Παιδιατρική | Τόμος 66 • Τεύχος 6 • Νοέμβριος -...

ISSN 0377-2551

Hellenic Paediatric Society

∞¡∞™∫O¶∏™∂π™OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ÛÙ· ·È‰È¿ ∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁÎ¿ÎË

°ÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ·: Èı·Ó¤˜ÂÈÙÒÛÂÈ˜ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘ÏÔ˜,º. ™·ÍÒÓË-¶··ÁÂˆÚÁ›Ô˘

OÈÎÔÏÔÁ›·, ÂÈ‰ËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚÈ·Î‹‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ÎÂÊ·Ï‹˜ ÛÂ ·È‰È¿ ∂. ºÚ·ÁÎÔ‡ÏË

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍËÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘ÁÂ›·˜ ÛÙ· Û¯ÔÏÂ›·ÙË˜ ∫Ú‹ÙË˜ª. §ÈÓ·Ú‰¿ÎË˜, ∫. ™·ÚÚ‹, º. ªÂÚ‚·Ó¿ÎË,∂. ª¿ÚÎ·Ù˙Ë, Ã. Ã·Ù˙‹˜, ™. ºÏÔ˘Ú‹, ∞. ∫·Ê¿ÙÔ˜

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™À¿Ú¯ÂÈ Û˘Ó¤ÂÈ· ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ Â·Ú¯›·; ŒÚÂ˘Ó· ÛÂ ·È‰ÈÎfiÏËı˘ÛÌfi ∫¤ÓÙÚÔ˘ ÀÁÂ›·˜ ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜

¶ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓÛÂ ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ ∂. ¶·Ú·ÛÎ¿ÎË˜, ª. ∆ÛÈÌÈÓfi˜, ∫. ∫·Ú·Ó¿ÛÈÔ˘, ¡. ª·Î·ÚÒÓ·˜, ∂. °·Ï·Ó¿ÎË˜

¡Â˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ·È‰ÈÒÓÌÂ ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ ∫. µÔ‡‰ÚË˜, ∫. ™ÙÂÊ·Ó›‰Ë˜, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘,∂. ∫·ÙÛ·ÚÔ‡, ™. ª·ÛÙÚÔÁÈ¿ÓÓË, ∂. µ·ÁÈ¿ÎÔ˘

REVIEW ARTICLESCardiomyopathies in childrenH. Apostolou, A. Tsilimigaki

Genetically modified food: potentialeffects on allergenicity E. Vassilopoulou, N. G. Papadopoulos,F. Saxoni-Papageorgiou

Ecology, epidemiologyand diagnosis of tinea capitisin childrenE. Frangoulis

AWARD-WINNING ARTICLETen-year evaluation of the initiation of a health education program in the schools of Crete M. Linardakis, K. Sarri, F. Bervanaki, I. Markatzi, C. Hatzis, S. Flouri, A. Kafatos

ORIGINAL ARTICLESIs there consistency in immunization ofchildren who live in the countryside? Study ofthe child population of a Rural Health Centre M. Schina, G. Schinas, K. Pateropoulos

Health problems of child-touristsin a Cycladic island E. Paraskakis, M. Tsimbinos, K. Karanasiou, N. Makaronas, E. Galanakis

Neurological complications of children withhaemolytic-uraemic syndromeK. Voudris, C. Stefanidis, A. Skardoutsou, E. Katsarou, S. Mastroyianni, E. Vagiakou

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


Greek Paediatric Society

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∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ Î·È ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ 533 ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔDown Ù· ¤ÙË 1973-2001 Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™∞ÓÂ¿ÚÎÂÈ· ÙË˜ ÔÚÓÈıÈÓÈÎ‹˜ ÙÚ·ÓÛÎ·Ú‚·Ì˘Ï¿ÛË˜ - ˘ÔÍ‡˜ Ù‡Ô˜.¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ™. ºÂÛÛ¿ÙÔ˘, ∞. ∞ÙÙÈÏ¿ÎÔ˜, ∂. ∆Û¿Ú·, °. ª·ÚfiÔ˘ÏÔ˜, ∂. ªÈ¯ÂÏ·Î¿ÎË, ∫. ™Ô‡ÏË

¡fiÛÔ˜ Cushing ÛÂ ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 15ó ÂÙÒÓ.¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∂. ∫ˆÛÙ·ÎÈÒÙË, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∂. ∫Ô‡ÛÙ·, ∞. ∆ÂÚÙ›Ë, Ã. Ã·Ù˙Ë·ı·Ó·Û›Ô˘, µ. ¶¤ÙÚÔ˘, ∞. ¶··ı·Ó·Û›Ô˘

N∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

Cytogenetic and epidemiologicalcharacteristics of 533 patients with Downsyndrome between the years 1973-2001 H. Hatzissevastou-Loukidou, P. Kambouridou

CASE REPORTS Late onset ornithine transcarbamylase deficiency. A case reportS. Fessatou, A. Attilakos, H. Tsapra, G. Maropoulos, H. Michelakakis, K. Schulpis

Cushing’s disease in a 15ó year-old girl. A case report E. Kostakioti, C. Theodoridis, E. Kousta, A. Tertipi, C. Hadjiathanasiou, V. Petrou, A. Papathanasiou

NEWS FROM THE INTERNET

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™˘Ó¤¯ÂÈ· ÂÚÈÂ¯ÔÌ¤ÓˆÓ Continuation of table of contents

™˘ÓÂ¯›˙ÔÓÙ·È Continued







∫ÚÈÙ¤˜ ÙÔ˘ ÙfiÌÔ˘ 66

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘ ÙfiÌÔ˘ 66

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿ ÙÔ˘ ÙfiÌÔ˘ 66

¶ÚÔÛÂ¯‹ ™˘Ó¤‰ÚÈ·

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

Reviewers of Manuscripts, Volume 66

Author Index, Volume 66

Subject Index, Volume 66

Scheduled Medical Meetings

Abbreviations

478

479

482

xi

xv

™˘Ó¤¯ÂÈ· ÂÚÈÂ¯ÔÌ¤ÓˆÓ Continuation of table of contents





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

EÎ‰fiÙË˜K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹ÙË˜©EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92Aı‹Ó·È 115 28TËÏ.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹¶ÚfiÂ‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜¢ÈÂ˘ı˘ÓÙ‹˜ : ™. Ã·˚‰¿˜M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

: °. µ·ÚÏ¿ÌË˜: ª. ∏Ï›·: π. ¶··‰¿ÙÔ˜: ¡. ¶··‰fiÔ˘ÏÔ˜: ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘: ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡: ∫. ™ÙÂÊ·Ó›‰Ë˜: ª. ∆ÛÔÏÈ¿: ™. ºˆÙfiÔ˘ÏÔ˜

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·∂ÈÌ¤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓI. K·Ú·‚Ú¿ÓÔ˘

EÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ™. ¡¿ÎÔ˘

∞ÏÏËÏÔÁÚ·Ê›·∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92∞ı‹Ó·È 115 28∆ËÏ: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Bimonthly PublicationThe Official Journal of the Hellenic Paediatric Society

PublisherK. Griveas

Owner©Hellenic Paediatric SocietyMichalakopoulou 92Athens 115 28Tel.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Scientific Editorial BoardPresident : A. ConstantopoulosEditor : S. HaidasMembers : F. Athanassiadou-Piperopoulou

: G. Varlamis: M. Ilia: I. Papadatos: N. Papadopoulos: S. Polychronopoulou: K. Prountzou-Kassiou: C. Stefanidis: M. Tsolia: S. Fotopoulos

Manuscript Editing

Greek EditingI. Karavranou

English EditingS. Nakou

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰fiÛÂˆ˜E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.¶. ∆Û·Ï‰¿ÚË 3, 151 22 M·ÚÔ‡ÛÈTËÏ.: 210-61 41 360-5 Fax: 210-61 41 366

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 40 cEÈ‰ÈÎÂ˘fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 c

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdP. Tsaldari 3, Marousi 151 22Tel.: 210-61 41 360-5 Fax: 210-61 41 366

Annual SubscriptionAll foreign countries: US $ 50




Hellenic Paediatric SocietyHellenic Paediatric Society


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πSSN 0377-2551



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A. °ÂÓÈÎ¤˜ ¶ÏËÚÔÊÔÚ›Â˜∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈÎ‹ ¤Î-

‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›-·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· Ì¤ÏË ÙË˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi-¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡¤ÚÁÔ˘ Î·È ÙË Û˘ÓÂ¯‹ ÂÓËÌ¤ÚˆÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·ÈÛ˘ÁÎÂÎÚÈÌ¤Ó·:

1. ÕÚıÚ· Û‡ÓÙ·ÍË˜ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË ÙË˜ EÈÛÙË-ÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂÈ˜.3. µÚ·‚Â˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜.4. ∂ÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜.5. ∂ÈÏÂÁÌ¤ÓÂ˜ Û˘˙ËÙ‹ÛÂÈ˜ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.6. ∂›Î·ÈÚ· ı¤Ì·Ù·.7. £¤Ì·Ù· ÂÎ·›‰Â˘ÛË˜ Î·È ÔÚÁ¿ÓˆÛË˜ ˘ÁÂ›·˜.8. ∫ÏÈÓÈÎ¤˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜.9. ™‡ÓÙÔÌ· Ó¤·.

10. µÚ·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜.11. ∂ÈÛÙÔÏ¤˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.12. ¶ÂÚÈÏ‹„ÂÈ˜ ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.13. ∞Ó·ÎÔÈÓÒÛÂÈ˜ ÚÔÛÂ¯ÒÓ Û˘ÓÂ‰Ú›ˆÓ Î·È ÂÈÛÙËÌÔÓÈ-

ÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈÎ‹ Ó¤ˆÓ ÂÎ‰fiÛÂˆÓ, ÂÏÏËÓÈÎÒÓ Î·È

Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‰È·ÙËÚÂ› ÙÔ ‰ÈÎ·›-ˆÌ· Ó· ‰ËÌÔÛÈÂ‡ÂÈ ¿ÚıÚ· ÌÂ È‰È·›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂÓ‰È·-Ê¤ÚÔÓ Î·ıÒ˜ Î·È ¿ÚıÚ· ÌÂ Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙË-ÚÂ›Ù·È Ë ÛÂÈÚ¿ ̆ Ô‚ÔÏ‹˜. ∂›ÛË˜, ÌÔÚÂ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ·ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛıÂ› ÛÙÔÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›-Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ-Î‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈÎ¿ ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

™ÙÈ˜ ÂÚÁ·Û›Â˜ ÌÂ Â›Î·ÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿-ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓÁÈ· ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ÙË˜ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘ÛË˜. ∏ ∂È-ÙÚÔ‹ ™‡ÓÙ·ÍË˜ ‰È·ÙËÚÂ› ÙÔ ‰ÈÎ·›ˆÌ· ÙË˜ ·Ô‰Ô¯‹˜ ÙË˜Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘ÛË˜.

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

Û›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ÙÚÈÏÔ‡Ó ÛÙË ‰ÈÂ‡ı˘ÓÛË:

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

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘Á-ÁÚ·ÊÂ›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ·ÎÚ›ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘ÓÙË ‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹”. ∂ÈÏ¤-ÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹ÛÂÈ˜ - ¯ÔÚË-

Á›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘Á-ÁÚ·Ê¤ˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›ÓÂÛËÙˆÓ ÌÂÙÂ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡ÌÊˆ-Ó· ÌÂ ÙÈ˜ ‰È·ÎËÚ‡ÍÂÈ˜ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ.

∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰·ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙˆÓ ∏¶∞(DHEW Publication, NIH, 80-23). ™ÙÈ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ı·Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈıÂ› ·fi ÙËÓ ÂÈÙÚÔ-‹ ∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹” Î·È Ë ÔÏÈÎ‹ ‹ ÌÂÚÈ-Î‹ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤Á-ÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙÂ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈ-Ó¤˜ ¶ÚÔ‰È·ÁÚ·Ê¤˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·ÈÛÂ µÈÔ˚·ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿” (Uniform Requirements forManuscripts Submitted to Biomedical Journals) Ô˘ ‰Ë-ÌÔÛÈÂ‡ÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934

http://jama.ama-assn.org/info/auinst_req.html

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

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘-ÏÔÁÚ·ÊËÌ¤ÓÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ÛÙËÓ EÈÛÙË-ÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi ‰ÈÛÎ¤Ù·Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· ÛÂ ÚfiÁÚ·ÌÌ· Word Î·ÈÙÔ˘˜ ›Ó·ÎÂ˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, ÛÂ ÚfiÁÚ·ÌÌ· Excel, Î·-ıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ ÔÈ ÙÚÔ-ÔÔÈ‹ÛÂÈ˜ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂÈ˜ ÛÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ.

H Î·ı˘ÛÙ¤ÚËÛË ÙË˜ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈ-ËÌ¤ÓÔ˘ ÎÂÈÌ¤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·ÈÓ¤· ˘Ô‚ÔÏ‹.

°È· Ó· ÂÈÙÂ˘¯ıÂ› Ë ¤ÁÎ·ÈÚË ‰ËÌÔÛ›Â˘ÛË ÙË˜ ÂÚÁ·-Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÙ˘ÔÁÚ·ÊÈÎfi ‰ÔÎ›ÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Ì¤Û· ÛÂ‰‡Ô (2) ËÌ¤ÚÂ˜.

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

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

°. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ ÙË˜ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ

ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë ÏÂ˘ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·ÊÂ›˜

v

A4 (21x29.7 cm) ÌÂ ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ ÙˆÓ ÁÚ·ÌÌÒÓÎ·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙÈ˜ ‰‡Ô ÏÂ˘Ú¤˜.

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

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ 2000-3000 Ï¤ÍÂÈ˜. ‚. ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ Â-

ÚÈÙÒÛÂÈ˜ ÛÂ 1500-2500 Ï¤ÍÂÈ˜. Á. ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000-1500 Ï¤ÍÂÈ˜. ‰. ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-500 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:

- ÙÔÓ Ù›ÙÏÔ (<14 Ï¤ÍÂÈ˜) Î·ıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5Ï¤ÍÂÈ˜) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂÈ˜,

- ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁÚ·Ê¤· ÛÙËÓÔÓÔÌ·ÛÙÈÎ‹,

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

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

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

ÙË˜ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· Î˘ÚÈfiÙÂÚ· ·ÔÙÂÏ¤-ÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜. £· Ú¤ÂÈ Ó·ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 Ï¤ÍÂÈ˜, fiÌˆ˜ ‰ÂÓ ı· Ú¤-ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·-ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌËÌ¤ÓË ÛÙÈ˜ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜:ÂÈÛ·ÁˆÁ‹, Ì¤ıÔ‰ÔÈ, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Ô Ù›ÙÏÔ˜ ÙË˜ ÂÚÁ·Û›·˜ Î·ÈÙ· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙ· ·ÁÁÏÈÎ¿. TÔ ÂÚÈÂ¯fi-ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈÌ¤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌËÌ¤ÓÔÛÂ ÂÈÛ·ÁˆÁ‹ (background), Ì¤ıÔ‰ÔÈ (methods), ·ÔÙÂ-Ï¤ÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). HÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈÎ¿.

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

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

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

ÌÂıfi‰Ô˘˜, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ Â-ÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Û˘-ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂ ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·-

ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi ÙË˜ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂ-ıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ÂÚÂ˘ÓËÙ¤˜. ∂›ÛË˜, Ú¤ÂÈ ÌÂ ÏÂÙÔÌ¤ÚÂÈÂ˜ Ó· ·Ó·Ê¤ÚÔ-ÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ·Ó¿Ï˘ÛË˜ Î·È ·ÍÈÔÏfiÁËÛË˜ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂÏ¤ÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘-ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÙËÓ ··-Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈ-Ï·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡ÙÔ˘Ó ·fi ÙËÓ ÂÚ-Á·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘-Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ·Ú·ÙËÚ‹ÛÂÈ˜ ¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

OÈ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È ‚Ú·¯Â›· Û˘˙‹-ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË ÌÂ ¤Ì-Ê·ÛË ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘ÓÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘˜.

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

TÈÌ¤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓOÈ ÙÈÌ¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó·

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

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

ÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈÎ·È Ì·ÎÚÔÛÎÂÏÂ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ÛÙÔ ÎÂ›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔ-ÁÚ·Ê›Â˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ÛÂ ÂÈ-‰ÈÎfi Î·Ù¿ÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› ÌÂ ÙËÓ ÂÚÁ·-Û›·. OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ·Ú¤ÓıÂÛË Ìfi-ÓÔ ÛÙÈ˜ ÂÚÈÏ‹„ÂÈ˜.

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

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

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

vi

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

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

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

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

ÛË ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ¶·È‰È·ÙÚÈÎ‹ 1999;59:272-279.

Proesmans W. Bartter syndrome and its neonatalvariant. Eur J Pediatr 1997;156:669-679.

™˘ÌÏËÚˆÌ·ÙÈÎfi ÙÂ‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:Flyvbjerg A. Role of growth hormone, insulin-like

growth factors (IGFs) and IGF-binding proteins in therenal complications of diabetes. Kidney Int 1997;52 (60Suppl):S12-S19.

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

Conference. Neurofibromatosis conference statement.Arch Neurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:Ã·Ú·Ï·Ì›‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚÎ›· Î·È

˘ÂÚÏÈÈ‰·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘-Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199.

Schreiner GF, Lange L. Ethanol modulation ofmacrophage influx in glomerulonephritis [abstract].

J Am Soc Nephrol 1991;2:562.

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

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

II. µÈ‚Ï›·

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

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

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

and neck. 3rd ed. New York: Oxford University Press; 1990.

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

In: Smith AJ, Rogers CA, eds. Proceedings of the ThirdInternational Congress of Chemotherapy; 1962 May 29-

31; New York: International Society of Chemotherapy;1963. p. 484-500.

¢È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹:¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂÚ·Â›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·-

ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

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

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

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

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

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

¶ÚÈÓ ·ÔÛÙÂ›ÏÂÙÂ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚Â‚·ÈˆıÂ›ÙÂ fiÙÈ Â-ÚÈÏ·Ì‚¿ÓÂÈ:

1. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜.2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜ ‰ËÌÔÛ›Â˘ÛË˜ ÙË˜ ÂÚÁ·Û›·˜.3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜.4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ:

·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁÚ·Ê¤ˆÓ (ÔÏÔÁÚ¿Êˆ˜), Á. ÂÈÛÙËÌÔÓÈÎfi/¿ Î¤ÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰. fiÓÔÌ·, ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤ÊˆÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ·

·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏfi

‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆ-

ÚÈÛÙ‹ ÛÂÏ›‰·).7. ∫Â›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).8. ∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹-

ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜).9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ¶›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.11. ∂ÈÎfiÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜

Ù· Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó.12. ∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ ¯ˆ-

ÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

vii

¶·È‰È·ÙÚÈÎ‹ 2003;66:405-417 Paediatriki 2003;66:405-417

405

OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ÛÙ· ·È‰È¿ ∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁÎ¿ÎË

Cardiomyopathies in children H. Apostolou, A. Tsilimigaki

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

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

2nd Paediatric Clinic of Venizelion Hospital, Heraklion, Crete

∂ÈÛ·ÁˆÁ‹OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· Ófi-

ÛˆÓ, Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ë ÚÔ-Û‚ÔÏ‹ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ì˘fi˜, ÂÓÒ Û˘ÓÈ-ÛÙÔ‡Ó ‰ÔÌÈÎ¤˜ ‹ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Î·Ú-‰È·ÎÔ‡ Ì˘fi˜ Ô˘ ‰ÂÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘¤ÚÙ·ÛË˜,‚·Ï‚È‰Ô¿ıÂÈ·˜ ‹ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘ (1). ∏ ÙÂÏÂ˘Ù·›· Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔÎ·Ú-‰ÈÔ·ıÂÈÒÓ ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (1).

OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜, ÌÂ ‚¿ÛË ÙË ÏÂÈÙÔ˘ÚÁÈÎ‹ÙÔ˘˜ ‰È·Ù·Ú·¯‹, Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ: ·) ‰È·Ù·ÙÈÎ‹ ‹Û˘ÌÊÔÚËÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, ÛÙËÓ ÔÔ›· Ë ·ÚÈ-ÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈÏ›Â˜ Â›Ó·È ‰È·ÙÂÙ·Ì¤ÓÂ˜ Î·È ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÈˆÌ¤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ·, ‚) ˘ÂÚÙÚÔ-ÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Û˘Ó‹ıˆ˜ ·Û‡Ì-

ÌÂÙÚË, Á) ÂÚÈÔÚÈÛÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈÎ¿ ‰È·ÙÂÙ·Ì¤ÓÔ˘˜ ÎfiÏÔ˘˜,ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ‰È·ÛÙ¿ÛÂÈ˜ ÙˆÓ ÎÔÈÏÈÒÓ (3) (¶›Ó·-Î·˜ 2), ‰) ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈ-Ï›·˜, ÛÙËÓ ÔÔ›· Ù· Î‡ÙÙ·Ú· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ·ÓÙÈ-Î·ı›ÛÙ·ÓÙ·È ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi (4) Î·È Â) ÌËÛ˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔ, Ì›· Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Ô˘ Â-ÚÈÁÚ¿ÊËÎÂ ÚfiÛÊ·Ù·. ªÂ ÙË Ú·Á‰·›· ÂÍ¤ÏÈÍË ÛÙÔÓÙÔÌ¤· ÙË˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ Î·È ÌÂ ÙË ‚ÂÏÙ›ˆÛËÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ì¤ÛˆÓ, ÔÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ·Ó·-ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·ÈıÓËÛÈÌfiÙËÙ·˜, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ fiÛÔ Î·È ÛÙ··È‰È¿.

¢È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ∏ ‰È·Ù·ÙÈÎ‹ ‹ Û˘ÌÊÔÚËÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·

(¢ª∫) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜,

�¶ÂÚ›ÏË„Ë: OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ·ÔÙÂÏÔ‡Ó ÛË-Ì·ÓÙÈÎ‹ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÂfiÏÔ ÙÔÓ ÎfiÛÌÔ, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ fiÛÔ Î·È ÛÙ··È‰È¿. OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ·ÔÙÂÏÔ‡Ó ·ı‹ÛÂÈ˜ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ì˘fi˜ Î·È ¯ˆÚ›˙ÔÓÙ·È ÛÙËÓ ˘ÂÚÙÚÔ-ÊÈÎ‹, ÙË ‰È·Ù·ÙÈÎ‹, ÙËÓ ÂÚÈÔÚÈÛÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿-ıÂÈ·, ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈ-Ï›·˜, Î·ıÒ˜ Î·È ÛÙÔ “ÌË Û˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔ” Ô˘ÂÚÈÁÚ¿ÊËÎÂ ÚfiÛÊ·Ù·. OÈ Ú·Á‰·›Â˜ ÂÍÂÏ›ÍÂÈ˜Ô˘ ÛËÌÂÈÒÓÔÓÙ·È ÛÙË ÌÔÚÈ·Î‹ ÁÂÓÂÙÈÎ‹, ¤¯Ô˘ÓÛ˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙË˜ ·ÈÙÈÔÏÔ-Á›·˜ ÙˆÓ Ì˘ÔÎ·Ú‰ÈÔ·ıÂÈÒÓ, ÙË˜ ÂÍ¤ÏÈÍË˜, Î·ıÒ˜Î·È ÛÙËÓ ÙÚÔÔÔ›ËÛË ˆ˜ ¤Ó· ‚·ıÌfi ÙË˜ ıÂÚ·Â˘-ÙÈÎ‹˜ ÛÙÚ·ÙËÁÈÎ‹˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜, ‰È·Ù·ÙÈÎ‹, ˘ÂÚ-ÙÚÔÊÈÎ‹, ÂÚÈÔÚÈÛÙÈÎ‹, ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›·ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÌË Û˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔ.

�Abstract: Cardiomyopathies represent a varietyof cardiac diseases that are an important cause ofmorbidity and mortality throughout the world, inboth children and adults. They are classified intocategories of hypertrophic, dilated and restrictivecardiomyopathy, arrythmiogenic right ventriculardysplasia, and the recently described non-compaction of the left ventricle. The recentadvances in molecular genetics have contributed tothe better understanding of the aetiology of thecardiomyopathies, the therapeutic interventionsand the prognosis.

Key words: cardiomyopathies, dilated, hypertrophic,restrictive, arrythmiogenic right ventricular dysplasia,non-compaction of the left ventricle.

ÌÂ ÂÙ‹ÛÈ· Â›ÙˆÛË 40-50 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000ÏËı˘ÛÌÔ‡ ÛÙÈ˜ ∏.¶.∞. Î·È ÙËÓ ∂˘ÚÒË (5,6). Ã·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ‰È¿Ù·ÛË Î·È ÌÂÈˆÌ¤ÓË Û˘ÛÙ·ÏÙÈÎfiÙË-Ù· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ.

∞ÈÙÈÔÏÔÁ›· ∏ ¢ª∫ ·ÔÙÂÏÂ› Ì›· ÎÔÈÓ‹ ¤ÎÊÚ·ÛË Ì˘ÔÎ·Ú‰È·-

Î‹˜ ‚Ï¿‚Ë˜ Ô˘ ÚÔ‹ÏıÂ ·fi Ì›· ÔÈÎÈÏ›· ÌË Ï‹-Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓˆÓ ‚Ï·ÙÈÎÒÓ ÂÈ‰Ú¿ÛÂˆÓ Â›ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (¶›Ó·Î·˜ 3). ∏ ¤ÚÂ˘Ó· Û¯ÂÙÈÎ¿ ÌÂÙËÓ ·ıÔÁ¤ÓÂÈ· ¤¯ÂÈ ÂÛÙÈ·ÛÙÂ› ÛÂ 4 ‚·ÛÈÎÔ‡˜ ÌË¯·-ÓÈÛÌÔ‡˜: ÔÈÎÔÁÂÓÂ›˜ Î·È ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, ÈÔÁÂ-Ó‹˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·, ·ÓÔÛÔÏÔÁÈÎ¤˜ Î·È ÌÂÙ·‚ÔÏÈÎ¤˜‰È·Ù·Ú·¯¤˜ (7).

∏ ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË ÙË˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú-‰ÈÔ¿ıÂÈ·˜ Â›Ó·È Û˘¯ÓfiÙÂÚË ·fi fi,ÙÈ Û˘Ó‹ıˆ˜ ·Ó·-ÁÓˆÚ›˙ÂÙ·È. ™Â ÔÛÔÛÙfi 20% ÙˆÓ ·ÛıÂÓÒÓ, ¤Ó·˜ÚÒÙÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹˜ ÂÌÊ·Ó›˙ÂÈ ÂÓ‰Â›ÍÂÈ˜ ¢ª∫

‹ ˘ÔÎÏÈÓÈÎ‹ ÓfiÛÔ, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ËÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Â›Ó·È ÔÏ‡ Û˘¯Ó‹ (8). ªÂ ÏÈ-ÁfiÙÂÚÔ ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ·, ÛÂ ÔÛÔÛÙfi ÂÚ›Ô˘ 35-48% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ¢ª∫, ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÔÈÎÔ-ÁÂÓ‹˜ (9,10). ∏ ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜Â›Ó·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹-Ú· (>90%), ÌÂ ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ¤ÎÊÚ·ÛË ·ÎfiÌ·Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· Î·È ÌÂ ‰ÈÂÈÛ‰˘ÙÈÎfiÙË-Ù· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈÎ›· (9-11). ∏ ÓfiÛÔ˜ Â›-Ó·È ÁÂÓÂÙÈÎ¿ ·ÓÔÌÔÈÔÁÂÓ‹˜ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Â-ÚÈÙÒÛÂÈ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi˘ÔÏÂÈfiÌÂÓÔ, ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú·, ·ÏÏ¿Î·È ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (12,13). ∆·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÌÂÏÂÙËıÂ› ·ÚÎÂÙ¿ Ë ÁÂÓÂÙÈÎ‹‚¿ÛË ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› 8 ‰È·ÊÔÚÂÙÈÎ¿ ·˘ÙÔÛˆÌ·ÙÈÎ¿ÁÔÓ›‰È· Î·È 8 ÂÈÚfiÛıÂÙÂ˜ ÂÚÈÔ¯¤˜ ̄ ÚˆÌÔÛˆÌ¿ÙˆÓ


406

¶›Ó·Î·˜ 1. ∞ÈÙÈÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔÎ·Ú‰ÈÔ·ıÂÈÒÓ

¢Â˘ÙÂÚÔ·ıÂ›˜ ¶ÚˆÙÔ·ıÂ›˜ ∞Ù·ÍÈÓfiÌËÙÂ˜

ÀÂÚÙ·ÛÈÎ‹ ¢È·Ù·ÙÈÎ‹ πÓÔÂÏ¿ÛÙˆÛËµ·Ï‚È‰ÈÎ‹ ÀÂÚÙÚÔÊÈÎ‹ ªË Û˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔπÛ¯·ÈÌÈÎ‹ ¶ÂÚÈÔÚÈÛÙÈÎ‹ ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹™˘ÛÙËÌ·ÙÈÎ‹˜ ÓfiÛÔ˘ ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›·ºÏÂÁÌÔÓÒ‰Ë˜ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜

∆ÚÔÔÔÈËÌ¤ÓÔ ·fi Circulation 1996;93:341-342

¶›Ó·Î·˜ 2. ∫ÏÈÓÈÎ¿, ·ÈÌÔ‰˘Ó·ÌÈÎ¿ Î·È ÌÔÚÊÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ Ì˘ÔÎ·Ú‰ÈÔ·ıÂÈÒÓ

ÀÂÚÙÚÔÊÈÎ‹ ¢È·Ù·ÙÈÎ‹ ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ¶ÂÚÈÔÚÈÛÙÈÎ‹‰˘ÛÏ·Û›· ÙË˜·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜

∫ÏÈÓÈÎ¿ñ ∫·Ú‰È·Î‹ ™ÔÚ·‰ÈÎ¿ ™˘¯Ó¿ ™˘¯Ó¿ ™˘¯Ó¿

·ÓÂ¿ÚÎÂÈ· ∫ÔÈÏÈ·Î¤˜ Î·È ∫ÔÈÏÈ·Î¤˜ Î·È ∫ÔÈÏÈ·Î‹ Ù·¯˘Î·Ú‰›·, ∫ÔÏÈÎ‹ Ì·ÚÌ·Ú˘Á‹ñ ∞ÚÚ˘ıÌ›Â˜ ˘ÂÚÎÔÈÏÈ·Î¤˜ ˘ÂÚÎÔÈÏÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜

·ÚÚ˘ıÌ›Â˜ ·ÚÚ˘ıÌ›Â˜, ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜

ñ ∞ÈÊÓ›‰ÈÔ˜ 0,7-11%/¤ÙÔ˜ ™˘¯Ó¿ ™˘¯Ó¿ 1-5%/¤ÙÔ˜ı¿Ó·ÙÔ˜

∞ÈÌÔ‰˘Ó·ÌÈÎ¿ñ ™˘ÛÙÔÏÈÎ‹ ÀÂÚ‰˘Ó·ÌÈÎ‹, ∂Ï·ÙÙˆÌ¤ÓË º˘ÛÈÔÏÔÁÈÎ‹/ º˘ÛÈÔÏÔÁÈÎ‹

ÏÂÈÙÔ˘ÚÁ›· ·fiÊÚ·ÍË ÙÔ˘ ÂÏ·ÙÙˆÌ¤ÓË¯ÒÚÔ˘ ÂÍfi‰Ô˘

ñ ¢È·ÛÙÔÏÈÎ‹ ∂Ï·ÙÙˆÌ¤ÓË ∂Ï·ÙÙˆÌ¤ÓË ∂Ï·ÙÙˆÌ¤ÓË ™ËÌ·ÓÙÈÎ¿ÏÂÈÙÔ˘ÚÁ›· ÂÏ·ÙÙˆÌ¤ÓË

ªÔÚÊÔÏÔÁÈÎ¿ñ ª¤ÁÂıÔ˜ ∂Ï·ÙÙˆÌ¤ÓÔ ∞˘ÍËÌ¤ÓË ·ÚÈÛÙÂÚ‹ ∞˘ÍËÌ¤ÓÔ º˘ÛÈÔÏÔÁÈÎfi

ÎÔÈÏÔÙ‹ÙˆÓ ÎÔÈÏ›· ‹ Î·È ÔÈ ‰‡Ô (‰ÂÍÈ¿ ÎÔÈÏ›·) ‹ ÂÏ·ÙÙˆÌ¤ÓÔ (Î·È∫ÔÈÏ›Â˜ ÎfiÏÔÈ ÔÈ ‰‡Ô ÎÔÈÏ›Â˜)∫fiÏÔÈ º˘ÛÈÔÏÔÁÈÎfi/ ∞˘ÍËÌ¤ÓÔ˜ ·ÚÈÛÙÂÚfi˜ ∞˘ÍËÌ¤ÓÔ ∞˘ÍËÌ¤ÓÔ

·˘ÍËÌ¤ÓÔ ‹ Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ (‰ÂÍÈfi˜ ÎfiÏÔ˜) (Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ)(·ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜)

ñ ¶¿¯Ô˜ ∞Û‡ÌÌÂÙÚË ¿¯˘ÓÛË º˘ÛÈÔÏÔÁÈÎfi ‹ º˘ÛÈÔÏÔÁÈÎfi/ º˘ÛÈÔÏÔÁÈÎfiÙÔÈ¯ÒÌ·ÙÔ˜ (·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·) ÂÏ·ÙÙˆÌ¤ÓÔ ÂÏ·ÙÙˆÌ¤ÓÔ

(‰ÂÍÈ¿ ÎÔÈÏ›·)

∆ÚÔÔÔÈËÌ¤ÓÔ ·fi Lancet 2001;358:1628


407

(6,11). ∏ ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÌÔ-ÚÂ› Ó· ¯ˆÚÈÛÙÂ› ÛÂ 4 Î‡ÚÈÂ˜ ÔÌ¿‰Â˜ ÌÂ ‚¿ÛË ÙËÓ ÎÏÈ-ÓÈÎ‹ ÂÈÎfiÓ· Î·È ÙÔÓ ˘Â‡ı˘ÓÔ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·:·) ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÌÂ ÁÚ‹ÁÔÚË ÂÈ‰Â›Óˆ-ÛË ÛÙÔ˘˜ ÓÂ·ÚÔ‡˜ ¿Ó‰ÚÂ˜, Ô˘ ÔÊÂ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÂÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙˆÓ ÁÔÓÈ‰›ˆÓ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÈ˜ÚˆÙÂ˝ÓÂ˜ ‰˘ÛÙÚÔÊ›ÓË Î·È Ù·Ê·˙›ÓË, ‚) ‰È·Ù·ÙÈÎ‹Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Ô˘ ÂÎ‰ËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÌÂ ‰˘-ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, fiÔ˘ ÔÈ ˘Â‡-ı˘ÓÂ˜ ÚˆÙÂ˝ÓÂ˜ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙÂ› ÌÂÙ¿ÏÏ·ÍË Â›-Ó·È Ë ÙÚÔÔÓ›ÓË ∆, Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË, Ë ‚-MHC (‚·-ÚÈ¿ ¿Ï˘ÛÔ˜ ÙË˜ ‚-Ì˘ÔÛ›ÓË˜) Î·È Ë ·ÎÙ›ÓË, Á) ‰È·Ù·ÙÈ-Î‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÌÂ ÚÒÈÌË ‰È·Ù·Ú·¯‹ ÙË˜ ·Áˆ-Á‹˜, ÌÂ ‚Ï¿‚Ë ÛÙÈ˜ ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ ˘Ú‹Ó· Ï·Ì›ÓÂ˜ AÎ·È C Î·È ÛÙË ‰ÂÛÌ›ÓË, ‰) ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿-ıÂÈ· Ô˘ Û˘Ó˘¿Ú¯ÂÈ ÌÂ ÓÂ˘ÚÔ·ÈÛıËÙ‹ÚÈÔ ‚·ÚËÎÔ˝·Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ¿ÏÏ·ÍË ÙË˜ ı¤ÛË˜ ÙÔ˘ ¯ÚˆÌÔ-ÛÒÌ·ÙÔ˜ 6q23-24 (∂ÈÎfiÓ· 1) (4,9).

ŒÓ·˜ ·ıÔÁÂÓÂÙÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ ÙË˜ ‰È·Ù·ÙÈÎ‹˜Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ Â›Ó·È ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓÔ˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ Î˘ÙÙ·ÚÔÛÎÂÏÂÙÔ‡,fiˆ˜ Ë ‰˘ÛÙÚÔÊ›ÓË (¯ÚˆÌfiÛˆÌ· Ãp21), Ë Ù·Ê·˙›ÓË(¯ÚˆÌfiÛˆÌ· Xq28), Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË (¯ÚˆÌfiÛˆ-Ì· 5q33-q34) Î·È Ë ‰ÂÛÌ›ÓË (¯ÚˆÌfiÛˆÌ· 2q35) (14).

O Ê·ÈÓfiÙ˘Ô˜ ÙË˜ Ê˘ÏÔÛ‡Ó‰ÂÙË˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ·˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ÁÔÓÈ‰›Ô˘ Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙËÓ ÚˆÙÂ˝ÓË ‰˘ÛÙÚÔÊ›ÓË(Ãp21), Û˘Ó‹ıˆ˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÛÙËÓ ÂÊË‚Â›· ‹ ÛÂÓ¤Ô˘˜ ¿ÚÚÂÓÂ˜ Î·È Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÙË Ì˘˚Î‹‰˘ÛÙÚÔÊ›· Duchenne Î·È Becker, ·Ú’ fiÏÔ Ô˘¤¯Ô˘Ó ÂÓÙÔÈÛÙÂ› ÌÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ‰È·-Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘Ô-ÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (15-17). ∏ Ê˘ÏÔÛ‡Ó‰ÂÙËÌ˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÙË˜ Ù·Ê·˙›ÓË˜ (Û‡Ó‰ÚÔÌÔ Barth), ÂÌÊ·Ó›˙ÂÙ·È Ù˘È-Î¿ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Î·È Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜ (17).ªÂÙ·ÏÏ¿ÍÂÈ˜ ÙˆÓ ÁÔÓÈ‰›ˆÓ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó Úˆ-ÙÂ˝ÓÂ˜ ÙÔ˘ Û·ÚÎÔÌÂÚÈ‰›Ô˘, fiˆ˜ Ë ‰ÂÛÌ›ÓË, Ë ‰-Û·Ú-ÎÔÁÏ˘Î¿ÓË, Ë ·ÎÙ›ÓË Î·È Ë ÙÈÙ›ÓË, ÌÂÙ·‚È‚¿˙ÔÓÙ·È ÌÂÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (18-21)(∂ÈÎfiÓ· 1). ∞ÓˆÌ·Ï›Â˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÁˆÁ‹˜¤¯Ô˘Ó ·Ú·ÙËÚËıÂ› ÛÙË Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· Emery-Dreifus, Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Â›ÙÂ ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·-Ú·ÎÙ‹Ú· Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ÙË˜ ÂÌÂÚ›ÓË˜, Â›ÙÂ ÌÂ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ·¯·Ú·ÎÙ‹Ú· Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓÔ˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÈ˜ ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ ˘Ú‹Ó· Ï·Ì›ÓÂ˜A Î·È C (22,23). ∫¿ÔÈ· Û‡Ó‰ÚÔÌ· Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Î·È ‚·ÚËÎÔ˝· ÓÂ˘ÚÔ·È-ÛıËÙËÚÈ·ÎÔ‡ Ù‡Ô˘, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Alstrom (24),ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi tRNA Î·È ÌÂÙ·ÏÏ¿-ÍÂÈ˜ ÛÙÔ ¯ÚˆÌfiÛˆÌ· 6q23-24 (25). ¡ÂfiÙÂÚÂ˜ ÌÂÏ¤-ÙÂ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Î·È ¿ÏÏˆÓ ‰ÔÌÈÎÒÓÚˆÙÂ˚ÓÒÓ ÙÔ˘ Û·ÚÎÔÌÂÚÈ‰›Ô˘, fiˆ˜ Ë ÚˆÙÂ˝ÓË LIM(Lin-11, Isl-1 Î·È Mec-3) (26) Î·È Ë ÌÂÙ·‚ÈÎÔ˘Ï›ÓË (27).

∂›Ó·È Èı·Ófi fiÙÈ ¤Ó· ÂÂÈÛfi‰ÈÔ ˘ÔÎÏÈÓÈÎ‹˜ ÈÔÁÂ-ÓÔ‡˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·˜ ÌÔÚÂ› Ó· ÎÈÓËÙÔÔÈ‹ÛÂÈ ·ÓÔ-ÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË, Ô‰ËÁÒÓÙ·˜ ÛÙËÓ ·Ó¿Ù˘ÍË‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ (28,29). ¢È·Ù·Ú·¯¤˜,ÙfiÛÔ ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ fiÛÔ Î·È ÙË˜ ¯˘ÌÈÎ‹˜ ·ÓÔÛ›·˜,¤¯Ô˘Ó ‚ÚÂıÂ› ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ-¿ıÂÈ·. Œ¯ÂÈ ‰È·Ù˘ˆıÂ› Ë ˘fiıÂÛË fiÙÈ ÂÈ‰ÈÎ¿ ·ÓÙÈ-ÁfiÓ· ÙË˜ Î·ÙËÁÔÚ›·˜ HLA Ù¿ÍË˜ ππ (HLA-DR4 Î·ÈHLA-DQB1) ÛÙÔ ¯ÚˆÌfiÛˆÌ· 6, Â›Ó·È ÁÂÓÂÙÈÎÔ› ‰Â›-ÎÙÂ˜ ÙË˜ ÚÔ‰È¿ıÂÛË˜ ÁÈ· ·Ó¿Ù˘ÍË ¢ª∫ (3). ∂›-ÛË˜, ¤¯Ô˘Ó ·ÓÈ¯ÓÂ˘ıÂ› ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ ÙˆÓÎ˘ÙÙ¿ÚˆÓ ÛÂ ‚ÈÔ„›Â˜ Ì˘ÔÎ·Ú‰›Ô˘ ·ÛıÂÓÒÓ ÌÂ ¢ª∫,fiˆ˜ ÔÈ ÛÂÏÂÎÙ›ÓÂ˜ CD62E Î·È CD62P, ‚2 ÈÓÙÂÁÎÚ›-ÓÂ˜ CD29, ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ ÛÙ· ÙÔÈ¯ÒÌ·Ù· ÙˆÓ·ÁÁÂ›ˆÓ (VCAM-1) Î·È ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ ÛÙ·Î‡ÙÙ·Ú· (30). Œ¯Ô˘Ó ‰È·ÈÛÙˆıÂ› Î˘ÎÏÔÊÔÚÔ‡ÓÙ··ÓÙÈÌ˘ÔÎ·Ú‰È·Î¿ ·ÓÙÈÛÒÌ·Ù· ÂÓ·ÓÙ›ˆÓ ÔÈÎ›ÏˆÓ·ÓÙÈÁfiÓˆÓ, fiˆ˜ Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ ÙË˜ Ì˘ÔÛ›ÓË˜, ÔÈ‚-·‰ÚÂÓÂÚÁÈÎÔ› ˘Ô‰Ô¯Â›˜, Ô ÌÔ˘ÛÎ·ÚÈÓÈÎfi˜ ˘Ô‰Ô-¯¤·˜, Ë Ï·Ì›ÓË Î·È Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· (31). ∆· ·ÓÙÈÌ˘Ô-Î·Ú‰È·Î¿ ·ÓÙÈÛÒÌ·Ù· ·ÓÈ¯ÓÂ‡ÔÓÙ·È Î·È ÛÂ ÌË Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ Û˘ÁÁÂÓÂ›˜ ·ÛıÂÓÒÓ ÌÂ ‰È·Ù·ÙÈÎ‹Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Î·È Â›Ó·È ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜

¶›Ó·Î·˜ 3. AÈÙÈÔÏÔÁ›· ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜

ªÂÙ·‚ÔÏÈÎ¿∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎ¿ £˘ÚÂÔÙÔÍ›ÎˆÛË

ÀÔı˘ÚÂÔÂÈ‰ÈÛÌfi˜¢È·‚ËÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·ÀÔÁÏ˘Î·ÈÌ›·º·ÈÔ¯ÚˆÌÔÎ‡ÙÙˆÌ·¡Â˘ÚÔ‚Ï¿ÛÙˆÌ·

¡fiÛÔÈ ÂÓ·Ôı¤ÛÂˆ˜ °Ï˘ÎÔÁÔÓÈ¿ÛÂÈ˜µÏÂÓÓÔÔÏ˘Û·Î¯·ÚÈ‰ÒÛÂÈ˜™ÊÈÁÁÔÏÈÈ‰ÒÛÂÈ˜

ÀÔÛÈÙÈÛÌfi˜ KwashiorkorBeriberi

∞ÓÂ¿ÚÎÂÈ· Î·ÚÓÈÙ›ÓË˜∞ÓÂ¿ÚÎÂÈ· ‚-ÎÂÙÔÏ¿ÛË˜ÀÂÚÙ·˘ÚÈÓÔ˘Ú›·OÈÎÔÁÂÓ‹˜ π‰ÈÔ·ı‹˜ (·˘Ùo ÛˆÌ·ÙÈÎ‹Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÂÈÎÚ·ÙÔ‡Û·, ˘ÔÏÂÈfiÌÂÓË,

Ê˘ÏÔÛ‡Ó‰ÂÙË, ÛÔÚ·‰ÈÎ‹)º˘ÏÔÛ‡Ó‰ÂÙË Î·Ú‰ÈÔÛÎÂÏÂÙÈÎ‹Ì˘Ô¿ıÂÈ· (Û. Barth)

∫ÏËÚÔÓÔÌÈÎ¤˜‰È·Ù·Ú·¯¤˜ª˘˚Î¤˜ ‰˘ÛÙÚÔÊ›Â˜ Duchene-Becker

Emery-Dreiffusª˘ÔÙÔÓÈÎ‹ ‰˘ÛÙÚÔÊ›·

ªÈÙÔ¯ÔÓ‰ÚÈ·Î¤˜ ™. Kearns-Sayre‰È·Ù·Ú·¯¤˜ ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ NADH-Co QÕÏÏ· ∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ

ª˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÙË˜ ÏÔ¯Â›·˜∞ÙÂÏ‹˜ ÔÛÙÂÔÁ¤ÓÂÛË§ÔÈÌÒ‰Ë˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·

∆ÚÔÔÔÈËÌ¤ÓÔ ·fi Curr Opin Pediatr 1995;7:587-594


408

ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘ (32). ∞ÓˆÌ·Ï›Â˜ ˘ÔÏËı˘ÛÌÒÓ∆ Î˘ÙÙ¿ÚˆÓ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Î˘ÙÙ·ÚÔÙÔÍÈ-ÎÒÓ ∆ Î˘ÙÙ¿ÚˆÓ, ÙˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ ∆ ÏÂÌÊÔÎ˘ÙÙ¿-ÚˆÓ Î·È ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ¿ÚˆÓ-ÊÔÓ¤ˆÓ, ¤¯Ô˘Ó ‚ÚÂ-ıÂ› ÛÂ ÌÂÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜ (33). Œ¯ÂÈ ˘ÔÛÙËÚÈ¯ıÂ› fiÙÈ·˘Ù¤˜ ÔÈ ·ÓÔÛÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚÂ› Ó· Â›Ó·ÈÛ˘Ó¤ÂÈ· ÈÔÁÂÓÔ‡˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·˜. £ÂˆÚÂ›Ù·È fiÙÈÛ˘ÛÙ·ÙÈÎ¿ ÙˆÓ ÈÒÓ ÌÔÚÂ› Ó· ¤¯Ô˘Ó ÂÓÛˆÌ·ÙˆıÂ›ÛÙÔ Û·ÚÎÂ›ÏËÌ· ÙˆÓ Ì˘ÔÎ·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È‰ÚÔ˘Ó ˆ˜ ·ÓÙÈÁÔÓÈÎ‹ ËÁ‹ Ô˘ Î·ÙÂ˘ı‡ÓÂÈ ÙËÓ ·ÓÔ-ÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË ÚÔ˜ ÙÔ Ì˘ÔÎ¿Ú‰ÈÔ.

¶·ıÔÊ˘ÛÈÔÏÔÁ›· ™ÙË ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, Ë ·ÚÈÛÙÂÚ‹ ‹

Î·È ÔÈ ‰‡Ô ÎÔÈÏ›Â˜ Â›Ó·È ‰È·ÙÂÙ·Ì¤ÓÂ˜ Î·È ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·. ª·ÎÚÔÛÎÔÈÎ¿, Ë Î‡ÚÈ·ÌÔÚÊÔÏÔÁÈÎ‹ ·ÓˆÌ·Ï›· Â›Ó·È Ë ‰È¿Ù·ÛË ÙˆÓ ‰‡Ô ÎÔÈ-ÏÈÒÓ, Î·ıÒ˜ Î·È Ë ‰È¿Ù·ÛË ÙˆÓ ÎfiÏˆÓ. ∏ Î·Ú‰È¿¤¯ÂÈ ÛÊ·ÈÚÈÎ‹ ÂÌÊ¿ÓÈÛË Î·È ÙÔ Ì˘ÔÎ¿Ú‰ÈÔ Â›Ó·È ̂ ¯ÚfiÎ·È, ÌÂÚÈÎ¤˜ ÊÔÚ¤˜, ‰È¿ÛÙÈÎÙÔ. ∆Ô ÂÓ‰ÔÎ¿Ú‰ÈÔ Â›Ó·ÈÏÂÙfi Î·È ‰È¿Ê·ÓÔ, ÌÂ ÛËÌÂ›· ÙÔÈÎ‹˜ ÛÎÏ‹Ú˘ÓÛË˜.πÛÙÔÏÔÁÈÎ¿ ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÔÎ·Ú-‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÎÊ‡ÏÈÛË, ·ÏÏ¿ ·ÓÂ˘Ú›ÛÎÂÙ·ÈÎ·È ‰È¿ÌÂÛË ›ÓˆÛË (2,3,5).

∏ ÂÏ¿ÙÙˆÛË ÙË˜ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›-

Ô˘ Ô‰ËÁÂ› ÛÂ ÂÏ·ÙÙˆÌ¤ÓÔ ÎÏ¿ÛÌ· ‚Ú¿¯˘ÓÛË˜, ÎÏ¿-ÛÌ· ÂÍÒıËÛË˜ Î·È Î·Ú‰È·Î‹ ·ÚÔ¯‹, Ô˘ Ô‰ËÁÔ‡ÓÛÂ Ï›ÌÓ·ÛË ·›Ì·ÙÔ˜ ÛÙÈ˜ ÎÔÈÏfiÙËÙÂ˜ Î·È ÛÂ ‰Â˘ÙÂÚÔ-·ı‹ ·‡ÍËÛË ÙÔ˘ ÙÂÏÔ‰È·ÛÙÔÏÈÎÔ‡ fiÁÎÔ˘ Î·È ›ÂÛË˜,Î·ıÒ˜ Î·È ÙË˜ ›ÂÛË˜ Ï‹ÚˆÛË˜ ÙˆÓ ÎÔÈÏÈÒÓ. °È· Ó·‰È·ÙËÚËıÂ› Â·ÚÎ‹˜ Î·Ú‰È·Î‹ ·ÚÔ¯‹, ÔÈ ÎÔÈÏ›Â˜ ‰È·-ÙÂ›ÓÔÓÙ·È Î·È ÙÔ Ì˘ÔÎ¿Ú‰ÈÔ ˘ÂÚÙÚ¤ÊÂÙ·È ÛÂ Î¿ÔÈÔ‚·ıÌfi. ∏ ‰È¿Ù·ÛË ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛËÙË˜ ÙÔÈ¯ˆÌ·ÙÈÎ‹˜ Ù¿ÛË˜ Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ÛÂ ÔÍ˘ÁfiÓÔ. ∫·ıÒ˜ ÂÏ·ÙÙÒÓÂÙ·È ËÎ·Ú‰È·Î‹ ·ÚÔ¯‹, ÂÏ·ÙÙÒÓÂÙ·È Î·È Ë ·ÈÌ¿ÙˆÛË ÙˆÓÓÂÊÚÒÓ. ¶·Ú·ÙËÚÂ›Ù·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÓÂ˘ÚÔÔÚ-ÌÔÓÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ, Î˘Ú›ˆ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›-ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜-·Ï‰ÔÛÙÂÚfiÓË˜ Î·È ÙÔ˘ Û˘Ì·ıË-ÙÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆˘ÈÎ¿, ·˘Ù¤˜ ÔÈ ·ÏÏ·-Á¤˜ Á›ÓÔÓÙ·È ·ÚÁ¿ Î·È Ô‰ËÁÔ‡Ó ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·ÙË˜ Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜˘¤ÚÙ·ÛË˜, ÂÓÒ Ë ›ÓˆÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Ì˘ÔÎ·Ú‰›Ô˘‰ËÌÈÔ˘ÚÁÂ› ÂÛÙ›Â˜ ÎÔÈÏÈ·ÎÒÓ ·ÚÚ˘ıÌÈÒÓ (3,6).

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ· ŸÙ·Ó ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È·Ù‹ÚËÛË Â·ÚÎÔ‡˜

Î·Ú‰È·Î‹˜ ·ÚÔ¯‹˜, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛËÌÂ›· Î·È Û˘-ÌÙÒÌ·Ù· Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (2,3,6). ∞Ú¯ÈÎ¿,Ù· Û˘ÌÙÒÌ·Ù· ÌÔÚÂ› Ó· Â›Ó·È ˘ÔÎÏÈÓÈÎ¿ Î·È Ó·

∂ÈÎfiÓ· 1. ∏ ÌÔÚÈ·Î‹ ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ÚÔÛ‚Â‚ÏËÌ¤ÓˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙË ‰È·Ù·ÙÈÎ‹, ÙËÓ ˘ÂÚÙÚÔÊÈÎ‹ Î·È ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘-ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∞¢¢∫) (ÙÚÔÔÔÈËÌ¤ÓÔ ·fi Lancet 2001;358:1630).∫fiÎÎÈÓÔ: ÔÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÚˆÙÂ˝ÓÂ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, ∫›ÙÚÈÓÔ: ÔÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÚˆÙÂ˝ÓÂ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Î·È ¶Ú¿ÛÈÓÔ: ÔÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÚˆÙÂ˝ÓÂ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ∞¢¢∫, ÂÓÒ ªÏÂ: ÔÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÚˆÙÂ˝ÓÂ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ‹ ‰È·Ù·ÙÈÎ‹ ‹ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·.

‰-Û·ÚÎÔÁÏ˘Î¿ÓË Ï·ÌÈÓ›ÓË ·-2‰˘ÛÙÚÔÁÏ˘Î¿ÓÂ˜

ÂÌÂÚ›ÓË Ï·Ì›ÓË A/C

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ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜ ÙË˜ ‰˘ÛÙÚÔÊ›ÓË˜

‰˘ÛÙÚÔÊ›ÓË

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Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ‹ ÌÂÌ‚Ú¿ÓËÂÍˆÎ˘ÙÙ¿ÚÈ· Ô˘Û›·

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409

·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜ ·˘ÍËÌ¤ÓÔ˘ ÌÂÙ·‚Ô-ÏÈÛÌÔ‡, .¯. ÛÂ ÏÔÈÌÒÍÂÈ˜, fiÙ·Ó Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹‰ÂÓ Â·ÚÎÂ› ÁÈ· Ó· Î·Ï‡„ÂÈ ÙÈ˜ ·Ó¿ÁÎÂ˜ ÙÔ˘ ÔÚÁ·ÓÈ-ÛÌÔ‡. ªÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ‹ ¤ÊË‚ÔÈ ÌÔÚÂ› Ó· ·-ÚÔ˘ÛÈ¿ÛÔ˘Ó ÂÏ·ÙÙˆÌ¤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ‹ ‰‡-ÛÓÔÈ· ÛÙËÓ ÚÔÛ¿ıÂÈ·. ∆· ‚Ú¤ÊË ÌÔÚÂ› Ó· ·-ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù·¯‡ÓÔÈ·, ·ÓÂ·ÚÎ‹ ÚfiÛÏË„Ë ‚¿-ÚÔ˘˜ Î·È ÛËÌÂ›· Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ™Â ÔÛÔ-ÛÙfi 13% ÙˆÓ ·È‰ÈÒÓ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘ÁÎÔÙÈÎ¿ ÂÂÈ-Ûfi‰È· Î·È ·›ÛıËÌ· ·ÏÌÒÓ (3).

º˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ∆· Â˘Ú‹Ì·Ù· ÙË˜ Ê˘ÛÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ÌÔÚÂ› Ó·

ÔÈÎ›ÏÏÔ˘Ó, ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘. ∆Ô 70-80% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ‰È·Ù·ÙÈÎ‹ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌÂ›· Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜ (3,5). ∆· ¿ÙÔÌ· ·˘Ù¿ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó Ù·¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›· Î·È ˆ¯ÚfiÙËÙ·. ∞fi ÙËÓ·ÎÚfi·ÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÌÔÚÂ› Ó· ̆ ¿Ú¯Ô˘Ó ̆ ÁÚÔ›ÚfiÁ¯ÔÈ ‹ ÌÂ›ˆÛË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ÏfiÁˆ ·ÙÂÏÂÎÙ·Û›·˜ ÙÔ˘ ÓÂ‡ÌÔÓ· ·fi ÙËÓ ˘ÂÚÌÂ-Á¤ıË Î·Ú‰È¿. ∏ ·ÎÚfi·ÛË ÙË˜ Î·Ú‰È¿˜ ·ÔÎ·Ï‡ÙÂÈÛ˘Ó‹ıˆ˜ Î·Ï·ÛÙÈÎfi Ú˘ıÌfi Î·È, Û¿ÓÈ·, Û˘ÛÙÔÏÈÎfiÊ‡ÛËÌ· ·ÓÂ¿ÚÎÂÈ·˜ ÌÈÙÚÔÂÈ‰Ô‡˜. OÈ ÂÚÈÊÂÚÈÎ¤˜ÛÊ‡ÍÂÈ˜ Â›Ó·È ·ÛıÂÓÂ›˜. ∆Ô ‹·Ú Î·È Ô ÛÏ‹Ó·˜ Â›Ó·È„ËÏ·ÊËÙ¿ fiÙ·Ó ˘¿Ú¯ÂÈ Û˘ÌÊfiÚËÛË ÙˆÓ Û˘ÛÙËÌ·-ÙÈÎÒÓ ÊÏÂ‚ÒÓ.

¢È¿ÁÓˆÛË ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙË˜

Î·Ú‰È·Î‹˜ ÛÎÈ¿˜ ÂÍ·ÈÙ›·˜ ÙË˜ ‰È·ÙÂÙ·Ì¤ÓË˜ ·ÚÈÛÙÂ-Ú‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ÎfiÏÔ˘. ªÔÚÂ›, Â›ÛË˜, Ó·˘¿Ú¯Ô˘Ó ÂÚÈÔ¯¤˜ ÌÂ ·ÙÂÏÂÎÙ·Û›· ÛÙÔÓ ·ÚÈÛÙÂÚfiÓÂ‡ÌÔÓ· ÂÍ·ÈÙ›·˜ ÙË˜ Û˘Ì›ÂÛË˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ ·fiÙÔÓ ‰È·ÙÂÙ·Ì¤ÓÔ ·ÚÈÛÙÂÚfi ÎfiÏÔ Î·È ÙË ‰È·ÙÂÙ·Ì¤ÓË·ÚÈÛÙÂÚ‹ ÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›·. ™ËÌÂ›· ÓÂ˘ÌÔÓÈÎ‹˜˘¤ÚÙ·ÛË˜ Î·È ÓÂ˘ÌÔÓÈÎÔ‡ ÔÈ‰‹Ì·ÙÔ˜ ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È ÛÂ Î·Ú‰È·Î‹ Î¿Ì„Ë (3).

∆Ô ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· ·ÔÎ·Ï‡ÙÂÈ ÊÏÂ‚Ô-ÎÔÌ‚ÈÎ‹ Ù·¯˘Î·Ú‰›·, ˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ÎÔÈÏ›·˜, ¯·ÌËÏ¿ ‰˘Ó·ÌÈÎ¿ ÛÙÈ˜ ÚÔÎ¿Ú‰ÈÂ˜ ··Áˆ-Á¤˜, Î·ıÒ˜ Î·È ÌË ÂÈ‰ÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÙÔ˘ ST Î·È T.∞Ó·Ê¤ÚÂÙ·È fiÙÈ ÂÚ›Ô˘ ÙÔ 46% ÙˆÓ ·È‰ÈÒÓ ÌÂ ‰È·-Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÚ˘ıÌ›Â˜ÛÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∫°, ÙfiÛÔ ˘ÂÚÎÔÈÏÈ·-Î¤˜ fiÛÔ Î·È ÎÔÈÏÈ·Î¤˜, ÔÈ ÔÔ›Â˜ ÚÔ¤Ú¯ÔÓÙ·È ·fiÙÔÈÎ¤˜ ÂÛÙ›Â˜ ÛÙÔ ˘ÂÓ‰ÔÎ¿Ú‰ÈÔ ‹ ÛÙÈ˜ ˘ÔÂÈÎ·Ú-‰È·Î¤˜ ÛÙÈ‚¿‰Â˜ (34,35).

O ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÙË˜ ‰È¿ÁÓˆÛË˜ ÙË˜ ‰È·Ù·-ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ Â›Ó·È ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊË-Ì·, ÌÂ ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒÓÂÙ·È ‰È¿Ù·ÛË Î·È ˘ÔÛ˘-ÛÙ·ÏÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ, Î˘Ú›ˆ˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜(‰È·ÛÙ¿ÛÂÈ˜ Î·Ù¿ ÙË ‰È·ÛÙÔÏ‹ >95Ë ∂£ ÁÈ· ÙËÓ ÂÈ-Ê¿ÓÂÈ· ÛÒÌ·ÙÔ˜ Î·È ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ <50%). ∂›-ÛË˜, ‰È·ÈÛÙÒÓÂÙ·È Î·È ‰È¿ÊÔÚÔ˘ ‚·ıÌÔ‡ ·ÓÂ¿Ú-ÎÂÈ· ÌÈÙÚÔÂÈ‰Ô‡˜, Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ‰È¿Ù·-

ÛË˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙË˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ÙˆÓ ıËÏÔÂÈ‰ÒÓ Ì˘ÒÓ (3,6).

∂Ó‰Â›ÍÂÈ˜ ÁÈ· Î·ıÂÙËÚÈ·ÛÌfi Î·È ·ÁÁÂÈÔÁÚ·Ê›··ÔÙÂÏÔ‡Ó Ë Ï‹„Ë ‚ÈÔ„›·˜ ·fi ÙÔÓ Î·Ú‰È·Îfi Ì˘ Î·ÈË ÛÎÈ·ÁÚ¿ÊËÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓ.

∞Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· ÂÌÊ¿ÓÈÛË˜ ÙË˜ ÓfiÛÔ˘, Â›-Ó·È ¯Ú‹ÛÈÌÂ˜ ‰È¿ÊÔÚÂ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜,fiˆ˜ Ô Ï‹ÚË˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·(36), ÂÓÒ ‰È·ÁÓˆÛÙÈÎ‹ ÌÔÚÂ› Ó· Â›Ó·È Ë ·Ó¿Ï˘ÛËDNA ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ ÌÂÙ·ÏÏ¿-ÍÂˆÓ. ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË (¶›Ó·Î·˜ 4) ı· Û˘ÓÙÂ-Ï¤ÛÂÈ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Èı·Ó¿ È¿ÛÈÌˆÓ ·ÈÙ›ˆÓ.

£ÂÚ·Â›·∞Ó ‰ÂÓ ·Ó·ÁÓˆÚÈÛÙÂ› Î¿ÔÈÔ È¿ÛÈÌÔ ·›ÙÈÔ, Ë ıÂ-

Ú·Â›· Â›Ó·È Û˘ÌÙˆÌ·ÙÈÎ‹ Î·È Û˘Ó›ÛÙ·Ù·È ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Û˘ÌÊÔÚËÙÈÎ‹˜ Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜, ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·È ÙˆÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈ-ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∆· ÂÓ‰ÔÊÏ¤‚È· ÈÓfiÙÚÔ· (ÓÙÔ·Ì›-ÓË, ÓÙÔÌÔ˘Ù·Ì›ÓË), ÔÈ ·Ó·ÛÙÔÏÂ›˜ ÙË˜ ÊˆÛÊÔ‰ÈÂ-ÛÙÂÚ¿ÛË˜ (·ÌÚÈÓfiÓË, ÌÈÏÚÈÓÏfiÓË), Ù· ‰ÈÔ˘ÚËÙÈÎ¿, ÔÈ·Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Î·È Ë ‰ÈÁÔÍ›-ÓË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›-·˜ Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (3,6). ∏ ¯Ú‹ÛË ÙˆÓ ‚-·‰ÚÂÓÂÚÁÈÎÒÓ ·ÔÎÏÂÈÛÙÒÓ ¤¯ÂÈ, Â›ÛË˜, ÂÓı·ÚÚ˘-ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· (37). °È· ÙË ıÂÚ·Â›· ÙˆÓ ·Ú-Ú˘ıÌÈÒÓ, Ô˘ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¤˜ ÛÙ· ·È‰È¿, ¯ÚË-ÛÈÌÔÔÈÔ‡ÓÙ·È ·ÓÙÈ·ÚÚ˘ıÌÈÎ¿ Ê¿ÚÌ·Î·. ∂› ·ÚÔ˘-Û›·˜ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ı· Ú¤ÂÈ Ó·¯ÚËÛÈÌÔÔÈÂ›Ù·È ·ÓÙÈËÎÙÈÎ‹ ıÂÚ·Â›·. ∆ÂÏÂ˘Ù·›·,¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› ¯ˆÚ›˜ ÂÈÙ˘¯›· Ë ·ÓÔÛÔıÂÚ·-Â›· ÌÂ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ·˙·ıÂÈÔÚ›ÓË ‹ Î˘ÎÏÔ-ÛÔÚ›ÓË, Î˘Ú›ˆ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎ‹‰È‹ıËÛË ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Ë‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·-‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ··ÈÙÂ›Ù·È Ë ¿ÌÂÛË ·ÔÎ·Ù¿-ÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ∂¿Ó ‰ÂÓ ˘¿Ú-ÍÂÈ ·ÓÙ·fiÎÚÈÛË ÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ıÂÚ·Â›·, ÙfiÙÂ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÂÌ‚·ÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ, fiˆ˜ ÔÈ Û˘-ÛÎÂ˘¤˜ ˘ÔÛÙ‹ÚÈÍË˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ë ÂÓ‰Ô-·ÔÚÙÈÎ‹ ·ÓÙÏ›· Î·È Ë Û˘ÛÎÂ˘‹ ÂÍˆÛˆÌ·ÙÈÎ‹˜ Î˘ÎÏÔ-ÊÔÚ›·˜. ™ÙÈ˜ ÔÏ‡ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂÈ˜ ··ÈÙÂ›Ù·ÈÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜ (2,3,6).

¶ÚfiÁÓˆÛË ∏ ÚfiÁÓˆÛË ÙË˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜

ÛÙ· ·È‰È¿ ÔÈÎ›ÏÏÂÈ Î·È ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÂÙÂÚÔÁÂÓ‹·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘. ∞Ó·Ê¤ÚÂÙ·È 5ÂÙ‹˜ ıÓËÙfiÙËÙ·¤ˆ˜ 80% ÛÙ· ·È‰È¿ (38). ø˜ ‰Â›ÎÙÂ˜ Î·Î‹˜ Úfi-ÁÓˆÛË˜ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Ë ÂÎÛÂÛËÌ·ÛÌ¤ÓË ‰˘ÛÏÂÈ-ÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·Ù¿ ÙË ÛÙÈÁÌ‹ ÙË˜‰È¿ÁÓˆÛË˜ ‹ ÛÙËÓ Â·ÓÂÍ¤Ù·ÛË, ÂÈÌ¤ÓÔÓÙ· Û˘ÌÙÒÌ·Ù· Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ÙÔ ÔÈÎÔÁÂÓÂÈ-·Îfi ÈÛÙÔÚÈÎfi Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜, Ù· ÈÛÙÔÏÔÁÈÎ¿ Â˘-Ú‹Ì·Ù· ÂÓ‰ÔÎ·Ú‰È·Î‹˜ ÈÓÔÂÏ¿ÛÙˆÛË˜ Î·È Ë ·Ó¿ÁÎË·ÓÙÈËÎÙÈÎ‹˜ ıÂÚ·Â›·˜ (38).


410

ŸÙ·Ó ÙÂıÂ› Ë ‰È¿ÁÓˆÛË ÙË˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú-‰ÈÔ¿ıÂÈ·˜, Ú¤ÂÈ Ó· ÏËÊıÂ› ¤Ó· ÏÂÙÔÌÂÚ¤˜ ÔÈÎÔ-ÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂ-ÚÔ˘ ‚·ıÌÔ‡ (Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ‰È·Ù·ÙÈÎ‹˜Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜, ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ·ÚÚ˘ıÌÈÒÓÎ.Ï.) ÁÈ· Ó· ‰ÈÂÚÂ˘ÓËıÂ› Ë Èı·ÓfiÙËÙ· ÔÈÎÔÁÂÓÔ‡˜Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜. ∆Ô ÈÛÙÔÚÈÎfi, ‚¤‚·È·, ‰ÂÓ ¤¯ÂÈ Ùfi-ÛÔ ÌÂÁ¿ÏË Â˘·ÈÛıËÛ›· fiÛÔ ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È Î·-ıÒ˜ Ë ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÌÂÙ·-‚È‚¿˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·-ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÚÔÙÂ›ÓÂÙ·È Ë ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛËÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ ‚·ıÌÔ‡ (ÁÔÓÂ›˜, ·‰¤ÚÊÈ·,·È‰È¿) Ó· Á›ÓÂÙ·È ÌÂ Î·Ï‹ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡, ÎÏÈÓÈÎ‹ÂÍ¤Ù·ÛË, ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Î·È Ë¯ÔÎ·Ú‰ÈÔ-ÁÚ¿ÊËÌ· (8-11). ∂ÂÈ‰‹ ÙfiÛÔ Ë ËÏÈÎ›· ¤Ó·ÚÍË˜ fiÛÔÎ·È Ë ÎÏÈÓÈÎ‹ ÂÌÊ¿ÓÈÛË ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈÎ‹˜Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ Â›Ó·È ·ÛÙ·ı‹ ·ÎfiÌ· Î·È Ì¤Û·ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÚÈÔ‰ÈÎfi˜Â·Ó¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓÂ›˜ Î¿ıÂ 3-5 ¯ÚfiÓÈ· (11).

ÀÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ∏ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· (Àª∫) Â›Ó·È Ë

‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÛÙ· ·È‰È¿Î·È ·ÔÙÂÏÂ› ÙÔ 20-30% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì˘ÔÎ·Ú-‰ÈÔ·ıÂÈÒÓ (3). ∏ Â›ÙˆÛ‹ ÙË˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘-ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1/5000 ¤ˆ˜ 1/500 ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈ-ÎÂ˜, ÌÂ ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÌÊ¿ÓÈÛËÎ·È ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (6,40,41). ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈı-Ìfi˜ ·ı‹ÛÂˆÓ Â˘ı‡ÓÂÙ·È ÁÈ· ÙË ‰Â˘ÙÂÚÔ·ı‹ ˘ÂÚ-ÙÚÔÊ›· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ÛÙ· ·È‰È¿, fiˆ˜ Ù· ÌÂÙ·-‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·, ‰È¿ÊÔÚ· Û‡Ó‰ÚÔÌ· Î·È ÓÂ˘ÚÔÌ˘-˚Î¤˜ ‰È·Ù·Ú·¯¤˜ (5) (¶›Ó·Î·˜ 5), ÂÓÒ ÛÙÔ ÌÂÁ·Ï‡ÙÂ-ÚÔ ÔÛÔÛÙfi Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È ¿ÁÓˆÛÙË.

∏ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ ·ÔÙÂÏÂ› ÙÔ 50% ÙˆÓ ·ÈÙ›ˆÓ

ÙË˜ ÓfiÛÔ˘ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÙÔÓ ·˘ÙfiÛˆÌÔ ÂÈ-ÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (6). OÈ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ¤¯Ô˘Ó Î¿ÔÈÔÓ ¿Û¯ÔÓÙ· Û˘ÁÁÂÓ‹, ¤¯Ô˘Ó Èı·Ó¿ÛÔÚ·‰ÈÎ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙË˜ ÓfiÛÔ˘ Ô˘ ‰‡ÛÎÔÏ··ÓÈ¯ÓÂ‡ÔÓÙ·È Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È (6). ∞ÎfiÌ· Î·È Ì¤Û·ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏËÔÈÎÈÏ›· ÂÎ‰ËÏÒÛÂˆÓ. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ ¤¯ÂÈ ·ÙÂÏ‹ ‰È-ÂÈÛ‰˘ÙÈÎfiÙËÙ· ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›·, ÂÓÒÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ¤¯ÂÈ Ï‹ÚË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (3). ∏ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË ¤¯ÂÈ ·ÔÎˆ‰ÈÎÔÔÈ‹ÛÂÈ 9 ‰È·ÊÔ-ÚÂÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌ·ÙÔÛˆÌ¿ÙˆÓ ˆ˜ ·ÈÙÈÔÏÔÁÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚÙÚÔÊÈÎ‹˜Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜, ÔÈ ÔÔ›Â˜ Îˆ‰ÈÎÔÔÈÔ‡Ó Úˆ-ÙÂ˝ÓÂ˜ ÙÔ˘ Û·ÚÎÔÌÂÚÈ‰›Ô˘ (6,41). ŸÏÂ˜ ·˘Ù¤˜ ÔÈÚˆÙÂ˝ÓÂ˜ ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÚfiÏÔ˘˜ ÛÙÔÓ Î‡ÎÏÔÛ˘ÛÙÔÏ‹˜-¯¿Ï·ÛË˜ Î·È Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ÛÙËÓ ÔÌÔÈfi-ÛÙ·ÛË ÙË˜ Î·Ú‰È¿˜ (6). ∏ ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ ÙË˜ ·-Ì˘Ô-Û›ÓË˜ Î·È Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ ÙË˜ ‚-Ì˘ÔÛ›ÓË˜ ·ÏÏËÏÂÈ-‰ÚÔ‡Ó ÌÂ ÙËÓ ·ÎÙ›ÓË ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÌË¯·ÓÈÎ‹˜ÂÓ¤ÚÁÂÈ·˜, Ë ÙÚÔÔÓ›ÓË ∆, Ë ÙÚÔÔÓ›ÓË π, Ë ·-ÙÚÔÔ-Ì˘ÔÛ›ÓË Î·È Ë ÂÏ·ÊÚ¿ ¿Ï˘ÛÔ˜ ÙË˜ Ì˘ÔÛ›ÓË˜ ¤¯Ô˘ÓÚ˘ıÌÈÛÙÈÎfi ÚfiÏÔ, ÂÓÒ Ë ÚˆÙÂ˝ÓË C Ô˘ Û˘Ó‰¤ÂÙ·ÈÌÂ ÙË Ì˘ÔÛ›ÓË Î·È Ë ÙÈÙ›ÓË ‚ÔËıÔ‡Ó ÛÙË ÌÂÙ·ÊÔÚ¿ÂÓ¤ÚÁÂÈ·˜ (∂ÈÎfiÓ· 1) (42-50). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÛ-ÛfiÙÂÚÂ˜ ·fi 150 ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓ Ô˘ Îˆ‰ÈÎÔ-ÔÈÔ‡Ó ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ Û·ÚÎÔÌÂÚÈ‰›Ô˘ Ô˘ Â›Ó·È˘Â‡ı˘ÓÂ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ̆ ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú-‰ÈÔ¿ıÂÈ·˜ (41). ∆Ô ÂÓ‰È·Ê¤ÚÔÓ ¤¯ÂÈ ÛÙÚ·ÊÂ› ÛÙË‰ÈÂÚÂ‡ÓËÛË Èı·Ó‹˜ Û˘Û¯¤ÙÈÛË˜ ÌÂÙ·Í‡ ÙÔ˘ ÁÔÓfi-Ù˘Ô˘ Î·È ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·ÏÏ¿-ÍÂˆÓ (41-43). OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ‚·-ÚÈ¿˜ ·Ï‡ÛÔ˘ ÙË˜ ‚-Ì˘ÔÛ›ÓË˜ (¯ÚˆÌfiÛˆÌ· 14q11.2-12) Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚÂ˜ Î·È ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ 35-50%fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (41). ∫¿ÔÈÂ˜ ·fi ·˘Ù¤˜ ÙÈ˜ÌÂÙ·ÏÏ¿ÍÂÈ˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ‹È· ÎÏÈÓÈÎ‹ ÔÚÂ›· Î·È

¶›Ó·Î·˜ 4. ¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿

¶ÚÔÛ¤ÁÁÈÛË ∞ÓˆÌ·Ï›· ¶Èı·Ó‹ ‰È¿ÁÓˆÛË

ñ ∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ∂ÁÎÂÊ·ÏÔ¿ıÂÈ· ªÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ‹ ÓfiÛÔ˜ ÂÓ·fiıÂÛË˜ª˘Ô¿ıÂÈ·¢˘ÛÌÔÚÊÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜∏·ÙÔÛÏËÓÔÌÂÁ·Ï›·

ñ ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ∞˘ÍËÌ¤ÓË ∆∫∂, CRP πÔÁÂÓ‹˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·∞˘ÍËÌ¤Ó· Î·Ú‰È·Î¿ ¤Ó˙˘Ì·£ÂÙÈÎfi˜ ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ÀÔÁÏ˘Î·ÈÌ›· ÌÂ ÔÍ¤ˆÛË °Ï˘ÎÔÁÔÓ›·ÛË, ÔÚÁ·ÓÈÎ‹ ÔÍ˘·ÈÌ›·ÀÔÁÏ˘Î·ÈÌ›· ¯ˆÚ›˜ ÔÍ¤ˆÛË ¢È·Ù·Ú·¯¤˜ ÙË˜ ÔÍÂ›‰ˆÛË˜ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ,

·ÓÂ¿ÚÎÂÈ· Î·ÚÓÈÙ›ÓË˜ñ ∏ÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· ÀÂÚÎÔÈÏÈ·Î‹ Ù·¯˘Î·Ú‰›· ¢È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÌÂÙ¿ ·fi ·ÚÚ˘ıÌ›·

∂ÈÎfiÓ· Ô˘Ï‹˜ ÛÙÔ ÚfiÛıÈÔ ∞ÓˆÌ·Ï›· ÙË˜ ¤ÎÊ˘ÛË˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜‰È·ÊÚ·ÁÌ·ÙÈÎfi ÙÔ›¯ˆÌ· ·ÚÙËÚ›·˜ ·fi ÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›·

ñ ∏¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·, ™˘ÁÁÂÓ‹˜ Î·Ú‰ÈÔ¿ıÂÈ·Î·Ú‰È·Îfi˜ Î·ıÂÙËÚÈ·ÛÌfi˜

ñ µÈÔ„›· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ºÏÂÁÌÔÓ‹ ÌÂ Ó¤ÎÚˆÛË, ª˘ÔÎ·Ú‰›ÙÈ‰·ıÂÙÈÎ¿ ·ÓÙÈÁfiÓ· ÈÒÓ

∆ÚÔÔÔÈËÌ¤ÓÔ ·fi Eur J Pediatr 2000;159:803-810


411

·˘ÍËÌ¤ÓÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛË˜, ÂÓÒ ¿ÏÏÂ˜ Î·ÎÔ‹-ıÂÈ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÂÎÛÂÛËÌ·ÛÌ¤ÓËÎÔÈÏÈ·Î‹ ˘ÂÚÙÚÔÊ›· Î·È ÌÂ›ˆÛË Î·Ù¿ 50% ÙÔ˘ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛË˜ (6,43-46). OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ Î·Ú‰È·Î‹˜ ÙÚÔÔÓ›ÓË˜ ∆ (¯ÚˆÌfi-ÛˆÌ· 1q3) Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ, ÚÔÎ·ÏÔ‡Ó ‹È· ˘ÂÚÙÚÔÊ›· Î·È ¤¯Ô˘Ó Î·Î‹ÚfiÁÓˆÛË (47,48). OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜Û˘Ó‰ÂfiÌÂÓË˜ ÌÂ ÙËÓ Î·Ú‰È·Î‹ Ì˘ÔÛ›ÓË ÚˆÙÂ˝ÓË˜ C(¯ÚˆÌfiÛˆÌ· 11p11.2) Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 20% ÙˆÓÂÚÈÙÒÛÂˆÓ, Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÈÔ ‹È· ÎÏÈÓÈÎ‹ Ô-ÚÂ›· Î·È ÌÂ ÚÔÔ‰Â˘ÙÈÎ‹ ÂÌÊ¿ÓÈÛË ÙË˜ ˘ÂÚÙÚÔÊ›·˜Î˘Ú›ˆ˜ ÛÂ ÌÂÁ¿ÏË ËÏÈÎ›· (49-51), ÂÓÒ ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÙË˜ ·-ÙÚÔÔÌ˘ÔÛ›ÓË˜ (¯ÚˆÌfiÛˆÌ· 15q22) Â˘ı‡ÓÔ-ÓÙ·È ÁÈ· ÏÈÁfiÙÂÚÔ ·fi ÙÔ 3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (52).ÕÏÏÂ˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ô˘ Â˘ı‡ÓÔÓÙ·È ÁÈ·ÙËÓ Àª∫ Â›Ó·È: ÙÔ 19q13.4 Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙËÓ ÙÚÔ-ÔÌ˘ÔÛ›ÓË π Î·È Ù· 3p21 Î·È 12q23-24.3 ÁÈ· ÙËÓ ÂÏ·-ÊÚ¿ ¿Ï˘ÛÔ ÙË˜ Ì˘ÔÛ›ÓË˜ 1 Î·È 2, ·ÓÙ›ÛÙÔÈ¯· (6).¶ÚfiÛÊ·Ù· ·Ó·Î·Ï‡ÊıËÎÂ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓÈ‰›Ô˘Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙË Á2 ˘ÔÔÌ¿‰· ÙË˜ ∞ªƒ ÚˆÙÂ˚-ÓÈÎ‹˜ ÎÈÓ¿ÛË˜, Ë ÔÔ›· Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔWolf-Parkinson-White (6). ∂›ÛË˜, ˘¿Ú¯Ô˘Ó ÓÂfiÙÂ-ÚÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÙËÓ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎfi-ÙËÙ·˜ Î·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·-Ú·ÎÙ‹Ú· (54). ¶·Ú’ fiÏÔ Ô˘ Ô Ù‡Ô˜ ÙË˜ ÌÂÙ¿ÏÏ·-ÍË˜ Ê·›ÓÂÙ·È Ó· Â˘ı‡ÓÂÙ·È ÁÈ· Û˘ÁÎÂÎÚÈÌ¤ÓÔ Ê·ÈÓfi-Ù˘Ô ÙË˜ ÓfiÛÔ˘, ·Ú·ÙËÚÔ‡ÓÙ·È ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÎ-‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ ÌÂÙ·Í‡ ÌÂÏÒÓ ÙË˜ ›‰È·˜ ÔÈÎÔÁ¤-ÓÂÈ·˜ Ô˘ Ê¤ÚÔ˘Ó ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË. Œ¯Ô˘Ó ÂÓÔ-¯ÔÔÈËıÂ› ÁÈ’ ·˘Ùfi ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜,fiˆ˜ Ë ¿ÛÎËÛË Î·È Î·Ú‰È·ÁÁÂÈ·Î¤˜ ·ÓˆÌ·Ï›Â˜,fiˆ˜ Ë ˘¤ÚÙ·ÛË (6). ∂›ÛË˜, ÙÔ ÁÂÓÂÙÈÎfi ˘fi-ÛÙÚˆÌ· Î¿ıÂ ·ÙfiÌÔ˘ ·Ô‰ÂÈÎÓ‡ÂÙ·È ÛËÌ·ÓÙÈÎfi Î·È,Û˘ÁÎÂÎÚÈÌ¤Ó·, Ù· Ú˘ıÌÈÛÙÈÎ¿ ÁÔÓ›‰È· Ô˘ Îˆ‰ÈÎÔ-ÔÈÔ‡Ó ÙÔ Û‡ÛÙËÌ· ÚÂÓ›ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜-·Ï‰Ô-

ÛÙÂÚfiÓË˜. ªÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÏÏ·ÏÔ› ÔÏ˘-ÌÔÚÊÈÛÌÔ› ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ÂËÚÂ¿˙Ô˘ÓÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ÛÙËÓ ˘ÂÚÙÚÔÊÈÎ‹Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Î·È Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÂÎÛÂÛËÌ·ÛÌ¤-ÓË Î·Ú‰È·Î‹ ˘ÂÚÙÚÔÊ›· Î·È Î›Ó‰˘ÓÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿-ÙÔ˘ (54). ∞˘Ùfi ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔ ¤Ó˙˘ÌÔ Î·Ú‰È·Î‹ ¯˘-Ì¿ÛË Ô˘ Ú˘ıÌ›˙ÂÈ ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ ÛÙÔ Ì˘ÔÎ¿Ú-‰ÈÔ, Î·ıÒ˜ Î·È ÁÈ· ÁÔÓ›‰È· ÙÔ˘ ·ÁÁÂÈÔÙÂÓÛÈÓÔÁfiÓÔ˘Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ ππ (55,56). OÚfiÏÔ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜-·Ï-‰ÔÛÙÂÚfiÓË˜ ÛÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ ÙË˜˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂ-ÁfiÌÂÓÔ˜ (55). ¶·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ë ÂÓ‰ÔıËÏ›ÓË-1 Î·ÈÔ ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛË˜ ÙˆÓ fiÁÎˆÓ ÂÈ‰ÚÔ‡Ó, Â›-ÛË˜, ÛÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (57).

∏ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÌÔÚÂ›, Â›-ÛË˜, Ó· ·ÔÙÂÏÂ› ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ‰È·Ù·Ú·¯‹ Ô˘ ÎÏË-ÚÔÓÔÌÂ›Ù·È ·fi ÙË ÌËÙ¤Ú·, ÂÂÈ‰‹ ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎfiDNA ÙË˜ ÌËÙ¤Ú·˜ ÌÂÙ·Ê¤ÚÂÙ·È ÛÂ fiÏ· Ù· ·È‰È¿(·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·) (58).

¶·ıÔÏÔÁÔ·Ó·ÙÔÌ›·∏ ÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÌÔÚÊÔÏÔÁÈÎ‹ ·ÓˆÌ·Ï›·

ÙË˜ Î·Ú‰È¿˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú-‰ÈÔ¿ıÂÈ· Â›Ó·È Ë ˘ÂÚÙÚÔÊ›· Î·È fi¯È Ë ‰È¿Ù·ÛË ÙË˜·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ù˘ÈÎ¿ ·Û‡ÌÌÂÙÚË. ™ÙËÓ ÏÂÈÔ-„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ (55-60%) ˘¿Ú¯ÂÈ ˘ÂÚÙÚÔÊ›·ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Î·È ÙÔ˘ Ô›ÛıÈÔ˘ÂÏÂ‡ıÂÚÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∞Óˆ-Ì·Ï›Â˜ ÙˆÓ ÂÓ‰ÔÙÔÈ¯ˆÌ·ÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙË-ÚÈÒÓ ÌÂ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·˘ÏÔ‡ Î·È ¿-¯˘ÓÛË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜, ··ÓÙÒÓÙ·È ÛÂ ÂÚÈÛÛfiÙÂÚÔ·fi ÙÔ 80% ÙˆÓ ·ÛıÂÓÒÓ, Û˘¯ÓfiÙÂÚ· ÛÙÔ ÌÂÛÔÎÔÈ-ÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· (2,3,6). ∏ ˘ÂÚÙÚÔÊ›· Â›Ó·È Û˘¯Ó¿·ÚÔ‡Û· ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ÌÈÎÚÒÓ ÂÓ‰ÔÙÔÈ¯ˆÌ·ÙÈ-ÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓ, Ô‰ËÁÒÓÙ·˜ ÛÂ ÈÛ¯·ÈÌ›·Î·È Û˘Ì›ÂÛË ÙˆÓ ÎÏ¿‰ˆÓ Ô˘ ·ÈÌ·ÙÒÓÔ˘Ó ÙÔ ÌÂÛÔ-ÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ·. O ‚·ıÌfi˜ Î·È Ë ı¤ÛË ÙË˜ ̆ ÂÚ-ÙÚÔÊ›·˜ ÌÔÚÂ› Ó· ÔÈÎ›ÏÏÔ˘Ó (2,3,5).

πÛÙÔÏÔÁÈÎ¿ ·Ú·ÙËÚÂ›Ù·È ·Ô‰ÈÔÚÁ¿ÓˆÛË ÙˆÓÎ·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·ÓÙÈÎ·Ù¿ÛÙ·Û‹ ÙÔ˘˜ ·fi ÈÓÒ-‰Ë ÈÛÙfi, ˘ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÔÎ·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓÌÂ ÔÈÎÈÏ›· ÛÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Û¯‹Ì· Î·È ·ÓˆÌ·Ï›Â˜ÛÙ· ÂÓ‰ÔÙÔÈ¯ˆÌ·ÙÈÎ¿ ÛÙÂÊ·ÓÈ·›· ·ÁÁÂ›· (58). ™Â ÌÈ-ÎÚ¿ ·È‰È¿ ÌÂ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Ô˘ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·‚ÔÏÈÎ¿ ·›ÙÈ· ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¤˜ ‰È·-Ù·Ú·¯¤˜, ·Ú·ÙËÚÂ›Ù·È ‰È‹ıËÛË ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ÌÂÁÏ˘ÎÔÁfiÓÔ.

∏ Î‡ÚÈ· ‰È·Ù·Ú·¯‹ ÙË˜ Î·Ú‰È·Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜Â›Ó·È Ë ‰È·ÛÙÔÏÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È Ë ÂÏ·ÙÙˆÌ¤ÓËÂÓ‰ÔÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ. ∂›ÛË˜, ·Ú·ÙËÚÂ›Ù·È Û˘-ÛÙÔÏÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÌÂ ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ÂÍÒıËÛË˜ (~75%) Î·È ˘ÔÎÈÓËÛ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·-ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ·Ú·ÙË-ÚÂ›Ù·È ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ÙË˜ ·ÚÈÛÙÂÚ‹˜

¶›Ó·Î·˜ 5. ∞ÈÙÈÔÏÔÁ›· ˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜

ñ ∞ÓˆÌ·Ï›Â˜ Û˘ÛÙ·ÏÙÒÓ OÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÔÊÈÎ‹ÚˆÙÂ˚ÓÒÓ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·

ñ MÂÙ·‚ÔÏÈÎ¿ ∞ÓÂ¿ÚÎÂÈ· Î·ÚÓÈÙ›ÓË˜°Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ π Î·È ππ∞ÓÂ¿ÚÎÂÈ· ÛÂÏËÓ›Ô˘§ÈÔ‰˘ÛÙÚÔÊ›Â˜™. Hurler¡fiÛÔ˜ ÙÔ˘ Fabryª·ÓÓÔÛ›‰ˆÛË¡ÂÔÁÓfi ‰È·‚ËÙÈÎ‹˜ ÌËÙ¤Ú·˜

ñ ™‡Ó‰ÚÔÌ· ™. Noonan™. Leopard™. Friedreich’s™. Beckwith-WiedermannªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ Ì˘Ô¿ıÂÈ·

ñ ¢È¿ÊÔÚ· À¤ÚÙ·ÛË™. Swyer-James

∆ÚÔÔÔÈËÌ¤ÓÔ ·fi Curr Opin Pediatr 1995;7:587-594


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ÎÔÈÏ›·˜ Î·È ·ÓÂ¿ÚÎÂÈ· ÌÈÙÚÔÂÈ‰Ô‡˜ ‚·Ï‚›‰·˜. ™·-ÓÈfiÙÂÚ·, Î¿ÔÈ· ·È‰È¿ ¤¯Ô˘Ó ÌÂÁ¿ÏÂ˜ Î·È ÌÂ ÌÂÈˆ-Ì¤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ·ÚÈÛÙÂÚ¤˜ ÎÔÈÏfiÙËÙÂ˜, ÔÈÔÔ›Â˜ ÛÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ ‰È·ÙÂ›ÓÔÓÙ·È ÂÚ·ÈÙ¤-Úˆ (2,3).

∫ÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·∆· ÛËÌÂ›· Î·È Ù· Û˘ÌÙÒÌ·Ù· ÙË˜ ˘ÂÚÙÚÔÊÈÎ‹˜

Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜ Â›Ó·È ÔÈÎ›Ï· Î·È ÂÍ·ÚÙÒÓÙ·È ·fiÙËÓ ËÏÈÎ›·. °ÂÓÈÎ¿, Ù· ‚Ú¤ÊË ÌÂ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·-Î‹ ·ÓÂ¿ÚÎÂÈ· Î·È ÔÏÏ¿ Î·Ù·Ï‹ÁÔ˘Ó ÛÙÔ ÚÒÙÔ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜ ÙÔ˘˜. ∆Ô 35% ÙˆÓ ‚ÚÂÊÒÓ Â›Ó·È ·Û˘-ÌÙˆÌ·ÙÈÎfi, ÂÓÒ ÙÔ 25% ÂÚ›Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ú-‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·. ∞ÓÙ›ıÂÙ·, Ù· ·È‰È¿ Â›Ó·È Û˘¯Ó¿·Û˘ÌÙˆÌ·ÙÈÎ¿. ∆Ô 40% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ‹È· Û˘ÌÙÒÌ·Ù·, ·ÏÏ¿ ÌfiÓÔ ÙÔ 6% ¤¯ÂÈ ÛËÌ·ÓÙÈÎfiÂÚÈÔÚÈÛÌfi ÙË˜ Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·Ù¿ ÙË‰È¿ÁÓˆÛË. ™Â ¤Ó·Ó ¿ÁÓˆÛÙÔ ·ÚÈıÌfi ·È‰ÈÒÓ, Ë ÚÒ-ÙË ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜(3,5). ∆· Û˘ÌÙÒÌ·Ù· Ô˘ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘ÓÙ· ·È‰È¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰‡ÛÓÔÈ·, Â‡ÎÔÏË ÎfiˆÛËÈ‰›ˆ˜ ÛÙËÓ ¿ÛÎËÛË, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜, ÚÔÛ˘ÁÎÔ‹,Û˘ÁÎÔ‹ Î·È ·›ÛıËÌ· ·ÏÌÒÓ. ∫·Ú‰È·Î‹ ·ÓÂ¿Ú-ÎÂÈ· Û˘Ì‚·›ÓÂÈ ÛÂ ÏÈÁfiÙÂÚÔ ·fi 4% ÙˆÓ ·È‰ÈÒÓ ËÏÈ-Î›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ 1 ¤ÙÔ˘˜ (3).

∫·Ù¿ ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË, fiÙ·Ó ˘¿Ú¯ÂÈ ·fiÊÚ·-ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ‰È·È-ÛÙÒÓÂÙ·È ¤ÓÙÔÓÔ ÔÏÔÛ˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· ÂÍÒıËÛË˜,ÙÔ ÔÔ›Ô Á›ÓÂÙ·È ÂÓÙÔÓfiÙÂÚÔ ÛÙËÓ ¿ÛÎËÛË, ÌÂ ÙË ‰Ô-ÎÈÌ·Û›· Valsava. O ‰Â‡ÙÂÚÔ˜ ÙfiÓÔ˜ Â›Ó·È ‰È¯·ÛÌ¤ÓÔ˜Î·È ÌÔÚÂ› Ó· ·ÎÔ˘ÛÙÂ› ÙÚ›ÙÔ˜ Î·È Ù¤Ù·ÚÙÔ˜ ÙfiÓÔ˜.

¢È¿ÁÓˆÛË ªÂ ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ‰È·ÈÛÙÒÓÂÙ·È ÌÂÁ·ÏÔÎ·Ú-

‰›·. ¶·Ú’ fiÏÔ Ô˘ ÙÔ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Â›Ó·ÈÛ˘Ó‹ıˆ˜ ·ıÔÏÔÁÈÎfi ÙfiÛÔ ÛÙ· ‚Ú¤ÊË fiÛÔ Î·È ÛÂÂÚÈÛÛfiÙÂÚÔ ·fi 90% ÙˆÓ ·È‰ÈÒÓ, Ù· Â˘Ú‹Ì·Ù·‰ÂÓ Â›Ó·È ÂÈ‰ÈÎ¿. ™Ù· ‚Ú¤ÊË ·Ú·ÙËÚÔ‡ÓÙ·È ˘ÂÚ-ÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·ÈÌË ÂÈ‰ÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÙÔ˘ ST Î·È ∆. ™Ù· ÌÂÁ·Ï‡ÙÂÚ··È‰È¿ ·ÓÂ˘Ú›ÛÎÔÓÙ·È ˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ÎÔÈÏ›·˜, ·ÏÏ·Á¤˜ ÛÙ· ST Â¿ÚÌ·Ù· Î·È ÛÙÔ Î‡Ì· ∆Î·È ·ÓÒÌ·Ï· Î‡Ì·Ù· Q, Î·ıÒ˜ Î·È ·Ú¿Ù·ÛË ÙÔ˘‰È·ÛÙ‹Ì·ÙÔ˜ QT. ™Ù· ÌÂÁ¿Ï· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈ-ÎÂ˜ ÙÔ ∏∫° ·ÔÙÂÏÂ› Ì›· ÈÎ·ÓÔÔÈËÙÈÎ‹ Ì¤ıÔ‰Ô ·-Ú·ÎÔÏÔ‡ıËÛË˜. ÕÏÏ· Â˘Ú‹Ì·Ù· Ô˘ ÌÔÚÂ› Ó·˘¿Ú¯Ô˘Ó Â›Ó·È ·ÚÚ˘ıÌ›Â˜, fiˆ˜ ÊÏÂ‚ÔÎÔÌ‚ÈÎ‹‚Ú·‰˘Î·Ú‰›·, ˘ÂÚÎÔÈÏÈ·Î‹ Ù·¯˘Î·Ú‰›·, ÚÒÈÌÂ˜¤ÎÙ·ÎÙÂ˜ ÎÔÈÏÈ·Î¤˜ Û˘ÛÙÔÏ¤˜ Î·È ÎÔÏÔÎÔÈÏÈ·Îfi˜·ÔÎÏÂÈÛÌfi˜ (59).

ªÂ ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Ù›ıÂÙ·È Î·È Ë ‰È¿ÁÓˆ-ÛË ÙË˜ ˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜. ¢È·ÈÛÙÒ-ÓÂÙ·È Ë ‡·ÚÍË Î·È Ë ¤ÎÙ·ÛË ÙË˜ ˘ÂÚÙÚÔÊ›·˜ ÙË˜·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ë Èı·Ó‹ ·fiÊÚ·ÍË ÙÔ˘ ¯Ò-ÚÔ˘ ÂÍfi‰Ô˘ ‹ Ë ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÌÈÙÚÔÂÈ‰Ô‡˜ ‚·Ï‚›-

‰·˜. ∂›ÛË˜, ÂÎÙÈÌ¿Ù·È Ë Û˘ÛÙÔÏÈÎ‹ Î·È Ë ‰È·ÛÙÔÏÈÎ‹ÏÂÈÙÔ˘ÚÁ›· ÙË˜ Î·Ú‰È¿˜ (3,5).

O Î·Ú‰È·Îfi˜ Î·ıÂÙËÚÈ·ÛÌfi˜ Â›Ó·È ¯Ú‹ÛÈÌÔ˜ ÛÙË‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÌÂ ÙË Ï‹„Ë ‚ÈÔ„ÈÒÓ ·fi ÙÔÌ˘ÔÎ¿Ú‰ÈÔ (60). ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ËÏÂÎÙÚÔ-Î·Ú‰ÈÔÁÚ·Ê‹Ì·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ·Ó›-¯ÓÂ˘ÛË Ù˘¯fiÓ ·ÚÚ˘ıÌÈÒÓ (34). OÈ ·ÛıÂÓÂ›˜ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ÈÛ¯·ÈÌ›·˜, ı· Ú¤ÂÈ Ó·˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ‰ÔÎÈÌ·Û›· ÎÔÒÛÂˆ˜ Î·È ÛÂ ·ÁÁÂÈ-ÔÁÚ·Ê›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓ ÁÈ· ÙÔÓ ·ÔÎÏÂÈ-ÛÌfi ÙË˜ Û˘Ì›ÂÛË˜ ÙˆÓ ·ÁÁÂ›ˆÓ Ô˘ ·ÈÌ·ÙÒÓÔ˘Ó ÙÔÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· ‹ ÙË˜ Û˘Ì›ÂÛË˜ ÙË˜ ·ÚÈ-ÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ (61-63). ™Ù· ÓÂÔÁÓ¿Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·,Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ï‹ÚË˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈÎ¿ÓÔÛ‹Ì·Ù· (36).

£ÂÚ·Â›· ∏ ıÂÚ·Â˘ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È ·Ó¿-

ÏÔÁ· ÌÂ Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·ÛıÂÓ‹. ∂ÂÈ‰‹ ÛÙËÓ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›··ÚÔ˘ÛÈ¿˙ÂÈ Û˘Ó‹ıˆ˜ ˘ÂÚÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·, ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏÂ›˜ Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ (3,6,64). OÈ ‚-·Ó·ÛÙÔÏÂ›˜(ÚÔÚ·ÓÔÏfiÏË, ·ÙÂÓÔÏfiÏË) Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎÔ›, Î·ıÒ˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ Î·Ú‰È·Î‹ Û˘¯Ófi-ÙËÙ·, ÙË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·ÈÙÔ ÙÔÈ¯ˆÌ·ÙÈÎfi stress. OÈ ·Ó·ÛÙÔÏÂ›˜ ÙˆÓ ‰È·‡ÏˆÓ·Û‚ÂÛÙ›Ô˘ (ÓÈÊÂ‰È›ÓË, ‚ÂÚ··Ì›ÏË, ‰ÈÏÙÈ·˙¤ÌË),Â›ÛË˜, ‚ÂÏÙÈÒÓÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·, ÌÂÈÒÓÔÓÙ·˜ ÙËÓÎ·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· Î·È ÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË. Œ¯ÂÈ¯ÚËÛÈÌÔÔÈËıÂ› Ë ‰ÈÛÔ˘Ú·Ì›‰Ë, Ë ÔÔ›· ¤¯ÂÈ ·ÚÓË-ÙÈÎ‹ ÈÓfiÙÚÔË ‰Ú¿ÛË Î·È ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·fiÊÚ·ÍËÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ÌÂ ÌÈÎÚ‹fiÌˆ˜ ÂÌÂÈÚ›· ÛÙ· ·È‰È¿ (2,3,6). ªÂÏ¤ÙÂ˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ ÂˆÊÂÏ‹ıËÎ·Ó ·fi ÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ıÂÚ·Â›· Î·È ‚ÂÏÙÈÒıËÎ·Ó Ù· Û˘-ÌÙÒÌ·Ù¿ ÙÔ˘˜. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ Ô˘ Ó· ·Ô-‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ¯Ú‹ÛË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ıÂÚ·Â›·˜ÌÔÚÂ› Ó· ÚÔÏ¿‚ÂÈ ‹ Ó· Î·ı˘ÛÙÂÚ‹ÛÂÈ ÙËÓ ÂÍ¤ÏÈÍËÙË˜ ˘ÂÚÙÚÔÊ›·˜ (3,6,65). ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÚ˘ıÌ›Â˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› Ë ·ÌÈˆ-‰·ÚfiÓË ÌÂ Â˘ÓÔ˚Î¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜,·ÏÏ¿ ÛÙ· ·È‰È¿ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÏfiÁˆÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ. ™Â ·ÛıÂÓÂ›˜ ÌÂ ‚Ú·‰˘Î·Ú‰›·,ıÂÚ·Â›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÂÌÊ‡ÙÂ˘ÛË ‚ËÌ·ÙÔ‰fiÙË.¶ÚÔÊ˘Ï·ÎÙÈÎ‹ ·ÓÙÈ·ÚÚ˘ıÌÈÎ‹ ıÂÚ·Â›· ı· Ú¤ÂÈÓ· ¯ÔÚËÁÂ›Ù·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Ù·¯˘·ÚÚ˘ıÌ›Â˜, ÎÔÈ-ÏÈ·Î‹ Ù·¯˘Î·Ú‰›· Î·È ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘.™Â ÂÚÈÙÒÛÂÈ˜ Ì·˙ÈÎ‹˜ ˘ÂÚÙÚÔÊ›·˜, ÁÈ· ÙËÓ ÚÔ-Ê‡Ï·ÍË ·fi ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ËÂÌÊ‡ÙÂ˘ÛË ·ÈÓÈ‰ˆÙ‹ (65). ∏ ÌË ÂÈ‰ÈÎ‹ ıÂÚ·Â›· Â-ÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚÔÊ‡Ï·ÍË ·fi ÙË ‚·ÎÙËÚÈ‰È·Î‹ ÂÓ-‰ÔÎ·Ú‰›ÙÈ‰· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·ÈÌ·ÙËÚÒÓ ÂÂÌ‚¿ÛÂ-ˆÓ Î·È ÙË ¯Ú‹ÛË ·ÓÙÈËÎÙÈÎ‹˜ ıÂÚ·Â›·˜ ÌÂÙ¿ ·fi

Î¿ÔÈÔ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎfi ÂÂÈÛfi‰ÈÔ. ™Â ·ÛıÂÓÂ›˜ ÌÂÌÂÙ·‚ÔÏÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, Â›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ Ë¿ÌÂÛË ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ(36). ¶Ú¤ÂÈ Ó· ÙÔÓ›˙ÂÙ·È Ë ·ÔÊ˘Á‹ ÙË˜ ¿ÛÎËÛË˜,ÂÎÙfi˜ ·fi ÂÏ·ÊÚ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜. ∞Ó ·ÔÙ‡¯ÂÈ ËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ıÂÚ·Â›· ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆ-Ì¿ÙˆÓ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ú¤Ì‚·ÛË,Ì˘ÔÙÔÌ‹-Ì˘ÂÎÙÔÌ‹ (Â¤Ì‚·ÛË Morrow) ‹ ¿ÏÏÂ˜ ¯ÂÈ-ÚÔ˘ÚÁÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜, ÌÂ ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ·fi-ÊÚ·ÍË˜ ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜.∆¤ÏÔ˜, ÛÂ ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiÔ˘ Ë Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹ ıÂÚ·Â›· ¤¯ÂÈ ·ÔÙ‡¯ÂÈ, ˘¿Ú¯ÂÈ Ë ÂÈÏÔÁ‹ÙË˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ Î·Ú‰È¿˜.

¶ÚfiÁÓˆÛË∏ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Â›Ó·È ÙÔ Û˘-

¯ÓfiÙÂÚÔ ·›ÙÈÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÂ Ó¤Ô˘˜ ÂÓ‹ÏÈÎÂ˜Î·È ·ıÏËÙ¤˜, ÌÂ ÔÛÔÛÙfi ÂÙ‹ÛÈ·˜ ıÓËÙfiÙËÙ·˜ 2-4%ÙˆÓ ÓÔÛËÏÂ˘fiÌÂÓˆÓ ·ÛıÂÓÒÓ (3,63). ∞ÈÊÓ›‰ÈÔ˜ Î·Ú-‰È·Îfi˜ ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ Î˘Ú›ˆ˜ ÛÂ ÂÊ‹‚Ô˘˜ Î·ÈÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ ËÏÈÎ›·˜ 15-35 ÂÙÒÓ Ô˘ ‹Ù·Ó·Û˘ÌÙˆÌ·ÙÈÎÔ› Î·È Û˘¯Ó¿ ·ÔÙÂÏÂ› ÙËÓ ÚÒÙË ÂÎ-‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘. ∆· ‚Ú¤ÊË ËÏÈÎ›·˜ Î¿Ùˆ ÙÔ˘ 1¤ÙÔ˘˜ ¤¯Ô˘Ó ÔÏ‡ Î·Î‹ ÚfiÁÓˆÛË. ∞Ó Ë ÚÒÙË ÂÎ-‰‹ÏˆÛË Â›Ó·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ‹ Î˘¿ÓˆÛË, Ùfi-ÙÂ Ô ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ ˆ˜ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ÚÒÙÔ˘ ¤ÙÔ˘˜ ÙË˜ ˙ˆ‹˜. ∞Ó Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù·Â›Ó·È ÈÔ ·Ì‚ÏË¯Ú¿, ÙfiÙÂ ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛË˜ ¤ˆ˜ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÊÙ¿ÓÂÈ ÙÔ 50% (3,61). ∏ ˘ÂÚÙÚÔÊÈ-Î‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Â›Ó·È Ì›· ÂÍÂÏÈÛÛfiÌÂÓË ÓfiÛÔ˜,Î˘Ú›ˆ˜ Î·Ù¿ ÙËÓ Ù·¯Â›· ÛˆÌ·ÙÈÎ‹ ·‡ÍËÛË. ∏ ıÓËÙfi-ÙËÙ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È ‰ÈÏ¿ÛÈ· ·’ fi,ÙÈÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È Ô Î›Ó‰˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Â›-Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙËÓ ‡·ÚÍË ‹ fi¯È Û˘ÌÙˆÌ¿-ÙˆÓ (3). ™ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ë ÈÔ Û˘¯Ó‹ ·ÈÙ›· ı·Ó¿ÙÔ˘Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Î·Ù¿ ÙËÓ ¿ÛÎËÛË. ¢˘ÛÌÂ-ÓÂ›˜ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈÎÈ·-Î¤˜ ÔÌ¿‰Â˜ Â›Ó·È Ë ·ÚÔ˘Û›· Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ-‰›ˆÓ, Ë ·ÚÔ˘Û›· Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙÔ ÚÒ-ÙÔ ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÔÈ Î·Ú-‰È·Î¤˜ ‰˘ÛÚ˘ıÌ›Â˜, Ë ·ÚÔ˘Û›· ÈÛ¯·ÈÌ›·˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘ Î·È Ë ‡·ÚÍË “Î·ÎÔ‹ıÔ˘˜” ÌÂÙ¿ÏÏ·ÍË˜(62). ∂Í·ÈÙ›·˜ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÔÛÔÛÙÔ‡ ÙË˜ ÔÈÎÔÁÂ-ÓÔ‡˜ ÌÔÚÊ‹˜, Û˘ÓÈÛÙ¿Ù·È ¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓÂ›˜ÚÒÙÔ˘ ‚·ıÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·.

¶ÂÚÈÔÚÈÛÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ø˜ ÂÚÈÔÚÈÛÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÔÚ›˙ÂÙ·È Ë Ófi-

ÛÔ˜ ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ì˘fi˜ Ô˘ Ô‰ËÁÂ› ÛÂ ÂÏ·ÙÙˆÌ¤ÓËÎÔÈÏÈ·Î‹ Ï‹ÚˆÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ÂÏ·ÙÙˆÌ¤ÓÔ‰È·ÛÙÔÏÈÎfi fiÁÎÔ ÙË˜ Ì›·˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∏Û˘ÛÙÔÏÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ·Ú·Ì¤ÓÂÈ Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È ÙÔ¿¯Ô˜ ÙˆÓ ÙÔÈ¯ˆÌ¿ÙˆÓ ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi‹ ·˘ÍËÌ¤ÓÔ, ·Ó¿ÏÔÁ· ÌÂ ÙÔ ˘ÔÎÂ›ÌÂÓÔ ·›ÙÈÔ. OÊÂ›-

ÏÂÙ·È ÛÂ ·˘ÍËÌ¤ÓË ‰˘ÛÎ·Ì„›· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, Ô˘ÚÔÎ·ÏÂ› ·‡ÍËÛË ÙË˜ ›ÂÛË˜ ÙˆÓ ÎÔÈÏÈÒÓ ¯ˆÚ›˜ ·‡-ÍËÛË ÙÔ˘ fiÁÎÔ˘. ∂›Ó·È Û¿ÓÈ· Î·È ·ÓÙÈÛÙÔÈ¯Â› ÛÙÔ 5%ÙˆÓ Ì˘ÔÎ·Ú‰ÈÔ·ıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏ ÈÔÛ˘¯Ó‹ ·ÈÙ›· ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ Â›Ó·È Ë ·Ì˘-ÏÔÂ›‰ˆÛË (66). ªÔÚÂ›, fiÌˆ˜, Ó· ÔÊÂ›ÏÂÙ·È Î·È ÛÂ‰È¿ÊÔÚÂ˜ ¿ÏÏÂ˜ ·ı‹ÛÂÈ˜ (¶›Ó·Î·˜ 6).

∏ È‰ÈÔ·ı‹˜ ÌÔÚÊ‹ Â›Ó·È ÔÏÏ¤˜ ÊÔÚ¤˜ ÎÏËÚÔ-ÓÔÌÈÎ‹ Î·È Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Û¯¤ÛË ÌÂ Ì˘Ô¿ıÂÈ· ÙˆÓÛÎÂÏÂÙÈÎÒÓ Ì˘ÒÓ. ™ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È Û˘¯ÓfiÙÂ-ÚË ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Ë ÚfiÁÓˆÛË Â›Ó·È ¯ÂÈÚfiÙÂÚË ·’fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛË˜: 1,4¯ÚfiÓÈ· ·fi ÙË ÛÙÈÁÌ‹ ÙË˜ ‰È¿ÁÓˆÛË˜) (66,67).

∂Î‰ËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜ ‹ Û˘ÌÈÂÛÙÈÎ‹˜ ÂÚÈÎ·Ú‰›ÙÈ‰·˜. ∆Ô 1/3ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎ¿ ÂÂÈÛfi-‰È· (66).

∞fi ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ÌÔÚÂ› Ó· ‰È·ÈÛÙˆıÔ‡Ó‰Ú·ÛÙ‹ÚÈÔ ÚÔÎ¿Ú‰ÈÔ, ÙÚ›ÙÔ˜ Î·È Ù¤Ù·ÚÙÔ˜ ÙfiÓÔ˜Î·È Ê‡ÛËÌ· ‰È·Ê˘Á‹˜. ªÂ ÙÔ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊË-Ì· ‰È·ÈÛÙÒÓÔÓÙ·È ¯·ÌËÏ¿ ‰˘Ó·ÌÈÎ¿ (Î˘Ú›ˆ˜ ÛÙËÓ·Ì˘ÏÔÂ›‰ˆÛË), ·ÚÈÛÙÂÚ‹ ÛÙÚÔÊ‹ ÙÔ˘ ¿ÍÔÓ·, ÎÔÏÈ-Îfi˜ ÙÂÚ˘ÁÈÛÌfi˜ Î·È ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜. ™ÙËÓ ·ÎÙÈ-ÓÔÁÚ·Ê›·, Ë Î·Ú‰È¿ ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈÎfi Ì¤ÁÂıÔ˜, ·Ï-Ï¿ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Û˘ÌÊfiÚËÛË ÙˆÓ ÓÂ˘ÌÔÓÈ-ÎÒÓ ·ÁÁÂ›ˆÓ (67). ªÂ ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· ·ÓÂ˘-Ú›ÛÎÂÙ·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÈÏÈÒÓ, ¯ˆ-Ú›˜ ‰È¿Ù·ÛË ‹ ˘ÂÚÙÚÔÊ›·, ÌÂ ÛËÌ·ÓÙÈÎ¿ ‰È·ÙÂÙ·Ì¤-ÓÔ˘˜ ÎfiÏÔ˘˜ (·ÔÙ¤ÏÂÛÌ· ÙˆÓ ·˘ÍËÌ¤ÓˆÓ È¤ÛÂˆÓÏ‹ÚˆÛË˜). ™Â ¿ÏÏÂ˜ ÂÚÈÙÒÛÂÈ˜ ‰È·ÈÛÙÒÓÂÙ·È¿¯˘ÓÛË ÙˆÓ ÙÔÈ¯ˆÌ¿ÙˆÓ Î·È ÙˆÓ ‚·Ï‚›‰ˆÓ, ÂÈ‰ÈÎ¿ÛÙËÓ ·Ì˘ÏÔÂ›‰ˆÛË. O Î·Ú‰È·Îfi˜ Î·ıÂÙËÚÈ·ÛÌfi˜ÂÈ‚Â‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË Î·È Ë ‚ÈÔ„›· ÙÔ˘ Î·Ú‰È·-ÎÔ‡ Ì˘fi˜ ·ÔÎ·Ï‡ÙÂÈ ÙÔ ˘ÔÎÂ›ÌÂÓÔ ·›ÙÈÔ (66).

£ÂÚ·Â›·∏ ıÂÚ·Â›· Â›Ó·È ˘ÔÛÙËÚÈÎÙÈÎ‹ Î·È Û˘Ó›ÛÙ·Ù·È

ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙË˜ ÓÂ˘ÌÔÓÈ-Î‹˜ Î·È ÊÏÂ‚ÈÎ‹˜ Û˘ÌÊfiÚËÛË˜. ∂Í·ÈÙ›·˜ ÙË˜ Î·Î‹˜ÚfiÁÓˆÛË˜ ÛÙ· ·È‰È¿ Î·È ÙË˜ ·ÔÙ˘¯›·˜ ÙË˜ Û˘-ÓÙËÚËÙÈÎ‹˜ ıÂÚ·Â›·˜, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜ıÂˆÚÂ›Ù·È ıÂÚ·Â›· ÂÎÏÔÁ‹˜ (68). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜Ô˘ ¤¯ÂÈ ‰È·ÁÓˆÛÙÂ› Ë ˘ÔÎÂ›ÌÂÓË ·ÈÙ›·, ÂÊ·ÚÌfi˙Ô-ÓÙ·È ·Ó¿ÏÔÁÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ (66).

∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ∏ ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜

(∞¢¢∫) Â›Ó·È Ì›· ¿ıËÛË ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ Ô˘ ¯·-Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚·ıÌÈ·›· ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙˆÓ Ì˘Ô-Î˘ÙÙ¿ÚˆÓ ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi. ∂›Ó·È Ì›· ÛË-Ì·ÓÙÈÎ‹ ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÂ ¿ÙÔÌ· ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ÙˆÓ 30 ÂÙÒÓ Î·È ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙÔ 20% ÙˆÓ ·ÈÊÓ›-‰ÈˆÓ ı·Ó¿ÙˆÓ ÓÂ·ÚÒÓ ÂÓ‹ÏÈÎˆÓ ·ÙfiÌˆÓ. ∏ Â›Ùˆ-ÛË ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1:5000 (6).∏ ÓfiÛÔ˜ Ù˘ÈÎ¿ ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ·˘ÙÔÛˆÌ·ÙÈÎfi


413


414

ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÌÂ ÔÈÎ›ÏË ‰ÈÂÈÛ‰˘ÙÈÎfiÙË-Ù· Î·È ·ÙÂÏ‹ ¤ÎÊÚ·ÛË. ∆· ÁÔÓ›‰È· Ô˘ Â›Ó·È ˘Â‡ı˘-Ó· ÁÈ· ÙËÓ ∞¢¢∫ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·ÁÓˆÚÈÛÙÂ›, ·Ï-Ï¿ ¤¯Ô˘Ó ¯·ÚÙÔÁÚ·ÊËıÂ› 7 ÂÚÈÔ¯¤˜ ÛÙ· ¯ÚˆÌÔÛÒ-Ì·Ù· 14(14q23-q24 Î·È 14q12-q22), 1(1q42-43),2(2q32.1-q32.2), 3(3p23) Î·È 10(10p12-p14). ¶Úfi-ÛÊ·Ù·, ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙˆÓ ÁÔÓÈ‰›ˆÓÔ˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÈ˜ ÚˆÙÂ˝ÓÂ˜ Ï·ÎÔÛÊ·ÈÚ›ÓË Î·È‰ÂÛÌÔÏ·Î›ÓË, ÔÈ ÔÔ›Â˜ Â›Ó·È ÚˆÙÂ˝ÓÂ˜ ÙˆÓ Î˘ÙÙ·-ÚÈÎÒÓ Û˘Ó‰¤ÛÂˆÓ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ·˘ÙÔÛˆ-Ì·ÙÈÎ‹ ˘ÔÏÂÈfiÌÂÓË ∞¢¢∫ (6,69,70). ∆Ô ÁÔÓ›‰ÈÔ·Ó·ÁÓˆÚ›ÛÙËÎÂ ÛÙË ÓfiÛÔ ÙË˜ ¡¿ÍÔ˘, fiÔ˘ ÛÙÔ 90%ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯Ô˘Ó ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ‰¤ÚÌ·, ÛÁÔ˘Ú¿ Ì·ÏÏÈ¿ Î·È ˘ÂÚÎÂÚ¿ÙˆÛË ÙÔ˘ ‰¤Ú-Ì·ÙÔ˜ ÙˆÓ ·Ï·ÌÒÓ Î·È ÙˆÓ ÂÏÌ¿ÙˆÓ Î·È ¤¯ÂÈ ÂÚÈ-ÁÚ·ÊÂ› ÛÂ ·È‰È¿ ËÏÈÎ›·˜ ·fi 7 ÂÙÒÓ. ∂ÎÙfi˜ ·fi ÙËÁÂÓÂÙÈÎ‹ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘, ¤¯Ô˘Ó ‰È·Ù˘ˆıÂ›Î·È ¿ÏÏÂ˜ ıÂˆÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÈÙÈÔÏÔÁ›·, fiˆ˜Ë ‰˘ÛÔÓÙÔÁ¤ÓÂÛË, Ë ÂÎÊ‡ÏÈÛË ÙˆÓ Ì˘ÔÎ·Ú‰È·ÎÒÓÈÓÒÓ ÂÍ·ÈÙ›·˜ Î¿ÔÈÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ËÊÏÂÁÌÔÓ‹ (ÌÂÙ¿ ·fi ÈÔÁÂÓ‹ Ì˘ÔÎ·Ú‰›ÙÈ‰·) Î·È Ë·fiÙˆÛË ÙˆÓ Ì˘ÔÎ·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (69).

∆˘ÈÎ¿ ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ ¿Ó‰ÚÂ˜Î·È ÛÂ ÔÛÔÛÙfi 80% Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÚÈÓ ÙËÓËÏÈÎ›· ÙˆÓ 40 ÂÙÒÓ (6,69). ∫ÏÈÓÈÎ¿ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·ÈÛ˘ÁÎÔÙÈÎ¿ ÂÂÈÛfi‰È·, ÎÔÈÏÈ·Î‹ Ù·¯˘Î·Ú‰›· (ÌÂÌÔÚÊÔÏÔÁ›· ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛÎ¤ÏÔ˘˜)Î·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Î˘Ú›ˆ˜ ÛÙËÓ 4Ë Î·È 5Ë ‰Â-Î·ÂÙ›· ÙË˜ ˙ˆ‹˜. O ÌË¯·ÓÈÛÌfi˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿-

ÙÔ˘ Â›Ó·È Ë ÂÈÙ¿¯˘ÓÛË ÙË˜ ÎÔÈÏÈ·Î‹˜ Ù·¯˘Î·Ú‰›·˜Î·È Ë ÂÎÙÚÔ‹ ÛÂ ÎÔÈÏÈ·Î‹ Ì·ÚÌ·Ú˘Á‹. ∏ ∞¢¢∫ Â˘-ı‡ÓÂÙ·È ÁÈ· ÙÔ 3-4% ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ı·Ó¿ÙˆÓ Ô˘Û˘Ì‚·›ÓÔ˘Ó ÛÙËÓ ¿ÛÎËÛË ÛÂ ÓÂ·ÚÔ‡˜ ·ıÏËÙ¤˜ (69).

∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ ÙË ‚ÈÔ„›· ÙÔ˘ Ì˘ÔÎ·Ú‰›-Ô˘, ÛÙËÓ ÔÔ›· ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÂÚÈÔ¯¤˜ fiÔ˘ ÙÔÌ˘ÔÎ¿Ú‰ÈÔ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ¤¯ÂÈ ·ÓÙÈÎ·Ù·ÛÙ·ıÂ›·fi ÈÓÒ‰Ë Î·È ÏÈÒ‰Ë ÈÛÙfi. ∂ÂÈ‰‹ Â›Ó·È ‰‡ÛÎÔÏË Ë‰ÈÂÓ¤ÚÁÂÈ· ‚ÈÔ„›·˜, ¤¯Ô˘Ó ıÂÛÈÛÙÂ› ‰È¿ÊÔÚ· ‰È·-ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· (69) (¶›Ó·Î·˜ 7), ÂÓÒ ÁÈ· Ó· ÙÂıÂ›Ë ‰È¿ÁÓˆÛË, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ¤¯ÂÈ ‰‡Ô ÌÂ›˙ÔÓ·ÎÚÈÙ‹ÚÈ· ‹ ¤Ó· ÌÂ›˙ÔÓ Î·È ‰‡Ô ÂÏ¿ÛÛÔÓ· ‹ Ù¤ÛÛÂÚ·ÂÏ¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·.

£ÂÚ·Â›·™Â ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜, ¯ÚËÛÈÌÔÔÈÔ‡-

ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏÂ›˜ ÁÈ· Ó· ÂÏ·ÙÙˆıÂ› Ë Èı·ÓfiÙËÙ·‰ËÌÈÔ˘ÚÁ›·˜ ·ÚÚ˘ıÌ›·˜ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË ÙÔ˘ Û˘-Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Â›Ó·È˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ı· Ú¤ÂÈ Ó·Á›ÓÂÙ·È ÂÌÊ‡ÙÂ˘ÛË ·ÈÓÈ‰ˆÙ‹ (69). ∂Í·ÈÙ›·˜ ÙË˜˘„ËÏ‹˜ ıÓËÙfiÙËÙ·˜ Î˘Ú›ˆ˜ ÛÂ ÓÂ·Ú¿ ¿ÙÔÌ·, ı·Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÈ-ÎÒÓ ·ıÏËÌ¿ÙˆÓ.

ªË Û˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔ∞Ó‹ÎÂÈ ÛÙÈ˜ ·Ù·ÍÈÓfiÌËÙÂ˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ (1)

Î·È ·ÔÙÂÏÂ› Ì›· Û¿ÓÈ· ‰È·Ù·Ú·¯‹ ÙË˜ ·Ú¯ÈÙÂÎÙÔÓÈ-Î‹˜ ÙÔ˘ Ì˘ÔÎ·Ú‰È·ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜, ÌÂ ÔÏÏ·Ï¤˜Â˘ÌÂÁ¤ıÂÈ˜ ‰ÔÎÈ‰ÒÛÂÈ˜ Î·È ‚·ıÈ¤˜ ÂÓÙÔÌ¤˜, ˆ˜ ·Ô-Ù¤ÏÂÛÌ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó·ÛÙÔÏ‹˜ ÙË˜ Ì˘ÔÎ·Ú‰È·Î‹˜ÌÔÚÊÔÁ¤ÓÂÛË˜, ÌÂ ·Ô˘Û›· ÔÔÈ·Û‰‹ÔÙÂ Û˘Ó˘-¿Ú¯Ô˘Û·˜ Û˘ÁÁÂÓÔ‡˜ Î·Ú‰È·Î‹˜ ·ÓˆÌ·Ï›·˜.

πÛÙÔÏÔÁÈÎ¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÔÏÏ·Ï¤˜ ‰ÔÎÈ‰Ò-ÛÂÈ˜ Î·È ‚·ıÈ¤˜ ÂÓÙÔÌ¤˜ ÌÂÙ·Í‡ ÙÔ˘˜. ∆Ô ÂÓ‰Ôı‹ÏÈÔÔ˘ Î·Ï‡ÙÂÈ ÙÈ˜ ÂÓÙÔÌ¤˜ ·ÔÙÂÏÂ› Û˘Ó¤¯ÂÈ· ÙÔ˘ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ‰ÔÎÈ‰ÒÛÂˆÓ Î·È ÙÔ˘ ˘fiÏÔÈÔ˘ ÂÓ-‰ÔÎ·Ú‰›Ô˘. ∆Ô Ì˘ÔÎ¿Ú‰ÈÔ Î·È ÔÈ ‰ÔÎÈ‰ÒÛÂÈ˜ ·Ú-‰Â‡ÔÓÙ·È ·fi ÙÔ ÛÙÂÊ·ÓÈ·›Ô ‰›ÎÙ˘Ô, ÂÓÒ ÔÈ ÂÓÙÔÌ¤˜ÏËÚÔ‡ÓÙ·È ·fi ÙÔ ·›Ì· ÙË˜ Î·Ú‰È·Î‹˜ ÎÔÈÏfiÙËÙ·˜(71,72).

∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÈÎÔÁÂÓ‹ ¯·Ú·ÎÙ‹Ú·, ÌÂÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÙÚfiÔ ÌÂÙ·‚›‚·ÛË˜. ªÂ-Ù·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ G4.5 ÛÙË ¯ÚˆÌ·ÙÔÛˆÌÈÎ‹ Â-ÚÈÔ¯‹ Xq28 Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙËÓ ÚˆÙÂ˝ÓË Ù·Ê·˙›ÓË,¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ÙÔ ÌË Û˘Ì·Á¤˜Ì˘ÔÎ¿Ú‰ÈÔ Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ù‹ Ë ‰È·Ù·Ú·¯‹ Â›Ó·È·ÏÏËÏfiÌÔÚÊË ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ Barth Ô˘ ÎÏËÚÔÓÔ-ÌÂ›Ù·È ÌÂ ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· (71,73).

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ·∂ÓÒ ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔ Â›Ó·È Ì›· ÓfiÛÔ˜

Ô˘ ˘¿Ú¯ÂÈ ·fi ÙË Á¤ÓÓËÛË, Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ÚÔÎ·ÏÂ› ÌÔÚÂ› Ó· Á›ÓÂÈ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó‹˜, ÛÙË‚ÚÂÊÈÎ‹, ·È‰ÈÎ‹ ‹ ÂÓ‹ÏÈÎË ˙ˆ‹. ∏ ÎÏÈÓÈÎ‹ ÔÚÂ›·

¶›Ó·Î·˜ 6. ∆·ÍÈÓfiÌËÛË ÙˆÓ Ù‡ˆÓ ÙË˜ ÂÚÈÔÚÈÛÙÈÎ‹˜ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ·˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ·ÈÙÈÔÏÔÁ›·

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∏ ·ÎÙÈÓÔÁÚ·Ê›· ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÛÂ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜, ÂÓÒ Ë ·ÚÔ˘Û›· ÌÂÁ·-ÏÔÎ·Ú‰›·˜ ·ÓÂ˘Ú›ÛÎÂÙ·È ÛÙÔ 85% ÙˆÓ ·ÛıÂÓÒÓ ÌÂÌÂÈˆÌ¤ÓË Û˘ÛÙÔÏÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ‹ ÂÌÊ·Ó‹ Û˘ÌÙÒ-Ì·Ù·. ªÂ ÙÔÓ Î·Ú‰È·Îfi Î·ıÂÙËÚÈ·ÛÌfi ÂÎÙÈÌ¿Ù·È Ë·ÈÌÔ‰˘Ó·ÌÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙË˜ Î·Ú‰È¿˜, Ë ÔÔ›·ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘. ¢ËÏ·‰‹, ÛÙ··Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘ Î·È ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜·ÛıÂÓÂ›˜ ‰È·ÈÛÙÒÓÂÙ·È ÂÚÈÔÚÈÛÙÈÎ‹ Ê˘ÛÈÔÏÔÁ›·,ÂÓÒ ÛÙÔ˘˜ Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ·Ú·ÙËÚÔ‡-ÓÙ·È ·ÈÌÔ‰˘Ó·ÌÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÚfiÌÔÈ· ÌÂ ·˘-Ù¿ ÙË˜ ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜.

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µÈ‚ÏÈÔÁÚ·Ê›· 1. Richardson P, McKenna W, Bristow M, Maisch B, Mautner

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ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ·1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰È·ÁÓˆÛÌ¤ÓË˜ ∞¢¢∫2. ∫ÔÈÏÈ·Î¿ ÌÂÙ·‰ÈÂÁÂÚÙÈÎ¿ Î‡Ì·Ù· (Î‡Ì·Ù· ∂) ‹ ‰ÈÂ‡Ú˘ÓÛË

ÙÔ˘ QRS (>110 ms) ÛÙÈ˜ ··ÁˆÁ¤˜ V1-33. ™Ô‚·Ú‹ ÙÌËÌ·ÙÈÎ‹ ‰È¿Ù·ÛË ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜4. ∆ÔÈÎ¿ ·ÓÂ˘Ú‡ÛÌ·Ù· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜5. πÓÔÏÈÒ‰Ë˜ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ÛÙË ‚ÈÔ„›·∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (<35 ÂÙÒÓ) ·fi

Èı·Ó‹ ∞¢¢∫2. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÎÏÈÓÈÎ¿ ‰È·ÁÓˆÛÌ¤ÓË˜ ∞¢¢∫3. ∞ÓÂÛÙÚ·ÌÌ¤Ó· Â¿ÚÌ·Ù· ∆ ÛÙÈ˜ ‰ÂÍÈ¤˜ ÚÔÎ¿Ú‰ÈÂ˜

··ÁˆÁ¤˜4. ¶·ÚÔ˘Û›· ÌÂÙ·‰˘Ó·ÌÈÎÒÓ ÛÙÔ ∏∫° Û˘Ì„ËÊÈÛÌÔ‡5. ∞ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛÎ¤ÏÔ˘˜ Î·È ÎÔÈÏÈ·Î‹

Ù·¯˘Î·Ú‰›·6. ◊È· ÙÌËÌ·ÙÈÎ‹ ‰È¿Ù·ÛË ÙË˜ ¢∫7. ∆ÔÈÎ¤˜ ÂÚÈÔ¯¤˜ ˘ÔÎÈÓËÛ›·˜ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜

∆ÚÔÔÔÈËÌ¤ÓÔ ·fi J Am Coll Cardiol 2001;38:1777


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71. ¶Ú¿· ∂, ∞Ó·ÛÙ·Û¿ÎË˜ ∞, Elliott P, McKenna W, ∆Ô‡-ÙÔ˘˙·˜ ¶∫. “ªË Û˘Ì·Á¤˜” Ì˘ÔÎ¿Ú‰ÈÔ: Ì›· Û¯Â‰fiÓ ¿ÁÓˆ-ÛÙË Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·. ∂ÏÏËÓÈÎ‹ ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∂ÈıÂÒÚË-ÛË 2002;43:236-245.

72. Conraads V, Paelinck B, Vorlat A, Goethals M, Jacobs W,Vrints C. Isolated non-compaction of the left ventricle: arare indication for transplantation. J Heart Lung Transplant2001;20:904-907.

73. Jenni R, Oechslin E, Schneider J, Jost CA, Kaufmann PA.Echocardiographic and pathoanatomical characteristics ofisolated left ventricular non-compaction: a step towardsclassification as a distinct cardiomyopathy. Heart2001;86:666-671.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ì·Ï›· ∆ÛÈÏÈÌÈÁÎ¿ÎË ∏ÚÔ‰fiÙÔ˘ 214, ¡¤· ∞ÏÈÎ·ÚÓ·ÛÛfi˜ ∆.∫. 716 01, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

418


°ÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ·: Èı·Ó¤˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘ÏÔ˜, º. ™·ÍÒÓË - ¶··ÁÂˆÚÁ›Ô˘

Genetically modified food: potential effects on allergenicity E. Vassilopoulou, N. G. Papadopoulos, F. Saxoni - Papageorgiou


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

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

�¶ÂÚ›ÏË„Ë: ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ‰ÈÏ‹ÌÌ·Ù·ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÔÏÈÙÈÛÌÔ‡ Â›Ó·È ÙÔ ÛËÌÂ›Ô Ì¤¯ÚÈ ÙÔÔÔ›Ô Ú¤ÂÈ Ó· ÂÈ‰ÈÒÎÂÙ·È Ô ¤ÏÂÁ¯Ô˜ ÙË˜ Ê‡ÛË˜.∆Ô ı¤Ì· ·˘Ùfi, ¤Ú· ·fi ÙÔÓ ÁÂÓÈÎfiÙÂÚÔ ÛÂ‚·ÛÌfiÚÔ˜ ÙË Ê‡ÛË, ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË Û¯¤ÛË Ì·˜ ÌÂÙËÓ ›‰È· ÙËÓ ÙÚÔÊ‹ Ô˘ Î·Ù·Ó·ÏÒÓÔ˘ÌÂ. ∆· ÂÈ-ÙÂ‡ÁÌ·Ù· ÛÙÔÓ ÙÔÌ¤· ÙË˜ ‚ÈÔÙÂ¯ÓÔÏÔÁ›·˜ ·Ú¯ÈÎ¿Î·È ÙË˜ ÁÂÓÂÙÈÎ‹˜ ÌË¯·ÓÈÎ‹˜ ÛÙË Û˘Ó¤¯ÂÈ·, ¤¯Ô˘ÓÊ¤ÚÂÈ ÚÈ˙ÈÎ¤˜ ·ÏÏ·Á¤˜ ÛÙË ‰È·ÙÚÔÊ‹, ı¤ÙÔÓÙ·˜ Ù··ÎfiÏÔ˘ı· ÂÚˆÙ‹Ì·Ù·: Ú¤ÂÈ Ó· Î·Ù·Ó·ÏÒÓÔÓÙ·ÈÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ·; À¿Ú¯ÂÈ Ë ‰˘Ó·-ÙfiÙËÙ· ÂÓËÌ¤ÚˆÛË˜ ÁÈ’ ·˘Ù¿ Ù· ÙÚfiÊÈÌ·; ¶ÔÈ· Ú¤-ÂÈ Ó· Â›Ó·È Ë ÁÂÓÈÎfiÙÂÚË ı¤ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘Î·È Ò˜ ÌÔÚÂ› Ó· Û˘Ì‚Ô˘ÏÂ‡ÂÈ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Û¯Â-ÙÈÎ¿ ÌÂ ·˘Ùfi ÙÔ ı¤Ì·; ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ·Ó·-ÛÎfiËÛË˜ Â›Ó·È Ë ÚÔÛ¿ıÂÈ· ÛÊ·ÈÚÈÎ‹˜ ÚÔÛ¤Á-ÁÈÛË˜ ÙÔ˘ ı¤Ì·ÙÔ˜ ÙˆÓ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓÙÚÔÊ›ÌˆÓ, ÂÚÈÁÚ¿ÊÔÓÙ·˜ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÏËÚ¤-ÛÙÂÚ· Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÙÈ˜ ·‰˘Ó·Ì›Â˜ ÙÔ˘˜.∞Ó·Ê¤ÚÔÓÙ·˜ ÙÈ˜ ‰˘ÓËÙÈÎ¤˜ ÂÈÙÒÛÂÈ˜ Ô˘ ÌÔÚÂ›Ó· ¤¯Ô˘Ó Ù¤ÙÔÈÂ˜ ÙÚÔÊ¤˜ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙË-Ù·, ÚÔÙÂ›ÓÔÓÙ·È, Â›ÛË˜, Èı·Ó¤˜ ÚÔÛÂÁÁ›ÛÂÈ˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ·ÓËÛ˘¯ÈÒÓÔ˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÏÏÂÚÁ›·, ÙÚfiÊÈÌ·, ÁÂÓÂÙÈÎ‹ ÙÚÔ-ÔÔ›ËÛË.

�Abstract: One of the greatest dilemmas of ourcivilization is the extent to which control of natureshould be attempted. This subject, apart from theaspect of a general respect for nature, also includesour relationship with the food we consume.Achievements, first in biotechnology andsubsequently in genetic engineering, have broughtabout radical changes in nutrition and are posingpressing questions: Should genetically modifiedfood be consumed? Is there the possibility ofobtaining information on what we eat? What shouldbe the general attitude of the medical communityand how can patients be informed on this subject?The intent of this review is to approach the issue ofgenetically modified foods globally, describing theiradvantages and weaknesses. By analyzing thepotential effects of these foods in terms ofallergenicity, approaches to dealing with theconcerns they create are suggested.

Key words: allergy, food, genetic modification.

∂ÈÛ·ÁˆÁ‹ŒÓ· ·fi Ù· ‚·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ·ÓıÚÒ-

Ô˘ Â›Ó·È Ë Ù¿ÛË ÙÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓÌÂ ÛÎÔfi Ó· ÙÔ ·ÏÏ¿ÍÂÈ. ™·Ó ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·Ì-Ê›‰ÚÔÌË˜ Û¯¤ÛË˜ Î·È ·ÏÏËÏÂ›‰Ú·ÛË˜ ·Ó¿ÌÂÛ·ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ, Î¿ıÂ ÌÂ-Ù·‚ÔÏ‹ ÙË˜ Ì›·˜ ·Ú·Ì¤ÙÚÔ˘ ÂËÚÂ¿˙ÂÈ ¿ÌÂÛ· Î·ÈÙËÓ ¿ÏÏË. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ, Ë ÂÍ¤ÏÈÍË ÙÔ˘ ·ÓıÚÒ-

ÈÓÔ˘ Â›‰Ô˘˜ ÂÍ·ÚÙ¿Ù·È ÙfiÛÔ ·fi ÙË Ê˘ÛÈÎ‹ ÔÚÂ›·fiÛÔ Î·È ·fi ÙËÓ ÙÂ¯ÓÔÏÔÁÈÎ‹ ÚfiÔ‰Ô.

µÚÈÛÎfiÌ·ÛÙÂ ÛÙÔ Ì¤ÛÔ Ì›·˜ ÈÛÙÔÚÈÎ‹˜ ÌÂÙ¿‚·-ÛË˜ ÚÔ˜ ÙË ‚ÈÔÙÂ¯ÓÔÏÔÁÈÎ‹ ÂÔ¯‹. ∏ Û‡Á¯ÚÔÓËÙÂ¯ÓÔÏÔÁÈÎ‹ Â·Ó¿ÛÙ·ÛË ¤¯ÂÈ ÙÚÂÈ˜ Î˘Ú›ˆ˜ ·ÎÚÔ-ÁˆÓÈ·›Ô˘˜ Ï›ıÔ˘˜: ÙËÓ ÏËÚÔÊÔÚÈÎ‹, ÙË Ó·ÓÔÙÂ¯ÓÔ-ÏÔÁ›· Î·È ÙË ÁÂÓÂÙÈÎ‹ ÌË¯·ÓÈÎ‹. ∆· Ì¤Û· ·˘Ù¿ ÌÔ-ÚÔ‡Ó Ó· ·ÏÏ¿ÍÔ˘Ó ÙÔÓ ÎfiÛÌÔ ÛÂ ÙÂÚ¿ÛÙÈÔ ‚·ıÌfi,


419

ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ·Ó·Ì¤ÓÂÙ·È ÚÈ˙ÈÎ‹ Î·È Ë ·ÏÏ·Á‹ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ (1).

∏ ÈÎ·ÓfiÙËÙ· ÙÔ˘ ·ÓıÚÒÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙËÓÔÚÂ›· ÂÍ¤ÏÈÍË˜ ÙˆÓ ÂÈ‰ÒÓ Î·È Ó· ‰ËÌÈÔ˘ÚÁÂ› ÙË ‰È-Î‹ ÙÔ˘ “¡¤· °¤ÓÂÛË”, ÂÚÈÔÚÈ˙fiÙ·Ó Ì¤¯ÚÈ ÚfiÛÊ·-Ù· ·fi Ù· fiÚÈ· Ô˘ ¤ıÂÙÂ Ë ÌÔÓ·‰ÈÎfiÙËÙ· Î·È Ë ‰È·-ÊÔÚÂÙÈÎfiÙËÙ· ÙˆÓ ÂÈ‰ÒÓ. OÈ Ó¤Â˜, fiÌˆ˜, ÙÂ¯ÓÔÏÔ-Á›Â˜ ÂÈÙÚ¤Ô˘Ó ÛÙÔ˘˜ ÂÈÛÙ‹ÌÔÓÂ˜ Ó· ¯ÂÈÚÈÛÙÔ‡ÓÙÔÓ Ê˘ÛÈÎfi ÎfiÛÌÔ ÛÙÔ Â›Â‰Ô Ô˘ ·ÔÙÂÏÂ› ÙË ‚¿-ÛË ÙË˜ ÂÍ¤ÏÈÍË˜: ÙÔ ÁÔÓÈ‰È·Îfi (2).

∏ ÁÂÓÂÙÈÎ‹ ÌË¯·ÓÈÎ‹ Â›Ó·È Ë ‰È·‰ÈÎ·Û›· Î·Ù¿ ÙËÓÔÔ›· Ù· ÁÔÓ›‰È· ·ÔÌÔÓÒÓÔÓÙ·È, ·Ó·ÁÓˆÚ›˙ÔÓÙ·È,·Ó·Û˘Ó‰˘¿˙ÔÓÙ·È Î·È ÌÂÙ·Ê¤ÚÔÓÙ·È ÙÂ¯ÓÔÏÔÁÈÎ¿·fi ¤Ó·Ó ÔÚÁ·ÓÈÛÌfi ÛÂ ¤Ó·Ó ¿ÏÏÔ. ™‹ÌÂÚ·, Ô ÁÂ-ÓÂÙÈÎfi˜ ÎÒ‰ÈÎ·˜ ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÈ‰ÒÓ ¤¯ÂÈ·ÔÎÚ˘ÙÔÁÚ·ÊËıÂ›. ∏ ÁÂÓÂÙÈÎ‹ ÌË¯·ÓÈÎ‹ Î¿ÓÂÈ‰˘Ó·Ù‹ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÙ·Í‡ÔÚÁ·ÓÈÛÌÒÓ Ô˘ ‰ÂÓ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó··Ú·-¯ıÔ‡Ó ÌÂÙ·Í‡ ÙÔ˘˜ ÌÂ ¿ÏÏÔ ÙÚfiÔ. ∆· ÙÂÏÂ˘Ù·›· 20¯ÚfiÓÈ· ·ÔÌÔÓÒÓÔÓÙ·È ÁÔÓ›‰È· ·fi Î¿ÔÈÔÓ ˙ˆÓÙ·ÓfiÔÚÁ·ÓÈÛÌfi Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÂ ¿ÏÏÔÓ ÌÂ Ù¤ÙÔÈÔ ÙÚfiÔÒÛÙÂ Ó· Â›Ó·È ÏÂÈÙÔ˘ÚÁÈÎ¿, Û¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ÊÚ·Á-Ìfi ·ÓÙ·ÏÏ·Á‹˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÙ·Í‡ ‰È·ÊÔÚÂÙÈ-ÎÒÓ ÂÈ‰ÒÓ (3). ∂ÔÌ¤Óˆ˜, ÚÔÎ‡ÙÔ˘Ó ÔÚÁ·ÓÈÛÌÔ›Ô˘, ÂÎÙfi˜ ·fi ÙÈ˜ ‰ÈÎ¤˜ ÙÔ˘˜ ÚˆÙÂ˝ÓÂ˜, ÂÎÊÚ¿˙Ô˘ÓÎ·È ÂÎÂ›ÓÂ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Ô˘ ÂÈÛ‹¯ıË.

ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÌÔÚÔ‡ÌÂ Ó· Î·Ù·ÓÔ‹ÛÔ˘-ÌÂ ÙË ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ÁÔÓÈ‰›ˆÓ ÛÂ ÂÚÂ˘ÓËÙÈÎfi Â›-Â‰Ô, ÂÈÛ¿ÁÔÓÙ·˜ ‹ ·Ê·ÈÚÒÓÙ·˜ ·˘Ù¿ ÛÂ ÂÈÚ·Ì·-Ùfi˙ˆ·. ∆Ô Â‡ÚÔ˜ ÙˆÓ Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ ÂÊ·ÚÌÔÁÒÓÂ›Ó·È ÌÂÁ¿ÏÔ, ·ÊÔ‡ ÔÏÏ¿ Ê¿ÚÌ·Î· ‹ ÂÌ‚fiÏÈ·, Ù··ÔÎ·ÏÔ‡ÌÂÓ· ·Ó·Û˘Ó‰˘·ÛÌ¤Ó·, ÚÔ¤Ú¯ÔÓÙ·È·fi ÁÂÓÂÙÈÎ‹ ÙÚÔÔÔ›ËÛË ‚·ÎÙËÚ›ˆÓ, ÒÛÙÂ Ó· ·-Ú¿ÁÔ˘Ó Ô˘Û›Â˜ ÁÈ· ·ÓıÚÒÈÓË ¯Ú‹ÛË, fiˆ˜ ÈÓÙÂÚ-ÊÂÚfiÓË, ÈÓÛÔ˘Ï›ÓË ‹ ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË (3).

¶ÈÔ ¿ÌÂÛÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÂÊ·ÚÌÔÁ¤˜ ‚Ú›ÛÎÔ-

ÓÙ·È ÛÂ ÂÍ¤ÏÈÍË, ¤ÙÔÈÌÂ˜ Ó· ‰ÒÛÔ˘Ó Ï‡ÛÂÈ˜ ÛÂ ÚÔ-‚Ï‹Ì·Ù· Ô˘ ÂÏ¤Á¯ÔÓÙ·È ÁÔÓÈ‰È·Î¿ Ì¤Ûˆ ÙË˜ ÁÂÓÂ-ÙÈÎ‹˜ ıÂÚ·Â›·˜.

∆Ô 1984 ·Ó·Ê¤ÚıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ Ë ¿ÌÂÛËÎ·È ÛÙ·ıÂÚ‹ ÌÂÙ·ÊÔÚ¿ ÁÔÓÈ‰›ˆÓ ÛÂ Ê˘Ù¿ (4,5). ∆ËÓÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· Ë ·Ó¿Ù˘ÍË ‹Ù·Ó Ú·Á‰·›·,fiÙ·Ó ÔÏÏ¤˜ ÂÙ·ÈÚÂ›Â˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË ÁÂÓÂ-ÙÈÎ‹ ÌË¯·ÓÈÎ‹, Î·Ù¿ÊÂÚ·Ó Ó· ÂÈÛ·Á¿ÁÔ˘Ó Í¤Ó· ÁÔ-Ó›‰È· ÛÂ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÛËÌ·ÓÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ, fiˆ˜ÙÔ Î·Ï·ÌfiÎÈ Î·È Ë ÛfiÁÈ· (6).

¶ÚfiÛÊ·Ù·, ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ·¿Ú¯ÈÛ·Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÂ ÔÏÏ¿ Â›‰Ë Â˘ÚÂ›·˜Î·Ù·Ó¿ÏˆÛË˜, ·ÔÙÂÏÒÓÙ·˜ Ï¤ÔÓ Ì›· Ú·ÁÌ·ÙÈ-ÎfiÙËÙ· Ô˘ ··Û¯ÔÏÂ› fi¯È ÌfiÓÔ ÙÔ˘˜ ÂÈÛÙ‹ÌÔÓÂ˜,·ÏÏ¿ Î·È ÙÔ˘˜ Î·Ù·Ó·ÏˆÙ¤˜.

°ÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ· O fiÚÔ˜ “ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ·”

(°∆∆) ·Ó·Ê¤ÚÂÙ·È ÛÂ ÙÚfiÊÈÌ· Ô˘ ·Ú·ÛÎÂ˘¿ÛÙË-Î·Ó ÌÂ ÙË ¯Ú‹ÛË ÙˆÓ Ì¤ÛˆÓ Ô˘ ·Ú¤¯ÂÈ Ë ÌÔÚÈ·-Î‹ ‚ÈÔÏÔÁ›·, ÁÈ· ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜ ·fi ·ÓıÚÒ-Ô˘˜ ‹ ˙Ò·. ¶ÚfiÎÂÈÙ·È ÁÈ· Î·ÏÏÈ¤ÚÁÂÈÂ˜ Ô˘ ÙÚÔ-ÔÔÈ‹ıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, ÌÂ ÛÎÔfi Ó· ·Ô‰Ô-ıÔ‡Ó ÛÂ ·˘Ù¤˜ Î¿ÔÈÂ˜ ÂÈı˘ÌËÙ¤˜ È‰ÈfiÙËÙÂ˜, fiˆ˜·˘ÍËÌ¤ÓË ıÚÂÙÈÎ‹ ·Í›· ‹ ·ÓıÂÎÙÈÎfiÙËÙ· ÛÂ ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ‡˜ (¶›Ó·Î·˜ 1). ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈı˘-ÌËÙÒÓ È‰ÈÔÙ‹ÙˆÓ ·Ú·‰ÔÛÈ·Î¿ ÁÈÓfiÙ·Ó ·fi ÁÂÓÈ¿ÛÂ ÁÂÓÈ¿ Ì¤Ûˆ ÙË˜ ·Ó··Ú·ÁˆÁ‹˜, Ì›· ‰È·‰ÈÎ·Û›·Ô˘ ‰ÂÓ ÌÔÚÔ‡ÛÂ, fiÌˆ˜, Ó· ÂÁÁ˘ËıÂ› ÙËÓ ·ÎÚ›-‚ÂÈ· ÙË˜ ÌÂÙ·‚›‚·Û‹˜ ÙÔ˘˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ‹Ù·ÓÈ‰È·›ÙÂÚ· ¯ÚÔÓÔ‚fiÚ·. ªÂ ÙË ÁÂÓÂÙÈÎ‹ ÌË¯·ÓÈÎ‹ÌÔÚÔ‡Ó ‰˘ÓËÙÈÎ¿ Ó· ·Ú·ÛÎÂ˘·ÛÙÔ‡Ó ÚÔ˚fiÓÙ·ÌÂ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ È‰ÈfiÙËÙÂ˜, ÁÚ‹ÁÔÚ· Î·È ÌÂ ÂÍ·È-ÚÂÙÈÎ‹ ·ÎÚ›‚ÂÈ·. °È· ·Ú¿‰ÂÈÁÌ·, ¤Ó· ÁÔÓ›‰ÈÔ ˘Â‡-ı˘ÓÔ ÁÈ· ÙËÓ ·ÓÔ¯‹ ÂÓfi˜ Ê˘ÙÔ‡ ÛÙËÓ ÍËÚ·Û›· ÌÔ-ÚÂ› Ó· ÂÈÛ·¯ıÂ› ÛÂ Ê˘Ùfi ‰È·ÊÔÚÂÙÈÎÔ‡ Â›‰Ô˘˜, ¤ÙÛÈ

¶›Ó·Î·˜ 1. °ÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ· (ÂÓ‰ÂÈÎÙÈÎfi˜ ›Ó·Î·˜)

∆ÚfiÊÈÌÔ °ÔÓ›‰ÈÔ ¶ËÁ‹ ™ÎÔfi˜ ∫ˆ‰ÈÎfi˜

∫·Ï·ÌfiÎÈ ∆ÚÔÔÔÈËÌ¤ÓÔ Bacillus thuringiensis, ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÙÔ ˙È˙¿ÓÈÔ ªO¡ 863Cry3Bb1, NptII Escherichia coli Coleopteran Î·È ÛÙ·

transposon, Tn5 ·ÌÈÓÔÁÏ˘ÎÔ˙È‰ÈÎ¿ ·ÓÙÈ‚ÈÔÙÈÎ¿∫·Ï·ÌfiÎÈ ¶ÚˆÙÂ˝ÓË Bacillus thuringiensis, ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÂ 1507

Cry1F, ƒ∞∆ Streptomyces Û˘ÁÎÂÎÚÈÌ¤Ó· ÏÂÈ‰fiÙÂÚ·viridochromogenes

∫·Ï·ÌfiÎÈ 5-EPSPS Agrobacterium sp, ∞ÓÔ¯‹ ÛÙÔ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓÔ ¡∫603¿Ï˘ÛÔ˜ CP4 ¯ÔÚÙ·Ú›‰ÈÔ

∫·Ï·ÌfiÎÈ ƒ∞∆ Bacillus amyloliquefaciens, ™ÙÂÈÚfiÙËÙ· ·Ó‰Úfi˜ MS6streptomyces hygroscopicus

ƒ‡˙È ƒ∞∆ Streptomyces hygroscopicus ∞ÓÔ¯‹ ÛÙÔ Herbicide glufosinate LLRICE E06,LLRICE E62

¶ÂfiÓÈ S-·‰ÂÓÔÛ˘ÏÌÂıÈÔÓ›ÓË E. coli ∫·ı˘ÛÙ¤ÚËÛË ÙË˜ ·ÔÛ‡ÓıÂÛË˜ ∞ Î·È µ˘‰ÚÔÏ¿ÛË bacteriophage T3 ÙÔ˘ ÊÚÔ‡ÙÔ˘ ÏfiÁˆ ÌÂ›ˆÛË˜ ÙË˜

Û‡ÓıÂÛË˜ ·Èı˘ÏÂÓ›Ô˘


420

ÒÛÙÂ Ó· ÌÔÚÂ› ·˘Ùfi Ó· Î·ÏÏÈÂÚÁËıÂ› ÛÂ Û˘Óı‹ÎÂ˜ÂÚ‹ÌÔ˘ (7).

∆· °∆∆ ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó ÛÂ ÙÚÂÈ˜ Î·-ÙËÁÔÚ›Â˜, ÌÂ ‚¿ÛË Ù· Â›‰Ë ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓ Á›ÓÂ-Ù·È Ë ÌÂÙ·‚›‚·ÛË ÁÔÓÈ‰›ˆÓ: ·) “Â˘ÚÂ›·” ÌÂÙ·‚›‚·ÛËÁÔÓÈ‰›ˆÓ, ·Ó·ÊÂÚfiÌÂÓË ÛÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓÈ‰›ˆÓÌÂÙ·Í‡ ÔÚÁ·ÓÈÛÌÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ‚·ÛÈÏÂ›ˆÓ, ‚)“ÂÚÈÔÚÈÛÌ¤ÓË” ÌÂÙ·‚›‚·ÛË ÁÔÓÈ‰›ˆÓ, fiÙ·Ó ·ÊÔÚ¿ÛÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓÈ‰›ˆÓ ÌÂÙ·Í‡ ÔÚÁ·ÓÈÛÌÒÓ ÙÔ˘›‰ÈÔ˘ ‚·ÛÈÏÂ›Ô˘ Î·È Á) “Û˘ÛÙÚÔÊ‹” (tweaking), fiÙ·ÓÁ›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ Ô˘ Á›ÓÔÓÙ·È ÌÂÛÎÔfi ÙËÓ ·‡ÍËÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÁÔÓÈ‰›ˆÓ ÙÔ˘ ›‰È-Ô˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (8).

OÊ¤ÏË Î·È ÚÔÛ‰ÔÎ›Â˜ ·fi Ù· ÁÂÓÂÙÈÎ¿ ÙÚÔÔ-ÔÈËÌ¤Ó· ÙÚfiÊÈÌ·

∏ ÂÍ·ÛÊ¿ÏÈÛË Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ ÙÚÔÊ›ÌˆÓÚfiÎÂÈÙ·È Ó· ·ÔÙÂÏ¤ÛÂÈ ÛËÌ·ÓÙÈÎ‹ ÚfiÎÏËÛË Ù·¯ÚfiÓÈ· Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó, ÂÓÒ Ù· °∆∆ ·Ó·Ì¤ÓÂÙ·È Ó·¤¯Ô˘Ó ‚·ÛÈÎfi ÚfiÏÔ ÌÂ ÔÈÎ›ÏÔ˘˜ ÙÚfiÔ˘˜. ∞Ú¯ÈÎ¿·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛ‰ÒÛÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÔÈÎÔÓÔÌÈÎ¿ÔÊ¤ÏË, Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·Ó¿Ù˘ÍË˜ Ó¤ˆÓ ÔÈÎÈ-ÏÈÒÓ Ê˘ÙÒÓ Î·È ˙ÒˆÓ (9). ∏ Û‡Á¯ÚÔÓË ÔÈÎÔÓÔÌ›···ÈÙÂ› ‰È·ÚÎ‹ ·Ó·˙‹ÙËÛË Ó¤ˆÓ ·ÁÔÚÒÓ Ô˘ ı··Ó·Ù‡ÛÛÔÓÙ·È ÌÂ ¯·ÌËÏfiÙÂÚÔ ÎfiÛÙÔ˜ ·Ú·ÁˆÁ‹˜,ÒÛÙÂ Î·È Ù· Î¤Ú‰Ë Ó· ·˘Í¿ÓÔ˘Ó.

ŒÓ·˜ ÔÏ‡ ÛËÌ·ÓÙÈÎfi˜ ·ÎfiÌ· ÏfiÁÔ˜, ÌÂ ¿ÌÂÛËÛ¯¤ÛË ÌÂ ÙÔÓ ÚÔ·Ó·ÊÂÚfiÌÂÓÔ, Â›Ó·È Ô ˘ÔÛÈÙÈÛÌfi˜ÙÔ˘ ÏÂÁfiÌÂÓÔ˘ “ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘”, fiÔ˘ ÂÎ·ÙÔÌÌ‡ÚÈ·¿ÓıÚˆÔÈ ÛÙËÚ›˙Ô˘Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ ÛÙËÓ Î·Ï-ÏÈ¤ÚÁÂÈ· ÂÓfi˜ ÌfiÓÔ Î·ÚÔ‡, ÙÔ˘ Ú˘˙ÈÔ‡, ÙÔ ÔÔ›Ô‰ÂÓ Â·ÚÎÂ› ÁÈ· Ó· Î·Ï‡„ÂÈ ÙÈ˜ ·Ó¿ÁÎÂ˜ ÛÂ ıÚÂÙÈÎ¿Û˘ÛÙ·ÙÈÎ¿, ÒÛÙÂ Ó· ·ÔÙÚ·Â› Ë ˘ÔıÚÂ„›·. ªÂ ÙË‚Ô‹ıÂÈ· ÙË˜ ÁÂÓÂÙÈÎ‹˜ ÌË¯·ÓÈÎ‹˜ ÙÔ Ú‡˙È ÌÔÚÂ› Ó·ÂÌÏÔ˘ÙÈÛÙÂ› ÛÂ ‚ÈÙ·Ì›ÓÂ˜ Î·È ÌÂÙ·ÏÏÈÎ¿ ÛÙÔÈ¯Â›·,ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÔ‡Ó ‰È·ÙÚÔÊÈÎ¤˜ ÂÏÏÂ›„ÂÈ˜. °È·ÙÔÓ ÛÎÔfi ·˘Ùfi ¤ÁÈÓÂ Ì›· ÚÒÙË ÚÔÛ¿ıÂÈ· ÌÂ ÙÔ“Golden rice”, Ì›· ÔÈÎÈÏ›· Ú˘˙ÈÔ‡ Ô˘ ÙÚÔÔÔÈ‹-ıËÎÂ ·fi ∂Ï‚ÂÙÔ‡˜ ÁÂÓÂÙÈÛÙ¤˜ ÌÂ Ù¤ÙÔÈÔ ÙÚfiÔÒÛÙÂ Ó· ÂÚÈ¤¯ÂÈ ÂÍ·ÈÚÂÙÈÎ¿ ÌÂÁ¿ÏÂ˜ ÔÛfiÙËÙÂ˜ ‚È-Ù·Ì›ÓË˜ ∞ (10). ∏ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ ∞, ÌÂ Ù·ÁÓˆÛÙ¿ ÎÏÈÓÈÎ¿ Â·ÎfiÏÔ˘ı· (11), Ì·ÛÙ›˙ÂÈ ¿Óˆ ·fi3.000.000 ·È‰È¿, Î˘Ú›ˆ˜ ÛÙÈ˜ ˘Ô·Ó¿Ù˘ÎÙÂ˜ ¯Ò-ÚÂ˜. ∏ ÚÔÛ¿ıÂÈ· ·˘Ù‹, Ô˘ ·¤Ù˘¯Â ÏfiÁˆ Ì›·˜ÛÂÈÚ¿˜ ÙÂ¯ÓÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (12),¿ÓÔÈÍÂ ÙÔ ‰ÚfiÌÔ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙÚÔÊ›ÌˆÓ Ô˘ı· ÌÔÚÔ‡Û·Ó Ó· Î·Ï‡„Ô˘Ó ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ÙÈ˜‰È·ÙÚÔÊÈÎ¤˜ ÂÏÏÂ›„ÂÈ˜ ÌË-ÚÔÓÔÌÈÔ‡¯ˆÓ ÎÔÈÓˆÓÈÒÓ.

™Â ¤Ó· ¿ÏÏÔ Â›Â‰Ô, Ô˘ ·ÊÔÚ¿ ÛÙËÓ Î·ÏÏÈ¤Ú-ÁÂÈ· ÚÔ˚fiÓÙˆÓ Â˘ÚÂ›·˜ Î·Ù·Ó¿ÏˆÛË˜, Î¿ÔÈ· °∆∆ÌÔÚÔ‡Ó Ó· Ê¤ÚÔ˘Ó Û˘ÁÎÂÎÚÈÌ¤Ó· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿,fiˆ˜ Ù·¯‡ÙÂÚË ·‡ÍËÛË Î·È ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÁÂıÔ˜ ÙÂ-ÏÈÎÔ‡ ÚÔ˚fiÓÙÔ˜, ÛÙÔ Ï·›ÛÈÔ ÙË˜ ·Ó·˙‹ÙËÛË˜ ‰È·Êfi-ÚˆÓ ÙÚfiˆÓ ·fi ÙÔ˘˜ Î·ÏÏÈÂÚÁËÙ¤˜, ÒÛÙÂ Ù· Ê˘Ù¿

ÙÔ˘˜ Ó· Â›Ó·È ÈÔ ·ÓıÂÎÙÈÎ¿, ˘ÁÈ‹ Î·È ·Ô‰ÔÙÈÎ¿ (13).∂ÈÏ¤ÔÓ, ÔÈ Î·Ù·Ó·ÏˆÙ¤˜ ·ÓÙÈ‰ÚÔ‡Ó ÛÙËÓ Î·Ù·-

Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ Ô˘ ¤¯Ô˘Ó ‰Â¯ıÂ› ÙËÓ Â›‰Ú·ÛË¯ËÌÈÎÒÓ ·Ú·ÛÈÙÔÎÙfiÓˆÓ, ÂÍ·ÈÙ›·˜ ÙˆÓ Èı·ÓÒÓ‚Ï·‚ÂÚÒÓ ÙÔ˘˜ ÂÈ‰Ú¿ÛÂˆÓ ÛÙËÓ ˘ÁÂ›·, ·ÏÏ¿ Î·ÈÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. OÚÈÛÌ¤Ó· °∆∆, fiˆ˜ ÙÔ Bacillusthuringiensis (B.t.) Î·Ï·ÌfiÎÈ, ‚ÔËıÔ‡Ó ÛÙË ÌÂ›ˆÛËÙË˜ ¯Ú‹ÛË˜ ¯ËÌÈÎÒÓ Î·È ÙÔ˘ ÎfiÛÙÔ˘˜ ·Ú·ÁˆÁ‹˜ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ÊÙ¿ÓÔ˘Ó ÛÙ· Î·Ù·ÛÙ‹Ì·Ù· ÙÚÔ-Ê›ÌˆÓ (14).

™ËÌ·ÓÙÈÎ¤˜ ÚÔÛ¿ıÂÈÂ˜ ¤¯Ô˘Ó Á›ÓÂÈ ÛÙÔ ¯ÒÚÔÙˆÓ °∆∆, ÒÛÙÂ Ó· ÙÔ˘˜ ·Ô‰ÔıÔ‡Ó Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜È‰ÈfiÙËÙÂ˜. ∫¿ÔÈ· ÂÌ‚fiÏÈ· Î·È Ê¿ÚÌ·Î· ÎÔÛÙ›˙Ô˘Ó·ÚÎÂÙ¿ ÁÈ· Ó· ·Ú·¯ıÔ‡Ó Î·È ··ÈÙÔ‡Ó ÂÈ‰ÈÎ¤˜ Û˘Ó-ı‹ÎÂ˜ ÁÈ· Ó· Û˘ÓÙËÚËıÔ‡Ó ÛˆÛÙ¿, Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ¤˜. ŒÙÛÈ ¤¯ÂÈ ·Ú·¯ıÂ› ÁÂÓÂÙÈ-Î¿ ÙÚÔÔÔÈËÌ¤ÓÔ Ú‡˙È Ô˘ ÂÚÈ¤¯ÂÈ Ê¿ÚÌ·ÎÔ ÁÈ·ÙËÓ Î˘ÛÙÈÎ‹ ›ÓˆÛË. ∏ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹-ıÂÚ·Â˘ÙÈÎ‹‰È¿ÛÙ·ÛË ÙˆÓ °∆∆ ‹Ù·Ó Ë ·ÊÔÚÌ‹ ÁÈ· ÙËÓ ÂÈÛ·ÁˆÁ‹·ÓıÚÒÈÓˆÓ ÁÔÓÈ‰›ˆÓ ÛÂ ÙÚfiÊÈÌ· (15). ŒÙÛÈ, Î·Ù¤-ÛÙË ‰˘Ó·Ùfi Ó· ·Ú¿ÁÂÙ·È Û˘ÓÂ¯Ò˜ ·ÓıÚÒÈÓË ·Ï-‚Ô˘Ì›ÓË ·fi Ê˘ÙÂ›Â˜ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓÔ˘ Î·-Ô˘ÙÛÔ‡Î (16). ¢ÈÂÓÂÚÁÔ‡ÓÙ·È, Â›ÛË˜, ·ÚÎÂÙ¤˜ ÌÂÏ¤-ÙÂ˜ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ‚ÚÒÛÈÌˆÓ ÂÌ‚ÔÏ›ˆÓ ÛÂ ÓÙÔ-Ì¿ÙÂ˜ Î·È ·Ù¿ÙÂ˜ (7) Î·È ÂÚÂ˘ÓÒÓÙ·È ÚˆÙÔÔÚÈ·-Î¤˜ Ì¤ıÔ‰ÔÈ ÌÂÙ·ÊÔÚ¿˜ ·ÓÙÈÁfiÓˆÓ ÈÒÓ ‹ Ú˘ıÌÈÛÙÒÓÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ °∆∆ (17).Œ¯Ô˘Ó, Ù¤ÏÔ˜, “Û¯Â‰È·ÛÙÂ›” Ì·Ó¿ÓÂ˜ Ô˘ ÂÚÈ¤¯Ô˘ÓÙÔ ÂÌ‚fiÏÈÔ ÙË˜ ¯ÔÏ¤Ú·˜ ‹/Î·È ÙË˜ Ë·Ù›ÙÈ‰·˜ µ.

ª›· ‰˘ÓËÙÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙË˜ ÁÂÓÂÙÈÎ‹˜ ÌË¯·ÓÈ-Î‹˜ Ô˘ ·ÊÔÚ¿ È‰È·›ÙÂÚ· ÛÙËÓ ·ÏÏÂÚÁÈÔÏÔÁ›·, ·Ô-ÙÂÏÂ› Ë ‰˘Ó·ÙfiÙËÙ· ÌÂ›ˆÛË˜ ÙˆÓ ÂÈ‰ÈÎÒÓ ·ÏÏÂÚÁÈÔ-ÁÔÓÈÎÒÓ ÚˆÙÂ˚ÓÒÓ ÛÙ· ÙÚfiÊÈÌ·. ∞˘Ùfi ÌÔÚÂ› Ó·ÂÈÙÂ˘¯ıÂ› ÌÂ ÙËÓ Î·Ù·ÛÙÔÏ‹ ÙË˜ ÁÔÓÈ‰È·Î‹˜ ¤ÎÊÚ·-ÛË˜ Ì¤Ûˆ ÙË˜ ·ÓÙÈÓÔËÌ·ÙÈÎ‹˜ ÙÂ¯ÓÔÏÔÁ›·˜(antisense-RNA). ™‡ÌÊˆÓ· ÌÂ ·˘Ù‹ ÙË Ì¤ıÔ‰Ô, ÂÈ-Û¿ÁÂÙ·È ¤Ó· ÁÔÓ›‰ÈÔ, ÙÔ mRNA ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È Û˘-ÌÏËÚˆÌ·ÙÈÎfi ÌÂ ÙÔ mRNA ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙÔ˘ ÔÔ›Ô˘Ë ¤ÎÊÚ·ÛË ÚfiÎÂÈÙ·È Ó· Î·Ù·ÛÙ·ÏÂ›. ŒÙÛÈ, ÙÔ mRNAÙÔ˘ ÂÈÛ·ÁfiÌÂÓÔ˘ ÁÔÓÈ‰›Ô˘ ˘‚ÚÈ‰ÔÔÈÂ›Ù·È ÌÂ ÙÔmRNA ÙÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ÁÔÓÈ‰›Ô˘ ÏfiÁˆ Û˘ÌÏËÚˆ-Ì·ÙÈÎfiÙËÙ·˜. ™ÙËÓ π·ˆÓ›·, ÂÈÛÙ‹ÌÔÓÂ˜ Î·Ù¿ÊÂÚ·ÓÓ· ·Ú·ÛÎÂ˘¿ÛÔ˘Ó Ú‡˙È ÌÂ 16% ÏÈÁfiÙÂÚË ÚˆÙÂ˝ÓË16 kD, Ë ÔÔ›· Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·Ï-ÏÂÚÁ›·˜ ÛÙÔ Ú‡˙È (18). ™Â Ì›· ·Ó¿ÏÔÁË ÔÚÂ›· ‚Ú›-ÛÎÔÓÙ·È, Â›ÛË˜, Ù· ˘Ô·ÏÏÂÚÁÈÎ¿ ÊÈÛÙ›ÎÈ· Î·È ÙÔ·ÏÂ‡ÚÈ ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË.

∞ÓÙÈÚÚ‹ÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ¯Ú‹ÛË ÁÂÓÂÙÈÎ¿ ÙÚÔ-ÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ

™ËÌ·ÓÙÈÎfi ÏfiÁÔ ·ÓÙ›‰Ú·ÛË˜ ¤Ó·ÓÙÈ ÙˆÓ °∆∆·ÔÙÂÏÂ› Ë ÔÚÈ˙fiÓÙÈ· ÌÂÙ·ÊÔÚ¿ ÁÔÓÈ‰›ˆÓ, Ë ÔÔ›·Û˘Ì‚·›ÓÂÈ ÌÂÙ·Í‡ ÌË Û˘ÁÁÂÓÒÓ ÂÈ‰ÒÓ, ÂËÚÂ¿˙Ô-ÓÙ·˜ ¤ÙÛÈ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÌÂ ·Úfi‚ÏÂÙÔ ÙÚfiÔ,


421

·ÊÔ‡ ÚfiÎÂÈÙ·È ÁÈ· ÂÈ‰Ú¿ÛÂÈ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÂ˙ˆÓÙ·ÓÔ‡˜ ÔÚÁ·ÓÈÛÌÔ‡˜. ∆· ÁÔÓ›‰È· ·fi Ù· °∆∆ÌÔÚÔ‡Ó ıÂˆÚËÙÈÎ¿ Ó· ÂÚ¿ÛÔ˘Ó ÛÙÔ˘˜ ·ÓıÚÒ-Ô˘˜ Ô˘ Ù· Î·Ù·Ó·ÏÒÓÔ˘Ó, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi Î¿ÔÈ· ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰Ô-Ì¤Ó· (3).

∆· ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÚÔ˚fiÓÙ· ·Ó··-Ú¿ÁÔÓÙ·È, ÌÂÁ·ÏÒÓÔ˘Ó Î·È ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó. OÈ ÂÈ-ÛÙ‹ÌÔÓÂ˜, ÁÈ· Ó· ·˘Í‹ÛÔ˘Ó ÙËÓ ·ÓıÂÎÙÈÎfiÙËÙ· ÙˆÓÎ·ÏÏÈÂÚÁÂÈÒÓ ÛÙ· ˙È˙¿ÓÈ· Î·È Ù· ·Ú¿ÛÈÙ·, ‰ËÌÈ-Ô‡ÚÁËÛ·Ó ÙÚÔÔÔÈËÌ¤ÓÂ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜. ªÂÁ¿ÏË·ÓËÛ˘¯›· ˘¿Ú¯ÂÈ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÂÙ·ÏÏ·ÁÌ¤-ÓˆÓ ˙È˙·Ó›ˆÓ, ·ÓıÂÎÙÈÎÒÓ ÛÙ· Ê˘ÙÔÊ¿ÚÌ·Î·, ÛÙËÓÂÚ›ÙˆÛË Ô˘ Ù· ÁÔÓ›‰È· ·ÓÙÔ¯‹˜ “ÂÚ¿ÛÔ˘Ó” ÛÂ·˘Ù¿, fiÔ˘ ı· ··ÈÙÂ›Ù·È ÂÎÙÂÓ¤ÛÙÂÚË ¯Ú‹ÛË ¯Ë-ÌÈÎÒÓ ÁÈ· ÙËÓ ··ÏÏ·Á‹ ·fi Ù· “ÌÂÙ·ÏÏ·ÁÌ¤Ó·” ˙È-˙¿ÓÈ·. ∏ “ÚÔ‹ ÁÔÓÈ‰›ˆÓ” ÌÔÚÂ› Ó· Ú·ÁÌ·ÙÔÔÈË-ıÂ› ÌÂÙ·Í‡ ¿ÏÏˆÓ Î·È Ì¤Ûˆ ÙË˜ Á‡ÚË˜ ÙˆÓ ÙÚÔÔ-ÔÈËÌ¤ÓˆÓ Ê˘ÙÒÓ.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ ÈÔ‡˜, Ë ·ÓËÛ˘¯›· Â›Ó·È ¤ÓÙÔ-ÓË Û¯ÂÙÈÎ¿ ÌÂ ÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤ˆÓ ÌË ·Ó·ÁÓˆÚ›ÛÈ-ÌˆÓ ÈÒÓ, ÌÂ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓÔ DNA Î·È ¿ÁÓˆÛÙÂ˜È‰ÈfiÙËÙÂ˜ (2). ∏ Èı·ÓfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÁÔÓÈ‰›ˆÓ,·ÓıÂÎÙÈÎÒÓ ÛÂ ·ÓÙÈ‚ÈÔÙÈÎ¿, ·fi ÌÂÙ·ÏÏ·ÁÌ¤Ó· Ê˘-Ù¿ ÛÂ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ì¤Ûˆ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ·Ó·-Û˘Ó‰˘·ÛÌÔ‡ ÛÙÔÓ ·ÓıÚÒÈÓÔ ‹ ˙ˆÈÎfi ÂÙÈÎfi Ûˆ-Ï‹Ó·, ·ÔÙÂÏÂ› ËÁ‹ ·ÓÙÈÚÚ‹ÛÂˆÓ ÁÈ· Ù· °∆∆.

¶ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÛÙÔ Lancet ÂÍ¤Ù·ÛÂ Û˘ÁÎÚÈ-ÙÈÎ¿ ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ‰‡Ô Î·ÙËÁÔÚÈÒÓÔÓÙÈÎÈÒÓ: ÂÎÂ›ÓˆÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ÁÂÓÂÙÈÎ¿ÙÚÔÔÔÈËÌ¤ÓÂ˜ ·Ù¿ÙÂ˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ Î·Ù·Ó¿-ÏˆÓ·Ó ÌË ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓÂ˜ ·Ù¿ÙÂ˜. OÈ‰È·ÊÔÚ¤˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó ‹Ù·Ó ÛËÌ·ÓÙÈÎ¤˜, ·ÓÎ·È Ë ÌÂÏ¤ÙË ıÂˆÚ‹ıËÎÂ ·fi ÔÏÏÔ‡˜ ·ÓÂ·ÚÎÒ˜ÙÂÎÌËÚÈˆÌ¤ÓË (7). OÈ Û˘Ó¤ÂÈÂ˜ ·ÊÔÚÔ‡Û·Ó Î˘-Ú›ˆ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÔÚÁ¿ÓˆÓ ÙÔ˘˜ Î·È ÛÙÔÓÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘˜ (19).

ÕÏÏË ÌÂÏ¤ÙË, Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÁÈ· ÏÔÁ·-ÚÈ·ÛÌfi ÙË˜ ÂÙ·ÈÚÂ›·˜ “Monsanto” ÛÙÔ πÓÛÙÈÙÔ‡ÙÔKOCH ÙË˜ °ÂÚÌ·Ó›·˜, ·Ó¤ÊÂÚÂ ÌÂÙ·‚ÔÏ‹ ÛÙË Û‡Ó-ıÂÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰ˆÓ Ô˘ ÙÚ¤ÊÔÓÙ·Ó ÌÂÌÂÙ·ÏÏ·ÁÌ¤ÓË ÛfiÁÈ·, ÌÂ ·‡ÍËÛË ÙˆÓ ÏÈ·ÚÒÓ ÛÂÔÛÔÛÙfi 8% (19).

∏ ÛÔ‚·ÚfiÙÂÚË, fiÌˆ˜, ·ÓËÛ˘¯›· ÁÈ· ÙËÓ ˘ÁÂ›··ÊÔÚ¿ ÛÙËÓ Èı·Ó‹ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÙˆÓ °∆∆,ÁÈ· ÙËÓ ÔÔ›· ı· Á›ÓÂÈ ÂÎÙÂÓ‹˜ ÏfiÁÔ˜ ÛÙË Û˘Ó¤¯ÂÈ·.

∆ÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ∏ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ Î¿ıÂ Â·Ó·-

Ï·Ì‚·ÓfiÌÂÓË ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË Ô˘ Û¯ÂÙ›˙Â-Ù·È ÌÂ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌÔ˘ ‹ ÚfiÛıÂÙÔ˘ÙÚÔÊÒÓ. ∏ ·ÓÙ›‰Ú·ÛË ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ÌÂÙ¿·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·fi ÙË Û˘-ÁÎÂÎÚÈÌ¤ÓË Ô˘Û›· Î·È Ú¤ÂÈ Ó· ‰È·¯ˆÚ›˙ÂÙ·È ·fi

ÌË ·ÓÔÛÔÏÔÁÈÎ¤˜, È‰ÈÔÛ˘ÛÙ·ÛÈ·Î¤˜, ÙÔÍÈÎ¤˜ ‹ „˘-¯ÔÏÔÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ (20).

°ÂÓÈÎ¿, ÂÎÙÈÌ¿Ù·È fiÙÈ ÙÔ 1-2% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏË-ı˘ÛÌÔ‡ ¿Û¯ÂÈ ·fi ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜, ÂÓÒ ÙÔ25-30% ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·Ó·Ê¤ÚÂÈ ÛÂ Î¿-ÔÈ· ÛÙÈÁÌ‹ ÙË˜ ˙ˆ‹˜ ÙÔ˘ ·ÓÂÈı‡ÌËÙË ·ÓÙ›‰Ú·ÛËÛÂ ÙÚÔÊ‹. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ·fi ·˘Ù¤˜ ÙÈ˜·ÓÙÈ‰Ú¿ÛÂÈ˜ ÛÙ· ·È‰È¿ ‰ÂÓ Â›Ó·È Â·Ó·Ï·Ì‚·ÓfiÌÂ-ÓÔ. ŒÙÛÈ, fiÙ·Ó ¤ÁÈÓ·Ó ÚÔÎÏ‹ÛÂÈ˜, ÙÔ ÔÛÔÛÙfi ÂÈ-‚Â‚·ÈˆÌ¤ÓË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ ÛÂ ·˘Ù¿ ‹Ù·Ó ÏÈ-ÁfiÙÂÚÔ ·fi 10%. ¶·Ú·Ì¤ÓÂÈ, fiÌˆ˜, ÛËÌ·ÓÙÈÎfi Úfi-‚ÏËÌ· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜, ÂÎÙfi˜·fi Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ·, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfiÎ·È ÏÈÁfiÙÂÚÔ ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, ÌÔÚÔ‡Ó Ó· ÚÔ-Î·Ï¤ÛÔ˘Ó Û˘ÛÙËÌ·ÙÈÎ‹ ·Ó·Ê˘Ï·Í›·, ·ÏÏÂÚÁÈÎ‹ Î·-Ù·ÏËÍ›· Î·È ı¿Ó·ÙÔ (21).

OÈ Î‡ÚÈÂ˜ ·ÏÏÂÚÁÈÔÁfiÓÂ˜ ÙÚÔÊ¤˜ Â›Ó·È ÙÔ ·‚Áfi,ÙÔ Á¿Ï·, Ù· „¿ÚÈ·, Ù· ÔÛÙÚ·ÎÔÂÈ‰‹, ÔÈ ÍËÚÔ› Î·ÚÔ›(Î˘Ú›ˆ˜ ÙÔ ·Ú¿ÈÎÔ ÊÈÛÙ›ÎÈ Î·È Ù· Î·Ú‡‰È·) Î·È Ë Ûfi-ÁÈ·. ∏ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙÚÔÊÒÓ ÔÈ-Î›ÏÏÂÈ ÛÙ· ‰È¿ÊÔÚ· Ì¤ÚË ÙÔ˘ ÎfiÛÌÔ˘, ·Ó¿ÏÔÁ· ÌÂÙÈ˜ ‰È·ÙÚÔÊÈÎ¤˜ ÚÔÙÈÌ‹ÛÂÈ˜ (22).

OÈ ·ÏÏÂÚÁÈÔÁÔÓÈÎ¤˜ ÚˆÙÂ˝ÓÂ˜ Â›Ó·È Û˘Ó‹ıˆ˜fiÍÈÓÂ˜ ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜, ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ 10-40kD, ÛÙ·ıÂÚ¤˜ ÛÙËÓ ÂÂÍÂÚÁ·Û›· Î·È ÎÔÈÓ¤˜, ¤ÙÛÈÒÛÙÂ Ë ¤ÎıÂÛË ÙˆÓ ·ÙfiÌˆÓ Ó· Â›Ó·È ÌÂÁ¿ÏË. ¢˘-ÛÙ˘¯Ò˜, fiÌˆ˜, Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·˘Ù¿ ‰ÂÓ Â›Ó·ÈÈÎ·Ó¿ ‹ ·Ó·ÁÎ·›· ÁÈ· Ó· Î·Ù·ÛÙ‹ÛÔ˘Ó Ì›· ÚˆÙÂ˝ÓË·ÏÏÂÚÁÈÔÁÔÓÈÎ‹, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ·ÏÏÂÚÁÈÔÁÔÓÈÎfi-ÙËÙ· Ó· ÌËÓ Â›Ó·È ÚÔ‚Ï¤„ÈÌË. À¿Ú¯Ô˘Ó, ¿ÏÏˆÛÙÂ,·Ó·ÊÔÚ¤˜ Û¿ÓÈˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ ÛÂ Â-ÚÈÛÛfiÙÂÚÂ˜ ·fi 150-200 ÙÚÔÊ¤˜ (20).

°ÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤Ó· ÙÚfiÊÈÌ· Î·È ÙÚÔÊÈÎ‹·ÏÏÂÚÁ›·

ŒÓ· ÛËÌ·ÓÙÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ °∆∆ Â›Ó·È Ë·ÚÔ˘Û›· Ó¤ˆÓ ÚˆÙÂ˚ÓÒÓ ÛÂ ·˘Ù¿. µ¤‚·È·, fiˆ˜·Ó·Ê¤ÚıËÎÂ ·Ú·¿Óˆ, ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈÎ¤˜ Úˆ-ÙÂ˝ÓÂ˜ ÌÂ ÎÏÈÓÈÎ‹ ÛËÌ·Û›· Â›Ó·È Û¯ÂÙÈÎ¿ Ï›ÁÂ˜, ·ÓÛÎÂÊÙÂ› Î·ÓÂ›˜ fiÙÈ Ù· Ê˘ÙÈÎ¿ Î‡ÙÙ·Ú· ÌÔÚÔ‡Ó Ó·ÂÎÊÚ¿ÛÔ˘Ó ¿Óˆ ·fi 100.000 ÚˆÙÂ˝ÓÂ˜ (23). °È·ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÔÈ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓÂ˜ Úˆ-ÙÂ˝ÓÂ˜ ¤¯Ô˘Ó ÌÈÎÚ‹ Èı·ÓfiÙËÙ· Ó· ÚÔÎ·Ï¤ÛÔ˘Ó·ÏÏÂÚÁ›·, ›Ûˆ˜ fiÛÔ Î·È ¤Ó· ÔÔÈÔ‰‹ÔÙÂ ÌË ÁÂÓÂ-ÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓÔ ÙÚfiÊÈÌÔ. ∆Ô ÂÓ‰Â¯fiÌÂÓÔ ·Ï-ÏÂÚÁÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÛÂ °∆∆ Â›Ó·È Èı·ÓfiÙÂÚÔ fiÙ·ÓË ÂÈÛ·¯ıÂ›Û· ÚˆÙÂ˝ÓË Â›Ó·È ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ,fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ÂÈÛ·ÁˆÁ‹ ÙË˜ ·ÏÏÂÚÁÈÔÁÔ-ÓÈÎ‹˜ ‚-Î·˙Â˝ÓË˜ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÙÔ˜ ÛÂ Î·Ï-ÏÈ¤ÚÁÂÈ· ÛfiÁÈ·˜, ·ÏÏ¿ Î·È ÙˆÓ ÁÏ˘ÎÈÓÈÓÒÓ ÙË˜ Ûfi-ÁÈ·˜ ÛÂ Î·ÏÏÈ¤ÚÁÂÈ· Ú˘˙ÈÔ‡ (24,25).

¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù¤ÙÔÈ· ÚÔ˚fiÓÙ· ‰ÂÓ ¤ÊÙ·-Û·Ó (Î·È ›Ûˆ˜ ‰ÂÓ ÊÙ¿ÛÔ˘Ó ÔÙ¤) ÛÙËÓ ·ÁÔÚ¿, Ô Î›Ó‰˘ÓÔ˜ ·Ó¿ÌÂÈÍË˜ ‹ ‰È¿¯˘ÛË˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡


422

˘ÏÈÎÔ‡ ˘¿Ú¯ÂÈ ¿ÓÙ·. ŒÙÛÈ, ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë·Ó¿ÁÎË ÁÈ· ÙË ıÂÛÌÔı¤ÙËÛË ‰È·‰ÈÎ·ÛÈÒÓ ÂÏ¤Á¯Ô˘ÙË˜ Èı·Ó‹˜ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙˆÓ °∆∆. ¶·Ú’fiÏ· ·˘Ù¿, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê¤˜ fiÙÈ Ù· ÙÚfiÊÈÌ··˘Ù‹˜ ÙË˜ Î·ÙËÁÔÚ›·˜, ·ÓÙÈÎÂÈÌÂÓÈÎ¿, ‰ÂÓ Â›Ó·È Î·È,ÂÔÌ¤Óˆ˜, ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÂÎÙˆÓ ÚÔÙ¤ÚˆÓ ˆ˜ ÂÈ‚Ï·‚‹ Î·È ÂÈÎ›Ó‰˘Ó· ÁÈ· ÙÔÓÎ·Ù·Ó·ÏˆÙ‹ ‹ ÛÂ ÌÂÈÔÓÂÎÙÈÎ‹ ı¤ÛË ÛÂ Û¯¤ÛË ÌÂ·ÓÙ›ÛÙÔÈ¯· ÌË °∆∆ ‹ ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿, ÚÔ‚¿Ï-ÏÔÓÙ·˜ ÙÔ ÂÈ¯Â›ÚËÌ· fiÙÈ Ë ‰È·ÙÚÔÊÈÎ‹ ·Í›· ÙÔ˘˜Â›Ó·È ¯·ÌËÏfiÙÂÚË.

∏ ‰È·‰ÈÎ·Û›· ·Ú·ÁˆÁ‹˜ °∆∆ ÂÚÈÏ·Ì‚¿ÓÂÈ, ÁÂ-ÓÈÎ¿, ÙÚ›· ÛÙ¿‰È·: ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘, ÙËÓÂÈÏÔÁ‹ ÙÔ˘ Â›‰Ô˘˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ô˘ ı· ÙÚÔÔ-ÔÈËıÂ› Î·È, ÙÂÏÈÎ¿, ÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È¿ıÂÛ‹ ÙÔ˘ÛÙËÓ ·ÁÔÚ¿ (26).

∏ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ú¤ÂÈ Ó·ÂÎÙÈÌ¿Ù·È ·fi ÙÔ ÚÒÙÔ ÛÙ¿‰ÈÔ. OÈ ··Ú·›ÙËÙÂ˜ÏËÚÔÊÔÚ›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ÙÔÓ Î·ıÔÚÈÛÌfiÙÔ˘ Ó¤Ô˘ ÙÚÔÊ›ÌÔ˘, ‚) ÙËÓ Â›‰Ú·ÛË ÙË˜ ·Ú·Áˆ-ÁÈÎ‹˜ ‰È·‰ÈÎ·Û›·˜ ÛÙÈ˜ È‰ÈfiÙËÙÂ˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘, Á)Ù· ·ÎÚÈ‚‹ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ı·¯ÚËÛÈÌÔÔÈËıÂ› ˆ˜ ÁÔÓÈ‰È·Î‹ ËÁ‹ Î·È ‰) ÙÈ˜ ÂÈ-‰Ú¿ÛÂÈ˜ ÙË˜ ÁÂÓÂÙÈÎ‹˜ ÙÚÔÔÔ›ËÛË˜ ÛÙÈ˜ È‰ÈfiÙË-ÙÂ˜ ÙË˜ “ÌËÙÚÈÎ‹˜” Î·ÏÏÈ¤ÚÁÂÈ·˜, ÌÂ Î·ıÔÚÈÛÌfi Î·ÈÌÔÚÈ·Îfi ¯·Ú·ÎÙËÚÈÛÌfi ÙË˜ Ê‡ÛË˜ ÙË˜ ÁÂÓÂÙÈÎ‹˜ÙÚÔÔÔ›ËÛË˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙË˜ ÁÔÓÈ-‰È·Î‹˜ ı¤ÛË˜ ÂÈÛ·ÁˆÁ‹˜, ÙÔ˘ Ï‹ıÔ˘˜ ·ÓÙÈÁÚ¿-ÊˆÓ Î·È ÙÔ˘ ÂÈ¤‰Ô˘ ‚ÈÔ¯ËÌÈÎ‹˜ ¤ÎÊÚ·ÛË˜ (27).

À¿Ú¯Ô˘Ó ÔÏÏÔ› ÏfiÁÔÈ Ô˘ Î·ıÈÛÙÔ‡Ó ÛËÌ·ÓÙÈ-Îfi ÙÔÓ ·ÎÚÈ‚‹ Î·ıÔÚÈÛÌfi ÙˆÓ Èı·ÓÒÓ ·ÏÏÂÚÁÈÔÁfi-ÓˆÓ Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÂ °∆∆. ∂ÊfiÛÔÓ ÙÂÏÈÎfi ÛÙfi¯Ô·ÔÙÂÏÂ› Ë ·ÛÊ·Ï‹˜ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜ ÙfiÛÔ ·fi ÙÔÛ‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ fiÛÔ Î·È ·fi ÙÔÓ ·ÏÏÂÚÁÈÎfi·ÛıÂÓ‹, Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÙË˜ Û·-ÊÔ‡˜ ÏËÚÔÊfiÚËÛË˜ ÁÈ· ÙÔ Â›‰Ô˜ Î·È ÙËÓ ·ÎÚÈ‚‹Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙÔ Ó¤Ô ÙÚfiÊÈÌÔ.

∞˘Ùfi ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÛÙ· ÙÚÔÔÔÈËÌ¤Ó· ÁÔÓ›-‰È·, ·ÏÏ¿ ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜, ·ÊÔ‡ Ë ÁÂÓÂÙÈÎ‹ ÙÚÔ-ÔÔ›ËÛË ÌÔÚÂ› Ó· ÂÈÊ¤ÚÂÈ ·ÏÏ·Á¤˜ Î·È ÛÙ· ˘fi-ÏÔÈ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ¤ÎÊÚ·ÛË˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡(27). ™Â Ì›· ‹‰Ë ·ÏÏÂÚÁÈÔÁÔÓÈÎ‹ ÙÚÔÊ‹, Ë ÔÛfiÙË-Ù· ¤ÎÊÚ·ÛË˜ ÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ı· ÌÔÚÔ‡ÛÂ Ó··ÏÏ¿ÍÂÈ, Î·ıÈÛÙÒÓÙ·˜ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ (‹ ÏÈÁfiÙÂ-ÚÔ) ·ÏÏÂÚÁÈÔÁÔÓÈÎ‹, ÂÍ·ÈÙ›·˜ ÙË˜ ÁÂÓÂÙÈÎ‹˜ ÙÚÔÔ-Ô›ËÛË˜ (1).

O Î·ıÔÚÈÛÌfi˜ ÙË˜ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ Á›ÓÂÙ·ÈÌÂ ‚ÈÔÏÔÁÈÎ¤˜ in vivo Î·È in vitro ÌÂıfi‰Ô˘˜, fiˆ˜ ‰È-Ï‹ Ù˘ÊÏ‹ ÚfiÎÏËÛË, ·ÓÔÈ¯Ù‹ ÚfiÎÏËÛË Î·È ‰ÂÚ-Ì·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ Ó˘ÁÌÔ‡ ÛÂ ·ÓıÚÒÔ˘˜, ·Ó·Ê˘-Ï·ÎÙÈÎ‹ ·¿ÓÙËÛË ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ·, Î·ıÒ˜ Î·È ÌÂin vitro Ì¤ÙÚËÛË ÙË˜ ¤ÎÏ˘ÛË˜ ÈÛÙ·Ì›ÓË˜ ·fi ‚·ÛÂfi-ÊÈÏ·, ÚÔÛ‰ÈÔÚÈÛÌfi ÂÈ‰ÈÎ‹˜ IgE ÌÂ ELISA, RAST,RAST-inhibition Î·È PCR, RT-PCR (27).

∞Ó ÙÔ ÁÔÓ›‰ÈÔ ¤¯ÂÈ ÎÔÈÓ‹ ·ÏÏËÏÔ˘¯›· ÌÂ ÎÔÈÓ‹·ÏÏÂÚÁÈÔÁfiÓÔ ËÁ‹, fiˆ˜ Ù· ÊÈÛÙ›ÎÈ· ‹ ÙÔ „¿ÚÈ,Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁËıÔ‡Ó ÔÈ Î·Ù¿ÏÏËÏÂ˜ ‰ÔÎÈÌ·Û›Â˜Ô˘ ı· ·ÔÎÏÂ›ÛÔ˘Ó ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ÙÔ Ó¤Ô ÙÚfiÊÈ-ÌÔ Ó· ÚÔÎ·ÏÂ› ·ÏÏÂÚÁ›Â˜ ÛÂ ¿ÙÔÌ· Â˘·ÈÛıËÙÔÔÈ-ËÌ¤Ó· ÛÂ ·˘Ù‹ ÙËÓ ËÁ‹ (26).

™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÚˆÙÂ˝ÓË ·Ó‹ÎÂÈ ÛÂ Ù¿ÍËÚˆÙÂ˚ÓÒÓ Ô˘ ¤¯Ô˘Ó Û¯ÂÙÈÛÙÂ› ÌÂ Èı·Ó‹ ·ÏÏÂÚ-ÁÈÔÁÔÓÈÎfiÙËÙ·, Ë Û˘ÁÎÂÎÚÈÌ¤ÓË Ó¤· ÚˆÙÂ˝ÓË ‰ËÌÈ-Ô˘ÚÁÂ› ÚfiÛıÂÙË ·ÓËÛ˘¯›· Î·È Ú¤ÂÈ Ó· ·ÍÈÔÏÔ-ÁËıÂ›. °È· ·Ú¿‰ÂÈÁÌ·, ÔÈ ¯ÈÙÈÓ¿ÛÂ˜ ÌÔÚÔ‡Ó Ó·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·fi ÙË ÁÂÓÂÙÈÎ‹ ÌË¯·ÓÈÎ‹ ÁÈ· ÙËÓÚÔÛÙ·Û›· ÙˆÓ Ê˘ÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·fi Ì‡ÎË-ÙÂ˜. ∂ÓÙÔ‡ÙÔÈ˜, Î¿ÔÈÂ˜ ¯ÈÙÈÓ¿ÛÂ˜ Â›Ó·È ˘Â‡ı˘ÓÂ˜ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÒÓ, ÌÂ ·ÔÙ¤-ÏÂÛÌ· Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ Ó¤Ô ÙÚfiÊÈÌÔ Ó· ÂÈ-‚¿ÏÏÂÈ ÙËÓ ÂÚ·ÈÙ¤Úˆ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘ (26).

OÈ Èı·ÓfiÙËÙÂ˜ ‰ËÌÈÔ˘ÚÁ›·˜ ÂÓfi˜ Ó¤Ô˘ ·ÏÏÂÚ-ÁÈÔÁfiÓÔ˘ Â›Ó·È Ì¿ÏÏÔÓ ÌÈÎÚ¤˜. ∏ ·˘ÍËÌ¤ÓË ¤ÎıÂÛËÛÂ Î¿ÔÈ· Ô˘Û›·, Ô˘ Ì¤¯ÚÈ ÚfiÙÈÓÔ˜ ·Ô˘Û›·˙Â·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ‹ Î·Ù·Ó·ÏˆÓfiÙ·Ó ÛÂ ÌÈÎÚ¤˜ Ô-ÛfiÙËÙÂ˜, ÌÔÚÂ› ıÂˆÚËÙÈÎ¿ Ó· ÚÔÎ·Ï¤ÛÂÈ ÙËÓ Â˘-·ÈÛıËÙÔÔ›ËÛË Î¿ÔÈˆÓ ·ÙfiÌˆÓ ÛÂ ·˘Ù‹.

ª›· ÙÂÏÂ˘Ù·›· ÛÎ¤„Ë, Ë ÔÔ›· fiÌˆ˜ ‰ÂÓ ¤¯ÂÈ¤ÁÎ˘ÚË ÂÈÛÙËÌÔÓÈÎ‹ ‚¿ÛË, ·ÊÔÚ¿ ÛÙË ÁÂÓÈÎfiÙÂÚËÂ›‰Ú·ÛË Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó ÔÈ ÁÂÓÂÙÈÎ¿ÙÚÔÔÔÈËÌ¤ÓÂ˜ ÙÚÔÊ¤˜ ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙË-Ì·. OÈ Û˘Ó¤ÂÈÂ˜ Èı·ÓfiÙ·Ù· ı· ‹Ù·Ó ·ÓÂÍ¤ÏÂÁÎÙÂ˜,ÁÂÁÔÓfi˜ Ô˘ ÚÔÎ·ÏÂ›, ·ÎfiÌ· Î·È ÛÂ ıÂˆÚËÙÈÎfiÂ›Â‰Ô, ¤ÓÙÔÓË ·ÓËÛ˘¯›· (1). ¶Ú¤ÂÈ, ‚¤‚·È·, Ó·ÂÈÛËÌ·ÓıÂ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì›· Ù¤ÙÔÈ· Èı·ÓfiÙËÙ·,Â¿Ó ÈÛ¯‡ÂÈ, ı· ·ÊÔÚ¿ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙË˜ÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, ÙfiÛÔ ÏfiÁˆ ÙË˜ ÌÂÁ·Ï‡ÙÂ-ÚË˜ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ÛÂ ‰È·ÙÚÔÊÈÎ¤˜ ·ÚÂÌ‚¿ÛÂÈ˜, fiÛÔ Î·È ÏfiÁˆ ÙË˜ÔÏÏ·Ï¿ Û˘¯ÓfiÙÂÚË˜ ‡·ÚÍË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚ-Á›·˜ ÛÙ· ·È‰È¿ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜.

ªÂ ·˘Ù¿ Ù· ‰Â‰ÔÌ¤Ó·, ÙfiÛÔ ÛÙËÓ ∞ÌÂÚÈÎ‹ (Foodand Drug Administration - FDA) fiÛÔ Î·È ÛÙËÓ ∂˘ÚÒ-Ë, ıÂÛÌÔıÂÙ‹ıËÎ·Ó ‰È·Ù¿ÍÂÈ˜ ÁÈ· ÙÔÓ Î·Ù¿ÏÏËÏÔ¤ÏÂÁ¯Ô ÙˆÓ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ,ÚÔÛı¤ÙˆÓ Î.Ï., ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰ÈÂÓÂÚÁËıÂ› ÚÔ-ÛÂÎÙÈÎ‹ ·Ó¿Ï˘ÛË ÚÈÓ Î¿ÔÈÔ °∆∆ Î˘ÎÏÔÊÔÚ‹ÛÂÈÛÙËÓ ·ÁÔÚ¿ (28,29). ¶·Ú’ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰ÈÂıÓ‹˜ÎÔÈÓ‹ ÚfiÙ˘Ë ÛÙÚ·ÙËÁÈÎ‹ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ·Ï-ÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙˆÓ °∆∆, Ì›· ÁÂÓÈÎ‹ ÚÔÛ¤ÁÁÈÛËÂÚÈÏ·Ì‚¿ÓÂÈ ÛÙÔÈ¯Â›· fiˆ˜ Ë ·ÍÈÔÏfiÁËÛË ÙË˜ ÌÂ-ıfi‰Ô˘ Î·È Ë ÂÍ¤Ù·ÛË ÙË˜ ÁÔÓÈ‰È·Î‹˜ ËÁ‹˜, ÙË˜ ·ÌÈ-ÓÔÍÈÎ‹˜ ·ÏÏËÏÔ˘¯›·˜ Î·È ÔÌÔÏÔÁ›·˜, ÙË˜ ÂÈ‰ÈÎfiÙË-Ù·˜ ÌÂ ÔÚÔ‡˜ Î·È ÙË˜ ·ÓÔ¯‹˜ ÛÙËÓ Â„›ÓË (26).

°ÂÓÈÎ¿, ¤¯ÂÈ ÔÚÈÛÙÂ› Ô ·ÎfiÏÔ˘ıÔ˜ ·ÏÁfiÚÈıÌÔ˜,Ô˘ ·ÊÔÚ¿ ÛÙËÓ, Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ, ‚¤ÏÙÈÛÙË ÚÔ-ÛÙ·Û›· ·fi ·ÏÏÂÚÁ›· ÛÙ· °∆∆ (∂ÈÎfiÓ· 1).

∞Ú¯ÈÎ¿, ÂÍÂÙ¿˙ÂÙ·È Â¿Ó Ë ËÁ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Â›Ó·È


423

·ÏÏÂÚÁÈÔÁfiÓÔ ‹ fi¯È. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi Ï·Ì‚¿ÓÔÓÙ·È,Â›ÛË˜, ˘’ fi„ÈÓ Ù· ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·Ï-ÏÂÚÁÈÔÁfiÓˆÓ ÚˆÙÂ˚ÓÒÓ, fiˆ˜ ÙÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜.™ÙË Û˘Ó¤¯ÂÈ·, Ë ÚˆÙÂ˚ÓÈÎ‹ ·ÏÏËÏÔ˘¯›· Û˘ÁÎÚ›ÓÂÙ·ÈÌÂ Ì›· ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ, fiÔ˘ ˘¿Ú¯Ô˘Ó Î·Ù·ÁÂ-ÁÚ·ÌÌ¤ÓÂ˜ fiÏÂ˜ ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈÎ¤˜ ·ÏÏËÏÔ˘¯›Â˜,Ì¤¯ÚÈ ÙÔ Ì‹ÎÔ˜ ÙˆÓ ÔÎÙÒ ·ÌÈÓÔÍ¤ˆÓ.

ŒÓ· ‰Â‡ÙÂÚÔ, ÛËÌ·ÓÙÈÎfi ÚÔ˜ ÂÍ¤Ù·ÛË, ÛÙÔÈ-¯Â›Ô Â›Ó·È Ë ÛÙ·ıÂÚfiÙËÙ· ÙË˜ ÚˆÙÂ˝ÓË˜ ÛÙËÓ ÂÂ-ÍÂÚÁ·Û›·. OÈ Û˘Ó‹ıÂÈ˜ ·ÏÏÂÚÁÈÔÁfiÓÂ˜ ÚˆÙÂ˝ÓÂ˜Â›Ó·È ÛÙ·ıÂÚ¤˜ ÛÙË ıÂÚÌÔÎÚ·Û›· Î·È ÛÂ Û˘Óı‹ÎÂ˜fiÍÈÓÔ˘ pH, Ô˘ ÚÔÛÔÌÔÈ¿˙Ô˘Ó ·˘Ù¤˜ ÙÔ˘ ÛÙÔÌ¿-¯Ô˘. ∂¿Ó Ë ÚˆÙÂ˝ÓË ÂÌÊ·ÓÈÛÙÂ› ·ÛÙ·ı‹˜ ÛÂ ·˘Ù¤˜ÙÈ˜ Û˘Óı‹ÎÂ˜, ¤¯ÂÈ ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È·ÏÏÂÚÁÈÔÁÔÓÈÎ‹.

∂ÓÙÔ‡ÙÔÈ˜, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘, ÂÓÒ ‰ÂÓ ˘¿Ú-¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜, Ë ÚˆÙÂ˝ÓË Â›Ó·È ÛÙ·ıÂ-Ú‹ ÛÙËÓ ÂÂÍÂÚÁ·Û›·, ‰ÂÓ ÌÔÚÔ‡ÌÂ Ó· ·ÔÎÏÂ›-ÛÔ˘ÌÂ ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ·ÏÏÂÚÁ›·˜ Î·È, Ì¿ÏÈÛÙ·, ‰ÂÓÌÔÚÔ‡ÌÂ Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ Î·È ÔÌ¿‰· ·ÙfiÌˆÓÔ˘ ÌÔÚÂ› Ó· Â›Ó·È Â˘¿ÏˆÙË ÛÙËÓ Èı·Ó‹ “·ÏÏÂÚ-ÁÈÔÁfiÓÔ” ÚˆÙÂ˝ÓË.

∞ÓÙ›ıÂÙ·, Â¿Ó ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜ÌÂ ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ ‹ ÙÔ ÁÔÓ›‰ÈÔ Ô˘ ÚÔ¤Ú-¯ÂÙ·È ·fi ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ, ÌÔÚÔ‡ÌÂ Ó·ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÚÔ‡˜ ·ÛıÂ-ÓÒÓ, Î·Ù¿ fiÛÔ Ë Ó¤· ÚˆÙÂ˝ÓË ı· ·ÓÙÈ‰Ú¿ÛÂÈ ÌÂ·˘ÙÔ‡˜, ÌÂ ÙÈ˜ ÙÂ¯ÓÈÎ¤˜ ELISA ‹ RAST inhibition.

∂¿Ó Ë ·ÓÙ›‰Ú·ÛË Â›Ó·È ·ÚÓËÙÈÎ‹, ÙfiÙÂ Á›ÓÔÓÙ·È ‰ÂÚ-Ì·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ‹ ·ÎfiÌ· Î·È ÚÔÎÏ‹ÛÂÈ˜ ÛÂ Â˘-·›ÛıËÙ· ¿ÙÔÌ·. ∞Ó ÛÂ ÔÔÈ·‰‹ÔÙÂ Ê¿ÛË ÙË˜ ‰È·-‰ÈÎ·Û›·˜ ÏËÊıÔ‡Ó ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·, ÚÔÙÂ›ÓÂ-Ù·È Ë Û‹Ì·ÓÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙË˜ ÙÚÔÊ‹˜ ÚÈÓ·˘Ù‹ ÚÔˆıËıÂ› ÛÙËÓ ·ÁÔÚ¿.

∆Ô Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÚˆÙfiÎÔÏÏÔ ·ÎÔÏÔ˘ı‹ıËÎÂÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙË˜ Î·Ï-ÏÈ¤ÚÁÂÈ·˜ ÛfiÁÈ·˜, ÛÙËÓ ÔÔ›· ¤¯ÂÈ ÚÔÛÙÂıÂ› ÙÔÁÔÓ›‰ÈÔ 2S ÙÔ˘ ‚Ú·˙ÈÏÈ¿ÓÈÎÔ˘ ÊÈÛÙÈÎÈÔ‡. ™Â ÌÂÏ¤ÙËÔ˘ ‰ËÌÔÛ›Â˘ÛÂ ÙÔ “New England Journal ofMedicine” ÙÔ 1996, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë ·ÏÏÂÚÁÈÔ-ÁÔÓÈÎfiÙËÙ· ÌÂÙ·Ê¤ÚıËÎÂ ÛÙËÓ ÙÚÔÔÔÈËÌ¤ÓË Ûfi-ÁÈ·, ·ÊÔ‡ ÛÙËÓ in vitro ·ÓÙ›‰Ú·ÛË ‚Ú¤ıËÎ·Ó ıÂÙÈÎ¿·ÔÙÂÏ¤ÛÌ·Ù· ÛÂ 8 ·fi ÙÔ˘˜ 9 ÔÚÔ‡˜ Ô˘ ·Ó‹Î·ÓÛÂ Â˘·›ÛıËÙÔ˘˜ ·ÛıÂÓÂ›˜ (18). ∏ ·Ó·Î¿Ï˘„Ë ·˘Ù‹Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·ÛÙÔÏ‹ ÙË˜ ÂÌÊ¿ÓÈÛË˜ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ÚÔ˚fiÓÙÔ˜ ÛÙËÓ ·ÁÔÚ¿ (2,14).

∂ÔÌ¤Óˆ˜, Ô Î›Ó‰˘ÓÔ˜ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂ-ˆÓ ÌÂÈÒÓÂÙ·È, ·Ó ‰ÂÓ ÂÎÌË‰ÂÓ›˙ÂÙ·È, ÌÂ Î·Ù¿ÏÏË-ÏÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ Î·È ÌÂ ÙË Û‹Ì·Ó-ÛË ÙˆÓ °∆∆ Ô˘ Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ.

∏ ‰È¿‰ÔÛË ÙˆÓ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓÛ‹ÌÂÚ·

™‹ÌÂÚ·, ¤Ó·˜ ÙÂÚ¿ÛÙÈÔ˜ ·ÚÈıÌfi˜ ÂÈ‰ÒÓ Ô˘ Â-ÚÈÏ·Ì‚¿ÓÂÈ ÙÈ˜ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ ‚·ÛÈÎ¤˜ ÙÚÔÊ¤˜,¤¯ÂÈ ÙÚÔÔÔÈËıÂ› ÁÂÓÂÙÈÎ¿ Î·È Î˘ÎÏÔÊÔÚÂ› ÛÙËÓ

¶ËÁ‹ ÁÔÓÈ‰›Ô˘ (·ÏÏÂÚÁÈÔÁfiÓÔ)¡·È

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ŒÏÂÁ¯Ô˜ IgE(ELISA, RAST inh.)

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¶ÚÔÒıËÛË ÛÙËÓ ·ÁÔÚ¿

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∂ÈÎfiÓ· 1. ŒÏÂÁ¯Ô˜ ·ÛÊ¿ÏÂÈ·˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ.


424

·ÁÔÚ¿. ∆Ô 30% ÙÔ˘ Î·Ï·ÌÔÎÈÔ‡ Î·È ÙÔ 50% ÙË˜ÛfiÁÈ·˜ Ô˘ ·Ú¿ÁÂÙ·È Î·È Î·Ù·Ó·ÏÒÓÂÙ·È ÛÙÈ˜∏.¶.∞. Â›Ó·È ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓÔ, ÂÓÒ ÂÚ›Ô˘ÙÔ 75% ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· Ú¿ÊÈ·ÙË˜ ·ÌÂÚÈÎ·ÓÈÎ‹˜ ·ÁÔÚ¿˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÁÂÓÂÙÈ-Î¿ ÙÚÔÔÔÈËÌ¤ÓÂ˜ ÔÈÎÈÏ›Â˜ (1,26).

™ÙÈ˜ ∏.¶.∞., Ë ·Ô‰Ô¯‹ ÙˆÓ °∆∆ ¤ÁÈÓÂ ÈÔ Â‡ÎÔ-Ï· ·’ fiÙÈ ÛÙËÓ ∂˘ÚÒË, fiÔ˘ ÙÔ 1996, fiÙ·Ó ¤ÁÈÓÂË ÚÒÙË Ì·˙ÈÎ‹ ÂÈÛ·ÁˆÁ‹ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤-ÓË˜ ÛfiÁÈ·˜, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÔÚÁ·ÓˆÌ¤ÓÂ˜ ÂÎ-ÛÙÚ·ÙÂ›Â˜ ÂÓËÌ¤ÚˆÛË˜ ÙˆÓ Î·Ù·Ó·ÏˆÙÒÓ Î·È È¤-ÛÂˆÓ ÚÔ˜ ÙÈ˜ ÔÏÈÙÈÎ¤˜ ËÁÂÛ›Â˜ (19).

∏ ∂ÏÏ¿‰·, ÙÔ 1999, Ì·˙› ÌÂ Ù¤ÛÛÂÚÈ˜ ·ÎfiÌ· Â˘-Úˆ·˚Î¤˜ ¯ÒÚÂ˜, ÚfiÙÂÈÓÂ ¤Ó· ‰ÈÂÙ¤˜ ÌÔÚ·ÙfiÚÈ-Ô˘Ì, ÌÂ ÙÔ ÔÔ›Ô ·ÔÊ·Û›ÛÙËÎÂ Ë ·Ó·ÛÙÔÏ‹ ÙˆÓÂÁÎÚ›ÛÂˆÓ Ó¤ˆÓ ÁÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓ ÚÔ˚fi-ÓÙˆÓ, Ì¤¯ÚÈ˜ fiÙÔ˘ ÂÊ·ÚÌÔÛÙÂ› ÓÔÌÔıÂÛ›· Ô˘ Ó·ÔÚ›˙ÂÈ ··ÈÙ‹ÛÂÈ˜ ÁÈ· ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Î·È ÙË‰ÈÂÍÔ‰ÈÎ‹ ¤ÚÂ˘Ó· ÙˆÓ ÚÔ˚fiÓÙˆÓ ·˘ÙÒÓ (30).

∞fi ÙËÓ ÂÈÛÙËÌÔÓÈÎ‹ ÛÎÔÈ¿, ÔÏÏ¿ ÂÚˆÙ‹Ì·-Ù· ·Ú·Ì¤ÓÔ˘Ó ·Ó·¿ÓÙËÙ·. ∆· °∆∆ ÌÔÚÂ› Ó··ÔÙÂÏ¤ÛÔ˘Ó ÛˆÙ‹ÚÈ· Ï‡ÛË ÁÈ· ·ÛıÂÓÂ›˜ ÌÂ ÙÚÔ-ÊÈÎ‹ ·ÏÏÂÚÁ›·, ÂÓÒ ÌÔÚÂ› Ó· ·Ô‰ÂÈ¯ıÔ‡Ó ÔÏ¤-ıÚÈ· ÁÈ· ¿ÏÏÔ˘˜. ∆· ‰Â‰ÔÌ¤Ó· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó,ÂÌÊ·ÓÒ˜ ‰ÂÓ ‰ÈÎ·ÈÔÏÔÁÔ‡Ó Û˘Ó·ÈÛıËÌ·ÙÈÎ¤˜ ·ÓÙÈ-‰Ú¿ÛÂÈ˜, ÔÈ ÔÔ›Â˜ ÔÏ‡ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È Ùfi-ÛÔ ·fi Ù· Ì¤Û· Ì·˙ÈÎ‹˜ ÂÓËÌ¤ÚˆÛË˜ fiÛÔ Î·È ·fiÂÈÛÙ‹ÌÔÓÂ˜. ∏ ÈÛÔÚÚÔËÌ¤ÓË Î·È ¯ˆÚ›˜ ˘ÂÚ‚Ô-Ï¤˜ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÂÈ‰ÈÎÒÓ ÌÔÚÂ› Ó· ·Ô‚Â› Ô-Ï‡ ¯Ú‹ÛÈÌË, ·Ú¤¯ÔÓÙ·˜ ˘Â‡ı˘ÓË ÂÎ·›‰Â˘ÛË Î·ÈÂÓËÌ¤ÚˆÛË ÛÙÔ ÎÔÈÓfi.

µÈ‚ÏÈÔÁÚ·Ê›·1. ¶··‰fiÔ˘ÏÔ˜ ¡°. °ÂÓÂÙÈÎ¿ ÙÚÔÔÔÈËÌ¤ÓÂ˜ ÙÚÔÊ¤˜: ÂÈ-

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 02-09-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ °. ¶··‰fiÔ˘ÏÔ˜ µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” §Â‚·‰Â›·˜ 13, ∆.∫. 115 27, °Ô˘‰› E-mail: [email protected]


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OÈÎÔÏÔÁ›·, ÂÈ‰ËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ ÛÂ ·È‰È¿∂. ºÚ·ÁÎÔ‡ÏË

Ecology, epidemiology and diagnosis of tinea capitis in childrenE. Frangoulis


∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ·ıÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ∞ÊÚÔ‰›ÛÈˆÓ Î·È¢ÂÚÌ·ÙÈÎÒÓ ¡fiÛˆÓ “∞. ™˘ÁÁÚfi˜”, ∞ı‹Ó·

Laboratory of Biopathology, “Andreas Sygros” Skin andVenereal Disease Hospital, Athens

�¶ÂÚ›ÏË„Ë: ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·-Ï‹˜ Â›Ó·È Ì›· ·fi ÙÈ˜ Û˘Ó‹ıÂÈ˜ ‰ÂÚÌ·ÙÈÎ¤˜ ÏÔÈÌÒ-ÍÂÈ˜ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈÎ‹ Î·È Û¯ÔÏÈÎ‹ËÏÈÎ›·. ∞ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ·ÔÙÂÏÔ‡Ó ÔÚÈ-ÛÌ¤Ó· Â›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ÙÔ˘ Á¤ÓÔ˘˜Microsporum Î·È Trichophyton. ∆· Â›‰Ë ·˘Ù¿, ·Ó¿-ÏÔÁ· ÌÂ ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ ÚÔÙ›-ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹, ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ·Ó-ıÚˆfiÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ÁÂÒÊÈÏ·. ™ÙË ¯ÒÚ· Ì·˜,Ù· Î‡ÚÈ· ·›ÙÈ· Â›Ó·È ÙÔ ˙ˆfiÊÈÏÔ M. canis ÛÂ ÔÛÔ-ÛÙfi 87% Î·È ÙÔ ·ÓıÚˆfiÊÈÏÔ ∆. violaceum ÛÂ Ô-ÛÔÛÙfi 6%. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·ÓÈ¯ÓÂ‡ÔÓÙ·È Î·ÈÌË ÂÓ‰ËÌÈÎ¿ ·ÓıÚˆfiÊÈÏ· Â›‰Ë, Î˘Ú›ˆ˜ ÛÂ ÔÈÎÔÓÔ-ÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙÂ˜ ·fi ¯ÒÚÂ˜ ÙË˜ ª¤ÛË˜ ∞Ó·ÙÔ-Ï‹˜, ÙË˜ ∞Û›·˜ Î·È ÙË˜ ∞ÊÚÈÎ‹˜. ¶ËÁ‹ ÌfiÏ˘ÓÛË˜ÁÈ· ÙÈ˜ ˙ˆÔÊÈÏÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ Â›Ó·È Ù· ˙Ò· Ô˘ ÓÔ-ÛÔ‡Ó ‹ fi¯È, ÂÈ‰ÈÎ¿ ‰Â ÁÈ· ÙÔ M. canis Â›Ó·È Ù· Î·ÙÔÈ-Î›‰È· Î·È Ù· ·‰¤ÛÔÙ· (Á¿ÙÂ˜, ÛÎ‡ÏÔÈ). ∏ ÌÂÙ¿‰ÔÛËÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›ÙÂ ÌÂ¿ÌÂÛË Â·Ê‹ ÌÂ ¿Û¯ÔÓÙÂ˜ ‹ ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ÊÔÚÂ›˜ Â›ÙÂ ÌÂ ¯Ú‹ÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ·ÓÙÈÎÂÈÌ¤ÓˆÓ. OÈÌ˘ÎËÙÈ¿ÛÂÈ˜ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ ˆ˜ Â› ÙÔÏÂ›ÛÙÔÓ Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂÈ˜. OÈ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ÌÔÚÊ¤˜ (¤Ì˘Ô˜ ÙÚÈ¯ÔÊ˘Ù›·) Û˘Ó‰¤ÔÓÙ·È Î˘Ú›ˆ˜ÌÂ ˙ˆfiÊÈÏÔ˘˜ Î·È ÁÂÒÊÈÏÔ˘˜ Ì‡ÎËÙÂ˜ Î·È Û¿ÓÈ·ÌÂ ·ÓıÚˆfiÊÈÏÔ˘˜. O ¿¯ÔÚ·˜, Û¿ÓÈ· ÌÔÚÊ‹ Ì˘ÎËÙ›·ÛË˜ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜, ÚÔÎ·ÏÂ›-Ù·È ·fi ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii. ∏ÂÚÁ·ÛÙËÚÈ·Î‹ ÂÍ¤Ù·ÛË Â›Ó·È ·Ó·ÁÎ·›· ÁÈ· ÙËÓ ÂÈ-‚Â‚·›ˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Î·È ÙÔÓ ÚÔÛ-‰ÈÔÚÈÛÌfi ÙÔ˘ ˘Â‡ı˘ÓÔ˘ Â›‰Ô˘˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ‰Â›ÁÌ·ÙÔ˜ ·fiÙËÓ ÂÚÈÔ¯‹ ÙË˜ ÏÔ›ÌˆÍË˜, Î·ÏÏÈ¤ÚÁÂÈ· Î·È Ù·˘ÙÔ-Ô›ËÛË ÙÔ˘ Ì‡ÎËÙ· ÌÂ ‚¿ÛË Ù· ÌÈÎÚÔÛÎÔÈÎ¿ Î·ÈÌ·ÎÚÔÛÎÔÈÎ¿ ÌÔÚÊÔÏÔÁÈÎ¿ ÛÙÔÈ¯Â›· ÙË˜ ·ÔÈÎ›·˜.

�Abstract: Tinea capitis is a common scalpinfection affecting predominantly children ofpreschool and school age. It is caused bydermatophytes mostly of the genus Microsporumand Trichophyton. These dermatophytes,depending on their natural habitat and hostpreference, are classified as geophilic, zoophilicand anthropophilic. The main tinea capitispathogens in Greece are the zoophilic M. canis(87%) and the anthropophilic T. violaceum (6%).During the last few years a number of dermato-phyte species non-endemic in Greece have beenisolated from immigrants from the Middle East, Asiaand Africa. The main sources of zoophilic infectionsare infected animals; for M. canis domestic or straydogs and cats. The transmission mode ofanthropophilic infection involves contact withinfected persons, asymptomatic carriers or fomites.Tinea capitis is usually not inflammatory.Inflammatory infections (Kerion) involve mostlyzoophilic and geophilic dermatophytes and rarelyanthropophilic. Favus is a rare scalp infectioncaused by the anthropophilic T. schoenleinii.Clinical diagnosis should be confirmed bymycological examination which includes directmicroscopy of the specimen, culture andidentification of the pathogen on the basis of themacro- and microscopic features of the colony.Identification is necessary for the selection of theappropriate antifungal agent. Clinicians shouldsuspect tinea capitis in all scalp infections involvingchildren of prepubertal age.

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∂ÈÛ·ÁˆÁ‹O fiÚÔ˜ tinea ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ·fi ÙÔ˘˜ ƒˆ-

Ì·›Ô˘˜ ÁÈ· ÙÈ˜ Ì˘ÎËÙÈ·ÛÈÎ¤˜ Î·È ·Ú·ÛÈÙÈÎ¤˜ ÏÔÈÌÒ-ÍÂÈ˜ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜, Î·ıÒ˜ ıÂˆÚÔ‡Û·Óˆ˜ ˘Â‡ı˘ÓÔ ÙÔÓ ÛÎfiÚÔ ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ (Ï·ÙÈÓÈÎ¿:tinea) (1). O fiÚÔ˜ ·˘Ùfi˜ ‚·ıÌÈ·›· ÂÈÎÚ¿ÙËÛÂ,ÒÛÙÂ ÛÙ· Ì¤Û· ÙÔ˘ 16Ô˘ ·ÈÒÓ· Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·ÈÁÈ· fiÏÂ˜ ÙÈ˜ ·ı‹ÛÂÈ˜ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜.

OÚfiÛËÌÔ ÛÙËÓ È·ÙÚÈÎ‹ Ì˘ÎËÙÔÏÔÁ›· ·ÔÙÂÏÂ› Ë·Ó·Î¿Ï˘„Ë ·fi ÙÔ˘˜ J. Schöenlein Î·È R. Remak,ÛÙÈ˜ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ·, fiÙÈ Ô Ì‡ÎËÙ·˜ ∞¯fiÚÈÔÓ(ÛËÌÂÚÈÓ‹ ÔÓÔÌ·Û›· Trichophyton schoenleinii) Â›Ó·ÈÔ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· (2). ∆· ÎÏÈÓÈ-Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ÓfiÛÔ˘, Ô ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛË˜,Î·ıÒ˜ Î·È Ô ÙÚfiÔ˜ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ Ì‡ÎËÙ· ÛÙËÓÙÚ›¯· ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ Gruby, ÛÂ Ì›· ÛÂÈÚ¿·fi ÌÂÏ¤ÙÂ˜ ÙÔ˘, ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1840-1844 (3).

O Sabouraud, ÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ·, ÌÂÏ¤-ÙËÛÂ ÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ‰È¤ÎÚÈÓÂÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Ì˘ÎËÙÈ¿ÛÂˆÓ (ÌÈÎÚÔÛÔ-Ú›·, ÙÚÈ¯ÔÊ˘Ù›·, ¿¯ÔÚ·˜), ÂÚÈ¤ÁÚ·„Â ÙËÓ ÎÏÈÓÈÎ‹ÙÔ˘˜ ÂÈÎfiÓ· Î·È ·Ú·Ù‹ÚËÛÂ fiÙÈ Ô ÙÚÈ¯ÔÊ˘ÙÈÎfi˜ Ù‡-Ô˜ ÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ·fi ÔÏÏ¿ Â›‰Ë ‰ÂÚÌ·-ÙfiÊ˘ÙˆÓ (4). ∂›ÛË˜, Ù·ÍÈÓfiÌËÛÂ Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·ÛÂ Ù¤ÛÛÂÚ· Á¤ÓË: Trichophyton, Microsporum,Epidermophyton Î·È Achorion.

∆Ô 1934, Ô Emmons, ÌÂÏÂÙÒÓÙ·˜ ÙË ÌÈÎÚÔÛÎÔÈ-Î‹ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÓÈ‰›ˆÓ (ÛÔÚ›ˆÓ) Î·È ÙË ‰ÔÌ‹ÙˆÓ ˘ÊÒÓ (ÓËÌ·Ù›ˆÓ) ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, Î·ıfiÚÈÛÂÙÔ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ô‰ÂÎÙfi Û‡ÛÙËÌ· Ù·ÍÈÓfiÌËÛ‹˜ÙÔ˘˜ Î·È Ù· Î·Ù¤Ù·ÍÂ ÛÂ ÙÚ›· Á¤ÓË: Trichophyton,Microsporum Î·È Epidermophyton (5).

OÈÎÔÏÔÁ›· ∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ÓËÌ·ÙÔÂÈ‰ÒÓ

Ì˘Î‹ÙˆÓ Ô˘, ÌÂ ÙË ‚Ô‹ıÂÈ· ÂÈ‰ÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Î·ÈÂÓ˙‡ÌˆÓ (ÎÂÚ·ÙÈÓ¿ÛÂ˜), ·ÔÈÎÔ‰ÔÌÔ‡Ó Î·È ‰ÈÂÈÛ‰‡-Ô˘Ó ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰·, ÚÔÎ·ÏÒÓÙ·˜ ÏÔÈÌÒÍÂÈ˜ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙˆÓ Ó˘¯ÈÒÓ Î·È ÙˆÓ ÙÚÈ¯ÒÓ.

∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ ÛÂ ÙÚ›· ·Ó¿ÌÔÚ-Ê· (·ÛÂÍÔ˘·ÏÈÎ¿) Á¤ÓË (Trichophyton, MicrosporumÎ·È ∂pidermophyton), Ù· ‰ÂÚÌ·ÙfiÊ˘Ù· Ù·ÍÈÓÔÌÔ‡-ÓÙ·È, Â›ÛË˜, ÛÂ ÁÂÒÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ·ÓıÚˆfiÊÈÏ·(6), ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ

ÚÔÙ›ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹ (¶›Ó·Î·˜ 1). ∆· ÁÂÒÊÈÏ· Â›‰Ë ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÈÎÚfi ·ÚÈıÌfi

‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜ Î·ÈÚÔÎ·ÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂÈ˜ ÙfiÛÔ ÛÙ· ˙Ò· fiÛÔ Î·È ÛÙÔÓ¿ÓıÚˆÔ. ∆· ˙ˆfiÊÈÏ· Â›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò·,ÔÏÏ¿ fiÌˆ˜ ÛÙÂÏ¤¯Ë ÙÔ˘˜ ÚÔÎ·ÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂÈ˜Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ·ÓıÚˆfiÊÈÏ· Â›‰Ë ÚÔ-Û‚¿ÏÏÔ˘Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÙÔÓ ¿ÓıÚˆÔ.

ŒÙÛÈ, ÔÚÈÛÌ¤Ó· Â›‰Ë Ì˘Î‹ÙˆÓ fiˆ˜ Ù· ª.gypseum Î·È ª. fulvum Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜Î·È ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, Ù· ª.canis Î·È T. mentagrophytes var mentagrophytesÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, ÂÓÒ ¿ÏÏ·,fiˆ˜ Ù· T. rubrum Î·È T. violaceum ·Ú·ÛÈÙÔ‡Ó·ÔÎÏÂÈÛÙÈÎ¿ ÛÙËÓ ·ÓıÚÒÈÓË ÎÂÚ·Ù›ÓË ÛÙÈ‚¿‰·.

∞fi Ù· 40 Â›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ Â›Ó·È ·ıÔ-ÁfiÓ· ÁÈ· ÙÔÓ ¿ÓıÚˆÔ, ÌfiÓÔ 10-12 Â›‰Ë, ·fi Ù· Á¤-ÓË Microsporum Î·È Trichophyton Î·È Û·ÓÈfiÙ·Ù··fi ÙÔ Á¤ÓÔ˜ Epidermophyton, Û˘Ó‰¤ÔÓÙ·È ÌÂ ‰ÂÚ-Ì·ÙÔÊ˘Ù›Â˜ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜.

∂È‰ËÌÈÔÏÔÁ›· ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ (ª∆∫)

Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ‰ÂÚÌ·ÙÈÎ‹ ÏÔ›ÌˆÍË ÙÔ˘ ÙÚÈ-¯ˆÙÔ‡ ÎÂÊ·Ï‹˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, Î·Ù¿ ÙËÓÔÔ›· ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ ÙÚ›¯Â˜, ÔÈ ı‡Ï·ÎÔÈ Î·È ÙÔÂÚÈ‚¿ÏÏÔÓ ‰¤ÚÌ·. ∂›Ó·È ÌÔÏ˘ÛÌ·ÙÈÎ‹ ÓfiÛÔ˜, ËÔÔ›· ¤¯ÂÈ ˆ˜ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù· ‰ÂÚÌ·Ùfi-Ê˘Ù·. ¶ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌË-ÓÒÓ Ì¤¯ÚÈ ÙËÓ ÂÊË‚Â›· (7,8). ∂›Ó·È Û¿ÓÈ· ÛÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ Î·È ·˘Ùfi ·Ô‰›‰ÂÙ·È ÛÙË Ì˘ÎËÙÔÎÙfiÓÔ‰Ú¿ÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜, Ë Â-ÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ·˘Í¿ÓÂÈ ÌÂÙ¿ ÙËÓ ÂÊË-‚Â›· (9,10).

∆· ÁÂÒÊÈÏ· ‰ÂÚÌ·ÙfiÊ˘Ù· Â›Ó·È Â˘Ú¤ˆ˜ ‰È·‰Â-‰ÔÌ¤Ó·, ÂÓÒ Ù· ·ÓıÚˆfiÊÈÏ· Î·È ÔÚÈÛÌ¤Ó· ˙ˆfiÊÈ-Ï· Â›‰Ë Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤¯Ô˘Ó ÂÚÈÔÚÈÛÌ¤ÓË ÁÂˆ-ÁÚ·ÊÈÎ‹ Î·Ù·ÓÔÌ‹, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÍÂ-ÓÈÛÙ‹. ∏ Î·Ù·ÓÔÌ‹ ·˘Ù‹ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈÎ¿ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ‚ÂÏÙÈÒÛÂˆÓ ÛÙÈ˜ Û˘Óı‹ÎÂ˜‰È·‚›ˆÛË˜ Î·È ˘ÁÈÂÈÓ‹˜, ÙˆÓ ÌÂÙ·ÎÈÓ‹ÛÂˆÓ ÏËı˘-ÛÌÒÓ Î·È ÙË˜ ·Ó¿Ù˘ÍË˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ (11). ∏ ·Ó·Î¿Ï˘„Ë ÙË˜ ÁÎÚÈ˙ÂÔÊÔ˘Ï‚›ÓË˜, ÙÔ 1958, ·ÔÙÂÏÂ› ÔÚfiÛËÌÔ ÁÈ· ÙË ıÂÚ·Â›· ÙˆÓ

∏ Ù·˘ÙÔÔ›ËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÂÈÏÔÁ‹ÙË˜ Î·Ù¿ÏÏËÏË˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹˜ ·ÁˆÁ‹˜. ŸÏÂ˜ ÔÈÂÚÈÙÒÛÂÈ˜ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·-Ï‹˜ ÛÂ ·È‰È¿ ÚÔÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ı· Ú¤ÂÈ Ó··ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·fi ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi ˆ˜ ‡Ô-ÙÂ˜ Ì˘ÎËÙÈ·ÛÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ì˘ÎËÙ›·ÛË ÙÚÈ¯ˆÙÔ‡ ÎÂÊ·Ï‹˜, ÔÈ-ÎÔÏÔÁ›·, ÂÈ‰ËÌÈÔÏÔÁ›·, ÂÚÁ·ÛÙËÚÈ·Î‹ ‰È¿ÁÓˆÛË.

Key words: tinea capitis, ecology, epidemiology,mycological examination.


428

Ì˘ÎËÙÈ¿ÛÂˆÓ Î·È Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÛËÌ·-ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÓ‰ËÌÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (12).

∏ ÁÂˆÁÚ·ÊÈÎ‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓÔÈÎ›ÏÂÈ. ™ÙË µfiÚÂÈ· Î·È ÙËÓ ∫ÂÓÙÚÈÎ‹ ∞ÌÂÚÈÎ‹ ÂÈ-ÎÚ·Ù¤ÛÙÂÚÔ ·›ÙÈÔ ª∆∫ ·ÔÙÂÏÂ› Ô ·ÓıÚˆfiÊÈÏÔ˜Ì‡ÎËÙ·˜ ∆. tonsurans (90%) (13-15). O Ì‡ÎËÙ·˜ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ πÛ·ÓfiÊˆÓÔ˘˜ Î·È ∞ÊÚÔ·ÌÂÚÈ-Î·ÓÔ‡˜ (16). ™ÙË ¡fiÙÈ· ∞ÌÂÚÈÎ‹, ÙËÓ ∞˘ÛÙÚ·Ï›· Î·ÈÙË ¡¤· ∑ËÏ·Ó‰›· ÂÈÎÚ·ÙÔ‡Ó Ù· Â›‰Ë M. canis Î·È T.tonsurans (7,17). ™ÙË ¢˘ÙÈÎ‹ Î·È ¡fiÙÈ· ∞Û›· ÙÔ Û˘-ÓËı¤ÛÙÂÚÔ Â›‰Ô˜ Â›Ó·È ÙÔ T. violaceum (18), ÂÓÒÛÙÈ˜ ¯ÒÚÂ˜ ÙË˜ ª¤ÛË˜ ∞Ó·ÙÔÏ‹˜ ÂÈÎÚ·ÙÔ‡Ó Ù· Â›-‰Ë M. canis, T. violaceum Î·È T. mentagrophytes varmentagrophytes (19,20). ™ÙËÓ ∞ÊÚÈÎ‹, ÌÂ ÂÍ·›ÚÂÛËÙËÓ ∞›Á˘ÙÔ fiÔ˘ ÚÔÂÍ¿Ú¯ÂÈ ÙÔ M. canis (21), ÂÓ‰Ë-ÌÔ‡Ó Î˘Ú›ˆ˜ ·ÓıÚˆfiÊÈÏ· Â›‰Ë, fiˆ˜ Ù· ∆.violaceum, M. audouinii, M. rivalieri, T. soudanense,M. ferrugineum Î·È T. schoenleinii, ∆. yaoundei Î·È T.gourvilii (22,23). ™Â ·ÚÎÂÙ¤˜ ¯ÒÚÂ˜ ÙË˜ ∞ÊÚÈÎ‹˜ ÙÔÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÂÓÂÚÁ‹ ÓfiÛÔ ·Ó¤Ú¯ÂÙ·È ÛÂ10-30% (21).

™ÙË ¢˘ÙÈÎ‹ ∂˘ÚÒË, Û‡ÌÊˆÓ· ÌÂ ÚfiÛÊ·ÙËÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ ª∆∫ ÛÂ 19 Â˘Úˆ·˚Î¤˜¯ÒÚÂ˜, ·Ú·ÙËÚ‹ıËÎÂ, Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·Â-Ù›·, ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂ-ˆÓ È‰È·›ÙÂÚ· ÛÙÈ˜ ·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜, ÌÂ ·ÔÙ¤ÏÂÛÌ·Ó· ˘ÂÚÙÂÚÔ‡Ó ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ ÛÂ ·Ó·ÏÔÁ›· 1:0,8(24). ∏ ·‡ÍËÛË ·˘Ù‹ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ÂÈÛÚÔ‹ ÌÂ-Ù·Ó·ÛÙÒÓ ·fi ¯ÒÚÂ˜ ÙË˜ ∞ÊÚÈÎ‹˜ Î·È ÙË˜ ∞Û›·˜(25). ¶·Ú¿ Ù·‡Ù·, Ô ˙ˆfiÊÈÏÔ˜ M. canis Â›Ó·È Ô ÂÈ-ÎÚ·Ù¤ÛÙÂÚÔ˜ Ì‡ÎËÙ·˜, ÌÂ ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛËÛÙÈ˜ ¯ÒÚÂ˜ ÙË˜ ¡fiÙÈ·˜ ∂˘ÚÒË˜ (8,26-28).

∆ËÓ ÙÂÏÂ˘Ù·›· ÙÚÈ·ÎÔÓÙ·ÂÙ›· ·Ú·ÙËÚ‹ıËÎ·ÓÛËÌ·ÓÙÈÎ¤˜ ·ÏÏ·Á¤˜ ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ‰ÂÚ-Ì·ÙfiÊ˘ÙˆÓ ÛÙË ¯ÒÚ· Ì·˜. ∆· ·ÓıÚˆfiÊÈÏ· Â›‰Ë ∆.schoenleinii Î·È M. audouinii, Ù· ÔÔ›· ÂÈÎÚ·ÙÔ‡-Û·Ó ÙÈ˜ ÚÒÙÂ˜ ‰ÂÎ·ÂÙ›Â˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, ·ÓÙÈÎ·-Ù·ÛÙ¿ıËÎ·Ó ‚·ıÌÈ·›· ·fi ÙÔ T. violaceum (29,30), Ë·ÚÔ˘Û›· ÙÔ˘ ÔÔ›Ô˘, fiÌˆ˜, ÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿ÛÙË Û˘Ó¤¯ÂÈ· Î·È ·ÓÙÈÎ·Ù·ÛÙ¿ıËÎÂ ·fi ÙÔ ª. canis,ÙÔ ÔÔ›Ô Û‹ÌÂÚ· Â›Ó·È Ô Î˘ÚÈfiÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜·Ú¿ÁÔÓÙ·˜. ∆· Â›‰Ë ∆. schoenleinii Î·È M. audouinii¤¯Ô˘Ó Û¯Â‰fiÓ ÂÎÚÈ˙ˆıÂ› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi, ÂÓÒÙÔ T. violaceum ÂÚÈÔÚ›˙ÂÙ·È Ï¤ÔÓ ÛÂ ·ÁÚÔÙÈÎ¤˜ Â-ÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜, fiÔ˘ ˘¿Ú¯ÂÈ Û˘Á¯ÚˆÙÈÛÌfi˜·ÙfiÌˆÓ Î·È ÔÈ Û˘Óı‹ÎÂ˜ ˘ÁÈÂÈÓ‹˜ Î·È ‰È·‚›ˆÛË˜ Â›Ó·È‰˘ÛÌÂÓÂ›˜, Î·ıÒ˜ Â›ÛË˜ Î·È ÛÂ ÔÈÎÔÓÔÌÈÎÔ‡˜ ÌÂÙ·-Ó¿ÛÙÂ˜, ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ·fi ¯ÒÚÂ˜ ÙË˜ µ·ÏÎ·ÓÈ-Î‹˜ Î·È ÙË˜ ∞Ó·ÙÔÏÈÎ‹˜ ∂˘ÚÒË˜ (31,32).

∂È‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘-Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÂ ·ÛıÂÓÂ›˜ÌÂ ª∆∫ ¤¯ÂÈ ·ÔÌÔÓˆıÂ› Â˘Ú‡ Ê¿ÛÌ· ·ıÔÁfiÓˆÓÌ˘Î‹ÙˆÓ, fiˆ˜ Ù· ª. canis, T. violaceum, T.mentagrophytes var mentagrophytes, M. gypseum,T. verrucosum, T. tonsurans, M. audouinii, T.soudanense, M. ferrugineum, T. schoenleinii Î·È T.erinacei (¶›Ó·Î·˜ 2). ∆· ÚÒÙ· 6 Â›‰Ë ·fi ·˘Ù¿¤¯Ô˘Ó ·ÔÌÔÓˆıÂ› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi (28,33-36), ÂÓÒ Ù· ˘fiÏÔÈ· ¤¯Ô˘Ó ·ÔÌÔÓˆıÂ› ÛÂ ·È‰È¿ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚÂ˜ ÙË˜ ∞ÊÚÈÎ‹˜ Î·È ÙË˜ ∞Û›·˜,fiÔ˘ Ù· Â›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó (37,38). ∆Ô T. violaceum ·ÔÌÔÓÒıËÎÂ, Â›ÛË˜, ÛÂ ·È‰È¿ ÌÂ-Ù·Ó·ÛÙÒÓ ·fi ÙËÓ ∞Ï‚·Ó›· Î·È ÙËÓ ∞Ó·ÙÔÏÈÎ‹ ∂˘ÚÒ-Ë (31,32). °È· ÙÔÓ ·ÓıÚˆfiÊÈÏÔ Ì‡ÎËÙ· ∆. rubrum,

¶›Ó·Î·˜ 1. ∆· Î˘ÚÈfiÙÂÚ· Â›‰Ë ÙˆÓ ·ıÔÁfiÓˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ

∞ÓıÚˆfiÊÈÏÔÈ ∑ˆfiÊÈÏÔÈ °ÂÒÊÈÏÔÈ

Trichophyton sppT. rubrum T. mentagrophytes var mentagrophytes T. terestreT. mentagrophytes var interdigitale T. verrucosumT. megninii T. equinumT. violaceum T. mentagrophtes var erinaceiT. tonsurans T. simiiT. soudanenseT. concentricumT. gourviliiT. youndeiiT. schoenleinii∆. raubitschekiiMicrosporum sppM. audouinii M. canis var canis M. gypseumM. audouinii var rivalieri M. canis var distortum M. fulvumM. ferrugineum M. equinum M. paecox

M. gallinae M. vanbreuseghemiiM. persicolorM. nanum

Epidermophyton spp∂. floccosum

Û‡ÓËıÂ˜ ·›ÙÈÔ Ì˘ÎËÙÈ¿ÛÂˆÓ Ó˘¯ÈÒÓ Î·È ‰¤ÚÌ·ÙÔ˜ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ˘¿Ú¯Ô˘Ó ÛÔÚ·‰ÈÎ¤˜ ·Ó·ÊÔÚ¤˜ª∆∫ ÌÂ ¿Ù˘Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· (39). ∆Ô ·ÓıÚˆfiÊÈÏÔÂ›‰Ô˜ ∂. floccosum ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ·ÔÙÂÏÂ› ·›ÙÈÔª∆∫ (40), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó·ÊÔÚ¿ ÁÈ· ÙÔ ·ÓıÚˆ-fiÊÈÏÔ Â›‰Ô˜ ∆. concentricum (11).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ·Ú·ÙËÚÂ›Ù·È: ·) ·‡ÍËÛË ÙË˜Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ M. canis ÛÙË ¡fiÙÈ· ∞ÌÂÚÈÎ‹, ÛÙË¡fiÙÈ· Î·È ∞Ó·ÙÔÏÈÎ‹ ∂˘ÚÒË Î·È ÛÙË ª¤ÛË ∞Ó·ÙÔ-Ï‹, ‚) ·‡ÍËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ T. tonsurans ÛÙËµfiÚÂÈ· ∞ÌÂÚÈÎ‹ Î·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ¯ÒÚÂ˜ ÙË˜ ∂˘-ÚÒË˜ (∞ÁÁÏ›·, °·ÏÏ›·), Á) ·Ú·ÌÔÓ‹ ÙÔ˘ ∆.violaceum ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ∞Ó·ÙÔÏÈÎ‹˜∂˘ÚÒË˜, ÙË˜ ∞ÊÚÈÎ‹˜ Î·È ÛÙËÓ πÓ‰›·, ‰) ·Ú·ÌÔ-Ó‹ ÂÓ‰ËÌÈÎÒÓ Ì˘Î‹ÙˆÓ ÛÙËÓ ∞ÊÚÈÎ‹, fiˆ˜ ÙÔ˘ T.soudanense Î·È ÙÔ˘ M. ferrugineum Â) ÂÌÊ¿ÓÈÛËÛÙËÓ ∂˘ÚÒË ÔÚÈÛÌ¤ÓˆÓ ·ÓıÚˆfiÊÈÏˆÓ Ì˘Î‹ÙˆÓ,fiˆ˜ Ô T. soudanense, Ô M. audouinii Î·È Ô T.Violaceum, ÛÂ ÎÔÈÓfiÙËÙÂ˜ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ∞ÊÚÈÎ‹, ÙËÓ ∞Û›· Î·È ÙË ¡ÔÙÈÔ·Ó·ÙÔÏÈÎ‹ ∂˘ÚÒËÎ·È ÛÙ) ÂÎÚ›˙ˆÛË ÙÔ˘ ∆. shoenleinii ÛÙÈ˜ ÂÚÈÛÛfiÙÂ-ÚÂ˜ ¯ÒÚÂ˜, ÏËÓ ÙË˜ ∞ÊÚÈÎ‹˜ (41).

∏ ª∆∫ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜Î·È Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜, ÌÂÙ·Í‡ 3-8 ÂÙÒÓ (8,27,28,42).Œ¯ÂÈ, Â›ÛË˜, ·Ú·ÙËÚËıÂ› fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ ÙË˜ Â›-Ó·È Û˘Ó¿ÚÙËÛË ÙÔ˘ Ê‡ÏÔ˘ Î·È ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·-Ú¿ÁÔÓÙ· (43).

OÈ ÌÈÎÚÔÛÔÚÈÎÔ› Ì‡ÎËÙÂ˜ ÚÔÛ‚¿ÏÏÔ˘Ó Î·Ù¿ÚÔÙ›ÌËÛË ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ, ÂÓÒ ÛÙÔ˘˜ ÙÚÈ¯ÔÊ˘ÙÈ-ÎÔ‡˜ Ë Î·Ù·ÓÔÌ‹ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Â›Ó·È ÈÛfiÚ-ÚÔË (28,43). ∆o M. canis ÚÔÛ‚¿ÏÏÂÈ Î·È Ù· ‰‡ÔÊ‡Ï·, È‰È·›ÙÂÚ· fiÌˆ˜ Ù· ·ÁfiÚÈ·, ÂÓÒ ÙÔ M.audouinii ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ÂÈÏÂÎÙÈÎfiÙËÙ· (5:1)ÛÙ· ·ÁfiÚÈ· ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (44). ™Â ÚfiÛÊ·-ÙË ÌÂÏ¤ÙË Ô˘ ¤ÁÈÓÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜”,Ë Û¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 6:1ÁÈ· ÙÔ˘˜ ÌÈÎÚÔÛÔÚÈÎÔ‡˜ Ì‡ÎËÙÂ˜ M. audouinii, M.

ferrugineum Î·È ª. gypseum, ÂÓÒ ÁÈ· ÙÔ ª. canis Ë·Ó·ÏÔÁ›· ‹Ù·Ó ÌfiÓÔ 1,3:1. ¶Èı·ÓÒ˜, Ù· ÎÔÓÙ¿ Ì·Ï-ÏÈ¿ ÙˆÓ ·ÁÔÚÈÒÓ Ó· Â˘ÓÔÔ‡Ó ÙËÓ ÂÌÊ‡ÙÂ˘ÛË ÙˆÓÛÔÚ›ˆÓ (16). ∞ÓÙ›ıÂÙ·, Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ T.violaceum ‹Ù·Ó ÂÚ›Ô˘ 1:1 (38).

∆ÚfiÔ˜ ÌfiÏ˘ÓÛË˜ ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È

Â›ÙÂ ÌÂ ÙËÓ ¿ÌÂÛË Â·Ê‹ ÌÂ Î·ÙÔÈÎ›‰È· ‹ ¿ÁÚÈ· ˙Ò·Ô˘ Â›Ó·È ÌÔÏ˘ÛÌ¤Ó· ‹ ÓÔÛÔ‡Ó Â›ÙÂ ¤ÌÌÂÛ·, ÌÂÂÓÂÚÁ¿ ÎÔÓ›‰È·, Ù· ÔÔ›· ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÂ ÊÚ¿-ÎÙÂ˜, ÛÙ¿‚ÏÔ˘˜ Î.Ï.

∏ Î‡ÚÈ· ËÁ‹ ÌfiÏ˘ÓÛË˜ ÁÈ· ÙÔ ª. canis Â›Ó·È Ù·Î·ÙÔÈÎ›‰È· ˙Ò· (Á¿ÙÂ˜, ÛÎ‡ÏÔÈ), Î˘Ú›ˆ˜ Ù· ·‰¤ÛÔ-Ù· (28,33,36). ∏ ‰ÂÍ·ÌÂÓ‹ ·˘Ù‹ ÌfiÏ˘ÓÛË˜ Â›Ó·È··Ú·›ÙËÙË, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ÌÔÏ˘ÛÌ·ÙÈÎ‹ ÈÛ¯‡˜ÙÔ˘ M. canis ÂÍ·ÛıÂÓÂ› ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ÌÂÙ¿ ·fiÙ¤ÛÛÂÚÈ˜ ‰È·‰Ô¯ÈÎ¤˜ ÌÂÙ·‚È‚¿ÛÂÈ˜ ·fi ¿ÓıÚˆÔÛÂ ¿ÓıÚˆÔ (45).

∏ ËÁ‹ ÌfiÏ˘ÓÛË˜ ÁÈ· ÙÔ T. verrucosum Â›Ó·È Ù·‚ÔÔÂÈ‰‹ Î·È Ù· ·ÈÁÔÚfi‚·Ù· Ô˘ ÓÔÛÔ‡Ó, ÂÓÒ ÁÈ· ÙÔ∆. mentagrophytes var mentagrophytes Â›Ó·È oÈ ¯Ô›ÚÔÈ,ÔÈ ÎfiÓÈÎÏÔÈ, Ù· ·ÈÁÔÚfi‚·Ù· Î·È Ù· ÙÚˆÎÙÈÎ¿.

OÈ ÁÂÒÊÈÏÔÈ Ì‡ÎËÙÂ˜ Û·ÓÈfiÙ·Ù· ÂÌÏ¤ÎÔÓÙ·Èˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ª∆∫.

¶ËÁ‹ ÌfiÏ˘ÓÛË˜ ÁÈ· ÙÈ˜ ·ÓıÚˆÔÊÈÏÈÎ¤˜ ÏÔÈÌÒ-ÍÂÈ˜ ·ÔÙÂÏÔ‡Ó ÔÈ ¿Û¯ÔÓÙÂ˜ Î·È ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ı-Ìfi ÔÈ ·Û˘ÌÙˆÌ·ÙÈÎÔ› ÊÔÚÂ›˜ ÙË˜ ÓfiÛÔ˘ (46,47).

∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓÁ›ÓÂÙ·È Â›ÙÂ ÌÂ ¿ÌÂÛË Â·Ê‹ ÌÂ ¿Û¯ÔÓÙ· ‹ ·Û˘-ÌÙˆÌ·ÙÈÎfi ÊÔÚ¤· Â›ÙÂ ¤ÌÌÂÛ·, ÌÂ ÌÔÏ˘ÛÌ¤Ó··ÓÙÈÎÂ›ÌÂÓ·, fiˆ˜ Â›‰Ë ÎÔÌÌˆÙÈÎ‹˜, ÚÔ‡¯·, Î·¤-Ï·, ÂÙÛ¤ÙÂ˜, ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù·, ·ÎÔ˘ÛÙÈÎ¿ ÙËÏÂ-ÊˆÓÈÎÒÓ Û˘ÛÎÂ˘ÒÓ, ·È¯Ó›‰È· Î.¿. (48,49). ∫ÔÓ›‰È·(ÛfiÚÈ·) Ì˘Î‹ÙˆÓ ¤¯Ô˘Ó ·ÔÌÔÓˆıÂ› fi¯È ÌfiÓÔÓ ÛÂÙÚ›¯Â˜ ·Û¯fiÓÙˆÓ Ô˘ ¤¯Ô˘Ó ·Ô¤ÛÂÈ, ·ÏÏ¿ Î·ÈÛÂ ÌÔÏ˘ÛÌ¤Ó· ·ÓÙÈÎÂ›ÌÂÓ· Î·È ¤ÈÏ· ÙÔ˘ ÛÈÙÈÔ‡.


429

¶›Ó·Î·˜ 2. ∂›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÂ ·È‰È¿ ÌÂ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜” Î·Ù¿ ÙËÓ ÂÍ·ÂÙ›· 1996-2001

°ËÁÂÓÂ›˜ ªÂÙ·Ó¿ÛÙÂ˜¢ÂÚÌ·ÙfiÊ˘ÙÔ No % A £ ∞ £

M. canis 454 87,1 233 163 32 26T. violaceum 31 6,0 10 8 6 7M. audouinii 9 1,7 - - 8 1T. mentagrÔphytes var ment 6 1,2 4 1 1 -M. ferrugineum 7 1,3 - - 6 1M. gypseum 5 1,0 4 1 - -T. verrucosum 2 0,4 2 - - -T. soudanense 3 0,6 - - 2 1T. rubrum 2 0,4 2 - - -T. schoenleinii 1 0,2 - - - 1T. erinacei 1 0,2 - - - 1™‡ÓÔÏÔ 521 100,0 255 173 55 38


430

∆· ÎÔÓ›‰È· Â›Ó·È ‚ÈÒÛÈÌ· ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ·, Ë ‰Â ·Ú·ÌÔÓ‹ ÙÔ˘˜ ÛÂ ¤ÈÏ· Î·È ·ÓÙÈÎÂ›-ÌÂÓ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÂÍËÁÂ› fi¯È Ìfi-ÓÔÓ ÙË ÌÂÙ¿‰ÔÛË ÙË˜ ÓfiÛÔ˘ ÂÓ ·Ô˘Û›· ÍÂÓÈÛÙ‹, ·ÏÏ¿Î·È ÙËÓ Ù˘¯fiÓ ·ÔÙ˘¯›· ÙË˜ ıÂÚ·Â›·˜, Î·ıÒ˜ Â›ÛË˜Î·È ÙÈ˜ Û˘¯Ó¤˜ ˘ÔÙÚÔ¤˜ ÙË˜ ÓfiÛÔ˘ ÌÂÙ¿ ÙË ıÂÚ·-Â›·. ∏ ÌÂÙ¿‰ÔÛË Á›ÓÂÙ·È Â›ÙÂ ÛÙÔ Û›ÙÈ ·fi ÙÔ ÔÈÎÔ-ÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‹ ÛÂ ¿ÏÏÔ˘˜ ÙfiÔ˘˜ Û˘Á¯ÚˆÙÈ-ÛÌÔ‡, fiˆ˜ Ù· ÓËÈ·ÁˆÁÂ›·, Ù· Û¯ÔÏÂ›·, Ù· ÓÔÛÔÎÔ-ÌÂ›·, Ù· ÎÔ˘ÚÂ›· Î.¿. (50,51), ÂÓÒ ‰ÈÂ˘ÎÔÏ‡ÓÂÙ·È ·fiÙÔÓ ÛÙÂÓfi Û˘Á¯ÚˆÙÈÛÌfi Î·È ÙËÓ Î·Î‹ ·ÙÔÌÈÎ‹ ˘ÁÈÂÈÓ‹.

™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ·ÏÏ¿ Î·È ÙË Û˘-ÓÙ‹ÚËÛË ÙˆÓ ÂÈ‰ËÌÈÒÓ Î·Ù¤¯ÂÈ Ë ‡·ÚÍË ·Û˘-ÌÙˆÌ·ÙÈÎÒÓ ÊÔÚ¤ˆÓ. ø˜ ·Û˘ÌÙˆÌ·ÙÈÎÔ› ÊÔÚÂ›˜ÔÚ›˙ÔÓÙ·È Ù· ¿ÙÔÌ· Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÌÊ·Ó‹ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Ì˘ÎËÙ›·ÛË˜, ¤¯Ô˘Ó Û˘¯Ó¿ ·ÚÓËÙÈÎ¿¿ÌÂÛ· ÌÈÎÚÔÛÎÔÈÎ¿ ·Ú·ÛÎÂ˘¿ÛÌ·Ù·, ·ÏÏ¿ ÔÈÎ·ÏÏÈ¤ÚÁÂÈÂ˜ Â›Ó·È ÙÂÏÈÎ¿ ıÂÙÈÎ¤˜ (43,47). ŸÏÂ˜Û¯Â‰fiÓ ÔÈ ·Ó·ÊÔÚ¤˜ ÌÂ ˘„ËÏfi ÔÛÔÛÙfi ·Û˘ÌÙˆ-Ì·ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·ÊÔÚÔ‡Ó ÛÂ ·ÓıÚˆfiÊÈÏÔ˘˜ Ì‡-ÎËÙÂ˜, fiˆ˜ ÔÈ T. tonsurans Î·È T. violaceum Î·È ÛÂ‹È·˜ ÌÔÚÊ‹˜ ÏÔ›ÌˆÍË, ÔÌÔÈ¿˙Ô˘Û· ÌÂ ÛÌËÁÌ·-ÙÔÚÚÔ˚Î‹ ‰ÂÚÌ·Ù›ÙÈ‰· (46).

∆Ô ÔÛÔÛÙfi ÙˆÓ ·Û˘ÌÙˆÌ·ÙÈÎÒÓ ÊÔÚ¤ˆÓ ÔÈ-Î›ÏÏÂÈ ÛËÌ·ÓÙÈÎ¿ Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË Û˘¯ÓfiÙËÙ·ÙˆÓ ª∆∫ ·Ó¿ ¯ÒÚ·. OÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜, ÔÈ ÔÔ›Â˜¤ÁÈÓ·Ó ÛÂ Û¯ÔÏÂ›· Î·È ÛÂ ÎÔÈÓfiÙËÙÂ˜, fiÔ˘ Ë ª∆∫Â›Ó·È Û˘¯Ó‹, ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Û˘ÌÙˆ-Ì·ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·Ó¤Ú¯ÂÙ·È ÛÂ 15% ÂÚ›Ô˘(23,51), ÂÓÒ ·ÓÙ›ıÂÙ·, ÛÂ Â˘ÚÂ›· ÌÂÏ¤ÙË Ì·ıËÙÒÓÔ˘ ¤ÁÈÓÂ ÛÙËÓ πÛ·Ó›· Î·È ÙËÓ πÙ·Ï›·, ÙÔ ÔÛÔÛÙfiÂ›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏfi (0,2% Î·È 0,3%, ·ÓÙ›ÛÙÔÈ-¯·) (52,53). ¶ÔÏ‡ ˘„ËÏ¿ ÔÛÔÛÙ¿ ·Û˘ÌÙˆÌ·ÙÈ-ÎÒÓ ÊÔÚ¤ˆÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¡fiÙÈ· ∞ÊÚÈÎ‹, fiÔ˘ÂÓ‰ËÌÂ› ÙÔ ∆. violaceum. OÈ Nail Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘ÓfiÙÈ ÛÂ ÔÚÈÛÌ¤Ó· Ì¤ÚË ÙË˜ ∞ÊÚÈÎ‹˜ ÔÛÔÛÙfi 41%ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Â›Ó·È ÊÔÚ¤·˜ Î·È30% ÙˆÓ ÌËÙ¤ÚˆÓ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ÂÓÂÚÁ‹ÓfiÛÔ (54). OÈ Vargo Î·È Cohen, ÂÍÂÙ¿˙ÔÓÙ·˜ ÙfiÛÔÙ· ÂÓ‹ÏÈÎ· Ì¤ÏË fiÛÔ Î·È Ù· ·È‰È¿ ÙË˜ ›‰È·˜ ÔÈÎÔ-Á¤ÓÂÈ·˜, ‚Ú‹Î·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Û˘ÌÙˆÌ·ÙÈ-ÎÒÓ ÂÓ‹ÏÈÎˆÓ ÊÔÚ¤ˆÓ ÌÂ T. tonsurans ‹Ù·Ó 12%,ÂÓÒ ÙˆÓ ·È‰ÈÒÓ 44% (55). ∞Ó¿ÏÔÁË ÌÂÏ¤ÙË Ô˘¤ÁÈÓÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜” ÛÂ 25 ·È‰È¿ ÌÂª∆∫ ·fi T. violaceum ¤‰ÂÈÍÂ fiÙÈ ‰‡Ô Ó‹È· ÌÔÏ‡Ó-ıËÎ·Ó ·fi ·Û˘ÌÙˆÌ·ÙÈÎ¤˜ ÔÈÎÈ·Î¤˜ ‚ÔËıÔ‡˜, 18·È‰È¿ ·fi ¿Û¯ÔÓÙÂ˜ Î·È ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ÊÔ-ÚÂ›˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÂÓÒ ÁÈ· Ù·˘fiÏÔÈ· 5 ·È‰È¿ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ÂÓÙÔÈÛÙÂ›Ë ËÁ‹ ÌfiÏ˘ÓÛË˜ (31). OÈ ·Ú·¿Óˆ ÌÂÏ¤ÙÂ˜ ˘Ô-‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‹/Î·È ÙÔÛ¯ÔÏÂ›Ô ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ¯ÒÚÔ˘˜ fiÔ˘ Ë ÓfiÛÔ˜ ÌÂ-Ù·‰›‰ÂÙ·È ÛÙ· ·È‰È¿.

¶·ıÔÁ¤ÓÂÈ· ª˘ÎËÙ›·ÛË ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ ÚÔÎ·-

ÏÔ‡Ó ÌfiÓÔ Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∞Ó·ÊÔÚ¤˜ fiÙÈ ¿ÏÏ· Â›-‰Ë, fiˆ˜ Ù· ÌË ‰ÂÚÌ·ÙfiÊ˘Ù·, ÌÔÚÔ‡Ó Ó· ÚÔÎ·-Ï¤ÛÔ˘Ó ª∆∫ ‰ÂÓ ¤¯Ô˘Ó ÂÈ‚Â‚·ÈˆıÂ› ÌÂ Û˘Ì‚·ÙÈ-Î¤˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÌÂıfi‰Ô˘˜ (ÌÈÎÚÔÛÎfiËÛË-Î·Ï-ÏÈ¤ÚÁÂÈ·).

O ÌË¯·ÓÈÛÌfi˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓÛÙËÓ ÙÚ›¯· ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙfi˜. ∏ ‰˘Ó·Ùfi-ÙËÙ· ÎÂÚ·ÙfiÏ˘ÛË˜ ‰ÂÓ ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ·ıÔÁfi-ÓÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓfi˜ Ì‡ÎËÙ·, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ˘¿Ú-¯ÂÈ Ï‹ıÔ˜ Ì˘Î‹ÙˆÓ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙËÓ ÎÂ-Ú·Ù›ÓË ÛÙÈ‚¿‰·, ·ÏÏ¿ ‰ÂÓ ÚÔÛ‚¿ÏÏÔ˘Ó ÙËÓ ÙÚ›¯·,fiˆ˜ .¯. ÔÈ Ì‡ÎËÙÂ˜ T. concentricum, Scytalidiumdimidiatum Î·È ∂. floccosum (13).

∏ ÌÂÙ·ÊÔÚ¿ ÎÔÓÈ‰›ˆÓ ‹ ˘ÊÒÓ ·fi ·ÛıÂÓ‹ ‹ ÌÔ-Ï˘ÛÌ¤Ó· ·ÓÙÈÎÂ›ÌÂÓ· ÛÙËÓ ÎÂÊ·Ï‹ ˘ÁÈÔ‡˜ ·ÙfiÌÔ˘‰ÂÓ Û˘ÓÂ¿ÁÂÙ·È Î·Ù’ ·Ó¿ÁÎËÓ ÙË ÌfiÏ˘ÓÛË. ™‡Ì-ÊˆÓ· ÌÂ ÙÔÓ Kligman, ÚÔËÁÂ›Ù·È ÚÔÛ‚ÔÏ‹ ÙË˜ÎÂÚ¿ÙÈÓË˜ ÛÙÈ‚¿‰·˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙË˜ ÎÂÊ·Ï‹˜ Î·È¤ÂÙ·È Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÙÚÈ¯ÒÓ (56). ¶Èı·ÓfiÓ Ó· Â›-Ó·È ·Ó·ÁÎ·›· Ë ‡·ÚÍË ÙÚ·‡Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ‚ÔËı¿ÛÙÔÓ ÂÓÔÊı·ÏÌÈÛÌfi ÙÔ˘ Ì‡ÎËÙ·. ∏ ÏÔ›ÌˆÍË ·Ú¯›˙ÂÈÌÂ ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ ÎÔÓÈ‰›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ·ÙˆÓ ÎÂÚ·ÙÈÓÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ÎÔÏÔ˘ıÂ›ÂÎ‚Ï¿ÛÙËÛË, ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Î·È ‰ÈÂ›Û‰˘ÛË ÙÔ˘Ì‡ÎËÙ· Ê˘ÁÔÎÂÓÙÚÈÎ¿ ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰· ÌÂ ÙË‚Ô‹ıÂÈ· ÚˆÙÂÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ÙÈ˜ ÎÂÚ·ÙÈÓ¿ÛÂ˜,Ô˘ ÂÎÎÚ›ÓÂÈ Ô Ì‡ÎËÙ·˜. ∏ ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô˜ ·fiÙÔÓ ÂÓÔÊı·ÏÌÈÛÌfi Ì¤¯ÚÈ ÙËÓ ÚÔÛ‚ÔÏ‹ ÙË˜ ÙÚ›¯·˜Â›Ó·È ÂÚ›Ô˘ ÙÚÂÈ˜ Â‚‰ÔÌ¿‰Â˜ (57).

∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ÚÔÛ‚¿ÏÏÔ˘Ó ÌfiÓÔÓ ÙÈ˜ ·Ó·-Ù˘ÛÛfiÌÂÓÂ˜ ÙÚ›¯Â˜ (·Ó·ÁÂÓ‹˜ Ê¿ÛË).

∆Ô ÛÙ¤ÏÂ¯Ô˜ ÙË˜ ÙÚ›¯·˜ ÚÔÛ‚¿ÏÏÂÙ·È ÛÙÔ Ì¤-ÛÔÓ ÂÚ›Ô˘ ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ı‡Ï·Î·. OÈ ÂÓÙfi˜ ÙÔ˘ÛÙÂÏ¤¯Ô˘˜ ˘Ê¤˜ ·Ó·Ù‡ÛÛÔÓÙ·È ÚÔ˜ Ù· Î¿Ùˆ,ÚÔ˜ ÙÔÓ ‚ÔÏ‚fi, ·ÏÏ¿ Ë ·Ó¿Ù˘ÍË ÛÙ·Ì·Ù¿ ÛÙÔÛËÌÂ›Ô fiÔ˘ Ë ÎÂÚ·ÙÈÓÔÔ›ËÛË Â›Ó·È ·ÙÂÏ‹˜. ™ÙÔÛËÌÂ›Ô ·˘Ùfi, ÔÈ ÎÔÚ˘Ê¤˜ ÙˆÓ ˘ÊÒÓ Û¯ËÌ·Ù›˙Ô˘Óı‡Û·ÓÔ ÌÂ ÌÔÚÊ‹ § (ı‡Û·ÓÔ˜ Adamson). OÈ ÂÓÙfi˜ÙÔ˘ ÛÙÂÏ¤¯Ô˘˜ ˘Ê¤˜ ÌÂÙ·Ê¤ÚÔÓÙ·È, Î·ıÒ˜ ·Ó·-Ù‡ÛÛÂÙ·È Ë ÙÚ›¯·, ÚÔ˜ Ù· Â¿Óˆ, ‰È·ÙËÚÒÓÙ·˜fiÌˆ˜ ÙË Û¯ÂÙÈÎ‹ ı¤ÛË ÙÔ˘˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‚ÔÏ-‚Ô‡. ™ÙÈ˜ ÂÍˆÙÚÈ¯ÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, ·ÚÈıÌfi˜ ÏÂ˘ÚÈ-ÎÒÓ ·Ï‡ÛÂˆÓ ÙˆÓ ˘ÊÒÓ ‰È·ÂÚÓ¿ ÙÔ ÛÙ¤ÏÂ¯Ô˜ ÙË˜ÙÚ›¯·˜ Î·È ·Ó·Ù‡ÛÛÂÈ ˘ÎÓfi Ì˘Î‹ÏÈÔ ÛÙËÓ ÂÈÊ¿-ÓÂÈ¿ ÙÔ˘, ÙÔ ÔÔ›Ô Î·Ù·ÎÂÚÌ·Ù›˙ÂÙ·È Û¯ËÌ·Ù›˙ÔÓÙ·˜ÔÏ˘¿ÚÈıÌ· ÛfiÚÈ·, Ù· ÔÔ›· ÂÚÈ‚¿ÏÏÔ˘Ó ÙËÓ ÙÚ›-¯· Î·È ÚÔÎ·ÏÔ‡Ó Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚÈ¯›Ô˘. ∫·-Ù¿ ÙËÓ ·fiÛ·Û‹ ÙË˜, Ë ÙÚ›¯· Û¿ÂÈ ÛÙÔ ÈÔ ·‰‡-Ó·ÙÔ ÛËÌÂ›Ô, ·ÎÚÈ‚Ò˜ ¿Óˆ ·fi ÙÔÓ ı‡Û·ÓÔ ÙÔ˘Adamson. ™ÙÈ˜ ÂÓ‰ÔÙÚÈ¯ÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, Ë ·Ó¿Ù˘ÍËÙˆÓ ÛÔÚ›ˆÓ Á›ÓÂÙ·È Ì¤Û· ÛÙÔ ÛÙ¤ÏÂ¯Ô˜ ÙË˜ ÙÚ›¯·˜,

ÂÓÒ ÙÔ ÂÚÈÙÚ›¯ÈÔ ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙÔ. ∏ ÙÚ›¯· Á›ÓÂÙ·ÈÂ‡ıÚ·˘ÛÙË Î·È Û¿ÂÈ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÙÚÈ¯ˆÙÔ‡,·Ê‹ÓÔÓÙ·˜ ÛÙÔ ÛËÌÂ›Ô ÂÎÂ›ÓÔ ¤Ó· Ì·‡ÚÔ ÛÙ›ÁÌ·(black dot) (7,58).

¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫ Û˘Ó‹ıˆ˜ ‚·Û›˙ÂÙ·È ÛÙËÓ

Ù˘ÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÌÂ ÏÂÈ‰Ò‰ÂÈ˜ Ï¿ÎÂ˜, ·Ô-ÎÔÌÌ¤ÓÂ˜ ÙÚ›¯Â˜ Î·È ‰ÈfiÁÎˆÛË ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ·‰¤ÓˆÓ. ∏ ÂÈ‚Â‚·›ˆÛË Á›ÓÂÙ·È ÌÂ ÂÚÁ·ÛÙËÚÈ·Îfi¤ÏÂÁ¯Ô. ∏ ‰È·‰ÈÎ·Û›· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi-˙ÂÙ·È ÛÂ Î¿ıÂ ÌÈÎÚfi ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·fi-ÙˆÛË ÙˆÓ ÙÚÈ¯ÒÓ Î·È ¤ÓÙÔÓË ·ÔÏ¤ÈÛË, ¿Û¯ÂÙ··fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ÈÎ‹˜ ‹ ÌË ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜Ì˘ÎËÙ›·ÛË˜ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜.

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ·∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ª∆∫ Â›Ó·È Ë ·fi-

ÙˆÛË ÙˆÓ ÙÚÈ¯ÒÓ Ô˘ Û˘¯Ó¿ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÛË-ÌÂ›· ÊÏÂÁÌÔÓ‹˜, fiˆ˜ ·ÔÏ¤ÈÛË, ı˘Ï·ÎÈÎ¿ ÊÏ˘-ÎÙ·ÈÓ›‰È· Î·È ÎÓËÛÌfi. OÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÔÈ-Î›ÏÏÔ˘Ó. O ‚·ıÌfi˜ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ‚Ï·‚ÒÓ ÂÍ·Ú-Ù¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ Ì‡ÎËÙ· Î·È ÙËÓ·ÓÔÛ›· ÙÔ˘ ÍÂÓÈÛÙ‹.

¢È·ÎÚ›ÓÔÓÙ·È ÔÈ ·ÎfiÏÔ˘ıÔÈ Ù‡ÔÈ: ÌÈÎÚÔÛÔÚ›Â˜,ÙÚÈ¯ÔÊ˘Ù›Â˜, ¿¯ÔÚ·˜ Î·È ÎËÚ›Ô. ∂ÎÙfi˜ ·fi ÙËÓ Ù·-ÍÈÓfiÌËÛË ·˘Ù‹, ÔÈ ª∆∫ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ÌË ÊÏÂÁÌÔ-ÓÒ‰ÂÈ˜ Î·È ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÌÔÚÊ¤˜ (7,49,59).

·) ªÈÎÚÔÛÔÚ›Â˜: Ã·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi Ì›· ÌÂ-ÌÔÓˆÌ¤ÓË (Û·ÓÈfiÙÂÚ· ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÂ˜) Î˘ÎÏÈ-Î‹ ÏÂÈ‰Ò‰Ë Ï¿Î· ‰È·Ì¤ÙÚÔ˘ 2-5 cm, ÂÏ·ÊÚÒ˜ÂÚ˘ıËÌ·ÙÒ‰Ë, Ë ÂÈÊ¿ÓÂÈ· ÙË˜ ÔÔ›·˜ Î·Ï‡ÙÂÙ·È·fi ÎÔÌÌ¤ÓÂ˜ ÙÚ›¯Â˜ ÛÂ ‡„Ô˜ 2-3 cm ¿Óˆ ·fi ÙËÓÂÈÊ¿ÓÂÈ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÙÚ›-¯Â˜ Â›Ó·È Ê·È¤˜ Î·È ·Ï·ÌÂ›˜ ÏfiÁˆ ÙË˜ ÂÈÎ¿Ï˘„‹˜ÙÔ˘˜ ·fi Ù· ·ÚıÚÔÎÔÓ›‰È· ÙˆÓ ÂÍÒÙÚÈ¯ˆÓ ‰ÂÚÌ·-ÙfiÊ˘ÙˆÓ. ø˜ Â› ÙÔ ÏÂ›ÛÙÔÓ, Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ-‰ÂÈ˜ Î·È Û˘Ó‰¤ÔÓÙ·È ÌÂ ÙÔ ˙ˆfiÊÈÏÔ Â›‰Ô˜ M. canisÎ·È Û·ÓÈfiÙÂÚ· ÌÂ Ù· ·ÓıÚˆfiÊÈÏ· Â›‰Ë M.audouinii Î·È ª. ferrugineum (∂ÈÎfiÓ· 1).

‚) ∆ÚÈ¯ÔÊ˘Ù›Â˜: Ã·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙË ÌÔÚÊ‹ÌÈÎÚÒÓ ‰È¿Û·ÚÙˆÓ ÔÏ˘ÁˆÓÈÎÒÓ Ï·ÎÒÓ ÌÂ ÈÙ˘-ÚÒ‰Ë ·ÔÏ¤ÈÛË, ÌÂ ·ÔÎÔÌÌ¤ÓÂ˜ ÙÚ›¯Â˜ ÛÙÔ ÛË-ÌÂ›Ô ÙË˜ ¤ÎÊ˘Û‹˜ ÙÔ˘˜. ∆Ô ˘fiÏÂÈÌÌ· ÙË˜ ÙÚ›¯·˜Ì¤Û· ÛÙÔÓ ı‡Ï·Î· ‰›ÓÂÈ ÙËÓ ÂÈÎfiÓ· Ì·‡ÚÔ˘ ÛÙ›ÁÌ·-ÙÔ˜ (black dots). O ÌË ÊÏÂÁÌÔÓÒ‰Ë˜ Ù‡Ô˜ ·ÚÔ˘-ÛÈ¿˙ÂÈ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÔÌÔÈ¿˙Ô˘Û· ÌÂ ÙË ÛÌËÁÌ·-ÙÔÚÚÔ˚Î‹ ‰ÂÚÌ·Ù›ÙÈ‰·. OÈ Ï¿ÎÂ˜ Û˘¯Ó¿ Û˘ÚÚ¤Ô˘Ó,Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÌÂ ·ÔÏ¤ÈÛË Î·È ÛË-ÌÂ›· ‹È·˜ ÊÏÂÁÌÔÓ‹˜. ªÂÙ·Í‡ ÙˆÓ ÚÔÛ‚Â‚ÏËÌ¤-ÓˆÓ ÙÚÈ¯ÒÓ ˘¿Ú¯Ô˘Ó ˘ÁÈÂ›˜ ÙÚ›¯Â˜ ‹/Î·È Ì·‡Ú·ÛÙ›ÁÌ·Ù·, Ù· ÔÔ›· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ‰˘Û‰È¿ÎÚÈÙ·ÛÙ· ·È‰È¿. ™˘Ó‰¤ÔÓÙ·È ÌÂ Ù· ·ÓıÚˆfiÊÈÏ· Â›‰Ë T.

tonsurans Î·È T. violaceum (∂ÈÎfiÓÂ˜ 2 Î·È 3).Á) ŒÌ˘Ô˜ ÙÚÈ¯ÔÊ˘Ù›·/ÎËÚ›ÔÓ Î¤ÏÛÔ˘: Ã·Ú·-

ÎÙËÚ›˙ÂÙ·È ·fi ÂÒ‰˘ÓÂ˜ ‚Ï·ÙÈ‰ÔÔ˙Ò‰ÂÈ˜ Ï¿ÎÂ˜,ÌÂ ÊÏ˘ÎÙ·ÈÓ›‰È· Ô˘ Î·Ï‡ÙÔÓÙ·È ·fi ÌÂÏÈÙfi¯ÚÔÂ˜ÂÊÂÏÎ›‰Â˜. ∞fi Ù· ÛÙfiÌÈ· ÙˆÓ ÙÚÈ¯ÔÛÌËÁÌ·ÙÔÁfi-ÓˆÓ ı˘Ï¿ÎˆÓ ÂÍ¤Ú¯ÂÙ·È ‡ÔÓ Î·È ˘¿Ú¯ÂÈ ·fiÙˆ-ÛË ÙˆÓ ÙÚÈ¯ÒÓ. ∂›Ó·È ÎÓËÛÌÒ‰Ë˜ Î·È Û˘¯Ó¿ Û˘ÓÔ-‰Â‡ÂÙ·È ·fi ˘ÚÂÙfi Î·È ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·.∏ ÊÏÂÁÌÔÓÒ‰Ë˜ ·˘Ù‹ ÌÔÚÊ‹ Û˘Ó‰¤ÂÙ·È ÌÂ ˙ˆfiÊÈ-ÏÔ˘˜ ‹ ÁÂÒÊÈÏÔ˘˜ Ì‡ÎËÙÂ˜, fiˆ˜ Ù· ª. canis, T.verrucosum, T. mentagrophytes var mentagrophytes,M. nanum, M. gypseum Î·È, Û·ÓÈfiÙÂÚ·, ÌÂ Ùo ·Ó-ıÚˆfiÊÈÏo Â›‰o˜ ∆. violaceum (∂ÈÎfiÓ· 4).

‰) Õ¯ÔÚ·˜: ¶ÚfiÎÂÈÙ·È ÁÈ· Û·ÓÈfiÙ·ÙË ÓfiÛÔ ÛÙË¯ÒÚ· Ì·˜. ∂ÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ‚Ï¿‚Â˜, Ù·ÛÎ˘Ê›·, ‰ËÏ. Î˘ÂÏÏÔÂÈ‰Â›˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ ÙË˜ ÂÈ-‰ÂÚÌ›‰·˜, ÛÙÚÔÁÁ˘ÏÔ‡ Û¯‹Ì·ÙÔ˜, ÛÙÔ Î¤ÓÙÚÔ ÙˆÓÔÔ›ˆÓ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ ÌÔÓ‹ÚË˜, ÍËÚ‹, ·Ï·Ì‹˜ÙÚ›¯·. ∆· ÛÎ˘Ê›· ¤¯Ô˘Ó ¯ÚÒÌ· ÎÈÙÚÈÓfiÊ·ÈÔ Î·È·Ó·‰›‰Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ‰˘Û¿ÚÂÛÙË ÔÛÌ‹. OÈÙÚ›¯Â˜ ‰ÂÓ Â›Ó·È Â‡ıÚ·˘ÛÙÂ˜ fiˆ˜ ÛÙÈ˜ ¿ÏÏÂ˜ ÌÔÚ-Ê¤˜. ∞ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· Â›Ó·È ÙÔ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii (∂ÈÎfiÓ· 5).

∂ÚÁ·ÛÙËÚÈ·Î‹ ‰È¿ÁÓˆÛË ∏ ÂÚÁ·ÛÙËÚÈ·Î‹ ÌÂıÔ‰ÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ

¿ÌÂÛË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ÏÂ›ˆÓ, ÙÚÈ¯ÒÓÎ·È ı˘Ï¿ÎˆÓ, ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÁÈ· ÙËÓ ·ÔÌfiÓˆÛËÙÔ˘ ˘Â‡ı˘ÓÔ˘ Ì‡ÎËÙ· Î·È ÙËÓ Ù·˘ÙÔÔ›ËÛË. ∏ ‚ÈÔ-„›· Û·Ó›ˆ˜ ÂÓ‰Â›ÎÓ˘Ù·È ÁÈ· ÙËÓ ÂÚÁ·ÛÙËÚÈ·Î‹ ‰È¿-ÁÓˆÛË ÙˆÓ ª∆∫. ¶ÚˆÙ·Ú¯ÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙÈ˜·Ú·¿Óˆ Ì˘ÎËÙÔÏÔÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ Â›Ó·È Ë ÂÈÏÔ-Á‹ Î·È Û˘ÏÏÔÁ‹ ÙÔ˘ Î·Ù¿ÏÏËÏÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∏ ÌË ÛˆÛÙ‹ Ï‹„Ë ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ „Â˘‰Ò˜·ÚÓËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜


431

∂ÈÎfiÓ· 1. ªÈÎÚÔÛÔÚ›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum canis.


432

ÂÈÙÂÏÂ›Ù·È ÌÂ Ì›· ÛÂÈÚ¿ ·ÓÒ‰˘ÓˆÓ ÙÂ¯ÓÈÎÒÓ. ªÂ ÙË‚Ô‹ıÂÈ· ·ÔÛÙÂÈÚˆÌ¤ÓÔ˘ ·È¯ÌËÚÔ‡ Í¤ÛÙÚÔ˘,‚Ô‡ÚÙÛ·˜ Ì›·˜ ¯Ú‹ÛË˜, ÙÚÈ¯ÔÏ·‚›‰·˜ ‹/Î·È ‚·Ì‚·-ÎÔÊfiÚÔ˘ ÛÙ˘ÏÂÔ‡ Û˘ÏÏ¤ÁÔÓÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ Ï¤È·, ÙÚ›¯Â˜ Î·È ÂÚÈÂ¯fiÌÂÓ· ı˘-Ï¿ÎˆÓ, Ù· ÔÔ›· Ê¤ÚÔÓÙ·È ÛÂ Î·ı·Ú‹ ·ÓÙÈÎÂÈÌÂÓÔ-ÊfiÚÔ Ï¿Î·. OÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÙÚ›¯Â˜ ·ÔÛÒ-ÓÙ·È ¯ˆÚ›˜ ·ÓÙ›ÛÙ·ÛË, ·ÓÒ‰˘Ó·, ÌÂ Í¤ÛÙÚÔ ‹ ÌÂÙÚÈ¯ÔÏ·‚›‰·. ∂¿Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÌÊ·ÓÂ›˜ ‚Ï¿‚Â˜,Ì›· ¿ÏÏË ÈÎ·ÓÔÔÈËÙÈÎ‹ Ì¤ıÔ‰Ô˜ Â›Ó·È ÙÔ ‚Ô‡ÚÙÛÈ-ÛÌ· ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ ÌÂ Ô‰ÔÓÙfi‚Ô˘ÚÙÛ·Ì›·˜ ¯Ú‹ÛË˜, Ë ÔÔ›·, ÛÙË Û˘Ó¤¯ÂÈ·, Ê¤ÚÂÙ·È ÛÂÂ·Ê‹ ÌÂ ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ıÚÂÙÈÎÔ‡ ˘ÔÛÙÚÒ-Ì·ÙÔ˜. ™Â ÂÒ‰˘ÓÂ˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ·ÏÏÔÈÒÛÂÈ˜, ËÏ‹„Ë ÏÂ›ˆÓ Î·È ÙÚÈ¯ÒÓ Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹.™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Û˘ÏÏ¤ÁÂÙ·È ‡ÔÓ ÌÂ ‚·Ì-‚·ÎÔÊfiÚÔ ÛÙ˘ÏÂfi. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Â›Ó·È ‰˘Ó·-Ù‹ Ë ÌÂÙ·ÊÔÚ¿ ı˘Ï¿ÎˆÓ Î·È ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÎÔ-ÓÈ‰›ˆÓ, ÒÛÙÂ Ó· ·Ó·Ù˘¯ıÂ› Ô Ì‡ÎËÙ·˜ ÛÙËÓ Î·Ï-ÏÈ¤ÚÁÂÈ· (60).

∏ ¯Ú‹ÛË ÙË˜ Ï˘¯Ó›·˜ Wood ÚÔÛÊ¤ÚÂÈ ÛËÌ·-ÓÙÈÎ‹ ‚Ô‹ıÂÈ· ÛÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ ÂÍˆÙÚÈ¯ÈÎÒÓ ·Ï-ÏÔÈÒÛÂˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ÔÚÈÛÌ¤Ó· Â›‰Ë ÙÔ˘ Á¤-

ÓÔ˘˜ Microsporum. ™ÙÔ ˘ÂÚÈÒ‰Â˜ Êˆ˜ ÙË˜ Ï˘-¯Ó›·˜ (3650 Å), ÔÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÙÚ›¯Â˜ ÂÎ¤-ÌÔ˘Ó ¤ÓÙÔÓÔ ÊıÔÚÈÛÌfi. O ÊıÔÚÈÛÌfi˜ ÔÊÂ›ÏÂÙ·ÈÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙË˜ ÙÚ˘ÙÔÊ¿ÓË˜, Ë ÔÔ›· Û˘Û-ÛˆÚÂ‡ÂÙ·È ÛÙÈ˜ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÙÚ›¯Â˜, ÔÈ ÔÔ›Â˜‰ÈÂÁÂ›ÚÔÓÙ·È Î·È ÊıÔÚ›˙Ô˘Ó (7). £· Ú¤ÂÈ Ó· ÛË-ÌÂÈˆıÂ› fiÙÈ ÙÔÈÎ‹ ıÂÚ·Â›· ÂÓ‰¤¯ÂÙ·È Ó· ÂËÚÂ¿-ÛÂÈ ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÂÍ¤Ù·ÛË˜, ‰›‰ÔÓÙ·˜ ·¯ÓfiÊıÔÚÈÛÌfi ‹ „Â˘‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÂÚÈÔ-Ú›˙ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÂÈ‰ÈÎfiÙËÙ· ÙË˜ ÌÂıfi‰Ô˘ (28).

™ÙÈ˜ ÂÓ‰ÔÙÚÈ¯ÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·ÈÊıÔÚÈÛÌfi˜, ÂÓÒ ÛÙÔÓ ¿¯ÔÚ· ÔÈ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ÙÚ›¯Â˜ ‰È·ÙËÚÔ‡ÓÙ·È ·Ó¤·ÊÂ˜ Î·È ÂÎ¤ÌÔ˘Ó·¯Ófi ÊıÔÚÈÛÌfi. ∂ÂÈ‰‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÔÈÌÒÍÂˆÓ·fi ÂÓ‰fiÙÚÈ¯Ô˘˜ Ì‡ÎËÙÂ˜ ¤¯ÂÈ ·˘ÍËıÂ› ÛËÌ·ÓÙÈÎ¿Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ¯Ú‹ÛË ÙË˜ Ï˘¯Ó›·˜ Wood¤¯ÂÈ ÌÂÚÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹ ·Í›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÌÂÁ¿-ÏÔ˘ ·ÚÈıÌÔ‡ ·ÙfiÌˆÓ, fiˆ˜ ÁÈ· ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ÌÂÏ¤ÙÂ˜ ÛÙ· Û¯ÔÏÂ›· Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛËÙË˜ ıÂÚ·Â›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜.

∆Ô ÚÔ˜ ÂÍ¤Ù·ÛË ‰Â›ÁÌ· Ê¤ÚÂÙ·È ÛÂ ·ÓÙÈÎÂÈÌÂ-ÓÔÊfiÚÔ Ï¿Î·, ÚÔÛÙ›ıÂÓÙ·È ÌÂÚÈÎ¤˜ ÛÙ·ÁfiÓÂ˜

∂ÈÎfiÓ· 3. ∆ÚÈ¯ÔÊ˘Ù›· „ˆÚÈ·ÛÈÎ‹˜ ÌÔÚÊ‹˜ ·fi ÙÔÓ Ì‡ÎËÙ·Trichophyton violaceum. ∂ÈÎfiÓ· 2. ∆ÚÈ¯ÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum.

∫O∏ 20% (‰È·˘Á·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜), Î·Ï‡ÙÂÙ·ÈÌÂ Î·Ï˘ÙÚ›‰· Î·È ÌÈÎÚÔÛÎÔÂ›Ù·È ÌÂ ÍËÚfi Ê·Îfix10 ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ,ÂÓÒ ÁÈ· ÂÈ‚Â‚·›ˆÛË ··ÈÙÂ›Ù·È ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ Ê·-Îfi˜ x40. ªÂ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ·ÓÈ-¯ÓÂ‡ÔÓÙ·È Ù· Î˘ÙÙ·ÚÈÎ¿ ÛÙÔÈ¯Â›· ÙË˜ ·Ú·ÛÈÙÈÎ‹˜ÌÔÚÊ‹˜ ÙÔ˘ Ì‡ÎËÙ·. ™Ù· Ï¤È· ·Ó·˙ËÙÔ‡ÓÙ·È ÔÈ ˘·-ÏÔÂÈ‰Â›˜, Û˘¯Ó¿ ‰È·ÎÏ·‰È˙fiÌÂÓÂ˜, ˘Ê¤˜ (ÓËÌ¿ÙÈ·)ÌÂ ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·È ÔÈ ·Ï‡ÛÂÈ˜ ÙˆÓ ·ÚıÚÔÎÔÓÈ-‰›ˆÓ, ÔÈ ÔÔ›Â˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ Î·Ù·ÎÂÚÌ·ÙÈ-ÛÌfi ÙˆÓ ˘ÊÒÓ, ÂÓÒ ÛÙÈ˜ ÙÚ›¯Â˜ Ë ‰È¿Ù·ÍË Î·È ÙÔ Ì¤-ÁÂıÔ˜ ÙˆÓ ÎÔÓÈ‰›ˆÓ, ÌÔÚÊÔÏÔÁÈÎÔ› ¯·Ú·ÎÙ‹ÚÂ˜Ô˘ ÌÔÚÂ› Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙÔ Á¤ÓÔ˜ ÙÔ˘ ˘Â‡-ı˘ÓÔ˘ Ì‡ÎËÙ·. ™Â ·ÛıÂÓÂ›˜ ÌÂ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ‚Ï¿-‚Â˜, ÛÙÔÈ¯Â›· ÙÔ˘ Ì‡ÎËÙ· Û¿ÓÈ· ·ÓÂ˘Ú›ÛÎÔÓÙ·ÈÛÙ· ¿ÌÂÛ· ·Ú·ÛÎÂ˘¿ÛÌ·Ù·. OÙÈÎ¿ ÛÊ¿ÏÌ·Ù·‰ÂÓ ·ÔÎÏÂ›ÔÓÙ·È (60).

∏ ¿ÌÂÛË ÌÈÎÚÔÛÎfiËÛË Â›Ó·È Ù·¯Â›· Î·È ·ÍÈfiÈ-ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ Ì¤ıÔ‰Ô˜. ∏ Â˘·ÈÛıËÛ›· Î·È Ë ÂÈ‰È-ÎfiÙËÙ¿ ÙË˜, fiÌˆ˜, ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓÌ˘Î‹ÙˆÓ ÛÙÔ ·Ú·ÛÎÂ‡·ÛÌ·, ·fi Ù˘¯fiÓ ÚÔÁÂÓ¤-ÛÙÂÚË ıÂÚ·Â›· Î·È ·fi ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ÂÚÁ·-ÛÙËÚÈ·ÎÔ‡ È·ÙÚÔ‡. ∏ ıÂÙÈÎ‹ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈÎ‹ÂÍ¤Ù·ÛË ÂÈ‚Â‚·ÈÒÓÂÈ ÙËÓ ÎÏÈÓÈÎ‹ ‰È¿ÁÓˆÛË Î·È ÂÈ-

ÙÚ¤ÂÈ ÙËÓ ¤Ó·ÚÍË ıÂÚ·Â›·˜. ¶·Ú¿ Ù·‡Ù·, Ë ÌË·ÓÂ‡ÚÂÛË ÙÔ˘ Ì‡ÎËÙ· ÛÙ· ¿ÌÂÛ· ·Ú·ÛÎÂ˘¿ÛÌ·-Ù· ‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙË Ì˘ÎËÙÈ·ÛÈÎ‹ ÏÔ›ÌˆÍË.

∏ Ì¤ıÔ‰Ô˜ Î·ıÈÛÙ¿ ‰˘Ó·Ùfi ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓÙÚÈÒÓ Ù‡ˆÓ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ Ì‡ÎËÙ· ÛÙËÓ ÙÚ›¯·:ÂÍÒÙÚÈ¯Ô, ÂÓ‰fiÙÚÈ¯Ô Î·È ·¯ÔÚÈÎfi. ™ÙËÓ ÂÍÒÙÚÈ¯ËÏÔ›ÌˆÍË, ÔÈ ˘Ê¤˜ Î·Ù·ÎÂÚÌ·Ù›˙ÔÓÙ·È ÛÂ ÌÈÎÚÔ‡ ÌÂ-Á¤ıÔ˘˜ ·ÚıÚÔÎÔÓ›‰È· (ÛfiÚÈ·), Ù· ÔÔ›· Î·Ï‡-ÙÔ˘Ó ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÂÚÈ‚¿ÏÏÔ˘Ó ÙÔ ÛÙ¤ÏÂ¯Ô˜ÙË˜ ÙÚ›¯·˜, ÚÔÎ·ÏÒÓÙ·˜ ÔÚÈÛÙÈÎ‹ Î·Ù·ÛÙÚÔÊ‹ÙÔ˘ ÂÚÈÙÚÈ¯›Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÓ‰ÔÙÚÈ¯ÈÎ‹ ÏÔ›Ìˆ-ÍË, Ù· ·ÚıÚÔÎÔÓ›‰È· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜,·Ú·Ì¤ÓÔ˘Ó ÛÙÔ ÛÙ¤ÏÂ¯Ô˜ ÙË˜ ÙÚ›¯·˜, ¯ˆÚ›˜ fiÌˆ˜Ó· ·Ú·ÙËÚÂ›Ù·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚÈ¯›Ô˘. ™ÙÔÓ¿¯ÔÚ·, ÔÈ ÙÚ›¯Â˜ Ì¤ÓÔ˘Ó ·Ó¤·ÊÂ˜ Î·È ¯·Ú·ÎÙËÚ›-˙ÔÓÙ·È ·fi ÙËÓ ·ÓÂ‡ÚÂÛË ÌfiÓÔ ÓËÌ·Ù›ˆÓ Î·Ù¿ Ì‹-ÎÔ˜ ÙË˜ ÙÚ›¯·˜, ÏÈÔÛÊ·ÈÚ›ˆÓ Î·È ÎÂÓÒÓ ·¤ÚÔ˜ (61).

°È· ÙËÓ ÂÈ‚Â‚·›ˆÛË ÙÔ˘ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ÙË˜¿ÌÂÛË˜ ÌÈÎÚÔÛÎÔÈÎ‹˜ ÂÍ¤Ù·ÛË˜ Î·È ÙÔÓ ÚÔÛ‰ÈÔ-ÚÈÛÌfi ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·, fiÏ· Ù· ÏËÊı¤-ÓÙ· ‰Â›ÁÌ·Ù· Ú¤ÂÈ Ó· Î·ÏÏÈÂÚÁÔ‡ÓÙ·È.

∏ Î·ÏÏÈ¤ÚÁÂÈ· ·ÔÙÂÏÂ› ‚·ÛÈÎ‹ ÂÍ¤Ù·ÛË ÁÈ· ÙË‰È¿ÁÓˆÛË ÙË˜ Ì˘ÎËÙÈ·ÛÈÎ‹˜ ÏÔ›ÌˆÍË˜. ∆· ıÚÂÙÈÎ¿˘ÔÛÙÚÒÌ·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÁÈ·ÙÈ˜ ÚˆÙÔÎ·ÏÏÈ¤ÚÁÂÈÂ˜ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Â›Ó·È Ù·Sabouraud ‹ potato dextrose ¿Á·Ú ÂÌÏÔ˘ÙÈÛÌ¤ÓÔÌÂ ·ÓÙÈ‚ÈÔÙÈÎ¿, fiˆ˜ ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË Î·È Î˘ÎÏÔÂ-Í·Ì›‰Ë, Ù· ÔÔ›· ‚ÔËıÔ‡Ó ÛÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË

∂ÈÎfiÓ· 4. ŒÌ˘Ô˜ ‰ÂÚÌ·ÙÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporumgypseum. ∂ÈÎfiÓ· 5. Õ¯ÔÚ·˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton schoenleinii.


433


434

ÙË˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ‚·ÎÙËÚÈ‰›ˆÓ Î·È ÙˆÓ Û·ÚÔ-Ê˘ÙÈÎÒÓ Ì˘Î‹ÙˆÓ. ∆· ÙÂÏÂ˘Ù·›· ·Ó·Ù‡ÛÛÔÓÙ·ÈÙ·¯‡Ù·Ù·, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚÎ·Ï‡ÙÔ˘Ó Ù·‚Ú·‰¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓ· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∏ ÂÒ·-ÛË ÌÔÚÂ› Ó· Á›ÓÂÈ ÛÂ ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, ·Ï-Ï¿ Û˘ÓÈÛÙ¿Ù·È ÎÏ›‚·ÓÔ˜ ÛÙ·ıÂÚ‹˜ ıÂÚÌÔÎÚ·Û›·˜.∏ ¿ÚÈÛÙË ıÂÚÌÔÎÚ·Û›· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰ÂÚ-Ì·ÙfiÊ˘ÙˆÓ Â›Ó·È 26-28ÔC Î·È Ô ¯ÚfiÓÔ˜ ÂÒ·ÛË˜ 2-4 Â‚‰ÔÌ¿‰Â˜. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ı· Ú¤ÂÈ Ó· ÂÏ¤Á-¯ÔÓÙ·È Û˘¯Ó¿ ÁÈ· ÙË ‰È·›ÛÙˆÛË ·Ó¿Ù˘ÍË˜ ÙÔ˘·ıÔÁfiÓÔ˘ Ì‡ÎËÙ· Î·È Ù˘¯fiÓ ÂÈÌÔÏ‡ÓÛÂÈ˜ ·fiÛ·ÚÔÊ˘ÙÈÎÔ‡˜ Ì‡ÎËÙÂ˜ (62).

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Á¤ÓÔ˘˜ Î·È ÙÔ˘ Â›‰Ô˘˜ÙÔ˘ ·ıÔÁfiÓÔ˘ Ì‡ÎËÙ· (Ù·˘ÙÔÔ›ËÛË) Â›Ó·È ··-Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ Î·Ù¿ÏÏËÏÔ˘ ıÂÚ·-Â˘ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜, ‰Â‰ÔÌ¤ÓË˜ ÙË˜ ‰È·ÊÔÚÂÙÈÎ‹˜Â˘·ÈÛıËÛ›·˜ ÔÚÈÛÌ¤ÓˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙ· Ó¤··ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ¿ Ê¿ÚÌ·Î·, Î·ıÒ˜ Î·È ÁÈ· ÂÈ‰ËÌÈÔ-ÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂ÈÙ˘Á¯¿ÓÂÙ·È ÌÂ ÙËÓ ·Ú·Ù‹ÚËÛËÙË˜ Ì·ÎÚÔÛÎÔÈÎ‹˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ·ÔÈÎÈÒÓ ÙÔ˘Ì‡ÎËÙ·, Î·ıÒ˜ Î·È ÌÂ ÙË ÏÂÙÔÌÂÚ‹ ÌÂÏ¤ÙË ÙË˜ ÌÈ-ÎÚÔÛÎÔÈÎ‹˜ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘, ‰ËÏ. ÙË˜ ‰ÔÌ‹˜ ÙˆÓÓËÌ·Ù›ˆÓ Î·È ÙË˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÎÔÓÈ‰›ˆÓ (63,64).

™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ‚¿ÛË Ù· ÛÙ·ÙÈÛÙÈÎ¿ ÛÙÔÈ¯Â›· ÙÔ˘ ÓÔÛÔÎÔÌÂ›-

Ô˘ “∞. ™˘ÁÁÚfi˜” Î·È ÙËÓ ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Û˘-Ó¿ÁÂÙ·È fiÙÈ ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ª∆∫ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·Èo ˙ˆfiÊÈÏÔ˜ Ì‡ÎËÙ·˜ ª. canis Î·È ‰Â˘ÙÂÚÂ˘fiÓÙˆ˜ Ô·ÓıÚˆfiÊÈÏÔ˜ T. violaceum. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË,ÚfiÛÊ·Ù·, ·‡ÍËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÙÂÏÂ˘Ù·›-Ô˘, Î·ıÒ˜ Î·È Ë ·ÚÔ˘Û›· ÌË ÂÓ‰ËÌÈÎÒÓ ÂÈ‰ÒÓ ÛÙË¯ÒÚ· Ì·˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÌÂÙ·Ó·ÛÙÂ˘ÙÈÎÔ‡Î‡Ì·ÙÔ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙÒÓ ·fi ¯ÒÚÂ˜ ÙË˜ µ·Ï-Î·ÓÈÎ‹˜, ÙË˜ ∞Ó·ÙÔÏÈÎ‹˜ ∂˘ÚÒË˜, ÙË˜ ∞Û›·˜ Î·ÈÙË˜ ∞ÊÚÈÎ‹˜, fiÔ˘ Ù· Â›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó.

°È· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙË˜ ÂÍ¿ÏˆÛË˜ ÙˆÓ ª∆∫ÛÙ· ·È‰È¿ ··ÈÙÂ›Ù·È ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ·‰¤ÛÔÙˆÓ ˙ÒˆÓ Ô˘ ÓÔÛÔ‡Ó, ÛˆÛÙ‹ ˘ÁÈÂÈÓ‹ ÙˆÓÎ·ÙÔÈÎ›‰ÈˆÓ ˙ÒˆÓ ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ô˘ Â›Ó·È ˘ÁÈ-Â›˜ ÊÔÚÂ›˜ Î·È ÌÂÙ·‰›‰Ô˘Ó ÙË ÓfiÛÔ, Î·ıÒ˜ Â›ÛË˜ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙˆÓ ·ÛıÂÓÒÓ ‹ ·Û˘ÌÙˆ-Ì·ÙÈÎÒÓ ÂÓËÏ›ÎˆÓ ÙÔ˘ ÔÈÎÂ›Ô˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘·ÛıÂÓÔ‡˜.

OÈ ÎÏÈÓÈÎÔ› È·ÙÚÔ› ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙Ô˘ÓÌÂ ÚÔÛÔ¯‹ Î·È ˆ˜ Èı·Ó¤˜ ª∆∫ fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒ-ÛÂÈ˜ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜ ·È-‰ÈÒÓ ÚÔÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜, È‰È·›ÙÂÚ· ÙˆÓ ·È‰ÈÒÓÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ. £· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È Ï‹ÚÂ˜ÈÛÙÔÚÈÎfi, Ó· Á›ÓÂÙ·È Ï‹ÚË˜ Ì˘ÎËÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ-¯Ô˜ (¿ÌÂÛË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË Î·È Î·ÏÏÈ¤ÚÁÂÈ·)ÛÂ ÂÍÂÈ‰ÈÎÂ˘Ì¤Ó· ÂÚÁ·ÛÙ‹ÚÈ· Î·È Ó· ÂÏ¤Á¯ÂÙ·È ÙÔ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜ ÁÈ· Ù˘¯fiÓ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ÊÔÚÂ›˜.

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Ten-year evaluation of the initiation of a health education program in the schools of Crete* M. Linardakis, K. Sarri, F. Bervanaki, I. Markatzi, C. Hatzis, S. Flouri, A. Kafatos

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ AWARD-WINNING ARTICLE

�¶ÂÚ›ÏË„Ë: ∏ ÚfiÏË„Ë ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓÚ¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, Î·ıÒ˜ ÔÈ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘Ù¿ ÂÌ-Ê·Ó›˙ÔÓÙ·È ÔÏ‡ ÓˆÚ›˜. ™Ùfi¯Ô˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ-Á·Û›·˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-Ù·˜ ÙË˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÂ ı¤Ì·Ù·˘ÁÂ›·˜ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÎ·›‰Â˘ÛË˜ ÛÙÔ ‰ËÌÔÙÈ-Îfi, ÛÂ ÔÌ¿‰· ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ ¤Ó·Ú-ÍË ÙË˜ ·Ú¤Ì‚·ÛË˜ Î·È ÙÚ›·, ¤ÍÈ Î·È ‰¤Î· ¯ÚfiÓÈ·ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË. ∆Ô ÚfiÁÚ·ÌÌ·, ‰È¿ÚÎÂÈ·˜ 6 ÂÙÒÓ,ÍÂÎ›ÓËÛÂ ÙÔ 1992 ÛÂ 5681 Ì·ıËÙ¤˜ ÙË˜ ∞’ Ù¿ÍË˜fiÏˆÓ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ·fi ÙÚÂÈ˜ ÓÔÌÔ‡˜ÙË˜ ∫Ú‹ÙË˜. ∆· 4171 ·È‰È¿ ·ÔÙÂÏÔ‡Û·Ó ÙËÓ ÔÌ¿-‰· ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ Î·È Ù· ˘fiÏÔÈ·1510 ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ™Â ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi‰Â›ÁÌ· 40 Û¯ÔÏÂ›ˆÓ, 1046 Ì·ıËÙ¤˜ (·Ú¤Ì‚·ÛË˜:602, ÂÏ¤Á¯Ô˘: 444) ˘Ô‚Ï‹ıËÎ·Ó ÛÙÈ˜ ·ÎfiÏÔ˘ıÂ˜ÂÍÂÙ¿ÛÂÈ˜: ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜, ÏÈÔÚˆ-ÙÂ˝ÓÂ˜ ÔÚÔ‡ Î·È ·ÚÙËÚÈ·Î‹ ›ÂÛË ·›Ì·ÙÔ˜, ÂÓÒ ·-Ú¿ÏÏËÏ· ÂÎÙÈÌ‹ıËÎ·Ó Ë Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË, ÙÔ ‰È-·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi Î·È ÔÈ Û˘Ó‹ıÂÈÂ˜ ˘ÁÂ›·˜. ¢È·¯ÚÔ-ÓÈÎ¿ Î·È ‰¤Î· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔ-ÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·ÛË˜ ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ¿ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜(¢ª™) ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ (+3,3 kg/m2) ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (+4,3 kg/m2)(p<0,001). ™ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÛË-ÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË Â›‰ÔÛË ÛÙËÓÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ (p<0,001). ∏ ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfi-ÏË ÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿ ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·-Ú¤Ì‚·ÛË˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (-9% Î·È -0,5% ·ÓÙ›ÛÙÔÈ¯·, p<0,001), ÂÓÒ Ë LDL-¯ÔÏËÛÙÂÚfiÏË

�Abstract: Prevention of chronic diseases shouldstart in childhood since the risk factors related tothese diseases make their appearance at earlyages. The objective of this study was to assess thelong-term effectiveness of a health educationintervention program applied to primary schoolpupils, 10 years after the initiation of the program.The 6-year-long school-based intervention programwas applied to all students (5681) who registered inthe first grade of primary school in three counties ofCrete (intervention group: 4171, control group:1510) in 1992. A number of biochemical andbehavioural parameters (somatometric measure-ments, serum lipoproteins, blood pressure,physical activity, dietary record, health habits) weremeasured in 1046 students from 40 schoolsrandomly selected (602 intervention group and 444control group). Re-evaluation of the interventionprogram was performed at 3, 6 and 10 years afterthe initiation of the program. Ten years after theinitiation of the program, the results showed that thebody mass index (µªπ) had increased significantlyless (p<0.001) and performance in the shuttle runtest was significantly better (p<0.001) in theintervention group as compared to the controlgroup. The reduction in total cholesterol noted inboth groups was significantly greater in theintervention group than in the control group(p<0.001). The LDL decreased significantly in theintervention group, but increased in the controlgroup (p<0.001). The incidence of smoking wasalso significantly lower in the intervention group

∆ÔÌ¤·˜ ∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜ ∆Ì‹Ì· π·ÙÚÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜

*∞’ µÚ·‚Â›Ô ∫ÔÈÓˆÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2003

Department of Social Medicine Preventive Medicine and Nutrition Clinic University of Crete Medical School

*1st Prize of Social Paediatrics 41st Panhellenic Paediatric Meeting, 2003


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™˘ÓÙÔÌÔÁÚ·Ê›Â˜ ¶ OÌ¿‰· ·Ú¤Ì‚·ÛË˜ ∂ OÌ¿‰· ÂÏ¤Á¯Ô˘ ¢ª™ ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ HDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜

ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜

ÏÈÔÚˆÙÂ˚ÓÒÓ ª™ ™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

∂ÈÛ·ÁˆÁ‹∏ Ù·¯Â›· ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÓÔÛËÚfiÙËÙ·˜ Î·È

ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔÓ ÏËı˘ÛÌfi ÙË˜ ¯ÒÚ·˜ Ì·˜ Î·Ù¿ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜ (2,10) Î·ıÈÛÙ¿ ·Ó·ÁÎ·›·ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔ·ÁˆÁ‹˜ ÙË˜ ˘ÁÂ›·˜Î·È ÚfiÏË„Ë˜ ÔÏ‡ ÓˆÚ›˜ ·fi ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·(1-3,23-29).

∏ ∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›-Ô˘ ∫Ú‹ÙË˜ ÍÂÎ›ÓËÛÂ ¤Ó· ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ÂÎ·È-‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙ· Û¯ÔÏÂ›· ÙË˜ ∫Ú‹ÙË˜, ÙÔÛ¯ÔÏÈÎfi ¤ÙÔ˜ 1992-1993. ™ÙÔ ÚfiÁÚ·ÌÌ· ÁÚ¿ÊÙËÎ·ÓfiÏ· Ù· ·È‰È¿ ÙË˜ ∞’ Ù¿ÍË˜ ‰ËÌÔÙÈÎÔ‡, ÂÓÒ ÙÔ Úfi-ÁÚ·ÌÌ· ÂÓÙ¿¯ıËÎÂ ÛÙËÓ ÂÎ·È‰Â˘ÙÈÎ‹ ‰È·‰ÈÎ·Û›· ÛÂ‰È·Û‡Ó‰ÂÛË ÌÂ ¿ÏÏ· Ì·ı‹Ì·Ù·. ∏ ÂÎ·È‰Â˘ÙÈÎ‹ ·-Ú¤Ì‚·ÛË ÂÛÙÈ¿ÛÙËÎÂ Î˘Ú›ˆ˜ ÛÙË ‰È·ÙÚÔÊ‹, ÙË Ê˘ÛÈ-Î‹ ¿ÛÎËÛË Î·È ÙËÓ ·ÔÊ˘Á‹ ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ.

∏ ÚÒÙË ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¤ÁÈÓÂÛÙ· 3 ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ (4,5) Î·È Ë‰Â‡ÙÂÚË ¤ÁÈÓÂ ÌÂ ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙÔ˘ ÛÙ· 6 ¯ÚfiÓÈ·(6-9). ∞ÎÔÏÔ‡ıËÛÂ Ë ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË, 4 ¯ÚfiÓÈ· ÌÂ-Ù¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ·Ú¤Ì‚·ÛË˜ Î·È ÂÓÒ Ù· ·È‰È¿ ‹Ù·ÓËÏÈÎ›·˜ 14-16 ÂÙÒÓ. ∏ ·ÚÔ‡Û· ¤ÚÂ˘Ó· ÛÙÔ¯Â‡ÂÈÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙË˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙË˜ Î·È 4 ¯ÚfiÓÈ· ·fi ÙË‰È·ÎÔ‹ ÙË˜ ·ÁˆÁ‹˜ ˘ÁÂ›·˜.

°È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÏÂÙ‹-ıËÎ·Ó Ù· Â›Â‰· ˘ÁÂ›·˜, ıÚ¤„Ë˜ Î·È ·Ó¿Ù˘ÍË˜ÙˆÓ ·È‰ÈÒÓ Î·È Ë ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ∆Ô ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÂ Û¯ÔÏÂ›·

ÙË˜ ∫Ú‹ÙË˜ ¿Ú¯ÈÛÂ ÌÂ fiÏ· Ù· ·È‰È¿ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ÙÔ 1992-1993 ÛÂ ÙÚÂÈ˜ ÓÔÌÔ‡˜ ÙË˜ ∫Ú‹ÙË˜.∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·-ÎÏÂ›Ô˘, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ Î·È ÙˆÓ 5681 Ì·ıËÙÒÓ Ô˘ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË, ÂÂÏ¤ÁË ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ·40 Û¯ÔÏÂ›ˆÓ ÌÂ 1046 Ì·ıËÙ¤˜ ËÏÈÎ›·˜ 5,5-7 ÂÙÒÓ, ÔÈ ÔÔ›ÔÈ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Ï‹ÚË ¤ÏÂÁ¯Ô ÙË˜ ˘ÁÂ›·˜ ÙÔ˘˜. ∞fi Ù· 40Û¯ÔÏÂ›·, Ù· 24 ‹Ù·Ó ·fi ÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏÂ›Ô˘ Î·È ƒÂı‡-ÌÓÔ˘ ÌÂ 602 Ì·ıËÙ¤˜ [ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ (¶)] Î·È Ù· 16·fi ÙÔÓ ÓÔÌfi Ã·Ó›ˆÓ ÌÂ 444 Ì·ıËÙ¤˜ [ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (∂)].∏ ÌÂıÔ‰ÔÏÔÁ›· ÙË˜ ¤ÚÂ˘Ó·˜, Ë ÂÎ·È‰Â˘ÙÈÎ‹ ‰È·‰ÈÎ·Û›· Î·ÈÔÈ ÂÚÈÔ‰ÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜ Ô˘ ¤ÁÈÓ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙˆÓ ¤ÍÈ ÂÙÒÓ ÂÊ·ÚÌÔÁ‹˜ ÙË˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜(1992-1998), ÂÚÈÁÚ¿ÊÔÓÙ·È Ï‹Úˆ˜ ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ÂÚ-Á·Û›Â˜ (4-9).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜ 2001-2002, Ù· ·È-‰È¿ Ô˘ Â›¯·Ó Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙÔ ÚfiÁÚ·ÌÌ· ÙÔ 1992 ÂÓÙÔ›-ÛÙËÎ·Ó ÛÂ 63 Û¯ÔÏÂ›· ÛÙÔ˘˜ ÙÚÂÈ˜ ÓÔÌÔ‡˜ ÙË˜ ∫Ú‹ÙË˜. OÈÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÁÚ·ÙÒ˜ ÁÈ· ÙÈ˜ ÂÍÂÙ¿-ÛÂÈ˜ ÙË˜ Â·Ó·ÍÈÔÏfiÁËÛË˜ Î·È ˘¤ÁÚ·„·Ó ˘Â‡ı˘ÓË ‰‹ÏˆÛËÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.

∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ·fi ÙÔ1992 ¤ˆ˜ ÙÔ 1998, ÙÔ 2002 ·¿ÓÙËÛ·Ó 728 ·È‰È¿ (70%), Ù·49 ÂÎ ÙˆÓ ÔÔ›ˆÓ Â›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜. ∂‚‰ÔÌ‹-ÓÙ· ÂÙ¿ ·È‰È¿ ·ÚÓ‹ıËÎ·Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜, ÂÓÒ 651 ‰¤-¯ÙËÎ·Ó. ™ÙËÓ È·ÙÚÈÎ‹ ÂÍ¤Ù·ÛË ÚÔÛ‹Ïı·Ó, ÙÂÏÈÎ¿, 634 ·È‰È¿(61%) (¶: 331, ∂: 303), ÂÓÒ ÌfiÏÈ˜ 7 ·fi Ù· 49 ·È‰È¿ Ô˘ Â›-¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜ ÚÔÛ‹Ïı·Ó ÛÙÈ˜ ÂÍÂÙ¿ÛÂÈ˜.

OÈ ÂÍÂÙ¿ÛÂÈ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÙÔ 2002 ·fi ÙËÓÂÚÂ˘ÓËÙÈÎ‹ ÔÌ¿‰· ÙË˜ ∫ÏÈÓÈÎ‹˜ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·-ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜, ·ÊÔÚÔ‡Û·Ó ÛÂ ÛˆÌ·ÙÔ-ÌÂÙÚÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜, ·ÚÙËÚÈ·Î‹ ›ÂÛË ·›Ì·ÙÔ˜, ·ÈÌÔÏË„›· ÁÈ·ÏÈÔÚˆÙÂ˝ÓÂ˜, ·ÍÈÔÏfiÁËÛË ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÌÂ ·-Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶∆∞), Ï‹„Ë ‰È·ÈÙÔÏÔÁ›Ô˘ ÚÔË-ÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘ Î·È ˙˘ÁÈÛÌ¤ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Î·È

ÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ Î·È·˘Í‹ıËÎÂ ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (-10% Î·È +5%·ÓÙ›ÛÙÔÈ¯·, p<0,001). ∂›ÛË˜, ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂ-ÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜ ·Ú¤Ì‚·ÛË˜ Î¿-ÓÈ˙Â ÙÔ 2002 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘(7% Î·È 13% ·ÓÙ›ÛÙÔÈ¯·, p<0,05). ∏ ÂÎ·È‰Â˘ÙÈÎ‹·Ú¤Ì‚·ÛË Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙÔ Â›Â‰Ô ˘ÁÂ›-·˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈÎ¿ ÙÔ˘˜ ·-Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. ∂¿Ó ·˘-Ù¤˜ ÔÈ ıÂÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ Û˘ÓÂ¯ÈÛÙÔ‡Ó ÙÈ˜ ÂfiÌÂ-ÓÂ˜ ‰ÂÎ·ÂÙ›Â˜, ›Ûˆ˜ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ÌÂ›ˆÛË ÙÔ˘ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·È‰È¿, ·ÁˆÁ‹ ˘ÁÂ›·˜, ÏÈÔÚˆ-ÙÂ˝ÓÂ˜, ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜, Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË.

(intervention group: 7%, control group 13%,p<0.005). This health and nutrition educationprogram appears to improve children’s health andto decrease risk factors for chronic diseases. Ifthese positive effects are maintained in theforthcoming decades, the risk of chronic diseasesmay well be reduced.

Key words: children, health and nutrition education,lipoproteins, anthropometric measurements, fitness.


438

Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÙˆÓ Û˘ÓËıÂÈÒÓ ˘ÁÂ›·˜, Î·ıÒ˜Î·È ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. °È· ÙÈ˜ Û˘Ó‹ıÂÈÂ˜ Î·È ÙÈ˜ ÁÓÒÛÂÈ˜ ˘ÁÂ›-·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·Ó·ÊÂÚfiÙ·Ó ÛÙÔÎ¿ÓÈÛÌ·, ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ‡Ì·ÙÔ˜ Î·È Î·Ê¤, ÛÙËÓÎ·Ù·ÁÚ·Ê‹ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È ÛÙÈ˜ ÁÓÒÛÂÈ˜ ÛÂ ı¤Ì·Ù·‰È·ÙÚÔÊ‹˜ Î·È ˘ÁÂ›·˜.

∏ ·Ó¿Ï˘ÛË ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ¤ÁÈÓÂ ·fi ËÏÂÎÙÚÔÓÈÎ‹ ‚¿-ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ, ‚·ÛÈÛÌ¤ÓË ÙfiÛÔ ÛÙË ‚¿ÛË ÙÔ˘ÀÔ˘ÚÁÂ›Ô˘ °ÂˆÚÁ›·˜ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ (UnitedStates Department of Agriculture - USDA) fiÛÔ Î·È ÛÙË ¯ËÌÈ-Î‹ ·Ó¿Ï˘ÛË 120 ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ¤ÁÈÓÂ ÛÙÔ TNONutrition Institute ÛÙËÓ OÏÏ·Ó‰›· ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ Â˘Úˆ·˚-ÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Transfair, ÂÓÒ 20 ÙÚfiÊÈÌ· ·Ó·Ï‡ıËÎ·Ó¯ËÌÈÎ¿ ÛÙÔ Wegeningen Agricultural University. ∞fi Ù· 634·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 2002, Ù· 617 Û˘ÌÏ‹ÚˆÛ·Ó ‰È·È-ÙËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (¶: 329, ∂: 288), ÂÓÒ 107·È‰È¿ Û˘ÌÏ‹ÚˆÛ·Ó Î·È Â¤ÛÙÚÂ„·Ó ‰È·ÈÙÔÏfiÁÈÔ ˙˘ÁÈÛÌ¤-ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ (¶: 77, ∂: 30).

∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËÎÂ ÌÂ ËÏÂÎÙÚÔÓÈÎfi ˙˘Áfi Ù‡-Ô˘ Seca Alpha ·ÎÚÈ‚Â›·˜ ±100 g Î·È Ë ˙‡ÁÈÛË ¤ÁÈÓÂ ÌÂ ÂÛÒ-ÚÔ˘¯·, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËÎÂ ÌÂ ·Ó·ÛÙËÌfi-ÌÂÙÚÔ ·ÎÚÈ‚Â›·˜ <0,5 cm, ÛÂ fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·,ÌÂ ¯·Ï·ÚÔ‡˜ ÒÌÔ˘˜ Î·È Ù· ¯¤ÚÈ· ÙÔÔıÂÙËÌ¤Ó· ÛÙÔ Ï¿È. O‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙË Û¯¤ÛËÙÔ˘ ‚¿ÚÔ˘˜ ÛÂ ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ ÛÂ Ì¤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ(kg/m2). ªÂ ‚¿ÛË ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËÎÂÎ·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘-Û·ÚÎ›· (22). OÈ ‰ÂÚÌ·ÙÈÎ¤˜ Ù˘¯¤˜ ‰ÈÎ¤Ê·ÏÔ˘, ÙÚÈÎ¤Ê·ÏÔ˘,Ï·ÁÔÓ›Ô˘ Î·È ˆÌÔÏ¿ÙË˜ ÌÂÙÚ‹ıËÎ·Ó ÌÂ fiÚÁ·ÓÔ Ù‡Ô˘Lange. ∆Ô ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËÎÂ ÌÂ ‚¿ÛËÙÔÓ ¢ª™, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›· (21). ∏ ÂÚ›ÌÂÙÚÔ˜ ÙË˜ Ì¤-ÛË˜ ÌÂÙÚ‹ıËÎÂ ÌÂ Ï·ÛÙÈÎ‹ ÌÂÙÚÈÎ‹ Ù·ÈÓ›· ÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÌ-Ê·ÏÔ‡ Î·È Î¿ÙˆıÂÓ ÙÔ˘ ÏÂ˘ÚÈÎÔ‡ ÙfiÍÔ˘ (ÛÙÔ Ì¤ÛÔ ÙË˜ ·fi-ÛÙ·ÛË˜ ÌÂÙ·Í‡ ÏÂ˘ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘ ·ÎÚÔÏÔÊ›·˜)Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÏÂÎ¿ÓË˜ ÛÙÔ ‡„Ô˜ ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒ-ÛÂˆÓ Î·È ¿ÓˆıÂÓ ÙÔ˘ ÂÊË‚·›Ô˘. OÈ Û¯¤ÛÂÈ˜ ÙË˜ ÂÚÈÌ¤ÙÚÔ˘Ì¤ÛË˜ ÚÔ˜ ÏÂÎ¿ÓË Î·È ÚÔ˜ ‡„Ô˜ ˘ÔÏÔÁ›ÛÙËÎ·Ó ·fi ÙÈ˜·Ú·¿Óˆ ÌÂÙÚ‹ÛÂÈ˜ (11). ™ÙË Ì¤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈ-ÎÒÓ ÌÂÁÂıÒÓ Û˘ÌÌÂÙÂ›¯·Ó 617 ·È‰È¿.

∏ Û˘ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÌÂÙÚ‹ıËÎÂÛÂ 622 ·È‰È¿ ÌÂ ˘‰Ú·ÚÁ˘ÚÈÎfi Ì·ÓfiÌÂÙÚÔ ÙÚÂÈ˜ ÊÔÚ¤˜, ÌÂÌÂÛÔ‰È¿ÛÙËÌ· 1-2 min (12). ∫¿ıÂ ·È‰› ‚ÚÈÛÎfiÙ·Ó ÛÂ Î·ıÈ-ÛÙ‹ ı¤ÛË ÌÂ ÙËÓ Ï¿ÙË Î·È Ù· ¯¤ÚÈ· ÛÙËÚÈÁÌ¤Ó· ÛÙ· ÁfiÓ·Ù·Î·È ÛÂ Î·Ù¿ÛÙ·ÛË ËÚÂÌ›·˜ ÚÈÓ ·fi ÙË Ì¤ÙÚËÛË ÁÈ· ÙÔ˘Ï¿-¯ÈÛÙÔÓ 5 min. ∞fi ÙÈ˜ ÙÚÂÈ˜ ·˘Ù¤˜ ÌÂÙÚ‹ÛÂÈ˜ ÂÏ‹ÊıË Ô Ì¤ÛÔ˜fiÚÔ˜. ∏ ·ÚÙËÚÈ·Î‹ ›ÂÛË Â›¯Â ÌÂÙÚËıÂ› Î·È Î·Ù·ÁÚ·ÊÂ› Î·-Ù¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙÔ 1992 ÛÂ 932 ·È‰È¿.

¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi 556 ·È‰È¿ ÙÈ˜ ÚˆÈ-Ó¤˜ ÒÚÂ˜ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙÂ›· Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈÎ‹¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (Trigl) Î·È Ë HDL-¯ÔÏË-ÛÙÂÚfiÏË. ∏ LDL-¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙÔÓ Ù‡ÔLDL=TC-(Trigl/5+HDL), ÂÓÒ Ô ·ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ ˘Ô-ÏÔÁ›ÛÙËÎÂ ·fi ÙÔ ËÏ›ÎÔ ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ ÙËÓHDL-¯ÔÏËÛÙÂÚfiÏË (4).

∆¤ÏÔ˜, Ë ÂÎÙ›ÌËÛË ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÌÂ ÙÔ ·Ï›Ó-‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ¤ÁÈÓÂ ÛÂ 421 ·È‰È¿ (4-6).

∏ ¤ÁÎÚÈÛË ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙˆÓ Â-ÚÈÔ‰ÈÎÒÓ ·ÍÈÔÏÔÁ‹ÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ ÂÏ‹ÊıË ·fi ÙÔÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ÂÓÒfiÏÔÈ ÔÈ ÁÔÓÂ›˜ ¤‰ˆÛ·Ó ÂÓ˘fiÁÚ·ÊË ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›-ÓÂÛË ÁÈ· ÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛËOÈ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜, ÔÈ ÏÈÔÚˆÙÂ˝ÓÂ˜, Ë ·Ú-

ÙËÚÈ·Î‹ ›ÂÛË ·›Ì·ÙÔ˜, Ë ‰ÔÎÈÌ·Û›· ·ÓÙÔ¯‹˜ Î·È Ë ÚfiÛÏË-„Ë ‰È·ÈÙËÙÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÁÈ· ÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜(·Ú¤Ì‚·ÛË˜ Î·È ÂÏ¤Á¯Ô˘) ÁÈ· ÙÈ˜ ÂÚÈfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛË˜1995, 1998 Î·È 2002 ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ1992. ªÂ ÙË ¯Ú‹ÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÁÚ·ÌÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ ·Ó¿-Ï˘ÛË˜ Û˘Ó‰È·Î‡Ì·ÓÛË˜ (ANCOVA) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡-ÏÔ˘ Î·È ¢ª™, ÂÏ¤Á¯ıËÎÂ Ë ‡·ÚÍË ‹ ÌË ‰È·ÊÔÚ¿˜ ÌÂÙ¿ 10¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ¶·Ú¿ÏÏËÏ· ÌÂÙË ¯Ú‹ÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÌÔÓÙ¤ÏÔ˘ ·Ó¿Ï˘ÛË˜ Û˘Ó‰È·Î‡Ì·Ó-ÛË˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM-Repeatedmeasures analysis) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘ Î·È Ì¤ÛË˜‰È·ÊÔÚ¿˜ ¢ª™ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË, ÂÏ¤Á¯ıËÎÂ Ë ‰È·-ÊÔÚÔÔ›ËÛË ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·ÛË˜ Î·È ÂÏ¤Á¯Ô˘ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛË˜. OÈ ¤ÏÂÁ¯ÔÈ ¤ÁÈÓ·Ó ÛÙÈ˜‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ 1992 ÌÂÙËÓ Î¿ıÂ ÂÚ›Ô‰Ô ·ÍÈÔÏfiÁËÛË˜.

°È· ÙÔÓ ¤ÏÂÁ¯Ô ˙Â˘ÁÒÓ ·Ú·ÙËÚ‹ÛÂˆÓ (Student pairedsamples t-test) Û˘ÁÎÚ›ıËÎ·Ó Ù· 107 ‰È·ÈÙÔÏfiÁÈ· 3 ËÌÂÚÒÓ ÌÂÙ· ·ÓÙ›ÛÙÔÈ¯· ‰È·ÈÙÔÏfiÁÈ· ÙÔ˘ 24ÒÚÔ˘ Î·Ù¿ ÙËÓ ÙÚ›ÙË ·ÍÈÔ-ÏfiÁËÛË ÙÔ 2002. ¶·Ú¿ÏÏËÏ· ÌÂ ÙË ¯Ú‹ÛË ÂÏ¤Á¯Ô˘ ·Ó¿Ï˘ÛË˜Û˘Ó‰È·Î‡Ì·ÓÛË˜ (ANCOVA) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘,¢ª™, ËÏÈÎ›·˜ Î·È ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, ¤ÁÈÓÂ Û‡ÁÎÚÈÛËÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ, ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ·›Ì·ÙÔ˜, ÙˆÓÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂÍ›Ì·ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ·È‰ÈÒÓ ÂÎÂ›ÓˆÓ Ô˘ Â¤ÛÙÚÂ„·Ó Ù· 107 ‰È·ÈÙÔÏfiÁÈ· ˙˘ÁÈ-ÛÌ¤ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ, ÌÂ Ù· ˘fiÏÔÈ· 498 ·È‰È¿ ÛÙ·ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙÔÏfiÁÈÔ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘.

O ¯2 ¤ÏÂÁ¯Ô˜ (Chi-square test) ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÙË‰È·ÊÔÚ¿ Û˘¯ÓÔÙ‹ÙˆÓ ÛÙÔ Î¿ÓÈÛÌ· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÁÔ-Ó¤ˆÓ ÙÔ˘˜, ÂÓÒ Ô ÌË ·Ú·ÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ Mann-WhitneyÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ‰È¿ÚÎÂÈ·˜ Î·È ÙË˜ ÔÛfiÙËÙ·˜ ÙÔ˘ Î·Ó›-ÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜.

∞ÔÙÂÏ¤ÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ô Û¯Â‰È·ÛÌfi˜ ÙÔ˘

ÚÔÁÚ¿ÌÌ·ÙÔ˜, fiˆ˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ ÛÙ· 10 ¯ÚfiÓÈ··fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘. ∏ ÂÎ·È‰Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË‰È¿ÚÎÂÈ·˜ 6 ÂÙÒÓ ÔÏÔÎÏËÚÒıËÎÂ ÙÔ 1998 Î·È ·ÎÔ-ÏÔ‡ıËÛÂ Ë ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ÙÔ 2002. ∞fi Ù· 1046 ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·ÓÛÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ 1992, 471 ·È‰È¿ Û˘ÌÌÂ-ÙÂ›¯·Ó ÙÔ 1995 ÛÙËÓ 1Ë ·ÍÈÔÏfiÁËÛË (45% ÙÔ˘ ·Ú¯È-ÎÔ‡ ‰Â›ÁÌ·ÙÔ˜), 831 ·È‰È¿ (79%) Û˘ÌÌÂÙÂ›¯·Ó ÛÙË2Ë ·ÍÈÔÏfiÁËÛË ÙÔ 1998 Î·È, Ù¤ÏÔ˜, 634 ·È‰È¿(61%) Û˘ÌÌÂÙÂ›¯·Ó ÛÙËÓ 3Ë ·ÍÈÔÏfiÁËÛË ÙÔ 2002.


439

™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â›Â‰· ÙˆÓÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ÙˆÓ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 1992 Î·È ÙÔ 2002. ∏ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËÎÂ ÛÂ ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·-Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (¶: -24,0±1,7 mg/dL,E: -10,1±1,8 mg/dL, p<0,001), fiˆ˜ Î·È Ë LDL-¯Ô-ÏËÛÙÂÚfiÏË (¶: -18,5±1,4 mg/dL, E: -3,1±1,6 mg/dL,p<0,001). O ·ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ ·˘Í‹ıËÎÂ ÛËÌ·-

ÓÙÈÎ¿ ÏÈÁfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ (¶:0,06±0,05, E: 0,29±0,05, p<0,01), ÂÓÒ ‰ÂÓ ˘‹ÚÍÂÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÌÂÙ·Í‡ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ.

O ¶›Ó·Î·˜ 3 ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÈ˜ ÌÂÙ·‚ÔÏ¤˜ ÛÙÈ˜ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜ Î·È ÛÙË ‰ÔÎÈÌ·Û›··ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ 1992 Î·È ÙÔ 2002. ∆Ô ‚¿-ÚÔ˜ Î·È Ô ¢ª™ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ÂÚÈÛÛfiÙÂÚÔÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰·

¶›Ó·Î·˜ 1. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘ÁÂ›·˜ ÛÙ· Û¯ÔÏÂ›· ÙË˜ ∫Ú‹ÙË˜

∞•πO§O°∏™∏1992 1Ë: 1995 2Ë: 1998 3Ë: 2002

(∞ƒÃ∏ ¶∞ƒ∂ªµ∞™∏™) (∆∂§O™ ¶∞ƒ∂ªµ∞™∏™) °’ °˘ÌÓ·Û›Ô˘ & ∞’ ¢ËÌÔÙÈÎÔ‡ °’ ¢ËÌÔÙÈÎÔ‡ ™∆’ ¢ËÌÔÙÈÎÔ‡ ∞’ §˘ÎÂ›Ô˘

ñ ∏ÏÈÎ›· (¤ÙË) 6,3±0,4* 8,6±0,3* 11,6±0,3* 15,1±0,5*ñ OÌ¿‰· ·Ú¤Ì‚·ÛË˜

ª·ıËÙ¤˜ ∞’ Ù¿ÍË˜ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÙË˜ ∫Ú‹ÙË˜ 4171ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó 602** 288** 457** 331**™¯ÔÏÂ›· 24 12 24 37

ñ OÌ¿‰· ÂÏ¤Á¯Ô˘ª·ıËÙ¤˜ ∞’ Ù¿ÍË˜ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÙË˜ ∫Ú‹ÙË˜ 1510ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó 444** 183** 374* 303**™¯ÔÏÂ›· 16 9 16 26

ñ ™‡ÓÔÏÔª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó 1046 471 831 634

∞ÁfiÚÈ· 545 242 427 302∫ÔÚ›ÙÛÈ· 501 229 404 332

™¯ÔÏÂ›· 40 21 42 63

* ª¤ÛÔ˜ fiÚÔ˜ ± Ù˘ÈÎ‹ ·fiÎÏÈÛË ** ∂ÈÏÂÁÌ¤ÓÔ Ù˘¯·›Ô ‰Â›ÁÌ· ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡

¶›Ó·Î·˜ 2. ªÂÙ·‚ÔÏ¤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·ÛË˜ Î·È ÂÏ¤Á¯Ô˘ ÛÂ‰È¿ÛÙËÌ· 10 ÂÙÒÓ

∞ƒÃ∏ 3Ë ·ÍÈÔÏfiÁËÛË1992 2002 ªÂÙ·‚ÔÏ‹ p**

¡ ª¤ÛÔ˜ ± ∆™

OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (mg/dL) ¶* 255 188,1±1,9 164,1±1,8 -24,0±1,7 <0,001∂* 214 176,0±2,1 165,9±1,9 -10,1±1,8

∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) ¶ 255 52,9±1,3 66,9±1,7 13,9±1,8 ª™***∂ 214 52,9±1,4 64,8±1,8 11,9±1,9

HDL-C (mg/dL) ¶ 255 60,5±0,9 51,9±0,7 -8,5±0,8 ª™∂ 214 59,7±0,9 50,3±0,7 -9,3±0,9

LDL-C (mg/dL) ¶ 255 117,2±1,8 98,7±1,5 -18,5±1,4 <0,001∂ 214 105,7±1,9 102,6±1,6 -3,1±1,6

∞ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜: ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË/HDL-C ¶ 255 3,22±0,05 3,28±0,05 0,06±0,05 0,001

∂ 214 3,11±0,06 3,40±0,05 0,29±0,05™˘ÛÙÔÏÈÎ‹ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg) ¶ 274 100,4±0,6 117,6±0,7 17,2±0,8 ª™

∂ 244 104,4±0,7 120,8±0,7 16,5±0,8¢È·ÛÙÔÏÈÎ‹ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg) ¶ 274 58,6±0,5 71,5±0,6 12,9±0,7 ª™

∂ 244 60,0±0,5 74,9±0,6 14,9±0,8

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜, ∂: ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÛÙË ‰È·ÊÔÚ¿ ÙË˜ 3Ë˜ ·ÍÈÔÏfiÁËÛË˜ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (∞ƒÃ∏)

Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (1992) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿


440

·Ú¤Ì‚·ÛË˜ (¶: 38,4±0,8 kg, ∂: 42,5±0,7 kg,p<0,001 Î·È ¶: 5,9±0,2 kg/m2, ∂: 6,9±0,2 kg/m2,p<0,01, ·ÓÙ›ÛÙÔÈ¯·). OÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙËÓ ÂÚ›ÌÂÙÚÔÌ¤ÛË˜ (¶: 20,1±0,5 cm, ∂: 20,8±0,5 cm) Î·È ÛÙÔ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶: 2,3±0,1 ÛÙ¿‰È·,∂: 2,1±0,1 ÛÙ¿‰È·) ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂÙ·-Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ.

™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â›Â‰· Úfi-ÛÏË„Ë˜ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ. §fiÁˆ ÙÔ˘ ÌÈ-ÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ ÌÂ ˙˘ÁÈÛÌ¤ÓÔ Ê·-ÁËÙfi 3 ËÌÂÚÒÓ (Ó=107) Ô˘ ÂÈÛÙÚ¿ÊËÎ·Ó ÙÔ2002, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙÈ˜ ·Ú·Î¿Ùˆ Û˘Û¯Â-Ù›ÛÂÈ˜ Ù· ‰Â‰ÔÌ¤Ó· ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ÙÂÏÂ˘-Ù·›Ô˘ 24ÒÚÔ˘ (Ó=617). °È· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ·ÍÈÔÈ-ÛÙ›·˜ ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘,¤ÁÈÓÂ Û‡ÁÎÚÈÛË ˙Â˘ÁÒÓ ‰È·ÈÙÔÏÔÁ›ˆÓ ÛÙ· ›‰È· ·È-‰È¿ (Student paired samples t-test) ÌÂÙ·Í‡ ÙˆÓ 107‰È·ÈÙÔÏÔÁ›ˆÓ 3 ËÌÂÚÒÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ 107ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘. O ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ fiÙÈ ÛÙËÓÙÚ›ÙË ·ÍÈÔÏfiÁËÛË (2002) ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈÎ¤˜‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ù‡ˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ, ·-Ú¿ ÌfiÓÔ ÛÙËÓ ÚfiÛÏË„Ë ÓÈ·Û›ÓË˜ (24ˆÚÔ:19,1±1,0 mg, 3 ËÌÂÚÒÓ: 17,0±0,7 mg, p<0,05),ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ˆ˜ ÔÛÔÛÙÔ‡ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 16,2±0,5%, 3 ËÌÂÚÒÓ:17,9±0,4%, p<0,01) Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ, Â›ÛË˜ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ:4,7±0,2%, 3 ËÌÂÚÒÓ: 5,2±0,2%, p<0,05). ∏ Û‡-

ÁÎÚÈÛË ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜, ·ÚÙË-ÚÈ·Î‹ ›ÂÛË, ÏÈÔÚˆÙÂ˝ÓÂ˜ Î·È ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈ-ÌÔ ·ÓÙÔ¯‹˜) ÙˆÓ 107 ·È‰ÈÒÓ Ô˘ Â¤ÛÙÚÂ„·Ó ‰È-·ÈÙÔÏfiÁÈ· ˙˘ÁÈÛÌ¤ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ ÌÂ ÂÎÂ›-ÓÂ˜ ÙˆÓ 510 ·È‰ÈÒÓ ·fi Ù· ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙË-ÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, ¤‰ÂÈÍÂ fiÙÈ ˘‹Ú-ÍÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌfiÓÔ ÛÙÔ ‡„Ô˜ (·È‰È¿ ÌÂ‰È·ÈÙÔÏfiÁÈÔ 3 ËÌÂÚÒÓ: 165,9±0,7 cm, ·È‰È¿ ÌÂ ‰È-·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 167,5±0,3 cm, p<0,05) Î·ÈÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (·È‰È¿ ÌÂ ‰È·ÈÙÔÏfiÁÈÔ 3ËÌÂÚÒÓ: 54,0±1,1 mg/dl, ·È‰È¿ ÌÂ ‰È·ÈÙÔÏfiÁÈÔ24ÒÚÔ˘: 50,5±0,5 mg/dl, p<0,01). ∆· 107 ‰È·ÈÙÔ-ÏfiÁÈ· 3 ËÌÂÚÒÓ ÚÔ¤Ú¯ÔÓÙ·È ÛÂ ÔÛÔÛÙfi 17% ·fi·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ Î·È ÛÂ ÔÛÔÛÙfi 83% ·fi ·ÛÙÈ-Î¤˜-ËÌÈ·ÛÙÈÎ¤˜, ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· 510 ÙÂÏÂ˘Ù·›Ô˘24ÒÚÔ˘, Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È ÛÂ ÔÛÔÛÙfi 30%·fi ·ÁÚÔÙÈÎ¤˜ Î·È Î·Ù¿ 70% ·fi ·ÛÙÈÎ¤˜-ËÌÈ·ÛÙÈ-Î¤˜ ÂÚÈÔ¯¤˜ (¯2, p<0,01).

™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·-ÛË˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛËÛÙËÓ ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ, ÌÔÓÔ·ÎfiÚÂÛÙˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ, Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜, ‚ÈÙ·Ì›ÓË˜ C Î·È‚ÈÙ·Ì›ÓË˜ µ2, ÂÓÒ Ë ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ÔÏÈÎ‹˜ ÂÓ¤ÚÁÂÈ·˜ Î·È transÏÈ·ÚÒÓ ÔÍ¤ˆÓ.

™ÙÔ˘˜ ¶›Ó·ÎÂ˜ 5 Î·È 6 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂ-ÙÚ‹ÛÂÈ˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂ-ˆÓ Î·È ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂÍ›Ì·ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ

¶›Ó·Î·˜ 3. ªÂÙ·‚ÔÏ¤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·ÛË˜ Î·È ÂÏ¤Á-¯Ô˘ ÛÂ ‰È¿ÛÙËÌ· 10 ÂÙÒÓ


¡ ª¤ÛÔ˜ ± ∆™

µ¿ÚÔ˜ (kg) ¶* 291 22,8±0,3 61,1±0,8 38,4±0,8 <0,001∂* 265 24,3±0,3 66,6±0,9 42,5±0,7

⁄„Ô˜ (cm) ¶ 291 118,4±0,3 165,7±0,4 47,3±0,3 ª™***∂ 265 121,5±0,3 169,1±0,5 47,6±0,3

¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ 298 16,2±0,1 22,1±0,2 5,9±0,2 0,001∂ 265 16,3±0,1 23,1±0,3 6,9±0,2

¶ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ (cm) ¶ 288 54,2±0,3 74,3±0,6 20,1±0,5 ª™∂ 265 55,7±0,3 76,5±0,6 20,8±0,5

¢Â›ÎÙË˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜/ÏÂÎ¿ÓË˜ ¶ 287 0,86±0,003 0,78±0,004 -0,07±0,005 ª™∂ 265 0,85±0,003 0,79±0,005 -0,06±0,005

¢Â›ÎÙË˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜/‡„Ô˜ ¶ 287 0,46±0,002 0,45±0,003 -0,01±0,003 ª™∂ 265 0,46±0,002 0,45±0,003 -0,01±0,003

ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm) ¶ 275 29,6±0,9 60,5±1,7 30,9±1,3 ª™∂ 247 31,6±1,0 60,1±1,8 28,6±1,4

¶ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ (%) ¶ 291 19,7±0,2 22,2±0,3 2,5±0,3 ª™∂ 265 19,9±0,2 22,1±0,4 2,2±0,3

¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·) ¶ 133 1,7±0,1 4,0±0,1 2,3±0,1 ª™∂ 169 1,8±0,1 3,9±0,1 2,1±0,1

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜, ∂: ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÛÙË ‰È·ÊÔÚ¿ ÙË˜ 3Ë˜ ·ÍÈÔÏfiÁËÛË˜ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (∞ƒÃ∏)

Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıË-ÎÂ ÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜)

*** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

·È‰ÈÒÓ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜ ÙË˜ ·Ú¯È-Î‹˜ ÂÍ¤Ù·ÛË˜ ÙÔ 1992 Î·È ÙˆÓ ÂfiÌÂÓˆÓ ÙÚÈÒÓ·ÍÈÔÏÔÁ‹ÛÂˆÓ.

∞fi ÙÔÓ ¶›Ó·Î· 5 ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ÔÌ¿‰··Ú¤Ì‚·ÛË˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏË˜, ¤Ó·-ÓÙÈ ·‡ÍËÛË˜ ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ∂›ÛË˜, Ë ÔÌ¿‰··Ú¤Ì‚·ÛË˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚË ·‡ÍËÛËÛÙÔÓ ·ıËÚˆÌ·ÙÈÎfi ‰Â›ÎÙË (ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏËÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË), ÂÓÒ ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÛÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÛÙËÓHDL-¯ÔÏËÛÙÂÚfiÏË.

™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ÂÏ¤Á¯Ô˘·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙÔ‚¿ÚÔ˜, ÛÙÔÓ ¢ª™, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ÚÔ˜ ‡„Ô˜ Î·È ÛÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜, ÂÓÒ·ÓÙ›ıÂÙ· ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ·ÚÔ˘-ÛÈ¿˙ÂÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ ÛÙÔ ‡„Ô˜ Î·È ÛÙÔ ·-Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜. ¢ÂÓ ÛËÌÂÈÒÓÔÓÙ·È ÛË-Ì·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙËÓÂÚ›ÌÂÙÚÔ Ì¤ÛË˜, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜

ÚÔ˜ ÏÂÎ¿ÓË Î·È ÛÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓÙ˘¯ÒÓ.

™ÙËÓ ∂ÈÎfiÓ· 1 ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰È·¯ÚÔÓÈÎ¿ ÔÈ ÌÂ-Ù·‚ÔÏ¤˜ ÛÙËÓ ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™ Î·ÈÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÙˆÓ ‰È·ÊfiÚˆÓÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛË˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·Ú¯ÈÎ‹ ÙÔ1992.

∞fi ÙÔ ÌÂÙ·‚·ÏÏfiÌÂÓÔ ‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ Ô˘ÂÍÂÙ¿ÛÙËÎ·Ó ÛÂ Î¿ıÂ ÂÚ›Ô‰Ô, fiˆ˜ ·˘Ùfi Ê·›ÓÂÙ·ÈÛÙÔÓ ¶›Ó·Î· 1, ‚Ú¤ıËÎÂ fiÙÈ ÙÔ 20,5% ÙÔ˘ Û˘ÓfiÏÔ˘ÙˆÓ ·È‰ÈÒÓ Â›¯Â ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜ (¯2 ¤ÏÂÁ¯Ô˜, ¶:19,2%, E: 21,9%, ª™) Î·È ÙÔ 8,3% Â›¯Â ·¯˘Û·ÚÎ›·(¯2 ¤ÏÂÁ¯Ô˜, ¶: 6,9%, ∂: 9,7%, ª™).

™ÙÔÓ ¶›Ó·Î· 7 Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ Û˘Ó‹ıÂÈÂ˜ Î·-Ó›ÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜, Î·ıÒ˜Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ÛÙÔ Û›ÙÈ, fiˆ˜ ÚÔ¤Î˘„·ÓÎ·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ·ÍÈÔÏfiÁËÛË ÙÔ 2002. ∆Ô 7%ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜ ·Ú¤Ì‚·ÛË˜ ‹Ù·Ó Î·ÓÈ-ÛÙ¤˜ ¤Ó·ÓÙÈ 13% ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜ ÂÏ¤Á¯Ô˘(p<0,05). ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ÛÙ· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·ÛË˜ Î·È ÂÏ¤Á¯Ô˘


441

¶›Ó·Î·˜ 4. ªÂÙ·‚ÔÏ¤˜ ÛÙËÓ ÚfiÛÏË„Ë ‰È·ÈÙËÙÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·ÛË˜ Î·È ÂÏ¤Á¯Ô˘ ÛÂ ‰È¿ÛÙËÌ· 10 ÂÙÒÓ


ª¤ÛÔ˜ ± ∆™

∂Ó¤ÚÁÂÈ· (kcal) ¶* 1845±49 2386±89 541±103 0,027∂* 1843±45 2066±82 222±96

¶ÚˆÙÂ˝ÓÂ˜ (g) ¶ 61,7±2,1 78,6±3,7 16,8±4,3 ª™***∂ 64,2±1,9 70,8±3,4 6,6±4,0

À‰·Ù¿ÓıÚ·ÎÂ˜ (g) ¶ 208,4±6,5 274,9±10,8 66,6±12,8 0,050∂ 201,3±6,0 232,9±9,9 31,7±11,9

OÏÈÎfi Ï›Ô˜ (g) ¶ 86,1±2,6 109,8±4,9 23,7±5,7 ª™∂ 86,9±2,4 95,7±4,5 8,8±5,3

∫ÔÚÂÛÌ¤Ó· ÏÈ·Ú¿ ÔÍ¤· (g) ¶ 30,6±37,4 37,5±0,9 6,9±2,1 ª™∂ 30,7±0,9 32,9±1,7 2,2±1,9

ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· (g) ¶ 35,9±1,3 45,7±2,2 9,7±2,5 0,036∂ 36,8±1,2 39,3±2,0 2,4±2,3

¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· (g) ¶ 9,6±0,4 13,3±1,0 3,7±1,0 ª™∂ 9,6±0,3 11,9±0,9 2,3±0,9

Trans ÏÈ·Ú¿ ÔÍ¤· (g) ¶ 1,5±0,1 2,9±0,1 1,4±0,2 0,022∂ 1,6±0,1 2,2±0,2 0,6±0,2

º˘ÙÈÎ¤˜ ›ÓÂ˜ (g) ¶ 14,4±0,6 17,7±0,9 3,3±1,1 ª™∂ 14,0±0,5 15,3±0,9 1,3±1,0

º˘ÏÏÈÎfi ÔÍ‡ (Ìg) ¶ 183,5±14,2 240,3±14,9 56,7±20,4 0,001∂ 248,6±13,1 211,9±13,7 -36,7±18,9

∞Û‚¤ÛÙÈÔ (mg) ¶ 846,1±36,7 865,6±55,7 19,4±64,8 ª™∂ 899,4±33,9 913,9±51,5 14,4±59,9

™›‰ËÚÔ˜ (mg) ¶ 10,6±0,7 13,9±0,7 3,1±1,0 ª™∂ 11,8±0,7 13,0±0,7 1,9±0,9

µÈÙ·Ì›ÓË C (mg) ¶ 93,1±6,4 149,9±13,9 56,8±15,2 0,019∂ 116,9±5,9 123,7±12,9 6,8±14,2

µÈÙ·Ì›ÓË µ2 (mg) ¶ 1,7±0,1 2,0±0,1 0,26±0,14 0,015∂ 2,0±0,1 1,9±0,1 0,21±0,13

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ (¡=80), ∂: ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (¡=93) ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÛÙË ‰È·ÊÔÚ¿ ÙË˜ 3Ë˜ ·ÍÈÔÏfiÁËÛË˜ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (∞ƒÃ∏)

Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿


442

fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÛfiÙËÙ· Î·Ó›ÛÌ·ÙÔ˜ (¶:8,4±1,9 ÙÛÈÁ¿Ú·/ËÌ¤Ú·, E: 11,0±1,3 ÙÛÈÁ¿Ú·/ ËÌ¤-Ú·) Î·È ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ Î·Ó›˙Ô˘Ó (¶:15,6±2,3 Ì‹ÓÂ˜, E: 22,5±3,2 Ì‹ÓÂ˜). ŸÛÔÓ ·ÊÔÚ¿ÛÙÔ˘˜ ÁÔÓÂ›˜, ÙÔ 38% ÙˆÓ ÌËÙ¤ÚˆÓ Â›Ó·È Î·Ó›-ÛÙÚÈÂ˜, ¤Ó·ÓÙÈ ÙÔ˘ 55% ÙˆÓ ·Ù¤ÚˆÓ (p<0,001).∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 614 ˙Â˘Á·ÚÈÒÓ-ÁÔÓ¤ˆÓ, ÙÔ 25%Â›Ó·È Î·È ÔÈ ‰‡Ô Î·ÓÈÛÙ¤˜, ÂÓÒ ÙÔ 33% Â›Ó·È Î·È ÔÈ‰‡Ô ÌË Î·ÓÈÛÙ¤˜ (p<0,001). ™¯ÂÙÈÎ¿ ÌÂ ÙÔ˘˜ ÁÔ-ÓÂ›˜-Î·ÓÈÛÙ¤˜ ÚÔÎ‡ÙÂÈ fiÙÈ ÙÔ 92% ÙˆÓ ÌËÙ¤ÚˆÓÎ·Ó›˙Ô˘Ó ÛÙËÓ ÔÈÎ›· ÙÔ˘˜, ¤Ó·ÓÙÈ ÙÔ˘ 84% ÙˆÓ ·-Ù¤ÚˆÓ (p<0,05).

™˘˙‹ÙËÛË ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÚÔ-

ÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·ÛË˜ ÛÂ ı¤Ì·Ù· ˘ÁÂ›·˜, ‰È·-ÙÚÔÊ‹˜ Î·È ¿ıÏËÛË˜ ÛÂ Ì·ıËÙ¤˜ ÙË˜ ∫Ú‹ÙË˜ ·ÍÈÔ-ÏÔÁ‹ıËÎÂ Î·Ù¿ Ù· 6 ¯ÚfiÓÈ· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÛÂÚÔËÁÔ‡ÌÂÓÂ˜ ÂÚÁ·Û›Â˜ (4-9). ∏ Û˘ÓÂ¯È˙fiÌÂÓË,fiÌˆ˜, ıÂÙÈÎ‹ Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙÔ˘˜‰Â›ÎÙÂ˜ ˘ÁÂ›·˜ 4 ¯ÚfiÓÈ· ·fi ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·È 10¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘, ·ÔÙÂÏÂ› ÂÍ·ÈÚÂÙÈÎ¿ÂÏÈ‰ÔÊfiÚÔ Â‡ÚËÌ·. º·›ÓÂÙ·È fiÙÈ Ë ÂÈ‰ËÌ›· ÙˆÓ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ ÌÂ ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓÎÈÓ‰‡ÓÔ˘ ·fi ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È ‰˘Ó·ÙfiÓ Ó·ÂÚÈÛÙ·ÏÂ›.

¢È·¯ÚÔÓÈÎ¿, ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 2002, ÙÔ ‚¿ÚÔ˜ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË (ÔÌ¿‰· ÂÏ¤Á¯Ô˘)·˘Í‹ıËÎÂ Î·Ù¿ 2,3 kg ÂÚÈÛÛfiÙÂÚÔ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ (p<0,01), fiˆ˜ Â›ÛË˜Î·È o ¢ª™ ·˘Í‹ıËÎÂ Î·Ù¿ 1 kg/m2 (p<0,01), ÂÓÒ ÙÔ‡„Ô˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ ·˘Í‹ıËÎÂ ÛËÌ·ÓÙÈ-Î¿ ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ 2,1 cm (p<0,001). ¶·Úfi-ÌÔÈ·, Ë ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ Â›¯Â ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·-Ï‡ÙÂÚË ÌÂ›ˆÛË ÛÙËÓ ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 15,3

mg/dl (p<0,001), ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 6,9mg/dl (p<0,001), ÂÓÒ ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚË ‹Ù·Ó Ë·‡ÍËÛË Ô˘ ·ÚÔ˘Û›·ÛÂ ÛÙÔÓ ·ıËÚˆÌ·ÙÈÎfi ‰Â›-ÎÙË, Î·Ù¿ 0,26 ÌÔÓ¿‰Â˜ (p<0,01). ∆· ·ÔÙÂÏ¤ÛÌ·-Ù· ·˘Ù¿ ·Ú¤¯Ô˘Ó Ì›· ÂÏ›‰· fiÙÈ Ë ÂÈ‰ËÌ›· ÙË˜·¯˘Û·ÚÎ›·˜ Î·È ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜ ı· ÌÔÚÔ‡-ÛÂ Ó· ÙÂıÂ› ˘fi ¤ÏÂÁ¯Ô ÌÂ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÚfiÌÔÈ-ˆÓ ·ÓÂÏÏ‹ÓÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÎ·›‰Â˘ÛË˜ ÛÂı¤Ì·Ù· ˘ÁÂ›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛË˜.

∏ ‰È·›ÛÙˆÛË fiÙÈ Ë ÂÌÊ¿ÓÈÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·-Ù· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Ô‰ËÁÂ› ÛÙË ‰È·Ù‹ÚËÛË Î·ÈÂ·‡ÍËÛË ·˘ÙÒÓ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (19-20),ÒıËÛÂ ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Ó· ÚÔÛ·ı‹ÛÔ˘Ó Ì¤ÛˆÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·ÛË˜ Ó· ÌÂÈÒÛÔ˘Ó Ù· Â›-Â‰· ‹ ·ÎfiÌ· Î·È Ó· ÂÍ·ÏÂ›„Ô˘Ó ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜·˘ÙÔ‡˜ Î·Ù¿ ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (1,3,23-29).

¶·ÚfiÌÔÈ· ÌÂ ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ì›· ¿ÏÏË ÌÔ-ÓÔÂÙÔ‡˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ Ô˘ ÂÊ·ÚÌfi-ÛÙËÎÂ ÛÂ 171 Ì·ıËÙ¤˜ ÙË˜ ∫Ú‹ÙË˜ ËÏÈÎ›·˜ 13 Î·È14 ÂÙÒÓ, ¤‰ÂÈÍÂ fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ Â›¯Â ÌÈ-ÎÚfiÙÂÚË ·‡ÍËÛË ÛÙËÓ ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ¢ª™, ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÛÙÔÓ ·ıËÚˆÌ·ÙÈ-Îfi ‰Â›ÎÙË ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ HDL-¯ÔÏË-ÛÙÂÚfiÏË ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (1).ÕÏÏË ¤ÚÂ˘Ó· ÛÙÈ˜ ∏ÓˆÌ¤ÓÂ˜ ¶ÔÏÈÙÂ›Â˜ (24) ¤‰ÂÈÍÂfiÙÈ ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·-ÛË˜, Ë ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ Â›¯Â ÌÈÎÚfiÙÂÚË ·‡ÍËÛËÙË˜ Û˘ÛÙÔÏÈÎ‹˜ ›ÂÛË˜, ÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆÛË ÙË˜‰È·ÛÙÔÏÈÎ‹˜ ›ÂÛË˜, ÌÂ›ˆÛË ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ Î·È ÙÔ˘ ·ıËÚˆÌ·ÙÈÎÔ‡ ‰Â›ÎÙË ÔÏÈÎ‹˜ ¯ÔÏË-ÛÙÂÚfiÏË˜ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË ÛÂ Û¯¤ÛË ÌÂÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ªÂÈˆÌ¤ÓË ·ÚÙËÚÈ·Î‹ ›ÂÛËÎ·È ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË ·ÚÔ˘Û›·ÛÂ Ë ÔÌ¿‰· ·-Ú¤Ì‚·ÛË˜ ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ·Ú¤Ì‚·ÛË˜ Î·È

¶›Ó·Î·˜ 5. ∂›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜ Î·Ù¿ ÙË ‰È·¯ÚÔÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË 10 ÂÙÒÓ

∞ƒÃ∏ ∞•πO§O°∏™∏1992 1Ë: 1995 2Ë: 1998 3Ë: 2002 ™‡ÓÔÏÔ ªÂÙ·‚ÔÏ‹ p**

¡ ª¤ÛÔ˜ ± ∆™

OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (mg/dL) ¶* 139 186,9±2,6 173,9±2,5 173,8±2,6 164,4±2,4 174,7±2,2 -16,2±1,8 <0,001∂* 101 174,2±3,1 185,1±2,9 172,3±3,1 162,6±2,8 173,6±2,6 -0,9±2,0

∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) ¶ 139 51,3±1,7 44,3±1,9 65,6±2,0 64,7±2,2 56,5±1,4 6,9±1,8 ª™***∂ 101 50,9±1,9 40,1±2,3 67,6±2,4 62,9±2,6 55,3±1,7 6,0±2,1

HDL-C (mg/dL) ¶ 137 60,6±1,3 54,3±1,3 58,7±1,3 52,7±1,0 56,6±1,0 -5,3±1,0 ª™∂ 101 62,8±1,5 58,2±1,5 57,8±1,5 50,9±1,2 57,4±1,2 -7,2±1,1

LDL-C (mg/dL) ¶ 139 115,9±2,5 110,5±2,2 102,7±2,3 98,6±2,1 106,9±2,0 -12,0±1,6 <0,001∂ 101 101,2±3,0 118,9±2,6 101,0±2,7 99,1±2,4 105,1±2,4 5,1±1,9

∞ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜: ¶ 137 3,21±0,07 3,49±0,09 3,12±0,07 3,27±0,07 3,27±0,06 0,08±0,05 0,002ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË/HDL-C ∂ 101 2,92±0,09 3,34±0,10 3,15±0,08 3,31±0,08 3,18±0,07 0,34±0,06

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜, ∂: ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÛÙÈ˜ ‰È·ÊÔ-

Ú¤˜ Î¿ıÂ ·ÍÈÔÏfiÁËÛË˜ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË ‰È·-ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (∞ƒÃ∏)

***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿


443

¶›Ó·Î·˜ 6. ∂›Â‰· ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜ Î·Ù¿ ÙË ‰È·¯ÚÔÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË10 ÂÙÒÓ

∞ƒÃ∏ ∞•πO§O°∏™∏1992 1Ë: 1995 2Ë: 1998 3Ë: 2002 ™‡ÓÔÏÔ ªÂÙ·‚ÔÏ‹ p**

¡ ª¤ÛÔ˜ ± ∆™

µ¿ÚÔ˜ (kg) ¶* 167 22,7±0,3 30,1±0,5 43,9±0,9 60,8±1,1 39,4±0,7 22,4±0,5 0,004∂* 120 24,9±0,4 33,2±0,6 47,4±1,0 68,2±1,3 43,4±0,8 24,7±0,6

⁄„Ô˜ (cm) ¶ 167 118,0±0,4 133,5±0,5 149,0±0,6 165,5±0,6 141,5±0,5 31,3±0,2 <0,001∂ 120 122,5±0,5 134,6±0,6 150,3±0,7 169,8±0,7 144,3±0,6 29,1±0,3

¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ 167 16,2±0,2 16,9±0,2 19,5±0,3 22,0±0,3 18,7±0,2 3,3±0,2 <0,001∂ 120 16,5±0,2 18,2±0,3 20,8±0,3 23,6±0,4 19,8±0,3 4,3±0,2

¶ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ (cm) ¶ 163 54,3±0,4 59,5±0,6 68,6±0,8 74,2±0,8 64,2±0,6 13,1±0,4 ª™***∂ 120 56,3±0,5 61,8±0,7 73,1±0,9 77,2±0,9 67,1±0,7 14,3±0,5

¢Â›ÎÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ¶ 162 0,86±0,003 0,83±0,004 0,86±0,005 0,79±0,007 0,83±0,003 -0,03±0,01 ª™Ì¤ÛË˜/ÏÂÎ¿ÓË˜ ∂ 120 0,85±0,004 0,82±0,004 0,86±0,006 0,79±0,008 0,83±0,003 -0,03±0,01¢Â›ÎÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ¶ 163 0,46±0,003 0,45±0,004 0,46±0,005 0,45±0,004 0,45±0,003 -0,009±0,003 <0,001Ì¤ÛË˜/‡„Ô˜ ∂ 120 0,46±0,004 0,46±0,004 0,49±0,006 0,46±0,005 0,47±0,004 0,006±0,003ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ¶ 155 28,6±1,3 31,4±1,2 55,8±2,3 58,1±2,2 43,5±1,6 19,8±1,1 ª™‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm) ∂ 116 32,4±1,5 35,1±1,4 62,7±2,7 60,5±2,5 47,7±1,8 20,3±1,3¶ÔÛÔÛÙfi Ï›Ô˘˜ ¶ 167 19,6±0,3 19,0±0,3 20,1±0,4 21,8±0,5 20,3±0,3 1,0±0,2 0,001ÛÒÌ·ÙÔ˜ (%) ∂ 120 20,0±0,3 20,9±0,4 22,9±0,5 22,3±0,5 21,7±0,5 2,2±0,3¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ¶ 77 1,7±0,1 3,4±0,2 4,8±0,2 4,2±0,2 3,5±0,1 2,4±0,1 <0,001·ÓÙÔ¯‹˜ (ÛÙ¿‰È·) ∂ 85 1,9±0,1 3,3±0,3 3,1±0,2 4,0±0,2 3,1±0,1 1,5±0,1

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜, ∂: ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÛÙÈ˜ ‰È·-

ÊÔÚ¤˜ Î¿ıÂ ·ÍÈÔÏfiÁËÛË˜ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ·ÓÙÔ¯‹˜)

*** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

ÛÙËÓ ¤ÚÂ˘Ó· KNOW YOUR BODY (25). ™ÙÈ˜ ¤ÚÂ˘-ÓÂ˜ CHIC II (27), Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙË µfi-ÚÂÈ· ∫·ÚÔÏ›Ó·, ¤ÁÈÓÂ ÂÎ·È‰Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË ÁÈ·8 Â‚‰ÔÌ¿‰Â˜ ÌfiÓÔ ÌÂ Ê˘ÛÈÎ‹ ¿ÛÎËÛË, ÌfiÓÔ ÌÂ ÂÎ-·›‰Â˘ÛË ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜. ¢È·ÈÛÙÒıËÎÂ fiÙÈË ÙÂÏÂ˘Ù·›· ÔÌ¿‰· Ô˘ Û˘Ó‰‡·˙Â ÙÈ˜ ‰‡Ô ÌÔÚÊ¤˜·Ú¤Ì‚·ÛË˜ (Ê˘ÛÈÎ‹˜ ¿ÛÎËÛË˜ Î·È ÂÎ·›‰Â˘ÛË˜)ÌÂ›ˆÛÂ Ù· Â›Â‰· ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙÔ˘Û˘ÓfiÏÔ˘ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ, Î·ıÒ˜ Â›ÛË˜·‡ÍËÛÂ ÛËÌ·ÓÙÈÎ¿ ÙËÓ ·ÂÚfi‚È· ÈÎ·ÓfiÙËÙ¿ ÙË˜. ¶·-ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ CHIC,Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÙËÓ ›‰È· ÂÚÈÔ¯‹ Î·È‰È‹ÚÎÂÛÂ 12 Ì‹ÓÂ˜ (29).

OÈ ·Ú·¿Óˆ ÌÂÏ¤ÙÂ˜, ·Ó Î·È ÂÈ‚Â‚·ÈÒÓÔ˘Ó ÙËıÂÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ÛÙË ÌÂ›ˆÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÂÈ¤‰ˆÓ, Î·ıÒ˜Î·È ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜, ¤¯Ô˘Ó Û˘ÁÎÚÈÙÈÎ¿ÔÏ‡ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ·Ú¤Ì‚·ÛË˜ ÛÂ Û¯¤ÛËÌÂ ÙËÓ ·ÚÔ‡Û· ¤ÚÂ˘Ó·.

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ·Ú¿ ÙË ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ ÛÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ-˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜, ˘‹Ú¯Â ÔÛÔ-ÛÙfi 18,5% ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜Î·È 21,5% ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ÌÂ LDL-¯ÔÏËÛÙÂÚfi-ÏË >130 mg/dl. ¶·Ú¿ÏÏËÏ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È-‰ÈÒÓ ÌÂ ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚÎ›· ·ÔÙÂ-

ÏÂ› ¤Ó‰ÂÈÍË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ô˘ ¤¯ÂÈ Ï¿‚ÂÈ ÛÙË ¯Ò-Ú· Ì·˜ Ë ·¯˘Û·ÚÎ›·. ∆Ô 28,8% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ·È‰ÈÒÓ Â›¯Â ·˘ÍËÌ¤ÓÔ ‹ ˘ÂÚ‚ÔÏÈÎ¿ ·˘ÍËÌ¤ÓÔ ‚¿-ÚÔ˜/·¯˘Û·ÚÎ›·, ÂÓÒ ÛÂ ÌË ‰È·¯ÚÔÓÈÎ‹ ÌÂÏ¤ÙË·È‰ÈÒÓ ËÏÈÎ›·˜ 6-17 ÂÙÒÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ £ÂÛ-Û·ÏÔÓ›ÎË˜ ÙÔ 2000-2001 (13) Î·È ¯ˆÚ›˜ ÙËÓ ÂÊ·Ú-ÌÔÁ‹ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, ÙÔ ·ÓÙ›ÛÙÔÈ¯ÔÔÛÔÛÙfi ‹Ù·Ó 26,3% (22,2% Â›¯Â ˘ÂÚ‚ÔÏÈÎfi ‚¿-ÚÔ˜ Î·È 4,1% ·¯˘Û·ÚÎ›·).

™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÎÙfi˜ ·fi ÙË Ê˘ÛÈÎ‹ ¿ÛÎË-ÛË, ÛÔ˘‰·›Ô˜ Â›Ó·È Ô ÚfiÏÔ˜ ÙË˜ ‰È·ÙÚÔÊ‹˜. ∏“‰˘ÙÈÎÔÔ›ËÛË” ÙË˜ Û‡Á¯ÚÔÓË˜ ‰È·ÙÚÔÊ‹˜ ÙˆÓ∫ÚËÙÒÓ Ù· ÙÂÏÂ˘Ù·›· Û·Ú¿ÓÙ· ¯ÚfiÓÈ·, Ô˘ ·Ú·-ÙËÚÂ›Ù·È Î·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ∂ÏÏ‹ÓˆÓ, Î·ıÒ˜ Î·È Ë·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘˜ ·fi ÙËÓ ·Ú·‰ÔÛÈ·Î‹ ÎÚËÙÈÎ‹‰È·ÙÚÔÊ‹ (30), ÙÔ˘˜ Ô‰ËÁÔ‡Ó ÛÂ ‰È·ÚÎÒ˜ ·˘Í·Ófi-ÌÂÓÔ˘˜ ‰Â›ÎÙÂ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi Î·Ú‰È·ÁÁÂÈ·Î¿Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÓÒ ÛÂ ¿ÏÏÂ˜ ÚÔËÁ-Ì¤ÓÂ˜ ¯ÒÚÂ˜ ÔÈ ‰Â›ÎÙÂ˜ ·˘ÙÔ› ÂÏ·ÙÙÒÓÔÓÙ·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎ¿ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜ (10).

∏ ÂÏ¿ÙÙˆÛË ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙË˜LDL-¯ÔÏËÛÙÂÚfiÏË˜ ‰ÂÓ ÂÍËÁÂ›Ù·È ·fi Ù· ‰È·ÈÙËÙÈÎ¿‰Â‰ÔÌ¤Ó·, Î·ı’ fiÙÈ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹‰È·ÊÔÚ¿ ÛÙË Ï‹„Ë ÎÔÚÂÛÌ¤ÓÔ˘ Ï›Ô˘˜ ÛÙË ‰È·-ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·ÛË˜ Î·È


444

∂ÈÎfiÓ· 1. ¢È·ÊÔÚ¤˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜, ¢ª™ Î·È ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂÍ›Ì·ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ ÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛË˜ (1994, 1998 Î·È2002) ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÍ¤Ù·ÛË (1992).

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0,0

-5,0

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8,0

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OÌ¿‰· ¶·Ú¤Ì‚·ÛË˜ (¡=77)

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¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)

ÂÏ¤Á¯Ô˘. ∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi Ù· ·È‰È¿ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÁÈÓfiÙ·Ó Î·Ù¿ 41% ·fi ÔÏÈÎfi Ï›-Ô˜, 14% ·fi ÙÔ ÔÔ›Ô ‹Ù·Ó ÎÔÚÂÛÌ¤ÓÔ. ∆Ô ÔÛÔ-ÛÙfi ÂÓ¤ÚÁÂÈ·˜ ·fi ÎÔÚÂÛÌ¤ÓÔ Ï›Ô˜ ‹Ù·Ó ÌfiÏÈ˜ 7%fiÙ·Ó ¿Ú¯ÈÛÂ Ë ÌÂÏ¤ÙË ÙˆÓ ∂Ù¿ ÃˆÚÒÓ ÙÔ 1960. ∆·ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ÏÈÔÚˆ-ÙÂ˝ÓÂ˜ Èı·ÓfiÓ Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔÓ ÛËÌ·ÓÙÈÎ¿ ¯·-ÌËÏfiÙÂÚÔ ¢ª™ Î·È ÙË ÛËÌ·ÓÙÈÎ¿ Î·Ï‡ÙÂÚË ·ıÏËÙÈ-Î‹ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜ ·Ú¤Ì‚·ÛË˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ¤ÚÂ˘Ó· CATCH (26) ÛËÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜ ÌÂÙ·-‚ÔÏ¤˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ ·fi ÙËÓ °’ ÛÙËÓ ∂’Ù¿ÍË ‰ËÌÔÙÈÎÔ‡, ÌÂ ÌÂ›ˆÛË ÛÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ-·˜ Î·È ÛÙ· ÔÛÔÛÙ¿ ÂÓ¤ÚÁÂÈ·˜ ·fi ÔÏÈÎfi, ÎÔÚÂÛÌ¤-ÓÔ Î·È ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜. ™Â ¿ÏÏË ¤ÚÂ˘Ó· ÛÙËÓÂÚÈÔ¯‹ ÙÔ˘ Leeds (28), ÌÂÙ¿ ·fi 12 Ì‹ÓÂ˜ ÂÎ·È-‰Â˘ÙÈÎ‹˜ ÂÈÌfiÚÊˆÛË˜ Î·È ÂÓËÌ¤ÚˆÛË˜, ·Ú·ÙËÚ‹-ıËÎÂ fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ Î·Ù·Ó¿ÏˆÓÂ ÂÚÈÛ-ÛfiÙÂÚ· Ï·¯·ÓÈÎ¿. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ÔÌ¿‰··Ú¤Ì‚·ÛË˜ Â›¯Â ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË Ï‹„Ë Ê˘ÏÏÈ-ÎÔ‡ Î·È ·ÛÎÔÚ‚ÈÎÔ‡ ÔÍ¤Ô˜, ‰ËÏ·‰‹ ˘„ËÏfiÙÂÚË Ï‹„ËÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ. ªÂÏ¤ÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹-ıËÎÂ ÛÂ ·È‰È¿ ÙË˜ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜ ËÏÈÎ›·˜ 11,6-16,6 ÂÙÒÓ, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·-Ú¤Ì‚·ÛË˜, ¤‰ÂÈÍÂ fiÙÈ ÙÔ 45% ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂ-ÓË˜ ÂÓ¤ÚÁÂÈ·˜ ÚÔ¤Ú¯ÂÙ·È ·fi ˘‰·Ù¿ÓıÚ·ÎÂ˜, ÂÓÒÙÔ 42% ÚÔ¤Ú¯ÂÙ·È ·fi ÔÏÈÎfi Ï›Ô˜, ·fi ÙÔ ÔÔ›ÔÔÛÔÛÙfi 12% Â›Ó·È ÎÔÚÂÛÌ¤ÓÔ (18).

ÕÏÏÔÓ ÚˆÙÂ‡ÔÓÙ· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂ-ÏÂ› ÙÔ Î¿ÓÈÛÌ· Ô˘ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ÛÙËÓ ÂÊË‚È-Î‹ ËÏÈÎ›· (14,17). ∆Ô Î¿ÓÈÛÌ· ·ÔÙÂÏÂ› ÙÔ ÌÂÁ·-Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ ÙfiÛÔ ÛÙË ¯ÒÚ·Ì·˜ fiÛÔ Î·È ·ÁÎÔÛÌ›ˆ˜, ÂÓÒ ÔÈ ‚ÈÔÌË¯·Ó›Â˜ Î·-ÓÔ‡ ¤¯Ô˘Ó ÛÙÚ¤„ÂÈ ÙÈ˜ ‰È·ÊËÌÈÛÙÈÎ¤˜ ÙÔ˘˜ ÚÔ-Û¿ıÂÈÂ˜ ÚÔ˜ Ù· ·È‰È¿, ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÈ˜ Á˘-

Ó·›ÎÂ˜. ™ÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’80, ÛÂ Ì›·ÂıÓÈÎ‹ ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Î·-Ó›ÛÌ·ÙÔ˜ (17), ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ ÍÂÎ›ÓËÛÂ ÙËÌÂÙ¿‰ÔÛË ·ÓÙÈÎ·ÓÈÛÙÈÎÒÓ ÌËÓ˘Ì¿ÙˆÓ Ì¤Ûˆ ÙË˜ÙËÏÂfiÚ·ÛË˜ Î·È ÙÔ˘ Ú·‰ÈÔÊÒÓÔ˘. O Ú˘ıÌfi˜ ÙË˜ÂÙ‹ÛÈ·˜ ·‡ÍËÛË˜ Î·Ù·Ó¿ÏˆÛË˜ Î·ÓÔ‡ ÌÂÈÒıËÎÂÛËÌ·ÓÙÈÎ¿ Ù· ¤ÙË 1979 Î·È 1980, ‰ËÏ·‰‹ ÛÙ· ‰‡Ô¯ÚfiÓÈ· ÙË˜ ÌÂÙ¿‰ÔÛË˜ ÙˆÓ ÌËÓ˘Ì¿ÙˆÓ, Ë ÔÔ›·ÚÔÛ¤ÁÁÈÛÂ ÙÔ 0%. ¶·Ú¿ÏÏËÏ·, ÛÙÔ ‰È¿ÛÙËÌ· ·˘-Ùfi ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÙÔ 10,5% ‰Â›ÁÌ·ÙÔ˜ 1500 ·Ùfi-ÌˆÓ ËÏÈÎ›·˜ 15-64 ÂÙÒÓ ‰È¤ÎÔ„Â ÌfiÓÈÌ· ÙÔ Î¿ÓÈ-ÛÌ·, ÂÓÒ fiÙ·Ó ÛÙ·Ì¿ÙËÛ·Ó Ù· ·ÓÙÈÎ·ÓÈÛÙÈÎ¿ ÌË-Ó‡Ì·Ù·, ÔÈ Ú˘ıÌÔ› ·‡ÍËÛË˜ ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ Î·-ÓÔ‡ Â·Ó‹Ïı·Ó ÛÙ· ·Ú¯ÈÎ¿ Â›Â‰·. ™Â ¤ÚÂ˘Ó·Ô˘ ¤ÁÈÓÂ ÛÙËÓ ∫Ú‹ÙË (1) ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ ÂÎ-·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, ‚Ú¤ıËÎÂ Ó· Î·Ó›˙ÂÈ ÙÔ6% ÙË˜ ÔÌ¿‰·˜ ·Ú¤Ì‚·ÛË˜ Î·È ÙÔ 20% ÙË˜ ÔÌ¿-‰·˜ ÂÏ¤Á¯Ô˘, ÛÂ Û¯¤ÛË ÌÂ Ù· ·ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿7% Î·È 13% ÙË˜ ·ÚÔ‡Û·˜ ¤ÚÂ˘Ó·˜. ™Â ¿ÏÏË ¤ÚÂ˘-Ó· ÛÂ ÂÊ‹‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ ÛÙËÓ ∫·ÏÈ-ÊfiÚÓÈ·, Ô˘ ‰ÈÂÍ‹¯ıË ·fi ÙÔ 1979 ¤ˆ˜ ÙÔ 1990(16), ·Ú·ÙËÚ‹ıËÎÂ fiÙÈ Î·Ù¿ ÙÔ 1979 ÙÔ 28,7% ÙˆÓ‰ÂÈÁÌ¿ÙˆÓ ·Ú¤Ì‚·ÛË˜ Î·È ÙÔ 21,7% ÙˆÓ ‰ÂÈÁÌ¿-ÙˆÓ ÂÏ¤Á¯Ô˘ ‹Ù·Ó Î·ÓÈÛÙ¤˜, ÂÓÒ ÙÔ 1990 Ù· Ô-ÛÔÛÙ¿ ·˘Ù¿ ÌÂÈÒıËÎ·Ó ÛÂ 15,2% Î·È 15,8%, ·ÓÙ›-ÛÙÔÈ¯·. ¶·Ú¿ÏÏËÏ·, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔ-ÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·ÛË˜, ÛÂ ‰È·¯ÚÔÓÈÎ‹ ÌÂÏ¤ÙË‰È·ÊfiÚˆÓ ÂÚÈÔ¯ÒÓ ÙË˜ ∂ÏÏ¿‰·˜ (14) ÛÙ· Ù¤ÏËÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’80 Î·È ÛÂ ‰Â›ÁÌ· 4268 Ì·ıËÙÒÓ§˘ÎÂ›Ô˘ ‚Ú¤ıËÎÂ fiÙÈ ÙÔ 29,7% ‹Ù·Ó Î·ÓÈÛÙ¤˜, ÂÓÒÛÙ· Ì¤Û· ÙË˜ ›‰È·˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ ÔÛÔÛÙfi Â›¯Â ÊÙ¿-ÛÂÈ ÙÔ 43,4%. ∫·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô, ¤ÚÂ˘-Ó· ÛÙËÓ ∞ı‹Ó· (15) ¤‰ÂÈÍÂ fiÙÈ ÛÂ ‰Â›ÁÌ· 11.058 Ì·-ıËÙÒÓ ËÏÈÎ›·˜ 14-18 ÂÙÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ Î·ÓÈ-ÛÙÒÓ ‹Ù·Ó 22,3%.


445

¶›Ó·Î·˜ 7. ™˘Ó‹ıÂÈÂ˜ Î·Ó›ÛÌ·ÙÔ˜ ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ

∫·ÓÈÛÙ¤˜ ªË Î·ÓÈÛÙ¤˜ p-value**ñ ¶·È‰È¿

OÌ¿‰· ·Ú¤Ì‚·ÛË˜ 7 (23)* 93 (303) 0,016OÌ¿‰· ÂÏ¤Á¯Ô˘ 13 (37) 87 (260)

ñ °ÔÓÂ›˜ªËÙ¤Ú· 38 (236) 62 (386) <0,001¶·Ù¤Ú·˜ 55 (337) 45 (277)

™˘Ó‰˘·ÛÌfi˜ ÁÔÓ¤ˆÓ Î·ÓÈÛÙÒÓ ‹ ÌË ¶·Ù¤Ú·˜∫·ÓÈÛÙ‹˜ ªË Î·ÓÈÛÙ‹˜

ñ ªËÙ¤Ú·∫·Ó›ÛÙÚÈ· 25 (156) 13 (76) <0,001ªË Î·Ó›ÛÙÚÈ· 29 (180) 33 (202)

∫¿ÓÈÛÌ· ÛÙÔ Û›ÙÈ¡·È Ÿ¯È

ªËÙ¤Ú· 92 (213) 8 (19) 0,010¶·Ù¤Ú·˜ 84 (280) 16 (84)

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446

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∞‰˘Ó·Ì›· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÔÙ¤ÏÂÛÂ Ë ¤Ï-ÏÂÈ„Ë ÛÙÂÓ‹˜ ÂÈÎÔÈÓˆÓ›·˜ Î·È ·ÍÈÔÏfiÁËÛË˜ ÙÔ˘¤ÚÁÔ˘ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰fiıËÎÂÙÔ Î·Ù¿ÏÏËÏÔ ¤ÓÙ˘Ô ˘ÏÈÎfi ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙËÓ Ù¿ÍË ÙÔ˘˜ ÛÂ ¤Ó· ‹ ‰‡Ô ÛÂÌÈ-Ó¿ÚÈ·. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÂÓ‰È·Ê¤-ÚÔÓÙÔ˜ Î·È ÙË˜ ÚÔÛ¿ıÂÈ·˜ Ô˘ Î·Ù¤‚·ÏÂ Î¿ıÂÂÎ·È‰Â˘ÙÈÎfi˜ ÁÈ’ ·˘Ùfi ÙÔ ÚfiÁÚ·ÌÌ·, fiˆ˜ Â›-ÛË˜ Î·È ÔÈ Û˘Ó‹ıÂÈÂ˜ ˘ÁÂ›·˜ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓÎ·È ÁÂÓÈÎ¿ Ë ÛÙ¿ÛË Î·È Ë Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘˜ ÛÂı¤Ì·Ù· ˘ÁÂ›·˜, Ù· ÔÔ›· Û¯ÂÙ›˙ÔÓÙ·È ÛÙÂÓ¿ ÌÂ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·ÁˆÁ‹ ÛÂ ı¤Ì·Ù· ˘ÁÂ›·˜. ∏ Â-ÚÈÔÚÈÛÌ¤ÓË ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜‰ÂÓ Â¤ÙÚÂ„Â ÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ 300 ÂÚ›Ô˘ ÂÎ-·È‰Â˘ÙÈÎÒÓ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙÔ ÚfiÁÚ·ÌÌ··˘Ùfi. ∆· ÌÂÏÏÔÓÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· Ú¤ÂÈ Ó· Û˘-ÌÂÚÈÏ¿‚Ô˘Ó ÙËÓ Ô˘ÛÈÒ‰Ë ·˘Ù‹ ‰È¿ÛÙ·ÛË, ÌÂÂÓÙ·ÙÈÎfiÙÂÚË ·Ú¤Ì‚·ÛË Î·È ·ÍÈÔÏfiÁËÛË ÙÔ˘ ¤Ú-ÁÔ˘ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ.

∏ Û˘Ì‚ÔÏ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÎ·È‰Â˘ÙÈÎ‹˜·Ú¤Ì‚·ÛË˜ ÛÂ ı¤Ì·Ù· ˘ÁÂ›·˜, ‰È·ÙÚÔÊ‹˜ Î·È¿ıÏËÛË˜ ÛÂ Ì·ıËÙ¤˜ ÙË˜ ∫Ú‹ÙË˜ ÁÈ· ÙËÓ ÂÏ¿ÙÙˆÛËÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ıÂ-ˆÚÂ›Ù·È ÛËÌ·ÓÙÈÎ‹ ÚÔÛ¿ıÂÈ· ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›-·˜ ÌÂ ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· Î·Ù¿ Ù· 10 ¯ÚfiÓÈ· ·-Ú·ÎÔÏÔ‡ıËÛË˜-·ÍÈÔÏfiÁËÛË˜. ¶·Ú¿ ÙË ‰È·ÎÔ‹ ÙË˜ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÙÔ 1998, Ë Â·Ó·ÍÈÔÏfi-ÁËÛË ÙˆÓ ·È‰ÈÒÓ ÌÂÙ¿ ·fi 4 ¯ÚfiÓÈ· ¤‰ÂÈÍÂ fiÙÈ Ë ıÂ-ÙÈÎ‹ Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙË Û˘ÌÂÚÈÊÔ-Ú¿ ÙÔ˘˜ ÛÂ ı¤Ì·Ù· ˘ÁÂ›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛË˜,fiˆ˜ ·˘Ù‹ ‰È·ÌÔÚÊÒıËÎÂ ÛÙ· 6 ¯ÚfiÓÈ· ÙË˜ ÂÎ·›-‰Â˘Û‹˜ ÙÔ˘˜ ÛÙÔ ‰ËÌÔÙÈÎfi, ·Ú¤ÌÂÈÓÂ ÛÂ ÌÂÁ¿ÏÔ‚·ıÌfi ÛÙ·ıÂÚ‹. ∞˘Ùfi ‰È·ÈÛÙÒıËÎÂ ·fi ÙÔ˘˜ ‚ÂÏ-ÙÈˆÌ¤ÓÔ˘˜ ‰Â›ÎÙÂ˜ ˘ÁÂ›·˜ ÙË˜ ÔÌ¿‰·˜ ·Ú¤Ì‚·ÛË˜.°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ·Úfi-ÌÔÈ· ÚÔÁÚ¿ÌÌ·Ù· ÛÂ ·ÓÂÏÏ‹ÓÈ· ÎÏ›Ì·Î·.

∂˘¯·ÚÈÛÙ›Â˜ ∏ ÌÂÏ¤ÙË ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËÎÂ ·fi ÙË °ÂÓÈÎ‹ °Ú·ÌÌ·ÙÂ›·

∞ıÏËÙÈÛÌÔ‡, Ù· ÀÔ˘ÚÁÂ›· ÀÁÂ›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ Î·È

ÙËÓ Kellogg’s. ∂›ÛË˜, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÔÈ Û˘ÓÂÚ-Á¿ÙÂ˜ Î.Î. ªÈ¯¿ÏË˜ ∫˘ÚÈ·Î¿ÎË˜, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ·∞ÔÛÙÔÏ¿ÎË, ∞ÁÁÂÏÈÎ‹ ¶··‰¿ÎË, ¢ËÌ‹ÙÚË˜ ∞ı·Ó·ÛfiÔ˘-ÏÔ˜, ∂‡· ªÔ‡Î·, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ∫·ÚÔÏ¿ÈÓ ∫fi‰ÚÈ-ÁÎÙÔÓ Î·È °È¿ÓÓË˜ ª·ÓÈfi˜.

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3. ∫·Ê¿ÙÔ˜ ∞, ∆Û›ÙÔ˘Ú· ™, ¶·ÓÙÂÏ¿ÎË˜ ™, ¢ÔÍÈ¿‰Ë˜ ™. ∂›-‰Ú·ÛË ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙËÓ ¤ÁÎ˘Ô Î·È ÙÔ ‚Ú¤-ÊÔ˜. πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ∞ı‹Ó·; 1985.

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8. ∫·Ê¿ÙÔ˜ ∫, Ã·Ù˙‹˜ Ã, ª·ÓÈfi˜ °, §ÈÓ·Ú‰¿ÎË˜ ª, ªÔÛ¯·Ó-‰Ú¤· π, ª¿ÚÎ·Ù˙Ë ƒ. ∞ÁˆÁ‹ ˘ÁÂ›·˜ ÛÙ· Û¯ÔÏÂ›· ÙË˜ ∫Ú‹-ÙË˜. ¶·È‰È·ÙÚÈÎ‹ 1999;62:371-378.

9. ª·ÓÈfi˜ °, ªÔÛ¯·Ó‰Ú¤· π, Ã·Ù˙‹˜ Ã, ∫·Ê¿ÙÔ˜ ∞. ¶·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ ÛÂ ·È‰È¿ ‰ËÌÔÙÈÎÔ‡ÙË˜ ∫Ú‹ÙË˜ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÂÍ·ÂÙÔ‡˜ ÚÔÁÚ¿ÌÌ·-ÙÔ˜ ·ÁˆÁ‹˜ ˘ÁÂ›·˜. ¶·È‰È·ÙÚÈÎ‹ 2002;65:66-76.

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11. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A,Silikiotou N et al. Waist circumference and waist-to-heightratio are better predictors of cardiovascular disease riskfactors in children than body mass index. Int J Obes RelatMetab Disord 2000;24:1453-1458.

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡-ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ÙˆÓ ·È‰ÈÒÓ Ô˘ Î·ÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ Â˘ı‡ÓË˜ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁÂ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ¡ÔÌÔ‡ ƒÔ‰fiË˜,Î·ıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙË˜ ÂÚÈÔ-¯‹˜ ÌÂ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ÚÔ‚Ï¤ÔÓÙ·È ·fi ÙËÓ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜ Î·È ÌÂ ·Ó¿ÏÔÁ· ÛÙÔÈ-¯Â›· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ∞ÓÙÈÎÂ›ÌÂÓÔ ÙË˜ ÌÂÏ¤ÙË˜ ·Ô-Ù¤ÏÂÛ·Ó 230 ·È‰È¿ ÙË˜ ÂÚÈÔ¯‹˜, ËÏÈÎ›·˜ 6-14ÂÙÒÓ, Ô˘ ÂÈÛÎ¤ÊıËÎ·Ó ÙÔ ∫¤ÓÙÚÔ ÀÁÂ›·˜ ÁÈ· Ïfi-ÁÔ˘˜ ˘ÁÂ›·˜ ‹ ÁÈ· ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ Ù· ¤ÙË2000-2001, ÙˆÓ ÔÔ›ˆÓ Ù· ‚È‚ÏÈ¿ÚÈ· ÌÂÏÂÙ‹ıËÎ·ÓÎ·È Î·Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ ÙÔ˘˜ Î›ÓËÛË. O·ÚÈıÌfi˜ ÙˆÓ ‰fiÛÂˆÓ ÌÂÏÂÙ‹ıËÎÂ ¯ÚËÛÈÌÔÔÈÒ-ÓÙ·˜ ˆ˜ ËÏÈÎ›Â˜ ÔÚfiÛËÌÔ ÙÔ 1Ô Î·È 2Ô ¤ÙÔ˜, Î·ıÒ˜Î·È Û˘ÓÔÏÈÎ¿ ÛÙÔ Î¿ıÂ ·È‰› ·ÓÂÍ·ÚÙ‹Ùˆ˜ ËÏÈÎ›·˜.™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÁÈ· ÙË ‰ÈÊıÂÚ›ÙÈ‰·,ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔÎÎ‡ÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·, ÙÔ63%, 63%, 62,2% Î·È ÙÔ 63,5% ÙˆÓ ·È‰ÈÒÓ ·ÓÙÈ-ÛÙÔ›¯ˆ˜ ‹Ù·Ó ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔ ÌÂ 3 ‰fiÛÂÈ˜ ÛÂ ËÏÈÎ›·ÌÈÎÚfiÙÂÚË ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ÙÔ 51%, 51%, 49,1% Î·È49,6% ·ÓÙ›ÛÙÔÈ¯· ‹Ù·Ó ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔ ÌÂ 4 ‰fiÛÂÈ˜ÛÂ ËÏÈÎ›· Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ Î·È ÙÔ 83,9%, 83,9%,64,8% Î·È 82,2% ·ÓÙÈÛÙÔ›¯ˆ˜ Â›¯Â 5 ‰fiÛÂÈ˜ Û˘ÓÔÏÈ-Î¿, ·ÓÂÍ·ÚÙ‹Ùˆ˜ ËÏÈÎ›·˜, ÁÈ· ÙËÓ Î¿ıÂ ÓfiÛÔ. °È·ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›ÙÈ‰·, Ì›· ‰fi-ÛË ÛÂ ËÏÈÎ›· ÌÈÎÚfiÙÂÚË ÙˆÓ ‰‡Ô ÂÙÒÓ Â›¯Â Ï¿‚ÂÈ ÙÔ4,8% ÙˆÓ ·È‰ÈÒÓ, ‰‡Ô ‰fiÛÂÈ˜ ·ÓÂÍ·ÚÙ‹Ùˆ˜ ËÏÈ-Î›·˜ ÙÔ 53,9%, ÂÓÒ ÙÔ 8,7% ·Ú¤ÌÂÓÂ ·ÓÂÌ‚ÔÏ›·-ÛÙÔ. ∫·Ù¿ ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛÙÔÈ¯Â›ˆÓ ·˘ÙÒÓ, ‰È·-ÈÛÙÒÓÂÙ·È ÛËÌ·ÓÙÈÎ‹ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ÙË˜ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ ÀÁÂ›·˜, fiÔ˘ ÂÓ‰ÂÈ-ÎÙÈÎ¿ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ··ÈÙÂ›Ù·È ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿-Ï˘„Ë ≥90% ÁÈ· ÙË ‰ÈÊıÂÚ›ÙÈ‰· Î·È ÙÔÓ Ù¤Ù·ÓÔ ÛÂ·È‰È¿ ËÏÈÎ›·˜ <1 ¤ÙÔ˘˜, ·ÏÏ¿ Î·È ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ ÌÂ ¿ÏÏÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ∂ÏÏ¿‰·˜. ∞ÔÙÂÏÂ›,

�Abstract: The aim of this study was to examineand record the degree of sufficiency ofimmunization of the children living in the areacovered by the Iasmos Health Care Centre and tocompare the findings with the standards set by theWorld Health Organization (WHO) and results fromsimilar studies. The subjects of the study were 230children aged 6-14 years, living in the area, whohad visited the Health Care Centre for preventiveexamination or acute disease in the years 2000-2001. Their health booklets were examined andtheir immunizations were recorded, specifically thenumber of doses which had been administered inthe 1st and 2nd years of life, and the total numberof doses given to each child independent of age. Itwas found that for diphtheria, tetanus, pertussisand poliomyelitis vaccines, three doses had beengiven before the end of the first year to respectively63%, 63%, 62.2% and 63.5% of the children, fourdoses by the end of the second year to respectively51%, 51%, 49.1% and 49.6%, and a total of five doses,irrespective of age, had been given to respectively83.9%, 83.9%, 64.8% and 82.2% of the children.Regarding the vaccine for measles, mumps andrubella, 4.8% of the children had received one dosebefore the end of the second year and 53.9% hadreceived two doses irrespective of age, while 8.7%were unimmunized. The study revealed significantdeviation from the targets set by the WHO, whereby90% cover of children for diphtheria and tetanus isdemanded for children in the first year of life. Therewas also less effective coverage in comparison tostudies conducted in other parts of Greece. It isnecessary for similar studies to be conducted at a locallevel in order for effective planning of immunizationpromotion programmes to be carried out.

∫¤ÓÙÚÔ ÀÁÂ›·˜ ™Ô˘ÊÏ›Ô˘, ¡ÔÌfi˜ Œ‚ÚÔ˘ Health Care Centre of Soufli, Prefecture of Evros


449

ÏÔÈfiÓ, ·Ó·ÁÎ·ÈfiÙËÙ· Ë ‰ÈÂÓ¤ÚÁÂÈ· ÌÂÏ¤ÙË˜ ÙË˜ Î·-Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÂ ÙÔÈÎfi Â›Â‰Ô Î·È ËÚÔÒıËÛË ÙÔÈÎÔ‡ Û¯Â‰È·ÛÌÔ‡ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓÚÔ·ÁˆÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÌ‚ÔÏÈ·ÛÌÔ›, ·È‰È¿, ∫¤ÓÙÚÔ ÀÁÂ›-·˜, £Ú¿ÎË.

Key words: immunization, children, Health CareCentre, Thrace.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜∫À ∫¤ÓÙÚÔ ÀÁÂ›·˜ ¶OÀ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜ πÀ¶ πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

∂ÈÛ·ÁˆÁ‹∏ ·ÓÙ›ÏË„Ë fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ ·ÛıÂÓÂÈÒÓ ·Ô-

ÙÂÏÂ› ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ÙÔ˘˜ Â›Ó·È ·Ô‰ÂÎÙ‹ ·fi ·Ú¯·ÈÔÙ¿ÙˆÓ ¯ÚfiÓˆÓ. ∞˘-Ùfi ÂÈ‚Â‚·ÈÒÓÂÙ·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÂıfi‰ˆÓ ÂÌ-‚ÔÏÈ·ÛÌÔ‡ ÚÈÓ ·ÎfiÌË ·fi ÙË Á¤ÓÓËÛË ÙÔ˘ ÃÚÈ-ÛÙÔ‡, ·Ú¯ÈÎ¿ ÌÂ ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ Î·È ÎÈÓ‰‡-ÓÔ˘˜ ÁÈ· ÙËÓ ˘ÁÂ›· ÙÔ˘ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ˘.

™‹ÌÂÚ·, Ë ÂÍ¤ÏÈÍË ÙË˜ ÌÔÚÈ·Î‹˜ Î·È Î˘ÙÙ·ÚÈÎ‹˜‚ÈÔÏÔÁ›·˜ ¤¯ÂÈ Ê¤ÚÂÈ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ·Ú·ÛÎÂ˘‹·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Î·È ·Î›Ó‰˘ÓˆÓ ÂÌ‚ÔÏ›ˆÓ, ÌÂ ÙÈ˜ÏÈÁfiÙÂÚÂ˜ ‰˘Ó·Ù¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·-˙fiÌÂÓÔ.

O ·ÒÙÂÚÔ˜ ÛÙfi¯Ô˜ ÙË˜ ÂÓÂÚÁËÙÈÎ‹˜ ·ÓÔÛÔÔ›-ËÛË˜ Â›Ó·È Ë ÂÍ¿ÏÂÈ„Ë ÙË˜ ÓfiÛÔ˘. O ÂÓ‰È¿ÌÂÛÔ˜ÛÙfi¯Ô˜ Â›Ó·È Ó· ·ÔÙÚ·Â› Ë ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ÛÂ ¿ÙÔÌ· ‹ ÔÌ¿‰Â˜ ·ÙfiÌˆÓ. °È· Ó· ÂÈÙÂ˘¯ıÔ‡Ó ·˘-ÙÔ› ÔÈ ÛÙfi¯ÔÈ, ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ÙËÚÔ‡Ó ÛÙ·ıÂÚfiÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ‚ÚÂÊÒÓ, ÙˆÓ ·È-‰ÈÒÓ, ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËÏ›ÎˆÓ, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ·˘Ùfi ·ÔÙÂÏÂ› Ú¿ÍË Ì¤ÁÈÛÙË˜ ÛÔ˘‰·ÈfiÙËÙ·˜.∞fi‰ÂÈÍË ·˘ÙÔ‡ ·ÔÙÂÏÂ› Ë Ï‹ÚË˜ ÂÍ¿ÏÂÈ„Ë ÙË˜Â˘ÏÔÁÈ¿˜ ÙÔ 1979 Î·È Ô ÛËÌ·ÓÙÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜ÙË˜ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜, ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ‚·ÛÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ-‚ÔÏÈ·ÛÌÒÓ.

™ÎÔfi ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ·ÔÙÂÏÂ› Ë ‰ÈÂÚÂ‡ÓË-ÛË Î·È Î·Ù·ÁÚ·Ê‹ ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ ÙˆÓ·È‰ÈÒÓ Ô˘ Î·ÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ Â˘ı‡ÓË˜ ÙÔ˘∫¤ÓÙÚÔ˘ ÀÁÂ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ÓÔÌÔ‡ ƒÔ‰fiË˜, Ì›·˜ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÌÂ ÏËı˘ÛÌÈ·Î¤˜ È‰È·ÈÙÂÚfiÙËÙÂ˜,Î·ıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙË˜ ÂÚÈÔ¯‹˜ÌÂ ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙË˜ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ ÀÁÂ›-·˜ (¶OÀ) Î·È ÌÂ ÛÙÔÈ¯Â›· ¿ÏÏˆÓ ·Ó¿ÏÔÁˆÓ ÌÂÏÂÙÒÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÓÙÈÎÂ›ÌÂÓÔ ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ ÙË˜ Â-

ÚÈÔ¯‹˜, ËÏÈÎ›·˜ 6-14 ÂÙÒÓ, Ù· ÔÔ›· ÂÈÛÎ¤ÊıËÎ·Ó ÙÔ ∫À ÁÈ·ÏfiÁÔ˘˜ ÔÍÂ›·˜ ÓfiÛËÛË˜ ‹ ÁÈ· ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË Î·È Û˘-ÌÏ‹ÚˆÛË ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‰ÂÏÙ›Ô˘ ˘ÁÂ›·˜, Î·Ù¿ Ù· ¤ÙË 2000-2001. ªÂÏÂÙ‹ıËÎ·Ó Ù· ‚È‚ÏÈ¿ÚÈ· ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Î·È Î·-

Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ ÙÔ˘˜ Î·Ù¿ÛÙ·ÛË. ∞Í›˙ÂÈ Ó· ÛËÌÂÈ-ˆıÂ› fiÙÈ ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ªÔ˘ÛÔ˘ÏÌ¿ÓÔÈ ÂÏÏËÓÈÎ‹˜Î·Ù·ÁˆÁ‹˜.

∏ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ ÙÔ˘˜ Î¿Ï˘„Ë ÌÂÏÂÙ‹ıËÎÂ: ·) ÁÈ· ÙË ‰ÈÊıÂÚ›ÙÈ‰·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔÎÎ‡ÙË Î·È ÙËÓ

ÔÏÈÔÌ˘ÂÏ›ÙÈ‰· ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚË-Á‹ıËÎ·Ó ÛÂ ËÏÈÎ›· ÌÈÎÚfiÙÂÚË ÙÔ˘ 1Ô˘ Î·È ÙÔ˘ 2Ô˘ ¤ÙÔ˘˜ Î·Èˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û˘ÓÔÏÈ-Î¿, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈÎ›·,

‚) ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›ÙÈ‰·, ˆ˜ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó ÛÂ ËÏÈÎ›· ÌÈ-ÎÚfiÙÂÚË ÙÔ˘ 2Ô˘ ¤ÙÔ˘˜ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈÎ›· ¯ÔÚ‹ÁËÛË˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÛÂfiÏ· Û¯Â‰fiÓ Ù· ·È‰È¿ Â›¯Â ¯ÔÚËÁËıÂ› ÙÔ ÙÚÈÏfi ÂÌ‚fiÏÈÔ MMRÎ·È ‰ÂÓ Â›¯·Ó Á›ÓÂÈ ÍÂ¯ˆÚÈÛÙÔ› ÂÌ‚ÔÏÈ·ÛÌÔ› ÁÈ· Î¿ıÂ ÓfiÛÔ,

Á) ÁÈ· ÙËÓ Ë·Ù›ÙÈ‰· µ, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓÔ˘ Â›¯·Ó Ï¿‚ÂÈ ÙÔ ÚÔ‚ÏÂfiÌÂÓÔ Û¯‹Ì· ÙˆÓ 3 ‰fiÛÂˆÓ,

‰) ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ ÙË˜ ÈÓÊÏÔ˘¤ÓÙÛ·˜, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈı-Ìfi ÙˆÓ ·È‰ÈÒÓ Ô˘ Â›¯·Ó Ï¿‚ÂÈ ÙÔ Ï‹ÚÂ˜ Û¯‹Ì· ÙˆÓ ‰fiÛÂ-ˆÓ, fiˆ˜ ÚÔ‚Ï¤ÂÙ·È Û‡ÌÊˆÓ· ÌÂ ÙËÓ ËÏÈÎ›·,

Â) ÁÈ· ÙËÓ Ë·Ù›ÙÈ‰· ∞: ‰‡Ô ‰fiÛÂÈ˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓËÏÈÎ›· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È, Ù¤ÏÔ˜,

ÛÙ) Ë Î¿Ï˘„‹ ÙÔ˘˜ ÌÂ ÙÔ BCG. ™¯ÂÙÈÎ¿ ÌÂ ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÔÌ¿‰·˜

C, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ó¤Ó· ·È‰› ‰ÂÓ ‹Ù·Ó ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔ. ¶ÚfiÙ˘Ô ÁÈ· ÙË ÌÂÏ¤ÙË ·ÔÙ¤ÏÂÛÂ ÌÂıÔ‰ÔÏÔÁ›· ·Ó¿ÏÔÁË

ÙË˜ ·ÓÂÏÏ·‰ÈÎ‹˜ ÌÂÏ¤ÙË˜ Ô˘ ¤Ï·‚Â ¯ÒÚ· ÙÔ 1996-1997 Î·È‰ÈÔÚÁ·ÓÒıËÎÂ ·fi ÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (πÀ¶).

∞ÔÙÂÏ¤ÛÌ·Ù· ∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙË ‰ÈÊıÂÚ›ÙÈ‰·, ÙÔÓ

Ù¤Ù·ÓÔ, ÙÔÓ ÎÔÎÎ‡ÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰· Ê·›ÓÂ-Ù·È ÛÙÔÓ ¶›Ó·Î· 1. °›ÓÂÙ·È, ÏÔÈfiÓ, ·ÓÙÈÏËÙfi fiÙÈÌfiÏÈ˜ ÙÔ 51% ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔ ÌÂ 4‰fiÛÂÈ˜ ÁÈ· ‰ÈÊıÂÚ›ÙÈ‰· Î·È Ù¤Ù·ÓÔ ÛÂ ËÏÈÎ›· ÌÈÎÚfi-ÙÂÚË ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ ÙÂÏÈÎ¿, ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈ-Î›Â˜, ÙÔ ÔÛÔÛÙfi Î¿Ï˘„Ë˜ ÌÂ 5 ‰fiÛÂÈ˜ ÊÙ¿ÓÂÈ ÙÔ83,9% (ÔÛÔÛÙfi Ô˘ Â›Ó·È ÛÂ ·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù·ÛÙÔÈ¯Â›· ·fi ÙËÓ ·ÓÂÏÏ·‰ÈÎ‹ ÌÂÏ¤ÙË) (¶›Ó·Î·˜ 2)Î·È ¿ÏÏÂ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÌÂÏ¤ÙÂ˜. ∂È‰ÈÎ¿ ÁÈ· ÙÔÓ ÎÔÎ-Î‡ÙË, ÂÎÙfi˜ ·fi ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÂÌ‚ÔÏÈ·-ÛÌÔ‡, ·Ú·ÙËÚÂ›Ù·È Î·È ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚÔ ÔÛÔ-ÛÙfi ·È‰ÈÒÓ ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ÌÂ 5 ‰fiÛÂÈ˜ ÏfiÁˆ ¯Ô-Ú‹ÁËÛË˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ DT ÛÙËÓ 5Ë ‰fiÛË, ·ÏÏ¿ Ù·ÔÛÔÛÙ¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ·

·fi Ù· ·Ó¿ÏÔÁ· ÙË˜ ·ÓÂÏÏ·‰ÈÎ‹˜ ÌÂÏ¤ÙË˜, Êı¿-ÓÔÓÙ·˜ ÙÔ 64,8%, ÂÓÒ ÂÈÛËÌ·›ÓÂÙ·È Î·È ÙÔ 3% ÙˆÓ·ÓÂÌ‚ÔÏ›·ÛÙˆÓ ·È‰ÈÒÓ.

™¯ÔÏÈ¿˙ÔÓÙ·˜ Ù· ÛÙÔÈ¯Â›· ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›ÙÈ‰· (¶›Ó·Î·˜ 3), È‰È·›ÙÂÚËÂÓÙ‡ˆÛË ÚÔÎ·ÏÂ› ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·-ÛÌÔ‡ ÛÂ ËÏÈÎ›Â˜ Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ (4,8% ÁÈ· ÙËÓ ÈÏ·-Ú¿), fiÙ·Ó Ô ÛÙfi¯Ô˜ ÙË˜ ¶OÀ (¶›Ó·Î·˜ 4) Â›Ó·È Ó·ÂÌ‚ÔÏÈ·ÛÙÂ› ÌÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ‰fiÛË ÙÔ 90% ÙˆÓ·È‰ÈÒÓ ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ.

∞Ó¿ÏÔÁ· Â›Ó·È Î·È Ù· ÛÙÔÈ¯Â›· ÁÈ· ÙËÓ ÂÚ˘ıÚ¿Î·È ÙËÓ ·ÚˆÙ›ÙÈ‰·, ÁÂÁÔÓfi˜ Ô˘ Î·ıÈÛÙ¿ ÂÍ·ÈÚÂÙÈ-Î¿ ‰‡ÛÎÔÏÔ ÛÙfi¯Ô ÙËÓ ÂÎÚ›˙ˆÛË ÙˆÓ ÓfiÛˆÓ ·˘ÙÒÓÛÙ· ·Ì¤Ûˆ˜ ÂfiÌÂÓ· ¯ÚfiÓÈ·. OÈ ÔÌÔÈfiÙËÙÂ˜ ÛÙ·ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙÈ˜ ÙÚÂÈ˜ ÓfiÛÔ˘˜ ÔÊÂ›-ÏÔÓÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÚÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ MMRÛÂ fiÏ· Û¯Â‰fiÓ Ù· ·È‰È¿.

™Â ·Ó¿ÏÔÁË ÌÂÏ¤ÙË Ô˘ ¤Ï·‚Â ¯ÒÚ· ÛÙÔÓ ÓÔÌfi¶ÈÂÚ›·˜ ÙÔ 2000 (8), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ·ÙÈ˜ ÙÚÂÈ˜ ÓfiÛÔ˘˜ ‹Ù·Ó 34,4% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ §˘-ÎÂ›Ô˘ Î·È 34,8% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ °˘ÌÓ·Û›Ô˘. ∆·ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È ‚¤‚·È· ˘„ËÏfiÙÂÚ· ·fi ÙÔ26,1% ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ (¶›Ó·Î·˜ 3), ·ÏÏ¿ÙÔÓ›˙ÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ Ë ÛËÌ·ÓÙÈÎ‹ ·fiÎÏÈÛË·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙË˜ ¶OÀ.

™Â ÌÂÏ¤ÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎÂ ·fi ÙËÓ ∞’ ¶·È‰È·-ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÙÔ 1995,ÛÂ ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi (3), Ù· ÔÛÔÛÙ¿ ÂÌ‚Ô-ÏÈ·ÛÌÔ‡ Â›¯·Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÁÈ· ÙË ‰ÈÊıÂÚ›ÙÈ‰·,ÙÔÓ ÎÔÎÎ‡ÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·, ÂÓÒ ·Ú·ÙËÚ‹-ıËÎÂ ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·ÈÙËÓ ·ÚˆÙ›ÙÈ‰·, fiÔ˘ Ù· ÔÛÔÛÙ¿ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡‹Ù·Ó 89%, 76% Î·È 82%, ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ Ù· ÔÛÔÛÙ¿ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Êı¿ÓÔ˘Ó ÌfiÏÈ˜ ÙÔ 26,1% ÁÈ·ÙËÓ ÈÏ·Ú¿, ÙÔ 25,2% ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙÔ 26,1% ÁÈ·ÙËÓ ·ÚˆÙ›ÙÈ‰·.

∞ÎfiÌË, ÂÈÛËÌ·›ÓÂÙ·È ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚Ô-

ÏÈ·ÛÌÔ‡ ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ ÙË˜ ÈÓÊÏÔ˘¤ÓÙÛ·˜ (ÌfiÏÈ˜11,7%) (¶›Ó·Î·˜ 5) Î·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·-ÛÌÔ‡ ÙË˜ Ë·Ù›ÙÈ‰·˜ µ ¯¿ÚË ÛÙÈ˜ ÚÔÛ¿ıÂÈÂ˜ ÙÔ˘ÚÔÛˆÈÎÔ‡ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁÂ›·˜ Ô˘ Â¤ÌÂÓÂ ÛÙÈ˜ÂÈÛÎ¤„ÂÈ˜ Î·È Î·ıfiÚÈ˙Â Û·Ê¤˜ ¯ÚÔÓÔ‰È¿ÁÚ·ÌÌ· ÂÌ-‚ÔÏÈ·ÛÌÒÓ ÛÙ· ·È‰È¿ ÙË˜ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Ô˘ ÂÈ-ÛÎ¤ÙÔÓÙ·Ó ÙÔ ∫À ÁÈ· ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô (¶›Ó·Î·˜ 5).

™˘˙‹ÙËÛË ∞fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ Á›ÓÂÙ·È ·ÓÙÈ-

ÏËÙ‹ Ë ÛËÌ·ÓÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ÛÙË ‰ÈÂÓ¤ÚÁÂÈ·


450

¶›Ó·Î·˜ 1. ¢Â›ÎÙÂ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙË ‰ÈÊıÂÚ›ÙÈ‰·, ÙÔÓ Ù¤Ù·ÓÔ Î·È ÙÔÓ ÎÔÎÎ‡ÙË

3 ‰fiÛÂÈ˜ 4 ‰fiÛÂÈ˜ 5 ‰fiÛÂÈ˜ <3 ‰fiÛÂÈ˜ ∞ÓÂÌ‚ÔÏ›·ÛÙ·<1 ¤ÙÔ˘˜ <2 ÂÙÒÓ ·ÓÂÍ·ÚÙ‹Ùˆ˜ ËÏÈÎ›·˜

¢ÈÊıÂÚ›ÙÈ‰·* 63% 51% 83,9% 3,9%∫ÔÎÎ‡ÙË˜ 62,2% 49,6% 64,8% 10,4% 3%Sabin 63,5% 49,6% 82,2% 4%

* ∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· Ù¤Ù·ÓÔ Â›Ó·È Ë ›‰È· ÌÂ ÙË˜ ‰ÈÊıÂÚ›ÙÈ‰·˜, ÁÈ’ ·˘Ùfi Î·È ‰ÂÓ ÌÂÏÂÙÒÓÙ·È ¯ˆÚÈÛÙ¿

¶›Ó·Î·˜ 2. ™ÙÔÈ¯Â›· ·ÓÂÏÏ·‰ÈÎ‹˜ ÌÂÏ¤ÙË˜

3 ‰fiÛÂÈ˜ 4 ‰fiÛÂÈ˜ 5 ‰fiÛÂÈ˜<1 ¤ÙÔ˘˜ <2 ÂÙÒÓ ·ÓÂÍ·ÚÙ‹Ùˆ˜

ËÏÈÎ›·˜

¢ÈÊıÂÚ›ÙÈ‰· 84,1% 69% 80,8%∫ÔÎÎ‡ÙË˜ 82,4% 65% 46,3%¶ÔÏÈÔÌ˘ÂÏ›ÙÈ‰· 81,2% 65,6% 80,3%

¶›Ó·Î·˜ 4. ™Ùfi¯ÔÈ ÙË˜ ¶·ÁÎfiÛÌÈ·˜ OÚÁ·ÓˆÛË˜ ÀÁÂ›·˜(¶OÀ)

™Ùfi¯ÔÈ ÙË˜ ¶OÀ

ñ ¢ÈÊıÂÚ›ÙÈ‰·/Ù¤Ù·ÓÔ˜ ≥90%(3 ¤ÁÎ˘ÚÂ˜ ‰fiÛÂÈ˜ ¤ˆ˜ 1 ¤ÙÔ˘˜)

ñ ∫ÔÎÎ‡ÙË˜ ≥90%(3 ¤ÁÎ˘ÚÂ˜ ‰fiÛÂÈ˜ ¤ˆ˜ 1 ¤ÙÔ˘˜)

ñ ¶ÔÏÈÔÌ˘ÂÏ›ÙÈ‰· ≥90%(3 ¤ÁÎ˘ÚÂ˜ ‰fiÛÂÈ˜ ¤ˆ˜ 1 ¤ÙÔ˘˜)

ñ πÏ·Ú¿, ÂÚ˘ıÚ¿, ·ÚˆÙ›ÙÈ‰· ≥90%(1 ¤ÁÎ˘ÚË ‰fiÛË ¤ˆ˜ 2 ÂÙÒÓ)

¶›Ó·Î·˜ 5. ¢Â›ÎÙÂ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ Ë·Ù›ÙÈ‰· µ, ÙËÓË·Ù›ÙÈ‰· ∞, ÙÔÓ ·ÈÌfiÊÈÏÔ Î·È ÙË Ê˘Ì·Ù›ˆÛË

ñ ∏·Ù›ÙÈ‰· µ 80,4%(3 ‰fiÛÂÈ˜ ·ÓÂÍ·ÚÙ‹Ùˆ˜ ËÏÈÎ›·˜)

ñ ∏·Ù›ÙÈ‰· ∞ 1,7%(3 ‰fiÛÂÈ˜ ·ÓÂÍ·ÚÙ‹Ùˆ˜ ËÏÈÎ›·˜)

ñ ∞ÈÌfiÊÈÏÔ˜ 11,7%(Ï‹ÚË˜ ÂÌ‚ÔÏÈ·ÛÌfi˜)

ñ BCG 32,6%

¶›Ó·Î·˜ 3. ¢Â›ÎÙÂ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿Î·È ÙËÓ ·ÚˆÙ›ÙÈ‰·

πÏ·Ú¿ ∂Ú˘ıÚ¿ ¶·ÚˆÙ›ÙÈ‰·

ñ 0 ‰fiÛÂÈ˜ 8,7% 8,7% 8,7%ñ 1 ‰fiÛË 4,8% 4,8% 4,8%

(<2ÂÙÒÓ)ñ 1 ‰fiÛË 26,1% 25,2% 26,1%ñ 2 ‰fiÛÂÈ˜ 53,9% 54,3% 53,9%

(·ÓÂÍ·ÚÙ‹Ùˆ˜ËÏÈÎ›·˜)

ñ 2 ‰fiÛÂÈ˜ 6,5% 6,9% 6,5%(<6 ÂÙÒÓ)


451

ÙˆÓ ˘Ô¯ÚÂˆÙÈÎÒÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ÌÂÏ¤ÙË˜. ∞˘Ùfi ÔÊÂ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙËÓ ÂÏÏÈ‹ ÏË-ÚÔÊfiÚËÛË Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙÔ ˘„ËÏfi ÔÛÔÛÙfi·Ó·ÏÊ·‚ËÙÈÛÌÔ‡. ∏ ‰˘ÛÎÔÏ›· ÙË˜ ÂÓËÌ¤ÚˆÛË˜ ÂÈ-ÙÂ›ÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ Î·ÙÔ›ÎˆÓ ·Ó‹ÎÂÈ ÛÙË ÌÔ˘-ÛÔ˘ÏÌ·ÓÈÎ‹ ÌÂÈÔÓfiÙËÙ· Î·È ÂÌÊ·Ó›˙ÂÈ Úfi‚ÏËÌ·ÂÈÎÔÈÓˆÓ›·˜ ÌË Î·Ù·ÓÔÒÓÙ·˜ Â·ÚÎÒ˜ ÙË ÁÏÒÛÛ·,È‰›ˆ˜ ÔÈ ÌËÙ¤ÚÂ˜ Ô˘ Û˘Ó‹ıˆ˜ ÊÚÔÓÙ›˙Ô˘Ó ÁÈ· ÙËÓÙ‹ÚËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ¤¯Ô˘ÓÎ·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ÙËÓ ÂÈÌ¤ÏÂÈ· ÙˆÓ ·È‰ÈÒÓ. ŒÙÛÈ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ-Ù·Ê¤ÚÂÙ·È ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜, fiÙ·Ó ‰ËÏ. ÂÈ-‚¿ÏÏÂÙ·È Ë ÂÍ¤Ù·ÛË ÙˆÓ ·È‰ÈÒÓ ·fi ·È‰›·ÙÚÔ ÁÈ·ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‰ÂÏÙ›Ô˘ ˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡. µÚ¤-ıËÎÂ ÏÔÈfiÓ fiÙÈ ÌfiÓÔ ÙÔ 75% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÛÂ ËÏÈÎ›Â˜ <7 ÌËÓÒÓ, ÂÓÒ ¤Ó·20% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÂÙ·È ÌÂÙ¿ ÙËÓËÏÈÎ›· ÙˆÓ 2 ÂÙÒÓ (∂ÈÎfiÓ· 1). ∆ÔÓ›˙ÂÙ·È, Ù¤ÏÔ˜, Ë ÌÂ-Á¿ÏË ÛËÌ·Û›· ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô ‰fiÛÂˆÓ ÂÌ-‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·-ÚˆÙ›ÙÈ‰·, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊÂ˘¯ıÔ‡Ó ÂÈ‰ËÌ›Â˜fiˆ˜ ·˘Ù‹ ÙË˜ ÈÏ·Ú¿˜ ÙÔ 1996 Î·È ÙË˜ Û˘ÁÁÂÓÔ‡˜ÂÚ˘ıÚ¿˜ ÙÔ 1993.

§·Ì‚¿ÓÔÓÙ·˜, ÏÔÈfiÓ, ˘’ fi„ÈÓ Ù· ¯·ÌËÏ¿ Ô-ÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙË˜ ÂÚÈÔ¯‹˜ ‰È·ÈÛÙÒÓÂÙ·ÈfiÙÈ Â›Ó·È ··Ú·›ÙËÙ· ÙfiÛÔ Ë ÂÎfiÓËÛË Û¯Â‰›Ô˘ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ fiÛÔ Î·È Ô Û·Ê‹˜ Î·-ıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÁÈ· ÙË ¯¿Ú·ÍËÎÔÈÓ‹˜ ÛÙÚ·ÙËÁÈÎ‹˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÓËÌ¤ÚˆÛËÙÔ˘ ÏËı˘ÛÌÔ‡, Î·ıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ˆ˜ ÚÔ˜ ÙËÓ·ÓÙ·fiÎÚÈÛË ‹ fi¯È ÛÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙÔ˘ ÚÔ-ÁÚ¿ÌÌ·ÙÔ˜.

ªÂÁ¿ÏË˜, Â›ÛË˜, ÛÔ˘‰·ÈfiÙËÙ·˜ Â›Ó·È Ë ÌÂÏ¤-ÙË ÙË˜ Î·Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÂ ÙÔÈÎfi Â›Â-‰Ô, ¤ÙÛÈ ÒÛÙÂ Ó· Á›ÓÂÙ·È ÁÓˆÛÙ‹ Ë ÂÌ‚ÔÏÈ·ÛÙÈÎ‹

Î·Ù¿ÛÙ·ÛË ÙˆÓ ·ÙfiÌˆÓ ÙË˜ Î¿ıÂ ÂÚÈÔ¯‹˜ Î·È Ó·ÂÊ·ÚÌfi˙ÔÓÙ·È Û˘ÁÎÂÎÚÈÌ¤Ó· ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· Ó·ÂÈÙÂ˘¯ıÔ‡Ó, ÙÂÏÈÎ¿, ÔÈ ÛÙfi¯ÔÈ Ô˘ Ù›ıÂÓÙ·È ·fiÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ ∆, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË. ¶·ÓÂÏÏ·-

‰ÈÎ‹ ÌÂÏ¤ÙË Î·Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∞ı‹Ó·: πÓÛÙÈÙÔ‡ÙÔÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡; 1998.

2. ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ T. ªÂıÔ‰ÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ¤ÚÂ˘Ó· ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰·: Û˘-ÛÙËÌ·ÙÈÎ‹ ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ, 1970-1995. ¶·È‰È·ÙÚÈÎ‹1999;62:116-130.

3. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∞ÔÙ‡ˆÛË Î·Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ÛÂ ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈ-Î‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1995;42:82-86.

4. ºˆÙ›Ô˘ ∫, ¶··‰¿ÎË ∂. O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÁÈ· ÙËÓ Ë·Ù›ÙÈ‰·µ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ¶·È‰È·ÙÚÈÎ¿ ÃÚÔÓÈÎ¿ 1995;22:63-68.

5. °ÂˆÚÁ¿ÙÔ˜ ¢, ∫·Ú·Î·˚‰fi˜ ¢, ªÔÛ¯ÔÓ¿ ¢, ™·ÍÈÒÓË ∂, ∆˙È-Ô˘‚¿Ú· Ã, ƒËÁ¿ÙÔ˘ ∂ Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ∫ÂÊ·ÏÔÓÈ¿˜ [¶ÂÚ›ÏË„Ë]. 35Ô ¶·ÓÂÏ-Ï‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1997 13-15 πÔ˘Ó›Ô˘; ∫Ú‹ÙË;1997. ÛÂÏ. 69. #62µ∞.

6. American Academy of Pediatrics (Active and PassiveImmunization). In: Pickering LK, editor. 2000 Red Book:Report of the Committee on Infectious Diseases. 25th ed.Elk Grove Village, IL: American Academy of Pediatrics;2000. p. 1.

7. ª·ÏˆÌ¤ÓÔ˜ ∫, ¶··‰ËÌËÙÚ›Ô˘ ∂, °Ú‡ÏÏË˜ ™, ∫ÔÏ˘¤Ú·˜¢, ∞ÁÔÚ›ÙÛ· ™. ªÂÏ¤ÙË Î·Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì·ıËÙÒÓ§˘ÎÂ›Ô˘ ÛÙÔ ¡ÔÌfi ∆ÚÈÎ¿ÏˆÓ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ.289. #568.

8. ºÈ‰¿ÓË §, ¢¿Ú‰· ∞, ∞ÎÙÛ¤ÏË ∫, ªfi˙ÔÁÏÔ˘ ª, ºÈÏÈ›‰Ë˜™, µ·Ï·‚¿ÓË Ã Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ·ÈÏ·Ú¿, ÂÚ˘ıÚ¿ Î·È ·ÚˆÙ›ÙÈ‰· ÛÙÔÓ ¡ÔÌfi ¶ÈÂÚ›·˜ [¶ÂÚ›ÏË-„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 5. #002.

9. ∆˙Ô˘‚ÂÏ¤ÎË˜ °, ¡¿Ó·˜ Ã, Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª, ∫·ÙÚÈÔ‡ ¢.∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÒÓ ÙˆÓ Ì·ıËÙÒÓ ËÏÈÎ›·˜ 7-15 ÂÙÒÓÙÔ˘ ¡. ∫ÈÏÎ›˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘-Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 289. #569.

10. ¶ÂÙÚÔÔ‡ÏÔ˘ º, ªÂÚ›‰Ë˜ £, ∆Û¿ÌÈÚ· ¶, ¶·Ó·ÁÈˆÙfiÔ˘-ÏÔ˜ ∆. ∂È‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË ÙË˜ Î·Ù¿ÛÙ·ÛË˜ ÂÌ‚ÔÏÈ·-ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¢‹ÌÔ˘µfiÏÔ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ;1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 161. #306∞∞.

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¶ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ ÛÂ ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ ∂. ¶·Ú·ÛÎ¿ÎË˜1, ª. ∆ÛÈÌÈÓfi˜1, ∫. ∫·Ú·Ó¿ÛÈÔ˘1, ¡. ª·Î·ÚÒÓ·˜1, ∂. °·Ï·Ó¿ÎË˜2

Health problems of child-tourists in a Cycladic island E. Paraskakis1, M. Tsimbinos1, K. Karanasiou1, N. Makaronas1, E. Galanakis2


�¶ÂÚ›ÏË„Ë: ∏ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘ÁÂ›·˜ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù·ÍÈ‰ÈÒÓ Î·È ‰È·ÎÔ-ÒÓ ÌÔÚÂ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë Î·È ÙË Ûˆ-ÛÙ‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜.™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ·˘ÙÒÓ ÙˆÓÚÔ‚ÏËÌ¿ÙˆÓ ÛÂ ·È‰È¿ Ô˘ ‹Ù·Ó ıÂÚÈÓÔ› ÂÈÛÎ¤-ÙÂ˜ ÛÙÔ ÓËÛ› ÙË˜ ™›ÊÓÔ˘. ªÂÏÂÙ‹ıËÎ·Ó 311 ·È-‰È¿-·Ú·ıÂÚÈÛÙ¤˜, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ Ô-Ï˘‰‡Ó·ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ™›ÊÓÔ˘ Î·Ù¿ ÙÔ˘˜ıÂÚÈÓÔ‡˜ Ì‹ÓÂ˜ ÙË˜ ‰ÈÂÙ›·˜ 2001-2002 Î·È Û˘ÁÎÚ›-ıËÎ·Ó ÌÂ 311 ·È‰È¿-ÌfiÓÈÌÔ˘˜ Î¿ÙÔÈÎÔ˘˜, Ù· ÔÔ›··ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ™˘¯ÓfiÙÂÚË ·ÈÙ›·ÚÔÛ¤ÏÂ˘ÛË˜ ÙˆÓ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ ÛÙÔ È·-ÙÚÂ›Ô ‹Ù·Ó Ù· ·Ù˘¯‹Ì·Ù· (16%) Î·È ·ÎÔÏÔ˘ıÔ‡Û·ÓÔÈ ˆÙ›ÙÈ‰Â˜ (13%), ÔÈ ‰ÂÚÌ·Ù›ÙÈ‰Â˜ (13%), ÔÈ ÏÔÈÌÒ-ÍÂÈ˜ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (12%) Î·È Ë Á·-ÛÙÚÂÓÙÂÚ›ÙÈ‰· (10%). ∆· ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ·ÚÔ˘Û›·˙·Ó ‰È·ÊÔÚÂÙÈÎ¿ ÔÛÔÛÙ¿ ÛÙÈ˜ ·ÈÙ›Â˜ÚÔÛ¤ÏÂ˘ÛË˜ (ÏÔÈÌÒÍÂÈ˜ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈ-ÎÔ‡ 16%, ‰ÂÚÌ·Ù›ÙÈ‰Â˜ 12%, ÏÔÈÌÒÍÂÈ˜ ·ÓÒÙÂÚÔ˘·Ó·ÓÂ˘ÛÙÈÎÔ‡ 7%, ¿ÛıÌ· 6%, ˆÙ›ÙÈ‰Â˜ 5%). ∆··È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ· ·fi Á·ÛÙÚÂÓÙÂÚ›ÙÈ-‰Â˜, ˆÙ›ÙÈ‰Â˜ Î·È ·Ù˘¯‹Ì·Ù· (p=0,0002, p=0,0012Î·È p=0,011, ·ÓÙ›ÛÙÔÈ¯·). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ·È-‰È¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ıÂÚÈÓÒÓ ‰È·ÎÔÒÓ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÓÔÛ‹Ì·Ù· ‰È·ÊÔÚÂÙÈÎ¿ ·fi ÂÎÂ›Ó· ÙˆÓ·È‰ÈÒÓ-ÌfiÓÈÌˆÓ Î·ÙÔ›ÎˆÓ. ∏ Î·Ù¿ÏÏËÏË ÚfiÏË„ËÎ·È ·Ú¤Ì‚·ÛË ÌÔÚÂ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÂÍ·ÛÊ¿-ÏÈÛË ‰È·ÎÔÒÓ ÌÂ Ù· ÏÈÁfiÙÂÚ· Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜, ·È‰È¿-·Ú·-ıÂÚÈÛÙ¤˜, ∫˘ÎÏ¿‰Â˜.

�Abstract: Information about children’s healthproblems on holiday is essential for theirappropriate prevention and management. The aimof this study was to investigate the health problemsof child-tourists on the island of Sifnos during thesummer. All 311 child-tourists who visited theHealth Centre of Sifnos during the summers of theyears 2001-2002 were included and compared with311 children-residents of the island, who were usedas the control group. Child-tourists presented with(in descending order of frequency) accidents(16%), otitis (13%), dermatitis (13%), lowerrespiratory tract infection (12%) and gastroenteritis(10%). In contrast, the resident children presentedmore frequently with lower respiratory tract infection(16%), dermatitis (12)%, upper respiratory tractinfection (7%), asthma (6%) and otitis (5%). Child-tourists compared to their age matched residents ofthe island presented more often with gastroenteritis,otitis and accidents (p=0.0002, p=0.0012 andp=0.011, respectively). In conclusion, children onholiday appear to have health problems in adistribution quite different from that observed in theresident children. Appropriate prevention andintervention may lead to children’s holidays freefrom severe health problems.

Key words: health problems, child-tourists, Cyclades.

1 ¶ÔÏ˘‰‡Ó·ÌÔ ¶ÂÚÈÊÂÚÂÈ·Îfi π·ÙÚÂ›Ô ™›ÊÓÔ˘ 2 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜

1 Health Centre of Sifnos 2 Paediatric Clinic of University of Crete


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∂ÈÛ·ÁˆÁ‹∆· Ù·Í›‰È· ·Ó·„˘¯‹˜, ÙfiÛÔ ÛÙÔ ÂÍˆÙÂÚÈÎfi fiÛÔ

Î·È ÂÓÙfi˜ ∂ÏÏ¿‰·˜, ·ÔÙÂÏÔ‡Ó Ï¤ÔÓ Ì›· Î·ıÈÂÚˆ-Ì¤ÓË Û˘Ó‹ıÂÈ· ÙË˜ ÂÏÏËÓÈÎ‹˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∫·ıÒ˜ÔÈ ·ÚÂ¯fiÌÂÓÂ˜ ˘ËÚÂÛ›Â˜ ÛÙÔ˘˜ ÙÔ˘ÚÈÛÙÈÎÔ‡˜ÚÔÔÚÈÛÌÔ‡˜ ÙË˜ ∂ÏÏ¿‰·˜ Â›Ó·È Î·Ù¿ Î·ÓfiÓ· ˘„Ë-ÏÔ‡ ÂÈ¤‰Ô˘, ÔÈ ÁÔÓÂ›˜ ·ÈÛı¿ÓÔÓÙ·È ·ÛÊ¿ÏÂÈ· Î·ÈÎ¿ÓÔ˘Ó ‰È·ÎÔ¤˜ Ì·˙› ÌÂ Ù· ·È‰È¿ ÙÔ˘˜. ŒÙÛÈ, Ô·È‰ÈÎfi˜ ÏËı˘ÛÌfi˜ ·ÔÙÂÏÂ› ¤Ó· ÛËÌ·ÓÙÈÎfi Ì¤-ÚÔ˜ ÙˆÓ ·Ú·ıÂÚÈÛÙÒÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ÚÔ-‚Ï‹Ì·Ù· ˘ÁÂ›·˜ ÛÂ Ù·ÍÈ‰ÈÒÙÂ˜ Â›Ó·È Û˘¯Ó¿, ÙfiÛÔÎ·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ fiÛÔ Î·È ÌÂÙ¿ ÙËÓÂÈÛÙÚÔÊ‹ ÙÔ˘˜. øÛÙfiÛÔ, ÔÈ ÌÂÏ¤ÙÂ˜ Ô˘ ¤¯Ô˘Ó‰ÈÂÍ·¯ıÂ› ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ ÛÂ ·Ú·ıÂÚÈÛÙ¤˜Ô˘ ‚Ú›ÛÎÔÓÙ·È ‹ ÂÈÛÙÚ¤ÊÔ˘Ó ·fi ÌÂÁ¿Ï· Ù·Í›‰È·ÛÙÔ ÂÍˆÙÂÚÈÎfi, ÂÓÒ ÂÏ¿¯ÈÛÙÂ˜ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ Ù·ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ·Ú·-ıÂÚÈÛÙ¤˜ ÛÂ ÌÈÎÚfiÙÂÚ· Ù·Í›‰È· ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙË˜¯ÒÚ·˜ (1-4). ∞ÎfiÌË, fiÌˆ˜ Î·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜Ô˘ ÙÔ Â›Â‰Ô ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛË˜ Â›Ó·È ÙÔÎ·Ï‡ÙÂÚÔ, Ë ·ÏÏ·Á‹ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÔÈ Û˘Óı‹-ÎÂ˜ „˘¯·ÁˆÁ›·˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ Î¿ıÂ Ù·Í›‰È,Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ Ó· ÌÂÙ·‚¿ÏÏÔ˘Ó Ù· Û˘Ó‹ıË ·›-ÙÈ· ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ. ∏ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘ÁÂ›·˜ ÛÙ· ·È‰È¿ Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜ Â›Ó·È ÚÔ¸fiıÂÛËÁÈ· ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÚfiÏË„‹ ÙÔ˘˜.

∆Ô ÓËÛ› ÙË˜ ™›ÊÓÔ˘ ·ÔÙÂÏÂ› ÚÔÛÊÈÏ¤˜ ı¤ÚÂ-ÙÚÔ, Î˘Ú›ˆ˜ ∂ÏÏ‹ÓˆÓ ·Ú·ıÂÚÈÛÙÒÓ. ™ÎÔfi˜ ÙË˜·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÚÔ-‚ÏËÌ¿ÙˆÓ ˘ÁÂ›·˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ ·È‰È¿ËÏÈÎ›·˜ ¤ˆ˜ 14 ÂÙÒÓ Î·Ù¿ ÙÈ˜ ıÂÚÈÓ¤˜ ‰È·ÎÔ¤˜ÙÔ˘˜ ÛÙÔ ÓËÛ› Î·È Ë Û‡ÁÎÚÈÛ‹ ÙÔ˘˜ ÌÂ ·˘Ù¿ ÙˆÓ·È‰ÈÒÓ Ô˘ Â›Ó·È ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ÙÔ˘ ÓËÛÈÔ‡, ÙËÓ›‰È· ÂÚ›Ô‰Ô.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ˘ÁÂÈÔÓÔÌÈÎ‹ Î¿Ï˘„Ë fiÏˆÓ ÙˆÓ ÂÈÛÎÂÙÒÓ, Î·ıÒ˜ Î·È

ÙˆÓ ÌfiÓÈÌˆÓ Î·ÙÔ›ÎˆÓ ÙË˜ ™›ÊÓÔ˘ Á›ÓÂÙ·È ·fi ÙÔ ÔÏ˘‰‡Ó·-ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ÙÔ˘ ÓËÛÈÔ‡, ÙÔ ÔÔ›Ô ÛÙÂÏÂ¯ÒÓÂÙ·È·fi ·ıÔÏfiÁÔ˘˜, ·È‰›·ÙÚÔ Î·È È·ÙÚÔ‡˜ ˘fi¯ÚÂÔ˘˜ ˘ËÚÂ-Û›·˜ ˘·›ıÚÔ˘ Î·È ‰È·ı¤ÙÂÈ ÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi Î·È ·ÎÙÈÓÔÏÔÁÈÎfiÂÚÁ·ÛÙ‹ÚÈÔ. ∆Ô È·ÙÚÂ›Ô ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂ-ÓÒÓ, ·ÊÔ‡ ÛÙÔ ÓËÛ› ‰ÂÓ ˘¿Ú¯Ô˘Ó È‰ÈˆÙÈÎ¿ È·ÙÚÂ›· ‹ È·ÙÚÈÎ¿Î¤ÓÙÚ·.

ªÂÏÂÙ‹ıËÎ·Ó 311 ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ËÏÈÎ›·˜ 1 ÌËÓfi˜¤ˆ˜ 14 ÂÙÒÓ (Ì¤ÛË ËÏÈÎ›·±SD: 6,3±4 ¤ÙË) Î·È 311 ·È‰È¿-Ìfi-ÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ™›ÊÓÔ˘ (Ì¤ÛË ËÏÈÎ›·±SD: 6,4±3,8 ¤ÙË). ∆· ·È-‰È¿ ·˘Ù¿ ÂÍÂÙ¿ÛÙËÎ·Ó Î·Ù¿ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹ÓÂ˜ (πÔ‡ÓÈÔ˜,πÔ‡ÏÈÔ˜, ∞‡ÁÔ˘ÛÙÔ˜) ÙË˜ ‰ÈÂÙ›·˜ 2001-2002. °È· Î¿ıÂ ·È‰›-·Ú·ıÂÚÈÛÙ‹ Î·Ù·ÁÚ¿ÊËÎÂ ÙÔ ·Ì¤Ûˆ˜ ÂfiÌÂÓÔ ·È‰›-ÌfiÓÈ-ÌÔ˜ Î¿ÙÔÈÎÔ˜ Ô˘ ÂÍÂÙ¿ÛÙËÎÂ. ∆· 311 ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈ-ÎÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÌÂÙ¿ Ù· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ·ÔÙ¤-

ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. OÈ ·ÈÙ›Â˜ ÚÔÛ¤ÏÂ˘ÛË˜ Ù·ÍÈÓÔÌ‹-ıËÎ·Ó ÌÂ ‚¿ÛË ÙË ¢ÈÂıÓ‹ ∆·ÍÈÓfiÌËÛË ¡ÔÛËÌ¿ÙˆÓ (5). °È·ÙÔ˘˜ ÛÎÔÔ‡˜ ÙË˜ ·Ó·‰ÚÔÌÈÎ‹˜ ·˘Ù‹˜ ÌÂÏ¤ÙË˜, ÛÙËÓ ÔÌ¿‰·ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Î·ÎÒÛÂÈ˜, Í¤Ó· ÛÒÌ·Ù·,‰‹ÁÌ·Ù· ÂÓÙfiÌˆÓ Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ‰ËÏËÙËÚÈ¿ÛÂÈ˜. ™ÙËÓÔÌ¿‰· ÙˆÓ ˆÙ›ÙÈ‰ˆÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ë ÔÍÂ›· Ì¤ÛË Î·È ËÂÍˆÙÂÚÈÎ‹ ˆÙ›ÙÈ‰·. ∞fi ÙÈ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·-ÓÂ˘ÛÙÈÎÔ‡ Î·Ù·ÁÚ¿ÊËÎ·Ó ¯ˆÚÈÛÙ¿ ÂÎÂ›ÓÂ˜ Ô˘ Â›¯·Ó Û·Ê‹ÂÓÙfiÈÛË (.¯. ˆÙ›ÙÈ‰Â˜, Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰Â˜) Î·È ÂÎÂ›ÓÂ˜Ô˘ ‰ÂÓ Â›¯·Ó. OÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ÌÂÏÂÙ‹ıËÎ·Ó ˆ˜ ÎÔÈÓ‹ ÔÌ¿‰·. °È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›·ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈÌ·Û›Â˜ ¯2 Î·ÈÔ ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ Û¯ÂÙÈÎÒÓ ÎÈÓ‰‡ÓˆÓ ÌÂ 95% ‰È·ÛÙ‹Ì·Ù·ÂÌÈÛÙÔÛ‡ÓË˜. ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ıÂˆÚ‹ıËÎ·Ó ÔÈ ‰È·ÊÔ-Ú¤˜ ÌÂ p<0,05.

∞ÔÙÂÏ¤ÛÌ·Ù· OÈ Û˘¯ÓfiÙÂÚÂ˜ ·ÈÙ›Â˜ ÚÔÛ¤ÏÂ˘ÛË˜ ÛÙÈ˜ ‰‡Ô

ÔÌ¿‰Â˜ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆··È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ¿ ·˘-ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ· ÛÙ· ÓÔÛ‹Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. OÈ ÂÈÛÎ¤„ÂÈ˜ ÙˆÓ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ ·Ó¿ ¤ÙÔ˜ ‹Ù·Ó ÂÚ›Ô˘ ÔÈ ›‰ÈÂ˜ ÛÙ·¤ÙË 2001 Î·È 2002 (153 Î·È 158, ·ÓÙ›ÛÙÔÈ¯·). ∞˘ÍË-Ì¤ÓË ÚÔÛ¤ÏÂ˘ÛË Î·Ù·ÁÚ¿ÊËÎÂ Î·Ù¿ ÙÔÓ Ì‹Ó· ∞‡-ÁÔ˘ÛÙÔ (50% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ¤Ó·ÓÙÈ 29% ÙÔÓπÔ‡ÏÈÔ Î·È 21% ÙÔÓ πÔ‡ÓÈÔ). ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰È·-ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ ·Ó¿ÌÂÛ· ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜ (56% ·ÁfiÚÈ· Î·È 44% ÎÔÚ›ÙÛÈ·).

™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÂÈ‚Â‚·ÈÒÓÂÈ Ù· Â˘Ú‹Ì·Ù·

ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ, ÛÙÈ˜ ÔÔ›Â˜ ¤¯ÂÈ ·Ó·ÊÂÚ-ıÂ› ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÓÔÛËÌ¿ÙˆÓ fiˆ˜ Ù· ·Ù˘-¯‹Ì·Ù·, Ë ˆÙ›ÙÈ‰·, Ù· ‰ÂÚÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù· Î·È ËÁ·ÛÙÚÂÓÙÂÚ›ÙÈ‰·, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÎÔÒÓ(1-4). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÂ ÙÚÔÈÎ¤˜ ‹ ·Ó·Ù˘ÛÛfi-ÌÂÓÂ˜ ¯ÒÚÂ˜ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÏfiÁÔ˜ ·˘ÍËÌ¤ÓË˜ÓÔÛËÚfiÙËÙ·˜ ÙˆÓ ·Ú·ıÂÚÈÛÙÒÓ Â›Ó·È ÔÈ Î·Î¤˜Û˘Óı‹ÎÂ˜ ˘ÁÈÂÈÓ‹˜ (1,2). ∞˘Ùfi ÈÛ¯‡ÂÈ ·ÎfiÌ· ÂÚÈÛ-ÛfiÙÂÚÔ ÁÈ· Ù· ·È‰È¿, Ù· ÔÔ›· Â›Ó·È ÛÂ ·˘ÍËÌ¤ÓÔÎ›Ó‰˘ÓÔ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ (6).øÛÙfiÛÔ, ·ÎfiÌ· Î·È ÛÙÈ˜ ÈÔ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜Î·È ÛÙÈ˜ ÂÚÈÔ¯¤˜ ÌÂ ÂÍ·ÈÚÂÙÈÎ¤˜ Û˘Óı‹ÎÂ˜ ˘ÁÈÂÈ-Ó‹˜, fiˆ˜ Â›Ó·È Ù· ÂÏÏËÓÈÎ¿ ı¤ÚÂÙÚ·, ÔÈ ‰È·ÊÔÚ¤˜ÛÙÈ˜ Û˘Óı‹ÎÂ˜ ‰È·‚›ˆÛË˜, Ë ·˘ÍËÌ¤ÓË ‰Ú·ÛÙËÚÈfi-ÙËÙ· ÙˆÓ ·È‰ÈÒÓ, Ë Â·Ê‹ ÌÂ ÙË ı¿Ï·ÛÛ· Î·È ÙÔÓ‹ÏÈÔ, Î·ıÒ˜ Î·È Ë ·fiÙÔÌË ·ÏÏ·Á‹ ÛÙÈ˜ ‰È·ÙÚÔÊÈ-Î¤˜ Û˘Ó‹ıÂÈÂ˜ Ô‰ËÁÔ‡Ó ÛÂ ·˘ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ·ÛÂ Û˘ÁÎÂÎÚÈÌ¤Ó· ÓÔÛ‹Ì·Ù· (2,3). ∆· Â˘Ú‹Ì·Ù· ·˘-Ù¿ ÂÈ‚Â‚·ÈÒıËÎ·Ó Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË,fiÔ˘ ·Ú·ÙËÚ‹ıËÎÂ ·‡ÍËÛË ÂÎÂ›ÓˆÓ ÙˆÓ ÓÔÛËÌ¿-ÙˆÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÂ ÙÔ˘Ú›ÛÙÂ˜ ÌÂ ÌÂÁ¿Ï·


454

Ù·Í›‰È· ÛÙÔ ÂÍˆÙÂÚÈÎfi (1,7), ·Ó Î·È ÔÈ Û˘Óı‹ÎÂ˜‰È·‚›ˆÛË˜ Ô˘ ·Ú¤¯ÔÓÙ·È ÛÙÔ ÓËÛ› ÙË˜ ™›ÊÓÔ˘ Â›-Ó·È ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ Î·È ·Ó¿ÏÔÁÂ˜ ÂÎÂ›ÓˆÓ ÙÔ˘ Ìfi-ÓÈÌÔ˘ ÙfiÔ˘ Î·ÙÔÈÎ›·˜. ¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ù··È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÛÙË ™›ÊÓÔ ÚÔ¤Ú¯ÔÓÙ·È Û¯Â-‰fiÓ ·ÔÎÏÂÈÛÙÈÎ¿ ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·, ÌÂ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Óı‹ÎÂ˜ ‰È·‚›ˆÛË˜ ÛÙË ÌfiÓÈÌË Î·-ÙÔÈÎ›· ÙÔ˘˜ Ó· ÌËÓ ‰È·Ê¤ÚÔ˘Ó ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi·fi ÂÎÂ›ÓÂ˜ ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜. º·›ÓÂÙ·È, ÏÔÈfiÓ,fiÙÈ Ë ·fiÙÔÌË ÌÂÙ·Î›ÓËÛË Î·È Ë ÌÈÎÚ‹, ¤ÛÙˆ, ·ÏÏ·-Á‹ ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛË˜ Î·È „˘¯·ÁˆÁ›·˜ ·Ú-ÎÔ‡Ó ÁÈ· ÙË Û˘¯Ó‹ ÂÎ‰‹ÏˆÛË ÔÚÈÛÌ¤ÓˆÓ ÓÔÛËÌ¿-ÙˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ (8).

∏ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ·Ù˘¯ËÌ¿ÙˆÓ ÛÙ· ·È-‰È¿-ÙÔ˘Ú›ÛÙÂ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË, Î˘Ú›ˆ˜ ÏfiÁˆ ÙË˜·˘ÍËÌ¤ÓË˜ Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘˜ ·˘Ù‹ÙËÓ ÂÚ›Ô‰Ô Î·È ÙË˜ ‰˘ÛÎÔÏ›·˜ ÂÈÙ‹ÚËÛ‹˜ ÙÔ˘˜ ÂÎÌ¤ÚÔ˘˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ Û˘¯Ó‹ Î·È ·Ú·ÙÂÙ·Ì¤ÓË˜‰È¿ÚÎÂÈ·˜ Â·Ê‹ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÙÔ ı·Ï·ÛÛÈÓfi ÓÂ-Úfi Î·È ÙÔÓ ˙ÂÛÙfi ·¤Ú· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙË ÌÈÎÚ‹ËÏÈÎ›· ·ÔÙÂÏÔ‡Ó ÁÓˆÛÙÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ Û¯Â-Ù›˙ÔÓÙ·È ÌÂ ÙËÓ ·˘ÍËÌ¤ÓË Â›ÙˆÛË ÙË˜ ÂÍˆÙÂÚÈÎ‹˜ˆÙ›ÙÈ‰·˜ (“swimmer’s ear”, fiˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ÔÓÔÌ¿˙ÂÙ·È ‰ÈÂıÓÒ˜) (9-14). øÛÙfiÛÔ, ¤¯ÂÈ ˘ÔÛÙË-ÚÈ¯ıÂ› fiÙÈ Î·È Ë Ì¤ÛË ˆÙ›ÙÈ‰· Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙ··È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ (7).

∏ ·‡ÍËÛË ÙˆÓ ‰ÂÚÌ·Ù›ÙÈ‰ˆÓ, ÙË˜ ÎÓ›‰ˆÛË˜ Î·ÈÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓËÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ ÛÂ ıÂÚÌ¿ Î·È ÌÂ ·˘ÍË-

Ì¤ÓË ËÏÈÔÊ¿ÓÂÈ· Ì¤ÚË, È‰È·›ÙÂÚ· fiÙ·Ó Ë ¤ÓÙÔÓË‰Ú·ÛÙËÚÈfiÙËÙ· Ô‰ËÁÂ› Û˘¯Ó¿ ÛÂ Î·Ù·fiÓËÛË ÙÔ˘‰¤ÚÌ·ÙÔ˜. OÈ ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi,·Ó Î·È Û˘¯ÓfiÙÂÚÂ˜ ÛÙ· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÛÂÛ¯¤ÛË ÌÂ Ù· ·È‰È¿-ÌfiÓÈÌÔ˘˜ Î·ÙÔ›ÎÔ˘˜, ‰ÂÓ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Ô˘ ·Ó·ÌÂÓfiÙ·ÓÛÙ· ·È‰È¿ Ô˘ ·ÏÏ¿˙Ô˘Ó ·fiÙÔÌ· ÙË ‰È·ÙÚÔÊ‹ÙÔ˘˜ Î·È ÙËÓ Î·ıËÌÂÚÈÓ‹ ˘ÁÈÂÈÓ‹ ÙÔ˘˜. ∞˘Ùfi ÌÔÚÂ›Ó· ·Ô‰ÔıÂ› ÛÙÈ˜ Î·Ï¤˜ Û˘Óı‹ÎÂ˜ ‰È·‚›ˆÛË˜, ÛÂ·ÓÙ›ıÂÛË ÌÂ ¿ÏÏÔ˘˜ ÚÔÔÚÈÛÌÔ‡˜ ÌÂ Î·Î‹ ˘ÁÈÂÈÓ‹,fiÔ˘ Ë Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· ·ÔÙÂÏÂ› ÙÔ ÚÒÙÔ ÛÂ Û˘-¯ÓfiÙËÙ· ÓfiÛËÌ· (1,2).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ·È‰È¿ Ô˘ ·Ú·ıÂÚ›˙Ô˘ÓÛÙË ¯ÒÚ· ÙÔ˘˜ ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·-Ó›ÛÔ˘Ó Û˘ÁÎÂÎÚÈÌ¤Ó· ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜. ∆Ô ÓÔ-ÛÔÏÔÁÈÎfi Ê¿ÛÌ· ÚÔÛÔÌÔÈ¿˙ÂÈ ÌÂ ÂÎÂ›ÓÔ Ô˘ ·-Ú·ÙËÚÂ›Ù·È ÛÙ· ÌÂÁ¿Ï· Ù·Í›‰È· ÛÙÔ ÂÍˆÙÂÚÈÎfi, ‰È·-ÙËÚÒÓÙ·˜ fiÌˆ˜ Î¿ÔÈÂ˜ È‰ÈÔÌÔÚÊ›Â˜. ªÂÏ¤ÙÂ˜ ÌÂÌÂÁ·Ï‡ÙÂÚ· ‰Â›ÁÌ·Ù· Î·È ÛÂ ¿ÏÏÂ˜ ÁÂˆÁÚ·ÊÈÎ¤˜ÂÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜ ı· ‚ÔËıÔ‡Û·Ó ÛÙËÓ Î·Ï‡ÙÂÚËÎ·Ù·ÁÚ·Ê‹ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÛÙË ‰È¿ÚıÚˆÛËÎ·Ù¿ÏÏËÏË˜ ÛÙÚ·ÙËÁÈÎ‹˜ ÚfiÏË„Ë˜ Î·È ·ÓÙÈÌÂÙÒ-ÈÛË˜ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜.

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2. Reinthaler FF, Feierl G, Stunzner D, Marth E. Diarrhea in

¶›Ó·Î·˜ 1. ∞ÈÙ›Â˜ ÚÔÛ¤ÏÂ˘ÛË˜ ÛÂ ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Î·È ÛÂ ·È‰È¿-ÌfiÓÈÌÔ˘˜ Î·ÙÔ›ÎÔ˘˜ ÙË˜ ™›ÊÓÔ˘

¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ¡ (%) ¡ (%)

∞Ù˘¯‹Ì·Ù· 50 (16%) 29 (9,3%)øÙ›ÙÈ‰Â˜ 40 (12,9%) 16 (5%)∫Ó›‰ˆÛË, ‰ÂÚÌ·Ù›ÙÈ‰· 40 (12,9%) 36 (11,6%)§ÔÈÌÒÍÂÈ˜ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ 39 (12,5%) 50 (16%)°·ÛÙÚÂÓÙÂÚ›ÙÈ‰· 31 (10%) 7 (2,3%)§ÔÈÌÒÍÂÈ˜ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡* 27 (8,7%) 23 (7,4%)ÕÛıÌ· 15 (4,8%) 18 (5,9%)º·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰· 10 (3,2%) 12 (3,9%)ƒÈÓ›ÙÈ‰· 6 (2%) 2 (0,6%)∂ÈÂÊ˘Î›ÙÈ‰· 3 (1%) 12 (3,9%)∞ÓÂÌÔ‚ÏÔÁÈ¿ 2 (0,6%) 11 (3,5%)πÁÌÔÚ›ÙÈ‰· 1 (0,3%) 3 (1%)§ÔÈ¿ ÓÔÛ‹Ì·Ù· 47 (15,1%) 92 (29,6%)

* ÕÏÏÂ˜ ÔÍÂ›Â˜ ÏÔÈÌÒÍÂÈ˜ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÌÂ ÔÏÏ·Ï‹ ÂÓÙfiÈÛË

¶›Ó·Î·˜ 2. ¶ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÛÂ ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÌÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È-‰È¿-ÌfiÓÈÌÔ˘˜ Î·ÙÔ›ÎÔ˘˜

¶Úfi‚ÏËÌ· ˘ÁÂ›·˜ ¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ™¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ p(95% CI) (ÌÂ ¯2)

°·ÛÙÚÂÓÙÂÚ›ÙÈ‰· 31 7 4,43 (1,98-9,91) 0,0002øÙ›ÙÈ‰Â˜ 40 16 2,50 (1,43-4,37) 0,0012∞Ù˘¯‹Ì·Ù· 50 29 1,72 (1,12-2,65) 0,0111


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12. Simchen E, Franklin D, Shuval HI. “Swimmer’s ear” amongchildren of kindergarten age and water quality of swimmingpools in 11 Kibbutzim. Isr J Med Sci 1984;20:584-588.

13. Calderon R, Mood EW. An epidemiological assessment ofwater quality and “swimmer’s ear”. Arch Environ Health1982;37:300-305.

14. Hoadley AW, Knight DE. External otitis among swimmersand nonswimmers. Arch Environ Health 1975;30:445-448.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ¡. ¶·Ú·ÛÎ¿ÎË˜ ™·ÊÔ‡˜ 4, ∆.∫. 712 02, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜


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¡Â˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ·È‰ÈÒÓ ÌÂ ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ ∫. µÔ‡‰ÚË˜1, ∫. ™ÙÂÊ·Ó›‰Ë˜2, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘3, ∂. ∫·ÙÛ·ÚÔ‡1, ™. ª·ÛÙÚÔÁÈ¿ÓÓË1, ∂. µ·ÁÈ¿ÎÔ˘4

Neurological complications of children with haemolytic-uraemic syndromeK. Voudris1, C. Stefanidis2, A. Skardoutsou3, E. Katsarou1, S. Mastroyianni1, E. Vagiakou4


1 ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

2 ¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

3 µ’ ¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

4 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

1 Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens

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

3 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens

4 Department of Microbiology,“G. Gennimatas” General Hospital, Athens

�¶ÂÚ›ÏË„Ë: ∞Ó Î·È ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÓÂ˘ÚÔÏÔ-ÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·È-ÌÈÎfi Û‡Ó‰ÚÔÌÔ (∞O™), ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙÂ˜ ÂÚÂ˘ÓË-ÙÈÎ¤˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ÈÂÚÂ˘ÓÔ‡Ó ÙËÓ ÂÓ‰Â¯fiÌÂÓË Û˘-Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Î·-Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Î·È ÙË Ì·ÎÚÔ¯ÚfiÓÈ·ÚfiÁÓˆÛË. ∂›ÛË˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘ÙÒÓ ÙˆÓÌÂÏÂÙÒÓ Â›Ó·È ·ÓÙÈÊ·ÙÈÎ¿. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ÌÂ ∞O™ Ô˘ ·ÚÔ˘Û›·Û·Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·-Ù· Î·È Î·ı˘ÛÙÂÚËÌ¤ÓË ÂÈÛ·ÁˆÁ‹ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô.™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓÂ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘ ÌÂ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· Î·Ù¿ ÙËÓÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘, ÂÓÒ ÛÂ 3 ·È‰È¿ ¤ÁÈÓÂ Â·-Ó¤ÏÂÁ¯Ô˜ ÙÚÂÈ˜ Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ·-ÚÔ˘Û›·Û·Ó ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘ÓÂ›‰ËÛË˜ Î·È4 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤-ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, Ô˘ ·ÔÙ¤ÏÂÛ·ÓÙËÓ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘˜. ™Â fiÏ· Ù· ·È‰È¿ Â›¯ÂÚÔËÁËıÂ› Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· ÌÂ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒ-ÛÂÈ˜ Î·È ÔÈ Û·ÛÌÔ› ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿-‰È· ÙË˜ ÓfiÛÔ˘, ÔÈ ÔÔ›ÔÈ Èı·ÓfiÙ·Ù· ÔÊÂ›ÏÔÓÙ·Ó ÛÂ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â ¤Ó·Ó ·ÛıÂÓ‹ ‚Ú¤ıËÎ·Ó ·ÌÊÔÙÂ-ÚfiÏÂ˘ÚÂ˜ ÂÛÙ›Â˜ ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ, Î˘Ú›ˆ˜ ÛÙËÓ˘ÔÊÏÔÈÒ‰Ë ÏÂ˘Î‹ Ô˘Û›· ÙˆÓ ÌÂÙˆÈ·›ˆÓ Î·È ‚ÚÂÁ-Ì·ÙÈÎÒÓ ÏÔ‚ÒÓ, ÔÈ ÔÔ›Â˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó·˘¿Ú¯Ô˘Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Î·È Èı·ÓfiÙ·Ù· ÔÊÂ›ÏÔ-ÓÙ·Ó ÛÂ ÌÈÎÚ¿ ·ÁÁÂÈ·Î¿ ¤ÌÊÚ·ÎÙ·. ŸÏ· Ù· ·È‰È¿Â›¯·Ó Ï‹ÚË ÓÂ˘ÚÔÏÔÁÈÎ‹ Î·È ÓÂÊÚÈÎ‹ ·ÔÎ·Ù¿ÛÙ·-ÛË Î·È ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËÎ·Ó. ∆· Â˘Ú‹Ì·-Ù· ÙË˜ ÌÂÏ¤ÙË˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘-ÌÙÒÌ·Ù· Î·È È‰È·›ÙÂÚ· ÔÈ Û·ÛÌÔ› ÛÙ· ·Ú¯ÈÎ¿

�Abstract: Although neurological complicationsoften occur in children with haemolytic-uraemicsyndrome (HUS), there are few reports describingthe presence of neurological symptoms and thelong-term neurological prognosis, and theirfindings are variable. Five children with HUS andneurological symptoms, with late referral, aredescribed. Brain magnetic resonance imaging(MRI) was performed in all five children in the acutephase, and repeated in three children three monthslater. Lethargy was observed in all children andbrief, generalized tonic-clonic seizures in four,leading to hospitalization. All of the patients hadprodromal gastrointestinal symptoms and theseizures which occurred early in the illness wereprobably due to hyponatraemia. Distinctivesubcortical white matter lesions in the frontal andparietal lobes bilaterally, which remainedunchanged three months later, were found on brainMRI in one child and were probably due tomicroinfarctions. All patients had a full recovery freefrom neurological deficits or recurrent seizures. Thefindings of this study suggest that the presence ofneurological manifestations and particularly ofseizures in children with HUS does not usuallyimply an unfavourable prognosis. Theseneurological manifestations are probably related tometabolic abnormalities. Earlier diagnosis andbetter fluid and electrolyte management mightprevent these complications.


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™˘ÓÙÔÌÔÁÚ·Ê›Â˜∞O™ ∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔHUS Haemolytic-uraemic syndromeMRI Magnetic resonance imaging

∂ÈÛ·ÁˆÁ‹∆Ô ∞O™ Â›Ó·È ¤Ó· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ· Ô˘

¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈÎ‹ ·ÈÌÔÏ˘ÙÈ-Î‹ ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ÔÍÂ›· ÓÂÊÚÈÎ‹ ·ÓÂ¿Ú-ÎÂÈ·. ∆Ô Ê¿ÛÌ· ÙË˜ ÓfiÛÔ˘ Â›Ó·È Â˘Ú‡, ÂÓÒ ¤¯Ô˘ÓÂÚÈÁÚ·ÊÂ› ‹ÈÂ˜ ˘ÔÎÏÈÓÈÎ¤˜ Ì¤¯ÚÈ ·ÂÈÏËÙÈÎ¤˜ ÁÈ·ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÙÒÛÂÈ˜. ∆Ô ∞O™ ÂÌÊ·Ó›-˙ÂÙ·È Î˘Ú›ˆ˜ ÛÂ ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂ-ÚË˜ ÙˆÓ 5 ÂÙÒÓ Î·È ·ÔÙÂÏÂ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›·ÔÍÂ›·˜ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÂ ·˘Ù¿. ™¯ÂÙ›˙ÂÙ·ÈÌÂ ÚÔËÁËıÂ›ÛÂ˜ ÏÔÈÌÒÍÂÈ˜ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·ÈÛ˘¯Ó¿ ÚÔËÁÂ›Ù·È Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· ‹ ÏÔ›ÌˆÍË ÙÔ˘·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

¡Â˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞O™ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÔÈÎ›Ï··ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1-11), ÂÓÒ Û¿ÓÈ· ¤¯Ô˘Ó ÂÚÈÁÚ·-ÊÂ› ÂÚÈÙÒÛÂÈ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂ Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (7-11). ∏ ·ÚÔ˘Û›· ÓÂ˘-ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Î·È È‰È·›ÙÂÚ· Û·ÛÌÒÓÎ·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËıÂ›fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·Î‹ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘, ·ÏÏ¿Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÂÏ¿¯ÈÛÙˆÓ ÌÂÏÂÙÒÓ Ô˘¤¯Ô˘Ó Á›ÓÂÈ Â›Ó·È ·ÓÙÈÊ·ÙÈÎ¿ (10,12-14). ™Â ·˘Ù‹ ÙËÌÂÏ¤ÙË ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ ÌÂ ∞O™ Î·È ÓÂ˘-ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, 4 ·fi Ù· ÔÔ›· Â›¯·Ó ÚÒ-ÈÌË ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Èı·Ó¿ ÔÊÂ›ÏÔ-ÓÙ·Ó ÛÂ ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓÂ Ì·-ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·Ù¿ ÙËÓ ÔÍÂ›·Ê¿ÛË ÙË˜ ÓfiÛÔ˘, ÂÓÒ ÛÂ 3 ·È‰È¿ Â·Ó·Ï‹ÊıËÎÂÙÚÂÈ˜ Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ Â›¯·Ó Î·Ï‹ÂÍ¤ÏÈÍË, ¯ˆÚ›˜ ÓÂ˘ÚÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ ÔÈÛ·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËÎ·Ó.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ (3 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›-

ÙÛÈ·) ÌÂ ∞O™, ÙˆÓ ÔÔ›ˆÓ Ë ËÏÈÎ›· Î˘Ì·ÈÓfiÙ·Ó ·fi1 ¤ˆ˜ 5 ¤ÙË (‰È¿ÌÂÛË ËÏÈÎ›·: 2,5 ¤ÙË). ∂ÎÙfi˜ ·fi

¤Ó· ·È‰› ÌÂ ‹È· „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, fiÏ·Ù· ¿ÏÏ· ·È‰È¿ Â›¯·Ó Î·Ï‹ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË Î·ÈÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ¶ÚÈÓ ÂÈÛ·¯ıÔ‡ÓÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô, fiÏ· Ù· ·È‰È¿ Â›¯·Ó Á·ÛÙÚÂÓÙÂÚ›-ÙÈ‰· ÌÂ ·ÈÌÔÚÚ·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜. ∆Ú›· ·fi ·˘Ù¿ Â›-¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË Î·È 4 ·È‰È¿ Â›¯·Ó ·ÚÔ˘ÛÈ¿-ÛÂÈ ÂÂÈÛfi‰È· ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·-ÛÌÒÓ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ (4-6 ËÌ¤ÚÂ˜ ·fi ÙËÓ ¤Ó·Ú-ÍË ÙË˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·˜). ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô, fiÏ· ‹Ù·Ó ·‡ÚÂÙ· Î·È Â›¯·Ó ˘ÓË-Ï›·, ÂÙ¤¯ÂÈÂ˜ ÛÙÔ ‰¤ÚÌ·, ÔÈ‰‹Ì·Ù·, ÔÏÈÁÔ˘Ú›·,ˆ¯ÚfiÙËÙ· Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË. ∂›-ÛË˜, Î·Ù¿ ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, Î·Ó¤Ó· ·È‰› ‰ÂÓÂ›¯Â ÂÛÙÈ·Î¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Î·È ÛÙË ‚˘ıÔ-ÛÎfiËÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÛÂ fiÏ· Ù· ·È‰È¿ Î·-Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍÂ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, ¯·ÌËÏ¿Â›Â‰· ·ÈÌÔÛÊ·ÈÚ›ÓË˜ Î·È ÌÂÈˆÌ¤ÓÔ ·ÚÈıÌfi ·ÈÌÔ-ÂÙ·Ï›ˆÓ, Î·Ù·ÎÂÚÌ·ÙÈÛÌ¤Ó· ÂÚ˘ıÚ¿, ‰ÈÎÙ˘ÔÂÚ˘-ıÚÔÎ˘ÙÙ¿ÚˆÛË, ·˘ÍËÌ¤Ó· Â›Â‰· Ô˘Ú›·˜, ÎÚÂ·ÙÈ-Ó›ÓË˜, ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ¯ÔÏËÛÙÂÚfiÏË˜, ÙÚÈÁÏ˘ÎÂÚÈ-‰›ˆÓ Î·È Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜, ·ÈÌ·-ÙÔ˘Ú›· Î·È ÚˆÙÂ˚ÓÔ˘Ú›·, ÂÓÒ ¤‰ÂÈÍÂ Î·È ˘ÔÓ·ÙÚÈ-·ÈÌ›· ÛÙ· 4 ·È‰È¿ ÌÂ ÙÔ˘˜ ÚÔËÁËı¤ÓÙÂ˜ Û·-ÛÌÔ‡˜ (¶›Ó·Î·˜ 1). OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ‹Ù·Ó ·ÚÓËÙÈÎ¤˜ ÛÂ 4 ·È‰È¿, ÂÓÒ ÛÂ 1 ·ÔÌÔÓÒıË-ÎÂ ÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ ÛÙ¤ÏÂ¯Ô˜ Escherichia coliO157:H7. O ¤ÏÂÁ¯Ô˜ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙˆÓ ÓÂÊÚÒÓ ÌÂ ·˘ÍËÌ¤ÓËË¯ÔÁ¤ÓÂÈ· ÛÙÔ ÓÂÊÚÈÎfi ÊÏÔÈfi, ÂÓÒ ÛÙÔ ËÏÂÎÙÚÔÂ-ÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒıËÎÂ ‚Ú·‰˘ÚÚ˘ıÌ›· ÛÂfiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. O ¤ÏÂÁ¯Ô˜ ÌÂ ÙË Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË Î·È ÛÙÔÓ Â·Ó¤-ÏÂÁ¯Ô ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ÛÂ 4 ·È‰È¿, ÂÓÒ ÛÂ ¤Ó··È‰› ¤‰ÂÈÍÂ ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜, ˘„ËÏÔ‡ Û‹Ì·ÙÔ˜ÛÙÈ˜ ∆2 ÂÈÎfiÓÂ˜, ÌÈÎÚ¤˜ ÂÛÙ›Â˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰ËÌÔ›Ú· ÙË˜ ÏÂ˘Î‹˜ Ô˘Û›·˜ ÙˆÓ ÌÂÙˆÈ·›ˆÓ Î·È ‚ÚÂÁ-Ì·ÙÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ì›· ÌÂÁ·Ï‡ÙÂÚË·ÚfiÌÔÈ· ÂÛÙ›· ÎÔÓÙ¿ ÛÙÔ ÌÂÙˆÈ·›Ô Î¤Ú·˜ ÙË˜·ÚÈÛÙÂÚ‹˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 1). OÈ ·ÓˆÌ·-Ï›Â˜ ·˘Ù¤˜ Â¤ÌÂÓ·Ó Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô 3 Ì‹ÓÂ˜·ÚÁfiÙÂÚ·.

ÛÙ¿‰È· ÙÔ˘ ∞O™ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Ù’ ·Ó¿ÁÎËÓÎ·Î‹ ÚfiÁÓˆÛË. A˘Ù¤˜ ÔÈ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒ-ÛÂÈ˜ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·-Ù·Ú·¯ÒÓ, ÙˆÓ ÔÔ›ˆÓ Ë ¤ÁÎ·ÈÚË ·ÓÙÈÌÂÙÒÈÛË ÂÓ-‰Â¯fiÌÂÓ· ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ,ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, Û·ÛÌÔ›, ˘ÔÓ·ÙÚÈ·È-Ì›·, ¤ÌÊÚ·ÎÙ· ÂÁÎÂÊ¿ÏÔ˘, Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·,·È‰È¿.

Key words: haemolytic-uraemic syndrome,neurological complications, seizures, hyponatraemia,microinfarctions, magnetic resonance imaging,children.


458

OÈ Û·ÛÌÔ› ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Â‡ÎÔÏ· ÌÂ ÂÓ‰Ô-ÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈÎ‹˜ ·ÁˆÁ‹˜ (ÌÈ‰·-˙ÔÏ¿ÌË Î·È Ê·ÈÓ˘ÙÔ˝ÓË) Î·È ‰ÈfiÚıˆÛË ÙË˜ ˘ÔÓ·-ÙÚÈ·ÈÌ›·˜. ŒÁÈÓ·Ó ÌÂÙ·ÁÁ›ÛÂÈ˜ Û˘Ì˘ÎÓˆÌ¤ÓˆÓÂÚ˘ıÚÒÓ. ∆Ú›· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ ·ÈÌÔ-Î¿ı·ÚÛË Î·È 1 ÌÂ ÂÚÈÙÔÓ·˚Î‹ Î¿ı·ÚÛË. ∏ Î·Ù¿-ÛÙ·ÛË ÙˆÓ ·È‰ÈÒÓ ÛÙ·‰È·Î¿ ‚ÂÏÙÈÒıËÎÂ, ÙÔ Â›Â-‰Ô Û˘ÓÂ›‰ËÛË˜ ÛÙ·‰È·Î¿ ·ÔÎ·Ù·ÛÙ¿ıËÎÂ Î·È ÔÈÛ·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËÎ·Ó. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, 3-4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÔÍÂ›· ÓfiÛËÛË, fiÏ· Ù· ·È‰È¿ Â›-¯·Ó Î·Ï‹ ÂÍ¤ÏÈÍË, ¯ˆÚ›˜ ÓÂ˘ÚÔÏÔÁÈÎ¿ ‹ ÓÂÊÚÈÎ¿ÚÔ‚Ï‹Ì·Ù·.

™˘˙‹ÙËÛË¡Â˘ÚÔÏÔÁÈÎ¤˜ ÂÈÏÔÎ¤˜, ‹ÈÂ˜ ‹ ÛÔ‚·Ú¤˜ Î·È

ÌfiÓÈÌÂ˜ ‹ ·ÚÔ‰ÈÎ¤˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 20-50%ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ∞O™. Œ¯ÂÈ ÂÚÈÁÚ·ÊÂ› ¤Ó· Â˘Ú‡Ê¿ÛÌ· ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ÂÈÏËÙÈ-Î¤˜ ÎÚ›ÛÂÈ˜, ‰˘ÛÙÔÓ›·, ·Ù·Í›·, ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤-‰Ô˘ Û˘ÓÂ›‰ËÛË˜, ÎÒÌ·, ÊÏÔÈÒ‰Ë˜ Ù‡ÊÏˆÛË, ÂÍˆ-˘Ú·ÌÈ‰ÈÎ¿ Û˘ÌÙÒÌ·Ù· ‹ ÂÛÙÈ·Î¿ Â˘Ú‹Ì·Ù·,fiˆ˜ ËÌÈ¿ÚÂÛË. ∞˘Ù¤˜ ÔÈ ÂÎ‰ËÏÒÛÂÈ˜ ÂÌÊ·Ó›˙Ô-ÓÙ·È Û˘¯Ó¿ ÛÙËÓ Úfi‰ÚÔÌË Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Î·ÈÛÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· ÂÈ-Ûfi‰Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (1,3,6,12).™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÙÔ Ù˘ÈÎfi ÈÛÙÔÚÈÎfi, Ë ÎÏÈÓÈ-Î‹ ÂÈÎfiÓ· Î·È Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÂÈ‚Â-‚·›ˆÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ∞O™ ÌÂ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ÂÈÏÔÎ¤˜ ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜. ∫·Ó¤Ó·˜ ·ÛıÂ-Ó‹˜ ‰ÂÓ Â›¯Â ÂÛÙÈ·Î¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Î·È ÔÈÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ - Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· Ë ÌÂ-Ù·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘ÓÂ›‰ËÛË˜ Î·È ÔÈ ÂÈÏËÙÈ-Î¤˜ ÎÚ›ÛÂÈ˜ - ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ÙË˜ ÓfiÛÔ˘ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. OÈ ÂÈÏËÙÈÎ¤˜ÎÚ›ÛÂÈ˜ Î·È ÛÙÔ˘˜ 4 ·ÛıÂÓÂ›˜ ‹Ù·Ó ‚Ú·¯Â›·˜ ‰È¿Ú-ÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ› Î·È È-ı·Ó¿ Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂ ÙËÓ ˘ÔÓ·ÙÚÈ·ÈÌ›· Ô˘ ‰È·È-ÛÙÒıËÎÂ ÌÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.

∏ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂÎ‰ËÏÒÛÂˆÓ ·fi ÙÔ ÎÂÓÙÚÈÎfi

ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∞O™ ÔÈÎ›ÏÏÂÈÎ·È Èı·ÓÒ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎ‹. OÈ ÓÂ˘ÚÔÏÔÁÈ-Î¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ¤¯Ô˘Ó ·Ô‰ÔıÂ› ÛÂ ¤ÌÊÚ·ÎÙ· ÙˆÓÌÈÎÚÒÓ Î·È ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁÂ›ˆÓ, ÂÁÎÂÊ·ÏÈÎ‹ ·È-ÌÔÚÚ·Á›·, ÌÂÙ·‚ÔÏÈÎ¤˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎ¤˜ ‰È·Ù·-Ú·¯¤˜, ˘ÔÍ›·, ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· Î·È ˘¤ÚÙ·ÛË(1-3,5,6). ™Â ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó‚ÚÂıÂ› ıÚfiÌ‚ÔÈ ÛÂ ÌÈÎÚ¿, ·ÏÏ¿ Î·È ÛÂ ÌÂÁ¿Ï· ·Á-ÁÂ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·ÚÂÁ¯˘Ì·ÙÈÎ¤˜ ·ÈÌÔÚÚ·-Á›Â˜, ÌË ÂÈ‰ÈÎ¤˜ ÈÛ¯·ÈÌÈÎ¤˜ Î·È ·ÓÔÍÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜Î·È ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· (1-3,5,6). ∏ÏÂÎÙÚÔÏ˘ÙÈÎ¤˜‰È·Ù·Ú·¯¤˜ Î·È ˘¤ÚÙ·ÛË Ô˘ Û˘¯Ó¿ Û˘ÓÔ‰Â‡Ô˘ÓÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∞O™ ¤¯Ô˘Ó Â›ÛË˜ ÂÓÔ¯ÔÔÈËıÂ›ÁÈ· ÙÈ˜ ÔÈÎ›ÏÂ˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜. ™ÙËÓ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ˘¤ÚÙ·ÛË ‰ÂÓ ¤·ÈÍÂ Î·Ó¤Ó·ÚfiÏÔ, Î·ıÒ˜ Î·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿-ÛÂÈ ˘¤ÚÙ·ÛË, ÂÓÒ Ë Ô˘Ú·ÈÌ›· Î·È Ë ˘ÔÓ·ÙÚÈ·ÈÌ›·ÚÔÊ·ÓÒ˜ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÚfiÎÏËÛË ÙˆÓ ÓÂ˘ÚÔ-ÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ. ™ÙÔÓ ·ÛıÂÓ‹ ÌÂ ÙÈ˜ ·ÏÏÔÈÒ-ÛÂÈ˜ ÛÙË Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ÔÈÈÛ¯·ÈÌÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁÂ›ˆÓ Èı·Ó¿Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ-‰ËÏÒÛÂˆÓ. ∏ ‚ÂÚÔÙÔÍ›ÓË, Ë ÔÔ›· ÂÏÂ˘ıÂÚÒÓÂÙ·È·fi ÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ ÛÙ¤ÏÂ¯Ô˜ Escherichia coliO157:H7, ÌÔÚÂ› Ó· Â˘ı‡ÓÂÙ·È ÁÈ· ÙÈ˜ ÓÂ˘ÚÔÏÔÁÈ-Î¤˜ ÂÎ‰ËÏÒÛÂÈ˜ (16). ŸÌˆ˜, Ë ‚ÂÚÔÙÔÍ›ÓË ‰ÂÓ ÚÔÛ-‰ÈÔÚ›ÛÙËÎÂ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜Î·È ÔÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ ÁÈ· Escherichia coliO157:H7 ‹Ù·Ó ıÂÙÈÎ¤˜ ÌfiÓÔ ÛÂ Ì›· ÂÚ›ÙˆÛË. £·Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›, fiÌˆ˜, fiÙÈ 3 ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·Áˆ-Á‹ ÚÈÓ ÂÈÛ·¯ıÔ‡Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.

¶ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ ∞O™ ÌÂ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÈ-ÏÔÎ¤˜ ¤¯Ô˘Ó ÂÏÂÁ¯ıÂ› ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· Î·ÈÔÈÎ›Ï· Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ›, fiˆ˜ Ô›‰ËÌ·ÂÁÎÂÊ¿ÏÔ˘, ¤ÌÊÚ·ÎÙ· ÔÈÎ›ÏÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÂÓ‰ÔÎÚ·ÓÈ·Î¤˜ ·ÈÌÔÚÚ·Á›Â˜ (4-6). ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ Ë ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚÂ› Ó· ÌËÓ Â›Ó·È ·ÚÎÂÙ¿ Â˘·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ÌÈÎÚÒÓ

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹

·/· ∞ÛıÂÓÂ›˜ §Â˘Î¿ Hb ¢∂∫ AMT O˘Ú›· Cr ¡¿ÙÚÈÔ ·ÈÌÔÛÊ·›ÚÈ· (g/dl) (%) (/mm3) (mg/dl) (mg/dl) (mEq/l)

·›Ì·ÙÔ˜ (/mm3)

1 ∞ÁfiÚÈ 2,5 ÂÙÒÓ 18.600 5,4 2,8 80.000 209 6,8 1052 ∞ÁfiÚÈ 5 ÂÙÒÓ 15.400 5,5 2,6 22.000 369 7,8 1293 ∞ÁfiÚÈ 3 ÂÙÒÓ 21.300 7,5 2,9 62.000 411 11,2 1184 ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜ 21.500 7,1 2,9 22.000 199 4,8 1155 ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜ 22.900 6,2 4,2 21.000 175 3,8 119

Hb: ∞ÈÌÔÛÊ·ÈÚ›ÓË Ï¿ÛÌ·ÙÔ˜ ¢∂∫: ¢ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ·›Ì·ÙÔ˜ ∞ª∆: ∞ÈÌÔÂÙ¿ÏÈ· ·›Ì·ÙÔ˜ Cr: ∫ÚÂ·ÙÈÓ›ÓË ÔÚÔ‡


459

·ÓˆÌ·ÏÈÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞O™, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙËÌ·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Â›Ó·È ÈÔÂ˘·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ·˘ÙÒÓ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ,·ÎfiÌË Î·È ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘ (10).ŒÏÂÁ¯Ô˜ ÌÂ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÌfiÓÔ ÛÂ Ï›ÁÂ˜ ÚÔËÁÔ‡ÌÂÓÂ˜ ÂÚÈ-ÙÒÛÂÈ˜ ∞O™ Î·È Ù· ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Â›Ó·È Î˘-Ú›ˆ˜ ¤ÌÊÚ·ÎÙ· ‹ ·ÈÌÔÚÚ·Á›Â˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ (7-11). ŒÌÊÚ·ÎÙ· ÛÙË Ì·ÁÓËÙÈ-Î‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ÚfiÌÔÈ· ÌÂ ÂÎÂ›Ó· ÙË˜·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜, ·ÏÏ¿ ÂÓÙÔÈ˙fiÌÂÓ· Î˘Ú›ˆ˜ÛÙË ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ Î·È ÛÙËÓ ÂÓ Ùˆ‚¿ıÂÈ ÏÂ˘Î‹ Ô˘Û›·, ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÂ ÚÔËÁÔ‡-ÌÂÓÔ ·ÛıÂÓ‹ ÌÂ ∞O™ Î·È ÔÊı·ÏÌÈÎ‹ Û˘ÌÌÂÙÔ¯‹(17). ¶ÈÛÙÂ‡ÂÙ·È, fiÌˆ˜, fiÙÈ Ù· Â˘Ú‹Ì·Ù· ÛÙË Ì·ÁÓË-ÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ÚfiÁÓˆÛË(10), fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ ·ÛıÂÓ‹ ·˘Ù‹˜ÙË˜ ÌÂÏ¤ÙË˜, fiÔ˘ ÂÓÒ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙË Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· ·Ú¤ÌÂÈÓ·Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô, ÙÔ ·È‰›‰ÂÓ ·ÚÔ˘Û›·˙Â ÓÂ˘ÚÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·.

∞Ó Î·È Ë ˘ÔÛÙËÚÈÎÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË, Ë ·ÈÌÔÎ¿-ı·ÚÛË Î·È Ë ÂÚÈÙÔÓ·˚Î‹ Î¿ı·ÚÛË ¤¯Ô˘Ó ÌÂÈÒÛÂÈÙË ıÓËÛÈÌfiÙËÙ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞O™, ÔÈ Ì·ÎÚÔ¯Úfi-ÓÈÂ˜ Û˘Ó¤ÂÈÂ˜, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÓÂ˘ÚÔÏÔÁÈ-ÎÒÓ ÂÈÏÔÎÒÓ, ÙË˜ ¯ÚfiÓÈ·˜ ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜

Î·È ÙË˜ ˘¤ÚÙ·ÛË˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 10-20% ÙˆÓ·ÛıÂÓÒÓ (1,6). Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ë ÚfiÁÓˆÛËÛ¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ‰È·Ù·Ú·¯ÒÓ Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘. ™˘-ÁÎÂÎÚÈÌ¤Ó·, Ë ‡·ÚÍË ÎÒÌ·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·Î‹ÚfiÁÓˆÛË. ∞ÓÙ›ıÂÙ·, Î¿ÔÈÔÈ ÂÚÂ˘ÓËÙ¤˜ ÈÛÙÂ‡Ô˘ÓfiÙÈ Ù· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· ˘Ô¯ˆÚÔ‡Ó ÁÚ‹-ÁÔÚ· Î·È ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Î‹ ÚfiÁÓˆÛË (10).∂›ÛË˜, ¤¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ë ·ÚÔ˘Û›· Û·ÛÌÒÓÎ·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌÂ-Á¿ÏË ıÓËÛÈÌfiÙËÙ· ‹ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ÂÈÏÔÎ¤˜ (12), ¿Ô„Ë Ô˘ ¤¯ÂÈ, fiÌˆ˜, ·ÌÊÈÛ‚ËÙË-ıÂ› ·fi ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ (13). ∂›Ó·È Èı·Ófi Ë ·-ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘-Ú›ˆ˜ ÛÂ ¿Û¯ÔÓÙÂ˜ ÌÂ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙÔÓ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô˘ ˘Ô-‰ËÏÒÓÔ˘Ó ‚·Ú‡ÙÂÚË ÂÁÎÂÊ·ÏÈÎ‹ ‚Ï¿‚Ë, Ó· ÛËÌ·-ÙÔ‰ÔÙÂ› Î·Î‹ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ (14), ÂÓÒ ÔÈ ÁÂ-ÓÈÎÂ˘Ì¤ÓÔÈ, ‚Ú·¯Â›˜ Û·ÛÌÔ›, Ô˘ ÔÊÂ›ÏÔÓÙ·È Î˘-Ú›ˆ˜ ÛÂ ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, Ó· ¤¯Ô˘Ó Î·Ï‹ÚfiÁÓˆÛË (13,14), fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ·ÚÔ‡Û· ÌÂÏ¤ÙË.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞O™ Î·È ÓÂ˘-ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, Ë ·ÚÔ˘Û›· ‚Ú·¯Â›·˜ ‰È¿Ú-ÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û·ÛÌÒÓ Èı·Ó¿ ÔÊÂ›ÏÂÙ·È ÛÂ

∂ÈÎfiÓ· 1. ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ÛÂ ∆2 ÂÈÎfiÓÂ˜, ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ·ÛıÂÓÔ‡˜ Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘. ¢Â›¯ÓÂÈ·˘ÍËÌ¤ÓÔ˘ Û‹Ì·ÙÔ˜ ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜ ÂÛÙ›Â˜ ÂÓÙÔÈ˙fiÌÂÓÂ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë ÏÂ˘Î‹ Ô˘Û›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÌÂ-ÙˆÈ·›Ô˘˜ Î·È ‚ÚÂÁÌ·ÙÈÎÔ‡˜ ÏÔ‚Ô‡˜ (·) Î·È Ì›· ·ÚfiÌÔÈ· ÌÂÁ·Ï‡ÙÂÚË ÂÛÙ›· (‚) ÎÔÓÙ¿ ÛÙÔ ÌÂÙˆÈ·›Ô Î¤Ú·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ Ï¿-ÁÈ·˜ ÎÔÈÏ›·˜ (‚¤ÏË).

· ‚


460

ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi·ÓˆÌ·Ï›Â˜ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿-ÏÔ˘. ∞˘ÙÔ› ÔÈ Û·ÛÌÔ› ÂÏ¤Á¯ÔÓÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹-ÁÔÚ· Î·È ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Î·Î‹ ÚfiÁÓˆÛË. ∏¤ÁÎ·ÈÚË ·Ó·ÁÓÒÚÈÛË Î·È Ë Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛËÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Èı·ÓÒ˜ ı· ·ÔÙÚ¤-„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Û·ÛÌÒÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Rooney JC, Anderson RM, Hopkins IJ. Clinical and

pathological aspects of central nervous system involvementin the haemolytic uraemic syndrome. Aust Paediatr J1971;7:28-33.

2. Gianantonio CA, Vitacco M, Mendilaharzu F, Gallo GE, SojoET. The haemolytic-uremic syndrome. Nephron 1973;11:174-192.

3. Upadhyaya K, Barwick K, Fishaut M, Kashgarian M, SiegelNJ. The importance of nonrenal involvement in hemolytic-uremic syndrome. Pediatrics 1980;65:115-120.

4. Crisp DE, Siegler RL, Bale JF, Thompson JA. Hemorrhagiccerebral infarction in the haemolytic-uremic syndrome. JPediatr 1981;99:273-276.

5. Trevathan E, Dooling EC. Large thrombotic strokes inhaemolytic-uremic syndrome. J Pediatr 1987;111:863-866.

6. Hahn JS, Havens PL, Higgins JJ, O’Rourke PP, Estroff JA,Strand R. Neurological complications of hemolytic-uremicsyndrome. J Child Neurol 1989;4:108-113.

7. DiMario FJ Jr, Bronte-Stewart H, Sherbotie J, Turner ME.Lacunar infarction of the basal ganglia as a complication ofhemolytic-uremic syndrome. MRI and clinical correlations.Clin Pediatr 1987;26:586-590.

8. Sherwood JW, Wagle WA. Hemolytic uremic syndrome: MRfindings of CNS complications. Am J Neuroradiol1991;12:703-704.

9. Jeong YK, Kim IO, Kim WS, Hwang YS, Choi Y, Yeon KM.

Hemolytic uremic syndrome: MR findings of CNScomplications. Pediatr Radiol 1994;24:585-586.

10. Barnett ND, Kaplan AM, Bernes SM, Cohen ML. Hemolyticuremic syndrome with particular involvement of basalganglia and favorable outcome. Pediatr Neurol1995;12:155-158.

11. Ogura H, Takaoka M, Kishi M, Kimoto M, Shimazu T,Yoshioka T et al. Reversible MR findings of hemolytic uremicsyndrome with mild encephalopathy. Am J Neuroradiol1998;19:1144-1145.

12. Eriksson KJ, Boyd SG, Tasker RC. Acute neurology andneurophysiology of haemolytic-uraemic syndrome. Arch DisChild 2001;84:434-435.

13. Bale JF Jr, Brasher C, Siegler RL. CNS manifestations of thehemolytic-uremic syndrome. Relationship to metabolicalterations and prognosis. Am J Dis Child 1980;134:869-872.

14. Dhuna A, Pascual-Leone A, Talwar D, Torres F. EEG andseizures in children with hemolytic-uremic syndrome.Epilepsia 1992;33:482-486.

15. Sheth KJ, Swick HM, Haworth N. Neurological involvement inthe haemolytic-uremic syndrome. Ann Neurol 1986;19:90-93.

16. Cimolai N, Morrison BJ, Carter JE. Risk factors for thecentral nervous system manifestations of gastroenteritis-associated hemolytic uremic syndrome. Am J Dis Child1980;134:869-872.

17. Siegler RL, Brewer ED, Swartz M. Ocular involvement inhemolytic-uremic syndrome. J Pediatr 1988;112:594-597.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 27-06-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰ÚË˜ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. &∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: [email protected]


461

�¶ÂÚ›ÏË„Ë: ∏ ¯ÚˆÌÔÛˆÌÈÎ‹ Û‡ÓıÂÛË ÙˆÓ ÂÚÈÛ-ÛfiÙÂÚˆÓ ·ÙfiÌˆÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down Â›Ó·È Ë ÂÏÂ‡-ıÂÚË ÙÚÈÛˆÌ›· 21, ÂÓÒ ¤Ó·˜ ÂÚÈÔÚÈÛÌ¤ÓÔ˜ ·ÚÈı-Ìfi˜ ¤¯ÂÈ ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈÎ‹˜ Û‡ÓÙËÍË˜(Robertsonian translocation). ™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜‹Ù·Ó: ·) Ë ÌÂÏ¤ÙË ÙˆÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ¯·Ú·ÎÙË-ÚÈÛÙÈÎÒÓ ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down, ‚) Ë ÂÎÙ›ÌË-ÛË ÙˆÓ Û˘Ó‹ıˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛ‹˜ ÙÔ˘˜ Î·È Á) Ë ·ÓÙÈÌÂÙÒÈÛ‹ÙÔ˘˜. ∞Ó·ÛÎÔ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿ ÔÈ Ê¿ÎÂÏÔÈ 533·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down, ÔÈ ÔÔ›ÔÈ ÂÚÂ˘Ó‹ıË-Î·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈÎ¿ Ù· ¤ÙË 1973-2001, ÂÓÒÂÚÂ˘Ó‹ıËÎ·Ó ÂÈÏÂÎÙÈÎ¿ Î·È ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈÛÌ¤ÓˆÓÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ ÁÈ· ·ÔÎÏÂÈÛÌfi ÙË˜ ÎÏËÚÔ-ÓÔÌÈÎfiÙËÙ·˜. ∫·Ù·ÁÚ¿ÊËÎ·Ó: ·) ÙÔ Ê‡ÏÔ, ‚) Ë ËÏÈ-Î›· Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ, ‰) ÔÈ ÌÔ-Ó‹ÚÂÈ˜ ‹ ‰›‰˘ÌÂ˜ Î˘‹ÛÂÈ˜, Â) Ë ËÏÈÎ›· ÙˆÓ ÁÔÓ¤ˆÓÎ·Ù¿ ÙÔÓ ÙÔÎÂÙfi, ÛÙ) Ô ÙfiÔ˜ Î·ÙÔÈÎ›·˜ Î·È, Ù¤ÏÔ˜,Û˘ÁÎÚ›ıËÎ·Ó Ù· Â˘Ú‹Ì·Ù· ÌÂ ÂÎÂ›Ó· ¿ÏÏˆÓ ÂÚÂ˘-ÓËÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó 56% Î·È ÙˆÓÎÔÚÈÙÛÈÒÓ 44%. ∞ÌÈÁ‹ ÂÏÂ‡ıÂÚË ÙÚÈÛˆÌ›· Â›¯Â ÙÔ90%, ÌˆÛ·˚ÎÈÛÌfi ÙÔ 5,5%, ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈÎ‹˜ Û‡-ÓÙËÍË˜ ÙÔ 4,5%, ÂÓÒ ·fi ·˘ÙÔ‡˜ ÌfiÓÔ ÙÔ 1% Â›¯ÂÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È ÙˆÓ ·Ù¤ÚˆÓ Ù· 34¤ÙË. ∏ ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‰È·-ÌÔÚÊˆÓfiÙ·Ó ˆ˜ ÂÍ‹˜: 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹ÙË˜ Î‡ËÛË˜ ÏfiÁˆ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘, 56% ‹Ù·Ó ÓÂÔÁÓ¿, 27% ‹Ù·Ó ‚Ú¤ÊË Î·È 11% Â›¯Â ËÏÈÎ›·ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1 ¤ÙÔ˘˜. ∞fi ÙËÓ Â·Ú¯›· ·Ú·-¤ÌÊıËÎÂ Û˘ÓÔÏÈÎ¿ ÙÔ 56% ÙˆÓ ·ÛıÂÓÒÓ Î·È ·fi ÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ ÙÔ 38%. ∆· Â˘Ú‹-Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ·˘Ù¿ÙË˜ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∆· ÚÒÙ· 12 ¯ÚfiÓÈ·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ·Ú·¤ÌÊıËÎ·Ó ÛÙË

�Abstract: In most patients with Down syndrome, thecondition derives from non-familial trisomy 21 and in afew of them the extra chromosomal material is theresult of Robertsonian translocation. The aim of thisstudy was: a) investigation of the cytogeneticcharacteristics of the patients with Down syndrome, b)evaluation of the usual characteristics relevant to theirbirth control, c) evaluation of the most prevalentmedical problems and their management. The fileswere reviewed of 533 patients with Down syndromewho had been successfully examined chromosomi-cally between 1973 and 2001. Selectively, some of thefamilies had been examined in order to estimate theprevalence of heredity. For each patient, record wasmade of the: a) sex, b) age at diagnosis, c) karyotype,d) occurrence of single or twin pregnancy, e) parents’age at delivery, and f) residential area, and the findingswere compared to those of other researchers. Girlscomprised 44% and boys 56% of the group.Chromosomal examination revealed free trisomy 21 in90%, mosaicism in 5.5% and Robertsoniantranslocation in 4.5%, and among these only 1%showed heredity. The average age of the mothers was30.5 years and of the fathers 34 years. Regarding thepatients’ age at diagnosis, 4 were fetuses derived fromtermination of pregnancy due to prenatal diagnosis,56% were neonates, 27% were infants and 11% wereaged over 12 months. The residence of 56% of thepatients was in the provinces and 38% lived in the cityof Thessaloniki. The findings of this study are similarto those reported in the international bibliography.Most of the mothers were younger than 35 years. In the first 12 years most of the patients were referredby the attending physicians in the neonatal age(47%) and 23% of the patients were neonates from the

∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ Î·È ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ 533 ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down Ù· ¤ÙË 1973-2001 Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘

Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001 H. Hatzissevastou - Loukidou, P. Kambouridou


∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜, ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔÓ›ÎË˜

Cytogenetic Laboratory, 1st Paediatric Clinic of Aristotle University of Thessaloniki “Ippokration” General Hospital, Thessaloniki

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ DS ™‡Ó‰ÚÔÌÔ Downª∫™ ªÂÙ¿ıÂÛË ÎÂÓÙÚÈÎ‹˜ Û‡ÓÙËÍË˜∂∆ ∂ÏÂ‡ıÂÚË ÙÚÈÛˆÌ›·

∂ÈÛ·ÁˆÁ‹∆Ô Û‡Ó‰ÚÔÌÔ Down (DS) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ¯Úˆ-

ÌÔÛˆÌÈÎ‹ ·ÓˆÌ·Ï›· ÛÙ· ·È‰È¿ Î·È Ë ÈÔ Û˘¯Ó‹ ÁÂ-ÓÂÙÈÎ‹ ·ÈÙ›· ÓÔËÙÈÎ‹˜ ˘ÛÙ¤ÚËÛË˜ (1-3). ™Â fiÏÔ ÙÔÓÎfiÛÌÔ, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È 1/800¤ˆ˜ 1/1000 ÁÂÓÓ‹ÛÂÈ˜ (2). ∆· ·ÁfiÚÈ· Â›Ó·È ÂÚÈÛÛfi-ÙÂÚ· ·fi Ù· ÎÔÚ›ÙÛÈ· ÌÂ ·Ó·ÏÔÁ›· 1,3/1 (3). ¶·Ï·È-fiÙÂÚ·, Ë ÁÔÓÂ˚Î‹ ÚÔ¤ÏÂ˘ÛË ÙÔ˘ ˘ÂÚ¿ÚÈıÌÔ˘¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ 21 ÛÙËÚÈ˙fiÙ·Ó ÛÂ Î˘ÙÙ·ÚÔÁÂÓÂÙÈ-ÎÔ‡˜ ÂÙÂÚÔÌÔÚÊÈÛÌÔ‡˜ Î·È ÌÂ ‚¿ÛË ÂÎÂ›ÓÂ˜ ÙÈ˜ ÌÂ-Ï¤ÙÂ˜, ÔÛÔÛÙfi 80% ‹Ù·Ó ÌËÙÚÈÎ‹˜ Î·È 20% ·ÙÚÈ-Î‹˜ ÚÔ¤ÏÂ˘ÛË˜. ™‹ÌÂÚ·, fiÌˆ˜, ÌÂ ÙÔ˘˜ ÔÏ˘ÌÔÚ-ÊÈÛÌÔ‡˜ ÙÔ˘ DNA ‚Ú¤ıËÎÂ fiÙÈ ÔÛÔÛÙfi 95% Â›Ó·ÈÌËÙÚÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ Î·È ÌfiÓÔÓ 5% ·ÙÚÈÎ‹˜ (1,4-10). O Î›Ó‰˘ÓÔ˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ Ì›· Á˘Ó·›Î· ËÏÈ-Î›·˜ 35-39 ÂÙÒÓ Ó· ·ÔÎÙ‹ÛÂÈ ·È‰› ÌÂ ÙÚÈÛˆÌ›· 21Â›Ó·È 6,5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ·˘ÙfiÓ Ì›·˜ ¿ÏÏË˜ËÏÈÎ›·˜ 20-24 ÂÙÒÓ. ∞˘Ù‹ Ë ·Ó·ÏÔÁ›· Êı¿ÓÂÈ ÛÙÔ20,5 ÁÈ· Á˘Ó·›ÎÂ˜ ËÏÈÎ›·˜ 40-44 ÂÙÒÓ. ∞ÔÙ¤ÏÂÛÌ·Â›Ó·È fiÙÈ ÔÈ Á˘Ó·›ÎÂ˜ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 35¯ÚfiÓˆÓ Î˘ÔÊÔÚÔ‡Ó ÙÔ 20-25% ÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÂ DS,fiÌˆ˜ ÛÙËÓ ËÏÈÎ›· ·˘Ù‹ ·Ó·ÏÔÁÂ› ÌfiÓÔ ÙÔ 7% ÙˆÓÎ˘‹ÛÂˆÓ (2,11-14).

™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ‰ÈÂÚÂ˘Ó‹ÛÂÈ Ù·Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÛıÂÓÒÓ, ÙËÓËÏÈÎ›· ÎÏÈÓÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Î·È ·Ú·ÔÌ‹˜ ÛÂ Û¯¤-ÛË ÌÂ ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ Î·È ÙÔÓ ÙfiÔ Î·ÙÔÈÎ›·˜,ÙËÓ ËÏÈÎ›· ÙˆÓ ÁÔÓ¤ˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi Î·È, Ù¤ÏÔ˜,Ó· Û˘Ì‚¿ÏÂÈ: ·) ÛÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛË˜ ·È‰ÈÒÓÌÂ DS Î·È ‚) ÛÙËÓ ÚÒÈÌË ·Ú¤Ì‚·ÛË ÛÂ Â›Â‰ÔÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„Ë˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ 533 ·ÛıÂÓÒÓ ÌÂ DS (¯·Ú·-

ÎÙËÚ›˙ÔÓÙ·È ˆ˜ “·ÛıÂÓÂ›˜”, Î·ıÒ˜ Ë ËÏÈÎÈ·Î‹ ÙÔ˘˜ Î·Ù·ÓÔÌ‹Â›Ó·È ·fi 0-50 ÂÙÒÓ) Ô˘ ÂÚÂ˘Ó‹ıËÎ·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈ-Î¿ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ù· ¤ÙË 1973-2001. ∂›ÛË˜, ·Ó·ÛÎÔ‹ıË-

Î·Ó ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ, ÔÈ ÔÔ›Â˜ÂÚÂ˘Ó‹ıËÎ·Ó ¯ÚˆÌÔÛˆÌÈÎ¿ ÁÈ· Ó· ·ÔÎÏÂÈÛÙÂ› Ë ÎÏËÚÔÓÔÌÈ-ÎfiÙËÙ·. ∫·Ù·ÁÚ¿ÊËÎ·Ó: ·) ÙÔ Ê‡ÏÔ, ‚) Ë ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓÎ·Ù¿ ÙË ‰È¿ÁÓˆÛË, Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ: ÂÏÂ‡ıÂÚË ÙÚÈÛˆÌ›· (·ÌÈ-Á‹˜ ÌÔÚÊ‹ ‹ ÌˆÛ·˚ÎÈÛÌfi˜), ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈÎ‹˜ Û‡ÓÙËÍË˜(de novo ‹ ÎÏËÚÔÓÔÌÈÎ‹), ‰) ÔÈ ÌÔÓ‹ÚÂÈ˜ ‹ ‰›‰˘ÌÂ˜ Î˘‹ÛÂÈ˜,Â) Ô ÙfiÔ˜ Î·ÙÔÈÎ›·˜ (Â·Ú¯›· ‹ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜) Î·ÈÛÙ) ÔÈ ËÏÈÎ›Â˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô 1985 ÂÊ·ÚÌfi-ÛÙËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ Ë ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ¯ÚˆÌÔÛˆ-ÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÂÚÁ·ÛÙ‹-ÚÈÔ, ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ fiÏÂ˜ ÙÈ˜ ¶·ÓÂÈÛÙËÌÈ·Î¤˜ Ì·ÈÂ˘ÙÈÎ¤˜ÎÏÈÓÈÎ¤˜ ÙÔ˘ “πÔÎÚ¿ÙÂÈÔ˘” ¡ÔÛÔÎÔÌÂ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜. ∆Ô¤ÙÔ˜ ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ˆ˜ ÔÚfiÛËÌÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛËÙ˘¯fiÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ. ŒÁÈÓÂ ÛÙ·ÙÈ-ÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÌÂ ÙË ‰ÔÎÈÌ·Û›· ¯2. £ÂˆÚ‹-ıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜ ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ Â›¯·Ó ÛÙ¿ıÌË ÛËÌ·ÓÙÈÎfi-ÙËÙ·˜ ÌÂ p<0,05. ∆· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘-ÁÎÚ›ıËÎ·Ó ÌÂ ·˘Ù¿ ¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ÌÂÏ¤ÙË·) ¶ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜: ŒÁÈÓÂ Î·Ú˘fiÙ˘Ô˜ ÌÂÙ¿ ·fi

Î·ÏÏÈ¤ÚÁÂÈ· ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (ÌÂÏÂÙ‹ıËÎ·Ó 20-30 ÌÂÙ·Ê¿-ÛÂÈ˜ ÁÈ· Î¿ıÂ ·ÛıÂÓ‹). ∏ Û‹Ì·ÓÛË ¤ÁÈÓÂ ÌÂ G Î·È Q-banding.

‚) ∞ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡: ŒÁÈÓÂ ·Ó¿Ï˘ÛË 20-30 ÌÂÙ·Ê¿ÛÂˆÓ·fi 2-3 Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·ÌÓÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙ· 4 ¤Ì‚Ú˘· Ô˘ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·. ∏ Û‹Ì·ÓÛË ¤ÁÈÓÂÌÂ G Î·È Q-banding.

∞ÔÙÂÏ¤ÛÌ·Ù· ∞fi ÙÔ˘˜ 533 ·ÛıÂÓÂ›˜, 292 (56%) ‹Ù·Ó ·ÁfiÚÈ·

Î·È 235 (44%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. ∏ Û¯¤ÛË ·ÁfiÚÈ·/ÎÔÚ›-ÙÛÈ· ‹Ù·Ó 1,3/1 (∂ÈÎfiÓ· 1).

∞ÌÈÁ‹ ÂÏÂ‡ıÂÚË ÙÚÈÛˆÌ›· Â›¯·Ó 478/533 (90%),ÌˆÛ·˚ÎÈÛÌfi 30/533 (5,5%), ª∫™ 25/533 (4,5%) Î·È,ÌÂÙ¿ ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, Ê¿ÓËÎÂ fiÙÈ ÎÏË-ÚÔÓÔÌÈÎfiÙËÙ· ˘‹Ú¯Â ÌfiÓÔ ÛÂ 6/25 (1%) (∂ÈÎfiÓ· 2).

¢ÈÏ‹ ¯ÚˆÌÔÛˆÌÈÎ‹ ·Ù˘›· Â›¯·Ó 2 ·ÛıÂÓÂ›˜:48,ÃÃÃ,+21 Î·È 46,ÃÀ,-13,-14,+t(13;14),+21. ¢›‰˘-ÌÂ˜ Î˘‹ÛÂÈ˜ ‹Ù·Ó 8, ÂÓÒ ÌfiÓÔ ÛÂ Ì›· Â›¯·Ó Î·È Ù·‰‡Ô ·È‰È¿ DS. ª›· ÔÈÎÔÁ¤ÓÂÈ· ·¤ÎÙËÛÂ 2 ·È‰È¿ ÌÂÂÏÂ‡ıÂÚË ÙÚÈÛˆÌ›· ÛÂ ‰‡Ô ‰È·ÊÔÚÂÙÈÎ¤˜ Î˘‹ÛÂÈ˜Î·È ÔÈ ÁÔÓÂ›˜ Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi Î·Ú˘fiÙ˘Ô ÛÙÔ Â-ÚÈÊÂÚÈÎfi ·›Ì·, ÛÂ Â·ÓÂÈÏËÌÌ¤ÓÂ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜


462

ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· (47%) Î·È ÙÔ 23% ‹Ù·Ó ÓÂÔÁÓ¿ ·fiÙËÓ Â·Ú¯›·. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ ÂÓÈÛ¯‡ıËÎ·Ó ÛËÌ·ÓÙÈ-Î¿ ÌÂÙ¿ ÙÔ 1985 (65% Î·È 39%, ·ÓÙ›ÛÙÔÈ¯·). ∞ÔÎ·-Ï‡ÊıËÎÂ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÛÂ 6 ÔÈÎÔÁ¤ÓÂÈÂ˜ Î·È ‰fi-ıËÎÂ Î·Ù¿ÏÏËÏË ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË ÛÂ fiÏ· Ù· ˙Â˘-Á¿ÚÈ·. OÈ 139/533 ·ÛıÂÓÂ›˜ Ù¤ıËÎ·Ó ÛÂ Û˘ÛÙËÌ·ÙÈÎ‹·Ú·ÎÔÏÔ‡ıËÛË ÛÙÔ ÂÍˆÙÂÚÈÎfi È·ÙÚÂ›Ô.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û‡Ó‰ÚÔÌÔ Down, Û˘¯ÓfiÙËÙ·, Î·-Ú˘fiÙ˘Ô˜, ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË, ÂÈ‰ËÌÈÔÏÔÁÈÎ¿¯·Ú·ÎÙËÚÈÛÙÈÎ¿.

provinces. These percentages rose markedly after1985. Heredity was discovered in 6 families andappropriate genetic counseling was provided to all ofthem. Of the group, 139/533 children have been undersystematic follow-up in outpatient department.

Key words: Down syndrome, prevalence, karyotype,prenatal diagnosis, epidemiological characteristics.


463

ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÂÙ·Ê¿ÛÂˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË

‰È¿ÁÓˆÛË, 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹ Î‡ËÛË˜ ÌÂ-Ù¿ ·fi ·ÌÓÈÔÎ¤ÓÙËÛË (ÛÂ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô Ïfi-Áˆ ÚÔ¯ˆÚËÌ¤ÓË˜ ËÏÈÎ›·˜ ÙË˜ ÌËÙ¤Ú·˜ ‹ ÌËÙ¤Ú·˜ÊÔÚ¤· ÌÂÙ¿ıÂÛË˜), 298/533 (56%) ‹Ù·Ó ÓÂÔÁÓ¿,144/533 (27%) ‹Ù·Ó ‚Ú¤ÊË Î·È 58/533 (11%) ‹Ù·Ó·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (1-50 ÂÙÒÓ). ™Â 33/533 (6%) ·ÛıÂÓÂ›˜, Ë ËÏÈÎ›· ‰ÂÓ‹Ù·Ó Î·Ù·ÁÂÁÚ·ÌÌ¤ÓË (∂ÈÎfiÓ· 3).

∞fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 289/533·ÛıÂÓÂ›˜ (54%) Î·È ·fi ÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›-ÎË˜ 202/533 (38%). °È· 42/533 (8%) ‰ÂÓ ‹Ù·Ó Î·Ù·-ÁÂÁÚ·ÌÌ¤ÓÔ˜ Ô ÙfiÔ˜ Î·ÙÔÈÎ›·˜. ™Â Û¯¤ÛË ÌÂ ÙËÓËÏÈÎ›· ÙÔ˘˜, ·fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 160ÓÂÔÁÓ¿ (30%), 98 ‚Ú¤ÊË (18%) Î·È 31 ·È‰È¿ ËÏÈ-Î›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (6%), ÂÓÒ ·fi

ÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ 125 ÓÂÔÁÓ¿ (23%), 51‚Ú¤ÊË (10%) Î·È 26 ·È‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%) (∂ÈÎfiÓ· 4).

¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô220 ·ÛıÂÓÂ›˜, 103 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿(47%), 87 ‹Ù·Ó ‚Ú¤ÊË (37%) Î·È 25 ‹Ù·Ó ·È‰È¿ ËÏÈ-Î›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%). ªÂÙ¿ ÙÔ1986 ·Ú·¤ÌÊıËÎ·Ó 281 ·ÛıÂÓÂ›˜, 182 ·fi ÙÔ˘˜ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (65%), 67 ‹Ù·Ó ÌÈÎÚ¿ ‚Ú¤ÊË(24%) Î·È 32 ‹Ù·Ó ·È‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ÂÓfi˜ ¤ÙÔ˘˜ (11%) (∂ÈÎfiÓ· 5).

¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓÂ·Ú¯›· 110/220 ·ÛıÂÓÂ›˜ (55%) Î·È ÌÂÙ¿ ÙÔ 1986179/281 (63%), ÂÓÒ ·fi ÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›-ÎË˜ ·Ú·¤ÌÊıËÎ·Ó 100/220 (45%) Î·È 102/281(36%), ·ÓÙ›ÛÙÔÈ¯· (∂ÈÎfiÓ· 6).

∂ÈÎfiÓ· 1. ™¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ·.

44% 56%∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ·

∂ÈÎfiÓ· 2. ÃÚˆÌÔÛˆÌÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ (∂∆: ÂÏÂ‡ıÂÚË ÙÚÈ-ÛˆÌ›·, ª∫™: ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈÎ‹˜ Û‡ÓÙËÍË˜).

1% ∂∆ - ·ÌÈÁ‹˜ ÌÔÚÊ‹

∂∆ - ÌˆÛ·˚ÎÈÛÌfi˜

ª∫™ de novo

ª∫™ ÎÏËÚÔÓÔÌÈÎ‹

90%

3,5%

5,5%

∂ÈÎfiÓ· 3. ∫·Ù·ÓÔÌ‹ Î·Ù¿ ËÏÈÎ›Â˜ ÛÙË ‰È¿ÁÓˆÛË.

6%

µÚ¤ÊË

¶·È‰È¿

ÕÁÓˆÛÙ·

56%

11%

27%

¡ÂÔÁÓ¿

∂ÈÎfiÓ· 5. ∞ÏÏ·Á¤˜ ÛÙËÓ ËÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ Î·Ù¿ ÙË ‰È¿ÁÓˆ-ÛË ÌÂ ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ (ÓÂÔÁÓ¿: p=0,001, ‚Ú¤ÊË:p<0,005).

80%

70%

60%

50%

40%

30%

20%

10%

0%

1973-1985 1986-2001

47% 37%

11%

65%

24%

11%

¡ÂÔÁÓ¿µÚ¤ÊË

¶·È‰È¿¡ÂÔÁÓ¿

µÚ¤ÊË¶·È‰È¿

∂ÈÎfiÓ· 4. ∏ÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÛÂ Û¯¤ÛË ÌÂÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜.

40%

35%

30%

25%

20%

15%

10%

5%

0%¡ÂÔÁÓ¿ µÚ¤ÊË ¶·È‰È¿

30%

23%

18%

10%

6% 5%

£ÂÛÛ·ÏÔÓ›ÎË∂·Ú¯›·

∞Ó·Ï‡ÔÓÙ·˜ ÂÚ·ÈÙ¤Úˆ ÙËÓ ËÏÈÎ›· ·Ú·ÔÌ‹˜ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔÓ ÙfiÔ Î·ÙÔÈÎ›·˜ ‰È·ÈÛÙÒıËÎÂfiÙÈ ÚÈÓ ·fi ÙÔ 1985 ·fi ÙËÓ Â·Ú¯›· ‹Ù·Ó 50/220ÓÂÔÁÓ¿ (23%), 50/220 ‚Ú¤ÊË (23%) Î·È 10/220 ·È-‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%), ÂÓÒÌÂÙ¿ ÙÔ 1986 ÓÂÔÁÓ¿ ‹Ù·Ó 110/281 (39%), ‚Ú¤ÊË48/281 (17%) Î·È ·È‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ÂÓfi˜ ¤ÙÔ˘˜ ‹Ù·Ó 21/281 (7%). ∞fi ÙËÓ fiÏË ÙË˜£ÂÛÛ·ÏÔÓ›ÎË˜ ÚÈÓ ·fi ÙÔ 1985 ‹Ù·Ó 53/220 ÓÂÔ-ÁÓ¿ (24%), 32/220 ‚Ú¤ÊË (15%) Î·È 15/220 ·È‰È¿ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (7%), ÂÓÒ ÌÂ-Ù¿ ÙÔ 1986 ÓÂÔÁÓ¿ ‹Ù·Ó 72/281 (26%), ‚Ú¤ÊË19/281 (7%) Î·È ·È‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ÂÓfi˜ ¤ÙÔ˘˜ ‹Ù·Ó 11/281 (4%) (∂ÈÎfiÓ· 7).

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ ËÏÈÎ›· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓÙÔÎÂÙfi, ÏËÚÔÊÔÚ›Â˜ ˘‹Ú¯·Ó ÁÈ· 460/533. OÈ105/460 ‹Ù·Ó ÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ 25 ÂÙÒÓ (23%),146/460 ‹Ù·Ó 25-30 ÂÙÒÓ (32%), 104/460 ‹Ù·Ó 30-35ÂÙÒÓ (23%) Î·È 104/560 Â›¯·Ó ËÏÈÎ›· ÌÂÁ·Ï‡ÙÂÚËÙˆÓ 35 ÂÙÒÓ (22%) (∂ÈÎfiÓ· 8).

ŒÁÈÓÂ ·Ó¿Ï˘ÛË ÙË˜ ËÏÈÎ›·˜ ÙˆÓ ÌËÙ¤ÚˆÓ ÚÈÓÎ·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘Î·È ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÚÈÓ ·fi ÙÔ 1985 55/193 ‹Ù·ÓÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ 25 ÂÙÒÓ (28%), 47/193 ‹Ù·Ó 25-30ÂÙÒÓ (24%), 39/193 ‹Ù·Ó 30-35 ÂÙÒÓ (20%) Î·È52/193 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙˆÓ 35 ÂÙÒÓ (27%). ªÂÙ¿ÙÔ 1986, 50/267 ‹Ù·Ó ÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ 25 ÂÙÒÓ(19%), 98/267 ‹Ù·Ó 25-30 ÂÙÒÓ (37%), 65/267 ‹Ù·Ó30-35 ÂÙÒÓ (24%) Î·È 54/267 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙˆÓ35 ÂÙÒÓ (20%) (∂ÈÎfiÓ· 9).

™˘˙‹ÙËÛË ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·fi ÙÔ˘˜

·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Down, 95% ¤¯ÂÈ ÂÏÂ‡ıÂÚË

ÙÚÈÛˆÌ›·, 1% ÌˆÛ·˚ÎÈÛÌfi Î·È 3-4% ÌË ÈÛÔ˙˘ÁÈÛÌ¤-ÓË ÌÂÙ¿ıÂÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 21 Î·È ÂÓfi˜ ·ÎÚÔ-ÎÂÓÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜, Û˘Ó‹ıˆ˜ ÙÔ˘ 14. ªfiÓÔÙÔ Å/4 ÙˆÓ ÌÂÙ·ı¤ÛÂˆÓ Â›Ó·È ÎÏËÚÔÓÔÌÈÎ¤˜ Î·È ÔÈ˘fiÏÔÈÂ˜ Â›Ó·È de novo (3,15-17).

∆· Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÛıÂ-ÓÒÓ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ·˘Ù¿ÙË˜ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜: 95,5% Â›¯Â ÂÏÂ‡ıÂÚËÙÚÈÛˆÌ›·, 4,5% Â›¯Â ª∫™ Î·È, ·fi ·˘ÙÔ‡˜, ÎÏËÚÔ-ÓÔÌÈÎ‹ ÌÂÙ¿ıÂÛË Â›¯·Ó ÌfiÓÔ 6/533 ·ÛıÂÓÂ›˜ (1%)(∂ÈÎfiÓ· 2).

OÈ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ·ÚÔ‡Û·˜ ÌÂ-Ï¤ÙË˜ ‰¤¯ıËÎ·Ó Î·Ù¿ÏÏËÏË ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË,ÂÓÒ ‰ÈÂÚÂ˘Ó‹ıËÎ·Ó Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ Ù· Ì¤ÏË ÙˆÓÔÈÎÔÁÂÓÂÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·È-ÛÙÒıËÎÂ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔÂÓËÌÂÚÒıËÎ·Ó ÔÈ Û˘ÁÁÂÓÂ›˜ ÊÔÚÂ›˜ ÁÈ· ÙË ÛˆÛÙ‹·ÓÙÈÌÂÙÒÈÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Ó··Ú·Áˆ-Á‹˜, ‰ËÏ·‰‹ ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ÙË˜ ‰ÈÂÓ¤ÚÁÂÈ·˜ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÛÙÔ Î‡ËÌ¿ ÙÔ˘˜ (18).

∏ ËÏÈÎ›· ÙË˜ ‰È¿ÁÓˆÛË˜, ·ÓÂÍ·ÚÙ‹Ùˆ˜ ¿ÏÏˆÓ·Ú·Ì¤ÙÚˆÓ, ‹Ù·Ó Î˘Ú›ˆ˜ Ë ÓÂÔÁÓÈÎ‹. ¶ÂÚÈÛÛfiÙÂ-ÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓÂ›˜ ·Ú·¤ÌÊıËÎ·Ó ÁÈ·¤ÏÂÁ¯Ô ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· (56%), Ï›ÁÔÈ ÛÙË ‚ÚÂÊÈ-Î‹ (27%) Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔÈ (11%) ÌÂÙ¿ ÙËÓ ËÏÈÎ›·ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (1-50 ÂÙÒÓ) (∂ÈÎfiÓ· 3).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈÎ›·, Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÛıÂ-ÓÒÓ ‰ÂÓ ÙÚÔÔÔÈ‹ıËÎÂ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÙfiÔ Î·-ÙÔÈÎ›·˜ Î·Ù¿ Ù· ¤ÙË 1973-2001. ¢ËÏ·‰‹, ÙfiÛÔ ·fiÙËÓ Â·Ú¯›· fiÛÔ Î·È ·fi ÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›-ÎË˜, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ Î·È ÔÈÏÈÁfiÙÂÚÔÈ ‹Ù·Ó ·È‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ 1¤ÙÔ˘˜ (∂ÈÎfiÓ· 4).

™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·ÓÔÚfiÛËÌÔ ÙÔ ¤ÙÔ˜ 1985, Î·Ù¿ ÙÔ ÔÔ›Ô ¿Ú¯ÈÛÂ ËÂÊ·ÚÌÔÁ‹ ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ¯ÚˆÌÔ-ÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.∆Ô ¤ÙÔ˜ ·˘Ùfi ·ÔÙ¤ÏÂÛÂ ÛÙ·ıÌfi ·ÏÏ·Á‹˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ÂÁÎ‡ˆÓ


464

∂ÈÎfiÓ· 6. ∞ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤Ì-ÊıËÎ·Ó ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÚÈÓ Î·È ÌÂÙ¿ ÙÔ1985 (Â·Ú¯›·: p<0,05, £ÂÛÛ·ÏÔÓ›ÎË: p<0,05).

0,85 ∂·Ú¯›·

£ÂÛÛ·ÏÔÓ›ÎË0,75

0,65

0,55

0,45

0,35

0,25

0,15

0,05

-0,051973-1985 1986-2001

55% 45%

63%

36%

∂ÈÎfiÓ· 7. ∞ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤Ì-ÊıËÎ·Ó ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ËÏÈÎ›· Î·È ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÚÈÓÎ·È ÌÂÙ¿ ÙÔ 1985 (ÓÂÔÁÓ¿ ·fi ÙËÓ Â·Ú¯›·: p<0,001, ‚Ú¤ÊË·fi ÙË £ÂÛÛ·ÏÔÓ›ÎË: p<0,005).

50% ∂·Ú¯›· £ÂÛÛ·ÏÔÓ›ÎË

40%

30%

20%

10%

0%

1973-1985 1986-2001

23%24%

23%

15%

5% 7%

39%

26% 17%7% 7%4%

¡ÂÔÁÓ¿ µÚ¤ÊË ¶·È‰È¿ ¡ÂÔÁÓ¿ µÚ¤ÊË ¶·È‰È¿

Á˘Ó·ÈÎÒÓ ÌÂ ˘„ËÏfi Î›Ó‰˘ÓÔ ÁÈ· ¯ÚˆÌÔÛˆÌÈÎfi Úfi-‚ÏËÌ· ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰·. ∆Ô Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÂÚÁ·-ÛÙ‹ÚÈÔ Û˘ÛÙÂÁ¿˙ÂÙ·È ÛÙÔ ›‰ÈÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂ fiÏÂ˜ÙÈ˜ Ì·ÈÂ˘ÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÙÔ˘ ∞.¶.£. Î·È ·fi fi,ÙÈ ‹Ù·ÓÁÓˆÛÙfi ‰ÂÓ ˘‹Ú¯Â ·ÔÛÙÔÏ‹ ‰ÂÈÁÌ¿ÙˆÓ ·ÌÓÈ·ÎÔ‡˘ÏÈÎÔ‡ ÛÂ È‰ÈˆÙÈÎ¿ ÂÚÁ·ÛÙ‹ÚÈ· ÂÓÙfi˜ Î·È ÂÎÙfi˜∂ÏÏ¿‰·˜ ÙËÓ ›‰È· ÂÚ›Ô‰Ô. ªÂ ·˘Ù¿ Ù· ‰Â‰ÔÌ¤Ó·ÂÎÙÈÌ‹ıËÎÂ Ë Û˘Ì‚ÔÏ‹ ÙË˜ ÌÂÏ¤ÙË˜ ÛÙÔÓ ‚ÔÚÂÈÔÂÏ-Ï·‰ÈÎfi ¯ÒÚÔ, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÎ·›‰Â˘ÛË ÙˆÓ·È‰È¿ÙÚˆÓ Î·È ÙˆÓ Ì·ÈÂ˘Ù‹ÚˆÓ.

¶ÚÈÓ ·fi ÙÔ 1985, ÏÈÁfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ·È‰È¿Ô˘ ·Ú·¤ÌÊıËÎ·Ó ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 37% ‹Ù·Ó‚Ú¤ÊË Î·È ÌfiÓÔÓ 11% ‹Ù·Ó ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ªÂÙ¿ ÙÔ 1986, fiÌˆ˜, Ù· ÓÂÔÁÓ¿‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ÂÚÈÛÛfiÙÂÚ· (65%,p=0,001), Ù· ‚Ú¤ÊË ÛËÌ·ÓÙÈÎ¿ ÏÈÁfiÙÂÚ· (24%,p<0,005), ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ù·ÓËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‰ÂÓ ÌÂÙ·‚Ï‹-ıËÎÂ (11%) (∂ÈÎfiÓ· 5).

ªÂÙ¿ ÙÔ 1986 ·Ú·ÙËÚ‹ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·-¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 55% ÛÂ 63%,p<0,05), ÂÓÒ ·ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜(·fi 45% ÛÂ 36%, p<0,05) (∂ÈÎfiÓ· 6).

™ÙËÓ ∂ÈÎfiÓ· 7 Ê·›ÓÂÙ·È, ·ÎfiÌË, fiÙÈ ÌÂÙ¿ ÙÔ 1986˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ÓÂÔÁÓÒÓÔ˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 23% ÛÂ39%, p<0,001) Î·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛËÙˆÓ ‚ÚÂÊÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏËÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ (·fi 15% ÛÂ 7%, p<0,005). OÈ·ÛıÂÓÂ›˜ ÙˆÓ ¿ÏÏˆÓ ËÏÈÎÈÒÓ ‰ÂÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿.

∆· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÂÚÌËÓÂ‡-ıËÎ·Ó ÌÂ ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, ÔÈ ÁÈ·-ÙÚÔ› Ô˘ ÂÈ‰ÈÎÂ‡ÔÓÙ·È ÛÙÈ˜ ¶·ÓÂÈÛÙËÌÈ·Î¤˜ ÎÏÈÓÈÎ¤˜

Â˘·ÈÛıËÙÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙÔ˘ DS.ªÂ ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ ÛÙÂÏ¤¯ˆÛ·Ó ÙËÓ Â·Ú¯›·,ÒÛÙÂ Ó· ·Ú·¤ÌÔÓÙ·È ¤ÁÎ·ÈÚ· Ù· ·È‰È¿. ∏ ‰È·›-ÛÙˆÛË ·˘Ù‹ Û˘ÌÊˆÓÂ› ÌÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ËÌÔÁÚ·-ÊÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ (19,20).

ªÂÙ¿ ÙË ‰È¿ÁÓˆÛË, 139/533 ·ÛıÂÓÂ›˜ ÂÓÙ¿¯ıË-Î·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· ÚˆÙÔ‚¿ıÌÈ·˜ ·Ú·ÎÔÏÔ‡ıË-ÛË˜ ·È‰ÈÒÓ ÌÂ DS ÛÙ· ÂÈ‰ÈÎ¿ ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›·.∞ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÔÚÁ·ÓÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·Ù¿ ÙËÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô (Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜, Û˘Á-ÁÂÓ‹˜ Î·Ù·ÚÚ¿ÎÙË˜, ·ÙÚËÛ›· ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘,Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi˜), ÂÓËÌÂÚÒıËÎ·Ó ÔÈÁÔÓÂ›˜ ÁÈ· ÙÈ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Â›Ó·È Û˘¯ÓfiÙÂÚÂ˜ÛÙ· ·È‰È¿ ÌÂ DS Î·È ÙÔ˘˜ ‰fiıËÎ·Ó Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ¤ÓÙ·ÍË ÙˆÓ ·È‰ÈÒÓ ÛÂ ÂÈ‰ÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· ÂÎ·›-‰Â˘ÛË˜ (3,15-16).

∏ÏÈÎÈ·Î¿, ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌËÙ¤ÚÂ˜ ‹Ù·Ó Ó¤Â˜.∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó Ù· 30,5 ¤ÙË Î·ÈÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∆Ô 78% ÙˆÓ ÌËÙ¤ÚˆÓ ÛÙË‰È¿ÚÎÂÈ· fiÏˆÓ ÙˆÓ ÂÙÒÓ Û˘ÓÔÏÈÎ¿ Â›¯Â ËÏÈÎ›· ÌÈ-ÎÚfiÙÂÚË ÙˆÓ 35 ÂÙÒÓ Î·È ÌfiÓÔ ÙÔ 22% Â›¯Â ËÏÈÎ›·ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 35 ÂÙÒÓ (∂ÈÎfiÓ· 8). ∆· ÔÛÔÛÙ¿‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔ-ÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘, ‰ËÏ·‰‹ ÚÈÓ ·fi ÙÔ 1985 ÙÔ72% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 35ÂÙÒÓ Î·È ÌÂÙ¿ ÙÔ 1986 ÙÔ 80% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·ÓËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 35 ÂÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓÌËÙ¤ÚˆÓ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 35 ÂÙÒÓ ‹Ù·Ó27% Î·È ¤ÁÈÓÂ 20%, ·ÓÙ›ÛÙÔÈ¯· (‰È·ÊÔÚ¿ ÌË ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹). ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË˘‹ÚÍÂ ÌfiÓÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌËÙ¤ÚˆÓ ËÏÈÎ›·˜ 25-30 ÂÙÒÓ (·fi 24% ÛÂ 37%, p=0,006) (∂ÈÎfiÓ· 9).∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ÂÈ‚Â‚·ÈÒÓÂÈ ÙË ÁÓÒÛË fiÙÈ Ù·ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ÌÂ DS ÁÂÓÓÈÔ‡ÓÙ·È ·fi Á˘Ó·›-ÎÂ˜ Ó¤ˆÓ ËÏÈÎÈÒÓ (<35 ÂÙÒÓ), ÛÙÈ˜ ÔÔ›Â˜ ‰ÂÓ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÂÌ‚·ÙÈÎ‹˜ ÌÂıfi‰Ô˘ ÚÔÁÂÓÓËÙÈ-Î‹˜ ‰È¿ÁÓˆÛË˜ (·ÌÓÈÔ·Ú·Î¤ÓÙËÛË˜ ‹ Ï¿¯ÓË˜),·Ú¿ ÌfiÓÔ Ù· screening tests ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ÙÚÈ-Ì‹ÓÔ˘ (˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ Î·È ÔÚÔÏÔÁÈÎ¿), Ù· ÔÔ›·


465

∂ÈÎfiÓ· 9. ∞ÏÏ·Á‹ ÛÙËÓ ËÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·-Ù¿ ÙÔÓ ÙÔÎÂÙfi ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈ-ÎÔ‡ ÂÏ¤Á¯Ô˘ (ÌËÙ¤ÚÂ˜ <25 ÂÙÒÓ: ¡S, ÌËÙ¤ÚÂ˜ 31-35 ÂÙÒÓ:NS, ÌËÙ¤ÚÂ˜ 25-30 ÂÙÒÓ: p=0,006, ÌËÙ¤ÚÂ˜ >35 ÂÙÒÓ: NS).

45%40%35%30%25%20%15%10%5%0%

28%24%

20%27%

<2525-3031-35>35

1973-1985 1986-2001

19%

37%

24%

20%

∂ÈÎfiÓ· 8. ∏ÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi.

40%

35%

30%

25%

20%

15%

10%

5%

0%

23%

<25 25-30 31-35 >35

32%

23% 22%

ˆ˜ ÁÓˆÛÙfiÓ ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈÎ¿ ·ÛÊ·Ï‹ (12-14).™˘ÌÂÚ·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙË-ıÔ‡Ó Î·È Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ·ÍÈfiÈÛÙÂ˜ ÌË ÂÂÌ‚·-ÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ÌÂ ÌÈÎÚfi ÔÛÔÛÙfi „Â˘‰Ò˜ ıÂÙÈÎÔ‡·ÔÙÂÏ¤ÛÌ·ÙÔ˜, ÔÈ ÔÔ›Â˜ ı· ÂÈÏ¤ÁÔ˘Ó ÙÈ˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓÂ·Ú¤˜ ¤ÁÎ˘Â˜, ÒÛÙÂ ·˘Ù¤˜ ÂÎÏÂ-ÎÙÈÎ¿ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ÂÂÌ‚·ÙÈÎ¤˜ ÌÂıfi‰Ô˘˜ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ (12-14,21-23).

∂˘¯·ÚÈÛÙ›Â˜ £ÂÚÌ¤˜ Â˘¯·ÚÈÛÙ›Â˜ ÛÙÈ˜ ·Ú·ÛÎÂ˘¿ÛÙÚÈÂ˜ Î.Î. ¢. ∑·-

ÁÎ·Ú¤ÙÔ˘ Î·È ∑. OÓÔ˘ÊÚÈ¿‰Ô˘ ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙÔ ÙÂ-¯ÓÈÎfi Ì¤ÚÔ˜ ÙË˜ ÂÚÁ·Û›·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Antonarakis SE, Down Syndrome Collaborative Group.

Parental origin of the extra chromosome in trisomy 21 asindicated by analysis of DNA polymorphisms. N Engl J Med1991;324:872-876.

2. Baird PA, Sadovnick AD. Life tables for Down syndrome.Hum Genet 1989;82:291-292.

3. Hayes A, Batshaw ML. Down syndrome. Clin Pediatr1993;40:699-715.

4. Hassold TJ, Jacobs PA. Trisomy in man. Annu Rev Genet1984;18:69-97.

5. Antonarakis SE, Adelsberger PA, Petersen MB, Binkert F,Schinzel AA. Analysis of DNA polymorphisms suggests thatmost de novo dup(21q) chromosomes in patients with Downsyndrome are isochromosomes and not translocations. AmJ Hum Genet 1990;47:968-972.

6. Petersen MB, Adelsberger PA, Schinzel AA, Binkert F, HinkelGK, Antonarakis SE. Down syndrome due to de novoRobertsonian translocation t(14q;21q): DNA polymorphismanalysis suggests that the origin of the extra 21q is maternal.Am J Hum Genet 1991;49:529-536.

7. Davies KE, Harper K, Bonthron D, Krumlauf R, Polkey A,Pembrey ME et al. Use of a chromosome 21 cloned DNAprobe for the analysis of non-disjunction in Down syndrome.Hum Genet 1984;66:54-56.

8. Antonarakis SE, Kittur SD, Metaxotou C, Watkins PC, Patel AS.Analysis of DNA haplotypes suggests a genetic predispositionto trisomy 21 associated with DNA sequences onchromosome 21. Proc Natl Acad Sci USA 1985;82:3360-3364.

9. Gardiner K, Horisberger M, Kraus J, Tantravahi U, KorenbergJ, Rao V et al. Analysis of human chromosome 21:correlation of physical and cytogenetic maps; gene and CpGisland distributions. Embo J 1990;9:25-34.

10. Petersen MB, Slaugenhaupt SA, Lewis JD, Warren AC,Chakravarti A, Antonarakis SE. A genetic linkage map of 27markers on human chromosome 21. Genomics 1991;9:407-419.

11. Carothers AD. Down syndrome and maternal age: the effectof erroneous assignment of parental origin. Am J Hum Genet1987;40:147-150.

12. ¶··ÓÙˆÓ›Ô˘ ¡, ¢·ÛÎ·Ï¿ÎË˜ °, µfiÁÁ·˜ ∂, ªÂÛÔÁ›ÙË˜ ™,

∫Ô‡ÙÚ· ¶, ÃÚÈÛÙÔÊÔÚ¿ÎË ª Î·È Û˘Ó. ¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ-¯Ô˜ ÁÈ· Û‡Ó‰ÚÔÌÔ Down ÌÂ ÙË ̄ Ú‹ÛË ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ. ∏ÂÌÂÈÚ›· ·fi Ì›· ÌÂÁ¿ÏË Ì·ÈÂ˘ÙÈÎ‹ ÌÔÓ¿‰·. ∂ÊË‚ °˘Ó ∞Ó·∂ÌÌËÓ 2001;13:299-303.

13. ∞ÓÙˆÓÈ¿‰Ë˜ ™, ¶·ÏÈÔ‡ÚË ∫, ¶··‰¿ÎÔ˘ ∞, ª›Ù˙ÈÔ˘ °, ∫·Ú-‚ÂÏ¿ ∞, ¶¿ÁÎ·ÏÔ˜ ∫ Î·È Û˘Ó. O ÚfiÏÔ˜ ÙÔ˘ a-test (‚ÈÔ¯ËÌÈÎÔ›‰Â›ÎÙÂ˜: AFP, HCG, UE3 ÛÙÔÓ ÌËÙÚÈÎfi ÔÚfi) ÛÙËÓ ·Ó›¯ÓÂ˘ÛËÛ˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ [¶ÂÚ›ÏË„Ë]. 37Ô ¶·ÓÂÏ-Ï‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 28-30 ª·˝Ô˘; £ÂÛÛ·ÏÔÓ›-ÎË; 1999. ÛÂÏ. 148. #285∞∞.

14. µÔÁÈ·˙·Ófi˜ ª, ∞ÚÁ˘Ú›Ô˘ ∞, ∫fiÏÔÎÔ˜ °, °·‚ÚÈ‹Ï ™, ∆ÈÁÁÈÚ›-‰Ô˘ ª. µÈÔ¯ËÌÈÎfi ·ÓÈ¯ÓÂ˘ÙÈÎfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔDown ·fi ÙÔ Î¤ÓÙÚÔ ÚfiÏË„Ë˜ ÓÂ˘Ì·ÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚË-ÛË˜ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ;1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜; 1998. ÛÂÏ. 76. #136∂∞.

15. Saenz RB. Primary care of infants and young children withDown syndrome. Am Fam Physician 1999;59:381-390, 392,395-396.

16. American Academy of Pediatrics, Committee on Genetics.Health supervision for children with Down syndrome.Pediatrics 2001;107:442-449.

17. Kovaleva NV, Butomo IV, Verlinskaia DK, Il’iashenko TN,Pantova IG, Prozorova MV et al. Karyological characteristicsof Down’s syndrome: clinical and theoretical aspects.Tsitologiia 1999;41:1014-1021.

18. ¶¿ÁÎ·ÏÔ˜ ∫. ¡¤· ‰Â‰ÔÌ¤Ó· ÛÙË ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË ÔÈ-ÎÔÁÂÓÂÈÒÓ ÌÂ ÙÚÈÛˆÌ›· 21 (Û‡Ó‰ÚÔÌÔ Down) ·fi ÌÂÏ¤ÙÂ˜ÌÔÚÈ·Î‹˜ ÁÂÓÂÙÈÎ‹˜ [¶ÂÚ›ÏË„Ë]. 31Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈ-Îfi ™˘Ó¤‰ÚÈÔ; 1993 4-6 πÔ˘Ó›Ô˘; ∫·ÛÛ¿Ó‰Ú·, Ã·ÏÎÈ‰ÈÎ‹;1993. #195∞.

19. Mavrou A, Metaxotou C, Trichopoulos D. Awareness and useof prenatal diagnosis among Greek women: a nationalsurvey. Prenat Diagn 1998;18:349-355.

20. ª·Ú·ÁÎfi˜ Ã, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ¶ÚÔÁÂÓÓËÙÈÎfi˜ Î·È ÚÔÛ˘-ÌÙˆÌ·ÙÈÎfi˜ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ·fi„ÂÈ˜ ·È‰È¿ÙÚˆÓ. ¶·È-‰È·ÙÚÈÎ‹ 1999;62:490-498.

21. ∫ÔÏÈ·Ï¤ÍË ∞, ª·ÎÔ‡Ï·˜ µ, ¶·Ó·ÁÈˆÙÔÔ‡ÏÔ˘ ¶, ¢·Ê¤Ú-ÌÔ˘ ∂, ª·‡ÚÔ˘ ∞, ªÂÙ·ÍˆÙÔ‡ ∞. In situ ˘‚ÚÈ‰ÈÛÌfi˜ ·ÌÓÈ·-ÎÒÓ Î˘ÙÙ¿ÚˆÓ [¶ÂÚ›ÏË„Ë]. 34Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘-Ó¤‰ÚÈÔ; 1996 31 ª·˝Ô˘ & 1-2 πÔ˘Ó›Ô˘; ƒfi‰Ô˜; 1996. #307∞.

22. ª·‡ÚÔ˘ ∞, ∫ÔÏÈ·Ï¤ÍË ∞, ∆Û¿ÁÎ·ÚË˜ °, ∞ÓÙÛ·ÎÏ‹˜ ∞, ¢·-Ê¤ÚÌÔ˘ ∂, ∆ÛÂÁÎ‹ Ã Î·È Û˘Ó. ∞ÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿-ÚˆÓ ·fi ÙË ÌËÙÚÈÎ‹ Î˘ÎÏÔÊÔÚ›· ÌÂ Ì·ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi,·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ̄ ÚÒÛË Î·È FISH. °ÂÓÂÙÈÎ‹ ÙÔ˘ ∞ÓıÚÒÔ˘1999;1:40-46.

23. ∫·ÌÔ˘Ú¿ÎË˜ °, ∫ÔÓÙÔÁÈ¿ÓÓË ∂. ¶ÚÔÂÌÊ˘ÙÂ˘ÙÈÎ‹ ‰È¿ÁÓˆÛËÙˆÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ: ÂÈÙÂ‡ÁÌ·Ù· Î·È ÌÂÏÏÔÓÙÈÎ¤˜ÚÔÔÙÈÎ¤˜. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2000;12:46-54.


466

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-01-2003HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 31-10-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã·Ú›ÎÏÂÈ· Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜, ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔÓ›ÎË˜ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂˆ˜ 49, ∆.∫. 544 62, £ÂÛÛ·ÏÔÓ›ÎË


467

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ OTC OÚÓÈıÈÓÈÎ‹ ÙÚ·ÓÛÎ·Ú‚·Ì˘Ï¿ÛË °O¶ °·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË

∂ÈÛ·ÁˆÁ‹∏ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÔÚÓÈıÈÓÈÎ‹˜ ÙÚ·ÓÛÎ·Ú‚·Ì˘-

Ï¿ÛË˜ (O∆C) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË‰È·Ù·Ú·¯‹ ÙÔ˘ Î‡ÎÏÔ˘ ÙË˜ Ô˘Ú›·˜. ∫ÏËÚÔÓÔÌÂ›Ù·ÈÌÂ ÂÈÎÚ·ÙËÙÈÎfi Ê˘ÏÔÛ‡Ó‰ÂÙÔ Ù‡Ô Î·È, fiˆ˜ Î·ÈÔÈ ¿ÏÏÂ˜ ·ÓÂ¿ÚÎÂÈÂ˜ ÂÓ˙‡ÌˆÓ ÙÔ˘ Î‡ÎÏÔ˘ ÙË˜ Ô˘-Ú›·˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÎÏÈÓÈÎ¿ ÛËÌÂ›· Î·È Û˘-

ÌÙÒÌ·Ù· Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ¿ıÚÔÈÛË˜ ÌÂ-Ù·‚ÔÏÈÙÒÓ ÙË˜ Ô˘Ú›·˜, Î˘Ú›ˆ˜ ·ÌÌˆÓ›·˜ Î·È ÁÏÔ˘-Ù·Ì›ÓË˜. ∏ ÛÔ‚·ÚfiÙÂÚË ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ Ófi-ÛÔ˘ Û˘Ì‚·›ÓÂÈ ÛÂ ¿Û¯ÔÓÙ· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ Î·È Â-ÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ˘ÂÚ·ÌÌˆÓÈ·ÈÌÈÎfi ÎÒÌ· Î·È ÙÔÓ ı¿-Ó·ÙÔ. O ˘ÔÍ‡˜ Ù‡Ô˜ (late onset) ÂÎ‰ËÏÒÓÂÙ·È ÛÂ¿ÚÚÂÓÂ˜ ÌÂ ÌÂÚÈÎ‹ ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÛÂı‹ÏÂ· Ô˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ÓfiÛÔ˘ (1,2). OÎÏÈÓÈÎfi˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ ¤¯ÂÈ ÌÂÁ¿ÏÔÂ‡ÚÔ˜ ÂÎ‰ËÏÒÛÂˆÓ Î·È ÌÔÚÂ› ÌfiÓÔ ÌÂÚÈÎÒ˜ Ó·ÂÍËÁËıÂ› ·fi ÙÔÓ ÁÔÓfiÙ˘Ô (3).

�¶ÂÚ›ÏË„Ë: ∏ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÔÚÓÈıÈÓÈÎ‹˜ ÙÚ·Ó-ÛÎ·Ú‚·Ì˘Ï¿ÛË˜, Ì›· Ê˘ÏÔÛ‡Ó‰ÂÙË ‰È·Ù·Ú·¯‹, Â›-Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÌÂÙ·‚ÔÏÈÎ‹ ‰È·-Ù·Ú·¯‹ ÙÔ˘ Î‡ÎÏÔ˘ ÙË˜ Ô˘Ú›·˜. ªÂÏ¤ÙÂ˜ ¤¯Ô˘Ó Â-ÚÈÁÚ¿„ÂÈ ÙËÓ ‡·ÚÍË ·ÚÎÂÙÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂ-Ù·ÏÏ¿ÍÂˆÓ, ÔÈ ÔÔ›Â˜ ÂÓ Ì¤ÚÂÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹-ÛÔ˘Ó ÙË Ê·ÈÓÔÙ˘ÈÎ‹ ÔÈÎÈÏ›· ÛÙËÓ ¤ÎÊÚ·ÛË ÙË˜ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ÌÂ ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÙËÓ ÔÔ›· ÎÏËÚÔÓfiÌËÛÂ ·fiÙË ÌËÙ¤Ú· ÙÔ˘. ÀÔÁÚ·ÌÌ›˙ÂÙ·È Ô ·Ú¯ÈÎfi˜ ‰È·ÁÓˆ-ÛÙÈÎfi˜ ·ÔÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÛÙËÓ ·Ú¯ÈÎ‹ ÂÎ‰‹Ïˆ-ÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, ‰ÈfiÙÈ Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù·ÂÌÊ·Ó›ÛÙËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÔÚÓÈıÈÓÈÎ‹˜ ÙÚ·Ó-ÛÎ·Ú‚·Ì˘Ï¿ÛË˜, Î‡ÎÏÔ˜ ÙË˜ Ô˘Ú›·˜, ˘ÂÚ·ÌÌˆÓÈ-·ÈÌ›·.

�Abstract: Ornithine transcarbamylase deficiency,an X-linked metabolic disorder, is the mostcommon inherited urea cycle defect. Previousreports have documented the existence of severaldifferent mutations that can explain, at least in part,the phenotypic variability of the disorder. The caseis described of a male infant with T343K mutation,also present in his mother, which is described forthe first time. The disorientation of the clinicians atthe time of presentation of symptoms is underlined,because the patient started vomiting after fruitswere added to his diet.

Key words: ornithine transcarbamylase deficiency,urea cycle, hyperammonaemia.

∞ÓÂ¿ÚÎÂÈ· ÙË˜ ÔÚÓÈıÈÓÈÎ‹˜ ÙÚ·ÓÛÎ·Ú‚·Ì˘Ï¿ÛË˜ - ˘ÔÍ‡˜ Ù‡Ô˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ™. ºÂÛÛ¿ÙÔ˘1, ∞. ∞ÙÙÈÏ¿ÎÔ˜1, ∂. ∆Û¿Ú·1, °. ª·ÚfiÔ˘ÏÔ˜2, ∂. ªÈ¯ÂÏ·Î¿ÎË3, ∫. ™Ô‡ÏË4

Late onset ornithine transcarbamylase deficiency. A case report S. Fessatou1, A. Attilakos1, H. Tsapra1, G. Maropoulos2, H. Michelakakis3, K. Schulpis4

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

1 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

2 µÈÔ¯ËÌÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

3 ∆Ì‹Ì· ∂Ó˙˘ÌÔÏÔÁ›·˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡Ô-ÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “AÁ. ™ÔÊ›·”, ∞ı‹Ó·

4 ∆Ì‹Ì· ªÂÙ·‚ÔÏÈÎÒÓ ¡ÔÛËÌ¿ÙˆÓ, πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “AÁ. ™ÔÊ›·”, ∞ı‹Ó·

1 2nd Paediatric Clinic, “P. & A. Kyriakou” Children’s Hospital, Athens

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

3 Department of Enzymology, Institute of Child Health,“Aghia Sophia” Children’s Hospital, Athens

4 Department of Metabolic Diseases, Institute of ChildHealth, “Aghia Sophia” Children’s Hospital, Athens

∆Ô ÁÔÓ›‰ÈÔ ÙË˜ OTC ¤¯ÂÈ ‚ÚÂıÂ› ÛÙÔ ‚Ú·¯‡ ÛÎ¤-ÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã, ÛÙË ı¤ÛË p21.1 Î·È ¤¯ÂÈÌÂÏÂÙËıÂ› ·fi ÙÔ˘˜ Horwich Î·È Û˘Ó Î·È ÙÔ˘˜ HataÎ·È Û˘Ó. ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÙÚÈÌÂÚ¤˜ Ô˘ ·ÔÙÂÏÂ›Ù·È·fi 322 ·ÌÈÓÔÍ¤· Î·È ¤¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ÂÚ›Ô˘36000 Daltons ·Ó¿ ÔÏ˘ÂÙÈ‰ÈÎ‹ ·Ï˘Û›‰· (4,5).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜ÌÂ ·ÓÂ¿ÚÎÂÈ· OTC, Ô˘ ÂÎ‰ËÏÒıËÎÂ ÛÂ ËÏÈÎ›· 6ÌËÓÒÓ, Û˘Á¯ÚfiÓˆ˜ ÌÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÊÚÔ‡ÙˆÓ ÛÙË‰È·ÙÚÔÊ‹ ÙÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ·ÁfiÚÈ Ô˘ ÁÂÓÓ‹ıËÎÂ ÌÂÙ¿

·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Î‡ËÛË Î·È ÙÔÎÂÙfi, ÌÂ ‚¿ÚÔ˜ Á¤Ó-ÓËÛË˜ 3350 g. ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ÂÚ›Ô‰Ô˜ ‹Ù·Ó ¯ˆ-Ú›˜ ÚÔ‚Ï‹Ì·Ù· Î·È Ë ·Ó¿Ù˘Í‹ ÙÔ˘ ÔÏ‡ Î·Ï‹ Ì¤-¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ. ™Â ·˘Ù‹ ÙËÓ ËÏÈÎ›· ÚÔ-ÛÙ¤ıËÎ·Ó ÊÚÔ‡Ù· ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Î·È ¿Ú¯ÈÛÂ Ó·ÂÌÊ·Ó›˙ÂÈ ÂÌ¤ÙÔ˘˜. ŒÁÈÓÂ ¤ÏÂÁ¯Ô˜ ÌÂ ˘ÂÚË¯ÔÁÚ¿-ÊËÌ· ÔÈÛÔÊ¿ÁÔ˘-ÛÙÔÌ¿¯Ô˘ ÁÈ· Èı·Ó‹ Á·ÛÙÚÔÔÈ-ÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) Î·È Ë ÂÍ¤Ù·ÛË ¤‰ÂÈ-ÍÂ Â˘ÚÂ›· °O¶. ∂Ù¤ıË ·ÁˆÁ‹ ÁÈ· ÙË °O¶ ÌÂ ÛÈ˙·-Ú›‰Ë Î·È ÔÈ ¤ÌÂÙÔÈ ‚ÂÏÙÈÒıËÎ·Ó. ™Â ËÏÈÎ›· 7 ÌËÓÒÓÂÌÊ¿ÓÈÛÂ ·ÈÊÓ›‰È· ÂÂÈÛfi‰È· ÌÂ Û˘ÓÂ¯fiÌÂÓÔ˘˜ ÂÌ¤-ÙÔ˘˜, Î·Ù¿ÛÙ·ÛË Ô˘ Ô‰‹ÁËÛÂ ÙÔ˘˜ ÁÔÓÂ›˜ Ó· Ê¤-ÚÔ˘Ó ÙÔ ·È‰› ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô. ∫·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹ÂÍ¤Ù·ÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Î¿ÙÈ ÙÔ ·ıÔÏÔÁÈÎfi,ÏËÓ ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂ-ÏÂ˘Ù·›ˆÓ ‰‡Ô Â‚‰ÔÌ¿‰ˆÓ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ ¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓË ·ÌÌˆÓ›· (250 Ìg/dl), ·ıÔÏÔ-ÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ‹·ÙÔ˜ (SGOT:835 U/L, SGPT: 1490 U/L, PT: 39,9 sec, PTTK: 62,6sec, INR: 4,09) Î·È ·˘ÍËÌ¤Ó· Â›Â‰· ÛÙ· Ô‡Ú·ÔÚÔÙÈÎÔ‡ ÔÍ¤Ô˜ (>1900 Ìmol/mmol creatinine, Ê.Ù.:<13) Î·È Ô˘Ú·Î›ÏË˜. ™ÙÔ ·ÌÈÓfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ ·-ÚÔ˘Û›·˙Â ·˘ÍËÌ¤Ó· Â›Â‰· ÁÏÔ˘Ù·Ì›ÓË˜ (35,64mg/dl, Ê.Ù.: 8,4-10,8), Ï˘Û›ÓË˜ (7,14 mg/dl, Ê.Ù.:1,65-3,05), ·Û·ÚÙÈÎÔ‡ (1,57 mg/dl, Ê.Ù.: 0,29-0,51)Î·È ÌÂıÂÈÔÓ›ÓË˜ (2,97 mg/dl, Ê.Ù.: 0,17-0,43) Î·ÈÂÏ·ÙÙˆÌ¤Ó· Â›Â‰· ÎÈÙÚÔ˘ÏÏ›ÓË˜ Î·È ·ÚÁÈÓ›ÓË˜. O¤ÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ÊÚÔ˘ÎÙfi˙Ë˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘, ÙÔ ·È‰› ÂÌÊ¿ÓÈÛÂ ÂÚ·ÈÙ¤Úˆ·‡ÍËÛË ÙË˜ ·ÌÌˆÓ›·˜ (700 Ìg/dl) Î·È ÙˆÓ ÙÚ·ÓÛ·-ÌÈÓ·ÛÒÓ (SGOT: 2500 U/L, SGPT: 2200 U/L). ªÂÙ¿·fi ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, Ë ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÚÔ-Û·Ó·ÙÔÏ›ÛÙËÎÂ ÛÂ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Î‡ÎÏÔ˘ ÙË˜ Ô˘-Ú›·˜. ŒÁÈÓÂ ‚ÈÔ„›· ‹·ÙÔ˜ ‰È¿ ‚ÂÏfiÓË˜ ·Ì¤Ûˆ˜ Ìfi-ÏÈ˜ ‚ÂÏÙÈÒıËÎÂ Ë Ë·ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, fiÔ˘ ÂÈ‚Â-‚·ÈÒıËÎÂ Ë ÌÂÈˆÌ¤ÓË ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜OTC: i) ‰Ú·ÛÙËÚÈfiÙËÙ· OTC: 1,1 Ìmol/mg/h (Ê.Ù.:13-43) Î·È ii) ‰Ú·ÛÙËÚÈfiÙËÙ· Î·Ú‚·Ì˘ÏÔÊˆÛÊÔÚÈ-Î‹˜ Û˘ÓıÂÙ¿ÛË˜ (CPS): 4,61 Ìmol/mg/h (Ê.Ù.: 0,6-5,5). ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘

(MRI) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. £ÂÚ·Â˘ÙÈÎ¿, ÛÙËÓ ÎÚ›ÛË ÙË˜ ˘ÂÚ·ÌÌˆÓÈ·È-

Ì›·˜ ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÊÏÂ‚›ˆ˜ ˘ÁÚ¿, ıÂÚÌÈ‰ÈÎ‹Î¿Ï˘„Ë ÌÂ Û·Î¯·ÚÔ‡¯· ˘ÁÚ¿, ÊÚ¤ÛÎÔ Î·ÙÂ„˘ÁÌ¤-ÓÔ Ï¿ÛÌ·, ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ, L-·ÚÁÈÓ›ÓË Î·È L-Î·ÚÓÈ-Ù›ÓË Î·È ¤ÁÈÓÂ ÛÙ¤ÚËÛË ÚˆÙÂ˚ÓÒÓ. ∆· Â›Â‰· ÙË˜·ÌÌˆÓ›·˜ ÛÙÔ Ï¿ÛÌ· ¤ÊÙ·Û·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿Â›Â‰· ÌÂÙ¿ ·fi 7 ËÌ¤ÚÂ˜ Î·È Ë Ë·ÙÈÎ‹ ÏÂÈÙÔ˘Ú-Á›· ·ÔÎ·Ù·ÛÙ¿ıËÎÂ ÌÂÙ¿ ·fi 20 ËÌ¤ÚÂ˜. ∞fi Ùfi-ÙÂ, ÙÔ ·È‰› ‚Ú›ÛÎÂÙ·È ÛÂ ‰›·ÈÙ· ÌÂ ¯·ÌËÏ‹ ÚfiÛÏË-„Ë ÚˆÙÂ˝ÓË˜ (~2 g/kg/24ˆÚÔ). ÃÔÚËÁÔ‡ÓÙ·È Ù···Ú·›ÙËÙ· ·ÌÈÓÔÍ¤·, ‚ÈÙ·Ì›ÓÂ˜, ¿Ï·Ù· Î·È È¯ÓÔ-ÛÙÔÈ¯Â›· ÌÂ ÙË ÌÔÚÊ‹ È‰ÈÔÛÎÂ˘·ÛÌ¿ÙˆÓ (UCD), Û˘-ÌÏ‹ÚˆÌ· ıÂÚÌ›‰ˆÓ ÌÂ caloreen Î·È ‚ÂÓ˙Ô˚Îfi Ó¿-ÙÚÈÔ. ∆Ô ·È‰› ‚Ú›ÛÎÂÙ·È ÛÂ ÔÏ‡ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿-ÛÙ·ÛË Î·È Ë „˘¯ÔÎÈÓËÙÈÎ‹ ÙÔ˘ ÂÍ¤ÏÈÍË Â›Ó·È Ì¤¯ÚÈÙÒÚ· Û¯ÂÙÈÎ¿ Î·Ï‹ (˘¿Ú¯ÂÈ Ì›· Û¯ÂÙÈÎ‹ Î·ı˘ÛÙ¤-ÚËÛË Î·Ù¿ 6 ÂÚ›Ô˘ Ì‹ÓÂ˜).

∏ ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ¤‰ÂÈÍÂ ÌÂ-Ù¿ÏÏ·ÍË c�a ÛÙÔ ÂÍfiÓÈÔ 10 ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ OTC.∞˘Ù‹ Ë ·ÏÏ·Á‹ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·ÓÙÈÎ·Ù¿ÛÙ·-ÛË˜ ÙË˜ ıÚÂÔÓ›ÓË˜ ·fi Ï˘Û›ÓË ÛÙË ı¤ÛË 343(∆343∫). ∏ ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓÂ ÛÙË ÌËÙ¤Ú·¤‰ÂÈÍÂ fiÙÈ ‹Ù·Ó ÂÙÂÚÔ˙˘ÁÒÙË˜ ÛÙÔ ÂÍfiÓÈÔ 10 ÁÈ· ÙËÓ∆343∫ ÌÂÙ¿ÏÏ·ÍË. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚÂ fiÙÈ ‹Ù·Ó Ê˘-ÙÔÊ¿ÁÔ˜, ‰ÈfiÙÈ Î¿ıÂ ÊÔÚ¿ Ô˘ ¤·ÈÚÓÂ ÁÂ‡Ì· ÌÂ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ ÚˆÙÂ˝ÓÂ˜ ÂÌÊ¿ÓÈ˙Â ÎÂ-Ê·Ï·ÏÁ›· Î·È Ó·˘Ù›· (Û˘ÌÙÒÌ·Ù· Ô˘ ÂÚÈÁÚ¿ÊÔ-ÓÙ·È ÛÙÔ˘˜ ÊÔÚÂ›˜ ÙË˜ ÓfiÛÔ˘).

™˘˙‹ÙËÛË ∏ OTC Â›Ó·È ¤Ó· ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ¤Ó˙˘ÌÔ Ô˘ Î·-

Ù·Ï‡ÂÈ ÙÔ Î·Ú‚·Ì˘ÏÔÊˆÛÊÔÚÈÎfi ÔÍ‡ ÛÂ ÎÈÙÚÔ˘ÏÏ›-ÓË ÛÙÔÓ Î‡ÎÏÔ ÙË˜ Ô˘Ú›·˜. ∆Ô ÁÔÓ›‰ÈÔ ÙË˜ OTC ‚Ú›-ÛÎÂÙ·È ÛÙÔ ‚Ú·¯‡ ¿ÎÚÔ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã(Ãp21.1). ¶ÂÚÈ¤¯ÂÈ 10 ÂÍfiÓÈ· Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó Ì›·ÚÔ-ÚˆÙÂ˝ÓË, Ë ÔÔ›· ·ÔÙÂÏÂ›Ù·È ·fi 354 ·ÌÈÓÔ-Í¤·. ∏ Î‡ÚÈ· ÚˆÙÂ˝ÓË ·ÔÙÂÏÂ›Ù·È ·fi 32 ·ÌÈÓÔ-Í¤· Î·È ·ÂÏÂ˘ıÂÚÒÓÂÙ·È ÌÂÙ¿ ÙË ÌÂÙ·ÊÔÚ¿ ÙË˜Ì¤Û· ÛÙ· ÌÈÙÔ¯fiÓ‰ÚÈ· (3).

OÈ Tuchman Î·È Û˘Ó ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÂÈ‰ÈÎ¤˜·Ó·Ï‡ÛÂÈ˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÁÈ· Ó· ˘ÔÏÔÁ›ÛÔ˘ÓÙËÓ ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ Î·È ıËÏ¤ˆÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈÌÂÙ·ÏÏ¿ÍÂÈ˜ ¤¯Ô˘Ó Û˘Ì‚Â› ÛÙ· ÁÂÓÓËÙÈÎ¿ Î‡ÙÙ·Ú·ÂÓfi˜ ·fi ÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘˜. ∞fi Ù· 28 ·ÁfiÚÈ· ÌÂ·ÓÂ¿ÚÎÂÈ· OTC, ÌfiÓÔ 2 (7%) Â›¯·Ó ÛÔÚ·‰ÈÎ¤˜ÌÂÙ·ÏÏ¿ÍÂÈ˜, ÂÓÒ ·fi Ù· 15 ÎÔÚ›ÙÛÈ· ÌÂ ·ÓÂ¿Ú-ÎÂÈ· OTC, 12 (80%) Â›¯·Ó ÛÔÚ·‰ÈÎ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜.∞fi ·˘Ù¤˜ ÙÈ˜ ÌÔÚÈ·Î¤˜ ‰ÔÎÈÌ·Û›Â˜ Ê·›ÓÂÙ·È fiÙÈ ÔÎ›Ó‰˘ÓÔ˜ ÁÈ· Ì›· ÌËÙ¤Ú· ·ÁÔÚÈÔ‡ Ô˘ ÓÔÛÂ› Ó· Â›Ó·ÈÂÙÂÚÔ˙˘ÁÒÙË˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi fi,ÙÈ ·Ó·ÌÂ-ÓfiÙ·Ó (2/3) Î·È ÏËÛÈ¿˙ÂÈ ÙÔ 9/10. ∞ÓÙÈÛÙÚfiÊˆ˜, Ì›·ÌËÙ¤Ú· ¿Û¯ÔÓÙÔ˜ ı‹ÏÂÔ˜ ¤¯ÂÈ ÔÏ‡ ÌÈÎÚfiÙÂÚË È-ı·ÓfiÙËÙ· Ó· Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙË˜ (6).


468


469

ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› 230 ÌÂÙ·ÏÏ¿ÍÂÈ˜Î·È 13 ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ OTC. O·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ Â›Ó·È ÙÔ ÌÔÓ·-‰ÈÎfi ·ÁfiÚÈ ÌÂ ÙË ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÛÙËÓ ÔÔ›· ËÌËÙ¤Ú· ÙÔ˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙË˜. OÈ ¿ÏÏÔÈ ‰‡Ô ·ÛıÂ-ÓÂ›˜ ÌÂ ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË Â›Ó·È ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜8 ÂÙÒÓ Ô˘ ÂÚÈÁÚ¿ÊËÎÂ ·fi ÙÔ˘˜ Tuchman Î·ÈÛ˘Ó ÙÔ 1995 (7) Î·È ¤Ó· ·ÁfiÚÈ ËÏÈÎ›·˜ 7 ÂÙÒÓ Ô˘ Â-ÚÈÁÚ¿ÊËÎÂ ·fi ÙÔ˘˜ Leibundgut Î·È Û˘Ó ÙÔ 1996, ÔÈÔÔ›ÔÈ ‰ÂÓ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌÈÎ‹ ÌÂÙ¿ÏÏ·ÍË (8).

∏ OTC ˘¿Ú¯ÂÈ ÛÙÔ ‹·Ú Î·È ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. ∆Ô ¤Ó˙˘ÌÔ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ›‰ÈÔ ÁÔÓ›‰ÈÔ Î·È ÛÙ· ‰‡Ô fiÚÁ·Ó·. OÈ Hamano Î·ÈÛ˘Ó ¤¯Ô˘Ó ÚÔÛ‰ÈÔÚ›ÛÂÈ ÂÙÂÚÔ˙˘ÁÒÙË ÙË˜ OTC ÌÂ·ÓÔÛÔÎ˘ÙÙ·ÚÔ¯ËÌÈÎ‹ ÌÂÏ¤ÙË ‚ÈÔ„›·˜ ·fi ÙÔÓ ‚ÏÂÓ-ÓÔÁfiÓÔ ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘ (9).

O Ê·ÈÓfiÙ˘Ô˜ ÙˆÓ ·ÁÔÚÈÒÓ Ô˘ ÓÔÛÔ‡Ó Î·È ÙˆÓÂÙÂÚÔ˙˘ÁˆÙÒÓ ÎÔÚÈÙÛÈÒÓ ¤¯ÂÈ ÌÂÁ¿ÏÔ Â‡ÚÔ˜, ·fiÙÔ ÛÔ‚·ÚfiÙ·ÙÔ ÓÂÔÁÓÈÎfi ˘ÂÚ·ÌÌˆÓÈ·ÈÌÈÎfi ÎÒÌ·Ì¤¯ÚÈ ÙÔÓ ·Û˘ÌÙˆÌ·ÙÈÎfi ÂÓ‹ÏÈÎ· (3). ∆· ·Ú¯ÈÎ¿Û˘ÌÙÒÌ·Ù· ÙË˜ ˘ÂÚ·ÌÌˆÓÈ·ÈÌ›·˜ Î˘Ì·›ÓÔÓÙ·ÈÂ›ÛË˜ Î·È ÌÔÚÂ› Ó· Â›Ó·È ÌfiÓÔ ‹È· Û˘Á¯˘ÙÈÎ¿ÂÂÈÛfi‰È·, Â˘ÂÚÂıÈÛÙfiÙËÙ· ‹ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈ-ÊÔÚ¿˜, Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· ÂÎÏËÊıÔ‡Ó ÏfiÁˆ Ï¿-ıÔ˘˜ ˆ˜ „˘¯È·ÙÚÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ¯Ú‹ÛË “Ô˘ÛÈÒÓ”‹ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·. øÛÙfiÛÔ, ÙÔ Î‡ÚÈÔ Û‡ÌÙˆÌ·ÌÔÚÂ› Ó· Â›Ó·È ÔÈ ¤ÌÂÙÔÈ, È‰›ˆ˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÌÂÌÂÙ·‚ÔÏÈÎfi ÛÙÚÂ˜, fiˆ˜ ÔÈ ÏÔÈÌÒÍÂÈ˜ Î·È Ó· ÂÛÙÈ·-ÛÙÂ› Ë ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÛÂ ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔÂÙÈÎfi Û‡ÛÙËÌ·. OÈ ¤ÌÂÙÔÈ Â›Ó·È Û˘¯ÓÔ› Î˘Ú›ˆ˜ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Î·È Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Î·ı˘ÛÙ¤-ÚËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜. O ·‰Úfi˜ ‚ÈÔ¯ËÌÈ-Îfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ·Ï‡ÙÂÈ ·˘ÍËÌ¤ÓÂ˜ ÙÚ·ÓÛ·ÌÈÓ¿-ÛÂ˜ Î·È ·Ú·¤ÌÂÈ ÛÂ Ë·Ù›ÙÈ‰· (10). ™ÙÔÓ ·ÛıÂ-Ó‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ¤Ó·ÚÍË ÙˆÓ ÂÌ¤ÙˆÓ Û˘Ó¤-ÂÛÂ ÌÂ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ÙÔ˘ Î·È Ë ·ÓÂ‡ÚÂÛË Â˘ÚÂ›·˜ °O¶ ÌÂ ÙÔÓ ˘ÂÚË¯Ô-ÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ‹Ù·Ó ÔÈ ÏfiÁÔÈ Ô˘ “Î·ı˘ÛÙ¤ÚËÛ·Ó”ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ¤ÏÂÁ¯Ô.

∂›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ·ÛıÂÓ‹ ÌÂ ‰È·Ù·-Ú·¯‹ ÛÙÔÓ Î‡ÎÏÔ ÙË˜ Ô˘Ú›·˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ ˘Â-Ú·ÌÌˆÓÈ·ÈÌ›· Ó· ·Ú¯›ÛÂÈ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ·ıÂÚ·Â›·. °ÓˆÚ›˙ÔÓÙ·˜ fiÙÈ ÔÈ ¤ÌÂÙÔÈ ‹/Î·È Ô Ï‹ı·Ú-ÁÔ˜ ·ÔÙÂÏÔ‡Ó ÚÒÈÌ· ÛËÌÂ›· ˘ÂÚ·ÌÌˆÓÈ·ÈÌ›·˜,Ú¤ÂÈ ·Ì¤Ûˆ˜ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ù· Â›Â‰· ÙË˜·ÌÌˆÓ›·˜ ÛÙÔ Ï¿ÛÌ·. ∂¿Ó Ù· Â›Â‰· Â›Ó·È ÙÚÈ-Ï¿ÛÈ· ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÙÂÚ· ·fi 120uM, Ï·Ì‚¿ÓÂÙ·È Ó¤Ô ‰Â›ÁÌ· ÁÈ· Â·Ï‹ıÂ˘ÛË ÙÔ˘·ÔÙÂÏ¤ÛÌ·ÙÔ˜, ·¤ÚÈ· ·›Ì·ÙÔ˜, ÈÔÓÙfiÁÚ·ÌÌ· Î·ÈÔÈÔÙÈÎfi ·ÌÈÓfiÁÚ·ÌÌ· Î·È Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ¿ÌÂÛ·Ë ıÂÚ·Â›·, ¯ˆÚ›˜ Ó· ·Ó·Ì¤ÓÔÓÙ·È ÔÈ ··ÓÙ‹ÛÂÈ˜ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‰Â›ÁÌ·ÙÔ˜ (11).

∆Ô Î‡ÚÈÔ Ì¤ÏËÌ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·ÁˆÁ‹ Â›Ó·ÈË ‰›·ÈÙ· ÌÂ ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ ÚˆÙÂ˝ÓÂ˜,

·Ó Î·È ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÙÔÓ ˘ÔÍ‡ Ù‡Ô (late onset)¯ÚÂÈ¿˙ÔÓÙ·È Ì¤ÙÚÈÔ ÂÚÈÔÚÈÛÌfi ÙÔ˘ ÏÂ˘ÎÒÌ·ÙÔ˜(1,5-2,2 g/kg/ËÌ¤Ú·). ªÂÚÈÎÔ› ·ÛıÂÓÂ›˜ ÌÔÚÂ› Ó··ÓÂ¯ÙÔ‡Ó ·ÎfiÌ· Î·È Î·ÓÔÓÈÎ‹ ‰›·ÈÙ·, ¯ˆÚ›˜ ÂÚÈÔ-ÚÈÛÌfi ÏÂ˘ÎÒÌ·ÙÔ˜. ÕÏÏÔÈ ·ÛıÂÓÂ›˜ ÚÔÙÈÌÔ‡Ó Ó·¤¯Ô˘Ó ÂÏÂ‡ıÂÚË ‰›·ÈÙ· Î·È Ó· Ï·Ì‚¿ÓÔ˘Ó ‚ÂÓ˙Ô˚ÎfiÓ¿ÙÚÈÔ ·ÓÙ› Ó· ÂÚÈÔÚ›˙Ô˘Ó ÙÔ ÏÂ‡ÎˆÌ· ÛÙË ‰È·-ÙÚÔÊ‹ ÙÔ˘˜ (10).

∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ·ÔÙÂÏÂ› ıÂÚ·Â›·Ô˘ ·Ó Â›Ó·È ÂÈÙ˘¯ËÌ¤ÓË, ‰›ÓÂÈ Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ··˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ. ÃÚÂÈ¿˙ÂÙ·È ÔÏ‡ Î·Ï‹ ÂÓËÌ¤-ÚˆÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙË˜ ÌÂÁ¿ÏË˜·˘Ù‹˜ Â¤Ì‚·ÛË˜. ªÂ ÙË Û˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹ ÔÈ·ÛıÂÓÂ›˜ ÍÂÂÚÓÔ‡Ó Ù· ÚÒÙ· ‰‡Ô ¯ÚfiÓÈ· ˙ˆ‹˜ Î·È·ÔÎÙÔ‡Ó Ù¤ÙÔÈÂ˜ ÛˆÌ·ÙÈÎ¤˜ ‰È·ÛÙ¿ÛÂÈ˜, ÒÛÙÂ Ó·ÌÔÚÔ‡Ó Ó· ˘ÔÛÙÔ‡Ó ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Ó· ÌÂÈ-ˆıÔ‡Ó ÛÂ Î¿ÔÈÔ ‚·ıÌfi ÔÈ Î›Ó‰˘ÓÔÈ ·fi ÙËÓ Â¤Ì-‚·ÛË (12).

OÈ Morsy Î·È Û˘Ó Î·Ù¿ÊÂÚ·Ó Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙË‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ OTC ÛÂ ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔÌÂ ÔÓÙ›ÎÈ·, Î¿ÓÔÓÙ·˜ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜·ÓıÚÒÈÓË˜ OTC ÌÂ ÌÂÙ·ÊÔÚ¤· ·‰ÂÓÔ˚fi. ∏ ÌÂ›ˆÛËÙË˜ ÔÚÔÙÈÎÔ˘Ú›·˜ ·Ú·ÙËÚ‹ıËÎÂ ÂÓÙfi˜ 24 ˆÚÒÓ·fi ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÔÓÈ‰›Ô˘. ∏ ‰ÈfiÚıˆÛË ÙË˜ÌÂÙ·‚ÔÏÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË‚ÂÏÙ›ˆÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Î·È ÙË Ì¤ÙÚÈ· ·‡ÍËÛËÙË˜ ÂÓ˙˘ÌÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (13).

∏ Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÛÙÔÈ¯Â›ˆÓÙˆÓ ·Û¯fiÓÙˆÓ ·fi ·ÓÂ¿ÚÎÂÈ· OTC ‰Â›¯ÓÂÈ fiÙÈ ÔÈÌÂÙÚ‹ÛÂÈ˜ Â›Ó·È Î¿Ùˆ ·fi ÙÔÓ Ì¤ÛÔ fiÚÔ ÁÈ· ÙËÓ ËÏÈ-Î›· ÙÔ˘˜, Èı·Ó¿ ÏfiÁˆ ÙË˜ ÌÂÈˆÌ¤ÓË˜ Ï‹„Ë˜ Úˆ-ÙÂ˝ÓË˜ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ (12). OÈ Msall Î·È Û˘Ó Â-ÚÈ¤ÁÚ·„·Ó ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤ÏÈÍË 26 ·È‰ÈÒÓ ÌÂ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ Î‡ÎÏÔ ÙË˜ Ô˘Ú›·˜. ∆Ô 79% Â›¯ÂÌ›· ‹ ÂÚÈÛÛfiÙÂÚÂ˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·ÈÌ¤ÛÔ fiÚÔ IQ 43±6. £ÂˆÚÂ›Ù·È fiÙÈ Ë ÚfiÏË„Ë ‹ ËÚÒÈÌË ·Ú¤Ì‚·ÛË ÛÙË ÓÂÔÁÓÈÎ‹ ˘ÂÚ·ÌÌˆÓÈ·ÈÌ›·ÌÔÚÂ› Ó· ·ÔÙÚ¤„ÂÈ ÛÔ‚·Ú¤˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·-Ù·Ú·¯¤˜ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÓÔÛË-Ì¿ÙˆÓ (14). OÈ Maestri Î·È Û˘Ó ÛËÌÂÈÒÓÔ˘Ó fiÙÈ ÔÈ·ÛıÂÓÂ›˜ Ô˘ Ù¤ıËÎ·Ó ÛÂ ıÂÚ·Â›· ·fi ÙËÓ ·Ú¯‹,¤¯Ô˘Ó Î·Ï‡ÙÂÚË ÓÂ˘ÚÔÏÔÁÈÎ‹ ·Ó¿Ù˘ÍË ·fi ÙÔ˘˜ÂÎÂ›ÓÔ˘˜ Ô˘ Â¤˙ËÛ·Ó ·fi ¤Ó· ÓÂÔÁÓÈÎfi ˘ÂÚ·ÌÌˆ-ÓÈ·ÈÌÈÎfi ÎÒÌ·. ∏ ·ÔÊ˘Á‹ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ˘ÂÚ·ÌÌˆ-ÓÈ·ÈÌÈÎÔ‡ ÎÒÌ·ÙÔ˜ ÌÔÚÂ› Ó· Â›Ó·È Ô Î‡ÚÈÔ˜ ÏfiÁÔ˜ÁÈ· ·˘Ù¤˜ ÙÈ˜ ·Ú·ÙËÚÔ‡ÌÂÓÂ˜ ‰È·ÊÔÚ¤˜ ÛÙË ÓÂ˘ÚÔ-ÏÔÁÈÎ‹ ·Ó¿Ù˘ÍË (12).

¶·Ú¿ ÙË Û·ÓÈfiÙËÙ¿ ÙË˜ Î·È ÙËÓ ¿Ù˘Ë ÎÏÈÓÈÎ‹ÙË˜ ·ÚÔ˘Û›·ÛË, Ë ÓfiÛÔ˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÁÓÔÂ›-Ù·È ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË.

µÈ‚ÏÈÔÁÚ·Ê›·1. Walser M. Urea cycle disorders and other hereditary

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JB, Fredrickson DS, Goldstein JL, Brown MS, editors. Themetabolic basis of inherited disease. 5th ed. New York:McGraw-Hill; 1983. p. 403.

2. Soulpis C, Markosoglou D, Papadelis F, Caraboula A,Giouroukos S, Skarpalezou A et al. Ornithinetranscarbamylase deficiency: findings and treatment in asymptomatic female heterozygote. J Inherit Metab Dis1991;14:107-108.

3. Tuchman M, McCullough BA, Yudkoff M. The molecularbasis of ornithine transcarbamylase definciency. Eur JPediatr 2000;159 (Suppl 3):S196-S198.

4. Horwich AL, Fenton WA, Williams KR, Kalousek F, Kraus JP,Doolittle RF et al. Structure and expression of acomplementary DNA for the nuclear coded precursor ofhuman mitochondrial ornithine transcarbamylase. Science1984;224:1068-1074.

5. Hata A, Tsuzuki T, Shimada K, Takiguchi M, Mori M,Matsuda I. Structure of the human ornithine transcarba-mylase gene. J Biochem 1988;103:302-308.

6. Tuchman M, Matsuda I, Munnich A, Malcolm S, StrautnieksS, Briede T. Proportions of spontaneous mutations in malesand females with ornithine transcarbamylase deficiency. AmJ Med Genet 1995;55:67-70.

7. Tuchman M, Plante RJ. Mutations and polymorphisms inthe human ornithine transcarbamylase gene: mutationupdate addendum. Hum Mutat 1995;5:293-295.

8. Oppliger Leibundgut EO, Wermuth B, Colombo JP, Liechti-Gallati S. Ornithine transcarbamylase deficiency:characterization of gene mutations and polymorphisms.Hum Mutat 1996;8:333-339.

9. Hamano Y, Kodama H, Fujikawa Y, Tanaka Y, Nishimura K,

Yanagisawa M. Use of immunocytochemical analysis of aduodenal biopsy specimen to identify a carrier of ornithinetranscarbamylase deficiency. N Engl J Med 1988;318:1521-1523.

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11. Brusilow SW. Protocol for treatment of intercurrenthyperammonemia in patients with urea cycle defects.http://divis17.pedgen.uiowa.edu/genetics/HyperAmmonemiaTx.html.

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14. Msall M, Batshaw ML, Suss R, Brusilow SW, Mellits ED.Neurologic outcome in children with inborn errors of ureasynthesis. Outcome of urea-cycle enzymopathies. N Engl JMed 1984;310:1500-1505.


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∂ÈÛ·ÁˆÁ‹∏ ÓfiÛÔ˜ Cushing ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ¤Î-

ÎÚÈÛË ÙË˜ ÊÏÔÈÔÂÈÓÂÊÚÈ‰ÈÔÙÚfiÔ˘ ÔÚÌfiÓË˜ACTH, ÔÊÂÈÏfiÌÂÓË ÛÂ ÎÔÚÙÈÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· ÙË˜˘fiÊ˘ÛË˜ (1,2), Ë ÔÔ›· Ô‰ËÁÂ› ÛÂ ˘ÂÚ·Ú·ÁˆÁ‹ÎÔÚÙÈ˙fiÏË˜ ·fi ÙÔÓ ÊÏÔÈfi ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ, ÂÓÒÙÔ Û‡Ó‰ÚÔÌÔ Cushing ·ÊÔÚ¿ ÛÂ Î¿ıÂ ˘ÂÚÎÔÚÙÈ-˙ÔÏ·ÈÌ›· ·ÓÂÍ·ÚÙ‹ÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ (ÂÓ‰ÔÁÂÓ‹˜ ‹ÂÍˆÁÂÓ‹˜) (2,3). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘Cushing Â›Ó·È Ë È·ÙÚÔÁÂÓ‹˜, Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·ÈÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓË˜, Û˘-ÛÙËÌ·ÙÈÎ‹˜ ‹ Î·È ÙÔÈÎ‹˜ (4,5). ∆· ÂÓ‰ÔÁÂÓ‹ ·›ÙÈ·ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ ·‰¤ÓˆÌ· ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ(3,5), ÙÔ Î·ÚÎ›ÓˆÌ· (6), ÙÔ ·‰¤ÓˆÌ· ÙË˜ ˘fiÊ˘ÛË˜

�¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ Cushing Â›Ó·È Û¿ÓÈ· ·Ûı¤-ÓÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ÎÔÚÙÈ-ÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· ÙË˜ ˘fiÊ˘ÛË˜. ∏ ˘ÂÚÎÔÚÙÈ˙Ô-Ï·ÈÌ›· ÙË˜ ÓfiÛÔ˘ Ô‰ËÁÂ› ÛÂ Î·Ù·ÛÙÔÏ‹ ÙˆÓ ÂÚÈÛ-ÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ ÙË˜ ÚfiÛıÈ·˜ ˘fiÊ˘ÛË˜, fiˆ˜ÙˆÓ FSH, LH, PRL, TSH Î·È GH. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ófi-ÛÔ˜ Cushing ÛÂ ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 15ó ÂÙÒÓ, Ô˘ÚÔ¤‚·ÏÏÂ ÌÂ ·ÓÛÂÏËÓÔÂÈ‰¤˜ ÚÔÛˆÂ›Ô, Î·ı˘-ÛÙ¤ÚËÛË ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, ·¯˘Û·ÚÎ›·, ·Î-Ì‹, ˘ÂÚÙÚ›¯ˆÛË Î·È ˘¤ÚÙ·ÛË. O ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· Î·È Ë Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· ÌÈÎÚÔ·‰¤ÓˆÌ· ÙË˜ ˘fiÊ˘ÛË˜. ∏·ÛıÂÓ‹˜ ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ ÂÈÙ˘¯Ò˜ Î·È ÙÔ ·‰¤ÓˆÌ·ÙË˜ ˘fiÊ˘ÛË˜ ·Ê·ÈÚ¤ıËÎÂ ÌÂ ‰È·ÛÊËÓÔÂÈ‰‹ ÚÔ-Û¤Ï·ÛË. ™˘˙ËÙÂ›Ù·È Ë ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹, Ù· ÔÚÌÔ-ÓÔÏÔÁÈÎ¿ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù·, Î·ıÒ˜ Î·È ËıÂÚ·Â›· ÙË˜ ÓfiÛÔ˘ Cushing.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·‰¤ÓˆÌ· ˘fiÊ˘ÛË˜, Û‡Ó‰ÚÔÌÔCushing, ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ‰È·-ÛÊËÓÔÂÈ‰‹˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË.

�Abstract: Cushing’s disease refers specifically toan ACTH-producing pituitary adenoma thatstimulates excess cortisol production and it is veryrare in children and adolescents. Hypercortisolismleads to suppression of most of the anterior pituitaryhormones: FSH, LH, PRL, TSH and GH. The case isdescribed of a 15ó year-old girl with Cushing’sdisease who presented with the characteristic moonface, short stature, obesity, acne, hirsutism andhypertension. Hypercortisolism was detected duringthe laboratory examination and MRI of the pituitaryrevealed a microadenoma. She was successfullytreated surgically by transsphenoidal removal of thepituitary adenoma. The clinical features atpresentation, the diagnosis, hormonal changes andimaging findings, as well as the treatment ofCushing’s disease are discussed.

Key words: pituitary adenoma, Cushing’s syndrome,hypercortisolism, short stature, transsphenoidalsurgical treatment.

¡fiÛÔ˜ Cushing ÛÂ ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 15ó ÂÙÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∂. ∫ˆÛÙ·ÎÈÒÙË, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∂. ∫Ô‡ÛÙ·, ∞. ∆ÂÚÙ›Ë, Ã. Ã·Ù˙Ë·ı·Ó·Û›Ô˘, µ. ¶¤ÙÚÔ˘, ∞. ¶··ı·Ó·Û›Ô˘

Cushing’s disease in a 15ó year-old girl. A case reportE. Kostakioti, C. Theodoridis, E. Kousta, A. Tertipi, C. Hadjiathanasiou, V. Petrou, A. Papathanasiou

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

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

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ACTH ºÏÔÈÔÂÈÓÂÊÚÈ‰ÈÔÙÚfiÔ˜ ÔÚÌfiÓËFSH £˘Ï·ÎÈÔÙÚfiÔ˜ ÔÚÌfiÓËLH ø¯ÚÈÓÔÙÚfiÔ˜ ÔÚÌfiÓËE2 OÈÛÙÚ·‰ÈfiÏËDHEA’S £ÂÈ˚Î‹ ‰Â¸‰ÚÔÂÈ·Ó‰ÚÔÛÙÂÚfiÓË17-OH-ÚÔÁÂÛÙÂÚfiÓË 17-˘‰ÚÔÍ˘-ÚÔÁÂÛÙÂÚfiÓËTSH £˘ÚÂÔÂÈ‰ÔÙÚfiÔ˜ ÔÚÌfiÓËT4 £˘ÚÔÍ›ÓËFT4 ∂ÏÂ‡ıÂÚË ı˘ÚÔÍ›ÓËT3 ∆ÚÈÈˆ‰Ôı˘ÚÔÓ›ÓËFT3 ∂ÏÂ‡ıÂÚË ÙÚÈÈˆ‰Ôı˘ÚÔÓ›ÓË DXM ¢ÂÍ·ÌÂı·˙fiÓËGH ∞˘ÍËÙÈÎ‹ ÔÚÌfiÓËU/S ÀÂÚË¯ÔÁÚ¿ÊËÌ·MRI ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·

(1), ÙË ‰È¿¯˘ÙË ÔÏ˘Ô˙Ò‰Ë ˘ÂÚÏ·Û›· ÙˆÓ ÂÈÓÂ-ÊÚÈ‰›ˆÓ (3,7,8) Î·È, ÔÏ‡ Û¿ÓÈ·, ÙËÓ ¤ÎÙÔË ·Ú·-ÁˆÁ‹ ACTH (7). ∏ ÓfiÛÔ˜ Cushing ÚÔÛ‚¿ÏÏÂÈ ·È-‰È¿ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ, ·ÏÏ¿ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÂ ËÏÈ-Î›Â˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙˆÓ 7 ÂÙÒÓ (7). ∏ Û˘¯ÓfiÙËÙ¿ ÙË˜Â›Ó·È ›‰È· ÛÙ· ‰‡Ô Ê‡Ï· (2), ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜fiÁÎÔ˘˜ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ, ÔÈ ÔÔ›ÔÈ ˘ÂÚÙÂÚÔ‡ÓÛÙ· ÎÔÚ›ÙÛÈ· (3:1) (7).

∏ Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ Cushing ÛÙÔÓ ÁÂÓÈÎfiÏËı˘ÛÌfi Â›Ó·È 5-10 ÂÚÈÙÒÛÂÈ˜/¤ÙÔ˜, ·Ó¿1.000.000 ÏËı˘ÛÌÔ‡ (9). ∏ ÓfiÛÔ˜ Cushing Â›Ó·È·ÎfiÌË ÈÔ Û¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (1,8,10). ∏˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Ô‰ËÁÂ›ÛÂ Î·Ù·ÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ ÙË˜ÚfiÛıÈ·˜ ˘fiÊ˘ÛË˜ (10). ™˘¯Ó¿, Ë ÎÏÈÓÈÎ‹ ‰È·Ù·-Ú·¯‹ ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È, ÙfiÛÔ ·fi ÙÔ˘˜ ÁÔÓÂ›˜fiÛÔ Î·È ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÁÈ· ÌÂÁ¿ÏË ¯ÚÔÓÈÎ‹ Â-Ú›Ô‰Ô (1,2). ∏ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›· ÂÍ·ÛÊ·Ï›˙ÂÈ Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÊË‚Â›· Î·È ‚ÂÏÙÈˆ-Ì¤ÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (2,10).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 15ó ÂÙÒÓ ÚÔÛ‹ÏıÂ ÛÙÔ ÂÓ‰Ô-

ÎÚÈÓÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÌÂ Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈÎ‹˜·Ó¿Ù˘ÍË˜ Î·È ·¯˘Û·ÚÎ›·. °ÂÓÓ‹ıËÎÂ ÌÂÙ¿ ·fiÊ˘ÛÈÔÏÔÁÈÎ‹ ÙÂÏÂÈfiÌËÓË Î‡ËÛË Î·È ÙÔÎÂÙfi, ÌÂ µ°1500 g. ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ÂÚ›Ô‰Ô˜, ÙÔ ·ÙÔÌÈÎfi Î·ÈÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚ·. ∏ „˘¯ÔÎÈÓË-ÙÈÎ‹ ÂÍ¤ÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ∞fi‰ÈÂÙ›·˜, ÔÈ ÁÔÓÂ›˜ ·Ú·Ù‹ÚËÛ·Ó È‰È·›ÙÂÚË ·‡ÍËÛËÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜, ÌÂ ·Ó·Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›-Ô˘˜ ÛÙËÓ ÎÔÈÏÈ¿ Î·È ÙÔÓ ıÒÚ·Î·, ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘Ú˘ıÌÔ‡ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ Î·È ‹ÈÂ˜ ÎÂÊ·Ï·Ï-Á›Â˜ Ô˘ ˘Ô¯ˆÚÔ‡Û·Ó ¯ˆÚ›˜ ·ÁˆÁ‹.

∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ¯·ÌËÏfi ·Ó¿ÛÙËÌ· (<3Ë ∂£), ·ÓÛÂÏËÓÔÂÈ‰¤˜ ÚÔ-ÛˆÂ›Ô ÌÂ ÂÍ¤Ú˘ıÚÂ˜ ·ÚÂÈ¤˜, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘·¯˘Û·ÚÎ›·, È‰È·›ÙÂÚ· ¤Î‰ËÏË ÛÙÔÓ ÎÔÚÌfi, ÌÂ ¯·-Ú·ÎÙËÚÈÛÙÈÎfi ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, Û¯ÂÙÈÎ¿ ·‰‡Ó·Ù·¿ÎÚ·, ¯ÓÔÒ‰Ë ÙÚ›¯ˆÛË ÚÔÛÒÔ˘, ¿ÎÚˆÓ, ÎÔÚÌÔ‡Î·È Ú¿¯Ë˜. ∆Ô ‡„Ô˜ ÙË˜ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 137,3 cm(<3Ë ∂£, -4,1 SDS) ÌÂ ‡„Ô˜-ÛÙfi¯Ô 160,7 cm, ÙÔ‚¿ÚÔ˜ 43,1 kg (3Ë ∂£, -1,3 SDS) Î·È Ô ‰Â›ÎÙË˜ Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ 22,9 kg/m2 (0,9 SDS). ∆· ÛËÌÂ›· ÂÓ‹-‚ˆÛË˜ Î·Ù¿ Tanner ‹Ù·Ó: ÙÚ›¯ˆÛË ÂÊË‚·›Ô˘ ÛÙ¿-‰ÈÔ πππ, ÙÚ›¯ˆÛË Ì·Û¯¿ÏË˜ ÛÙ¿‰ÈÔ ππ Î·È ·Ó¿Ù˘ÍËÌ·ÛÙÒÓ ÛÙ¿‰ÈÔ ππ ÚÔ˜ πππ. ∆· ¤Íˆ ÁÂÓÓËÙÈÎ¿ fiÚÁ·-Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙Â Úˆ-ÙÔ·ı‹ ·ÌËÓfiÚÚÔÈ·. ∏ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÛÂ fiÏÂ˜ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜ ‹Ù·Ó >140/90 mmHg. ∏ ÂÍ¤Ù·ÛË ·fiÙ· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.

O ÔÚÌÔÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÎÔÚÙÈ˙fiÏË(Úˆ›): 64,3 Ìg/dl (Ê.Ù.: 7-25), ÎÔÚÙÈ˙fiÏË (‚Ú¿‰˘):42,6 Ìg/dl (Ê.Ù.: 2-9), ÂÏÂ‡ıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ

24ÒÚÔ˘: 750 Ìg/24ˆÚÔ (Ê.Ù.: 6,5-90 Ìg/ 24ˆÚÔ),ACTH (Úˆ›): 118 pg/ml (Ê.Ù.: 9-52), FSH: 0,53mIU/ml, LH <0,1 mIU/ml, E2 <10 pg/ml, ÙÂÛÙÔÛÙÂ-ÚfiÓË: 0,9 ng/ml (Ê.Ù.: 0,7-3,9), DHEA’S: 6,3 Ìg/ml(Ê.Ù.: 0,4-1,4), 17-OH-ÚÔÁÂÛÙÂÚfiÓË: 5,7 ng/ml(Ê.Ù.: 0,25-1,9), ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓË: 5,8 ng/ml (Ê.Ù.:0,55-2,5), TSH: 0,5 mIU/ml (Ê.Ù.: 0,4-5), T4: 5,8 Ìg/dl(Ê.Ù.: 5,6-13,9), FT4: 1,0 ng/dl (Ê.Ù.: 0,9-2), ∆3: 0,7ng/dl (Ê.Ù.: 0,9-2) Î·È FT3: 1,5 pg/dl (Ê.Ù.: 2,4-5).

∏ ÚˆÈÓ‹ ÎÔÚÙÈ˙fiÏË Î·È Ë ACTH ·›Ì·ÙÔ˜ ÌÂÙ¿·fi ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ‰ÂÍ·ÌÂı·˙fiÓË˜(DXM) (8 mg ËÌÂÚËÛ›ˆ˜: 2 mg DXM ·Ó¿ ÂÍ¿ˆÚÔÂ› ‰‡Ô ËÌ¤ÚÂ˜) Î·ÙÂÛÙ¿ÏËÛ·Ó ·fi 64,3 Ìg/dl Î·È118 pg/ml ÛÂ 31,82 Ìg/dl Î·È 45 pg/ml, ·ÓÙ›ÛÙÔÈ¯·.

OÈ ‰ÔÎÈÌ·Û›Â˜ ‰È¤ÁÂÚÛË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜(GH) ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË L-DOPA Î·È ÎÏÔÓÈ‰›ÓË˜¤‰ÂÈÍ·Ó ·ÓÂ·ÚÎ‹ ¤ÎÎÚÈÛË ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ (Ì¤-ÁÈÛÙË ·ÓÙ·fiÎÚÈÛË 0,57 Î·È 3,32 ÌIU/ml, ·ÓÙ›ÛÙÔÈ¯·).

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ÎÔÚÙÈ˙fiÏË˜, ÙˆÓ TSH, T3,T4, FSH, LH, E2, ÙË˜ ÙÂÛÙÔÛÙÂÚfiÓË˜, ÙË˜ DHEA’S,ÙË˜ 17-OH-ÚÔÁÂÛÙÂÚfiÓË˜ Î·È ÙË˜ ¢4-·Ó‰ÚÔÛÙÂÓ-‰ÈfiÓË˜ ¤ÁÈÓÂ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ËÏÂÎÙÚÔ¯ËÌÂÈÔÊˆ-Ù·‡ÁÂÈ·˜ (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· kits ÙË˜ ROCHE). ∏ACTH Î·È Ë GH ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜¯ËÌÂÈÔÊˆÙ·‡ÁÂÈ·˜ (kit: Nichols Advantaged) Î·È ËÂÏÂ‡ıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ ÌÂ ÙË Ì¤ıÔ‰ÔRIA (Ì¤ıÔ‰Ô˜ Ú·‰ÈÔ·ÓÔÛÔÌÂÙÚ›·˜, kit: DSL).

∏ ÔÛÙÈÎ‹ ËÏÈÎ›· ÙË˜ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 12,5 ÂÙÒÓ,ÂÓÒ Ë ¯ÚÔÓÔÏÔÁÈÎ‹ 15ó. ∆Ô U/S ÂÈÓÂÊÚÈ‰›ˆÓ ¤‰ÂÈ-ÍÂ ·ÌÊÔÙÂÚfiÏÂ˘ÚË ‰ÈfiÁÎˆÛË ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ(ÙÔ ‰ÂÍ›: 2,4 x 1,1 cm Î·È ÙÔ ·ÚÈÛÙÂÚfi: 2,06 x 0,98cm). ™ÙÔ U/S Ì‹ÙÚ·˜-ˆÔıËÎÒÓ, Ë Ì‹ÙÚ· Â›¯Â ‰È·-ÛÙ¿ÛÂÈ˜ 4,37 x 1,18 cm, ÌÂ ·Ó·ÏÔÁ›· ÛÒÌ·ÙÔ˜ Ì‹-ÙÚ·˜-ÙÚ·¯‹ÏÔ˘ 2/1, ÂÓÒ ÔÈ ˆÔı‹ÎÂ˜ ‹Ù·Ó ÌÈÎÚ¤˜(fiÁÎÔ˜ ‰ÂÍÈ¿˜ ˆÔı‹ÎË˜: 0,83 cc Î·È ·ÚÈÛÙÂÚ‹˜:1,11 cc). ™ÙËÓ MRI ˘fiÊ˘ÛË˜ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌÈÎÚÔ-·‰¤ÓˆÌ· ‰È·Ì¤ÙÚÔ˘ <1 cm, ÛÙÔ ·ÚÈÛÙÂÚfi Ï¿ÁÈÔÙÔ˘ ·‰¤Ó· ÙË˜ ˘fiÊ˘ÛË˜, ÌÂ ·ÚÔ˘Û›· ·ÈÌÔÚÚ·ÁÈ-Î‹˜ ÂÛÙ›·˜, ÂÓÒ Ô Ì›Û¯Ô˜ ÚÔ¤‚·ÏÏÂ ÚÔ˜ Ù· ‰ÂÍÈ¿.

∫·Ù¿ ÙËÓ ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, Ô ‚˘ıfi˜‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ™ÙÔ U/S Î·Ú‰È¿˜ ‰È·ÈÛÙÒıËÎÂÔÚÈ·Î‹ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿Á-Ì·ÙÔ˜. ∏ ·ÛıÂÓ‹˜, ÏfiÁˆ ÙË˜ ˘¤ÚÙ·ÛË˜, ¤Ï·‚Â·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·ÁˆÁ‹ ÌÂ ‚-·Ó·ÛÙÔÏÂ›˜ (ÚÔÚ·-ÓÔÏfiÏË, 20 mg ËÌÂÚËÛ›ˆ˜).

∆Ô ÌÈÎÚÔ·‰¤ÓˆÌ· ·Ê·ÈÚ¤ıËÎÂ ÂÈÙ˘¯Ò˜ ÌÂ ‰È·-ÛÊËÓÔÂÈ‰‹ ÚÔÛ¤Ï·ÛË. ª›· Â‚‰ÔÌ¿‰· ÌÂÙÂÁ¯ÂÈ-ÚËÙÈÎ¿, ÔÈ ÙÈÌ¤˜ ÙË˜ ÚˆÈÓ‹˜ ÎÔÚÙÈ˙fiÏË˜ ÂÏ·ÙÙÒ-ıËÎ·Ó ·fi 64,3 Ìg/dl ÛÂ 0,04 Ìg/dl Î·È ÙË˜ ACTH·fi 118 pg/ml ÛÂ 10 pg/ml, fiˆ˜ Â›ÛË˜ Î·È ÔÈ ÙÈ-Ì¤˜ ÙË˜ ÂÏÂ‡ıÂÚË˜ ÎÔÚÙÈ˙fiÏË˜ Ô‡ÚˆÓ 24ÒÚÔ˘·fi 750 Ìg/24ˆÚÔ ÛÂ 5 Ìg/24ˆÚÔ. ∏ ·ÛıÂÓ‹˜Ï·Ì‚¿ÓÂÈ ·ÁˆÁ‹ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ˘‰ÚÔÎÔÚÙÈ˙fi-ÓË. ªÂÙÂÁ¯ÂÈÚËÙÈÎ¿ ‰ÂÓ ·ÚÔ˘Û›·ÛÂ ¿ÔÈÔ ‰È·‚‹ÙË.


472


473

¶¤ÓÙÂ Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Â›¯Â ÂÌÌËÓ·Ú¯‹Î·È ÔÈ ÙÈÌ¤˜ ÙˆÓ FSH, LH, E2, TSH, T3 Î·È T4 ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎ¤˜.

O Ú˘ıÌfi˜ ·Ó¿Ù˘ÍË˜ ÙË˜ ·ÛıÂÓÔ‡˜ ‚ÂÏÙÈÒıËÎÂÎ·È ‰Ò‰ÂÎ· Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË ÙÔ ‡„Ô˜ ÙË˜Â›Ó·È 143 cm, ÙÔ ‚¿ÚÔ˜ 38,5 kg, Ë ÂÌÊ¿ÓÈÛ‹ ÙË˜ ¤¯ÂÈ‚ÂÏÙÈˆıÂ› ÛËÌ·ÓÙÈÎ¿ Î·È Ù· ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ÙË˜ ÓfiÛÔ˘ Cushing ¤¯Ô˘Ó ˘Ô¯ˆÚ‹ÛÂÈ. ∏ ·ÚÙËÚÈ·-Î‹ ÙË˜ ›ÂÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ¯ˆÚ›˜ ıÂÚ·Â›·.

™˘˙‹ÙËÛË ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÌÂ ÓfiÛÔ Cushing ·-

ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Ô˘ ‰È·Ê¤ÚÂÈ ·fiÂÎÂ›ÓË ÙˆÓ ÂÓËÏ›ÎˆÓ (1,2). O ÈÔ Â˘·›ÛıËÙÔ˜ ‰Â›-ÎÙË˜ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·˜ ÛÙ· ·È‰È¿ Â›Ó·È Ë Î·ı˘-ÛÙ¤ÚËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, Ë ÔÔ›· Û˘Ó‹-ıˆ˜ ÚÔËÁÂ›Ù·È ÙˆÓ ¿ÏÏˆÓ ÂÎ‰ËÏÒÛÂˆÓ (2,10),ÂÓÒ Ë ·¯˘Û·ÚÎ›· ÛÙ· ·È‰È¿ ÌÂ Û‡Ó‰ÚÔÌÔCushing Â›Ó·È ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÊÔÚ¤˜ ÁÂÓÈÎÂ˘Ì¤-ÓË, ·Ú¿ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ (2).

∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ Î·-Ù¿ÚÁËÛË ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Ú˘ıÌÔ‡ ¤ÎÎÚÈÛË˜ ÙË˜ ÎÔÚ-ÙÈ˙fiÏË˜ Î·È Ë Î·Ù·ÛÙÔÏ‹ ÙË˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË˘„ËÏÒÓ ‰fiÛÂˆÓ DXM, ·ÏÏ¿ fi¯È ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛËÌÈÎÚÒÓ ‰fiÛÂˆÓ, Â›Ó·È ·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ıÔ-ÁÓˆÌÔÓÈÎ¿ Â˘Ú‹Ì·Ù· ÙË˜ ÓfiÛÔ˘ Cushing (1,2).

∏ ·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›¯Â fiÏ· Ù·ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing:Î·ı˘ÛÙ¤ÚËÛË ·‡ÍËÛË˜ Î·È ÂÓ‹‚ˆÛË˜, ÎÂÓÙÚÈÎÔ‡Ù‡Ô˘ ·¯˘Û·ÚÎ›·, ·ÓÛÂÏËÓÔÂÈ‰¤˜ ÚÔÛˆÂ›ÔÎ·È ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, ˘¤ÚÙ·ÛË Î·È ˘ÂÚÙÚ›¯ˆÛË.∏ ÂÏÂ‡ıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ ‹Ù·Ó ÔÏ‡·˘ÍËÌ¤ÓË, Î·ıÒ˜ Î·È Ë ACTH. OÈ È‰È·›ÙÂÚ· ·˘ÍËÌ¤-ÓÂ˜ ÙÈÌ¤˜ ÙË˜ ÎÔÚÙÈ˙fiÏË˜ Û˘ÓÔ‰Â‡ÔÓÙ·Ó ·fi ·‡ÍË-ÛË fiÏˆÓ ÙˆÓ ÛÙÂÚÔÂÈ‰ÈÎÒÓ ·Ú·ÁÒÁˆÓ ÙˆÓ ÂÈÓÂ-ÊÚÈ‰›ˆÓ (17-O∏-ÚÔÁÂÛÙÂÚfiÓË, ·Ó‰ÚÔÁfiÓ·), ÂÓÒÂ›¯Â Î·Ù·ÚÁËıÂ› Ë ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË ÙË˜ ÎÔÚÙÈ-˙fiÏË˜. ∏ ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ DXM Î·Ù¤-ÛÙÂÈÏÂ ÙËÓ ÎÔÚÙÈ˙fiÏË Î·È ÙËÓ ACTH ÛÂ ÔÛÔÛÙfi>50%. ∏ ·˘ÍËÌ¤ÓË ACTH Î·È Ë Î·Ù·ÛÙÔÏ‹ ÙË˜ÎÔÚÙÈ˙fiÏË˜ Î·È ÙË˜ ACTH ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÌÂÁ¿-ÏˆÓ ‰fiÛÂˆÓ DXM, Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú ÙË˜ ÓfiÛÔ˘Cushing Î·È ·˘Ùfi ÂÈ‚Â‚·ÈÒıËÎÂ ·ÂÈÎÔÓÈÛÙÈÎ¿ ÌÂMRI ˘fiÊ˘ÛË˜ Î·È U/S ÂÈÓÂÊÚÈ‰›ˆÓ.

∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ CushingÔ‰ËÁÂ› ÛÂ Î·Ù·ÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓÙË˜ ÚfiÛıÈ·˜ ˘fiÊ˘ÛË˜ (FSH, LH, PRL, TSH Î·ÈGH) (10). O Ú˘ıÌfi˜ ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÂÈ-‚Ú·‰‡ÓÂÙ·È Ì¤¯ÚÈ ÌË‰ÂÓÈÛÌÔ‡ (11). ∏ ·Ó·ÛÙÔÏ‹ÙË˜ ·Ó¿Ù˘ÍË˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ·-¯˘Û·ÚÎ›·˜ ÛÙ· ·È‰È¿, ı¤ÙÂÈ ÙËÓ ˘Ô„›· Û˘Ó‰Úfi-ÌÔ˘ Cushing (10), ·ÊÔ‡ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·‡ÍËÛËÙÔ˘ ‚¿ÚÔ˘˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Û˘ÓÔ‰Â‡ÂÙ·È ·fiÙ·¯‡ÙÂÚÔ Ú˘ıÌfi ·Ó¿Ù˘ÍË˜. ∏ ·ÓÙ·fiÎÚÈÛË ÙË˜

·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÛÙÈ˜ ‰ÔÎÈÌ·Û›Â˜ ‰È¤ÁÂÚÛË˜ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ ÂÏ·ÙÙˆÌ¤ÓË(2,10,11). ™ÙËÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜‹Ù·Ó ÂÏ·ÙÙˆÌ¤ÓË. ∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ·ÛıÂ-ÓÒÓ Â›Ó·È Û˘Ó‹ıˆ˜ ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ÚÔ‚ÏÂfi-ÌÂÓÔ (2). ∆Ô ÚÔ‚ÏÂfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙË˜Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ·ÛıÂÓÔ‡˜, ‚¿ÛË ÙË˜ ÔÛÙÈÎ‹˜ ËÏÈ-Î›·˜, ‹Ù·Ó 144,7 cm, ÙÔ ÔÔ›Ô ˘ÔÏÂ›ÂÙ·È ÛËÌ·-ÓÙÈÎ¿ ÙÔ˘ ‡„Ô˘˜-ÛÙfi¯Ô˘ (160,7 cm).

O ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi˜ ˘ÔÁÔÓ·‰ÈÛÌfi˜ Û˘ÓÔ-‰Â‡ÂÈ Ù· ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û‡Ó‰ÚÔÌÔ CushingÛÙËÓ ·Ú¯‹ ÙË˜ ÂÊË‚Â›·˜ (8,10). ∏ ·ÛıÂÓ‹˜ ÙË˜ ·-ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ·ÚÔ˘Û›·ÛÂ Â›ÛË˜ ˘ÔÁÔÓ·‰Ô-ÙÚÔÊÈÎfi ˘ÔÁÔÓ·‰ÈÛÌfi (¯·ÌËÏ¤˜ ÙÈÌ¤˜ FSH, LH Î·È∂2 Î·È ÛÙÔ U/S ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÌÈÎÚ¤˜ˆÔı‹ÎÂ˜). ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜, ËÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÔÓ¿‰ˆÓ Û˘Ó‹ıˆ˜ ·ÔÎ·ı›ÛÙ·Ù·ÈÎ·È ÔÈ ·ÛıÂÓÂ›˜ ÙË˜ ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÊË‚ÈÎ‹ ÂÍ¤ÏÈÍË, Ê˘ÛÈÔÏÔÁÈÎÔ‡˜Î‡ÎÏÔ˘˜ ÂÌÌËÓÔÚÚ˘Û›·˜ Î·È Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰·ÛÙÂÚÔÂÈ‰ÒÓ ÙÔ˘ Ê‡ÏÔ˘ (10), fiˆ˜ Û˘Ó¤‚Ë Î·È ÌÂ ÙËÛ˘ÁÎÂÎÚÈÌ¤ÓË ·ÛıÂÓ‹.

¶ÔÏÏÔ› ·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Cushing ÂÌÊ·Ó›-˙Ô˘Ó ¯·ÌËÏ‹ TSH, T3 Î·È FT3 (10). ∏ Û˘ÁÎ¤ÓÙÚˆÛËÙË˜ TSH Â›Ó·È ÌÂÈˆÌ¤ÓË ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ‰Ú¿-ÛË˜ ÙˆÓ ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰ÒÓ, ÙfiÛÔ ÛÂ Â›Â‰Ô ˘Ô-ı·Ï¿ÌÔ˘ fiÛÔ Î·È ˘fiÊ˘ÛË˜ (10). ∏ T3 Â›Ó·È Â›ÛË˜ÌÂÈˆÌ¤ÓË, ·ÊÔ‡ Ë ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÂÌÔ‰›˙ÂÈ ÙËÓÂÚÈÊÂÚÈÎ‹ ÌÂÙ·ÙÚÔ‹ ÙË˜ ·fi ÙËÓ T4. ∫ÏÈÓÈÎ¿, Ëı˘ÚÂÔÂÈ‰ÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹. ªÂÙÂÁ-¯ÂÈÚËÙÈÎ¿, ÔÈ ÙÈÌ¤˜ ÙˆÓ ı˘ÚÂÔÂÈ‰ÈÎÒÓ ÔÚÌÔÓÒÓTSH, T3 Î·È FT3 ·ÔÎ·ı›ÛÙ·ÓÙ·È ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿,fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡-Û·˜ ÌÂÏ¤ÙË˜.

∏ ıÂÚ·Â›· ÂÈÏÔÁ‹˜ ÛÙË ÓfiÛÔ Cushing Â›Ó·È Ë‰È·ÛÊËÓÔÂÈ‰‹˜ ·Ê·›ÚÂÛË ÙÔ˘ ˘ÔÊ˘ÛÈ·ÎÔ‡ ·‰Â-ÓÒÌ·ÙÔ˜ (2,8). ∏ ÂÈÙ˘¯‹˜ ·Ê·›ÚÂÛË fiÏÔ˘ ÙÔ˘ ·‰Â-ÓÒÌ·ÙÔ˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù· ÔÏ‡ ¯·ÌËÏ¿ Â›-Â‰· ÎÔÚÙÈ˙fiÏË˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿ (12). ∞˘Ùfi Û˘Ì-‚·›ÓÂÈ ÁÈ·Ù› Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ÎÔÚÙÈ˙fiÏË˜ Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓfiÛÔ˘ Ô‰ËÁÔ‡Ó ÛÂ Î·Ù·ÛÙÔÏ‹ ÙˆÓÊ˘ÛÈÔÏÔÁÈÎÒÓ ÎÔÚÙÈÎÔÙÚfiÊˆÓ Î˘ÙÙ¿ÚˆÓ ÙË˜ ˘fi-Ê˘ÛË˜, Ô˘ ‚Ú›ÛÎÔÓÙ·È Á‡Úˆ ·fi ÙÔÓ fiÁÎÔ ÙË˜˘fiÊ˘ÛË˜ (12). ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·-ÙÔ˜, Ë ACTH Î·È Ë ·Ú·ÁˆÁ‹ ÙË˜ ÎÔÚÙÈ˙fiÏË˜ ·Ó·-ÛÙ¤ÏÏÔÓÙ·È ÁÈ· ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∏ ·Ô-Î·Ù¿ÛÙ·ÛË ÙË˜ ÎÔÚÙÈ˙fiÏË˜ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â-‰· Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÂ ‰È¿ÛÙËÌ· 6 ¤ˆ˜ 45ÌËÓÒÓ (12). ∏ Û˘ÁÎÂÎÚÈÌ¤ÓË ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂÂÏ¿ÙÙˆÛË ÙË˜ ÎÔÚÙÈ˙fiÏË˜ Î·È ÙË˜ ACTH ÌÂÙÂÁ¯ÂÈ-ÚËÙÈÎ¿ Î·È ¯ÚÂÈ¿ÛÙËÎÂ ·ÁˆÁ‹ ÌÂ ˘‰ÚÔÎÔÚÙÈ˙fiÓË.

∂› ·ÔÙ˘¯›·˜ ÙË˜ ‰È·ÛÊËÓÔÂÈ‰Ô‡˜ ¯ÂÈÚÔ˘ÚÁÈ-Î‹˜ ÚÔÛ¤Ï·ÛË˜, Û˘ÓÈÛÙ¿Ù·È Â·Ó¿ÏË„Ë (2). ∂›Ó¤·˜ ·ÔÙ˘¯›·˜, Û˘ÓÈÛÙ¿Ù·È ·ÎÙÈÓÔıÂÚ·Â›· ÙË˜

˘fiÊ˘ÛË˜ (8). ™ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ÂÎÙfi˜ ·fi ÙË ‰È·-ÛÊËÓÔÂÈ‰‹ ÚÔÛ¤Ï·ÛË, ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ›Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ (fiˆ˜ Ë ÌÂÙ˘Ú·fiÓË Î·ÈË ÌÈÙÔÙ¿ÓË, Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÎÔÚÙÈ-˙fiÏË˜ ·fi Ù· ÂÈÓÂÊÚ›‰È·). ™Ù· ·È‰È¿ ‰ÂÓ Û˘ÓÈ-ÛÙ¿Ù·È ÏfiÁˆ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ (8).

∏ ‰È·ÛÊËÓÔÂÈ‰‹˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÚÔÛ¤Ï·ÛËÛÙËÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ¤‰ˆÛÂ ÈÎ·ÓÔ-ÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∆Ô ÔÚÌÔÓÔÏÔÁÈÎfi ÙË˜ ÚÔ-Ê›Ï ‚ÂÏÙÈÒıËÎÂ Î·È Â›Ó·È ˘fi ·ÁˆÁ‹ ÌÂ ˘‰ÚÔÎÔÚÙÈ-˙fiÓË. ¢Ò‰ÂÎ· Ì‹ÓÂ˜ ÌÂÙ¿, Ë ·ÛıÂÓ‹˜ Â›Ó·È ˘ÁÈ‹˜Î·È ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌÂ›· ˘ÔÙÚÔ‹˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Savage MO, Lienhardt A, Lebrethon MC, Johnston LB,

Huebner A, Grossman AB et al. Cushing’s disease inchildhood: presentation, investigation, treatment and long-term outcome. Horm Res 2001;55 (Suppl 1):S24-S30.

2. Devoe DJ, Miller WL, Conte FA, Kaplan SL, Grumbach MM,Rosenthal SM et al. Long-term outcome in children andadolescents after transsphenoidal surgery for Cushing’sdisease. J Clin Endocrinol Metab 1997;82:3196-3202.

3. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞, Ã·Ù˙Ë·ı·Ó·Û›Ô˘ Ã, §··ÙÛ¿-ÓË˜ ¶, ªÔ˘ÙÛÔ‡ÚË˜ Ã, ¶··ıÂÔ‰ÒÚÔ˘ ∞, £ÂÔ‰ˆÚ›‰Ë˜ Ã.™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓÛÂ ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 12 ÂÙÒÓ. ¶·È‰È·ÙÚÈÎ‹ 1991;54:300-306.

4. ª›ÙÛË ª, £ÂÔ‰ˆÚ›‰Ë˜ Ã, ™˘ÚÈÔÔ‡ÏÔ˘ µ, ∫·ÙÂÚ¤ÏÔ˜ Ã,ª·ÙÛ·ÓÈÒÙË˜ ¡. ™‡Ó‰ÚÔÌÔ Cushing ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ÙÔ-ÈÎ‹ ¯Ú‹ÛË ÎÔÚÙÈ˙ÔÓÔ‡¯Ô˘ ·ÏÔÈÊ‹˜ Clobetasolpropionate. ¢ÂÏÙ›Ô ∞’ ∫ÏÈÓÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ1982;29:135-145.

5. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÚÈ·ÛÔ‡ÏË˜ °, ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ ∆, ªÔ˘Û¿ÙÔ˜°, ∆˙ˆÚÙ˙¿ÙÔ˘ º, ∫·ÙÂÚ¤ÏÔ˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ ÛÂ ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜

5ó ÌËÓÒÓ. ¶·È‰È·ÙÚÈÎ‹ 1983;46:57-62. 6. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÔ˘ÚÏÔÁÈ¿ÓÓË˜ Ã, ∫·Ú¿ıÈÔ˜ £, µÏ¿¯Ô˘

¶, ∫·ÙÙ¿ÌË˜ Ã. ∞‰ÂÓÔÎ·ÚÎ›ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚÈ-‰›ˆÓ. ¶·È‰È·ÙÚÈÎ‹ 1979;42:295-301.

7. McArthur RG, Cloutier MD, Hayles AB, Sprague RG.Cushing’s disease in children. Findings in 13 cases. MayoClin Proc 1972;47:318-326.

8. Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT,Doppman JL, Cutler GB et al. Cushing’s syndrome inchildren and adolescents. Presentation, diagnosis, andtherapy. N Engl J Med 1994;331:629-636.

9. Stewart PM. The adrenal cortex. In: Larsen PR, KronenbergHM, Melmed S, Polonsky KS, editors. Williams Textbook ofEndocrinology. 10th edition. Philadelphia: WB SaundersCompany; 2003. p. 509.

10. Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA.Treatment of Cushing’s disease in childhood andadolescence by transsphenoidal microadenomectomy. NEngl J Med 1984;310:889-893.

11. Magiakou MA, Mastorakos G, Gomez MT, Rose SR,Chrousos GP. Suppressed spontaneous and stimulatedgrowth hormone secretion in patients with Cushing’sdisease before and after surgical cure. J Clin EndocrinolMetab 1994;78:131-137.

12. Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG,Grossman AB et al. Transsphenoidal resection in Cushing’sdisease: undetectable serum cortisol as the definition ofsuccessful treatment. Clin Endocrinol 1993;38:73-78.


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475

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO


¡∂∞∏ ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ Û˘Ó‰˘·ÛÌ¤ÓË ÌÂ ·ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ ‹ Î·È ÎÔÚÙÈ˙fiÓË ‰ÂÓ‚ÂÏÙÈÒÓÂÈ ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·

∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜

™‡ÌÊˆÓ· ÌÂ ·˘Ù‹ ÙË ÌÂÏ¤ÙË, ÔÈ Chonmaitree Î·È Û˘Ó ·fi ÙÔ Galveston ÙË˜ ÔÏÈÙÂ›·˜ ÙÔ˘Texas (∏¶∞) ÂÚÂ‡ÓËÛ·Ó ÙËÓ ˘fiıÂÛË fiÙÈ ÚfiÛıÂÙË ıÂÚ·Â›·, ÂÎÙfi˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÌÂ·ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ ‹ Î·È ÎÔÚÙÈ˙fiÓË ı· ÌÔÚÔ‡ÛÂ Ó· ÂÏ·ÙÙÒÛÂÈ ÙË ‚·Ú‡ÙËÙ· ÙË˜ ÊÏÂÁÌÔÓ‹˜ Î·È,Î·Ù¿ Û˘Ó¤ÂÈ·, Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ¿ÌÂÛË ‹ Ì·ÎÚÔÚfiıÂÛÌË ¤Î‚·ÛË ÙË˜ Oªø. ∫·Ù¤ÓÂÈÌ·Ó Ù˘-¯·›· ÛÂ Ì›· ‰ÈÏ‹-Ù˘ÊÏ‹, ÌÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÌÂÏ¤ÙË 179 ·È‰È¿ ËÏÈÎ›·˜ 3 ÌËÓÒÓ ¤ˆ˜ 6 ÂÙÒÓÛÂ ÙÚÂÈ˜ ÔÌ¿‰Â˜, ·ÊÔ‡ fiÏ· ¤Ï·‚·Ó Ì›· ¤ÓÂÛË ÎÂÊÙÚÈ·ÍfiÓË˜: Ë ÚÒÙË ÔÌ¿‰· ¤Ï·‚Â ÚfiÛıÂ-Ù· ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË 0,35 mg/kg ÙËÓ ËÌ¤Ú·, Ë ‰Â‡ÙÂÚË ÚÂ‰ÓÈ˙ÔÏfiÓË 2 mg/kg ÙËÓ ËÌ¤Ú·, ËÙÚ›ÙË ÔÌ¿‰· ¤Ï·‚Â ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË Î·È ÚÂ‰ÓÈ˙fiÓË ÛÙÈ˜ ·ÓˆÙ¤Úˆ ‰fiÛÂÈ˜ Î·È Ë Ù¤Ù·ÚÙË ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· 5 ËÌ¤ÚÂ˜. ¢ÂÓ ˘‹ÚÍÂ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÛÙËÓ ÂÏ¿ÙÙˆ-ÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, Û‡ÌÊˆÓ· ÌÂ ÙË ‚·ıÌÔÏÔÁ›· ‚·Ú‡ÙËÙ·˜, ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›-·˜ Î·È Î·Ù¿ ÙËÓ ÂÍ¤Ù·ÛË ÙËÓ 5Ë Î·È 14Ë ËÌ¤Ú·. ¢ÂÓ ˘‹ÚÍÂ, Â›ÛË˜, ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfiÙˆÓ ˘ÔÙÚÔÒÓ Î·È ÁÈ· 6 Ì‹ÓÂ˜ ÌÂÙ¿.

ªË ·Ó·ÌÂÓfiÌÂÓË ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙ· ·È‰È¿ Ô˘ ¯ÔÚËÁ‹ıËÎÂ ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi, ·-Ú·Ù¿ıËÎÂ Ë Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ (Ì¤ÛË ‰È¿ÚÎÂÈ· 73 ËÌ¤ÚÂ˜ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ¿ÏÏÂ˜3 ÔÌ¿‰Â˜ fiÔ˘ Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ‹Ù·Ó 23-36 ËÌ¤ÚÂ˜). ¢ÂÓ Â›Ó·È ÍÂÎ¿ı·ÚÔ˜ Ô ÌË¯·ÓÈÛÌfi˜ ÌÂ‚¿ÛË ÙÔÓ ÔÔ›Ô Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi Â›¯·Ó ·Ú·ÌÔÓ‹ ÙÔ˘ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔÔ˘˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ·. OÈ Û˘ÁÁÚ·ÊÂ›˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ù· ·ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ ·˘Í¿ÓÔ˘ÓÙË ÁÏÔÈfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ Î·È ¤ÙÛÈ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È ÙËÓ ·ÚÔ¯¤ÙÂ˘Û‹ ÙÔ˘.∫·Ù·Ï‹ÁÔ˘Ó, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ ÛÙËÓ Oªø Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È. ¢ÂÓ Â›-Ó·È Û·Ê¤˜, ·fi ·˘Ù‹ ÙË ÌÂÏ¤ÙË, Â¿Ó Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÂÈ‰ÒÓ ˆÊÂÏÂ› ‹ ‚Ï¿ÙÂÈ.

J Pediatr 2003;143:377-385

∏ ÛÈ‰ËÚÔÂÓ›· ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙË ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘-‚‰Ô ÛÙ· ·È‰È¿

∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜

∞˘Ùfi Â›Ó·È ÙÔ Û˘Ì¤Ú·ÛÌ· Ì›·˜ ÌÂÏ¤ÙË˜ ÙˆÓ Choi J Î·È Kim S ·fi ÙË ¡fiÙÈ· ∫ÔÚ¤·.∏ ÛÈ‰ËÚÔÂÓ›· Î·ÙËÁÔÚÈÔÔÈÂ›Ù·È ÛÂ 3 ÛÙ¿‰È·: ÛÙ¿‰ÈÔ π (ÂÍ¿ÓÙÏËÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÛÈ-

‰‹ÚÔ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ô˘Û›· ·Ó·ÈÌ›·˜, Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· ÛÈ‰‹ÚÔ˘ ÛÙÔ ·›-Ì· (>50 mcg/dL) Î·È ÂÏ·ÙÙˆÌ¤ÓË ÊÂÚÚÈÙ›ÓË (<12 mcg/L), ÛÙ¿‰ÈÔ ππ (Ê¿ÛË ÛÈ‰ËÚÔÂÓÈÎ‹˜ÂÚ˘ıÚÔÔ›ËÛË˜) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ <12 mcg/L Î·È Û›‰ËÚÔÔÚÔ‡ <50 mcg/dL ¯ˆÚ›˜ ÚÔÊ·Ó‹ ·Ó·ÈÌ›· Î·È ÛÙ¿‰ÈÔ πππ (ÛÈ‰ËÚÔÂÓÈÎ‹ ·Ó·ÈÌ›·) Ô˘ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi Û›‰ËÚÔ ÔÚÔ‡, ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË <12 g/dL.

∞fi ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·È‰È¿ ÌÂ ÛÈ‰ËÚÔÂÓ›· ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ·Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ ·›Ì·.

OÈ ÂÚÂ˘ÓËÙ¤˜ ÚÔÛ‰ÈfiÚÈÛ·Ó Ù· Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ ·›Ì· ÛÂ Î¿ıÂ ¤Ó· ·fi Ù· 3 ÛÙ¿‰È·ÙË˜ ÛÈ‰ËÚÔÂÓÈÎ‹˜ ·Ó·ÈÌ›·˜, Î·ıÒ˜ Â›ÛË˜ Î·È Ù· Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ ·›Ì· ÌÂÙ¿ ·fi

476

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ÛÈ‰ËÚÔıÂÚ·Â›·. ¶ÚÔÛ‰ÈfiÚÈÛ·Ó ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÙÔÓ Û›‰ËÚÔ ÔÚÔ‡, ÙË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·ÈÙ· Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ ·›Ì· ÛÂ 279 ·È‰È¿ (ËÏÈÎ›·˜ 10-15 ÂÙÒÓ) Ô˘ ‰È¤ÌÂÓ·Ó ÛÂ ÂÚÈ-‚¿ÏÏÔÓ ÂÚÁÔÛÙ·ÛÈ·Î‹˜ ÌfiÏ˘ÓÛË˜. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó ÛÂ 4 ÔÌ¿‰Â˜ (ÛÙ¿‰È· π, ππ, πππ Î·È ˘ÁÈ-Â›˜ Ì¿ÚÙ˘ÚÂ˜). ŸÏ· Ù· ·È‰È¿ ÌÂ ÛÈ‰ËÚÔÂÓ›· Â›¯·Ó ÂÏ·ÙÙˆÌ¤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡, ·ÏÏ¿ ÌfiÓÔÙ· ·È‰È¿ ÛÙ· ÛÙ¿‰È· ππ Î·È πππ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÌÔÏ‡‚‰Ô˘. OÈ Û˘ÁÁÚ·-ÊÂ›˜ Î·Ù·Ï‹ÁÔ˘Ó fiÙÈ Ë ÂÏ·ÙÙˆÌ¤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ ‰ÂÓ ÂËÚÂ¿˙ÂÈ Ù· Â›Â‰· ÌÔÏ‡‚‰Ô˘, ÂÓÒÙ· ¯·ÌËÏ¿ Â›Â‰· ÛÈ‰‹ÚÔ˘ ÛÙÔÓ ÔÚfi (ÛÙ¿‰È· ππ Î·È πππ) ·˘Í¿ÓÔ˘Ó Ù· Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ·›Ì·.

∆· Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ ·›Ì· ÙˆÓ ·Ó·ÈÌÈÎÒÓ ·È‰ÈÒÓ ‚Ú¤ıËÎ·Ó ·˘ÍËÌ¤Ó· 1,6 ÊÔÚ¤˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∆ÚÈ¿ÓÙ· Ù¤ÛÛÂÚ· ·È‰È¿ ÌÂ ·Ó·ÈÌ›· ıÂÚ·Â‡ÙËÎ·Ó ÌÂ ÛÎÂ‡·ÛÌ·ıÂÈÈÎÔ‡ ÛÈ‰‹ÚÔ˘ (3-6 mg ÛÙÔÈ¯ÂÈ·ÎÔ‡ ÛÈ‰‹ÚÔ˘ ·Ó¿ kg µ™ ÙËÓ ËÌ¤Ú·) Î·È ÌÂÙ¿ ¤Ó· Ì‹Ó· Ù· Â›-Â‰· ÌÔÏ‡‚‰Ô˘ Â›¯·Ó ÌÂÈˆıÂ› ÛËÌ·ÓÙÈÎ¿ (·fi 6,8 ± 1,7 ÛÂ 2,7 ± 1,2 mcg/dL, p<0,01). µ·ÛÈ-˙fiÌÂÓÔÈ ÛÂ ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, ÔÈ ÂÚÂ˘ÓËÙ¤˜ Î·Ù·Ï‹ÁÔ˘Ó fiÙÈ Ë ÛÈ‰ËÚÔÂÓ›· Â›Ó·È Èı·ÓfiÓ Ó··ÔÙÂÏÂ› ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô, ÂÓÒ ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË ÛÈ-‰ËÚÔÂÓ›·, ÌÔÚÂ› Ó· ÂÏ·ÙÙˆıÔ‡Ó Î·È Ù· Â›Â‰· ÌÔÏ‡‚‰Ô˘ ÛÙÔ ·›Ì·.

™¯fiÏÈÔ: ™ÙËÓ ∂ÏÏ¿‰·, Ë ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô Û·Ó›ˆ˜ ıÂˆÚÂ›Ù·È ˆ˜ Èı·ÓfiÙËÙ·.ÿÛˆ˜, Û‡ÌÊˆÓ· ÌÂ Ù· ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù·, ı· Ú¤ÂÈ Ó· ‰ÈÂÚÂ˘Ó¿Ù·È Û˘ÛÙËÌ·ÙÈÎ¿ Ë ‰È·ÁÓˆ-ÛÙÈÎ‹ ·˘Ù‹ Èı·ÓfiÙËÙ· ÛÂ ‚ÈÔÌË¯·ÓÈÎ¤˜ ÂÚÈÔ¯¤˜ Î·È ÛÂ ·È‰È¿ ÌÂ ÛÈ‰ËÚÔÂÓ›·. ∏ ‰ËÏËÙË-Ú›·ÛË ·fi ÌfiÏ˘‚‰Ô Â›Ó·È ‡Ô˘ÏË Î·È ¤¯ÂÈ ÚˆÙÂ˚Î¤˜ ÂÎ‰ËÏÒÛÂÈ˜, Â›Ó·È fiÌˆ˜ ÛÔ‚·Ú‹ Î·È Ú¤-ÂÈ Ó· ‰È·ÁÈÁÓÒÛÎÂÙ·È ¤ÁÎ·ÈÚ· ÁÈ· Ó· ·ÔÊÂ˘¯ıÔ‡Ó ÛÔ‚·Ú¤˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ÂÈÏÔÎ¤˜.

Arch Dis Child 2003;88:791-792

∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™§·ÌÚfi ª¤ÏÏÔÓ!! http://www.brightfutures.org/

∆Ô ¶·ÓÂÈÛÙ‹ÌÈÔ ÙË˜ Georgetown Î·È ÙÔ ∂ıÓÈÎfi ∫¤-ÓÙÚÔ ∂Î·›‰Â˘ÛË˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÀÁÂ›· ªËÙ¤Ú·˜ Î·È¶·È‰ÈÔ‡ ÙˆÓ ∏.¶.∞. ¤¯Ô˘Ó Û¯Â‰È¿ÛÂÈ ¤Ó·Ó ÎÔÌ„fiÙ·ÙÔ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ô˘ ÂÚÈ¤¯ÂÈ Ï‹ıÔ˜ Ú·ÎÙÈÎÒÓ Ô‰Ë-ÁÈÒÓ. ¶ÔÏÏ¿ ·fi Ù· ÂÁ¯ÂÈÚ›‰È· Ô˘ ÂÎ‰›‰ÂÈ Ë ÔÚÁ¿ÓˆÛË·˘Ù‹ ·Ú¤¯ÔÓÙ·È ‰ˆÚÂ¿Ó, ÌÂ ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ .pdf. ∏ÂÈÎÔÓÔÁÚ¿ÊËÛË Â›Ó·È Î·ı·Ú‹ Î·È ¿„ÔÁË, Ù·ÈÚÈ¿˙ÔÓÙ·˜·fiÏ˘Ù· ÌÂ ÙÔ ÏÈÙfi ÎÂ›ÌÂÓÔ, ÙÔ ÔÔ›Ô Â›Ó·È ÚÔÛ·ÚÌÔ-

ÛÌ¤ÓÔ ÛÙÈ˜ ·Ó¿ÁÎÂ˜ ÙÔ˘ ÔÏ˘¿Û¯ÔÏÔ˘ Â·ÁÁÂÏÌ·Ù›· ˘ÁÂ›·˜, Î·Ù·Ê¤ÚÓÔÓÙ·˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈÂÚ›ÏÔÎ· ı¤Ì·Ù· ÌÂ ÙÚfiÔ Î·Ù·ÓÔËÙfi, ¯ˆÚ›˜ Ó· ¯¿ÓÂÈ ÙËÓ Ô˘Û›· ÙÔ˘˜. ™˘ÛÙ‹ÓÂÙ·È ·ÓÂÈÊ‡-Ï·ÎÙ·, ·ÊÔ‡ ¿ÏÏˆÛÙÂ ¤¯ÂÈ Î·Ù·ÎÙ‹ÛÂÈ ÔÏÏ¿ Û¯ÂÙÈÎ¿ ‚Ú·‚Â›·.


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∞Ó¿Ï˘ÛË ‚È‚ÏÈÔÁÚ·Ê›·˜: ÚÈÓ ·fi ÂÛ¿˜... ÁÈ· ÂÛ¿˜! http://pediatrics.jwatch.org/

¢Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ÔÛfiÙËÙ· ÙË˜ ÎÏÈÓÈÎ‹˜ ¤ÚÂ˘Ó·˜ ÛÙÈ˜ Ì¤ÚÂ˜ Ì·˜ fiÏÔ Î·È ·˘Í¿ÓÂÈ, ¤Ó·˜ ÛË-Ì·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÔÚÁ·ÓÒÛÂˆÓ ·Ó·Ï·Ì‚¿ÓÂÈ ÙËÓ ·Ô‰ÂÏÙ›ˆÛË ÙˆÓ Û¯ÂÙÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ Â-ÚÈÔ‰ÈÎÒÓ, ÙË Û‡ÓÔ„Ë Î·È ÙÔÓ Û¯ÔÏÈ·ÛÌfi ÙÔ˘˜. OÈ ÚˆÙÔ‚Ô˘Ï›Â˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÈÙ˘-

¯ËÌ¤ÓÂ˜, ·ÊÔ‡ Ú¤ÂÈ Ó· ÈÛÔÚÚÔ‹ÛÔ˘Ó ÌÂÙ·Í‡ ÙË˜ ÈÛÔ-¤‰ˆÛË˜ ÙÔ˘ ‚¿ıÔ˘˜ Î·È ÙË˜ ÎÔ‡Ú·ÛË˜ ÙË˜ ÏÂÙÔÌ¤ÚÂÈ-·˜. ŸÙ·Ó, fiÌˆ˜, ÙÔ ÂÁ¯Â›ÚËÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ˘˜ ÂÎ-‰fiÙÂ˜ ÙÔ˘ New England Journal of Medicine, ÔÈ ÂÁÁ˘‹-ÛÂÈ˜ Â›Ó·È ˘„ËÏ¤˜. ∆Ô Journal Watch Pediatrics andAdolescent Medicine, ÂÌÊ·Ó›˙ÂÙ·È ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰Ô-Ì¿‰· ÛÙÔ ‰›ÎÙ˘Ô, ÂÓÒ Ë ¤ÓÙ˘Ë ¤Î‰ÔÛË Î˘ÎÏÔÊÔÚÂ› ÌËÓÈ-·›·. ∞Ó¿ÌÂÛ· ÛÙ· 28 ÂÈ‰ÈÎ¿ ÂÚÈÔ‰ÈÎ¿ Ô˘ ·Ô‰ÂÏÙÈÒÓÂÈÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· ÙË˜ ÂÈ‰ÈÎfiÙËÙ·˜, ·Ï-

Ï¿ Î·È ÁÂÓÈÎ¿ ÂÚÈÔ‰ÈÎ¿ ˘„ËÏÔ‡ impact, fiˆ˜ ÙÔ Lancet, ÙÔ NEJM Î.¿. ∏ ¯Ú‹ÛË fiÏˆÓ ÙˆÓ ‰˘-Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ··ÈÙÂ› ÂÙ‹ÛÈ· Û˘Ó‰ÚÔÌ‹, Ë ÔÔ›· ÁÈ· ÙËÓ ∂ÏÏ¿‰· ·Ó¤Ú¯ÂÙ·ÈÛÂ 115 £ ÁÈ· ÙÔ˘˜ ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘˜ Î·È ÛÂ 66 £ ÁÈ· ÙÔ˘˜ ÂÈ‰ÈÎÂ˘fiÌÂÓÔ˘˜.


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¶·È‰È·ÙÚÈÎ‹ 2003;66:478 Paediatriki 2003;66:478

478

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™ÎÂÓÙ¤ÚË˜ ¡ÈÎfiÏ·Ô˜™ÎÈ·‰¿˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜™ÌÒÎÔ˘-µÂÚÈÁ¿ÎË ¢fiÍ·™ËÏÈÒÙË-°ÎÚ¤Î· µ·ÛÈÏÈÎ‹™Ù·ÌÔ˘Ï·Î¿ÙÔ˘ ∞ÏÂÍ¿Ó‰Ú·™ÙÈ‚·ÎÙ¿ÎË-¶··‰¿ÎË ∂ÚÁ¿ÓË™˘Ú›ÁÔ˘-¶··‚·ÛÈÏÂ›Ô˘ ∞ÓÙÈÁfiÓË™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜∆˙Ô˘Ì¿Î·-ª·ÎÔ‡Ï· ÃÚ‡Û·∆Û·ÁÎ·ÚÔÔ‡ÏÔ˘-™Ù›ÁÁ· ∏Ú·ÎÏÂ›·∆Û·Ó¿Î·˜ πˆ¿ÓÓË˜∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ·∆ÛÈÏÈÁÈ¿ÓÓË˜ £ÂÔÊ¿ÓË˜∆ÛfiÎ·-°ÂÓÓ·Ù¿ ∂Ï¤ÓË∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ª·Ú›˙·∆ÛÔ˘Ì¿Î·˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ºÚÂÙ˙¿ÁÈ·˜ ∞Ó‰Ú¤·˜ ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂Ï¤ÓËºˆÙfiÔ˘ÏÔ˜ ™˘Ú›‰ˆÓ·˜ ºˆÙÔÔ‡ÏÔ˘ ª·Ú›·Ã·Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜ÃÈÒÙË˜ ¢ËÌ‹ÙÚÈÔ˜

∂˘¯·ÚÈÛÙ›Â˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜”

∏ ¢ÈÂ‡ı˘ÓÛË Î·È Ù· ª¤ÏË ÙË˜ ∂ÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ ∂ÈÙÚÔ‹˜ Â˘¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹” Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ Â›Ú· Î·È ÙÔÓ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘-ÛÙËÌ·ÙÈÎ¤˜, ÙÂÎÌËÚÈˆÌ¤ÓÂ˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜ ÁÈ· ÙÈ˜ ÂÈÛÙËÌÔÓÈÎ¤˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛÈÂ‡-ıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2003.

∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 66 ÙÔ˘ ¤ÙÔ˘˜ 2003

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Wevers R.A. 133

∞∞ÁÁÂÏ¿ÎÔ˘ µ. 392∞ÁÁÂÏfiÔ˘ÏÔ˜ ¢. 316∞˙·ÚÈ¿‰Ë˜ ¶. 381∞ı·Ó·ÛÈ¿‰Ô˘ º. 195,284∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. 52,55,128∞˚‚¿˙Ë˜ µ. 55,211∞ÏÂÍ¿Ó‰ÚÔ˘ ∂. 188∞Ï¤ÍÂ ¡.ª. 20∞ÏÂÍ›Ô˘ ¡. 278∞ÏÂÍfiÔ˘ÏÔ˜ ∂. 208∞Ì¤ÓÙ· ™. 215∞Ó·ÛÙ·ÛÈ¿‰Ë˜ °. 316∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁÂˆÚÁÔÔ‡ÏÔ˘ ∂. 304∞Ó·ÛÙ·Û›Ô˘ ∞. 364∞Ó‰Ú¤Ô˘ ∞. 304∞ÓÙˆÓÔÁÂÒÚÁÔ˜ °. 155∞ÔÛÙfiÏÔ˘ ∂. 405∞ÚÁ˘ÚÔ‡ ™. 145ÕÚÛÔ˜ °. 296∞ÚÒÓË ™. 387∞ÙÙÈÏ¿ÎÔ˜ ∞. 467∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶. 118

µµ·ÁÈ¿ÎÔ˘ ∂.∞. 202,456µ·ÚÏ¿ÌË˜ °. 128µ·ÛÈÏÂÈ¿‰Ô˘ ∂. 145µ·ÛÈÏfiÔ˘ÏÔ˜ ∞. 97µ·ÛÈÏÔÔ‡ÏÔ˘ ∞. 418µÔÚÁÈ¿ ¶. 133µÔ‡‰ÚË˜ ∫.∞. 118,202,387,456

°°·‚Ú›ÏË ™. 344°·Ï·Ó¿ÎË˜ ∂. 452°È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. 58,255°È·ÓÓÔ‡ÏÈ· ∞. 185°ÈÔ˘ÚÔ‡ÎÔ˜ ™. 215°ÎÈÒÓË˜ ¢. 37°ÎÔ˘ÁÎÔ‡‰Ë ∂. 145°Ô˘‰ÂÛ›‰Ô˘ ª.∑. 140°Ô‡Ó·ÚË˜ ∞. 278°Ô˘ÚÁÔ˘ÏÈ¿ÓË˜ ∫. 208

¢¢·›ÎÔ˜ °. 188¢ÂÌÂÚÙ˙›‰Ô˘ µ. 296¢ÂÛ‡ÚË˜ ¡. 364¢‹ÌÔ˘ ™. 202¢ÚÔÁÎ¿ÚË ∂. 118

¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ. 29,148

∂∂˘·ÁÁÂÏ›Ô˘ ∞. 133

∑∑·‚ÈÙÛ¿ÓÔ˜ •. 364∑·ÊÂÈÚ›Ô˘ ¢. 211∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘ ª. 239

££ÂÔ‰ˆÚ›‰Ë˜ Ã. 471£ÂÔ‰ˆÚ›‰Ô˘ ª. 188

ππÁÓ·ÙÈ¿‰Ë˜ π.π. 140

∫∫·‰›ÙË˜ ∞. 208∫·Ï·‚ÚÔ˘˙ÈÒÙË˜ °. 381∫·Ï·ÓÙ˙‹˜ ∞. 185∫·Ï¤ÁÈ·˜ π. 278,344∫·ÏÔÁÂÚÔÔ‡ÏÔ˘ Ã.¶. 311∫·ÏÔ‡ÙÛË µ. 195∫·Ì¿˜ ¡. 247∫·ÌÔ˘Ú›‰Ô˘ ¶. 461∫·Ó¿ÚÈÔ˘ ª. 47∫·ÓÈÙÛ¿ÎË˜ ∞. 133∫·Ú·ÁÈ¿ÓÓË ¶. 29∫·Ú·Ì¤ÚË˜ ™. 128∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ ¢. 232∫·Ú·Ó¿ÛÈÔ˘ ∫. 452∫·Ú·Ó›Î·˜ ∏. 47∫·Ú·ÓÙ·Ó¿ ∂. 185∫·Ú·Ù˙¿ ∞.∞. 311∫·Ú·Ù˙¿ ∂. 296∫·Ú·Ù˙¿˜ ¡. 296∫·Ú›Î·˜ °.∞. 113∫·ÚÎ·‚›ÙÛ·˜ ¡. 264∫·Ù˙ËÏ¿ÎË˜ ¡. 133∫·ÙÚÈÔ‡ ¢. 195,284∫·ÙÛ·ÚÔ‡ ∂. 456∫·ÙÛÈ·Ú‰¿ÓË˜ ∫. 364∫·Ê¿ÙÔ˜ ∞. 264,436∫¤ÎÔ˘ ∫. 215∫ÂÚ·Ì›‰·˜ ¢. 145∫fiÎÔÚË ∂. 12,133,223∫Ô‡Ï·ÏË ∂. 304∫Ô˘ÓÂÓÔ‡ ∫. 357∫Ô˘ÚÙ¤ÛË˜ ∞. 381∫Ô‡ÚÙË ª. 284∫Ô‡ÛÙ· ∂. 471∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °. 29,148


479

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§§··ÙÛ¿ÓË˜ ¶.¢. 82§·Ú›Ô˘ ª.™. 89§¿ÛÎ·ÚË Ã. 316§ÂÈ‚·‰›ÙË ∂. 145§ÈıÔÍÔÔ‡ÏÔ˘ ª. 55§ÈÓ·Ú‰¿ÎË˜ ª. 264,436§ÈÔÓ‹˜ Ã. 133

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¡¡ÈÎËÙ¿ÎË˜ ¶. 133¡ÈÎÔÏ¿Ô˘ ™. 145

••˘ÓÈ¿˜ π. 296

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9-12 ºÂ‚ÚÔ˘·Ú›Ô˘ 2004 15th International Congress Paris, France on anti-Cancer Treatment ¶ÏËÚÔÊÔÚ›Â˜: T.C.O. Tel.: (33-1) 42 94 87 32 Fax: (33-1) 42 94 87 33 Website: www.icact.com E-mail: [email protected]

28 ºÂ‚ÚÔ˘·Ú›Ô˘- 6th International Congress Lisbon, Portugal2 ª·ÚÙ›Ô˘ 2004 on Pediatric Pulmonology

¶ÏËÚÔÊÔÚ›Â˜: Annie Bidart Tel.: 33-0-497-038-597Fax: 33-0-497-038-598

13-14 ª·ÚÙ›Ô˘ 2004 3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂÈ‰ÈÎÔÙ‹ÙˆÓ ∞ı‹Ó· ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜•ÂÓÔ‰Ô¯Â›Ô Divani Caravel ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ¶ÏËÚÔÊÔÚ›Â˜: C&C International∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: [email protected] Website: www.ped-subspec2004.gr

28-31 ª·ÚÙ›Ô˘ 2004 30th Annual Meeting of the Barcelona, Spain European Group for Blood and Marrow Transplantation ¶ÏËÚÔÊÔÚ›Â˜: ISAM-EBMTAKM Congress ServiceTel.: +41 61 686 77 11 Fax: +41 61 686 77 88 Website: www.akm.ch/ebmt2004E-mail: [email protected]

23-25 ∞ÚÈÏ›Ô˘ 2004 16Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈÎ‹˜ ƒfi‰Ô˜ ∂Ù·ÈÚÂ›·˜ ∫ÔÈÓˆÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜“¶·È‰› Î·È ∞ıÏËÙÈÛÌfi˜”∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜ π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔÚ›Â˜: ∂‡Ë ∞Ù˙¤ÌË, ÃÚ‡Û· ª·˘Ú›‰Ô˘ Tel.: 22410-99101 Website: www.socped.gr

27 ∞ÚÈÏ›Ô˘- 30Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó· 1 ª·˝Ô˘ 2004 •ÂÓÔ‰Ô¯Â›Ô Hilton

¶ÏËÚÔÊÔÚ›Â˜: π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ∞ıËÓÒÓ ∆ËÏ.: 210-72 11 845 Fax: 210-72 15 082 E-mail: [email protected]

6-8 ª·˝Ô˘ 2004 2nd International Congress on Adult ∞ı‹Ó· Consequences of Childhood Endocrine Diseases¶ÏËÚÔÊÔÚ›Â˜: ÕÓÓ· °È·Ï·ÓÙ˙‹ Tel.: (0030) 2310-447.444 Fax: (0030) 2310-447.444 & 2310-282476 E-mail: [email protected] Website: www.ghsociety.gr

¶PO™EXH ™YNE¢PIA

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13-16 ª·˝Ô˘ 2004 3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜ ª‡ÎÔÓÔ˜ ÌÂ ¢ÈÂıÓ‹ ™˘ÌÌÂÙÔ¯‹ •ÂÓÔ‰Ô¯Â›Ô Royal Myconian & Spa ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜¶ÏËÚÔÊÔÚ›Â˜: ∑π∆∞ Congress & Travel ∆ËÏ.: +30 210-66 41 190Fax: +30 210-66 42 116E-mail: [email protected]

28-30 ª·˝Ô˘ 2004 42Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∫Ú‹ÙË •ÂÓÔ‰Ô¯Â›Ô Creta Maris ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ¶ÏËÚÔÊÔÚ›Â˜: C&C International∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: [email protected] Website: www.pediatric2004.gr

6-9 πÔ˘Ó›Ô˘ 2004 7Ô ¶·ÁÎfiÛÌÈÔ ™˘Ó¤‰ÚÈÔ ÁÈ· ÙËÓ ¶ÚfiÏË„Ë Vienna, Austria ∞Ù˘¯ËÌ¿ÙˆÓ Î·È ÙËÓ ¶ÚÔ·ÁˆÁ‹ ÀÁÂ›·˜/∞ÛÊ¿ÏÂÈ·˜ ¶ÏËÚÔÊÔÚ›Â˜: ∫∂¶¶∞ ∆ËÏ.: 210-74 62 187 & 74 62 201 Fax: 210-74 62 105 Website: www.safety2004.info

10-13 πÔ˘Ó›Ô˘ 2004 9th Congress of the European Geneva, Hematology Association Switzerland ¶ÏËÚÔÊÔÚ›Â˜: Eurocongres ConferenceManagement∆el.: +31 20 679 3411Fax: +31 20 673 7306E-mail: [email protected]: www.eurocongres.com/eha2004

16-19 πÔ˘Ó›Ô˘ 2004 Advances in Neuroblastoma Research 2004 Genoa, Italy ¶ÏËÚÔÊÔÚ›Â˜: ANR 2004 SecretariatItalian Neuroblastoma Association Tel.: +39 010 60 18 938 Fax: +39 010 60 18 961 Website: www.anr2004.org E-mail: [email protected]

28-31 ∞˘ÁÔ‡ÛÙÔ˘ 2004 6th Balkan Meeting on Human £ÂÛÛ·ÏÔÓ›ÎËGenetics (BMHG 2004) ¶ÏËÚÔÊÔÚ›Â˜: TOPLINE Travel and Tourism Tel.: +30 2310-538 001 Fax: +30 2310-566 713 E-mail: [email protected]

26 ™ÂÙÂÌ‚Ú›Ô˘- XII Meeting of the European Association £ÂÛÛ·ÏÔÓ›ÎË 1 OÎÙˆ‚Ú›Ô˘ 2004 for Haematopathology

¶ÏËÚÔÊÔÚ›Â˜: Triaena Tours & Congress ∆ËÏ.: +30 2310-25 61 94-5 Fax: +30 2310-25 61 96 E-mail: [email protected]

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™˘ÓÙÔÌÔÁÚ·Ê›Â˜AIDS

AMP, ADP, ATP

ATPasecalCSF ‹ ENYCNS ‹ ∫¡™cmCoAcmÑcm2

cAMPÆCCRPDNAECG ‹ ∏∫°EEG ‹ ∏∂°ELISA

ESR ‹ ∆∫∂EDTAgHctHbHLA

IgICU ‹ ª∂£IUi.m. ‹ ∂.ª.i.p. ‹ ∂.¶.i.v. ‹ ∂.º.LlogmolªW ‹ MBMCHMCVmRNAmminnNNS ‹ ª™Ôsm%PCRpHPCO2PO2p

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·ÂÎ·ÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞Î˘‚ÈÎfi ÂÎ·ÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂÎ·ÙÔÛÙfiÎ˘ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚfiÊËÛË˜ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi ÔÍ‡ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›ÙË˜·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚Î¿ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ÂÓ‰ÔÊÏ¤‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚÔ˜Ì¤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓÌ¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNAÌ¤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ ÓÂ˘ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔÂ› ÙÔÈ˜ ÂÎ·Ùfi·Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁÎ¤ÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈÎ‹ Ù¿ÛË CO2ÌÂÚÈÎ‹ Ù¿ÛË ÔÍ˘ÁfiÓÔ˘Èı·ÓfiÙËÙ·

AÁÁÏÈÎÔ› fiÚÔÈacquired immunodeficiencysyndromeadenosine 5mono-, di-,triphosphateadenosine triphosphatasecaloriecerebrospinal fluidcentral nervous systemcentimetercoenzyme Acubic centimetersquare centimetercyclic AMPdegree(s) CelsiusC-reactive proteindeoxyribonucleic acidelectrocardiogramelectroencephalogramenzyme-linked immunoabsorbentassayerythrocyte sedimentation rateethylenediaminetetracetategramhaematocrithaemoglobin(human) histocompatibilityleucocyte antigenimmunoglobulinintensive care unitinternational Unitintramuscularintraperitonealintravenousliterlogarithmmolemolecular weightmean corpuscular haemoglobinmean corpuscular volumemessenger RNAmeterminutenumber newtonnot significantosmolepercent polymerase chain reactionpotentia hydrogeniicarbon dioxide pressureoxygen pressureprobability

™YNTOMO°PAºIE™ ABBREVIATIONS

EÏÏËÓÈÎÔ› fiÚÔÈ™˘ÓÙÔÌÔÁÚ·Ê›Â˜

p.o.RIARNARDSsecs.c. ‹ À.¢.SDSEU

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

tera- (1012)giga- (109)mega-(106)kilo- (103)hecto(102)deca (101)deci (10-1)centi- (10-2)milli(10-3)micro (10-6)nano (10-9)pico (10-12) femto (10-15)atto (10-18)

·fi ÙÔ ÛÙfiÌ·Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈÎ‹ ‰ÔÎÈÌ·Û›·ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡Û‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÈ·˜‰Â˘ÙÂÚfiÏÂÙÔ˘Ô‰fiÚÈ·ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËÛÙ·ıÂÚfi ÛÊ¿ÏÌ·ÌÔÓ¿‰·

Combining prefixes

TGMkhdadcmÌnpfa

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

AÁÁÏÈÎÔ› fiÚÔÈ

xvi

Παιδιατρική | Τόμος 66 • Τεύχος 6 • Νοέμβριος -...

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