and liposoluble vitaminsS. Nousia-Arvanitakis, A. Galli-Tsinopoulou, N. RÔubies, K. Tentzidou, M. Xefteri

CASE REPORTS“Wandering” spleen in a 7 year old girlK. Chaidopoulou, M. Stamou-Tsiaprazi, F. Athanasiadou, K. Kouskouras, A. Antoniadis

Hereditary giant platelet disorder presenting as "pseudothrombocytopenia" A report of two casesE. Hatzipantelis, M. Athanassiou-Metaxa, H. Tsantali, K. Avramidou, D. Zambuli, N. Gombakis

C6 complement deficiency andmeningococcal infectionsM. Theodoridou, M. Ioannou, G. Mostrou, A. Germenis

Streptococcus pneumoniae meningitis withinitial normal cerebrospinal fluid findings in a non-immunocompomised patientA. Hadjipanayis, M. Sidera

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™˘ÓÂ¯›˙ÔÓÙ·È Continued



2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 5

K·ÏÔ‹ıË˜ ·ÚÔ‰ÈÎ‹ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›· ÛÂ·ÁfiÚÈ 16 ÌËÓÒÓ¡. °Î·Ì›ÏË˜, °. ∆ÛfiÏ·˜

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∞Ó·ÎÔ›ÓˆÛË

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶√ ∆∏ µπµ§π√°ƒ∞ºπ∞µÚÔÁ¯ÈÎ‹ ÚÔÛÙ·Û›· ÌÂ ¤Ó· ·ÓÙ·ÁˆÓÈÛÙ‹ÏÂ˘ÎÔÙÚÈÂÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ ÛÂ ·ÛıÌ·ÙÈÎ¿ ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜H. Bisgaard, K. Nielsen∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: £. ∆ÛÈÏÈÁÈ¿ÓÓË˜

∆Ô ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ ÛÙÔ˘˜ ÁÔÓÂ›˜ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÂÎ‰‹ÏˆÛË˜ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÌÂ ‹ ¯ˆÚ›˜ Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹ ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 18 ÌËÓÒÓC. Bosken, WC. Hunt, WE. Lambert, JM. Samet∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: £. ∆ÛÈÏÈÁÈ¿ÓÓË˜

£ÂÚ·Â›· ÙË˜ ÓfiÛÔ˘ ÙÔ˘ Crohn ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛË˜ ÙˆÓ fiÁÎˆÓ - ¿ÏÊ·Hyams JS, Markowitz J, Wyllie R∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: °.π. ∫·ÊÚ›ÙÛ·

§Ô›ÌˆÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎ¿ ·È‰È¿: Û‡ÁÎÚÈÛË ‰È·ÁÓˆÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓMalaty HM, Logan ND, Graham DY, Ramchatesingh JE, Reddy SG∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: °.π. ∫·ÊÚ›ÙÛ·

¶ÚÔÛÂ¯‹ ™˘Ó¤‰ÚÈ·

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Benign transient hyperphosphatasaemia in a 16-month old boyN. Gamilis, G. Tsolas

PAEDIATRIC NEWS∑. Papadopoulou-Couloumbis

Communication

LITERATURE ABSTRACTSBronchoprotection with a leukotriene receptor antagonist in asthmatic preschool childrenH. Bisgaard, K. NielsenGreek translation: Th. Tsiligiannis

A parental history of asthma is a risk factor for wheezing and nonwheezing respiratory illnesses in infants younger than 18 months of ageC. Bosken, WC. Hunt, WE. Lambert, JM. SametGreek translation: Th. Tsiligiannis

Use of infliximab in the treatment of Crohn’s disease in children and adolescentsHyams JS, Markowitz J, Wyllie RGreek translation: G.I. Kafritsa

Helicobacter pylori infection in asymptomatic children: comparison of diagnostic testsMalaty HM, Logan ND, Graham DY, Ramchatesingh JE, Reddy SGGreek translation: G.I. Kafritsa

Scheduled Medical Meetings

Abbreviations

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92

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71

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2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 6

¢ÈÌËÓÈ·›· ¤Î‰ÔÛËE›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

EÎ‰fiÙË˜K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹ÙË˜©EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92Aı‹Ó·È 115 28TËÏ:. (01) 7771 140 / 7771 663, Fax: 7758 354

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹¶ÚfiÂ‰ÚÔ˜ : ∫. ª·Ï·Î¿¢ÈÂ˘ı˘ÓÙ‹˜ : ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË

: º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘: ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜: °. µ·ÚÏ¿ÌË˜: ¶. ∫·ÊÚ›ÙÛ·: ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜: £. ∆ÛÈÏÈÁÈ¿ÓÓË˜: ∫. ∆ÛÔ˘Ì¿Î·˜: ™. ºˆÙfiÔ˘ÏÔ˜: A. Ã·Ù˙‹˜

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·∂ÈÌ¤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓº. ª·˘ÚÔÂÈ‰‹

∂ÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∞ÏÏËÏÔÁÚ·Ê›·∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92∞ı‹Ó·È 115 28∆ËÏ: (01) 7771 140, Fax: 7758 354

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 : K. MalakaEditor : Z. Papadopoulou-CouloumbisMembers : E. Agelaki-Georgaki

: F. Athanassiadou-Piperopoulou: M. Anthrakopoulos: G. Varlamis: P. Kafritsa: A. Konstadopoulos: Th. Tsiligiannis: K. Tsoumakas: S. Fotopoulos: ∞. Hatzis

Manuscript Editing

Greek EditingF. Mavroidi

English EditingZ. Papadopoulou-Couloumbis

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰fiÛÂˆ˜E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.¶·Ú·‰Â›ÛÔ˘ 14, 151 25 M·ÚÔ‡ÛÈTËÏ.: 68 89 180 Fax: 68 89 290

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

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdParadisou 14, Marousi 151 25Tel.: 68 89 180 Fax: 68 89 290

Annual SubscriptionAll foreign countries: US $ 30



πSSN 0377-2551

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 7

A. °ÂÓÈÎ¤˜ ¶ÏËÚÔÊÔÚ›Â˜∆Ô ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫∏" Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙË-

ÌÔÓÈÎ‹ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈ-Î‹˜ EÙ·ÈÚÂ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡-ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘-ÓÂ¯‹ È·ÙÚÈÎ‹ ÂÓËÌ¤ÚˆÛË Î·È ÂÈÌfiÚÊˆÛË ÙˆÓ EÏÏ‹ÓˆÓ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛËÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈÌ¤Ó·: ¿ÚıÚ· Û‡ÓÙ·ÍË˜(ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË ÙË˜ EÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂÈ˜, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂÈ˜ÛÙËÓ π·ÙÚÈÎ‹ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘Â˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤-ÙÂ˜ ÌÂ ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚÈÂ¯fiÌÂÓÔ, ÁÂÓÈ-Î¿ ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓÔÚÁ¿ÓˆÛË ÙË˜ È·ÙÚÈÎ‹˜ ÂÎ·›‰Â˘ÛË˜ Î·È ˘ÁÂ›·˜, ‚Ú·-‚Â˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁÌ¤ÓÂ˜ Û˘˙ËÙ‹ÛÂÈ˜ ÛÙÚÔÁÁ˘-ÏÒÓ ÙÚ·Â˙ÒÓ, ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÎÏÈÓÈÎ¤˜ Î·È ·ÂÈÎÔÓÈÛÙÈ-Î¤˜ ÂÚÈÙÒÛÂÈ˜, ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜, ‚È‚ÏÈÔÎÚÈÛ›Â˜,ÂÈÛÙÔÏ¤˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂÈ˜ ÙË˜ ÂÏÏËÓÈÎ‹˜Î·È Í¤ÓË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂÈ˜ ÚÔÛÂ¯ÒÓ Û˘-ÌÔÛ›ˆÓ Î·È Û˘ÓÂ‰Ú›ˆÓ ÛÂ ı¤Ì·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ¶·È-‰È·ÙÚÈÎ‹ Î·È ·Ó·ÊÔÚ¤˜ Ó¤ˆÓ ÂÎ‰fiÛÂˆÓ, ÂÏÏËÓÈÎÒÓ Î·ÈÍ¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‰È·ÙËÚÂ› ÙÔ‰ÈÎ·›ˆÌ· Ó· ‰ËÌÔÛÈÂ‡ÂÈ ¿ÚıÚ· ÌÂ È‰È·›ÙÂÚÔ ÂÈÛÙËÌÔ-ÓÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘¤¯Ô˘Ó ‚Ú·‚Â˘ıÂ› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈ-ÎÔ‡ ™˘ÓÂ‰Ú›Ô˘, ÙËÓ ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁ-Á˘ÏÒÓ ÙÚ·Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ-Î‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·ÈÛÂ ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈÎ¿ ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓOÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰Ë-

ÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫∏" ·ÔÛÙ¤ÏÏÔÓÙ·ÈÂÈ˜ ÙÚÈÏÔ‡Ó ÛÙË ‰ÈÂ‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92115 28 Aı‹Ó·

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘Á-ÁÚ·ÊÂ›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ̆ Ô‚ÏËıÂ› ÁÈ· ÎÚ›-ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫∏". ∂ÈÏ¤ÔÓ,ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹ÛÂÈ˜ - ¯ÔÚËÁ›Â˜‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘Á-ÁÚ·Ê¤ˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›ÓÂÛËÙˆÓ ÌÂÙÂ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ì-ÊˆÓ· ÌÂ ÙÈ˜ ‰È·ÎËÚ‡ÍÂÈ˜ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ "¶∞π¢π∞∆ƒπ∫∏" Î·È Ë ÔÏÈÎ‹ ‹ ÌÂ-

ÚÈÎ‹ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙÂ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ“∫ÔÈÓ¤˜ ¶ÚÔ‰È·ÁÚ·Ê¤˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿Ï-ÏÔÓÙ·È ÛÂ µÔ˚·ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿” (UniformRequirements for Manuscripts Submitted to BiomedicalJournals) Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934, http://jama.ama-assn.org/info/auinst_req.html.

OÈ ·fi„ÂÈ˜ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤-ˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙÈ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜‰ÂÓ ·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰È-ÎÔ‡. H Î·Ù·¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙÂ ¤ÁÎÚÈÛË ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·, ÙËÓ EÈ-ÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EÎ‰fiÙË ÙÔ˘ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·-ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓEÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi‰ÈÛÎ¤Ù· Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· ÛÂ ÚfiÁÚ·Ì-Ì· Word .doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·ÎÂ˜, ·Ó Â›Ó·È ‰˘-Ó·ÙfiÓ, ÛÂ ÚfiÁÚ·ÌÌ· Exel Î·ıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó··Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ ÔÈ ÙÚÔÔÔÈ‹ÛÂÈ˜ ‹ ÔÈ ·ÓÙÈÚÚ‹-ÛÂÈ˜ ÛÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ. H Î·ı˘ÛÙ¤ÚËÛË ÙË˜Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈËÌ¤ÓÔ˘ ÎÂÈÌ¤ÓÔ˘ ¤Ú·ÓÙˆÓ 4 ÌËÓÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

°È· Ó· ÂÈÙÂ˘¯ıÂ› Ë ¤ÁÎ·ÈÚË ‰ËÌÔÛ›Â˘ÛË ÙË˜ ÂÚÁ·-Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÙ˘ÔÁÚ·ÊÈÎfi ‰ÔÎ›ÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Ì¤Û· ÛÂÂÙ¿ (7) ËÌ¤ÚÂ˜.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ˜ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘ÓÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È ÌÂ ÙËÓ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ Î·ÙÂ˘ıÂ›·Ó ÛÙÔÓ Ù˘Ô-ÁÚ¿ÊÔ.

T· ÎÂ›ÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰Â-ÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚÂ› Ó·ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËıÂ›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ Êˆ-ÙÔÁÚ·Ê›Â˜ Ô˘ Ù· Û˘ÓÔ‰Â‡Ô˘Ó.

°. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ ÙË˜ 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·ÊËÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë ÏÂ˘ÎÔ‡ ¯·ÚÙÈÔ‡ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) ÌÂ ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙÈ˜ ‰‡ÔÏÂ˘Ú¤˜.

TÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË:ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈÎ¿Î·È Ù· ·ÁÁÏÈÎ¿, ÎÂ›ÌÂÓÔ, Â˘¯·ÚÈÛÙ›Â˜ Î·ıÒ˜ Î·È ·Ó·-ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘Ô-ÛÙ‹ÚÈÍË˜, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜, Ù›ÙÏÔÈ ÂÈÎfi-ÓˆÓ, Î·Ù¿ÏÔÁÔ˜ Û˘ÓÙÌ‹ÛÂˆÓ. K¿ıÂ ¤Ó· ·fi Ù· ·Ú·-¿Óˆ ÛÙÔÈ¯Â›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÛÂ ¯ˆÚÈÛÙfi Ê‡ÏÏÔÎ·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯ÈÎ¿ ·Ú¯›˙ÔÓÙ·˜ÌÂ ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·ÊÂ›˜

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 9

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ15-25, ÁÈ· ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÛÂ 12-15 ÛÂÏ›‰Â˜,ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÛÂ 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÂ˜ ÛÂÏ›‰Â˜, ÂÓÒÁÈ· ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000 Ï¤ÍÂÈ˜ Î·È ÁÈ·ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-300 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:- ÙÔÓ Ù›ÙÏÔ (<14 Ï¤ÍÂÈ˜) Î·ıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ

(<5 Ï¤ÍÂÈ˜) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂÈ˜, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁÚ·Ê¤· ÛÙËÓ

ÔÓÔÌ·ÛÙÈÎ‹, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi Î¤ÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈÎ‹, ÂÚÁ·-

ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›Ùˆ-ÛË ¤ÏÏÂÈ„Ë˜ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈÌ¤Ó· Î¤ÓÙÚ·,Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁÚ·Ê¤-ˆÓ (.¯. È‰ÈÒÙË˜ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ÙÔ˘/ÙˆÓ,

- ÙËÓ Ï‹ÚË ‰ÈÂ‡ı˘ÓÛË Î·È ÙÔ ÙËÏ¤ÊˆÓÔ ÙÔ˘ Û˘Á-ÁÚ·Ê¤· ÌÂ ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂÈ˜H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi-

¯Ô˘˜ ÙË˜ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· Î˘ÚÈfiÙÂÚ· ·Ô-ÙÂÏ¤ÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜. ¢ÂÓ Ú¤-ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Ô Ù›ÙÏÔ˜ ÙË˜ ÂÚÁ·Û›·˜ Î·ÈÙ· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙ· ·ÁÁÏÈÎ¿. TÔ ÂÚÈÂ¯fi-ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈÌ¤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi.

T· ¿ÚıÚ· Û‡ÓÙ·ÍË˜ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒ-ÛÂÈ˜ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ Î·È ÙËÓ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„ËÛËÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Ô˘ ı·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi Â˘ÚÂÙ‹ÚÈÔ.

KÂ›ÌÂÓÔOÈ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·Áˆ-

Á‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·Áˆ-Á‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂ ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈ-Î¤˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi ÙË˜ ÂÚÁ·Û›·˜. H ÂÚÈ-ÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂ-Ù¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜. T· ∞ÔÙÂÏ¤ÛÌ·Ù· Ú¤ÂÈÓ· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛËÚ¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡-ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó·¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ·Ú·ÙËÚ‹ÛÂÈ˜¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

OÈ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÛ‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ Â-ÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È

‚Ú·¯Â›· Û˘˙‹ÙËÛË ÌÂ ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆ-ÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹-ÛÂÈ˜ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜) ı· Ú¤ÂÈÓ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Î·È ÚÈÓ ·fi ÙÈ˜‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜.

TÈÌ¤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓOÈ ÙÈÌ¤˜ 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· Ì¤-Û· ÛÂ ·Ú¤ÓıÂÛË. ¶›Ó·ÎÂ˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËıÂ› ‰ÈÂıÓÒ˜

‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂ-ÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏÂ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘-¯Ó¿ ÛÙÔ ÎÂ›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi Û˘-ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ÛÂ ÂÈ‰ÈÎfi Î·Ù¿ÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› ÌÂ ÙËÓÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ·Ú¤ÓıÂ-ÛË ÌfiÓÔ ÛÙÈ˜ ÂÚÈÏ‹„ÂÈ˜.

BÈ‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜™ÙÔ ÙÌ‹Ì· ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·Ù·¯ˆÚÔ‡ÓÙ·È fiÏÂ˜

ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ÌÂ ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤-ÚÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ™ÙÔ ÎÂ›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·-Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÛÂ ·-Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó·˘ÂÚ‚·›ÓÔ˘Ó ÙÈ˜ 70 ÛÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜, ÙÈ˜ 30 ÛÙÈ˜ ÂÚÂ˘-ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜, ÙÈ˜ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ-‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜, ÙÈ˜ 5 ÛÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈ-Â‡ÛÂÈ˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂ-Ù·È Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ InternationalCommittee of Medical Journal Editors / UniformRequirements for Manuscripts Submitted to BiomedicalJournals (JAMA 1997;277:927-934), http://jama.ama-assn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ Cumulated IndexMedicus (List of Journals Indexed in Index Medicus,http://www.nlm.nih.gov).

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

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

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

T·ÎÙÈÎ‹ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:∞ÏÂÍ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·,

·ÚfiÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË.

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 10

¶·È‰È·ÙÚÈÎ‹ 1996;59:272-279.

Proesmans W. Bartter syndrome and its neonatalvariant. Eur J Pediatr 1997;156:669-679.™˘ÌÏËÚˆÌ·ÙÈÎfi ÙÂ‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:

Flyvbjerg A. Role of growth hormone, insulin-likegrowth factors (IGFs) and IGF-binding proteins in therenal complications of diabetes. Kidney Int 1997;52 (60Suppl):S12-S19.

ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:National Institutes of Health Consensus

Development Conference. Neurofibromatosisconference statement. Arch Neurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:∫Ô˘Ú›‰Ë˜ Ã, ∫Ô˘Ú›‰Ë˜ °. ¶·¯˘Û·ÚÎ›· Î·È ˘ÂÚÏÈ-

È‰·ÈÌ›· ÛÂ ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈÎ‹˜ ∫‡ÚÔ˘ [¶ÂÚ›ÏË-„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜;1998. ÛÂÏ. 172.

Schreiner GF, Lange L. Ethanol modulation ofmacrophage influx in glomerulonephritis [abstract]. J Am Soc Nephrol 1991;2:562.

Should antileukotriene therapies be used insteadof inhaled corticosteroids in asthma? [Editorial]. Am JRespir Crit Care Med 1998;158:1697-1701.

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

II. µÈ‚Ï›·

∫ÂÊ¿Ï·ÈÔ ÛÂ ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic

syndrome. In: Barratt TM, Arner ED, Harmon WE,editors. Pediatric Nephrology. 4th ed. Baltimore:Lippincott William Wilkins; 1999. p. 742.

™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the

head and neck. 3rd ed. New York: Oxford UniversityPress; 1990.

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

resistance. In: Smith AJ, Rogers CA, eds. Proceedingsof the Third International Congress of Chemotherapy;1962 May 29-31; New York: International Society ofChemotherapy; 1963. p. 484-500.

¢È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹:¡ÙÔ˘ÓÙÔ˘Ï¿ÎË˜ π. ∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›· ÙÔ˘

Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ ÛÂ ·È‰È¿ Î¿ÙˆÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂ-ÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: theelderly’s access and utilization [dissertation]. St. Louis(Mo): Washington Univ.; 1995.

¶›Ó·ÎÂ˜ Î·È ÂÈÎfiÓÂ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô

ÊˆÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ Ï¿-ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ fiÏË˜ ÙË˜ ÛÂ-Ï›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› ÌÂ ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·ÎÂ˜ ·ÚÈıÌÔ‡ÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÌÂÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿ÙˆÌ¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·ÎÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ Î¿ıÂ-ÙÂ˜ ÁÚ·ÌÌ¤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·-Ù·, ÊˆÙÔÁÚ·Ê›Â˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓÂ˜. £·Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙË˜ ÔÈfiÙËÙ·˜ ÌÂ ÌÔÚÊ‹ ÊˆÙÔÁÚ·-ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓÚ¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È ÌÂ ÌÔÏ‡‚È Ô ·ÚÈıÌfi˜ ÙË˜ ÂÈÎfiÓ·˜Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁÚ·Ê¤·, Î·ıÒ˜ Î·È ¤Ó·‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ Ì¤ÚÔ˜ ÙË˜ ÂÈÎfiÓ·˜.™ÙÈ˜ ÊˆÙÔÁÚ·Ê›Â˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙Â-Ù·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓÂ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·-Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈÎ¿.

¶ÚÈÓ ·ÔÛÙÂ›ÏÂÙÂ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚Â‚·ÈˆıÂ›ÙÂ fiÙÈÂÚÈÏ·Ì‚¿ÓÂÈ:- ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜- ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜ ‰ËÌÔÛ›Â˘ÛË˜ ÙË˜ ÂÚÁ·Û›·˜- 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜- ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ

- Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜- fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁÚ·Ê¤ˆÓ (ÔÏÔÁÚ¿Êˆ˜),

ÂÈÛÙËÌÔÓÈÎfi/¿ Î¤ÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤ÊˆÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ·

·ÏÏËÏÔÁÚ·Ê›·- ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏfi

‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- Î·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹

ÛÂÏ›‰·)- ÎÂ›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- Â˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹-

ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜)- ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó- ÂÈÎfiÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù·

Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó- Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹

ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 11

1

�Abstract: The mature lung is a complex organ,comprised of more than 60 different cell types, of atotal expansion area of 80 m2 and thickness of 0.2Ìm. The development and growth of the lung is aremarkable blend of genetic, biochemical, hormonaland physical factors, many of which are still underinvestigation. Aberrations in development in the

various stages of this process lead to congenitalmalformations. A better knowledge of lung growthregulation has already led to new treatments,especially to reverse lung hypoplasia.

Key words: lung development, growth factors.

∏ Î·Ù·‚ÔÏ‹ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ÂÌÊ·Ó›˙ÂÙ·È ÂÚ›Ô˘ 24 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙË ÁÔÓÈÌÔ-Ô›ËÛË, ˆ˜ ÚÔÛÂÎ‚ÔÏ‹ ·fi ÙÔ ÎÔÈÏÈ·Îfi ÙÔ›¯ˆÌ·ÙÔ˘ ÚfiÛıÈÔ˘ ÂÓÙ¤ÚÔ˘. ™ÙË Û˘Ó¤¯ÂÈ· ÔÈ ÓÂ‡ÌÔ-ÓÂ˜ ÚÔÔ‰Â˘ÙÈÎ¿ ÂÍÂÏ›ÛÛÔÓÙ·È ÛÂ ¤Ó· ÔÏ‡ÏÔÎÔfiÚÁ·ÓÔ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi 60 ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰È·-ÊÔÚÂÙÈÎ¿ Î‡ÙÙ·Ú· Î·È ¤¯ÂÈ Û·Ó ÛÎÔfi ÙËÓ ·ÓÙ·Ï-Ï·Á‹ ÙˆÓ ·ÂÚ›ˆÓ, ÌÂ ÂÈÊ¿ÓÂÈ· Û˘ÓÔÏÈÎ‹˜ ¤ÎÙ˘-ÍË˜ ÂÚ›Ô˘ 80 m2 Î·È ¿¯Ô˜ 0,2 Ìm (1).

∆¤ÛÛÂÚ· Â›Â‰· ¤¯Ô˘Ó Î·ıÔÚÈÛÙÂ› ÛÙËÓ ‰È·-‰ÈÎ·Û›· ·Ó¿Ù˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ. ∏ ÂÌ‚Ú˘ÔÁ¤-ÓÂÛË, ˘Ô‰ËÏÒÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ÔÚÁ¿ÓÔ˘. ∏ ÌÔÚÊÔÁ¤ÓÂÛË, Â›Ó·È Ë ‰È·ÌfiÚÊˆÛËÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÍˆÙÂÚÈÎ¿ ·ÏÏ¿Î·È ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÌÔ-Ó¿‰ˆÓ, ÌÂ ÙËÓ ÔÏ˘ÏÔÎfiÙËÙ· Î·È ÙËÓ ˆÚ›Ì·ÓÛËÙˆÓ ÈÛÙÒÓ. ∏ ‰È·ÊÔÚÔÔ›ËÛË Â›Ó·È Ë ·Ó¿Ù˘ÍËÂÍÂÈ‰ÈÎÂ˘Ì¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ ·fi Ù· Úfi‰ÚÔÌ· Î‡Ù-Ù·Ú·, fiˆ˜ Ù· ÓÂ˘ÌÔÓÔÎ‡ÙÙ·Ú· Ù‡Ô˘ ππ. ∏ ·‡-ÍËÛË, Â›Ó·È Ë ‰ÈÂÚÁ·Û›· ÙË˜ ÌÂÁ¤ı˘ÓÛË˜ ÙÔ˘fiÁÎÔ˘ Î·È ÙË˜ ÈÛÙÈÎ‹˜ Ì¿˙·˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ Ì¤-Ûˆ ˘ÂÚÏ·Û›·˜ Î·È ˘ÂÚÙÚÔÊ›·˜ (2).

ªÂÙ¿ ÙËÓ ·Ú¯ÈÎ‹ ÂÌ‚Ú˘˚Î‹ ÂÚ›Ô‰Ô ÙˆÓ ÚÒ-ÙˆÓ Â‚‰ÔÌ¿‰ˆÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÙË ÁÔÓÈÌÔÔ›Ë-ÛË, Ë ·Ó¿Ù˘ÍË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÍÂÏ›ÛÛÂÙ·È ÛÂ

Ù¤ÛÛÂÚ· ¯ÚÔÓÈÎ¿ ÛÙ¿‰È· ‹ ÂÚÈfi‰Ô˘˜ Ô˘ ¯ÚÔÓÈ-Î¿ ·ÏÏËÏÂÈÎ·Ï‡ÙÔÓÙ·È (3).

1. ∏ æÂ˘‰Ô·‰ÂÓÈÎ‹ ÂÚ›Ô‰Ô˜ (Pseudogladularphase)

™ÙÔ ÛÙ¿‰ÈÔ ·˘Ùfi Ô˘ ‰È·ÚÎÂ› ·fi ÙËÓ 5Ë Ì¤¯ÚÈÙË 17Ë Â‚‰ÔÌ¿‰· ÙË˜ Î‡ËÛË˜, ·Ó·Ù‡ÛÛÂÙ·È ÙÔÚˆÙfiÁÔÓÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ· Î·È ‰È·ÊÔÚÔ-ÔÈÂ›Ù·È ÛÂ ‚ÚfiÁ¯Ô˘˜ Î·È ‚ÚÔÁ¯ÈfiÏÈ· ÌÂ ÙËÓ ·ÓÙ›-ÛÙÔÈ¯Ë ·ÁÁÂ›ˆÛË, Ì¤¯ÚÈ ÙÔ ÚÔÏÔ‚È‰È·Îfi Â›Â‰Ô.

2. ∏ ÂÚ›Ô‰Ô˜ ÙˆÓ ¶fiÚˆÓ (Canalicular phase)∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹ Ô˘ ‰È·ÚÎÂ› ·fi ÙË 16Ë

Ì¤¯ÚÈ ÙËÓ 26Ë Â‚‰ÔÌ¿‰· ÙË˜ Î‡ËÛË˜, ·˘Í¿ÓÂÈ ÛÂ ÛË-Ì·ÓÙÈÎfi ‚·ıÌfi Ë ·ÁÁÂ›ˆÛË ÙÔ˘ ÌÂÛÂÁ¯‡Ì·ÙÔ˜ ÚÔ˜ÙËÓ ÂÚÈÊ¤ÚÂÈ· Î·È Ù· ÙÚÈ¯ÔÂÈ‰‹ Û˘ÌÏËÛÈ¿˙Ô˘Ó ÌÂÙÔ ÂÈÊ·ÓÂÈ·Îfi ÂÈı‹ÏÈÔ ÙˆÓ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ ·ÂÚ·-ÁˆÁÒÓ. √ ·˘Ïfi˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ ·˘Í¿ÓÂÈ ÛÂ Ì¤ÁÂ-ıÔ˜ Î·È ÙÔ ÙÔ›¯ˆÌ¿ ÙÔ˘˜ ÏÂÙ·›ÓÂÈ, Î·ıÒ˜ ÂÏ·ÙÙÒÓÂ-Ù·È ÙÔ ÌÂÛ¤Á¯˘Ì·.

3. ∏ ÂÚ›Ô‰Ô˜ ÙˆÓ ∆ÂÏÈÎÒÓ ™¿ÎÎˆÓ (Terminal sacor Saccular phase)

∏ ÂÚ›Ô‰Ô˜ ·˘Ù‹ Ô˘ ÂÎÙÂ›ÓÂÙ·È ·fi ÙËÓ 24ËÌ¤¯ÚÈ ÙËÓ 36Ë Â‚‰ÔÌ¿‰· Î·È Û˘ÓÂ¯›˙ÂÈ Ì¤¯ÚÈ ÙÔ Ù¤-ÏÔ˜ ÙË˜ Î‡ËÛË˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÈÏ¤ÔÓ

¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÈ‰ÚÔ‡Ó ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ·Ó¿Ù˘ÍË ÙˆÓ ÓÂ˘ÌfiÓˆÓ£. ∆ÛÈÏÈÁÈ¿ÓÓË˜

Factors affecting intrauterine lung growthT. Tsiligiannis

Aƒ£ƒ√ ™À¡∆∞•∏™ EDITORIAL

¶·È‰È·ÙÚÈÎ‹ 2001;64:1-3 Paediatriki 2001;64:1-3

¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì· - ¡·˘ÙÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ Division of Paediatrics - Naval Hospital of Athens

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 1

2

·Ó¿Ù˘ÍË ·Ó·ÓÂ˘ÛÙÈÎÒÓ ·ÂÚ·ÁˆÁÒÓ, ÙËÓ ·‡ÍË-ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›ˆÓÎ·È ÙˆÓ ÌÂÏÏÔÓÙÈÎÒÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÌÔÓ¿‰ˆÓ, ‰Ë-Ï·‰‹ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔ‚È‰›ˆÓ (acini).

4. ∏ ∫˘„ÂÏÈ‰ÈÎ‹ ÂÚ›Ô‰Ô˜ (Alveolar phase)∏ ÂÚ›Ô‰Ô˜ ·˘Ù‹ Ô˘ ÂÎÙÂ›ÓÂÙ·È ·fi ÙËÓ 36Ë

Â‚‰ÔÌ¿‰· Ì¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙË˜ Î‡ËÛË˜ Î·È Û˘ÓÂ¯›-˙ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤¯ÚÈ Ù· ÚÒÙ· 3 ¯ÚfiÓÈ· ÙË˜ ˙ˆ-‹˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ·‡-ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ Î˘„ÂÏ›-‰ˆÓ. ∆Ô 85% ÙˆÓ Î˘„ÂÏ›‰ˆÓ ·Ó·Ù‡ÛÛÂÙ·È ÌÂÔÏÏ·Ï·ÛÈ·ÛÌfi ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÂÓÒ ·ÚÁfiÙÂÚ·Ë ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÈÙ˘Á¯¿ÓÂ-Ù·È Î˘Ú›ˆ˜ ÌÂ ÙËÓ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ Î˘-„ÂÏ›‰ˆÓ (4).

∏ ‰È·‰ÈÎ·Û›· ÙË˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓÂ›Ó·È È‰È·›ÙÂÚ· ÔÏ‡ÏÔÎË Î·È Î·ıÔÚ›˙ÂÙ·È ·fiÌÈ· ÔÈÎÈÏ›· ·Ú·ÁfiÓÙˆÓ Ô˘ Â›Ó·È ÁÂÓÂÙÈÎÔ›, ‚ÈÔ-¯ËÌÈÎÔ›, ÔÚÌÔÓÈÎÔ› Î·È ÌË¯·ÓÈÎÔ›.

√È ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› ÛÂÂÈÚ·Ì·Ùfi˙ˆ· ‹ ÛÂ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÂÌ‚Ú˘˚ÎÒÓ Î˘Ù-Ù¿ÚˆÓ Î·È ·ÊÔÚÔ‡Ó Ù· ÁÔÓ›‰È·, Ù· ÔÔ›· Û˘ÓÙÔÓ›-˙ÔÓÙ·È Î·È ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È ÛÙÔÓ "Î·Ù¿ÏÏËÏÔ ÙfiÔÎ·È ¯ÚfiÓÔ" Î·È Î·ıÔÚ›˙Ô˘Ó ÙÈ˜ ‰È·‰ÈÎ·Û›Â˜ ÙË˜·Ó¿Ù˘ÍË˜ Î·È ‰È·ÊÔÚÔÔ›ËÛË˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ. ∏Â›‰Ú·ÛË ÁÂÓÂÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‰È·Ê·›ÓÂÙ·È ·fiÙËÓ ·ÚÔ˘Û›· ÔÈÎÔÁÂÓÒÓ ÔÌÔÈÔÙ‹ÙˆÓ ÛÙÔÓ ÙÚfiÔÙË˜ ·ÚÙËÚÈ·Î‹˜ ‰È·ÎÏ¿‰ˆÛË˜ (1).

√È ‚ÈÔ¯ËÌÈÎÔ› ‹ Ú˘ıÌÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜(regulatory factors) Â›Ó·È Ì›· ÌÂÁ¿ÏË ÔÌ¿‰· Â-ÙÈ‰›ˆÓ Ù· ÔÔ›· ÂÎÏ‡ÔÓÙ·È ·fi Ù· ÂÈıËÏÈ·Î¿Î‡ÙÙ·Ú· Î·È Ù· Î‡ÙÙ·Ú· ÙÔ˘ ÌÂÛÂÁ¯‡Ì·ÙÔ˜ Î·ÈÛ¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÔÚÊÔÁ¤ÓÂÛË˜ ÙˆÓÓÂ˘ÌfiÓˆÓ, fiˆ˜ Ô TTF-1 (thyroid transcriptionfactor-1), ÙÔ Û·Ê‹ ‰È·¯ˆÚÈÛÌfi Î·È ÙËÓ ·Û˘ÌÌÂÙÚ›·ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Î·È ÙÔ˘ ‰ÂÍÈÔ‡ ÓÂ‡ÌÔÓ· lrd (left-right dyenin), TGF-‚ (transforming growth factor–‚), ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÙÚfiÔ˘ ‰È·ÎÏ¿‰ˆÛË˜ ÙÔ˘‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘ Î·È ÙÔ˘ ‰È·¯ˆÚÈÛÌÔ‡ ÙÔ˘ ·fiÙÔÓ ÔÈÛÔÊ¿ÁÔ, FGF (fibroblast growth factorpathway), ÙÔÓ ·ÚÌÔÓÈÎfi Û˘Ó‰˘·ÛÌfi ÙË˜ ‰È·ÎÏ¿-‰ˆÛË˜ ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘ ÌÂ ÙËÓ ·ÁÁÂ›ˆÛËÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·È ÙËÓ Î˘„ÂÏÈ‰ÔÁ¤ÓÂÛË Î·È ÙËÓÙÂÏÈÎ‹ ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ (5).

º˘ÛÈÎÔ› ‹ ÌË¯·ÓÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, Â›ÛË˜,ÂÓ¤¯ÔÓÙ·È ÛÙË ‰È·‰ÈÎ·Û›· ÙË˜ ·Ó¿Ù˘ÍË˜ ÙˆÓÓÂ˘ÌfiÓˆÓ. √ ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘ ··Ú·›ÙËÙÔ˘‰È·ı¤ÛÈÌÔ˘ ¯ÒÚÔ˘ ÛÂ ÚÒÈÌ· ÛÙ¿‰È· ÙË˜ Î‡ËÛË˜,·fi ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜, ‰È·-ÊÚ·ÁÌ·ÙÔÎ‹ÏË, Û˘ÁÁÂÓ‹ ˘‰ÚÔıÒÚ·Î· ‹ ‚·ÚÈ¿˘‰ÚÔÓ¤ÊÚˆÛË, Ô‰ËÁÂ› ÛÂ ÌÂ›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÛÂ ·Ó¿ÏÔÁÔ˘ ‚·ıÌÔ‡ ÓÂ˘-ÌÔÓÈÎ‹ ˘ÔÏ·Û›· (6).

∆Ô ÂÌ‚Ú˘˚Îfi ˘ÁÚfi ÙˆÓ ÓÂ˘ÌfiÓˆÓ Ô˘ ·Ú¿-ÁÂÙ·È ·fi Ù· ÂÈıËÏÈ·Î¿ Î‡ÙÙ·Ú· Â›Ó·È ˙ˆÙÈÎ‹˜ÛËÌ·Û›·˜ ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ·Ó¿Ù˘ÍË. ∏ ·ÚÔ¯¤-ÙÂ˘ÛË ÙÔ˘ ˘ÁÚÔ‡ Â›ÙÂ ÂÈÚ·Ì·ÙÈÎ¿ Â›ÙÂ Û·Ó ·Ô-Ù¤ÏÂÛÌ· ÚfiˆÚË˜ Ú‹ÍË˜ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ (7),Ô‰ËÁÂ› ÛÂ ˘ÔÏ·ÛÙÈÎÔ‡˜ ÓÂ‡ÌÔÓÂ˜, ÂÓÒ Ë ÂÈ-Ú·Ì·ÙÈÎ‹ ·ÔÏ›ÓˆÛË ÙË˜ ÙÚ·¯Â›·˜ ÛÂ ÂÈÚ·Ì·-Ùfi˙ˆ· ‹ Û·Ó Â·ÎfiÏÔ˘ıÔ ·ÙÚËÛ›·˜ ÙÔ˘ Ï¿Ú˘Á-Á·, Ô‰ËÁÂ› ÛÂ ·˘ÍËÌ¤ÓÔ Ì¤ÁÂıÔ˜ ÓÂ˘ÌfiÓˆÓ(8,9). ∞Ó¿ÏÔÁ·, Ë ÌÂ›ˆÛË ÙË˜ ÔÛfiÙËÙ·˜ ÙÔ˘·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÔÏÈÁÔ¸‰Ú¿ÌÓÈ-Ô˘, Ô‰ËÁÂ› ÛÂ ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›· Û˘ÓÂÂ›·ÂÏÏÈÔ‡˜ ‰È·ÎÏ¿‰ˆÛË˜ ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘‹ ÌÂ›ˆÛË˜ ÙÔ˘ ·ÚÈıÌÔ‡ ‹ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓÎ˘„ÂÏ›‰ˆÓ Î·È Â›Ó·È ‚·Ú‡ÙÂÚË, fiÙ·Ó ÙÔ ÔÏÈÁÔ¸-‰Ú¿ÌÓÈÔ ÂÌÊ·Ó›˙ÂÙ·È ÂÓˆÚ›˜ Î·Ù¿ ÙËÓ Î‡ËÛË ‹·Ú·Ì¤ÓÂÈ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

√È ÂÌ‚Ú˘˚Î¤˜ ÎÈÓ‹ÛÂÈ˜ ·Ó·ÓÔ‹˜ Û·Ó ·Ú¿-ÁÔÓÙÂ˜ ¤ÎÙ·ÛË˜ ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜,Ê·›ÓÂÙ·È fiÙÈ Â›ÛË˜ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓÓÂ˘ÌfiÓˆÓ Î·È ÂËÚÂ¿˙Ô˘Ó Ùo ÙÂÏÈÎfi ‚¿ÚÔ˜ Î·È ÙÔÓfiÁÎÔ ÙÔ˘˜ Î·ıÒ˜ Î·È ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ(10).

ŒÓ·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÔÚÌÔÓÒÓ, fiˆ˜ ÔÈÔÚÌfiÓÂ˜ ÙË˜ ˘ÔÊ‡ÛÂˆ˜, ÙÔ˘ ı˘ÚÂÔÂÈ‰Ô‡˜ Î·ÈÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ ÂÓ¤¯ÔÓÙ·È ÛÙË ‰È·‰ÈÎ·Û›· ·Ó¿-Ù˘ÍË˜ Î·È ˆÚ›Ì·ÓÛË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ. π‰È·›ÙÂÚÔ˜Â›Ó·È Ô ÚfiÏÔ˜ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Ô˘ ÂÓ¤¯Ô-ÓÙ·È ÛÙÔ ¯ÚfiÓÔ ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ÂÙ·ÏÏÈˆ‰ÒÓ Ûˆ-Ì·Ù›ˆÓ (lamellar bodies) ÛÙ· ÓÂ˘ÌÔÓÔÎ‡ÙÙ·Ú· Ù‡-Ô˘ ππ Î·È ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ·˘ÍËÌ¤ÓË˜ ·Ú·ÁˆÁ‹˜‰Ú·ÛÙÈÎ‹˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎ‹˜ Ô˘Û›·˜(surfactant) (11).

√È ‰È¿ÊÔÚÂ˜ ·ÚÂÎÎÏ›ÛÂÈ˜ Ô˘ ÌÔÚÂ› Ó· ÂÈ-Û˘Ì‚Ô‡Ó Î·Ù¿ ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÓÂ˘ÌfiÓˆÓ¤¯Ô˘Ó Û·Ó Â·ÎfiÏÔ˘ıÔ ·ÓÙ›ÛÙÔÈ¯Â˜ Û˘ÁÁÂÓÂ›˜·ÓˆÌ·Ï›Â˜. ∆Ô ÛÙ¿‰ÈÔ ÙË˜ ·Ó¿Ù˘ÍË˜ Î·Ù¿ ÙÔÔÔ›Ô ÂÈÛ˘Ì‚·›ÓÂÈ Ë ·Ú¤ÎÎÏÈÛË ·fi ÙËÓ ÔÌ·Ï‹‰È·‰ÈÎ·Û›·, Î·ıÔÚ›˙ÂÈ ÙÔ Ì¤ÁÂıÔ˜, ÙË ı¤ÛË Î·È ÙËÓÎÏÈÓÈÎ‹ ÛËÌ·Û›· ÙË˜ ·ÓˆÌ·Ï›·˜. ∏ ÓÂ˘ÌÔÓÈÎ‹·ÁÂÓÂÛ›· Î·È ·Ï·Û›· Â›Ó·È Â·ÎfiÏÔ˘ı· ÙË˜ ·‡-ÛË˜ ÙË˜ ·Ó¿Ù˘ÍË˜ ÛÂ ÚÒÈÌ· ÛÙ¿‰È· ÙË˜ Î‡ËÛË˜.√È ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ Î‡ÛÙÂÈ˜ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙ·ÚÒÈÌ· ÛÙ¿‰È·, ÂÓÒ ÔÈ ÂÚÈÊÂÚÈÎÔ‡ Ù‡Ô˘ ÛÙ· ÙÂ-ÏÈÎ¿ ÛÙ¿‰È·. √È ‚ÚÔÁ¯ÔÁÂÓÂ›˜ Î‡ÛÙÂÈ˜ Û¯ËÌ·Ù›˙Ô-ÓÙ·È ·fi ·ÓÒÌ·ÏË ¤ÎÊ˘ÛË ‚ÚÔÁ¯ÈÎÔ‡ ÈÛÙÔ‡, ÂÓÒÔÈ ÓÂ˘ÌÔÓÈÎ¤˜ Î‡ÛÙÂÈ˜ ÂÎ‰ËÏÒÓÔÓÙ·È Î·Ù¿ ÙËÓ Î˘-„ÂÏÈ‰ÔÔ›ËÛË Î·È Ë Î˘ÛÙÈÎ‹ ·‰ÂÓˆÌ·ÙÒ‰Ë˜ ‰˘-ÛÏ·Û›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘ÂÚÏ·Û›·˜ ÙˆÓ ÙÂÏÈ-ÎÒÓ ‚ÚÔÁ¯ÈÔÏ›ˆÓ (12). √È Û˘ÁÁÂÓÂ›˜ ·ÁÁÂÈ·Î¤˜ ‹Î·È Î·Ú‰È·Î¤˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂ-ÛÌ· ÌÂÈˆÌ¤ÓË ÓÂ˘ÌÔÓÈÎ‹ ·ÈÌ¿ÙˆÛË Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi Î·È Ì¤ÁÂıÔ˜ Î˘„ÂÏ›‰ˆÓ,


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fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÙËÓ ÂÙÂÚfiÏÂ˘ÚË ·ÁÂÓÂÛ›· ÙË˜ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜ (13).

∏ ÁÓÒÛË ÙˆÓ ÔÈÎ›ÏˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÓ¤¯Ô-ÓÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ÓÂ˘Ìfi-ÓˆÓ, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜Î·È ‰È·ÁÓˆÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜ Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙË˜ÂÌ‚Ú˘˚Î‹˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜, ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÂ ÈÔ¤ÁÎ·ÈÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·Â˘ÙÈÎ‹ ·-Ú¤Ì‚·ÛË ÛÂ ·ÚÎÂÙ¤˜ Ù¤ÙÔÈÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿-ÛÂÈ˜ (14,15).

µÈ‚ÏÈÔÁÚ·Ê›·1. Jeffery P. The development of the large and small airways.

Am J Respir Crit Care Med 1998;157:174-180.2. Thurlbeck WM. Pre- and postnatal organ development. In:

Chernick V, Mellins RB, eds. µasic Mechanisms ofPediatric Respiratory Disease: Cellular and Integrative. 1sted. Philadelphia: Decker; 1991. p. 23-36.

3. Merkus PJ, ten Have-Opbroek AA, Quanjer PH. HumanLung Growth: A Review. Pediatr Pulmonol 1996;21:383-397.

4. Thurlbeck WM. Quantitative anatomy of the lung. In:Thurlbeck WM, ed. Pathology of the lung. Stuttgart:Thieme; 1988. p. 51-55.

5. Warburton D, Lee MK. Current concepts on lungdevelopment. Curr Opin Pediatr 1999;11:188-192.

6. Reid LM. Lung growth in health and disease. Br J DisChest 1984;78:113-114.

7. Perlman M, Williams J, Hirsch M. Neonatal pulmonaryhypoplasia after prolonged leakage of amniotic fluid. ArchDis Child 1976;51:349-353.

8. Alcorn D, Adamson TM, Lambert TF. Morphologic effectsof tracheal ligation and drainage in the fetal lamb lung. JAnat 1977;123:649-660.

9. Wigglesworth JS, Hislop A, Desai R. Fetal lung growth inlaryngeal atresia. Pediatr Pathol 1987;7:515-525.

10. Wigglesworth JS, Desai R. Is fetal respiratory function amajor determinant of perinatal survival? Lancet1982;1:264-267.

11. Difiore JW, Wilson JM. Lung Development. Semin PediatrSurg 1994;3:221-232.

12. Kravitz RM. Congenital malformations of the lung. PediatrClin N Am 1994;41:453-473.

13. Haworth SG, McKenzie SA, Fitzpatrick ML. Alveolardevelopment after ligation of left pulmonary artery innewborn pig: Clinical relevance to unilateral pulmonaryartery. Thorax 1981;36:938-943.

14. Adzick NS, Harrison MR, Crombleholme TM, Flake AW,Howell LJ. Fetal lung lesions: management and outcome.Am J Obstet Gynecol 1998;179:884-889.

15. Hubbarb AM, Crombleholme TM. Anomalies andmalformations affecting the fetal/neonatal chest. SeminRoentenol 1998;33:117-125.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-11-2000HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 18-12-2000

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: £. ∆ÛÈÏÈÁÈ¿ÓÓË˜ ¡·˘ÙÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ, ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·¢ÂÈÓÔÎÚ¿ÙÔ˘˜ 70 - ∞ı‹Ó· 115 21

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�¶ÂÚ›ÏË„Ë: ∏ ÔÍÂ›· ‰È¿ÚÚÔÈ· Â›Ó·È ¤Ó· ÎÔÈÓfiÚfi‚ÏËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏ Î·Ù·ÓfiËÛË ÙˆÓÌË¯·ÓÈÛÌÒÓ Ô˘ ˘ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙËÓ ·ıÔÊ˘ÛÈÔ-ÏÔÁ›· ÙË˜ ‰È¿ÚÚÔÈ·˜ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÙÔÓ ÁÈ·-ÙÚfi ÛÙÔ Ó· ÚÔ‚Ï¤„ÂÈ ÙËÓ ·ÈÙ›· ÙË˜ ‰È¿ÚÚÔÈ·˜ÛÙËÓ Î¿ıÂ ÂÚ›ÙˆÛË. √È ÈÔ Û˘¯ÓÔ› ·ÈÙÈÔÏÔÁÈÎÔ›·Ú¿ÁÔÓÙÂ˜ ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ Â›Ó·È ÏÔÈÌÒ‰ÂÈ˜(ÈÔ› ‹ ‚·ÎÙ‹ÚÈ·). ∏ ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘ ‚·ıÌÔ‡·Ê˘‰¿ÙˆÛË˜ Â›Ó·È ıÂÌÂÏÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙÔÓ˘ÔÏÔÁÈÛÌfi ÙÔ˘ ÔÛÔ‡ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ˘ÁÚÒÓ. ∏ ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ Ú¤ÂÈÓ· Î·ÙÂ˘ı‡ÓÂÙ·È ÚÔ˜ ÙË ‰ÈfiÚıˆÛË ÙË˜ ·Ê˘‰¿-ÙˆÛË˜, Î˘Ú›ˆ˜ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ‰È·Ï˘Ì¿ÙˆÓ ÂÓ˘-‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· Ô˘ ÂÚÈ¤¯Ô˘Ó ÙÈ˜ Î·Ù¿Ï-ÏËÏÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ËÏÂ-ÎÙÚÔÏ˘ÙÒÓ. ™‹ÌÂÚ· Û˘ÓÈÛÙ¿Ù·È Ë ¤ÁÎ·ÈÚË Â·Ó·-Û›ÙÈÛË ¯ˆÚ›˜ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë ·Ó¿ÁÎË ÁÈ· ‰È·-ÎÔ‹ ÙË˜ Û›ÙÈÛË˜ ÛÙÔ ·Ú¯ÈÎfi ÛÙ¿‰ÈÔ, ·Ú·›ˆÛË ÙÔ˘Á¿Ï·ÎÙÔ˜ ‹ ÂÍ¿ÏÂÈ„Ë ÙË˜ Ï·ÎÙfi˙Ë˜ ·fi ÙË ‰›·ÈÙ·.∆· ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ‰È¿ÚÚÔÈ·˜ Â›Ó·È ·˘ÙÔ-ÂÚÈÔÚÈ˙fiÌÂÓ· Î·È ‰ÂÓ ¯Ú‹˙Ô˘Ó ·ÓÙÈÌÈÎÚÔ‚È·Î‹˜ıÂÚ·Â›·˜. ∆Ô Î˘ÚÈfiÙÂÚÔ ‚‹Ì· ÛÙÔÓ ¤ÏÂÁ¯Ô ÙË˜‰È¿ÚÚÔÈ·˜ Â›Ó·È Ë ÚfiÏË„Ë, Ë ÔÔ›· ÌÔÚÂ› Ó·ÂÈÙÂ˘¯ıÂ› ÌÂ ÙËÓ Î·Ï‹ Ù‹ÚËÛË ÙˆÓ Î·ÓfiÓˆÓ ˘ÁÈ-ÂÈÓ‹˜, ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ô¯ÂÙÂ‡ÛÂˆÓ, ÙÔ ÛˆÛÙfiÌ·ÁÂ›ÚÂÌ· Î·È ÙËÓ Î·Ù¿„˘ÍË ÙˆÓ ÙÚÔÊÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÔÍÂ›· ‰È¿ÚÚÔÈ·, ·Ê˘‰¿ÙˆÛË, ÂÓ˘-‰¿ÙˆÛË.

�Abstract: Acute diarrhea is a commonproblem in children. Understanding the differentpathophysiologic processes implicated in diar-rhea can help the physician to predict theetiology of diarrhea in an individual patient. Themost common etiologic agents in acute diarrheaare infectious (viruses or bacteria). The clinicalevaluation of the degree of dehydration is ofprimary importance in the estimation of theamount of fluids needed to be administered. Thetreatment of acute diarrhea should be directedtowards the correction of dehydration, principallywith the use of oral rehydration solutions whichcontain appropriate concentrations of carbo-hydrates and electrolytes. Early refeeding iscurrently recommended without the need ofdiscontinuing oral feeding in the initial stages,formula dilution or elimination of lactose from thediet. Most diarrheal episodes are self-limited anddo not require antimicrobial therapy. The mostimportant step in controlling diarrhea is preven-tion which can be accomplished by the main-tenance of good personal hygiene, improved sa-nitation, adequate cooking and refrigeration offood.

Key words: acute diarrhea, dehydration,rehydration.

√ÍÂ›· ‰È¿ÚÚÔÈ·∫. ™È·Ê¿Î·˜1, π. ¶·Ó·ÁÈÒÙÔ˘-∞ÁÁÂÏ·ÎÔÔ‡ÏÔ˘2

Acute diarrheaC. Siafakas1, J. Panayiotou-Angelakopoulou2

A¡∞™∫√¶∏™H REVIEW ARTICLE


1 Ã·ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ2 ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,

∆Ì‹Ì· ¶·È‰È·ÙÚÈÎ‹˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜

1 Charokopio University 2 ∞’ Pediatric Clinic of University of Athens,

Division of Pediatric Gastroenterology and Nutrition

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∂ÈÛ·ÁˆÁ‹∏ ‰È¿ÚÚÔÈ· Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÔÚÈÛÙÂ›. √È

·ÛıÂÓÂ›˜ ‹ ÔÈ ÁÔÓÂ›˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔÓ fiÚÔ ·˘-Ùfi fiÙ·Ó ·Ó·Ê¤ÚÔÓÙ·È ÛÂ Û˘¯Ó¤˜ ‹ ˘‰·ÚÂ›˜ ÎÂÓÒ-ÛÂÈ˜. ∂ÂÈ‰‹ fiÌˆ˜ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚ-Ê›· fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ·ÚÈıÌfi, ÙÔÓ fiÁÎÔ Î·È ÙË Û‡-ÛÙ·ÛË ÙˆÓ ÎÔÚ¿ÓˆÓ, fi¯È ÌfiÓÔ ÌÂÙ·Í‡ ‰È·ÊÔÚÂ-ÙÈÎÒÓ ·ÙfiÌˆÓ ·ÏÏ¿ Î·È ÙÔ˘ ›‰ÈÔ˘ ·ÙfiÌÔ˘ ÛÙÈ˜ ‰È¿-ÊÔÚÂ˜ Ê¿ÛÂÈ˜ ÙË˜ ˙ˆ‹˜ ÙÔ˘, ¤Ó·˜ ¯Ú‹ÛÈÌÔ˜ ÔÚÈ-ÛÌfi˜ Â›Ó·È ·˘Ùfi˜ ÙË˜ ·˘ÍËÌ¤ÓË˜ ·Ú·ÁˆÁ‹˜ ÎÔ-Ú¿ÓˆÓ Ù· ÔÔ›· Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ·˘ÍËÌ¤ÓË Â-ÚÈÂÎÙÈÎfiÙËÙ· ‡‰·ÙÔ˜. ŒÙÛÈ ÏÔÈfiÓ, Ë ‰È¿ÚÚÔÈ·ÔÚ›˙ÂÙ·È Û·Ó ‚¿ÚÔ˜ ÎÔÚ¿ÓˆÓ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ10 g/kg/24 h ÁÈ· Ù· ‚Ú¤ÊË ‹ 200 g/24 h ÁÈ· Ù· ·È-‰È¿ (1). ∏ ‰È¿ÚÚÔÈ· ‰È·ÎÚ›ÓÂÙ·È ·˘ı·›ÚÂÙ· ÛÂÔÍÂ›·, fiÙ·Ó Ë ‰È¿ÚÎÂÈ¿ ÙË˜ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 2Â‚‰ÔÌ¿‰Â˜ Î·È ÛÂ ¯ÚfiÓÈ·, fiÙ·Ó ÙÈ˜ ˘ÂÚ‚·›ÓÂÈ. ∏ÔÍÂ›· ‰È¿ÚÚÔÈ· Â›Ó·È ÌÈ· ·fi ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ·È-Ù›Â˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙÈ˜ ·Ó·-Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜. ∂›Ó·È ˘Â‡ı˘ÓË ÁÈ· 4 ÂÎ·-ÙÔÌÌ‡ÚÈ· ı·Ó¿ÙÔ˘˜ ·È‰ÈÒÓ, ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ÙˆÓ 5 ÂÙÒÓ, ÂÙËÛ›ˆ˜ (2). ™ÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯Ò-ÚÂ˜, Ë ÔÍÂ›· ‰È¿ÚÚÔÈ· Â˘ı‡ÓÂÙ·È ÁÈ· ÙÔ 10% ÙˆÓÂÈÛ·ÁˆÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·È‰ÈÒÓ ËÏÈÎ›·˜ Î¿ÙˆÙˆÓ 5 ÂÙÒÓ (3).

∞ÈÙÈÔÏÔÁ›· √È ÏÔÈÌÒÍÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÔÍÂ›-

·˜ ‰È¿ÚÚÔÈ·˜ ÛÙ· ·È‰È¿. ∏ ÂÈÎÚ¿ÙËÛË ÙˆÓ ÈÒÓÛ·Ó ÙÔ Î‡ÚÈÔ ·ıÔÁfiÓÔ ·›ÙÈÔ ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ-·˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ÌÂ ÙË ‚ÂÏÙ›ˆÛË ÙˆÓÛ˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ Î·È ·Ô¯¤ÙÂ˘ÛË˜, ¤¯ÂÈ ÌÂÙ·-ÙÔ›ÛÂÈ ÙËÓ Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ ·fi ÙÔ Î·ÏÔÎ·›-ÚÈ ÚÔ˜ ÙÔ ¯ÂÈÌÒÓ·. ∂È‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ÛÙËÓ ∂ÏÏ¿‰· ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ ÙÔ ÚfiÙ·-Èfi Û·Ó ÙÔÈÔ Û˘¯Ófi ·›ÙÈÔ ÔÍÂ›·˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·˜ ÛÙ· ·È-‰È¿ ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 19,6% (4)¤ˆ˜ 26,6% (5). πÔ› ÚÔÎ·ÏÔ‡Ó 400 ı·Ó¿ÙÔ˘˜ ÙÔ¯ÚfiÓÔ ·fi Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· ÛÙÈ˜ ∏¶∞ (3). √ ›-Ó·Î·˜ 1 ‰Â›¯ÓÂÈ ÙÔ˘˜ ÈÔ‡˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÔÍÂ›·ÂÓÙÂÚ›ÙÈ‰· ÛÙ· ·È‰È¿ Î·ıÒ˜ Î·È ÌÂÚÈÎ¿ ·fi Ù·

ÈÔ ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘˜. ªÂÙ·‰›‰ÔÓÙ·È ÌÂÙËÓ ÂÓÙÂÚÔÛÙÔÌ·ÙÈÎ‹ Ô‰fi, ÂÓÒ ÁÈ· ÙÔ ÚfiÙ· Èfi˘¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ ÌÔÚÂ› Ó· ÌÂÙ·‰ÔıÂ› Î·ÈÌÂ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ Ô‰fi. ∆· Û˘ÌÙÒÌ·Ù· Ô˘ÚÔÎ·ÏÔ‡Ó Â›Ó·È ÂÌÂÙfi˜, ‰È¿ÚÚÔÈ·, ÎÔÏÈÎÔÂÈ‰¤˜ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È ˘ÚÂÙfi˜. ∂ÂÈ‰‹ fiÌˆ˜ ÔÈ ÈÔ›·˘ÙÔ› ÚÔÛ‚¿ÏÏÔ˘Ó Ù· Î‡ÙÙ·Ú· ÙˆÓ Ï·¯ÓÒÓ ÙÔ˘ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, ÛÂ ‚·ÚÈ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ÚÔÎ·ÏÔ‡Ó ÙËÓ ÂÈ¤‰ˆÛ‹ ÙÔ˘˜ ÌÂ ·ÔÙ¤ÏÂÛÌ· ËÔÍÂ›· ‰È¿ÚÚÔÈ· Ó· ÌÂÙ·¤ÛÂÈ ÛÂ ¯ÚfiÓÈ· Î·È Ó· ·-Ú·Ù·ıÂ› Ì¤¯ÚÈ Î·È ‰‡Ô Ì‹ÓÂ˜ ¤ˆ˜ fiÙÔ˘ Ô ‚ÏÂÓÓÔ-ÁfiÓÔ˜ ·ÔÎ·Ù·ÛÙ·ıÂ› (ÌÂÙ·ÏÔÈÌÒ‰Ë˜ ÂÓÙÂÚ›ÙÈ‰·).

√È ‚·ÎÙËÚÈ‰È·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÌÂÙ·‰›‰ÔÓÙ·È ÌÂÙËÓ ÂÓÙÂÚÔÛÙÔÌ·ÙÈÎ‹ Ô‰fi ‹ ÌÂ ÙË Ï‹„Ë ÌÔÏ˘ÛÌ¤-ÓÔ˘ ÓÂÚÔ‡ ‹ ÙÚÔÊ‹˜ (6,7). ™ÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯Ò-ÚÂ˜ Ù· Î˘ÚÈfiÙÂÚ· ·›ÙÈ· Â›Ó·È Ë Û·ÏÌÔÓ¤ÏÏ·, Ë ÛÈ-ÁÎ¤ÏÏ·, ÙÔ ÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ, ÙÔ Î·Ì˘ÏÔ‚·ÎÙËÚ›-‰ÈÔ jejuni, Ë ˘ÂÚÛ›ÓÈ·. √È ‚·ÎÙËÚÈ‰È·Î¤˜ ÂÓÙÂÚ›ÙÈ-‰Â˜ ÂÎ‰ËÏÒÓÔÓÙ·È Â›ÙÂ ÌÂ ÙË ÌÔÚÊ‹ ÂÈ‰ËÌÈÒÓ Â›-ÙÂ ÌÂ ÙË ÌÔÚÊ‹ ÛÔÚ·‰ÈÎÒÓ ÎÚÔ˘ÛÌ¿ÙˆÓ. ™ÙËÓ·ÙÚ›‰· Ì·˜ ÔÈ Û·ÏÌÔÓ¤ÏÏÂ˜ Î·È ÔÈ ÛÈÁÎ¤ÏÏÂ˜·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÙË˜ ‰È¿ÚÚÔÈ·˜ ÙÔ˘ Î·-ÏÔÎ·ÈÚÈÔ‡, ÂÓÒ ÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ ÎÔÏÔ‚·ÎÙËÚ›-‰ÈÔ (EPEC) Î·È ÙÔ Î·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ ‰ÂÓ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹ (4,8). ∆· Û˘-ÌÙÒÌ·Ù· ÛÙÈ˜ ‚·ÎÙËÚÈ‰È·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ¤¯Ô˘Ó·fiÙÔÌË ¤Ó·ÚÍË Î·È Û˘Ó›ÛÙ·ÓÙ·È ÛÂ ˘ÚÂÙfi, ÎÔÈ-ÏÈ·Îfi ¿ÏÁÔ˜, ‚ÏÂÓÓÔ·ÈÌ·ÙËÚ¤˜ ÎÂÓÒÛÂÈ˜ Î·È ÙÂÈ-ÓÂÛÌfi. √ ›Ó·Î·˜ 2 ‰Â›¯ÓÂÈ ÌÂÚÈÎ¿ ·fi Ù· ¯·Ú·-ÎÙËÚÈÛÙÈÎ¿ ‚·ÎÙËÚÈ‰È·ÎÒÓ ·ıÔÁfiÓˆÓ Ô˘ ÚÔ-Î·ÏÔ‡Ó ‰È¿ÚÚÔÈ· ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜.

ªÈ· È‰È·›ÙÂÚË ÔÌ¿‰· ·ÔÙÂÏÂ› Ë ‰È¿ÚÚÔÈ· Ô˘ÔÊÂ›ÏÂÙ·È ÛÂ ÙÔÍ›ÓÂ˜ ‚·ÎÙËÚÈ‰›ˆÓ Ô˘ ÌÔÏ‡ÓÔ˘ÓÙÔÓ ¿ÓıÚˆÔ ÌÂ ÙÈ˜ ÙÚÔÊ¤˜ (9). √È ÙÔÍ›ÓÂ˜ Â›ÙÂÂ›Ó·È ÚÔÛ¯ËÌ·ÙÈÛÌ¤ÓÂ˜, fiˆ˜ Ë ÙÔÍ›ÓË ÙÔ˘ ¯Ú˘-Û›˙ÔÓÙÔ˜ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘, Â›ÙÂ ·Ú¿ÁÔÓÙ·È ·fiÙÔ ‚·ÎÙËÚ›‰ÈÔ ÌÂÙ¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÛÙÔÓ ·ÓıÚÒ-ÈÓÔ ÔÚÁ·ÓÈÛÌfi, fiˆ˜ ÙÔ ‰ÔÓ¿ÎÈÔ ÙË˜ ¯ÔÏ¤Ú·˜Ô˘ ·ÔÙÂÏÂ› ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÙË˜ ‰È¿ÚÚÔÈ·˜ ÛÙÔÓÙÚ›ÙÔ ÎfiÛÌÔ, ÙÔ ÎÏˆÛÙËÚ›‰ÈÔ ÙË˜ ·ÏÏ·ÓÙ›·ÛË˜, ÙÔÂÓÙÂÚÔÙÔÍÈÓÔÁfiÓÔ ÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ (ETEC) Ô˘


¶›Ó·Î·˜ 1. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÈÒÓ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi.

πfi˜ ∏ÏÈÎ›· ÔÌ¿‰·˜ ÃÚfiÓÔ˜ ∂Ô¯ÈÎfiÙËÙ· ¢È¿ÚÎÂÈ·ÚÔÛ‚ÔÏ‹˜ ÂÒ·ÛË˜ Û˘ÌÙˆÌ¿ÙˆÓ

ƒfiÙ·-Èfi˜ 6-24 ÌËÓÒÓ 2-3 Ì¤ÚÂ˜ ÃÂÈÌÒÓ·˜ 2-8 Ì¤ÚÂ˜Norwalk/calici-ÈÔ› > 3 ÂÙÒÓ 1-2 Ì¤ÚÂ˜ ÃÂÈÌÒÓ·˜ 12-48 ÒÚÂ˜

Î·È Î·ÏÔÎ·›ÚÈ∂ÓÙÂÚÔ·‰ÂÓÔ-ÈÔ› < 2 ÂÙÒÓ 7-8 Ì¤ÚÂ˜ ∫·ÏÔÎ·›ÚÈ Ì¤¯ÚÈ 14 Ì¤ÚÂ˜∞ÛÙÚÔ-ÈÔ› 1-3 ÂÙÒÓ 3-4 Ì¤ÚÂ˜ ÕÁÓˆÛÙË 1-4 Ì¤ÚÂ˜

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 5

6

·ÔÙÂÏÂ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÙË˜ ‰È¿ÚÚÔÈ·˜ ÙˆÓÙ·ÍÈ‰ÈˆÙÒÓ Î·È ÙÔ ÂÓÙÂÚÔ·ÈÌÔÚÚ·ÁÈÎfi ÎÔÏÔ‚·-ÎÙËÚ›‰ÈÔ (O157:H7) Ô˘ Â›Ó·È ¤Ó· ·fi Ù· Î‡ÚÈ· ·›-ÙÈ· ÙÔ˘ ·ÈÌÔÏ˘ÙÈÎÔ‡-Ô˘Ú·ÈÌÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ∏ÓfiÛÔ˜ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÚÔÛ¯ËÌ·ÙÈÛÌ¤ÓÂ˜ÙÔÍ›ÓÂ˜ ¤¯ÂÈ ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ÂÒ·ÛË˜ (1 ¤ˆ˜ 6ÒÚÂ˜) Î·È ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· (<12 ÒÚÂ˜) ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙË ÓfiÛÔ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi in vivo·Ú·ÁˆÁ‹ ÙÔÍÈÓÒÓ Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ÂÒ·ÛË˜ (6 ¤ˆ˜ 73 ÒÚÂ˜) Î·ÈÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· (1 ¤ˆ˜ 10 Ì¤ÚÂ˜). ∆¤ÏÔ˜, ÙÔClostridium difficile Â›Ó·È Î˘Ú›ˆ˜ ÓÔÛÔÎÔÌÂÈ·Îfi˜ÔÚÁ·ÓÈÛÌfi˜ Ô˘ ÚÔÎ·ÏÂ› ‰È¿ÚÚÔÈ· Ì¤Ûˆ ·Ú·-ÁˆÁ‹˜ ÙÔÍÈÓÒÓ. ∏ ÓfiÛÔ˜ ÔÊÂ›ÏÂÙ·È ÛÙÔÓ ÔÏÏ·-Ï·ÛÈ·ÛÌfi ÙÔ˘ ‚·ÎÙËÚÈ‰›Ô˘ ÌÂÙ¿ ·fi ÙËÓ ·ÏÏ·Á‹ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜ Ô˘ ¤¯ÂÈ ÂÈÊ¤ÚÂÈ ËÚÔËÁÔ‡ÌÂÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ∏ ÏÂÈÔÓfi-ÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎÔ› ÊÔÚÂ›˜ ‹¤¯Ô˘Ó ˘‰·Ú‹ ‰È¿ÚÚÔÈ·, ÂÓÒ Ë ÎÏ·ÛÛÈÎ‹ ÂÈÎfiÓ·ÙË˜ „Â˘‰ÔÌÂÌ‚Ú·ÓÒ‰Ô˘˜ ÎÔÏ›ÙÈ‰·˜ ÌÂ ÎÔÏÈÎÔÂÈ-‰‹ ÎÔÈÏÈ·Î¿ ¿ÏÁË, ˘ÚÂÙfi Î·È ‚ÏÂÓÓÔ·ÈÌ·ÙËÚ¤˜ÎÂÓÒÛÂÈ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ 10% ÙˆÓ ÂÚÈÙÒ-

ÛÂˆÓ (10). √È ·Ú·ÛÈÙÈÎ¤˜ ·ÈÙ›Â˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜

¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ¤˜ Û˘Ó¤ÂÈÂ˜ ÁÈ· ÙË ‰ËÌfiÛÈ·˘ÁÂ›· (6,7). ∏ Ï¿Ì‚ÏÈ· Î·È ÙÔ ÎÚ˘ÙÔÛÔÚ›‰ÈÔ Â›-Ó·È Ù· ÈÔ Û˘¯Ó¿ ·›ÙÈ· ·Ú·ÛÈÙÈÎ‹˜ ‰È¿ÚÚÔÈ·˜ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜. ™ÙËÓ ·ÙÚ›‰· Ì·˜, ËÛ˘¯ÓfiÙËÙ· ÙË˜ ÔÍÂ›·˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·˜ ·fi ÎÚ˘-ÙÔÛÔÚ›‰ÈÔ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÂ ·È‰È¿ ËÏÈÎ›·˜ÌÂÙ·Í‡ 6 ÌËÓÒÓ Î·È 4 ¯ÚfiÓˆÓ, ÌÂ ÙÔ 44% ÙˆÓ·ÛıÂÓÒÓ Î¿Ùˆ ÙˆÓ 24 ÌËÓÒÓ (11). ∆fiÛÔ ÙÔ ÎÚ˘-ÙÔÛÔÚ›‰ÈÔ fiÛÔ Î·È Ë Ï¿Ì‚ÏÈ· ÚÔÛÎÔÏÏÒÓÙ·È ‹‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘Î·È ÌÔÚÔ‡Ó, ·Ó ¯ÚÔÓ›ÛÔ˘Ó, Ó· ÚÔÎ·Ï¤ÛÔ˘Ó Û‡Ó-‰ÚÔÌÔ ‰˘Û·ÔÚÚfiÊËÛË˜. ªÂÙ·‰›‰ÔÓÙ·È ÌÂ ÙËÓÎÔÚ·ÓÔÛÙÔÌ·ÙÈÎ‹ Ô‰fi ·fi ¿ÙÔÌÔ ÛÂ ¿ÙÔÌÔ ‹ ÌÂÌfiÏ˘ÓÛË ÙˆÓ ˘‰·ÙÈÎÒÓ ËÁÒÓ ·fi ÙÈ˜ Î‡ÛÙÂÈ˜ÙˆÓ ·Ú·Û›ÙˆÓ Ô˘ Â›Ó·È Ì¿ÏÈÛÙ· ·ÓıÂÎÙÈÎ¤˜ ÛÙË¯ÏˆÚ›ˆÛË ÙÔ˘ ÓÂÚÔ‡. ∏ ‰È·ÎÔ‹ ÙË˜ ÌÂÙ¿‰ÔÛË˜,Î˘Ú›ˆ˜ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÎÚÔ‡ÛÌ·Ù· ÛÂ ‚ÚÂÊÔÓË-È·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜, Â›Ó·È ÚˆÙ·Ú¯ÈÎ‹˜ ÛËÌ·Û›·˜.∏ ‰È¿ÚÚÔÈ· Ô˘ ÚÔÎ·ÏÔ‡Ó ‰ÂÓ Â›Ó·È ‚ÏÂÓÓÔ·ÈÌ·-ÙËÚ‹, ÂÓÒ ·˘Ù‹ ÙÔ˘ ÎÚ˘ÙÔÛÔÚÈ‰›Ô˘ Â›Ó·È ÔÏ‡


ªÂÙ¿‰ÔÛË ¤ÓÙÂÚÔ- ¤ÓÙÂÚÔ- ¤ÓÙÂÚÔ- ¤ÓÙÂÚÔ- ¤ÓÙÂÚÔ- §‹„ËÛÙÔÌ·ÙÈÎ‹ ÛÙÔÌ·ÙÈÎ‹ ÛÙÔÌ·ÙÈÎ‹ ÛÙÔÌ·ÙÈÎ‹ ÛÙÔÌ·ÙÈÎ‹ ÌÔÏ˘ÛÌ¤ÓÔ˘

Â·Ê‹ ÌÂ ˙Ò· Â·Ê‹ ÌÂ ˙Ò·, ÓÂÚÔ‡ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜

¶ËÁ‹ ∫Ú¤·˜, ¡ÂÚfi ∆ÚÔÊ¤˜, ¡ÂÚfi, Á¿Ï·, ¡ÂÚfi, Á¿Ï·, ¡ÂÚfiÌfiÏ˘ÓÛË˜ ·˘Á¿, ÓÂÚfi (Î˘Ú›ˆ˜ ÎÚ¤·˜

Á¿Ï· Ô˘ÏÂÚÈÎ¿) (Î˘Ú›ˆ˜ ¯ÔÈÚÈÓfi)

ÃÚfiÓÔ˜ 6-72 ÒÚÂ˜ 7-14 Ì¤ÚÂ˜ 12-48 ÒÚÂ˜ 2-4 Ì¤ÚÂ˜ 1-3 ‚‰ÔÌ¿‰Â˜ ÕÁÓˆÛÙÔ˜ÂÒ·ÛË˜ºÔÚÂ›· ¡·È ¡·È Ÿ¯È Ÿ¯È Ÿ¯È <1% ÛÙÈ˜

·Ó·Ù˘ÁÌ¤-ÓÂ˜ ¯ÒÚÂ˜

µ·ÎÙËÚÈ·ÈÌ›· 5-40% ™˘¯Ó‹ ™¿ÓÈ· ™¿ÓÈ· ™¿ÓÈ· ™¿ÓÈ·(‚Ú¤ÊË) (‚Ú¤ÊË)

¢È¿ÚÎÂÈ· 2-7 Ì¤ÚÂ˜ 2-3 Â‚‰. 2-5 Ì¤ÚÂ˜ 2-7 Ì¤ÚÂ˜ 14 Ì¤ÚÂ˜ 7-14 Ì¤ÚÂ˜ÓfiÛÔ˘∂ÈÏÔÎ¤˜ ªËÓÈÁÁ›ÙÈ‰·, ∞ÈÌÔÚÚ·Á›· ™·ÛÌÔ›, ™·ÛÌÔ›, ∞ÚıÚ›ÙÈ‰· ™˘Ó‹ıˆ˜

ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·, ÂÙÈÎÔ‡, ·ÈÌÔÏ˘ÙÈÎfi Û‡Ó‰ÚÔÌÔ „Â˘‰ÔÛÎˆÏË- ÚÔÛ‚¿ÏÏÂÈ·ÚıÚ›ÙÈ‰·, Ë·Ù›ÙÈ‰·, -Ô˘Ú·ÈÌÈÎfi Guillain-Barre ÎÔÂÈ‰›ÙÈ‰·, ·È‰È¿ Î¿Ùˆ„Â˘‰ÔÛÎˆÏË- ¯ÔÏÔÎ˘ÛÙ›ÙÈ‰· Û‡Ó‰ÚÔÌÔ, ÂÁÎÔÏÂ·ÛÌfi˜ ÙˆÓ 3 ÂÙÒÓÎÔÂÈ‰›ÙÈ‰·, ‰È¿ÙÚËÛË ÙÔÍÈÎfi

ÂÓÙ¤ÚÔ˘ ÌÂÁ¿ÎÔÏÔ

¶›Ó·Î·˜ 2. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ‚·ÎÙËÚÈ‰›ˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ‰È¿ÚÚÔÈ·.

µ·ÎÙ‹ÚÈ· ™·ÏÌÔÓ¤ÏÏ· ™·ÏÌÔÓ¤ÏÏ· ™ÈÁÎ¤ÏÏ· ∫·Ì˘ÏÔ‚·- ÀÂÚÛ›ÓÈ· ∞ÂÚÔÌÔÓ¿‰·(ÌË Ù˘ÊÔÂÈ‰‹˜) Ù‡ÊÔ˘ ÎÙËÚ›‰ÈÔ enterocolitica

jejuni

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 6

7

˘‰·Ú‹˜. H ·ÌÔÈ‚¿‰· Â›Ó·È Û˘¯Ófi ·›ÙÈÔ ·Ú·ÛÈÙÈ-Î‹˜ ‰È¿ÚÚÔÈ·˜ ÛÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜ Î·ÈÂÎ‰ËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ‰˘ÛÂÓÙÂÚÈÎ‹˜ ÎÔÏ›ÙÈ-‰·˜ (˘ÚÂÙfi, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÌÈÎÚ¤˜ Î·È Û˘¯Ó¤˜‚ÏÂÓÓÔ·ÈÌ·ÙËÚ¤˜ ÎÂÓÒÛÂÈ˜, ÙÂÈÓÂÛÌfi).

¶·ıÔÊ˘ÛÈÔÏÔÁ›·¶·ıÔÊ˘ÛÈÔÏÔÁÈÎ¿, Ë ‰È¿ÚÚÔÈ· ‰È·ÎÚ›ÓÂÙ·È ÛÂ 4

Ù‡Ô˘˜: ÂÎÎÚÈÙÈÎ‹, Î˘ÙÙ·ÚÔÙÔÍÈÎ‹, ÔÛÌˆÙÈÎ‹ Î·È‰˘ÛÂÓÙÂÚ›·. ∏ ‰È¿ÚÚÔÈ· ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› Û˘Ó-‰˘·ÛÌfi ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi ÙÔ˘˜ ÌË¯·ÓÈ-ÛÌÔ‡˜ ·˘ÙÔ‡˜ (1,12).

∏ ÂÎÎÚÈÙÈÎ‹ ‰È¿ÚÚÔÈ· ÔÊÂ›ÏÂÙ·È ÛÂ ÂÓÙÂÚÔÙÔÍ›-ÓÂ˜ ÔÈ ÔÔ›Â˜ ·Ú¿ÁÔÓÙ·È ·fi ÏÔÈÌÔÁfiÓÔ˘˜ ÔÚÁ·-ÓÈÛÌÔ‡˜. ∏ ÂÓÙÂÚÔÙÔÍ›ÓË Û˘Ó‰¤ÂÙ·È ÌÂ ÂÈ‰ÈÎÔ‡˜˘Ô‰Ô¯Â›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È: ·) ÛÙ· Î‡ÙÙ·Ú· ÙˆÓÎÚ˘ÙÒÓ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ô‰ËÁÂ› ÛÙËÓ ¤ÎÎÚÈ-ÛË ‡‰·ÙÔ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ, ‚) ÛÙ· Î‡ÙÙ·Ú· ÙˆÓÏ·¯ÓÒÓ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ·ÔÚÚfiÊËÛË ‡‰·ÙÔ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ. ∏ ‰È·‰È-Î·Û›Â˜ ·˘Ù¤˜ ÂÈÙÂÏÔ‡ÓÙ·È ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ÌÂ ÙË ÌÂ-ÛÔÏ¿‚ËÛË ÙË˜ Î˘ÎÏÈÎ‹˜ ÌÔÓÔÊˆÛÊÔÚÈÎ‹˜ ·‰ÂÓÔ-Û›ÓË˜ ‹ ÁÔ˘·ÓÔÛ›ÓË˜. §ÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘‰ÚÔ˘Ó Ì¤Ûˆ ÙÔ˘ ÂÎÎÚÈÙÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡ Â›Ó·È ÙÔÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ, Ë Û·ÏÌÔÓ¤ÏÏ·, Ë ÛÈÁÎ¤ÏÏ·, Ë˘ÂÚÛ›ÓÈ·, Ë ·ÂÚÔÌÔÓ¿‰·, Ë Ï¿Ì‚ÏÈ·, Ë ¯ÔÏ¤Ú·, Ô¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ÙÔ Clostridium difficileÎ·È ÙÔ ÎÏˆÛÙËÚ›‰ÈÔ ÙË˜ ·ÏÏ·ÓÙ›·ÛË˜ (Clostridiumbotulinum).

∏ Î˘ÙÙ·ÚÔÙÔÍÈÎ‹ ‰È¿ÚÚÔÈ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Ô˘ Ô‰ËÁÂ› ÛÂ ÌÂÚÈÎ‹ ‹Ï‹ÚË ÂÈ¤‰ˆÛË ÙˆÓ Ï·¯ÓÒÓ. ™·Ó Û˘Ó¤ÂÈ·,Â¤Ú¯ÂÙ·È ÌÂ›ˆÛË ÙË˜ ·ÔÚÚÔÊËÙÈÎ‹˜ ÂÈÊ¿ÓÂÈ·˜ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Î·È ·ÒÏÂÈ· ‡‰·ÙÔ˜ Î·È ËÏÂ-ÎÙÚÔÏ˘ÙÒÓ. ∂ÈÏ¤ÔÓ, Ù· ÂÚÈÛÛfiÙÂÚ· Î‡ÙÙ·Ú·Ô˘ ·ÔÌ¤ÓÔ˘Ó Â›Ó·È ·˘Ù¿ ÙˆÓ ÎÚ˘ÙÒÓ ÙÔ˘ ÂÓÙÂ-ÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Ô˘ Â›Ó·È Î·ÙÂÍÔ¯‹Ó ÂÎÎÚÈÙÈÎ¿Î‡ÙÙ·Ú·. ∆· ÈÔ Û˘¯Ó¿ ·›ÙÈ· ·˘ÙÔ‡ ÙÔ˘ ÌË¯·ÓÈ-ÛÌÔ‡ ·ÔÙÂÏÔ‡Ó ÔÈ ÈÔ› (ƒfiÙ·, Norwalk). §ÈÁfiÙÂÚÔÛ˘¯Ó¿ Â›Ó·È ÙÔ ÎÚ˘ÙÔÛÔÚ›‰ÈÔ Î·È ÙÔ ÎÔÏÔ‚·ÎÙË-Ú›‰ÈÔ.

∏ ÔÛÌˆÙÈÎ‹ ‰È¿ÚÚÔÈ· ··ÓÙ¿Ù·È ÛÙ· Û‡Ó‰ÚÔ-Ì· ‰˘Û·ÔÚÚfiÊËÛË˜, ·fi Ù· ÔÔ›· ÙÔ ÈÔ Û˘¯ÓfiÂ›Ó·È Ë ‰˘Û·ÓÂÍ›· ÛÙË Ï·ÎÙfi˙Ë, Ë ÔÔ›· ·Ú·ÙË-ÚÂ›Ù·È ÌÂ ÙË ‚Ï¿‚Ë ÙˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ ÂÚÈ¤¯Ô˘Ó ÙÔ¤Ó˙˘ÌÔ Ï·ÎÙ¿ÛË. ∞˘Ùfi ÌÔÚÂ› Ó· Û˘Ì‚Â› ÌÂÙ¿ ·fiÏÔÈÌÒÍÂÈ˜ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ(.¯. ƒfiÙ·-Èfi˜, §¿Ì‚ÏÈ·). ∆· ‰˘Û·ÔÚÚÔÊÔ‡ÌÂÓ·ÌfiÚÈ· fiÙ·Ó Êı¿ÛÔ˘Ó ÛÂ ÌÈ· Û˘ÁÎ¤ÓÙÚˆÛË ÛÙÔÓ·˘Ïfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ Â›Ó·È ÔÛÌˆÙÈÎ¿ ÂÓÂÚÁ‹, Û˘-Ì·Ú·Û‡ÚÔ˘Ó ÌfiÚÈ· ÓÂÚÔ‡ Ì¤Û· ÛÙÔÓ ·˘Ïfi Î·ÈÎ·Ù¿ Û˘Ó¤ÂÈ· Ô‰ËÁÔ‡Ó ÛÂ ·‡ÍËÛË ÙÔ˘ ÂÚÈÛÙ·Ï-

ÙÈÛÌÔ‡ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ‰È¿ÚÚÔÈ·. √È ‰˘Û·ÔÚÚÔ-ÊÔ‡ÌÂÓÔÈ ˘‰·Ù¿ÓıÚ·ÎÂ˜ ˙˘ÌÒÓÔÓÙ·È ·fi ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ‡˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ∆· ÚÔ˚fiÓÙ·ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ·˘ÙÔ‡ Â›Ó·È Ù· CO2, H2, Ù·ÔÔ›· ÚÔÎ·ÏÔ‡Ó ·¤ÚÈ· Î·È ÌÂÙÂˆÚÈÛÌfi ÛÙÔÓ·ÛıÂÓ‹ Î·È Ù· ÏÈ·Ú¿ ÔÍ¤· ÌÈÎÚ‹˜ ·Ï‡ÛÔ˘, Ù·ÔÔ›· Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙÔ ¯·ÌËÏfi pH ÙˆÓ ÎÔ-Ú¿ÓˆÓ (Î¿Ùˆ ÙÔ˘ 5,5).

∏ ‰˘ÛÂÓÙÂÚ›· ÚÔÎ·ÏÂ›Ù·È ·fi ÊÏÂÁÌÔÓ‹ ÙÔ˘‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ˘Ô‚ÏÂÓÓÔÁfiÓÈÔ˘ ÙÔ˘ ÙÂÏÈÎÔ‡ ÂÈ-ÏÂÔ‡ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ·fi ÙË ‰ÈÂ›Û‰˘ÛË‚·ÎÙËÚ›ˆÓ. ∏ ‰ÈÂ›Û‰˘ÛË ·˘Ù‹ ÚÔÎ·ÏÂ› Ô›‰ËÌ·,·ÈÌÔÚÚ·Á›· Î·È ‰È‹ıËÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ·fiÏÂ˘ÎÔÎ‡ÙÙ·Ú·. ∆· ÏÂ˘ÎÔÎ‡ÙÙ·Ú· Î·È ÙÔ ·›Ì· ‰È·-¯¤ÔÓÙ·È ÛÙÔÓ ·˘Ïfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ·Ô‚¿ÏÏÔÓÙ·ÈÛÙ· ÎfiÚ·Ó·. √ ÂÚÂıÈÛÌfi˜ ·fi ÙË ÊÏÂÁÌÔÓ‹ÚÔÎ·ÏÂ› ·˘ÍËÌ¤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÎfiÏÔ˘ Î·ÈÛ˘¯Ó¤˜ ÎÂÓÒÛÂÈ˜, Û˘¯Ó¿ ÌÂ ÙÂÈÓÂÛÌfi. §ÔÈÌÔÁfiÓÔÈ·Ú¿ÁÔÓÙÂ˜ Ô˘ ‰ÚÔ˘Ó Ì¤Ûˆ ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ·˘-ÙÔ‡ Â›Ó·È Ë Û·ÏÌÔÓ¤ÏÏ·, Ë ÛÈÁÎ¤ÏÏ·, ÙÔ Î·Ì˘ÏÔ-‚·ÎÙËÚ›‰ÈÔ, Ë ˘ÂÚÛ›ÓÈ·, Ë ·ÌÔÈ‚¿‰· Î·È ÙÔClostridium difficile.

¢ÈÂÚÂ‡ÓËÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜πÛÙÔÚÈÎfi: ∆Ô Î·Ïfi ÈÛÙÔÚÈÎfi ı· ÚÔÛ·Ó·ÙÔÏ›ÛÂÈ

ÙË ‰ÈÂÚÂ‡ÓËÛË ÛÙË ÛˆÛÙ‹ Î·ÙÂ‡ı˘ÓÛË Î·È ı· ·Ô-ÙÚ¤„ÂÈ ¿ÛÎÔÂ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜. √ÈÂÚˆÙ‹ÛÂÈ˜ ·ÊÔÚÔ‡Ó ÚfiÛÊ·ÙË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈ-ÎÒÓ, ˘ÔÎÂ›ÌÂÓÂ˜ ÓfiÛÔ˘˜ (.¯. ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÂ-¿ÚÎÂÈ·), Ù·Í›‰È· ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜ ‹ ÂÚÈÔ¯¤˜fiÔ˘ ÔÈ Û˘Óı‹ÎÂ˜ ·Ô¯¤ÙÂ˘ÛË˜ ‹ fiÛÈÌÔ˘ ÓÂÚÔ‡‰ÂÓ Â›Ó·È ÔÈ Î·Ù¿ÏÏËÏÂ˜, ·Ú·ÎÔÏÔ‡ıËÛË ‚ÚÂÊÔ-ÓËÈ·ÎÔ‡ ÛÙ·ıÌÔ‡ Î·ıÒ˜ Î·È ÏËÚÔÊÔÚ›Â˜ ÁÈ·ÙÚÔÊ¤˜ Ô˘ Î·Ù·Ó·ÏÒıËÎ·Ó ÚfiÛÊ·Ù·.

¢‡Ô ·Ú¿ÁÔÓÙÂ˜ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔÈ ÁÈ·ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙË˜ ·ÈÙÈÔÏÔÁ›·˜ ÙË˜ ‰È¿ÚÚÔÈ·˜, ÙÔÈÛÙÔÚÈÎfi ÂÌÂÙÔ‡ Î·È Ë Û‡ÛÙ·ÛË Î·È Û˘¯ÓfiÙËÙ· ÙˆÓÎÂÓÒÛÂˆÓ. ∏ ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ÙË˜ ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ÂÌÂÙÔ‡ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿-ÁÓˆÛË ÓfiÛÔ˘ ÙÔ˘ ÏÂÙÔ‡ ·fi ÙÔ ·¯‡ ¤ÓÙÂÚÔ. ∏ÓfiÛÔ˜ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, Ë ÔÔ›· Î˘Ú›ˆ˜ ÔÊÂ›-ÏÂÙ·È ÛÂ ÈÔ‡˜, ÚÔÎ·ÏÂ› ÂÈÏÂfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÂ ‰È¿-Ù·ÛË ÙÔ˘ ·˘ÏÔ‡ Î·È ÂÈ‚Ú¿‰˘ÓÛË ÙË˜ Î¤ÓˆÛË˜ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ÂÌÂÙfi ÚÈÓ ÙËÓ¤Ó·ÚÍË ÙË˜ ‰È¿ÚÚÔÈ·˜. √È ÎÂÓÒÛÂÈ˜ Â›Ó·È ̆ ‰·ÚÂ›˜,ÌÂÁ¿ÏÔ˘ fiÁÎÔ˘ Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ·fi ÙÈ˜ Ófi-ÛÔ˘˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ fiÔ˘ Â›Ó·È ÂÚÈÛÛfiÙÂ-ÚÂ˜, ÌÈÎÚfiÙÂÚÂ˜ Î·È ÏÈÁfiÙÂÚÔ ˘‰·ÚÂ›˜.

º˘ÛÈÎ‹ ÂÍ¤Ù·ÛË: √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ‚·ı-ÌÔ‡ ÙË˜ ·Ê˘‰¿ÙˆÛË˜ Â›Ó·È ÙÔ ÚˆÙÂ‡ÔÓ Ì¤ÏËÌ·ÙË˜ Ê˘ÛÈÎ‹˜ ÂÍ¤Ù·ÛË˜. √ ›Ó·Î·˜ 3 ·ÚÔ˘ÛÈ¿˙ÂÈÙ· ÎÏÈÓÈÎ¿ ÛËÌÂ›· Ô˘ ‚ÔËıÔ‡Ó ÛÙËÓ ÂÎÙ›ÌËÛ‹ ÙË˜.∫·Ù¿ ÙËÓ ÂÍ¤Ù·ÛË ÙË˜ ÎÔÈÏÈ¿˜, ÂÎÙÈÌ¿Ù·È ·Ó ˘¿Ú-¯ÂÈ Â˘·ÈÛıËÛ›·, ÌÂÙÂˆÚÈÛÌfi˜ Î·È ·ÍÈÔÏÔÁÔ‡ÓÙ·È ÔÈ


2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 7

8

ÂÓÙÂÚÈÎÔ› ‹¯ÔÈ. √ ÌÂÙÂˆÚÈÛÌfi˜ ÙË˜ ÎÔÈÏÈ¿˜ ÌÔ-ÚÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂÈÏÂfi ‹ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹·ÂÚ›ˆÓ ÏfiÁˆ ‰˘Û·ÔÚÚfiÊËÛË˜. ∞ÓÙ›ıÂÙ·, Ë ÛÎ·-ÊÔÂÈ‰‹˜ ÎÔÈÏÈ¿ ÌÔÚÂ› Ó· ˘Ô‰ËÏÒÓÂÈ ÛÔ‚·ÚÔ‡‚·ıÌÔ‡ ·Ê˘‰¿ÙˆÛË. ∞‡ÍËÛË ÙÔ˘ ÂÚÈÛÙ·ÏÙÈÛÌÔ‡ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÂÓÙÂÚ›ÙÈ‰· Î·È ÙËÓÂÎÎÚÈÙÈÎ‹ ‰È¿ÚÚÔÈ·, ÂÓÒ ÛÙË ‰˘ÛÂÓÙÂÚ›· ÔÈ ÂÓÙÂÚÈ-ÎÔ› ‹¯ÔÈ Â›Ó·È ÏÈÁfiÙÂÚÔ ÂÓÂÚÁÔ›. ªÔÏÔÓfiÙÈ Ù· ÛË-ÌÂ›· ÂÚÂıÈÛÌÔ‡ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ ÌÔÚÂ› Ó· Â›Ó·È·ÚfiÓÙ· ÛÂ ÂÚÈÙÒÛÂÈ˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ·fi ÌÂ-Á¿ÏË ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (E.coli 0157:H7, ™È-ÁÎ¤ÏÏ·, ·ÌÔÈ‚¿‰·), ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ú·‚ÏÂÊıÂ›Ë Èı·ÓfiÙËÙ· Ë ‰È¿ÚÚÔÈ· Ó· Â›Ó·È ‰Â˘ÙÂÚÔ·ı‹˜,‰ËÏ·‰‹ ·ÔÙ¤ÏÂÛÌ· ˘¿Ú¯Ô˘Û·˜ ÂÚÈÙÔÓ›ÙÈ‰·˜.

∏ ·Ï‹ ·Ú·Ù‹ÚËÛË ÙˆÓ ÎÔÚ¿ÓˆÓ ÁÈ· ·ÚÔ˘-Û›· ‚Ï¤ÓÓ·˜ Î·È ·›Ì·ÙÔ˜ Â›Ó·È ÛËÌ·ÓÙÈÎ‹˜ ÛËÌ·Û›·˜ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜.

∂ÚÁ·ÛÙËÚÈ·Î‹ ‰ÈÂÚÂ‡ÓËÛË: ∏ ·ÚÔ˘Û›· ÏÂ˘ÎÔ-Î˘ÙÙ¿ÚˆÓ ÛÙ· ÎfiÚ·Ó· Â›Ó·È ¯Ú‹ÛÈÌË ÛÙË ‰È¿ÁÓˆ-ÛË ÙË˜ ‰È¿ÚÚÔÈ·˜ ·fi ‚·ÎÙËÚ›‰È·, Î˘Ú›ˆ˜ ·˘ÙÒÓÔ˘ ÚÔÎ·ÏÔ‡Ó ‰˘ÛÂÓÙÂÚ›·. √È ·ÛıÂÓÂ›˜ Ô˘¤¯Ô˘Ó ÏÂ˘ÎÔÎ‡ÙÙ·Ú· ÛÙ· ÎfiÚ·Ó¿ ÙÔ˘˜ ¤¯Ô˘Ó ‚·-ÎÙËÚÈ‰È·Î‹ ‰È¿ÚÚÔÈ· ÌÂ Èı·ÓfiÙËÙ· 70%. ∏ ·ÚÔ˘-Û›· ÔÏÏÒÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ·ÓÙÂÏ‹ ·Ô˘Û›·ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ Â›Ó·È ‡ÔÙË ÁÈ· ÏÔ›ÌˆÍË ·fi·ÌÔÈ‚¿‰·, ÌÈ· Î·È ÙÔ ·Ú¿ÛÈÙÔ ·˘Ùfi ÙÂ›ÓÂÈ Ó· Î·Ù·-ÛÙÚ¤ÊÂÈ Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·.

√È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ Û˘ÓÈÛÙÒÓÙ·È ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÂÎÂ›ÓÔ˘˜ Ô˘: ·) Ë ‰È¿ÚÚÔÈ¿ ÙÔ˘˜Û˘ÓÂ¯›˙ÂÙ·È ÁÈ· ÂÚÈÛÛfiÙÂÚÂ˜ ·fi 5 Ì¤ÚÂ˜ ·Ú¿ÙËÓ ÂÓ˘‰¿ÙˆÛË Î·È Â·Ó·Û›ÙÈÛË, ‚) ¤¯Ô˘Ó ÛËÌÂ›·ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÓfiÛÔ˘ fiˆ˜ ˘ÚÂÙfi, ·ÚıÚ·ÏÁ›Â˜,Ì˘·ÏÁ›Â˜, Á) ¤¯Ô˘Ó ÏÂ˘ÎÔÎ‡ÙÙ·Ú· ‹ ÔÚ·Ùfi ·›Ì· ÛÙ·ÎfiÚ·Ó·, ‰) Â›Ó·È ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔÈ, Â) ¤¯Ô˘Ó

¶›Ó·Î·˜ 3. ∂ÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙË˜ ·Ê˘‰¿ÙˆÛË˜.

µ·ıÌfi˜ ™˘ÌÙÒÌ·Ù· Î·È ÎÏÈÓÈÎ¿ ÛËÌÂ›··Ê˘‰¿ÙˆÛË˜◊È· (3-5%) º˘ÛÈÔÏÔÁÈÎ¿ ˙ˆÙÈÎ¿ ÛËÌÂ›·

∆Ô ·È‰› Â›Ó·È ÛÂ ÂÁÚ‹ÁÔÚÛËµÏÂÓÓÔÁfiÓÔÈ (ÛÙfiÌ·ÙÔ˜ Î·È ¯ÂÈÏÈÒÓ) ÌÂ ‹È· ÍËÚfiÙËÙ·, ¤¯ÂÈ ‰¿ÎÚ˘· fiÙ·Ó ÎÏ·›ÂÈ◊ÈÔ ·›ÛıËÌ· ‰›„·˜º˘ÛÈÔÏÔÁÈÎ‹ Û·ÚÁ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ÃÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Â·Ó·Ï‹ÚˆÛË˜ ÙÚÈ¯ÔÂÈ‰ÒÓ* ÌË ·Ú·ÙÂÙ·Ì¤ÓË (Î¿Ùˆ ÙˆÓ 2 sec)™Â ‚Ú¤ÊË Ë ÚfiÛıÈ· ËÁ‹ ‰ÂÓ Â›Ó·È ‚˘ıÈÛÌ¤ÓË

ª¤ÙÚÈ· (6-9%) √È ÛÊ˘ÁÌÔ› Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ó·ÓÔÒÓ Â›Ó·È ·˘ÍËÌ¤ÓÂ˜, Ë ·ÚÙËÚÈ·Î‹ ›ÂÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ ÂÏ·ÊÚÒ˜ ÂÏ·ÙÙˆÌ¤ÓË∆Ô ·È‰› Â›Ó·È ÓˆıÚfi ‹ Â˘ÂÚ¤ıÈÛÙÔ√È ‚ÏÂÓÓÔÁfiÓÔÈ (ÛÙfiÌ·ÙÔ˜ Î·È ¯ÂÈÏÈÒÓ) Â›Ó·È ÍËÚÔ›, ‰ÂÓ ¤¯ÂÈ ‰¿ÎÚ˘· fiÙ·Ó ÎÏ·›ÂÈ™ËÌ·ÓÙÈÎfi ·›ÛıËÌ· ‰›„·˜∏ Û·ÚÁ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ÂÏ·ÊÚ¿ ÂÏ·ÙÙˆÌ¤ÓËÃÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Â·Ó·Ï‹ÚˆÛË˜ ÙÚÈ¯ÔÂÈ‰ÒÓ ·Ú·ÙÂÙ·Ì¤ÓË (2-3 sec)™Â ‚Ú¤ÊË Ë ÚfiÛıÈ· ËÁ‹ Â›Ó·È ‚˘ıÈÛÌ¤ÓË

™Ô‚·Ú‹ (≥10%) √È ÛÊ˘ÁÌÔ› Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ó·ÓÔÒÓ Â›Ó·È ·˘ÍËÌ¤ÓÂ˜, Ë ·ÚÙËÚÈ·Î‹ ›ÂÛË Â›Ó·È ÂÏ·ÙÙˆÌ¤ÓË∆Ô ·È‰› ‚Ú›ÛÎÂÙ·È ÛÂ Ï‹ı·ÚÁÔ ‹ ÎÒÌ·√È ‚ÏÂÓÓÔÁfiÓÔÈ (ÛÙfiÌ·ÙÔ˜ Î·È ¯ÂÈÏÈÒÓ) Â›Ó·È ÍËÚÔ›, ‰ÂÓ ¤¯ÂÈ ‰¿ÎÚ˘· fiÙ·Ó ÎÏ·›ÂÈ™ËÌ·ÓÙÈÎfi ·›ÛıËÌ· ‰›„·˜∏ Û·ÚÁ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ÔÏ‡ ÂÏ·ÙÙˆÌ¤ÓË∆Ô ‰¤ÚÌ· Â›Ó·È „˘¯ÚfiÃÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Â·Ó·Ï‹ÚˆÛË˜ ÙÚÈ¯ÔÂÈ‰ÒÓ ÔÏ‡ ·Ú·ÙÂÙ·Ì¤ÓË (>3 sec)™Â ‚Ú¤ÊË Ë ÚfiÛıÈ· ËÁ‹ Â›Ó·È ÔÏ‡ ‚˘ıÈÛÌ¤ÓË

* √ ¯ÚfiÓÔ˜ Â·Ó·Ï‹ÚˆÛË˜ ÙÚÈ¯ÔÂÈ‰ÒÓ Â›Ó·È Ë ¯ÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ÂÈÛÙÚÔÊ‹ ÙÔ˘ Úfi‰ÈÓÔ˘ ¯ÚÒÌ·-ÙÔ˜ Ô˘ ‰ËÌÈÔ˘ÚÁÂ› ÙÔ ÂÚÈÊÂÚÈÎfi ‰›ÎÙ˘Ô ÙˆÓ ÙÚÈ¯ÔÂÈ‰ÒÓ ÛÙÈ˜ ¿ÎÚÂ˜ ÙˆÓ ‰·ÎÙ‡ÏˆÓ ÌÂÙ¿ ÙËÓ ÂÏ·ÊÚ¿ ¿ÛÎËÛË ›ÂÛË˜ ÛÙ·ÛËÌÂ›· ·˘Ù¿ ÒÛÙÂ Ó· ÚÔÎÏËıÂ› ˆ¯ÚfiÙËÙ· (25).


2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 8

9

‚·ÚÈ¿˜ ÌÔÚÊ‹˜ ‰È¿ÚÚÔÈ· ÒÛÙÂ Ó· Â›Ó·È ·Ó·ÁÎ·›· ËÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô. ∆¤ÏÔ˜, Î·ÏÏÈ¤Ú-ÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÙÔ˘˜ Û˘ÌÙˆÌ·-ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÈ‰ËÌÈÒÓ ÛÂ ·È-‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜, ÓÔÛÔÎÔÌÂ›· ‹ ¿ÏÏ· È‰Ú‡Ì·Ù·fiÔ˘ ·Ú·ÙËÚÂ›Ù·È Û˘Á¯ÚˆÙÈÛÌfi˜. ∏ Î·ÏÏÈ¤ÚÁÂÈ·ÎÔÚ¿ÓˆÓ ı· Ú¤ÂÈ ¿ÓÙ· Ó· ÚÔËÁÂ›Ù·È ÙË˜ Ï‹-„Ë˜ ·ÓÙÈ‚ÈÔÙÈÎÔ‡. ∏ ‰ÈÂÚÂ‡ÓËÛË ·Ú¯ÈÎ¿ ÛÙÚ¤ÊÂÙ·ÈÛÙ· ÈÔ ÎÔÈÓ¿ ·›ÙÈ· ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ÌÂ ÙÈ˜ Û˘Ó‹-ıÂÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ ÁÈ· Û·ÏÌÔÓ¤ÏÏ·, ÛÈ-ÁÎ¤ÏÏ·, Î·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ, ÙËÓ ·Ú·ÛÈÙÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË Î·È ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ Úfi-Ù·-ÈÔ‡. ∆Ô ÈÛÙÔÚÈÎfi ı· Î·ÙÂ˘ı‡ÓÂÈ ÙË ‰ÈÂÚÂ‡ÓËÛËÛÂ ÈÔ ÂÈ‰ÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜. √ ›Ó·Î·˜ 4 ‰Â›¯ÓÂÈ ÙÈ˜ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÎÔÚ¿ÓˆÓ Ô˘ ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜.

∞ÚÎÂÙ¤˜ ÊÔÚ¤˜ Â›Ó·È ¯Ú‹ÛÈÌÔ ·fi ‰È·ÁÓˆÛÙÈ-Î‹˜ ÛÎÔÈ¿˜ Ó· ‰È·ÎÚÈıÂ› Ë ‰È¿ÚÚÔÈ· ÛÂ ÔÛÌˆÙÈÎ‹‹ ÂÎÎÚÈÙÈÎ‹. ∏ ÔÛÌˆÙÈÎ‹ ‰È¿ÚÚÔÈ· ÛÙ·Ì·Ù¿ fiÙ·Ó ËÛ›ÙÈÛË ‰È·ÎÔÂ›, ÂÓÒ ·ÓÙ›ıÂÙ· Ë ÂÎÎÚÈÙÈÎ‹ ·Ú·-Ì¤ÓÂÈ ·ÎfiÌË Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ Û›ÙÈÛË˜. ™ÙË‰È¿ÎÚÈÛË ·˘Ù‹ ‚ÔËı¿ Ë Ì¤ÙÚËÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘-ÙÒÓ ÛÙ· ÎfiÚ·Ó· (Riedel, 1995 #12). ∏ ÂÎÎÚÈÙÈÎ‹‰È¿ÚÚÔÈ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ˘„ËÏ‹ ÂÚÈÂ-ÎÙÈÎfiÙËÙ· ÙˆÓ ÎÔÚ¿ÓˆÓ ÛÂ Ó¿ÙÚÈÔ, Û˘Ó‹ıˆ˜˘„ËÏfiÙÂÚË ÙˆÓ 50 mEq/L Î·È ¯·ÌËÏfi ÔÛÌˆÙÈÎfi¯¿ÛÌ· ÎÔÚ¿ÓˆÓ, ÌÈÎÚfiÙÂÚÔ ÙˆÓ 50 mOsm. ToÔÛÌˆÙÈÎfi ¯¿ÛÌ· ÎÔÚ¿ÓˆÓ ˘ÔÏÔÁ›˙ÂÙ·È ˆ˜ÂÍ‹˜:ÔÛÌˆÙÈÎfi ¯¿ÛÌ· ÎÔÚ¿ÓˆÓ = 290 – 2 x (mEq NaÎÔÚ¿ÓˆÓ + mEq K ÎÔÚ¿ÓˆÓ).

∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÛÌˆÙÈÎÔ‡ Ù‡Ô˘ ‰È¿ÚÚÔÈ· ÙÔÔÛÌˆÙÈÎfi ¯¿ÛÌ· ÎÔÚ¿ÓˆÓ Â›Ó·È ·˘ÍËÌ¤ÓÔ, Û˘Ó‹-ıˆ˜ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 100 mOsm, ÁÈ·Ù› Ù· ÌËÚÔÛ‰ÈÔÚÈ˙fiÌÂÓ· ÔÛÌˆÙÈÎÒ˜ ÂÓÂÚÁ¿ ÌfiÚÈ· ·˘Í¿-ÓÔ˘Ó ÙËÓ ÔÛÌˆÙÈÎfiÙËÙ· ÙˆÓ ÎÔÚ¿ÓˆÓ.

∏ÏÂÎÙÚÔÏ‡ÙÂ˜ ÔÚÔ‡, ‰ÈÙÙ·ÓıÚ·ÎÈÎ¿, Ô˘Ú›· Î·ÈÎÚÂ·ÙÈÓ›ÓË ı· Ú¤ÂÈ Ó· ·Ú·ÁÁ¤ÏÏÔÓÙ·È ÁÈ· Î¿ıÂ

·È‰› ÌÂ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ·Ê˘‰¿ÙˆÛË. ∂›ÛË˜,‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ú·ÏÂ›ÂÙ·È Ë ÁÂÓÈÎ‹ Ô‡ÚˆÓ,·ÊÔ‡ ÔÈ Ô˘ÚÔÏÔÈÌÒÍÂÈ˜ ÌÔÚÂ› Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È·fi ‰È¿ÚÚÔÈ·.

£ÂÚ·Â›·∂Ó˘‰¿ÙˆÛË: √ ÚˆÙ·Ú¯ÈÎfi˜ ÛÎÔfi˜ ÙË˜ ıÂ-

Ú·Â›·˜ ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ·ÔÛÎÔÂ› ÛÙËÓ·Ó·Ï‹ÚˆÛË ÙÔ˘ ÂÏÏÂ›ÌÌ·ÙÔ˜ ‡‰·ÙÔ˜ Î·È ËÏÂ-ÎÙÚÔÏ˘ÙÒÓ Î·È ÛÙË ‰È·Ù‹ÚËÛË ÙË˜ ÂÓ˘‰¿ÙˆÛË˜fiÛÔ Ë ‰È¿ÚÚÔÈ· Û˘ÓÂ¯›˙ÂÙ·È (13). ∏ ÂÓ‰ÔÊÏ¤‚È·ÂÓ˘‰¿ÙˆÛË ÂÓ‰Â›ÎÓ˘Ù·È ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛÔ-‚·ÚÔ‡ ‚·ıÌÔ‡ ·Ê˘‰¿ÙˆÛË, ·Ú·Ï˘ÙÈÎfi ÂÈÏÂfi,·Î·Ù¿Û¯ÂÙÔ˘˜ ÂÌ¤ÙÔ˘˜. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ÌÔ-ÚÔ‡Ó Ó· ‰ÔıÔ‡Ó ·fi ÙÔ ÛÙfiÌ· Î·Ù¿ ÚÔÙ›ÌËÛËÈÛfiÙÔÓ· ‹ ˘fiÙÔÓ· ‰È·Ï‡Ì·Ù· ˘‰·Ù·ÓıÚ¿ÎˆÓÔ˘ ÂÚÈ¤¯Ô˘Ó ËÏÂÎÙÚÔÏ‡ÙÂ˜. ∏ ‚¿ÛË ÙË˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ·˘ÙÒÓ ÛÙËÚ›˙ÂÙ·È ÛÙËÛ˘Ó‰Â‰ÂÌ¤ÓË ÌÂÙ·ÊÔÚ¿ Ó·ÙÚ›Ô˘ Î·È ÁÏ˘Îfi˙Ë˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘. √ ÌË¯·ÓÈÛÌfi˜·˘Ùfi˜ ‰È·ÙËÚÂ›Ù·È ÂÓ Ì¤ÚÂÈ ·ÎfiÌË Î·È ÛÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ Ô˘ ÙÔ Î‡ÙÙ·ÚÔ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfi-ÓÔ˘ ¤¯ÂÈ ˘ÔÛÙÂ› ÛËÌ·ÓÙÈÎ‹ ‚Ï¿‚Ë, fiˆ˜ .¯. ÛÙËÏÔ›ÌˆÍË ·fi ÚfiÙ·-Èfi. ∏ Ì¤ÁÈÛÙË ·ÔÚÚfiÊËÛË‡‰·ÙÔ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ ·fi ÙÔ ¤ÓÙÂÚÔ ÂÈÙÂ-ÏÂ›Ù·È fiÙ·Ó o ÌÔÚÈ·Îfi˜ ÏfiÁÔ˜ ˘‰·Ù·ÓıÚ¿ÎˆÓÚÔ˜ Ó¿ÙÚÈÔ ÛÙÔ ‰È¿Ï˘Ì· ÂÓ˘‰¿ÙˆÛË˜ ‰ÂÓ ˘ÂÚ-‚·›ÓÂÈ ÙÔ 2:1 (14). ∆Ô ‰È¿Ï˘Ì· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔÛÙfiÌ· Ô˘ Û˘ÓÈÛÙ¿ Ë ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛËÀÁÂ›·˜ (¶√À) Î·È Ë UNICEF ¤¯ÂÈ ÌÔÚÈ·Îfi ÏfiÁÔ˘‰·Ù·ÓıÚ¿ÎˆÓ ÚÔ˜ Ó¿ÙÚÈÔ 1,4:1 Î·È Û˘ÁÎ¤ÓÙÚˆ-ÛË Ó·ÙÚ›Ô˘ 90 mmol/L ÂÓÒ ·˘Ù¿ Ô˘ Û˘ÓÈÛÙ¿ Ë∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ ¤¯Ô˘Ó ÏfiÁÔÌÈÎÚfiÙÂÚÔ ÙÔ˘ 2:1 Î·È Û˘ÁÎ¤ÓÙÚˆÛË Ó·ÙÚ›Ô˘ ÌÂ-Á·Ï‡ÙÂÚË ÙˆÓ 55 mmol/L. ¢˘ÛÙ˘¯Ò˜, ·ÎfiÌË Î·ÈÛ‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿-ÍË ˘ÁÚ¿ ÁÈ· ÂÓ˘‰¿ÙˆÛË (ÙÛ¿˚, ÊÚÔ˘ÙÔ¯˘ÌÔ›,Coca Cola) Ô˘ ÂÚÈ¤¯Ô˘Ó ¯·ÌËÏ‹ Û˘ÁÎ¤ÓÙÚˆÛË

¶›Ó·Î·˜ 4. ∂ÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÂÓÙÂÚÔ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ.

∂ÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ √ÚÁ·ÓÈÛÌÔ›ªÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÎÔÚ¿ÓˆÓ§Â˘ÎÔÎ‡ÙÙ·Ú· µ·ÎÙ‹ÚÈ· Ô˘ ÚÔÎ·ÏÔ‡Ó ‰˘ÛÂÓÙÂÚ›·∆ÚÔÊÔ˙ˆ˝ÙÂ˜, Î‡ÛÙÂÈ˜, ˆÔÎ‡ÛÙÂÈ˜ §¿Ì‚ÏÈ·, ∞ÌÔÈ‚¿‰·, ∫Ú˘ÙÔÛÔÚ›‰ÈÔ™ÂÈÚÔÂÈ‰‹ ‚·ÎÙ‹ÚÈ· ∫·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ

∫·ÏÏÈ¤ÚÁÂÈ· ÎÔÚ¿ÓˆÓ™˘Ó‹ıË˜ ™·ÏÌÔÓ¤ÏÏ·, ™ÈÁÎ¤ÏÏ·, ∫·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ∂È‰ÈÎ‹ ÀÂÚÛ›ÓÈ·, ∞ÂÚÔÌÔÓ¿‰·, Clostridium difficile,

E. coli 0157:H7∞Ó›¯ÓÂ˘ÛË ·ÓÙÈÁfiÓÔ˘ ‹ ÙÔÍ›ÓË˜(ELISA ‹ latex Û˘ÁÎfiÏÏËÛË) ∞ÓÙÈÁfiÓÔ (ƒfiÙ·-Èfi˜, §¿Ì‚ÏÈ·), ∆ÔÍ›ÓË

(Clostridium difficile)


2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 9

Ó·ÙÚ›Ô˘ Î·È ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË ·ÏÒÓ Û·Î-¯¿ÚˆÓ Ô˘ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ˘ÔÓ·ÙÚÈ-·ÈÌ›· Î·È ÂÈ‰Â›ÓˆÛË ÙË˜ ‰È¿ÚÚÔÈ·˜ ÂÍ·ÈÙ›·˜ ÙË˜˘„ËÏ‹˜ ÙÔ˘˜ ÔÛÌˆÙÈÎfiÙËÙ·˜. √ ›Ó·Î·˜ 5 ‰Â›-¯ÓÂÈ ÙË Û‡ÓıÂÛË ‰È·Ï˘Ì¿ÙˆÓ Ô˘ ÛˆÛÙ¿ ‹ Ï¿ıÔ˜¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙË ıÂÚ·Â›· ÙË˜ ‰È¿ÚÚÔÈ·˜.ŒÓ· ÛËÌ·ÓÙÈÎfi ÌÂÈÔÓ¤ÎÙËÌ· ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÂÓ˘-‰¿ÙˆÛË˜ Ô˘ ÂÚÈ¤¯Ô˘Ó ÁÏ˘Îfi˙Ë Î·È ËÏÂÎÙÚÔÏ‡-ÙÂ˜ Â›Ó·È fiÙÈ ‰ÂÓ ÂÚÈÔÚ›˙Ô˘Ó ÙË Û˘¯ÓfiÙËÙ· ‹ ÙÔÓfiÁÎÔ ÙˆÓ ÎÔÚ¿ÓˆÓ Ô‡ÙÂ ÌÂÈÒÓÔ˘Ó ÙË ‰È¿ÚÎÂÈ·ÙË˜ ‰È¿ÚÚÔÈ·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ¤¯Ô˘Ó ‰ÔÎÈÌ·-ÛÙÂ› ‰È·Ï‡Ì·Ù· ÂÓ˘‰¿ÙˆÛË˜ Ô˘ ÂÚÈ¤¯Ô˘Ó ‰Ë-ÌËÙÚÈ·Î¿ ‹ fiÛÚÈ·. ∞fi ·˘Ù¿ Ù· Î·Ï‡ÙÂÚ· ÌÂÏÂ-ÙËÌ¤Ó· Â›Ó·È ·˘Ù¿ Ô˘ ÂÚÈ¤¯Ô˘Ó Ú‡˙È (50 gr/L)

·ÓÙ› ÁÈ· ÁÏ˘Îfi˙Ë (15). ∆· ‰È·Ï‡Ì·Ù· ·˘Ù¿ Ê·›ÓÂ-Ù·È fiÙÈ ÌÂÈÒÓÔ˘Ó ÙÔÓ fiÁÎÔ ÙˆÓ ÎÔÚ¿ÓˆÓ Î·È ÙË‰È¿ÚÎÂÈ· ÙË˜ ‰È¿ÚÚÔÈ·˜. √È Û‡ÓıÂÙÔÈ ˘‰·Ù¿Ó-ıÚ·ÎÂ˜ Ô˘ ÂÚÈ¤¯Ô˘Ó .¯. ¿Ì˘ÏÔ, ˘‰ÚÔÏ‡ÔÓÙ·È·fi Ù· ¤Ó˙˘Ì· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ·˘ÏÔ‡ ÛÂ ÌÈÎÚfiÙÂ-Ú· ÌfiÚÈ· Ù· ÔÔ›· ·Ú·Ï·Ì‚¿ÓÔÓÙ·È ÔÏ‡ ÁÚ‹-ÁÔÚ· ·fi Ù· ÂÈÊ·ÓÂÈ·Î¿ Î‡ÙÙ·Ú· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡‚ÏÂÓÓÔÁfiÓÔ˘ ÚÈÓ ·˘ÍËıÂ› ÛËÌ·ÓÙÈÎ¿ Ë ÔÛÌˆÙÈ-ÎfiÙËÙ· Ì¤Û· ÛÙÔÓ ÂÓÙÂÚÈÎfi ·˘Ïfi. °È· ÙÔ Ú‡˙È ¤¯ÂÈ‚ÚÂıÂ› fiÙÈ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ÂÎÎÚÈÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ ÙË˜ ‰Ú¿ÛË˜ ÙÔ˘ÛÙËÓ Î˘ÎÏÈÎ‹ ÌÔÓÔÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË(cAMP)(16).

ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ¯ÔÚËÁÔ‡ÌÂ-


¶›Ó·Î·˜ 5. ™‡ÓıÂÛË ˘ÁÚÒÓ Ô˘ ÛˆÛÙ¿ ‹ Ï·Óı·ÛÌ¤Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÂÓ˘‰¿ÙˆÛË.

¢È¿Ï˘Ì· À‰·Ù¿ÓıÚ·ÎÂ˜ (g/L) ¡¿ÙÚÈÔ ∫¿ÏÈÔ µ¿ÛË √ÛÌˆÙÈÎfiÙËÙ·(mmol/L) (mmol/L) (‰ÈÙÙ·ÓıÚ·ÎÈÎfi (mOsm/L)

‹ ÎÈÙÚÈÎfi)

¢È¿Ï˘Ì· ¶√À/UNICEF 20 (ÁÏ˘Îfi˙Ë) 90 20 30 310

Orisel (NUTRICIA) 20 (ÁÏ˘Îfi˙Ë) 60 25 10 269

Almora (ELPEN) 20 (ÁÏ˘Îfi˙Ë) 35 13,5 18

Soparyx(FARMANIC) 30 (¿ÏÂ˘ÚÔ Ú˘˙ÈÔ‡) 60 20 10 140

Rizolyte(UNI PHARM) 30 (¿Ì˘ÏÔ Ú˘˙ÈÔ‡) 60 20 10 200

ElectroRice(PANAX) 30 (¿Ì˘ÏÔ Ú˘˙ÈÔ‡) 60 20 10 140

Gatorade 45 (ÁÏ˘Îfi˙Ë, 20 3 3 330ÊÚÔ˘ÎÙfi˙Ë, ÛÔ˘ÎÚfi˙Ë)

Ã˘Ìfi˜ Ì‹ÏÔ˘ 100-150 3 20 0 700(ÁÏ˘Îfi˙Ë, ÊÚÔ˘ÎÙfi˙Ë)

Cola 50-150 (ÁÏ˘Îfi˙Ë, 2 0,1 13 550ÊÚÔ˘ÎÙfi˙Ë)

∆Û¿È 0 0 0 0 0

∑ˆÌfi˜ ·fiÎÔÙfiÔ˘ÏÔ 0 250 5 5 450

∏ ÔÛÌˆÙÈÎfiÙËÙ· ÙÔ˘ Almora ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È.Ã˘Ìfi˜ Ì‹ÏÔ˘, Cola, ÙÛ¿È, ˙ˆÌfi˜ ·fi ÎÔÙfiÔ˘ÏÔ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÌfiÓÔ Î·È ÌfiÓÔ ÁÈ· Û‡ÁÎÚÈÛË. ¢ÂÓ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÂÓ˘‰¿ÙˆÛË.

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ÓˆÓ ˘ÁÚÒÓ, ÁÈ· ÙËÓ ‹È· ·Ê˘‰¿ÙˆÛË (3-5%) Û˘ÓÈ-ÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË 50 ml/kg ‚¿ÚÔ˘˜ ÂÓ˘‰·ÙÈÎÔ‡‰È·Ï‡Ì·ÙÔ˜ ÛÂ ‰È¿ÛÙËÌ· 6 ˆÚÒÓ. °È· ÌÂÙÚ›Ô˘ ‚·ı-ÌÔ‡ ·Ê˘‰¿ÙˆÛË (5-9%) Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË100 ml/kg ‚¿ÚÔ˘˜ ‰È·Ï‡Ì·ÙÔ˜ ÛÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ·. ∆¤ÏÔ˜, ÁÈ· ÙË ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ·Ê˘‰¿-ÙˆÛË (10% Î·È ¿Óˆ) Û˘ÓÈÛÙ¿Ù·È Ë ·Ú¯ÈÎ‹ ·Ó·˙ˆÔ-ÁfiÓËÛË ÌÂ ÂÓ‰ÔÊÏ¤‚È· ˘ÁÚ¿ (20-60 ml/kg) ÛÙÈ˜ÚÒÙÂ˜ ‰‡Ô ÒÚÂ˜ Ì¤¯ÚÈ Ó· ·ÔÎ·Ù·ÛÙ·ıÔ‡Ó Ù·˙ˆÙÈÎ¿ ÛËÌÂ›· Î·È Ô Ú˘ıÌfi˜ Ô‡ÚËÛË˜. ™ÙË Û˘Ó¤-¯ÂÈ· ÌÔÚÔ‡Ó Ó· ‰ÔıÔ‡Ó ‰È·Ï‡Ì·Ù· ÂÓ˘‰¿ÙˆÛË˜·fi ÙÔ ÛÙfiÌ·. √È Û˘ÓÂ¯È˙fiÌÂÓÂ˜ ·ÒÏÂÈÂ˜ ˘ÁÚÒÓÌÔÚÔ‡Ó Ó· ·Ó·ÏËÚÒÓÔÓÙ·È ÌÂ ÙË ¯ÔÚ‹ÁËÛË 10ml/kg ‚¿ÚÔ˘˜ ÂÓ˘‰·ÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÁÈ· Î¿ıÂ‰È·ÚÚÔ˚Î‹ Î¤ÓˆÛË.

ŸÌˆ˜, ·ÚfiÏÔ Ô˘ Ù· ‰È·Ï‡Ì·Ù· ÂÓ˘‰¿ÙˆÛË˜·fi ÙÔ ÛÙfiÌ· ¤¯Ô˘Ó ÛÒÛÂÈ ÂÎ·ÙÔÌÌ‡ÚÈ· ˙ˆ¤˜ ÛÙÔÓÙÚ›ÙÔ ÎfiÛÌÔ, Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙÔ˘˜ ÛÙÈ˜ ·Ó·Ù˘Á-Ì¤ÓÂ˜ ¯ÒÚÂ˜ Â›Ó·È Î·ÙÒÙÂÚË ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘.¶ÔÏÏ¤˜ ÊÔÚ¤˜ ÚÔÙÈÌ¿Ù·È Ë ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË˘ÁÚÒÓ ·ÎfiÌË Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ Ì¤ÙÚÈ·˜ ·Ê˘‰¿-ÙˆÛË˜. ªÂÏ¤ÙË ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ Ì¤¯ÚÈ 3ÂÙÒÓ Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó ÁÈ· ÔÍÂ›· Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·¤‰ÂÈÍÂ fiÙÈ ÛÙÔ 52% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¯ÔÚËÁ‹ıËÎ·ÓÂÓ‰ÔÊÏÂ‚›ˆ˜ ˘ÁÚ¿ ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË (17).∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÂÓ˘‰¿ÙˆÛË˜ Â›-Ó·È Ë ··›ÙËÛË ÙË˜ Û˘ÓÂ¯Ô‡˜ ·ÚÔ˘Û›·˜ ÙÔ˘ ÁÔ-Ó¤· ÛÙÔ ÏÂ˘Úfi ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· Ó· Ù· ¯ÔÚËÁÂ› Î·-ıÒ˜ Î·È Ë ÁÂ‡ÛË ÙÔ˘˜, ·ÊÔ‡ ÛÂ ÔÏÏ¿ ·È‰È¿ ‰ÂÓÂ›Ó·È ·ÚÂÛÙ‹. ¶ÏÂÔÓÂÎÙ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó Ë È‰·ÓÈÎfi-ÙÂÚË ·Ó·Ï‹ÚˆÛË ÙˆÓ ˘ÁÚÒÓ ·fi ÏÂ˘Ú¿˜ Ê˘ÛÈÔ-ÏÔÁ›·˜, Ë ·ÔÊ˘Á‹ ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›ÔÎ·È ÙÔ ÌÈÎÚfiÙÂÚÔ ÎfiÛÙÔ˜.

™›ÙÈÛË: ∏ Û›ÙÈÛË ı· Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ·Ì¤Ûˆ˜ÌÂÙ¿ ÙËÓ ÂÓ˘‰¿ÙˆÛË. ∏ ·Ï·È¿ ·ÓÙ›ÏË„Ë fiÙÈ Ë Û›ÙÈ-ÛË Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· Î·ı˘ÛÙÂÚÂ› ÁÈ· Ó· ‰ÔıÂ›Î¿ÔÈÔ˜ ¯ÚfiÓÔ˜ ·Ó¿·˘ÛË˜ ÛÙÔ «ÙÚ·˘Ì·ÙÈÛÌ¤ÓÔ»¤ÓÙÂÚÔ, ÙÔ ÔÔ›Ô ‰˘Û·ÔÚÚÔÊ¿ Î·È Û˘ÓÂÒ˜ ÂÈ-ÙÂ›ÓÂÈ ÙË ‰È¿ÚÚÔÈ·, ‰ÂÓ Â˘ÛÙ·ıÂ›. ∞ÓÙ›ıÂÙ·, ÌÂÏ¤ÙÂ˜¤‰ÂÈÍ·Ó fiÙÈ ÙÔ 80 ÌÂ 95% ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ, ÙÔ70% ÙÔ˘ Ï›Ô˘˜ Î·È ÙÔ 75% ÙË˜ ÚˆÙÂ˝ÓË˜ ·ÔÚ-ÚÔÊÔ‡ÓÙ·È (18). ∏ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ ·fi ÙÔ ¤ÓÙÂ-ÚÔ ‚ÔËı¿ ÛÙËÓ ÂÔ‡ÏˆÛË ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌ¤ÓÔ˘‚ÏÂÓÓÔÁfiÓÔ˘, ÂÓÒ Ë ·ÛÈÙ›· Ô‰ËÁÂ› ÛÙËÓ ˘ÔÏ·Û›·ÙÔ˘ Î·È ÛÙË ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÂÙÈÎÒÓÂÓ˙‡ÌˆÓ. ŸÙ·Ó ÙÔ ·È‰› ·ÚÁ‹ÛÂÈ Ó· ÛÈÙÈÛÙÂ› ¤¯ÂÈÛ˘¯Ó¤˜, ÌÈÎÚÔ‡ fiÁÎÔ˘, Î·È ‚ÏÂÓÓÒ‰ÂÈ˜ ÎÂÓÒÛÂÈ˜(ÎÂÓÒÛÂÈ˜ «Â›Ó·˜»). ™Ù· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó, ÔÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ı· Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ·Ì¤Ûˆ˜ÌÂÙ¿ ÙËÓ ÂÓ˘‰¿ÙˆÛË. ™Ù· ‚Ú¤ÊË Ô˘ ‰ÂÓ ıËÏ¿˙Ô˘ÓÌÔÚÂ› Ó· ‰ÔıÂ› ÙÔ ÎÔÓÈÔÔÈËÌ¤ÓÔ Á¿Ï· Ô˘ ¤·ÈÚ-Ó·Ó ÚÔËÁÔ‡ÌÂÓ· ¯ˆÚ›˜ ·Ú·›ˆÛË (15). ∏ ¯ÔÚ‹ÁË-ÛË ·Ú·ÈˆÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜, fiˆ˜ Û˘¯Ó¿ Á›ÓÂÙ·È

ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË, ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÁÈ·Ù› Ù·‚Ú¤ÊË ˘ÔÛÈÙ›˙ÔÓÙ·È Ì¤¯ÚÈ Ó· ÙÔ˘˜ ‰ÔıÂ› ÙÔ Ï‹-ÚÂ˜ Á¿Ï· (19). ∆Ô Á¿Ï· ÂÏÂ‡ıÂÚÔ Ï·ÎÙfi˙Ë˜ ‰ÂÓ ı·Ú¤ÂÈ Ó· ‰›ÓÂÙ·È ÂÍ·Ú¯‹˜, ÁÈ·Ù› ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÛÙËÓ ÔÍÂ›· ‰È¿ÚÚÔÈ· ÙˆÓ ‚ÚÂÊÒÓ‰ÂÓ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ‰˘Û·ÓÂÍ›· ÛÙËÏ·ÎÙfi˙Ë. °¿Ï· ÂÏÂ‡ıÂÚÔ Ï·ÎÙfi˙Ë˜ (Á¿Ï· ·ÁÂÏ¿-‰·˜ ‹ ÛfiÁÈ·˜) Û˘ÓÈÛÙ¿Ù·È fiÙ·Ó ÔÈ ·ÛıÂÓÂ›˜ Â›Ó·ÈÛÔ‚·Ú¿ ·Ê˘‰·ÙˆÌ¤ÓÔÈ Î·Ù¿ ÙËÓ ÚÒÙË Â›ÛÎÂ„Ë,¤¯Ô˘Ó ÎÏÈÓÈÎ¿ ÛËÌÂ›· ˘ÔÛÈÙÈÛÌÔ‡ ‹ Ë ‰È¿ÚÚÔÈ·ÙÔ˘˜ ¯ÂÈÚÔÙÂÚÂ‡ÂÈ ÂÌÊ·ÓÒ˜ ÌÂ ÙËÓ Â·ÓÂÈÛ·ÁˆÁ‹ÙË˜ Ï·ÎÙfi˙Ë˜ (19). ∆Ô ÊÔÚÙ›Ô ÙË˜ Ï·ÎÙfi˙Ë˜ ÚÔ˜ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ ÌÔÚÂ› Ó· ÂÏ·ÙÙˆıÂ› ÌÂ ÙË ¯Ú‹ÛËÁ¿Ï·ÎÙÔ˜ Ô˘ ¤¯ÂÈ ˘ÔÛÙÂ› ˙‡ÌˆÛË ‹ ¤¯ÂÈ ÚÔÛÙÂ-ıÂ› ÙÔ ¤Ó˙˘ÌÔ ‚-Á·Ï·ÎÙÔÛÈ‰¿ÛË fiˆ˜ Û˘Ì‚·›ÓÂÈ ÌÂÙÔ ÁÈ·Ô‡ÚÙÈ. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ë Û˘Ó¤¯È-ÛË ÙË˜ ‰›·ÈÙ·˜ Ô˘ ÂÚÈ¤¯ÂÈ Ï·ÎÙfi˙Ë ÌÔÚÂ› Ó· Û˘-ÓÔ‰Â‡ÂÙ·È ·fi ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ·‡ÍËÛË ÙˆÓ ÎÂÓÒ-ÛÂˆÓ Î·È ·Ú¿Ù·ÛË ÙË˜ ‰È¿ÚÚÔÈ·˜ Û˘ÁÎÚÈÓfiÌÂÓËÌÂ ÌÈ· ‰›·ÈÙ· ÂÏÂ‡ıÂÚË Ï·ÎÙfi˙Ë˜ (20). ∞˘Ùfi ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ·Ó˘ÔÌÔÓËÛ›· ÙˆÓ ÁÔÓ¤ˆÓ Î¿-ÓÂÈ ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ Ó·ÚÔ¯ˆÚÔ‡Ó ÛÙÔÓ ÚfiˆÚÔ ‰È·ÈÙËÙÈÎfi ·ÔÎÏÂÈÛÌfiÙË˜.

™Â ÂÚÈÙÒÛÂÈ˜ ÛÔ‚·Ú‹˜ ‚Ï¿‚Ë˜ ÙÔ˘ ÂÈÊ·ÓÂÈ-·ÎÔ‡ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Ô˘ Ë ‰Ú·ÛÙËÚÈfiÙËÙ·ÙˆÓ ÂÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ¤¯ÂÈ ÌÂÈˆıÂ› Î·Ù¿ ÔÏ‡,fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜ÂÓÙÂÚ›ÙÈ‰·˜, Ô ·ÛıÂÓ‹˜ ÌÔÚÂ› Ó· ˆÊÂÏËıÂ› ·fi ÙË¯ÔÚ‹ÁËÛË ÛÙÔÈ¯ÂÈ·ÎÒÓ Á·Ï¿ÙˆÓ, ÂÏÂ‡ıÂÚˆÓ Ï·-ÎÙfi˙Ë˜ ÌÂ ˘‰ÚÔÏ˘Ì¤ÓË ÚˆÙÂ˝ÓË. ∂ÂÈ‰‹ Ù· Á¿Ï·-Ù· ·˘Ù¿ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ˘„ËÏ‹ ÔÛÌˆÙÈÎfiÙËÙ· Ô˘ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓÒÛÂÈ ÙË ‰È¿ÚÚÔÈ·, ı· Ú¤ÂÈ Ó·ÂÈÏÂÁÂ› ·˘Ùfi ÌÂ ÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹ ÔÛÌˆÙÈÎfiÙË-Ù· (19).

°È· Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, Ë ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·-‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ Û˘ÓÈÛÙ¿ ÙËÓ ¤ÁÎ·ÈÚË Â·Ó·Û›-ÙÈÛË ÌÂ ÌÈ· ÈÛÔÚÚÔËÌ¤ÓË ‰›·ÈÙ· ‚·ÛÈÛÌ¤ÓË ÛÂÙÚÔÊ¤˜ Ô˘ ÂÚÈ¤¯Ô˘Ó Û‡ÓıÂÙÔ˘˜ ˘‰·Ù¿ÓıÚ·ÎÂ˜(Ú‡˙È, ‰ËÌËÙÚÈ·Î¿, „ˆÌ›, ·Ù¿ÙÂ˜), „·¯Ófi ÎÚ¤·˜,Ì·ÁÂÈÚÂÌ¤Ó· ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈÎ¿, ÁÈ·Ô‡ÚÙÈ Î·È·ÔÊ˘Á‹ ÙÚÔÊÒÓ ¯·ÌËÏÒÓ ÛÂ Ï›Ë Î·È ·Ï¿ Û¿Î-¯·Ú· (¤ÙÔÈÌÔÈ ¯˘ÌÔ› ÊÚÔ‡ÙˆÓ, ·Ó·„˘ÎÙÈÎ¿) (15).

∞ÓÙÈ‚ÈÔÙÈÎ¿: ∆· ·ÓÙÈ‚ÈÔÙÈÎ¿ Û¿ÓÈ· ÂÓ‰Â›ÎÓ˘ÓÙ·ÈÛÙË ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜, ·ÊÔ‡ ÛÙËÓÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ÓfiÛÔ˜ ·Ô‰Ú¿ÌÂÈ·fi ÌfiÓË ÙË˜ (21). ™Â ÂÚ›ÙˆÛË ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·Áˆ-Á‹˜ Î·Ïfi ı· Â›Ó·È Ó· Á›ÓÂÙ·È ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·, Î·ıÒ˜¤¯ÂÈ ·Ú·ÙËÚËıÂ› ·Ó¿Ù˘ÍË ·ÓıÂÎÙÈÎÒÓ ÛÙÂÏÂ¯ÒÓ.™ÙË ÏÔ›ÌˆÍË ·fi ÛÈÁÎ¤ÏÏ· Ù· ·ÓÙÈ‚ÈÔÙÈÎ¿ Û˘ÓÙÔ-ÌÂ‡Ô˘Ó ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ Î·È ÙÔ ¯ÚfiÓÔ ·Ô‚Ô-Ï‹˜ ÙÔ˘ ‚·ÎÙËÚ›Ô˘ ÛÙ· ÎfiÚ·Ó·. ∏ ÎÔÙÚÈÌÔÍ·˙fiÏË(ÙÚÈÌÂıÔÚ›ÌË - ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË) ·Ú·Ì¤ÓÂÈ ÙÔÊ¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ·ÏÏ¿


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Ë ·˘Í·ÓfiÌÂÓË ·ÓıÂÎÙÈÎfiÙËÙ· ÌÔÚÂ› Ó· ··ÈÙ‹ÛÂÈÙË ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, fiˆ˜ ÔÈÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ ÙÚ›ÙË˜ ÁÂÓÂ¿˜ (.¯. Ë ÎÂÊÈÍ›ÌË)Î·È ÔÈ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜. ªÂÁ¿ÏË ÌÂÏ¤ÙË Ô˘ ·ÊÔ-ÚÔ‡ÛÂ ÙË ÛÈÁÎ¤ÏÏˆÛË ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ÛÙË µ.∂ÏÏ¿‰· Î·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1971-1994 ¤‰ÂÈÍÂfiÙÈ ˘‹Ú¯Â ÛËÌ·ÓÙÈÎ‹ ·ÓÙÔ¯‹ ÙÔ˘ ‚·ÎÙËÚ›Ô˘ ÛÙËÓÎÔÙÚÈÌÔÍ·˙fiÏË (24%) Î·È ÛÙËÓ ·ÌÈÎÈÏÏ›ÓË (16%)(22). ∏ ıÂÚ·Â›· ÂÓÙÂÚ›ÙÈ‰·˜ ·fi Û·ÏÌÔÓ¤ÏÏ· Û˘-ÓÈÛÙ¿Ù·È ÁÈ· ÙÈ˜ ·Ú·Î¿Ùˆ Î·ÙËÁÔÚ›Â˜ ·ÛıÂÓÒÓ: ·)·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤Ó· ¿ÙÔÌ·, ‚) ·È‰È¿ ÌÂ ·ÈÌÔ-ÛÊ·ÈÚÈÓÔ¿ıÂÈÂ˜, Á) ·È‰È¿ ÌÂ Ù˘ÊÔÂÈ‰‹ ˘ÚÂÙfi, ‰)‚·ÎÙËÚÈ·ÈÌ›· ·fi Û·ÏÌÔÓ¤ÏÏ·, Â) ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ3 ÌËÓÒÓ. º¿ÚÌ·ÎÔ ÚÒÙË˜ ÂÎÏÔÁ‹˜ Â›Ó·È ÔÈ ÎÂÊ·-ÏÔÛÔÚ›ÓÂ˜, Î˘Ú›ˆ˜ ·˘Ù¤˜ ÙË˜ 3Ë˜ ÁÂÓÂ¿˜, ÂÓÒ Ë·ÌÈÎÈÏÏ›ÓË Î·È Ë ÎÔÙÚÈÌÔÍ·˙fiÏË ÌÔÚÔ‡Ó Ó· ¯ÚË-ÛÈÌÔÔÈÔ‡ÓÙ·È fiÙ·Ó ‚ÚÂıÂ› Â˘·ÈÛıËÛ›· ÛÙÔ ·ÓÙÈ-‚ÈfiÁÚ·ÌÌ·. ™Â ÌÈ· ¤ÚÂ˘Ó· ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ÎÏÈ-ÓÈÎ‹˜ ÙÔ˘ ·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ (23) Ô˘ ¤ÁÈÓÂÛÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1993-1995 ‚Ú¤ıËÎÂ fiÙÈ ÔÈ ÈÔÛ˘¯Ó¿ ··ÓÙÒÌÂÓÂ˜ Û·ÏÌÔÓ¤ÏÏÂ˜ ÛÙÔÓ ÂÏÏËÓÈÎfi¯ÒÚÔ S. typhimurium Î·È S. enteritidis ·ÚÔ˘Û›·˙·ÓÚÔÔ‰Â˘ÙÈÎ¿ ·˘Í·ÓfiÌÂÓË ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈÎÈÏÏ›ÓËÔ˘ ¤Êı·Ó·Ó ÙÔ 43 Î·È 65% ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ Ë S.typhimurium ÛÙËÓ ÎÔÙÚÈÌÔÍ·˙fiÏË (42%) Î·È ¯Ïˆ-Ú·ÌÊÂÓÈÎfiÏË (51%). ∞ÓÙ›ıÂÙ·, Ë ·ÓÙÔ¯‹ ÛÙÈ˜ ÎÂÊ·-ÏÔÛÔÚ›ÓÂ˜ 1Ë˜, 2Ë˜ Î·È 3Ë˜ ÁÂÓÂ¿˜ Î˘Ì¿ÓıËÎÂ ÛÂÔÏ‡ ¯·ÌËÏ¿ Â›Â‰· (0-5%). °È· ÙË ¯ˆÚ›˜ ÂÈÏÔ-Î¤˜ ÂÓÙÂÚ›ÙÈ‰· ·fi Û·ÏÌÔÓ¤ÏÏ· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ıÂ-Ú·Â›· ÁÈ·Ù› Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÌÔÚÂ› Ó··Ú·ÙÂ›ÓÂÈ ÙË ÊÔÚÂ›·. ∏ ¯ÔÏ¤Ú· ıÂÚ·Â‡ÂÙ·È ÌÂÙÂÙÚ·Î˘ÎÏ›ÓÂ˜ ‹ ÎÔÙÚÈÌÔÍ·˙fiÏË. √È ÂÚÈÙÒÛÂÈ˜·Ú·ÙÂÙ·Ì¤ÓË˜ ‹ ÛÔ‚·Ú‹˜ ‰È¿ÚÚÔÈ·˜ ·fi Î·Ì˘-ÏÔ‚·ÎÙËÚ›‰ÈÔ ıÂÚ·Â‡ÔÓÙ·È ÌÂ ÂÚ˘ıÚÔÌ˘Î›ÓË. ∏·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ Û˘ÓÈÛÙ¿Ù·È Î·È ÁÈ· ÙË ÏÔ›ÌˆÍËÌÂ ÂÓÙÂÚÔ‰ÈÂÈÛ‰˘ÙÈÎfi ‹ ÂÓÙÂÚÔÙÔÍÈÓÔÁfiÓÔ ÎÔÏÔ‚·-ÎÙËÚ›‰ÈÔ. ∆Ô ÙÂÏÂ˘Ù·›Ô ·ÔÙÂÏÂ› Î·È ÙËÓ Î˘Ú›· ·ÈÙ›·ÙË˜ ‰È¿ÚÚÔÈ·˜ ÙˆÓ Ù·ÍÈ‰ÈˆÙÒÓ. ∆Ô Ê¿ÚÌ·ÎÔ ÂÎÏÔ-Á‹˜ Â›Ó·È Ë ÎÔÙÚÈÌÔÍ·˙fiÏË. ∆Ô ÚˆÙ·Ú¯ÈÎfi ‚‹Ì·ÛÙË ıÂÚ·Â›· ÙË˜ ÎÔÏ›ÙÈ‰·˜ ·fi Clostridiumdifficile Â›Ó·È Ë ‰È·ÎÔ‹ ÙˆÓ ‹‰Ë ¯ÔÚËÁÔ‡ÌÂÓˆÓ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ∞ÓÙÈ‚ÈÔÙÈÎ¿ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈË-ıÂ› ÌÂ ÂÈÙ˘¯›· ·ÔÙÂÏÔ‡Ó Ë ÌÂÙÚÔÓÈ‰·˙fiÏË Î·È Ë‚·ÓÎÔÌ˘Î›ÓË ·fi ÙÔ ÛÙfiÌ·. √ ÚfiÏÔ˜ ÙË˜ ·ÓÙÈ‚ÈÔ-ÙÈÎ‹˜ ·ÁˆÁ‹˜ ÁÈ· ÙÈ˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰Â˜ ·fi ÂÓÙÂ-ÚÔ·ÈÌÔÚÚ·ÁÈÎfi, ÂÓÙÂÚÔÚÔÛÎÔÏÏËÙÈÎfi ÎÔÏÔ‚·ÎÙË-Ú›‰ÈÔ, ·ÂÚÔÌÔÓ¿‰·, Î·È ˘ÂÚÛ›ÓÈ· ‰ÂÓ ¤¯ÂÈ ‰È·ÏÂ˘-Î·ÓıÂ› Ï‹Úˆ˜. ∏ ÎÚ˘ÙÔÛÔÚÈ‰›·ÛË ÛÂ ÌË ·ÓÔ-ÛÔÎ·Ù·ÛÙ·ÏÌ¤Ó· ¿ÙÔÌ· ·Ô‰Ú¿ÌÂÈ ·fi ÌfiÓË ÙË˜¯ˆÚ›˜ ıÂÚ·Â›·. ∏ ÌÂÙÚÔÓÈ‰·˙fiÏË ·ÔÙÂÏÂ› ÙÔÊ¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ÂÓÙÂÚÈÎ‹ ·ÌÔÈ‚¿‰ˆÛË.

¶ÚÔ‚ÈÔÙÈÎ¿: ¶ÚfiÎÂÈÙ·È ÁÈ· ÌË ·ıÔÁfiÓÔ˘˜ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ fiÙ·Ó Î·Ù·ÔıÔ‡Ó ÌÔÚÔ‡Ó

Ó· ÚÔÏ¿‚Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ‰È¿ÚÚÔÈ·˜ ‹ Ó·‚ÔËı‹ÛÔ˘Ó ÛÙË ıÂÚ·Â›· ÙË˜ (24). ∏ Î·ÙËÁÔÚ›··˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Â›‰Ë Lactobacillus (.¯. GG Î·Èacidophilus), Â›‰Ë Saccharomyces (.¯. boulardii),Bifidobacterium, Streptococcus thermophilus. √ÈÌË¯·ÓÈÛÌÔ› ‰Ú¿ÛË˜ ÙÔ˘˜ Â›Ó·È ÔÈ ·ÎfiÏÔ˘ıÔÈ: ·)·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙËÓ ÚÔÛÎfiÏÏËÛË ·ıÔÁfiÓˆÓ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÒÓ ¿Óˆ ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ,Ô˘ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ‚Ï·-ÙÈÎ‹˜ ‰Ú¿ÛË˜ ÙÔ˘˜, ‚) ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙÔ˘˜ ·-ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ˆ˜ ÚÔ˜ ÙËÓ Úfi-ÛÏË„Ë ÙÚÔÊ‹˜ ‹ ·Ú¿ÁÔ˘Ó Ô˘Û›Â˜ Ô˘ ·Ó·ÛÙ¤Ï-ÏÔ˘Ó ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜, Á) ¤¯Ô˘Ó ·ÓÔÛÔÙÚoÔÔÈ-ËÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜, .¯ Ô Lactobacillus GG ‰ÈÂÁÂ›ÚÂÈÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÚfiÙ·-ÈÔ‡.∆· ÚÔ‚ÈÔÙÈÎ¿ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ÛÙËÓ ÚfiÏË„Ë Î·È ıÂÚ·Â›· ÙË˜ ÏÔÈÌÒ‰Ô˘˜ ‰È¿Ú-ÚÔÈ·˜, ÙË˜ ‰È¿ÚÚÔÈ·˜ ÙˆÓ Ù·ÍÈ‰ÈˆÙÒÓ Î·È ÙË˜ ‰È¿Ú-ÚÔÈ·˜ ·fi ·ÓÙÈ‚ÈÔÙÈÎ¿. ÃÚÂÈ¿˙ÔÓÙ·È fiÌˆ˜ ÂÚÈÛÛfi-ÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· Ó· Î·ÙÔ¯˘ÚˆıÂ› Ë ·ÔÙÂÏÂÛÌ·-ÙÈÎfiÙËÙ· Î·È Ë ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜ ÌÔÏÔÓfiÙÈ ‰ÂÓ ¤¯Ô˘ÓÂÚÈÁÚ·ÊÂ› ÙÔÍÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜.

µÈÙ·Ì›ÓÂ˜ Î·È È¯ÓÔÛÙÔÈ¯Â›·: Y¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜·fi ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ¤Ï·‚·Ó ¯ÒÚ· ÛÂ ·Ó·-Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜, fiÔ˘ ÂÓ‰ËÌÂ› Ô ˘ÔÛÈÙÈÛÌfi˜Î·È Ë ˘Ô‚ÈÙ·Ì›ÓˆÛË, fiÙÈ Ë ¯ÔÚ‹ÁËÛË „Â˘‰·ÚÁ‡-ÚÔ˘, ‚ÈÙ·Ì›ÓË˜ ∞ ‹ Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜ ÌÔÚÂ› Ó· ÂÏ·Ù-ÙÒÛÂÈ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÔ‚·Ú‹˜‰È¿ÚÚÔÈ·˜ ‹ fiÙ·Ó ·˘Ù‹ Â¤ÏıÂÈ Ó· ÌÂÈÒÛÂÈ ÙË ‚·-Ú‡ÙËÙ· Î·È ÙË ‰È¿ÚÎÂÈ¿ ÙË˜ (19). ∞˘Ù‹ ÙË ÛÙÈÁÌ‹fiÌˆ˜ Â›Ó·È ÔÏ‡ ÚfiˆÚÔ Ó· Ô‡ÌÂ fiÙÈ fiÏ· Ù· ·È-‰È¿ ÌÂ ÔÍÂ›· ‰È¿ÚÚÔÈ· ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÙÈ˜Ô˘Û›Â˜ ·˘Ù¤˜.

ÕÏÏ· Ê¿ÚÌ·Î· Î·Ù¿ ÙË˜ ‰È¿ÚÚÔÈ·˜: ∆· Ê¿ÚÌ·-Î· Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙÔÓ ÂÚÈÛÙ·ÏÙÈÛÌfi ÙÔ˘ ÂÓÙ¤-ÚÔ˘, fiˆ˜ Ë ÏÔÂÚ·Ì›‰Ë Î·È Ë ‰ÈÊ·ÈÓÔÍ˘Ï¿ÙË ÌÂÙËÓ ·ÙÚÔ›ÓË, ‰ÂÓ ¤¯Ô˘Ó ı¤ÛË ÛÙË ıÂÚ·Â›· ÙË˜ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ÛÙ· ·È‰È¿, ÁÈ·Ù› ÌÔÚÔ‡Ó Ó·ÚÔÎ·Ï¤ÛÔ˘Ó ÂÈÏÂfi Î·È ˘ÂÚ·Ó¿Ù˘ÍË ÙˆÓ ·ıÔ-ÁfiÓˆÓ ÔÚÁ·ÓÈÛÌÒÓ (bacterial overgrowth). Œ¯Ô˘ÓÂ›ÛË˜ ·Ó·ÊÂÚıÂ› Î·Ù·ÛÙÔÏ‹ ÙË˜ ·Ó·ÓÔ‹˜ Î·ÈÎÒÌ· (15). º¿ÚÌ·Î· Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ ·ÔÚÚfi-ÊËÛË, fiˆ˜ ¯ÔÏÂÛÙ˘Ú·Ì›ÓË ‹ ÌÂ›ÁÌ· Î·ÔÏ›ÓË˜ Ë-ÎÙ›ÓË˜, ‰ÂÓ Û˘ÓÈÛÙÒÓÙ·È Â›ÛË˜, ÁÈ·Ù› ÌÔÏÔÓfiÙÈ ‚ÂÏ-ÙÈÒÓÔ˘Ó ÙË Û‡ÛÙ·ÛË ÙˆÓ ÎÔÚ¿ÓˆÓ, ÌÂÈÒÓÔ˘Ó ÙËÓÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÌÔÚÂ› Ó· Ô‰ËÁ‹-ÛÔ˘Ó ÛÂ ˘ÂÚ·Ó¿Ù˘ÍË ÙˆÓ ÌÈÎÚÔ‚›ˆÓ (13,15).

¶ÚfiÏË„Ë: ∆Ô ÚˆÙ·Ú¯ÈÎfi Ì¤ÏËÌ· fiÌˆ˜, ·Ô-ÙÂÏÂ› Ë ÚfiÏË„Ë Ë ÔÔ›· ÌÔÚÂ› Ó· ÂÈÙÂ˘¯ıÂ› ÌÂÙËÓ Î·Ï‹ Ù‹ÚËÛË ÙˆÓ Î·ÓfiÓˆÓ ˘ÁÈÂÈÓ‹˜, Î˘Ú›ˆ˜ ÙÔÏ‡ÛÈÌÔ ÙˆÓ ¯ÂÚÈÒÓ, ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ô¯ÂÙÂ‡ÛÂ-ˆÓ, ÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÙËÓ ·ÔÊ˘Á‹ ÌË ·ÛÙÂ-ÚÈˆÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜, ÌË Â·ÚÎÒ˜ „ËÌ¤ÓˆÓ ÎÚÂ¿-

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ÙˆÓ, Ô˘ÏÂÚÈÎÒÓ Î·È ·ÙÂÏÒ˜ ‚Ú·ÛÌ¤ÓˆÓ (Î¿Ùˆ ÙˆÓ6 ÏÂÙÒÓ) ·˘ÁÒÓ Î·È ÙËÓ Â·ÚÎ‹ Î·Ù¿„˘ÍË ÙˆÓÙÚÔÊÒÓ. ∏ ¤ÚÂ˘Ó· ·Ó·Ù‡ÛÛÂÙ·È ÚÔ˜ ÙËÓ Î·ÙÂ‡-ı˘ÓÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Ô˘ ÚÔÊ˘Ï¿ÛÛÔ˘Ó ·fi ÙËÏÔ›ÌˆÍË ÌÂ ÂÓÙÂÚÔ·ıÔÁfiÓ· ÌÈÎÚfi‚È·.

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6. ª·ÙÛ·ÓÈÒÙË˜ ¡, ∫·Ú¿ıÈÔ˜ £. ™ÙÔ: ¶·È‰È·ÙÚÈÎ‹. ∆fiÌÔ˜∞’. ∞ı‹Ó·: π·ÙÚÈÎ¤˜ ÂÎ‰fiÛÂÈ˜ §›ÙÛ·˜; 1995. ÛÂÏ. 234.

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20. Brown K, Peerson J, Fontaine O. Use of non-human milksin the dietary management of young children with acutediarrhea: a meta-analysis of clinical trials. Pediatrics1994;93:17-27.

21. Richards L, Claeson M, Pierce N. Management of acutediarrhea in children: lessons learned. Pediatr Infect Dis J1993;12:5-9.

22. ∫·‚·ÏÈÒÙË˜ π, ™·˚Ó›‰Ô˘ ∞, ∫ˆÓÛÙ·ÓÙÔ‡Ï· £, ∆˙ÈÓÈ¤ÚË˜ ¢,∫·ÓÛÔ˘˙›‰Ô˘ ∞, ∆Û·ÁÎ·ÚÔÔ‡ÏÔ˘ ∏. ™ÈÁÎ¤ÏÏˆÛË ÙË˜·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ÛÙË µ. ∂ÏÏ¿‰·: ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ÎÏÈÓÈÎ¿Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÙË˜ ÂÚÈfi‰Ô˘ 1971-1994.¶·È‰È·ÙÚÈÎ‹ 1997;60:372-383.

23. ™ˆÙËÚÔÔ‡ÏÔ˘ º, ÃÚ˘Û¿ÎË ∞, ∑·¯·ÚÈ¿‰Ô˘ §, ∫·Ú‡‰· ∞,∆ÛÈÏ¿ÎÔ˘ ™, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ¶. ∞ÔÌfiÓˆÛË Û·ÏÌÔ-ÓÂÏÏÒÓ ·fi Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ ·È‰ÈÒÓ ÌÂ ‰È¿ÚÚÔÈ·Î·Ù¿ ÙËÓ ÙÚÈÂÙ›· 1993-1995. ∞ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ [¶Â-Ú›ÏË„Ë]. 34Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1996 31ª·˝Ô˘ - 2 πÔ˘Ó›Ô˘; ƒfi‰Ô˜; 1996:µ∞101.

24. Vanderhoof J, Young R. Use of probiotics in childhoodgastrointestinal disorders. J Pediatr Gastroenterol Nutr1997;27:323-332.

25. Meyers A. Fluid and electrolyte therapy for children. CurrOpin Pediatr 1994;6:303-309.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™È·Ê¿Î·˜, ¶‡ÚÁÔ˘ 1, ∏ÏÈÔ‡ÔÏË 16345E-mail: [email protected]

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 13

14

�¶ÂÚ›ÏË„Ë: H Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË Â›Ó·È Û˘¯ÓfiÚfi‚ÏËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓË, ·Ó Î·È ÂÓÔ¯ÔÔÈ-Ô‡ÓÙ·È ÁÂÓÂÙÈÎ¿ Î·ıÔÚÈÛÌ¤ÓÂ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌË-¯·ÓÈÛÌÔ‡ ·Ê‡ÓÈÛË˜ Î·ıÒ˜ Î·È ÌÂÈˆÌ¤ÓË ¤ÎÎÚÈÛË·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÙË Ó‡¯Ù·. ¶·ÚfiÏÔ Ô˘·ÚÔ˘ÛÈ¿˙ÂÈ ·˘ÍËÌ¤ÓÔ Ú˘ıÌfi ÂÙ‹ÛÈ·˜ ·˘ÙfiÌ·ÙË˜˘Ô¯ÒÚËÛË˜, ÂÈ‰Ú¿ ·ÚÓËÙÈÎ¿ ÛÙËÓ ·˘ÙÔÂÎÙ›ÌËÛËÙÔ˘ ·È‰ÈÔ‡, ·ÔÙÂÏÒÓÙ·˜ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ÁÈ· „˘¯ÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ÚÔ‚Ï‹Ì·Ù· ÎÔÈÓˆÓÈ-Î‹˜ ÚÔÛ·ÚÌÔÁ‹˜. ∂ÔÌ¤Óˆ˜, Ë ÛÙ¿ÛË ·Ó·ÌÔÓ‹˜Î·È ·Ú·ÎÔÏÔ‡ıËÛË˜ ‰ÂÓ Â›Ó·È ‰ÈÎ·ÈÔÏÔÁËÌ¤ÓË,·ÏÏ¿ ·ÓÙ›ıÂÙ· ··ÈÙÂ›Ù·È ‰Ú·ÛÙÈÎ‹ ·Ú¤Ì‚·ÛË,ÂÊfiÛÔÓ ‚¤‚·È· ÙÔ ÂÈı˘ÌÂ› ÙÔ ·È‰› Î·È ÔÈ ÁÔÓÂ›˜,Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ··Ú·›ÙËÙË. √ÈÏ¤ÔÓ ·Ô‰ÂÎÙ¤˜ ıÂÚ·Â›Â˜ Â›Ó·È Ë Û˘ÛÎÂ˘‹ ·Ê‡-ÓÈÛË˜ Î·È Ë ‰ÂÛÌÔÚÂÛÛ›ÓË, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó··ÔÙÂÏÔ‡Ó ÙËÓ È‰·ÓÈÎ‹ Ï‡ÛË. ∏ ·Ô˘Û›· ÎÔÈÓ¿·Ô‰ÂÎÙÔ‡ ÙÚfiÔ˘ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ÂÓÔ‡ÚËÛË˜, ÂÈ‚¿ÏÏÂÈ ÙËÓ Â·Ó·ÙÔÔı¤ÙËÛË ÙÔ˘È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ ÛÙÔ Úfi‚ÏËÌ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, Û˘ÛÎÂ˘‹·Ê‡ÓÈÛË˜, ‰ÂÛÌÔÚÂÛÛ›ÓË, DD∞VP.

�Abstract: Nocturnal enuresis is a commonproblem in children. The etiology remains unclearand is probably genetically determined, involvingpoor arousal from sleep and insufficient antidiuretichormone secretion at night. Enuresis can causepoor self-esteem and is a risk factor for psychiatricdisorders and social adjustment problems, despitethe high annual spontaneous cure rate. Therefore,a "wait and see" attitude is not justifiable, but on thecontrary immediate treatment is indicated with aclose co-operation of child, family and physician.The most acceptable treatment is the use ofenuresis alarm and desmopressin although theyare not the ideal solution to the problem. Theexperts’ opinions vary widely, indicating a need fora consensus regarding the management ofnocturnal enuresis.

Key words: nocturnal enuresis, enuresis alarm,vasopressin, DDAVP.


H Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·∞. ∏Ï›·˜

Nocturnal enuresis in childrenA. Elias

∂ÈÛ·ÁˆÁ‹∏ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ·ÔÙÂÏÂ› Û˘¯ÓfiÙ·ÙÔ

·È‰È·ÙÚÈÎfi Úfi‚ÏËÌ·, ·ÊÔ‡ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ15-20% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 5 ÂÙÒÓ. ∞·ÓÙ¿Ù·ÈÛ˘¯ÓfiÙÂÚ· ÛÙ· ·ÁfiÚÈ· ÛÂ Û¯¤ÛË ÌÂ Ù· ÎÔÚ›ÙÛÈ·Î·È Ë ·Ó·ÏÔÁ›· Â›Ó·È 2:1 (1). £ÂˆÚÂ›Ù·È Î·ÏÔ‹ıË˜‰È·Ù·Ú·¯‹ ÁÈ·Ù› ·ÊÂÓfi˜ ÌÂÓ ‰ÂÓ ÚÔÎ·ÏÂ› ‚Ï¿‚ËÛÙË ÛˆÌ·ÙÈÎ‹ ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ·ÊÂÙ¤ÚÔ˘ ·-ÚÔ˘ÛÈ¿˙ÂÈ ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÂÓÙ˘ˆÛÈ·-

Î‹ Ù¿ÛË ·˘ÙfiÌ·ÙË˜ ˘Ô¯ÒÚËÛË˜. Œ¯ÂÈ ˘ÔÏÔÁÈ-ÛıÂ› fiÙÈ Ô ÂÙ‹ÛÈÔ˜ Ú˘ıÌfi˜ ·˘ÙfiÌ·ÙË˜ ˘Ô¯ÒÚË-Û‹˜ ÙË˜ Â›Ó·È 15%, ÂÓÒ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 15 ÂÙÒÓ ËÛ˘¯ÓfiÙËÙ¿ ÙË˜ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÏÈ˜ ÛÙÔ 1% (2). °È·ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ô È·ÙÚÈÎfi˜ ÎfiÛÌÔ˜ Î·Ù¿ ÙÔ ·ÚÂÏ-ıfiÓ, ‰È·Ù‹ÚËÛÂ ··ı‹ ÛÙ¿ÛË ·¤Ó·ÓÙÈ ÛÙÔ Úfi-‚ÏËÌ·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÁÈ· ¿Ú· ÔÏÏ¿ ¯ÚfiÓÈ· ËÂÓÔ‡ÚËÛË Ó· ·ÔÙÂÏÂ› ‚·Ú‡ ÊÔÚÙ›Ô ÁÈ· ÙÔ ·È‰›Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ·ÏÏ¿ fi¯È ÁÈ· ÙÔ ÁÈ·ÙÚfi. ŸÌˆ˜,

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ª·Î¿ÚÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô §Â˘ÎˆÛ›·˜

Pediatric Clinic, Makario Hospital of Nicosia, Cyprus

A¡∞™∫√¶∏™H REVIEW ARTICLE

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 14

15


ÙÔ 1985, ÌÈ· ÂÚÂ˘ÓËÙÈÎ‹ ÂÚÁ·Û›· ÚÔÂÚ¯fiÌÂÓË ·fiÙË ¢·Ó›·, ‹ÏıÂ Ó· Ù·Ú¿ÍÂÈ Î˘ÚÈÔÏÂÎÙÈÎ¿ Ù· ÏÈÌÓ¿˙Ô-ÓÙ· ‡‰·Ù·. ™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù·Â›Â‰· ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÛÙ· ¿ÙÔÌ·ÌÂ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ‰ÂÓ ·˘Í¿ÓÔÓÙ·È Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÙ· ÌË ÂÓÔ˘-ÚËÙÈÎ¿ ·È‰È¿, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚfiÎÏËÛË Ó˘¯ÙÂ-ÚÈÓ‹˜ ÔÏ˘Ô˘Ú›·˜ (3). ŒÎÙÔÙÂ, ÙÔ ÎÏÈÓÈÎfi Î·È ÂÚÂ˘-ÓËÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ·Ó·˙ˆ˘ÚÒıËÎÂ ÌÂ ·ÔÙ¤ÏÂÛÌ·Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÂÎ·ÙÔÓÙ¿‰Â˜ ÌÂÏ¤ÙÂ˜, ÚÔÛ‰›‰Ô-ÓÙ·˜ ÛÙÔ ı¤Ì· ÙËÓ Ú·ÁÌ·ÙÈÎ‹ ÙÔ˘ ‰È¿ÛÙ·ÛË. ∂È-Ï¤ÔÓ, ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ÙËÓ ·ÚÓË-ÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ ÂÓÔ‡ÚËÛË˜ ÛÙËÓ „˘¯ÈÎ‹ ˘ÁÂ›·ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË ‰È·Ù·Ú·¯‹ ÙˆÓ Û¯¤ÛÂÒÓ ÙÔ˘ ÌÂÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ™˘ÓÂ-Ò˜, Ë ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË ıÂˆÚÂ›Ù·È ÂÈ‚Â-‚ÏËÌ¤ÓË, È‰È·›ÙÂÚ· ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, Ô˘ ÁÂ-Ì¿Ù· ÂÓÔ¯¤˜ ¯¿ÓÔ˘Ó ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛË ÙÔ˘˜, ÌÂ ·Ú-ÓËÙÈÎ‹ Â›‰Ú·ÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙË˜ ÚÔÛˆÈÎfiÙË-Ù¿˜ ÙÔ˘˜ (4).

OÚÈÛÌÔ›ø˜ ÌÔÓÔÛ˘ÌÙˆÌ·ÙÈÎ‹ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË,

ÔÚ›˙ÂÙ·È Ë ·ÎÔ‡ÛÈ· Ô‡ÚËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘‡ÓÔ˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ÊÔÚ¤˜ ÙÔÓ Ì‹Ó·, ÌÂÙ¿ ÙËÓ ËÏÈ-Î›· ÙˆÓ 5 ÂÙÒÓ, ¯ˆÚ›˜ Û˘ÁÁÂÓ‹ ‹ Â›ÎÙËÙË ‰È·Ù·Ú·-¯‹ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ¢È·ÎÚ›ÓÂ-Ù·È ÛÂ ÚˆÙÔ·ı‹ Î·È ‰Â˘ÙÂÚÔ·ı‹. ∏ ÚˆÙÔ·-ı‹˜ ··ÓÙ¿Ù·È ÛÙÔ 75-80% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ Î·È ÙÔ ·È‰› Ô˘‰¤ÔÙÂ ·¤ÎÙËÛÂ ÙÔÓ ¤ÏÂÁ-¯Ô ÙË˜ Î‡ÛÙÂÒ˜ ÙÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘(1). ∞ÓÙ›ıÂÙ·, ÛÙË ‰Â˘ÙÂÚÔ·ı‹, ÚÔËÁÂ›Ù·È ÂÚ›Ô-‰Ô˜ 6 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌËÓÒÓ, ÛÙËÓ ÔÔ›· ÙÔ ·È‰› ÛÙ·-Ì¿ÙËÛÂ Ó· ‚Ú¤¯ÂÙ·È. ∞ÒÏÂÈ· Ô‡ÚˆÓ Î·È Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ› ÛÙÔ15-20% ÙˆÓ ·È‰ÈÒÓ ÌÂ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË. ∏ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ·ÔÎÙ¿ ÙÔÓ ¤ÏÂÁ¯ÔÙË˜ Ô‡ÚËÛË˜, ÚÒÙ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜Î·È ÛÙË Û˘Ó¤¯ÂÈ· Î·È ÙË Ó‡¯Ù·. ∂ÈÙ˘¯‹˜ ·ÓÙ·fi-ÎÚÈÛË ÛÙË ıÂÚ·Â›· ÔÚ›˙ÂÙ·È Ë ‰È·Ù‹ÚËÛË ÛÙÂÁÓÔ‡ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· 14 Û˘ÓÂ¯fiÌÂÓÂ˜ Ó‡¯ÙÂ˜ ÛÂ ‰È¿ÛÙË-Ì· 16 Â‚‰ÔÌ¿‰ˆÓ ıÂÚ·Â›·˜. ÀÔÙÚÔ‹ ÔÚ›˙ÂÙ·È ËÂÌÊ¿ÓÈÛË 2 ÂÂÈÛÔ‰›ˆÓ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÛÂ‰È¿ÛÙËÌ· 2 Â‚‰ÔÌ¿‰ˆÓ. ™˘ÓÂ¯È˙fiÌÂÓË ÂÈÙ˘¯›· ÔÚ›-˙ÂÙ·È Ë ·Ô˘Û›· ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ·fi 6 Ì‹ÓÂ˜, ÂÓÒÏ‹ÚË˜ ÂÈÙ˘¯›·, Ë ·Ô˘Û›· ˘ÔÙÚÔ‹˜ ÌÂÙ¿ 2¯ÚfiÓÈ· ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÈÙ˘¯‹ ·ÓÙ·fiÎÚÈÛË (5).

øÚ›Ì·ÓÛË ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ÂÏ¤Á¯Ô˘ ÙË˜ Ô‡ÚËÛË˜∏ ˆÚ›Ì·ÓÛË ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¤¯ÂÈ ˆ˜

·ÔÙ¤ÏÂÛÌ· ÙÔ ÛÙ·‰È·Îfi ¤ÏÂÁ¯Ô ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ÙË˜ Î‡ÛÙÂˆ˜ Î·È ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÌÂ ÙËÓ ·ÎfiÏÔ˘ıË ÛÂÈÚ¿:

- ŒÏÂÁ¯Ô˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘‡ÓÔ˘.

- ŒÏÂÁ¯Ô˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·Ù¿ ÙËÓ ÂÁÚ‹ÁÔÚÛË.- ŒÏÂÁ¯Ô˜ ÙË˜ Î‡ÛÙÂˆ˜ Î·Ù¿ ÙËÓ ÂÁÚ‹ÁÔÚÛË.- ŒÏÂÁ¯Ô˜ ÙË˜ Î‡ÛÙÂˆ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘

‡ÓÔ˘. ™ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜, Ë Ô‡ÚËÛË Á›ÓÂÙ·È

·ÎÔ‡ÛÈ· (·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿), ¯ˆÚ›˜ ÙÔ ‚Ú¤ÊÔ˜ Ó·¤¯ÂÈ ÙËÓ ·›ÛıËÛË Ï‹ÚˆÛË˜ ‹ Î¤ÓˆÛË˜ ÙË˜ Î‡-ÛÙÂˆ˜. ∏ Ï‹ÚˆÛË ÙË˜ Î‡ÛÙÂˆ˜ ÚÔÎ·ÏÂ› ·ÓÙ·-Ó·ÎÏ·ÛÙÈÎ‹ Û‡Û·ÛË ÙÔ˘ ÂÍˆÛÙ‹Ú· Ì˘fi˜ ÌÂ Ù·˘-Ùfi¯ÚÔÓË ¯·Ï¿ÚˆÛË ÙÔ˘ ÛÊÈÁÎÙ‹Ú·, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· ÙËÓ ÂÏÂ‡ıÂÚË Î¤ÓˆÛ‹ ÙË˜. ™ÙËÓ ËÏÈÎ›· ·˘Ù‹,Ë ¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡ÛÙÂˆ˜ Â›Ó·È ÌÈÎÚ‹ (ÂÚ›Ô˘60 ml), ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘Ú‹ÛÂˆÓ ÌÂÁ¿ÏÔ˜(ÂÚ›Ô˘ 20 ËÌÂÚËÛ›ˆ˜) (6). ™Ù· ÂfiÌÂÓ· 2 ¯Úfi-ÓÈ·, Ë Ô‡ÚËÛË ÂÍ·ÎÔÏÔ˘ıÂ› Ó· Á›ÓÂÙ·È ·ÓÙ·Ó·ÎÏ·-ÛÙÈÎ¿, Ô ËÌÂÚ‹ÛÈÔ˜ fiÌˆ˜ ·ÚÈıÌfi˜ ÙˆÓ Ô˘Ú‹ÛÂˆÓÂ›Ó·È ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÔ˜. ∆Ô‡ÙÔ ÔÊÂ›ÏÂÙ·È Î˘-Ú›ˆ˜, ÛÙË ‚·ıÌÈ·›· ·‡ÍËÛË ÙË˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ÙË˜ Î‡ÛÙÂˆ˜ ·ÏÏ¿ Î·È ÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ Úfi-ÛıÈÔ˘ Î·È ÙˆÓ Ï·Á›ˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÏÔ‚ÒÓ, ËÔÔ›· ÚÔÎ·ÏÂ› ÌÂÚÈÎ‹ ÎÂÓÙÚÈÎ‹ ·Ó·ÛÙÔÏ‹ ÛÙÔ·ÓÙ·Ó·ÎÏ·ÛÙÈÎfi ÙË˜ Ô‡ÚËÛË˜ (7). ŒÙÛÈ, ÛÙÔ ‰Â‡-ÙÂÚÔ ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜, ÙÔ ·È‰› ·Ú¯›˙ÂÈ Ó· ·ÓÙÈÏ·Ì-‚¿ÓÂÙ·È ÙËÓ Ï‹ÚˆÛË ÙË˜ Î‡ÛÙÂˆ˜ Î·È ·Ó·ÁÓˆÚ›-˙ÂÈ ÙËÓ ÂÈÎÂ›ÌÂÓË Ô‡ÚËÛË, ¯ˆÚ›˜ fiÌˆ˜, Ó· ÙËÓÂÏ¤Á¯ÂÈ. ∫·Ù¿ ÙÔ ÙÚ›ÙÔ ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜, ÙÔ ·È‰›ÂÏ¤Á¯ÂÈ Î·Ï‡ÙÂÚ· ÙËÓ Î‡ÛÙË ÙÔ˘ Î·È ·Ú·Ì¤ÓÂÈÛÙÂÁÓfi Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜. ™ÙËÓ ËÏÈÎ›·ÙˆÓ 4-6 ÂÙÒÓ, Ë ¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡ÛÙÂˆ˜ ·˘Í¿-ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Î·È ·Ú¿ÏÏËÏ· ·ÔÎÙ¿Ù·ÈÂÎÔ‡ÛÈÔ˜ ¤ÏÂÁ¯Ô˜ Â› ÙÔ˘ ¤Íˆ ÛÊÈÁÎÙ‹Ú·, Ô ÔÔ›-Ô˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ÂÎÔ‡ÛÈ· ¤Ó·ÚÍË Î·ÈÙÔÓ ÙÂÚÌ·ÙÈÛÌfi ÙË˜ Ô‡ÚËÛË˜. ◊‰Ë ÛÙËÓ ËÏÈÎ›·ÙˆÓ 4-5 ÂÙÒÓ, Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Â›Ó·È ÈÎ·Ó¿Ó· ‰È·ÙËÚÔ‡Ó ÈÎ·ÓÔÔÈËÙÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ Ô‡ÚˆÓÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (1).

AÈÙÈÔÏÔÁ›· ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Ê·›ÓÂ-

Ù·È Ó· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ Î·È fi¯È Ï‹Úˆ˜ ‰È-Â˘ÎÚÈÓÈÛÌ¤ÓË. ™ÙËÓ ·ıÔÁ¤ÓÂÈ¿ ÙË˜ ÂÌÏ¤ÎÔÓÙ·ÈÔÈÎ›ÏÔÈ ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ë Î·ı˘ÛÙ¤ÚËÛË ÙË˜ˆÚ›Ì·ÓÛË˜ ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ÂÏ¤Á¯Ô˘ ÙË˜ Î‡ÛÙÂ-ˆ˜, ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, ‰È·Ù·Ú·¯¤˜ ÛÙÔ Ú˘ıÌfi¤ÎÎÚÈÛË˜ ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·È ‰È·Ù·-Ú·¯¤˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‡ÓÔ˘-·Ê‡ÓÈÛË˜.

K·ı˘ÛÙ¤ÚËÛË ˆÚ›Ì·ÓÛË˜ ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ÂÏ¤Á-¯Ô˘ ÙË˜ Î‡ÛÙÂˆ˜

∏ ÏÂÈÙÔ˘ÚÁÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ˆÚ›Ì·ÓÛË˜ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÌÂÈÒÓÂÈ ÙËÓ

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 15

ÈÎ·ÓfiÙËÙ· ·Ó·ÛÙÔÏ‹˜ ÙˆÓ Û˘Û¿ÛÂˆÓ ÙË˜ Î‡ÛÙÂ-ˆ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜. ∏ ¿Ô„Ë ·˘Ù‹ÂÓÈÛ¯‡ÂÙ·È ¤ÓÙÔÓ· ·fi ÙÔÓ ·˘ÍËÌ¤ÓÔ Ú˘ıÌfi ·˘Ùfi-Ì·ÙË˜ ˘Ô¯ÒÚËÛË˜ ÙË˜ ÂÓÔ‡ÚËÛË˜ ÌÂ ÙËÓ ¿ÚÔ-‰Ô ÙË˜ ËÏÈÎ›·˜. ∂Í¿ÏÏÔ˘, Ë Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛËÂ›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·È‰È¿ ÌÂ ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤-ÚËÛË ‹ Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ „˘¯ÔÎÈÓËÙÈÎ‹ ÙÔ˘˜·Ó¿Ù˘ÍË (1,8).

°ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ∞fi ÔÏÏ¿ ¯ÚfiÓÈ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Ó˘¯ÙÂÚÈÓ‹

ÂÓÔ‡ÚËÛË ·Ú·ÙËÚÂ›Ù·È ÌÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙË-Ù· ÛÂ Ì¤ÏË ÙË˜ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ŒÙÛÈ, Â¿Ó ÎÈ ÔÈ‰‡Ô ÁÔÓÂ›˜ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ÂÓÔ‡ÚËÛË˜, ÔÈ Èı·Ófi-ÙËÙÂ˜ ÁÈ· ÙÔ ·È‰› Â›Ó·È ÂÚ›Ô˘ 77%, ÂÓÒ fiÙ·Ó Ô¤Ó·˜ ÁÔÓ¤·˜ ¤¯ÂÈ ÈÛÙÔÚÈÎfi, ÔÈ Èı·ÓfiÙËÙÂ˜ ÁÈ· ÙÔ·È‰› Â›Ó·È 44% (1). ™Â Û¯ÂÙÈÎ‹ ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ fiÙÈÙ· ·È‰È¿ ÌÂ ÂÓÔ˘ÚËÙÈÎÔ‡˜ ·Ù¤ÚÂ˜, ¤¯Ô˘Ó 7,1 ÊÔ-Ú¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚË-ÛË˜, ÂÓÒ Ë Èı·ÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÂÓÔ˘ÚËÙÈ-ÎÒÓ ÌËÙ¤ÚˆÓ Â›Ó·È 5,2 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË (9). √ÙÚfiÔ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÌÂÏÂÙ‹ıËÎÂ ÛÂ 392 ÔÈ-ÎÔÁ¤ÓÂÈÂ˜ ÌÂ ÈÛÙÔÚÈÎfi Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Î·È‚Ú¤ıËÎÂ Ó· Â›Ó·È ÂÈÎÚ·ÙÒÓ ÛÙÔ 43%, ˘ÔÏÂÈfiÌÂ-ÓÔ˜ ÛÙÔ 9%, ÂÓÒ ÛÙÔ 48% Â›Ó·È ÛÔÚ·‰ÈÎfi˜ (10).∂ÔÌ¤Óˆ˜, Ô ÁÔÓfiÙ˘Ô˜ Î·È Ô ÙÚfiÔ˜ Ô˘ ÂÎÊÚ¿-˙ÂÙ·È, Ê·›ÓÂÙ·È Ó· Â›Ó·È Û‡ÓıÂÙÔ˜ Î·È ÌÂ ÌÂÁ¿ÏËÂÙÂÚÔÁ¤ÓÂÈ·. ∞˘Ùfi ÂÓÈÛ¯‡ÂÙ·È ÎÈ ·fi ÙÔ ÁÂÁÔÓfi˜ÙË˜ ÂÓÙfiÈÛË˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ÂÓÔ‡ÚËÛË˜ ÛÂ ‰È¿-ÊÔÚ· ¯ÚˆÌÔÛÒÌ·Ù· (¯ÚˆÌÔÛÒÌ·Ù· 8, 12, 13 Î·È22) (11,12).

∞ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹ ÔÚÌfiÓË∏ ·ıÔÏÔÁÈÎ‹ ¤ÎÎÚÈÛË ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚ-

ÌfiÓË˜ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËıÂ› ˆ˜ ¤Ó· ·fi Ù· Î˘ÚÈfiÙÂÚ··›ÙÈ· ÙË˜ ·ıÔÁ¤ÓÂÛË˜ ÙË˜ ÚˆÙÔ·ıÔ‡˜ Ó˘¯ÙÂÚÈ-Ó‹˜ ÂÓÔ‡ÚËÛË˜. ™Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· Ê·›ÓÂÙ·ÈfiÙÈ ˘¿Ú¯ÂÈ ·ÚÌÔÓÈÎ‹ ÂÈÎÔÈÓˆÓ›· ÌÂÙ·Í‡ ÓÂÊÚÒÓÎ·È Ô˘ÚÔ‰fi¯Ô˘ Î‡ÛÙÂˆ˜, ÛÂ ‚·ıÌfi Ô˘ Ë Ï‹Úˆ-ÛË ÙË˜ Î‡ÛÙÂˆ˜, ÌÂÈÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ Ô‡-ÚˆÓ ·fi Ù· ÓÂÊÚ¿. ∞˘Ùfi ÈÛÙÂ‡ÂÙ·È fiÙÈ ÂÈÙ˘Á¯¿-ÓÂÙ·È ÌÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ ÚˆÙÂ˝ÓË˜ ˘‰·ÙÔÔÚ›ÓË˜2, Ë ÔÔ›· ‚Ú›ÛÎÂÙ·È ˘fi ÙËÓ Â›‰Ú·ÛË ÙË˜ ·ÓÙÈ‰È-Ô˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜. ∏ ˘‰·ÙÔÔÚ›ÓË 2, ‰ËÌÈÔ˘ÚÁÂ›Î·Ó¿ÏÈ· ‡‰·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘Ù-Ù¿ÚˆÓ ÙˆÓ ·ıÚÔÈÛÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ, ÂÈÙÚ¤Ô-ÓÙ·˜ ÙË ‰È·Ê˘Á‹ ‡‰·ÙÔ˜ ÚÔ˜ ÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘·›Ì·ÙÔ˜, ‰È·‰Ú·Ì·Ù›˙ÔÓÙ·˜ ¤ÙÛÈ, ÛËÌ·ÓÙÈÎfi ÚfiÏÔÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ÂÓÔ‡ÚËÛË˜ (13). ¶ÔÏ-Ï¤˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ fiÙÈ Ë¤ÎÎÚÈÛË ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ Â›Ó·È ·˘ÍË-Ì¤ÓË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿¿ÙÔÌ·, ÂÓÒ ÛÂ ÂÓÔ˘ÚËÙÈÎ¿ Ë ¤ÎÎÚÈÛ‹ ÙË˜ Â›Ó·È ÛË-

Ì·ÓÙÈÎ¿ ÌÂÈˆÌ¤ÓË ÌÂÙ·Í‡ ÙˆÓ ˆÚÒÓ 23:00 Î·È04:00 (3,14,15). ∏ ÌÂÈˆÌ¤ÓË ·˘Ù‹ ¤ÎÎÚÈÛË Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜, Ô‰ËÁÂ› ÛÂ ·˘ÍËÌ¤ÓÔ fiÁÎÔ Ô‡-ÚˆÓ, Ô ÔÔ›Ô˜ Â¿Ó ˘ÂÚ‚Â› ÙË ¯ˆÚËÙÈÎfiÙËÙ· ÙË˜Î‡ÛÙÂˆ˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡-ÚËÛË. ªÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂÏ¤ÙË ·¤‰ÂÈÍÂ fiÙÈ Ë ¤Î-ÎÚÈÛË ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ Ó‡¯Ù·˜, Â›Ó·È ÌÂÈˆÌ¤ÓË ÌfiÓÔ ÛÙ· ÂÓÔ˘ÚË-ÙÈÎ¿ ¿ÙÔÌ· ÌÂ Ó˘¯ÙÂÚÈÓ‹ ÔÏ˘Ô˘Ú›·, ÂÓÒ ‰ÂÓ ·-Ú·ÙËÚÂ›Ù·È ÌÂÈˆÌ¤ÓË ¤ÎÎÚÈÛË ÛÙ· ÂÓÔ˘ÚËÙÈÎ¿ ¿ÙÔ-Ì· ÌÂ ·Ú·ÁˆÁ‹ ÌÈÎÚÒÓ fiÁÎˆÓ Ô‡ÚˆÓ Î·Ù¿ ÙË Ó‡-¯Ù· Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÔÛÌˆÙÈÎ‹ ›ÂÛË ÛÙ· ÚˆÈÓ¿Ô‡Ú· (16). ∂›Ó·È, ÂÔÌ¤Óˆ˜, Ê·ÓÂÚfi fiÙÈ Ë Ó˘¯ÙÂÚÈ-Ó‹ ÂÓÔ‡ÚËÛË ‰ÂÓ ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ·ÔÎÏÂÈÛÙÈ-Î¿ ÛÙË ÌÂÈˆÌ¤ÓË ¤ÎÎÚÈÛË ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚ-ÌfiÓË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜. ∞˘Ùfi, ¿ÏÏˆ-ÛÙÂ, ÂÈ‚Â‚·ÈÒÓÂÙ·È ÎÈ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌfiÓÔ ÙÔ10-70% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ ÌÂ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡-ÚËÛË ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙË ıÂÚ·Â›· ÌÂ ·ÓÙÈ‰ÈÔ˘ÚË-ÙÈÎ‹ ÔÚÌfiÓË.

¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘ – ·Ê‡ÓÈÛË˜√È ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÈ˜ ·Ï·ÈfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜

·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË Â›Ó·È ‰˘Ó·-ÙfiÓ Ó· Û˘Ì‚Â› ÛÂ fiÏ· Ù· ÛÙ¿‰È· ÙÔ˘ ‡ÓÔ˘. ∞˘ÙfiÔ‰‹ÁËÛÂ ÛÙËÓ ¿Ô„Ë fiÙÈ ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘Î·È ÙË˜ ·Ê‡ÓÈÛË˜ ‰ÂÓ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfiÚfiÏÔ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÂÓÔ‡ÚËÛË˜. ∏ ¿Ô„Ë ·˘-Ù‹ ÎÏÔÓ›ÛıËÎÂ ÛÙË Û˘Ó¤¯ÂÈ·, ·fi ÌÂÏ¤ÙË ÙˆÓ ÂÓÔ˘-ÚËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÌÂ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ Î·È Î˘ÛÙÂÔÌ·ÓÔÌÂ-ÙÚ›·˜. ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜·˘Ù‹˜, ÙÔ 60% Î·È Ï¤ÔÓ ÙˆÓ ÂÓÔ˘ÚËÙÈÎÒÓ ÂÂÈÛÔ-‰›ˆÓ Û˘Ì‚·›ÓÔ˘Ó ÛÂ ÛÙ¿‰ÈÔ ÌÂÚÈÎ‹˜ ·Ê‡ÓÈÛË˜,¯ˆÚ›˜, fiÌˆ˜, ÙÔ ·È‰› Ó· ¤¯ÂÈ Ï‹Úˆ˜ ·Ê˘ÓÈÛıÂ›(17). ™‹ÌÂÚ·, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 4 ÂÁÎÂ-Ê·ÏÈÎ¿ ‰›ÎÙ˘· ÓÂ˘ÚÒÓˆÓ Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙËÓ·Ê‡ÓÈÛË. ∞fi ·˘Ù¿, ÙÔ ‰›ÎÙ˘Ô Ô˘ ÚÔ¤Ú¯ÂÙ·È·fi ÙÔÓ ˘Ú‹Ó· locus coeruleus (LC) Ô ÔÔ›Ô˜Â‰Ú¿˙ÂÙ·È ÛÙÔÓ ˘ıÌ¤Ó· ÙË˜ 4Ë˜ ÎÔÈÏ›·˜ ÙÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘ Î·È ÂÓÂÚÁÔÔÈÂ›Ù·È ·fi ÙË ÓÔÚ·‰ÚÂÓ·Ï›ÓË,ÈÛÙÂ‡ÂÙ·È fiÙÈ ·ÔÙÂÏÂ› ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Û‡ÛÙË-Ì· ÛÙË ‰È¤ÁÂÚÛË ÙË˜ ·Ê‡ÓÈÛË˜ (18,19). ∏ Ï‹Úˆ-ÛË ÙË˜ Ô˘ÚÔ‰fi¯Ô˘ Î‡ÛÙÂˆ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘‡ÓÔ˘, ·ÔÙÂÏÂ› ÙÔ ÂÚ¤ıÈÛÌ· ÁÈ· ÙËÓ ÂÓÂÚÁÔÔ›Ë-ÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰ÈÎÙ‡ˆÓ ÙË˜ ·Ê‡ÓÈÛË˜, Î˘-Ú›ˆ˜ ÙÔ˘ LC ‰ÈÎÙ‡Ô˘ Ô˘ ÌÂÙ·ÙÚ¤ÂÈ ÙÔÓ ‚·ı‡‡ÓÔ ÛÂ ÂÏ·ÊÚ‡. ∆Ô Î¤ÓÙÚÔ ÙÔ˘ ‡ÓÔ˘ ÙÔ ÔÔ›ÔÂ‰Ú¿˙ÂÙ·È Èı·ÓÒ˜ ÛÙÔ ı¿Ï·ÌÔ ‹ ÛÙÔÓ ˘Ôı¿Ï·-ÌÔ, ‰Ú· ·ÓÙ·ÁˆÓÈÛÙÈÎ¿ Î·Ù·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ·Ê‡-ÓÈÛË. °È· ÙËÓ ·Ê‡ÓÈÛË ÙÔ˘ ·È‰ÈÔ‡, ¤Ó· ·ÓÒÙÂÚÔÎ¤ÓÙÚÔ ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÊÏÔÈÔ‡, ı· ‰ÒÛÂÈ ‹ fi¯ÈÙËÓ ÙÂÏÈÎ‹ ÂÓÙÔÏ‹ (19). ¢È·Ù·Ú·¯‹ ÙˆÓ ÌË¯·ÓÈÛÌÒÓ


16

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 16


17

·˘ÙÒÓ, ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ÌË ·Ê‡ÓÈÛË Î·ÈÙËÓ ÂÓÔ‡ÚËÛË. ªÂ ‚¿ÛË ÙË ‰È·Ù·Ú·¯‹ ÛÙÔ˘˜ ÌË¯·-ÓÈÛÌÔ‡˜ ·Ê‡ÓÈÛË˜, ÙÔ 1989 ÚÔÙ¿ıËÎÂ ¤Ó· Ó¤ÔÛ‡ÛÙËÌ· ‰È·¯ˆÚÈÛÌÔ‡ ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ÛÂ 3 Ù‡Ô˘˜. ∆ÔÓ Ù‡Ô π, ÙÔÓ ππ· Î·È ÙÔÓ ππ‚ (17). ∏Î·Ù¿Ù·ÍË Á›ÓÂÙ·È ÌÂ ÙËÓ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ÙÔ˘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ Î·È ÙË˜ Î˘ÛÙÂÔ-Ì·ÓÔÌÂÙÚ›·˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜, Ú¿ÁÌ·Ô˘ Î·ıÈÛÙ¿ ‰‡ÛÎÔÏË ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ ÛÙËÓ Î·-ıËÌÂÚÈÓ‹ Ú¿ÍË (20). ∏ ÂÓÔ‡ÚËÛË Ù‡Ô˘ π Â›Ó·È ÔÈÔ Û˘¯Ófi˜ Ù‡Ô˜, ·ÊÔÚ¿ ÙÔ 60% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡·ÚÈıÌÔ‡ ÙˆÓ ÂÓÔ˘ÚËÙÈÎÒÓ Î·È ÚÔÎ·ÏÂ›Ù·È ·fi‹ÈÂ˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ê‡ÓÈÛË˜. ŸÙ·Ó Ë Ô˘ÚÔ‰fi-¯Ô˜ Î‡ÛÙË ÁÂÌ›ÛÂÈ, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‚·ı¤ˆ˜‡ÓÔ˘ (ÛÙ¿‰ÈÔ ‡ÓÔ˘ 3 ‹ 4), Ë ·Ê‡ÓÈÛË ·Ú¯›˙ÂÈ Ó·Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ÌÂ-Ù·ÙÚ¤ÔÓÙ·˜ ÙÔ ‚·ı‡ ‡ÓÔ ÛÂ ÂÏ·ÊÚ‡ (ÛÙ¿‰ÈÔ 1 ‹2). ¶ÂÚ›Ô˘ 5-15 ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ·ÏÏ·Á‹ ·˘Ù‹, ËÂÓÔ‡ÚËÛË Â¤Ú¯ÂÙ·È ¯ˆÚ›˜ ÙËÓ ·Ê‡ÓÈÛË ÙÔ˘ ·Ùfi-ÌÔ˘. √ Ù‡Ô˜ ππ· ·ÊÔÚ¿ ÛÙÔ 10% ÙÔ˘ Û˘ÓfiÏÔ˘ÙˆÓ ·È‰ÈÒÓ ÌÂ ÂÓÔ‡ÚËÛË Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ·‰˘Ó·-Ì›· ‰È¤ÁÂÚÛË˜ ÙÔ˘ Î¤ÓÙÚÔ˘ ÙË˜ ·Ê‡ÓÈÛË˜ ·Ú¿ÙËÓ Ï‹ÚˆÛË ÙË˜ Ô˘ÚÔ‰fi¯Ô˘ Î‡ÛÙÂˆ˜. √ Ù‡Ô˜ππ‚ ·ÊÔÚ¿ ÛÙÔ 30% ÙÔ˘ Û˘ÓfiÏÔ˘ Î·È ÔÊÂ›ÏÂÙ·È ÛÂÏ·Óı¿ÓÔ˘Û· ÓÂ˘ÚÔÁÂÓ‹ Î‡ÛÙË Ë ÔÔ›· Â›Ó·È Ê·ÓÂ-Ú‹ ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. √È Û˘¯Ó¤˜Û˘Û¿ÛÂÈ˜ ÙË˜ Ô˘ÚÔ‰fi¯Ô˘ Î‡ÛÙÂˆ˜ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ Ó‡¯Ù·˜, ·ÚfiÏÔ Ô˘ Ë Î˘ÛÙÂÔÌ·ÓÔÌÂÙÚ›·Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÙËÓ ËÌ¤Ú·, Ô‰ËÁÔ‡Ó ÛÂ ·‰˘Ó·-Ì›· ‰È¤ÁÂÚÛË˜ ÙÔ˘ Î¤ÓÙÚÔ˘ ÙË˜ ·Ê‡ÓÈÛË˜ fiÙ·Ó ËÎ‡ÛÙË Â›Ó·È ÁÂÌ¿ÙË, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÓÔ‡ÚËÛË.

∂›Ó·È, ÂÔÌ¤Óˆ˜, Ê·ÓÂÚfi fiÙÈ ˘¿Ú¯ÂÈ ÈÛ¯˘Ú‹Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Î·È ÙÔ˘ÌË¯·ÓÈÛÌÔ‡ ‡ÓÔ˘–·Ê‡ÓÈÛË˜.

∂ÈÙÒÛÂÈ˜ ÛÙÔÓ „˘¯ÈÛÌfi ∏ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙË˜,

‰ÂÓ ÚÔÎ·ÏÂ›Ù·È, fiˆ˜ ·Ï·ÈfiÙÂÚ· ÈÛÙÂ˘fiÙ·Ó,·fi „˘¯ÔÏÔÁÈÎÔ‡˜, ÎÔÈÓˆÓÈÎÔ‡˜ ‹ ÂÚÈ‚·ÏÏÔÓÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ∞ÓÙ›ıÂÙ·, ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-ÛÂÈ ‰Â˘ÙÂÚÔ·ıÒ˜ „˘¯ÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÛÙÔ·È‰›, ÌÂ È‰È·›ÙÂÚ· ·ÚÓËÙÈÎ‹ Â›‰Ú·ÛË ÛÙËÓ ·˘ÙÔ-ÂÎÙ›ÌËÛ‹ ÙÔ˘ (21,22).

™Â ÌÂÏ¤ÙË, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ·˘ÙÔÂÎÙ›ÌËÛË ÙˆÓ·È‰ÈÒÓ ÌÂ ÂÓÔ‡ÚËÛË ‰ÂÓ Â›Ó·È ¯·ÌËÏfiÙÂÚË ÌfiÓÔ·fi ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ·ÏÏ¿ Â›Ó·È ÛËÌ·-ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ·È‰È¿ ÌÂ ¯ÚfiÓÈ·ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ÚÂ˘Ì·ÙÔÂÈ‰‹˜ ·ÚıÚ›ÙÈ‰· Î·È ËÎ˘ÛÙÈÎ‹ ›ÓˆÛË (4). ∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ·Ô‰Â›-ÍÂÈ fiÙÈ Ë ¯·Ì¤ÓË ·˘ÙÔÂÎÙ›ÌËÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ Ó˘-¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË Â·Ó·ÔÎÙ¿Ù·È ÌÂÙ¿ ·fi ÂÈÙ˘-¯‹ ıÂÚ·Â›· ÙÔ˘ ÚÔ‚Ï‹Ì·Ùfi˜ ÙÔ˘˜ (23-25). ™‡Ì-ÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ,

Ú¤ÂÈ Ó· ‰ÔıÂ› È‰È·›ÙÂÚË ‚·Ú‡ÙËÙ· ÛÙË ıÂÚ·Â›·ÙˆÓ ·È‰ÈÒÓ ÌÂ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË. °È·Ù›, fiˆ˜Â›Ó·È ÁÓˆÛÙfi, Ë ¯·Ì¤ÓË ·˘ÙÔÂÎÙ›ÌËÛË ÛÙË ÓÂ·Ú‹ËÏÈÎ›· ·ÔÙÂÏÂ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· „˘¯ÈÎ¤˜‰È·Ù·Ú·¯¤˜ Î·È ÚÔ‚Ï‹Ì·Ù· ÎÔÈÓˆÓÈÎ‹˜ ÚÔÛ·Ú-ÌÔÁ‹˜.

¢ÈÂÚÂ‡ÓËÛË∏ ·Ú¯ÈÎ‹ ÂÎÙ›ÌËÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ Ó˘¯ÙÂÚÈÓ‹

ÂÓÔ‡ÚËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi,ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË Î·È ÙË ÁÂÓÈÎ‹, Î·ıÒ˜ Î·È Î·Ï-ÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ. ∆Ô ÈÛÙÔÚÈÎfi Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔ-Ú›˙ÂÈ ÙË Û˘¯ÓfiÙËÙ·, ÙË ‰È¿ÚÎÂÈ· Î·È ÙÔ Â›‰Ô˜ ÙË˜ÂÓÔ‡ÚËÛË˜. ™˘Ó˘¿Ú¯ÔÓÙ· Û˘ÌÙÒÌ·Ù· Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜ fiˆ˜ ·ÎÚ¿ÙÂÈ· Ô‡ÚˆÓ, ÔÍÂ›·¤ÂÈÍË, ‰È·ÎÂÎÔÌÌ¤ÓË Ô‡ÚËÛË Î·È ·‰‡Ó·ÙË ÚÔ‹Ô‡ÚˆÓ, Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÔÓÙ·È. ∂›ÛË˜, ‰ÈÂÚÂ˘-ÓÒÓÙ·È Èı·Ó¿ ÚÔËÁÔ‡ÌÂÓ· ÂÂÈÛfi‰È· Ô˘ÚÔÏÔ›-ÌˆÍË˜, Û˘Ó˘¿Ú¯Ô˘Û· ‰˘ÛÎÔÈÏÈfiÙËÙ· ‹ ÂÁÎfiÚÈ-ÛË Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi. ∏ Ê˘ÛÈÎ‹ÂÍ¤Ù·ÛË ÂÚÈÏ·Ì‚¿ÓÂÈ „ËÏ¿ÊËÛË ÙË˜ ÎÔÈÏÈ·Î‹˜¯ÒÚ·˜, ÂÈÛÎfiËÛË Î·È „ËÏ¿ÊËÛË ÙË˜ ÔÛÊ˘˚Î‹˜¯ÒÚ·˜ ÁÈ· ¤ÏÂÁ¯Ô ·ÓˆÌ·ÏÈÒÓ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ÛÙ‹ÏË˜ Î·È ÂÈÛÎfiËÛË ÙˆÓ ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚ-Á¿ÓˆÓ. ∏ ÂÍ¤Ù·ÛË ÔÏÔÎÏËÚÒÓÂÙ·È ÌÂ ÙËÓ ·‰Ú‹ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË Ë ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÂÈ¤ÏÂÁ¯Ô ÂÚÈÊÂÚÈÎÒÓ Î·È ÂÓ Ùˆ ‚¿ıÂÈ ÙÂÓÔÓÙ›ˆÓ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ Î·È ¤ÏÂÁ¯Ô ÂÚÈÓÂ˚Î‹˜ ·ÈÛıËÙÈ-ÎfiÙËÙ·˜ Î·È ÙÔ˘ ÙfiÓÔ˘ ÙÔ˘ ÛÊÈÁÎÙ‹Ú· ÙÔ˘ ÔÚıÔ‡.°ÂÓÈÎ‹ Î·È Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·ÈÛÂ fiÏ· Ù· ·È‰È¿. ™ÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ Ú¤ÂÈ Ó·ÂÏ¤Á¯ÂÙ·È ÌÂ ÚÔÛÔ¯‹ ÙÔ ÂÈ‰ÈÎfi ‚¿ÚÔ˜ Î·ıÒ˜ Î·ÈË Ù˘¯fiÓ ·ÚÔ˘Û›· Û·Î¯¿ÚÔ˘ ‹ ÏÂ˘ÎÒÌ·ÙÔ˜. ªÂ‚¿ÛË ÙËÓ ·Ú¯ÈÎ‹ ·˘Ù‹ ÂÎÙ›ÌËÛË, ÔÈ ·ÛıÂÓÂ›˜ ‰È·-ÎÚ›ÓÔÓÙ·È ÛÂ 2 Î·ÙËÁÔÚ›Â˜: 1) ÛÂ ·˘ÙÔ‡˜ ÌÂ ÌËÂÈÏÂÁÌ¤ÓË ÂÓÔ‡ÚËÛË Î·È 2) ÛÂ ·˘ÙÔ‡˜ ÌÂ ÂÈ-ÏÂÁÌ¤ÓË ÂÓÔ‡ÚËÛË (∂ÈÎfiÓ· 1) (26). ∆· ·È‰È¿ ÌÂ·ÚÓËÙÈÎ‹ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË Î·È ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿Â˘Ú‹Ì·Ù· ·fi ÙË ÁÂÓÈÎ‹ Î·È ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· Ô‡-ÚˆÓ, ¤¯Ô˘Ó ÌË ÂÈÏÂÁÌ¤ÓË ÂÓÔ‡ÚËÛË. AÔÙÂÏÔ‡ÓÙË Û˘ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›· Î·È ‰ÂÓ ¯Ú‹˙Ô˘Ó Â-Ú·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË˜.

∞ÓÙ›ıÂÙ·, Ù· ·È‰È¿ ÌÂ ÈÛÙÔÚÈÎfi ÛËÌ·ÓÙÈÎÒÓ ‰˘-ÛÏÂÈÙÔ˘ÚÁÈÒÓ ÙË˜ Ô‡ÚËÛË˜ (ÔÏ‡ Û˘¯Ó‹ Ô‡ÚËÛË,‰È·ÎÂÎÔÌÌ¤ÓË Ô‡ÚËÛË, ·ÎÚ¿ÙÂÈ· Ô‡ÚˆÓ, ·ÛıÂÓ‹ÚÔ‹ Ô‡ÚˆÓ), ÂÁÎfiÚÈÛË, ıÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ‹ ÈÛÙÔÚÈÎfi Ô˘ÚÔÏÔÈÌÒÍÂˆÓ, ·ıÔÏÔÁÈÎ‹ ÁÂÓÈÎ‹ Ô‡-ÚˆÓ ‹ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·fi ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË, ¤¯Ô˘Ó ÂÈÏÂÁÌ¤ÓË ÂÓÔ‡ÚËÛË. ∆· ·È‰È¿·˘Ù¿, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙË ÌÂÈÔ„ËÊ›·, ¯Ú‹˙Ô˘ÓÂÚ·ÈÙ¤Úˆ ÂÏ¤Á¯Ô˘ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÓÂ-ÊÚÒÓ–Î‡ÛÙÂˆ˜, ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ Ô‡ÚËÛË, ·Ï‹·ÎÙÈÓÔÁÚ·Ê›· ¡√∫ Î·È ·ÓÈÔ‡Û· Î˘ÛÙÂÔÁÚ·Ê›·. √

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 17

¤ÏÂÁ¯Ô˜ ·˘Ùfi˜ ·ÔÛÎÔÂ› ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ·Ô-ÊÚ·ÎÙÈÎ‹˜ Ô˘ÚÔ¿ıÂÈ·˜, ˘‰ÚÔÓ¤ÊÚˆÛË˜, ‰ÈÛ¯È-‰Ô‡˜ Ú¿¯Ë˜, Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜,¿¯˘ÓÛË˜ ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜ Î‡ÛÙÂˆ˜ ‹ ˘ÔÏÂ›Ì-Ì·ÙÔ˜ Ô‡ÚˆÓ ÛÙËÓ Î‡ÛÙË. ∆· ÙÂÏÂ˘Ù·›· Â˘Ú‹Ì·Ù·,Èı·ÓÒ˜ Ó· ··ÈÙ‹ÛÔ˘Ó Ô˘ÚÔ‰˘Ó·ÌÈÎfi ¤ÏÂÁ¯Ô ÙË˜Î‡ÛÙÂˆ˜. ™Ù· ·È‰È¿ ÌÂ ÂÈÏÂÁÌ¤ÓË Ó˘¯ÙÂÚÈÓ‹ÂÓÔ‡ÚËÛË, ÌÈ· ·‰Ú‹ ÂÎÙ›ÌËÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ ÌÂ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ Ô˘Ú›·˜ Î·È ÙË˜ ÎÚÂ-·ÙÈÓ›ÓË˜ ÔÚÔ‡, ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË. TÂÏÂ˘Ù·›·, Û˘-ÓÈÛÙ¿Ù·È Ë ·ÎÚÈ‚‹˜ Î·Ù·Ì¤ÙÚËÛË ·fi ÙÔ˘˜ ÁÔÓÂ›˜,ÙÔ˘ fiÁÎÔ˘ ÙˆÓ Ô‡ÚˆÓ Î¿ıÂ Ô‡ÚËÛË˜, ÙfiÛÔ ÙËÓ ËÌ¤-Ú· fiÛÔ Î·È ÙË Ó‡¯Ù· ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 48 ÒÚÂ˜. ªÂÙÔÓ ÙÚfiÔ ·˘Ùfi, ÌÔÚÂ› Ó· ÂÎÙÈÌËıÂ› Ë ÏÂÈÙÔ˘ÚÁÈÎ‹¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡ÛÙÂˆ˜ Î·È Ë ·ÚÔ˘Û›· ‹ fi¯ÈÓ˘¯ÙÂÚÈÓ‹˜ ÔÏ˘Ô˘Ú›·˜, ‰Â‰ÔÌ¤Ó· Ô˘ Î·ıÔ‰Ë-ÁÔ‡Ó ÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË Î·È ıÂÚ·Â›·(7,27). ∏ ÏÂÈÙÔ˘ÚÁÈÎ‹ ¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡ÛÙÂˆ˜˘ÔÏÔÁ›˙ÂÙ·È Î·Ù¿ ÚÔÛ¤ÁÁÈÛË ÌÂ ÙÔÓ Ù‡Ô: xˆÚË-

ÙÈÎfiÙËÙ· Î‡ÛÙÂˆ˜ (ml) = [ËÏÈÎ›· (¤ÙË) +2] x 32ml(± 64ml SD) (2,28). ¡˘¯ÙÂÚÈÓ‹ ÔÏ˘Ô˘Ú›· ÔÚ›˙ÂÙ·È,fiÙ·Ó Ô ÏfiÁÔ˜ fiÁÎÔ˘ Ô‡ÚˆÓ ËÌ¤Ú·˜ ÚÔ˜ fiÁÎÔ Ô‡-ÚˆÓ Ó‡¯Ù·˜ Â›Ó·È <1 (29,30).

£ÂÚ·Â›·∏ Î·ÏÔ‹ıË˜ Ê‡ÛË ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜

Î·È Ô ˘„ËÏfi˜ ÂÙ‹ÛÈÔ˜ Ú˘ıÌfi˜ ÙË˜ ·˘ÙfiÌ·ÙË˜ ˘Ô-¯ÒÚËÛË˜, ÂÈ‚¿ÏÏÔ˘Ó Î¿ıÂ Â›‰Ô˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·-Ú¤Ì‚·ÛË˜ Ó· ÛÙÂÚÂ›Ù·È ÔÔÈÔ˘‰‹ÔÙÂ ÎÈÓ‰‡ÓÔ˘ ‹ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ. ∂ÈÏ¤ÔÓ,Î¿ıÂ ıÂÚ·Â˘ÙÈÎfi Ì¤ÙÚÔ ıÂˆÚÂ›Ù·È ÈÎ·ÓÔÔÈËÙÈÎfi,ÌfiÓÔ Â¿Ó ÙÔ ·ÔÙ¤ÏÂÛÌ¿ ÙÔ˘ Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·-Ï‡ÙÂÚÔ ·fi ÙÔÓ ·Ó·ÌÂÓfiÌÂÓÔ Ú˘ıÌfi ·˘ÙfiÌ·ÙË˜˘Ô¯ÒÚËÛË˜ ÙË˜ ÂÓÔ‡ÚËÛË˜. ∏ ıÂÚ·Â›· Ú¤ÂÈÓ· ÚÔÙÂ›ÓÂÙ·È ÌfiÓÔ ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ ·È‰›‹/Î·È ÔÈ ÁÔÓÂ›˜ ÙÔ˘ ÂÈı˘ÌÔ‡Ó Ó· ··ÏÏ·ÁÔ‡Ó ·fiÙÔ ÂÓÔ¯ÏËÙÈÎfi ·˘Ùfi Úfi‚ÏËÌ· Î·È ÙÔ‡ÙÔ ÁÈ·Ù› Ë Û˘-ÓÂÚÁ·Û›· ÙÔ˘˜ ·ÔÙÂÏÂ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÙË˜


18

¢π∂ƒ∂À¡∏™∏ ∆∏™ ¡ÀÃ∆∂ƒπ¡∏™ ∂¡√Àƒ∏™∏™

ªË ÂÈÏÂÁÌ¤ÓË ∂ÈÏÂÁÌ¤ÓË

�¶ÚˆÙÔ·ı‹˜ �¢È·Ù·Ú·¯¤˜ ÛÙËÓ Ô‡ÚËÛË

�∞ÚÓËÙÈÎ‹ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË �£ÂÙÈÎfi ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi

�∞ÚÓËÙÈÎfi ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi (.¯. Ô˘ÚÔÏÔ›ÌˆÍË, ÂÁÎfiÚÈÛË)

�°ÂÓÈÎ‹ Î·È Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ

�¡Â˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË

∞ÚÓËÙÈÎ‹ £ÂÙÈÎ‹

¢ÂÓ ··ÈÙÂ›Ù·È �U/S ÓÂÊÚÒÓ-Î‡ÛÙË˜ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ (ÚÈÓ Î·È ÌÂÙ¿ Ô‡ÚËÛË)

�∞Ï‹ ¡√∫�∞ÓÈÔ‡Û· Î˘ÛÙÂÔÁÚ·Ê›·�√˘Ú›· Î·È ÎÚÂ·ÙÈÓ›ÓË ÔÚÔ‡�√˘ÚÔ‰˘Ó·ÌÈÎfi˜ ¤ÏÂÁ¯Ô˜;�¡Â˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË;

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÙË˜ ‰ÈÂÚÂ‡ÓËÛË˜ ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜.

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 18


19

ÂÈÙ˘¯Ô‡˜ Î·Ù¿ÏËÍË˜ ÔÔÈÔ˘‰‹ÔÙÂ ıÂÚ·Â˘ÙÈÎÔ‡Ì¤ÙÚÔ˘ (31). ∆Ô ıÂÚ·Â˘ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Î·Ù·ÁÚ¿-ÊÂÙ·È ·fi ÙÔ ·È‰› ÛÂ ËÌÂÚÔÏfiÁÈÔ fiÔ˘ ÛËÌÂÈÒÓÔ-ÓÙ·È ÔÈ ÛÙÂÁÓ¤˜ Ó‡¯ÙÂ˜ Î·È ·ÍÈÔÏÔÁÂ›Ù·È ·fi ÙÔÓ ıÂ-Ú¿ÔÓÙ· È·ÙÚfi ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·, Ôfi-ÙÂ Î·È ÙÔ ·È‰› ÂÈ‚Ú·‚Â‡ÂÙ·È Î·È ÂÓı·ÚÚ‡ÓÂÙ·È ÁÈ·ÙËÓ ÚÔÛ¿ıÂÈ· Î·È ÙÔ ·Ó¿ÏÔÁÔ ·ÔÙ¤ÏÂÛÌ·. ∆·ÔÏÏ¿ ıÂÚ·Â˘ÙÈÎ¿ Ì¤ÙÚ·, Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ Î·È ÌË,Ô˘ ÚÔÙÂ›ÓÔÓÙ·È, Ì·ÚÙ˘ÚÔ‡Ó fiÙÈ Î·Ó¤Ó· Ì¤ÙÚÔıÂÚ·Â›·˜ ‰ÂÓ ıÂˆÚÂ›Ù·È È‰·ÓÈÎfi ÁÈ· ÙË Ó˘¯ÙÂÚÈÓ‹ÂÓÔ‡ÚËÛË. ∞˘Ùfi ÂÈ‚Â‚·ÈÒÓÂÙ·È ·fi ÙÔ ‰È·ÊÔÚÂÙÈ-Îfi ÙÚfiÔ ıÂÚ·Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ Ô˘ ÂÊ·Ú-Ìfi˙ÂÙ·È ÛÂ ‰È¿ÊÔÚÂ˜ ¯ÒÚÂ˜. ™ÙÈ˜ ∏.¶.∞. ÁÈ· ·Ú¿-‰ÂÈÁÌ·, Ë Û˘¯ÓfiÙÂÚ· ÚÔÙÂÈÓfiÌÂÓË ıÂÚ·Â›· Â›Ó·ÈË ‰ÂÛÌÔÚÂÛÛ›ÓË, ÂÓÒ Ë Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ ¯ÚË-ÛÈÌÔÔÈÂ›Ù·È ÛÂ ÔÛÔÛÙfi <5% (26,32). ™ÙË °·ÏÏ›·,ÙÔ 20% ÙˆÓ È·ÙÚÒÓ ‰ÂÓ ÚÔÙÂ›ÓÂÈ Î·Ì›· ıÂÚ·Â›·.∏ ÏÂÈÔ„ËÊ›· ÚÔÙÂ›ÓÂÈ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ·Ï-Ï·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. ∞fi ·˘ÙÔ‡˜ Ô˘ ÚÔÙÂ›-ÓÔ˘Ó ıÂÚ·Â›·, ÙÔ 48% ¯ÔÚËÁÔ‡Ó ÔÍ˘‚Ô˘ÙÈÓ›ÓË, ÙÔ22% ‰ÂÛÌÔÚÂÛÛ›ÓË, ÙÔ 12% ÈÌÈÚ·Ì›ÓË Î·È ÙÔ 5%Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ (33). ∞ÓÙ›ıÂÙ·, ÛÙÔ ∏ÓˆÌ¤ÓÔµ·Û›ÏÂÈÔ, Ë Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ Î·È Ë ‰ÂÛÌÔÚÂÛ-Û›ÓË Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ· ÚÔÙÂÈÓfiÌÂÓÂ˜ ıÂÚ·Â›Â˜(34). °ÂÓÈÎ¿ ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ Ì¤ÙÚ· fiˆ˜ ÂÚÈÔ-ÚÈÛÌfi˜ ÙË˜ Ï‹„Ë˜ ˘ÁÚÒÓ ÙÔ ‚Ú¿‰˘, ·Ê‡ÓÈÛË ÙÔ˘·È‰ÈÔ‡ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜ ÁÈ· Ó· Ô˘Ú‹-ÛÂÈ ‹ ·ÎfiÌË ¿ÛÎËÛË „˘¯ÔÏÔÁÈÎ‹˜ ‚›·˜ ÛÙÔ ·È‰›,‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ˘Ô¯Ò-ÚËÛË ÙË˜ ÂÓÔ‡ÚËÛË˜ (1,35). ¶¿ÓÙˆ˜, Ô ÂÚÈÔÚÈ-ÛÌfi˜ ÙË˜ Ï‹„Ë˜ ˘ÁÚÒÓ ÙË Ó‡¯Ù· Î·È Ë Ô‡ÚËÛË·Ì¤Ûˆ˜ ÚÈÓ ÙËÓ Î·Ù¿ÎÏÈÛË, ÚÔÙÂ›ÓÔÓÙ·È ·fi ·Ú-ÎÂÙÔ‡˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙÔ ı¤Ì· Û·Ó Û˘ÌÏË-

ÚˆÌ·ÙÈÎfi ıÂÚ·Â˘ÙÈÎfi Ì¤ÙÚÔ ÔÔÈ·Û‰‹ÔÙÂ ¿Ï-ÏË˜ ·Ú¤Ì‚·ÛË˜, È‰È·›ÙÂÚ· fiÙ·Ó ÛÙÔ ·È‰› ¯ÔÚË-ÁÂ›Ù·È ‰ÂÛÌÔÚÂÛÛ›ÓË (32). √‰ËÁ›Â˜ ÁÈ· ·˘ÍËÌ¤-ÓË ÚfiÛÏË„Ë ˘ÁÚÒÓ Î·È ·Ó·‚ÔÏ‹ ÙˆÓ Ô˘Ú‹ÛÂˆÓÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜ ÌÂ ÛÎÔfi ÙËÓ ÚÔÔ-‰Â˘ÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙˆÓ Ô‡ÚˆÓ ÎÈ ÂÈÌ‹-Î˘ÓÛË ÙˆÓ ÌÂÛÔ‰È·ÛÙËÌ¿ÙˆÓ ÌÂÙ·Í‡ ÙˆÓ Ô˘Ú‹ÛÂ-ˆÓ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó Î·ÌÈ¿ ıÂÚ·Â˘ÙÈÎ‹ ·Í›·,·ÚfiÏÔ Ô˘ Ë ÏÂÈÙÔ˘ÚÁÈÎ‹ ¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡-ÛÙÂˆ˜ ·˘Í¿ÓÂÙ·È (36).

∏ ÂÈÏÔÁ‹ ÙÔ˘ Â›‰Ô˘˜ ÙË˜ ıÂÚ·Â›·˜ Ô˘ ı··ÎÔÏÔ˘ıËıÂ› Á›ÓÂÙ·È ·ÊÔ‡ ÏËÊıÂ› ÛÔ‚·Ú¿ ˘’fi„ÈÓ Ë ÂÈı˘Ì›· ÙˆÓ ÁÔÓ¤ˆÓ ‹/Î·È ÙÔ˘ ·È‰ÈÔ‡,ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÍËÁÔ‡ÓÙ·È ÏÂÙÔÌÂÚÒ˜ Ù· ÏÂÔ-ÓÂÎÙ‹Ì·Ù· Î·È Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Î¿ıÂ ÌÂıfi‰Ô˘.√È Î˘ÚÈfiÙÂÚÂ˜ Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙ¤˜ ıÂÚ·Â›Â˜ ÙË˜Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Â›Ó·È Ë Û˘ÛÎÂ˘‹ ·Ê‡ÓÈ-ÛË˜, Ë ‰ÂÛÌÔÚÂÛÛ›ÓË Î·È Ë ÈÌÈÚ·Ì›ÓË. ™‡ÁÎÚÈÛËÙˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ·˘ÙÒÓ Ì¤ÙÚˆÓ ·Ú·Ù›ıÂÙ·ÈÛÙÔÓ ¶›Ó·Î· 1.

™˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜∏ Ì¤ıÔ‰Ô˜ ·˘Ù‹ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÚÒÙË

ÊÔÚ¿ ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÙÔ1938 ·fi ÙÔ˘˜ Mowrer Î·È Mowrer. ∏ Û˘ÛÎÂ˘‹ ÛÙËÛ˘Ó¤¯ÂÈ· ÙÂÏÂÈÔÔÈ‹ıËÎÂ Î·È Û‹ÌÂÚ· ‰È·Ù›ıÂÙ·ÈÛÙËÓ ·ÁÔÚ¿ ÛÂ ÌÈÎÚfi Ú·ÎÙÈÎfi Ì¤ÁÂıÔ˜ Î·È Û¯ÂÙÈ-Î¿ ¯·ÌËÏfi ÎfiÛÙÔ˜. ∞ÔÙÂÏÂ›Ù·È ·fi ¤Ó· ÌÈÎÚfi ·È-ÛıËÙ‹Ú· Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔ ÂÛÒÚÔ˘¯Ô ÎÈ ·fi¤Ó· ÌÈÎÚfi Í˘ÓËÙ‹ÚÈ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔ ¿ÓˆÌ¤ÚÔ˜ ÙË˜ ˘Ù˙¿Ì·˜ ÙÔ˘ ·È‰ÈÔ‡. ŸÙ·Ó Ô ·ÈÛıË-Ù‹Ú·˜ ‚Ú·¯Â›, ÙfiÙÂ ÙÔ Í˘ÓËÙ‹ÚÈ ÎÙ˘¿ÂÈ ÌÂ ·Ô-Ù¤ÏÂÛÌ· ÙËÓ ·Ê‡ÓÈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË ‰È·ÎÔ‹

¶›Ó·Î·˜ 1. ™‡ÁÎÚÈÛË ÙˆÓ Î˘ÚÈÔÙ¤ÚˆÓ ıÂÚ·Â˘ÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜.

™˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ ¢ÂÛÌÔÚÂÛÛ›ÓË πÌÈÚ·Ì›ÓË

∞Ú¯ÈÎ‹ 65-100% 10-70% 10-40%·ÓÙ·fiÎÚÈÛË

∂ÈÙ˘¯‹˜ 13,3 ÊÔÚ¤˜ 4,5 ÊÔÚ¤˜ 4,2 ÊÔÚ¤˜·ÓÙ·fiÎÚÈÛË ÛÂ ÌÂÁ·Ï‡ÙÂÚË ÌÂÁ·Ï‡ÙÂÚË ÌÂÁ·Ï‡ÙÂÚËÛ¯¤ÛË ÌÂplacebo

¶ÔÛÔÛÙfi 20-30% 30-45% 40-60%˘ÔÙÚÔ‹˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜

¢È¿ÚÎÂÈ· 3-6 Ì‹ÓÂ˜ 3-6 Ì‹ÓÂ˜ 3-6 Ì‹ÓÂ˜ıÂÚ·Â›·˜

∞ÓÂÈı‡ÌËÙÂ˜ ∫·Ì›· ™¿ÓÈÂ˜ ™¿ÓÈÂ˜ ·ÏÏ¿ ÂÓ¤ÚÁÂÈÂ˜ ‰˘Ó·ÙfiÓ ÛÔ‚·Ú¤˜

∂ÌÊ¿ÓÈÛË ªÂÙ¿ ·fi 2-3 Â‚‰ÔÌ¿‰Â˜ ÕÌÂÛË ÕÌÂÛË·ÔÙÂÏ¤ÛÌ·ÙÔ˜

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 19

ÙË˜ Ô‡ÚËÛË˜ (26). √ ÌË¯·ÓÈÛÌfi˜ ÌÂ ÙÔÓ ÔÔ›Ô ËÛ˘ÛÎÂ˘‹ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Ô‡ÚËÛË ‰ÂÓ Â›Ó·È ·ÎfiÌËÎ·È Û‹ÌÂÚ· Ï‹Úˆ˜ Î·Ù·ÓÔËÙfi˜. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈÔÊÂ›ÏÂÈ ÙÔÓ ÙÚfiÔ ‰Ú¿ÛË˜ ÙË˜ ÛÙÔ Û˘Ó‰˘·ÛÌfiÙÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙË ÁÂÌ¿ÙËÎ‡ÛÙË, ÌÂ ÙÔ ÂÚ¤ıÈÛÌ· ÙË˜ ·Ê‡ÓÈÛË˜ Ô˘ ·Ú¿-ÁÂÙ·È ·fi ÙË Û˘ÛÎÂ˘‹ fiÙ·Ó ·Ú¯›ÛÂÈ Ë Ô‡ÚËÛË.

∆ÂÏÈÎ¿, ÙÔ ÂÚ¤ıÈÛÌ· ÙË˜ ÁÂÌ¿ÙË˜ Î‡ÛÙÂˆ˜ ÂÈ-Ù˘Á¯¿ÓÂÈ Ó· ·Ê˘Ó›ÛÂÈ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ ÙÔ ·È‰› ÚÔ-ÙÔ‡ Ô˘Ú‹ÛÂÈ ‹ ·Ó·ÛÙ¤ÏÏÂÈ ·˘ÙfiÌ·Ù· ÙËÓ Ô‡ÚËÛË ̄ ˆ-Ú›˜ ÙÔ ·È‰› Ó· ·Ê˘ÓÈÛıÂ› (2). ∏ ÂÈÙ˘¯›· ÙË˜ ÌÂıfi-‰Ô˘ ·˘Ù‹˜ ÛÙËÚ›˙ÂÙ·È ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙË Î·Ï‹Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙˆÓ ÁÔÓ¤ˆÓ. ªÂÚÈÎ¿·È‰È¿ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙÔÓ ‹¯Ô ÙË˜ Û˘ÛÎÂ˘‹˜ÎÈ ÂÔÌ¤Óˆ˜ Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ÂÓ‹ÏÈÎÔ˜ ÔÔÔ›Ô˜, fiÙ·Ó ÎÙ˘‹ÛÂÈ Ë Û˘ÛÎÂ˘‹, Ó· ·Ê˘Ó›ÛÂÈ ÙÔ·È‰›. ŸÙ·Ó ÙÔ ·È‰› Í˘Ó‹ÛÂÈ Ú¤ÂÈ Ó· ¿ÂÈ Ó· Ô˘-Ú‹ÛÂÈ (37). ∏ ÂÈÙ˘¯‹˜ ·ÓÙ·fiÎÚÈÛË ÙË˜ ÌÂıfi‰Ô˘Î˘Ì·›ÓÂÙ·È ·fi 65-100% ÌÂÙ¿ ·fi 4-6 Ì‹ÓÂ˜ ıÂÚ·-Â›·˜ (1), ÌÂ Ì¤ÛÔ fiÚÔ ÛÂ 2 ÌÂÁ¿ÏÂ˜ Û˘ÁÎÂÓÙÚˆÙÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ 82% (1) Î·È 67,7% ·ÓÙ›ÛÙÔÈ¯· (38). ∏ Û˘-ÛÎÂ˘‹ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Â¿Ó Ë ÂÓÔ‡ÚËÛËÛ˘Ì‚·›ÓÂÈ Î¿ıÂ Ó‡¯Ù·. £ÂˆÚÂ›Ù·È ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎ‹ fiÛÔ ÌÈÎÚfiÙÂÚÔ˜ Â›Ó·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÓÔ˘-ÚËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ÂÓÒ ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ‰ÂÓ Û˘-Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ËÏÈÎ›· ‹ ÙÔ Ê‡ÏÔ (37). ∏ ‰È¿ÚÎÂÈ·ÙË˜ ıÂÚ·Â›·˜ ÌÂ ÙË Û˘ÛÎÂ˘‹ Î˘Ì·›ÓÂÙ·È ·fi 3-6Ì‹ÓÂ˜, ÂÓÒ Ë ıÂÚ·Â›· Ú¤ÂÈ Ó· Û˘ÓÂ¯›˙ÂÙ·È ÙÔ˘Ï¿-¯ÈÛÙÔÓ Ì¤¯ÚÈ Ó· ÂÈÙÂ˘¯ıÔ‡Ó 4 Û˘ÓÂ¯fiÌÂÓÂ˜ ÛÙÂÁÓ¤˜Â‚‰ÔÌ¿‰Â˜ (1,26). ∏ Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ ¤¯ÂÈ 13,3ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ Ó· ÚÔÎ·Ï¤ÛÂÈ 14Û˘ÓÂ¯fiÌÂÓÂ˜ ÛÙÂÁÓ¤˜ Ó‡¯ÙÂ˜ ÛÂ Û¯¤ÛË ÌÂ ÌË ıÂÚ·-Â›·, ¤Ó·ÓÙÈ 4,5 ÊÔÚ¤˜ ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜Î·È 4,2 ÊÔÚ¤˜ ÙË˜ ÈÌÈÚ·Ì›ÓË˜ (34). ÀÔÙÚÔ‹ ÌÂÙ¿ÙË ‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ›ÛÙÔ 20-30% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (39) Î·È ·ÓÙÈÌÂÙˆ›˙Â-Ù·È ÌÂ Â·Ó¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È Â› ÌË ÈÎ·ÓÔ-ÔÈËÙÈÎÔ‡ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜, ÚÔÛı‹ÎË ‰Â‡ÙÂÚË˜ ıÂ-Ú·Â›·˜ (Û˘Ó‹ıˆ˜ ‰ÂÛÌÔÚÂÛÛ›ÓË˜).

¶·Ú¿ Ù· Û·Ê‹ ÏÂÔÓÂÎÙ‹Ì·Ù·, Ë ·Ó·ÊÂÚıÂ›Û·Ì¤ıÔ‰Ô˜ ‰ÂÓ Î·Ù¤¯ÂÈ ‰ÈÂıÓÒ˜ ÙËÓ ·Ó¿ÏÔÁË ı¤ÛË ÛÙËıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜, ·ÚfiÏÔ Ô˘ÚÔÙÂ›ÓÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ Ë ıÂÚ·Â›· ÚÒ-ÙË˜ ÂÎÏÔÁ‹˜, ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·fi Î¿ıÂ ¿ÏÏË(2,40-42). ∏ Û˘ÛÎÂ˘‹ ÛÙÂÚÂ›Ù·È Î¿ıÂ ·ÚÂÓ¤ÚÁÂÈ·˜ÁÈ·Ù› ‰ÂÓ Â›Ó·È Ê¿ÚÌ·ÎÔ, ¤¯ÂÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÈ-Ù˘¯›·˜ Î·È Û¯ÂÙÈÎ¿ ¯·ÌËÏfi ÎfiÛÙÔ˜. ∞ÓÙ›ıÂÙ·, ÛÙ·ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙË˜ ·Ó·Ê¤ÚÂÙ·È ÙÔ fi¯È ¿ÌÂÛÔ ·ÔÙ¤-ÏÂÛÌ· ÙÔ ÔÔ›Ô Â›Ó·È ÔÚ·Ùfi ÌÂÙ¿ ·fi ¯Ú‹ÛË 2-3Â‚‰ÔÌ¿‰ˆÓ Î·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ ÌÂÙ¿ÙË ‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜. ∂›ÛË˜, ÌÂÈÔÓ¤ÎÙËÌ··ÔÙÂÏÂ› Ë ÂÓfi¯ÏËÛË Ô˘ ÚÔÎ·ÏÂ› Ë ·fiÙÔÌË ·Ê‡-ÓÈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, È‰È·›ÙÂÚ·

fiÙ·Ó ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ·È‰È¿ ÛÙÔ ›‰ÈÔ ‰ˆÌ¿ÙÈÔ.∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ·Ó·Ù˘¯ıÂ› Û˘ÛÎÂ˘‹ Ë ÔÔ›· ·ÔÙÂ-ÏÂ›Ù·È ·fi ¤Ó·Ó ·Ïfi ˘ÂÚË¯ÔÁÚ¿ÊÔ Î·È ¤Ó·Ó ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊÔ (18). ∏ Û˘ÛÎÂ˘‹ Î·Ù·ÁÚ¿ÊÂÈ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ ÙËÓ Ï‹ÚˆÛË ÙË˜ Ô˘ÚÔ‰fi¯Ô˘ Î‡-ÛÙÂˆ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ÌÂ ÙË ‚Ô‹ıÂÈ·ÂÓfi˜ ·ÈÛıËÙ‹Ú· Ô ÔÔ›Ô˜ ÛÙÂÚÂÒÓÂÙ·È ÛÙËÓ Î·ÙÒÙÂ-ÚË ÎÔÈÏÈ·Î‹ ¯ÒÚ·. ¶·Ú¿ÏÏËÏ· Î·Ù·ÁÚ¿ÊÂÙ·È ËÂÁÎÂÊ·ÏÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∆ËÓ Ï‹ÚˆÛË ÙË˜ Ô˘-ÚÔ‰fi¯Ô˘ Î‡ÛÙÂˆ˜, ·ÎÔÏÔ˘ıÂ› ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ‚·ı¤-ˆ˜ ‡ÓÔ˘ ÛÂ ÂÏ·ÊÚ‡ Î·È Ô Û˘Ó‰˘·ÛÌfi˜ ·˘Ùfi˜ ÂÓÂÚ-ÁÔÔÈÂ› ÙË Û˘ÛÎÂ˘‹, Ë ÔÔ›· ÎÙ˘¿ÂÈ Î·È ·Ê˘Ó›˙ÂÈÙÔÓ ·ÛıÂÓ‹ ÚÈÓ ·˘Ùfi˜ Ô˘Ú‹ÛÂÈ. ∏ Û˘ÛÎÂ˘‹ Â›Ó·È·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙË ıÂÚ·Â›· ÙË˜ ÂÓÔ‡ÚËÛË˜ Ù‡-Ô˘ π Î·È ·Ó·Ì¤ÓÂÙ·È Ó· Î˘ÎÏÔÊÔÚ‹ÛÂÈ ÌÂÏÏÔÓÙÈÎ¿ÛÙÔ ÂÌfiÚÈÔ.

¢ÂÛÌÔÚÂÛÛ›ÓË∏ ‰ÂÛÌÔÚÂÛÛ›ÓË, ¤Ó· Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ ÙË˜

·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜·fi ÔÏÏ¿ ¯ÚfiÓÈ· ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ÂÓÔ‡ÚËÛË˜. Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ ÈÔ ¿Óˆ, Ù· ÂÚÈÛ-ÛfiÙÂÚ· ÂÓÔ˘ÚËÙÈÎ¿ ¿ÙÔÌ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÈˆÌ¤ÓË¤ÎÎÚÈÛË ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ Ó‡¯Ù·˜ ÛÂ Û¯¤ÛË ÌÂ Ù· ÌË ÂÓÔ˘ÚËÙÈÎ¿. ∞˘ÙfiÔ‰ËÁÂ› ÛÂ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ Ô‡ÚˆÓ, Ë ÔÔ›· fiÙ·Ó˘ÂÚ‚Â› ÙË ÏÂÈÙÔ˘ÚÁÈÎ‹ ¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡ÛÙÂˆ˜,ÚÔÎ·ÏÂ› ÂÓÔ‡ÚËÛË. ∏ ¯ÔÚ‹ÁËÛË ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚËÙÈ-Î‹˜ ÔÚÌfiÓË˜ ÌÂÈÒÓÂÈ ÙÔÓ fiÁÎÔ ÙˆÓ ·Ú·ÁÔÌ¤ÓˆÓÔ‡ÚˆÓ ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔÙÚÔ‹ ÙË˜ Ó˘¯ÙÂÚÈ-Ó‹˜ ÂÓÔ‡ÚËÛË˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ıÂÚ·Â›· ÎÚ›-ÓÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ÛÙ· ·È‰È¿ ÌÂ Ó˘¯ÙÂÚÈÓ‹ÔÏ˘Ô˘Ú›· (43,44). ∏ ‰ÂÛÌÔÚÂÛÛ›ÓË ‰È·Ù›ıÂÙ·È ÛÙÔÂÌfiÚÈÔ ˘fi ÌÔÚÊ‹ spray ÁÈ· ÂÓ‰ÔÚÈÓÈÎ‹ ¯Ú‹ÛË Î·ÈÚfiÛÊ·Ù· ˘fi ÌÔÚÊ‹ ¯·ÈÒÓ ÁÈ· ¯ÔÚ‹ÁËÛË ·fi ÙÔÛÙfiÌ·. ∞ÔÚÚÔÊ¿Ù·È Ù·¯¤ˆ˜ ·fi ÙÔ ÚÈÓÈÎfi Î·È Á·-ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ, Ë ‚ÈÔ‰È·ıÂÛÈÌfiÙËÙ¿ ÙË˜, fiÌˆ˜,ÌÂÈÒÓÂÙ·È Î·Ù¿ 90% fiÙ·Ó ·ÔÚÚÔÊ¿Ù·È ·fi ÙÔ ÛÙÔ-Ì¿¯È Î·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ¯ÔÚËÁÂ›Ù·È ÛÂ ÌÂÁ·-Ï‡ÙÂÚË ‰fiÛË. ∂ÌÊ·Ó›˙ÂÈ Ì¤ÁÈÛÙË Û˘ÁÎ¤ÓÙÚˆÛË ÛÙÔÏ¿ÛÌ· ÂÚ›Ô˘ 50-60 ÏÂÙ¿ ÌÂÙ¿ ÙË Ï‹„Ë ÙË˜, Ô¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Â›Ó·È 4-6 ÒÚÂ˜ Î·È Ë ‰È¿ÚÎÂÈ·‰Ú¿ÛË˜ ÙË˜ Â›Ó·È ÂÚ›Ô˘ 10 ÒÚÂ˜ (45). ∏ ·Ú¯ÈÎ‹Û˘ÓÈÛÙÒÌÂÓË ÂÓ‰ÔÚÈÓÈÎ‹ ‰fiÛË Â›Ó·È 10Ìg ÂÚ›Ô˘ 1ÒÚ· ÚÈÓ ÙËÓ Î·Ù¿ÎÏÈÛË, Ë ÔÔ›· ·˘Í¿ÓÂÙ·È ·Ó¿ÏÔ-Á· ÌÂ ÙËÓ ·ÓÙ·fiÎÚÈÛË Î¿ıÂ 3 ËÌ¤ÚÂ˜ Ì¤¯ÚÈ Ù·40Ìg (46) Ô˘ Â›Ó·È Ë Ì¤ÁÈÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÏÏ¿ Î·ÈÈÔ Û˘ÓËıÈÛÌ¤ÓË ‰fiÛË (47).

∆Ô ·ÔÙ¤ÏÂÛÌ· ÙË˜ ¯ÔÚ‹ÁËÛË˜ ÙË˜ ‰ÂÛÌÔÚÂÛ-Û›ÓË˜ Â›Ó·È Ê·ÓÂÚfi ·fi ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜. ∏ ·Ú¯È-Î‹ ·ÓÙ·fiÎÚÈÛË ÛÙÔ Ê¿ÚÌ·ÎÔ Î˘Ì·›ÓÂÙ·È ÛÂ ‰È¿ÊÔ-ÚÂ˜ ÌÂÏ¤ÙÂ˜ ·fi 10-70% (1), ÂÓÒ Ï‹ÚË˜ ÂÈÙ˘¯›·ÛÙË ıÂÚ·Â›· ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 10-30%. √È Moffatt


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2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 20


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Î·È Û˘Ó, ÁÈ· Ó· ÂÎÙÈÌ‹ÛÔ˘Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ·Ó¤Ï˘Û·Ó 18 ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÏ¤-ÙÂ˜ ÌÂ Û˘ÓÔÏÈÎ¿ 580 ·È‰È¿ ÌÂ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛËÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ ‰ÂÛÌÔÚÂÛÛ›ÓË (41). ¶·Ú¿ÙË ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ÂÓÔ˘ÚËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓÌfiÓÔ ÙÔ 25% ·ÚÔ˘Û›·ÛÂ Ï‹ÚË ·ÓÙ·fiÎÚÈÛË, ÂÓÒÛÂ ¿ÏÏË ·ÚfiÌÔÈ· ÌÂÏ¤ÙË ÙÔ ÔÛÔÛÙfi Ï‹ÚÔ˘˜ÂÈÙ˘¯›·˜ ‹Ù·Ó 21% (40). ™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË·fi ÙË ™Ô˘Ë‰ÈÎ‹ √Ì¿‰· ∂ÓÔ‡ÚËÛË˜, ÂÎÙÈÌ‹ıËÎÂË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ Ì·ÎÚfi¯ÚÔÓË˜ ıÂÚ·Â›-·˜ (1 ¯ÚfiÓÔ) ÌÂ ‰ÂÛÌÔÚÂÛÛ›ÓË. ™‡ÌÊˆÓ· ÌÂ ÙÔ·ÔÙ¤ÏÂÛÌ·, ÙÔ 61% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·Û·Ó·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›· (>50% ÌÂ›ˆÛË ÙˆÓ‚ÚÂÁÌ¤ÓˆÓ ÂÂÈÛÔ‰›ˆÓ), ÂÓÒ ÌfiÓÔ ÙÔ 22% ·ÚÔ˘-Û›·ÛÂ Ï‹ÚË ÂÈÙ˘¯›· (47). ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿·ÓÙ·ÔÎÚ›ıËÎ·Ó ÌÂÙ¿ ·fi ıÂÚ·Â›· 3-6 ÌËÓÒÓ ÎÈ¤ÙÛÈ ÚÔÙÂ›ÓÂÙ·È Û·Ó ‰È¿ÚÎÂÈ· ıÂÚ·Â›·˜ ÔÈ 6 Ì‹-ÓÂ˜. ∆Ô Ê¿ÚÌ·ÎÔ ·Ó·Ê¤ÚÂÙ·È ·ÛÊ·Ï¤˜ Î·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfi Î·È ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ 6-7 ÂÙÒÓ, ·Úfi-ÏÔ Ô˘ ·Ï·ÈfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ Î·Ù·Ï‹ÁÔ˘Ó fiÙÈ Â›Ó·È·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ ÛÂ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ10 ÂÙÒÓ. √È ÂÚÈÛÛfiÙÂÚÂ˜ ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘-Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ Û˘ÌÊˆÓÔ‡Ó fiÙÈ Ë ‰È¿ÚÎÂÈ· ıÂÚ·-Â›·˜ Â›Ó·È 3-6 Ì‹ÓÂ˜ (48). ∂ÂÈ‰‹ Ë Èı·ÓfiÙËÙ·˘ÔÙÚÔ‹˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·ÈÌÂÁ¿ÏË (30-45%), ÚÔÙÂ›ÓÂÙ·È ÛÙ·‰È·Î‹ ÌÂ›ˆÛ‹ÙÔ˘ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ·ÔÙ¤ÏÂÛÌ· (27,48,49). √È·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È ÔÈ·ÎfiÏÔ˘ıÂ˜: ÎÔÈÓfi ÎÚ˘ÔÏfiÁËÌ·, ˘ÚÂÙfi˜, ÚÈÓ›ÙÈ˜,ÔÓÔÎ¤Ê·ÏÔ˜ Î·È Á·ÛÙÚÂÓÙÂÚ›ÙÈ˜.

™Â ÂÚÈÙÒÛÂÈ˜ ¯ÚfiÓÈ·˜ ÚÈÓ›ÙÈ‰·˜, ÙÔ Ê¿ÚÌ·ÎÔ¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÛÙfiÌ· (48). ¶·ÚfiÏÔ Ô˘ Ô Î›Ó-‰˘ÓÔ˜ Î·Ù·ÎÚ¿ÙËÛË˜ ÓÂÚÔ‡ Î·È ˘ÔÓ·ÙÚÈ·ÈÌ›·˜Â›Ó·È ˘·ÚÎÙfi˜, ÂÓÙÔ‡ÙÔÈ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÏ¿-¯ÈÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ Û˘ÌÙˆÌ·ÙÈÎ‹˜ ˘ÔÓ·ÙÚÈ·ÈÌ›·˜·Ó·Ê¤ÚÔÓÙ·È (50-52). ¶¿ÓÙˆ˜, Ú¤ÂÈ Ó· ÙÔÓ›˙ÂÙ·ÈÌÂ ¤ÌÊ·ÛË ÛÙÔ˘˜ ÁÔÓÂ›˜ Ë ÛËÌ·Û›· ÙË˜ ÛÙ¤ÚËÛË˜Ï‹„Ë˜ ˘ÁÚÒÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ÒÚ· ÚÈÓ ·fi ÙË Ï‹-„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ÌÈÎÚÔ‡,¤ÛÙˆ, ·˘ÙÔ‡ ÎÈÓ‰‡ÓÔ˘ (48). ∏ ‰ÂÛÌÔÚÂÛÛ›ÓË ıÂ-ˆÚÂ›Ù·È Ê¿ÚÌ·ÎÔ ÚÒÙË˜ ÂÎÏÔÁ‹˜ ÛÙË ıÂÚ·Â›·ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ·Ó Î·È ÙÔ ÔÛÔÛÙfi ÂÈ-Ù˘¯›·˜ ÙË˜ ‰ÂÓ Â›Ó·È ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ Î·È Â›Ó·È Û·-ÊÒ˜ ÌÈÎÚfiÙÂÚÔ, Û˘ÁÎÚÈÓfiÌÂÓÔ ÌÂ ·˘Ùfi ÙË˜ Û˘-ÛÎÂ˘‹˜ ·Ê‡ÓÈÛË˜. ∂ÈÏ¤ÔÓ, ÛÙ· ÌÂÈÔÓÂÎÙ‹Ì·Ù¿ÙË˜ ·Ó·Ê¤ÚÂÙ·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜. ∞ÓÙ›ıÂÙ·, ÏÂÔ-Ó¤ÎÙËÌ¿ ÙË˜ ıÂˆÚÂ›Ù·È Ë ¿ÌÂÛË ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ¿ ÙË˜ Î·È Û˘ÓÂÒ˜ ·ÔÙÂÏÂ› ÙË Ï‡ÛË ÁÈ· ÙÔÂÓÔ˘ÚËÙÈÎfi ·È‰› Ô˘ Ú¤ÂÈ Ó· ‰È·Ó˘ÎÙÂÚÂ‡ÛÂÈÂÎÙfi˜ ÛÈÙÈÔ‡ (.¯. ‰È·ÌÔÓ‹ ÛÂ ·È‰ÈÎ‹ Î·Ù·ÛÎ‹-ÓˆÛË) Î·È ¯ÚÂÈ¿˙ÂÙ·È ¤Ó· Ê¿ÚÌ·ÎÔ Ô˘ ‰Ú· ÁÚ‹-ÁÔÚ· Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ¿.

™˘Ó‰˘·ÛÌfi˜ Û˘ÛÎÂ˘‹˜ ·Ê‡ÓÈÛË˜ Î·È ‰ÂÛÌÔ-ÚÂÛÛ›ÓË˜

∏ Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ Î·È Ë ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹ ÔÚ-ÌfiÓË fiÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù·˘Ùfi¯ÚÔÓ·, Ê·›ÓÂÙ·ÈÓ· ¤¯Ô˘Ó Û˘ÓÂÚÁÈÎ‹ ‰Ú¿ÛË. √È Bradbury Î·ÈMeadow ·Ó·Ê¤ÚÔ˘Ó ÛÂ ÌÂÏ¤ÙË ÙÔ˘˜ Î·Ï‡ÙÂÚÔ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ Ó˘¯ÙÂÚÈÓ‹ÂÓÔ‡ÚËÛË ÛÙ· ÔÔ›· ÂÊ·ÚÌfiÛıËÎÂ Û˘Ó‰˘·ÛÌfi˜·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·È Û˘ÛÎÂ˘‹˜ ·Ê‡ÓÈÛË˜ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎÂ ÌfiÓÔÌÂ Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ (53). ŒÙÛÈ, ÚÔÙÂ›ÓÂÙ·È -Â›·ÔÙ˘¯›·˜ Ì›·˜ ·fi ÙÈ˜ 2 ÌÂıfi‰Ô˘˜- Ë ÚÔÛı‹ÎËÙË˜ ‰Â‡ÙÂÚË˜ Û·Ó Û˘ÌÏËÚˆÌ·ÙÈÎfi Ì¤ÙÚÔ ıÂÚ·-Â›·˜ (42,48).

πÌÈÚ·Ì›ÓË∏ ÈÌÈÚ·Ì›ÓË, ¤Ó· ÙÚÈÎ˘ÎÏÈÎfi ·ÓÙÈÎ·Ù·ıÏÈÙÈÎfi,

¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1960 ÛÙË ıÂ-Ú·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜. √ ·ÎÚÈ‚‹˜ ÌË-¯·ÓÈÛÌfi˜ ‰Ú¿ÛË˜ ÙË˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜, ·Ó Î·È¤¯Ô˘Ó ÚÔÙ·ıÂ› ‰È¿ÊÔÚÂ˜ ıÂˆÚ›Â˜ Û¯ÂÙÈ˙fiÌÂÓÂ˜ÌÂ ÙËÓ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ‹ Î·È ·ÓÙÈ¯ÔÏËÓÂÚÁÈÎ‹ ÙË˜‰Ú¿ÛË Î·ıÒ˜ Î·È ÙÈ˜ ÌÂÙ·‚ÔÏ¤˜ Ô˘ ÚÔÎ·ÏÂ› ÛÙÔÌË¯·ÓÈÛÌfi ‡ÓÔ˘ – ·Ê‡ÓÈÛË˜. ÃÔÚËÁÂ›Ù·È ÛÂ ‰fi-ÛË 25mg ÁÈ· ·È‰È¿ 6-8 ÂÙÒÓ Î·È 50-75mg ÁÈ· ÌÂ-Á·Ï‡ÙÂÚ· ·È‰È¿, 1-2 ÒÚÂ˜ ÚÈÓ ÙËÓ Î·Ù¿ÎÏÈÛË(26). ªÂ ‚¿ÛË ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜, Ë Û˘Ó‹ıË˜ÚÔÙÂÈÓfiÌÂÓË ‰fiÛË Â›Ó·È 0,9-1,5 mg/kg/ËÌ¤Ú·. ∏ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛıÂ› ÌÂ Ù· Â›Â-‰· ÙË˜ ÛÙÔ Ï¿ÛÌ· (54), ··ÈÙÂ›Ù·È fiÌˆ˜ È‰È·›ÙÂÚËÚÔÛÔ¯‹ ÛÙË ¯ÔÚ‹ÁËÛË, ÁÈ·Ù› ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ Ù·ıÂÚ·Â˘ÙÈÎ¿ Â›Â‰· Â›Ó·È ÎÔÓÙ¿ ÛÙ· ÙÔÍÈÎ¿. ¶·-ÚfiÏÔ Ô˘ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ Â›Ó·È ¿ÌÂÛ·ÔÚ·Ù‹, ÂÓÙÔ‡ÙÔÈ˜ ı· ‹Ù·Ó ÚÔÙÈÌfiÙÂÚÔ Ó· Û˘ÓÂ¯È-ÛıÂ› Ë ıÂÚ·Â›· ÁÈ· 1-2 Â‚‰ÔÌ¿‰Â˜ ÚÔÙÔ‡ ÂÎÙÈ-ÌËıÂ› ÙÔ ·ÔÙ¤ÏÂÛÌ· Î·È ÙÚÔÔÔÈËıÂ› Ë ‰fiÛË. ∏·Ú¯ÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›· Î˘Ì·›ÓÂÙ·È ·fi10-40%, ÂÓÒ Ê·›ÓÂÙ·È ÙÔ Ê¿ÚÌ·ÎÔ Ó· Â›Ó·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙÂÚÔ ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (26). ¶Ú¤-ÂÈ, ¿ÓÙˆ˜, Ó· ÙÔÓÈÛıÂ› Ë ·Ô˘Û›· ·fi ÙË ‚È‚ÏÈÔ-ÁÚ·Ê›· Û‡Á¯ÚÔÓË˜ ‰ÈÏ‹˜-Ù˘ÊÏ‹˜ ÌÂÏ¤ÙË˜ Ô˘Ó· ·ÍÈÔÏÔÁÂ› ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙÈ˜ ·-ÚÂÓ¤ÚÁÂÈÂ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ∏ ÚÔÙÂÈÓfiÌÂÓË ‰È¿Ú-ÎÂÈ· ıÂÚ·Â›·˜ Â›Ó·È 3-6 Ì‹ÓÂ˜, ÂÓÒ ˘ÔÙÚÔ‹ ÌÂ-Ù¿ ÙË ‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜ ÌÔÚÂ› Ó· ·Ú·ÙË-ÚËıÂ› ÛÙÔ 40-60% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (55,56). ÀÔ-ÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ÛÙ·‰È·Î‹ ÌÂ›ˆÛË Î·È ‰È·ÎÔ‹ ÙÔ˘Ê·ÚÌ¿ÎÔ˘ ÌÔÚÂ› Ó· ÌÂÈÒÛÂÈ ÙËÓ Èı·ÓfiÙËÙ· ˘Ô-ÙÚÔ‹˜. ∂› ÂÌÊ¿ÓÈÛË˜ ˘ÔÙÚÔ‹˜, Ë ıÂÚ·Â›·ÌÔÚÂ› Ó· Â·Ó·ÏËÊıÂ›. √È ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤Ú-ÁÂÈÂ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‰ÂÓ Â›Ó·È Û˘¯Ó¤˜ Î·È ÂÚÈÏ·Ì-‚¿ÓÔ˘Ó ·ÓËÛ˘¯›·, ·¸Ó›·, ÍËÚÔÛÙÔÌ›·, Ó·˘Ù›·, ÎÂ-Ê·Ï·ÏÁ›·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ‰È·Ù·Ú·¯¤˜ ÙË˜

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 21

ÚÔÛˆÈÎfiÙËÙ·˜. ∏ ˘ÂÚ‰ÔÛÔÏÔÁ›· ÌÔÚÂ› Ó··Ô‚Â› ı·Ó·ÙËÊfiÚ·, ÚÔÎ·ÏÒÓÙ·˜ Î·Ú‰È·Î‹ ·Ú-Ú˘ıÌ›·, ˘fiÙ·ÛË, Û·ÛÌÔ‡˜ Î·È ÎÒÌ·. √ ÚfiÏÔ˜ÙË˜ ÈÌÈÚ·Ì›ÓË˜ ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ÂÓÔ‡ÚËÛË˜ ¤¯ÂÈ ÂÚÈÔÚÈÛıÂ› ÏfiÁÔ ÙˆÓ ÛÔ‚·ÚÒÓ -·Ó Î·È Û¿ÓÈˆÓ- ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÙË˜ (42).ªÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› Î·Ù¿ ÚÔÙ›ÌËÛË ·fi·È‰Ô„˘¯›·ÙÚÔ ÛÂ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 7 ÂÙÒÓÌÂ ÂÓÔ‡ÚËÛË Î·È ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÚÔÛÔ¯‹, ·ÓÙ›-ÏË„Ë ‹ ÎÈÓËÙÈÎfiÙËÙ· (4,48). ™Â Î¿ıÂ, fiÌˆ˜, ÂÚ›-ÙˆÛË, ·ÔÙÂÏÂ› Ê¿ÚÌ·ÎÔ ‰Â‡ÙÂÚË˜ ‹ ÙÚ›ÙË˜ÂÎÏÔÁ‹˜ ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜(1).

ÕÏÏÂ˜ ıÂÚ·Â›Â˜¢È¿ÊÔÚÂ˜ ıÂÚ·Â›Â˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜ (ÔÍ˘‚Ô˘-

ÙÈÓ›ÓË, Î·Ú‚·Ì·˙Â›ÓË) Î·È ÌË („˘¯ÔıÂÚ·Â›·, ‰È-·ÈÙËÙÈÎÔ› ÂÚÈÔÚÈÛÌÔ›, ˘ÓÔıÂÚ·Â›·), ¤¯Ô˘Ó ¯ÚË-ÛÈÌÔÔÈËıÂ› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÓÔ‡ÚËÛË˜,ÌÂ ‰È·ÊÔÚÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∏ ÔÍ˘‚Ô˘ÙÈÓ›ÓË,Î·ıÒ˜ Î·È ¿ÏÏ· ·ÓÙÈ¯ÔÏËÓÂÚÁÈÎ¿ Ê¿ÚÌ·Î·, ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È Û˘¯Ó¿ ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ÂÓÔ‡ÚËÛË˜, ·ÚfiÏÔ Ô˘ ‰ÂÓ ·ÔÙÂÏÔ‡Ó Ê¿ÚÌ·Î·ÂÎÏÔÁ‹˜.

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ë ÔÍ˘‚Ô˘ÙÈÓ›ÓË Â›Ó·È ÙÔÛ˘¯ÓfiÙÂÚ· Û˘ÓÙ·ÁÔÁÚ·ÊËÌ¤ÓÔ Ê¿ÚÌ·ÎÔ ÁÈ· ÙËıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÛÙË °·ÏÏ›·(33). ∏ ÔÍ˘‚Ô˘ÙÈÓ›ÓË ÌÂÈÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘-Û¿ÛÂˆÓ ÙÔ˘ ÂÍˆÛÙ‹Ú· ÎÈ ÂÔÌ¤Óˆ˜, ·˘Í¿ÓÂÈ ÙË¯ˆÚËÙÈÎfiÙËÙ· ÙË˜ Î‡ÛÙÂˆ˜. ∏ Û˘Ó‹ıË˜ ‰fiÛË ÁÈ··È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 7 ÂÙÒÓ Â›Ó·È 5mg 2 ‹ 3 ÊÔ-Ú¤˜ ÙËÓ ËÌ¤Ú· (1). √È Û˘Ó‹ıÂÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ÂÓ¤ÚÁÂÈÂ˜ Â›Ó·È ÍËÚÔÛÙÔÌ›·, ÂÚ˘ıÚfiÙËÙ· ÙÔ˘ ÚÔ-ÛÒÔ˘ Î·È ı¿Ì‚Ô˜ ÙË˜ fiÚ·ÛË˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜‰fiÛÂÈ˜. ∏ ÔÍ˘‚Ô˘ÙÈÓ›ÓË ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·Ô-ÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙË ıÂÚ·Â›· ÙË˜ ÚˆÙÔ·ıÔ‡˜ Ó˘-¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Î·È Û˘ÓÂÒ˜ Ô ÚfiÏÔ˜ ÙË˜ Â›-Ó·È ÂÚÈÔÚÈÛÌ¤ÓÔ˜ (57). ∞ÓÙ›ıÂÙ·, ‰È·‰Ú·Ì·Ù›˙ÂÈÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ıÂÚ·Â›· ÙË˜ ÂÓÔ‡ÚËÛË˜,fiÙ·Ó ·˘Ù‹ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ·ÛÙ·ı‹ ‹ ÓÂ˘ÚÔÁÂÓ‹Î‡ÛÙË. ∏ Î·Ú‚·Ì·˙Â›ÓË ·˘Í¿ÓÂÈ ÙË ¯ˆÚËÙÈÎfiÙËÙ·ÙË˜ Î‡ÛÙÂˆ˜ Î·È ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂÊÚÈÎÒÓ Ûˆ-ÏËÓ·Ú›ˆÓ ÛÙËÓ ·ÓÙÈ‰ÈÔ˘ÚËÙÈÎ‹ ÔÚÌfiÓË, ÌÂÈÒÓÔ-ÓÙ·˜ ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ Ô‡ÚˆÓ. Œ¯ÂÈ ¯ÚËÛÈÌÔÔÈ-ËıÂ› ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÌÂÂÓı·ÚÚ˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· (58), ÏËÓ fiÌˆ˜, ËÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ÙË˜ Â›Ó·È ÔÏ‡ ÂÚÈÔÚÈÛÌ¤-ÓË. ∏ „˘¯ÔıÂÚ·Â›· ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎ‹ ÛÙË ıÂÚ·Â›· ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÂÓÔ‡ÚË-ÛË˜ (26). √È ‰È·ÈÙËÙÈÎÔ› ÂÚÈÔÚÈÛÌÔ› (Á·Ï·ÎÙÔÎÔ-ÌÈÎ¿ ÚÔ˚fiÓÙ·, ÛÔÎÔÏ¿Ù·, ·Ó·„˘ÎÙÈÎ¿ Ù‡Ô˘ Îfi-Ï·˜ Î·È ¯˘ÌÔ›), ·Ó·Ê¤ÚÂÙ·È ÛÂ ÌÂÏ¤ÙË, fiÙÈ ÌÂÈÒ-

ÓÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÓÔ˘ÚËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ(26,59), ·ÚfiÏÔ Ô˘ ·˘Ùfi ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËıÂ›.

∫·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Î·È ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÓÔ‡ÚËÛË˜ ÌÂ ˘ÓÔıÂÚ·Â›·,·ÚfiÏÔ Ô˘ ‰ÂÓ Â›Ó·È ·Ô‰ÂÎÙ‹ Û·Ó Ì¤ıÔ‰Ô˜ ıÂ-Ú·Â›·˜ ÙË˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ (26,60).

™˘ÌÂÚ¿ÛÌ·Ù·∏ Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË Â›Ó·È Û˘¯Ófi Úfi‚ÏËÌ·

ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Ô˘ ‰˘Ó·ÙfiÓ Â›Ó·È Ó· ÚÔÎ·-Ï¤ÛÂÈ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ·˘ÙÔÂÎÙ›ÌËÛËÙÔ˘ ·È‰ÈÔ‡. ∏ ·ÈÙÈÔÏÔÁ›· ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ Î·Ù·-ÓÔËÙ‹. ∂ÓÔ¯ÔÔÈÔ‡ÓÙ·È Î˘Ú›ˆ˜, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ÌË¯·ÓÈÛÌÔ‡ ·Ê‡ÓÈÛË˜ fiÙ·Ó Ë Î‡ÛÙË Â›Ó·È Ï‹-ÚË˜, Î·ıÒ˜ Î·È ÌÂÈˆÌ¤ÓË ¤ÎÎÚÈÛË ÙË˜ ·ÓÙÈ‰ÈÔ˘ÚË-ÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜. √È‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÁÂÓÂÙÈÎ¿ Î·-ıÔÚÈÛÌ¤ÓÂ˜. √È ÔÏÏ¤˜ ÚÔÙÂÈÓfiÌÂÓÂ˜ ıÂÚ·Â˘ÙÈ-Î¤˜ Ï‡ÛÂÈ˜ Ê·ÓÂÚÒÓÔ˘Ó fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ È‰·ÓÈÎ‹ıÂÚ·Â›· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. √ ‰È·ÊÔÚÂÙÈÎfi˜ ÙÚfi-Ô˜ ÚÔÛ¤ÁÁÈÛË˜ Î·È ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘ ÚÔ‚Ï‹-Ì·ÙÔ˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÂ ÔÏÏ¤˜ ¯ÒÚÂ˜, ‰Â›¯ÓÂÈÙËÓ ·Ô˘Û›· ÎÔÈÓ¿ ·Ô‰ÂÎÙÔ‡ ‰ÈÂıÓÔ‡˜ ÚˆÙÔ-ÎfiÏÏÔ˘. √È ÂÈÎÚ·ÙÔ‡ÛÂ˜ ¿ÓÙˆ˜ ıÂÚ·Â›Â˜ Â›Ó·ÈË Û˘ÛÎÂ˘‹ ·Ê‡ÓÈÛË˜ Î·È Ë ‰ÂÛÌÔÚÂÛÛ›ÓË, Ìfi-ÓÂ˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi. ∏ Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÌÂ ÙÔÓ È·ÙÚfi ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙËÁÈ· ÙËÓ ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÓÔ‡ÚËÛË˜. °È·ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ÂÈÏÔÁ‹ ÙÔ˘ Â›‰Ô˘˜ ÙË˜ ıÂÚ·Â›-·˜ Á›ÓÂÙ·È Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ Î·È ÙËÓ ÚÔÙ›ÌË-Û‹ ÙÔ˘˜, ·ÊÔ‡ ÙÔ˘˜ ·Ú·ÙÂıÔ‡Ó ·Ó·Ï˘ÙÈÎ¿ Ù·ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Î¿ıÂ ıÂÚ·-Â›·˜. ∏ ÛÙ¿ÛË ÙË˜ ÏÂÈÔ„ËÊ›·˜ ÙÔ˘ È·ÙÚÈÎÔ‡ Îfi-ÛÌÔ˘ Ó· ·Ú·ÎÔÏÔ˘ıÂ› ÙÔ Úfi‚ÏËÌ· ·Ó·Ì¤ÓÔÓÙ·˜·˘ÙfiÌ·ÙË ˘Ô¯ÒÚËÛË ‰ÂÓ Â›Ó·È ‰ÈÎ·ÈÔÏÔÁËÌ¤ÓË.∞ÓÙ›ıÂÙ·, ÂÈ‚¿ÏÏÂÙ·È ‰Ú·ÛÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÁÈ·ÙËÓ ··ÏÏ·Á‹ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘·fi ÙÔ ‚·Ú‡ ·˘Ùfi ÊÔÚÙ›Ô.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞‚Ú·¿Ì ∏Ï›·˜ ∫ËÊÈÛ›·˜ 23, ∞Á. ¢ÔÌ¤ÙÈÔ˜ 2369, §Â˘ÎˆÛ›·, ∫‡ÚÔ˜

™ÎÔfi˜: ÀÔı¤Û·ÌÂ fiÙÈ ¤Ó·˜ ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓÙˆÓ ÏÂ˘ÎÔÙÚÈÂÓ›ˆÓ (LTRA) ı· ÌÔÚÔ‡ÛÂ Ó· ÚÔÛÙ·ÙÂ‡ÛÂÈ ÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ·fi ÙËÓ ·ÓÙ›‰Ú·ÛË ÛÂ ÂÈÛÓÔ‹ ÍËÚÔ‡-„˘¯ÚÔ‡ ·¤Ú· ÛÂ ·ÛıÌ·ÙÈÎ¿ ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜.ª¤ıÔ‰Ô˜: ™Â Ì›· Ù˘¯·ÈÔÔÈËÌ¤ÓË, ‰ÈÏ‹ Ù˘ÊÏ‹ ÂÏÂÁ¯fiÌÂÓË ÌÂplacebo, ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ÌÂÏ¤ÙË, ÂÍÂÙ¿Û·ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·-Ù· ÙÔ˘ ÂÈ‰ÈÎÔ‡ ·Ó·ÛÙÔÏ¤· ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ ÏÂ˘ÎÔÙÚÈÂÓ›ˆÓmontelukast ÛÂ ‰fiÛË 5mg ËÌÂÚËÛ›ˆ˜ ÁÈ· ‰‡Ô ËÌ¤ÚÂ˜, ÛÙÔÓ‚ÚÔÁ¯fiÛ·ÛÌÔ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙÔÓ ˘ÂÚ·ÂÚÈÛÌfi ÌÂ ÍË-Úfi-„˘¯Úfi ·¤Ú· ÛÂ 13 ·ÛıÌ·ÙÈÎ¿ ·È‰È¿ ËÏÈÎ›·˜ 3 ¤ˆ˜ 5 ¯ÚÔ-ÓÒÓ. √ ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ ÌÂÙÚ‹ıËÎÂ ÌÂ ÙË ÌÔÚÊ‹ ÙË˜ ÂÈ‰ÈÎ‹˜·ÓÙ›ÛÙ·ÛË˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ (sRaw) ÛÂ ÏËı˘ÛÌÔÁÚ¿ÊÔ ÔÏÈ-ÎÔ‡ ÛÒÌ·ÙÔ˜ (whole-body plethesmograph) ÚÈÓ, Î·È 4 ÏÂÙ¿ÌÂÙ¿ ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ ÌÂ ÍËÚfi „˘¯Úfi-·¤Ú·. ∏ ‰˘Ó·-ÙfiÙËÙ· Â·Ó¿ÏË„Ë˜ ÙË˜ ‚ÚÔÁ¯ÈÎ‹˜ ÚÔÛÙ·Û›·˜ ÂÏ¤Á¯ıËÎÂ ÌÂÙËÓ Â·Ó¿ÏË„Ë ÙË˜ ÌÂÏ¤ÙË˜ ÌÂ placebo ÛÂ 6 ·fi Ù· 13 ·È‰È¿. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ÂÈ‰ÈÎ‹ ·ÓÙ›ÛÙ·ÛË ÙˆÓ ·ÂÚ·ÁˆÁÒÓ sRaw·˘Í‹ıËÎÂ Î·Ù¿ Ì¤ÛÔ fiÚÔ 46% (95% confidence interval, (CI):30 ¤ˆ˜ 63%) ÌÂÙ¿ ·fi ıÂÚ·Â›· ÌÂ placebo, Î·È 17% (95%CI: 3 ¤ˆ˜ 31%) ÌÂÙ¿ ıÂÚ·Â›· ÌÂ montelukast. √ÎÙÒ ·fi Ù··È‰È¿ ÂÏ¿Ì‚·Ó·Ó ıÂÚ·Â›· Û˘ÓÙ‹ÚËÛË˜ ÌÂ ‚Ô˘‰ÂÛÔÓ›‰Ë¯ÔÚËÁÔ‡ÌÂÓË ÌÂ ·ÂÚÔı¿Ï·ÌÔ ÛÂ Ì›· Ì¤ÛË ËÌÂÚ‹ÛÈ· ‰fiÛË350 mcg, ·ÏÏ¿ Ë ‚ÚÔÁ¯ÈÎ‹ ÚÔÛÙ·Û›· ·fi ÙÔ montelukast‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ Ù·˘Ùfi¯ÚÔÓË ıÂÚ·Â›· ÌÂ ÛÙÂÚÔÂÈ-‰‹. ¢ÂÓ ˘‹ÚÍÂ ·ÍÈfiÈÛÙË ¤Ó‰ÂÈÍË ·ÔÙ˘¯›·˜ ÛÙËÓ ·ÓÙ·fi-ÎÚÈÛË, Î·È Ô ÚÔÛÙ·ÙÂ˘ÙÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ montelukast ‹Ù·ÓÛÙ·ıÂÚfi˜ ÌÂ ÙËÓ Â·Ó¿ÏË„Ë ÙË˜ ‰ÔÎÈÌ·Û›·˜ (p=0,02).

™˘ÌÂÚ¿ÛÌ·Ù·: √ ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÏÂ˘ÎÔÙÚÈÂÓ›ˆÓmontelukast ·Ú¤Û¯Â ÎÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‚ÚÔÁ¯ÈÎ‹ ÚÔÛÙ·-Û›· ¤Ó·ÓÙÈ ÙˆÓ ÂÈÙÒÛÂˆÓ ÙÔ˘ ˘ÂÚ·ÂÚÈÛÌÔ‡ ÌÂ ÍËÚfi-„˘-¯Úfi ·¤Ú· ÛÂ ·ÛıÌ·ÙÈÎ¿ ·È‰È¿ ËÏÈÎ›·˜ 3 ¤ˆ˜ 5 ÂÙÒÓ. ∏ ‚ÚÔÁ-¯ÈÎ‹ ÚÔÛÙ·Û›· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÔÌÔÈÔÁÂÓ‹˜ ÌÂÙ·Í‡ ÙˆÓ·È‰ÈÒÓ Î·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ Ù·˘Ùfi¯ÚÔÓË ıÂÚ·Â›· ÌÂÛÙÂÚÔÂÈ‰‹. ∞˘Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ ÔÈ ·Ó·Ù·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô-‰Ô¯¤ˆÓ ÙˆÓ ÏÂ˘ÎÔÙÚÈÂÓ›ˆÓ ÌÔÚÂ› Ó· ¤¯Ô˘Ó ıÂÚ·Â˘ÙÈÎ‹ÂÊ·ÚÌÔÁ‹ ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘¿ÛıÌ·ÙÔ˜ ÛÂ ÌÈÎÚ¿ ·È‰È¿.

1H. Bisgaard, K. NielsenBronchoprotection with a leukotriene receptor antagonist in asthmatic preschool childrenAm J Respir Crit Care Med 2000;162:187-190

£ÂÔÊ¿ÓË˜ ∆ÛÈÏÈÁÈ¿ÓÓË˜ ¢ÈÂ˘ı˘ÓÙ‹˜ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡·˘ÙÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∞ıËÓÒÓ

µÚÔÁ¯ÈÎ‹ ÚÔÛÙ·Û›· ÌÂ ¤Ó· ·ÓÙ·ÁˆÓÈÛÙ‹ ÏÂ˘ÎÔÙÚÈÂÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ ÛÂ ·ÛıÌ·ÙÈÎ¿ ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 24


™˘ÓÙÔÓÈÛÙ‹˜ ∞’ ™ÙÚÔÁÁ˘Ï‹˜ ∆Ú¿Â˙·˜: Ã. ∫·ÙÙ¿ÌË˜√ÌfiÙÈÌÔ˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈÎ‹˜¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ

ªË¯·ÓÈÛÌÔ› –·ÈÙÈÔÏÔÁ›· ·Ï·ÛÙÈÎ‹˜ ·Ó·ÈÌ›·˜

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË

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

∞Ï·ÛÙÈÎ¿ Û‡Ó‰ÚÔÌ· Î·È ·˘ÍËÙÈÎÔ› ·ÈÌÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ª. ªÔÛ¯fi‚Ë

™˘ÁÁÂÓÂ›˜ √˘‰ÂÙÂÚÔÂÓ›Â˜Õ. ∫·Ú·ÎfiÏË

™˘ÓÙÔÓ›ÛÙÚÈ· µ’ ™ÙÚÔÁÁ˘Ï‹˜ ∆Ú¿Â˙·˜:º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘∞Ó·Ï. ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈÎ‹˜ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜

£ÚÔÌ‚ÔÂÓ›Â˜ ÔÊÂÈÏfiÌÂÓÂ˜ ÛÂ ·ÓÂ·ÚÎ‹ ·Ú·ÁˆÁ‹ ·ÈÌÔÂÙ·Ï›ˆÓ∂. ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘



ªÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªª√) ÛÂ ·È‰È¿ ÌÂ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜¢. ¶ÂÙÚfiÔ˘ÏÔ˜

Coordinator of Round Table A’: Ch. Kattamis Professor Emeritus of PediatricsUniversity of Athens

∂tiology and pathogenetic mechanisms of acquired and inherited aplastic anemia inchildhood S. Polychronopoulou-Androulakaki

Aplastic syndromes and myelodysplasia ∞. Pourtsidis

Aplastic syndromes and hematopoietic growth factorsM. Moschovi

Congenital neutropenias∞. Karakoli

Coordinator of Round Table µ’: F. Athanasiadou-PiperopoulouAssoc. Professor of Pediatrics Aristotelion University of Thessaloniki

Thrombocytopenias resulting from deficientplatelet productionH. Platokouki-Komitopoulou


Immunosuppressive therapy in children withsevere aplastic anemiaJ.P. Panagiotou

Bone marrow transplantation in children with bonemarrow failure syndromes D. Petropoulos

∆Ô ı¤Ì· ÙË˜ ™˘ÓÂ¯È˙fiÌÂÓË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Î·›‰Â˘ÛË˜ Â›Ó·È «™‡Ó‰ÚÔÌ· ª˘ÂÏÈÎ‹˜ ∞ÓÂ¿ÚÎÂÈ·˜». ¶·ÚÔ˘ÛÈ¿ÛÙËÎÂ ˆ˜ ‰‡Ô ™ÙÚÔÁÁ˘Ï¤˜ ∆Ú¿Â˙Â˜ ÛÙÔ 12Ô ∂Ù‹ÛÈÔ ™˘Ó¤‰ÚÈÔ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∞ÈÌ·ÙÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, ∞ı‹Ó·, 20.11.1999

™À¡∂Ãπ∑√ª∂¡∏ ¶∞π¢π∞∆ƒπ∫∏ ∂∫¶∞π¢∂À™∏ CONTINUING MEDICAL EDUCATION

∂ÈÌ¤ÏÂÈ· °Ú·ÙÔ‡ ™˘ÌÔÛ›Ô˘:º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘∞Ó·Ï. ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈÎ‹˜ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜

Editing of Symposium Manuscripts:F. Athanasiadou-PiperopoulouAssoc. Professor of Pediatrics Aristotelion University of Thessaloniki

™À¡¢ƒ√ª∞ ªÀ∂§π∫∏™ ∞¡∂¶∞ƒ∫∂π∞™

THE BONE MARROW FAILURESYNDROMES

25

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 25

�¶ÂÚ›ÏË„Ë: ∏ ÌÂ›ˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÛÙÔ ·›Ì· Ô˘‰ÂÙÂÚÔÊ›ÏˆÓÎ¿Ùˆ ·fi 1500/mm3 ÔÚ›˙ÂÙ·È ˆ˜ Ô˘‰ÂÙÂÚÔÂÓ›·.∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ Û˘ÁÁÂÓ‹‹ Â›ÎÙËÙ· ·›ÙÈ·. ∆· Î˘ÚÈfiÙÂÚ· Û˘ÁÁÂÓ‹ ÓÔÛ‹Ì·-Ù· ÌÂ ‚·ÚÈ¿ Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ë ·ÁÂÓÂÛ›· ÙÔ˘‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·ÎÔ‡ ÈÛÙÔ‡, ÙÔ Û‡Ó‰ÚÔÌÔ Kost-mann, Ë ª˘ÂÏÔÎ¿ıÂÍË, ÙÔ Û‡Ó‰ÚÔÌÔ ShwachmanÎÏ., Ù· ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ÚÒÈÌËÂÌÊ¿ÓÈÛË ·ÂÈÏËÙÈÎÒÓ ÁÈ· ÙË ˙ˆ‹ ÏÔÈÌÒÍÂˆÓ. ∏Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ë ÔÈÎÔÁÂÓ‹˜ Î·ÏÔ‹ıË˜Ô˘‰ÂÙÂÚÔÂÓ›· ¤¯Ô˘Ó Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË Î·È¯Ú‹˙Ô˘Ó ÌfiÓÔÓ ÂÏ·¯›ÛÙË˜ ‹ Î·Ì›·˜ È·ÙÚÈÎ‹˜ ·-Ú¤Ì‚·ÛË˜. √È Û˘ÁÁÂÓÂ›˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜ ·ÓÙÈÌÂ-Ùˆ›˙ÔÓÙ·È Û‹ÌÂÚ· ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈÎÔ‡·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ (G-CSF) Î·È ÌÂ-Ù·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û˘ÁÁÂÓÂ›˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜, ·˘ÍË-ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ (G-CSF),ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.

�Abstract: Neutropenia is defined as an absolutedecrease in the number of circulating neutrophilsin the blood to less than 1500/mm3. Congenital orextrinsic factors may cause neutropenia. The maincongenital disorders associated with severe neu-tropenia are reticular dysgenesis, Kostmann’ssyndrome, Myelokathexis and Shwachman’s syn-drome and which are characterized by an earlyonset of life-threatening pyogenic infections.Patients with cyclic neutropenia and familialbenign neutropenia have a good prognosis re-quiring only minimal or no medical intervention.The use of granulocyte colony-stimulating factor(G-CSF) and bone marrow transplantation havedramatically improved the outcome for manypatients with severe congenital neutropenia.

Key words: congenital neutropenias, granulocytecolony-stimulating factor (G-CSF), bone marrowtransplantation.


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™˘ÁÁÂÓÂ›˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜Õ. ∫·Ú·ÎfiÏË

Congenital neutropenias∞. Karakoli

™˘ÁÁÂÓÂ›˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜ø˜ Ô˘‰ÂÙÂÚÔÂÓ›· ÔÚ›˙ÂÙ·È Ë ÌÂ›ˆÛË ÙÔ˘ ·fi-

Ï˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ Ô˘‰ÂÙÂÚoÊ›-ÏˆÓ ÛÙÔ ·›Ì· Î¿Ùˆ ·fi 1000 Ô˘‰ÂÙÂÚfiÊÈÏ·/mm3

ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ ‰‡Ô Â‚‰ÔÌ¿‰ˆÓ ¤ˆ˜ ÂÓfi˜ ¤ÙÔ˘˜Î·È Î¿Ùˆ ·fi 1500 ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ-‹˜ (1).

∞Ó¿ÏÔÁ· ÌÂ ÙË ‚·Ú‡ÙËÙ·, Ë Ô˘‰ÂÙÂÚÔÂÓ›·‰È·ÎÚ›ÓÂÙ·È ÛÂ ÂÏ·ÊÚ¿, ÌÂ ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ·fi 1000 Ì¤¯ÚÈ 1500/mm3, Ì¤ÙÚÈ·, ÌÂ ·ÚÈıÌfi Ô˘-‰ÂÙÂÚÔÊ›ÏˆÓ ·fi 500 Ì¤¯ÚÈ 1000/mm3 Î·È ‚·ÚÈ¿,

ÌÂ ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÌÈÎÚfiÙÂÚÔ ·fi500/mm3. √È ·ÛıÂÓÂ›˜ ÌÂ ‚·ÚÈ¿ Ô˘‰ÂÙÂÚÔÂÓ›·¤¯Ô˘Ó ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÛÂ ·ÂÈÏËÙÈÎ¤˜, ÁÈ· ÙË˙ˆ‹, ÏÔÈÌÒÍÂÈ˜. √È Û˘¯ÓfiÙÂÚÂ˜ ÌÔÚÊ¤˜ ÏÔÈÌÒÍÂ-ˆÓ ·fi ˘ÔÁfiÓÔ˘˜ ÎfiÎÎÔ˘˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‚·ÚÈ¿Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È: ‰ÂÚÌ·ÙÈÎ‹ Î˘ÙÙ·Ú›ÙÈ˜, ÂÈÔ-Ï‹˜ ‹ ÂÓ Ùˆ ‚¿ıÂÈ ‰ÂÚÌ·ÙÈÎ¿ ·ÔÛÙ‹Ì·Ù·, ‰ÔıÈ‹-ÓˆÛË, ÓÂ˘ÌÔÓ›· Î·È ÛË„·Ì›·. ∂›ÛË˜, Û˘Ì‚·›-ÓÔ˘Ó ÛÙÔÌ·Ù›ÙÈ˜, Ô˘ÏÔÛÙÔÌ·Ù›ÙÈ˜, ÂÚÈÚˆÎÙÈÎ‹ÊÏÂÁÌÔÓ‹ Î·È Ì¤ÛË ˆÙ›ÙÈ˜. √È ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›Ô˘ Û˘Ó‹ıˆ˜ ·ÔÌÔÓÒÓÔÓÙ·È ·fi Ô˘‰ÂÙÂÚÔÂÓÈ-


¶·È‰ÔÔÁÎÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ πÔÎÚ·ÙÂ›Ô˘ ¡ÔÛÔÎÔÌÂ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜

Pediatric Oncology ClinicIppokration Hospital of Thessaloniki

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 26


27

ÎÔ‡˜ ·ÛıÂÓÂ›˜ Â›Ó·È Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜Î·È gram-·ÚÓËÙÈÎ¿ ‚·ÎÙËÚ›‰È· (2). ∏ Ù·ÍÈÓfiÌËÛËÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ·Ó¿ÏÔÁ· ÌÂ Ù· ·›ÙÈ· Ê·›ÓÂÙ·ÈÛÙÔÓ ›Ó·Î· 1.

∞ÁÂÓÂÛ›· ÙÔ˘ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·ÎÔ‡ ÈÛÙÔ‡∏ ·‰˘Ó·Ì›· ˆÚ›Ì·ÓÛË˜ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ÔÏ˘-

‰‡Ó·ÌÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘ (stem cell) ÛÂÚÔÁÔÓÈÎfi ÎÔÎÎÈÔÎ‡ÙÙ·ÚÔ Î·È Î‡ÙÙ·ÚÔ ÙË˜ ÏÂÌÊÈ-Î‹˜ ÛÂÈÚ¿˜, ÔÚ›˙ÂÙ·È ˆ˜ ·ÁÂÓÂÛ›· ÙÔ˘ ‰ÈÎÙ˘ÔÂÓ‰Ô-ıËÏÈ·ÎÔ‡ ÈÛÙÔ‡. ∫ÏËÚÔÓÔÌÂ›Ù·È ÌÂ ·˘ÙÔÛˆÌ·ÙÈÎfi˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∂ÎÙfi˜ ·fi ÙË ‚·ÚÈ¿ Ô˘-‰ÂÙÂÚÔÂÓ›·, Û˘Ó˘¿Ú¯ÂÈ ÏÂÌÊÔÂÓ›· Î·È ·Á·ÌÌ·-ÛÊ·ÈÚÈÓ·ÈÌ›·, Ù· ‰Â ¿Û¯ÔÓÙ· ‚Ú¤ÊË ‰ÂÓ ÂÈ˙Ô‡ÓÌÂÙ¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜. ∏ ÌÂÙ·Ìfi-Û¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¤¯ÂÈ ÂÊ·ÚÌÔÛıÂ› ÌÂ Î·-Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÂ ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ (2,3).

µ·ÚÈ¿ Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· (Û‡Ó‰ÚÔÌÔ Kostmann)

∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÂÚÈÁÚ¿ÊËÎÂ ·fi ÙÔÓKostmann ÙÔ 1956 Û·Ó Ì›· ‰È·Ù·Ú·¯‹ ÎÏËÚÔÓÔ-ÌÔ‡ÌÂÓË ÌÂ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·-ÎÙ‹Ú·. √È ¿Û¯ÔÓÙÂ˜ ¤¯Ô˘Ó ·fiÏ˘ÙÔ ·ÚÈıÌfi Ô˘-‰ÂÙÂÚÔÊ›ÏˆÓ ÌÈÎÚfiÙÂÚÔ ·fi 200/mm3 Î·È Û˘¯Ó¿¤¯Ô˘Ó ÂÎ‰ËÏÒÛÂÈ˜ ˘ÚÂÙÔ‡, ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ‰¤Ú-Ì·ÙÔ˜, ÛÙÔÌ·Ù›ÙÈ‰·˜ Î·È ÂÚÈÚˆÎÙÈÎÒÓ Û˘ÚÈÁÁ›ˆÓÔ˘ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙÔÓ ÚÒÙÔ Ì‹Ó·ÙË˜ ˙ˆ‹˜. ∏ ÂÍ¤Ù·ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ‰Â›-¯ÓÂÈ Ì›· Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÍ¤ÏÈÍË ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓÌ¤¯ÚÈ ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ÚÔÌ˘ÂÏÔÎ˘ÙÙ¿ÚÔ˘ ‹ Ì˘ÂÏÔ-

Î˘ÙÙ¿ÚÔ˘, ÂÓÒ ·Ô˘ÛÈ¿˙Ô˘Ó Ù· ÒÚÈÌ· Ô˘‰ÂÙÂÚfi-ÊÈÏ·. ∏ ·Ú·ÁˆÁ‹ G-CSF ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ Â›Ó·ÈÊ˘ÛÈÔÏÔÁÈÎ‹, ·Ó fi¯È ·˘ÍËÌ¤ÓË. ∏ ‰È·Ù·Ú·¯‹ ‚Ú›-ÛÎÂÙ·È ÛÙÔ Â›Â‰Ô ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ G-CSF (G-CSF receptor, G-CSF-R) ‹ ÛÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ÌÂ-Ù·ÁˆÁ‹ Û‹Ì·ÙÔ˜ Ô˘ Ù›ıÂÙ·È ÛÂ ÂÓ¤ÚÁÂÈ· ·fi ÙÔÓG-CSF-R ‹ Î·È ÛÙ· ‰‡Ô (4). √È ¿Û¯ÔÓÙÂ˜ ·fiÛ‡Ó‰ÚÔÌÔ Kostmann ¤¯Ô˘Ó ·˘ÍËÌ¤ÓË Èı·ÓfiÙËÙ·Ó· ÂÎ‰ËÏÒÛÔ˘Ó ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›·.

∏ ÛÏËÓÂÎÙÔÌ‹, Ù· ÎÔÚÙÈÎÔÂÈ‰‹ Î·È Ù· ·Ó‰ÚÔ-ÁfiÓ· ‰ÔÎÈÌ¿ÛÙËÎ·Ó ÛÙÔ ·ÚÂÏıfiÓ ¯ˆÚ›˜ ÂÈÙ˘¯›·.∏ ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÏÔÈ-ÌÒÍÂˆÓ ‚ÔËı¿ ÛÙËÓ ·Ú¿Ù·ÛË ÙË˜ ˙ˆ‹˜ ÙˆÓ·ÛıÂÓÒÓ. ∏ ¯ÔÚ‹ÁËÛË G-CSF ‚ÔËı¿ ÛËÌ·ÓÙÈÎ¿ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ÏÔÈÌÒÍÂˆÓ Î·È ÙËÓ Ì·ÎÚ‡ÙÂ-ÚË ÂÈ‚›ˆÛË ÙˆÓ ·Û¯fiÓÙˆÓ, ·Ó Î·È ‰ÂÓ ··ÓÙÔ‡ÓfiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜. ∏ ‰fiÛË ÙÔ˘ G-CSF ÁÈ· ÙÔÓ Î¿ıÂ·ÛıÂÓ‹ Î˘Ì·›ÓÂÙ·È ·fi 3 ¤ˆ˜ 6 Ìg/kgµ™/∏ (2). ∏ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÂÈÙ˘Á¯¿ÓÂÈ ÈÔÌfiÓÈÌ· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙË ‰ÈfiÚıˆÛË ÙË˜ ·ÎÔÎÎÈÔ-Î˘ÙÙ·Ú·ÈÌ›·˜ ÎÈ ·ÔÙÚ¤ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜ÔÍÂ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ ÏÂ˘¯·ÈÌ›·˜ (5).

∫˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·∏ Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ì›· Û¿ÓÈ· ‰È·-

Ù·Ú·¯‹ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÚÈÔ‰ÈÎ‹ -·Ó¿21- ËÌ¤ÚÂ˜ ‰È·Î‡Ì·ÓÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÎÏÔ-ÊÔÚÔ‡ÓÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎ¿Ì¤¯ÚÈ Ù· Ô˘‰ÂÙÂÚÔÂÓÈÎ¿ Â›Â‰·. ™Â ÌÂÚÈÎ¤˜ Â-ÚÈÙÒÛÂÈ˜ Ù· ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú·, Ù· ·ÈÌÔÂÙ¿-ÏÈ· Î·È ÔÈ ¿ÏÏÂ˜ ÌÔÚÊ¤˜ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ¤¯Ô˘Ó,Â›ÛË˜, ÌÈ· Î˘ÎÏÈÎ‹ ‰È·Î‡Ì·ÓÛË. ∏ Î˘ÎÏÈÎ‹ Ô˘‰Â-ÙÂÚÔÂÓ›· ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡-ÓÙ· ̄ ·Ú·ÎÙ‹Ú·, ·ÏÏ¿ ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ Ë Ófi-ÛÔ˜ ÂÎ‰ËÏÒÓÂÙ·È ÛÔÚ·‰ÈÎ¿. ™ÙÔÓ Ì˘ÂÏfi ÙˆÓÔÛÙÒÓ Ù· ÚÔÁÔÓÈÎ¿ ÎÔÎÎÈÔ-/ÌÔÓÔ- Î‡ÙÙ·Ú· Â›Ó·È·fiÓÙ· 1 Â‚‰ÔÌ¿‰· ÚÈÓ ·fi ÙÔ Ô˘‰ÂÙÂÚÔÂÓÈÎfiÓ·‰›Ú, ÙÔ ÔÔ›Ô ‰È·ÚÎÂ› 3-10 Ì¤ÚÂ˜. ∏ ˘fiÓÔÈ· ÙË˜ÓfiÛÔ˘ Ù›ıÂÙ·È ·fi Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ·Ó¿ 21 Ì¤-ÚÂ˜ ÏÔÈÌÒÍÂÈ˜, ÂÓÒ ÁÈ· ÙËÓ ÂÈ‚Â‚·›ˆÛË ¯ÚÂÈ¿˙Â-Ù·È Ó· Á›ÓÂÙ·È ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜ 2-3 ÊÔÚ¤˜ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ÌËÓÒÓ.∞fi ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ‰È·-Ù·Ú·¯‹ ÛÙÔ˘˜ Ú˘ıÌÈÛÙÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜ Ô˘·ÊÔÚÔ‡Ó ÙÈ˜ ÚÔÁÔÓÈÎ¤˜ ÌÔÚÊ¤˜ ÙˆÓ ·ÈÌÔÔÈËÙÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Ô˘‰ÂÙÂÚÔÂÓÈÎÒÓ ÂÚÈfi-‰ˆÓ, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ÛÙÔ-Ì·ÙÈÎ¿ ¤ÏÎË, ÛÙÔÌ·Ù›ÙÈ‰· Î·È Ê·Ú˘ÁÁ›ÙÈ‰· Û˘ÓÔ-‰Â˘fiÌÂÓË ·fi ‰ÈfiÁÎˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ. ¶ÈÔ ÛÔ-‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜ ÌÔÚÂ›, Â›ÛË˜, Ó· ÂÈÛ˘Ì‚Ô‡Ó.√È ¿Û¯ÔÓÙÂ˜ ·fi Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·ÈÂÈÚÚÂÂ›˜ ÛÂ ÏÔÈÌÒÍÂÈ˜ ·fi clostridium per-

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË Ô˘‰ÂÙÂÚÔÂÓÈÒÓ

™˘ÁÁÂÓÂ›˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜

∞ÁÂÓÂÛ›· ÙÔ˘ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·ÎÔ‡ ÈÛÙÔ‡µ·ÚÈ¿ Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· (Û. Kostmann)∫˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·ª˘ÂÏÔÎ¿ıÂÍË (Myelokathexis)™‡Ó‰ÚÔÌÔ Shwachman™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË™‡Ó‰ÚÔÌÔ Chediak-Higashi√ÈÎÔÁÂÓ‹˜ Î·ÏÔ‹ıË˜ Ô˘‰ÂÙÂÚÔÂÓ›· Î.·.

√˘‰ÂÙÂÚÔÂÓ›· ÔÊÂÈÏfiÌÂÓË ÛÂ ÂÍˆÁÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜

√˘‰ÂÙÂÚÔÂÓ›· Û¯ÂÙÈ˙fiÌÂÓË ÌÂ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù· ¢È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ÓÂÔÏ·ÛÌ·ÙÈÎ¿ Î‡ÙÙ·Ú·ªË ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆÚ›Ì·ÓÛË ÙˆÓ Ì˘ÂÏÔÎ˘ÙÙ¿ÚˆÓ (ÌÂÁ·ÏÔ‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·)§ÔÈÌÒÍÂÈ˜πÛÔ¿ÓÔÛË ÓÂÔÁÓÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· ∞˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·√˘‰ÂÙÂÚÔÂÓ›· ÔÊÂÈÏfiÌÂÓË ÛÂ Ê¿ÚÌ·Î·ÀÂÚÛÏËÓÈÛÌfi˜

2001 paid(teliko) 17-10-01 15:45 ™ÂÏ›‰· 27

fringens. ªÂÙ·Í‡ ÙˆÓ ÚÔÛ‚ÔÏÒÓ ÔÈ ¿Û¯ÔÓÙÂ˜¤¯Ô˘Ó Î·Ï‹ ˘ÁÂ›·. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ÙËÓ¿ÚÔ‰Ô ÙË˜ ËÏÈÎ›·˜ ˘¿Ú¯ÂÈ ‚ÂÏÙ›ˆÛË ÙË˜ ÎÏÈÓÈ-Î‹˜ ÂÈÎfiÓ·˜, Î·ıfiÛÔÓ ÔÈ Ô˘‰ÂÙÂÚÔÂÓÈÎÔ› Î‡ÎÏÔÈÁ›ÓÔÓÙ·È ÏÈÁfiÙÂÚÔ ÂÎÛÂÛËÌ·ÛÌ¤ÓÔÈ.

∏ Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·Ó¿Ù˘ÍË Ì˘ÂÏÔÁÂÓÔ‡˜ÏÂ˘¯·ÈÌ›·˜, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙËÓ ‚·ÚÈ¿ Û˘ÁÁÂÓ‹Ô˘‰ÂÙÂÚÔÂÓ›·.

°È· Ó· ÌÂÈˆıÂ› Ô Î›Ó‰˘ÓÔ˜ ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓÎ·Ù¿ ÙÈ˜ Ê¿ÛÂÈ˜ ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, ÔÈ ·ÛıÂÓÂ›˜·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ G-CSF (3-10Ìg/kg µ™/∏) (6).√ GM-CSF ‰ÂÓ ¤¯ÂÈ ÙÔ ›‰ÈÔ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù·.

Myelokathexis (ª˘ÂÏÔÎ¿ıÂÍÈ˜)√ fiÚÔ˜ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÈ˜ ÂÏÏËÓÈÎ¤˜ Ï¤ÍÂÈ˜

«Ì˘ÂÏfi˜» Î·È «Î¿ıÂÍÈ˜» Ô˘ ÛËÌ·›ÓÂÈ ÂÚÈÔÚÈ-ÛÌfi˜, ·Ó·¯·›ÙÈÛË (·Ó·¯·›ÙÈÛË ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓÂÓÙfi˜ ÙÔ˘ Ì˘ÂÏÔ‡). ∂›Ó·È Ì›· Û˘ÁÁÂÓ‹˜ ‰È·Ù·Ú·¯‹Ô˘ ÚÔÎ·ÏÂ› ‚·ÚÈ¿ ¯ÚfiÓÈ· ÏÂ˘ÎÔÂÓ›· Î·È Ô˘‰Â-ÙÂÚÔÂÓ›·. ∆· Ô˘‰ÂÙÂÚfiÊÈÏ· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·¤¯Ô˘Ó Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ¿ ÎÂÓÔÙfiÈ·, ÔÈ ‰Â ˘Ú‹-ÓÂ˜ ÙÔ˘˜ ¤¯Ô˘Ó ÔÏÏ¿ Ïfi‚È· Û˘Ó‰Â‰ÂÌ¤Ó· ÌÂÙ·Í‡ÙÔ˘˜ ÌÂ Á¤Ê˘ÚÂ˜. √ Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ·ÚÔ˘-ÛÈ¿˙ÂÈ ÂÈÎfiÓ· ÚÒÈÌË˜ ·fiÙˆÛË˜ ÙˆÓ Úfi‰ÚÔ-ÌˆÓ ÌÔÚÊÒÓ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (˘ÂÚÏ·Û›· ÌÂ˘ÂÚÎ·Ù¿ÙÌËÛË ÙÔ˘ ˘Ú‹Ó· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓÎ·È ÂÓ‰ÔÌ˘ÂÏÈÎ‹ Î·Ù·ÛÙÚÔÊ‹ ·˘ÙÒÓ) (7).

∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙË ÓfiÛÔ ·˘Ù‹ ÌÔÚÂ› ÌÂÚÈ-ÎÒ˜ Ó· ‰ÈÔÚıˆıÂ› ÌÂ ÙË ¯ÔÚ‹ÁËÛË G-CSF ‹ GM-CSF. ∞Ó·Ê¤ÚÂÙ·È Î·È Ì˘ÂÏÔÎ¿ıÂÍË ÌÂ ˘ÔÁ·ÌÌ·-ÛÊ·ÈÚÈÓ·ÈÌ›·.

™‡Ó‰ÚÔÌÔ Shwachman∂›Ó·È Ì›· Û¿ÓÈ· ÔÏ˘ÔÚÁ·ÓÈÎ‹ ÓfiÛÔ˜ Ô˘

ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ¯·Ú·ÎÙ‹Ú·. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÙ·Ê˘ÛÈ·Î‹¯ÔÓ‰ÚÔ‰˘ÛÏ·Û›·, Ó·ÓÈÛÌfi, ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÍˆ-ÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È Ô˘‰ÂÙÂÚÔÂ-Ó›·.

√ ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙÔ ÂÚÈÊÂÚÈ-Îfi ·›Ì· ÔÈÎ›ÏÏÂÈ, Î˘Ì·ÈÓfiÌÂÓÔ˜ ·fi 200 Ì¤¯ÚÈ400 Î‡ÙÙ·Ú·/mm3. §fiÁˆ ÙË˜ ÛÙÂ·ÙfiÚÚÔÈ·˜ Î·ÈÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÌÔÚÂ› Ó· ıÂˆÚËıÂ›,ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘, ˆ˜ Î˘ÛÙÈÎ‹ ›ÓˆÛË,·fi ÙËÓ ÔÔ›·, fiÌˆ˜, Â‡ÎÔÏ· ‰È·ÎÚ›ÓÂÙ·È ÏfiÁˆÙÔ˘ ·ÚÓËÙÈÎÔ‡ test È‰ÚÒÙ·. ŒÓ· Ì¤ÚÔ˜ ÙˆÓ ·ÛıÂ-ÓÒÓ, ÂÚ›Ô˘ 25%, ÂÌÊ·Ó›˙ÂÈ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·ÛÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘.

√È ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ‚·ÚÈ¤˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈ-ÌÒÍÂÈ˜ ÎÈ Ë ÂÎ‰‹ÏˆÛË Ì˘ÂÏÔÁÂÓÔ‡˜ ÏÂ˘¯·ÈÌ›·˜ Â›-Ó·È ÔÈ Î‡ÚÈÂ˜ ·ÈÙ›Â˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ·fi Û‡Ó‰ÚÔÌÔ Shwachman.

°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ¯Ô-ÚËÁÂ›Ù·È G-CSF ÌÂ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù·. °È· ÙÔÛ‡Ó‰ÚÔÌÔ Shwachman ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ıÂˆ-ÚÂ›Ù·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ‰ÈfiÙÈÂÎÙfi˜ ·fi ÙË ‰ÈfiÚıˆÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·-Ù·Ú·¯ÒÓ ·Ó·¯·ÈÙ›˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ Ì˘Â-ÏÔÁÂÓÔ‡˜ ÏÂ˘¯·ÈÌ›·˜ (8).

™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË∫ÏËÚÔÓÔÌÂ›Ù·È ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ÁfiÓÔ Â˘ÚÈ-

ÛÎfiÌÂÓÔ ÛÙÔ ¯ÚˆÌfiÛˆÌ· Ã.Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰˘ÛÙÚÔÊ›· ÔÓ‡¯ˆÓ, ÏÂ˘-

ÎÔÏ·Î›·, ˘¤Ú¯ÚˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È Ô˘‰ÂÙÂ-ÚÔÂÓ›·. √È ·ÛıÂÓÂ›˜ Û˘Ó‹ıˆ˜ Êı¿ÓÔ˘Ó ÛÙËÓÂÓËÏÈÎ›ˆÛË. £ÂÚ·Â˘ÙÈÎ¿ ¯ÔÚËÁÂ›Ù·È G-CSF (9).

™‡Ó‰ÚÔÌÔ Chediak - Higashi∂›Ó·È Ì›· Û¿ÓÈ· ÁÂÓÂÙÈÎ‹ ‰È·Ù·Ú·¯‹. Ã·Ú·-

ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÚÈÎfi ÔÊı·ÏÌÔ‰ÂÚÌ·ÙÈÎfi ·ÏÊÈ-ÛÌfi, ·ÚÔ˘Û›· ÁÈÁ¿ÓÙÈˆÓ (2 - 5Ìm) ÁÎÚÈ-ÌÏÂ ÎÔÎ-Î›ˆÓ ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ,ËˆÛÈÓÔÊ›ÏˆÓ, ‚·ÛÂÔÊ›ÏˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ.

√È ·ÛıÂÓÂ›˜ ÌÂ ·˘Ùfi ÙÔ Û‡Ó‰ÚÔÌÔ ¤¯Ô˘Ó ·˘-ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÛÂ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜Î·È ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Ô‰Ô‡. √È ÂÚÈÛÛfiÙÂÚÔÈÎ·Ù·Ï‹ÁÔ˘Ó ÚÈÓ ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÂÙÒÓ, ·ÓÎ·È ÔÚÈÛÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ¤Ù˘¯·Ó Ì›· Ì·ÎÚ¿ ÂÈ-‚›ˆÛË ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓÔÛÙÒÓ (1).

√ÈÎÔÁÂÓ‹˜ Î·ÏÔ‹ıË˜ Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ¯ÚfiÓÈ·È‰ÈÔ·ı‹˜ Ô˘‰ÂÙÂÚÔÂÓ›·

™Â ·˘Ù‹ ÙËÓ ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ· ÂÚÈÏ·Ì‚¿ÓÂÙ·ÈÌ›· ÂÙÂÚÔÁÂÓ‹˜ ÔÌ¿‰· ·ÛıÂÓÒÓ. ∏ ·ÈÙ›· ‰ÂÓ Â›Ó·È·fiÏ˘Ù· ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓË. À¿Ú¯ÂÈ ÌÂÈˆÌ¤ÓË ‹ ÌË·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·Ú·ÁˆÁ‹ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ, ÁÈ·ÙËÓ ÔÔ›· Èı·ÓfiÓ Â˘ı‡ÓÔÓÙ·È ‰È·ÊÔÚÂÙÈÎÔ› ÌË¯·-ÓÈÛÌÔ› ·fi ·ÛıÂÓ‹ ÛÂ ·ÛıÂÓ‹. ∞Ó·Ê¤ÚÔÓÙ·È ÂÚÈ-ÙÒÛÂÈ˜ ·˘ÙfiÌ·ÙË˜ ›·ÛË˜ ÛÂ ËÏÈÎ›· 2-4 ÂÙÒÓ, ·Ï-Ï¿ Î·È ÌÂÙ¿ ·fi ·˘Ù‹ ÙËÓ ËÏÈÎ›· (2). √È ÂÚÈÛÛfi-ÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ Â›Ó·È ÛÔÚ·‰ÈÎ¤˜.

Œ¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÌÂ ·˘ÙÔÛˆ-Ì·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· ÛÂ ÌÂÚÈÎ¤˜ ÔÈÎÔ-Á¤ÓÂÈÂ˜, Î˘Ú›ˆ˜ ÛÙÔ˘˜ ∂‚Ú·›Ô˘˜ ÙË˜ ÀÂÌ¤ÓË˜.

∏ ÌÔÚÊÔÏÔÁ›· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÔÈÎ›Ï-ÏÂÈ ·fi ·ÛıÂÓ‹ ÛÂ ·ÛıÂÓ‹, ·ÏÏ¿ Î·È ÛÙÔÓ ›‰ÈÔ ÙÔÓ·ÛıÂÓ‹ ·fi Ï‹„ÂÈ˜ Ô˘ Á›ÓÔÓÙ·È ÛÂ ‰È·ÊÔÚÂÙÈ-ÎÔ‡˜ ¯ÚfiÓÔ˘˜. √ ·ÚÈıÌfi˜ ÙˆÓ ÚÔ‰ÚÔÌÈÎÒÓ ÎÔÎ-ÎÈÔ-/ÌÔÓÔ- Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi Â›Ó·È Â·ÚÎ‹˜,·Ú·ÙËÚÂ›Ù·È ‰È·ÎÔ‹ ÙË˜ ˆÚ›Ì·ÓÛË˜ ÛÂ ‰È¿ÊÔ-Ú· ÛÙ¿‰È· ·fi ÙÔ ÚÔÌ˘ÂÏÔÎ‡ÙÙ·ÚÔ Ì¤¯ÚÈ ÙÈ˜ÒÚÈÌÂ˜ ÌÔÚÊ¤˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ.

£ÂÚ·Â˘ÙÈÎ¿ ÔÚÈÛÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ··ÓÙÔ‡Ó


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ÛÙ· ÎÔÚÙÈÎÔÂÈ‰‹. ∏ ¯ÔÚ‹ÁËÛË G-CSF ¤¯ÂÈ, Â›ÛË˜,Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· (1,2).ÀÔÏ·Û›· ¯fiÓ‰ÚˆÓ – ÙÚÈ¯ÒÓ(Cartilage – hair hypoplasia)

∫ÏËÚÔÓÔÌÂ›Ù·È ÌÂ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ¯·Ú·ÎÙ‹Ú·. √È ¿Û¯ÔÓÙÂ˜ ÂÌÊ·Ó›˙Ô˘Ó Ó·ÓÈÛÌfi ÌÂÎÔÓÙ¿ Î¿Ùˆ ¿ÎÚ·, ÏÂÙ¤˜ ÙÚ›¯Â˜, Ì¤ÙÚÈ· Ô˘‰ÂÙÂÚÔ-ÂÓ›· (100–2000 Ô˘‰ÂÙÂÚfiÊÈÏ·/mm3) Î·È ‰È·Ù·Ú·-¯‹ ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ ·ÓÔÛ›·˜.

∞Ó·Ê¤ÚÂÙ·È ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ·ÓÔÛÈ·ÎÒÓ ÏÂÈ-ÙÔ˘ÚÁÈÒÓ Î·È ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÌÂÙ¿ ·fi ·ÏÏÔ-ÁÂÓ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fiHLA–ÈÛÙÔÛ˘Ì‚·ÙÔ‡˜ ‰fiÙÂ˜ (2,10).

ÕÏÏ· Û˘ÁÁÂÓ‹ ÓÔÛ‹Ì·Ù· Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È·fi Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È: Ë ·Ó·ÈÌ›· Fanconi, Ë·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, Ù· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎ¿ Û‡Ó‰ÚÔ-Ì·, Ë ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· (1/3 ÙˆÓ ·ÛıÂÓÒÓ), Ë‰˘ÛÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· Ù‡Ô˘ I, ÎÏ.

µÈ‚ÏÈÔÁÚ·Ê›·1. Bernini JC. Diagnosis and management of chronic

neutropenia during childhood. Pediatr Clin N Am 1996;43:773-775.

2. ¡athan DG, Oski FA. Hematology of infancy andchildhood. 4th ed. Philadelphia: Saunders Co; 1993. p.939-945.

3. Levinsky RJ, Tiedeman K. Successful bone - marrowtransplantation for reticular dysgenesis. Lancet 1983;1:671.

4. Deshpande RV, Lalezari P, Pergolizzi RG, Moore MA.Structural abnormalities in the G-CSF receptor in severecongenital neutropenia. J Hematother Stem Cell Res1999;8:411-420.

5. Zeidler C, Welte K, Barak Y, Barriga F, Bolyard AA, BoxerL et al. Stem cell transplantation in patients with severecongenital neutropenia without evidence of leukemictransformation. Blood 2000;95:1195-1198.

6. Dale DC, Hammond WP. Cyclic neutropenia: A clinicalreview. Blood Rev 1998;2:178.

7. ∞prikyan AA, Liles WC, Park JR, Jonas M, Chi EY, DaleDC. Myelokathexis, a congenital disorder of severeneutropenia characterized by accelerated apoptosis anddefective expression of bcl-x in neutrophil precursors.Blood 2000;95:320-327.

8. Faber J, Lauener R, Wick F, Betts D, Filgueira L, Seger RAet al. Shwachman–Diamond syndrome: early bone mar-row transplantation in a high risk patient and new clues topathogenesis. Eur J Pediatr 1999;158:995-1000.

9. Dokal I. Dyskeratosis congenita: recent advances andfuture directions. J Pediatr Hematol Oncol 1999;21:344-350.

10. Makitie O, Juvonen E, Dunkel L, Kaitila I, Siimes MA.Anemia in children with cartilage – hair hypoplasia isrelated to body growth and to the insulin – like growth


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. ∫·Ú·ÎfiÏË £. ™ÔÊÔ‡ÏË 50, 54655 £ÂÛÛ·ÏÔÓ›ÎË

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�¶ÂÚ›ÏË„Ë: ∂›Â‰· ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙÔ ÂÚÈÊÂ-ÚÈÎfi ·›Ì· Î¿Ùˆ ·fi Ù· Î·ÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈÎ¿ÔÚ›˙ÂÙ·È ˆ˜ ıÚÔÌ‚ÔÂÓ›·. ¶·Ú¿ ÙÔ ÌÂÁ¿ÏÔ ·ÚÈı-Ìfi Î·È ÙËÓ ÔÈÎÈÏ›· ÙˆÓ ·ÈÙ›ˆÓ Ô˘ ÙËÓ ÚÔÎ·ÏÔ‡Ó,Ë ıÚÔÌ‚ÔÂÓ›· Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÚÈÒÓ ‰ÈÂÚ-Á·ÛÈÒÓ: ÌÂÈˆÌ¤ÓË˜ ·Ú·ÁˆÁ‹˜ ·ÈÌÔÂÙ·Ï›ˆÓ ·fiÙÔÓ Ì˘ÂÏfi, ·˘ÍËÌ¤ÓË˜ Î·Ù·ÛÙÚÔÊ‹˜ ‹ ·ÓÒÌ·ÏË˜Î·Ù·ÓÔÌ‹˜ ÛÙËÓ ÂÚÈÊ¤ÚÂÈ·. ™ÙËÓ ÂÈÛ‹ÁËÛË ·˘Ù‹Î·Ù·ÁÚ¿ÊÂÙ·È Ë Î·Ù¿Ù·ÍË ÙˆÓ ıÚÔÌ‚ÔÂÓÈÒÓ Ô˘ÔÊÂ›ÏÔÓÙ·È ÛÂ ·ÓÂ¿ÚÎÂÈ· ·Ú·ÁˆÁ‹˜ ·ÈÌÔÂÙ·-Ï›ˆÓ ‚¿ÛÂÈ ÙÔ˘ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡Ô˘ ÂÌÏ¤ÎÂÙ·È Î·È Û˘˙ËÙÂ›Ù·È ‚Ú·¯¤ˆ˜ Ë ÎÏÈÓÈÎ‹ÂÈÎfiÓ· Î·È Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ıÚÔÌ‚ÔÂÓ›·, ÌÂÁ·Î·Ú˘ÔÎ‡ÙÙ·-ÚÔ, ·Ï·Û›·, ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÚÔÌ‚ÔÔ›ËÛË.

�Abstract: Thrombocytopenia is defined as asubnormal platelet count in the circulating blood.Despite the number and the diversity of disordersthat may be associated aetiologically, thrombocyto-penia results from only three processes: deficientplatelet production, accelerated platelet destructionand abnormal distribution or pooling of the plateletswithin the body. ∞ classification of thrombocytope-nia resulting from deficient platelet production basedon pathophysiologic, clinical and laboratory criteriais presented and briefly discussed in this paper.

Key words: thrombocytopenia, megakaryocyte,aplasia, ineffective thrombopoiesis.

£ÚÔÌ‚ÔÂÓ›Â˜ ÔÊÂÈÏfiÌÂÓÂ˜ ÛÂ ·ÓÂ·ÚÎ‹ ·Ú·ÁˆÁ‹ ·ÈÌÔÂÙ·Ï›ˆÓ∂. ¶Ï·ÙÔÎÔ‡ÎË - ∫ÔÌÈÙÔÔ‡ÏÔ˘

Thrombocytopenias resulting from deficient platelet production H. Platokouki - Komitopoulou

ø˜ ıÚÔÌ‚ÔÂÓ›· ÔÚ›˙ÂÙ·È ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ(∞ª¶) ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· <150.000/mm3, Ô˘ Â›-Ó·È Ù· Î·ÙÒÙÂÚ· fiÚÈ· ÁÈ· Î¿ıÂ ËÏÈÎ›·. ∏ ÛÔ‚·Ú‹ıÚÔÌ‚ÔÂÓ›· (∞ª¶ <50.000/mm3 ) ·ÔÙÂÏÂ› ÙË Û˘-¯ÓfiÙÂÚË ·ÈÙ›· ·ÈÌÔÚÚ·Á›·˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÂ ·-ıÔÏÔÁÈÎ¿ ·›ÙÈ·(1,2). ¶·Ú¿, fiÌˆ˜, ÙÔ ÌÂÁ¿ÏÔ ·ÚÈıÌfiÎ·È ÙËÓ ÔÈÎÈÏ›· ÙˆÓ ·ÈÙ›ˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ıÚÔÌ-‚ÔÂÓ›·, ·˘Ù‹ ÛÂ ÙÂÏÈÎ‹ ·Ó¿Ï˘ÛË ·ÔÙÂÏÂ› ÙÔ ÚÔ˚-fiÓ ÙÚÈÒÓ ‰ÈÂÚÁ·ÛÈÒÓ, ‰ËÏ·‰‹: ·ÓÂ·ÚÎÔ‡˜ ·Ú·-ÁˆÁ‹˜ ∞ª¶, ·˘ÍËÌ¤ÓË˜ Î·Ù·ÛÙÚÔÊ‹˜ Î·È ‰È·Ù·Ú·-¯‹˜ Î·Ù·ÓÔÌ‹˜ ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· (3-5).

°È· ÙË ‰È¿ÎÚÈÛË ÌÂÙ·Í‡ ÙÔ˘˜, ¯Ú‹ÛÈÌË ·Ú¿ÌÂ-ÙÚÔ˜ ı· ‹Ù·Ó Ë ·Â˘ıÂ›·˜ Ì¤ÙÚËÛË ÙÔ˘ Ú˘ıÌÔ‡ ·-Ú·ÁˆÁ‹˜ Ó¤ˆÓ ∞ª¶, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÌÂ Ù· ‰ÈÎÙ˘ÔÂ-Ú˘ıÚÔÎ‡Ù·ÚÚ· ÙˆÓ ÂÚ˘ıÚÒÓ. ∂ÏÏÂ›„ÂÈ Ù¤ÙÔÈ·˜ ‰˘-

Ó·ÙfiÙËÙ·˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È¤ÌÌÂÛÔÈ ‰Â›ÎÙÂ˜, fiˆ˜ Ë Û˘ÓÔ‰fi˜ ·Ï·Û›· Î·È ÙˆÓ¿ÏÏˆÓ ÛÂÈÚÒÓ ‹ ÔÈ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÙÔ˘ Ì¤ÛÔ˘ fiÁÎÔ˘·ÈÌÔÂÙ·Ï›ˆÓ (mean platelet volume, MPV) Ô˘ ·-Ú·ÙËÚÔ‡ÓÙ·È ÛÂ ıÚÔÌ‚ÔÂÓ›Â˜ ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔ-Á›·˜. ∏ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È, ·ÓÙÈı¤-Ùˆ˜, ¯Ú‹ÛÈÌË Ì¤ıÔ‰Ô˜ ÁÈ· ÙË Ì¤ÙÚËÛË ÌÂÁ¿ÏˆÓ ÓÂ-·ÚÒÓ ∞ª¶ Ô˘ ÂÚÈ¤¯Ô˘Ó RNA Î·È ÙÔ ÔÔ›Ô ˘fi Î·-ÓÔÓÈÎ¤˜ Û˘Óı‹ÎÂ˜ ‰ÂÓ ÂÌÂÚÈ¤¯ÂÙ·È ÛÙ· ∞ª¶ Ô˘Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ·›Ì·. µÂ‚·›ˆ˜, ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ·Â›Ó·È Ë ÂÍ¤Ù·ÛË ÂÎÏÔÁ‹˜ (2,4,6).

∆· ·ÈÌÔÂÙ¿ÏÈ·, ˆ˜ ÁÓˆÛÙfiÓ, ·ÔÙÂÏÔ‡Ó ÙÔ ÙÂÏÈ-Îfi ÚÔ˚fiÓ Ì›·˜ ‰È·‰ÈÎ·Û›·˜ Ô˘ ÍÂÎÈÓ¿ ·fi ÙÔ Ô-Ï˘‰‡Ó·ÌÔ ·Ú¯¤ÁÔÓÔ ·ÈÌÔÔÈËÙÈÎfi Î‡ÙÙ·ÚÔ Ô˘ ‰È·-ÊÔÚÔÔÈÂ›Ù·È ÛÙ·‰È·Î¿ ÛÂ ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú· Î·È

ªÔÓ¿‰· ∞ÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Division of Hemorrhagic Diathesis“Saint Sophia” Children’s Hospital, Athens


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Úfi‰ÚÔÌÂ˜ ÌÔÚÊ¤˜. ∞Ó·ÏfiÁˆ˜ ÙÔ˘ ÛÙ·‰›Ô˘ ÙË˜ ˆÚ›-Ì·ÓÛË˜, ‰È·Ê¤ÚÂÈ Ë ÈÎ·ÓfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÁÈ· ·Ó·-Ó¤ˆÛË, ·Ó¿Ù˘ÍË Î·È ‰Ú·ÛÙËÚÈfiÙËÙ· (7). ™ÙË Ú‡ıÌÈ-ÛË ÙË˜ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ·ÚÔÔ›ËÛË˜ ÂÌÏ¤ÎÔÓÙ·È ÔÈ-Î›ÏÔÈ ·Ú¿ÁÔÓÙÂ˜: ¯˘ÌÈÎÔ›, Î˘ÙÙ·ÚÈÎÔ›, ·˘ÍËÙÈÎÔ› Î·ÈÎ˘ÙÙ·ÚÔÎ›ÓÂ˜ (ÔÈ ÈÓÙÂÚÏÂ˘Î›ÓÂ˜ -IL 1,3,6,11, Ô GM-CSF, Ë ÂÚ˘ıÚÔÔÈËÙ›ÓË (EPO) Î·È Ë ıÚÔÌ‚ÔÔÈËÙ›ÓË(TPO), Ô˘ ÛÎÔfi ¤¯Ô˘Ó Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÍ¤ÏÈÍË·fi ÙÔ ¤Ó· ÛÙ¿‰ÈÔ ÛÙÔ ¿ÏÏÔ. ∂ÈÏ¤ÔÓ, ¤¯Ô˘Ó ÙËÓ ÈÎ·-ÓfiÙËÙ· (.¯. Ë ∆ƒ√) Ó· ·˘Í‹ÛÔ˘Ó ÙÔÓ ·ÚÈıÌfi, ÙÔ Ì¤-ÁÂıÔ˜, ÙËÓ ÏÔÈ‰›· Î·È ÙË Û˘ÓıÂÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙˆÓÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ. ∞ÓÙÈı¤Ùˆ˜, ÔÎ›ÏÂ˜ ÚˆÙÂ˝ÓÂ˜,fiˆ˜ Ô ·ÈÌÔÂÙ·ÏÈ·Îfi˜ ·Ú¿ÁÔÓÙ·˜ 4 (PF4), Ë ÈÓÙÂÚ-ÊÂÚfiÓË (INF) ÎÏ, ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔ Û¯ËÌ·ÙÈÛÌfi Î·ÈÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ (1,7,8). ™ÂÎ¿ıÂ ÂÚ›ÙˆÛË, ¿ÓÙˆ˜, Ô ÙÂÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ Ô˘ Î˘ÎÏÔÊÔÚÂ› ·ÓÙ·Ó·ÎÏ¿ ¤Ó·Ó Î·Ï¿Ú˘ıÌÈÛÌ¤ÓÔ ÌË¯·ÓÈÛÌfi ÈÛÔÚÚÔ›·˜ ÌÂÙ·Í‡ ·Ú·Áˆ-Á‹˜ Î·È Î·Ù·ÛÙÚÔÊ‹˜. ∏ ‰Â ·ÓÂ·ÚÎ‹˜ ·Ú·ÁˆÁ‹ ·È-ÌÔÂÙ·Ï›ˆÓ, ÚÔÎ‡ÙÂÈ ·fi ‰È·Ù·Ú·¯‹, ÛÂ ÔÔÈÔ‰‹-ÔÙÂ ·fi Ù· ÛÙ¿‰È· ÙË˜ ıÚÔÌ‚ÔÔ›ËÛË˜.

£ÚÔÌ‚ÔÂÓ›· ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ (2,5,8), Û˘-¯ÓfiÙÂÚ· ÔÊÂ›ÏÂÙ·È ÛÂ ˘ÔÏ·Û›· ‹ Î·Ù·›ÂÛË ÙˆÓÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ, ÏfiÁˆ Î·Ù·ÛÙÔÏ‹˜ ÙÔ˘ Ì˘ÂÏÔ‡·fi Ê¿ÚÌ·Î· Î·È ¿ÏÏÔ˘˜ ¯ËÌÈÎÔ‡˜/ Ê˘ÛÈÎÔ‡˜ ·Ú¿-ÁÔÓÙÂ˜ ‹ Î·Ù¿ÏË„‹˜ ÙÔ˘ ·fi Í¤Ó· Î‡ÙÙ·Ú·. ∏ ıÚÔÌ-‚ÔÂÓ›· Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÚÔÌ-‚ÔÔ›ËÛË (·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ µ12/Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜,·ÚÔÍ˘ÛÌÈÎ‹ Ó˘ÎÙÂÚÈÓ‹ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·), Û·Ó›ˆ˜Â›Ó·È ÛÔ‚·Ú‹. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ë ·Ú·ÁˆÁ‹ ·È-ÌÔÂÙ·Ï›ˆÓ ˘ÔÏÂ›ÂÙ·È, Â›ÙÂ ÏfiÁˆ ·ÓÂ·ÚÎÔ‡˜ Û‡Ó-ıÂÛË˜ DNA, Â›ÙÂ ÏfiÁˆ ˘ÂÚÂ˘·ÈÛıËÛ›·˜ ÙË˜ ÌÂÌ‚Ú¿-ÓË˜ ÙÔ˘˜ ÛÂ ·ÓÙÈÛÒÌ·Ù· Î·È ÙÔ Û˘ÌÏ‹ÚˆÌ·, ·Ú¿ÙÔÓ ·˘ÍËÌ¤ÓÔ ·ÚÈıÌfi ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ. √È‰È·Ù·Ú·¯¤˜ ÙˆÓ Ú˘ıÌÈÛÙÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ ÙË˜ ıÚÔÌ-‚ÔÔ›ËÛË˜ (·ÓÂ¿ÚÎÂÈ· ıÚÔÌ‚ÔÔÈËÙ›ÓË˜, Î˘ÎÏÈÎ‹ıÚÔÌ‚ÔÂÓ›·, ÂÚÈÔ‰ÈÎ‹ ‰˘ÛÁÂÓÂÛ›· ·ÈÌÔÂÙ·Ï›ˆÓ)Â›Ó·È, Ô‡Ùˆ˜ ‹ ¿ÏÏˆ˜, Û¿ÓÈÂ˜ Î·È Î·Ù¿ Î·ÓfiÓ· ‰ÂÓÚÔÎ·ÏÔ‡Ó ÔÏ‡ ÛÔ‚·Ú¤˜ ıÚÔÌ‚ÔÂÓ›Â˜. √ ·ıÔ-Ê˘ÛÈÔÏÔÁÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ Ô˘ ÂÌÏ¤ÎÂÙ·È ÛÙÈ˜ ‰È¿-ÊÔÚÂ˜ ÎÏËÚÔÓÔÌÈÎ¤˜ ıÚÔÌ‚ÔÂÓ›Â˜ Â›Ó·È ÂÚÈÛÛfiÙÂ-ÚÔ Û‡ÓıÂÙÔ˜ Î·È ÔÈÎ›ÏÔ˜ (5).

∞Ó Î·È Ô ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ ıÚÔÌ‚ÔÂÓÈÒÓ ÎÂÓÙÚÈ-Î‹˜ ·ÈÙÈÔÏÔÁ›·˜, ‚¿ÛÂÈ ÙÔ˘ ·ÈÙ›Ô˘ Ô˘ ÙÈ˜ ÚÔÎ·ÏÂ›,ÛÂ ÚˆÙÔ·ıÂ›˜ (ÎÏËÚÔÓÔÌÈÎ¤˜, Û˘ÁÁÂÓÂ›˜ ·ÌÂÁ·Î·-Ú˘ÔÎ˘ÙÙ·ÚÈÎ¤˜, Î˘ÎÏÈÎ¤˜, ÎÏ) Î·È ‰Â˘ÙÂÚÔ·ıÂ›˜(·Ï·Û›Â˜, Ì˘ÂÏÔ‰˘ÛÏ·Û›Â˜, Ì˘ÂÏfiÊıÈÛË, ÏÔÈÌÒ-ÍÂÈ˜, ˘Ô‚ÈÙ·ÌÈÓÒÛÂÈ˜, ÎÏ) ÌÔÚÂ› Ó· Â›Ó·È ÎÏÈÓÈÎ¿¯Ú‹ÛÈÌÔ˜, ÂÓÙÔ‡ÙÔÈ˜, ÔÈ fiÚÔÈ ÚˆÙÔ·ıÂ›˜/È‰ÈÔ·ıÂ›˜‰ÂÓ ¤¯Ô˘Ó Ô˘ÛÈ·ÛÙÈÎfi ÓfiËÌ· ÛÙË Û‡Á¯ÚÔÓË È·ÙÚÈÎ‹.¶ÚÔÎÂÈÌ¤ÓÔ˘ ÁÈ· Ù· ·È‰È¿, Ù· ÔÔ›· Î·È Ì¿˜ ÂÓ‰È·-Ê¤ÚÔ˘Ó, ı· ‹Ù·Ó ›Ûˆ˜ ÚÔÙÈÌfiÙÂÚÔ ÔÈ ıÚÔÌ‚ÔÂÓ›Â˜ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ Ó· ‰È·¯ˆÚÈÛıÔ‡Ó ÎÏÈÓÈÎ¿ ÛÂ

Û˘ÁÁÂÓÂ›˜, ÎÏËÚÔÓÔÌÈÎ¤˜, ÓÂÔÁÓÈÎ¤˜ Î·È Â›ÎÙËÙÂ˜(¶›Ó·Î·˜ 1).

∏ Û˘ÁÁÂÓ‹˜ ·ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ·ÚÈÎ‹ ıÚÔÌ‚ÔÂÓ›·(5,8,9) Â›Ó·È ·ÌÊ›‚ÔÏÔ ·Ó ·ÔÙÂÏÂ› ÌÔÓ‹ÚË ‰È·Ù·Ú·-¯‹ ‹ ·ÏÒ˜ Ì›· Ê¿ÛË ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ·Ï·ÛÙÈÎ‹˜·Ó·ÈÌ›·˜. ™Â ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ ÂÚÈÁÚ¿ÊÂÙ·ÈıÚÔÌ‚ÔÂÓ›· ÔÈÎ›ÏË˜ ‚·Ú‡ÙËÙ·˜ ÚÔ ÙË˜ ËÏÈÎ›·˜ÙˆÓ 12-18 ÌËÓÒÓ Î·È ·Ó¿Ù˘ÍË ·ÁÎ˘ÙÙ·ÚÔÂÓ›·˜·ÚÁfiÙÂÚ·. ∞Ó Î·È ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛıÂ› Â·ÎÚÈ-‚Ò˜ ÔÈ ÁÔÓÈ‰È·Î¤˜ ‚Ï¿‚Â˜ (fiˆ˜ ¯ ÛÙËÓ ·Ó·ÈÌ›·Fanconi), ¿ÓÙˆ˜ ˘¿Ú¯ÂÈ Û·Ê¤˜ ÁÂÓÂÙÈÎfi ˘fi-ÛÙÚˆÌ·. ∞Ó·Ê¤ÚÂÙ·È ÌÂÁ¿ÏË ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ(ÙÚÈÏ¿ÛÈ· Û˘¯ÓfiÙËÙ· ·fi Ù· ÎÔÚ›ÙÛÈ·). ªfiÓÔ ÛÂÛÔÚ·‰ÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ Ê·›ÓÂÙ·È Ó· Û˘Ó˘¿Ú¯Ô˘Ó¿ÏÏÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜. ª¤ÙÚËÛË ·ÈÌÔÂÙ·Ï›ˆÓÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ Ì¤ÛÔÓ ÙË˜ Î˘‹ÛÂˆ˜ ÚÔÙÂ›ÓÂÙ·Èˆ˜ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË. ∏ ÚfiÁÓˆÛË Â›Ó·È Î·Î‹,Â›ÙÂ Â›Ó·È ÌÔÓ‹ÚË˜ Ë ‰È·Ù·Ú·¯‹ Â›ÙÂ Û˘Ó‰˘·ÛÌ¤ÓË.

∏ Û˘ÁÁÂÓ‹˜ ·Ô˘Û›· ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ Ô˘Û˘ÓÔ‰Â‡ÂÙ·È ·fi ¿ÏÏÂ˜ ·ÓˆÌ·Ï›Â˜, ·ÔÙÂÏÂ› Û¿ÓÈÔ·›ÙÈÔ ÛÔ‚·Ú‹˜, fiÌˆ˜, ıÚÔÌ‚ÔÂÓ›·˜ ÛÂ ÓÂÔÁÓ¿ (5).¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈÎ›ÏÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ (ÛÎÂ-ÏÂÙÈÎ¤˜ ‹ Ô˘ÚÔÔÈËÙÈÎÔ‡ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹-Ì·ÙÔ˜), Ë Û˘¯ÓfiÙÂÚ·, fiÌˆ˜, ··ÓÙÒÌÂÓË ‰È·Ù·Ú·¯‹(~90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ) Â›Ó·È Ë ·ÌÊÔÙÂÚfiÏÂ˘ÚË·Ô˘Û›· ÙˆÓ ÔÛÙÒÓ ÙË˜ ÎÂÚÎ›‰·˜ (ÂÍ Ô˘ Î·È Û‡Ó-‰ÚÔÌÔ ∆∞R - thrombocytopenia with absent radiisyndrome). ¶¿ÓÙÔÙÂ, fiÌˆ˜, ˘¿Ú¯Ô˘Ó ÔÈ ·ÓÙ›¯ÂÈÚÂ˜,ÁÂÁÔÓfi˜ ¯Ú‹ÛÈÌÔ ÁÈ· ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ¿ÏÏˆÓÛ˘Ó‰ÚfiÌˆÓ (·Ó·ÈÌ›· Fanconi ‹ ÙÚÈÛˆÌ›· 18). ¢Â‰Ô-Ì¤ÓÔ˘ fiÙÈ ÔÈ ÎÂÚÎ›‰Â˜, Ë Î·Ú‰È¿ Î·È Ù· ÌÂÁ·Î·Ú˘Ô-Î‡ÙÙ·Ú· ·Ó·Ù‡ÛÛÔÓÙ·È fiÏ· ÌÂÙ·Í‡ 6Ë˜-8Ë˜ Â‚‰Ô-Ì¿‰·˜ Î˘‹ÛÂˆ˜, ÂÓ‰¤¯ÂÙ·È ÂÓ‰ÔÌ‹ÙÚÈ· ‚Ï¿‚Ë Û’ ·˘-Ù‹ ÙËÓ ËÏÈÎ›· Ó· ÚÔÎ·ÏÂ› ÙË ‰È·Ù·Ú·¯‹. ∞Ó ÎÈ ¤¯ÂÈ

¶›Ó·Î·˜ 1: ∫ÏÈÓÈÎ‹ Î·Ù¿Ù·ÍË ıÚÔÌ‚ÔÂÓÈÒÓ ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜

™˘ÁÁÂÓ‹˜ ıÚÔÌ‚ÔÂÓ›··Ó·ÈÌ›· FanconiÛ‡Ó‰ÚÔÌÔ TAR·ÓÂ¿ÚÎÂÈ· ıÚÔÌ‚ÔÔÈËÙ›ÓË˜

∫ÏËÚÔÓÔÌÈÎ‹ ıÚÔÌ‚ÔÂÓ›·Û‡Ó‰ÚÔÌÔ Wiskott-Aldrich·ÓˆÌ·Ï›· May-HegglinÛ‡Ó‰ÚÔÌÔ AlportªÂÛÔÁÂÈ·Î‹ Ì·ÎÚÔıÚÔÌ‚ÔÂÓ›·ÔÈÎ›ÏˆÓ Ù‡ˆÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜

¡ÂÔÁÓÈÎ‹ ıÚÔÌ‚ÔÂÓ›·‰È‹ıËÛË Ì˘ÂÏÔ‡ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË (ÂÚ˘ıÚ¿, CMV)Ï‹„Ë ıÂÈ·˙È‰ÒÓ ·fi ÙË ÌËÙ¤Ú·

∂›ÎÙËÙË ıÚÔÌ‚ÔÂÓ›·

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 31

ÂÓÔ¯ÔÔÈËıÂ› ÏÔ›ÌˆÍË ·fi ÂÚ˘ıÚ¿, Ë ‚Ï¿‚Ë ıÂˆ-ÚÂ›Ù·È Ì¿ÏÏÔÓ ÁÂÓÂÙÈÎ‹, ·Ú¿ Â›ÎÙËÙË. ¶Èı·ÓÔÏÔ-ÁÂ›Ù·È fiÙÈ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfiÁÔÓ›‰ÈÔ, ·Ó Î·È ·Ó·Ê¤ÚÂÙ·È ÂÏ·ÊÚ¿ ˘ÂÚÔ¯‹ ÙˆÓÎÔÚÈÙÛÈÒÓ. ¶¿ÓÙˆ˜, ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÚ›ÙË 16Ë-20Ë Â‚‰ÔÌ¿‰· Î˘‹ÛÂˆ˜ ‚ÔËı¿ ÛÙËÓ ÚÔ-ÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË. ∞·ÈÙÂ›Ù·È, fiÌˆ˜, ·ÂÈÎfiÓÈÛËÎ·È ÙˆÓ ‰‡Ô ¿Óˆ ¿ÎÚˆÓ, ÁÈ·Ù› ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Ï›-ÁÂ˜ ÂÚÈÙÒÛÂÈ˜ ÂÙÂÚfiÏÂ˘ÚË˜ ·Ï·Û›·˜ ÎÂÚÎ›‰Ô˜(5,8). ∏ ÚfiÁÓˆÛË Â›Ó·È Î·Î‹. £¿Ó·ÙÔ˜ ÛÙË ‚ÚÂÊÈÎ‹ËÏÈÎ›·, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ÈÌÔÚÚ·Á›·˜, Û˘Ì‚·›ÓÂÈ ÛÙÔ25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ŸÛÔÈ, fiÌˆ˜, ÂÈ‚ÈÒÛÔ˘Ó,·ÓÂ‚¿˙Ô˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ>100.000/mm3 Û˘Ó‹ıˆ˜, Â›Â‰· ¯Ú‹ÛÈÌ· ÁÈ· ÙÈ˜ÔÚıÔÂ‰ÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ Ô˘ ı· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó.ªÂÙ¿ÁÁÈÛË ∞ª¶ ·fi ‰fiÙË HLA Û˘Ì‚·Ùfi ÚÔÙÂ›ÓÂ-Ù·È ˆ˜ ıÂÚ·Â›· ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ,ÚÔÊ˘Ï·ÎÙÈÎ‹, fiÌˆ˜, ¯ÔÚ‹ÁËÛË ÛÂ ·È‰È¿ Î¿Ùˆ ÙÔ˘¤ÙÔ˘˜ ‰ÂÓ Â›Ó·È ÎÔÈÓ¿ ·Ô‰ÂÎÙ‹.

°È· ÙË ıÚÔÌ‚ÔÔÈËÙ›ÓË Ì·ı·›ÓÔ˘ÌÂ ÔÏÏ¿ Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·ÏÏ¿ ·ÁÓÔÔ‡ÌÂ ÔÏÏ¿ ÂÚÈÛÛfiÙÂ-Ú·. ∏ ˘fiıÂÛË ÁÈ· ÙËÓ ‡·ÚÍ‹ ÙË˜ Î·È ÙÔ fiÓÔÌ· ‰fi-ıËÎÂ ‹‰Ë ·fi ÙÔ 1958, ·ÏÏ¿ ÌfiÏÈ˜ ÙÔ 1994 ÎÏˆÓÔ-ÔÈ‹ıËÎÂ. ∆Ô ÁÔÓ›‰ÈÔ Ô˘ ÙËÓ Îˆ‰ÈÎÔÔÈÂ› Â‰Ú¿˙ÂÙ·ÈÛÙÔ ¯ÚˆÌfiÛˆÌ· 1 (1p34). ∏ ∆ƒ√ Î·È Ô Î˘ÙÙ·ÚÈÎfi˜˘Ô‰Ô¯¤·˜ ÙË˜, ÙÔ ÚˆÙÔÔÁÎÔÁÔÓ›‰ÈÔ c-mpl, ÙÔ˘ÔÔ›Ô˘ ÙÔ ÁÔÓ›‰ÈÔ ¤¯ÂÈ Â›ÛË˜ ¯·ÚÙÔÁÚ·ÊËıÂ›(3q26.3-q27), Ê·›ÓÂÙ·È fiÙÈ ·›˙Ô˘Ó ‚·ÛÈÎfi ÚfiÏÔ ÛÙËÚ‡ıÌÈÛË ÙË˜ ·Ú·ÁˆÁ‹˜ ∞ª¶. ™Â Û˘Óı‹ÎÂ˜ ıÚÔÌ-‚ÔÂÓ›·˜, ÁÂÓÈÎÒ˜, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ∆ƒ√ ÛÙÔ Ï¿-ÛÌ· Â›Ó·È ·˘ÍËÌ¤ÓÂ˜, ÏfiÁˆ ÂÓÂÚÁÔÔ›ËÛË˜ ÌË¯·ÓÈ-ÛÌÔ‡ ·Ï›Ó‰ÚÔÌË˜ ·ÏÏËÏÔÚÚ‡ıÌÈÛË˜ (feed-back).∂ÈÏ¤ÔÓ, Ê·›ÓÂÙ·È fiÙÈ Ù· ·ÈÌÔÂÙ¿ÏÈ· ·ÚÂÌ‚·›-ÓÔ˘Ó ÛÙË ÛÙ¿ıÌË ÙË˜ ∆ƒ√, ‰ÈfiÙÈ ¤¯Ô˘Ó ÙË ‰˘Ó·Ùfi-ÙËÙ· Ó· ÙË ‰ÂÛÌÂ‡Ô˘Ó ÌÂ ÙË ‚Ô‹ıÂÈ· ÂÈ‰ÈÎÔ‡ ˘Ô-‰Ô¯¤·. ∂ÚÂ˘Ó¿Ù·È Î·Ù¿ fiÛÔ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜·Ï·Û›·˜ ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ˘¿Ú¯ÂÈ ·‰˘Ó·-Ì›· ÚfiÛ‰ÂÛË˜ ÙË˜ ∆ƒ√ ÛÙÔÓ ˘Ô‰Ô¯¤· ÙË˜ (10).

√È ÎÏËÚÔÓÔÌÈÎ¤˜ ıÚÔÌ‚ÔÂÓ›Â˜ (5), ·ÔÙÂÏÔ‡ÓÌ›· ÔÌ¿‰· ıÚÔÌ‚ÔÂÓÈÒÓ ÛÙÈ˜ ÔÔ›Â˜ Ë ‚·ÛÈÎ‹ ‚Ï¿-‚Ë Â›Ó·È ¿ÁÓˆÛÙË, Ë ÂÈÎfiÓ· ÙÔ˘ Ì˘ÂÏÔ‡ ¯ˆÚ›˜ È‰È·›-ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È Ë ÁÓÒÛË Ì·˜ ÁÈ· ÙËÓ ÎÈÓË-ÙÈÎ‹ ÙˆÓ ∞ª¶ ·ÙÂÏ‹˜. √È ÂÚÈÛÛfiÙÂÚÂ˜ Û˘ÓÔ‰Â‡Ô-ÓÙ·È ÂÈÚÔÛı¤Ùˆ˜, ·fi ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜∞ª¶. ¢È·¯ˆÚ›˙ÔÓÙ·È Î·Ï‡ÙÂÚ· ‚¿ÛÂÈ ÙÔ˘ ÙÚfiÔ˘ÌÂÙ·‚›‚·ÛË˜ ÙË˜ ‰È·Ù·Ú·¯‹˜.

∆Ô Û‡Ó‰ÚÔÌÔ Wiskott-Aldrich Â›Ó·È ‰È·Ù·Ú·¯‹Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯ÚˆÌfiÛˆÌ·,Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Î·Ù¿ Î·ÓfiÓ· ¿Û¯Ô˘Ó ·ÁfiÚÈ·. Ã·-Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤Î˙ÂÌ·, ıÚÔÌ‚ÔÂÓ›· ÎÈ Â˘·ÈÛıË-Û›· ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜, ÏfiÁˆ ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙË˜ ¯˘ÌÈ-Î‹˜, ·ÏÏ¿ Î·È Î˘ÙÙ·ÚÈÎ‹˜, ·ÓÔÛ›·˜. √ ·fiÏ˘ÙÔ˜·ÚÈıÌfi˜ ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ Ì˘ÂÏfi Â›Ó·È

Ê˘ÛÈÔÏÔÁÈÎfi˜ ‹/Î·È ·˘ÍËÌ¤ÓÔ˜, ˘¿Ú¯ÂÈ, fiÌˆ˜, ‰È·-Ù·Ú·¯‹ ÛÙËÓ ˆÚ›Ì·ÓÛ‹ ÙÔ˘˜. ∞˘Ùfi Ô‰ËÁÂ› ÙfiÛÔ ÛÂ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·Ú·ÁˆÁ‹ ∞ª¶, fiÛÔ Î·È ÛÂ ‚Ú¿-¯˘ÓÛË ÙË˜ ˙ˆ‹˜ ÙÔ˘˜ (30% ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡), ÂÓ-‰Â¯ÔÌ¤Óˆ˜ ÏfiÁˆ ÂÓ‰ÔÌ˘ÂÏÈÎ‹˜ Î·Ù·ÛÙÚÔÊ‹˜. £Â-Ú·Â›· ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹, ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›ÓË˜ ‹ ÛÏËÓÂÎÙÔÌ‹ ÂÏ¿¯ÈÛÙ· ·Ô‰›‰ÂÈ (5).

√È ıÚÔÌ‚ÔÂÓ›Â˜ Ô˘ ÌÂÙ·‚È‚¿˙ÔÓÙ·È ÌÂ ÂÈ-ÎÚ·ÙÔ‡ÓÙ· ÛˆÌ·ÙÈÎfi ÁfiÓÔ ¤¯Ô˘Ó, ·Ú·‰fiÍˆ˜, ‰È·-ÊÔÚÂÙÈÎfi Ì¤ÁÂıÔ˜ ∞ª¶ ·fi ÙÈ˜ ˘fiÏÔÈÂ˜ ıÚÔÌ‚Ô-ÂÓ›Â˜ ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ -Î˘Ì·›ÓÂÙ·È ·fi ·ÏÒ˜ÌÂÁ·Ï‡ÙÂÚÔ ¤ˆ˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÈÏ¿ÛÈÔ. ∫·È ·˘Ù¤˜ÔÈ ıÚÔÌ‚ÔÂÓ›Â˜ ÂÓ‰¤¯ÂÙ·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fiÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ∞ª¶.

∏ ·ÓˆÌ·Ï›· May-Hegglin ·Ô‰›‰ÂÙ·È ÛÂ ‰È·Ù·-Ú·¯‹ Î·Ù¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ Î·Ù·ÎÂÚÌ·ÙÈÛÌÔ‡ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ Ô˘ Î·Ù·Ï‹ÁÂÈ ÛÂ Û‡ÓÙË-ÍË/ Û˘Á¯ÒÓÂ˘ÛË ∞ª¶, Ù· ÔÔ›· ÂÚÈ¤¯Ô˘Ó ÙÂÚ¿ÛÙÈ·ÎÔÎÎ›·. µ·ÛÂfiÊÈÏ· ÎÔÎÎ›· (Dohle bodies) ·ÓÈ¯ÓÂ‡Ô-ÓÙ·È, Â›ÛË˜, ÛÙ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·. ∏ ıÚÔÌ‚ÔÂ-Ó›· Â›Ó·È ÂÓ›ÔÙÂ ÛÔ‚·Ú‹.

™ÙÔ Û‡Ó‰ÚÔÌÔ Alport (ıÚÔÌ‚ÔÂÓ›·, ÎÒÊˆÛË,ÓÂÊÚ›ÙÈ˜), Ë Ì·ÎÚÔıÚÔÌ‚ÔÂÓ›· ·Ô‰›‰ÂÙ·È ÛÂ ·-Ú·ÁˆÁ‹ ∞ª¶ Ï›ÁˆÓ ÛÂ ·ÚÈıÌfi, ÌÂÁ¿ÏˆÓ ÛÂ Ì¤ÁÂ-ıÔ˜, ·ÏÏ¿ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ‰ÔÌ‹˜, ·fi ÌÂÁ·Î·Ú˘Ô-Î‡ÙÙ·Ú· ÌË Ê˘ÛÈÔÏÔÁÈÎ‹˜ ‰ÔÌ‹˜.

™ÙË ªÂÛÔÁÂÈ·Î‹ ıÚÔÌ‚ÔÂÓ›· ÂÚÈÁÚ¿ÊÂÙ·È ·-Ú·ÁˆÁ‹ ÏÈÁfiÙÂÚˆÓ ∞ª¶ ·Ó¿ ÌÂÁ·Î·Ú˘ÔÎ‡ÙÙ·ÚÔ,ÏfiÁˆ ‚Ï¿‚Ë˜ ÛÙË ‰È·›ÚÂÛË ÙÔ˘ Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹ ∞ª¶.∂›Ó·È, ¿ÓÙˆ˜, Î·ÏÔ‹ıË˜ ‰È·Ù·Ú·¯‹ Ô˘ ‰ÂÓ Û˘ÓÔ-‰Â‡ÂÙ·È ·fi ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿ıÂÛË.

∆¤ÏÔ˜, ÛÂ ÂÏ¿¯ÈÛÙÂ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ¤¯Ô˘Ó ÂÚÈÁÚ·-ÊÂ› ıÚÔÌ‚ÔÂÓ›Â˜ Ô˘ ıÂˆÚÂ›Ù·È fiÙÈ ÎÏËÚÔÓÔÌÔ‡-ÓÙ·È ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi ÁÔÓ›‰ÈÔ. ∞ÔÙÂÏÔ‡ÓÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÌÂ ÔÈÎ›Ï· ̄ ·Ú·ÎÙËÚÈÛÙÈÎ¿. ∆Ô Î˘-ÚÈfiÙÂÚÔ Â›Ó·È Ë ÔÛÔÙÈÎ‹ ‹/Î·È ÔÈÔÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ Ô˘ ·Ô‰›‰Ô˘Ó ∞ª¶ ÌÂÔÏ‡ ‚Ú·¯‡ ¯ÚfiÓÔ ˙ˆ‹˜ ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· Î·È, Ê˘ÛÈ-Î¿ ÏÂÈÙÔ˘ÚÁÈÎ¿ ·ÓÂ·ÚÎ‹. ™Â ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›·˘¿ÁÂÙ·È Ë Bernard-Soulier, ÙÔ gray plateletsyndrome, ÎÏ (5).

∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ı· ·ÔÙÂ-ÏÔ‡ÛÂ ÙË ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ, ·Ófi¯È ÛÙÔ ·ÚfiÓ, ÁÈ· ÔÏÏ¤˜ ·fi ÙÈ˜ ıÚÔÌ‚ÔÂÓ›Â˜ ÌÂÌfiÓÈÌÂ˜ ‚Ï¿‚Â˜.

∏ ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ (ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÛË, Û˘ÁÁÂ-Ó‹˜ ÏÂ˘¯·ÈÌ›·) Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ·ÈÙ›· ıÚÔÌ-‚ÔÂÓ›·˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô (2,4,5). ∞ÓÙÈı¤-Ùˆ˜, ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· Â›Ó·È Û˘¯Ófi Â‡ÚËÌ· ÛÂÓÂÔÁÓ¿ Ô˘ ¿Û¯Ô˘Ó ·fi Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜, Î˘-Ú›ˆ˜ ÂÚ˘ıÚ¿ Î·È ÓfiÛÔ ·fi Î˘ÙÙ·ÚÔÌÂÁ·ÏÔÈfi. ∏ıÚÔÌ‚ÔÂÓ›· ·Ô‰›‰ÂÙ·È ÛÂ Î·Ù·ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË


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ÙÔ˘ ÈÔ‡ ÛÙËÓ ·Ú·ÁˆÁ‹ ∞ª¶. ™Ù· ÓÂÔÁÓ¿ Ô˘ ÂÈ-˙Ô‡Ó, Ë ıÚÔÌ‚ÔÂÓ›· ·ÔÎ·ı›ÛÙ·Ù·È ÔÏÏÔ‡˜ Ì‹ÓÂ˜·ÚÁfiÙÂÚ·. ŒÁÎ˘Â˜, ÂÍ¿ÏÏÔ˘, Ô˘ Ï·Ì‚¿ÓÔ˘Ó ıÂÈ·˙›-‰Â˜ ÂÓ‰¤¯ÂÙ·È Ó· ÁÂÓÓ‹ÛÔ˘Ó ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ıÚÔÌ-‚ÔÂÓ›· Ô˘ ÌÔÚÂ› Ó· Î·Ù·Ï‹ÍÔ˘Ó ·fi ÂÁÎÂÊ·ÏÈÎ‹·ÈÌÔÚÚ·Á›·, ¯ˆÚ›˜ ÔÈ ›‰ÈÂ˜ Ó· ¤¯Ô˘Ó ıÚÔÌ‚ÔÂÓ›·. ∏ıÚÔÌ‚ÔÂÓ›· ·Ô‰›‰ÂÙ·È ÛÂ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÙÔ˘ Ê·Ú-Ì¿ÎÔ˘ ÛÙ· ÌÂÁ·Î·Ú˘ÔÎ‡ÙÙ·Ú· Î·È ·ÔÎ·ı›ÛÙ·Ù·ÈÔÏ‡ ÁÚ‹ÁÔÚ· (~10 ËÌ¤ÚÂ˜).

™ÙÔÓ ¶›Ó·Î· 2 ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Â›ÎÙËÙÂ˜ Î·Ù·-ÛÙ¿ÛÂÈ˜ Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ıÚÔÌ‚ÔÂÓ›· ÎÂÓÙÚÈ-Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ (5). ∂Í ·˘ÙÒÓ, Ë ÂÈÏÂÎÙÈÎ‹ ·Ï·Û›·ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ Â›Ó·È ÂÍ·ÈÚÂÙÈÎÒ˜ Û¿ÓÈ·,ÂÓ‰¤¯ÂÙ·È, fiÌˆ˜, Ó· ·ÔÙÂÏÂ› ÚÒÈÌË ÂÎ‰‹ÏˆÛË ÁÂ-ÓÈÎÂ˘Ì¤ÓË˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈ-ÎÔ‡ Î˘ÙÙ¿ÚÔ˘ (stem cell), Ë ÔÔ›· ı· ÂÎ‰ËÏˆıÂ› ·Ú-ÁfiÙÂÚ·. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, Ë ·ÔÎ·Ù¿ÛÙ·ÛËÙË˜ ıÚÔÌ‚ÔÂÓ›·˜ Â›Ó·È ÔÏ‡ ‚Ú·‰‡ÙÂÚË ÙˆÓ ¿ÏÏˆÓÛÂÈÚÒÓ. ¶·ÚfiÙÈ Ô ÂÌÏÂÎfiÌÂÓÔ˜ ÌË¯·ÓÈÛÌfi˜ ÁÈ· ÙËÓÎ·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ‹ ÙËÓ Î¿ı·Ú-ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È ·ÓÔÛÔÏÔÁÈ-Îfi˜, ÂÓÙÔ‡ÙÔÈ˜, ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ¯ÚˆÌÔÛˆÌÈ·Î¤˜·ÓˆÌ·Ï›Â˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡.

∏ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜ ÔÏfiÛˆÌË˜ ·ÎÙÈÓÔ‚ÔÏ›·˜ ÛÙÈ˜Úfi‰ÚÔÌÂ˜ ÌÔÚÊ¤˜ ÙˆÓ ∞ª¶, ·ÏÏ¿ fi¯È ÛÙ· Î˘ÎÏÔ-ÊÔÚÔ‡ÓÙ· ∞ª¶, ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ·ÊÚ¿Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ÂÌÊ¿ÓÈÛË ıÚÔÌ‚ÔÂÓ›·˜. ∏ Î˘-ÎÏÈÎ‹, ·Ó¿ 30 ËÌ¤ÚÂ˜ ÂÚ›Ô˘, ıÚÔÌ‚ÔÂÓ›·, ÔÈÎ›-ÏË˜ ‚·Ú‡ÙËÙ·˜, Û˘Ì‚·›ÓÂÈ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÂÊ‹-‚Ô˘˜ Î·È Á˘Ó·›ÎÂ˜ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜, ~2Â‚‰ÔÌ¿‰Â˜ ÚÔ ÙË˜ ÂÚÈfi‰Ô˘ (·ÎÚÈ‚Ò˜ ÙÔ ·ÓÙ›ıÂÙÔÙË˜ ‰È·Î‡Ì·ÓÛË˜ ÙˆÓ ∞ª¶, ÏfiÁˆ ÔÚÌÔÓÈÎÔ‡ Î‡-ÎÏÔ˘). ™·Ó›ˆ˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÔÚÊ‡Ú·. ∞Ô‰›-‰ÂÙ·È ÛÂ ·ÔÚÚ‡ıÌÈÛË ÙˆÓ ÌË¯·ÓÈÛÌÒÓ feed-back.√È ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ Â›Ó·È Û˘¯Ófi ·›ÙÈÔ ‹È·˜, Û˘Ó‹-

ıˆ˜, ıÚÔÌ‚ÔÂÓ›·˜ ÛÙ· ·È‰È¿, Ë ÔÔ›· ·ÔÎ·ı›-ÛÙ·Ù·È Ì¤Û· ÛÂ 1-2 Â‚‰ÔÌ¿‰Â˜. √È ÈÔ› ‚Ú›ÛÎÔ˘Ó ÛÙ·ÌÂÁ·Î·Ú˘ÔÎ‡ÙÙ·Ú· È‰·ÓÈÎ¤˜ ı¤ÛÂÈ˜ ÁÈ· ÙÔÓ ÔÏÏ·-Ï·ÛÈ·ÛÌfi ÙÔ˘˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔÎ·ÏÔ‡Ó ÌÂ›-ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ Î·È ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÏÂÈÙÔ˘Ú-Á›·˜ ÙÔ˘˜ (2-5).

µÈ‚ÏÈÔÁÚ·Ê›·1. Bithell TC. Pathophysiology and classification of

thrombocytopenia. In: Wintrobe’s Clinical Hematology. 9thed. Philadelphia: Lea and Febiger; 1993. p. 1325-1328.

2. Beardsley DS. Platelet abnormalities in infancy andchildhood. In: Nathan DJ, Oski FA, eds. Hematology ofinfancy and childhood. 5th ed. Philadelphia: WBSaunders; 1997. p. 1561-1588.

3. Bithell TC. Deficient platelet production. In: Wintrobe’sClinical Hematology. 9th ed. Philadelphia, London: Leaand Febiger; 1993. p. 1363-1367.

4. McMillan CW. Decreased or ineffective production ofplatelets. In: Miller DR, editor. Blood diseases of infancyand childhood. 7th ed. St Louis, Toronto, Princeton:Mosby; 1996. p. 815-820.

5. George JN, Aster RH. Thrombocytopenia due todiminished or defective platelet production. In: Williams,Beutler, Erslev, Lichtman, eds. Hematology. 4thInternational ed. McGraw-Hill Book Company; 1991. p.1343-1348.

6. Nesthammer AG, Forman EN. Use of platelet histogrammaximum in evaluating thrombocytopenia. Am J Hematol1999;60:19-23.

7. Gewirtz AM, Schick B. Megakaryocytopoiesis. In: Colman,Hirsh, Marder, Salzman, eds. Hemostasis andThrombosis: Basic principles and clinical practice. 3rd ed.Philadelphia: Lippincott Company; 1994. p. 353-383.

8. Alter BP, Young NS. The bone marrow failure syndromes.In: Nathan, Oski, eds. Hematology of infancy andchildhood. 5th ed. Philadelphia, London, Toronto,Montreal, Sydney, Tokyo: WB Saunders; 1993. p. 216-286.

9. Hardisty RM. Platelet disorders. In: Hoffbrand AV, LewisSM, editors. Postgraduate Haematology. 3rd ed. London:Heineman Medical Books; 1989. p. 598-626.

10. Wolber EM, Dame C, Fahnenstich H, Hofmann D,Bartmann P, Jelkmann W et al. Expression of the throm-bopoietin gene in human fetal and neonatal tissues. Blood1999;94:97-105.

¶›Ó·Î·˜ 2: ∞›ÙÈ· Â›ÎÙËÙË˜ ıÚÔÌ‚ÔÂÓ›·˜ ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜.

∞Ï·ÛÙÎ‹ ·Ó·ÈÌ›·ªÂÁ·Î·Ú˘ÔÎ˘ÙÙ·ÚÈÎ‹ ·Ï·Û›·¢È‹ıËÛË Ì˘ÂÏÔ‡∞ÎÙÈÓÔ‚ÔÏ›·ª˘ÂÏÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ Ê¿ÚÌ·Î·∞ÏÎÔfiÏ, ıÂÈ·˙›‰Â˜, ÈÓÙÂÚÊÂÚfiÓË, ÔÈÛÙÚÔÁfiÓ·∫‡ËÛË∫˘ÎÏÈÎ‹ ıÚÔÌ‚ÔÂÓ›·∞ÓÂ¿ÚÎÂÈ· µ12/Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜, ÛÈ‰‹ÚÔ˘πÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜¶·ÚÔÍ˘ÛÌÈÎ‹ Ó˘ÎÙÂÚÈÓ‹ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·ŒÎıÂÛË ÛÂ ˘ÂÚ‚·ÚÈÎfi ÔÍ˘ÁfiÓÔ


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘ ¶·‰›·ÙÚÔ˜, ∞Ó·ÏËÚÒÙÚÈ· ¢ÈÂ˘ı‡ÓÙÚÈ· ∂™ÀªÔÓ¿‰· ∞ÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·" 115 27, ∞ı‹Ó·

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�¶ÂÚ›ÏË„Ë: ∏ ·ÌÈÁ‹˜ ·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈ-Ú¿˜ (PRCA) ·ÔÙÂÏÂ› ÂÈ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚÈ-˙fiÌÂÓÔ ·fi ·Ó·ÈÌ›·, ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ·ÚÔÂÓ›·Î·È ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÂÏ¿ÙÙˆÛË Ì¤¯ÚÈ ÂÍ·Ê¿ÓÈÛËÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÌÂ Ê˘-ÛÈÔÏÔÁÈÎ‹ ˆÚ›Ì·ÓÛË Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ˘Ô-ÏÔ›ˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ, ‰ËÏ·‰‹ ÙË˜ ÎÔÎÎÈÒ-‰Ô˘˜ Î·È ÙË˜ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ·ÚÈÎ‹˜. ™ÙËÓ ·È‰ÈÎ‹ËÏÈÎ›· ˘¿Ú¯Ô˘Ó 2 ÎÏÈÓÈÎ¿ ‰È·ÊÔÚÂÙÈÎÔ› Ù‡ÔÈ, ËÛ˘ÁÁÂÓ‹˜ ·Ó·ÈÌ›· Diamond-Blackfan (DBA) Î·È Ë·ÚÔ‰ÈÎ‹ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›· (TEC). ∏ DBA Â›Ó·È¤Ó· Û‡Ó‰ÚÔÌÔ ÌÂ ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ·, ÛÙËÓ ÏÂÈÔ-ÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ, ÛÔÚ·‰ÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·ÂÓÒ ÌfiÓÔ ÙÔ 20% ıÂˆÚÂ›Ù·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ ÌÂÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ‹ ÙÔÓ ˘ÔÏÂÈfi-ÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ ·ÚÔ‰ÈÎ‹ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›·(TEC) Â›Ó·È Â›ÎÙËÙË ·Ó·ÈÌ›· ÂÌÊ·ÓÈ˙fiÌÂÓË ÛÙÔ85% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÂ ÚÔËÁÔ‡ÌÂÓ· ˘ÁÈ¤˜ ·È-‰› ËÏÈÎ›·˜ 1-4 ÂÙÒÓ Î·È Û˘Ó‹ıˆ˜ ¤¯ÂÈ ÚÔËÁËıÂ›Ì›· ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË. ∫˘Ú›ˆ˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi·˘ÙfiÌ·ÙÂ˜ ˘Ê¤ÛÂÈ˜ ÂÓÙfi˜ 4-8 Â‚‰ÔÌ¿‰ˆÓ Î·È·Ô˘Û›· ˘ÔÙÚÔÒÓ. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ PRCA··ÈÙÂ› ÚÔÛÂÎÙÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÁÈ·ÙËÓ ¤ÁÎ·ÈÚË Î·È ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Î·È ÙË ‰È·ÊÔÚÔ-Ô›ËÛË ÌÂÙ·Í‡ ÎÏËÚÔÓÔÌÈÎ‹˜ ‹ Â›ÎÙËÙË˜ ÓfiÛÔ˘,Î·ıÒ˜ Î·È ÌÂÙ·Í‡ ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ‹ ‰Â˘ÙÂÚÔ-·ıÔ‡˜ Ù‡Ô˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ ·Ú¯ÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÙË˜ PRCA ··ÈÙÂ›, Û¯Â‰fiÓ ¿ÓÙÔÙÂ, ÌÂÙ·Á-Á›ÛÂÈ˜ ·›Ì·ÙÔ˜. ∞˘Ù‹ Ë ÚÔÛ¤ÁÁÈÛË ‰›ÓÂÈ ÙËÓ Â˘-Î·ÈÚ›· Ó· ÔÏÔÎÏËÚˆıÂ› Ô ¤ÏÂÁ¯Ô˜, Î·ıÒ˜ Î·È ÙË‰˘Ó·ÙfiÙËÙ· ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÁÈ·ÙËÓ Èı·ÓfiÙËÙ· ·˘ÙfiÌ·ÙË˜ ›·ÛË˜, ÛÂ ÂÚ›ÙˆÛËÔ˘ ¿Û¯ÂÈ ·fi ·ÚÔ‰ÈÎ‹ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›·. ∏ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙË˜ DBA ÂÚÈÏ·Ì‚¿ÓÂÈÌÂÙ·ÁÁ›ÛÂÈ˜ ·›Ì·ÙÔ˜, ¯ÔÚ‹ÁËÛË ·Ó‰ÚÔÁfiÓˆÓ ‹

�Abstract: Pure red cell aplasia (PRCA) is aspecific syndrome characterized by anaemia,reticulocytopenia, and strikingly reduced or absenterythroid precursor cells in the bone marrow withpreservation of the lymphoid and other hemato-poietic lineages. There are two main clinical formsof PRCA that are absolutely unique to pediatrics,the Diamond–Blackfan anaemia (DBA) and thetransient erythroblastopenia of childhood (TEC),which are clearly distinguishable from each other.DBA is congenital and presents in early infancy;although it may be associated with autosomaldominant or recessive patterns of inheritance(20%), most reported cases are sporadic. TEC isan acquired self-limited form of PRCA, whichoccurs gradually in previously healthy children 1-4years of age (85% of cases) following a viralinfection. It is characterized by spontaneousrecovery, usually within 4-8 weeks, without epi-sodes of recurrences. Management of childhoodPRCA begins with a thorough investigation of thediagnostic possibilities that may underlie thesyndrome being careful to distinguish between thecongenital and acquired causes as well as theprimary and secondary forms of the syndrome.Until a firm diagnosis is established, the initialtreatment requires almost always blood trans-fusions. This allows flexibility to complete theinvestigations and to observe for a spontaneousremission if the anaemia is due to TEC or other self-limited condition. Several therapeutic approacheshave been attempted for DBA, such as admi-nistration of androgens or cyclosporine; howeverthe treatment of choice is the use of steroids. Bonemarrow transplantation is a possibility for those

ªÔÓ¿‰· ªÂÙ·ÌfiÛ¯Â˘ÛË˜ ª˘ÂÏÔ‡ ÙˆÓ √ÛÙÒÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Division of Bone Marrow Transplantation “Saint Sophia” Children’s Hospital, Athens


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∏ ·ÌÈÁ‹˜ ·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ·ÔÙÂÏÂ›ÂÈ‰ÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ó·ÈÌ›·, ‰È-ÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ·ÚÔÂÓ›· Î·È ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÂÏ¿Ù-ÙˆÛË Ì¤¯ÚÈ Ï‹ÚÔ˘˜ ¤ÏÏÂÈ„Ë˜ ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ˆÚ›Ì·ÓÛË Î·È‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ˘ÔÏÔ›ˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈ-ÚÒÓ, ‰ËÏ·‰‹ ÙË˜ ÎÔÎÎÈÒ‰Ô˘˜ Î·È ÙË˜ ÌÂÁ·Î·Ú˘ÔÎ˘Ù-Ù·ÚÈÎ‹˜.

∏ ·ÈÙÈÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË (¶›Ó·Î·˜ 1), fiˆ˜ ¤¯ÂÈÚÔÙ·ıÂ› ·fi ÙÔ˘˜ Alter Î·È Young, ‰Â›¯ÓÂÈ fiÙÈ Ë·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÔÈÎ›-ÏˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù··È‰È¿ (1). ™ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ˘¿Ú¯Ô˘Ó 2 Ù‡ÔÈ ·ÌÈ-ÁÔ‡˜ ·Ï·Û›·˜ ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜, Ë Û˘ÁÁÂÓ‹˜·Ó·ÈÌ›· Diamond - Blackfan (DBA) Î·È Ë ·ÚÔ‰ÈÎ‹ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›· (transient erythroblastopenia ofchildhood TEC).

™˘ÁÁÂÓ‹˜ ·Ó·ÈÌ›· Diamond – Blackfan∏ DBA Â›Ó·È ¤Ó· Û‡Ó‰ÚÔÌÔ ÌÂ ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ·

ˆ˜ ÚÔ˜ ÙËÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, Ù· ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·-ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·, ÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛËÎ·È ÙËÓ ¤Î‚·ÛË. ∆Ô 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›Ó·È ÛÔ-Ú·‰ÈÎ¤˜ Î·È ÌfiÓÔ ÙÔ 20% ıÂˆÚÔ‡ÓÙ·È ÎÏËÚÔÓÔÌÔ‡ÌÂ-ÓÂ˜ ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ‹ ÙÔÓ ˘ÔÏÂÈ-fiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ¶Èı·ÓfiÓ Ó· ˘¿Ú¯ÂÈ Î·È Ê˘ÏÔ-Û‡Ó‰ÂÙË (x-linked) ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ÁÂÁÔÓfi˜ Ô˘ÂÍËÁÂ› ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘ ÛÙ· ¿ÚÚÂÓ· ·È‰È¿ ÛÂÔÚÈÛÌ¤ÓÂ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜.

√È ÂÚÈÛÛfiÙÂÚÂ˜ Î˘‹ÛÂÈ˜ ÌÂ ÚÔÛ‚Â‚ÏËÌ¤Ó· ¤Ì-‚Ú˘· ‰ÂÓ Â›Ó·È ÙÂÏÂÈfiÌËÓÂ˜ Î·È ÙÔ 5% ÙˆÓ ÌËÙ¤ÚˆÓ·Ó·Ê¤ÚÔ˘Ó ÚÔËÁÔ‡ÌÂÓÂ˜ ·Ô‚ÔÏ¤˜. ¶ÚÔ‚Ï‹Ì·Ù·ÂÌÊ·ÓÈ˙fiÌÂÓ· Î·Ù¿ ÙËÓ Î‡ËÛË Â›Ó·È Ë ÚÔÂÎÏ·Ì„›·, ËÙÔÍÈÓ·ÈÌ›·, Ë ÚÔˆÚfiÙËÙ· Î·È Ô ÚÔ‰ÚÔÌÈÎfi˜ Ï·-ÎÔ‡ÓÙ·˜. ∏ ¤ÎıÂÛË, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡-ÓË˜, ÛÂ ÙÔÍÈÎ¤˜ Ô˘Û›Â˜ fiˆ˜ ¯ÏˆÚÔıÂÈ·˙›‰Ë, ¯ÏˆÚ·Ì-ÊÂÓÈÎfiÏË, ÚÂ˙ÂÚ›ÓË, ı˘ÚÂÔÂÈ‰ÈÎ¤˜ ÔÚÌfiÓÂ˜ Î·È ÎÔÚ-ÙÈ˙fiÓË ÚÔ‰È·ı¤ÙÂÈ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘. ™˘Ó‹-ıˆ˜ Ù· ÚÔÛ‚Â‚ÏËÌ¤Ó· ·È‰È¿ ÁÂÓÓÈÔ‡ÓÙ·È ÏÈÔ‚·Ú‹Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÌÂ ÂËÚÂ·ÛÌ¤ÓÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘˜.∂ÎÙfi˜ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ‰ÂÓ ·Ó·Ê¤-ÚÔÓÙ·È ¿ÏÏÂ˜ ‰È·Ù·Ú·¯¤˜, ·Ú¿ ÌfiÓÔ Û¿ÓÈÂ˜ ÂÚÈ-ÙÒÛÂÈ˜ ÌÂ Â˘ÂÚÂıÈÛÙfiÙËÙ·, Ï‹ı·ÚÁÔ ‹ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ·. ∆· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÂÈ‚Â‚·›ˆÛË˜ÙË˜ ÓfiÛÔ˘ ·ÔÙÂÏÔ‡Ó:·) ÔÚıÔ-Ì·ÎÚÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›· ÂÌÊ·ÓÈ˙fiÌÂÓË ÛÙÔ

90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙÔ˘˜ ‰‡Ô ÚÒÙÔ˘˜ Ì‹ÓÂ˜ÙË˜ ˙ˆ‹˜,

‚) ÂÎÛÂÛËÌ·ÛÌ¤ÓË ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ·ÚÔÂÓ›·, Á) Ê˘ÛÈÔÏÔÁÈÎ‹ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ

¶›Ó·Î·˜ 1. ∞ÈÙÈÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË ÙË˜ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›·˜.

� ™˘ÁÁÂÓ‹˜ Diamond–Blackfan ·Ó·ÈÌ›· (DBA)� ∂›ÎÙËÙË

¶·ÚÔ‰ÈÎ‹ ÂÚ˘ıÚÔ‚Ï·-ÛÙÔÂÓ›·

¶ÚˆÙÔ·ı‹˜ ÀÔÙÚÔÈ¿˙Ô˘Û· ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜∞˘ÙÔ¿ÓÔÛËπ‰ÈÔ·ı‹˜

¢Â˘ÙÂÚÔ·ı‹˜πÔÁÂÓ‹˜ (Parvovirus B19, EBV, HBV)

§ÔÈÌÒ‰Ë˜ ªÈÎÚÔ‚È·Î‹ (ÛÙ·Ê˘Ïfi-ÎÔÎÎÔ˜, ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˜, Ì˘ÎfiÏ·ÛÌ·)

∞˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (™∂§, ƒ∞)

§Â˘¯·ÈÌ›Â˜, Û˘Ì·ÁÂ›˜ fiÁÎÔÈ (£‡ÌˆÌ·, ÓÂÔÏ·-Û›Â˜ ÏÂÌÊÈÎ‹˜ ÛÂÈÚ¿˜, Î·ÚÎÈÓÒÌ·Ù·)

º¿ÚÌ·Î· – ∆ÔÍ›ÓÂ˜

∫‡ËÛË¢È¿ÊÔÚ· ∞µ√ ·Û‡Ì‚·ÙË ªª√

¡ÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·

Î˘ÎÏÔÛÔÚ›ÓË˜, ·ÏÏ¿ ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ·ÔÙÂÏÂ›Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ÎÔÚÙÈÎÔÂÈ‰ÒÓ. ™Â ·ÛıÂÓÂ›˜·ÓıÂÎÙÈÎÔ‡˜ ÛÙ· ÎÔÚÙÈÎÔÂÈ‰‹ ‹ ÛÂ ·˘ÙÔ‡˜ Ô˘ÂÍ·ÚÙÒÓÙ·È ·fi ÌÂÁ¿ÏÂ˜ ‰fiÛÂÈ˜ ‹ ÌÂÙ·ÁÁ›ÛÂÈ˜ ÂÚ˘-ıÚÔÎ˘ÙÙ¿ÚˆÓ, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘Ù-Ù¿ÚˆÓ, fiÙ·Ó ˘¿Ú¯ÂÈ Î·Ù¿ÏÏËÏÔ˜ ‰fiÙË˜, Â›Ó·È Ë ÂÓ-‰Â‰ÂÈÁÌ¤ÓË ıÂÚ·Â›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÌÈÁ‹˜ ·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈ-Ú¿˜, ·È‰ÈÎ‹ ËÏÈÎ›·.

patients who do not respond to reasonable dosesof steroids.

Key words: pure red cell aplasia, childhood.

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 35

ÔÛÙÒÓ ÌÂ ÂÓÙ˘ˆÛÈ·Î‹ ·ÒıËÛË ÙË˜ ÂÚ˘ıÚ¿˜ÛÂÈÚ¿˜,

‰) ·˘ÍËÌ¤Ó· Â›Â‰· ÂÚ˘ıÚÔÔÈËÙ›ÓË˜ ÛÙÔÓ ÔÚfi ÙˆÓ·ÛıÂÓÒÓ, ·˘ÍËÌ¤ÓÔ ·ÓÙÈÁfiÓÔ i Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË F,Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÂÌ‚Ú˘˚ÎÔ‡ Ù‡Ô˘ ·ÈÌÔÔ›ËÛË,

Â) ·˘ÍËÌ¤ÓË ··ÌÈÓ¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜ (ADA) ÙˆÓÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ,

ÛÙ) Ê˘ÛÈÔÏÔÁÈÎ¤˜ (‹ ÂÏ·ÊÚÒ˜ ÂÏ·ÙÙˆÌ¤ÓÂ˜) ÙÈÌ¤˜ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È

˙) Ê˘ÛÈÔÏÔÁÈÎ¿ ‹ ·˘ÍËÌ¤Ó· ·ÈÌÔÂÙ¿ÏÈ·. ™ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ·ÚÎÂÙ¿ ·fi ·˘Ù¿ Ù· ·È‰È¿

Î·È Î˘Ú›ˆ˜ Ù· ·ÁfiÚÈ· ÂÌÊ·Ó›˙Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜·ÓˆÌ·Ï›Â˜ (¶›Ó·Î·˜ 2), fiˆ˜ ̄ ·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆ-Â›Ô (Cathie) ÌÂ Î·ı›˙ËÛË ÙË˜ Ú›˙·˜ ÙË˜ ÚÈÓfi˜, ˘ÂÚ-ÙÂÏÔÚÈÛÌfi, ·¯‡ ¿Óˆ ¯Â›ÏÔ˜ ÎÈ ¤Í˘ÓË ¤ÎÊÚ·ÛË. ŸÏÔÈÔÈ ·ÛıÂÓÂ›˜ ÌÂ DBA ÂÍ ÔÚÈÛÌÔ‡ ¤¯Ô˘Ó ·Ó·ÈÌ›· ÌÂ ÙÈÌ¤˜Hb Î·Ù¿ ÙË Á¤ÓÓËÛË 2,6-14,8 gr/dl (Ì¤ÛË ÙÈÌ‹ 7), Ì·-ÎÚÔÎ˘ÙÙ¿ÚˆÛË ÛÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿-ÚˆÓ, ÂÏ·ÙÙˆÌ¤ÓÂ˜ ¤ˆ˜ ÌË‰ÂÓÈÎ¤˜ ÙÈÌ¤˜ ÙˆÓ ¢∂∫, ÂÌ-‚Ú˘˚ÎÔ‡ Ù‡Ô˘ ·ÈÌÔÔ›ËÛË ÌÂ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ HbF,Ag i, ADA Î·È Ì˘ÂÏfiÁÚ·ÌÌ· ÌÂ ÂÎÏÂÎÙÈÎ‹ ·Ô˘Û›· ÙˆÓÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ. ∆· Â˘Ú‹Ì·Ù· ÙË˜ Ì˘ÂÏÈÎ‹˜ ‚ÈÔ„›·˜¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ˘ÔÏ·Û›· Ì¤¯ÚÈ Ï‹ÚË ·Ï·-Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ,˘ÂÚÏ·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÌÂ ·Ó·ÛÙÔÏ‹ ÙË˜ˆÚ›Ì·ÓÛË˜ Î·È ·‡ÍËÛË ÙˆÓ ·ÒÚˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓÛÙÔ 5%, ÂÓÒ ÛÙÔ ˘fiÏÔÈÔ 5% ·Ú·ÙËÚÂ›Ù·È Ê˘ÛÈÔ-ÏÔÁÈÎfi˜ ·ÚÈıÌfi˜ Î·È ˆÚ›Ì·ÓÛË ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ.

∏ ‰È·Ù·Ú·¯‹ ÙË˜ ÂÚ˘ıÚÔÔ›ËÛË˜ ÛÙË DBA ¤¯ÂÈÌÂÏÂÙËıÂ› ÂÎÙÂÓÒ˜ ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓÎ·ÏÏÈÂÚÁÂÈÒÓ, ÙË ¯Ú‹ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓÎ·È ÙˆÓ ÌÔÚÈ·ÎÒÓ ÙÂ¯ÓÈÎÒÓ Î·È ¤¯Ô˘Ó Î·Ù·ÓÔËıÂ› ·Ú-ÎÂÙ¿ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ‚¿ÛË ÛÂ ÏÂ›ÛÙÂ˜ÂÚÈÙÒÛÂÈ˜ ÌÂ DBA. ŸÌˆ˜, ·Ú·Ì¤ÓÂÈ ÙÔ ÂÚÒÙËÌ··Ó Ë ‚Ï¿‚Ë ·ÊÔÚ¿ ÙÔ ÂÚ˘ıÚfi ·ÈÌÔÛÊ·›ÚÈÔ ‹ ÙÔ ÌÈ-ÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ‹ ·Ó ÂÚÈÔÚ›-˙ÂÙ·È ÛÂ ·Ó·ÛÙÔÏÂ›˜ ÙË˜ ¯˘ÌÈÎ‹˜ ·ÓÔÛ›·˜.

∏ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ù‡Ô˘ Î·Ù·ÛÙÔÏ‹ ÙË˜ ÂÚ˘ıÚÔ-Ô›ËÛË˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ·ÚÎÂÙÔ‡˜ ÂÚÂ˘ÓËÙ¤˜.¶ÔÏÏÔ›, fiÌˆ˜, ·Ô‰›‰Ô˘Ó ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ DBA ÛÂ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙË˜ ÂÚ˘ıÚ¿˜ÛÂÈÚ¿˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜·˘ÙÒÓ (CFU-E, BFU-E). ∏ ·Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ ÚÔÁÔ-ÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÂ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ DBA‹Ù·Ó ÂÏ¿¯ÈÛÙË Ì¤¯ÚÈ ÌË‰ÂÓÈÎ‹ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ Â-ÚÈÙÒÛÂÈ˜. ¶ÚfiÛÊ·Ù·, Ë ÂÈÎÚ·ÙÔ‡Û· ¿Ô„Ë ÁÈ· ÙËÓ·ıÔÁ¤ÓÂÈ· ÙË˜ DBA Û¯ÂÙ›˙ÂÙ·È ÌÂ ‰È·Ù·Ú·¯¤˜ ·ÓÙ›-‰Ú·ÛË˜ ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ ÛÙÔ˘˜ Â·ÁˆÁÂ›˜ ÙÔ˘ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È ÙË˜ ‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜. ∏‚Ï¿‚Ë ÂÓÙÔ›˙ÂÙ·È ÛÂ ·‰˘Ó·Ì›· ÌÂÙ·‚›‚·ÛË˜ ÙÔ˘ Û‹-Ì·ÙÔ˜ ÙˆÓ Â·ÁˆÁ¤ˆÓ ÙË˜ ÂÚ˘ıÚÔÔ›ËÛË˜ {∂Ú˘ıÚÔ-ÔÈËÙ›ÓË (Epo), πÓÙÂÚÏÂ˘Î›ÓË 3 (IL-3), ∞˘ÍËÙÈÎfi˜ ·Ú¿-

ÁÔÓÙ·˜ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘(Stem Cell Factor, SCF)} ·fi ÙÔ˘˜ ˘Ô‰Ô¯Â›˜(receptor-ligand) ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ. ∆Ô ·ÓˆÙ¤ÚˆÂÓÈÛ¯‡ÂÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÏÂÌÊÔÎ‡ÙÙ·Ú· ·˘-ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ·Ú¿ÁÔ˘Ó IL-3, ÙÔ ÛÙÚÒÌ· ÙÔ˘ Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÂÎÊÚ¿˙ÂÈ ÙÔÓ (SCF) Î·È ˘¿Ú¯Ô˘Ó ÌÂ-ÙÚËÙ¿ Â›Â‰· ÙÔ˘ SCF ÛÙÔÓ ÔÚfi Î·ıÒ˜, Â›ÛË˜,˘Ô‰Ô¯Â›˜ ·˘Ùo‡ ÛÙ· Ì˘ÂÏÈÎ¿ Î‡ÙÙ·Ú·. ∂ÈÏ¤ÔÓ, ‰ÂÓ¤¯Ô˘Ó ‚ÚÂıÂ› ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙ· ÁÔÓ›‰È· ÙÔ˘ ˘Ô‰Ô¯¤·SCF. ¶·Ú’fiÏÔ Ô˘ Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ DBA ‰ÂÓ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›, ÏËÚÔÊÔÚ›Â˜ ·fi ÙÈ˜ invitro ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ÂÊ·ÚÌÔÛıÂ› ÂÈÙ˘¯Ò˜ ÛÙËÓ ÎÏÈÓÈ-Î‹ Ú·ÎÙÈÎ‹ Î·È ÛÙË ıÂÚ·Â˘ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÙË˜ ÓfiÛÔ˘.

∏ ıÂÚ·Â›· ·ÓÙÈÌÂÙÒÈÛË˜ ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ªÂÙ·ÁÁ›ÛÂÈ˜ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Î·È ‰È·Ù‹-ÚËÛË ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ¿Óˆ ·fi 8 gr/dl Î·Ù¿ ÙË‰È¿ÁÓˆÛË. ∏ ÛÔ‚·ÚfiÙÂÚË ÂÈÏÔÎ‹ ÙˆÓ ÌÂÙ·ÁÁ›ÛÂˆÓ,Ë ·ÈÌÔÛÈ‰‹ÚˆÛË, ··ÈÙÂ› ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜Ù·ÎÙÈÎ‹ ·ÔÛÈ‰‹ÚˆÛË ÌÂ ‰ÂÛÊÂÚÈÔÍ·Ì›ÓË. ∏ ÛÏËÓÂ-ÎÙÔÌ‹ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È.‚) ∆· ÎÔÚÙÈÎÔÂÈ‰‹, ÚÂ‰ÓÈ˙fiÓË ‹ ÚÂ‰ÓÈ˙ÔÏfiÓË, ·Ô-ÙÂÏÔ‡Ó Ê¿ÚÌ·Î· ÚÒÙË˜ ÂÎÏÔÁ‹˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ DBA. ∏ ‰fiÛË ¤Ó·ÚÍË˜ Â›Ó·È 2mg/kg/∏ ÛÂ 3 ‹ 4 ‰fi-ÛÂÈ˜. ∆· ¢∂∫ Û˘Ó‹ıˆ˜ ·˘Í¿ÓÔÓÙ·È ÛÂ 1-2 ‚‰ÔÌ¿‰Â˜ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È Ë Hb ÌÂÙ¿ ÙÔÓ 1Ô-3Ô Ì‹Ó·. ∏ ˘„ËÏ‹ ‰fiÛË ÎÔÚÙÈ˙fiÓË˜ Û˘ÓÂ¯›˙ÂÙ·È Ì¤¯ÚÈË Hb Ó· ‰È·ÙËÚËıÂ› ÛÂ Â›Â‰· 10gr/dl Î·È Ë ‰È·ÎÔ‹ÙË˜ Á›ÓÂÙ·È ·ÚÁ¿ Î·È ÛÙ·ıÂÚ¿ ÌÂ ÚÔÔÙÈÎ‹ ÙË ¯ÔÚ‹-ÁËÛË ÌÈÎÚÒÓ ‰fiÛÂˆÓ ÛÂ ·Ú‹ÌÂÚÔ Û¯‹Ì·, ‰È·ÙËÚÒ-ÓÙ·˜ ÛÙ·ıÂÚ‹ ÙËÓ Hb. ∞˘ÙÔ› ÔÈ ·ÛıÂÓÂ›˜ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÂÓÙ˘ˆÛÈ·Î‹ Â˘·ÈÛıËÛ›· ÛÂ ÌÈÎÚ¤˜ ÙÚÔÔÔÈ‹-ÛÂÈ˜ ÙË˜ ‰fiÛË˜ ÙˆÓ ÎÔÚÙÈÎÔÂÈ‰ÒÓ.

∞Ó¿ÏÔÁ· ÌÂ ÙËÓ ·¿ÓÙËÛË ÛÙ· ÎÔÚÙÈÎÔÂÈ‰‹


¶›Ó·Î·˜ 2. ∂È‰ÈÎ¤˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÛÙËÓ D.B.∞Ó·ÈÌ›·.

� ∫ÂÊ·Ï‹ (Cathie Facies)� ª¿ÙÈ· (˘ÂÚÙÂÏÔÚÈÛÌfi˜, ÁÏ·‡ÎˆÌ·, ÌÏÂ ÛÎÏËÚÔ›)� ∞˘¯¤Ó·˜ (ÎÔÓÙfi˜ Ï·ÈÌfi˜, ·Ó‡„ˆÛË ˆÌÔÏ¿ÙË˜)� ÕÓˆ ¿ÎÚ· (·ÓˆÌ·Ï›Â˜ Î˘Ú›ˆ˜ ÙÔ˘ ·ÓÙ›¯ÂÈÚ·, ‚Ú·¯›Ô-

Ó·)� ª‡ÙË (Ï·ÙÈ¿, Â›Â‰Ë, Î·ı›˙ËÛË ÚÈ˙ÔÚÚÈÓ›Ô˘)� Ã·ÌËÏfi ·Ó¿ÛÙËÌ·� ¡ÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË� ¡ÂÊÚÔ› (¢ÈÏ·ÛÈ·ÛÌfi˜ Ô˘ÚËÙ‹ÚˆÓ, ÂÙ·ÏÔÂÈ‰‹˜ ÓÂ-

ÊÚfi˜, Ô˘ÚÔÏÔÈÌÒÍÂÈ˜)� °ÂÓÓËÙÈÎ¿ fiÚÁ·Ó· (ÀÔÏ·Û›·, ‚Ô˘‚ˆÓÔÎ‹ÏË, ˘Ô-

Û·‰›·˜, ˘‰ÚÔÎ‹ÏË)� ∫·Ú‰È¿ (™Ù¤ÓˆÛË ·ÔÚÙ‹˜, ÛÙ¤ÓˆÛË ÓÂ˘ÌÔÓÈÎ‹˜ ÎÏ)� ™ÎÂÏÂÙfi˜ (™ÎÔÏ›ˆÛË, ·¯ÔÓ‰ÚÔÏ·Û›·, ÎÔÓÙ¿ ¿ÎÚ·)

36

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 36


37

‰È·ÎÚ›ÓÔÓÙ·È ÔÈ ·ÎfiÏÔ˘ıÂ˜ Î·ÙËÁÔÚ›Â˜ ·ÛıÂÓÒÓ: 1) ÁÚ‹ÁÔÚÔÈ ··ÓÙËÙ¤˜ ÌÂ ÎÔÚÙÈ˙ÔÓÔÂÍ·ÚÙÒÌÂÓË

‡ÊÂÛË (Û˘Ì‚·›ÓÂÈ ÛÙÔ 5% ÙˆÓ ·ÛıÂÓÒÓ)2) ÂÓ‰È¿ÌÂÛÔÈ ··ÓÙËÙ¤˜ <5%3) ÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ ··ÓÙÔ‡Ó Î·Ï¿. ∞fi ·˘-

ÙÔ‡˜, ÙÔ 40% Á›ÓÔÓÙ·È ÎÔÚÙÈ˙ÔÓÔÂÍ·ÚÙÒÌÂÓÔÈÎ·È ÙÔ ˘fiÏÔÈÔ 20% ‰È·ÙËÚÔ‡Ó Î·Ï¿ Â›Â‰··ÈÌÔÛÊ·ÈÚ›ÓË˜ ·ÂÍ·ÚÙÒÌÂÓÔÈ ÙË˜ ÎÔÚÙÈ˙fiÓË˜

4) ·Ú¯ÈÎ‹ ·¿ÓÙËÛË ÛÙËÓ ÎÔÚÙÈ˙fiÓË ·ÎÔÏÔ˘ıÔ‡-ÌÂÓË ·fi ÂÍ¿ÚÙËÛË Î·È ÌÂÙ¿ ˘ÔÙÚÔ‹ Î·È·ÔÙ˘¯›· ·¿ÓÙËÛË˜ ÛÙËÓ ›‰È· ‹ ÌÂÁ·Ï‡ÙÂÚË‰fiÛË ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 5%

5) ÔÛÔÛÙfi Î¿Ùˆ ÙÔ˘ 5% ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÍ¿ÚÙËÛË·fi ÔÏ‡ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ÎÔÚÙÈÎÔÂÈ‰ÒÓ Î·È ¤¯Ô˘Ó·Ó¿ÁÎË Û˘¯ÓÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ

6) ·ÚÎÂÙÔ› ·ÛıÂÓÂ›˜ (30-40%) ‰ÂÓ ··ÓÙÔ‡Ó Î·-ıfiÏÔ˘ ÛÙ· ÎÔÚÙÈÎÔÂÈ‰‹.∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛË˜ ÙˆÓ ÎÔÚÙÈÎÔÂÈ‰ÒÓ

ı· Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È Î·Ù·ÛÙ·ÏÙÈÎ¿ Ê¿ÚÌ·Î·ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ fiˆ˜ ÔÈÛÙÚÔÁfiÓ·, Ê·ÈÓÔ‚·Ú-‚ÈÙ¿ÏË, Ê·ÈÓ˘ÙÔ˝ÓË. ∞˘ÙfiÌ·ÙÂ˜ ˘Ê¤ÛÂÈ˜, Î˘Ú›ˆ˜ Û˘Ì-‚·›ÓÔ˘Ó ÛÙËÓ ÂÊË‚Â›· Î·È ¤¯Ô˘Ó ·Ú·ÙËÚËıÂ› ÛÙÔ20% ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ.Á) ∏ ¯ÔÚ‹ÁËÛË ·Ó‰ÚÔÁfiÓˆÓ, 6-ÌÂÚÎ·ÙÔÔ˘Ú›ÓË˜,·ÓÙÈÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÔ‡ ÔÚÔ‡ Î·È Î˘ÎÏÔÛÔÚ›ÓË˜ ∞,‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ı¤ÛË ÛÙË ıÂÚ·Â›· ÙË˜ DBA. ‰) ∏ ÚÔÛı‹ÎË ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ EpoÎ·È IL-3, Û˘Ó¤‚·ÏÂ ÌfiÓÔ ÛÂ ·ÚÔ‰ÈÎ¤˜ ˘Ê¤ÛÂÈ˜.

√ SCF ÏfiÁˆ ÙˆÓ ÂÓı·ÚÚ˘ÓÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿-ÙˆÓ in vitro, ÙÂÏÂ˘Ù·›· ‰ÔÎÈÌ¿˙ÂÙ·È ÛÂ ÂÚÂ˘ÓËÙÈÎ¿ÚˆÙfiÎÔÏÏ·. ™ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ··ÈÙÂ›Ù·È ÚÔÛÔ¯‹,·Ó ÏËÊıÂ› ̆ fi„Ë Ë ÚÔ‰È¿ıÂÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ DBAÛÂ ÏÂ˘¯·ÈÌ›Â˜ Î·È Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎ¿ Û‡Ó‰ÚÔÌ·, ÁÈ·-Ù› Ë ¯Ú‹ÛË ÂÓfi˜ ‰˘Ó·ÌÈÎÔ‡ Â·ÁˆÁÈÎÔ‡ ·˘ÍËÙÈÎÔ‡·Ú¿ÁÔÓÙ·, fiˆ˜ Ô SCF, ›Ûˆ˜ Ô‰ËÁ‹ÛÂÈ ÛÂ ÌË ·Ó·-ÌÂÓfiÌÂÓ· ÂÈÎ›Ó‰˘Ó· ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·.Â) ªÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∂›Ó·È ıÂ-Ú·Â›· ÂÎÏÔÁ‹˜ ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ ··ÓÙÔ‡Ó ÛÙ·ÎÔÚÙÈÎÔÂÈ‰‹ ‹ ÂÍ·ÚÙÒÓÙ·È ·fi ÌÂÁ¿ÏÂ˜ ‰fiÛÂÈ˜ Î·ÈÌÂÙ·ÁÁ›ÛÂÈ˜ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ Î·È ‰È·ı¤ÙÔ˘Ó Û˘Ì‚·-Ùfi ‰fiÙË. ∏ ÁÚ‹ÁÔÚË Î·È ¿ÌÂÛË ÚfiÛÏË„Ë ÙÔ˘ ÌÔ-Û¯Â‡Ì·ÙÔ˜ Î·È Ë Ï‹ÚË˜ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ·ÈÌÔÔ›-ËÛË˜ ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÂ ˘„ËÏfi ÔÛÔÛÙfi, ·Ô-‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ‚Ï¿‚Ë ÙË˜ DBA Ì¿ÏÏÔÓ ÔÊÂ›ÏÂÙ·ÈÛÙ· ·Ú¯¤ÁÔÓ· ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· Î·È fi¯È ÛÙÔ ÌÈ-ÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙË˜ ÂÚ˘ıÚÔÔ›ËÛË˜. ∏ ÚfiÁÓˆÛË Â›-Ó·È ·ÌÊ›‚ÔÏË. ∆Ô 50% ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Ô˘ ·¿-ÓÙËÛ·Ó ÛÙ· ÎÔÚÙÈÎÔÂÈ‰‹ ÂÌÊ·Ó›˙Ô˘Ó Ì·ÎÚÔ¯ÚfiÓÈ·ÂÈ‚›ˆÛË ÌÂ ÔÏ‡ Î·Ï‹ ÔÈfiÙËÙ· ˙ˆ‹˜, È‰È·›ÙÂÚ·fiÛÔÈ Â›¯·Ó ·˘ÙfiÌ·ÙÂ˜ ˘Ê¤ÛÂÈ˜ ‹ ÂÏ¿Ì‚·Ó·Ó ÔÏ‡ ÌÈ-ÎÚ‹ ‰fiÛË ÎÔÚÙÈ˙fiÓË˜. ∆Ô ¿ÏÏÔ 50% Â›ÙÂ ¯ÚÂÈ¿˙ÂÙ·ÈÌÂÙ·ÁÁ›ÛÂÈ˜, Â›ÙÂ ˘Ô‚¿ÏÏÂÙ·È ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË

Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·Ó ‰È·ı¤ÙÂÈ Û˘Ì‚·Ùfi ‰fiÙË.∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ Î·ÎÔ‹ıÂÈ·˜ ÛÂ ·˘ÙÔ‡˜

ÙÔ˘˜ ·ÛıÂÓÂ›˜ Â›Ó·È ˘„ËÏfiÙÂÚË ÙË˜ ÂÌÊ·ÓÈ˙fiÌÂÓË˜ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÏËı˘ÛÌfi. ¢Â˘ÙÂÚÔ·ıÂ›˜ ÓÂÔÏ·-Û›Â˜ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÛÂ 10 ·ÛıÂÓÂ›˜: ÛÂ 2 ÔÍÂ›·ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·, ÛÂ 5 ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹˜ÏÂ˘¯·ÈÌ›·, Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ÛÂ 2 Î·ÈË·ÙÔÎ˘ÙÙ·ÚÈÎfi Î·ÚÎ›ÓˆÌ· ÛÂ 1. ∏ ÚÔÁÂÓÓËÙÈÎ‹‰È¿ÁÓˆÛË Â›Ó·È ÔÏ‡ ÂÚÈÔÚÈÛÌ¤ÓË. ™Â ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÂÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·˘ÍËÌ¤ÓË˜∞DA, Ë ·Ô˘Û›· Û¯ËÌ·ÙÈÛÌÔ‡ ·ÔÈÎÈÒÓ ÛÂ Î˘ÙÙ·ÚÈ-Î¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ BFU-E, CFU-E ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓÛÙÔ ¤Ì‚Ú˘Ô ‹ Î·È ÙÔ ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·Doppler ÌÂ ·Ó·Û‡ÓıÂÛË ÂÈÎfiÓ·˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ·È-ÌÔ‰˘Ó·ÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ·ÔÙÂÏÔ‡Ó ÂÓ‰Â›ÍÂÈ˜ ÙË˜ÓfiÛÔ˘.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë DBA ·Ú·Ì¤ÓÂÈ Ì›· ‰È·Ù·Ú·-¯‹ ÌÂ Û¯ÂÙÈÎ¿ Î·Ï‹ ÚfiÁÓˆÛË ÛÂ Û¯¤ÛË ÌÂ ¿ÏÏ· Û‡Ó-‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜.

¶·ÚÔ‰ÈÎ‹ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜(Transient erythroblastopenia of childhood, TEC)

∏ ·ÚÔ‰ÈÎ‹ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜ Â›Ó·È Ì›· Â›ÎÙËÙË ·Ó·ÈÌ›· ÂÌÊ·ÓÈ˙fiÌÂÓË ÛÙÔ 85%ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÂ ÚÔËÁÔ‡ÌÂÓ· ˘ÁÈ¤˜ ·È‰› ËÏÈ-Î›·˜ 1-4 ÂÙÒÓ. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÙ·‰È·Î‹ ÂÌÊ¿ÓÈ-ÛË Î·È ÛÂ ¿Óˆ ·fi 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¤¯ÂÈ ÚÔË-ÁËıÂ› ÌÈ· ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË.

∏ ·Ó·ÈÌ›· Â›Ó·È ÔÚıÔ¯ÚˆÌ·ÙÈÎ‹, ÔÚıÔÎ˘ÙÙ·ÚÈÎ‹ÌÂ ÔÈÎ›ÏË ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ-Î˘ÙÙ·ÚÔÂÓ›· Î·È ÛÂ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ·fi 60% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓÔÛÙÒÓ ·ÓÂ˘Ú›ÛÎÂÙ·È ˘ÔÏ·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜.∏ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘ ¤¯ÂÈ ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹ Î·È ÌÂÂÏ¿¯ÈÛÙÂ˜ ÂÍ·ÈÚ¤ÛÂÈ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÙfiÌ·ÙÂ˜˘Ê¤ÛÂÈ˜ ÂÓÙfi˜ 4-8 Â‚‰ÔÌ¿‰ˆÓ Î·È ·Ô˘Û›· ˘ÔÙÚÔ-ÒÓ. ∂ÈÏ¤ÔÓ, ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛıÂ› Û˘Á¯ÚfiÓˆ˜ ÛÙ··‰¤ÏÊÈ· Ì›·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi·ÚÔ‰ÈÎ¤˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ÂÍÔÊı¿Ï-ÌÈÂ˜ ÎÈÓ‹ÛÂÈ˜, ·ÛÙ¿ıÂÈ·, ËÌÈ¿ÚÂÛË Î·È Û·ÛÌÔ‡˜.√˘ÛÈ·ÛÙÈÎ¿, Ë TEC ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ï·Û›· ÙË˜ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈ˜ ˘fiÏÔÈÂ˜ ÛÂÈ-Ú¤˜, ÎÔÎÎÈÒ‰Ë Î·È ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ·ÚÈÎ‹. ∞Ó·Ê¤ÚÔ-ÓÙ·È, fiÌˆ˜, ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È·fi ˘ÔÎ˘ÙÙ·ÚÈÎfi Ì˘ÂÏfi ‹ ·Ó·ÛÙÔÏ‹ ˆÚ›Ì·ÓÛË˜ ÙË˜ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ (maturation arrest).

∏ ·ıÔÁ¤ÓÂÈ· ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹. √parvo-Èfi˜ Î·ıÒ˜ Î·È ¿ÏÏÔÈ ÈÔ› ÂÓ¤¯ÔÓÙ·È ÛÙËÓ TEC,ÚÔÎ·ÏÒÓÙ·˜ ·ÚÔ‰ÈÎ‹ Î·Ù·ÛÙÔÏ‹ ÙË˜ ÂÚ˘ıÚÔÔ›Ë-ÛË˜. ¶·Ú·ÙËÚ‹ıËÎÂ fiÙÈ ¿Óˆ ·fi ÙÔ 60% ÙˆÓ ·ÛıÂ-ÓÒÓ ÌÂ TEC Â›¯·Ó ·Ó·Ù‡ÍÂÈ ·˘ÙÔ- ‹ ·ÏÏÔ- ·ÓÙÈÛÒÌ·-Ù· Î·Ù¿ ·ÔÈÎÈÒÓ ÙˆÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙË˜ ÂÚ˘-ıÚ¿˜ ÛÂÈÚ¿˜ (CFU-E, BFU-E).

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 37

∏ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ù‡Ô˘ ·ÈÙÈÔÏfiÁËÛË ÙË˜ TEC Î·-ıÒ˜ Î·È Ë ·ÚÔ‰ÈÎ‹ ÂÌÊ¿ÓÈÛ‹ ÙË˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·Û˘ÓËÁÔÚÔ‡Ó fiÙÈ Â›Ó·È ·ÚfiÌÔÈÔ ÓfiÛËÌ· ÌÂ ¿ÏÏ· ·˘-ÙÔ¿ÓÔÛ· ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë È‰ÈÔ·ı‹˜ıÚÔÌ‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú· (ITP) Î·È Ë ·˘ÙÔ¿ÓÔÛË ·ÈÌÔ-Ï˘ÙÈÎ‹ ·Ó·ÈÌ›·.

¶·ÚfiÏÔ Ô˘ Ë ·ÌÈÁ‹˜ ·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈ-Ú¿˜ (PRCA) fiÛÔ Î·È Ë TEC ÂÌÊ·Ó›˙Ô˘Ó ÎÔÈÓ¿ ÎÏÈÓÈÎ¿¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÛÙËÓ ·Ú¯ÈÎ‹ ‰È¿ÁÓˆÛË, ÂÓÙÔ‡ÙÔÈ˜˘¿Ú¯Ô˘Ó Û·Ê‹ ÛÙÔÈ¯Â›· Ô˘ ÍÂ¯ˆÚ›˙Ô˘Ó ÙÈ˜ ‰‡Ô ÓÔ-ÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜ (¶›Ó·Î·˜ 3). √ parvo-Èfi˜ Â›Ó·ÈÔ ÈÔ Û˘¯Ófi˜ Ù‡Ô˜ ÈÔ‡ Ô˘ ÚÔÎ·ÏÂ› ·ÚÔ‰ÈÎ¤˜·Ï·ÛÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È Î˘Ú›ˆ˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ¯ÚfiÓÈ· ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·, fiˆ˜ ‰ÚÂ·-ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›· Î·È ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿-ÚˆÛË. ∞ÓıÂÎÙÈÎ¤˜ ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›Â˜ ·fi parvo-Èfi·Ú·ÙËÚÔ‡ÓÙ·È ÛÂ ¤ÓÙÔÓ· ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤Ó· ·È-‰È¿ ÌÂ AIDS, ÔÍÂ›· ÏÂ˘¯·ÈÌ›· Î·È ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜.ÕÏÏÔÈ ÈÔ› fiˆ˜ ÙË˜ Ë·Ù›ÙÈ‰·˜, Epstein Barr, HIV-1,HTLV-1, ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ÁÈ· Î·Ù·ÛÙÔÏ‹ ÙË˜ ÂÚ˘-ıÚÔÔ›ËÛË˜.

∞ÛıÂÓÂ›˜ ÌÂ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· fiˆ˜ Û˘ÛÙË-Ì·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ‹ ÚÂ˘Ì·ÙÔÂÈ‰‹ ·ÚıÚ›ÙÈ‰·,ÂÌÊ·Ó›˙Ô˘Ó ‰Â˘ÙÂÚÔ·ı‹ PRCA, ÏfiÁˆ Î·Ù·ÛÙ·ÏÙÈ-Î‹˜ ‰Ú¿ÛË˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ ÚÔÁÔÓÈÎÒÓÎ˘ÙÙ¿ÚˆÓ ÙË˜ ÂÚ˘ıÚ¿˜. ∂›ÛË˜, ‰Â˘ÙÂÚÔ·ı‹˜PRCA ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ› ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛËÌ˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÂ ÂÚÈÙÒÛÂÈ˜ ∞µ√ ·Û˘Ì‚·Ùfi-ÙËÙ·˜ ‰fiÙË-Ï‹ÙË. ∏ ·Ï·Û›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·Ó-ıÂÎÙÈÎÒÓ ÈÛÔ·ÈÌÔÛ˘ÁÎÔÏÏËÙÈÓÒÓ ÙÔ˘ Ï‹ÙË Î·Ù¿ ÙˆÓ∞ Î·È µ ·ÓÙÈÁfiÓˆÓ ÙˆÓ BFU-E Î·È CFU-E ÙÔ˘ ‰fiÙË.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ·ÓÙÈÌÂÙÒÈÛË ÙË˜ PRCA ÙË˜·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ··ÈÙÂ› ÚÔÛÂÎÙÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹ÚÔÛ¤ÁÁÈÛË (¶›Ó·Î·˜ 4). ∏ Ï‹„Ë ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔ-ÚÈÎÔ‡ ÌÂ ÂÎÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ

‰Â‰ÔÌ¤ÓˆÓ ı· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ¤ÁÎ·ÈÚË Î·È ÛˆÛÙ‹ ‰È¿-ÁÓˆÛË Î·ıÒ˜ Î·È ÛÙËÓ ·ÎÚÈ‚‹ ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Alter BP, Young NS. The Bone Marrow failure syndromes.

In: Nathan DJ, Oski FA, editors. Hematology of infancy andchildhood. Philadelphia: WB Saunders; 1992. p. 216-236.

2. Alter BP, Knobloch ME, He L, Gillio AP, O’Reilly RJ, ReillyLK et al. Effect of stem cell factor on in vitro erythropoiesisin patients with bone marrow failure syndromes. Blood1192;80:3000-3008.

3. Bagnara GP, Zauli G, Vitale L, Rosito P, Vecchi V, PaolucciG et al. In vitro growth and regulation of bone marrowenriched CD34+ hematopoietic progenitors in Diamond-Blackfan anemia. Blood 1991;78:2203-2210.

4. Bhambhani K, Inoue S, Sarnaik S. Seasonal clustering oftransient erythroblastopenia of childhood. Am J Dis Child1998;142:175-177.

5. Chan HS, Saunders EF, Freedman MH. Diamond-Blackfansyndrome. I. Erythropoiesis in prednisone responsive andresistant disease. Pediatric Res 1982; 16:474-476.

6. Chan HS, Saunders EF, Freedman MH. Diamond-Blackfansyndrome. II. In vitro corticosteroid effect on erythropoiesis.Pediatric Res 1982;16:477-478.

7. Freedman MH, Saunders EF. Diamond-Blackfansyndrome: evidence against cell-mediated erythropoieticsuppression. Blood 1978;51:1125-1128.

8. Freedman MH, Saunders EF. Transient erythrobla-stopenia of childhood: varied pathogenesis. Am J Hematol1983;14:247-254.

9. Gussetis ES, Peristeri J, Kitra V, Liakopoulou T, Kattamis A,Grafakos S. Clinical value of bone marrow culture inchildhood pure red cell aplasia. J Pediatr Hematol Oncol1998;2:120-124.

10. Halperin DS, Freedman MH. Diamond-Blackfan anemia:etiology, pathophysiology, and treatment. Am J PediatrHematol Oncol 1989;11:380-394.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: µ. ∫›ÙÚ· ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

¶›Ó·Î·˜ 3. ∫ÚÈÙ‹ÚÈ· ‰È·ÊÔÚÈÎ‹˜ ‰È¿ÁÓˆÛË˜.

PRCA TEC

∞ÈÙ›· ™˘ÁÁÂÓ‹˜ ∂›ÎÙËÙË¶ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi - ÈÔÁÂÓ‹˜

ÏÔ›ÌˆÍË∞ÓˆÌ·Ï›Â˜ 30% 0%¡Â˘ÚÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· - ÂÓ›ÔÙÂ∞ÓÔÛÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Û¿ÓÈ· Û˘Ó‹ıË¢È¿ÚÎÂÈ· ¯ÚfiÓÈ· ·ÚÔ‰ÈÎ‹ª¤ÛË ËÏÈÎ›· 6 ÌËÓ 27 ÌËÓ

(1-72) (1-192)∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·:

HbF � ∫ºADA � ∫ºAg i � Ag I∞ÈÌÔÔ›ËÛË ÂÌ‚Ú˘ïÎÔ‡ Ù‡Ô˘

¶›Ó·Î·˜ 4. ¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ PRCA.

� ™˘ÁÁÂÓ‹˜ (ËÏÈÎ›·)� ∂›ÎÙËÙË¶ÚˆÙÔ·ı‹˜ ¢Â˘ÙÂÚÔ·ı‹˜πÛÙÔÚÈÎfi (ÙÔÍÈÎ¿ Ê¿ÚÌ·Î·, ÈÔ›)∫ÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ª˘ÂÏfiÁÚ·ÌÌ·∫˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓPCR + in situ ˘‚ÚÈ‰ÈÛÌfi˜ ÁÈ· ÚÔÛ‰ÈÔÚÈÛÌfi Parvovirus

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�¶ÂÚ›ÏË„Ë: ∏ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ·Ó‹ÎÂÈ ÛÙ·Û¿ÓÈ· ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ï·Û›· ÙÔ˘ ÂÚÈÊÂ-ÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ˘ÔÎ˘ÙÙ·ÚÈÎfi Ì˘ÂÏfi ÙˆÓÔÛÙÒÓ. ∏ ÓfiÛÔ˜ ·ÓÙÈÌÂÙˆÈ˙fiÌÂÓË ÌfiÓÔ ÌÂ Û˘ÓÙË-ÚËÙÈÎ‹ ·ÁˆÁ‹ ¤¯ÂÈ ÊÙˆ¯‹ ÚfiÁÓˆÛË, Î·ıfiÛÔÓÌfiÓÔ ÙÔ 20% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÂÈ‚ÈÒÓÂÈ ¤-Ú·Ó ÙÔ˘ ¤ÙÔ˘˜. ∞ÓÙ›ıÂÙ·, ÌÂ ÙËÓ ÂÙÂÚfiÏÔÁË ÌÂÙ·-ÌfiÛ¯Â˘ÛË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ËÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ ‚ÂÏÙÈÒÓÂÙ·È ‰Ú·Ì·ÙÈÎ¿.™ËÌ·ÓÙÈÎfi, fiÌˆ˜, ÔÛÔÛÙfi ÙˆÓ ·È‰È·ÙÚÈÎÒÓ·ÛıÂÓÒÓ ÌÂ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ·‰˘Ó·ÙÂ› Ó· ‚ÚÂÈÛ˘Ì‚·Ùfi ‰fiÙË ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙË˜ ÌÂÙ·ÌfiÛ¯Â˘-ÛË˜. °È· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ Ë ·ÓÔÛÔÎ·Ù·-ÛÙ·ÏÙÈÎ‹ ıÂÚ·Â›· ·ÔÙÂÏÂ› ÙË ıÂÚ·Â›· ÂÎÏÔ-Á‹˜. ∏ ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂ ÙË ¯Ô-Ú‹ÁËÛË ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎÔ‡/ ·ÓÙÈÏÂÌÊÔÎ˘ÙÙ·ÚÈ-ÎÔ‡ ÔÚÔ‡, ÌÂÌÔÓˆÌ¤Ó· ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Î˘-ÎÏÔÛÔÚ›ÓË ∞, ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ·Ó‰ÚÔÁfiÓ· ‹·˘ÍËÙÈÎÔ‡˜ ·ÈÌÔÔÈËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ÙÔ60% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÂ ·˘-Ù‹Ó. ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Úfi-ÛÊ·Ù· ‰Â‰ÔÌ¤Ó· ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙË ı¤ÛË, ÙËÓ ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙÈ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ·ÓÔÛÔ-Î·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹, ·Ï·ÛÙÈÎ‹·Ó·ÈÌ›·, ·È‰ÈÎ‹ ËÏÈÎ›·.

�Abstract: Aplastic anemia is a rare hema-tologic disorder in children characterized by bloodpancytopenia and bone marrow hypoplasia.Disease have a poor prognosis with supportivecare alone, with only 20% surviving one year fromdiagnosis. On the contrary, bone marrow tran-splantation is the more effective therapeutic ap-proach, but a significant percentage of pediatricpatients lack suitable donors. For these patientsimmunosuppressive treatment comprises aneffective alternative treatment option. Immunosup-pression is mainly based on antithymocyte/antilymphocyte globulin administration, which isused either alone or in combination with cyclo-sporine A, corticosteroids, androgens or hemo-poietic growth factors with an overall response inapproximately 60%. In this review article, the role,efficacy, and side effects of immunosuppressivetreatment is presented.

Key words: immunosuppression, aplastic anemia,childhood.


Immunosuppressive therapy in children with severe aplastic anemiaJ.P. Panagiotou

∏ ÈÛÙÔÚ›· ÙË˜ ·Ï·ÛÙÈÎ‹˜ ·Ó·ÈÌ›·˜ (AA) Û·Ó ‰È·-ÎÚÈÙ‹ ÓÔÛÔÏÔÁÈÎ‹ ÔÓÙfiÙËÙ·, ÍÂÎÈÓ¿ ÚÈÓ ·fi 112 ¯Úfi-ÓÈ·, fiÙ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ Ô Paul Ehrlich ÂÚÈ¤ÁÚ·„ÂÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∞fi ÙfiÙÂ ¤¯Ô˘Ó Â-

Ú¿ÛÂÈ ·ÚÎÂÙ¤˜ ‰ÂÎ·ÂÙ›Â˜, ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÂÎ·ÙÔÓÙ¿-‰Â˜ Ó¤Â˜ ÂÚÈÙÒÛÂÈ˜, ÛÂ ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ÎÈ ¤¯Ô˘Ó‰ÔÎÈÌ·ÛıÂ› ÔÈÎ›Ï· ıÂÚ·Â˘ÙÈÎ¿ Û¯‹Ì·Ù·, ¿ÏÏÔÙÂ ·Ô-ÙÂÏÂÛÌ·ÙÈÎ¿ Î·È ¿ÏÏÔÙÂ fi¯È.

∂ÈÌÂÏËÙ‹˜ ∞’ ∆Ì‹Ì·ÙÔ˜ ¶·È‰È·ÙÚÈÎ‹˜ ∞ÈÌ·ÙÔÏÔÁ›·˜ / √ÁÎÔÏÔÁ›·˜¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Registrar Pediatric Hematology/Oncology Division“Saint Sophia” Children’s Hospital, Athens


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∆· ÚÒÙ· ¯ÚfiÓÈ·, Ô˘ Ë ıÂÚ·Â›· ÙË˜ ∞∞ ÛÙËÚÈ˙fi-Ù·Ó ÛÙËÓ ˘ÔÛÙËÚÈÎÙÈÎ‹ ·ÁˆÁ‹ ÌÂ ÌÂÙ·ÁÁ›ÛÂÈ˜ ·›Ì·ÙÔ˜Î·È ÛÙÔÈ¯ÂÈÒ‰Ë ·ÓÙÈÌÈÎÚÔ‚È·Î‹ Î¿Ï˘„Ë, Ë ÔÚÂ›· ÙˆÓ·ÛıÂÓÒÓ ‹Ù·Ó ·ÔÁÔËÙÂ˘ÙÈÎ‹ ÌÂ ‰ÈÂÙ‹ ÂÈ‚›ˆÛË ÛÂ Ô-ÛÔÛÙfi Î˘Ì·ÈÓfiÌÂÓÔ ÌÂÙ·Í‡ 20-30%. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi,¿ÏÏˆÛÙÂ, ÛÙÔ ÂÁ¯ÂÈÚ›‰ÈÔ Wintrobe’s Clinical Haema-tology ÙÔ˘ 1956, Ë ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·Èˆ˜ «ÓfiÛÔ˜ Ô˘ ÚÔÔ‰Â˘ÙÈÎ¿, ·ÌÂ›ÏÈÎÙ· Î·È Î·Ù¿ ÙÔÌ¿ÏÏÔÓ ‹ ‹ÙÙÔÓ Ù·¯¤ˆ˜ Ô‰ËÁÂ› ÛÙÔ ı¿Ó·ÙÔ. √ ı¿Ó·-ÙÔ˜ Â¤Ú¯ÂÙ·È ÂÓÙfi˜ ÔÏ›ÁˆÓ Â‚‰ÔÌ¿‰ˆÓ ‹ ˘¿Ú¯ÂÈ ·-Ú¿Ù·ÛË ˙ˆ‹˜ Ì¤¯ÚÈ 6 Ì‹ÓÂ˜».

∏ ÚÒÙË ·Ó·ÊÔÚ¿ ÛÂ 40 ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ∞∞ Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÌÂ Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛËÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Î·È ÙÂÛÙÔÛÙÂÚfiÓË˜ Á›ÓÂÙ·È ÙÔ 1959·fi ÙÔ˘˜ Shahidi Î·È Diamond Î·È ÔÈ ÔÔ›ÔÈ ·Ó·Ê¤ÚÔ˘ÓÔÛÔÛÙfi Ì·ÎÚfi¯ÚÔÓË˜ ÂÈ‚›ˆÛË˜ ÛÂ ÔÛÔÛÙfi 4% ÙˆÓ·ÛıÂÓÂ›˜. ∆Ë˜ ‰ËÌÔÛ›Â˘ÛË˜ ·˘Ù‹˜, Â›¯Â ÚÔËÁËıÂ› Ë·Ó·ÎÔ›ÓˆÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÂ 334 ·ÛıÂÓÒÓ, ÂÎÙˆÓ ÔÔ›ˆÓ ÙÔ 24,3% ·ÊÔÚÔ‡ÛÂ ·È‰È¿. ∏ Û˘ÓÔÏÈÎ‹ Ì·-ÎÚfi¯ÚÔÓË ÂÈ‚›ˆÛË ÙˆÓ ·ÓÂÚ¯fiÙ·Ó ÌfiÏÈ˜ ÛÙÔ 3,3% ÙÔ˘Û˘ÓfiÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ.

™Ù· Ù¤ÏË ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’60, ·fi ÙÔÓ Mathé GÎ·È Û˘Ó, Á›ÓÂÙ·È Ë ÚÒÙË ·Ó·ÊÔÚ¿ ÛÙÔ ıÂÚ·Â˘ÙÈÎfi Úfi-ÏÔ Ô˘ ÂÓ‰Â¯fiÌÂÓ· ı· ÌÔÚÔ‡ÛÂ Ó· ¤¯ÂÈ Ë ·ÓÙÈÏÂÌÊÔ-Î˘ÙÙ·ÚÈÎ‹ ÛÊ·ÈÚ›ÓË (ALG) ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞∞,¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ALG Û·Ó ÚÔ·Ú·ÛÎÂ˘·ÛÙÈÎfiÛ¯‹Ì· ÛÂ ·ÏÏÔÁÂÓ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ. ∆· ̄ ÚfiÓÈ· Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ÂÈ‚Â‚·›ˆÛ·Ó ÙÈ˜ ıÂ-Ú·Â˘ÙÈÎ¤˜ ‰˘Ó·ÙfiÙËÙÂ˜ ÙÔ˘ ÛÎÂ˘¿ÛÌ·ÙÔ˜ ÎÈ ¤ÎÙÔÙÂ·Ú·Ì¤ÓÂÈ ¤Ó·˜ ‚·ÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙË ıÂÚ·Â›··˘ÙÔ‡ ÙÔ˘ ÛÔ‚·ÚÔ‡ ÓÔÛ‹Ì·ÙÔ˜.

°È· ÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ∞∞‹Ù·Ó ··Ú·›ÙËÙÔ Ó· ‚ÚÂıÂ› ÎÔÈÓ‹ ÁÏÒÛÛ· ÂÈÎÔÈÓˆ-Ó›·˜. ¶ÚÔ˜ ÙËÓ Î·ÙÂ‡ı˘ÓÛË ·˘Ù‹ ÎÈÓÔ‡ÌÂÓÔÈ ÔÈ CamittaÎ·È Û˘Ó, ı¤ÛÈÛ·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙË˜ ‚·ÚÈ¿˜ ∞∞ ÌÂ ‚¿ÛËÙ· ÔÔ›· ÔÈ ·ÛıÂÓÂ›˜ ÂÓÙ¿ÛÛÔÓÙ·È ÛÂ ÔÌ¿‰Â˜ ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘ Î·È ¯Ú‹˙Ô˘Ó ÂÓÙ·ÙÈÎ‹˜ Î·È ÂÈıÂÙÈÎ‹˜ ıÂÚ·-Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜. ∆· ÎÚÈÙ‹ÚÈ· ·˘Ù¿ ·Ó·Ï˘ÙÈÎ¿Â›Ó·È:

� ∫˘ÙÙ·ÚÈÎfiÙËÙ· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ª√) Î¿Ùˆ ·fiÙÔ 25% ÙË˜ ·Ó·ÌÂÓfiÌÂÓË˜ ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂ-ÓÔ‡˜, ÌÂ ÙË Ì˘ÂÏÈÎ‹ ÛÂÈÚ¿ Ó· ·ÔÙÂÏÂ› ÏÈÁfiÙÂÚÔ ·fiÙÔ 30% Î·È ‚Ï·ÛÙÈÎ¿ Î‡ÙÙ·Ú· Î¿Ùˆ ÙÔ˘ ÔÚ›Ô˘ ÙˆÓ5%. ∆·˘Ùfi¯ÚÔÓ·, ı· Ú¤ÂÈ Ó· Û˘Ó˘¿Ú¯Ô˘Ó 2, ÙÔ˘-Ï¿¯ÈÛÙÔÓ, ·fi Ù· Î·ÙˆÙ¤Úˆ ·Ó·ÊÂÚfiÌÂÓ· Â˘Ú‹Ì·-Ù· ·fi ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È Ù· ÔÔ›· Â›Ó·È:

� ∞fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ˘-Ú‹ÓˆÓ <500/mm3

� ∞ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ <2x104/mm3

� ¢ÈÔÚıˆÌ¤ÓÔ˜ ‰ÈÎÙ˘Ô-ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎfi˜ ‰Â›ÎÙË˜<1%. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÛÙ· ÚÔ·Ó·ÊÂÚı¤ÓÙ· ÎÚÈÙ‹-

ÚÈ· Û˘ÌÂÚÈÏ‹ÊıËÎÂ Ì›· ·ÎfiÌË ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ

ÔÏ‡ ‚·ÚÈ¿ ∞∞ Î·È ÌÂ ÔÏ‡ Î·Î‹ ¤Î‚·ÛË, ÛÙËÓ ÔÔ›·ÂÓÙ¿ÛÛÔÓÙ·È ÔÈ ·ÛıÂÓÂ›˜ ÙˆÓ ÔÔ›ˆÓ Ô ·fiÏ˘ÙÔ˜ ·ÚÈı-Ìfi˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ ·ÓÂ˘Ú›-ÛÎÂÙ·È <200/mm3.

°È· ÙËÓ Î·Ï‡ÙÂÚË ÚÔÛ¤ÁÁÈÛË ÙË˜ Ê˘ÛÈÎ‹˜ ÈÛÙÔ-Ú›·˜ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Î·È ÙË ‰ÈÂ˘ÎÚ›ÓÈÛË ÙÔ˘ ‹ ÙˆÓ ·ÈÙ›ˆÓÔ˘ ÂÈ‰ÚÔ‡Ó ¿Óˆ ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ Î˘ÙÙ·ÚÈÎfiÙËÙ·Î·È ÙË ‰È·‰ÈÎ·Û›· ·ÈÌÔÔ›ËÛË˜ ÙÔ˘ ª√, ·ÔÁ˘ÌÓÒÓÔ-ÓÙ·˜ ÙÔÓ ÙÂÏÂ˘Ù·›Ô ·fi Ù· Î˘ÙÙ·ÚÈÎ¿ ÙÔ˘ ÛÙÔÈ¯Â›·, ¤ÁÈ-Ó·Ó ÔÏÏ¤˜ Â›ÔÓÂ˜ Î·È ¯ÚÔÓÔ‚fiÚÂ˜ ÌÂÏ¤ÙÂ˜. ™˘ÓÔ-ÙÈÎ¿, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘ÙÒÓ ÙˆÓ ÚÔÛ·ıÂÈÒÓ Û˘-Ó¤ÎÏÈÓ·Ó ÛÙÔ fiÙÈ Ë ∞∞ ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È: 1. ™Â ‚Ï¿‚Ë ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ÔÏ˘‰‡Ó·ÌÔ˘ ·ÈÌÔÔÈËÙÈ-

ÎÔ‡ Î˘ÙÙ¿ÚÔ˘ (stem cell-SC), ÔÊÂÈÏfiÌÂÓË ÛÂ ÂÓ‰ÔÁÂ-Ó¤˜ ¤ÏÏÂÈÌÌ· ÙÔ˘ SC ‹ ÛÂ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÂÍˆÁÂÓÒÓ·Ú·ÁfiÓÙˆÓ (.¯. Î˘ÎÏÈÎÔ› ˘‰ÚÔÁÔÓ¿ÓıÚ·ÎÂ˜, Èfi˜Ë·Ù›ÙÈ‰·˜ µ Î.¿.). ∫¿Ùˆ ·fi ·˘Ùfi ÙÔ Ú›ÛÌ·, ÂÈ¯ÂÈ-ÚÂ›Ù·È Ë ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ SC Ì¤ÛˆÙË˜ ·ÏÏÔÁÂÓÔ‡˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ Î·È Ë ÔÔ›· ¤¯ÂÈ ÔÏ‡ Î·Ï¿ ıÂÚ·Â˘ÙÈÎ¿ ·ÔÙÂ-Ï¤ÛÌ·Ù·.

2. ™Â Î·Ù·ÛÙÚÔÊÈÎ‹ ‰Ú¿ÛË ÔÈÎ›ÏˆÓ ·Ú·ÁfiÓÙˆÓ Ì¤-Ûˆ ‰Ú·ÛÙËÚÈÔÔ›ËÛË˜ ¿ÓÔÛˆÓ ÌË¯·ÓÈÛÌÒÓ Î·È ÙË˜Î·Ù·ÛÙÚÔÊ‹˜ ÙˆÓ SC Ì¤Ûˆ ·ÓÔÛÔÚÔÎÏËÙÒÓ ·ÓÙÈ-‰Ú¿ÛÂˆÓ, ÛÙÈ˜ ÔÔ›Â˜ ÎÂÓÙÚÈÎ‹, ˘„›ÛÙË˜ ÛËÌ·Û›·˜ı¤ÛË Î·Ù¤¯ÂÈ ÙÔ ÂÓÂÚÁÔÔÈËÌ¤ÓÔ ÏÂÌÊÔÎ‡ÙÙ·ÚÔ. ∏ALG, Ë ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎ‹ ÛÊ·ÈÚ›ÓË (ATG), Ù· ÎÔÚÙÈ-ÎÔÂÈ‰‹ Î·È Ë Î˘ÏÔÛÔÚ›ÓË-∞ ÂÓÙ¿ÛÛÔÓÙ·È ÛÙË ÌÂÁ¿-ÏË ÔÌ¿‰· ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜, ÙË˜ÔÔ›·˜ Ô ÚfiÏÔ˜ Û˘Ó›ÛÙ·Ù·È ÛÙË ‰È·ÎÔ‹ Î·È ·Ó·-ÛÙÚÔÊ‹ ·˘Ù‹˜ ÙË˜ Î·Ù·ÛÙÚÔÊÈÎ‹˜ ‰È·‰ÈÎ·Û›·˜. ∆··ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È ÈÎ·ÓÔÔÈËÙÈÎ¿, ·ÏÏ¿ Û·ÊÒ˜˘ÔÏÂ›ÔÓÙ·È ÙË˜ ·ÏÏÔÁÂÓÔ‡˜ ªª√.

3. ™Â ‚Ï¿‚Ë ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜, ÚÔÎ·ÏÔ‡ÌÂÓË ·fi ÙË‰Ú¿ÛË ÙÔÍÈÎÒÓ ·Ú·ÁfiÓÙˆÓ.

H ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ ÍÂÎ›ÓËÛÂ Ó· ÂÊ·ÚÌfi-˙ÂÙ·È ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’50 ÌÂ ÙË ̄ ÔÚ‹ÁËÛËÛÎÂ˘·ÛÌ¿ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ Â›Ó·È‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËıÂ›, ‰Â‰ÔÌ¤ÓË˜ ÙË˜ ¤ÏÏÂÈ„Ë˜ ·ÓÙÈ-ÎÂÈÌÂÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ Î·Ù¿Ù·ÍË˜ Î·È ·ÓÙ·fiÎÚÈÛË˜ ÙˆÓ·ÛıÂÓÒÓ.

¶·ÚfiÙÈ Ù· ÛÙÂÚÔÂÈ‰‹ Â›Ó·È ÛÎÂ˘¿ÛÌ·Ù· Ô˘ ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÔÈÎ›ÏË˜ ·ÈÙÈÔÏÔÁ›·˜ÓÔÛËÌ¿ÙˆÓ Â› ÔÏÏ¤˜ ‰ÂÎ·ÂÙ›Â˜, Ì¤¯ÚÈ Û‹ÌÂÚ· Ô ·ÎÚÈ-‚‹˜ ÙÚfiÔ˜ ‰Ú¿ÛË˜ ÙÔ˘˜ Â›Ó·È ·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ˜. ∂›Ó·È È-ı·Ófi Ë ‰Ú¿ÛË ÙÔ˘˜ Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ·Ú¤Ì‚·Û‹ÙÔ˘˜ ÛÂ ·ÓÔÛÔÏÔÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ Î˘ÙÙ·ÚÔÌÂÛÔÏ·‚Ë-ÙÈÎÔ‡ Ù‡Ô˘ ‹ ÌÂ ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ Â›Ó·ÈÂÓ‰Â¯fiÌÂÓÔ Ó· Î·Ù·ÛÙÚ¤ÊÔ˘Ó ‹ Ó· ÂÌÔ‰›˙Ô˘Ó ÙÔÓÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ. ∞˘Ùfi ¿ÓÙˆ˜,Ô˘ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› Â›Ó·È fiÙÈ ¯ÔÚËÁÔ‡ÌÂÓ· ÛÂ ¯·ÌË-Ï¤˜ ‰fiÛÂÈ˜ ‰ÂÓ ¤¯Ô˘Ó ‰Ú¿ÛË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞∞. °È· ÙÔÓ

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ÏfiÁÔ ·˘Ùfi, ÔÈ ÚÔÙÂÈÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜ Â›Ó·È ˘„ËÏ¤˜ Î·È·Ó¿ÏÔÁ· ÌÂ ÙÔ Î¤ÓÙÚÔ ÚÔ¤ÏÂ˘ÛË˜ ÙˆÓ ÌÂÏÂÙÒÓ, Î˘-Ì·›ÓÂÙ·È ·fi 20-30 mg/Kg ·Ú¯ÈÎ¿ Î·È ÛÙË Û˘Ó¤¯ÂÈ·ÌÂÈÒÓÂÙ·È ÛÙ·‰È·Î¿. ∏ ÌÂ›ˆÛË ‰È·ÚÎÂ› ÂÚ›Ô˘ 30 ËÌ¤-ÚÂ˜ Î·È ·ÎÔÏÔ‡ıˆ˜ ¯ÔÚËÁÂ›Ù·È ÛÂ ‰fiÛË Û˘ÓÙ‹ÚËÛË˜,Î˘Ì·ÈÓfiÌÂÓË ·fi 0,1-0,2 mg/Kg/24ˆÚÔ. ∆Ô ÔÛÔÛÙfiÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÂ ·˘Ù¿ Ù· ıÂÚ·-Â˘ÙÈÎ¿ Û¯‹Ì·Ù· Î˘Ì·›ÓÂÙ·È ·fi 25-60%. ™‹ÌÂÚ·, ÛÙ·Û˘Ó‰˘·ÛÌ¤Ó· Û¯‹Ì·Ù· ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜Ô˘ ̄ ÔÚËÁÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞∞, ÔÈ ̆ „Ë-Ï¤˜ ‰fiÛÂÈ˜ ÙˆÓ ÛÙÂÚÔÂÈ‰ÒÓ ¤¯Ô˘Ó ÙË ı¤ÛË ÙÔ˘˜ ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ALG/ATG ‹ Î·È Î˘ÎÏÔÛÔÚ›ÓË-∞ (CsA).

√È ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙˆÓ ÛÙÂÚÔÂÈ‰ÒÓ Â›Ó·È ÁÓˆÛÙ¤˜Î·È ÔÈ ÈÔ Û˘¯Ó¿ ·Ó·ÊÂÚfiÌÂÓÂ˜ Â›Ó·È Ë ˘¤ÚÙ·ÛË, Ë˘ÂÚÁÏ˘Î·ÈÌ›·, Ë ·˘ÍËÌ¤ÓË ·ÒÏÂÈ· Î·Ï›Ô˘, Ë Â˘·È-ÛıËÛ›· ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜, Ë „‡¯ˆÛË Î·È Ë ¿ÛËÙË Ó¤-ÎÚˆÛË ÙË˜ ÎÂÊ·Ï‹˜ ÙÔ˘ ÌËÚÈ·›Ô˘.

∏ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë (CP), ÂÚÈÛÛfiÙÂÚÔ ÁÓˆÛÙ‹Û·Ó ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, ‰ÔÎÈÌ¿ÛıËÎÂÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞∞ ÛÙ· Ì¤Û·ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’70, ̄ ˆÚ›˜ fiÌˆ˜, ÙÂÏÈÎ¿, Ó· Ù‡¯ÂÈ Â˘-ÚÂ›·˜ ·Ô‰Ô¯‹˜ ˆ˜ Ê¿ÚÌ·ÎÔ ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÛÂ·ÛıÂÓÂ›˜ ¯ˆÚ›˜ Û˘Ì‚·Ùfi ‰fiÙË. ∏ ‰Ú¿ÛË ÙË˜ CP Ê·›-ÓÂÙ·È Ó· ÛÙËÚ›˙ÂÙ·È ÛÙË ÌË ÂÈ‰ÈÎ‹ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹‰Ú¿ÛË Ô˘ ÂÌÊ·Ó›˙ÂÈ, ÂÎ‰ËÏÔ‡ÌÂÓË ÛÙ· Ï·›ÛÈ· ÙË˜Ì˘ÂÏÔÙÔÍÈÎ‹˜ ÙË˜ ‰Ú¿ÛË˜. ∏ Èı·ÓfiÙËÙ· ‰Â, Ó· Î·Ù·-ÛÙÚ¤ÊÂÈ Ù· SC Ô˘ ¤¯Ô˘Ó ·Ú·‚Ï·ÊıÂ›, ÛÙ· ÔÔ›· Â›-Ó·È ÂÓ‰Â¯fiÌÂÓÔ Ó· ÔÊÂ›ÏÂÙ·È Ë ÌÂÏÏÔÓÙÈÎ‹ ÂÌÊ¿ÓÈÛËÌ˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ·ÚÔÍ˘ÛÌÈÎ‹˜ Ó˘-ÎÙÂÚÈÓ‹˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·˜ ‹ ÔÍÂ›·˜ ÏÂ˘¯·ÈÌ›·˜, ÙË˜ÚÔÛ‰›‰ÂÈ, fiˆ˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Ó·Ê¤ÚÔ˘Ó ÔÈ Û˘ÁÁÚ·-ÊÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜, ÏÂÔÓ¤ÎÙËÌ· ¤Ó·ÓÙÈ ÙˆÓ ¿ÏÏˆÓ ·ÓÔ-ÛÔÎ·Ù·ÛÙ·ÏÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∆Ô ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì·Ô˘ ÂÊ·ÚÌfiÛÙËÎÂ ÛÙË ÌÂÏ¤ÙË ‹Ù·Ó 45 mg/Kg ÙËÓ ËÌ¤-Ú·, Â› 4 Û˘ÓÂ¯Â›˜ ËÌ¤ÚÂ˜, ÙÔ Ê¿ÚÌ·ÎÔ ¯ÔÚËÁ‹ıËÎÂÌÂ ‹ ¯ˆÚ›˜ Cs∞ Î·È 7/10 ·ÛıÂÓÂ›˜ ¤Ù˘¯·Ó Ï‹ÚË ‡ÊÂ-ÛË ÙË˜ ÓfiÛÔ˘.

∏ ÙÔÍÈÎfiÙËÙ· ÙË˜ CP ÂÎ‰ËÏÒÓÂÙ·È, Î˘Ú›ˆ˜ ·fi ÙÔÔ˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· (·ÈÌÔÚÚ·ÁÈÎ‹ Î˘ÛÙ›ÙÈ‰·, ÓÂÊÚÈ-Î‹ ‚Ï¿‚Ë), ÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÌÂ ·Ï·Û›· fiÏˆÓ ÙˆÓÛÂÈÚÒÓ Î·È ÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜ ÌÂ ‰È¿ÌÂÛË ÓÂ˘ÌÔÓ›ÙÈ‰·.

√È ALG Î·È ATG Â›Ó·È ÎÂÎ·ı·ÚÌ¤ÓÂ˜ Î·È Û˘Ì˘-ÎÓˆÌ¤ÓÂ˜ ÛÊ·ÈÚ›ÓÂ˜, ÚÔÂÚ¯fiÌÂÓÂ˜ ·fi Â˘·ÈÛıËÙÔ-ÔÈËÌ¤Ó· ˙Ò· (¿ÏÔÁÔ, ÎÔ˘Ó¤ÏÈ), ÛÙ· ÔÔ›· ¤¯ÂÈ Á›ÓÂÈ¤Á¯˘ÛË ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ·fi ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‹ ÙÔıˆÚ·ÎÈÎfi fiÚÔ ·ÓÙ›ÛÙÔÈ¯·. ∞ÔÙÂÏÔ‡Ó ÙÔ˘˜ Ï¤ÔÓ Î·-Ï¿ ÌÂÏÂÙËÌ¤ÓÔ˘˜ Î·È ÂÚÈÛÛfiÙÂÚÔ ¯ÚËÛÈÌÔÔÈËÌ¤-ÓÔ˘˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÛÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ÙË˜ ∞∞, ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 30 ÂÚ›Ô˘ÂÙÒÓ.

∞ÓÂÍ¿ÚÙËÙ· ÙË˜ ÂÌÂÈÚ›·˜ Ô˘ ¤¯ÂÈ Î¿ıÂ ıÂÚ·Â˘-ÙÈÎfi Î¤ÓÙÚÔ, fiÏÔÈ Û˘ÌÊˆÓÔ‡Ó fiÙÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‚·ÚÈ¿∞∞ Î·È ¯ˆÚ›˜ Û˘Ì‚·Ùfi ‰fiÙË Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û¯‹-

Ì· Ô˘ ı· ÂÌÂÚÈ¤¯ÂÈ ÙËÓ ALG/∞TG. ∏ ¯Ú‹ÛË ÙÔ˘˜ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ˘fiıÂÛË fiÙÈ ÛÂ ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi·ÛıÂÓÒÓ ÌÂ ∞∞ Ë ÓfiÛÔ˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· Î˘Ù-Ù·ÚÔÙÔÍÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ·ÛÎÔ‡Ó Î·Ù·-ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ‰È·‰ÈÎ·Û›· ÙË˜ ·ÈÌÔ-Ô›ËÛË˜. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ô ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘˜ Ì¤ÛˆÙˆÓ ÛÊ·ÈÚÈÓÒÓ, ¯ˆÚ›˜ Ó· ·ÔÎ·ıÈÛÙ¿ ÙËÓ ÂÓ‰Â¯fiÌÂÓË‚Ï¿‚Ë ÙˆÓ SC, ‚ÔËı¿ ÛÙËÓ Â·Ó¤Ó·ÚÍË ÙË˜ ·Ô‰ÔÙÈ-Î‹˜ ·ÈÌÔÔ›ËÛË˜. ∆· ÛÎÂ˘¿ÛÌ·Ù· ÙˆÓ ÛÊ·ÈÚÈÓÒÓ Â-ÚÈ¤¯Ô˘Ó ÔÈÎ›Ï· ·ÓÙÈÛÒÌ·Ù· ÛÙÚÂÊfiÌÂÓ· ¤Ó·ÓÙÈ ÔÏ-ÏÒÓ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ (.¯. CD2, CD3,CD4, Î.¿.), ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ‰Ú¿ÛË ÙÔ˘˜ Ó· Â›Ó·È Û‡Ó-ıÂÙË Î·È Ó· ·ÊÔÚ¿ ÛÂ:

� ∫·Ù·ÛÙÚÔÊ‹ Î·È ·Ó·ÛÙÔÏ‹ ÙË˜ ‰Ú¿ÛË˜ fiÏˆÓ,Û¯Â‰fiÓ, ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ÌÂ ÂÈ‰ÈÎfiÙËÙ· Î˘-Ú›ˆ˜ ÛÙ· Î˘ÙÙ·ÚÔÙÔÍÈÎ¿, Ô˘ Î·Ù¤¯Ô˘Ó ÚfiÏÔ Î·-Ù·ÛÙ·ÏÙÈÎfi ÙË˜ ·ÈÌÔÔ›ËÛË˜. ªÂ ÙÔÓ ÙÚfiÔ ·˘-Ùfi, ÂÈÙÚ¤Ô˘Ó ÙÔÓ ·ÚfiÛÎÔÙÔ ÔÏÏ·Ï·ÛÈ·-ÛÌfi ÙˆÓ SC Î·È ÙËÓ Â·ÓÂÁÎ·Ù¿ÛÙ·ÛË ÙË˜ Ê˘-ÛÈÔÏÔÁÈÎ‹˜ ·ÈÌÔÔ›ËÛË˜.

� ¶·ÚÂÌfi‰ÈÛË ÙË˜ ·Ú·ÁˆÁ‹˜ Î·Ù·ÛÙ·ÏÙÈÎÒÓÙË˜ ·ÈÌÔÔ›ËÛË˜ ÏÂÌÊÔÎÈÓÒÓ, ÌÂ ·Ó¿ÏÔÁÔ ÌÂÙÔÓ ·ÓˆÙ¤Úˆ ÌË¯·ÓÈÛÌfi.

� ∞ÓÔÛÔ‰È¤ÁÂÚÛË ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙˆÓÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ ÚÔ˜ ·Ú·ÁˆÁ‹ ·˘-ÍËÙÈÎÒÓ ÙË˜ ·ÈÌÔÔ›ËÛË˜ ·Ú·ÁfiÓÙˆÓ Î·È ÙËÓ,ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ‚Ï¿‚Ë˜.

� ∞ÓÔÛÔ‰È¤ÁÂÚÛË Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ ·ÓÙÈ-·ÓÙÈ-È‰ÈÔ-Ù˘ÈÎÒÓ ÌÔÚ›ˆÓ, Ù· ÔÔ›· ÌÈÌÔ‡ÓÙ·È ÙË Û‡Ó‰ÂÛËÌÂ Ù· ÚˆÙfiÙ˘· ·ÓÙÈÛÒÌ·Ù· Ù· Â˘ÚÈÛÎfiÌÂÓ·ÛÙÔÓ ›ÂÈÔ ÔÚfi.

� ÕÌÂÛË ‰Ú¿ÛË ÛÙ· SC, Ù· ÔÔ›· Î·È ‰Ú·ÛÙËÚÈÔ-ÔÈÔ‡Ó.¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÔÈ ‰‡Ô ÙÂÏÂ˘Ù·›ÔÈ ÌË¯·ÓÈ-

ÛÌÔ› ·ÊÔÚÔ‡Ó ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ¯ˆÚ›˜ Ó· ¤¯Ô˘ÓÂÈ‚Â‚·ÈˆıÂ› in vitro.

∞fi ÙÔ 1970, fiÙ·Ó ÂÊ·ÚÌfiÛıËÎÂ Ë ¯ÔÚ‹ÁËÛË ÙˆÓALG/ATG, ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛıÂ› ÔÈÎ›Ï· ıÂÚ·Â˘ÙÈÎ¿ Û¯‹-Ì·Ù· ÌÂ ‰fiÛÂÈ˜ Ô˘ Î˘Ì·›ÓÔÓÙ·Ó ·fi 15-40mg/Kg/24ˆÚÔ Î·È ‰È¿ÚÎÂÈ·˜ ·fi 5-28 ËÌ¤ÚÂ˜. ªÂÙ¿·fi ÂÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ÛÙfi¯Â˘·Ó ÛÙËÓ ÂÎÙ›ÌËÛËÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È ÙË˜ ÙÔÍÈÎfiÙËÙ·˜, Û‹ÌÂ-Ú· ÚÔÙÈÌÒÓÙ·È Ù· ‚Ú·¯Â›·˜ ¯ÚÔÓÈÎ‹˜ ‰È¿ÚÎÂÈ·˜ Û¯‹-Ì·Ù·, ‰È¿ÚÎÂÈ·˜ 4-5 ËÌÂÚÒÓ, ÌÂ ‰fiÛË ÂÎÏÔÁ‹˜ Ù· 40mg/Kg/24ˆÚÔ ÌÂ ·Ú¿ÏÏËÏË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂÈ‰ÒÓ‹ Î·È CsA. H ¤Á¯˘ÛË ÙˆÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ ‰È·ÚÎÂ› 6-8ÒÚÂ˜ Î·È ÚÔ˜ ·ÔÊ˘Á‹ ¤ÓÙÔÓˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ-‰Ú¿ÛÂˆÓ ÚÔËÁÂ›Ù·È ‰ÔÎÈÌ·Û›· Â˘·ÈÛıËÛ›·˜. °È· ÙËÓÈÔ ·ÛÊ·Ï‹ ¯ÔÚ‹ÁËÛË ÙˆÓ ÛÊ·ÈÚÈÓÒÓ Î·È ÙËÓ Î·Ï‡ÙÂ-ÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÂÔÌ¤ÓˆÓ ÙË˜ ¯ÔÚ‹ÁËÛË˜,··Ú·›ÙËÙË ÎÚ›ÓÂÙ·È Ë ·ÚÔ˘Û›· ÎÂÓÙÚÈÎÔ‡ ÊÏÂ‚ÈÎÔ‡Î·ıÂÙ‹Ú· Î·È Ë ÂÍ·ÛÊ¿ÏÈÛË ÈÎ·ÓÔ‡ ·ÚÈıÌÔ‡ ÌÔÓ¿‰ˆÓÛ˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Î·È Î˘Ú›ˆ˜ ·ÈÌÔÂÙ·Ï›ˆÓ.

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√È Î‡ÚÈÂ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙˆÓ ALG/ATG ·ÊÔÚÔ‡ÓÛÂ ¿ÌÂÛÂ˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ÔÚÔÓÔÛ›· Î·È ·-ÚÔ‰ÈÎ‹ ·Ï·Û›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜.

√ ˘ÚÂÙfi˜, Ù· Ú›ÁË Î·È ÙÔ ÎÓÈ‰ˆÙÈÎfi ÂÍ¿ÓıËÌ· ÙÔ˘‰¤ÚÌ·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ÙÈ˜ Û˘ÓËı¤ÛÙÂÚÂ˜ ·ÏÏÂÚÁÈÎ¤˜·ÓÙÈ‰Ú¿ÛÂÈ˜, ÔÈ ÔÔ›Â˜ ÂÌÊ·Ó›˙ÔÓÙ·È 1-2 ËÌ¤ÚÂ˜ ·fiÙËÓ ¤Ó·ÚÍË ÙË˜ ̄ ÔÚ‹ÁËÛË˜, ·ÓÙÈÌÂÙˆÈ˙fiÌÂÓÂ˜ ÌÂ ·ÓÙÈ-ÈÛÙ·ÌÈÓÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·. £ÂÙÈÎ‹ ‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·Û›·ÌÔÚÂ› Ó· ÚÔ·ÁÁ¤ÏÏÂÈ ‚·ÚÈ¤˜ Î·È ÂÈÎ›Ó‰˘ÓÂ˜ ÁÈ· ÙËÓ˙ˆ‹ ÙˆÓ ·ÚÚÒÛÙˆÓ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘-Ù¤˜ ÂÈ¯ÂÈÚÂ›Ù·È ·Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂÛ˘ÓÂ¯Ò˜ ·˘Í·ÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜ ¯ÔÚËÁÔ‡ÌÂÓÂ˜ ÂÓ‰Ô‰ÂÚ-ÌÈÎ¿, ˘Ô‰fiÚÈ· Î·È ÙÂÏÈÎ¿ ÂÓ‰ÔÊÏ¤‚È·. ªÂ ÙÔÓ ÙÚfiÔ·˘Ùfi, ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Á›ÓÂÙ·È Î·-ÏÒ˜ ·ÓÂÎÙ‹ Ë ÂÚ·ÈÙ¤Úˆ ¯ÔÚ‹ÁËÛË ÙˆÓ ALG/ATG.

∏ ÔÚÔÓÔÛ›· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿-ÙˆÓ ÛÙÚÂÊfiÌÂÓˆÓ Î·Ù¿ ÙˆÓ ›ÂÈˆÓ ÚˆÙÂ˚ÓÒÓ Î·È ÂÌ-Ê·Ó›˙ÂÙ·È Û¯Â‰fiÓ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Ï·Ì‚¿-ÓÔ˘Ó ATG. ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È 5-11 ËÌ¤ÚÂ˜ ·fi ÙËÓ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ‰È·ÚÎÂ› ·fi Ï›ÁÂ˜ ËÌ¤ÚÂ˜ Ì¤-¯ÚÈ, Û·ÓÈfiÙÂÚ·, ÌÂÚÈÎ¤˜ Â‚‰ÔÌ¿‰Â˜. ∆· ÚÔ¤¯ÔÓÙ·Û˘ÌÙÒÌ·Ù· Â›Ó·È ˘ÚÂÙfi˜, ÎfiˆÛË, ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò-‰Â˜ ÂÍ¿ÓıËÌ·, ·ÚıÚ·ÏÁ›· Î·È Ì˘·ÏÁ›·. ¶·ıÔÁÓˆÌÔÓÈ-Îfi Â‡ÚËÌ· Û˘ÓÈÛÙ¿ ÙÔ ÂÚËÙÔÂÈ‰¤˜ ÂÍ¿ÓıËÌ· ÙˆÓ¿ÎÚˆÓ ¯ÂÈÚÒÓ Î·È Ô‰ÒÓ. ¶ÚÔ˜ ·ÔÊ˘Á‹ ÙË˜ ÔÚÔÓÔ-Û›·˜ ¯ÔÚËÁÂ›Ù·È, ·Ú¿ÏÏËÏ· ÌÂ ÙÔÓ ›ÂÈÔ ÔÚfi, ÌÂı˘Ï-ÚÂ‰ÓÈ˙ÔÏfiÓË ¯ˆÚ›˜, fiÌˆ˜, Ó· Â›Ó·È ·Ô‰Â‰ÂÈÁÌ¤ÓÔ˜ ÔÂ˘ÂÚÁÂÙÈÎfi˜ ÚfiÏÔ˜ ÙË˜, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ÔÚÔÓÔÛ›· Â›-Ó·È ÓfiÛÔ˜ ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË.

∏ ÙÒÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ·ÈÌÔÂÙ·Ï›ˆÓ Î·Ù¿ ÙÔ ¿ÌÂÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ¯ÔÚ‹-ÁËÛË˜ ÙˆÓ ALG/ATG Â›Ó·È ÔÏ‡ Û˘¯Ófi Î·È ·ÚÔ‰ÈÎfiÊ·ÈÓfiÌÂÓÔ. ¶Èı·ÓÒ˜ Ó· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÚÔÛÎfiÏÏËÛËÙˆÓ ›ÂÈˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Â› ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ-‚Ú·ÓÒÓ, ¯ˆÚ›˜ ¿ÓÙˆ˜ Ó· ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÔÈALG/ATG Î·Ù¤¯Ô˘Ó ÂÈ‰ÈÎ‹ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙÈÁÔÓÈÎfiÙËÙ·.

∏ ¯ÔÚ‹ÁËÛË ÙˆÓ ALG/ATG ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞∞ ¤¯ÂÈÈÎ·ÓÔÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∏ ·¿ÓÙËÛË ÛÙË ıÂÚ·-Â›·, Û˘¯Ó¿, Â›Ó·È Î·ı˘ÛÙÂÚËÌ¤ÓË Î·È ÔÏÏ¤˜ ÊÔÚ¤˜¯ÚÂÈ¿˙ÂÙ·È ·Ó·ÌÔÓ‹ Ì¤¯ÚÈ Î·È 4 Ì‹ÓÂ˜ ÚÔÎÂÈÌ¤ÓÔ˘ Ó·ÂÎÙÈÌËıÂ› ÙÔ ıÂÚ·Â˘ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. ™ÙÔ˘˜ Î·ÎÔ‡˜··ÓÙËÙ¤˜ ÌÔÚÂ› Ó· ÂÈ¯ÂÈÚËıÂ› Ë ¯ÔÚ‹ÁËÛË Î·È ‰Â‡-ÙÂÚÔ˘ ıÂÚ·Â˘ÙÈÎÔ‡ Î‡ÎÏÔ˘ ÌÂ ATG ÌÂ Èı·ÓfiÙËÙ··ÓÙ·fiÎÚÈÛË˜ Î˘Ì·ÈÓfiÌÂÓË ÌÂÙ·Í‡ 50 Î·È 63%. ™ÙÔ˘˜ÙÂÏÂ˘Ù·›Ô˘˜ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ·ÏÏÔÁÂÓ‹˜ ¤Á¯˘ÛË ·ÈÌÔ-ÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi Û˘Ì‚·Ùfi ÌË Û˘ÁÁÂÓ‹ ‰fiÙË,‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ˘¿Ú¯ÂÈ ˘„ËÏfi ÔÛÔÛÙfi ·ÔÙ˘¯›·˜,ÔÊÂÈÏfiÌÂÓÔ ÛÂ ·fiÚÚÈ„Ë ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜, ÓfiÛÔ ÌÔ-Û¯Â‡Ì·ÙÔ˜ Î·Ù¿ ÍÂÓÈÛÙ‹ Î·È ÛÂ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜. ∆ÔÛ˘ÓÔÏÈÎfi ÔÛÔÛÙfi ·¿ÓÙËÛË˜ Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 50Î·È 60% ÙˆÓ ·ÛıÂÓÒÓ, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ 1/3 ÂÚ›Ô˘ÂÌÊ·Ó›˙ÂÈ Ï‹ÚË Î·È Ù· 2/3 ÌÂÚÈÎ‹ ‡ÊÂÛË, fiÏÔÈ fiÌˆ˜,·Ô‰ÂÛÌÂ‡ÔÓÙ·È ·fi ÙÈ˜ ÌÂÙ·ÁÁ›ÛÂÈ˜. ¶Ú¤ÂÈ Ó· ÙÔÓÈ-

ÛıÂ›, fiÙÈ ‰˘ÛÌÂÓÂ›˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÁÈ· ÙËÓ ÙÂ-ÏÈÎ‹ ·ÓÙ·fiÎÚÈÛË ·ÔÙÂÏÔ‡Ó Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘-‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ Î¿Ùˆ ÙˆÓ 200/mm3,Ë ÛË„·ÈÌ›·, ÔÈ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È ÙÔ ı‹Ï˘Ê‡ÏÔ.

∏ CsA Â›Ó·È ¤Ó· Î˘ÎÏÈÎfi ÂÓÙÂÎ·ÂÙ›‰ÈÔ ·Ú·ÁfiÌÂ-ÓÔ ·fi Ì‡ÎËÙÂ˜, ÙÔ ÔÔ›Ô ÂÌÏÔ‡ÙÈÛÂ ÙË ıÂÚ·Â˘ÙÈÎ‹Ê·Ú¤ÙÚ· Î·Ù¿ ÙË˜ ∞∞ ÙÔ 1984, fiÙ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎfi Ê¿ÚÌ·ÎÔÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞∞. ∏ ÂÊ·ÚÌÔÁ‹ ÙË˜ CsA ÛÙËÚ›˙ÂÙ·È Î˘-Ú›ˆ˜ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¯ˆÚ›˜ Ó· Â›Ó·È Î˘ÙÙ·ÚÔÙÔÍÈÎ‹,·ÚÂÌÔ‰›˙ÂÈ ÂÎÏÂÎÙÈÎ¿ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Î·È ÙÔÓ ÔÏ-Ï·Ï·ÛÈ·ÛÌfi ÙˆÓ ∆-Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ.°È· ÙËÓ Â›ÙÂ˘ÍË ÙË˜ ‰Ú¿ÛË˜ ÙË˜ Û˘Ó‰¤ÂÙ·È ÌÂ Î˘ÙÙ·-ÚÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜ (immunophilins), ÙˆÓ ÔÔ›ˆÓ Ô ·ÎÚÈ-‚‹˜ ÚfiÏÔ˜ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÂÍ·ÎÚÈ‚ˆÌ¤ÓÔ˜. ¶·Ú¿ÏÏËÏ·, ·ÚÂ-ÌÔ‰›˙ÂÈ ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜-2 Î·È ÙˆÓ˘Ô‰Ô¯¤ˆÓ ÙË˜ Î·ıÒ˜ Î·È ÙË˜ ÈÓÙÂÚÊÂÚfiÓË˜-Á, ·Ó·-ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ·ÓÔÛÔÚÔÎÏËÙ‹ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ SCÎ·È ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜·ÈÌÔÔ›ËÛË˜.

∆Ô Ê¿ÚÌ·ÎÔ ¯ÔÚËÁÂ›Ù·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Ë ‰fiÛËÙÔ˘ Â›Ó·È 10-12 mg/Kg/24ˆÚÔ ̄ ÔÚËÁÔ˘Ì¤ÓË ·Ó¿ 12ˆÚÔÁÈ· ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ÌËÓÒÓ. ¶ÚÔ˜ ·ÔÊ˘Á‹Ó·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Î·È ÌË ·Ó·ÛÙÚ¤„ÈÌˆÓ ‚Ï·‚ÒÓÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛË˜, Ú¤ÂÈ ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿‰È·ÛÙ‹Ì·Ù· Ó· ÂÏ¤Á¯ÔÓÙ·È Ù· Â›Â‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ÛÙÔ ·›Ì·, Ù· ÔÔ›· Ú¤ÂÈ Ó· Î˘Ì·›ÓÔÓÙ·È ÌÂÙ·Í‡ 200Î·È 400 ng/mL. ∞Ó¿ÏÔÁ· ÌÂ Ù· Â›Â‰· ·˘ÍÔÌÔÈÒÓÔÓÙ·ÈÔÈ ¯ÔÚËÁÔ‡ÌÂÓÂ˜ ‰fiÛÂÈ˜, ÂÓÒ ·Ú¿ÏÏËÏ· Ì¤Ûˆ ‚ÈÔ¯Ë-ÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÂÏ¤Á¯ÂÙ·È Ë ÓÂÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·.

∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ê·›ÓÂÙ·È ÌÂ-Ù¿ ·fi 3-6 Ì‹ÓÂ˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘, ÂÓÒ ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜·ÛıÂÓÂ›˜ ÂÌÊ·Ó›˙ÂÙ·È ‚ÂÏÙ›ˆÛË ÙË˜ ·ÈÌÔÔ›ËÛË˜ ÌÂÙ¿ÙË ‰È·ÎÔ‹ ÙÔ˘. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ÙË˜ CsAÛ·Ó ÚÒÙË˜ ÂÈÏÔÁ‹˜ ıÂÚ·Â˘ÙÈÎfi Û¯‹Ì· Î·È Î·Ù¿ Î·-ÓfiÓ· ̄ ÔÚËÁÂ›Ù·È ÌÂÙ¿ ·fi ·ÔÙ˘¯›· ÙˆÓ ALG/ATG ‹, ÙÔÛ˘ÓËı¤ÛÙÂÚÔ, ÂÓÙ¿ÛÛÂÙ·È ÛÂ ÚˆÙfiÎÔÏÏ· ÂÓÙ·ÙÈÎ‹˜·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜. ™Â Â·ÓÂÌÊ¿ÓÈÛË ÙË˜∞∞ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÌÔÚÂ› Ó· Â·Ó·-¯ÔÚËÁËıÂ› ÛÙÈ˜ ·Ú¯ÈÎ¤˜ ‰fiÛÂÈ˜ ‹ Î·È Ó· ··ÈÙËıÂ› Ì·-ÎÚfi¯ÚÔÓË Ï‹„Ë ÙË˜ CsA ÛÂ ‰fiÛÂÈ˜ Û˘ÓÙ‹ÚËÛË˜.

∏ ÙÔÍÈÎfiÙËÙ· ÙË˜ CsA ‰ÂÓ Â›Ó·È ·ÌÂÏËÙ¤·. √È Û˘-Ó‹ıÂÈ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ·ÊÔÚÔ‡Ó ÛÂ ÂÌÊ¿ÓÈÛË ˘¤ÚÙ·-ÛË˜, Ô˘Ú·ÈÌ›·˜, ˘ÂÚÙÚ›¯ˆÛË˜ Î·È ˘ÂÚÙÚÔÊ›·˜ ÙˆÓÔ‡ÏˆÓ. ∏ ¿ÓÔ‰Ô˜ ÙË˜ ÙÈÌ‹˜ ÙË˜ ÎÚÂ·ÙÈÓ›ÓË˜ ÙÔ˘ ÔÚÔ‡·ÔÙÂÏÂ› ·fiÏ˘ÙË ¤Ó‰ÂÈÍË ÌÂ›ˆÛË˜ ÙˆÓ ̄ ÔÚËÁÔ˘Ì¤ÓˆÓ‰fiÛÂˆÓ, Î·ıfiÛÔÓ Â›Ó·È È‰È·›ÙÂÚ· ÓÂÊÚÔÙÔÍÈÎfi Ê¿ÚÌ·-ÎÔ ÎÈ ÂÎÙfi˜ ·fi ÔÍÂ›·, ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ Î·È ¯Úfi-ÓÈ· ÌË ·Ó·ÛÙÚ¤„ÈÌË ‚Ï¿‚Ë, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ‰È¿-ÌÂÛË ›ÓˆÛË Î·È ·ÙÚÔÊ›· ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ.∂È‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÊÚÈ-

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 42

43


Î‹˜ ‚Ï¿‚Ë˜ ·ÔÙÂÏÔ‡Ó ÔÈ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ÙË˜ CsA, ËÌ·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛ‹ ÙË˜ Î·È Ë ÌÂÁ¿ÏË ËÏÈÎ›· ÙˆÓ·ÛıÂÓÒÓ (ÔÈ ÂÓ‹ÏÈÎÂ˜ ·ÛıÂÓÂ›˜ Â›Ó·È ÈÔ ÂÈÚÚÂÂ›˜·fi Ù· ·È‰È¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù¤ÙÔÈˆÓ ‚Ï·‚ÒÓ).

√ Û˘Ó‰˘·ÛÌfi˜ ÙË˜ CsA ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹ Â›Ó·È ‰˘-Ó·ÙfiÓ Ó· ÚÔÎ·Ï¤ÛÂÈ ·ÚÔ‰ÈÎ‹ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ÌÂ·ÔÙ¤ÏÂÛÌ· ÔÈ ¿Û¯ÔÓÙÂ˜ Ó· Â›Ó·È Â˘·›ÛıËÙÔÈ ÛÂ ÔÈ-Î›ÏÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Û˘-ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÙË˜ Ê˘Ì·Ù›ˆ-ÛË˜ Î·È Ë ÓÂ˘ÌÔÓÔÎ‡ÛÙË carinii. ™Ô‚·Ú‹ ·ÚÂÓ¤ÚÁÂÈ·ÙË˜ ıÂÚ·Â›·˜ ÌÂ CsA Â›Ó·È Ù· ÂÂÈÛfi‰È· Û·ÛÌÒÓ.∂Ó›ÔÙÂ ‰Â, Ë ·Ú·ÙËÚÔ‡ÌÂÓË ÏfiÁˆ ÓÂÊÚÈÎ‹˜ ‚Ï¿‚Ë˜˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÌÂÈÒÛÂÈ ÙÔÓ Ô˘‰fiÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ·˘Í¿ÓÂÙ·È Î·È Ë Èı·ÓfiÙËÙ· ÂÌÊ¿-ÓÈÛË˜ Û·ÛÌÒÓ.

∞fi ÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’90 Á›ÓÂÙ·È ÚÔ-Û¿ıÂÈ· ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË˜ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜ Ì¤Ûˆ ‰ËÌÈÔ˘ÚÁ›·˜ÚˆÙÔÎfiÏÏˆÓ, Ù· ÔÔ›· ÂÌÂÚÈ¤¯Ô˘Ó Û˘Ó‰˘·ÛÌÔ‡˜ÙˆÓ ·ÓˆÙ¤Úˆ ÛÎÂ˘·ÛÌ¿ÙˆÓ (ÂÓÙ·ÙÈÎ‹ ·ÓÔÛÔÎ·Ù·-ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹). √È ÏfiÁÔÈ Ô˘ Ô‰‹ÁËÛ·Ó ÛÂ ·˘Ù‹ÙËÓ ÚÔÛ¿ıÂÈ· ‹Ù·Ó ·Ê’ ÂÓfi˜ Ë ‰˘ÛÎÔÏ›· ·ÓÂ‡ÚÂÛË˜Ï‹Úˆ˜ Û˘ÁÁÂÓÔ‡˜ Û˘Ì‚·ÙÔ‡ ‰fiÙË Î·È ·Ê’ ÂÙ¤ÚÔ˘ ËıÂÚ·Â˘ÙÈÎ‹ Î¿Ï˘„Ë ÙˆÓ ÌÂÁ¿ÏË˜ ËÏÈÎ›·˜ ·ÛıÂÓÒÓ,ÔÈ ÔÔ›ÔÈ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ˘Ô‚ÏËıÔ‡Ó ÛÙË ‰È·‰È-Î·Û›· ÙË˜ ·ÏÏÔÁÂÓÔ‡˜ ¤Á¯˘ÛË˜ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ. ∆· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙË˜ ¤ÓÙÔÓË˜ ıÂÚ·Â›·˜, ËÔÔ›· ‰Â›¯ÓÂÈ Ó· ¤¯ÂÈ Û¯Â‰fiÓ ‰ÈÏ·ÛÈ¿ÛÂÈ ÙËÓ ·ÓÙ·fi-ÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ, ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ÌÂ ‚·ÚÈ¿ ‹ Î·È ÔÏ‡ ‚·ÚÈ¿ ∞∞ Î·È Ê·›ÓÂÙ·È fiÙÈ ÔÏ‡ÛËÌ·ÓÙÈÎ‹ ‚Ô‹ıÂÈ· ÛÙËÓ Â›ÙÂ˘ÍË ÙÔ˘ ÛÙfi¯Ô˘ ·˘ÙÔ‡

¤‰ˆÛÂ Ë ¤ÓÙ·ÍË ÙË˜ CsA ÛÙ· ÚˆÙfiÎÔÏÏ· ·˘Ù¿.∏ ıÂˆÚËÙÈÎ‹ ‚¿ÛË ÙË˜ ÂÓÙ·ÙÈÎÔÔÈËÌ¤ÓË˜ ·ÓÔÛÔ-

Î·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜ Â›Ó·È fiÙÈ ÛÙÔ¯Â‡ÂÈ ÛÙËÓ ·ıÚÔÈ-ÛÙÈÎ‹ ‹ Î·È Û˘ÓÂÚÁÈÎ‹ ‰Ú¿ÛË ÙˆÓ ÂÈÌ¤ÚÔ˘˜ Ê·ÚÌ¿-ÎˆÓ Î·È Ë ÔÔ›· ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ:� Û˘Ó‰˘·ÛÌ¤ÓË˜ ‰Ú¿ÛË˜ Â› ÂÓfi˜ ·ıÔÁÂÓÂÙÈÎÔ‡

ÌË¯·ÓÈÛÌÔ‡ ‹ � ‰È·ÊÔÚÂÙÈÎ‹˜ ‰Ú¿ÛË˜ ÙˆÓ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎÒÓ

·Ú·ÁfiÓÙˆÓ Â› ÂÚÈÛÛÔÙ¤ÚˆÓ ÙÔ˘ ÂÓfi˜ ·ıÔÁÂ-ÓÂÙÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ.Ÿˆ˜ ÚÔÎ‡ÙÂÈ ·fi ÙÈ˜ Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂÏ¤ÙÂ˜, Ë

Û˘Ó‰˘·ÛÌ¤ÓË ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ ÌÔÚÂ› Ó·ÂÙ‡¯ÂÈ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÌÈÎÚfiÙÂÚÂ˜ ‰fiÛÂÈ˜ÙˆÓ Ê·ÚÌ¿ÎˆÓ, ÌÂ ¿ÌÂÛÔ ÛÙfi¯Ô ÙËÓ Èı·Ó‹ ÌÂ›ˆÛËÙË˜ ÙÔÍÈÎfiÙËÙ·˜. ŒÙÛÈ Û‹ÌÂÚ·, Â›Ó·È ÛÂ ÂÍ¤ÏÈÍË ıÂÚ·-Â›Â˜ ÌÂ Û˘Ó‰˘·ÛÌÔ‡˜ ÙˆÓ ·ÓˆÙ¤Úˆ ·ÓÔÛÔÎ·Ù·ÛÙ·Ï-ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÙˆÓ ÔÔ›ˆÓ ÚÔ‚Ï¤-ÂÙ·È Î·È Ë ÚÔÛı‹ÎË ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ. ∞ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ‰Â›¯ÓÂÈ Ó· Â›Ó·È Ô Û˘Ó‰˘·-ÛÌfi˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ALG, CsA Î·È ÌÂı˘ÏÚÂ‰ÓÈ˙Ô-ÏfiÓË (¶›Ó·Î·˜ 1).

ŸÛÔÓ ·ÊÔÚ¿ ‰Â, ÙËÓ Â·ÓÂÌÊ¿ÓÈÛË ÙË˜ ∞∞, ÙË˜ÔÔ›·˜ Ë Èı·ÓfiÙËÙ· ÛÙ· 14 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛË˜ ÍÂ-ÂÚÓ¿ ÙÔ 35%, ÌÂÙ¿ ÙËÓ ÚÒÙË Ï‹ÚË ‹ ÌÂÚÈÎ‹ ‡ÊÂ-ÛË, Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙË˜ ÔÈÎ›ÏÏÂÈ Î·È ÂÍ·ÚÙ¿Ù·È Î˘-Ú›ˆ˜ ·fi ÙËÓ ÂÌÂÈÚ›· Î·È ÙÈ˜ ‰˘Ó·ÙfiÙËÙÂ˜ ÙÔ˘ ıÂÚ·-Â˘ÙÈÎÔ‡ Î¤ÓÙÚÔ˘. ™Â ÁÂÓÈÎ¤˜, ¿ÓÙˆ˜, ÁÚ·ÌÌ¤˜ Â›Ó·È‰˘Ó·ÙfiÓ Ó· ‰ÔÎÈÌ·ÛıÔ‡Ó Ù· Î¿ÙˆıÈ: � ¢Â‡ÙÂÚÔ˜ Î‡ÎÏÔ˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·Áˆ-

Á‹˜ ÌÂ Èı·ÓfiÙËÙ· ·ÓÙ·fiÎÚÈÛË˜ ÂÚ› ÙÔ 50% � ªÂÌÔÓˆÌ¤ÓË ¯ÔÚ‹ÁËÛË CsA, CP ÌÂ ‹ ¯ˆÚ›˜

¶›Ó·Î·˜ 1. ∏ ‰È·¯ÚÔÓÈÎ‹ ÂÍ¤ÏÈÍË ÛÙË ıÂÚ·Â›· Î·È ÂÈ‚›ˆÛË ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ ÌÂ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· Î·È ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹.

™˘ÁÁÚ·ÊÂ›˜ ŒÙË ∞ÚÈıÌfi˜ £ÂÚ·Â›· ∂È‚›ˆÛË ÃÚfiÓÔ˜ ·ÛıÂÓÒÓ (%) ·Ú·ÎÔÏÔ‡ıËÛË˜

Cairo MS et al ¶ÚÔ ÙÔ˘ 1982 23 ATG+PDN 48 12 Ì‹ÓÂ˜

Bayever E et al 1977 – 1982 22 ATG+PDN 45 2 ¤ÙË

Warner EJ et al 1981 – 1986 9 ATG+PDN+CsA (2) 88 2 ¤ÙË

Halpérin DS et al 1977 – 1987 12 hATG ‹ rATG+MePDN 42 15 Ì‹ÓÂ˜

Locasciulli A at al 1970 – 1988 133 ALG+PDN+AÓ‰ÚÔÁfiÓ· 48 10 ¤ÙË

Weble DKH et al 1974 – 1988 18 ALG+√Í˘ÌÂıÔÏfiÓË 30 5 ¤ÙË

Matloub Y et al 1990 – 1993 22 ATG+PDN+CsA 80 43 Ì‹ÓÂ˜

Lawlor ER et al 1982 – 1994 27 ATG+MePDN+CsA 92 33,5 Ì‹ÓÂ˜

Pitcher IA et al 1989 – 1996 25 ATG+CsA+MePDN 86 8 ¤ÙË

Fürher M et al 1993 – 1997 114 ALG+CsA+G-CSF 54 (EFS) 4 ¤ÙË

Kojima S et al 1992 - 1997 111 ALG+CsA+Danazole

+G-CSF 87 5 ¤ÙË

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·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ � ÀÔÛÙËÚÈÎÙÈÎ‹ ·ÁˆÁ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ‹ ¯ˆ-

Ú›˜ ·Ó‰ÚÔÁfiÓ· � ∞ÏÏÔÁÂÓ‹˜ ¤Á¯˘ÛË ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi

Û˘Ì‚·Ùfi ÌË Û˘ÁÁÂÓ‹ ‰fiÙË.∆Ô ÌÂÁ¿ÏÔ ÌÂÈÔÓ¤ÎÙËÌ· ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜

·ÁˆÁ‹˜, ÂÓÙ·ÙÈÎ‹˜ ‹ ÌË, Â›Ó·È fiÙÈ ·ÔÎ·ıÈÛÙ¿ ÙËÓ ·È-ÌÔÔ›ËÛË ¯ˆÚ›˜, fiÌˆ˜, Ó· ·ÓÙÈÎ·ıÈÛÙ¿ Ù· ·ıÔÏÔÁÈ-Î¿ SC. ∆Ô‡ÙÔ Ú·ÎÙÈÎ¿ Î·Ù·Ï‹ÁÂÈ ÛÙËÓ ÌÂÚÈÎ‹ ·Ô-Î·Ù¿ÛÙ·ÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÂ ÛË-Ì·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ, ·ÚfiÙÈ, ‚Â‚·›ˆ˜, Â›Ó·ÈÂÏÂ‡ıÂÚÔÈ ÌÂÙ·ÁÁ›ÛÂˆÓ. ¢Â‡ÙÂÚË ÛËÌ·ÓÙÈÎ‹ Û˘Ó¤-ÂÈ· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∞∞ Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·ÓÌÂ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹, Â›Ó·È Ô ·˘ÍËÌ¤ÓÔ˜Î›Ó‰˘ÓÔ˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÁÈ· ÎÏˆÓÈÎÔ‡ Ù‡Ô˘ ·ÈÌ·-ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù· Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· Ì˘ÂÏÔ‰˘ÛÏ·-ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ, ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›· Î·È ·-ÚÔÍ˘ÛÌÈÎ‹ Ó˘ÎÙÂÚÈÓ‹ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·. ∆Ô ÔÛÔÛÙfiÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Ù¤ÙÔÈÔ˘ Ù‡Ô˘ ·ÈÌ·ÙÔ-ÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÁÈ· ÌÂÓ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ·ÛıÂÓÂ›˜·Ó¤Ú¯ÂÙ·È ÛÙ· 10 ¤ÙË ÛÙÔ 30-50%, ÂÓÒ ÛÙ· ·È‰È¿ ÙÔÔÛÔÛÙfi Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÔ Î˘Ì·ÈÓfiÌÂÓÔÂÚ› ÙÔ 10% ÛÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡-ıËÛË˜.

√ÏÔÎÏËÚÒÓÔÓÙ·˜ ÙË Û‡ÓÙÔÌË ·˘Ù‹ ·Ó·ÊÔÚ¿ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ‚·ÚÈ¿˜ ·Ï·ÛÙÈÎ‹˜ ·Ó·ÈÌ›·˜ÌÂ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹, ı· Ú¤ÂÈ Û˘ÌÂÚ·-ÛÌ·ÙÈÎ¿ Ó· ˘ÔÁÚ·ÌÌ›Ûˆ fiÙÈ:

� ∏ ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ‚·ÚÈ¿∞∞ ‹Ù·Ó Î·È ·Ú·Ì¤ÓÂÈ Ë ·ÏÏÔÁÂÓ‹˜ ¤Á¯˘ÛË ÚÔ-ÁÔÓÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

� ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Ì‚·Ùfi˜ Û˘Á-ÁÂÓ‹˜ ‰fiÙË˜, ÂÈ¯ÂÈÚÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË ÂÓÙ·ÙÈÎ‹˜·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜ Î·È Ë ÔÔ›· Î·Ù¿Î·ÓfiÓ· ÛÙËÚ›˙ÂÙ·È ÛÙË Û˘Ó‰˘·ÛÌ¤ÓË ¯ÔÚ‹ÁËÛËALG/CsA/ ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Young NS. Aplastic anaemia. Lancet 1995;346:228-232.2. Definitive treatment of acquired aplastic anemia. In: Young

NS, Alter BP, eds. Aplastic anemia acquired and inherited.1st edition. Philadelphia: WB Saunders; 1994. p. 159-200.

3. Camitta BM, Storb R, Thomas ED. Aplastic Anemia:pathogenesis, diagnosis, treatment and prognosis. N EnglJ Med 1982;306:645-652.

4. Brodsky RA, Sensenbrenner LL, Jones RJ. Completeremission in severe aplastic anemia after high-dosecyclophosphamide without bone marrow transplantation.Blood 1996;87:491-494.

5. Werner EJ, Stout RD, Valdez LP, Harris RE. Immuno-suppressive therapy versus bone marrow transplantationfor children with aplastic anemia. Pediatrics 1989;83:61-65.

6. Halperin DS, Grisaru D, Freedman MH, Saunders EF.Severe acquired aplastic anemia in children: 11-yearexperience with bone marrow transplantation andimmunosuppressive therapy. Am J Pediatr Hematol Oncol1989;11:304-309.

7. Bayever E, Champlin R, Ho W, Lenarsky C, Storch S,Ladiscch S et al. Comparison between bone marrowtrasplantation and antithymocyte globulin in treatment ofyoung patients with severe aplastic anemia. J Pediatr1984;105:920-925.

8. Cairo MS, Baehner RL. The use of antithymocyte globulinin the treatment of severe aplastic anemia in children. JPediatr 1982;100:307-311.

9. Bielory L, Wright L, Nienhuis AW, Young NS. Anti-thymocyte globulin hypersensitivity in bone marrow failurepatients. JAMA 1988;260:3164-3167.

10. Bacigalupo A, Broccia G, Corda G, Arcese W, CarotenutoM, Gallamini A et al. Antilymphocyte globulin, cyclosporin,and granulocyte colony-stimulating factor in patients withacquired severe aplastic anemia (SAA); A pilot study of theEBMT SAA Working Party. Blood 1995;85:1348-1353.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: π.¶. ¶·Ó·ÁÈÒÙÔ˘°ÂÓÓ·‰›Ô˘ 1, 184-52 ¡›Î·È·

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45

��¶ÂÚ›ÏË„Ë: ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ(ªª√) ·ÔÙÂÏÂ› ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ· ·È‰È¿ ÌÂ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, fiÙ·Ó ˘¿Ú¯ÂÈ HLA-Û˘Ì‚·Ùfi˜·‰ÂÏÊfi˜ ‰fiÙË˜. ∏ ¤Î‚·ÛË ÙË˜ ·ÏÏÔÁÂÓÔ‡˜ ªª√ ¤¯ÂÈÛËÌ·ÓÙÈÎ¿ ‚ÂÏÙÈˆıÂ› Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›·Î·È ÙÔ ÔÛÔÛÙfi Ì·ÎÚ¿˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÚÔ-ÛÂÁÁ›˙ÂÈ ÙÔ 90%. √È Î˘ÚÈfiÙÂÚÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘¤¯Ô˘Ó Û˘ÓÙÂÏ¤ÛÂÈ ÛÂ ·˘Ù‹ ÙËÓ ÚfiÔ‰Ô Â›Ó·È Ë ÌÂÙ·Ìfi-Û¯Â˘ÛË ÛÂ ÚÒÈÌË Ê¿ÛË ÙË˜ ÓfiÛÔ˘, Ë ÚÔÛı‹ÎË ·ÓÙÈ-ı˘ÌÔÎ˘ÙÙ·ÚÈÎ‹˜ ÛÊ·ÈÚ›ÓË˜ ÛÙÔ Û¯‹Ì· ÚÔÂÙÔÈÌ·Û›·˜Î·È Ë ¯Ú‹ÛË ÙË˜ Î˘ÎÏÔÛÔÚ›ÓË˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÌÈ-ÎÚ¤˜ ‰fiÛÂÈ˜ ÌÂıÔÙÚÂÍ¿ÙË˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙÔ˘GVHD. √È ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜ ·fi Û˘Ì‚·ÙÔ‡˜ ÌË Û˘Á-ÁÂÓÂ›˜ ‹ ÌË ·fiÏ˘Ù· Û˘Ì‚·ÙÔ‡˜ Û˘ÁÁÂÓÂ›˜ ‰fiÙÂ˜, Â›-Ó·È ÏÈÁfiÙÂÚÔ ÂÈÙ˘¯Â›˜ ÎÈ ¤¯Ô˘Ó ¤Ó‰ÂÈÍË ÌfiÓÔ ÛÂ ·ÛıÂ-ÓÂ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈ-Î‹ ·ÁˆÁ‹. ∏ ·ÏÏÔÁÂÓ‹˜ ªª√ ¤¯ÂÈ Â›ÛË˜, Î·ıÈÂÚˆ-ıÂ› ˆ˜ ıÂÚ·Â›· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·Ó·ÈÌ›· Fanconi, Ô˘ÂÌÊ·Ó›˙Ô˘Ó ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ‹ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¤˜·ÓˆÌ·Ï›Â˜ Ô˘ ÚÔÌËÓ‡Ô˘Ó ÂÍ·ÏÏ·Á‹ ÛÂ Ì˘ÂÏÔ‰˘-ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·. ÕÏÏ· Û¿ÓÈ·Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Ô˘ ¤¯Ô˘Ó ·ÓÙÈÌÂÙˆ-ÈÛıÂ› ÂÈÙ˘¯Ò˜ ÌÂ ·ÏÏÔÁÂÓ‹ ªª√, Â›Ó·È Ë ·Ó·ÈÌ›·Diamond-Blackfan ÌÂ ·ÓÙÔ¯‹ ÛÙ· ÛÙÂÚÔÂÈ‰‹, ÙÔ Û‡Ó-‰ÚÔÌÔ Schwachman-Diamond, Ë ·ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ·-ÚÈÎ‹ ıÚÔÌ‚ÔÂÓ›· Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Kostmann.

§¤ÍÂÈ˜-ÎÏÂÈ‰È¿: Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ·Ï-ÏÔÁÂÓ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·Ï·ÛÙÈÎ‹·Ó·ÈÌ›·, ·Ó·ÈÌ›· Fanconi, ·Ó·ÈÌ›· Diamond-Blackfan.

��Abstract: Bone marrow transplantation (BMT) is thetreatment of choice for children with severe aplasticanemia when an HLA-compatible sibling donor isavailable. The outcome of allogeneic transplantationhas greatly improved over the last two decades withlong-term survival approaching 90%. Factors that havecontributed to this advance include transplantationearlier in the course of the disease, the addition ofantithymocyte globulin in the conditioning regimen,and the use of cyclosporine in combination with short-dose methotrexate for GVHD prophylaxis. Transplantsfrom matched unrelated or mismatched related donorsis associated with an inferior outcome, and is indicatedonly in cases refractory to immunosuppression.Allogeneic BMT is also an established treatment forpatients with Fanconi anemia who develop aplasticanemia or cytogenetic abnormalities which aresuggestive of impending myelodysplastic syndrome oracute leukemia. Other less common bone marrowfailure syndromes, in which successful treatment withallogeneic BMT has been reported include steroid-refractory Diamond-Blackfan anemia, Schwachman-Diamond syndrome, amegakaryocytic thrombo-cytopenia, and Kostmann syndrome.

Key words: bone marrow failure syndromes, alloge-neic bone marrow transplantation, aplastic anemia,Fanconi anemia, Diamond-Blackfan anemia.


ªÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªª√) ÛÂ ·È‰È¿ ÌÂ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜¢. ¶ÂÙÚfiÔ˘ÏÔ˜

Bone marrow transplantation in children with bone marrow failure syndromesD. Petropoulos

∂ÈÌÂÏËÙ‹˜ µ’ ªÔÓ¿‰·˜ ªÂÙ·ÌfiÛ¯Â˘ÛË˜ ª˘ÂÏÔ‡ ÙˆÓ √ÛÙÒÓ

Register, 2nd Division of Bone Marrow Transplantation


2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 45

∞Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· (∞∞)∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·ÔÙÂÏÂ› ÙË

ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÛÂ ·È‰È¿ Î·È ÓÂ·ÚÔ‡˜ ·ÛıÂÓÂ›˜ÌÂ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, fiÙ·Ó ˘¿Ú¯ÂÈ HLA-Û˘Ì‚·Ùfi˜·‰ÂÏÊfi˜ ‰fiÙË˜. √È ·Ú¯ÈÎ¤˜ ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜ ÛÂ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ÌÂ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ‰ÂÓ ‹Ù·ÓÛ˘Ó‹ıˆ˜ ÂÈÙ˘¯Â›˜, ÏfiÁˆ ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ÌÔÛ¯Â‡-Ì·ÙÔ˜, ÓfiÛÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ Î·Ù¿ ÙÔ˘ ÍÂÓÈÛÙ‹(GVHD) Î·È ÌÂÁ¿ÏË˜ ıÓËÙfiÙËÙ·˜ ·fi ÏÔÈÌÒÍÂÈ˜.

∏ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ ‰È·ÎÚ›ÓÂÙ·È ÛÂ: - ÚˆÙÔ·ı‹ (fiÙ·Ó ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È Î·ıfiÏÔ˘

·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ·ÈÌÔÔ›ËÛË˜ ÌÂÙ¿ ·fi ÌÂ-Ù·ÌfiÛ¯Â˘ÛË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ) Î·È

- ‰Â˘ÙÂÚÔ·ı‹ (fiÙ·Ó Û˘Ì‚·›ÓÂÈ ·Ú¯ÈÎ¿, ÂÁÎ·Ù¿-ÛÙ·ÛË ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜, ·ÎÔÏÔ˘ıÂ›Ù·È, fiÌˆ˜,·fi ·fiÚÚÈ„Ë).Ÿˆ˜ ¤ÁÈÓÂ ·ÓÙÈÏËÙfi ·fi ÙÈ˜ ÚÒÙÂ˜ ÌÂÙ·ÌÔ-

Û¯Â‡ÛÂÈ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞∞, fiÙ·Ó ÙÔ Û¯‹Ì· ÚÔÂ-ÙÔÈÌ·Û›·˜ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ÈÛ¯˘Ú‹ ·ÓÔÛÔÎ·Ù·ÛÙÔ-Ï‹, ‰ÂÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Û˘Ó‹ıˆ˜ ÂÁÎ·Ù¿ÛÙ·ÛË ÙÔ˘ÌÔÛ¯Â‡Ì·ÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ Èı·ÓfiÓ Û¯ÂÙ›˙ÂÙ·È ÌÂÙÔÓ ˘ÔÎÂ›ÌÂÓÔ ·ÓÔÛÔÏÔÁÈÎfi ÌË¯·ÓÈÛÌfi ÙÔ˘ ÓÔÛ‹-Ì·ÙÔ˜. ∏ È‰È·ÈÙÂÚfiÙËÙ· ÙË˜ ªª√ ÛÂ ∞∞ ¤ÁÈÓÂ Û·-Ê¤ÛÙÂÚË ·fi ÙËÓ ÂÌÂÈÚ›· ÌÂÙ·ÌÔÛ¯Â‡ÛÂˆÓ ·fiÌÔÓÔ˙˘ÁˆÙÈÎÔ‡˜ ·‰ÂÏÊÔ‡˜ ‰fiÙÂ˜. £ÂˆÚËÙÈÎ¿,fiÙ·Ó Ô ‰fiÙË˜ Â›Ó·È ÌÔÓÔ˙˘ÁˆÙÈÎfi˜ ‰›‰˘ÌÔ˜ ·‰ÂÏ-Êfi˜, ‰ËÏ·‰‹ ÁÂÓÂÙÈÎ¿ ·fiÏ˘Ù· Ù·˘ÙfiÛËÌÔ˜ ÌÂ ÙÔ‰¤ÎÙË, ‰ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ·fiÚÚÈ„Ë˜ ÙÔ˘ ÌÔ-Û¯Â‡Ì·ÙÔ˜ ‹ GVHD. ¶·Ú·ÙËÚ‹ıËÎÂ fiÌˆ˜, fiÙÈ ·Îfi-ÌË Î·È ÛÂ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜, Î·È Ì¿ÏÈÛÙ· ÛÂ Ô-ÛÔÛÙfi 50%, ‰ÂÓ ÂÈÙ˘Á¯·ÓfiÙ·Ó ÂÁÎ·Ù¿ÛÙ·ÛË ÙÔ˘ÌÔÛ¯Â‡Ì·ÙÔ˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ¯ÔÚ‹ÁËÛË ˘„ËÏ‹˜‰fiÛË˜ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë˜ 200 mg/kg ¤Ï˘ÛÂ ÙÔ Úfi-‚ÏËÌ· ÙË˜ ÂÁÎ·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ ÛÂ ÌÔ-ÓÔ˙˘ÁˆÙÈÎÔ‡˜ ‰È‰‡ÌÔ˘˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÂÈ‚›ˆÛËÛÂ ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 90% ÙˆÓ ·ÛıÂÓÒÓ.™ÙÈ˜ ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜ ·fi HLA ÈÛÙÔÛ˘Ì‚·ÙÔ‡˜·‰ÂÏÊÔ‡˜, Ë ·ÓÂ¿ÚÎÂÈ· ÌÔÛ¯Â‡Ì·ÙÔ˜ ÂÍ·ÎÔÏÔ˘-ıÔ‡ÛÂ Ó· ·ÔÙÂÏÂ› Úfi‚ÏËÌ· fiÙ·Ó ÙÔ Û¯‹Ì· ÚÔÂ-ÙÔÈÌ·Û›·˜ ÂÚÈÂ›¯Â ÌfiÓÔ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë. °È· ÙÔÓÏfiÁÔ ·˘Ùfi, ‰fiıËÎÂ ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË ¤ÌÊ·ÛË ÛÙÔ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎfi ÙÌ‹Ì· ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÚÔÂÙÔÈ-Ì·Û›·˜. ™¯‹Ì·Ù· ÚÔÂÙÔÈÌ·Û›·˜ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈ-ÌÔÔÈËıÂ› Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë˜ÌÂ ·ÎÙÈÓÔ‚ÔÏ›·, Ô˘ ÌÔÚÂ› Ó· Â›Ó·È ıˆÚ·ÎÔÎÔÈÏÈ·-Î‹, ÔÏÔÛˆÌ·ÙÈÎ‹ ‹ ÔÏÔ·‰ÂÓÈÎ‹. º·›ÓÂÙ·È, fiÌˆ˜, fiÙÈÙ· Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ‰›ÓÂÈ Ô Û˘Ó‰˘·ÛÌfi˜ Î˘-ÎÏÔÊˆÛÊ·Ì›‰Ë˜ ÌÂ ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎ‹ ÛÊ·ÈÚ›ÓËÔ˘ ·ÓÂ‚¿˙ÂÈ ÙÔ ÔÛÔÛÙfi ÂÁÎ·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ÌÔ-Û¯Â‡Ì·ÙÔ˜ ÛÂ 95%.

∏ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ Ô˘ ¯ÔÚËÁÂ›Ù·ÈÁÈ· ÙËÓ ÚfiÏË„Ë ÙÔ˘ ÔÍ¤Ô˜ GVHD Û˘Ì‚¿ÏÏÂÈ ÂÈ-

ÚfiÛıÂÙ·, ÛÙËÓ ·ÔÙÚÔ‹ ÙË˜ ·fiÚÚÈ„Ë˜ ÙÔ˘ ÌÔ-Û¯Â‡Ì·ÙÔ˜. ∏ ¯Ú‹ÛË ÙË˜ Î˘ÎÏÔÛÔÚ›ÓË˜ (ÛÂ Û˘Ó-‰˘·ÛÌfi ÌÂ ÌÈÎÚ¤˜ ‰fiÛÂÈ˜ ÌÂıÔÙÚÂÍ¿ÙË˜) ÁÈ· ÙËÓÚfiÏË„Ë ÙÔ˘ ÔÍ¤Ô˜ GVHD, ·ÔÙÂÏÂ› ÙÔÓ ÛËÌ·ÓÙÈ-ÎfiÙÂÚÔ ·Ú¿ÁÔÓÙ· Ô˘ ‚ÂÏÙ›ˆÛÂ ÙËÓ ¤Î‚·ÛË ÙË˜ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ÛÙËÓ ∞∞. Œ¯ÂÈ Ì¿ÏÈÛÙ· ·Ú·ÙËÚË-ıÂ› fi„ÈÌË ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ ÌÂÙ¿ ÙË‰È·ÎÔ‹ ÙË˜ Î˘ÎÏÔÛÔÚ›ÓË˜, ÁÂÁÔÓfi˜ Ô˘ Ô‰‹ÁËÛÂÎ¿ÔÈÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ù¤˜ Ó· Û˘ÓÂ¯›˙Ô˘Ó ÙË ¯ÔÚ‹-ÁËÛË ÙË˜ Î˘ÎÏÔÛÔÚ›ÓË˜ Â› 12 ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜Ì‹ÓÂ˜ ÌÂÙ¿ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∞˘ÍËÌ¤ÓË Û˘-¯ÓfiÙËÙ· ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ ·Ú·ÙËÚÂ›-Ù·È, Â›ÛË˜, ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ô ·ÚÈıÌfi˜ ÙˆÓÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ÌfiÛ¯Â˘Ì· Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ·fi2x108 ÌÔÓÔ‡ÚËÓ· Î‡ÙÙ·Ú·/kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ÙÔ˘ Ï‹ÙË. ∆¤ÏÔ˜, Ë ·ÏÏÔ·ÓÔÛÔÔ›ËÛË ·fi ÚÔË-ÁÔ‡ÌÂÓÂ˜ ÌÂÙ·ÁÁ›ÛÂÈ˜ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËıÂ› ÁÈ· ÙËÓ·fiÚÚÈ„Ë ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜. Œ¯ÂÈ, Ì¿ÏÈÛÙ·, ‰È·È-ÛÙˆıÂ› Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌÂ-Ù·ÁÁ›ÛÂˆÓ Ô˘ ¤¯Ô˘Ó ÚÔËÁËıÂ› Î·È ÙË Û˘¯ÓfiÙËÙ·ÙË˜ ·fiÚÚÈ„Ë˜. ∏ ¯Ú‹ÛË ÊÈÏÙÚ·ÚÈÛÌ¤ÓˆÓ Î·È ·ÎÙÈ-ÓÔ‚ÔÏËÌ¤ÓˆÓ ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ∞∞ Â›Ó·È ÂÈÙ·ÎÙÈÎ‹ ÚÈÓ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, ÁÈ·ÙËÓ ÚfiÏË„Ë ÙfiÛÔ ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·-ÙÔ˜ fiÛÔ Î·È ÙÔ˘ GVHD. √ Î›Ó‰˘ÓÔ˜ ÔÍ¤Ô˜ GVHD(‚·ıÌÔ‡ II-IV) ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi HLA-Û˘Ì‚·Ùfi ·‰ÂÏÊfi Â›Ó·È 15-30%. ∂ÈÏ¤ÔÓ, 30-45%ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ù‡ÛÛÔ˘Ó ¯ÚfiÓÈÔ GVHD. √ ÈÔÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍËGVHD Â›Ó·È Ë ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓÔ‡˜, ÌÂ ¯·ÌËÏfiÙÂÚËÂ›ÙˆÛË ÛÂ ÓÂ·ÚfiÙÂÚÔ˘˜ ·ÛıÂÓÂ›˜.

∏ Û˘ÓÂ¯‹˜ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÙ·ÌÔ-Û¯Â‡ÛÂˆÓ ÛÙËÓ ∞∞ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‹Ù·Ó Ë·ÊÔÚÌ‹ ÁÈ· ÌÈ· Û˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ ÛÂ ‰È¿ÊÔÚÂ˜ ¯ÚÔÓÈÎ¤˜ ÂÚÈfi‰Ô˘˜ ·fi ÙÔ¢ÈÂıÓ¤˜ ∞Ú¯Â›Ô ∫·Ù·ÁÚ·Ê‹˜ ªÂÙ·ÌÔÛ¯Â‡ÛÂˆÓª˘ÂÏÔ‡ ÙˆÓ √ÛÙÒÓ. ∞˘Ùfi Ô˘ ‰È·ÈÛÙÒıËÎÂ Â›Ó·ÈÌ›· Û˘ÓÂ¯‹˜ Ù¿ÛË ·‡ÍËÛË˜ ÙË˜ ÂÈ‚›ˆÛË˜ ÙˆÓ·ÛıÂÓÒÓ (Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË ÛÂ ÔÛÔÛÙfi 80-90% ÙˆÓ ·ÛıÂÓÒÓ). ¢ÂÓ Â›Ó·È Û·Ê¤˜ ÔÈÔ› ·Ú¿ÁÔ-ÓÙÂ˜ Â›Ó·È ˘Â‡ı˘ÓÔÈ ÁÈ’ ·˘Ù‹ ÙË ‚ÂÏÙ›ˆÛË. ™ÙË ÌÂ-Ï¤ÙË ·˘Ù‹ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙË-Ù· ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜¯ÚÔÓÈÎ¤˜ ÂÚÈfi‰Ô˘˜ Î·È Ë ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹‚ÂÏÙ›ˆÛË ÙË˜ ÂÈ‚›ˆÛË˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÂÏ¿ÙÙˆÛËÙË˜ ÚÒÈÌË˜ ıÓËÙfiÙËÙ·˜ ·fi ªª√. ŒÙÛÈ, Ë ‚ÂÏ-Ù›ˆÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·Ô‰fiıËÎÂ Î˘Ú›ˆ˜:

- ÛÙË ¯Ú‹ÛË Î˘ÎÏÔÛÔÚ›ÓË˜,- ÛÙËÓ ÂÈÏÔÁ‹ ÓÂfiÙÂÚˆÓ ·ÛıÂÓÒÓ ÁÈ· ÌÂÙ·Ìfi-

Û¯Â˘ÛË,- ÛÙËÓ ÚˆÈÌfiÙÂÚË ÂÊ·ÚÌÔÁ‹ ÙË˜ ªª√ ÌÂ ·Ô-

Ù¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÚÔË-ÁËıÂÈÛÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ,

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- ÛÙË ¯Ú‹ÛË ÂÓ‰ÔÊÏ¤‚È·˜ Á-ÛÊ·ÈÚ›ÓË˜ Î·È ÎÔÙÚÈ-ÌÔÍ·˙fiÏË˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Â˘Î·ÈÚÈ·ÎÒÓ ÏÔÈ-ÌÒÍÂˆÓ.∏ Û˘Ó‰˘·ÛÌ¤ÓË ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ ÌÂ

Î˘ÎÏÔÛÔÚ›ÓË Î·È ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎ‹ ÛÊ·ÈÚ›ÓË Â›Ó·È·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÂÓ·ÏÏ·ÎÙÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ ÂÈÏÔÁ‹ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞∞ Ô˘ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó ÈÛÙÔÛ˘Ì‚·Ùfi·‰ÂÏÊfi ‰fiÙË.

¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ·fi ‰È¿ÊÔÚ· Î¤ÓÙÚ· ·Ó·-Ê¤ÚÔ˘Ó ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈ‚›ˆÛË˜ ÌÂÙ¿ ·fi ·ÓÔÛÔ-Î·Ù·ÛÙÔÏ‹ ÛÂ Â›Â‰· ·ÚfiÌÔÈ· ÌÂ ·˘Ù¿ ÙË˜ ÌÂÙ·-ÌfiÛ¯Â˘ÛË˜ Ì˘ÂÏÔ‡. ∏ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹,fiÌˆ˜, ‰ÂÓ ·ÔÙÚ¤ÂÈ ÙËÓ ÎÏˆÓÈÎ‹ ÂÍ·ÏÏ·Á‹ ÙÔ˘ ÓÔ-Û‹Ì·ÙÔ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛËÓ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙˆÙÈÎ‹ Ù¿ÛË. ™Â 860 ·ÛıÂÓÂ›˜ ÌÂ‚·ÚÈ¿ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, Ô˘ Î·Ù·ÁÚ¿ÊËÎ·Ó ·fiÙËÓ ∂˘Úˆ·˚Î‹ √Ì¿‰· ∂ÚÁ·Û›·˜ ÁÈ· ÙË ªª√ Î·ÈÂ›¯·Ó ·ÓÙÈÌÂÙˆÈÛıÂ› ÌÂ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹,Ë Û˘¯ÓfiÙËÙ· ·Ó¿Ù˘ÍË˜ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘ ‹ ÏÂ˘¯·ÈÌ›·˜ ÛÂ ‰È¿ÛÙËÌ· 10 ÂÙÒÓ ‹Ù·Ó9,6% Î·È 6,6% ·ÓÙ›ÛÙÔÈ¯·. ∞ÓÙ›ıÂÙ·, Ë Î·Ì‡ÏË ÙË˜ÂÈ‚›ˆÛË˜ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ú·Ì¤ÓÂÈ ÛÙ·-ıÂÚ‹, È‰È·›ÙÂÚ· ÛÙ· ·È‰È¿, ‰ÈfiÙÈ ÙÔ ¯ÚfiÓÈÔ GVHD,Ô˘ ·ÔÙÂÏÂ› ÙË ÛÔ‚·ÚfiÙÂÚË ÂÈÏÔÎ‹, ¤¯ÂÈ ÌÈÎÚ‹Û˘¯ÓfiÙËÙ· (5%).

¢Â˘ÙÂÚÔ·ıÂ›˜ ÓÂÔÏ·Û›Â˜ ·Ó·Ê¤ÚÔÓÙ·È Î·È ÛÂÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË.™˘ÓÂÚÁ·ÙÈÎ‹ ÌÂÏ¤ÙË ·fi ÙÔ Seattle Î·È ÙÔ ¡ÔÛÔÎÔ-ÌÂ›Ô St. Louis ÛÙÔ ¶·Ú›ÛÈ, ·Ó·Ê¤ÚÂÙ·È ÛÂ 621 ·ÛıÂ-ÓÂ›˜ ÌÂ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ÌÂ ‰È¿ÌÂÛË ËÏÈÎ›· Ù· 19¤ÙË, Ô˘ ÌÂÙ·ÌÔÛ¯Â‡ıËÎ·Ó ·fi HLA-Û˘Ì‚·Ùfi ·‰ÂÏ-Êfi. ∞Ó·Ù‡¯ıËÎ·Ó 18 ÓÂÔÏ·Û›Â˜: - 5 ÙÔ˘ ÏÂÌÊÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (3 ÏÂÌÊÔ¸ÂÚÏ·-

ÛÙÈÎ¿ – 2 ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·) Ì¤Û·ÛÙÔ˘˜ ÚÒÙÔ˘˜ 15 Ì‹ÓÂ˜,

- 13 Û˘Ì·ÁÂ›˜ fiÁÎÔÈ (6 ÎÂÊ·Ï‹˜-ÙÚ·¯‹ÏÔ˘, 6‰¤ÚÌ·ÙÔ˜ Î·È 1 ·È‰Ô›Ô˘).

¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Û˘Ì·ÁÒÓfiÁÎˆÓ ‹Ù·Ó: - Ë ¯ÔÚ‹ÁËÛË ·˙·ıÂÈÔÚ›ÓË˜ ÁÈ· ıÂÚ·Â›· ¯ÚfiÓÈ-

Ô˘ GVHD, - Ë ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ Î·È - Ë ¯ÔÚ‹ÁËÛË ·ÎÙÈÓÔ‚ÔÏ›·˜ ÛÙÔ Û¯‹Ì· ÚÔÂÙÔÈÌ·-

Û›·˜.∆Ô ¯ÚfiÓÈÔ GVHD ‰ÂÓ ·ÔÙÂÏÂ› È‰È·›ÙÂÚÔ Úfi‚ÏË-

Ì· ÛÙ· ·È‰È¿ Î·È Ù· Û¯‹Ì·Ù· ÚÔÂÙÔÈÌ·Û›·˜ Ô˘¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û‹ÌÂÚ· ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ÎÙÈ-ÓÔ‚ÔÏ›·. ∂ÔÌ¤Óˆ˜, Ô Î›Ó‰˘ÓÔ˜ ‰Â˘ÙÂÚÔ·ıÒÓ ÓÂÔ-Ï·ÛÈÒÓ ÛÙ· ·È‰È¿ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·ÌÂÏËÙ¤Ô˜.

∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ÂÓ·Ï-Ï·ÎÙÈÎÔ‡˜ ‰fiÙÂ˜ (ÌË Û˘ÁÁÂÓÂ›˜ Û˘Ì‚·ÙÔ‡˜ ‹ Û˘ÁÁÂ-ÓÂ›˜ Ê·ÈÓÔÙ˘ÈÎ¿ Û˘Ì‚·ÙÔ‡˜ ‹ ÌÂ 1 ·ÓÙÈÁfiÓÔ ‰È·ÊÔ-Ú¿) ‰ÂÓ ·ÔÙÂÏÂ› ıÂÚ·Â›· ÚÒÙË˜ ÁÚ·ÌÌ‹˜, ¤¯ÂÈ

fiÌˆ˜ ¤Ó‰ÂÈÍË ÛÂ ·È‰È¿ ÌÂ ∞∞ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›-ÓÔÓÙ·È ÛÙËÓ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹.

∞Ó·ÈÌ›· Fanconi¢Â˘ÙÂÚÔ·ı‹˜ ∞∞ ·Ú·ÙËÚÂ›Ù·È ÛÂ ·È‰È¿ ÌÂ

·Ó·ÈÌ›· Fanconi, fiÔ˘ ˘¿Ú¯ÂÈ ·ÚÎÂÙ‹ ÂÌÂÈÚ›· ÌÂÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. π‰È·›ÙÂÚÔÚfi‚ÏËÌ· Î·Ù¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÛÂ ·Ó·ÈÌ›·Fanconi ·ÔÙÂÏÂ› Ë ÂÁÁÂÓ‹˜ ˘ÂÚÂ˘·ÈÛıËÛ›· ÙˆÓÎ˘ÙÙ¿ÚˆÓ ÛÂ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙË‰ÔÌ‹ ÙÔ˘ DNA, fiˆ˜ Â›Ó·È Ë Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë Î·ÈË ·ÎÙÈÓÔ‚ÔÏ›· ÛÙÈ˜ ‰fiÛÂÈ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÈÛÙ· Û˘Ó‹ıË Û¯‹Ì·Ù· ÚÔÂÙÔÈÌ·Û›·˜. °È’ ·˘ÙfiÓ ÙÔÏfiÁÔ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È:

- ÌfiÓÔ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë, - Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë ÛÂ ‰fiÛË 20-40 mg/kg + ıˆ-

Ú·ÎÔÎÔÈÏÈ·Î‹ ·ÎÙÈÓÔ‚ÔÏ›· 400-500cGy, - Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë + ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎ‹ ÛÊ·ÈÚ›-

ÓË + ÊÏÔ˘ÓÙ·Ú·Ì›ÓË, - ‚Ô˘ÛÔ˘ÏÊ¿ÓË + Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë.

∏ ÌÂÁ·Ï‡ÙÂÚË ÔÌ¿‰· ·ÛıÂÓÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›-ÛıËÎ·Ó ÌÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔIBMTR (International Bone Marrow TransplantationRegistry). ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1978-1992, ÌÂÙ·ÌÔ-Û¯Â‡ıËÎ·Ó 199 ·ÛıÂÓÂ›˜ ÌÂ ·Ó·ÈÌ›· Fanconi. ™ÙÔ˘˜151 Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi HLA-Û˘Ì‚·Ùfi ·‰ÂÏÊfi, Ë ‰ÈÂÙ‹˜ ÂÈ‚›ˆÛË ‹Ù·Ó 66%.™ÙÔ˘˜ 48 Ô˘ ¤Ï·‚·Ó ÌfiÛ¯Â˘Ì· ·fi ÂÓ·ÏÏ·ÎÙÈÎÔ‡˜‰fiÙÂ˜, Ë ‰ÈÂÙ‹˜ ÂÈ‚›ˆÛË ‹Ù·Ó 29%. ¶·Ú¿ÁÔÓÙÂ˜Ô˘ Û˘Û¯ÂÙ›ÛıËÎ·Ó ÌÂ ÛËÌ·ÓÙÈÎ¿ ÂÏ·ÙÙˆÌ¤ÓË ıÓË-ÙfiÙËÙ· ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó:

- ËÏÈÎ›· ·ÛıÂÓÔ‡˜ <10 ¤ÙË- ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ ÚÈÓ ·fi ÙË ªª√- ¯Ú‹ÛË ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎ‹˜ ÛÊ·ÈÚ›ÓË˜- ¯Ú‹ÛË Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë˜ (15-25mg/kg) + ·ÎÙÈ-

ÓÔ‚ÔÏ›· ÂÚÈÔÚÈÛÌ¤ÓÔ˘ Â‰›Ô˘- ¯Ú‹ÛË Î˘ÎÏÔÛÔÚ›ÓË˜ ÁÈ· ÚÔÊ‡Ï·ÍË ·fi

GVHD.ª¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 40 ÂÙÒÓ, ÂÚÈÛÛfiÙÂÚÔÈ ·fi

ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ·Ó·ÈÌ›· Fanconi ·Ó·Ù‡Û-ÛÔ˘Ó Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÏÂ˘¯·ÈÌ›·.∂›ÛË˜, ·˘ÍËÌ¤ÓË Â›Ó·È Ë Û˘¯ÓfiÙËÙ· Û˘Ì·ÁÒÓfiÁÎˆÓ. Œ¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÂÚÈÙÒÛÂÈ˜ ÔÍÂ›·˜ Ì˘Â-ÏÔÁÂÓÔ‡˜ ÏÂ˘¯·ÈÌ›·˜ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘Â-ÏÔ‡ ÛÂ ·Ó·ÈÌ›· Fanconi, ¯ˆÚ›˜ fiÌˆ˜ Ó· Â›Ó·È Û·Ê¤˜·Ó ÔÈ ·ÛıÂÓÂ›˜ ·˘ÙÔ› Â›¯·Ó ‹‰Ë ·Ó·Ù‡ÍÂÈ ÏÂ˘¯·ÈÌ›·‹ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ÚÈÓ ·fi ÙË ÌÂÙ·-ÌfiÛ¯Â˘ÛË. ™ÙË ÛÂÈÚ¿ ÙˆÓ ·ÛıÂÓÒÓ ·fi ÙÔ SeattleÎ·È ÙÔ ¡ÔÛÔÎÔÌÂ›Ô St. Louis, ÛÂ 79 ·ÛıÂÓÂ›˜ ÌÂ·Ó·ÈÌ›· Fanconi Î·È ‰È¿ÌÂÛË ËÏÈÎ›· Ù· 10 ¤ÙË, ·Ó·-Ù‡¯ıËÎ·Ó 5 Û˘Ì·ÁÂ›˜ fiÁÎÔÈ ÎÂÊ·Ï‹˜ Î·È ÙÚ·¯‹-ÏÔ˘ ÛÂ ‰È¿ÛÙËÌ· 6-11 ÂÙÒÓ ÌÂÙ¿ ·fi ÙË ÌÂÙ·Ìfi-Û¯Â˘ÛË, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›· ÓÂÔÏ·Û›·

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ÙÔ˘ ÏÂÌÊÔ·ÈÌÔÔÈËÙÈÎÔ‡ ÈÛÙÔ‡. ∆Ô Â‡ÚËÌ· ·˘ÙfiÂ›Ó·È Û˘Ì‚·Ùfi ÌÂ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË·ÔÎ·Ù¤ÛÙËÛÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÈÌÔÔÈ›· ÛÙÔ˘˜·ÛıÂÓÂ›˜, ·ÏÏ¿ ‰ÂÓ ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÂÈ ÙËÓ Â˘-¿ıÂÈ· ÙˆÓ ¿ÏÏˆÓ ÈÛÙÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË ÓÂÔÏ·-ÛÈÒÓ. √È ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔÈ ·ÛıÂÓÂ›˜ ÌÂ ·Ó·ÈÌ›·Fanconi ‹Ù·Ó ËÏÈÎ›·˜ 17-29 ÂÙÒÓ fiÙ·Ó ‰È·ÁÓÒ-ÛıËÎ·Ó ÔÈ Û˘Ì·ÁÂ›˜ fiÁÎÔÈ, ËÏÈÎ›· ·ÚfiÌÔÈ· ÌÂÙËÓ ·Ó·ÊÂÚfiÌÂÓË ÁÈ· ÌË ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜·ÛıÂÓÂ›˜.

ÕÏÏ· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¤¯ÂÈ ¯ÚË-

ÛÈÌÔÔÈËıÂ› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ·Ó·ÈÌ›· Diamond-Blackfan, Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔ-ÓÙ·È ÛÙË ıÂÚ·Â›· ÌÂ ÛÙÂÚÔÂÈ‰‹ ÎÈ ¤¯Ô˘Ó ·Ó¿ÁÎË·fi Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂÈ˜. ¶·ÚfiÙÈ Ë ‰ÈÂıÓ‹˜ ÂÌÂÈ-Ú›· Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË, ÏfiÁˆ ÙË˜ Û·ÓÈfiÙËÙ·˜ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È ÂÓı·ÚÚ˘-ÓÙÈÎ¿. ÕÏÏ· Û·ÓÈfiÙÂÚ· Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜·Ï·Û›·˜ ÛÂ ·È‰È¿ fiÔ˘ ˘¿Ú¯Ô˘Ó ÌÂÌÔÓˆÌ¤ÓÂ˜·Ó·ÊÔÚ¤˜ ıÂÚ·Â›·˜ ÌÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È ËÛ˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË, ÙÔ Û‡Ó‰ÚÔÌÔSchwachman-Diamond, Ë ·ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ·ÚÈÎ‹ıÚÔÌ‚ÔÂÓ›·, ÙÔ Û‡Ó‰ÚÔÌÔ ıÚÔÌ‚ÔÂÓ›·˜ ÌÂ·Ô˘Û›· ÎÂÚÎ›‰ˆÓ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Kostmann.

∞Ó·ÎÂÊ·Ï·ÈÒÓÔÓÙ·˜, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ÙˆÓ ÔÛÙÒÓ ·ÔÙÂÏÂ› ÙË ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ· ·È-‰È¿ ÌÂ ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ÌÂ ÈÛÙÔÛ˘Ì‚·Ùfi ·‰ÂÏÊfi‰fiÙË. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·Ó·ÈÌ›· Fanconi, ÂÈ‚¿Ï-ÏÂÙ·È Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ù·ÎÙÈÎ¿ ÔÈ ·ÛıÂÓÂ›˜

ÌÂ Ì˘ÂÏfiÁÚ·ÌÌ· Î·È Ó· Á›ÓÂÙ·È ÌÂÙ·ÌfiÛ¯Â˘ÛËfiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÓˆÚ›ÙÂÚ· fiÙ·Ó ·Ó·Ù˘¯ıÂ›·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ‹ fiÙ·Ó ·ÓÈ¯ÓÂ‡ÔÓÙ·È Î˘ÙÙ·ÚÔ-ÁÂÓÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ÚÔÙÔ‡ ÂÎ‰ËÏˆıÂ› Ì˘ÂÏÔ-‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·. ∆¤ÏÔ˜,Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È ÂÈÙ˘¯‹˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ·Ó·ÈÌ›· Diamond-Blackfan, Ô˘ Â›Ó·È ·ÓıÂÎÙÈÎ‹ÛÙ· ÛÙÂÚÔÂÈ‰‹.

µÈ‚ÏÈÔÁÚ·Ê›·1. Young NS, Barrett AJ. The treatment of severe aplastic

anemia. Blood 1995;85:3367-3377.2. Gluckman E, Auerbach AD, Horowitz MM, Sobocinski KA,

Ash RC, Bortin MM et al. Bone marrow transplantation forFanconi anemia. Blood 1995;86:2856-2862.

3. Deeg HJ, Socié G, Schoch G, Henry-Amar M,Witherspoon RP, Devergie A et al. Malignancies aftermarrow transplantation for aplastic anemia and Fanconianemia: a joint Seattle and Paris analysis of results in 700patients. Blood 1996;87:386-392.

4. Passweg JR, Socié G, Hinterberger W, Bacigalupo A,Biggs JC, Camitta BM et al. Bone marrow transplantationfor severe aplastic anemia: has outcome improved? Blood1997;90:858-864.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-10-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-11-2000

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ËÌ‹ÙÚÈÔ˜ ¶ÂÙÚfiÔ˘ÏÔ˜ª.ª.ª.√., ¶.°.¡.∞. “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∞ı‹Ó· 115 27

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�¶ÂÚ›ÏË„Ë: ∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·Ê˘‰¿ÙˆÛË˜Û˘ÓÂÂ›· ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ Â›Ó·È Û˘¯Ófi Úfi‚ÏË-Ì· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈÎ‹ ÙÔ˘ ·È‰›·ÙÚÔ˘. ∏·ÚÔ‡Û· ÌÂÏ¤ÙË ÚÔÛ·ıÂ› Ó· ‰ÈÂÚÂ˘Ó‹ÛÂÈ ÙÔ‚·ıÌfi ·Ô‰Ô¯‹˜ ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ÙˆÓ ÚÔ-Ù¿ÛÂˆÓ ÙË˜ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙË ıÂÚ·-Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· (£∂™) Î·È ÙÔ˘˜·Ú¿ÁÔÓÙÂ˜ Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË Û˘ÓÙ·ÁÔÁÚ¿-ÊËÛ‹ ÙË˜. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ ¤Ó· ·ÓÒÓ˘ÌÔ ÂÚˆÙË-Ì·ÙÔÏfiÁÈÔ ÚÔ˜ ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Ô˘ ·ÊÔÚ¿ ÙËÁÓÒÛË, ÙË ÛÙ¿ÛË Î·È ÙËÓ Ú·ÎÙÈÎ‹ ÙÔ˘˜ ÛÂ Û¯¤ÛËÌÂ ÙËÓ ÂÓ˘‰¿ÙˆÛË ·fi ÙÔ ÛÙfiÌ· ÛÂ ÔÍ¤· ‰È·Ú-ÚÔ˚Î¿ Û‡Ó‰ÚÔÌ·. √È ÂÚÈÛÛfiÙÂÚÔÈ ·È‰›·ÙÚÔÈ(90%) ¤¯Ô˘Ó ıÂÙÈÎ‹ ÛÙ¿ÛË ˆ˜ ÚÔ˜ ÙËÓ ÂÓ˘‰¿Ùˆ-ÛË ·fi ÙÔ ÛÙfiÌ·. ªfiÓÔ ÙÔ 13% ÈÛÙÂ‡ÂÈ fiÙÈ Ë ÂÎ-·›‰Â˘ÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Â›Ó·È ‰‡ÛÎÔÏË ‹ ·‰‡-Ó·ÙË Î·È fiÙÈ ÔÈ ÁÔÓÂ›˜ ‰ÂÓ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó··ÓÙÈÌÂÙˆ›ÛÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Ù· ·È‰È¿ ÛÙÔÛ›ÙÈ. ŸÏÔÈ ÔÈ ·È‰›·ÙÚÔÈ ÚÔÙÂ›ÓÔ˘Ó, ·Ó¿ÏÔÁ· ÌÂÙËÓ ÂÚ›ÙˆÛË, ÙfiÛÔ ÙËÓ ÂÓ˘‰¿ÙˆÛË ·fi ÙÔ ÛÙfi-Ì· fiÛÔ Î·È ÙËÓ ÂÓ‰ÔÊÏ¤‚È· ÂÓ˘‰¿ÙˆÛË. ŸÌˆ˜, ÙÔ43% ıÂˆÚÂ› ÙÔ˘˜ ÂÌ¤ÙÔ˘˜ ·ÓÙ¤Ó‰ÂÈÍË ÛÙËÓ ·fiÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÂÓ˘‰¿ÙˆÛË. √È ÂÚÈÛÛfiÙÂÚÔÈ ·È-‰›·ÙÚÔÈ (87%) Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó ÂÈ‰ÈÎ¿ ‰È·Ï‡Ì·Ù·ÁÈ· ÂÓ˘‰¿ÙˆÛË ·fi ÙÔ ÛÙfiÌ·, ·Ó Î·È ÙÔ 17% ·fi·˘ÙÔ‡˜ ÚÔÙÂ›ÓÔ˘Ó ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ Î·È ÌË ÂÓ‰ÂÈ-ÎÓ˘fiÌÂÓ· ˘ÁÚ¿. ªfiÓÔ ÙÔ 13% ÚÔÙÂ›ÓÂÈ ÛÙÔ˘˜ÁÔÓÂ›˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ‰ÔÛÔÌÂÙÚËÙ‹ (ÎÔ˘Ù·Ï¿-ÎÈ ‹ Û‡ÚÈÁÁ·). √È ÂÚÈÛÛfiÙÂÚÔÈ (55%) Û˘ÛÙ‹ÓÔ˘ÓÂ·Ó·Û›ÙÈÛË ÛÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙËÓ ¤Ó·ÚÍËÙË˜ ÓfiÛÔ˘. √ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ó·ÛÙ·ÏÙÈÎfi˜ ·-Ú¿ÁÔÓÙ·˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ £∂™ Â›Ó·È Ë ÛÙ¿ÛËÙˆÓ ·È‰›·ÙÚˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙË ‰˘ÛÎÔÏ›· ÂÎ·›-‰Â˘ÛË˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ. ∞·ÈÙÔ‡ÓÙ·È ÚfiÛıÂÙÂ˜

�Abstract: Management of dehydration resultingfrom acute diarrhea is a common problem inpediatric practice. This complication can beprevented and managed with prompt admini-stration of appropriate oral solutions. This studyattempts to determine the degree of acceptanceby the pediatricians of the recommendationspublished in the international literature regardingthe use of oral rehydration therapy (ORT), as wellas the factors responsible for its non implemen-tation. By using an anonymous questionnaireaddressed to pediatricians, we investigated theirknowledge, attitudes and practices in relation tothe ORT. Almost all pediatricians (90%) have apositive attitude as far as ORT is concerned. Only13% believe that training the families is a difficult orimpossible process due to their inability to copesuccessfully with their sick child at home. All thepediatricians, depending on the case, suggest theuse of either ORT or intravenous rehydration.However 43% consider vomiting as a contra-indication to oral rehydration. Most pediatricians(87%) prescribe appropriate oral rehydrationsolutions, although 17% of them propose occa-sionally the use of inappropriate liquids. Only 13%suggest to the parents the use of volumetricmeasurements for feeding (spoon or syringe) and55% suggest refeeding in the first 24 hours fromthe beginning of the illness. The most importantinhibiting factor for its application is the difficulty intraining the families. Additional efforts are requiredto encourage the use of the recommended guide-lines for the outpatient management of childrenwith acute diarrhea.

£ÂÚ·Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· ÛÙËÓ ÔÍÂ›· ‰È¿ÚÚÔÈ· Î·È ·Ó·ÛÙ·ÏÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ¡. ™ÎÂÓÙ¤ÚË˜, ¡. ™Ô‡ÎÈ·˜, ∂. ∫ˆÛÙ·‰‹Ì·, ™. Ã·˚‰¿˜

Oral rehydration therapy for acute diarrhea and factors that inhibit its applicationE. Alexopoulos, N. Skenteris, N. Soukias, E. Kostadima, S. Haidas

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL PAPER

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·Ï›·˜, ¶.¶.°.¡.§¿ÚÈÛ·˜

Pediatric Clinic of the University of Thessalia University General Hospital of Larisa

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∂ÈÛ·ÁˆÁ‹∏ ÔÍÂ›· ‰È¿ÚÚÔÈ· Û˘ÓÂ¯›˙ÂÈ Ó· ·ÔÙÂÏÂ› Î‡ÚÈÔ

·›ÙÈÔ ÙË˜ ·È‰ÈÎ‹˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ, Î˘Ú›ˆ˜, ÎfiÛÌÔ (1). ™ÙË ¯ÒÚ·Ì·˜ ÔÈ Û˘Ó¤ÂÈ¤˜ ÙË˜ ÛÙËÓ ˘ÁÂ›· ÙˆÓ ·È‰ÈÒÓ Â›Ó·ÈËÈfiÙÂÚÂ˜, ˆÛÙfiÛÔ ‰ÂÓ ·‡ÂÈ Ó· ·ÔÙÂÏÂ› Î·ıËÌÂ-ÚÈÓfi Úfi‚ÏËÌ· ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ. π‰È·›ÙÂÚ· ··-Û¯ÔÏÂ› Ë ÂÈÏÔÁ‹ ÙË˜ Ô‰Ô‡ ·fi ÙËÓ ÔÔ›· ı· ¯ÔÚË-ÁËıÔ‡Ó Ù· ··Ú·›ÙËÙ· ˘ÁÚ¿ (p.o. ‹ i.v.) ÁÈ· ÙË ‰ÈfiÚ-ıˆÛË ÙË˜ ·Ê˘‰¿ÙˆÛË˜, ÙË˜ Û˘¯ÓfiÙÂÚË˜ ÂÈÏÔÎ‹˜ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜.

ŸÙ·Ó ÔÈ Schultz Î·È Zalusky (2) ·¤‰ÂÈÍ·Ó ÛÂÏËı˘ÛÌfi ÎÔ˘ÓÂÏÈÒÓ Î·È Ô Binder (3) ÛÂ ·ÓıÚÒÈ-ÓÔ ÏËı˘ÛÌfi, fiÙÈ Ë ÁÏ˘Îfi˙Ë ÂÓÈÛ¯‡ÂÈ ÙËÓ ÚfiÛÏË-„Ë ÙÔ˘ Ó·ÙÚ›Ô˘ ·fi ÙË Ó‹ÛÙÈ‰·, Ù¤ıËÎ·Ó ÔÈ ‚¿-ÛÂÈ˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ‰È·Ï˘Ì¿-ÙˆÓ ÁÈ· ÂÓ˘‰¿ÙˆÛË ·fi ÙÔ ÛÙfiÌ·.

™‹ÌÂÚ· ‰È¿ÊÔÚÔÈ ‰ÈÂıÓÂ›˜ ÔÚÁ·ÓÈÛÌÔ› (WHO,AAP, European Society of Pediatric Gastroente-rology and Nutrition) ÚÔÙÂ›ÓÔ˘Ó ‰È·Ï‡Ì·Ù· Ô˘ıÂˆÚÔ‡Ó Î·Ù¿ÏÏËÏ· ÁÈ· ÂÓ˘‰¿ÙˆÛË p.o. Î·È Ô˘ÂÚÈ¤¯Ô˘Ó ËÏÂÎÙÚÔÏ‡ÙÂ˜ Î·È ˘‰·Ù¿ÓıÚ·ÎÂ˜ (ÁÏ˘-Îfi˙Ë, Û·Î¯·Úfi˙Ë, Ú˘˙¿ÏÂ˘ÚÔ ÎÏ). ∏ ¯Ú‹ÛË ·Ó¿-ÏÔÁˆÓ ‰È·Ï˘Ì¿ÙˆÓ Â›Ó·È ·ÛÊ·Ï¤ÛÙÂÚË, ÏÈÁfiÙÂÚÔÂÒ‰˘ÓË Î·È ÔÈÎÔÓÔÌÈÎfiÙÂÚË ·fi ÙËÓ i.v. ÂÓ˘‰¿Ùˆ-ÛË (4-9). ¶ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ·Ê˘‰¿ÙˆÛË˜(6-10), ÂÏ·ÙÙÒÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÈÛÎ¤„ÂˆÓ ÛÙÔÓ·È‰›·ÙÚÔ (11) Î·È Â›Ó·È ÂÍ›ÛÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÌÂÙËÓ i.v. ÂÓ˘‰¿ÙˆÛË, ÙfiÛÔ ÁÈ· ÙÔ˘˜ ÓÔÛËÏÂ˘fiÌÂ-ÓÔ˘˜ fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÔ‡˜ ·ÛıÂ-ÓÂ›˜ (12). º·›ÓÂÙ·È fiÙÈ Ù· ‰È·Ï‡Ì·Ù· Ô˘ ÂÚÈ¤¯Ô˘Ó¿Ì˘ÏÔ Ú˘˙ÈÔ‡ Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ·fi ·˘Ù¿Ô˘ ÂÚÈ¤¯Ô˘Ó ÁÏ˘Îfi˙Ë, ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ·ˆÏÂÈÒÓ ·fi ÙÈ˜ ‰È¿ÚÚÔÈÂ˜ (13).

™Â ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ ‰ÈÂıÓÒÓ ÔÚ-Á·ÓÈÛÌÒÓ Î·È ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Ë ·ÓÙÈÌÂÙÒ-ÈÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ÛÙÔÓ ·ÓÂÙ˘ÁÌ¤ÓÔ Îfi-ÛÌÔ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ÛÙËÚ›˙ÂÙ·È, ÂÚÈÛÛfiÙÂÚÔ ·fiÙÔ ÂÓ‰Â‰ÂÈÁÌ¤ÓÔ, ÛÙËÓ i.v. ÂÓ˘‰¿ÙˆÛË (14).

™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·-Â›· ÙÔ˘ ·È‰ÈÔ‡ ÌÂ ÔÍÂ›· ‰È¿ÚÚÔÈ· Î·Ù¤¯ÂÈ Î·È Ë¤ÁÎ·ÈÚË Â·Ó·Û›ÙÈÛË Ë ÔÔ›· Â›Ó·È ˆÊ¤ÏÈÌË (15,16)Î·È, ÂÊfiÛÔÓ Â›Ó·È Ë ÂÓ‰ÂÈÎÓ˘fiÌÂÓË, ÌÔÚÂ› Ó· ÂÏ·Ù-ÙÒÛÂÈ ÙË Û˘¯ÓfiÙËÙ· Î·È ÙÔÓ fiÁÎÔ ÙˆÓ ÎÂÓÒÛÂˆÓÎ·È Ó· ÂÈÛÂ‡ÛÂÈ ÙËÓ ›·ÛË (17-21). ∫·Ù¿ÏÏËÏÂ˜

ÙÚÔÊ¤˜, Î·Ï¿ ·ÓÂÎÙ¤˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ‰È¿Ú-ÚÔÈ·˜ Â›Ó·È ·˘Ù¤˜ Ô˘ ÂÚÈ¤¯Ô˘Ó ¿Ì˘ÏÔ (ÔÏ˘ÌÂÚ‹ÁÏ˘Îfi˙Ë˜) fiˆ˜ ÙÔ Ú‡˙È, Ô ·Ú·‚fiÛÈÙÔ˜, ÙÔ ÛÈÙ¿ÚÈÎ·È Ë ·Ù¿Ù· (19,22-23).

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÚÔÛ·ıÂ› Ó· ‰ÈÂÚÂ˘Ó‹ÛÂÈ:·) ÙÔ ‚·ıÌfi ·Ô‰Ô¯‹˜ ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ÙˆÓÚÔÙ¿ÛÂˆÓ ÙË˜ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ıÂ-Ú·Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· (£∂™) Î·È ‚)ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË Û˘¯ÓfiÙÂÚËÛ˘ÓÙ·ÁÔÁÚ¿ÊËÛ‹ ÙË˜. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¯ÚËÛÈÌÔ-ÔÈ‹Û·ÌÂ ¤Ó· ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Â‰fiıË

¶›Ó·Î·˜ 1. ¶ÂÚÈÂ¯fiÌÂÓÔ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘

I. °ÓÒÛË ÙˆÓ ·È‰›·ÙÚˆÓ∂ÚˆÙ‹ÛÂÈ˜ ÌÂ ··ÓÙ‹ÛÂÈ˜ ÔÏÏ·Ï‹˜ ÂÈÏÔÁ‹˜ Ô˘ ·ÊÔ-ÚÔ‡Ó: ∆È˜ ÂÓ‰Â›ÍÂÈ˜ ÙË˜ £∂™∆È˜ ·ÓÙÂÓ‰Â›ÍÂÈ˜ ÙË˜ £∂™∆· Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÂÓ˘‰¿ÙˆÛË˜∆Ô ¯ÚfiÓÔ Â·Ó·Û›ÙÈÛË˜

II. ™Ù¿ÛË ÙˆÓ ·È‰›·ÙÚˆÓ∂ÚˆÙ‹ÛÂÈ˜ ÌÂ ··ÓÙ‹ÛÂÈ˜ Û¯Â‰È·ÛÌ¤ÓÂ˜ ÌÂ ÙËÓ ÎÏ›Ì·Î·Likert 5 ÛËÌÂ›ˆÓ Ô˘ ·ÊÔÚÔ‡Ó:∆ËÓ ·ÛÊ¿ÏÂÈ· Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ £∂™∆Ë ı¤ÛË ÙË˜ £∂™ ÛÙËÓ ÚfiÏË„Ë ÙË˜ ·Ê˘‰¿ÙˆÛË˜∆ËÓ Â˘ÎÔÏ›· ÂÎ·›‰Â˘ÛË˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ∆ËÓ ÚÔÙ›ÌËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÁÈ· £∂™ ‹ÂÓ‰ÔÊÏ¤‚È· ÂÓ˘‰¿ÙˆÛË∆ËÓ ÚÔÙ›ÌËÛË ÙÔ˘ ÓÔÛËÏÂ˘ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡ ÁÈ· £∂™ ‹ÂÓ‰ÔÊÏ¤‚È· ÂÓ˘‰¿ÙˆÛË

III. ¶Ú·ÎÙÈÎ‹ ÙˆÓ ·È‰›·ÙÚˆÓ∂ÚˆÙ‹ÛÂÈ˜ ÌÂ ÂÏÂ‡ıÂÚÂ˜ ··ÓÙ‹ÛÂÈ˜ Ô˘ ·ÊÔÚÔ‡Ó:∆È˜ ÂÓ‰Â›ÍÂÈ˜ ÙË˜ £∂™∆È˜ ·ÓÙÂÓ‰Â›ÍÂÈ˜ ÙË˜ £∂™∆· ‰È·Ï‡Ì·Ù· ÂÓ˘‰¿ÙˆÛË˜ Ô˘ Û˘ÛÙ‹ÓÔ˘Ó∆È˜ Ô‰ËÁ›Â˜ Â·Ó·Û›ÙÈÛË˜ Ô˘ ÚÔÙÂ›ÓÔ˘Ó

IV. ∏ Û˘ÌÊˆÓ›· ÌÂ ÙË ı¤ÛË:«∏ £∂™ Î·Ù¤¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ı¤ÛË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈÎ‹Ú¿ÍË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜» ÂÏ¤Á-¯ıËÎÂ ÌÂ ÎÏ›Ì·Î· Likert 5 ÛËÌÂ›ˆÓ

ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ÙËÓ ÂÈÎÚ¿ÙËÛË ÙË˜ ÂÓ‰ÂÈÎÓ˘fiÌÂ-ÓË˜ ÂÍˆÓÔÛÔÎÔÌÂÈ·Î‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ·È-‰ÈÒÓ ÌÂ ÔÍÂ›· ‰È¿ÚÚÔÈ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÔÍÂ›· ‰È¿ÚÚÔÈ·, ·Ê˘‰¿ÙˆÛË, ıÂ-Ú·Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ·.

Key words: acute diarrhea, dehydration, oralrehydration therapy.

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ÛÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Î·È ·ÊÔÚ¿: ·) ÛÙË ÁÓÒÛË, ‚) ÙËÛÙ¿ÛË Î·È Á) ÙËÓ Ú·ÎÙÈÎ‹ ÙÔ˘˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓÂÓ˘‰¿ÙˆÛË p.o. ÛÂ ÔÍ¤· ‰È·ÚÚÔ˚Î¿ Û‡Ó‰ÚÔÌ·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜∆Ô ‰Â›ÁÌ· ÙË˜ ÌÂÏ¤ÙË˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰›·ÙÚÔ˘˜ Ô˘

·ÛÎÔ‡Ó ÙÔ Â¿ÁÁÂÏÌ· ÛÙË £ÂÛÛ·Ï›·. ∆Ô˘˜ ˙ËÙ‹ıËÎÂ Ó· Û˘-ÌÏËÚÒÛÔ˘Ó ¤Ó· ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈÎfi ÌÂ ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‰È·ÚÚÔ˚Î‹˜ ÓfiÛÔ˘. ŸÏ· Ù· ÂÚˆ-ÙËÌ·ÙÔÏfiÁÈ· Ô˘ Û˘ÌÏËÚÒıËÎ·Ó ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜(47 ·fi ÙÔ˘˜ 49 Ô˘ ·Â˘ı˘Óı‹Î·ÌÂ Û˘ÓÔÏÈÎ¿) Û˘ÌÂÚÈÂ-Ï‹ÊıËÛ·Ó ÛÙË ÌÂÏ¤ÙË. ∞fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜, ÔÈ 40 (85%)·ÛÎÔ‡Û·Ó ÂÏÂ‡ıÂÚÔ Â¿ÁÁÂÏÌ·, ÔÈ 5 (11%) ˘ËÚÂÙÔ‡Û·ÓÛÂ ÓÔÛÔÎÔÌÂ›· Î·È ÔÈ 2 (4%) ÛÂ Î¤ÓÙÚ· ÀÁÂ›·˜.

∫·Ù¿ÏÏËÏ· ‰È·Ï‡Ì·Ù· ÂÓ˘‰¿ÙˆÛË˜ ıÂˆÚ‹ıËÎ·Ó ·˘Ù¿Ô˘ ÂÚÈ¤¯Ô˘Ó Na 35-90 mEq/l, ˘‰·Ù¿ÓıÚ·ÎÂ˜ 1-3% ÎÈ¤¯Ô˘Ó ˆÛÌˆÙÈÎfiÙËÙ· <310 mmol/l. ∆¤ÙÔÈ· ‰È·Ï‡Ì·Ù· Â›Ó·ÈÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ·fi ÙoÓ WHO ÎÈ ·˘Ù¿ Ô˘ Î˘ÎÏÔÊÔÚÔ‡ÓÛÙÔ ÂÌfiÚÈÔ.

∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ (¶›Ó·Î·˜ 1)¯ˆÚ›ÛÙËÎÂ ÛÂ Ù¤ÛÛÂÚ· Ì¤ÚË Ô˘ ·ÊÔÚÔ‡Ó:·) ™ÙË ÁÓÒÛË ÙÔ˘ ·È‰›·ÙÚÔ˘ ÁÈ· ÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙË˜ Û‡Á-

¯ÚÔÓË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË £∂™. ‚) ™ÙË ÛÙ¿ÛË ÙˆÓ ·È‰›·ÙÚˆÓ ·¤Ó·ÓÙÈ ÛÙË £∂™ Î·ıÒ˜ Î·È

ÛÙËÓ ÚÔı˘Ì›· ·Ô‰Ô¯‹˜ Ô˘ ıÂˆÚÔ‡Ó ÔÈ ·È‰›·ÙÚÔÈ fiÙÈ‰Â›¯ÓÔ˘Ó ÔÈ ·ÛıÂÓÂ›˜, ÔÈ ÔÈÎÔÁ¤ÓÂÈ¤˜ ÙÔ˘˜ Î·È ÙÔ ÓÔÛË-ÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi ÁÈ· ÙÔ ›‰ÈÔ ı¤Ì·.

Á) ™ÙËÓ Ú·ÎÙÈÎ‹ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÔÈ ·È‰›·ÙÚÔÈ ÁÈ· ÙË¯ÔÚ‹ÁËÛË ÙˆÓ ··Ú·›ÙËÙˆÓ ˘ÁÚÒÓ Î·È ÙËÓ Â·Ó·Û›ÙÈÛËÛÙÔ ÔÍ‡ ‰È·ÚÚÔ˚Îfi Û‡Ó‰ÚÔÌÔ ÌÂ ·Ê˘‰¿ÙˆÛË.

‰) ∆¤ÏÔ˜, ÂÏ¤Á¯ıËÎÂ Â¿Ó ÔÈ ·È‰›·ÙÚÔÈ ıÂˆÚÔ‡Ó ÛËÌ·ÓÙÈÎ‹ÙË £∂™ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ÛÙËÓÎ·ıËÌÂÚÈÓ‹ È·ÙÚÈÎ‹ Ú¿ÍË.°È· Ó· ‰ÈÂÚÂ˘Ó‹ÛÔ˘ÌÂ ÙÔ˘˜ Èı·ÓÔ‡˜ ·Ó·ÛÙ·ÏÙÈÎÔ‡˜

·Ú¿ÁÔÓÙÂ˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ £∂™, Û˘Û¯ÂÙ›Û·ÌÂ ÛÙ·ÙÈ-ÛÙÈÎ¿ ÙÔ˘˜ ÙÔÌÂ›˜ ÙË˜ ÁÓÒÛË˜ Î·È ÙË˜ ÛÙ¿ÛË˜ ÙˆÓ ·È‰›·-ÙÚˆÓ ÌÂ ÙË Û˘Ó‹ıË Ú·ÎÙÈÎ‹ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó, ¯ÚËÛÈÌÔÔÈ-ÒÓÙ·˜ ÙË ‰ÔÎÈÌ·Û›· ¯2 ‹ ÙË ‰ÔÎÈÌ·Û›· Fisher’s Exact.

∞ÔÙÂÏ¤ÛÌ·Ù·°ÓÒÛË ÙË˜ ıÂÚ·Â›·˜ ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfi-

Ì·. ∏ ÂÏ·ÊÚÈ¿ ·Ê˘‰¿ÙˆÛË ıÂˆÚ‹ıËÎÂ ÔÚıÒ˜ ˆ˜

¤Ó‰ÂÈÍË ¯ÔÚ‹ÁËÛË˜ £∂™ ·fi ÙÔ 98% ÙˆÓ ·È‰›·-ÙÚˆÓ Î·È Ë Ì¤ÛË˜ ‚·Ú‡ÙËÙ·˜ ·Ê˘‰¿ÙˆÛË ·fi ÙÔ70%.

∆ËÓ ÚÔÏËÙÈÎ‹ ¯ÔÚ‹ÁËÛË ‰È·Ï˘Ì¿ÙˆÓ ÂÓ˘‰¿-ÙˆÛË˜ ·Ó·ÁÓˆÚ›˙ÂÈ ˆ˜ ¤Ó‰ÂÈÍË ÙÔ 47% ÙˆÓ ·È‰›·-ÙÚˆÓ. √È ÂÚÈÛÛfiÙÂÚÔÈ (53%), ÛˆÛÙ¿, ‰Â ıÂˆ-ÚÔ‡Ó ÙÔ˘˜ ÂÌ¤ÙÔ˘˜ ˆ˜ ·ÓÙ¤Ó‰ÂÈÍË £∂™, ÂÓÒ ÙÔ 4%ıÂˆÚÂ›, Ï·Óı·ÛÌ¤Ó·, ÙË Ì¤ÙÚÈ· ·Ê˘‰¿ÙˆÛË ˆ˜·ÓÙ¤Ó‰ÂÈÍË ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ·. ªfiÓÔ ÙÔ6%, ÔÚı¿, Â¤ÏÂÍÂ ÙÔ Ó¿ÙÚÈÔ Î·È ÙÔ˘˜ ˘‰·Ù¿ÓıÚ·-ÎÂ˜ ˆ˜ Ù· Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ Ô˘ Ú¤ÂÈÓ· ‚Ú›ÛÎÔÓÙ·È ÛÂ Î·Ù¿ÏÏËÏË ·Ó·ÏÔÁ›·, ÚÔÎÂÈÌ¤-ÓÔ˘ Ó· ·ÔÚÚÔÊÒÓÙ·È Î·Ï‡ÙÂÚ·. ∆¤ÏÔ˜, ÙÔ 77%,

ÔÚı¿, ıÂˆÚÂ› fiÙÈ Ë Â·Ó·Û›ÙÈÛË Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ·fi ÙÔ ÚÒÙÔ 24ˆÚÔ ¤Ó·ÚÍË˜ ÙË˜ ‰È¿ÚÚÔÈ·˜.

™Ù¿ÛË ¤Ó·ÓÙÈ ÙË˜ ıÂÚ·Â›·˜ ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔÛÙfiÌ·

™¯Â‰fiÓ fiÏÔÈ ÔÈ ·È‰›·ÙÚÔÈ (90%) Ô˘ Û˘ÌÌÂÙÂ›-¯·Ó ÛÙË ÌÂÏ¤ÙË, ¤¯Ô˘Ó ıÂÙÈÎ‹ ÛÙ¿ÛË ˆ˜ ÚÔ˜ ÙË£∂™ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·Ê˘‰¿ÙˆÛË˜ ˆ˜·ÔÙ¤ÏÂÛÌ· ÔÍ¤ˆÓ ‰È·ÚÚÔ˚ÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙ··È‰È¿ Î·È ÙËÓ Â·ÎfiÏÔ˘ıË ·ÔÊ˘Á‹ ÙË˜ ÓÔÛËÏÂ›-·˜ ÙÔ˘˜ ÛÂ ÓÔÛÔÎÔÌÂ›Ô. ∆Ô 90% ÙˆÓ ·È‰›·ÙÚˆÓÈÛÙÂ‡ÂÈ fiÙÈ ÔÈ ÔÈÎÔÁ¤ÓÂÈÂ˜ Î·È ÔÈ ·ÛıÂÓÂ›˜ ÚÔÙÈ-ÌÔ‡Ó ÙË £∂™. ∆Ô 13% ÈÛÙÂ‡ÂÈ fiÙÈ Ë ÂÎ·›‰Â˘ÛËÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Â›Ó·È ‰‡ÛÎÔÏË ‹ ·‰‡Ó·ÙË Î·È fiÙÈÔÈ ÁÔÓÂ›˜ ‰ÂÓ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·ÓÙÈÌÂÙˆ›-ÛÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÙÔ ·È‰› ÛÙÔ Û›ÙÈ. ∆Ô 4% È-ÛÙÂ‡ÂÈ fiÙÈ Ë £∂™ ‰ÂÓ Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂ-ÛÌ·ÙÈÎ‹ Ì¤ıÔ‰Ô˜. √È ÂÚÈÛÛfiÙÂÚÔÈ ·È‰›·ÙÚÔÈ(76%) ·fi fiÛÔ˘˜ ‰È·ı¤ÙÔ˘Ó ‹ ‰È¤ıÂÙ·Ó ÓÔÛËÏÂ˘ÙÈ-Îfi ÚÔÛˆÈÎfi, ıÂˆÚÔ‡Ó fiÙÈ ·˘Ùfi ÚÔÙÈÌ¿ ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·Ê˘‰¿ÙˆÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ£∂™. ∆¤ÏÔ˜, ÙÔ 4% ·˘ÙÒÓ ıÂˆÚÂ› fiÙÈ Ë £∂™ ¤¯ÂÈÌÂÁ¿ÏÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·ÈÙÈ˜ ÔÈÎÔÁ¤ÓÂÈ¤˜ ÙÔ˘˜.

∏ ıÂÚ·Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· ÛÙËÓ Ú¿ÍË√ ¶›Ó·Î·˜ 2 ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÈ˜ ··ÓÙ‹ÛÂÈ˜ Ô˘

¤‰ˆÛ·Ó ÔÈ ·È‰›·ÙÚÔÈ ÛÙÈ˜ ÂÚˆÙ‹ÛÂÈ˜ ÂÏÂ‡ıÂÚË˜¤ÎÊÚ·ÛË˜, ÁÈ· ÙËÓ Î·ıËÌÂÚÈÓ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ·ÛıÂÓÒÓ ÌÂ ÔÍÂ›· ‰È¿ÚÚÔÈ·. ŸÏÔÈ ÔÈ ·È‰›·ÙÚÔÈÚÔÙÂ›ÓÔ˘Ó, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÂÚ›ÙˆÛË, ÙfiÛÔ ÙËÓÂÓ˘‰¿ÙˆÛË p.o. fiÛÔ Î·È ÙËÓ i.v. ÂÓ˘‰¿ÙˆÛË. ∞Îfi-ÌË, fiÏÔÈ ÔÈ ·È‰›·ÙÚÔÈ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙËÓ ÂÏ·ÊÚÈ¿·Ê˘‰¿ÙˆÛË ÌÂ ÂÓ˘‰¿ÙˆÛË p.o. Î·È ÌfiÓÔ ÙÔ 2% ıÂ-ˆÚÂ› ÙËÓ ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ·Ê˘‰¿ÙˆÛË ·ÓÙ¤Ó‰ÂÈÍËÂÓ˘‰¿ÙˆÛË˜ p.o. ŸÌˆ˜, ÙÔ 43% ıÂˆÚÂ› ÙÔ˘˜ ÂÌ¤-ÙÔ˘˜ ·ÓÙ¤Ó‰ÂÈÍË. √È ÂÚÈÛÛfiÙÂÚÔÈ ·È‰›·ÙÚÔÈ(87%) Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó Î·Ù¿ÏÏËÏ· ‰È·Ï‡Ì·Ù· ÁÈ·ÂÓ˘‰¿ÙˆÛË p.o., ·Ó Î·È ÙÔ 17% ÚÔÙÂ›ÓÂÈ ÌÂÚÈÎ¤˜ÊÔÚ¤˜ Î·È ÌË ÂÓ‰ÂÈÎÓ˘fiÌÂÓ· ˘ÁÚ¿ (¯˘ÌÔ‡˜, ·Ó·-„˘ÎÙÈÎ¿, ÙÛ¿È, sport drinks). ªfiÓÔ ÙÔ 2% ‰›ÓÂÈ Ô‰Ë-Á›Â˜ ·Ú·ÛÎÂ˘‹˜ ‰È·Ï‡Ì·ÙÔ˜ ÂÓ˘‰¿ÙˆÛË˜ ·fi˘ÏÈÎ¿ Ô˘ Û˘Ó‹ıˆ˜ ˘¿Ú¯Ô˘Ó ÛÙÔ Û›ÙÈ (·Ï¿ÙÈ, ˙¿-¯·ÚË ÎÏ.). ∆Ô 13% ÚÔÙÂ›ÓÂÈ ·ÔÎÏÂÈÛÙÈÎ¿ ÌË ÂÓ-‰ÂÈÎÓ˘fiÌÂÓ· ˘ÁÚ¿. ŸÌˆ˜, ÌfiÓÔ ÙÔ 13% ÚÔÙÂ›ÓÂÈÛÙÔ˘˜ ÁÔÓÂ›˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ‰ÔÛÔÌÂÙÚËÙ‹(ÎÔ˘Ù·Ï¿ÎÈ ‹ Û‡ÚÈÁÁ·), ¤ÙÛÈ ÒÛÙÂ Ó· ÂÏ¤Á¯ÂÙ·È ÔÚ˘ıÌfi˜ Î·È Ë ÔÛfiÙËÙ· ÙˆÓ ˘ÁÚÒÓ Ô˘ ¯ÔÚËÁÔ‡-ÓÙ·È. √È ÂÚÈÛÛfiÙÂÚÔÈ (55%), ÔÚı¿ Û˘ÛÙ‹ÓÔ˘ÓÂ·Ó·Û›ÙÈÛË Ì¤Û· ÛÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙËÓ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘. √È ÈÔ Û˘¯Ó¿ ÚÔÙÂÈÓfiÌÂÓÂ˜ÙÚÔÊ¤˜ ÁÈ· Â·Ó·Û›ÙÈÛË Â›Ó·È ÙÔ ÌËÙÚÈÎfi Á¿Ï·, ÙÔ·Ú·ÈˆÌ¤ÓÔ Á¿Ï· ÁÈ· Ù· ‚Ú¤ÊË Ô˘ ‰Â ıËÏ¿˙Ô˘Ó

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 51


52

Î·È ÙÔ Ú‡˙È, ÙÔ ÎÔÙfiÔ˘ÏÔ, Ë ·Ù¿Ù· Î·È Ë Ì·Ó¿-Ó· ÁÈ· Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿. ∆¤ÏÔ˜, Û¯Â‰fiÓ fiÏÔÈ(98%) ˘ÈÔıÂÙÔ‡Ó ÙÔ fiÙÈ Ë £∂™ ¤¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ı¤ÛËÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜ ÛÙËÓ Î·-ıËÌÂÚÈÓ‹ È·ÙÚÈÎ‹ Ú¿ÍË.

∞Ó·ÛÙ·ÏÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ·

°È· Ó· ‰ÈÂÚÂ˘Ó‹ÛÔ˘ÌÂ ·Ó·ÛÙ·ÏÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜ Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Ó· ÚÔÙÂ›-ÓÔ˘Ó ÙËÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË ÂÓ˘‰¿ÙˆÛË p.o., ¤ÁÈÓÂ Û˘-Û¯¤ÙÈÛË ÙË˜ ÁÓÒÛË˜ Î·È ÙË˜ ÛÙ¿ÛË˜ ÙˆÓ ·È‰È¿-ÙÚˆÓ ÌÂ ÙËÓ Ú·ÎÙÈÎ‹ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó.

™ËÌ·ÓÙÈÎ‹ ÛÙ·ÙÈÛÙÈÎ‹ Û¯¤ÛË (P<0,01 ) ‚Ú¤ıËÎÂÌÂÙ·Í‡ ÙË˜ ¯ÔÚ‹ÁËÛË˜ ÙË˜ ÂÓ˘‰¿ÙˆÛË˜ p.o., ÛÂ·È‰È¿ ÌfiÓÔ ÌÂ ÂÏ·ÊÚÈ¿ ‹ ÌÂ ÂÏ·ÊÚÈ¿ Î·È Ì¤ÙÚÈ··Ê˘‰¿ÙˆÛË Î·È ÙË˜ ÛÙ¿ÛË˜ ÙˆÓ ·È‰›·ÙÚˆÓ Û¯ÂÙÈ-Î¿ ÌÂ ÙËÓ Â˘ÎÔÏ›· ÂÎ·›‰Â˘ÛË˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓÛÙËÓ ÂÓ˘‰¿ÙˆÛË p.o. ŒÙÛÈ, ÙÔ 75% ÙˆÓ ·È‰È¿ÙÚˆÓÔ˘ ıÂˆÚÂ› Â‡ÎÔÏË ÙËÓ ÂÎ·›‰Â˘ÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈ-ÒÓ Û˘ÓÈÛÙ¿ ÂÓ˘‰¿ÙˆÛË p.o. Î·È ÛÂ ·È‰È¿ ÌÂ ÌÂÙÚ›-Ô˘ ‚·ıÌÔ‡ ·Ê˘‰¿ÙˆÛË, ÂÓÒ ÌfiÓÔ ÙÔ 25% fiÛˆÓıÂˆÚÂ› ‰‡ÛÎÔÏË ÙËÓ ÂÎ·›‰Â˘ÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ·ÎÔÏÔ˘ıÂ› ÙËÓ ›‰È· Ú·ÎÙÈÎ‹.

¢ÂÓ ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛË ÌÂ-Ù·Í‡ ÙË˜ ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ· ÛÂ ·È‰È¿ Ìfi-

ÓÔ ÌÂ ÂÏ·ÊÚÈ¿ ‹ ÌÂ ÂÏ·ÊÚÈ¿ Î·È Ì¤ÙÚÈ· ·Ê˘‰¿Ùˆ-ÛË Î·È ÙË˜ ÛÙ¿ÛË˜ ‹ ÙË˜ ÁÓÒÛË˜ ÙˆÓ ·È‰›·ÙÚˆÓ,fiˆ˜ ·˘Ù‹ ÂÏ¤Á¯ÂÙ·È ÌÂ ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ.

™˘˙‹ÙËÛË∏ ÂÈÎfiÓ· Ô˘ ·ÔÙ˘ÒÓÂÙ·È ÛÙËÓ ÂÚÁ·Û›· Ì·˜

Â›Ó·È ÌfiÓÔ ÂÓ Ì¤ÚÂÈ Û‡ÌÊˆÓË ÌÂ ÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ‰ÈÂıÓÒÓ ÔÚÁ·ÓÈÛÌÒÓ Î·È ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·,ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‰È¿ÚÚÔÈ·˜. H Ú·-ÎÙÈÎ‹ ÙˆÓ ·È‰›·ÙÚˆÓ ÙË˜ £ÂÛÛ·Ï›·˜ ÛÂ Û¯¤ÛË ÌÂÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÙÔ˘˜ ÙˆÓ ∏.¶.∞., Û˘ÓÙ¿ÛÛÂÙ·ÈÔÏ‡ ÂÚÈÛÛfiÙÂÚÔ ÌÂ ÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙË˜ ‰ÈÂıÓÔ‡˜‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜‰È¿ÚÚÔÈ·˜ (24, 25). øÛÙfiÛÔ, fiˆ˜ ‰Â›¯ÓÔ˘Ó Î·È ¿Ï-ÏÂ˜ ÌÂÏ¤ÙÂ˜ (24-26), ˘¿Ú¯Ô˘Ó ÂÚÈıÒÚÈ· Î·Ï‡ÙÂ-ÚË˜, ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË˜ Î·È ÏÈÁfiÙÂÚÔ Ô‰˘ÓËÚ‹˜·ÓÙÈÌÂÙÒÈÛË˜, ¯ˆÚ›˜ Ó· ˘ÔÛÙÔ‡Ó ÔÈ ÔÈÎÔÁ¤ÓÂÈÂ˜ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ ÙËÓ ·Ó·ÛÙ¿ÙˆÛË Ô˘ Û˘ÓÂ-¿ÁÂÙ·È Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.

∏ ÂÏ·ÊÚÔ‡ ‚·ıÌÔ‡ ·Ê˘‰¿ÙˆÛË ·ÓÙÈÌÂÙˆ›˙Â-Ù·È ·fi ÙÔ 100% Î·È Ë Ì¤ÙÚÈ· ·fi ÙÔ 85% ÙˆÓ ·È-‰›·ÙÚˆÓ ÌÂ ÂÓ˘‰¿ÙˆÛË p.o. ∆Ô 87% Û˘ÓÙ·ÁÔÁÚ·-ÊÂ› (fi¯È ·ÔÎÏÂÈÛÙÈÎ¿) ÂÓ‰ÂÈÎÓ˘fiÌÂÓ· ‰È·Ï‡Ì·Ù·,ÙÔ 98% ˘ÈÔıÂÙÂ› ÙË ¿Ô„Ë fiÙÈ Ë £∂™ Î·Ù¤¯ÂÈ ÛË-Ì·ÓÙÈÎ‹ ı¤ÛË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‰È¿Ú-ÚÔÈ·˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈÎ‹ ÙÔ˘ È·ÙÚÂ›Ô˘, ÂÓÒË ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰›·ÙÚˆÓ Â·Ó·ÛÈÙ›˙ÂÈ Ù· ·È-‰È¿ ÌÂ Î·Ù¿ÏÏËÏÂ˜ ÙÚÔÊ¤˜. ∞ÓÙ›ıÂÙ·, ÙÔ 43% ÙˆÓ·È‰›·ÙÚˆÓ ÚÔÙÈÌ¿ ÙËÓ i.v. ÂÓ˘‰¿ÙˆÛË fiÙ·Ó Û˘Ó˘-¿Ú¯Ô˘Ó ¤ÌÂÙÔÈ. ∆Ô 45%, Â›ÛË˜, ‰ÂÓ Â·Ó·ÛÈÙ›˙ÂÈÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÛıÂÓÂ›˜ Ì¤Û· ÛÙÔ ÚÒÙÔ 24ˆÚÔ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘, ÂÓÒ ÙÔ 87% ‰ÂÓ ÚÔ-ÙÂ›ÓÂÈ ÛÙÔ˘˜ ÁÔÓÂ›˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ‰ÔÛÔÌÂÙÚË-Ù‹ (ÎÔ˘Ù·Ï¿ÎÈ ‹ Û‡ÚÈÁÁ·), ÒÛÙÂ Ó· ÂÏ¤Á¯ÂÙ·È ÔÚ˘ıÌfi˜ Î·È Ë ÔÛfiÙËÙ· ÙˆÓ ˘ÁÚÒÓ Ô˘ ¯ÔÚËÁÔ‡-ÓÙ·È.

∞fi Ù· ‰È·Ï‡Ì·Ù· Ô˘ Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfi-ÚÈÔ, Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÙÔ ‰È¿Ï˘Ì· ÌÂÙË ¯·ÌËÏfiÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ Ó¿ÙÚÈÔ (35mEq/l), Ú¿ÁÌ· Ô˘ ÙÔ Î·ıÈÛÙ¿ ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfi ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·Ê˘‰¿ÙˆÛË˜. ∆·˘ÁÚ¿ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ Û›ÙÈ Î·È Û˘¯Ó¿ ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ·Ê˘‰¿ÙˆÛË˜ (˙ˆÌfi˜ ÎÚ¤·ÙÔ˜ ‹ ÎÔÙfiÔ˘ÏÔ˘,¯˘ÌÔ›, ÙÛ¿È, ·ÓıÚ·ÎÔ‡¯· ·Ó·„˘ÎÙÈÎ¿) ‰ÂÓ ÂÓ‰Â›-ÎÓ˘ÓÙ·È, ÁÈ·Ù› ¿ÏÏ· ÂÚÈ¤¯Ô˘Ó ÂÏ¿¯ÈÛÙÂ˜ Î·È ¿ÏÏ·ÔÏ‡ ÌÂÁ¿ÏÂ˜ ÔÛfiÙËÙÂ˜ Ó·ÙÚ›Ô˘ Î·È Ù· ÂÚÈÛÛfi-ÙÂÚ· Â›Ó·È ˘ÂÚˆÛÌˆÙÈÎ¿, ÂÈ‰ÂÈÓÒÓÔÓÙ·˜ ¤ÙÛÈ ÙÈ˜‰È¿ÚÚÔÈÂ˜ (27) (¶›Ó·Î·˜ 3).

∏ ‚ÂÏÙ›ˆÛË ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ ·È‰›·ÙÚˆÓ È-ÛÙÂ‡Ô˘ÌÂ fiÙÈ ı· Ô‰ËÁÔ‡ÛÂ ÛÂ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒ-ÈÛË ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ. √È 3 ·È‰›·ÙÚÔÈ Ô˘ÁÓˆÚ›˙Ô˘Ó Ù· Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ Ô˘ Ú¤-

¶›Ó·Î·˜ 2: ¶Ú·ÎÙÈÎ‹ ÙˆÓ ·È‰È¿ÙÚˆÓ

∂Ó‰Â›ÍÂÈ˜ ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ·∂Ï·ÊÚÈ¿ ·Ê˘‰¿ÙˆÛË 100%ª¤ÙÚÈ· ·Ê˘‰¿ÙˆÛË 85%µ·ÚÈ¿ ·Ê˘‰¿ÙˆÛË 6%∞ÓÙÂÓ‰Â›ÍÂÈ˜ ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ·µ·ÚÈ¿ ·Ê˘‰¿ÙˆÛË 68%∫ÔÈÓˆÓÈÎÔ› / ÔÈÎÔÓÔÌÈÎÔ› ÏfiÁÔÈ 30%ŒÌÂÙÔÈ 43%™˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· ˘ÁÚ¿Almora 70%Soparyx 40%Orisel 26%Risolyte 26%¢È¿Ï˘Ì· WHO/Unicef 2%Sport drinks 21%Ã˘ÌÔ›, ÙÛ¿È, ·Ó·„˘ÎÙÈÎ¿ 25%ƒ˘ıÌfi˜ ¯ÔÚ‹ÁËÛË˜ªÈÎÚ‹ ÔÛfiÙËÙ· 4%™˘¯Ó‹ ¯ÔÚ‹ÁËÛË 15%∫Ô˘Ù·Ï¿ÎÈ / Û‡ÚÈÁÁ· 13%ÃÚfiÓÔ˜ Â·Ó·Û›ÙÈÛË˜<24 ÒÚÂ˜ 55%24-48 ÒÚÂ˜ 40%>48 ÒÚÂ˜ 5%

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 52

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ÂÈ Ó· ‚Ú›ÛÎÔÓÙ·È ÛÂ Î·Ù¿ÏÏËÏË ·Ó·ÏÔÁ›· ÁÈ· Ó··ÔÚÚÔÊÒÓÙ·È Î·Ï‡ÙÂÚ·, Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó ·Ô-ÎÏÂÈÛÙÈÎ¿ ÂÓ‰ÂÈÎÓ˘fiÌÂÓ· ‰È·Ï‡Ì·Ù·, ÂÓÒ ÙÔ 64%·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 44 Ú¿ÙÙÂÈ ÙÔ ›‰ÈÔ. ∞Ó Î·È ÙÔ·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi(P=0,54) Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi fiÙÈ Ë ÁÓÒÛË ÙË˜ £∂™ Ô‰Ë-ÁÂ› ÛÙË ¯Ú‹ÛË Î·Ù¿ÏÏËÏˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÂÓ˘‰¿Ùˆ-ÛË˜. √ ÈÔ Î·Ù¿ÏÏËÏÔ˜, fiÌˆ˜, ÙÚfiÔ˜ ·Ú¤Ì‚·-ÛË˜ ÁÈ· ÙËÓ ·ÚÔ¯‹ ÙË˜ ··ÈÙÔ‡ÌÂÓË˜ ÁÓÒÛË˜ Â›Ó·È·ÌÊÈÛ‚ËÙ‹ÛÈÌÔ˜.

∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ (28-29) ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·Ï‹·ÚÔ¯‹ ¤ÓÙ˘Ô˘ ˘ÏÈÎÔ‡ ‰ÂÓ ¤¯ÂÈ ÈÎ·ÓÔÔÈËÙÈÎfi·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ·ÏÏ·Á‹ ÙË˜ Ú·ÎÙÈÎ‹˜ ÙÔ˘ ÁÈ·-ÙÚÔ‡, ÂÓÒ ¤¯ÂÈ ÌÈÎÚfi ‹ Î·Ó¤Ó· ·ÔÙ¤ÏÂÛÌ· ÛÙË‰ÈfiÚıˆÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∏ ·Ï-Ï·Á‹ ÙË˜ Ú·ÎÙÈÎ‹˜, fiÙ·Ó ÚÔÙÂ›ÓÔÓÙ·È Ó¤Â˜ Ì¤ıÔ-‰ÔÈ, ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ÈÛÙÔÚÈÎ¿ ‰‡ÛÎÔÏË (30) Î·È Ì¿-ÏÈÛÙ· fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·Â›· ÙË˜ ‰È¿ÚÚÔÈ·˜, ÁÈ·ÙËÓ ÔÔ›· Ë i.v. ·ÓÙÈÌÂÙÒÈÛË ¤¯ÂÈ, ÁÈ· ÌÂÁ¿ÏÔ ‰È¿-ÛÙËÌ·, ÂÊ·ÚÌÔÛıÂ› ÌÂ ÂÈÙ˘¯›·.

∏ ÌÂÏ¤ÙË Ì·˜ ¤‰ÂÈÍÂ fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓÔ˘ ÌÂ ÙË ‰È¿ÁÓˆÛË Ì¤ÙÚÈ·˜ ·Ê˘‰¿ÙˆÛË˜ Î·Ù·Ï‹-ÁÔ˘Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· Ó· ÙÔ˘˜ ¯ÔÚËÁËıÂ› i.v.ÂÓ˘‰¿ÙˆÛË, ‰ÂÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ÁÓÒÛË ·ÏÏ¿ Ìfi-ÓÔ ·fi ÙË ÛÙ¿ÛË ÙˆÓ ·È‰›·ÙÚˆÓ ·¤Ó·ÓÙÈ ÛÙËÓ Â˘-ÎÔÏ›· ‹ ÌË ÂÎ·›‰Â˘ÛË˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÛÙË ¯ÔÚ‹-ÁËÛË ÙË˜ £∂™. √ ·Ú¿ÁÔÓÙ·˜ ·˘Ùfi˜ ‰ÂÓ Â›Ó·È Â‡-ÎÔÏÔ Ó· ÙÚÔÔÔÈËıÂ›, ÒÛÙÂ Ó· Ô‰ËÁ‹ÛÂÈ ÛÙË ÌÂ›ˆ-ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·‰ÈÎ·ÈÔÏfiÁËÙ· Î·-Ù·Ï‹ÁÔ˘Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô. √È ·ÚÌfi‰ÈÔÈ ÊÔÚÂ›˜Ú¤ÂÈ Ó· ˘ÈÔıÂÙ‹ÛÔ˘Ó ÚÔÛ¿ıÂÈÂ˜ Ô˘ ı· ·Ô-‚Ï¤Ô˘Ó ÛÙË ‰È¿‰ÔÛË ÙË˜ ÛˆÛÙ‹˜ ÂÍˆÓÔÛÔÎÔÌÂÈ·-Î‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÔÍÂ›· ‰È¿ÚÚÔÈ·,Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÂÈ‰ÈÎ¿ ‰È·Ï‡Ì·Ù· ÂÓ˘‰¿ÙˆÛË˜Î·È ÙËÓ ¤ÁÎ·ÈÚË ÛˆÛÙ‹ Â·Ó·Û›ÙÈÛË (£∂™).

µÈ‚ÏÈÔÁÚ·Ê›·1. Snyder JD, Merson MH. The magnitude of the global

problem of acute diarrhoeal disease: a review of activesurveillance data. Bull WHO 1982;60:605-613.

2. Shultz S, Zalusky R. Ion transport in isolated rabbit ileum.The interaction between active sodium and active sugar

transport. J Gen Physiol 1964;47:1043.3. Binder HJ. Sodium transport across isolated human

jejunum. Gastroenterology 1974;67:231.4. Listernick R, Zieserl E, Davis AT. Outpatient oral rehydra-

tion in the United States. Am J Dis Child 1986;140:211-215.5. Phillips M, Kumate-Rodriquez J, Mota-Hernandez F. Costs

of treating diarrhoea in a children’s hospital in Mexico City.Bull WHO 1989;67:373-380.

6. Santosham M, Greenough WB 3rd. Oral rehydrationtherapy: a global perspective. J Pediatr 1991;118:S44-S51.

7. Santosham M, Brown KH, Sack RB. Oral rehydrationtherapy and dietary therapy for acute childhood diarrhea.Pediatr Rev 1987;8:273-278.

8. Goepp JG, Katz SA. Oral rehydration therapy. Am FamPhysician 1993;47:843-851.

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10. ƒÒÌ· ∂. §¿ıË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ‰È¿ÚÚÔÈ·˜. ¢ÂÏÙ›Ô∞’ ¶·È‰. ∫ÏÈÓ. ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ 1981;28:315-320.

11. Duggan C, Lasche J, McCarty M, Mitchell K, Dershewitz R,Lerman SJ et al. Oral rehydration solution for acutediarrhea prevents subsequent unscheduled follow-upvisits. Pediatrics 1999;104:3,e29.

12. Finberg L, Harper PA, Harrison HE, Sack RB. Oralrehydration for diarrhea. J Pediatr 1982;101:497-499.

13. Gracey M. Nutritional effects and management of diarrheain infancy. Acta Paediatr Suppl 1999;430:110-126.

14. Avery M, Snyder J. Oral therapy for acute diarrhea. Theunderused simple solution. N Engl J Med 1990;323:891-894.

15. Brown KH, MacLean WC Jr. Nutritional management ofacute diarrhea: an appraisal of the alternatives. Pediatrics1984;73:119-125.

16. Subcommittee on Nutrition and Diarrheal Disease ControlCommittee on International Nutritional Programs, NutritionResearch Council. Nutritional Management of AcuteDiarrhea in Infants and Children. Washington, DC: NationalAcademy Press; 1985.

17. Santosham M, Foster S, Reid R, Bertrando R, Yolken R,Bums B et al. Role of soy-based, lactose-free formuladuring treatment of acute diarrhea. Pediatrics 1985;76:292-298.

18. Khin-Maung-v, Nyut-Nyut-Wai, Myo-Khin, Mu Mu Khin, Tin U Thane Toe. Effect on clinical outcome of breast

¶›Ó·Î·˜ 3. ™‡ÓıÂÛË ÌË ÂÓ‰ÂÈÎÓ˘fiÌÂÓˆÓ ˘ÁÚÒÓ ÁÈ· ÙË ıÂÚ·Â›· ÂÓ˘‰¿ÙˆÛË˜ ·fi ÙÔ ÛÙfiÌ·.

ÀÁÚ¿ Na+ (mEq/l) K+ (mEq/l) À‰·Ù¿ÓıÚ·ÎÂ˜ øÛÌˆÙÈÎfiÙËÙ· (gr/100ml) (mmol/l)

∑ˆÌfi˜ ÎÚ¤·ÙÔ˜ 110-248 2,5-17 - 300-390∑ˆÌfi˜ ÎfiÙ·˜ 140-251 1,5-8,2 - 380-500Ã˘Ìfi˜ Ì‹ÏÔ˘ 3 32 6 700∆Û¿È (¯ˆÚ›˜ ˙¿¯·ÚË) - 5 - -∫fiÎ·-ÎfiÏ· 1,7 0,1 11 5507up 5,5 2 7,4 550Gatorade 20 3 4,6 330

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27. §·ÁÎÒÓ·–™Ù¿ıË ∂. ∞ÔÛÙÔÏ‹ ·ÚÚÒÛÙˆÓ ÛÂ ÓÔÛÔÎÔÌÂ›·‰Â˘ÙÂÚÔ‚¿ıÌÈ·˜ Î·È ÙÚÈÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„Ë˜: ÂÓ‰Â›-ÍÂÈ˜–ÚÔÂÙÔÈÌ·Û›·. ¢ÂÏÙ›Ô ∞’ ¶·È‰. ∫ÏÈÓ. ¶·Ó/Ì›Ô˘ ∞ıË-ÓÒÓ 1995;42(Û˘ÌÏËÚˆÌ·ÙÈÎfi ÙÂ‡¯Ô˜):71-76.

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30. Soumerai SB, McLaughlin TJ, Avorn J. Improving drugprescribing in primary care: a critical analysis of theexperimental literature. Milbank Mem Fund Q Health Soc1989;67:268-317.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ∞ÏÂÍfiÔ˘ÏÔ˜ÃÚ˘ÛÔÛÙfiÌÔ˘ ™Ì‡ÚÓË˜ 2, ¶ÂÚÈÔ¯‹ ™Ù·ıÌÔ‡, 412 23 §¿ÚÈÛ·.

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�¶ÂÚ›ÏË„Ë: ∏ §ÈÔÚˆÙÂ˝ÓË (·), Lp(·), Â›Ó·È Ì›· ÏÈ-ÔÚˆÙÂ˝ÓË ÁÂÓÂÙÈÎ¿ ÚÔÛ‰ÈÔÚÈÛÌ¤ÓË Î·ıÒ˜, Â›-ÛË˜, ·Ú¿ÁˆÓ ÔÛÔÙÈÎ¿ Î·ıÔÚÈÛÌ¤ÓÔ˜ Î·È Û˘Û¯ÂÙÈ-˙fiÌÂÓÔ˜ ÌÂ ÙËÓ ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘.™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ Ì·˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ Lp(·) Î·È Ë Î·Ù·ÓÔÌ‹ ÙÔ˘˜ ÛÂ ÂÎ·-ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›·,ÒÛÙÂ Ó· ¯ÚËÛÈÌÂ‡ÛÔ˘Ó ˆ˜ ÙÈÌ¤˜ ·Ó·ÊÔÚ¿˜ Î˘Ú›ˆ˜ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ 6-14 ÂÙÒÓ ÛÙËÓ ∂ÏÏ¿‰·. ∆Ô‰Â›ÁÌ· ÙÔ˘ ÏËı˘ÛÌÔ‡ Ì·˜ ÂÚÈ¤Ï·‚Â 3298 ·È‰È¿,1590 ·ÁfiÚÈ· Î·È 1708 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 6-14 ÂÙÒÓ‰È·Ì¤ÓÔÓÙ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈÎ‹˜. ∏ Ì¤-ıÔ‰Ô˜ Ì¤ÙÚËÛË˜ ÙË˜ Lp(·) ‹Ù·Ó ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹. ∆··ÔÙÂÏ¤ÛÌ·Ù· Ì¿˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓÂÈ¤‰ˆÓ ÙË˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 153 ¤ˆ˜ 159 (mg/L)ÁÈ· Ù· ·ÁfiÚÈ· Î·È ·fi 146 ¤ˆ˜ 151 (mg/L) ÁÈ· Ù· ÎÔ-Ú›ÙÛÈ·. ∏ ‰È¿ÌÂÛË ÙÈÌ‹ ÙË˜ ÌÂÙÚ‹ıËÎÂ ·fi 133 ¤ˆ˜157 (mg/L) ÁÈ· Ù· ·ÁfiÚÈ· Î·È ·fi 100 ¤ˆ˜ 108(mg/L) ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ™‡ÌÊˆÓ· ÌÂ Ù· Â˘Ú‹Ì·Ù¿Ì·˜, Ù· Â›Â‰· ÙË˜ Lp(·) ÛÙ· ∂ÏÏËÓfiÔ˘Ï· Û¯ÔÏÈ-Î‹˜ ËÏÈÎ›·˜, ‹Ù·Ó Ù· ¯·ÌËÏfiÙÂÚ· Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ-Â˘ıÂ› Ì¤¯ÚÈ Û‹ÌÂÚ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: §ÈÔÚˆÙÂ˝ÓË (·), Lp(·), ÂÎ·ÙÔÛÙÈ-·›Â˜ ı¤ÛÂÈ˜.

�Abstract: Lipoprotein (a), Lp (a), is a lipoproteinwhich is genetically determined, as well as a factorquantitatively defined, that is associated with thedevelopment of cardiovascular disease. ∆he aim ofthis study was to measure the serum Lp(a) levels inGreek school-aged children and determine theircentile distribution according to age and sex so thatthey can be used as reference points. We studied atotal of 3298 children (1590 boys, 1708 girls) aged 6-14 yrs, all of whom resided in the greater Athensarea. Lp(a) levels were evaluated using an enzymelinked immunorbent assay. Mean Lp(a) levels rangedfrom 153 to 159 mg/L for boys and from 146 to 151mg/L for girls. The median levels ranged from 133 to157 mg/L for boys and from 100 to 108 mg/L forgirls. The results of our study indicate that the Lp(a)levels in the school-aged Greek children, were thelowest ever reported up to the present time.

Key words: Lp(a), Lipoprotein (a), centiles.

∂›Â‰· §ÈÔÚˆÙÂ˝ÓË˜(·) ÛÂ 3298 ∂ÏÏËÓfiÔ˘Ï·, ËÏÈÎ›·˜ 6-14 ÂÙÒÓ∫. ∂. ™Ô‡ÏË1, °.∞. ∫·Ú›Î·˜2, ™. °·‚Ú›ÏË

Serum Lipoprotein (a) concentration in 3298 healthy school aged Greek childrenK.H. Schulpis1, G.A. Karikas2, S. Gavrili

∂ÈÛ·ÁˆÁ‹∏ §ÈÔÚˆÙÂ˝ÓË (·), Lp(·), ıÂˆÚÂ›Ù·È ¤Ó·˜ -·ÓÂ-

Í¿ÚÙËÙÔ˜ ÙË˜ ‰È·ÙÚÔÊ‹˜- ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘

·Ó¿Ù˘ÍË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.¶ÚÔÛ‰ÈÔÚ›ÛıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙÔ ·ÓıÚÒÈÓÔÏ¿ÛÌ· ·fi ÙÔÓ Berg (1), Ô˘ ¤‰ÂÈÍÂ fiÙÈ ÚfiÎÂÈÙ·È

1 πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, 11527 ∞ı‹Ó·

2 ªÔÓ¿‰· ¶·ÚÂÓÙÂÚÈÎ‹˜ ¢È·ÙÚÔÊ‹˜ Î·È º·ÚÌ·ÎÔÎÈÓËÙÈÎ‹˜ (ª∂¢º)¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, 11527 ∞ı‹Ó·

1 Institute of Child Health“St. Sophia” Children’s Hospital, Athens

2 Division of Parenteral Nutrition and Pharmacokinetics“St. Sophia” Children’s Hospital, Athens


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ÁÈ· Ì›· ·ÔÏÈÔÚˆÙÂ˝ÓË (·) Î·È Ì›· ¯·ÌËÏ‹˜ ˘-ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˝ÓË (LDL) (2). ∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜·¤‰ÂÈÍ·Ó fiÙÈ Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ Lp(·) Û˘Ì-‚¿ÏÏÔ˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ·ıËÚˆÌ¿ÙˆÛË˜ Î·È ÂÁÎÂ-Ê·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (3,4). ŸÙ·Ó Ù· Â›Â‰¿ ÙË˜˘ÂÚ‚·›ÓÔ˘Ó Ù· 300 mg/L, ÙfiÙÂ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÙËÓÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ ‰ÈÏ·ÛÈ¿˙Â-Ù·È (5,6). ∏ ÂÓÙfiÈÛË ÙË˜ Lp(·) fi¯È ÌfiÓÔ ÛÙ· ÙÔÈ¯Ò-Ì·Ù· ·ÁÁÂ›ˆÓ, ·ÏÏ¿ ÛÙ· ÌÔÛ¯Â‡Ì·Ù·, ¤‰ˆÛÂ ÙÔÓ¯·Ú·ÎÙËÚÈÛÌfi ÙË˜ ˆ˜ ·ıËÚˆÌ·ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·,·Ô‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ Ë ·ÔÏÈÔÚˆÙÂ˝ÓË (·) ÚÔÛÔ-ÌÔÈ¿˙ÂÈ ÌÔÚÈ·Î¿ ÌÂ ÙÔ Ï·ÛÌÈÓÔÁfiÓÔ. Œ¯ÂÈ ıÚÔÌ‚Ô-ÁÂÓÂÙÈÎ¤˜ Î·È ·ıËÚˆÌ·ÙÔÁfiÓÂ˜ È‰ÈfiÙËÙÂ˜ (7,8).

™ÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜ ·Ú·ÙËÚ‹ıËÎÂ ·‡ÍËÛË ÙË˜Lp(·) ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË, fiˆ˜ Î·È Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡-ÓË (9, 10). ™‡ÌÊˆÓ· ÌÂ ÙË ÌÂÏ¤ÙË ÙË˜ Bogalusa ·-Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙ· Â›Â‰· ÙË˜ Lp(·)fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ Î·È ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ‹‚Ë˜(11,12). ∞Ó ÎÈ ¤Ó·˜ ÂÚÈÔÚÈÛÌ¤ÓÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ‰ÂÓ ÂÈ‚Â‚·›ˆÛÂ ÙË Û¯¤ÛË ÌÂÙ·Í‡ ÂÈ¤‰ˆÓ Lp(·)Î·È ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, Èı·ÓfiÓ ¤ÓÂÎ· ÙË˜ ‰È·ÊÔ-ÚÂÙÈÎ‹˜ ÌÂıÔ‰ÔÏÔÁ›·˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ (13).™Â ·ÛıÂÓÂ›˜ ÌÂ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÈÓ·ÈÌ›· ÌÂ-ÙÚ‹ıËÎ·Ó ˘„ËÏfiÙÂÚ· Â›Â‰· Lp(·), Û˘ÁÎÚÈÓfiÌÂÓ·ÌÂ ÂÎÂ›Ó· ÙˆÓ ˘ÁÈÒÓ (14,15). ∞fi ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ‰È-Â˘ÎÚÈÓ›ÛÙËÎÂ fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ ÁfiÓÔ LDLR (16).

Œ¯ÔÓÙ·˜ ˘fi„Ë fiÙÈ Ë ÛÙ¿ıÌË ÙË˜ Lp(·) ÂËÚÂ¿-˙ÂÙ·È ÁÂÓÂÙÈÎ¿, Û¯Â‰È¿Û·ÌÂ ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙËÂÎÙ›ÌËÛË˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÏÈÔÚˆÙÂ˝ÓË˜ ÛÂ ¤Ó·ÌÂÁ¿ÏÔ ·ÚÈıÌfi ∂ÏÏËÓÔ·›‰ˆÓ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ 6-14ÂÙÒÓ, ÒÛÙÂ Ó· ‰È·ÌÔÚÊÒÛÔ˘ÌÂ ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈ-Ì¤˜ (ÙÈÌ¤˜ ·Ó·ÊÔÚ¿˜) ÙÔ˘ ÓÂ·ÓÈÎÔ‡ Ì·˜ ÏËı˘ÛÌÔ‡.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ∞fi ÙËÓ 1Ë π·ÓÔ˘·Ú›Ô˘ 1996 ¤ˆ˜ ÙËÓ 31Ë ¢ÂÎÂÌ‚Ú›Ô˘

1997, ÂÏ‹ÊıËÛ·Ó ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ·fi 3298 ˘ÁÈ‹ ∂ÏÏËÓfi-Ô˘Ï· Ô˘ Î·ÙÔÈÎÔ‡Û·Ó ÛÙÔ ÓÔÌfi ∞ÙÙÈÎ‹˜. ∞fi ·˘Ù¿, Ù·1590 ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù· 1708 ÎÔÚ›ÙÛÈ·. ™Â Î¿ıÂ ÂÚ›Ùˆ-ÛË, ·Ó·ÁÚ·ÊfiÙ·Ó Ë ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡, fiÙ·Ó ÁÈÓfiÙ·Ó Ë ÎÏÈ-ÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ë ·ÈÌÔÏË„›·, Î·ÙfiÈÓ ¤ÁÁÚ·ÊË˜ ÏËÚÔ-ÊfiÚËÛË˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ∏ ÛÙ¿ıÌË ÙË˜ Lp(·) ÛÙÔ ·›Ì·ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ kit-test ÂÌÔÚ›Ô˘ (·ÓÔÛÔÏÔÁÈÎ‹ Ì¤ıÔ-‰Ô˜ Elisa, Biopool AB, Umea, Sweden) (17,18).

∏ Î·Ù·¯ÒÚËÛË ÙˆÓ ÙÈÌÒÓ ·Ó¿ ËÏÈÎ›· Î·È Ê‡ÏÔ ÛÂ ÂÎ·-ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ ¤ÁÈÓÂ ÛÂ ÚfiÁÚ·ÌÌ· SPSS 7,5 ÌÂ ÙË ‚Ô‹-ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹.

∞ÔÙÂÏ¤ÛÌ·Ù·√È Ì¤ÛÂ˜ Î·È ÔÈ ‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜ ·Ó¿ ËÏÈÎ›· Î·È

Ê‡ÏÔ Î·Ù·ÓÂÌËÌ¤ÓÂ˜ ÛÂ ÂÎ·ÙÔÛÙÈ·›Â˜ ·Ó·ÏÔÁ›Â˜,·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √È Ì¤ÛÂ˜ ÙÈÌ¤˜ ÙË˜Lp(·) ÌÂÙÚ‹ıËÎ·Ó ·fi 152 ¤ˆ˜ 159 (mg/L) ÁÈ· Ù··ÁfiÚÈ· Î·È ·fi 146 ¤ˆ˜ 151 (mg/L) ÁÈ· Ù· ÎÔÚ›ÙÛÈ·.√È ‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜ Î˘Ì·›ÓÔÓÙ·Ó ·fi 133 ¤ˆ˜157(mg/L) ÁÈ· Ù· ·ÁfiÚÈ· Î·È ·fi 100 ¤ˆ˜ 108 (mg/L)ÁÈ· Ù· ÎÔÚ›ÙÛÈ·.

™˘˙‹ÙËÛËªÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë ÙË˜ Lp(·) ·fi ÙoÓ Berg (1)

Î·È ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ (19,20,21), ·¤‰ÂÈÍ·Ó fiÙÈ ÔÈÛ˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ ÛÙÔ Ï¿ÛÌ· Â›Ó·È ÔÛÔÙÈÎ¿ Î·-ıÔÚÈÛÌ¤ÓÂ˜. √È ÁÂÓÂÙÈÎ¿ Î·ıÔÚÈÛÌ¤ÓÂ˜ ÙÈÌ¤˜ ÙË˜Lp(·) Ô‰‹ÁËÛ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Â›Ó·È ¯·Ú·-ÎÙËÚÈÛÙÈÎ¤˜ ÁÈ· Î¿ıÂ ¯ÒÚ· (20,21). ∞ÎfiÌË, Ë Ê˘ÏÂ-ÙÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· Ô˘ ‚Ú¤ıËÎÂ ÛÂ ÔÏÏ¤˜ ¯ÒÚÂ˜ÙÔ˘ ‰˘ÙÈÎÔ‡ ÎfiÛÌÔ˘ (∞ÁÁÏ›·, °·ÏÏ›·) ·ÚÔ˘Û›·ÛÂÔÏÏ¤˜ ·ÓÙÈÊ¿ÛÂÈ˜, .¯. ÔÈ πÓ‰Ô› Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙÔ§ÔÓ‰›ÓÔ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ· Â›Â‰· Lp(·), Û˘ÁÎÚÈ-

¶›Ó·Î·˜ 1. ∂›Â‰· §ÈÔÚˆÙÂ˝ÓË˜ Lp(·) (mg/L) ÛÂ 3298 ∂ÏÏËÓfiÔ˘Ï· ËÏÈÎ›·˜ 6-14 ÂÙÒÓ.

∏ÏÈÎ›· ∂Î·Ù. £¤ÛÂÈ˜ (Lp(a))

(¯Ú.) ¡ ª¤ÛË ™∞ ¢È·Ì 10 25 50 75 95

AÁfiÚÈ· 6 - 8 405 153 90 133 85 109 133 176 2648 -10 414 152 105 134 96 97 138 195 257

10 - 12 388 159 104 135 90 95 130 180 26410 - 14 383 157 116 157 95 100 139 240 284

™‡ÓÔÏÔ 1.590

∫ÔÚ›ÙÛÈ· 6 - 8 394 146 107 100 91 100 115 256 2708 - 10 405 149 99 106 99 104 126 240 268

10 - 12 415 150 108 107 77 95 120 256 27812 - 14 494 151 120 108 89 108 128 260 298

™‡ÓÔÏÔ 1.708

°ÂÓÈÎfi ™‡ÓÔÏÔ 3.298™∞: ™Ù·ıÂÚ‹ ∞fiÎÏÈÛË

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ÓfiÌÂÓ· ÌÂ ÂÎÂ›Ó· ¿ÏÏˆÓ ÂıÓÈÎÔÙ‹ÙˆÓ Ô˘ ‰È·Ì¤-ÓÔ˘Ó ÛÙËÓ ›‰È· ÂÚÈÔ¯‹ (20). √ ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓÂÈ¤‰ˆÓ ÙË˜ Lp(·) ÛÂ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ∂ÏÏËÓfi-Ô˘Ï· ¤ÁÈÓÂ ÂÈÏ¤ÔÓ, ÌÂ ÛÎÔfi Ó· ÂÓÙÔ›ÛÔ˘ÌÂ¤Ó·Ó ·ÎfiÌË ÁÂÓÂÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘, Ô˘ ı·ÌÔÚÔ‡ÛÂ Ó· ÚÔÎ·Ï¤ÛÂÈ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›-Ô˘ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∆· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıË-Û·Ó ÌÂÙ¿ 12ˆÚË ÓËÛÙÂ›· ·ÚfiÙÈ ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜Ô˘ ‰ÂÓ ‰È·ÊÔÚÔÔÈÔ‡Ó Ù· Â›Â‰· ÙË˜ Lp(·) ÌÂÙ¿·fi Ê·ÁËÙfi (17).

√È Rifai Î·È Û˘Ó (21), ÛÂ ÌÂÏ¤ÙË ÙÔ˘˜ ·Ó·Ê¤-ÚÔ˘Ó fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Lp(·) ÛÂ ‚Ú¤ÊË, ·È‰È¿Î·È ÂÓ‹ÏÈÎÂ˜ ÛÙÈ˜ ∏¶∞ ‰Â›¯ÓÔ˘Ó Ì›· ·‡ÍËÛË ·fi ÙËÁ¤ÓÓËÛË ¤ˆ˜ ÙÔ 2o ¤ÙÔ˜ ˙ˆ‹˜ Î·È Â›Ó·È ›‰ÈÂ˜ Î·ÈÛÙËÓ ÂÓËÏÈÎ›ˆÛË.

√È Ì¤ÛÂ˜ Î·È ‰È¿ÌÂÛÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜Lp(·) ÛÂ 3298 ˘ÁÈ‹ ·È‰È¿, Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó ÌÂÙËÓ ›‰È· Ì¤ıÔ‰Ô, ‹Ù·Ó Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜¯·ÌËÏ¤˜. ™˘ÓÂÒ˜, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Lp(·) ÛÂ·È‰È¿ ËÏÈÎ›·˜ 6-14 ÂÙÒÓ Ô˘ ‹Ù·Ó Û¯Â‰fiÓ ·ÌÂÙ¿-‚ÏËÙÂ˜, ı· ÌÔÚÔ‡Û·Ó Ó· ıÂˆÚËıÔ‡Ó ·ÚfiÌÔÈÂ˜Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜ (21). °È· ÙÔÓ ›‰ÈÔ ÏfiÁÔ, ıÂˆ-Ú‹Û·ÌÂ ˆ˜ ·ÓÒÙ·ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ ÙË˜ Lp(·)ÙËÓ ÙÈÌ‹ ÙˆÓ 300 mg/L. √È Ì¤ÛÂ˜ ÙÈÌ¤˜, fiˆ˜ Â-ÚÈÁÚ¿ÊËÎ·Ó ÛÂ ‰È¿ÊÔÚÂ˜ ÂÚÁ·Û›Â˜ Î·È ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÂ ‰È¿ÊÔÚÂ˜ ÂıÓfiÙËÙÂ˜, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 2. ∏ ¤ÏÏÂÈ„Ë ‰ÈfiÚıˆÛË˜ ÙˆÓ ÙÈÌÒÓÙË˜ Lp(·), Ô˘ ‰ÂÓ ¤¯Ô˘Ó Î·ÓÔÓÈÎ‹ Î·Ù·ÓÔÌ‹ (nongaussian) Î·È Ë ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ÂÈ‰ÒÓ ÙÈÌÒÓ ·Ó·-ÊÔÚ¿˜, Î¿ÓÂÈ ÙË ÌÂÙ·Í‡ ÙÔ˘˜ Û‡ÁÎÚÈÛË ÙˆÓ ÙÈÌÒÓ‰‡ÛÎÔÏË ·ÏÏ¿ ·Ô‰ÂÎÙ‹, ·ÊÔ‡ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ Lp(·) ¤ÁÈÓÂ ÌÂ ÙËÓ ›‰È· Ì¤ıÔ‰Ô(ELISA). ∂›ÛË˜, ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓÂ˜ ‰È·ÊÔÚ¤˜ÌÂÙ·Í‡ Ì¤ÛˆÓ Î·È ‰È·Ì¤ÛˆÓ ÙÈÌÒÓ ÙË˜ Lp(a) Â›Ó·È·ÔÙ¤ÏÂÛÌ· ÙË˜ ÚÔÂÚÈÁÚ·ÊÂ›Û·˜ ÌË Î·ÓÔÓÈÎ‹˜Î·Ù·ÓÔÌ‹˜ ÙˆÓ ÙÈÌÒÓ ÙË˜ ÏÈÔÚˆÙÂ˝ÓË˜. ∞ÎfiÌË,·ÊÔ‡ ÔÈ ÌÂÙÚ‹ÛÂÈ˜ ÙË˜ Lp(·) ÛÙ· ∂ÏÏËÓfiÔ˘Ï·¤ÁÈÓ·Ó Î¿Ùˆ ·fi ÙÈ˜ ›‰ÈÂ˜ Û˘Óı‹ÎÂ˜ ÛÙÔ ›‰ÈÔ ÂÚ-Á·ÛÙ‹ÚÈÔ, ı· ÌÔÚÔ‡ÛÂ Ó· Á›ÓÂÈ ·Ô‰ÂÎÙ‹ Ë Û‡-

ÁÎÚÈÛ‹ ÙÔ˘˜ ÌÂ ÂÎÂ›ÓÂ˜ ¿ÏÏˆÓ ¯ˆÚÒÓ. ªÂ ‚¿ÛË Ù··ÔÙÂÏ¤ÛÌ·Ù·, Ë Lp(·) ÛÙË ¯ÒÚ· Ì·˜ Ê·›ÓÂÙ·È Ó·‚Ú›ÛÎÂÙ·È ÛÙ· ¯·ÌËÏfiÙÂÚ· Â›Â‰·, Û˘ÁÎÚÈÓfiÌÂ-Ó· ÌÂ ÂÎÂ›Ó· ¿ÏÏˆÓ ¯ˆÚÒÓ (¶›Ó·Î·˜ 2).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿ ı· ÌÔÚÔ‡ÛÂ Ó· ÏÂ¯ıÂ›, fiÙÈ·ÚfiÏÔ Ô˘ ÔÈ Î·Ú‰È·ÁÁÂÈ·Î¤˜ ÓfiÛÔÈ ·ÔÙÂÏÔ‡ÓÙËÓ ÚÒÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙËÓ ∂ÏÏ¿‰·, Ù· ·Úfi-ÓÙ· Â˘Ú‹Ì·Ù· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÂÎÂ›Ó· Ô˘ ·ÊÔ-ÚÔ‡Ó ÛÙ· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ·È‰ÈÒÓ ›‰È·˜ ËÏÈ-Î›·˜ (26), ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙÔ Û˘-Ì¤Ú·ÛÌ· fiÙÈ Ô ÂÏÏËÓÈÎfi˜ ÏËı˘ÛÌfi˜ Â˘Ú›ÛÎÂÙ·ÈÛÂ ÏÂÔÓÂÎÙÈÎ‹ ı¤ÛË ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÚÔÂÚ¯fi-ÌÂÓÔ Î›Ó‰˘ÓÔ ·fi ÙÈ˜ ÚÔ·Ó·ÊÂÚfiÌÂÓÂ˜ ‚ÈÔ¯ËÌÈ-Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜.

∂˘¯·ÚÈÛÙ›Â˜∂˘¯·ÚÈÛÙÔ‡ÌÂ ÙËÓ Î. ∫·ÏÏÈfiË ∆·ÛÛÔÔ‡ÏÔ˘ ÁÈ· ÙËÓ ÂÈ-ÌÂÏËÌ¤ÓË ‰·ÎÙ˘ÏÔÁÚ¿ÊËÛË ÙË˜ ÂÚÁ·Û›·˜ ·˘Ù‹˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Berg R. A new serum type system in man – the Lp (a)

system. Acta Pathol Microbiol Scand 1963;59: 369–382.2. Utermann G. The Mysteries of lipoprotein (a). Science

1989;246: 904–910.3. Dahlen GH, Guyton JR, Attar M. Farmer JA, Kauz JA.

Association of levels of lipoprotein (a), plasma lipids andothers lipoproteins with coronary artery disease docu-mented by angiography. Circulation 1986;14:758–765.

4. Rhonds GG, Dahlen GH, Bera K, Morton NE, DannenbergA. Lp(a) lipoprotein as a risk factor in myocardial infarction.JAMA 1986;256:2540–2544.

5. Murai A, Miyahara I, Fujinoto N, Matsuda M. Lp(a)lipoprotein as a risk factor for coronary heart disease andcerebral infarction. Atherosclerosis 1986;59:199–206.

6. Armstrong VW, Cremer P, Eberle E. The associationbetween serum Lp(a) concentrations and angiogra-phically assessed coronary atherosclerosis: dependenceon serum LDL levels. Atherosclerosis 1986;62:249–257.

7. Walton KW, Hitchens I, Magnani HN, Khan M. A study ofmethods of identification and estimation of Lp(a)

¶›Ó·Î·˜ 2. ª¤ÛË ∆ÈÌ‹ §ÈÔÚˆÙÂ˝ÓË˜ (·) (mg/L) fiˆ˜ ·Ó·Ê¤ÚÂÙ·È ÛÙË Û¯ÂÙÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›·.

ÃÒÚ· ÕÓ‰ÚÂ˜ °˘Ó·›ÎÂ˜ µÈ‚ÏÈÔÁÚ·Ê›·

¡ÈÁËÚ›· 256 243 (22)°·ÏÏ›· 220 245 (23)π·ˆÓ›· 170 150 (24)∏¶∞ (ÃÈÔ‡ÛÙÔÓ-§Â˘ÎÔ›) 157 173 (25)(¡. √ÚÏÂ¿ÓË-¡¤ÁÚÔÈ) 239 260 (25)(™ÈÎ¿ÁÔ-§Â˘ÎÔ›) 160 150 (25)(ªÔÁÎ·ÏÔ‡Û·-§Â˘ÎÔ›) 170 168 (11)(ªÔÁÎ·ÏÔ‡Û·-¡¤ÁÚÔÈ) 240 230 (11)∂§§∞™ 152 127

∆· Â›Â‰· ÙË˜ §ÈÔÚˆÙÂ˝ÓË˜ (·) ÌÂÙÚ‹ıËÎ·Ó ÌÂ Ì¤ıÔ‰Ô ELISA.

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lipoprotein and its significance in health, hyperlipidemiaand atherosclerosis. Atherosclerosis 1974;20:323–346.

8. Cushing GL, Ganbarts JW, Nava ML. Quantitation andlocalization of apolipoprotein (a) and B in coronary arterybypass vein grafts rejected at reoperation. Athero-sclerosis 1989;9:593–603.

9. Zechner R, Desoys, Schweicditch MO, Pfeiffer KP, KostnerGM. Fluctuations of plasma lipoprotein concentrationsduring pregnancy and post partum. Metabolism1986;35:333–336.

10. Roth M, Niedor A, Rebbin T, Dietel M, Krebber St,Beisiegel U. Detection and quantification of lipoprotein (a)in the arterial wall of 107 coronary bypass patients.Atherosclerosis 1989;9:579–592.

11. Srinivasan SR, Dahlen GH, Jarpa RA, Webber LS,Berenson GS. Racial (Black–White) in serum lipoprotein(a) distribution and in its relation to parental myocardialinfarction in children. Bogalusa Heart study. Circulation1991;90:59–66.

12. Edtelberg IM, Gonzales–Gronow M, Pizzo SV. Lipoprotein(a) inhibition of plasminogen activation by tissue typeplasminogen activation. Thromb Res 1990;57:135-162.

13. Djurovic S, Breg K. Epidemiology of Lp(a) lipoprotein: Itsrole in atherosclerotic/ thrombotic disease. Clin Genet1997;52:281-292.

14. Ridket PM, Hennekens CH, Mair MJ. A prospective studyof lipoprotein (a) and the risk of myocardial infarction.JAMA 1993;270:2197-2179.

15. Bosto, AG Cupples LA, Jenner JL. Elevated plasmalipoprotein (a) and coronary heart disease in men aged 55years and younger: A prospective study. JAMA1996;27:544-546.

16. Boerwinkle E, Menzel HI, Kraft HG. Genetics of thequantitive Lp(a) lipoprotein trait. Human Genet1989;82:73–78.

17. Cohn JS, Lam C, Sullivan DR, Stensley WS. Plasmalipoprotein distribution of apolipoprotein (a) in the fed andfasted states. Atherosclerosis 1991;90:59–66.

18. Fless GM, Snyder ML, Doetsch R. Enzyme Linkedimmunoassay for Lp(a). J Lipid Res 1989;30:651–62.

19. Bowden JF, Pritchard PH, Frohlich JJ. Lp(a) concentrationand apo (a) isoform size. Relation to the presence ofcoronary artery disease in familial hypercholesterolemia.Arterioscler Thromb 1994;14:1561-1568.

20. Krempler G, Kostner G, Bolzano K. Lipoprotein (a) is not ametabolic product of other lipoproteins containingapoprotein B. Biochim Biophys Acta 1979;575:63–70.

21. Rifai N, Heiss G, Doetsch K. Lipoprotein (a) at birth, inblacks and whites. Atherosclerosis 1992;92:123–129.

22. Kesteloot H, Oviasu VO, Obasohan AO. Serum lipid andapolipoprotein levels in a Nigerian population trait.Atherosclerosis 1989;78:33–38.

23. Janhiainen H, Koskinen P, Ehnholm C. Lipoprotein (a)and coronary heart disease risk. A case – control study ofthe Helsinki. Heart study participants. Atherosclerosis1991;89:59-67.

24. Taro Ohji, Chiba K, Kohri T, Yamagishi M. Serumlipoprotein (a) in healthy Japanese children 5 yrs. of age.Acta Paediatr Jpn 1993;35:302–306.

25. Para H, Luyeye J, Bouramne J. Black, white differences inserum Lipoprotein (a) levels. Clin Chim Acta1987;168:27–31.

26. Schulpis KH, Karikas GA. Serum cholesterol andtriglycerides distribution in 7767 school–aged Greekchildren. Pediatrics 1998;101:861–864.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ÏÂÔ¿ÙÚ· ™Ô‡ÏËπÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·», 11527 ∞ı‹Ó·

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�Abstract: Recent studies have demonstratedthat the intramuscular administration of dexa-methasone in children in the outpatient depar-tment with acute viral laryngotracheitis (AVL) ofmild to moderate severity, is associated with areduction in the severity of illness within 24 hoursafter treatment. The purpose of our study was todetermine if topical anti-inflammatory therapy withaerolized beclomethazone dipropionate-(BD) issimilarly or even more effective in the outpatientmanagement of mild to moderate severity AVL.Sixty two children aged 6 months to 5 years ,whocame to the emergency room (ER) with AVL and acroup score of at least 2 (range 0 to 10), wereassigned, in a randomised double-blind fashion,to receive either aerolized L-epinephrine, or asingle intramuscular injection of dexamethasone0,6 mg/kg, or aerolized BD 200 mcg via aero-chamber, before discharge from the ER. Croupscore (CS), heart rate (HR),blood pressure(BP),respiratory rate (RR) and oxygen saturation(SO2) were recorded before treatment and at 15,30, 60, 90 and 120 minutes after treatment. Pa-tients in all groups demonstated a significanttransient reduction of the CS at the end of theobservation period. After discharge from the ERnone of the patients returned for additional therapyduring the next 24 hours. The L-epinephrine group

�¶ÂÚ›ÏË„Ë: ¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈfiÙÈ Ë ÂÓ‰ÔÌ˘˚Î‹ ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓË˜ (¢ª)ÛÂ ÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ÔÍÂ›· Ï·Ú˘Á-ÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›ÙÈ‰· (§∆µ) ‹È·˜-Ì¤ÙÚÈ·˜ ‚·Ú‡-ÙËÙ·˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂÏ¿ÙÙˆÛË ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ÓfiÛÔ˘ Ì¤Û· ÛÂ 24 ÒÚÂ˜. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜‹Ù·Ó Ó· ‰È·ÈÛÙˆıÂ› ·Ó Ë ÙÔÈÎ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ıÂÚ·Â›· ÌÂ ·ÂÚÔÔÈËÌ¤ÓË ‰ÈÚÔÈÔÓÈÎ‹ ÌÂÎÏÔ-ÌÂı·˙fiÓË (¢¶ª) Â›Ó·È ÂÍ›ÛÔ˘ ‹ ÂÚÈÛÛfiÙÂÚÔ ·Ô-ÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙË ıÂÚ·Â›· ÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÒÓ·ÛıÂÓÒÓ ÌÂ ‹ÈÔ˘-Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ÔÍÂ›·-§∆µ.™ÙËÓ ·ÚÔ‡Û· ‰ÈÏ‹ Ù˘ÊÏ‹ Û˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ÌÂ-ÏÂÙ‹ıËÎ·Ó 62 ·È‰È¿ ËÏÈÎ›·˜ ÌÂÙ·Í‡ 6 ÌËÓÒÓ Î·È 5ÂÙÒÓ, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ Â›ÙÂ ·‰ÚÂÓ·Ï›ÓË (LE)ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ÓÂÊÂÏÔÔ›ËÛË˜, Â›ÙÂ ÌÈ· ÂÊ¿·ÍÂÓ‰ÔÌ˘˚Î‹ xoÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓË˜ (¢ª)0,6mg/Kg B™ (max 8mg), Â›ÙÂ ·ÂÚÔÔÈËÌ¤ÓË ¢¶ª200 mcg ÌÂ ·ÂÚÔı¿Ï·ÌÔ. ∂ÎÙÈÌ‹ıËÎ·Ó Ô ‚·ıÌfi˜‰‡ÛÓÔÈ·˜ (µ¢),Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ó·ÓÔÒÓ (∞∞) Î·ÈÙˆÓ Î·Ú‰È·ÎÒÓ ÛÊ‡ÍÂˆÓ (∫™), Ë ·ÚÙËÚÈ·Î‹ ›ÂÛË(∞¶) Î·È Ô ÎÔÚÂÛÌfi˜ ÙË˜ ÔÍ˘·ÈÌÔÛÊ·ÈÚ›ÓË˜ (SO2)ÛÂ ¯ÚfiÓÔ˘˜ 0, 15, 30, 60, 90 & 120 ÏÂÙ¿ ÙË˜ ÒÚ·˜ÌÂÙ¿ ÙË ıÂÚ·Â›·. √È ·ÛıÂÓÂ›˜ Î·È ÙˆÓ ÙÚÈÒÓ ıÂ-Ú·Â˘ÙÈÎÒÓ ÔÌ¿‰ˆÓ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ‹ÂÏ¿ÙÙˆÛË ÙÔ˘ µ¢ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜. ªÂÙ¿ ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘˜ ·fi Ù·ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· (∂π) Î·ÓÂ›˜ ·fi ·˘ÙÔ‡˜ ‰ÂÓ Â·-Ó‹ÏıÂ Ì¤Û· ÛÙÈ˜ ÂfiÌÂÓÂ˜ 24 ÒÚÂ˜. ∏ ÔÌ¿‰· ÙË˜

∆ÔÈÎ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ·ÁˆÁ‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›ÙÈ‰·˜¶. ™Ù·ÌÔ‡ÏË˜1, Ã. ÃÚ˘Û·ÓıfiÔ˘ÏÔ˜2, ª. ∂ÌÔÚÈ¿‰Ô˘3, ¡. ∆Û¤Ë˜4, ∂. °ÂˆÚÁÈ¿‰Ô˘5, ¡. ª·ÁÎÏ·‚¤Ú·˜6

Topical anti-inflammatory therapy in the management of acute laryngotracheitisP. Stamoulis1, C. Chryssanthopoulos2, M. Emporiadou3, N. Tsepis4, E. Georgiadou5, N. Maglaveras6


1 ¶·È‰›·ÙÚÔ˜, ∫.À. ™ÎÈ¿ıÔ˘, ™ÎÈ¿ıÔ˜2 ¶·È‰›·ÙÚÔ˜-∞ÏÏÂÚÁÈÔÏfiÁÔ˜, £ÂÛ/Ó›ÎË3 ∞Ó·Ï. Î·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈÎ‹˜,

4Ë ¶·È‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, ∞¶£4 ¶·È‰›·ÙÚÔ˜, ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜” £ÂÛ/Ó›ÎË5 Œ‰Ú· ™Ù·ÙÈÛÙÈÎ‹˜, ∞¶£6 ∞Ó·ÏËÚˆÙ‹˜ Î·ıËÁËÙ‹˜,

¤‰Ú· π·ÙÚÈÎ‹˜ ™Ù·ÙÈÛÙÈÎ‹˜, ∞¶£

1 Pediatrician, Health Center, Skiathos2 Pediatric-Allergiologist, Thessaloniki3 Assoc. Professor of Pediatrics,

4th Pediatric Clinic, AHEPA Hospital, Thessaloniki4 Pediatrician,“G. Gennimatas” Hospital, Thessaloniki5 Department of Statistics, Aristotelion University of Thessaloniki6 Assoc. Professor, Department of Statistics, Aristotelion

University of Thessaloniki

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showed significant improvement of CS, HR andRR in comparison to the other two groups. Therewas no significant difference in the measuredparameters between the dexamethasone andbeclome- thasone groups. In summary, the use ofaerolized L-epinephrine is superior to intra-muscular dexamethasone and aerolized beclome-thazone in the management of ALV in the ERsetting. However, the use of aerolized beclome-thasone in the outpatient management of viralcroup is associated with a significant reduction inseverity of illness within 24 hrs after treatment.Thismode of administration of local steroids provides asafe and cost effective method of treatment of AVLin ER or at home.

Key words: croup (laryngotracheobronchitis),local antiinflammatory drugs, beclomethazone,croup score.

LE ÂÌÊ¿ÓÈÛÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·Ì¤-ÙÚˆÓ µ¢, ∫™ Î·È ∞∞ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ¿ÏÏÂ˜ ‰‡ÔÔÌ¿‰Â˜. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ÛÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿-‰ˆÓ ÙË˜ ¢ª Î·È ÙË˜ ¢¶ª. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿ Ë ¯Ô-Ú‹ÁËÛË ÓÂÊÂÏÔÔÈËÌ¤ÓË˜ LE ˘ÂÚ¤¯ÂÈ ıÂÚ·Â˘ÙÈ-Î¿ ÙË˜ ÂÓ‰ÔÌ˘˚Î‹˜ ¯ÔÚ‹ÁËÛË˜ ¢ª Î·È ÙË˜ ·ÂÚÔ-ÔÈËÌ¤ÓË˜ ¢¶ª ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÏ·ÊÚÈ¿˜Î·È ÌÂÙÚ›·˜ ‚·Ú‡ÙËÙ·˜ ∞∆µ. øÛÙfiÛÔ, Ë ¯Ú‹ÛË ÙË˜¢¶ª ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÒÓ ·ÛıÂ-ÓÒÓ ÌÂ ÈÔÁÂÓ‹ ÔÍÂ›· §∆µ (croup) Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓÂÏ¿ÙÙˆÛË ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ Ì¤Û· ÛÙÔÂfiÌÂÓÔ 24ˆÚÔ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. ∏·Ú·¿Óˆ Ì¤ıÔ‰Ô˜ ¯ÔÚ‹ÁËÛË˜ ÙÔÈÎ‹˜ ·ÓÙÈÊÏÂÁ-ÌˆÓÒ‰Ô˘˜ ·ÁˆÁ‹˜ ·ÔÙÂÏÂ› ÌÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹,·ÛÊ·Ï‹, ·ÓÒ‰˘ÓË Î·È ÔÈÎÔÓÔÌÈÎ‹ ıÂÚ·Â›· ÙË˜ÔÍÂ›·˜ §∆µ ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ‹ ÛÙÔ Û›ÙÈ ÙÔ˘·ÛıÂÓÔ‡˜.

§¤ÍÂÈ˜-ÎÏÂÈ‰È¿: Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›ÙÈ‰·, ÙÔÈ-Î¿ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ÌÂÎÏÔ-ÌÂı·˙fiÓË, ‚·ıÌfi˜ ‰‡ÛÓÔÈ·˜.

∂ÈÛ·ÁˆÁ‹∏ ÔÍÂ›· Ï·Ú˘ÁÁ›ÙÈ‰· (Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›-

ÙÈ‰·) ‹ ÈÔÁÂÓ¤˜ croup ‹ croup Â›Ó·È ¤Ó· Û‡Ó‰ÚÔ-ÌÔ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÓÒÙÂÚˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓÔ‰ÒÓ.Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘Ï·ÎÒ‰Ë ‚‹¯·, ‚Ú¿Á¯Ô˜ÊˆÓ‹˜ Î·È ÂÈÛÓÂ˘ÛÙÈÎfi Û˘ÚÈÁÌfi. ¶·ıÔÏÔÁÔ·Ó·-ÙÔÌÈÎ¿, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÁÏˆÙÙÈ‰ÈÎ‹ ÊÏÂÁ-ÌÔÓ‹, Û˘Ó‹ıˆ˜ ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ (1).

¡ÔÛÔÎÔÌÂÈ·ÎÔ› ·ÛıÂÓÂ›˜ ÌÂ croup ¤¯Ô˘Ó ·ÓÙÈ-ÌÂÙˆÈÛıÂ› ÌÂ ÓÂÊÂÏÔÔÈËÌ¤ÓË ·‰ÚÂÓ·Ï›ÓË(LE)‹/Î·È Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ(2). ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ÓÂÊÂÏÔÔÈËÌ¤ÓË˜LE ÛÙË ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ §∆µ Â›Ó·È ·Ô‰Â-‰ÂÈÁÌ¤ÓË Î·È Ë ¯Ú‹ÛË ÙË˜ Â˘ÚÂ›· ÛÂ ·ÁÎfiÛÌÈÔÂ›Â‰Ô (3-7). ªÂÙ¿ ·fi ·ÌÊÈÛ‚‹ÙËÛË 40 ¯ÚfiÓˆÓ(8,9) ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ÙÂÎÌËÚÈÒÛÂÈ ÙËÓ

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÛÙËıÂÚ·Â›· ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ·ÛıÂÓÒÓ ÌÂ croup(10,16). ∂›Ó·È Ï¤ÔÓ ·Ô‰Â‰ÂÈÁÌ¤ÓÔ fiÙÈ ·È‰È¿ ÌÂÂÏ·ÊÚÈ¿˜, Ì¤ÙÚÈ·˜ Î·È ‚·ÚÈ¿˜ ÌÔÚÊ‹˜ croupÂˆÊÂÏÔ‡ÓÙ·È ·fi ÙËÓ ¤ÁÎ·ÈÚË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ-ÎÔÛÙÂÚÔÂÈ‰ÒÓ (17). ∏ ÓÂÊÂÏÔÔÈËÌ¤ÓË ‚Ô˘‰ÂÛÔ-‰›ÓË ˘ÂÚÙÂÚÂ› ıÂÚ·Â˘ÙÈÎ¿ ÛÂ ·È‰È¿ ÌÂ ÂÏ·-ÊÚ‡-Ì¤ÙÚÈÔ (14) Î·È Ì¤ÙÚÈÔ-‚·Ú‡ croup (10,15) ÛÂÛ¯¤ÛË ÌÂ ÙÔ ¯ÔÚËÁÔ‡ÌÂÓÔ ÓÂÊÂÏÔÔÈËÌ¤ÓÔ Ê˘-ÛÈÔÏÔÁÈÎfi ÔÚfi (placebo), ·ÏÏ¿ Â›Ó·È ÙÔ ›‰ÈÔ ·Ô-ÙÂÏÂÛÌ·ÙÈÎ‹ ÌÂ ÙË ¯ÔÚËÁÔ‡ÌÂÓË ÓÂÊÂÏÔÔÈËÌ¤-ÓË˜ LE ÛÙÔ Ì¤ÙÚÈÔ-‚·Ú‡ croup (2). ∞’ fi,ÙÈ ÁÓˆÚ›-˙Ô˘ÌÂ, ˘¿Ú¯ÂÈ ÂÚÈÔÚÈÛÌ¤ÓË ·Ó·ÊÔÚ¿ ÛÙËÓ ·Á-ÁÏÔÛ·ÍÔÓÈÎ‹ È·ÙÚÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· ÙˆÓ ·ÂÚÔ-ÔÈËÌ¤ÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Ù· ÔÔ›· ¯ÔÚË-ÁÔ‡ÓÙ·È ÙÔÈÎ¿ ÌÂ Û˘ÛÎÂ˘¤˜ ·ÂÚÔı·Ï¿ÌˆÓ, ÛÂÛ¯¤ÛË ÌÂ ÙËÓ ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈÎ¿ÌÂ ÙËÓ ∂ª ¯ÔÚ‹ÁËÛË ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ (¢ª)Î·È ÙË˜ ÓÂÊÂÏÔÔÈËÌ¤ÓË˜ LE ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙˆÓ ÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÒÓ ·ÛıÂÓÒÓ ÌÂ ÔÍÂ›·§∆µ(9).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌË-ÛË ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È ·ÛÊ¿ÏÂÈ·˜ ÙË˜·ÂÚÔÔÈËÌ¤ÓË˜ ¢¶ª ÛÙË ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜§∆µ ÛÂ ÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÔ‡˜ ·ÛıÂÓÂ›˜.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ·ÔÙ¤ÏÂÛ·Ó 62 ·ÛıÂÓÂ›˜

ËÏÈÎ›·˜ 6 ÌËÓÒÓ Ì¤¯ÚÈ 5 ÂÙÒÓ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ∂.π. ÙÔ˘

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

¢ª: ¢ÂÍ·ÌÂı·˙fiÓË¢¶ª: ¢ÈÚÔÈÔÓÈÎ‹ ªÂÎÏÔÌÂı·˙fiÓË§∆µ: §·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›ÙÈ˜LE: L-ÂÈÓÂÊÚ›ÓË, ·‰ÚÂÓ·Ï›ÓËB¢: µ·ıÌfi˜ ¢‡ÛÓÔÈ·˜∂π: ∂ÍˆÙÂÚÈÎ¿ π·ÙÚÂ›·SO2: ∫ÔÚÂÛÌfi˜ ÔÍ˘·ÈÌÔÛÊ·ÈÚ›ÓË˜∞∞: ∞ÚÈıÌfi˜ ·Ó·ÓÔÒÓK™: ∫·Ú‰È·Î¤˜ ™Ê‡ÍÂÈ˜∞¶: ∞ÚÙËÚÈ·Î‹ ¶›ÂÛË

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 60

61


ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜ ÙËÓ ÂÚ›Ô‰Ô √ÎÙˆ‚Ú›Ô˘ 1996-¡ÔÂÌ‚Ú›-Ô˘1998 ÌÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ §∆µ. ∆· ÎÚÈÙ‹ÚÈ· ÂÈ-ÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó: 1) ¶ÚÔËÁËıÂ›Û· (12-72 ÒÚÂ˜)ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÌÂ ÎfiÚ˘-˙·, ‚Ú¿Á¯Ô˜ ÊˆÓ‹˜ Î·È ˘Ï·ÎÒ‰Ë ‚‹¯· Î·È 2) ∫ÏÈÓÈÎ‹ ‰È·-›ÛÙˆÛË ‚Ú¿Á¯Ô˘˜ ÊˆÓ‹˜, ˘Ï·ÎÒ‰Ô˘˜ ‚‹¯· Î·È ÂÈÛÓÂ˘-ÛÙÈÎÔ‡ Û˘ÚÈÁÌÔ‡ Î·Ù¿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÛÙ· ∂.π.

∏ ‚·Ú‡ÙËÙ· ÙË˜ ÏÔ›ÌˆÍË˜ ÂÎÙÈÌ‹ıËÎÂ, 1) ÌÂ ÙÔ ‚·ıÌfi‰‡ÛÓÔÈ·˜ (µ.¢), croup score ÙÔ˘Ï¿¯ÈÛÙÔÓ >2, ¯ÚËÛÈÌÔ-ÔÈÒÓÙ·˜ ÙÔ ÙÚÔÔÔÈËÌ¤ÓÔ Û¯‹Ì· Î·Ù¿ Downes Î·ÈRaphaely (18) (¶›Ó·Î·˜ 1) Î·È 2) ÌÂ ÙÔ ·Ó Ë Î·Ù¿ÛÙ·ÛËÙÔ˘ ·ÛıÂÓÔ‡˜ ‰ÂÓ ··ÈÙÔ‡ÛÂ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô.∞ÔÎÏÂ›ÛıËÎ·Ó ·fi ÙË ÌÂÏ¤ÙË ·È‰È¿ Ô˘ Â›¯·Ó ·Ó·ÙÔÌÈ-Î¤˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Ô‰ÒÓ, ÔÍÂ›· ÂÈÁÏˆÙÙ›-ÙÈ‰·, ‚·ÎÙËÚÈ·Î‹ ÙÚ·¯ÂÈ›ÙÈ‰·, ÓÂ˘ÌÔÓ›·, ÂÈÛÚfiÊËÛË Í¤-ÓÔ˘ ÛÒÌ·ÙÔ˜, ÈÛÙÔÚÈÎfi Ï·Ú˘ÁÁÔÛÎfiËÛË˜ Î·È ÂÓ‰ÔÙÚ·-¯ÂÈ·Î‹˜ ‰È·ÛˆÏ‹ÓˆÛË˜, ¯ÚfiÓÈ· ·fiÊÚ·ÍË ÙˆÓ ·ÓˆÙ¤ÚˆÓ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, ÂÎÂ›Ó· Ô˘ ¤Ï·‚·Ó ÂÚÈÛÛfiÙÂÚÂ˜ ÙË˜Ì›·˜ ÊÔÚ¿˜ ıÂÚ·Â›· ÌÂ ÓÂÊÂÏÔÔÈËÌ¤ÓË LE, ÂÎÂ›Ó· Ô˘Â›¯·Ó Û˘¯Ó¤˜ ÓÔÛËÏÂ›Â˜ ÛÙ· ÓÔÛÔÎÔÌÂ›· Î·Ù¿ ÙÔ ÚfiÛÊ·-ÙÔ ·ÚÂÏıfiÓ, ÂÎÂ›Ó· Ô˘ ÂÏ¿Ì‚·Ó·Ó ıÂÚ·Â›· ÌÂ ‚-‰ÈÂ-Á¤ÚÙÂ˜ Î·È ÂÎÂ›Ó· Ô˘ ‹Û·Ó ˘fi ıÂÚ·Â›· ÌÂ ÎÔÚÙÈÎÔÛÙÂ-ÚÔÂÈ‰‹ ÙÈ˜ ÚÔËÁÔ‡ÌÂÓÂ˜ 24 ÒÚÂ˜. ∏ ÎÏÈÓÈÎ‹ Ì·˜ ‹Ù·Ó ËÌfiÓË ÂÊËÌÂÚÂ‡Ô˘Û· ·È‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹ Â› 24ÒÚÔ˘ ‚¿-ÛÂˆ˜ Î·È Î¿Ï˘ÙÂ Ù· ·È‰È·ÙÚÈÎ¿ ÂÚÈÛÙ·ÙÈÎ¿ ÌÈ·˜ ÂÚÈÔ-¯‹˜ ÂÚ›Ô˘ 2,5 ÂÎ·ÙÔÌÌ˘Ú›ˆÓ Î·ÙÔ›ÎˆÓ.

∏ ‰ÈÂÍ·ÁˆÁ‹ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ÂÁÎÚ›ıËÎÂ ·fi ÙËÓ∂ÈÙÚÔ‹ ¶·È‰È·ÙÚÈÎ‹˜ ŒÚÂ˘Ó·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ Ì·˜.

√ ‚·ıÌfi˜ ‰‡ÛÓÔÈ·˜ (µ¢) ÙÔ˘ croup (croupscore)˘ÔÏÔÁ›ÛÙËÎÂ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ÙÚÔÔÔÈËÌ¤ÓÔ Û¯‹Ì·Î·Ù¿ Downes Î·È Raphaly (8) (¶›Ó·Î·˜ 1), ÙÔ ÔÔ›Ô ÂÎÙÈÌ¿5 ÎÏÈÓÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜, ÔÈ ÔÔ›Â˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ‚·ı-Ìfi ·fiÊÚ·ÍË˜ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Ô‰ÒÓ. °È·Î·Ï‡ÙÂÚË ·ÓÙÈÎÂÈÌÂÓÈÎfiÙËÙ·, Ë ·Ú¿ÌÂÙÚÔ˜ ÙË˜ Î˘¿Óˆ-ÛË˜ ÙÚÔÔÔÈ‹ıËÎÂ Î·È ÔÚ›ÛÙËÎÂ Û·Ó SO2 <95%. ∏ ‰È·-‚¿ıÌÈÛË ÙÔ˘ µ¢ Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 0 Î·È 10, fiÔ˘ 10 ˘Ô-‰ÂÈÎÓ‡ÂÈ ÙË ‚·Ú‡ÙÂÚË Î·Ù¿ÛÙ·ÛË. ÃÚËÛÈÌÔÔÈ‹Û·ÌÂ ÙÔµ¢≥6 ÁÈ· ·ÛıÂÓÂ›˜ ÌÂ Ì¤ÙÚÈÔ-‚·Ú‡ croup.

OÈ ·ÛıÂÓÂ›˜ ¯ˆÚ›ÛıËÎ·Ó Ù˘¯·›· ÛÂ ÙÚÂÈ˜ ÔÌ¿‰Â˜: √Ì¿‰· ∞: ¡ÂÊÂÏÔÔÈËÌ¤ÓË LE 1/1000 (1amp:1ml/1mg)

ÛÂ ‰fiÛË 5 ml. √Ì¿‰· µ: ¢ÂÍ·ÌÂı·˙fiÓË (¢ª) 0,6 mg/kg B™, ∂ª(max 8

mg)

√Ì¿‰· °: ∞ÂÚÔÔÈËÌ¤ÓË ¢¶ª, 200 mcg ÌÂ ·ÂÚÔı¿Ï·ÌÔ.∏ ÛÎ¤„Ë ÁÈ· ¯ÔÚ‹ÁËÛË ·ÂÚÔÔÈËÌ¤ÓË˜ ¢¶ª ‚·Û›ÛÙË-

ÎÂ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Â›Ó·È ÔÈÎÔÓÔÌÈÎ¿ ÊıËÓfiÙÂÚË ·fi ¿ÏÏ·ÛÎÂ˘¿ÛÌ·Ù·, Â›Ó·È ‰È·ı¤ÛÈÌË ·ÁÎfiÛÌÈ·, fiˆ˜ Î·È ÛÙË¯ÒÚ· Ì·˜ Î·È ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› Î·È ÛÙÔ Û›ÙÈ ÙÔ˘·ÛıÂÓÔ‡˜ ÌÂ ÂÈ‰ÈÎ¤˜ Û˘ÛÎÂ˘¤˜ (.¯ ·ÂÚÔı¿Ï·ÌÔÈ) (19,25).∏ ÚÔ‹ ÔÍ˘ÁfiÓÔ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÙË ÓÂÊÂÏÔÔ›-ËÛË ÙË˜ LE ‹Ù·Ó 4-5 L/min Î·È Ë ‰È¿ÚÎÂÈ· 5-10min. ∏ ¢¶ª¯ÔÚËÁ‹ıËÎÂ ÌÂ Û˘ÛÎÂ˘‹ ·ÂÚÔı·Ï¿ÌÔ˘, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜˘Ô‰Â›ÍÂÈ˜ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡. ∂ÎÙÈÌ‹ıËÎ·Ó ÔÈ ·Ú¿-ÌÂÙÚÔÈ: ‚·ıÌfi˜ ‰‡ÛÓÔÈ·˜ (µ¢),Î·Ú‰È·Î¤˜ ÛÊ‡ÍÂÈ˜ (∫™),·ÚÈıÌfi˜ ·Ó·ÓÔÒÓ (∞∞), ·ÚÙËÚÈ·Î‹ ›ÂÛË (∞¶), Î·È Ô ÎÔ-ÚÂÛÌfi˜ ÔÍ˘·ÈÌÔÛÊ·ÈÚ›ÓË˜ (SO2). H ÂÍ¤Ù·ÛË ÙˆÓ ·Ú·Ì¤-ÙÚˆÓ ·˘ÙÒÓ ¤ÁÈÓÂ ÛÙÔ˘˜ ¯ÚfiÓÔ˘˜ 0, ‰ËÏ. ÚÈÓ ÙËÓ ¤Ó·ÚÍËÙË˜ ıÂÚ·Â›·˜, Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÛÙ· 15, 30, 60, 90 Î·È120 ÏÂÙ¿ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË. ¶·Ú¿ÏÏËÏ·, ÁÈÓfiÓÙ·Ó Û˘ÓÂ-¯Ò˜ Î·Ù·ÁÚ·Ê‹ ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È ÙˆÓ ·ÚÂ-ÓÂÚÁÂÈÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ˘˜ ÚÔ·Ó·ÊÂÚı¤ÓÙÂ˜ ¯Úfi-ÓÔ˘˜. ∞Ó Ô µ¢ ‰ÂÓ ‚ÂÏÙÈˆÓfiÙ·Ó Î·Ù¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ‚·ı-ÌÔ‡˜, Ô ·ÛıÂÓ‹˜ ıÂˆÚÂ›ÙÔ ıÂÚ·Â˘ÙÈÎ‹ ·ÔÙ˘¯›· Î·È ÂÈ-Û·ÁfiÙ·Ó ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ÁÈ· ¯ÔÚ‹ÁËÛË ÙË˜ Û˘ÓËıÈÛÌ¤-ÓË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜. ∞ÎÙÈÓÔÁÚ·Ê›Â˜ ·˘¯ÂÓÈÎ‹˜ ÌÔ›-Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ıÒÚ·Î· Î·È ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË·›Ì·ÙÔ˜ ‰ÈÂÓÂÚÁÔ‡ÓÙ·Ó ÌfiÓÔ fiÙ·Ó ˘‹Ú¯·Ó ÎÏÈÓÈÎ¤˜ ÂÓ-‰Â›ÍÂÈ˜ ·ÔÎÏÂÈÛÌÔ‡ ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ˘Â‡ı˘ÓˆÓ ÙË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜.

∆ÔÓ Î¿ıÂ ·ÛıÂÓ‹ ÂÎÙÈÌÔ‡ÛÂ Ô ›‰ÈÔ˜ È·ÙÚfi˜ Î·ı’ fiÏË ÙË‰È¿ÚÎÂÈ· ÙˆÓ 2 ˆÚÒÓ ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜. ™˘ÌÏËÚˆ-Ì·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÔÍ˘ÁfiÓÔ˘ ¯ÔÚËÁ‹ıËÎÂ ÛÙ· ·È‰È¿ ÌÂSO2>95%. ªÂÙ¿ ÙÔ ¤Ú·˜ ÙˆÓ 2 ˆÚÒÓ Ù· ·È‰È¿ ·Ô¯ˆ-ÚÔ‡Û·Ó ÁÈ· ÙÔ Û›ÙÈ ÙÔ˘˜, ÂÎÙfi˜ ÂÎÂ›ÓˆÓ Ô˘ ÎÚ›ÓÔÓÙ·ÓÛ·Ó ıÂÚ·Â˘ÙÈÎ¤˜ ·ÔÙ˘¯›Â˜, ÔfiÙÂ ÂÈÛ¿ÁÔÓÙ·Ó ÛÙÔ ¡Ô-ÛÔÎÔÌÂ›Ô ÁÈ· ÂÚ·ÈÙ¤Úˆ ıÂÚ·Â›·. ∑ËÙ‹ıËÎÂ ·fi ÙÔ˘˜·Ô¯ˆÚ‹Û·ÓÙÂ˜ ·ÛıÂÓÂ›˜ Ó· Â·Ó¤ÏıÔ˘Ó ÛÙ· ∂π ÛÂ ÂÚ›-ÙˆÛË ˘ÔÙÚÔ‹˜ ÙË˜ ÓfiÛÔ˘ Ì¤Û· ÛÙÈ˜ ÂfiÌÂÓÂ˜ 24ÒÚÂ˜. ∆· ∂π ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜ ‹Ù·Ó Ù· ÌfiÓ· Ô˘ ÂÊË-Ì¤ÚÂ˘·Ó Â› 24ˆÚÔ˘ ‚¿ÛÂˆ˜ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· fiÏÂ˜ ÔÈıÂÚ·Â˘ÙÈÎ¤˜ ·ÔÙ˘¯›Â˜ ÂÚfiÎÂÈÙÔ Ó· Â·ÓÂÎÙÈÌËıÔ‡Ó·fi ÂÌ¿˜ ÙÔ˘˜ ›‰ÈÔ˘˜.

∏ ·ÓÙ·fiÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ 3 ÔÌ¿‰ˆÓ ÛÙËÓÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ Û˘ÁÎÚ›ıËÎÂ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÈ˜ÌÂÙÚ‹ÛÂÈ˜ ÙÔ˘ µ¢. ∏ Û‡ÁÎÚÈÛË ¤ÁÈÓÂ ÌÂ ÙËÓ Ì¤ıÔ‰Ô∞¡√VA. ∂·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ÌÂÙÚ‹ÛÂÈ˜ ¯ÚËÛÈÌÔÔÈÒ-

µ·ıÌÔÏÔÁ›· ÛÔ‚·ÚfiÙËÙ·˜ ‰‡ÛÓÔÈ·˜*¶·Ú¿ÌÂÙÚÔ˜ 0 1 2∂ÈÛÓÂ˘ÛÙÈÎ¿ Â˘Ú‹Ì·Ù· Ÿ¯È ∆Ú·¯‡ÙËÙ·-ÚfiÁ¯ÔÈ ¶·Ú¿Ù·ÛË™˘ÚÈÁÌfi˜(Stridor) Ÿ¯È ∂ÈÛÓÂ˘ÛÙÈÎfi˜ ∞ÌÊ›¯ÚÔÓÔ˜ µ‹¯·˜ Ÿ¯È ∆Ú·¯‡ ÎÏ¿Ì· ÀÏ·ÎÒ‰Ë˜∂ÈÛÔÏÎ¤˜/∞Ó·¤Ù·ÛË ÚÈÓ. ÙÂÚ. Ÿ¯È ÀÂÚÛÙÂÚÓÈÎ¤˜/¡∞π ÀÂÚÛÙÂÚÓÈÎ¤˜ &

ÌÂÛÔÏÂ‡ÚÈÂ˜/¡∞π∫˘¿ÓˆÛË** Ÿ¯È ™Â ·¤Ú· ™Â F1O2: 0,4***

* ¶ËÁ‹:Downes & Raphaely (18)** √Ú›˙ÂÙ·È ˆ˜ √2sat<95%*** ∫Ï¿ÛÌ· ÂÈÛÓÂfiÌÂÓÔ˘ √2

¶›Ó·Î·˜ 1. µ·ıÌÔÏÔÁ›· ÛÔ‚·ÚfiÙËÙ·˜ ÙÔ˘ ‚·ıÌÔ‡ ‰‡ÛÓÔÈ·˜ (µ¢) Î·Ù¿ Downes & Raphaely (ÙÚÔÔÔÈËÌ¤ÓÔ).

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 61

62


ÓÙ·˜ ÙËÓ ·Ú·¿Óˆ Ì¤ıÔ‰Ô ¤ÁÈÓ·Ó ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Û˘-ÁÎÚÈıÔ‡Ó Î·È ÔÈ ˘fiÏÔÈÂ˜ ·Ú¿ÌÂÙÚÔÈ (∞∞, ∫™, ∞¶, SO2)ÌÂÙ·Í‡ ÙˆÓ 3 ÔÌ¿‰ˆÓ. ∏ ÛÙ·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿¤ÁÈÓÂ ÌÂ ƒ<0,05.

∞ÔÙÂÏ¤ÛÌ·Ù·∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ·ÔÙ¤ÏÂÛ·Ó 62 ·ÛıÂ-

ÓÂ›˜. √È ıÂÚ·Â˘ÙÈÎ¤˜ ÔÌ¿‰Â˜ ‹Û·Ó ÔÌÔÈÔÁÂÓÂ›˜ ˆ˜ÚÔ˜ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ Î·È ÙË Û˘ÌÙˆÌ·ÙÔÏÔÁ›·. ∏ÌfiÓË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ Ô˘ ‰È·ÈÛÙÒıËÎÂ ÌÂÙ·Í‡ÙˆÓ 3 ÔÌ¿‰ˆÓ ‹Ù·Ó ·˘Ù‹ ÙÔ˘ ‚·ıÌÔ‡ ‰‡ÛÓÔÈ·˜ (µ¢)ÚÔ ÙË˜ ıÂÚ·Â›·˜ ÛÙËÓ ÔÌ¿‰· µ (‰ÂÍ·ÌÂı·˙fiÓË˜),Ô ÔÔ›Ô˜ ‹Ù·Ó ÂÏ·ÊÚÒ˜ ˘„ËÏfiÙÂÚÔ˜ ÙË˜ ÔÌ¿‰·˜ ∞(·‰ÚÂÓ·Ï›ÓË˜).(Ã: 5,89 vs 5,13, P<0,05) (¶›Ó·Î·˜ 2).¢È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙÔ˘ µ¢ Î·È ÛÙÈ˜ 3ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔ ¤Ú·˜ ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔÏÔ‡ıË-ÛË˜. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â¤ÛÙÚÂ„Â ÛÙÔ ∂π ÙËÓ ›‰È·Ì¤Ú· (∂ÈÎfiÓ· 1).

∏ ÔÌ¿‰· ÙË˜ LE ·ÚÔ˘Û›·ÛÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏ-Ù›ˆÛË ÛÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜ µ¢, ∫™ Î·È ∞∞ ÛÂ Û¯¤ÛËÌÂ ÙÈ˜ ¿ÏÏÂ˜ 2 ÔÌ¿‰Â˜. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ, ˆÛÙfi-ÛÔ, ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙÈ˜ ÌÂÙÚËıÂ›ÛÂ˜ ·Ú·Ì¤-

ÙÚÔ˘˜ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ÙË˜ ¢ª Î·È ÙË˜ ¢¶ª. ™˘˙‹ÙËÛË

∏ ÔÍÂ›· Ï·Ú˘ÁÁ›ÙÈ‰· (Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›-ÙÈ‰·) ‹ ÈÔÁÂÓ¤˜ croup ‹ croup Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ·È-Ù›· ÔÍÂ›·˜ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·Ó·ÓÂ˘ÛÙÈ-ÎÒÓ Ô‰ÒÓ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 6 ÌËÓÒÓ ¤ˆ˜ 6ÂÙÒÓ(1). ∏ ¯Ú‹ÛË ÓÂÊÂÏÔÔÈËÌ¤ÓË˜ LE ¤¯ÂÈ ·Ô-‰ÂÈ¯ıÂ› fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈÎ¿ ÙË ‚·Ú‡ÙËÙ· ÙË˜ÓfiÛÔ˘, ˆÛÙfiÛÔ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙË˜ ÂÚÈÔ-Ú›˙ÂÙ·È ÛÙÈ˜ ÂfiÌÂÓÂ˜ 2 ÒÚÂ˜ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ÙË˜. ∏ ¯ÔÚ‹ÁËÛË ÌÈ·˜ ÂÊ¿·Í ∂.ª ‰fiÛË˜ ¢ª ÛÂÂÍˆÓÔÛÔÎÔÌÂÈ·ÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ÔÍÂ›· §∆µ ÂÏ·Ù-ÙÒÓÂÈ ÙË ‚·Ú‡ÙËÙ· Î·È ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓfiÛÔ˘(15).™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ÂÏ¿ÙÙˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ‚·Ú‡ÙËÙ·˜ ÙÔ˘ croup ÛÂfiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·È ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. ∞ÓÎ·È ÔÈ ‰È·ÊÔÚ¤˜ ÛÙÈ˜ ÙÈÌ¤˜ ı· ÌÔÚÔ‡Û·Ó Ó· ÔÊÂ›-ÏÔÓÙ·È ÛÂ ·Ú¿ÁÔÓÙÂ˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙˆÓ Ê·ÚÌ¿-ÎˆÓ, ·˘ÙÔ› ÔÈ ·Ú¿ÁÔÓÙÂ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Î·Ù·-ÓÂÌËıÂ› ÔÌÔÈfiÌÔÚÊ· ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ.

∏ ÛÎ¤„Ë ÁÈ· ¯ÔÚ‹ÁËÛË ·ÂÚÔÔÈËÌ¤ÓË˜ ¢¶ª‚·Û›ÛÙËÎÂ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÌÔÚÊ‹ ·˘Ù‹ ÙÔ˘Ê·ÚÌ¿ÎÔ˘ Î·ÙÂ˘ı‡ÓÂÙ·È ·Ì¤Ûˆ˜ ÛÙÔ fiÚÁ·ÓÔÛÙfi¯Ô˜, ·Ú·Î¿ÌÙÔÓÙ·˜ ÙËÓ ·ÈÌ·ÙÈÎ‹ Î˘ÎÏÔÊÔ-Ú›·, Â›Ó·È ·Ï‹ ÛÙË ¯ÔÚ‹ÁËÛ‹ ÙË˜, ¤¯ÂÈ ¯·ÌËÏfi ÔÈ-ÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ Î·È Â›Ó·È ‰È·ı¤ÛÈÌË ·ÁÎfiÛÌÈ·.

∏ ıÂÚ·Â›· ÌÂ ÂÓ‰ÔÌ˘˚Î‹ ¢ª, Â›¯Â Û·Ó ·ÔÙ¤-ÏÂÛÌ· ÙËÓ ›‰È· ‚ÂÏÙ›ˆÛË ÙÔ˘ µ¢ ÛÂ Û‡ÁÎÚÈÛË ÌÂÙË ıÂÚ·Â›· ÌÂ ·ÂÚÔÔÈËÌ¤ÓË ¢¶ª. ∞Ó Î·È Ë ÎÏÈ-ÓÈÎ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓÛ¯ËÌ¿ÙˆÓ ÌÔÚÂ› Ó· Î·ı˘ÛÙÂÚ‹ÛÂÈ (∂ÈÎfiÓ· 1), Ë¢¶ª ¤¯ÂÈ Ù¤ÙÔÈÔ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, ÒÛÙÂ ÌÈ··Ï‹ ‰fiÛË ÙˆÓ 200 mcg ‹ Î·È ÌÂÁ·Ï‡ÙÂÚË Ó· Â›-Ó·È ·ÚÎÂÙ‹ ÚÔÎÂÈÌ¤ÓÔ˘ Ô ·ÛıÂÓ‹˜ Ó· ÍÂÂÚ¿ÛÂÈÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Î·È Ó· ·ÔÊ‡ÁÂÈ ÙËÓ ÂÓ-‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ÓÔÛËÏÂ›·. ∏ ¢ª ÂÓ‹ÚÁËÛÂ Ù·¯‡-ÙÂÚ· ·’ fi,ÙÈ Ë ¢¶ª. ∞˘Ùfi ÙÔ Â‡ÚËÌ· ‹Ù·Ó ·ÚÔÛ-‰fiÎËÙÔ, Î·ıfiÛÔÓ Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ ¢¶ª ÛÙÔ˘˜ÈÛÙÔ‡˜ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ·˘Í¿ÓÂÈ ÁÚË-ÁÔÚfiÙÂÚ· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛ‹ ÙË˜ ÌÂ ·ÂÚÔı¿Ï·ÌÔ·’ fi,ÙÈ ·˘Í¿ÓÂÈ Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ ¢ª ÌÂÙ¿ ÙËÓ∂ª ¯ÔÚ‹ÁËÛ‹ ÙË˜ (21). øÛÙfiÛÔ, ÙÔ Â‡ÚËÌ· ·˘ÙfiÂ›Ó·È ·›ı·ÓÔ Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓÂ·ÚÎ‹ ÌÂÙ·ÊÔ-Ú¿ ÙË˜ ¢¶ª ÛÙÔ˘˜ ÈÛÙÔ‡˜ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·ÂÚÔ-ÊfiÚˆÓ Ô‰ÒÓ. √È ·ÛıÂÓÂ›˜ ‚Ú›ÛÎÔÓÙ·Ó ˘fi ·˘-ÛÙËÚ‹ ÂÈÙ‹ÚËÛË ·fi ÙÔÓ ıÂÚ¿ÔÓÙ· È·ÙÚfi ÚÔ-ÎÂÈÌ¤ÓÔ˘ Ó· ‰È·ÛÊ·ÏÈÛıÂ› Ë Û˘ÌÌfiÚÊˆÛ‹ ÙÔ˘˜fiÛÔÓ ·ÊÔÚ¿ ÙË ÛˆÛÙ‹ ¯Ú‹ÛË ÙË˜ Û˘ÛÎÂ˘-‹˜(22,23). ¶ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ˘„ËÏfiÙÂ-ÚˆÓ ‰fiÛÂˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ı· ÌÔÚÔ‡ÛÂ Ó· ÂÈ-Ê¤ÚÂÈ Ù·¯‡ÙÂÚ· Î·È Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù·. ∂›-Ó·È ·Ô‰Â‰ÂÈÁÌ¤ÓÔ fiÙÈ Ë ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ·ÙÔ˘ ÂÈÛÓÂfiÌÂÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·Ì¤ÓÂÈ ÛÙ· ÙÔÈ-

¶›Ó·Î·˜ 2. ¢ËÌÔÁÚ·ÊÈÎfi ÚÔÊ›Ï* ·ÛıÂÓÒÓ.

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ √Ì¿‰· ∞ √Ì¿‰· µ √Ì¿‰· °ª¤ÛË ËÏÈÎ›·(¯Ú) 2,6 3,2 3,4º‡ÏÏÔ(∞/∫) 20:3 11:8 13:7ª¤ÛË ÙÈÌ‹ µ¢ ÂÈÛfi‰Ô˘ 5,13 5,89** 3,95

* M¤ÛÂ˜ ÙÈÌ¤˜(SD)**P<0,05 ÌfiÓÔ ÌÂÙ·Í‡ ÔÌ¿‰ˆÓ ∞ & µ

L- ∂ÈÓÂÊÚ›ÓË

¢ÂÍ·ÌÂı·˙fiÓË

ªÂÎÏÔÌÂı·˙fiÓË

¢ÂÍ·ÌÂı·˙fiÓË

ªÂÎÏÔÌÂı·˙fiÓË

L- ∂ÈÓÂÊÚ›ÓË

Ãƒ√¡√™(min)

6

5

4

3

2

1

0

µ·

ıÌfi

˜ ¢

‡Û

ÓÔÈ·

˜ (µ

¢)

15 30 60 90 120

∂ÈÎfiÓ· 1. °Ú·ÊÈÎ‹ ·ÂÈÎfiÓÈÛË ÙÔ˘ ‚·ıÌÔ‡ ‰‡ÛÓÔÈ·˜(µ¢) ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ¯ÚfiÓÔ, ∏ ¯ÔÚ‹-ÁËÛË ·ÂÚÔÔÈËÌ¤ÓË˜ ÌÂÎÏÔÌÂı·˙fiÓË˜ ‚ÂÏÙ›ˆÛÂ ÛËÌ·-ÓÙÈÎ¿ ÙÔ µ¢.

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¯ÒÌ·Ù· ÙˆÓ ·ÂÚÔÊfiÚˆÓ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ·Ó·ÓÂ˘-ÛÙÈÎÔ‡ Î·È ÌfiÓÔ 1-5% ÙË˜ ¯ÔÚËÁÔ‡ÌÂÓË˜ ‰fiÛË˜Êı¿ÓÂÈ ÛÙÔ Î·ÙÒÙÂÚÔ ‚ÚÔÁ¯ÈÎfi ‰¤Ó‰ÚÔ. µÂ‚·›ˆ˜,·˘Ùfi ·ÔÙÂÏÂ› ¤Ó· ÛËÌ·ÓÙÈÎfi ÌÂÈÔÓ¤ÎÙËÌ· ÛÙË ıÂ-Ú·Â›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ¿ÛıÌ·, ·ÏÏ¿ È‰·ÓÈÎfi ÏÂ-ÔÓ¤ÎÙËÌ· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ ÔÍÂ›·§∆µ. ¶Èı·ÓÔÏÔÁÔ‡ÌÂ fiÙÈ Ì›· ÂÊ¿·Í ‰fiÛË ·ÂÚÔ-ÔÈËÌ¤ÓË˜ ¢¶ª, ·ÓÂÍ¿ÚÙËÙ· ÙË˜ ÔÛfiÙËÙ·˜, Â›-Ó·È ÔÏ‡ Î·Ï¿ ·ÓÂÎÙ‹ ·fi ÙÔÓ ·ÛıÂÓ‹, ¯ˆÚ›˜ ·-ÚÂÓ¤ÚÁÂÈÂ˜.

∞Ó Î·È ‰ÂÓ ÌÂÏÂÙ‹Û·ÌÂ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-Ù· ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÙË˜ LE ÌÂ ÙËÓ ¢¶ª, ı· Û˘ÓÈ-ÛÙÔ‡Û·ÌÂ Ë ¢¶ª Ó· ·ÎÔÏÔ˘ıÂ› ÙË ¯ÔÚ‹ÁËÛË ÙË˜LE, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÚÔÏ¿‚Ô˘ÌÂ ÙËÓ ˘ÔÙÚÔ‹ÙË˜ ÓfiÛÔ˘, ÏfiÁˆ ÙË˜ ÂÏ·ÙÙˆÌ¤ÓË˜ ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙËÙ·˜ ÙË˜ LE ÛÂ ‚¿ıÔ˜ ¯ÚfiÓÔ˘. ∏ È‰·ÓÈÎ‹ ‰Ô-ÛÔÏÔÁ›· ÙË˜ ¢¶ª ‹ ¿ÏÏˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔ-ÛÙÂÚÔÂÈ‰ÒÓ ·ÔÌ¤ÓÂÈ Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› ÛÙÔ Ì¤ÏÏÔÓ.

™Â ·˘Ù‹ ÙË ÌÂÏ¤ÙË ‰ÂÓ ·Ú·ÙËÚ‹Û·ÌÂ Î·ÌÈ¿‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Ê·ÚÌ¿ÎˆÓÌÂÙ·Í‡ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ÙË˜ ¢¶ª Î·È ÙË˜¢ª ÌÂ Ì¤ÙÚÈÔ-ÛÔ‚·Úfi croup.

∏ ·ÂÚÔÔÈËÌ¤ÓË ¢¶ª Â›¯Â ÂÚÈÔÚÈÛÌ¤ÓË ‰Ú¿-ÛË Î·Ù¿ Ù· ÚÒÙ· 30 min ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛ‹ ÙË˜,·ÏÏ¿ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ·˘Í‹ıËÎÂ ‚·ıÌÈ-·›· ÙÈ˜ ÂfiÌÂÓÂ˜ ÒÚÂ˜, ÌÈ· ÔÚÂ›· ·ÚfiÌÔÈ· ÙË˜‰ÂÍ·ÌÂı·˙fiÓË˜. ∏ Ù·¯Â›· ¤Ó·ÚÍË ‰Ú¿ÛË˜ ÙË˜ LEÂ›Ó·È ÂÌÊ·Ó‹˜ ·fi ÙÔ ÁÂÁÔÓfi˜ ÙË˜ ¿ÌÂÛË˜ ÌÂ›ˆ-ÛË˜ ÙÔ˘ µ¢ (croupscore) ÛÂ Û¯¤ÛË ÌÂ ÚÈÓ ÙËÓ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ÙÔ˘ ˘„ËÏÔ‡ ÎÔÚÂÛÌÔ‡ÙË˜ ÔÍ˘·ÈÌÔÛÊ·ÈÚ›ÓË˜ (SO2) ÌÂÙ¿ 30 min. ∏ ÌÂÁ·-Ï‡ÙÂÚË ÎÏÈÓÈÎ‹ ‚ÂÏÙ›ˆÛË, fiˆ˜ ·˘Ù‹ ÌÂÙÚ‹ıËÎÂÌÂ ÙËÓ ÙÒÛË ÙÔ˘ Ì¤ÛÔ˘ ÔÏÈÎÔ‡ µ¢, ÛËÌÂÈÒıËÎÂ2 ÒÚÂ˜ ÌÂÙ¿ Î·È ÁÈ· ÙÈ˜ 3 ÔÌ¿‰Â˜ ÚÈÓ ·ÔÊ·ÛÈ-ÛıÂ› Ë ÂÚ·ÈÙ¤Úˆ Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ-ÎÔÛÙÂÚÔÂÈ‰ÒÓ. ¶Èı·ÓÔÏÔÁÂ›Ù·È ˆÛÙfiÛÔ, fiÙÈ ·˘ÙÔ‡ÙÔ˘ Â›‰Ô˘˜ Ë ıÂÚ·Â›· ÂÓ‰¤¯ÂÙ·È Ó· ÌËÓ ¤¯ÂÈ ÂÈ-Ê¤ÚÂÈ Î·ÌÈ¿ ·ÔÏ‡Ùˆ˜ ÙÚÔÔÔ›ËÛË ÛÙËÓ ÔÚÂ›·ÙË˜ ÓfiÛÔ˘. ∞˘Ù‹ Ë ˘fiıÂÛË ‰ÂÓ ÌÔÚÂ› Ó· ÙÂÎÌË-ÚÈˆıÂ› ÏfiÁˆ ¤ÏÏÂÈ„Ë˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÌÂÙ·Í‡ÙˆÓ ÙÚÈÒÓ ıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ÛÂ ÔÔÈÔ‰‹-ÔÙÂ ÛÙ¿‰ÈÔ ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜. ∏ ÚÔÛı‹ÎËÌÈ·˜ ÔÌ¿‰·˜ placebo ı· ÌÔÚÔ‡ÛÂ Ó· ‰È·ÏÂ˘Î¿-ÓÂÈ ÙËÓ ·¿ÓÙËÛË. øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È ËıÈÎ¿ ·Ô-‰ÂÎÙfi Ó· ¯ÔÚËÁËıÂ› ıÂÚ·Â›· placebo ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÌÂÙÚ›Ô˘-ÛÔ‚·Ú‹˜ ‚·Ú‡ÙËÙ·˜ croup. H ÌÂÏ¤ÙË Ì·˜, ·Ó Î·È ÌÈÎÚ‹ ÛÙÔ Ì¤ÁÂıfi˜ ÙË˜, Â›Ó·ÈË ÚÒÙË Ô˘ ı¤ÙÂÈ ÙÔ ÂÚÒÙËÌ·, ·Ó ÔÈ ·ÂÚÔÔÈË-Ì¤ÓÂ˜ ÌÔÚÊ¤˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÌÔÚÔ‡Ó Ó·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÛÙË ‚·ÛÈÎ‹ ıÂÚ·Â›· ÂÍˆÓÔÛÔ-ÎÔÌÂÈ·ÎÒÓ ·ÛıÂÓÒÓ ÌÂ ÌÂÙÚ›Ô˘-‚·Ú¤ˆ˜ ‚·ıÌÔ‡§∆µ. ∞Ô‰Â›¯ıËÎÂ fiÙÈ ÌÈ· ÂÊ¿·Í ‰fiÛË ·ÂÚÔÔÈ-

ËÌ¤ÓË˜ ¢¶ª 200 mcg Â·ÚÎÂ› Î·È ‰ÂÓ ˘¿Ú¯ÂÈÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂÙ·Í‡ÙˆÓ 2 ÔÌ¿‰ˆÓ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ (¢ª-¢¶ª)fiˆ˜ ·˘Ù‹ ÚÔÎ‡ÙÂÈ ·fi ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜ ÙˆÓ ·-Ú·Ì¤ÙÚˆÓ µ¢, ∞∞, ∫™ Î·È SO2 . ™ÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË Ù· Â˘Ú‹Ì·Ù· ÙË˜ ÛÙ·ıÂÚ‹˜‚ÂÏÙ›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÔÍÂ›· §∆µ ÌÂÙ¿ ·fi¯ÔÚ‹ÁËÛË ·ÂÚÔÔÈËÌ¤ÓË˜ ¢¶ª ¤¯ÂÈ Ù· ·ÎfiÏÔ˘ı·ÏÂÔÓÂÎÙ‹Ì·Ù·:·) ∂›Ó·È ·Ï‹ ÛÙË ¯Ú‹ÛË Î·È ‰È·ı¤ÛÈÌË ·ÁÎfi-

ÛÌÈ·, fiˆ˜ Î·È ÛÙË ¯ÒÚ· Ì·˜. ‚) ¢ÂÓ ··ÈÙÂ› ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi ÁÈ· ÙË

¯ÔÚ‹ÁËÛ‹ ÙË˜. Á) ∂›Ó·È ·ÓÒ‰˘ÓË ÁÈ· ÙÔÓ ·ÛıÂÓ‹.‰) ªÔÚÂ› Ó· ¯ÔÚËÁËıÂ› ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÛıÂÓÔ‡˜. Â) Œ¯ÂÈ ÂÏ¿¯ÈÛÙË ‹ Î·ÌÈ¿ „˘¯ÔÏÔÁÈÎ‹ ÂÈ‚¿Ú˘Ó-

ÛË ÁÈ· ÙÔ ·È‰›. ÛÙ) Œ¯ÂÈ ¯·ÌËÏfi ÎfiÛÙÔ˜.

∏ ÂÍ·ÎÚ›‚ˆÛË ÙË˜ È‰·ÓÈÎ‹˜ ‰ÔÛÔÏÔÁ›·˜ Î·È Ë¯Ú‹ÛË Î·È ¿ÏÏˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÙÔÈÎÒÓ ÛÙÂÚÔÂÈ-‰ÒÓ ÌÂ ÙÔÓ ›‰ÈÔ ÙÚfiÔ ¯ÔÚ‹ÁËÛË˜, ÌÔÚÂ› Ó· Î·-ıÈÂÚÒÛÂÈ ¤Ó· Î·ÈÓÔ‡ÚÁÈÔ ıÂÚ·Â˘ÙÈÎfi Û¯‹Ì·, ‰ËÌÈ-Ô˘ÚÁÒÓÙ·˜ Ó¤Â˜ ÚÔÔÙÈÎ¤˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË·È‰ÈÒÓ ÌÂ ‹ÈÔ-Ì¤ÙÚÈÔ Î·È Ì¤ÙÚÈÔ-‚·Ú‡ croup ÛÙÔÛ›ÙÈ ÙÔ˘˜. À„ËÏfiÙÂÚÂ˜ ‰fiÛÂÈ˜ ¢¶ª ı· ÌÔÚÔ‡-Û·Ó ÂÓ‰Â¯ÔÌ¤Óˆ˜, Ó· Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Jaff DM. The treatment of crÔup with glucocorticoids. N

Engl J Med 1998;339:553.2. Fitzqerald D, Melliw C, Johnson M, Allen H, Cooper P, Van

Asperen P. Nebulized budesonide is as effective asnebulized adrenaline in moderately severe croup.Pediatrics 1996;97:722-725.

3. Taussing LM, Castro O, Beaudry PH, Fox WW, Bureau M.Treatment of laryngotracheobronchitis (croup): use ofintermittent positive pressure breathing and racemicepinephrine AJDC 1975;129:790-793.

4. Fogel JM, Berg IZ, Gerer MA, Shorter CB. Racemicepinephrine in the treatment of croup: nebulization aloneversus nebulization with intermittent positive pressurebreathing J Pediatr 1982;101:1028-1031.

5. Waisman Y, Klein BL, Boenning DA, Younp GM,Chamberlain JM, O’Donnell R, Ochsenschlager RW.Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in thetreatment of laryngotr·cheitis (Croup) Pediatrics1992;89:302-306.

6. Kristiansson S, Berg-Kelly, Winso E. Inhalation of racemicadrenaline in the treatment of mild and moderately severecroup. Acta Paediatr 1994;83:1156-1160.

7. Prendergast M, Jones JS, Hartman D. Racemicepinephrine in the treatment of laryngotracheitis: can weidentify children for outpatient therapy? Am J Emerg Med1994;12:613-616.

8. Martenson B, Nilson G, Torbjat J. The effect of corti-

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costeroids in the treatment of pseudo-croup. ActaOtolaryngl Suppl 1969;158:6271.

9. Kairns S, Olmstead EM, O’Connor GT. Steroid treatmentof laryngotracheitis: a meta-analysis of the evidence fromrandomized trials. Pediatrics 1989;83:683-693.

10. Husby S, Agertort L, Mortensen, Pedersen S. Treatment ofcroup with nebulised steroid (budesonide): a doubleblind,placebo controlled study. Arch Dis Child1993;68:352-325.

11. Tibbals J, Shann FA, Landau LI. Placebo-controlled trial ofprednisolone in children incubated for croup. Lancet1992;340:745-748.

12. Super DM, Cartelli NA, Brooks LJ, Lembo RM, Kumar ML.A prospective randomized double-blind study to evaluatethe effect of dexamethasone in acute laryngotracheitis. J Pediatr 1989;115:323-329.

13. Kuusela AL, Vesikari T. A randomized double-blind,placebo-controlled trial of dexamethasone and racemicepinephrine in the treatment of croup. Acta PaediatrScand 1988;77:99-104.

14. Klassen TP, Feldam ME, Watters LK, Sutclife T, Rowe PC,et al. Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med 1994;331:285-289.

15. Johnson DW, Jacobson S, Edney PC, Hadfield P, MundyME, Schuh S. A comparison of nebulized budesonide,intramuscular dexamethasone, and placebo formoderately severe croup. N Engl J.Med 1998;339:498-503.

16. Klassen TP, Watters LK, Feldman ME, Sutcliffet RW*,Rowe PC. The efficacy of nebulized budesonide indexamethasone-treated outpatients with croup. Pediatrics

1998;97:463-466.17. Geelhoed C. Croup. Pediatr Pulmonol 1997;23:370-374.18. Downes JJ, Raphaely RC. Pediatric intensive care.

Anesthesiology 1975;43:238-250.19. Freelander M, Van Asperen PP. Nebulizer versus spacer in

children with acute asthma Br Med J 1984;288:1873-1874.20. O’Callaghan C, Milner AD, Swarbrick A. Spacer device

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25. Newhouse MT, Dolovich MB. Control of asthma byaerosols. N Engl J Med 1986;315:870-874.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙË˜ ™Ù·ÌÔ‡ÏË˜ ∫.À. ™ÎÈ¿ıÔ˘ 37002 ™ÎÈ¿ıÔ˜

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�¶ÂÚ›ÏË„Ë: √È ‰È·Ù·Ú·¯¤˜ ıÚ¤„Ë˜ ÛÙËÓ Î˘ÛÙÈÎ‹›ÓˆÛË ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÍˆÎÚÈÓÔ‡˜ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜. ™ÙÔÓ ÔÚfi 41 ·ÛıÂÓÒÓ ÌÂÎ˘ÛÙÈÎ‹ ›ÓˆÛË Î·È ·ÁÎÚÂ·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ËÏÈÎ›·˜8 ˆ˜ 32 ¯ÚfiÓˆÓ, ÌÂÙÚ‹ıËÎ·Ó Ù· Â›Â‰· ÙÔ˘ „Â˘-‰·ÚÁ‡ÚÔ˘ Î·È ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ ∞ Î·È ∂. √È ·ÛıÂÓÂ›˜ÂÏ¿Ì‚·Ó·Ó ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ 150% ÙˆÓ ··ÈÙÔ‡-ÌÂÓˆÓ ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ Î·È 300% ÙˆÓ ·Ó·ÁÎÒÓÙÔ˘˜ ÛÂ ‚ÈÙ·Ì›ÓÂ˜ ∞ Î·È ∂, 6000 IU (1800Ìg) Î·È100mg, ·ÓÙ›ÛÙÔÈ¯·. ªÂÏÂÙ‹ıËÎ·Ó ÔÈ ›‰ÈÔÈ ·Ú¿ÁÔ-ÓÙÂ˜ ÛÂ 41 ·ÛıÂÓÂ›˜ ÌÂ ÎÔÈÏÈÔÎ¿ÎË, ÛÂ ‰›·ÈÙ· ÂÏÂ‡-ıÂÚË ÁÏÔ˘Ù¤ÓË˜ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔ-ÁfiÓÔ, Î·ıÒ˜ Â›ÛË˜ Î·È 41 ˘ÁÈ‹ ·È‰È¿ ·ÓÙ›ÛÙÔÈ¯Ë˜ËÏÈÎ›·˜. ∆· Â›Â‰· ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ Î·È ÙË˜ ‚ÈÙ·-Ì›ÓË˜ ∂ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿ (1,21±0,22 Î·È 10,7±4,0 mg/L,·ÓÙ›ÛÙÔÈ¯·) ·ÏÏ¿ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ·˘Ù¿ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎË (1,02±0,10Î·È 7,6±3,0 mg/L, ·ÓÙ›ÛÙÔÈ¯·) Î·È ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ(0,94±0,12 Î·È 10,9±5,0, ·ÓÙ›ÛÙÔÈ¯·). ∞ÓÙ›ıÂÙ·, Ù·Â›Â‰· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Î˘ÛÙÈÎ‹›ÓˆÛË (0,30±0,09 mg/L) ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂ-Ú· ÛÂ Û‡ÁÎÚÈÛË ÙfiÛÔ ÌÂ Ù· Â›Â‰· ÙˆÓ ·ÛıÂÓÒÓ ÌÂÎÔÈÏÈÔÎ¿ÎË (0,39±0,16 mg/L), fiÛÔ Î·È ÌÂ Ù· Â›Â‰·ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ (0,56±0,16 mg/L). ∏ ıÂÚ·Â›·˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì·, 6000 IU(1800 Ìg) ‚ÈÙ·Ì›ÓË˜ ∞ Î·È 100 mg ‚ÈÙ·Ì›ÓË˜ ∂ Û¯ÂÙ›-˙ÂÙ·È ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· „Â˘‰·ÚÁ‡ÚÔ˘ Î·È ÙË˜

�Abstract: Malnutrition in cystic fibrosis isassociated with exocrine pancreatic insufficiency.We measured serum zinc and vitamins A and E inthe serum of 41 patients (age range: 8-32 years)with cystic fibrosis and exocrine pancreaticinsufficiency. The patients were on a closelymonitored pancreatic enzyme replacementtherapy and a diet providing 150% of daily require-ments and 300% of vitamins A and E requirements(6000 IU or 1800 Ìg and 100 mg, respectively).Similar measurements were performed in 41patients with celiac disease (matched for age) whowere on gluten free diet and had a normalintestinal morphology, documented by biopsy, aswell as in 41 normal individuals matched for agewho served as controls. Serum zinc and vitamin Elevels were normal in the cystic fibrosis group(1.21±0.22 and 10.7±4.0 mg/L, respectively) butsignificantly higher compared to the celiac diseasegroup (1.02±0.10 and 7.6±3.0 mg/L, respectively)and to normal controls (0.94±0.12 and 10.9±5.0,respectively). However, vitamin A serum concen-tration was low in cystic fibrosis (0.30±0.09 mg/L)and significantly lower in comparison to that in thegroup with celiac disease (0.39±0.16 mg/L) andthe group of normal children (0.55±0.16 mg/L).Adequate supplementation with pancreaticenzymes, 6000 IU (1800Ìg) of vitamin A and 100mg

∂›Â‰· ‚ÈÙ·ÌÈÓÒÓ ∞ Î·È ∂ ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË ÛÂ ıÂÚ·Â›·˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì· Î·È ÏÈÔ‰È·Ï˘Ù¤˜ ‚ÈÙ·Ì›ÓÂ˜

Serum vitamin A and E levels in cystic fibrosis patients supplemented with pancreatic enzymesand liposoluble vitaminsS. Nousia-Arvanitakis1, A. Galli-Tsinopoulou2, N. RÔubies3, K. Tentzidou4, M. Xefteri4

1 ∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈÎ‹˜-°·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£

2 ¶·È‰›·ÙÚÔ˜, EÈÌÂÏ‹ÙÚÈ· ∂™À ¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£

3 ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜, ∂ÚÁ·ÛÙ‹ÚÈÔ ∫ÏÈÓÈÎ‹˜ ¢È·ÁÓˆÛÙÈÎ‹˜ Î·È ¶ÚÔ·È‰Â˘ÙÈÎ‹˜ ¶·ıÔÏÔÁ›·˜, ∆Ì‹Ì· ∫ÙËÓÈ·ÙÚÈÎ‹˜ ∞¶£

4 ¶·È‰›·ÙÚÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜, ¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£

1 Assoc. Professor of Pediatric Gastroenterology4th Pediatric Clinic, Aristotelion University of Thessaloniki

2 Staff Pediatrician, Register 4th Pediatric ClinicAristotelion University of Thessaloniki

3 Assistant Professor, Division of Veterinary MedicineLaboratories of Clinical Diagnostic and Academic PathologyAristotelion University of Thessaloniki

4 Pediatrician, Scientific Collaborator, 4th DepartmentAristotelion University of Thessaloniki


™. ¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË1, ∞. °·ÏÏ‹-∆ÛÈÓÔÔ‡ÏÔ˘2, ¡. ƒÔ˘ÌÈ¤˜3, ∫. ∆ÂÓÙ˙›‰Ô˘4, ª. •ÂÊÙ¤ÚË4

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∂ÈÛ·ÁˆÁ‹∞ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÍˆÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·-

ÁÎÚ¤·ÙÔ˜ Î·È ÏËÌÌÂÏ‹˜ ·ÔÚÚfiÊËÛË ÙˆÓ ÏÈÒÓÎ·È ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈÓÒÓ ¯·Ú·ÎÙËÚ›˙ÂÈ 85% ÙˆÓ·ÛıÂÓÒÓ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË (∫π). ∏ ¯ÔÚ‹ÁËÛË ·-ÁÎÚÂ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ‚ÈÙ·ÌÈÓÒÓ Â›Ó·È ·Ó·ÁÎ·›·ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. ¶·Ú¿ ÙË ıÂÚ·Â›· ˘Ô-Î·Ù¿ÛÙ·ÛË˜, ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ¯·ÌË-Ï¿ Â›Â‰· ‚ÈÙ·Ì›ÓË˜ ∞ Î·È ∂ ÛÙÔÓ ÔÚfi ÔÚÈÛÌ¤ÓˆÓ·ÛıÂÓÒÓ ÌÂ ∫π (1,2).

∏ ‚ÈÙ·Ì›ÓË ∞ Â›Ó·È ·ÓÙÈÔÍÂÈ‰ˆÙÈÎfi˜ ·Ú¿ÁÔ-ÓÙ·˜, Ô ÔÔ›Ô˜ ÚÔ¤Ú¯ÂÙ·È ·fi ÚÔÛ¯ËÌ·ÙÈÛÌ¤ÓË‚ÈÙ·Ì›ÓË ∞ Î·È ·fi Î·ÚÔÙ¤ÓÈ·. ∏ ÚÔÛ¯ËÌ·ÙÈÛÌ¤-ÓË ‚ÈÙ·Ì›ÓË ∞ Â›Ó·È ÁÓˆÛÙ‹ ˆ˜ ÚÂÙÈÓfiÏË. ∆· Î·ÚÔ-Ù¤ÓÈ· Â›Ó·È Î·Ù·ÓÂÌËÌ¤Ó· ÛÂ ÌÂÌ‚Ú¿ÓÂ˜, Ì·˙› ÌÂÙË ‚ÈÙ·Ì›ÓË ∂, ¿ÏÏÔÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎfi ·Ú¿ÁÔÓÙ·, ÔÔÔ›Ô˜ Ê·›ÓÂÙ·È fiÙÈ ÚÔÛÙ·ÙÂ‡ÂÈ ÙËÓ ‚ÈÙ·Ì›ÓË ∞·fi ÙËÓ ÔÍÂ›‰ˆÛË (3). √È Ê˘ÛÈÔÏÔÁÈÎ¤˜ ËÌÂÚ‹-ÛÈÂ˜ ·Ó¿ÁÎÂ˜ ÛÂ ‚ÈÙ·Ì›ÓË ∞ Â›Ó·È 2000 IU (600 Ìg).™ÙËÓ ∫π, Û˘ÓÈÛÙ¿Ù·È ËÌÂÚ‹ÛÈ· ‰fiÛË 5000 ¤ˆ˜10000 IU (1200-3000 Ìg) ‚ÈÙ·Ì›ÓË˜ ∞ ÛÂ ·ÛıÂÓÂ›˜ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 8 ¯ÚfiÓˆÓ (4-6). ∏ ‚ÈÙ·-Ì›ÓË ∂ (·-ÙÔÎÔÊÂÚfiÏË) Â›Ó·È ·ÓÙÈÔÍÂÈ‰ˆÙÈÎfi˜ ·-Ú¿ÁÔÓÙ·˜, Ô ÔÔ›Ô˜ ÚÔÛÙ·ÙÂ‡ÂÈ ÙÈ˜ ÌÂÌ‚Ú¿ÓÂ˜·fi ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙËÓ ÔÔ›· ÂÈÊ¤ÚÔ˘Ó ÔÈÂÏÂ‡ıÂÚÂ˜ ÔÍÂÈ‰ˆÙÈÎ¤˜ Ú›˙Â˜. ∏ ·-ÙÔÎÔÊÂÚfiÏËÛ˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÓÙÂÚÈÎ‹ ·ÔÚÚfiÊËÛË ÙˆÓ ·Î¤-Ú·ÈˆÓ ‚-Î·ÚÔÙ¤ÓÈˆÓ Î·È Èı·ÓfiÓ ÙÚÔÔÔÈÂ› ÙË ÌÂ-Ù·ÙÚÔ‹ ÙˆÓ ‚-Î·ÚÔÙ¤ÓÈˆÓ ÛÂ ÚÂÙÈÓfiÏÂ˜ (7). º·›-ÓÂÙ·È fiÙÈ Ë ‚ÈÙ·Ì›ÓË ∂ ¤¯ÂÈ Û˘ÓÂÚÁÈÎ‹ ‰Ú¿ÛË ÌÂ ¿Ï-Ï· ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿ fiˆ˜ ÙÔ ÛÂÏ‹ÓÈÔ, ÙÔ ¯ÚÒÌÈÔ, ÙÔ‚-Î·ÚÔÙ¤ÓÈÔ Î·È ÙË ‚ÈÙ·Ì›ÓË C. ∆· ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿È¯ÓÔÛÙÔÈ¯Â›·, fiˆ˜ ÔÈ ‚ÈÙ·Ì›ÓÂ˜ ∞ Î·È ∂, Ê·›ÓÂÙ·ÈfiÙÈ ·›˙Ô˘Ó ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÚfiÏÔ ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜Î·Ù¿ ÙÈ˜ ÔÔ›Â˜ Ë ·ÂÏÂ˘ı¤ÚˆÛË ÂÏÂ˘ı¤ÚˆÓ ÚÈ-˙ÒÓ ÚÔÎ·ÏÂ› Î·Ù·ÛÙÚÔÊ‹ ÈÛÙÒÓ fiˆ˜ Û˘Ì‚·›ÓÂÈÛÙËÓ ∫π (8). √È ËÌÂÚ‹ÛÈÂ˜ ·Ó¿ÁÎÂ˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜∂ ‰È·Ê¤ÚÔ˘Ó ÌÂ ÙËÓ ËÏÈÎ›· Î·È Î˘Ì·›ÓÔÓÙ·È ·fi 10ˆ˜ 30 mg ËÌÂÚËÛ›ˆ˜ (9). √È ·Ó¿ÁÎÂ˜ ÛÂ ‚ÈÙ·Ì›ÓË∂ Â›Ó·È ·˘ÍËÌ¤ÓÂ˜ ÛÙËÓ ∫π ÏfiÁˆ ÙË˜ ˘ÔÏÂÈfiÌÂ-ÓË˜ ÏËÌÌÂÏÔ‡˜ ·ÔÚÚfiÊËÛË˜, ÌÂÙ¿ ÙË ¯ÔÚ‹ÁË-

ÛË ·ÁÎÚÂ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, È‰È·›ÙÂÚ· fiÙ·Ó Ë ËÌÂ-Ú‹ÛÈ· ÚfiÛÏË„Ë Â›Ó·È ÏÔ‡ÛÈ· ÛÂ ÏÈ›‰È· Î·È Ô-Ï˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·. ™ÙËÓ ∫π Û˘ÓÈÛÙ¿Ù·È ËÌÂ-Ú‹ÛÈ· ‰fiÛË 100 mg ‚ÈÙ·Ì›ÓË˜ ∂, ÌÂ ÙËÓ ÔÔ›· ÂÈ-Ù˘Á¯¿ÓÔÓÙ·È ÈÎ·ÓÔÔÈËÙÈÎ¿ Â›Â‰· ÛÙÔ ·›Ì· (10).

√ „Â˘‰¿ÚÁ˘ÚÔ˜ Â›Ó·È ¤Ó· ÛËÌ·ÓÙÈÎfi È¯ÓÔÛÙÔÈ-¯Â›Ô ÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È ÛÂ ÔÏÏ¿ fiÚÁ·Ó· (‹·Ú,Ì‡Â˜, ÔÛÙ¿, ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹˜) Î·È ÈÛÙÔ‡˜ (ÏÂ˘Î¿Î·È ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ·). ªÈÎÚ‹ ÔÛfiÙËÙ· Â›Ó·È·ÔıËÎÂ˘Ì¤ÓË ÛÙÔ ‹·Ú Î·È ÎÈÓËÙÔÔÈÂ›Ù·È ÛÂ Î·-Ù·ÛÙ¿ÛÂÈ˜ ¤Ó‰ÂÈ·˜. ∞ÔÙÂÏÂ› Û˘ÛÙ·ÙÈÎfi ÔÏÏÒÓ ÂÓ-˙‡ÌˆÓ (Î·Ú‚ÔÍ˘ÂÙÈ‰¿ÛË, ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË,5-ÓÔ˘ÎÏÂÔÙÈ‰¿ÛË). ∏ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÛÙË ‚ÈÔ‰È·ıÂ-ÛÈÌfiÙËÙ· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ Â›Ó·È ÌÈ· ·fi ÙÈ˜ ÏÂÈ-ÙÔ˘ÚÁ›Â˜ ÙÔ˘. ∏ Û˘ÓÈÛÙÒÌÂÓË ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë„Â˘‰·ÚÁ‡ÚÔ˘ Î˘Ì·›ÓÂÙ·È ·fi 5 ˆ˜ 15 mg (11).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÂÍÂÙ¿-ÛÂÈ Ù· Â›Â‰· ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ ∞ Î·È ∂ Î·È ÙÔ˘ ZnÂÈÏÂÁÌ¤ÓË˜ ÔÌ¿‰·˜ ·ÛıÂÓÒÓ ÌÂ ∫π, ÔÈ ÔÔ›ÔÈ ‚Ú›-ÛÎÔÓÙ·Ó ÛÂ ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·ÁÎÚÂ-·ÙÈÎ¿ ¤Ó˙˘Ì·, ÛÂ ‰È·ÙÚÔÊ‹ Ë ÔÔ›· ·ÓÙ·ÔÎÚ›ÓÔ-ÓÙ·Ó ÛÙÔ 150% ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ, ÛÂ 6000IU (1800 Ìg) ‚ÈÙ·Ì›ÓË˜ ∞ Î·È ÛÂ 100 mg ‚ÈÙ·Ì›ÓË˜∂. ∏ ÌÂÏ¤ÙË Û¯Â‰È¿ÛÙËÎÂ Â›ÛË˜, ÌÂ ÛÎÔfi Ó· Á›-ÓÂÈ Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ∫π ÌÂ ÙÈ˜ ÙÈÌ¤˜ ‰‡Ô ÔÌ¿‰ˆÓ Ì·ÚÙ‡ÚˆÓ, ÔÌ¿‰·˜·ÙfiÌˆÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎË ÛÂ ‰È·ÙÚÔÊ‹ ÂÏÂ‡ıÂÚËÁÏÔ˘Ù¤ÓË˜ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔÎ·È ÔÌ¿‰·˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfiÌˆÓ.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ∂ÍÂÙ¿ÛÙËÎ·Ó 41 ·ÛıÂÓÂ›˜ ÌÂ ∫π, ËÏÈÎ›·˜ 8 ˆ˜ 32 ¯Úfi-

ÓˆÓ (25 ·ÁfiÚÈ·, 16 ÎÔÚ›ÙÛÈ·) ÌÂ Û˘ÁÎ¤ÓÙÚˆÛË ¯ÏˆÚÈÔ‡¯ˆÓÈ‰ÚÒÙ· >60meq/L Î·È ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÍˆÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ (·ÁÎÚÂ·ÙÈÎ‹ ÂÏ·ÛÙ¿ÛË ÎÔÚ¿ÓˆÓ<200Ìg/g Î·È Ï›Ô˜ ÎÔÚ¿ÓˆÓ 24ÒÚÔ˘ >4g. §¿Ì‚·Ó·Ó ıÂ-Ú·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì· (6000-8000 ÌÔÓ¿‰Â˜ ÏÈ¿ÛË˜/Kg/µ™ ËÌÂÚËÛ›ˆ˜), ‰›·ÈÙ· Ë ÔÔ›··ÚÂ›¯Â 150% ÙˆÓ ËÌÂÚËÛ›ˆÓ ·Ó·ÁÎÒÓ, 6000 πU (1800Ìg)‚ÈÙ·Ì›ÓË˜ ∞ Î·È 100mg ‚ÈÙ·Ì›ÓË˜ ∂ ËÌÂÚËÛ›ˆ˜. ∏ Û¯¤ÛËÚˆÙÂ˚ÓÒÓ, ÏÈÒÓ Î·È ˘‰·Ù·ÓıÚ¿ÎˆÓ ‹Ù·Ó 20, 40, 40%,·ÓÙ›ÛÙÔÈ¯·. √ ÎÏÈÓÈÎfi˜ ‰Â›ÎÙË˜ Shwachman Î˘Ì·›ÓÔÓÙ·Ó

‚ÈÙ·Ì›ÓË˜ ∂, ·ÏÏ¿ ¯·ÌËÏ¿ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ÛÙÔÓ ÔÚfi·ÛıÂÓÒÓ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË ËÏÈÎ›·˜ >8 ¯ÚfiÓˆÓ. ∞˘ÙfiÛËÌ·›ÓÂÈ fiÙÈ Ë ¯ÔÚËÁÔ‡ÌÂÓË ÔÛfiÙËÙ· ÙË˜ ‚ÈÙ·Ì›ÓË˜∞ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙÈ˜ ··ÈÙ‹ÛÂÈ˜ ·˘ÙÒÓ ÙˆÓ·ÛıÂÓÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Î˘ÛÙÈÎ‹ ›ÓˆÛË, ‚ÈÙ·Ì›ÓË ∞, ‚ÈÙ·Ì›ÓË ∂,„Â˘‰¿ÚÁ˘ÚÔ˜.

of vitamin E is associated with normal serum levelsof zinc and vitamin E but low levels of vitamin A inpatients with cystic fibrosis aged >8 years. This findingindicates that the usual supplementation doses ofvitamin A in this group of CF patients do not fulfill theirdaily requirements.

Key words: cystic fibrosis, zinc, vitamin A, vitamin E.

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·fi 65 Ì¤¯ÚÈ 98 Î·È ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙˆÓ ·ÛıÂÓÒÓ Î˘-Ì·›ÓÔÓÙ·Ó ·fi ÙËÓ ‰¤Î·ÙË ˆ˜ ÙËÓ Â‚‰ÔÌËÎÔÛÙ‹ ¤ÌÙËÂÎ·ÙÔÛÙÈ·›· ı¤ÛË. ∆· Â›Â‰· ÏÂ˘ÎˆÌ·Ù›ÓË˜ ‹Ù·Ó Ê˘ÛÈÔ-ÏÔÁÈÎ¿ (>3,8 g/dl) Î·È Ù· Â›Â‰· ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î˘-Ì·›ÓÔÓÙ·Ó ·fi 120 Ì¤¯ÚÈ 180 mg/dl. ¶¤ÓÙÂ ·ÛıÂÓÂ›˜ Â›¯·ÓË·ÙÈÎ‹ ‚Ï¿‚Ë Î·È ÂÏ¿Ì‚·Ó·Ó ·ÁˆÁ‹ ÌÂ Ô˘ÚÛÔ‰ÂÔÍ˘¯ÔÏÈ-Îfi ÔÍ‡ (UDCA 20mg/Kg/µ™ ËÌÂÚËÛ›ˆ˜).

√Ì¿‰Â˜ Ì·ÚÙ‡ÚˆÓ ·ÔÙ¤ÏÂÛ·Ó 41 ·ÛıÂÓÂ›˜ ÌÂ ÎÔÈÏÈÔ-Î¿ÎË ·ÚfiÌÔÈ·˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘, ÔÈ ÔÔ›ÔÈ ‚Ú›ÛÎÔÓÙ·ÓÛÂ ‰›·ÈÙ· ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË Î·È Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ‚ÏÂÓÓÔÁfi-ÓÔ ÛÙË ‚ÈÔ„›· ÂÓÙ¤ÚÔ˘ Î·È 41 Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ·. ™Â fiÏÔ˘˜ÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜ ¤ÁÈÓÂ ·ÈÌÔÏË„›· ÊÏÂ‚ÈÎÔ‡ ·›-Ì·ÙÔ˜ ÙÔ ÔÔ›Ô ÙÔÔıÂÙ‹ıËÎÂ ÛÂ Á˘¿ÏÈÓ· ÛˆÏËÓ¿ÚÈ· ÁÈ·Ê˘ÁÔÎ¤ÓÙÚËÛË. √ ÔÚfi˜ „‡¯ıËÎÂ ÛÙÔ˘˜ -20ÔC Ì¤¯ÚÈ ÙËÓËÌ¤Ú· ÙÔ˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡. ∏ ÌÂÏ¤ÙË ‰ÈÂÓÂÚÁ‹ıËÎÂ Û‡Ì-ÊˆÓ· ÌÂ ÙË ‰È·Î‹Ú˘ÍË ÙÔ˘ Helsinki.

æÂ˘‰¿ÚÁ˘ÚÔ˜∏ Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ,

ÌÂÙ¿ ·fi ·Ú·›ˆÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÛÂ ·ÔÛÙ·ÁÌ¤ÓÔ ÓÂÚfi(1:4), ÛÂ Ê·ÛÌ·ÙfiÌÂÙÚÔ ·ÙÔÌÈÎ‹˜ ·ÔÚÚfiÊËÛË˜ (PerkinElmer Model 430) (12).

µÈÙ·Ì›ÓË ∞∏ Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ÛÙÔÓ ÔÚfi ÚÔÛ‰ÈÔÚ›-

ÛÙËÎÂ ÌÂ ÙË ¯ÚˆÌ·ÙÔÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô ÙˆÓ Neeld Î·ÈPearson, fiˆ˜ ·˘Ù‹ ÙÚÔÔÔÈ‹ıËÎÂ ·fi ÙÔ˘˜ Roels Î·ÈTrout (13). √ ÔÚfi˜ ıÂÚÌ¿ÓıËÎÂ ÛÙÔ˘˜ 60ÔC ÌÂ ·Èı·ÓÔÏÈÎfi‰È¿Ï˘Ì· ˘‰ÚÔÍÂÈ‰›Ô˘ ÙÔ˘ Î·Ï›Ô˘ 1¡, ÁÈ· ÙËÓ Î·Ù·ÎÚ‹ÌÓÈÛËÙˆÓ ÚˆÙÂ˚ÓÒÓ Î·È ÙËÓ Û·ˆÓÔÔ›ËÛË ÔÚÈÛÌ¤ÓˆÓ ÏÈÈ‰›ˆÓ,Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ÂÛÙ¤ÚˆÓ ÙË˜ ÚÂÙÈÓfiÏË˜(·Ú¿ÁˆÁ· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞). ∏ ÚÂÙÈÓfiÏË, Ë ÔÔ›· ÚÔ‹ÏıÂ·fi ÙÔ˘˜ ÂÛÙ¤ÚÂ˜ ÙË˜ ÚÂÙÈÓfiÏË˜, ·Ú·Ï‹ÊıËÎÂ ÌÂ ÂÎ¯‡ÏÈ-ÛË ÌÂ n- ÂÍ¿ÓÈÔ. √ ‰È·Ï‡ÙË˜ ÂÍ·ÙÌ›ÛÙËÎÂ ÌÂ ÙËÓ Â›‰Ú·ÛËÏÂÙÔ‡ ÚÂ‡Ì·ÙÔ˜ ·˙ÒÙÔ˘ Î·È ÙÔ ˘fiÏÔÈÔ ‰È·Ï‡ıËÎÂ ÛÂ¯ÏˆÚÔÊfiÚÌÈÔ. ªÂÙ¿ ·fi ·ÓÙ›‰Ú·ÛË ·˘ÙÔ‡ ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ÌÂ ÙÚÈÊıÔÚÔÍÈÎfi ÔÍ‡, Ë ·ÔÚÚfiÊËÛË ÙÔ˘ ¯ÚÒÌ·ÙÔ˜ ÌÂ-ÙÚ‹ıËÎÂ ÛÙ· 620 nm (Ê·ÛÌ·ÙÔÊˆÙfiÌÂÙÚÔ Hitachi 2000)ÁÈ· ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞.

µÈÙ·Ì›ÓË ∂∏ ‚ÈÙ·Ì›ÓË ∂ (·-ÙÔÎÔÊÂÚfiÏË) ÛÙÔÓ ÔÚfi ÚÔÛ‰ÈÔÚ›ÛÙË-

ÎÂ ÌÂ ÙË ÊıÔÚÈÛÌÔÊˆÙÔÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô ÙˆÓ Hansen Î·ÈWarwick (14). √È ÙÔÎÔÊÂÚfiÏÂ˜ ·Ú·Ï·Ì‚¿ÓÔÓÙ·Ó ·fi ÙÔÓÔÚfi ÌÂ ÂÎ¯‡ÏÈÛË ÌÂ n- ÂÍ¿ÓÈÔ, ÌÂÙ¿ ·fi Î·Ù·ÎÚ‹ÌÓÈÛË ÙˆÓÚˆÙÂ˚ÓÒÓ ÌÂ ·Èı·ÓfiÏË. √ ÊıÔÚÈÛÌfi˜ ÙÔ˘ ‰È·Ï‡ÙË ÌÂ-ÙÚÈfiÙ·Ó ÛÂ ∂Ã 295 nm Î·È ∂ª 340 nm ÌÂ Ê·ÛÌ·ÙÔÊıÔÚÈ-ÛÌfiÌÂÙÚÔ Hitachi Model F-2000.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË√È ÙÈÌ¤˜ ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘, ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ Î·È ∂ Û˘-

ÁÎÚ›ıËÎ·Ó ÌÂ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ (t-student’stest).

∞ÔÙÂÏ¤ÛÌ·Ù·∆· Â›Â‰· ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ ÛÙÔÓ ÔÚfi ÙˆÓ

˘ÁÈÒÓ ·ÙfiÌˆÓ Î˘Ì¿ÓıËÎ·Ó ·fi 0,70 Ì¤¯ÚÈ 1,15mg/L ÌÂ Ì¤ÛË ÙÈÌ‹ Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË0,94±0,12mg/L. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π, ÔÈ ÙÈÌ¤˜ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ Î˘Ì¿ÓıËÎ·Ó ·fi 0,75 Ì¤¯ÚÈ

1,70 (1,21±0,22) mg/L Î·È ÛÙËÓ ÔÌ¿‰· ÙË˜ ∫ÔÈ-ÏÈÔÎ¿ÎË˜ ·fi 0,82 Ì¤¯ÚÈ 1,20 (1,02±0,10) mg/L.√È ÙÈÌ¤˜ ‹Ù·Ó ˘„ËÏfiÙÂÚÂ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π·’ fi,ÙÈ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÎÔÈÏÈÔÎ¿ÎË Î·È ÛÙ·˘ÁÈ‹ ·È‰È¿. ∏ ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î‹ (tind 5,1453, p<0,001 Î·È tind 7,1174,p<0,001) (∂ÈÎfiÓ· 1).

∆· Â›Â‰· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∂ ÛÙÔÓ ÔÚfi ÙˆÓ˘ÁÈÒÓ ·ÙfiÌˆÓ Î˘Ì¿ÓıËÎ·Ó ·fi 5 Ì¤¯ÚÈ 20 mg/LÌÂ Ì¤ÛË ÙÈÌ‹ Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 10,9±5,0mg/L. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π, ÔÈ ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜∂ Î˘Ì¿ÓıËÎ·Ó ·fi 4 ˆ˜ 24 (10,7±4,0) mg/L Î·ÈÛÙËÓ ÔÌ¿‰· ÙË˜ ∫ÔÈÏÈÔÎ¿ÎË˜ ·fi 4 ˆ˜ 12(7,6±3,0) mg/L. √È Ì¤ÛÂ˜ ÙÈÌ¤˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿˘„ËÏfiÙÂÚÂ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π ·fi ·˘Ù¤˜ ÙˆÓ·ÛıÂÓÒÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎË Î·È Û˘ÁÎÚ›ÛÈÌÂ˜ ÌÂ ÂÎÂ›ÓÂ˜ÙˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ (tind 4,4512, p<0,001 Î·È tind0,7308 mg/L ÌÂ p=0,2335, ·ÓÙ›ÛÙÔÈ¯·) (∂ÈÎfiÓ· 2).

∆· Â›Â‰· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ÛÙÔÓ ÔÚfi ÙˆÓ˘ÁÈÒÓ ·ÙfiÌˆÓ Î˘Ì¿ÓıËÎ·Ó ·fi 0,35 Ì¤¯ÚÈ 0,80 ÌÂÌ¤ÛË ÙÈÌ‹ Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 0,55±0,16 mg/L.™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π, ÔÈ ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ Î˘-Ì¿ÓıËÎ·Ó ·fi 0,16 ˆ˜ 0,58 (0,30±0,09) mg/L Î·ÈÛÙËÓ ÔÌ¿‰· ÙË˜ ∫ÔÈÏÈÔÎ¿ÎË˜ ·fi 0,18 ˆ˜ 0,71(0,39±0,16) mg/L. √È Ì¤ÛÂ˜ ÙÈÌ¤˜ ‹Ù·Ó ¯·ÌËÏfi-ÙÂÚÂ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π Û˘ÁÎÚÈÓfiÌÂÓÂ˜ ÌÂ ·˘-Ù¤˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎË Î·È ÙˆÓ ˘ÁÈÒÓ ·È-‰ÈÒÓ. ∏ ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (tind-3,6345, p<0,001 Î·È tind 9,1881, p<0,001, ·ÓÙ›-ÛÙÔÈ¯·) (∂ÈÎfiÓ· 3).

™˘˙‹ÙËÛË∆· Â˘Ú‹Ì·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ‰Â›¯ÓÔ˘Ó ¯·-

ÌËÏ¿ Â›Â‰· ‚ÈÙ·Ì›ÓË˜ ∞ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∫π ÔÈÔÔ›ÔÈ ‚Ú›ÛÎÔÓÙ·Ó ÛÂ ıÂÚ·Â›· ÌÂ ·ÁÎÚÂ·ÙÈÎ¿¤Ó˙˘Ì· Î·È ‚ÈÙ·ÌÈÓÔ‡¯Ô ÛÎÂ‡·ÛÌ·, ÂÓÒ ÔÈ ÙÈÌ¤˜ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∂ Î·È ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ ‹Ù·Ó Ê˘ÛÈÔ-ÏÔÁÈÎ¤˜.

√ „Â˘‰¿ÚÁ˘ÚÔ˜ ¤¯ÂÈ ÂÚÈÏËÊıÂ› ÛÙË ÌÂÏ¤ÙËÁÈ·Ù› ÂËÚÂ¿˙ÂÈ ÙËÓ ·ÔÚÚfiÊËÛË, ÙË ÌÂÙ·ÊÔÚ¿Î·È ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ (15). ∞ÔÚ-ÚÔÊ¿Ù·È ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ Î·È Î˘Ú›ˆ˜ ÛÙÔ ‰ˆ‰Â-Î·‰¿ÎÙ˘ÏÔ (11). À¿Ú¯ÂÈ Â˘ÚÂ›· ¤ÓÙÂÚÔ-·ÁÎÚÂ·-ÙÈÎ‹ Î˘ÎÏÔÊÔÚ›· ÛÙËÓ ÔÔ›· Ë ÂÓÙÂÚÈÎ‹ ¤ÎÎÚÈÛËÙÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ „Â˘‰·ÚÁ‡ÚÔ˘ ÌÔÚÂ› Ó· Â›Ó·È ÙÂ-ÏÈÎ¿ ‰ÈÏ¿ÛÈ· ·fi ÙËÓ ÔÛfiÙËÙ· Ë ÔÔ›· Î·Ù·Ó·-ÏÒÓÂÙ·È ËÌÂÚËÛ›ˆ˜ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ¿ˆÂÓÙÂÚÈÎ‹ ·ÔÚÚfiÊËÛË ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ Â›Ó·È ÏÂÈ-ÙÔ˘ÚÁÈÎ¿ ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ (10). ™ÙËÓ Î˘ÎÏÔÊÔÚ›· Ô„Â˘‰¿ÚÁ˘ÚÔ˜ Û˘Ó‰¤ÂÙ·È ÌÂ ÏÂ˘ÎˆÌ·Ù›ÓË (80%),ÌÂ ÙËÓ ·-2 Ì·ÎÚÔÛÊ·ÈÚ›ÓË (15%) Î·È ÌÂ ¿ÏÏÂ˜ÚˆÙÂ˝ÓÂ˜. ∆Ô ‹·Ú ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙÔÓ¤ÏÂÁ¯Ô ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘. ∏

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 67

68


Znmg/L

∫À™∆π∫∏ π¡ø™∏ ∫√π§π√∫∞∫∏ ª∞ƒ∆Àƒ∂™

2,01,91,81,71,61,51,41,31,21,11,00,90,80,70,60,50,40,30,20,10,0

t=5,1453p<0,001

t=7,1174p<0,001

∂ÈÎfiÓ· 1. ™ÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ· ·Ó·ÁÚ¿ÊÔÓÙ·È Ù· Â›Â‰· ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ ÛÙÔÓ ÔÚfi. ∆· Â›Â‰· ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘ ÛÙÔÓÔÚfi ·ÛıÂÓÒÓ ÌÂ ∫π Î˘Ì·›ÓÔÓÙ·Ó ·fi 0,70 Ì¤¯ÚÈ 1,70 mg/L. ∞˘Ù¤˜ ÔÈ ÙÈÌ¤˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ÙˆÓ ·ÛıÂ-ÓÒÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎË ·ÏÏ¿ Î·È ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ.

Znmg/L ∫À™∆π∫∏ π¡ø™∏ ∫√π§π√∫∞∫∏ ª∞ƒ∆Àƒ∂™

242322212019181716151413121110

9876543210

t=4,4512p<0,001

t=0,7308p<0,001

∂ÈÎfiÓ· 2. √È ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∂ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ·. √È ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∂ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ÌÂ∫π Î˘Ì·›ÓÔÓÙ·Ó ·fi 4 Ì¤¯ÚÈ 24 mg/L. ∞˘Ù¤˜ ÔÈ ÙÈÌ¤˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈÌÂ˜ ÌÂ ÂÎÂ›ÓÂ˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfiÌˆÓ Î·È ÛËÌ·ÓÙÈÎ¿˘„ËÏfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎË.

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 68


69

µπ∆∞ªπ¡∏mg/L

∫À™∆π∫∏ π¡ø™∏ ∫√π§π√∫∞∫∏ ª∞ƒ∆Àƒ∂™

1,0

0,9

0,8

0,7

0,6

0,5

0,4

0,3

0,2

0,1

0,0t=9,1881p<0,001

t=3,6345p<0,001

∂ÈÎfiÓ· 3. √È ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ·. √È ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ÌÂ∫π Î˘Ì·›ÓÔÓÙ·Ó ·fi 0,16 Ì¤¯ÚÈ 0,58 mg/L. ∞˘Ù¤˜ ÔÈ ÙÈÌ¤˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÎÔÈÏÈÔÎ¿ÎËÎ·È ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ.

ÌÂÙ·ÏÏÔıÂÈÔÓ›ÓË Û˘Ì‚¿ÏÏÂÈ ÛÙÈ˜ ÂÓ‰ÔË·ÙÈÎ¤˜·Ôı‹ÎÂ˜ „Â˘‰·ÚÁ‡ÚÔ˘ ÁÈ·Ù› Û˘Ó‰¤ÂÈ ¿ÙÔÌ·„Â˘‰·ÚÁ‡ÚÔ˘. ™ÙËÓ ∫π, Ë ·ÔÚÚfiÊËÛË ÙÔ˘ „Â˘-‰·ÚÁ‡ÚÔ˘ ÂËÚÂ¿˙ÂÙ·È ·fi ÙËÓ ·ÁÎÚÂ·ÙÈÎ‹·ÓÂ¿ÚÎÂÈ· (16) Î·È ‚ÂÏÙÈÒÓÂÙ·È ÌÂ ÙË ¯ÔÚ‹ÁËÛË·ÁÎÚÂ·ÙÈÎÒÓ ÂÎ¯˘ÏÈÛÌ¿ÙˆÓ (17-19). ™‡ÌÊˆÓ·ÌÂ ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈ ÙÈÌ¤˜ „Â˘‰·ÚÁ‡ÚÔ˘‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫π. ∆· Â˘-Ú‹Ì·Ù· ·˘Ù¿ ‹Ù·Ó Û‡ÌÊˆÓ· ÌÂ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ·ÛıÂÓÂ›˜ Ï¿Ì‚·Ó·Ó Â·ÚÎ‹ ıÂÚ·Â›· ˘ÔÎ·Ù¿-ÛÙ·ÛË˜ ÌÂ ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì· Î·È ÙÚÈÏ¿ÛÈ· ‰fi-ÛË ÙˆÓ ËÌÂÚËÛ›ˆÓ ·Ó·ÁÎÒÓ ÛÂ „Â˘‰¿ÚÁ˘ÚÔ ÌÂÙË ÌÔÚÊ‹ ÛÎÂ˘·ÛÌ¿ÙˆÓ ·ÏÏ¿ Î·È ÌÂ ˙ˆÈÎ¤˜ Úˆ-ÙÂ˝ÓÂ˜ ÛÙË ‰›·ÈÙ¿ ÙÔ˘˜.

™‡ÌÊˆÓ· ÌÂ ÙË ÌÂÏ¤ÙË ·˘Ù‹, Ë ‚ÈÙ·Ì›ÓË ∂‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ∫π,ÔÈ ÔÔ›ÔÈ ÂÏ¿Ì‚·Ó·Ó Â·ÚÎÂ›˜ ÔÛfiÙËÙÂ˜ ·-ÁÎÚÂ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ‚ÈÙ·ÌÈÓÒÓ. ∞˘Ùfi ÛËÌ·›-ÓÂÈ fiÙÈ Ë Â·ÚÎ‹˜ ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ·ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì· Î·È ‚ÈÙ·Ì›ÓË ∂ Ô‰ËÁÂ› ÛÂ Ê˘-ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ‚ÈÙ·Ì›ÓË˜ ∂ ÛÙÔÓ ÔÚfi. À¿Ú-¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ù· Â›Â‰· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∂ÛÙËÓ Î˘ÎÏÔÊÔÚ›· Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓ· (20).

™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ÌÂÏ¤ÙË˜, Ë ‚ÈÙ·Ì›ÓË ∞ ‹Ù·Ó ¯·ÌËÏ‹ ÛÙÔÓ ÔÚfi·ÛıÂÓÒÓ ÌÂ ∫π ·Ú¿ ÙËÓ Î·ıËÌÂÚÈÓ‹ ¯ÔÚ‹ÁËÛË‰fiÛË˜ 6000 IU (1800 Ìg) ‚ÈÙ·Ì›ÓË˜ ∞. ∞˘Ùfi ÙÔ Â‡-ÚËÌ· ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ÛÙËÓ ¿Ô„Ë fiÙÈ Ë ‚ÈÙ·-

Ì›ÓË ∞ Â›Ó·È Î˘Ú›ˆ˜ ·ÔıËÎÂ˘Ì¤ÓË ÛÙÔ ‹·Ú Î·ÈÛÙÔ˘˜ ÈÛÙÔ‡˜. °È· Ó· ·˘ÍËıÔ‡Ó Ù· Â›Â‰· ÙË˜‚ÈÙ·Ì›ÓË˜ ∞ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· Â›Ó·È ··Ú·›ÙËÙË Ë¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ‚ÈÙ·Ì›ÓË˜. √ Î›Ó‰˘-ÓÔ˜ Ó· ‰ËÌÈÔ˘ÚÁËıÂ› ˘ÂÚ‚ÈÙ·Ì›ÓˆÛË ∞ Ê·›ÓÂÙ·ÈÓ· Â›Ó·È ÌÈÎÚfi˜ ·Ú¿ ÙËÓ ˘ÔÎ·Ù¿ÛÙ·ÛË ÌÂ ÌÂ-Á¿ÏÂ˜ ‰fiÛÂÈ˜ (21). ∏ ·ÔÚÚfiÊËÛË ÙË˜ ‚ÈÙ·Ì›ÓË˜∞ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ¯ÔÏÈÎ‹ ¤ÎÎÚÈÛË, ÙËÓ ·ÔÚÚfi-ÊËÛË ÙˆÓ ÏÈÒÓ, ÙËÓ ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ ÌÂ ÙË‰È·ÙÚÔÊ‹, ÙËÓ ·ÚÔ˘Û›· „Â˘‰·ÚÁ‡ÚÔ˘ Î·È ÙÈ˜·Ó¿ÁÎÂ˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÂ „Â˘‰¿ÚÁ˘ÚÔ (22). ∏‚ÈÔ‰È·ıÂÛÈÌfiÙËÙ· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ Â›Ó·È ÂÏ·ÙÙˆ-Ì¤ÓË ÛÂ ÔÚÈÛÌ¤ÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ (Ë·ÙÈÎ‹ ÓfiÛÔ˜,·ÁÎÚÂ·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ¤ÏÏÂÈ„Ë „Â˘‰·ÚÁ‡-ÚÔ˘, ˘ÔÚˆÙÂ˚Ó·ÈÌ›·), ÔÈ ÔÔ›Â˜ ıÂˆÚËÙÈÎ¿ Â›-Ó·È Û˘¯Ó¤˜ ÛÙËÓ ∫π ·ÏÏ¿ Â›¯·Ó ·ÔÎÏÂÈÛÙÂ› ÛÙÔ˘˜·ÛıÂÓÂ›˜ ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜. ∏ ÚÂÙÈÓfiÏË Î˘ÎÏÔ-ÊÔÚÂ› ÛÙÔ Ï¿ÛÌ· ÌÂ Ù· ¯˘ÏÔÌÈÎÚ¿ Î·È ·ÔıË-ÎÂ‡ÂÙ·È ÛÙÔ ‹·Ú Ì¤Ûˆ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ˘Ô‰Ô¯¤ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ (23). À¿Ú¯ÂÈ‰È¿ÛÙ·ÛË ·fi„ÂˆÓ Û¯ÂÙÈÎ¿ ÌÂ Ù· Ë·ÙÈÎ¿ ·Ô-ı¤Ì·Ù· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ÛÙËÓ ∫π (4,24). √ Î›Ó‰˘-ÓÔ˜ ¤ÏÏÂÈ„Ë˜ ‚ÈÙ·Ì›ÓË˜ ∞ ·˘Í¿ÓÂÈ ÌÂ ÙËÓ ËÏÈÎ›·(4). ∞Ó·Ê¤ÚÂÙ·È ÌÂÁ¿ÏË ·ÒÏÂÈ· ‚ÈÙ·Ì›ÓË˜ ∞ ÌÂÙ· ÎfiÚ·Ó· (25).

√È ·ÛıÂÓÂ›˜ ÌÂ ∫π Î·È Ë·ÙÈÎ‹ ÚÔÛ‚ÔÏ‹ Â›-¯·Ó Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· ‚ÈÙ·Ì›ÓË˜ ∞. ∞˘Ùfi ÙÔÂ‡ÚËÌ· Èı·ÓfiÓ Ó· ÔÊÂ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 69

70


·ÛıÂÓÂ›˜ ÌÂ Ë·ÙÈÎ‹ ÚÔÛ‚ÔÏ‹ ÂÏ¿Ì‚·Ó·Ó ÌÂÁ¿-ÏÂ˜ ‰fiÛÂÈ˜ Ô˘ÚÛÔ‰ÂÔÍ˘¯ÔÏÈÎÔ‡ ÔÍ¤Ô˜, ÙÔ ÔÔ›Ô¤¯ÂÈ Ë·ÙÔÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛË Î·È ‚ÂÏÙÈÒÓÂÈÙÔÓ Ë·ÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ··Ú·ÈÙ‹ÙˆÓ ÏÈ·-ÚÒÓ ÔÍ¤ˆÓ Î·È ÙË˜ ÚÂÙÈÓfiÏË˜ ÛÙ· ·È‰È¿ ÌÂ ∫π(26).

∂ÊfiÛÔÓ Ï·Ì‚¿ÓÔ˘Ó Â·ÚÎÂ›˜ ÔÛfiÙËÙÂ˜ ·-ÁÎÚÂ·ÙÈÎÒÓ ÂÎ¯˘ÏÈÛÌ¿ÙˆÓ, 100 mg ‚ÈÙ·Ì›ÓË˜ ∂Î·È 6000 IU (1800 Ìg) ‚ÈÙ·Ì›ÓË˜ ∞ ËÌÂÚËÛ›ˆ˜,·ÛıÂÓÂ›˜ ÌÂ ∫π ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ ÔÎÙÒ¯ÚfiÓˆÓ Î·È ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÍˆÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ „Â˘-‰·ÚÁ‡ÚÔ˘ Î·È ‚ÈÙ·Ì›ÓË˜ ∂ ·ÏÏ¿ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ‚È-Ù·Ì›ÓË˜ ∞ ÛÙÔÓ ÔÚfi. ∆· Â›Â‰· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ·ÔÙÂÏÔ‡Ó ÊÙˆ¯fi ‰Â›ÎÙË ÙË˜Â¿ÚÎÂÈ·˜ ‹ ·ÓÂ¿ÚÎÂÈ·˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ (27),ÁÈ·Ù› ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ· Ë·ÙÈÎ¿ ·Ôı¤Ì·-Ù· (28-30). ªÔÚÔ‡ÌÂ Ó· Û˘ÌÂÚ¿ÓÔ˘ÌÂ fiÙÈ ÙÔÂ‡ÚËÌ· ·˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ ··ÈÙ‹ÛÂÈ˜ ÙˆÓ·ÛıÂÓÒÓ ÌÂ ∫π ËÏÈÎ›·˜ >8 ¯ÚfiÓˆÓ ÛÂ ‚ÈÙ·Ì›ÓË ∞Â›Ó·È ˘„ËÏfiÙÂÚÂ˜ Î·È fiÙÈ Ë ËÌÂÚ‹ÛÈ· ‰fiÛË ÙˆÓ6000 IU (1800 Ìg) ‰ÂÓ Â·ÚÎÂ›.

µÈ‚ÏÈÔÁÚ·Ê›·1. Rayner RJ, Tyrrell JC, Hiller EJ, Marenah C, Neugebauer

MA, Vernon SA et al. Night blindness and conjunctivaxerosis caused by vitamin A deficiency in patients withcystic fibrosis. Arch Dis Child 1989;64:1151-1156.

2. Congden PJ, Bruce G, Rothburn MM, Clarke PC, LittlewoodJM, Kelleher J et al. Vitamin status in treated patients withcystic fibrosis. Arch Dis Child 1981;56:708-714.

3. Olson JA. Vitamin A and carotenoids as antioxidant ina physiological context. J Nutr Sci Vitaminol 1993;39(Suppl):57-65.

4. Ramsey BW, Farrell PM, Pencharz P, and the ConsensusCommittee. Nutritional assessment and management incystic fibrosis: a consensus report. Am J Clin Nutr1992;55:108-116.

5. Carr SB, Bratney J. The role of vitamins in cystic fibrosis.J R Soc Med 2000;93(Sup 38):14-19.

6. Lindlblad A, Diczfalusy U, Hultcrantz R, Thorell A,Strandvik B. Vitamin A concentrations in the liver decreasewith age in patients with cystic fibrosis. J PediatrGastroenterol Nutr 1997;24;264-270.

7. Wang XD, Marini RP, Hebuterne X, Fox JG, Krinsky NI,Russell RM. Vitamin E enhances the lymphatic transport ofbeta-carotene and its conversion to vitamin A in the ferret.Gastroenterology 1995;108:719-726.

8. Rock CL, Jacob RA, Bowen PE. Update on the biologicalcharacteristics of the antioxidant micronutrients: vitamin C,vitamin E and the carotenoids. J Am Diet Assoc 1996;96:693-702.

9. Sokol R. Metabolism and disorders of vitamin E in infancyand childhood. Internat Sem Pediatr Gastroenterol Nutr1995;4:8-15.

10. Peters SA, Kelly FJ. Vitamin E supplementation in cystic

fibrosis. J Pediatr Gastroenterol Nutr 1996; 22: 341-345.11. Aggett PJ. Zinc. Annales Nesle 1994;52:94-106.12. The Perkin-Elmer Corporation. Analytical Methods for

Atomic Absorption Spectroscopy 1996;160-161.13. Roels OA, Trout M. Vitamin A and carotene. In: Cooper GR

and Kings JS, editors. Standard methods of clinicalchemistry. New York and London: Academic Press; 1972.p. 215-230.

14. Hansen LG, Warnick WJ. A fluorometric micro methodfor serum tocopherol. Tech Bull Reg Med Tech1966;36:131-136.

15. Christian P, West KP Jr. Interactions between zinc andvitamin A: an update. Am J Clin Nutr 1998;68(2Suppl):435-441.

16. Jacob RA, Sandstead H H, Solomons NW, Rieger C,Rothberg R. Zinc status and vitamin A transport in cysticfibrosis. Am J Clin Nutr 1978;31:638-644.

17. Krebs N, Sontag M, Accurso F, Hambidge KM. Lowplasma zinc concentrations in young infants with cysticfibrosis. J Pediatr 1998;133:761-764.

18. Easley D, Krebs N, Jefferson M, Miller L, Erskine J,Accurso F et al. Effect of pancreatic enzyme on zincabsorption in cystic fibrosis. J Pediatr GastrÔenterol Nutr1998;26:136-139.

19. Safai-Kutti S, Selin E, Larsson E, Jagenburg R, Denfors I,Sten G et al. Zinc therapy in children with cystic fibrosis.Beitr Infusionsther 1991;27:104-114.

20. Borel P, Mekki N, Boirie Y, Partier A, Groiler P, Alexandre-Couabau MC et al. Postprandial chylomicron vitamin Eresponses in healthy older subjects compared withyounger ones. Eur J Clin Invest 1997;27:812-821.

21. James DR, Owen G, Campbell IA, Goodchild MC. VitaminA absorption in cystic fibrosis: risk of hyper- vitaminosis A.Gut 1992;33:707-710.

22. Herrera MG. Vitamin A deficiency: Prevention andtreatment. Internat Sem Paediatr Gastroenterol Nutr1995;4:2-8.

23. ∆raber MG, Diamond SR, Lane JC, Brody RI, Kayden HJ.Beta-carotene- transport in human lipoproteins. Compa-risons with a-tocopherol. Lipids 1994;29:665-669.

24. Underwood BA, Denning CR. Blood and liver concen-trations of vitamins A and E in children with cystic fibrosisof the pancreas. Pediatr Res 1972;6:26-31

25. Ahmed F, Ellis J, Murphy J, Wootton S, Jackson AA.Excessive fecal losses of vitamin A (retinol) in cysticfibrosis. Arch Dis Child 1990;65:589-593.

26. Lepage G, Paradis K, Lacaille F, Sénéchal L, Ronco N,Champagne J et al. Ursodeoxycholic acid improves thehepatic metabolism of essential fatty acids and retinol inchildren with cystic fibrosis. J Pediatr 1997;130:52-58.

27. Amedee-Manesme O, Furr HC, Alvarez F et al.Biochemical indicators of vitamin A depletion in childrenwith cholestasis. Hepatology 1985;5:1143-1148.

28. Mourey MS, Siegenthaler G, Amedee-Manesme O.Regulation of metabolism of retinol-binding protein byvitamin A status in children with biliary atresia. Am J ClinNutr 1990;51:638-643.

29. Lancellotti L, D’Orazio C, Mastella G et al. Deficiency of

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vitamins A and E in cystic fibrosis is independent ofpancreatic function and current enzyme and vitaminsupplementation. Euro P J Pediatr1996;155:281-285.

30. Dodge JA, O’Rawe AM. nutritional aspects of cysticfibrosis (Review). Europ J Gastroenterol Hepatol1006;8:739-743.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™. ¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË ∆£ 322, £¤ÚÌË, 57001 £ÂÛÛ·ÏÔÓ›ÎËe-mail: [email protected]

™ÎÔfi˜: ∏ Û¯¤ÛË ÌÂÙ·Í‡ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ·Ï-ÏÂÚÁ›·˜ Û·Ó ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÓfiÛÔ˘ÌÂ Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹ (wheezing) ÛÂ ‚Ú¤ÊË, ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËıÂ›. ÀÔı¤Û·ÌÂ fiÙÈ Ë ‡·ÚÍË ÈÛÙÔÚÈÎÔ‡ ·ÏÏÂÚÁÈ-Î‹˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ÁÔÓÂ›˜ ı· ÌÔÚÔ‡ÛÂ Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍË-Ì¤ÓË Û˘¯ÓfiÙËÙ· ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙ· ‚Ú¤ÊË, fiˆ˜Â›ÛË˜ Î·È ÌÂ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· Û˘ÚÚ›ÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ. ª¤ıÔ‰Ô˜: ∂ÎÙÈÌ‹ıËÎ·Ó ÚÔÔÙÈÎ¿ 1.193 ‚Ú¤ÊË, ·fi ÙË Á¤Ó-ÓËÛË Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÌËÓÒÓ, ÌÂ ÙËÏÂÊˆÓÈÎ‹ ÂÈÎÔÈ-ÓˆÓ›· ‰‡Ô ÊÔÚ¤˜ Â‚‰ÔÌ·‰È·›ˆ˜, ÌÂ ÛÎÔfi ÙËÓ Î·Ù·ÁÚ·Ê‹fiÏˆÓ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ Û˘ÓÔÏÈÎ‹ Û˘¯ÓfiÙËÙ· ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈ-ÌÒÍÂˆÓ (all RI) ·ÚÔ˘Û›·˙Â Ì›· ÚÔÔ‰Â˘ÙÈÎ‹ ·‡ÍËÛË, ˆ˜ ÙËÌ¤ÁÈÛÙË ÙÈÌ‹ ÙˆÓ 10,6 ÓÔÛ‹ÛÂˆÓ /‚Ú¤ÊÔ˜/¤ÙÔ˜, ÛÙ· ‚Ú¤ÊËËÏÈÎ›·˜ 7 ¤ˆ˜ 9 ÌËÓÒÓ Î·È ÛÙ·ıÂÚÔÔÈ‹ıËÎÂ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ·‚Ú¤ÊË. ªÂ ÙË ¯Ú‹ÛË ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ÂÍÔÌ¿Ï˘ÓÛË˜ ÁÈ·‰ËÌÔÁÚ·ÊÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜, ÌËÙÚÈÎfi ıËÏ·ÛÌfi, Ì‹Ó· ÓfiÛË-ÛË˜, ·ÚÈıÌfi ·‰ÂÏÊÒÓ, Î·È ·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÎÔ‡ ÛÙ·ı-ÌÔ‡, ‰È·ÈÛÙÒıËÎÂ Ì›· ·‡ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· fiÏˆÓ ÙˆÓ ·Ó·-ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÂ ‚Ú¤ÊË ¿Óˆ ÙˆÓ 7 ÌËÓÒÓ Ô˘ Â›¯·ÓÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ (Odds Ratio (OR)= 1,24,Confidence Interval, (CI) 1,09 ¤ˆ˜ 1,41), ‹ ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ (OR= 1,14, CI 1,03 ¤ˆ˜ 1,26). ∏ Û˘¯ÓfiÙËÙ·ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Ô˘ Û˘ÓÔ‰Â˘-fiÙ·Ó ·fi Û˘ÚÚ›ÙÔ˘ÛÛ· ·Ó·ÓÔ‹ Û¯ÂÙÈ˙fiÙ·Ó ÌfiÓÔÓ ÌÂ ÙËÓ ·-ÚÔ˘Û›· ¿ÛıÌ·ÙÔ˜ ÛÙÔ˘˜ ÁÔÓÂ›˜ (OR= 2,06, CI = 1,36 ¤ˆ˜3,11).

™˘ÌÂÚ¿ÛÌ·Ù·: ŸÏÂ˜ ÔÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡, Ô˘ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜, Â›Ó·È ·˘ÍË-Ì¤ÓÂ˜ ÛÂ ˘ÁÈ‹ Î·Ù¿ Ù· ¿ÏÏ· ‚Ú¤ÊË, ÌÂ ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ ‹·ÙÔ›·˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÂÓÒ Ë Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹(wheezing) Û¯ÂÙ›˙ÂÙ·È ÌfiÓÔ ÌÂ ÙËÓ ·ÚÔ˘Û›· ¿ÛıÌ·ÙÔ˜ÛÙÔ˘˜ ÁÔÓÂ›˜.

1Bosken CH, Hunt WC, Lambert WE, Samet JMA parental history of asthma is a risk factor for wheezing and nonwheezing respiratory illnesses in infants younger than 18 months of ageAm J Respir Crit Care Med 2000; 161:1810-1815

£ÂÔÊ¿ÓË˜ ∆ÛÈÏÈÁÈ¿ÓÓË˜ ¢ÈÂ˘ı˘ÓÙ‹˜ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡·˘ÙÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∞ıËÓÒÓ

∆Ô ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ ÛÙÔ˘˜ ÁÔÓÂ›˜ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÂÎ‰‹ÏˆÛË˜ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÌÂ ‹ ¯ˆÚ›˜ Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹ ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 18 ÌËÓÒÓ1


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�¶ÂÚ›ÏË„Ë: √ fiÚÔ˜ "ÎÚÂÌ¿ÌÂÓÔ˜" ÂÚÈÁÚ¿ÊÂÈÌÈ· Ì¿ÏÏÔÓ Û¿ÓÈ· ÛÙ· ·È‰È¿ ÂÎÙÔ›· ÙÔ˘ ÛÏ‹-Ó·, Ë ÔÔ›· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·Ô˘Û›· ‹ ÙË ¯·Ï¿Úˆ-ÛË ÙˆÓ Û˘Ó‰¤ÛÌˆÓ Ô˘ Ê˘ÛÈÔÏÔÁÈÎ¿ ÙÔÓ ‰È·ÙË-ÚÔ‡Ó Î·ıËÏˆÌ¤ÓÔ ÛÙË ı¤ÛË ÙÔ˘. ∏ ‰È¿ÁÓˆÛË Ù›-ıÂÙ·È ‰‡ÛÎÔÏ· ÎÏÈÓÈÎ¿. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›Ùˆ-ÛË ÂÓfi˜ ÎÔÚÈÙÛÈÔ‡ ËÏÈÎ›·˜ 7 ÂÙÒÓ ÌÂ „ËÏ·ÊËÙ‹Ì¿˙· ÛÙËÓ ÎÔÈÏÈ¿. ªÂ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô‰È·ÈÛÙÒıËÎÂ fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ÎÚÂÌ¿ÌÂÓÔ ÛÏ‹-Ó·. ∏ ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËÎÂ ÛÂ Ï··ÚÔÙÔÌ›· Î·È ÔÛÏ‹Ó·˜ Î·ıËÏÒıËÎÂ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ˘Ô‰È·-ÊÚ·ÁÌ·ÙÈÎ‹ ÂÚÈÔ¯‹ ÌÂ ÂÈÙ˘¯›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÛÏ‹Ó·˜, ÎÚÂÌ¿ÌÂÓÔ˜ ÛÏ‹Ó·˜.

�Abstract: The wandering spleen is a rarecondition characterized by splenic malpositiondue to congenital maldevelopment or laxity of thesupporting ligamentous structures that usuallyfixate the spleen in its anatomical position. Thediagnosis is often difficult to establish, clinically.We report the case of a 7 years old girl with anabdominal mass that proved to be a wanderingspleen. The patient underwent laparotomy and thespleen was successfully repositioned in the leftphrenorenal angle.

Key words: spleen, wandering spleen.

"∫ÚÂÌ¿ÌÂÓÔ˜" ÛÏ‹Ó·˜ ÛÂ ÎÔÚ›ÙÛÈ 7 ÂÙÒÓ∫. Ã·˚‰ÔÔ‡ÏÔ˘1, ª. ™Ù¿ÌÔ˘-∆ÛÈ·Ú¿˙Ë2, º. ∞ı·Ó·ÛÈ¿‰Ô˘2, ∫. ∫Ô‡ÛÎÔ˘Ú·˜3, ∞. ∞ÓÙˆÓÈ¿‰Ë˜4

"Wandering" spleen in a 7 year old girlK. Haidopoulou1, M. Stamou-Tsiaprazi2, F. Athanassiadou2, K. Kouskouras3, A. Antoniadis4

ªÂ ÙÔÓ fiÚÔ «ÎÚÂÌ¿ÌÂÓÔ˜» (wandering, ectopic,floating, aberrant spleen, lien mobile, splenoptosis)ÛÏ‹Ó·˜, ÂÚÈÁÚ¿ÊÂÙ·È Ë ÌÂÙ·Ó¿ÛÙÂ˘ÛË ÙÔ˘ÛÏ‹Ó· ·fi ÙËÓ ·Ó·ÙÔÌÈÎ‹ ı¤ÛË ÙÔ˘, ÏfiÁˆ ‰È·-Ì·ÚÙ›·˜ Î·Ù¿ ÙË ‰È¿Ï·ÛË ‹ ¯·Ï¿ÚˆÛË˜ ÙˆÓ Û˘Ó-‰¤ÛÌˆÓ Ô˘ Ê˘ÛÈÔÏÔÁÈÎ¿ ÙÔÓ Î·ıËÏÒÓÔ˘Ó ÛÙÔ·ÚÈÛÙÂÚfi ¿Óˆ ÙÂÙ·ÚÙËÌfiÚÈÔ ÙË˜ ÎÔÈÏ›·˜. √ ÎÚÂ-Ì¿ÌÂÓÔ˜ ÛÏ‹Ó·˜ Â›Ó·È Û˘Ó‹ıˆ˜ ‰ÈÔÁÎˆÌ¤ÓÔ˜ Î·È¤¯ÂÈ Ì·ÎÚ‡ ·ÁÁÂÈ·Îfi Ì›Û¯Ô, ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔÛ˘ÛÙÚÔÊ‹˜ ‹ Ú‹ÍË˜, ÛÂ ‹ÈÂ˜ Î·ÎÒÛÂÈ˜ ÙË˜ Â-ÚÈÔ¯‹˜.

ªÂ ÙËÓ Â˘Î·ÈÚ›· ÓÔÛËÏÂ›·˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜

ÎÔÚÈÙÛÈÔ‡ 7 ÂÙÒÓ ÌÂ ÎÔÈÏÈ·Î¿ ¿ÏÁË Î·È „ËÏ·ÊËÙ‹Ì¿˙· ÛÙÔÓ ·ÚÈÛÙÂÚfi Ï·ÁfiÓÈÔ ‚fiıÚÔ, ÂÚÈÁÚ¿ÊÔ˘-ÌÂ ÙË Û¿ÓÈ· ·˘Ù‹ ÂÚ›ÙˆÛË ÎÚÂÌ¿ÌÂÓÔ˘ ÛÏ‹Ó·Î·È Á›ÓÂÙ·È Â˘ÚÂ›· Û˘˙‹ÙËÛË ÌÂ ‚¿ÛË Ù· Û‡Á¯ÚÔÓ·‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 7 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹

Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô Î·È ·ÓÙÈÌÂÙÒÈÛË „Ë-Ï·ÊËÙ‹˜ ·ÓÒ‰˘ÓË˜ Ì¿˙·˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi Ï·ÁfiÓÈÔ‚fiıÚÔ. ∆Ô ·Ú·¿Óˆ Â‡ÚËÌ· ‹Ù·Ó Ù˘¯·›Ô Î·Ù¿ÙËÓ „ËÏ¿ÊËÛË ÙË˜ ÎÔÈÏ›·˜ ÛÂ ÂÍ¤Ù·ÛË ÚÔ˘Ù›Ó·˜.

1 ¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£., ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

2 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£., ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

3 ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ∞.¶.£., ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

4 ÃÂÈÚÔ˘ÚÁÈÎ‹ ∫ÏÈÓÈÎ‹ ªÂÙ·ÌÔÛ¯Â‡ÛÂˆÓ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË

1 4th Pediatric Clinic, AHEPA Hospital, Thessaloniki

2 2nd Pediatric Clinic, AHEPA Hospital, Thessaloniki

3 Radiology Laboratory, AHEPA Hospital, Thessaloniki

4 Department of Surgery, Division of Transplantation, Ippokration Hospital, Aristotelion University of Thessaloniki

∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

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∂›Ó·È ÙÔ ÙÚ›ÙÔ ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ Î·ÈÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ÙË˜ ·ÛıÂÓÔ‡˜ Â›Ó·ÈÂÏÂ‡ıÂÚÔ. ∞fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙÔ˘ ·È‰È-Ô‡ ·Ó·Ê¤ÚÔÓÙ·È ÂÂÈÛfi‰È· ¤ÓÙÔÓÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¿Ï-ÁÔ˘˜ ÌÂÙ¿ ·fi ÎfiˆÛË. ∏ ·ÓÙÈÎÂÈÌÂÓÈÎ‹, Î·Ù¿ Ù·ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ÂÍ¤Ù·ÛË, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.

√ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜,ÛÙÔÓ ÔÔ›Ô ˘Ô‚Ï‹ıËÎÂ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏·ÂÈÎfiÓÈÛË ÙË˜ ÎÔÈÏÈ¿˜, ÌÂ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ-¯Ô, ¤ıÂÛÂ ÙË ‰È¿ÁÓˆÛË ¤ÎÙÔÔ˘ ‰ÈÔÁÎˆÌ¤ÓÔ˘ÛÏ‹Ó·. √ ÂÚ·ÈÙ¤Úˆ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂCT ÎÔÈÏ›·˜ Î·È ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÛÏ‹Ó· ÎÚ›ıËÎÂ·Ó·ÁÎ·›Ô˜, ÙfiÛÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·ÁÁÂ›ˆÛË˜ÙÔ˘ ÛÏ‹Ó·, fiÛÔ Î·È ÁÈ· ÙËÓ ÏËÚ¤ÛÙÂÚË ·ÚÂÁ-¯˘Ì·ÙÈÎ‹ Î·È ÏÂÈÙÔ˘ÚÁÈÎ‹ ·ÂÈÎfiÓÈÛË ÙÔ˘ ÔÚÁ¿ÓÔ˘.∞fi ÙËÓ CT ÎÔÈÏ›·˜ ‚Ú¤ıËÎÂ ÂÎÙÔ›· ÛÏ‹Ó· ÌÂ‰ÈfiÁÎˆÛË ·˘ÙÔ‡ Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÂÈÎfiÓÈÛË ÙˆÓÛÏËÓÈÎÒÓ ·ÁÁÂ›ˆÓ, Ù· ÔÔ›· ÂÍÔÚÌÒÓÙ·È ·fi ÙËÓ·Ó·ÙÔÌÈÎ¿ ·Ó·ÌÂÓfiÌÂÓË ı¤ÛË Î·È ÔÚÂ‡ÔÓÙ·È Î·-Ù·ÎfiÚ˘Ê· ÌÚÔÛÙ¿ ·fi ÙÔÓ ·ÚÈÛÙÂÚfi ÓÂÊÚfi Î·È·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ·ÚÈÛÙÂÚ‹ ·Ú·ÎÔÏÈÎ‹ ·‡Ï·Î·(∂ÈÎfiÓÂ˜ 1-4). ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ fiÙÈÚfiÎÂÈÙ·È ÁÈ· ¤ÎÙÔÔ ÛÏ‹Ó·, ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ÌÂ Î·Ù·ÎÚ¿ÙËÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÂÓÙfi˜ ·˘ÙÔ‡(ıÂÚÌfi˜ ÛÏ‹Ó·˜) (∂ÈÎfiÓ· 5). ªÂ ‰Â‰ÔÌ¤ÓË ÙË ‰È¿-ÁÓˆÛË ÙË˜ ÛÏËÓÈÎ‹˜ ÂÎÙÔ›·˜ ÌÂÏÂÙ‹Û·ÌÂ ÙË ‚È-‚ÏÈÔÁÚ·Ê›· Î·È ÏfiÁˆ ÎÈÓ‰‡ÓÔ˘ Ú‹ÍË˜ ‹ Û˘ÛÙÚÔ-Ê‹˜ ÙÔ˘ ¤ÎÙÔÔ˘ ÛÏ‹Ó· Û˘ÛÙ‹ıËÎÂ ÛÙÔ˘˜ ÁÔÓÂ›˜Ë ¿ÌÂÛË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÎÙ›ÌËÛË. ∞ÔÊ·Û›ÛıËÎÂ·ÓÔÈÎÙ‹ Ï··ÚÔÙÔÌ›· Î·È ·ÓÙÈÌÂÙÒÈÛË ‹ ÌÂ ÛÏË-ÓÂÎÙÔÌ‹, ‹ ÂÊfiÛÔÓ ‹Ù·Ó ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÂÊÈÎÙfi, ÌÂÂ·Ó·ÙÔÔı¤ÙËÛË ÙÔ˘ ÛÏ‹Ó· ÛÙËÓ ·Ó·ÙÔÌÈÎ‹ÙÔ˘ ı¤ÛË. °È· ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ÛÏËÓÂÎÙÔÌ‹˜ ¤ÁÈÓÂÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ ÙÔ˘ ÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘, ÙÔ˘ ÌË-ÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ Î·È ÙÔ˘ ·ÈÌfiÊÈÏÔ˘ ÙË˜ ÈÓÊÏÔ˘¤-ÓÙ˙·˜. ∆Ô ·È‰› ˘Ô‚Ï‹ıËÎÂ ÛÂ ·ÓÔÈÎÙ‹ Ï··ÚÔÙÔ-

Ì›·, fiÔ˘ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ô ÛÏ‹Ó·˜ "ÎÚÂÌfiÙ·Ó"·fi ·ÁÁÂÈ·Îfi Ì›Û¯Ô, ‹Ù·Ó ‰ÈÔÁÎˆÌ¤ÓÔ˜ Î·È ÂÓÙÔÈ-˙fiÙ·Ó ÛÙÔÓ ·ÚÈÛÙÂÚfi Ï·ÁfiÓÈÔ ‚fiıÚÔ. ªÂÙ¿ ÙÔÓÂÍÂÏÎ˘ÛÌfi ÙÔ˘ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ô Ì›Û¯Ô˜ ‹Ù·Ó Â-ÚÈÛÙÚ·ÌÌ¤ÓÔ˜ Î·Ù¿ ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ· Î·Ù¿ 180Ô.ªÂÙ¿ ÙËÓ ·Ó¿Ù·ÍË ÙË˜ ÛÙÚÔÊ‹˜ ÙÔ˘ Ì›Û¯Ô˘ ÔÛÏ‹Ó·˜ ·ÔÛ˘ÌÊÔÚ‹ıËÎÂ Î·È Ì›ÎÚ˘ÓÂ ÛËÌ·ÓÙÈ-Î¿. ™ÙË Û˘Ó¤¯ÂÈ· ÙÔÔıÂÙ‹ıËÎÂ ÛÙËÓ ·ÚÈÛÙÂÚ‹˘Ô‰È·ÊÚ·ÁÌ·ÙÈÎ‹ ÂÚÈÔ¯‹ Î·È Î·ıËÏÒıËÎÂ ÂÎÂ›ÌÂ ·Ó·Û¯ËÌ·ÙÈÛÌfi ÙÔ˘ ÊÚÂÓÔÎÔÏÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘¿Óˆ ÛÙÔÓ ÔÔ›Ô ÂÈÎ¿ıËÛÂ Ô Î¿Ùˆ fiÏÔ˜ ÙÔ˘ÛÏ‹Ó·.

™˘˙‹ÙËÛË∏ ÚÒÙË Â›ÛËÌË ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ÎÚÂ-

Ì¿ÌÂÓÔ˘ ÛÏ‹Ó· ¤ÁÈÓÂ ÙÔ 1667 ·fi ÙÔÓ Van HorneÎ·È ·ÊÔÚÔ‡ÛÂ Ù˘¯·›Ô Â‡ÚËÌ· ÓÂÎÚÔ„›·˜, ·Ó Î·È ÔÈ·ÓˆÌ·Ï›Â˜ ÙË˜ ı¤ÛË˜ ÙÔ˘ ÛÏ‹Ó· ‹Ù·Ó ÁÓˆÛÙ¤˜·ÎfiÌ· ·fi ÙÔ˘˜ πÔÎÚ¿ÙË Î·È °·ÏËÓfi(1). ∏ ÚÒ-ÙË ÛÏËÓÂÎÙÔÌ‹ ÛÂ ·ÛıÂÓ‹ ÌÂ ÎÚÂÌ¿ÌÂÓÔ ÛÏ‹Ó·Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÌÂ ÂÈÙ˘¯›· ÙÔ 1878 ·fi ÙÔÓMartin(2). ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· Î·Ù¿ÛÙ·ÛË, ÌÂ Û˘-¯ÓfiÙËÙ· Ô˘ ‰‡ÛÎÔÏ· ˘ÔÏÔÁ›˙ÂÙ·È ÌÂ ·ÎÚ›‚ÂÈ·. ∏‰È¿ÁÓˆÛË Û˘¯ÓfiÙÂÚ· Ù›ıÂÙ·È ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛËÂÈÏÔÎÒÓ, fiˆ˜ Ë Û˘ÛÙÚÔÊ‹, ÙË˜ ÔÔ›·˜ Ë Û˘-¯ÓfiÙËÙ· ˘ÔÏÔÁ›˙ÂÙ·È ÌÈÎÚfiÙÂÚË ÙÔ˘ 0,2%(3). ∆Ô1989, ÛÂ ·Ó·ÛÎfiËÛË ÙË˜ Ì¤¯ÚÈ ÙfiÙÂ µÚÂÙ·ÓÈÎ‹˜‚È‚ÏÈÔÁÚ·Ê›·˜ ·fi ÙÔÓ Allen, ‚Ú¤ıËÎ·Ó Û˘ÓÔÏÈÎ¿35 ÂÚÈÙÒÛÂÈ˜ ÎÚÂÌ¿ÌÂÓÔ˘ ÛÏ‹Ó· ÛÂ ·È‰È¿ ËÏÈ-Î›·˜ Î¿Ùˆ ÙˆÓ 10 ÂÙÒÓ(4), ÂÓÒ ÛÂ ÛÂÈÚ¿ 1413·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÛÏËÓÂÎÙÔÌ‹, ÔÈ·ÛıÂÓÂ›˜ ÌÂ ÎÚÂÌ¿ÌÂÓÔ ÛÏ‹Ó· ‹Ù·Ó ÌfiÓÔ 4(5).√È ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ Â›Ó·È ÂÚ›Ô˘400(6). ∆Ô Â‡ÚÔ˜ ÙË˜ ËÏÈÎ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Â-ÚÈÁÚ¿ÊËÎ·Ó Â›Ó·È ·fi 3 Ì‹ÓÂ˜ ¤ˆ˜ 82 ¯ÚfiÓÈ·. √ÈÌÈÛ¤˜ ·fi ÙÈ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ·ÊÔ-

∂ÈÎfiÓ· 1. ∏ ·Ó·ÙÔÌÈÎ‹ ı¤ÛË ÙÔ˘ ÛÏ‹Ó·, Ë ÔÔ›· ÙÒÚ·Î·Ù·Ï·Ì‚¿ÓÂÙ·È ·fi ÙÔÓ ıfiÏÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘.

∂ÈÎfiÓ· 2. ∂›Â‰Ô ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ ¿Óˆ fiÏÔ˘ ÙÔ˘ ÛÏ‹Ó·Î¿Ùˆ ·fi ÙÔ ÛËÌÂ›Ô ¤ÎÊ˘ÛË˜ ÙË˜ ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙË-Ú›·˜ (ı12-√1).

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ÚÔ‡Ó ·È‰È¿(7), ÂÓÒ ̆ ¿Ú¯ÂÈ ÈÛfiÙÈÌË Î·Ù·ÓÔÌ‹ ÛÙ·‰‡Ô Ê‡Ï· (6,7). ∞fi ÙËÓ ÚÔÛÈÙ‹ ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔ-ÁÚ·Ê›·, ·Ó·ÊÔÚÈÎ¿ ÌÂ ·È‰È¿, ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡ÔÂÚÈÙÒÛÂÈ˜ ¤ÎÙÔÔ˘ ÛÏ‹Ó· (8).

∏ ·ÈÙÈÔÏÔÁ›· ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ·ÔÛ·ÊËÓÈÛÌ¤-ÓË. √È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·ÊÂ›˜ ıÂˆÚÔ‡Ó ˆ˜ÚfiÎÂÈÙ·È ÁÈ· Û˘ÁÁÂÓ‹ ‰È·Ì·ÚÙ›· ÂÚ› ÙË ‰È¿Ï·-ÛË ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ Û˘Ó‰ÂÛÌÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ, Ô˘Ê˘ÛÈÔÏÔÁÈÎ¿ Î·ıËÏÒÓÔ˘Ó ÙÔÓ ÛÏ‹Ó· ÛÙÔ ¿Óˆ·ÚÈÛÙÂÚfi ÎÔÈÏÈ·Îfi ÙÂÙ·ÚÙËÌfiÚÈÔ Î·È Ù· ÔÔ›· ·Ó·-Ù‡ÛÛÔÓÙ·È Î·Ù¿ ÙÔÓ 2Ô Ì‹Ó· ÙË˜ Î‡ËÛË˜ (6,7,9-11). √È Û‡Ó‰ÂÛÌÔÈ ·˘ÙÔ› Â›Ó·È Ô Á·ÛÙÚÔÛÏËÓÈÎfi˜,Ô˘ ÂÓÒÓÂÈ ÙÔ ÌÂ›˙ÔÓ ÙfiÍÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÌÂ ÙËÓ‡ÏË ÙÔ˘ ÛÏ‹Ó· Î·È Ô ÛÏËÓÔÓÂÊÚÈÎfi˜, Ô˘ Â-ÚÈ¤¯ÂÈ Ù· ·ÁÁÂ›· Î·È ÓÂ‡Ú· ÙË˜ ‡ÏË˜ Î·È Û˘ÁÎÚ·-ÙÂ› ÙÔÓ ÛÏ‹Ó· ÛÙÔ Ô›ÛıÈÔ ÂÚÈÙÔÓ·˚Îfi ÙÔ›¯ˆÌ·(7,9). ŸÙ·Ó ÙÔ Ú·¯È·›Ô ÙÌ‹Ì· ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÌÂÛÂ-ÓÙÂÚ›Ô˘ ·ÔÙ‡¯ÂÈ Ó· ÂÓˆıÂ› ÌÂ ÙÔ Ú·¯È·›Ô ÙÌ‹Ì·ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ Î·Ù¿ ÙË ‰È¿Ï·ÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘,Û¯ËÌ·Ù›˙ÂÙ·È Â›ÌËÎÂ˜ ÛÏËÓÈÎfi ÌÂÛÂÓÙ¤ÚÈÔ, ÔÛÏ‹Ó·˜ Â›Ó·È Â˘Î›ÓËÙÔ˜ Î·È Ë fiÏË Î·Ù¿ÛÙ·ÛËÚÔ‰È·ı¤ÙÂÈ ÛÂ ÔÍÂ›·, ˘ÔÍÂ›· ‹ ¯ÚfiÓÈ· Û˘ÛÙÚÔÊ‹Î·ıÒ˜ Î·È ÛÂ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ·Ó Ô ÛÏ‹Ó·˜ ÌÂÙ·-ÙÔÈÛıÂ› ·fi ÙË ı¤ÛË ÙÔ˘ (7,9). ∂Ó›ÔÙÂ ·Ô˘ÛÈ¿˙ÂÈ·ÓÙÂÏÒ˜ Î¿ıÂ ÛÙËÚÈÎÙÈÎfi Û˘Ó‰ÂÛÌÈÎfi ÛÙÔÈ¯Â›Ô(9,11,12). Œ¯Ô˘Ó Â›ÛË˜ ÂÚÈÁÚ·ÊÂ› ÙÔ˘Ï¿¯ÈÛÙÔÓ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ÂÓ‰ÔıˆÚ·ÎÈÎ‹˜ ÂÓÙfiÈÛË˜ ÎÚÂ-Ì¿ÌÂÓÔ˘ ÛÏ‹Ó· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ‰È·ÊÚ·ÁÌ·ÙÔ-Î‹ÏË, ·ÏÏ¿ ·ÔÙÂÏÂ› ‰È·ÊÔÚÂÙÈÎ‹ ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ·(6). ÕÏÏÔÈ Û˘ÁÁÚ·ÊÂ›˜, ÂÓÙÔ›˙Ô˘Ó ·˘ÍËÌ¤ÓË Û˘-¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÎÚÂÌ¿ÌÂÓÔ˘ ÛÏ‹Ó· ÛÂ Á˘Ó·›-ÎÂ˜ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÙÔ ·Ô‰›‰Ô˘ÓÛÙË ¯·Ï¿ÚˆÛË ÙˆÓ ÛÏËÓÈÎÒÓ Û˘Ó‰¤ÛÌˆÓ Î·Ù¿Î·È ÌÂÙ¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË (6,10). ÕÏÏÔÈ Â›ÎÙËÙÔÈÚÔ‰È·ıÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Â›Ó·ÈÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ›, ÔÈ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ Î·ÈÎ·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÛÏËÓÔÌÂÁ·-

Ï›·, fiˆ˜ Ë ÂÏÔÓÔÛ›·, ÔÈ ÛÏËÓÈÎ¤˜ Î‡ÛÙÂÈ˜, Ù··ÔÛÙ‹Ì·Ù·, ÚˆÙÔ·ıÂ›˜ ‹ ÌÂÙ·ÛÙ·ÙÈÎÔ› fiÁÎÔÈ,·ÈÌ·ÁÁÂÈÒÌ·Ù·, Ë ÓfiÛÔ˜ ÙÔ˘ Hodgkin, ·ÈÌÔÏ˘ÙÈÎ¤˜·Ó·ÈÌ›Â˜ ÎÏ. (6,9,11). øÛÙfiÛÔ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ÂÚÈÙÒÛÂÈ˜ Ô ÛÏ‹Ó·˜ ·˘Ùfi˜ Î·ı·˘Ùfi˜ Â›Ó·È Ê˘-ÛÈÔÏÔÁÈÎfi˜ (6).

√È ·ÛıÂÓÂ›˜ ÌÔÚÂ› Ó· Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎÔ› ‹Û˘ÓËı¤ÛÙÂÚ· Ó· ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ¯ÚfiÓÈ· ÎÔÈ-ÏÈ·Î¿ ¿ÏÁË, ÌÂÙÚ›·˜ ÂÓÙ¿ÛÂˆ˜, ÏfiÁˆ ‰È·ÏÂ›Ô˘-Û·˜ Û˘ÛÙÚÔÊ‹˜ (6,9) ‹ ÌÂÙ·Ó¿ÛÙÂ˘ÛË˜ ÙÔ˘ ÛÏ‹-Ó· (10). ÕÏÏÔÙÂ ¿ÏÈ, Ô ÛÏ‹Ó·˜ „ËÏ·Ê¿Ù·È ÂÎÙfi˜ÙË˜ ·Ó·ÙÔÌÈÎ‹˜ ÙÔ˘ ı¤ÛË˜ Î·È ‰›ÓÂÈ ÙËÓ ÂÓÙ‡ˆÛËÂÓ‰ÔÎÔÈÏÈ·Î‹˜ Ì¿˙·˜ (6,7,9). ∆¤ÏÔ˜, ÛÂ ·ÚÎÂÙÔ‡˜·ÛıÂÓÂ›˜ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌfiÓÔ ·ÊÔ‡ ÛËÌÂÈˆ-ıÔ‡Ó ÂÈÏÔÎ¤˜ (.¯. Û˘ÛÙÚÔÊ‹ ‹ Ú‹ÍË) Î·È ÙfiÙÂÙ· Û˘ÌÙÒÌ·Ù· Û˘Ó‹ıˆ˜ Â›Ó·È ÔÍ‡ ÎÔÈÏÈ·Îfi ¿Ï-ÁÔ˜, ÌÂ ‹ ¯ˆÚ›˜ shock (6,7,11,12), Î·Ù¿ÛÙ·ÛË Ô˘Ô‰ËÁÂ› ÛÂ ÂÂ›ÁÔ˘Û· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË.

∏ ·ÚÔ˘Û›· ÂÈÌËÎ˘ÛÌ¤ÓÔ˘ ·ÁÁÂÈ·ÎÔ‡ Ì›Û¯Ô˘‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÛÙÚÔÊ‹˜, Ë ÔÔ›·ÌÔÚÂ› Ó· Â›Ó·È ÔÍÂ›· , ‰È·ÏÂ›Ô˘Û· ‹ ¯ÚfiÓÈ·. ∏Û˘ÛÙÚÔÊ‹ ÂÌÔ‰›˙ÂÈ ·Ú¯ÈÎ¿ ÙË ÊÏÂ‚ÈÎ‹ ÚÔ‹ ÙÔ˘·›Ì·ÙÔ˜ ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ Û˘ÌÊfiÚËÛË, ÂÓÒ Ë ·ÚÙË-ÚÈ·Î‹ ·ÈÌ¿ÙˆÛË ÙÔ˘ ÛÏ‹Ó· ÂËÚÂ¿˙ÂÙ·È ·ÚÁfiÙÂ-Ú· (ÈÛ¯·ÈÌ›·). √ ‚·ıÌfi˜ ÙË˜ Û˘ÛÙÚÔÊ‹˜ ÔÈÎ›ÏÂÈÌÂÙ·Í‡ 90Ô, 360Ô ‹ Î·È ÔÏÏ·Ï¿ÛÈÔ˘ ·˘ÙÒÓ. √fiÓÔ˜ ÔÊÂ›ÏÂÙ·È ÛÙË ‰È¿Ù·ÛË ÙË˜ Î¿„·˜ ÙÔ˘ÛÏ‹Ó· Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂÒÓ ÙÔ˘, ·Ï-Ï¿ Î·È ÛÂ ÙÔÈÎ‹ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ (6).∞Ó Ë ‰È¿ÁÓˆÛË – ·ÓÙÈÌÂÙÒÈÛË Î·ı˘ÛÙÂÚ‹ÛÂÈ,ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÔ‡Ó Á¿ÁÁÚ·ÈÓ· ‹ ·ÔÛÙ‹Ì·-Ù· ÙÔ˘ ÛÏ‹Ó· Î·ıÒ˜ Î·È ·ÈÌÔÚÚ·Á›· ·fi ÎÈÚ-ÛÔ‡˜ ÔÈÛÔÊ¿ÁÔ˘. ™·ÓÈfiÙ·Ù· ÂÚÈÁÚ¿ÊÔÓÙ·È Û˘-ÛÙÚÔÊ‹ (ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹) ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È Û˘-ÛÙÚÔÊ‹ ÙË˜ Ô˘Ú¿˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, Ì¤¯ÚÈ Î·È ·-ÁÎÚÂ·ÙÈÎ‹ Ó¤ÎÚˆÛË (6,13).

∆ÔÓ Î‡ÚÈÔ ÏfiÁÔ ÛÙË ‰È¿ÁÓˆÛË ¤¯Ô˘Ó ÔÈ ·ÂÈÎÔ-

∂ÈÎfiÓ· 3. ™ÏËÓÔÌÂÁ·Ï›· ÌÂ ÛÙÚÔÊ‹ ÙÔ˘ ÛÏ‹Ó· (∏ ‡ÏË‚Ï¤ÂÈ ÛÙÔÓ ÔÈÛıÔÂÚÈÙÔÓ·˚Îfi ¯ÒÚÔ).

∂ÈÎfiÓ· 4. ∫¿Ùˆ fiÏÔ˜ ÛÏ‹Ó·, Â›ÛÔ‰Ô˜ ÂÏ¿ÛÛÔÓÔ˜ ˘¤ÏÔ˘ (π1-π2).

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ÓÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜·ÔÙÂÏÂ› ÙË Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜. Ã·Ú·ÎÙËÚÈÛÙÈÎfi Â‡-ÚËÌ· Â›Ó·È Ë ·Ô˘Û›· ÙÔ˘ ÛÏ‹Ó· ·fi ÙËÓ «ÎÔÈÙ›-‰·» ÙÔ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ˘Ô¯fiÓ‰ÚÈÔ Î·È Ë ·ÓÂ‡ÚÂÛË«Ì¿˙·˜» ÔÔ˘‰‹ÔÙÂ ÂÓ‰ÔÎÔÈÏÈ·Î¿, ÌÂ Û·Ê¤˜ Â-Ú›ÁÚ·ÌÌ·, Î¿„· Î·È ˘ÂÚË¯ÔÁÂÓ‹ ‰ÔÌ‹ ‹·ÙÔ˜-ÛÏ‹Ó·(6,7). ∞ÓÙ›ÛÙÔÈ¯·, ÛËÌ·ÓÙÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹‚Ô‹ıÂÈ· ÚÔÛÊ¤ÚÂÈ Î·È ÙÔ ¤Á¯ÚˆÌÔ ˘ÂÚË¯ÔÁÚ¿-ÊËÌ·, ÌÂ ÙÔ ÔÔ›Ô ÌÔÚÂ› Ó· ÂÎÙÈÌËıÂ› Î·È Ë ·ÈÌ¿-ÙˆÛË ÙÔ˘ ÛÏ‹Ó· Î·È Ó· ‰È·ÈÛÙˆıÂ› Ë ·ÚÔ˘Û›·Û˘ÌÊfiÚËÛË˜ ‹ ÈÛ¯·ÈÌ›·˜ ÙÔ˘ ÛÏËÓÈÎÔ‡ ·ÚÂÁ¯‡-Ì·ÙÔ˜, Î·ıÒ˜ Î·È Ë ÔÚÂ›· ÙˆÓ ÛÏËÓÈÎÒÓ ·ÁÁÂ›ˆÓÙÔ˘ ¤ÎÙÔÔ˘ ÛÏ‹Ó· (6,11).

∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÓ‰Â›ÎÓ˘Ù·È Î˘Ú›ˆ˜ ÛÂÂÚÈÙÒÛÂÈ˜ Û˘ÛÙÚÔÊ‹˜ ‹ Ú‹ÍË˜, ÚÔÛÊ¤ÚÔÓÙ·˜ÂÎÙfi˜ ·fi ÙË ‰È¿ÁÓˆÛË, ÂÈÚfiÛıÂÙÂ˜ ÏËÚÔÊÔ-Ú›Â˜ ÁÈ· ÙËÓ ·ÈÌ¿ÙˆÛË Î·È ÙËÓ ˘Ê‹ ÙÔ˘ ÛÏËÓÈÎÔ‡·ÚÂÁ¯‡Ì·ÙÔ˜ ÛÙÔÓ ¯ÂÈÚÔ˘ÚÁfi (6,7,9).

∏ ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÚÔ˘Û›· ‹fi¯È ÂÈÏÔÎÒÓ Î·È ÙË ‚ÈˆÛÈÌfiÙËÙ· ‹ ÌË ÙÔ˘ ÛÏË-ÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜. ∆· ÂÚÈÛÛfiÙÂÚ· ÂÚˆÙËÌ·ÙÈ-Î¿ ÁÂÓÓ¿ Ë ·ÓÙÈÌÂÙÒÈÛË ·ÚÚÒÛÙˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈ-Îfi Î·Ù¿ Ù· ¿ÏÏ· ÛÏ‹Ó·, fiˆ˜ ÛÙË ‰ÈÎ‹ Ì·˜ ÂÚ›-ÙˆÛË, Î·ıÒ˜ - ÔÈ ·fi„ÂÈ˜ Î·Ù¿ Î·ÈÚÔ‡˜ ·ÏÏ¿-˙Ô˘Ó Ê¤ÚÔÓÙ·˜ ¿ÏÏÔÙÂ ˆ˜ Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜ ÙËÓÛÏËÓÂÎÙÔÌ‹ Î·È ¿ÏÏÔÙÂ ÙËÓ ÛÏËÓÔËÍ›·. ¶ÚÔ-ÎÂÈÌ¤ÓÔ˘ ÁÈ· ·È‰È¿, fiÔ˘ Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛË˜ÏÔÈÌÒÍÂˆÓ Î·È ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÌÂÙ¿ ÛÏËÓÂÎÙÔÌ‹Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜, Î·Ù·‚¿ÏÏÂÙ·È ÚÔÛ¿ıÂÈ· ÁÈ·Ó· ‰È·ÙËÚËıÂ› Ô ÛÏ‹Ó·˜. ™Â ÂÚÈÙÒÛÂÈ˜ ÈÛ¯·ÈÌÈ-Î‹˜ Ó¤ÎÚˆÛË˜ ‹ ˘ÔÎÂ›ÌÂÓË˜ ÓÂÔÏ·ÛÌ·ÙÈÎ‹˜ Ófi-ÛÔ˘ ˘¿Ú¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË ÛÏËÓÂÎÙÔÌ‹˜ (6).™ÙË ‰ÈÎ‹ Ì·˜ ÂÚ›ÙˆÛË, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ¤ıÂÛÂ ÙË‰È¿ÁÓˆÛË, Ë ÔÔ›· ÂÈ‚Â‚·ÈÒıËÎÂ ÌÂ ÙÈ˜ ·ÂÈÎÔÓÈ-

ÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜. ∏ ·Ô˘Û›· ÂÈÏÔÎÒÓ ·fi ÙÔÛÏËÓÈÎfi ·Ú¤Á¯˘Ì· Î·È Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ÙÔ˘ ·ÈÌ¿-ÙˆÛË ‹Ù·Ó ‰‡Ô ÛÙÔÈ¯Â›· Ô˘ Û˘ÓÂÎÙÈÌ‹ıËÎ·Ó,ÒÛÙÂ Ó· Á›ÓÂÈ ÚÔÛ¿ıÂÈ· ‰È·Ù‹ÚËÛË˜ ÙÔ˘ ÔÚÁ¿-ÓÔ˘ Î·È ·ÔÎ·Ù¿ÛÙ·Û‹˜ ÙÔ˘ ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ·Ó·-ÙÔÌÈÎ‹ ÙÔ˘ ı¤ÛË. ™‹ÌÂÚ·, ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË, ÙÔ ·È‰› ‰ÂÓ ·ÚÔ˘ÛÈ¿-˙ÂÈ ÎÔÈÏÈ·Î¿ ¿ÏÁË Î·È Ô ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ÙÔ˘ ÛÏ‹Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Robinson AP. Wandering spleen: case report and review.

Mt Sin J Med 1988;55:428-434.2. Martin A. A successful case of splenotomy. Br J Med

1978;61:191-192.3. Fujiwara T, Takehara Y, Isoda H, Ichijo K, Tooyama N,

Kodaira N et al. Torsion of a wandering spleen: CT andangiographic appearance. Comput Assist Tomogr1995;19:84-86.

4. Allen KB, Gibbs A. Pediatric wandering spleen, the caseof splenopexy. J Pediatr Surg 1989;17:373.

5. Eraklis AJ, Filler RM. Splenectomy in childhood, a reviewof 1413 cases. J Pediatr Surg 1972;7:382-388.

6. Peitgen K, Scweden K. Management of intermittentsplenic torsion ("wandering spleen"): a review. Eur J Surg1995;161:49-52.

7. Raissaki M, Prassopoulos P, Daskalogiannaki M,Magkanas E, Gourtsoyiannis N. Acute abdomen pain dueto torsion of wandering spleen: CT diagnosis. Eur Radiol1998;8:1409-1412.

8. ¶ÚˆÙÔÛ˘ÁÁÂÏ›‰Ô˘ ª, °·ÚÔ‡ÊË ∞, µÏfiÓÙ˙Ô˘ ∫, ∫·ÙÛÈÎ¿-ÚË ª, ª·ÚÔ‡¯·˜ °, ªÔ˘ÙÛÔ‡ÚË˜ Ã. ¶Ï¿ÓËÙ·˜ ÛÏ‹Ó·˜ÛÂ 2 ·È‰È¿. [¶ÂÚ›ÏË„Ë ∞Ú. 153∞∞]. 32Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È-‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1994 17-19 πÔ˘Ó›Ô˘; ∫¤ÚÎ˘Ú·; 1994.

9. Saadaoui H, Toppet V, Hubloux G, Horth M, Cadiere G,Spehl M. Acute torsion of a wandering spleen in a child:preoperative diagnosis by ultrasonography andcomputed tomography. Eur J Radiol 1998;26:205-209.

10. Possilico L, Shah A. A wandering spleen detection by In-111 leucocyte imaging. Clin Nucl Med 1996;4:287-289.

11. Newman B, Bowen A, Eggli KD. Recognition ofmalposition of the liver and spleen: CT, MRI, nuclear scanand fluoroscopic imaging. Pediatr Radiol 1994;24:274-279.

12. Papakyriacou K, Nicolaou N, Symeonides P. Wanderingspleen: a rare emergency condition. Br J Surg1996;83:46-50.

13. Sheflin JR, Lee CM, Kretchmar KA. Torsion of wanderingspleen and distal pancreas. Am J Roentgenol 1984;142:100-101.

∂ÈÎfiÓ· 5. ŒÎÙÔÔ˜ ‰ÈÔÁÎˆÌ¤ÓÔ˜ ÛÏ‹Ó·˜ ÌÂ Î·Ù·ÎÚ¿ÙË-ÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÂÓÙfi˜ ·˘ÙÔ‡. (£ÂÚÌfi˜ ÛÏ‹Ó·˜).


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

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�¶ÂÚ›ÏË„Ë: OÈ ÎÏËÚÔÓÔÌÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ Ô˘ ÂÎ‰ËÏÒÓÔÓÙ·È ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛËÁÈÁ·ÓÙÈ·›ˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ıÚÔÌ‚ÔÂÓ›· ¯·Ú·-ÎÙËÚ›˙ÔÓÙ·È ¿ÏÏÔÙÂ ˆ˜ ÔÛÔÙÈÎ¤˜ (·ÓˆÌ·Ï›· May-Hegglin, Û‡Ó‰ÚÔÌ· Fechtner Î·È Sebastian) Î·È¿ÏÏÔÙÂ ˆ˜ ÔÈÔÙÈÎ¤˜ (Û‡Ó‰ÚÔÌ· Bernard-Soulier,Epstein, Montreal, ÓfiÛÔ˜ Von Willebrand Ù‡Ô˘ππb). ™Â ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂÈ˜ fiÌˆ˜, Ë ·ÎÚÈ‚‹˜ Î·-Ù¿Ù·ÍË ÙË˜ ÎÏËÚÔÓÔÌÈÎ‹˜ ·˘Ù‹˜ ‰È·Ù·Ú·¯‹˜ ‰ÂÓÂ›Ó·È ‰˘Ó·Ù‹ ÏfiÁˆ ÙË˜ ·Ô˘Û›·˜ ÂÈ‰ÈÎÒÓ Â˘ÚËÌ¿-ÙˆÓ. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜ (ÌËÙ¤Ú· Î·ÈÎfiÚË), ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ·ÈÌÔÚÚ·ÁÈÎ‹˜ ‰È¿ıÂÛË˜, ÌÂ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (ÁÈÁ·-ÓÙÈ·›·) Ô˘ ÂÎ‰ËÏÒıËÎÂ Û·Ó „Â˘‰‹˜ ıÚÔÌ‚ÔÂ-Ó›·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡ Î·ÈÙË˜ ÌËÙ¤Ú·˜ ¤‰ÂÈÍÂ ıÚÔÌ‚ÔÂÓ›· (·ÚÈıÌfi˜ ·ÈÌÔ-ÂÙ·Ï›ˆÓ 50-120 x 109/L) ÛÂ Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ÌÂ-ÙÚ‹ÛÂÈ˜ ÛÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ·Ó·Ï˘Ù‹ Î·È ·˘ÍËÌ¤ÓÔÌ¤ÛÔ fiÁÎÔ ·ÈÌÔÂÙ·Ï›ˆÓ (12-16 fl). ∞fi ÙË ÌÈÎÚÔ-ÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ·ÚÈıÌÔ‡ Î·È ÙË˜ ÌÔÚÊÔÏÔ-Á›·˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÂ Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡·›Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi˜ ·ÚÈıÌfi˜ ·È-ÌÔÂÙ·Ï›ˆÓ, ·ÚÔ˘Û›· ÌÈÎÚÒÓ ·ÈÌÔÂÙ·ÏÈ·ÎÒÓÛˆÚÒÓ Î·ıÒ˜ Î·È ÌÂÁ¿Ï·-ÁÈÁ·ÓÙÈ·›· ·ÈÌÔÂÙ¿ÏÈ·.™ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ÙÔ˘ ·È‰ÈÔ‡ ‚Ú¤ıËÎÂ ·˘ÍËÌ¤-ÓÔ˜ ·ÚÈıÌfi˜ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ÌÔÚÊÔÏÔÁ›·. ∞ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î¿ ·ÓÙÈÛÒÌ·Ù· ·ÓÈ-¯ÓÂ‡ıËÎ·Ó ÌÂ ÙËÓ ¿ÌÂÛË Ì¤ıÔ‰Ô (ÔÏÈÎfi ·›Ì·)Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜. ª¤¯ÚÈ Û‹ÌÂÚ· ÌËÙ¤-Ú· Î·È ÎfiÚË ‰ÂÓ ¤¯Ô˘Ó ÂÌÊ·Ó›ÛÂÈ Î·Ó¤Ó· ÎÏÈÓÈÎfi

�Abstract: Hereditary giant platelet disorders arecharacterized either as quantitative (May-Hegglinanomaly, Fechtner and Sebastian platelet syndro-mes), or as qualitative (Bernard-Soulier, Epsteinand Montreal syndromes, type IIb von Willebranddisease). However, a number of giant plateletdisorders cannot be classified as yet, due to theabsence of specific findings. We describe twocases (mother and daughter) with non specifichereditary giant platelet disorder, that presentedas "pseudothrombocytopenia", in the absence ofany history of bleeding diathesis. Platelet counts(Coulter),which were performed several timesover an eight-month period were found to bedecrea- sed ranging from 50 to 120 x 109/L,whilethe mean platelet volume (MPV) was alwayselevated (12-16 fl). Microscopic examination ofplatelet morphology stained peripheral bloodfilms revealed the presence of small plateletaggregates as well as giant thrombocytes whilethe platelet count was within normal limits.Examination of the child’s bone marrow aspiraterevealed an increased number of megacaryocyteswith normal morphology. Platelet associated IgGantibodies (PAIgG) were increased in bothpatients. Up to the present time both mother anddaughter have not developed any bleedingsymptoms and have not required any specifictreatment. It is postulated that the diagnosis is thatof a non specific hereditary giant platelet disorder

∫ÏËÚÔÓÔÌÈÎ‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (ÁÈÁ·ÓÙÈ·›·) Ô˘ ÂÎ‰ËÏÒıËÎÂ Û·Ó “„Â˘‰ÔıÚÔÌ‚ÔÂÓ›·” ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ∂. Ã·Ù˙Ë·ÓÙÂÏ‹˜, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿, Ã. ∆Û¿ÓÙ·ÏË, ∫. ∞‚Ú·Ì›‰Ô˘, ¢. ∑·ÌÔ‡ÏË*, ¡. °ÔÌ¿ÎË˜

Hereditary giant platelet disorder presenting as "pseudothrombocytopenia" A report of two casesE. Hatzipantelis, M. Athanassiou-Metaxa, H. Tsantali, K. Avramidou, D. Zambuli*, N. Gombakis

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£., “πÔÎÚ¿ÙÂÈÔ” °.¶.¡.£.*∞ÈÌ·ÙÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, “£Â·Á¤ÓÂÈÔ” ∞ÓÙÈÎ·ÚÎÈÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô, £ÂÛÛ·ÏÔÓ›ÎË

1st Pediatric Clinic of the Aristotelion University ofThessaloniki, “Ippokration” Hospital*Hematology Laboratory, “Theagenio” ∞nticancer Hospital, Thessaloniki


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∂ÈÛ·ÁˆÁ‹OÈ ÎÏËÚÔÓÔÌÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ

Ô˘ ÂÎ‰ËÏÒÓÔÓÙ·È ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÁÈÁ·ÓÙÈ·›ˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ ‰˘Ó·ÙfiÓ Ó· Â›Ó·È ÔÛÔÙÈÎ¤˜ Î·È ÔÈÔÙÈ-Î¤˜. √È ÔÛÔÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ Ë ·ÓˆÌ·Ï›·May-Hegglin Î·È Ù· Û‡Ó‰ÚÔÌ· Fechtner Î·ÈSebastian, ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ıÚÔÌ‚ÔÂÓ›· Î·ÈÙËÓ ·ÚÔ˘Û›· ÏÂ˘ÎÔÎ˘ÙÙ·ÚÈÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ Î·È ÎÏË-ÚÔÓÔÌÔ‡ÓÙ·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ·¯·Ú·ÎÙ‹Ú·. ™ÙÈ˜ ÔÈÔÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÛÙÈ˜ ÔÔ›Â˜Ô ¯·Ú·ÎÙ‹Ú·˜ ÙË˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÔÈÎ›ÏÏÂÈ,·Ó‹ÎÔ˘Ó Ù· Û‡Ó‰ÚÔÌ· Bernard-Soulier, Epstein,Montreal Î·È Ë ÓfiÛÔ˜ Von Willebrand Ù‡Ô˘ ππb. ™ÂÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ Ë ·ÚÔ˘Û›· ÌÂÁ¿ÏˆÓ ·ÈÌÔÂ-Ù·Ï›ˆÓ Û˘ÓÔ‰Â˘fiÌÂÓË ·fi ıÚÔÌ‚ÔÂÓ›· ¤¯ÂÈ Û˘-Û¯ÂÙÈÛıÂ› ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ Alport (1-5). ¶·ÚfiÏ· ·˘-Ù¿, ÛÂ ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂÈ˜ Ë ·ÎÚÈ‚‹˜ Î·Ù¿Ù·ÍËÙË˜ ÎÏËÚÔÓÔÌÈÎ‹˜ ·˘Ù‹˜ ‰È·Ù·Ú·¯‹˜ ‰ÂÓ Â›Ó·È ‰˘-Ó·Ù‹ ÏfiÁˆ ÙË˜ ·Ô˘Û›·˜ ÂÈ‰ÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. æÂ˘-‰‹˜ ıÚÔÌ‚ÔÂÓ›· Î·Ù¿ ÙË Ì¤ÙÚËÛË ÙˆÓ ·ÈÌÔÂÙ·-Ï›ˆÓ ·fi ÙÔÓ ·Ó·Ï˘Ù‹ ÌÔÚÂ› Ó· Û˘Ì‚Â› ÛÂ Î·Ù·-ÛÙ¿ÛÂÈ˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi Û˘ÛÛÒÚÂ˘ÛËÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ·Ú¿ ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈËÎÙÈÎÔ‡‹ ·fi ÙËÓ ·ÚÔ˘Û›· ÌÂÁ¿ÏˆÓ-ÁÈÁ·ÓÙÈ·›ˆÓ ·ÈÌÔÂ-Ù·Ï›ˆÓ (6-9).

¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜ (ÌËÙ¤Ú· Î·È Îfi-ÚË), ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ·ÈÌÔÚÚ·ÁÈÎ‹˜ ‰È¿ıÂÛË˜, ÌÂ„Â˘‰‹ ıÚÔÌ‚ÔÂÓ›·, Ô˘ ·Ó·Î·Ï‡ÊıËÎÂ ÛÂ Ù˘¯·›Ô¤ÏÂÁ¯Ô Î·È ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·ÈÌÔÂÙ·-Ï›ˆÓ (ÁÈÁ·ÓÙÈ·›·), ÏfiÁˆ ÙË˜ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜ Î·ÈÙÔ˘ ÌÂÁ¿ÏÔ˘ ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ ÂÙ¿ ¯ÚÔÓÒÓ Ô˘ ÚÔÛÎÔ-

Ì›ÛıËÎÂ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÁÈ· Èı·Ó‹ ÏÔ›Ìˆ-ÍË ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È ÛÙÔ ÔÔ›Ô‰È·ÈÛÙÒıËÎÂ ‹È· ıÚÔÌ‚ÔÂÓ›· ¯ˆÚ›˜ ÎÏÈÓÈÎ¤˜ ÂÎ-‰ËÏÒÛÂÈ˜. ∞fi ÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂ-Ù·È fiÙÈ ÁÂÓÓ‹ıËÎÂ ÚfiˆÚ·, ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜

1510 gr Î·È ·Ú¤ÌÂÈÓÂ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡Ô-ÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ (ª∂¡¡) ÁÈ· ¤ÍÈ Â‚‰ÔÌ¿‰Â˜ ÏfiÁˆÚÔ‚ÏËÌ¿ÙˆÓ Û›ÙÈÛË˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛË-ÏÂ›·˜ ÙÔ˘ ÛÙË ª∂¡¡ ‚Ú¤ıËÎÂ ‹È· ıÚÔÌ‚ÔÂÓ›·(·ÈÌÔÂÙ¿ÏÈ· 50-100 x 109/L) ¯ˆÚ›˜ ·ÈÌÔÚÚ·ÁÈÎ‹‰È¿ıÂÛË Î·È ·Ó·ÈÌ›· ÁÈ· ÙËÓ ÔÔ›· ˘Ô‚Ï‹ıËÎÂ ÛÂÌÂÙ¿ÁÁÈÛË ÌÂ Û˘Ì˘ÎÓˆÌ¤Ó· ÂÚ˘ıÚ¿. ∞fi ÙÔ ·ÙÔ-ÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÛÂ 2-3 Ù˘¯·›Â˜ ÌÂÙÚ‹-ÛÂÈ˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ‚Ú¤ıËÎÂ ‹È· ıÚÔÌ‚ÔÂÓ›·(·ÈÌÔÂÙ¿ÏÈ· 80-150 Ã 109/L), Ë ÔÔ›· ‰ÂÓ ‰ÈÂÚÂ˘-Ó‹ıËÎÂ ÂÚ·ÈÙ¤Úˆ. ∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë ÌËÙ¤Ú· ·Ó·Ê¤ÚÂÈ Î·È ·˘Ù‹ ‹È·ıÚÔÌ‚ÔÂÓ›· ¯ˆÚ›˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, Ë ÔÔ›··Ó·Î·Ï‡ÊıËÎÂ Ù˘¯·›· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∞fi ÙËÓÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ·È‰ÈÔ‡, ÌÂÙ¿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ÏÔ›ÌˆÍË˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡, ‰ÂÓ ‰È·ÈÛÙÒıË-ÎÂ Ù›ÔÙ· ·ıÔÏÔÁÈÎfi, ÂÓÒ Ë ÛˆÌ·ÙÈÎ‹ Î·È „˘¯ÔÎÈ-ÓËÙÈÎ‹ ·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ∞fi ÙËÓ ·ÓÙÈ-ÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ÙË˜ ÌËÙ¤Ú·˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈÂÚfiÎÂÈÙÔ ÁÈ· Á˘Ó·›Î· 33 ¯ÚÔÓÒÓ, ˘ÁÈ‹, ÌÂ Ê˘ÛÈÔ-ÏÔÁÈÎ‹ ÛˆÌ·ÙÈÎ‹ Î·È ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍË, ¯ˆÚ›˜ ÈÛÙÔ-ÚÈÎfi ·ÈÌÔÚÚ·ÁÈÎ‹˜ ‰È¿ıÂÛË˜ Ì¤¯ÚÈ Û‹ÌÂÚ·.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÙÔ˘ ·È‰ÈÔ‡ Î·ÈÙË˜ ÌËÙ¤Ú·˜ ‰È·ÈÛÙÒıËÎÂ ıÚÔÌ‚ÔÂÓ›· (·ÚÈıÌfi˜·ÈÌÔÂÙ·Ï›ˆÓ 50-120 x 109/L) ÛÂ Â·ÓÂÈÏËÌÌ¤ÓÂ˜ÌÂÙÚ‹ÛÂÈ˜ ÛÂ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ·Ó·Ï˘Ù¤˜, ÂÓÒ ÔÈ˘fiÏÔÈÂ˜ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÛÂÈÚ¤˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-Î¤˜. ªÂÙÚ‹ÛÂÈ˜ ÙÔ˘ ·ÚÈıÌÔ‡ Î·È ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ ¤ÁÈÓ·Ó ¤ÓÙÂ ÊÔÚ¤˜ ÛÂ ‰È¿ÛÙËÌ· Ô¯ÙÒÌËÓÒÓ Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜. ™ÙÈ˜ Ï‹„ÂÈ˜ ‰Â›Á-Ì·ÙÔ˜ ·›Ì·ÙÔ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ·ÓÙÈËÎÙÈÎ¿K3-EDTA, Ë·Ú›ÓË Î·È ÎÈÙÚÈÎfi Ó¿ÙÚÈÔ. √È ÌÂÙÚ‹ÛÂÈ˜¤ÁÈÓ·Ó ÛÙÔ ¯ÚfiÓÔ 0, 60, 180 Î·È 240 min. T·˘Ùfi¯ÚÔ-Ó· ÁÈÓfiÙ·Ó Î·È ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ·ÚÈıÌÔ‡Î·È ÙË˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÂ Â›¯ÚÈ-ÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÌÂ Î·È ¯ˆÚ›˜ ÙË ¯ÚËÛÈÌÔ-Ô›ËÛË ·ÓÙÈËÎÙÈÎÔ‡. √ ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓÛÙÔÓ ·Ó·Ï˘Ù‹ Î˘Ì·ÈÓfiÙ·Ó ¿ÓÙÔÙÂ ÌÂÙ·Í‡ 50-120 x109/L Î·È Ô Ì¤ÛÔ˜ fiÁÎÔ˜ ÙÔ˘˜ ÌÂÙ·Í‡ 12-16 fl. ∞ÓÙ›-ıÂÙ·, Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ‚Ú¤ıËÎÂ Ì¤Û·

Û‡ÌÙˆÌ· Î·È ‰ÂÓ ¯ÚÂÈ¿ÛıËÎÂ Î·Ì›· ıÂÚ·Â˘ÙÈÎ‹·ÓÙÈÌÂÙÒÈÛË. ¶Èı·ÓÔÏÔÁÔ‡ÌÂ fiÙÈ Ë ‰È¿ÁÓˆÛË Â›-Ó·È ·˘Ù‹ ÙË˜ ÎÏËÚÔÓÔÌÈÎ‹˜, ÌË ÂÈ‰ÈÎ‹˜ ‰È·Ù·Ú·-¯‹˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÌÂ ÂÌÊ¿ÓÈÛË ÁÈÁ·ÓÙÈ·›ˆÓ·ÈÌÔÂÙ·Ï›ˆÓ, ‰È¿ÁÓˆÛË Ô˘ ÌÔÚÂ› Ó· ·Ó·ÙÚ·-Â› ·Ó ÔÈ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È ·-Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈÎ¿ ÂÌÊ·Ó›ÛÔ˘Ó Î¿ÔÈ·ÎÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÛÙÔ Ì¤ÏÏÔÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÁÈÁ·ÓÙÈ·›· ·ÈÌÔÂÙ¿ÏÈ·, ÎÏËÚÔÓÔÌÈ-Î‹ ‰È·Ù·Ú·¯‹ ·ÈÌÔÂÙ·Ï›ˆÓ, „Â˘‰ÔıÚÔÌ‚ÔÂÓ›·.

However, this diagnosis may change, if the caseswe describe develop any clinical symptoms onfollow up.

Key words: giant platelets, hereditary platelet disor-der, pseudothrombocytopenia.

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ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· (150-400 Ã 109/L) fiÙ·Ó ÔÈ ÌÂ-ÙÚ‹ÛÂÈ˜ ¤ÁÈÓ·Ó ÌÂ ¿ÌÂÛÔ ÙÚfiÔ ÛÙÔ ÌÈÎÚÔÛÎfiÈÔ.ªfiÓÔ ÛÂ ¤Ó· ‰Â›ÁÌ· Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ‚Ú¤ıËÎÂ ÔÚÈ·Î¿ ÂÏ·ÙÙˆÌ¤ÓÔ˜. £¤ÚÌ·ÓÛË ÙˆÓ ‰ÂÈÁ-Ì¿ÙˆÓ ÛÙÔ˘˜ 37ÔC ‰ÂÓ ÙÚÔÔÔ›ËÛÂ Ù· Â˘Ú‹Ì·Ù··fi ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜. ∆Ô Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·-ÙÔ˜ ¤‰ÂÈÍÂ ÙËÓ ·ÚÔ˘Û›· ÛˆÚÒÓ Î·È ÌÂÁ¿ÏˆÓ ·ÈÌÔ-ÂÙ·Ï›ˆÓ (∂ÈÎfiÓ· 1). ∏ Ï‹ÚË˜ ÂÚÁ·ÛÙËÚÈ·Î‹ ‰ÈÂ-ÚÂ‡ÓËÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 1.™ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ÙÔ˘ ·È‰ÈÔ‡ ‚Ú¤ıËÎÂ ·˘ÍËÌ¤ÓÔ˜·ÚÈıÌfi˜ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ÌÔÚ-ÊÔÏÔÁ›· Î·È ÔÏÏ¿ ·ÈÌÔÂÙ¿ÏÈ· (∂ÈÎfiÓÂ˜ 2, 3). ∞ÓÙÈ-·ÈÌÔÂÙ·ÏÈ·Î¿ ·ÓÙÈÛÒÌ·Ù· ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÌfiÓÔ ÌÂÙËÓ ¿ÌÂÛË Ì¤ıÔ‰Ô, ‰ËÏ·‰‹ ÛÙÔ ÔÏÈÎfi ·›Ì· Î·È fi¯ÈÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ, ÂÓÒ Ô Ù›ÙÏÔ˜ ÙˆÓ ÎÚ˘Ô-ÛÊ·ÈÚÈÓÒÓ ÛÙÔÓ ÔÚfi (ÌËÙ¤Ú·) ‹Ù·Ó ÂÏ·ÊÚ¿ ·˘ÍË-Ì¤ÓÔ˜. ª¤¯ÚÈ Û‹ÌÂÚ· ÌËÙ¤Ú· Î·È ÎfiÚË ‰ÂÓ ¤¯Ô˘ÓÂÌÊ·Ó›ÛÂÈ Î·Ó¤Ó· ÎÏÈÓÈÎfi Û‡ÌÙˆÌ· Î·È ‰ÂÓ ¯ÚÂÈ¿-ÛıËÎÂ Î·Ì›· ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË.

™˘˙‹ÙËÛË∏ «„Â˘‰ÔıÚÔÌ‚ÔÂÓ›·» ·ÔÙÂÏÂ› Ì›· ÂÚÁ·ÛÙË-

∂ÈÎfiÓ· 1. ¢Â›ÁÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÌÂ Ûˆ-ÚÔ‡˜ Î·È ÌÂÁ¿Ï· ·ÈÌÔÂÙ¿ÏÈ·.

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚÈ·Î‹ ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ (ÌËÙ¤Ú·-ÎfiÚË).∞ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ªËÙ¤Ú· ¶·È‰›∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl) 12 11,2AÚÈıÌfi˜ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ (X109/L) 5,5 4,7∞Ú. ∞ÈÌÔÂÙ·Ï›ˆÓ (x109/L) 50-90 60-120(·ÈÌ·ÙÔÏ. ·Ó·Ï˘Ù‹˜ ÌÂ ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ·ÓÙÈËÎÙÈÎÒÓ)

∞Ú. ∞ÈÌÔÂÙ·Ï›ˆÓ (x109/L) 150-400 150-400(Ì¤ÙÚËÛË ÛÂ Ï¿Î· Neubauer Î·È Â›¯ÚÈÛÌ· ÂÚ. ·›Ì·ÙÔ˜)

ª¤ÛÔ˜ fiÁÎÔ˜ ·ÈÌÔÂÙ·Ï›ˆÓ (Fl) ~ 16 ~ 12ªÔÚÊÔÏÔÁ›· ·ÈÌÔÂÙ·Ï›ˆÓ ÌÂÁ¿Ï· ·ÈÌÔÂÙ¿ÏÈ· Ô˘ Û¯ËÌ·Ù›˙Ô˘Ó ÛˆÚÔ‡˜ŒÏÂÁ¯Ô˜ ·Ó·ÈÌ›·˜ ÎÊ ÎÊ(Û›‰ËÚÔ˜, ÊÂÚÚÈÙ›ÓË, µ12, Ê˘ÏÏÈÎfi ÔÍ‡, ¢∂∫, G6PD, ÌÔÚÊÔÏÔÁ›· ÂÚ˘ıÚÒÓ, ËÏÂÎÙÚÔÊfiÚËÛË Hb)

ŒÏÂÁ¯Ô˜ ·ÈÌfiÛÙ·ÛË˜ ÎÊ ÎÊPT-APTT, ÈÓˆ‰ÔÁfiÓÔ, ·Ú¿ÁÔÓÙ·˜ VIII,vWF, vWFAg, ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ·ÈÌÔÂÙ·Ï›ˆÓ(Û˘ÛÛÒÚÂ˘ÛË ÌÂÙ¿ ÚÔÛı‹ÎË ADP, ÎÔÏÏ·ÁfiÓÔ˘, ÚÈÛÙÔÛÂÙ›ÓË˜) ÃÚfiÓÔ˜ ÚÔ‹˜ (IVY method) 7,5 min 4 minª˘ÂÏfiÁÚ·ÌÌ· ·˘ÍËÌ¤ÓÔ˜ ·ÚÈıÌfi˜ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ÌÂ (‰ÂÓ ¤ÁÈÓÂ ÛÙË ÌËÙ¤Ú·) Ê˘ÛÈÔÏÔÁÈÎ‹ ÌÔÚÊÔÏÔÁ›· Î·È ÔÏÏ¿ ·ÈÌÔÂÙ¿ÏÈ·

U/S ‹·ÙÔ˜-ÛÏËÓfi˜ ‰ÂÓ ¤ÁÈÓÂ ÎÊ

µ·ÛÈÎfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÊ ÎÊ

∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜∞ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜-˘ÔÙ¿ÍÂÈ˜, ∞¡∞-DNA-C3-C4-CIC ÎÊ ÎÊ∫Ú˘ÔÛÊ·ÈÚ›ÓÂ˜ ÔÚÔ‡ (ng/100ml) 18 4AÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î¿ ·ÓÙÈÛÒÌ·Ù·

(¿ÌÂÛË Ì¤ıÔ‰Ô˜, ÔÏÈÎfi ·›Ì·) ıÂÙÈÎ¿ ıÂÙÈÎ¿(¤ÌÌÂÛË Ì¤ıÔ‰Ô˜, ÔÚfi˜) ·ÚÓËÙÈÎ¿ ·ÚÓËÙÈÎ¿

√ÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÚÓËÙÈÎfi˜ ·ÚÓËÙÈÎfi˜(Ë·Ù›ÙÈ‰· B Î·È C, HIV, ÂÚ˘ıÚ¿, ÙÔÍfiÏ·ÛÌ·, Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜)∞ÎÔ˘ÔÏÔÁÈÎfi˜-ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÊ ÎÊ

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ÚÈ·Î‹ ÔÓÙfiÙËÙ· Ô˘ ‰È·ÈÛÙÒıËÎÂ ÌÂÙ¿ ÙËÓ ¤ÓÙ·ÍËÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ·Ó·Ï˘ÙÒÓ ÛÙËÓ Î·ıËÌÂÚÈÓ‹Ú¿ÍË Î·È ÔÊÂ›ÏÂÙ·È ÛÙË Û˘ÛÛÒÚÂ˘ÛË ÙˆÓ ·ÈÌÔÂ-Ù·Ï›ˆÓ ·Ú¿ ÙË ¯ÚËÛÈÌÔÔ›ËÛË ·ÓÙÈËÎÙÈÎÒÓ. ∏«„Â˘‰ÔıÚÔÌ‚ÔÂÓ›·» ·ÓÂ˘Ú›ÛÎÂÙ·È ÛÂ ÔÛÔÛÙ¿0,01-0,1% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·›Ì·ÙÔ˜ Ô˘ Ï·Ì‚¿ÓÔÓÙ·ÈÌÂ ·ÓÙÈËÎÙÈÎfi ÙÔ EDTA, Ô˘ ·ÔÙÂÏÂ› ÙË Û˘¯ÓfiÙÂ-ÚË ·ÈÙ›· ·˘ÙÔ‡ ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ (6-9). ¶ÚfiÎÂÈÙ·ÈÌ¿ÏÏÔÓ ÁÈ· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ Î·ÙÂ˘ı‡ÓÔÓÙ·ÈÂÓ·ÓÙ›ÔÓ ÎÔÈÓÒÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ Û˘ÁÁÂÓÒÓ ÚÔ˜ ÙÔEDTA Î·È Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ·ÓÙ›-‰Ú·ÛË (6). "æÂ˘‰ÔıÚÔÌ‚ÔÂÓ›·" ÌÔÚÂ› Â›ÛË˜ Ó··ÚÔ˘ÛÈ·ÛÙÂ› Î·È ·fi ¿ÏÏÂ˜ ·ÈÙ›Â˜, fiˆ˜ ÌÂÙ¿ ·fiÏ‹„Ë ·›Ì·ÙÔ˜ ÌÂ Î·Î‹ ÙÂ¯ÓÈÎ‹ ‹ ÏfiÁˆ Û¯ËÌ·ÙÈÛÌÔ‡‹ÁÌ·ÙÔ˜, ÂÓÒ ÙÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ¤¯ÂÈ Û˘Û¯ÂÙÈÛıÂ›Î·È ÌÂ ‰È¿ÊÔÚÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÛÙÈ˜ÔÔ›Â˜ ·Ú·ÙËÚÂ›Ù·È ·ÓÔÛÔÏÔÁÈÎ‹ ‰È¤ÁÂÚÛË (Î·-ÎÔ‹ıÂÈÂ˜, Ë·ÙÈÎ‹ ÓfiÛÔ˜, ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·).™˘Û¯ÂÙ›˙ÂÙ·È ·ÎfiÌË Î·È ÌÂ ÏÔ›ÌˆÍË ·fi CMV, HIV,ÂÚ˘ıÚ¿ ÎÏ (6,9). √ ÏÂÙÔÌÂÚ‹˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·¤ÎÏÂÈÛÂ ÙËÓ ÂÚ›Ùˆ-ÛË «„Â˘‰ÔıÚÔÌ‚ÔÂÓ›·˜» ÔÊÂÈÏfiÌÂÓË˜ ÛÂ EDTA ‹¿ÏÏ· ·ÓÙÈËÎÙÈÎ¿, fiˆ˜ Î·È ÙËÓ ‡·ÚÍË ÙˆÓ ·ıÔ-ÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛıÂ› ÌÂ ÙÔÊ·ÈÓfiÌÂÓÔ ·˘Ùfi. «æÂ˘‰ÔıÚÔÌ‚ÔÂÓ›·» Û˘Ì‚·›ÓÂÈÂ›ÛË˜ ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fiÌÂÁ¿Ï· ‹ Î·È ÁÈÁ¿ÓÙÈ· ·ÈÌÔÂÙ¿ÏÈ·, ÁÈ·Ù› Ù· ·ÈÌÔÂ-Ù¿ÏÈ· ·˘Ù¿ ÏfiÁˆ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘˜ Î·Ù·ÌÂÙÚÒ-ÓÙ·È Ï·Óı·ÛÌ¤Ó· ·fi ÙÔÓ ·Ó·Ï˘Ù‹ (6-9). ™ÙÈ˜ ‰ÈÎ¤˜Ì·˜ ÂÚÈÙÒÛÂÈ˜ ÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓÂÈ¯ÚÈÛÌ¿ÙˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ·Ú·ÙËÚ‹-ıËÎ·Ó ÌÈÎÚÔ› ÛˆÚÔ› ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÌÂÁ¿Ï·-ÁÈÁ·-ÓÙÈ·›· ·ÈÌÔÂÙ¿ÏÈ· (∂ÈÎfiÓ· 1), Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ‰È-Î·ÈÔÏÔÁÔ‡Ó Èı·ÓÒ˜ ÙÈ˜ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÙˆÓ ·ÈÌÔÂ-Ù·Ï›ˆÓ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÂÙÚ‹ÛÂÈ˜.

∞’ fiÛ· ÁÓˆÚ›˙Ô˘ÌÂ ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÁ¤-ıÔ˘˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ‹È·

¤ˆ˜ ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· ÌÂ ·Ó¿ÏÔÁ· Û˘ÌÙÒÌ·Ù·(1,2,5). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó fiÏÂ˜ ÔÈÁÓˆÛÙ¤˜ ‰È·Ù·Ú·¯¤˜ ÌÂ ÁÈÁ·ÓÙÈ·›· ·ÈÌÔÂÙ¿ÏÈ··ÔÎÏÂ›ÛıËÎ·Ó ÏfiÁˆ ÙË˜ ·Ô˘Û›·˜ ÏÂ˘ÎÔÎ˘ÙÙ·ÚÈ-ÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ, ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙË-Ù·˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ¯ÚfiÓÔ˘ÚÔ‹˜, ÙË˜ ·Ô˘Û›·˜ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÙÔ˘Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚ÈÔ¯ËÌÈÎÔ‡, ÔÊı·ÏÌÔÏÔÁÈÎÔ‡ Î·È·ÎÔ˘ÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘. ™·ÓÈfiÙÂÚÂ˜ ‰È·Ù·Ú·¯¤˜ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, fiˆ˜ 1) Ë ÔÈÎÔÁÂ-Ó‹˜ ıÚÔÌ‚ÔÂÓ›· Paris-Trousseau Ô˘ ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÁÈÁ·ÓÙÈ·›ˆÓ ·-ÛˆÌ·Ù›ˆÓ ÛÂ¤Ó·Ó ˘ÔÏËı˘ÛÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (12), 2) ÌÈ··Ú·ÏÏ·Á‹ ·˘Ù‹˜ (12) Î·È 3) ÙÔ ÔÈÎÔÁÂÓ¤˜ Û‡Ó‰ÚÔ-ÌÔ ÁÈÁ·ÓÙÈ·›ˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Ô˘ ÂÚÈÁÚ¿ÊËÎÂ ·fiÙÔÓ Greaves Î·È ÙÔ˘˜ Û˘ÓÂÚÁ¿ÙÂ˜ ÙÔ˘ (13), ¯·Ú·-ÎÙËÚ›˙ÔÓÙ·È ·fi ‰ÔÌÈÎ¤˜, ÌÂÙ·‚ÔÏÈÎ¤˜ Î·È ÏÂÈÙÔ˘Ú-ÁÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, fiˆ˜ Î·È ÙˆÓÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ (11). ™ÙÈ˜ ‰ÈÎ¤˜ Ì·˜ ÂÚÈÙÒ-ÛÂÈ˜ ÔÈ ·Ú·¿Óˆ Î·Ù·ÛÙ¿ÛÂÈ˜ ·ÔÎÏÂ›ÔÓÙ·È ÏfiÁˆÊ˘ÛÈÔÏÔÁÈÎ‹˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿-ÚˆÓ Î·È Ê˘ÛÈÔÏÔÁÈÎ‹˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ ·ÈÌÔ-ÂÙ·Ï›ˆÓ.

∏ ‰È¿ÁÓˆÛË ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ π£¶ ÏfiÁˆ ·‡ÍËÛË˜ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ Î·È ·ÓÂ‡ÚÂ-ÛË˜ ıÂÙÈÎÒÓ ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·Ô-ÎÏÂ›ÛıËÎÂ, ‰ÈfiÙÈ ÛÙ· ‰Â›ÁÌ·Ù· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ÌÈÎÚÔÛÎÔÈÎ¿ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ıÚÔÌ‚ÔÂÓ›·. ∂›-ÛË˜, ÛÙËÓ π£¶ Ù· ·ÈÌÔÂÙ¿ÏÈ· ÌÔÚÂ› Ó· Â›Ó·È ÌÂ-Á¿Ï· ·ÏÏ¿ ‰ÂÓ ·ıÚÔ›˙ÔÓÙ·È ÛÂ ÛˆÚÔ‡˜ (3,14). ∆¤-ÏÔ˜, ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÚÎÂÙ¤˜ ÂÚÈ-ÙÒÛÂÈ˜ ıÚÔÌ‚ÔÂÓ›·˜ ÌÂ ÌÂÁ¿Ï· ·ÈÌÔÂÙ¿ÏÈ· Ô˘‰ÂÓ ÌÔÚÔ‡Ó Ó· Î·Ù·Ù·ÁÔ‡Ó ÛÂ Î·Ì›· ·fi ÙÈ˜ ÚÔ-·Ó·ÊÂÚıÂ›ÛÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È·fi ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· ÎÏË-ÚÔÓÔÌÈÎfiÙËÙ·˜ ‹ ¿ÁÓˆÛÙÔ ÛÂ ¿ÏÏÂ˜ ÂÚÈÙÒÛÂÈ˜,·ÓÂ‡ÚÂÛË ÌÂÁ¿ÏˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·˘ÍËÌ¤ÓÔ˘

∂ÈÎfiÓ· 2. ¢Â›ÁÌ· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÌÂ ¿ÊıÔÓ· ¿ˆÚ· ÌÂ-Á·Î·Ú˘ÔÎ‡ÙÙ·Ú·.

∂ÈÎfiÓ· 3. ¢Â›ÁÌ· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ fiÔ˘ ‰È·ÎÚ›ÓÔÓÙ·È ÌÂ-Á·Î·Ú˘ÔÎ‡ÙÙ·Ú· Î·È ÛˆÚÔ› ·fi ÌÂÁ¿Ï· ·ÈÌÔÂÙ¿ÏÈ·.

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Ì¤ÛÔ˘ fiÁÎÔ˘ ÙÔ˘˜, ‹È· ‹ Î·Ì›· ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿-ıÂÛË, Ê˘ÛÈÔÏÔÁÈÎfi ·ÚÈıÌfi ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ,·Ô˘Û›· ÏÂ˘ÎÔÎ˘ÙÙ·ÚÈÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ, Ê˘ÛÈÔÏÔÁÈ-Îfi ¯ÚfiÓÔ ÚÔ‹˜, Ê˘ÛÈÔÏÔÁÈÎ‹ Û˘Ó‹ıˆ˜ ÏÂÈÙÔ˘ÚÁÈÎfi-ÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·ÚÔ˘Û›· ·ÓÙÈ·ÈÌÔÂÙ·-ÏÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÂ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi (1-2,9-10).

∏ ·ÚÔ˘Û›· ÙˆÓ ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿-ÙˆÓ Èı·ÓfiÓ ·ÓÙ·Ó·ÎÏ¿ ÌfiÓÔ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÌÂ-Á¤ıÔ˘˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (1), ÂÓÒ ÌÔÚÂ› Ó· Û¯ÂÙ›-˙ÂÙ·È ÌÂ ¿ÏÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, fiˆ˜ ·ÓÔÛÔ·ÓÂ¿Ú-ÎÂÈÂ˜, ÏÔ›ÌˆÍË ·fi ÙÔÓ Èfi ÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜,Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ, ·˘ÙÔ¿ÓÔÛË ı˘ÚÂ-ÔÂÈ‰›ÙÈ‰· Î·È Ï‹„Ë Ê·ÚÌ¿ÎˆÓ (3,5). √È Î·Ù·ÛÙ¿-ÛÂÈ˜ ·˘Ù¤˜ ·ÔÎÏÂ›ÛıËÎ·Ó ÚÔ˜ ÙÔ ·ÚfiÓ ÛÙÈ˜ ‰È-Î¤˜ Ì·˜ ÂÚÈÙÒÛÂÈ˜ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙÔÓ ÂÚÁ·-ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∏ ·ÓÂ‡ÚÂÛË ·˘ÍËÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ÌÂÁ·Î·Ú˘ÔÎ˘ÙÙ¿ÚˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ÌÔÚÊÔÏÔÁ›·ÛÙÔ ·È‰›, Ù· ÛÙ·ıÂÚ¿ Â˘Ú‹Ì·Ù· ÙˆÓ ÁÈÁ·ÓÙÈ·›ˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ Î·È ÙË˜ Ù·¯Â›·˜ Û˘ÛÒÚÂ˘ÛË˜ ·˘ÙÒÓ, Ë·ÚÔ˘Û›· ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙËÌËÙ¤Ú· Î·È ÛÙÔ ·È‰›, Ë ÌÈÎÚ‹ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ÙˆÓ ÎÚ˘ÔÛÊ·ÈÚÈÓÒÓ ÛÙË ÌËÙ¤Ú·, fiˆ˜ Î·È Ë ·ÓÂ‡-ÚÂÛË ÔÚÈ·Î¿ ÂÏ·ÙÙˆÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ ·ÈÌÔÂÙ·Ï›ˆÓÛÂ Ì›· Ì¤ÙÚËÛË, ¯ˆÚ›˜ ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·, ‰ÂÓ ‰‡Ó·-Ù·È Ó· ‰ÈÎ·ÈÔÏÔÁËıÔ‡Ó Ï‹Úˆ˜. £· ÌÔÚÔ‡Û·Ó Ó·‰ÈÎ·ÈÔÏÔÁËıÔ‡Ó Èı·ÓÒ˜ ·fi Î¿ÔÈ· ·ÓÔÛÔÏÔÁÈÎ‹‰È·Ù·Ú·¯‹ Ô˘ Ô‰ËÁÂ› ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ·˘ÙÔ·ÓÙÈ-ÛˆÌ¿ÙˆÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÓÂ¯‹ Î·Ù·ÛÙÚÔÊ‹ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙËÓ ˘ÂÚÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ¤ÙÛÈ ÒÛÙÂ Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·-Ï›ˆÓ ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· Ó· Â›Ó·È ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ÌÂÙÚ‹ÛÂÈ˜ Ê˘ÛÈÔÏÔÁÈÎfi˜. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ı·ÌÔÚÔ‡ÛÂ Ó· ÂÍËÁËıÂ› Ë ·ÚÔ˘Û›· ÙˆÓ ÌÂÁ¿ÏˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ, Ë Ù·¯Â›· Û˘ÁÎfiÏÏËÛË ·˘ÙÒÓ Î·È Ô Û¯Ë-Ì·ÙÈÛÌfi˜ ÌÈÎÚÒÓ ÛˆÚÒÓ, ÁÂÁÔÓfi˜ Ô˘ ÂÍËÁÂ› ÙËÓ«„Â˘‰ÔıÚÔÌ‚ÔÂÓ›·».

™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ ‰ÂÓ ‚Ú¤ıË-ÎÂ ·fi ÙÔÓ ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î¿ÔÈ· ‰È·Ù·Ú·¯‹Î·È Èı·ÓÔÏÔÁÔ‡ÌÂ fiÙÈ Ë ‰È¿ÁÓˆÛË Â›Ó·È ·˘Ù‹ ÙË˜ÎÏËÚÔÓÔÌÈÎ‹˜, ÌË ÂÈ‰ÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ·ÈÌÔÂ-Ù·Ï›ˆÓ ÌÂ ÂÌÊ¿ÓÈÛË ÁÈÁ·ÓÙÈ·›ˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (2),‰È¿ÁÓˆÛË Ô˘ ÌÔÚÂ› Ó· ·Ó·ÙÚ·Â› ·Ó ÔÈ ÂÚÈÙÒ-ÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Û˘-ÛÙËÌ·ÙÈÎ¿ ÂÌÊ·Ó›ÛÔ˘Ó ÎÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·ÛÙÔ Ì¤ÏÏÔÓ.

∂˘¯·ÚÈÛÙ›Â˜∂˘¯·ÚÈÛÙÔ‡ÌÂ ıÂÚÌ¿ ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ∞ÈÌ·ÙÔÏÔÁÈÎÔ‡ ∂Ú-Á·ÛÙËÚ›Ô˘ ÙË˜ µ’ ¶ÚÔ·È‰Â˘ÙÈÎ‹˜ ¶·ıÔÏÔÁÈÎ‹˜ ÙÔ˘ ∞.¶.£.ÁÈ· ÙËÓ ÂÈÛÙËÌÔÓÈÎ‹ ÙÔ˘˜ ‚Ô‹ıÂÈ· ÛÙË ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ÂÚÈ-ÛÙ·ÙÈÎÔ‡ Î·È ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ÂÏ¤Á¯Ô˘ ÙË˜ ·ÈÌfiÛÙ·ÛË˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Fabris F, Cordiano I, Salvan F, Ramon R, Valente M,

Luzzatto G et al. Cronic isolated macrothrom- bocytopeniawith autosomal dominant transmission: a morphologicaland qualitative platelet disorder. Eur J Haematol1997;58:40-45.

2. Young G, Luban N, White GJ. Giant platelet disorders inAfrican-American children misdiagnosed as idiopathicthrombocytopenic purpura. J Pediatr Hematol Oncol1999;21:231-236.

3. µÔÚÁÈ¿˜ ¡π, §·Ô˘Ù¿ÚË˜ ¡¶. ¢È·Ù·Ú·¯¤˜ ÙˆÓ ·ÈÌÔÌÂÙ·-Ï›ˆÓ. ∞ÈÌÔÚÚ·ÁÈÎ¿ ÓÔÛ‹Ì·Ù· Î·È ıÚfiÌ‚ˆÛË. ™ÙËÓ: ∞ÈÌ·-ÙÔÏÔÁ›·. ∆fiÌÔ˜ µ’. 1Ë ¤Î‰. ∞ı‹Ó·: 1990. ÛÂÏ. 582-615.

4. Murphy S, Nepo A, Sills R. Thrombocytopenia. Paediatr inReview 1999;2:64-69.

5. Schultz-Beardsley D, Nathan GD. Platelet abnormalities ininfancy and childhood. πn: Nathan GD, Oski AF, eds.Paediatric Haematology and Oncology. 4th ed. Phila-delphia: WB Saunders Company; 1998. p.1585-1630.

6. µ˘˙·ÓÙÈ¿‰Ë˜ ∞∆, µ·Î·ÏÔÔ‡ÏÔ˘ ™, ª·Ó‰·Ï¿ ∂, §È¿ÏÈ· ∞,°·Ú˘›‰Ô˘ µ. æÂ˘‰‹˜ ıÚÔÌ‚ÔÂÓ›·: ‰‡Ô ÂÚÈÙÒÛÂÈ˜.πÔÎÚ¿ÙÂÈ· 1998;2:91-95.

7. Hoyt HR, Durie GMB. Pseudothrombocytopenia inducedby a monoclonal IgM kappa platelet agglutinin. Am JHematol 1989;31:50-52.

8. Silvestri F, Virgolini L, Savignano C, Zaja F, Velisig M,Baccarani M. Incidence and diagnosis of EDTA-dependentpseudothrombocytopenia in a consecutive outpatientpopulation referred for isolated thrombocytopenia. VoxSang 1995;68:35-39.

9. Silvestri F, Masotti A, Pradella P, Zaja F, Barillari G, MarcoL. More on false thrombocytopenias: EDTA-dependentpseudothrombocytopenia associated with a congenitalplatelet release defect. Vox Sang 1996;71:27-29.

10. Najean Y, Lecompte T. Genetic thrombocytopenia withautosomal dominant transmission: a review of 54 cases. JHaematol 1990;74:203-208.

11. Najean Y, Lecompte T. Hereditary thrombocytopenias inchildhood. Semin Thromb Hemost 1995;21:294-304.

12. Breton-Gorius J, Favier R, Guichard J, Cherif D, Berger R,Debili N et al. A new congenital dysmegakaryopoieticthrombocytopenia (Paris-Trousseau) associated withgiant platelet a-granules and chromosome 11 deletion at11q23. Blood 1995;7:1805-1814.

13. Greaves M, Pickering C, Martin J, Cartwright I, Preston EF.A new familial ‘giant platelet syndrome’ with structural,metabolic and functional abnormalities due to a primarymegacaryocyte defect. Br J Haematol 1987;65:429-435.

14. Sanchez-Fayos J, Olavarrva E, Roman A, Cabello A, SotoC, Panigua C. Idiopathic thrombocytopenic purpura in 5members of a family. Sangre (Barc) 1994;39:215-217.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã·Ù˙Ë·ÓÙÂÏ‹˜ ∂ÌÌ·ÓÔ˘‹Ï¶. ¶··ÁÂˆÚÁ›Ô˘ 8, 546 35 £ÂÛÛ·ÏÔÓ›ÎË

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81


�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ËÏÈÎ›·˜ 11 ÂÙÒÓ ÌÂ ‰‡Ô ÚÔÛ‚ÔÏ¤˜ ÌËÓÈÁÁÈÙÈ‰Ô-ÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È Ì›· ÛË„·ÈÌ›·˜ ÛÂ ‰È¿-ÛÙËÌ· 3 ¯ÚfiÓˆÓ ÌÂ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘-Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ ÏÔ›ÌˆÍË ·fi ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ. √È ÂÚÈÙÒÛÂÈ˜ Â·ÓÂÈÏËÌÌ¤ÓˆÓ Û˘ÛÙËÌ·ÙÈ-ÎÒÓ ÏÔÈÌÒÍÂˆÓ ‰ÂÓ Â›Ó·È Û˘Ó‹ıÂÈ˜, ÁÈ’ ·˘Ùfi Ú¤-ÂÈ Ó· ·Ó·˙ËÙÂ›Ù·È ˘fiÛÙÚˆÌ· ·ÓÔÛÔÏÔÁÈÎ‹˜ ‹·Ó·ÙÔÌÈÎ‹˜ ‰È·Ù·Ú·¯‹˜. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ Ô˘ ¤ÁÈÓÂ, ¤‰ÂÈÍÂ fiÙÈ ÙÔ ·È‰› Â›¯Â Û˘ÁÁÂÓ‹ÔÌfi˙˘ÁÔ, ¤ÏÏÂÈ„Ë ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ C6 ÙÔ˘ Û˘ÌÏË-ÚÒÌ·ÙÔ˜. ™˘˙ËÙÔ‡ÓÙ·È ÔÈ È‰È·ÈÙÂÚfiÙËÙÂ˜ ÙË˜ ÌË-ÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ Î·È Ë ·ıÔÁ¤ÓÂÈ· (1) ÙË˜ÏÔ›ÌˆÍË˜ ÛÙ· ¿ÙÔÌ· ÌÂ ¤ÏÏÂÈ„Ë ÂÓfi˜ ·fi ÙÔ˘˜·Ú¿ÁÔÓÙÂ˜ ÙÔ˘ ÙÂÏÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙÔ˘ Û˘-ÌÏËÚÒÌ·ÙÔ˜ C5-C9.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ÌËÓÈÁÁ›ÙÈ‰Â˜, ÌË-ÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, ¤ÏÏÂÈ„Ë Û˘ÌÏËÚÒ-Ì·ÙÔ˜.

�Abstract: The case of an 11ó year old child isdescribed who had two episodes of menin-gococcal meningitis and one episode of menin-gococcal septicemia over a three-year period.Recurrent meningococcal disease is rare in child-hood and if present, a full investigation should beperformed in order to detect an immunologic oranatomic defect. Examination of the terminalpathway of the complement system in our patientrevealed C6 deficiency, a rare autosomal reces-sive disorder. The patient’s parents had half-normal levels of C6 and were carriers for thedeficiency. The peculiarities of meningococcal in-fection and the pathogenesis of infection incomplement deficiency states are discussed.

Key words: recurrent meningitis, recurrentmeningococcal disease, complement deficiency.

ŒÏÏÂÈ„Ë ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ C6 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ Î·È ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ª. £ÂÔ‰ˆÚ›‰Ô˘, ª. πˆ¿ÓÓÔ˘, °. ªÔÛÙÚÔ‡, ∞. °ÂÚÌÂÓ‹˜

C6 complement deficiency and meningococcal infectionsM. Theodoridou, M. Ioannou, G. Mostrou, A. Germenis

∂ÈÛ·ÁˆÁ‹∏ ·ÓÂ¿ÚÎÂÈ· (1-3) ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘-

ÌÏËÚÒÌ·ÙÔ˜ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÛÔ‚·Ú¤˜ ÌÈÎÚÔ-‚È·Î¤˜ ÏÔÈÌÒÍÂÈ˜. ÕÙÔÌ· ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÎÏ·-ÛÌ¿ÙˆÓ ÙË˜ ÎÏ·ÛÈÎ‹˜ Ô‰Ô‡ (4) (C1,C4,C2) ¤¯Ô˘Ó·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÓÔÛ‹Ì·Ù· ÎÔÏÏ·ÁfiÓÔ˘ Î·ÈÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û˘ÛÙËÌ·ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ·fiÓÂ˘ÌÔÓÈfiÎÔÎÎÔ (Pn), ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ (ªn) Î·È·ÈÌfiÊÈÏÔ ÈÓÊÏÔ˘¤ÓÙ˙·˜ Ù‡Ô˘ ‚ (Hib) (5). ÕÙÔÌ·ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÓ·ÏÏ·ÎÙÈÎ‹˜ Ô‰Ô‡ (ÚÔÂÚ-‰›ÓË˜ (6), ·Ú¿ÁÔÓÙ· D) ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ

ÁÈ· Û˘ÛÙËÌ·ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ Î˘Ú›ˆ˜ ·fi ¡. ÙË˜ÌËÓÈÁÁ›ÙÈ‰·˜, ÂÓÒ Ë ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ C3, ÙÔ˘ ·-Ú¿ÁÔÓÙ· ∏ Î·È π ÚÔ‰È·ı¤ÙÂÈ ÁÈ· ÏÔÈÌÒÍÂÈ˜ ·fiÌÈÎÚfi‚È· ÌÂ Î¿„·, fiˆ˜ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ, ÌËÓÈÁ-ÁÈÙÈ‰fiÎÔÎÎÔ Î·È ·ÈÌfiÊÈÏÔ ÈÓÊÏÔ˘¤ÓÙ˙·˜ Ù‡Ô˘ b.∂›ÛË˜, Ë ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÙÂÏÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ (4)ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ (C5-C9) ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘-ÓÔ ÁÈ· Û˘ÛÙËÌ·ÙÈÎ‹ ÌËÓÔÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË.∆· ¿ÙÔÌ· ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·‰˘Ó·Ì›· Û¯ËÌ·ÙÈ-ÛÌÔ‡ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ C5-C9, ÌÂ ·ÔÙ¤ÏÂÛÌ·Ó· ¤¯Ô˘Ó ¤ÏÏÂÈ„Ë ÙË˜ ‚·ÎÙËÚÈÔÏ˘ÙÈÎ‹˜ ‰Ú¿ÛË˜


∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”

1st Pediatric Clinic of Athens University,“G. Gennimatas” Hospital, Athens

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ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ·˘ÙÔ‡, Ë ÔÔ›· ¤¯ÂÈ ÌÂÁ¿ÏËÛËÌ·Û›· ÛÙËÓ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Î·ÙÂÍÔ¯‹Ó¤Ó·ÓÙÈ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Î·È fi¯È ¿ÏÏˆÓ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÒÓ. ªÂ ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ¤¯Ô˘ÌÂ ÂÓÂÚÁÔÔ›ËÛËÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ·Ú·ÁˆÁ‹ Î·È ÚÔÛÎfiÏÏË-ÛË ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ C5-C9 ÛÙËÓ ÂÍˆÙÂÚÈÎ‹ÌÂÌ‚Ú¿ÓË ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ô˘ Ô‰ËÁÂ› ÛÂÏ‡ÛË ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Î·È ·ÂÏÂ˘ı¤ÚˆÛËÂÓ‰ÔÙÔÍ›ÓË˜ (2,3). ™Ù· ¿ÙÔÌ· ·˘Ù¿ ‰ÂÓ ÂËÚÂ¿˙Â-Ù·È Ë ¯ËÌÂÈÔÙ·Í›·, Ë Ô„ˆÓÈÓÔÔ›ËÛË, Ë Ê·ÁÔÎ˘Ù-Ù¿ÚˆÛË Î·È Ë ÂÓÂÚÁÔÔ›ËÛË ÙË˜ ÂÓ·ÏÏ·ÎÙÈÎ‹˜Ô‰Ô‡ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∞ÁfiÚÈ ËÏÈÎ›·˜ 9 ÂÙÒÓ ÌÂÙ·Ê¤ÚıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹

Ì·˜ ·fi ÓÔÛÔÎÔÌÂ›Ô ÙË˜ Â·Ú¯›·˜ ÏfiÁˆ ˘„ËÏÔ‡˘ÚÂÙÔ‡ 39oC ·fi 24ÒÚÔ˘, ÂÌ¤ÙÔ˘˜ Î·È ·ÈÌÔÚÚ·-ÁÈÎfi ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È ÛÙ· ¿ÎÚ·. ™ÙÔÓ·ÛıÂÓ‹ ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ˘Ô„›· ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ÛË„·ÈÌ›·˜ ¯ÔÚËÁ‹ıËÎÂ ·ÓÙÈ‚›ˆÛË.

¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÙÚ›ÙÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜.∆· 2 ·‰¤ÏÊÈ· ÙÔ˘ Â›Ó·È ˘ÁÈ‹. ∆Ô ·È‰› ·˘Ùfi ‰ÂÓ Â›-¯Â ÓÔÛ‹ÛÂÈ ÛÙÔ ·ÚÂÏıfiÓ Î·È Â›¯Â Î¿ÓÂÈ Î·ÓÔÓÈÎ¿fiÏ· Ù· ÂÌ‚fiÏÈ·. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ·È‰› ‹Ù·ÓÛÂ Î·Ï‹ Î·Ù¿ÛÙ·ÛË, ¯ˆÚ›˜ ·˘¯ÂÓÈÎ‹ ‰˘ÛÎ·Ì„›·,ÌÂ Î·Ï¿ ˙ˆÙÈÎ¿ ÛËÌÂ›· Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÓÂ˘ÚÔÏÔ-ÁÈÎ‹ ÂÍ¤Ù·ÛË. ¶·ÚÔ˘Û›·˙Â ÛÙÈÎÙfi ÌÂ ·Û‡ÌÌÂÙÚËÎ·Ù·ÓÔÌ‹ ÂÙÂ¯ÂÈÒ‰Â˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·ÈÙ· ¿ÎÚ·. ∏ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ÂÍ¤Ù·ÛË ‹Ù·Ó Ê˘ÛÈÔ-ÏÔÁÈÎ‹. ∞fi ÙÔ ÁÂÓfiÌÂÓÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô‚Ú¤ıËÎ·Ó Ù· ÂÍ‹˜: Hb=13,3 g/dl, Ht=31%, §Â˘-Î¿=28.900/Ìl (¶=88%, §=5%), ∞ª¶=198.000/Ìl,∆∫∂=44 mm/h, CRP=174 mg/dl, P.T.=16’’.

∆· Â˘Ú‹Ì·Ù· ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡‹Ù·Ó: ∫‡ÙÙ·Ú·=930/mm3 (¶=70%, §=26%), §Â‡-ÎˆÌ·=128mg/dl, ™¿Î¯·ÚÔ=60 mg/dl (™¿Î¯·ÚÔ·›Ì·ÙÔ˜=97 mg/dl).

To ¿ÌÂÛÔ ·Ú·ÛÎÂ‡·ÛÌ· ‹Ù·Ó ·ÚÓËÙÈÎfi, fiˆ˜Î·È Ë ·Ó·˙‹ÙËÛË ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ·ÓÙÈÁfiÓˆÓ(Latex test). √È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜, ÂÁÎÂÊ·ÏÔ-ÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ Î·È ÚÈÓÔÊ¿Ú˘ÁÁÔ˜ ‰ÂÓ ·Ó¤Ù˘Í·Ó·ıÔÁfiÓ· ÌÈÎÚfi‚È·. ªÂ ‚¿ÛË ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·Î·È Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ¯ÔÚËÁ‹ıËÎÂ ÛÙÔÓ·ÛıÂÓ‹ ÂÓÈÎÈÏ›ÓË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË ÂÓ‰ÔÊÏÂ-‚›ˆ˜. ∆Ô ·È‰›, ‹‰Ë ·fi ÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ ÓÔÛË-ÏÂ›·˜, ‹Ù·Ó ÛÂ ¿ÚÈÛÙË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË Î·È ÂÍ‹Ï-ıÂ ÙÔ fiÁ‰ÔÔ 24ˆÚÔ ÌÂÙ¿ ÙË Û˘ÌÏ‹ÚˆÛË ÙË˜ ıÂ-Ú·Â›·˜.

¢‡Ô ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ÛÂ ËÏÈÎ›· 11 ¯ÚfiÓˆÓ, ÙÔ·È‰› ·ÚÔ˘Û›·ÛÂ ˘ÚÂÙfi ¤ˆ˜ 39,5ÔC ·fi24ÒÚÔ˘, ÌÂ Ú›ÁÔ˜, ÎÂÊ·Ï·ÏÁ›· Î·È ·ÈÌÔÚÚ·ÁÈÎfiÂÍ¿ÓıËÌ· ÛÙËÓ ÂÎÙ·ÙÈÎ‹ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ‰ÂÍÈÔ‡

‚Ú·¯›ÔÓ·. √ ·ÛıÂÓ‹˜ ÌÂÙ·Ê¤ÚÂÙ·È Î·È ¿ÏÈ ÛÙËÓ∞ı‹Ó·, ·ÊÔ‡ ÚÒÙ· ¯ÔÚËÁ‹ıËÎÂ ÂÓ‰ÔÊÏÂ‚›ˆ˜ ÎÂ-Ê·ÏÔÛÔÚ›ÓË 3Ë˜ ÁÂÓÈ¿˜. ∫·Ù¿ ÙË 2Ë Â›ÛÔ‰Ô, ÙÔ·È‰› Â›¯Â Î·Ï¿ ˙ˆÙÈÎ¿ ÛËÌÂ›·, ‹È· ÓˆıÚfiÙËÙ·,ÂÙÂ¯ÂÈÒ‰Â˜ ÂÍ¿ÓıËÌ· Î˘Ú›ˆ˜ ¿ÎÚˆÓ Î·È ÏÔÈ¿Û˘ÛÙ‹Ì·Ù· ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∆· Â˘Ú‹-Ì·Ù· ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ·-ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ‹Ù·Ó ·ÚÓËÙÈÎ¿ ÁÈ· ÌËÓÈÁÁ›ÙÈ‰·(Î‡ÙÙ·Ú·=0 mm3, ÏÂ‡ÎˆÌ·=22 mgr/dl, Û¿Î¯·-ÚÔ=67 mgr/dl, Û¿Î¯·ÚÔ ·›Ì·ÙÔ˜=106 mgr/dl). ∏¿ÌÂÛË Î·Ù¿ Gram ¯ÚÒÛË ‹Ù·Ó ·ÚÓËÙÈÎ‹ fiˆ˜ Î·ÈË ‰ÔÎÈÌ·Û›· Û˘ÁÎfiÏÏËÛË˜ ÁÈ· ·Ó›¯ÓÂ˘ÛË ÌÈÎÚÔ‚È·-ÎÔ‡ ·ÓÙÈÁfiÓÔ˘. √È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·fi ÙÔ ÚÈÓÔÊ¿-Ú˘ÁÁ·, ÙÔ ·›Ì· Î·È ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ‰ÂÓ·Ó¤Ù˘Í·Ó ÌÈÎÚfi‚ÈÔ. √ ÏÔÈfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: Hb=13,5 gr/dl, Ht=40%, §Â˘-Î¿=19.000/ÌL (¶=84%, §=13%), ∆∫∂=15 mm/1Ëh, CRP=85 mgr/dl Î·È PT=17’’. ªÂ ÙËÓ Èı·Ó‹ ‰È¿-ÁÓˆÛË ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÛË„·ÈÌ›·˜ ¯ÔÚËÁ‹-ıËÎÂ ÂÓÈÎÈÏ›ÓË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË ÁÈ· ÔÎÙÒ24ˆÚ·, ÂÓÒ ÛÂ fiÏ· Ù· ¿ÙÔÌ· ÙÔ˘ ¿ÌÂÛÔ˘ ÂÚÈ‚¿Ï-ÏÔÓÙÔ˜ ¯ÔÚËÁ‹ıËÎÂ ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË ÌÂ ÚÈÊ·ÌÈ-Î›ÓË.

∂ÂÈ‰‹ ÔÈ ÂÚÈÙÒÛÂÈ˜ Â·ÓÂÈÏËÌÌ¤ÓË˜ Û˘ÛÙË-Ì·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜ ÌÂ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ ‰ÂÓ Â›Ó·ÈÛ˘Ó‹ıÂÈ˜, ¤ÁÈÓÂ ÏÂÙÔÌÂÚ‹˜ ·ÓÔÛÔÏÔÁÈÎfi˜ Î·È·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 1). √È ·ÈÌÔÏ˘ÙÈ-ÎÔ› Ù›ÙÏÔÈ ÙË˜ ÎÏ·ÛÈÎ‹˜ Î·È ÙË˜ ÂÓ·ÏÏ·ÎÙÈÎ‹˜ Ô‰Ô‡ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ‚Ú¤ıËÎ·Ó ÌË‰ÂÓÈÎÔ›, ÁÂÁÔ-Ófi˜ Ô˘ Â¤‚·ÏÂ ÙÔÓ ·ÓÔÛÔ¯ËÌÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfiÙˆÓ ·Ú·ÁfiÓÙˆÓ ÙË˜ ÙÂÏÈÎ‹˜ Ô‰Ô‡. ∞fi ÙÔÓ ¤ÏÂÁ-¯Ô ·˘Ùfi, ‚Ú¤ıËÎ·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÔÈ Û˘ÁÎÂÓÙÚÒ-ÛÂÈ˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ C5, C7, C8 Î·È C9, ÂÓÒ Ë Û˘-ÁÎ¤ÓÙÚˆÛË ÙÔ˘ C6 ‹Ù·Ó ÌfiÏÈ˜ ·ÓÈ¯ÓÂ‡ÛÈÌË. ∫·Ùfi-ÈÓ ÙÔ‡ÙÔ˘, Â·Ó·Ï‹ÊıËÎ·Ó ÔÈ ·ÈÌÔÏ˘ÙÈÎÔ› Ù›ÙÏÔÈÙË˜ ÎÏ·ÛÈÎ‹˜ Î·È ÙË˜ ÂÓ·ÏÏ·ÎÙÈÎ‹˜ Ô‰Ô‡ ÌÂÙ¿ ·fiÚÔÛı‹ÎË ÎÂÎ·ı·ÚÌ¤ÓÔ˘ C6 ÛÙÔÓ ÔÚfi ÙÔ˘ ·ÛıÂ-ÓÔ‡˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔÎ·Ù¿ÛÙ·Û‹ ÙÔ˘˜ ÛÙ·


¶›Ó·Î·˜ 1

CT ÂÁÎÂÊ¿ÏÔ˘ = Ê˘ÛÈÔÏÔÁÈÎfi IgG1 = 710 mg/dl

MRI ÂÁÎÂÊ¿ÏÔ˘ = Ê˘ÛÈÔÏÔÁÈÎ‹ IgG2 = 152 mg/dl∞ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜IgG = 1150 mmg/dl IgG3 = 98 mg/dlIgA = 127 mg/dl IgG4 = 55 mg/dlIgM = 425 mg/dl ANA = (-)C3 = 74 mg/dl (50-90) antiDNA = (-)C4 = 14 mg/dl (10-40) SMA = (-)C5 = 6 mg/dl (6-9) AMA = (-)C6 = 8 mg/dl (45-95) VIII Ag (-)

∞ÈÌÔÏ˘ÙÈÎfi˜ Ù›ÙÏÔ˜ ÎÏ·ÛÈÎ‹˜ Ô‰Ô‡ = 0∞ÈÌÔÏ˘ÙÈÎfi˜ Ù›ÙÏÔ˜ ÂÓ·ÏÏ·ÎÙÈÎ‹˜ Ô‰Ô‡ = 0

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Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ·. √ ·ÓÔÛÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓÁÔÓ¤ˆÓ Î·È ÙÔ˘ ÂÓfi˜ ·fi Ù· ‰‡Ô ·‰¤ÏÊÈ· ¤‰ÂÈÍÂ ÙÈ-Ì¤˜ ÎÏ¿ÛÌ·ÙÔ˜ C6, ÂÚ› ÙÔ 50% ÙˆÓ Ê˘ÛÈÔÏÔÁÈ-ÎÒÓ, ÁÂÁÔÓfi˜ Ô˘ ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ÂÙÂÚfi˙˘ÁË˜ÌÔÚÊ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ C6. ™ÙÔ ·È‰›, ÚÈÓ ÙËÓ¤ÍÔ‰fi ÙÔ˘ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô, ¤ÁÈÓÂ ÂÌ‚fiÏÈÔ ÓÂ˘-ÌÔÓÈfiÎÔÎÎÔ˘, ·ÈÌfiÊÈÏÔ˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ Ù‡Ô˘ b Î·È‰È‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎˆÓ A+C. ∂›-ÛË˜, Û˘ÛÙ‹ıËÎÂ ÛÙÔ˘˜ ‹‰Ë Â˘·ÈÛıËÙÔÔÈËÌ¤ÓÔ˘˜ÁÔÓÂ›˜ Ë ¿ÌÂÛË È·ÙÚÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ Û˘Ì‚·Ù‹˜ ÌÂÏÔ›ÌˆÍË.

∂Ù¿ Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ· Î·È ÛÂ ËÏÈÎ›· 11ó ¯Úfi-ÓˆÓ, ÙÔ ·È‰› ÁÈ· 3Ë ÊÔÚ¿ ÏfiÁˆ ˘„ËÏÔ‡ ˘ÚÂÙÔ‡,ÂÌ¤ÙˆÓ, ÎÂÊ·Ï·ÏÁ›·˜ Î·È ÂÙÂ¯ÂÈÒ‰Ô˘˜ ÂÍ·Óı‹Ì·-ÙÔ˜ ÛÙ· Î¿Ùˆ ¿ÎÚ·, ÌÂÙ·Ê¤ÚÂÙ·È ÛÙËÓ ∞ı‹Ó·.

™ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ‚Ú¤ıËÎ·Ó Î‡ÙÙ·-Ú·=874/mm3 (¶=98%, §=2%), §Â‡ÎˆÌ·=67mgr/dl, ™¿Î¯·ÚÔ=65 mgr/dl (™¿Î¯·ÚÔ ·›Ì·-ÙÔ˜=156 mgr/dl), ÂÓÒ ÛÙÔ ¿ÌÂÛÔ ·Ú·ÛÎÂ‡·ÛÌ·ÙÔ˘ ∂¡À ·Ú·ÙËÚ‹ıËÎ·Ó gram (-) ‰ÈÏfiÎÔÎÎÔÈ.√È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜, ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘, ÚÈ-ÓÔÊ¿Ú˘ÁÁ· Î·È ‰ÂÚÌ·ÙÈÎ‹˜ ‚Ï¿‚Ë˜ ‰ÂÓ ·Ó¤Ù˘Í·ÓÌÈÎÚfi‚È·. §ÔÈfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜:Hb=12,6 g/dl, Ht=36%, §Â˘Î¿=23.000/ÌL(¶=91%, §=3%), ∆∫∂=12 mm/1Ë h, CRP=98mgr/dl, PT=16,5’’. ∆Ô ·È‰› ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ˆ˜ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· ÌÂ ÙËÓ ›‰È· ıÂÚ·-Â˘ÙÈÎ‹ ·ÁˆÁ‹, ÌÂ ¿ÚÈÛÙË ¤Î‚·ÛË.

™˘˙‹ÙËÛË∏ Û˘¯ÓfiÙËÙ· (8,2) ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ·ÓÂ·Ú-

ÎÂÈÒÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÔÈÎ›ÏÏÂÈ ·fi ÙËÓ ÂıÓÈ-ÎfiÙËÙ· ÙÔ˘ ÂÍÂÙ·˙fiÌÂÓÔ˘ ÏËı˘ÛÌÔ‡. ÀÔÏÔÁ›˙Â-Ù·È fiÙÈ ÛÂ ÂÚ›Ô˘ 0,03% ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ÏËı˘-ÛÌÔ‡ ‰È·ÈÛÙÒÓÂÙ·È Î¿ÔÈÔ˘ Ù‡Ô˘ ·ÓÂ¿ÚÎÂÈ·Û˘ÌÏËÚÒÌ·ÙÔ˜. °ÂÓÈÎ¿ fiÌˆ˜, ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÂÂÈÛÔ‰›ˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÔÎ‹˜ÏÔ›ÌˆÍË˜, fiˆ˜ ÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜, Ë Û˘¯ÓfiÙËÙ··ÓÂ‡ÚÂÛË˜ ·ÓÂ¿ÚÎÂÈ·˜ Û˘ÌÏËÚÒÌ·ÙÔ˜ Êı¿ÓÂÈÎ·È ÙÔ 30%.

∏ ¤ÏÏÂÈ„Ë ÙÔ˘ C6, fiˆ˜ Î·È ÙˆÓ ˘fiÏÔÈˆÓ ÙÂ-ÏÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÎÏËÚÔÓÔ-ÌÂ›Ù·È ÌÂ ÙÔÓ ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ. √¤ÏÂÁ¯Ô˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì·˜ ¤‰ÂÈÍÂfiÙÈ ÔÈ ÁÔÓÂ›˜ ÙÔ˘ ‹Ù·Ó ÂÙÂÚfi˙˘ÁÔÈ ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜C6, ·ÊÔ‡ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÎÏ¿-ÛÌ·ÙÔ˜ C6 ÛÙÔÓ ÔÚfi ÙÔ˘˜, ÂÓÒ Ù· ·‰¤ÏÊÈ· ÙÔ˘ Â›-¯·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜. £· Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ›fiÙÈ Ù· ÂÙÂÚfi˙˘Á· ¿ÙÔÌ· ‰ÂÓ ¤¯Ô˘Ó ·˘ÍËÌ¤ÓË Â˘¿-ıÂÈ· ÛÂ ÏÔÈÌÒÍÂÈ˜.

∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ÛÙ· ¿ÙÔÌ· ÌÂ ·ÓÂ-¿ÚÎÂÈ· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ C5-C6 ·ÚÔ˘ÛÈ¿˙ÂÈ

ÔÚÈÛÌ¤ÓÂ˜ È‰È·ÈÙÂÚfiÙËÙÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ ÁÂÓÈ-Îfi ÏËı˘ÛÌfi. ŒÙÛÈ, Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜(7,2,1) ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÏÔ›ÌˆÍË˜ ·Ú·ÙË-ÚÂ›Ù·È ÛÙÔ 40-45% ÛÂ ¿ÙÔÌ· ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÙÂ-ÏÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, fiˆ˜ Û˘-Ó¤‚Ë Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜, ÂÓÒ ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿¿ÙÔÌ· ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È Û¯Â‰fiÓ Ô˘‰ÂÌ›· ˘ÔÙÚÔ‹.∞˘Ùfi ÂÈ‚Â‚·ÈÒÓÂÈ fiÙÈ Ë ·Ú¯ÈÎ‹ ÏÔ›ÌˆÍË ÛÙ· ¿ÙÔ-Ì· ·˘Ù¿ ‰ÂÓ Î·Ù·ÏÂ›ÂÈ ·ÓÔÛ›·. ∫¿ıÂ ÂÂÈÛfi‰ÈÔÏÔ›ÌˆÍË˜ Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ ÁÂÁÔÓfi˜, Ô˘ ‰ÂÓ ÌÂÈ-ÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÂfiÌÂÓË ÏÔ›ÌˆÍË ·fi ÙÔÓ ›‰ÈÔÙ‡Ô ÌÈÎÚÔ‚›Ô˘.

∂›ÛË˜, Ë ıÓËÙfiÙËÙ· ·fi ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ÏÔ›ÌˆÍË ÙˆÓ ·ÙfiÌˆÓ ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ Û˘ÌÏË-ÚÒÌ·ÙÔ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Â›-Ó·È ¯·ÌËÏ‹ (2,3,9).

∏ ıÓËÙfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔ-Ì· Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 10-19%, ÂÓÒ ÛÙ· ¿ÙÔÌ· ÌÂ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÙÂÏÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏË-ÚÒÌ·ÙÔ˜ Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 1,5-2,4%. ∆Ô ·È‰›Ì·˜, ·fi ÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ ·ÁˆÁ‹˜, ‹Ù·Ó ÛÂ ¿ÚÈ-ÛÙË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. ∏ Î·ÏÔ‹ıË˜ ¤Î‚·ÛË Û˘Ó-‰¤ÂÙ·È Èı·ÓfiÓ ÌÂ ÌÂÈˆÌ¤ÓË ·Ú·ÁˆÁ‹ ÂÓ‰ÔÙÔÍ›-ÓË˜ (ÏÈÔÔÏ˘Û·Î¯·Ú›ÙË˜) ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘,Ë ÔÔ›· Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· ÌÂ ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛËÎ˘ÙÙ·ÚÔÎÈÓÒÓ Î·È ¿ÏÏˆÓ ÌÂÛÔÏ·‚ËÙÒÓ ÊÏÂÁÌÔ-Ó‹˜, ÔÈ ÔÔ›ÔÈ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÈÛÙÈÎ‹ ‚Ï¿‚Ë. º·›ÓÂ-Ù·È, ‰ËÏ·‰‹, fiÙÈ Ù· ¿ÙÔÌ· ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÙÂÏÈ-ÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ (9,3) ‰ÂÓ ÂÌ-Ê·Ó›˙Ô˘Ó Û˘¯Ó¿ ı·Ó·ÙËÊfiÚÔ ¤Î‚·ÛË. √È ̄ ·ÌËÏ¤˜Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÂÓ‰ÔÙÔÍ›ÓË˜ ÛÙÔ Ï¿ÛÌ·, Ë ÂÚÈÔ-ÚÈÛÌ¤ÓË ÈÛÙÈÎ‹ ‚Ï¿‚Ë Î·È Ô ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÌÈÎÚÔ-‚›ˆÓ ÁÈ· ÚfiÎÏËÛË ÙË˜ ÓfiÛÔ˘ ÔÊÂ›ÏÔÓÙ·È Î·Ù¿ Î‡-ÚÈÔ ÏfiÁÔ ÛÙËÓ ·‰˘Ó·Ì›· Û¯ËÌ·ÙÈÛÌÔ‡ ÙÔ˘ Û˘-ÌÏ¤ÁÌ·ÙÔ˜ C5-C9.

∂›ÛË˜, Ë ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË ÛÂ ¿ÙÔÌ·ÌÂ ·˘Ù¤˜ ÙÈ˜ ·ÓÂ¿ÚÎÂÈÂ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÂ fiÏÂ˜ ÙÈ˜ËÏÈÎ›Â˜, Û˘Ó‹ıˆ˜ fiÌˆ˜ ÛÙÈ˜ ËÏÈÎ›Â˜ 14-17 ¯ÚfiÓˆÓ.¶Èı·Ó‹ ÂÚÌËÓÂ›· ·˘ÙÔ‡ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ Â›Ó·È fiÙÈ ÔÊ˘ÛÈÔÏÔÁÈÎfi˜ ÏËı˘ÛÌfi˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Â˘¿ıÂÈ·ÛÙÈ˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ Î˘Ú›ˆ˜ ÛÙÈ˜ËÏÈÎ›Â˜ ·fi 1 Ì‹Ó· ¤ˆ˜ 4 ¯ÚfiÓˆÓ. ™ÙÔ ‰È¿ÛÙËÌ··˘Ùfi, ÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ·È‰ÈÔ‡ ÂÎÙ›-ıÂÙ·È ÛÂ ÌË ·ıÔÁfiÓÔ˘˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘˜ Î·È¿ÏÏ· Gram(-) ‚·ÎÙËÚ›‰È· ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·-Ú·ÁˆÁ‹ ÚÔÛÙ·ÙÂ˘ÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ.

∆· ¿ÙÔÌ· ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÙÂÏÈÎÒÓ ÎÏ·ÛÌ¿-ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ·Ú¿ÁÔ˘Ó ·ÓÙÈÌËÓÈÁÁÈÙÈ-‰ÔÎÔÎÎÈÎ¿ ·ÓÙÈÛÒÌ·Ù· (1,2,3), fiˆ˜ Î·È Ô Ê˘ÛÈÔ-ÏÔÁÈÎfi˜ ÏËı˘ÛÌfi˜.

∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ Ù· ¿ÙÔÌ· ÌÂ ·ÓÂ¿ÚÎÂÈ-Â˜ ÓÔÛÔ‡Ó ·fi Û¿ÓÈÔ˘˜ ÔÚfiÙ˘Ô˘˜ (3,8) ÌËÓÈÁ-ÁÈÙÈ‰fiÎÔÎÎˆÓ, fiˆ˜ X,Y,Z 2qE, W135. ¶Èı·Ó‹

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ÂÚÌËÓÂ›· Â›Ó·È Ë ÂÈÎÚ¿ÙËÛË ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ·˘ÙÒÓ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ¿ÙÔÌ·. °È· ·Ú¿‰ÂÈÁÌ·,Ë Û˘¯ÓfiÙËÙ· ÙË˜ ÊÔÚÂ›·˜ ÁÈ· Ù· ÛÙÂÏ¤¯Ë ÙË˜ÔÚÔÔÌ¿‰·˜ À ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ·˘Í¿ÓÂÙ·ÈÌÂ ÙËÓ ËÏÈÎ›· Î·È ·ÊÔ‡ Ë ÚÒÙË ÏÔ›ÌˆÍË ÛÙ·¿ÙÔÌ· ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÂ ÌÂÁ¿ÏË ËÏÈÎ›·,·ÔÙÂÏÂ› ÙË Û˘¯ÓfiÙÂÚË ÔÚÔÔÌ¿‰· Ô˘ ÚÔÎ·ÏÂ›ÙËÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË. ∏ ÌË ·Ó¿Ù˘ÍËÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙÔ˘·ÛıÂÓÔ‡˜, Èı·ÓfiÙ·Ù· ÏfiÁˆ ÙË˜ ¯ÔÚ‹ÁËÛË˜·ÓÙÈ‚›ˆÛË˜, Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ Î·ıÔÚÈ-ÛÙÂ› Ô ÔÚfiÙ˘Ô˜.

∏ ˘ÔÙÚÔ‹ (1) ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÏÔ›ÌˆÍË˜ÂÈ‚¿ÏÏÂÈ ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ·Ï˘Û›‰·˜ ÙˆÓ ÎÏ·ÛÌ¿-ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘‰È·ÈÛÙˆıÂ› Ë ·ÓÂ¿ÚÎÂÈ·, Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ÙÚfi-Ô˜ ÚÔÛÙ·Û›·˜ ÙÔ˘ ·ÙfiÌÔ˘ Â›Ó·È Ë Â˘·ÈÛıËÙÔÔ›-ËÛË ÛÙÔ Úfi‚ÏËÌ· ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙÔ˘ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∂ÓÙÔ‡ÙÔÈ˜, ÚÔÙÂ›-ÓÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÎÈ ¿ÏÏ· Ì¤ÙÚ·, fiˆ˜ ÔÂÌ‚ÔÏÈ·ÛÌfi˜ (10) ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ ÙÂÙÚ·‰‡Ó·ÌÔÂÌ‚fiÏÈÔ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ (A,C,Y,W135) ·ÏÏ¿Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›fiÙÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎÂ›˜ ÌÂÏ¤ÙÂ˜ÁÈ· ÙËÓ ÎÏÈÓÈÎ‹ ·Í›· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ ÙÔ˘ ÌË-ÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÂ ¿ÙÔÌ· ÌÂ ·ÓÂ¿ÚÎÂÈÂ˜ Û˘-ÌÏËÚÒÌ·ÙÔ˜. ¶Èı·ÓfiÓ Ù· ¿ÙÔÌ· ·˘Ù¿ Ó· ‚ÔËıË-ıÔ‡Ó ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, ÁÈ·Ù› Ù· ÔÏ˘Û·Î¯·ÚÈ‰È-Î¿ ·ÓÙÈÛÒÌ·Ù· ‰ÈÂÁÂ›ÚÔ˘Ó ÙÔ ÌË¯·ÓÈÛÌfi ÙË˜ Ô„ˆ-ÓÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË˜ Ô˘ ·Ú·Ì¤ÓÂÈ Ô ÌÔÓ·‰ÈÎfi˜ÌË¯·ÓÈÛÌfi˜ ¿Ì˘Ó·˜. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ ÙÔ ÂÌ‚fi-ÏÈÔ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ¿ÓÙˆ˜, ‰ÂÓ ·ÔÎÏÂ›ÂÈÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË.

∏ Ì·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚›ˆÛË˜ ÁÈ· ÚÔ-Ê‡Ï·ÍË (1,2,11) ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓË. ™Â ÂÚÈ-ÙÒÛÂÈ˜ Ô˘ ¤¯ÂÈ ‰ÔıÂ›, Î·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜Â›Ó·È Ë ÂÓ‰ËÌÈÎfiÙËÙ· ÙË˜ ÏÔ›ÌˆÍË˜ ÛÙËÓ ÂÚÈÔ¯‹fiˆ˜ Î·È Ë ·ÓÙÔ¯‹ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÙËÓ ÂÓÈÎÈ-Ï›ÓË. ∞fi ÔÚÈÛÌ¤ÓÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈË ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË˜, Ë ‰È¿ÚÎÂÈ· ÙË˜ÔÔ›·˜ ‰ÂÓ Î·ıÔÚ›˙ÂÙ·È, Èı·ÓfiÓ Ó· ÌÂÈÒÓÂÈ ÙÔÓ·ÚÈıÌfi ÙˆÓ ˘ÔÙÚÔÒÓ.

∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÛÂ Ì›· ÎÏÈÓÈÎ‹ Ô˘ ÓÔÛËÏÂ‡ÂÈÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÈÎÚÔ‚È·ÎÒÓ ÌËÓÈÁÁ›ÙÈ‰ˆÓ ÂÚÈ-ÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÌËÓÈÁ-ÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË, ˘Ô‰ËÏÒÓÂÈ ÙË Û·ÓÈfiÙËÙ·ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. Ÿˆ˜ ÚÔÎ‡ÙÂÈ Î·È ·fi ÙË ‚È-‚ÏÈÔÁÚ·Ê›·, Ë Û·Ê‹˜ Û˘Û¯¤ÙÈÛË ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ÙˆÓ ÙÂÏÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ ÌÂ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜, ÛÔ-‚·Ú¤˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, ÂÈ‚¿ÏÏÂÈÙËÓ ·Ó·˙‹ÙËÛË ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ ·˘Ù‹˜ ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÌË ÂÈ‰ËÌÈÎ‹ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ-

‰· ‹ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÌËÓÈÁÁÈÙÈ-‰ÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Ross SC, Densen P. Complement deficiency states and

infection: Epidemiology, pathogenesis and conse-quences of Neisseria and other infections in an immunedeficiency. Medicine 1984;63:243-267.

2. Figueroa JE, Densen P. Infectious diseases associatedwith complement deficiencies. Cl Microbiol Rev 1991:359-395.

3. Figueroa JE, Andreoni J, Densen P. Complementdeficiency states and meningococcal disease. ImmunolRes 1993;12:295-311.

4. Richard B, Johnston JR. The complement system in hostdefense and inflammation: the cutting edges of a doubleedged sword. Pediatr Inf Dis J 1993;12:933-941.

5. Pallares D, Figueroa E, Julio E, Densen R, Marchall GS.Invasive Haemophilus influenzae type b infection in a childwith familial deficiency of the beta subunit of the eighthcomponent of complement. J Pediatr 1996;128:102-103.

6. Gelfand Erwin W, Pandu RC, Minta JD, Purkall DB, ShuanR. Inherited deficiency of properdin and C2 in a patientwith recurrent bacteremia. Am J Med 1987;82:671-675.

7. Vogler LB, Johnston RB. Recurrent meningococcalmeningitis with absence of the sixth component ofcomplement: An evaluation of underlying immunologicmechanisms. Pediatrics 1979;64:465-467.

8. Fijen Cees AP, Kuijper EJ, van Putten Jos PM.Complement deficiencies in patients over ten years oldwith meningococcal disease due to uncommonserogroups. Lancet 1989;2:585-588.

9. Derkx HHF, Kuijper EJ, Fijen CAP, Dankert J. Inheritedcomplement deficiency in children surviving fulminantmeningococcal septic shock. Eur J Paediatr 1995;154:735-738.

10. Andreoni J, Kayhty H, Densen P. Vaccination and the roleof capsular polysaccharide antibody in prevention ofrecurrent meningococcal disease in late complementcomponent deficient individuals. J Infect Dis 1993;168:227-231.

11. Potter PC, Frasch CE, Van der Sande WJM. Profylaxisagainst Neisseria meningitidis infections and antibodyresponses in patients with deficiency of the sixthcomponent of complement. J Infect Dis 1990;161:932-937.

12. Platonov AE, Vershinina IV, Kayhty H. Vaccination ofpatients deficient in a late complement component withtetravalent meningococcal capsular polysaccharidevaccine. Clin Exp Immunol 1995;100:32-39.



¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· £ÂÔ‰ˆÚ›‰Ô˘ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

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�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÓÂ˘ÌÔ-ÓÈÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜, Ë ‰È¿ÁÓˆÛË ÙË˜ ÔÔ›·˜Î·ı˘ÛÙ¤ÚËÛÂ, ÁÈ·Ù› Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·Ú¯ÈÎ‹˜ÔÛÊ˘ÔÓˆÙÈ·›·˜ ·Ú·Î¤ÓÙËÛË˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿.∆Ô ·È‰› ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ·Ù› ·ÚÔ˘Û›·-ÛÂ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜. ∆· Â˘Ú‹Ì·Ù· ÙË˜ ÚÒ-ÙË˜ ÔÛÊ˘ÔÓˆÙÈ·›·˜ ·Ú·Î¤ÓÙËÛË˜ ‹Ù·Ó Ê˘ÛÈÔÏÔ-ÁÈÎ¿, ÂÓÒ Ë ‰Â‡ÙÂÚË ¤‰ÂÈÍÂ 1350 ÏÂ˘Î¿ ·ÈÌÔÛÊ·›-ÚÈ·/mm3. √È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙÔ˘ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂ-ÚÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡, Î·ıÒ˜ Â›ÛË˜ Î·ÈÔÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜, ·Ó¤Ù˘Í·Ó ÓÂ˘ÌÔÓÈfi-ÎÔÎÎÔ. ∆Ô Ê˘ÛÈÔÏÔÁÈÎfi ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÌËÓÈÁÁ›ÙÈ‰·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·,ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi.

�Abstract: A case of Streptococcus pneumoniaemeningitis is reported in a child in whom the dia-gnosis was delayed because of an initially normalcerebrospinal fluid analysis. The child was admit-ted to the hospital because of febrile seizures. Theinitial lumbar puncture revealed normal cerebro-spinal fluid findings but a second one, performed24h later, showed 1350 white blood cells/mm3.Streptococcus pneumoniae was cultured from theCSF obtained from the initial and the secondlumbar puncture as well as from blood cultures.Normal cerebrospinal fluid findings do not alwaysexclude the possibility of meningitis.

Key words: Streptococcus pneumoniae menin-gitis, cerebrospinal fluid.

¶ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· ÌÂ ·Ú¯ÈÎÒ˜ Ê˘ÛÈÔÏÔÁÈÎfi ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÛÂ ÌË ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔ ¿ÚÚˆÛÙÔ ∞. Ã·Ù˙Ë·Ó·Á‹˜, ª. ™È‰ÂÚ¿

Streptococcus pneumoniae meningitis with initial normal cerebrospinal fluid findings in a non-immunocompromised patientA. Hadjipanayis, M. Sidera

∂ÈÛ·ÁˆÁ‹∏ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË (√¡¶) Â›Ó·È Ë

·Ó·ÁÎ·›· ÂÍ¤Ù·ÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ÛÂ ÔÔÈÔÓ‰‹ÔÙÂ ¿ÚÚˆÛÙÔ ˘¿Ú¯ÂÈ ˘Ô„›· ÁÈ· ÙËÓfiÛÔ ·˘Ù‹. ∂ÓÙÔ‡ÙÔÈ˜, Ê˘ÛÈÔÏÔÁÈÎfi ÂÁÎÂÊ·ÏÔÓˆÙÈ-·›Ô ˘ÁÚfi (∂¡À) ‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÌË-ÓÈÁÁ›ÙÈ‰·˜ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ·Ú-ÎÂÙ¿ ÂÚÈÛÙ·ÙÈÎ¿ ÌËÓÈÁÁ›ÙÈ‰·˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∂¡À(1-4).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ ‰‡Ô ¯ÚfiÓˆÓ ÚÔÛ‹ÏıÂ ÛÙÔ ÓÔ-

ÛÔÎÔÌÂ›Ô ÁÈ·Ù› ·ÚÔ˘Û›·ÛÂ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜‰È¿ÚÎÂÈ·˜ 10-15 ÏÂÙÒÓ. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·-ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÂÚfi-ÎÂÈÙÔ ÁÈ· ÓˆıÚfi ·È‰›, ¯ˆÚ›˜ fiÌˆ˜ Ù›ÔÙ· ÙÔ ·ıÔ-

ÏÔÁÈÎfi ·fi ÙËÓ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤-Ù·ÛË. ™ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ·ÎfiÌ· ¤Ó·ÂÂÈÛfi‰ÈÔ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÚÈÓ ¤Ó· ¯ÚfiÓÔ. ∆··ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘ Î·Ù¿ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: §Â˘-Î¿=10.000/mm3 /73 Ï/19 Ì/8, HB=10,4 gr%, ∞ÈÌÔ-ÂÙ¿ÏÈ·=403.000/mm3, °Ï˘Îfi˙Ë=201 mg%, √˘-Ú›·=24 mg%, ∫ÚÂ·ÙÈÓ›ÓË=0,4 mg%, Ca=8,9 mg%,P=3,4 mg%, Na=132 mEq/L, K=5,5 mEq/L,Cl=106 mEq/L. ∏ √¡¶ ¤‰ÂÈÍÂ ‰È·˘Á¤˜ ∂¡À ÌÂ Î·-Ó¤Ó· ÂÚ˘ıÚfi ·ÈÌÔÛÊ·›ÚÈÔ, 5 ÏÂ˘Î¿/mm3, ÁÏ˘Îfi-˙Ë=92 mg/dl, Î·È ÚˆÙÂ˝ÓË=16 mg/dl. ŸÏÔ˜ Ô ÏË-ı˘ÛÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ ∂¡À ‹Ù·ÓÏÂÌÊÔÎ˘ÙÙ·ÚÈÎfi˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ‚Ú¤ıË-ÎÂ ÂÛÙ›· ÏÔ›ÌˆÍË˜, ¯ÔÚËÁ‹ıËÎÂ ÛÙÔ ·È‰› ÎÂÊoÙ·-Í›ÌË 200 mg/kg, ÂÚÈÌ¤ÓÔÓÙ·˜ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·


¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ª·Î¿ÚÈÔ ¡ÔÛÔÎÔÌÂ›Ô §¿ÚÓ·Î·˜, §¿ÚÓ·Î·, K‡ÚÔ˜

Pediatric Clinic, Makario Hospital of LarnakaLarnaka, Cyprus

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·fi ÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ Î·È ∂¡À. ∂ÈÎÔÛÈ-Ù¤ÛÛÂÚÈ˜ ÒÚÂ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ·È‰›¿Ú¯ÈÛÂ Ó· Î¿ÓÂÈ ÂÌÂÙÔ‡˜ Î·È ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ ·˘¯ÂÓÈÎ‹ ‰˘ÛÎ·Ì„›·. ∏Î·ÈÓÔ‡ÚÁÈ· √¡¶ ¤‰ÂÈÍÂ 1350 ÏÂ˘Î¿/mm3

(/95%, Ï/5%), ÁÏ˘Îfi˙Ë=59 mg/dl Î·È Úˆ-ÙÂ˝ÓË=45 mg/dl. √ Ó¤Ô˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ ¤‰ÂÈÍÂ: §Â˘Î¿= 23100/mm3 /85 Ï/7 Ì/7,HB=10,7 gr%, ∞ÈÌÔÂÙ¿ÏÈ·=259.000/mm3,∆∫∂=72 mm/1h, °Ï˘Îfi˙Ë= 125 mg%, √˘-Ú›·=13 mg%, ∫ÚÂ·ÙÈÓ›ÓË=0,4 mg%, Na=136mEq/L, K=3,7 mEq/L, Cl=102 mEq/L. ∏ ÎÂÊÔÙ·-Í›ÌË ‰È·ÎfiËÎÂ Î·È ¯ÔÚËÁ‹ıËÎÂ ÛÙÔ ·È‰› ÂÓÈÎÈ-Ï›ÓË-¯ÏˆÚ·ÌÊÂÓÈÎfiÏË. √È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙÔ˘ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ∂¡À, Î·ıÒ˜ Î·È ÔÈ Î·Ï-ÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜, ·Ó¤Ù˘Í·Ó ÓÂ˘ÌÔÓÈfiÎÔÎÎÔÔ˘ ‹Ù·Ó Â˘·›ÛıËÙÔ˜ ÛÙËÓ ÂÓÈÎÈÏ›ÓË, ÎÂÊÔÙ·Í›-ÌË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË. ªfiÏÈ˜ ‹Ú·ÌÂ Ù· ·Ô-ÙÂÏ¤ÛÌ·Ù· ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ∂¡À,‰ÈÂÎfiË Ë ¯ÔÚ‹ÁËÛË ÙË˜ ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË˜. ∏‰È·ÎÔ‹ ÙË˜ ÎÂÊÔÙ·Í›ÌË˜ ‰ÂÓ ‹Ù·Ó ÔÚı‹, ÁÈ·Ù›·ÎfiÌ· ÎÈ ·Ó Ô ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜ ‹Ù·Ó ·ÓıÂÎÙÈÎfi˜ÛÙËÓ ÎÂÊÔÙ·Í›ÌË ÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi Ô˘ ı· ¤ÚÂÂÓ· ¯ÚËÛÈÌÔÔÈËıÂ› ‹Ù·Ó Ë ‚·ÓÎÔÌ˘Î›ÓË. √ ¤ÏÂÁ-¯Ô˜ ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ Î·È ¯˘ÌÈÎ‹˜ ·ÓÔÛ›·˜ ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎfi˜.

™˘˙‹ÙËÛË∏ ‰È¿ÁÓˆÛË ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ù›ıÂÙ·È ÌÂ ÙËÓ ÂÍ¤-Ù·ÛË ÙÔ˘ ∂¡À ÛÂ Î¿ıÂ ·È‰› Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈ-ÓÈÎ‹ ÂÈÎfiÓ· ÛË„·ÈÌ›·˜ ‹ ·Ó Ë ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·-Û‹ ÙÔ˘ ·Ó·‰ÂÈÎÓ‡ÂÈ ÛËÌÂ›· ÏÔ›ÌˆÍË˜ ÙÔ˘ ∫ÂÓÙÚÈ-ÎÔ‡ ¡Â˘ÚÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜. ∂ÓÙÔ‡ÙÔÈ˜, Ê˘ÛÈÔÏÔÁÈ-Îfi ∂¡À ‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÌËÓÈÁÁ›ÙÈ-‰·˜ (1-4).À¿Ú¯Ô˘Ó ‰È¿ÊÔÚÂ˜ ˘Ôı¤ÛÂÈ˜ Ô˘ ÚÔÛ·ıÔ‡ÓÓ· ÂÍËÁ‹ÛÔ˘Ó ÙÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi. ∏ ÚÒÙË ÂÈÛË-ÁÂ›Ù·È ÙËÓ Èı·ÓfiÙËÙ· Ë √¡¶ Ó· ¤¯ÂÈ Á›ÓÂÈ ÛÙ··Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘ Î·È Ó· ÌËÓ ¤¯ÂÈ ‰ÔıÂ›¯ÚfiÓÔ˜ ÁÈ· Ï‹ÚË Î˘ÙÙ·ÚÈÎ‹ ·ÓÙ·fiÎÚÈÛË. ™ÙÔÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Ë √¡¶ ¤ÁÈÓÂ Ù¤Û-ÛÂÚÈ˜ ÒÚÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡. ªÂÏ¤-ÙÂ˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ fiÙÈ Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ÙË˜√¡¶ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡ Â›Ó·È 6-24ÒÚÂ˜ ÛÙ· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∂¡À Î·È ÌËÓÈÁÁ›-ÙÈ‰·, ÂÓÒ ÛÙ· ·È‰È¿ ÌÂ ·ıÔÏÔÁÈÎfi ∂¡À Ô Ì¤ÛÔ˜¯ÚfiÓÔ˜ Â›Ó·È 43 ÒÚÂ˜ (1,2). ∆· ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤-Ó· ¿ÙÔÌ· ÌÔÚÂ› Ó· ¤¯Ô˘Ó ÌËÓÈÁÁ›ÙÈ‰· ÌÂ Ê˘ÛÈÔ-ÏÔÁÈÎfi ∂¡À. √ ¿ÚÚˆÛÙÔ˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ¤¯ÂÈ

Ê˘ÛÈÔÏÔÁÈÎ‹ ¯˘ÌÈÎ‹ Î·È Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›·. ∏ ÙÚ›ÙË˘fiıÂÛË ÂÈÛËÁÂ›Ù·È ÙËÓ Èı·ÓfiÙËÙ· Ë ›‰È· Ë √¡¶Ó· ¤¯ÂÈ ÚÔÎ·Ï¤ÛÂÈ ÌËÓÈÁÁ›ÙÈ‰· ÛÂ ·ÚÚÒÛÙÔ˘˜ ÌÂÛË„·ÈÌ›· (5). ™Â ÂÚ›ÙˆÛË ‰ËÏ·‰‹ Ô˘ Ë √¡¶Â›Ó·È ÙÚ·˘Ì·ÙÈÎ‹ ÛÂ ¿ÚÚˆÛÙÔ ÌÂ ÛË„·ÈÌ›·, ÌÔ-ÚÂ› Ó· ÌÂÙ·ÊÂÚıÔ‡Ó ÌÈÎÚfi‚È· ÌÂ ÙÔ ·›Ì· ÛÙÔ ∂¡À.∏ √¡¶ fiÌˆ˜, Ô˘ ¤ÁÈÓÂ ÛÙÔ ¿ÚÚˆÛÙÔ ·È‰› ‰ÂÓ‹Ù·Ó ÙÚ·˘Ì·ÙÈÎ‹ Î·È Î·Ó¤Ó· ÂÚ˘ıÚfi ·ÈÌÔÛÊ·›ÚÈÔ‰ÂÓ ‚Ú¤ıËÎÂ ÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ∂¡À.ÃÚÒÛË Î·Ù¿ Gram ‰˘ÛÙ˘¯Ò˜ ‰ÂÓ Á›ÓÂÙ·È ÛÙÔ Ê˘-ÛÈÔÏÔÁÈÎfi ∂¡À. ∏ ÁÓÒÛË fiÌˆ˜ fiÙÈ ˘¿Ú¯ÂÈ ÌËÓÈÁ-Á›ÙÈ‰· ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∂¡À ÂÈ‚¿ÏÏÂÈ ÙËÓ ·Ó¿ÁÎËÓ· Á›ÓÂÙ·È ¯ÚÒÛË Î·Ù¿ Gram ÛÂ Î¿ıÂ ∂¡À, È‰È·›-ÙÂÚ· ÛÙ· ·È‰È¿ ÌÂ Û·ÛÌÔ‡˜. ∞˘Ù‹ Ë ·Ï‹ ÂÍ¤-Ù·ÛË ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Î·ÈÓÔ‡ÚÁÈÂ˜ ÙÂ¯ÓÈÎ¤˜ ·Ó›-¯ÓÂ˘ÛË˜ ·ÓÙÈÁfiÓˆÓ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ı· ·˘Í‹ÛÔ˘ÓÙËÓ ÈÎ·ÓfiÙËÙ· ‰È¿ÁÓˆÛË˜ ·Ù‡ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓÌËÓÈÁÁ›ÙÈ‰·˜.√ ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜ ‰ÂÓ Ú¤ÂÈ Ó· ‚·Û›˙ÂÙ·È ÌfiÓÔÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ∂¡À ÁÈ· ÙËÓ ¤Ó·ÚÍË ‹ fi¯È·ÓÙÈÌÈÎÚÔ‚È·Î‹˜ ıÂÚ·Â›·˜, ·ÏÏ¿ ÈÛ¯˘Úfi ÎÚÈÙ‹-ÚÈÔ ·ÔÙÂÏÂ› ¿ÓÙÔÓÙÂ Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ ·ÚÚÒ-ÛÙÔ˘. ∂›ÛË˜, Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÙ·È ‰Â‡ÙÂÚË√¡¶, fiÙ·Ó Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Â›Ó·È ‡ÔÙË ÌËÓÈÁÁ›-ÙÈ‰·˜, ·Ú¿ ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ∂¡À ÛÙËÓ ÚÒÙË√¡¶.

µÈ‚ÏÈÔÁÚ·Ê›·1. Uchihara T, Ichikawa K, Yoshida S, Tsukagoshi H. Positive

culture from normal CSF of Streptococcus pneumoniaemeningitis. Eur Neurol 1996;36:234.

2. Rosenthal J, Golan A, Dagan R. Bacterial meningitis withinitial normal cerebrospinal fluid findings. Isr J Med Sci1989;25:186-188.

3. Coll MT, Uriz MS, Pineda V, Fontanals D, Bella F, Nava JMet al. Meningococcal meningitis with "normal": cerebrospi-nal fluid. J Infect 1994;29:289-294.

4. Polk B, Steele R. Bacterial meningitis presenting withnormal cerebrospinal fluid. Pediatr Infect Dis J1987;6:1040-1042.

5. Fischer GW, Brenz RW, ∞lden ER, Beckwith JB. Lumbarpuncture and meningitis. Am J Dis Child 1975;129:590-592.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞‰¿ÌÔ˜ Ã·Ù˙Ë·Ó·Á‹˜ 25Ë˜ ª·ÚÙ›Ô˘ 6, ¢ÂÚ‡ÓÂÈ·, 5380, ∫‡ÚÔ˜

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87


�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ÎÏÈÓÈÎ¿ ˘ÁÈÔ‡˜ ÓË›Ô˘, ËÏÈÎ›·˜ 16 ÌËÓÒÓ, ÌÂ ÛËÌ·-ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ Êˆ-ÛÊ·Ù¿ÛË˜ ÔÚÔ‡, ˆ˜ Ù˘¯·›Ô˘ Î·È ÌÔÓ·‰ÈÎÔ‡ Â˘Ú‹-Ì·ÙÔ˜ ÛÙ· Ï·›ÛÈ· ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘ ÚÔ˘-Ù›Ó·˜. ∏ ÙÈÌ‹ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡, ËÔÔ›· ¤Êı·ÛÂ ÛÙÈ˜ 3.568 ÌÔÓ¿‰Â˜/L, Â·Ó‹ÏıÂ ÛÂÊ˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· ÌÂÙ¿ ·fi ¤ÍÈ Ì‹ÓÂ˜, ¯ˆÚ›˜Î·Ì›· ·Ú¤Ì‚·ÛË. ∂ÎÙÂÓ‹˜ ÎÏÈÓÈÎfi˜ Î·È ÂÚÁ·ÛÙË-ÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·¤‚Ë ·ÚÓËÙÈÎfi˜ ÁÈ· ÔÛÙÈÎ‹, Ë·-ÙÈÎ‹ ‹ ¿ÏÏË ÓfiÛÔ Ë ÔÔ›· Ó· ‰‡Ó·Ù·È Ó· ÂÚÌËÓÂ‡-ÛÂÈ ÙËÓ ÙfiÛÔ ÌÂÁ¿ÏË ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ ·ÏÎ·-ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜. ªÂ ·ÊÔÚÌ‹ ÙËÓ ÂÚ›ÙˆÛË·˘Ù‹, ·Ó·Ï‡ÔÓÙ·È Ë Èı·Ó‹ ·ÈÙÈÔÏÔÁ›· Î·È Ë ·ıÔ-Á¤ÓÂÈ· ÙË˜ ÂÓ‰È·Ê¤ÚÔ˘Û·˜ ·˘Ù‹˜ ÔÓÙfiÙËÙ·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË, ˘ÂÚÊˆ-ÛÊ·Ù·Û·ÈÌ›·, ·ÚÔ‰ÈÎ‹ ·‡ÍËÛË ÙË˜ ·ÏÎ·ÏÈÎ‹˜ÊˆÛÊ·Ù¿ÛË˜, ÈÛÔ¤Ó˙˘Ì· ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·-Ù¿ÛË˜.

�Abstract: A previously well 16-month-old boy ispresented who on routine examination was foundto have marked, transient hyperphosphatasaemiaof infancy and early childhood. The diagnosis wasbased on the finding of increased activity of serumalkaline phosphatase, more than fivefold the upperreference limit (3568 u/l), without evidence of liverand bone disease, and also by its subsequentreturn to normal levels within 6 months afterdiagnosis. The etiology of the condition and thepossible mechanisms of the enzyme increase arediscussed.

Key words: alkaline phosphatase, hyperphospha-tasaemia, transient elevation of alkaline phospha-tase, isoenzymes of alkaline phosphatase.

∫·ÏÔ‹ıË˜ ·ÚÔ‰ÈÎ‹ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›· ÛÂ ·ÁfiÚÈ 16 ÌËÓÒÓ¡. °Î·Ì›ÏË˜1, °. ∆ÛfiÏ·˜2

Benign transient hyperphosphatasaemia in a 16-month old boyN. Gamilis1, G. Tsolas2

∂ÈÛ·ÁˆÁ‹∏ ·ÚÔ‰ÈÎ‹ ÂÎÛÂÛËÌ·ÛÌ¤ÓË ·‡ÍËÛË ÙË˜ ·ÏÎ·-

ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÙÔ˘ ÔÚÔ‡ Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ Î·ÈÓËÈ·Î‹ ËÏÈÎ›·, ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜, Â›¯Â ÂÚÈ-ÁÚ·ÊÂ› ÁÈ· ÚÒÙË ÊÔÚ¿, ÚÈÓ ·fi ÌÈÛfi ÂÚ›Ô˘ ·È-ÒÓ·, ·fi ÙÔÓ Bach (1). H Î·ÏÔ‹ıË˜ ·˘Ù‹ Î·Ù¿ÛÙ·-ÛË, ·ÔÙÂÏÂ› Î·Ù¿ Î·ÓfiÓ· Ù˘¯·›Ô Â‡ÚËÌ·. ¶·Ú·ÙË-ÚÂ›Ù·È Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ Î·È ÓËÈ·Î‹ ËÏÈÎ›· ÌÂ·ÎÚ·›· ËÏÈÎÈ·Î¿ fiÚÈ· ·fi 2 ¤ˆ˜ 54 ÌËÓÒÓ Î·È ˘Ô-¯ˆÚÂ› Î·Ù¿ Î·ÓfiÓ· ÛÂ 3-6 Ì‹ÓÂ˜. ∏ ·ÈÙÈÔ·ıÔÁ¤-

ÓÂÈ¿ ÙË˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, Èı·ÓÔÏÔÁÂ›Ù·È fiÌˆ˜fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÚÔËÁËıÂ›Û· ÏÔ›ÌˆÍË, ÈÔÁÂÓÔ‡˜,Î·Ù¿ Î·ÓfiÓ·, ·ÈÙÈÔÏÔÁ›·˜. ∂ÎÙÂÓ‹˜ ÎÏÈÓÈÎfi˜ Î·È ·-Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ·ÔÎ·Ï‡ÙÂÈ Ë·ÙÈÎ‹ ‹ÔÛÙÈÎ‹ ·ıÔÏÔÁ›· Ë ÔÔ›· Ó· ÂÍËÁÂ› ÙËÓ ·‡ÍËÛËÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜, ÔÚÈÛÌ¤ÓÂ˜ Ì¿ÏÈÛÙ·ÊÔÚ¤˜, ¤ˆ˜ Î·È 30 ÊÔÚ¤˜ ¿Óˆ ·fi Ù· ·ÓÒÙÂÚ·Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· (2).

¶ÂÚÈÁÚ¿ÊÂÙ·È ÛÙË Û˘Ó¤¯ÂÈ·, Ë ÂÚ›ÙˆÛË ¿ÚÚÂ-ÓÔ˜ ÓË›Ô˘, ËÏÈÎ›·˜ 16 ÌËÓÒÓ, ÌÂ ÔÏ‡ ·˘ÍËÌ¤ÓË

1 π‰ÈÒÙË˜ ¶·È‰›·ÙÚÔ˜2 ∂ÈÌÂÏËÙ‹˜ µ' ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜

¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ¡›Î·È·˜, ¶ÂÈÚ·È¿˜“ÕÁÈÔ˜ ¶·ÓÙÂÏÂ‹ÌˆÓ”

1 Private practicing Pediatrician2 Registrar 2nd Pediatric Clinic

General Hospital of Nikea, Piraeus“Saint Panteleimon”


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88

ÙÈÌ‹ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡, Ë ÔÔ›· ·ÓÂ˘-Ú¤ıËÎÂ ÛÙ· Ï·›ÛÈ· Ù˘¯·›Ô˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á-¯Ô˘ Î·È ˘Ô¯ÒÚËÛÂ Ï‹Úˆ˜ ÛÂ ‰È¿ÛÙËÌ· 6 ÌËÓÒÓ.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∞ÁfiÚÈ, ËÏÈÎ›·˜ 16 ÌËÓÒÓ, ÌÂ ÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ-

·Îfi ÈÛÙÔÚÈÎfi Î·È Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ·-Ú·Ì¤ÙÚÔ˘˜, ÂÍÂÙ¿ÛıËÎÂ ‰‡Ô ÊÔÚ¤˜ Ì¤Û· ÛÂ ‰È¿-ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜ ·fi ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘, ÏfiÁˆ ˘-ÚÂÙÔ‡ ÙËÓ ÚÒÙË ÊÔÚ¿, Ô ÔÔ›Ô˜ ·Ô‰fiıËÎÂ ÛÂ ÈÔ-ÁÂÓ‹ Î˘Ó¿Á¯Ë Î·È ÏfiÁˆ ÂÌ‡ÚÂÙË˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ-‰·˜ ÙË ‰Â‡ÙÂÚË ÊÔÚ¿, ÌÂ ¯·Ú·ÎÙ‹ÚÂ˜ ÈÔÁÂÓÔ‡˜ ÏÔ›-ÌˆÍË˜. ∆Ô ·È‰› ‰ÂÓ ¤Ï·‚Â Ê¿ÚÌ·Î·, ÂÎÙfi˜ ·fi ·-Ú·ÎÂÙ·ÌfiÏË ˆ˜ ·ÓÙÈ˘ÚÂÙÈÎfi ÛÂ Î·ÓÔÓÈÎ¤˜ ‰fiÛÂÈ˜.

™Â ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜, Ô ÔÔ›Ô˜·ÎÔÏÔ‡ıËÛÂ ‰‡Ô Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ÙË˜ ‰Â‡ÙÂÚË˜ ÏÔ›ÌˆÍË˜, ·ÓÂ˘Ú¤ıËÎÂ ÔÏ‡ ·˘ÍËÌ¤-ÓË ÙÈÌ‹ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡, Û¯Â‰fiÓ ‰Â-Î·Ï¿ÛÈ· ÙË˜ ·ÓÒÙÂÚË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ÙÈÌ‹˜ (ÙÈÌ‹·ÛıÂÓÔ‡˜ 3490 u/l, Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÁÈ· ÙËÓ ËÏÈ-Î›· ·˘Ù‹ 150-420 u/l).

∫·Ù¿ ÙË ÏÂÙÔÌÂÚ‹ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÓË›-Ô˘, ‰ÂÓ ·ÓÂ˘Ú¤ıËÎ·Ó ÛËÌÂ›· ÂÓ‰ÂÈÎÙÈÎ¿ Ú·¯›ÙÈ‰·˜,Ô‡ÙÂ Ë·ÙÔÌÂÁ·Ï›· ‹ ¿ÏÏÔ ·ÍÈÔÛËÌÂ›ˆÙÔ ·ıÔÏÔ-ÁÈÎfi Â‡ÚËÌ·. √ ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËÎÂ ÛÂ Ï‹ÚËÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ô ÔÔ›Ô˜ ·¤ÎÏÂÈÛÂ ÔÛÙÈÎ‹,Ë·ÙÈÎ‹ ‹ ¿ÏÏË ÓfiÛÔ Ô˘ Ó· ‰ÈÎ·ÈÔÏÔÁÂ› ÙÔ ·Ú·-¿Óˆ ÂÚÁ·ÛÙËÚÈ·Îfi Â‡ÚËÌ·. ™˘ÁÎÂÎÚÈÌ¤Ó·, ·ÓÂ˘-Ú¤ıËÎ·Ó: Hb: 12,2 g/dl, Ht: 36,1%, MCV: 77,5 fl,MCH: 26,1 pg, RDW-CV: 13,8%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›-ÚÈ·: 12.480/mm3 (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·: 49%, ÏÂÌÊÔ-Î‡ÙÙ·Ú·: 37%, ÌÂÁ¿Ï· ÌÔÓÔ‡ÚËÓ·: 8%, ËˆÛÈÓfiÊÈ-Ï·: 6%), ·ÈÌÔÂÙ¿ÏÈ·: 365.000/mm3, AST(SGOT):41 u/l (ÊÙ <65 u/l), ALT(SGPT): 32 u/l (ÊÙ <54 u/l),Á-GT (Á-ÁÏÔ˘Ù·Ì˘ÏÈÎ‹ ÙÚ·ÓÛÂÙÈ‰¿ÛË): 9u/l (ÊÙ:0-23 u/l), ÔÏÈÎ¿ ÏÂ˘ÎÒÌ·Ù· ÔÚÔ‡: 6,1 g/dl (ÊÙ: 3,7-7,5 g/dl), ÏÂ˘ÎˆÌ·Ù›ÓË ÔÚÔ‡: 4,2 g/dl (ÊÙ: 1,9-5g/dl), ÛÊ·ÈÚ›ÓÂ˜ ÔÚÔ‡: 1,9 g/dl (ÊÙ: 1,3-5 g/dl), ÔÏÈ-Îfi ·Û‚¤ÛÙÈÔ ·›Ì·ÙÔ˜: 9,5 mg/dl (ÊÙ: 8-10,5 mg/dl),ÈÔÓÈÛÌ¤ÓÔ ·Û‚¤ÛÙÈÔ ·›Ì·ÙÔ˜: 0,96 mMol/l (ÊÙ: 1,05-1,3 mMol/l), ÊˆÛÊfiÚÔ˜ ·›Ì·ÙÔ˜: 4,8 mg/dl (ÊÙ:3,2-6,3 mg/dl), ·Ú·ıÔÚÌfiÓË ÔÚÔ‡: 13 pg/ml (ÊÙ:10-65 pg/ml), ÔÛÙÂ¿ÛË (ÔÛÙÈÎ‹ ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿-ÛË) ÔÚÔ‡: 121 Ìg/L (ÊÙ: 6-183,5 Ìg/l), 25(OH) ‚ÈÙ·-Ì›ÓË D3: 51,8 ng/ml (ÊÙ: 16-74 ng/ml).

™Â Ó¤· Ì¤ÙÚËÛË, Ì›· Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ·Ú¯È-Î‹, Ë ÙÈÌ‹ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡ ‚ÚÈ-ÛÎfiÙ·Ó ÛÙ· ›‰È· ÂÚ›Ô˘ Â›Â‰·, ÛÙÈ˜ 3568 u/l. ∏Ì¤ÙÚËÛË ÙˆÓ ÈÛÔÂÓ˙‡ÌˆÓ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿-ÛË˜ ÌÂ ËÏÂÎÙÚÔÊfiÚËÛË ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ‰Ú·-ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÔÛÙÈÎÔ‡ ÎÏ¿ÛÌ·ÙÔ˜ ·ÏÏ¿ ·˘ÍËÌ¤-ÓÔ ÙÔ Ë·ÙÈÎfi ÎÏ¿ÛÌ· L1: 57,1% + L2: 20,7% =77,8% (ÊÙ: 30-40%). ∏ ÙÈÌ‹ ÙË˜ 5-ÓÔ˘ÎÏÂÔÙÈ‰¿ÛË˜

‹Ù·Ó Â›ÛË˜ ·˘ÍËÌ¤ÓË, 23,1 u/l ÛÂ 30ÔC ÌÂ Ê˘ÛÈÔ-ÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ›ÛÂ˜ ‹ ÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ 5 u/l ÛÂ 30ÔC.

∏ ·ÎÙÈÓÔÁÚ·Ê›· ÙË˜ ‰ÂÍÈ¿˜ Ë¯ÂÔÎ·ÚÈÎ‹˜ ¿Ú-ıÚˆÛË˜ ‰ÂÓ ·ÔÎ¿Ï˘„Â Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈÎ¿ Ú·-¯›ÙÈ‰·˜ ‹ ¿ÏÏË˜ ÔÛÙÈÎ‹˜ ·ıÔÏÔÁ›·˜. ¶ÚÔÛ‰ÈÔÚ›-ÛıËÎÂ Â›ÛË˜, Ë ÙÈÌ‹ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ÔÚÔ‡ ÙˆÓ ÁÔÓ¤ˆÓ, Ë ÔÔ›· ‹Ù·Ó Ì¤Û· ÛÂ Ê˘ÛÈÔÏÔ-ÁÈÎ¿ fiÚÈ·.

√ ·ÚÓËÙÈÎfi˜ ÁÈ· Ë·ÙÈÎ‹ Î·È ÔÛÙÈÎ‹ ÓfiÛÔ ·-Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ë ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡, ÔÈ Ê˘-ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡ÙˆÓ ÁÔÓ¤ˆÓ, ÔÈ ÚÔËÁËıÂ›ÛÂ˜ ÎÏÈÓÈÎ¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ‚¤‚·ÈÂ˜ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ (ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜¤Ó·ÓÙÈ ÈÒÓ ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·ÙfiÓ Ó· Ú·ÁÌ·ÙÔÔÈË-ıÂ›) Î·ıÒ˜ Î·È Ë ¿ÚÈÛÙË, ·fi Î¿ıÂ ¿Ô„Ë, Î·Ù¿-ÛÙ·ÛË ÙÔ˘ ÓË›Ô˘, ¤ÛÙÚÂ„·Ó ÙË ‰È·ÁÓˆÛÙÈÎ‹ Ì·˜ÛÎ¤„Ë ÚÔ˜ ÙËÓ ÏÂ˘Ú¿ ÙË˜ ·ÚÔ‰ÈÎ‹˜ Î·ÏÔ‹-ıÔ˘˜ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›·˜, ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜ Èı·-ÓfiÙ·Ù· ·ÈÙÈÔÏÔÁ›·˜ Î·È ·ÔÊ·Û›ÛıËÎÂ ·Ó·ÌÔÓ‹Î·È Â·Ó¤ÏÂÁ¯Ô˜ ÛÂ ¤ÍÈ Ì‹ÓÂ˜.

¶Ú¿ÁÌ·ÙÈ, ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ô ÔÔ›Ô˜ ¤ÁÈÓÂÌÂÙ¿ ·fi ¤ÍÈ Ì‹ÓÂ˜, Ë ÙÈÌ‹ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·-Ù¿ÛË˜ ÔÚÔ‡ Â›¯Â Â·Ó¤ÏıÂÈ ÛÂ ·ÔÏ‡Ùˆ˜ Ê˘ÛÈÔ-ÏÔÁÈÎ¿ Â›Â‰· (275 u/l), ÛÙÔÈ¯Â›Ô ÙÔ ÔÔ›Ô Û˘Ó¤-‚·ÏÂ ÛÙËÓ ÔÚÈÛÙÈÎ‹ ÙÂÎÌËÚ›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜ÙË˜ Î·ÏÔ‹ıÔ˘˜ ·ÚÔ‰ÈÎ‹˜ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›·˜.

™˘˙‹ÙËÛË∏ Î·ÏÔ‹ıË˜ ·ÚÔ‰ÈÎ‹ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›·

(·‡ÍËÛË ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡) Ê·›ÓÂ-Ù·È fiÙÈ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹ ÓÔÛÔÏÔÁÈÎ‹ ÔÓÙfiÙËÙ·, ·ÓÎÚ›ÓÂÈ Î·ÓÂ›˜ ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Û¯ÂÙÈÎÒÓ ‚È‚ÏÈÔ-ÁÚ·ÊÈÎÒÓ ·Ó·ÊÔÚÒÓ, ·ÏÏ¿ Î·È ·fi ÙÔ ÂÍ·ÈÚÂÙÈÎ¿Èı·Ófi ÁÂÁÔÓfi˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ Ó·‰È·ÊÂ‡ÁÔ˘Ó ·‰È¿ÁÓˆÛÙÂ˜, Î·ıÒ˜ Ì¿ÏÈÛÙ· ÚfiÎÂÈ-Ù·È ÂÚ› ·Û˘ÌÙˆÌ·ÙÈÎ‹˜ Î·Ù·ÛÙ¿ÛÂˆ˜, Ô ‰Â ÚÔÛ-‰ÈÔÚÈÛÌfi˜ ÙË˜ ÙÈÌ‹˜ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ÙÔ˘ ÔÚÔ‡ ‰ÂÓ Û˘ÓËı›˙ÂÙ·È Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÈ˜ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÚÔ˘Ù›Ó·˜ ÛÙÈ˜ ÔÔ›Â˜˘Ô‚¿ÏÏÔÓÙ·È Ù· ‚Ú¤ÊË Î·È Ù· Ó‹È·. ¶ÚfiÎÂÈÙ·È ÁÈ·Î·ÏfiËıÂ˜, ·ÚÔ‰ÈÎfi Ê·ÈÓfiÌÂÓÔ, ÙÔ ÔÔ›Ô ·Ú·ÙË-ÚÂ›Ù·È ÛÂ ‚Ú¤ÊË Î·È Ó‹È· ËÏÈÎ›·˜ ¤ˆ˜ 5 ÂÙÒÓ, ÂÍ›-ÛÔ˘ ÛÙ· ‰‡Ô Ê‡Ï·, ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· Ë·ÙÈÎ‹˜ ‹ÔÛÙÈÎ‹˜ ·ıÔÏÔÁ›·˜ (1, 2), Â·Ó¤Ú¯ÂÙ·È ‰Â ÛÙÔ Ê˘-ÛÈÔÏÔÁÈÎfi ÛÂ ÙÚÂÈ˜ ¤ˆ˜ ¤ÍÈ Ì‹ÓÂ˜.

∏ ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË Â›Ó·È ‰ÈÌÂÚ‹˜ ÁÏ˘ÎÔ-ÚˆÙÂ˝ÓË, ÏÔ‡ÛÈ· ÛÂ „Â˘‰¿ÚÁ˘ÚÔ, Ë ÔÔ›· ·-Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ‹·Ú Î·È Ù· ÔÛÙ¿. ∞ÔÙÂÏÂ›ÙÔÓ Î‡ÚÈÔ ÂÎÚfiÛˆÔ ÙË˜ ÔÌ¿‰·˜ ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓÂÍÂÙ¿ÛÂˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙË ¯ÔÏfiÛÙ·ÛË. ∞˘-Í¿ÓÂÈ ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË ¯ÔÏÈÎ‹˜ ÛÙ¿ÛË˜, Ï‹-ÚÔ˘˜ ‹ ·ÙÂÏÔ‡˜, ÛÂ ÔÔÈÔ‰‹ÔÙÂ ÛËÌÂ›Ô ÙÔ˘ ¯Ô-ÏËÊfiÚÔ˘ ‰¤Ó‰ÚÔ˘ Î·È ÏÈÁfiÙÂÚÔ ÛÂ ÂÚÈÙÒÛÂÈ˜


2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 88

89


‚Ï¿‚Ë˜ ÙˆÓ Ë·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∂ÂÈ‰‹ fiÌˆ˜, Ë·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË ·Ú¿ÁÂÙ·È Î·È ÛÙ· ÔÛÙ¿(·fi ÙÔ˘˜ ÔÛÙÂÔ‚Ï¿ÛÙÂ˜), Ë ÙÈÌ‹ ÙË˜ ‚Ú›ÛÎÂÙ·È·˘ÍËÌ¤ÓË ÛÙËÓ ÂÚ›Ô‰Ô ÙË˜ ÔÛÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜Î·ıÒ˜ Î·È ÛÂ ÔÔÈ·‰‹ÔÙÂ Î·Ù¿ÛÙ·ÛË ÌÂ ·˘ÍË-Ì¤ÓË ÔÛÙÂÔ‚Ï·ÛÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· (Ú·¯›ÙÈ‰·,˘ÂÚ·Ú·ı˘ÚÂÔÂÈ‰ÈÛÌfi˜, ÔÛÙÂÔ‚Ï·ÛÙÈÎ¤˜ ÌÂÙ·-ÛÙ¿ÛÂÈ˜, ÔÛÙÂÔÏ˘ÙÈÎ¤˜ ÂÂÍÂÚÁ·Û›Â˜ Î.Ï.). ∞ÓÎ·È Ô ‚ÏÂÓÓÔÁfiÓÔ˜ ÙˆÓ ÂÓÙ¤ÚˆÓ Î·È Ô ÓÂÊÚfi˜¤¯Ô˘Ó ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·-Ù¿ÛË, ÓfiÛÔÈ ÙˆÓ ÔÚÁ¿ÓˆÓ ·˘ÙÒÓ ‰ÂÓ ÂËÚÂ¿˙Ô˘ÓÙÈ˜ ÂÚÈÊÂÚÈÎ¤˜ ÙÈÌ¤˜. ™Â Î‡ËÛË ÂÍ¿ÏÏÔ˘, ·˘ÍËÌ¤-ÓË ÙÈÌ‹ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÌÔÚÂ› Ó·ÔÊÂ›ÏÂÙ·È ÛÂ ·Ú·ÁˆÁ‹ ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ·.

™Â Ê˘ÛÈÔÏÔÁÈÎ¿ ·È‰È¿, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ Â›Ó·È ·˘ÍËÌ¤ÓË ÛÂ Û¯¤ÛËÌÂ ·˘Ù‹ ÙˆÓ ÂÓËÏ›ÎˆÓ. ∞˘Ùfi ÔÊÂ›ÏÂÙ·È ÛÂ ·‡ÍËÛËÙÔ˘ ÔÛÙÈÎÔ‡ ÈÛÔÂÓ˙‡ÌÔ˘, ˆ˜ Û˘Ó¤ÂÈ· ÙË˜ Ê˘ÛÈÔ-ÏÔÁÈÎ¿ ·˘ÍËÌ¤ÓË˜ ÔÛÙÂÔ‚Ï·ÛÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜ ÛÂ ¤Ó·Ó ÁÚ‹ÁÔÚ· ·˘Í·ÓfiÌÂÓÔ ÔÚÁ·ÓÈÛÌfi. ∂È-‰ÈÎfiÙÂÚ·, Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô Ë ‰Ú·ÛÙËÚÈfi-ÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›Ó·È ·ÛÙ·ı‹˜, ÒÛÙÂ Â›Ó·È ‰˘-Û¯ÂÚ‹˜ Ô Î·ıÔÚÈÛÌfi˜ ·ÛÊ·ÏÒÓ ÔÚ›ˆÓ Ê˘ÛÈÔÏÔÁÈ-ÎÒÓ ÙÈÌÒÓ. ª¤¯ÚÈ ÙÔÓ ¤ÎÙÔ Ì‹Ó·, Ë ÂÓ˙˘ÌÈÎ‹ ‰Ú·-ÛÙËÚÈfiÙËÙ· ·˘Í¿ÓÂÙ·È ÛÂ Â›Â‰· ÙÚÈÏ¿ÛÈ· ¤ˆ˜ÂÍ·Ï¿ÛÈ· ·˘ÙÒÓ ÙˆÓ ÂÓËÏ›ÎˆÓ, ÂÓÒ ·ÎÔÏÔ‡ıˆ˜˘Ô¯ˆÚÂ› ÚÔÔ‰Â˘ÙÈÎ¿ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 2ÂÙÒÓ, ÔfiÙÂ Ë ÙÈÌ‹ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›Ó·È ‰ÈÏ¿ÛÈ·¤ˆ˜ ÙÂÙÚ·Ï¿ÛÈ· ·fi ÂÎÂ›ÓË ÙˆÓ ÂÓËÏ›ÎˆÓ. ™ÙËÛ˘Ó¤¯ÂÈ·, Ù· Â›Â‰· ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ÙÔ˘ ÔÚÔ‡ ·Ú·Ì¤ÓÔ˘Ó ÛÙ·ıÂÚ¿ Ì¤¯ÚÈ ÙËÓ ÂÊË-‚Â›·, ¿ÓÙÔÙÂ fiÌˆ˜ Â›Ó·È ·˘ÍËÌ¤Ó· ÛÂ Û¯¤ÛË ÌÂÙ· Â›Â‰· ÙˆÓ ÂÓËÏ›ÎˆÓ, Èı·ÓfiÙ·Ù· ÏfiÁˆ ÙË˜Ê˘ÛÈÔÏÔÁÈÎ¿ ·˘ÍËÌ¤ÓË˜ ¤ÎÎÚÈÛË˜ ÙÔ˘ ÔÛÙÈÎÔ‡ÙË˜ ÈÛÔÂÓ˙‡ÌÔ˘ ·fi ÙÔ˘˜ ÔÛÙÂÔ‚Ï¿ÛÙÂ˜ Î·Ù¿ ÙËÓ·Û‚ÂÛÙÔÔ›ËÛË ÙÔ˘ ·˘Í·ÓfiÌÂÓÔ˘ ÛÎÂÏÂÙÔ‡. ∫·-Ù¿ ÙËÓ ÂÊË‚Â›·, ÏfiÁˆ ÙË˜ Ù·¯Â›·˜ ·‡ÍËÛË˜ ÙÔ˘ÛÎÂÏÂÙÔ‡, ÙÈÌ¤˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÔÚÔ‡ ÌÂ-Á·Ï‡ÙÂÚÂ˜ ·ÎfiÌË Î·È ÙˆÓ 1000 u/l ıÂˆÚÔ‡ÓÙ·È·Ó·ÌÂÓfiÌÂÓÂ˜, È‰›ˆ˜ ÛÙ· ·ÁfiÚÈ·.

°ÂÓÈÎ¿ ¿ÓÙˆ˜, Î¿ıÂ ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ ·Ï-Î·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÙÔ˘ ÔÚÔ‡, ÛÂ Â›Â‰· Â-ÓÙ·Ï¿ÛÈ· ‹ Î·È ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ ·ÓˆÙ¤ÚˆÓ Ê˘-ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÛÂ ‚Ú¤ÊÔ˜ ‹ Ó‹ÈÔ, Â›ıÈÛÙ·È Ó·‰ÈÂÚÂ˘Ó¿Ù·È ‰ÈÂÍÔ‰ÈÎ¿ Î·È ÂÊfiÛÔÓ ·ÔÎÏÂÈÛıÂ›ÔÛÙÈÎ‹ ‹ Ë·ÙÈÎ‹ ·ıÔÏÔÁ›· Ó· ·Ô‰›‰ÂÙ·È ÛÂ Î·-ÏÔ‹ıË ·ÚÔ‰ÈÎ‹ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›·, ‰È¿ÁÓˆÛËË ÔÔ›· ı· Ú¤ÂÈ Ó· ÂÈ‚Â‚·ÈˆıÂ› ÌÂ ÙËÓ Â¿ÓÔ-‰Ô ÙˆÓ ÙÈÌÒÓ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· Ì¤Û· ÛÂ 3-6 Ì‹ÓÂ˜.

∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ Î·ÏÔ‹ıÔ˘˜ ·ÚÔ‰ÈÎ‹˜ ˘ÂÚ-ÊˆÛÊ·Ù·Û·ÈÌ›·˜ ·Ú·Ì¤ÓÂÈ ·‰ÈÂ˘ÎÚ›ÓÈÛÙË. ¶Èı·-ÓÔÏÔÁÂ›Ù·È fiÙÈ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÚÔËÁËıÂ›Û·˜

ÏÔ›ÌˆÍË˜, Î·Ù¿ Î·ÓfiÓ· ÈÔÁÂÓÔ‡˜, fiˆ˜ Û˘Ó¿ÁÂ-Ù·È ·fi ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·Ú·ÙËÚ‹ÛÂˆÓ (3-10). £Â-ˆÚÂ›Ù·È fiÙÈ Ô ˘Â‡ı˘ÓÔ˜ ÏÔÈÌÔÁfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜ÂËÚÂ¿˙ÂÈ Èı·ÓfiÙ·Ù· ÙËÓ ·Ú·ÁˆÁ‹, ÙË ÛÙ·ıÂ-ÚfiÙËÙ· ‹ ÙËÓ Î¿ı·ÚÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·fi ÙËÓ Î˘-ÎÏÔÊÔÚ›·. ¶Èı·ÓfiÙÂÚË ıÂˆÚÂ›Ù·È Ë ·ÚÂÌfi‰ÈÛËÙË˜ Î¿ı·ÚÛË˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ì¤Ûˆ ·Â˘ıÂ›·˜ ‰Ú¿-ÛË˜ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· ÛÙÔÓ ÂÓ˙˘ÌÈÎfiÌÂÙ·‚ÔÏÈÛÌfi Î·È ÛÙËÓ Ë·ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·. ∂‰ÒÚ¤ÂÈ Ó· ÛËÌÂÈÒÛÔ˘ÌÂ fiÙÈ Ë ÙÈÌ‹ ÙÔ˘ Ë·ÙÈÎÔ‡ÈÛÔÂÓ˙‡ÌÔ˘ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜, ÙË˜ 5-ÓÔ˘ÎÏÂÔÙÈ‰¿ÛË˜, ·˘Í¿ÓÂÙ·È ÛÙÔÓ ÔÚfi ÛÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ Ë·ÙÔ¯ÔÏÈÎÒÓ ·ı‹ÛÂˆÓ, ÂÓÒ ·Ú·Ì¤ÓÂÈÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÔÛÙÈ-Î‹˜ ‚Ï¿‚Ë˜. ™ÙË ‰ÈÎ‹ Ì·˜ ÂÚ›ÙˆÛË ‹Ù·Ó ·˘ÍË-Ì¤Ó· ÙfiÛÔ Ë 5-ÓÔ˘ÎÏÂÔÙÈ‰¿ÛË, fiÛÔ Î·È Ù· ÏÔÈ¿Ë·ÙÈÎ¿ ÈÛÔ¤Ó˙˘Ì· ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜,ÛÙÔÈ¯Â›Ô ÙÔ ÔÔ›Ô ¤¯ÂÈ ·ÓÂ˘ÚÂıÂ› Î·È ÛÂ ¿ÏÏÂ˜ Â-ÚÈÙÒÛÂÈ˜ Î·ÏÔ‹ıÔ˘˜ ·ÚÔ‰ÈÎ‹˜ ˘ÂÚÊˆÛÊ·Ù·-Û·ÈÌ›·˜ (4). ∏ ·Ô˘Û›· ÈÎÙ¤ÚÔ˘ Î·È ÔÈ Ê˘ÛÈÔÏÔÁÈ-Î¤˜ ÙÈÌ¤˜ ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ÙË˜ Á-ÁÏÔ˘Ù·-Ì˘ÏÈÎ‹˜ ÙÚ·ÓÛÂÙÈ‰¿ÛË˜ (Á-GT) Û˘ÓËÁÔÚÔ‡Ó˘¤Ú ÙË˜ ·Ô˘Û›·˜ Ë·ÙÈÎ‹˜ ÓfiÛÔ˘. º·›ÓÂÙ·È ÏÔÈ-fiÓ fiÙÈ ˘fi ÙËÓ Â›‰Ú·ÛË ÂÓfi˜ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿-ÁÔÓÙ· Â¤Ú¯ÂÙ·È ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ·fi ÙÔ‹·Ú (fiˆ˜ ¿ÏÏˆÛÙÂ Û˘Ì‚·›ÓÂÈ Î·È ÌÂ ¿ÏÏÂ˜ÚˆÙÂ˝ÓÂ˜ ¯. C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË, ÊÂÚÚÈÙ›ÓË,ÎÏ.) ‹ ‰ÔÌÈÎ‹ ÌÂÙ¿ÏÏ·ÍË ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·-Ù¿ÛË˜ ‹ Ù¤ÏÔ˜ ·ÚÔ‰ÈÎ¿ ÌÂÈˆÌ¤ÓË Ë·ÙÈÎ‹ Î¿-ı·ÚÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ (¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÂÌÊ·-ÓÔ‡˜ Ë·ÙÈÎ‹˜ ÓfiÛÔ˘) ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÛÂ Î¿ıÂÂÚ›ÙˆÛË ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi (5,6).

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ Î·ÏÔ‹ıÔ˘˜ ·ÚÔ-‰ÈÎ‹˜ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›·˜, ¤Ú·Ó ‚Â‚·›ˆ˜ ÙˆÓÓÔÛËÌ¿ÙˆÓ ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ÛÎÂÏÂÙÔ‡, Ú¤ÂÈÓ· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙËÓ ÔÈÎÔÁÂÓ‹ Î·ÏÔ‹ıË ˘ÂÚ-ÊˆÛÊ·Ù·Û·ÈÌ›· Ë ÔÔ›· ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÙÔÓ ·˘-ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·. ŸÌˆ˜, Ë Î·Ù¿-ÛÙ·ÛË ·˘Ù‹ Â›Ó·È Â›ÌÔÓË Î·È ‰ÂÓ ˘Ô¯ˆÚÂ› ÛÂ‰È¿ÛÙËÌ· Ï›ÁˆÓ ÌËÓÒÓ (7). ÕÏÏˆÛÙÂ, ÛÙË ‰ÈÎ‹ Ì·˜ÂÚ›ÙˆÛË Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ ·¤‚Ë ·ÚÓËÙÈ-Îfi˜. ∂›ÛË˜, ÔÚÈÛÌ¤Ó· Ê¿ÚÌ·Î·, ·ÓÙÈÂÈÏËÙÈÎ¿,·ÓÙÈ‚ÈÔÙÈÎ¿ Î·È ¿ÏÏ·, ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ·-ÚÔ‰ÈÎ¿ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿-ÛË˜ Ì¤Ûˆ Èı·ÓfiÙ·Ù· Ë·ÙÔÙÔÍÈÎ‹˜ ‰Ú¿ÛË˜ ÌÂÛ˘ÓÔ‰fi ¯ÔÏfiÛÙ·ÛË (8). ™ÙË ‰ÈÎ‹ Ì·˜ ÂÚ›ÙˆÛË‰ÂÓ Â›¯·Ó ¯ÔÚËÁËıÂ› ÛÙÔ ·È‰› Ê¿ÚÌ·Î·, ÂÎÙfi˜ÙË˜ ·Ú·ÎÂÙ·ÌfiÏË˜ ÛÂ Î·ÓÔÓÈÎ¤˜ ·ÓÙÈ˘ÚÂÙÈÎ¤˜‰fiÛÂÈ˜, ÔÈ ÔÔ›Â˜ ‰ÂÓ ı· ‰ÈÎ·ÈÔÏÔÁÔ‡Û·Ó ÛÂ Î·-Ì›· ÂÚ›ÙˆÛË ÙËÓ ·Ú·ÙËÚËıÂ›Û· ˘ÂÚÊˆÛÊ·-Ù·Û·ÈÌ›·.

∂Ó Î·Ù·ÎÏÂ›‰È, Ù· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÁÈ·ÙËÓ ÙÂÎÌËÚ›ˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÙË˜ Î·ÏÔ‹ıÔ˘˜

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 89

90

·ÚÔ‰ÈÎ‹˜ ˘ÂÚÊˆÛÊ·Ù·Û·ÈÌ›·˜ Â›Ó·È (3,10):·. ∏ÏÈÎ›· <5 ÂÙÒÓ.‚. ∞Ô˘Û›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ ÛËÌÂ›ˆÓ ÂÓ-

‰ÂÈÎÙÈÎÒÓ Ë·ÙÈÎ‹˜ ‹ ÔÛÙÈÎ‹˜ ·ıÔÏÔÁ›·˜ ‹·Ó·ÊÔÚ¿ ÛÙÔ ÚfiÛÊ·ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Û˘ÌÙˆÌ¿ÙˆÓ ÂÓ‰ÂÈÎÙÈÎÒÓ ÚÔËÁËıÂ›-Û·˜ ÏÔ›ÌˆÍË˜, Ù· ÔÔ›· fiÌˆ˜ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ Ë·ÙÈÎ‹ ‹ ÔÛÙÈÎ‹ ÓfiÛÔ.

Á. ∫ÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ·ÚÓËÙÈÎ‹ ÁÈ· ÔÛÙÈÎ‹ ‹ Ë·ÙÈÎ‹·ıÔÏÔÁ›·.

‰. ¶·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÚÓËÙÈÎfi˜ ÁÈ· ÔÛÙÈÎ‹ ‹Ë·ÙÈÎ‹ ÓfiÛÔ.

Â. ∏ÏÂÎÙÚÔÊfiÚËÛË ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜Û˘Ì‚·Ù‹ ÌÂ Î·ÏÔ‹ıË ·ÚÔ‰ÈÎ‹ ˘ÂÚÊˆÛÊ·-Ù·Û·ÈÌ›· (·‡ÍËÛË ÙˆÓ Ë·ÙÈÎÒÓ ÈÛÔÂÓ˙‡ÌˆÓ)Î·È Ù¤ÏÔ˜,

ÛÙ. ∂¿ÓÔ‰Ô˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ Êˆ-ÛÊ·Ù¿ÛË˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÂÓÙfi˜ ÙÚÈÒÓ ¤ˆ˜¤ÍÈ ÌËÓÒÓ.™˘ÓÂÒ˜, Ë ‰ÈÎ‹ Ì·˜ ÂÚ›ÙˆÛË ·ÔÙÂÏÂ› ¯·-

Ú·ÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· ÙË˜ Î·ÏÔ‹ıÔ˘˜ ·˘Ù‹˜ÔÓÙfiÙËÙ·˜.

∂›Ó·È ¿ÓÙˆ˜ Ê·ÓÂÚfi fiÙÈ Ô ·È‰›·ÙÚÔ˜ ‚Ú›ÛÎÂ-Ù·È ÂÓÒÈÔÓ ÂÓfi˜ ÛÔ‚·ÚÔ‡ ‰ÈÏ‹ÌÌ·ÙÔ˜, ˆ˜ ÚÔ˜ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· Î·È ÙÔ ‚¿ıÔ˜ ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·-ÎÔ‡ ÂÏ¤Á¯Ô˘ Ô ÔÔ›Ô˜ ı· ··ÈÙËıÂ›, fiÙ·Ó Î·ÏÂ›Ù·ÈÓ· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙËÓ ÂÚ›ÙˆÛË ÂÓfi˜ ÎÏÈÓÈÎ¿ ˘ÁÈ-Ô‡˜ ·È‰ÈÔ‡ ÌÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙË˜·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÙÔ˘ ÔÚÔ‡. ¶ÈÛÙÂ‡Ô˘ÌÂfiÙÈ ÂÊfiÛÔÓ Ë ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Ê˘ÛÈÔ-ÏÔÁÈÎ‹, Ë ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ·ÚÓËÙÈÎ‹, Â›ÛË˜ ·ÚÓË-ÙÈÎfi˜ Î·È Ô ·‰Úfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ (·Û‚¤-ÛÙÈÔ, ÊˆÛÊfiÚÔ˜, ÙÚ·ÓÛ·ÌÈÓ¿ÛÂ˜, Á-GT, ·ÎÙÈÓÔ-ÁÚ·Ê›· ‰ÂÍÈ¿˜ Ë¯ÂÔÎ·ÚÈÎ‹˜ ¿ÚıÚˆÛË˜) ÁÈ·ÔÛÙÈÎ‹ ‹ Ë·ÙÈÎ‹ ÓfiÛÔ, Â¿Ó Ì¿ÏÈÛÙ· ÙÔ ·È‰› ÏË-ÚÔ› Ù· ËÏÈÎÈ·Î¿ ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ÔÏ‡ÂÚÈÛÛfiÙÂÚÔ Â¿Ó Û˘Ó˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ÚÔËÁË-ıÂ›Û·˜ ÈÔÁÂÓÔ‡˜ ‹ ¿ÏÏË˜ ÏÔ›ÌˆÍË˜ (ÌÔÏÔÓfiÙÈ ÙÔÙÂÏÂ˘Ù·›Ô ‰ÂÓ Â›Ó·È ·ÔÏ‡Ùˆ˜ ··Ú·›ÙËÙÔ, ‰Ôı¤-ÓÙÔ˜ fiÙÈ ·ÚÎÂÙ¤˜ ÏÔÈÌÒÍÂÈ˜ ¤¯Ô˘Ó ˘ÔÎÏÈÓÈÎ‹ Ô-ÚÂ›·), ÙfiÙÂ Ë ·Ó·ÌÔÓ‹ Â› ÂÍ¿ÌËÓÔ Î·È Ô Â·Ó·-ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ÙÈÌ‹˜ ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·-Ù¿ÛË˜ ÙÔ˘ ÔÚÔ‡ Â›Ó·È Ë Ï¤ÔÓ ÂÓ‰Â‰ÂÈÁÌ¤ÓË Ù·ÎÙÈ-Î‹. ∂¿Ó, ‚Â‚·›ˆ˜, ÛÙÔÓ ÌÂÙ¿ ÂÍ¿ÌËÓÔ Â·Ó¤ÏÂÁ¯ÔÙ· Â›Â‰· ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÙÔ˘ ÔÚÔ‡ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÓÂ˘Ú›ÛÎÔÓÙ·È ·˘ÍËÌ¤Ó·, ÙfiÙÂı· ··ÈÙËıÂ› ÂÚ·ÈÙ¤Úˆ ÏÂÙÔÌÂÚ‹˜ ¤ÏÂÁ¯Ô˜ Ùfi-ÛÔ ÙÔ˘ ·ÛıÂÓÔ‡˜, fiÛÔ Î·È ÙˆÓ ÌÂÏÒÓ ÙË˜ ÔÈÎÔÁ¤-ÓÂÈ¿˜ ÙÔ˘.

∏ ÂÚ›ÙˆÛË ÂÚÈÁÚ¿ÊÂÙ·È ÂÂÈ‰‹ Â›Ó·È ÛËÌ·-ÓÙÈÎ‹ Ë ÁÓÒÛË ÙË˜ Î·ÏÔ‹ıÔ˘˜ ·˘Ù‹˜ ÔÓÙfiÙËÙ·˜·fi ÙÔÓ ·ÛÎÔ‡ÓÙ· ·È‰›·ÙÚÔ, Ô ÔÔ›Ô˜ ‰ÂÓ ·Ô-ÎÏÂ›ÂÙ·È Ó· ÙË Û˘Ó·ÓÙ‹ÛÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ÛÙ·‰ÈÔ‰ÚÔÌ›·˜ ÙÔ˘, ·ÊÔ‡ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·ÚÎÂ-Ù¿ Û˘¯Ó‹. ∞˘Ùfi ı· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·ÔÊ˘Á‹ ÙË˜¿ÛÎÔË˜ Ù·Ï·ÈˆÚ›·˜ ÙfiÛÔ ÙÔ˘ ·È‰ÈÔ‡, fiÛÔ Î·ÈÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÌÂ ÂÚÈÙ-Ù¤˜ ÂÍÂÙ¿ÛÂÈ˜, ·ÏÏ¿ Î·È ÌÂ ÙÔ ¿Á¯Ô˜ ÂÓfi˜ Èı·-ÓÔ‡, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· fiÌˆ˜ ·Ó‡·ÚÎÙÔ˘ ÛÔ-‚·ÚÔ‡ ÓÔÛ‹Ì·ÙÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Bach U. Das Verhalten der alkalischen serum -

phosphatase bei Fruhgeborenen, Rachitikern andSpasmophilen. Z Kinderheilk 1954;74:593-603.

2. Schönau E, Herzog KH, Böhles HJ. Transient hyper-phosphatasaemia of infancy. Eur J Pediatr 1988;148:264-266.

3. Kruse K, Kurz N. Further evidence for infectious origin ofisolated transient hyperphosphatasaemia. Eur J Pediatr1989;148:453-454.

4. Crofton PM. What is the cause of benign transienthyperphosphatasaemia? A study of 35 cases. Clin Chem1988;34/2:335-340.

5. Stein P, Rosalki SB, Foo Y, Hjelm M. Transienthyperphosphatasaemia of infancy and early childhood:Clinical and biochemical features of 21 cases andliterature review. Clin Chem 1987;33/2:313-318.

6. Kruse K. Normal bone turnover in isolated hyperphosphatasaemia. J Pediatr 1985;106:946-948.

7. Nathan E. Transient hyperphosphatasaemia of infancy.Acta Paediatr Scand 1980;69:235-238.

8. Lockitch G, Pudek MR, Haltstead AC. Isolated elevation ofserum alkaline phosphatase. J Pediatr 1984;105:773-775.

9. Frank U, Kruse K. Evidence for infectious origin of isolatedtransient hyperphosphatasemia. Eur J Pediatr1985;143:323-324.

10. Krant JR, Metrick M, Maxwell NR, Kaplan MM. Isoenzymestudies in transient hyperphosphatasemia of infancy. Tennew cases and a review of the literature. AJDC1985;139:736-740.



¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ °Î·Ì›ÏË˜∫ÔÏÔÎÔÙÚÒÓË 28 187 56, ∫ÂÚ·ÙÛ›ÓÈ, ¶ÂÈÚ·È¿˜

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 90

∂ÈÛ·ÁˆÁ‹: H ÓfiÛÔ˜ ÙÔ˘ Crohn ¤¯ÂÈ ·ÚÎÂÙ¿ Û˘¯Ó¿ Ùˆ¯‹·ÓÙ·fiÎÚÈÛË ÛÙË Û˘Ó‹ıË ıÂÚ·Â›· ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹ Î·È·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ¿. ∏ ¯Ú‹ÛË ¯ÈÌ·ÈÚÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ¤Ó·ÓÙÈ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛË˜ ÙˆÓ fiÁÎˆÓ -¿ÏÊ· (TNF·)ÛÂ ÂÓ‹ÏÈÎÂ˜ ÌÂ ·ÓıÂÎÙÈÎ‹ ÛÙË ıÂÚ·Â›· ÓfiÛÔ ÙÔ˘ Crohn¤¯ÂÈ ‰ÒÛÂÈ ÂÓı·ÚÚ˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ™ÎÔfi˜: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙË˜ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙË˜ ¯ÔÚ‹ÁËÛË˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘TNF· (·ÓÙÈ-TNF·) ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ÂÓÂÚÁfi ÓfiÛÔÙÔ˘ Crohn.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 19 ·ÛıÂÓÂ›˜, 9 Ì¤¯ÚÈ 19 ÂÙÒÓ, (Ì¤ÛËËÏÈÎ›· 14,4 ¤ÙË) ¤Ï·‚·Ó 1 ˆ˜ 3 ÂÁ¯‡ÛÂÈ˜ ·ÓÙÈ-TNF·(5mg/kg) ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 12 Â‚‰ÔÌ¿‰ˆÓ. ∂Ù¿ ·È-‰È¿ Â›¯·Ó ÎÔÚÙÈÎÔ·ÓıÂÎÙÈÎ‹ ÓfiÛÔ ÂÓÒ Ù· ˘fiÏÔÈ· Â›¯·ÓÎÔÚÙÈÎÔÂÍ·ÚÙÒÌÂÓË ÓfiÛÔ. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ¤ÁÈÓÂ ÌÂ Î·Ù·ÁÚ·Ê‹ ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜ Î·È ÙÔ˘ ·È-‰È·ÙÚÈÎÔ‡ ‰Â›ÎÙË ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ (Pediatric CrohnActivity Index).∞ÔÙÂÏ¤ÛÌ·Ù·: ™ÙÈ˜ ÚÒÙÂ˜ 4 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÚÒ-ÙË ¤Á¯˘ÛË ÔÈ ÙÈÌ¤˜ ÙÔ˘ ‰Â›ÎÙË ÂÓÂÚÁfiÙËÙ·˜ ÌÂÈÒıËÎ·Ó ÛË-Ì·ÓÙÈÎ¿ ·fi 42,1±13,7 ÛÂ 10±5,6 (p<0,001). ∆È˜ ÂfiÌÂ-ÓÂ˜ 8 Â‚‰ÔÌ¿‰Â˜, 8 ·fi ÙÔ˘˜ 19 ·ÛıÂÓÂ›˜ ·ÚÔ˘Û›·Û·ÓÛ¯ÂÙÈÎ‹ ÂÈ‰Â›ÓˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘‰Â›ÎÙË ÂÓÂÚÁfiÙËÙ·˜ ÙË 12Ë Â‚‰ÔÌ¿‰· ‹Ù·Ó 26,8±16,4,¯ˆÚ›˜ fiÌˆ˜ Î·ÓÂ›˜ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ‚·-

ÚÂÈ¿ ÓfiÛÔ. ∏ Ì¤ÛË ËÌÂÚ‹ÛÈ· ‰fiÛË ÚÂ‰ÓÈ˙fiÓË˜ ·Ú¯ÈÎ¿,ÙËÓ 4Ë Â‚‰ÔÌ¿‰· Î·È ÙËÓ 12Ë Â‚‰ÔÌ¿‰· ‹Ù·Ó 28±14 mg,20±12 mg Î·È 8±12 mg, ·ÓÙ›ÛÙÔÈ¯· (p<0,01). ∞ÓÂÈı‡ÌË-ÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜, fiˆ˜ ÂÍ¿ÓıËÌ· ‹ ‰‡ÛÓÔÈ·, ·ÚÔ˘Û›·Û·Ó3 ·ÛıÂÓÂ›˜ Î·Ù· ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¤Á¯˘ÛË˜ ¯ˆÚ›˜ Ó· ¯ÚÂÈ·-ÛÙÂ› È‰È·›ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘TNF· ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ÂÓÂÚÁfi ÓfiÛÔ ÙÔ˘ CrohnÚÔÎ·ÏÂ› ‚Ú·¯˘ÚfiıÂÛÌË ÎÏÈÓÈÎ‹ ‚ÂÏÙ›ˆÛË. ∏ ÁÚ‹ÁÔÚËÂÈ‰Â›ÓˆÛË ÙË˜ ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ ÛÂ ÌÂÚÈÎÔ‡˜·ÛıÂÓÂ›˜ Û˘ÓËÁÔÚÂ› ÁÈ· ‰È·ÊÔÚÂÙÈÎ¿ ‰ÔÛÔÏÔÁÈÎ¿ Û¯‹Ì·-Ù·, Ô˘ ›Ûˆ˜ Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó. ª·ÎÚ˘ÚfiıÂÛÌ· Ë·ÛÊ¿ÏÂÈ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È ¿ÁÓˆÛÙË Î·È ÁÈ· ·˘Ùfi Â›Ó·È··Ú·›ÙËÙË Ë Û˘¯Ó‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ¤ÏÂÁ¯Ô˜ ÙˆÓ·ÛıÂÓÒÓ.

£ÂÚ·Â›· ÙË˜ ÓfiÛÔ˘ ÙÔ˘ Crohn ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛË˜ ÙˆÓ fiÁÎˆÓ - ¿ÏÊ·1


1Hyams JS, Markowitz J, Wyllie R Use of infliximab in the treatment of Crohn’s disease in children and adolescents J Pediatr 2000;137:192-196

∂ÈÛ·ÁˆÁ‹: ∏ ·È‰ÈÎ‹ ËÏÈÎ›· ·ÔÙÂÏÂ› ÂÚ›Ô‰Ô ˘„ËÏÔ‡ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÏÔ›ÌˆÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ (H.pylori). EÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfiÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÏÔ›ÌˆÍË˜ ÛÙËÚ›˙ÔÓÙ·È ÛÂ ‰È·ÁÓˆÛÙÈ-Î¤˜ ‰ÔÎÈÌ·Û›Â˜ ÌÂ ÔÈÎ›ÏË ·ÍÈÔÈÛÙ›·.™ÎÔfi˜: ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤¯ÂÈ ÛÎÔfi ÙË Û‡ÁÎÚÈÛË ‰È·-ÊfiÚˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· ÙËÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜Û˘¯ÓfiÙËÙ·˜ ÙË˜ ÏÔ›ÌˆÍË˜ ·fi H. pylori ÛÂ ·Û˘ÌÙˆÌ·ÙÈ-Î¿ ·È‰È¿.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó 287·È‰È¿ (151 ·ÁfiÚÈ·-136 ÎÔÚ›ÙÛÈ·) ËÏÈÎ›·˜ 2-18 ÂÙÒÓ ¯ˆÚ›˜Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ·. ™Â Î¿ıÂ ·È‰› ¤ÁÈ-ÓÂ ÙËÓ ›‰È· ËÌ¤Ú· ÂÍ¤Ù·ÛË˜, ‰ÔÎÈÌ·Û›· ·Ó·ÓÔ‹˜ ÌÂ C13 ,Ì¤ÙÚËÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ·›Ì· Î·È Ì¤ÙÚËÛË ·ÓÙÈÛˆÌ¿-ÙˆÓ ÛÙË Û›ÂÏÔ.∞ÔÙÂÏ¤ÛÌ·Ù·: §ÔÈÌˆÍË ·fi H. pylori ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÙÔ32%, 22% Î·È 18% ÙˆÓ ·È‰ÈÒÓ ÌÂ ÙË ‰ÔÎÈÌ·Û›· ·Ó·ÓÔ‹˜,·ÓÙÈÛÒÌ·Ù· ÛÙÔ ·›Ì· Î·È ·ÓÙÈÛÒÌ·Ù· ÛÙË Û›ÂÏÔ ·ÓÙ›ÛÙÔÈ-¯·. 103 ·fi Ù· 287 ·È‰È¿ (35%) Â›¯·Ó ¤ÛÙˆ Î·È Ì›· ‰ÔÎÈ-Ì·Û›· ıÂÙÈÎ‹ (92 ıÂÙÈÎ‹ ‰ÔÎÈÌ·Û›· ·Ó·ÓÔ‹˜, 8 ·ÓÙÈÛÒÌ·-Ù· ÛÙÔ ·›Ì·, 3 ·ÓÙÈÛÒÌ·Ù· ÛÙË Û›ÂÏÔ). ªfiÓÔ 39 ·È‰È¿(14%) Â›¯·Ó Î·È ÙÈ˜ ÙÚÂ›˜ ‰ÔÎÈÌ·Û›Â˜ ıÂÙÈÎ¤˜. £ÂˆÚÒÓÙ·˜ÙË ‰ÔÎÈÌ·Û›· ·Ó·ÓÔ‹˜ Û·Ó Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜ Ë Â˘·ÈÛıË-Û›· ÙË˜ ÌÂıfi‰Ô˘ Ì¤ÙÚËÛË˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ·›Ì· Î·È·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙË Û›ÂÏÔ ‹Ù·Ó 48% Î·È 65% ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ

Ë ÂÈ‰ÈÎfiÙËÙ· Î·È ÙˆÓ ‰‡Ô ‰ÔÎÈÌ·ÛÈÒÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚËÙÔ˘ 95%. √ Û˘Ó‰˘·ÛÌfi˜ ÙË˜ Ì¤ÙÚËÛË˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ·›Ì· Î·È Û›ÂÏÔ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙË Ì¤ıÔ‰Ô ·Ó·ÓÔ‹˜ Â›¯Â ÌÂ-Á·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· (71%) Î·È ÂÈ‰ÈÎfiÙËÙ· (95%) ·’ fi,ÙÈË Î¿ıÂ ÂÍ¤Ù·ÛË ÍÂ¯ˆÚÈÛÙ¿.™˘ÌÂÚ¿ÛÌ·Ù· : ™Â ·Û˘ÌÙˆÌ·ÙÈÎ¿ ·È‰È¿ , Ë Û˘¯ÓfiÙËÙ·ÙË˜ ÏÔ›ÌˆÍË˜ ·fi H. pylori ÔÈÎ›ÏÂÈ Â˘Ú¤ˆ˜ ·Ó¿ÏÔÁ· ÌÂ ÙË‰È·ÁÓˆÛÙÈÎ‹ ‰ÔÎÈÌ·Û›· Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È. √È Ì¤ıÔ‰ÔÈÔ˘ ‚·Û›˙ÔÓÙ·È ÛÂ Ì¤ÙÚËÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Â›Ó·È ÏÈÁÒÙÂÚÔ·ÍÈfiÈÛÙÂ˜ ·fi ÙË ‰ÔÎÈÌ·Û›· ·Ó·ÓÔ‹˜ ÌÂ C13. ¶·Ú’ fiÏ··˘Ù¿, Î¿Ùˆ ·fi ÔÚÈÛÌ¤ÓÂ˜ Û˘Óı‹ÎÂ˜, fiˆ˜ Ô Û˘Ó‰˘·-ÛÌfi˜ ÌÂıfi‰ˆÓ ÛÂ ·›Ì· Î·È Û›ÂÏÔ, Ë Ì¤ÙÚËÛË ·ÓÙÈÛˆÌ¿ÙˆÓÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ÌÈ· ÊıËÓ‹ ÂÓ·ÏÏ·ÎÙÈÎ‹ ÂÍ¤Ù·ÛË ÛÂÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿.

§Ô›ÌˆÍË ·fi ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎ¿ ·È‰È¿: Û‡ÁÎÚÈÛË ‰È·ÁÓˆÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ1


1Malaty HM, Logan ND, Graham DY,Ramchatesingh JE, Reddy SGHelicobacter pylori infection in asymptomaticchildren: comparison of diagnostic testsHelicobacter 2000;5:155-159

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ· ¶·È‰›·ÙÚÔ˜ ¢È‰¿ÎÙˆÚ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ

91

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ· ¶·È‰›·ÙÚÔ˜ ¢È‰¿ÎÙˆÚ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 91

92

∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ,

¶ÚÈÓ ·fi ÌÂÚÈÎ¿ ¯ÚfiÓÈ· ÍÂÎ›ÓËÛÂ Ë È‰¤· ÁÈ· ÙËÓ ¤ÓÙ·ÍË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ «¶∞π¢π∞∆ƒπ∫∏» ÛÙÔÓ Î·Ù¿ÏÔ-ÁÔ ÙˆÓ ·Ó·ÁÓˆÚÈÛÌ¤ÓˆÓ Í¤ÓˆÓ ÂÚÈÔ‰ÈÎÒÓ ÛÙËÓ ∂ıÓÈÎ‹ µÈ‚ÏÈÔı‹ÎË π·ÙÚÈÎ‹˜ ÙˆÓ ∏.¶.∞. (National Libraryof Medicine). ª·˙› ÌÂ ÙÔÓ ∫·ıËÁËÙ‹ Î. £ÂÌÈÛÙÔÎÏ‹ ∫·Ú¿ıÈÔ (ÙÔÓ ÙfiÙÂ ¢ÈÂ˘ı˘ÓÙ‹ ŒÎ‰ÔÛË˜ ÙÔ˘ ÂÚÈÔ-‰ÈÎÔ‡) Î·Ù·‚¿ÏÏ·ÌÂ Î¿ıÂ ÚÔÛ¿ıÂÈ· ÁÈ· Ó· ÂÎÏËÚÒÛÔ˘ÌÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÚÈÎ¤˜ ·fi ÙÈ˜ ÚÔ¸Ôı¤ÛÂÈ˜Ô˘ ··ÈÙÔ‡ÓÙ·Ó ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ì·˜. ¢˘ÛÙ˘¯Ò˜, fiÌˆ˜, ÔÈ ÚÔÛ¿ıÂÈ¤˜ Ì·˜ ‰ÂÓ Â˘-Ô‰ÒıËÎ·Ó.

™‹ÌÂÚ·, ÌÂ ÙËÓ ¤Ó·ÚÍË ÌÈ·˜ Î·ÈÓÔ‡ÚÁÈ·˜ ¯ÈÏÈÂÙ›·˜, Ë Ó¤· ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹ ·ÔÊ¿ÛÈÛÂ Ó· Û˘ÓÂ¯›-ÛÂÈ ÙËÓ ÚÔÛ¿ıÂÈ·. ∞ÒÙÂÚÔ˜ ÛÎÔfi˜ Ì·˜ Â›Ó·È Ó· Û˘ÌÂÚÈÏËÊıÂ› ÙÔ ÂÚÈÔ‰ÈÎfi Ì·˜ ÛÙÔ ScienceCitation Index (SCI) Î·È Ó· ·ÔÎÙ‹ÛÂÈ ÂÈÙ¤ÏÔ˘˜ ÙÔ ÁÓˆÛÙfi Impact Factor (™˘ÓÙÂÏÂÛÙ‹ ∂Ì‚¤ÏÂÈ·˜).∫·Ù’·Ú¯¿˜, Ë ÂÌÊ¿ÓÈÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ı· Ú¤ÂÈ Ó· Â›Ó·È «ÊÈÏÈÎ‹» ÚÔ˜ ÙÔÓ Í¤ÓÔ ÂÈÛÙ‹ÌÔÓ· Ô˘ ‰ÂÓÁÓˆÚ›˙ÂÈ ÙËÓ ÂÏÏËÓÈÎ‹ ÁÏÒÛÛ·. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ô ¶›Ó·Î·˜ ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÛÙÔ ÂÍÒÊ˘ÏÏÔ ÙÔ˘ ÂÚÈÔ‰È-ÎÔ‡ ı· ÂÚÈ¤¯ÂÈ Î·È ÛÙËÓ ∞ÁÁÏÈÎ‹ ÁÏÒÛÛ· ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ¿ÚıÚˆÓ Î·ıÒ˜ Î·È Ù· ÔÓfi-Ì·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ. ∂ÈÏ¤ÔÓ, ıÂˆÚÂ›Ù·È ··Ú·›ÙËÙÔ Ó· ÂÎ‰›‰ÂÙ·È ¤ÁÎ·ÈÚ· ÙÔ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ Â-ÚÈÔ‰ÈÎÔ‡, Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Ë fiÏË ‰È·‰ÈÎ·Û›· ·ÍÈÔÏfiÁËÛË˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Î·È ÔÈ Û¯ÂÙÈÎ¤˜ ‰ÈÔÚıÒÛÂÈ˜ ·fiÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ı· Ú¤ÂÈ Ó· ÎÈÓÂ›Ù·È ÂÌÚfiıÂÛÌ·. ∆¤ÏÔ˜, ÁÈ· Ó· Á›ÓÂÈ ÙÔ ÂÚÈÔ‰ÈÎfi Ì·˜ ÈÔ ÚÔÛÈÙfiÛÙÔÓ Â˘Ú‡ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ¯ÒÚÔ, ÛÎÔÂ‡Ô˘ÌÂ Ó· ÙÔ ÂÓÙ¿ÍÔ˘ÌÂ ÔÏ‡ ÁÚ‹ÁÔÚ· Î·È ÛÙÔ Internet.

°È· ÙËÓ Â›ÙÂ˘ÍË ÙˆÓ ·Ú·¿Óˆ ÛÙfi¯ˆÓ Ì·˜ ¯ÚÂÈ·˙fiÌ·ÛÙÂ ÙËÓ ˘ÔÛÙ‹ÚÈÍË Î·È Û˘ÓÂÚÁ·Û›· fiÏˆÓ Û·˜.√È ÌÂÓ ÎÚÈÙ¤˜ ı· Ú¤ÂÈ Ó· ·ÔÛÙ¤ÏÏÔ˘Ó ÙÈ˜ ·Ú·ÙËÚ‹ÛÂÈ˜ ÙÔ˘˜ ¤ÁÎ·ÈÚ·, ÔÈ ‰Â Û˘ÁÁÚ·ÊÂ›˜ ı· Ú¤ÂÈÓ· ÙËÚÔ‡Ó ·˘ÛÙËÚ¿ Ù· ÚÔÙÂÈÓfiÌÂÓ· ¯ÚÔÓÈÎ¿ Ï·›ÛÈ· ÁÈ· ÙË ‰ÈfiÚıˆÛË ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙÔ˘˜ Î·ıÒ˜ Î·È ÙÔ˘ÚÒÙÔ˘ Ù˘ˆÌ¤ÓÔ˘ ‰ÔÎÈÌ›Ô˘.

∂¿Ó ·ÓÙÈÌÂÙˆ›ÛÔ˘ÌÂ fiÏÔÈ Ì·˙› ·˘Ù‹ ÙËÓ ÚfiÎÏËÛË, Â›Ì·È Û›ÁÔ˘ÚË fiÙÈ ı· ÂÈÙ‡¯Ô˘ÌÂ.

∂Î Ì¤ÚÔ˘˜ ÙË˜ ™˘ÓÙ·ÎÙÈÎ‹˜ ∂ÈÙÚÔ‹˜∑ˆ‹ ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏ PEADIATRIC NEWS

¶ÚÔ˜ fiÏ· Ù· Ì¤ÏË ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

∫‡ÚÈÔÈ ™˘Ó¿‰ÂÏÊÔÈ,

°È· Ó· ÌÔÚ¤ÛÂÈ Ë ÂÙ·ÈÚÂ›· Ì·˜ Ó· ÂÎÏËÚÒÛÂÈ ÙÔ˘˜ ÛÎÔÔ‡˜ ÙË˜ Î·È Ó· Î·Ï‡„ÂÈ ÙÈ˜ ·Ó¿ÁÎÂ˜ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ fiÚÔ˘˜ ·fi ÙÈ˜ Û˘Ó‰ÚÔÌ¤˜ ÙˆÓ ÌÂÏÒÓ ÙË˜.

∏ ·ÓÂÍ·ÚÙËÛ›· Î·È Ë ·˘ÙÔÓÔÌ›· ÙË˜ ¤¯Ô˘Ó Û·Ó ·˘ÙÔÓfiËÙË ÚÔ¸fiıÂÛË ÙËÓ ÔÈÎÔÓÔÌÈÎ‹ ·ÓÂ-Í·ÚÙËÛ›· ÙË˜ Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÙÔ ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·È-ÚÂ›Â˜ (∂.¶.∂.) ÌÂ ÁÚ·Ù‹ ˘fiÌÓËÛ‹ ÙÔ˘, ˙‹ÙËÛÂ ·fi Ù· Ì¤ÏË ÙÔ˘, ÌÂ ÂÈÛÙÔÏ¤˜ Ô˘ ÙÔ˘˜ ·Ë‡-ı˘ÓÂ, ÙËÓ ÔÈÎÔÓÔÌÈÎ‹ ÙÔ˘˜ Ù·ÎÙÔÔ›ËÛË ÚÔÎÂÈÌ¤ÓÔ˘ Ë ∂Ù·ÈÚÂ›· Ì·˜ Ó· ÌÔÚÂ› ·˘ÙÔ‰‡Ó·ÌË Ó· Î·-Ï‡„ÂÈ ÙÈ˜ ‰·¿ÓÂ˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ Î·È Ó· ÂÈ‰ÈÒÎÂÈ ÙË˜ ÂÎÏ‹ÚˆÛË ÙˆÓ ÛÎÔÒÓ ÙË˜.

∫‡ÚÈÔÈ ™˘Ó¿‰ÂÏÊÔÈ,

∆Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂.¶.∂. Û·˜ Î·ÏÂ› Ó· ·ÓÙ·ÔÎÚÈıÂ›ÙÂ ÛÙËÓ ¤ÎÎÏËÛË Ô˘ Û·˜ ·Ë‡-ı˘ÓÂ Ì¤Ûˆ ÙˆÓ ˆ˜ ¿Óˆ ÂÈÛÙÔÏÒÓ.

∞Ó·ÎÔ›ÓˆÛË

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 92

¶PO™EXH ™YNE¢PIA

2-4 ºÂ‚ÚÔ˘·Ú›Ô˘ First World Congress on the Bombay, IndiaFetal Origins of Adult Disease¶ÏËÚÔÊÔÚ›Â˜: Ms Alifiya MotiwalaTel.: +91 22 651 6439Fax: +91 22 6516438e-mail: [email protected]: www.sneha-india.org

10-11 ºÂ‚ÚÔ˘·Ú›Ô˘ International Symposium on Tokyo, Japanthe West Syndrome and Related Infantile Epileptic Encephalopathies (ISWS)¶ÏËÚÔÊÔÚ›Â˜: Yukio Fukuyama Secretariat, ISWSC/o Child Neurology InstituteSamban-cho TY Plaza, SFL24 Samban-cho, Chiyoda-KuTokyo 102-0075 JapanTel.: +81 3 3238 1580Fax: +81 3 3238 1502e-mail: [email protected]

8-10 ª·ÚÙ›Ô˘ 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Holiday Inn, ∞ı‹Ó·∞ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈÎ‹˜ ∞ÓÔÛÔÏÔÁ›·˜¶ÏËÚÔÊÔÚ›Â˜: ∂æπ§√¡∆ËÏ.: 01 7254 360-2Fax: 01 7254 363e-mail: [email protected]

15-17 ª·ÚÙ›Ô˘ 5th European Postgraduate Course Barn, ∂Ï‚ÂÙ›·in Neonatal and Pediatric Intensive care¶ÏËÚÔÊÔÚ›Â˜: BBS Congress GmbHBarbara BülmannP.O. Box, CH-3000 Barn 25, Switzerland∆ËÏ.: +41 31 331 8275Fax: +41 31 332 9879e-mail: [email protected]

26-28 ª·ÚÙ›Ô˘ European Society for Eilat, IsraelPediatric Infectious Diseases (ESPID)Secretariat: PO Box 50006Tel Aviv 61500, IsraelTel.: +972 3 5140000Fax: +972 3 51 40077e-mail: [email protected]: http://www.kenes.com/espid2001

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 93

¶PO™EXH ™YNE¢PIA

17-20 ∞ÚÈÏ›Ô˘ 22nd Course of Pediatric Dermatology Arcachon, °·ÏÏ›·¶ÏËÚÔÊÔÚ›Â˜: e-mail: [email protected]

28 ∞ÚÈÏ›Ô˘ – 1 ª·˝Ô˘ Pediatric Academic Societies µ·ÏÙÈÌfiÚË, ∏¶∞Annual MeetingBaltimore Convention CenterBaltimore, Maryland¶ÏËÚÔÊÔÚ›Â˜: Program Office∆ËÏ.: ++281 419 0052Fax: ++281 419 0082e-mail: [email protected]

5-6 ª·˝Ô˘ 10Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞ı‹Ó·∞Ó·ÓÂ˘ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ∂Î·È‰Â˘ÙÈÎfi ∫¤ÓÙÚÔ ∞ÁÚÔÙÈÎ‹˜ ∆Ú¿Â˙·˜, ¡. ∂Ú˘ıÚ·›·, ∞ı‹Ó·√ÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· °¡¶¶™˘ÓÂÚÁ·Û›·: ∂ÏÏËÓÈÎ‹ ¶·È‰ÔÓÂ˘ÌÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›·¶ÏËÚÔÊÔÚ›Â˜: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· °¡¶¶152 36, ¶. ¶ÂÓÙ¤ÏË∆ËÏ.: 01 80 36 472Fax: 01 61 31 173e-mail: [email protected]

18-20 ª·˝Ô˘ 13Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶¿ÙÚ·∂ÏÏËÓÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ∫ÔÈÓˆÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜£¤Ì·: π·ÙÚÔÎÔÈÓˆÓÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ÙˆÓ ÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜¶ÏËÚÔÊÔÚ›Â˜: ∂Ï¤ÓË ¶ÂÙÚ›‰Ô˘∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÂÈÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜ π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓª. ∞Û›·˜ 75, 115 27, ∞ı‹Ó·∆ËÏ.: 775 9962 – 0944 974249Fax: 777 3840 – 748 5872∏ÏÂÎÙÚÔÓÈÎ‹ ‰ÈÂ‡ı˘ÓÛË ÙË˜ ∂Ù·ÈÚ›·˜ ÁÈ· ˘Ô‚ÔÏ‹ ÂÚÈÏ‹„ÂˆÓ:http://www.socped.gr ‹ e-mail: [email protected]

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 94

™˘ÓÙÔÌÔÁÚ·Ê›Â˜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

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·ÂÎ·ÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞Î˘‚ÈÎfi ÂÎ·ÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂÎ·ÙÔÛÙfiÎ‡ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚfiÊËÛË˜ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi ÔÍ‡ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›ÙË˜·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚Î¿ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ÂÓ‰ÔÊÏ¤‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚÔ˜Ì¤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓÌ¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNAÌ¤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ ÓÂ˘ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔÂ› ÙÔÈ˜ ÂÎ·Ùfi·Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁÎ¤ÓÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈÎ‹ Ù¿ÛË CO2

ÌÂÚÈÎ‹ Ù¿ÛË ÔÍ˘ÁfiÓÔ˘Èı·ÓfiÙËÙ·

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

™YNTOMO°PAºIE™ ABBREVIATIONS

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 95

AÁÁÏÈÎÔ› fiÚÔÈEÏÏËÓÈÎÔ› fiÚÔÈ™˘ÓÙÔÌÔÁÚ·Ê›Â˜

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)

·fi ÙÔ ÛÙfiÌ·Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈÎ‹ ‰ÔÎÈÌ·Û›·ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡Û‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÈ·˜‰Â˘ÙÂÚfiÏÂÙÔ˘Ô‰fiÚÈ·ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËÛÙ·ıÂÚfi ÛÊ¿ÏÌ·ÌÔÓ¿‰·

Combining prefixes

TGMkhdadcmÌnpfa

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 96

CECLOR: ¶∂ƒπ§∏æ∏ Ã∞ƒ∞∫∆∏ƒπ™∆π∫ø¡ ¶ƒO´O¡∆O™∂N¢EI•EI™: ∆Ô CECLOR® ÂÓ‰Â›ÎÓ˘Ù·È ÛÙË ıÂÚ·Â›· ÙˆÓ ·ÎfiÏÔ˘ıˆÓ ÏÔÈÌÒÍÂˆÓ, fiÙ·Ó ·˘Ù¤˜ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi Ù· ·Ó·ÊÂÚfiÌÂÓ· Î·ÙˆÙ¤Úˆ ÛÙÂÏ¤¯Ë ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÒÓ ÂÊfiÛÔÓ ·˘Ù¿ Â›Ó·È Â˘·›ÛıËÙ· ÛÂ ·˘Ùfi: §ÔÈÌÒÍÂÈ˜ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Ô‰ÒÓ. ª¤ÛË ˘Ò‰Ë˜ ˆÙ›ÙÈ‰·: ÚÔÎ·ÏÔ‡ÌÂÓË ·fi S.pneumoniae, H. influenzae, Staphylococci (ÂÍ·ÈÚÔ˘Ì¤ÓˆÓ ÙˆÓ ÛÙÂÏÂ¯ÒÓ Ô˘ Â›Ó·È ·ÓıÂÎÙÈÎ¿ ÛÙË ÌÂıÈÎÈÏÏ›ÓË), ‚-·ÈÌÔÏ˘ÙÈÎfi ™ÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ Î·È ª.catarrhalis. º·Ú˘ÁÁ›ÙÈ‰· Î·È ·Ì˘Á‰·Ï›ÙÈ‰·, ·fi ‚-·ÈÌÔÏ˘ÙÈÎfi ™ÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞.¶·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰· ·fi Â˘·›ÛıËÙ· ÛÙÂÏ¤¯Ë H. influenzae ( ‚-Ï·-ÎÙ·Ì¿ÛË ±), ‚-·ÈÌÔÏ˘ÙÈÎfi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞, S. pneumoniae, M. catarrhalis Î·È S. aureus ( ‚-Ï·ÎÙ·Ì¿ÛË˜ ±). ™ÙË ¯ÚfiÓÈ· ÌÔÚÊ‹ ··ÈÙÂ›Ù·È Û˘Ó‹ıˆ˜ÚÔÛı‹ÎË Î·È ÂÓfi˜ ¿ÏÏÔ˘ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡ ·Ú¿ÁÔÓÙ·, ‰Ú·ÛÙÈÎÔ‡ ÛÙÔ˘˜ ·Ó·ÂÚfi‚ÈÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜. §ÔÈÌÒÍÂÈ˜ ÙˆÓ Î·ÙˆÙ¤ÚˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Ô‰ÒÓ:√ÍÂ›· ‚ÚÔÁ¯›ÙÈ‰·, Î·È ÔÍÂ›Â˜ ÂÍ¿ÚÛÂÈ˜ ¯ÚfiÓÈ·˜ ‚ÚÔÁ¯›ÙÈ‰·˜ Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi S. pneumoniae, H. influenzae (‚-Ï·ÎÙ·Ì¿ÛË ±), H. parainfluenzae, M.catarrhalis (‚-Ï·ÎÙ·Ì¿ÛË ±), S. aureus. ¶ÓÂ˘ÌÔÓ›· ÛÂ ·ÛıÂÓÂ›˜ ÙË˜ ÎÔÈÓfiÙËÙ·˜ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·Ô S. pneumoniae, H. influenzae (‚-Ï·ÎÙ·Ì¿ÛË±) Î·È M.catarrhalis(‚-Ï·ÎÙ·Ì¿ÛË±). ªË ÂÈÂÏÂÁÌ¤ÓÂ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙË˜ ˘ÂÏÔÓÂÊÚ›ÙÈ‰·˜ Î·È Î˘ÛÙ›-ÙÈ‰·˜, (ÌÂ Ù·˘Ùfi¯ÚÔÓË Î¿Ï˘„Ë ÁÈ· Ù· ·Ó·ÂÚfi‚È· ) Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ∂. coli, P. mirabilis, Klebsiella spp. §ÔÈÌÒÍÂÈ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ,Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi Staphylococcus aureus(‚-Ï·ÎÙ·Ì¿ÛË±) Î·È ‚-·ÈÌÔÏ˘ÙÈÎÒÓ ÛÙÚÂÙÔÎfiÎÎˆÓ ÔÌ¿‰·˜ ∞. ANTEN¢EI•EI™: °ÓˆÛÙ‹ ˘ÂÚÂ˘·ÈÛıËÛ›· ÛÙËÎÂÊ·ÎÏfiÚË Î·È ¿ÏÏÂ˜ ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ Î·ıÒ˜ Î·È ÈÛÙÔÚÈÎfi ·Ó·Ê˘Ï·ÎÙÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÛÙÈ˜ ÂÓÈÎÈÏÏ›ÓÂ˜. ∞¡∂¶π£Àª∏∆∂™ ∂¡∂ƒ°∂π∂™: ∞ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ-‰Ú¿ÛÂÈ˜ (‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ·ÏÏÂÚÁ›· ÌÂ ÙÈ˜ ÂÓÈÎÈÏÏ›ÓÂ˜10%). ¡·˘Ù›·,¤ÌÂÙÔÈ, ‰È¿ÚÚÔÈÂ˜, ÂÈÁ·ÛÙÚÈÎfi˜ ÊfiÚÙÔ˜. ∞§§∏§∂¶π¢ƒ∞™∂π™: ∏ Û‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛËÚÔ‚ÂÓÂÛ›‰Ë˜ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ CECLOR® ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È ÌÂ ¿ÏÏ· ·ÓÙÈ‚ÈÔÙÈÎ¿. ™‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÌÂ ÙÂÙÚ·Î˘ÎÏ›ÓÂ˜‹ ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË, ¤¯ÂÈ ·ÓÙ·ÁˆÓÈÛÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. ŸÙ·Ó ¯ÔÚËÁÂ›Ù·È ÛÂ ÌÂÁ¿ÏÂ˜ ‰fiÛÂÈ˜ Ì·˙› ÌÂ ¿ÏÏ· ÓÂÊÚÔÙÔÍÈÎ¿ Ê¿ÚÌ·Î·, fiˆ˜ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜, ·˘-Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÓÂÊÚÔÙÔÍÈÎfiÙËÙ·˜ ¢√™√§√°π∞: XÔÚËÁÂ›Ù·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÌÂ ‹ ¯ˆÚ›˜ Ê·ÁËÙfi. ∂Ó‹ÏÈÎÂ˜: 250 mg Î¿ıÂ 8 ÒÚÂ˜, ‰ÈÏ·ÛÈ·˙fiÌÂÓËÛÂ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜. M¤ÁÈÛÙË ‰fiÛË ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ 4 gr ËÌÂÚËÛ›ˆ˜ ¶·È‰È¿: 20-40 mg/kg ËÌÂÚËÛ›ˆ˜ ‰È·ÈÚÂÌ¤ÓË ÛÂ ÙÚÂÈ˜ ›ÛÂ˜ ‰fiÛÂÈ˜. ™ÙË ıÂÚ·Â›· ÙË˜Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ Î·È Ê·Ú˘ÁÁ›ÙÈ‰·˜, Ë Û˘ÓÔÏÈÎ‹ ËÌÂÚ‹ÛÈ· ‰fiÛË ÌÔÚÂ› Ó· ‰È·ÈÚÂıÂ› Î·È Ó· ¯ÔÚËÁËıÂ› ·Ó¿ 12ˆÚÔ. ª¤ÁÈÛÙË Û˘ÓÈÛÙÒÌÂÓË ‰fiÛË ÛÙ· ·È‰È¿ Â›Ó·È1 gr ËÌÂÚËÛ›ˆ˜.ªOƒº∂™: Susp 125mg/5ml, 60ml, Susp 250mg/5ml, 60ml, Susp 375mg/5ml, 60ml, Caps 500mg ÛÂ ÎÔ˘Ù› ÙˆÓ 12. ¶ÔÛÔÛÙfi ÂÈ¯ÔÚ‹ÁËÛË˜ ·fi Ù· Ù·ÌÂ›·:75 %

™˘ÓÙ·ÁÔÁÚ·ÊÈÎ¤˜ ¶ÏËÚÔÊÔÚ›Â˜ ¢È·ÊËÌÈ˙fiÌÂÓˆÓ ¶ÚÔ˚fiÓÙˆÓ

2001 paid(teliko) 17-10-01 15:46 ™ÂÏ›‰· 97

Παιδιατρική | Τόμος 64 • Τεύχος 1 • Ιανουάριος -...

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