Παιδιατρική | Τόμος 66 • Τεύχος 1 • Ιανουάριος -...

¶·È‰È·ÙÚÈÎ‹ 2003;66:1 Paediatriki 2003;66:1

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∂¶π™∆O§∏ ∞¶O ∆∏ ™À¡∆∞∫∆π∫∏ ∂¶π∆ƒO¶∏

∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ,

ªÂ ÙËÓ Â˘Î·ÈÚ›· ÙˆÓ ÂÔÚÙÒÓ ÙˆÓ ÃÚÈÛÙÔ˘Á¤ÓÓˆÓ Î·È ÙÔ˘ ·Ó·Ù¤ÏÏÔÓÙÔ˜ ¡¤Ô˘ ŒÙÔ˘˜, Ë ™˘ÓÙ·ÎÙÈÎ‹ ∂È-ÙÚÔ‹ ÙË˜ “¶∞π¢π∞∆ƒπ∫∏™” Î·È ÂÁÒ ÚÔÛˆÈÎ¿, Û·˜ ÛÙ¤ÏÏÔ˘ÌÂ ÙÈ˜ ıÂÚÌfiÙÂÚÂ˜ Â˘¯¤˜ Ì·˜.

∂˘¯fiÌ·ÛÙÂ ÛÂ Û·˜ Î·È ÙÈ˜ ÔÈÎÔÁ¤ÓÂÈ¤˜ Û·˜ ˘ÁÂ›·, ÚÔÎÔ‹ Î·È Î¿ıÂ ÂÈÙ˘¯›· ÛÙÔ˘˜ ÛÙfi¯Ô˘˜ Û·˜.

∏ Ó¤· ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹ ÙË˜ “¶∞π¢π∞∆ƒπ∫∏™” Ô˘ ·Ó¤Ï·‚Â ·fi Ù· Ì¤Û· ÙÔ˘ ÙÚ¤¯ÔÓÙÔ˜ ¤ÙÔ˘˜, Û˘-ÓÂ¯›˙ÔÓÙ·˜ ÙÔ ‰ËÌÈÔ˘ÚÁÈÎfi ¤ÚÁÔ ÙË˜ ÚÔËÁÔ‡ÌÂÓË˜, Î¿ÓÂÈ Î¿ıÂ ‰˘Ó·Ù‹ ÚÔÛ¿ıÂÈ· ÁÈ· ÙË Û˘ÓÂ¯‹ ·ÓÔ‰È-Î‹ ÔÚÂ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ì·˜ ÁÈ· ÙË ÛˆÛÙ‹ ÂÓËÌ¤ÚˆÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ Î·È ÙËÓ ¤ÓÙ·Í‹ ÙÔ˘ Ì¤Û· ÛÙ· ‰ÈÂ-ıÓ‹ È·ÙÚÈÎ¿ ÂÚÈÔ‰ÈÎ¿.

ªÂ Û˘Ó·‰ÂÏÊÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜ ÁÈ· ÙË ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹ O ¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

™Ù·‡ÚÔ˜ Ã·˚‰¿˜

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·1

¶·È‰È·ÙÚÈÎ‹ 2003;66:2-11 Paediatriki 2003;66:2-11

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¡Â˘ÚÔÏÔÁÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ª. ¡. ¶··‰ËÌËÙÚ›Ô˘

Neurological assessment of the newborn infants M. N. Papadimitriou

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

�¶ÂÚ›ÏË„Ë: ™ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÙÂÏÂ˘Ù·›ˆÓ ‰Â-Î·ÂÙÈÒÓ ÛËÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÛÙË ÓÔ-ÛËÏÂ›· ÙˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ.∞˘Ùfi Ô‰‹ÁËÛÂ ÛÂ ·˘ÍËÌ¤ÓË ÂÈ‚›ˆÛË ÙˆÓ ¯·ÌËÏÔ‡‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∆·˘Ùfi¯ÚÔÓ·ÌÂ ·˘Ù‹ ÙË ‚ÂÏÙ›ˆÛË, ¤ÁÈÓÂ ÂÊÈÎÙ‹ Ë ¯Ú‹ÛË ÂÚÈÛ-ÛfiÙÂÚˆÓ ÙÂ¯ÓÈÎÒÓ Î·Ù¿ÏÏËÏˆÓ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛËÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÈÎfiÓ·˜ ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ. ∏ÚÔÛÔ¯‹ ¤¯ÂÈ ÂÈÎÂÓÙÚˆıÂ› Î˘Ú›ˆ˜ ÛÙÔ ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· Î·È Doppler ÂÁÎÂÊ¿ÏÔ˘, ÙË Ì·ÁÓËÙÈÎ‹ ÙÔ-ÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÙËÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔ-ÁÚ·Ê›· Î·È ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ÙˆÓ ÚÔÎÏË-ÙÒÓ ‰˘Ó·ÌÈÎÒÓ. O ÛÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜Â›Ó·È Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ Ò˜ Ì›· ÔÏÔÎÏËÚˆÌ¤ÓË ÚÔ-Û¤ÁÁÈÛË ÌÂ ÙË Û˘Ó‰˘·ÛÌ¤ÓË ¯Ú‹ÛË ÙˆÓ ·ÂÈÎÔÓÈ-ÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÎÙ›ÌËÛË˜ ÌÔÚÂ›Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ÚfiÁÓˆÛË ÙË˜ ·ÒÙÂÚË˜ ÓÂ˘ÚÔ-·Ó·Ù˘ÍÈ·Î‹˜ ÂÍ¤ÏÈÍË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂÔÁÓfi, ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊË-Ì·, ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘, ÚÔÎÏËÙ¿ ‰˘Ó·-ÌÈÎ¿, Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘.

�Abstract: During the last two decades there hasbeen significant progress in the management ofhigh-risk preterm infants resulting in an increasedsurvival of low-birthweight infants. At the same timemore techniques assessing the neurological wellbeing of these infants have become available.Attention is mainly focused on brain ultrasound,Doppler, MRI, electroencephalography and variousevoked potential modalities. The aim of this study isto illustrate how an integrated approach with thecombined use of imaging and clinical evaluationcan help in predicting neurodevelopmentaloutcomes.

Key words: newborn infant, electroencephalogra-phy, brain ultrasound, evoked potentials, magne-ticresonance imaging.

∆Ì‹Ì· ¡ÂÔÁ¤ÓÓËÙˆÓ, µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

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

∂ÈÛ·ÁˆÁ‹∆È˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜ ¤¯ÂÈ ·Ó·Ù˘¯ıÂ› ·ÚÎÂ-

Ùfi ÂÓ‰È·Ê¤ÚÔÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÓÂ˘ÚÔÏÔÁ›· ÙÔ˘ÓÂÔÁ¤ÓÓËÙÔ˘. ∞˘Ùfi ¤¯ÂÈ Û˘Ó‰˘·ÛÙÂ› ÌÂ ÙËÓ ‡·ÚÍË‚ÂÏÙÈÒÛÂˆÓ ÛÙË ÓÔÛËÏÂ›· ÙˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ, Î·ıÒ˜ Î·È ÌÂ ÙËÓ ·Ó·Î¿Ï˘„ËÎ·È ¯Ú‹ÛË Ó¤ˆÓ ÙÂ¯ÓÈÎÒÓ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÓÂ˘-ÚÔÏÔÁÈÎ‹˜ ÂÈÎfiÓ·˜ ÙÔ˘˜. ∏ ÚÔÁÂÓÓËÙÈÎ‹ ¯ÔÚ‹ÁË-ÛË ÎÔÚÙÈÎÔÂÈ‰ÒÓ Î·È Ë ¯Ú‹ÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈ-ÎÔ‡ ·Ú¿ÁÔÓÙ· ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏ-Ù›ˆÛË ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜Á¤ÓÓËÛË˜ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (¶Ãµ°) (1,2).

∏ ÚÔÁÂÓÓËÙÈÎ‹ ¯Ú‹ÛË ÎÔÚÙÈÎÔÂÈ‰ÒÓ Á›ÓÂÙ·È ÌÂ·ÚÎÂÙ‹ ÂÚ›ÛÎÂ„Ë ÙÂÏÂ˘Ù·›·, ·ÊÔ‡ ˘¿Ú¯Ô˘Ó ÂÓ-‰Â›ÍÂÈ˜ fiÙÈ Ù· Ì·ÎÚ¿ (fi¯È fiÌˆ˜ Î·È Ù· ‚Ú·¯¤· Î·ÈÌÂÌÔÓˆÌ¤Ó·) Û¯‹Ì·Ù· ÚÔÁÂÓÓËÙÈÎ‹˜ ¯ÔÚ‹ÁËÛË˜ÎÔÚÙÈÎÔÂÈ‰ÒÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ¯·ÌËÏfiÙÂÚÔ Ú˘ıÌfi·Ó¿Ù˘ÍË˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ·ÏÏ¿ Î·È ÂÌÊ¿ÓÈÛË ÂÚÈ-ÎÔÈÏÈ·Î‹˜ ÏÂ˘ÎÔÌ·Ï·Î›·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÂÓÒ Ù·Ì·ÎÚ¿ Û¯‹Ì·Ù· ÌÂÙ¿ ÙË Á¤ÓÓËÛË Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ¯ÂÈÚfiÙÂÚË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË (3,4).

™ÙËÓ ∂˘ÚÒË ÂÈ‚ÈÒÓÂÈ ÙÔ 50% ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ∏∫ 25 Â‚‰ÔÌ¿‰Â˜. ™ÙËÓ ∞ÁÁÏ›· Î·È ÙËÓ πÚÏ·Ó‰›·¤ÁÈÓÂ ÙÔ 1995 Ë EPICure ÌÂÏ¤ÙË, Ë ÔÔ›· ¤‰ÂÈÍÂ

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·2

ÔÛÔÛÙfi ÂÈ‚›ˆÛË˜ 39% ÁÈ· ÓÂÔÁÓ¿ ÌÂ ∏∫ <26Â‚‰ÔÌ¿‰Â˜. ∞fi Ù· ÓÂÔÁÓ¿ Ô˘ ÂÈ‚›ˆÛ·Ó, ÔÛÔ-ÛÙfi 23% ·˘ÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÂ ËÏÈÎ›· 2,5ÂÙÒÓ, ·ÚÔ˘Û›·˙Â Ù¤ÙÔÈ· ÓÂ˘ÚÔÏÔÁÈÎ¿ ÂÏÏÂ›ÌÌ·Ù·Ô˘ Â¤‚·Ï·Ó ÙËÓ ÂÍ¿ÚÙËÛ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÁÈ·fiÏË ÙÔ˘˜ ÙË ˙ˆ‹ (5,6).

¶ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ (7) ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ20% ·fi Ù· ·È‰È¿ Ô˘ ÂÈ‚›ˆÛ·Ó ÌÂÙ¿ ·fi Î‡ËÛË32 Â‚‰ÔÌ¿‰ˆÓ ‹ ÌÂ µ° <1500 g ¯ÚÂÈ¿˙ÂÙ·È ÂÈ‰ÈÎ‹ÂÎ·›‰Â˘ÛË.

ªÂÏ¤ÙÂ˜ ·fi ÙÈ˜ ∏¶∞ ·Ó·Ê¤ÚÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ·ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÁÈ· ÓÂÔÁÓ¿ ÌÂ µ° <1000 g, Ô˘Êı¿ÓÔ˘Ó Ì¤¯ÚÈ ÙÔ 72% (8), ·ÏÏ¿ ·ÚfiÌÔÈ· ÔÛÔ-ÛÙ¿ ÌÂ ÙÈ˜ ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ fiÛÔÓ ·ÊÔÚ¿ÛÙËÓ ÂÌÊ¿ÓÈÛË ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ (8,9).

∫ÏÈÓÈÎ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË OÈ ÚÒÙÂ˜ ÚÔÛ¿ıÂÈÂ˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÎÙ›ÌË-

ÛË˜ ¤ÁÈÓ·Ó ·fi ÙÔ˘˜ Andrè-Thomas Î·È Saint-AnnDargassies (10-12) ÙÔ 1952, 1960 Î·È 1977. ø˜ ÛÙfi-¯Ô Â›¯·Ó ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ, ·ÏÏ¿ Î·È ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ.∞˘Ùfi˜ Ô ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·ÓÂ Î˘Ú›ˆ˜ ÙËÓ ÂÎÙ›ÌË-ÛË ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘ Î·È ·Ú¯¤ÁÔÓˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈ-ÎÒÓ Î·È ¤‰ÂÈ¯ÓÂ fiÙÈ Ë ÂÍ¤ÏÈÍ‹ ÙÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fiÙËÓ ËÏÈÎ›· Î‡ËÛË˜ Î·È fi¯È ·fi ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜.

™¯Â‰fiÓ Ù·˘Ùfi¯ÚÔÓ· (1977) ÛÙËÓ OÏÏ·Ó‰›·, oPrechtl (13) ÂÊ¿ÚÌÔÛÂ Ì›· ÂÍ¤Ù·ÛË ÙÂÏÂÈfiÌËÓˆÓÓÂÔÁÓÒÓ Ô˘ ÂÈÎÂÓÙÚÒıËÎÂ ÛÙÔÓ Î·ıÔÚÈÛÌfi ‰È·-ÊfiÚˆÓ “Û˘Ó‰ÚfiÌˆÓ” (Û‡Ó‰ÚÔÌÔ ˘ÂÚÂ˘ÂÚÂıÈÛÙfi-ÙËÙ·˜, Û‡Ó‰ÚÔÌÔ ·¿ıÂÈ·˜, ËÌÈÛ‡Ó‰ÚÔÌÔ), ·ÏÏ¿Î·È ‰È·ÊfiÚˆÓ ÛÙ·‰›ˆÓ ÂÁÚ‹ÁÔÚÛË˜, Ù· ÔÔ›· Î·-ıÔÚ›˙Ô˘Ó ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË.

™ÙÈ˜ ·Ú¯¤˜ ÙÔ˘ 1970, Ô Brazelton (14) ÂÛÙ›·ÛÂÙËÓ ÂÍ¤Ù·ÛË ÛÙËÓ ·ÓÙ·fiÎÚÈÛË ·Ó¿ÌÂÛ· ÛÙÔÓ ÂÍÂ-Ù·ÛÙ‹ Î·È ÙÔ ÂÍÂÙ·˙fiÌÂÓÔ ÓÂÔÁÓfi, ÌÂ ÂÈÎ¤ÓÙÚˆÛËÛÂ ÛËÌÂ›· Û˘ÌÂÚÈÊÔÚ¿˜, fiˆ˜ Ë ·¿ÓÙËÛË ÛÂ·ÎÔ˘ÛÙÈÎ¿, ÔÙÈÎ¿, ·ÙÈÎ¿ Î·È ÂÒ‰˘Ó· ÂÚÂı›ÛÌ·-Ù· Î·È Ë ÂÎÙ›ÌËÛË ÙfiÓÔ˘ Î·È Â˘ÂÚÂıÈÛÙfiÙËÙ·˜.

ŸÏÂ˜ ÔÈ ÚÔËÁÔ‡ÌÂÓÂ˜ Ì¤ıÔ‰ÔÈ ··ÈÙÔ‡Û·Ó ÌÂ-Á¿ÏË ÂÌÂÈÚ›· ·fi ÙÔÓ ÂÍÂÙ·ÛÙ‹ Î·È ·ÚÎÂÙfi ¯ÚfiÓÔÁÈ· Ó· ÂÚ·ÙˆıÔ‡Ó.

∆Ô 1970, ÔÈ Dubowitz Î·È Û˘Ó (15) ·Ó¤Ù˘Í·Ó¤Ó· Û‡ÛÙËÌ· ÂÎÙ›ÌËÛË˜ ÙË˜ ËÏÈÎ›·˜ Î‡ËÛË˜. ∞ÚÁfi-ÙÂÚ· (1981), ÔÈ ›‰ÈÔÈ ‰ËÌÈÔ‡ÚÁËÛ·Ó ¤Ó· Ó¤Ô Û‡ÛÙË-Ì· ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÎÙ›ÌËÛË˜ (16). O ÛÙfi¯Ô˜ ‹Ù·Ó Ó·‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ¤Ó· Û‡ÛÙËÌ· Â‡ÎÔÏÔ Î·È ÚÔÛÈÙfiÛÂ ÏÈÁfiÙÂÚÔ ¤ÌÂÈÚÔ˘˜ ÁÈ·ÙÚÔ‡˜, ·Ó··Ú·ÁÒÁÈÌÔÎ·È ÌÂ Î·Ï‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ ÂÍÂÙ·-ÛÙÒÓ. ¶ÂÚÈÂÏ¿Ì‚·ÓÂ ÙËÓ ÂÎÙ›ÌËÛË Ì˘˚ÎÔ‡ ÙfiÓÔ˘,ÎÈÓËÙÈÎfiÙËÙ·˜, ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ ÛÂ Û¯¤ÛË ÌÂ ÙÔÂ›Â‰Ô Û˘ÓÂ›‰ËÛË˜, Î·ıÒ˜ Î·È ÙËÓ ÂÎÙ›ÌËÛË ÛË-ÌÂ›ˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË Û˘ÌÂÚÈÊÔÚ¿. ∞Ó Î·È ËÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ›

ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÓÂÔÁÓÒÓ Î·È ÙËÛ‡ÁÎÚÈÛË ÂÓfi˜ ÓÂÔÁÓÔ‡ ÌÂ ¿ÏÏÔ, ÂÓÙÔ‡ÙÔÈ˜, Ë ÚÔ-ÁÓˆÛÙÈÎ‹ ·Í›· Ê·›ÓÂÙ·È Ó· Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË.

∂ÓÒ Ë ÛÙ·ıÂÚ¿ ·ÓÂ˘ÚÈÛÎfiÌÂÓË Ê˘ÛÈÔÏÔÁÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÈÎfiÓ· Û˘Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi Ê˘-ÛÈÔÏÔÁÈÎ‹ ¤Î‚·ÛË, Ë ·ÚÔ˘Û›· ÓÂ˘ÚÔÏÔÁÈÎÒÓ ·Ô-ÎÏ›ÛÂˆÓ Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ˙ˆ‹˜ ‰ÂÓ ÌÔÚÂ›¿ÓÙÔÙÂ Ó· ÚÔ‰ÈÎ¿ÛÂÈ ÙËÓ ·ÚÔ˘Û›·, ÙÔÓ Ù‡Ô ‹ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ (17).

∂ÓÙÔ‡ÙÔÈ˜, ÓÂfiÙÂÚË ÌÂÏ¤ÙË (18) ‰Â›¯ÓÂÈ fiÙÈ ËÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÓÂÔÁÓÔ‡ ÌÂ ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈ-Î‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, fiÙ·Ó Á›ÓÂÙ·È ÌÂÙ¿ ÙË ‰Â‡ÙÂÚËÂ‚‰ÔÌ¿‰· ÙË˜ ˙ˆ‹˜, Â›Ó·È ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙË˜¤Î‚·ÛË˜ ÁÈ· ·˘Ù¿ Ù· ÓÂÔÁÓ¿ ÌÂ Î·Ï‹ Û˘Û¯¤ÙÈÛË ÌÂÛ˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÂÈÎfiÓÂ˜ ‚Ï¿‚Ë˜ ÛÙË Ì·ÁÓËÙÈÎ‹ ÙÔ-ÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘.

™¯Â‰fiÓ Ù·˘Ùfi¯ÚÔÓ·, Ë ÔÌ¿‰· ÙˆÓ Dubowitz ‰Ë-ÌÔÛÈÂ‡ÂÈ Ì›· Ó¤· ÂÎ‰Ô¯‹ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÍ¤Ù·ÛË˜Ô˘ ‰›ÓÂÈ È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÂ Ó¤· ı¤Ì·Ù·, fiˆ˜ ÔÈÁÂÓÈÎ¤˜ ÎÈÓ‹ÛÂÈ˜ Î·È Ù· ÚfiÙ˘· Î·Ù·ÓÔÌ‹˜ ÙÔ˘ Ùfi-ÓÔ˘. ¶·Ú¿ÏÏËÏ·, Î·ıÔÚ›˙ÂÙ·È ¤Ó· Â˘ÓÔ˚Îfi score(optimality score) ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Î·Ù·ÛÙ‹ÛÂÈ ÙËÓÂÎÙ›ÌËÛË ÂÚÈÛÛfiÙÂÚÔ ÔÛÔÙÈÎ‹ Î·È Û˘ÁÎÚ›ÛÈÌË ÛÂ‰È·‰Ô¯ÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÌÂ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ Î·È ÓÂ˘ÚÔ-Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÌÂıfi‰Ô˘˜ (19).

∏ ‰˘Ó·ÙfiÙËÙ· ¯Ú‹ÛË˜ ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Î·ÈÛÂ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ÙˆÓ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ÌÂıfi-‰ˆÓ ¤¯ÂÈ Û·Ó Û˘Ó¤ÂÈ· Ó· ‰›‰ÂÙ·È ÌÈÎÚfiÙÂÚË ¤ÌÊ·-ÛË ÛÙËÓ ÎÏÈÓÈÎ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË Î˘Ú›ˆ˜ ÙÔ˘ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡. ∞˘Ùfi ÂÈ‚¿ÏÏÂÙ·È ˆ˜ ¤Ó· ‚·ıÌfi·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Û˘ÓÈÛÙ¿Ù·ÈË ÌÂ›ˆÛË ÙˆÓ ¯ÂÈÚÈÛÌÒÓ ÛÙÔ ÂÏ¿¯ÈÛÙÔ, Î·ıÒ˜ Â›-ÛË˜ Î·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ›‰ÈÂ˜ ÔÈ Û˘Óı‹ÎÂ˜ ÓÔ-ÛËÏÂ›·˜ ÙÔ˘˜ (·Ó·ÓÂ˘ÛÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË, ‡·ÚÍËÊÏÂ‚ÈÎÒÓ ÁÚ·ÌÌÒÓ Î.Ï.) ÂËÚÂ¿˙Ô˘Ó ÙËÓ ·˘ÙfiÌ·-ÙË ÎÈÓËÙÈÎfiÙËÙ·. ∞fi ÙË ÛÙÈÁÌ‹ Ô˘ Ù· ÓÂÔÁÓ¿ ·˘Ù¿·ÔÛ˘Ó‰ÂıÔ‡Ó ·fi ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú· Î·È Â›Ó·È ÛÂÛÙ·ıÂÚ‹ Î·Ù¿ÛÙ·ÛË, Ë ÎÏÈÓÈÎ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌË-ÛË ÌÔÚÂ› Ó· ·Ú¿Û¯ÂÈ ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜.

¶ÔÏ‡ ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË ÙË˜ ›‰È·˜ ÔÌ¿‰·˜(20) ÚÔÙÂ›ÓÂÈ ÙËÓ Â¤ÎÙ·ÛË ÙË˜ ¯Ú‹ÛË˜ ÙÔ˘optimality score ÛÂ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚfiˆÚ· ÓÂÔ-ÁÓ¿ fiÙ·Ó Êı¿ÓÔ˘Ó ÛÙËÓ ËÏÈÎ›· ÙˆÓ 9 ÌËÓÒÓ, ÌÂ ‰˘-Ó·ÙfiÙËÙ· Ó· ‰›ÓÂÈ ÚfiÁÓˆÛË ÁÈ· ·ÒÙÂÚË ¤Î‚·ÛË.

∆ÂÏÂ˘Ù·›· ‰›‰ÂÙ·È ÌÂÁ¿ÏË ¤ÌÊ·ÛË ÛÙËÓ ÚÔ-ÁÓˆÛÙÈÎ‹ ·Í›· Ô˘ ÌÔÚÂ› Ó· ¤¯ÂÈ Ë ÔÈfiÙËÙ· ÙˆÓ·˘ÙfiÌ·ÙˆÓ ÎÈÓ‹ÛÂˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙË ÓÂ˘ÚÔ·Ó·-Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË (21-23). ™Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÓÂÔÁÓ¿,ÔÈ ·‰Ú¤˜ ÎÈÓ‹ÛÂÈ˜ ¤¯Ô˘Ó ÚÔÔ‰Â˘ÙÈÎ‹ ¤Ó·ÚÍË Î·ÈÂÍ¤ÏÈÍË ÛÂ ¤Ó· Ì¤ÁÈÛÙÔ Â›Â‰Ô ¤ÓÙ·ÛË˜ Î·È, ·ÎÔ-ÏÔ‡ıˆ˜, ÔÌ·Ï‹ Î·È ÛÙ·‰È·Î‹ ÌÂ›ˆÛË. ∞ÓÙÈı¤Ùˆ˜, ÔÈÛÙÂÚÂfiÙ˘Â˜ ÎÈÓ‹ÛÂÈ˜ Ô˘ ÍÂÎÈÓÔ‡Ó Î·È Î·Ù·Ï‹-ÁÔ˘Ó ·fiÙÔÌ· Û˘ÓÔ‰Â‡Ô˘Ó ·ÓÒÌ·ÏË ÓÂ˘ÚÔÏÔÁÈÎ‹ÂÈÎfiÓ·.


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JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·3


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∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· ˘¿Ú¯ÂÈ ÏÔ‡ÛÈ· ‚È-‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘Û¯¤ÙÈÛË ÙˆÓ ÏÂÁfi-ÌÂÓˆÓ ÁÂÓÈÎÒÓ ÎÈÓ‹ÛÂˆÓ (general movements) ÌÂÙËÓ ·ÒÙÂÚË ¤Î‚·ÛË ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ·ÊÔ-ÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, .¯. ÂÙÂÚfiÏÂ˘-ÚË ·ÚÂÁ¯˘Ì·ÙÈÎ‹ ·ÈÌÔÚÚ·Á›· Ô˘ Û˘ÓÔ‰Â‡ÂÈ ÂÓ-‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›· ‹ ÂÚÈÎÔÈÏÈ·Î‹ ÏÂ˘ÎÔÌ·Ï·-Î›· (22,23).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ¤ÏÂÁ¯Ô ÓÂ˘ÚÈÎ‹˜ Û˘ÌÂÚÈÊÔ-Ú¿˜, ÚÔÛ‹ÏˆÛË ‚Ï¤ÌÌ·ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È ·fi ÙËÓËÏÈÎ›· ÙˆÓ 32 Â‚‰ÔÌ¿‰ˆÓ (24). ∏ ·Ú·ÎÔÏÔ‡ıËÛËÙÔ˘ ÔÙÈÎÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜, .¯. ÊÔ‡ÓÙ· ÎfiÎÎÈÓÔ˘ Ì·Ï-ÏÈÔ‡, ·Ú·ÙËÚÂ›Ù·È ·fi ÙÈ˜ 34 Â‚‰ÔÌ¿‰Â˜ Î·È ÌÂÙ¿,ÂÓÒ ÚÔÛ‹ÏˆÛË ‚Ï¤ÌÌ·ÙÔ˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË ÛÂÔÚÈ˙fiÓÙÈÔ Î·È Î¿ıÂÙÔ Â›Â‰Ô Â›Ó·È Î·Ï¿ ·ÓÂÙ˘ÁÌ¤-Ó· ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 40 Â‚‰ÔÌ¿‰ˆÓ Î·È ÌÂÙ¿.

∏ ·ÓÙ›‰Ú·ÛË ÛÙÔÓ ‹¯Ô Â›Ó·È ‹‰Ë ·ÚÔ‡Û· ·fiÙËÓ ÂÌ‚Ú˘˚Î‹ ˙ˆ‹ Î·È ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÙË ÌÂÙ·‚ÔÏ‹ÙË˜ Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘. ªÂÙ¿ ÙËÁ¤ÓÓËÛË, Û·Ê‹˜ ·ÓÙ·fiÎÚÈÛË ÛÙÔÓ ‹¯Ô ÌÔÚÂ› Ó··Ú·ÙËÚËıÂ› ÛÙËÓ ËÏÈÎ›· ÙˆÓ 28 Â‚‰ÔÌ¿‰ˆÓ ÂÚ›-Ô˘, fiÙ·Ó ÙÔ ÓÂÔÁÓfi ÌÔÚÂ› Ó· ·ÓÙÈ‰Ú¿ÛÂÈ ÌÂ ·ÓÔÈ-ÁÔÎÏÂ›ÛÈÌÔ ÙˆÓ Ì·ÙÈÒÓ ‹ Í¿ÊÓÈ·ÛÌ· (12). ™Â ·Ô˘-Û›· ·˘Ù‹˜ ÙË˜ ·ÓÙ·fiÎÚÈÛË˜, ÌÔÚÔ‡Ó Ó· Á›ÓÔ˘ÓÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙÂ˜, fiˆ˜ ·ÎÔ˘ÛÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘-Ó·ÌÈÎ¿.

∏ ¯Ú‹ÛË ÙÔ˘ ÚÔÙ‡Ô˘ ÂÍ¤Ù·ÛË˜ ÙË˜ ÔÌ¿‰·˜Dubowitz (16) ÛÙÈ˜ ÓÂÔÁÓÈÎ¤˜ ÌÔÓ¿‰Â˜ Â›Ó·È ¯Ú‹ÛÈÌËÎ·È Û¯ÂÙÈÎ¿ ·Ï‹ ÁÈ· ‰È·‰Ô¯ÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÙˆÓ ÓÂÔ-ÁÓÒÓ, ·ÎfiÌË Î·È ·fi ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÂÍÂÙ·ÛÙ¤˜.

∏ ÛÙ·ıÂÚ¿ ·ÓÂ˘ÚÈÛÎfiÌÂÓË Ê˘ÛÈÔÏÔÁÈÎ‹ ÓÂ˘ÚÔ-ÏÔÁÈÎ‹ ÂÈÎfiÓ· Û˘Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi Ê˘ÛÈÔÏÔ-ÁÈÎ‹ ¤Î‚·ÛË, ÂÊfiÛÔÓ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ÂÈÎfiÓÂ˜ ÛÙÈ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ Î·È ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎ¤˜ÙÂ¯ÓÈÎ¤˜.

∏ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔ-ÁÓÒÓ ÌÂ ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ÌÂÙ¿ÙË ‰Â‡ÙÂÚË Â‚‰ÔÌ¿‰· ÙË˜ ˙ˆ‹˜ ıÂˆÚÂ›Ù·È ·ÍÈfiÈ-ÛÙÔ˜ ‰Â›ÎÙË˜, È‰È·›ÙÂÚ· fiÙ·Ó Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘-ÁÎÂÎÚÈÌ¤ÓÂ˜ ÂÈÎfiÓÂ˜ ‚Ï¿‚Ë˜ ÛÙÈ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ÙÂ¯ÓÈÎ¤˜ Î·È Î˘Ú›ˆ˜ ÙË ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁ›·, fiˆ˜·Ó·Ê¤ÚÂÙ·È ·Ó·Ï˘ÙÈÎ¿ Î·ÙˆÙ¤Úˆ.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, Ê·›ÓÂÙ·È fiÙÈË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÂÚ›Ô˘ ÛÙËÓ ËÏÈÎ›· ÙÔ˘ ÙÂ-ÏÂÈfiÌËÓÔ˘ ‹ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÙÌ‹Ì· ÓÂÔÁ¤Ó-ÓËÙˆÓ ÌÔÚÂ› Ó· ¤¯ÂÈ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·, ÛÂ Û¯¤ÛË¿ÓÙÔÙÂ ÌÂ Ù· Â˘Ú‹Ì·Ù· ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ·ÂÁÎÂÊ¿ÏÔ˘ (·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ Î·ÙˆÙ¤Úˆ).

∞ÂÈÎÔÓÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ÂÁÎÂÊ¿ÏÔ˘ÀÂÚË¯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘∏ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÙÔ 1970

Î·È Î˘Ú›ˆ˜ Ë ¯Ú‹ÛË ÙˆÓ Ó¤ˆÓ ˘ÂÚË¯ÔÁÚ¿ÊˆÓ(sector scanners) ÙÔ 1980 Î·Ù¤ÛÙËÛ·Ó ‰˘Ó·Ùfi ÙÔÓÎ·ıÔÚÈÛÌfi ÙfiÛÔ ÙÔ˘ Ù‡Ô˘ Î·È ÙË˜ ı¤ÛË˜, fiÛÔ Î·ÈÙË˜ Â›ÙˆÛË˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‚Ï·-‚ÒÓ, ÛÂ Û¯¤ÛË ¿ÓÙÔÙÂ ÌÂ ÙËÓ ËÏÈÎ›· Î‡ËÛË˜. ∏¯Ú‹ÛË ÙˆÓ ˘ÂÚ‹¯ˆÓ ¤‰ˆÛÂ Ú·ÁÌ·ÙÈÎ‹ ÒıËÛËÛÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ, ‰ÈfiÙÈÂ›Ó·È Â‡ÎÔÏË, ·ÛÊ·Ï‹˜ Î·È ÊıËÓ‹ Ì¤ıÔ‰Ô˜, ÂÓÒ ÙÔÌË¯¿ÓËÌ· Â›Ó·È ÊÔÚËÙfi Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Î·Ù¿ÏÏË-ÏÔ ÁÈ· ¯Ú‹ÛË ÚÔ˘Ù›Ó·˜ ÛÙÈ˜ ÓÂÔÁÓÈÎ¤˜ ÌÔÓ¿‰Â˜.

ªÂ ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Â›Ó·È Â‡ÎÔÏÔ Ó· ‰È·-ÁÓˆÛÙÂ› fi¯È ÌfiÓÔ Ë ÂÚÈÎÔÈÏÈ·Î‹-ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·È-ÌÔÚÚ·Á›· (¶∂∞), ·ÏÏ¿ Î·È Ë ÂÚÈÎÔÈÏÈ·Î‹ ÏÂ˘ÎÔÌ·-Ï·Î›· (¶§), ÁÂÁÔÓfi˜ ÔÏ‡ ÛËÌ·ÓÙÈÎfi ·ÊÔ‡ Ë ÙÂ-ÏÂ˘Ù·›· Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ¯ÂÈÚfiÙÂÚË ¤Î‚·ÛË. ŒÙÛÈ¤ÁÈÓÂ ‰˘Ó·Ùfi Ó· ‰ÂÈ¯ıÂ› fiÙÈ Ë ¶§ Û˘Ì‚·›ÓÂÈ Î˘Ú›ˆ˜ÌÂÙ·Í‡ 28 Î·È 32 Â‚‰ÔÌ¿‰ˆÓ (25), ÂÓÒ Ë ˘ÔÊÏÔÈ-Ò‰Ë˜ ÏÂ˘ÎÔÌ·Ï·Î›· Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÂ ÈÔ ÒÚÈÌ·ÓÂÔÁÓ¿.

™¯ÂÙÈÎ¿ ÌÂ ÙËÓ ¶∂∞, ÁÂÓÈÎ¿ Â›Ó·È ·Ô‰ÂÎÙ‹ ÙÂ-ÏÂ˘Ù·›· Ë Ù·ÍÈÓfiÌËÛË ÙÔ˘ Volpe (26) Ô˘ ÂÚÈÏ·Ì-‚¿ÓÂÈ ÙÚÂÈ˜ ‚·ıÌÔ‡˜ Î·È ÍÂ¯ˆÚÈÛÙ‹ ÂÚÈÁÚ·Ê‹ ÙË˜·ÚÂÁ¯˘Ì·ÙÈÎ‹˜ Û˘ÌÌÂÙÔ¯‹˜ (¶›Ó·Î·˜ 1). º·›ÓÂÙ·ÈfiÙÈ Ë ÂÙÂÚfiÏÂ˘ÚË ·ÚÂÁ¯˘Ì·ÙÈÎ‹ Û˘ÌÌÂÙÔ¯‹ Ô˘Û˘ÓÔ‰Â‡ÂÈ ÂÙÂÚfiÏÂ˘ÚË ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›·Û˘Ó‰¤ÂÙ·È, Û‹ÌÂÚ·, ÌÂ ÊÏÂ‚ÈÎfi ¤ÌÊÚ·ÎÙÔ (26-28).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÚÈÎÔÈÏÈ·Î‹ ÏÂ˘ÎÔÌ·Ï·Î›·,Â›Ó·È ÁÂÓÈÎ¿ ·Ô‰ÂÎÙ‹ Ë Ù·ÍÈÓfiÌËÛË ÙË˜ de Vries(29) (¶›Ó·Î·˜ 2). ∏ ¶∂∞ ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯ÂÈ ÌÂÙËÓ ¶§ Ô˘ Â›Ó·È Ì›· Î·Ù¿ÛÙ·ÛË ·ÌÊÔÙÂÚfiÏÂ˘ÚË,·Ó Î·È fi¯È ¿ÓÙÔÙÂ Û˘ÌÌÂÙÚÈÎ‹.

∏ ¶§ Û˘Ì‚·›ÓÂÈ Ì¤¯ÚÈ Î·È 11 Â‚‰ÔÌ¿‰Â˜ ·fi ÙËÁ¤ÓÓËÛË, ·ÎfiÌË Î·È Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 40 Â‚‰Ô-Ì¿‰ˆÓ ·fi ÙË Û‡ÏÏË„Ë. ∂ÓÙÔ‡ÙÔÈ˜, ÔÈ ÌÂÙ·‚ÔÏ¤˜ÙË˜ ÂÚÈÎÔÈÏÈ·Î‹˜ ÏÂ˘Î‹˜ Ô˘Û›·˜ Û˘Ì‚·›ÓÔ˘Ó ·Ú-ÁfiÙÂÚ·. ∞˘ÍËÌ¤ÓË ˘ÂÚË¯ÔÁ¤ÓÂÈ· ÛÂ ·˘Ù¤˜ ÙÈ˜ Â-ÚÈÔ¯¤˜ Â›Ó·È Û˘¯Ó‹ ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜, Á›-ÓÂÙ·È fiÌˆ˜ ÂÓ‰ÂÈÎÙÈÎ‹ ¶§ ÌfiÓÔÓ fiÙ·Ó ÂÈÌ¤ÓÂÈ ÁÈ·¿Óˆ ·fi 7-10 ËÌ¤ÚÂ˜.

OÈ Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ÂÍÂÙ¿ÛÂÈ˜ ÌÂ ˘ÂÚË¯ÔÁÚ¿-ÊËÌ· ÙÈ˜ ÂfiÌÂÓÂ˜ 2-3 Â‚‰ÔÌ¿‰Â˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó·‰Â›ÍÔ˘Ó ÙËÓ ÂÍ¤ÏÈÍË ÛÂ ÏÈÁfiÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔÂÎÙÂÙ·Ì¤ÓÂ˜ Î˘ÛÙÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜, Î¿ÔÈÔ˘ ‚·ıÌÔ‡·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÎÔÈÏÈÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘‹ Î·È Î·Ì›· ÂÌÊ·Ó‹ ÌÂÙ·‚ÔÏ‹.

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ÂÚÈÎÔÈÏÈ·Î‹˜-ÂÓ‰ÔÎÔÈÏÈ·Î‹˜ ·ÈÌÔÚÚ·Á›·˜

µ·ıÌfi˜ 1. ∞ÈÌÔÚÚ·Á›· ‚Ï·ÛÙÈÎ‹˜ ÛÙÈ‚¿‰·˜ ¯ˆÚ›˜ ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›· ‹ ÌÂ ÌÈÎÚ‹ ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›· µ·ıÌfi˜ 2. ∞ÈÌÔÚÚ·Á›· ‚Ï·ÛÙÈÎ‹˜ ÛÙÈ‚¿‰·˜ + ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›· (10-50% ÙË˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ ÛÂ ·Ú·Ô‚ÂÏÈ·›· ÙÔÌ‹) µ·ıÌfi˜ 3. ∞ÈÌÔÚÚ·Á›· ‚Ï·ÛÙÈÎ‹˜ ÛÙÈ‚¿‰·˜ + ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›· (>50% ÙË˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ + ÔÍÂ›· ‰È¿Ù·ÛË)

•Â¯ˆÚÈÛÙ‹ ÂÚÈÁÚ·Ê‹ ·ÚÂÁ¯˘Ì·ÙÈÎ‹˜ Û˘ÌÌÂÙÔ¯‹˜

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∏ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Î˘ÛÙÈÎÒÓ ‚Ï·‚ÒÓ ÂÍ·ÚÙ¿Ù·ÈÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙÔ ¯ÚfiÓÔ ÂÍ¤Ù·ÛË˜ Î·È ÙË‰È·ÎÚÈÙÈÎ‹ Â˘¯¤ÚÂÈ· ÙÔ˘ Ë¯Ô‚ÔÏ¤·. ∂ÓÒ ÂÎÙÂÙ·Ì¤-ÓÂ˜ ‚Ï¿‚Â˜ Û˘Ó‹ıˆ˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÌÂ ÙË ¯Ú‹ÛËË¯Ô‚ÔÏ¤· 5 ª∏z, ÂÓÙÔÈÛÌ¤ÓÂ˜ Î‡ÛÙÂÈ˜ ··ÈÙÔ‡ÓË¯Ô‚ÔÏ¤· 7,5 MHz Î·È 10 MHz.

∏ Â˘ÎÔÏ›· ÙË˜ ·Ó·ÁÓÒÚÈÛË˜ ÙˆÓ ‚Ï·‚ÒÓ ·˘ÙÒÓÎ·È ÙË˜ ÂÍ¤ÏÈÍ‹˜ ÙÔ˘˜ ÂÈÙÚ¤ÂÈ ÙË Û˘Û¯¤ÙÈÛË ÌÂ-Ù·Í‡ ÙˆÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, ÙË˜ ·Ú¯È-Î‹˜ ÎÏÈÓÈÎ‹˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÈÎfiÓ·˜ Î·È ÙË˜ ÂÍ¤ÏÈ-ÍË˜ ÙˆÓ ÎÏÈÓÈÎÒÓ ÛËÌÂ›ˆÓ.

∂ÓÒ Ù· ÎÏÈÓÈÎ¿ ÛËÌÂ›· ÛÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ÙË˜ ÏÂ˘ÎÔÌ·Ï·Î›·˜ÌÔÚÂ› Ó· ÌËÓ Â›Ó·È ÔÏ‡ ‰È·ÊÔÚÂÙÈÎ¿, Û˘Ó‹ıˆ˜ ‰›-ÓÔ˘Ó ÔÏ‡ ‰È·ÊÔÚÂÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÛÙËÓ ËÏÈÎ›·ÙˆÓ 40 Â‚‰ÔÌ¿‰ˆÓ ·fi ÙË Û‡ÏÏË„Ë.

∏ ÂÈÌ¤ÓÔ˘Û·, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ˘ÔÙÔÓ›· (ÌÂÌÂÈˆÌ¤ÓË fiÌˆ˜ ÈÁÓ˘·Î‹ ÁˆÓ›·) Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·ÈÛ˘Ó‹ıˆ˜ ÌÂ ÂÚÈÎÔÈÏÈ·Î‹-ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·-Á›· ¤¯ÂÈ Û˘Ó‹ıˆ˜ Î·Ï‹ ¤Î‚·ÛË.

∞ÓÙ›ıÂÙ·, Ô ·˘ÍËÌ¤ÓÔ˜ ÙfiÓÔ˜ ÙˆÓ ÂÎÙÂÈÓfiÓÙˆÓÌ˘ÒÓ, Ë Â˘ÂÚÂıÈÛÙfiÙËÙ· Î·È Ë ·ÓÒÌ·ÏË ı¤ÛË ÙˆÓ‰·ÎÙ‡ÏˆÓ ÙˆÓ ¿Óˆ Î·È ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Ô˘ Û˘Ó‹-ıˆ˜ Û˘ÓÔ‰Â‡ÂÈ ÙËÓ ÂÚÈÎÔÈÏÈ·Î‹ ÏÂ˘ÎÔÌ·Ï·Î›· Â›-Ó·È Û˘Ó‹ıˆ˜ ÚÔÁÓˆÛÙÈÎ¿ Î·Î‹˜ ¤Î‚·ÛË˜ (30).

¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ÂÍÂÙ¿ÛÂÈ ÙË Û˘Û¯¤ÙÈÛË·Ó¿ÌÂÛ· ÛÙÈ˜ ·ıÔÏÔÁÈÎ¤˜ ˘ÂÚË¯ÔÁÚ·ÊÈÎ¤˜ ÂÈÎfi-ÓÂ˜ Î·È ÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË.

ªÈÎÚ‹ ‹ Î·Ì›· ‰È·ÊÔÚ¿ ¤¯ÂÈ ‚ÚÂıÂ› ÛÙËÓ ¤Î‚·-ÛË ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ¯ˆÚ›˜ ¶∂∞ ‹ Î·È ÌÂ 1Ô˘ ‚·ı-ÌÔ‡ (¯ˆÚ›˜ ‰È¿Ù·ÛË ÎÔÈÏÈÒÓ) ·ÈÌÔÚÚ·Á›· (31).

¡ÂÔÁÓ¿ ÌÂ ∏∫ ≤32 Â‚‰ÔÌ¿‰ˆÓ Ô˘ ·Ó·Ù‡Û-ÛÔ˘Ó ‰È¿Ù·ÛË ÎÔÈÏÈÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÌÂÙ¿ ¶∂∞ ÌÂ‹ ¯ˆÚ›˜ ·ÚÂÁ¯˘Ì·ÙÈÎ‹ Û˘ÌÌÂÙÔ¯‹, ·ÚÔ˘ÛÈ¿˙Ô˘ÓÛÂ ÔÛÔÛÙfi 75% ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË Î·È ÓÔËÙÈ-Î‹ ˘ÛÙ¤ÚËÛË ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (32,33).

O Î›Ó‰˘ÓÔ˜ ·Ó¿Ù˘ÍË˜ ÓÂ˘ÚÔÏÔÁÈÎÒÓ Â·Îfi-ÏÔ˘ıˆÓ ÂÍ·ÚÙ¿Ù·È ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙË Û˘ÓÔ-‰fi ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜. µÚ¤ÊËÔ˘ Â›¯·Ó ÂÙÂÚfiÏÂ˘ÚË ·ÚÂÁ¯˘Ì·ÙÈÎ‹ ·ÈÌÔÚÚ·-Á›· (ÊÏÂ‚ÈÎfi ¤ÌÊÚ·ÎÙÔ) ÌÔÚÂ› Ó· ¤¯Ô˘Ó Î·Ï‹¤Î‚·ÛË, Î˘Ú›ˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÓÔËÙÈÎ‹ ÂÍ¤ÏÈÍË(34). OÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó·ÓÙ›ÏÂ˘ÚË ËÌÈÏËÁ›· (22,34). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ Û˘-Ó‹ıˆ˜ fiÙ·Ó ÔÈ ‚Ï¿‚Â˜ Â›Ó·È ÌÂÁ¿ÏÂ˜ Î·È ÂÓÙÔ›˙Ô-ÓÙ·È ÛÂ ı¤ÛË ÚÔ˜ Ù· ›Ûˆ.

∏ ¤Î‚·ÛË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ÚÒÙÔ˘ ‚·ıÌÔ‡ ¶§

Â›Ó·È ÏÈÁfiÙÂÚÔ Â˘ÓÔ˚Î‹ ·fi Ù· ÓÂÔÁÓ¿ ÌÂ ¶∂∞ 1Ô˘Î·È 2Ô˘ ‚·ıÌÔ‡. ¶ÔÛÔÛÙfi ÂÚ›Ô˘ 10% ·Ó·Ù‡Û-ÛÂÈ Û·ÛÙÈÎ‹ ‰ÈÏËÁ›· (35). O Î›Ó‰˘ÓÔ˜ ·Ó¿Ù˘ÍË˜ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ ·˘Í¿ÓÂÈ ÛÙÔ˘˜ ÂfiÌÂ-ÓÔ˘˜ ‚·ıÌÔ‡˜ ¶§ Î·Ù¿ ÙËÓ de Vries. ∏ ı¤ÛË ÙˆÓÎ‡ÛÙÂˆÓ ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Î·È Û˘Ó‹ıˆ˜ ËÂÓÙfiÈÛ‹ ÙÔ˘˜ ÛÙË ‚ÚÂÁÌ·ÙÔ˚ÓÈ·Î‹ ÂÚÈÎÔÈÏÈ·Î‹ÏÂ˘Î‹ Ô˘Û›· Û˘Ó‰¤ÂÙ·È ÌÂ ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË(‰ÈÏËÁ›·, ÙÂÙÚ·ÏËÁ›·) ÌÂ ‹ ¯ˆÚ›˜ Ù‡ÊÏˆÛË Î·ÈÛ˘Ó‹ıˆ˜ ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË (25,36-39).

Ÿˆ˜ Â›Ó·È Ê·ÓÂÚfi, Ë ¤Î‚·ÛË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ¶§ Â›Ó·È ‰È·ÊÔÚÂÙÈÎ‹ ·fi ÂÎÂ›ÓË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂÊÏÂ‚ÈÎfi ¤ÌÊÚ·ÎÙÔ Ô˘ Û˘ÓÔ‰Â‡ÂÈ ¶∂∞. ŒÙÛÈ, Â›Ó·ÈÛËÌ·ÓÙÈÎfi Ó· Á›ÓÂÙ·È ‰È¿ÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Î·-Ù·ÛÙ¿ÛÂˆÓ ÌÂ ÙË ¯Ú‹ÛË Â·ÓÂÈÏËÌÌ¤ÓˆÓ ˘ÂÚË¯Ô-ÁÚ·ÊËÌ¿ÙˆÓ ÂÁÎÂÊ¿ÏÔ˘, Î·ıÒ˜ Î·È (ÂÈÏÂÁÌ¤Ó·)Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¤‰ˆÛÂ Ó¤·

ÌÂÁ¿ÏË ÒıËÛË ÛÙË ÓÂ˘ÚÔÏÔÁ›· ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÙÂÏÂ˘Ù·›·˜ ‰ÂÎ·ÂÙ›·˜. ∂›Ó·È Ì¤-ıÔ‰Ô˜ ·ÎÚÈ‚‹, ··ÈÙÂ› ÌÂÙ·ÊÔÚ¿ Î·È ·Ú·ÌÔÓ‹ÙÔ˘ ÓÂÔÁÓÔ‡ ÁÈ· ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÎÔÓÙ¿ÛÙÔ Ì·ÁÓ‹ÙË, ¤¯ÂÈ fiÌˆ˜ ÙÔ ÏÂÔÓ¤ÎÙËÌ· ÛÂ Û¯¤ÛËÌÂ ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, fiÙÈ ÛÙÂÚÂ›-Ù·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙË˜ ·ÎÙÈÓÔ‚ÔÏ›·˜. ∆ÂÏÂ˘Ù·›·, ÌÂÙË ¯Ú‹ÛË ÓÂfiÙÂÚˆÓ ÙÂ¯ÓÈÎÒÓ ¤ÁÈÓÂ ‰˘Ó·Ù‹ Ë Ï‹„ËÂÈÎfiÓˆÓ ˘„ËÏ‹˜ Â˘ÎÚ›ÓÂÈ·˜, ·ÎfiÌË Î·È ÛÙ· Úfiˆ-Ú· ÓÂÔÁÓ¿.

∏ ÈÎ·ÓfiÙËÙ· ÙË˜ ·ÂÈÎfiÓÈÛË˜ ÛÂ ÙÔÌ¤˜ ÙÚÈÒÓÂÈ¤‰ˆÓ (ÛÙÂÊ·ÓÈ·›Â˜, Ô‚ÂÏÈ·›Â˜ Î·È ·ÍÔÓÈÎ¤˜)·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· ÛÙËÓ ·ÂÈÎfiÓÈÛËÙˆÓ ·Ó·ÙÔÌÈÎÒÓ ÏÂÙÔÌÂÚÂÈÒÓ. ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È Ë Î·Ï‡ÙÂÚË ÌË ÂÂÌ‚·ÙÈ-Î‹ Ì¤ıÔ‰Ô˜ ·ÂÈÎfiÓÈÛË˜ ÙË˜ ·Ó·ÙÔÌ›·˜ ÙÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘, Î·ıÒ˜ Î·È ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ Ì˘ÂÏ›ÓˆÛË˜ invivo. ŒÙÛÈ, ¤ÁÈÓÂ ‰˘Ó·Ù‹ Ë ÂÎÙ›ÌËÛË ÙË˜ Â›‰Ú·ÛË˜ÙˆÓ ‰È·ÊfiÚˆÓ ‚Ï·‚ÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÙË Ì˘Â-Ï›ÓˆÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (40,41). ∞˘Ùfi Ê·›ÓÂÙ·È Î·Ï¿ÌÂ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙˆÓ Î˘ÛÙÈÎÒÓ‚Ï·‚ÒÓ ‰È·ÊÔÚÂÙÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜.

º·›ÓÂÙ·È fiÙÈ ÔÈ Î‡ÛÙÂÈ˜ Ô˘ ÚÔÎ‡ÙÔ˘Ó Û·Ó·ÔÙ¤ÏÂÛÌ· ÂÚÈÎÔÈÏÈ·Î‹˜ ÏÂ˘ÎÔÌ·Ï·Î›·˜ Û˘Ó‹-ıˆ˜ Î·Ù·Ï‹ÁÔ˘Ó ÛÂ ‰È¿Ù·ÛË ÙˆÓ ÎÔÈÏÈÒÓ ÙÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘, ÁÏÔ›ˆÛË Î·È Î·ı˘ÛÙ¤ÚËÛË ÙË˜ Ì˘ÂÏ›ÓˆÛË˜ÛÙË ı¤ÛË ÙˆÓ Î‡ÛÙÂˆÓ. ∞ÓÙ›ıÂÙ·, ÛÙË ı¤ÛË ÙˆÓ Ô-ÚÂÁÎÂÊ·ÏÈÎÒÓ Î‡ÛÙÂˆÓ Ô˘ Â›Ó·È ‰Â˘ÙÂÚÔ·ıÂ›˜

¶›Ó·Î·˜ 2. ∆·ÍÈÓfiÌËÛË ÂÚÈÎÔÈÏÈ·Î‹˜ ÏÂ˘ÎÔÌ·Ï·Î›·˜ Î·Ù¿ de Vries

µ·ıÌfi˜ 1. ¶·ÚÔ‰ÈÎ¤˜ ÂÚÈÎÔÈÏÈ·Î¤˜ ˘ÂÚË¯ÔÁ¤ÓÂÈÂ˜ ÂÈÌ¤ÓÔ˘ÛÂ˜ ÁÈ· >7 ËÌ¤ÚÂ˜ µ·ıÌfi˜ 2. ¶ÂÚÈÎÔÈÏÈ·Î¤˜ ˘ÂÚË¯ÔÁ¤ÓÂÈÂ˜ ÂÍÂÏÈÛÛfiÌÂÓÂ˜ ÛÂ ÌÈÎÚ¤˜ ÂÓÙÔÈÛÌ¤ÓÂ˜ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈÎ¤˜ Î˘ÛÙÈÎ¤˜ ‚Ï¿‚Â˜ µ·ıÌfi˜ 3. ¶ÂÚÈÎÔÈÏÈ·Î¤˜ ˘ÂÚË¯ÔÁ¤ÓÂÈÂ˜ ÂÍÂÏÈÛÛfiÌÂÓÂ˜ ÛÂ ÂÎÙÂÙ·Ì¤ÓÂ˜ ÂÚÈÎÔÈÏÈ·Î¤˜ Î˘ÛÙÈÎ¤˜ ‚Ï¿‚Â˜ µ·ıÌfi˜ 4. ÀÂÚË¯ÔÁ¤ÓÂÈÂ˜ ÂÂÎÙÂÈÓfiÌÂÓÂ˜ ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ ÏÂ˘Î‹ Ô˘Û›·, ÂÍÂÏÈÛÛfiÌÂÓÂ˜ ÛÂ ÂÎÙÂÙ·Ì¤ÓÂ˜ ˘ÔÊÏÔÈÒ‰ÂÈ˜

Î˘ÛÙÈÎ¤˜ ‚Ï¿‚Â˜

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·ÚÂÁ¯˘Ì·ÙÈÎ‹˜ Û˘ÌÌÂÙÔ¯‹˜ Ô˘ Û˘ÓÔ‰Â‡ÂÈ ÂÚÈ-ÎÔÈÏÈ·Î‹ ÂÓ‰ÔÎÔÈÏÈ·Î‹ ·ÈÌÔÚÚ·Á›·, ·Ú·ÙËÚÂ›Ù·È“‰È¿ÛˆÛË” ÙË˜ Ì˘ÂÏ›ÓˆÛË˜.

Œ¯Ô˘Ó Á›ÓÂÈ ·ÚÎÂÙ¤˜ ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ÙË ¯Ú‹ÛËÙË˜ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ˆ˜ÚÔÁÓˆÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹˜¤Î‚·ÛË˜ (18,25,30,42-44).

ŒÙÛÈ, ¤ÁÈÓÂ ‰˘Ó·Ùfi Ó· ‰ÂÈ¯ıÂ› fiÙÈ ÛÙ· ÙÂÏÂÈfiÌË-Ó· ÓÂÔÁÓ¿ ÔÈ ˘ÔÍÈÎ¤˜ ÈÛ¯·ÈÌÈÎ¤˜ ‚Ï¿‚Â˜ ÂÌÊ·Ó›-˙Ô˘Ó ¤Ó· Ê¿ÛÌ· ‰È·ÊÔÚÂÙÈÎÒÓ ÂÈÎfiÓˆÓ, Ô˘ Î˘Ì·›-ÓÔÓÙ·È ·fi ÂÈÎÚ¿ÙËÛË ÙË˜ ‚Ï¿‚Ë˜ ÛÙ· ‚·ÛÈÎ¿Á¿ÁÁÏÈ· Ì¤¯ÚÈ ÙËÓ ÂÈÎÚ¿ÙËÛË ÙË˜ ‚Ï¿‚Ë˜ ÛÙË ÏÂ˘-Î‹ Ô˘Û›·. ¡ÂÔÁÓ¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈ-Î‹ ‚Ï¿‚Ë ÌÂÙ¿ ·fi ÔÍ‡ ÂÚÈÁÂÓÓËÙÈÎfi Úfi‚ÏËÌ·,ÂÎ‰ËÏÒÓÔ˘Ó Î˘Ú›ˆ˜ ‚Ï¿‚Ë ÛÙ· ‚·ÛÈÎ¿ Á¿ÁÁÏÈ·,ÂÓÒ ·˘Ù¿ Ô˘ ÂÎ‰ËÏÒÓÔ˘Ó ÙËÓ ›‰È· ÂÈÎfiÓ· ÌÂÙ¿·fi Â›‰Ú·ÛË ÚÔÁÂÓÓËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, .¯.Â·ÓÂÈÏËÌÌ¤ÓË ·ÈÌÔÚÚ·Á›· ‹ ÌÂÈˆÌ¤ÓÂ˜ ÎÈÓ‹ÛÂÈ˜ÙÔ˘ ÂÌ‚Ú‡Ô˘, Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙Ô˘Ó ‚Ï¿‚Ë ÙË˜ ÏÂ˘-Î‹˜ Ô˘Û›·˜.

∆· ÓÂÔÁÓ¿ ÌÂ ‚Ï¿‚Ë ÛÙ· ‚·ÛÈÎ¿ Á¿ÁÁÏÈ· ¤¯Ô˘Ó¯ÂÈÚfiÙÂÚÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°), ·-ÚÔ˘ÛÈ¿˙Ô˘Ó Û·ÛÌÔ‡˜ ÌÂÙ¿ ·fi Ï›ÁÂ˜ ËÌ¤ÚÂ˜ Ô˘Â›Ó·È ·ÓıÂÎÙÈÎÔ› ÛÙËÓ ·ÓÙÈÛ·ÛÌˆ‰ÈÎ‹ ·ÁˆÁ‹, ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÒÌ·ÏÂ˜ ÎÈÓ‹ÛÂÈ˜ ÙˆÓ ÔÊı·ÏÌÒÓ Î·È‰˘ÛÎÔÏ›Â˜ ÛÙÔ ıËÏ·ÛÌfi Î·È ÙËÓ Î·Ù¿ÔÛË. ∆· ÓÂ-ÔÁÓ¿ ·˘Ù¿, ÌÂÙ¿ ·fi Ì›· ÌÈÎÚ‹ ÂÚ›Ô‰Ô ‡ÊÂÛË˜,ÂÎ‰ËÏÒÓÔ˘Ó ÂÈÎfiÓ· ‰˘ÛÙÔÓÈÎ‹˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·-Ú¿Ï˘ÛË˜ ÌÂ ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË Î·È ÂÈÏË„›· (45).

™Ù· ÓÂÔÁÓ¿ ÌÂ ‚Ï¿‚Ë ÙË˜ ÏÂ˘Î‹˜ Ô˘Û›·˜, ÙÔ∏∂° Â›Ó·È ÏÈÁfiÙÂÚÔ ·Û˘ÓÂ¯¤˜, ÔÈ Û·ÛÌÔ› ÂÏ¤Á¯Ô-ÓÙ·È Î·Ï‡ÙÂÚ·, ÂÓÒ Î·È Ù· ‰‡Ô (∏∂° Î·È Û·ÛÌÔ›)·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚ÂÏÙ›ˆÛË. ∆· ÓÂÔÁÓ¿ ·˘Ù¿, ·Ú¿ ÙÔfiÙÈ ·Ó·Ù‡ÛÛÔ˘Ó ÌÈÎÚÔÎÂÊ·Ï›·, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì›·Ê˘ÛÈÔÏÔÁÈÎ‹ ·Ú¯ÈÎ¿ ÂÈÎfiÓ·. ™ËÌÂ›· ÂÁÎÂÊ·ÏÈÎ‹˜·Ú¿Ï˘ÛË˜ Á›ÓÔÓÙ·È ÂÌÊ·Ó‹ ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 4-6 ÌËÓÒÓ (45).

∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, fiˆ˜ Î·ÈÙÔ ÚÒÈÌÔ ∏∂°, ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Â›Ó·È ÔÏ‡ ‚ÔËıËÙÈ-Î¿ ÛÙËÓ ÚfiÁÓˆÛË ÁÈ· ÂÎ‰‹ÏˆÛË ËÌÈÏËÁ›·˜ ÛÙ·ÓÂÔÁÓ¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÂÈÎfiÓ· ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌ-ÊÚ¿ÎÙÔ˘ (44,46).

ª·ÁÓËÙÈÎ‹ Ê·ÛÌ·ÙÔÛÎÔ›· (Magnetic resona-nce spectroscopy)

∏ Ì·ÁÓËÙÈÎ‹ Ê·ÛÌ·ÙÔÛÎÔ›· Â›Ó·È Ì›· ÌË ÂÂÌ-‚·ÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÂÎÙ›ÌËÛË˜ ÙË˜ ‚ÈÔ¯ËÌÂ›·˜ ÙˆÓÈÛÙÒÓ Ì¤Ûˆ ÙË˜ ·Ó·ÁÓÒÚÈÛË˜ ÙˆÓ Ô˘ÛÈÒÓ ÛÙÔ˘˜ÂÍÂÙ·˙fiÌÂÓÔ˘˜ ÈÛÙÔ‡˜. ∆ÂÏÂ˘Ù·›·, ÛÙÈ˜ ÌÔÓ¿‰Â˜Ô˘ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÙË˜ ÌÂıfi-‰Ô˘, ‰›ÓÂÙ·È ÌÂÁ¿ÏË ¤ÌÊ·ÛË ÒÛÙÂ Ì¤Ûˆ ÙË˜ ¯Ú‹-ÛË˜ ÙË˜ Ó· ÂÎÙÈÌËıÂ› Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙÔ˘ ÂÁÎÂÊ¿-ÏÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ˆÚ›Ì·Ó-ÛË˜, ·ÏÏ¿ Î·È ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ô˘ Â›-Ó·È ·ÔÙ¤ÏÂÛÌ· ‰È·ÊfiÚˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·È Î˘Ú›ˆ˜

ÙË˜ ·ÛÊ˘Í›·˜. OÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ·ÊÔÚÔ‡ÓÛÙË Ê·ÛÌ·ÙÔÛÎÔ›· ÙÔ˘ ÊˆÛÊfiÚÔ˘ Î·È ÙÔ˘ Úˆ-ÙÔÓ›Ô˘.

ªÂÏ¤ÙÂ˜ ÛÂ ÓÂÔÁÓ¿ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÛËÌ·ÓÙÈÎ‹ ÌÂ›-ˆÛË ÙÔ˘ ÏfiÁÔ˘ ÊˆÛÊÔÎÚÂ·Ù›ÓË˜ (Pcr) ÚÔ˜ ÙÔÓ·ÓfiÚÁ·ÓÔ ÊˆÛÊfiÚÔ (Pi) ÌÂÙ¿ ·fi ·ÛÊ˘Í›·, ÛÂÛ¯¤ÛË ÌÂ ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi Î·È ·˘Ùfi Û˘ÓÔ‰Â‡ÂÙ·È ÌÂÎ·Î‹ ¤Î‚·ÛË (47,48). OÈ ÌÂÙ·‚ÔÏ¤˜, fiÌˆ˜, ·˘Ù¤˜Ê·›ÓÔÓÙ·È ÌÂÙ¿ ÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ˙ˆ‹˜. ∞ÓÙ›ıÂ-Ù·, Ë Ê·ÛÌ·ÙÔÛÎÔ›· ÙÔ˘ ÚˆÙÔÓ›Ô˘ Î·Ù¤ÛÙËÛÂ‰˘Ó·Ù‹ ÙË Ï‹„Ë ÚˆÈÌfiÙÂÚˆÓ ÌÂÙ·‚ÔÏÒÓ Ô˘ÚÔ‰ÈÎ¿˙Ô˘Ó Î·Î‹ ÚfiÁÓˆÛË. ∏ ·ÚÔ˘Û›· Á·Ï·-ÎÙÈÎÔ‡ ÔÍ¤Ô˜ (lactate) ÛÙÔ˘˜ ÈÛÙÔ‡˜ ÌÔÚÂ› Ó· ·ÓÈ-¯ÓÂ˘ıÂ› ·ÎfiÌË Î·È ÙÈ˜ ÚÒÙÂ˜ 12-24 ÒÚÂ˜ ÛÙ· ÓÂÔ-ÁÓ¿ Ô˘ ˘¤ÛÙËÛ·Ó ·ÛÊ˘Í›·, ÁÂÁÔÓfi˜ Ô˘ Û˘Û¯Â-Ù›˙ÂÙ·È ÌÂ Î·Î‹ ÚfiÁÓˆÛË (49-51).

Doppler ÂÁÎÂÊ¿ÏÔ˘ ∏ ·ıÔÁ¤ÓÂÈ· ÔÏÏÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÔ

ÓÂÔÁÓÈÎfi ÂÁÎ¤Ê·ÏÔ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂËÚÂ·ÛÌ¤ÓË·ÈÌ·ÙÈÎ‹ ÚÔ‹ ÛÙ· ÂÁÎÂÊ·ÏÈÎ¿ ·ÁÁÂ›·. ∞˘Ùfi ·ÊÔÚ¿ÛÙ· ÙÂÏÂÈfiÌËÓ· Î·È È‰È·ÈÙ¤Úˆ˜ ÛÙ· ÚfiˆÚ· ÓÂÔ-ÁÓ¿. ∏ ÚfiÛıÈ· ËÁ‹ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ¤¯ÂÈ ‰ÒÛÂÈ¤Ó· ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ·, fi¯È ÌfiÓÔ ÛÙËÓ ·ÂÈÎfi-ÓÈÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÌÂ ÙË ¯Ú‹ÛË ÙˆÓ ˘ÂÚ‹¯ˆÓ,·ÏÏ¿ Î·È ÛÙË Ì¤ÙÚËÛË ÙË˜ Ù·¯‡ÙËÙ·˜ ÙË˜ ·ÈÌ·ÙÈÎ‹˜ÚÔ‹˜ ÛÙÈ˜ ÂÁÎÂÊ·ÏÈÎ¤˜ ·ÚÙËÚ›Â˜ ÌÂ ÙË ¯Ú‹ÛË ÙË˜ÙÂ¯ÓÈÎ‹˜ Doppler.

ªÂ ·˘Ù‹ ÙËÓ ÙÂ¯ÓÈÎ‹ Á›ÓÂÙ·È Ì¤ÙÚËÛË ÙË˜ Ù·¯‡-ÙËÙ·˜ Î·È fi¯È ÙË˜ ÚÔ‹˜, Î·ıÒ˜ Ë ‰È¿ÌÂÙÚÔ˜ ÙˆÓ ·Á-ÁÂ›ˆÓ ‰ÂÓ ÌÔÚÂ› Ó· ÌÂÙÚËıÂ› (ƒÔ‹ = Ù·¯‡ÙËÙ· xÂÈÊ¿ÓÂÈ·).

™ÙÈ˜ ÂÁÎÂÊ·ÏÈÎ¤˜ ·ÚÙËÚ›Â˜, ÙÔ ‡„Ô˜ ÙË˜ Ì¤ÁÈ-ÛÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Ù·¯‡ÙËÙ·˜ (Peak systolic velocity,PSV) Â›Ó·È ÂÚ›Ô˘ 3 ÊÔÚ¤˜ ÙÔ ‡„Ô˜ ÙË˜ ÙÂÏÔ‰È·-ÛÙÔÏÈÎ‹˜ Ù·¯‡ÙËÙ·˜ (End diastolic velocity, EDV).

O ‰Â›ÎÙË˜ ÙÔ˘ Pourcelot (the resistance index ofPourcelot, PI) ˘ÔÏÔÁ›˙ÂÙ·È ÌÂ ÙÔÓ ·ÎfiÏÔ˘ıÔ Ù‡Ô:

∆· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· ÙÔ˘ PI Î˘Ì·›ÓÔÓÙ·È ÌÂÙ·Í‡0,65-0,90.

∆È˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜, Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ÓÂÔÁÓ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·ÌËÏfiÙÂÚË Ù·¯‡ÙËÙ· ·ÈÌ·-ÙÈÎ‹˜ ÚÔ‹˜ Ô˘ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ˘„ËÏfiÙÂÚÔ ‰Â›-ÎÙË ·ÓÙ›ÛÙ·ÛË˜ Î·Ù¿ Pourcelot, ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ÂfiÌÂÓÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜.

OÈ ÂÓ‰Â›ÍÂÈ˜ ¯Ú‹ÛË˜ ÙÔ˘ Doppler ÛÙ· ÓÂÔÁ¤ÓÓË-Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ó·ÁÓÒÚÈÛË Ê˘ÛÈÔÏÔÁÈÎ‹˜Î·È ÌË ·ÁÁÂÈ·Î‹˜ ÚÔ‹˜ ÛÂ ·ÚÙËÚÈÔÊÏÂ‚ÈÎ¤˜ ·Óˆ-Ì·Ï›Â˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÙËÓ ÙÔÈÎ‹ ‹ ÁÂÓÈÎÂ˘Ì¤ÓËÌÂ›ˆÛË ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ÚÔ‹˜ ÛÂ ÂÁÎÂÊ·ÏÈÎ¿ ¤Ì-ÊÚ·ÎÙ·, ÙËÓ “ÎÏÔ‹ ·›Ì·ÙÔ˜ Ì¤Ûˆ ÙÔ˘ ‚ÔÙ¿ÏÂÈÔ˘

PSV-EDV

PSVPI =

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·6


7

fiÚÔ˘” (ÌÂ›ˆÛË ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ Ù·¯‡ÙËÙ·˜ ÌÂÂ·ÎfiÏÔ˘ıË Î·Ù¿ÚÁËÛ‹ ÙË˜ Î·È ÛÙÔ Ù¤ÏÔ˜ ·ÚÓËÙÈ-Î‹ ‰È·ÛÙÔÏÈÎ‹ Ù·¯‡ÙËÙ· Ô˘ ·ÓÙ·Ó·ÎÏ¿ ÙË ÚÔ‹ ÙÔ˘·›Ì·ÙÔ˜ ·fi ÙËÓ ·ÔÚÙ‹ ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ÛÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ‰È·ÛÙÔÏ‹˜) Î·È ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÁÎÂÊ·-ÏÈÎÔ‡ ı·Ó¿ÙÔ˘ (Î·Ù¿ÚÁËÛË ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜) (52).

∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· ‰fiıËÎÂ ÌÂÁ¿ÏË ¤ÌÊ·ÛËÛÙË ¯Ú‹ÛË ÙÔ˘ Doppler ÂÁÎÂÊ¿ÏÔ˘ ÛÂ ÓÂÔÁÓ¿ ÌÂ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·. O Archer, ‹‰Ë·fi ÙÔ 1986 (53), ¤‰ÂÈÍÂ fiÙÈ ¯·ÌËÏfi˜ ‰Â›ÎÙË˜ ·ÓÙ›-ÛÙ·ÛË˜ ¤¯ÂÈ Â˘·ÈÛıËÛ›· 100% Î·È ÂÈ‰ÈÎfiÙËÙ· 81%,fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË ÁÈ· ÊÙˆ¯‹ ¤Î‚·ÛË.

O Levene (54), ÙÔ 1989, ¤‰ÂÈÍÂ fiÙÈ Ì›· ·ÓÒÌ·Ï··˘ÍËÌ¤ÓË ·ÈÌ·ÙÈÎ‹ ÚÔ‹ ¤¯ÂÈ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· 93%ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· 83% ÁÈ· ¯·ÌËÏfi‰Â›ÎÙË ·ÓÙ›ÛÙ·ÛË˜.

∞˘Ù¤˜ ÔÈ ·ÏÏ·Á¤˜, ¿ÓÙˆ˜, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÓÈ-¯ÓÂ˘ıÔ‡Ó ÌfiÓÔÓ ÌÂÙ¿ ÙÈ˜ ÚÒÙÂ˜ 12-24 ÒÚÂ˜ ÙË˜˙ˆ‹˜ Î·È, ÂÔÌ¤Óˆ˜, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÂ‡-ÛÔ˘Ó Û·Ó ÚÒÈÌÔÈ ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜ ÛÙÈ˜ ÚÒ-ÙÂ˜ 6 ÒÚÂ˜ ÙË˜ ˙ˆ‹˜ (55).

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°) ∆Ô Û˘Ì‚·ÙÈÎfi ÔÏ˘Î¿Ó·ÏÔ (multichannel) ∏∂°

Â›Ó·È ¤Ó· ÔÏ‡ ÛËÌ·ÓÙÈÎfi ÂÚÁ·ÏÂ›Ô ÛÙË Û˘ÓÔÏÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ. ∆Ô ∏∂°‰ÂÓ ·ÔÙÂÏÂ› ÂÍ¤Ù·ÛË ÚÔ˘Ù›Ó·˜ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ÓÂÔÁÓÈÎ¤˜ ÌÔÓ¿‰Â˜. ™˘Ó‹ıˆ˜ Á›ÓÂÙ·È ÛÂ ÙÂÏÂÈfiÌËÓ·ÓÂÔÁÓ¿ ÌÂÙ¿ ·fi ·ÛÊ˘Í›· ‹ ÁÂÓÈÎ¿ ÛÂ Û·ÛÌÔ‡˜,ÂÓÒ Á›ÓÂÙ·È Û¿ÓÈ· ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È Î˘Ú›ˆ˜ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜. ∏ Ï‹„Ë ÂÓfi˜ Ù˘ÈÎÔ‡∏∂° ÛÂ ¤Ó· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚfiˆÚÔ ÓÂÔÁÓfi ÂÈ-‚¿ÏÏÂÈ ·Ú·ÙÂÙ·Ì¤ÓÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜, ÂÓÒ Èı·ÓfiÙ·-Ù· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È artifacts Ì¤Ûˆ ËÏÂÎÙÚÈÎÒÓ ·-ÚÂÌ‚¿ÛÂˆÓ ·fi ·ÚÎÂÙ¤˜ Û˘ÛÎÂ˘¤˜ Ô˘ ˘¿Ú¯Ô˘ÓÛÙÈ˜ ÌÔÓ¿‰Â˜. ∂ÈÏ¤ÔÓ, Ë ÂÚÌËÓÂ›· ÙÔ˘ ∏∂° ÛÙ·ÚfiˆÚ· ÓÂÔÁÓ¿ Â›Ó·È ÔÏ‡ ÈÔ ÔÏ‡ÏÔÎË ÛÂ Û¯¤-ÛË ÌÂ Ù· ÙÂÏÂÈfiÌËÓ·, ÌÂ ÌÂÁ¿ÏÂ˜ ÌÂÙ·‚ÔÏ¤˜ ÛÙË‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· (background activity) Ô˘Û˘ÓÔ‰Â‡Ô˘Ó ÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ˆÚ›Ì·ÓÛË (56).

∏ Î·Ù·ÁÚ·Ê‹ ·fi ÔÏÏ·Ï¿ ËÏÂÎÙÚfi‰È· (4 ‹ 8channels ÌÂ ÙÔ Û‡ÛÙËÌ· Medilog) ÌÂ ÙËÓ Ù·˘Ùfi-¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ ÙË˜ ·Ó·ÓÔ‹˜ Î·È ÙË˜ Î·Ú‰È·-Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÔÚÔ‡Ó Ó· ·Ú¿Û¯Ô˘Ó ÏËÚÔÊÔ-Ú›Â˜ ÁÈ· ÙË ‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÙËÓ ÙÔÔÁÚ·ÊÈ-Î‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÚÔÍ˘ÛÌÈÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ, ÙÈ˜·Û˘ÌÌÂÙÚ›Â˜ ·Ó¿ÌÂÛ· ÛÙ· ËÌÈÛÊ·›ÚÈ· Î·È ÙÈ˜ ÌÂÙ·-‚ÔÏ¤˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (57).

™Â ÔÏÏ¤˜ ÌÔÓ¿‰Â˜ ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ¯Ú‹-ÛË˜ ÊÔÚËÙÒÓ Û˘ÛÎÂ˘ÒÓ ∏∂° (Medilog System) ‹,ÈÔ ÚfiÛÊ·Ù·, ÌÈÎÚÒÓ Û˘ÛÙËÌ¿ÙˆÓ ‚·ÛÈÛÌ¤ÓˆÓ ÛÂcomputer, Ù· ÔÔ›· ÂÈÙÚ¤Ô˘Ó ÙËÓ ·Ôı‹ÎÂ˘ÛËÛÂ ‰ÈÛÎ¤Ù· ÙˆÓ Î·Ù·ÁÚ·ÊÒÓ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ·, ¯ˆÚ›˜ Ó· ·ÚÂÌ‚·›ÓÔ˘Ó È‰È·›ÙÂÚ· ÛÙË

ÊÚÔÓÙ›‰· ÙˆÓ ÓÂÔÁÓÒÓ. À¿Ú¯ÂÈ, Â›ÛË˜, Ë ÙÂ¯ÓÈÎ‹ Cerebral Function

Monitor (CFM, Lectromed), Ë ÔÔ›· ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ›¯Ú‹ÛÈÌË ÛÙËÓ ÂÓÙ·ÙÈÎ‹ ÌÔÓ¿‰· ÓÂÔÁÓÒÓ. ∏ Î·Ù·-ÁÚ·Ê‹ Á›ÓÂÙ·È ÌfiÓÔ ·fi 2 ·ÌÊÈ‚ÚÂÁÌ·ÙÈÎ¿ ËÏÂ-ÎÙÚfi‰È·. ªÂ ÙÔ CFM ·Ú¤¯ÂÙ·È ¤Ó· Û˘Ì˘ÎÓˆÌ¤-ÓÔ, ÂÓÔÔÈËÌ¤ÓÔ Û‹Ì· ÙÔ˘ Â‡ÚÔ˘˜ ÙË˜ ‚·ÛÈÎ‹˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂ ÙË ¯Ú‹ÛË Ì›·˜ ÌÈÎÚ‹˜ Û˘ÛÎÂ˘-‹˜ ‰›Ï· ÛÙË ıÂÚÌÔÎÔÈÙ›‰· ÙÔ˘ ÓÂÔÁÓÔ‡.

OÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙË ‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Ë·Ú·ÙÂÙ·Ì¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Û·ÛÌÒÓ Â›Ó·È ÔÏ‡Â‡ÎÔÏÔ Ó· ‰È·ÈÛÙˆıÔ‡Ó ÛÙÔ CFM, ·ÎfiÌË Î·È ·fi¿ÙÔÌ· ÌÂ ÌÈÎÚ‹ ÂÌÂÈÚ›· ÛÙËÓ ·Ó¿ÁÓˆÛË Î·È ÂÚÌË-ÓÂ›· ÙÔ˘ Ù˘ÈÎÔ‡ ∏∂°. ŸÌˆ˜, ÔÈ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜Û·ÛÌÔ›, Ë ·ÚÔ‰ÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, Î·ıÒ˜ Î·È Ë·Û‡ÌÌÂÙÚË ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ 2 ËÌÈÛÊ·È-Ú›ˆÓ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÏfiÁˆ ÙË˜ ¯Ú‹ÛË˜ 2 ÌfiÓÔËÏÂÎÙÚÔ‰›ˆÓ.

™Â Û˘ÁÎÂÎÚÈÌ¤Ó· ÙÌ‹Ì·Ù· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙË-Ù· ¯Ú‹ÛË˜ ÙË˜ ÌÂıfi‰Ô˘ ·˘Ù‹˜ ÌÂ Î·Ï‹ Û˘Û¯¤ÙÈÛË,fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ÌÂ ÙÔ ÔÏ˘-Î¿Ó·ÏÔ ∏∂° Ô˘ ÂÎÙÂÏÂ›Ù·È ÌÂ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÓÂÔ-ÁÓÔ‡ ÛÙÔ ÙÌ‹Ì· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊËÌ¿ÙˆÓÙˆÓ ÓÔÛÔÎÔÌÂ›ˆÓ.

™ÙÈ˜ 27-28 Â‚‰ÔÌ¿‰Â˜, Ë ‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·ÛÙÔ ∏∂° Â›Ó·È Î˘Ú›ˆ˜ ·Û˘ÓÂ¯‹˜ (discontinu-ous),ÌÂ ÁÚ‹ÁÔÚÂ˜ ÂÎÊÔÚÙ›ÛÂÈ˜ (brief bursts) Ô˘ ‰È·Îfi-ÙÔÓÙ·È ·fi Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ÂÚÈfi‰Ô˘˜ ¤ÏÏÂÈ-„Ë˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ªÂ ÙËÓ ·‡ÍËÛË ÙË˜ ËÏÈÎ›·˜Î‡ËÛË˜, ·˘Ù¤˜ ÔÈ ÂÚ›Ô‰ÔÈ ¤ÏÏÂÈ„Ë˜ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜ ÚÔÔ‰Â˘ÙÈÎ¿ ÌÂÈÒÓÔÓÙ·È ÛÂ ‰È¿ÚÎÂÈ· Î·È ÛÙ·ÙÂÏÂÈfiÌËÓ· Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Â›Ó·È Î˘Ú›ˆ˜ Û˘ÓÂ¯‹˜(continuous). ∞Û˘ÓÂ¯‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ú·ÙË-ÚÂ›Ù·È Ê˘ÛÈÔÏÔÁÈÎ¿ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (58).∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ÙÂÏÂ˘Ù·›· ÂÈÎÂÓÙÚÒÓÔ˘Ó ÙÔ ÂÓ-‰È·Ê¤ÚÔÓ ÛÙËÓ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· Ô˘ ÌÔÚÂ› Ó·¤¯ÂÈ ¤Ó· “ÚÒÈÌÔ” ∏∂°, ‰ËÏ. fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÈÔÛ‡ÓÙÔÌ· ÌÂÙ¿ ÙË Á¤ÓÓËÛË. OÈ Wertheim Î·È Û˘Ó(58), Ùo 1994, ÌÂ ÙËÓ Î·Ù·ÁÚ·Ê‹ ∏∂° ÙÈ˜ ÚÒÙÂ˜ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ˘ÔÍÈÎ‹-ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ¤‰ÂÈÍ·Ó fiÙÈ ÙÔÚÒÈÌÔ ∏∂° ÌÔÚÂ› Ó· ‰ÒÛÂÈ ÚfiÁÓˆÛË ÛÂ Ì·ÎÚÔ-ÚfiıÂÛÌË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ Î·ı˘ÛÙ¤ÚËÛË.

∏ ÌÂÏ¤ÙË ·˘Ù‹ ¤‰ÂÈÍÂ fiÙÈ Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ‚·ÛÈÎ‹‰Ú·ÛÙËÚÈfiÙËÙ· Û˘ÓÔ‰Â‡ÂÙ·È ·fi Ê˘ÛÈÔÏÔÁÈÎ‹¤Î‚·ÛË, ÂÓÒ Ë ·Û‡ÌÌÂÙÚË Û˘ÓÔ‰Â‡ÂÙ·È ·fi ËÌÈ-ÏËÁ›·. ∂›ÛË˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ fiÔ˘ ˘¿Ú¯ÂÈ ÌÂ-Á¿ÏË Î·Ù·ÛÙÔÏ‹ ÙË˜ ‚·ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ‹ ÂÈ-ÎfiÓ· status epilepticus, ˘¿Ú¯ÂÈ ÊÙˆ¯‹ ÚfiÁÓˆÛË.

ÕÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (59-62) ¤‰ÂÈÍ·Ó ·ÚfiÌÔÈ· ·Ô-ÙÂÏ¤ÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙË-Ù·, ÂÓÒ ·Ú¿ÏÏËÏ· Û˘Û¯¤ÙÈÛ·Ó ÙËÓ ‡·ÚÍË ÌË Ê˘ÛÈÔÏÔÁÈÎÒÓ Ú˘ıÌÒÓ ÛÙÔ ∏∂° ÌÂ Î·Î‹ ¤Î‚·ÛË,ÂÓÒ ÙË ÁÚ‹ÁÔÚË Î·È Û·Ê‹ ‚ÂÏÙ›ˆÛË ÛÂ ‰È·‰Ô¯ÈÎ¿

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·7

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∏∂°, ÌÂ Â˘ÓÔ˚Î‹ ¤Î‚·ÛË. ∆ÂÏÂ˘Ù·›· ˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ‡ÛÂÈ˜ Ô˘ ‰Â›-

¯ÓÔ˘Ó Â˘ÓÔ˚Î¿ ·ÔÙÂÏ¤ÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙÔ˘ ÚÒÈÌÔ˘ CFM ÛÙ· ÙÂÏÂÈfiÌË-Ó· ÓÂÔÁÓ¿. ¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ (55,63,64) Ô˘¯ÚËÛÈÌÔÔ›ËÛ·Ó CFM Ì¤Û· ÛÙÈ˜ ÚÒÙÂ˜ 6 ÒÚÂ˜ÙË˜ ˙ˆ‹˜, ¤‰ÂÈÍ·Ó fiÙÈ ÛÙ·ıÂÚ¿ ·Û˘ÓÂ¯¤˜ ‹ ¯·ÌË-ÏÔ‡ ‰˘Ó·ÌÈÎÔ‡ CFM Û˘Ó‰˘¿˙ÂÙ·È ÌÂ Î·Î‹ ¤Î‚·ÛË,ÂÓÒ Ê˘ÛÈÔÏÔÁÈÎfi CFM Û˘Ó‰˘¿˙ÂÙ·È ÌÂ Ê˘ÛÈÔÏÔÁÈ-Î‹ ¤Î‚·ÛË.

∏ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙÔ˘ ∏∂° ÛÙ· ÚfiˆÚ· ÓÂÔ-ÁÓ¿ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÓÙÈÊ·ÙÈÎ‹. ª›· Û¯ÂÙÈÎ¿ÚfiÛÊ·ÙË ÌÂÏ¤ÙË (56) ¤‰ÂÈÍÂ fiÙÈ Ë ÂÈÌÔÓ‹ ·ÚÔ˘-Û›·˜ ÛÙÔ ∏∂°, ÌÂÙ¿ ÙÈ˜ 30-32 Â‚‰ÔÌ¿‰Â˜, ÂÈÎfiÓ·˜Ô˘ Ê˘ÛÈÔÏÔÁÈÎ¿ ·Ú·ÙËÚÂ›Ù·È ÛÂ ∏∫ 28-30 Â‚‰Ô-Ì¿‰ˆÓ, Â›Ó·È ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ ÁÈ· Î·Î‹ ¤Î‚·-ÛË. ∞˘Ùfi Èı·ÓÒ˜ ‰Â›¯ÓÂÈ fiÙÈ, ÂÎÙfi˜ ·fi ÙË ‚·ÛÈÎ‹‰Ú·ÛÙËÚÈfiÙËÙ·, ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏÂ˜ ·Ú¿ÌÂÙÚÔÈÔ˘ Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌÒÓÙ·È Î·Ù¿ ÙËÓ ÂÚÌËÓÂ›·ÙÔ˘ ∏∂° ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿.

¢‡Ô ÔÏ‡ ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ (65,66) ‰Â›¯ÓÔ˘ÓfiÙÈ ÙÔ CFM Â›Ó·È ÙÔ ›‰ÈÔ ·ÍÈfiÈÛÙÔ ÌÂ ÙÔ ∏∂° fiÛÔÓ·ÊÔÚ¿ ÛÙËÓ ÚÔÁÓˆÛÙÈÎ¿ ·Í›·. ∞˘Ùfi Î·ıÈÛÙ¿ ÙÔCFM ÔÏ‡ÙÈÌË ÙÂ¯ÓÈÎ‹ ÛÙ· ¯¤ÚÈ· ÙˆÓ ÓÂÔÁÓÔÏfiÁˆÓ.

¡Â˘ÚÔÊ˘ÛÈÔÏÔÁ›· ¶ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ (∂voked potentials) ∆· ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ (ÛˆÌ·ÙÔ·ÈÛıËÙÈÎ¿, ÔÙÈ-

Î¿ Î·È ·ÎÔ˘ÛÙÈÎ¿) Â›Ó·È ËÏÂÎÙÚÈÎ¤˜ ··ÓÙ‹ÛÂÈ˜ ÛÂÂ·ÓÂÈÏËÌÌ¤Ó· ÂÍˆÙÂÚÈÎ¿ ÂÚÂı›ÛÌ·Ù· Ô˘ ÌÔÚÂ›Ó· Â›Ó·È ÛˆÌ·ÙÔ·ÈÛıËÙÈÎ¿, ÔÙÈÎ¿ ‹ ·ÎÔ˘ÛÙÈÎ¿.∞ÔÙÂÏÔ‡Ó ·ÓÙÈÎÂÈÌÂÓÈÎ¤˜ ÌÂıfi‰Ô˘˜ ÂÎÙ›ÌËÛË˜ ÙË˜ÏÂÈÙÔ˘ÚÁÈÎ‹˜ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. Œ¯Ô˘ÓÙÔ ÌÂÁ¿ÏÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ Â›Ó·È ÌË ÂÂÌ‚·ÙÈÎ¤˜Î·È ÊıËÓ¤˜ Ì¤ıÔ‰ÔÈ, ·Ú¤¯Ô˘Ó Ì›· ·ÓÙÈÎÂÈÌÂÓÈÎ‹ÂÎÙ›ÌËÛË ÙˆÓ ÛˆÌ·ÙÔ·ÈÛıËÙÈÎÒÓ, ·ÎÔ˘ÛÙÈÎÒÓ Î·ÈÔÙÈÎÒÓ Ô‰ÒÓ, ¯ˆÚ›˜ ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ÓÂÔÁÓÔ‡.∂ÓÙÔ‡ÙÔÈ˜, Î¿ÔÈÂ˜ Â›Ó·È ¯ÚÔÓÔ‚fiÚÂ˜ Î·È ÌÂ ‰˘-ÛÎÔÏ›· ÛÙËÓ Î·Ù·ÁÚ·Ê‹, ÂÓÒ ÂÈÏ¤ÔÓ ‰ÂÓ ˘¿Ú-¯Ô˘Ó ·ÚÎÂÙ¿ Ê˘ÛÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó·. ∆ÂÏÂ˘Ù·›·, Ë‚ÂÏÙÈˆÌ¤ÓË ÌÂıÔ‰ÔÏÔÁ›· ¤¯ÂÈ ÂÈÙÚ¤„ÂÈ ÙË Û˘ÏÏÔ-Á‹ ÂÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ·fi Úfiˆ-Ú· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿.

O Û˘ÓÂ¯‹˜ ¤ÏÂÁ¯Ô˜ ÌÂ Ù· ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ÌÔÚÂ› Ó· ·Ú¿Û¯ÂÈ ÛËÌ·ÓÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜fiÛÔÓ ·ÊÔÚ¿ ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È ÌË Ê˘ÛÈÔÏÔÁÈÎ‹ˆÚ›Ì·ÓÛË ÙˆÓ ·ÈÛıËÙÈÎÒÓ Ô‰ÒÓ (sensorypathways). ∫¿ıÂ ‰È·Ù·Ú·¯‹ Ô˘ ‰˘ÓËÙÈÎ¿ ÂËÚÂ¿-˙ÂÈ ÙÈ˜ ·ÈÛıËÙÈÎ¤˜ Ô‰Ô‡˜, ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ÁÈ· ¯Ú‹-ÛË ÙˆÓ ÚÔÎÏËÙÒÓ ‰˘Ó·ÌÈÎÒÓ.

™ÙÂÏÂ¯È·›· ·ÎÔ˘ÛÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿(Auditory brainstem evoked responses)

∆· ÛÙÂÏÂ¯È·›· ·ÎÔ˘ÛÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿

Â›Ó·È È‰È·ÈÙ¤Úˆ˜ ¯Ú‹ÛÈÌ· ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙË˜·ÒÏÂÈ·˜ ·ÎÔ‹˜ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, .¯. ÛÙ·˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚfiˆÚ· ÓÂÔÁÓ¿, ÙËÓ ˘ÔÍÈÎ‹ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÙÈ˜ Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒ-ÍÂÈ˜, ÙÈ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ∫¡™, ÙÈ˜ ÎÚ·ÓÈÔÚÔÛˆÈÎ¤˜·ÓˆÌ·Ï›Â˜, ÙË ÌËÓÈÁÁ›ÙÈ‰·, ÙËÓ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·È-Ì›·, ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ¿ÏÏÔ˘˜·Ú¿ÁÔÓÙÂ˜.

∏ Î·Ï‡ÙÂÚË ËÏÈÎ›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ·ÎÔ‹˜ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚfiˆÚ· ÓÂÔÁÓ¿ Â›Ó·È Ë ËÏÈ-Î›· ÙˆÓ 40 Â‚‰ÔÌ¿‰ˆÓ ·fi ÙË Û‡ÏÏË„Ë ‹ ÚÈÓ ÙËÓ¤ÍÔ‰Ô ·fi ÙÔ ÙÌ‹Ì·, ‰ÈfiÙÈ Ù· ·ÎÔ˘ÛÙÈÎ¿ ÚÔÎÏËÙ¿‰˘Ó·ÌÈÎ¿ ÌÔÚÂ› Ó· Â›Ó·È ·ıÔÏÔÁÈÎ¿ ÛÙ· ÚfiˆÚ·fiÙ·Ó Á›ÓÔÓÙ·È ÓˆÚ›˜ ÙÈ˜ ÚÒÙÂ˜ Â‚‰ÔÌ¿‰Â˜ (ÚÈÓÙÈ˜ 36 Â‚‰ÔÌ¿‰Â˜), ÂÓÒ ·˘Ùfi Û˘Ó‹ıˆ˜ ‰ÂÓ ·Ú·-ÙËÚÂ›Ù·È fiÙ·Ó Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÛÂ Ï›ÁÂ˜ Â‚‰ÔÌ¿-‰Â˜ (67). ∆· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Î·Ïfi Â›Ó·È Ó· ÂÏ¤Á-¯ÔÓÙ·È ÚÈÓ ÙÔ˘˜ 3 Ì‹ÓÂ˜, ‰ÈfiÙÈ ÌÂÙ¿ Â›Ó·È ‰‡ÛÎÔÏÔÓ· ‰ÈÂÓÂÚÁËıÔ‡Ó ·ÎÔ˘ÛÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ÛÙË ‰È¿ÚÎÂÈ· Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‡ÓÔ˘.

∆· ·ÎÔ˘ÛÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ Â›Ó·È Ù· ÏÈÁfi-ÙÂÚÔ Î·Ù¿ÏÏËÏ· ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÓÂÔÁÓÒÓÔ˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ Î›Ó‰˘ÓÔ ÁÈ· ·Ó¿Ù˘ÍË ÓÂ˘ÚÔ·-Ó·Ù˘ÍÈ·Î‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ (68,69).

OÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ (Visual evokedpotentials, VEPs)

£ÂˆÚÔ‡ÓÙ·È Â‡ÎÔÏ· ÛÙË ¯Ú‹ÛË ÙÔ˘˜ Î·È ÛÙ·ÚfiˆÚ· ÓÂÔÁÓ¿. ∂›Ó·È ¯Ú‹ÛÈÌ· ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛËÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ‹ ¯ˆÚ›˜ Úfi‚ÏËÌ· ÛÙËÓ ˆÚ›Ì·ÓÛËÙˆÓ ÔÙÈÎÒÓ Ô‰ÒÓ. ™Â ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ÂÚÈÎÔÈ-ÏÈ·Î‹ Î˘ÛÙÈÎ‹ ÏÂ˘ÎÔÌ·Ï·Î›·, ·ıÔÏÔÁÈÎ¿ ÔÙÈÎ¿‰˘Ó·ÌÈÎ¿ ÚÔ‰ÈÎ¿˙Ô˘Ó Î·Î‹ fiÚ·ÛË. ∂ÓÙÔ‡ÙÔÈ˜, ‰ÂÓ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‰ÒÛÔ˘Ó ÚfiÁÓˆÛË fiÛÔÓ·ÊÔÚ¿ ÛÙËÓ ·ÒÙÂÚË ¤Î‚·ÛË (68). ™Ù· ÙÂÏÂÈfiÌËÓ·Á›ÓÔÓÙ·È Â˘¯ÂÚÒ˜ ·fi ÙË Á¤ÓÓËÛË Î·È ÌÂÙ¿. ¶Úfi-ÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ÙËÓ ÚÔÁÓˆÛÙÈÎ‹·Í›· ÙˆÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÚÔÎÏËÙÒÓ ‰˘Ó·ÌÈÎÒÓÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂ-Ê·ÏÔ¿ıÂÈ·, ‰È·›ÛÙˆÛ·Ó fiÙÈ, ÂÎ ÙˆÓ ÙÚÈÒÓ, Ù·ÔÙÈÎ¿ Î·È Ù· ÛˆÌ·ÙÔ·ÈÛıËÙÈÎ¿ Â›Ó·È ·ÍÈfiÈÛÙ·.¢ÂÓ ÈÛ¯‡ÂÈ fiÌˆ˜ ÙÔ ›‰ÈÔ Î·È ÁÈ· Ù· ·ÎÔ˘ÛÙÈÎ¿ ÚÔ-ÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ (70-73).

™ˆÌ·ÙÔ·ÈÛıËÙÈÎ¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ (Somato-sensory evoked potentials, SEPs)

∂›Ó·È ¯ÚÔÓÔ‚fiÚ· ‰È·‰ÈÎ·Û›· (·fi ÙÔ Ì¤ÛÔ Î·ÈÙÔ Ô›ÛıÈÔ ÎÓËÌÈ·›Ô ÓÂ‡ÚÔ). £ÂˆÚÂ›Ù·È fiÙÈ ¤¯Ô˘ÓÔÏ‡ Î·Ï‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·, ·ÎfiÌË Î·È ÛÙ· Úfi-ˆÚ· ÓÂÔÁÓ¿ (È‰È·›ÙÂÚ· ·fi ÙÔ Ô›ÛıÈÔ ÎÓËÌÈ·›ÔÓÂ‡ÚÔ). ∞˘Ùfi ·Ô‰›‰ÂÙ·È Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÈ-ÙÒÛÂÈ˜ ÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ÂËÚÂ¿˙Ô˘Ó Î˘Ú›ˆ˜ Ù· fi‰È· (.¯. ‰ÈÏËÁ›·) (74).∞ÓÙ›ıÂÙ·, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙÔ Ì¤ÛÔ ÓÂ‡ÚÔ ‰ÂÓÂ›Ó·È ÙfiÛÔ ·ÍÈfiÈÛÙ· (75,76).

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·8

™Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈÎ‹ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÛˆÌ·ÙÔ·ÈÛıËÙÈ-Î¿ ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Î·Ï‹¤Î‚·ÛË, ÂÓÒ Ù· ·ıÔÏÔÁÈÎ¿ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Î·Î‹(77). ™Ù· ›‰È· ÓÂÔÁÓ¿, Ì¤Û· ÛÙÈ˜ 6 ÚÒÙÂ˜ ÒÚÂ˜ ÙË˜˙ˆ‹˜, ÌÔÚÔ‡Ó (fiˆ˜ Î·È Ù· ÔÙÈÎ¿ ‰˘Ó·ÌÈÎ¿) Ó·‰ÒÛÔ˘Ó ·ÍÈfiÈÛÙË ÚfiÁÓˆÛË ÁÈ· Î·Î‹ ¤Î‚·ÛË (71-73). ™ÙÈ˜ 72 ÒÚÂ˜, Ë ÂÈ‰ÈÎfiÙËÙ· ·˘Í¿ÓÂÙ·È ÛÙÔ 93%.ªË Ê˘ÛÈÔÏÔÁÈÎ¿ ·Ú¯ÈÎ¿ ÛˆÌ·ÙÔ·ÈÛıËÙÈÎ¿ ‰˘Ó·ÌÈ-Î¿ Ú¤ÂÈ Ó· Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È, ‰ÈfiÙÈ fiÙ·Ó ÔÌ·ÏÔ-ÔÈÔ‡ÓÙ·È Ì¤Û· ÛÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÙË˜ ˙ˆ‹˜,Â›Ó·È ·ÎfiÌË Èı·Ó‹ Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ¤Î‚·ÛË.

§fiÁˆ ÙË˜ Èı·ÓfiÙËÙ·˜ ·ÓÂ‡ÚÂÛË˜ ÓÂ˘ÚÔÚÔÛÙ·-ÙÂ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ˘ÔÍÈÎ‹ ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ¤¯ÂÈ ÔÏ‡ ÌÂÁ¿-ÏË ÛËÌ·Û›· Ë ·Ó·ÁÓÒÚÈÛË ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘‚Ú›ÛÎÔÓÙ·È ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· Î·Î‹ ¤Î‚·ÛË,‰ÈfiÙÈ ÔÈ ·Ú¿ÁÔÓÙÂ˜ ·˘ÙÔ› Ú¤ÂÈ Ó· ¯ÔÚËÁËıÔ‡Ó Ì¤-Û· ÛÙÈ˜ 6 ÚÒÙÂ˜ ÒÚÂ˜ ÙË˜ ˙ˆ‹˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ·fi fiÏÂ˜ ÙÈ˜ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔ-ÁÈÎ¤˜ ÌÂıfi‰Ô˘˜ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ÙÔ ∏∂°, ÙÔ CFM Î·ÈÙ· SEPs ·Ú¤¯Ô˘Ó ÙÈ˜ Ï¤ÔÓ ·ÍÈfiÈÛÙÂ˜ ÏËÚÔÊÔ-Ú›Â˜ Á‡Úˆ ·fi ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ÔÚÂ›· ÙË˜ ˘ÔÍÈ-Î‹˜ ÈÛ¯·ÈÌÈÎ‹˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ Î·È ÙË˜ Â·Îfi-ÏÔ˘ıË˜ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹˜ ÂÍ¤ÏÈÍË˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Garland JS, Buck R, Leviton A. Effect of maternal

glycocorticoid exposure on risk of severe intraventricularhemorrhage in surfactant-treated preterm infants. J Pediatr1995;126:272-279.

2. Mercier CE, Soll RF. Clinical trials of natural surfactantextract in respiratory distress syndrome. Clin Perinatol1993;91:1083-1088.

3. LeFlore JL, Salhab WA, Broyles RS, Engle WD. Associationof antenatal and postnatal dexamethasone exposure withoutcomes in extremely low birth weight neonates. Pediatrics2002;110:275-279.

4. O’Shea TM, Doyle LW. Perinatal glucocorticoid therapy andneurodevelopmental outcome: an epidemiologicperspective. Semin Neonatol 2001;6:293-307.

5. Costeloe K, Hennessy E, Gibson AT, Marlow N, WilkinsonAR. The EPICure study: outcomes to discharge fromhospital for infants born at the threshold of viability.Pediatrics 2000;106:659-671.

6. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR.Neurologic and developmental disability after extremelypreterm birth. N Engl J Med 2000;343:378-384.

7. Hill ET, den Ouden AL, Bauer L, van den Oudenrijn C,Brand R, Verloove-Vanhorick SP. School performance atnine years of age in very premature and very low birthweight infants: perinatal risk factors and predictors at fiveyears of age. J Pediatr 1994;125:426-434.

8. Hack M, Wilson-Costello D, Friedman H, Taylor GH,Schluchter M, Fanaroff AA. Neurodevelopment andpredictors of outcomes of children with birth weights of less

than 1000 g: 1992-1995. Arch Pediatr Adolesc Med2000;154:725-731.

9. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, SteichenJJ et al. Neurodevelopmental and functional outcomes ofextremely low birth weight infants in the National Institute ofChild Health and Human Development Neonatal ResearchNetwork, 1993-1994. Pediatrics 2000;105:1216-1226.

10. Thomas A, Saint-Ann Dargassies S. Etudes neurologic surle nouveau-né et le jeune nourisson. Paris: Masson; 1952.

11. Thomas A, Chesni Y, Saint-Ann Dargassies S. Neurologicalexamination of the infant. Little Club Clin Dev Med, No 1.London: Medical Advisory Committee of the NationalSpastics Society; 1960.

12. Saint-Ann Dargassies S. Neurological development in full-term and premature neonate. Amsterdam: ExcerptaMedica; 1977.

13. Prechtl HFR. The neurological examination of the full-termnewborn infant: a manual for clinical use. 2nd ed. Clin DevMed, No 63. London: SIMP. Philadelphia: HeinemmanMedical; 1977.

14. Brazelton TB. Neonatal behavioral assessment scale. ClinDev Med, No 50. London: SIMP Heinemann Medical; 1973.

15. Dubowitz LM, Dubowitz V, Goldberg C. Clinical assessmentof gestational age in the newborn infant. J Pediatr1970;77:1-10.

16. Dubowitz LMS, Dubowitz V. The neurological assessmentof the preterm and full term newborn infant. Clin Dev MedNo 79. London: SIMP Heinemann Medical. Philadelphia:Lippincott; 1981.

17. Dubowitz LM, Dubowitz V, Palmer PG, Miller G, Fawer CL,Levene MI. Correlation of neurologic assessment in thepreterm newborn infant with outcome at one year. J Pediatr1984;105:452-456.

18. Mercuri E, Guzzetta A, Haataja L, Cowan F, Rutherford M,Counsell S et al. Neonatal neurological examination ininfants with hypoxic ischaemic encephalopathy: correlationwith MRI findings. Neuropediatrics 1999;30:83-89.

19. Dubowitz L, Mercuri E, Dubowitz V. An optimality score forthe neurologic examination of the term newborn. J Pediatr1998;133:406-416.

20. Frisone MF, Mercuri E, Laroche S, Foglia C, Maalouf EF,Haataja L et al. Prognostic value of the neurologic optimalityscore at 9 and 18 months in preterm infants born before 31weeks’ gestation. J Pediatr 2002;140:57-60.

21. Cioni G, Prechtl HF. Preterm and early postterm motorbehavior in low-risk premature infants. Early Hum Dev1990;23:159-191.

22. Cioni G, Bos AF, Einspieler C, Ferrari F, Martijn A, PaolicelliPB et al. Early neurological signs in preterm infants withunilateral intraparenchymal echodensity. Neuropediatrics2000;31:240-251.

23. Bos AF, Martijn A, Okken A, Prechtl HF. Quality of generalmovements in preterm infants with transient periventricularechodensities. Acta Paediatr 1998;87:233-234.

24. Hack M, Mostow A, Miranda SB. Development of attentionin preterm infants. Pediatrics 1976;58:669-674.

25. Fujimoto S, Togari H, Banno T, Takashima S, Funato M,Yoshioka H et al. Correlation between magnetic resonance


9

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·9

10


imaging and clinical profiles of periventricular leukomalacia.Tohoku J Exp Med 1999;188:143-151.

26. Volpe JJ. Neonatal Neurology. 3rd ed. Philadelphia:Saunders; 1995.

27. Gould SJ, Howard S, Hope PL, Reynolds EO.Periventricular intraparenchymal cerebral haemorrhage inpreterm infants: the role of venous infarction. J Pathol1987;151:197-202.

28. de Vries LS, Roelants-van Rijn AM, Rademaker KJ, VanHaastert IC, Beek FJ, Groenendaal F. Unilateralparenchymal haemorrhagic infarction in the preterm infant.Eur J Paediatr Neurol 2001;5:139-149.

29. de Vries LS, Eken P, Dubowitz LM. The spectrum ofleukomalacia using cranial ultrasound. Behav Brain Res1992;49:1-6.

30. de Vries LS, Dubowitz LMS, Dubowitz V, Pennock JM. Braindisorders in the newborn. London: Wolfe Medical; 1990.

31. Roth SC, Baudin J, Pezzani-Goldsmith M, Townsend J,Reynolds EO, Stewart AL. Relation betweenneurodevelopmental status of very preterm infants at oneand eight years. Dev Med Child Neurol 1994;36:1049-1062.

32. Randomised trial of early tapping in neonatalposthaemorrhagic ventricular dilatation. VentriculomegalyTrial Group. Arch Dis Child 1990;65:3-10.

33. Fernell E, Hagberg G, Hagberg B. Infantile hydrocephalusin preterm, low-birth-weight infants: a nationwide Swedishcohort study 1979-1988. Acta Paediatr 1993;82:45-48.

34. Blackman JA, McGuinness GA, Bale JF Jr, Smith WL Jr.Large postnatally acquired porencephalic cysts:unexpected developmental outcomes. J Clin Neurol1991;6:58-64.

35. de Vries LS, Eken P, Groenendaal F, van Haastert IC,Meiners LC. Correlation between the degree ofperiventricular leukomalacia diagnosed using cranialultrasound and MRI later in infancy in children with cerebralpalsy. Neuropediatrics 1993;24:263-268.

36. Fazzi E, Orcesi S, Caffi L, Ometto A, Rondini G, Telesca Cet al. Neurodevelopmental outcome at 5-7 years in preterminfants with periventricular leukomalacia. Neuropediatrics1994;25:134-139.

37. Rogers B, Msall M, Owens T, Guernsey K, Brody A, Buck Get al. Cystic periventricular leukomalacia and type ofcerebral palsy in preterm infants. J Pediatr 1994;125:S1-8.

38. Cioni G, Fazzi B, Ipata AE, Canapicchi R, van Hof-van DuinJ. Correlation between cerebral visual impairment and MRimaging in children with neonatal encephalopathy. DevMed Child Neurol 1996;38:120-132.

39. Pierrat V, Duquennoy C, van Haastert IC, Ernst M, Guilley N,de Vries LS. Ultrasound diagnosis and neurodevelopmentaloutcome of localised and extensive cystic periventricularleukomalacia. Arch Dis Child Fetal Neonatal Ed2001;84:F151-F156.

40. Dubowitz LM, Bydder GM. Nuclear magnetic resonanceimaging in the diagnosis and follow-up of neonatal cerebralinjury. Clin Perinatol 1985;12:243-260.

41. Dubowitz LM, Bydder GM, Mushin J. Developmentalsequence of periventricular leukomalacia. Correlation ofultrasound, clinical, and nuclear magnetic resonancefunctions. Arch Dis Child 1985;60:349-355.

42. Rutherford MA, Pennock JM, Dubowitz LM. Cranialultrasound and magnetic resonance imaging in hypoxic-ischaemic encephalopathy: a comparison with outcome.Dev Med Child Neurol 1994;36:813-825.

43. Rutherford MA, Pennock JM, Counsell SJ, Mercuri E,Cowan FM, Dubowitz LM et al. Abnormal magneticresonance signal in the internal capsule predicts poorneurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy. Pediatrics 1998;102:323-328.

44. de Vries LS, Groenendaal F, van Haastert IC, Eken P,Rademaker KJ, Meiners LC. Asymmetrical myelination ofthe posterior limb of the internal capsule in infants withperiventricular haemorrhagic infarction: an early predictor ofhemiplegia. Neuropediatrics 1999;30:314-319.

45. Dubowitz LM, Cowan F, Rutherford M, Mercuri E, PennockJ. Neonatal neurology, past present and future. A windowon the brain. Brain Dev 1995;17 (Suppl):22-30.

46. Mercuri E, Rutherford M, Cowan F, Pennock J, Counsell S,Papadimitriou M et al. Early prognostic indicators ofoutcome in infants with neonatal cerebral infarction: aclinical, electroencephalogram, and magnetic resonanceimaging study. Pediatrics 1999;103:39-46.

47. Azzopardi D, Wyatt JS, Cady EB, Delpy DT, Baudin J,Stewart AL et al. Prognosis of newborn infants with hypoxic-ischemic brain injury assessed by phosphorus magneticresonance spectroscopy. Pediatr Res 1989;25:445-451.

48. Moorcraft J, Bolas NM, Ives NK, Sutton P, Blackledge MJ,Rajagopalan B et al. Spatially localized magnetic resonancespectroscopy of the brains of normal and asphyxiatednewborns. Pediatrics 1991;87:273-282.

49. Peden CJ, Cowan FM, Bryant DJ, Sargentoni J, Cox IJ,Menon DK et al. Proton MR spectroscopy of the brain ininfants. J Comput Assist Tomogr 1990;14:886-894.

50. Amess PN, Penrice J, Wylezinska M, Lorek A, Townsend J,Wyatt JS et al. Early brain proton magnetic resonancespectroscopy and neonatal neurology related toneurodevelopmental outcome at 1 year in term infants afterpresumed hypoxic-ischaemic brain injury. Dev Med ChildNeurol 1999;41:436-445.

51. Barkovich AJ, Baranski K, Vigneron D, Partridge JC, HallamDK, Hajnal BL et al. Proton MR spectroscopy for theevaluation of brain injury in asphyxiated, term neonates.AJNR Am J Neuroradiol 1999;20:1399-1405.

52. McMenamin JB, Volpe JJ. Doppler ultrasonography in thedetermination of neonatal brain death. Ann Neurol1983;14:302-307.

53. Archer LN, Levene MI, Evans DH. Cerebral artery Dopplerultrasonography for prediction of outcome after perinatalasphyxia. Lancet 1986;2:1116-1118.

54. Levene MI, Fenton AC, Evans DH, Archer LN, Shortland DB,Gibson NA. Severe birth asphyxia and abnormal cerebralblood-flow velocity. Dev Med Child Neurol 1989;31:427-434.

55. Eken P, Toet MC, Groenendaal F, de Vries LS. Predictivevalue of early neuroimaging, pulsed Doppler andneurophysiology in full term infants with hypoxic-ischaemicencephalopathy. Arch Dis Child Fetal Neonatal Ed1995;73:F75-F80.

56. Biagioni E, Bartalena L, Boldrini A, Cioni G, Giancola A,

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·10

Ipata AE. Background EEG activity in preterm infants:correlation of outcome with selected maturational features.Electroencephalogr Clin Neurophysiol 1994;91:154-162.

57. Connell JA, Oozeer R, Dubowitz V. Continuous 4-channelEEG monitoring: a guide to interpretation, with normalvalues, in preterm infants. Neuropediatrics 1987;18:138-145.

58. Wertheim D, Mercuri E, Faundez JC, Rutherford M, AcoletD, Dubowitz L. Prognostic value of continuouselectroencephalographic recording in full term infants withhypoxic-ischaemic encephalopathy. Arch Dis Child1994;71:F97-102.

59. Biagioni E, Boldrini A, Bottone U, Pieri R, Cioni G.Prognostic value of abnormal EEG transients in preterminfants and full-term neonates. Electroencephalogr ClinNeurophysiol 1996;99:1-9.

60. Biagioni E, Bartalena L, Biver P, Pieri R, Cioni G.Electroencephalographic dysmaturity in preterm infants: aprognostic tool in the early postnatal period.Neuropediatrics 1996;27:1-6.

61. Pinto LC, Giliberti P. Neonatal seizures: background EEGactivity and the electroclinical correlation in full-termneonates with hypoxic-ischaemic encephalopathy. Analysisby computer-synchronized long-term polygraphic video-EEG monitoring. Epileptic Disord 2001;3:125-132.

62. Zeinstra E, Fock JM, Begeer JH, van Weerden TW, MauritsNM, Zweens MJ. The prognostic value of serial EEGrecordings following acute neonatal asphyxia in full-terminfants. Eur J Paediatr Neurol 2001;5:155-160.

63. Hellstrom-Westas L, Rosen I, Svenningsen NW. Predictivevalue of early continuous amplitude integrated EEGrecordings on outcome after severe birth asphyxia in full terminfants. Arch Dis Child Fetal Neonatal Ed 1995;72:F34-F38.

64. al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D.Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics 1999;103:1263-1271.

65. Murdoch-Eaton D, Darowski M, Livingston J. Cerebralfunction monitoring in paediatric intensive care: usefulfeatures for predicting outcome. Dev Med Child Neurol2001;43:91-96.

66. Toet MC, van der Meij W, de Vries LS, Uiterwaal CS, vanHuffelen KC. Comparison between simultaneouslyrecorded amplitude integrated electroencephalogram(cerebral function monitor) and standard electroence-phalogram in neonates. Pediatrics 2002;109:772-779.

67. Stockard JE, Stockard JJ, Kleinberg F, Westmoreland BF.

Prognostic value of brainstem auditory evoked potentials inneonates. Arch Neurol 1983;40:360-365.

68. Beverley DW, Smith IS, Beesley P, Jones J, Rhodes N.Relationship of cranial ultrasonography, visual and auditoryevoked responses with neurodevelopmental outcome. DevMed Child Neurol 1990;32:210-222.

69. Guinard C, Fawer CL, Despland PA, Calame A. Auditorybrainstem responses and ultrasound changes in a high-riskinfants population. Helv Paediatr Acta 1989;43:377-388.

70. de Vries LS, Eken P, Pierrat V, Daniels H, Casaer P.Prediction of neurodevelopmental outcome in the preterminfant: short latency cortical somatosensory evokedpotentials compared with cranial ultrasound. Arch Dis Child1992;67:1177-1181.

71. Taylor MJ, Murphy WJ, Whyte HE. Prognostic reliability ofsomatosensory and visual evoked potentials of asphyxiatedterm infants. Dev Med Child Neurol 1992;34:507-515.

72. Majnemer A, Rosenblatt B. Evoked potentials as predictorsof outcome in neonatal intensive care unit survivors: reviewof the literature. Pediatr Neurol 1996;14:189-195.

73. Scalais E, Francois-Adant A, Nuttin C, Bachy A, Guerit JM.Multimodality evoked potentials as a prognostic tool in termasphyxiated newborns. Electroencephalogr ClinNeurophysiol 1998;108:199-207.

74. White CP, Cooke RW. Somatosensory evoked potentialsfollowing posterior tibial nerve stimulation predict latermotor outcome. Dev Med Child Neurol 1994;36:34-40.

75. Pierrat V, Eken P, Duquennoy C, Rousseau S, de Vries LS.Prognostic value of early SEP in neonates with cysticleukomalacia. Dev Med Child Neurol 1993;35:683-690.

76. Ekert PG, Taylor MJ, Keenan NK, Boulton JE, Whyte HE.Early somatosensory evoked potentials in preterm infants:their prognostic utility. Biol Neonate 1997;71:83-91.

77. de Vries LS, Pierrat V, Eken P, Minami T, Daniels H, CasaerP. Prognostic value of early somatosensory evokedpotentials for adverse outcome in full-term infants with birthasphyxia. Brain Dev 1991;13:320-325.


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Polyunsaturated fatty acids in infant nutrition M. Mavrocosta, I. Charoniti, E. Kokori

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

�¶ÂÚ›ÏË„Ë: ∆· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ì·ÎÚ¿˜·Ï‡ÛÔ˘ (LC-PUFAs), Î˘Ú›ˆ˜ ÙÔ ÓÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi ÔÍ‡(DHA) Î·È ÙÔ ·Ú·¯È‰ÔÓÈÎfi ÔÍ‡ (AA) Ô˘ ÂÚÈ¤¯ÔÓÙ·ÈÛÙÔ ·ÓıÚÒÈÓÔ, ·ÏÏ¿ fi¯È ÛÙÔ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï··ÁÂÏ¿‰·˜, ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÛÙÔÈ¯Â›·ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜.¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÈÛ¯˘Ú¿ ÏÂÔÓÂÎÙ‹Ì·Ù·ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, Î·ıÒ˜ Î·È ÙÔ˘ ÂÌÏÔ˘ÙÈ-ÛÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ÌÂ LC-PUFAs ¤Ó·ÓÙÈ ÙÔ˘ ÙÚÔÔÔÈ-ËÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜, Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·Ó¿Ù˘ÍË ÙË˜ ‰È·-ÓÔËÙÈÎ‹˜ Î·È ÔÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜. ∆· Ì·ÎÚÔÚfiıÂÛÌ··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ¯ÔÚ‹ÁËÛË˜ LC-PUFAs ÛÂ ÓÂÔÁÓ¿Î·È ‚Ú¤ÊË Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ó·Ï˘ıÔ‡Ó, ÏfiÁˆ ÙˆÓ‰˘ÛÎÔÏÈÒÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÔÙÈÎ‹˜Î·È ‰È·ÓÔËÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ ÛÙ· ·È‰È¿. ¶¿ÓÙˆ˜, ÔÈÌ¤¯ÚÈ ÙÒÚ· ÌÂÏ¤ÙÂ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈÎ¿ ÏÂÔ-ÓÂÎÙ‹Ì·Ù· ÙË˜ ¯ÔÚ‹ÁËÛË˜ LC-PUFAs ÛÙËÓ ·Ó¿Ù˘-ÍË, È‰È·›ÙÂÚ· ÙˆÓ ÚfiˆÚˆÓ ‚ÚÂÊÒÓ. º˘ÛÈÎ¿ ‰ÂÓ ÏÂ›-Ô˘Ó Î·È ÔÈ ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÛÊ¿ÏÂÈ·ÙˆÓ LC-PUFAs. ∏ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÌÔÚÂ› Ó· ¤¯ÂÈ Û¯¤-ÛË ÌÂ ¯·ÌËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÛÂ ÌÂ-ÙÚ‹ÛÂÈ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ ÙË˜ ˙ˆ-‹˜ ‹ ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÔÍÂÈ‰ˆÙÈÎ¤˜ ‚Ï¿‚Â˜. OÚfiÏÔ˜ ÙˆÓ LC-PUFAs ÛÙËÓ ÂÌ‚Ú˘˚Î‹ Î·È ‚ÚÂÊÈÎ‹·Ó¿Ù˘ÍË ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓÔ˜ Î·È ‰ÂÓ˘¿Ú¯ÂÈ ·ÎfiÌË ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ÙË˜ È‰·ÓÈÎ‹˜ ·Ó·ÏÔÁ›·˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜. °È· ·˘ÙÔ‡˜ÙÔ˘˜ ÏfiÁÔ˘˜ ··ÈÙÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ì·ÎÚ¿˜·Ï‡ÛÔ˘, ÓÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi ÔÍ‡, ·Ú·¯È‰ÔÓÈÎfi ÔÍ‡, ÏÈ-ÓÔÏÂ˚Îfi ÔÍ‡, ·-ÏÈÓÔÏÂÓÈÎfi ÔÍ‡, ˆ-3 ÏÈ·Ú¿ ÔÍ¤·, ˆ-6 ÏÈ·Ú¿ ÔÍ¤·.

�Abstract: LC-PUFAs, especially DHA and AA, arecontained in breast milk but not in infant formulas.They are important components of the brain andretina. Many studies have demonstrated advantagesof breastfeeding and of the supplemented with LC-PUFAs milk versus the unsupplemented formulas onsubsequent cognitive and visual function. The longterm effects of the supplementation with LC-PUFAscan not be evaluated properly, because of thedifficulty in assessing the visual and the cognitivefunction in children. Most of the studies however,demonstrate significant advantages of LC-PUFAssupplementation in infant growth, especially inpremature infants. There are several concernsregarding the safety of LC-PUFAs supplements. Thesupplementation with LC-PUFAs may be related toreduced weight gain during the first year of life orincreased risk for oxidant damage. The role of LC-PUFAs in fetal and infant growth is not completelyclarified; moreover there is no reliable method toevaluate the optimal proportions of DHA and AA tobe taken. More studies are required so as toascertain the role and the ideal intake of LC-PUFAs ininfants’ diet.

Key words: long chain polyunsaturated fatty acids,linoleic acid, a-linolenic acid, docosahexaenoidacid, n-3 fatty acids, n-6 fatty acids.

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, µÂÓÈ˙¤ÏÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘ ∫Ú‹ÙË˜

1st Pediatric Clinic, Venizelion Hospital of Heraklion, Crete

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·12

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ LC-PUFAs ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ì·ÎÚ¿˜

·Ï‡ÛÔ˘ LA §ÈÓÔÏÂ˚Îfi ÔÍ‡ ALA ·-ÏÈÓÔÏÂÓÈÎfi ÔÍ‡ AA ∞Ú·¯È‰ÔÓÈÎfi ÔÍ‡ DHA ¡ÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi ÔÍ‡ §O §È·Ú¿ ÔÍ¤· ∫¡™ ∫ÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·

∂ÈÛ·ÁˆÁ‹∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙÔ ÂÓ‰È·Ê¤ÚÔÓ ÙˆÓ ÂÚÂ˘-

ÓËÙÒÓ ¤¯ÂÈ ÂÛÙÈ·ÛÙÂ› ÛÙËÓ ÚÔÛı‹ÎË LC-PUFAsÙˆÓ ÔÌ¿‰ˆÓ ˆ-3 Î·È ˆ-6 ÛÙ· ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·-Ù· ·ÁÂÏ¿‰·˜. ∏ ·ÚÔ˘Û›· ÙˆÓ LC-PUFAs ÛÙÔ ÌË-ÙÚÈÎfi Á¿Ï· Î·È fi¯È ÛÙ· ÙÚÔÔÔÈËÌ¤Ó·, ÛÂ Û˘Ó‰˘·-ÛÌfi ÌÂ ˘„ËÏfiÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÂ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·-Î¤˜ ‰ÔÎÈÌ·Û›Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÙÚ¤ÊÔÓÙ·Ó ÌÂ ÌË-ÙÚÈÎfi Á¿Ï·, ¤¯ÂÈ Û˘ÁÎÂÓÙÚÒÛÂÈ ÙËÓ ÚÔÛÔ¯‹ ÛÙËÛËÌ·Û›· ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ÔÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘ ∫¡™. °È· ÙÔÓ ·ÓıÚÒ-ÈÓÔ ÔÚÁ·ÓÈÛÌfi, Ù· ÏÈ›‰È· ·ÔÙÂÏÔ‡Ó ‚·ÛÈÎ‹ ËÁ‹ÂÓ¤ÚÁÂÈ·˜ Î·È Î‡ÚÈ· ‰ÔÌÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ ÈÛÙÒÓ.∆· ÏÈ·Ú¿ ÔÍ¤· ·ÔÙÂÏÔ‡ÓÙ·È ·fi ·ÓıÚ·ÎÈÎ¤˜·Ï˘Û›‰Â˜, Ù· ¿ÎÚ· ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ Â›Ó·È ¯ËÌÈÎÒ˜fiÌÔÈ· ÌÂÙ·Í‡ ÙÔ˘˜. ™ÙÔ ¤Ó· ¿ÎÚÔ Û˘Ó‰¤ÂÙ·È Ì›·Î·Ú‚ÔÍ˘ÏÈÎ‹ ÔÌ¿‰· (-COOH), ÂÓÒ ÛÙÔ ¿ÏÏÔ ¿ÎÚÔ¤Ó· ÌÂı‡ÏÈÔ (-CH3). ∆Ô ÙÂÏÂ˘Ù·›Ô ÔÓÔÌ¿˙ÂÙ·È ˆ-¿ÎÚÔ. ¶ÔÏ˘·ÎfiÚÂÛÙ· ÔÓÔÌ¿˙ÔÓÙ·È ·˘Ù¿ Ô˘ ¤¯Ô˘Ó‰‡Ô ¤ˆ˜ ¤ÍÈ ‰ÈÏÔ‡˜ ‰ÂÛÌÔ‡˜. ∞Ó¿ÏÔÁ· ÌÂ ÙË ı¤ÛËÙÔ˘ ÚÒÙÔ˘ ‰ÈÏÔ‡ ‰ÂÛÌÔ‡ ˆ˜ ÚÔ˜ ÙÔ ˆ-¿ÎÚÔ,‰È·ÎÚ›ÓÔÓÙ·È ÛÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÔÌ¿‰Â˜: ˆ-3, ˆ-6, ˆ-9 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·. ª·ÎÚ¿˜ ·Ï‡ÛÔ˘ Ï¤-ÁÔÓÙ·È Ù· ÏÈ·Ú¿ ÔÍ¤· Ô˘ ¤¯Ô˘Ó ¿Ï˘ÛÔ ÌÂ ¿Óˆ·fi 18 ¿ÙÔÌ· ¿ÓıÚ·Î·. ∆Ô ÏÈÓÔÏÂ˚Îfi (LA) (∂ÈÎfiÓ·1) Î·È ÙÔ ·-ÏÈÓÔÏÂÓÈÎfi (ALA) (∂ÈÎfiÓ· 2) ¯·Ú·ÎÙËÚ›-˙ÔÓÙ·È ˆ˜ ··Ú·›ÙËÙ· ÏÈ·Ú¿ ÔÍ¤·, ÁÈ·Ù› ‰ÂÓ Û˘-ÓÙ›ıÂÓÙ·È ·fi ÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi Î·È Ú¤ÂÈ

Ó· Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙÈ˜ ÙÚÔÊ¤˜. ¶ÚfiÎÂÈÙ·È ÁÈ· Ô-Ï˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·, Ô˘ ÌÔÚÔ‡Ó Ó· ÌÂÙ·-ÙÚ·Ô‡Ó ÌÂ Ì›· ÛÂÈÚ¿ ·ÓÙÈ‰Ú¿ÛÂˆÓ ÛÂ ÏÈ·Ú¿ ÔÍ¤·Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘. ™˘ÓÂÒ˜, Ë Û‡ÓıÂÛË ÙˆÓ LC-PUFAs ÂÍ·ÚÙ¿Ù·È ·fi ÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ Úfi-‰ÚÔÌˆÓ ÂÓÒÛÂˆÓ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. ∂›ÛË˜, Ë ·Ó·-ÏÔÁ›· ÙÔ˘ ÏÈÓÔÏÂ˚ÎÔ‡ ÚÔ˜ ÙÔ ·-ÏÈÓÔÏÂÓÈÎfi ÔÍ‡·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ÁÈ· ÙËÓ ÈÛÔÚÚÔ›·ÙˆÓ LC-PUFAs ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi.

∆· LC-PUFAs ·ÔÙÂÏÔ‡Ó ËÁ‹ ÂÓ¤ÚÁÂÈ·˜ ÁÈ·ÙÔÓ ÔÚÁ·ÓÈÛÌfi Î·È Úfi‰ÚÔÌÂ˜ ÂÓÒÛÂÈ˜ ÁÈ· ÙËÓÔÌ¿‰· ÙˆÓ ÂÈÎÔÛ·ÓÔÂÈ‰ÒÓ (ÚÔÛÙ·ÁÏ·Ó‰›ÓÂ˜, ÚÔ-ÛÙ·Î˘ÎÏ›ÓÂ˜, ıÚÔÌ‚ÔÍ¿ÓÂ˜ Î·È ÏÂ˘ÎÔÙÚÈ¤ÓÂ˜).

∂ÈÏ¤ÔÓ, Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ì·-ÎÚ¿˜ ·Ï‡ÛÔ˘ ·ÔÙÂÏÔ‡Ó ‚·ÛÈÎfi ‰ÔÌÈÎfi ÛÙÔÈ¯Â›ÔÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ, fiÔ˘ ˘¿Ú¯Ô˘Ó Î˘-Ú›ˆ˜ ÛÂ ÌÔÚÊ‹ ÊˆÛÊÔÏÈÈ‰›ˆÓ. ∂È‰ÈÎfiÙÂÚ·, Ù· Êˆ-ÛÊÔÏÈ›‰È· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜Î·È ÙÔ˘ ·ÌÊÈ‚ÏÈÛÙÚÔÂÈ‰Ô‡˜ ¯ÈÙÒÓ· Â›Ó·È È‰È·›ÙÂÚ·ÏÔ‡ÛÈ· ÛÂ ‰‡Ô LC-PUFAs, ÛÙÔ ·Ú·¯È‰ÔÓÈÎfi ÔÍ‡(AA, ˆ-6 ÔÏ˘·ÎfiÚÂÛÙÔ ÏÈ·Úfi ÔÍ‡ Ì·ÎÚ¿˜ ·Ï‡-ÛÔ˘) (∂ÈÎfiÓ· 3) Î·È ÛÙÔ ÓÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi ÔÍ‡(DHA, ˆ-3 ÔÏ˘·ÎfiÚÂÛÙÔ ÏÈ·Úfi ÔÍ‡ Ì·ÎÚ¿˜ ·Ï‡-ÛÔ˘) (∂ÈÎfiÓ· 4). ™ÙÔ˘˜ ÈÛÙÔ‡˜ ·˘ÙÔ‡˜, ÙÔ LA Î·È∞LA ÂÚÈ¤¯ÔÓÙ·È ÛÂ ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜. ∆Ô DHA Â›-Ó·È ÙÔ Î‡ÚÈÔ ˆ-3 ÏÈ·Úfi ÔÍ‡ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ ÈÛÙÔ‡ Î·È·ÔÙÂÏÂ› ÙÔ 40% ÙˆÓ ÔÏÈÎÒÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙÈ˜ÌÂÌ‚Ú¿ÓÂ˜ ÙˆÓ ÊˆÙÔ¸Ô‰Ô¯¤ˆÓ ÙÔ˘ ·ÌÊÈ‚ÏÈÛÙÚÔ-ÂÈ‰Ô‡˜. ∆Ô ∞∞ Â›Ó·È ÙÔ Î‡ÚÈÔ ˆ-6 ÏÈ·Úfi ÔÍ‡ ÙÔ˘ÓÂ˘ÚÈÎÔ‡ ÈÛÙÔ‡ Î·È ·ÔÙÂÏÂ› Úfi‰ÚÔÌË ¤ÓˆÛË ÁÈ·ÙË Û‡ÓıÂÛË ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, ÏÂ˘ÎÔÙÚÈÂÓ›ˆÓ Î·È¿ÏÏˆÓ ÂÈÎÔÛ·ÓÔÂÈ‰ÒÓ (1).

∆Ô ∞∞ ÌÔÚÂ› Â‡ÎÔÏ· Ó· Û˘ÓÙÂıÂ› ·fi LA. ¶Úfi-ÎÂÈÙ·È ÁÈ· ÙÔ Û˘¯ÓfiÙÂÚ· ··ÓÙÒÌÂÓÔ LC-PUFA ÙË˜‰È·ÙÚÔÊ‹˜. ∏ Û‡ÓıÂÛË ÙÔ˘ DHA ·fi ÙÔ ∞LA Ú·Á-Ì·ÙÔÔÈÂ›Ù·È ÌÂ ÈÔ ÂÚ›ÏÔÎÂ˜ ·Ó·‚ÔÏÈÎ¤˜ ‰ÈÂÚÁ·-Û›Â˜, Ë ·Ô‰ÔÙÈÎfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ì¿ÏÏÔÓ ÌÂÈ-ˆÌ¤ÓË Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜ (2,3).


13

CH3-CH2-CH2-CH2-CH2-CH=CH-CH2-CH=CH-CH2-CH2-CH2-CH2-CH2-CH2-CH2-COOH

∂ÈÎfiÓ· 1. §ÈÓÔÏÂ˚Îfi ÔÍ‡ (C 18:2 ˆ-6).

CH3-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH2-CH2-CH2-CH2-CH2-CH2-COOH

∂ÈÎfiÓ· 2. ·-§ÈÓÔÏÂÓÈÎfi ÔÍ‡ (C 18:3 ˆ-3).

CH3-CH2-CH2-CH2-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH2-CH2-COOH

∂ÈÎfiÓ· 3. ∞Ú·¯È‰ÔÓÈÎfi ÔÍ‡ (C 20:4 ˆ-6).

CH3-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH=CH-CH2-CH2-COOH

∂ÈÎfiÓ· 4. ¡ÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi ÔÍ‡ (C 22:6 ˆ-3).

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·13

ª¤¯ÚÈ Û‹ÌÂÚ·, Ù· ÂÚÈÛÛfiÙÂÚ· ÙÚÔÔÔÈËÌ¤Ó·Á¿Ï·Ù·, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ ÌËÙÚÈÎfi Á¿Ï·, ÂÚÈÂ›¯·ÓÌfiÓÔ Ù· ··Ú·›ÙËÙ· ÏÈ·Ú¿ ÔÍ¤·. ™‹ÌÂÚ·, ¤¯ÂÈ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ LC-PUFAs ÛÙÔÏ¿ÛÌ·, ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓ ÂÚ˘ıÚÒÓ Î·È ÛÙÔ ÊÏÔÈfiÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È ÌÂÈˆÌ¤ÓÂ˜ ÛÙ· ·È‰È¿ Ô˘ ÛÈ-Ù›˙ÔÓÙ·È ÌÂ ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·Ù· ¯ˆÚ›˜ ÚÔÛı‹-ÎË LC-PUFAs, ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¤˜ Ô˘ ··ÓÙÒÓÙ·ÈÛÙ· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ‹ ÛÙ· ‚Ú¤ÊË Ô˘ ÛÈÙ›˙ÔÓÙ·ÈÌÂ ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·Ù· ÛÙ· ÔÔ›· ¤¯Ô˘Ó ÚÔ-ÛÙÂıÂ› LC-PUFAs (4). ∞Ó Î·È ÌÂÏ¤ÙÂ˜ ÌÂ ÛÙ·ıÂÚ¿ÈÛfiÙÔ· ‰Â›¯ÓÔ˘Ó fiÙÈ ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ‚Ú¤-ÊË ÌÔÚÔ‡Ó Ó· ÌÂÙ·ÙÚ¤„Ô˘Ó LA ÛÂ AA Î·È ALA ÛÂDHA, Ù· ÂÓ˙˘ÌÈÎ¿ Û˘ÛÙ‹Ì·Ù· (·ÔÎ·Ú‚ÔÍ˘Ï¿ÛËÎ·È ÚÔÛıÂÙ¿ÛË) Ô˘ ÌÂÙ·ÙÚ¤Ô˘Ó Ù· ··Ú·›ÙËÙ·ÏÈ·Ú¿ ÔÍ¤· (§O) ÏÈÓÔÏÂ˚Îfi Î·È ÏÈÓÔÏÂÓÈÎfi ÛÂ LC-PUFAs Â›Ó·È Ì¿ÏÏÔÓ ·ÓÂ·ÚÎ‹ Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜ (5,6).

¢ÂÓ Â›Ó·È ÂÈ‚Â‚·ÈˆÌ¤ÓÔ ·Ó Ë Û¯ÂÙÈÎ‹ ·ÓÂ¿Ú-ÎÂÈ· ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ ÛÙ· ÛÈÙÈ˙fiÌÂ-Ó· ÌÂ ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·Ù· ‚Ú¤ÊË, ÛÂ Ì›· ÎÚ›ÛÈ-ÌË ËÏÈÎ›· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ¤¯ÂÈÛËÌ·ÓÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ Û˘Ó¤ÂÈÂ˜. ™˘ÁÎÚÈÙÈÎ¤˜ÌÂÏ¤ÙÂ˜ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ¤Ó·-ÓÙÈ ÙÚÔÔÔÈËÌ¤ÓÔ˘ Á¿Ï·ÙÔ˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· LC-PUFAs, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ·ÎÚÈ‚¤˜ ·ÔÙ¤ÏÂ-ÛÌ·, ÁÈ·Ù› ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÂÈ ÔÏÏÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜ ÂÎÙfi˜ ÙˆÓ LC-PUFAs Ô˘ ÌÔÚÂ› Ó· ÂË-ÚÂ¿˙Ô˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÔÙÈÎÔ‡ ÊÏÔÈÔ‡ Î·È ÙÔ˘∫¡™. ŒÙÛÈ, ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ Û˘ÁÎÚ›ÓÔ˘ÓÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ‰È·ÙÚÔÊ‹˜ ÌÂ ÙÚÔÔÔÈËÌ¤-ÓÔ Á¿Ï· ÌÂ ‹ ¯ˆÚ›˜ ÙËÓ ÚÔÛı‹ÎË LC-PUFAs.ŸÏÂ˜ ÔÈ ÌÂÏ¤ÙÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÂÚÈÂ¯fiÌÂÓÔ ÙˆÓ§O ÛÙÔ Ï¿ÛÌ· ¤¯Ô˘Ó ‰Â›ÍÂÈ ˘„ËÏfiÙÂÚ· Â›Â‰·LC-PUFAs ÛÙ· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË (7). ªÂÏ¤ÙÂ˜ Ô˘·ÊÔÚÔ‡Ó ÛÙË Û˘ÁÎ¤ÓÙÚˆÛË §O ÛÙÔ Ï¿ÛÌ· Î·ÈÛÙ· ÏÈ›‰È· ÂÚ˘ıÚÒÓ ÛÂ ·È‰È¿ ÛÈÙÈ˙fiÌÂÓ· ÌÂ ÙÚÔ-ÔÔÈËÌ¤ÓÔ Á¿Ï·, ÌÂ ‹ ¯ˆÚ›˜ ÚÔÛı‹ÎË LC-PUFAs, ¤‰ÂÈÍ·Ó fiÙÈ Ù· Â›Â‰¿ ÙÔ˘˜ Â›Ó·È ·ÓÙ›ÛÙÔÈ-¯· ÙË˜ ‰È·ÈÙËÙÈÎ‹˜ ÚfiÛÏË„Ë˜. ¶ÚÔÛı‹ÎË ÌfiÓÔDHA ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ˘„ËÏfiÙÂÚ· Â›Â‰·DHA ÛÙ· ÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ÙˆÓ ÂÚ˘ıÚÒÓÎ·È Û˘Ó‹ıˆ˜ ¯·ÌËÏfiÙÂÚ· Â›Â‰· ∞∞ Î·È ¿ÏÏˆÓ ˆ-6 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ (8). ∏ ÚÔÛı‹ÎËAA Î·È DHA Ì·˙› ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ˘„ËÏ¿ Â›-Â‰· Î·È ÙˆÓ ‰‡Ô §O ÛÙÔ Ï¿ÛÌ·.

¶ËÁ¤˜ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ∆· ÏÈ·Ú¿ ÔÍ¤· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ LA, ∞LA, AA Î·È

DHA ¤¯Ô˘Ó È‰È·›ÙÂÚË ‰È·ÙÚÔÊÈÎ‹ ÛËÌ·Û›· ÁÈ· ÙÔÓ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi. ª›· Î‡ÚÈ· ËÁ‹ ÏÈ·ÚÒÓÔÍ¤ˆÓ Â›Ó·È ÙÔ È¯ı˘¤Ï·ÈÔ Ô˘ ÂÚÈ¤¯ÂÈ ÌÂÁ¿Ï· ÔÛ¿ˆ-3, ·ÏÏ¿ ÂÏ¿¯ÈÛÙ· ÔÛ¿ ˆ-6 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Ì·-ÎÚ¿˜ ·Ï‡ÛÔ˘. ∆Ô LA Ô˘ ‚Ú›ÛÎÂÙ·È Î˘Ú›ˆ˜ ÛÂ ¤Ï·È·

Ï·¯·ÓÈÎÒÓ Î·È ¿ÏÏ· ÙÚfiÊÈÌ·, ıÂˆÚÂ›Ù·È ÙÔ ‚·ÛÈÎfi··Ú·›ÙËÙÔ ÏÈ·Úfi ÔÍ‡. ∆Ô ∞LA Î·È ÙÔ DHA Â›Ó·È,Â›ÛË˜, ··Ú·›ÙËÙ·. ∆· ˆ-3 ÏÈ·Ú¿ ÔÍ¤· ˘¿Ú¯Ô˘ÓÛÂ ‰È¿ÊÔÚ· ÙÚfiÊÈÌ·, fiˆ˜ ÛÙÔ ¤Ï·ÈÔ ÛfiÁÈ·˜, ÙÔÁÔÁÁ‡ÏÈ Î·È Ù· Ú¿ÛÈÓ· Ï·¯·ÓÈÎ¿. ∆Ô DHA ‚Ú›ÛÎÂÙ·ÈÎ˘Ú›ˆ˜ ÛÙÔÓ ÎÚfiÎÔ ÙÔ˘ ·˘ÁÔ‡, ÛÙ· ÛÙÚÂ›‰È· Î·È Ù·„¿ÚÈ·. ∆· ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·Ù· ÌÔÚÔ‡Ó Ó·ÂÌÏÔ˘ÙÈÛÙÔ‡Ó ÌÂ LC-PUFAs ·fi È¯ı˘¤Ï·ÈÔ, ¤Ï·È··fi ÎÚfiÎÔ ·˘ÁÔ‡ ‹ ¤Ï·È· ·ÔÌÔÓˆÌ¤Ó· ·fi ÚÔ˚fi-ÓÙ· ˙‡ÌˆÛË˜ ÌÔÓÔÎ˘ÙÙ¿ÚÈˆÓ ÔÚÁ·ÓÈÛÌÒÓ (9).

LC-PUFAs Î·È ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ∆· LC-PUFAs ‚Ú›ÛÎÔÓÙ·È ÛÙÔ Á¿Ï· fiÏˆÓ ÙˆÓ ıË-

Ï·˙Ô˘ÛÒÓ Á˘Ó·ÈÎÒÓ, Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·-ÛÌÔ‡. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÂÈ Ù· ··Ú·›ÙËÙ· ÏÈ-·Ú¿ ÔÍ¤· Î·È Ù· DHA, ALA, Î·ıÒ˜ Î·È ¿ÏÏ· LC-PUFAs (10). ∆Ô 50% ÙË˜ ÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿-Ï·ÎÙÔ˜ ÚÔÛÊ¤ÚÂÙ·È ÛÙÔ ‚Ú¤ÊÔ˜ ÌÂ ÙË ÌÔÚÊ‹ ÏÈÈ-‰›ˆÓ. ∆· ÂÚÈÛÛfiÙÂÚ· ÏÈ·Ú¿ ÔÍ¤· ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÛÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· (98-99%), ÂÓÒ ¤Ó· ÌÈÎÚfi Ô-Ûfi ˘¿Ú¯ÂÈ ÛÙ· ÊˆÛÊÔÏÈ›‰È·, ÌÔÓÔÁÏ˘ÎÂÚ›‰È· Î·È‰ÈÁÏ˘ÎÂÚ›‰È·. ∆Ô ÔÏÈÎfi ÂÚÈÂ¯fiÌÂÓÔ ÏÈÈ‰›ˆÓ ÙÔ˘ ÌË-ÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Û˘Ó‹ıˆ˜ ·˘Í¿ÓÂÙ·È Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ÁÂ‡Ì·ÙÔ˜ Î·È ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ıËÏ·ÛÌÔ‡.∂ËÚÂ¿˙ÂÙ·È, Â›ÛË˜, ·fi ÙËÓ ËÏÈÎ›· Î‡ËÛË˜ ÛÙËÁ¤ÓÓËÛË, ÙÈ˜ ‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ ÙË˜ ÌËÙ¤Ú·˜ Î·ÈÙÔÓ ËÌÂÚ‹ÛÈÔ Ú˘ıÌfi (11,12). ∏ Û‡ÓıÂÛË ÙÔ˘ Ï›Ô˘˜ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂËÚÂ¿˙ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙÈ˜ ‰È·È-ÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ ÙË˜ ÌËÙ¤Ú·˜. ŒÙÛÈ, fiÙ·Ó ÛÙÈ˜ ıË-Ï¿˙Ô˘ÛÂ˜ ÌËÙ¤ÚÂ˜ ¯ÔÚËÁËıÂ› DHA, Ù· Â›Â‰¿ ÙÔ˘ÛÙÔ Á¿Ï· ·˘Í¿ÓÔÓÙ·È ÌÂ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ Ú˘ıÌfi(13). µÚ¤ÊË Ù· ÔÔ›· Ï¿Ì‚·Ó·Ó DHA Ì¤Ûˆ ÌËÙÚÈÎÔ‡ıËÏ·ÛÌÔ‡, Â›¯·Ó ˘„ËÏfiÙÂÚ· Â›Â‰· ·˘ÙÔ‡ ÙÔ˘ ÌÔ-Ú›Ô˘ ÛÙÈ˜ ‚·ÛÈÎ¤˜ ‰ÔÌ¤˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ (14). ∆· ˘„ËÏfiÙÂÚ· Â›Â‰· LC-PUFAs(AA, DHA) ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÙÔ ‡·Ú Î·È ÌÂÙ¿ ·fi¤Ó· Ì‹Ó· Í·ÊÓÈÎ¿ ÌÂÈÒÓÔÓÙ·È, ÛÂ Â›Â‰· Ô˘ ‰È·-ÙËÚÔ‡ÓÙ·È Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ‚ÚÂÊÈÎ‹˜ Â-ÚÈfi‰Ô˘. ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó Û¯Â‰fiÓ ÛÙ·ıÂÚ¤˜ Û˘ÁÎÂ-ÓÙÚÒÛÂÈ˜ ∞∞ Î·È D∏∞ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·, ÛÂ ÌÂÙÚ‹-ÛÂÈ˜ Ô˘ ¤ÁÈÓ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 12 ÌË-ÓÒÓ ÙË˜ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡. ∂ÔÌ¤Óˆ˜, LC-PUFAs ¯Ô-ÚËÁÔ‡ÓÙ·È ÛÙ· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË Î·È Î·Ù¿ ÙÔÓ ·-Ú·ÙÂÙ·Ì¤ÓÔ ıËÏ·ÛÌfi. ∆Ô ·fiÏ˘ÙÔ ÂÚÈÂ¯fiÌÂÓÔ ·Ó¿dl ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚfi Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 12 ÌË-ÓÒÓ. ∏ Ê‡ÛË ÙˆÓ ¯ËÌÈÎÒÓ ÂÓÒÛÂˆÓ ÛÙÈ˜ ÔÔ›Â˜ Â-ÚÈ¤¯ÔÓÙ·È Ù· LC-PUFAs Î·È Î¿ÔÈÂ˜ Ú˘ıÌÈÛÙÈÎ¤˜ ‰È·-‰ÈÎ·Û›Â˜ ÛÙÔÓ Ì·˙ÈÎfi ·‰¤Ó·, ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó·˘Ùfi ÙÔ ÚÔÊ·ÓÒ˜ ·Ú¿‰ÔÍÔ Ê·ÈÓfiÌÂÓÔ (12,15,16).

LC-PUFAs Î·È ÚÔˆÚfiÙËÙ· Œ¯ÂÈ ·Ú·ÙËÚËıÂ› fiÙÈ Ë ÈÔ ÁÚ‹ÁÔÚË ·‡ÍËÛË

AA Î·È DHA ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ Û˘Ì‚·›ÓÂÈ ÛÙÔ ÙÂÏÂ˘-Ù·›Ô ÙÚ›ÌËÓÔ ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, fiÙ·Ó Ù· LC-PUFAs


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JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·14

·Ú¤¯ÔÓÙ·È ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ·. ∞fi ÙÔ ÙÚ›ÙÔ ÙÚ›-ÌËÓÔ ÙË˜ Î‡ËÛË˜ Ì¤¯ÚÈ ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜, Ô ÂÁÎ¤-Ê·ÏÔ˜ ·˘Í¿ÓÂÙ·È ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚ‹ ÙÔ˘ Ù·¯‡ÙËÙ·Î·È ÊÙ¿ÓÂÈ ÙÔ 70% ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÙÔ˘ÂÓËÏ›ÎÔ˘. ∞ÔÙÂÏÂ›Ù·È Î˘Ú›ˆ˜ ·fi ‰ÔÌÈÎ¿ ÊˆÛÊÔ-ÏÈ›‰È· Î·È ÓÂÚfi. ∆· ÊˆÛÊÔÏÈ›‰È· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘Î·È ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ Â›Ó·È ÌÔÓ·‰ÈÎ¿, ‰ÈfiÙÈ¤¯Ô˘Ó Ì›· ·Û˘Ó‹ıÈÛÙ· ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË LC-PUFAs, Î˘Ú›ˆ˜ ∞∞ Î·È DHA, Ù· ÔÔ›· ·›˙Ô˘Ó ÛË-Ì·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·ÈÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜. ∫·Ù¿ ÙËÓ ÂÌ‚Ú˘˚Î‹ ˙ˆ‹,Ù· ÏÈ·Ú¿ ÔÍ¤· ·Ú¤¯ÔÓÙ·È Ì¤Ûˆ ‰È·Ï·ÎÔ˘ÓÙÈ·-Î‹˜ ÌÂÙ·ÊÔÚ¿˜. ªÂÙ¿ ·fi ¤Ó· ÚfiˆÚÔ ÙÔÎÂÙfi, ËÌÂÙ·ÊÔÚ¿ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ‰È·ÎfiÙÂÙ·È, ÌÂÈÒÓÔ-ÓÙ·˜ ¤ÙÛÈ ÙË Û˘ÁÎ¤ÓÙÚˆÛË ∞∞ Î·È DHA (17-19). Ãˆ-Ú›˜ Ì›· ‰È·ÈÙËÙÈÎ‹ ËÁ‹, Ù· ‚Ú¤ÊË Ú¤ÂÈ Ó· Û˘Ó-ı¤ÙÔ˘Ó ÌÂÁ¿Ï· ÔÛ¿ DHA Î·È ∞∞ ÁÈ· Ó· ·ÓÙ·Ô-ÎÚ›ÓÔÓÙ·È ÛÙÈ˜ ·Ó¿ÁÎÂ˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘. ŒÙÛÈ, Ù· ÚfiˆÚ· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Â˘¿-ÏˆÙ· ÛÂ ·ÓÂ¿ÚÎÂÈ· DHA (20-22).

ªÂÙ¿ ÙË Á¤ÓÓËÛË, ÙÔ ÌËÙÚÈÎfi Á¿Ï· ·Ú¤¯ÂÈ ÈÎ·-ÓÔÔÈËÙÈÎ¿ ÔÛ¿ ∞∞ Î·È DHA, ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù·ÂÚÈÛÛfiÙÂÚ· ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·Ù·. ¶ÚfiˆÚ·‚Ú¤ÊË Ô˘ ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÌËÙÚÈÎfi Á¿Ï·, fiÙ·Ó ÂÍÂ-Ù¿ÛÙËÎ·Ó Â›¯·Ó ˘„ËÏfiÙÂÚÔ ‰Â›ÎÙË ÓÔËÌÔÛ‡ÓË˜ Î·-Ù¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 7,5-8 ÂÙÒÓ, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Úfiˆ-Ú· Ô˘ ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· (23).ªÂÙ¿ ÙËÓ ÚÔÛı‹ÎË LC-PUFAs ÛÙ· Á¿Ï·Ù· Úfiˆ-ÚˆÓ ‚ÚÂÊÒÓ, Ù· ‚Ú¤ÊË ¤‰ÂÈÍ·Ó ‚ÂÏÙÈˆÌ¤ÓÂ˜ ·È-ÛıËÙËÚÈ·Î¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ (·ÓÙ·fiÎÚÈÛË ·ÌÊÈ‚ÏË-ÛÙÚÔÂÈ‰Ô‡˜ ÛÙÔ Êˆ˜, ÔÙÈÎ‹ ÔÍ‡ÙËÙ·), ÔÙÈÎ‹ ÚÔ-ÛÔ¯‹ Î·È ˘„ËÏfiÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÂ ·Ó·Ù˘ÍÈ·Î¤˜‰ÔÎÈÌ·Û›Â˜. ∂ÂÈ‰‹ Ù· ÚfiˆÚ· ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚÂ˜Û˘ÁÎÂÓÙÚÒÛÂÈ˜ LC-PUFAs ÛÙË Á¤ÓÓËÛË ·’ fiÙÈ Ù·ÙÂÏÂÈfiÌËÓ·, ÌÔÚÂ› Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÌÊ·Ó‹Ù· ÔÊ¤ÏË ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ LC-PUFAs ÁÈ· ÙËÓ ·Ó¿-Ù˘ÍË ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (24). ŒÙÛÈ, Î·Ù¿ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ÔÈ ··ÈÙ‹ÛÂÈ˜ ÛÂ DHA Ú¤ÂÈÈÎ·ÓÔÔÈÔ‡ÓÙ·È, ÒÛÙÂ Ó· ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ê˘ÛÈÔÏÔÁÈ-Î‹ ·Ó¿Ù˘ÍË ÙÔ˘ ÊÏÔÈÔ‡ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ˘·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜.

™‹ÌÂÚ·, ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ÛÙÔÈ¯Â›· Ô˘ ˘Ô-ÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ AA Î·È ÙÔ DHA Â›Ó·È ÛËÌ·ÓÙÈÎÔ›·Ú¿ÁÔÓÙÂ˜ ·Ó¿Ù˘ÍË˜. ™˘ÁÎÂÓÙÚÒÛÂÈ˜ ∞∞ ÛÙÔ ·›-Ì· Û¯ÂÙ›˙ÔÓÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Úfi-ˆÚˆÓ ‚ÚÂÊÒÓ. ∂›ÛË˜, Ë ÛËÌ·Û›· ÙÔ˘ DHA ÁÈ· ÙËÓ·Ó¿Ù˘ÍË ÂÈ‰ÈÎfiÙÂÚ· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È Ï¤ÔÓÙÂÎÌËÚÈˆÌ¤ÓË (25). Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ ÙÔ ‚¿ÚÔ˜Á¤ÓÓËÛË˜ Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÌÂ ÙËÓ ÚfiÛÏË-„Ë ··Ú·›ÙËÙˆÓ §O Î·Ù¿ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË, ·Ú¿ÌÂ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ (19,25,26).∏ Â˘ÂÚÁÂÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ ··Ú·›ÙËÙˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ, ÙfiÛÔ ÛÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ fiÛÔ Î·È ÛÙÈ˜ ÂÎ-˙ÂÌ·ÙÔÂÈ‰Â›˜ ‰ÂÚÌ·Ù›ÙÈ‰Â˜ ÙˆÓ ‚ÚÂÊÒÓ, ¤¯ÂÈ ·Ú·-

ÙËÚËıÂ› Â‰Ò Î·È ·ÚÎÂÙ¿ ¯ÚfiÓÈ·. º·›ÓÂÙ·È fiÙÈ Ë ¯Ô-Ú‹ÁËÛË ··Ú·›ÙËÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÚÔ¿ÁÂÈ ÙËÛˆÌ·ÙÈÎ‹ ·‡ÍËÛË Î·È ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ·Ó¿Ù˘ÍËÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÂÎ˙¤Ì·ÙÔ˜ (27,28). ∂›ÛË˜, ·Ó·Ê¤ÚÂ-Ù·È fiÙÈ Ë ¯·ÌËÏ‹ ÚfiÛÏË„Ë ··Ú·›ÙËÙˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ·‡-ÍËÛË˜ ÙÔ˘ Ï·ÎÔ‡ÓÙ· Î·È, Û˘ÓÂÒ˜, ÂÓ‰ÔÌ‹ÙÚÈ·Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜ (29).

ŒÙÛÈ, ÁÈ· Ó· ÂÍ·ÛÊ·ÏÈÛÙÂ› Ë ‚¤ÏÙÈÛÙË ÂÌ‚Ú˘˚Î‹Î·È ‚ÚÂÊÈÎ‹ ·Ó¿Ù˘ÍË, ÔÈ ¤ÁÎ˘Â˜ Î·È ıËÏ¿˙Ô˘ÛÂ˜ÌËÙ¤ÚÂ˜ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Â·ÚÎÂ›˜ Ô-ÛfiÙËÙÂ˜ ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ LC-PUFAs ÛÙË ‰›·È-Ù¿ ÙÔ˘˜, fiˆ˜ „¿ÚÈ Î·È ·˘Áfi, ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙË˜‰È·Ï·ÎÔ˘ÓÙÈ·Î‹˜ ÌÂÙ·ÊÔÚ¿˜ ·˘ÙÒÓ ÙˆÓ §O Î·ÈÁÈ· ÙËÓ ·‡ÍËÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂÒÓ ÙÔ˘˜ ÛÙÔ Á¿-Ï·. ∆· ‚ÚÂÊÈÎ¿ Á¿Ï·Ù· Î·È ÂÈ‰ÈÎ¿ ·˘Ù¿ Ô˘ ·Â˘-ı‡ÓÔÓÙ·È ÛÂ ‚Ú¤ÊË ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜Ú¤ÂÈ Ó· Â›Ó·È ÂÌÏÔ˘ÙÈÛÌ¤Ó· ÌÂ Â·ÚÎ‹ ÔÛ¿LC-PUFAs, ÒÛÙÂ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙÈ˜ ·Ó¿ÁÎÂ˜ÙˆÓ Ù·¯¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ ‚ÚÂÊÒÓ (9,30).

LC-PUFAs Î·È ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÌÂÌ‚Ú¿ÓÂ˜ ÙˆÓ ÊˆÙÔ¸Ô-

‰Ô¯¤ˆÓ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹ ¤¯Ô˘Ó ÙÈ˜ ˘„ËÏfiÙÂ-ÚÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ DHA ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈ-ÛÌfi. ∆· Î‡ÙÙ·Ú· ÙˆÓ ÊˆÙÔ¸Ô‰Ô¯¤ˆÓ ˆÚÈÌ¿˙Ô˘ÓÙ·¯‡Ù·Ù· ÛÙÔ 3Ô ÙÚ›ÌËÓÔ ÙË˜ Î‡ËÛË˜ Î·È ÛÙÔ˘˜ÚÒÙÔ˘˜ 4-6 Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜. ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë‰È·ÈÙËÙÈÎ‹ Â¿ÚÎÂÈ· DHA Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ÏÂÈÙÔ˘Ú-Á›· ÙË˜ fiÚ·ÛË˜. ¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó Á›ÓÂÈ ÛÂ‚Ú¤ÊË ÁÈ· Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ıËÏ·ÛÌÔ‡ ‹ ÙË˜ÚÔÛı‹ÎË˜ LC-PUFAs ÛÙËÓ ÔÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·(31-34).

∏ ÚÔÛı‹ÎË DHA ÛÙË ‰›·ÈÙ· ·Ú¿ÁÂÈ ıÂÙÈÎfi·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ·, Ô˘ Â›Ó·È ÂÚÈÛ-ÛfiÙÂÚÔ ÂÌÊ·Ó¤˜ ÛÙ· ÚfiˆÚ· ·Ú¿ ÛÙ· ÙÂÏÂÈfiÌË-Ó· ÓÂÔÁÓ¿. ª›· ÌÂÏ¤ÙË Ô˘ ¤ÁÈÓÂ ÛÂ ÚfiˆÚ· ÛÈÙÈ-˙fiÌÂÓ· ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· Î·È ÌÂ Á¿Ï·ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ È¯ı˘¤Ï·ÈÔ, ¤‰ÂÈÍÂ ‰È·ÊÔÚ¿ ÛÙËÓÔÙÈÎ‹ ÔÍ‡ÙËÙ· ÛÙÔ˘˜ 2 Î·È ÛÙÔ˘˜ 4 Ì‹ÓÂ˜ ˙ˆ‹˜ÛÙ· ‚Ú¤ÊË Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ÌÂ ÚÔÛı‹ÎË LC-PUFAs.ŸÌˆ˜, ÛÙÈ˜ ËÏÈÎ›Â˜ ÙˆÓ 6,5, 9 Î·È 12 ÌËÓÒÓ ‰ÂÓ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ (32). ªÔ-ÚÂ› Ó· Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚÔ Ó· ‚ÚÂıÔ‡Ó ‰È·ÊÔÚ¤˜ ÛÂÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜, ÁÈ·Ù› Ë ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ·ÏÏ¿-˙ÂÈ Ù·¯‡Ù·Ù· ÙÔ˘˜ ÚÒÙÔ˘˜ ¤ÍÈ Ì‹ÓÂ˜ Î·È ÌÂÙ¿ ÛÙ·-ıÂÚÔÔÈÂ›Ù·È. ™Â ¿ÏÏÂ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜Ô˘ ¤ÁÈÓ·Ó ÛÂ ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂÙ¿·fi ¯ÔÚ‹ÁËÛË DHA, ·Ú·ÙËÚ‹ıËÎÂ ˘„ËÏfiÙÂÚËÔÙÈÎ‹ ÔÍ‡ÙËÙ· ÛÂ Ì›· ‹ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÈ˜ ·Îfi-ÏÔ˘ıÂ˜ ËÏÈÎ›Â˜: 1, 5, 2, 4, 7 Î·È 12 ÌËÓÒÓ (24,35).∂›ÛË˜, Ê·›ÓÂÙ·È fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ˘ÂÚ¤¯ÂÈ ¤Ó·-ÓÙÈ ÙË˜ ÂÌÏÔ˘ÙÈÛÌ¤ÓË˜ ÙÂ¯ÓËÙ‹˜ ‰È·ÙÚÔÊ‹˜ Î·È


15

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·15


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·˘Ù‹ ¤Ó·ÓÙÈ ÙË˜ ÌË ÂÌÏÔ˘ÙÈÛÌ¤ÓË˜ ÙÂ¯ÓËÙ‹˜ ‰È·-ÙÚÔÊ‹˜, ÛÂ ÌÂÙÚ‹ÛÂÈ˜ ÔÙÈÎ‹˜ ÔÍ‡ÙËÙ·˜ (36-39).ª›· ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘ Û˘ÁÎÚ›ÓÂÈ ÌËÙÚÈÎfi Á¿Ï·,ÎÔÈÓfi ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· Î·È Á¿Ï· ÂÌÏÔ˘ÙÈÛÌ¤-ÓÔ ÌÂ LC-PUFAs ‰Â›¯ÓÂÈ ÏÂÔÓ¤ÎÙËÌ· ÙÔ˘ ÌËÙÚÈÎÔ‡ıËÏ·ÛÌÔ‡ ‹ ÙË˜ ÂÌÏÔ˘ÙÈÛÌ¤ÓË˜ ‰È·ÙÚÔÊ‹˜ ÛÂ ÌÂ-ÙÚ‹ÛÂÈ˜ ÔÙÈÎ‹˜ ÔÍ‡ÙËÙ·˜ ÛÂ ËÏÈÎ›· 2 ÌËÓÒÓ Î·È ÛÂËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜ ÛÂ ËÏÈÎ›· 4 ÌË-ÓÒÓ. ¶¿ÓÙˆ˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ Û›ÙÈÛË˜ ÌÂ ÌË-ÙÚÈÎfi ıËÏ·ÛÌfi, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ·,‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ÙÂÎÌËÚÈˆÌ¤Ó·, fiÛÔÓ ·ÊÔÚ¿ ÛÙ·ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË. ™Ù· ÚfiˆÚ· ‚Ú¤ÊË, ÔÈ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó ˘„ËÏfiÙÂÚË ÔÙÈÎ‹ ÔÍ‡-ÙËÙ· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‰È·ÈÙËÙÈÎÒÓ LC-PUFAs.∆Ô ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ô˘ ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ÛÙ· ÚfiˆÚ· ‚Ú¤ÊË, ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÙÔÓ Ù·-¯‡ÙÂÚÔ ‚·ıÌfi ˆÚ›Ì·ÓÛË˜ ÙÔ˘ ÔÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚÂ› Ó· ÂËÚÂ¿˙ÂÈ ÙËÓ ÔÛfi-ÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ÚÒÈÌˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ.∂›ÛË˜, Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ÌÔÚÂ› Ó· ÂËÚÂ¿˙ÂÈ¿ÏÏÔ˘˜ ÙÔÌÂ›˜ ÙË˜ ÔÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È fi¯È Ìfi-ÓÔ ÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ· (40).

LC-PUFAs Î·È ‰È·ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍË Î·È Û˘ÌÂÚÈ-ÊÔÚ¿

ªÂÏ¤ÙÂ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰È·ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍËÎ·È Û˘ÌÂÚÈÊÔÚ¿ ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ ‹ ¯ˆÚ›˜ÂÌÏÔ˘ÙÈÛÌ¤ÓË ‰È·ÙÚÔÊ‹ Î·È ÌÂ ÌËÙÚÈÎfi ıËÏ·ÛÌfi,‰ÂÓ Ê·›ÓÂÙ·È Ó· Î·Ù·Ï‹ÁÔ˘Ó ÛÂ Î¿ÔÈÔ ÔÚÈÛÙÈÎfi·ÔÙ¤ÏÂÛÌ·. ª›· ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ ÔÈ ÓÂ˘ÚÔ·Ó·-Ù˘ÍÈ·Î¤˜ ‰ÔÎÈÌ·Û›Â˜ ÛÂ ‚Ú¤ÊË Ô˘ ‰È·ÙÚ¤ÊÔÓÙ·ÓÌÂ ÂÌÏÔ˘ÙÈÛÌ¤ÓË ÌÂ LC-PUFAs ÙÂ¯ÓËÙ‹ ‰È·ÙÚÔÊ‹‹Ù·Ó ıÂÙÈÎ¤˜ ÛÂ ËÏÈÎ›· 4 ÌËÓÒÓ, ÂÓÒ ‰ÂÓ ˘‹Ú¯Â‰È·ÊÔÚ¿ ÛÙÔ˘˜ 12 Î·È 24 Ì‹ÓÂ˜ ˙ˆ‹˜.

Œ¯Ô˘Ó Ú·ÁÌ·ÙÔÔÈËıÂ› ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ·ÍÈÔ-ÏfiÁËÛË˜ ÙË˜ ‰È·ÓÔËÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ Î·È Û˘ÌÂÚÈ-ÊÔÚ¿˜ ÛÂ ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË. ª›· ÌÂÙ·-·Ó¿Ï˘ÛËÛ˘ÁÎÚ›ÓÂÈ ‚Ú¤ÊË Ô˘ ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÌËÙÚÈÎfi ıËÏ·-ÛÌfi ‹ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· Î·È ÂÍÂÙ¿ÛÙËÎ·Ó ÛÂËÏÈÎ›Â˜ 6-23 ÌËÓÒÓ, ·ÏÏ¿ Î·È ÛÔÚ·‰ÈÎ¿ Î·Ù¿ ÙËÓ·È‰ÈÎ‹ ËÏÈÎ›· Ì¤¯ÚÈ 10-15 ÂÙÒÓ, ÌÂ ‰ÔÎÈÌ·Û›Â˜ ‰È·-ÓÔËÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜. ∆Ô ›‰ÈÔ ÙÂÛÙ ‰È·ÓÔËÙÈÎ‹˜ ·Ó¿-Ù˘ÍË˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ÎÔÈÓfi Ì¤ÙÚÔ Û‡ÁÎÚÈ-ÛË˜ ·fi fiÏÂ˜ ÙÈ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ‹Ú·Ó Ì¤ÚÔ˜ ÛÙË ÌÂ-Ù·-·Ó¿Ï˘ÛË. ™Ù· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ·Ú·ÙËÚ‹ıË-Î·Ó ˘„ËÏfiÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ ‰È·ÓÔËÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜,ÔÈ ÔÔ›Â˜ Û˘ÓÂ¯›ÛÙËÎ·Ó Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜·È‰ÈÎ‹˜ ËÏÈÎ›·˜. Ÿˆ˜ Î·È ÌÂ ÙÈ˜ ÚÔËÁÔ‡ÌÂÓÂ˜ÌÂÏ¤ÙÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ·, ·Ú·ÙËÚ‹-ıËÎÂ ÌÂÁ·Ï‡ÙÂÚÔ ÏÂÔÓ¤ÎÙËÌ· ÛÙË ‰È·ÓÔËÙÈÎ‹·Ó¿Ù˘ÍË ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹-ıËÎÂ ÌËÙÚÈÎfi Á¿Ï·, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ÙÂÏÂÈfiÌËÓ·.∂›ÛË˜, ·Ú·ÙËÚ‹ıËÎÂ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙË˜ ‰È¿Ú-

ÎÂÈ·˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È ÙË˜ ‰È·ÓÔËÙÈÎ‹˜·Ó¿Ù˘ÍË˜ Î·È Û˘ÌÂÚÈÊÔÚ¿˜, ÂÓÒ ‰ÂÓ ˘‹ÚÍ·Ó·ÍÈfiÏÔÁÂ˜ ‰È·ÊÔÚ¤˜ ÛÂ ‚Ú¤ÊË fiÔ˘ Ë ‰È¿ÚÎÂÈ· ıË-Ï·ÛÌÔ‡ ‹Ù·Ó 4-7 Â‚‰ÔÌ¿‰Â˜. ¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›fiÙÈ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÚÌËÓÂ˘-ÙÔ‡Ó Â·ÎÚÈ‚Ò˜, Î˘Ú›ˆ˜ ÏfiÁˆ ÙË˜ ‡·ÚÍË˜ ÂÍˆÁÂ-ÓÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÌÔÚÂ› Ó· Ù· ÂËÚÂ¿ÛÔ˘Ó,fiˆ˜ .¯. ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, Ô ‰Â›ÎÙË˜ÓÔËÌÔÛ‡ÓË˜ ÙˆÓ ÁÔÓ¤ˆÓ, ÔÈ Û¯¤ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓÌÂÏÒÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Ë „˘¯ÔÎÔÈÓˆÓÈÎ‹ Î·Ù¿ÛÙ·-ÛË ÙË˜ ÌËÙ¤Ú·˜ Î·È ¿ÏÏ· (41-44).

ÕÏÏË ÌÂÏ¤ÙË Ô˘ Û‡ÁÎÚÈÓÂ ‚Ú¤ÊË ÛÈÙÈ˙fiÌÂÓ· ÌÂ‹ ¯ˆÚ›˜ ÂÌÏÔ˘ÙÈÛÌ¤ÓË ‰È·ÙÚÔÊ‹ ÌÂ LC-PUFAs,¤‰ÂÈÍÂ fiÙÈ ÔÈ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î¤˜ ‰ÔÎÈÌ·Û›Â˜ ÛÂ·È‰È¿ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ÌÂ ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ Á¿Ï· ‹Ù·ÓıÂÙÈÎ¤˜ ÛÂ ËÏÈÎ›· 4 ÌËÓÒÓ, ÂÓÒ ‰ÂÓ ˘‹Ú¯Â ÂÌÊ·-Ó‹˜ ‰È·ÊÔÚ¿ ÛÙÔ˘˜ 12 Î·È 24 Ì‹ÓÂ˜ ˙ˆ‹˜. ÕÏÏÔÈÂÚÂ˘ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ÌË ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÓÔËÙÈÎ‹ Î·È „˘¯ÔÎÔÈÓˆÓÈÎ‹·Ó¿Ù˘ÍË ÙˆÓ ‚ÚÂÊÒÓ (40,45).

∏ ‰È·ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍË, Ô˘ ÂÎÙÈÌ‹ıËÎÂ ÛÙÔ˘˜10 Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜ Ì¤Ûˆ ÙË˜ ÈÎ·ÓfiÙËÙ·˜ Â›Ï˘ÛË˜Î¿ÔÈÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ (ÂÎÙ¤ÏÂÛË ÛÂÈÚ¿˜ ‚ËÌ¿ÙˆÓÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÈÙÂ˘¯ıÂ› Î¿ÔÈÔ˜ ÛÙfi¯Ô˜), Ê¿ÓË-ÎÂ Ó· ˘ÂÚ¤¯ÂÈ ÛÂ ‚Ú¤ÊË Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ÌÂÂÌÏÔ˘ÙÈÛÌ¤Ó· ÌÂ LC-PUFAs Á¿Ï·Ù· ·fi ÙË Á¤ÓÓË-ÛË Î·È ÁÈ· Ù¤ÛÛÂÚÈ˜ Û˘ÓÂ¯Â›˜ Ì‹ÓÂ˜. ∆Ô Â‡ÚËÌ· ·˘-Ùfi ıÂˆÚÂ›Ù·È ÛËÌ·ÓÙÈÎfi, ÁÈ·Ù› ·˘ÍËÌ¤ÓÂ˜ ÂÈ‰fiÛÂÈ˜ÛÂ Ù¤ÙÔÈÔ˘ Â›‰Ô˘˜ ÈÎ·ÓfiÙËÙ· Â›Ï˘ÛË˜ ÚÔ‚ÏËÌ¿-ÙˆÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ ‰Â›ÎÙË ÓÔËÌÔÛ‡ÓË˜ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ¶ÈÛÙÂ‡ÂÙ·È, ·ÎfiÌË, fiÙÈ Ù· LC-PUFAs ÌÔÚÔ‡Ó Ó· ÂËÚÂ¿ÛÔ˘Ó ıÂÙÈÎ¿ Î·È ÙËÓ Ù·-¯‡ÙËÙ· ÂÂÍÂÚÁ·Û›·˜ ÏËÚÔÊÔÚÈÒÓ, Î·ıÒ˜ Î·È ÙÈ˜‰È·‰ÈÎ·Û›Â˜ ÂÏ¤Á¯Ô˘ ÙË˜ ÚÔÛÔ¯‹˜. ∂›ÛË˜, Ê·›ÓÂ-Ù·È fiÙÈ Ù· ÔÊ¤ÏË ÙË˜ Û›ÙÈÛË˜ ÌÂ LC-PUFAs ÂÈÌ¤ÓÔ˘Ó¤Ú· ·fi ÙËÓ ÂÚ›Ô‰Ô Î·Ù¿ ÙËÓ ÔÔ›· Ù· ‚Ú¤ÊË ÛÈ-Ù›˙ÔÓÙ·Ó ÌÂ ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ Á¿Ï·. ¶¿ÓÙˆ˜, ÚÔ˜ ÙÔ·ÚfiÓ, ·Ó Î·È ·Ó·Ê¤ÚÔÓÙ·È ·ÚÎÂÙ¿ ıÂÙÈÎ¿ ·ÔÙÂÏ¤-ÛÌ·Ù·, ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ ÛÙÔÈ¯Â›· Ô˘ Ó· ÙÂÎ-ÌËÚÈÒÓÔ˘Ó Ù· Ì·ÎÚÔÚfiıÂÛÌ· ÔÊ¤ÏË ÙË˜ ¯ÔÚ‹ÁË-ÛË˜ LC-PUFAs Û¯ÂÙÈÎ¿ ÌÂ ÙË ‰È·ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍËÎ·È Û˘ÌÂÚÈÊÔÚ¿ (46,47).

∞ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ Á¿Ï·Ù· ÂÌÏÔ˘ÙÈÛÌ¤Ó·

ÌÂ LC-PUFAs ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ¤Ï·È· „·ÚÈÒÓ Ô˘ÂÚÈ¤¯Ô˘Ó DHA Î·È ¿ÏÏ· ˆ-3 §O. ™Â Ì›· ·fi ·˘Ù¤˜ÙÈ˜ ÌÂÏ¤ÙÂ˜, fiÔ˘ ¯ÔÚËÁ‹ıËÎ·Ó ÌfiÓÔ ˆ-3 ÏÈ·Ú¿ÔÍ¤·, ÚfiˆÚ· ‚Ú¤ÊË ˙‡ÁÈ˙·Ó ÏÈÁfiÙÂÚÔ ‹ Â›¯·Ó ÌÈ-ÎÚfiÙÂÚÔ ‚¿ÚÔ˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ‡„Ô˜ ÛÂ ‰È¿ÊÔÚÂ˜ÂÚÈfi‰Ô˘˜ Î·Ù¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜, ·fifi,ÙÈ ‚Ú¤ÊË ÛÈÙÈ˙fiÌÂÓ· ÌÂ ·Ï¿, ÌË ÂÌÏÔ˘ÙÈÛÌ¤Ó·Á¿Ï·Ù·. ™Â ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ ¯ÔÚ‹ÁËÛË LC-PUFAs

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·16

·fi È¯ı˘¤Ï·È· ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ‰È·ÊÔÚ¿. ∂›-ÛË˜, ÙÔ ‚¿ÚÔ˜ ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜ Ê·›ÓÂ-Ù·È Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ ÂÚÈÂ¯fiÌÂÓÔ ÙÔ˘ ∞∞ ÛÙ· Êˆ-ÛÊÔÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (fiÛÔ ÌÂÁ·Ï‡ÙÂÚ· Â›Ó·ÈÙ· ÔÛ¿ ÙÔ˘ ∞A, ÙfiÛÔ ˘„ËÏfiÙÂÚÔ Â›Ó·È ÙÔ ‚¿ÚÔ˜ÛÙÔ˘˜ 12 Ì‹ÓÂ˜ ˙ˆ‹˜) (48).

¶¤Ú· ·fi ÙÈ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙÔ˘ È¯ı˘¤Ï·ÈÔ˘ Î·ÈÙˆÓ ˆ-3 §O ÛÙËÓ ·Ó¿Ù˘ÍË, ÂÏ¿¯ÈÛÙÂ˜ Û˘Ó¤ÂÈÂ˜ÙË˜ ¯ÔÚ‹ÁËÛË˜ LC-PUFAs ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›.ŸÌˆ˜, ·ÚÎÂÙÔ› ıÂˆÚËÙÈÎÔ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ¤¯Ô˘ÓÚÔÎ‡„ÂÈ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ LC-PUFAs.ŒÓ·˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ·ÊÔÚ¿ ÛÙÔ fiÙÈ Ë ¯ÔÚ‹ÁËÛËÔÏ˘·ÎfiÚÂÛÙˆÓ ÂÏ·›ˆÓ ÌÔÚÂ› Ó· ·˘Í‹ÛÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ÁÈ· ÔÍÂÈ‰ˆÙÈÎ‹ ‚Ï¿‚Ë, ÁÈ·Ù› ÔÈ ÌÂÌ‚Ú¿ÓÂ˜ ÌÂÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·ÎfiÚÂÛÙˆÓ §O Á›ÓÔÓÙ·È ÈÔÂ˘¿ÏˆÙÂ˜ ÛÂ ÔÍÂÈ‰ˆÙÈÎ‹ ‚Ï¿‚Ë. ŒÙÛÈ, Ë ¯ÔÚ‹ÁËÛËLC-PUFAs ÌÔÚÂ› Ó· ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· Ófi-ÛÔ˘˜ ÓÂÔÁÓÒÓ Û¯ÂÙÈÎ¤˜ ÌÂ ÔÍÂÈ‰ˆÙÈÎ¤˜ ‚Ï¿‚Â˜ÌÂÌ‚Ú·ÓÒÓ, fiˆ˜ Â›Ó·È Ë ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ-‰·, Ë ¯ÚfiÓÈ· ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ˜ ÙˆÓ ÓÂÔÁÓÒÓ, Ë ·Ì-ÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· ÙË˜ ÚÔˆÚfiÙËÙ·˜. ∂›ÛË˜,¯ÔÚ‹ÁËÛË ¯ˆÚ›˜ Î·Ïfi ÈÛÔ˙‡ÁÈÔ ÌÂÙ·Í‡ ˆ-3 Î·È ˆ-6LC-PUFAs ÌÔÚÂ› Ó· ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ ·ÏÏÔ›ˆ-ÛË ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÂÈÎÔÛ·ÓÔÂÈ‰ÒÓ. ŒÓ· ·ÎfiÌË·ÚÓËÙÈÎfi ÛËÌÂ›Ô Â›Ó·È Ë Èı·Ó‹ ‰Ú¿ÛË ÙˆÓ ÂÈ‰ÈÎÒÓLC-PUFAs ÛÙË ÌÂÙ·ÁÚ·Ê‹ ‰È·ÊfiÚˆÓ ÁÔÓÈ‰›ˆÓ (1).ŸÏÔÈ ÔÈ ·Ú·¿Óˆ ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Û¯ÂÙ›˙ÔÓÙ·È ÌÂÙÈ˜ ‚ÈÔÏÔÁÈÎ¤˜ ‰Ú¿ÛÂÈ˜ ÙˆÓ §O. ŸÌˆ˜, Ù· ÛÙÔÈ¯Â›·Ô˘ ÙÔ˘˜ ˘ÔÛÙËÚ›˙Ô˘Ó Â›Ó·È ÂÏ¿¯ÈÛÙ·. ™Â Ì›· ÌÂ-Ï¤ÙË Ô˘ ¤ÁÈÓÂ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ Â›ÙˆÛË ÓÂÎÚˆÙÈ-Î‹˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜, ¯ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÓfiÛÔ˘ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÛË„·ÈÌ›·˜, ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ÌÂ‹ ¯ˆÚ›˜ ÚÔÛı‹ÎË LC-PUFAs. ¶¿ÓÙˆ˜, Ë Â›ÙˆÛËÓÂÎÚˆÙÈÎ‹˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜ Î·È ÛË„·ÈÌ›·˜ ‹Ù·ÓÂÏ·ÊÚÒ˜ ˘„ËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· Ô˘ ÛÈÙÈ˙fiÙ·Ó ÌÂÂÌÏÔ˘ÙÈÛÌ¤Ó· Á¿Ï·Ù· ÌÂ LC-PUFAs. ™Â Ì›· Úfi-ÛıÂÙË ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ fiÙÈ Ë Â›ÙˆÛË ÓÂÎÚˆÙÈÎ‹˜ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË ÛÂ‚Ú¤ÊË Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ÌÂ ÂÌÏÔ˘ÙÈÛÌ¤Ó· Á¿Ï·Ù· ÌÂÊˆÛÊÔÏÈ›‰È· ·fi ÎÚfiÎÔ ·˘ÁÔ‡, ¤Ó·ÓÙÈ ÙˆÓ ‚ÚÂ-ÊÒÓ Ô˘ ÙÚ¤ÊÔÓÙ·Ó ÌÂ ÌË ÂÌÏÔ˘ÙÈÛÌ¤Ó· Á¿Ï·Ù·(49-51).

∂›ÛË˜, ¤¯Ô˘Ó ÚÔÎ‡„ÂÈ ÂÚˆÙËÌ·ÙÈÎ¿ Û¯ÂÙÈÎ¿ÌÂ ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ÌÂLC-PUFAs Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ÂÓ Ì¤ÚÂÈ ·fi ÏÈ›‰È··˘ÁÔ‡. ∆Ô ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ Á¿Ï· ÂÚÈ¤¯ÂÈ ÔÏÏ·-Ï¿ÛÈ· ÔÛ¿ ¯ÔÏËÛÙÂÚfiÏË˜ ·’ fiÙÈ ÙÔ ÎÔÈÓfi Á¿Ï·,ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ ÚÔÎ·Ï¤ÛÂÈ ·ÓËÛ˘¯›· Û¯ÂÙÈÎ¿ ÌÂÙÈ˜ Èı·Ó¤˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ÔÚÂ›·˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈ-ÛÌÔ‡ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙËÓ ÚÒÈÌË ‚ÚÂÊÈÎ‹ ËÏÈ-Î›·. ¶Ú¿ÁÌ·ÙÈ, ÛÂ Û˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ÌÂÙ·Í‡ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ˘ Î·È ÎÔÈÓÔ‡ Á¿Ï·ÎÙÔ˜, ‚Ú¤ıËÎ·Ó

·˘ÍËÌ¤Ó· Â›Â‰· ¯ÔÏËÛÙÂÚfiÏË˜, ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓÎ·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ (∞-π, ∞-ππ, µ) ÙËÓ 5Ë Î·È 30‹ËÌ¤Ú· ¯ÔÚ‹ÁËÛË˜. ™ÙË Û˘Ó¤¯ÂÈ·, fiÌˆ˜, ÌÂÙ¿ ÙËÓËÏÈÎ›· ÙÔ˘ ÂÓfi˜ Ì‹Ó· ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈ-Î¤˜ ‰È·ÊÔÚ¤˜ ÛÙË Û‡ÓıÂÛË Î·È ÙÔ ÂÚÈÂ¯fiÌÂÓÔ ÙˆÓÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜. ∆· ·ÔÙÂÏ¤ÛÌ·Ù··˘Ù¿ Â›Ó·È Èı·Ófi Ó· ÂÍËÁÔ‡ÓÙ·È ÌÂ ÌË¯·ÓÈÛÌÔ‡˜ÚÔÛ·ÚÌÔÁ‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏËÛÙÂÚfi-ÏË˜ ÛÂ Û¯¤ÛË ÌÂ ÙË ‰È·ÈÙËÙÈÎ‹ ÚfiÛÏË„Ë, Ú˘ıÌ›˙Ô-ÓÙ·˜ ·Ó¿ÏÔÁ· ÙËÓ ÂÓ‰ÔÁÂÓ‹ Û‡ÓıÂÛ‹ ÙË˜ (52-56).

™˘ÌÂÚ¿ÛÌ·Ù· ™‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ÛÙÔÈ¯Â›· fiÙÈ ÙÔ ∞∞

Î·È ÙÔ DHA ÌÔÚÂ› Ó· Â›Ó·È ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜·Ó¿Ù˘ÍË˜. ∂È‰ÈÎfiÙÂÚ·, Ë ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿-ÏÔ˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙÔ˘DHA. ™˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙÔ ·›Ì· ÙˆÓ ∞∞ Î·È DHAÛ¯ÂÙ›˙ÔÓÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Úfiˆ-ÚˆÓ ÓÂÔÁÓÒÓ.

¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÏÂÔÓÂÎÙ‹Ì·Ù·ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ¤Ó·ÓÙÈ ÙÔ˘ ÙÚÔÔÔÈËÌ¤-ÓÔ˘ Á¿Ï·ÎÙÔ˜, ÛÙË ‰È·ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍË Î·È ÙËÓÔÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, ÁÂÁÔÓfi˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ·ÚÔ˘Û›· LC-PUFAs ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∆· ÔÊ¤ÏË¯ÔÚ‹ÁËÛË˜ ÙˆÓ LC-PUFAs Â›Ó·È ÂÌÊ·Ó¤ÛÙÂÚ· ÛÙ·ÚfiˆÚ·, ·Ú¿ ÛÙ· ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË. ªÂÏ¤ÙÂ˜ ÌÂÂÌÏÔ˘ÙÈÛÌ¤ÓÔ Á¿Ï· ÌÂ LC-PUFAs ¤Ó·ÓÙÈ ÎÔÈÓÔ‡Á¿Ï·ÎÙÔ˜, ‰Â›¯ÓÔ˘Ó ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ ÂÌÏÔ˘ÙÈ-ÛÌ¤ÓÔ˘, ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ÙˆÓÚfiˆÚˆÓ Î˘Ú›ˆ˜ ‚ÚÂÊÒÓ, ÛÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ÙÔ˘˜ Î·Ù¿ÛÙ·ÛË, Î·ıÒ˜ Î·È ÛÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜.§ÔÁÈÎ¿, ı· ÌÔÚÔ‡Û·ÌÂ Ó· ˘Ôı¤ÛÔ˘ÌÂ fiÙÈ ÔÈ ÂÈ-‰Ú¿ÛÂÈ˜ ÙˆÓ LC-PUFAs ı· Â›Ó·È Î·È Ì·ÎÚÔÚfiıÂ-ÛÌÂ˜, fiÌˆ˜, ÚÔ˜ ÙÔ ·ÚfiÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ÛÙÔÈ¯Â›· Ó· ÂÈ‚Â‚·ÈÒÓÔ˘Ó ·˘Ùfi ÙÔ Û˘Ì¤Ú·ÛÌ·(57,58). ¶¿ÓÙˆ˜, ı· ÌÔÚÔ‡Û·ÌÂ Ó· Ô‡ÌÂ ÌÂ Û¯Â-ÙÈÎ‹ ·ÛÊ¿ÏÂÈ·, ÂÚÈÛÛfiÙÂÚÔ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· Úfi-ˆÚ· ‚Ú¤ÊË, fiÙÈ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÂÓfi˜ ÙÚÔÔÔÈË-Ì¤ÓÔ˘ Á¿Ï·ÙÔ˜ ÌÂ LC-PUFAs ı· Â›¯Â ÔÏÏ¿ Ó·ÚÔÛÊ¤ÚÂÈ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÙÚfiÔ ÂÌÏÔ˘ÙÈ-ÛÌÔ‡ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ÌÂ LC-PUFAs, Â›Ó·È ÛËÌ·ÓÙÈÎfiÓ· ˘¿Ú¯ÂÈ ÛˆÛÙfi ÈÛÔ˙‡ÁÈÔ ÌÂÙ·Í‡ ˆ-3 Î·È ˆ-6 ÏÈ-·ÚÒÓ ÔÍ¤ˆÓ. ∏ ÚÔÛı‹ÎË ÌfiÓÔ ˆ-3 LC-PUFAs¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ¯·ÌËÏfiÙÂÚË Û˘ÓÔÏÈÎ‹ ·Ó¿Ù˘-ÍË, ¯·ÌËÏfiÙÂÚÔ ÏfiÁÔ ÙÔ˘ ‚¿ÚÔ˘˜ ÚÔ˜ ÙÔ ‡„Ô˜Î·È ·Ó¿Ù˘ÍË ÔÌÈÏ›·˜ ÛÙÔ˘˜ 14 Ì‹ÓÂ˜ ˙ˆ‹˜ Ô˘˘ÔÏÂ›ÂÙ·È. ∏ È‰·ÓÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË DHA Î·È ËÈ‰·ÓÈÎ‹ ·Ó·ÏÔÁ›· ˆ-3 Î·È ˆ-6 LC-PUFAs ÛÙÈ˜ ÌÂÌ-‚Ú¿ÓÂ˜ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ ‰ÂÓ Â›Ó·È ·ÎfiÌË ÁÓˆÛÙ¤˜, ÁÂ-ÁÔÓfi˜ Ô˘ ÚÔÎ·ÏÂ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ Û¯ÂÙÈÎ¿ ÌÂÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜. ÃÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÔ˘Ó ·ÎfiÌË Â-ÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜Ô˘ Ù· LC-PUFAs ‰ÚÔ˘Ó ÛÙË ‚ÚÂÊÈÎ‹ ·Ó¿Ù˘ÍË.


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£ÂˆÚÂ›Ù·È ÛÎfiÈÌÔ Ó· ÚÔÛÙ›ıÂÓÙ·È Ù· ˆ-3 Î·È ˆ-6 ÏÈ·Ú¿ ÔÍ¤· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ ÛÙÈ˜ ·Ó·ÏÔÁ›Â˜ Ô˘˘¿Ú¯Ô˘Ó ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∞˘Ù¤˜ Â›Ó·È 10:1 ÁÈ·Ù· LA Î·È ALA Î·È 2:1 ÁÈ· Ù· AA Î·È DHA (59). ŒÙÛÈ,Ì›· ÈÛÔÚÚÔËÌ¤ÓË Î·È ÚÔÛÂÎÙÈÎ‹ ÚÔÛı‹ÎË LC-PUFAs ı· ÌÔÚÔ‡ÛÂ Ó· ÈÎ·ÓÔÔÈ‹ÛÂÈ ÙËÓ ·Ó¿ÁÎËÙˆÓ ‚ÚÂÊÒÓ ÛÂ ÏÈ·Ú¿ ÔÍ¤·, È‰È·›ÙÂÚ· ÙˆÓ ÚÔÒ-ÚˆÓ Î·È ·˘ÙÒÓ ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜. º˘ÛÈ-Î¿, Ô ÚfiÏÔ˜ ÙˆÓ LC-PUFAs ‰ÂÓ ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›Ï‹Úˆ˜. ∞·ÈÙÔ‡ÓÙ·È ÂÈÏ¤ÔÓ ¤ÚÂ˘ÓÂ˜ ÒÛÙÂ Ó·ÙÂÎÌËÚÈˆıÂ› Ë Â˘ÂÚÁÂÙÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË ÛÙË ‰È·ÙÚÔ-Ê‹ ÙˆÓ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ‚ÚÂÊÒÓ, Î·ıÒ˜Î·È ÔÈ È‰·ÓÈÎ¤˜ ·Ó·ÏÔÁ›Â˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Heird WC. The role of polyunsaturated fatty acids in term

and preterm infants and breastfeeding mothers. Pediatr ClinNorth Am 2001;48:173-185.

2. Giovannini M, Riva E, Agostoni C. Fatty acids in pediatricnutrition. Pediatr Clin North Am 1995;42:861-877.

3. Voss A, Reinhart M, Sankarappa S, Sprecher H. Themetabolism of 7,10,13,16,19-docosapentaenoic acid to4,7,10,13,16,19-docosahexaenoic acid in rat liver isindependent of a 4-desaturase. J Biol Chem 1991;266:19995-20000.

4. Makrides M, Neumann MA, Byard RW, Simmer K, GibsonRA. Fatty acid composition of brain, retina, and erythrocytesin breast- and formula-fed infants. Am J Clin Nutr1994;60:189-194.

5. Crawford MA, Costeloe K, Ghebremeskel K, Phylactos A.The inadequacy of the essential fatty acid content of presentpreterm feeds. Eur J Pediatr 1998;157 (Suppl 1):S23-S27.

6. Innis SM. Plasma and red blood cell fatty acid values asindexes of essential fatty acids in the developing organs ofinfants fed with milk or formulas. J Pediatr 1992;120:S78-86.

7. Decsi T, Thiel I, Koletzko B. Essential fatty acids in full terminfants fed breast milk or formula. Arch Dis Child FetalNeonatal Ed 1995;72:F23-F28.

8. Maurage C, Guesnet P, Pinault M, Rochette de LempdesJB, Galent A, Durand G et al. Plasma and erythrocytephospholipid fatty acids of term infants fed breast milk orformulas supplemented with docosahexaenoic acid (DHA).J Pediatr Gastroenterol Nutr 1997;24:491.

9. Xiang ª, Zetterstrom R. Relation between polyunsaturatedfatty acids and growth. Acta Paediatr 1999;88:78-82.

10. Agostoni C, Marangoni F, Bernardo L, Lammardo AM, GalliC, Riva E. Long-chain polyunsaturated fatty acids in humanmilk. Acta Paediatr 1999;88 (Suppl):68-71.

11. Jensen RG. The lipids in human milk. Prog Lipid Res1996;35:53-92.

12. Hachey DL, Thomas MR, Emken EA, Garza C, Brown-BoothL, Adlof RO et al. Human lactation: maternal transfer ofdietary triglycerides labeled with stable isotopes. J Lipid Res1987;28:1185-1192.

13. Farquharson J, Cockburn F, Patrick WA, Jamieson EC,Logan RW. Infant cerebral cortex phospholipid fatty-acidcomposition and diet. Lancet 1992;340:810-813.

14. Agostoni C, Trojan S, Bellu R, Riva E, Bruzzese MG,

Giovannini M. Developmental quotient at 24 months andfatty acid composition of diet in early infancy: a follow upstudy. Arch Dis Child 1997;76:421-424.

15. Koletzko B, Mrotzek M, Bremer HJ. Fatty acid compositionof mature milk in Germany. Am J Clin Nutr 1988;47:954-959.

16. Makrides M, Neumann M, Simmer K, Pater J, Gibson R. Arelong-chain polyunsaturated fatty acids essential nutrients ininfancy? Lancet 1995;345:1463-1468.

17. Hamosh M, Salem N Jr. Long-chain polyunsaturated fattyacids. Biol Neonate 1998;74:106-120.

18. Crawford M. Placental delivery of arachidonic anddocosahexaenoic acids: implications for the lipid nutrition ofpreterm infants. Am J Clin Nutr 2000;71:S275-S284.

19. Martinez M. Tissue levels of polyunsaturated fatty acidsduring early human development. J Pediatr 1992;120:S129-138.

20. Clandinin MT, Chappell JE, Leong S, Heim T, Swyer PR,Chance GW. Intrauterine fatty acid accretion rates in humanbrain: implications for fatty acid requirements. Early HumDev 1980;4:121-124.

21. Zelczak G, Klowat B, Kramer M, Jacobs D, Lentze MJ.Psychomotor development of term infants receiving LC-PUFA-enriched formula in a prospective, randomized,double blind study. J Pediatr Gastroenterol Nutr 1997;24:492.

22. Carlson SE, Rhodes PG, Ferguson MG. Docosahexaenoicacid status of preterm infants at birth and following feedingwith human milk or formula. Am J Clin Nutr 1986;44:798-804.

23. Reynolds A. Breastfeeding and brain development. PediatrClin North Am 2001;48:159-169.

24. Carlson SE. Long-chain polyunsaturated fatty acids anddevelopment of human infants. Acta Paediatr Suppl1999;88:72-77.

25. Koletzko B, Braun M. Arachidonic acid and early humangrowth: is there a relation? Ann Nutr Metab 1991;35:128-131.

26. Olsen SF, Hansen HS, Sorensen TI, Jensen B, Secher NJ,Sommer S et al. Intake of marine fat, rich in (n-3)-polyunsaturated fatty acids, may increase birthweight byprolonging gestation. Lancet 1986;2:367-369.

27. Holman RT. The slow discovery of the importance of omega3 essential fatty acids in human health. J Nutr 1998;128 (2Suppl):S427-S433.

28. Innis SM. Essential fatty acids in growth and development.Prog Lipid Res 1991;30:39-103.

29. Crawford MA, Doyle W, Drury P, Lennon A, Costeloe K,Leighfield M. n-6 and n-3 fatty acids during early humandevelopment. J Intern Med 1989;225 (Suppl):159-169.

30. Chirouze V, Lapillonne A, Putet G, Salle BL. Red blood cellfatty acid composition in low-birth-weight infants fed eitherhuman milk or formula during the first months of life. ActaPaediatr 1994;405 (Suppl):70-77.

31. Birch E, Birch D, Hoffman D, Hale L, Everett M, Uauy R.Breast-feeding and optimal visual development. J PediatrOphthalmol Strabismus 1993;30:33-38.

32. Carlson SE, Werkman SH, Rhodes PG, Tolley EA. Visual-acuity development in healthy preterm infants: effect ofmarine-oil supplementation. Am J Clin Nutr 1993;58:35-42.

33. Gibson RA, Makrides M. Polyunsaturated fatty acids and

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·18

infant visual development: a critical appraisal ofrandomised clinical trials. Lipids 1999;34:179-184.

34. Auestad N, Montalto MB, Hall RT, Fitzgerald KM, WheelerRE, Connor WE et al. Visual acuity, erythrocyte fatty acidcomposition, and growth in term infants fed formulas withlong chain polyunsaturated fatty acids for one year. PediatrRes 1997;41:1-10.

35. Hoffman DR, Uauy R et al. Essentiality of dietary omega 3fatty acids for premature infants: plasma and red blood cellfatty acid composition. Lipids 1992;27:886-895.

36. Carlson SE, Werkman SH. A randomised trial of visualattention of preterm infants fed docosahexaenoic acid untiltwo months. Lipids 1996;31:85-90.

37. Makrides M, Simmer K, Goggin M, Gibson RA. Erythrocytedocosahexaenoic acid correlates with the visual responseof healthy, term infants. Pediatr Res 1993;33:425-427.

38. Birch EE, Hoffman DR, Uauy R, Birch DG, Prestidge C.Visual acuity and the essentiality of docosahexaenoic acidand arachidonic acid in the diet of term infants. Pediatr Res1998;44:201-209.

39. Carlson SE, Ford AJ, Werkman SH, Peeples JM, Koo WW.Visual acuity and fatty acid status of term infants fed humanmilk and formulas with and without docosahexaenoate andarachidonate from egg yolk lecithin. Pediatr Res1996;39:882-888.

40. Lucas A, Stafford M, Morley R, Abbott R, Stephenson T,MacFadyen U et al. Efficacy and safety of long-chainpolyunsaturated fatty acid supplementation of infant-formula milk: a randomized trial. Lancet 1999;354:1948-1954.

41. Cogill SR, Caplan HL, Alexandra H, Robson KM, Kumar R.Impact of maternal postnatal depression on cognitivedevelopment of young children. Br Med J 1986;292:1165-1167.

42. Anderson JW, Johnstone BM, Remley DT. Breast-feedingand cognitive development: a meta-analysis. Am J Clin Nutr1999;70:525-535.

43. Florey CD, Leech AM, Blackhall A. Infant feeding andmental and motor development at 18 months of age in firstborn singletons. Int J Epidemiol 1995;24 (Suppl 1):S21-S26.

44. Doyle LW, Rickards AL, Kelly EA, Ford GW, Callanan C.Breastfeeding and intelligence [letter]. Lancet 1992;339:744-745.

45. Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. Arandomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental developmentin term infants. Dev Med Child Neurol 2000;42:174-181.

46. Willatts P, Forsyth JS, DiModugno MK, Varma S, Colvin M.Effect of long-chain polyunsaturated fatty acids in infantformula on problem solving at 10 months of age. Lancet1998;352:688-691.

47. Jacobson SW, Jacobson JL, O’Neill JM, Padgett RJ,Frankowski JJ, Bihun JT. Visual expectation anddimensions of infant information processing. Child Dev1992;63:711-724.

48. Carlson SE, Cooke RJ, Werkman SH, Tolley EA. First yeargrowth of preterm infants fed standard compared to marineoil n-3 supplemented formula. Lipids 1992;27:901-907.

49. Carlson SE, Montalto MB, Ponder DL, Werkman SH,Korones SB. Lower incidence of necrotizing enterocolitis ininfants fed a preterm formula with egg phospholipids.Pediatr Res 1998;44:491-498.

50. Uauy R, Hoffman DR, Birch EE, Birch DG, Jameson DM,Tyson J. Safety and efficacy of omega-3 fatty acids in thenutrition of very low birth weight infants: soy oil and marineoil supplementation of formula. J Pediatr 1994;124:612-620.

51. Auestad N, Montalto MB, Hall RT, Fitzgerald KM, WheelerRE, Connor WE et al. Visual acuity, erythrocyte fatty acidcomposition, and growth in term infants fed formulas withlong chain polyunsaturated fatty acids for one year. PediatrRes 1997;41:1-10.

52. Decsi T, Fekete M, Koletzko B. Plasma lipid andapolipoprotein concentrations in full term infants fed formulasupplemented with long-chain polyunsaturated fatty acidsand cholesterol. Eur J Pediatr 1997;156:397-400.

53. Akeson PM, Axelsson IE, Raiha NC. Plasma lipids andapolipoproteins in breastfed and formula-fed Swedishinfants. Acta Paediatr 1999;88:1-6.

54. Kallio MJ, Salmenpera L, Siimes MA, Perheentupa J,Miettinen TA. Exclusive breast-feeding and weaning: effecton serum cholesterol and lipoprotein concentrations ininfants during the first year of life. Pediatrics 1992;89:663-666.

55. Salo P, Viikari J, Ronnemaa T, Hamalainen M, Jokinen E,Valimaki I et al. Milk type during mixed feeding: contributionto serum cholesterol ester fatty acids in late infancy. JPediatr 1997;130:110-116.

56. Wong WW, Hachey DL, Insull W, Opekun AR, Klein PD.Effect of dietary cholesterol on cholesterol synthesis inbreast-fed and formula-fed infants. J Lipid Res1993;34:1403-1411.

57. Decsi T, Koletzko B. Polyunsaturated fatty acids in infantnutrition. Acta Paediatr 1994;83 (Suppl):31-37.

58. Koletzko B, Thiel I, Abiodun PO. The fatty acid compositionof human milk in Europe and Africa. J Pediatr 1992;120:S62-S70.

59. Clark KJ, Makrides M, Neumann MA, Gibson RA.Determination of the optimal ratio of linoleic acid to alpha-linolenic acid in infant formulas. J Pediatr 1992;120:S151-S158.


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�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛËÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ıÂÚ-Ì·ÓÙÈÎ¿ ÛÒÌ·Ù· (Î·ÏÔÚÈÊ¤Ú) Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· Ë¤ÎÙ·ÛË Î·È Ê‡ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, ÔÈ ·Ú¿ÁÔÓÙÂ˜ÎÈÓ‰‡ÓÔ˘ Î·È Ë ÚfiÙ·ÛË ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ. ÃÚË-ÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â‰ÔÌ¤Ó· ·fi ÙË ‚¿ÛË EDISS(Emergency Department Injury SurveillanceSystem) Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÂ ·Ù˘¯‹Ì·Ù· ÙË˜ ÂÚÈfi-‰Ô˘ 1996-1998, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÛÂ Ù¤Û-ÛÂÚ· ÌÂÁ¿Ï· ·È‰È·ÙÚÈÎ¿ ÓÔÛÔÎÔÌÂ›· ÙË˜ ¯ÒÚ·˜.∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË Û˘ÌÂÚÈ¤Ï·‚Â ÂÚÈÛÙ·ÙÈÎ¿ 533·È‰ÈÒÓ Î¿Ùˆ ÙˆÓ 14 ÂÙÒÓ. ø˜ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ıÂ-ˆÚ‹ıËÎ·Ó 21.865 ·È‰È¿ Ô˘ ˘¤ÛÙËÛ·Ó ¿ÏÏÔ˘˜ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ÛÂ ÂÛˆÙÂÚÈÎfi ¯ÒÚÔ. OÈ ·ÓÔÈ¯Ù¤˜Î·ÎÒÛÂÈ˜ ÙË˜ ÎÂÊ·Ï‹˜ ‹Ù·Ó Ô Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜ÙÚ·˘Ì·ÙÈÛÌÔ‡, ÂÓÒ ÌfiÓÔ 8 ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È-‰ÈÒÓ ˘¤ÛÙËÛ·Ó ¤ÁÎ·˘Ì· ·fi Â·Ê‹ ÌÂ ıÂÚÌ·ÓÙÈ-Îfi ÛÒÌ·. ∆Ô 63% ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ Ô˘ Û¯ÂÙ›˙Ô-ÓÙ·Ó ÌÂ ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ·ÊÔÚÔ‡ÛÂ ÛÂ ·È‰È¿Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ, ÂÓÒ ÙÔ 65% ·ÊÔÚÔ‡ÛÂ ÛÂ ·Áfi-ÚÈ·. ¢‡Ô ‹Ù·Ó ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓÔ˘ ÙÚ·˘Ì·Ù›˙ÔÓÙ·Ó ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·: ËÌ›· ·ÊÔÚÔ‡ÛÂ ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (10-14 ÂÙÒÓ)Ô˘ ˘¤ÛÙËÛ·Ó ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ (Î˘Ú›ˆ˜ Î·Ù¿ÁÌ·-Ù·, ÂÍ·ÚıÚ‹Ì·Ù· Î·È ‰È·ÛÙÚ¤ÌÌ·Ù· ¿ÎÚˆÓ) ÛÂ ÂÎ-·È‰Â˘ÙÈÎ¿ È‰Ú‡Ì·Ù·, ÂÓÒ Ë ‰Â‡ÙÂÚË Û˘ÌÂÚÈÏ¿Ì-‚·ÓÂ ·È‰È¿ Î¿Ùˆ ÙˆÓ 4 ÂÙÒÓ, Ù· ÔÔ›· ÙÚ·˘Ì·Ù›-˙ÔÓÙ·Ó ÌÂÙ¿ ·fi ÙÒÛË ·fi ‡„Ô˜ ÛÙÔ ¯ÒÚÔ ÙË˜ÎÔ˘˙›Ó·˜ ‹ ÙÔ˘ Î·ıÈÛÙÈÎÔ‡, ·Ú’ fiÏÔ Ô˘ ‚Ú›ÛÎÔ-ÓÙ·Ó ˘fi ÙËÓ ÂÈÙ‹ÚËÛË ÂÓËÏ›ÎˆÓ. ∂ÁÎ·‡Ì·Ù· ·-Ú·ÙËÚ‹ıËÎ·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙË ‰Â‡ÙÂÚË ÔÌ¿‰··È‰ÈÒÓ. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛËÌÂÈÒÓÂÙ·È fiÙÈ ÔÈÙÚ·˘Ì·ÙÈÛÌÔ› Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÂ ıÂÚÌ·ÓÙÈÎ¿

�Abstract: This research aimed to identify themagnitude, nature and risk factors of childhoodinjuries related to central heating devices in Greeceand to propose preventive strategies. We used datarecorded by the Emergency Department InjurySurveillance System (EDISS) over a three-yearperiod (1996-1998) in four major pediatric hospitalsacross the country. The case group comprised offive hundred and thirty-three children less than 14years-old, while 21865 children with other indoorinjuries were used as controls. Open wounds of thehead were the most common injuries and only eightchildren sustained burn injuries due to thesedevices. Sixty-three percent of central heatingdevice related injuries were noted among childrenless than five years-old with a significant malepreponderance (65%). Of the clusters identified,two are the most important: the first refers to olderchildren (10-14 years old), who frequently sustaincentral heating device related injuries (mainlyfractures, dislocations and strains of the limbs) ineducational buildings. The second cluster includeschildren less than 4 years old who suffer injuries -mainly falls from height - in the kitchen as well asthe living room and bedroom despite recordedsupervision. Burns were noted exclusively in thisgroup. As a conclusion, injuries related to centralheating devices represent a small, but notnegligible, fraction of all indoor injuries. Preventionstrategies pertain mainly to modifications of theproduct design or safer use of it and improvementsin building design.

T· ÛÒÌ·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ ˆ˜ ·ÈÙ›· ·È‰ÈÎÒÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ, ·ÏÏ¿ Û·Ó›ˆ˜ ÂÁÎ·˘Ì¿ÙˆÓ ∂. ¶ÂÙÚ›‰Ô˘1,2, ¡. ª. ∞Ï¤ÍÂ1, º. ¶··‰fiÔ˘ÏÔ˜1, ¢. ∆ÚÈ¯fiÔ˘ÏÔ˜1,2

Central heating devices cause childhood injuries but rarely burns E. Petridou1,2, D. M. Alexe1, F. Papadopoulos1, D. Trichopoulos1,2

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

2 ∆Ì‹Ì· ∂È‰ËÌÈÔÏÔÁ›·˜, ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁÂ›·˜, ¶·ÓÂÈÛÙ‹ÌÈÔ Harvard, ∏¶∞

1 Department of Hygiene and Epidemiology, University of Athens Medical School

2 Department of Epidemiology, Harvard School of Public Health, USA

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ÛÒÌ·Ù· ·ÔÙÂÏÔ‡Ó ÌÈÎÚfi, ·ÏÏ¿ fi¯È ·ÌÂÏËÙ¤Ô ÎÏ¿-ÛÌ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÂ ÂÛˆÙÂÚÈ-ÎÔ‡˜ ¯ÒÚÔ˘˜. ∆· Ì¤ÙÚ· ÚfiÏË„Ë˜ ÙˆÓ ·Ù˘¯ËÌ¿-ÙˆÓ ·˘ÙÒÓ Û˘Ó›ÛÙ·ÓÙ·È Î˘Ú›ˆ˜ ÛÂ ÙÚÔÔÔ›ËÛËÙÔ˘ Û¯Â‰È·ÛÌÔ‡ ÙˆÓ ıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ ‹ Î·ÈÙˆÓ ÎÙÈÚÈ·ÎÒÓ ˘Ô‰ÔÌÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ıÂÚÌ·ÓÙÈÎfi ÛÒÌ·, Î·ÏÔÚÈÊ¤Ú, ·Ù‡-¯ËÌ·, ÙÚ·˘Ì·ÙÈÛÌfi˜, ·È‰›.

Key words: central heating device, childhoodinjury, safety modifications.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ EDISS Emergency Department Injury

Surveillance System∫∂¶¶∞ ∫¤ÓÙÚÔ ŒÚÂ˘Ó·˜ Î·È ¶ÚfiÏË„Ë˜

¶·È‰ÈÎÒÓ ∞Ù˘¯ËÌ¿ÙˆÓEHLASS The European Home and Leisure

Accidents Surveillance SystemNOMESCO Nordic Medico - Statistical

CommitteeICD9 International Classification of

Diseases 9th rev.

∂ÈÛ·ÁˆÁ‹O Û¯Â‰È·ÛÌfi˜ ÙˆÓ ıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ ¤¯ÂÈ

‚ÂÏÙÈˆıÂ› ÛËÌ·ÓÙÈÎ¿ Î·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô ·ÈÒÓ·,fiÛÔÓ ·ÊÔÚ¿ ÙfiÛÔ ÛÙËÓ ·ÛÊ¿ÏÂÈ· fiÛÔ Î·È ÛÙË ÏÂÈ-ÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘˜. ∆· Û˘ÛÙ‹Ì·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤Ú-Ì·ÓÛË˜ ¤¯Ô˘Ó Ï¤ÔÓ ·ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ ıÂÚÌ·ÓÙÈÎ¤˜ËÁ¤˜ fiˆ˜ ÙÔ Ù˙¿ÎÈ Î·È Ë ÛfiÌ· Í‡ÏÔ˘, ‚ÂÏÙÈÒÓÔ-ÓÙ·˜ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÌÂÈÒÓÔÓÙ·˜ ÙÔÓ Î›Ó‰˘-ÓÔ ˘ÚÎ·ÁÈ¿˜.

§fiÁˆ ÙÔ˘ Â‡ÎÚ·ÙÔ˘ ÎÏ›Ì·ÙÔ˜ ÙË˜ ¯ÒÚ·˜ Ì·˜, Ë¯Ú‹ÛË ıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ ÛÙÔ Û›ÙÈ Â›Ó·È ·Ó·-ÁÎ·›· ÌfiÓÔ ÁÈ· Ù¤ÛÛÂÚÈ˜ Ì‹ÓÂ˜ ÙÔ ¯ÚfiÓÔ ÛÙ· Â-ÚÈÛÛfiÙÂÚ· ‰È·ÌÂÚ›ÛÌ·Ù· ÙË˜ ¯ÒÚ·˜. ∆· ÎÏ·ÛÈÎ¿Ù˙¿ÎÈ· ‰ÂÓ ·ÔÙÂÏÔ‡Û·Ó ÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ˘ÚÎ·-ÁÈ¿˜, Î·ıÒ˜ Ù· ÂÚÈÛÛfiÙÂÚ· Û›ÙÈ· ‹Ù·Ó ¯ÙÈÛÌ¤Ó·ÌÂ ÌË Â‡ÊÏÂÎÙ· ˘ÏÈÎ¿, fiˆ˜ ¤ÙÚÂ˜ Î·È ÙÔ‡‚Ï·.ª¤¯ÚÈ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1960, fiÌˆ˜, ·ÚÎÂÙ¤˜ ÂÚÈ-ÙÒÛÂÈ˜ ı·Ó·ÙËÊfiÚˆÓ ÂÚÈÙÒÛÂˆÓ ‰ËÏËÙËÚ›·-ÛË˜ ·fi ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ¿ÓıÚ·Î· Î·Ù·ÁÚ¿ÊÔÓÙ·ÓÎ¿ıÂ ¯ÚfiÓÔ.

™ÙÈ˜ Ì¤ÚÂ˜ Ì·˜, Ù· Û˘ÛÙ‹Ì·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤Ú-Ì·ÓÛË˜ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ Ì¤ÛÔ ı¤ÚÌ·ÓÛË˜, ÂÓÒÛÙ·‰È·Î¿ ÂÈÛ¿ÁÂÙ·È Î·È Ë ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ ÎÏÈÌ·ÙÈ-ÛÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ. ∞Ó Î·È Ù· Û˘ÛÙ‹Ì·Ù· ÎÂÓÙÚÈ-Î‹˜ ı¤ÚÌ·ÓÛË˜ ıÂˆÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ ·ÛÊ·Ï‹, ÌÂÏ¤-ÙÂ˜ ÛÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1990 ¤‰ÂÈÍ·Ó fiÙÈ ÂÁÎ·‡Ì·Ù·Î·È ¿ÏÏÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂ ÙË ¯Ú‹ÛËıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ (1,2).

øÛÙfiÛÔ, Ï›ÁÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ÂÎÔÓËıÂ› ÌÂÁÓÒÌÔÓ· ÙÔ˘˜ ‰˘ÓËÙÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÚ·˘Ì·ÙÈ-ÛÌÔ‡ ·fi ÙË ¯Ú‹ÛË ıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ, ÂÓÒ ÔÈ

ÂÚÈÛÛfiÙÂÚÂ˜ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙ· ÂÁÎ·‡Ì·Ù· Ô˘ÌÔÚÂ› Ó· ÚÔÎÏËıÔ‡Ó ·fi ÙÈ˜ ÂÁÎ·Ù·ÛÙ¿ÛÂÈ˜ ·˘-Ù¤˜ (3-6). ∏ Û˘¯ÓfiÙËÙ·, Ë ‚·Ú‡ÙËÙ· Î·È Ë ¤Î‚·ÛË¿ÏÏˆÓ Ù‡ˆÓ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ·fi Ù· ıÂÚÌ·ÓÙÈÎ¿ÛÒÌ·Ù· ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› Â·ÚÎÒ˜.

°È· Ó· ˘ÔÏÔÁÈÛÙÂ› Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÙÚ·˘Ì·ÙÈ-ÛÌÒÓ ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ÛÂ ·È‰È¿ Î·È Ó· ÌÂ-ÏÂÙËıÔ‡Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ·˘ÙÒÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ì›· ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ Ô˘ÂÚÈÏ·Ì‚¿ÓÂÈ 300.000 ¿ÙÔÌ· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·ÓÛÂ ÙÌ‹Ì·Ù· ∂ÂÈÁfiÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ ÂÓfi˜ ‰ÈÎÙ‡-Ô˘ Û˘ÓÂÚÁ·˙fiÌÂÓˆÓ ÓÔÛÔÎÔÌÂ›ˆÓ, ¤¯ÔÓÙ·˜ ˘Ô-ÛÙÂ› ÙÚ·˘Ì·ÙÈÛÌfi.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆Ô ∫¤ÓÙÚÔ ŒÚÂ˘Ó·˜ Î·È ¶ÚfiÏË„Ë˜ ¶·È‰ÈÎÒÓ ∞Ù˘¯ËÌ¿-

ÙˆÓ (∫∂¶¶∞) È‰Ú‡ıËÎÂ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ ÛÙÔ ∆Ì‹Ì·ÀÁÈÂÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜ ÙË˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂ-ÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÌÂ ÛÎÔfi ÙË ‰ÈÂÚÂ‡ÓËÛË Î·È ÚfiÏË„ËÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ. ™Â Û˘ÓÂÚÁ·Û›· ÌÂ Ù¤ÛÛÂÚ· ÌÂ-Á¿Ï· ÓÔÛÔÎÔÌÂ›· ÙË˜ ¯ÒÚ·˜, ¤¯ÂÈ ·Ó·Ù˘¯ıÂ› Î·È ‰È·ÙËÚÂ›-Ù·È ·fi ÙÔ ∫∂¶¶∞ Ì›· ÌÂÁ¿ÏË ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ (EmergencyDepartment Injury Surveillance System-EDISS), Ë ÔÔ›· Î·-Ï‡ÙÂÈ fiÏÔ˘˜ ÙÔ˘˜ Ù‡Ô˘˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÁÈ· fiÏÂ˜ ÙÈ˜ ËÏÈ-ÎÈ·Î¤˜ ÔÌ¿‰Â˜. ¢‡Ô ·fi Ù· Ù¤ÛÛÂÚ· ÓÔÛÔÎÔÌÂ›·, ÙÔ ¶·ÓÂ-ÈÛÙËÌÈ·Îfi ¶·È‰È·ÙÚÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” Î·ÈÙÔ ¡ÔÛÔÎÔÌÂ›Ô ∞Ù˘¯ËÌ¿ÙˆÓ “∞ÛÎÏËÈÂ›Ô” µÔ‡Ï·˜, ÂÓÙÔ›˙Ô-ÓÙ·È ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ÙˆÓ ∞ıËÓÒÓ. ∆· ¿ÏÏ· ‰‡Ô ÓÔ-ÛÔÎÔÌÂ›· ‚Ú›ÛÎÔÓÙ·È ÂÎÙfi˜ ∞ıËÓÒÓ Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· ÛÙÔµfiÏÔ (“¡ÔÌ·Ú¯È·Îfi ¡ÔÛÔÎÔÌÂ›Ô ª·ÁÓËÛ›·˜”) Î·È ÛÙËÓ ∫¤Ú-Î˘Ú· (“¡ÔÌ·Ú¯È·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∫¤ÚÎ˘Ú·˜”). ∏ ‚¿ÛË Î·Ï‡-ÙÂÈ fiÏ· Ù· ÂÚÈÛÙ·ÙÈÎ¿ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ ·ÚÔ˘-ÛÈ¿ÛÙËÎ·Ó ÛÙÔ ÙÌ‹Ì· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÙˆÓ Û˘ÓÂÚ-Á·˙fiÌÂÓˆÓ ÓÔÛÔÎÔÌÂ›ˆÓ ÙËÓ ÂÚ›Ô‰Ô 1996-1998.

∂È‰ÈÎ¿ ÂÎ·È‰Â˘Ì¤ÓÂ˜ ÂÈÛÎ¤ÙÚÈÂ˜ ˘ÁÂ›·˜ ‹Ú·Ó ÚÔ-ÛˆÈÎ¿ Û˘Ó¤ÓÙÂ˘ÍË ·fi ÙÔ ·È‰› Î·È ÙÔ Û˘ÓÔ‰fi ÙÔ˘, ¯ÚËÛÈ-ÌÔÔÈÒÓÙ·˜ ¤Ó· ÚÔ-Îˆ‰ÈÎÔÔÈËÌ¤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, Û˘Ï-Ï¤ÁÔÓÙ·˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÎÔÈÓˆÓÈÎ¿ Î·È ‰ËÌÔÁÚ·-ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ Î·È ÙÈ˜ ÏÂ-ÙÔÌ¤ÚÂÈÂ˜ ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌÔ‡.

∏ ÂÈÏÔÁ‹ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ¤ÁÈÓÂ ÌÂ ÎÚÈÙ‹ÚÈÔ ÙË Û˘Ì-ÌÂÙÔ¯‹ ÙÔ˘ ıÂÚÌ·ÓÙÈÎÔ‡ ÛÒÌ·ÙÔ˜ ‹ ÙÔ˘ ÛˆÏ‹Ó· ÙÔ˘ Û˘ÛÙ‹-Ì·ÙÔ˜ ı¤ÚÌ·ÓÛË˜ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜. °È· ÙËÓ

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22

¶›Ó·Î·˜ 1. ∫·Ù·ÓÔÌ‹ ÙˆÓ 22.398 ·È‰ÈÒÓ (0-14 ÂÙÒÓ) Ô˘ ˘¤ÛÙËÛ·Ó ·Ù‡¯ËÌ· ÛÂ ÂÛˆÙÂÚÈÎfi ¯ÒÚÔ Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÛÙÔEDISS, ÁÈ· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô ÙÚÈÒÓ ÂÙÒÓ (1996-1998) ˆ˜ ÚÔ˜ ÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÂÙ·‚ÏËÙ¤˜

ªÂÙ·‚ÏËÙ‹ ∞Ù˘¯‹Ì·Ù· ·fi ÕÏÏ· ·Ù˘¯‹Ì·Ù· ∆ÈÌ‹ ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘ ÎÚÈÙËÚ›Ô˘

No % No %

¢ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿∏ÏÈÎ›· (¤ÙË) 0,001

0-4 335 62,9 12814 58,65-9 144 27,0 5575 25,510-14 54 10,1 3476 15,9

º‡ÏÔ 0,001ÕÚÚÂÓ 346 64,9 12549 57,4£‹Ï˘ 187 35,1 9316 42,6

∂ıÓÈÎfiÙËÙ· 0,21∂ÏÏËÓÈÎ‹ 514 96,4 20834 95,3ÕÏÏË 19 3,6 1031 4,7

°ÂˆÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹ 0,88∞ı‹Ó· 449 84,2 18473 84,5∞ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ 84 15,8 3392 15,5

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ·Ù˘¯‹Ì·ÙÔ˜∆fiÔ˜ 0,001

™›ÙÈ∫·ıÈÛÙÈÎfi 177 33,2 5664 25,9∫ÚÂ‚·ÙÔÎ¿Ì·Ú· 164 30,8 6768 30,9∫Ô˘˙›Ó· 44 8,3 3539 16,2∞ÏÏÔ‡ 54 10,1 3253 14,9

∂Î·È‰Â˘ÙÈÎfi-‰ËÌfiÛÈÔ ÎÙ›ÚÈÔ 94 17,6 2641 12,1ÃÚfiÓÔ˜ 0,26

¶ÚˆÈÓ¤˜ ÒÚÂ˜ (9.00-20.59) 439 82,4 18405 84,2¡˘¯ÙÂÚÈÓ¤˜ ÒÚÂ˜ (21.00-8.59) 94 17,6 3460 15,8

∏Ì¤Ú· 0,35∫·ıËÌÂÚÈÓ‹ 387 72,6 15470 70,7™·‚‚·ÙÔÎ‡ÚÈ·ÎÔ 146 27,4 6395 29,3

∂Ô¯‹ 0,001∑ÂÛÙÔ› Ì‹ÓÂ˜ (∞Ú›ÏÈÔ˜-™ÂÙ¤Ì‚ÚÈÔ˜) 191 35,8 9619 44,0æ˘¯ÚÔ› Ì‹ÓÂ˜ (OÎÙÒ‚ÚÈÔ˜-ª¿ÚÙÈÔ˜) 342 64,2 12246 56,0

ªË¯·ÓÈÛÌfi˜ Î¿ÎˆÛË˜ 0,001¶ÙÒÛË ·fi ‡„Ô˜ 109 20,5 5946 27,2¶ÙÒÛË ·fi ·Ú·¿ÙËÌ·/ÁÏ›ÛÙÚËÌ· 190 35,6 4659 21,3¶ÙÒÛË ·fi Û‡ÁÎÚÔ˘ÛË/ÛÚÒÍÈÌÔ ·fi ÙÚ›ÙÔ ¿ÙÔÌÔ 66 12,4 1097 5,0™‡ÁÎÚÔ˘ÛË ÌÂ ·ÓÙÈÎÂ›ÌÂÓÔ 145 27,2 3513 16,1∂·Ê‹ ÌÂ ˙ÂÛÙfi ·ÓÙÈÎÂ›ÌÂÓÔ 8 1,5 1026 4,7ÕÏÏÔ˜ 15 2,8 5624 25,7

∂ÈÙ‹ÚËÛË 0,06¡·È 374 70,2 14488 66,3Ÿ¯È 159 29,8 7377 33,7

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ Î¿ÎˆÛË˜∆‡Ô˜ Î¿ÎˆÛË˜ 0,001

∞ÓÔÈ¯Ùfi ÙÚ·‡Ì· 412 77,3 7325 33,5∂Î¯‡ÌˆÛË 78 14,6 5581 25,5∫¿Ù·ÁÌ· 11 2,1 1855 8,5∂Í¿ÚıÚËÌ·, ‰È¿ÛÙÚÂÌÌ· 3 0,6 1972 9,0¢È¿ÛÂÈÛË 7 1,3 583 2,7ŒÁÎ·˘Ì· 8 1,5 1111 5,1ÕÏÏÔ˜ 0 0,0 1542 7,0∫·Ì›· Î¿ÎˆÛË 14 2,6 1896 8,7

ª¤ÏÔ˜ ÛÒÌ·ÙÔ˜ Ô˘ ˘¤ÛÙË ÙËÓ Î¿ÎˆÛË 0,001∫ÂÊ·Ï‹ 279 52,3 4523 20,7

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·22

¿ÓÙÏËÛË ‰Â‰ÔÌ¤ÓˆÓ Û¯ÂÙÈÎÒÓ ÌÂ ·Ù˘¯‹Ì·Ù· ·fi ıÂÚÌ·ÓÙÈ-Î¿ ÛÒÌ·Ù· ÛÂ ÂÛˆÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈÂÍ‹˜ ÎÒ‰ÈÎÂ˜: ·fi ÙË ‚¿ÛË EDISS 11-15, 38, 51, 53, 55, 60,62 ÁÈ· ÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜, 20220, 20230 ÁÈ· ÙÔ ÂÌÏÂ-ÎfiÌÂÓÔ ·ÓÙÈÎÂ›ÌÂÓÔ, ·fi ÙÔ ÂÁ¯ÂÈÚ›‰ÈÔ Îˆ‰ÈÎÔÔ›ËÛË˜ ÙÔ˘European Home and Leisure Accidents Surveillance System(EHLASS-1986) (7) 1382, 2041 ÁÈ· ÙÔ ÂÌÏÂÎfiÌÂÓÔ ·ÓÙÈÎÂ›-ÌÂÓÔ, ·fi ÙËÓ ∆·ÍÈÓfiÌËÛË ∂ÍˆÙÂÚÈÎÒÓ ∞ÈÙ›ˆÓ ∆Ú·˘Ì·ÙÈ-ÛÌÔ‡ ÙË˜ NOMESCO (8) Î·È Ù¤ÏÔ˜, ÔÈ ·ÓÙ›ÛÙÔÈ¯ÔÈ ÎÒ‰ÈÎÂ˜ÙÔ˘ ICD-9 (9).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÚÈÒÓ ÂÙÒÓ ÙË˜ ÌÂÏ¤ÙË˜, ÛÙË ‚¿ÛËEDISS Î·Ù·ÁÚ¿ÊËÎ·Ó 22.398 ·È‰È¿ Ô˘ Â›¯·Ó ·Ù˘¯‹Ì·Ù·ÛÂ ÂÛˆÙÂÚÈÎfi ¯ÒÚÔ. ∆· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ÂÓÂÏ¿ÎËÛ·ÓÛÂ 533 ÂÚÈÙÒÛÂÈ˜. ∆· ÛÙÔÈ¯Â›· ·˘Ù¿ Â›Ó·È ÂÚÈÁÚ·ÊÈÎ¿ Î·È‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ Î·ıÔÚÈÛÌ¤Ó· ÚfiÙ˘· ¯ÚÔÓÈÎ‹˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜-¤ÎıÂÛË˜, ÌÔÚÔ‡Ó ˆÛÙfiÛÔ Ó· ·Ó·Ï˘ıÔ‡Ó ˆ˜ÌÂÏ¤ÙË ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ. ∫·Ù¿ Û˘Ó¤ÂÈ·, ·ÛıÂÓÂ›˜ ıÂˆ-ÚÔ‡ÓÙ·È Ù· ·È‰È¿ ÌÂ ·Ù˘¯‹Ì·Ù· ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·Î·È Ì¿ÚÙ˘ÚÂ˜ Ù· ˘fiÏÔÈ· 21.865 ·È‰È¿ ÌÂ ¿ÏÏ· ·Ù˘¯‹Ì·-Ù· ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘ (10).

∏ ·Ú¯ÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ·Ï¤˜ ÈÓ·ÎÔÔÈ‹ÛÂÈ˜ ÙˆÓÛÙÔÈ¯Â›ˆÓ. ∞ÎÔÏÔ‡ıˆ˜, Ô Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜, ¤Ó· ·Ù‡¯ËÌ·Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ‹ fi¯È ·Ó¿ÏÔÁ· ÌÂ Û˘-ÁÎÂÎÚÈÌ¤ÓÂ˜ ÙÈÌ¤˜ ÙˆÓ ˘fi ÌÂÏ¤ÙË ÌÂÙ·‚ÏËÙÒÓ, ˘ÔÏÔÁ›-ÛÙËÎÂ ÌÂ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÏÔÁ·ÚÈıÌÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. ∆ÔÚÔÊ›Ï ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÓÌÂ ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· Î·ıÔÚ›ÛÙËÎÂ ÌÂÙ¿ ·fi ·Ó¿Ï˘ÛË Î·-Ù¿ Û˘ÛÙ¿‰Â˜. °È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· ÙˆÓ ÛÙÔÈ¯Â›ˆÓ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÏÔÁÈÛÌÈÎfi SAS (11).

∞ÔÙÂÏ¤ÛÌ·Ù· ∆· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ‚Ú¤ıËÎÂ fiÙÈ Â›Ó·È ˘Â‡-

ı˘Ó· ÁÈ· ÙÔ 2,4% fiÏˆÓ ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓÛÂ ÂÛˆÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜. øÛÙfiÛÔ, ÌfiÏÈ˜ 8 ·fi Ù·533 ·È‰È¿ Ô˘ ÙÚ·˘Ì·Ù›ÛÙËÎ·Ó ·fi ıÂÚÌ·ÓÙÈÎ¿ÛÒÌ·Ù· ˘¤ÛÙËÛ·Ó ¤ÁÎ·˘Ì·, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰Ë-ÏÒÓÂÈ fiÙÈ ÔÈ Û˘ÛÎÂ˘¤˜ ·˘Ù¤˜ Û˘ÓÈÛÙÔ‡Ó Î›Ó‰˘ÓÔ ÁÈ··Ù˘¯‹Ì·Ù· Î˘Ú›ˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ È‰ÈfiÙËÙ¤˜ÙÔ˘˜ ˆ˜ ÛÒÌ·Ù· Ô˘ Î·Ù·Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚÔ Ì¤Û·ÛÙÔ Û›ÙÈ, ·Ú¿ ˆ˜ ·ÓÙÈÎÂ›ÌÂÓ· Ô˘ ÂÎ¤ÌÔ˘ÓıÂÚÌfiÙËÙ·.

™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Î·Ù·ÓÔÌ¤˜

ÙˆÓ ·È‰ÈÒÓ Ô˘ ˘¤ÛÙËÛ·Ó ·Ù‡¯ËÌ· ÛÂ ÂÛˆÙÂÚÈ-Îfi ¯ÒÚÔ, ·Ó¿ÏÔÁ· ÌÂ ÙÔ ·Ó Ù· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·‹Ù·Ó Ë ·ÈÙ›· ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ‹ fi¯È, ÛÂ Û¯¤ÛË ÌÂ‰ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ÛÙÔÈ¯Â›· ÙÔ˘ ÙfiÔ˘Ô˘ ¤ÁÈÓÂ ÙÔ ·Ù‡¯ËÌ·, ·ÏÏ¿ Î·È ÛÂ Û¯¤ÛË ÌÂ ÌÂÙ·-‚ÏËÙ¤˜ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi. OÈ Û˘-ÁÎÚ›ÛÂÈ˜ ÛÙÔÓ ›Ó·Î· ·˘Ùfi ‚·Û›˙ÔÓÙ·È ÛÙÈ˜ ‰È·ÊÔ-ÚÂÙÈÎ¤˜ Î·Ù·ÓÔÌ¤˜ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·È‰ÈÒÓ Î·ÈÂÍ˘ËÚÂÙÔ‡Ó ÙËÓ ÂÚÈÁÚ·Ê‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ·Ú¿ÙËÓ ·Ó¿Ï˘Û‹ ÙÔ˘˜, Î·ıÒ˜ ‰ÂÓ ¤¯Ô˘Ó ÏËÊıÂ› ˘’fi„ÈÓ ·ÌÔÈ‚·›ÔÈ Û˘Á¯˘ÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜.

¶·Ú·ÙËÚÂ›Ù·È Ì›· ‰˘Û·Ó¿ÏÔÁË Û˘ÁÎ¤ÓÙÚˆÛËÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·, ÛÂ Û¯¤-ÛË ÌÂ Ù· ¿ÏÏ· ·Ù˘¯‹Ì·Ù· ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘, ÛÙ··È‰È¿ ÔÏ‡ ÌÈÎÚ‹˜ ËÏÈÎ›·˜ Î·È ÛÙ· ·ÁfiÚÈ·, ÂÓÒ ËÂıÓÈÎfiÙËÙ· Î·È Ë ÁÂˆÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹ ‰ÂÓ ·›˙Ô˘ÓÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙÈ˜ Û˘Óı‹ÎÂ˜ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜,‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Ô‡ÙÂ ÌÂ ÙËÓ ÒÚ· ÙÔ˘ ·Ù˘-¯‹Ì·ÙÔ˜ Ô‡ÙÂ ÌÂ ÙËÓ ËÌ¤Ú· ÙË˜ Â‚‰ÔÌ¿‰·˜. ™¯Â-‰fiÓ Ù· ‰‡Ô ÙÚ›Ù· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·fi ıÂÚÌ·ÓÙÈÎ¿ÛÒÌ·Ù· Û˘Ó¤‚ËÛ·Ó ÛÙÔ Î·ıÈÛÙÈÎfi ÙÔ˘ ÛÈÙÈÔ‡ ‹ÙËÓ ÎÚÂ‚·ÙÔÎ¿Ì·Ú·, ÂÈ‰ÈÎ¿ ÛÙ· ÌÈÎÚfiÙÂÚË˜ ËÏÈ-Î›·˜ ·È‰È¿, ÂÓÒ Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Ê·›ÓÂÙ·È fiÙÈ˘Ê›ÛÙ·ÓÙ·È Ù· ·Ù˘¯‹Ì·Ù· ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ Û˘¯Ófi-ÙÂÚ· ÛÂ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ¯ÒÚÔ˘˜.

OÈ Û˘Û¯ÂÙ›ÛÂÈ˜ ·˘Ù¤˜ ·ÓÙ·Ó·ÎÏÔ‡Ó Èı·ÓÒ˜‰È·ÊÔÚÂÙÈÎÔ‡˜ Ù‡Ô˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∏ ›‰È·˘fiıÂÛË ÌÔÚÂ› Ó· ‰È·Ù˘ˆıÂ› Î·È ÁÈ· ÙËÓ ·‡ÍËÛËÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÂÛˆÙÂÚÈ-ÎÔ‡ ¯ÒÚÔ˘ Î·Ù¿ ÙÔ˘˜ „˘¯ÚÔ‡˜ Ì‹ÓÂ˜ ÙÔ˘ ¯ÚfiÓÔ˘,fiÔ˘ ÔÈ ÂÍˆÙÂÚÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ·Ú·ÎˆÏ‡Ô-ÓÙ·È ·fi ÙÈ˜ Î·ÈÚÈÎ¤˜ Û˘Óı‹ÎÂ˜. ª¿ÏÈÛÙ·, Ë ÂÔ-¯È·Î‹ ·˘Ù‹ ‰È·Î‡Ì·ÓÛË Â›Ó·È ÈÛ¯˘ÚfiÙÂÚË ÁÈ· Ù··Ù˘¯‹Ì·Ù· ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·.

O ÈÔ Û˘¯Ófi˜ ÌË¯·ÓÈÛÌfi˜ Î¿ÎˆÛË˜ ÛÙ· ·Ù˘¯‹-Ì·Ù· ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· Â›Ó·È ÙÔ ·Ú·¿ÙË-Ì· ‹ ÙÔ ÁÏ›ÛÙÚËÌ· Î·È Ë Â·ÎfiÏÔ˘ıË Û‡ÁÎÚÔ˘ÛËÌÂ Ù· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·. ª¿ÏÈÛÙ·, ÛÙËÓ ÏÂÈÔÓfi-ÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ˘‹Ú¯Â ÂÈ‚Ï¤ˆÓ ÂÓ‹ÏÈÎ·˜ÛÙÔ ¯ÒÚÔ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒ-ÓÂÈ fiÙÈ ÔÈ ÂÈ‚Ï¤ÔÓÙÂ˜ Â›Ó·È Ì¿ÏÏÔÓ ·Ó˘Ô„›·ÛÙÔÈ


23

¶ÚfiÛˆÔ 186 34,9 6630 30,3ÕÎÚ· 58 10,9 8270 37,8∫ÔÚÌfi˜ 10 1,9 2442 11,2

∞ÚÈıÌfi˜ Î·ÎÒÛÂˆÓ 0,001ª›· 508 95,3 19625 89,8¶ÂÚÈÛÛfiÙÂÚÂ˜ ·fi Ì›· 25 4,7 2240 10,2

ŒÎ‚·ÛË 0,001ÃˆÚ›˜ ıÂÚ·Â›· 52 9,8 5017 23,0£ÂÚ·Â›· ¯ˆÚ›˜ ·Ú·ÎÔÏÔ‡ıËÛË 70 13,1 5902 27,0£ÂÚ·Â›· ÌÂ ·Ú·ÎÔÏÔ‡ıËÛË 407 76,4 9205 42,2¡ÔÛÔÎÔÌÂÈ·Î‹ ÂÚ›ı·Ï„Ë 4 0,7 1733 7,8£¿Ó·ÙÔ˜ 0 0,0 4 0,0

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·23

Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ Î›Ó‰˘ÓÔ ·Ù˘¯‹Ì·ÙÔ˜ ·fi ıÂÚÌ·ÓÙÈ-Î¿ ÛÒÌ·Ù· Î·È ¤ÙÛÈ ‰ÂÓ ÂÛÙÈ¿˙Ô˘Ó ÙËÓ ÚÔÛÔ¯‹ÙÔ˘˜ ÛÂ ·˘Ù¿.

™¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÓÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi, ‚Ú¤ıËÎÂ fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ··Ù˘¯‹Ì·Ù· ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· Â›Ó·È ·ÓÔÈ¯Ù¿ÙÚ·‡Ì·Ù· ÛÙÔ ÎÂÊ¿ÏÈ Î·È ÙÔ ÚfiÛˆÔ. ∏ ÏÂÈÔÓfi-ÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·˘ÙÒÓ (ÂÚ›Ô˘ 75%) ¯Ú‹˙ÂÈıÂÚ·Â›·˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË˜, ÁÂÁÔÓfi˜ Ô˘˘Ô‰ËÏÒÓÂÈ fiÙÈ Â›Ó·È ·ÚÎÂÙ¿ ÛÔ‚·Ú¿. ∂ÓÙÔ‡ÙÔÈ˜,Û˘Ó‹ıˆ˜ ‰ÂÓ ··ÈÙÔ‡Ó ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›ÔÎ·È ‰ÂÓ Â›Ó·È ·ÂÈÏËÙÈÎ¿ ÁÈ· ÙË ˙ˆ‹.

™ÙÔÓ ¶›Ó·Î· 2, ÌÂÙ¿ ·fi ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÏÔ-

Á·ÚÈıÌÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË, ·Ú·Ù›ıÂÙ·È Ô Û¯ÂÙÈÎfi˜ Î›Ó-‰˘ÓÔ˜ (™∫) Î·È Ù· 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (95% O∞)ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· ¤Ó· ·Ù‡¯ËÌ· ÂÛˆÙÂÚÈÎÔ‡ ¯Ò-ÚÔ˘ Ó· ÚÔÎ·ÏÂ›Ù·È ·fi ıÂÚÌ·ÓÙÈÎfi ÛÒÌ·, ÁÈ· Î¿-ıÂ Ì›· ·fi ÙÈ˜ ˘fi ÌÂÏ¤ÙË ÌÂÙ·‚ÏËÙ¤˜. ∆· ·ÔÙÂ-Ï¤ÛÌ·Ù· Û˘ÌÊˆÓÔ‡Ó ÁÂÓÈÎ¿ ÌÂ ÂÎÂ›Ó· ÙË˜ ÌÔÓÔ·-Ú·ÁÔÓÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜. OÈ ÌÂÁ·Ï‡ÙÂÚÂ˜ ·ÔÎÏ›ÛÂÈ˜Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙË ÌÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘-ÛË ÔÊÂ›ÏÔÓÙ·È ÛÂ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

O Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ Ó· ÔÊÂ›ÏÂÙ·È ¤Ó· ·Ù‡¯ËÌ·ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘ ÛÂ ıÂÚÌ·ÓÙÈÎfi ÛÒÌ· ÌÂÈÒÓÂÙ·ÈÛËÌ·ÓÙÈÎ¿ ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜ ËÏÈÎ›·˜, Â›Ó·È ÌÈÎÚfi-ÙÂÚÔ˜ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ÛÂ Û¯¤ÛË ÌÂ Ù· ·ÁfiÚÈ·,


24

¶›Ó·Î·˜ 2. ™¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ (™.∫.) Î·È 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (O.∞.) ÁÈ· ·Ù˘¯‹Ì·Ù· ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜˘fi ÌÂÏ¤ÙË ÌÂÙ·‚ÏËÙ¤˜ ÌÂÙ¿ ·fi ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·ÏÁÔÚÈıÌÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

ªÂÙ·‚ÏËÙ‹ ∫·ÙËÁÔÚ›· ‹ ÚÔÛ·‡ÍËÛË ™.∫. 95% O.∞. ∆ÈÌ‹ ÎÚÈÙËÚ›Ô˘

∏ÏÈÎ›· 5 ¤ÙË 0,70 0,61 0,80 0,001º‡ÏÔ ÕÚÚÂÓ ¶.∞.*

£‹Ï˘ 0,79 0,66 0,95 0,01∂ıÓÈÎfiÙËÙ· ∂ÏÏËÓÈÎ‹ ¶.∞.*

ÕÏÏË 0,85 0,53 1,35 0,49ÃÚfiÓÔ˜ ¶ÚˆÈÓ¤˜ ÒÚÂ˜ (9.00-20.59) ¶.∞.*

¡˘¯ÙÂÚÈÓ¤˜ ÒÚÂ˜ (21.00-8.59) 1,23 0,98 1,55 0,08∂Ô¯‹ ∑ÂÛÙÔ› Ì‹ÓÂ˜ (∞Ú›ÏÈÔ˜-™ÂÙ¤Ì‚ÚÈÔ˜) ¶.∞.*

æ˘¯ÚÔ› Ì‹ÓÂ˜ (OÎÙÒ‚ÚÈÔ˜-ª¿ÚÙÈÔ˜) 1,31 1,09 1,58 0,003∆fiÔ˜ ™›ÙÈ

∫·ıÈÛÙÈÎfi 0,99 0,80 1,24 0,97∫ÚÂ‚·ÙÔÎ¿Ì·Ú· ¶.∞.*∫Ô˘˙›Ó· 0,62 0,44 0,88 0,008∞ÏÏÔ‡ 0,72 0,52 0,98 0,04

∂Î·È‰Â˘ÙÈÎfi-‰ËÌfiÛÈÔ ÎÙ›ÚÈÔ 1,20 0,91 1,60 0,19∂ÈÙ‹ÚËÛË ¡·È ¶.∞.*

Ÿ¯È 0,77 0,64 0,94 0,01ªË¯·ÓÈÛÌfi˜ ¶ÙÒÛË ·fi ‡„Ô˜ 0,45 0,35 0,57 0,0001

¶ÙÒÛË ·fi ·Ú·¿ÙËÌ·/ÁÏ›ÛÙÚËÌ· ¶.∞.*¶ÙÒÛË ÌÂÙ¿ ·fi Û‡ÁÎÚÔ˘ÛË/ÛÚÒÍÈÌÔ 1,51 1,11 2,05 0,009™‡ÁÎÚÔ˘ÛË ÌÂ ·ÓÙÈÎÂ›ÌÂÓÔ 1,08 0,87 1,36 0,48∂·Ê‹ ÌÂ ˙ÂÛÙfi ·ÓÙÈÎÂ›ÌÂÓÔ 0,23 0,11 0,49 0,0001ÕÏÏÔ˜ 0,07 0,04 0,12 0,0001

∂Ó·ÏÏ·ÎÙÈÎ‹ ÚÔÛı‹ÎË ÌÂÙ·‚ÏËÙÒÓ∆‡Ô˜ Î¿ÎˆÛË˜ ∞ÓÔÈ¯Ùfi ÙÚ·‡Ì· 3,77 2,94 4,83 0,0001

∂Î¯‡ÌˆÛË ¶.∞.*∫¿Ù·ÁÌ· 0,44 0,23 0,84 0,01∂Í¿ÚıÚËÌ·, ‰È¿ÛÙÚÂÌÌ· 0,21 0,07 0,69 0,01¢È¿ÛÂÈÛË 0,84 0,38 1,84 0,66ŒÁÎ·˘Ì· 0,27 0,004 20,26 0,55ÕÏÏÔ˜/Î·Ì›· Î¿ÎˆÛË 0,48 0,27 0,86 0,01

ª¤ÏÔ˜ ÛÒÌ·ÙÔ˜ Ô˘ ˘¤ÛÙËÙËÓ Î¿ÎˆÛË ∫ÂÊ·Ï‹ 7,60 3,94 14,68 0,0001

¶ÚfiÛˆÔ 2,83 1,46 5,49 0,002ÕÎÚ· 1,19 0,60 2,35 0,61∫ÔÚÌfi˜ ¶.∞.*

¡ÔÛÔÎÔÌÂÈ·Î‹ ÂÚ›ı·Ï„Ë Ÿ¯È ¶.∞.*

¡·È 0,19 0,07 0,52 0,001

*¶.∞.: ¶ÏËı˘ÛÌfi˜ ·Ó·ÊÔÚ¿˜

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·24

˘„ËÏfiÙÂÚÔ˜ ÙÔ˘˜ „˘¯ÚÔ‡˜ Ì‹ÓÂ˜ ÙÔ˘ ¯ÚfiÓÔ˘ Î·È˘„ËÏfiÙÂÚÔ˜ fiÙ·Ó ˘¿Ú¯ÂÈ Â›‚ÏÂ„Ë ·fi ÂÓ‹ÏÈÎ·.∞ÓÙÈı¤Ùˆ˜, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ¯ÒÚÔ fiÔ˘ Û˘Ó¤‚Ë ÙÔ ·Ù‡¯ËÌ·,ÌÂ ÂÍ·›ÚÂÛË ÙË Ì¤ÙÚÈ· ÌÂ›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡-ÓÔ˘ ÁÈ· ·Ù‡¯ËÌ· ÛÙÔ ¯ÒÚÔ ÙË˜ ÎÔ˘˙›Ó·˜. ŸÛÔÓ

·ÊÔÚ¿ ÛÙÔ ÌË¯·ÓÈÛÌfi ÙË˜ Î¿ÎˆÛË˜, Ô Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜ ÙÔ ·Ù‡¯ËÌ· Ó· ÚÔÎÏ‹ıËÎÂ ·fi ıÂÚÌ·-ÓÙÈÎfi ÛÒÌ· Â›Ó·È ˘„ËÏfiÙÂÚÔ˜ fiÙ·Ó ˘‹Ú¯Â ·Ú·-¿ÙËÌ· ‹ ÁÏ›ÛÙÚËÌ· Î·È Û‡ÁÎÚÔ˘ÛË ÌÂ ·ÓÙÈÎÂ›ÌÂ-ÓÔ. ∏ ·Ó¿Ï˘ÛË ÙË˜ Ê‡ÛË˜ ÙˆÓ Î·ÎÒÛÂˆÓ ·fi ıÂÚ-Ì·ÓÙÈÎ¿ ÛÒÌ·Ù· Î·Ù·‰ÂÈÎÓ‡ÂÈ Î˘Ú›ˆ˜ ·ÓÔÈ¯Ù¿

25


¶›Ó·Î·˜ 3. ∫·Ù·ÓÔÌ‹ ÙˆÓ 533 ·È‰ÈÒÓ (0-14 ÂÙÒÓ) Ô˘ ˘¤ÛÙËÛ·Ó ·Ù‡¯ËÌ· ÛÂ ÂÛˆÙÂÚÈÎfi ¯ÒÚÔ Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÛÙÔ EDISS,ÁÈ· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô ÙÚÈÒÓ ÂÙÒÓ (1996-1998), ˆ˜ ÚÔ˜ Ù· ‰ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, Î·ıÒ˜ Î·È ÂÎÂ›Ó· Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÓÙÔ ·Ù‡¯ËÌ· Î·È ÙËÓ Î¿ÎˆÛË, ÛÂ Ù¤ÛÛÂÚÈ˜ ÔÌ¿‰Â˜, ÌÂÙ¿ ·fi ·Ó¿Ï˘ÛË Î·Ù¿ Û˘ÛÙ¿‰Â˜

ªÂÙ·‚ÏËÙ‹ ™˘ÛÙ¿‰·1Ë 2Ë 3Ë 4Ë

¡Ô % ¡Ô % ¡Ô % ¡Ô %

∏ÏÈÎ›· (¤ÙË)0-4 15 4,5 189 56,4 2 0,6 129 38,55-9 23 16,0 13 9,0 79 54,9 29 20,110-14 16 29,6 11 20,4 18 33,3 9 16,7

º‡ÏÔÕÚÚÂÓ 30 8,7 145 41,9 70 20,2 101 29,2£‹Ï˘ 24 12,8 68 36,3 29 15,5 66 35,3

∂ıÓÈÎfiÙËÙ·∂ÏÏËÓÈÎ‹ 53 10,3 204 39,7 93 18,1 164 31,9ÕÏÏË 1 5,2 9 47,4 6 31,6 3 15,8

∆fiÔ˜™›ÙÈ

∫·ıÈÛÙÈÎfi 16 9,0 70 39,6 31 17,5 60 33,9∫ÚÂ‚·ÙÔÎ¿Ì·Ú· 13 7,9 81 49,4 13 7,9 57 34,8∫Ô˘˙›Ó· 1 2,3 28 63,6 4 9,1 11 25,0∞ÏÏÔ‡ 9 16,7 20 37,0 4 7,4 21 38,9

∂Î·È‰Â˘ÙÈÎfi-‰ËÌfiÛÈÔ ÎÙ›ÚÈÔ 15 16,0 14 14,9 47 50,0 18 19,1ÃÚfiÓÔ˜

¶ÚˆÈÓ¤˜ ÒÚÂ˜ (9.00-20.59) 47 10,7 176 40,1 84 19,1 132 30,1¡˘¯ÙÂÚÈÓ¤˜ ÒÚÂ˜ (21.00-8.59) 7 7,4 37 39,4 15 16,0 35 37,2

∂Ô¯‹∑ÂÛÙÔ› Ì‹ÓÂ˜ (∞Ú›ÏÈÔ˜-™ÂÙ¤Ì‚ÚÈÔ˜) 27 14,1 95 49,7 29 15,2 40 21,0æ˘¯ÚÔ› Ì‹ÓÂ˜ (OÎÙÒ‚ÚÈÔ˜-ª¿ÚÙÈÔ˜) 27 7,9 118 34,5 70 20,5 127 37,1

ªË¯·ÓÈÛÌfi˜ Î¿ÎˆÛË˜¶ÙÒÛË ·fi ‡„Ô˜ 6 5,5 66 60,6 20 18,3 17 15,6¶ÙÒÛË ·fi ·Ú·¿ÙËÌ·/ÁÏ›ÛÙÚËÌ· 7 3,7 82 43,2 27 14,2 74 38,9¶ÙÒÛË ÌÂÙ¿ ·fi Û‡ÁÎÚÔ˘ÛË/ÛÚÒÍÈÌÔ 3 4,6 15 22,7 38 57,6 10 15,1™‡ÁÎÚÔ˘ÛË ÌÂ ·ÓÙÈÎÂ›ÌÂÓÔ 30 20,7 38 26,2 14 9,7 63 43,4∂·Ê‹ ÌÂ ˙ÂÛÙfi ·ÓÙÈÎÂ›ÌÂÓÔ 0 0,0 8 100,0 0 0,0 0 0,0ÕÏÏÔ˜ 8 53,3 4 26,7 0 0,0 3 20,0

∂ÈÙ‹ÚËÛË¡·È 31 8,3 157 42,0 60 16,0 126 33,7Ÿ¯È 23 14,5 56 35,2 39 24,5 41 25,8

∆‡Ô˜ Î¿ÎˆÛË˜∞ÓÔÈ¯Ùfi ÙÚ·‡Ì· 9 2,2 160 38,8 90 21,9 153 37,1∂Î¯‡ÌˆÛË 32 41,0 28 35,9 5 6,4 13 16,7

∫¿Ù·ÁÌ· 9 81,8 1 9,1 0 0,0 1 9,1∂Í¿ÚıÚËÌ·, ‰È¿ÛÙÚÂÌÌ· 2 66,7 1 33,3 0 0,0 0 0,0¢È¿ÛÂÈÛË 0 0,0 6 85,7 1 14,3 0 0,0ŒÁÎ·˘Ì· 0 0,0 8 100,0 0 0,0 0 0,0ÕÏÏÔ˜/Î·Ì›· Î¿ÎˆÛË 2 14,3 9 64,3 3 21,4 0 0,0

ª¤ÏÔ˜ ÛÒÌ·ÙÔ˜ Ô˘ ˘¤ÛÙË ÙËÓ Î¿ÎˆÛË∫ÂÊ·Ï‹ 4 1,4 180 64,5 89 31,9 6 2,2¶ÚfiÛˆÔ 1 0,5 19 10,2 9 4,9 157 84,4ÕÎÚ· 45 77,6 9 15,5 0 0,0 4 6,9∫ÔÚÌfi˜ 4 40,0 5 50,0 1 10,0 0 0,0

¡ÔÛÔÎÔÌÂÈ·Î‹ ÂÚ›ı·Ï„ËŸ¯È 53 10,0 211 39,9 98 18,5 167 31,6¡·È 1 25,0 2 50,0 1 25,0 0 0,0

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·25

ÙÚ·‡Ì·Ù· ÛÙÔ ÎÂÊ¿ÏÈ Î·È ÙÔ ÚfiÛˆÔ. O ¶›Ó·Î·˜ 3 ·ÚÔ˘ÛÈ¿˙ÂÈ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi

ÙËÓ ·Ó¿Ï˘ÛË Î·Ù¿ Û˘ÛÙ¿‰Â˜. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù¤Û-ÛÂÚÈ˜ Î‡ÚÈÂ˜ ÔÌ¿‰Â˜ ÌÂ Êı›ÓÔ˘Û· ÛËÌ·Û›·:

∏ ÚÒÙË ÔÌ¿‰· ·Ó·Ê¤ÚÂÙ·È ÛÂ ÌÂÁ·Ï‡ÙÂÚË˜ËÏÈÎ›·˜ ·È‰È¿ (10-14 ¯ÚfiÓˆÓ), Ù· ÔÔ›· Û˘¯Ó¿ ˘Ê›-ÛÙ·ÓÙ·È ·Ù˘¯‹Ì·Ù· ·fi ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ÛÂ ÂÎ-·È‰Â˘ÙÈÎ¿ È‰Ú‡Ì·Ù· Î·È ÙˆÓ ÔÔ›ˆÓ ÔÈ Î·ÎÒÛÂÈ˜Û˘Ó›ÛÙ·ÓÙ·È ÛÂ Î·Ù¿ÁÌ·Ù·, ÂÍ·ÚıÚÒÛÂÈ˜ Î·È ‰È·-ÛÙÚ¤ÌÌ·Ù· ÙˆÓ ¿ÎÚˆÓ.

∏ ‰Â‡ÙÂÚË ÔÌ¿‰· ·ÊÔÚ¿ ÛÂ ·È‰È¿ ÔÏ‡ ÓÂ·-Ú‹˜ ËÏÈÎ›·˜ (0-4 ¯ÚfiÓˆÓ), Ù· ÔÔ›· ˘Ê›ÛÙ·ÓÙ·È ·Ù˘-¯‹Ì·Ù· ÙfiÛÔ ÛÙËÓ ÎÔ˘˙›Ó· fiÛÔ Î·È ÛÙÔ Î·ıÈÛÙÈÎfiÎ·È ÙËÓ ÎÚÂ‚·ÙÔÎ¿Ì·Ú·, ·Ó Î·È ‚Ú›ÛÎÔÓÙ·È ˘fi ÂÈ-Ù‹ÚËÛË. O Î‡ÚÈÔ˜ ÌË¯·ÓÈÛÌfi˜ Â›Ó·È Ë ÙÒÛË ·fi‡„Ô˜. ∆· ÂÁÎ·‡Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ÛÙËÓ ÔÌ¿‰· ·˘Ù‹. ªÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ‰È·ÛÂ›ÛÂ-ˆÓ Î·È ÁÂÓÈÎfiÙÂÚ· ÙˆÓ Î·ÎÒÛÂˆÓ ÙÔ˘ ÎÚ·Ó›Ô˘ ÂÌ-Ê·Ó›˙ÔÓÙ·È Â›ÛË˜ ÛÂ ·˘Ù‹ ÔÌ¿‰·.

∏ ÙÚ›ÙË ÔÌ¿‰· ·Ó·Ê¤ÚÂÙ·È ÛÂ ·È‰È¿ ÂÓ‰È¿ÌÂ-ÛË˜ ËÏÈÎ›·˜ (5-9 ¯ÚfiÓˆÓ). ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÛÂ ÔÏ‡˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ Ô˘ Û˘-¯Ó¿ ÙÚ·˘Ì·Ù›˙ÔÓÙ·È ÛÂ ÂÎ·È‰Â˘ÙÈÎ¿ È‰Ú‡Ì·Ù· Î·È‰ËÌfiÛÈ· ÎÙ›ÚÈ·, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Û˘ÁÎÚÔ‡ÛÂˆÓ ÌÂıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· ‹ ÛÚˆÍ›Ì·ÙÔ˜ ·fi ¿ÏÏ· ¿ÙÔ-Ì·. OÈ Î·ÎÒÛÂÈ˜ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜ ·˘Ù‹˜ Â›-Ó·È Û˘¯Ó¿ Ù· ·ÓÔÈ¯Ù¿ ÙÚ·‡Ì·Ù· ÛÙÔ ÎÂÊ¿ÏÈ.

∏ Ù¤Ù·ÚÙË ÔÌ¿‰· ÌÔÈ¿˙ÂÈ ÌÂ ÙË ‰Â‡ÙÂÚË ÛÙÔ fiÙÈÎ·Ï‡ÙÂÈ Î˘Ú›ˆ˜ ·È‰È¿ ÓÂ·Ú‹˜ ËÏÈÎ›·˜, ·ÏÏ¿ ÛÂ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ù· ·È‰È¿ Â›Ó·È Î˘Ú›ˆ˜ ÂÏÏËÓÈ-Î‹˜ ÂıÓÈÎfiÙËÙ·˜, Ù· ÔÔ›· ˘Ê›ÛÙ·ÓÙ·È ·Ù˘¯‹Ì·Ù·ÛÙÔ Û›ÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ „˘¯ÚÒÓ ÌËÓÒÓ ÙÔ˘¤ÙÔ˘˜ Î·ıÒ˜ Û˘ÁÎÚÔ‡ÔÓÙ·È ÌÂ Ù· ıÂÚÌ·ÓÙÈÎ¿ ÛÒ-Ì·Ù·. OÈ Î·ÎÒÛÂÈ˜, ˆÛÙfiÛÔ, Â›Ó·È ÌÈÎÚfiÙÂÚË˜ ‚·-Ú‡ÙËÙ·˜ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘Ú›ˆ˜ ·ÓÔÈ¯Ù¿ ÙÚ·‡-Ì·Ù· ÛÙÔ ÚfiÛˆÔ.

™˘˙‹ÙËÛË∆· Û˘ÛÙ‹Ì·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ Ô˘ ÂÚÈ-

Ï·Ì‚¿ÓÔ˘Ó ‰›ÎÙ˘· ıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ, ·ÔÙÂ-ÏÔ‡Ó ÙÔ Î‡ÚÈÔ Ì¤ÛÔ ı¤ÚÌ·ÓÛË˜ ÙˆÓ Î·ÙÔÈÎÈÒÓ ÛÂÔÏÏ¤˜ ¯ÒÚÂ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ ÙË˜ ∂ÏÏ¿-‰·˜. ∏ ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙË˜ ¯Ú‹ÛË˜ ÙˆÓ Û˘ÛÙË-Ì¿ÙˆÓ ·˘ÙÒÓ ¯·ÈÚÂÙ›ÛÙËÎÂ ˆ˜ ¤Ó· ÛËÌ·ÓÙÈÎfi ‚‹Ì·ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜, ·ÏÏ¿ Î·È ÙË˜˘ÁÂ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ (12).

∫·Ù¿ ÙË ‰ÂÎ·ÂÙ›· 1990-2000, ÔÏÏÔ› Û˘ÁÁÚ·-ÊÂ›˜ ·fi ¯ÒÚÂ˜ ÙË˜ µfiÚÂÈ·˜ ∂˘ÚÒË˜ Î·È ÙË˜ ∞ÌÂ-ÚÈÎ‹˜ ÂÓÙfiÈÛ·Ó ÎÈÓ‰‡ÓÔ˘˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË¯Ú‹ÛË ÙˆÓ ÛˆÌ¿ÙˆÓ ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ (3-6). OÈÛ˘ÁÁÚ·ÊÂ›˜ ·˘ÙÔ› ·Û¯ÔÏ‹ıËÎ·Ó ÌÂ ÙÔ Ï¤ÔÓ ÚÔ-Ê·Ó¤˜ Úfi‚ÏËÌ· Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙË ¯Ú‹ÛË ÙˆÓıÂÚÌ·ÓÙÈÎÒÓ ÛˆÌ¿ÙˆÓ, ‰ËÏ·‰‹ Ù· ÂÁÎ·‡Ì·Ù·. ∞ÓÎ·È Ë ‚È‚ÏÈÔÁÚ·Ê›· Á‡Úˆ ·fi ÙÔ ı¤Ì· Â›Ó·È ÂÚÈÔ-

ÚÈÛÌ¤ÓË, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ÂÂÛ‹Ì·Ó·Ó fiÙÈ Ù· ıÂÚÌ·-ÓÙÈÎ¿ ÛÒÌ·Ù· ı· ÌÔÚÔ‡Û·Ó Ó· ÂÌÏ¤ÎÔÓÙ·È ÛÂ·Ù˘¯‹Ì·Ù· ÌÂ ÌË¯·ÓÈÛÌfi ‰È·ÊÔÚÂÙÈÎfi ·fi ·˘ÙfiÓÙË˜ ÌÂÙ¿‰ÔÛË˜ ıÂÚÌfiÙËÙ·˜.

™‡ÌÊˆÓ· ÌÂ ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ê·›ÓÂÙ·È fiÙÈÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÂ ¯ÒÚÂ˜ ÌÂ Â‡ÎÚ·ÙÔ ÎÏ›Ì·, Ù· ÛÒÌ·-Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ Úfi-ÎÏËÛË ·Ù˘¯ËÌ¿ÙˆÓ Ì¤Ûˆ ÌË¯·ÓÈÛÌÒÓ ÌÂÙ·ÊÔÚ¿˜ÌË¯·ÓÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜ (ÙÒÛË, Û‡ÁÎÚÔ˘ÛË Î·È ÁÏ›-ÛÙÚËÌ·) Î·È fi¯È ıÂÚÌfiÙËÙ·˜ (¤ÁÎ·˘Ì·). ∏ ˘ÂÚÔ¯‹ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·˘ÙÒÓ ÛÙËÓ ·ÚÔ‡-Û· ÌÂÏ¤ÙË Â›Ó·È ÙfiÛÔ ÛËÌ·ÓÙÈÎ‹, Ô˘ ıÂˆÚÂ›Ù·È È-ı·Ófi Ù· ·Ù˘¯‹Ì·Ù· ÌÂ ÌË¯·ÓÈÛÌfi ÌÂÙ·ÊÔÚ¿˜ ÌË-¯·ÓÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜ Ó· ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ÔÛÔ-ÛÙfi ÙˆÓ Û˘ÓÔÏÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂÛÒÌ·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ ·ÎfiÌ· Î·È ÛÂ ¯ÒÚÂ˜ÌÂ „˘¯ÚfiÙÂÚÔ ÎÏ›Ì·. O ¯·ÌËÏfi˜ ÂÈÔÏ·ÛÌfi˜ ÙˆÓÂÁÎ·˘Ì¿ÙˆÓ ÛÙË ÌÂÏ¤ÙË ·˘Ù‹ ·ÓÙ·Ó·ÎÏ¿ Èı·ÓÒ˜ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÛÒÌ·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ÛÙËÓ ∂ÏÏ¿‰· ·ÔÙÂÏÔ‡Ó ·ÁˆÁÔ‡˜ ˙ÂÛÙÔ‡ ÓÂÚÔ‡,ÙÔ ÔÔ›Ô Û¿ÓÈ· ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ 50ÔC, ıÂÚÌÔÎÚ·-Û›· Ô˘ ‰ÂÓ ÚÔÎ·ÏÂ› Â‡ÎÔÏ· ıÂÚÌÈÎ¤˜ ‚Ï¿‚Â˜.∞ÓÙ›ıÂÙ·, Ë ıÂÚÌÔÎÚ·Û›· ÙˆÓ ·ÁˆÁÒÓ ·ÙÌÔ‡ Â›-Ó·È Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË, ˘ÂÚ‚·›ÓÔÓÙ·˜ Û˘¯Ó¿ÙÔ˘˜ 90ÔC, ıÂÚÌÔÎÚ·Û›· Ô˘ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-ÛÂÈ ¿ÌÂÛ· ÛÔ‚·Ú¿ ÂÁÎ·‡Ì·Ù· ÛÙÔ ‰¤ÚÌ·(6,13,14).

™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜, Ù·ÛÒÌ·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ ÂÌÏ¤ÎÔÓÙ·È ÛÂ Â-Ú›Ô˘ 1/40 ·È‰ÈÎ¿ ·Ù˘¯‹Ì·Ù· Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÂÂÛˆÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜. O ·ÚÈıÌfi˜ ·˘Ùfi˜ ÌÔÚÂ› Ó·ÌËÓ Ê·›ÓÂÙ·È ÂÓÙ˘ˆÛÈ·Îfi˜, ·ÏÏ¿ Ë ÂÌÂÈÚ›· ¤¯ÂÈÎ·Ù·‰Â›ÍÂÈ fiÙÈ Ë ·Í›· ÙË˜ ÚfiÏË„Ë˜ ¤ÁÎÂÈÙ·È ÛÙËÓÂÓ·Û¯fiÏËÛË ·ÎfiÌË Î·È ÌÂ ÌÈÎÚ¿ Û¯ÂÙÈÎ¿ ÚÔ‚Ï‹-Ì·Ù·, ¤ÙÛÈ ÒÛÙÂ Ó· ÂÈÙÂ˘¯ıÔ‡Ó ÙÂÏÈÎ¿ ÌÂÁ¿Ï· ‚‹-Ì·Ù· (15). ∏ ÚfiÏË„Ë ÛÙÔÓ ÙÔÌ¤· ·˘Ùfi Â·Ê›ÂÙ·È·Ú¯ÈÎÒ˜ ÛÙÔ˘˜ ÁÔÓÂ›˜ Î·È ÊÚÔÓÙÈÛÙ¤˜ ÙˆÓ ·È‰ÈÒÓ,ÔÈ ÔÔ›ÔÈ Ú¤ÂÈ Ó· ÂÓËÌÂÚˆıÔ‡Ó ·fi ÙÔ˘˜ ÁÂÓÈ-ÎÔ‡˜ È·ÙÚÔ‡˜ Î·È ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜. ∆Ô ÁÂÓÈÎfiÙÂÚÔÚfiÙ˘Ô ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÛÒ-Ì·Ù· ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ ·ÊÔÚ¿ Î˘Ú›ˆ˜ ÛÂ ÌÈ-ÎÚfiÙÂÚ· ·È‰È¿ Î·È ÂÈ‰ÈÎfiÙÂÚ· ·ÁfiÚÈ·, Û˘Ó‹ıˆ˜Î·Ù¿ ÙÔ˘˜ „˘¯ÚÔ‡˜ Ì‹ÓÂ˜ ÙÔ˘ ¯ÚfiÓÔ˘, fiÙ·Ó Ù··È‰È¿ ÂÚÈÔÚ›˙Ô˘Ó ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ ÙÔ˘˜ ÛÙÔ¯ÒÚÔ ÛÙÔ ÛÈÙÈÔ‡. ∏ Û˘Ó‹ıË˜ ÂÈÙ‹ÚËÛË ÙˆÓ ·È-‰ÈÒÓ ‰ÂÓ Â›Ó·È Â·ÚÎ‹˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ·Ù˘-¯ËÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Ù· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·-Ù·, Ù· ÔÔ›· Û˘Ì‚·›ÓÔ˘Ó Î˘Ú›ˆ˜ fiÙ·Ó Ù· ·È‰È¿·›˙Ô˘Ó Î·È ÛÚÒ¯ÓÔÓÙ·È ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÔ ¯ÒÚÔ.§fiÁˆ ÙË˜ Î·Ù·ÛÎÂ˘‹˜ ÙˆÓ ·Ï·ÈfiÙÂÚˆÓ ÛˆÌ¿ÙˆÓÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ ÌÂ ·È¯ÌËÚ¤˜ ÁˆÓ›Â˜, Ù· ·Ù˘-¯‹Ì·Ù· Ô˘ ÚÔÎ‡ÙÔ˘Ó Û˘¯Ó¿ ·ÊÔÚÔ‡Ó ÛÂ ·ÓÔÈ-¯Ù¤˜ Î·ÎÒÛÂÈ˜ ÙË˜ ÎÂÊ·Ï‹˜ Ô˘ ¯Ú‹˙Ô˘Ó È·ÙÚÈÎ‹˜ÂÎÙ›ÌËÛË˜.


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™‡ÌÊˆÓ· ÌÂ ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·Ù¿Û˘ÛÙ¿‰Â˜, ÔÈ ÚÔÛ¿ıÂÈÂ˜ ÚfiÏË„Ë˜ ı· Ú¤ÂÈ Ó·ÂÛÙÈ¿˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÂ ÙÚÂÈ˜ ÔÌ¿‰Â˜. ∏ ÚÒÙË·ÊÔÚ¿ ÛÙ· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ Î·È Î˘Ú›ˆ˜ÛÙ· ·ÁfiÚÈ·, Ô˘ ˘Ê›ÛÙ·ÓÙ·È Ì¤Û· ÛÂ ÂÎ·È‰Â˘ÙÈÎ¿È‰Ú‡Ì·Ù· ÛÔ‚·ÚÔ‡˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜, fiˆ˜ Î·Ù¿Á-Ì·Ù·, ›Ûˆ˜ ÏfiÁˆ ÙË˜ ‰˘Ó·ÌÈÎfiÙËÙ·˜ Ô˘ Ù· ¯·Ú·-ÎÙËÚ›˙ÂÈ Î·Ù¿ Ù· ÂÚÈ-ÂÊË‚ÈÎ¿ ¯ÚfiÓÈ·. ™ÙË ‰Â‡ÙÂÚËÔÌ¿‰· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ·È‰È¿ ÔÏ‡ ÌÈÎÚ‹˜ËÏÈÎ›·˜, Ù· ÔÔ›· ÚÔÛ·ıÒÓÙ·˜ Ó· ·Ó¤‚Ô˘Ó ¿ÓˆÛÙ· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù·, ¤ÊÙÔ˘Ó ÛÙÔ ‰¿Â‰Ô Î·È˘Ê›ÛÙ·ÓÙ·È Û˘¯Ó¿ ‰È¿ÛÂÈÛË ‹ Î·È Î·ÎÒÛÂÈ˜ ÙÔ˘ÎÚ·Ó›Ô˘. ∆¤ÏÔ˜, Ë ÙÚ›ÙË ÔÌ¿‰· ·ÊÔÚ¿ ÛÂ ·È‰È¿ÌÂÙ·Ó·ÛÙÒÓ, ·ÏÏ¿ ÌÔÚÂ› Ó· ·ÓÙ·Ó·ÎÏ¿ Î·Ù·ÛÎÂ˘-·ÛÙÈÎ¿ ÂÏ·ÙÙÒÌ·Ù· ÙË˜ ˘Ô‰ÔÌ‹˜ ÙˆÓ Û¯ÔÏÂ›ˆÓÛÂ ˘Ô‚·ıÌÈÛÌ¤ÓÂ˜ Û˘ÓÔÈÎ›Â˜, ÛÙÈ˜ ÔÔ›Â˜ Û˘¯Ó¿Î·ÙÔÈÎÔ‡Ó Ù· ·È‰È¿ ·˘Ù¿.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÓË-ÁÔÚÔ‡Ó Î·È ˘¤Ú ÔÏÏÒÓ Î·ÙÂ˘ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓÛ¯ÂÙÈÎ¿ ÌÂ ÙËÓ Î·Ù·ÛÎÂ˘‹ ÙˆÓ ÛˆÌ¿ÙˆÓ ÎÂÓÙÚÈÎ‹˜ı¤ÚÌ·ÓÛË˜: ·) Ë ÂÈÊ¿ÓÂÈ· ÙˆÓ ÛˆÌ¿ÙˆÓ ı· Ú¤-ÂÈ Ó· Â›Ó·È fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ Â›Â‰Ë,ÂÓÒ Ù· ÛÒÌ·Ù· ·Ï·ÈfiÙÂÚË˜ Î·Ù·ÛÎÂ˘‹˜ Ô˘¤¯Ô˘Ó ÔÏÏ·Ï¤˜ ·È¯ÌËÚ¤˜ ÁˆÓ›Â˜ ı· Ú¤ÂÈ ÛÙ·-‰È·Î¿ Ó· ·ÓÙÈÎ·Ù·ÛÙ·ıÔ‡Ó, ‚) Ù· ÛÒÌ·Ù· ÌÂ ·È¯ÌË-Ú¤˜ ÁˆÓ›Â˜ Ô˘ ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÔÛ˘ÚıÔ‡Óı· Ú¤ÂÈ Ó· ÂÚÈ‚ÏËıÔ‡Ó ·fi ¿ÏÏÔ, Â›Â‰Ô ˘ÏÈ-Îfi, Á) Ù· ÎÚÂ‚¿ÙÈ· ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ı· Ú¤ÂÈ Ó· Â›-Ó·È ÙÔÔıÂÙËÌ¤Ó· ÎÔÓÙ¿ ÛÙ· ÛÒÌ·Ù·, Î·ıÒ˜ Ù··È‰È¿ Û˘¯Ó¿ ÙÔÔıÂÙÔ‡Ó ÂÎÂ› Ù· ¯¤ÚÈ· ÙÔ˘˜ ‹, ¤-ÊÙÔÓÙ·˜ ·fi ÙÔ ÎÚÂ‚¿ÙÈ, ÂÁÎÏˆ‚›˙ÔÓÙ·È ·Ó¿ÌÂÛ·ÛÂ ·˘Ùfi Î·È ÙÔ ıÂÚÌ·ÓÙÈÎfi ÛÒÌ·, ‰) Ù· ÛÒÌ·Ù· ‰ÂÓı· Ú¤ÂÈ Ó· ÙÔÔıÂÙÔ‡ÓÙ·È ÛÂ ÁˆÓÈ¤˜ ÙÔ˘ ÛÈÙÈÔ‡Ô˘ Â›Ó·È ÁÂÌ¿ÙÂ˜ ÌÂ ¤ÈÏ·, Â) Ù· ÛÒÌ·Ù· ı· Ú¤-ÂÈ Ó· Â›Ó·È ¤ÙÛÈ ÙÔÔıÂÙËÌ¤Ó· ÒÛÙÂ Ó· ÌËÓ ÌÔ-ÚÔ‡Ó Â‡ÎÔÏ· Ù· ·È‰È¿ Ó· ÏËÛÈ¿ÛÔ˘Ó ÂÓÒ ·›˙Ô˘ÓÛÙÔ˘˜ ÂÛˆÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜ ÙÔ˘ ÛÈÙÈÔ‡, ÛÙ) ÎÈÓË-Ù¿ ·ÓÙÈÎÂ›ÌÂÓ· ÌÂÙ·Í‡ ÙÔ˘ ıÂÚÌ·ÓÙÈÎÔ‡ ÛÒÌ·ÙÔ˜Î·È ÙÔ˘ ¯ÒÚÔ˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó Ù· ·È‰È¿ ÁÈ· Ó··›˙Ô˘Ó ı· Ú¤ÂÈ Ó· ·ÔÌ·ÎÚ‡ÓÔÓÙ·È, ˙) Ù· ÌÈÎÚ¿·È‰È¿ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÈÙÚ¤ÂÙ·È Ó· ·ÓÂ‚·›ÓÔ˘Ó¿Óˆ ÛÙ· ıÂÚÌ·ÓÙÈÎ¿ ÛÒÌ·Ù· (·Ï¤˜ ÚÔÊ˘Ï¿-ÍÂÈ˜, fiˆ˜ Ë ÙÔÔı¤ÙËÛË ÌÈ·˜ Î·Ú¤ÎÏ·˜ ‹ ÂÓfi˜ÙÚ·Â˙ÈÔ‡ ÌÚÔÛÙ¿ ·fi ÙÔ ÛÒÌ·, ı· ÌÔÚÔ‡Û·ÓÓ· ÌÂÈÒÛÔ˘Ó ÙËÓ Â›ÙˆÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ) Î·ÈË) ÛÂ Û¯ÔÏÂ›· Î·È ‰ËÌfiÛÈ· ÎÙ›ÚÈ·, Î·Ù¿ ÙËÓ ÙÔÔ-ı¤ÙËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜, Ë·ÛÊ¿ÏÂÈ· ÙˆÓ ·È‰ÈÒÓ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏÂ› ¿ÌÂ-ÛË ÚÔÙÂÚ·ÈfiÙËÙ·, ›ÛË˜ ‚·Ú‡ÙËÙ·˜ ÌÂ ÙËÓ ÂÓÂÚ-ÁÂÈ·Î‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. O¤ÏÂÁ¯Ô˜ ÙË˜ ·ÛÊ·ÏÔ‡˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Î·Ù·ÛÎÂ˘-‹˜ ÙˆÓ ÛˆÌ¿ÙˆÓ ÎÂÓÙÚÈÎ‹˜ ı¤ÚÌ·ÓÛË˜ ÌÔÚÂ› Ó·Á›ÓÂÈ ÌÂ ‚¿ÛË ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ Ô˘ Î·ıÔÚ›˙ÔÓÙ·È·fi ÙÔÓ ∂ÏÏËÓÈÎfi OÚÁ·ÓÈÛÌfi ∆˘ÔÔ›ËÛË˜ (16).

∏ ÚfiÏË„Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·ÔÙÂÏÂ› Ì›· ·fiÙÈ˜ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ ÚÔÎÏ‹ÛÂÈ˜ ÛÙÔ ¯ÒÚÔ ÙË˜ ¶·È-‰È·ÙÚÈÎ‹˜ Î·È ÙË˜ ¢ËÌfiÛÈ·˜ ÀÁÂ›·˜ ·ÁÎÔÛÌ›ˆ˜(17). À¿Ú¯ÂÈ Ì›· Ù¿ÛË ·Ó·ÁÓÒÚÈÛË˜ Ù·˘ÙÔÔÈ‹ÛÈ-ÌˆÓ ·ÈÙÈÒÓ ÁÈ· Î¿ıÂ ·Ù‡¯ËÌ·, ÔÈ ÔÔ›Â˜ ÌÔÚÔ‡ÓÙ·˘Ùfi¯ÚÔÓ· Ó· ÚÔ‚ÏÂÊıÔ‡Ó Î·È Ó· ÚÔÏËÊıÔ‡Ó(18). ∏ Ù¿ÛË ·˘Ù‹ ÌÔÚÂ› Ó· Ê·›ÓÂÙ·È ·ÎÚ·›·, ·ÏÏ¿Â›Ó·È Û›ÁÔ˘Ú· ·ÍÈ¤·ÈÓË, Î·ı’ fiÙÈ ÚÔ¿ÁÂÈ ÙÔÓ ÂÓ-ıÔ˘ÛÈ·ÛÌfi Î·È ÂÓÈÛ¯‡ÂÈ ÙËÓ ¤ÚÂ˘Ó· Î·È ÙÔÓ ·ÎÙÈ‚È-ÛÌfi ÛÙÔ ¯ÒÚÔ ÙË˜ ÚfiÏË„Ë˜ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ. ™ÙÔÏ·›ÛÈÔ ·˘Ùfi, Ë ÂÈÛ‹Ì·ÓÛË ÙÔ˘ ÚÔÊ›Ï ÂÈÎÈÓ‰˘-ÓfiÙËÙ·˜, ¤ÛÙˆ Î·È ÂÓfi˜ ÌÈÎÚÔ‡ ÔÛÔÛÙÔ‡ (2,4% ÛÂ·˘Ù‹ ÙË ÌÂÏ¤ÙË) ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·Ù˘-¯ËÌ¿ÙˆÓ, ÌÔÚÂ› Ó· ıÂˆÚËıÂ› ˆ˜ ¤Ó· ÌÈÎÚfi, ·ÏÏ¿ÛËÌ·ÓÙÈÎfi ‚‹Ì· ÛÙÔÓ ÙÔÌ¤· ÙË˜ ÚfiÏË„Ë˜ ÙˆÓ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Home and Leisure Accident Research (HALAR). Fourteenth

Annual Report of the Home Accident Surveillance System.London: Consumer Safety Unit, Department of Trade andIndustry; 1990.

2. US Consumer Product Safety Commission. 1993 ProductSummary Report. Washington; DC: National ElectronicInjury Surveillance System; 1994.

3. Datubo-Brown DD, Gowar JP. Contact burns in children.Burns 1989;15:285-286.

4. Harper RD, Dickson WA. Domestic central heatingradiators: a cause for concern in all age groups. Burns1996;22:217-220.

5. Hurren JS, Dunn KW. Entrapment against radiators - anunderestimated burn hazard to the elderly. Burns1993;19:522-523.

6. Quinlan KP. Injury control in practice. Home radiator burnsin inner-city children. Arch Pediatr Adolesc Med1996;150:954-957.

7. EHLASS. European Home and Leisure Surveillance SystemCoding manual; 1986.

8. NOMESCO. Nordic Medico-Statistical Committee; May,1994.

9. World Health Organization. International Classification ofDiseases. 9th rev. Geneva, Switzerland: World HealthOrganization; 1980.

10. Miettinen OS. The “case-control” study: valid selection ofsubjects. J Chronic Dis 1985;38:543-548.

11. SAS/STAT User’s Guide, Version 6. 4th Edition; 1990. SASInstitute Inc.

12. Seretakis D, Lagiou P, Lipworth L, Signorello LB, RothmanKJ, Trichopoulos D. Changing seasonality of mortality fromcoronary heart disease. JAMA 1997;278:1012-1014.

13. Feldman KW, Schaller RT, Feldman JA, McMillon M. Tapwater scald burns in children. Pediatrics 1978;62:1-7.

14. American Academy of Pediatrics Committee on Injury andPoison Prevention. Office-based counseling for injuryprevention. Pediatrics 1991;88:1112-1118.

15. Petridou E. Injury prevention: an uphill battle (annotation).Inj Prev 1995;1:8.

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·27

16. ∂ÏÏËÓÈÎfi˜ OÚÁ·ÓÈÛÌfi˜ ∆˘ÔÔ›ËÛË˜ (∂§O∆). www.elot.gr 17. Rivara FP, Aitken M. Prevention of injuries to children and

adolescents. Adv Pediatr 1998;45:37-72.18. Davis RM, Pless B. BMJ bans “accidents”. BMJ

2001;322:1320-1321.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË ¶ÂÙÚ›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜ π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ª. ∞Û›·˜ 75, ∆.∫. 115 27, °Ô˘‰› E-mail: [email protected]

™ÎÔfi˜: OÈ fi„ÈÌ· ÂÌÊ·ÓÈ˙fiÌÂÓÂ˜ ÓÂÔÁÓÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ‹,fiˆ˜ ÔÓÔÌ¿˙ÔÓÙ·È, ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ (∂¡§) Ô˘Û˘Ì‚·›ÓÔ˘Ó Î˘Ú›ˆ˜ ÌÂÙ¿ ÙËÓ ÙÚ›ÙË ËÌ¤Ú· ˙ˆ‹˜, ·ÔÙÂÏÔ‡Ó¤Ó· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÁÈ· Ù· ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤Ó-ÓËÛË˜ (¶Ãµ°) ÓÂÔÁÓ¿. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ‰ÈÂÚÂ˘ÓË-ıÔ‡Ó Ù· ÔÛÔÛÙ¿ ÙˆÓ ∂¡§, ÔÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È ËÂ›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ÔÚÂ›· ÙˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ ÙËÓ ·Ú·ÌÔÓ‹ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÎÙÈÌ‹ıËÎÂ Ì›· ÔÌ¿‰· 6956 ¶Ãµ°(µ°=401-1500 g) ÓÂÔÁÓÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙ· ÎÏÈÓÈÎ¿ Î¤-ÓÙÚ· ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ∞Ó¿-Ù˘ÍË˜ ÙÔ˘ ∞ÓıÚÒÔ˘-¢›ÎÙ˘Ô ŒÚÂ˘Ó·˜ ¡ÂÔÁÓÈÎ‹˜ ∏ÏÈÎ›·˜Î·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1998-2000. ∆Ô ∂ıÓÈÎfi πÓÛÙÈÙÔ‡ÙÔÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ∞Ó¿Ù˘ÍË˜ ÙÔ˘ ∞ÓıÚÒÔ˘-¢›ÎÙ˘ÔŒÚÂ˘Ó·˜ ¡ÂÔÁÓÈÎ‹˜ ∏ÏÈÎ›·˜ ‰È·ÙËÚÂ› ¤Ó· Ï‹ÚÂ˜ ·Ú¯Â›Ô Î·-Ù·ÁÚ·Ê‹˜ fiÏˆÓ ÙˆÓ ÂÈÛ·ÁfiÌÂÓˆÓ ¶Ãµ° ÓÂÔÁÓÒÓ ÛÙ· Û˘ÌÌÂ-Ù¤¯ÔÓÙ· ÓÂÔÁÓÈÎ¿ Î¤ÓÙÚ· Ì¤Û· ÛÂ ‰ÂÎ·Ù¤ÛÛÂÚÈ˜ ËÌ¤ÚÂ˜ ·fiÙË Á¤ÓÓËÛË. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∞fi Ù· 6215 ÓÂÔÁÓ¿ Ô˘ Â¤˙ËÛ·Ó ¤Ú·Ó ÙˆÓ3 ËÌÂÚÒÓ, Ù· 1313 (21%) ·ÚÔ˘Û›·Û·Ó ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ·ÂÂÈÛfi‰È·, ÂÈ‚Â‚·ÈˆÌ¤ÓË˜ ÌÂ ıÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜,fi„ÈÌË˜ ÛË„·ÈÌ›·˜. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ (70%) ÔÊÂÈ-ÏfiÙ·Ó ÛÂ Gram ıÂÙÈÎ¿ ÌÈÎÚfi‚È·, ÌÂ ÙÔ˘˜ ÎÔ·ÁÎÔ˘Ï¿ÛË ·ÚÓË-ÙÈÎÔ‡˜ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘˜ Ó· Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 48% ÙˆÓ ∂¡§.∆Ô ÔÛÔÛÙfi ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‹Ù·Ó ·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁÔ ÙÔ˘‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ Î·È ÙË˜ ËÏÈÎ›·˜ Î‡ËÛË˜. OÈ ÂÈÏÔÎ¤˜ ÙË˜ÚÔˆÚfiÙËÙ·˜, fiˆ˜ Ô ·ÓÔÈÎÙfi˜ ‚ÔÙ¿ÏÂÈÔ˜ fiÚÔ˜, Ô ·Ú·ÙÂ-

Ù·Ì¤ÓÔ˜ ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, Ë ·Ú·ÙÂÙ·Ì¤ÓË ¯Ú‹ÛË ·ÁÁÂÈ·-ÎÒÓ Î·ıÂÙ‹ÚˆÓ, Ë ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹ ‰˘ÛÏ·Û›· Î·È Ë ÓÂ-ÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·, ‚Ú¤ıËÎÂ Ó· ¤¯Ô˘Ó Û¯¤ÛË ÌÂ ÙÔ ·˘ÍË-Ì¤ÓÔ ÔÛÔÛÙfi ∂¡§. ∆· ÓÂÔÁÓ¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ∂¡§ Â›¯·ÓÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ (Î·Ù¿ Ì¤ÛÔ fiÚÔ76 ¤Ó·ÓÙÈ 60 ËÌÂÚÒÓ). ∆· ·È‰È¿ ÌÂ ∂¡§ Â›¯·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂ-Á·Ï‡ÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ Ó· Âı¿ÓÔ˘Ó ·’ fiÙÈ ÂÎÂ›Ó· ¯ˆÚ›˜ ÏÔ›-ÌˆÍË (18% ¤Ó·ÓÙÈ 7%). O Î›Ó‰˘ÓÔ˜ ÁÈ· ı¿Ó·ÙÔ ‹Ù·Ó È‰È·›ÙÂÚ·ÌÂÁ¿ÏÔ˜ fiÙ·Ó Ë ÏÔ›ÌˆÍË ÔÊÂÈÏfiÙ·Ó ÛÂ Gram ·ÚÓËÙÈÎ¿ ÌÈÎÚfi-‚È· (36%) ‹ ÛÂ Ì‡ÎËÙÂ˜ (32%). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ fi„ÈÌË Û‹„Ë ·ÔÙÂÏÂ› ¤Ó·Ó ÛËÌ·ÓÙÈÎfi ÂÈ-‚·Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ı·Ó¿ÙÔ˘ ÛÙ· ¶Ãµ° ÓÂÔÁÓ¿, Î·ıÒ˜ Â›-ÛË˜ Î·È ÛÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÓÔÛËÏÂ›·˜ ÙˆÓ ÂÈ˙Ò-ÓÙˆÓ. OÈ ÛÙÚ·ÙËÁÈÎ¤˜ ÌÂ›ˆÛË˜ ÙË˜ fi„ÈÌË˜ Û‹„Ë˜ Î·È ÙˆÓ Û˘-ÓÂÂÈÒÓ ÙË˜ ÎÚ›ÓÔÓÙ·È ¿ÎÚˆ˜ ÂÈÙ·ÎÙÈÎ¤˜.

∂Ó‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ Û‹„Ë ÛÂ ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿: Ë ÂÌÂÈÚ›· ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈ-ÙÔ‡ÙÔ˘ ÀÁÂ›·˜ Î·È ∞Ó¿Ù˘ÍË˜ ÙÔ˘ ∞ÓıÚÒÔ˘ - ¢›ÎÙ˘Ô ¤ÚÂ˘Ó·˜ ¡ÂÔÁÓÈÎ‹˜ ∏ÏÈÎ›·˜1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA,Ehrenkranz R et al Late-onset sepsis in very low birth weight neonates: theexperience of the NICHD Neonatal Research Network Pediatrics 2002;110:285-291

™‡ÚÔ˜ ºˆÙfiÔ˘ÏÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ∞Ó·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

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O fiÓÔ˜ ÛÙ· ÓÂÔÁÓ¿ µ. ¢ÚfiÛÔ˘ - ∞Á·Î›‰Ô˘, ∫. ™·Ú·Ê›‰Ë˜, ¶. ∫·Ú·ÁÈ¿ÓÓË, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜

Pain in neonates V. Drossou - Agakidou, K. Sarafidis, P. Karagianni, G. Kremenopoulos


¡ÂÔÁÓÔÏÔÁÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·Î‹ ∫ÏÈÓÈÎ‹ ∞.¶.£ πÔÎÚ¿ÙÂÈÔ °¶¡ £ÂÛ/Ó›ÎË˜

Department of Neonatology, Aristotelion University ofThessaloniki, Ippokration General Hospital, Thessaloniki

�¶ÂÚ›ÏË„Ë: ™ÎÔfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛÂ Ë Î·-Ù·ÁÚ·Ê‹ ÙˆÓ ·fi„ÂˆÓ ÙˆÓ ∂ÏÏ‹ÓˆÓ ÁÈ·ÙÚÒÓ Ô˘ÂÚÁ¿˙ÔÓÙ·È ÛÂ ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈÎ‹˜ ÓÔÛËÏÂ›·˜ ÓÂÔ-ÁÓÒÓ (ª∂¡¡) Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÈÎ·ÓfiÙËÙ· ÙˆÓ ÓÂÔ-ÁÓÒÓ Ó· ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ, Î·ıÒ˜ Î·È ÙˆÓÙ·ÎÙÈÎÒÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙÈ˜ ª∂¡¡. ∞ÓÒÓ˘Ì·ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·ÂÛÙ¿ÏËÛ·Ó ÛÙÔ È·ÙÚÈÎfi ÚÔÛˆ-ÈÎfi Î·È ÛÙÔ˘˜ ‰ÈÂ˘ı˘ÓÙ¤˜ 14 ª∂N¡ ‰ËÌfiÛÈˆÓ Î·ÈÈ‰ÈˆÙÈÎÒÓ ÓÔÛÔÎÔÌÂ›ˆÓ ÛÂ fiÏË ÙËÓ ∂ÏÏ¿‰·. ∞ÓÙ·-ÔÎÚ›ıËÎ·Ó 106/117 ÁÈ·ÙÚÔ› (90,6%) ·fi 13ª∂¡¡. ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·, fiÏÔÈ È-ÛÙÂ‡Ô˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔÎ·È Â›Ó·È ÂÓ‹ÌÂÚÔÈ ÁÈ· ÙÈ˜ ‰˘ÛÌÂÓÂ›˜ Û˘Ó¤ÂÈÂ˜ Ô˘¤¯ÂÈ Ô fiÓÔ˜ ÛÂ ·˘Ù¿. ∏ ·Ó·ÏÁËÛ›·-Î·Ù·ÛÙÔÏ‹ ıÂ-ˆÚÂ›Ù·È ··Ú·›ÙËÙË ‹ ÛËÌ·ÓÙÈÎ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ÚÈÓ ·fi ÙË ‰ÈÂÓ¤ÚÁÂÈ·ÌË ÂÂ›ÁÔ˘Û·˜ ‰È·ÛˆÏ‹ÓˆÛË˜ Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿·fi ÙÔ 81%, 60% Î·È 96% ÙˆÓ ÁÈ·ÙÚÒÓ, ·ÓÙ›ÛÙÔÈ¯·.øÛÙfiÛÔ, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ‰‹ÏˆÛ·Ó fiÙÈ ‰ÂÓ¯ÚÂÈ¿˙ÂÙ·È ·Ó·ÏÁËÛ›· ÚÈÓ ·fi ÙÈ˜ ÂÏ¿ÛÛÔÓÂ˜, ·Ï-Ï¿ ÂÒ‰˘ÓÂ˜ ÌÈÎÚÔÂÂÌ‚¿ÛÂÈ˜, ÌÂ ÂÍ·›ÚÂÛË ÙËÓÙÔÔı¤ÙËÛË ıˆÚ·ÎÈÎ‹˜ ·ÚÔ¯¤ÙÂ˘ÛË˜. ¶·Ú¿ÏÏË-Ï·, Ë ÏÂÈÔ„ËÊ›· ÈÛÙÂ‡ÂÈ fiÙÈ ‰È¿ÊÔÚ· ÌË Ê·ÚÌ·-ÎÂ˘ÙÈÎ¿ Ì¤ÙÚ· ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ fiÓÔ Î·ÈÙË ‰˘ÛÊÔÚ›· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÈÎÚÔÂÂÌ‚¿ÛÂˆÓ.™ÙÔ ÂÈ‰ÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ Ù·ÎÙÈÎ‹ Ô˘·ÎÔÏÔ˘ıÂ›Ù·È ÛÙÈ˜ ÌÔÓ¿‰Â˜ ·¿ÓÙËÛ·Ó 12 ‰ÈÂ˘ı˘-ÓÙ¤˜. ªfiÓÔ ÛÂ 4/12 ª∂¡¡ ˘¿Ú¯ÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔÚˆÙfiÎÔÏÏÔ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ fiÓÔ˘. ∏ ·Ó·ÏÁËÛ›·-Î·Ù·ÛÙÔÏ‹ ÌÂÙÂÁ¯ÂÈÚËÙÈ-Î¿ ·ÔÙÂÏÂ› ¿ÁÈ· Ù·ÎÙÈÎ‹ ÛÂ fiÏÂ˜ ÙÈ˜ ª∂¡¡, ÂÓÒÌfiÓÔ ÛÂ 9 ¯ÔÚËÁÂ›Ù·È Û˘¯Ó¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ÛÂ 1 ÚÈÓ ·fi ÙË ÌË ÂÂ›-ÁÔ˘Û· ‰È·ÛˆÏ‹ÓˆÛË. ∆¤ÏÔ˜, ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜

�Abstract: The objective of the study was toidentify views of Greek doctors as to painperception by neonates and determine currentpractices regarding pain management in neonatalintensive care units (NICUs). Anonymous postalquestionnaires were sent to 117 doctors working in14 NICUs across Greece concerning their personalviews and to 14 heads of NICUs concerning currentpractices. Overall, 106/117 (90.6 %) doctorsworking in 13 NICUs responded. All respondersbelieve that neonates experience pain and areaware of the harmful effects pain and stress mayhave on them. Analgesia and sedation are regardedas necessary or important during mechanicalventilation, prior to non-emergency endotrachealintubation and postoperatively by 81%, 60% and96% of the doctors, respectively. However, mostdoctors stated that analgesia is unnecessary duringminor procedures, in all but chest tube placement.Most doctors stated that non-pharmacologicmeasures are effective in decreasing pain anddiscomfort during minor procedures. Thequestionnaires regarding NICUs’ practices werereturned completed by 12 directors. Only in 4/12NICUs there is a certain protocol for pain preventionand management. Analgesia-sedation administra-tion postoperatively is a standard practice in allNICUs, whereas during mechanical ventilation it isoften given in 9/12 NICUs and prior to non-emergency intubation in only one. Non-pharmaco-logic measures to reduce exposure to noxious stimuli and alleviate pain during minor proceduresare used in most NICUs. Greek neonatologistsbelieve that neonates experience pain and are aware

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∂ÈÛ·ÁˆÁ‹∏ ÂÓÙ·ÙÈÎ‹ ıÂÚ·Â›· ÙˆÓ ÓÂÔÁÓÒÓ ÛÙÈ˜ Û‡Á¯ÚÔ-

ÓÂ˜ ÌÔÓ¿‰Â˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ‰È¿ÊÔÚÔ˘˜ ¯ÂÈÚÈ-ÛÌÔ‡˜, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Â›Ó·ÈÂÒ‰˘ÓÔÈ ‹ ÚÔÎ·ÏÔ‡Ó ‰˘ÛÊÔÚ›· (1). øÛÙfiÛÔ, ÔfiÓÔ˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Î·È, Î·Ù¿ Û˘Ó¤ÂÈ·, Î¿-ıÂ ÙÚfiÔ˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ‹ ÌË ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘Â›Ó·È Î¿ÙÈ Ô˘ Ì¤¯ÚÈ ÚfiÛÊ·Ù· Â›¯Â ·ÁÓÔËıÂ›ÂÛÊ·ÏÌ¤Ó·, Î·ıÒ˜ ˘‹Ú¯Â Ë ·ÓÙ›ÏË„Ë fiÙÈ Ù· ÓÂÔ-ÁÓ¿ Î·È È‰È·›ÙÂÚ· Ù· ÚfiˆÚ· ‰ÂÓ ÔÓÔ‡Ó. ∂›Ó·È Ï¤-ÔÓ Û·Ê¤˜ fiÙÈ Ù· ÓÂÔÁÓ¿ ‰È·ı¤ÙÔ˘Ó ÙË ÓÂ˘ÚÔÊ˘ÛÈÔ-ÏÔÁÈÎ‹ Î·È ·Ó·ÙÔÌÈÎ‹ ˆÚÈÌfiÙËÙ· Ô˘ Ù· Î·ıÈÛÙ¿ÈÎ·Ó¿ Ó· ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ, ·ÎfiÌË Î·È ·ÓÂ›Ó·È ÚfiˆÚ· (2). ª¿ÏÈÛÙ·, ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÂÌ-Ê·Ó›˙Ô˘Ó ·ÚfiÌÔÈÂ˜ ‹ ·˘ÍËÌ¤ÓÂ˜, Û˘ÁÎÚÈÙÈÎ¿ ÌÂÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ¤˜, ÔÚÌÔÓÈÎ¤˜Î·È ÌÂÙ·‚ÔÏÈÎ¤˜ ··ÓÙ‹ÛÂÈ˜ (3). ∂ÈÏ¤ÔÓ, Ù· Úfi-ˆÚ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ú·ÙÂÙ·Ì¤ÓÂ˜ ÂÚÈfi‰Ô˘˜˘ÂÚ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·˜, ·ÎfiÌË Î·È ÛÂ ÌË ÂÒ‰˘Ó·ÂÚÂı›ÛÌ·Ù·, ÏfiÁˆ ÂÏ·ÙÙˆÌ¤ÓÔ˘ Ô˘‰Ô‡ ÙÔ˘ fiÓÔ˘ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·˘ÍËÌ¤ÓË ‰ÈÂÁÂÚÛÈÌfiÙËÙ· ÙˆÓÔ›ÛıÈˆÓ ÎÂÚ¿ÙˆÓ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, ÁÂÁÔÓfi˜Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ “Ê·ÈÓfiÌÂÓÔ ¯ÔÚ‰›ÛÌ·ÙÔ˜”(4,5). ∆·˘Ùfi¯ÚÔÓ·, ÏËı·›ÓÔ˘Ó ÔÈ ÂÓ‰Â›ÍÂÈ˜ fiÙÈ ÔfiÓÔ˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÛÔ‚·-Ú¤˜ ÂÈÙÒÛÂÈ˜, ¿ÌÂÛÂ˜ ‹ ·ÒÙÂÚÂ˜ (3,6).

∏ Î·Ù·ÓfiËÛË ÙË˜ ÛËÌ·Û›·˜ ÙÔ˘ fiÓÔ˘ Â›¯Â ˆ˜·ÔÙ¤ÏÂÛÌ· Ó· ˘¿ÚÍÔ˘Ó Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ Î·ÙÂ˘-ı‡ÓÛÂÈ˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fi-ÓÔ˘ Î·È ÙÔ˘ stress ÛÙ· ÓÂÔÁÓ¿ ·fi ÊÔÚÂ›˜ fiˆ˜ Ë∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ (AmericanAcademy of Pediatrics) Î·È Ë ∫·Ó·‰ÈÎ‹ ¶·È‰È·ÙÚÈÎ‹∂Ù·ÈÚÂ›· (Canadian Paediatric Society) (7). øÛÙfi-ÛÔ, ˘¿Ú¯Ô˘Ó ‰ÈÂıÓÒ˜ ÌÂÁ¿ÏÂ˜ ‰È·ÊÔÚ¤˜ ÛÙÈ˜ÛÙÚ·ÙËÁÈÎ¤˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ÙÈ˜ ‰È¿ÊÔÚÂ˜ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈÎ‹˜ ÓÔÛËÏÂ›·˜ ÓÂÔÁÓÒÓ (MENN),·ÏÏ¿ Î·È ÛÙÈ˜ ·fi„ÂÈ˜ ÙˆÓ ÓÂÔÁÓÔÏfiÁˆÓ Ô˘ ÂÚÁ¿-

˙ÔÓÙ·È ÛÂ ‰È·ÊÔÚÂÙÈÎ¿ ‹ Î·È ÛÙÔ ›‰ÈÔ ÙÌ‹Ì·, ·Ó·-ÊÔÚÈÎ¿ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÛ›·˜ Î·È Î·Ù·ÛÙÔ-Ï‹˜ ÛÙ· ÓÂÔÁÓ¿ (8).

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ·fi„ÂˆÓ ÙˆÓ ÁÈ·ÙÚÒÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ÛÂ ª∂¡¡·Ó·ÊÔÚÈÎ¿ ÌÂ ÙË ‰˘Ó·ÙfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ Ó· ·ÓÙÈ-Ï·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ Î·È ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ·ÓÙÈ-ÌÂÙÒÈÛ‹˜ ÙÔ˘. ∂›ÛË˜, Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ÙÚ¤¯Ô˘-ÛÂ˜ Ù·ÎÙÈÎ¤˜ ÚfiÏË„Ë˜ Î·È ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘ fi-ÓÔ˘ Î·È ÙË˜ ‰˘ÛÊÔÚ›·˜, Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙ·ÙÚÈÙÔ‚¿ıÌÈ· ÓÂÔÁÓÔÏÔÁÈÎ¿ ÙÌ‹Ì·Ù· ÙË˜ ∂ÏÏ¿‰·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∂È‰ÈÎ¿ ·ÓÒÓ˘Ì· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·ÂÛÙ¿ÏËÛ·Ó ÛÂ 14

‰ËÌfiÛÈÂ˜ Î·È È‰ÈˆÙÈÎ¤˜ ª∂¡¡ ÙË˜ ¯ÒÚ·˜, ·ÊÔ‡ ÚÔËÁ‹ıË-ÎÂ ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›· ÂÓfi˜ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ÌÂ ÙÔ‰ÈÂ˘ı˘ÓÙ‹ Î¿ıÂ ÌÔÓ¿‰·˜. ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·ÔÙÂÏÔ‡-ÓÙ·Ó ·fi Ì›· ÂÓfiÙËÙ· Ô˘ ·Â˘ı˘ÓfiÙ·Ó ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È·ÊÔÚÔ‡ÛÂ ÙÈ˜ ÚÔÛˆÈÎ¤˜ ÙÔ˘˜ ·fi„ÂÈ˜ ÁÈ· ÙË ‰˘Ó·ÙfiÙËÙ·ÙˆÓ ÓÂÔÁÓÒÓ Ó· ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ Î·È ÙËÓ ·Ó·ÁÎ·È-fiÙËÙ· Ï‹„Ë˜ Ì¤ÙÚˆÓ ÚfiÏË„Ë˜ Î·È ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘ Î·È·fi Ì›· ¿ÏÏË ÂÓfiÙËÙ· Ô˘ ·Â˘ı˘ÓfiÙ·Ó ÛÙÔ˘˜ ‰ÈÂ˘ı˘ÓÙ¤˜Î·È ·ÊÔÚÔ‡ÛÂ ÙËÓ Ù·ÎÙÈÎ‹ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙË ª∂¡¡ Ô˘‰ÈÂ˘ı‡ÓÔ˘Ó.

∞ÔÙÂÏ¤ÛÌ·Ù· ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÂÈÛÙÚ¿ÊËÎ·Ó Û˘ÌÏËÚˆ-

Ì¤Ó· ·fi 13 ª∂¡¡, 11 ‰ËÌfiÛÈÂ˜ Î·È 2 È‰ÈˆÙÈÎ¤˜. OÈÌÔÓ¿‰Â˜ Ô˘ ·¿ÓÙËÛ·Ó ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ıÂ˜: ∞’ ª∂¡¡ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ“∞Á›· ™ÔÊ›·”, µ’ ª∂¡¡ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “∞Á›·™ÔÊ›·”, ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· °ÂÓÈÎÔ‡ ∫Ú·ÙÈÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘ ¶·ÙÚÒÓ “ÕÁÈÔ˜ ∞Ó‰Ú¤·˜”, ¡ÂÔÁÓÔ-ÏÔÁÈÎfi ∆Ì‹Ì· ª·ÈÂ˘ÙËÚ›Ô˘ “∞ÏÂÍ¿Ó‰Ú·”, ¡ÂÔÁÓÔ-ÏÔÁÈÎfi ∆Ì‹Ì· °ÂÓÈÎÔ‡ ∫Ú·ÙÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∞ÏÂ-Í·Ó‰ÚÔ‡ÔÏË˜, ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ª·ÈÂ˘ÙËÚ›Ô˘“∂. µÂÓÈ˙¤ÏÔ˘”, ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ª·ÈÂ˘ÙËÚ›Ô˘

ª∂¡¡ ÂÊ·ÚÌfi˙ÔÓÙ·È ‰È¿ÊÔÚ· ÌË Ê·ÚÌ·ÎÔÏÔÁÈÎ¿Ì¤ÙÚ· ÁÈ· ÙË ÌÂ›ˆÛË ÙË˜ ¤ÎıÂÛË˜ ÛÂ ÂÒ‰˘Ó·ÂÚÂı›ÛÌ·Ù· Î·È ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÓÔ˘ ÙˆÓ ÌÈ-ÎÚÔÂÂÌ‚¿ÛÂˆÓ. OÈ ŒÏÏËÓÂ˜ ÓÂÔÁÓÔÏfiÁÔÈ ÈÛÙÂ‡-Ô˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ Î·ÈÂ›Ó·È ÂÓ‹ÌÂÚÔÈ ÁÈ· ÙÈ˜ ‰˘ÛÌÂÓÂ›˜ Û˘Ó¤ÂÈ¤˜ ÙÔ˘ ÛÂ·˘Ù¿. ∂ÓÒ Ô ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi˜ fiÓÔ˜ ·ÓÙÈÌÂÙˆ›˙Â-Ù·È Â·ÚÎÒ˜, ‰ÂÓ Û˘Ì‚·›ÓÂÈ ÙÔ ›‰ÈÔ Î·È ÌÂ ÙÔÓ fi-ÓÔ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ¿ÏÏÂ˜ È·ÙÚÈÎ¤˜ ·ÚÂÌ‚¿-ÛÂÈ˜. OÈ ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎÔ› ÙÚfiÔÈ ÌÂ›ˆÛË˜ ÙÔ˘fiÓÔ˘ Â›Ó·È Â˘Ú¤ˆ˜ ·Ú·‰ÂÎÙÔ› ÛÙÈ˜ ÂÚÈÛÛfiÙÂ-ÚÂ˜ ÌÔÓ¿‰Â˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: fiÓÔ˜, ·Ó·ÏÁËÛ›·, Î·Ù·ÛÙÔÏ‹,ÓÂÔÁÓfi.

of the harmful effects that pain and stress may haveon them. Postoperative pain is treated adequately,whereas procedural pain is not. Non-pharmacologic measures are widely accepted.

Key words: pain, analgesia, sedation, neonate.

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·30


31

“π·ÛÒ”, ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ ¶·-ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ, ¡ÂÔÁÓÔÏÔ-ÁÈÎfi ∆Ì‹Ì· ª·ÈÂ˘ÙËÚ›Ô˘ “ªËÙ¤Ú·”, ¡ÂÔÁÓÔÏÔÁÈÎfi∆Ì‹Ì· ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”,¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ∫Ú·-ÙÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ¡›Î·È·˜ ¶ÂÈÚ·ÈÒ˜, ª∂¡¡ ¶ÂÚÈ-ÊÂÚÂÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ƒ›Ô˘Î·È ¡ÂÔÁÓÔÏÔÁÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·Î‹ ∫ÏÈÓÈÎ‹ πÔ-ÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜.

∂ÚˆÙ‹ıËÎ·Ó Û˘ÓÔÏÈÎ¿ 117 ÁÈ·ÙÚÔ› Î·È ·¿ÓÙË-Û·Ó 106 (90,6%). ∏ Î·Ù·ÓÔÌ‹ ÙˆÓ ÁÈ·ÙÚÒÓ Ô˘·¿ÓÙËÛ·Ó ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ·Ó·ÏÔÁ›· ÂÈ-‰ÈÎÒÓ ÓÂÔÁÓÔÏfiÁˆÓ, ÂÈ‰ÈÎÒÓ ·È‰È¿ÙÚˆÓ Ô˘ ÂÚÁ¿-˙ÔÓÙ·È ÛÂ ÓÂÔÁÓÔÏÔÁÈÎ¿ ÙÌ‹Ì·Ù· Î·È ÂÍÂÈ‰ÈÎÂ˘fiÌÂ-ÓˆÓ ÛÙË ¡ÂÔÁÓÔÏÔÁ›· Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ™ÙÔÂÈ‰ÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ Ù·ÎÙÈÎ‹ Ô˘ ·ÎÔ-ÏÔ˘ıÂ› Ë ª∂¡¡ ·¿ÓÙËÛ·Ó 12/13 ‰ÈÂ˘ı˘ÓÙ¤˜.

∞fi„ÂÈ˜ ÙˆÓ ÁÈ·ÙÚÒÓ OÈ ÂÚˆÙËı¤ÓÙÂ˜ È·ÙÚÔ› ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜ È-

ÛÙÂ‡Ô˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿, ·ÎfiÌË Î·È Ù· ÚfiˆÚ·, ·ÓÙÈ-Ï·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ Î·È Â›Ó·È ÂÓ‹ÌÂÚÔÈ ÁÈ· ÙÈ˜ ‰˘-Û¿ÚÂÛÙÂ˜ Û˘Ó¤ÂÈÂ˜ Ô˘ ¤¯ÂÈ Ô fiÓÔ˜ Î·È ÙÔ stressÛÂ ·˘Ù¿. ™ÙÔÓ ¶›Ó·Î· 2 Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ ‰˘ÛÌÂ-ÓÂ›˜ Û˘Ó¤ÂÈÂ˜ ÙÔ˘ fiÓÔ˘ ÛÙ· ‰È¿ÊÔÚ· fiÚÁ·Ó· Î·ÈÛ˘ÛÙ‹Ì·Ù· Î·È Ë Û˘¯ÓfiÙËÙ· ÌÂ ÙËÓ ÔÔ›· ·Ó·Ê¤Ú-ıËÎ·Ó ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› (81%) ıÂˆÚÔ‡Ó fiÙÈ Ë¯ÔÚ‹ÁËÛË Î·Ù·ÛÙÔÏ‹˜ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ‚Ú›ÛÎÔÓÙ·ÈÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi Â›Ó·È ··Ú·›ÙËÙË (23%) ‹ ÛË-Ì·ÓÙÈÎ‹ (58%). ¶·Ú¿ÏÏËÏ·, Ë ¯ÔÚ‹ÁËÛË Î·Ù·ÛÙÔ-Ï‹˜ ÚÈÓ ·fi ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË˜ ÌËÂÂ›ÁÔ˘Û·˜ ‰È·ÛˆÏ‹ÓˆÛË˜ ÎÚ›ÓÂÙ·È ˆ˜ ··Ú·›ÙË-ÙË ‹ ÛËÌ·ÓÙÈÎ‹ ·fi ÙÔ 14% Î·È 46% ÙˆÓ ÂÚˆÙËı¤-ÓÙˆÓ, ·ÓÙ›ÛÙÔÈ¯·.

™¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ¯ÔÚ‹ÁËÛË˜ ·Ó·Ï-ÁËÛ›·˜ Î·È Î·Ù·ÛÙÔÏ‹˜ ÛÂ ÂÏ¿ÛÛÔÓÂ˜, ·ÏÏ¿ ÂÒ-‰˘ÓÂ˜ ÌÈÎÚÔÂÂÌ‚¿ÛÂÈ˜ fiˆ˜ ·˘Ù¤˜ Ô˘ Ê·›ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 3, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ‰‹ÏˆÛ·ÓfiÙÈ ‰ÂÓ ıÂˆÚÔ‡Ó ··Ú·›ÙËÙË ÙË Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹-ÁËÛË ·Ó·ÏÁËÛ›·˜ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ·˘Ù¤˜, ÌÂÂÍ·›ÚÂÛË ÙËÓ ÙÔÔı¤ÙËÛË ıˆÚ·ÎÈÎ‹˜ ·ÚÔ¯¤ÙÂ˘-ÛË˜. øÛÙfiÛÔ, ÙÔ 81% ÙˆÓ ÁÈ·ÙÚÒÓ Ô˘ ·¿ÓÙËÛ·ÓÛÙËÓ ÂÚÒÙËÛË ·˘Ù‹ ıÂˆÚÂ› ··Ú·›ÙËÙË ÙË ¯Ú‹ÛËÙÔÈÎÒÓ ·Ó·ÈÛıËÙÈÎÒÓ ÚÈÓ ÙÈ˜ ÌÈÎÚÔÂÂÌ‚¿ÛÂÈ˜.

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÛ›·˜ ÌÂÙÂÁ-¯ÂÈÚËÙÈÎ¿ ÛÙ· ÓÂÔÁÓ¿, ÙÔ 96% ÙˆÓ ÓÂÔÁÓÔÏfiÁˆÓ ÙË

ıÂˆÚÂ› ··Ú·›ÙËÙË (78%) ‹ ÛËÌ·ÓÙÈÎ‹ (18%). ¶Ô-Ï‡ ÌÈÎÚfi (4%) ‹Ù·Ó ÙÔ ÔÛÔÛÙfi ·˘ÙÒÓ Ô˘ ÈÛÙÂ‡-Ô˘Ó fiÙÈ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ·Ó·ÏÁËÛ›· ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿.

∏ ¯ÚËÛÈÌÔÔ›ËÛË ÌË Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ Ì¤ÙÚˆÓÁÈ· ÙË ÌÂ›ˆÛË ÙË˜ ¤ÎıÂÛË˜ ÛÙ· ÂÒ‰˘Ó· ÂÚÂı›-ÛÌ·Ù· Î·È ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÓÔ˘ ÙˆÓ ÌÈÎÚÔÂ-ÂÌ‚¿ÛÂˆÓ ıÂˆÚÂ›Ù·È ··Ú·›ÙËÙË ·fi ÙÔ 95% ÙˆÓÁÈ·ÙÚÒÓ Ô˘ ·¿ÓÙËÛ·Ó (¶›Ó·Î·˜ 4).

∆Ú¤¯Ô˘ÛÂ˜ Ù·ÎÙÈÎ¤˜ ÛÙÈ˜ ª∂¡¡ ™‡ÌÊˆÓ· ÌÂ ÙÈ˜ ··ÓÙ‹ÛÂÈ˜ ÙˆÓ ‰ÈÂ˘ı˘ÓÙÒÓ,

ÌfiÓÔ ÛÙÔ 33% ÙˆÓ ÌÔÓ¿‰ˆÓ ˘¿Ú¯ÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔÚˆÙfiÎÔÏÏÔ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ fiÓÔ˘.

™Â 9 ª∂¡¡ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û˘¯Ó¿ Î·Ù·ÛÙÔÏ‹Î·È ·Ó·ÏÁËÛ›· ÛÙ· ÓÂÔÁÓ¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÌË-¯·ÓÈÎfi ·ÂÚÈÛÌfi, ÛÂ 2 ÌÔÓ¿‰Â˜ ÌfiÓÔ ÛÂ ÂÈ‰ÈÎ¤˜ Â-ÚÈÙÒÛÂÈ˜, fiˆ˜ fiÙ·Ó ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙÔÓ ·Ó·ÓÂ˘-ÛÙ‹Ú· Î·È ÛÂ 1 ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÔÙ¤. ™ÙÔÓ ¶›Ó·Î· 5Ê·›ÓÔÓÙ·È Ù· Î·Ù·ÛÙ·ÏÙÈÎ¿-·Ó·ÏÁËÙÈÎ¿ Ô˘ ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈ-ÛÌÔ‡ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÔÓ¿‰Â˜. ™Â 4 ª∂¡¡ ÂÊ·ÚÌfi-˙ÂÙ·È ÌfiÓÔ Ë Û˘ÓÂ¯‹˜ ÛÙ¿Á‰ËÓ ¯ÔÚ‹ÁËÛË ÙˆÓ Î·-Ù·ÛÙ·ÏÙÈÎÒÓ Î·È ·Ó·ÏÁËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ, ÂÓÒ ÛÂ 7¯ÔÚËÁÔ‡ÓÙ·È, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ˘Â‡-ı˘ÓÔ˘ ÁÈ·ÙÚÔ‡, ÛÂ Û˘ÓÂ¯‹ ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË (3ª∂¡¡) ‹ ÛÂ ÚÔÎ·ıÔÚÈÛÌ¤Ó· ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·(4 ª∂¡¡).

ª˘Ô¯¿Ï·ÛË ÛÙ· ÓÂÔÁÓ¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ·Ó·ÓÂ˘ÛÙ‹Ú· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û˘¯Ó¿ ÛÂ 2 ÌÔÓ¿-‰Â˜, Û¿ÓÈ· ÛÂ 6, ÂÓÒ ÛÂ 4 ÌÔÓ¿‰Â˜ ‰ÂÓ ¯ÔÚËÁÂ›Ù·ÈÔÙ¤. ªÂÚÈÎ¤˜ ÌÔÓ¿‰Â˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó 2 Â›‰Ë Ì˘Ô-¯·Ï·ÚˆÙÈÎÒÓ. ∆· Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ·Ì˘Ô¯·Ï·ÚˆÙÈÎ¿ Â›Ó·È ÙÔ ‚ÚˆÌÈÔ‡¯Ô ·ÓÎÔ˘ÚfiÓÈÔ

¶›Ó·Î·˜ 1. ¢ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ È·ÙÚÒÓ Ô˘Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË

ÕÓ‰ÚÂ˜ °˘Ó·›ÎÂ˜ ™‡ÓÔÏÔ

™‡ÓÔÏÔ 35 (33%) 71 (67%) 106 (100%)¡ÂÔÁÓÔÏfiÁÔÈ 30 49 79 (74,5%)∂ÍÂÈ‰ÈÎÂ˘fiÌÂÓÔÈ 2 16 18 (17%)¶·È‰›·ÙÚÔÈ 3 6 9 (8,5%)

¶›Ó·Î·˜ 2. ∞fi„ÂÈ˜ ÙˆÓ È·ÙÚÒÓ: ‰˘ÛÌÂÓÂ›˜ Û˘Ó¤ÂÈÂ˜ ÙÔ˘fiÓÔ˘ ÛÙ· ÓÂÔÁÓ¿

™˘Ó¤ÂÈÂ˜ ÙÔ˘ fiÓÔ˘ °È·ÙÚÔ› Ô˘ ·¿ÓÙËÛ·Ó(n=79) %

ÀÔÍ›· - ÙÒÛË ÎÔÚÂÛÌÔ‡ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ 32 40,5ªÂÙ·‚ÔÏ‹ Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜ 26 33ªÂÙ·‚ÔÏ‹ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ 22 27,8ªÂÙ·‚ÔÏ‹ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜ 9 11,4∂ÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›· 3 3,8∞ÓÙ·ÁˆÓÈÛÌfi˜ ·Ó·ÓÂ˘ÛÙ‹Ú· 4 5™‡Ó‰ÚÔÌ· ‰È·Ê˘Á‹˜ ·¤Ú· 4 5∂È‰Â›ÓˆÛË ·Ó·ÓÂ˘ÛÙÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜ 9 11,4ÕÓÔÈ· 9 11,4∂˘ÂÚÂıÈÛÙfiÙËÙ·/stress 15 19ªÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ 5 6,3∞ÒÙÂÚÂ˜ „˘¯ÔÎÈÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ 21 26,6

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·31

(Pavulon®) (5), ÙÔ ·ÙÚ·ÎÔ‡ÚÈÔ (Tracrium®) (3) Î·ÈÙÔ cis-·ÙÚ·ÎÔ‡ÚÈÔ (Nimbex®) (2). ™Â 3 ÌÔÓ¿‰Â˜,Ù·˘Ùfi¯ÚÔÓ· ÌÂ Ù· Ì˘Ô¯·Ï·ÚˆÙÈÎ¿ ¯ÔÚËÁÂ›Ù·È Î·ÈÎ¿ÔÈÔ Î·Ù·ÛÙ·ÏÙÈÎfi-·Ó·ÏÁËÙÈÎfi (ÛÂ 1 ÌÔÓ¿‰·ÊÂÓÙ·Ó‡ÏË, ÛÂ 1 ‰È·˙Â¿ÌË Î·È ÛÂ 1 ¤Ó˘‰ÚË ¯Ïˆ-Ú¿ÏË), ÂÓÒ ÛÂ 5 ÌÔÓ¿‰Â˜ ÂÈÎÚ·ÙÂ› Ë ¿Ô„Ë fiÙÈ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Î·È ¿ÏÏÔ Ê¿ÚÌ·ÎÔ. ™Â Î·Ì›· ÌÔÓ¿-‰· ‰ÂÓ ¯ÔÚËÁÂ›Ù·È Ì˘Ô¯¿Ï·ÛË ÚÈÓ ·fi ÙË ‰ÈÂ-Ó¤ÚÁÂÈ· ÂÂ›ÁÔ˘Û·˜ ÌË ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË˜ ‰È·-ÛˆÏ‹ÓˆÛË˜.

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ Ù·ÎÙÈÎ‹ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·ÈÛÙÈ˜ ÌÔÓ¿‰Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÛ›·˜ÛÙÈ˜ ÂÒ‰˘ÓÂ˜ ÌÈÎÚÔÂÂÌ‚¿ÛÂÈ˜, ÛÂ 8 ÌÔÓ¿‰Â˜ ¯Ô-ÚËÁÂ›Ù·È Î¿ÔÈÔ ·Ó·ÏÁËÙÈÎfi, Û˘ÛÙËÌ·ÙÈÎ¿ ‹ ÙÔÈÎ¿.™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ¯ÔÚ‹ÁËÛË˜Î·È ÙÔ Â›‰Ô˜ ÙÔ˘ ·Ó·ÏÁËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ ¯ÚË-ÛÈÌÔÔÈÂ›Ù·È ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ª∂¡¡ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙˆÓ ÂÒ‰˘ÓˆÓ ÌÈÎÚÔÂÂÌ‚¿ÛÂˆÓ. ∞ÓÂÍ¿ÚÙËÙ·, ¿-ÓÙˆ˜, ·fi ÙËÓ Ù·ÎÙÈÎ‹ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ÚÔ˜ ÙÔ·ÚfiÓ ÛÙÔ ÙÌ‹Ì· ÙÔ˘˜, 9 ‰ÈÂ˘ı˘ÓÙ¤˜ ıÂˆÚÔ‡Ó ÙË

¯ÔÚ‹ÁËÛË Î·Ù·ÛÙÔÏ‹˜ Î·È ·Ó·ÏÁËÛ›·˜ ÛÙ· ÓÂÔÁÓ¿Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ÂÒ‰˘ÓÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ ··-Ú·›ÙËÙË ‹ ÛËÌ·ÓÙÈÎ‹, 2 ÈÛÙÂ‡Ô˘Ó fiÙÈ ‰ÂÓ ¯ÚÂÈ¿˙Â-Ù·È, ÂÓÒ Ô ‰ÈÂ˘ı˘ÓÙ‹˜ Ì›·˜ ÌÔÓ¿‰·˜ ‰ÂÓ ·¿ÓÙËÛÂ.

ªÂÙ¿ ·fi ÌÂ›˙ÔÓÂ˜ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜,·Ó·ÏÁËÛ›· ¯ÔÚËÁÂ›Ù·È ÛÂ 11/12 ÌÔÓ¿‰Â˜ Ô˘ Û˘Ì-ÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË, ÂÓÒ 1 ÌÔÓ¿‰· ‰ÂÓ ÓÔÛËÏÂ‡ÂÈ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÂÚÈÛÙ·ÙÈÎ¿. ™ÙÔÓ ¶›Ó·Î· 7 Ê·›ÓÔÓÙ·ÈÙ· ·Ó·ÏÁËÙÈÎ¿ Ê¿ÚÌ·Î· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌÂ-ÙÂÁ¯ÂÈÚËÙÈÎ¿.

∆¤ÏÔ˜, ÛÂ fiÏÂ˜ ÙÈ˜ ÌÔÓ¿‰Â˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î¿-ÔÈÔ Â›‰Ô˜ ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, ÌÂÛÎÔfi ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÍˆÙÂÚÈÎÒÓ ‰ÈÂÁÂÚÙÈÎÒÓÂÚÂıÈÛÌ¿ÙˆÓ Î·È ÙË ÌÂ›ˆÛË ÙÔ˘ fiÓÔ˘ Î·È ÙË˜ ‰˘-ÛÊÔÚ›·˜ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ¯ÂÈ-ÚÈÛÌÔ‡˜ (¶›Ó·Î·˜ 8).

™˘˙‹ÙËÛË ™ÙË ÌÂÏ¤ÙË ·˘Ù‹ ¤ÁÈÓÂ ÚÔÛ¿ıÂÈ· Î·Ù·ÁÚ·Ê‹˜

ÙˆÓ ·fi„ÂˆÓ ÙˆÓ ∂ÏÏ‹ÓˆÓ ÁÈ·ÙÚÒÓ Ô˘ ·Û¯ÔÏÔ‡-ÓÙ·È ÌÂ ÙË ÊÚÔÓÙ›‰· ÓÂÔÁÓÒÓ, ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ·Ó·ÁÎ·ÈfiÙËÙ· ÚfiÏË„Ë˜ Î·È ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘fiÓÔ˘ Î·È ÙÔ˘ stress ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·. §fiÁˆ ÙË˜ÌÂÁ¿ÏË˜ ·ÓÙ·fiÎÚÈÛË˜ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ, ıÂˆÚÂ›-Ù·È fiÙÈ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó Â·Ú-ÎÒ˜ ÙËÓ ÂÏÏËÓÈÎ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛÙÔ ı¤Ì· ·˘Ùfi.

∂›Ó·È ÔÏ‡ ÂÓı·ÚÚ˘ÓÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈŒÏÏËÓÂ˜ ÓÂÔÁÓÔÏfiÁÔÈ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ Î·È Â›Ó·È ÂÓ‹ÌÂÚÔÈ ÁÈ· ÙÈ˜‚Ï·ÙÈÎ¤˜ Û˘Ó¤ÂÈ¤˜ ÙÔ˘ ÛÂ ·˘Ù¿ Î·È È‰È·›ÙÂÚ· ÛÙÔÎ·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·. øÛÙfiÛÔ, ÛÂ ÏÈÁfiÙÂ-ÚÂ˜ ·fi ÙÈ˜ ÌÈÛ¤˜ ª∂¡¡ ˘¿Ú¯ÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔÚˆÙfiÎÔÏÏÔ ¯ÔÚ‹ÁËÛË˜ ·Ó·ÏÁËÛ›·˜ ÛÙ· ÓÂÔÁÓ¿Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ÂÒ‰˘ÓÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜. ™ÙÈ˜˘fiÏÔÈÂ˜ ª∂¡¡, Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÂÍ·Ú-Ù¿Ù·È Ì¿ÏÏÔÓ ·fi ÙÈ˜ ÚÔÛˆÈÎ¤˜ ·fi„ÂÈ˜ Î·È ÚÔ-ÙÈÌ‹ÛÂÈ˜ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡. ¶·ÚfiÌÔÈ· Â›Ó·ÈÙ· ‰Â‰ÔÌ¤Ó· ·fi ÙÔ ‰ÈÂıÓ‹ ¯ÒÚÔ, fiÔ˘ ¤¯ÂÈ ‰È·È-ÛÙˆıÂ› fiÙÈ Ù· ·Ó·ÏÁËÙÈÎ¿ Ê¿ÚÌ·Î· ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ÔÏ‡ ÏÈÁfiÙÂÚÔ ÛÙÈ˜ ÓÂÔÁÓÈÎ¤˜ ·’ fiÙÈ ÙÈ˜ ·È-‰È·ÙÚÈÎ¤˜ ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜ (9). ŒÙÛÈ,Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ÓÂÔÁÓ¿ ·Ú·Ì¤ÓÂÈÌË ÈÎ·ÓÔÔÈËÙÈÎ‹, ·Ú¿ ÙËÓ ÈÛ¯˘Ú‹ ÂÔ›ıËÛË ÙˆÓÁÈ·ÙÚÒÓ fiÙÈ Ù· ÓÂÔÁÓ¿ ‚ÈÒÓÔ˘Ó ÂÒ‰˘ÓÂ˜ ÂÌÂÈÚ›Â˜Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÊfiÚˆÓ ¯ÂÈÚÈÛÌÒÓ (10-12).


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¶›Ó·Î·˜ 4. ¶ÚÔÙ›ÌËÛË ÙˆÓ È·ÙÚÒÓ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ˘˜ ÌË Ê·Ú-Ì·ÎÂ˘ÙÈÎÔ‡˜ ÙÚfiÔ˘˜ ÌÂ›ˆÛË˜ ÙÔ˘ fiÓÔ˘ Î·È ÙË˜ ‰˘ÛÊÔ-Ú›·˜ ÛÙ· ÓÂÔÁÓ¿

°È·ÙÚÔ› (n=106) %

¶ÂÚÈÔÚÈÛÌfi˜ ¯ÂÈÚÈÛÌÒÓ 93 87,7∂Ï¿ÙÙˆÛË ÊˆÙÈÛÌÔ‡ Î·È ıÔÚ‡‚Ô˘ 85 80,2∞·Ï¿ ·ÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· (¯¿‰È) 82 77,3ºˆÏÈ¤˜ 60 50,6ªË ‰È·ÙÚÔÊÈÎfi˜ ıËÏ·ÛÌfi˜ (È›Ï·) 70 66ÃÔÚ‹ÁËÛË ÁÏ˘ÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ 33 31,1

¶›Ó·Î·˜ 5. ∆·ÎÙÈÎ‹ ÙˆÓ ª∂¡¡ (n=11): ¯Ú‹ÛË ·Ó·ÏÁËÙÈÎÒÓÎ·È Î·Ù·ÛÙ·ÏÙÈÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈ-ÛÌÔ‡

∫·Ù·ÛÙ·ÏÙÈÎ¿-·Ó·ÏÁËÙÈÎ¿ Ê¿ÚÌ·Î· ª∂¡¡n (%)

ºÂÓÙ·Ó‡ÏË 2 (18,3%)ªÔÚÊ›ÓË 2 (18,3%)¶ÂıÈ‰›ÓË 1 (9,1%)ªÈ‰·˙ÔÏ¿ÌË 1 (9,1%)ªÔÚÊ›ÓË + ÊÂÓÙ·Ó‡ÏË ‹ ‰È·˙Â¿ÌË 2 (18,3%)ºÂÓÙ·Ó‡ÏË + Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ‹/Î·È 4 (36,3%)¯ÏˆÚ¿ÏË ‹ ‚ÂÓ˙Ô‰È·˙Â›ÓË

¶›Ó·Î·˜ 3. ∞fi„ÂÈ˜ ÙˆÓ È·ÙÚÒÓ: ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛË˜ ·Ó·ÏÁËÛ›·˜ ÛÂ ÂÏ¿ÛÛÔÓÂ˜, ·ÏÏ¿ ÂÒ‰˘ÓÂ˜ ÂÂÌ‚¿ÛÂÈ˜

∂›‰Ë Â¤Ì‚·ÛË˜ ∞·Ú·›ÙËÙË ™ËÌ·ÓÙÈÎ‹ ¢ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ¢ÂÓ ·¿ÓÙËÛ·Ón (%) n (%) n (%) n (%)

£ˆÚ·ÎÈÎ‹ ·ÚÔ¯¤ÙÂ˘ÛË 55 (51,8%) 37 (34,9%) 11 (10,3%) 3 (2,8%)OÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË 10 (9,4%) 31 (29,2%) 65 (61,3%) -ÀÂÚË‚ÈÎ‹ ·Ú·Î¤ÓÙËÛË 5 (4,7%) 20 (20,7%) 75 (70,7%) 4 (3,7%)∆ÔÔı¤ÙËÛË ·ÚÙ. ÁÚ·ÌÌ‹˜ 11 (10,3%) 42 (39,6%) 50 (47,1%) 3 (2,8%)∞Ó·ÚÚÔÊ‹ÛÂÈ˜ ÙÚ·¯ÂÈÔÛˆÏ‹Ó· 3 (2,8%) 16 (15%) 86 (81,1%) 1 (0,9%)

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·32


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∏ ‰ÈÛÙ·ÎÙÈÎfiÙËÙ· ÛÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ Î·ÈÎ·Ù·ÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚÂ› Î·Ù¿ ¤Ó· Ì¤ÚÔ˜Ó· ·Ô‰ÔıÂ› ÛÙË ‰˘ÛÎÔÏ›· ÎÏÈÓÈÎ‹˜ ÂÎÙ›ÌËÛË˜ ÙÔ˘fiÓÔ˘, ÛÙÔ Êfi‚Ô ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÙˆÓÊ·ÚÌ¿ÎˆÓ ·˘ÙÒÓ Î·È È‰È·›ÙÂÚ· ÛÙÔÓ ÚÔ‚ÏËÌ·ÙÈ-ÛÌfi Ô˘ ˘¿Ú¯ÂÈ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÓÂÔÁÓÈÎfi ÂÁÎ¤Ê·ÏÔ (7).

∏ ‰È·ÛˆÏ‹ÓˆÛË Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜Ô˘ ÚÔÎ·ÏÂ› fiÓÔ Î·È ‰˘ÛÊÔÚ›· ÛÙ· ÓÂÔÁÓ¿. ™ÂÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ‰ÂÓ ÓÔÂ›Ù·È, ÂÎÙfi˜ÂÈ‰ÈÎÒÓ ÂÚÈÙÒÛÂˆÓ, ‰È·ÛˆÏ‹ÓˆÛË ¯ˆÚ›˜ Â·ÚÎ‹Î·Ù·ÛÙÔÏ‹, ÏfiÁˆ ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ stress Ô˘Û˘ÓÂ¿ÁÂÙ·È. ∂›ÛË˜, ÛÂ ÌË Î·ÙÂÛÙ·ÏÌ¤Ó· Úfiˆ-Ú· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÛÙË‰È¿ÚÎÂÈ· ÙË˜ ‰È·ÛˆÏ‹ÓˆÛË˜ ÂÏ·ÙÙÒÓÂÙ·È Ë ÌÂÚÈÎ‹›ÂÛË ÙÔ˘ ÔÍ˘ÁfiÓÔ˘ (13) Î·È ·˘Í¿ÓÂÙ·È Ë ·ÚÙËÚÈ·-Î‹ Î·È ÂÓ‰ÔÎÚ¿ÓÈ· ›ÂÛË (14,15), ·Ú¿ÁÔÓÙÂ˜ Ô˘ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË ÂÁÎÂÊ·ÏÈÎ‹˜ ·È-ÌÔÚÚ·Á›·˜. øÛÙfiÛÔ, ‹Ù·Ó Î·È, ÂÓ Ì¤ÚÂÈ, ·Ú·Ì¤ÓÂÈ¿ÁÈ· ‰ÈÂıÓ‹˜ Ù·ÎÙÈÎ‹ ÛÙÈ˜ ª∂¡¡ Ó· ‰È·ÛˆÏËÓÒ-ÓÔÓÙ·È “ÛÂ ÂÁÚ‹ÁÔÚÛË” Ù· ÓÂÔÁÓ¿, ¯ˆÚ›˜ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹ Î·Ù·ÛÙÔÏ‹, ·Ú¿ ÙÈ˜ ÂÓ‰Â›ÍÂÈ˜ fiÙÈ ÔÈ ·Ú·-¿Óˆ ‰˘ÛÌÂÓÂ›˜ ÂÈ‰Ú¿ÛÂÈ˜ ÂÏ·¯ÈÛÙÔÔÈÔ‡ÓÙ·È ÌÂÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ Î·È Î·Ù·ÛÙ·ÏÙÈÎÒÓ ÚÈÓÙË ‰È·ÛˆÏ‹ÓˆÛË (16,17). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈÌÈÛÔ› ÁÈ·ÙÚÔ› Ô˘ ·¿ÓÙËÛ·Ó ıÂˆÚÔ‡Ó ÙË ¯ÔÚ‹ÁË-ÛË Î·Ù·ÛÙÔÏ‹˜ ÛÂ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË ‰È·ÛˆÏ‹Óˆ-ÛË ··Ú·›ÙËÙË ‹ ÛËÌ·ÓÙÈÎ‹. ∏ Ù·ÎÙÈÎ‹ ·˘Ù‹, fiÌˆ˜,ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ ÛÂ 1 ÌÔÓ¿‰·. ™Â ·Ó¿ÏÔÁÂ˜ ÌÂ-Ï¤ÙÂ˜ ‚Ú¤ıËÎÂ fiÙÈ ÛÙÔ 37% Î·È 69% ÙˆÓ ÓÂÔÁÓÈÎÒÓÌÔÓ¿‰ˆÓ ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Î·È ∞˘ÛÙÚ·Ï›·,·ÓÙ›ÛÙÔÈ¯·, ¯ÔÚËÁÂ›Ù·È Î¿ÔÈÔ Î·Ù·ÛÙ·ÏÙÈÎfi ÚÈÓ·fi ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË ‰È·ÛˆÏ‹ÓˆÛË. ª¿ÏÈ-ÛÙ·, Î·È ÛÙÈ˜ ‰‡Ô ¯ÒÚÂ˜ Ë ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿-

ÎˆÓ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙ· ÙÂÏÂÈfiÌËÓ·, ÚÔÊ·ÓÒ˜ÏfiÁˆ ÙË˜ ÌÂÁ·Ï‡ÙÂÚË˜ ‰˘ÛÎÔÏ›·˜ ÛÙË ‰È·ÛˆÏ‹Óˆ-ÛË ÙÔ˘ ÌÂÁ¿ÏÔ˘ Î·È ˙ˆËÚÔ‡ ÓÂÔÁÓÔ‡ (18,19).

O ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, Ô˘ Û˘Ó‹ıˆ˜ ·ÎÔÏÔ˘-ıÂ› ÙË ‰È·ÛˆÏ‹ÓˆÛË, ·ÔÙÂÏÂ› ‰˘Û¿ÚÂÛÙÔ, ›Ûˆ˜Î·È ÂÒ‰˘ÓÔ, ÂÚ¤ıÈÛÌ· ÁÈ· Ù· ÓÂÔÁÓ¿, ÙÔ ÔÔ›ÔÚÔÎ·ÏÂ› ‰˘ÛÎÔÏ›· Û˘Á¯ÚÔÓÈÛÌÔ‡ ÌÂ ÙÔÓ ·Ó·ÓÂ˘-ÛÙ‹Ú·, ÂÂÈÛfi‰È· ˘ÔÍ›·˜, Û‡Ó‰ÚÔÌ· ‰È·Ê˘Á‹˜·¤Ú· Î·È ÌÂÙ·‚ÔÏ¤˜ ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜. OÈ ÂÈ-ÏÔÎ¤˜ ·˘Ù¤˜ ÂÏ·ÙÙÒÓÔÓÙ·È ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÔÈÔ-ÂÈ‰ÒÓ (ÌÔÚÊ›ÓË ‹ ÊÂÓÙ·Ó‡ÏË) (20-22). ∞Ó Î·È ËÂÏ¿ÙÙˆÛË ÙÔ˘ fiÓÔ˘ Â›Ó·È ÌÂ›˙ÔÓ ËıÈÎfi ‰›ÏËÌÌ·, Ë¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ ‰ÂÓ ıÂˆÚÂ›Ù·È ˘Ô¯ÚÂˆÙÈ-Î‹ Î·È ·ÔÙÂÏÂ› Â‰›Ô ÎÏÈÓÈÎ‹˜ ¤ÚÂ˘Ó·˜ (23). ™ÙËÓ∂ÏÏ¿‰·, Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ÓÂÔÁÓÔÏfiÁˆÓ ÈÛÙÂ‡ÂÈfiÙÈ Ù· ‰È·ÛˆÏËÓˆÌ¤Ó· ÓÂÔÁÓ¿ ¯ÚÂÈ¿˙ÔÓÙ·È Î·Ù·-ÛÙÔÏ‹ Î·È Â›Ó·È È‰È·›ÙÂÚ· ÂÓı·ÚÚ˘ÓÙÈÎfi fiÙÈ ÛÙÈ˜ Â-ÚÈÛÛfiÙÂÚÂ˜ ÌÔÓ¿‰Â˜ ¯ÔÚËÁÂ›Ù·È Î¿ÔÈÔ ·Ó·ÏÁËÙÈ-Îfi ‹ Î·Ù·ÛÙ·ÏÙÈÎfi. ∏ ÔÈÎÈÏ›· ÙˆÓ ·Ó·ÏÁËÙÈÎÒÓ ‹Î·Ù·ÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÈÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ÔÊÂ›ÏÂÙ·ÈÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰ÈÂıÓÒ˜ ÔÌÔÊˆÓ›·Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÈÔ Î·Ù¿ÏÏËÏÔ Ê¿ÚÌ·ÎÔ ‹ Û˘Ó‰˘·-ÛÌfi ÙÔ˘˜. ¶¿ÓÙˆ˜, Ù· ÔÈÔÂÈ‰‹, È‰È·›ÙÂÚ· Ë ıÂÈÈÎ‹ÌÔÚÊ›ÓË Î·È ÙÔ Û˘ÓıÂÙÈÎfi ÔÈÔÂÈ‰¤˜ ÊÂÓÙ·Ó‡ÏË,·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÈÔ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˘˜·Ó·ÏÁËÙÈÎÔ‡˜ Î·È Î·Ù·ÛÙ·ÏÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÛÙ·ÓÂÔÁÓ¿, fiˆ˜ Î·È ÛÙÈ˜ ª∂¡¡ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜. ∏ ¯Ú‹ÛË Î·È ÙˆÓ ‰‡Ô ıÂˆÚÂ›Ù·È ÁÂÓÈÎ¿·ÛÊ·Ï‹˜ (24,25) Î·È ÚÔÛÊ¤ÚÂÈ ·ÚfiÌÔÈÔ ·Ó·ÏÁË-ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· (26). ∏ ÌÈ‰·˙ÔÏ¿ÌË, Ô˘ Â›Ó·È‚Ú·¯Â›·˜ ‰Ú¿ÛË˜ ‚ÂÓ˙Ô‰È·˙Â›ÓË, ÏfiÁˆ ÙˆÓ Ê·Ú-Ì·ÎÔÏÔÁÈÎÒÓ ÙË˜ ÏÂÔÓÂÎÙËÌ¿ÙˆÓ Î·È Î˘Ú›ˆ˜ ÙË˜

¶›Ó·Î·˜ 7. ∆·ÎÙÈÎ‹ ÙˆÓ ª∂¡¡ (n=11): ¯Ú‹ÛË ·Ó·ÏÁËÙÈÎÒÓÎ·È Î·Ù·ÛÙ·ÏÙÈÎÒÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿

∞Ó·ÏÁËÙÈÎfi ª∂¡¡ n (%)

ªÔÚÊ›ÓË 1 (9,1%)ªÔÚÊ›ÓË + ÊÂÓÙ·Ó‡ÏË 2 (18,2%)ªÔÚÊ›ÓË + ·Ú·ÎÂÙ·ÌfiÏË 1 (9,1%)ºÂÓÙ·Ó‡ÏË 3 (27,2%)ºÂÓÙ·Ó‡ÏË + ·Ú·ÎÂÙ·ÌfiÏË 2 (18,2%)¶·Ú·ÎÂÙ·ÌfiÏË 1 (9,1%)

¶›Ó·Î·˜ 8. ∆Ú¤¯Ô˘Û· Ú·ÎÙÈÎ‹ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌËÊ·ÚÌ·ÎÔÏÔÁÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ÛÙÈ˜ ª∂¡¡

ª∂¡¡ n (%)

¶ÂÚÈÔÚÈÛÌfi˜ ¯ÂÈÚÈÛÌÒÓ 10 (83,3%)∂Ï¿ÙÙˆÛË ÊˆÙÈÛÌÔ‡ Î·È ıÔÚ‡‚Ô˘ 5 (42%)∞·Ï¿ ·ÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· (¯¿‰È) 8 (66,6%)ºˆÏÈ¤˜ 4 (33,3%)ªË ‰È·ÙÚÔÊÈÎfi˜ ıËÏ·ÛÌfi˜ (È›Ï·) 10 (83,3%)ÃÔÚ‹ÁËÛË ÁÏ˘ÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ 3 (25%)ÕÏÏ· 1 (8,3%)

¶›Ó·Î·˜ 6. ∆·ÎÙÈÎ‹ ÙˆÓ ª∂¡¡: Û˘ÛÙËÌ·ÙÈÎ‹ ‹ ÙÔÈÎ‹ ¯Ú‹ÛË ·Ó·ÏÁËÙÈÎÒÓ Î·È Î·Ù·ÛÙ·ÏÙÈÎÒÓ ÚÈÓ ·fi ÂÒ‰˘ÓÂ˜ ÌÈÎÚÔÂÂÌ-‚¿ÛÂÈ˜

ª∂¡¡ º¿ÚÌ·Î· (·ÚÈıÌfi˜ ª∂¡¡)

£ˆÚ·ÎÈÎ‹ ·ÚÔ¯¤ÙÂ˘ÛË 8 (66,7%) ºÂÓÙ·Ó‡ÏË (1), ÌÔÚÊ›ÓË (1), ÏÈ‰ÔÎ·˝ÓË (4), EMLA (1)OÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË 3 (25%) §È‰ÔÎ·˝ÓË (2), EMLA (1)∆ÔÔı¤ÙËÛË ·ÚÙËÚÈ·Î‹˜ ÁÚ·ÌÌ‹˜ - -∂ÎÏÂÎÙÈÎ‹ ‰È·ÛˆÏ‹ÓˆÛË 1 (8,3%) ºÂÓÙ·Ó‡ÏË∞Ó·ÚÚfiÊËÛË ·fi ÙÚ·¯ÂÈÔÛˆÏ‹Ó· - -ÀÂÚË‚ÈÎ‹ ·Ú·Î¤ÓÙËÛË 2 (17%) EMLA (2)ÕÏÏ· 5 (41,7%) §È‰ÔÎ·˝ÓË (4), EMLA (1)

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·33


34

¤ÏÏÂÈ„Ë˜ ÂÓÂÚÁÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ, ¤¯ÂÈ ÂÎÙÔ›ÛÂÈ ÙË‰È·˙Â¿ÌË ·fi ÙÈ˜ ÓÂÔÁÓÈÎ¤˜ ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈÎ‹˜ ÓÔ-ÛËÏÂ›·˜ (7). øÛÙfiÛÔ, ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤Ó· ı¤ÙÔ˘Ó˘fi ·ÌÊÈÛ‚‹ÙËÛË ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿-ÏÂÈ· ÙË˜ ¯Ú‹ÛË˜ ÙË˜, Î·ı’ fiÛÔÓ Ë ¯ÔÚ‹ÁËÛ‹ ÙË˜ ÛÂÓÂÔÁÓ¿ ÌÂ ™∞¢ ‰ÂÓ ÌÂÙ¤‚·ÏÂ ÙËÓ ÂÍ¤ÏÈÍË Î·È ÙÈ˜ ÂÈ-ÏÔÎ¤˜ ÙË˜ ÓfiÛÔ˘ (27). ∂ÈÏ¤ÔÓ, Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂÂÏ¿ÙÙˆÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (27,28) Î·È ÙËÓÂÌÊ¿ÓÈÛË ÛËÌ·ÓÙÈÎÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ·fi ÙÔ ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· (Ì˘ÔÎÏÔÓ›Â˜, ÂÁÎÂÊ·ÏÈÎ‹·ÈÌÔÚÚ·Á›· ‚·ıÌÔ‡ πππ-πV, ÂÚÈÎÔÈÏÈ·Î‹ ÏÂ˘ÎÔÌ·Ï·-Î›· Î·È ı¿Ó·ÙÔÈ) (24,29).

™‡ÌÊˆÓ· ÌÂ Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤-ÙË˜, Ë Ì˘Ô¯¿Ï·ÛË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÂ ÂÚÈÙÒÛÂÈ˜·‰˘Ó·Ì›·˜ Û˘Á¯ÚÔÓÈÛÌÔ‡ ÌÂ ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú·ÌfiÓÔ ÛÂ 2 ª∂¡¡. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Û˘Ì‚·‰›˙ÂÈ ÌÂÙË ÁÂÓÈÎfiÙÂÚË Ù¿ÛË ÌÂ›ˆÛË˜ ÙË˜ ¯Ú‹ÛË˜ ÙË˜ Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÏfiÁˆ Î˘Ú›ˆ˜ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ·fi Ù· Ì˘Ô¯·Ï·ÚˆÙÈÎ¿ Î·È ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘Û˘Á¯ÚÔÓÈÛÌ¤ÓÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (30-33).ŒÙÛÈ, ÌÂ Ù· ÛËÌÂÚÈÓ¿ ‰Â‰ÔÌ¤Ó·, Ù· Ì˘Ô¯·Ï·ÚˆÙÈÎ¿¤¯Ô˘Ó ı¤ÛË ÌfiÓÔ ÛÙËÓ ÂÚ›ÙˆÛË fiÔ˘ ÙÔ ÓÂÔÁÓfiÂÍ·ÎÔÏÔ˘ıÂ› Ó· “Ì¿¯ÂÙ·È” ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú· ·Ú¿ÙËÓ Â·ÚÎ‹ ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÛ›·˜ Î·È Î·Ù·ÛÙÔÏ‹˜Î·È ÌÂÙ¿ ÙËÓ ·ÔÙ˘¯›· ÙÔ˘ Û˘Á¯ÚÔÓÈÛÌ¤ÓÔ˘ ÌË¯·ÓÈ-ÎÔ‡ ·ÂÚÈÛÌÔ‡ (33).

ŒÓ·˜ Û˘¯Ófi˜ ¯ÂÈÚÈÛÌfi˜ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ‚Ú›-ÛÎÔÓÙ·È ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi Â›Ó·È Ë ·Ó·ÚÚfiÊËÛËÌ¤Ûˆ ÙÔ˘ ÙÚ·¯ÂÈÔÛˆÏ‹Ó·, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ÔÔ›·˜ ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ Î·ÈÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛË˜ Î·È ·ÚÔ‰ÈÎ‹ ˘ÔÍ·ÈÌ›·(34,35). Œ¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ Ù· Ê·ÈÓfiÌÂÓ· ·˘Ù¿ÂÏ·¯ÈÛÙÔÔÈÔ‡ÓÙ·È ÌÂ ÙË ¯ÔÚ‹ÁËÛË Î·Ù·ÛÙÔÏ‹˜(24,36). øÛÙfiÛÔ, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÓÂÔ-ÁÓÔÏfiÁÔ˘˜ Ô˘ ÂÚˆÙ‹ıËÎ·Ó Ê·›ÓÂÙ·È Ó· ·Ú·‚Ï¤-Ô˘Ó ÙË ÛËÌ·Û›· ÙÔ˘ ¯ÂÈÚÈÛÌÔ‡ ·˘ÙÔ‡ ˆ˜ ËÁ‹˜fiÓÔ˘ Î·È ‰˘ÛÊÔÚ›·˜ Î·È Ó· ıÂˆÚÔ‡Ó ÌË ··Ú·›-ÙËÙË ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÛ›·˜ ÚÈÓ ÙËÓ ·Ó·ÚÚfiÊË-ÛË ÙË˜ ÙÚ·¯Â›·˜. ∫·Ù’ Â¤ÎÙ·ÛË, Ë ¯ÔÚ‹ÁËÛË Î¿ÔÈ-Ô˘ Î·Ù·ÛÙ·ÏÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÚÈÓ ÙËÓ ·Ó·ÚÚfiÊËÛË‰ÂÓ ·ÔÙÂÏÂ› Ù·ÎÙÈÎ‹ ÙˆÓ ª∂¡¡ ÛÙËÓ ∂ÏÏ¿‰·.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË‰‹ÏˆÛ·Ó fiÙÈ Ô ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi˜ fiÓÔ˜ Ú¤ÂÈ Ó··ÓÙÈÌÂÙˆ›˙ÂÙ·È Â·ÚÎÒ˜. øÛÙfiÛÔ, ·ÎfiÌË Î·È ÙÔ ÌÈ-ÎÚfi ÔÛÔÛÙfi (4%) Ô˘ ÈÛÙÂ‡ÂÈ ÙÔ ·ÓÙ›ıÂÙÔ, ıÂˆ-ÚÂ›Ù·È fiÙÈ ‰ÂÓ Â›Ó·È ·Ô‰ÂÎÙfi. ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ÌÔÓ¿‰Â˜, Ô fiÓÔ˜ ÌÂÙ¿ ·fi ÌÂ›˙ÔÓÂ˜ ÂÂÌ‚¿ÛÂÈ˜·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÈÎ·ÓÔÔÈËÙÈÎ¿, Î˘Ú›ˆ˜ ÌÂ ÔÈÔÂÈ‰‹.∞ÓÙ›ıÂÙ·, ÛÂ Ì›· ÌÔÓ¿‰· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌfiÓÔ ·-Ú·ÎÂÙ·ÌfiÏË, Ë ÔÔ›· fiÌˆ˜ ‰ÂÓ ÚÔÛÊ¤ÚÂÈ ÈÎ·ÓÔ-ÔÈËÙÈÎ‹ ·Ó·ÏÁËÛ›· ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿ (37).

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÛ›·˜ ÛÂÂÏ¿ÛÛÔÓÂ˜ ·ÏÏ¿ ÂÒ‰˘ÓÂ˜ ÌÈÎÚÔÂÂÌ‚¿ÛÂÈ˜, ËÏÂÈÔÓfiÙËÙ· ÙˆÓ ÁÈ·ÙÚÒÓ ÈÛÙÂ‡ÂÈ fiÙÈ ‰ÂÓ ··ÈÙÂ›-

Ù·È Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË Î¿ÔÈÔ˘ ·Ó·ÏÁËÙÈÎÔ‡ÁÈ· ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ·˘Ù¤˜, ÌÂ ÂÍ·›ÚÂÛË ÙËÓÙÔÔı¤ÙËÛË ıˆÚ·ÎÈÎ‹˜ ·ÚÔ¯¤ÙÂ˘ÛË˜. ∞ÓÙ›ıÂÙ·,Ù· ÙÔÈÎ¿ ·Ó·ÈÛıËÙÈÎ¿ ıÂˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ· ÁÈ·ÙÈ˜ ÌÈÎÚÔÂÂÌ‚¿ÛÂÈ˜. øÛÙfiÛÔ, ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ª∂¡¡ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÚˆÙfiÎÔÏÏÔ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÙˆÓ ÌÈÎÚÔÂÂÌ‚¿ÛÂ-ˆÓ. O ÂÒ‰˘ÓÔ˜ ¯ÂÈÚÈÛÌfi˜, ÁÈ· ÙÔÓ ÔÔ›Ô Û˘¯ÓfiÙÂ-Ú· ¯ÔÚËÁÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎ¿ ‹ ÙÔÈÎ¿ ·Ó·ÏÁËÛ›·, Â›-Ó·È Ë ÙÔÔı¤ÙËÛË ıˆÚ·ÎÈÎ‹˜ ·ÚÔ¯¤ÙÂ˘ÛË˜ Î·È, ÏÈ-ÁfiÙÂÚÔ Û˘¯Ó¿, Ë ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË. ¶·-ÚfiÌÔÈÂ˜ Ù·ÎÙÈÎ¤˜ ·ÓÂ·ÚÎÔ‡˜ ‹ ÂÏ¿¯ÈÛÙË˜ ·ÓÙÈÌÂ-ÙÒÈÛË˜ ÙÔ˘ fiÓÔ˘ ÙˆÓ ÌÈÎÚÔÂÂÌ‚¿ÛÂˆÓ ·Ú·ÙË-ÚÔ‡ÓÙ·È ‰ÈÂıÓÒ˜ (9-11,38). ∂Ó‰Â¯ÔÌ¤Óˆ˜, ·˘ÙfiÔÊÂ›ÏÂÙ·È ÛÙÔ Êfi‚Ô ÂÌÊ¿ÓÈÛË˜ ·ÓÂÈı‡ÌËÙˆÓÂÓÂÚÁÂÈÒÓ, fiˆ˜ Ë ÌÂı·ÈÌÔÛÊ·ÈÚÈÓ·ÈÌ›· Ô˘ ·Ú·-ÙËÚÂ›Ù·È ÌÂ ÙË ¯Ú‹ÛË ÙË˜ ·ÏÔÈÊ‹˜ ÏÈ‰ÔÎ·˝ÓË˜/ÚÈ-ÏÔÎ·˝ÓË˜ (EMLA) (39).

OÈ ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎÔ› ÙÚfiÔÈ ·Ó·ÏÁËÛ›·˜, fiˆ˜Ô ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ÂÒ‰˘ÓˆÓ ¯ÂÈÚÈÛÌÒÓ, Ë ÂÏ¿ÙÙˆ-ÛË ÙÔ˘ ÊˆÙÈÛÌÔ‡ Î·È ÙÔ˘ ıÔÚ‡‚Ô˘, ÙÔ ¯¿‰È, Ë ÙÔ-Ôı¤ÙËÛË ÙˆÓ ÓÂÔÁÓÒÓ ÛÂ ÊˆÏÈ¤˜ Î·È Ô ÌË ‰È·ÙÚÔ-ÊÈÎfi˜ ıËÏ·ÛÌfi˜ (È›Ï·) ‹ Ë ¯ÔÚ‹ÁËÛË ÁÏ˘ÎÒÓ ‰È·-Ï˘Ì¿ÙˆÓ, ·ÔÙÂÏÔ‡Ó ÂÓ·ÏÏ·ÎÙÈÎ¿ Ì¤Û· ÌÂ›ˆÛË˜ÙÔ˘ stress Î·È ÙÔ˘ fiÓÔ˘ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙÈ˜ÂÏ¿ÛÛÔÓÂ˜ ÂÂÌ‚¿ÛÂÈ˜ (40,41). OÈ ÌË¯·ÓÈÛÌÔ› ÌÂÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ¯ÂÈÚÈÛÌÔ› ·˘ÙÔ› ÚÔÎ·ÏÔ‡Ó ·Ó·Ï-ÁËÛ›·, ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›. ŒÙÛÈ, Ë·Ó·ÏÁËÙÈÎ‹ ‰Ú¿ÛË ÙÔ˘ ÌË ‰È·ÙÚÔÊÈÎÔ‡ ıËÏ·ÛÌÔ‡·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·ÔÙÂÏÂ› ¤Ó·Î˘Ú›·Ú¯Ô Î·È Â˘¯¿ÚÈÛÙÔ ÂÚ¤ıÈÛÌ· Ô˘ ·ÔÛ¿ ÙËÓÚÔÛÔ¯‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔÓ fiÓÔ, ÂÓÒ ·˘Ù‹ ÙˆÓÁÏ˘ÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ ·Ô‰›‰ÂÙ·È ÛÙËÓ ·ÂÏÂ˘ı¤Úˆ-ÛË ÂÓ‰ÔÁÂÓÒÓ ÔÈÔÂÈ‰ÒÓ (42). ∞fi Ù· ·ÔÙÂÏ¤ÛÌ·-Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÚÔÎ‡ÙÂÈ fiÙÈ ÔÈ ‰È¿ÊÔ-ÚÂ˜ ÌË Ê·ÚÌ·ÎÔÏÔÁÈÎ¤˜ ·ÚÂÌ‚¿ÛÂÈ˜ Â›Ó·È ÁÂÓÈÎ¿·Ô‰ÂÎÙ¤˜ ·fi ÙË ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ÁÈ·ÙÚÒÓÔ˘ ÂÚˆÙ‹ıËÎ·Ó Î·È fiÙÈ ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙÈ˜ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ÓÂÔÁÓÈÎ¤˜ ÌÔÓ¿‰Â˜. ∆· Ì¤ÙÚ· Ô˘ Â›Ó·È·Ô‰ÂÎÙ¿ ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ È·ÙÚÔ‡˜ Â›Ó·È ÔÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ¯ÂÈÚÈÛÌÒÓ Î·È ÙˆÓ ¤ÓÙÔÓˆÓ ÂÍˆÙÂ-ÚÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ (ÊˆÙÈÛÌfi˜, ıfiÚ˘‚Ô˜), Î·ıÒ˜Î·È Ë ÂÊ·ÚÌÔÁ‹ ··ÏÒÓ ·ÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ (¯¿-‰È). ∞ÓÙ›ıÂÙ·, ·fi ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ù·ÎÙÈÎÒÓ ÙˆÓª∂¡¡, Ê·›ÓÂÙ·È fiÙÈ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ Â›Ó·È ‰‡-ÛÎÔÏÔ Ó· ÂÚÈÔÚÈÛÙÂ› ÙÔ Êˆ˜ Î·È Ô ıfiÚ˘‚Ô˜, ÂÓÒÙ· ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ Ì¤ÙÚ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÈÛ˘¯ÓfiÙÂÚ· Â›Ó·È Ô ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ¯ÂÈÚÈÛÌÒÓ Î·È ËÈ›Ï·.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÚÔÎ‡ÙÂÈ fiÙÈ ÔÈ ŒÏÏËÓÂ˜ ÓÂ-ÔÁÓÔÏfiÁÔÈ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿ “ÔÓÔ‡Ó” Î·È,·Ú¿ÏÏËÏ·, ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÈ˜ ‰˘ÛÌÂÓÂ›˜ Û˘Ó¤-ÂÈÂ˜ ÙÔ˘ fiÓÔ˘ Î·È ÙÔ˘ stress ÛÂ ·˘Ù¿. øÛÙfiÛÔ, ÛÂÏ›ÁÂ˜ ª∂¡¡ ÂÊ·ÚÌfi˙ÂÙ·È Î¿ÔÈÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ

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ÚˆÙfiÎÔÏÏÔ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ fiÓÔ˘ Ô˘ Û˘ÓÔ‰Â‡ÂÈ ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ È·ÙÚÈ-ÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜, ÌÂ ÂÍ·›ÚÂÛË ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹·Ó·ÏÁËÛ›·. ∞·ÈÙÂ›Ù·È ÈÔ Û˘ÛÙËÌ·ÙÈÎ‹ ÚÔÛ¤ÁÁÈ-ÛË ÙÔ˘ fiÓÔ˘ ÛÙÈ˜ ÂÏÏËÓÈÎ¤˜ ª∂¡¡. ¶Èı·ÓÒ˜, ÂÈ-ÛÙËÌÔÓÈÎÔ› ÊÔÚÂ›˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙËÓ ˘ÁÂ›·ÙÔ˘ ·È‰ÈÔ‡, fiˆ˜ ÔÈ ¶·È‰È·ÙÚÈÎ¤˜ Î·È ¶ÂÚÈÁÂÓÓËÙÈ-Î¤˜ ∂Ù·ÈÚÂ›Â˜, ı· ¤ÚÂÂ Ó· ·Ó·Ù‡ÍÔ˘Ó ÔÌ¿‰·ÂÚÁ·Û›·˜ Ë ÔÔ›· ı· ÚÔÙÂ›ÓÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ Ô‰Ë-Á›Â˜ Ê·ÚÌ·ÎÔÏÔÁÈÎ‹˜ ÚfiÏË„Ë˜ Î·È ·ÓÙÈÌÂÙÒÈ-ÛË˜ ÙÔ˘ fiÓÔ˘ ÛÙ· ÓÂÔÁÓ¿.

∂˘¯·ÚÈÛÙ›Â˜OÈ Û˘ÁÁÚ·ÊÂ›˜ Â˘¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ È·ÙÚÈÎfi ÚÔÛˆÈÎfi

ÙˆÓ ª∂¡¡ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙË ÌÂÏ¤ÙË Î·ıÒ˜ Î·È ÙÔ˘˜‰ÈÂ˘ı˘ÓÙ¤˜ ÙˆÓ ÌÔÓ¿‰ˆÓ: ∞Ó‰ÚfiÓÈÎÔ˘ ™, ¢ÂÏ·ÁÚ·ÌÌ¿ÙÈÎ· ∏,º·ÚÚ‹-∫ˆÛÙÔÔ‡ÏÔ˘ §, °Ô‡Ó·ÚË ∞, ∫·ÏÔÁÈ¿ÓÓË ¡, ∫ˆÛÙ·-ÓÙ›ÓÔ˘ °, ∫ÒÛÙ·ÏÔ Ã, ª·ÓÙ·Áfi ™, ¶ÂÙÌÂ˙¿ÎË ™, ™ÈÁ¿Ï· π, ™Ô-Ê·Ù˙‹ π Î·È •¿ÓıÔ˘ ª.

µÈ‚ÏÈÔÁÚ·Ê›·1. Barker DP, Rutter ¡. Exposure to invasive procedures in

neonatal intensive care unit admissions. Arch Dis ChildFetal Neonatal Ed 1995;72:F47-48.

2. Anand KJ, Carr DB. The neuroanatomy, neurophysiology,and neurochemistry of pain, stress, and analgesia innewborns and children. Pediatr Clin North Am 1989;36:795-821.

3. Anand KJ, Hickey PR. Pain and its effects in the humanneonate and fetus. N Engl J Med 1987;317:1321-1329.

4. Porter FL, Wolf CM, Miller JP. Procedural pain in newborninfants: the influence of intensity and development.Pediatrics 1999;104:e13.

5. Menon G, Anand KJ, McIntosh ¡. Practical approach toanalgesia and sedation in the neonatal intensive care unit.Semin Perinatol 1998;22:417-424.

6. Porter FL, Grunau RE, Anand KJ. Long-term effects of painin infants. J Dev Behav Pediatr 1999;20:253-261.

7. American Academy of Pediatrics and Canadian PaediatricSociety. Prevention and management of pain and stress inthe neonate. Pediatrics 2000;105:454-461.

8. Kahn DJ, Richardson DK, Gray JE, Bednarek F, Rubin LP,Shah B et al. Variation among neonatal intensive care unitsin narcotic administration. Arch Pediatr Adolesc Med1998;152:844-851.

9. Bauchner ∏, May ∞, Coates ∂. Use of analgesic agents forinvasive medical procedures in pediatric and neonatalintensive care units. J Pediatr 1992;121:647-649.

10. Porter FL, Wolf CM, Gold J, Lotsoff D, Miller JP. Pain andpain management in newborn infants: a survey ofphysicians and nurses. Pediatrics 1997;100:626-632.

11. Johnston CC, Collinge JM, Henderson SJ, Anand KJ. ∞cross-sectional survey of pain and pharmacologicalanalgesia in Canadian neonatal intensive care units. Clin JPain 1997;13:308-312.

12. Heaton ƒ, Herd D. Neonatal pain relief [letter]. Arch DisChild Fetal Neonatal Ed 2000;83:F77-78.

13. Gibbons ƒ∞, Swedlow DB. Changes in oxygen saturationduring elective tracheal intubation in infants. Anesth Analg1987;66:860-862.

14. Raju ∆¡, Vidyasagar D, Torres C, Grundy D, Bennett EJ.Intracranial pressure during intubation and anesthesia ininfants. J Pediatr 1980;96:860-862.

15. Friesen RH, Honda ∞∆, Thieme RE. Changes in anteriorfontanel pressure in preterm neonates during trachealintubation. Anesth Analg 1987;66:874-878.

16. Hickey PR, Hansen DD. Fentanyl- and sufentanil-oxygen-pancuronium anesthesia for cardiac surgery in infants.Anesth Analg 1984;63:117-124.

17. Bhutada ∞, Sahni R, Rastogi S, Wung J∆. Randomizedcontrolled trial of thiopental for intubation in neonates. ArchDis Child Fetal Neonatal Ed 2000;82:F34-37.

18. Whyte S, Birrell G, Wyllie J. Premedication before intubationin UK neonatal units. Arch Dis Child Fetal Neonatal Ed2000;82:F38-41.

19. Hancock S, Newell S, Brierley J, Berry ∞. Premedication forneonatal intubation: current practice in Australia and theUnited Kingdom [letter]. Arch Dis Child Fetal Neonatal Ed2000;83:F77.

20. Dyke ªƒ, Kohan R, Evans S. Morphine increasessynchronous ventilation in preterm infants. J Paediatr ChildHealth 1995;31:176-179.

21. Goldstein RF, µrazy JE. Narcotic sedation stabilizes arterialblood pressure fluctuations in sick premature infants. JPerinatol 1991;11:365-371.

22. Sabatino G, Quartulli L, Di Fabio S, Ramenghi LA.Hemodynamic effects of intravenous morphine infusion inventilated preterm babies. Early Hum Dev 1997;47:263-270.

23. Kennedy KA, Tyson JE. Narcotic analgesia for ventilatednewborns: are placebo-controlled trials ethical andnecessary? J Pediatr 1999;134:127-129.

24. Anand KJ, Barton µ∞, McIntosh ¡, Lagercrantz ∏, Pelausa∂, Young ∆∂ et al. Analgesia and sedation in pretermneonates who require ventilatory support: results from the¡Oƒ∞π¡ trial. Neonatal Outcome and Prolonged Analgesiain Neonates. Arch Pediatr Adolesc Med 1999;153:331-338.

25. Quinn MW, Wild J, Dean HG, Hartley R, Rushforth JA,Puntis JW et al. Randomized double-blind controlled trial ofeffect of morphine Ôn catecholamine concentrations inventilated preterm babies. Lancet 1993;342:324-327.

26. Lago ƒ, Benini F, Agosto C, Zacchello F. Randomizedcontrolled trial of low dose fentanyl infusion in preterminfants with hyaline membrane disease. Arch Dis Child FetalNeonatal Ed 1998;79:F194-197.

27. Jacqz-Aigrain ∂, Daoud ƒ, Burtin ƒ, Desplanques L,Beaufils F. Placebo-controlled trial of midazolam sedation inmechanically ventilated newborn babies. Lancet1994;344:646-650.

28. Jacqz-Aigrain ∂, Daoud ƒ, Burtin ƒ, Maherzi S, Beaufils F.Pharmacokinetics of midazolam during continuous infusionin critically ill neonates. Eur J Clin Pharmacol 1992;42:329-332.

29. Waisman D, Weintraub Z, Rotschild A, Bental Y. Myoclonicmovements in very low birth weight premature infantsassociated with midazolam intravenous bolusadministration. Pediatrics 1999;104:579.

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·35


36

30. Cheung PY, Tyebkhan JM, Peliowski A, Ainsworth W,Robertson CM. Prolonged use of pancuronium bromideand sensorineural hearing loss in childhood survivors ofcongenital diaphragmatic hernia. J Pediatr 1999; 135:233-239.

31. Fanconi S, Ensner S, Knecht B. Effects of paralysis withpancuronium bromide on joint mobility in premature infants.J Pediatr 1995;127:134-136.

32. McIntosh N. Hypotension associated with pancuronium usein the newborn. Lancet 1985;2:279.

33. Cools F, Offringa M. Neuromuscular paralysis for newborninfants receiving mechanical ventilation. CochraneDatabase Syst Rev 2000;4:CD002773.

34. Shah AR, Kurth CD, Gwiazdowski SG, Chance µ, Delivoria-Papadopoulos ª. Fluctuations in cerebral oxygenation andblood volume during endotracheal suctioning in prematureinfants. J Pediatr 1992;120:769-774.

35. Kohlhauser C, Bernert G, Hermon ª, Popow C, Seidl R,Pollak ∞. Effects of endotracheal suctioning in high-frequency oscillatory and conventionally ventilated lÔw birthweight neonates on cerebral hemodynamics observed bynear infrared spectroscopy (NIRS). Pediatr Pulmonol2000;29:270-275.

36. Ninan ∞, O’Donnell ª, Hamilton ∫, ∆an L, Sankaran ∫.Physiologic changes induced by endotracheal instillationand suctioning in critically ill preterm infants with andwithout sedation. Am J Perinatol 1986;3:94-97.

37. Howard CR, Howard FM, Weitzman ML. Acetaminophenanalgesia in neonatal circumcision: the effect on pain.Pediatrics 1994;93:641-646.

38. Fernandez CV, Rees ∂ƒ. Pain management in Canadianlevel 3 neonatal intensive care units. CMAJ 1994;150:499-504.

39. Brisman ª, Ljung µª, Otterbom π, Larsson LE, AndreassonSE. Methaemoglobin formation after the use of EMLA creamin term neonates. Acta Paediatr 1998;87:1191-1194.

40. Franck LS, Lawhon G. Environmental and behavioralstrategies to prevent and manage neonatal pain. SeminPerinatol 1998;22:434-443.

41. Bucher HU, Baumgartner R, Bucher N, Seiler M, FauchereJC. Artificial sweetener reduces nociceptive reaction in termnewborn infants. Early Hum Dev 2000;59:51-60.

42. Carbajal R, Chauvet X, Couderc S, Olivier-Martin M.Randomized trial of analgesic effect of sucrose, glucose,and pacifiers in term neonates. BMJ 1999;319:1393-1397.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™·Ú·Ê›‰Ë˜ ∫ÔÛÌ¿˜ ∫‡ÌË˜ 6µ, ∆.∫. 546 55, £ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]

™ÎÔfi˜: ∏ Ô˘ÚÔÏÔ›ÌˆÍË Â›Ó·È Ì›· ·fi ÙÈ˜ ÈÔ Û˘ÓËıÈÛÌ¤ÓÂ˜·ÈÙ›Â˜ ˘ÚÂÙÔ‡ ·‰ÈÂ˘ÎÚ›ÓÈÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜ ÛÙ· ÓÂÔÁÓ¿. ™Ùfi-¯Ô˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ‰È·ÈÛÙˆıÂ› Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·Óˆ-Ì·ÏÈÒÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Î·È Ë ÔÍÂ›· ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë ÛÂ ÓÂÔ-ÁÓ¿ ÌÂÙ¿ ÙËÓ ÚÒÙË Ô˘ÚÔÏÔ›ÌˆÍË.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 57 ÓÂÔÁÓ¿ (42 ·ÁfiÚÈ· Î·È 15ÎÔÚ›ÙÛÈ·), ·ÊÔ‡ ·ÔÎÏÂ›ÛÙËÎ·Ó Ù· ÓÂÔÁÓ¿ ÌÂ ÚÔÁÂÓÓËÙÈÎ‹‰È¿ÁÓˆÛË ˘‰ÚÔÓ¤ÊÚˆÛË˜. ∏ Ì¤ÛË ËÏÈÎ›· ÛÙË ‰È¿ÁÓˆÛË ‹Ù·Ó32 ËÌ¤ÚÂ˜ (5-60 ËÌ¤ÚÂ˜). ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ, Î˘ÛÙÂÔÔ˘ÚËıÚÔÁÚ·Ê›· Î·È ÛÙ·ÙÈ-Îfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ (99m)Tc-dimercaptosuccinicacid (DMSA). ∞ÔÙÂÏ¤ÛÌ·Ù·: ∞ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ‰È·ÈÛÙÒıËÎ·ÓÛÙÔ 35% ÙˆÓ ÓÂÔÁÓÒÓ. ∫˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË ‰È·-ÁÓÒÛıËÎÂ ÛÂ 19 (33%) ÓÂÔÁÓ¿ (12 ·ÁfiÚÈ· Î·È 7 ÎÔÚ›ÙÛÈ·). ∂›-Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ ÔÍÂ›Â˜ ‚Ï¿‚Â˜ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÊÏÔÈÔ‡ ‰È·È-ÛÙÒıËÎ·Ó ÛÙÔ ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA ÛÂ19 ÓÂÊÚÔ‡˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌË-

ÛË Î·È ÛÂ 25 ÓÂÊÚÔ‡˜ ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ·ÏÈÓ‰ÚfiÌËÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÓÈÛÙ¿Ù·È, ÌÂÙ¿ ÙËÓ ÚÒÙË Ô˘ÚÔÏÔ›ÌˆÍË, Ó·‰ÈÂÚÂ˘ÓÒÓÙ·È ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ, Î˘ÛÙÂÔÔ˘ÚËıÚÔ-ÁÚ·Ê›· Î·È ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA fiÏ· Ù·ÓÂÔÁÓ¿ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 8 Â‚‰ÔÌ¿‰ˆÓ.

OÍÂ›· ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë ÌÂÙ¿ ÙËÓ ÚÒÙË Ô˘ÚÔÏÔ›ÌˆÍË ÛÂ ÓÂÔÁÓ¿1


1Cascio S, Chertin B, Yoneda A, Rolle U, KelleherJ, Puri P Acute renal damage in infants after first urinarytract infection Pediatr Nephrol 2002;17:503-505

™ÙÂÊ·Ó›‰Ë˜ ∫. π. ∞Ó·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜ ¡ÂÊÚÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·36


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∂ÍˆÓÔÛÔÎÔÌÂÈ·Î¤˜ ÌÂÙ·ÊÔÚ¤˜ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ ∞. ∆ÛÔ‡ÙÛÔ˘, ¢. °ÎÈÒÓË˜, ¶. ªfiÓÔ˘, §. ∆ÚÔ˘Ì¤Ù·˜, π. ¶··‰¿ÙÔ˜

Interhospital transport of critically ill children A. Tsoutsou, D. Gionis, P. Bonou, L. Troubetas, I. Papadatos


ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

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

�¶ÂÚ›ÏË„Ë: ∏ ÌÂÙ·ÊÔÚ¿ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂ-ÓÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÛˆÛÙ‹ ÚÔÂÙÔÈÌ·Û›· Î·È ÛˆÛÙfiÛ¯Â‰È·ÛÌfi, ÒÛÙÂ Ó· Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂ-ÛÌ·ÙÈÎ‹. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ Â›Ó·È Ë ÂÎÙ›ÌË-ÛË ÙË˜ ·ÛÊ¿ÏÂÈ·˜ ÙË˜ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ‚·Ú¤ˆ˜ ·-Û¯fiÓÙˆÓ ·È‰ÈÒÓ ·fi Î¤ÓÙÚÔ ˘ÁÂ›·˜ ‹ ÓÔÛÔÎÔÌÂ›ÔÙË˜ ÂÚÈÊ¤ÚÂÈ·˜ ÛÂ ¤Ó· ÙÚÈÙÔ‚¿ıÌÈÔ ·È‰È·ÙÚÈÎfiÓÔÛÔÎÔÌÂ›Ô. ªÂÏÂÙ‹ıËÎ·Ó ‚¿ÛÂÈ ÚˆÙÔÎfiÏÏÔ˘100 ·ÛıÂÓÂ›˜ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÌÂ Û‡ÛÙËÌ· ÌÂ-Ù·ÊÔÚ¿˜ Ì›·˜ ‹ ‰‡Ô Î·ÙÂ˘ı‡ÓÛÂˆÓ Î·È ÂÈÛ‹¯ıËÛ·Ó·Â˘ıÂ›·˜ ÛÙË ª∂£ (ÂÚ›Ô‰Ô˜ 1/1/1997 -1/5/2000). ∆ÚÈ¿ÓÙ· ¤ÓÙÂ ·ÛıÂÓÂ›˜ ‹Ù·Ó ÎÔÚ›ÙÛÈ·Î·È 65 ·ÁfiÚÈ·, ËÏÈÎ›·˜ ·fi 19 ËÌÂÚÒÓ Ì¤¯ÚÈ Î·È 14¯ÚfiÓˆÓ (Ì¤ÛË ËÏÈÎ›· 6,8 ¤ÙË). ™·Ú¿ÓÙ· ÔÎÙÒ Â›¯·ÓÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË, 14 ‹Ù·Ó ÔÏ˘ÙÚ·˘Ì·-Ù›Â˜ Î·È 28 ·ÚÔ˘Û›·˙·Ó ·ıÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·(·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ÏÔ›ÌˆÍË, Û·ÛÌÔ‡˜).∂›ÎÔÛÈ ÙÚÂÈ˜ ÌÂÙ·Ê¤ÚıËÎ·Ó ·fi ÓÔÛÔÎÔÌÂ›· ÙË˜∞ÙÙÈÎ‹˜ Î·È 77 ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·. ∆Ô ∂∫∞µ·Ó¤Ï·‚Â ÙË ÌÂÙ·ÊÔÚ¿ 54 ·ÛıÂÓÒÓ. ∫·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ÌÂÙ·ÊÔÚ¿˜, 62 ·ÛıÂÓÂ›˜ ‹Ù·Ó ÛÂ ÌË¯·ÓÈ-Îfi ·ÂÚÈÛÌfi. ¶·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡ ÙË˜·ÈÌÔÛÊ·ÈÚ›ÓË˜ ÁÈÓfiÙ·Ó ÛÂ 59 ·ÛıÂÓÂ›˜, ÂÓÒ Ï‹-ÚË˜ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ˙ˆÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÁÈ-ÓfiÙ·Ó ÌfiÓÔ ÛÂ 10 ÂÚÈÙÒÛÂÈ˜. ∂Í‹ÓÙ· ¤ÍÈ ·ÛıÂ-ÓÂ›˜ ‹Úı·Ó ¯ˆÚ›˜ ÏËÚÔÊÔÚÈ·Îfi ÛËÌÂ›ˆÌ· Î·È 30·ÛıÂÓÂ›˜ ¤Êı·Û·Ó ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓË ÂÈ‰ÔÔ›Ë-ÛË. ∫·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∂£, 76 ·ÛıÂÓÂ›˜Â›¯·Ó ‚ÂÏÙÈˆıÂ› Î·È 5 ·ÚÔ˘Û›·Û·Ó ˘ÔÏÂÈÌÌ·ÙÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹ (19 ·ÛıÂÓÂ›˜ ·Â‚›ˆÛ·Ó).

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÌÂÙ·ÊÔÚ¿ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È-‰ÈÒÓ, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË, ÔÏ˘ÙÚ·˘Ì·Ù›·˜.

�Abstract: Transfer of pediatric patients has to bewell prepared and planned, in order to be safe andharmless. The purpose of this study is to estimatesafety of transfer of critically ill children from healthcenters or regional hospital to a tertiary care center.We studied 100 patients who were transfered bytransfer systems of 1 or 2 directions and wereadmitted directly in ICU between 1/1/1997 -1/5/2000. Thirty five were girls and 65 were boys,aged from 19 days to 14 years (mean age 6.8years). Forty eight had brain injury, 14 had multipletrauma, 28 presented medical problems(respiratory distress, infection, seizures). Twentythree were transfered from Attica hospitals and 77from the rest of Greece. The National EmergencySystem transfered 54 patients. During transfer 62patients were on mechanical ventilation. Fifty ninepatients had saturation monitoring but only 10 hadfull monitoring of vital signs. Sixty six patientspresented without any accompanying medicalreport and 30 patients presented without previousinformation. On discharge from ICU, 76 wereimproved and 5 had neurological sequellae (19patients died).

Key words: transport of critically ill children,traumatic brain injury, multiple trauma.

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·37


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∂ÈÛ·ÁˆÁ‹∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ˘„ËÏ‹ È·ÙÚÈÎ‹ ÊÚÔÓÙ›‰·

Ô˘ ·Ú¤¯Ô˘Ó ÔÈ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜(ª∂£) Î·È Ë ·Ó¿Ù˘ÍË ÂÈ‰ÈÎÒÓ ÙÌËÌ¿ÙˆÓ (.¯. ÓÂÊÚÔ-ÏÔÁÈÎfi, ÔÁÎÔÏÔÁÈÎfi, Î·Ú‰ÈÔ¯ÂÈÚÔ˘ÁÈÎfi) Ô‰‹ÁËÛ·ÓÛÙË ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfi-ÙËÙ·˜ ·fi ÛÔ‚·Ú¤˜ ·Ûı¤ÓÂÈÂ˜ Î·È ÙÚ·˘Ì·ÙÈÛÌÔ‡˜. ∆ÔÁÂÁÔÓfi˜ fiÙÈ ÔÈ ª∂£ ·È‰ÈÒÓ ÏÂÈÙÔ˘ÚÁÔ‡Ó Û˘Ó‹ıˆ˜ ÛÂÙÚÈÙÔ‚¿ıÌÈ· ÓÔÛÔÎÔÌÂ›·, Î¿ÓÂÈ ÙË ÌÂÙ·ÊÔÚ¿ ·È‰ÈÒÓÔ˘ ¤¯Ô˘Ó ·Ó¿ÁÎË Ù¤ÙÔÈ·˜ ÊÚÔÓÙ›‰·˜, ··Ú·›ÙËÙÔÎÚ›ÎÔ ÛÙË Û˘ÓÔÏÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜.

™ÙËÓ ∂ÏÏ¿‰·, ÙÔ ∂∫∞µ ·ÔÙÂÏÂ› “ÙÔÓ Â›ÛËÌÔÊÔÚ¤· ˘ËÚÂÛÈÒÓ ÂÂ›ÁÔ˘Û·˜ ÚÔÓÔÛÔÎÔÌÂÈ·Î‹˜È·ÙÚÈÎ‹˜” Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ, ÂÎÙfi˜ ·fi ÙËÓ ¿ÌÂÛË·ÚÔ¯‹ È·ÙÚÈÎ‹˜ Î·È ÓÔÛËÏÂ˘ÙÈÎ‹˜ ÊÚÔÓÙ›‰·˜ Î·ÈÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÛÙÔ Î·Ù·ÏÏËÏfiÙÂÚÔÎ·È ÏËÛÈ¤ÛÙÂÚÔ ˘ÁÂÈÔÓÔÌÈÎfi Û¯ËÌ·ÙÈÛÌfi.

™ÙËÓ Ú¿ÍË, ÔÈ ÌÂÙ·ÊÔÚ¤˜ Á›ÓÔÓÙ·È ·fi ÚÔÛˆ-ÈÎfi Ô˘ ·Ó‹ÎÂÈ ÛÂ ÂÚÈÊÂÚÂÈ·Î¿ ÓÔÛÔÎÔÌÂ›·, Î¤-ÓÙÚ· ˘ÁÂ›·˜ (∫À) ‹ ·ÁÚÔÙÈÎ¿ È·ÙÚÂ›· (∞π) Î·È ‰ÂÓ¤¯ÂÈ ÙËÓ ··Ú·›ÙËÙË ÂÍÂÈ‰›ÎÂ˘ÛË ÛÙÈ˜ ÌÂÙ·ÊÔÚ¤˜.

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ Â›Ó·È Ë ÂÎÙ›ÌËÛË ÙË˜·ÛÊ¿ÏÂÈ·˜ ÙË˜ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ·È‰ÈÒÓ ·fi Î¤ÓÙÚÔ ˘ÁÂ›·˜, ·ÁÚÔÙÈÎfi È·ÙÚÂ›Ô ‹ ÓÔ-Ì·Ú¯È·Îfi ÓÔÛÔÎÔÌÂ›Ô ÛÂ ¤Ó· ÙÚÈÙÔ‚¿ıÌÈÔ ·È‰È·-ÙÚÈÎfi ÓÔÛÔÎÔÌÂ›Ô.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆Ô ˘ÏÈÎfi ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó ·ÛıÂÓÂ›˜ Ô˘ ÌÂ-

Ù·Ê¤ÚıËÎ·Ó ÌÂ Û‡ÛÙËÌ· ÌÂÙ·ÊÔÚ¿˜ Ì›·˜ ‹ ‰‡Ô Î·ÙÂ˘ı‡ÓÛÂ-ˆÓ ·fi Î¿ÔÈÔ ¿ÏÏÔ ÓÔÛÔÎÔÌÂ›Ô, ∫À ‹ ∞π Î·È ÂÈÛ‹¯ıËÛ·Ó ·Â˘-ıÂ›·˜ ÛÙË ª∂£, Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1/1/1997 - 1/5/2000. OÈ ÌÂ-Ù·ÊÔÚ¤˜ Ì›·˜ Î·ÙÂ‡ı˘ÓÛË˜ Â›Ó·È ÔÈ ÌÂÙ·ÊÔÚ¤˜ Ô˘ Ú·ÁÌ·ÙÔ-ÔÈÔ‡ÓÙ·È ·fi Ù· ÓÔÌ·Ú¯È·Î¿ ÓÔÛÔÎÔÌÂ›· (Ù· Î¤ÓÙÚ· ˘ÁÂ›·˜ ‹Ù· ·ÁÚÔÙÈÎ¿ È·ÙÚÂ›·), ÂÓÒ ÔÈ ÌÂÙ·ÊÔÚ¤˜ ‰‡Ô Î·ÙÂ˘ı‡ÓÛÂˆÓ Â›-Ó·È ÔÈ ÌÂÙ·ÊÔÚ¤˜ Ô˘ ÔÚÁ·ÓÒÓÔÓÙ·È ·fi ÙÔ ÂÈ‰ÈÎÂ˘Ì¤ÓÔ Î¤-ÓÙÚÔ ÌÂÙ·ÊÔÚÒÓ.

∫·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÙˆÓ ·ÛıÂÓÒÓ, Û˘ÌÏËÚÒıËÎÂ ÂÎÙÂÙ·Ì¤ÓÔÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ÂÚÈÏ¿Ì‚·ÓÂ ÛÙÔÈ¯Â›· ÁÈ· ÙÔ ·Ù‡¯ËÌ· (‹Û‡ÓÙÔÌÔ ÈÛÙÔÚÈÎfi, Â¿Ó ÂÚfiÎÂÈÙÔ ÁÈ· ·ıÔÏÔÁÈÎfi ÂÚÈÛÙ·ÙÈÎfi),ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙË ÛÙ·ıÂÚÔÔ›ËÛË, ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿Ô˘ ¤ÁÈÓÂ ÛÙÔÓ ÚÒÙÔ ˘ÁÂÈÔÓÔÌÈÎfi ÛÙ·ıÌfi (∫À, ∞π), ÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË Î·È ÙË ÛÙ·ıÂÚÔÔ›ËÛË ÛÙÔ ÓÔÌ·Ú¯È·Îfi ÓÔÛÔÎÔÌÂ›Ô,ÙË ÌÂÙ·ÊÔÚ¿ ÚÔ˜ ÙÔ ÓÔÛÔÎÔÌÂ›Ô ˘Ô‰Ô¯‹˜, ÌÂ ·Ó·ÊÔÚ¿ ÛÙÔÌ¤ÛÔ Î·È ÙÔ ÊÔÚ¤· ÌÂÙ·ÊÔÚ¿˜, ÛÙË Û‡ÓıÂÛË ÙË˜ ÔÌ¿‰·˜ ÌÂ-Ù·ÊÔÚ¿˜, ÛÙÔÓ ÂÍÔÏÈÛÌfi ÌÂÙ·ÊÔÚ¿˜ Î·È ÛÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘·ÛıÂÓÔ‡˜ ‹ ÁÈ· Ù˘¯fiÓ ÂÓ¤ÚÁÂÈÂ˜ Î·Ù¿ ÙË ÌÂÙ·ÊÔÚ¿. ∏ Î·Ù¿-ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÛÙË ª∂£ ÂÎÙÈÌ‹ıËÎÂ·fi ÂÈ‰ÈÎÂ˘Ì¤ÓÔ È·ÙÚfi Î·È ·Ó·ÁÚ¿ÊËÎÂ Ë ¤Î‚·Û‹ ÙÔ˘ (‚ÂÏÙ›ˆ-ÛË, ÓÂ˘ÚÔÏÔÁÈÎ¿ ˘ÔÏÂ›ÌÌ·Ù·, ı¿Ó·ÙÔ˜) Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô.

∞ÛıÂÓÂ›˜ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÌÂ Û‡ÛÙËÌ· ÌÂÙ·ÊÔÚ¿˜, ·Ï-Ï¿ ‰ÂÓ ÂÈÛ‹¯ıËÛ·Ó ¿ÌÂÛ· ÛÙË ª∂£, ‰ÂÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·ÓÛÙË ÌÂÏ¤ÙË, ÂÂÈ‰‹ ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· Û˘ÏÏÂ¯ıÔ‡Ó fiÏÂ˜ ·˘Ù¤˜ÔÈ ÏËÚÔÊÔÚ›Â˜.

∞ÔÙÂÏ¤ÛÌ·Ù·™Â ·˘Ù‹ ÙËÓ ÂÚ›Ô‰Ô ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ 678

·È‰È¿. ∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ·ÔÙ¤ÏÂÛ·Ó 100·ÛıÂÓÂ›˜ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÌÂ ÙÔ Û‡ÛÙËÌ· ÌÂÙ·-ÊÔÚÒÓ Î·È ÂÈÛ‹¯ıËÛ·Ó ¿ÌÂÛ· ÛÙË ª∂£. ∆· 65 ·È-‰È¿ ‹Ù·Ó ·ÁfiÚÈ·, Ù· 35 ÎÔÚ›ÙÛÈ· Î·È Ë Ì¤ÛË ËÏÈÎ›·ÙÔ˘˜ ‹Ù·Ó 6,9 ¯ÚfiÓÈ· (19 ËÌÂÚÒÓ ¤ˆ˜ 14 ¯ÚfiÓˆÓ).¶ÂÚ›Ô˘ Ù· ÌÈÛ¿ ·fi Ù· ·È‰È¿ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó(48%) Â›¯·Ó ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË (∫∂∫) Î·È14% ‹Ù·Ó ÔÏ˘ÙÚ·˘Ì·Ù›Â˜. ∆· ˘fiÏÔÈ· ·È‰È¿ ÌÂ-Ù·Ê¤ÚıËÎ·Ó ÏfiÁˆ ÂÁÎ·‡Ì·ÙÔ˜ (4%), ‚·ÚÈ¿˜ ÏÔ›Ìˆ-ÍË˜ (6%), ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ (5%), Û·-ÛÌÒÓ (5%), Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ó·ÎÔ‹˜ (4%)Î·È ¿ÏÏˆÓ ·ÈÙ›ˆÓ (14%) (∂ÈÎfiÓ· 1).

™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ ·fiÛÙ·ÛË, ÙÔ 23% ÙˆÓ·ÛıÂÓÒÓ ÌÂÙ·Ê¤ÚıËÎÂ ·fi ÙËÓ ∞ÙÙÈÎ‹, ÙÔ 45% ·fiÓÔÛÔÎÔÌÂ›· ÙË˜ ™ÙÂÚÂ¿˜ ∂ÏÏ¿‰·˜ Î·È ÙË˜ ¶ÂÏÔ-ÔÓÓ‹ÛÔ˘ Î·È ÙÔ 32% ·fi ÙË ÓËÛÈˆÙÈÎ‹ ∂ÏÏ¿‰·.

∆Ô ∂∫∞µ ‹Ù·Ó Ô ÊÔÚ¤·˜ Ô˘ ·Ó¤Ï·‚Â ÙË ÌÂÙ·-ÊÔÚ¿ ÛÂ 54 ÂÚÈÙÒÛÂÈ˜. ∞fi ·˘Ù¤˜, ÔÈ 48 ÌÂÙ·ÊÔ-Ú¤˜ ‹Ù·Ó Î·Ï¿ ÔÚÁ·ÓˆÌ¤ÓÂ˜ (Ï‹ÚˆÌ· ÌÂ È·ÙÚÈÎfiÎ·È ·Ú·˚·ÙÚÈÎfi/ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi ÂÎ·È‰Â˘-Ì¤ÓÔ ÛÙÈ˜ ÌÂÙ·ÊÔÚ¤˜, Î·Ù¿ÏÏËÏÔ˜ ÂÍÔÏÈÛÌfi˜),ÂÓÒ ÛÂ 6 ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ ˘‹Ú¯Â Û˘ÓÔ‰Â›· È·ÙÚÔ‡.

OÈ ˘fiÏÔÈÂ˜ 46 ÌÂÙ·ÊÔÚ¤˜ ÔÚÁ·ÓÒıËÎ·Ó ·fiÙ· Î·Ù¿ ÙfiÔ˘˜ ÓÔÛÔÎÔÌÂ›·. ∞fi ·˘Ù¤˜, ÌfiÓÔ ÛÂ 11ÂÚÈÙÒÛÂÈ˜ ˘‹Ú¯Â Û˘ÓÔ‰Â›· ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ È·ÙÚÔ‡.

™˘ÓÔÏÈÎ¿, ÛÂ 59% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘‹Ú¯Â Û˘-ÓÔ‰Â›· ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ È·ÙÚÔ‡, ÛÂ 31% ˘‹Ú¯Â È·-ÙÚfi˜, ·ÏÏ¿ ¯ˆÚ›˜ ÙËÓ ··Ú·›ÙËÙË ÂÎ·›‰Â˘ÛË (ÂÈ‰È-ÎÂ˘fiÌÂÓÔ˜ ‹ ·ÁÚÔÙÈÎfi˜ È·ÙÚfi˜) Î·È ÛÂ 10% ÙˆÓ Â-ÚÈÙÒÛÂˆÓ, Ô ‚·Ú¤ˆ˜ ¿Û¯ˆÓ ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ÌÂ-Ù·Ê¤ÚıËÎÂ ¯ˆÚ›˜ Û˘ÓÔ‰Â›· È·ÙÚÔ‡ (∂ÈÎfiÓ· 2). ªfi-ÓÔ ÙÔ 3% ÙˆÓ ÌÂÙ·ÊÔÚÒÓ ¤ÁÈÓÂ ÌÂ Û˘ÓÔ‰Â›· ·È‰È¿-ÙÚÔ˘, ¯ˆÚ›˜ fiÌˆ˜ ÂÌÂÈÚ›· ÛÙÈ˜ ÌÂÙ·ÊÔÚ¤˜.

™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ì¤Û· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·ÓÁÈ· ÙË ÌÂÙ·ÊÔÚ¿, Â›¯·ÌÂ 34 ·ÂÚÔÌÂÙ·ÊÔÚ¤˜ (32·fi ÙÔ ∂∫∞µ), ÂÓÒ ÛÙÈ˜ ˘fiÏÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜(66) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·ÛıÂÓÔÊfiÚ· Ô¯‹Ì·Ù·.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÙ·ÊÔÚ¿˜, 62 ·ÛıÂÓÂ›˜‹Ù·Ó ‰È·ÛˆÏËÓˆÌ¤ÓÔÈ Î·È ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi(ª∞), 33 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÙ·Ê¤ÚıËÎ·Ó ·fi ÙÔ∂∫∞µ. ∂›ÎÔÛÈ ¤ÓÙÂ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÂ ª∞ ·ÂÚ›-˙ÔÓÙ·Ó ÌÂ ·ÛÎfi (Û˘ÛÎÂ˘‹ Ambu). ∏ ·Ó·›Ì·ÎÙË ·-Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜¤ÁÈÓÂ ÛÂ 59 ·ÛıÂÓÂ›˜, ÂÓÒ Ï‹ÚË˜ ·Ú·ÎÔÏÔ‡ıËÛËÙˆÓ ˙ˆÙÈÎÒÓ ÛËÌÂ›ˆÓ (ÛÊ‡ÍÂÈ˜, ·Ó·ÓÔ¤˜, ∞¶) ÌÂÂÈÛÎfiÈÔ ÌÂÙ·ÊÔÚ¿˜ ¤ÁÈÓÂ ÌfiÓÔ ÛÂ 10 ÂÚÈÙÒ-ÛÂÈ˜ (ÛËÌÂÈÒÓÂÙ·È fiÙÈ ÙÔ ∂∫∞µ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›ÂÈÛÎfiÈÔ ÌÂÙ·ÊÔÚ¿˜, ·Ú¿ ÌfiÓÔ ·Ó·›Ì·ÎÙË Ì¤-ÙÚËÛË ÎÔÚÂÛÌÔ‡). ¢ÂÎ·Ù¤ÛÛÂÚÈ˜ ·ÛıÂÓÂ›˜ ‰ÂÓ ¤Ï·-‚·Ó Ï‹ÚË Î·Ù·ÛÙÔÏ‹ Î·È Ì˘Ô¯¿Ï·ÛË, 13 ·ÛıÂÓÂ›˜ÚÔÛ‹Ïı·Ó ¯ˆÚ›˜ IV ÁÚ·ÌÌ‹, 66 ·ÛıÂÓÂ›˜ ‰ÂÓ Û˘-ÓÔ‰Â‡ÔÓÙ·Ó ·fi ÏËÚÔÊÔÚÈ·Îfi ÛËÌÂ›ˆÌ· Î·È ÛÂ 30

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ÂÚÈÙÒÛÂÈ˜ ÌÂÙ·ÊÔÚÒÓ ‰ÂÓ ˘‹Ú¯Â ÂÓËÌ¤ÚˆÛËÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ ˘Ô‰Ô¯‹˜.

∫·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∂£, 76 ·ÛıÂÓÂ›˜Â›¯·Ó ‚ÂÏÙÈˆıÂ› Î·È 5 ·ÚÔ˘Û›·˙·Ó ˘ÔÏÂÈÌÌ·ÙÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹. ¢ÂÎ·ÂÓÓ¤· ·ÛıÂÓÂ›˜ ·Â-‚›ˆÛ·Ó. OÈ ı¿Ó·ÙÔÈ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔÈ ÛÙËÓ ÔÌ¿‰·ÌÂÙ·ÊÔÚÒÓ ÙÔ˘ ∂∫∞µ (13/54 ¤Ó·ÓÙÈ 6/46).

™˘˙‹ÙËÛË OÈ ÌÂÙ·ÊÔÚ¤˜ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ ·Ô-

ÙÂÏÔ‡Ó È‰È·›ÙÂÚÔ Úfi‚ÏËÌ· ÛÙËÓ ∂ÏÏ¿‰· ÏfiÁˆ ÙË˜ÁÂˆÁÚ·ÊÈÎ‹˜ È‰ÈÔÌÔÚÊ›·˜ (˘¿Ú¯Ô˘Ó ÔÏÏ¤˜ ·Ô-ÌÔÓˆÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜ Î·È ÓËÛÈ¿ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÙË‰˘Ó·ÙfiÙËÙ· ·ÓÙÈÌÂÙÒÈÛË˜ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ·ÛıÂÓÒÓ) Î·È ÏfiÁˆ ÙË˜ ·Ô˘Û›·˜ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ·ÊÔÚÒÓ ÛÂ ·È‰È¿. ª¤¯ÚÈ ÚÈÓ 2¯ÚfiÓÈ· ‰ÂÓ ˘‹Ú¯·Ó ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜·È‰ÈÒÓ ÂÎÙfi˜ ∞ÙÙÈÎ‹˜. ªÂ ÙË ‰ËÌÈÔ˘ÚÁ›·, ·Ú¯ÈÎ¿,ÙË˜ ª∂£ ·È‰ÈÒÓ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË Î·È ·ÚÁfiÙÂÚ·ÛÙÔ ∏Ú¿ÎÏÂÈÔ ÙË˜ ∫Ú‹ÙË˜ ¤¯ÂÈ ÌÂÈˆıÂ› Ô ·ÚÈıÌfi˜ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÙËÓ ∞ı‹Ó·. ∏ ÌÂÏ-ÏÔÓÙÈÎ‹ ‰ËÌÈÔ˘ÚÁ›· Î·È ¿ÏÏˆÓ ª∂£ ·È‰ÈÒÓ ı· Â-ÚÈÔÚ›ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ·˘Ùfi ÙÔÓ ·ÚÈıÌfi. ¶·Ú’ fiÏ·

·˘Ù¿, Ë ·Ó¿ÁÎË ÁÈ· ÌÂÙ·ÊÔÚ¤˜ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ·È‰ÈÒÓ ı· Û˘ÓÂ¯›˙ÂÈ Ó· ˘¿Ú¯ÂÈ (ÏfiÁˆ ·ÎÚÈ‚Ò˜ÙË˜ ÁÂˆÁÚ·ÊÈÎ‹˜ È‰ÈÔÌÔÚÊ›·˜).

™ÙË ¯ÒÚ· Ì·˜, fiˆ˜ Î·È ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜ (1), ÔÈÌÂÙ·ÊÔÚ¤˜ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ ÔÚÁ·ÓÒÓÔ-ÓÙ·È Î·È Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÙfiÛÔ ·fi Ù· ›‰È· Ù· Â-ÚÈÊÂÚÂÈ·Î¿ ÓÔÛÔÎÔÌÂ›· Ô˘ Î¿ÓÔ˘Ó ÙËÓ ·Ú·Ô-Ì‹ (ÌÂÙ·ÊÔÚ¤˜ Ì›·˜ Î·ÙÂ‡ı˘ÓÛË˜), fiÛÔ Î·È ·fiÙÔ ∂∫∞µ, ÙÔ ÔÔ›Ô ‰È·ı¤ÙÂÈ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ Û‡ÛÙËÌ·ÌÂÙ·ÊÔÚÒÓ ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ (ÌÂÙ·ÊÔÚ¤˜‰‡Ô Î·ÙÂ˘ı‡ÓÛÂˆÓ) (2). °È· ÙËÓ Â›ÙÂ˘ÍË ÙÔ˘ ÛÙfi-¯Ô˘ ÙË˜ ·ÛÊ·ÏÔ‡˜ ÌÂÙ·ÊÔÚ¿˜, ÔÈ ˘ËÚÂÛ›Â˜ ÙÔ˘∂∫∞µ ·Ó¿ ÂÚÈÊ¤ÚÂÈ· (˘¿Ú¯Ô˘Ó 12 ÂÚÈÊ¤ÚÂÈÂ˜)ÚÔ‚Ï¤Ô˘Ó (3): ·) ÂÈ¯ÂÈÚËÛÈ·Îfi Î¤ÓÙÚÔ ÂÈÎÔÈÓˆ-Ó›·˜ Î·È Û˘ÓÙÔÓÈÛÌÔ‡ Ô˘ ÛÙÂÏÂ¯ÒÓÂÙ·È ·fi È·ÙÚÈ-Îfi Î·È ·Ú·˚·ÙÚÈÎfi ÚÔÛˆÈÎfi, Î·ıÒ˜ Î·È ÚÔÛˆ-ÈÎfi ‰ÈÔÈÎ‹ÛÂˆ˜ Î·È ÙÂ¯ÓÈÎ‹˜ ˘ÔÛÙ‹ÚÈÍË˜, Ô˘ÂÏ¤Á¯ÂÈ Î·È Û˘ÓÙÔÓ›˙ÂÈ fiÏÂ˜ ÙÈ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ‚)Ì¤Û· ¿ÌÂÛË˜ Â¤Ì‚·ÛË˜ Î·È ÌÂÙ·ÊÔÚ¿˜ ·Û¯fi-ÓÙˆÓ Ô˘ ÛÙÂÏÂ¯ÒÓÔÓÙ·È ·fi È·ÙÚÈÎfi Î·È ·Ú·˚·-ÙÚÈÎfi ÚÔÛˆÈÎfi (·ÛıÂÓÔÊfiÚ· - ·Ï¿ Î·È ÎÈÓËÙ¤˜ÌÔÓ¿‰Â˜ - Î·È ·ÛıÂÓÔÊfiÚ· ·ÂÚÔÛÎ¿ÊË, ÂÏÈÎfiÙÂ-Ú· ‹ ·ÂÚÔÏ¿Ó·).

§fiÁˆ ÙˆÓ Û˘ÓıËÎÒÓ Ô˘ ÂÈÎÚ·ÙÔ‡Ó ÛÙË ¯ÒÚ·Ì·˜, ÔÈ ÌÂÙ·ÊÔÚ¤˜ ‰‡Ô Î·ÙÂ˘ı‡ÓÛÂˆÓ ıÂˆÚÔ‡ÓÙ·ÈfiÙÈ Â›Ó·È ·˘Ù¤˜ Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔÛÊ¤ÚÔ˘Ó ÙËÓ··Ú·›ÙËÙË ÊÚÔÓÙ›‰· Î·È ·ÛÊ¿ÏÂÈ· ÛÙÔ˘˜ ‚·Ú¤ˆ˜¿Û¯ÔÓÙÂ˜ ·ÛıÂÓÂ›˜ Î·È ı· Ú¤ÂÈ Ó· ÚÔÙÈÌÒÓÙ·È,Û‡ÌÊˆÓ· ÌÂ ‰Â‰ÔÌ¤Ó· ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ (1,2,4). ™ÂÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜, ÔÈ ÌÂÙ·ÊÔÚ¤˜ Ì›·˜ Î·ÙÂ‡ı˘Ó-ÛË˜ ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÔ˘Ó ÙÔ ÌÔÓ·‰ÈÎfi ÙÚfiÔ ÌÂ-Ù·ÊÔÚ¿˜. Œ¯Ô˘Ó, fiÌˆ˜, ÔÏÏ¿ ÌÂÈÔÓÂÎÙ‹Ì·Ù· (2).∏ ÛËÌÂÚÈÓ‹ ‰È¿ÚıÚˆÛË ÙÔ˘ ∂∫∞µ ‰ÂÓ Î·Ï‡ÙÂÈfiÏÂ˜ ÙÈ˜ ·Ó¿ÁÎÂ˜ ÌÂÙ·ÊÔÚ¿˜ ‚·Ú¤ˆÓ ·Û¯fiÓÙˆÓ.

∂ÈÎfiÓ· 1. ∞ÈÙ›Â˜ ÌÂÙ·ÊÔÚ¿˜ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ.

∂ÈÎfiÓ· 2. ™˘ÓÔ‰Â›· È·ÙÚÔ‡.

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JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·39


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∞fi ÙÈ˜ ÌÂÙ·ÊÔÚ¤˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ÙÔ∂∫∞µ ·Ó¤Ï·‚Â ÙË ÌÂÙ·ÊÔÚ¿ ÛÙÔ 54% ÙˆÓ ÂÚÈÙÒ-ÛÂˆÓ, ÂÓÒ ÔÈ ˘fiÏÔÈÂ˜ ÌÂÙ·ÊÔÚ¤˜ ÔÚÁ·ÓÒıËÎ·Ó·fi Ù· Î·Ù¿ ÙfiÔ˘˜ ÓÔÛÔÎÔÌÂ›·.

∆Ô ÚÔÛˆÈÎfi ·ÔÙÂÏÂ› ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÛÙÔÈ-¯Â›Ô Î¿ıÂ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ·ÊÔÚÒÓ (4,5). À¿Ú¯Ô˘ÓÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙË Û‡ÓıÂÛË ÙË˜ ÔÌ¿‰·˜ ÌÂ-Ù·ÊÔÚÒÓ, ·Ó¿ÏÔÁ· ÌÂ ÙÔ Û‡ÛÙËÌ· Ô˘ ˘¿Ú¯ÂÈ ÛÂÎ¿ıÂ ¯ÒÚ·. ™ÙËÓ ∞ÁÁÏ›· ÚÔÙÂ›ÓÂÙ·È, ÂÊfiÛÔÓ Ë ÙÔ-ÈÎ‹ ª∂£ ·È‰ÈÒÓ ·Ó·Ï·Ì‚¿ÓÂÈ ÙË ÌÂÙ·ÊÔÚ¿ ·È-‰ÈÒÓ, Ë ÔÌ¿‰· ÌÂÙ·ÊÔÚÒÓ Ó· ·ÔÙÂÏÂ›Ù·È ·fi ÂÈ‰È-ÎÂ˘Ì¤ÓÔ È·ÙÚfi Î·È ÂÂÈÚ·Ì¤ÓË ÓÔÛËÏÂ‡ÙÚÈ· (6). ∆·Ì¤ÏË ÙË˜ ÔÌ¿‰·˜ Ú¤ÂÈ Ó· Â›Ó·È ÂÎ·È‰Â˘Ì¤Ó· Î·ÈÁÓÒÛÙÂ˜ ¯ÂÈÚÈÛÌÒÓ fiˆ˜ Â›Ó·È Ë ‰È·ÛˆÏ‹ÓˆÛË, Ô·ÂÚÈÛÌfi˜, Ë ÛÙ·ıÂÚÔÔ›ËÛË ·ÂÚ·ÁˆÁÔ‡, Ë ÙÔÔı¤-ÙËÛË ÊÏÂ‚ÈÎÒÓ ÁÚ·ÌÌÒÓ Î·È Ë ·Ú·ÎÔÏÔ‡ıËÛË·ÛıÂÓÒÓ (1,5). ∂›ÛË˜, ÙÔ ÚÔÛˆÈÎfi ÌÂÙ·ÊÔÚÒÓÚ¤ÂÈ Ó· Â›Ó·È ÂÍÔÈÎÂÈˆÌ¤ÓÔ ÌÂ ÙÔ “ÂÚÈ‚¿ÏÏÔÓ”ÙË˜ ÌÂÙ·ÊÔÚ¿˜ (·ÛıÂÓÔÊfiÚÔ, ÂÍÔÏÈÛÌfi˜) Î·È Ó·Â›Ó·È ÛÂ ı¤ÛË Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ ÌÈÎÚ¿ Û˘Ì‚¿ÓÙ· (2).™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÛÙÔ 59% ÙˆÓ ÂÚÈÙÒÛÂˆÓ˘‹Ú¯Â Û˘ÓÔ‰Â›· ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ ÛÂ ÌÂÙ·ÊÔÚ¤˜ È·-ÙÚÔ‡ (·Ó·ÈÛıËÛÈÔÏfiÁÔ˜), ÛÙÔ 31% ˘‹Ú¯Â È·ÙÚfi˜¯ˆÚ›˜, fiÌˆ˜, ÙÈ˜ ÂÈ‰ÈÎ¤˜ ÁÓÒÛÂÈ˜ (ÂÈ‰ÈÎÂ˘fiÌÂÓÔÈ Î·È·ÁÚÔÙÈÎÔ› È·ÙÚÔ›) Î·È ÛÙÔ 10% ÙˆÓ ÂÚÈÙÒÛÂˆÓ‰ÂÓ ˘‹Ú¯Â Û˘ÓÔ‰Â›· È·ÙÚÔ‡. ™˘ÁÎÚÈÙÈÎ¿, ÛÂ 48/54ÌÂÙ·ÊÔÚ¤˜ ‰‡Ô Î·ÙÂ˘ı‡ÓÛÂˆÓ ˘‹Ú¯Â Ï‹ÚÂ˜ Î·ÈÂÎ·È‰Â˘Ì¤ÓÔ Ï‹ÚˆÌ·, ÂÓÒ ÛÙÈ˜ ÌÂÙ·ÊÔÚ¤˜ Ì›·˜Î·ÙÂ‡ı˘ÓÛË˜ ÌfiÓÔ ÛÂ 11/46 ÂÚÈÙÒÛÂÈ˜ ˘‹Ú¯ÂÛ˘ÓÔ‰Â›· ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ È·ÙÚÔ‡. ∞ÎfiÌ· Î·È ÙÔ ÚÔ-ÛˆÈÎfi ÙÔ˘ ∂∫∞µ (È·ÙÚÈÎfi Î·È ÓÔÛËÏÂ˘ÙÈÎfi) ‰ÂÓ¤¯ÂÈ ÙËÓ ··Ú·›ÙËÙË ÂÎ·›‰Â˘ÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛË ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ, ·Ó Î·È ˘¿Ú¯ÂÈÛËÌ·ÓÙÈÎ‹ ÚfiÔ‰Ô˜.

∏ ÂÈÏÔÁ‹ ÙË˜ ÌÂıfi‰Ô˘ ÌÂÙ·ÊÔÚ¿˜ Î·ıÔÚ›˙ÂÙ·È·fi ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ Ë ·fiÛÙ·ÛË ÌÂÙ·-ÊÔÚ¿˜, Ë ÛÔ‚·ÚfiÙËÙ· ÙË˜ ¿ıËÛË˜, ÔÈ Î·ÈÚÈÎ¤˜Û˘Óı‹ÎÂ˜ Î·È Ë ÙÔÈÎ‹ ÁÂˆÁÚ·Ê›·, Ë ·ÛÊ¿ÏÂÈ·, Ù·‰È·ı¤ÛÈÌ· Ì¤Û· Î·È ÙÔ ÎfiÛÙÔ˜ (1,2). ∂ÎÙfi˜ ·fi ÙËÓÙ·¯‡ÙËÙ·, Î¿ıÂ Ì¤ıÔ‰Ô˜ ÌÂÙ·ÊÔÚ¿˜ (·ÛıÂÓÔÊfiÚÔÂ‰¿ÊÔ˘˜, ÂÏÈÎfiÙÂÚÔ, ·ÂÚÔÏ¿ÓÔ) ¤¯ÂÈ ÏÂÔÓÂÎÙ‹-Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ô˘ ı· ·ÍÈÔÏÔÁËıÔ‡Ó ·Ó¿-ÏÔÁ· ÌÂ ÙÈ˜ Û˘Óı‹ÎÂ˜ (2,4,6). ™ÙË ÌÂÏ¤ÙË ·˘Ù‹, Â-Ú›Ô˘ ÙÔ 1/3 (32%) ÙˆÓ ÌÂÙ·ÊÔÚÒÓ ÚÔÂÚ¯fiÙ·Ó·fi Ù· ÓËÛÈ¿ Î·È ‹Ù·Ó ·ÂÚÔÌÂÙ·ÊÔÚ¤˜, ÌÂ ÂÈÏ¤ÔÓ‰˘ÛÎÔÏ›· Î·È ÎfiÛÙÔ˜. ∏ Î·Ï‡ÙÂÚË ÔÚÁ¿ÓˆÛË ÙˆÓ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ÓËÛÈ¿ Î·È Ë Ì¤-ÚÈÌÓ· ÁÈ· ‰È·Û‡Ó‰ÂÛË ÌÂ Ù· ÓÔÛÔÎÔÌÂ›· ÙˆÓ ÓËÛÈÒÓ·˘ÙÒÓ ı· Ô‰ËÁ‹ÛÔ˘Ó ÛÙË ÌÂ›ˆÛË ÙˆÓ ·ÂÚÔÌÂÙ·ÊÔ-ÚÒÓ. ª·˙› ÌÂ ÙÈ˜ ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ÙË ÌÂ›ˆÛ‹ ÙÔ˘˜,fiÌˆ˜, ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈËıÂ› ÂÓ›Û¯˘ÛË Î·È‚ÂÏÙ›ˆÛ‹ ÙÔ˘˜, ÒÛÙÂ Ó· ÌÔÚÔ‡Ó Ó· ÂÍ˘ËÚÂÙ‹-ÛÔ˘Ó ·Ó¿ ¿Û· ÛÙÈÁÌ‹ ÂÂ›ÁÔ˘ÛÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜.

ŸÏÔ ÙÔ Ê·ÚÌ·ÎÂ˘ÙÈÎfi ˘ÏÈÎfi Î·È Ô ··Ú·›ÙËÙÔ˜

ÂÍÔÏÈÛÌfi˜ ÁÈ· ÙË ÛÙ·ıÂÚÔÔ›ËÛË Î·È ÙË ÌÂÙ·ÊÔÚ¿Ú¤ÂÈ Ó· ÌÂÙ·Ê¤ÚÂÙ·È ·fi ÙËÓ ÔÌ¿‰· ÌÂÙ·ÊÔÚÒÓ(1,6). O ÂÍÔÏÈÛÌfi˜ ÌÂÙ·ÊÔÚÒÓ Ú¤ÂÈ Ó· Â›Ó·ÈÂÏ·ÊÚ‡˜ Î·È ÊÔÚËÙfi˜, Ó· Â›Ó·È ÚÔÛ·ÚÌÔÛÌ¤ÓÔ˜ÛÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ·È‰ÈÔ‡ (‰ËÏ·‰‹ Ó· ˘¿Ú¯Ô˘Ó fiÏ·Ù· ÌÂÁ¤ıË), Ó· ÏÂÈÙÔ˘ÚÁÂ› Î·È Ó· ÂÊ·ÚÌfi˙ÂÈ ÛÂfiÏÔ˘˜ ÙÔ˘˜ Ù‡Ô˘˜ ÙˆÓ ·ÛıÂÓÔÊfiÚˆÓ (4). ∏ ‰È¿Ú-ÎÂÈ· ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ÂÓÛˆÌ·ÙˆÌ¤ÓË˜ ËÁ‹˜ÂÓ¤ÚÁÂÈ·˜ Ú¤ÂÈ Ó· Â›Ó·È ‰ÈÏ¿ÛÈ· ÙË˜ ·Ó·ÌÂÓfiÌÂ-ÓË˜ ‰È¿ÚÎÂÈ·˜ ÙË˜ ÌÂÙ·ÊÔÚ¿˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ ÌÂÙ·ÊÔÚ¿˜, Ô ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ Ú¤ÂÈ Ó·Á›ÓÂÙ·È ÌÂ ·Ó·ÓÂ˘ÛÙ‹Ú· ÌÂÙ·ÊÔÚ¿˜ (1,4). ∏ ·Ú·-ÎÔÏÔ‡ıËÛË ÙˆÓ ˙ˆÙÈÎÒÓ ÛËÌÂ›ˆÓ (ÛÊ‡ÍÂÈ˜, ∞¶,·Ó·ÓÔ¤˜, ÎÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜, ıÂÚÌÔÎÚ·Û›·)Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂ ÂÈÛÎfiÈÔ ÌÂÙ·ÊÔÚ¿˜, Î·ıÒ˜Ë ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÛıÂÓÔÊfi-ÚÔ˘ ‰ÂÓ Â›Ó·È ·ÍÈfiÈÛÙË (1,2). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤-ÙË, ÙÔ 62% ÙˆÓ ·ÛıÂÓÒÓ ‚ÚÈÛÎfiÙ·Ó ÛÂ ª∞, ÂÓÒ25/62 ·ÛıÂÓÂ›˜ ·ÂÚ›˙ÔÓÙ·Ó ÌÂ ·ÛÎfi (Û˘ÛÎÂ˘‹Ambu) Î·È fi¯È ÌÂ ·Ó·ÓÂ˘ÛÙ‹Ú· ÌÂÙ·ÊÔÚ¿˜ fiˆ˜Û˘ÓÈÛÙ¿Ù·È. ∏ ·Ó·›Ì·ÎÙË ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÎÔ-ÚÂÛÌÔ‡ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ¤ÁÈÓÂ ÛÂ 59% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ, ·ÏÏ¿ ÌfiÓÔ ÛÂ 10% ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÂÈ-ÛÎfiÈÔ ÌÂÙ·ÊÔÚ¿˜ ÌÂ Ï‹ÚË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ˙ˆÙÈÎÒÓ ÛËÌÂ›ˆÓ.

OÈ ·ÈÙ›Â˜ Ô˘ Î·ıÈÛÙÔ‡Ó ··Ú·›ÙËÙË ÙË ÌÂÙ·ÊÔÚ¿ÙÔ˘ ·ÛıÂÓ‹ ÛÂ ÙÚÈÙÔ‚¿ıÌÈÔ ÓÔÛÔÎÔÌÂ›Ô ‹ ª∂£ Â›Ó·ÈÔÈÎ›ÏÂ˜. ™ÙË ÌÂÏ¤ÙË ·˘Ù‹, ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·È‰ÈÒÓÌÂÙ·Ê¤ÚıËÎÂ ÏfiÁˆ ÙÚ·‡Ì·ÙÔ˜, Î˘Ú›ˆ˜ ÏfiÁˆ ∫∂∫(48%), ·ÏÏ¿ Î·È ÔÈÎ›ÏˆÓ ¿ÏÏˆÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·-ÛÙ¿ÛÂˆÓ (‚·ÚÈ¿ ÏÔ›ÌˆÍË, ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·,¤ÁÎ·˘Ì·, ∫∞∞, ‰ËÏËÙËÚÈ¿ÛÂÈ˜, ÓÈÁÌfi˜, ÌÂÙ·‚ÔÏÈÎ¤˜‰È·Ù·Ú·¯¤˜ Î.¿.). ∂ÔÌ¤Óˆ˜, Ô È·ÙÚfi˜ Ô˘ ı· Î¿ÓÂÈÙË ÌÂÙ·ÊÔÚ¿ Ú¤ÂÈ ·Ú¯ÈÎ¿ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ Î·È Ó·ÛÙ·ıÂÚÔÔÈ‹ÛÂÈ ÙÔ ¿ÚÚˆÛÙÔ ·È‰› Ô˘ ÌÂÙ·Ê¤ÚÂÙ·ÈÌÂ ‰È¿ÊÔÚÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜.

∏ ·Ú¯ÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÛÙ·ıÂÚÔÔ›ËÛË, Ô˘Â›Ó·È ÙÔ ÚÒÙÔ ‚‹Ì· Ì›·˜ ÛˆÛÙ‹˜ ÌÂÙ·ÊÔÚ¿˜, ÛÎÔ-fi ¤¯ÂÈ ÙË ‰È·Ù‹ÚËÛË ÙˆÓ ˙ˆÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ, ÙË˜·Ó·ÓÔ‹˜ Î·È ÙË˜ Î˘ÎÏÔÊÔÚ›·˜ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›-Â‰·, ¤ˆ˜ fiÙÔ˘ Ô ·ÛıÂÓ‹˜ Ó· ÌÔÚÂ› Ó· ·ÓÙÈÌÂÙˆ-ÈÛÙÂ› Ï‹Úˆ˜ ÛÙÔ ÙÚÈÙÔ‚¿ıÌÈÔ ÓÔÛÔÎÔÌÂ›Ô (7). ∂¿ÓÎÚÈıÂ› ··Ú·›ÙËÙË Ë ‰È·ÛˆÏ‹ÓˆÛË (·ÎfiÌ· Î·È Â›·ÌÊÈ‚ÔÏ›·˜), ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ÙÔ Ù·¯‡ÙÂÚÔ ‰˘Ó·-ÙfiÓ, ¯ˆÚ›˜ ·Ó·ÌÔÓ‹ Î·È ÂÚ·ÈÙ¤Úˆ ÂÈ‰Â›ÓˆÛË(1,2). ∏ ·ÁÁÂÈ·Î‹ ÚÔÛ¤Ï·ÛË Î·È Ë ¯ÔÚ‹ÁËÛË˘ÁÚÒÓ (‹ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ) ÁÈ· ÙËÓ ·ÔÎ·Ù¿ÛÙ·-ÛË ÙÔ˘ Î˘ÎÏÔÊÔÚÔ‡ÓÙÔ˜ fiÁÎÔ˘ Î·È ÙË˜ ∞¶ Ú¤ÂÈÓ· Â›Ó·È ¿ÌÂÛË. ∏ ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ Î·ıÂ-Ù‹Ú· Î·È Ë ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ÙÚ·¯ÂÈÔÛˆÏ‹Ó·, ÙˆÓÊÏÂ‚ÈÎÒÓ ÁÚ·ÌÌÒÓ ‹ Î·ıÂÙ‹ÚˆÓ ·ÚÔ¯¤ÙÂ˘ÛË˜·ÔÙÂÏÔ‡Ó ·Ï¿ Ì¤Û· ÚfiÏË„Ë˜ ·ÓÂÈı‡ÌËÙˆÓÂÈÏÔÎÒÓ Î·Ù¿ ÙË ÌÂÙ·ÊÔÚ¿. ∏ ¯ÔÚ‹ÁËÛË Î·Ù¿Ï-ÏËÏË˜ Î·Ù·ÛÙÔÏ‹˜ ‹ Î·È Ì˘Ô¯¿Ï·ÛË˜ ÌÂÈÒÓÂÈ ÙÔÓ

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·40


41

Î›Ó‰˘ÓÔ ÙË˜ Ù˘¯·›·˜ ·ÔÛˆÏ‹ÓˆÛË˜ ‹ ÌÂÙ·Î›ÓËÛË˜Î·ıÂÙ‹ÚˆÓ, ·ÏÏ¿ Î·È ÙÈ˜ Èı·ÓfiÙËÙÂ˜ ·‡ÍËÛË˜ ÙË˜ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛË˜ ÛÂ ·È‰›· ÌÂ ∫∂∫ (1).

™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∫∂∫, ıÂÌÂÏÈÒ‰Ô˘˜ ÛË-Ì·Û›·˜ Â›Ó·È Ë ÚfiÏË„Ë ÙË˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÂÁÎÂ-Ê·ÏÈÎ‹˜ ‚Ï¿‚Ë˜ Ô˘ ÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ÏfiÁˆÙË˜ ˘fiÙ·ÛË˜, ÙË˜ ˘ÔÍ·ÈÌ›·˜ ‹ ÙË˜ ÔÍ¤ˆÛË˜.ŸÙ·Ó Ë ÎÏ›Ì·Î· °Ï·ÛÎÒ‚Ë˜ (GCS) Â›Ó·È ÌÈÎÚfiÙÂÚË·fi 10, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ‰È·ÛˆÏËÓÒÓÂÙ·È (È‰È-·›ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰›ÓÂÙ·È ÛÙÔ˘˜ ¯ÂÈÚÈ-ÛÌÔ‡˜, Â¿Ó ‰ÂÓ ¤¯ÂÈ ·ÔÎÏÂÈÛÙÂ› Ë Èı·ÓfiÙËÙ· Î·-ÎÒÛÂˆÓ ÙË˜ ∞ª™™) Î·È Ó· ÌÂÙ·Ê¤ÚÂÙ·È ÛÂ Ï‹ÚËÎ·Ù·ÛÙÔÏ‹ Î·È Ì˘Ô¯¿Ï·ÛË. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·-ÎÔ˜ ı· ¤¯ÂÈ ÂÈ‚Â‚·ÈÒÛÂÈ ÙËÓ ÔÚı‹ ı¤ÛË ÙÔ˘ ÙÚ·-¯ÂÈÔÛˆÏ‹Ó·.

∂›ÛË˜, ÛÂ ÂÈÁÏˆÙÙ›ÙÈ‰· ‹ ‚·ÚÈ¿ Ï·Ú˘ÁÁ›ÙÈ‰·,Ë ÌÂÙ·ÊÔÚ¿ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·ÊÔ‡ Ô ·ÛıÂÓ‹˜ ¤¯ÂÈ‰È·ÛˆÏËÓˆıÂ› Î·È Î·Ù·ÛÙ·ÏÂ›.

™ÙÔ ¤ÁÎ·˘Ì·, ÂÎÙfi˜ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ˘ÁÚÒÓÁÈ· ÚfiÏË„Ë ÙË˜ ˘ÔÔÁÎ·ÈÌÈÎ‹˜ Î·Ù·ÏËÍ›·˜, Â¿Ó˘¿Ú¯Ô˘Ó ‚Ï¿‚Â˜ ÛÙÔ ÚfiÛˆÔ ‹ ÛÙÔÈ¯Â›· ÂÈÛÓÂ˘-ÛÙÈÎÔ‡ ÂÁÎ·‡Ì·ÙÔ˜, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ‰È·ÛˆÏË-ÓÒÓÂÙ·È ¿ÌÂÛ· ‹ ¤ÁÎ·ÈÚ·, ‰ÈfiÙÈ ÛÙËÓ ÚÒÙË ÂÚ›-ÙˆÛË ÙÔ Ô›‰ËÌ· Ô˘ ı· ‰ËÌÈÔ˘ÚÁËıÂ› ÌÔÚÂ› Ó·‰˘ÛÎÔÏ¤„ÂÈ ÙË ‰È·ÛˆÏ‹ÓˆÛË, ÂÓÒ ÛÙË ‰Â‡ÙÂÚË Â-Ú›ÙˆÛË ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÂÚ·-ÁˆÁÒÓ ·fi ÙÈ˜ ‚Ï¿‚Â˜ ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜.

™ÙË ÌÂÏ¤ÙË Ì·˜, ·Ó Î·È ÙÔ 62% ÙˆÓ ·ÛıÂÓÒÓ‹Ù·Ó ‰È·ÛˆÏËÓˆÌ¤ÓÔ, ÔÈ 29/62 Û˘ÓÔ‰Â‡ÔÓÙ·Ó ·fiÈ·ÙÚfi ¯ˆÚ›˜ ÁÓÒÛÂÈ˜ ‰È·ÛˆÏ‹ÓˆÛË˜. ∂ÈÏ¤ÔÓ,14/62 ‰ÂÓ ¤Ï·‚·Ó Î·Ù¿ÏÏËÏË Î·Ù·ÛÙÔÏ‹.

∏ ÁÚ‹ÁÔÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÂÈÎÔÈÓˆÓ›··Ó¿ÌÂÛ· ÛÙÔ˘˜ ÂÌÏÂÎfiÌÂÓÔ˘˜ ÛÙË ÌÂÙ·ÊÔÚ¿ ÊÔ-ÚÂ›˜ (ÓÔÛÔÎÔÌÂ›Ô Ô˘ ·Ú·¤ÌÂÈ, ÓÔÛÔÎÔÌÂ›Ô˘Ô‰Ô¯‹˜ Î·È Û‡ÛÙËÌ· ÌÂÙ·ÊÔÚ¿˜) Â›Ó·È ÂÍ›ÛÔ˘ÛËÌ·ÓÙÈÎ‹ (1,2,4). ¢˘ÛÙ˘¯Ò˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤-ÙË ÙÔ 66% ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ Û˘ÓÔ‰Â˘fiÙ·Ó ·fi ÏË-ÚÔÊÔÚÈ·Îfi ÛËÌÂ›ˆÌ· Î·È ÛÙÔ 30% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ ‰ÂÓ ˘‹Ú¯Â ÂÓËÌ¤ÚˆÛË ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ ˘Ô-‰Ô¯‹˜.

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· “·ÓÂÈı‡-ÌËÙ· Û˘Ì‚¿ÓÙ·” Î·Ù¿ ÙË ÌÂÙ·ÊÔÚ¿ Â›Ó·È ÈÔ Û¿ÓÈ·fiÙ·Ó Ë ÌÂÙ·ÊÔÚ¿ Á›ÓÂÙ·È ·fi ÂÈ‰ÈÎÂ˘Ì¤ÓË ÔÌ¿‰·ÌÂÙ·ÊÔÚÒÓ, ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ÌÂÙ·ÊÔÚ¤˜ Ô˘ Á›ÓÔ-ÓÙ·È ·fi ÌË ÂÈ‰ÈÎÂ˘Ì¤ÓË ÔÌ¿‰· (5). ™Â fi,ÙÈ ·ÊÔÚ¿ÛÙËÓ ¤Î‚·ÛË, ÛÙË ÌÂÏ¤ÙË ·˘Ù‹, ÔÈ ı¿Ó·ÙÔÈ ‹Ù·Ó Â-ÚÈÛÛfiÙÂÚÔÈ ÛÙËÓ ÔÌ¿‰· ÌÂÙ·ÊÔÚÒÓ ÙÔ˘ ∂∫∞µ(13/54 ¤Ó·ÓÙÈ 6/46), ÂÓÒ Ë ·ÚÔ˘Û›· ÓÂ˘ÚÔÏÔÁÈÎÔ‡˘ÔÏÂ›ÌÌ·ÙÔ˜ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙÈ˜ 2 ÔÌ¿‰Â˜ (3/54¤Ó·ÓÙÈ 2/40). ŒÙÛÈ, Ë “Î·Ï‡ÙÂÚË” ÌÂÙ·ÊÔÚ¿ Ê·›ÓÂ-Ù·È Ó· ÌË Û˘Ó‰˘¿˙ÂÙ·È, ÛÂ ·˘Ù‹ ÙË ÌÂÏ¤ÙË, ÌÂ Î·-Ï‡ÙÂÚË ¤Î‚·ÛË. ŸÌˆ˜, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÚÔ-

ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙË˜ ¤Î‚·ÛË˜ ÔˆÛ‰‹ÔÙÂÏ·Ì‚¿ÓÂÙ·È ̆ ’ fi„ÈÓ Ë ·Ú¯ÈÎ‹ ‚·Ú‡ÙËÙ·, ÂÎÙ›ÌËÛË ËÔÔ›· ‰ÂÓ ¤ÁÈÓÂ ÛÙË ÌÂÏ¤ÙË Ì·˜. ∏ ÂÓÙ‡ˆÛ‹ Ì·˜Â›Ó·È fiÙÈ Ù· ·È‰È¿ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ·fi ÙÔ ∂∫∞µÂ›¯·Ó ÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ·. ∂›ÛË˜, ‰ÂÓ ¤¯Ô˘Ó Î·-Ù·ÁÚ·ÊÂ› Ù· ÂÚÈÛÙ·ÙÈÎ¿ Ô˘ Î·Ù¤ÏËÍ·Ó Î·Ù¿ ÙËÌÂÙ·ÊÔÚ¿.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÌÂÙ·ÊÔÚ¿ ÙˆÓ ‚·Ú¤ˆ˜ ·-Û¯fiÓÙˆÓ ·È‰ÈÒÓ Â›Ó·È ¤Ó· ÛËÌ·ÓÙÈÎfi ÎÔÌÌ¿ÙÈ ÛÙËÓÂÂ›ÁÔ˘Û· ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ∏ ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒ-ÈÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·˘ÙÒÓ ÛÙÔÓ ÚÒÙÔ ÛÙ·ıÌfiÌÂÙ·ÊÔÚ¿˜, Ë ÛÙ·ıÂÚÔÔ›ËÛË Î·È Ë Î·Ï‹ ÔÚÁ¿Óˆ-ÛË ÙË˜ ÌÂÙ·ÊÔÚ¿˜ ÛÙÔ Î¤ÓÙÚÔ ÂÎÂ›ÓÔ Ô˘ ı· ÌÔ-ÚÂ› Ó· ·Ú¿Û¯ÂÈ ÔÏÔÎÏËÚˆÌ¤ÓË ÂÚ›ı·Ï„Ë Â›Ó·ÈÎÂÊ·Ï·ÈÒ‰Ë˜. ∏ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ˙ˆÙÈÎÒÓ ÏÂÈÙÔ˘Ú-ÁÈÒÓ Î·È Ë ÛÙ·ıÂÚÔÔ›ËÛ‹ ÙÔ˘˜ ı· Á›ÓÂÈ Û˘Á¯Úfi-Óˆ˜ ÌÂ ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙË˜ ÔÌ¿‰·˜ ÌÂÙ·ÊÔÚ¿˜,·ÔÙÂÏÔ‡ÌÂÓË ·fi ÚÔÛˆÈÎfi ÂÎ·È‰Â˘Ì¤ÓÔ ÁÈ’·˘Ù‹. ªÂÙ·ÊÔÚ¤˜ Ô˘ Á›ÓÔÓÙ·È ·fi ÔÌ¿‰Â˜ ¯ˆÚ›˜ÙËÓ ··ÈÙÔ‡ÌÂÓË ÂÌÂÈÚ›· ÌÔÚÂ› Ó· ¤¯Ô˘Ó ·ÚÓËÙÈ-Î¤˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ÔÚÂ›· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ.¢ÂÓ Ú¤ÂÈ Ó· ·Ú·ÏÂ›ÂÙ·È Ë ÂÓËÌ¤ÚˆÛË ÙÔ˘ Î¤-ÓÙÚÔ˘ ˘Ô‰Ô¯‹˜, Ë ÂÈÏÔÁ‹ ÙÔ˘ ÔÔ›Ô˘ ı· ‚·ÛÈÛÙÂ›ÛÙÈ˜ ‰˘Ó·ÙfiÙËÙÂ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤-ÓË˜ ÂÚ›ÙˆÛË˜ (.¯. Â¿Ó ˘¿Ú¯ÂÈ ÓÂ˘ÚÔ¯ÂÈÚÔ˘ÚÁÈ-Îfi ÙÌ‹Ì·, ª∂£), ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÔ‡Ó ¿ÛÙÔ¯Â˜ÌÂÙ·ÎÈÓ‹ÛÂÈ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Macrae DJ. Paediatric intensive care transport. Arch Dis

Child 1994;71:175-178.2. Pon S, Notterman DA. ∏ ÔÚÁ¿ÓˆÛË ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜

ÌÂÙ·ÊÔÚÒÓ ÂÓÙ·ÙÈÎ‹˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿. Pediatr ClinNorth Am 1993;40:325-3529 (ÌÂÙ·ÊÚ·ÛÌ¤ÓÔ).

3. ªÈÏ¿ÏË˜ ¢, ∫·Ú·Ì›ÓË˜ ∞. ªÂÙ·Ù˘¯È·Î¿ ª·ı‹Ì·Ù·∂Â›ÁÔ˘Û·˜ ¶ÚÔÓÔÛÔÎÔÌÂÈ·Î‹˜ π·ÙÚÈÎ‹˜ 1995;134-163.

4. American Academy of Pediatrics. Guidelines for air andground transportation of pediatric patients. Pediatrics1986;78:943-950.

5. Edge WE, Kanter RK, Weigle CGM, Walsh RF. Reduction ofmorbidity in interhospital transport by specialized pediatricstaff. Crit Care Med 1992;20:117-124.

6. British Paediatric Association. The care of critically illchildren. Report of the multidisciplinary working party onpaediatric intensive care. London: BPA; 1993.

7. Henning R. Emergency transport of critically ill children:stabilization before departure. Med J Aust 1992;156:117-124.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ËÌ‹ÙÚÈÔ˜ °ÎÈÒÓË˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

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∞ÍÈÔÏfiÁËÛË ÙË˜ ÎÂÊÚÔ˙›ÏË˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ËÏÈÎ›·˜ 3-18 ÂÙÒÓ ÌÂ ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ· ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1, OÌ¿‰· ªÂÏ¤ÙË˜2

Evaluation of cefprozil in the treatment of streptococcal tonsillo-pharyngitis in children A. Constantopoulos1, Study Group2


�¶ÂÚ›ÏË„Ë: §fiÁˆ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ·ÔÙ˘¯›·˜ÙË˜ ıÂÚ·Â›·˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÙfiÛÔ ÌÂ ÙËÓ Â-ÓÈÎÈÏ›ÓË fiÛÔ Î·È ÙÈ˜ Ì·ÎÚÔÏ›‰Â˜, ÔÈ ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ÎÂÚ‰›˙Ô˘Ó Û˘ÓÂ¯Ò˜ ¤‰·ÊÔ˜ Û·Ó ıÂÚ·Â›· ÂÎÏÔÁ‹˜ÙË˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜.™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ÎÂÊÚÔ˙›ÏË, Ì›· ÓÂfiÙÂÚËÎÂÊ·ÏÔÛÔÚ›ÓË Ô˘ ¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÛÙfiÌ·, ¯Ô-ÚËÁ‹ıËÎÂ ÛÂ 5175 ·ÛıÂÓÂ›˜ ·fi ·ÚÎÂÙ¿ Ì¤ÚË ÙË˜∂ÏÏ¿‰·˜, ËÏÈÎ›·˜ 3-18 ÂÙÒÓ ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÛÙÚÂ-ÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜ ÌÂ ÂÍ·ÈÚÂÙÈÎ¿·ÔÙÂÏ¤ÛÌ·Ù·. ∫ÏÈÓÈÎ‹ ›·ÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÂ Ô-ÛÔÛÙfi 89,3% ÙˆÓ ·ÛıÂÓÒÓ, ÌÂ ·Ú¿ÏÏËÏ· ˘„ËÏ¿ÔÛÔÛÙ¿ Û˘ÌÌfiÚÊˆÛË˜ ÛÙË ıÂÚ·Â›· (98,2%) Î·È¯·ÌËÏ¿ ÔÛÔÛÙ¿ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ (4%) Î·È·ÏÏ·Á‹˜ ÙË˜ ıÂÚ·Â›·˜ (2,6%). ∆· ·ÔÙÂÏ¤ÛÌ·Ù··˘Ù¿ Û˘ÌÊˆÓÔ‡Ó ·fiÏ˘Ù· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ-ÏÂÙÒÓ ·fi Í¤ÓÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ËÎÂÊÚÔ˙›ÏË Â›Ó·È Ì›· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Î·È ·ÛÊ·Ï‹˜ÂÈÏÔÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·È‰›, ÛÙÚÂÙfiÎÔÎÎÔ˜, ÏÔ›ÌˆÍË,ÎÂÊÚÔ˙›ÏË, ıÂÚ·Â›·, ·Ì˘Á‰·Ï›ÙÈ‰·.

�Abstract: Due to the increased incidence ofclinical failure following oral penicillin and macrolidestreatment, cephalosporins are continuously gainingground as an alternative therapy of streptococcaltonsillo-pharyngitis. In the present study, cefprozil anovel oral cephalosporin, was administered to 5175patients aged 3-18 years old, in several parts ofGreece, with clinical evidence of streptococcaltonsillo-pharyngitis having excellent results. Curebased on clinical evidence was observed in 89.3%of patients, with concurrent high rates of complianceto the treatment (98.2%), low rates of adverseevents (4%) and even lower rate of switch to othertherapy (2.6%). These results are in full accordancewith those of previous studies, indicating thatcefprozil is an effective and safe choice for thetreatment of streptococcal tonsillo-pharyngitis.

Key words: child, streptococcus, infection, cefprozil,treatment, tonsillitis.

1 ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

2 ª. ∞ÁÁÂÏ¿ÎË˜, ¢. ∞ÁÁÂÏfiÔ˘ÏÔ˜, ª. ∞ÚÁ˘Ú¿ÎË˜, ∂. ∞Ú¯ÈÙÂÎÙÔÓ›‰Ô˘, ª. ∞Ú¯ÔÓÙ›‰Ô˘, ™. ∞˘ÏˆÓ›ÙË˜, ¢. µÈ‰¿ÎË˜, ∫. µÔ˘ÎÂÏ¿-ÙÔ˘, °. µÚ˘ÒÓË˜, §. °·Ï¿ÓË˜, ª. °È·ÓÓ·Î›‰Ô˘, ¡. °Î·Ì›ÏË˜, ¶. °Ô˘Ú‰Ô˘¿ÚË˜, ™. °Ú‡ÏÏË˜, ∫. ¢·ÓÂÏ¿ÙÔ˘, ∞. ¢È‰¿ÁÁÂÏÔ˜, °.¢Ô‡‚ÚË˜, ™. ¢ÚfiÛË˜, ∂. ∂ÏÂ˘ıÂÚÈ¿‰Ô˘, °. ∑ÂÚ‚¿˜, Ã. ∑Ô˘Á·Ó¤ÏË, ∫. £ÂÚÌfi˜, Œ. π·Îˆ‚›‰Ô˘, ∞. ∫·ÎÔÁÈ¿ÓÓË, °. ∫·ÏÔÁÂÚfi-Ô˘ÏÔ˜, °. ∫·ÂÙ·Ó¿ÎË˜, ¶. ∫·Ú·ÁÈ¿ÓÓË˜, ™. ∫·Ú·ÛÙ·Ì¿ÙË˜, ∫. ∫ÔÚÒÓË-¶··ÓÙˆÓ›Ô˘, ¢. ∫·Û·¿ÎË˜, ¢. ∫·ÙÛÈÎ¿ÚË, º. ∫·-ÙÛÈÔ‡Ï·, ¢. ∫ÏˆÛÙÔÔ‡ÏÔ˘, ∂. ∫fiÎÎÔÚË, ∞. ∫ÔÏÈÔ¿ÓÔ˘, ™. ∫fiÚÚ·, ∫. ∫ÔÙÛÈÒÓË, ∞. ∫Ô˘ÎfiÁÈ·, º. ∫Ô˘ÁÈ¿ÓÔ˜, ∫. ∫Ô‡ÚÙË˜, °.∫ÚÔÎÈ‰¿˜, §. ∫˘Ú·ÓÔ‡‰Ë, ∂. ∫˘ÚÈ·ÎÔ‡, ∂. ∫˘Ú›ÙÛË, ∞. §ËÌÓ·›Ô˘, ∞. §˘ÎÔ˘Ú›ÓÔ˘, ∏. ª¿Ì·ÏË˜, Ã. ª·ÓÙ¿, °. ª·ÚÎ¤ÙÔ˜, ª.ª·ÈÙ›ÓË, ∂. ª·ÙÛÔ‡Î·-¶··ÓÈÎÔÏ¿Ô˘, °. ª·˘Ú¿ÎË˜, §. ªËÙÚfiÔ˘ÏÔ˜, π. ªÈÛ·Ï¤ÌË˜, §. ªÈÏ¿ÏË˜, ∞. ªÔ˘Ú¿ÓÙ·-º·ÏÔ‡-ÙÛÔ˘, ∞. ¡Èfi˙·, ∫. ¡Ù·ÏÔ‡Î·˜, ƒ. ¡ÙÈÔ‡‰Ë-∞¯ÙÛfiÁÏÔ˘, ¶. ¡ÙÔ‡ÚÌ·, ª. ¶¿ÓÔ˘, ∂. ¶··‰ËÌËÙÚ›Ô˘, ∂. ¶··ı·Ó·Û›Ô˘, π. ¶·-·˚ˆ¿ÓÓÔ˘, ∞. ¶··ÓÙˆÓ›Ô˘, ¶. ¶›ÛÎÔÔ˜, π. ¶ÔÏ›ÙÛÔ˜, ∑. ¶ÔÏ˘¯ÚÔÓ›‰Ô˘, ¡. ¶Ô˘Ï·ÓÙ˙¿˜, ∫. ƒ¿ÙË˜, ∞. ™·Î·Ï›‰Ô˘, ∂. ™·-Ú·¿ÚË˜, Ÿ. ™È‰ËÚÔÔ‡ÏÔ˘, ¢. ™ÔÏÔ‡ÎÔ˜, π. ™ÙÂÚÁ›‰Ë˜, ∞. ™Ù˘ÏÈ·Ó¿ÎË, ¢. ™˘ÌÂˆÓ›‰Ë˜, ¢. ∆·Ï›‰Ë˜, ¢. ∆˙¿Ï·˜, °. ∆Û·ÁÎ·-‰fiÔ˘ÏÔ˜, π. ∆Û·ÎÓ¿ÎË-ª·ÓˆÏ¿ÎË, ∫. ∆ÛÂÚÏÂÓÙ¿ÎË, °. ∆ÛÔÏ¿˜, °. ∆˘¯¿Ï·˜, ª. Ã·ÈÚ¤ÙË˜, ∫. Ã·Ï‰·ÈÔÔ‡ÏÔ˘-¶Ú¤ÓÙ˙·, ¶. Ã·-ÏÂÏ‹, º. Ã·ÏÈÒÙË˜, π. Ã·ÚˆÓ›ÙË, ∂. Ã·ÛÈÒÙÔ˘-∆Ô˘Ú›ÎË, ∂. Ã·Ù˙Ë·ı·Ó·ÛÈ¿‰Ô˘, ∞. ÃÚËÛÙ¿ÎÔ˘, ¶. ÃÚ˘ÛfiÌ·ÏÏÔ˘

1 Professor of Pediatrics, University of Athens

∂ÈÛ·ÁˆÁ‹∏ ÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰· ÚÔ-

Î·ÏÂ›Ù·È ·fi ÙÔÓ ‚-·ÈÌÔÏ˘ÙÈÎfi ÛÙÚÂÙfiÎÔÎÎÔ ÙË˜

ÔÌ¿‰·˜ ∞ (˘ÔÁfiÓÔ ÛÙÚÂÙfiÎÔÎÎÔ) Î·È ÌÔÚÂ› Ó·ÂÌÊ·ÓÈÛÙÂ› ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›·. ∂›Ó·È, fiÌˆ˜,È‰È·›ÙÂÚ· Û˘¯Ó‹ ÛÙ· ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. ∏

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‰È¿ÁÓˆÛ‹ ÙË˜ Ù›ıÂÙ·È ÌÂ ·ÛÊ¿ÏÂÈ· ÌÂ ÙËÓ ·ÔÌfi-ÓˆÛË ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘Ê·Ú˘ÁÁÈÎÔ‡ ÂÈ¯Ú›ÛÌ·ÙÔ˜, ÂÓÒ ·ÍÈfiÈÛÙ· ·ÔÙÂÏ¤-ÛÌ·Ù· ‰›ÓÂÈ Î·È Ë Ù·¯Â›· Ì¤ıÔ‰Ô˜ ·Ó›¯ÓÂ˘ÛË˜ ÙÔ˘·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ (1). ™ÙËÓ Î·ıËÌÂÚÈ-Ó‹ ÎÏÈÓÈÎ‹ Ú¿ÍË, ¿ÓÙˆ˜, Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Â-ÚÈÙÒÛÂˆÓ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜ Á›ÓÂÙ·È Û˘Ó‹-ıˆ˜ ¯ˆÚ›˜ ÙË ‚Ô‹ıÂÈ· Ù¤ÙÔÈˆÓ ÙÂ¯ÓÈÎÒÓ. ™ÙÈ˜ ÏÂ›-ÛÙÂ˜ ÂÚÈÙÒÛÂÈ˜, Ë ‰È¿ÁÓˆÛË ÙË˜ ÛÙÚÂÙÔÎÔÎÎÈ-Î‹˜ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜ Ù›ıÂÙ·È ·fi ÛÙÔÈ¯Â›·ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ Î·È ÂÈ‚Â‚·ÈÒÓÂÙ·È ÌÂ Î·Ï-ÏÈ¤ÚÁÂÈ· ÂÈ¯Ú›ÛÌ·ÙÔ˜, ÂÓÒ Ë ıÂÚ·Â›· ¯ÔÚËÁÂ›Ù·ÈÂÌÂÈÚÈÎ¿.

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ-·Ì˘Á‰·Ï›ÙÈ‰·˜ ÌÂ ·ÓÙÈ‚ÈÔÙÈÎ¿ ·ÔÛÎÔÂ› ·ÊÂÓfi˜ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ˆ‰ÒÓ ÂÈÏÔÎÒÓ Ô˘ Â›Ó·È‰˘ÓËÙÈÎ¿ ÛÔ‚·Ú¤˜ (.¯. ÂÚÈ·Ì˘Á‰·ÏÈÎfi ·fiÛÙË-Ì·), ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ ·ÔÊ˘Á‹ ÙˆÓ ÌË ˘ˆ‰ÒÓ ÂÈ-ÏÔÎÒÓ (.¯. ÚÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜) (2).

∏ 10‹ÌÂÚË ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏ›ÓË˜ ·ÔÙÂÏÂ› ÙËÓÎÏ·ÛÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙË ÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘Á-ÁÔ·Ì˘Á‰·Ï›ÙÈ‰· (1). ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ÔÏÏ¤˜ ·Ó·-ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ·ÔÙ˘¯›· ÙË˜ ÂÓÈÎÈÏ›-ÓË˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·-Ì˘Á‰·Ï›ÙÈ‰·˜ (1). ∏ ·ÔÙ˘¯›· ·˘Ù‹ ‰ÂÓ ÔÊÂ›ÏÂÙ·ÈÛÙËÓ ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜ ·fi ÙÔÓ ÛÙÚÂÙfiÎÔÎÎÔ,·ÏÏ¿ ·Ô‰›‰ÂÙ·È ÌÂÙ·Í‡ ¿ÏÏˆÓ ÛÙËÓ ·ÚÔ˘Û›·ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ Ê¿Ú˘ÁÁ· ÌÈÎÚÔ‚›ˆÓ Ô˘, ¯ˆÚ›˜Ó· Â›Ó·È ·ıÔÁfiÓ·, ·Ú¿ÁÔ˘Ó ¤Ó˙˘Ì· (‚-Ï·ÎÙ·Ì¿-ÛÂ˜) Ô˘ ‰È·ÛÔ‡Ó Î·È ·‰Ú·ÓÔÔÈÔ‡Ó ÙËÓ ÂÓÈÎÈÏ›-ÓË (Ê·ÈÓfiÌÂÓÔ ‚·ÎÙËÚÈ·Î‹˜ ·ÚÂÌ‚ÔÏ‹˜) (1,3). ™Â·ÓÙ›ıÂÛË ÌÂ ÙËÓ ÂÓÈÎÈÏ›ÓË, ÔÈ Ì·ÎÚÔÏ›‰Â˜ Ô˘ ·Ó¤-Î·ıÂÓ ·ÔÙÂÏÔ‡Û·Ó ÙËÓ ÂÓ·ÏÏ·ÎÙÈÎ‹ Ï‡ÛË ÛÂÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÈ˜ ‚-Ï·ÎÙ¿ÌÂ˜, ¤¯Ô˘Ó Úfi-‚ÏËÌ· ·ÓÙÔ¯‹˜ ÙÔ˘ ˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘, Ô˘ÛÂ ÌÂÚÈÎ¤˜ ¯ÒÚÂ˜ Â›Ó·È ÔÏ‡ ÛÔ‚·Úfi. ∏ ·ÓÙÔ¯‹ ·˘-Ù‹ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ÛËÌ·ÓÙÈÎ¿ Â›Â‰· (38%) Î·ÈÛÙËÓ ∂ÏÏ¿‰· Î·È ·ÊÔÚ¿ ÛÙÈ˜ ·Ï·ÈfiÙÂÚÂ˜ (ÂÚ˘ıÚÔ-Ì˘Î›ÓË), ·ÏÏ¿ Î·È ÛÙÈ˜ ÓÂfiÙÂÚÂ˜ Ì·ÎÚÔÏ›‰Â˜ (ÚÔÍÈ-ıÚÔÌ˘Î›ÓË, ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, ·˙ÈıÚÔÌ˘Î›ÓË) (4).

OÈ ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ Â›Ó·È ÂÍ›ÛÔ˘ ‰Ú·ÛÙÈÎ¤˜ ÌÂÙËÓ ÂÓÈÎÈÏ›ÓË ¤Ó·ÓÙÈ ÙÔ˘ ˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎ-ÎÔ˘, ¯ˆÚ›˜ fiÌˆ˜ Ó· ‰È·ÛÒÓÙ·È ·fi ÙÈ˜ Ï·ÎÙ·Ì¿-ÛÂ˜ ÙˆÓ Û·ÚÔÊ‡ÙˆÓ ÙÔ˘ Ê¿Ú˘ÁÁ·. À¿Ú¯Ô˘ÓÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ‰Â›¯ÓÔ˘Ó˘ÂÚÔ¯‹ ÙˆÓ ÎÂÊ·ÏÔÛÔÚÈÓÒÓ ¤Ó·ÓÙÈ ÙË˜ ÂÓÈÎÈÏ›-ÓË˜ ÛÙË ÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘ÁÁ›ÙÈ‰· (1).

∏ ÎÂÊÚÔ˙›ÏË Â›Ó·È Ì›· Ó¤· ÎÂÊ·ÏÔÛÔÚ›ÓË Ô˘¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÛÙfiÌ·. Œ¯ÂÈ Â˘Ú‡ ·ÓÙÈÌÈÎÚÔ‚È·-Îfi Ê¿ÛÌ· Î·Ï‡ÙÔÓÙ·˜ ÂÍ›ÛÔ˘ Î·Ï¿ Gram(+) Î·ÈGram(-) ·ıÔÁfiÓ· ÙË˜ Î·ıËÌÂÚÈÓ‹˜ ÎÏÈÓÈÎ‹˜ Ú¿-ÍË˜. ∂ÌÊ·Ó›˙ÂÈ ÌÂÁ¿ÏË ‰Ú·ÛÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÙÔ˘˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ (MIC90 ≤0,032 mg/l) (4).ÃÔÚËÁÔ‡ÌÂÓË ·fi ÙÔ ÛÙfiÌ· ¤¯ÂÈ ÂÍ·ÈÚÂÙÈÎ¿ Ê·Ú-

Ì·ÎÔÎÈÓËÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿: ¿ÚÈÛÙË ‚ÈÔ‰È·ıÂÛÈÌfi-ÙËÙ· Î·È ·Ú·ÙÂÙ·Ì¤ÓÔ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, ÌÂ·ÔÙ¤ÏÂÛÌ· Ó· ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› Ì›· ‹ ‰‡Ô ÊÔ-Ú¤˜ ËÌÂÚËÛ›ˆ˜, ÁÂÁÔÓfi˜ Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡-ÙÂÚË Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ıÂÚ·Â›· (5,6).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó: ·) Ë ÂÎÙ›-ÌËÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙË˜ ÎÂÊ-ÚÔ˙›ÏË˜ ÛÂ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ ËÏÈÎ›·˜ 3-18ÂÙÒÓ ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ-·Ì˘Á‰·Ï›ÙÈ‰·˜, ‚) Ë ÂÎÙ›ÌËÛË ÙË˜ ·ÛÊ¿ÏÂÈ·˜ ÙË˜ÎÂÊÚÔ˙›ÏË˜ Î·È Á) Ë ÂÎÙ›ÌËÛË ÙË˜ Û˘ÌÌfiÚÊˆÛË˜ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ıÂÚ·Â˘ÙÈÎfi ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂÏ¤ÙË ÂÚÈÏ‹ÊıËÎ·Ó ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ 3-18 ÂÙÒÓ

·fi ·ÚÎÂÙ¿ Ì¤ÚË ÙË˜ ∂ÏÏ¿‰·˜ ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Û˘Ì‚·Ù‹ ÌÂÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ı·ÌÔÚÔ‡ÛÂ Ó· ¯ÔÚËÁËıÂ› ıÂÚ·Â›· ÂÍˆÓÔÛÔÎÔÌÂÈ·Î¿ ÌÂ ·ÓÙÈ-‚ÈÔÙÈÎfi ·fi ÙÔ ÛÙfiÌ·.

∫ÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡ ·ÛıÂÓÒÓ ·fi ÙË ÌÂÏ¤ÙË ·ÔÙ¤ÏÂ-Û·Ó: ·) ÁÓˆÛÙ‹ ·ÏÏÂÚÁ›· ÛÙËÓ ÎÂÊÚÔ˙›ÏË Î·È ÁÂÓÈÎfiÙÂÚ·ÛÙÈ˜ ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ ‹ ÛÙÈ˜ ÂÓÈÎÈÏ›ÓÂ˜ ÏfiÁˆ Èı·Ó‹˜ ‰È·-ÛÙ·˘ÚÔ‡ÌÂÓË˜ ·ÏÏÂÚÁ›·˜, ‚) Ë Ù·˘Ùfi¯ÚÔÓË Ï‹„Ë Î·È ¿ÏÏÔ˘·ÓÙÈ‚ÈÔÙÈÎÔ‡ ‹ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ 7 ËÌ¤ÚÂ˜ÚÈÓ ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙË ÌÂÏ¤ÙË Î·È Á) Ë ·ÚÔ˘Û›· ·ÓÔÛÔÎ·-Ù·ÛÙÔÏ‹˜ ÔÔÈ·Û‰‹ÔÙÂ Ê‡ÛË˜ (Û˘ÁÁÂÓÔ‡˜, È·ÙÚÔÁÂÓÔ‡˜ ‹ÔÊÂÈÏfiÌÂÓË˜ ÛÂ ˘ÔÎÂ›ÌÂÓË ÓfiÛÔ).

™ÙËÓ ·Ú¯ÈÎ‹ Â›ÛÎÂ„Ë ÁÈÓfiÙ·Ó ·ÍÈÔÏfiÁËÛË ·fi ÙÔÓ ·È-‰›·ÙÚÔ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ·fiÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (¶›Ó·Î·˜ 1) Î·È·ÔÊ·ÛÈ˙fiÙ·Ó Â¿Ó Ë fiÏË ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ‹Ù·Ó Û˘Ì‚·Ù‹ ÌÂÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·.

™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ô ·ÛıÂÓ‹˜ ‹Ù·Ó Î·Ù¿ÏÏËÏÔ˜ ÁÈ·Û˘ÌÌÂÙÔ¯‹ ÛÙË ÌÂÏ¤ÙË, ÂÏ¿Ì‚·ÓÂ ·ÁˆÁ‹ ÌÂ ÎÂÊÚÔ˙›ÏË 30mg/kg/24ˆÚÔ ÁÈ· 10 ËÌ¤ÚÂ˜. ∏ Û˘ÓÔÏÈÎ‹ ËÌÂÚ‹ÛÈ· ‰ÔÛÔÏÔ-Á›· ¯ÔÚËÁÔ‡ÓÙ·Ó ÛÂ ‰‡Ô ‰fiÛÂÈ˜ (·Ó¿ 12ˆÚÔ), Â›ÙÂ ˘fi ÙËÌÔÚÊ‹ ÂÓ·ÈˆÚ‹Ì·ÙÔ˜ Â›ÙÂ ˘fi ÙË ÌÔÚÊ‹ ‰ÈÛÎ›ˆÓ ÙˆÓ 500mg. ∏ Ì¤ÁÈÛÙË ÂÈÙÚÂfiÌÂÓË ‰ÔÛÔÏÔÁ›· ‹Ù·Ó 1 g/24ˆÚÔ.

™Â ÙËÏÂÊˆÓÈÎ‹ ÂÈÎÔÈÓˆÓ›·, 5-8 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍËÙË˜ ıÂÚ·Â›·˜, Ï·Ì‚¿ÓÔÓÙ·Ó ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙËÓ ÔÚÂ›·ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙËÓ Ù˘¯fiÓ ÂÌÊ¿ÓÈÛË ÂÈ-ÏÔÎÒÓ ÙË˜ ÓfiÛÔ˘ ‹ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ·fi ÙË ıÂÚ·-Â›·. ªÂ ‚¿ÛË Ù· ÛÙÔÈ¯Â›· ·fi ÙËÓ ÙËÏÂÊˆÓÈÎ‹ ÂÈÎÔÈÓˆÓ›·,‰ÈÓfiÙ·Ó Î·È Ô ¯·Ú·ÎÙËÚÈÛÌfi˜ ÙË˜ ¤Î‚·ÛË˜ ÙË˜ ıÂÚ·Â›·˜:

·) ÿ·ÛË: Ï‹ÚË˜ ·Ô‰ÚÔÌ‹ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛË-ÌÂ›ˆÓ ÙË˜ ÏÔ›ÌˆÍË˜,

‚) µÂÏÙ›ˆÛË: ÌÂ›ˆÛË ÙË˜ ‚·Ú‡ÙËÙ·˜ ‹/Î·È ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌÂ›ˆÓ Î·È

Á) ∞ÔÙ˘¯›·: ÔÚÈ·Î‹ ·Ô‰ÚÔÌ‹, ÂÈÌÔÓ‹ ‹ ÂÈ‰Â›ÓˆÛËÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ.

¶·Ú¿ÏÏËÏ·, Î·Ù¿ ÙËÓ ÙËÏÂÊˆÓÈÎ‹ ÂÈÎÔÈÓˆÓ›· Ï·Ì‚¿ÓÔ-ÓÙ·Ó ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË Û˘ÌÌfiÚÊˆÛË ÛÙË ıÂÚ·-Â›·, ÙËÓ Èı·Ó‹ ·ÏÏ·Á‹ ÙË˜ ıÂÚ·Â›·˜, Î·ıÒ˜ Î·È ÙÔ˘˜ Ïfi-ÁÔ˘˜ Ô˘ ÙËÓ ˘·ÁfiÚÂ˘Û·Ó.

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·43


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™ËÌÂÈÒÓÂÙ·È fiÙÈ fiÔ˘ ·Ó·Ê¤ÚÂÙ·È Ô fiÚÔ˜ Û˘ÌÌfiÚÊˆÛËÛÙË ıÂÚ·Â›·, ¤¯ÂÈ ÔÚÈÛÙÂ› ‰ÈÂıÓÒ˜ fiÙÈ Ô ¿ÚÚˆÛÙÔ˜ Ï·Ì‚¿ÓÂÈÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 80% ÙË˜ Û˘ÓÔÏÈÎ‹˜ ıÂÚ·Â›·˜.

∞ÔÙÂÏ¤ÛÌ·Ù·™ÙË ÌÂÏ¤ÙË Û˘ÌÌÂÙÂ›¯·Ó 89 ÂÚÂ˘ÓËÙ¤˜ ·fi ·Ú-

ÎÂÙ¿ Ì¤ÚË ÙË˜ ∂ÏÏ¿‰·˜, ÌÂ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi 5175·ÛıÂÓÒÓ. ∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 6,5±3,3¯ÚfiÓÈ· (‰È¿ÌÂÛË ËÏÈÎ›·: 6 ¯ÚfiÓÈ·). ¶Ï‹Úˆ˜ ·ÍÈÔÏÔ-Á‹ÛÈÌÔÈ ‹Ù·Ó 5087 ·ÛıÂÓÂ›˜.

™˘ÓÔÏÈÎ¿, ›·ÛË ÌÂ ‚¿ÛË ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ÌÂÏ¤ÙË˜ ÂÌÊ¿ÓÈÛÂ ÙÔ 89,3%, ‚ÂÏÙ›ˆÛË ÙÔ 9,2% Î·È·ÔÙ˘¯›· ÙÔ 1,5% ÙˆÓ ·ÍÈÔÏÔÁ‹ÛÈÌˆÓ ·ÛıÂÓÒÓ (∂È-ÎfiÓ· 1). ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ Û˘Ì-ÌÔÚÊÒıËÎ·Ó ÛÙË ıÂÚ·Â›· ‹Ù·Ó ÔÏ‡ ÌÈÎÚfi(1,8%), fiÌˆ˜ Ë Â›ÙˆÛË ÙË˜ ÌË Û˘ÌÌfiÚÊˆÛË˜ÛÙËÓ ¤Î‚·ÛË ÙË˜ ıÂÚ·Â›·˜ ‹Ù·Ó ÔÏ‡ ÛËÌ·ÓÙÈÎ‹.OÈ ‰È·ÊÔÚ¤˜ Ê·›ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2. ŒÙÛÈ, ÛÙËÓÂÚ›ÙˆÛË ÌË Û˘ÌÌfiÚÊˆÛË˜ ÛÙË ıÂÚ·Â›· ÙÔ Ô-ÛÔÛÙfi ›·ÛË˜ ‹Ù·Ó ·ÚÎÂÙ¿ Î¿Ùˆ ·fi ÙÔ 50% Î·È Ô˘ÔÏÔÁÈ˙fiÌÂÓÔ˜ Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÁÈ· “fi¯È Ï‹ÚË›·ÛË” (‚ÂÏÙ›ˆÛË+·ÔÙ˘¯›·) ‹Ù·Ó 12,9 (95% ‰È¿-ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜: 8,0-20,9). ∂ÔÌ¤Óˆ˜, Â¿Ó ÏË-

ÊıÔ‡Ó ˘’ fi„ÈÓ ÌfiÓÔ Ù· ¿ÙÔÌ· Ô˘ Û˘ÌÌÔÚÊÒıË-Î·Ó ÛÙË ıÂÚ·Â›·, ÙÔ ÔÛÔÛÙfi ÙË˜ ›·ÛË˜ ‹Ù·Ó ·Îfi-ÌË ˘„ËÏfiÙÂÚÔ (90,2%).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ Ô˘ ˘Ô¯ÒÚË-ÛÂ Ô ˘ÚÂÙfi˜, Ë Ì¤ÛË ÙÈÌ‹ ‹Ù·Ó 2,39±0,82 ËÌ¤ÚÂ˜,ÂÓÒ ÙfiÛÔ Ë ‰È¿ÌÂÛË fiÛÔ Î·È Ë ÂÈÎÚ·ÙÔ‡Û· ÙÈÌ‹‹Ù·Ó Ë ‰Â‡ÙÂÚË ËÌ¤Ú· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·-Â›·˜ (¶›Ó·Î·˜ 2).

∏ ·ÓÙ›ÛÙÔÈ¯Ë Ì¤ÛË ÙÈÌ‹ ÁÈ· ÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓÏÔÈÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹Ù·Ó 2,92±1,22, ÂÓÒ Ë ‰È¿-ÌÂÛË ‹Ù·Ó Ë ÙÚ›ÙË Î·È Ë ÂÈÎÚ·ÙÔ‡Û· ÙÈÌ‹ ‹Ù·Ó Ë‰Â‡ÙÂÚË ËÌ¤Ú· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ (¶›-Ó·Î·˜ 3).

∏ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÙË˜ ÏÔÈÌÒÍÂˆ˜ ‹Ù·ÓÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· (44 ·ÛıÂÓÂ›˜, ÔÛÔÛÙfi 0,86%).∏ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ Û˘ÓÔ‰Â˘fiÙ·Ó, ¿ÓÙˆ˜, ·fi·ÏÏ·Á‹ ÛÙË ıÂÚ·Â›·. ∞ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ·fiÙË ıÂÚ·Â›· ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÂ 204 ·ÛıÂÓÂ›˜ (4%)Î·È ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÂ ‰È¿ÚÚÔÈ· Î·È ÛÂ ÌÈÎÚfiÙÂ-ÚÔ ÔÛÔÛÙfi ÛÂ ¤ÌÂÙÔ. OÈ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜‰ÂÓ ‹Ù·Ó Û˘Ó‹ıˆ˜ ÛÔ‚·Ú¤˜ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘ÙfiÏÈÁfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÌÊ¿ÓÈ-Û·Ó Î¿ÔÈ· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ¿ÏÏ·Í·Ó ÙÂÏÈÎ¿

¶›Ó·Î·˜ 1. ™ÙÔÈ¯Â›· Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ·ÛıÂÓÒÓ

™˘ÌÙÒÌ·Ù· ™˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ∞ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ¶ÔÛÔÛÙfi

¶ÔÓfiÏ·ÈÌÔ˜ 82% °ÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ÂËÚÂ·ÛÌ¤ÓË 32,3%¢˘ÛÎ·Ù·ÔÛ›· 60,8% ¢‡ÛÙÚÔÔ 20,1%¶ÔÓÔÎ¤Ê·ÏÔ˜ 48,1% ª¤ÁÂıÔ˜ ·Ì˘Á‰·ÏÒÓ ‰ÈÔÁÎˆÌ¤ÓÔ 71,1%ƒ›ÁÔ˜ 46,9% ∂›¯ÚÈÛÌ· 76,8%∫ÔÈÏÈ·Îfi ¿ÏÁÔ˜ 32,5% ∂Ú˘ıÚfiÙË˜ 97,4%£ÂÚÌÔÎÚ·Û›· Ì·Û¯¿ÏË˜ 38,9ÔC ∂Í›‰ÚˆÌ· 53,7%

∞˘ÙÈ¿-Ì‡ÙË-Ï·ÈÌfi˜ Û˘Ì‚·Ù¿ ÌÂ ·Ì˘Á‰·Ï›ÙÈ‰· (‰ÂÓ ˘‹Ú¯Â ‚‹¯·˜, ÚÈÓ›ÙÈ˜, ˆÙ›ÙÈ˜, ÂÈÂÊ˘Î›ÙÈ˜ Î.¿.) 92,2%

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙÈ·›· Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙË˜·ÁˆÁ‹˜.

BÂÏÙ›ˆÛË9,2%

∞ÔÙ˘¯›·1,5%

ÿ·ÛË89,3%

∂ÈÎfiÓ· 2. Ã·Ú·ÎÙËÚÈÛÌfi˜ ·ÁˆÁ‹˜ ·Ó¿ÏÔÁ· ÌÂ ÙË Û˘ÌÌfiÚ-ÊˆÛË ÛÙË Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

∞ÔÙ˘¯›·

100%

80%

60%

40%

20%

0%

BÂÏÙ›ˆÛË

ÿ·ÛË

™˘ÌÌfiÚÊˆÛË ªË Û˘ÌÌfiÚÊˆÛË

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·44


45

ÙË ıÂÚ·Â›· ÂÍ·ÈÙ›·˜ ·˘Ù‹˜. ™˘ÓÔÏÈÎ¿, ·ÏÏ·Á‹ ıÂ-Ú·Â›·˜ ÁÈ· fiÏÂ˜ ÙÈ˜ ·ÈÙ›Â˜ ¤ÁÈÓÂ ÛÂ 130 ·ÛıÂÓÂ›˜(2,6%).

∞Ó Î·È ‰ÂÓ ¤ÁÈÓ·Ó Î·ÏÏÈ¤ÚÁÂÈÂ˜ Ê·Ú˘ÁÁÈÎÔ‡ ÂÈ-¯Ú›ÛÌ·ÙÔ˜, Ù· Â˘Ú‹Ì·Ù· ÛÙËÓ ∂ÈÎfiÓ· 2 ‰Â›¯ÓÔ˘ÓfiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ·Ì˘Á‰·Ï›ÙÈ‰· ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜·ÈÙÈÔÏÔÁ›·˜. ¢È·ÊÔÚÂÙÈÎ¿, Â¿Ó ÂÚfiÎÂÈÙÔ ÁÈ· ÈÔÁÂ-ÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜, ‰ÂÓ ı· ‰È·ÈÛÙˆÓfiÙ·Ó ‰È·ÊÔÚ¿ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Î‹ Û˘ÌÌfiÚÊˆÛË.

™˘˙‹ÙËÛË ∏ ÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰· Â›Ó·È

Ì›· Û˘¯Ó‹ ¿ıËÛË ÙË˜ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. ∏ ·Ú·-‰ÔÛÈ·Î‹ ıÂÚ·Â›· ÌÂ ÂÓÈÎÈÏ›ÓË ¤¯ÂÈ ˘„ËÏ¿ ÔÛÔ-ÛÙ¿ ·ÔÙ˘¯›·˜ Î·È ˘ÔÙÚÔÒÓ, ·Ú¿ ÙË ‰Ú·ÛÙÈÎfi-ÙËÙ¿ ÙË˜ ¤Ó·ÓÙÈ ÙÔ˘ ˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ (1).∂ÈÏ¤ÔÓ, ÔÈ Ì·ÎÚÔÏ›‰Â˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ÂÓ·ÏÏ·ÎÙÈÎ‹ ıÂÚ·Â›·, ¤¯Ô˘Ó ÛÔ‚·Úfi Úfi‚ÏËÌ··ÓÙÔ¯‹˜ ÙÔ˘ ˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘, Ô˘ ·ÊÔ-Ú¿ ÙfiÛÔ ÛÙ· ·Ï·ÈfiÙÂÚ· fiÛÔ Î·È ÛÙ· ÓÂfiÙÂÚ· Ì¤-ÏË ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ (4). ∞ÓÙ›ıÂÙ·, ÔÈÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ Â›Ó·È ‰Ú·ÛÙÈÎ¤˜ ¤Ó·ÓÙÈ ÙÔ˘ ÛÙÚÂ-ÙfiÎÔÎÎÔ˘ fiˆ˜ Î·È Ë ÂÓÈÎÈÏ›ÓË, ÂÓÒ ÛÙÂÚÔ‡ÓÙ·ÈÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ·˘Ù‹ ÂÌÊ·Ó›˙ÂÈ (‰È¿Û·ÛË·fi ‚-Ï·ÎÙ·Ì¿ÛÂ˜, Î·Î‹ Ê·ÚÌ·ÎÔÎÈÓËÙÈÎ‹). π‰È·›-ÙÂÚ· Ë ÎÂÊÚÔ˙›ÏË, Ì›· ÓÂfiÙÂÚË ÎÂÊ·ÏÔÛÔÚ›ÓËÔ˘ ¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÛÙfiÌ·, ¤¯ÂÈ ÌÂÁ¿ÏË ‰Ú·ÛÙÈ-

ÎfiÙËÙ· ¤Ó·ÓÙÈ ÙÔ˘ ˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘. ™ÂÌÂÏ¤ÙÂ˜ Û˘ÁÎÚÈÙÈÎ¤˜ Î·È ÌË ¤‰ÂÈÍÂ ÂÍ·ÈÚÂÙÈÎ‹ ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÂ ÔÈÎÈÏ›· ÏÔÈÌÒÍÂˆÓ, ÂÚÈÏ·Ì-‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘-Á‰·Ï›ÙÈ‰·˜ (5,6).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ÎÂÊÚÔ˙›ÏË ¯ÔÚËÁÔ‡-ÌÂÓË ÛÂ ‰ÔÛÔÏÔÁ›· 30 mg/kg/24ˆÚÔ ÛÂ ·ÛıÂÓÂ›˜ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘-Á‰·Ï›ÙÈ‰·˜, ¤Ù˘¯Â ˘„ËÏfi ÔÛÔÛÙfi ÎÏÈÓÈÎ‹˜ ›·ÛË˜(89,3%). ™ËÌÂÈÒÓÂÙ·È, Â›ÛË˜, fiÙÈ Ô ¯ÚfiÓÔ˜ Ì¤¯ÚÈÙËÓ ˘Ô¯ÒÚËÛË ÙÔ˘ ˘ÚÂÙÔ‡ Î·È ÙˆÓ ÏÔÈÒÓ Û˘-ÌÙˆÌ¿ÙˆÓ ‹Ù·Ó ÌÈÎÚfi˜, ÌÂ ÙÔ ÏÂ›ÛÙÔ ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ Ó· ˘Ô¯ˆÚÂ› ‹‰Ë ·fi ÙË ‰Â‡ÙÂÚË ËÌ¤-Ú· ÙË˜ ıÂÚ·Â›·˜, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ Ù·¯Â›··ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›·.

∆Ô ÔÛÔÛÙfi ·˘Ùfi (89,3%) ‹Ù·Ó ·ÎfiÌË ˘„ËÏfiÙÂ-ÚÔ (90,2%) ·Ó Ï·Ì‚¿ÓÔÓÙ·Ó ˘’ fi„ÈÓ ÌfiÓÔ ÔÈ ·ÛıÂ-ÓÂ›˜ Ô˘ Û˘ÌÌÔÚÊÒıËÎ·Ó ÛÙË ıÂÚ·Â›·. To ÌÂÁ¿-ÏÔ ÔÛÔÛÙfi Û˘ÌÌfiÚÊˆÛË˜ ÛÙË ıÂÚ·Â›· Ô˘ ·-Ú·ÙËÚ‹ıËÎÂ ÌÂ ÙËÓ ÎÂÊÚÔ˙›ÏË ÛÙËÓ ·ÚÔ‡Û· ÌÂ-Ï¤ÙË Î·È Ô˘ ·ÔÙÂÏÂ› Ô˘ÛÈ·ÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ·ÎÏÈÓÈÎ‹ ÂÈÙ˘¯›· ÙË˜ ıÂÚ·Â›·˜, Ú¤ÂÈ Ó· ·Ô‰Ô-ıÂ› ·ÊÂÓfi˜ ÛÙÔ ·Ïfi ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· ÙË˜ ÎÂÊ-ÚÔ˙›ÏË˜, ·ÊÂÙ¤ÚÔ˘ ÛÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó. ∞Í›-˙ÂÈ Ó· ÙÔÓÈÛÙÂ› ÙÔ È‰È·›ÙÂÚ· ¯·ÌËÏfi ÔÛÔÛÙfi ·ÏÏ·-Á‹˜ ÙË˜ ıÂÚ·Â›·˜ Ô˘ Î·Ù·ÁÚ¿ÊËÎÂ ÛÙËÓ ·ÚÔ‡Û·

¶›Ó·Î·˜ 2. ÃÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ÙÒÛË˜ ÙÔ˘ ˘ÚÂÙÔ‡

™˘¯ÓfiÙËÙ· ¶ÔÛÔÛÙfi Â› ÙÔ˘ Û˘ÓfiÏÔ˘ÙˆÓ ··ÓÙËı¤ÓÙˆÓ (%)

∏Ì¤Ú· ÙÒÛË˜ 1 496 10,8%˘ÚÂÙÔ‡ 2 2118 46,1%

3 1638 35,6%4 310 6,7%5 26 0,6%

6+ 11 0,2%

™‡ÓÔÏÔ ·ÓÙ·ÔÎÚÈı¤ÓÙˆÓ 4599 100%™‡ÓÔÏÔ ÌË ·ÓÙ·ÔÎÚÈı¤ÓÙˆÓ 576°ÂÓÈÎfi Û‡ÓÔÏÔ 5175

¶›Ó·Î·˜ 3. ÃÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ˘Ô¯ÒÚËÛË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ

™˘¯ÓfiÙËÙ· ¶ÔÛÔÛÙfi Â› ÙÔ˘ Û˘ÓfiÏÔ˘ÙˆÓ ··ÓÙËı¤ÓÙˆÓ (%)

∏Ì¤Ú· ˘Ô¯ÒÚËÛË˜ 1 353 7,9%ÙˆÓ ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ 2 1491 33,3%

3 1474 32,9%4 679 15,2%5 340 7,6%6 93 2,1%7 30 0,7%8 15 0,3%

™‡ÓÔÏÔ ·ÓÙ·ÔÎÚÈı¤ÓÙˆÓ 4475 100%™‡ÓÔÏÔ ÌË ·ÓÙ·ÔÎÚÈı¤ÓÙˆÓ 700°ÂÓÈÎfi Û‡ÓÔÏÔ 5175

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ÌÂÏ¤ÙË, Ô˘ ‹Ù·Ó Û˘Ó¿ÚÙËÛË ÙfiÛÔ ÙË˜ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ·˜ fiÛÔ Î·È ÙË˜ ·ÛÊ¿ÏÂÈ·˜ ÙË˜ ıÂÚ·Â›-·˜, fiˆ˜ ·˘Ù‹ ÂÎÊÚ¿ÛÙËÎÂ ÌÂ ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ.

∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È Ë ·ÛÊ¿ÏÂÈ· ÙË˜ ÎÂÊ-ÚÔ˙›ÏË˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘Á-ÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜ ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ› ÛÂ ÔÏÏ¤˜ ÌÂÏ¤-ÙÂ˜, Û˘ÁÎÚÈÙÈÎ¤˜ Î·È ÌË. ŒÙÛÈ, .¯. ÔÈ µrook Î·È Û˘Ó(7) ÛÂ Ì›· Û˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ÌÂ ÂÚ˘ıÚÔÌ˘Î›ÓË ·Ó·-Ê¤ÚÔ˘Ó ÔÛÔÛÙfi ›·ÛË˜ 90% ÌÂ ÙËÓ ÎÂÊÚÔ˙›ÏË,ÂÓÒ ÙÔ ÔÛÔÛÙfi ‚·ÎÙËÚÈÔÏÔÁÈÎ‹˜ ÂÎÚ›˙ˆÛË˜ ÙÔ˘˘ÔÁfiÓÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÛÙËÓ ›‰È· ÌÂÏ¤ÙË ¤Êı·ÛÂÙÔ 95% ¤Ó·ÓÙÈ ÌfiÏÈ˜ 74% ÌÂ ÙËÓ ÂÚ˘ıÚÔÌ˘Î›ÓË. ™ÂÛ˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË, Â›ÛË˜, ÙˆÓ Milatovic Î·È Û˘Ó, ËÎÂÊÚÔ˙›ÏË ‹Ù·Ó ·ÓÒÙÂÚË ÙË˜ ÂÓÈÎÈÏ›ÓË˜ ÙfiÛÔ ÛÂÎÏÈÓÈÎfi fiÛÔ Î·È ÛÂ ‚·ÎÙËÚÈÔÏÔÁÈÎfi Â›Â‰Ô (8). ™ÂÌ›· ¿ÏÏË ÌÂÏ¤ÙË, Ë ÎÂÊÚÔ˙›ÏË ¯ÔÚËÁÔ‡ÌÂÓË Ì›·ÊÔÚ¿ ÙËÓ ËÌ¤Ú· Â›¯Â Ù· ›‰È· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÙËÓÎÂÊ·ÎÏfiÚË Ô˘ ¯ÔÚËÁ‹ıËÎÂ 3 ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ Î·ÈÙËÓ ÂÚ˘ıÚÔÌ˘Î›ÓË Ô˘ ¯ÔÚËÁ‹ıËÎÂ 4 ÊÔÚ¤˜ ÙËÓËÌ¤Ú· (9).

∏ ·ÓÒÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÎÂÊ·ÏÔ-ÛÔÚÈÓÒÓ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ÎÂÊÚÔ˙›ÏË˜,ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘Á‰·-Ï›ÙÈ‰·˜, Ô‰‹ÁËÛÂ ÔÏÏÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ Ó· Û˘˙ËÙÔ‡ÓÙÔ ÂÓ‰Â¯fiÌÂÓÔ ·Ó·ıÂÒÚËÛË˜ ÙË˜ ıÂÚ·Â›·˜ ÂÎÏÔ-Á‹˜ ÁÈ· ÙË ÛÙÚÂÙÔÎÔÎÎÈÎ‹ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·.™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÙÔ Î‡ÚÈÔ ÂÈ¯Â›ÚËÌ· ˘¤ÚÙË˜ ÂÓÈÎÈÏ›ÓË˜ Â›Ó·È ÙÔ ¯·ÌËÏfi ÎfiÛÙÔ˜ ÙË˜ ıÂÚ·-Â›·˜. ∂¿Ó, fiÌˆ˜, ÏËÊıÂ› ˘’ fi„ÈÓ ÙÔ “ÎÚ˘Êfi” Îfi-ÛÙÔ˜ Ô˘ ÂÚÈÎÏÂ›ÂÈ Ì›· ·ÔÙ˘¯›· ÙË˜ ıÂÚ·Â›·˜(Ó¤· È·ÙÚÈÎ‹ Â›ÛÎÂ„Ë, Ó¤Ô ·ÓÙÈ‚ÈÔÙÈÎfi, ÙÚÒÛË ÙÔ˘Î‡ÚÔ˘˜ ÙÔ˘ È·ÙÚÔ‡, ·Ô˘Û›· ·fi Û¯ÔÏÂ›Ô-‰Ô˘ÏÂÈ¿Î.Ï.), Î·ıÒ˜ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘ÓÌÂÁ¿ÏË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÌÂ ÙË ¯Ú‹ÛË ‚Ú·¯¤ˆÓ(5 ÌÂÚÒÓ) Û¯ËÌ¿ÙˆÓ, Ë “Ï¿ÛÙÈÁÁ· ›Ûˆ˜ ÁÂ›ÚÂÈ ÙÂ-ÏÈÎ¿ ÚÔ˜ ÙÔ Ì¤ÚÔ˜ ÙˆÓ ÎÂÊ·ÏÔÛÔÚÈÓÒÓ” (10).

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ Ë ÎÂÊÚÔ˙›ÏË ¯Ô-ÚËÁÔ‡ÌÂÓË ÛÂ ·È‰È¿ ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÛÙÚÂÙÔ-ÎÔÎÎÈÎ‹˜ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜ ÂÌÊ·Ó›˙ÂÈ ÌÂÁ¿ÏË·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ¯·ÌËÏfiÔÛÔÛÙfi ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Î·È ÂÍ·ÈÚÂÙÈÎ¿ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Û˘ÌÌfiÚÊˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ. ªÂ‚¿ÛË Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿, Ë ÎÂÊÚÔ˙›ÏË Ú¤ÂÈ

Ó· ıÂˆÚÂ›Ù·È Û·Ó Ì›· ·ÍÈfiÈÛÙË Î·È ·ÛÊ·Ï‹˜ ÂÈÏÔ-Á‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÛÙÚÂÙÔÎÔÎÎÈÎ‹˜ Ê·-Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Pichichero ME, Casey JR, Mayes T, Francis AB, Marsocci

SM, Murphy AM et al. Penicillin failure in streptococcaltonsillopharyngitis: causes and remedies. Pediatr InfectDis J 2000;19:917-923.

2. Kaplan EL. The resurgence of group A streptococcalinfections and their sequelae. Eur J Clin Microbiol InfectDis 1991;10:55-57.

3. Brook I. ∆he role of beta-lactamase producing bacteriaand bacterial interference in streptococcal tonsillitis. Int JAntimicrob Agents 2001;17:439-442.

4. Syrogiannopoulos GA, Grivea IN, Fitoussi F, Doit C,Katopodis GD, Bingen E et al. High prevalence oferythromycin resistance of Streptococcus pyogenes inGreek children. Pediatr Infect Dis J 2001;20:863-868.

5. Barriere SL. Review of in vitro activity, pharmacokineticcharacteristics, safety, and clinical efficacy of cefprozil, anew oral cephalosporin. Ann Pharmacother 1993;27:1082-1089.

6. Wiseman LR, Benfield P. Cefprozil. A review of itsantibacterial activity, pharmacokinetic properties, andtherapeutic potential. Drugs 1993;45:295-317.

7. Brook I, Aronovitz GH, Pichichero ME. Open-label,parallel-group, multicenter, randomized study of cefprozilversus erythromycin in children with group A streptococcalpharyngitis/tonsillitis. Clin Ther 2001;23: 1889-1900.

8. Milatovic D, Adam D, Hamilton H, Materman E. Cefprozilversus penicillin V in the treatment of streptococcaltonsillopharyngitis. Antimicrob Agents Chemother 1993;37:1620-1623.

9. Aronovitz G. Treatment of upper and lower respiratory tractinfections: Clinical trials with cefprozil. Pediatr Infect Dis J1998;17 (8 Suppl):S83-S88.

10. ∞dam D, Scholz H, Helmerking M. Short-course antibiotictreatment of 4782 culture-proven cases of group Astreptococcal tonsillopharyngitis and incidence ofpoststreptococcal sequelae. J Infect Dis 2000;182:509-516.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-11-2002HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 10-12-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ µ’ ¶·È‰È·ÙÚÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·Î‹ ∫ÏÈÓÈÎ‹¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

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ÀÔÍÂ›· ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÛÂ ·È‰› ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ I °. ∆Ú›ÌË˜1, ª. ªÔÛ¯fi‚Ë1, ∏. ∫·Ú·Ó›Î·˜2, ª. ∫·Ó¿ÚÈÔ˘3, ∞. ƒ·ÊÙÔÔ‡ÏÔ˘4, º. ∆˙ˆÚÙ˙¿ÙÔ˘ - ™Ù·ıÔÔ‡ÏÔ˘1

Subacute vertebral osteomyelitis in a child with type I diabetes mellitusG. Trimis1, M. Moschovi1, I. Karanikas2, M. Kanariou3, A. Raftopoulou4, F. Tzortzatou - Stathopoulou1

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 1 ªÔÓ¿‰· ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜,

A’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 µ’ OÚıÔÂ‰ÈÎ‹ ∫ÏÈÓÈÎ‹ 3 ∞ÓÔÛÔÏÔÁÈÎfi ∆Ì‹Ì· 4 ∆Ì‹Ì· ∫ÏÈÓÈÎ‹˜ ªÈÎÚÔ‚ÈÔÏÔÁ›·˜

“Agia Sophia” Children’s Hospital, Athens 1 Hematology-Oncology Unit,

1st Pediatric Clinic of University of Athens 2 2nd Orthopedic Clinic 3 Department of Immunology 4 Department of Clinical Microbiology

∂ÈÛ·ÁˆÁ‹∏ ·ÎÙÈÓÔÏÔÁÈÎ‹ ÂÈÎfiÓ· ˘ÔÍÂ›·˜ ‹ ¯ÚfiÓÈ·˜

ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ Û˘Á¯¤ÂÙ·È ÔÏÏ¤˜ ÊÔÚ¤˜ ÌÂ ·˘Ù‹ÙˆÓ Î·ÎÔ‹ıˆÓ fiÁÎˆÓ, fiˆ˜ ÙÔ Ï¤ÌÊˆÌ·, ÙÔ ÔÛÙÂ-ÔÛ¿ÚÎˆÌ·, ÙÔ Û¿ÚÎˆÌ· Ewing’s, ÙÔ ËˆÛÈÓfiÊÈÏÔÎÔÎÎ›ˆÌ· Î·È ·ÓÙ›ÛÙÚÔÊ· (1). ∏ ÈÔ Â˘·›ÛıËÙË·ÂÈÎÔÓÈÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÔÛÙÂÔ-Ì˘ÂÏ›ÙÈ‰·˜ Â›Ó·È Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI) ÌÂÂ˘·ÈÛıËÛ›· 98%, fiÌˆ˜ Ë ÂÈ‰ÈÎfiÙËÙ¿ ÙË˜ ‰ÂÓ Â›Ó·È·ÓÙ›ÛÙÔÈ¯Ë Î·È ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 75% (2). °È· ÙËÓÂ‰Ú·›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜ ··ÈÙÂ›Ù·È ‰È·‰ÂÚÌÈÎ‹‚ÈÔ„›· ˘fi ·ÍÔÓÈÎfi ÙÔÌÔÁÚ¿ÊÔ ‹, Â› ·ÔÙ˘¯›·˜,·ÓÔÈ¯Ù‹ ‚ÈÔ„›· (3).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ 14 ÂÙÒÓ ÌÂÛ·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ I Ô˘ ·ÚÔ˘Û›·ÛÂ Â›-

ÌÔÓÔ ¿ÏÁÔ˜ ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË ·fi ÌËÓfi˜. O·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÂÚÈÔ¯‹˜ ¤ıÂÛÂ ÙËÓ˘fiÓÔÈ· ÏÂÌÊÒÌ·ÙÔ˜. ªÂ ÙË ‚Ô‹ıÂÈ· ‰È·‰ÂÚÌÈÎ‹˜‚ÈÔ„›·˜ ‰È·ÁÓÒÛıËÎÂ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰· ÙÔ˘ ‰ˆ‰¤Î·-ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ‰‡ÏÔ˘. ™ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘˘ÏÈÎÔ‡ ÙË˜ ‚ÈÔ„›·˜ ·Ó·Ù‡¯ıËÎÂ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘-ÏfiÎÔÎÎÔ˜. OÈ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ ˘Ô¯ÒÚËÛ·ÓÌÂ Û˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∞ÁfiÚÈ ËÏÈÎ›·˜ 14 ÂÙÒÓ ·Ú·¤ÌÊıËÎÂ ÛÙËÓ ÎÏÈ-

ÓÈÎ‹ ÌÂ ÙËÓ ˘fiÓÔÈ· ÏÂÌÊÒÌ·ÙÔ˜ ÛÙÔ ‰ˆ‰¤Î·ÙÔıˆÚ·ÎÈÎfi ÛfiÓ‰˘ÏÔ. ∏ Èı·Ó‹ ·˘Ù‹ ‰È¿ÁÓˆÛË Ù¤-ıËÎÂ ·fi ÙËÓ MRI ÙË˜ ıˆÚ·ÎÔ-ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ÛÙËÓ ÔÔ›· ˘Ô‚Ï‹ıËÎÂ

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡14 ÂÙÒÓ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ I Î·È Â›ÌÔ-ÓÔ ¿ÏÁÔ˜ ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË ·fi ÌËÓfi˜. O·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·ÛÙËÓ ÂÚÈÔ¯‹ ¤ıÂÛÂ ÙËÓ ˘fiÓÔÈ· ÏÂÌÊÒÌ·ÙÔ˜. ¢È·-‰ÂÚÌÈÎ‹ ‚ÈÔ„›· ¤ıÂÛÂ ÙË ‰È¿ÁÓˆÛË ÔÛÙÂÔÌ˘ÂÏ›ÙÈ-‰·˜ ÙÔ˘ ‰ˆ‰¤Î·ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ‰‡ÏÔ˘. ™ÙËÓÎ·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘ ˘ÏÈÎÔ‡ ÙË˜ ‚ÈÔ„›·˜ ·Ó·Ù‡¯ıËÎÂ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜. OÈ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ Ófi-ÛÔ˘ ˘Ô¯ÒÚËÛ·Ó ÌÂ Û˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹. ∆Ô ÂÓ-‰È·Ê¤ÚÔÓ ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙË Û¿ÓÈ· ÂÎ‰‹ÏˆÛË˘ÔÍÂ›·˜ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹-ÏË˜ ÛÂ ·È‰› ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ÛÙË ‰È·-ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Ï·ÛË ÙË˜ ÂÚ›ÙˆÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË, ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜,Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜.

�Abstract: A case of a 14 year-old boy with type Idiabetes mellitus and persistent pain in the spine ofone month’s duration is described. A magneticresonance imaging of vertebral column wasperformed and the patient was initially considered tohave lymphoma. The diagnosis of twelfth thoracicvertebrae osteomyelitis was established bytranscutaneous biopsy. Staphylococcus aureus wasisolated from the culture of the biopsy material. Themanifestations of the disease resolved after antibiotictreatment. Subacute vertebral osteomyelitis is a rarecondition, even in a child with diabetes mellitus, andthe diagnosis is often overlooked initially.

Key words: spine, osteomyelitis, diabetes mellitus.

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Ô ·ÛıÂÓ‹˜ ÁÈ·Ù› ·ÚÔ˘Û›·˙Â Â›ÌÔÓÔ ¿ÏÁÔ˜ ÛÙËÓÂÚÈÔ¯‹ ·fi ÌËÓfi˜.

O ·ÛıÂÓ‹˜ Â›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› ÙÂÙÚ·ÌÂÏÔ‡˜ÔÈÎÔÁ¤ÓÂÈ·˜ Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ ÌÂ ÂÏÂ‡ıÂ-ÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∞fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓË-ÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ Û·Î¯·-ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Ù‡Ô˘ I ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 7 ÂÙÒÓ,Ô ÔÔ›Ô˜ Ú˘ıÌ›˙ÂÙ·È ÌÂÙÚ›ˆ˜ ÌÂ ˘Ô‰fiÚÈÂ˜ ÂÓ¤ÛÂÈ˜ÈÓÛÔ˘Ï›ÓË˜ Î·È ‰È·ÈÙËÙÈÎ‹ ·ÁˆÁ‹ (ÙÈÌ¤˜ ÁÏ˘Îfi˙Ë˜ÓËÛÙÂ›·˜: 200-350 mg/dl, ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË ·ÈÌÔ-ÛÊ·ÈÚ›ÓË HbA1c: 9,5-11%, ÙÂÏÂ˘Ù·›· ÙÈÌ‹: 9,6%). OÈÂÓÔ¯Ï‹ÛÂÈ˜ ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË ÍÂÎ›ÓËÛ·Ó ÚÔÌËÓfi˜, ÌÂÙ¿ ·fi ¤ÓÙÔÓË ¿ÛÎËÛË. O ·ÛıÂÓ‹˜ ·-ÚÔ˘Û›·ÛÂ, Â›ÛË˜, ˘„ËÏfi ˘ÚÂÙfi Ì¤¯ÚÈ 40ÔC Ù·ÙÚ›· ÚÒÙ· 24ˆÚ·, Ô˘ ·Ô‰fiıËÎÂ ÛÂ ÈÔÁÂÓ‹ ÏÔ›-ÌˆÍË. §fiÁˆ ÚÔÔ‰Â˘ÙÈÎ‹˜ ÂÈ‰Â›ÓˆÛË˜ ÙÔ˘ ¿Ï-ÁÔ˘˜, ¤ÁÈÓÂ ÔÚıÔÂ‰ÈÎ‹ ÂÎÙ›ÌËÛË ÙËÓ ¤ÌÙË ËÌ¤-Ú· ÙË˜ ÓfiÛÔ˘. ∏ ÎÏÈÓÈÎ‹ ·ÍÈÔÏfiÁËÛË Î·È Ô ·ÎÙÈÓÔ-ÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, fiÔ˘ Ë ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÛÔÓ‰‡-ÏˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹, ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙË˜ıÏ¿ÛË˜ Ì˘ÒÓ. ™˘ÛÙ‹ıËÎÂ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ·ÁˆÁ‹Î·È ·˘ÛÙËÚ‹ Î·Ù¿ÎÏÈÛË ÛÂ ·ÓÙ·ÏÁÈÎ‹ ı¤ÛË ÁÈ· 15ËÌ¤ÚÂ˜.

™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ÙÔ ¿ÏÁÔ˜ ·ÚÔ˘Û›·ÛÂ Û¯ÂÙÈ-Î‹ ‡ÊÂÛË. ™ÙË Û˘Ó¤¯ÂÈ·, fiÌˆ˜, ·ÚÔ˘ÛÈ¿ÛÙËÎÂ‰Ú·Ì·ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ·ÚÂ-ÌÔ‰›˙ÔÓÙ·È ÔÈ ·Ï¤˜ ÎÈÓ‹ÛÂÈ˜ ÙÔ˘ ·È‰ÈÔ‡. ŒÁÈÓÂ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ÌÂ MRI Î·È ‰È·ÈÛÙÒıËÎÂ ÛÊËÓÔÂÈ‰‹˜ ·Ú·ÌfiÚÊˆ-ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ ‰ˆ‰¤Î·ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ-‰‡ÏÔ˘ ÌÂ ·ÓÒÌ·ÏÔ ÂÚ›ÁÚ·ÌÌ· ÙË˜ ÚfiÛıÈ·˜ Î·ÈÎ¿Ùˆ ·Ú˘Ê‹˜ ·˘ÙÔ‡, Ë ÔÔ›· ‰ËÌÈÔ˘ÚÁÔ‡ÛÂ ÙËÓÂÓÙ‡ˆÛË ‰È·‚ÚÒÛÂˆÓ Î·È ÏÈÁfiÙÂÚÔ Û˘ÌÈÂÛÙÈÎÔ‡Î·Ù¿ÁÌ·ÙÔ˜. ∆·˘Ùfi¯ÚÔÓ·, ·ÂÈÎÔÓÈ˙fiÙ·Ó Ì¿˙· Ì·-Ï·ÎÒÓ ÌÔÚ›ˆÓ ¤ÚÈÍ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘, Ë ÔÔ›· ·-ÚÔ˘Û›·˙Â ÌÈÎÚ‹ Â¤ÎÙ·ÛË ÚÔ˜ Ù· Î¿Ùˆ ¤ÌÚÔÛıÂÓÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ÛÔÓ‰‡ÏÔ˘(∂ÈÎfiÓ· 1). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ¤ıÂÙ·Ó ÙËÓ ˘fiÓÔÈ·‰ÈËıËÙÈÎ‹˜ ÂÍÂÚÁ·Û›·˜ ÙÔ˘ ‰ˆ‰¤Î·ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ÛÔÓ‰‡ÏÔ˘, Ë ÔÔ›· ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÔÊÂÈÏfiÙ·Ó ÛÂÏ¤ÌÊˆÌ·.

O ·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ ÁÈ· ÙË‰ÈÂÚÂ‡ÓËÛË ÙË˜ Èı·Ó‹˜ Î·ÎÔ‹ıÂÈ·˜. ∞fi ÙËÓ ·ÓÙÈ-ÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ ¤ÓÙÔÓË Â˘·ÈÛıË-Û›· ÛÙËÓ Î·ÙÒÙÂÚË ıˆÚ·ÎÈÎ‹ Î·È ·ÓÒÙÂÚË ÔÛÊ˘˚Î‹ÌÔ›Ú· ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÌÂ Û˘ÓÔ‰fi Ì˘˚ÎfiÛ·ÛÌfi. ∆Ô ¿ÏÁÔ˜ ÂÈÙÂÈÓfiÙ·Ó Î·Ù¿ ÙÈ˜ ÎÈÓ‹ÛÂÈ˜Î¿Ì„Ë˜ Î·È ¤ÎÙ·ÛË˜ ÙÔ˘ ÎÔÚÌÔ‡. ∆Ô ÛËÌÂ›ÔLaseque ‹Ù·Ó ÂÓÙfiÓˆ˜ ıÂÙÈÎfi ¿ÌÊˆ. ∞fi ÙËÓ ÂÍ¤-Ù·ÛË ÙˆÓ ˘fiÏÔÈˆÓ Û˘ÛÙËÌ¿ÙˆÓ ‰ÂÓ ÂÓÙÔ›ÛÙË-Î·Ó ¿ÏÏ· ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∞fi ÙÔÓ ÂÚÁ·ÛÙË-ÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎ·Ó ·˘ÍËÌ¤ÓÔÈ ‰Â›ÎÙÂ˜ÊÏÂÁÌÔÓ‹˜ (∆∫∂: 85 mm, CRP: 50 mg/L, ÊÂÚÚÈÙ›ÓË:

196 ng/ml, LDH: 497 IU/L, Cu: 150 Ìg/dl), ÂÓÒ Ë ÁÂ-ÓÈÎ‹ ·›Ì·ÙÔ˜ (Ht: 42,9%, Hb: 14,2 g/dl, WBC:8200/Ìl, PLT: 268.000/Ìl) Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜‰ÂÓ ·ÚÔ˘Û›·˙·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. O ¤ÏÂÁ-¯Ô˜ ÁÈ· Ê˘Ì·Ù›ˆÛË Î·È ‚ÚÔ˘Î¤ÏÏˆÛË ·¤‚Ë ·ÚÓË-ÙÈÎfi˜. ™ÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÙË˜ ÂÚÈÔ¯‹˜ ·ÂÈ-ÎÔÓ›ÛÙËÎÂ Ë ÛÊËÓÔÂÈ‰‹˜ ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ‰ˆ‰¤-Î·ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ‰‡ÏÔ˘ ÌÂ Ï‡ÛË Î·Ù¿ ÙÔ Úfi-ÛıÈÔ Î¿Ùˆ ¯Â›ÏÔ˜ ·˘ÙÔ‡. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ·ÔÛÙÒÓ ÌÂ ÙÂ¯Ó‹ÙÈÔ ¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓË Î·ı‹ÏˆÛË ÙÔ˘Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÛÙÔÓ ‰ˆ‰¤Î·ÙÔ ıˆÚ·ÎÈÎfi ÛfiÓ‰˘-ÏÔ. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È ÙÔ ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ¶ÚÔÎÂÈÌ¤ÓÔ˘Ó· ÙÂıÂ› ‰È¿ÁÓˆÛË, ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ ‰È·‰ÂÚÌÈÎ‹‚ÈÔ„›· ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÛÔÓ‰‡ÏÔ˘ ˘fi ·ÍÔÓÈÎfi ÙÔ-ÌÔÁÚ¿ÊÔ.

∆Ô ·È‰› Ù¤ıËÎÂ ÛÂ ·˘ÛÙËÚ‹ Î·Ù¿ÎÏÈÛË, ÛÂ·ÓÙ·ÏÁÈÎ‹ ı¤ÛË Î·È ÙÔ˘ ¯ÔÚËÁ‹ıËÎÂ ÈÛ¯˘Ú‹ ·Ó·Ï-ÁËÙÈÎ‹ ·ÁˆÁ‹. ¶·ÚÔ˘Û›·ÛÂ ÚÔÔ‰Â˘ÙÈÎ‹ ÎÏÈÓÈÎ‹‚ÂÏÙ›ˆÛË, fiÌˆ˜ ÙËÓ Ù¤Ù·ÚÙË ËÌ¤Ú· ÓÔÛËÏÂ›·˜ ÂÌ-Ê¿ÓÈÛÂ ˘ÚÂÙfi Ì¤¯ÚÈ 39oC ÌÂ Ú›ÁÔ˜, ¯ˆÚ›˜ Û˘ÓÔ‰¿Û˘ÌÙÒÌ·Ù·. ™ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ Ô˘ ÂÏ‹ÊıË ·ÔÌÔÓÒıËÎÂ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ÙÂ˚ÎÔÏ·Ó›ÓË 800mg/24ˆÚÔ:2 (Ì¤ÁÈÛÙË ‰fiÛË), ÎÂÊÔÙ·Í›ÌË 150mg/kg/24ˆÚÔ:3 Î·È ·ÌÈÎ·Û›ÓË 15 mg/kg/24ˆÚÔ:2ÂÓ‰ÔÊÏÂ‚›ˆ˜. O ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛÂ ÂÓÙfi˜ 36

∂ÈÎfiÓ· 1. ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙË˜ ıˆÚ·ÎÔ-ÔÛÊ˘˚Î‹˜ ÌÔ›-Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ·ÛıÂ-ÓÔ‡˜. ¢È·ÎÚ›ÓÂÙ·È Ë ÛÊËÓÔÂÈ‰‹˜ ·Ú·ÌfiÚÊˆÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ÙÔ˘ ‰ˆ‰¤Î·ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ‰‡ÏÔ˘ Î·È Ë ·Ú·ÛÔÓ‰˘ÏÈ-Î‹ Ì¿˙·, Ë ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÂÈ Â¤ÎÙ·ÛË ÚÔ˜ Ù· Î¿Ùˆ ¤ÌÚÔ-ÛıÂÓ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ÛÔÓ‰‡ÏÔ˘.

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ˆÚÒÓ Î·È ÙËÓ ÂfiÌÂÓË ËÌ¤Ú· ¤ÁÈÓÂ Ë ÚÔÁÚ·ÌÌ·ÙÈ-ÛÌ¤ÓË ‰È·‰ÂÚÌÈÎ‹ ‚ÈÔ„›· ÙÔ˘ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ÛÔÓ‰‡ÏÔ˘. ∞fi ÙËÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ‹ ÂÍ¤Ù·ÛËÙÔ˘ ˘ÏÈÎÔ‡ ‚ÈÔ„›·˜ ‰È·ÈÛÙÒıËÎÂ ÊÏÂÁÌÔÓÒ‰Ë˜‰ÈÂÚÁ·Û›· (ÂÈÎfiÓ· ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜), ÛÙÔ ¿ÌÂÛÔ·Ú·ÛÎÂ‡·ÛÌ· ‹Ù·Ó ÔÚ·ÙÔ› Gram(+) ÎfiÎÎÔÈ ÛÂÛˆÚÔ‡˜, ÂÓÒ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ‰Â›ÁÌ·ÙÔ˜ ·fi ÙÔ›‰ÈÔ ˘ÏÈÎfi ·Ó·Ù‡¯ıËÎÂ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜Ô˘ ·ÚÔ˘Û›·˙Â ÙËÓ ›‰È· Â˘·ÈÛıËÛ›· ÛÙ· ·ÓÙÈ‚ÈÔÙÈ-Î¿ ÌÂ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÛÙ¤ÏÂ¯Ô˜ Ô˘ ·ÔÌÔÓÒıËÎÂÛÙÔ ·›Ì·. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÙÔ ÛÙ¤ÏÂ¯Ô˜ ‹Ù·Ó ·ÓıÂÎÙÈ-Îfi ÛÙËÓ ÔÍ·ÎÈÏÏ›ÓË, ÙËÓ ÎÂÊ·ÏÂÍ›ÓË Î·È ÙËÓ ÎÂÊÔ˘-ÚÔÍ›ÌË, ÌÂÙÚ›ˆ˜ Â˘·›ÛıËÙÔ ÛÙË ÁÂÓÙ·ÌÈÎ›ÓË Î·È ÙËÓ·ÌÈÎ·Û›ÓË Î·È Â˘·›ÛıËÙÔ ÛÙËÓ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘Ï-ÊÔÌÂıÔÍ·˙fiÏË, ÙÔ ÊÔ˘ÛÈ‰ÈÎfi ÔÍ‡, ÙËÓ ÎÏÈÓ‰·Ì˘Î›-ÓË, ÙËÓ ÙÂ˚ÎÔÏ·Ó›ÓË Î·È ÙË ‚·ÓÎÔÌ˘Î›ÓË. ™‡ÌÊˆÓ·ÌÂ ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙË˜ ˘Ô-ÍÂ›·˜ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ Î·È ·ÔÊ·Û›ÛÙËÎÂ Ë Û˘Ó¤¯ÈÛËÙË˜ ·ÁˆÁ‹˜ ÌÂ ÙÂ˚ÎÔÏ·Ó›ÓË Î·È ·ÌÈÎ·Û›ÓË. ∆Ô ¿ÏÁÔ˜˘Ô¯ÒÚËÛÂ ıÂ·Ì·ÙÈÎ¿ ÂÓÙfi˜ 5 ËÌÂÚÒÓ Î·È ÙÔ ·È‰›¿Ú¯ÈÛÂ Ó· ÎÈÓËÙÔÔÈÂ›Ù·È ÌÂ ÙË ‚Ô‹ıÂÈ· ÔÚıÔÂ‰ÈÎÔ‡ÎË‰ÂÌfiÓ·. ™˘Á¯ÚfiÓˆ˜, ˘‹ÚÍÂ ‚ÂÏÙ›ˆÛË ÛÙÔ˘˜ ‰Â›-ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ (∆∫∂: 30 mm, CRP: 4 mg/L, ÊÂÚÚÈÙ›-ÓË: 60 ng/ml, LDH: 240 IU/L, Cu: 50 Ìg/dl).

¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÔÏÔÎÏËÚˆıÂ› Ô ¤ÏÂÁ¯Ô˜, ¤ÁÈÓÂ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÛÙËÓ ÂÚÈÔ¯‹, fiÔ˘ ÂÈ‚Â‚·È-ÒıËÎÂ Ë ÔÛÙÂÔÏ˘ÙÈÎ‹ ÂÍÂÚÁ·Û›· ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘‰ˆ‰¤Î·ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ‰‡ÏÔ˘ Î·È Ë ·Ô˘Û›·‚Ï¿‚Ë˜ ÙˆÓ ·ÔÊ‡ÛÂˆÓ Î·È ÙÔ˘ Ì˘ÂÏÈÎÔ‡ ÛˆÏ‹Ó·,ÂÓÒ ¿ÏÏÂ˜ ÂÛÙ›Â˜ ˘ÔÍÂ›·˜ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ ·Ô-ÎÏÂ›ÛÙËÎ·Ó ÌÂ ÔÏfiÛˆÌÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ Á¿Ï-ÏÈÔ. §fiÁˆ ÙË˜ ÌÈÎÚÔ‚È·ÈÌ›·˜, ¤ÁÈÓÂ ˘ÂÚË¯ÔÁÚ¿ÊË-Ì· Î·Ú‰È¿˜ fiÔ˘ ‰ÂÓ ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÂÎ‚Ï·ÛÙ‹ÛÂÈ˜.∆· ·ÓÙÈÛÒÌ·Ù· ÁÈ· HIV ‹Ù·Ó ·ÚÓËÙÈÎ¿, ÔÈ ÙÈÌ¤˜ ÙˆÓ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏË-ÚÒÌ·ÙÔ˜ ÛÙÔÓ ÔÚfi ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜, ÂÓÒ ÔÈ ˘Ô-ÔÌ¿‰Â˜ Ig3 Î·È Ig4 ‹Ù·Ó ¯·ÌËÏ¤˜: Ig3: 20 mg/dl (º∆:28-141 mg/dl) Î·È Ig4: 25 mg/dl (º∆: 40-184 mg/dl).∏ Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›·, fiˆ˜ Î·È Ë ‰ÔÎÈÌ·Û›· DHR(dihydrorhodamine 123 fluorescence test) ÌÂ ‰È¤-ÁÂÚÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ, Ë ÔÔ›· ÂÏ¤Á¯ÂÈÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÂÓ˙‡ÌˆÓ ÙÔ˘˜ Ô˘ ·ÛÎÔ‡ÓÌÈÎÚÔ‚ÈÔÎÙfiÓÔ ‰Ú¿ÛË, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜.

O ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ ·ÊÔ‡ Û˘ÌÏ‹ÚˆÛÂ 28 ËÌ¤-ÚÂ˜ ÂÓ‰ÔÊÏ¤‚È·˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ Î·È ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹˜·ÁˆÁ‹˜. ¢ÂÓ ·ÚÔ˘Û›·˙Â Î·Ì›· ÂÓfi¯ÏËÛË ÛÙËÓ ¿-Û¯Ô˘Û· ÂÚÈÔ¯‹ Î·È Â›¯Â ·Ó·Ù‡ÍÂÈ ÈÎ·ÓÔÔÈËÙÈÎ‹‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÔÚıÔÂ‰ÈÎÔ‡ ÎË-‰ÂÌfiÓ·. ™˘ÓÂÛÙ‹ıË Ë Û˘Ó¤¯ÈÛË ÙË˜ ·ÁˆÁ‹˜ ·fiÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÌÂ ÊÔ˘ÛÈ‰ÈÎfi ÔÍ‡ 20 mg/kg/24ˆÚÔ:3Î·È ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË 10 mg/kg/24ˆÚÔ:2 ÁÈ· ¿ÏÏÂ˜ 8 Â‚‰ÔÌ¿‰Â˜ Î·È Ë ·Ú·ÎÔÏÔ‡-ıËÛË ÙË˜ ÔÚÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙË-

ÚÈ·Î¿. ¢‡Ô Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜ ¤ÁÈ-ÓÂ Ó¤· MRI ÛÙË ıˆÚ·ÎÔ-ÔÛÊ˘˚Î‹ ÌÔ›Ú· ÙË˜ ÛÔÓ-‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, fiÔ˘ ·Ú·ÙËÚ‹ıËÎÂ ÂÍ¿ÏÂÈ„Ë ÙË˜·Ú·ÛÔÓ‰˘ÏÈÎ‹˜ Ì¿˙·˜, ·ÏÏ¿ ·Ú·ÌÔÓ‹ ÙˆÓ ‰È·-‚ÚÒÛÂˆÓ ÛÙÔÓ ‰ˆ‰¤Î·ÙÔ ıˆÚ·ÎÈÎfi ÛfiÓ‰˘ÏÔ,ÛÙ¤ÓˆÛË ÙÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘ ÌÂÛ·ÚıÚ›Ô˘ ‰È·ÛÙ‹Ì·-ÙÔ˜, Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ Î·ÈÂ¤ÎÙ·ÛË ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÛÙËÓ ¿Óˆ ÂÈÊ¿ÓÂÈ· ÙÔ˘ÛÒÌ·ÙÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ÛÔÓ‰‡ÏÔ˘, fiÔ˘·Ú·ÙËÚ‹ıËÎ·Ó Â›ÛË˜ ‰È·‚ÚÒÛÂÈ˜ (∂ÈÎfiÓ· 2). OÈ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ ·Ú¤ÌÂÓ·Ó ¯·ÌËÏÔ› (∆∫∂: 22mm, CRP: <3,4 mg/L). ™˘ÓÂÛÙ‹ıË Ù·ÎÙÈÎ‹ ÔÚıÔÂ-‰ÈÎ‹ Î·È ÓÂ˘ÚÔÏÔÁÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ÙËÓ Úfi-ÏË„Ë ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ.

™˘˙‹ÙËÛË ∏ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜, ÂÈ‰ÈÎ¿ ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË,

Â›Ó·È Û¿ÓÈ· Î·È Ë ‰È¿ÁÓˆÛ‹ ÙË˜ - ÛÙÔ ‹ÌÈÛ˘ ÙˆÓ Â-ÚÈÙÒÛÂˆÓ - Î·ı˘ÛÙÂÚÂ› ÂÚÈÛÛfiÙÂÚÔ ·fi ¤Ó· Ì‹-Ó·, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· Î·ı˘ÛÙÂÚÂ› Ë ¤Ó·ÚÍË ·Áˆ-Á‹˜ Î·È Ó· ÂÈ‚·Ú‡ÓÂÙ·È Ë ÚfiÁÓˆÛË (4). ¶·Ú·ÙË-ÚÂ›Ù·È Û˘Ó‹ıˆ˜ ÛÂ ¿ÙÔÌ· ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 50 ÂÙÒÓ,ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ¿ÚÚÂÓÔ˜ Ê‡ÏÔ˘, ÌÂ Î¿-ÔÈÔ ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· fiˆ˜ ·ÓÔÛÔ·ÓÂ-¿ÚÎÂÈ·, ¯ÚfiÓÈ· Ï‹„Ë ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ, Î·ÎÔ‹-ıÂÈ·, ·ÏÎÔÔÏÈÛÌfi, Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ‹ ÚÔËÁË-ıÂ›Û· ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË (4,5). ∆Ô Â›ÌÔÓÔ


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∂ÈÎfiÓ· 2. ¡¤· Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÛÙËÓ ›‰È· ÂÚÈÔ¯‹ ÙË˜ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÌÂÙ¿ ·fi 2 Ì‹ÓÂ˜. ¢È·ÈÛÙÒÓÂÙ·È ·-Ú·ÌÔÓ‹ ÙˆÓ ‰È·‚ÚÒÛÂˆÓ ÛÙÔ ÛÒÌ· ÙÔ˘ ‰ˆ‰¤Î·ÙÔ˘ ıˆÚ·ÎÈ-ÎÔ‡ ÛÔÓ‰‡ÏÔ˘, ·Ú·ÙËÚÂ›Ù·È fiÌˆ˜ Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ Î·ÙÒ-ÙÂÚÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ Î·È ‰È¿‚ÚˆÛË ÙË˜ ¿Óˆ ÂÈ-Ê¿ÓÂÈ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ÛÔÓ‰‡ÏÔ˘. ∏·Ú·ÛÔÓ‰˘ÏÈÎ‹ Ì¿˙· ¤¯ÂÈ ÂÍ·ÏÂÈÊıÂ›.

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·49

¿ÏÁÔ˜ Î·È Ë Â˘·ÈÛıËÛ›· ÛÂ ÂÓÙÔÈÛÌ¤ÓÔ ÛËÌÂ›Ô ÙË˜ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, fiÙ·Ó Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·˘ÍË-Ì¤ÓÔ˘˜ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ (∆∫∂, CRP), ı¤ÙÔ˘Ó ˆ˜Èı·ÓfiÙÂÚË ‰È¿ÁÓˆÛË ÙËÓ ÔÍÂ›· ‹ ˘ÔÍÂ›· ÔÛÙÂÔ-Ì˘ÂÏ›ÙÈ‰·. O ˘ÚÂÙfi˜ Î·È Ë ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË fiÙ·ÓÛ˘Ó˘¿Ú¯Ô˘Ó ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ‰È¿ÁÓˆÛË, fiÌˆ˜ Ë·Ô˘Û›· ÙÔ˘˜ ‰ÂÓ ÙËÓ ·ÔÎÏÂ›ÂÈ. ∂› ·‰˘Ó·Ì›·˜‰È¿ÎÚÈÛË˜ ÌÂÙ·Í‡ ÊÏÂÁÌÔÓ‹˜ Î·È Î·ÎÔ‹ıÂÈ·˜ ÌÂ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜Î·È ÙË˜ MRI ÛÙËÓ ÂÚÈÔ¯‹, ··ÈÙÂ›Ù·È ‰È·‰ÂÚÌÈÎ‹‚ÈÔ„›· ÙË˜ ÔÛÙÈÎ‹˜ ‚Ï¿‚Ë˜ ˘fi ·ÍÔÓÈÎfi ÙÔÌÔÁÚ¿-ÊÔ, ÂÓÒ Â› ·ÔÙ˘¯›·˜ Á›ÓÂÙ·È ·ÓÔÈ¯Ù‹ ‚ÈÔ„›· (3,5).∏ Û˘ÓËı¤ÛÙÂÚË ÂÓÙfiÈÛË ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ ÛÙËÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË Â›Ó·È Ë ÔÛÊ˘Ô˚ÂÚ‹ ÌÔ›Ú· (60%)Î·È ·ÎÔÏÔ˘ıÂ› Ë ıˆÚ·ÎÈÎ‹ (33%) Î·È Ë ·˘¯ÂÓÈÎ‹(7%) (5). OÈ ˘Â‡ı˘ÓÔÈ ·ıÔÁfiÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›Â›Ó·È, Î·Ù¿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜, Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘-ÏfiÎÔÎÎÔ˜, Ô ÂÈ‰ÂÚÌÈÎfi˜ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ÙÔ Ì˘ÎÔ-‚·ÎÙËÚ›‰ÈÔ ÙË˜ Ê˘Ì·Ù›ˆÛË˜, Ô ‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂ-ÙfiÎÔÎÎÔ˜ ÙË˜ ÔÌ¿‰·˜ µ, Ô ÛÙÚÂÙfiÎÔÎÎÔ˜viridans Î·È ÙÔ ÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ. ª˘ÎËÙÈ·ÛÈÎÔ› ·Ú¿-ÁÔÓÙÂ˜ ˆ˜ Û˘ÓÔ‰fi ·›ÙÈÔ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ Â›Ó·È Û·-ÓÈfiÙ·ÙÔÈ (4,6).

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È Û˘ÓÙËÚËÙÈÎ‹ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ (75-85%), ÌÂÂÓ‰ÔÊÏ¤‚È· ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÁÈ· 4-6 Â‚‰ÔÌ¿‰Â˜Î·È, ·ÎÔÏÔ‡ıˆ˜, ·ÁˆÁ‹ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜. ¢ÂÓ˘¿Ú¯ÂÈ ÔÌÔÊˆÓ›· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÁˆÁ‹˜ (2 ˆ˜ 8 Â‚‰Ô-Ì¿‰Â˜) (6,7). ™ËÌ·ÓÙÈÎ‹ Â›Ó·È Ë ÛÙ·ıÂÚÔÔ›ËÛË ÙË˜¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜ ÌÂ ÙË ‚Ô‹ıÂÈ· ÔÚıÔÂ‰ÈÎÔ‡ÎË‰ÂÌfiÓ· ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ Û˘Ó‰ÚÔ-Ì‹˜ (6). ø˜ ÎÚÈÙ‹ÚÈÔ ·ÓÙ·fiÎÚÈÛË˜ ÛÙË ıÂÚ·Â›·ıÂˆÚÂ›Ù·È Ë ·ÔÎ·Ù¿ÛÙ·ÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓÛÙÔ˘˜ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜, fiˆ˜ Â›Ó·È Ë ∆∫∂ Î·È ËCRP. ™Â ÔÚÈÛÌ¤Ó· Î¤ÓÙÚ·, ÔÈ ·ÚÓËÙÈÎ¤˜ ÙÈÌ¤˜ ·˘ÙÒÓÙˆÓ ‰ÂÈÎÙÒÓ ·ÔÙÂÏÔ‡Ó ¤Ó‰ÂÈÍË ‰È·ÎÔ‹˜ ÙË˜ ıÂ-Ú·Â›·˜ (7). ∂› ·ÔÙ˘¯›·˜ ÙˆÓ ·ÓˆÙ¤Úˆ ıÂÚ·Â˘-ÙÈÎÒÓ Ì¤ÙÚˆÓ, ·ÎÔÏÔ˘ıÂ› ¯ÂÈÚÔ˘ÚÁÈÎfi˜ Î·ı·ÚÈÛÌfi˜ÙË˜ ÚÔÛ‚Â‚ÏËÌ¤ÓË˜ ÂÚÈÔ¯‹˜ (3,6). ∏ ·ÔÎ·Ù¿-ÛÙ·ÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ·Ó·Ì¤ÓÂÙ·È ÛÂ 3-6 Ì‹ÓÂ˜ (8). ∏ ËÏÈÎ›· Î¿Ùˆ ÙˆÓ 40ÂÙÒÓ, Ë ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜, Ë ÛˆÛÙ‹ ·ÎÈÓËÙÔÔ›ËÛË, Ë ¤ÁÎ·ÈÚË ¤Ó·ÚÍË·ÁˆÁ‹˜ Î·È Ë ÁÚ‹ÁÔÚË ÙÒÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔ-Ó‹˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÔÊ˘Á‹ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÈ-ÏÔÎÒÓ (4,5).

∏ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ Â›Ó·ÈÛ¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›·, ·ÎfiÌ· Î·ÈÛÂ ¿ÙÔÌ· ÌÂ ·˘ÍËÌ¤ÓÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘, fiˆ˜Â›Ó·È Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜. ™˘Ó‹ıˆ˜, ¯ÚÂÈ¿˙Ô-ÓÙ·È ·ÚÎÂÙ¤˜ ‰ÂÎ·ÂÙ›Â˜ Ì¤¯ÚÈ Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ÔÈÚÔ¸Ôı¤ÛÂÈ˜ ÂÁÎ·Ù¿ÛÙ·ÛË˜ Ì›·˜ ÙfiÛÔ ÛÔ‚·Ú‹˜

ÏÔ›ÌˆÍË˜ ÛÂ ‰È·‚ËÙÈÎ¿ ¿ÙÔÌ·. ∆¤ÙÔÈÔÈ ·Ú¿ÁÔÓÙÂ˜Â›Ó·È Ë ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·, Ë ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿-ıÂÈ· Î·È ·ÓÔÛÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜. ™˘ÁÎÂÎÚÈÌ¤Ó·,Ë ˘ÂÚÏ·Û›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ Î·È Ë ¿¯˘ÓÛË ÙË˜‚·ÛÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ ÙˆÓ ·ÁÁÂ›ˆÓ ÚÔÎ·ÏÔ‡Ó ÌÂ›ˆ-ÛË ÙË˜ ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜, ÌÂ Â·ÎfiÏÔ˘ıÔ ÙË ‰ËÌÈ-Ô˘ÚÁ›· ÌÈÎÚÔıÚfiÌ‚ˆÓ Ô˘ Â˘ÓÔÔ‡Ó ÙËÓ ·Ó¿Ù˘ÍËÌÈÎÚÔ‚›ˆÓ (9). ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi Â˘Ô‰ÒÓÂÙ·È ÛÂÈÛÙÔ‡˜ ÌÂ ÊÙˆ¯‹ ·ÁÁÂ›ˆÛË, fiˆ˜ Â›Ó·È Ù· ÔÛÙ¿. OÈÛ˘¯ÓfiÙÂÚÂ˜ ·ÓÔÛÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ··-ÓÙÒÓÙ·È ÛÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Â›Ó·È Ë ·Ó·ÛÙÔÏ‹ÙË˜ ÌÈÎÚÔ‚ÈÔÎÙfiÓÔ˘ ‰Ú¿ÛË˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ÙˆÓ Ô-Ï˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È Ë ‰È·Ù·Ú·¯‹ ÙË˜ ÈÎ·ÓfiÙËÙ¿˜ÙÔ˘˜ ÁÈ· Ê·ÁÔÎ˘ÙÙ¿ÚˆÛË (10). ™Â ‰È·‚ËÙÈÎÔ‡˜·ÛıÂÓÂ›˜, Â›ÛË˜, ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ÙÒÛË ÙË˜ IgG·ÓÔÛÔÛÊ·ÈÚ›ÓË˜ ‹ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÔÚÈÛÌ¤ÓˆÓ ˘Ô-ÔÌ¿‰ˆÓ ÙË˜ Î·È ·‡ÍËÛË ÙË˜ IgA Î·È ÙË˜ IgM ÛÙÔÓÔÚfi. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›·, ¤¯ÂÈ Î·-Ù·ÁÚ·ÊÂ› ÌÂ›ˆÛË ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ∆ ÏÂÌÊÔ-Î˘ÙÙ¿ÚˆÓ Î·È ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈ-ÎÒÓ ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜ Ì·ÎÚÔ¯ÚfiÓÈ-Ô˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (11).

∏ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰· ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÌÔ-ÚÂ› Ó· ÚÔÎÏËıÂ› ·ÈÌ·ÙÔÁÂÓÒ˜, Ô˘ Â›Ó·È Î·È ÙÔ Û˘-ÓËı¤ÛÙÂÚÔ, ·fi ‰È·ÙÈÙÚ·›ÓÔÓ ÙÚ·‡Ì· ‹ Î·Ù¿ Û˘Ó¤-¯ÂÈ· ÈÛÙÔ‡. O Û˘ÓËı¤ÛÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔ-ÓÙ·˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ Ô‰fi ÌÂÙ¿‰ÔÛË˜, Â›Ó·È Ô¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜. ™Â ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂ-ÓÂ›˜, fiÌˆ˜, ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·ÚÈÓÈÎ‹˜ ÊÔÚÂ›·˜ Î·È ÌÈÎÚÔ‚È·ÈÌ›·˜ ·fi ÙÔ Û˘ÁÎÂÎÚÈ-Ì¤ÓÔ ·Ú¿ÁÔÓÙ·. ∏ Û˘¯ÓfiÙËÙ· ·ÔÈÎÈÛÌÔ‡ ÙÔ˘ ÚÈÓÈ-ÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÙÈ Â›Ó·È ÌÂÁ·Ï‡-ÙÂÚË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÌË ÈÎ·ÓÔÔÈËÙÈÎ‹ Ú‡ıÌÈÛË ÙË˜ÓfiÛÔ˘, fiˆ˜ ·˘Ù‹ ·ÔÙ˘ÒÓÂÙ·È ÛÂ ÙÈÌ¤˜ ÁÏ˘Îfi-˙Ë˜ ÓËÛÙÂ›·˜ Î·È ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜(HbA1c) (12). º·›ÓÂÙ·È fiÙÈ ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜‰È·Ù·Ú¿ÛÛÂÙ·È Ë ÈÎ·ÓfiÙËÙ· ÙˆÓ ÂÓ˙‡ÌˆÓ ÙˆÓ ÔÏ˘-ÌÔÚÊÔ‡ÚËÓˆÓ Ó· Î·Ù·ÛÙÚ¤ÊÔ˘Ó ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· Ù·ÛÙÂÏ¤¯Ë ÙÔ˘ ‚·ÎÙËÚÈ‰›Ô˘. ∂›ÛË˜, Ù· ÏÂÌÊÔÎ‡ÙÙ·-Ú¿ ÙÔ˘˜ ‰ÂÓ ‰ÈÂÁÂ›ÚÔÓÙ·È Â·ÚÎÒ˜ in vitro ·fi ÙÔÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ·ÓÙÈÁfiÓÔ (11,12).

™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓ‹ Ì·˜, Ë ÚÔÛ‚ÔÏ‹ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÛÔÓ‰‡ÏÔ˘ ¤ÁÈÓÂ ·ÈÌ·ÙÔÁÂÓÒ˜. ∏ÂÓ‰Â¯fiÌÂÓË Î¿ÎˆÛË ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË Î·Ù¿ÙËÓ ¿ÛÎËÛË, ÌÂ ÙÈ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·ÁÁÂ›ˆÛË, ÙËÓ¤ÎÚˆÛË ÙÔ˘ ÔÛÙÔ‡ Î·È ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË Î˘ÙÔÎÈ-ÓÒÓ Ô˘ ÚÔÎ¿ÏÂÛÂ, Â˘fi‰ˆÛÂ ÙËÓ ÂÛÙÈ·Î‹ ÚfiÎÏË-ÛË ÌÈÎÚÔ‚È·Î‹˜ ÊÏÂÁÌÔÓ‹˜. ∞ÎÔÏÔ‡ıˆ˜, ÂÍÂÏ›¯ıË-ÎÂ Ë ÏÔ›ÌˆÍË ÛÙÔÓ ÛfiÓ‰˘ÏÔ, Ë ÔÔ›· ÏfiÁˆ ÙË˜ ·˘-ÛÙËÚ‹˜ Î·Ù¿ÎÏÈÛË˜ Î·È ÙË˜ ÈÛ¯˘Ú‹˜ ·ÓÙÈÊÏÂÁÌÔÓÒ-‰Ô˘˜ ·ÁˆÁ‹˜ ‰È¤‰Ú·ÌÂ ˘ÔÎÏÈÓÈÎ¿ ÙÔ ÚÒÙÔ20‹ÌÂÚÔ. ¶ÚÔÔ‰Â˘ÙÈÎ¿, Ë ÊÏÂÁÌÔÓÒ‰Ë˜ ‰ÈÂÚÁ·Û›·ÚÔÎ¿ÏÂÛÂ ‰È‹ıËÛË ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ Ì¤ÚÔ˘˜ ÙÔ˘


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JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·50

ÛÔÓ‰˘ÏÈÎÔ‡ ÛÒÌ·ÙÔ˜ Î·È ‰ËÌÈÔ˘ÚÁ›· ·ÔÛÙËÌ·ÙÈ-Î‹˜ ÎÔÈÏfiÙËÙ·˜ ·Ú·ÛÔÓ‰˘ÏÈÎ¿. ∂›Ó·È ÁÓˆÛÙfi fiÙÈË ‡·ÚÍË ·ÚÙËÚÈÔÊÏÂ‚ˆ‰ÒÓ ÎfiÏˆÓ ÌÂ ‚Ú·‰Â›··ÈÌ·ÙÈÎ‹ ÚÔ‹ ÛÙË ÌÂÙ¿Ê˘ÛË ÙÔ˘ ÛÔÓ‰‡ÏÔ˘, ÏË-Û›ÔÓ ÙË˜ ÂÈÊ˘ÛÈ·Î‹˜ Ï¿Î·˜, ÌÂÈÒÓÂÈ ÙËÓ Î·Ù·-ÛÙÚÔÊ‹ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ·fi Ù· ÏÂ˘ÎÔÎ‡ÙÙ·Ú·, ÌÂ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÔÛÙËÌ¿ÙˆÓ (13). ∏¤ÍÔ‰Ô˜ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙË Û˘ÛÙËÌ·ÙÈÎ‹ Î˘ÎÏÔÊÔ-Ú›· ÚÔÎ¿ÏÂÛÂ ÙÔ ‰Â‡ÙÂÚÔ ÂÌ‡ÚÂÙÔ ÂÂÈÛfi‰ÈÔ.ªÂÙ·ÁÂÓ¤ÛÙÂÚ·, Ë ÊÏÂÁÌÔÓ‹ ÂÂÎÙ¿ıËÎÂ Ì¤Ûˆ ÙÔ˘ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ ÛÙÔÓ Î·ÙÒÙÂÚÔ ÛfiÓ‰˘ÏÔ,ÁÈ’ ·˘Ùfi ÛÙË ‰Â‡ÙÂÚË MRI ·ÂÈÎÔÓ›˙ÂÙ·È Î·Ù·ÛÙÚÔ-Ê‹ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙÔ˘ ÚÒÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ÛÔÓ-‰‡ÏÔ˘. ÕÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜, ÏËÓ ÙÔ˘ ÎÏÂÈÛÙÔ‡ÙÚ·‡Ì·ÙÔ˜, Ô˘ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÙË˜˘ÔÍÂ›·˜ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜ ‹Ù·Ó Ë Ì¤ÙÚÈ· Ú‡ıÌÈÛËÙÔ˘ Û·Î¯¿ÚÔ˘ ÛÙÔÓ ÔÚfi, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙÈ˜ ÙÈ-Ì¤˜ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ (HbA1c) Î·È ÔÈ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÙˆÓ ˘ÔÙ¿ÍÂˆÓ Ig3 Î·È Ig4.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ê·›ÓÂÙ·È fiÙÈ Ë ‰ÈËıËÙÈÎ‹ ÂÍÂÚ-Á·Û›· ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÚÔÎ·ÏÂ› ¤ÓÙÔÓÔ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ÌÂÙ·Í‡ ÔÛÙÂÔÌ˘Â-Ï›ÙÈ‰·˜ Î·È Î·ÎÔ‹ıÔ˘˜ ÓÔÛ‹Ì·ÙÔ˜. ∏ ˘ÔÍÂ›·ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜ ÛÂ ·È‰È¿ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË,·Ó Î·È Â›Ó·È Û¿ÓÈ·, Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·ÈÛÙË ‰È·ÁÓˆÛÙÈÎ‹ ÛÎ¤„Ë. ∏ Û˘ÓÂÎÙ›ÌËÛË ÙÔ˘ ·ÙÔÌÈ-ÎÔ‡ ·Ó·ÌÓËÛÙÈÎÔ‡ Î·È ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÙË˜ ·ÚÔ‡Û·˜ÓfiÛÔ˘ Î·È Î˘Ú›ˆ˜ Ë ‰ÈÂÓ¤ÚÁÂÈ· ‰È·‰ÂÚÌÈÎ‹˜ ‹ ·ÓÔÈ-¯Ù‹˜ ‚ÈÔ„›·˜ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· Ó· ÙÂÎÌËÚÈˆıÂ›Ë ‰È¿ÁÓˆÛË. ŒÙÛÈ ı· ÏËÊıÔ‡Ó Ù· ·Ó·ÁÎ·›· ıÂÚ·-Â˘ÙÈÎ¿ Ì¤ÙÚ· ÌÂ ÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹ Î·ı˘ÛÙ¤ÚË-ÛË, ¯ˆÚ›˜ Ó· ÚÔÎ·ÏÂ›Ù·È ·‰ÈÎ·ÈÔÏfiÁËÙË ·ÓËÛ˘¯›·ÛÙÔÓ ·ÛıÂÓ‹ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Î·È Ó· ‰ÈÂÓÂÚ-ÁÔ‡ÓÙ·È ¿ÛÎÔÂ˜ ÔÏ˘‰¿·ÓÂ˜ ÂÍÂÙ¿ÛÂÈ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Cottias P, Tomeno B, Anract P, Vinh TS, Forest M.

Subacute osteomyelitis presenting as a bone tumour. Areview of 21 cases. Int Orthop 1997;21:243-248.

2. Erdman WA, Tamburro F, Jayson HT, Weatherall PT, FerryKB, Peshock RM. Osteomyelitis: characteristics and pitfalls

of diagnosis with MR imaging. Radiology 1991;180:533-539.

3. Mader JT, Ortiz M, Calhoun JH. Update on the diagnosisand management of osteomyelitis. Clin Podiatr Med Surg1996;13:701-724.

4. Carragee EJ. Pyogenic vertebral osteomyelitis. J BoneJoint Surg Am 1997;79:874-880.

5. Beronius M, Bergman B, Andersson R. Vertebralosteomyelitis in Goteborg, Sweden: a retrospective studyof patients during 1990-95. Scand J Infect Dis 2001;33:527-532.

6. Carek PJ, Dickerson LM, Sack JL. Diagnosis andmanagement of osteomyelitis. Am Fam Physician 2001;63:2413-2420.

7. Song KM, Sloboda JF. Acute hematogenous osteo myelitisin children. J Am Acad Orthop Surg 2001;9:166-175.

8. Rasool MN. Primary subacute haematogenous osteo-myelitis in children. J Bone Joint Surg Br 2001;83:93-98.

9. DeFeo WT, Jay RM. Osteomyelitis associated withperipheral vascular disease secondary to diabetes mellitus.J Foot Surg 1976;15:159-165.

10. Dziatkowiak H, Kowalska M, Denys A. Phagocytic andbactericidal activity of granulocytes in diabetic children.Diabetes 1982;31:1041-1043.

11. Gorus FK, Vandewalle CL, Winnock F, Lebleu F,Keymeulen B, Van der Auwera B et al. Increasedprevalence of abnormal immunoglobulin M, G, and Aconcentrations at clinical onset of insulin-dependentdiabetes mellitus: a registry-based study. The BelgianDiabetes Registry. Pancreas 1998;16:50-59.

12. Tuazon CU, Perez A, Kishaba T, Sheagren JN.Staphylococcus aureus among insulin-injecting diabeticpatients. An increased carrier rate. JAMA 1975;231:1272.

13. Whalen JL, Parke WW, Mazur JM, Stauffer ES. The intrinsicvasculature of developing vertebral end plates and itsnutritive significance to the intervertebral discs. J PediatrOrthop 1985;5:403-410.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›ÌË˜ ∏Ï›· ∑ÂÚ‚Ô‡ 72, ∆.∫. 111 44, ∞ı‹Ó·

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∂ÈÛ·ÁˆÁ‹∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·

ÔÊÂ›ÏÂÙ·È Â›ÙÂ ÛÂ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙË˜ ·Û‡Ó‰Â-ÙË˜ (¤ÌÌÂÛË˜) ¯ÔÏÂÚ˘ıÚ›ÓË˜, Â›ÙÂ ÛÂ ÌÂÈˆÌ¤ÓË Ë·-ÙÈÎ‹ ÚfiÛÏË„Ë ‹ Û‡Ó‰ÂÛË ·˘Ù‹˜ (1). ∏ ·ÈÌfiÏ˘ÛË Â›-Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ˘ÂÚ·Ú·ÁˆÁ‹˜ ÙË˜ ¤ÌÌÂÛË˜ ¯Ô-ÏÂÚ˘ıÚ›ÓË˜ Î·È Ì›· ·fi ÙÈ˜ Û˘ÓËı¤ÛÙÂÚ· ··ÓÙÒ-ÌÂÓÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÈÌÔÏ˘ÙÈÎ¤˜ ·Ó·ÈÌ›Â˜ Â›Ó·È Ë ÎÏË-ÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË (hereditaryspherocytosis, HS). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌÂÈˆÌ¤ÓËÛ‡Ó‰ÂÛË ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜, Ë ÓfiÛÔ˜ Gilbert ıÂˆ-ÚÂ›Ù·È Ë ˘Â‡ı˘ÓË ‰È·Ù·Ú·¯‹ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ÂÚÈÙÒÛÂÈ˜ (2,3).

¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ÌÂ ÙËÓÂÍ·›ÚÂÛË ÙÔ˘ ÈÎÙ¤ÚÔ˘, ‰È·Ê¤ÚÂÈ ÛÙÈ˜ ‰‡Ô ÚÔ·Ó·-ÊÂÚıÂ›ÛÂ˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, Ë Û˘Ó‡·ÚÍË·˘ÙÒÓ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎ¿ÚÔ‚Ï‹Ì·Ù· (4-6), fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙË˜ ÓÂ·-Ú‹˜ ·ÛıÂÓÔ‡˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 12 ÂÙÒÓ ÌÂ ÁÓˆÛÙ‹

ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË Ô˘ ‰È·ÁÓÒÛÙËÎÂÛÙ· Ï·›ÛÈ· ‰ÈÂÚÂ‡ÓËÛË˜ ¤ÌÌÂÛË˜ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈ-Ó·ÈÌ›·˜ ÛÂ ËÏÈÎ›· 4 ÂÙÒÓ. ∏ ‰È¿ÁÓˆÛË Â›¯Â ÙfiÙÂ ÙÂ-ıÂ› ÌÂ ‚¿ÛË ÙËÓ ·ÓÂ‡ÚÂÛË ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ Â-ÚÈÊÂÚÈÎfi ·›Ì·, ÙÔÓ ·˘ÍËÌ¤ÓÔ ·ÚÈıÌfi ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ-Î˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ÂÏ·ÙÙˆÌ¤ÓË ˆÛÌˆÙÈÎ‹ ·ÓÙ›ÛÙ·ÛËÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ. ◊‰Ë ·fi ÙÔÓ ·Ú¯ÈÎfiÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Â›¯Â ‰È·ÈÛÙˆıÂ› ˘ÂÚË¯Ô-ÁÚ·ÊÈÎ¿ Ë ·ÚÔ˘Û›· ¯ÔÏÔÏ›ıˆÓ ÛÙË ¯ÔÏË‰fi¯Ô Î‡-ÛÙË. ∆Ô ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ÙË˜ ·ÛıÂÓÔ‡˜ ‹Ù·ÓÂÏÂ‡ıÂÚÔ. ∫·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÙÒÓ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜, Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ÛÂ ¿ÚÈÛÙË ÁÂÓÈÎ‹ Î·Ù¿-ÛÙ·ÛË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÌfiÓÔÓ ‹È· ÛÏËÓÔÌÂÁ·Ï›·(ÂÚ›Ô˘ 2 cm) Î·È ÈÎÙÂÚÈÎ‹ ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜ Î·È ÂÈ-ÂÊ˘ÎfiÙˆÓ. ¢È·ÙËÚÔ‡ÛÂ ÈÎ·ÓÔÔÈËÙÈÎ¿ Â›Â‰· ·È-ÌÔÛÊ·ÈÚ›ÓË˜ Î·È ·ÈÌ·ÙÔÎÚ›ÙË (Hb ~13,2 g/dl, Ht

~40%) ÌÂ ÌÈÎÚ‹ ·‡ÍËÛË ÙˆÓ ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ

™˘Ó‡·ÚÍË ÎÏËÚÔÓÔÌÈÎ‹˜ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË˜ Î·È ÓfiÛÔ˘ Gilbert: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ª. OÈÎÔÓfiÌÔ˘, π. ∆Û¿ÙÚ·, ª. ∞ı·Ó·Û›Ô˘ - ªÂÙ·Í¿

Co-existence of hereditary spherocytosis and Gilbert’s syndrome: a case reportM. Economou, I. Tsatra, M. Athanassiou - Metaxa


∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, °¶¡ πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË

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

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÓÂ·Ú‹˜·ÛıÂÓÔ‡˜ ÌÂ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ÎÏËÚÔÓÔÌÈÎ‹˜ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË˜ Î·È ÓfiÛÔ˘ Gilbert. ∏ ÓfiÛÔ˜Gilbert, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ÂÂÈÛfi‰È· Î·ÏÔ‹-ıÔ˘˜ ¤ÌÌÂÛË˜ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, ·ÚÔ˘ÛÈ¿˙ÂÈÌÈÎÚ‹ ÎÏÈÓÈÎ‹ ÛËÌ·Û›· ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ·.øÛÙfiÛÔ, ÛÂ ÂÚÈÙÒÛÂÈ˜ ¯ÚfiÓÈ·˜ ·ÈÌfiÏ˘ÛË˜ ÚÔ-Î·ÏÂ› ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ÊÔÚÙ›Ô˘ ¯ÔÏÂÚ˘-ıÚ›ÓË˜, ÂÈÙÂ›ÓÔÓÙ·˜ ÙÔÓ Î›Ó‰˘ÓÔ Û¯ËÌ·ÙÈÛÌÔ‡ ¯Ô-ÏÔÏ›ıˆÓ Î·È Ô‰ËÁÂ› ÛÂ ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎ¿ ÚÔ-‚Ï‹Ì·Ù·, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙË˜ ·ÛıÂÓÔ‡˜ Ô˘ÂÚÈÁÚ¿ÊÂÙ·È.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË,ÓfiÛÔ˜ Gilbert, ¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·, ¯Úfi-ÓÈ· ·ÈÌfiÏ˘ÛË, ¯ÔÏÔÏÈı›·ÛË.

�Abstract: A case of hereditary spherocytosis andGilbert’s syndrome co-existence in a young girl isdescribed. Gilbert’s syndrome, characterized byepisodes of mild unconjugated hyperbilirubinaemia,is of limited importance in normal individuals. Incases of chronic hemolysis, however, co-existenceof the syndrome may lead to a combined effect inproducing high levels of bilirubin and increase therisk of gallstone formation. Additionally, it may resultin diagnostic problems, as in the case describedbelow.

Key words: hereditary spherocytosis, Gilbert’ssyndrome, unconjugated hyperbilirubinaemia,chronic haemolysis, gallstones.

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(ÂÚ›Ô˘ 3%) Î·È Ì¤ÙÚÈ· ·‡ÍËÛË ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜(6,5 mg/dl), ¤ÌÌÂÛË˜ Î·Ù¿ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi(5,5 mg/dl).

™Â ËÏÈÎ›· 11 ÂÙÒÓ, ÏfiÁˆ ÂÎ‰‹ÏˆÛË˜ ¤ÓÙÔÓˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ ¯ÔÏÔÏÈı›·ÛË˜ (ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜, ‰˘-ÛÂ„›·˜, Ó·˘Ù›·˜, ÂÌ¤ÙˆÓ Î·È ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜),·ÔÊ·Û›ÛÙËÎÂ Ë ‰ÈÂÓ¤ÚÁÂÈ· ¯ÔÏÔÎ˘ÛÙÂÎÙÔÌ‹˜ ÌÂÙ·˘Ùfi¯ÚÔÓË ÛÏËÓÂÎÙÔÌ‹. øÛÙfiÛÔ, Ë ˘ÂÚ¯ÔÏÂÚ˘-ıÚÈÓ·ÈÌ›· ‰ÂÓ ·ÔÎ·Ù·ÛÙ¿ıËÎÂ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛËÙÔ˘ ÛÏ‹Ó· (ÔÏÈÎ‹ ¯ÔÏÂÚ˘ıÚ›ÓË 4,3 mg/dl, ¤ÌÌÂÛË¯ÔÏÂÚ˘ıÚ›ÓË 3,45 mg/dl). ™Ù· Ï·›ÛÈ· ÙË˜ ÂÎ Ó¤Ô˘‰ÈÂÚÂ‡ÓËÛË˜ ÙË˜ ¤ÌÌÂÛË˜ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜,·ÔÎÏÂ›ÛÙËÎÂ Ë Èı·ÓfiÙËÙ· Ê·ÚÌ·ÎÔÁÂÓÔ‡˜ ·Ó·-ÛÙÔÏ‹˜ Û‡Ó‰ÂÛË˜ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜, Î·ıÒ˜ Î·È Ë·ÚÔ˘Û›· ÂÈÎÔ˘ÚÈÎÔ‡ ÛÏ‹Ó· Ô˘ ı· ÌÔÚÔ‡ÛÂÓ· Â˘ı‡ÓÂÙ·È ÁÈ· ÙËÓ ·ÓÙÈÚÚÔÔ‡ÌÂÓË ‹È· ·ÈÌfiÏ˘-ÛË. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ë·ÙÈÎ‹˜ ÏÂÈÙÔ˘Ú-Á›·˜ (SGOT, SGPT, ÁGT, ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË,ÔÏÈÎ¿ ÏÂ˘ÎÒÌ·Ù·, ÏÂ˘ÎˆÌ·Ù›ÓÂ˜ Î·È ÛÊ·ÈÚ›ÓÂ˜)‹Ù·Ó, Â›ÛË˜, Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ‰ÔÎÈÌ·Û›· Ì¤ÙÚËÛË˜¯ÔÏÂÚ˘ıÚ›ÓË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÓËÛÙÂ›·˜ Î·È ÌÂÙ¿·fi ¯ÔÚ‹ÁËÛË ÙÚÔÊ‹˜ ¤‰ÂÈÍÂ ÙÈÌ¤˜ ¤ÌÌÂÛË˜ ¯ÔÏÂ-Ú˘ıÚ›ÓË˜ 3,5 Î·È 2,3 mg/dl, ·ÓÙ›ÛÙÔÈ¯·. ªÂ ÙËÓ ÈÛ¯˘-Ú‹, Ï¤ÔÓ, ˘Ô„›· ÙË˜ ÓfiÛÔ˘ Gilbert, ˙ËÙ‹ıËÎÂ ËÚ·ÁÌ·ÙÔÔ›ËÛË ·Ó¿Ï˘ÛË˜ DNA ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜·Ï˘ÛÈ‰ˆÙ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÔÏ˘ÌÂÚ¿ÛË˜ (PCR) ÛÙËÓπ·ÙÚÈÎ‹ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, fiÔ˘Î·È ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÂ ÔÌÔ˙˘ÁˆÙ›· Ë ‰È·ÌfiÚÊˆÛË∞(∆∞)7∆∞∞, Ë ÔÔ›· ÂÓ¤¯ÂÙ·È ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ÓfiÛÔ˘.

ŒÎÙÔÙÂ, Ë ·ÛıÂÓ‹˜, ·ÎÔÏÔ˘ıÒÓÙ·˜ ÛˆÛÙ‹ ‰È·-ÙÚÔÊÈÎ‹ ·ÁˆÁ‹, ·Ú·Ì¤ÓÂÈ ÛÂ ¿ÚÈÛÙË ÁÂÓÈÎ‹ Î·Ù¿-ÛÙ·ÛË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÌfiÓÔ ÂÚÈÛÙ·ÛÈ·Î¿ ˘›-ÎÙÂÚÔ.

™˘˙‹ÙËÛË ∏ ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË Â›Ó·È Ë Û˘-

¯ÓfiÙÂÚË Û˘ÁÁÂÓ‹˜ ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· ÔÊÂÈÏfiÌÂÓËÛÂ ‰È·Ù·Ú·¯‹ ÙË˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜,ÌÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ 1:2000 ÛÙË µÔÚÂÈÔ‰˘ÙÈÎ‹∂˘ÚÒË Î·È ÙË µfiÚÂÈ· ∞ÌÂÚÈÎ‹ (7). ∏ ‚ÈÔ¯ËÌÈÎ‹ ‚¿-ÛË ÙË˜ ÓfiÛÔ˘ Û˘Ó›ÛÙ·Ù·È ÛÂ ·ÏÏ·Á‹ ÙË˜ ‰ÔÌ‹˜ ÙÔ˘Î˘ÙÙ·ÚÔÛÎÂÏÂÙÔ‡ ÙË˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹˜ ÌÂÌ‚Ú¿-ÓË˜, ÏfiÁˆ ‚Ï¿‚Ë˜ ‰ÔÌÈÎÒÓ ÚˆÙÂ˚ÓÒÓ fiˆ˜ Â›Ó·È ËÛÂÎÙÚ›ÓË, Ë ·ÓÎ˘Ú›ÓË ‹, Û·ÓÈfiÙÂÚ·, Ë ÚˆÙÂ˝ÓË4.2 (1,8). ∞ÔÙ¤ÏÂÛÌ· ÙË˜ ‰È·Ù·Ú·¯‹˜ Â›Ó·È Ë ·Ò-ÏÂÈ· ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚÔ˘, ÌÂ ÌÂÙ·-ÙÚÔ‹ ·˘ÙÔ‡ ·fi ·ÌÊ›ÎÔÈÏÔ ‰›ÛÎÔ ÛÂ ÛÊ·ÈÚÔÎ‡Ù-Ù·ÚÔ Î·È ·ÎfiÏÔ˘ıË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÛÙÔ ÛÏ‹Ó·. ∏HS ÎÏËÚÔÓÔÌÂ›Ù·È ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·,ÂÓÒ Ë ÌÂÙ·‚›‚·ÛË ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfi-ÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Â›Ó·È Û·ÓÈfiÙÂÚË (9).

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÓfiÛÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏËÂÙÂÚÔÁ¤ÓÂÈ·: ·fi ÙËÓ ·Û˘ÌÙˆÌ·ÙÈÎ‹ ÊÔÚÂ›· Ì¤¯ÚÈÙËÓ ÂÎ‰‹ÏˆÛË ‚·ÚÈ¿˜ ·Ó·ÈÌ›·˜ ÂÍ·ÚÙÒÌÂÓË˜ ·fiÌÂÙ·ÁÁ›ÛÂÈ˜ Î·È Û˘ÓÔ‰Â˘fiÌÂÓË˜ ·fi ÛÏËÓÔÌÂÁ·-Ï›· Î·È ›ÎÙÂÚÔ. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È,Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙Â ‹È· HS, ÌÂ ·ÓÙÈÚÚÔÔ‡ÌÂ-ÓË ·ÈÌfiÏ˘ÛË ¯ˆÚ›˜ Û˘ÓÔ‰fi ·Ó·ÈÌ›·. ∏ ‰ËÌÈÔ˘ÚÁ›·¯ÔÏÔÏ›ıˆÓ, Ô˘ ·ÔÙÂÏÂ› ÙË Û˘¯ÓfiÙÂÚË ÂÈÏÔÎ‹ÙË˜ ÓfiÛÔ˘, ‹Ù·Ó ‹‰Ë ·ÚÔ‡Û· ÛÙË ÌÈÎÚ‹ ·ÛıÂÓ‹Î·Ù¿ ÙÔ ¯ÚfiÓÔ ‰È¿ÁÓˆÛË˜ ÙË˜ HS. ∏ ¯ÔÏÔÏÈı›·ÛËÂ›Ó·È ›Ûˆ˜ Ë ÌfiÓË ¤Ó‰ÂÈÍË ÁÈ· ‰ÈÂÓ¤ÚÁÂÈ· ÛÏËÓÂ-ÎÙÔÌ‹˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ HS ‹È·˜ ‹ Ì¤ÙÚÈ·˜ ‚·Ú‡-ÙËÙ·˜, ÌÂÙ¿ ÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÙ·È ÎÏÈÓÈÎ‹ ›·ÛË, ‰Ë-Ï·‰‹ ˘Ô¯ÒÚËÛË ÙË˜ ·Ó·ÈÌ›·˜ Î·È ÙÔ˘ ÈÎÙ¤ÚÔ˘ ÛÂÔÛÔÛÙfi 100% (9). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿-ÊÂÙ·È, ˆÛÙfiÛÔ, Ë ·Ó·ÌÂÓfiÌÂÓË ›·ÛË ‰ÂÓ ·Ú·ÙË-Ú‹ıËÎÂ. ∞ÊÔ‡ ·ÔÎÏÂ›ÛÙËÎ·Ó Ù· ˘fiÏÔÈ· Èı·Ó¿·›ÙÈ· ¤ÌÌÂÛË˜ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, Ù¤ıËÎÂ Ë˘Ô„›· Û˘Ó‡·ÚÍË˜ ÙË˜ ÓfiÛÔ˘ Gilbert Î·È ·ÔÊ·-Û›ÛÙËÎÂ Ë Ú·ÁÌ·ÙÔÔ›ËÛË ÙË˜ ÂÌÂÈÚÈÎ‹˜ ‰ÔÎÈÌ·-Û›·˜ Ì¤ÙÚËÛË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÌÂÙ¿ ·fi ÓËÛÙÂ›· Î·È·fi ¯ÔÚ‹ÁËÛË ÙÚÔÊ‹˜ (9), ÂÓÒ Ë ‰È¿ÁÓˆÛË ÙË˜ Ófi-ÛÔ˘ Ù¤ıËÎÂ ÙÂÏÈÎ¿ ÌÂ ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘ÛË˜ DNA.

H ÓfiÛÔ˜ Gilbert ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔÁÔÓ›‰ÈÔ UDP-ÁÏ˘ÎÔ˘ÚÔÓ˘Ï-ÙÚ·ÓÛÊÂÚ¿ÛË˜ 1 ÛÙÔ¯ÚˆÌfiÛˆÌ· 2q37 (ÂÍfiÓÈ· 1-5 ‹ ÂÎÎÈÓËÙ‹˜TATAAbox), ÌÂ ·ÔÙ¤ÏÂÛÌ· ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙÈÎfiÙË-Ù· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ÚÈ‰ÈÓÔ-‰ÈÊˆÛÊÔÓÈÎ‹ ÁÏ˘ÎÔ˘ÚÔÓÈ-Î‹ ÙÚ·ÓÛÊÂÚ¿ÛË Î·È ·ÎfiÏÔ˘ıË ·Ó·ÛÙÔÏ‹ Û‡Ó‰Â-ÛË˜ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ (9). ∏ Û˘¯ÓfiÙËÙ· ÂÎ‰‹Ïˆ-ÛË˜ ÙË˜ ÓfiÛÔ˘ ÔÈÎ›ÏÏÂÈ ÛÂ ‰È¿ÊÔÚÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ ·fi 3-36%, ·Ó¿ÏÔÁ· ÌÂ ÙË Ê˘Ï‹ Î·È ÙÔÊ‡ÏÔ (2,3,11-13). O ÙÚfiÔ˜ ÎÏËÚÔÓÔÌÈÎ‹˜ ÌÂÙ·‚›-‚·ÛË˜ Â›Ó·È Ô ·˘ÙÔÛˆÌ·ÙÈÎfi˜ ÂÈÎÚ·ÙÒÓ, ¯·Ú·ÎÙË-ÚÈ˙fiÌÂÓÔ˜ ·fi ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·. ∏ ÓfiÛÔ˜Gilbert ıÂˆÚÂ›Ù·È fiÙÈ ·ÔÙÂÏÂ› Ê˘ÛÈÔÏÔÁÈÎ‹ ·Ú·Ï-Ï·Á‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜, ¯·Ú·-ÎÙËÚÈ˙fiÌÂÓË ÎÏÈÓÈÎ¿ ·fi ÂÂÈÛfi‰È· Î·ÏÔ‹ıÔ˘˜ ¤Ì-ÌÂÛË˜ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, Î˘Ú›ˆ˜ ÛÂ Î·Ù·ÛÙ¿-ÛÂÈ˜ ÓËÛÙÂ›·˜. ∂ÓÒ ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· Ë ÎÏÈÓÈ-Î‹ ÛËÌ·Û›· ÙË˜ ÓfiÛÔ˘ Â›Ó·È ÌÈÎÚ‹, ÛÂ ÂÚÈÙÒÛÂÈ˜¯ÚfiÓÈ·˜ ·ÈÌfiÏ˘ÛË˜ ÚÔÎ·ÏÂ› ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ·˘-ÍËÌ¤ÓÔ˘ ÊÔÚÙ›Ô˘ ¯ÔÏÂÚ˘ıÚ›ÓË˜, ÂÈÙÂ›ÓÔÓÙ·˜ ¤ÙÛÈÙÔÓ Î›Ó‰˘ÓÔ Û¯ËÌ·ÙÈÛÌÔ‡ ¯ÔÏÔÏ›ıˆÓ (7,14). ∏ ÂÈ-‚¿Ú˘ÓÛË ·˘Ù‹ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ú·ÙËÚËıÂ› fi¯ÈÌfiÓÔ ÛÂ Û˘Ó‡·ÚÍË ÙË˜ ÓfiÛÔ˘ ÌÂ ÎÏËÚÔÓÔÌÈÎ‹ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË, ·ÏÏ¿ Î·È ÌÂ ¿ÏÏÂ˜ ÌÔÚÊ¤˜ ÎÏË-ÚÔÓÔÌÈÎ‹˜ (‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·, ¤ÏÏÂÈ„Ë G6PD) ‹Â›ÎÙËÙË˜ ¯ÚfiÓÈ·˜ ·ÈÌfiÏ˘ÛË˜ (·˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘-ÙÈÎ‹ ·Ó·ÈÌ›·) (7,15).

™Â Î¿ıÂ ÂÚ›ÙˆÛË, Ô ·È‰›·ÙÚÔ˜ Ô˘ ·Ú·ÎÔ-ÏÔ˘ıÂ› ¤Ó·Ó ·ÛıÂÓ‹ ÌÂ ¯ÚfiÓÈ· ·ÈÌfiÏ˘ÛË, ·ÏÏ¿ Î·È·˘Ùfi˜ Ô˘ ‰ÈÂÚÂ˘Ó¿ ¤Ó·Ó ·ÛıÂÓ‹ ÌÂ ¯ÔÏÔÏÈı›·ÛË,

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ı· Ú¤ÂÈ Ó· ¤¯Ô˘Ó Î·Ù¿ ÓÔ˘ ÙËÓ Èı·ÓfiÙËÙ· Û˘Ó‡-·ÚÍË˜ Î·È ·ÏÏËÏÂ›‰Ú·ÛË˜ ÙË˜ ¯ÚfiÓÈ·˜ ·ÈÌÔÏ˘ÙÈ-Î‹˜ ÓfiÛÔ˘ ÌÂ ÙË ÓfiÛÔ Gilbert.

∂˘¯·ÚÈÛÙ›Â˜ ∂˘¯·ÚÈÛÙÔ‡ÌÂ ıÂÚÌ¿ ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ ÙË˜

∞’ ¶·ıÔÏÔÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÁÈ· ÙË ÌÔ-ÚÈ·Î‹ ÂÈ‚Â‚·›ˆÛË ÙË˜ ÓfiÛÔ˘ Gilbert.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Becker P, Lux S. Disorders of the red cell membrane. In:

Nathan DG, Oski FA, editors. Hematology of infancy andchildhood. 4th ed. Philadelphia: W.B. Saunders Company;1993. p. 529-633.

2. Borlak J, Thum T, Landt O, Erb K, Hermann R. Moleculardiagnosis of a familial nonhemolytic hyperbilirubinemia(Gilbert’s syndrome) in healthy subjects. Hepatology2000;32:792-795.

3. Burchell B, Hume R. Molecular genetic basis of Gilbert’ssyndrome. J Gastroenterol Hepatol 1999;14:960-966.

4. Berk PD, Blaschke TF. Detection of Gilbert’s syndrome inpatients with hemolysis. Ann Intern Med 1972;77:527-531.

5. Katz ME, Weinstein IM. Extreme hyperbilirubinemia in apatient with hereditary spherocytosis, Gilbert’s syndrome,and obstructive jaundice. Am J Med Sci 1978;275:373-379.

6. Sharma S, Vukelja SJ, Kadakia S. Gilbert’s syndrome co-existing with and masking hereditary spherocytosis. AnnHematol 1997;74:287-289.

7. del Giudice EM, Perrotta S, Nobili B, Specchia C, d’Urzo G,Iolascon A. Coinheritance of Gilbert syndrome increases therisk for developing gallstones in patients with hereditaryspherocytosis. Blood 1999;94:2259-2262.

8. Palek J, Jarolim P. Clinical expression and laboratorydetection of red blood cell membrane protein mutations.Semin Hematol 1993;30:249-283.

9. Palek J, Jarolim P. Red cell membrane disorders. In:

Hoffman R, Benz EJ, Shattil SJ, Furil B, Cohen HJ,Silberstein LE, editors. Hematology. Basic Principles andPractice. 2nd ed. Churchill Livingstone Inc; 1995. p. 667-709.

10. Monaghan G, Ryan M, Seddon R, Hume R, Burchell B.Genetic variation in bilirubin UDP-glucurononyltransferasegene promoter and Gilbert’s syndrome. Lancet1996;347:578-581.

11. Rudenski AS, Halsall DJ. Genetic testing for Gilbert’ssyndrome: how useful is it in determining the cause ofjaundice? Clin Chem 1998;44:1604-1609.

12. Beutler E, Gelbart T, Demina A. Racial variability in the UDP-glucuronosyltransferase 1 (UGT1A1) promoter: a balancedpolymorphism for regulation of bilirubin metabolism? ProcNatl Acad Sci USA 1998;95:8170-8174.

13. ∆Û¤˙Ô˘ ∞, ∆˙¤ÙË ª, ∫›ÙÛÈÔ˘ ™, °·ÏÏ¿ ∞, ∫·‚·˙·Ú¿ÎË˜ ∂,Ã·Ù˙Ë‰ËÌÔ‡Ï· ∞ Î·È Û˘Ó. ™‡Ó‰ÚÔÌÔ Gilbert: ÁÔÓÔÙ˘ÈÎ‹·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ Ê·ÈÓfiÙ˘Ô ÛÂ ·È‰ÈÎfi ÏËı˘-ÛÌfi. ¶·È‰È·ÙÚÈÎ‹ 2000;63:21-26.

14. Berk PD, Berman MD, Blitzer BL, Chretien P, Martin JF,Scharschmidt BF et al. Effect of splenectomy on hepaticbilirubin clearance in patients with herediatry spherocytosis:implications for the diagnosis of Gilbert’s syndrome. J LabClin Med 1981;98:37-45.

15. Sampietro M, Lupica L, Perrero L, Comino A, Martinez diMontemuros F, Cappellini MD et al. The expression of UDP-glucuronosyltransferase gene is a major determinant ofbilirubin level in heterozygous beta-thalassaemia and inG6PD deficiency. Br J Haematol 1997;99:437-439.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ªÈÚ¿ÓÙ· ∞ı·Ó·Û›Ô˘ ∞Á. ™ÔÊ›·˜ 30, ∆.∫. 546 22, £ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]

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¶·ÚÔ˘Û›· ·ÚÔ‰ÈÎÔ‡ ·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ Ï‡ÎÔ˘ ÛÂ ·È‰› ÌÂ ÓfiÛÔ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜ ª. §ÈıÔÍÔÔ‡ÏÔ˘, ª. ∞ı·Ó·Û›Ô˘, Ã. ∆Û·Î·Ï›‰Ë˜, µ. ∞˚‚¿˙Ë˜

Presentation of lupus anticoagulant in a child caused by cat scratch disease: a case report M. Lithoxopoulou, M. Athanasiou, C. Tsakalidis, V. Aivazis


∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£ °.¶.¡. “πÔÎÚ¿ÙÂÈÔ”, £ÂÛÛ·ÏÔÓ›ÎË

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

∂ÈÛ·ÁˆÁ‹∏ ÓfiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜ ·ÔÙÂÏÂ› Ì›·

·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÏÔÈÌÒ‰Ë ÓfiÛÔ Ô˘ ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ·fi Ô›‰ËÌ· Î·È ¿ÏÁÔ˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (Â-ÚÈÔ¯ÈÎ‹ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÏÂÌÊ·‰ÂÓ›ÙÈ‰·) Î·È ÔÈ-ÎÈÏ›· ÎÔÈÓÒÓ Û˘ÓÔ‰ÒÓ Û˘ÌÙˆÌ¿ÙˆÓ fiˆ˜ Î·ÎÔ˘-¯›·, ÎfiˆÛË, ·ÓÔÚÂÍ›·, ÂÌ¤ÙÔ˘˜, ÎÂÊ·Ï·ÏÁ›·, Ê·-Ú˘ÁÁ›ÙÈ‰·, ˘ÚÂÙfi ‹ Î·È ÛÔ‚·ÚfiÙÂÚˆÓ fiˆ˜ ·Ò-ÏÂÈ· ‚¿ÚÔ˘˜, ÛÏËÓÔÌÂÁ·Ï›·, Î·ıÒ˜ Î·È ·ÚÔ‰ÈÎfiÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· ÙÔ˘ ÎÔÚÌÔ‡ Î·È ¿ÏÏ·(1-4). ™˘Ó‹ıˆ˜ ÚÔÎ·ÏÂ› ÏÂÌÊ·‰ÂÓ›ÙÈ‰· Ô˘ Â›Ó·È¯ÚfiÓÈ· Î·È ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ¿ÏÏ· Û˘ÌÙÒÌ·-Ù·. ÕÙ˘· Â˘Ú‹Ì·Ù· Â›Ó·È Ë ÂÈÂÊ˘Î›ÙÈ‰·, Ë ÚÔ-ˆÙÈ·›· ·‰ÂÓ›ÙÈ‰·, Ë ÂÁÎÂÊ·Ï›ÙÈ‰·, Ë ¿ÚÂÛË ÎÚ·-ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ, Ë ıÚÔÌ‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú·, Ë ÔÛÙÂ-

ÔÌ˘ÂÏ›ÙÈ‰·, Ë Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÙÔ Ô˙Ò‰Â˜ÂÚ‡ıËÌ·, ÙÔ ÔÏ‡ÌÔÚÊÔ ÂÚ‡ıËÌ· Î·È Ë ÓÂ˘ÌÔÓ›·(2,5). ∏ ÚÒÙË ·Ó·ÊÔÚ¿ Î·È ÂÚÈÁÚ·Ê‹ ÙË˜ ÓfiÛÔ˘¤ÁÈÓÂ ·fi ÙÔÓ Henri Parinaud ÙÔ 1889, ÂÓÒ Ô RobertDebre ÙÔ 1931 ·Ó·ÁÓÒÚÈÛÂ fiÙÈ Ë Á¿Ù· ·ÔÙÂÏÂ› ÙÔÓÂÓ‰È¿ÌÂÛÔ ÍÂÓÈÛÙ‹ Î·È ¤‰ˆÛÂ ÙËÓ ÔÓÔÌ·Û›· ÛÙË Ófi-ÛÔ. ∏ Bartonella henselae ˆ˜ ·›ÙÈÔ ÙË˜ ÓfiÛÔ˘, Ô˘ÌÂÙ·‰›‰ÂÙ·È ·fi ¤ÓÙÔÌÔ ÛÙË Á¿Ù·, Ë ÔÔ›· Î·È ·Ô-ÙÂÏÂ› ÙË ‰ÂÍ·ÌÂÓ‹ ÙË˜ ÓfiÛÔ˘, ·Ó·ÁÓˆÚ›ÛÙËÎÂ ÙÔ1993 (4,5).

™ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, Ë ÂÌÊ¿ÓÈÛË ·Ú·ÙÂÙ·Ì¤-ÓÔ˘ ¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈËÌ¤ÓË˜ ÌÂÚÈÎ‹˜ ıÚÔÌ‚ÔÏ·-ÛÙ›ÓË˜ (·ƒ∆∆) ÏfiÁˆ Î˘ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ·ÓÙÈËÎÙÈÎÔ‡ÙÔ˘ Ï‡ÎÔ˘ (LA) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ú·ÙËÚËıÂ› ÌÂÙ¿·fi ÏÔÈÌÒÍÂÈ˜, ÈÔÁÂÓÂ›˜, ÚˆÙÔ˙ˆÈÎ¤˜, Ê˘Ì·Ù›ˆÛË

�¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜·ÔÙÂÏÂ› Ì›· ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÏÔÈÌÒ‰Ë ÓfiÛÔÔ˘ ¤¯ÂÈ ˆ˜ ·›ÙÈÔ ÙË Bartonella henselae Î·È ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi Ô›‰ËÌ· Î·È ¿ÏÁÔ˜ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ.¶ÚÔÛ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ ·È‰È¿ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜.™˘Ó‹ıˆ˜ ÚÔÎ·ÏÂ› ÏÂÌÊ·‰ÂÓ›ÙÈ‰· Ô˘ Â›Ó·È ¯ÚfiÓÈ·Î·È ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ¿ÏÏ· Û˘ÌÙÒÌ·Ù·. ¶ÂÚÈ-ÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ô˘ ·ÚÔ˘Û›·ÛÂÏÂÌÊ·‰ÂÓ›ÙÈ‰· ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜ Î·È, ˆ˜ Û˘-ÓÔ‰fi Û‡ÌÙˆÌ· ÙË˜ ÏÔ›ÌˆÍ‹˜ ÙÔ˘, Ù˘¯·›· ·ÓÂ‡ÚÂ-ÛË ·Ú¿Ù·ÛË˜ ÙÔ˘ ¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈËÌ¤ÓË˜ ÌÂÚÈ-Î‹˜ ıÚÔÌ‚ÔÏ·ÛÙ›ÓË˜ (·ƒTT) ÏfiÁˆ ·ÚÔ˘Û›·˜·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ Ï‡ÎÔ˘ (LA) Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÚÔ-ÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÁÈ· ÙËÓ ÈÛÙÔ·ıÔÏÔÁÈÎ‹ ÂÍ¤-Ù·ÛË ÙÔ˘ ÏÂÌÊ·‰¤Ó·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓfiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜,bartonella henselae, ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, ·ÓÙÈËÎÙÈÎfiÙÔ˘ Ï‡ÎÔ˘, ¯ÚfiÓÔ˜ ÂÓÂÚÁÔÔÈËÌ¤ÓË˜ ÌÂÚÈÎ‹˜ıÚÔÌ‚ÔÏ·ÛÙ›ÓË˜.

�Abstract: Cat scratch disease is a self-limitedinfectious disease characterized by edema andpain in the lymph nodes caused by Bartonellahenselae. Most patients are children and youngadults. Usual symptoms are chronic or regionallymphadenopathy, malaise, anorexia and fever. Wedescribe a patient with regional lymphadenopathyand transient prolonged activated partialthromboplastine time associated with lupusanticoagulant caused by cat scratch disease. Thiswas found during the preoperative tests.

Key words: cat scratch disease, bartonellahenselae, chronic lymphadenopathy, lupusanticoagulant, activated partial thromboplastinetime.

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(3-5), ÓfiÛÔ ÙÔ˘ Lyme, Î·ÎÔ‹ıÂÈÂ˜, (ÌÔÓ‹ÚË fiÁÎÔ,ÏÂ˘¯·ÈÌ›Â˜, ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎ¿ ÓÔÛ‹Ì·Ù·), Ï‹„ËÊ·ÚÌ¿ÎˆÓ (Ê·ÈÓÔıÂÈ·˙›ÓÂ˜, ÚÔÎ·˚Ó·Ì›‰Ë, ¯ÏˆÚÔ-ıÂÈ·˙›ÓÂ˜, ·ÓÙÈÛ˘ÏÏËÙÈÎ¿), ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·,Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÚÂ˘Ì·ÙÈÎ¿ ÓÔÛ‹Ì·Ù· (™∂§,ƒ∞, Û‡Ó‰ÚÔÌÔ Sjogren, ‰ÂÚÌ·ÙÔÌ˘ÔÛ›ÙÈ‰·/ÔÏ˘-Ì˘ÔÛ›ÙÈ‰·, „ˆÚÈ·ÛÈÎ‹ ·ÚıÚ›ÙÈ‰·, ·ÁÎ˘ÏˆÙÈÎ‹ ÛÔÓ-‰˘Ï›ÙÈ‰·) ‹ Ó· ·ÔÙÂÏÂ› Ù˘¯·›Ô Â‡ÚËÌ· ÛÙË ‰È¿Ú-ÎÂÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ (6-8). ∆Ô ·ÓÙÈËÎÙÈÎfiÙÔ˘ Ï‡ÎÔ˘ (LA) ·ÔÙÂÏÂ› ¤Ó·Ó Â›ÎÙËÙÔ ·Ó·ÛÙÔÏ¤·ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ÙË˜ ‹ÍË˜. ∞Ó‹ÎÂÈ Ì·˙› ÌÂ Ù· ·ÓÙÈ-Î·Ú‰ÈÔÏÈÈÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· Î·È Ù· ÂÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·-Ù· ¤Ó·ÓÙÈ ÙˆÓ Ô˘‰¤ÙÂÚˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ, ÛÙ· ·ÓÙÈ-ÊˆÛÊÔÏÈÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù· (9-12), in vitro ‰Â, ÚÔ-Î·ÏÔ‡Ó ·Ú¿Ù·ÛË Û˘Ó‹ıˆ˜ ÙÔ˘ ·PTT.

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ô˘ ·ÚÔ˘-Û›·ÛÂ ÏÂÌÊ·‰ÂÓ›ÙÈ‰· ·fi ÓfiÛÔ ·Ì˘¯‹˜ Ó˘¯ÈÒÓ Á¿-Ù·˜ Î·È Ù˘¯·›· ·ÓÂ‡ÚÂÛË ·Ú·ÙÂÙ·Ì¤ÓÔ˘ ·ƒTT Ïfi-Áˆ Î˘ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ Ï‡ÎÔ˘ Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÁÈ· ÙËÓ ÈÛÙÔ-·ıÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÏÂÌÊ·‰¤Ó·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∞ÁfiÚÈ ËÏÈÎ›·˜ 9 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ·È‰È·ÙÚÈÎ‹

ÎÏÈÓÈÎ‹ ÏfiÁˆ ÙÚ·¯ËÏÈÎ‹˜ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·˜, È‰›ˆ˜·ÚÈÛÙÂÚ¿. ∏ ÓfiÛÔ˜ ÂÌÊ·Ó›ÛÙËÎÂ ÌÂ ˘ÚÂÙfi Î·È ‰Èfi-ÁÎˆÛË ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ (block) ÛÙËÓ ·ÚÈ-ÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ·, ¯ˆÚ›˜ ¿ÏÏ· Û˘ÓÔ‰¿ Û˘-ÌÙÒÌ·Ù·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: Hb:12,3 g/dl, Ht: 38%, ÏÂ˘Î¿: 8900/mm3 (¶: 64%, §:28%, ª: 7%), ·ÈÌÔÂÙ¿ÏÈ·: 368.000/mm3, ∆∫∂: 45mm ÙËÓ 1Ë ÒÚ· Î·È CRP: 33,4 mg/dl. O ÔÚÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·ÓÂ‡ÚÂÛË Û˘Ó‹ıˆÓ ÈÒÓ, fiˆ˜ ÙÔ˘Epstein Barr, Cytomegalovirus, Herpes simple,Parvo B19, Coxsackie B1-B5, Î·ıÒ˜ Î·È ÁÈ· ÙÔÍfi-Ï·ÛÌ· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆¤ÏÔ˜, Ë mantoux ‹Ù·Ó·ÚÓËÙÈÎ‹. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔ-ÁÈÎ‹. O ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÙÚ·¯ËÏÈÎ‹˜¯ÒÚ·˜ ¿ÌÊˆ ¤‰ÂÈÍÂ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹ ¯Ò-Ú· Û˘ÚÚ¤ÔÓÙÂ˜ ÏÂÌÊ·‰¤ÓÂ˜ ÌÂ ÂÏ·ÙÙˆÌ¤ÓË Ë¯ÔÁ¤-ÓÂÈ·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‚Ú›ÛÎÔ-ÓÙ·Ó ÛÂ Ù‹ÍË. ¶·ÚfiÌÔÈ·˜ ˘Ê‹˜ ÏÂÌÊ·‰¤ÓÂ˜ ˘‹Ú-¯·Ó ÛÙËÓ ·ÚˆÙÈ‰ÈÎ‹ Î·È ÛÙË ‰ÂÍÈ¿ Ï¿ÁÈ· ÙÚ·¯ËÏÈ-Î‹ ¯ÒÚ·. ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi.

§ÂÙÔÌÂÚ¤ÛÙÂÚË Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ ·ÔÎ¿Ï˘„ÂÙËÓ ‡·ÚÍË Á¿Ù·˜ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÛıÂÓ‹. ¢‹ÁÌ·Ù·‹ ·Ì˘¯¤˜ ÛÙ· ¿ÎÚ· ÙÔ˘ ·ÛıÂÓ‹ ‰ÂÓ ·Ú·ÙËÚ‹ıË-Î·Ó. ªÂ ÙËÓ ˘fiÓÔÈ· ÙË˜ ÓfiÛÔ˘ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓÁ¿Ù·˜ ¤ÁÈÓÂ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·ÓÂ‡-ÚÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ÙË˜ Bartonella henselae, Ô ÔÔ›-Ô˜ ¤‰ÂÈÍÂ IgM ·ÓÙÈÛÒÌ·Ù· ıÂÙÈÎ¿ 1:20 Î·È IgG>1:256. O Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó Ô ›‰ÈÔ˜ Î·È

ÌÂÙ¿ ·fi 15 ËÌ¤ÚÂ˜. O ·ÛıÂÓ‹˜ Ù¤ıËÎÂ ÛÂ ıÂÚ·Â›· ÌÂ ·ÌÔÍÈÎÈÏÏ›ÓË

ÛÂ ‰fiÛË 80 mg/kg ·fi ÙÔ ÛÙfiÌ· ÁÈ· 10 ËÌ¤ÚÂ˜ Î·ÈÛÙË Û˘Ó¤¯ÂÈ· ÌÂ ÎÂÊÙÚÈ·ÍfiÓË 100 mg/kg ÂÓ‰ÔÊÏÂ-‚›ˆ˜ ÁÈ· 10 ËÌ¤ÚÂ˜, ¯ˆÚ›˜ ‚ÂÏÙ›ˆÛË, ÌÂ Ó¤· ‰Èfi-ÁÎˆÛË ÏÂÌÊ·‰¤ÓˆÓ ÙË˜ Ì·Û¯·ÏÈ·›·˜ ¯ÒÚ·˜ Î·È ÌË˘Ô¯ÒÚËÛË ÙÔ˘ ˘ÚÂÙÔ‡. ∞ÔÊ·Û›ÛÙËÎÂ Ë ·Ê·›ÚÂ-ÛË Î·È Ë ÈÛÙÔ·ıÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÏÂÌÊ·‰¤Ó·ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÙÚ·¯ËÏÈÎ‹˜ ¯ÒÚ·˜.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÚÁ·-ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘ ÁÈ· ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ‰ÈÂÚÂ‡ÓËÛËÙÔ˘ ÏÂÌÊ·‰¤Ó·, ‚Ú¤ıËÎÂ ÌÂÁ¿ÏË ·Ú¿Ù·ÛË ÙÔ˘¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈËÌ¤ÓË˜ ÌÂÚÈÎ‹˜ ıÚÔÌ‚ÔÏ·ÛÙ›-ÓË˜ (·PTT) 31”/59” (Â‡ÚÔ˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÁÈ··ƒTT: 30”-37”), ÂÓÒ Ô ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›ÓË˜ Î·È Ù··ÈÌÔÂÙ¿ÏÈ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿.

∆· Â›Â‰· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ππ, VIII, IX, XI, XII‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿, ÂÓÒ ‚Ú¤ıËÎÂ ·ÓÙÈËÎÙÈÎfi ÙÔ˘Ï‡ÎÔ˘ (LA) ıÂÙÈÎfi, Ë ·ÚÔ˘Û›· ÙÔ˘ ÔÔ›Ô˘ ÂÈ‚Â-‚·ÈÒıËÎÂ ÌÂ ÙË ‰ÔÎÈÌ·Û›· dRVVT (dilute Russell’sviper venom time) 35”/70”. ∆· ·ÓÙÈÎ·Ú‰ÈÔÏÈÈÓÈÎ¿·ÓÙÈÛÒÌ·Ù· (APC) ‚Ú¤ıËÎ·Ó ·ÚÓËÙÈÎ¿.

∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ Ï‹Úˆ˜ Î·Ù·ÚÁË-Ì¤ÓË ·Ú¯ÈÙÂÎÙÔÓÈÎ‹ ·fi ÙËÓ ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓÂÈıËÏÈÔÂÈ‰ÒÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÌÂ ÎÂÓÙÚÈÎ‹ Ó¤ÎÚˆÛË,ÂÓÒ Á‡Úˆ ·fi ÙË Ó¤ÎÚˆÛË ·Ú·ÙËÚ‹ıËÎ·Ó ÂÈıË-ÏÈÔÂÈ‰‹ ÈÛÙÈÔÎ‡ÙÙ·Ú·, Î·ıÒ˜ Î·È ÔÏ˘‡ÚËÓ· ÁÈÁ·-ÓÙÔÎ‡ÙÙ·Ú·. OÈ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎ¤˜ ¯ÚÒÛÂÈ˜ ÁÈ· Ì‡-ÎËÙÂ˜ Î·È Ì˘ÎÔ‚·ÎÙËÚ›‰È· ‹Ù·Ó ·ÚÓËÙÈÎ¤˜. ∏ ÈÛÙÔ-ÏÔÁÈÎ‹ ÂÈÎfiÓ·, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔ ÈÛÙÔÚÈÎfi, ‹Ù·ÓÛ˘Ì‚·Ù‹ ÌÂ ÓfiÛÔ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜.

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ ‚ÂÏÙÈÒıËÎÂ ÌÂÙ¿·fi ‰¤Î· ËÌ¤ÚÂ˜, ÂÓÒ Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·(·PTT: 31”/31,5” Î·È LA(-) ·ÚÓËÙÈÎfi) ·ÔÎ·Ù·ÛÙ¿-ıËÎ·Ó ÌÂÙ¿ ·fi 2 Ì‹ÓÂ˜, ¯ˆÚ›˜ Ô ·ÛıÂÓ‹˜ Ó· ·-ÚÔ˘ÛÈ¿ÛÂÈ ÔÔÈÔ‰‹ÔÙÂ Û‡ÌÙˆÌ· ‹ Ó· Ï¿‚ÂÈ ÂÈ‰È-Î‹ ıÂÚ·Â›·.

™˘˙‹ÙËÛËŸˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ë ÂÌÊ¿ÓÈÛË ·Ú¿Ù·ÛË˜

ÙÔ˘ ¯ÚfiÓÔ˘ ·ƒTT ÛÙ· ·È‰È¿ ÏfiÁˆ Î˘ÎÏÔÊÔÚÔ‡-ÓÙÔ˜ LA Â›Ó·È ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ·-ÚÔ‰ÈÎ‹ Î·È Î·ÏÔ‹ıË˜ Î·È Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ú·ÙË-ÚÂ›Ù·È ÌÂÙ¿ ·fi ÏÔÈÌÒÍÂÈ˜ ‹ Ó· ·ÔÙÂÏÂ› Ù˘¯·›Ô Â‡-ÚËÌ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘(6-8).

™ÙÔÓ ·ÛıÂÓ‹ Ì·˜, Ë ·ÓÂ‡ÚÂÛË ÙË˜ ·Ú¿Ù·ÛË˜ÙÔ˘ ·ƒ∆∆ ‹Ù·Ó Ù˘¯·›·, ÛÙ· Ï·›ÛÈ· ÚÔÂÁ¯ÂÈÚËÙÈ-ÎÔ‡ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘ ÁÈ· ÙËÓ ÈÛÙÔÏÔÁÈÎ‹‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ‰ÈÔÁÎˆÌ¤ÓÔ˘ ÏÂÌÊ·‰¤Ó·, ÏfiÁˆÙË˜ ÓfiÛÔ˘ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜, Ë ÔÔ›· ÂÈ‚Â-‚·ÈÒıËÎÂ ÌÂ ÙËÓ ·ÓÂ‡ÚÂÛË ÛÙÔÓ ÔÚfi ÙÔ˘ ·ÛıÂÓÔ‡˜

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IgM Î·È IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ÙË˜ Bartonella henselae.∏ ·ÓˆÙ¤Úˆ ‰È¿ÁÓˆÛË Ù¤ıËÎÂ ÌÂÙ¿ ·fi ÙÔÓ ÏÂÙÔ-ÌÂÚ‹ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ô ÔÔ›Ô˜ ·¤ÎÏÂÈÛÂÙËÓ Î·ÎÔ‹ıË ‰ÈfiÁÎˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È Î˘-Ú›ˆ˜ ·fi ÙË ÏÂÙÔÌÂÚ‹ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡, Ë ÔÔ›··ÔÎ¿Ï˘„Â ÙËÓ ‡·ÚÍË Î·ÙÔÈÎ›‰ÈÔ˘ ˙ÒÔ˘ (Á¿Ù·˜)ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÛıÂÓ‹.

∏ ÓfiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜ Â›Ó·È Û˘Ó‹-ıˆ˜ ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË. ∆Ô 30% ÙˆÓ ·ÛıÂÓÒÓ Â›-Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÏÂÌÊ·‰¤ÓÂ˜ ÛÂ ÔÏÏ·-Ï¤˜ ı¤ÛÂÈ˜. ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÂÓ‰Â›ÎÓ˘Ù·ÈÛÂ ·ÓÔÛÔÎ·ÙÂÛÙ·ÏÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜, ÂÓÒ ¿ÏÏÔÈÛ˘ÁÁÚ·ÊÂ›˜ Û˘ÓÈÛÙÔ‡Ó ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·ÈÛÂ ÂÚ›ÙˆÛË ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ˘ÚÂÙÔ‡ (2,3,13).™ÙÔÓ ·ÛıÂÓ‹ Ì·˜ ¯ÔÚËÁ‹ıËÎÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-Á‹ ÏfiÁˆ ÙÔ˘ ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ˘ÚÂÙÔ‡ Î·È ÙË˜ Ó¤-·˜ ÂÌÊ¿ÓÈÛË˜ ‰ÈÔÁÎˆÌ¤ÓÔ˘ ÏÂÌÊ·‰¤Ó· (ÛÙË Ì·-Û¯·ÏÈ·›· ¯ÒÚ·). ∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ Â˘-Ú‹Ì·Ù· ÌË ÂÈ‰ÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ, Î·ıÒ˜ Î·È ÔÏÏ·-Ï¿ ÂÈıËÏÈÔÂÈ‰‹ ÎÔÎÎÈÒÌ·Ù· ÌÂ ÎÂÓÙÚÈÎ‹ Ó¤ÎÚˆ-ÛË, fiˆ˜ ¿ÏÏˆÛÙÂ ·Ó·ÌÂÓfiÙ·Ó (1,2,14). ∏ Ù˘¯·›··ÓÂ‡ÚÂÛË ÙÔ˘ ·Ú·ÙÂÙ·Ì¤ÓÔ˘ ·ƒ∆∆ ÛÙÔÓ ÚÔÂÁ-¯ÂÈÚËÙÈÎfi ¤ÏÂÁ¯Ô ÌÂÙ¿ ·fi ÏÂÙÔÌÂÚ‹ ‰ÈÂÚÂ‡ÓËÛË‚Ú¤ıËÎÂ fiÙÈ ÔÊÂÈÏfiÙ·Ó ÛÙËÓ ‡·ÚÍË Î˘ÎÏÔÊÔÚÔ‡-ÓÙÔ˜ LA. £ÂˆÚ‹Û·ÌÂ fiÙÈ Ë ·ÚÔ˘Û›· ÙÔ˘ LA ÛÂ ¤Ó··È‰› Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈ˙Â ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜‹ ıÚÔÌ‚ÒÛÂÈ˜, ‹Ù·Ó ·ÚÔ‰ÈÎ‹ Î·È Î·ÏÔ‹ıË˜, ÔÊÂÈ-ÏfiÌÂÓË ÛÙË ÏÔ›ÌˆÍË ÙÔ˘ ·ÛıÂÓ‹ ·fi ÙË Bartonellahenselae. ™ÙËÚÈ˙fiÌÂÓÔÈ ÛÙ· ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤-Ó· (4,6,8,11,12), ÚÔ¯ˆÚ‹Û·ÌÂ ÛÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ÏÂÌÊ·‰¤Ó· ·Ú¿ ÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ ·ƒ∆∆, ¯ˆÚ›˜Ó· ·Ú·ÙËÚËıÂ› ·ÈÌÔÚÚ·Á›· ‹ Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓÂÔ‡ÏˆÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙ· ·È‰È¿ Â›Ó·È ‰˘Ó·ÙfiÓ Ó··Ú·ÙËÚËıÂ› ·Ú¿Ù·ÛË ÙÔ˘ ·ƒ∆∆, Ë ÔÔ›· ‰ÂÓÔÊÂ›ÏÂÙ·È ÛÂ ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿ıÂÛË, ·ÏÏ¿ Â›Ó·È ·Ô-Ù¤ÏÂÛÌ· ‡·ÚÍË˜ LA (6,8,11,12). ∆Ô LA, o Â›ÎÙË-ÙÔ˜ ·Ó·ÛÙÔÏ¤·˜ ÙË˜ ‹ÍË˜, Â›Ó·È Û˘Ó‹ıˆ˜ ·ÚÔ‰È-Îfi ÌÂ Î·ÏÔ‹ıË ÔÚÂ›·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Joseph R Lex. Catscratch disease. Medicine Journal

2001;2:8.2. Regnery RL, Olson JG, Perkins BA, Bibb W. Serological

response to “Rochalimaea henselae” antigen in suspected

cat-scratch disease. Lancet 1992;339:1443-1445. 3. Margileth AM. Antibiotic therapy for catscratch disease:

clinical study of therapeutic outcome in 268 patients and areview of the literature. Pediatr Infect Dis J 1992;11:474-478.

4. Eckart P, Tournade G, Amiour M, Guillot M, Courtheoux P,Rousselot P. Maladie des griffes du chat de presentationpseudotumorale. Arch Pediatr 2001;8:393-396.

5. Carithers HA. Cat-scratch disease. An overview based on astudy of 1200 patients. Am J Dis Child 1985;139:1124-1133.

6. OÈÎÔÓfiÌÔ˘ ª, ∫Ô‡ÛË ∞, ∆Û¿ÙÚ· π, °·Ú˘›‰Ô˘ µ, ∞ı·Ó·Û›-Ô˘-ªÂÙ·Í¿ ª. ¶·ÚÔ‰ÈÎfi ·ÓÙÈËÎÙÈÎfi ÙÔ˘ Ï‡ÎÔ˘ ÛÙËÓ ·È-‰ÈÎ‹ ËÏÈÎ›·: ÂÚÈÁÚ·Ê‹ ÙÂÛÛ¿ÚˆÓ ÂÚÈÙÒÛÂˆÓ. ¶·È‰È·-ÙÚÈÎ‹ 2002;65:77-80.

7. ªale C, Lechner K, Eichinger S, Kyrle PA, Kapiotis S, WankH et al. Clinical significance of lupus anticoagulants inchildren. J Pediatr 1999;134:199-205.

8. Lee MT, Nardi MA, Hadzi-Nesic J, Karpatkin M. Transienthemorrhagic diathesis associated with an inhibitor ofprothrombin with lupus anticoagulant in a 1ó year-old girl:report of a case and review of literature. Am J Hematol1996;51:307-314.

9. Hoffman R, Benz EJ, Shattil SJ, Furil B, Cohen HJ, eds.Inhibitors of blood coagulation. In: Hematology. BasicPrinciples and Practice. 2nd ed. Churchill Livingstone Inc;1995. p. 1746-1755.

10. Seaman DE, Londino AV Jr, Kwoh CK, Medsger TA Jr,Manzi S. Antiphospholipid antibodies in pediatric systemiclupus erythematosus. Pediatrics 1995;96:1040-1045.

11. Manco-Johnson MJ, Nuss R, Key N, Moertel C, Jacobson L,Meech S et al. Lupus anticoagulant and protein S deficiencyin children with postvaricella purpura fulminans orthrombosis. J Pediatr 1996;128:319-323.

12. Manco-Johnson MJ. Antiphospholipid antibodies inchildren. Semin Thromb Hemost 1998;24:591-598.

13. Adal KA, Cockerell CJ, Petri WA Jr. Cat scratch disease,bacillary angiomatosis, and other infections due toRochalimaea. N Engl J Med 1994;330:1509-1515.

14. Infectious Diseases and Immunization Committee,Canadian Pediatric Society. CPS: Cat scratch disease:diagnosis and management. Paediatr Child Health1997;2:275-278.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-08-2002∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 20-11-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª. §ÈıÔÍÔÔ‡ÏÔ˘ µ·Û. °ÂˆÚÁ›Ô˘ 24, ∆.∫. 546 40, £ÂÛÛ·ÏÔÓ›ÎË

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∂ÈÛ·ÁˆÁ‹¶ÂÚÈÛÛfiÙÂÚ· ·fi Â›ÎÔÛÈ ¯ÚfiÓÈ· ¤¯Ô˘Ó ÂÚ¿ÛÂÈ

·fi ÙË Á¤ÓÓËÛË ÙÔ˘ ÚÒÙÔ˘ “ÌˆÚÔ‡ ÙÔ˘ ÛˆÏ‹Ó·”(1). ∞fi ÙfiÙÂ, ÔÈ Ì¤ıÔ‰ÔÈ ˘Ô‚ÔËıÔ‡ÌÂÓË˜ ·Ó··-

Ú·ÁˆÁ‹˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂ-ÚÔ, ¤¯Ô˘Ó ‰ÒÛÂÈ ÙË ¯·Ú¿ ÙË˜ ·fiÎÙËÛË˜ ÂÓfi˜ ·È‰ÈÔ‡ ÛÂ ÔÏÏ¿ ˙Â˘Á¿ÚÈ· ÌÂ ÚÔ‚Ï‹Ì·Ù· ˘ÔÁÔ-ÓÈÌfiÙËÙ·˜. ¶·Ú¿ÏÏËÏ·, fiÌˆ˜, ¤¯Ô˘Ó ÂÁÂ›ÚÂÈ Î·È

ŒÎ‚·ÛË ÓÂÔÁÓÒÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ∞. ª·ÓÔ˘Ú¿, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Outcome of newborns conceived by in vitro fertilization A. Manoura, C. Giannakopoulou

∂¶π∫∞πƒ∞ £∂ª∞∆∞ CURRENT ISSUES

¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜ Department of Neonatology of University of Crete

�¶ÂÚ›ÏË„Ë: ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÂÚ›Ô˘ ÂÓ‹ÓÙ·¯ÈÏÈ¿‰Â˜ ·È‰È¿ ÁÂÓÓÈÔ‡ÓÙ·È Î¿ıÂ ¯ÚfiÓÔ ÌÂ ÙË Ì¤ıÔ-‰Ô ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜. ∂›ÎÔÛÈ ¯ÚfiÓÈ·ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÙÔ˘ ÚÒÙÔ˘ “·È‰ÈÔ‡ ÙÔ˘ ÛˆÏ‹Ó·”˘¿Ú¯Ô˘Ó ·ÎfiÌ· ÂÚˆÙËÌ·ÙÈÎ¿ ˆ˜ ÚÔ˜ ÙËÓ Úfi-ÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ÙË ‚Ô‹ıÂÈ·ÙË˜ ÙÂ¯ÓÔÏÔÁ›·˜. ∆· ·È‰È¿ ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈ-ÌÔÔ›ËÛË˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿Á¤ÓÓËÛË˜ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹, ÚÔˆÚfiÙËÙ·˜, ¯·ÌË-ÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ Î·È ÂÚÈÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌfi-ÙËÙ·˜ ÛÂ Û¯¤ÛË ÌÂ Ù· ÓÂÔÁÓ¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡Ï-ÏË„Ë. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ÌÂ-Á¿ÏÔ ÔÛÔÛÙfi ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ, Ô˘ ÊÙ¿ÓÂÈ ÛÙÔ¤Ó· ÙÚ›ÙÔ ÙˆÓ Î˘‹ÛÂˆÓ Ô˘ ¤¯Ô˘Ó ÚÔ¤ÏıÂÈ ·fiÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË. ¢È·ÊÔÚ¤˜ ÛÙ· ¯·Ú·-ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÌËÙ¤ÚˆÓ Û˘Ì‚¿ÏÏÔ˘Ó, Â›ÛË˜, ÛÙË‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Î‚·ÛË. ∆· ·È‰È¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÂÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÓÂ˘ÚÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·ÈÂÈ‰ÈÎ¿ ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰›‰Â-Ù·È Â›ÛË˜ ÛÙÔ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ÔÏ‡‰˘ÌˆÓÎ˘‹ÛÂˆÓ. ∏ ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘Í‹ ÙÔ˘˜ Â›Ó·È Ê˘ÛÈÔÏÔ-ÁÈÎ‹, ÂÓÒ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ‰ÂÓÊ·›ÓÂÙ·È Ó· Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ˜. ∏ Â·Ó·ÙÔ-Ôı¤ÙËÛË ÛÙË Ì‹ÙÚ· ‰‡Ô, ÙÔ ·ÓÒÙÂÚÔ, ÂÌ‚Ú‡ˆÓ, ÌÂÚÔÔÙÈÎ‹ ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ ÙËÓ ÙÔÔı¤ÙËÛË ÂÓfi˜ÌfiÓÔ “Î·Ï‹˜ ÔÈfiÙËÙ·˜” ‚ÈÒÛÈÌÔ˘ ÂÌ‚Ú‡Ô˘, ı· ‚ÂÏ-ÙÈÒÛÂÈ Î·Ù¿ ÔÏ‡ ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ ÙË˜ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË, ÔÏ‡-‰˘ÌË Î‡ËÛË.

�Abstract: During the last years, almost fiftythousand children are born every year after in vitrofertilization. Twenty years after the birth of the firstbaby conceived by in vitro fertilization, manyquestions concerning the outcome of thesechildren remain unanswered. Pregnancies achievedafter in vitro fertilization bear an increased risk forprematurity, low birth weight, perinatal mortality anddelivery by cesarean section compared withpregnancies after spontaneous conception.Adverse outcome is mainly due to the highfrequency of multiple pregnancies, which reach onethird of in vitro fertilization pregnancies. Differencesin maternal characteristics also contribute to thisadverse outcome. Children conceived by in vitrofertilization are at higher risk of neurologicalsequelae, especially cerebral palsy, which is alsomainly due to the high frequency of multiplegestations. Physical growth is within normal rangewhile congenital malformations do not seem to behigher. Two-embryo transfer policy and, in the nearfuture, the effective selection and transfer of oneviable embryo will improve the outcome of childrenborn after in vitro fertilization.

Key words: in vitro fertilization, multiple pregnancy.

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ÔÏÏÔ‡˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Úfi-ÁÓˆÛË Î·È ÙÔ˘˜ Èı·ÓÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· Ù· ·È‰È¿Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ ÙÂ¯ÓÔÏÔÁ›·˜. ªÂÙËÓ ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË, ·ÚÎÂÙ¿ ÛÙ¿‰È· ÙË˜Ê˘ÛÈÔÏÔÁÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ˘ÂÚË‰Ô‡ÓÙ·È,·ÊÔ‡ Ë ÂÌ‚Ú˘˚Î‹ ·Ó¿Ù˘ÍË Á›ÓÂÙ·È ·Ú¯ÈÎ¿ in vitro.∆· ÂÚˆÙËÌ·ÙÈÎ¿ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ Èı·Ó¤˜ ÂÈ‰Ú¿ÛÂÈ˜ÛÙÔ ¤Ì‚Ú˘Ô, ·˘Ù‹˜ ÙË˜ ·Ú¤Ì‚·ÛË˜ ÛÙÈ˜ Ê˘ÛÈÔÏÔ-ÁÈÎ¤˜ ‰È·‰ÈÎ·Û›Â˜ ÙË˜ ÁÔÓÈÌÔÔ›ËÛË˜, ‰ÂÓ ¤¯Ô˘Ó··ÓÙËıÂ› ·ÎfiÌ·.

∏ ·Ó·ÛÎfiËÛË ·˘Ù‹ ÛÎÔfi ¤¯ÂÈ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈÙ· ¿ÌÂÛ· ÂÚÈÁÂÓÓËÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÓÂÔÁÓÒÓÔ˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË Î·ÈÓ· Û˘ÓÔ„›ÛÂÈ ÙÔ˘˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ Ô˘ ˘¿Ú-¯Ô˘Ó Û‹ÌÂÚ· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÒÙÂÚË ÚfiÁÓˆÛËÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.

∆Â¯ÓÔÏÔÁ›· ˘Ô‚ÔËıÔ‡ÌÂÓË˜ ·Ó··Ú·ÁˆÁ‹˜ ∏ ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ÛÙËÚ›˙ÂÙ·È ÛÙË

Û˘ÏÏÔÁ‹ ˆ·Ú›ˆÓ Î·È ÛÙËÓ ÙÔÔı¤ÙËÛ‹ ÙÔ˘˜, Ì·˙›ÌÂ Î·Ù¿ÏÏËÏ· ÂÂÍÂÚÁ·ÛÌ¤ÓÔ Û¤ÚÌ·, ÛÂ ‰ÔÎÈÌ·-ÛÙÈÎfi ÛˆÏ‹Ó· ‹ ÙÚ˘‚Ï›· ÌÂ Î·Ù¿ÏÏËÏÔ ıÚÂÙÈÎfi˘ÏÈÎfi, ÒÛÙÂ Ó· Á›ÓÂÈ Ë ÁÔÓÈÌÔÔ›ËÛË. ™ÙË Û˘Ó¤¯ÂÈ·,·ÎÔÏÔ˘ıÂ› ÂÌÊ‡ÙÂ˘ÛË ÙˆÓ ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·-Ú›ˆÓ ÛÙË Ì‹ÙÚ· (2). ∞Ú¯ÈÎ¿, ‰ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·ÓÊ¿ÚÌ·Î· ÚfiÎÏËÛË˜ ˆÔÚÚËÍ›·˜, ‰È·ÈÛÙÒıËÎÂfiÌˆ˜ fiÙÈ Ë Ì¤ıÔ‰Ô˜ ÌÂ Ï‹„Ë ˆ·Ú›Ô˘ ·fi Á˘Ó·›Î·ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÁÂÓÓËÙÈÎfi Î‡ÎÏÔ ·ÚÔ˘Û›·˙Â ÔÏÏ¿Ú·ÎÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·È ÌÈÎÚfi ÔÛÔÛÙfi ÂÈÙ˘-¯›·˜. ™‹ÌÂÚ·, ÁÈ· ÙË Ï‹„Ë ˆ·Ú›ˆÓ, Á›ÓÂÙ·È Î·Ù¿ Î·-ÓfiÓ· Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ‰È¤ÁÂÚÛË ÙˆÓ ˆÔıËÎÒÓ. ∂Í¤ÏÈ-ÍË ÙË˜ ÎÏ·ÛÈÎ‹˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜·ÔÙÂÏÂ› Ë ÙÔÔı¤ÙËÛË ÂÓfi˜ ÌfiÓÔ ÛÂÚÌ·ÙÔ˙ˆ·Ú›-Ô˘ ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÙÔ˘ ˆ·Ú›Ô˘ (ICSH) ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÔÏÈÁÔ·ÛıÂÓÔ-ÛÂÚÌ›·˜. ∏ Î·Ù¿„˘ÍË ÂÌ‚Ú‡ˆÓ ÛÂ ·Ú¯ÈÎ¿ ÛÙ¿‰È·ÙË˜ ÁÔÓÈÌÔÔ›ËÛË˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙ·ÚÔÁÚ¿ÌÌ·Ù· ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ÁÈ·Ê‡Ï·ÍË ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ (2).

∏ ¯ÚËÛÈÌÔÔ›ËÛË ‰È·ÊfiÚˆÓ ÔÚÌÔÓÈÎÒÓ ÛÎÂ˘·-ÛÌ¿ÙˆÓ ÁÈ· ÙËÓ ÚfiÎÏËÛË ˆÔÚÚËÍ›·˜, Ë Èı·ÓfiÙË-Ù· ‚Ï¿‚Ë˜ ÙÔ˘ ˆ·Ú›Ô˘ Î·Ù¿ ÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ Ï‹„Ë˜ÙÔ˘ ‹ Î·Ù¿ ÙËÓ Â·Ó·ÙÔÔı¤ÙËÛ‹ ÙÔ˘ ÛÙË Ì‹ÙÚ·, Ë¯Ú‹ÛË Î·ÏÏÈÂÚÁËÙÈÎÒÓ ˘ÏÈÎÒÓ Ô˘ Èı·ÓfiÓ ¤¯Ô˘ÓÎ¿ÔÈ· Â›‰Ú·ÛË ÛÙÔ ·Ó·Ù˘ÛÛfiÌÂÓÔ ¤Ì‚Ú˘Ô, Î·-ıÒ˜ Î·È Ë Î·Ù¿„˘ÍË ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ÂÌ‚Ú‡ˆÓ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ·ÓËÛ˘¯›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ˘ÁÂ›· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ·˘Ù¤˜ ÙÈ˜ ÌÂ-ıfi‰Ô˘˜ (3,4). ¶·Ú¿ÏÏËÏ·, Ë ÚÔÛ¿ıÂÈ· ·‡ÍËÛË˜ÙˆÓ ÔÛÔÛÙÒÓ Â›ÙÂ˘ÍË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ ÌÂÙ¿ ·fi¤Ó· Î‡ÎÏÔ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ¤¯ÂÈ Ô‰Ë-Á‹ÛÂÈ ÛÙËÓ Â·Ó·ÙÔÔı¤ÙËÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi¤Ó· ÂÌ‚Ú‡ˆÓ ÛÙË Ì‹ÙÚ·. ∏ Ú·ÎÙÈÎ‹ ·˘Ù‹ Â›¯Â Û·Ó

·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÔÏ‡‰˘ÌˆÓ Î˘‹-ÛÂˆÓ ÌÂ ·ÚÓËÙÈÎ¤˜ Û˘Ó¤ÂÈÂ˜ ÛÙËÓ ÚfiÁÓˆÛË ÙˆÓÓÂÔÁÓÒÓ.

¶ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜ ∆· ÔÏ‡‰˘Ì· ÓÂÔÁÓ¿ ÛÙÔÓ ¿ÓıÚˆÔ ·ÔÙÂÏÔ‡Ó

Ê˘ÛÈÔÏÔÁÈÎ¿ ÙÔ 2-3% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÓÂÔÁÓÒÓ (5).∏ Û˘¯ÓfiÙËÙ· ‰›‰˘ÌË˜ Î‡ËÛË˜ ·Ó·Ê¤ÚÂÙ·È 1/80, ÙÚ›-‰˘ÌË˜ 1/6400, ÂÓÒ fiÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚË˜Ù¿ÍË˜ ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜, Ë Û˘¯ÓfiÙËÙ· ÌÂÈÒÓÂÙ·ÈÂÎıÂÙÈÎ¿. ∏ ÔÏ‡‰˘ÌË Î‡ËÛË Â›Ó·È Û˘Ó‹ıˆ˜ ÙÔ ·Ô-Ù¤ÏÂÛÌ· ÁÔÓÈÌÔÔ›ËÛË˜ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤Ó·ˆ·Ú›ˆÓ (‰ÈˆÔÁÂÓ‹ ‰›‰˘Ì·) (6). ∏ ‰È·›ÚÂÛË ÂÓfi˜ ÁÔ-ÓÈÌÔÔÈËÌ¤ÓÔ˘ ˆ·Ú›Ô˘ ÛÂ ‰‡Ô ·ÓÔÌÔÈfiÙ˘· ¤Ì-‚Ú˘· (ÌÔÓÔˆÔÁÂÓ‹) ·ÔÙÂÏÂ› ¤Ó·Ó ¿ÏÏÔ ÌË¯·ÓÈÛÌfi‰ËÌÈÔ˘ÚÁ›·˜ ‰È‰‡ÌˆÓ. ∏ Û˘¯ÓfiÙËÙ· ÌÔÓÔˆÔÁÂÓÔ‡˜‰›‰˘ÌË˜ Î‡ËÛË˜ Â›Ó·È 3,5 ÛÙÈ˜ 1000 ÁÂÓÓ‹ÛÂÈ˜ Î·ÈÂ›Ó·È Û¯ÂÙÈÎ¿ ÛÙ·ıÂÚ‹ ·ÁÎfiÛÌÈ· (7). ∞ÓÙ›ıÂÙ·, ËÛ˘¯ÓfiÙËÙ· ‰ÈˆÔÁÂÓÔ‡˜ ‰›‰˘ÌË˜ Î‡ËÛË˜ Î˘Ì·›ÓÂÙ·È·fi 4 ¤ˆ˜ 50 ÛÙÈ˜ 1000 ÁÂÓÓ‹ÛÂÈ˜ Î·È ÂËÚÂ¿˙ÂÙ·È·fi ÙË Ê˘Ï‹, ·fi Ì›· ÔÈÎÔÁÂÓÂÈ·Î‹ ÚÔ‰È¿ıÂÛËÔ˘ ÌÂÙ·Ê¤ÚÂÙ·È ·fi ÙË ÌËÙ¤Ú·, ·fi ÙËÓ ËÏÈÎ›·ÙË˜ ÌËÙ¤Ú·˜, ÙÔÓ ÙfiÎÔ, ÙË ‰È·ÙÚÔÊ‹ ‹ ÙËÓ ÂÔ¯‹ÙÔ˘ ¯ÚfiÓÔ˘. OÈ ÔÏ‡ÙÔÎÂ˜ ÌËÙ¤ÚÂ˜ ¤¯Ô˘Ó ·˘ÍËÌ¤-ÓË Èı·ÓfiÙËÙ· ÁÈ· ‰›‰˘ÌË Î‡ËÛË, Î·ıÒ˜ Î·È ÔÈ Á˘-Ó·›ÎÂ˜ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ ÌÂ ÙË Ì¤ÁÈÛÙË Û˘¯Ófi-ÙËÙ· ÛÙ· 37 ¯ÚfiÓÈ· (7). ∆· ÌÔÓÔˆÔÁÂÓ‹ ‰›‰˘Ì··ÔÙÂÏÔ‡Ó ÙÔ 10-18% ÙˆÓ ˙ÒÓÙˆÓ ‰È‰‡ÌˆÓ (8). ∏ÂÚÈÁÂÓÓËÙÈÎ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Â›Ó·ÈÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÂ˜ Î·È Ë Èı·ÓfiÙËÙ· ÂÚÈÁÂÓÓË-ÙÈÎÔ‡ ı·Ó¿ÙÔ˘ Â›Ó·È 2,5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi Ù·‰ÈˆÔÁÂÓ‹ (9).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·Ú·ÙËÚÂ›Ù·È ÛÙÈ˜ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ¯ÒÚÂ˜ Ì›· ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ÔÏ‡‰˘-ÌˆÓ Î˘‹ÛÂˆÓ. ∏ ·‡ÍËÛË ·˘Ù‹ ·Ô‰›‰ÂÙ·È Î·Ù¿ ÙÔ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÛÙËÓ ÚÔ˜ Ù· ¿Óˆ ÌÂÙ·ÙfiÈÛËÙË˜ Ì¤ÛË˜ ËÏÈÎ›·˜ ÙˆÓ ÂÁÎ‡ˆÓ Á˘Ó·ÈÎÒÓ Î·È Î·Ù¿ Ù·‰‡Ô ÙÚ›Ù· ÛÙËÓ Â˘ÚÂ›· ¯Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô-‚ÔËıÔ‡ÌÂÓË˜ ·Ó··Ú·ÁˆÁ‹˜ (5). ∏ ıÂÚ·Â›· ·Óˆ-ÔÚÚËÎÙÈÎÒÓ Á˘Ó·ÈÎÒÓ ÌÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ ÛÎÂ˘¿ÛÌ·-Ù· Â·ÁˆÁ‹˜ ˆÔÚÚËÍ›·˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÛËÌ·ÓÙÈÎ‹·‡ÍËÛË ÙË˜ Èı·ÓfiÙËÙ·˜ ÔÏ‡‰˘ÌË˜ Î‡ËÛË˜ Ô˘ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ê¿ÚÌ·ÎÔ Î·È ÙË ‰fiÛË. ∏ ÎÈÙÚÈÎ‹ÎÏÔÌÈÊ·›ÓË Î·È ¿ÏÏ· ·ÓÙÈ-ÔÈÛÙÚÔÁfiÓ· ·˘Í¿ÓÔ˘Ó ÙÔÓÎ›Ó‰˘ÓÔ ‰›‰˘ÌË˜ Î‡ËÛË˜ ÛÂ 10% Î·È ÙÚ›‰˘ÌË˜ Î‡Ë-ÛË˜ ÛÂ 1%, ÂÓÒ ÛÂ ıÂÚ·Â›· ÌÂ Û˘Ì‚·ÙÈÎ¿ Û¯‹Ì·-Ù· ÁÔÓ·‰ÔÙÚÔÈÓÒÓ, Ô Î›Ó‰˘ÓÔ˜ ÔÏ‡‰˘ÌË˜ Î‡ËÛË˜Â›Ó·È ÂÚ›Ô˘ 25% (3). ™ÙËÓ ÂÚ›ÙˆÛË ÙË˜ ÂÍˆÛˆ-Ì·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜, Ô Î›Ó‰˘ÓÔ˜ ÔÏ‡‰˘ÌË˜Î‡ËÛË˜ ·˘Í¿ÓÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÁÔ-ÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ Ô˘ Â·Ó·ÙÔÔıÂÙÔ‡ÓÙ·ÈÛÙË Ì‹ÙÚ·. OÚÈÛÌ¤Ó· Î¤ÓÙÚ· ıÂˆÚÔ‡Ó fiÙÈ Ë ÂÌÊ‡-ÙÂ˘ÛË ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·59

·˘Í¿ÓÂÈ ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ ÙË˜ ÌÂıfi‰Ô˘. øÛÙfi-ÛÔ, ¤¯ÂÈ ‰ÂÈ¯ıÂ› fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ‰È·ı¤ÛÈÌˆÓ ˆ·-Ú›ˆÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Î·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜Î·È fiÙÈ Ë ÂÌÊ‡ÙÂ˘ÛË ÙÚÈÒÓ ·ÓÙ› ‰‡Ô ˆ·Ú›ˆÓ ‰ÂÓ ·˘-Í¿ÓÂÈ ÛËÌ·ÓÙÈÎ¿ ÙÔ ÔÛÔÛÙfi ÙˆÓ Î˘‹ÛÂˆÓ Ô˘ ÂÈ-Ù˘Á¯¿ÓÔÓÙ·È (3).

∏ Û˘¯ÓfiÙËÙ· ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ ÛÂ ÂÚÈÙÒ-ÛÂÈ˜ ˘Ô‚ÔËıÔ‡ÌÂÓË˜ ·Ó··Ú·ÁˆÁ‹˜ Â›Ó·È 20-30%, ÂÓÒ ÙÔ 30-40% ÙˆÓ ÌˆÚÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·ÈÌÂÙ¿ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ÚÔ¤Ú¯ÔÓÙ·È·fi ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜ (5). OÈ ‰›‰˘ÌÂ˜ Î˘‹ÛÂÈ˜¤¯Ô˘Ó ·˘ÍËıÂ› ÛÙÈ˜ ∏¶∞ ·fi 1,8% ÙÔ 1971 ÛÂ 2,7%ÙÔ 1997 (8). ¶ÂÚÈÛÛfiÙÂÚÔ ÂÓÙ˘ˆÛÈ·Î‹ Â›Ó·È Ë ·‡-ÍËÛË ÙˆÓ ÌÂÁ·Ï‡ÙÂÚË˜ Ù¿ÍË˜ ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ.∆· ÙÚ›‰˘Ì· ÓÂÔÁÓ¿, ·fi 296 ·Ó¿ 1 ÂÎ·ÙÔÌÌ‡ÚÈÔ ˙Ò-ÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÙÔ 1971, ¤ÊÙ·Û·Ó ÙÈ˜ 1584 ·Ó¿ÂÎ·ÙÔÌÌ‡ÚÈÔ ÙÔ 1997, Ù· ÙÂÙÚ¿‰˘Ì· ·fi 13 ·Ó¿ÂÎ·ÙÔÌÌ‡ÚÈÔ ÙÔ 1971 ¤ÊÙ·Û·Ó ÙÈ˜ 144 ÙÔ 1996, ÂÓÒÙ· ÂÓÙ¿‰˘Ì· ·fi 3,8 ·Ó¿ ÂÎ·ÙÔÌÌ‡ÚÈÔ ÙÔ 1971¤ÊÙ·Û·Ó ÙÈ˜ 20,8 ÙÔ 1996 (8).

¶ÚfiÁÓˆÛË ÓÂÔÁÓÒÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔ-Ô›ËÛË

∆· ÓÂÔÁÓ¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ÁÔÓÈÌÔÔ›ËÛË ·ÚÔ˘ÛÈ¿˙Ô˘Ó, ÁÂÓÈÎ¿, ÌÂÁ·Ï‡ÙÂÚ·ÔÛÔÛÙ¿ Á¤ÓÓËÛË˜ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹, ÚÔˆÚfiÙË-Ù·˜, ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ Î·È ÂÚÈÁÂÓÓËÙÈÎ‹˜ıÓËÛÈÌfiÙËÙ·˜ ÛÂ Û¯¤ÛË ÌÂ Ù· ÓÂÔÁÓ¿ ·fi Ê˘ÛÈÔÏÔ-ÁÈÎ‹ Û‡ÏÏË„Ë (3,5,10,11). ™Â ÌÂÏ¤ÙË Ô˘ Û˘ÌÂÚÈ-Ï·Ì‚¿ÓÂÈ 4298 Î˘‹ÛÂÈ˜ Î·È 5539 ÓÂÔÁÓ¿ ·fi ˘Ô-‚ÔËıÔ‡ÌÂÓË ·Ó··Ú·ÁˆÁ‹ ‚Ú¤ıËÎÂ fiÙÈ ÙÔ ÔÛÔ-ÛÙfi ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ‹Ù·Ó 31,9%,ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÁÂÓÓËÙÈÎÒÓ ı·Ó¿ÙˆÓ ‹Ù·Ó1,8% Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ÚfiˆÚˆÓ ÙÔÎÂÙÒÓ ÌÂ ËÏÈ-Î›· Î‡ËÛË˜ ÌÈÎÚfiÙÂÚË ÙˆÓ 33 Â‚‰ÔÌ¿‰ˆÓ ‹Ù·Ó4,8%, ÛÂ ·ÓÙ›ıÂÛË ÌÂ 13,2%, 0,8% Î·È 1,1% ·ÓÙ›-ÛÙÔÈ¯· ÁÈ· Ù· ÓÂÔÁÓ¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡ÏÏË„Ë(11). ™Â ¿ÏÏË ÌÂÁ¿ÏË ÌÂÏ¤ÙË ·fi ÙË ™Ô˘Ë‰›·, ÙÔ Ô-ÛÔÛÙfi ÙˆÓ ÚfiˆÚˆÓ ÙÔÎÂÙÒÓ ‚Ú¤ıËÎÂ 30,3% ÛÙÈ˜Î˘‹ÛÂÈ˜ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË, ÛÂ ·ÓÙ›ıÂ-ÛË ÌÂ ÙÔ 6,3% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. Ã·ÌËÏfi ‚¿-ÚÔ˜ Á¤ÓÓËÛË˜ ‰È·ÈÛÙÒıËÎÂ ÛÙÔ 27,4%, ÛÂ Û¯¤ÛËÌÂ ÙÔ 6,3% ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (5). ¶Èı·Ófi Â›Ó·È,ˆÛÙfiÛÔ, fiÙÈ ÛÙÔ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ÙˆÓ ÚfiˆÚˆÓÙÔÎÂÙÒÓ Û˘Ì‚¿ÏÏÂÈ Î·È ÙÔ ¿Á¯Ô˜, ÙfiÛÔ ÙˆÓ ÁÔÓ¤ˆÓfiÛÔ Î·È ÙˆÓ ÁÈ·ÙÚÒÓ, ÁÈ· ÂÈÙ˘¯‹ ¤Î‚·ÛË ÙË˜ Î‡Ë-ÛË˜ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË,Ô˘ Ô‰ËÁÂ› ÛÂ ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÌÂÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÛÙÈ˜ 36 ÌÂ 37Â‚‰ÔÌ¿‰Â˜ (3,10). ™ËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ‚Ú¤ıËÎ·ÓÎ·È ÛÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· Ô˘ ‹Ù·Ó8,2ò, ÂÓÒ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‹Ù·Ó 6,6ò (5). ∏‰˘ÛÌÂÓ¤ÛÙÂÚË ·˘Ù‹ ¤Î‚·ÛË ¤¯ÂÈ ·Ô‰ÔıÂ› ÛÂ ÌÂ-

Á¿ÏÔ ‚·ıÌfi ÛÙÔ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ÔÏ‡‰˘-ÌˆÓ Î˘‹ÛÂˆÓ ÌÂ Ù· ·˘ÍËÌ¤Ó· ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û‡-ÓÔÏÔ ÙˆÓ Î˘‹ÛÂˆÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË(5,12). øÛÙfiÛÔ, Ê·›ÓÂÙ·È fiÙÈ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜Û˘ÓÙÂÏÔ‡Ó ÛÙË ‰˘ÛÌÂÓ¤ÛÙÂÚË ·˘Ù‹ ¤Î‚·ÛË, ·ÊÔ‡‰È·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË ¤¯ÂÈ ‚ÚÂıÂ› Î·È ÛÂ ÓÂÔÁÓ¿·fi ·Ï¤˜ Î˘‹ÛÂÈ˜ (3,13,14).

·. ¶ÚfiÁÓˆÛË ÓÂÔÁÓÒÓ ·fi ·Ï¤˜ Î˘‹ÛÂÈ˜ ÂÍˆ-ÛˆÌ·ÙÈÎ‹˜ ·Ó··Ú·ÁˆÁ‹˜

¶ÔÏÏÔ› ÂÚÂ˘ÓËÙ¤˜ ¤¯Ô˘Ó Û˘ÁÎÚ›ÓÂÈ ÙËÓ ¤Î‚·ÛËÓÂÔÁÓÒÓ ·fi ·Ï¤˜ Î˘‹ÛÂÈ˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ·Ó··-Ú·ÁˆÁ‹˜ ÌÂ ÂÎÂ›ÓË ÓÂÔÁÓÒÓ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡Ï-ÏË„Ë. OÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÌÊˆÓÔ‡Ó fiÙÈ Ù· ÓÂÔÁÓ¿·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ‰È·ÙÚ¤¯Ô˘Ó ÌÂÁ·-Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÚfiˆÚÔ ÙÔÎÂÙfi Î·È ÁÈ· ¯·ÌËÏfi‚¿ÚÔ˜ Á¤ÓÓËÛË˜ (4,5,10,15). ¶·Ú’ fiÏÔ Ô˘ ¤Ó· Ì¤-ÚÔ˜ ·fi Ù· ÚÔ‚Ï‹Ì·Ù· ·Ô‰›‰ÂÙ·È ÛÙ· ‰È·ÊÔÚÂÙÈ-Î¿ ̄ ·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ̆ Ô‚¿ÏÏÔÓÙ·ÈÛÂ ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË (ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›·,ÚˆÙÔÙfiÎÂ˜), ·ÎfiÌ· Î·È fiÙ·Ó Á›ÓÂÈ ÂÍÔÌÔ›ˆÛË ÙˆÓÔÌ¿‰ˆÓ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎ›· Î·È ÙÔÓ ÙfiÎÔ ÙË˜ ÌËÙ¤-Ú·˜, Ë ‰È·ÊÔÚ¿ ÛÙËÓ ¤Î‚·ÛË ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ ÛÂÛ¯¤ÛË ÌÂ ÂÎÂ›Ó· ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡ÏÏË„Ë ·Ú·-Ì¤ÓÂÈ (4,5,15-17). ∂›Ó·È Èı·Ófi fiÙÈ Ë ˘ÔÎÂ›ÌÂÓË ·È-Ù›· ÙË˜ ˘ÔÁÔÓÈÌfiÙËÙ·˜ Î·È Ë Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ‰È¤-ÁÂÚÛË ÙˆÓ ˆÔıËÎÒÓ ÂËÚÂ¿˙Ô˘Ó ÙËÓ ¤Î‚·ÛË(3,4,18). ∂ÓÈÛ¯˘ÙÈÎfi ÙË˜ ¿Ô„Ë˜ ·˘Ù‹˜ Â›Ó·È fiÙÈ ÛÂÎ˘‹ÛÂÈ˜ Ô˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È ÌÂÙ¿ ·fi ÂÓ‰ÔÎ˘ÙÙ·-ÚÔÏ·ÛÌ·ÙÈÎ‹ ÙÔÔı¤ÙËÛË ÛÂÚÌ·ÙÔ˙ˆ·Ú›Ô˘,fiÔ˘ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ ·Ó‰ÚÈÎ‹ ÛÙÂÈÚfiÙËÙ· ÂÓÒ ÔÈÁ˘Ó·›ÎÂ˜ Â›Ó·È ˘ÁÈÂ›˜, Ô Î›Ó‰˘ÓÔ˜ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡,Î·ıÒ˜ Î·È ÙÔ Ì¤ÛÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÙˆÓ ÓÂÔÁÓÒÓ Â›-Ó·È ·ÚfiÌÔÈ· ÌÂ Ù· ÓÂÔÁÓ¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡Ï-ÏË„Ë (4,19,20).

‚. ¶ÚfiÁÓˆÛË ÔÏ‡‰˘ÌˆÓ ÓÂÔÁÓÒÓ ·fi ÂÍˆÛˆÌ·-ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË

∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜, ·ÓÂÍ¿Ú-ÙËÙ· ·fi ÙÔÓ ÙÚfiÔ Û‡ÏÏË„Ë˜, Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi·˘ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ· ÙË˜ ÌËÙ¤Ú·˜ Î·È ÌÂÁ·Ï‡ÙÂÚËÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ. OÈ ÂÈ-ÏÔÎ¤˜ ·fi ÏÂ˘Ú¿˜ ÙË˜ ÂÁÎ‡Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È 3-7ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· ÛÂ ÂÚ›ÙˆÛË ÔÏ‡‰˘ÌˆÓ Î˘‹-ÛÂˆÓ ·’ fi,ÙÈ ÛÙÈ˜ ÌÔÓ‹ÚÂÈ˜ Î˘‹ÛÂÈ˜ (6). ∆Ô ÔÛÔ-ÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔ-Ì‹ Â›Ó·È ·˘ÍËÌ¤ÓÔ (6).

∏ ÚÔˆÚfiÙËÙ· Î·È ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜·ÔÙÂÏÔ‡Ó ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ÙˆÓ ÓÂÔÁÓÒÓÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ. ¶ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ ·Ó·Ê¤ÚÂ-Ù·È ÛÙÔ 20-50% ÙˆÓ ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ, ÂÓÒ ÙÔ50% ÂÚ›Ô˘ ÙˆÓ ‰È‰‡ÌˆÓ Î·È ¿Óˆ ·fi ÙÔ 90%ÙˆÓ ÙÚ›‰˘ÌˆÓ Î·È ÙÂÙÚ¿‰˘ÌˆÓ ÁÂÓÓÈ¤Ù·È ÌÂ ‚¿ÚÔ˜


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ÌÈÎÚfiÙÂÚÔ ÙˆÓ 2500 g (7,8). O Î›Ó‰˘ÓÔ˜ Á¤ÓÓËÛË˜ÔÏ‡ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓÔ‡ (<1500 g) Â›Ó·È 6-8% ÁÈ· Ù· ‰›‰˘Ì·, ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fiÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô Î›Ó‰˘ÓÔ ÛÙÈ˜ ÌÔÓ‹ÚÂÈ˜ Î˘‹ÛÂÈ˜ (0,7-1,6%) (6,8). ∏ ÓÔÛËÚfiÙËÙ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ-Î¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ÓÂÔÁÓÒÓ ÔÏ‡‰˘ÌˆÓ Î·È·ÏÒÓ Î˘‹ÛÂˆÓ, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÙÔÓ ·˘-ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ (6,7,21). O Î›Ó-‰˘ÓÔ˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ ‚Ú¤ıËÎÂ 0,2%,1,3% Î·È 7,6% ÛÂ ·Ï¤˜, ‰›‰˘ÌÂ˜ Î·È ÙÚ›‰˘ÌÂ˜Î˘‹ÛÂÈ˜, ·ÓÙ›ÛÙÔÈ¯· (21,22). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘Á-ÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·˘ÍËÌ¤ÓË Î˘-Ú›ˆ˜ ÛÙ· ÌÔÓÔˆÔÁÂÓ‹ ‰›‰˘Ì· (7). ∏ ıÓËÛÈÌfiÙËÙ·Â›Ó·È ÔÏ‡ ·˘ÍËÌ¤ÓË ÛÙ· ÓÂÔÁÓ¿ ÔÏ‡‰˘ÌˆÓ Î˘‹-ÛÂˆÓ. ™Ù· ‰›‰˘Ì· ÓÂÔÁÓ¿, Ë ıÓËÛÈÌfiÙËÙ· Â›Ó·ÈÙ¤ÛÛÂÚÈ˜ ÌÂ ¤ÓÙÂ ÊÔÚ¤˜ ·˘ÍËÌ¤ÓË ÛÂ Û¯¤ÛË ÌÂÙ· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛÂˆÓ, ÂÓÒ fiÛÔÓ ·ÊÔÚ¿ ÛÙ·ÙÚ›‰˘Ì· ÓÂÔÁÓ¿, Ë ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ·ÂÙ·Ï·ÛÈ¿˙ÂÙ·È (7,22). ™ÙËÓ ·‡ÍËÛË ·˘Ù‹ Û˘-ÓÙÂÏÔ‡Ó Ë ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÚfiˆÚÔ˘ ÙÔÎÂ-ÙÔ‡, ÚÔÂÎÏ·Ì„›·˜, ÚfiÙˆÛË˜ ÔÌÊ·Ï›‰·˜ Î·È¿ÏÏˆÓ ÂÈÏÔÎÒÓ.

¶¤Ú· ·fi Ù· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ Ô˘ ·ÊÔÚÔ‡ÓÛÙ· ÓÂÔÁÓ¿ ÔÏ‡‰˘ÌË˜ Î‡ËÛË˜ ·ÓÂÍ¿ÚÙËÙ· ·fiÙÔÓ ÙÚfiÔ Û‡ÏÏË„Ë˜, ÁÈ· ÙËÓ ÔÌ¿‰· ÙˆÓ ÔÏ‡‰˘-ÌˆÓ ÓÂÔÁÓÒÓ Ù›ıÂÙ·È ÙÔ ÂÚÒÙËÌ· ·Ó Ë ‰È·‰ÈÎ·Û›·˘Ô‚ÔËıÔ‡ÌÂÓË˜ ·Ó··Ú·ÁˆÁ‹˜ ÂÈ‚·Ú‡ÓÂÈ Â-Ú·ÈÙ¤Úˆ ÙËÓ ÚfiÁÓˆÛË. ™Â Û‡ÁÎÚÈÛË ÌÂ Ù· ÓÂÔ-ÁÓ¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡ÏÏË„Ë, Ù· ÓÂÔÁÓ¿ ·fi˘Ô‚ÔËıÔ‡ÌÂÓË ·Ó··Ú·ÁˆÁ‹ ÁÂÓÓÈÔ‡ÓÙ·È ·fiÌËÙ¤ÚÂ˜ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ Î·È ÚˆÙÔÙfiÎÂ˜,·Ú¿ÁÔÓÙÂ˜ Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ Ì·ÈÂ˘ÙÈ-ÎÒÓ ÂÈÏÔÎÒÓ (23). øÛÙfiÛÔ, ÔÈ ÔÏ‡‰˘ÌÂ˜ Î˘‹-ÛÂÈ˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ÚÔ¤Ú¯ÔÓÙ·È·fi ÂÌÊ‡ÙÂ˘ÛË ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÂÌ‚Ú‡ˆÓ,ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È ÙÔ ÔÛÔÛÙfiÙˆÓ ÌÔÓÔˆÔÁÂÓÒÓ ‰È‰‡ÌˆÓ Ô˘ ¤¯Ô˘Ó Î·È ÙË ‰˘-ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË. ªÂ ‚¿ÛË ÙÔ ÛÎÂÙÈÎfi ·˘-Ùfi, ı· ÂÚ›ÌÂÓÂ ›Ûˆ˜ Î·ÓÂ›˜ ‚ÂÏÙÈˆÌ¤ÓË ¤Î‚·ÛËÙˆÓ ‰È‰‡ÌˆÓ ·fi ˘Ô‚ÔËıÔ‡ÌÂÓË ·Ó··Ú·ÁˆÁ‹ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡ÏÏË„Ë.ª›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ‰Â›¯ÓÂÈ ·˘ÍËÌ¤ÓË ıÓËÛÈÌfi-ÙËÙ· ÙˆÓ ÔÏ‡‰˘ÌˆÓ ÓÂÔÁÓÒÓ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹Û‡ÏÏË„Ë (24). OÚÈÛÌ¤ÓÔÈ Û˘ÁÁÚ·ÊÂ›˜ ·Ó·Ê¤ÚÔ˘Ó·˘ÍËÌ¤Ó· ÔÛÔÛÙ¿ ÚfiˆÚˆÓ ÙÔÎÂÙÒÓ, Î·ıÒ˜ Î·ÈÓÂÔÁÓÒÓ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÛÙËÓ ÔÌ¿‰·ÙˆÓ ÔÏ‡‰˘ÌˆÓ ÓÂÔÁÓÒÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈ-ÌÔÔ›ËÛË (25,26). OÈ ÂÚÈÛÛfiÙÂÚÔÈ, fiÌˆ˜, Û˘Ì-ÊˆÓÔ‡Ó fiÙÈ Ë ÓÂÔÁÓÈÎ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfi-ÙËÙ· ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÁÈ· Ù· ÓÂÔÁÓ¿ Ô-Ï‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›Ë-ÛË ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡ÏÏË„Ë(5,11,27).

™˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜∏ Â›ÙˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È ¯ÚˆÌÔÛˆÌÈ·ÎÒÓ

·ÓˆÌ·ÏÈÒÓ ÌÂÙ¿ ·fi ÙËÓ ÎÏ·ÛÈÎ‹ ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔ-ÓÈÌÔÔ›ËÛË Î˘Ì·›ÓÂÙ·È ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ÌÂÙ·Í‡ 2% Î·È 2,5%, ÔÛÔÛÙ¿ Ô˘ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó·fi ·˘Ù¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÁÈ· ÙÔ ÁÂÓÈÎfi ÏËı˘-ÛÌfi (4,10,28,29). ™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË, ˆÛÙfiÛÔ,·Ó·Ê¤ÚÂÙ·È ‰ÈÏ¿ÛÈÔ˜ Î›Ó‰˘ÓÔ˜ ÌÂÈ˙fiÓˆÓ Û˘ÁÁÂ-ÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙ· ·È‰È¿ ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈ-ÌÔÔ›ËÛË˜ (30). OÚÈÛÌ¤ÓÔÈ ÂÚÂ˘ÓËÙ¤˜, ÂÍ¿ÏÏÔ˘,·Ó·Ê¤ÚÔ˘Ó Ì›· ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÌÂÙ¿ıÂÛË˜ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁÂ›ˆÓ, ·ÙÚËÛ›·˜ ÔÈÛÔÊ¿ÁÔ˘ Î·È·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ÛÙ· ·È‰È¿ ·˘Ù¿ (3,5,31,32). µ¤‚·È·, Ú¤ÂÈ Ó· Ï¿-‚ÂÈ Î·ÓÂ›˜ ˘’ fi„ÈÓ ÙÔ˘ fiÙÈ ˘¿Ú¯ÂÈ Î·Ï‡ÙÂÚË ·-Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ Î˘‹ÛÂˆÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔ-ÓÈÌÔÔ›ËÛË, ·˘ÍËÌ¤ÓË ‰ÈÛÙ·ÎÙÈÎfiÙËÙ· ‰È·ÎÔ‹˜·˘ÙÒÓ ÙˆÓ Î˘‹ÛÂˆÓ ÛÂ ÂÚ›ÙˆÛË ‰È·›ÛÙˆÛË˜Î¿ÔÈ·˜ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜, Î·ıÒ˜ Î·È ·˘ÍËÌ¤-ÓÔ ÔÛÔÛÙfi ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙÔÁÂÓÈÎfi ÏËı˘ÛÌfi. øÛÙfiÛÔ, Ë ·ÓÂ‡ÚÂÛË - ÛÂ Úfi-ÛÊ·ÙË ÌÂÏ¤ÙË - ‰ÈÏ¿ÛÈ·˜ Û˘¯ÓfiÙËÙ·˜ Û˘ÁÁÂÓÒÓ·ÓˆÌ·ÏÈÒÓ ÛÙ· ·È‰È¿ ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔ-ÔÈËÛË˜, ·ÎfiÌ· Î·È fiÙ·Ó ÌÂÏÂÙÒÓÙ·È ·È‰È¿ ÌfiÓÔ·fi ·Ï¤˜ Î˘‹ÛÂÈ˜ Î·È Á›ÓÂÈ ÂÍÔÌÔ›ˆÛË ÙˆÓ ÔÌ¿-‰ˆÓ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ Î·È ¿ÏÏÔ˘˜ È-ı·ÓÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ‰È·ÙËÚÂ› ÙËÓ·ÓËÛ˘¯›· Ô˘ ˘¿Ú¯ÂÈ ˆ˜ ÚÔ˜ ÙÔÓ Î›Ó‰˘ÓÔ Û˘ÁÁÂ-ÓÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ‰ËÌÈÔ˘ÚÁÂ› ÙËÓ ·Ó¿ÁÎË ÂÚ·È-Ù¤Úˆ ÌÂÏ¤ÙË˜ (30). ∞Ó¿ÏÔÁ· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÙËÓÎÏ·ÛÈÎ‹ ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ·Ó·Ê¤ÚÔÓÙ·ÈÎ·È ÛÙËÓ ÂÚ›ÙˆÛË ÙË˜ Î·Ù¿„˘ÍË˜ ÂÌ‚Ú‡ˆÓ(3,4,33). ªÂÁ·Ï‡ÙÂÚÂ˜ ·ÓËÛ˘¯›Â˜ ÂÁÂ›ÚÔ˘Ó ÔÈ ÓÂfi-ÙÂÚÂ˜, ÂÚÈÛÛfiÙÂÚÔ ÂÂÌ‚·ÙÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜ ÂÍˆÛˆ-Ì·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ Î·È, Û˘ÁÎÂÎÚÈÌ¤Ó·, Ë ÂÓ‰Ô-Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ‹ ¤Á¯˘ÛË ÛÂÚÌ·ÙÔ˙ˆ·Ú›Ô˘.™ÙË Ì¤ıÔ‰Ô ·˘Ù‹, ÔÈ ÌË¯·ÓÈÛÌÔ› ÂÈÏÔÁ‹˜ Î·Ù¿·ÓÒÌ·ÏˆÓ ÛÂÚÌ·ÙÔ˙ˆ·Ú›ˆÓ Î·È ˆ·Ú›ˆÓ ˘ÂÚË-‰Ô‡ÓÙ·È, ÔÈ ·˘ÍËÌ¤ÓÔÈ ¯ÂÈÚÈÛÌÔ› ÌÔÚÂ› Ó· ÂÈÊ¤-ÚÔ˘Ó ÌË¯·ÓÈÎ‹ ‹ ¯ËÌÈÎ‹ ‚Ï¿‚Ë ÛÙÔ ˆ¿ÚÈÔ ÌÂ ·Ô-Ù¤ÏÂÛÌ· ‰È·Ù·Ú·¯‹ ÛÙË ÌÂ›ˆÛË Î·È ÙË Ì›ÙˆÛË, ÂÓÒË ¤ÎıÂÛË ÛÂ ÔÈÎ›ÏÔ˘˜ ¯ËÌÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÛËÌÂÈ·ÎÒÓÌÂÙ·ÏÏ¿ÍÂˆÓ (4,34,35). ¶·Ú’ fiÏÔ Ô˘ Ô ·ÚÈıÌfi˜ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÁÂÓÓËıÂ› ÌÂ ·˘Ù‹ ÙË Ì¤ıÔ-‰Ô Â›Ó·È Û¯ÂÙÈÎ¿ ÌÈÎÚfi˜, ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜Ì¤¯ÚÈ ÙÒÚ· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍËÌ¤Ó· ÔÛÔÛÙ¿Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ (4,19,35,36). ∫·È ÛÙË Ì¤ıÔ‰Ô·˘Ù‹, fiÌˆ˜, ˘¿Ú¯Ô˘Ó ÂÚÂ˘ÓËÙ¤˜ Ô˘ ·Ó·Ê¤ÚÔ˘ÓÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓÛÂ Û¯¤ÛË ÌÂ ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (30). ŸÛÔÓ ·ÊÔ-Ú¿ ÛÙÈ˜ ¯ÚˆÌÔÛˆÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, Ê·›ÓÂÙ·È fiÙÈ ËÛ˘¯ÓfiÙËÙ· ÙˆÓ ·ÓˆÌ·ÏÈÒÓ, ÙfiÛÔ ÙˆÓ ÛˆÌ·ÙÈÎÒÓ

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·61

fiÛÔ Î·È ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙÔ˘ Ê‡ÏÔ˘, Â›Ó·È ·˘ÍË-Ì¤ÓË ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (0,83% ¤Ó·-ÓÙÈ 0,19-0,23% ÁÈ· ÙÈ˜ ·ÓˆÌ·Ï›Â˜ ¯ÚˆÌÔÛˆÌ¿ÙˆÓÙÔ˘ Ê‡ÏÔ˘, 0,36% ¤Ó·ÓÙÈ 0,07% ÁÈ· ÙÈ˜ ·ÓˆÌ·Ï›Â˜·˘ÙfiÛˆÌˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ) (4,20,37). O ·˘ÍËÌ¤-ÓÔ˜ Î›Ó‰˘ÓÔ˜ Èı·Ó¿ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘Ù‹ Î·ı·˘Ù‹ ÙË‰È·‰ÈÎ·Û›· ÁÔÓÈÌÔÔ›ËÛË˜, ¯ˆÚ›˜ Ó· ·ÔÎÏÂ›ÂÙ·ÈÌ›· ·˘ÍËÌ¤ÓË Â›ÙˆÛË ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓÛÙ· ÛÂÚÌ·ÙÔ˙ˆ¿ÚÈ· ·ÓÙÚÒÓ ÌÂ Úfi‚ÏËÌ· ÁÔÓÈÌfi-ÙËÙ·˜ (4,20).

æ˘¯ÔÛˆÌ·ÙÈÎ‹ ÂÍ¤ÏÈÍË - ∞ÒÙÂÚ· ÚÔ‚Ï‹Ì·Ù·∏ ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Ô˘ ÚÔ¤Ú-

¯ÔÓÙ·È ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË ‚Ú¤ıËÎÂ·Ó¿ÏÔÁË ÌÂ ·˘Ù‹ ÙˆÓ ·È‰ÈÒÓ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹Û‡ÏÏË„Ë (4). ŸÙ·Ó ÌÂÏÂÙÒÓÙ·È Û·Ó ÂÓÈ·›· ÔÌ¿‰·,Ù· ·È‰È¿ ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ÂÌÊ·-Ó›˙Ô˘Ó ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÓÂ˘ÚÔÏÔÁÈÎ¿ ÚÔ-‚Ï‹Ì·Ù· Î·È ÂÈ‰ÈÎ¿ ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË (38).øÛÙfiÛÔ, ÙÔ Â‡ÚËÌ· ·˘Ùfi ·Ô‰›‰ÂÙ·È ÛÙÔ ÌÂÁ¿ÏÔÔÛÔÛÙfi ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ, ÂÓÒ Ù· ·È‰È¿ Ô˘ÚÔ¤Ú¯ÔÓÙ·È ·fi ·Ï¤˜ Î˘‹ÛÂÈ˜ ·ÚÔ˘ÛÈ¿˙Ô˘ÓÂÏ·ÊÚ¿ ·˘ÍËÌ¤ÓÔ, ·ÏÏ¿ fi¯È ÛËÌ·ÓÙÈÎfi ÛÙ·ÙÈÛÙÈÎ¿,ÔÛÔÛÙfi ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ (38). ∂ÔÌ¤-Óˆ˜, Ê·›ÓÂÙ·È fiÙÈ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ „˘¯ÔÛˆÌ·ÙÈÎ‹ÙÔ˘˜ ÂÍ¤ÏÈÍË, Ù· ·È‰È¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÍˆ-ÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË Â›Ó·È Ì¤Û· ÛÙ· Ê˘ÛÈÔÏÔÁÈ-Î¿ Ï·›ÛÈ· (3,4). ∞Ó¿ÏÔÁË Â›Ó·È Î·È Ë ·Ó¿Ù˘ÍË Î·ÈË „˘¯oÛˆÌ·ÙÈÎ‹ ÂÍ¤ÏÈÍË ÙˆÓ ·È‰ÈÒÓ Ô˘ ÚÔ¤Ú¯Ô-ÓÙ·È ·fi ÙËÓ ÂÚÈÛÛfiÙÂÚÔ ÂÂÌ‚·ÙÈÎ‹ Ì¤ıÔ‰Ô ÙË˜ÂÓ‰ÔÎ˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ‹˜ ÙÔÔı¤ÙËÛË˜ ÛÂÚÌ·ÙÔ-˙ˆ·Ú›Ô˘ (ISCI) (35). ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿ Ô˘ÚÔ¤Ú¯ÔÓÙ·È ·fi ¤Ì‚Ú˘· Ô˘ Î·Ù·„‡¯ıËÎ·Ó Î·ÈÛ˘ÓÙËÚ‹ıËÎ·Ó, ‰ÂÓ ¤¯Ô˘Ó ‚ÚÂıÂ› ‰È·ÊÔÚ¤˜ ˆ˜ÚÔ˜ ÙËÓ „˘¯ÔÛˆÌ·ÙÈÎ‹ ÂÍ¤ÏÈÍË ÛÂ Û¯¤ÛË ÌÂ ·È-‰È¿ Ê˘ÛÈÔÏÔÁÈÎ‹˜ Û‡ÏÏË„Ë˜ ‹ ·È‰È¿ ·fi ÂÍˆÛˆ-Ì·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË “ÊÚ¤ÛÎˆÓ” ÂÌ‚Ú‡ˆÓ (39). ∏Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ, Î·ıÒ˜ Î·È Ë Û¯¤ÛË ÁÔ-Ó¤ˆÓ-·È‰ÈÒÓ ¤¯ÂÈ ÌÂÏÂÙËıÂ› Î·È Û˘ÁÎÚÈıÂ› ÌÂ ·È‰È¿·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡ÏÏË„Ë. ∏ ÔÈfiÙËÙ· ÙË˜ ÁÔÓÈÎ‹˜ÊÚÔÓÙ›‰·˜ Î·È Ë ·ÏÏËÏÂ›‰Ú·ÛË ÁÔÓ¤ˆÓ-·È‰ÈÔ‡‚Ú¤ıËÎÂ ·ÓÒÙÂÚË ÛÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÂ ·È‰È¿ ·fiÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË (3,4). OÈ ÌËÙ¤ÚÂ˜ ÙˆÓ·È‰ÈÒÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË Â›Ó·È Â-ÚÈÛÛfiÙÂÚÔ Û˘Ó·ÈÛıËÌ·ÙÈÎ¿ ‰ÂÌ¤ÓÂ˜ ÌÂ Ù· ·È‰È¿ÙÔ˘˜, ÔÈ ·Ù¤ÚÂ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ·Ó·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ Î·È ÔÈ Û¯¤ÛÂÈ˜ ÁÔÓ¤ˆÓ-·È-‰ÈÒÓ Â›Ó·È ·ÓÒÙÂÚÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ÌÂ ·È‰› ˘ÈÔıÂÙËÌ¤ÓÔ ‹ ·È‰› ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Û‡Ï-ÏË„Ë (4,40).

™Â ·Ï·ÈfiÙÂÚË ÌÂÏ¤ÙË Â›¯Â ·Ó·ÊÂÚıÂ› ·˘ÍËÌ¤ÓÔÔÛÔÛÙfi ÓÂ˘ÚÔÂÎÙÔ‰ÂÚÌÈÎÒÓ fiÁÎˆÓ ÛÂ ·È‰È¿ ·fiÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË (41). ¡ÂfiÙÂÚÂ˜ ÌÂÏ¤-

ÙÂ˜, ˆÛÙfiÛÔ, ‰ÂÓ ¤‰ÂÈÍ·Ó ·‡ÍËÛË ÙË˜ Èı·ÓfiÙËÙ·˜·Ó¿Ù˘ÍË˜ Î·ÎÔ‹ıÂÈ·˜ ÛÂ ·˘Ù¿ Ù· ·È‰È¿, ÛÂ Û¯¤ÛËÌÂ ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (5,42). øÛÙfiÛÔ, ÂÂÈ‰‹ ÔÎ·ÚÎ›ÓÔ˜ ÛÙ· ·È‰È¿ Â›Ó·È Û¿ÓÈÔ˜, ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ÙÂÎÌËÚÈˆÌ¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ¯ÚÂÈ¿˙ÔÓÙ·È Â-ÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜, ÌÂÁ·Ï‡ÙÂÚË˜ ‰È¿ÚÎÂÈ·˜ ·Ú·-ÎÔÏÔ‡ıËÛË˜ Î·È ÌÂ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·È‰ÈÒÓ(5,42).

™˘ÌÂÚ¿ÛÌ·Ù· ∂›ÎÔÛÈ ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÚÒÙË ÂÈÙ˘¯ËÌ¤ÓË Î‡Ë-

ÛË ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË, ˘¿Ú¯Ô˘Ó ·Îfi-Ì· ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Î·È ·ÓËÛ˘¯›Â˜ ÁÈ· ÙÔ˘˜ Èı·-ÓÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ÎÚ‡‚ÂÈ Ë ˘ÂÚÎ¤Ú·ÛË ÔÏÏÒÓÛÙ·‰›ˆÓ ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜. ∫¿ıÂ¯ÚfiÓÔ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ÙË Ì¤ıÔ‰Ô·˘Ù‹ 50.000 ·È‰È¿ (37). ∞fi ·˘Ù¿, ¤Ó· Û¯ÂÙÈÎ¿ ÛË-Ì·ÓÙÈÎfi ÔÛÔÛÙfi (ÂÚ›Ô˘ 30%) ÁÂÓÓÈÔ‡ÓÙ·È Úfiˆ-Ú· ‹ ÌÂ ÌÈÎÚfi ‚¿ÚÔ˜ (ÂÚ›Ô˘ 27%) ÛÂ Û¯¤ÛË ÌÂ6,3% Î·È 4,6% ·ÓÙ›ÛÙÔÈ¯·, ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (5).∏ ÔÏÔ¤Ó· Â˘Ú‡ÙÂÚË ÂÊ·ÚÌÔÁ‹ ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ÁÔÓÈÌÔÔ›ËÛË˜ ¤¯ÂÈ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·‡ÍËÛË ÙˆÓÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ÓÂÔÁÓÒÓ ¯·ÌËÏÔ‡ ‚¿-ÚÔ˘˜ Á¤ÓÓËÛË˜. ¶ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ·Ô‰›‰ÂÈ ÙÔ 45%ÙË˜ ·‡ÍËÛË˜ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Î¿Ùˆ·fi 1250 g Î·È ÙÔ 50% ÙË˜ ·‡ÍËÛË˜ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓÛÂ ËÏÈÎ›· Î‡ËÛË˜ Î¿Ùˆ ÙˆÓ 35 Â‚‰ÔÌ¿‰ˆÓ ÛÙ· ÓÂÔ-ÁÓ¿ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË (43). ∆Ô Î‡ÚÈÔ·›ÙÈÔ ÁÈ· Ù· ‰˘ÛÌÂÓ¤ÛÙÂÚ· ·˘Ù¿ ·ÔÙÂÏ¤ÛÌ·Ù· Â›-Ó·È ÔÈ ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜ Ô˘ ÊÙ¿ÓÔ˘Ó ÛÙÔ ¤Ó· ÙÚ›-ÙÔ ÙˆÓ Î˘‹ÛÂˆÓ ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË(5,44). ¢È·ÊÔÚ¤˜ ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÌËÙ¤ÚˆÓÛ˘Ì‚¿ÏÏÔ˘Ó, Â›ÛË˜, ÛÙ· ·˘ÍËÌ¤Ó· ÔÛÔÛÙ¿ ÚÔ-ˆÚfiÙËÙ·˜ Î·È ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ (5). ∏ ·‡-ÍËÛË ÙˆÓ ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ Â›Ó·È È·ÙÚÔÁÂÓ‹˜ Î·ÈÔÊÂ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙË ıÂÚ·Â›· ÌÂ Ê·ÚÌ·ÎÂ˘ÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÚfiÎÏËÛË˜ ˆÔÚÚËÍ›·˜ Î·È ·ÊÂ-Ù¤ÚÔ˘ ÛÙËÓ Â·Ó·ÙÔÔı¤ÙËÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi¤Ó· ÂÌ‚Ú‡ˆÓ ÛÙË Ì‹ÙÚ·, ÛÂ Ì›· ÚÔÛ¿ıÂÈ· ·‡ÍË-ÛË˜ ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÈÙ˘¯›·˜ ÙË˜ ÌÂıfi‰Ô˘. øÛÙfiÛÔ,ÔÏÏ¤˜ ÂÚÁ·Û›Â˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÂÌÊ‡ÙÂ˘ÛË ÂÚÈÛ-ÛfiÙÂÚˆÓ ·fi ‰‡Ô ÂÌ‚Ú‡ˆÓ ‰ÂÓ ·˘Í¿ÓÂÈ Ù· ÔÛÔÛÙ¿ÂÈÙ˘¯›·˜, ÂÓÒ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙÚ›‰˘ÌË˜ Î‡Ë-ÛË˜ (22,45,46). ∞Ó¿Ï˘ÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi 44.000Î‡ÎÏˆÓ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ¤‰ÂÈÍÂ fiÙÈ ËÌÂÙ·ÊÔÚ¿ ‰‡Ô ·ÓÙ› ÙÚÈÒÓ ÂÌ‚Ú‡ˆÓ ÌÂÈÒÓÂÈ ÙÔ Ô-ÛÔÛÙfi ÙÚ›‰˘ÌË˜ Î‡ËÛË˜ ·fi 6% ÛÂ 0,4%, ¯ˆÚ›˜‰È·ÊÔÚ¿ ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙË˜ Î‡ËÛË˜ (5). ªÂ ‚¿-ÛË ·˘Ù¿ Ù· ‰Â‰ÔÌ¤Ó· ˘ÔÏÔÁ›ÛÙËÎÂ fiÙÈ Ë ÛÙÚ·ÙËÁÈ-Î‹ ÌÂÙ·ÊÔÚ¿˜ ‰‡Ô ÂÌ‚Ú‡ˆÓ ı· ÌÂ›ˆÓÂ ÙËÓ Â›Ùˆ-ÛË ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ ·fi 1,69% ÛÂ 0,89% (22,47). ™Â ÔÏÏ¤˜ ¯ÒÚÂ˜, Û‹ÌÂÚ·, ·ÊÔ‡¤ÁÈÓ·Ó Î·Ù·ÓÔËÙ¤˜ ÔÈ Û˘Ó¤ÂÈÂ˜ ÙË˜ ·‡ÍËÛË˜ ÙˆÓ


62

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ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ Î·È ¤ÁÈÓÂ ·ÓÙÈÏËÙfi fiÙÈ Ë ÂÈ-Ù˘¯›· ÙË˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ ‰ÂÓ ÎÚ›ÓÂ-Ù·È ÌfiÓÔ ·fi Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯Ô‡˜ ÂÁÎ˘ÌÔÛ‡ÓË˜,·ÏÏ¿ Î˘Ú›ˆ˜ ·fi ÙËÓ ˘ÁÂ›· ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ú¯Ô-ÓÙ·È ÛÙÔÓ ÎfiÛÌÔ, Û˘ÓÈÛÙ¿Ù·È Ë ÂÌ‚Ú˘ÔÌÂÙ·ÊÔÚ¿‰‡Ô ÙÔ ÔÏ‡ ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ (5,44). ∏‚ÂÏÙ›ˆÛË ÙˆÓ ÌÂıfi‰ˆÓ Î·Ù¿„˘ÍË˜ Î·È Ê‡Ï·ÍË˜ÙˆÓ ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ Î·È Ë Â›ÙÂ˘ÍË ·Ô-ÙÂÏÂÛÌ·ÙÈÎÒÓ ÙÚfiˆÓ ÂÈÏÔÁ‹˜ “Î·Ï‹˜ ÔÈfiÙËÙ·˜”‚ÈÒÛÈÌˆÓ ÂÌ‚Ú‡ˆÓ ı· ÂÈÙÚ¤„Ô˘Ó ÛÙÔ ¿ÌÂÛÔ Ì¤Ï-ÏÔÓ ÙËÓ Î·ıÈ¤ÚˆÛË ÙË˜ ÛÙÚ·ÙËÁÈÎ‹˜ Â·Ó·ÙÔÔı¤-ÙËÛË˜ ÂÓfi˜ ÌfiÓÔ ÂÌ‚Ú‡Ô˘, Ô˘ ¯ˆÚ›˜ Ó· ÂËÚÂ¿-ÛÂÈ ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯Ô‡˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, ı· ÌÂÈÒ-ÛÂÈ ÛËÌ·ÓÙÈÎ¿ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· Ù· ·È‰È¿ Ô˘ÁÂÓÓÈÔ‡ÓÙ·È ·fi ÂÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË (44).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Steptoe PC, Edwards RG. Birth after reimplantation of a

human embryo [letter]. Lancet 1978;2:366. 2. ª·ÓÙ˙·‚›ÓÔ˜ £, ∫·Ó¿Î·˜ ¡. ∂ÍˆÛˆÌ·ÙÈÎ‹ ÁÔÓÈÌÔÔ›ËÛË

Î·È ÓÂfiÙÂÚÂ˜ ÂÍÂÏ›ÍÂÈ˜ ÛÙËÓ ˘Ô‚ÔËıÔ‡ÌÂÓË ·Ó··Ú·Áˆ-Á‹. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 1998;10:106-116.

3. Buitendijk SE. Children after in vitro fertilization. An overviewof the literature. Int J Technol ∞ssess Health Care1999;15:52-65.

4. Tarlatzis BC, Grimbizis G. Pregnancy and child outcomeafter assisted reproduction techniques. Hum Reprod1999;14 (1 Suppl):231-244.

5. Bergh T, Ericson A, Hillensjo T, Nygren KG, WennerholmUB. Deliveries and children born after in vitro fertilisation inSweden 1982-95: a retrospective cohort study. Lancet1999;354:1579-1582.

6. The ESHRE Capri Workshop Group. Multiple gestation andpregnancy. Hum Reprod 2000;15:1856-1864.

7. Revenis ME, Johnson LA. Multiple gestations. In: Avery GB,Fletcher MA, MacDonald MG, editors. Neonatology:Patholophysiology and Management of the Newborn. 4thed. Philadelphia: JB Lippincott Co; 1994. p. 417-426.

8. Warner µB, Kiely JL, Donovan EF. Multiple births andoutcome. Clin Perinatol 2000;27:347-361.

9. Kochenour NK. Obstetric management of multiplegestation. In: Fanaroff AA, Martin RJ, editors. Neonatal-Perinatal Medicine: Diseases of the fetus and infant. 6th ed.St. Louis: Mosby-Year book Inc; 1997. p. 289-294.

10. D’Souza SW, Rivlin E, Cadman J, Richards B, Buck P,Lieberman BA. Children conceived by in vitro fertilizationafter fresh embryo transfer. Arch Dis Child 1997;76:F70-F74.

11. Dhont M, De Sutter P, Ruyssinck G, Martens G, Bekaert A.Perinatal outcome of pregnancies after assistedreproduction: a case-control study. Am J Obstet Gynecol1999;181:688-695.

12. Lancaster B, on behalf of Australian in vitro fertilizationcollaborative group. High incidence of preterm deliveriesand early losses in pregnancy after in vitro fertilization. BMJ1985;291:1160-1163.

13. Doyle P, Beral V, Maconochie N. Preterm delivery, low birth

weight and small-for-gestational-age in liveborn singletonbabies resulting from in vitro fertilization. Hum Reprod1992;7:425-428.

14. Tanbo T, Dale PO, Lunde O, Moe N, Abyholm T. Obstetricoutcome in singleton pregnancies after assistedreproduction. Obstet Gynecol 1995;86:188-192.

15. Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G,Wilcox LS. Low and very low birth weight in infantsconceived with use of assisted reproductive technology. NEngl J Med 2002;346:731-737.

16. Tan SL, Doyle P, Campbell S, Beral V, Rizk B, Brinsden P etal. Obstetric outcome of in vitro fertilization pregnanciescompared with normally conceived pregnancies. Am JObstet Gynecol 1992;167:778-784.

17. Wang JX, Clark AM, Kirby CA, Philipson G, Petrucco O,Anderson G et al. The obstetric outcome of singletonpregnancies following in vitro fertilization/gamete intra-fallopian transfer. Hum Reprod 1994;9:141-146.

18. de Mouzon J, Allali F, Bachelot A. Results of the Frenchmulticenter study comparing babies born after IVF and afternatural conception [abstracts]. 14th Annual Meeting of theESHRE; 1998 June; Goteborg; Hum Reprod 1998 (Abstractbook);13:107-108.

19. Wennerholm UB, Bergh C, Hamberger L, Nilsson L,Reismer E, Wennergren M et al. Obstetric and perinataloutcome of pregnancies following intracytoplasmic sperminjection. Hum Reprod 1996;11:1113-1119.

20. Bonduelle M, Camus M, De Vos A, Straessen C, TournayeH, Van Assche E et al. Seven years of intracytoplasmicsperm injection and follow-up of 1987 subsequent children.Hum Reprod 1999;14 (1 Suppl):243-264.

21. Petterson B, Nelson KB, Watson L, Stanley F. Twins,triplets, and cerebral palsy in births in Western Australia inthe 1980s. BMJ 1993;307:1239-1243.

22. Fisk NM, Trew G. Two’s company, three’s a crowd forembryo transfer. Lancet 1999;354:1572-1573.

23. Kessler I, Lancet M, Borenstein R, Steinmetz A. Theproblem of the older primipara. Obstet Gynecol1980;56:165-169.

24. Fitzsimmons BP, Bebbington MW, Fluker MR. Perinatal andneonatal outcomes in multiple gestations: assistedreproduction versus spontaneous conception. Am J ObstetGynecol 1998;179:1162-1167.

25. Daniel Y, Ochshorn Y, Fait G, Geva E, Bar-Am A, LessingJB. Analysis of 104 twin pregnancies conceived withassisted reproductive technologies and 193 spontaneouslyconceived twin pregnancies. Fertil Steril 2000;74:683-689.

26. Lambalk CB, van Hoof M. Natural versus induced twinningand pregnancy outcome: a Dutch nationwide survey ofprimiparous dizygotic twin deliveries. Fertil Steril2001;75:731-736.

27. Bernasko J, Lunch L, Lapinski R, Berkowitz RL. Twinpregnancies conceived by assisted reproductivetechniques: maternal and neonatal outcomes. ObstetGynecol 1997;89:368-372.

28. ASRM/SART. Assisted Reproductive technology in theUnited States and Canada: 1993 results generated from theAmerican Society for Reproductive Medicine/Society forAssisted Reproductive Technology Registry. Fertil Steril


63

JAN-FEB-03 14-05-03 14:37 ™ÂÏ›‰·63

1995;64:13-21. 29. de Mouzon J, Lancaster P. World collaborative report on in

vitro fertilization, preliminary data for 1995. J Assist ReprodGenet 1997;14S:251-265.

30. Hansen M, Kurinczuk JJ, Bower C, Webb S. The risk ofmajor birth defects after intracytoplasmic sperm injectionand in vitro fertilization. N Engl J Med 2002;346:725-730.

31. Beral V, Doyle P. MRC Working Party on children conceivedby in vitro fertilisation. Births in Great Britain resulting fromassisted conception, 1978-87. BMJ 1990;300:1229-1233.

32. Lancaster PA. Congenital malformations after in vitrofertilization. Lancet 1987;2:1392-1393.

33. Sutcliffe AG, D’Souza SW, Cadman J, Richards B, McKinlayIA, Lieberman B. Minor congenital anomalies, majorcongenital malformations and development in childrenconceived from cryopreserved embryos. Hum Reprod1995;10:3332-3337.

34. Bonduelle M, Wilikens A, Buysse A, Van Assche E, WisantoA, Devroey P et al. Prospective follow-up study of 877children born after intracytoplasmic sperm injection (ICSI)with ejaculated epididymal and testicular spermatozoa andafter replacement of cryopreserved embryos obtained afterICSI. Hum Reprod 1996;11 (4 Suppl):131-155.

35. Sutcliffe AG, Taylor B, Saunders K, Thornton S, LiebermanBA, Grudzinskas JG. Outcome in the second year of life afterin vitro fertilization by intracytoplasmic sperm injection: a UKcase-control study. Lancet 2001;357:2080-2084.

36. Wennerholm UB, Bergh C, Hamberger L, Lundin K, NilssonL, Wikland M et al. Incidence of congenital malformations inchildren born after ICSI. Hum Reprod 2000;15:944-948.

37. Nielsen J, Wohlert M. Chromosome abnormalities foundamong 34910 newborn children: results from a 13-yearincidence study in Arhus, Denmark. Hum Genet 1991;87:81-83.

38. Stromberg B, Dahlquist G, Ericson A, Finnstrom O, KosterM, Stjernqvist K. Neurological sequelae in children after invitro fertilisation: a population-based study. Lancet2002;359:461-465.

39. Wennerholm UB, Albertsson-Wikland K, Bergh C,

Hamberger L, Niklasson A, Nilsson L et al. Postnatal growthand health in children born after cryopreservation asembryos. Lancet 1998;351:1085-1090.

40. Golombok S, Brewaeys A, Cook R, Giavazzi MT, Guerra D,Mantovani A et al. The European study of assistedreproduction families: family functioning and childdevelopment. Hum Reprod 1996:11:2324-2331.

41. White L, Giri N, Vowels MR, Lancaster PA. Neuroectodermaltumours in children born after assisted conception. Lancet1990;336:1577.

42. Doyle P, Bunch KJ, Beral V, Draper GJ. Cancer incidence inchildren conceived with assisted reproduction technology.Lancet 1998;352:452-453.

43. Tough SC, Greene CA, Svenson LW, Belik J. Effects of invitro fertilization on low birth weight, preterm delivery, andmultiple birth. J Pediatr 2000;136:618-622.

44. Hazekamp J, Bergh C, Wennerholm UB, Hovatta O,Karlstrom PO, Selbing A. Avoiding multiple pregnancies inART: consideration of new strategies. Hum Reprod2000;15:1217-1219.

45. Staessen C, Janssenswillen C, Van den Abbeel E, DevroeyP, Van Steirteghem AC. Avoidance of triplet pregnancies byelective transfer of two good quality embryos. Hum Reprod1993;8:1650-1653.

46. Vauthier-Brouzes D, Lefebvre G, Lesourd S, Gonzales J,Darbois Y. How many embryos should be transferred in invitro fertilization? A prospective randomized study. FertilSteril 1994;62:339-342.

47. Blickstein I, Weissman A. Estimating the risk of cerebralpalsy after assisted conceptions. N Engl J Med1999;341:1313-1314.


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Evaluation of the immunocytochemical expression of P-170 in acute leukemias of childhood* P. Tzortzi1, S. Polychronopoulou - Androulakaki1, J. P. Panagiotou1, K. Tsitsikas1, K. Stefanaki2, S. Haidas1

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ AWARD-WINNING ARTICLE

�¶ÂÚ›ÏË„Ë: ∏ ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜ ÛÙË ¯ËÌÂÈÔıÂ-Ú·Â›· ·ÔÙÂÏÂ› Ì›· ·fi ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ·ÈÙ›Â˜ ıÂ-Ú·Â˘ÙÈÎ‹˜ ·ÔÙ˘¯›·˜ ÛÙ· Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù· ÂÓË-Ï›ÎˆÓ Î·È ·È‰ÈÒÓ. ¶ÔÏÏÔ› ÌË¯·ÓÈÛÌÔ› ¤¯Ô˘Ó ÂÓÔ¯Ô-ÔÈËıÂ› ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜, ·ÏÏ¿ Ô ÈÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi˜Î·È Î·Ï¿ ÌÂÏÂÙËÌ¤ÓÔ˜ Â›Ó·È ·˘Ùfi˜ Ô˘ Û˘Û¯ÂÙ›˙Â-Ù·È ÌÂ ÙËÓ ˘ÂÚ¤ÎÊÚ·ÛË ÙÔ˘ MDR-1 ÁÔÓÈ‰›Ô˘. ∆ÔÁÔÓ›‰ÈÔ ·˘Ùfi Îˆ‰ÈÎÔÔÈÂ› Ì›· ÁÏ˘ÎÔÚˆÙÂ˝ÓË ÙË˜Î˘ÙÙ·ÚÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜, ÙËÓ ƒ-170, Ô˘ ‰Ú· ˆ˜·ÓÙÏ›·, ÌÂÙ·Ê¤ÚÔÓÙ·˜ ÙÔÓ Î¿ıÂ Ê·ÚÌ·ÎÂ˘ÙÈÎfi, ÙÔ-ÍÈÎfi ·Ú¿ÁÔÓÙ· ·fi ÙÔ ÂÛˆÙÂÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘Î˘ÙÙ¿ÚÔ˘ ÛÙÔÓ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ, Î·Ù·ÚÁÒÓÙ·˜¤ÙÛÈ ÙË ‚Ï·ÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈ-Î‹˜ Ô˘Û›·˜ ÛÙÔ Î·ÎfiËıÂ˜ Î‡ÙÙ·ÚÔ. ∆ËÓ ·Ó·ÁÓÒÚÈ-ÛË ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ·˘ÙÔ‡ ·ÎÔÏÔ‡ıËÛ·Ó ·ÚÎÂÙ¤˜ÌÂÏ¤ÙÂ˜, Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ™ÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›·, Ë ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙË˜ ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ÙË˜ ƒ-170 ·Ó·˙ËÙ‹ıËÎÂ Î·Ù’ ÂÍÔ¯‹Ó ÛÙËÓ ÔÍÂ›· ÌËÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·, ÂÓÒ ÔÏ‡ Ï›ÁÂ˜ ÌÂÏ¤ÙÂ˜·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰Â‰ÔÌ¤Ó· ÁÈ· ÙËÓ ÔÍÂ›· ÏÂÌÊÔ‚Ï·-ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· Ô˘ Â›Ó·È Î·È Ë ÂÈÎÚ·Ù¤ÛÙÂÚËÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ¶ÔÏ‡ ÏÈÁfiÙÂÚÂ˜ ·Ó·Ê¤ÚÔÓÙ·ÈÎ·È ÛÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜ ÏÂ˘¯·ÈÌ›·˜ ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜Ê¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ (.¯. ‰È¿ÁÓˆÛË Î·È ˘ÔÙÚÔ‹).™ÎÔfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛÂ Ë ·ÔÙ‡ˆÛË ÙË˜·ÚÔ˘Û›·˜ ‹ ÌË ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170ÌÂ ÙËÓ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎ‹ Ì¤ıÔ‰Ô ∞ƒ∞∞ƒ Î·Ù¿ ÙË‰È¿ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÔÍÂ›·˜ ÏÂÌÊÔ‚Ï·-ÛÙÈÎ‹˜ Î·È ÙË˜ ÔÍÂ›·˜ ÌË ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Î·È Ë ÚÔÁÓˆÛÙÈÎ‹ ÙË˜ ı¤ÛËÛÙËÓ ¤Î‚·ÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ. ªÂÏÂÙ‹ıËÎ·Ó

�Abstract: The multidrug resistant (MDR)phenotype has been suggested as a major cause oftreatment failure in hematologic malignancies.However, there is a complexity of MDRmechanisms. Perhaps the best understoodmechanism of multidrug resistance involves that ofthe P-170 glycoprotein (P-gp), one membranetransporter protein which is responsible fortransporting chemotoxic agents out of themalignant cells. Encoded by the MDR-1 gene, P-gpacts as an efflux pump, excreting chemotherapeuticagents from cells, before they can exert theircytotoxic effect. Several prospective studies haveattempted to evaluate the clinical relevance of P-170in childhood acute leukemia. In our study, P-170expression was evaluated in 57 children with acutelymphoblastic leukemia (ALL) (49 on diagnosis and8 on relapse) and in 13 children with acute nonlymphoblastic leukemia (ANLL) (8 on diagnosis and5 on relapse), diagnosed between 1 January 1996and 31 July 1999. Bone marrow was examinedimmunocyto-chemically (APAAP technique) withthree monoclonal antibodies of P-170 (JSB-1, C219and MRK16). P-170 positive expression (P-170+)was found in 18/49 patients with ALL at initialdiagnosis (36.7%) and in 5/8 patients at relapse(62.5%), while in patients with ANLL, P-170 positiveexpression was found in 5/8 at diagnosis (62.5%)and 2/5 at relapse (40%). In the ALL group with P-170 positive at diagnosis complete remission (CR)was achieved in 16/18 (88.9%) patients, and 2/18(11.1%) died, while in the ALL group with P-170

¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 1 ∆Ì‹Ì· ¶·È‰È·ÙÚÈÎ‹˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ 2 ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ

* µ’ ÃˆÚ¤ÌÂÈÔ Œ·ıÏÔ38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2000

“Agia Sophia” Children’s Hospital, Athens 1 Department of Pediatric Hematology-Oncology2 Laboratory of Clinical Pathology

* 2nd “Choremeio” Award 38th Panhellenic Pediatric Meeting, 2000

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ÚÔÔÙÈÎ¿ 57 ·È‰È¿ ÌÂ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘-¯·ÈÌ›· (O§§) Î·È 13 ÌÂ ÔÍÂ›· ÌË ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ÏÂ˘¯·ÈÌ›· (OM§§), Ô˘ ‰È·ÁÓÒÛÙËÎ·Ó ÛÙo ∆Ì‹Ì·Ì·˜ Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1/1/1996 ¤ˆ˜31/7/1999 Î·È ÛÙ· ÔÔ›· ·ÎÔÏÔ˘ı‹ıËÎÂ ÔÌÔÈÔÁÂ-ÓÒ˜ ÙÔ ·Ó¿ÏÔÁÔ ÌÂ ÙÔ ÓfiÛËÌ· ıÂÚ·Â˘ÙÈÎfi Úˆ-ÙfiÎÔÏÏÔ (ALL-BFM ’95 Î·È AML-BFM ’93) ÁÈ· ÙËÓO§§ Î·È ÙËÓ Oª§§, ·ÓÙ›ÛÙÔÈ¯·. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ·ÛıÂÓÒÓ ÌÂ O§§ (57), ÔÈ 49 ÌÂÏÂÙ‹ıËÎ·Ó ÛÙË ‰È¿-ÁÓˆÛË. ∞fi ·˘ÙÔ‡˜, 3 ˘ÔÙÚÔ›·Û·Ó Î·È Ì·˙› ÌÂ¿ÏÏÔ˘˜ 5 ·Ï·ÈfiÙÂÚÔ˘˜ ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰··ÛıÂÓÒÓ ÌÂ O§§ ÛÂ ˘ÔÙÚÔ‹ (Û‡ÓÔÏÔ 8). ∞fi ÙÔÛ‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Oª§§ (13), 8 ÌÂÏÂÙ‹ıË-Î·Ó ÛÙË ‰È¿ÁÓˆÛË. ∞fi ·˘ÙÔ‡˜, 2 ˘ÔÙÚÔ›·Û·ÓÎ·È Ì·˙› ÌÂ ¿ÏÏÔ˘˜ 3 ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ·ÛıÂ-ÓÒÓ ÌÂ Oª§§ ÛÂ ˘ÔÙÚÔ‹ (Û‡ÓÔÏÔ 5). OÈ ‰È¿ÌÂÛÔÈ¯ÚfiÓÔÈ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÁÈ· ÙÈ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓÌÂ O§§ Î·È Oª§§ ÛÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 24 Ì‹ÓÂ˜ Î·È18 Ì‹ÓÂ˜ ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ ÁÈ· ÙÈ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓÌÂ O§§ Î·È Oª§§ ÛÙËÓ ˘ÔÙÚÔ‹ ‹Ù·Ó 28,5 Ì‹ÓÂ˜Î·È 26 Ì‹ÓÂ˜ ·ÓÙ›ÛÙÔÈ¯·. ∂È¯Ú›ÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓÔÛÙÒÓ ÌÂÏÂÙ‹ıËÎ·Ó ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎ¿ (∞ƒ∞∞ƒ ÙÂ-¯ÓÈÎ‹) ÌÂ ÙË ¯Ú‹ÛË ÙÚÈÒÓ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿-ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ ƒ-170 (JSB-1, C219 Î·È MRK16). ∏·ÚÔ‡Û· ÌÂÏ¤ÙË Â›Ó·È Ë ÌÔÓ·‰ÈÎ‹ ‚È‚ÏÈÔÁÚ·ÊÈÎ¿Ô˘ ¯ÚËÛÈÌÔÔÈÂ› ÙÚ›· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÛÂ ÏÂ˘-¯·ÈÌÈÎ¿ Î‡ÙÙ·Ú·, ÌÂ ÛÎÔfi ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ Èı·-ÓfiÙËÙ·˜ ÌË ·Ó›¯ÓÂ˘ÛË˜ ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘. ∏ ÛÙ·ÙÈ-ÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ÙÔ ¯2 ÙÂÛÙ. ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ‰ÂÈÁÌ¿ÙˆÓ, ıÂÙÈÎ‹ ¤ÎÊÚ·ÛË ÛÙËÓ ƒ-170 ·ÓÈ¯ÓÂ‡ıË-ÎÂ ÛÂ ÔÛÔÛÙfi 52,6%. ∂ÓÓ¤· ·ÛıÂÓÂ›˜ ·ÚÔ˘Û›·-Û·Ó ıÂÙÈÎfiÙËÙ· Î·È ÛÙ· ÙÚ›· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒ-Ì·Ù·. ∆· ÔÛÔÛÙ¿ ıÂÙÈÎfiÙËÙ·˜ ÙˆÓ ÌÔÓÔÎÏˆÓÈÎÒÓ·ÓÙÈÛˆÌ¿ÙˆÓ Â› ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ıÂÙÈÎÒÓ ‰ÂÈÁÌ¿-ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 86,6% ÁÈ· ÙÔ JSB1, 80% ÁÈ·ÙÔ C219 Î·È 63,3% ÁÈ· ÙÔ MRK16. ∂È‰ÈÎfiÙÂÚ·, ÁÈ·ÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ: ™Â 18/49 ·ÛıÂÓÂ›˜(36,7%) ÌÂ O§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÛÂ 5/8 ·ÛıÂ-ÓÂ›˜ (62,5%) Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ ‚Ú¤ıËÎÂ ·˘ÍËÌ¤-ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Oª§§Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170‚Ú¤ıËÎÂ ÛÂ 5/8 (62,5%), ÂÓÒ ÛÙËÓ ˘ÔÙÚÔ‹ ÛÂ 2/5(40%). ™Â Û¯¤ÛË ÌÂ ÙËÓ ÔÚÂ›· ÙˆÓ ÓÔÛËÌ¿ÙˆÓ: ·)ÛÙËÓ ÔÌ¿‰· ÙË˜ O§§ ÌÂ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛË (18), Ï‹ÚË˜ ‡ÊÂÛË ·Ú·-ÙËÚ‹ıËÎÂ ÛÂ 16/18 ·ÛıÂÓÂ›˜ (88,9%), ÂÓÒ 2/18(11,1%) Î·Ù¤ÏËÍ·Ó (1 ÛÙËÓ ¤ÊÔ‰Ô Î·È 1 ÛÂ ÔÏ‡ÚÒÈÌË ˘ÔÙÚÔ‹). ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· ÙË˜ O§§ÌÂ ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛË(31), Ï‹ÚË˜ ‡ÊÂÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÂ 27/31 ·ÛıÂ-ÓÂ›˜ (87,1%), 1/31 (3,2%) ·ÚÔ˘Û›·ÛÂ ˘ÔÙÚÔ‹,ÂÓÒ 3/31 (9,7%) Î·Ù¤ÏËÍ·Ó (1 ÛÙËÓ ¤ÊÔ‰Ô). ‚) ™ÙËÓ

negative at diagnosis complete remission (CR) wasachieved in 27/31 (87.1%) patients, 1/31 relapsedand 3/31 (9.7%) died. In the ALL group with P-170positive at relapse complete remission (CR) wasachieved in 2/5 (40%) patients, 1/5 (20%) relapsedand 2/5 (40%) died, while in the ALL group with P-170 negative at relapse, complete remission (CR)was achieved in 3/3 (100%) patients. In the ANLLgroup with P-170 positive expression at diagnosis,complete remission was achieved in 3/5 (60%)patients, while 2/5 (40%) died, due to uncontrolleddisease. In the ANLL group with P-170 negative atdiagnosis 2/3 (66.6%) patients relapsed, and 1/3(3.3%) died during the induction phase. In the ANLLgroup with P-170 positive expression at relapsecomplete remission was achieved in 2/2 (100%)patients, while in the ANLL group with P-170negative at relapse 3/3 (100%) patients entered intocomplete remission. In the total population of ourstudy, 30 out of 67 patients (52.6%) expressed theMDR protein. We found 26 (86.6%) cases positivefor JSB-1, 24 (80%) for C219 and 19 (63.3%) forMRK16. Increased P-170 expression was morefrequently found in patients with ALL at relapse thanat initial diagnosis, while in patients with ANLLincreased P-170 expression was found on bothdiagnosis and relapse. In the ALL group, P-170(+)at relapse was associated with a shorter remissionrate (40%) and shorter median survival (40%)compared with P-170(-) expression (thepercentages were 100% and 0% respectively). In theANLL group, P-170 positive at diagnosis wasassociated with a shorter median survival (40%)compared with P-170 negative expression (33.3%).In our study the correlation between P-170expression and age, WBC count, karyotype, sexand FAB morphology in childhood acute leukemiawas not found statistically significant, perhaps dueto the relatively small number of patients and thelimited follow-up period. P-170 expression seemsinsufficient so far, to fully explain all patterns ofresistance. However, determination of the P-gpstatus in the leukaemic blasts at diagnosis andrelapse may be used as an additional prognosticfactor.

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ÔÌ¿‰· ÙË˜ Oª§§ ÌÂ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170Î·Ù¿ ÙË ‰È¿ÁÓˆÛË (5), Ï‹ÚË˜ ‡ÊÂÛË ·Ú·ÙËÚ‹ıË-ÎÂ ÛÂ 3/5 ·ÛıÂÓÂ›˜ (60%), ÂÓÒ ı¿Ó·ÙÔ˜ Â‹ÏıÂ ÛÂ2/5 (40%) (1 ÛÙËÓ ¤ÊÔ‰Ô Î·È 1 ÛÂ ÔÏ‡ ÚÒÈÌË ˘Ô-ÙÚÔ‹). ™ÙËÓ ÔÌ¿‰· ÙË˜ Oª§§ ÌÂ ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·-ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛË (3), 2/3 (66,6%) ·-ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹, ÂÓÒ 1/3 (33,3%) Î·Ù¤ÏËÍÂ(ÛÙËÓ ¤ÊÔ‰Ô). Á) ™ÙËÓ ÔÌ¿‰· ÙË˜ O§§ ÌÂ ·˘ÍËÌ¤ÓË¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ (5), 2/5·ÛıÂÓÂ›˜ (40%) ÂÈÛ‹¯ıËÛ·Ó Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÂ 2ËÏ‹ÚË ‡ÊÂÛË ÁÈ· ‰È¿ÌÂÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ÙÔ˘˜ 15 Ì‹ÓÂ˜, 1/5 (20%) ·ÚÔ˘Û›·ÛÂ ˘ÔÙÚÔ‹,ÂÓÒ 2/5 ·ÛıÂÓÂ›˜ (40%) ·Â‚›ˆÛ·Ó. ∞ÓÙ›ıÂÙ·, ÛÙËÓÔÌ¿‰· ÙË˜ O§§ ÌÂ ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ (3), 3/3 (100%) ÂÈÛ‹¯ıËÛ·Ó Î·È·Ú·Ì¤ÓÔ˘Ó ÛÂ 2Ë Ï‹ÚË ‡ÊÂÛË ÁÈ· 26, 30 Î·È 36Ì‹ÓÂ˜, ·ÓÙ›ÛÙÔÈ¯· Î·È Ù¤ÏÔ˜, ‰) ÛÙËÓ ÔÌ¿‰· Oª§§ÌÂ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙËÓ ˘ÔÙÚÔ-‹ (2), 2/2 ·ÛıÂÓÂ›˜ (100%) ÂÈÛ‹¯ıËÛ·Ó Î·È ·Ú·-Ì¤ÓÔ˘Ó ÛÂ 2Ë Ï‹ÚË ‡ÊÂÛË ÁÈ· 20 Î·È 25 Ì‹ÓÂ˜·ÓÙ›ÛÙÔÈ¯·. ™ÙËÓ ÔÌ¿‰· ÙË˜ Oª§§ ÌÂ ·ÚÓËÙÈÎ‹ ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ (3), 3/3(100%) ÂÈÛ‹¯ıËÛ·Ó Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÂ 2Ë Ï‹ÚË‡ÊÂÛË ÁÈ· 20, 26 Î·È 38 Ì‹ÓÂ˜, ·ÓÙ›ÛÙÔÈ¯·. ™˘ÌÂ-Ú·ÛÌ·ÙÈÎ¿: ·) ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÚ›· ÌÔÓÔÎÏˆÓÈÎ¿·ÓÙÈÛÒÌ·Ù· ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ·Ó›-¯ÓÂ˘ÛË˜ ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170, ÂÊfiÛÔÓÙ· ÔÛÔÛÙ¿ ıÂÙÈÎfiÙËÙ·˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· ¤Ó· ÌÔ-ÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ·, ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ¤˜·ÔÎÏ›ÛÂÈ˜ Î·Ù¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ÛÂ ıÂÙÈÎ¿‰Â›ÁÌ·Ù·. ™ÙÔ ˘fi ÌÂÏ¤ÙË ˘ÏÈÎfi ‚Ú¤ıËÎÂ fiÙÈ ÙÔJSB-1 ¤¯ÂÈ Û¯ÂÙÈÎ‹ ‹ ·fiÏ˘ÙË ÌÂÁ·Ï‡ÙÂÚË Â˘·È-ÛıËÛ›· Î·È ÂÈ‰ÈÎfiÙËÙ· ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170, Î·ı’ fiÛÔÓ ÙÔ ÔÛÔÛÙfi ıÂÙÈ-ÎfiÙËÙ¿˜ ÙÔ˘ ‹Ù·Ó 86,6% ¤Ó·ÓÙÈ 80% ÙÔ˘ C219 Î·È63,3% ÙÔ˘ MRK16. ‚) ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ ·-Ú·ÙËÚ‹ıËÎÂ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË‰È¿ÁÓˆÛË ÛÂ ÔÛÔÛÙfi 36,7%, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯ÔÔÛÔÛÙfi ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÛÙËÓ˘ÔÙÚÔ‹ ‚Ú¤ıËÎÂ Û¯Â‰fiÓ ‰ÈÏ¿ÛÈÔ (62,5%). Á)™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ ·Ú·ÙËÚ‹ıËÎÂ ˘„ËÏfiÙÂ-ÚÔ ÔÛÔÛÙfi ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 Î·Ù¿ÙË ‰È¿ÁÓˆÛË ÛÂ Û¯¤ÛË ÌÂ ÙËÓ O§§ (62,5%). ∫·Ù¿ÙËÓ ˘ÔÙÚÔ‹, ·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ ·˘ÍËÌ¤ÓË ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 (40%). ‰) OÈ ·ÛıÂÓÂ›˜ ÌÂ Oª§§Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË‰È¿ÁÓˆÛË, ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfiıÓËÙfiÙËÙ·˜ (40%), Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ‰ÂÓÂ›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 (33,3%). Â) OÈ·ÛıÂÓÂ›˜ ÌÂ O§§ Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ƒ-170 Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹, ·ÚÔ˘Û›·Û·Ó ÌÈÎÚfiÙÂÚÔÔÛÔÛÙfi ÂÈÛ·ÁˆÁ‹˜ ÛÂ ‡ÊÂÛË (40%) Î·È ÌÂÁ·Ï‡ÙÂÚÔÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ (40%), Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜

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∂ÈÛ·ÁˆÁ‹O Î·ÚÎ›ÓÔ˜ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi, ·Ó Î·È

Û¯ÂÙÈÎ¿ Û¿ÓÈÔ ÓfiÛËÌ·, ·ÔÙÂÏÂ› Û‹ÌÂÚ· ÙË ‰Â‡ÙÂ-ÚË ÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂÙ¿ ·fi Ù· ·Ù˘-¯‹Ì·Ù· (1). ∏ ÂÙ‹ÛÈ· Â›ÙˆÛË ÙÔ˘ Î·ÚÎ›ÓÔ˘ ÛÙÈ˜ËÏÈÎ›Â˜ ¤ˆ˜ 5 ÂÙÒÓ ·Ó·Ê¤ÚÂÙ·È ÛÂ 150 Ó¤Â˜ ÂÚÈ-ÙÒÛÂÈ˜, ÂÓÒ ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ (5-14 ÂÙÒÓ)Â›Ó·È 90-100 Ó¤Â˜ ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 1.000.000 ·È-‰È¿, ·ÓÙÈÛÙÔ›¯ˆ˜. ∞fi ÙÔ Û‡ÓÔÏÔ ·˘Ùfi, ÙÔ ¤Ó· ÙÚ›ÙÔÂÚ›Ô˘ ·ÊÔÚ¿ ÛÙÈ˜ ÔÍÂ›Â˜ ÏÂ˘¯·ÈÌ›Â˜ Î·È Û˘¯ÓfiÙÂ-Ú· ÛÙÈ˜ ÔÍÂ›Â˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ¤˜ (1-4).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÔÈ Ó¤Â˜ ÂÈÙÂ‡ÍÂÈ˜ ÛÙÔÓ ÙÔ-Ì¤· ÙË˜ ·ÓÔÛÔÏÔÁ›·˜, ÙË˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ Î·ÈÙË˜ ÁÂÓÂÙÈÎ‹˜ ‚Ô‹ıËÛ·Ó ·ÊÂÓfi˜ ÛÙËÓ Î·Ù·ÓfiËÛËÙË˜ Î·ÚÎÈÓÔÁ¤ÓÂÛË˜, ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ Î·Ï‡ÙÂÚË Ù·ÍÈ-ÓfiÌËÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈ-ÌÂÙÒÈÛË ÙˆÓ Î·ÎÔËıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ (1).

™ËÌ·ÓÙÈÎ¤˜ ·Ú¿ÌÂÙÚÔÈ ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ÂÓfi˜ Î·ÎÔ‹ıÔ˘˜ Î˘ÙÙ¿ÚÔ˘, Ô˘ Î·Ù¿ Î¿ÔÈÔ ÙÚfiÔÌÔÚÔ‡Ó Ó· ÚÔ‰ÈÎ¿ÛÔ˘Ó ÙËÓ ÚfiÁÓˆÛË ÙË˜ Ófi-ÛÔ˘, ‰ËÏ·‰‹ ÙËÓ Èı·ÓfiÙËÙ· ÂÓfi˜ ·ÛıÂÓÔ‡˜ Ó··ÓÙ·ÔÎÚÈıÂ› ÈÎ·ÓÔÔÈËÙÈÎ¿ ÛÙË ıÂÚ·Â›· Î·È Ó··Ú·ÌÂ›ÓÂÈ ÛÂ Û˘ÓÂ¯‹ Ï‹ÚË ‡ÊÂÛË ‹ fi¯È, Â›Ó·È: ·)Ô Ú˘ıÌfi˜ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘, ‚) Ë ‰˘Ó·ÙfiÙËÙ·Î·È Ë Ù·¯‡ÙËÙ· ‰È·ÛÔÚ¿˜ ÙÔ˘, Á) Ë ·˘ÍËÌ¤ÓË ‹ÂÏ·ÙÙˆÌ¤ÓË ·Ú¯ÈÎ‹ ·ÓÙ·fiÎÚÈÛ‹ ÙÔ˘ ÛÙ· ¯ÔÚËÁÔ‡-ÌÂÓ· ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ Î·È ‰) Ë ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜ÛÙ· Ê¿ÚÌ·Î· ·˘Ù¿ Î·Ù¿ ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ (5).

∏ ÂÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ Î·ÚÎ›ÓÔ

¤¯ÂÈ ·˘ÍËıÂ› ÛËÌ·ÓÙÈÎ¿ Ù· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·. OÈÏÂ˘¯·ÈÌ›Â˜, ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ Î·È ÔÍÂ›· ÌË ÏÂÌ-ÊÔ‚Ï·ÛÙÈÎ‹, ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·-ÂÙ›·˜ ÙÔ˘ 1990 ·fi ÂÈ‚›ˆÛË ÙË˜ Ù¿ÍË˜ ÙÔ˘ 70% Î·È50% ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ ÚÈÓ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1960 ÔÈÙÈÌ¤˜ ·˘Ù¤˜ ‹Ù·Ó ÛÙ·ıÂÚ¿ Î¿Ùˆ ÙÔ˘ 10% (2). ™‹ÌÂ-Ú·, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ 2 ÛÙ· 3 ·È‰È¿ ÌÂ Î·ÎfiËıÂ˜ ÓÂ-fiÏ·ÛÌ· ı· Ù‡¯Ô˘Ó Ì·ÎÚ¿˜ ÂÈ‚›ˆÛË˜ ÂÏÂ‡ıÂÚË˜ÓfiÛÔ˘, ÂÓÒ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ı· ıÂÚ·Â˘-ıÔ‡Ó. £ÂˆÚÂ›Ù·È fiÙÈ ÙÔÓ 21Ô ·ÈÒÓ· ÌÂÙ·Í‡ ÙˆÓ ÂÓË-Ï›ÎˆÓ ËÏÈÎ›·˜ 20-29 ÂÙÒÓ, 1/1000 ı· ¤¯ÂÈ ıÂÚ·Â˘-ıÂ› ·fi Î¿ÔÈ· Î·ÎÔ‹ıÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ (4).

¶·Ú¿ ÙË ÌÂÁ¿ÏË ÚfiÔ‰Ô fiÌˆ˜ Ô˘ ¤¯ÂÈ ÛËÌÂÈˆ-ıÂ› ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜ ÛÙË ıÂÚ·Â›· ÙˆÓ ·È-‰ÈÒÓ ÌÂ ÏÂ˘¯·ÈÌ›·, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·˘ÙÒÓÛ˘ÓÂ¯›˙ÂÈ Ó· ˘ÔÙÚÔÈ¿˙ÂÈ ÌÂÙ¿ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÈ-Û·ÁˆÁ‹ ÛÂ ‡ÊÂÛË. ∞˘Ùfi ÛÂ ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi·Ô‰›‰ÂÙ·È ÛÙËÓ ÂÁÁÂÓ‹ ‹ Â›ÎÙËÙË ·ÓÙÔ¯‹ Ô˘ ÂÌ-Ê·Ó›˙Ô˘Ó Ù· Î·ÎÔ‹ıË Î‡ÙÙ·Ú· ÛÙÔ˘˜ ¯ËÌÂÈÔıÂÚ·-Â˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ·ÎfiÌ· Î·ÈÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ıÂÚ·Â›·˜, ÔfiÙÂ ¤¯Ô˘ÌÂ ÎÏÈÓÈÎ‹ÂÍ·Ê¿ÓÈÛË ÙË˜ ÓfiÛÔ˘, ıÂˆÚËÙÈÎ¿, ·Ú·Ì¤ÓÂÈ ¤Ó·˜·ÚÈıÌfi˜ Î·ÎÔ‹ıˆÓ Î˘ÙÙ¿ÚˆÓ, Ô˘ ·ÔÙÂÏÂ› ÙËÓÂÔÓÔÌ·˙fiÌÂÓË ÂÏ¿¯ÈÛÙË ˘ÔÏÂÈÌÌ·ÙÈÎ‹ ÓfiÛÔ(minimal residual disease, MRD), Ù· ÔÔ›· ÏfiÁˆ·ÓÙÔ¯‹˜ ÛÙË ıÂÚ·Â›·, ÂÈ‚ÈÒÓÔ˘Ó Î·È Â˘ı‡ÓÔÓÙ·ÈÙÂÏÈÎ¿ ÁÈ· ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘ (5).

∏ ·Ó¿Ù˘ÍË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ Â›Ó·È ·ÔÙ¤-ÏÂÛÌ· ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó ÌÂÌÔÓˆÌ¤Ó·

Ô˘ ‰ÂÓ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË (100% Î·È 0%,·ÓÙ›ÛÙÔÈ¯·). ¶·Ú’ fiÙÈ ‰È·Ê·›ÓÂÙ·È ÂÎ ÙˆÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÌÂÏ¤ÙË˜ Ë ‰˘ÛÌÂÓ‹˜ÚÔÁÓˆÛÙÈÎ‹ ÛËÌ·Û›· Ô˘ ÂÓ¤¯ÂÈ Ë ·ÚÔ˘Û›· ÙË˜·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛËÎ·È ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ O§§ Î·È Oª§§ ÛÙËÓ ·È‰ÈÎ‹ËÏÈÎ›·, Èı·ÓfiÓ ÏfiÁˆ ÙÔ˘ ÂÚÈÔÚÈÛÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ÙˆÓ ·ÛıÂÓÒÓ Ì·˜, ‰ÂÓ ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î‹ Û˘Û¯¤ÙÈÛË ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÌÂÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô, ÙÔ Ê‡ÏÔ, ÙËÓ Î·Ù¿ FAB ÌÔÚ-ÊÔÏÔÁ›·, ÙËÓ ËÏÈÎ›·, ÙÔÓ ·ÚÈıÌfi ÏÂ˘ÎÒÓ Î·Ù¿ ÙË‰È¿ÁÓˆÛË Î·È ÙÔÓ Î·Ú˘fiÙ˘Ô. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÛÂ ÏÂ˘¯·ÈÌÈÎ¿ Î‡ÙÙ·Ú· Î·-Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹, ·Ó Î·È ‰ÂÓ Â›Ó·ÈÈÎ·Ófi˜ Ó· ÂÚÌËÓÂ‡ÛÂÈ fiÏÔ˘˜ ÙÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ ÙÔ˘Ê·ÈÓÔÌ¤ÓÔ˘ ÙË˜ ÔÏÏ·Ï‹˜ Ê·ÚÌ·ÎÔ·ÓÙÔ¯‹˜,ˆÛÙfiÛÔ, ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ¤Ó·Ó ÂÈÏ¤ÔÓ ÚÔ-ÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÙË˜ ÔÚÂ›·˜ ÙË˜ ÓfiÛÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÔÏÏ·Ï‹ Ê·ÚÌ·ÎÔ·ÓÙÔ¯‹, ƒ-ÁÏ˘-ÎÔÚˆÙÂ˝ÓË, ÔÍÂ›· ÏÂ˘¯·ÈÌ›·, ·È‰ÈÎ‹ ËÏÈÎ›·, ·ÓÔ-ÛÔ˚ÛÙÔ¯ËÌÂ›·, ∞ƒ∞∞ƒ.

Key words: MDR, P-glycoprotein, childhood, ALL,ANLL, immunocytochemistry, APAAP.

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‹ ÛÂ Û˘Ó‰˘·ÛÌfi (1). ∂ÓÔ¯ÔÔÈËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ıÂˆÚÔ‡ÓÙ·È:

·) Ë ‰˘Ó·ÙfiÙËÙ· in vivo “·fiÎÚ˘„Ë˜” ÙˆÓ ÏÂ˘-¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÂ ÂÚÈÔ¯¤˜-“ÎÚËÛÊ‡ÁÂÙ·” ÙÔ˘ÔÚÁ·ÓÈÛÌÔ‡ ·fi fiÔ˘ ‰È·ÊÂ‡ÁÔ˘Ó ÙˆÓ ˘„ËÏÒÓÛ˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓ ¯ÔÚËÁÔ˘Ì¤ÓˆÓ ¯ËÌÂÈÔıÂÚ·-Â˘ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (.¯. Ô ÂÁÎ¤Ê·ÏÔ˜ Î·È Ô ÓˆÙÈ-·›Ô˜ Ì˘ÂÏfi˜ ÌÂ ÙÈ˜ ÂÚÈ‚¿ÏÏÔ˘ÛÂ˜ Ì‹ÓÈÁÁÂ˜ ·Ô-ÙÂÏÔ‡Ó ÎÏ·ÛÈÎ¿ ·Ú·‰Â›ÁÌ·Ù· “Î·Ù·Ê˘Á›Ô˘” ÙˆÓÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÏfiÁˆ ÙÔ˘ ˘¿Ú¯ÔÓÙÔ˜ ·ÈÌ·-ÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡, ÙÔÓ ÔÔ›Ô ‰È·ÂÚÓÔ‡Ó Ù·¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ Ê¿ÚÌ·Î· ÌfiÓÔ ÛÂ ÔÏ‡ ˘„Ë-Ï¤˜ ‰fiÛÂÈ˜).

‚) ÙÔ Ì¤ÁÂıÔ˜ ÙË˜ ÏÂ˘¯·ÈÌÈÎ‹˜ Ì¿˙·˜ (ÌÂÁ¿ÏËÏÂ˘¯·ÈÌÈÎ‹ Ì¿˙· ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· Â›ÎÙËÙË˜·Ó¿Ù˘ÍË˜ ÔÏ˘Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜).

Á) Ë ·ÚÔ˘Û›· ÂÓ‰ÔÁÂÓÔ‡˜ ÔÏ˘Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜·ÓÙÔ¯‹˜ (multi drug resistance, MDR). Œ¯ÂÈ ·Ô-‰ÂÈ¯ıÂ› fiÙÈ ÔÈ ÌÂÁ¿ÏÂ˜ ÏÂ˘¯·ÈÌÈÎ¤˜ Ì¿˙Â˜ ÂÚÈ¤¯Ô˘ÓÎ‡ÙÙ·Ú· ‹‰Ë ·ÓıÂÎÙÈÎ¿ ÛÂ ÔÌ¿‰Â˜ Î˘ÙÙ·ÚÔÛÙ·ÙÈ-ÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È Ì¿ÏÈÛÙ· ÛÂ Û˘¯ÓfiÙËÙ·1/1.000.000 Î‡ÙÙ·Ú· (de novo Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÔ-¯‹, ıÂˆÚ›· ÙˆÓ Goldie-Goldman).

‰) Ë ·Ó¿Ù˘ÍË ÔÏ˘Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ Î¿-Ùˆ ·fi ÙËÓ ›ÂÛË ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Î˘ÙÙ·ÚÔÛÙ·-ÙÈÎÒÓ (Â›ÎÙËÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÔ¯‹), ÁÂÁÔÓfi˜Ô˘ Î·ıÔÚ›˙ÂÙ·È Î·È ·fi È‰ÈÔÛ˘ÛÙ·ÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ·fi¿ÙÔÌÔ ÛÂ ¿ÙÔÌÔ (6).

∆· Î·ÎÔ‹ıË Î‡ÙÙ·Ú· ¤¯Ô˘Ó ÙËÓ ÈÎ·ÓfiÙËÙ· Ó··Ó·Ù‡ÛÛÔ˘Ó ÌË¯·ÓÈÛÌÔ‡˜ Ô˘ ·Ú·Î¿ÌÙÔ˘Ó ÙËÓÙÔÍÈÎ‹ ÁÈ· ·˘Ù¿ ‰Ú¿ÛË ÙË˜ ¯ËÌÂÈÔıÂÚ·Â›·˜ Ì¤ÛˆÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ‹ ÙÚÔÔÔ›ËÛË˜ ÙË˜ ‰Ú¿ÛË˜Ì›·˜ ÛÂÈÚ¿˜ ÁÔÓÈ‰›ˆÓ (6-9). OÈ ÈÔ ÁÓˆÛÙ¤˜ Ô‰Ô›·Ó¿Ù˘ÍË˜ ·fi Ù· Î·ÎÔ‹ıË Î‡ÙÙ·Ú· Ê·ÚÌ·ÎÂ˘ÙÈ-Î‹˜ ·ÓÙÔ¯‹˜ ÛÙ· ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ Â›Ó·È:

·) ∏ ˘ÂÚ¤ÎÊÚ·ÛË ÙÔ˘ MDR-1 ÁÔÓÈ‰›Ô˘, Ô˘Ô‰ËÁÂ› ÛÙËÓ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ Ì›·˜ ÁÏ˘ÎÔÚˆ-ÙÂ˝ÓË˜, ÙË˜ ƒ-170, Ô˘ ‰ÚÒÓÙ·˜ ˆ˜ ·ÓÙÏ›· ÌÂÙ·Ê¤-ÚÂÈ ÙÔ Ê¿ÚÌ·ÎÔ ·fi ÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ÛÙÔÓ ÂÚÈ‚¿ÏÏÔÓÙ· ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ, ÌÂ ·ÔÙ¤-ÏÂÛÌ· Ó· Î·Ù·ÚÁÂ›Ù·È Ë ÙÔÍÈÎ‹ ‰Ú¿ÛË ÙÔ˘ ÛÙÔ Î·-ÎfiËıÂ˜ Î‡ÙÙ·ÚÔ.

‚) OÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙËÓ ·fiÙˆÛË, ‰ËÏ·‰‹ ÙÔÓÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ (˘ÂÚ¤ÎÊÚ·-ÛË ‹ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ƒ-53 ‹ ÙÔ˘ µcl-2 ÁÔÓÈ‰›Ô˘).

Á) ∏ ˘ÂÚ¤ÎÊÚ·ÛË ‹ Ë ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ MRP ÁÔ-ÓÈ‰›Ô˘, Ô˘ Â‰Ú¿˙ÂÙ·È ÛÙÔ 10q24 ¯ÚˆÌfiÛˆÌ·, ÌÂ·ÔÙ¤ÏÂÛÌ· ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙË˜ MRP Úˆ-ÙÂ˝ÓË˜ (multidrug resistance associated protein), ËÔÔ›· ÌÂÙ·Ê¤ÚÂÈ Ì›· ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÚÔ˚fiÓÙˆÓ,fiˆ˜ ÏÈÔÊÈÏÈÎ¿ ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎ¿ Ê¿ÚÌ·Î· Ô˘‰ÚÔ˘Ó Ì¤Ûˆ ATP-ÂÍ·ÚÙÒÌÂÓˆÓ ÌË¯·ÓÈÛÌÒÓ.

‰) OÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ÁÏÔ˘-Ù·ıÂÈfiÓË˜-S-ÙÚ·ÓÛÊÂÚ¿ÛË˜, Î˘Ú›ˆ˜ ˘fi ÙËÓ ¤Ó-ÓÔÈ· ÙË˜ ·‡ÍËÛË˜ ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙË˜. ∆· ·˘-ÍËÌ¤Ó· Î˘ÙÙ·ÚÈÎ¿ Â›Â‰· ÁÏÔ˘Ù·ıÂÈfiÓË˜ ¤¯Ô˘Óˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·˘ÍËÌ¤ÓË ·Ô‰fiÌËÛË ÙˆÓ ÂÓ-‰ÔÎ˘ÙÙ¿ÚÈˆÓ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ·fi Ù· Î·ÎÔ‹ıËÎ‡ÙÙ·Ú·.

Â) ∏ ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ÙÔÔ˚ÛÔÌÂ-Ú¿ÛË˜ ππ, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ÛÙfi¯ˆÓÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔÓ ˘Ú‹Ó·.

ÛÙ) ∏ ˘ÂÚ¤ÎÊÚ·ÛË ÙÔ˘ LRP ÁÔÓÈ‰›Ô˘, Ô˘Â‰Ú¿˙ÂÙ·È ÛÙÔ 16p42 ¯ÚˆÌfiÛˆÌ·, ÌÂ ·ÔÙ¤ÏÂÛÌ·ÙËÓ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙË˜ LRP ÚˆÙÂ˝ÓË˜ (LRP- lung resistance related protein), Ë ÔÔ›· ‚Ú›ÛÎÂÙ·ÈÛÙÔ˘˜ fiÚÔ˘˜ ÙË˜ ˘ÚËÓÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ Î·È ÂË-ÚÂ¿˙ÂÈ ÙËÓ ˘ÚËÓÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ.

∂È‰ÈÎfiÙÂÚ·, Ë ˘ÂÚ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ÔÏÏ·Ï‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ (MDR-1) Â›Ó·ÈÔ ÈÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi˜ Î·È ÈÔ Î·Ï¿ ÌÂÏÂÙËÌ¤-ÓÔ˜ ÌË¯·ÓÈÛÌfi˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔÙË˜ ÔÏÏ·Ï‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ (MDR). ∆ÔMDR-1 ÁÔÓ›‰ÈÔ ‚Ú›ÛÎÂÙ·È ÛÙÔ Ì·ÎÚ‡ ÛÎ¤ÏÔ˜ ÙÔ˘¯ÚˆÌÔÛÒÌ·ÙÔ˜ 7. ∞Ó·Ï‡ÛÂÈ˜ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜ ÙÔ˘ ·Ó-ıÚÒÔ˘ ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯Ô˘Ó ‰‡Ô ÁÔÓ›‰È·, Ù·MDR-1 Î·È MDR-2, Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÛÙÂÓ¿ Î·È Îˆ‰È-ÎÔÔÈÔ‡Ó ÔÌfiÏÔÁÂ˜ ÌÂÌ‚Ú·ÓÈÎ¤˜ ÚˆÙÂ˝ÓÂ˜. ∞Ó Î·ÈÙ· ‰‡Ô ÔÓÔÌ¿˙ÔÓÙ·È MDR ÁÔÓ›‰È· ÏfiÁˆ ÙˆÓ ‰ÔÌÈ-ÎÒÓ ÙÔ˘˜ ÔÌÔÈÔÙ‹ÙˆÓ, ˆÛÙfiÛÔ, ÌfiÓÔ ÙÔ MDR-1 ¤¯ÂÈÛ˘Ó‰ÂıÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂ ÙËÓ ÔÏÏ·Ï‹ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹ ·ÓÙÔ¯‹. ∏ ‰Ú¿ÛË ÙË˜ ÚˆÙÂ˝ÓË˜ ÙÔ˘ MDR-2 ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, fiÌˆ˜ ‰ÂÓ ¤¯ÂÈ ‚ÚÂıÂ› Ó· Û¯ÂÙ›-˙ÂÙ·È ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔ MDR (6,7,10).

∆Ô MDR-1 ÁÔÓ›‰ÈÔ Îˆ‰ÈÎÔÔÈÂ›, fiˆ˜ ‹‰Ë ·Ó·-Ê¤ÚıËÎÂ, ÙËÓ ƒ-170, Ì›· ÁÏ˘ÎÔÚˆÙÂ˝ÓË ÌÔÚÈ·ÎÔ‡‚¿ÚÔ˘˜ 170.000 dalton, Ô˘ ÂÚÈÁÚ¿ÊËÎÂ ÙÔ 1976·fi ÙÔ˘˜ Juliano Î·È Ling (6,7). ∆Ô ·Ú¯ÈÎfi ƒ ÚÔ-¤Ú¯ÂÙ·È ·fi ÙËÓ ·ÁÁÏÈÎ‹ Ï¤ÍË permeability, Ô˘ ÛË-Ì·›ÓÂÈ ‰È·ÂÚ·ÙfiÙËÙ·, ÁÈ·Ù› Ë ƒ-170 ‰Ú· ˆ˜ ·ÓÙÏ›·,ÌÂÙ·Ê¤ÚÔÓÙ·˜ ÙÔ Ê¿ÚÌ·ÎÔ ‹ ÔÔÈÔÓ‰‹ÔÙÂ ¿ÏÏÔÙÔÍÈÎfi ·Ú¿ÁÔÓÙ· ·fi ÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ÛÙÔÓ ÂÚÈ‚¿ÏÏÔÓÙ· ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ.

OÈ FÔgÔ Î·È Û˘Ó (6) ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÁÔÓ›‰ÈÔ MDR-1 ÂÎÊÚ¿˙ÂÙ·È ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Î‡ÙÙ·Ú· ÂÈÓÂÊÚÈ-‰›ˆÓ, ÓÂÊÚÒÓ, ‹·ÙÔ˜, ¯ÔÏËÊfiÚˆÓ ·ÁÁÂ›ˆÓ, ÂÓÙ¤-ÚÔ˘, Ï·ÎÔ‡ÓÙ·, ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘ Î·È ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿-ÚˆÓ. ∏ ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÛÂ ÔÏÏ¿ ¿ÏÏ· fiÚ-Á·Ó· Â›Ó·È ¯·ÌËÏfiÙÂÚË ‹ ·Ó‡·ÚÎÙË. ∏ ƒ-170 ‚Ú›-ÛÎÂÙ·È ÛÙË ÌÂÌ‚Ú¿ÓË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÈıËÏÈ·ÎÒÓÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÈÙÔ˘ÚÁÂ› Û·Ó ·ÓÙÏ›·, Ô˘ ÚÔÛÙ·-ÙÂ‡ÂÈ Ù· Î‡ÙÙ·Ú· ·fi ‰È¿ÊÔÚÂ˜ ÙÔÍÈÎ¤˜ Ô˘Û›Â˜,.¯. Ê¿ÚÌ·Î·, ÚÔ˚fiÓÙ· ·ÏÎ·ÏÔÂÈ‰ÒÓ Î.¿. ™Ù· Ê˘-ÛÈÔÏÔÁÈÎ¿ ÂÈÓÂÊÚ›‰È· ‚Ú›ÛÎÂÙ·È ÛÙÈ˜ Î˘ÙÙ·ÚÈÎ¤˜

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ÌÂÌ‚Ú¿ÓÂ˜ Î·È ‰Ú· Û·Ó ÂÓ‰ÔÎ˘ÙÙ·ÚÈÎfi˜ ÌÂÙ·ÊÔÚ¤-·˜ ÁÈ· ÂÈ‰ÈÎ¿ ÚÔ˚fiÓÙ·, .¯. ÛÙÂÚÔÂÈ‰‹. ∂›ÛË˜, ·˘-ÍËÌ¤ÓË ¤ÎÊÚ·ÛË MDR ÁÔÓÈ‰›ˆÓ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓÂÁÎ˘ÌÔÛ‡ÓË. O Ê˘ÛÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙË˜ ÁÏ˘ÎÔ-ÚˆÙÂ˝ÓË˜ ƒ-170 ÂÓÙÂ›ÓÂÙ·È ÛÂ Î‡ÙÙ·Ú· ÔÚÁ¿ÓˆÓ ÌÂÂÓ‰ÔÎÚÈÓ‹ Î·È ÂÍˆÎÚÈÓ‹ ÌÔ›Ú·, .¯. ¯ÔÏ‹, ÂÁÁ‡˜ÛˆÏËÓ¿ÚÈ· ÓÂÊÚÒÓ, ÂÈÓÂÊÚ›‰È· Î.¿. ∆¤ÏÔ˜, ÌÈ-ÎÚ¤˜ ÔÛfiÙËÙÂ˜ ƒ-170 ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÛÙ· 2/3 ÙˆÓÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (µ Î·È ∆) Î·È ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ Î·ÈÂÚ›Ô˘ ÛÙÔ 1/3 ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Ô˘‰ÂÙÂ-ÚÔÊ›ÏˆÓ (10).

™Â ÌÂÙ·ÏÏ¿ÍÂÈ˜ ‹ ÛÂ ˘ÂÚ¤ÎÊÚ·ÛË ÙÔ˘ MDR-1ÁÔÓÈ‰›Ô˘ ÛÙÔ Î·ÎfiËıÂ˜ Î‡ÙÙ·ÚÔ, Ë ·Ú·ÁˆÁ‹ ÙË˜ƒ-170 ÚˆÙÂ˝ÓË˜ ·˘Í¿ÓÂÙ·È. ∂ÔÌ¤Óˆ˜, ÛÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ Î·ÎÔËıÂÈÒÓ, Ë ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Èı·Ó¿ ÈÛ¯˘ÚÔÔÈÂ› Ù· Î‡ÙÙ·Ú· ¤Ó·ÓÙÈ ÙË˜ ¯Ë-ÌÂÈÔıÂÚ·Â›·˜ (Ãª£), ÚÔÛ‰›‰ÂÈ ÌÂÁ·Ï‡ÙÂÚË ·ÓÙÔ-¯‹ ÛÙ· ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ Ê¿ÚÌ·Î· Î·È ·˘Í¿ÓÂÈÙËÓ Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙË˜ ÓfiÛÔ˘. ∞Í›˙ÂÈ Ó· ÛË-ÌÂÈˆıÂ› fiÙÈ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ·Ú·-ÙËÚÂ›Ù·È fi¯È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÂ Ê¿ÚÌ·Î·Û¯ÂÙÈ˙fiÌÂÓ· ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ ÔÏÏ·Ï‹˜ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜, ·ÏÏ¿ Î·È ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÂÌË Û¯ÂÙÈ˙fiÌÂÓ· ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ·Ú¿ÁÔ-ÓÙÂ˜, fiˆ˜ ÙÂÙÚ·¯ÏˆÚ›‰ÈÔ ÙÔ˘ ¿ÓıÚ·Î·, ÌÂÙ¿ ·fi

ËÏÂÎÙÚÔÛfiÎ ‹ Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡ stress(10-13).

∞fi ÔÏÏ¤˜ ‰ÈÂıÓÂ›˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËıÂ›Ë ·Ó¿Ù˘ÍË, Ì¤Ûˆ ‚ÈÔ¯ËÌÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ, ·ÓÙ›-ÛÙ·ÛË˜ ‹ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË˜ ·ÓÙ›ÛÙ·ÛË˜ ÙˆÓ Î·ÎÔ‹-ıˆÓ Î˘ÙÙ¿ÚˆÓ ÛÂ Û˘ÁÎÂÎÚÈÌ¤Ó· Î˘ÙÙ·ÚÔÛÙ·ÙÈÎ¿Ê¿ÚÌ·Î·, fiˆ˜ .¯. ÛÙ· ·ÏÎ·ÏÔÂÈ‰‹ ·Ú¿ÁˆÁ·ÙË˜ Vinca Rosea ‹ ÛÙ· ·Ú¿ÁˆÁ· ÙË˜ ÂÈÔ‰ÔÊ˘Ï-ÏÔÙÔÍ›ÓË˜. ∆· Î˘ÙÙ·ÚÔÛÙ·ÙÈÎ¿ ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÌÂÙ·Í‡ ÙˆÓ ‚·ÛÈÎÒÓ ·ÓÙÈÏÂ˘¯·ÈÌÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ Î·È Ë ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜ ÚÔ˜ ·˘Ù¿ ıÂˆÚÂ›Ù·Èˆ˜ ‚·ÛÈÎ‹ ·ÈÙ›· ˘ÔÙÚÔ‹˜, ÂÈ‰ÈÎfiÙÂÚ· ÙˆÓ ·ÈÌ·-ÙÔÏÔÁÈÎÒÓ Î·ÎÔËıÂÈÒÓ (13,14).

ªÂ ‚¿ÛË ÏÔÈfiÓ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ MDR, Ù· ·ÓÙÈ-ÓÂÔÏ·ÛÌ·ÙÈÎ¿ Ê¿ÚÌ·Î· ¤¯Ô˘Ó ¯ˆÚÈÛÙÂ› ÛÂ ‰‡ÔÌÂÁ¿ÏÂ˜ Î·ÙËÁÔÚ›Â˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔ ·Ó Û¯ÂÙ›˙ÔÓÙ·È‹ fi¯È ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜.™˘ÁÎÂÎÚÈÌ¤Ó·:

·) ™Ù· Û¯ÂÙÈ˙fiÌÂÓ· ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ ÔÏÏ·-Ï‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ Ê¿ÚÌ·Î· (˘‰ÚfiÊÔ‚·)ÂÓÙ¿ÛÛÔÓÙ·È ÔÈ ·ÓıÚ·Î˘ÎÏ›ÓÂ˜, Ù· ·ÏÎ·ÏÔÂÈ‰‹ ÙË˜Vinca, ÔÈ ÂÈÔ‰ÔÊ˘ÏÏÔÙÔÍ›ÓÂ˜ Î·È ÔÈ Ù·Í¿ÓÂ˜.

‚) ™Ù· ÌË Û¯ÂÙÈ˙fiÌÂÓ· ÌÂ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ ÔÏ-Ï·Ï‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ Ê¿ÚÌ·Î· (˘‰ÚfiÊÈ-Ï·) ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ·ÏÎ˘ÏÈÔ‡ÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜,

∂ÈÎfiÓ· 1·. ∞ÏÁfiÚÈıÌÔ˜ 49 ·ÛıÂÓÒÓ ÌÂ O§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È 8 ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹.

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ÔÈ ·ÓÙÈÌÂÙ·‚ÔÏ›ÙÂ˜, Ù· ·Ú¿ÁˆÁ· Ï·Ù›Ó·˜ Î·È ËÚÔÎ·Ú‚·˙›ÓË (14).

∏ ¤ÚÂ˘Ó· Û‹ÌÂÚ·, ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿,Û˘ÓÂ¯›˙ÂÙ·È ÂÓÙ·ÙÈÎ¿, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÎÙÈÌ‹ÛÂÈ ÙÈ˜Û˘Ó¤ÂÈÂ˜ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ÙË˜ ƒ-170 ÛÂ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Î·ÎÔ‹ıˆÓ ÓÔÛËÌ¿ÙˆÓ ÙˆÓ ·È-‰ÈÒÓ Î·È ÙˆÓ ÂÓËÏ›ÎˆÓ.

°È· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ÙË˜ ÔÏÏ·-Ï‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È‰È¿ÊÔÚÂ˜ Ì¤ıÔ‰ÔÈ, ÔÈ ÔÔ›Â˜ ÌÂÙÚÔ‡Ó Â›ÙÂ ÙËÓ ¤Î-ÊÚ·ÛË ÙˆÓ ÁÔÓÈ‰›ˆÓ MDR (ÔÈÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜) ‹ ÙËÏÂÈÙÔ˘ÚÁ›· ÙÔ˘˜ (ÔÛÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜) (9,11,13, 14).∆¤ÙÔÈÂ˜ Ì¤ıÔ‰ÔÈ Â›Ó·È ÔÈ ·ÎfiÏÔ˘ıÂ˜:

i) ∏ ·Ó›¯ÓÂ˘ÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙˆÓ ÁÔÓÈ‰›ˆÓ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ÛÂ Â›Â‰Ô RNA (Northernblot, RT-PCR) Î·È Ô In situ ˘‚ÚÈ‰ÈÛÌfi˜. OÈ Ì¤ıÔ‰ÔÈ·˘Ù¤˜, ·Ú’ fiÙÈ Â›Ó·È Â˘·›ÛıËÙÂ˜, ‰ÂÓ ·ÓÈ¯ÓÂ‡Ô˘ÓÙË ‰˘ÓËÙÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÙË˜ ¤ÎÊÚ·ÛË˜ ÙˆÓ Î˘ÙÙ·-ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Î·È ›Ûˆ˜ ÂËÚÂ¿˙ÔÓÙ·È ·fi ·Ó¿-ÌÂÈÍË ÌË Î·ÎÔ‹ıˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ ˘fi ¤ÏÂÁ¯ÔÏÂ˘¯·ÈÌÈÎfi ÏËı˘ÛÌfi.

ii) §ÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜. OÈ ‰ÔÎÈÌ·Û›Â˜ ·˘-Ù¤˜ ·ÊÔÚÔ‡Ó ÛÙË Ì¤ÙÚËÛË ÙË˜ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ·˜ Û˘-ÁÎ¤ÓÙÚˆÛË˜ ÙˆÓ ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ‹ÙË˜ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÔÚÈÛÌ¤ÓˆÓ ÂÓ˙‡ÌˆÓ ‹, Ù¤ÏÔ˜,ÛÙË ‰Ú¿ÛË ÔÚÈÛÌ¤ÓˆÓ Ô˘ÛÈÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ˆ˜ ÙÚÔÔÔÈËÙ¤˜ ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ-¯‹˜. ∂›ÛË˜, Ë Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ÌÂ ÙË ¯Ú‹ÛËÊıÔÚÈˆÌ¤ÓË˜ ¯ÚˆÛÙÈÎ‹˜ (dye rhodamine 123) ¯ÚË-

ÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ·Ú·ÁfiÓÙˆÓ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ( ƒ-170, MRP). £· Ú¤ÂÈ Â‰ÒÓ· ÙÔÓÈÛÙÂ› fiÙÈ ÔÈ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ Û˘¯Ó¿ÌÂÙÚÔ‡Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· ÔÏÏ·ÏÒÓ ÌË¯·ÓÈÛÌÒÓ·Ó¿Ù˘ÍË˜ ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ÙË˜ MDR ÙˆÓ Î˘ÙÙ¿-ÚˆÓ (.¯. Ë rhodamine 123 ·Ó·ÁÓˆÚ›˙ÂÙ·È ˆ˜ ÌÂÙ·-ÊÂÚfiÌÂÓË ·fi ‰‡Ô ÚˆÙÂ˝ÓÂ˜, ÙËÓ ƒ-170 Î·È ÙËÓMRP) Î·È fi¯È ÌÂÌÔÓˆÌ¤Ó·. ™ÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿-ÍË, ·ÓÙ›ıÂÙ·, ÔÈ Ì¤ıÔ‰ÔÈ ·Ó›¯ÓÂ˘ÛË˜ ÚˆÙÂ˚ÓÒÓÌ¤Ûˆ ÙË˜ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÂ›·˜ Â›Ó·È ·ÏÔ‡ÛÙÂÚÂ˜,Â˘ÎÔÏfiÙÂÚÂ˜ Î·È Ù·¯‡ÙÂÚÂ˜. °È’ ·˘ÙÔ‡˜ ÙÔ˘˜ Ïfi-ÁÔ˘˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÂÈÏ¤¯ıËÎÂ Ë ·ÓÔ-ÛÔ˚ÛÙÔ¯ËÌÂ›· ˆ˜ Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÙË˜·ÚÔ˘Û›·˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ÛÙ· ÏÂ˘¯·È-ÌÈÎ¿ Î‡ÙÙ·Ú·.

iii) ∏ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ·Ú·ÁfiÌÂÓˆÓ ÚˆÙÂ˚ÓÒÓÛÂ ÌÔÚÈ·Îfi Â›Â‰Ô (Western blot). °È· ÙÈ˜ ÌÂıfi-‰Ô˘˜ ·˘Ù¤˜ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘ÌÊˆÓ›· ÁÈ· ÙÔ ÔÈÔ Â›-Â‰Ô ıÂÙÈÎfiÙËÙ·˜ Â›Ó·È ··Ú·›ÙËÙÔ ÁÈ· ÙÔÓ ÚÔÛ-‰ÈÔÚÈÛÌfi ÙÔ˘ MDR Ê·ÈÓfiÙ˘Ô˘.

™Â Â›Â‰Ô ·ÓÔÛÔ˚ÛÙÔ¯ËÌÂ›·˜, Ù· ·ÔÙÂÏ¤ÛÌ·-Ù· ÂÍ·ÚÙÒÓÙ·È ·fi: ·) ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÙÈÛÒÌ·ÙÔ˜,‚) ÙË ‰È·‰ÈÎ·Û›· ÌÔÓÈÌÔÔ›ËÛË˜ Î·È Á) Ù· Â›Â‰·ıÂÙÈÎ‹˜ ¤ÎÊÚ·ÛË˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

™‹ÌÂÚ·, ¤¯Ô˘ÌÂ ÛÙË ‰È¿ıÂÛ‹ Ì·˜ ‰È¿ÊÔÚ· ÌÔ-ÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÚˆÙÂ˚-ÓÒÓ ÌÂ ÌÂıfi‰Ô˘˜ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÂ›·˜. ∂È‰ÈÎfiÙÂÚ·ÁÈ· ÙËÓ Ï¤ÔÓ ÁÓˆÛÙ‹ ÚˆÙÂ˝ÓË, ÙËÓ ƒ-170, ˘¿Ú-¯Ô˘Ó ‰È¿ÊÔÚ· ÂÈÌ¤ÚÔ˘˜ ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·


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∂ÈÎfiÓ· 1‚. ∞ÏÁfiÚÈıÌÔ˜ 8 ·ÛıÂÓÒÓ ÌÂ Oª§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È 5 ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹.

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Ô˘ ÙËÓ ·ÓÈ¯ÓÂ‡Ô˘Ó. ∞fi ·˘Ù¿, ¿ÏÏ· ·ÓÈ¯ÓÂ‡Ô˘ÓÂÈÊ·ÓÂÈ·ÎÔ‡˜ ÂÈÙfiÔ˘˜ ÙË˜, fiˆ˜ Ù· ªR∫16,ªR∫-17, VIC2, 4E2 (Ù· ‰‡Ô ÙÂÏÂ˘Ù·›· ¤¯Ô˘Ó ÌÂ-Á¿ÏË ÂÈ‰ÈÎfiÙËÙ·), ÂÓÒ ¿ÏÏ· ·ÓÈ¯ÓÂ‡Ô˘Ó Î˘ÙÙ·ÚÔ-Ï·ÛÌ·ÙÈÎÔ‡˜ ÂÈÙfiÔ˘˜ ÙË˜, fiˆ˜ ÙÔ JSB-1(¤¯ÂÈ ÌÂÁ¿ÏË ÂÈ‰ÈÎfiÙËÙ·), ÙÔ C219 Î·È ÙÔ C494(12,15). °È· ÙËÓ ·‡ÍËÛË ÙË˜ Â˘·ÈÛıËÛ›·˜ Î·È ÙË˜ÂÈ‰ÈÎfiÙËÙ·˜ ÙË˜ ÌÂıfi‰Ô˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈ-Ô‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÓÙÈÛÒÌ·Ù· Ô˘ ·Ó·ÁÓˆ-Ú›˙Ô˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÂÈÙfiÔ˘˜ ÙË˜ ƒ-170 Úˆ-ÙÂ˝ÓË˜. ∆· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· JSB-1, C219Î·È MPK16 Ê·›ÓÂÙ·È Ó· Â›Ó·È ÌÂÙ·Í‡ ÙˆÓ ÂÈÎÚ·-Ù¤ÛÙÂÚˆÓ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘Û‹ ÙË˜ (16-18).

∆Ô ÚÒÙÔ ÌÔÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ· Ô˘ ÌÂÏÂÙ‹-ıËÎÂ ‹Ù·Ó ÙÔ C219, ¤Ó· IgG-2a ·ÓÙ›ÛˆÌ· Ô˘ ·Ó·-Ù‡ÛÛÂÙ·È ¤Ó·ÓÙÈ Î˘ÙÙ¿ÚˆÓ ·ÓıÂÎÙÈÎÒÓ ÛÙËdoxorubicine, ‚ÈÓÎÚÈÛÙ›ÓË Î.¿. ∞Ó·ÁÓˆÚ›˙ÂÈ ¤Ó· ÌÈ-ÎÚfi ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ Â›ÙÔÔ ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ·ÙÔ˘ Î˘ÙÙ¿ÚÔ˘. ∞ÓÙÈ‰Ú¿ Î·È ÌÂ Ù· ‰‡Ô ÚˆÙÂ˚ÓÈÎ¿·Ú¿ÁˆÁ· MDR-1 Î·È MDR-2, ¯ˆÚ›˜ Ó· Â›Ó·È ÂÈ‰ÈÎfiÁÈ· Î¿ÔÈÔ ·fi Ù· ‰‡Ô.

∆Ô ÌÔÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ· JSB-1 Â›Ó·È ¤Ó· IgG-1·ÓÙ›ÛˆÌ· Ô˘ ·Ó·Ù‡ÛÛÂÙ·È ¤Ó·ÓÙÈ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓÎÔÏ¯ÈÎ›ÓË Î˘ÙÙ¿ÚˆÓ Î·È ·Ó·ÁÓˆÚ›˙ÂÈ ¤Ó· ÂÓ‰ÔÎ˘ÙÙ¿-ÚÈÔ Â›ÙÔÔ ÙË˜ ƒ-170, ÙfiÛÔ ÛÂ ·ÓıÚÒÈÓ· Î‡ÙÙ·Ú·,fiÛÔ Î·È ÛÂ Î·ÎÔ‹ıË Î‡ÙÙ·Ú· ÂÈÚ·Ì·Ùfi˙ˆˆÓ.

OÈ Tsuruo Î·È Û˘Ó ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÛÙË ÌÂÏ¤ÙËÙÔ˘˜ ÙÔ ªP∫16, ·ÓıÚÒÈÓÔ ÂÈ‰ÈÎfi ÌÔÓÔÎÏˆÓÈÎfi·ÓÙ›ÛˆÌ· ÌÂ ÌÂÁ¿ÏË ¯ËÌÈÎ‹ Û˘ÁÁ¤ÓÂÈ· ÁÈ· ÙÔ MDR-1 (16). ∂›Ó·È ¤Ó· ·ÓÙ›ÛˆÌ· Ô˘ ·Ó·Ù‡ÛÛÂÙ·È ¤Ó·-

ÓÙÈ ·ÓıÂÎÙÈÎÒÓ ÛÂ doxorubicine ·ÓıÚÒÈÓˆÓ ÏÂ˘-¯·ÈÌÈÎÒÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·Ó·ÁÓˆÚ›˙ÂÈ ¤Ó·ÓÂÍˆÙÂÚÈÎfi ÂÈÊ·ÓÂÈ·Îfi Â›ÙÔÔ. ∞ÓÙ›ıÂÙ· ÌÂ ÙÔC219, ‰ÂÓ ·ÓÙÈ‰Ú¿ ÌÂ ÙÔ ÚˆÙÂ˚ÓÈÎfi ·Ú¿ÁˆÁÔ ÙÔ˘MDR-2.

™ÎÔfi ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛÂ: ·) Ë·Ó·˙‹ÙËÛË Ù˘¯fiÓ ·ÚÔ˘Û›·˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ-¯‹˜ ÛÙË ¯ËÌÂÈÔıÂÚ·Â›·, Ì¤Ûˆ ÙË˜ ·ÓÂ‡ÚÂÛË˜ ·˘-ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ÚˆÙÂ˝ÓË˜ ƒ-170 ÌÂ ÌÂıfi-‰Ô˘˜ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÂ›·˜ ÛÂ ÛÂÈÚ¿ Ó¤ˆÓ ·È‰È·ÙÚÈ-ÎÒÓ ·ÛıÂÓÒÓ ÌÂ O§§ Î·È Oª§§ ÛÙË Ê¿ÛË ÙË˜ ·Ú-¯ÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ‹ ÙË˜ ˘ÔÙÚÔ‹˜ ÙË˜ ÓfiÛÔ˘ Î·È ‚)Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÌÂ ÙËÓ ·ÓÙ·fi-ÎÚÈÛË ÛÙË ¯ËÌÂÈÔıÂÚ·Â›· Î·È ÙËÓ ¤Î‚·ÛË ÙˆÓ ÌÈ-ÎÚÒÓ ·ÛıÂÓÒÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÀÏÈÎfi ÙË˜ ÚÔÔÙÈÎ‹˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó 67 ·ÛıÂÓÂ›˜

ÌÂ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·, 38 ·ÁfiÚÈ· Î·È 29 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 6 ÌË-ÓÒÓ ¤ˆ˜ 14 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈÎ›·: 6 ¤ÙË), Ô˘ ‰È·ÁÓÒÛÙËÎ·ÓÎ·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÛÙÔ ∆Ì‹Ì· Ì·˜ Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿-ÛÙËÌ· 1/1/1996 ¤ˆ˜ 31/7/1999.

∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÌÂÏÂÙ‹ıËÎ·Ó 57 ·ÛıÂÓÂ›˜ ÌÂ ÔÍÂ›· ÏÂÌ-ÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· (O§§) Î·È 13 ÌÂ ÔÍÂ›· ÌË ÏÂÌÊÔ‚Ï·-ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· (Oª§§). ∞fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§, 49 ÌÂ-ÏÂÙ‹ıËÎ·Ó ÛÙË ‰È¿ÁÓˆÛË Î·È 8 ÛÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘.∞fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ˘ÔÙÚÔ›·Û·Ó, 3 ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰·ÙˆÓ 49 ·ÛıÂÓÒÓ, ÂÓÒ 5 ·Ï·ÈfiÙÂÚÔÈ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÂ-Ï¤ÙË˜, ÌÂÏÂÙ‹ıËÎ·Ó ÌfiÓÔ Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘ (Û‡-ÓÔÏÔ ·ÛıÂÓÒÓ ÔÌ¿‰·˜ O§§ ÛÂ ˘ÔÙÚÔ‹: 8). OÈ ‰‡Ô ÔÌ¿‰Â˜

¶›Ó·Î·˜ 1. ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÏ¤Á¯ıËÎ·Ó ÛÂ ·È‰È¿ ÌÂ O§§ ÛÙË ‰È¿ÁÓˆÛË Î·È ÛÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘

O§§ ‰È¿ÁÓˆÛË O§§ ˘ÔÙÚÔ‹

º‡ÏÔ ∞ÁfiÚÈ· 29 (59,1%) 6 (75%)∫ÔÚ›ÙÛÈ· 20 (40,8%) 2 (25%)

OÌ¿‰· ÎÈÓ‰‡ÓÔ˘ ∂Ó‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ 31 (63,3%) 0 (0%)À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 18 (36,7%) 8 (100%)

∏ÏÈÎ›· 1-10 ¤ÙË 37 (75,5%) 6 (75%)<1 ¤ÙÔ˘˜ ‹ >10 ¤ÙË 12 (24,5%) 2 (25%)

∞ÚÈıÌfi˜ ÏÂ˘ÎÒÓ ÛÙË ‰È¿ÁÓˆÛË ≤100 x 109/L 46 (93,8%) 8 (100%)>100 x 109/L 3 (6,2%) 0 (0%)

∞ÚÈıÌfi˜ ‚Ï·ÛÙÒÓ ÛÙÔ ·›Ì· ÙËÓ 8Ë ËÌ¤Ú· ≤1 x 109/L 44 (89,8%) 7 (87,5%)>1 x 109/L 5 (10,2%) 1 (12,5%)

ªÔÚÊÔÏÔÁ›· Î·Ù¿ FAB L1 35 (71,4%) 6 (75%)L2 12 (24,5%) 2 (25%)L3 2 (4,1%) 0 (0%)

∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ µ-O§§ / (Common) 44 (89,8%) / (35) (71,5%) 7 (87,5%) / (6) (75%)T-O§§ 5 (10,2%) 1 (12,5%)

∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË º˘ÛÈÔÏÔÁÈÎ‹ 18 (36,7%) 2 (25%)ÀÂÚ‰ÈÏÔÂÈ‰ÈÛÌfi˜ 4 (8,1%) 2 (25%)∂ÏÏÂ›ÌÌ·Ù· 3 (6,2%) 1 (12,5%)∞¤Ù˘¯·Ó 9 (18,4%) 0 (0%)¢ÂÓ ¤ÁÈÓÂ 15 (30,6%) 3 (37,5%)

ŒÎÊÚ·ÛË ÙË˜ P-170 £ÂÙÈÎ‹ 18 (36,7%) 5 (62,5%)∞ÚÓËÙÈÎ‹ 39 (63,3%) 3 (37,5%)

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ÙˆÓ ·ÛıÂÓÒÓ ÌÂ O§§ (‰È¿ÁÓˆÛË˜-˘ÔÙÚÔ‹˜), Ë ÔÚÂ›· ÙˆÓ·ÛıÂÓÒÓ Î·È Ù· Â˘Ú‹Ì·Ù· ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 Ê·›ÓÔ-ÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1·.

∞ÓÙ›ÛÙÔÈ¯·, ·ÛıÂÓÂ›˜ ÌÂ OM§§, 8 ÌÂÏÂÙ‹ıËÎ·Ó ÛÙË ‰È¿-ÁÓˆÛË, ÂÓÒ ÛÙËÓ ÔÌ¿‰· ÙË˜ ˘ÔÙÚÔ‹˜ ÂÚÈÏ‹ÊıËÛ·Ó 2/8Ô˘ ˘ÔÙÚÔ›·Û·Ó Î·È ÔÈ 3 ·Ï·ÈfiÙÂÚÔÈ Ô˘ ÌÂÏÂÙ‹ıËÎ·ÓÌfiÓÔ Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘ (Û‡ÓÔÏÔ ·ÛıÂÓÒÓ ÔÌ¿-‰·˜ OM§§ ÛÂ ˘ÔÙÚÔ‹: 5). OÈ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂOM§§ (‰È¿ÁÓˆÛË˜-˘ÔÙÚÔ‹˜), Ë ÔÚÂ›· ÙˆÓ ·ÛıÂÓÒÓ Î·ÈÙ· Â˘Ú‹Ì·Ù· ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 Ê·›ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfi-Ó· 1‚.

∏ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ÛÙËÚ›¯ıËÎÂ ÛÙÔÓ ÌÔÚÊÔÏÔÁÈÎfi¤ÏÂÁ¯Ô ÙˆÓ Ì˘ÂÏÈÎÒÓ ÂÈ¯ÚÈÛÌ¿ÙˆÓ, ÙËÓ Î·Ù¿ FAB Ù·ÍÈÓfiÌË-ÛË Î·È ÙËÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛËÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ.

OÈ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ O§§ Î·ÈOM§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹ Ê·›ÓÔÓÙ·È ÛÙÔ˘˜¶›Ó·ÎÂ˜ 1 Î·È 2, ·ÓÙ›ÛÙÔÈ¯·.

OÈ ·ÛıÂÓÂ›˜ ÌÂ O§§ ¤Ï·‚·Ó ÔÌÔÈÔÁÂÓÒ˜ ÙÔ °ÂÚÌ·ÓÈÎfi™˘ÓÂÚÁ·ÙÈÎfi £ÂÚ·Â˘ÙÈÎfi ¶ÚˆÙfiÎÔÏÏÔ ALL-BFM ’95 Î·È‰È·¯ˆÚ›ÛÙËÎ·Ó ÛÂ ÔÌ¿‰Â˜: ·) ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ (MR)(31) Î·È ‚) ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (HR) (25).

™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ ÂÊ·ÚÌfiÛÙËÎÂ ÔÌÔÈÔÁÂÓÒ˜ ÙÔ·ÓÙ›ÛÙÔÈ¯Ô ™˘ÓÂÚÁ·ÙÈÎfi °ÂÚÌ·ÓÈÎfi £ÂÚ·Â˘ÙÈÎfi ¶ÚˆÙfiÎÔÏ-ÏÔ AML-BFM ’93.

O ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ O§§ ·fiÙË ‰È¿ÁÓˆÛË Î˘Ì·›ÓÂÙ·È ·fi 6 Ì‹ÓÂ˜ ¤ˆ˜ 3,5 ¯ÚfiÓÈ· (‰È¿ÌÂ-ÛÔ˜ ¯ÚfiÓÔ˜: 24 Ì‹ÓÂ˜), ÂÓÒ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ OM§§ ·fi 5¤ˆ˜ 29 Ì‹ÓÂ˜ (‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜: 18 Ì‹ÓÂ˜). O ‰È¿ÌÂÛÔ˜ ¯Úfi-ÓÔ˜ ˘ÔÙÚÔ‹˜ ·fi ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 19 Ì‹ÓÂ˜ ÁÈ· ÙËÓ ÔÌ¿-‰· ÙË˜ O§§ Î·È 26 Ì‹ÓÂ˜ ÁÈ· ÙËÓ ÔÌ¿‰· ÙË˜ OM§§. O ¯Úfi-ÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi ˘ÔÙÚÔ‹ Î˘-Ì·›ÓÂÙ·È ·fi 2 ¤ˆ˜ 27 Ì‹ÓÂ˜ (‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜: 28,5 Ì‹ÓÂ˜)ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ Î·È ·fi 11 ¤ˆ˜ 29 Ì‹ÓÂ˜ (‰È¿ÌÂ-ÛÔ˜ ¯ÚfiÓÔ˜: 26 Ì‹ÓÂ˜) ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ OM§§.

ø˜ Ì¿ÚÙ˘ÚÂ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 13 ·È‰È¿ ÌÂ ¿ÏÏ· Î·-ÏÔ‹ıË ‹ ÌË ·ÈÌ·ÙÔÏÔÁÈÎ¿ Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ÛÙ· ÔÔ›·˘‹Ú¯Â ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªO). ∞Ó·Ï˘ÙÈÎfiÙÂ-

Ú·, 3 ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È Ì˘ÂÏÈÎ‹ ‰È‹ıËÛË ¯ÚË-ÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ıÂÙÈÎÔ› Ì¿ÚÙ˘ÚÂ˜, ÂÓÒ 3 ·ÛıÂÓÂ›˜ ÌÂ ˘Ô-Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, 2 ÌÂ ·Ó·ÈÌ›· Fanconi, 2 ÌÂ È‰ÈÔ·ı‹ ıÚÔÌ-‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú· Î·È 3 ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›· ¯ÚËÛÈÌÔÔÈ‹ıË-Î·Ó ˆ˜ ·ÚÓËÙÈÎÔ› Ì¿ÚÙ˘ÚÂ˜. ∂ÈÏ¤ÔÓ, ˆ˜ ıÂÙÈÎ¿ ‰Â›ÁÌ·Ù··Ó·ÊÔÚ¿˜ (controls) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î˘ÙÙ·ÚÈÎ¿ ÂÈ¯Ú›-ÛÌ·Ù· ·fi Ê˘ÛÈÔÏÔÁÈÎfi ‹·Ú, ÂÓÒ ˆ˜ ·ÚÓËÙÈÎ¿ ¯ÚËÛÈÌÔ-ÔÈ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·ÛıÂÓÒÓ, ÛÙ·ÔÔ›· ÂÊ·ÚÌfiÛÙËÎÂ ∞ƒ∞∞ƒ: ·) ¯ˆÚ›˜ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ·ÓÙ›Ûˆ-Ì· ‹ ‚) ÌÂ ·ÓÙ›ÛˆÌ· ÌË ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÔ ÌÂ ÙË ÏÂ˘Î‹ ÛÂÈÚ¿(·ÓÙ›ÛˆÌ· ¤Ó·ÓÙÈ ÙË˜ Î˘ÙÙ·ÚÔÎÂÚ·Ù›ÓË˜ Î·È ÙË˜ ‰ÂÛÌ›ÓË˜).

∏ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÌÂÏÂÙ‹ıËÎÂ ÌÂ ÙËÓ ·ÓÔÛÔ˚ÛÙÔ¯Ë-ÌÈÎ‹ Ì¤ıÔ‰Ô ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜-·ÓÙÈ-·ÏÎ·ÏÈÎ‹˜ÊˆÛÊ·Ù¿ÛË˜ (∞ƒ∞∞ƒ) (16,18) ÛÂ Î˘ÙÙ·ÚÈÎ¿ ÂÈ¯Ú›ÛÌ·Ù·(cytospins) ·fi Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ˘ÔÙÚÔ‹ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ, Ì¤Ûˆ ÙÚÈÒÓ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈ-ÛˆÌ¿ÙˆÓ: JSB-1, (YLEM, code: MCF 404), C219 (CentocorWH29) Î·È MRK16 (KAMIYA BIOMEDICAL, MC-012). ∞fi Î¿-ıÂ ·ÛıÂÓ‹ ÌÂÏÂÙ‹ıËÎ·Ó 3 ‰Â›ÁÌ·Ù· ÁÈ· Î¿ıÂ ÌÔÓÔÎÏˆÓÈÎfi·ÓÙ›ÛˆÌ·, ·Ó¿ Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (‰È¿ÁÓˆÛË-˘ÔÙÚÔ‹).

∏ ÙÂ¯ÓÈÎ‹ ·˘Ù‹ Â›Ó·È ·ÍÈfiÈÛÙË, Ù·¯Â›· Î·È ÔÈÎÔÓÔÌÈÎ‹ ˆ˜Ì¤ıÔ‰Ô˜ ÚÔ˘Ù›Ó·˜ ÁÈ· ¤Ó· ·ÈÌ·ÙÔÏÔÁÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ. µÈ‚ÏÈÔ-ÁÚ·ÊÈÎ¿ ıÂˆÚÂ›Ù·È Î·Ù¿ÏÏËÏË ÁÈ· ‰Â›ÁÌ·Ù· ÌÂ ÌÈÎÚfi Û˘ÓÔ-ÏÈÎfi ·ÚÈıÌfi Î˘ÙÙ¿ÚˆÓ (<105), Ù· ÔÔ›· Â›Ó·È ‰‡ÛÎÔÏÔ ‹ ·‰‡-Ó·ÙÔ Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó ÌÂ ¿ÏÏÂ˜ ÌÂıfi‰Ô˘˜. ∆Ô ÛËÌ·ÓÙÈÎfi-ÙÂÚÔ Â›Ó·È fiÙÈ ÌÔÚÂ› Ó· ‰È·ÎÚ›ÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÛÂÌÂÌÔÓˆÌ¤ÓÔ˘˜ Â˘‰È¿ÎÚÈÙÔ˘˜ ÌÔÚÊÔÏÔÁÈÎ¿ ÏËı˘ÛÌÔ‡˜.

¶·Ú¿ÏÏËÏ·, Ù· ÂÈ¯Ú›ÛÌ·Ù· ÌÂÏÂÙ‹ıËÎ·Ó Î·È ÌÂ ¯ÚÒÛËGiemsa.

∏ Ì¤ıÔ‰Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÂÍ‹˜ ÛÙ¿‰È·: i) ™Â ‰Â›ÁÌ· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Á›ÓÂÙ·È ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ

Î˘ÙÙ¿ÚˆÓ ÌÂ Ficoll-Hypaque (density 1.077, Seromed), Ê˘-ÁÔÎ¤ÓÙÚËÛË ÛÂ 1800 ÛÙÚÔÊ¤˜ ÁÈ· 20 ÏÂÙ¿, ÌÂ ÛÎÔfi ÙÂÏÈÎ‹Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ 10x106 Î‡ÙÙ·-Ú·/ÌL.

ii) ª¤ÚÔ˜ ÙÔ˘ ÙÂÏÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ Ê˘ÁÔÎÂÓÙÚÂ›Ù·È ÂÎ Ó¤Ô˘ÛÙË Ê˘ÁfiÎÂÓÙÚÔ Cytospin (Shandon) ÛÂ 400 ÛÙÚÔÊ¤˜ ÁÈ· 3 ÏÂ-Ù¿, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· Î˘ÙÙ·ÚÈÎÒÓ ÂÈ¯ÚÈÛÌ¿ÙˆÓ

¶›Ó·Î·˜ 2. ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÏ¤Á¯ıËÎ·Ó ÛÂ ·È‰È¿ ÌÂ OM§§ ÛÙË ‰È¿ÁÓˆÛË Î·È ÛÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘

OM§§ ‰È¿ÁÓˆÛË OM§§ ˘ÔÙÚÔ‹

º‡ÏÔ ∞ÁfiÚÈ· 4 (50%) 5 (100%)∫ÔÚ›ÙÛÈ· 4 (50%) 0 (0%)

OÌ¿‰· ÎÈÓ‰‡ÓÔ˘ MR 3 (37,5%) 0 (0%)HR 5 (62,5%) 5 (100%)

FAB M1 2 (25%) 2 (40%)M2 3 (37,5%) 2 (40%)M3 1 (12,5%) 1 (20%)M5 1 (12,5%) 0 (0%)M7 1 (12,5%) 0 (0%)

∫·Ú˘fiÙ˘Ô˜ º˘ÛÈÔÏÔÁÈÎfi˜ 2 (25%) 2 (40%)ÀÂÚ‰ÈÏÔÂÈ‰ÈÛÌfi˜ 1 (12,5%) 1 (20%)

∂ÏÏÂ›ÌÌ·Ù· 1 (12,5%) 1 (20%)¢ÂÓ ¤ÁÈÓÂ 4 (50%) 1 (20%)

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ÌÂ ÙË ÌÔÚÊ‹ cytospin, Ù· ÔÔ›· ·ÔÍËÚ·›ÓÔÓÙ·È ÛÙÔÓ ·ÙÌÔ-ÛÊ·ÈÚÈÎfi ·¤Ú· ÁÈ· 3 ÒÚÂ˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÔÓÈÌÔÔÈÔ‡ÓÙ·ÈÛÂ ÌÂ›ÁÌ· ·ÎÂÙfiÓË˜-ÌÂı·ÓfiÏË˜ 1:1 ÁÈ· 90’’ ÛÂ ıÂÚÌÔÎÚ·Û›·‰ˆÌ·Ù›Ô˘. ∫·ÙfiÈÓ, ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÂ buffer TBS (tris-buffer-saline), Ô˘ Â›Ó·È 1/10 ‰È·Ï‡Ì·ÙÔ˜ 0.5 ª Tris -HCL ÌÂ p∏ 6 ÛÂ0.15 ª Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi ÁÈ· 5 ÚÒÙ· ÏÂÙ¿.

iii) ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ‰Â›ÁÌ·Ù· ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙÔ˘˜ Ï·-ÛÙÈÎÔ‡˜ ı·Ï·ÌÔ‡˜-coverplates ÙÔ˘ ÌË¯·Ó‹Ì·ÙÔ˜ SequenzaÙË˜ ÂÙ·ÈÚÂ›·˜ Shandon Î·È Âˆ¿˙ÔÓÙ·È ÌÂ 0,20 ml ‰È·Ï‡Ì·-ÙÔ˜ ÚˆÙÔÁÂÓÔ‡˜ ·ÓÙÈÛÒÌ·ÙÔ˜ anti-P glycoprotein 170 ÌÂbuffer TBS ÛÂ ·Ú·›ˆÛË 1:30, ÛÂ ˘ÁÚfi ı¿Ï·ÌÔ ÁÈ· 30 ÚÒÙ·ÏÂÙ¿.

iv) ∆· ‰Â›ÁÌ·Ù· ÍÂÏ¤ÓÔÓÙ·È ÙÚÂÈ˜ ÊÔÚ¤˜ (6 ÏÂÙ¿) ÌÂbuffer TBS Î·È ÛÙË Û˘Ó¤¯ÂÈ· Âˆ¿˙ÔÓÙ·È ÌÂ 0,20 ml ¤ÙÔÈÌÔ˘‰È·Ï‡Ì·ÙÔ˜ ÔÏ˘‰‡Ó·ÌÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ·ÓÙÈÛÒÌ·ÙÔ˜ goatanti-mouse ÁÈ· 10 ÚÒÙ· ÏÂÙ¿.

v) ªÂÙ¿ ·fi Ó¤Ô Í¤Ï˘Ì·, Âˆ¿˙ÔÓÙ·È ÌÂ 0,20 ml ·ÓÔÛÔ-Û˘ÌÏ¤ÁÌ·ÙÔ˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÁÈ· 10 ÚÒÙ· ÏÂÙ¿.

vi) ∞ÊÔ‡ ÍÂÏ˘ıÔ‡Ó ÂÎ Ó¤Ô˘ ÁÈ· 6 ÚÒÙ· ÏÂÙ¿, Âˆ¿˙Ô-ÓÙ·È ÌÂ 0,25 ml ¯ÚˆÌÔÁfiÓÔ˘ ÁÈ· 20 ÏÂÙ¿.

vii) •ÂÏ¤ÓÔÓÙ·È ¿ÏÈ ÁÈ· 6 ÚÒÙ· ÏÂÙ¿ Î·È ÂÓ Û˘ÓÂ¯Â›·

Ù· ‰Â›ÁÌ·Ù· ‚¿ÊÔÓÙ·È ÌÂ 0,25 ml ·ÈÌ·ÙÔÍ˘Ï›ÓË˜ Mayer’s(LIPSHAW IMMUNON, No 407050).

viii) ∆¤ÏÔ˜, ·ÊÔ‡ ÍÂÏ˘ıÔ‡Ó ÌÂ ·oÛÙ·ÁÌ¤Óo ÓÂÚfi, ÙÔÔ-ıÂÙÂ›Ù·È Â› ÙÔ˘ ˘ÏÈÎÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÂÈÎ·Ï˘ÙÚ›‰·, Ô˘Û˘ÁÎÔÏÏ¿Ù·È ÌÂ ‰È·Ê·Ó¤˜ ˘ÏÈÎfi.

∆· ‰Â›ÁÌ·Ù· ÌÂÏÂÙ‹ıËÎ·Ó ÛÂ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ ·fi ‰‡Ô·ÓÂÍ¿ÚÙËÙÔ˘˜ ÌÂÏÂÙËÙ¤˜, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÁÓÒÚÈ˙·Ó ÙË Ê¿ÛËÂÏ¤Á¯Ô˘ ÙË˜ ÓfiÛÔ˘. ™Â Î¿ıÂ ‰Â›ÁÌ· ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ Ë ·Ó·-ÏÔÁ›· ÙˆÓ ıÂÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È Ë ¤ÓÙ·ÛË ÙË˜ ıÂÙÈÎfiÙËÙ¿˜ÙÔ˘˜, Î·ıÒ˜ Î·È Ë ÌÔÚÊÔÏÔÁ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ ¯ÚÒÛËGiemsa.

ø˜ ıÂÙÈÎ¿ ÛÙËÓ P-170 ÚˆÙÂ˝ÓË Î‡ÙÙ·Ú· ıÂˆÚ‹ıËÎ·ÓÂÎÂ›Ó· Ô˘ ‚¿ÊÙËÎ·Ó ¤ÓÙÔÓ· ÎfiÎÎÈÓ· (∂ÈÎfiÓ· 2), ÂÓÒ ·ÚÓËÙÈ-Î¿ ÂÎÂ›Ó· Ô˘ ‰ÂÓ ‚¿ÊÙËÎ·Ó. ø˜ ıÂÙÈÎ¿ ıÂˆÚ‹ıËÎ·Ó Ù· ‰Â›Á-Ì·Ù· ÛÙ· ÔÔ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 1% ÙˆÓ ÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓÚÔÛÏ¿Ì‚·ÓÂ ¤Ó· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÔÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ·. ™Â Î¿-ıÂ Ì˘ÂÏÈÎfi Â›¯ÚÈÛÌ· ÂÏ¤Á¯ÔÓÙ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 1000 Î‡ÙÙ·Ú··fi ‰‡Ô ·ÓÂÍ¿ÚÙËÙÔ˘˜ ·Ú·ÙËÚËÙ¤˜.

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ÙÔ ¯2 ÙÂÛÙ. ªÂÏÂÙ‹ıËÎÂ ËÛ˘Û¯¤ÙÈÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙÔ˘ MDR Ê·ÈÓÔÌ¤ÓÔ˘ Ì¤Ûˆ ÙË˜ ·Ó›-¯ÓÂ˘ÛË˜ ÙË˜ ƒ-170 ÌÂ ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ Î·È ÙÔ˘˜ ÚÔ-ÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÔÍÂ›· ÏÂ˘-¯·ÈÌ›· (ËÏÈÎ›·, Ê‡ÏÔ, ·ÚÈıÌfi˜ ÏÂ˘ÎÒÓ, ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜, Î·-Ú˘fiÙ˘Ô˜, ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘).

∞ÔÙÂÏ¤ÛÌ·Ù· ∞fi Ù· 49 ·È‰È¿ ÌÂ O§§ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙË

‰È¿ÁÓˆÛË, 3 ˘ÔÙÚÔ›·Û·Ó (ÛÂ ‰È¿ÛÙËÌ· 4, 17 Î·È23 ÌËÓÒÓ ·fi ÙË ‰È¿ÁÓˆÛË, ·ÓÙ›ÛÙÔÈ¯·), 3 Î·Ù¤ÏË-Í·Ó (2 ÚÒÈÌÔÈ ı¿Ó·ÙÔÈ) Î·È Ù· ˘fiÏÔÈ· 43 ‚Ú›ÛÎÔ-ÓÙ·È ÛÂ Ï‹ÚË ÚÒÙË ‡ÊÂÛË ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 5 ¤ˆ˜ 46 Ì‹ÓÂ˜ (‰È¿ÌÂÛÔ˜

∂ÈÎfiÓ· 4. ∫·Ì‡ÏË ÂÈ‚›ˆÛË˜ ·ÛıÂÓÒÓ ÌÂ O§§.

∂È

‚›ˆ

ÛË

¶·Ú·ÎÔÏÔ‡ıËÛË (Ì‹ÓÂ˜)

∂ÈÎfiÓ· 2. £ÂÙÈÎ‹ ÂÈÊ·ÓÂÈ·Î‹ ¤ÎÊÚ·ÛË ÙË˜ P-170.

∂ÈÎfiÓ· 3. πÛ¯˘Ú¿ ıÂÙÈÎ‹ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ‹ ÌÂÌ‚Ú·ÓÈÎ‹ ¤Î-ÊÚ·ÛË ÙË˜ P-170.

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¯ÚfiÓÔ˜: 26 Ì‹ÓÂ˜). ∞fi Ù· 3 Ô˘ ˘ÔÙÚÔ›·Û·Ó, 2Î·Ù¤ÏËÍ·Ó ÛÂ 2 Î·È 3 Ì‹ÓÂ˜ ·fi ÙËÓ ˘ÔÙÚÔ‹ ·ÓÙ›-ÛÙÔÈ¯·, ÂÓÒ ÙÔ ÙÚ›ÙÔ ·Ú·Ì¤ÓÂÈ ÛÂ ‰Â‡ÙÂÚË Ï‹ÚË‡ÊÂÛË ÁÈ· 10 Ì‹ÓÂ˜ (∂ÈÎfiÓ· 1·).

∞fi ÙÔ˘˜ 5 ·ÛıÂÓÂ›˜ ÌÂ O§§ Ô˘ ÌÂÏÂÙ‹ıËÎ·ÓÌfiÓÔ ÛÙËÓ ˘ÔÙÚÔ‹, 3 Î·Ù¤ÏËÍ·Ó (1 ÚÒÈÌÔ˜ ı¿-Ó·ÙÔ˜), ÂÓÒ ÔÈ ¿ÏÏÔÈ 2 ‚Ú›ÛÎÔÓÙ·È ÛÂ ‰Â‡ÙÂÚË Ï‹-ÚË ‡ÊÂÛË ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ Î˘Ì·›ÓÂÙ·È·fi 19 ¤ˆ˜ 38 Ì‹ÓÂ˜ (‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜: 27 Ì‹ÓÂ˜).

∏ Î·Ì‡ÏË ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ O§§ Ô˘ÌÂÏÂÙ‹ıËÎ·Ó ÛÙË ‰È¿ÁÓˆÛË Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 4(Kaplan-Meier cumulative event-free survival).

∞fi ÙÔ˘˜ 8 ·ÛıÂÓÂ›˜ ÌÂ OM§§ Ô˘ ÌÂÏÂÙ‹ıË-Î·Ó ÛÙË ‰È¿ÁÓˆÛË, 2 ˘ÔÙÚÔ›·Û·Ó (ÛÂ ‰È¿ÛÙËÌ·12 Î·È 26 ÌËÓÒÓ ·fi ÙË ‰È¿ÁÓˆÛË, ·ÓÙ›ÛÙÔÈ¯·), 3Î·Ù¤ÏËÍ·Ó (2 ÚÒÈÌÔÈ ı¿Ó·ÙÔÈ) Î·È ÔÈ ˘fiÏÔÈÔÈ 3‚Ú›ÛÎÔÓÙ·È ÛÂ ÚÒÙË Ï‹ÚË ‡ÊÂÛË ÁÈ· ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 16 ¤ˆ˜ 29 Ì‹ÓÂ˜(‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜: 26 Ì‹ÓÂ˜). OÈ 2 ·ÛıÂÓÂ›˜ Ô˘˘ÔÙÚÔ›·Û·Ó ÂÈÛ‹¯ıËÛ·Ó Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÂ‰Â‡ÙÂÚË Ï‹ÚË ‡ÊÂÛË ÁÈ· 16 Î·È 20 Ì‹ÓÂ˜, ·ÓÙ›-ÛÙÔÈ¯·.

∆¤ÏÔ˜, Î·È ÔÈ 3 ·ÛıÂÓÂ›˜ ÌÂ Oª§§ Ô˘ ÌÂÏÂÙ‹-ıËÎ·Ó ÌfiÓÔ ÛÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘, ‚Ú›ÛÎÔÓÙ·ÈÛÂ ‰Â‡ÙÂÚË Ï‹ÚË ‡ÊÂÛË ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 20 ¤ˆ˜ 36 Ì‹ÓÂ˜ (‰È¿ÌÂÛÔ˜¯ÚfiÓÔ˜: 26 Ì‹ÓÂ˜) (∂ÈÎfiÓ· 1‚).

™ÙÔ Û‡ÓÔÏÔ ÙˆÓ 210 ‰ÂÈÁÌ¿ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ,˘‹Ú¯·Ó Û˘ÓÔÏÈÎ¿ 110 ıÂÙÈÎ¿ ‰Â›ÁÌ·Ù· (52,3%).

∂ÓÓ¤· ·ÛıÂÓÂ›˜ ·ÚÔ˘Û›·Û·Ó ıÂÙÈÎfiÙËÙ· Î·È ÛÙ·ÙÚ›· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·. ∂› ÙÔ˘ Û˘ÓfiÏÔ˘ÙˆÓ ıÂÙÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ, Ù· ÔÛÔÛÙ¿ıÂÙÈÎfiÙËÙ·˜ ÙˆÓ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó86,6% ÁÈ· ÙÔ JSB-1, 80% ÁÈ· ÙÔ C219 Î·È 63,3% ÁÈ·ÙÔ MRK16.

∆Ô ÔÛÔÛÙfi ıÂÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙ· ‰Â›ÁÌ·Ù¿Ì·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 11% ¤ˆ˜ 82%. ∏ ¤ÓÙ·ÛË ÙË˜ıÂÙÈÎfiÙËÙ·˜ ‰È·ÎÚ›ıËÎÂ ÛÂ ‹È·, Ì¤ÙÚÈ· Î·È ¤ÓÙÔÓË.∂›¯·ÌÂ ¤ÓÙÔÓË ÂÚ˘ıÚ‹ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ‹ ÌÂÌ-‚Ú·ÓÈÎ‹ ·ÓÙ›‰Ú·ÛË (∂ÈÎfiÓ· 3) ÌÂ Ù· JSB-1 Î·ÈC219, ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· Ô˘, fiˆ˜ ¤¯ÂÈ‹‰Ë ·Ó·ÊÂÚıÂ›, ·ÓÈ¯ÓÂ‡Ô˘Ó Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎÔ‡˜ÂÈÙfiÔ˘˜ ÙË˜ ƒ-170 Î·È ¤ÓÙÔÓË ÂÚ˘ıÚ‹ ÂÈÊ·ÓÂÈ·-Î‹ ÌÂÌ‚Ú·ÓÈÎ‹ ·ÓÙ›‰Ú·ÛË ÌÂ ªR∫16 ÌÔÓÔÎÏˆÓÈÎfi·ÓÙ›ÛˆÌ· Ô˘, fiˆ˜ Â›ÛË˜ ¤¯ÂÈ ·Ó·ÊÂÚıÂ›, ·ÓÈ-¯ÓÂ‡ÂÈ ÂÈÊ·ÓÂÈ·Îfi Â›ÙÔÔ ÙË˜ ƒ-170.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ¤ÎÊÚ·ÛË˜ Î¿ıÂ ÌÔÓÔ-ÎÏˆÓÈÎÔ‡ ·ÓÙÈÛÒÌ·ÙÔ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ Î·ÈOª§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ Ófi-ÛÔ˘ Ê·›ÓÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 3 Î·È 4, ·ÓÙ›ÛÙÔÈ¯·.

™Â 18/49 (36,7%) ·ÛıÂÓÂ›˜ ÌÂ O§§ ‚Ú¤ıËÎÂ ·˘-ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÛÙË ‰È¿ÁÓˆÛË, ÂÓÒ ÛÂ5/8 (62,5%) ÛÙËÓ ˘ÔÙÚÔ‹ (¶›Ó·Î·˜ 5).

™Â 5/8 (62,5%) ·ÛıÂÓÂ›˜ ÌÂ Oª§§ ‚Ú¤ıËÎÂ ·˘-ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÛÙË ‰È¿ÁÓˆÛË, ÂÓÒ ÛÂ2/5 (40%) ÛÙËÓ ˘ÔÙÚÔ‹ (¶›Ó·Î·˜ 5).

™ÙË ‰È¿ÁÓˆÛË: ·) ·fi ÙÔ˘˜ 18 ·ÛıÂÓÂ›˜ ÌÂ O§§ÌÂ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170, 2 (11,1%) ·Â-‚›ˆÛ·Ó (1 ÛÙËÓ ¤ÊÔ‰Ô Î·È 1 ÛÂ ÔÏ‡ ÚÒÈÌË ˘Ô-ÙÚÔ‹), ÂÓÒ 16 (88,9%) ÂÈÛ‹¯ıËÛ·Ó ÛÂ ÚÒÙËÏ‹ÚË ‡ÊÂÛË, ‚) ·fi ÙÔ˘˜ 31 ·ÛıÂÓÂ›˜ ÌÂ O§§ ÌÂ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170, 1 (3,6%) ˘ÔÙÚÔ›·-ÛÂ, 3 (9,7%) Î·Ù¤ÏËÍ·Ó (1 ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜) Î·È 27(87,1%) ÂÈÛ‹¯ıËÛ·Ó ÛÂ ÚÒÙË Ï‹ÚË ‡ÊÂÛË, Á)·fi ÙÔ˘˜ 5 ·ÛıÂÓÂ›˜ ÌÂ Oª§§ Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË¤ÎÊÚ·ÛË ÙË˜ ƒ-170, 2 (40%) ·Â‚›ˆÛ·Ó (1 ÛÙËÓ

¶›Ó·Î·˜ 4. ∞ÔÙÂÏ¤ÛÌ·Ù· ¤ÎÊÚ·ÛË˜ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ Î·Ù¿ ÙË ‰È¿-ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹

JSB-1+ JSB-1- C219+ C219- MPK16+ MPK16-

Oª§§ ‰È¿ÁÓˆÛË 5/8 3/8 5/8 3/8 4/8 4/862,5% 37,5% 62,5% 37,5% 50% 50%

Oª§§ ˘ÔÙÚÔ‹ 2/5 3/5 2/5 3/5 2/5 3/540% 60% 40% 60% 40% 60%

¶›Ó·Î·˜ 5. ŒÎÊÚ·ÛË ÙË˜ MDR ÛÙÈ˜ ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜

MDR+ MDR-

O§§ ‰È¿ÁÓˆÛË 18/49 (36,7%) 31/49 (63,9%)O§§ ˘ÔÙÚÔ‹ 5/8 (62,5%) 3/8 (37,5%)

Oª§§ ‰È¿ÁÓˆÛË 5/8 (62,5%) 3/8 (37,5%)Oª§§ ˘ÔÙÚÔ‹ 2/5 (40%) 3/5 (60%)

¶›Ó·Î·˜ 3. ∞ÔÙÂÏ¤ÛÌ·Ù· ¤ÎÊÚ·ÛË˜ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ Î·Ù¿ ÙË ‰È¿ÁÓˆ-ÛË Î·È ÙËÓ ˘ÔÙÚÔ‹

JSB-1+ JSB-1- C219+ C219- MPK16+ MPK16-

O§§ ‰È¿ÁÓˆÛË 15/49 34/49 12/49 37/49 11/49 38/4930,6% 69,4% 24,5% 75,5% 22,5% 77,5%

O§§ ˘ÔÙÚÔ‹ 4/8 4/8 5/8 3/8 2/8 6/850% 50% 62,5% 37,5% 25% 75%

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¤ÊÔ‰Ô Î·È 1 ÛÂ ÔÏ‡ ÚÒÈÌË ˘ÔÙÚÔ‹), ÂÓÒ 3(60%) ÂÌÊ¿ÓÈÛ·Ó Ï‹ÚË ‡ÊÂÛË Î·È ‰) ·fi ÙÔ˘˜ 3·ÛıÂÓÂ›˜ ÌÂ Oª§§ ÌÂ ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170, 2 (66,6%) ˘ÔÙÚÔ›·Û·Ó Î·È 1 Î·Ù¤ÏËÍÂ (ÚÒ-ÈÌÔ˜ ı¿Ó·ÙÔ˜) (¶›Ó·Î·˜ 6 Î·È 7).

™ÙËÓ ˘ÔÙÚÔ‹: ·) ·fi ÙÔ˘˜ 5 ·ÛıÂÓÂ›˜ ÌÂ O§§ÌÂ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170, 2 (40%) ·Â‚›ˆ-Û·Ó, 1 (20%) ˘ÔÙÚÔ›·ÛÂ ÂÎ Ó¤Ô˘, ÂÓÒ 2 (40%) ÂÈ-Û‹¯ıËÛ·Ó Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÂ ‰Â‡ÙÂÚË Ï‹ÚË‡ÊÂÛË ÁÈ· 19 Î·È 27 Ì‹ÓÂ˜, ·ÓÙ›ÛÙÔÈ¯·, ‚) Î·È ÔÈ 3·ÛıÂÓÂ›˜ ÌÂ O§§ (100%) ÌÂ ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·ÛËÙË˜ ƒ-170 ÂÈÛ‹¯ıËÛ·Ó Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÂ ‰Â‡ÙÂ-ÚË Ï‹ÚË ‡ÊÂÛË ÁÈ· 26, 30 Î·È 36 Ì‹ÓÂ˜, ·ÓÙ›ÛÙÔÈ-¯·, Á) Î·È ÔÈ 2 ·ÛıÂÓÂ›˜ ÌÂ Oª§§ (100%) ÌÂ ·˘ÍË-Ì¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÂÈÛ‹¯ıËÛ·Ó Î·È ·Ú·Ì¤-ÓÔ˘Ó ÛÂ ‰Â‡ÙÂÚË Ï‹ÚË ‡ÊÂÛË ÁÈ· 20 Î·È 26 Ì‹-ÓÂ˜, ·ÓÙ›ÛÙÔÈ¯· Î·È ‰) Î·È ÔÈ 3 ·ÛıÂÓÂ›˜ ÌÂ Oª§§(100%) ÌÂ ·ÚÓËÙÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÂÈÛ‹¯ıË-Û·Ó Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÂ ‰Â‡ÙÂÚË Ï‹ÚË ‡ÊÂÛË ÁÈ·20, 26 Î·È 36 Ì‹ÓÂ˜, ·ÓÙ›ÛÙÔÈ¯· (¶›Ó·Î·˜ 6 Î·È 7).

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ O§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ˘Ô-ÙÚÔ‹ ÙË˜ ÓfiÛÔ˘ Ê·›ÓÂÙ·È ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 8 Î·È 9,·ÓÙ›ÛÙÔÈ¯·.

∆· ÔÛÔÛÙ¿ fiÏˆÓ ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹ ‚Ú¤ıËÎ·Ó·˘ÍËÌ¤Ó·, Û¯Â‰fiÓ ‰ÈÏ¿ÛÈ·, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›Ó·ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ƒ-170. ¶·Ú’ fiÏ· ·˘Ù¿, ÏfiÁˆ ÙÔ˘ Û¯ÂÙÈÎ¿ ÂÚÈÔÚÈ-ÛÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ÛÙËÓ ·ÚÔ‡Û·ÌÂÏ¤ÙË ‰ÂÓ ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛËÌÂÙ·Í‡ ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÌÂ ÙÔ˘˜ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ‰ËÏ·‰‹ ÙÔ Ê‡ÏÔ, ÙËÓËÏÈÎ›·, ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙÔÓÎ·Ú˘fiÙ˘Ô, ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô Î·È ÙËÓ ÔÌ¿‰·ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 8 Î·È 9).

™˘˙‹ÙËÛË ∏ ÂÍ¤ÏÈÍË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÏÂ˘¯·ÈÌ›·˜ ÙË˜

·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Û˘ÓÙÂÏ¤ÛÙËÎÂ Ì¤Û· ·fi Ì›· ‰È·-‰ÚÔÌ‹ ÔÏÏÒÓ ‰ÂÎ·ÂÙÈÒÓ. ∆Ô 1945 ·Ó·ÁÓˆÚ›ÛÙËÎÂË ÓfiÛÔ˜ ˆ˜ È·ÙÚÈÎfi Úfi‚ÏËÌ· Î·È ÌfiÏÈ˜ ÙÔ 1975 ¿Ú-¯ÈÛÂ Ó· ‰È·Ê·›ÓÂÙ·È Ë Èı·ÓfiÙËÙ· Ú·ÁÌ·ÙÈÎ‹˜ ›·-ÛË˜ ÌÂ ÙËÓ ·Ó¿Ù˘ÍË ÈÔ ÂÈıÂÙÈÎÒÓ Î·È ÂÓÙ·ÙÈÎÔ-ÔÈËÌ¤ÓˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Î·È ÙËÓ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ˘ÔÛÙËÚÈÎÙÈÎ‹ ·ÁˆÁ‹ (2,4,6).∂ÈÏ¤ÔÓ, ÔÈ Ó¤Â˜ ÂÈÙÂ‡ÍÂÈ˜ ÛÙÔÓ ÙÔÌ¤· ÙË˜ ·ÓÔÛÔ-ÏÔÁ›·˜, ÙË˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ Î·È ÙË˜ ÁÂÓÂÙÈÎ‹˜

¶›Ó·Î·˜ 6. ™˘Û¯¤ÙÈÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ MDR ÌÂ ÙËÓ ÔÚÂ›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ O§§ ÛÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘

MDR+ % MDR- %

ñ O§§ ‰È¿ÁÓˆÛË (49)™‡ÓÔÏÔ ·ÛıÂÓÒÓ 18/49 36,7% 31/49 63,9%⁄ÊÂÛË 16/18 88,9% 27/31 87,1%¶ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜ 1/18 5,5% 1/31 3,2%ÀÔÙÚÔ‹ 0/18 0% 1/31 3,2%™‡ÓÔÏÔ ı·Ó¿ÙˆÓ 2/18 11,1% 3/31 9,7%

ñ O§§ ˘ÔÙÚÔ‹ (8)™‡ÓÔÏÔ ·ÛıÂÓÒÓ 5/8 62,5% 3/8 37,5%⁄ÊÂÛË 2/5 40% 3/3 100%¶ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜ 0/5 0% 0/3 0%2Ë ˘ÔÙÚÔ‹ 1/5 20% 0/3 0%™‡ÓÔÏÔ ı·Ó¿ÙˆÓ 2/5 40% 0/3 0%

¶›Ó·Î·˜ 7. ™˘Û¯¤ÙÈÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ MDR ÌÂ ÙËÓ ÔÚÂ›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ OM§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘

MDR+ % MDR- %

ñ OM§§ ‰È¿ÁÓˆÛË (8)™‡ÓÔÏÔ ·ÛıÂÓÒÓ 5/8 62,5% 3/8 37,5%⁄ÊÂÛË 3/5 60% 0/3 0%¶ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜ 1/5 20% 1/3 33,3%ÀÔÙÚÔ‹ 0/5 0% 2/3 66,6%™‡ÓÔÏÔ ı·Ó¿ÙˆÓ 2/5 40% 1/3 33,3%

ñ OM§§ ˘ÔÙÚÔ‹ (5)™‡ÓÔÏÔ ·ÛıÂÓÒÓ 2/5 40% 3/5 60%⁄ÊÂÛË 2/2 100% 3/3 100%¶ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜ 0/2 0% 0/3 0%2Ë ˘ÔÙÚÔ‹ 0/2 0% 0/3 0%™‡ÓÔÏÔ ı·Ó¿ÙˆÓ 0/2 0% 0/3 0%

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Ô˘ ‚Ô‹ıËÛ·Ó ·ÊÂÓfi˜ ÛÙËÓ Î·Ù·ÓfiËÛË ÙË˜ Î·ÚÎÈ-ÓÔÁ¤ÓÂÛË˜, ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ Î·Ï‡ÙÂÚË Ù·ÍÈÓfiÌËÛËÎ·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈ-ÛË ÙˆÓ Î·ÎÔËıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, fi¯È ÌfiÓÔÛÂ ÂÌÂÈÚÈÎ‹ ·ÏÏ¿ Î·È ÛÂ ·ÈÙÈÔÏÔÁËÌ¤ÓË ‚¿ÛË, Û˘-ÓÙ¤ÏÂÛ·Ó ÙÂÏÈÎ¿ ÛÙË ÛËÌÂÚÈÓ‹ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛËÙÔ˘ ÔÛÔÛÙÔ‡ ÂÓÙ·ÂÙÔ‡˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ·È‰ÈÒÓÌÂ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·. ¶·Ú¿ Ù·‡Ù·, ÂÍ·ÎÔÏÔ˘ıÂ› Ó··Ú·ÙËÚÂ›Ù·È ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ·ÎfiÌ· Î·È ÛÙÈ˜ ÏÂ˘¯·ÈÌ›Â˜ Ô˘ Î·ıÔÚ›˙ÔÓÙ·È ˆ˜ ÂÓ-‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ (ÂÚ›Ô˘ 20%), ÂÓÒ ÔÏ‡ ÌÂÁ·-Ï‡ÙÂÚÔ ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ·-Ú·Ì¤ÓÂÈ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∂ÈÏ¤-ÔÓ, fiÛÔÓ ·ÊÔÚ¿ ÛÙË Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›·, ·Ú¿ÙËÓ ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ ‹‰Ë Û˘ÓÙÂÏÂÛÙÂ›, Ù· ÙÚ¤¯ÔÓÙ·ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ·ÂÈ‚›ˆÛË ÙË˜ Ù¿ÍÂˆ˜ ÙÔ˘ 40% ¤ˆ˜ 60%. ™˘ÓÂÒ˜,Â›Ó·È Ê˘ÛÈÎfi Ó· ÂÁÂ›ÚÔÓÙ·È ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ˆ˜ÚÔ˜ Ù· ·›ÙÈ· ·ÔÙ˘¯›·˜ ÙË˜ ıÂÚ·Â›·˜(1,2,13,19,20).

¶ÔÏ˘¿ÚÈıÌÂ˜ ÌÂÏ¤ÙÂ˜ Û¯Â‰È¿ÛÙËÎ·Ó ÌÂ ÛÎÔfiÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·Ô-Ù˘¯›·˜ Î·È ÙËÓ ·Ó·˙‹ÙËÛË Ó¤ˆÓ ·Ú·ÁfiÓÙˆÓ ‹ ·-Ú·Ì¤ÙÚˆÓ Ô˘, ÂÚÈÏ·Ì‚·ÓfiÌÂÓÔÈ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ÔÚÂ›· ÙË˜ Ófi-ÛÔ˘, ı· ¤ÚÈ¯Ó·Ó Êˆ˜ ÛÂ ˘Â‡ı˘ÓÔ˘˜ ÁÈ· ÙË Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹ ·ÔÙ˘¯›· ÌË¯·ÓÈÛÌÔ‡˜ (‚ÈÔÏÔÁÈÎÔ› ÌË-¯·ÓÈÛÌÔ› ¿Ì˘Ó·˜ ÙˆÓ Î·ÎÔ‹ıˆÓ Î˘ÙÙ¿ÚˆÓ)(17,18,20,21).

ªÂÙ·Í‡ ÙˆÓ ÔÈÎ›ÏˆÓ ·Ú·ÁfiÓÙˆÓ, Ù· ÙÂÏÂ˘-

Ù·›· ¯ÚfiÓÈ· È‰È·›ÙÂÚ· ¤¯ÂÈ ÌÂÏÂÙËıÂ› ÙÔ Ê·ÈÓfiÌÂÓÔÙË˜ ·Ó¿Ù˘ÍË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ¤Ó·ÓÙÈ ‰È·-ÊfiÚˆÓ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÂ Â›Â‰ÔÎ˘Ú›ˆ˜ ÂÚÁ·ÛÙËÚÈ·Îfi. ø˜ Î˘ÚÈfiÙÂÚÔ˜ ÌË¯·ÓÈÛÌfi˜ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ·˘ÙÔ‡ ıÂˆÚÂ›Ù·È Ë ˘ÂÚ¤ÎÊÚ·ÛËÙÔ˘ MDR-1 ÁÔÓÈ‰›Ô˘, Ô˘ ·ÓÈ¯ÓÂ‡ÂÙ·È Ì¤Ûˆ ÙË˜ ·˘-ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÁÏ˘ÎÔÚˆÙÂ˝ÓË˜, ËÔÔ›· ›Ûˆ˜ Â›Ó·È ·ÚÔ‡Û· ÛÙËÓ ·Ú¯‹ Î·È ·˘Í¿ÓÂÙ·ÈÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ ‹ ÛÙÈ˜ ˘ÔÙÚÔ¤˜ÙË˜ ÓfiÛÔ˘ (12,19,20,22-24).

∆Ô 1990, ÔÈ Kuwazuru Î·È Û˘Ó ‰ËÌÔÛ›Â˘Û·Ó 3ÌÂÏ¤ÙÂ˜ ÛÂ ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§, 11 ÌÂ ¯Úfi-ÓÈ· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· Î·È 25 ÌÂ ∆-O§§,fiÔ˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÙÔ ÌÔÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ·C219 ÁÈ· ÙËÓ Ù˘¯fiÓ ·Ó›¯ÓÂ˘ÛË ÙË˜ ·˘ÍËÌ¤ÓË˜ ¤Î-ÊÚ·ÛË˜ ÙË˜ ƒ-170 ÌÂ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎ¤˜ ÌÂıfi‰Ô˘˜.OÈ ÂÓ ÏfiÁˆ ÂÚÂ˘ÓËÙ¤˜ ·¤‰ÂÈÍ·Ó Û˘Û¯¤ÙÈÛË ÙË˜·ÚÔ˘Û›·˜ ƒ-170 Î·È ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙ›ÛÙ·-ÛË˜, Ô˘ ÂÎ‰ËÏÒÓÂÙ·È Â›ÙÂ ˆ˜ ÌË ·Ú¯ÈÎ‹ ·¿ÓÙËÛËÛÙË ıÂÚ·Â›· (·ÓıÂÎÙÈÎ‹ ÓfiÛÔ˜), Â›ÙÂ ÌÂ ˘ÔÙÚÔ‹.ªÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ ÙÔ˘˜ ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ÎÏÈÓÈ-Î‹ ÛËÌ·Û›· ÙÔ˘ ªDR Ê·ÈÓÔÌ¤ÓÔ˘ (25-27).

™ÙË Û˘Ó¤¯ÂÈ·, ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿ ÌÂ O§§ Ô˘ÚÔÛ‰ÈfiÚÈ˙·Ó ÙËÓ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÌÂ ÌÔÚÈ·Î¤˜ÌÂıfi‰Ô˘˜ ÛÂ ‰È¿ÊÔÚÂ˜ Ê¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘, ¤‰ÂÈÍ·ÓfiÙÈ ˘¿Ú¯ÂÈ ·Ó·ÏÔÁÈÎ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÚÈ¤¯Ô˘Ó ·˘ÍËÌ¤Ó· ÔÛ¿ ƒ-170 Î·È ÙË˜ ·˘ÍËÌ¤ÓË˜ ·ÓÙÔ¯‹˜ ÙˆÓ ÏÂ˘¯·ÈÌÈÎÒÓÎ˘ÙÙ¿ÚˆÓ ÛÙË Ãª£, ÙfiÛÔ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ Ófi-ÛÔ˘, fiÛÔ Î·È ÛÙËÓ ‡ÊÂÛË, ÛÙËÓ ˘ÔÙÚÔ‹ Î·È ÛÙË

¶›Ó·Î·˜ 8. ™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÌÂÙ·Í‡ ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ¤ÎÊÚ·ÛË˜ ÙË˜ MDR ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ Î·Ù¿ ÙË ‰È¿-ÁÓˆÛË ÙË˜ ÓfiÛÔ˘

MDR+ MDR- P

º‡ÏÔ ∞ÁfiÚÈ· 11 (22,5%) 18 (36,7%) 0,075∫ÔÚ›ÙÛÈ· 7 (14,3%) 13 (26,5%)

OÌ¿‰· ÎÈÓ‰‡ÓÔ˘ ∂Ó‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ 10 (20,4%) 21 (42,9%) 0,255À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 8 (16,3%) 10 (20,4%)

∏ÏÈÎ›· 1-10 ¤ÙË 14 (28,5%) 23 (46,8%) 0,063<1 ¤ÙÔ˘˜ ‹ >10 ¤ÙË 4 (8,2%) 8 (16,3%)

∞ÚÈıÌfi˜ ÏÂ˘ÎÒÓ ÛÙË ‰È¿ÁÓˆÛË ≤100 x 109/L 18 (36,7%) 28 (57,1%) 0,063>100 x 109/L 0 (0%) 3 (6,2%)

∞ÚÈıÌfi˜ ‚Ï·ÛÙÒÓ ÙËÓ 8Ë ËÌ¤Ú· ≤1 x 109/L 17 (34,7%) 27 (55,1%) 0,062>1 x 109/L 1 (2%) 4 (8,2%)

ªÔÚÊÔÏÔÁ›· Î·Ù¿ FAB L1 10 (20,4%) 25 (50,7%) 0,099L2 6 (12,4%) 6 (12,4%)L3 2 (4,1%) 0 (0%)

∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ µ-O§§ (Common) 16 (10) (32,6%) 29 (24) (59,2%) 0,277T-O§§ 2 (4,1%) 2 (4,1%)

∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË º˘ÛÈÔÏÔÁÈÎ‹ 10 (20,4%) 8 (16,3%) 0,031ÀÂÚ‰ÈÏÔÂÈ‰ÈÛÌfi˜ 0 (0%) 4 (8,2%)∂ÏÏÂ›ÌÌ·Ù· 2 (4,1%) 1 (2%)∞¤Ù˘¯·Ó 2 (4,1%) 7 (14,3%)¢ÂÓ ¤ÁÈÓÂ 4 (8,2%) 11 (22,4%)

ŒÎÊÚ·ÛË ÙË˜ ƒ-170 18 (36,7%) 31 (63,3%) 0,168

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‰Â‡ÙÂÚË ‡ÊÂÛË (11,19,28). ∞ÎÔÏÔ‡ıËÛ·Ó, fiÌˆ˜, ‰‡Ô ÌÂÏ¤ÙÂ˜ Ô˘ ‰ÂÓ ¤‰ÂÈ-

Í·Ó ÎÏÈÓÈÎ‹ Û˘Û¯¤ÙÈÛË ÙË˜ ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ÙË˜ ƒ-170 ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÙˆÓ ·ÛıÂÓÒÓ(30,31). ™ÙËÓ ÚÒÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÌfiÓÔ ÙÔMPK16 ÌÔÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ· ÛÂ 19 ·ÛıÂÓÂ›˜ ÌÂÏÂ˘¯·ÈÌ›·, ÂÎ ÙˆÓ ÔÔ›ˆÓ 5 Â›¯·Ó O§§, ÂÓÒ ÛÙË ‰Â‡-ÙÂÚË ÌÂÏÂÙ‹ıËÎÂ Ë ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÛÂ 141·ÛıÂÓÂ›˜ ÌÂ O§§ Î·È ÛÂ 27 ÌÂ Oª§§ ÌÂ Î˘ÙÙ·ÚÔ-ÌÂÙÚ›· ÚÔ‹˜.

ªÂ ÛÎÔfi ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ Â›‰Ú·ÛË˜ ÙË˜MDR ÛÙËÓ ÚfiÁÓˆÛË ÙË˜ O§§ Î·È ÙË˜ Oª§§ ÛÙËÓ·È‰ÈÎ‹ ËÏÈÎ›· ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ Ê¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘(‰È¿ÁÓˆÛË-˘ÔÙÚÔ‹), ÌÂÏÂÙ‹Û·ÌÂ ÚÔÔÙÈÎ¿ ÙËÓ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÌÂ ÙËÓ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎ‹ Ì¤ıÔ-‰Ô ∞ƒ∞∞ƒ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÚ›· ÌÔÓÔÎÏˆÓÈÎ¿·ÓÙÈÛÒÌ·Ù· (JSB-1, MRK16, C219) ÛÂ 57 ·ÛıÂÓÂ›˜ÌÂ O§§ (49 ÛÙË ‰È¿ÁÓˆÛË Î·È 8 ÛÂ ˘ÔÙÚÔ‹) Î·ÈÛÂ 13 ·ÛıÂÓÂ›˜ ÌÂ Oª§§ (8 ÛÙË ‰È¿ÁÓˆÛË Î·È 5 ÛÂ˘ÔÙÚÔ‹), Ô˘ ‰È·ÁÓÒÛÙËÎ·Ó Î·È ıÂÚ·Â‡ÙËÎ·ÓÌÂ ·Ó¿ÏÔÁ· (ALL-BFM ’95 Î·È AML-BFM ’93) ıÂÚ·-Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· ÛÙÔ ∆Ì‹Ì· Ì·˜ Î·Ù¿ ÙÔ ¯ÚÔÓÈ-Îfi ‰È¿ÛÙËÌ· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜.

µÚ¤ıËÎÂ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 (Û¯Â‰fiÓ ‰ÈÏ¿ÛÈÔ) ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ÛÙËÓ ˘ÔÙÚÔ‹ (62,5%), ÂÓÒ ‰ÂÓ ıÂˆÚ‹ıËÎÂ Â˘-Î·Ù·ÊÚfiÓËÙÔ ÙÔ ÔÛÔÛÙfi ÙË˜ ıÂÙÈÎfiÙËÙ·˜ ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛË (36,7%) (de novo MDR).™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ ·Ú·ÙËÚ‹ıËÎÂ ·˘ÍËÌ¤-ÓÔ ÔÛÔÛÙfi ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170, ÙfiÛÔ ÛÙËÓ ˘Ô-ÙÚÔ‹ (40%), fiÛÔ Î·È ÛÙË ‰È¿ÁÓˆÛË (62,5%), Â˘-

Ú‹Ì·Ù· Ô˘ Û˘ÌÊˆÓÔ‡Ó ÌÂ ÂÎÂ›Ó· ¿ÏÏˆÓ ÂÚÂ˘ÓË-ÙÒÓ (29-35).

OÈ Herweijer Î·È Û˘Ó ·Ó›¯ÓÂ˘Û·Ó ˘„ËÏfiÙÂÚË ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 ÛÂ 5 ·fi ÙÔ˘˜ 9 ·ÛıÂÓÂ›˜ ÌÂ ∆-O§§ Î·È ÛÂ 2 ÌÂ µ-O§§ Î·È Î·Ù¤ÏËÍ·Ó ÛÙÔ Û˘Ì¤-Ú·ÛÌ· fiÙÈ ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÌÔÚÂ› Ó· ‚ÚÂıÂ› ÛÂfiÏÔ˘˜ ÙÔ˘˜ ˘ÔÙ‡Ô˘˜ ÙˆÓ ÏÂ˘¯·ÈÌÈÒÓ. ™ÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ‚Ú¤-ıËÎÂ ÛÂ 20/52 ·ÛıÂÓÂ›˜ ÌÂ µ-O§§ Î·È ÛÂ 3/5 ·ÛıÂ-ÓÂ›˜ ÌÂ ∆-O§§ (17).

∂Ó‰È·Ê¤ÚÔ˘ÛÂ˜ Â›Ó·È ÔÈ ÌÂÏ¤ÙÂ˜ ÙˆÓ Pirker Î·ÈÛ˘Ó Ô˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ MDR-1 ÁÔÓÈ‰›Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ‚Ú·¯‡ÙÂÚË˜ ‰È¿ÚÎÂÈ·˜‡ÊÂÛË, ÂÈ‚›ˆÛË ÂÏÂ‡ıÂÚË ÓfiÛÔ˘ Î·È ÙÂÏÈÎ‹ ÂÈ-‚›ˆÛË (32), Î·ıÒ˜ Î·È ÙˆÓ Goasguen JE Î·È Û˘Ó, ÔÈÔÔ›ÔÈ ‚Ú‹Î·Ó ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜(73%) ÙˆÓ ·ÛıÂÓÒÓ ÌÂ O§§ Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ‰ÂÓÂ›¯·Ó (32%) (30).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ O§§ Ô˘Â›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙËÓ ˘Ô-ÙÚÔ‹, ·ÚÔ˘Û›·Û·Ó ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi (40%) ÂÈ-Û·ÁˆÁ‹˜ ÛÂ ‡ÊÂÛË Î·È ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ıÓË-ÙfiÙËÙ·˜ (40%), Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ‰ÂÓ Â›-¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 (100% Î·È 0%,·ÓÙ›ÛÙÔÈ¯·). ∂›ÛË˜, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ ÌÂ ·˘ÍË-Ì¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·-ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi (40%) ıÓËÙfiÙË-Ù·˜, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ‰ÂÓ Â›¯·Ó ·˘ÍËÌ¤-ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 (33,3%) (ÌË ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹ ‰È·ÊÔÚ¿).

¶›Ó·Î·˜ 9. ™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÌÂÙ·Í‡ ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ MDR, ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ Î·Ù¿ÙËÓ ˘ÔÙÚÔ‹

MDR+ MDR- P

º‡ÏÔ ∞ÁfiÚÈ· 4 (50%) 2 (25%) 0,48∫ÔÚ›ÙÛÈ· 1 (12,5%) 1 (12,5%)

OÌ¿‰· ÎÈÓ‰‡ÓÔ˘ ∂Ó‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ 0 (0%) 0 (0%) 0,5À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 5 (62,5%) 3 (37,5%)

∏ÏÈÎ›· 1-10 ¤ÙË 4 (50%) 2 (25%) 0,157<1 ¤ÙÔ˘˜ ‹ >10 ¤ÙË 1 (12,5%) 1 (12,5%)

∞ÚÈıÌfi˜ ÏÂ˘ÎÒÓ ÛÙË ‰È¿ÁÓˆÛË ≤100 x 109/L 5 (62,5%) 3 (37,5%) 0,993>100 x 109/L 0 (0%) 0 (0%)

∞ÚÈıÌfi˜ ‚Ï·ÛÙÒÓ ÙËÓ 8Ë ËÌ¤Ú· ≤1 x 109/L 4 (50%) 3 (37,5%) 0,157>1 x 109/L 1 (12,5%) 0 (0%)

ªÔÚÊÔÏÔÁ›· Î·Ù¿ FAB L1 4 (50%) 2 (25%) 0,147L2 1 (12,5%) 1 (12,5%)L3 0 (0%) 0 (0%)

∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ µ-O§§ (Common) 4 (50%) 3 (37,5%) 0,48∆-O§§ 1 (12,5%) 0 (0%)

∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË º˘ÛÈÔÏÔÁÈÎ‹ 2 (25%) 0 (0%) 0,034ÀÂÚ‰ÈÏÔÂÈ‰ÈÛÌfi˜ 2 (25%) 0 (0%)∂ÏÏÂ›ÌÌ·Ù· 0 (0%) 1 (12,5%)¢ÂÓ ¤ÁÈÓÂ 1 (12,5%) 2 (25%)

ŒÎÊÚ·ÛË ÙË˜ ƒ-170 5 (62,5%) 3 (37,5%) 0,48

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¶ÈÛÙÂ‡ÂÔ˘ÌÂ fiÙÈ ÏfiÁˆ ÙÔ˘ Û¯ÂÙÈÎ¿ ÂÚÈÔÚÈÛÌ¤-ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂ-Ï¤ÙË ‰ÂÓ ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ƒ-170 ÌÂ ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘-Ô, ÙÔ Ê‡ÏÔ, ÙËÓ Î·Ù¿ FAB ÌÔÚÊÔÏÔÁ›·, ÙÔÓ Î·-Ú˘fiÙ˘Ô, ÙËÓ ËÏÈÎ›·, ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ Î·Ù¿ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘, ÁÂÁÔÓfi˜ Ô˘ÂÈÛËÌ·›ÓÂÙ·È Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (33,35,36). ∂›-ÛË˜, Èı·Ó¿ ÁÈ· ÙÔÓ ›‰ÈÔ ÏfiÁÔ, ·Ú’ fiÙÈ ‰È·Ê·›ÓÂÙ·ÈË ‰˘ÛÌÂÓ‹˜ ÚÔÁÓˆÛÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ ·ÚÔ˘Û›·˜·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÛÙËÓ ÔÚÂ›· ÙˆÓ·ÛıÂÓÒÓ Ì·˜ ÌÂ O§§ Î·È Oª§§ Î·Ù¿ ÙË ‰È¿ÁÓˆÛËÎ·È ÙËÓ ˘ÔÙÚÔ‹, ÙÔ‡ÙÔ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÌÂ ÛÙ·-ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎfiÙËÙ· (¶›Ó·Î·˜ 8 Î·È 9).

∆¤ÏÔ˜, ·ÓÙ›ıÂÙ· ÌÂ ÙÔ˘˜ Filipits Î·È Û˘Ó (1997)Î·È den Boer Î·È Û˘Ó (1997), ÔÈ ÔÔ›ÔÈ ·Ó·Ê¤ÚıË-Î·Ó ÌÂ È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÙÈ˜ ‰˘ÛÎÔÏ›Â˜ ÙˆÓ ·ÓÔ-ÛÔ˚ÛÙÔ¯ËÌÈÎÒÓ ÌÂıfi‰ˆÓ ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ÔÛÔ-ÛÙÔ‡ Â·Ó·ÏË„ÈÌfiÙËÙ·˜ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ÛÙËÓ·ÚÔ‡Û· ÂÚÁ·Û›· ·˘Í‹ıËÎÂ Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂÈ-‰ÈÎfiÙËÙ· ÙË˜ ∞ƒ∞∞ƒ ÙÂ¯ÓÈÎ‹˜: ·) ÌÂ ÙË ¯Ú‹ÛË ‰ÂÈÁ-Ì¿ÙˆÓ ·Ó·ÊÔÚ¿˜ Î¿ıÂ ÊÔÚ¿ Ô˘ ÚÔÛ‰ÈÔÚÈ˙fiÙ·ÓË ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ ƒ-170 ÛÂ Î¿ÔÈÔÓ ·ÛıÂ-Ó‹, ÒÛÙÂ Ó· ÌËÓ ˘¿Ú¯Ô˘Ó „Â˘‰Ò˜ ıÂÙÈÎ¿ ‹ „Â˘-‰Ò˜ ·ÚÓËÙÈÎ¿ ‰Â›ÁÌ·Ù·, Î·ıÒ˜ Î·È ‚) ÌÂ ÙË Û˘Ì-ÊˆÓ›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÌÂÙ·Í‡ ÙˆÓ ·ÓÂÍ¿ÚÙË-ÙˆÓ ·Ú·ÙËÚËÙÒÓ.

™ËÌÂÈÒÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙË-Ù· ·Ó›¯ÓÂ˘ÛË˜ ·˘ÍËÌ¤ÓË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÌÂÙË ¯Ú‹ÛË ÂÚÈÛÛfiÙÂÚˆÓ ÙÔ˘ ÂÓfi˜ ÌÔÓÔÎÏˆÓÈÎÒÓ·ÓÙÈÛˆÌ¿ÙˆÓ. ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË Â›Ó·È Ë ÌÔÓ·‰ÈÎ‹Ô˘ ¯ÚËÛÈÌÔÔÈÂ› ÙÚ›· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÛÂ ÏÂ˘-¯·ÈÌÈÎ¿ Î‡ÙÙ·Ú·. ™ÙÔ ˘fi ÌÂÏ¤ÙË ˘ÏÈÎfi ‚Ú¤ıËÎÂ fiÙÈÙÔ JSB-1 ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· Î·È ÂÈ‰ÈÎfiÙË-Ù· ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170.∆Ô ÔÛÔÛÙfi ıÂÙÈÎfiÙËÙ¿˜ ÙÔ˘ ‹Ù·Ó 86,6%, ¤Ó·ÓÙÈ80% ÙÔ˘ C219 Î·È 63,3% ÙÔ˘ MRK16.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ O§§ ·-Ú·ÙËÚ‹ıËÎÂ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÛÙËÓ ˘ÔÙÚÔ‹ (62,5%) ÛÂ Û¯¤ÛË ÌÂ ÙË ‰È¿-ÁÓˆÛË, ÂÓÒ ‰ÂÓ ıÂˆÚÂ›Ù·È Î·ıfiÏÔ˘ Â˘Î·Ù·ÊÚfiÓË-ÙÔ ÙÔ ÔÛÔÛÙfi ÙË˜ ıÂÙÈÎfiÙËÙ·˜ ÙË˜ ƒ-170 Î·Ù¿ ÙË‰È¿ÁÓˆÛË (36,7%) (de novo MDR).

™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ ‚Ú¤ıËÎÂ ·˘ÍËÌ¤ÓÔÔÛÔÛÙfi ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170, ÙfiÛÔ ÛÙË ‰È¿ÁÓˆÛË(62,5%), fiÛÔ Î·È ÛÙËÓ ˘ÔÙÚÔ‹ (40%).

OÈ ·ÛıÂÓÂ›˜ ÌÂ O§§ Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙËÓ ˘ÔÙÚÔ‹, ·ÚÔ˘Û›·-Û·Ó ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi (40%) ÂÈÛ·ÁˆÁ‹˜ ÛÂ ‡ÊÂ-ÛË Î·È ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ (40%) Û˘-ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ‰ÂÓ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 (100% Î·È 0%, ·ÓÙ›ÛÙÔÈ¯·).

OÈ ·ÛıÂÓÂ›˜ ÌÂ Oª§§ Ô˘ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤Î-ÊÚ·ÛË ÙË˜ ƒ-170 Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·ÚÔ˘Û›·Û·ÓÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ (40%) Û˘ÁÎÚÈÙÈ-Î¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ‰ÂÓ Â›¯·Ó ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛËÙË˜ ƒ-170 (33,3%) (ÌË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿).

∞fi ÙÈ˜ Ì¤¯ÚÈ ÙÒÚ· ÌÂÏ¤ÙÂ˜ Î·ıÒ˜ Î·È ·Ô ÙËÓ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÂÈÛËÌ·›ÓÂÙ·È fiÙÈ Ô ÚÔÛ‰ÈÔÚÈ-ÛÌfi˜ ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 Î·È, Ì¤Ûˆ ·˘Ù‹˜,ÙË˜ MDR ÛÙ· ÏÂ˘¯·ÈÌÈÎ¿ Î‡ÙÙ·Ú· ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈ-Î·ÚÎÈÓÈÎÒÓ Ê·ÚÌ¿ÎˆÓ, ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ¤Ó·Ó·ÎfiÌË ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÔÚÂ›· ÙË˜ÓfiÛÔ˘. ∏ ÌÂÏ¤ÙË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ÌÂ ÙË¯Ú‹ÛË ÙÚÈÒÓ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ, fiˆ˜ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Â›Ó·È Û¯ÂÙÈÎ¿ÚÔÛÈÙ‹, ·Ú·ÁÒÁÈÌË Î·È ·ÍÈfiÈÛÙË ÁÈ· ÙÔÓ ÚÔÛ-‰ÈÔÚÈÛÌfi ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ÙË˜ MDR.

∂›Ó·È ‚¤‚·È· ÁÓˆÛÙfi fiÙÈ Ë ·ÚÔ˘Û›· Ê·ÚÌ·ÎÂ˘-ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ÛÙË ¯ËÌÂÈÔıÂÚ·Â›· Â›Ó·È ¤Ó· ÔÏ˘-·Ú·ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ. ªÂÏ¤ÙÂ˜ ÌÂ ÌÂÁ·Ï‡ÙÂÚÔ·ÚÈıÌfi ·ÛıÂÓÒÓ, ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙË-Ì· ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·È ÌÂ ÙË ¯Ú‹ÛË Î·Ù¿ÏÏËÏˆÓÙÂ¯ÓÈÎÒÓ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·ÚÔ˘Û›·˜ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ÛÙË ¯ËÌÂÈÔıÂÚ·Â›·, Â›Ó·È ·Ó¿-ÁÎË Ó· ÚÔÁÚ·ÌÌ·ÙÈÛÙÔ‡Ó ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ. ¢Â-‰ÔÌ¤ÓÔ˘ fiÙÈ ÔÈ Ì¤¯ÚÈ ÙÒÚ· ÌÂÏ¤ÙÂ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ÙË˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ƒ-170 ·ÊÔÚÔ‡Ó ÛÂ ÌÈÎÚÔ‡˜·ÚÈıÌÔ‡˜ ·ÛıÂÓÒÓ, ıÂˆÚÔ‡ÌÂ fiÙÈ Ë ÌÂÙ·-·Ó¿Ï˘ÛËÛÙËÓ ÔÔ›· ı· Û˘ÌÂÚÈÏËÊıÔ‡Ó Î·È Ù· ·ÔÙÂÏ¤-ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ı· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ·ÍÈÔÏfiÁËÛË ÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· Â˘ÚËÌ¿ÙˆÓ ÁÈ· ÙÔÓÎ·ıÔÚÈÛÌfi ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙË˜ ÔÏÏ·Ï‹˜ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÔ¯‹˜ (Multi Drug Resistance, MDR)ÙˆÓ ÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ¤Ó·ÓÙÈ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂ-ÓˆÓ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∆· Û˘ÌÂ-Ú¿ÛÌ·Ù· Ì›·˜ Ù¤ÙÔÈ·˜ ÌÂÏ¤ÙË˜, ÌÂÙ·ÊÂÚfiÌÂÓ·ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈÎ‹ Ú¿ÍË, ı· ¤¯Ô˘Ó ÌÂÙ¿ ‚Â-‚·ÈfiÙËÙ·˜ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ ·È‰ÈÔ‡ ÌÂ ÏÂ˘¯·ÈÌ›·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Ditter L, Li FP. Epidemiology of cancer in childhood. In:

Nathan DG, Oski FA. Hematology of infancy and childhood.5th ed. Philadelphia: W.B. Saunders Company; 1998. p.1071-1091.

2. Niemeyer CM, Sally SE. Acute lymphoblastic leukemia. In:Nathan DG, Oski FA. Hematalogy of infancy and childhood.5th ed. Philadelphia: W.B. Saunders Company; 1998. p.1245-1285.

3. Grier ∏E, Sivin πC. Myeloid leukemia, myelodysplasia andmyeloproliferative diseases in children. In: Nathan DG, OskiFA. Hematology of infancy and childhood. 5th ed.Philadelphia: W.B. Saunders Company; 1998. p. 1286-1321.

JAN-FEB-03 14-05-03 14:38 ™ÂÏ›‰·79


80

4. Ã·˚‰¿˜ ™. ÀÔÛÙËÚÈÎÙÈÎ‹ ıÂÚ·Â›· ·È‰ÈÒÓ ÌÂ ÓÂÔÏ·ÛÌ·-ÙÈÎ¿ ÓÔÛ‹Ì·Ù·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ∞ıËÓÒÓ1990;40:212-234.

5. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. ¶ÚÔÁÓˆÛÙÈÎÔ› ‰Â›-ÎÙÂ˜ Î·È Û‡Á¯ÚÔÓ· ıÂÚ·Â˘ÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙÈ˜ ·ÈÌ·-ÙÔÏÔÁÈÎ¤˜ Î·ÎÔ‹ıÂÈÂ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∂›Î·ÈÚ· ¶·È-‰È·ÙÚÈÎ¿ £¤Ì·Ù·. ∆fiÌÔ˜ ¶ÂÚ·ÁÌ¤ÓˆÓ 6Ô˘ ™ÂÌÈÓ·Ú›Ô˘ µ’¶·ıÔÏÔÁÈÎÔ‡ ∆ÔÌ¤· ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”1994;77-85.

6. Chan HS, DeBoer G, Haddad G, Gallie BL, Ling V. Multidrugresistance in pediatric malignancies. Hematol Oncol ClinNorth Am 1995;9:275-317.

7. Hall AG, Cattan AR. Drug resistance mechanisms inleukemia. Baillieres Clin Haematol 1991;4:655-679.

8. Dalton WS. Mechanisms of drug resistance in hematologicmalignacies. Semin Hematol 1997;34 (Suppl 5):1-8.

9. List FA. Non-P-glucoprotein drug export mechanisms ofmultidrug resistance. Semin Hematol 1997;34 (Suppl5):20-24.

10. Damiani D, Michieli M, Michelutti A, Geromin A, RaspadoriD, Fanin R et al. Expression of multidrug resistance gene(MDR-1) in human normal leukocytes. Haematologica1993;78:12-17.

11. Marie JP, Legrand O, Perrot JY, Chevillard S, Huet S, RobertJ. Measuring multidrug resistance expression in humanmalignancies: elaboration of consensus recom-mendations. Semin Hematol 1997;34 (Suppl 5):63-71.

12. Scheper RJ, Bulte JW, Brakkee JG, Quak JJ, van derSchoot E, Balm AJ et al. Monoclonal antibody JBS-1 detectsa highly conserved epitope on the P-glycoproteinassociated with multi-drug-resistance. Int J Cancer1988;42:389-394.

13. Lowenberg B, Sonneveld P. Resistance to chemotherapy inacute leukemia. Curr Opin Oncol 1998;10:31-35.

14. Malayeri R, Filipits M, Suchomel RW, Zochbauer S, LechnerK, Pirker R. Multidrug resistance in leukemias and itsreversal. Leuk Lymphoma 1996;23:451-458.

15. Hegewisch-Becker S, Hossfeld DK. The MDR phenotype inhematologic malignancies: prognostic relevance and futureperspectives. Ann Hematol 1996;72:105-117.

16. Cordell JL, Falini B, Erber WN, Ghosh AK, Abdulaziz Z,MacDonald S at al. Immunoenzymatic labeling ofmonoclonal antibodies using immune complexes of alkalinephosphatase and monoclonal anti-alkaline phosphatase(APAAP complexes). The J Histochem Cytochem1984;32:219-229.

17. Broxterman HJ, Pinedo HM, Kuiper CM, van der Hoeven JJ,de Lange P et al. Immunohistochemical detection of P-glycoprotein in human tumor cells with a low degree of drugresistance. Int J Cancer 1989;43:340-343.

18. 8Ô ™ÂÌÈÓ¿ÚÈÔ ‰ÂÈÎÙÒÓ Î·ÚÎ›ÓÔ˘. ∂ÚÁ·ÛÙËÚÈ·Î‹ ‰ÈÂÚÂ‡ÓËÛËÎ·È ÎÏÈÓÈÎ‹ ·ÍÈÔÏfiÁËÛË. ∞ı‹Ó·; 1995.

19. Rothenberg ML, Mickley LA, Cole DE, Balis FM, Tsuruo T,Poplack DG et al. Expression of the MDR-1/P-170 gene inpatients with acute lymphoblastic leukemia. Blood1989;74:1388-1392.

20. Goasguen JE, Dossot JM, Fardel O, Le Mee F, Le Gall E,Leblay R et al. Expression of the multidrug resistance-associated P-glycoprotein (P-170) in 59 cases of de novo

acute lymphoblastic leukemia: prognostic implications.Blood 1993;81:2394-2398.

21. Musto P, Melillo L, Lombardi G, Matera R, di Giorgio G,Carotenuto M. High risk of early resistant relapse forleukaemic patients with presence of multidrug resistanceassociated P-glycoprotein positive cells in completeremission. Br J Haematol 1991;77:50-57.

22. Wood P, Burgess R, MacGregor A, Yin JA. P-glycoproteinexpression on acute myeloid leukaemia blast cells atdiagnosis predicts response to chemotherapy and survival.Br J Haematol 1994;87:509-514.

23. Campos L, Guyotat D, Archimbaud E, Calmard-Oriol P,Tsuruo T, Troncy J et al. Clinical significance of multidrugresistance P-glycoprotein expression on acute nonlym-phoblastic leukemia cells at diagnosis. Blood 1992;79:473-480.

24. Martinez A, San Miguel JF, Valverde B, Barez A, Moro MJ,Carcia-Marcos MA et al. Functional expression of MDR-1 inacute myeloid leukemia: correlation with the clinical-biological, immunophenotypical, and prognostic diseasecharacteristics. Ann Hematol 1997;75:81-86.

25. ∫uwazuru Y, Yoshimura A, Hanada S, Ichikawa M, Saito T,Uozumi K et al. Expression of the multidrug transporter, P-glycoprotein, in chronic myelogenous leukaemia cells inblast crisis. Br J Haematol 1990;74:24-30.

26. Kuwazuru Y, Yoshimura A, Hanada S, Utsunomiya A,Makino T, Ishibashi K et al. Expression of the multidrugtransporter, P-glycoprotein, in acute leukemia cells andcorrelation to clinical drug resistance. Cancer 1990;66:868-672.

27. Kuwazuru Y, Hanada S, Furukawa T, Yoshimura A,Sumizawa T, Utsunomiya A et al. Expression of P-glycoprotein in adult T-cell leukemia cells. Blood1990;76:2065-2070.

28. O’Meara A, Imamura A, Johnson P, Ball R, Rooney S, KierceB et al. Reactivity of P-glycoprotein monoclonal antibodiesin childhood cancers. Oncology 1992;49:203-208.

29. den Boer ML, Pieters R, Kazemier KM, Rottier MM, ZwaanCM, Kaspers GJ et al. Relationship between major vaultprotein/lung resistance protein, multidrug resistance-associated protein, P-glycoprotein expression, and drugresistance in childhood leukemia. Blood 1998;91:2092-2098.

30. Goasguen JE, Lamy T, Bergeron C, Ly Sunaram B, MordeletE, Gorre G et al. Multifactiorial drug-resistance phenomenonin acute leukemias: impact of P170-MDR1, LRP56 protein,glutathione-transferases and metallothio-nein systems onclinical outcome. Leuk Lymphoma 1996; 23:567-576.

31. ItÔ À, Tanimoto M, Kumazawa T, Okumura M, Morishima Y,Ohno R et al. Increased P-glycoprotein expression andmultidrug-resistant gene (MDR1) amplification areinfrequently found in fresh acute leukemia cells. Cancer1989;63:1534-1539.

32. ªarie JP, Zittoun R, Siki B. Multidrug resistance (MDR-1)gene expression in adult acute leukemia: correlation withtreatment outcome and in vitro drug sensitivity. Blood1990;78:586-590.

33. Pirker R, Wallner J, Geissler K, Linkesch W, Haas OA,Bettelheim P et al. MDR1 gene expression and treatment

JAN-FEB-03 14-05-03 14:38 ™ÂÏ›‰·80


81

outcome in acute myeloid leukemia. J Natl Cancer Inst1991;83:708-712.

34. Michieli M, Damiani D, Geromin A, Michelutti A, Fanin R,Raspadori D et al. Overexpression of multidrug resistance-associated p170-glycoprotein in acute non-lymphocyticleukemia. Eur J Haematol 1992;48:87-92.

35. Willman CL. The prognostic significance of the expressionand function of multifdrug resistance transporter proteins inacute myeloid leukemia: studies of the Southwest OncologyGroup Leukemia Research Program. Semin Hematol

1997;34 (5 Suppl):25-33.36. Dhooge C, Moerloose B, Laureys G, Kint J, Ferster A, De

Bacquer D et al. P-glycoprotein is an independentprognostic factor predicting relapse in childhood acutelymphoblastic leukaemia: results of a 6-year prospectivestudy. Br J Haematol 1999;105:676-683.

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙ· ∆˙ÒÚÙ˙Ë ¶Ï·Ù·ÈÒÓ 7, Ã·˚‰¿ÚÈ, ∆.∫. 124 61, ∞ı‹Ó·

™ÎÔfi˜: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÂÚÂ˘ÓËıÂ› ·Ó Ô ·Ó·ÛÙÔ-Ï¤·˜ ·1-ÚˆÙÂ˚Ó¿ÛË ÙË˜ ÂÏ·ÛÙ¿ÛË˜ (∂-·1-PI) ÛÙÔÓ ÔÚfi Î·È Ù·Ô‡Ú· ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› Û·Ó ¤Ó·˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›-ÎÙË˜ ÙˆÓ Ô˘ÚÔÏÔÈÌÒÍÂˆÓ ÛÙ· ÓÂÔÁÓ¿.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÙÚ‹ıËÎ·Ó ÌÂ ·ÓÔÛÔÚÔÛ‰ÈÔÚÈÛÌfi Ù·Â›Â‰· ∂-·1-PI ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú·: ·) ÛÂ 23 ÓÂÔÁÓ¿ ÌÂÔ˘ÚÔÏÔ›ÌˆÍË, Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È 72ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ‚) ÛÂ 10 “Ê˘ÛÈÔÏÔÁÈÎ¿”ÓÂÔÁÓ¿, ÌÂ ‹È· ÚÔ‚Ï‹Ì·Ù·, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û·ÓÌ¿ÚÙ˘ÚÂ˜ Î·È Á) ÛÂ 15 ÓÂÔÁÓ¿ ÌÂ ÂÈ‚Â‚·ÈˆÌ¤ÓË Û‹„Ë. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· Â›Â‰· Ï¿ÛÌ·ÙÔ˜ ÙÔ˘ ∂-·1-PI ‰ÂÓ ‰È¤-ÊÂÚ·Ó ÌÂÙ·Í‡ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ Ô˘ÚÔÏÔ›ÌˆÍË Î·È ÙˆÓ “Ê˘ÛÈÔ-ÏÔÁÈÎÒÓ”. ∆· Â›Â‰· fiÌˆ˜ ÙË˜ ∂-·1-PI ÛÙ· Ô‡Ú· ‹Ù·Ó ÛËÌ·-ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÛÙ· ÓÂÔÁÓ¿ ÌÂ Ô˘ÚÔÏÔ›ÌˆÍË Î·Ù¿ ÙËÓ ÂÈÛ·-ÁˆÁ‹ ÙÔ˘˜, Û˘ÁÎÚÈÓfiÌÂÓ· ÌÂ ÂÎÂ›Ó· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ. ª›·ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ∂-·1-PI ÛÙ· Ô‡Ú· ·-Ú·ÙËÚ‹ıËÎÂ 72 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Û¯Â‰fiÓÛÂ fiÏ· Ù· ÓÂÔÁÓ¿, ÂÎÙfi˜ ·fi 2 ÓÂÔÁÓ¿ ÛÙ· ÔÔ›· Ë ÏÔ›ÌˆÍË‹Ù·Ó Â›ÌÔÓË. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ fiÙÈ Ë Û˘ÁÎ¤-ÓÙÚˆÛË ÙÔ˘ ∂-·1-PI ÛÙ· Ô‡Ú· ÛÙÔ Â›Â‰Ô ·ÔÎÔ‹˜ (cutoff

level) ÙˆÓ 48 Ìg/l Â›¯Â Â˘·ÈÛıËÛ›· 83%, ÂÈ‰ÈÎfiÙËÙ· 90%, ıÂÙÈ-Î‹ ÚÔ‚ÏÂÙÈÎ‹ ·Í›· 95% Î·È Ì›· ·ÚÓËÙÈÎ‹ ÚÔ‚ÏÂÙÈÎ‹ ·Í›·69% ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ Ô˘ÚÔÏÔÈÌÒÍÂˆÓ ÛÙ· ÓÂÔÁÓ¿. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·˘ÍËÌ¤Ó· Â›Â‰· ÛÙ· Ô‡Ú· ÙÔ˘ ∂-·1-PIÊ·›ÓÂÙ·È Ó· Â›Ó·È ¤Ó· ¯Ú‹ÛÈÌÔ ‰È·ÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÛÙÈ˜ ÓÂÔ-ÁÓÈÎ¤˜ Ô˘ÚÔÏÔÈÌÒÍÂÈ˜, ·ÎfiÌË Î·È ÛÙ· ÓÂÔÁÓ¿ Ô˘ ·›ÚÓÔ˘Ó·ÓÙÈ‚›ˆÛË Î·È Èı·Ó¿ ¤Ó·˜ ÔÏ‡ÙÈÌÔ˜ ‰Â›ÎÙË˜ ÁÈ· ÙËÓ ·ÔÙ˘-¯›· ÙË˜ ıÂÚ·Â›·˜.

∂›Â‰· ÙÔ˘ ·Ó·ÛÙÔÏ¤· ·1-ÚˆÙÂ˚Ó¿ÛË ÙË˜ ÂÏ·ÛÙ¿ÛË˜ ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ÓÂÔÁ¤ÓÓËÙˆÓ ÌÂ Ô˘-ÚÔÏÔ›ÌˆÍË1


1Bakakos P, Messaritaki A, Mandyla H, Nicolaidou P,Anagnostakis D Plasma and urine elastase alpha-1-proteinase inhibitorlevels in neonatal urinary tract infection Biol Neonate 2002;81:109-112

™‡ÚÔ˜ ºˆÙfiÔ˘ÏÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ∞Ó·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

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¢ËÌfiÛÈ· ˘ÁÂ›·: Á¤Ê˘Ú· ÂÈÚ‹ÓË˜* ¶. ¢. §··ÙÛ¿ÓË˜

Public health: a bridge for peace* P. D. Lapatsanis

∂π¢π∫O ∞ƒ£ƒO SPECIAL ARTICLE

OÌ. ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ, πˆ¿ÓÓÈÓ·

* ∞Ó·ÎÔÈÓÒıËÎÂ ÛÙË 12Ë ∂ÈÛÙËÌÔÓÈÎ‹ ∂Î‰‹ÏˆÛË ¶·È‰È·ÙÚÈÎ‹˜, ™ÂÙ¤Ì‚ÚÈÔ˜ 2002, πˆ¿ÓÓÈÓ·

Em. Professor of Pediatrics University of Ioannina Medical School, Ioannina

* It was presented in the 12th Pediatric ScientificConference, September 2002, Ioannina

�¶ÂÚ›ÏË„Ë: “∫·› â› ÁÉ˜ ÂåÚ‹ÓË” ‰È·ÎËÚ‡ÛÛÂÙ·ÈÛÙÔ ÂÎÎÏËÛÈ·ÛÙÈÎfi ÙÚÔ¿ÚÈÔ. OÈ “ÌÂÁ¿ÏÔÈ” ÙË˜ ÁË˜·Û¿˙ÔÓÙ·È ÙÔ ÙÚÔ¿ÚÈÔ: “∫·› â› ÁÉ˜ fiÏÂÌÔ˜”. ∏ÙÚÔÌÔÎÚ·Ù›· ¤¯ÂÈ ÛËÌÂÈÒÛÂÈ Ú·Á‰·›· ·‡ÍËÛË Î·ÈÂ˘ÓÔÂ›Ù·È Ë ·Ó¿Ù˘Í‹ ÙË˜ ÛÙÈ˜ ¯ÒÚÂ˜ Ô˘ ˘¿Ú¯ÂÈÔÏÈÙÈÎ‹ ·ÛÙ¿ıÂÈ· Î·È ¿ÓÈÛË Î·Ù·ÓÔÌ‹ ÙÔ˘ ÂıÓÈÎÔ‡ÏÔ‡ÙÔ˘. O ÛÎÔfi˜ ÙÔ˘ ÙÚÔÌÔÎÚ·ÙÈÎÔ‡ ÎÙ˘‹Ì·-ÙÔ˜ Â›Ó·È Ó· ÚÔÎ·Ï¤ÛÂÈ ıÏ›„Ë, ·ÓÈÎfi Î·È Û‡Á¯˘ÛËÛÙËÓ ÎÔÈÓˆÓ›·. ∏ ÙÚÔÌÔÎÚ·Ù›· Â›Ó·È ¤Ó· Úfi‚ÏËÌ·‰˘ÛÂ›Ï˘ÙÔ, ‰ÈfiÙÈ ÔÈ ÙÚÔÌÔÎÚ¿ÙÂ˜ ¤¯Ô˘Ó ÚÔÁÚ·Ì-Ì·ÙÈÛÌfi Î·È ÛÙfi¯Ô. O ÛÙÚ·ÙËÁfi˜ Col. Powell ÚÔ-ÊËÙÈÎ¿ ·Ó¤ÊÂÚÂ ÛÙÔ ∫ÔÁÎÚ¤ÛÔ ÙˆÓ ∏¶∞ (ª¿ÈÔ˜2001): “∏ ÙÚÔÌÔÎÚ·Ù›· Â›Ó·È ÙÔ ÛÎÔÙÂÈÓfi ÎÔÌÌ¿ÙÈÙË˜ ·ÁÎÔÛÌÈÔÔ›ËÛË˜. ∂›Ó·È Ï˘ËÚfi, ·ÏÏ¿ ¤ÙÛÈ Â›-Ó·È. ŒÓ· Ì¤ÚÔ˜ ÙÔ˘ ÎfiÛÌÔ˘ ·Û¯ÔÏÂ›Ù·È ÌÂ ÙËÓ ÙÚÔ-ÌÔÎÚ·Ù›·”. ∂›¯·Ó ·Ú¤ÏıÂÈ ÌfiÓÔ ÙÚÂÈ˜ Ì‹ÓÂ˜ ·fiÙËÓ ÔÌÈÏ›· ÙÔ˘ Col. Powell, fiÙ·Ó Â‹ÏıÂ ÙÔ ÎÙ‡ËÌ·ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›Ô˘ ÛÙË ¡. ÀfiÚÎË. ∏ ÙÚÔÌÔÎÚ·-Ù›· Â›Ó·È Ì›· Î·Ù¿ÛÙ·ÛË Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È, ·ÏÏ¿‰ÂÓ ÂÍÔ˘‰ÂÙÂÚÒÓÂÙ·È. ∏ ‰ËÌfiÛÈ· ˘ÁÂ›· ÌÔÚÂ› Ó··ÔÙÂÏ¤ÛÂÈ ¤Ó· ·fi Ù· Ô˘ÛÈÒ‰Ë Ì¤ÙÚ· Î·Ù¿ ÙË˜ÙÚÔÌÔÎÚ·Ù›·˜. ∏ ÈÛÙÔÚ›· ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó ‰Â›¯ÓÂÈÒ˜ ·Ó·Ù‡¯ıËÎÂ Ë ÙÚÔÌÔÎÚ·Ù›·. ∏ ¯ÒÚ· ·˘Ù‹ Â›200 ¯ÚfiÓÈ· Â›¯Â ÛÙÚ·ÙËÁÈÎ‹ ÛËÌ·Û›· ÁÈ· ÙÈ˜ ·˘ÙÔ-ÎÚ·ÙÔÚ›Â˜. ∆Ô ∞ÊÁ·ÓÈÛÙ¿Ó, ÙÔ 1970, ¤ÁÈÓÂ ÙÔ Ì‹ÏÔÙË˜ ¤ÚÈ‰Ô˜ ÌÂÙ·Í‡ ÙˆÓ ∏¶∞ Î·È ÙË˜ ™Ô‚ÈÂÙÈÎ‹˜ ŒÓˆ-ÛË˜. OÈ ÎÔÌÌÔ˘ÓÈÛÙ¤˜ ÂÎıÚfiÓÈÛ·Ó ÙÔ ‚·ÛÈÏ¤· ™·¯ ÙÔ1973 Î·È ÙÔ 1978 ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ ÎÔÌÌÔ˘ÓÈÛÙÈÎ‹ ‰È-ÎÙ·ÙÔÚ›· Ô˘ Ô‰‹ÁËÛÂ ÛÂ Ì·˙ÈÎ¤˜ ÂÎÙÂÏ¤ÛÂÈ˜ ÙÔ˘ ·Ê-Á·ÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. OÈ ∏¶∞, ÔÈ ÔÔ›Â˜ ˘ÔÛÙ‹ÚÈ˙·ÓÙÔ ¶·ÎÈÛÙ¿Ó, ‰ËÌÈÔ‡ÚÁËÛ·Ó ·ÓÙ›ÛÙ·ÛË ÛÙÔ ∞ÊÁ·ÓÈ-ÛÙ¿Ó. ∆Ô 1989, Ô ÚfiÂ‰ÚÔ˜ °ÎÔÚÌ·ÙÛfiÊ ·Ó·ÁÎ¿-ÛÙËÎÂ Ó· ÙÂÏÂÈÒÛÂÈ ·˘ÙfiÓ ÙÔÓ ¯ÚfiÓÈÔ fiÏÂÌÔ.

�Abstract: The last decades the hymn of thechurch “a peace over the land” is not praised butthe hymn “a war over the land” is embraced.Terrorism thrives in countries with varying degreesof state failure. The purpose of the terroristic hit is toproduce panic, confusion, and grief in the society.The terrorists will not be easy to eradicate from thesociety because such is the nature of terrorism. TheGeneral Colin Powell reported in the US senate inMay 2001 that “Terrorism is part of the dark side ofglobalisation. However, sadly, it is part of doingbusiness in the world”. His words were to proveprophetic because on Tuesday September 11,2001, terrorism raised a threat on human life. Publichealth could be one of the important measuresagainst terrorism. The history of Afghanistan revealshow the terrorism has been developed. For almost200 years the country was a strategic spot forempires. The Russian-Iranian axis with US wereagainst the Taliban (2001). Afghanistan peoplecould be a little cynical to western politicians whopromised peace to the Afghans. Afghanistan andPakistan are both at the lowest level of child healthcare. Life-expectancy for men is 45.3 and women47.2 (1999). Infant mortality rate per 1000 live birthsis 165; mortality rate in under 5 year-old is 257ò;adult illiteracy 74%, malnutrition 70% while use ofbetterment water service is 13%. Concerning theMiddle East crisis it is obvious that bothcommunities will support revenge as a normal andacceptable strategy. C. Bellamy noted that “Israelisand Palestinians teach their children to use terrorismincreasing their acceptance of violence as a method

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∆· Ì¤Û· Ì·˙ÈÎ‹˜ ÂÓËÌ¤ÚˆÛË˜ ÙË˜ ¢‡ÛË˜ ·Ó¤ÊÂÚ·ÓÂÏ¿¯ÈÛÙ· ÁÈ· ÙËÓ ·ÓÙÈ·Ú¿ıÂÛË ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó,ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ¯ÒÚ· Ó· ÂÁÎ·Ù·ÏÂÈÊıÂ› ÛÙÔÓ fiÏÂ-ıÚÔ. OÈ ∆·ÏÈÌ¿Ó, ˘ÔÛÙËÚÈ˙fiÌÂÓÔÈ ·fi ÙÔ ¶·ÎÈ-ÛÙ¿Ó, Î·Ù¤Ï·‚·Ó ÙËÓ ÂÍÔ˘Û›· Î·È ·ÓÙÈÎ·Ù¤ÛÙËÛ·ÓÙÔ 1995 ÙÔ ÎÔÌÌÔ˘ÓÈÛÙÈÎfi Î·ıÂÛÙÒ˜ ÌÂ ¤Ó·Ó ÚÔÈ-ÎÈÛÌ¤ÓÔ, ·ÏÏ¿ ÂÍÙÚÂÌÈÛÙ‹ ÈÛÏ·ÌÈÛÙ‹ (Wahhabism).O ¿ÍÔÓ·˜ ƒˆÛ›·˜-πÚ¿Ó Ì·˙› ÌÂ ÙÈ˜ ∏¶∞ ‹Ù·Ó ÂÓ·-ÓÙ›ÔÓ ÙˆÓ ∆·ÏÈÌ¿Ó. OÈ ˘ÔÛ¯¤ÛÂÈ˜ ÙˆÓ ÔÏÈÙÈÎÒÓÙÔ˘ ‰˘ÙÈÎÔ‡ ÎfiÛÌÔ˘ ÁÈ· ÂÈÚ‹ÓÂ˘ÛË ÛÙËÓ ÂÚÈÔ¯‹·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ Î˘ÓÈÛÌfi ·fi ÙÔ˘˜ ∞ÊÁ·ÓÔ‡˜.O ‰Â›ÎÙË˜ ÂÈ‚›ˆÛË˜ Î·Ù¿ ÙÔ ¤ÙÔ˜ 1999 ÁÈ· ÙÔ˘˜¿Ó‰ÚÂ˜ ‹Ù·Ó 45,3 ¯ÚfiÓÈ· Î·È ÁÈ· ÙÈ˜ Á˘Ó·›ÎÂ˜ 47,2.∏ ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌfiÙËÙ· ·Ó¤Ú¯ÂÙ·È ÛÙÔ 165ò, ÂÓÒÛÙÈ˜ ∏¶∞ ÛÙÔ 7ò. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·Ó·ÏÊ¿‚ËÙˆÓÛÙÔÓ ÏËı˘ÛÌfi ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó ·Ó¤Ú¯ÂÙ·È ÛÙÔ64% Î·È ÛÙÈ˜ ∏¶∞ ÛÙÔ 1%. O ˘ÔÛÈÙÈÛÌfi˜ ÛÙÔ Û‡-ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó¤Ú¯ÂÙ·È ÛÂ 70% ÛÙÔ ∞ÊÁ·-ÓÈÛÙ¿Ó Î·È 0% ÛÙËÓ ∞ÌÂÚÈÎ‹. ∫·ı·Úfi, fiÛÈÌÔ ÓÂÚfiÂ›Ó·È ‰È·ı¤ÛÈÌÔ ÛÙÔ 13% ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙÔ˘ ∞ÊÁ·-ÓÈÛÙ¿Ó Î·È ÛÙÔ 100% ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ∞ÌÂÚÈÎ‹˜.™Â ¤Ó· ÙÌ‹Ì· ÙË˜ ∆Â¯ÂÚ¿ÓË˜, Ë ·ÚÔ¯‹ ÓÂÚÔ‡ ‰È·-ÎfiÙÂÙ·È 12 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰·. ∞ÍÈˆÌ·ÙÔ‡¯ÔÈ ÙÔ˘¶·ÎÈÛÙ¿Ó ·Ó¤ÊÂÚ·Ó fiÙÈ ÏfiÁˆ ÍËÚ·Û›·˜ ˘‹ÚÍ·Ó·ÒÏÂÈÂ˜ 1,2 ‰ÈÛÂÎ·ÙÔÌÌ˘Ú›ˆÓ ‰ÔÏ·Ú›ˆÓ ∞ÌÂÚÈÎ‹˜ÂÎ ÙˆÓ ·ÁÚÔÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ. ™¯Â‰fiÓ ÌÈÛfi ‰ÈÛÂ-Î·ÙÔÌÌ‡ÚÈÔ ¿ÓıÚˆÔÈ ÛÙÔÓ Ï·Ó‹ÙË Ì·˜ ‰ÂÓ ¤¯Ô˘ÓÂ¿ÚÎÂÈ· ·ÚÔ¯‹˜ ÓÂÚÔ‡ Î·È ·Ó ‰ÂÓ ÏËÊıÔ‡Ó Ì¤-ÙÚ·, ÙÔ 2025 ÙÔ 35% ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ÁË˜ ı·¤¯ÂÈ Ï›·Ó ÌÂÈˆÌ¤ÓË ·ÚÔ¯‹ ÓÂÚÔ‡ (Û¯Â‰fiÓ 2,8 ‰È-ÛÂÎ·ÙÔÌÌ‡ÚÈ· ¿ÓıÚˆÔÈ). ∏ ÌÂÈˆÌ¤ÓË ·ÚÔ¯‹ ÓÂ-ÚÔ‡ ‰ËÌÈÔ˘ÚÁÂ› ÎÔÈÓˆÓÈÎ‹ Î·È ÔÈÎÔÓÔÌÈÎ‹ ÂÚ‹ÌˆÛËÎ·È Èı·ÓÒ˜ “ÌÂÙ·Ó¿ÛÙÂ˜ ‡‰·ÙÔ˜”. ∆Ô 1998, Ë ¤Î-ıÂÛË ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ OÚÁ·ÓÈÛÌÔ‡ ÀÁÂ›·˜ ·Ó·Ê¤-ÚÂÈ fiÙÈ ··ÈÙÔ‡ÓÙ·È 10 ‰ÈÛÂÎ·ÙÔÌÌ‡ÚÈ· ‰ÔÏ¿ÚÈ· ÙÔ¯ÚfiÓÔ ÁÈ· Ó· ÂÊÔ‰È·ÛÙÂ› fiÏÔ˜ Ô ÏËı˘ÛÌfi˜ ÙË˜ÁË˜ ÌÂ Î·ı·Úfi ÓÂÚfi. ∞˘Ùfi ÙÔ ÎfiÛÙÔ˜ ÈÛÔ‰˘Ó·ÌÂ›ÌÂ ÙÔ 1/10 ÙˆÓ ¯ÚËÌ¿ÙˆÓ Ô˘ ÍÔ‰Â‡Ô˘Ó ÔÈ ∂˘Úˆ-·›ÔÈ ÁÈ· ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ ‹ ÌÂ ÙÔ ‹ÌÈÛ˘ ÙˆÓ ¯ÚË-Ì¿ÙˆÓ Ô˘ Î·Ù·Ó·ÏÒÓÔ˘Ó ∞ÌÂÚÈÎ·ÓÔ› Î·È ∂˘Úˆ·›-ÔÈ Î¿ıÂ ¯ÚfiÓÔ ÁÈ· ˙ˆÔÙÚÔÊ¤˜ ÙˆÓ Î·ÙÔÈÎ›‰ÈˆÓ ˙Ò-ˆÓ ÙÔ˘˜. ∞fi ÙËÓ ÎÚ›ÛË ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹ Ê·›ÓÂ-Ù·È fiÙÈ ÙfiÛÔ ÔÈ πÛÚ·ËÏÈÓÔ› fiÛÔ Î·È ÔÈ ¶·Ï·ÈÛÙ›ÓÈÔÈıÂˆÚÔ‡Ó ÙËÓ Â›Ï˘ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·Ùfi˜ ÙÔ˘˜ ÂÊÈ-ÎÙ‹ ÌÂ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ú¿ÍÂˆÓ ÂÎ‰›ÎËÛË˜ Î·È ‚›·˜.O ‰ÈÂ˘ı˘ÓÙ‹˜ ÙË˜ UNICEF C. Bellamy ·Ó¤ÊÂÚÂ fiÙÈÔÈ πÛÚ·ËÏÈÓÔ› Î·È ÔÈ ¶·Ï·ÈÛÙ›ÓÈÔÈ ‰È‰¿ÛÎÔ˘Ó ÛÙ··È‰È¿ ÙÔ˘˜ ÙËÓ ÙÚÔÌÔÎÚ·Ù›· ˆ˜ Ì¤ıÔ‰Ô Â›Ï˘ÛË˜ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜. OÈ Î˘‚ÂÚÓ‹ÛÂÈ˜ ÙË˜ ∂Ó.∂˘ÚÒË˜ Î·È ÙˆÓ ∏¶∞ Ô˘ ÈÛ¯˘Ú›˙ÔÓÙ·È fiÙÈ Â›Ó·ÈÌÂÛÔÏ·‚ËÙ¤˜ ÙË˜ ÂÈÚ‹ÓË˜ ÛÙÔÓ ÎfiÛÌÔ, Ú¤ÂÈ Ó·ÎÈÓËÙÔÔÈËıÔ‡Ó ÒÛÙÂ ÌÂÙ¿ ÙËÓ Î·Ù¿·˘ÛË ÙˆÓÂ¯ıÚÔÚ·ÍÈÒÓ Ó· ÂÈÌÂÏËıÔ‡Ó ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜, ‰ÈfiÙÈ Ô ¿Ì·¯Ô˜ ÏËı˘ÛÌfi˜

for resolving problems”. In old days there was oneHerod but nowadays there are many. Christ will notbe born again but he continues to suffer in theMiddle East on behalf of innocent civilian victimswho die in the street, bus, school or their houses.

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“∫·› â› ÁÉ˜ ÂåÚ‹ÓË” ‰È·ÎËÚ‡ÛÛÂÙ·È ÛÙÔ ÂÎÎÏË-ÛÈ·ÛÙÈÎfi ÙÚÔ¿ÚÈÔ ÙË˜ °¤ÓÓËÛË˜ ÙÔ˘ £Â·ÓıÚÒÔ˘.OÈ “ÌÂÁ¿ÏÔÈ” fiÌˆ˜ ÙË˜ ÁË˜ ·Û¿˙ÔÓÙ·È ÙÔ ÙÚÔ¿-ÚÈÔ “∫·› â› ÁÉ˜ fiÏÂÌÔ˜” (1). ∆· ÎÚÔ‡ÛÌ·Ù· ÙˆÓÙÚÔÌÔÎÚ·ÙÈÎÒÓ ÎÙ˘ËÌ¿ÙˆÓ ¤¯Ô˘Ó ·˘ÍËıÂ› ÛÂ ¯Ò-ÚÂ˜ ÌÂ ÔÏÈÙÈÎ‹ Î·È ÔÈÎÔÓÔÌÈÎ‹ ·ÛÙ¿ıÂÈ· fiˆ˜ Ë∞ÏÁÂÚ›·, ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó, Ë µfiÚÂÈ· πÚÏ·Ó‰›·, ÙÔπÚ¿Î, Ë ∫ÔÏÔÌ‚›·, Ë ¶·Ï·ÈÛÙ›ÓË Î·È ÙÔ ™Ô˘‰¿Ó. ∞˘-Ù¤˜ ÔÈ ¯ÒÚÂ˜ ‰È·ÎÚ›ÓÔÓÙ·È Î·È ÁÈ· ÙËÓ ¿ÓÈÛË Î·Ù·-ÓÔÌ‹ ÙÔ˘ ÂıÓÈÎÔ‡ ÏÔ‡ÙÔ˘.

O Pillar, ·Ú¯ËÁfi˜ ÙË˜ ·ÓÙÈÙÚÔÌÔÎÚ·ÙÈÎ‹˜ ÔÚÁ¿-ÓˆÛË˜ ÙˆÓ ∏¶∞, Ô ÔÔ›Ô˜ ‹Ù·Ó ·Ú¯ËÁfi˜ ÙË˜ CIA(Central Intelligence Agency), ÛÙÔ ‚È‚Ï›Ô “∏ ÙÚÔÌÔ-ÎÚ·Ù›· Î·È Ë ÂÍˆÙÂÚÈÎ‹ ÔÏÈÙÈÎ‹ ÙË˜ ∞ÌÂÚÈÎ‹˜”ÈÛ¯˘Ú›˙ÂÙ·È fiÙÈ Ë ÙÚÔÌÔÎÚ·Ù›· ÌÔÚÂ› Ó· ·ÓÙÈÌÂÙˆ-ÈÛÙÂ› ÌÂ ÂÍˆÙÂÚÈÎ‹ ÔÏÈÙÈÎ‹ Î·È fi¯È ÌÂ ·ÓÙÈÙÚÔÌÔ-ÎÚ·ÙÈÎ¿ Ì¤ÙÚ· fiˆ˜ ‰ÈÏˆÌ·Ù›·, ·Ú·ÓÔÌ›·, ÛÙÚ·-ÙÈˆÙÈÎ‹ ‚›· Î·È ÔÈÎÔÓÔÌÈÎfi ÂÌ¿ÚÁÎÔ (2). ∞˘Ù¿ ÎÚ›-ÓÔÓÙ·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Î·È ‰ÂÓ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ‡ÊÂÛË ÙË˜ ÙÚÔÌÔÎÚ·Ù›·˜. ¢ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ‰Èı‡-Ú·Ì‚ÔÈ Î·È Ê·ÓÊ·ÚÔÓÈÛÌÔ›. O ÛÙÚ·ÙËÁfi˜ Col.Powell ÚÔÊËÙÈÎ¿ ·Ó¤ÊÂÚÂ ÛÙËÓ ÔÌÈÏ›· ÙÔ˘ ÙÔÓª¿ÈÔ ÙÔ˘ 2001 ÛÙÔ ∫ÔÁÎÚ¤ÛÔ: “∏ ÙÚÔÌÔÎÚ·Ù›· Â›-Ó·È ÙÔ ÛÎÔÙÂÈÓfi ÎÔÌÌ¿ÙÈ ÙË˜ ·ÁÎÔÛÌÈÔÔ›ËÛË˜. ∂›-Ó·È Ï˘ËÚfi, ·ÏÏ¿ ¤ÙÛÈ Â›Ó·È. ŒÓ· Ì¤ÚÔ˜ ÙÔ˘ ÎfiÛÌÔ˘·Û¯ÔÏÂ›Ù·È ÌÂ ÙËÓ ÙÚÔÌÔÎÚ·Ù›·”.

∏ ÙÚÔÌÔÎÚ·Ù›· ·ÔÙÂÏÂ› ‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ·,Î·ıÒ˜ ÔÈ ÙÚÔÌÔÎÚ¿ÙÂ˜ ‰È·ı¤ÙÔ˘Ó ÚÔÁÚ·ÌÌ·ÙÈÛÌfiÎ·È ÛÙfi¯Ô Î·È ÂÓÂÚÁÔ‡Ó ÌÂ ÚÔÛÂÎÙÈÎÔ‡˜ ¯ÂÈÚÈ-ÛÌÔ‡˜. ∂›ÛË˜, Ô ¯ÚfiÓÔ˜ Î·È Ô ÙfiÔ˜ Ì›·˜ ÙÚÔÌÔ-ÎÚ·ÙÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜ Î·ıÔÚ›˙ÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ·fiÙÔ˘˜ ‰Ú¿ÛÙÂ˜. ŒÙÛÈ, ÔÔÈÔ‰‹ÔÙÂ Ì¤ÙÚÔ ·ÛÊ¿ÏÂÈ-·˜ ÛÂ ·ÂÚÔÏ¿Ó· ‹ ·ÂÚÔ‰ÚfiÌÈ·, fiˆ˜ ÛÙÚ·ÙÈˆÙÈ-Î¤˜ ‰˘Ó¿ÌÂÈ˜, Â›Ó·È ·ÓÂ·ÚÎ¤˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙˆÓ ÙÚÔÌÔÎÚ·ÙÒÓ.

∆Ô ÙÚÔÌÔÎÚ·ÙÈÎfi ÎÙ‡ËÌ· ÚÔÎ·ÏÂ› „˘¯ÔÏÔÁÈ-

Î¿ ÙÚ·‡Ì·Ù·, ıÏ›„Ë, ·ÓÈÎfi Î·È Û‡Á¯˘ÛË (3). ∏ÙÚÔÌÔÎÚ·Ù›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÔÏÈÙÈÎ‹˜ Î·È ÎÔÈÓˆ-ÓÈÎ‹˜ ·ÏÏ·Á‹˜.

ªÂÙ¿ ÙÔ ıÏÈ‚ÂÚfi ÎÙ‡ËÌ· ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›-Ô˘ 2001 ÛÙË ¡. ÀfiÚÎË, Ë ÂÍˆÙÂÚÈÎ‹ ·ÌÂÚÈÎ·ÓÈÎ‹ÔÏÈÙÈÎ‹ ÛÙËÚ›¯ÙËÎÂ ÛÙË ÛÙÚ·ÙÈˆÙÈÎ‹ ÈÛ¯‡ Î·È ¯ÚË-ÛÈÌÔÔ›ËÛÂ ÙË ÁÏÒÛÛ· ÙË˜ ·ÓÙÂÎ‰›ÎËÛË˜. O ªÔ˘˜˙‹ÙËÛÂ ·fi fiÏ· Ù· ÔÏÈÙÈÛÌ¤Ó· ÎÚ¿ÙË Ó· Û˘ÓÂÚÁ·-ÛÙÔ‡Ó ÁÈ· Ó· ÂÎ‰ÈÒÍÔ˘Ó ·fi ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó ÙÔ˘˜∆·ÏÈÌ¿Ó, ÔÈ ÔÔ›ÔÈ ›Ûˆ˜ ¤¯Ô˘Ó ÚÔÎ·Ï¤ÛÂÈ Îfiˆ-ÛË ÛÙÔ Ï·fi ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó. ∏ Ù·ÎÙÈÎ‹ ·˘Ù‹ ¤¯ÂÈ¯·Ú·ÎÙËÚÈÛÙÂ› ˆ˜ ÌË ÔÚı‹. OÈ ∞ÌÂÚÈÎ·ÓÔ› ÏËÛÌfi-ÓËÛ·Ó ÙËÓ È·ÙÚÈÎ‹ Î·È ÙË ‰ËÌfiÛÈ· ˘ÁÂ›·, ÔÈ ÔÔ›Â˜·›˙Ô˘Ó ¤Ó·Ó ¤ÌÌÂÛÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÈ· ÙËÓ·ÛÊ¿ÏÂÈ· ÙË˜ ÂÈÚ‹ÓË˜ Î·È ÙË ÛÙ·ıÂÚfiÙËÙ· ÛÂ ¯Ò-ÚÂ˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fi ‰È¿Ï˘ÛË Î·È Î·Ù¿ÙˆÛË. ∏‰ËÌfiÛÈ· ˘ÁÂ›· ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ÙÔ Î·Ï‡ÙÂÚÔ·ÓÙÈÙÚÔÌÔÎÚ·ÙÈÎfi Ì¤ÙÚÔ Ô˘ ·ÎfiÌË, fiÌˆ˜, ‰ÂÓ ¤¯ÂÈ¯ÚËÛÈÌÔÔÈËıÂ›.

∆Ô ∞ÊÁ·ÓÈÛÙ¿Ó ‰ÂÓ Â›Ó·È ÔÌÔÈÔÁÂÓ¤˜ ÎÚ¿ÙÔ˜.Œ¯ÂÈ 22 ÂÎ·ÙÔÌÌ‡ÚÈ· ÏËı˘ÛÌfi Ô˘ ·ÔÙÂÏÂ›Ù·È·fi ∆·˙›ÎÔ˘˜, O˘˙Ì¤ÎÔ˘˜ Î·È ¶·ÛÙÔ‡Ó˜. OÈ ∆·ÏÈ-Ì¿Ó ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ˘˜ ¶·ÛÙÔ‡Ó˜. ∏ ÚfiÛÊ·-ÙË ÈÛÙÔÚ›· ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó ‰Â›¯ÓÂÈ fiÙÈ ‹Ù·Ó Ì›· ¯Ò-Ú· ÂÈÚÚÂ‹˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙË˜ ÙÚÔÌÔÎÚ·Ù›·˜,‰ÈfiÙÈ Â› ‰‡Ô ·ÈÒÓÂ˜ ‹Ù·Ó ÛÙÚ·ÙËÁÈÎ‹ ı¤ÛË ÁÈ· ·˘-ÙÔÎÚ·ÙÔÚ›Â˜ ÛÂ ·ÎÌ‹ ‹ ·Ú·ÎÌ‹.

∆Ô 1970, ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó ¤ÁÈÓÂ ÙÔ Ì‹ÏÔ ÙË˜ ¤ÚÈ-‰Ô˜ ÌÂÙ·Í‡ ÙˆÓ ∏¶∞ Î·È ÙË˜ ™Ô‚ÈÂÙÈÎ‹˜ ŒÓˆÛË˜.∆Ô 1973, ÔÈ ÎÔÌÌÔ˘ÓÈÛÙ¤˜ ÂÎıÚfiÓÈÛ·Ó ÙÔ ‚·ÛÈÏ¤·™·¯. ∆Ô 1978 ¤ÁÈÓÂ ÎÔÌÌÔ˘ÓÈÛÙÈÎ‹ ‰ÈÎÙ·ÙÔÚ›·, ËÔÔ›· Ô‰‹ÁËÛÂ ÛÂ Ì·˙ÈÎ¤˜ ÂÎÙÂÏ¤ÛÂÈ˜ ÙÔ˘ ·ÊÁ·ÓÈ-ÎÔ‡ ÏËı˘ÛÌÔ‡. OÈ ∏¶∞ Ô˘ ˘ÔÛÙ‹ÚÈ˙·Ó ÙÔ ¶·ÎÈ-ÛÙ¿Ó ‰ËÌÈÔ‡ÚÁËÛ·Ó ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó ·ÓÙ›ÛÙ·ÛË.∞˘Ù‹ Ë ¯ÚfiÓÈ· Û‡ÚÚ·ÍË ·Ó¿ÁÎ·ÛÂ ÙÔ 1989 ÙÔÓ Úfi-Â‰ÚÔ °ÎÔÚÌ·ÙÛfiÊ Ó· ÙÂÚÌ·Ù›ÛÂÈ ÙÔÓ fiÏÂÌÔ. ∆·

Â›Ó·È Ù·Ï·ÈˆÚËÌ¤ÓÔ˜, Î·ÎÔÔÈËÌ¤ÓÔ˜ Î·È ÙÚ·˘Ì·-ÙÈÛÌ¤ÓÔ˜. O Benjamin Disraeli ·Ó·Ê¤ÚÂÈ ÙÔ 1877 fiÙÈ“Ë ˘ÁÂ›· ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È Ë Ú·ÁÌ·ÙÈÎ‹ ıÂÌÂ-Ï›ˆÛË˜ ÙË˜ Â˘Ù˘¯›·˜ Î·È ÙË˜ ‰‡Ó·ÌË˜ ÁÈ· Ì›· ·ÓÂ-Í¿ÚÙËÙË ÔÏÈÙÂ›·”. ∆ËÓ ÂÔ¯‹ Ô˘ ÁÂÓÓ‹ıËÎÂ Ô ÃÚÈ-ÛÙfi˜ ˘‹Ú¯Â ¤Ó·˜ ∏ÚÒ‰Ë˜. ™‹ÌÂÚ·, Ê·›ÓÂÙ·È fiÙÈ˘¿Ú¯Ô˘Ó ÔÏÏÔ› Ô˘ ˘ÈÔıÂÙÔ‡Ó ÙË Û˘ÌÂÚÈÊÔÚ¿ÙÔ˘ Î·È ÌÂıÔ‡Ó ·fi ÙÔ ·›Ì· ÙˆÓ ÛÊ·ÁÒÓ Î·È ÙÈ˜ ÊÔ-ÓÈÎ¤˜ ÂÎÚ‹ÍÂÈ˜. O ÃÚÈÛÙfi˜ ›Ûˆ˜ ‰ÂÓ ı· Í·Ó·ÁÂÓÓË-ıÂ›, ·ÏÏ¿ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ÛÙ·˘ÚÒÓÂÙ·È ÛÙÈ˜ ‰È¿ÊÔ-ÚÂ˜ ÂÚÈÔ¯¤˜ ÔÏ¤ÌÔ˘, ÛÙÔ ÚfiÛˆÔ ·ıÒˆÓ ı˘Ì¿-ÙˆÓ Ô˘ ·Ê‹ÓÔ˘Ó ÙËÓ ÙÂÏÂ˘Ù·›· ÓÔ‹ ÙÔ˘˜ ÛÙÔ‰ÚfiÌÔ, ÛÙÔ ÏÂˆÊÔÚÂ›Ô, ÛÙÔ Û¯ÔÏÂ›Ô ‹ Î¿Ùˆ ·fi ÙË‚ÔÌ‚·Ú‰ÈÛÌ¤ÓË ÛÙ¤ÁË ÙÔ˘ ÛÈÙÈÔ‡ ÙÔ˘˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ‰ËÌfiÛÈ· ˘ÁÂ›·, ÂÈÚ‹ÓË, ÙÚÔÌÔÎÚ·Ù›·. Key words: public health, peace, terrorism.

JAN-FEB-03 14-05-03 17:18 ™ÂÏ›‰·84

Ì¤Û· Ì·˙ÈÎ‹˜ ÂÓËÌ¤ÚˆÛË˜ ÙË˜ ¢‡ÛË˜ ·Ó¤ÊÂÚ·ÓÂÏ¿¯ÈÛÙ· ÁÈ· ÙËÓ ·ÓÙÈ·Ú¿ıÂÛË ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó,ÌÂ Û˘Ó¤ÂÈ· Ë ¯ÒÚ· Ó· ÂÁÎ·Ù·ÏÂÈÊıÂ› ÛÙÔÓ fiÏÂ-ıÚÔ. ™ÎÔÙÒıËÎ·Ó 1,5 ÂÎ·ÙÔÌÌ‡ÚÈÔ ÔÏ›ÙÂ˜, ÂÓÒ 6ÂÎ·ÙÔÌÌ‡ÚÈ· ‹Ú·Ó ÙÔ ‰ÚfiÌÔ ÙË˜ ÚÔÛÊ˘ÁÈ¿˜ÚÔ˜ ÙÔ πÚ¿Ó Î·È ÙÔ ¶·ÎÈÛÙ¿Ó.

ŒÓ·˜ ÙÚÔÌÂÚfi˜ ÂÌÊ‡ÏÈÔ˜ fiÏÂÌÔ˜ ·Ó·Ù‡¯ıË-ÎÂ ÛÙËÓ ÂÚÈÔ¯‹ ·fi ÙËÓ ·ÓÙÈ·Ú¿ıÂÛË ÙˆÓ ∏¶∞Î·È ÙË˜ ™Ô‚ÈÂÙÈÎ‹˜ ŒÓˆÛË˜. ∆Ô 1995, ÔÈ ∆·ÏÈÌ¿Ó˘ÔÛÙËÚÈ˙fiÌÂÓÔÈ ·fi ÙÔ ¶·ÎÈÛÙ¿Ó, ‹Ú·Ó ÙËÓÂÍÔ˘Û›· Î·È ·ÓÙÈÎ·Ù¤ÛÙËÛ·Ó ÙÔ ÎÔÌÌÔ˘ÓÈÛÙÈÎfi Î·-ıÂÛÙÒ˜ ·fi ¤Ó·Ó ÚÔÈÎÈÛÌ¤ÓÔ, ·ÏÏ¿ ÂÍÙÚÂÌÈÛÙ‹πÛÏ·ÌÈÛÙ‹ (Wahhabism). ∆Ô 2001, ÔÈ ∏¶∞ ˘ÔÛÙË-ÚÈ˙fiÌÂÓÂ˜ ·fi ÙË ƒˆÛ›· Î·È ÙÔ πÚ¿Ó, ‰ËÌÈÔ‡ÚÁËÛ·Ó¤Ó·Ó ¿ÍÔÓ· Î·Ù¿ ÙˆÓ ∆·ÏÈÌ¿Ó. ∂·Ó¤ÊÂÚ·Ó ÙÔÓ‚·ÛÈÏÈ¿ ™·¯ ÛÂ ËÏÈÎ›· 86 ÂÙÒÓ. OÈ ÔÏÈÙÈÎÔ› ÙË˜ ¢‡-ÛË˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÎÏ‹ÛÛÔÓÙ·È fiÙ·Ó Ô ÏËı˘-ÛÌfi˜ ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó Â›Ó·È Î˘ÓÈÎfi˜ ÁÈ· ÙËÓ ÂÈÚ‹ÓËÔ˘ ÙÔ˘˜ ÂÁÁ˘‹ıËÎ·Ó.

™‡ÌÊˆÓ· ÌÂ Ù· ÛÙÔÈ¯Â›· ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘OÚÁ·ÓÈÛÌÔ‡ ÀÁÂ›·˜, Ë ¯ÒÚ· ·˘Ù‹ ¤¯ÂÈ ÔÏ‡ ¯·ÌË-Ïfi Â›Â‰Ô ÊÚÔÓÙ›‰·˜ ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜, Î·Ù¤-¯ÔÓÙ·˜ ÙËÓ 173Ë ı¤ÛË ÛÂ Û‡ÓÔÏÔ 191 ¯ˆÚÒÓ. ™ÙÔ¶·ÎÈÛÙ¿Ó Î·È ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó, ÙÔ Â›Â‰Ô ˘ÁÂ›·˜ÙˆÓ ·È‰ÈÒÓ ‚Ú›ÛÎÂÙ·È ÛÙÔ Î·ÙÒÙ·ÙÔ Â›Â‰Ô, ‰Ë-Ï·‰‹ ·ÎfiÌË ¯·ÌËÏfiÙÂÚ· Î·È ·fi ÙË ™·¯¿Ú· ÙË˜∞ÊÚÈÎ‹˜.

∆Ô 1999, Ô ‰Â›ÎÙË˜ ÂÈ‚›ˆÛË˜ ÁÈ· ÙÔ˘˜ ¿Ó‰ÚÂ˜‹Ù·Ó Ù· 45,3 ¯ÚfiÓÈ· Î·È ÁÈ· ÙÈ˜ Á˘Ó·›ÎÂ˜ Ù· 47,2.™ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó, 165/1000 ·È‰È¿ Âı·›ÓÔ˘Ó Î·Ù¿ÙË Á¤ÓÓËÛË, ÂÓÒ ÛÙËÓ ∞ÌÂÚÈÎ‹ 7/1000. ™Ù· ·È‰È¿ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 5 ÂÙÒÓ, Âı·›ÓÔ˘Ó257/1000 Î·È 8/1000 ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó Î·È ÛÙÈ˜ ∏¶∞,·ÓÙ›ÛÙÔÈ¯·. ™ÙÈ˜ ËÏÈÎ›Â˜ ¿Óˆ ÙˆÓ 15 ÂÙÒÓ, ÙÔ 64%ÙˆÓ ∞ÊÁ·ÓÒÓ Â›Ó·È ·Ó·ÏÊ¿‚ËÙÔÈ, ÂÓÒ ÛÙÈ˜ ∏¶∞ ÙÔÔÛÔÛÙfi ·˘Ùfi ·Ó¤Ú¯ÂÙ·È ÌfiÏÈ˜ ÛÂ 1%. O ˘ÔÛÈÙÈ-ÛÌfi˜ ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ Â›Ó·È 70% Î·È 0%ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó Î·È ÛÙËÓ ∞ÌÂÚÈÎ‹, ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒÎ·ı·Úfi Î·È fiÛÈÌÔ ÓÂÚfi ·Ú¤¯ÂÙ·È ÛÙÔ 13% ÙÔ˘ÏËı˘ÛÌÔ‡ ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó Î·È ÛÙÔ 100% ÙˆÓ ∞ÌÂ-ÚÈÎ·ÓÒÓ (3). ∆Ô Û‡ÛÙËÌ· ˘ÁÂ›·˜ ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿ÓÛ¯Â‰fiÓ Î·Ù¤ÚÚÂ˘ÛÂ Ù· ÙÂÏÂ˘Ù·›· ‰‡Ô ¯ÚfiÓÈ·.

∏ ÍËÚ·Û›· Î·È Ô fiÏÂÌÔ˜ ÚÔÎ¿ÏÂÛ·Ó ÌÂÙ·Ó¿-ÛÙÂ˘ÛË ÚÔ˜ ÙÔ ¶·ÎÈÛÙ¿Ó Î·È ÙÔ πÚ¿Ó. ¢‡Ô ÂÎ·ÙÔÌ-Ì‡ÚÈ· ∞ÊÁ·ÓÔ› ÎÈÓ‹ıËÎ·Ó ÚÔ˜ ÙÔ ¶·ÎÈÛÙ¿Ó Î·È1.500.000 ÛÙÔ πÚ¿Ó. ªÂ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ·ÌÂÚÈÎ·ÓÈ-ÎÒÓ ‚ÔÌ‚·Ú‰ÈÛÌÒÓ, ¯ÈÏÈ¿‰Â˜ ¿ÓıÚˆÔÈ ¤Ê˘Á·ÓÚÔ˜ ÙÔ ¶·ÎÈÛÙ¿Ó, ÙÔ πÚ¿Ó Î·È ¿ÏÏÂ˜ ÁÂÈÙÔÓÈÎ¤˜ ¯Ò-ÚÂ˜. ∆Ô ÌÂÙ·Ó·ÛÙÂ˘ÙÈÎfi Î‡Ì· ˘ÔÏÔÁ›˙ÂÙ·È ÛÙ·ÔÎÙÒ ÂÎ·ÙÔÌÌ‡ÚÈ·. O ÏÈÌfi˜ ‹‰Ë Ì·ÛÙ›˙ÂÈ ÌÂÁ¿ÏÔÔÛÔÛÙfi ÙÔ˘ ÏËı˘ÛÌÔ‡. ∫¿Ùˆ ·fi ·˘Ù¤˜ ÙÈ˜ Û˘Ó-ı‹ÎÂ˜, Î·Ó¤Ó· ·ÓÙÈÙÚÔÌÔÎÚ·ÙÈÎfi Ì¤ÙÚÔ ‰ÂÓ Úfi-ÎÂÈÙ·È Ó· ·Ô‰ÒÛÂÈ. ¶Ú¤ÂÈ Ó· ‚ÚÂıÔ‡Ó ÙÚfiÔÈ

‚Ô‹ıÂÈ·˜ ÙˆÓ ÏËı˘ÛÌÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ Î›Ó-‰˘ÓÔ (populations at risk), ·Ú¿ Ì¤ıÔ‰ÔÈ ÙÈÌˆÚ›·˜.

O Lafeet Afridi, ·ÍÈˆÌ·ÙÔ‡¯Ô˜ ÙÔ˘ ¶·ÎÈÛÙ¿Ó,·Ó¤ÊÂÚÂ fiÙÈ Ë ¢‡ÛË Ú¤ÂÈ Ó· ÎÙ›ÛÂÈ Û¯ÔÏÂ›· Î·ÈÓÔÛÔÎÔÌÂ›· ÙÔ Ù·¯‡ÙÂÚÔ, ‰ÈfiÙÈ ÔÈ Û˘Ì·ıÔ‡ÓÙÂ˜ÚÔ˜ ÙÔ˘˜ ∆·ÏÈÌ¿Ó ı· Ï¿‚Ô˘Ó Ì¤ÚÔ˜ ÛÙÔÓ fiÏÂ-ÌÔ Î·È ı· Á›ÓÔ˘Ó ÂÈÚ·Ù¤˜ (3). ∆Ô ∞ÊÁ·ÓÈÛÙ¿Ó Â›Ó·ÈÙÔ ı‡Ì· ÙˆÓ Î˘‚ÂÚÓ‹ÛÂˆÓ Ô˘ ı¤ÏÔ˘Ó Ó· Î·Ù·Ô-ÏÂÌ‹ÛÔ˘Ó ÙËÓ ÙÚÔÌÔÎÚ·Ù›·.

∏ ÔÏÈÙÈÎ‹ ÙˆÓ ‰˘ÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ Ú¤ÂÈ Ó· Â›-Ó·È Ì·ÎÚÔ¯ÚfiÓÈ· Î·È Ó· ¤¯ÂÈ ÙÚÈÏ‹ Î·ÙÂ‡ı˘ÓÛË:˘ÁÂ›·, ·Ó¿Ù˘ÍË Î·È ·ÓıÚÒÈÓ· ‰ÈÎ·ÈÒÌ·Ù·. ∞˘Ù¿Ú¤ÂÈ Ó· ·ÔÙÂÏÔ‡Ó ÙÔ ÛÙÚ·ÙËÁÈÎfi ÎÏÂÈ‰› ÙË˜ ¢‡-ÛË˜. ∏ ÂÍˆÙÂÚÈÎ‹ ÔÏÈÙÈÎ‹ Â›Ó·È Û˘Ó‹ıˆ˜ ‚Ú·¯˘-ÚfiıÂÛÌË Î·È ÂÛÙÈ¿˙ÂÙ·È ÛÙÈ˜ ¿ÌÂÛÂ˜ ÔÏÈÙÈÎ¤˜ Î·ÈÛÙÚ·ÙÈˆÙÈÎ¤˜ ÂÈ‰ÈÒÍÂÈ˜. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘∞ÊÁ·ÓÈÛÙ¿Ó, Ù· ∏ÓˆÌ¤Ó· ŒıÓË ¤ÛÙÚÂ„·Ó fiÏË ÙËÓÚÔÛÔ¯‹ ÛÂ ¤Ó· ÚfiÛˆÔ Î·È ›ÂÛ·Ó ÙÔ˘˜ ∆·ÏÈ-Ì¿Ó Ó· ·Ú·‰ÒÛÔ˘Ó ÙÔÓ Osama Bin Laden.∞ÁÓfiËÛ·Ó ÙÈ˜ ÂÈ‰Ú¿ÛÂÈ˜ ÛÙËÓ ˘ÁÂ›· Î·È ·¤Ù˘¯·ÓÛÙËÓ ¿Ù·ÍË ÙË˜ ÙÚÔÌÔÎÚ·Ù›·˜.

OÈ ‰˘ÙÈÎ¤˜ ‰˘Ó¿ÌÂÈ˜ Ú¤ÂÈ Ó· È¤ÛÔ˘Ó ÙÔ˘˜¢ÈÂıÓÂ›˜ OÚÁ·ÓÈÛÌÔ‡˜ Ó· ‚ÔËı‹ÛÔ˘Ó ÙÔÓ ¿Û¯Ô-ÓÙ· ÏËı˘ÛÌfi. ¶·Ú¿ÏÏËÏ·, Ú¤ÂÈ Ó· ÌÂÚÈÌÓ‹-ÛÔ˘Ó ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ (Â¿Ú-ÎÂÈ· fiÛÈÌÔ˘ ÓÂÚÔ‡, ·ÔÊ˘Á‹ ÍËÚ·Û›·˜ Î.Ï.). O¶·ÁÎfiÛÌÈÔ˜ OÚÁ·ÓÈÛÌfi˜ ÀÁÂ›·˜ (¶OÀ) ¤ÛÙÂÈÏÂ10.000 ÙfiÓÔ˘˜ ÛÈÙ¿ÚÈ ÁÈ· ÙÔ˘˜ ÌÂÙ·Ó¿ÛÙÂ˜ ÙÔ˘∞ÊÁ·ÓÈÛÙ¿Ó.

™‡ÌÊˆÓ· ÌÂ ÙËÓ ¶·ÁÎfiÛÌÈ· ∆Ú¿Â˙·, ÙÔ ÎÙ‡-ËÌ· ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›Ô˘ 2001 ÛÙÈ˜ ∏¶∞ ı· ¤¯ÂÈ‰˘ÛÌÂÓÂ›˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ÔÈÎÔÓÔÌ›· ÙˆÓ ·Ó·-Ù˘ÛÛfiÌÂÓˆÓ ¯ˆÚÒÓ. ∫·Ù¿ ÙÔÓ Devaragan, ı· Â-ı¿ÓÔ˘Ó 20.000-40.000 ÂÚÈÛÛfiÙÂÚ· ·È‰È¿, ÂÓÒ Â-Ú›Ô˘ 10 ÂÎ·ÙÔÌÌ‡ÚÈ· ÂÈÏ¤ÔÓ ¿ÓıÚˆÔÈ ı· ˙‹-ÛÔ˘Ó ÌÂ ¤Ó· ‰ÔÏ¿ÚÈÔ ÙËÓ ËÌ¤Ú·. OÈ ˘Ô·Ó¿Ù˘ÎÙÂ˜¯ÒÚÂ˜ ı· ÂÚÈÔÚ›ÛÔ˘Ó ÙÈ˜ ‰·¿ÓÂ˜ ÁÈ· ÙË ‰ËÌfiÛÈ·˘ÁÂ›·, ‰ËÏ·‰‹ ÙË ‰·¿ÓË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÁÈ· Aids,Ê˘Ì·Ù›ˆÛË, ÂÏÔÓÔÛ›· Î·È ÌËÙÚÈÎ‹ ˘ÁÂ›·. ∂ÔÌ¤-Óˆ˜, ÙÔ ÎÙ‡ËÌ· ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›Ô˘ ÚÔÎ¿ÏÂÛÂÌÂÁ·Ï‡ÙÂÚË ÔÈÎÔÓÔÌÈÎ‹ ‰˘ÛÙ˘¯›· ÛÙÈ˜ ÊÙˆ¯¤˜ ·’fiÙÈ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜.

O ¶OÀ ˘ÔÏÔÁ›˙ÂÈ fiÙÈ ÙÔ 2005 ı· ¤¯ÂÈ ÂÍ·Ê·ÓÈ-ÛÙÂ› Ë ÔÏÈÔÌ˘ÂÏ›ÙÈ‰· ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó Î·È ÛÙÔ ¶·-ÎÈÛÙ¿Ó. ∫·È ÔÈ ‰‡Ô ¯ÒÚÂ˜ ÛËÌÂ›ˆÛ·Ó ÛËÌ·ÓÙÈÎ‹ÚfiÔ‰Ô ÛÙË ÌÂ›ˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÙË˜ ÔÏÈÔ-Ì˘ÂÏ›ÙÈ‰·˜. ªÂÙ¿ ÙËÓ Â›ıÂÛË ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›-Ô˘ ÛÙË ¡. ÀfiÚÎË ÙˆÓ ∏¶∞, 1,5 ÂÎ·ÙÔÌÌ‡ÚÈÔ ¿Ó-ıÚˆÔÈ ·fi ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó ÌÂÙ·Ó¿ÛÙÂ˘Û·Ó ÛÙ·Û‡ÓÔÚ· ÙÔ˘ ¶·ÎÈÛÙ¿Ó, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ 20% ‹Ù·Ó·È‰È¿. §fiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÌË ÂÌ‚ÔÏÈ·-ÛÌ¤ÓˆÓ ·È‰ÈÒÓ, ·Ó·Ì¤ÓÂÙ·È ÂÈ‰ËÌ›· ÈÏ·Ú¿˜ Î·ÈÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ ÛÙÔ ¶·ÎÈÛÙ¿Ó.


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∆Ô ™ÂÙ¤Ì‚ÚÈÔ ÙÔ˘ 2001 Â›¯Â ÚÔÁÚ·ÌÌ·ÙÈÛÙÂ›Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ Î·Ù¿ ÙË˜ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ÛÙ· ·È‰È¿ ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó, Ô ·ÚÈıÌfi˜ ÙˆÓ ÔÔ›ˆÓÛÙËÓ ËÏÈÎ›· Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ ·Ó¤Ú¯ÂÙ·È ÛÂ 5 ÂÎ·-ÙÔÌÌ‡ÚÈ·. §fiÁˆ ÙˆÓ ·ÌÂÚÈÎ·ÓÈÎÒÓ ‚ÔÌ‚·Ú‰ÈÛÌÒÓ,Ù· ·È‰È¿ ÌÂÙ·ÎÈÓ‹ıËÎ·Ó ·fi Ù· ·ÛÙÈÎ¿ Î¤ÓÙÚ·ÚÔ˜ ÙÈ˜ ·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜. ŒÙÛÈ ‹Ù·Ó ‰‡ÛÎÔÏÔÓ· ÂÓÙÔÈÛÙÔ‡Ó Î·È Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó. ª¤¯ÚÈ ÙÔ ™Â-Ù¤Ì‚ÚÈÔ ÙÔ˘ 2000, ·Ó·Ê¤ÚıËÎ·Ó 9 ÂÚÈÙÒÛÂÈ˜ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó Î·È 50 ÛÙÔ ¶·ÎÈ-ÛÙ¿Ó. ¡¤· ÂıÓÈÎ‹ ËÌ¤Ú· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·Ù¿ ÙË˜ Ô-ÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ Ë 8Ë ¡ÔÂÌ‚Ú›Ô˘2001, È‰È·›ÙÂÚ· ÁÈ· Ù· ·È‰È¿ ÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ Ô˘‹Ù·Ó ÛÙ· Û‡ÓÔÚ· ÌÂ ÙÔ ¶·ÎÈÛÙ¿Ó. ™ÙÈ˜ ·Ú¯¤˜ ÙÔ˘OÎÙˆ‚Ú›Ô˘ 2001 ‰È·Ù¤ıËÎ·Ó ·fi ÙË UNICEF 35ÂÎ·ÙÔÌÌ‡ÚÈ· ‰ÔÏ¿ÚÈ· ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È-‰ÈÒÓ ·fi ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó.

O ¶OÀ ·Ó¤ÊÂÚÂ fiÙÈ Ù· ÔÈÎÔÓÔÌÈÎ¿ ÎÂÊ¿Ï·È·‹Ù·Ó ÌÈÎÚ¿ ÁÈ· Ó· Î·Ï‡„Ô˘Ó ÙÈ˜ ·Ó¿ÁÎÂ˜ ˘ÁÂ›·˜ Î·ÈÂÈ‚›ˆÛË˜ ÙˆÓ ·È‰ÈÒÓ. O Kofi Annan ÂÂÛ‹Ì·ÓÂfiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È 854 ÂÎ·ÙÔÌÌ‡ÚÈ· ‰ÔÏ¿ÚÈ· ÁÈ· Ó·‚ÔËı‹ÛÔ˘Ó 7,5 ÂÎ·ÙÔÌÌ‡ÚÈ· ∞ÊÁ·ÓÔ‡˜ ÁÈ· 6 Ì‹ÓÂ˜(4). ∆· ∏ÓˆÌ¤Ó· ŒıÓË ‰È·›ÛÙˆÛ·Ó fiÙÈ ÌÂÙ¿ ·fi23 ¯ÚfiÓÈ· ÂÌfiÏÂÌË˜ Î·Ù¿ÛÙ·ÛË˜ Î·È 3 ¯ÚfiÓÈ· ÌÂ-Á¿ÏË˜ ÍËÚ·Û›·˜, ÔÈ Û˘Óı‹ÎÂ˜ ˙ˆ‹˜ ¤¯Ô˘Ó ÂÈ‰ÂÈÓˆ-ıÂ› ÛÙËÓ ÂÚÈÔ¯‹.

ªÂÙ¿ ·fi ÙÔ ÎÙ‡ËÌ· ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›Ô˘,ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÙÔ˘ OÎÙˆ‚Ú›Ô˘ 2001, ¤Êı·-Ó·Ó ÛÙË ∫·ÌÔ‡Ï 218 ÙfiÓÔÈ ÛÈÙ·ÚÈÔ‡. ∏ ÌÂÁ¿ÏË ÍË-Ú·Û›· ÚÔÎ¿ÏÂÛÂ ·Ûı¤ÓÂÈ· ÙÔ˘ ‹·ÙÔ˜, Ë ÔÔ›·‹Ù·Ó ı·Ó·ÙËÊfiÚÔ˜. ™‡ÌÊˆÓ· ÌÂ Ù· ÛÙÔÈ¯Â›· ÙÔ˘¶OÀ, ÙÔ 1999 ÂÎ·Ùfi ¿ÙÔÌ· ¤ı·Ó·Ó ·fi ·˘Ù‹ ÙËÓfiÛÔ ÙÔ˘ ‹·ÙÔ˜ Î·È 400 ·ÎfiÌ· ÚÔÛÂ‚Ï‹ıËÛ·Ó.∫·Ù¿ ÙËÓ ÍËÚ·Û›· ÙÔ˘ 1970 ·Ó·Ê¤ÚıËÎÂ fiÙÈ Ë Ófi-ÛÔ˜ ÚÔÎ·ÏÂ› ·fiÊÚ·ÍË ÙˆÓ Ë·ÙÈÎÒÓ ÊÏÂ‚ÒÓÔ˘ ÔÊÂ›ÏÂÙ·È ÛÙËÓ Î·Ù·Ó¿ÏˆÛË „ˆÌÈÔ‡ ÙÔ ÔÔ›Ô¤¯ÂÈ ·Ó·ÌÂÈ¯ıÂ› ÌÂ ÛfiÚÔ˘˜ ËÏÈÔÙÚÔ›Ô˘. ∞˘Ùfi ÙÔÂ›‰Ô˜ „ˆÌÈÔ‡ Î·Ù·Ó·ÏÒÓÂÙ·È ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó ÛÂÂÚ›Ô‰Ô ÍËÚ·Û›·˜. ∆Ô ËÏÈÔÙÚfiÈÔ, Ô˘ ·Ó·Ù‡ÛÛÂ-Ù·È ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÍËÚ·Û›·˜, ÂÚÈ¤¯ÂÈ ˘ÚÔÏÈ‰›ÓËÔ˘ Â›Ó·È ·ÏÎ·ÏÔÂÈ‰¤˜ Î·È ‚Ú›ÛÎÂÙ·È Î·È ÛÙÔ Á¿Ï·ÙˆÓ ·ÁÂÏ¿‰ˆÓ, ÙˆÓ ÚÔ‚¿ÙˆÓ Î.Ï., ·ÊÔ‡ ·˘Ùfi·ÔÙÂÏÂ› ‚·ÛÈÎ‹ ÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ Î·Ù¿ ÙËÓ ÍËÚ·-Û›·. ∆Ô 1975, ¿ÏÈ ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó ÚÔÛÂ‚Ï‹ıË-Û·Ó ·fi ÙË ÓfiÛÔ ÙÔ˘ ‹·ÙÔ˜ “Charmac” 7.200 Î¿-ÙÔÈÎÔÈ Ì¤Û· ÛÂ 2 ¯ÚfiÓÈ·. ∏ ¤ÏÏÂÈ„Ë ÁÓÒÛË˜ ·˘Ù‹˜ÙË˜ ·ÈÙ›·˜ ÚÔÎ·ÏÂ› ˘„ËÏ‹ ıÓËÛÈÌfiÙËÙ· Î·È ‰˘-ÛÙÚÔÊ›·, fiˆ˜ ÙÔ Kwashorkor. ∏ ‚ÂÏÙ›ˆÛË ÙË˜ÙÚÔÊ‹˜ Î·È Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ÛfiÚˆÓ ÙÔ˘ ËÏÈÔ-ÙÚÔ›Ô˘ ·fi ÙÔ „ˆÌ› Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛËÙË˜ ÓfiÛÔ˘. º˘ÛÈÎ¿, fiÏÂ˜ ÔÈ ÂÓ¤ÚÁÂÈÂ˜ ÁÈ· ÙËÓ Úfi-ÏË„Ë ÙË˜ ÓfiÛÔ˘ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ¤ÁÎ·ÈÚ·. ∆ÔÓOÎÙÒ‚ÚÈÔ 2001, ‚ÈÔÏfiÁÔÈ ‹Á·Ó ÛÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó

Ó· ÂÏ¤ÁÍÔ˘Ó ÙÔ „ˆÌ› ÙˆÓ ·ÓıÚÒˆÓ Î·È ÙÔ Á¿Ï·ÙˆÓ ·ÁÂÏ¿‰ˆÓ (4).

∏ ¤ÏÏÂÈ„Ë ÙÔ˘ ÓÂÚÔ‡ ÛÙË ÁË Ì·˜ Â›Ó·È Î·Ù·-ÛÙÚÔÊÈÎ‹ Î·È Á›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ¤Î‰ËÏË ÛÂ Â-ÚÈfi‰Ô˘˜ ÍËÚ·Û›·˜. À¿Ú¯Ô˘Ó ÔÏÏ¤˜ ¯ÒÚÂ˜ Ô˘˘ÔÊ¤ÚÔ˘Ó ·fi ÍËÚ·Û›· fiˆ˜ ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó, ËµfiÚÂÈ· ∞ÊÚÈÎ‹, Ë µfiÚÂÈ· ∫›Ó·, Ë πÓ‰›·, ÙÔ πÚ¿Ó, Ë∫ÂÓÙÚÈÎ‹ ∞ÌÂÚÈÎ‹, Ë ª¤ÛË ∞Ó·ÙÔÏ‹, Ë ¡fiÙÈ· ∫Ô-Ú¤·, ÙÔ ¶·ÎÈÛÙ¿Ó Î·È Ë ™·¯¿Ú·. ™Â ¤Ó· ÙÌ‹Ì· ÙË˜∆Â¯ÂÚ¿ÓË˜, Ë ·ÚÔ¯‹ ÓÂÚÔ‡ ‰È·ÎfiÙÂÙ·È Ì›· ËÌ¤Ú·ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· 12 ÒÚÂ˜. ∞ÍÈˆÌ·ÙÔ‡¯ÔÈ ÙÔ˘ ¶·-ÎÈÛÙ¿Ó ·Ó¤ÊÂÚ·Ó fiÙÈ ÏfiÁˆ ÙË˜ ÍËÚ·Û›·˜ Î·Ù·ÁÚ¿-ÊËÎ·Ó ·ÒÏÂÈÂ˜ 1,2 ‰ÈÛÂÎ·ÙÔÌÌ˘Ú›ˆÓ ‰ÔÏ·Ú›ˆÓ·fi ÙÈ˜ ·ÁÚÔÙÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜. ™ÙÔ ªÂÍÈÎfi Î·È ÙÔ¡fiÙÈÔ ∆¤Í·˜, Ù· ·Ôı¤Ì·Ù· ÓÂÚÔ‡ Â›Ó·È ¯·ÌËÏ¿ ÌÂÛ˘Ó¤ÂÈ· ÔÈ ·ÁÚfiÙÂ˜ Ó· ¤¯Ô˘Ó Úfi‚ÏËÌ· ·Ú‰Â‡ÛÂ-ˆ˜ ÙˆÓ ÎÙËÌ¿ÙˆÓ ÙÔ˘˜, ÔfiÙÂ ‰·ÓÂ›˙ÔÓÙ·È ÓÂÚfi·fi ÙÔ ∆¤Í·˜. ∞ÎfiÌË Î·È ÔÈ fiÏÂÈ˜ ÙÔ˘ ªÂÍÈÎÔ‡ Ô˘Û˘ÓÔÚÂ‡Ô˘Ó ÌÂ ÙÔ ∆¤Í·˜ ¤¯Ô˘Ó Úfi‚ÏËÌ· ÏÂÈ„˘-‰Ú›·˜. ŒÓ· ÍËÚfi Î·ÏÔÎ·›ÚÈ ÛÙËÓ ∫ÂÓÙÚÈÎ‹ ∞ÌÂÚÈÎ‹ÚÔÎ¿ÏÂÛÂ ÙËÓ ·ÒÏÂÈ· ÙˆÓ ·ÁÚÔÙÈÎÒÓ ÂÈÛÔ‰ËÌ¿-ÙˆÓ ÛÂ ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi 50% ÛÂ ÂÚÈÛÛfi-ÙÂÚÂ˜ ·fi 700.000 ·ÁÚÔÙÈÎ¤˜ ÔÈÎÔÁ¤ÓÂÈÂ˜.

™ÙÈ˜ ·Ú·¿Óˆ 10 ¯ÒÚÂ˜, ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÌÈ-Ûfi ‰ÈÛÂÎ·ÙÔÌÌ‡ÚÈÔ ¿ÓıÚˆÔÈ ˘ÔÊ¤ÚÔ˘Ó ·fi ·ÓÂ-¿ÚÎÂÈ· ·ÚÔ¯‹˜ ÓÂÚÔ‡. ∞Ó ‰ÂÓ ÏËÊıÔ‡Ó Î·Ù¿ÏÏË-Ï· Ì¤ÙÚ·, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ ¤ÙÔ˜ 2025 ÙÔ 35%ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ÁË˜ (ÂÚ›Ô˘ 2,8 ‰ÈÛÂÎ·ÙÔÌÌ‡-ÚÈ· ¿ÓıÚˆÔÈ) ı· ·ÓÙÈÌÂÙˆ›˙ÂÈ Úfi‚ÏËÌ· ÏÂÈ„˘-‰Ú›·˜, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÎÔÈÓˆÓÈÎ‹ Î·È ÔÈÎÔÓÔÌÈÎ‹ÂÚ‹ÌˆÛË ÙˆÓ ÂÚÈÔ¯ÒÓ Ô˘ Ï‹ÙÙÔÓÙ·È ·fi ÙËÓ ÍË-Ú·Û›· Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· Î‡Ì·ÙÔ˜ “ÌÂÙ·Ó·ÛÙÒÓ‡‰·ÙÔ˜”.

ªfiÓÔ ÙÔ 3% ÙÔ˘ ÓÂÚÔ‡ ÙË˜ ÁË˜ Â›Ó·È ÊÚ¤ÛÎÔ,ÂÓÒ ÙÔ ÂÚÈÛÛfiÙÂÚÔ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌÔ ÂÂÈ‰‹ Â›-Ó·È ÂÁÎÏˆ‚ÈÛÌ¤ÓÔ ÛÂ ˘‰·ÙÔı‹ÎÂ˜ ÙˆÓ ¿ÁˆÓ. ∏·Ó·ÏÔÁ›· ÊÚ¤ÛÎÔ˘ ÓÂÚÔ‡ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÁË ·ÓÙÈÛÙÔÈ¯Â› ÛÂ ó ÎÔ˘Ù·Ï¿ÎÈ ÙÔ˘ ÁÏ˘ÎÔ‡ ·Ó¿ 100L ÓÂÚÔ‡ (5). ∞˘Ùfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÔÏÈÙÈÎ¤˜·ÓÙÈ·Ú·ı¤ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ ÎÚ·ÙÒÓ ÁÈ· ÙÔ ÓÂÚfiÙˆÓ ÔÙ·ÌÒÓ Î·È ÙˆÓ ˘‰¿ÙÈÓˆÓ ·ÔıËÎÒÓ. ∏ Ì·-ÎÚÔ¯ÚfiÓÈ· ·ÓÙÈ·Ú¿ıÂÛË ÌÂÙ·Í‡ ÙˆÓ fiÏÂˆÓ ÙˆÓπÓ‰ÈÒÓ ·Ó¿ÁÎ·ÛÂ ÙËÓ Î˘‚¤ÚÓËÛË Ó· Î·ıÈÂÚÒÛÂÈ ‰È-Î·ÛÙ‹ÚÈ· ÓÂÚÔ‡ ÁÈ· Ó· Ú˘ıÌ›˙ÔÓÙ·È ÔÈ ‰È·ÊÔÚ¤˜ÙÔ˘˜. ™ÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó, Ë ÏÂÈ„˘‰Ú›· Î·È Ë ÍËÚ·Û›·ÚÔÎ¿ÏÂÛ·Ó ÙË ı·Ó·ÙËÊfiÚÔ ÓfiÛÔ ÙÔ˘ ‹·ÙÔ˜.

∏ ÌÂ›ˆÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÓÂÚÔ‡ ÚÔÎÏ‹ıËÎÂ·fi ÔÏÏ¤˜ ·ÈÙ›Â˜, fiˆ˜ Ë Ù·¯Â›· ·‡ÍËÛË ÙÔ˘ ÏË-ı˘ÛÌÔ‡ È‰›ˆ˜ ÛÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜, Ë ˘ÂÚ-‚ÔÏÈÎ‹ ¿ÓÙÏËÛË ÙˆÓ ·ÔıËÎÒÓ ÓÂÚÔ‡, ÔÈ Î·Ù·-ÛÎÂ˘¤˜ ˘‰·ÙÔÊÚ·ÎÙÒÓ Î·È ·ÔıËÎÒÓ ÓÂÚÔ‡, Ë˘ÂÚ‚ÔÏÈÎ‹ Î·Ù·Ó¿ÏˆÛË ÙÔ˘ ÓÂÚÔ‡ Î·È ÔÈ ·ÏÏ·Á¤˜ÙÔ˘ ÎÏ›Ì·ÙÔ˜.

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∂ÎÙfi˜ ·fi ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÓÂÚÔ‡, ÛËÌ·ÓÙÈ-Îfi Úfi‚ÏËÌ· ·ÔÙÂÏÂ› Î·È Ë ‰È·Ù‹ÚËÛË ÙË˜ ÔÈfi-ÙËÙ¿˜ ÙÔ˘. ∆Ô ‰È·ı¤ÛÈÌÔ ÓÂÚfi ÌÔÚÂ› Ó· ÂÈÌÔÏ‡-ÓÂÙ·È ÌÂ ·ÓıÚÒÈÓ· ÎfiÚ·Ó·, Ô‡Ú·, ·ıÔÁfiÓÔ˘˜ÔÚÁ·ÓÈÛÌÔ‡˜, ‚ÈÔÌË¯·ÓÈÎ¿ ·fi‚ÏËÙ·, È·ÙÚÈÎ¿ Î·ÈÎÙËÓÈ·ÙÚÈÎ¿ Ê¿ÚÌ·Î· Î·È Ê¿ÚÌ·Î· Ô˘ ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È Î·Ù¿ ÙˆÓ ÏÔÈÌÒÓ, fiˆ˜ ÂÓÙÔÌÔÎÙfiÓ·,Ê¿ÚÌ·Î· ÁÈ· ·ÚÔ˘Ú·›Ô˘˜, ÔÓÙÈÎÔ‡˜ Î.Ï. ™ÙÔª·ÁÎÏ·ÓÙ¤˜, ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 1/3 ÙË˜ ¯ÒÚ·˜·ÓÙÈÌÂÙˆ›˙ÂÈ ÛÔ‚·Úfi Úfi‚ÏËÌ· ÌfiÏ˘ÓÛË˜ ÙÔ˘ ÓÂ-ÚÔ‡ ·fi ·ÚÛÂÓÈÎfi. ∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜fiÙÈ ÙÔ ·ÚÛÂÓÈÎfi Ô˘ ÂÚÈ¤¯ÂÙ·È ÛÙÔ ÓÂÚfi ÚÔÊ˘-Ï¿ÛÛÂÈ ÌÂÓ ÙÔ˘˜ Î·ÙÔ›ÎÔ˘˜ ·fi ÓÔÛ‹Ì·Ù· Ô˘ ÌÂ-Ù·‰›‰ÔÓÙ·È ·fi ÙÔ ÓÂÚfi, fiˆ˜ .¯. ¯ÔÏ¤Ú·, Ù‡ÊÔÎ·È Ë·Ù›ÙÈ‰· ∞, ÛÎÔÙÒÓÂÈ ‰Â 500 ¯ÈÏÈ¿‰Â˜ Î·ÙÔ›-ÎÔ˘˜ ÙË˜ ¯ÒÚ·˜ Î¿ıÂ ¯ÚfiÓÔ (5).

¢È¿ÊÔÚÂ˜ Ï‡ÛÂÈ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÏÂÈ-„˘‰Ú›·˜ Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ÔÈfiÙËÙ·˜ ÙÔ˘ ÓÂÚÔ‡Ú¤ÂÈ Ó· ÚÔÙ·ıÔ‡Ó. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÔÙ·ÌÔ›ÂÏ¤Á¯ÔÓÙ·È ·fi ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ¯ÒÚÂ˜. ŒÙÛÈ Â›Ó·È˙ˆÙÈÎfi, ÌÂ ÂıÓÈÎ¤˜ Û˘ÌÊˆÓ›Â˜ Î·È ‰ÈÂıÓÂ›˜ Û˘Ì‚¿-ÛÂÈ˜, Ó· Î·Ù·ÓÂÌËıÂ› ÙÔ ÓÂÚfi ÌÂÙ·Í‡ ÙˆÓ ÂÓ‰È·ÊÂ-ÚfiÌÂÓˆÓ ¯ˆÚÒÓ. ∆Ô 1998, Ë ¤ÎıÂÛË ÙÔ˘ ¶OÀ ·Ó¤-ÊÂÚÂ fiÙÈ ··ÈÙÔ‡ÓÙ·È 10 ‰ÈÛÂÎ·ÙÔÌÌ‡ÚÈ· ‰ÔÏ¿ÚÈ·ÙÔ ¯ÚfiÓÔ ÁÈ· Ó· ÂÊÔ‰È·ÛÙÂ› fiÏÔ˜ Ô ÏËı˘ÛÌfi˜ ÙË˜ÁË˜ ÌÂ ˘ÁÈÂÈÓfi Î·È Î·ı·Úfi ÓÂÚfi. ∆Ô ÎfiÛÙÔ˜ ·˘ÙfiÈÛÔ‰˘Ó·ÌÂ› ÌÂ ÙÔ 1/10 ÙˆÓ ¯ÚËÌ¿ÙˆÓ Ô˘ ÍÔ‰Â‡Ô˘ÓÔÈ ∂˘Úˆ·›ÔÈ ÁÈ· ·ÏÎÔÔÏÔ‡¯· ÔÙ¿, ÌÂ ÙÔ ÔÛfiÔ˘ ÍÔ‰Â‡Ô˘Ó ÁÈ· ·ÁˆÙ¿ ‹ ÌÂ ÙÔ ‹ÌÈÛ˘ ÙˆÓ ¯ÚË-Ì¿ÙˆÓ Ô˘ ‰··ÓÔ‡Ó ∞ÌÂÚÈÎ·ÓÔ› Î·È ∂˘Úˆ·›ÔÈ Î¿-ıÂ ¯ÚfiÓÔ ÁÈ· ÙÚÔÊ¤˜ ÙˆÓ Î·ÙÔÈÎ›‰ÈˆÓ ˙ÒˆÓ ÙÔ˘˜. ∏Ó¤· Ù¿ÍË Ú·ÁÌ¿ÙˆÓ Ê·›ÓÂÙ·È fiÙÈ Ô‰‹ÁËÛÂ ÙÔÓ ¿Ó-ıÚˆÔ Ó· Á›ÓÂÈ ÂÚÈÛÛfiÙÂÚÔ ˙ˆfiÊÈÏÔ˜ Î·È ÏÈÁfiÙÂ-ÚÔ ÊÈÏ¿ÓıÚˆÔ˜.

∆Ô ÌÈÎÚfi ÎfiÛÙÔ˜ ¯ÚËÌ¿ÙˆÓ ÌÔÚÂ› Ó· Â›Ó·È ËÚÒÙË ÂÓ¤ÚÁÂÈ· ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Î·ı·ÚÔ‡ Î·È˘ÁÈÂÈÓÔ‡ ÓÂÚÔ‡ ÛÙÔÓ ÏËı˘ÛÌfi ÙÔ˘ Ï·Ó‹ÙË Ì·˜.∆· ∂ÓˆÌ¤Ó· ŒıÓË ÔÚÁ·ÓÒÓÔ˘Ó ÙÔ 2003 ÙÔ “¢ÈÂ-ıÓ¤˜ ŒÙÔ˜ ºÚ¤ÛÎÔ˘ ¡ÂÚÔ‡”. ∂›Ó·È ÛËÌ·ÓÙÈÎfi, ÔÈÎ˘‚ÂÚÓ‹ÛÂÈ˜ ÙˆÓ ÎÚ·ÙÒÓ, Ó· ÌËÓ ÂÚÈÔÚÈÛÙÔ‡Ó ÛÂÔÚ¿Ì·Ù· Î·È ıÂˆÚËÙÈÎ¿ Ï¿Ó· ÁÈ· Î·ı·Úfi ÓÂÚfi,·ÏÏ¿ Ó· ÂÊ·ÚÌfiÛÔ˘Ó Ì¤ÙÚ· Ú·ÎÙÈÎ¿ Î·È ·ÔÙÂÏÂ-ÛÌ·ÙÈÎ¿ ÁÈ· ÙËÓ Â›ÙÂ˘ÍË ·˘ÙÔ‡ ÙÔ˘ ÛÙfi¯Ô˘ (5).

™‡ÌÊˆÓ· ÌÂ ‰ËÌÔÛÎfiËÛË ÙÔ˘ CNN (∞Ú›ÏÈÔ˜2002), ÔÈ ∞ÌÂÚÈÎ·ÓÔ›, ‰˘ÛÙ˘¯Ò˜, ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë∞ÌÂÚÈÎ‹ Â›Ó·È ÈÛ¯˘ÚfiÙÂÚË ÌÂÙ¿ ÙËÓ 11Ë ™ÂÙÂÌ‚Ú›-Ô˘, ÂÓÒ ÙÔ 90% ‰¤¯ÂÙ·È fiÙÈ ¿ÏÏ·Í·Ó “Ù· ¿ÓÙ· ÁÈ·¿ÓÙ·”. ∆Ô 60% Ù¿ÛÛÂÙ·È ˘¤Ú ÙÔ˘ ÔÏ¤ÌÔ˘ Î·È ÙÔ75% ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ÔÈ ∏¶∞ Ú¤ÂÈ Ó· ÛÙÂ›ÏÔ˘ÓÛÙÚ·ÙÂ‡Ì·Ù· ÂÓ·ÓÙ›ÔÓ ÙÔ˘ πÚ¿Î ÁÈ· Ó· ·Ó·ÙÚ¤„Ô˘ÓÙÔÓ ™·ÓÙ¿Ì ÃÔ˘ÛÂ˝Ó (6).

∞fi ÙËÓ ÎÚ›ÛË ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹ Ê·›ÓÂÙ·È fiÙÈÙfiÛÔ ÔÈ πÛÚ·ËÏ›ÙÂ˜ fiÛÔ Î·È ÔÈ ¶·Ï·ÈÛÙ›ÓÈÔÈ ıÂˆ-

ÚÔ‡Ó ÙËÓ Â›Ï˘ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·Ùfi˜ ÙÔ˘˜ ÂÊÈÎÙ‹ ÌÂÙËÓ ÂÎ‰›ÎËÛË Î·È ÙË ‚›· (7). ™‡ÌÊˆÓ· ÌÂ ÙËÓ ¿Ô„ËÙˆÓ È·ÙÚÒÓ ÁÈ· Ù· ·ÓıÚÒÈÓ· ‰ÈÎ·ÈÒÌ·Ù·, ÔÈ ‰‡ÔÎÔÈÓˆÓ›Â˜ ¤¯Ô˘Ó ÂÈÛ¤ÏıÂÈ ÛÂ ¤Ó·Ó Î‡ÎÏÔ ·ÏÏËÏÔÂ-ÍfiÓÙˆÛË˜. ¶ÏËÚÔÊÔÚ›Â˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÓÔÛÔÎÔ-ÌÂÈ·Î¿ ·˘ÙÔÎ›ÓËÙ· ÙˆÓ ¶·Ï·ÈÛÙÈÓ›ˆÓ Ô˘ Â›¯·ÓÂÏÂÁ¯ıÂ› ·fi ÙÈ˜ ŒÓÔÏÂ˜ ¢˘Ó¿ÌÂÈ˜ ÙÔ˘ πÛÚ·‹Ï ˘-ÚÔ‚ÔÏ‹ıËÎ·Ó Î·È ÙÔ Ï‹ÚˆÌ¿ ÙÔ˘˜ ÊÔÓÂ‡ıËÎÂ.∂ÈÛÙÔÏ¤˜ ·fi È·ÙÚÔ‡˜ ÙˆÓ ∏¶∞, ÙÔ˘ EÓˆÌ¤ÓÔ˘µ·ÛÈÏÂ›Ô˘ Î·È ÙÔ˘ πÛÚ·‹Ï ÚÔ˜ ÙÔ ÂÚÈÔ‰ÈÎfiLancet, Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÛÙÔ ¿ÚıÚÔ ÌÂ Ù›ÙÏÔ“Failure to address the health toll of Middle Eastcrisis”, ÈÛ¯˘Ú›˙ÔÓÙ·È fiÙÈ ÓÔÛÔÎÔÌÂÈ·Î¿ ·˘ÙÔÎ›ÓËÙ·¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·fi ÙÔ˘˜ ¶·Ï·ÈÛÙ›ÓÈÔ˘˜ ˆ˜ ·˘-ÙÔÎ›ÓËÙ· ·˘ÙÔÎÙÔÓ›·˜ Ô˘ ¤ÊÂÚ·Ó ¿ÚÚˆÛÙ· ·È‰È¿‹ ÓÂÎÚÔ‡˜ ÙÔÔıÂÙËÌ¤ÓÔ˘˜ ÛÂ ÂÎÚËÎÙÈÎÔ‡˜ ÌË¯·-ÓÈÛÌÔ‡˜, ÌÂ ÛÎÔfi Ó· ·Ú·Ï·Ó‹ÛÔ˘Ó ÙÈ˜ ŒÓÔÏÂ˜¢˘Ó¿ÌÂÈ˜ ÙÔ˘ πÛÚ·‹Ï ÁÈ· Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜Î·ÌÈÎ¿˙È ÂÓ·ÓÙ›ÔÓ πÛÚ·ËÏÈÓÒÓ ÔÏÈÙÒÓ (7). ¶·Ï·È-ÛÙÈÓÈ·Îfi ·ÛıÂÓÔÊfiÚÔ ÌÂ ÂÎÚËÎÙÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜Î·È ‚fiÌ‚Â˜ ·ÔÂÈÚ¿ıËÎÂ Ó· ·ÂÈÏ‹ÛÂÈ ÙË ˙ˆ‹ ÙÔ˘Colin Powell ÙÔ ‚Ú¿‰˘ ÙË˜ ·Ê›ÍÂÒ˜ ÙÔ˘ ÛÙÔ πÛÚ·‹ÏÛ‡ÌÊˆÓ· ÌÂ ÙË Ì·ÚÙ˘Ú›· ÙÔ˘ Ô‰ËÁÔ‡ ÙÔ˘ ·ÛıÂÓÔ-ÊfiÚÔ˘, fiˆ˜ ÂÈÛËÌ·›ÓÂÈ ÛÙËÓ ÂÈÛÙÔÏ‹ ÙÔ˘ Ô ª.Lauer ·fi ÙÔ Cleveland ÙˆÓ ∏¶∞ (8).

À¿Ú¯Ô˘Ó Û·ÊÂ›˜ ÂÓ‰Â›ÍÂÈ˜ fiÙÈ ˘‹Ú¯Â ¤ÏÏÂÈ„ËÙÚÔÊ›ÌˆÓ, ÓÂÚÔ‡ Î·È ËÏÂÎÙÚÈÎÔ‡ ÚÂ‡Ì·ÙÔ˜ ÌÂ ÛÔ-‚·Ú¤˜ ÂÈÙÒÛÂÈ˜ ÛÙË ‰ËÌfiÛÈ· ˘ÁÂ›·. OÈ ËÏÂÎÙÚÈ-Î¤˜ ÂÁÎ·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ Î·Ù·ÛÎÂ˘¿ÛÙËÎ·Ó ÛÙË Ïˆ-Ú›‰· ÙË˜ °¿˙·˜ ÙÔ 1993 ÛÙÔ›¯ÈÛ·Ó 4,5 ‰ÈÛÂÎ·ÙÔÌ-Ì‡ÚÈ· ‰ÔÏ¿ÚÈ· ∞ÌÂÚÈÎ‹˜ Î·È ¤¯Ô˘Ó ˘ÔÛÙÂ› ÙÂÚ¿-ÛÙÈÂ˜ ˙ËÌÈ¤˜.

O Carrol Bellamy, ‰ÈÂ˘ı˘ÓÙ‹˜ ÙË˜ Unicef, ·Ó¤-ÊÂÚÂ fiÙÈ ÔÈ πÛÚ·ËÏÈÓÔ› Î·È ÔÈ ¶·Ï·ÈÛÙ›ÓÈÔÈ ‰È‰¿-ÛÎÔ˘Ó ÛÙ· ·È‰È¿ ÙÔ˘˜ ÙËÓ ÙÚÔÌÔÎÚ·Ù›· ˆ˜ Ì¤ıÔ-‰Ô Â›Ï˘ÛË˜ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜. OÈ Î˘‚ÂÚÓ‹-ÛÂÈ˜ ÙË˜ ∂Ó. ∂˘ÚÒË˜ Î·È ÙˆÓ ∏¶∞, ÔÈ ÔÔ›Â˜ ÈÛ¯˘-Ú›˙ÔÓÙ·È fiÙÈ Â›Ó·È ÌÂÛÔÏ·‚ËÙ¤˜ ÙË˜ ÂÈÚ‹ÓË˜ ÛÙÔÓÎfiÛÌÔ, Ú¤ÂÈ Ó· ÎÈÓËÙÔÔÈËıÔ‡Ó, ÒÛÙÂ ÌÂÙ¿ ÙËÓÎ·Ù¿·˘ÛË ÙˆÓ Â¯ıÚÔÚ·ÍÈÒÓ Ó· ÂÈÌÂÏËıÔ‡Ó ÙÔ˘ÚÔ‚Ï‹Ì·ÙÔ˜ ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ Ô˘ ‰ÂÓ Â›Ó·ÈÔÏ˘Ù¤ÏÂÈ·, ·ÏÏ¿ ÂÈ‚¿ÏÏÂÙ·È ‰ÈfiÙÈ Ô ¿Ì·¯Ô˜ ÏË-ı˘ÛÌfi˜ Â›Ó·È Ù·Ï·ÈˆÚËÌ¤ÓÔ˜, Î·ÎÔÔÈËÌ¤ÓÔ˜ Î·ÈÙÚ·˘Ì·ÙÈÛÌ¤ÓÔ˜.

O Benjamin Disraeli ÙÔ 1877 ·Ó¤ÊÂÚÂ fiÙÈ “∏˘ÁÂ›· ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È Ë Ú·ÁÌ·ÙÈÎ‹ ıÂÌÂÏ›ˆ-ÛË˜ ÙË˜ Â˘Ù˘¯›·˜ Î·È ÙË˜ ‰‡Ó·ÌË˜ ÁÈ· Ì›· ·ÓÂÍ¿Ú-ÙËÙË ÔÏÈÙÂ›·”. ∆ËÓ ÂÔ¯‹ Ô˘ ÁÂÓÓ‹ıËÎÂ Ô ÃÚÈÛÙfi˜˘‹Ú¯Â ÌfiÓÔ ¤Ó·˜ ∏ÚÒ‰Ë˜. ™‹ÌÂÚ· Ê·›ÓÂÙ·È fiÙÈ˘¿Ú¯Ô˘Ó ÔÏÏÔ› Ô˘ Û˘ÌÂÚÈÊ¤ÚÔÓÙ·È Û·Ó Ó·¤¯Ô˘Ó Ì¤Û· ÙÔ˘˜ ÙÔÓ ∏ÚÒ‰Ë Î·È ÌÂıÔ‡Ó ·fi ÙÔ ·›-Ì· ÙˆÓ ÛÊ·ÁÒÓ Î·È ·fi ÙÔ ıfiÚ˘‚Ô ÙˆÓ ÊÔÓÈÎÒÓÂÎÚ‹ÍÂˆÓ. O ÃÚÈÛÙfi˜ ›Ûˆ˜ Ó· ÌËÓ Í·Ó·ÁÂÓÓËıÂ›,


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·ÏÏ¿ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ÛÙ·˘ÚÒÓÂÙ·È ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ÂÚÈÔ¯¤˜ ÔÏ¤ÌÔ˘, ÛÙÔ ÚfiÛˆÔ ÙˆÓ ·ıÒˆÓ ı˘Ì¿-ÙˆÓ Ô˘ ·Ê‹ÓÔ˘Ó ÙËÓ ÙÂÏÂ˘Ù·›· ÓÔ‹ ÛÙÔ ‰ÚfiÌÔ,ÛÙÔ ÏÂˆÊÔÚÂ›Ô, ÛÙÔ Û¯ÔÏÂ›Ô ‹ Î¿Ùˆ ·fi ÙË ‚ÔÌ-‚·Ú‰ÈÛÌ¤ÓË ÛÙ¤ÁË ÙÔ˘ ÛÈÙÈÔ‡ ÙÔ˘˜ (1).

O ¶OÀ, ÔÈ ÌË ÎÚ·ÙÈÎ¤˜ ÔÚÁ·ÓÒÛÂÈ˜, Ë ∂ÓˆÌ¤ÓË∂˘ÚÒË Î·È Ë ¢ÈÂıÓ‹˜ ∆Ú¿Â˙· Ú¤ÂÈ Ó· Û˘Ì‚¿-ÏÔ˘Ó ÛÙËÓ ·Ó·Û˘ÁÎÚfiÙËÛË ÙË˜ ˘ÁÂ›·˜ ÙÔ˘ ÏËı˘-ÛÌÔ‡ ÙÔ˘ ∞ÊÁ·ÓÈÛÙ¿Ó. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ¿ÓıÚˆÔÈÂı·›ÓÔ˘Ó ÂÚ›Ô˘ ÛÂ ËÏÈÎ›· 47 ÂÙÒÓ, ÂÓÒ ¤Ó· ÛÙ·Ù¤ÛÛÂÚ· ·È‰È¿ Âı·›ÓÂÈ ÛÙ· ¤ÓÙÂ ÚÒÙ· ¯ÚfiÓÈ·ÙË˜ ˙ˆ‹˜ ÙÔ˘. ∆ÚÂÈ˜ ¯ÈÏÈ¿‰Â˜ ¿ÓıÚˆÔÈ ÛÎÔÙÒıË-Î·Ó ÛÂ ¤Ó· ¯ÚfiÓÔ ·fi ÙÈ˜ Ó¿ÚÎÂ˜ Î·È ·ÚÎÂÙÔ› ¤ÌÂÈ-Ó·Ó ·Ó¿ËÚÔÈ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Î·ıÂÛÙÒÙÔ˜ÙˆÓ ∆·ÏÈÌ¿Ó, ‰ÂÓ ·ÚÂ¯fiÙ·Ó È·ÙÚÈÎ‹ ÊÚÔÓÙ›‰·ÛÙÈ˜ ¤ÁÎ˘Â˜ Á˘Ó·›ÎÂ˜ Î·È ¤ÙÛÈ ÛËÌÂÈÒıËÎÂ ˘„ËÏ‹ÌËÙÚÈÎ‹ ıÓËÛÈÌfiÙËÙ·.

™ËÌ·ÓÙÈÎ‹ ÚÔÙÂÚ·ÈfiÙËÙ· ·ÔÙÂÏÂ›, Â›ÛË˜, ËÈ·ÙÚÈÎ‹ ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ Î·ÈÌÂ Ì¤ÙÚ· ÚfiÏË„Ë˜ ·fi Ù· ÌÂÙ·‰È‰fiÌÂÓ· ÓÔÛ‹Ì·-Ù·. ∏ ·Ó·‚¿ıÌÈÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜ ÙÔ˘∞ÊÁ·ÓÈÛÙ¿Ó ı· ¯ÚÂÈ·ÛÙÂ› 5-10 ¯ÚfiÓÈ·. ∂›Ó·È ÁÓˆÛÙfi·fi ÚÔËÁÔ‡ÌÂÓÂ˜ Û˘ÁÎÚÔ‡ÛÂÈ˜ fiˆ˜ ÙË˜ ªÔ˙·Ì-‚›ÎË˜, ÙÔ˘ ∫ÔÛfi‚Ô˘ Î.Ï. fiÙÈ Ë ÊıËÓ‹ Â¤Ó‰˘ÛË˘ÁÂ›·˜ Â›Ó·È ÛÊ¿ÏÌ·. ŒÓ· ·ÈÛÈfi‰ÔÍÔ Ì‹Ó˘Ì· ·fiÙÔ ∞ÊÁ·ÓÈÛÙ¿Ó Â›Ó·È fiÙÈ Î·ı‹ÎÔÓÙ· ÀÔ˘ÚÁÔ‡ ÀÁÂ›-·˜ ·Ó¤Ï·‚Â Ë Suhaila Seddiqui ¯ÂÈÚÔ˘ÚÁfi˜ ·fi ÙËÓ∫·ÌÔ‡Ï.

∏ ‰È¿ÛˆÛË ·ÓıÚÒˆÓ Î·È Ë ‚ÂÏÙ›ˆÛË ÙË˜ ÔÈfi-ÙËÙ·˜ ˙ˆ‹˜ Â›Ó·È ËıÈÎ‹ Î·È ÂÈÙ·ÎÙÈÎ‹ ·Ó¿ÁÎË ÁÈ·fiÏÔ ÙÔÓ ÎfiÛÌÔ. ∏ Â¤Ó‰˘ÛË ÛÙËÓ ˘ÁÂ›· ›Ûˆ˜ ·Ô-‰ÂÈ¯ıÂ› fiÙÈ Â›Ó·È Ë ·ÛÊ·Ï¤ÛÙÂÚË Â¤Ó‰˘ÛË ÁÈ· ÙËÓÂÈÚ‹ÓË. ∫·Ù¿ ÙÔÓ °ÂÚÌ·Ófi Obermann “Don’t try tobe God, just work hard to be Human”, ‰ËÏ·‰‹ “ÌËÓÚÔÛ·ıÂ›˜ Ó· Á›ÓÂÈ˜ £Âfi˜, ÂÚÁ¿ÛÔ˘ ÛÎÏËÚ¿ Ó· Â›-Û·È ºÈÏ¿ÓıÚˆÔ˜” (9).

∏ ‰ËÌfiÛÈ· ˘ÁÂ›· Â›Ó·È ¤Ó· Ó¤Ô ÂÚÁ·ÏÂ›Ô ÁÈ· ÙËÓÂÍˆÙÂÚÈÎ‹ ÔÏÈÙÈÎ‹ Î·È ÁÈ· Ù· ·ÓÙÈÙÚÔÌÔÎÚ·ÙÈÎ¿ Ì¤-ÙÚ·. ∂ÍÔ˘‰ÂÙÂÚÒÓÔÓÙ·˜ ÙËÓ Â›Ó·, ÙÔ ÏÈÌfi, ÙÈ˜ ·Ú-ÚÒÛÙÈÂ˜, ÙË ÊÙÒ¯ÂÈ· Î·È ÙËÓ ÎÔÈÓˆÓÈÎ‹ ·ÔÌfiÓˆÛËÌÔÚÂ› Ó· ÂÈÙÂ˘¯ıÂ› Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ· ·fiÙÈ˜ ‚fiÌ‚Â˜, Ù· ·ÂÚÔÏ¿Ó·, ÙÈ˜ ÂÈ‰ÈÎ¤˜ ‰˘Ó¿ÌÂÈ˜ Î·ÈÙËÓ ·ÔÌfiÓˆÛË.

∏ ·ÛÊ¿ÏÂÈ· ÙË˜ ÁË˜ ı· ÂÈÙÂ˘¯ıÂ› Î·Ï‡ÙÂÚ· ÌÂÙË ‰ËÌÈÔ˘ÚÁ›· ÛÙ·ıÂÚÒÓ Î·È ÈÛ¯˘ÚÒÓ ÎÔÈÓˆÓÈÒÓ. ∏

‰ËÌfiÛÈ· ˘ÁÂ›·, ÙÔÓ 21Ô ·ÈÒÓ·, Â›Ó·È Ì¤ÚÔ˜ ÙË˜ ·-ÁÎÔÛÌÈÔÔ›ËÛË˜ Î·Ù¿ ÙËÓ ÂÏÂ‡ıÂÚË ·ÁÔÚ¿ ‹ ¤¯ÂÈ·ÁÎÔÛÌÈfiÙËÙ·, ‰ËÏ·‰‹ ÔÈÎÔ˘ÌÂÓÈÎfiÙËÙ·, Î·Ù¿ ÙË¯ÚÈÛÙÈ·ÓÈÎ‹ ¿Ô„Ë. ∞˘Ù‹ Ë ·Ó¿ÁÎË ÙË˜ ·ÁÎÔÛÌÈfi-ÙËÙ·˜ ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ ‰ÂÓ Â›¯Â ÂÈÛËÌ·ÓıÂ› ÌÂÙfiÛË ¤ÌÊ·ÛË ÛÂ Î·Ó¤Ó· ÚÔËÁÔ‡ÌÂÓÔ ·ÈÒÓ·. ÃÚÂÈ-¿˙ÂÙ·È fiÌˆ˜ ÂÍÂÈ‰›ÎÂ˘ÛË, Û˘Ì·Ú¿ÛÙ·ÛË Î·È ‰Ú¿-ÛË Â› ÙË˜ ÎÔÈÓˆÓÈÎ‹˜ Î·È ÔÏÈÙÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ÁÈ· Ó· ‚ÂÏÙÈˆıÂ› Ë ‰ËÌfiÛÈ· ˘ÁÂ›· ÛÂ fiÏÔ ÙÔÓ ÏË-ı˘ÛÌfi ÙË˜ ÁË˜.

∏ ∂ÓˆÌ¤ÓË ∂˘ÚÒË, Û‡ÌÊˆÓ· ÌÂ ÙÔ ÚfiÁÚ·Ì-Ì· Ô˘ ı· ÂÊ·ÚÌfiÛÂÈ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2003,¤Î·ÓÂ ÙÔ ÚÒÙÔ ‚‹Ì· ÁÈ· Ó· ‚ÂÏÙÈˆıÂ› Ë ‰ËÌfiÛÈ·˘ÁÂ›· ÛÂ fiÏÔ ÙÔÓ ÎfiÛÌÔ. §Â›ÂÈ, fiÌˆ˜, Ô ÂÛÙÈ·ÛÌfi˜,Ë Û˘ÁÎÂÎÚÈÌ¤ÓË ‚Ô‹ıÂÈ· Î·È Ë ÔÏÈÙÈÎ‹ ‚Ô‡ÏËÛË. ∏‰ËÌfiÛÈ· ˘ÁÂ›· Â›Ó·È ¤Ó· Ì¤ÙÚÔ Ô˘ ˘ÔÙÈÌ‹ıËÎÂ·fi ÙËÓ ·ÁÎÔÛÌÈÔÔÈËÌ¤ÓË ·ÛÊ¿ÏÂÈ· ÙÔ˘ Ï·Ó‹-ÙË Ì·˜.

∏ ·ÚÔ¯‹ Î·Ï‹˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ ÁÈ· fiÏÔ ÙÔÓÏËı˘ÛÌfi ÙÔ˘ Ï·Ó‹ÙË Ú¤ÂÈ Ó· Á›ÓÂÈ Ë µ›‚ÏÔ˜ ÙÔ˘21Ô˘ ·ÈÒÓ·, Â¿Ó ı¤ÏÔ˘ÌÂ Ó· Ú·ÁÌ·ÙÔÔÈËıÂ› ÙÔ ÂÎ-ÎÏËÛÈ·ÛÙÈÎfi ÙÚÔ¿ÚÈÔ (10) “∫·› â› ÁÉ˜ ÂåÚ‹ÓË”.

µÈ‚ÏÈÔÁÚ·Ê›·1. ™ÙÂÊ·ÓÔÔ‡ÏÔ˘ ∞. ∫·È Â› ÁË˜ fiÏÂÌÔ˜. ∂ÛÙ›·; 2001, 24

¢ÂÎÂÌ‚Ú›Ô˘.2. Pillar PR. Terrorism and US foreign policy Washington:

Brookings Institution; 2001.3. Horton R. Public health: a neglected counter terrorist

measure. Lancet 2001;358:1112-1113. 4. Ahmad K. Health and safety of Afghans hangs in the

balance. Lancet 2001;358:1069-1070.5. Nor any drop to drink [Editorial]. Lancet 2001;358:1025.6. ÕÏÏ·Í·Ó “Ù· ¿ÓÙ· ÁÈ· ¿ÓÙ·” ÈÛÙÂ‡Ô˘Ó ÔÈ ∞ÌÂÚÈÎ·ÓÔ›.

∂ÛÙ›·; 2002, 2 ∞ÚÈÏ›Ô˘.7. Failure to address the health toll of the Middle East crisis

[Editorial]. Lancet 2002;359:1261.8. Lauer MS. Health toll of the Middle East crisis. Lancet

2002;359:1860-1861.9. Obermann K. More life for Lifeline. Lancet 2001;358:2174.

10. ∫·ÈÓ‹ ¢È·ı‹ÎË: ∫·Ù¿ §Ô˘Î¿Ó ∂˘·ÁÁ¤ÏÈÔ (2,14).


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶¤ÙÚÔ˜ §··ÙÛ¿ÓË˜ ∞ÛÎÏËÈÔ‡ 44, ∆.∫. 114 71, ∞ı‹Ó·

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Παιδιατρική | Τόμος 66 • Τεύχος 1 • Ιανουάριος -...

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