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

ISSN 0377-2551

Greek Paediatric Society

∞¡∞™∫O¶∏™∂π™∏ ·Ó·‰˘fiÌÂÓË ·ÂÈÏ‹ ÙË˜ ‚ÈÔÏÔÁÈÎ‹˜ Î·È ¯ËÌÈÎ‹˜ ÙÚÔÌÔÎÚ·Ù›·˜ Î·È ÔÈ Èı·Ó¤˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ÛÙ· ·È‰È¿ µ. ∆Û·ÁÚ‹˜, º. ∆˙ÈÊ‹, ∞. ∫ÈÙÛÔÔ‡ÏÔ˘, ª. µ·ÛÈÏÂÈ¿‰Ë˜, π. ¡Ù¿ÌÔ˜

∫·Ù¿ıÏÈ„Ë ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·∂. §·˙·Ú¿ÙÔ˘, ¢. ∫. ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ˜

∞ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·¢. π. ∑·ÊÂÈÚ›Ô˘, ª. OÈÎÔÓfiÌÔ˘

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Rb-1 ˆ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ ÛÙ· Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜∂.-∞. ª·ÚÎ¿ÎË, ∂. ¢ËÌËÙÚ›Ô˘, ª. ∆ÛÔ·ÓÔÌ›¯·ÏÔ˘, ∂. ™ÙÂÈ·Î¿ÎË, ¢. ™·ÓÙ›‰Ô˜, M. ∫·ÏÌ·ÓÙ‹

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™∂›‰Ú·ÛË ÙË˜ ·ÂÚfi‚È·˜ ¿ÛÎËÛË˜ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ ÛÂ ·È‰È¿ ÙË˜ ∫‡ÚÔ˘ ËÏÈÎ›·˜ 10-12 ÂÙÒÓX. Ã·Ù˙ËÁÂˆÚÁ›Ô˘, ª. Ã·Ù˙ËÈˆ¿ÓÓÔ˘, ª. ∆ÔÚÓ·Ú›ÙË˜, ∞. °È·ÁÎÔ˘Ï‹, ∂. ∫ˆÓÛÙ·ÓÙ›ÓÔ˘, µ. ¡Â¿Ú¯Ô˘, ™. ™¿‚‚·˜

∂È‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓÛÂ ¶·È‰È·ÙÚÈÎ‹ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜º. ¡ÈÎÔÏ¿Ô˘, º. ∫·Î·‚¿, ∫. ¶·¿˙ÔÁÏÔ˘, π. ¶··‰¿ÙÔ˜

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™µÚ¤ÊÔ˜ ÌÂ ‚·ÚÈ¿ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›·º. ∫·Î·‚¿, ™. ™Ù¤ÊÔ˜, ∞. ¶ÚÂ˙ÂÚ¿ÎÔ˘, ∞. ¢·Ú˙¤ÓÙ·˜, ∞. µ·ÛÈÏfiÔ˘ÏÔ˜

REVIEW ARTICLESThe emerging threat of biological and chemical terrorism and its potential implications for children V. Tsagris, F. Tzifi, A. Kitsopoulou, M. Vasileiadis, I. Ntampos

Childhood depressionH. Lazaratou, D. C. Anagnostopoulos

Strokes in childhoodD. I. Zafeiriou, M. Ikonomou

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

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

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

CASE REPORTSAn infant with severe staphylococcal pneumoniaF. Kakava, S. Stefos, A. Prezerakou, A. Darzentas, A. Vasilopoulos

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Continuation of table of contents inside title page

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

COVER July August 04 07-10-04 13:55 ™ÂÏ›‰·1

Hellenic Paediatric Society


IIÔÔ‡‡ÏÏÈÈÔÔ˜̃ -- ∞∞‡‡ÁÁÔÔ˘̆ÛÛÙÙÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 44


Greek Paediatric SocietyJJuullyy -- ∞∞uugguusstt 22000044 ññ VVoolluummee 6677 ññ NNoo 44

Aspergillus niger ÛÂ ‰‡Ô ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿π. §·Ì·‰·Ú›‰Ë˜, ∞. µÂÏÂÁÚ¿ÎË, ª. £ÂÔ‰ˆÚ¿ÎË, ∂. ¢ËÌËÙÚ›Ô˘, ∂. ªÈ¯ÂÏ·Î¿ÎË

∂π¢π∫O ∞ƒ£ƒO∆· ‰ÈÎ·ÈÒÌ·Ù· ÙË˜ ·ÙÚÈÎ‹˜ ÂÍÔ˘Û›·˜ Â› ÙˆÓÓÂÔÁ¤ÓÓËÙˆÓ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·∫. ∆·Ì¿ÎË, £. ∆·Ì¿ÎË˜

Aspergillus niger in two very low birth weight neonatesI. Labadaridis, A. Velegraki, M. Theodoraki, E. Dimitriou, H. Michelakakis

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

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™˘ÓÂ¯›˙ÔÓÙ·È Continued

July August 04 07-10-04 13:51 ™ÂÏ›‰·1



ππÔÔ‡‡ÏÏÈÈÔÔ˜̃ -- ∞∞‡‡ÁÁÔÔ˘̆ÛÛÙÙÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 44


Greek Paediatric SocietyJJuullyy -- AAuugguusstt 22000044 ññ VVoolluummee 6677 ññ NNoo 44

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

∞Ó·ÎÔ›ÓˆÛË

¶ÚÔÛÂ¯‹ ™˘Ó¤‰ÚÈ·

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

NEWS FROM THE INTERNET

Announcement

Scheduled Medical Meetings

Abbreviations

298

300

xiii

xix

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

July August 04 07-10-04 13:51 ™ÂÏ›‰·2

¢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‹˜ ™‡ÓÙ·ÍË˜ : ™. Ã·˚‰¿˜∞Ó·Ï. ¢ÈÂ˘ı. ™‡ÓÙ·ÍË˜ : ∫. ™ÙÂÊ·Ó›‰Ë˜M¤ÏË : ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘

A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë°. µ·ÚÏ¿ÌË˜∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰ËÃ. ∫ÒÛÙ·ÏÔ˜°. ªÚÈ·ÛÔ‡ÏË˜¡. ¶··‰fiÔ˘ÏÔ˜∞. ¶··‰ÔÔ‡ÏÔ˘ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË

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 Greek Paediatric Society

PublisherK. Griveas

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

Scientific Editorial BoardPresident : A. ConstantopoulosEditor : S. HaidasAssistant Editor : C. StefanidisMembers : H. Antonopoulou

A. Vazeou-GerasimidiG. Varlamis∂. Katsarou-PectasidesCh. CostalosG. BriasoulisN. Papadopoulos∞. PapadopoulouM. Tsolia-Pasparaki

Manuscript Editing

Greek EditingI. Karavranou

English EditingS. Nakou

Correspondence Greek 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.∞ÚÙ¤ÌÈ‰Ô˜ 3, 151 25 M·ÚÔ‡ÛÈTËÏ.: 210 87 78 810 Fax: 210 87 78 822

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

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdArtemidos 3, Marousi 151 25Tel.: 210 87 78 810 Fax: 210 87 78 822

Annual SubscriptionAll foreign countries: US $ 50



IIÔÔ‡‡ÏÏÈÈÔÔ˜̃ -- ∞∞‡‡ÁÁÔÔ˘̆ÛÛÙÙÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 44


Greek Paediatric SocietyGreek Paediatric SocietyJJuullyy -- ∞∞uugguusstt 22000044 ññ VVoolluummee 6677 ññ NNoo 44

πSSN 0377-2551



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July August 04 07-10-04 13:51 ™ÂÏ›‰·7

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›˜

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July August 04 07-10-04 13:51 ™ÂÏ›‰·11

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).

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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.

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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.

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

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

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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.

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¶›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.

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225

¶·È‰È·ÙÚÈÎ‹ 2004;67:225-240 Paediatriki 2004;67:225-240

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

∏ ·Ó·‰˘fiÌÂÓË ·ÂÈÏ‹ ÙË˜ ‚ÈÔÏÔÁÈÎ‹˜ Î·È ¯ËÌÈÎ‹˜ ÙÚÔÌÔÎÚ·Ù›·˜ Î·È ÔÈ Èı·Ó¤˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ÛÙ· ·È‰È¿ µ. ∆Û·ÁÚ‹˜1, º. ∆˙ÈÊ‹1, ∞. ∫ÈÙÛÔÔ‡ÏÔ˘1, ª. µ·ÛÈÏÂÈ¿‰Ë˜1, π. ¡Ù¿ÌÔ˜2

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

∂ÈÛ·ÁˆÁ‹∆Ô ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi Â›ıÂÛË˜ ÌÂ ‚ÈÔÏÔÁÈÎ¿

fiÏ· Î·Ù·ÁÚ¿ÊÂÙ·È ÙÔ 184 .Ã., fiÙ·Ó Ô ÛÙfiÏÔ˜ ÙË˜∫·Ú¯Ë‰fiÓ·˜, ˘fi ÙËÓ ·Ú¯ËÁ›· ÙÔ˘ ∞ÓÓ›‚·, Û˘Ó¤-ÙÚÈ„Â ÙÔÓ ·ÓÙ›·ÏÔ ÛÙfiÏÔ ÙË˜ ¶ÂÚÁ¿ÌÔ˘ ÂÎÙÔÍÂ‡-ÔÓÙ·˜ ‹ÏÈÓ· ÛÎÂ‡Ë Ô˘ ÂÚÈÂ›¯·Ó ÂÚÂÙ¿. ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ªÂÛ·›ˆÓ·, Ë ÂÎÙfiÍÂ˘ÛË ÈÛÙÒÓ ˙ÒˆÓÌÔÏ˘ÛÌ¤ÓˆÓ ·fi ·ÓÒÏË Î·Ù¿ ÙˆÓ ÔÏÈÔÚÎËÌ¤ÓˆÓ·ÔÙÂÏÔ‡ÛÂ Û˘Ó‹ıË Ù·ÎÙÈÎ‹ ÙˆÓ ÔÏÈÔÚÎËÙÒÓ fi-ÏÂˆÓ, Ú·ÎÙÈÎ‹ Ô˘ ÚÔÎ·ÏÔ‡ÛÂ ÛËÌ·ÓÙÈÎ¤˜ ·Ò-

ÏÂÈÂ˜ ·fi ÙËÓ ·Ó‰ËÌ›· Ô˘ ·ÎÔÏÔ˘ıÔ‡ÛÂ, ·ÏÏ¿Î˘Ú›ˆ˜ Î·Ù·ÚÚ¿ÎˆÛË ÙÔ˘ ËıÈÎÔ‡ (1).

∏ ·ÂÏÂ˘ı¤ÚˆÛË, ·fi ÙÚÔÌÔÎÚ·ÙÈÎ‹ ÔÚÁ¿Óˆ-ÛË, ÙÔ˘ ·ÂÚ›Ô˘ sarin ÛÙÔÓ ˘fiÁÂÈÔ ÛÈ‰ËÚfi‰ÚÔÌÔÙÔ˘ ∆fiÎÈÔ, ÙÔ 1995 (2), ÂÛÙ›·ÛÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔÂÓ‰È·Ê¤ÚÔÓ ÙË˜ ·ÁÎfiÛÌÈ·˜ ÎÔÈÓ‹˜ ÁÓÒÌË˜ ÛÙË ˙Ô-ÊÂÚ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙË˜ Â›ıÂÛË˜ ÌÂ ¯ËÌÈÎ¿ ‹‚ÈÔÏÔÁÈÎ¿ fiÏ·. ∏ ·ÔÎ¿Ï˘„Ë, ·fi ÙÔ OÌÔÛÔÓ-‰È·Îfi °Ú·ÊÂ›Ô ∂ÚÂ˘ÓÒÓ ÙˆÓ ∏¶∞, Û¯Â‰›Ô˘ ÁÈ· ·Â-ÏÂ˘ı¤ÚˆÛË ·ÂÚ›Ô˘ ¯ÏˆÚ›ÓË˜ ÛÙÔ ıÂÌ·ÙÈÎfi ¿ÚÎÔ

�¶ÂÚ›ÏË„Ë: ªÂÙ¿ Ù· ÙÚ·ÁÈÎ¿ ÁÂÁÔÓfiÙ· ÙË˜ 11Ë˜™ÂÙÂÌ‚Ú›Ô˘ Î·È ÙÈ˜ ÂÈı¤ÛÂÈ˜ ÌÂ ¿ÓıÚ·Î· Ì¤ÛˆÙ·¯˘‰ÚÔÌÂ›Ô˘ ÛÙÈ˜ ∏¶∞ ÙÔ 2001, ¤Ó· ÂÎÙÂÙ·Ì¤ÓÔÙÚÔÌÔÎÚ·ÙÈÎfi ¯Ù‡ËÌ· ÌÂ ‚ÈÔÏÔÁÈÎ¿ ‹ ¯ËÌÈÎ¿ fiÏ·ıÂˆÚÂ›Ù·È Ì›· fi¯È ÙfiÛÔ ·ÔÌ·ÎÚ˘ÛÌ¤ÓË Èı·ÓfiÙË-Ù·. ∏ Ù¤ÏÂÛË ÙˆÓ OÏ˘ÌÈ·ÎÒÓ ∞ÁÒÓˆÓ ÙÔ Î·ÏÔÎ·›-ÚÈ ÙÔ˘ 2004 ÛÙË ¯ÒÚ· Ì·˜, ÙËÓ Î·ıÈÛÙ¿ ¤Ó·Ó Èı·-Ófi Î·È, ‰˘ÛÙ˘¯Ò˜, Â˘¿ÏˆÙÔ ÛÙfi¯Ô. ¶ÔÈÂ˜ ı· ‹Ù·ÓÔÈ Û˘Ó¤ÂÈÂ˜ ÂÓfi˜ ÙÚÔÌÔÎÚ·ÙÈÎÔ‡ ¯Ù˘‹Ì·ÙÔ˜ ÌÂ·È‰È¿-ı‡Ì·Ù· ˆ˜ “·Ú¿ÏÂ˘ÚË ·ÒÏÂÈ·”; ¶ÔÈÔÈÂ›Ó·È ÔÈ ÂÍˆÙÈÎÔ› Î·È ·Û˘Ó‹ıÈÛÙÔÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹-ÚÂ˜ Ô˘ ı· ÎÏËıÔ‡Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÔÈ ·È‰›·-ÙÚÔÈ, Èı·ÓÒ˜ ÚÈÓ ·fi fiÏÔ˘˜ ÙÔ˘˜ Â·ÁÁÂÏÌ·Ù›Â˜˘ÁÂ›·˜; °È·Ù› Ù· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó È‰ÈÔÌÔÚÊ›Â˜Î·È ÔÈÂ˜ Â›Ó·È ÔÈ ··Ú·›ÙËÙÂ˜ ·ÚÂÌ‚¿ÛÂÈ˜; ∆È Â›-‰Ô˘˜ ÚfiÔ‰Ô ¤¯ÂÈ ÂÈÊ¤ÚÂÈ, ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓÛ¯ÂÙÈ˙fiÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ, Ë ·ÁÎfiÛÌÈ· ÂÌÊ¿ÓÈÛË“˘ÛÙÂÚ›·˜” Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ı¤Ì·; ™ÙËÓ ·ÚÔ‡Û· ·Ó·-ÛÎfiËÛË ÂÈ¯ÂÈÚÂ›Ù·È Ë ·ÓÂ‡ÚÂÛË ··ÓÙ‹ÛÂˆÓ ÙˆÓ·Ú·¿Óˆ ÂÚˆÙËÌ¿ÙˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ‚ÈÔÙÚÔÌÔÎÚ·Ù›·, ‚ÈÔÏÔÁÈÎ¿, ¯ËÌÈÎ¿,fiÏ·, ·È‰È¿.

�Abstract: In the aftermath of the September 11thattack and the anthrax mail bomb episodes in theUSA, a widespread and devastating terrorist actwith biological or chemical weapons, is no longerconsidered to be only a remote probability. InGreece, the organization of the Olympic Games of2004 poses the possibility of a terrorist threat. Whatwould be the implications of a biochemical attackinvolving children as “collateral damage”? What arethe uncommon and exotic clinical findings thatpaediatricians, playing a pivotal role amongst healthcare professionals, will be called upon torecognize? In what ways are children different fromadults and what interventions would be necessary?Have there been any recent advances in the careand management of children as a result of theworldwide “hysteria” with regards to the subject ofterrorism? This review attempts to provide answersto these questions.

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

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, “£ÚÈ¿ÛÈÔ” ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∂ÏÂ˘Û›Ó·˜

2 ∫ÏÈÓÈÎ‹ º˘ÛÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ∞ÔÎ·Ù¿ÛÙ·ÛË˜, “£ÚÈ¿ÛÈÔ”¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∂ÏÂ˘Û›Ó·˜

1 Paediatric Clinic, “Thriasio” General Hospital of Elefsina

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

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ÙË˜ ¡Ù›ÛÓÂ¸Ï·ÓÙ ÛÙËÓ ∫·ÏÈÊfiÚÓÈ·, Ù· ÙÚ·ÁÈÎ¿ ÁÂ-ÁÔÓfiÙ· ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›Ô˘ ÙÔ˘ 2001 ÛÙÈ˜ ∏¶∞Î·È Ë Â·ÎfiÏÔ˘ıË ‰È·ÛÔÚ¿ - Ì¤Ûˆ Ù·¯˘‰ÚÔÌÂ›Ô˘- ‚·Î›ÏÔ˘ ÙÔ˘ ¿ÓıÚ·Î·, Î·ıÈÛÙÔ‡Ó ÙËÓ Èı·ÓfiÙËÙ·ÚÔÛ‚ÔÏ‹˜ ·È‰ÈÒÓ, ÌÂÙ¿ ·fi ¯ËÌÈÎ‹ ‹ ‚ÈÔÏÔÁÈÎ‹Â›ıÂÛË, ÂÍ·ÈÚÂÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (3).

¶·Ú¿ ÙËÓ ÚÔÛ¿ıÂÈ·, ÛÂ ‰ÈÂıÓ¤˜ Â›Â‰Ô,ÂÏ¤Á¯Ô˘ ÙË˜ ·Ú·ÁˆÁ‹˜ ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓ Î·È ¯ËÌÈ-ÎÒÓ ·Ú·ÁfiÓÙˆÓ (™‡ÓÔ‰Ô˜ ÁÈ· ÙÔÓ ŒÏÂÁ¯Ô µÈÔÏÔ-ÁÈÎÒÓ Î·È ∆ÔÍÈÎÒÓ ŸÏˆÓ, 1972), ÂÍ·ÎÔÏÔ˘ıÔ‡Ó·˘Ù¿ Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÛÂ‰È¿ÊÔÚ· ÛËÌÂ›· ÙÔ˘ ÎfiÛÌÔ˘, Î·ıÒ˜ Ù· Ì¤Û· Ô˘··ÈÙÔ‡ÓÙ·È ÁÈ· Ó· “·ÍÈÔÔÈËıÔ‡Ó” ·˘ÙÔ› ÔÈ ·Ú¿-ÁÔÓÙÂ˜ Î·È Ó· ÌÂÙ·ÙÚ·Ô‡Ó ÛÂ fiÏ· Ì·˙ÈÎ‹˜ Î·Ù·-ÛÙÚÔÊ‹˜, Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ·Ï¿ Î·È, Î˘Ú›ˆ˜, Â˘Ú¤-ˆ˜ ‰È·ı¤ÛÈÌ·. ∆· ˘ÏÈÎ¿ ·Ú·ÁˆÁ‹˜ Â›Ó·È ÊıËÓ¿ Î·ÈÔÈ ÙÂ¯ÓÈÎ¤˜ ·Ôı‹ÎÂ˘ÛË˜ ·ÏÔ˘ÛÙÂ˘Ì¤ÓÂ˜, ÌÂ ·Ô-Ù¤ÏÂÛÌ· Ó· Â›Ó·È ‰‡ÛÎÔÏÔ˜ Ô ÂÓÙÔÈÛÌfi˜ ÙfiÛÔ ÙˆÓ¯ÒÚˆÓ ·Ú·ÁˆÁ‹˜ fiÛÔ Î·È ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·Ú·Áfi-ÓÙˆÓ, Î·ıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó Ì¤ıÔ‰ÔÈ ·Ó›¯ÓÂ˘ÛË˜.ªÂ ÙÔÓ Ú˘ıÌfi ÂÍ¤ÏÈÍË˜ ÙË˜ ˘¿Ú¯Ô˘Û·˜ ÙÂ¯ÓÔÏÔ-Á›·˜, ·Ó·Ì¤ÓÂÙ·È fiÙÈ ı· ··ÈÙËıÂ› ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›·ÂÓÙ·ÂÙ›· ·ÎfiÌË ÁÈ· Ó· ·Ó·Ù˘¯ıÔ‡Ó Ì¤ıÔ‰ÔÈ ¿ÌÂ-ÛÔ˘ ÂÓÙÔÈÛÌÔ‡ ‚ÈÔÏÔÁÈÎÒÓ ‹ ¯ËÌÈÎÒÓ fiÏˆÓ (4-6).

ª›· ‰ËÌÔÛ›Â˘ÛË ÙË˜ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ÀÁÂ›·˜ (WHO, www.who.int) ÙÔ˘ 1970 ÂÚÈÁÚ¿ÊÂÈÌÂ ÁÏ·Ê˘ÚfiÙËÙ· (ÛÂ ÂÔ¯‹ Ô˘ Ë ‚ÈÔ¯ËÌÈÎ‹ ·ÂÈÏ‹¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ˆ˜ ÛÙÚ·ÙËÁÈÎ‹ ÂÈÏÔÁ‹ ÂÚÈÛ-ÛfiÙÂÚÔ ÙˆÓ Î˘‚ÂÚÓ‹ÛÂˆÓ, ·Ú¿ ÙˆÓ ÙÚÔÌÔÎÚ·ÙÈ-ÎÒÓ ÔÚÁ·ÓÒÛÂˆÓ) (7) ÙÈ˜ ‰˘ÓËÙÈÎ¿ ÙÚ·ÁÈÎ¤˜ ÂÈ-ÙÒÛÂÈ˜ ÂÓfi˜ ‚ÈÔÏÔÁÈÎÔ‡ ¯Ù˘‹Ì·ÙÔ˜. ÀÔÏÔÁ›ÛÙË-ÎÂ fiÙÈ ·Ó 50 kg ·ÂÚÈÔÔÈËÌ¤ÓˆÓ ÛfiÚˆÓ ‚·Î›ÏÔ˘ÙÔ˘ ¿ÓıÚ·Î· ·ÂÏÂ˘ıÂÚÒÓÔÓÙ·Ó ·fi ·ÂÚÔÏ¿ÓÔÛÂ ·fiÛÙ·ÛË 2 ¯ÏÌ. ·fi ·ÛÙÈÎfi Î¤ÓÙÚÔ ÌÂ ÏËı˘-ÛÌfi 500.000 Î·ÙÔ›ÎˆÓ, ı· ‰È·ÛÂ›ÚÔÓÙ·Ó ÛÂ ·fi-ÛÙ·ÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ 20 ¯ÏÌ. Î·È ı· ÚÔÎ·ÏÔ‡Û·ÓÙÔÓ ı¿Ó·ÙÔ ‹ ÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË 220.000 ·ÓıÚÒ-ˆÓ. ∞Ó Ô ‚ÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ëfrancisella tularensis, Ô ·ÓÙ›ÛÙÔÈ¯Ô˜ ·ÚÈıÌfi˜ ı·‹Ù·Ó 155.000 ¿ÙÔÌ·.

™ÙË ¯ÒÚ· Ì·˜, ÙÔ ÂÓ‰Â¯fiÌÂÓÔ Ì›·˜ ‚ÈÔÏÔÁÈÎ‹˜ ‹¯ËÌÈÎ‹˜ ·ÂÈÏ‹˜ ·ÔÎÙ¿ ÂÍ·ÈÚÂÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ,ÏfiÁˆ ÙË˜ ÂÈÎÂ›ÌÂÓË˜ Ù¤ÏÂÛË˜ ÙˆÓ OÏ˘ÌÈ·ÎÒÓ∞ÁÒÓˆÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, È‰Ú‡ıËÎÂ ÚfiÛÊ·Ù· ËOÏ˘ÌÈ·Î‹ ÀÁÂÈÔÓÔÌÈÎ‹ ªÔÓ¿‰·, Ë ÔÔ›· ÙÂÏÂ› ˘fiÙËÓ ÂÔÙÂ›· ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ∂ıÓÈÎ‹˜ ÕÌ˘Ó·˜ Î·È·ÚÈıÌÂ› ÚÔÛˆÈÎfi 850 ·ÙfiÌˆÓ (ÚÔÛÂÁÁ›˙ÔÓÙ·˜ÙÔ Ì¤ÁÂıÔ˜ Ù·ÍÈ·Ú¯›·˜) (8). ∏ ÌÔÓ¿‰· ·˘Ù‹ ı· ·Ô-ÙÂÏ¤ÛÂÈ ÙÔÓ Ï¤ÔÓ ‰˘Ó·ÌÈÎfi ‚Ú·¯›ÔÓ· ÛÂ ÂÚ›Ùˆ-ÛË Ù˘ÊÏÔ‡ ¯Ù˘‹Ì·ÙÔ˜ Î·È ÚÔ‚Ï¤ÂÙ·È Ó· ‰ËÌÈ-Ô˘ÚÁ‹ÛÂÈ Î·È Ó· ÛÙÂÏÂ¯ÒÛÂÈ ÛÙ·ıÂÚÔ‡˜ Î·È ÎÈÓË-ÙÔ‡˜ ˘ÁÂÈÔÓÔÌÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ÛÙËÓ Â˘Ú‡ÙÂÚË Â-ÚÈÔ¯‹ ÙË˜ ÚˆÙÂ‡Ô˘Û·˜, Ó· ÂÍÔÏÈÛÙÂ› ÌÂ ·ÛıÂÓÔ-

ÊfiÚ· ÔÏÏ·ÏÒÓ Ù‡ˆÓ Î·È Ó· ÔÚÁ·ÓÒÛÂÈ ÔÌ¿‰Â˜·ÓÙÈÌÂÙÒÈÛË˜ ˘ÚËÓÈÎ‹˜, ‚ÈÔÏÔÁÈÎ‹˜ Î·È ¯ËÌÈÎ‹˜(¶µÃ) ÚÔÛ‚ÔÏ‹˜. °È· ÚÒÙË ÊÔÚ¿, ÛÙÔ 401 °ÂÓÈ-Îfi ™ÙÚ·ÙÈˆÙÈÎfi ¡ÔÛÔÎÔÌÂ›Ô, ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ù¤-Ú˘Á· ‚ÈÔÚÔÛÙ·Û›·˜ ÁÈ· ÂÚÈÛÙ·ÙÈÎ¿ ˘„ËÏ‹˜ ÂÈ-ÎÈÓ‰˘ÓfiÙËÙ·˜, ÂÓÒ ÛËÌ·ÓÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ó·-Ù‡ÛÛÂÈ Î·È Ë ™¯ÔÏ‹ ¶˘ÚËÓÈÎ‹˜ µÈÔÏÔÁÈÎ‹˜ Î·È ÃË-ÌÈÎ‹˜ ÕÌ˘Ó·˜ ÙË˜ ¶ÔÏÂÌÈÎ‹˜ ∞ÂÚÔÔÚ›·˜(™.¶.À.µ.π.Ã.∞.), ÛÙÈ˜ ÂÁÎ·Ù·ÛÙ¿ÛÂÈ˜ ÙÔ˘ 251 °ÂÓÈ-ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∞ÂÚÔÔÚ›·˜. ∂›ÛË˜, ÌÂ ·ÊÔÚÌ‹ÙËÓ ·ÁÎfiÛÌÈ· ÎÈÓËÙÔÔ›ËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ÂÈ‰ËÌ›·˜ ÙÔ˘ SARS, ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ÛÂ °ÂÓÈ-Î¿ ¡ÔÛÔÎÔÌÂ›· ÙË˜ ∞ÙÙÈÎ‹˜, ı¿Ï·ÌÔÈ ÌÂ ÂÍÔÏÈÛÌfi·ÚÓËÙÈÎ‹˜ ›ÂÛË˜ Î·È ·˘ÙfiÓÔÌÔ ÂÍ·ÂÚÈÛÌfi. ™ÙËÓOÏ˘ÌÈ·Î‹ ÀÁÂÈÔÓÔÌÈÎ‹ ªÔÓ¿‰· ·Ó·Ì¤ÓÂÙ·È Ó· ÂÎ-·È‰Â˘ÙÔ‡Ó Î·È Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ·ÛÙ˘ÓÔÌÈÎÔ›, ˘-ÚÔÛ‚¤ÛÙÂ˜, ÓÔÛËÏÂ˘Ù¤˜, È·ÙÚÔ› ‰È·ÊfiÚˆÓ ÂÈ‰ÈÎÔÙ‹-ÙˆÓ, Î·ıÒ˜ Î·È ˘¿ÏÏËÏÔÈ ÊÔÚ¤ˆÓ Ô˘ ÂÌÏ¤ÎÔ-ÓÙ·È ÛÙÔ˘˜ ÙÔÌÂ›˜ ·ÛÊ¿ÏÂÈ·˜ Î·È ˘ÁÂ›·˜. ∞Ó¿ÏÔÁËÌÔÓ¿‰· ·ÓÙÈÌÂÙÒÈÛË˜ ‚ÈÔÏÔÁÈÎ‹˜ ‹ ¯ËÌÈÎ‹˜ ·ÂÈ-Ï‹˜ ·Ó·Ù‡ÛÛÂÈ Î·È ÙÔ ¶˘ÚÔÛ‚ÂÛÙÈÎfi ™ÒÌ·. øÛÙfi-ÛÔ, ‰È·Ê·›ÓÂÙ·È Ë ‡·ÚÍË ÛËÌ·ÓÙÈÎÔ‡ ÂÏÏÂ›ÌÌ·ÙÔ˜ÛÙÔÓ ·Ú¯ÈÎfi ÛÙÚ·ÙËÁÈÎfi Û¯Â‰È·ÛÌfi, Î·ıÒ˜ ‰ÂÓÂÏ‹ÊıËÛ·Ó ˘’ fi„ÈÓ ÔÈ È‰ÈÔÌÔÚÊ›Â˜ ÙÔ˘ ·È‰ÈÎÔ‡ÏËı˘ÛÌÔ‡, Ô ÔÔ›Ô˜ ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛ‚ÏËıÂ›‰˘Û·Ó¿ÏÔÁ· ÛÂ ÂÚ›ÙˆÛË Â›ıÂÛË˜. ¶·Ú¿ ÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ ÛÙ· OÏ˘ÌÈ·Î¿ ¡ÔÛÔÎÔÌÂ›· Û˘ÌÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È ‰‡Ô ¡ÔÛÔÎÔÌÂ›· ¶·›‰ˆÓ ÙË˜ ∞ı‹Ó·˜,ÛÙËÓ OÏ˘ÌÈ·Î‹ ÀÁÂÈÔÓÔÌÈÎ‹ ªÔÓ¿‰· ‰ÂÓ Û˘ÌÌÂ-Ù¤¯Ô˘Ó ·È‰›·ÙÚÔÈ, ÂÓÒ ÛÙÔÓ Û¯Â‰È·ÛÌfi ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÂÓ‰Â¯fiÌÂÓË˜ ‚ÈÔ¯ËÌÈÎ‹˜ ·ÂÈÏ‹˜ ‰ÂÓÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·Ì›· ¶·È‰È·ÙÚÈÎ‹ ªÔÓ¿‰· ÙË˜∞ÙÙÈÎ‹˜.

°È·Ù› Ù· ·È‰È¿ ÎÈÓ‰˘ÓÂ‡Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ; ™Â ÂÚ›ÙˆÛË ·ÂÏÂ˘ı¤ÚˆÛË˜ ‚ÈÔÏÔÁÈÎÒÓ ‹ ¯Ë-

ÌÈÎÒÓ fiÏˆÓ, Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ı· ÌÔÚÔ‡ÛÂ Ó· Ï¿‚ÂÈ ‰˘Û·Ó¿ÏÔÁ· ÌÂÁ¿ÏÂ˜ ‰È·-ÛÙ¿ÛÂÈ˜, ÂÍ·ÈÙ›·˜ Ì›·˜ ÛÂÈÚ¿˜ ·Ú·ÁfiÓÙˆÓ Î·È ÌË-¯·ÓÈÛÌÒÓ Ô˘ ‰È·ÊÔÚÔÔÈÔ‡Ó Ù· ·È‰È¿-ı‡Ì·Ù··fi ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜.

∆· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍËÌ¤ÓÔ Î·Ù¿ ÏÂÙfi·ÂÚÈÛÌfi, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ·ÔÚÚfiÊËÛË ·fi ÙÔ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ· ¯ËÌÈÎÒÓ ·ÂÚ›ˆÓ, fiˆ˜ ÙÔsarin Î·È Ë Ê·ÈÓÙ·Ó‡ÏË, ‹ ·ÂÚÈÔÔÈËÌ¤ÓˆÓ ‚ÈÔÏÔÁÈ-ÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ô ¿ÓıÚ·Î·˜, Ó· Â›Ó·È ÛËÌ·-ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ∂ÈÏ¤-ÔÓ, ·¤ÚÈ· fiˆ˜ Ë ¯ÏˆÚ›ÓË Î·È ÙÔ sarin ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÙË Ì¤ÁÈÛÙË Û˘ÁÎ¤ÓÙÚˆÛ‹ ÙÔ˘˜ ÎÔÓÙ¿ ÛÙÔ ¤‰·-ÊÔ˜, ‰ËÏ·‰‹ ÏËÛÈ¤ÛÙÂÚ· ÛÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ˙ÒÓËÌÈÎÚÒÓ ·È‰ÈÒÓ. ∏ ÌÂÁ·Ï‡ÙÂÚË ‰È·ÂÚ·ÙfiÙËÙ· Î·È ËÌÂÈˆÌ¤ÓË ÎÂÚ·ÙÈÓÔÔ›ËÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ ÓÂÔ-ÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË

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ÌÂÁ·Ï‡ÙÂÚË ¤ÎıÂÛË ÛÂ ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘·ÔÚÚÔÊÒÓÙ·È ‰È·‰ÂÚÌÈÎ¿, fiˆ˜ ÊÏ˘ÎÙ·ÈÓÔÁfiÓ·Î·È ‰È·‚ÚˆÙÈÎ¿. O ·˘ÍËÌ¤ÓÔ˜ ÏfiÁÔ˜ ÙË˜ ÂÈÊ¿ÓÂÈ-·˜ ÚÔ˜ ÙË Ì¿˙· ÛÒÌ·ÙÔ˜ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂÛËÌ·ÓÙÈÎ‹ ˘ÔıÂÚÌ›·, Â¿Ó Ë ÚÔÛ¿ıÂÈ· ·ÔÌ¿-ÎÚ˘ÓÛË˜ ÙÔ˘ ‚Ï·ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (Û˘Ó‹ıˆ˜ ÌÂÂÎÙfiÍÂ˘ÛË ÓÂÚÔ‡ ˘fi ›ÂÛË) ‰ÂÓ Ï¿‚ÂÈ ¯ÒÚ· ÛÂÂÏÂÁ¯fiÌÂÓÔ ÂÚÈ‚¿ÏÏÔÓ, ÌÂ ¯Ú‹ÛË ıÂÚÌ·ÓÙÈÎÒÓÛˆÌ¿ÙˆÓ. ∏ Èı·ÓfiÙËÙ· ·Ê˘‰¿ÙˆÛË˜ ‹ Î·È Î·Ù·-ÏËÍ›·˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ·È‰È¿,ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ‰Ú¿ÛË˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ÚÔÎ·ÏÔ‡Ó Û˘ÓÂ¯Â›˜ ÂÌ¤ÙÔ˘˜ ‹ ‰È¿ÚÚÔÈÂ˜. ∂ÈÏ¤-ÔÓ, ÔÈ ÎÈÓËÙÈÎ¤˜ È‰ÈÔÌÔÚÊ›Â˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜Î·ıÈÛÙÔ‡Ó ‰‡ÛÎÔÏË ÙË ‰È·Ê˘Á‹ ÙˆÓ ·È‰ÈÒÓ ·fiÙÔÓ ¯ÒÚÔ ÙË˜ ·ÂÈÏ‹˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ·fiÚÔÛˆÈÎfi Ô˘ ¯ÚËÛÈÌÔÔÈÂ› ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÂÍÔ-ÏÈÛÌfi, Ô ÔÔ›Ô˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÛÙËÓ ÂÚ›Ùˆ-ÛË Ù¤ÙÔÈˆÓ ÁÂÁÔÓfiÙˆÓ, ÌÔÚÂ› Ó· ·Ô‰ÂÈ¯ıÂ› È‰È·›-ÙÂÚ· ‰‡ÛÎÔÏË. O ÚÔÛÙ·ÙÂ˘ÙÈÎfi˜ ÂÍÔÏÈÛÌfi˜ Â›Ó·ÈÈ‰È·›ÙÂÚ· ÔÁÎÒ‰Ë˜ Î·È ‰‡Û¯ÚËÛÙÔ˜, ÂÓÒ ÌÔÚÂ› Ó·ÚÔÎ·Ï¤ÛÂÈ Êfi‚Ô ÛÂ ÌÈÎÚ¿ ·È‰È¿, ¤¯ÔÓÙ·˜ Û·Ó Û˘-Ó¤ÂÈ· ÙË ‰˘ÛÎÔÏ›· ÛÙËÓ ÂÎÙ¤ÏÂÛË È·ÙÚÈÎÒÓ Ú¿ÍÂ-ˆÓ (∂ÈÎfiÓ· 1). ∆¤ÏÔ˜, ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·ÓÙÈÌÈ-ÎÚÔ‚È·ÎÒÓ ·Ú·ÁfiÓÙˆÓ, ·ÓÙ›‰ÔÙˆÓ Î·È Ê·ÚÌ·ÎÔ-ÏÔÁÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ Ô˘ Â›Ó·È Èı·Ófi Ó· ¯ÚÂÈ·-ÛÙÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó, ‰ÂÓ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ›ÔÙ¤ ÛÂ ·È‰È¿ ‹ ·ÓÙÂÓ‰Â›ÎÓ˘Ù·È Ë ¯Ú‹ÛË ÙÔ˘˜ ÛÂ·˘Ù¿, ÂÓÒ ÁÈ· Î¿ÔÈ· ¿ÏÏ· ‰ÂÓ ¤¯Ô˘Ó ÔÚÈÛÙÂ›·ÛÊ·ÏÂ›˜ ‹ ıÂÚ·Â˘ÙÈÎ¤˜ ‰fiÛÂÈ˜ (9-13).

µπO§O°π∫OI ¶∞ƒA°O¡∆∂™ ∆Ô 2000, ÙÔ ∫¤ÓÙÚÔ ∂Ï¤Á¯Ô˘ Î·È ¶ÚfiÏË„Ë˜ ¡Ô-

ÛËÌ¿ÙˆÓ ÙˆÓ ∏¶∞ (CDC, www.cdc.gov) Û˘ÁÎÚfiÙË-ÛÂ ÔÌ¿‰· ÂÚÁ·Û›·˜, ÌÂ ÛÎÔfi Ó· Î·ıÔÚÈÛÙÔ‡Ó ÔÈ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÌÂÁ·Ï‡-ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘ÁÂ›· Î·È ·ÛÊ¿ÏÂÈ·

(14,15). ªÂ ‚¿ÛË Û˘ÁÎÂÎÚÈÌ¤Ó· ÎÚÈÙ‹ÚÈ·, fiˆ˜ ËÂ˘ÎÔÏ›· ‰È·ÛÔÚ¿˜ Î·È ÌÂÙ¿‰ÔÛË˜ ·fi ¿ÙÔÌÔ ÛÂ¿ÙÔÌÔ, Ë ıÓËÙfiÙËÙ· Î·È Ë Â›ÙˆÛË ÛÙË ¢ËÌfiÛÈ·ÀÁÂ›·, Ë ÈÎ·ÓfiÙËÙ· ÚfiÎÏËÛË˜ ·ÓÈÎÔ‡ Î·È ÎÔÈÓˆÓÈ-Î‹˜ ·Ó·Ù·Ú·¯‹˜ Î·È Ë ·Ó·ÁÎ·ÈfiÙËÙ· ·Ó¿ÏË„Ë˜ ÂÈ-‰ÈÎ‹˜ ‰Ú¿ÛË˜ ·fi ÙÈ˜ ˘ÁÂÈÔÓÔÌÈÎ¤˜ ·Ú¯¤˜, ÔÈ ‚ÈÔ-ÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ 3 Î·ÙËÁÔ-Ú›Â˜ (A, B Î·È C). ø˜ Ï¤ÔÓ ÂÈÎ›Ó‰˘ÓÔÈ (Î·ÙËÁÔÚ›·∞) ıÂˆÚ‹ıËÎ·Ó Ô ¿ÓıÚ·Î·˜, Ë Â˘ÏÔÁÈ¿, Ë ·ÓÒÏË,Ë ÙÔ˘Ï·Ú·ÈÌ›·, Ë ·ÏÏ·ÓÙ›·ÛË Î·È ÔÈ ÈÔÁÂÓÂ›˜ ·ÈÌÔÚ-Ú·ÁÈÎÔ› ˘ÚÂÙÔ›. ™ÙËÓ Î·ÙËÁÔÚ›· µ Ù·ÍÈÓÔÌ‹ıËÎ·Ó·Ú¿ÁÔÓÙÂ˜ Ô˘ ·ÔÙÂÏÔ‡Ó ‹ÛÛÔÓÔ˜ ÛËÌ·Û›·˜·ÂÈÏ‹, ÂÓÒ ÛÙËÓ Î·ÙËÁÔÚ›· C Ù·ÍÈÓÔÌ‹ıËÎ·Ó ·-Ú¿ÁÔÓÙÂ˜ Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÔÙÂÏ¤ÛÔ˘Ó ÛËÌ·-ÓÙÈÎ‹ ·ÂÈÏ‹ ÛÙÔ Ì¤ÏÏÔÓ (¶›Ó·Î·˜ 1).

™ÙÔÓ ¶›Ó·Î· 2 Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ ÎÏÈÓÈÎÔ› ¯·Ú·-ÎÙ‹ÚÂ˜, ÔÈ ÚÔÙÂÈÓfiÌÂÓÔÈ ÙÚfiÔÈ ·ÔÌfiÓˆÛË˜ Î·ÈÚÔÊ‡Ï·ÍË˜, Ë ÌÂıÔ‰ÔÏÔÁ›· ‰È·ÁÓˆÛÙÈÎ‹˜ ÚÔ-Û¤ÁÁÈÛË˜ Î·È ÔÈ ıÂÚ·Â˘ÙÈÎ¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ ‚ÈÔ-ÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÙË˜ Î·ÙËÁÔÚ›·˜ ∞. ∂ÈÛËÌ·›-ÓÂÙ·È Ë ÂÈÏÔÁ‹ ÙˆÓ ÎÈÓÔÏÔÓÒÓ Î·È ÙˆÓ ÙÂÙÚ·Î˘ÎÏÈ-ÓÒÓ ˆ˜ ıÂÚ·Â›· ÚÒÙË˜ ÂÎÏÔÁ‹˜ ÛÙË ıÂÚ·Â›·Î·È ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË ·È‰ÈÒÓ ÌÂ ¿ÓıÚ·Î·, ·ÓÒÏËÎ·È ÙÔ˘Ï·Ú·ÈÌ›·. ∞Ó Î·È ÛÙÔ ·ÚÂÏıfiÓ ˘‹ÚÍ·Ó ÛË-Ì·ÓÙÈÎ¤˜ ÂÈÊ˘Ï¿ÍÂÈ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ¯Ú‹ÛË ÙÔ˘˜ÛÂ ·È‰È¿, ÚfiÛÊ·Ù·, ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·Ó·ÊÔ-ÚÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÚÔÙÂ›ÓÂÈ ÙË ¯Ú‹ÛË

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ‚ÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ù¿ CDC(ÚÔÛ·ÚÌÔÁ‹ ÌÂ ‚¿ÛË ÙÈ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜ 6, 14,URL: www.bt.cdc.gov)

∫·ÙËÁÔÚ›· ∞ I. ÕÓıÚ·Î·˜ II. ¶·ÓÒÏËIII. ∂˘ÏÔÁÈ¿IV. ∆Ô˘Ï·Ú·ÈÌ›·V. ∞ÏÏ·ÓÙ›·ÛË VI. πÔÁÂÓÂ›˜ ·ÈÌÔÚÚ·ÁÈÎÔ› ˘ÚÂÙÔ› (Ebola, Marburg, Lassa,Machupo Î.¿.) ∫·ÙËÁÔÚ›· µ I. µÚÔ˘Î¤ÏÏˆÛË II. ∆ÔÍ›ÓË ∂ ÙÔ˘ ÎÏˆÛÙËÚÈ‰›Ô˘ perfrigensIII. ∆ÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ (Â›‰Ë salmonella, shigella,Escherichia coli O157:∏7) IV. ª¿ÏÏË˜ (burkholderia mallei) V. ªÂÏÏÈÔÂ›‰ˆÛË (burkholderia pseudomallei) VI. æÈÙÙ¿ÎˆÛË VII. ¶˘ÚÂÙfi˜ Q VIII. ∆ÔÍ›ÓË ricin (ÚÈÎ›ÓË) IX. ™Ù·Ê˘ÏÔÎÔÎÎÈÎ‹ ÂÓÙÂÚÔÙÔÍ›ÓË µ X. ƒÈÎÂÙÛÈÒÛÂÈ˜ (rickettsia prowazekii) XI. πÔÁÂÓÂ›˜ ÂÁÎÂÊ·Ï›ÙÈ‰Â˜ (›ÂÈÔ˜ ÂÁÎÂÊ·Ï›ÙÈ‰·µÂÓÂ˙Ô˘¤Ï·˜, ·Ó·ÙÔÏÈÎ‹ ›ÂÈÔ˜ ÂÁÎÂÊ·Ï›ÙÈ‰·, ‰˘ÙÈÎ‹›ÂÈÔ˜ ÂÁÎÂÊ·Ï›ÙÈ‰·) XII. À‰·ÙÔÁÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜ (.¯. vibrio cholerae, cryptosporidium parvum) ∫·ÙËÁÔÚ›· C I. ∞Ó·‰˘fiÌÂÓÂ˜ ·ÂÈÏ¤˜, fiˆ˜ Èfi˜ Nipah Î·È hantavirus

∂ÈÎfiÓ· 1. ∆Ô ÚÔÛˆÈÎfi Ô˘ ÂÌÏ¤ÎÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË‚ÈÔÏÔÁÈÎ‹˜ ‹ ¯ËÌÈÎ‹˜ Â›ıÂÛË˜ ı· Ú¤ÂÈ ˘Ô¯ÚÂˆÙÈÎ¿ Ó· Ê¤-ÚÂÈ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÂÍÔÏÈÛÌfi (¶ËÁ‹: ¶˘ÚÔÛ‚ÂÛÙÈÎfi ™ÒÌ·∂ÏÏ¿‰·˜, ·fi ¿ÛÎËÛË ÙÔ˘ ™ÒÌ·ÙÔ˜).

July August 04 07-10-04 13:52 ™ÂÏ›‰·227

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ÙÔ˘˜ ÛÂ ÂÈÏÂÁÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ·È‰È·ÙÚÈÎÒÓ ÏÔÈ-ÌÒÍÂˆÓ (16,17). ™Â ÂÚ›ÙˆÛË ‚ÈÔÏÔÁÈÎ‹˜ Â›ıÂ-ÛË˜, ÔÈ ÂÓ‰Â¯fiÌÂÓÂ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ·fiÙË ¯Ú‹ÛË ÙÔ˘˜ ·ÔÙÂÏÔ‡Ó ı¤Ì· ‹ÛÛÔÓÔ˜ ÛËÌ·Û›·˜ÛÂ Û¯¤ÛË ÌÂ ÙË ÓÔÛËÚfiÙËÙ·, ıÓËÙfiÙËÙ· Î·È ıÓËÛÈ-ÌfiÙËÙ· Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë ·ÂÈÏ‹. ¶ÚfiÛÊ·Ù·, ÙÔFDA ÂÓ¤ÎÚÈÓÂ ÙË ¯Ú‹ÛË ÛÈÚÔÊÏÔÍ·Û›ÓË˜ Î·È ‰ÔÍ˘-Î˘ÎÏ›ÓË˜ ˆ˜ ıÂÚ·Â›· Î·È ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË ÛÂ·È‰È¿ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÙÔÓ ‚¿ÎÈÏÔ ÙÔ˘ ¿ÓıÚ·Î· Ì¤-Ûˆ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Ô‰Ô‡ (18).

∞ÎÔÏÔ˘ıÂ› ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÙË˜ Î·-ÙËÁÔÚ›·˜ ∞ Î·Ù¿ CDC, Î·ıÒ˜ Î·È ÛÂ ¤Ó·Ó ·Ú¿ÁÔ-ÓÙ· ÙË˜ Î·ÙËÁÔÚ›·˜ µ Ô˘ ··Û¯fiÏËÛÂ ÚfiÛÊ·Ù·ÙË ‰ËÌÔÛÈfiÙËÙ·.

µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·ÙËÁÔÚ›·˜ ∞ ÕÓıÚ·Î·˜ O ¿ÓıÚ·Î·˜ ÚÔÎ·ÏÂ›Ù·È ·fi ÙÔÓ Gram(+) ‚¿-

ÎÈÏÔ ÙÔ˘ ¿ÓıÚ·Î·, Ô ÔÔ›Ô˜ Â›Ó·È ÈÎ·Ófi˜, ˘fi ÙËÌÔÚÊ‹ ÛfiÚÔ˘, Ó· ÂÈ‚ÈÒÛÂÈ ÁÈ· ·Û˘Ó‹ıÈÛÙ· ÌÂÁ¿-Ï· ‰È·ÛÙ‹Ì·Ù·. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿, ÛfiÚÔÈ Ô˘ ·Â-ÏÂ˘ıÂÚÒıËÎ·Ó ÁÈ· ÂÚÂ˘ÓËÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ÛÂ ‚Ú·¯Ô-ÓËÛ›‰· ÙˆÓ ·ÎÙÒÓ ÙË˜ ™ÎˆÙ›·˜ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ ’50,ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÓÈ¯ÓÂ‡ÔÓÙ·È ¤ˆ˜ Û‹ÌÂÚ·. ∏ Ê˘-ÛÈÎ‹ ÓfiÛÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰ÂÚÌ·ÙÈÎ‹, Á·ÛÙÚÂÓÙÂÚÈ-Î‹ Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ ÌÔÚÊ‹. OÈ ¯·Ú·ÎÙ‹ÚÂ˜ ÙˆÓÛfiÚˆÓ ¿ÓıÚ·Î· ÙÔ˘˜ Î·ıÈÛÙÔ‡Ó È‰·ÓÈÎÔ‡˜ ÁÈ· ÌÂ-Ù·ÊÔÚ¿ Ì¤Ûˆ ÙÔ˘ ·¤Ú·. ∏ ‰È·ÛÔÚ¿ ÙÔ˘˜ ÛÂ ÂÍ·È-ÚÂÙÈÎ¿ ÌÂÁ¿ÏÂ˜ ·ÔÛÙ¿ÛÂÈ˜ ÌÂ Â˘ÓÔ˚Î¤˜ ·ÙÌÔÛÊ·È-ÚÈÎ¤˜ Û˘Óı‹ÎÂ˜, Ë ·ÓıÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ ÛÙÈ˜ ÂÚÈ-‚·ÏÏÔÓÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ Î·È Ë ·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ·ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÌÔÚÊ‹˜ ÙÔ‡˜ Î·ıÈÛÙÔ‡Ó ÂÍ·È-ÚÂÙÈÎfi ÙÚÔÌÔÎÚ·ÙÈÎfi fiÏÔ (19-22). OÈ ÂÈı¤ÛÂÈ˜Ì¤Ûˆ Ù·¯˘‰ÚÔÌÂ›Ô˘, ÙÔ ÊıÈÓfiˆÚÔ ÙÔ˘ 2001 ÛÙÈ˜∏¶∞, ÚÔÎ¿ÏÂÛ·Ó 22 ‚Â‚·ÈˆÌ¤Ó· ‹ ‡ÔÙ· ÎÚÔ‡-ÛÌ·Ù·, 5 ÂÎ ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó ı·Ó·ÙËÊfiÚ· (23).øÛÙfiÛÔ, ÂÍ·ÈÚÂÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‹Ù·Ó ÔÈ ·Ú¿ÏÂ˘-ÚÂ˜ Û˘Ó¤ÂÈÂ˜ ÙË˜ Â›ıÂÛË˜. O ·ÓÈÎfi˜ Ô˘ ÚÔ-ÎÏ‹ıËÎÂ Ô‰‹ÁËÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÛÙË ˙‹ÙË-ÛË È·ÙÚÈÎÒÓ ˘ËÚÂÛÈÒÓ. ÃËÌÂÈÔÚÔÊ‡Ï·ÍË ¯ÔÚË-Á‹ıËÎÂ ÛÂ ÂÚÈÛÛfiÙÂÚ· ·fi 30.000 ¿ÙÔÌ·, ÂÓÒ Ìfi-ÓÔ ÁÈ· ÙÔ ÎÙ‹ÚÈÔ ÙË˜ °ÂÚÔ˘Û›·˜ ÛÙËÓ Washington,Ë ·ÔÏ‡Ì·ÓÛË ‰È‹ÚÎÂÛÂ Ì‹ÓÂ˜ Î·È ÎfiÛÙÈÛÂ 23 ÂÎ·-ÙÔÌÌ‡ÚÈ· ‰ÔÏ¿ÚÈ·.

∏ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÌÔÚÊ‹ ÙË˜ ÓfiÛÔ˘ ·ÔÙÂÏÂ› ÙËÓÏ¤ÔÓ ÂÈÎ›Ó‰˘ÓË. ∆· ı·Ó·ÙËÊfiÚ· ÎÚÔ‡ÛÌ·Ù· ÛÙÈ˜∏¶∞ ·ÊÔÚÔ‡Û·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÛÂ ·˘Ù‹ ÙË ÌÔÚÊ‹,ÂÓÒ ÛÂ ·ÂÏÂ˘ı¤ÚˆÛË ¿ÓıÚ·Î· ÏfiÁˆ ·Ù˘¯‹Ì·ÙÔ˜ÛÂ ÛÙÚ·ÙÈˆÙÈÎ‹ ÂÁÎ·Ù¿ÛÙ·ÛË ÙË˜ ÚÒËÓ ∂™™¢, ÙÔ1979, 66 ·fi Ù· 77 ÎÚÔ‡ÛÌ·Ù· ˘‹ÚÍ·Ó ı·Ó·ÙËÊfi-Ú· (24). ªÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙË-Ì·, ÔÈ ÛfiÚÔÈ ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È ·fi Ù· Î˘„ÂÏÈ‰ÈÎ¿Ì·ÎÚÔÊ¿Á·. ∞ÎÔÏÔ˘ıÂ› Ë ·Ó¿Ù˘ÍË ÙˆÓ ‚·Î›ÏˆÓ Î·È

Ë ·ÂÏÂ˘ı¤ÚˆÛË ÙÔÍÈÓÒÓ ÛÙÔ˘˜ ÏÂÌÊ·‰¤ÓÂ˜ ÙÔ˘ ÌÂ-ÛÔıˆÚ·Î›Ô˘, Ë ÔÔ›· ÚÔÎ·ÏÂ› ·ÈÌÔÚÚ·ÁÈÎ‹ ÏÂÌÊ·-‰ÂÓ›ÙÈ‰·, ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È ÛË„·È-Ì›·. O B. anthracis ·Ú¿ÁÂÈ ‰‡Ô ÚˆÙÂ˚ÓÈÎ¤˜ ÙÔÍ›ÓÂ˜,ÙËÓ ÔÈ‰ËÌ·ÙÔÍ›ÓË Î·È ÙË ÓÂÎÚÔÙÔÍ›ÓË. ø˜ ÂÎ ÙÔ‡ÙÔ˘,Ê¿ÚÌ·Î· Ù· ÔÔ›· ·ÚÂÌÔ‰›˙Ô˘Ó ÙË Û‡ÓıÂÛË Úˆ-ÙÂ˚ÓÒÓ ·fi Ù· ÚÈ‚ÔÛÒÌ·Ù· (fiˆ˜ ÔÈ Ì·ÎÚÔÏ›‰Â˜ Î·ÈË ÎÏÈÓ‰·Ì˘Î›ÓË) ıÂˆÚËÙÈÎ¿ ÏÂÔÓÂÎÙÔ‡Ó.

∆· Û˘ÌÙÒÌ·Ù· ÍÂÎÈÓÔ‡Ó 1-6 ËÌ¤ÚÂ˜ ·fi ÙËÓ¤ÎıÂÛË, ·Ó Î·È ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›Ô‰Ô˜ ÂÒ·ÛË˜·ÚÎÂÙÒÓ Â‚‰ÔÌ¿‰ˆÓ.

∏ ÓfiÛÔ˜, ·Ú¯ÈÎ¿, ÚÔ‚¿ÏÏÂÈ ˆ˜ ÌË ÂÈ‰ÈÎfi ÂÌ‡-ÚÂÙÔ ÓfiÛËÌ·, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ˘ÚÂÙfi, Ì˘·Ï-Á›·, ÎÂÊ·Ï·ÏÁ›· Î·È ‚‹¯·. ∏ ·Ô˘Û›· Û˘ÌÙˆÌ¿-ÙˆÓ Î·È ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘Ì‚·ÙÒÓ ÌÂ ÚÔÛ‚Ô-Ï‹ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (Î·Ù·ÚÚÔ‹, Ê·-Ú˘ÁÁ·ÏÁ›·, ÂÈÂÊ˘Î›ÙÈ‰·, ÂÍ¤Ú˘ıÚ· ·Ú›ÛıÌÈ·)Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·fi ÈÔÁÂÓÂ›˜ÏÔÈÌÒÍÂÈ˜. ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜, ÌÂÛÔÏ·‚Â›‰È¿ÛÙËÌ· ‡ÊÂÛË˜, ÙÔ ÔÔ›Ô ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ù·-¯Â›· ÂÈ‰Â›ÓˆÛË, ÌÂ ˘„ËÏfi ˘ÚÂÙfi, Î˘¿ÓˆÛË, ‰‡-ÛÓÔÈ· Î·È Î·Ù·ÏËÍ›·. ™Â ÔÛÔÛÙfi 50%, Ë ÓfiÛÔ˜Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·ÈÌÔÚÚ·ÁÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·. ∏ ·ÎÙÈ-ÓÔÁÚ·Ê›· ıÒÚ·Î· Î·È Ë ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ˘„Ë-Ï‹˜ Â˘ÎÚ›ÓÂÈ·˜ ·ÔÎ·Ï‡ÙÔ˘Ó ‰È¿Ù·ÛË ÌÂÛÔıˆÚ·-Î›Ô˘, ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÌÂÛÔıˆ-Ú·Î›Ô˘ Î·È, ·ÚÎÂÙ¿ Û˘¯Ó¿, ÓÂ˘ÌÔÓÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜Î·È ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹. ™Â ·˘Ùfi ÙÔ ÛÙ¿‰ÈÔ, ¯ÚÒÛËGram ÛÂ Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ‰˘-Ó·Ùfi Ó· ·ÔÎ·Ï‡„ÂÈ ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi. ∏ ¤ÁÎ·È-ÚË ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ Â›Ó·È ÎÂÊ·-Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜. ∂¿Ó Ë ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜ Î·-ı˘ÛÙÂÚ‹ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 48 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Î-ıÂÛË, Ë ıÓËÙfiÙËÙ· ·Ó¤Ú¯ÂÙ·È ÛÂ ÔÛÔÛÙfi 95%.

∏ ‰ÂÚÌ·ÙÈÎ‹ ÌÔÚÊ‹ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂÙ¿ ·fiÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙÔ ‰¤ÚÌ·, Ì¤Ûˆ Ï‡-ÛÂˆ˜ ÙË˜ Û˘Ó¤¯ÂÈ¿˜ ÙÔ˘. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÌ-Ê¿ÓÈÛË ÎËÏ›‰·˜ ÛÙÔ ÛËÌÂ›Ô ÙÔ˘ ÂÓÔÊı·ÏÌÈÛÌÔ‡, ËÔÔ›· ÌÂÙ·ÙÚ¤ÂÙ·È ÛÙ·‰È·Î¿ ÛÂ ‚Ï·Ù›‰·, ¤ÏÎÔ˜Î·È, ÙÂÏÈÎ¿, ÛÙËÓ Ù˘ÈÎ‹ ÁÈ· ÙË ÓfiÛÔ Ì·‡ÚË ÂÛ¯¿Ú·.∏ ‚Ï¿‚Ë ÂÚÈ‚¿ÏÏÂÙ·È ·fi Ô›‰ËÌ· ÙˆÓ ÁÂÈÙÔÓÈÎÒÓÌ·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ¯ˆÚ›˜ ˆÛÙfiÛÔ Û˘ÓÔ‰fi Â˘·ÈÛıË-Û›·, ‚ÔËıÒÓÙ·˜ ¤ÙÛÈ ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·fiÙË Û˘Ó‹ıË Î˘ÙÙ·Ú›ÙÈ‰·. ªÂ ÙËÓ ¤Ó·ÚÍË ÙË˜ Î·Ù¿Ï-ÏËÏË˜ ·ÁˆÁ‹˜, Ë ıÓËÙfiÙËÙ· ÙË˜ ÌÔÚÊ‹˜ ·˘Ù‹˜ ·-Ú·Ì¤ÓÂÈ ÂÚÈÔÚÈÛÌ¤ÓË. ∆Ô ÌÔÓ·‰ÈÎfi ·È‰È·ÙÚÈÎfi Â-ÚÈÛÙ·ÙÈÎfi Î·Ù¿ ÙËÓ Â›ıÂÛË ÙÔ˘ 2001 ÛÙÈ˜ ∏¶∞,·ÊÔÚÔ‡ÛÂ ÛÂ ‚Ú¤ÊÔ˜ ËÏÈÎ›·˜ 7 ÌËÓÒÓ, ÙÔ ÔÔ›Ô·Ó¤Ù˘ÍÂ ¿ÓıÚ·Î· Î·Ù¿ ÙÔ ¿Óˆ ¿ÎÚÔ (25). ∏ ‰ÂÚ-Ì·ÙÈÎ‹ ‚Ï¿‚Ë ıÂˆÚ‹ıËÎÂ ·Ú¯ÈÎ¿ ‰‹ÁÌ· ·Ú¿¯ÓË˜,ÂÓÒ - Î·Ù¿ ÙËÓ ÂÍ¤ÏÈÍ‹ ÙË˜ - Ë ÓfiÛÔ˜ Û˘ÓÔ‰Â‡ÙËÎÂ·fi ·ÈÌfiÏ˘ÛË, ıÚÔÌ‚ÔÂÓ›· Î·È ÓÂÊÚÈÎ‹ ·ÓÂ¿Ú-ÎÂÈ·, Î·Ù·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙË ‰È·ÊÔÚÂÙÈÎ‹ ÔÚÂ›· ÙË˜

July August 04 07-10-04 13:52 ™ÂÏ›‰·230

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Ê˘ÛÈÎ‹˜ ÈÛÙÔÚ›·˜ ÙË˜ ÓfiÛÔ˘ ÛÙ· ·È‰È¿ Î·È ÂÈ‚Â-‚·ÈÒÓÔÓÙ·˜ ÙÈ˜ ·Ú¯ÈÎ¤˜ ˘Ôı¤ÛÂÈ˜ ÁÈ· ÙËÓ È‰ÈÔÌÔÚ-Ê›· ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÂ ÂÚ›ÙˆÛË ‚ÈÔÏÔ-ÁÈÎ‹˜ Â›ıÂÛË˜.

¶·ÓÒÏË ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ µ’ ¶·ÁÎÔÛÌ›Ô˘ ¶ÔÏ¤ÌÔ˘,

Ë π·ˆÓ›· ‰ÈÂÚÂ‡ÓËÛÂ ÙË ¯Ú‹ÛË ÙË˜ ·ÓÒÏË˜ ˆ˜‚ÈÔÏÔÁÈÎfi fiÏÔ, ÂÓÒ ÔÈ ∏¶∞ ‰ÈÂÍ‹Á·Á·Ó ·Ó¿ÏÔÁ·ÂÈÚ¿Ì·Ù· Î·Ù¿ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ ’50, ÛÙÔ Ï·›ÛÈÔ·Ó¿Ù˘ÍË˜ ÙÔ˘ ‰ÈÎÔ‡ ÙÔ˘˜ ÂÈıÂÙÈÎÔ‡ ‚ÈÔÏÔÁÈÎÔ‡ÔÏÔÛÙ·Û›Ô˘ (26).

¶ÚfiÎÂÈÙ·È ÁÈ· ˙ˆÔ·ÓıÚˆÔÓfiÛÔ. ∂›Ó·È ÓfiÛËÌ·ÙˆÓ ÙÚˆÎÙÈÎÒÓ, ÔÓÙÈÎÒÓ Î˘Ú›ˆ˜, ÂÓÒ ÌfiÓÔ ‰Â˘ÙÂ-ÚÔÁÂÓÒ˜ ÚÔÛ‚¿ÏÏÂÈ ÙÔÓ ¿ÓıÚˆÔ. ∞›ÙÈÔ Â›Ó·È ËÀÂÚÛ›ÓÈ· ÙË˜ ·ÓÒÏÔ˘˜, ¤Ó· Gram(-) ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔÌÈÎÚfi‚ÈÔ. ∏ ÈÎ·ÓfiÙËÙ¿ ÙÔ˘ Ó· ÂÈ‚ÈÒÓÂÈ ÂÓÙfi˜ ÙˆÓÌ·ÎÚÔÊ¿ÁˆÓ ˘Ô‚ÔËı¿ ÙË ‰È·ÛÔÚ¿ ÙÔ˘ ÌÂÙ¿ ·fiÂÈÛÓÔ‹ ‹ ÂÓÔÊı·ÏÌÈÛÌfi (27). ∏ Ê˘ÛÈÎ‹ ÓfiÛÔ˜ÌÔÚÂ› Ó· Ï¿‚ÂÈ ÓÂ˘ÌÔÓÈÎ‹ (Â›Ó·È Ë Èı·ÓfiÙÂÚËÌÔÚÊ‹ ÂÌÊ¿ÓÈÛË˜ ÛÂ ÂÚ›ÙˆÛË ‚ÈÔÏÔÁÈÎ‹˜ ·ÂÈ-Ï‹˜), ‚Ô˘‚ˆÓÈÎ‹ ‹ Î·È ÛË„·ÈÌÈÎ‹ ÌÔÚÊ‹. Ã·Ú·ÎÙË-ÚÈÛÙÈÎfi ÙË˜ ÓfiÛÔ˘ Â›Ó·È Ë ÂÍ·ÈÚÂÙÈÎ¿ ˘„ËÏ‹ ıÓËÙfi-ÙËÙ·, Ë ÔÔ›· ·ÁÁ›˙ÂÈ ÙÔ 100% ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ÌÔÚÊ‹, ÂÓÒ ÙÔ 50-75% ÛÙË ‚Ô˘‚ˆÓÈÎ‹. ∏ ıÂÚ·Â›·,ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹, Ú¤ÂÈ Ó··Ú¯›ÛÂÈ ÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ. ∏ ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË ı· Ú¤ÂÈ Ó·¯ÔÚËÁËıÂ› ÛÙ· ·Û˘ÌÙˆÌ·ÙÈÎ¿ ÂÓ ‰˘Ó¿ÌÂÈ ı‡Ì·Ù·ÙË˜ ‚ÈÔÏÔÁÈÎ‹˜ Â›ıÂÛË˜, fiˆ˜ Î·È ÛÙ· ¿ÙÔÌ· ÙÔ˘ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ ÓÂ˘ÌÔÓÈ-Î‹ ÌÔÚÊ‹. ∂Ì‚fiÏÈÔ, ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ÔÛfiÙËÙÂ˜,‰È·ı¤ÙÔ˘Ó ÔÈ ŒÓÔÏÂ˜ ¢˘Ó¿ÌÂÈ˜ ÙˆÓ ∏¶∞, ÙÔ ÔÔ›ÔÂÚÈÏ·Ì‚¿ÓÂÈ ÓÂÎÚˆÌ¤ÓÂ˜ ˘ÂÚÛ›ÓÈÂ˜, ÂÓÒ ¤¯ÂÈ Î·-Ù·ÛÎÂ˘·ÛÙÂ› Î·È ÂÌ‚fiÏÈÔ ÌÂ ˙ÒÛÂ˜ ÂÍ·ÛıÂÓËÌ¤ÓÂ˜.∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ ¤Ó·ÓÙÈ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ÌÔÚÊ‹˜ ·ÌÊÈÛ‚ËÙÂ›Ù·È (28).

∂˘ÏÔÁÈ¿ ∞ÔÙÂÏÂ› ÙÚ·ÁÈÎ‹ ÂÈÚˆÓÂ›· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ó

Î·È Ë Â˘ÏÔÁÈ¿ ÎËÚ‡¯ıËÎÂ ÂÎÚÈ˙ˆıÂ›Û· ÓfiÛÔ˜ ÙÔ1980 ·fi ÙËÓ ¶OÀ, 20 ¯ÚfiÓÈ· ÌÂÙ¿, ÔÈ ˘ÁÂÈÔÓÔÌÈÎ¤˜·Ú¯¤˜ ÙˆÓ ∏¶∞ Î·È ÙË˜ ª. µÚÂÙ·Ó›·˜ ÚÔ‚·›ÓÔ˘ÓÛÂ Ì·˙ÈÎ¤˜ ·Ú·ÁÁÂÏ›Â˜ ÂÌ‚ÔÏ›ˆÓ (29) ¤Ó·ÓÙÈ ÂÓfi˜‚ÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ ‰È·‚ÈÂ› Ï¤ÔÓ ÌfiÓÔ ÛÂÂÚÁ·ÛÙËÚÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. ∏ Â˘ÏÔÁÈ¿ - ¤Ï·‚Â ÙÔfiÓÔÌ¿ ÙË˜ Î·Ù’ Â˘ÊËÌÈÛÌfi - ÚÔÎ¿ÏÂÛÂ Èı·ÓfiÙ·-Ù· ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ı·Ó¿ÙÔ˘˜ ·fi ÔÔÈ·‰‹Ô-ÙÂ ¿ÏÏË ÓfiÛÔ ÛÙÔ ·ÚÂÏıfiÓ. ∆Ô ·›ÙÈfi ÙË˜ Â›Ó·È ÔÔÌÒÓ˘ÌÔ˜ Èfi˜, Ô ÔÔ›Ô˜ ·ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÛÂ Ì¤ÁÂıÔ˜ DNA ÈÔ‡˜.

¶ÚfiÛÊ·Ù·, ÂÎÊÚ¿ÛÙËÎ·Ó Êfi‚ÔÈ - ÛÂ ·Ó·ÊÔÚ¤˜ÛÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ·ÏÏ¿ Î·È ÌË ÂÈ‰ÈÎfi ∆‡Ô - Û¯ÂÙÈ-Î¿ ÌÂ ÙËÓ Èı·ÓfiÙËÙ· Ó· ‰È·Ù›ıÂÙ·È Ô Èfi˜ ÙË˜ Â˘ÏÔ-ÁÈ¿˜ ÚÔ˜ ¯Ú‹ÛË ÛÂ ‰È¿ÊÔÚÂ˜ ÙÚÔÌÔÎÚ·ÙÈÎ¤˜ ÔÚ-

Á·ÓÒÛÂÈ˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ. ∞ÚÎÂÙÔ› ·Ú¿ÁÔÓÙÂ˜Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔ Ó· ·ÔÙÂÏÂ› Ô Èfi˜ ¤Ó· ÂÏÎ˘ÛÙÈÎfifiÏÔ: Ë ·ÓÔÛ›· Ô˘ ÂÍ·ÛÊ·Ï›˙ÂÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·ÈÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ (3-5 ¤ÙË), Ë ÂÓÂÚÁËÙÈÎ‹ ·ÓÔÛÔÔ›-ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ‰È·ÎÔÂ› ·fi ÙË ‰ÂÎ·ÂÙ›·ÙÔ˘ ’70, Ù· ·ÁÎfiÛÌÈ· ·Ôı¤Ì·Ù· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›-Ó·È ÂÚÈÔÚÈÛÌ¤Ó·, Ë ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ÙË˜ ÓfiÛÔ˘ Â›-Ó·È ˘„ËÏ‹ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌË ıÂÚ·Â›·. ∆Ôπ·ÙÚÈÎfi ∂ÚÂ˘ÓËÙÈÎfi πÓÛÙÈÙÔ‡ÙÔ §ÔÈÌˆ‰ÒÓ ¡ÔÛËÌ¿-ÙˆÓ ÙˆÓ ∞ÌÂÚÈÎ·ÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ(USAMRIID, www.usamriid.army.mil) ‰ÈÂÚÂ˘Ó¿ ÙË¯Ú‹ÛË Î·ÙËÁÔÚÈÒÓ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ ÙË˜ Â˘ÏÔÁÈ¿˜.∆¤ÛÛÂÚ· ÛÎÂ˘¿ÛÌ·Ù· ‚Ú›ÛÎÔÓÙ·È ÛÂ ÂÍÂÏÈÁÌ¤ÓÔÛÙ¿‰ÈÔ ‰ÔÎÈÌÒÓ (·‰ÂÊÔ‚›ÚË, ‰ÈÈ‚ÔÍ›ÏË, ÛÈ‰ÔÊÔ‚›-ÚË Î·È ÚÈÌ·‚ÈÚ›ÓË). øÛÙfiÛÔ, Î·Ó¤Ó·, ÏËÓ ÙË˜ ÚÈ-Ì·‚ÈÚ›ÓË˜, ‰ÂÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙÂ› ÛÂ ·È‰È¿.

º˘ÛÈÎfi˜ ÍÂÓÈÛÙ‹˜ ÙÔ˘ ÈÔ‡ Â›Ó·È Ô ¿ÓıÚˆÔ˜. ¢ÂÓ˘¿Ú¯Ô˘Ó ˘ÁÈÂ›˜ ÌÈÎÚÔ‚ÈÔÊfiÚÔÈ. ∏ ÌÂÙ¿‰ÔÛË ÙË˜ÓfiÛÔ˘ Á›ÓÂÙ·È ÌÂ ÛÙ·ÁÔÓ›‰È·, ·ÂÚÔÁÂÓÒ˜ Î·È, Û·-ÓÈfiÙÂÚ·, Ì¤Ûˆ ÙˆÓ ÂÊÂÏÎ›‰ˆÓ, ÌÔÏ˘ÛÌ¤ÓˆÓ ÎÏÈÓÔ-ÛÎÂ·ÛÌ¿ÙˆÓ, ·ÓÙÈÎÂÈÌ¤ÓˆÓ ‹ ÎÔÓÈÔÚÙÔ‡. ¶‡ÏË ÂÈ-Ûfi‰Ô˘ ·ÔÙÂÏÂ› ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ· Î·È,Û·ÓÈfiÙÂÚ·, ÙÔ ‰¤ÚÌ·.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÛÙ·‰›Ô˘ ÂÒ·ÛË˜, Ô Èfi˜·Ó··Ú¿ÁÂÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙË-Ì·, Ô‰ËÁÒÓÙ·˜ ÛÂ ÚˆÙÔ·ı‹ È·ÈÌ›·. ªÂÙ¿ ÙËÓÂÁÎ·Ù¿ÛÙ·ÛË ÛÙÔÓ ÛÏ‹Ó· Î·È ÙÔ ‹·Ú, ·ÎÔÏÔ˘ıÂ›ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ È·ÈÌ›·˜ Ô˘ Ô‰ËÁÂ›ÙÂÏÈÎ¿ ÛÙËÓ ÎÏ·ÛÈÎ‹ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∏ÎÏÈÓÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ÓfiÛÔ˘ ·Ú¯›˙ÂÈ Î·Ù¿ ÙÔ ÛÙ¿‰ÈÔÙË˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ È·ÈÌ›·˜, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi˘ÚÂÙfi, Ú›ÁË, ¤ÌÂÙÔ, ÎÂÊ·Ï·ÏÁ›·, Ú·¯È·ÏÁ›· Î·È ÂÎ-ÛÂÛËÌ·ÛÌ¤ÓË Î·ÎÔ‰È·ıÂÛ›·. ∆Ô ÎÏ·ÛÈÎfi ÂÍ¿ÓıËÌ·ÂÌÊ·Ó›˙ÂÙ·È 2-4 ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ·, ·ÔÙÂÏÔ‡ÌÂÓÔ·fi ÎËÏ›‰Â˜ Ô˘ ÂÎı‡ÔÓÙ·È Û˘ÌÌÂÙÚÈÎ¿ ÛÙÔ Úfi-ÛˆÔ Î·È Ù· ¿ÎÚ·, ÔÈ ÔÔ›Â˜ ÂÍÂÏ›ÛÛÔÓÙ·È ÛÂ Ê˘Û·-Ï›‰Â˜ Î·È, ÙÂÏÈÎ¿, ÛÂ ÂÊÂÏÎ›‰Â˜. ∫·ıÒ˜ ÔÈ ÂÊÂÏÎ›‰Â˜·Ô›ÙÔ˘Ó, Î·Ù·ÏÂ›Ô˘Ó ‰‡ÛÌÔÚÊÂ˜, ·Ô¯ÚˆÌ·ÙÈ-ÛÌ¤ÓÂ˜ Ô˘Ï¤˜. ∏ Û˘ÌÌÂÙÚÈÎ‹ ¤Îı˘ÛË ÙÔ˘ ÂÍ·Óı‹Ì·-ÙÔ˜ ÛÂ ÚfiÛˆÔ Î·È ¿ÎÚ· Î·È Ë Ê˘ÁfiÎÂÓÙÚÔ˜ ÂÍ¿-ÏˆÛ‹ ÙÔ˘, ‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·fi¿ÏÏ· ÂÍ·ÓıËÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë ·ÓÂÌÔ‚ÏÔ-ÁÈ¿, Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÂÓÙÚÔÌfiÏÔ Î·Ù·ÓÔÌ‹ (30).

∏ ıÓËÙfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ·Ó¤Ú¯ÂÙ·È ÛÂ ÔÛÔÛÙfi30%, ·Ô‰È‰fiÌÂÓË ÛÂ ·ÚÙËÚÈ·Î‹ ˘fiÙ·ÛË, Î·Ù·-ÏËÍ›· Î·È ÓfiÛÔ ·fi ·ÓÔÛÔÛ˘ÌÏ¤ÁÌ·Ù·. ∏ Úfi-ÁÓˆÛË Â›Ó·È ‚·Ú‡ÙÂÚË ÛÂ Â˘·ıÂ›˜ ÔÌ¿‰Â˜ ÙÔ˘ÏËı˘ÛÌÔ‡, Î·ıÒ˜ Î·È ÛÙËÓ ·ÈÌÔÚÚ·ÁÈÎ‹ ÌÔÚÊ‹ÙË˜ ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È, ÈÛÙÔÚÈÎ¿, ‰‡Ô ÌÔÚÊ¤˜ÙË˜ ÓfiÛÔ˘: Ë “ÌÂ›˙ˆÓ” Î·È Ë “ÂÏ¿ÛÛˆÓ”.

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

July August 04 07-10-04 13:52 ™ÂÏ›‰·231

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¿ÁÓˆÛÙÔ˜. OÈ ÈÔ› Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ·Ú·ÁˆÁ‹ ÂÌ‚ÔÏ›Ô˘ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÎÛÙÚ·ÙÂ›·˜ÂÎÚ›˙ˆÛË˜ ÙˆÓ ÂÚ·ÛÌ¤ÓˆÓ ‰ÂÎ·ÂÙÈÒÓ, ·Ó‹Î·ÓÛÙÔ ÛÙ¤ÏÂ¯Ô˜ Lister Elstree ÁÈ· ÙËÓ ∂˘ÚÒË Î·ÈÛÙÔ ÛÙ¤ÏÂ¯Ô˜ NYCBH (New York City Board ofHealth) ÁÈ· ÙÈ˜ ∏¶∞ Î·È ÙÔÓ ∫·Ó·‰¿. ∆· ÂÌ‚fiÏÈ·ÂÚÈÂÏ¿Ì‚·Ó·Ó ˙ÒÓÙ· Èfi ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜orthopoxvirus Ô˘ ÌÔÈ¿˙ÂÈ, ·fi ·ÓÙÈÁÔÓÈÎ‹ ¿Ô„Ë,ÌÂ ÙÔÓ Èfi ÙË˜ Â˘ÏÔÁÈ¿˜.

øÛÙfiÛÔ, Ë ‰È·‰ÈÎ·Û›· ·Ú·ÁˆÁ‹˜ (ÌfiÏ˘ÓÛË ÌÔ-Û¯·ÚÈÒÓ Î·È ÚÔ‚¿ÙˆÓ Î·È Û˘ÏÏÔÁ‹ ÙÔ˘ ÊÏ˘ÎÙ·È-ÓÒ‰Ô˘˜ ˘ÏÈÎÔ‡) ‰ÂÓ ÏËÚÔ› ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ··ÈÙ‹-ÛÂÈ˜. ™‹ÌÂÚ·, Ù· ÂÌ‚fiÏÈ· Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fi ÂÍ¤-ÏÈÍË ·fi ÙÈ˜ ∞ÌÂÚÈÎ·ÓÈÎ¤˜ ŒÓÔÏÂ˜ ¢˘Ó¿ÌÂÈ˜, ·Ó·-Ù‡ÛÛÔÓÙ·È ÛÂ Î·ÏÏÈ¤ÚÁÂÈ· ÈÛÙÔ‡, ¯ˆÚ›˜ ˆÛÙfiÛÔÓ· ¤¯Ô˘Ó Ï¿‚ÂÈ ¿‰ÂÈ· Î˘ÎÏÔÊÔÚ›·˜. ŒÙÛÈ, ÔÈ ·ÚÌfi-‰ÈÂ˜ ˘ËÚÂÛ›Â˜ ÙˆÓ ∏¶∞ Î·È ÙË˜ ª. µÚÂÙ·Ó›·˜ Î·-Ù·ÊÂ‡ÁÔ˘Ó ÂÎ Ó¤Ô˘ ÛÙ· ·Ï·ÈÔ‡ Ù‡Ô˘ ÂÌ‚fiÏÈ·.[¶ÚfiÛÊ·Ù·, ÙÔ ı¤Ì· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ ÙË˜Â˘ÏÔÁÈ¿˜ ÚÔÛÂ›ÏÎ˘ÛÂ ÙÔ ¤ÓÙÔÓÔ ÂÓ‰È·Ê¤ÚÔÓ ÌÂÚ›-‰·˜ ÙÔ˘ ∆‡Ô˘ Î·È ÙË˜ ÎÔÈÓ‹˜ ÁÓÒÌË˜ ÛÙË ª. µÚÂ-Ù·Ó›·, fi¯È fiÌˆ˜ ÁÈ· ÏfiÁÔ˘˜ ÂÈÛÙËÌÔÓÈÎÔ‡˜ (31). ∏·fiÊ·ÛË ÁÈ· ÚÔÌ‹ıÂÈ· ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÂÌ-‚ÔÏ›Ô˘ Î·Ù¿ ÙË˜ Â˘ÏÔÁÈ¿˜, ÂÏ‹ÊıË ˘fi Î·ıÂÛÙÒ˜Ì˘ÛÙÈÎfiÙËÙ·˜ Î·È ÂÈÛÎÈ¿ÛÙËÎÂ ·fi ÙËÓ ·ÔÎ¿Ï˘-„Ë fiÙÈ Ô ÂÈÎÂÊ·Ï‹˜ ÙË˜ ÚÔÌËıÂ‡ÙÚÈ·˜ ÂÙ·ÈÚÂ›·˜ÚÔÛ¤ÊÂÚÂ ÛËÌ·ÓÙÈÎ‹ ÔÈÎÔÓÔÌÈÎ‹ ÂÓ›Û¯˘ÛË ÛÙÔ Î˘-‚ÂÚÓÒÓ ÎfiÌÌ· ÙˆÓ ∂ÚÁ·ÙÈÎÒÓ, Ï›ÁÔ ÚÈÓ ÙËÓ ˘Ô-ÁÚ·Ê‹ ÙË˜ Û˘ÌÊˆÓ›·˜. ∏ ‚ÚÂÙ·ÓÈÎ‹ Ì˘ÛÙÈÎfiÙËÙ·¤Ú¯ÂÙ·È ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙËÓ ÚÔÛ¤ÁÁÈÛË ÙË˜ ·ÌÂÚÈ-Î·ÓÈÎ‹˜ Î˘‚¤ÚÓËÛË˜, Ë ÔÔ›· ÚÔÎ‹Ú˘ÍÂ ·ÓÔÈÎÙfiÌÂÈÔ‰ÔÙÈÎfi ‰È·ÁˆÓÈÛÌfi.]

°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ ÂÌ‚Ô-ÏÈ·ÛÌÔ‡ Î·È ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ·ÓÔÛÔÎ·ÙÂÛÙ·ÏÌ¤-ÓˆÓ, ¯ÔÚËÁÂ›Ù·È ÂÈ‰ÈÎ‹ ·ÓÔÛÔÛÊ·ÈÚ›ÓË (VIG) (0,6ml/kg IM) ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 3 ËÌÂÚÒÓ ·fi ÙËÓÈı·Ó‹ ¤ÎıÂÛË ÛÙÔÓ Èfi. ∏ ÂÚÈÔÚÈÛÌ¤ÓË ‰È·ıÂÛÈÌfi-ÙËÙ·, ÙfiÛÔ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ fiÛÔ Î·È ÙË˜ VIG, ÂÁÂ›ÚÂÈ·ÓËÛ˘¯›Â˜, ˆÛÙfiÛÔ ·Ó·Ì¤ÓÂÙ·È Û‡ÓÙÔÌ· Ó· ¯ÔÚË-ÁËıÂ› ¿‰ÂÈ· Î˘ÎÏÔÊÔÚ›·˜ ÛÙÔ ˘fi ÂÍ¤ÏÈÍË ÂÌ‚fiÏÈÔ.¶ÚfiÛÊ·ÙÂ˜ ·Ó·ÊÔÚ¤˜ Î·Ù·‰ÂÈÎÓ‡Ô˘Ó fiÙÈ, ÛÂ ·Ú·›-ˆÛË 1:10, ÙÔ ˘¿Ú¯ÔÓ ÂÌ‚fiÏÈÔ ‰È·ÙËÚÂ› ÙËÓ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ (32).

™‹ÌÂÚ·, Ë ÂÌÊ¿ÓÈÛË ·ÎfiÌ· Î·È ÂÓfi˜ ÂÚÈÛÙ·ÙÈ-ÎÔ‡ Â˘ÏÔÁÈ¿˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ, ·ÔÙÂÏÂ› ÂÚÈÛÙ·ÙÈÎfiÔ˘ ÂÁÎ˘ÌÔÓÂ› ÛÔ‚·ÚfiÙ·ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. OÈ ··-Ú·›ÙËÙÂ˜ ÚÔÊ˘Ï¿ÍÂÈ˜ Î·È ÔÈ ÂÓ‰ÂÈÎÓ˘fiÌÂÓÂ˜ Ì¤ıÔ-‰ÔÈ ·ÔÌfiÓˆÛË˜ Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ¿ÌÂÛ·.OÈ Â·Ê¤˜ Ú¤ÂÈ Ó· ‚Ú›ÛÎÔÓÙ·È ˘fi ÛÙÂÓ‹ ÂÈÙ‹-ÚËÛË ÁÈ· ‰È¿ÛÙËÌ· 17 ËÌÂÚÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›·‡ÔÙË Â·Ê‹.

™¯Â‰fiÓ ÛÙÔ Û‡ÓÔÏfi ÙË˜, Ë ·ÁÎfiÛÌÈ· ÂÚÂ˘ÓË-ÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ ·Ó·Ù‡ÛÛÂÙ·È Û‹ÌÂÚ·

Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ Â˘ÏÔÁÈ¿, ·ÔÙÂÏÂ› ‰È·‚·ıÌÈÛÌ¤ÓË,ÛÙÚ·ÙÈˆÙÈÎ‹ ˘fiıÂÛË.

∆Ô˘Ï·Ú·ÈÌ›· ∏ francisella tularensis, Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔ-

ÓÙ·˜ ÙË˜ ÙÔ˘Ï·Ú·ÈÌ›·˜, Â›Ó·È ¤Ó·˜ ÌÈÎÚfi˜, ·Î›ÓË-ÙÔ˜, ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˜ Gram(-) ÎÔÎÎÔ‚¿ÎÈÏÔ˜. ¶ÚfiÎÂÈ-Ù·È ÁÈ· ˙ˆÔÓfiÛÔ, ÂÓÒ Ô ¿ÓıÚˆÔ˜ ÚÔÛ‚¿ÏÏÂÙ·È,˘fi Ê˘ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜, Ì¤Ûˆ ÂÓÔÊı·ÏÌÈÛÌÔ‡ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹ ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ ÌÂ ·›Ì· ‹ ÌÔÏ˘-ÛÌ¤ÓÔ˘˜ ÈÛÙÔ‡˜ ·Û¯fiÓÙˆÓ ˙ÒˆÓ (Û˘Ó‹ıˆ˜ ÎÔ˘Ó¤-ÏÈ· ‹ Ï·ÁÔ›) ‹ ‰‹ÁÌ·Ù· ·Ú·ÛÈÙÈÎÒÓ ÂÓÙfiÌˆÓ. ªfi-Ï˘ÓÛË Ì¤Ûˆ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‹ Á·ÛÙÚÂÓÙÂÚÈÎ‹˜Ô‰Ô‡ Â›Ó·È, Â›ÛË˜, ÂÊÈÎÙ‹. ∏ ·Ó·ÓÂ˘ÛÙÈÎ‹ ¤ÎıÂÛËÌ¤Ûˆ ·ÂÚÔÛfiÏË˜ (ÛÂ ÂÓ‰Â¯fiÌÂÓË Â›ıÂÛË) ÌÔÚÂ›Ó· ÚÔÎ·Ï¤ÛÂÈ ÙËÓ Ù˘ÊÔÂÈ‰ÈÎ‹ ÙÔ˘Ï·Ú·ÈÌ›·, ÌÂ Û˘-ÓÔ‰fi ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È ¿Ù˘Ë ÎÏÈ-ÓÈÎ‹ ÂÈÎfiÓ· ÌÂ ˘ÚÂÙfi, Î·ÎÔ‰È·ıÂÛ›· Î·È ÎÔÈÏÈ·Îfi¿ÏÁÔ˜. ∏ ıÓËÙfiÙËÙ· ÙË˜ ÌË ıÂÚ·Â˘ıÂ›Û·˜ Ù˘ÊÔ-ÂÈ‰ÈÎ‹˜ ÌÔÚÊ‹˜ ·Ó¤Ú¯ÂÙ·È ÛÂ 35%. O ÔÚÁ·ÓÈÛÌfi˜ÌÔÚÂ› Ó· ÂÈ‚ÈÒÛÂÈ ÁÈ· Â‚‰ÔÌ¿‰Â˜ ÛÙÔ ¯ÒÌ·, ÙÔÓÂÚfi Î·È ÙÔ˘˜ ÈÛÙÔ‡˜ ‹ ·ÎfiÌ· Î·È ¯ÚfiÓÈ· ÛÂ Î·ÙÂ-„˘ÁÌ¤ÓÔ ÎÚ¤·˜. ∂ÍÂÏ›¯ıËÎÂ ˆ˜ ‚ÈÔÏÔÁÈÎfi fiÏÔ·fi ÙÈ˜ ∏¶∞ ÌÂ ÙË ÌÔÚÊ‹ ·ÂÚÔÛfiÏË˜, Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ·Ó¿Ù˘ÍË˜ ÙÔ˘ ÂÈıÂÙÈÎÔ‡ ‚ÈÔÏÔÁÈÎÔ‡ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙˆÓ ‰ÂÎ·ÂÙÈÒÓ ’50 Î·È ’60. ∏ ÙÔ˘Ï·-Ú·ÈÌ›· ‰ÂÓ Â›Ó·È ÌÂÙ·‰ÔÙÈÎ‹ Î·È ÈÛ¯‡Ô˘Ó ÔÈ Û˘Ó‹ıÂÈ˜Ô‰ËÁ›Â˜ ÚÔÊ‡Ï·ÍË˜ Î·È ·ÔÌfiÓˆÛË˜ (33-36).

∞ÏÏ·ÓÙ›·ÛË OÊÂ›ÏÂÙ·È ÛÂ ÓÂ˘ÚÔÙÔÍ›ÓË Ô˘ ·Ú¿ÁÂÈ ˘fi ·Ó·-

ÂÚfi‚ÈÂ˜ Û˘Óı‹ÎÂ˜ Ô Gram(+) ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ÎÏˆÛÙËÚ›‰ÈÔ ÙË˜ ·ÏÏ·ÓÙ›·ÛË˜ (clostiridiumbotulinum). OÚÔÏÔÁÈÎ¿, ‰È·ÎÚ›ÓÔÓÙ·È 7 ·ÓÙÈÁÔÓÈÎÔ›Ù‡ÔÈ ÙË˜ ÙÔÍ›ÓË˜, ∞ ¤ˆ˜ G. OÈ ÓÂ˘ÚÔÙÔÍ›ÓÂ˜ ·˘Ù¤˜·ÔÙÂÏÔ‡Ó ÙÈ˜ ÈÛ¯˘ÚfiÙÂÚÂ˜ ÙÔÍ›ÓÂ˜ Ô˘ ¤¯Ô˘Ó ÂÚÈ-ÁÚ·ÊÂ›, ÌÂ lethal dose 50 (ÁÈ· ÙËÓ ÙÔÍ›ÓË ∞) 0,001Ìg/kg [Ì¤ÛË ı·Ó·ÙËÊfiÚÔ˜ ‰fiÛË (lethal dose 50): Ë‰fiÛË Ô˘ Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜ ÁÈ· ÙÔ 50% ÙˆÓ ÂÈÚ·-Ì·Ùfi˙ˆˆÓ ÙË˜ ÌÂÏÂÙÔ‡ÌÂÓË˜ ÔÌ¿‰·˜]. ŒÓ· mg Â›Ó·ÈÈÎ·Ófi Ó· ÊÔÓÂ‡ÛÂÈ 20.000 ÔÓÙÈÎÔ‡˜. ∏ ÂÍˆÙÔÍ›ÓËÎ·Ù·ÛÙÚ¤ÊÂÙ·È ÛÙÔ˘˜ 80ÔC ÁÈ· 30 ÏÂÙ¿ ‹ ÛÙÔ˘˜100ÔC ÁÈ· 10 ÏÂÙ¿. ¢Ú· ÛÙÈ˜ ÂÚÈÊÂÚÈÎ¤˜ ¯ÔÏÈÓÂÚ-ÁÈÎ¤˜ ÚÔÛ˘Ó·ÙÈÎ¤˜ ÓÂ˘ÚÈÎ¤˜ ·ÔÏ‹ÍÂÈ˜, Î˘Ú›ˆ˜ÛÙË ÓÂ˘ÚÔÌ˘˚Î‹ Û‡Ó·„Ë, ·ÚÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ ·Â-ÏÂ˘ı¤ÚˆÛË ·ÎÂÙ˘ÏÔ¯ÔÏ›ÓË˜ Î·È ÚÔÎ·ÏÒÓÙ·˜ ÁÂÓÈ-ÎÂ˘Ì¤ÓË, Û˘ÌÌÂÙÚÈÎ‹ ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË Î·È ‰˘ÛÏÂÈ-ÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

∏ ¤ÎıÂÛË ÛÙË ÓÂ˘ÚÔÙÔÍ›ÓË ·ÎÔÏÔ˘ıÂ›Ù·È ·fiÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ, ÛÂ ‰È¿-ÛÙËÌ· Ï›ÁˆÓ ˆÚÒÓ ¤ˆ˜ ËÌÂÚÒÓ. ◊È· Û˘ÌÙÒÌ·Ù··fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ·‰˘Ó·-Ì›·, ‰ÈÏˆ›·, ‚ÏÂÊ·ÚfiÙˆÛË, ‰˘Û·ÚıÚ›·, ‰˘ÛÎ·-Ù·ÔÛ›·, ·‰˘Ó·Ì›· ‚¿‰ÈÛË˜ Î·È, ÙÂÏÈÎ¿, ı¿Ó·ÙÔ Ïfi-Áˆ ¤ÎÙˆÛË˜ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ

July August 04 07-10-04 13:52 ™ÂÏ›‰·232

233


Ì˘ÒÓ. O ·ÛıÂÓ‹˜ ‰È·ÙËÚÂ› Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÈÛıËÙÈÎfi-ÙËÙ· Î·È ÓÂ˘Ì·ÙÈÎ‹ ‰È·‡ÁÂÈ·.

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ¿-‚ÂÈ ÙË Ì˘·Ûı¤ÓÂÈ· gravis Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Guillain-Barre. ∏ ˘ÔÛÙËÚÈÎÙÈÎ‹ ıÂÚ·Â›· Èı·ÓfiÓ ··ÈÙÂ›ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜, Ô˘ ÌÔÚÂ› Ó·‰È·ÚÎ¤ÛÂÈ ·ÎfiÌË Î·È Ì‹ÓÂ˜. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Î·ıÈ-ÛÙ¿ È‰È·›ÙÂÚ· ÚÔ‚ÏËÌ·ÙÈÎ‹ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ·ÛıÂÓÒÓ ÛÂ ÂÚ›ÙˆÛË Ì·˙ÈÎÒÓ ÎÚÔ˘ÛÌ¿ÙˆÓ.

™ÙÈ˜ ∏¶∞ Â›Ó·È ‰È·ı¤ÛÈÌÂ˜ Ë ›ÂÈÔ˜ ÙÚÈ‰‡Ó·ÌË·ÓÙÈÙÔÍ›ÓË ÙÔ˘ CDC (ÔÚfiÙ˘ÔÈ ∞, µ Î·È ∂, 1 ÊÈ·Ï›-‰ÈÔ ÙˆÓ 10 ml IV), Ë ›ÂÈÔ˜ ÂÙ·‰‡Ó·ÌË ·ÓÙÈÙÔÍ›ÓËÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÕÌ˘Ó·˜ (ÔÚfiÙ˘ÔÈ A ¤ˆ˜ G), Ë·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ÔÔ›·˜ ÛÂ ·ÓıÚÒÔ˘˜‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, Î·ıÒ˜ Î·È Ë ÂÓÙ·‰‡Ó·ÌË (ÔÚfi-Ù˘ÔÈ ∞-∂) ·ÓÔÛÔÛÊ·ÈÚ›ÓË ÙË˜ ¢ÈÂ‡ı˘ÓÛË˜ ÀÁÂ›·˜ÙË˜ ∫·ÏÈÊfiÚÓÈ·, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ‚ÚÂÊÈ-Î‹˜ ·ÏÏ·ÓÙ›·ÛË˜, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÛÙ¿‰ÈÔ ÎÏÈÓÈ-ÎÒÓ ‰ÔÎÈÌÒÓ (37,38).

πÔÁÂÓÂ›˜ ·ÈÌÔÚÚ·ÁÈÎÔ› ˘ÚÂÙÔ› ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ

Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÏÔ›ÌˆÍË ·fi ÚÈ‚Ô˚Ô‡˜ (RNA ÈÔ‡˜).Ã·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÂÌÊ¿ÓÈÛË ÔÍÂ›·˜ ÂÌ‡ÚÂÙË˜Û˘Ó‰ÚÔÌ‹˜, Û˘ÓÔ‰Â˘fiÌÂÓË˜ ·fi Î·ÎÔ‰È·ıÂÛ›·, ÛË-ÌÂ›· ·˘ÍËÌ¤ÓË˜ ·ÁÁÂÈ·Î‹˜ ‰È·ÂÚ·ÙfiÙËÙ·˜ Î·È Î˘-ÎÏÔÊÔÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜. ∞ÈÌÔÚÚ·Á›· ·ÂÈÏËÙÈÎ‹ ÁÈ·ÙË ˙ˆ‹ ÂÌÊ·Ó›˙ÂÙ·È Û¿ÓÈ·, ·Ó Î·È Ë ·ÈÌÔÚÚ·ÁÈÎ‹‰È¿ıÂÛË Â›Ó·È Û˘¯Ó‹, ̂ ˜ ·ÔÙ¤ÏÂÛÌ· ‚Ï¿‚Ë˜ ÙÔ˘ ·Á-ÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘. ªÂÙ·‰›‰ÔÓÙ·È ÛÙÔÓ ¿ÓıÚˆÔÌÂÙ¿ ·fi Â·Ê‹ ÌÂ ÌÔÏ˘ÛÌ¤Ó· ˙Ò· ‹ ·ÚıÚfiÔ‰·, ËÁÂˆÁÚ·ÊÈÎ‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ÔÔ›ˆÓ Î·ıÔÚ›˙ÂÈ Û˘¯Ó¿ÙË ÁÂˆÁÚ·ÊÈÎ‹ ÂÓÙfiÈÛË ÙË˜ ÓfiÛÔ˘ Î·È ÙËÓ ÔÓÔÌ·-ÙÔÏÔÁ›· ÙË˜. ¶ÚfiÛÊ·ÙÂ˜ ‰ËÌÔÁÚ·ÊÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜¤¯Ô˘Ó ÚÔÎ·Ï¤ÛÂÈ ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÓıÚÒÈÓˆÓÎÚÔ˘ÛÌ¿ÙˆÓ. OÈ ÈÔÁÂÓÂ›˜ ·˘ÙÔ› ·Ú¿ÁÔÓÙÂ˜ ·ÚÔ˘-ÛÈ¿˙Ô˘Ó ˘„ËÏ‹ ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ˘fi ÌÔÚÊ‹ ·ÂÚÔÛfi-ÏË˜, Û˘Ó‰˘¿˙Ô˘Ó ˘„ËÏ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·Î·È Ë ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ÛÂ Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈ-Â˜ ÙÔ˘˜ Î·ıÈÛÙ¿ ÈÛ¯˘Úfi ‚ÈÔÏÔÁÈÎfi fiÏÔ.

πÔ› ·fi ÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÙˆÓ Arenaviridae,Bunyaviridae, Filoviridae Î·È Flaviviridae ÂÚÈÏ·Ì-‚¿ÓÔÓÙ·È ÛÙÔ˘˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

™ÙÔ˘˜ Arenaviridae (·ÚÂÓ·˚Ô‡˜) Û˘ÁÎ·Ù·Ï¤ÁÔ-ÓÙ·È Ô Èfi˜ ÙÔ˘ ˘ÚÂÙÔ‡ Lassa (Èfi˜ Lassa) (39,40)Î·È ÔÈ ÈÔ› ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÚÂÙÔ‡ ÙË˜ ∞ÚÁÂÓÙÈ-Ó‹˜, ÙË˜ µÔÏÈ‚›·˜, ÙË˜ µÂÓÂ˙Ô˘¤Ï·˜ Î·È ÙË˜ µÚ·˙È-Ï›·˜ (ÈÔ› Junin, Machupo, Guanarito Î·È Sabia, ·ÓÙ›-ÛÙÔÈ¯·) (41-46).

™ÙÔ˘˜ Bunyaviridae Û˘ÁÎ·Ù·Ï¤ÁÂÙ·È Ô Èfi˜ ÙÔ˘˘ÚÂÙÔ‡ ÙË˜ ÎÔÈÏ¿‰·˜ Rift (47), ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿-ÁÔÓÙ·˜ ÂÈ‰ËÌ›·˜ ÛÙËÓ ∞ÊÚÈÎ‹ Ô˘ Û˘Ó‰¤ıËÎÂ ÌÂ·Û˘Ó‹ıÈÛÙË ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÎÔ˘ÓÔ˘ÈÒÓÛÙËÓ ÂÚÈÔ¯‹, Ô Èfi˜ ÙÔ˘ ˘ÚÂÙÔ‡ ÙÔ˘ ∫ÔÓÁÎfi Î·È ÙË˜

∫ÚÈÌ·›·˜ (48) Î·È Ô hantavirus Ô˘ ÌÂÙ·‰›‰ÂÙ·È ·fiÙÚˆÎÙÈÎ¿, Ô ÔÔ›Ô˜ ˆÛÙfiÛÔ ‰ÂÓ ÚÔÛÊ¤ÚÂÙ·È ÁÈ··Ó¿Ù˘ÍË ‚ÈÔÏÔÁÈÎÔ‡ fiÏÔ˘, ÏfiÁˆ ÙË˜ Ùˆ¯‹˜ ·Ó·-·Ú·ÁˆÁ‹˜ ÙÔ˘ ÛÂ Î˘ÙÙ·ÚÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ (49).

OÈ Filoviridae (ÊÈÏÔ˚Ô›) ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ˘˜ ÈÔ‡˜ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÚÂÙÔ‡ Ebola Î·È ÙÔÓ Èfi ÙË˜ Ófi-ÛÔ˘ Marburg (50-53). OÈ ÈÔ› ·˘ÙÔ› ‚Ú¤ıËÎ·Ó ÛÙÔ Â›-ÎÂÓÙÚÔ ÙË˜ ‰ËÌÔÛÈfiÙËÙ·˜ ÏfiÁˆ ÙË˜ ÚfiÎÏËÛË˜ÂÎÚËÎÙÈÎÒÓ - ·ÏÏ¿, Ù·˘Ùfi¯ÚÔÓ·, ÂÚÈÔÚÈÛÌ¤ÓˆÓ ÁÂˆ-ÁÚ·ÊÈÎ¿ - ÂÈ‰ËÌÈÒÓ. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ÈÔ‡ Ebola,ÔÈ ÂÈ‰ËÌÈÎ¤˜ ÂÍ¿ÚÛÂÈ˜ ÛÙÔ ∑·˝Ú Î·È ÙÔ ™Ô˘‰¿Ó, ÙÔ1976, Û˘ÓÔ‰Â‡ÙËÎ·Ó ·fi ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ 92%Î·È 53%, ·ÓÙ›ÛÙÔÈ¯·. øÛÙfiÛÔ, Ë Î·Ù¿ÛÙ·ÛË ÂÈ‰ÂÈ-ÓÒıËÎÂ ·fi ÙËÓ Â·Ó·¯ÚËÛÈÌÔÔ›ËÛË Û˘Ú›ÁÁˆÓ, ‚Â-ÏÔÓÒÓ Î·È ÏÔÈÔ‡ ÓÔÛÔÎÔÌÂÈ·ÎÔ‡ ÂÍÔÏÈÛÌÔ‡.

OÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹ÚÂ˜ ÙË˜ Û˘Ó‰ÚÔÌ‹˜ Â›Ó·È·ÔÙ¤ÏÂÛÌ· ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈÎ‹˜ ‚Ï¿‚Ë˜ Î·È ÌÂ-Ù·‚ÔÏÒÓ ÙË˜ ·ÁÁÂÈ·Î‹˜ ‰È·ÂÚ·ÙfiÙËÙ·˜. ∆· ·Ú¯È-Î¿ Û˘ÌÙÒÌ·Ù· Â›Ó·È ÌË ÂÈ‰ÈÎ¿ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó˘ÚÂÙfi, Ì˘·ÏÁ›· Î·È Î·ÎÔ‰È·ıÂÛ›·. ∏ ÎÏÈÓÈÎ‹ ÂÍ¤-Ù·ÛË ·ÔÎ·Ï‡ÙÂÈ ¤ÓÂÛË ÂÈÂÊ˘ÎfiÙˆÓ, ‹È· ˘fi-Ù·ÛË, ÂÚ‡ıËÌ· ÚÔÛÒÔ˘ Î·È ÂÙÂ¯ÂÈÒ‰ÂÈ˜ ‚Ï¿-‚Â˜. ™ÙËÓ Ï‹ÚË ¤ÎÊÚ·Û‹ ÙË˜, Ë Û˘Ó‰ÚÔÌ‹ ÂÚÈ-Ï·Ì‚¿ÓÂÈ ÁÂÓÈÎÂ˘Ì¤ÓË ·ÈÌÔÚÚ·Á›· ÙˆÓ ‚ÏÂÓÓÔÁfi-ÓˆÓ, Ë·ÙÈÎ‹ ‚Ï¿‚Ë, ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÚÔÛ‚Ô-Ï‹ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡, ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È ·ÈÌÔÔÈËÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Î·Ù·ÏËÍ›·, ÂÓÒ Ô ·ÛıÂÓ‹˜ Î·Ù·-Ï‹ÁÂÈ ·fi ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·. øÛÙfiÛÔ,Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÌÔÚÊ¤˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ˘ÚÂÙÔ‡ ‰È·-ÙËÚÔ‡Ó Î¿ÔÈ· ÌÔÚÊ‹ ÂÙÂÚÔÁ¤ÓÂÈ·˜, fiˆ˜ ÁÈ· ·-Ú¿‰ÂÈÁÌ· Ô ˘ÚÂÙfi˜ Lassa, ÛÙÔÓ ÔÔ›Ô Ë ·ÈÌÔÚÚ·-ÁÈÎ‹ ‰È¿ıÂÛË Î·È ÔÈ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÈÏÔÎ¤˜ Â›Ó·ÈÛ¿ÓÈÂ˜, ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· Û‡Ó‰ÚÔÌ· Ô˘ ÚÔÎ·-ÏÔ‡ÓÙ·È ·fi ÙÔ˘˜ ·ÚÂÓ·˚Ô‡˜ ÙË˜ ¡. ∞ÌÂÚÈÎ‹˜, fiÔ˘ÔÈ ÂÈÏÔÎ¤˜ ·˘Ù¤˜ Â›Ó·È Û˘ÓËıÈÛÌ¤ÓÂ˜. OÈ ÊÈÏÔ˚Ô›Marburg Î·È Ebola ÚÔÎ·ÏÔ‡Ó Û˘¯Ó¿ ÂÎÛÂÛËÌ·-ÛÌ¤Ó· ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Ë ÂÍ·Óı‹Ì·Ù· Î·È Î·Ù·Ï‹-ÁÔ˘Ó ÛÂ ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂÈ·Î‹ ‹ÍË (¢∂¶).

∏ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Î˘Ú›ˆ˜ Û˘ÌÙˆÌ·ÙÈÎ‹,ÂÓÒ È‰È·›ÙÂÚË ÊÚÔÓÙ›‰· ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·ÈÁÈ· ÙË ÌÂ›ˆÛË ÙˆÓ ¯ÂÈÚÈÛÌÒÓ Î·È ÙˆÓ È·ÙÚÈÎÒÓ Ú¿-ÍÂˆÓ ÛÙÔ˘˜ ·fiÏ˘Ù· ··Ú·›ÙËÙÔ˘˜, ÏfiÁˆ ÙË˜ ·Á-ÁÂÈ·Î‹˜ Â˘ıÚ·˘ÛÙfiÙËÙ·˜. ¢È¯ÔÁÓˆÌ›· ÂÈÎÚ·ÙÂ›ÛÙÔ ı¤Ì· ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓÂÈÏÔÎÒÓ, ÌÂ ÂÈÎÚ·ÙÔ‡Û· ÙËÓ ¿Ô„Ë ÙË˜ ÌË ·-Ú¤Ì‚·ÛË˜ ÛÂ ‹ÈÂ˜, ÌË ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹, ·È-ÌÔÚÚ·ÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜. OÈ ‰Â˘ÙÂÚÔ·ıÂ›˜ ÏÔÈÌÒ-ÍÂÈ˜ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Î·È Ó· ¯ÔÚËÁÂ›Ù·ÈË·Ú›ÓË ÛÂ ÂÚÁ·ÛÙËÚÈ·Î¿ ÂÈ‚Â‚·ÈˆÌ¤ÓÂ˜ ÌÔÚÊ¤˜¢∂¶. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘fiÙ·ÛË˜ Î·È ÙË˜ Î·Ù·-ÏËÍ›·˜ Û˘¯Ó¿ ÂÁÎ˘ÌÔÓÂ› ÎÈÓ‰‡ÓÔ˘˜, Î·ıÒ˜ Ë ·˘-ÍËÌ¤ÓË ·ÁÁÂÈ·Î‹ ‰È·ÂÚ·ÙfiÙËÙ· ÌÔÚÂ› Ó· Ô‰ËÁ‹-ÛÂÈ ÛÂ Ù·¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓÔ ÓÂ˘ÌÔÓÈÎfi Ô›‰ËÌ·. ∏

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·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ·ÚÂÓ·˚Ô‡˜ ÌÂ ÚÈ-Ì·‚ÈÚ›ÓË Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Â¿Ó·Ú¯›ÛÂÈ ÂÓÙfi˜ 7 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘.™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ˘ÚÂÙÔ‡ ÙË˜ ∞ÚÁÂÓÙÈÓ‹˜ Î·ÈÙË˜ µÔÏÈ‚›·˜, ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙÂ› ÌÂ ÂÈÙ˘¯›· Ë ¯ÔÚ‹-ÁËÛË Ï¿ÛÌ·ÙÔ˜ ·ÛıÂÓÔ‡˜ ÛÂ ·Ó¿ÚÚˆÛË, ÂÊfiÛÔÓË ıÂÚ·Â›· ·Ú¯›ÛÂÈ ÂÓÙfi˜ 8 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·Ú-ÍË ÙË˜ ÓfiÛÔ˘. ∆¤ÏÔ˜, ÂÌ‚fiÏÈ· ‚Ú›ÛÎÔÓÙ·È ÛÂ ÛÙ¿‰ÈÔ·ÍÈÔÏfiÁËÛË˜ ·fi ÙÔ USAMRIID ÁÈ· ÙÔ˘˜ ÈÔ‡˜ ÙÔ˘˘ÚÂÙÔ‡ ÙË˜ ÎÔÈÏ¿‰·˜ Rift, ÙË˜ ∞ÚÁÂÓÙÈÓ‹˜ Î·È ÙË˜µÔÏÈ‚›·˜ (54,55).

µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·ÙËÁÔÚ›·˜ µ ƒÈÎ›ÓË (ricin) ∏ ÙÔÍ›ÓË ÚÈÎ›ÓË Â›Ó·È ÚÔ˚fiÓ ÙÔ˘ ÔÏÈÁÔÂÙÔ‡˜ Ô-

Ò‰Ô˘˜ Ê˘ÙÔ‡ Î›ÎÈ˜ (Ô) ‹ Ú›ÎÈÓÔ˜ (Ricinuscommunis), ·fi ÙÔ ÔÔ›Ô ·Ú¿ÁÂÙ·È ÙÔ Î·ÛÙÔÚ¤-Ï·ÈÔ Î·È ÙÔ ÔÔ›Ô Â˘‰ÔÎÈÌÂ› ÙfiÛÔ ÛÙË ¯ÒÚ· Ì·˜fiÛÔ Î·È ·ÁÎfiÛÌÈ·. ¶ÚfiÛÊ·Ù·, ˘‹ÚÍ·Ó ·Ó·ÊÔ-Ú¤˜ ÛÙ· ¢ÈÂıÓ‹ ª¤Û· ∂ÓËÌ¤ÚˆÛË˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ·Ó·Î¿Ï˘„Ë Î·È Î·Ù¿Û¯ÂÛË ·fi ÙÈ˜ ∞Ú¯¤˜ ∞ÛÊ·ÏÂ›-·˜, ÛËÌ·ÓÙÈÎÒÓ ÔÛÔÙ‹ÙˆÓ ÚÈÎ›ÓË˜ ÛÙËÓ πÙ·Ï›· Î·ÈÙË ª. µÚÂÙ·Ó›·, ÔÈ ÔÔ›Â˜ ÚÔÔÚ›˙ÔÓÙ·Ó ÁÈ· ÙÚÔÌÔ-ÎÚ·ÙÈÎ‹ ¯Ú‹ÛË (56,57). ∏ ÚÈÎ›ÓË ÌÔÚÂ› Ó· ·Ú·-¯ıÂ› Â‡ÎÔÏ· Î·È ÛÂ ÌÂÁ¿ÏÂ˜ ÔÛfiÙËÙÂ˜. ªÔÚÂ› Ó·‰È·Û·ÚÂ› ÌÂ ÙË ÌÔÚÊ‹ ·ÂÚÔÛfiÏË˜ Î·È Ó· ÂÈÛ¤ÏıÂÈÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi ‹, Ì¤Ûˆ ÌÔÏ˘ÛÌ¤ÓË˜ ÙÚÔÊ‹˜ ‹‡‰·ÙÔ˜, Ó· ÚÔÛ‚¿ÏÏÂÈ ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi. ∏ ‰ËÏË-ÙËÚ›·ÛË ÌÔÚÂ› Ó· ·Ô‚Â› ÌÔÈÚ·›·, Î·ıÒ˜ ‰ÂÓ ‰È·-Ù›ıÂÙ·È ıÂÚ·Â›· ‹ ·ÓÙ›‰ÔÙÔ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Â›-Ó·È ·Ï¿ ˘ÔÛÙËÚÈÎÙÈÎ‹. ∂ÈÛÂÚ¯fiÌÂÓË ÛÙÔ ·Ó·-ÓÂ˘ÛÙÈÎfi, Ë ÚÈÎ›ÓË ÚÔÎ·ÏÂ› ·‰˘Ó·Ì›·, ˘ÚÂÙfi,‚‹¯·, ‚ÚÔÁ¯fiÛ·ÛÌÔ Î·È, ÙÂÏÈÎ¿, ÓÂ˘ÌÔÓÈÎfi Ô›‰Ë-Ì·. O ·ÛıÂÓ‹˜ Î·Ù·Ï‹ÁÂÈ ÂÓÙfi˜ 3 ËÌÂÚÒÓ. ŸÙ·Ó Ë‡ÏË ÂÈÛfi‰Ô˘ Â›Ó·È ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ÌÔÚÂ› Ó·ÚÔÎ·Ï¤ÛÂÈ ÂÓÙÂÚÈÎ‹ ·ÈÌÔÚÚ·Á›· Î·È ÔÏ˘ÔÚÁ·ÓÈÎ‹·ÓÂ¿ÚÎÂÈ·.

Ã∏ªπ∫Oπ ¶∞ƒA°O¡∆∂™ ∏ ÚÒÙË, ÂÎÙÂÙ·Ì¤ÓË˜ ÎÏ›Ì·Î·˜, ¯Ú‹ÛË ¯ËÌÈ-

ÎÒÓ fiÏˆÓ ¤Ï·‚Â ¯ÒÚ· Î·Ù¿ ÙÔÓ ∞’ ¶·ÁÎfiÛÌÈÔ ¶fi-ÏÂÌÔ, ÚÔÎ·ÏÒÓÙ·˜ ÂÎ·ÙfiÌ‚Â˜ ı˘Ì¿ÙˆÓ. ™ÙÈ˜ ËÌ¤-ÚÂ˜ Ì·˜, Ë ÚÒÙË Â›ıÂÛË ·fi ÙÚÔÌÔÎÚ·ÙÈÎ‹ ÔÚ-Á¿ÓˆÛË ¤ÁÈÓÂ ÙÔ 1995, ÌÂ ÙË ¯Ú‹ÛË ÙÔ˘ ·ÂÚ›Ô˘sarin ÛÙÔÓ ˘fiÁÂÈÔ ÛÈ‰ËÚfi‰ÚÔÌÔ ÙÔ˘ ∆fiÎÈÔ (2). OÈÙÔÍÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ ·fi ÙË ¯Ú‹ÛË ¯ËÌÈÎÒÓ fiÏˆÓÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔÈÎ¤˜ ‚Ï¿‚Â˜ ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜,ÙÔ ‰¤ÚÌ·, ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ Î·È ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfiÛ‡ÛÙËÌ·, Î·ıÒ˜ Î·È Û˘ÛÙËÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜, ÏfiÁˆ·ÔÚÚfiÊËÛË˜ ÙÔ˘ ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·fi ÙÔ·Ó·ÓÂ˘ÛÙÈÎfi ‹ ÙÔ ‰¤ÚÌ·.

OÈ ÁÂÓÈÎ¤˜ ·Ú¯¤˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ı˘Ì¿ÙˆÓÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ú¯ÈÎ‹ ·ÍÈÔÏfiÁËÛË Î·È ‰È·ÏÔÁ‹

(triage) ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡, ¤Ó·ÚÍË Î·Ú‰ÈÔÓÂ˘ÌÔÓÈ-Î‹˜ ·Ó·˙ˆÔÁfiÓËÛË˜ - ·Ó ··ÈÙÂ›Ù·È - Î·È ·ÔÏ‡-Ì·ÓÛË, ·fi ÚÔÛˆÈÎfi Ô˘ Ê¤ÚÂÈ ÙÔÓ Î·Ù¿ÏÏËÏÔÂÍÔÏÈÛÌfi (57,58). ∏ ‰È·‰ÈÎ·Û›· ÙË˜ ·ÔÏ‡Ì·ÓÛË˜ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Ï‹ÚË ·Ê·›ÚÂÛË ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓÙÔ˘ ·ÛıÂÓÔ‡˜, Ì›· ·Ï‹ ÂÓ¤ÚÁÂÈ· Ô˘ Â›Ó·È ÈÎ·Ó‹Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌfiÏ˘ÓÛË˜ Î·Ù¿ 80-90%, ÂÓÒÛÙË Û˘Ó¤¯ÂÈ· ·ÎÔÏÔ˘ıÂ› ÛÙ¿‰ÈÔ ÂÚ·ÈÙ¤Úˆ ·ÔÏ‡-Ì·ÓÛË˜ (59). °È· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¤ÎıÂÛË ÛÂ·ÙÌÔ‡˜, ··ÈÙÂ›Ù·È ÂÈÏ¤ÔÓ ÌfiÓÔ Ï‡ÛÈÌÔ ÎÂÊ·-Ï‹˜. ∞ÓÙ›ıÂÙ·, ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¤ÎıÂÛË ÛÂ˘ÁÚ¿, ··ÈÙÂ›Ù·È Ï‹ÚË˜ ‰È·‰ÈÎ·Û›· ·ÔÏ‡Ì·ÓÛË˜,Ë ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÂÈ Ï‡ÛÈÌÔ ‰¤ÚÌ·ÙÔ˜ Î·È ÎÂÊ·-Ï‹˜, ÌÂ ‹ÈÔ ÙÚfiÔ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Û·Ô‡ÓÈ Î·È¿ÊıÔÓÔ ÓÂÚfi, Í¤Ï˘Ì· ÙˆÓ ÔÊı·ÏÌÒÓ ÌÂ ¿ÊıÔÓÔÊ˘ÛÈÔÏÔÁÈÎfi ÔÚfi Î·È ÚÔÛÂÎÙÈÎ‹ ‰È·¯Â›ÚÈÛË ÙˆÓÂÓ‰˘Ì¿ÙˆÓ Î·È ÙˆÓ ÚÔÛˆÈÎÒÓ ·ÓÙÈÎÂÈÌ¤ÓˆÓ, Ù·ÔÔ›· ı· Ú¤ÂÈ Ó· ÙÔÔıÂÙÔ‡ÓÙ·È ÛÂ ÂÈ‰ÈÎÔ‡˜ Û¿-ÎÔ˘˜. OÚÈÛÌ¤ÓÂ˜ ˘ÁÂÈÔÓÔÌÈÎ¤˜ ·Ú¯¤˜ Û˘ÓÈÛÙÔ‡ÓÏ‡ÛÈÌÔ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÌÂ ‰È¿Ï˘Ì· ˘Ô¯ÏˆÚÈÒ‰Ô˘˜Ó·ÙÚ›Ô˘ 0,48% (‰È¿Ï˘Ì· ¯ÏˆÚ›ÓË˜ ÙÔ˘ ÂÌÔÚ›Ô˘),ˆÛÙfiÛÔ, ¤¯Ô˘Ó ÂÎÊÚ·ÛÙÂ› ÂÈÊ˘Ï¿ÍÂÈ˜, Î·ıÒ˜ Ô‰ÂÚÌ·ÙÈÎfi˜ ÂÚÂıÈÛÌfi˜ Ô˘ ÚÔÎ·ÏÂ›Ù·È ÌÔÚÂ› Ó··˘Í‹ÛÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È, Î·Ù¿Û˘Ó¤ÂÈ·, ÙËÓ ·ÔÚÚfiÊËÛË ÙÔ˘ ‚Ï·ÙÈÎÔ‡ ·Ú¿-ÁÔÓÙ·. ∂ÈÏ¤ÔÓ, Ë ÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ÛÂ·È‰È¿ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË. ∏ ‰È·¯Â›ÚÈÛË ÙˆÓ ı˘Ì¿-ÙˆÓ ÂÁÎ˘ÌÔÓÂ› ÛËÌ·ÓÙÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔÂÌÏÂÎfiÌÂÓÔ ÚÔÛˆÈÎfi, ÙÔ ÔÔ›Ô ı· Ú¤ÂÈ ˘Ô-¯ÚÂˆÙÈÎ¿ Ó· Ê¤ÚÂÈ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÂÍÔÏÈÛÌfi. π‰·-ÓÈÎ¿, Ë ·Ú¯ÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ı˘Ì¿ÙˆÓ ı· Ú¤-ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ÛÂ ÚÔÂÈÏÂÁÌ¤ÓÔ˘˜ ¯ÒÚÔ˘˜,fiÔ˘ ¤¯Ô˘Ó ·Ó·Ù˘¯ıÂ› ÔÈ ··ÈÙÔ‡ÌÂÓÂ˜ ÁÈ· ÙËÓÂÚ›ÛÙ·ÛË ÂÈ‰ÈÎ¤˜ ÌÔÓ¿‰Â˜. ™ÙÔÓ ¶›Ó·Î· 3 ÂÚÈ-ÁÚ¿ÊÔÓÙ·È ÔÈ ‚·ÛÈÎÔ› ¯·Ú·ÎÙ‹ÚÂ˜, Ù· ÎÏÈÓÈÎ¿ Â˘Ú‹-Ì·Ù· Î·È ÔÈ ÚÔÙÂÈÓfiÌÂÓÔÈ ÙÚfiÔÈ ·ÓÙÈÌÂÙÒÈÛË˜ÁÈ· ÙÔ˘˜ Î˘ÚÈfiÙÂÚÔ˘˜ ¯ËÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ ¶ÚfiÎÂÈÙ·È ÁÈ· ÔÚÁ·ÓÔÊˆÛÊÔÚÈÎ¿ Û˘ÌÏ¤ÁÌ·Ù·

Ô˘ ÚÔÎ·ÏÔ‡Ó ·Ó·ÛÙÔÏ‹ ÙË˜ ·ÎÂÙ˘ÏÔ¯ÔÏÈÓÂÛÙÂ-Ú¿ÛË˜, Î·Ù¿ ÙÚfiÔ ·ÚfiÌÔÈÔ ÌÂ ·˘ÙfiÓ ÙˆÓ ÔÚÁ·-ÓÔÊˆÛÊÔÚÈÎÒÓ ÂÓÙÔÌÔÎÙfiÓˆÓ. Àfi ·˘Ùfi ÙÔ Ú›-ÛÌ·, ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ¯ËÌÈÎfi fiÏÔ ÌÂ ÙÔ ÔÔ›Ô Â›-Ó·È Ï¤ÔÓ ÂÍÔÈÎÂÈˆÌ¤ÓÔ˜ Ô Û‡Á¯ÚÔÓÔ˜ ·È‰›·ÙÚÔ˜.∏ ·Ó·ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË Î·ı›ÛÙ·Ù·È ÌË ·Ó·ÛÙÚ¤„ÈÌËÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ì›· ‰È·‰ÈÎ·Û›· Ô˘ Â›-Ó·È ÁÓˆÛÙ‹ Î·È ˆ˜ “Á‹Ú·ÓÛË”. ∏ Î·ÙËÁÔÚ›· ÂÚÈ-Ï·Ì‚¿ÓÂÈ 10 ·Ú¿ÁÔÓÙÂ˜ (¶›Ó·Î·˜ 3), ÔÈ ÔÔ›ÔÈÚÔÎ·ÏÔ‡Ó ÙÔÍÈÎfiÙËÙ· Ì¤Ûˆ ÂÈÛÓÔ‹˜, Î·Ù¿ÔÛË˜Î·È ‰ÂÚÌ·ÙÈÎ‹˜ ·ÔÚÚfiÊËÛË˜ (ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÈ‰ÈÎ¿ÁÈ· ÙÔÓ VX ‹ Venom X) (60). ∏ Â›‰Ú·ÛË ÛÙËÓ ·ÎÂ-Ù˘ÏÔ¯ÔÏÈÓÂÛÙÂÚ¿ÛË ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË Û˘Û-ÛÒÚÂ˘ÛË ·ÎÂÙ˘ÏÔ¯ÔÏ›ÓË˜ ÛÙÈ˜ ÓÂ˘ÚÈÎ¤˜ Û˘Ó¿„ÂÈ˜,

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Ë ÔÔ›· ÌÂ ÙË ÛÂÈÚ¿ ÙË˜ ÚÔÎ·ÏÂ› ‰È¤ÁÂÚÛË ÙÔ˘ ¯Ô-ÏÈÓÂÚÁÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡. ∆Ô ¯ÔÏÈÓÂÚÁÈÎfi Û‡Ó‰ÚÔÌÔ‰È·ÎÚ›ÓÂÙ·È ÛÂ 3 ÌÔÚÊ¤˜: ÙËÓ ÎÂÓÙÚÈÎ‹ (·ÊÔÚ¿ ÛÙÔ∫¡™), ÙË ÓÈÎÔÙÈÓÈÎ‹ (·ÊÔÚ¿ ÛÙË ÓÂ˘ÚÔÌ˘˚Î‹ Û‡Ó·-„Ë Î·È ÛÙ· Û˘Ì·ıËÙÈÎ¿ Á¿ÁÁÏÈ·) Î·È ÙË ÌÔ˘ÛÎ·ÚÈ-ÓÈÎ‹ (·ÊÔÚ¿ ÛÙÈ˜ ÏÂ›Â˜ Ì˘˚Î¤˜ ›ÓÂ˜ Î·È ÛÙÔ˘˜ ÂÍˆ-ÎÚÈÓÂ›˜ ·‰¤ÓÂ˜). OÈ ÎÂÓÙÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÂÚÈÏ·Ì-‚¿ÓÔ˘Ó ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘ÓÂ›‰ËÛË˜, ÂÍÂ-ÏÈÛÛfiÌÂÓË ÛÙ·‰È·Î¿ ÛÂ Ï‹ı·ÚÁÔ Î·È ÎÒÌ·, ·Ù·Í›·,Û·ÛÌÔ‡˜ Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ Î·Ù·ÛÙÔÏ‹. ∏ ‰È·Ù·-Ú·¯‹ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÓÂ˘ÚÔÌ˘˚ÎÒÓ Û˘Ó¿„ÂˆÓÔ˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÈ˜ ÓÈÎÔÙÈÓÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, Ô‰Ë-ÁÂ› ÛÂ Ì˘˚Î¤˜ ‰ÂÛÌÈ‰ÒÛÂÈ˜ Î·È ·‰˘Ó·Ì›·, Ô˘ ÂÍÂ-Ï›ÛÛÂÙ·È ÛÂ ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË, ÂÓÒ ÔÈ ‰È·Ù·Ú·¯¤˜ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ÚÔÎ·ÏÔ‡Ó Ù·¯˘Î·Ú‰›·, ˘¤Ú-Ù·ÛË Î·È ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (˘ÂÚÁÏ˘Î·ÈÌ›·,˘ÔÎ·ÏÈ·ÈÌ›· Î·È ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË). OÈ ÌÔ˘ÛÎ·-ÚÈÓÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÚÔÎ·ÏÔ‡Ó ÔÊı·ÏÌÈÎ¤˜ ‰È·Ù·-Ú·¯¤˜ (Ì‡ÛË, ıfiÏˆÛË fiÚ·ÛË˜, ‰·ÎÚ‡ÚÚÔÈ·,ÔÊı·ÏÌÈÎfi ¿ÏÁÔ˜), ·Ó·ÓÂ˘ÛÙÈÎ¤˜ (Î·Ù·ÚÚÔ‹,‚ÚÔÁ¯fiÛ·ÛÌÔ, ·‡ÍËÛË ‚ÚÔÁ¯ÈÎÒÓ ÂÎÎÚ›ÛÂˆÓ, ‰‡-ÛÓÔÈ·, Î˘¿ÓˆÛË), Î·Ú‰È·ÁÁÂÈ·Î¤˜ (‚Ú·‰˘Î·Ú‰›·,˘fiÙ·ÛË, ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi), ‰ÂÚÌ·ÙÈÎ¤˜(ÂÚ‡ıËÌ·, ÂÊ›‰ÚˆÛË), Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ (ÛÈÂÏfiÚ-ÚÔÈ·, Ó·˘Ù›·, ¤ÌÂÙÔ, ‰È¿ÚÚÔÈ· ÂÍÂÏÈÛÛfiÌÂÓË ÛÂ·ÎÚ¿ÙÂÈ· ÎÔÚ¿ÓˆÓ, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜) Î·È Ô˘ÚÔÁÂÓ-ÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (·ÎÚ¿ÙÂÈ· Ô‡ÚˆÓ, Û˘¯ÓÔ˘Ú›·).

∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi, ÛÙËÓ ÎÏÈÓÈ-Î‹ ÂÈÎfiÓ· Î·È ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÂÈ¤‰ˆÓ ·ÎÂÙ˘-ÏÔ¯ÔÏÈÓÂÛÙÂÚ¿ÛË˜ ÛÙÔ Ï¿ÛÌ· Î·È Ù· ÂÚ˘ıÚÔÎ‡Ù-Ù·Ú·. OÈ ‚·ÛÈÎ¤˜ ·Ú¯¤˜ ·ÔÏ‡Ì·ÓÛË˜ Î·È ıÂÚ·Â›-·˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 (61,62).

ºÏ˘ÎÙ·ÈÓÔÁfiÓ· O Î‡ÚÈÔ˜ fiÁÎÔ˜ ÙˆÓ ·Ó·ÊÔÚÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È-

‚ÏÈÔÁÚ·Ê›· ·ÊÔÚ¿ Î˘Ú›ˆ˜ ÛÙË ÌÔ˘ÛÙ¿Ú‰·, ¤Ó·Î˘ÙÙ·ÚÈÎfi ‰ËÏËÙ‹ÚÈÔ Ô˘ ‰Ú· ·ÏÎ˘ÏÈÒÓÔÓÙ·˜ ÙÔÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ DNA. ∂ÎÙfi˜ ·fi ÙÔÓ ∞’ Î·È µ’ ¶·ÁÎfi-ÛÌÈÔ ¶fiÏÂÌÔ, ÙÔ ·¤ÚÈÔ ÌÔ˘ÛÙ¿Ú‰·˜ ¯ÚËÛÈÌÔÔÈ‹-ıËÎÂ Î·È ÛÙÔÓ fiÏÂÌÔ πÚ¿Ó-πÚ¿Î ÛÙ· Ì¤Û· ÙË˜ ‰Â-Î·ÂÙ›·˜ ÙÔ˘ ’80. ª›· ÌÂÏ¤ÙË 14 ·È‰ÈÒÓ-ı˘Ì¿ÙˆÓ·fi ÙÔ πÚ¿Ó, ÂÈ‚Â‚·›ˆÛÂ ÙË ıÂˆÚ›· ÁÈ· ‚·Ú‡ÙÂÚËÚÔÛ‚ÔÏ‹ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÂ ÂÚ›ÙˆÛË‚ÈÔ¯ËÌÈÎ‹˜ Â›ıÂÛË˜ (63-65).

¶ÓÂ˘ÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ∏ ¯ÏˆÚ›ÓË Î·È ÙÔ ÊˆÛÁ¤ÓÈÔ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó

ˆ˜ ÂÈıÂÙÈÎ¿ fiÏ· ÛÙÔÓ ∞’ ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ÂÓÒÛ‹ÌÂÚ· ‚Ú›ÛÎÔ˘Ó ·ÚÎÂÙ¤˜ ‚ÈÔÌË¯·ÓÈÎ¤˜ ÂÊ·ÚÌÔ-Á¤˜. ∏ ¯ÏˆÚ›ÓË, ¤Ó· ·ÔÏ˘Ì·ÓÙÈÎfi Ô˘ ¯ÚËÛÈÌÔ-ÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙÔ fiÛÈÌÔ ‡‰ˆÚ Î·È ÙÈ˜ ÈÛ›ÓÂ˜,Û¯ËÌ·Ù›˙ÂÈ ÛÙË Ê˘ÛÈÎ‹ ÙÔ˘ ÌÔÚÊ‹ ˘ÎÓfi ÎÈÙÚÈÓÔ-Ú¿ÛÈÓÔ ·¤ÚÈÔ, ÙÔ ÔÔ›Ô ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË Ì¤ÁÈÛÙË˘ÎÓfiÙËÙ¿ ÙÔ˘ ÎÔÓÙ¿ ÛÙÔ ¤‰·ÊÔ˜ Î·È, ˆ˜ ÂÎ ÙÔ‡-ÙÔ˘, Â›Ó·È È‰È·›ÙÂÚ· ÂÈÎ›Ó‰˘ÓÔ ÁÈ· Ù· ÌÈÎÚ¿ ·È‰È¿.

∆Ô ÓÂ˘ÌÔÓÈÎfi Ô›‰ËÌ· ÂÌÊ·Ó›˙ÂÙ·È Û¯ÂÙÈÎ¿ ÚÒÈÌ·(ÛÂ 2-4 ÒÚÂ˜ ÛÂ ÛÔ‚·Ú‹ ¤ÎıÂÛË ‹ ·ÎfiÌ· Î·È ÛÂ 30-60 ÏÂÙ¿ ÛÂ ÛÔ‚·ÚfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜).

∆Ô ÊˆÛÁ¤ÓÈÔ ·ÔÙÂÏÂ› È‰È·›ÙÂÚ· ‡Ô˘ÏÔ fiÏÔ,Î·ıÒ˜ ¤¯ÂÈ Û¯ÂÙÈÎ¿ Â˘¯¿ÚÈÛÙË ÔÛÌ‹ (‰›ÎËÓ ÊÚÂ-ÛÎÔÎÔ˘ÚÂÌ¤ÓË˜ ¯ÏfiË˜) Î·È ÛÂ ‹È· ¤ˆ˜ Ì¤ÙÚÈ·ÚÔÛ‚ÔÏ‹ ÙÔ ı‡Ì· ·Ú·Ì¤ÓÂÈ ·Ú¯ÈÎ¿ ·Û˘ÌÙˆÌ·-ÙÈÎfi, ·Ú·ÙÂ›ÓÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ¯ÚfiÓÔ ¤ÎıÂÛË˜. ∏ ÂÌ-Ê¿ÓÈÛË ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÔÈ‰‹Ì·ÙÔ˜ ·Ú¯›˙ÂÈ ÛÂ 4-6ÒÚÂ˜ ·fi ÙËÓ ¤ÎıÂÛË ‹ ·ÎfiÌ· Î·È ÛÂ 24 ÒÚÂ˜ ÛÂËÈfiÙÂÚÂ˜ ÚÔÛ‚ÔÏ¤˜ (63,66).

∆Ô ˘‰ÚÔÎ˘¿ÓÈÔ (ÁÓˆÛÙ‹ ·fi ÙËÓ ·Ú¯·ÈfiÙËÙ· ÙÔ-ÍÈÎ‹ Ô˘Û›·) ¤¯ÂÈ ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ‰˘Ó·ÙfiÙËÙÂ˜ ÂÊ·Ú-ÌÔÁ‹˜ ˆ˜ ¯ËÌÈÎfi fiÏÔ, ÏfiÁˆ ÙË˜ È‰ÈfiÙËÙ¿˜ ÙÔ˘ Ó·‰È·Û¿Ù·È ÁÚ‹ÁÔÚ· ÛÙÔÓ ·ÙÌÔÛÊ·ÈÚÈÎfi ·¤Ú· Î·ÈÙË˜ ÌÂÈˆÌ¤ÓË˜ ıÓËÙfiÙËÙ·˜ Ô˘ ÚÔÎ·ÏÂ›, ÛÂ Û¯¤ÛËÌÂ ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ. øÛÙfiÛÔ, Â¿Ó ·ÂÏÂ˘-ıÂÚˆıÂ› ÛÂ ÎÏÂÈÛÙfi ¯ÒÚÔ, ÌÔÚÂ› Ó· ¤¯ÂÈ Î·Ù·-ÛÙÚÔÊÈÎ¤˜ Û˘Ó¤ÂÈÂ˜. ∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ÛÙËÓ Ï‹ÚË¤ÎÊÚ·Û‹ ÙË˜, Â›Ó·È ‚·Ú‡Ù·ÙË. ∏ ıÂÚ·Â›· ‚·Û›˙Â-Ù·È ÛÙË Ï‹„Ë ˘ÔÛÙËÚÈÎÙÈÎÒÓ Ì¤ÙÚˆÓ Î·È ÛÙË ¯Ô-Ú‹ÁËÛË ÓÈÙÚÒ‰Ô˘˜ Ó·ÙÚ›Ô˘ (NaNO2), ÙÔ ÔÔ›Ô ÚÔ-Î·ÏÂ› Û¯ËÌ·ÙÈÛÌfi ÌÂı·ÈÌÔÛÊ·ÈÚ›ÓË˜, Ë ÔÔ›· ÌÂ ÙËÛÂÈÚ¿ ÙË˜, ÏfiÁˆ ˘„ËÏ‹˜ ¯ËÌÈÎ‹˜ Û˘ÁÁ¤ÓÂÈ·˜ ÌÂ ÙÔ˘‰ÚÔÎ˘¿ÓÈÔ, ÙÔ ·ÚÂÎÙÔ›˙ÂÈ ·fi ÙË Û‡Ó‰ÂÛ‹ ÙÔ˘ÌÂ ÙËÓ Î˘ÙÔ¯ÚˆÌÈÎ‹ ÔÍÂÈ‰¿ÛË. ∏ ·È‰È·ÙÚÈÎ‹ ‰fiÛËÎ·ıÔÚ›˙ÂÙ·È ·fi ÙÔ ‚¿ÚÔ˜ Î·È ·fi ÙË Û˘ÁÎ¤ÓÙÚˆÛËÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ (¶›Ó·Î·˜ 3). ∆Ô ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔıÂÚ·Â›·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ıÂÈÔıÂÈÈÎÔ‡Ó·ÙÚ›Ô˘ 25% (Na2S2O3), ÙÔ ÔÔ›Ô ÌÂÙ·ÙÚ¤ÂÈ ÙÔ˘‰ÚÔÎ˘¿ÓÈÔ ÛÙÔ ÏÈÁfiÙÂÚÔ ÙÔÍÈÎfi Î·È ˘‰·ÙÔ‰È·Ï˘ÙfiıÂÈÔÎ˘¿ÓÈÔ. ∆· ‰‡Ô ÚÔ·Ó·ÊÂÚfiÌÂÓ· ÛÎÂ˘¿ÛÌ·Ù·‰È·Ù›ıÂÓÙ·È ·fi ÙÈ˜ ÀÁÂÈÔÓÔÌÈÎ¤˜ ∞Ú¯¤˜ ÙˆÓ ∏¶∞ÛÂ Û˘ÛÎÂ˘·Û›· ¤ÙÔÈÌË ÚÔ˜ ¯Ú‹ÛË. ™ÙËÓ ∂˘ÚÒË,ÚÔÙÂ›ÓÔÓÙ·È ˆ˜ ÂÓ·ÏÏ·ÎÙÈÎ‹ ·ÁˆÁ‹ Ê¿ÚÌ·Î·fiˆ˜ Ë ˘‰ÚÔÍ˘ÎÔ‚·Ï·Ì›ÓË (Ë ÔÔ›· Ê·›ÓÂÙ·È Ó·ÏÂÔÓÂÎÙÂ› ÏfiÁˆ ÙË˜ ¯·ÌËÏ‹˜ ÙÔÍÈÎfiÙËÙ¿˜ ÙË˜) Î·ÈÙ· ¿Ï·Ù· ÎÔ‚·ÏÙ›Ô˘, ÂÓÒ ÛÎÂ˘¿ÛÌ·Ù· fiˆ˜ ÔÈ ·Ï-‰Â˛‰Â˜ Î·È ·Ú¿ÁˆÁ· ·ÌÈÓÔÊ·ÈÓ˘ÏÔÎÂÙfiÓË˜ ‚Ú›-ÛÎÔÓÙ·È ÛÂ ÛÙ¿‰ÈÔ ÎÏÈÓÈÎÒÓ ‰ÔÎÈÌÒÓ (67).

¢·ÎÚ˘ÁfiÓ· ∫˘ÚÈfiÙÂÚÔÈ ÂÎÚfiÛˆÔÈ Â›Ó·È Ù· ·¤ÚÈ· CS, CN

(‹ Mace®) Î·È ÙÔ ÛÚ¤È ÈÂÚÈÔ‡ (ÂÚÈ¤¯ÂÈ Î·„·˚Î›-ÓË) (¶›Ó·Î·˜ 3).

∞‰Ú·ÓÔÔÈËÙÈÎ¿ - ·Ú·ÈÛıËÛÈÔÁfiÓ· ™ÙËÓ Î·ÙËÁÔÚ›· ·Ó‹ÎÔ˘Ó Ô˘Û›Â˜ fiˆ˜ ÙÔ LSD, ÔÈ

Î·ÓÓ·‚ÈÓfiÏÂ˜, ÔÈ Ê·ÈÓÔıÂÈ·˙›ÓÂ˜ Î·È Ë Ê·ÈÓÙ·Ó‡ÏË,Ì›· Ô˘Û›· ÁÓˆÛÙ‹ ·fi ÙË ¯Ú‹ÛË ÙË˜ ˆ˜ ·Ó·ÈÛıËÙÈ-Îfi. ∏ Ê·ÈÓÙ·Ó‡ÏË, ¤Ó· Û˘ÓıÂÙÈÎfi ÔÈÔÂÈ‰¤˜, ·Ó‹ÎÂÈÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‚ÈÔÚ˘ıÌÈÛÙÒÓ, ¤¯ÔÓÙ·˜ ÙËÓ ÈÎ·-ÓfiÙËÙ· Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙÈ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ·˘Ùfi-ÓÔÌÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ó· Î·Ù·ÛÙ¤ÏÏÂÈ,ÌÂÙ·Í‡ ¿ÏÏˆÓ, ÙËÓ ·Ó·ÓÔ‹. ¶ÚfiÛÊ·Ù· ·¤ÎÙËÛÂ

July August 04 07-10-04 13:52 ™ÂÏ›‰·235

236


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‰ËÌÔÛÈfiÙËÙ·, ‡ÛÙÂÚ· ·fi ÙË ¯Ú‹ÛË ÙË˜ ÛÙË ÁÓˆ-ÛÙ‹ - Î·È ÌÂ ÙÚ·ÁÈÎ‹ Î·Ù¿ÏËÍË - ˘fiıÂÛË ÔÌËÚ›·˜ÙÔ˘ ∫Ú·ÙÈÎÔ‡ £Â¿ÙÚÔ˘ ÙË˜ ªfiÛ¯·˜.

∏ ÛËÌ·Û›· ÙË˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ ∞Ó Î·È Ë Èı·ÓfiÙËÙ· Ì›·˜ ‚ÈÔ¯ËÌÈÎ‹˜ Â›ıÂÛË˜

Â›Ó·È ¿ÁÓˆÛÙË Î·È Ë ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛ‹ ÙË˜ ·ÁÁ›˙ÂÈ Ù· fiÚÈ· (Î·Ù¿ ÂÚÈÙÒÛÂÈ˜)˘ÛÙÂÚ›·˜, ÔÏÏÔ› ÈÛÙÂ‡Ô˘Ó fiÙÈ Ô ‰˘ÙÈÎfi˜ ÎfiÛÌÔ˜·Ú·Ì¤ÓÂÈ ÂÍ·ÈÚÂÙÈÎ¿ Â˘¿ÏˆÙÔ˜. ∞˘Ùfi ÈÛ¯‡ÂÈ È‰È·›-ÙÂÚ· ÁÈ· ÙÔ˘˜ ·ÏÔ‡˜ ÔÏ›ÙÂ˜, Î·ıÒ˜ ‰ÂÓ ‰È·ı¤-ÙÔ˘Ó ÙËÓ ÂÎ·›‰Â˘ÛË, ÙËÓ ÂÙÔÈÌfiÙËÙ· Î·È Ù· Ì¤Û·ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÚÔÛÙ·Û›· ÙÔ˘˜. ∞ÔÙÂÏÂ›ÙÚ·ÁÈÎ‹ ÂÈÚˆÓÂ›· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ¿ÓıÚˆÔÈ ·Ô-ÙÂÏÔ‡Ó ÙÔÓ ÈÔ Â˘·›ÛıËÙÔ Î·È, Û˘¯Ó¿, ·ÔÎÏÂÈÛÙÈÎfi·Ú¿ÁÔÓÙ· ·Ó›¯ÓÂ˘ÛË˜ Ì›·˜ ‚ÈÔ¯ËÌÈÎ‹˜ ·ÂÈÏ‹˜.ÃˆÚ›˜ ÚÔËÁÔ‡ÌÂÓË ÁÓÒÛË ÙË˜ Â›ıÂÛË˜, ÙËÓ ÚÒ-ÙË ¤Ó‰ÂÈÍË Ì›·˜ ÂÈÙ˘¯ËÌ¤ÓË˜ ÚÔÛ‚ÔÏ‹˜ Û˘¯Ó¿·ÔÙÂÏÂ› Ë ÏËÌÌ˘Ú›‰· ·ÛıÂÓÒÓ Ô˘ ÚÔÛ¤Ú¯Ô-ÓÙ·È ÁÈ· È·ÙÚÈÎ‹ ‚Ô‹ıÂÈ·, ÂÌÊ·Ó›˙ÔÓÙ·˜ ·ÚfiÌÔÈ·Î·È ÂÍˆÙÈÎ¿ Û˘ÌÙÒÌ·Ù· (68-70).

ª›· ÛÔ‚·Ú‹ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙË˜ÂÈ‰ËÌÈÎ‹˜ ¤Í·ÚÛË˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ·Ó ÙÔ ·›-ÙÈÔ Â›Ó·È Ê˘ÛÈÎfi ‹ ÙÂ¯ÓËÙfi, ı· ‚ÔËı‹ÛÂÈ ÙÔ ˘ÁÂÈÔ-ÓÔÌÈÎfi ÚÔÛˆÈÎfi Ó· ÂÓÙÔ›ÛÂÈ ÙÔÓ ˘Â‡ı˘ÓÔ ·-Ú¿ÁÔÓÙ· Î·È Ó· ÂÎÎÈÓ‹ÛÂÈ ÙÈ˜ ··Ú·›ÙËÙÂ˜ ·ÚÂÌ-‚¿ÛÂÈ˜ (5). ∆Ô CDC, ·fi ÙÔ 1951, ›‰Ú˘ÛÂ ÙËÓ ÀË-ÚÂÛ›· ∂È‰ËÌÈÔÏÔÁÈÎÒÓ ¶ÏËÚÔÊÔÚÈÒÓ (ÙÔ ÂÈÛÙË-ÌÔÓÈÎfi ·Ó¿ÏÔÁÔ ÙË˜ CIA ÛÙËÓ ÂÔ¯‹ ÙÔ˘ æ˘¯ÚÔ‡¶ÔÏ¤ÌÔ˘), ÌÂ ÛÎÔfi ÙËÓ ÂÎ·›‰Â˘ÛË ÂÈ‰ËÌÈÔÏfi-ÁˆÓ ÁÈ· ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ‚ÈÔ¯ËÌÈÎ‹˜ Â›ıÂÛË˜. ∏ Î·-Ù·ÁÚ·Ê‹ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÚÔÛ‚Ï‹ıËÎ·Ó, ÙˆÓ È-ı·ÓÒÓ ÙÚfiˆÓ ¤ÎıÂÛË˜, ÙˆÓ ÚÔÁÂÓ¤ÛÙÂÚˆÓ Î·ÈÌÂÙ·ÁÂÓ¤ÛÙÂÚˆÓ Â·ÊÒÓ, ÙˆÓ ÛËÌÂ›ˆÓ Î·È Û˘-ÌÙˆÌ¿ÙˆÓ ÙË˜ ÓfiÛÔ˘, Î·ıÒ˜ Î·È Ë Ù·¯Â›· ·Ó›-¯ÓÂ˘ÛË ÙÔ˘ ·ÈÙ›Ô˘, ‰È·ÈÛÙÒıËÎÂ fiÙÈ ‚ÔËıÔ‡Ó ÛË-Ì·ÓÙÈÎ¿ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ˘ÁÂÈÔÓÔÌÈ-ÎÒÓ Î·È È·ÙÚÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ (71-73).

øÛÙfiÛÔ, ÙÔ ÎÚ›ÛÈÌÔ ÂÚÒÙËÌ· ·Ú·Ì¤ÓÂÈ: Ò˜ ı··Ó·ÁÓˆÚ›ÛÔ˘Ó ÔÈ Â·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜ (Î·È Û˘ÁÎÂ-ÎÚÈÌ¤Ó· ÔÈ ·È‰›·ÙÚÔÈ) ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÎÚÔÛˆ-Ô‡Ó ÙÔ ÚÒÙÔ Î‡Ì· ı˘Ì¿ÙˆÓ Ì›·˜ Â›ıÂÛË˜;

∆Ú›· ÎÚ›ÛÈÌ· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ı·‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·Ó·ÁÓÒÚÈÛË: ·) Ô ÂÈ‰ËÌÈÎfi˜·ÚÈıÌfi˜ ·ÛıÂÓÒÓ, ‚) ÙÔ ÎÔÈÓfi ÈÛÙÔÚÈÎfi ¤ÎıÂÛË˜ Î·ÈÁ) Ë ÂÍˆÙÈÎ‹ ÎÏÈÓÈÎ‹ ·ÚÔ˘Û›·ÛË ÙË˜ ÓfiÛÔ˘.

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Û˘Ó‰˘·˙fiÌÂÓÂ˜ ÌÂ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜, ‰ÂÓ ı· Ú¤ÂÈ, Â›ÛË˜, Ó· ·ÁÓÔËıÔ‡Ó.O ¶›Ó·Î·˜ 4, fiÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÚÒÈÌÂ˜ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÂ ‚ÈÔÏÔÁÈ-ÎÔ‡˜ ‹ ¯ËÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ÌÔÚÂ› Ó· ·Ô‰ÂÈ-¯ıÂ› ¯Ú‹ÛÈÌÔ ‚Ô‹ıËÌ· ÛÂ Ì›· Ù¤ÙÔÈ· ÂÚ›ÙˆÛË.

™ÙË ¯ÒÚ· Ì·˜, Ë Â˘·ÈÛıËÛ›· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈÙËÓ ÂÏÏËÓÈÎ‹ ÔÈÎÔÁ¤ÓÂÈ· ÛÙ· ı¤Ì·Ù· ÊÚÔÓÙ›‰·˜ ÙË˜˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡, Î·ıÈÛÙ¿ ÂÍ·ÈÚÂÙÈÎ¿ Èı·Ófi ÙÔÂÓ‰Â¯fiÌÂÓÔ Ó· ·ÔÙÂÏ¤ÛÔ˘Ó ÔÈ ·È‰›·ÙÚÔÈ ÙÔ˘˜ÚÒÙÔ˘˜ Â·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜ Ô˘ ı· ‚ÚÂıÔ‡Ó·ÓÙÈÌ¤ÙˆÔÈ - Î·È Èı·ÓÒ˜ ·ÚÔÂÙÔ›Ì·ÛÙÔÈ - ÌÂ ÙÔ·Ú¯ÈÎfi Î‡Ì· ı˘Ì¿ÙˆÓ. ∏ Â·ÁÚ‡ÓËÛ‹ Ì·˜, ·ÏÏ¿Î·È Ë ¿ÌÂÛË - ·ÎfiÌ· Î·È ·Ó Ë ‰È¿ÁÓˆÛË Â›Ó·È ÂÈ-ÛÊ·Ï‹˜ - ·Ó·ÊÔÚ¿ ÙˆÓ ‡ÔÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÛÙÈ˜·ÚÌfi‰ÈÂ˜ ÀËÚÂÛ›Â˜, ıÂˆÚÂ›Ù·È ÎÂÊ·Ï·ÈÒ‰Ô˘˜ ÛË-Ì·Û›·˜ ÁÈ· ÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙË˜ Â›ÙˆÛË˜ Ì›·˜‚ÈÔ¯ËÌÈÎ‹˜ Â›ıÂÛË˜ ÛÙ· ·È‰È¿.

µÈ‚ÏÈÔÁÚ·Ê›·1. Christopher GW, Cieslak TJ, Pavlin JA, Eitzen EM Jr.

Biological warfare. A historical perspective. JAMA 1997;278:412-417.

2. Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A,

Kumada K et al. Report on 640 victims of the Tokyo subwaysarin attack. Ann Emerg Med 1996;28:129-135.

3. Cieslak TJ, Henretig FM. Bioterrorism. Pediatr Ann2003;32:154-165.

4. Henretig F. Biological and chemical terrorism defence: a viewfrom the “front lines” of public health. Am J Public Health2001;91:718-720.

5. Chang MH, Glynn MK, Groseclose SL. Endemic, notifiablebioterrorism-related diseases, United States, 1992-1999.Emerg Infect Dis 2003;9:556-564.

6. APIC Bioterrorism Task Force and CDC Hospital InfectionsProgram Bioterrorism Working Group. Bioterrorism readinessplan: a template for healthcare facilities. Available at:http://www.cdc.gov/ncidod/hip/Bio/bio.htm.

7. World Health Organization. Health aspects of biological andchemical weapons. Report of a WHO group of consultants.Geneva, Switzerland: World Health Organization; 1970. p.72, 99.

8. °È· ÙÔ Êfi‚Ô ÙˆÓ “ªÈÓ §¿ÓÙÂÓ”. ∫˘ÚÈ·Î¿ÙÈÎË ∂ÏÂ˘ıÂÚÔÙ˘›·,15/12/2002. ÛÂÏ. 56-57.

9. Henretig FM, Cieslak TJ, Madsen JM, Eitzen EM Jr, FleisherGR. The emergency department response to incidents ofbiological and chemical terrorism. In: Fleisher GR, Ludwig S,editors. Textbook of Pediatric Emergency Medicine. 4th ed.Philadelphia (PA): Lippincott Williams & Wilkins 2000. p.1763-1784.

¶›Ó·Î·˜ 4. ¶ÚÒÈÌÂ˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÂ ‚ÈÔÏÔÁÈÎÔ‡˜-¯ËÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜

∂Î‰ËÏÒÛÂÈ˜ ¶·Ú¿ÁÔÓÙÂ˜/∞Ûı¤ÓÂÈÂ˜

∞Ó·ÓÂ˘ÛÙÈÎ¤˜∂ÈÎfiÓ· “ÁÚ›Ë˜” ¶˘ÚÂÙfi˜ Q, Â˘ÏÔÁÈ¿, ÙÔ˘Ï·Ú·ÈÌ›·, ˘ÚÂÙfi˜ µÚ·¯ˆ‰ÒÓ OÚ¤ˆÓ, ˘ÚÂÙfi˜ Ebola,

˘ÚÂÙfi˜ Lassaº·Ú˘ÁÁ›ÙÈ‰· ÕÓıÚ·Î·˜¢‡ÛÓÔÈ· Î·È ÛÈÁÌfi˜ ºˆÛÁ¤ÓÈÔ, ˘ÚÂÙfi˜ Q, ÙÔ˘Ï·Ú·ÈÌ›·, ·ÓÒÏË, hantavirus¶ÓÂ˘ÌÔÓ›ÙÈ‰· ¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ, ÓÂ˘ÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙÂ˜µÚÔÁ¯fiÛ·ÛÌÔ˜ ¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ, ÓÂ˘ÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙÂ˜¢ÂÚÌ·ÙÔÏÔÁÈÎ¤˜ºÏ‡ÎÙ·ÈÓÂ˜, ÂÙ¤¯ÂÈÂ˜, ÔÚÊ‡Ú· ∂˘ÏÔÁÈ¿, ˘ÚÂÙfi˜ Ebola, ˘ÚÂÙfi˜ Lassa, hantavirus, ˘ÚÂÙfi˜ µÚ·¯ˆ‰ÒÓ OÚ¤ˆÓŒÏÎË ÕÓıÚ·Î·˜, ÙÔ˘Ï·Ú·ÈÌ›·¢È·‚ÚˆÙÈÎ¤˜ ‚Ï¿‚Â˜ ‹ ÂÁÎ·‡Ì·Ù· ∞¤ÚÈÔ ÌÔ˘ÛÙ¿Ú‰·˜, ¯ÏˆÚ›ÓË∫·Ú‰È·ÁÁÂÈ·Î¤˜∫·Ù·ÏËÍ›· ƒÈÎ›ÓË, hantavirusµÚ·‰˘·ÚÚ˘ıÌ›Â˜ ¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ¡Â˘ÚÔÏÔÁÈÎ¤˜¶ÂÚÈÊÂÚÈÎ¤˜∞‰˘Ó·Ì›·, ˘ÔÙÔÓ›· ¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ, ·ÏÏ·ÓÙ›·ÛË¢ÂÛÌÈ‰ÒÛÂÈ˜ ¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓ∫ÂÓÙÚÈÎ¤˜∞¿ıÂÈ·, ·ÔÚÔÛ·Ó·ÙÔÏÈÛÌfi˜, ÎÒÌ· ¶˘ÚÂÙfi˜ Ebola™·ÛÌÔ› ¶·Ú¿ÁÔÓÙÂ˜ ÓÂ‡ÚˆÓªËÓÈÁÁ›ÙÈ‰· ÕÓıÚ·Î·˜¡ÂÊÚÈÎ¤˜OÏÈÁÔ˘Ú›· Hantavirus°·ÛÙÚÂÓÙÂÚÈÎ¤˜∞Ó·Ë‰ÒÛ· Â˘·ÈÛıËÛ›· ÕÓıÚ·Î·˜∞ÈÌ·Ù¤ÌÂÛË, Ì¤Ï·ÈÓÂ˜ ÎÂÓÒÛÂÈ˜ ÕÓıÚ·Î·˜¢È¿ÚÚÔÈ· ™Ù·Ê˘ÏÔÎÔÎÎÈÎ‹ ÂÓÙÂÚÔÙÔÍ›ÓË µ, ÙÔÍ›ÓË ÛÈÁÎ¤Ï·˜

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

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-09-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 10-03-2004

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: µ·Û›ÏÂÈÔ˜ ∆Û·ÁÚ‹˜ ∞ÚÂÔfiÏÂˆ˜ 30, ∆.∫. 124 62, ¢¿ÛÔ˜ Ã·˚‰·Ú›Ô˘, ∞ı‹Ó· E-mail: [email protected]

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∫·Ù¿ıÏÈ„Ë ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·∂. §·˙·Ú¿ÙÔ˘, ¢. ∫. ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ˜

Childhood depressionH. Lazaratou, D. C. Anagnostopoulos

�¶ÂÚ›ÏË„Ë: ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ·Ó·ÛÎÔÂ› ÙË ‚È-‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈÎ¿ ÌÂ ÙË ÓÔÛÔÏÔÁÈÎ‹ ı¤ÛË ÙË˜ Î·-Ù¿ıÏÈ„Ë˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ∏ Î·Ù¿ıÏÈ„Ë ÙË˜ ·È-‰ÈÎ‹˜ ËÏÈÎ›·˜ ¿ÚÁËÛÂ Ó· ·Ó·ÁÓˆÚÈÛÙÂ› Û·Ó ·˘Ùfi-ÓÔÌË ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ·. OÈ Û‡Á¯ÚÔÓÂ˜ ÌÂÏ¤ÙÂ˜ ·Ô-‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹ÌÂ Î›Ó‰˘ÓÔ ¯ÚÔÓÈfiÙËÙ·˜ ‹ ˘ÔÙÚÔÒÓ Ô˘ ÂËÚÂ¿-˙ÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË ˙ˆ‹ ÙË˜ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ÎÏÈÓÈÎ‹ ÙË˜ ÂÈÎfiÓ· ÔÈÎ›ÏÏÂÈ ·Ó¿ÏÔ-Á· ÌÂ ÙËÓ ·Ó·Ù˘ÍÈ·Î‹ Ê¿ÛË ÛÙËÓ ÔÔ›· ‚Ú›ÛÎÂÙ·ÈÙÔ ·È‰›. ∏ Î·Ù·ıÏÈÙÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÎÊÚ¿-˙ÂÙ·È ÌÂ ÛˆÌ·ÙÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È ‰È·Ù·Ú·¯¤˜ Û˘-ÌÂÚÈÊÔÚ¿˜ Î·È ÏÈÁfiÙÂÚÔ ÌÂ ÏÂÎÙÈÎ¤˜ ‰È·Ù˘ÒÛÂÈ˜ÙÔ˘ Î·Ù·ıÏÈÙÈÎÔ‡ Û˘Ó·ÈÛı‹Ì·ÙÔ˜. ∞Á¯Ò‰ÂÈ˜ ‰È·-Ù·Ú·¯¤˜, Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Î·È ‰È·Ù·Ú·¯‹‰È·ÁˆÁ‹˜ Û˘ÓÔ‰Â‡Ô˘Ó Û˘¯Ó¿ ÙËÓ ·È‰ÈÎ‹ Î·Ù¿ıÏÈ-„Ë. ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎ‹. ∏ ÁÂ-ÓÂÙÈÎ‹ ÂÈ‚¿Ú˘ÓÛË ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Î·È Ù· ·È‰È¿Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ‰È·Ù·Ú·¯‹˜. ∞ÚÓË-ÙÈÎ¿ ÁÂÁÔÓfiÙ· ˙ˆ‹˜ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Û˘¯Ó¿ ÙËÓ¤Ó·ÚÍË ÙÔ˘ Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ∏ ÁÓˆÛÈ·Î‹ÚÔÛ¤ÁÁÈÛË ÌÂÏÂÙ¿ ÙÈ˜ ÛËÌ·ÓÙÈÎ¤˜ ÁÓˆÛÈ·Î¤˜ ‰È·-ÛÙÚÂ‚ÏÒÛÂÈ˜ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙË ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›-ÌËÛË Î·È ÛÙËÓ ¤ÓÙÔÓË ·˘ÙÔÎÚÈÙÈÎ‹ ÙˆÓ Î·Ù·ıÏÈÙÈ-ÎÒÓ ·È‰ÈÒÓ. ∏ „˘¯Ô‰˘Ó·ÌÈÎ‹ Î·Ù·ÓfiËÛË ‚·Û›˙Â-Ù·È ÛÙË ÌÂÏ¤ÙË ÙˆÓ „˘¯ÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ Ô˘ ÂÓÂÚ-ÁÔÔÈÔ‡ÓÙ·È ÁÈ· Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÙËÓ ·ÒÏÂÈ·. ∏ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·È‰ÈÎ‹˜ Î·Ù¿ıÏÈ-„Ë˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ „˘¯ÔıÂÚ·Â›· ÙÔ˘ ·È‰ÈÔ‡Î·È ÙË Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹ ÙˆÓ ÁÔÓ¤ˆÓ. º·ÚÌ·ÎÔıÂÚ·-Â›· ¯ÔÚËÁÂ›Ù·È ÛÙÈ˜ ÛÔ‚·ÚfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜.∂ÓÒ Ù· ÙÚÈÎ˘ÎÏÈÎ¿ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ ‰ÂÓ ¤¯Ô˘Ó˘„ËÏfiÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·fi Ù· placebo,Ù· ÓÂfiÙÂÚË˜ ÁÂÓÈ¿˜ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ ˘fiÛ¯ÔÓÙ·È

�Abstract: This is a review of the current literatureon the nosological status of childhood depression.Child depression has been recognized as aseparate clinical entity since the 1970s. Recentstudies have shown that it is a very serious disorder,which involves the risk of perpetuation or relapse,and it has a great impact on the child’s functioning,as well as on the life of the whole family. Clinicalfeatures vary according to the developmental phaseof the child. Depressive symptomatology isexpressed in somatic symptoms and conductproblems rather than by verbal formulationconcerning the depressive feelings. The usualcomorbid conditions of child depression are anxietydisorders, learning disorders and conductdisorders. The aetiology of child depression ismulti-factorial. The genetic factor is implicated in thechildren of depressed parents, which puts thesechildren in a higher risk status for the developmentof the disorder. Negative life events often herald theonset of a depressive episode. Cognitiveapproaches have studied the role of major cognitivedistortions such as self-criticism and low self-esteem in depressed children. The psychodynamicapproach has been based on the study of thosepsychic mechanisms involved in confrontation ofloss. Therapeutic procedures involve childpsychotherapy and parental counselling, along withdrug therapy in serious cases. While tricyclicantidepressants proved to be no more effective thanplacebo, the new generation anti-depressants(SSRI) are more promising. There is a need for thedevelopment of more appropriate early interventionstrategies targeted at primary detection andtreatment.

ÀËÚÂÛ›· æ˘¯ÈÎ‹˜ ÀÁÂ›·˜ ¶·È‰ÈÒÓ Î·È ∂Ê‹‚ˆÓ, ∫ÔÈÓÔÙÈÎfi ∫¤ÓÙÚÔ æ˘¯ÈÎ‹˜ ÀÁÈÂÈÓ‹˜ µ‡ÚˆÓ· - ∫·ÈÛ·ÚÈ·Ó‹, æ˘¯È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ∞ı‹Ó·

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

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∂ÈÛ·ÁˆÁ‹∏ Î·Ù¿ıÏÈ„Ë Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÌÂÏÂÙËıÂ› ÛÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›· ÏfiÁˆ ÙË˜ ·‰˘Ó·Ì›·˜ ÙÔ˘ ·È‰ÈÔ‡ Ó·ÂÎÊÚ¿ÛÂÈ ÌÂ ÏfiÁÈ· Ù· Û˘Ó·ÈÛı‹Ì·Ù· ıÏ›„Ë˜, ·ÂÏ-ÈÛ›·˜ Î·È ·fiÁÓˆÛË˜. ∏ Î·Ù·ıÏÈÙÈÎ‹ Û˘ÌÙˆÌ·-ÙÔÏÔÁ›· ÂÎÊÚ¿˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂ ÛˆÌ·ÙÈÎ¿ Û˘ÌÙÒ-Ì·Ù· (ÎÔÈÏÈ·Î¿ ¿ÏÁË, ÎÂÊ·Ï·ÏÁ›Â˜, ·ÓÔÚÂÍ›·, ·¸-Ó›·) Î·È ‰È·Ù·Ú·¯¤˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ (Â˘ÂÚÂıÈ-ÛÙfiÙËÙ·, ÂÈıÂÙÈÎfiÙËÙ·, ·ÒÏÂÈ· ÂÓ‰È·Ê¤ÚÔÓÙÔ˜,·fiÛ˘ÚÛË).

£ÂˆÚÂ›Ù·È Ì›· Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·Ù·Ú·¯‹, ÌÂ Û·-Ê‹ ÁÂÓÂÙÈÎ‹ ÂÈ‚¿Ú˘ÓÛË, Ô˘ ÚÔÎ·ÏÂ› ÛÔ‚·Ú¿ÚÔ‚Ï‹Ì·Ù· ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ. ∂›-Ó·È Ì›· Î·Ù¿ÛÙ·ÛË Ô˘ Â‡ÎÔÏ· ·Ú·ÁÓˆÚ›˙ÂÙ·È,Î·ıÒ˜ Ù· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ ‰ÂÓ ·Ú·ÔÓÈÔ‡ÓÙ·ÈÎ·È Ù· ÚÔ‚Ï‹Ì·Ù· ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘˜ Â›Ó·ÈÌÂÈˆÌ¤ÓË˜ ¤ÓÙ·ÛË˜.

™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· Á›ÓÂÙ·È Ì›· ·Ó·ÛÎfiËÛËÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈ‰ËÌÈÔÏÔ-Á›·, ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ÙËÓ ·ÈÙÈÔÏÔÁ›·, ÙËÓ ÚfiÁÓˆ-ÛË Î·È ÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Î·Ù¿ıÏÈ-„Ë˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜.

¶·Ú’ fiÏÔ Ô˘ ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó ÔÈÌÂÏ¤ÙÂ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙËÓ ·È‰È-Î‹ ËÏÈÎ›· Î·È fi¯È ÛÙËÓ ÂÊË‚Â›·, ıÂˆÚ‹ıËÎÂ ÛÎfiÈ-ÌÔ Ó· Á›ÓÂÈ ÂÚÈÔÚÈÛÌfi˜ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ËÏÈÎÈ·ÎfiÊ¿ÛÌ·. ∏ ÂÊË‚Â›· ·ÔÙÂÏÂ› Ì›· ÂÍÂÏÈÎÙÈÎ‹ ‰ÈÂÚÁ·-Û›· ÛÙË ˙ˆ‹ ÙÔ˘ ·ÙfiÌÔ˘ Ô˘ Û˘¯Ó¿ ÂÚÈÁÚ¿ÊÂÙ·ÈÌÂ fiÚÔ˘˜ Ô˘ ı· Ù·›ÚÈ·˙·Ó ÁÈ· ÙËÓ ÂÚÈÁÚ·Ê‹ ÂÓfi˜Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘.

O ¤ÊË‚Ô˜ Â›Ó·È ·Ó·ÁÎ·ÛÌ¤ÓÔ˜ Ó· ·Ô¯ˆÚÈÛÙÂ›Û˘Ì‚ÔÏÈÎ¿ ÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘, Ó· ‰È·Îfi„ÂÈ ÙÔ˘˜ ‰Â-ÛÌÔ‡˜ Ì·˙› ÙÔ˘˜ Î·È Ó· ·ÔÌ·ÎÚ˘ÓıÂ› ·fi ÙÔÓ ·-Ú¿‰ÂÈÛÔ ÙˆÓ ·È‰ÈÎÒÓ ÙÔ˘ ¯ÚfiÓˆÓ, ÚÔÎÂÈÌ¤ÓÔ˘ Ó··ÓÙÈÌÂÙˆ›ÛÂÈ ÌfiÓÔ˜ ÙÔ˘ Ì›· Ó¤· Ú·ÁÌ·ÙÈÎfiÙËÙ·.∞˘Ù‹ Ë ‰ÈÂÚÁ·Û›· ‰È·ÎÔ‹˜ ÙˆÓ ‰ÂÛÌÒÓ Î·È ·Ò-ÏÂÈ·˜ ÙÔ˘ ·ÓÙÈÎÂÈÌ¤ÓÔ˘ ¤¯ÂÈ ·ÎÚÈ‚Ò˜ Ù· ›‰È· ÛÙ¿‰È·,fiˆ˜ Ë ‰ÈÂÚÁ·Û›· ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘ ı·Ó¿ÙÔ˘ÂÓfi˜ ·Á·ËÌ¤ÓÔ˘ ÚÔÛÒÔ˘.

¶ÚÔÎ‡ÙÂÈ, ¤ÙÛÈ, ÙÔ ÂÚÒÙËÌ· ·Ó Î·È fiÙÂ Ë Î·-Ù¿ıÏÈ„Ë ·ÔÙÂÏÂ› Ì›· Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ÂÊË‚Â›·˜ ‹ ÂÓÙ¿ÛÛÂÙ·È ÛÂ ·ıÔÏÔÁÈÎ¿ Ï·›ÛÈ· Î·È·ÔÙÂÏÂ› „˘¯È·ÙÚÈÎ‹ ‰È·Ù·Ú·¯‹.

∏ Î·Ù¿ıÏÈ„Ë ÛÙËÓ ÂÊË‚Â›· ı¤ÙÂÈ ÛÔ‚·Ú¿ ‰È·-ÊÔÚÔ‰È·ÁÓˆÛÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, Ë ‰Â ÎÏÈÓÈÎ‹ ÙË˜ ÂÈ-ÎfiÓ· Â›Ó·È ÏËÛÈ¤ÛÙÂÚË ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ Î·-Ù¿ıÏÈ„Ë˜ ÙˆÓ ÂÓËÏ›ÎˆÓ ·Ú¿ ÙˆÓ ·È‰ÈÒÓ. ª›· ¿Ï-ÏË ·Ó·ÛÎfiËÛË ÙˆÓ ›‰ÈˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÁÈ· ÙËÓ Î·-Ù¿ıÏÈ„Ë ÛÙËÓ ÂÊË‚Â›· ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈÂ˘ıÂ› (1).

πÛÙÔÚÈÎ‹ ·Ó·‰ÚÔÌ‹∏ ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë ¿ÚÁËÛÂ Ó· ·Ó·ÁÓˆÚÈÛÙÂ›

Û·Ó ·˘ÙfiÓÔÌË ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ·. À‹ÚÍÂ Ì›· ¤ÓÙÔÓË‰È·Ì¿¯Ë Î·Ù¿ fiÛÔ ‹Ù·Ó ·Ó·Ù˘ÍÈ·Î¿ Û˘Ì‚·Ùfi ÁÈ·Ù· ·È‰È¿ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ù¿ıÏÈ„Ë, ‚·ÛÈ˙fiÌÂÓËÛÙËÓ ÎÔÈÓ‹ ·Ú·‰Ô¯‹ fiÙÈ Ë ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È ËÈÔ ¯·ÚÔ‡ÌÂÓË Î·È Â˘¯¿ÚÈÛÙË ÂÚ›Ô‰Ô˜ ÙË˜ ·ÓıÚÒ-ÈÓË˜ ˙ˆ‹˜.

∏ „˘¯·Ó·Ï˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË, Â›ÛË˜, ıÂˆÚÒ-ÓÙ·˜ fiÙÈ ÛÙÔÓ ÌË¯·ÓÈÛÌfi Á¤ÓÂÛË˜ ÙË˜ ÌÂÏ·Á¯ÔÏ›·˜Û˘ÌÌÂÙ¤¯ÂÈ ¤Ó· Û·‰ÈÛÙÈÎfi ˘ÂÚÂÁÒ, ·ÚÓ‹ıËÎÂ ÙËÓ‡·ÚÍ‹ ÙË˜ ÛÙ· ·È‰È¿, Ù· ÔÔ›· ‰ÂÓ ¤¯Ô˘Ó ·Ó·-Ù‡ÍÂÈ ·ÎfiÌË ÙÔ ˘ÂÚÂÁÒ.

O Kraepelin, ·Ó¿ÌÂÛ· ÛÂ 900 ÂÚÈÙÒÛÂÈ˜ ÌÂ-Ï·Á¯ÔÏ›·˜ ÂÓËÏ›ÎˆÓ, ‰ÂÓ ‚Ú‹ÎÂ ·Ú¿ ÌfiÓÔ Ù¤ÛÛÂ-ÚÈ˜ fiÔ˘ ÔÈ ÂÎ‰ËÏÒÛÂÈ˜ ¿Ú¯ÈÛ·Ó ÚÈÓ ÙËÓ ÂÊË‚Â›·,·ÏÏ¿ fi¯È ÚÈÓ ÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÂÙÒÓ (2).

O L. Kanner, ÛÙÔ ‚È‚Ï›Ô ÙË˜ ·È‰Ô„˘¯È·ÙÚÈÎ‹˜ÙÔ 1937, ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÈ ÙËÓ ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„ËÛ·Ó ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ·. ∞Ó·Ê¤ÚÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ·Ï¿ıÔ˜ ‰È¿ÁÓˆÛË Î·È fiÙÈ Ë ÌÂÏ·Á¯ÔÏ›· Â›Ó·È Ì›· Ófi-ÛÔ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ (3).

∏ ÎÏÈÓÈÎ‹ Ú·ÎÙÈÎ‹, fiÌˆ˜, ·Ô‰Â›ÎÓ˘Â ÙËÓ ·-ÚÔ˘Û›· Î·Ù·ıÏÈÙÈÎ‹˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ÛÙ· ·È-‰È¿. ™ÙËÓ ·Ú¯‹ ÌÂÏÂÙ‹ıËÎÂ Û·Ó “ÎÂÎ·Ï˘ÌÌ¤ÓË Î·-Ù¿ıÏÈ„Ë” (masked depression) ÏfiÁˆ ÙË˜ ÚÔÂÍ¿Ú-¯Ô˘Û·˜ ÛˆÌ·ÙÈÎ‹˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ (ÎÔÈÏÈ·Î¿¿ÏÁË, ÎÂÊ·Ï·ÏÁ›Â˜, ·¸Ó›·, ·ÓÔÚÂÍ›· Î·È ·ÒÏÂÈ·‚¿ÚÔ˘˜). ™ÙË Û˘Ó¤¯ÂÈ·, ·Ó·ÁÓˆÚ›ÛÙËÎÂ ÙÔ Î·Ù·ıÏÈ-ÙÈÎfi Û˘Ó·›ÛıËÌ· Î·È ÔÈ ÂÎ‰ËÏÒÛÂÈ˜ ÙÔ˘, ·Ó¿ÏÔÁ·ÌÂ ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÛÙ¿‰ÈÔ ÙÔ˘ ·È‰ÈÔ‡.

∏ ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë ·Ó·ÁÓˆÚ›ÛÙËÎÂ Â›ÛËÌ·Û·Ó ·˘ÙfiÓÔÌË ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ· ÙÔ 1976 ÛÙÔ 4Ô ™˘-Ó¤‰ÚÈÔ ÙË˜ ∂˘Úˆ·˚Î‹˜ ŒÓˆÛË˜ ¶·È‰Ô„˘¯È¿ÙÚˆÓÛÙË ™ÙÔÎ¯fiÏÌË.

ÂÚÈÛÛfiÙÂÚ·. ¢È·ÈÛÙÒÓÂÙ·È Ë ·Ó¿ÁÎË ·Ó¿Ù˘ÍË˜ÛËÌ·ÓÙÈÎfiÙÂÚˆÓ ÚÔÏËÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ, ÌÂÛÎÔfi ÙËÓ ÚÒÈÌË ·Ó›¯ÓÂ˘ÛË, ·ÓÙÈÌÂÙÒÈÛË, ·ÏÏ¿Î·È ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ‰·ÛÎ¿ÏˆÓ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙË˜ ·È‰ÈÎ‹˜ Î·Ù¿-ıÏÈ„Ë˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Î·Ù¿ıÏÈ„Ë ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜,ıÂÚ·Â›·, ÚfiÏË„Ë.

Key words: childhood depression, treatment,prevention.

July August 04 07-10-04 13:52 ™ÂÏ›‰·242

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∆·ÍÈÓfiÌËÛË ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ∏ Î·Ù¿ıÏÈ„Ë Â›Ó·È ·fi ÙÈ˜ ÈÔ Û˘¯Ó¤˜ ÓfiÛÔ˘˜

Î·È ÚÔÎ·ÏÂ› ÛËÌ·ÓÙÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜ ÛÙË ÏÂÈÙÔ˘ÚÁÈ-ÎfiÙËÙ·, ÛÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ· Î·È ÛÙË ÁÂÓÈÎ‹ Î·Ù¿-ÛÙ·ÛË ÙË˜ ˘ÁÂ›·˜ ÙÔ˘ ·ÙfiÌÔ˘.

°È· ÙË ‰È¿ÁÓˆÛË ÙË˜ ‰È·Ù·Ú·¯‹˜, ı· ‹Ù·Ó ¯Ú‹-ÛÈÌÔ Ó· Á›ÓÂÈ ¤Ó·˜ ‚·ÛÈÎfi˜ ‰È·¯ˆÚÈÛÌfi˜ ·Ó¿ÌÂÛ·ÛÙËÓ ¤ÓÓÔÈ· ÙË˜ ıÏ›„Ë˜ Î·È ÛÙËÓ ¤ÓÓÔÈ· ÙË˜ Î·Ù¿-ıÏÈ„Ë˜ (4).

£Ï›„Ë Â›Ó·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi Î·È ·Ó·ÌÂÓfiÌÂÓÔÛ˘Ó·›ÛıËÌ·, Ô˘ ÂÎÏ‡ÂÙ·È Î¿Ùˆ ·fi ÔÚÈÛÌ¤ÓÂ˜ „˘-¯ÔÙÚ·˘Ì·ÙÈÎ¤˜ Û˘Óı‹ÎÂ˜. ŒÓ· ÈÛ¯˘Úfi „˘¯ÔÙÚ·˘-Ì·ÙÈÎfi ÁÂÁÔÓfi˜, fiˆ˜ Â›Ó·È Ë ·ÒÏÂÈ· ÂÓfi˜ ·Á·Ë-Ì¤ÓÔ˘ ÚÔÛÒÔ˘, Ë ‰È¿„Â˘ÛË Ì›·˜ ÛËÌ·ÓÙÈÎ‹˜ÚÔÛ‰ÔÎ›·˜, Ë ÎÔÈÓˆÓÈÎ‹ ‹ Â·ÁÁÂÏÌ·ÙÈÎ‹ ˘Ô‚¿ı-ÌÈÛË ‹ ·ÎfiÌË Î·È Ë ·ÒÏÂÈ· ˘ÏÈÎÒÓ ·Á·ıÒÓ, Â›Ó·ÈÊ˘ÛÈÎfi Ó· ÚÔÎ·ÏÂ› ıÏ›„Ë. ™Â ·ÓÙ›ıÂÛË ÌÂ ÙË ıÏ›-„Ë, Ë Î·Ù¿ıÏÈ„Ë Â›Ó·È ¤Ó· ·ıÔÏÔÁÈÎfi Û˘Ó·›ÛıËÌ·,‰ËÏ·‰‹ Â›ÙÂ ÌË ·Ó·ÌÂÓfiÌÂÓÔ, Â›ÙÂ ˘ÂÚ‚ÔÏÈÎfi ÛÂ¤ÓÙ·ÛË ‹ ‰È¿ÚÎÂÈ·.

OÈ ÚÔÛ¿ıÂÈÂ˜ Î·Ù¿Ù·ÍË˜ ÙË˜ Î·Ù¿ıÏÈ„Ë˜¯ÚÔÓÔÏÔÁÔ‡ÓÙ·È ·fi ÙÔÓ 4Ô ·ÈÒÓ· .Ã., fiÙ·Ó ÔπÔÎÚ¿ÙË˜ ‰ËÌÈÔ‡ÚÁËÛÂ ÙÔ˘˜ fiÚÔ˘˜ “ÌÂÏ·Á¯Ô-Ï›·” (Ì·‡ÚË ¯ÔÏ‹) Î·È “Ì·Ó›·” (ÙÚ¤Ï·) (5).

∆· Û‡Á¯ÚÔÓ· Û˘ÛÙ‹Ì·Ù· Ù·ÍÈÓfiÌËÛË˜, DSM-IVÎ·È ICD-10, ‰È·¯ˆÚ›˙Ô˘Ó ÙÔ˘˜ fiÚÔ˘˜ “ÂÂÈÛfi‰ÈÔ”Î·È “‰È·Ù·Ú·¯‹”. ∆Ô ÂÂÈÛfi‰ÈÔ Â›Ó·È Ì›· ÂÚ›Ô‰Ô˜Ô˘ ‰È·ÚÎÂ› ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô Â‚‰ÔÌ¿‰Â˜, Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÎÂÙ¿ Û˘-ÌÙÒÌ·Ù· ÁÈ· ÙËÓ Ï‹ÚˆÛË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓÎÚÈÙËÚ›ˆÓ.

ª›· ·fi ÙÈ˜ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ ‰È·ÎÚ›ÛÂÈ˜ ÌÂÙ·Í‡ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ ‰È¿ıÂÛË˜ Â›Ó·È Ô ‰È·¯ˆÚÈÛÌfi˜ÛÂ ÌÔÓÔÔÏÈÎ‹ Î·È ‰ÈÔÏÈÎ‹ Î·ÙËÁÔÚ›·. OÈ ÌÔÓÔÔ-ÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ‰È¿ıÂÛË˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È·fi Î·Ù·ıÏÈÙÈÎ¿ Û˘ÌÙÒÌ·Ù· ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ·-ıÔÏÔÁÈÎ¿ ·˘ÍËÌ¤ÓË˜ ‰È¿ıÂÛË˜. ™ÙÈ˜ ‰ÈÔÏÈÎ¤˜ ‰È·-Ù·Ú·¯¤˜ ÙË˜ ‰È¿ıÂÛË˜, Ë Î·Ù¿ıÏÈ„Ë ÂÓ·ÏÏ¿ÛÛÂÙ·È‹ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ Ì·Ó›· ‹ ˘ÔÌ·Ó›·. ™ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌfiÓÔ ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì·-Ó›· (ÌÔÓÔÔÏÈÎ‹ Ì·Ó›·) ‰›ÓÂÙ·È Ë ‰È¿ÁÓˆÛË ÙË˜ ‰È-ÔÏÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ ÙË˜ ‰È¿ıÂÛË˜, ˘fi ÙËÓ ÚÔ¸-fiıÂÛË fiÙÈ ÙÂÏÈÎ¿ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ¤Ó· ÂÂÈÛfi‰ÈÔÎ·Ù¿ıÏÈ„Ë˜.

∏ ÌÂ›˙ˆÓ Î·Ù·ıÏÈÙÈÎ‹ ‰È·Ù·Ú·¯‹ ¯·Ú·ÎÙËÚ›˙Â-Ù·È ·fi ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· Î·Ù·ıÏÈÙÈÎ¿ ÂÂÈÛfi-‰È·, ¯ˆÚ›˜ Ì·Ó›· ‹ ˘ÔÌ·Ó›·. ∆· Î·Ù·ıÏÈÙÈÎ¿ Û‡Ó-‰ÚÔÌ· Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÛˆÌ·ÙÈÎ¤˜ ÓfiÛÔ˘˜Î·È ·fi Ê¿ÚÌ·Î· ‹ „˘¯Ô‰Ú·ÛÙÈÎ¤˜ Ô˘Û›Â˜ ‰ÂÓ ıÂ-ˆÚÔ‡ÓÙ·È ÚˆÙÔ·ıÂ›˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ‰È¿ıÂÛË˜Î·È ‰ÂÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ÌÂ›˙ˆÓ Î·Ù·ıÏÈÙÈÎ‹‰È·Ù·Ú·¯‹.

∏ ‰˘Ûı˘ÌÈÎ‹ ‰È·Ù·Ú·¯‹ Û˘ÌÂÚÈÏ‹ÊıËÎÂ ÛÙÔ

DSM-III ÁÈ· Ó· ‰ËÏÒÛÂÈ Ì›· ¯ÚfiÓÈ· Î·Ù¿ıÏÈ„Ë Ô˘Â›Ó·È ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú‹ ·fi ÙË ÌÂ›˙ÔÓ· Î·Ù¿ıÏÈ„Ë.∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË˜ ‰˘Ûı˘ÌÈÎ‹˜ ‰È·Ù·Ú·-¯‹˜ Â›Ó·È Ì›· ¯ÚÔÓ›ˆ˜ Î·Ù·ıÏÈÙÈÎ‹ ‰È¿ıÂÛË, ËÔÔ›· ˘¿Ú¯ÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙË˜ ËÌ¤Ú·˜Î·È ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ËÌ¤ÚÂ˜ ÛÂ ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯È-ÛÙÔÓ 2 ÂÙÒÓ.

∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ¿ ÙÔ ÌÂ›˙ÔÓ Î·Ù·ıÏÈ-ÙÈÎfi ÂÂÈÛfi‰ÈÔ Î·È ÙË ‰˘Ûı˘Ì›· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›·, Î·ıÒ˜ ·˘Ù¤˜ ÔÈ ÎÏÈÓÈÎ¤˜ ÔÓÙfiÙËÙÂ˜ Û˘Ó·ÓÙÒ-ÓÙ·È Û˘¯ÓfiÙÂÚ·. ∏ ‰ÈÔÏÈÎ‹ ‰È·Ù·Ú·¯‹ Û˘Ó·ÓÙ¿Ù·ÈÔÏ‡ Û¿ÓÈ· Î·È ÂÎÊÚ¿˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂ „˘¯ˆÙÈÎ‹Û˘ÌÙˆÌ·ÙÔÏÔÁ›·.

¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ·∆· Û˘ÛÙ‹Ì·Ù· Ù·ÍÈÓfiÌËÛË˜ ÛÙ¿ıËÎ·Ó ·Ì‹¯·Ó·

ÛÙÔÓ ÔÚÈÛÌfi ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙËÓ ·È‰È-Î‹ Î·Ù¿ıÏÈ„Ë.

™ÙËÓ Ù¤Ù·ÚÙË ·Ó·ıÂÒÚËÛË ÙÔ˘ ¢È·ÁÓˆÛÙÈÎÔ‡Î·È ™Ù·ÙÈÛÙÈÎÔ‡ ∂Á¯ÂÈÚÈ‰›Ô˘ ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ æ˘-¯È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ (DSM-IV), Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÈ˜ ‰È·Ù·Ú·-¯¤˜ ÙË˜ ‰È¿ıÂÛË˜ Î·È fi¯È ÛÙÈ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘-Ó‹ıˆ˜ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ Î·Ù¿ ÙË‚ÚÂÊÈÎ‹-·È‰ÈÎ‹ ‹ ÂÊË‚ÈÎ‹ ËÏÈÎ›· (¶›Ó·ÎÂ˜ 1 Î·È 2).πÛ¯‡Ô˘Ó Ù· ÎÚÈÙ‹ÚÈ· ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ÂÓËÏ›ÎˆÓ ÌÂÌÈÎÚ¤˜ ‰ÈÂ˘ÎÚÈÓ›ÛÂÈ˜, fiˆ˜ .¯. “Ë ‰È¿ıÂÛË ÛÙ· ·È-‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÔÚÂ› Ó· Â›Ó·È Â˘ÂÚ¤ıÈÛÙË‰È¿ıÂÛË” ‹ “ÛËÌ·ÓÙÈÎ‹ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÛÙ· ·È-‰È¿: Ï¿‚ÂÙÂ ˘’ fi„ÈÓ ÙËÓ ·ÔÙ˘¯›· ÛÙËÓ ÚfiÛÏË„ËÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘ ‚¿ÚÔ˘˜”. ∞·Ú·›ÙËÙË ÚÔ¸fi-ıÂÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÌÂ›˙ÔÓÔ˜ Î·Ù·ıÏÈÙÈÎÔ‡ÂÂÈÛÔ‰›Ô˘ Â›Ó·È Ë ‰˘ÛÊÔÚÈÎ‹ ‰È¿ıÂÛË ‹ Ë ·ÒÏÂÈ·Â˘¯·Ú›ÛÙËÛË˜ ‹ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ Î·È ¤Ó· Û‡ÌÙˆÌ··fi ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ÙÔÌÂ›˜ ÏÂÈÙÔ˘ÚÁ›·˜: fiÚÂÍË-Ê·ÁËÙfi, ‡ÓÔ˜, „˘¯ÔÎÈÓËÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·.∞·ÈÙÂ›Ù·È Ë ÂÎ‰‹ÏˆÛË ¤ÓÙÂ Û˘ÌÙˆÌ¿ÙˆÓ Â›‰‡Ô Â‚‰ÔÌ¿‰Â˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ. ∞fi ÙËÓ ÎÏÈÓÈÎ‹ÂÌÂÈÚ›·, fiÌˆ˜, ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÛÔ ‰‡ÛÎÔÏË Â›-Ó·È Ë ‰È¿ÁÓˆÛË ÙË˜ ‰˘ÛÊÔÚ›·˜ ÛÙ· ·È‰È¿ Î·È fiÙÈ Ô¯ÚfiÓÔ˜ ÙˆÓ ‰‡Ô Â‚‰ÔÌ¿‰ˆÓ Â›Ó·È ·ÚÎÂÙ¿ ÌÂÁ¿ÏÔ˜Î·È ·Ú·¤ÌÂÈ ÛÂ ·ÓÙÈ‰Ú·ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘·È‰ÈÔ‡ ·¤Ó·ÓÙÈ ÛÂ „˘¯ÔÈÂÛÙÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜Ô˘ ‚ÈÒÓÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‹ ÛÙÔ Â˘Ú‡ÙÂÚÔ ÂÚÈ-‚¿ÏÏÔÓ (6).

¶·ÚfiÌÔÈÂ˜ ‰˘ÛÎÔÏ›Â˜ ‰È·ÈÛÙÒÓÔÓÙ·È ÛÙË ‰È·-ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ICD-10. ÃÚËÛÈÌÔÔÈÔ‡-ÓÙ·È Ù· ÁÂÓÈÎ¿ ÎÚÈÙ‹ÚÈ· ‰È·Ù·Ú·¯‹˜ ÙË˜ ‰È¿ıÂÛË˜(F30-39) ÌÂ ‰ÈÂ˘ÎÚÈÓ›ÛÂÈ˜ fiˆ˜: “ÌË Ù˘ÈÎ¤˜ ÂÈÎfi-ÓÂ˜ Â›Ó·È È‰È·›ÙÂÚ· Û˘¯Ó¤˜ Î·Ù¿ ÙËÓ ÂÊË‚Â›·”. ™ÙÔÎÂÊ¿Ï·ÈÔ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÌÂ ¤Ó·ÚÍË Û˘Ó‹ıˆ˜Î·Ù¿ ÙËÓ ·È‰ÈÎ‹ Î·È ÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›· ·Ó‹ÎÂÈ Ë‰È·Ù·Ú·¯‹ ÙË˜ ‰È·ÁˆÁ‹˜ Î·Ù·ıÏÈÙÈÎÔ‡ Ù‡Ô˘

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(F92.0). ¶ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ Â›ÌÔÓÔ Î·È ¤ÓÙÔÓÔ Î·-Ù·ıÏÈÙÈÎfi Û˘Ó·›ÛıËÌ· Ô˘ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ Û˘-ÌÙÒÌ·Ù· fiˆ˜ ˘ÂÚ‚ÔÏÈÎ‹ ÁÎÚ›ÓÈ·, ·ÒÏÂÈ· ÂÓ-‰È·Ê¤ÚÔÓÙÔ˜ Î·È Â˘¯·Ú›ÛÙËÛË˜ Ô˘ ÚÔÛÊ¤ÚÔ˘ÓÔÈ Û˘ÓËıÈÛÌ¤ÓÂ˜ ·Û¯ÔÏ›Â˜, ·˘ÙÔÌÔÌÊ‹ Î·È ·ÂÏ-ÈÛ›·. ¶Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘Ó‡·ÚÍË ‰È·Ù·Ú·¯ÒÓ‡ÓÔ˘ Î·È fiÚÂÍË˜ (7).

H Á·ÏÏÈÎ‹ Ù·ÍÈÓfiÌËÛË ÙˆÓ „˘¯ÈÎÒÓ ‰È·Ù·Ú·¯ÒÓÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘, ÈÛÙ‹ ÛÙÔÓ „˘¯·Ó·Ï˘-ÙÈÎfi ÚÔÛ·Ó·ÙÔÏÈÛÌfi, Î·Ù·Ù¿ÛÛÂÈ ÙËÓ Î·Ù¿ıÏÈ„Ë·Ó¿ÏÔÁ· ÌÂ ÙÔ ‰ÔÌÈÎfi ˘fi‚·ıÚÔ, ÛÂ ¤ÓÙÂ ‰È·ÊÔ-ÚÂÙÈÎ¤˜ Î·ÙËÁÔÚ›Â˜: „‡¯ˆÛË (1.06 ‰˘Ûı˘ÌÈÎ¤˜ „˘-¯ÒÛÂÈ˜), ÓÂ‡ÚˆÛË (2.05 ÓÂ˘ÚˆÙÈÎ‹ Î·Ù¿ıÏÈ„Ë), ·-ıÔÏÔÁ›· ÙË˜ ÚÔÛˆÈÎfiÙËÙ·˜ (3.05 Î·Ù¿ıÏÈ„Ë Ô˘

Û¯ÂÙ›˙ÂÙ·È ÌÂ ·ıÔÏÔÁ›· ÚÔÛˆÈÎfiÙËÙ·˜), ·ÓÙÈ-‰Ú·ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (4.00 ·ÓÙÈ‰Ú·ÛÙÈÎ‹ Î·Ù¿ıÏÈ-„Ë) Î·È ·Ú·ÏÏ·Á‹ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (9. 01 ·ÚÔ-‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë) (8).

∂È‰ËÌÈÔÏÔÁ›·∏ Â›ÙˆÛË ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ÛÙ· ·È‰È¿ Î˘Ì·›-

ÓÂÙ·È, ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ ÌÂÏ¤ÙÂ˜, ·fi 0,4% ¤ˆ˜ 2,5%(9,10).

∆Ô ÔÛÔÛÙfi ·˘Ùfi ·˘Í¿ÓÂÈ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ·ÎÏÈÓÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙÂ› fiÙÈ 1ÛÙ· 5 ·È‰È¿ Ô˘ ·Ú·¤ÌÔÓÙ·È ÛÂ „˘¯È·ÙÚÈÎ¿ÙÌ‹Ì·Ù·, ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ù·ıÏÈÙÈÎ‹ Û˘ÌÙˆÌ·ÙÔ-ÏÔÁ›· (11).

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¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÌÂ›˙ÔÓÔ˜ Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Û‡ÌÊˆÓ· ÌÂ ÙÔ DSM-IV

∞. ¶¤ÓÙÂ ‹ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·ÎfiÏÔ˘ı· Û˘ÌÙÒÌ·Ù· ‹Ù·Ó ·ÚfiÓÙ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ›‰È·˜ ÂÚÈfi‰Ô˘ ‰‡Ô Â‚‰ÔÌ¿‰ˆÓÎ·È ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Ì›· ·ÏÏ·Á‹ ÛÙËÓ ÚÔËÁÔ‡ÌÂÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·. ∆Ô˘Ï¿¯ÈÛÙÔÓ ÙÔ ¤Ó· ·fi Ù· Û˘ÌÙÒÌ·Ù· Â›Ó·È Â›ÙÂ(1) Î·Ù·ıÏÈÙÈÎ‹ ‰È¿ıÂÛË Â›ÙÂ (2) ·ÒÏÂÈ· ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ ‹ Â˘¯·Ú›ÛÙËÛË˜ 1. ∫·Ù·ıÏÈÙÈÎ‹ ‰È¿ıÂÛË ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙË˜ ËÌ¤Ú·˜

™ËÌÂ›ˆÛË: ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÔÚÂ› Ó· Â›Ó·È Â˘ÂÚ¤ıÈÛÙË ‰È¿ıÂÛË 2. ŒÓÙÔÓË ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ ‹ ÙË˜ Â˘¯·Ú›ÛÙËÛË˜ ÛÂ fiÏÂ˜ ‹ Û¯Â‰fiÓ fiÏÂ˜ ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ

Ì¤ÚÔ˜ ÙË˜ ËÌ¤Ú·˜ 3. ™ËÌ·ÓÙÈÎ‹ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ - ÂÓÒ ‰ÂÓ Â›Ó·È ÛÂ ‰›·ÈÙ· - ‹ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ (.¯. ÌÂÙ·‚ÔÏ‹ ¿Óˆ ·fi 5% ÙÔ˘

ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÛÂ ¤Ó· Ì‹Ó·) ‹ ÂÏ¿ÙÙˆÛË ‹ ·‡ÍËÛË ÙË˜ fiÚÂÍË˜ ™ËÌÂ›ˆÛË: ™Ù· ·È‰È¿ Ï¿‚ÂÙÂ ˘’ fi„ÈÓ ÙËÓ ·ÔÙ˘¯›· ÛÙËÓ ÚfiÛÏË„Ë ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘ ‚¿ÚÔ˘˜

4. ∞¸Ó›· ‹ ˘ÂÚ˘Ó›· 5. æ˘¯ÔÎÈÓËÙÈÎ‹ ‰È¤ÁÂÚÛË ‹ ÂÈ‚Ú¿‰˘ÓÛË6. ∫fiˆÛË ‹ ·ÒÏÂÈ· ÙË˜ ÂÓÂÚÁËÙÈÎfiÙËÙ·˜7. ∞ÈÛı‹Ì·Ù· ·Ó·ÍÈfiÙËÙ·˜ ‹ ˘¤ÚÌÂÙÚË˜ ‹ ·ÚfiÛÊÔÚË˜ ÂÓÔ¯‹˜ (fi¯È ·ÏÒ˜ ·˘ÙÔÌÔÌÊ‹ ‹ ÂÓÔ¯‹ ÂÂÈ‰‹ Â›Ó·È ·ÛıÂÓ‹˜) 8. ∂Ï·ÙÙˆÌ¤ÓË ÈÎ·ÓfiÙËÙ· Ó· ÛÎÂÊıÂ› ‹ Ó· Û˘ÁÎÂÓÙÚˆıÂ›, ‹ ·Ó·ÔÊ·ÛÈÛÙÈÎfiÙËÙ·9. ∂·ÓÂÚ¯fiÌÂÓÂ˜ ÛÎ¤„ÂÈ˜ ı·Ó¿ÙÔ˘ (fi¯È ÌfiÓÔ Êfi‚Ô˜ ı·Ó¿ÙÔ˘), Â·ÓÂÚ¯fiÌÂÓÔ˜ ·˘ÙÔÎÙÔÓÈÎfi˜ È‰Â·ÛÌfi˜ ¯ˆÚ›˜

Û˘ÁÎÂÎÚÈÌ¤ÓÔ Û¯¤‰ÈÔ ‹ Ì›· ·fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜ ‹ ¤Ó· Û˘ÁÎÂÎÚÈÌ¤ÓÔ Û¯¤‰ÈÔ Ó· ·˘ÙÔÎÙÔÓ‹ÛÂÈµ. ∆· Û˘ÌÙÒÌ·Ù· ÚÔÎ·ÏÔ‡Ó ÎÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÂÓfi¯ÏËÛË ‹ ¤ÎÙˆÛË ÙË˜ ÎÔÈÓˆÓÈÎ‹˜, Â·ÁÁÂÏÌ·ÙÈÎ‹˜ ‹ ¿ÏÏˆÓ ÛËÌ·ÓÙÈÎÒÓ

ÂÚÈÔ¯ÒÓ ÙË˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜°. ∆· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÔÊÂ›ÏÔÓÙ·È ÛÙÈ˜ ¿ÌÂÛÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ‰Ú¿ÛÂÈ˜ Ì›·˜ Ô˘Û›·˜

(.¯. Ô˘Û›· Î·Ù¿¯ÚËÛË˜, Ê¿ÚÌ·Î·) ‹ ÁÂÓÈÎ‹˜ ÛˆÌ·ÙÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ (.¯. ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi˜)¢. ∆· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÂÍËÁÔ‡ÓÙ·È Î·Ï‡ÙÂÚ· ÌÂ ¤ÓıÔ˜, ‰ËÏ·‰‹ ÌÂ ÙËÓ ·ÒÏÂÈ· ·Á·ËÌ¤ÓÔ˘ ÚÔÛÒÔ˘

¶›Ó·Î·˜ 2. ¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ‰˘Ûı˘ÌÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ Û‡ÌÊˆÓ· ÌÂ ÙÔ DSM-IV

∞. ∫·Ù·ıÏÈÙÈÎ‹ ‰È¿ıÂÛË ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙË˜ ËÌ¤Ú·˜, ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ËÌ¤ÚÂ˜, fiˆ˜ Ê·›ÓÂÙ·È Â›ÙÂ ·fi ÙËÓ˘ÔÎÂÈÌÂÓÈÎ‹ ÂÎÙ›ÌËÛË Â›ÙÂ ÌÂ ÙËÓ ·Ú·Ù‹ÚËÛË ÙˆÓ ¿ÏÏˆÓ, ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ¯ÚfiÓÈ· ™ËÌÂ›ˆÛË: ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÔÚÂ› Ó· Â›Ó·È Â˘ÂÚ¤ıÈÛÙË ‰È¿ıÂÛË Î·È Ë ‰È¿ÚÎÂÈ· Ú¤ÂÈ Ó· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ¤Ó·˜ ¯ÚfiÓÔ˜

µ. ¶·ÚÔ˘Û›·, fiÙ·Ó ˘¿Ú¯ÂÈ Î·Ù·ıÏÈÙÈÎ‹ ‰È¿ıÂÛË, ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·fi Ù· ·ÎfiÏÔ˘ı·: 1. ªÂÈˆÌ¤ÓË fiÚÂÍË ‹ ˘ÂÚÊ·Á›· 2. ∞¸Ó›· ‹ ˘ÂÚ˘Ó›· 3. Ã·ÌËÏ‹ ÂÓÂÚÁËÙÈÎfiÙËÙ· ‹ ÎfiˆÛË 4. Ã·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË5. ºÙˆ¯‹ Û˘ÁÎ¤ÓÙÚˆÛË ‹ ‰˘ÛÎÔÏ›· Ï‹„Ë˜ ·ÔÊ¿ÛÂˆÓ 6. ∞ÈÛı‹Ì·Ù· ·ÂÏÈÛ›·˜

°. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¯ÚÔÓÈÎ‹˜ ÂÚÈfi‰Ô˘ ÙˆÓ 2 ¯ÚfiÓˆÓ (¤Ó·˜ ¯ÚfiÓÔ˜ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜) ÙË˜ ‰È·Ù·Ú·¯‹˜, ÙÔ ¿ÙÔÌÔ‰ÂÓ ‹Ù·Ó ÔÙ¤ ÂÏÂ‡ıÂÚÔ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ ÎÚÈÙËÚ›ˆÓ ∞ Î·È µ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 2 Ì‹ÓÂ˜ ÙË ÊÔÚ¿

¢. ¢ÂÓ ˘‹ÚÍÂ ·ÚÔ˘Û›· ÌÂ›˙ÔÓÔ˜ Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 2 ¯ÚfiÓˆÓ ÙË˜ ‰È·Ù·Ú·¯‹˜ (¤Ó·˜ ¯ÚfiÓÔ˜ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜)

∂. ∆· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÔÊÂ›ÏÔÓÙ·È ÛÙÈ˜ ¿ÌÂÛÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ‰Ú¿ÛÂÈ˜ Ì›·˜ Ô˘Û›·˜ (.¯. Ô˘Û›· Î·Ù¿¯ÚËÛË˜, Ê¿ÚÌ·Î·) ‹ÁÂÓÈÎ‹˜ ÛˆÌ·ÙÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ (.¯. ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi˜)

™∆. ∆· Û˘ÌÙÒÌ·Ù· ÚÔÎ·ÏÔ‡Ó ÎÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÂÓfi¯ÏËÛË ‹ ¤ÎÙˆÛË ÙË˜ ÎÔÈÓˆÓÈÎ‹˜, Â·ÁÁÂÏÌ·ÙÈÎ‹˜ ‹ ¿ÏÏˆÓ ÛËÌ·ÓÙÈÎÒÓÂÚÈÔ¯ÒÓ ÙË˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜

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ÕÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÛÔÛÙfi 7% ÙˆÓ·È‰ÈÒÓ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÛÙÔ ÁÂÓÈÎfi ÓÔÛÔÎÔÌÂ›ÔÎ·È 40% ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ÎÂ-Ê·Ï·ÏÁ›· Â›¯·Ó Î·Ù¿ıÏÈ„Ë (12,13).

™Ù· ·È‰È¿, Ë ÌÂ›˙ˆÓ Î·Ù·ıÏÈÙÈÎ‹ ‰È·Ù·Ú·¯‹ÂÎ‰ËÏÒÓÂÙ·È ÛÂ ÂÚ›Ô˘ ›‰È· ·Ó·ÏÔÁ›· ÛÂ ·ÁfiÚÈ·Î·È ÎÔÚ›ÙÛÈ·, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·ÈÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ fiÔ˘ ˘ÂÚÙÂÚÔ‡Ó ÔÈ Á˘Ó·›ÎÂ˜ (14).

ŒÚÂ˘ÓÂ˜ ÛÂ ÎÏÈÓÈÎÔ‡˜ Î·È ÌË ÎÏÈÓÈÎÔ‡˜ ÏËı˘-ÛÌÔ‡˜ ¤‰ÂÈÍ·Ó fiÙÈ Ù· ¿ÙÔÌ· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔÙ¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ Èı·Ófi-ÙËÙÂ˜ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·Ù¿ıÏÈ„Ë Î·È fiÙÈ Ë ‰È·-Ù·Ú·¯‹ ÂÎ‰ËÏÒÓÂÙ·È ÛÂ fiÏÔ Î·È ÌÈÎÚfiÙÂÚÂ˜ ËÏÈ-Î›Â˜ (15,16).

∞˘Ù‹ Ë ‰È·›ÛÙˆÛË ·ÊÔÚ¿ ÛÂ ÂÏ·ÊÚ¤˜ Î·È Ì¤-ÙÚÈÔ˘ ‚·ıÌÔ‡ Î·Ù·ıÏ›„ÂÈ˜ Î·È fi¯È ÛÙË ÌÂ›˙ÔÓ· ‰È·-Ù·Ú·¯‹ (17). ∞Ô‰›‰ÂÙ·È ‰Â ÂÚÈÛÛfiÙÂÚÔ ÛÂ ·‡ÍË-ÛË ÙˆÓ ÛÙÚÂÛÔÁfiÓˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ Û˘ÓıËÎÒÓÎ·È ÏÈÁfiÙÂÚÔ ÛÂ ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ (18).

™Â Ì›· ÚfiÛÊ·ÙË ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË ÛÙËÓ∂ÏÏ¿‰·, ÔÛÔÛÙfi 11,5% ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ËÏÈ-Î›·˜ 10-17 ÂÙÒÓ ·ÍÈÔÏÔÁ‹ıËÎÂ ˆ˜ Û‡ÓÔÏÔ ·ÙfiÌˆÓÌÂ ˘„ËÏ‹ ·ÚÔ˘Û›· Î·Ù·ıÏÈÙÈÎ‹˜ Û˘ÌÙˆÌ·ÙÔ-ÏÔÁ›·˜. ¶·Ú·ÙËÚ‹ıËÎ·Ó ÂÈ‚·Ú˘Ì¤ÓÂ˜ ÔÈ ÂÚÈ-ÙÒÛÂÈ˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ˆ˜ ÚÔ˜ ÙËÓ ·ÚÔ˘Û›· Î·ÈÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙÔ Û˘ÓÔÏÈÎfi‰Â›ÁÌ· (19).

∆· ·ÚÓËÙÈÎ¿ ÁÓˆÛÙÈÎ¿ Û¯‹Ì·Ù· Î·È Ë ¯·ÌËÏ‹ ÂÈ-ÎfiÓ· Â·˘ÙÔ‡ ‰È·ÊÔÚÔÔ›ËÛ·Ó ÛËÌ·ÓÙÈÎ¿ Ù· ·È‰È¿Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÂ ˘„ËÏ‹ ·ÚÔ˘Û›· Î·Ù·ıÏÈÙÈ-ÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ ˘fiÏÔÈÔ˘˜Û˘ÌÌÂÙ¤¯ÔÓÙÂ˜.

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ· ∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ·È‰ÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜ ·ÚÔ˘-

ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰È·ÊÔÚ¤˜ ·fi ÂÎÂ›ÓË ÙˆÓ ÂÓËÏ›ÎˆÓ. ∏ ÏÂÎÙÈÎ‹ ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ıÏ›„Ë˜,

·fiÁÓˆÛË˜ ‹ ·ÂÏÈÛ›·˜ Û¿ÓÈ· Û˘Ó·ÓÙ¿Ù·È ÛÙ··È‰È¿. ªÂÏ·Á¯ÔÏÈÎ¿ ‹ „˘¯ˆÙÈÎ¿ Û˘ÌÙÒÌ·Ù·, ˘Ô-ÏÂÈÌÌ·ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ·fiÂÈÚÂ˜ ·˘ÙÔÎÙÔ-Ó›·˜ Î·È ·˘ÙÔÎÙÔÓ›Â˜ Û˘Ó·ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· fiÛÔ·˘Í¿ÓÂÈ Ë ËÏÈÎ›·. ∞ÓÙ›ıÂÙ·, ÙÔ ¿Á¯Ô˜ ÙÔ˘ ·Ô¯ˆÚÈ-ÛÌÔ‡, ÊÔ‚›Â˜, ÛˆÌ·ÙÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È ‰È·Ù·Ú·-¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ·È‰ÈÎ‹ËÏÈÎ›·. ∞ÎfiÌË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ·ÏÏ¿˙ÂÈ ·Ó¿-ÏÔÁ· ÌÂ ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÛÙ¿‰ÈÔ ÙÔ˘ ·È‰ÈÔ‡ (20).

O R. Spitz, ÌÂ ÙÈ˜ ¤ÚÂ˘Ó¤˜ ÙÔ˘ ÛÙ· ÔÚÊ·ÓÔÙÚÔ-ÊÂ›· ÌÂÙ¿ ÙÔÓ µ’ ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ, ¤‰ÂÈÍÂ fiÙÈ ¤Ó·‚Ú¤ÊÔ˜ ÌÔÚÂ› Ó· ¤¯ÂÈ ·ÈÛı‹Ì·Ù· Ï‡Ë˜ Î·È Ó· ˙‹-ÛÂÈ Ì›· Ú·ÁÌ·ÙÈÎ¿ Î·Ù·ıÏÈÙÈÎ‹ ÂÌÂÈÚ›· Û˘ÓÔ-‰Â˘fiÌÂÓË ·fi ¤ÓÙÔÓË „˘¯ÔÎÈÓËÙÈÎ‹ ÂÈ‚Ú¿‰˘ÓÛË.∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, fiˆ˜ ÙËÓ ÂÚÈ¤ÁÚ·„Â Ô Spitz, ÛÂ

¤Ó· ‚Ú¤ÊÔ˜ ËÏÈÎ›·˜ 6-8 ÌËÓÒÓ Ô˘ ¯ˆÚ›˙ÂÙ·È ·fiÙË ÌËÙ¤Ú· ÙÔ˘, ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈÎ‹ ·¿ıÂÈ·, ¿Ú-ÓËÛË Â·Ê‹˜, ·‰È·ÊÔÚ›· ÚÔ˜ ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ·ÓÔ-ÚÂÍ›· Î·È ·¸Ó›·. ∂¿Ó ‚ÚÂıÂ› ¤Ó· ÌËÙÚÈÎfi ˘ÔÎ·Ù¿-ÛÙ·ÙÔ ·Ó¿ÌÂÛ· ÛÙÔÓ 3Ô-5Ô Ì‹Ó· ·fi ÙÔÓ ·Ô¯ˆÚÈ-ÛÌfi, Ë ÂÈÎfiÓ· ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ÂÍ·Ê·Ó›˙ÂÙ·È ÚÔÔ-‰Â˘ÙÈÎ¿. ¢È·ÊÔÚÂÙÈÎ¿, ÂÍÂÏ›ÛÛÂÙ·È ÛÂ Ì›· Î·Ù¿ÛÙ·-ÛË Ê˘ÛÈÎÔ‡ Î·È „˘¯ÈÎÔ‡ Ì·Ú·ÛÌÔ‡. O Spitz ÙËÓÔÓfiÌ·ÛÂ ·Ó·ÎÏËÙÈÎ‹ Î·Ù¿ıÏÈ„Ë Î·È ¤ÛÙÚÂ„Â ÙËÓÚÔÛÔ¯‹ ÛÙÈ˜ „˘¯ÔÛˆÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ Î·-Ù¿ıÏÈ„Ë˜ ÛÙËÓ ·Ú¯‹ ÙË˜ ˙ˆ‹˜ (21).

™‹ÌÂÚ·, ‰Â¯fiÌ·ÛÙÂ fiÙÈ Ë ‚ÚÂÊÈÎ‹ Î·Ù¿ıÏÈ„ËÂÎ‰ËÏÒÓÂÙ·È ÌÂ: ·) Û˘Ó·ÈÛıËÌ·ÙÈÎ‹ ·ÙÔÓ›·: ÙÔ ‚Ú¤-ÊÔ˜ ‰ÂÓ ÂÍ·ÛÎÂ› ÙÈ˜ ·ÈÛıËÙËÚÈ·Î¤˜ ÙÔ˘ ÈÎ·ÓfiÙËÙÂ˜,‰ÂÓ ¤¯ÂÈ ‰È¿ıÂÛË Ó· ÎÔÈÙ¿ÂÈ, Ó· ·ÎÔ‡ÂÈ, Ó· Ì˘Ú›˙ÂÈ,Ó· ÎÈÓÂ›Ù·È, Ó· ÁÓˆÚ›˙ÂÈ, Ó· ÏÂÈÙÔ˘ÚÁÂ› Î·È Ó· ÚÔÔ-‰Â‡ÂÈ, ‚) ÌÂÈˆÌ¤ÓÂ˜ ÎÈÓËÙÈÎ¤˜ ÚˆÙÔ‚Ô˘Ï›Â˜, ÊÙˆ-¯‹ ÌÈÌÈÎ‹, ÌÔÓÔÙÔÓ›·, Ù¿ÛË ÁÈ· Â·Ó¿ÏË„Ë ÙˆÓÈ‰›ˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È Á) ÊÙˆ¯‹ ·ÏÏËÏÂÈ‰Ú·-ÛÙÈÎ‹ Û¯¤ÛË ÌÂ ÙË ÌËÙ¤Ú·, ÌÂ›ˆÛË ÙˆÓ ÚˆÙÔ‚Ô˘-ÏÈÒÓ ·ÏÏ¿ Î·È ÙˆÓ ··ÓÙ‹ÛÂˆÓ ÛÙÈ˜ ÚÔÙÚÔ¤˜,·ÔÙ˘¯›· ÂÈÎÔÈÓˆÓ›·˜.

∏ ‚ÚÂÊÈÎ‹ Î·Ù¿ıÏÈ„Ë, Û‡ÌÊˆÓ· ÌÂ „˘¯·Ó·Ï˘-Ù¤˜ Û˘ÁÁÚ·ÊÂ›˜, ıÂˆÚÂ›Ù·È ¤Ó·˜ Î‡ÚÈÔ˜ ·Ú¿ÁÔ-ÓÙ·˜ „˘¯ÔÛˆÌ·ÙÈÎ‹˜ ·Ô‰ÈÔÚÁ¿ÓˆÛË˜ (22). OÓÔ-Ì¿˙ÂÙ·È “ÎÚ‡·” Î·Ù¿ıÏÈ„Ë ‹ “Û‡Ó‰ÚÔÌÔ ÙÔ˘ ¿‰ÂÈ-Ô˘” Î·È ÂÎÊÚ¿˙ÂÈ ÙËÓ ¤ÏÏÂÈ„Ë ÛÙË Û˘Ó·ÈÛıËÌ·ÙÈÎ‹¤Ó‰ÂÈ·, ÙËÓ ·‰È·ÊÔÚ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÁÈ· ÙÔÓ Â·˘ÙfiÙÔ˘ Î·È ÙÔÓ ÂÍˆÙÂÚÈÎfi ÎfiÛÌÔ Ô˘ ÙÔ ÂÚÈ‚¿ÏÏÂÈ.

™ÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›· Î˘ÚÈ·Ú¯Ô‡Ó ÔÈ ÂÎ‰ËÏÒ-ÛÂÈ˜ „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈÎ‹˜ ·Ó·ÛÙÔÏ‹˜. ∏ ·‰È·ÊÔ-Ú›·, Ë ·¿ıÂÈ·, Ë ÌË ÂÎ‰‹ÏˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ÂÎ Ì¤-ÚÔ˘˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ÌË Û˘ÌÌÂÙÔ¯‹ ÛÙÔ ·È¯Ó›‰È·ÔÙÂÏÔ‡Ó ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·Ù¿ıÏÈ„Ë˜. ™Â ·˘Ù‹ÙËÓ ËÏÈÎ›· ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ‰È¿ÊÔÚÂ˜ ÊÔ‚›Â˜Î·È ¿Á¯Ô˜ ·Ô¯ˆÚÈÛÌÔ‡. ¶·Ú·ÙËÚÔ‡ÓÙ·È, Â›ÛË˜,ÛˆÌ·ÙÈÎ¿ Û˘ÌÙÒÌ·Ù· (ÎÔÈÏÈ·ÎÔ› fiÓÔÈ), ‰È·Ù·Ú·-¯¤˜ ‰È·ÙÚÔÊ‹˜ (·ÓÔÚÂÍ›·, ¿ÚÓËÛË ÙÚÔÊ‹˜) Î·È ‰È·-Ù·Ú·¯¤˜ ‡ÓÔ˘ (·¸Ó›·, Ó˘¯ÙÂÚÈÓÔ› ÂÊÈ¿ÏÙÂ˜).

¶ÚfiÛÊ·ÙÂ˜ ¤ÚÂ˘ÓÂ˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎËÚÔÛ·ÚÌÔÁ‹˜ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÙÔ˘DSM-IV, ÁÈ·Ù› Ù· ˘¿Ú¯ÔÓÙ· ÎÚÈÙ‹ÚÈ· ·ÔÙ˘Á¯¿-ÓÔ˘Ó Ó· Ù·˘ÙÔÔÈ‹ÛÔ˘Ó ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÎÏÈ-ÓÈÎÒÓ ÂÚÈÙÒÛÂˆÓ ÙË˜ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ (23).

™ÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·, Ë Î·Ù¿ıÏÈ„Ë ‰È·ÁÈÁÓÒÛÎÂÙ·ÈÎ˘Ú›ˆ˜ Û·Ó ·ÏÏ·Á‹ Û˘ÌÂÚÈÊÔÚ¿˜, ÌÂ›ˆÛË ÙË˜Û¯ÔÏÈÎ‹˜ Â›‰ÔÛË˜, ‰È·ÎÔ‹ ÙˆÓ Û¯¤ÛÂˆÓ ÌÂ Û˘ÓÔ-ÌËÏ›ÎÔ˘˜, ·ÒÏÂÈ· ÙË˜ Â˘¯·Ú›ÛÙËÛË˜ ÙÔ˘ ·È¯ÓÈ‰È-Ô‡ ‹ ·ÔÌfiÓˆÛË. ∆· ·È‰È¿ ·˘Ù‹˜ ÙË˜ ËÏÈÎ›·˜ ÌÔ-ÚÔ‡Ó Ó· ÂÎÊÚ¿ÛÔ˘Ó ÂÛÈÌÈÛÙÈÎ¤˜ ÛÎ¤„ÂÈ˜ Î·È È‰¤Â˜·˘ÙÔ-˘ÔÙ›ÌËÛË˜ Î·È ·˘ÙÔÌÔÌÊ‹˜.

OÈ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙË‰È·ÓÔËÙÈÎ‹ ·Ó·ÛÙÔÏ‹, Ë ÔÔ›· ÂÎ‰ËÏÒÓÂÙ·È ÌÂ

July August 04 07-10-04 13:52 ™ÂÏ›‰·245

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ÂÈ‚Ú¿‰˘ÓÛË ÙË˜ ÎÚ›ÛË˜, ·ÒÏÂÈ· Û˘ÁÎ¤ÓÙÚˆÛË˜Î·È ÚÔÛÔ¯‹˜, ÊÙˆ¯‹ Ê·ÓÙ·Û›· Î·È ÚÔ‚Ï‹Ì·Ù·ÌÓ‹ÌË˜. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È, Â›ÛË˜, ÂÈ‚Ú¿‰˘ÓÛË ÙË˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂ Ê˘ÛÈÎ‹ ·‰˘Ó·Ì›· (ÙÔ ·È‰› ÎÔ˘-Ú¿˙ÂÙ·È Â‡ÎÔÏ·), ¿ÚÓËÛË Û˘ÌÌÂÙÔ¯‹˜ ÛÂ ÔÌ·‰ÈÎ¿·È¯Ó›‰È· Î·È ‰˘ÛÎÔÏ›· ÂÎÙ¤ÏÂÛË˜ Î·ıËÎfiÓÙˆÓ Ô˘ÙÔ˘ ÂÈ‚¿ÏÏÔÓÙ·È.

∆· ÛˆÌ·ÙÈÎ¿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ ˙¿ÏË, ÎÂÊ·-Ï·ÏÁ›·, ËÌÈÎÚ·Ó›Â˜ Î·È ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ (·¸Ó›·,ÂÊÈ¿ÏÙÂ˜) Î·È ‰È·ÙÚÔÊ‹˜ (·ÓÔÚÂÍ›·, ÊÔ‚›Â˜ ÙÚÔÊ›-ÌˆÓ), Â›Ó·È Û˘Ó‹ıˆ˜ ·ÚfiÓÙ·.

∆Ô ·È‰› ‰Â›¯ÓÂÈ Ï˘ËÌ¤ÓÔ, ‰˘ÛÙ˘¯ÈÛÌ¤ÓÔ. ∆›Ô-Ù· ‰ÂÓ ÙÔ Â˘¯·ÚÈÛÙÂ› Î·È ‰ÂÓ Î·Ù·Ê¤ÚÓÂÈ Ù›ÔÙ·. ¶È-ÛÙÂ‡ÂÈ fiÙÈ ‰ÂÓ ÙÔ ·Á·Ô‡Ó Î·È ‰ÂÓ ÙÔ ı¤ÏÔ˘Ó. Œ¯ÂÈÌ›· ÊÙˆ¯‹ ÌÈÌÈÎ‹, ÌÂ ‚Ï¤ÌÌ· ¯ˆÚ›˜ ¤ÎÊÚ·ÛË Î·ÈÌÔÓfiÙÔÓË ÊˆÓ‹.

™Â ·˘Ù‹ ÙËÓ ËÏÈÎ›· ÌÔÚÂ› Ó· ÂÎÊÚ·ÛÙÔ‡Ó È‰¤-Â˜ ·˘ÙÔÎÙÔÓ›·˜, ·ÏÏ¿ ÔÈ ·fiÂÈÚÂ˜ Â›Ó·È Û·ÓÈfiÙÂ-ÚÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÂÊË‚Â›·. ™˘¯Ó¿ ·Ú·ÙË-ÚÔ‡ÓÙ·È ÂÎÚ‹ÍÂÈ˜ ÔÚÁ‹˜, ÓÂ˘ÚÈÎfiÙËÙ·, Â˘ÂÚÂıÈ-ÛÙfiÙËÙ·, ÚÔÎÏËÙÈÎfiÙËÙ· Î·È ·Ó˘·ÎÔ‹. OÈ ı˘ÌÈ-Î¤˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚÂ› Ó· ¤¯Ô˘Ó ¯·Ú·ÎÙ‹Ú· Î˘-ÎÏÈÎfi, ÌÂ ÁÚ‹ÁÔÚÂ˜ ÂÓ·ÏÏ·Á¤˜ ·ÎfiÌË Î·È Ì¤Û·ÛÙËÓ ›‰È· ËÌ¤Ú·. ∏ ·Ó·ÛÙÔÏ‹ ÌÂ Û˘Ó·›ÛıËÌ· ‚·ı‡Î·Ù·ıÏÈÙÈÎfi ÌÂÙ·ÙÚ¤ÂÙ·È ÛÂ ‰È¤ÁÂÚÛË Â˘ÊÔÚÈ-ÎÔ‡ Ù‡Ô˘.

OÈ Williamson Î·È Û˘Ó, ·fi ¤Ó· ÌÂÁ¿ÏÔ ‰Â›ÁÌ·1046 ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂ ‰È¿ÁÓˆÛË ÌÂ›˙ÔÓÔ˜ Î·-Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ‚Ú‹Î·Ó ¿Ù˘Ë Î·Ù·ıÏÈÙÈ-Î‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·. ∆· ¿Ù˘· Û˘ÌÙÒÌ·Ù· Ô˘ÂÌÊ·Ó›ÛÙËÎ·Ó ÌÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ‹Ù·Ó Û˘-Ó·ÈÛıËÌ·ÙÈÎ‹ ·ÛÙ¿ıÂÈ· (40,9%), ·˘ÍËÌ¤ÓË fiÚÂÍËÁÈ· Ê·ÁËÙfi (13,6%), ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (11,6%),˘ÂÚ˘Ó›· (21,8%) Î·È „˘¯ÔÎÈÓËÙÈÎ‹ ÂÈ‚Ú¿‰˘ÓÛË(10,7%) (24).

™˘ÓÓÔÛËÚfiÙËÙ·∫ÏÈÓÈÎ¤˜ Î·È ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó

fiÙÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Î·Ù·ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ (40-70%) ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘ÓÔ‰Ô‡˜ „˘¯È·ÙÚÈÎ¤˜ ‰È·Ù·Ú·-¯¤˜ (25,26).

OÈ Î˘ÚÈfiÙÂÚÂ˜ Û˘ÓÓÔÛËÚ¤˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘-Ó·ÓÙÒÓÙ·È Â›Ó·È Ë ‰˘Ûı˘ÌÈÎ‹ ‰È·Ù·Ú·¯‹, Ë ·Á¯Ò-‰Ë˜ ‰È·Ù·Ú·¯‹ ÌÂ Î˘Ú›·Ú¯Ô ÙÔ ¿Á¯Ô˜ ÙÔ˘ ·Ô¯ˆ-ÚÈÛÌÔ‡ (30-80%) Î·È Ë ‰È·Ù·Ú·¯‹ ÙË˜ ‰È·ÁˆÁ‹˜(10-80%).

ŸÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Ë ‰˘Ûı˘ÌÈÎ‹ ‰È·Ù·Ú·¯‹, Ù›ıÂ-Ù·È Ë ‰È¿ÁÓˆÛË ÙË˜ “‰ÈÏ‹˜ Î·Ù¿ıÏÈ„Ë˜” Î·È ÂÈ‚·-Ú‡ÓÂÙ·È Ë ÚfiÁÓˆÛË, ÙfiÛÔ ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙËÓ ÎÔÈÓˆÓÈÎ‹ÚÔÛ·ÚÌÔÁ‹ Î·È ÙÈ˜ ·fiÂÈÚÂ˜ ·˘ÙÔÎÙÔÓ›·˜ (25).

¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚÂ› Ó· ·Ó·Ù˘-¯ıÔ‡Ó Û·Ó ÂÈÏÔÎ‹ ÙË˜ Î·Ù¿ıÏÈ„Ë˜ Î·È Ó· ·Ú·-ÌÂ›ÓÔ˘Ó ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛ‹ ÙË˜. ∏ Î·Ù¿ıÏÈ„Ë,

Â›ÛË˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË Û˘ÓÓÔÛËÚfiÙËÙ· ÌÂ ÙÈ˜Ì·ıËÛÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ (60-80%) (27).

°ÂÓÈÎ¿, Ë Û˘ÓÓÔÛËÚfiÙËÙ· Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÈÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ˘ÔÙÚÔ¤˜, ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ-‰›Ô˘, ÙÈ˜ ·fiÂÈÚÂ˜ ·˘ÙÔÎÙÔÓ›·˜, ÙËÓ ·¿ÓÙËÛË ÛÙËıÂÚ·Â›· Î·È ÙË ¯Ú‹ÛË ˘ËÚÂÛÈÒÓ „˘¯ÈÎ‹˜ ˘ÁÂ›·˜.

∞ÈÙÈÔÏÔÁ›·∞. °ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ªÂÏ¤ÙÂ˜ ÛÂ ÏËı˘ÛÌfi ‰È‰‡ÌˆÓ Î·È ˘ÈÔıÂÙËÌ¤-

ÓˆÓ ·È‰ÈÒÓ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÔÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔ-ÓÙÂ˜ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 50% ÙË˜ ÔÈÎÈÏfi-ÙËÙ·˜ (ÌÂÙ·‚ÏËÙfiÙËÙ·˜) ÛÙË ÌÂÙ¿‰ÔÛË ÙˆÓ Û˘Ó·È-ÛıËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. º·›ÓÂÙ·È, Â›ÛË˜, fiÙÈ Ù·¿ÙÔÌ· ÌÂ ÁÂÓÂÙÈÎ‹ ÂÈ‚¿Ú˘ÓÛË Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÂ˘·›ÛıËÙ· ÛÙÈ˜ ÂÈ‰Ú¿ÛÂÈ˜ ÂÓfi˜ ·ÓÙ›ÍÔÔ˘ ÂÚÈ‚¿Ï-ÏÔÓÙÔ˜ (28).

OÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ Â›Ó·È ·˘Ù¤˜Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ·È‰È¿ Î·-Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ. ∫·Ù¿ıÏÈ„Ë ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ‰È·ÈÛÙˆıÂ› ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ Î›Ó‰˘ÓÔÔ˘ Î˘Ì·›ÓÂÙ·È ·fi 13% ¤ˆ˜ 70% (29,30). OÈ ·fi-ÂÈÚÂ˜ ·˘ÙÔÎÙÔÓ›·˜ ·Ó¤Ú¯ÔÓÙ·È ÛÂ 7,8% ÛÙ· ·È‰È¿Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·-ÓÙÈÎ‹, ÛÂ Û‡ÁÎÚÈÛË ÌÂ 1,4% ÛÙ· ·È‰È¿ ÌË Î·Ù·ıÏÈ-ÙÈÎÒÓ ÁÔÓ¤ˆÓ (31).

º·›ÓÂÙ·È fiÙÈ Ô Ù‡Ô˜ ÙË˜ ÁÔÓÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∏ ‡·ÚÍË ‰ÈÔÏÈÎ‹˜ ‰È·-Ù·Ú·¯‹˜, Ë ÚÒÈÌË ËÏÈÎ›· ¤Ó·ÚÍË˜ Î·È ÔÈ ˘ÔÙÚÔ-¤˜ ÙˆÓ ÁÔÓ¤ˆÓ Û˘Ó‰¤ÔÓÙ·È ÌÂ ˘„ËÏfiÙÂÚÔ Î›Ó‰˘-ÓÔ ÁÈ· Ù· ·È‰È¿ (32,33). ∂›ÛË˜, ˘„ËÏfiÙÂÚÔ Î›Ó-‰˘ÓÔ ‰È·ÙÚ¤¯Ô˘Ó Ù· ·È‰È¿ fiÙ·Ó ÓÔÛÔ‡Ó Î·È ÔÈ ‰‡ÔÁÔÓÂ›˜ (34).

∆Ô Î·Ù·ıÏÈÙÈÎfi ÂÂÈÛfi‰ÈÔ ‰È·ÚÎÂ› ÂÚÈÛÛfiÙÂÚÔÛÙ· ·È‰È¿ Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·ÓÎ·Ù¿ Ì¤ÛÔ fiÚÔ 54 Â‚‰ÔÌ¿‰Â˜ ÁÈ· Ó· ·ÔıÂÚ·Â˘-ÙÔ‡Ó, ÂÓÒ ·È‰È¿ ÙË˜ ›‰È·˜ ËÏÈÎ›·˜ ÌË Î·Ù·ıÏÈÙÈ-ÎÒÓ ÁÔÓ¤ˆÓ Â›¯·Ó Ì¤ÛÔ fiÚÔ 23 Â‚‰ÔÌ¿‰Â˜ ıÂÚ·-Â›·˜ (35). º·›ÓÂÙ·È fiÙÈ Ë ÁÔÓÈÎ‹ Î·Ù¿ıÏÈ„Ë ·›˙ÂÈÚfiÏÔ Î·È ÛÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ ÛÙ· ·È‰È¿.

∂ÎÙfi˜ ·fi ÙÈ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜,Ù· ·È‰È¿ ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ·fi fiÏÔ ÙÔ Ê¿ÛÌ· ÙË˜ ·È‰Ô„˘-¯È·ÙÚÈÎ‹˜.

¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, ‰È·Ù·Ú·¯‹ ÙË˜‰È·ÁˆÁ‹˜, ‰È¿Û·ÛË ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfi-ÙËÙ·, ‰È·Ù·Ú·¯¤˜ ÙË˜ ÚÔÛ·ÚÌÔÁ‹˜, ·ıÔÏÔÁ›·ÙË˜ ÚÔÛˆÈÎfiÙËÙ·˜, Î·ıÒ˜ Î·È ÂÍ¿ÚÙËÛË ·fi ·Ï-ÎÔfiÏ Î·È Ó·ÚÎˆÙÈÎ¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· Â˘Ú‹Ì·-Ù· ÙˆÓ ÌÂÏÂÙÒÓ (36,37).

µ. OÈÎÔÁÂÓÂÈ·ÎÔ› ·Ú¿ÁÔÓÙÂ˜ ∂ÎÙfi˜ ·fi ÙË ÁÂÓÂÙÈÎ‹ ÂÈ‚¿Ú˘ÓÛË, ÔÈ ÔÈÎÔÁ¤ÓÂÈ-

Â˜ Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÂÓÙÔ-ÓfiÙÂÚÂ˜ Û˘ÁÎÚÔ‡ÛÂÈ˜, ÂÚÈÛÛfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù·

July August 04 07-10-04 13:52 ™ÂÏ›‰·246

247


ÂÈÎÔÈÓˆÓ›·˜, ÌÂÈˆÌ¤ÓË ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿-ÙˆÓ, ÌÈÎÚfiÙÂÚË ˘ÔÛÙ‹ÚÈÍË ÚÔ˜ Ù· Ì¤ÏË ÙÔ˘˜ Î·È˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·È‰ÈÎ‹˜ Î·ÎÔÔ›ËÛË˜ (37).∞˘Ù¿ Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÔÙÂÏÔ‡Ó ÂÚÈ‚·ÏÏÔÓÙÔ-ÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÂ ÙË ÛÂÈÚ¿ ÙÔ˘˜ Û˘Ì-ÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙË˜ ‰È·Ù·Ú·¯‹˜ÛÙ· ·È‰È¿.

ª›· ÂÏÏËÓÈÎ‹ ¤ÚÂ˘Ó· ÂÍÂÙ¿˙ÂÈ Ù· „˘¯ÔÎÔÈÓˆÓÈ-Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·Ù·ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ Ô˘ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÁÂÓÈÎÔ‡ ÓÔÛÔ-ÎÔÌÂ›Ô˘. ™Â Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ·È‰ÈÒÓ,ÁÈ· Ù· ÔÔ›· Â›¯Â Á›ÓÂÈ ¿ÏÏÔ˘ Â›‰Ô˘˜ „˘¯È·ÙÚÈÎ‹‰È¿ÁÓˆÛË, ÛÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ Î·Ù¿-ıÏÈ„Ë ÂÌÊ·Ó›˙ÔÓÙ·È ÌÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ı¿-Ó·ÙÔ˜ ÂÓfi˜ ÁÔÓ¤·, ı¿Ó·ÙÔ˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ‰È·-˙‡ÁÈÔ Î·È ·Ú¿ÁÔÓÙÂ˜ ÂÓ‰ÂÈÎÙÈÎÔ› ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·-ÎÔ‡ „˘¯ÔÎÔÈÓˆÓÈÎÔ‡ stress, fiˆ˜ ‚ÈÒÌ·Ù· ·ÒÏÂÈ-·˜, ·ÂÈÏ‹ ·ÒÏÂÈ·˜, ·fiÚÚÈ„Ë Î·È „˘¯ÈÎ‹ ‰È·Ù·-Ú·¯‹ ÁÔÓ¤ˆÓ (38).

OÈ ÌË¯·ÓÈÛÌÔ› ÌÂ ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ·ÓÙ›ÍÔÂ˜ ÔÈ-ÎÔÁÂÓÂÈ·Î¤˜ Û˘Óı‹ÎÂ˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·Ó¿Ù˘ÍË Î·-Ù¿ıÏÈ„Ë˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙÔ›. ŒÓ·˜ Èı·Ófi˜ ÌË¯·ÓÈ-ÛÌfi˜ Â›Ó·È fiÙÈ ‰È·Ù·Ú·ÁÌ¤ÓÂ˜ ÚÒÈÌÂ˜ ·ÏÏËÏÂÈ-‰Ú¿ÛÂÈ˜ ÌÂÙ·Í‡ ÌËÙ¤Ú·˜ Î·È ·È‰ÈÔ‡ ÌÔÚÔ‡Ó Ó·Ô‰ËÁ‹ÛÔ˘Ó ÙÔ ·È‰› Ó· ·Ó·Ù‡ÍÂÈ ÙÚfiÔ˘˜ ‰È·¯Â›-ÚÈÛË˜ ÙÔ˘ stress Ô˘ ÚÔ‰È·ı¤ÙÔ˘Ó ÁÈ· Î·Ù¿ıÏÈ„Ë.OÈ ÁÔÓÂ›˜ ‰È‰¿ÛÎÔ˘Ó ÛÙ· ·È‰È¿ ÙÔ˘˜ Ó· ·ÔÛ‡ÚÔ-ÓÙ·È fiÙ·Ó ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ¤Ó· ‰‡ÛÎÔÏÔ Î·ı‹ÎÔÓ Î·È‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÌÂıfi‰Ô˘˜ ÚÔÛ·ÚÌÔÁ‹˜ ÁÈ· Ó·Ú˘ıÌ›˙Ô˘Ó Ù· ·ÚÓËÙÈÎ¿ Û˘Ó·ÈÛı‹Ì·Ù·.

¶Ú¤ÂÈ, Â›ÛË˜, Ó· ÙÔÓÈÛÙÂ› fiÙÈ Ù· Î·Ù·ıÏÈÙÈÎ¿·È‰È¿ ÌÂ ÙË ÛÂÈÚ¿ ÙÔ˘˜ ÂÈ‚·Ú‡ÓÔ˘Ó ÙËÓ ÔÈÎÔÁÂ-ÓÂÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ‰È·Ù‹-ÚËÛË ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ‹ ‰ËÌÈÔ˘Ú-ÁÔ‡Ó Û˘ÁÎÚÔ‡ÛÂÈ˜ ÛÂ Ì›· ÔÈÎÔÁ¤ÓÂÈ·, Ë ÔÔ›· Î·Ù¿Ù· ¿ÏÏ· ÏÂÈÙÔ˘ÚÁÂ› Ê˘ÛÈÔÏÔÁÈÎ¿.

∏ ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë ¤¯ÂÈ Û˘Ó‰ÂıÂ› ÌÂ ·ÚÓËÙÈÎ¿ÁÂÁÔÓfiÙ· ˙ˆ‹˜, Î˘Ú›ˆ˜ ·ÒÏÂÈÂ˜. ∆¤ÙÔÈ· ÁÂÁÔÓfi-Ù·, fiˆ˜ ‰È·˙‡ÁÈÔ, ·ÔÛÙ¤ÚËÛË, ı¿Ó·ÙÔ˜, ·˘ÙÔ-ÎÙÔÓ›· - ÌfiÓ· ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ¿ÏÏÔ˘˜ ·-Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (.¯. ¤ÏÏÂÈ„Ë ˘ÔÛÙ‹ÚÈÍË˜) -ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ÙËÓ ¤Ó·ÚÍË ÙË˜ Î·Ù¿ıÏÈ„Ë˜. ™ÙÈ˜ÂÚÈÙÒÛÂÈ˜ ı·Ó¿ÙÔ˘ ‹ ·˘ÙÔÎÙÔÓ›·˜, Ô Î›Ó‰˘ÓÔ˜Î·Ù¿ıÏÈ„Ë˜ Â›Ó·È ·Ó¿ÏÔÁÔ˜ ÌÂ ÙÔ fiÛÔ ÎÔÓÙÈÓfi‹Ù·Ó ÙÔ ·ÔÏÂÛı¤Ó ÚfiÛˆÔ Î·È ÙË ‚È·ÈfiÙËÙ· ÙË˜¤ÎıÂÛË˜ ÛÙÔ ÁÂÁÔÓfi˜.

∂›ÛË˜, ÛÔ‚·Ú¿ ÛÙÚÂÛÔÁfiÓ· ÁÂÁÔÓfiÙ·, fiˆ˜‰˘ÛÎÔÏ›Â˜ ÛÙÈ˜ Û¯¤ÛÂÈ˜ ÌÂ ÙÔ˘˜ Ê›ÏÔ˘˜ ‹ ÌÂ ÙÔ˘˜ÁÔÓÂ›˜ Î·È ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û¯ÔÏÂ›Ô, ·ÓÂ˘Ú›ÛÎÔÓÙ·ÈÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘ ÙË˜ ¤Ó·ÚÍË˜ Ô˘ ÚÔË-ÁÂ›Ù·È ÙË˜ Î·Ù¿ıÏÈ„Ë˜ (39).

°. °ÓˆÛÈ·Î‹ ÚÔÛ¤ÁÁÈÛË ∏ ÌÂÏ¤ÙË ÙË˜ ÁÓˆÛÈ·Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Î·Ù·-

ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ ¤‰ÂÈÍÂ fiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·ÌËÏ‹·˘ÙÔÂÎÙ›ÌËÛË, ¤ÓÙÔÓË ·˘ÙÔÎÚÈÙÈÎ‹, ÛËÌ·ÓÙÈÎ¤˜ÁÓˆÛÈ·Î¤˜ ‰È·ÛÙÚÂ‚ÏÒÛÂÈ˜ Î·È ·›ÛıËÌ· ¤ÏÏÂÈ„Ë˜ÂÏ¤Á¯Ô˘ ÛÂ ·ÚÓËÙÈÎ¿ ÁÂÁÔÓfiÙ· (40).

∆· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ ·›ÛıË-Ì· ÙÔ˘ ·‚Ô‹ıËÙÔ˘ Î·È ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ·Ô‰›-‰Ô˘Ó ÛÂ ÂÍˆÙÂÚÈÎÔ‡˜ ÌË ÂÏÂÁ¯fiÌÂÓÔ˘˜ ·Ú¿ÁÔ-ÓÙÂ˜ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜. OÈ ÎÔÈ-ÓˆÓÈÎ¤˜ ‰ÂÍÈfiÙËÙÂ˜ Â›Ó·È ÊÙˆ¯¤˜ Î·È ‰˘ÛÎÔÏÂ‡Ô-ÓÙ·È ÛÙÈ˜ Û¯¤ÛÂÈ˜ ÌÂ ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ (41).

∆· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·ÚÓËÙÈÎfi ÙÚfiÔ Ó· ÂÚÌË-ÓÂ‡Ô˘Ó Î·È Ó· ‰È·Ú·ÁÌ·ÙÂ‡ÔÓÙ·È ÌÂ ÙÔ stress -ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÎÏËıÔ‡Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘ÓÛÙÚÂÛÔÁfiÓ· ÁÂÁÔÓfiÙ·, fiˆ˜ Î·Î‹ Û¯ÔÏÈÎ‹ ‚·ıÌÔ-ÏÔÁ›· ‹ ·fiÚÚÈ„Ë ·fi Û˘ÓÔÌËÏ›ÎÔ˘˜ - Â›Ó·È ÛÂ˘„ËÏfi Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó Î·Ù¿ıÏÈ„Ë. ™˘˙ËÙÂ›-Ù·È Â¿Ó ·˘Ùfi˜ Ô ÁÓˆÛÈ·Îfi˜ ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛË˜Â›Ó·È ¤Ó· ‰ÔÌÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË˜ ÚÔÛˆÈÎfiÙË-Ù·˜ ‹ Â¿Ó ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌfiÓÔ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Î·-Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘.

ª›· ÚfiÛÊ·ÙË ¤ÚÂ˘Ó· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ÁÓˆÛÈ·-Îfi ÌÔÓÙ¤ÏÔ Ô˘ Û˘Ó‰¤ÂÈ ÙÔ Ù˘¯·›Ô, ÙÈ˜ ÈÎ·ÓfiÙËÙÂ˜Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÌÂ ÙËÓ Î·Ù¿ıÏÈ„Ë. ™Â Ì›· ·Ó·Ù˘-ÍÈ·Î‹ ÚÔÛ¤ÁÁÈÛË, ·˘Ùfi ÙÔ ÌÔÓÙ¤ÏÔ Ê·›ÓÂÙ·È Ó·ÏÂÈÙÔ˘ÚÁÂ› ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÂÊË‚Â›·, fiÔ˘ ˘¿Ú-¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ ÈÎ·ÓfiÙËÙÂ˜ ·Ê·ÈÚÂÙÈÎ‹˜ ÛÎ¤-„Ë˜, ·Ú¿ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ø˜ ¤ÏÂÁ¯Ô˜ ÔÚ›˙Â-Ù·È Ë ÈÎ·ÓfiÙËÙ· Ó· ·Ú·¯ıÂ› ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ·Ô-Ù¤ÏÂÛÌ·, ÂÓÒ Û˘Ó‰¤ÂÙ·È Î·È ÌÂ ‰‡Ô ÂÈÚfiÛıÂÙÔ˘˜·Ú¿ÁÔÓÙÂ˜: ÙËÓ ¤Î‚·ÛË ÙÔ˘ Ù˘¯·›Ô˘ Î·È ÙÈ˜ ÚÔ-ÛˆÈÎ¤˜ ÈÎ·ÓfiÙËÙÂ˜ (42).

¶ÚÔÔÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ·ÎfiÌË Î·È ÌÂÙ¿ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ù· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ Â›-¯·Ó ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË, Ë ÔÔ›· ÌÂ ÙË ÛÂÈÚ¿ ÙË˜·ÔÙÂÏÔ‡ÛÂ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÎ‰‹Ïˆ-ÛË Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ (43).

¢. æ˘¯·Ó·Ï˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ™‡ÌÊˆÓ· ÌÂ ÙÈ˜ ·fi„ÂÈ˜ ÙÔ˘ Freud (1917) Î·È

ÙÔ˘ Abraham (1927), ÛÙÔ Â›ÎÂÓÙÚÔ ÙË˜ ÌÂÏ·Á¯ÔÏÈ-Î‹˜ Û˘ÓÂ›‰ËÛË˜ Â›Ó·È Ë ÂÈıÂÙÈÎfiÙËÙ·, Ë ÔÔ›·ÂÓÂÚÁÔÔÈÂ›Ù·È ·fi Ì›· Ú·ÁÌ·ÙÈÎ‹ ‹ Ê·ÓÙ·ÛÙÈÎ‹·ÒÏÂÈ· ·ÓÙÈÎÂÈÌ¤ÓÔ˘ (44,45). ∏ ÂÈıÂÙÈÎfiÙËÙ· ÌÂ-Ù·ÛÙÚ¤ÊÂÙ·È ÛÂ Î·Ù·ÛÙÚÂÙÈÎ‹ ·˘ÙÔÌÔÌÊ‹ Ô˘Ï‹ÙÙÂÈ ÙÔ ›‰ÈÔ ÙÔ ¿ÙÔÌÔ.

¶ÚÔ¸Ôı¤ÙÂÈ ÙË Û‡ÁÎÚÔ˘ÛË ÙÔ˘ Û·‰ÈÛÙÈÎÔ‡˘ÂÚÂÁÒ Î·È ÙÔ˘ Â·˘ÙÔ‡, Ô ÔÔ›Ô˜ ¤¯ÂÈ Ù·˘ÙÈÛÙÂ› ÌÂÙÔ ¯·Ì¤ÓÔ ·ÓÙÈÎÂ›ÌÂÓÔ. ™Ù· ·È‰È¿, fiÌˆ˜, Ë ·Ó¿-Ù˘ÍË ÙÔ˘ ˘ÂÚÂÁÒ ·ÚÁÂ› Ó· ÔÏÔÎÏËÚˆıÂ›. ∂ÔÌ¤-Óˆ˜, ‰ÂÓ ÌÔÚÔ‡ÌÂ Ó· ÌÈÏ¿ÌÂ ÁÈ· ÌÂÏ·Á¯ÔÏ›·.

∏ ÂÚÈÁÚ·Ê‹ ÙË˜ ·Ó·ÎÏËÙÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜ ·fiÙÔÓ Spitz ÙÔÔı¤ÙËÛÂ ÙËÓ ·ÒÏÂÈ· ÙË˜ ÌËÙ¤Ú·˜ ˆ˜ÎÂÓÙÚÈÎfi ˘Ú‹Ó· ÙË˜ Î·Ù¿ıÏÈ„Ë˜. O Spitz ˘ÔÛÙ‹-ÚÈÍÂ fiÙÈ Ô ·Ô¯ˆÚÈÛÌfi˜ Â›Ó·È Ì›· ÂÈıÂÙÈÎ‹ Ú¿ÍË

July August 04 07-10-04 13:52 ™ÂÏ›‰·247

Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ›‰ÈÔ ÙÔ ·ÓÙÈÎÂ›ÌÂÓÔ ·Á¿Ë˜,Ô˘ ·ÎfiÌË Â›Ó·È ¤Ó· ÂÍˆÙÂÚÈÎfi ·ÓÙÈÎÂ›ÌÂÓÔ. ∏ ¤Ó-ÓÔÈ· ÙË˜ ·ÒÏÂÈ·˜ ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÛÂ Ê˘ÛÈÎ‹·Ô˘Û›· ÙË˜ ÌËÙ¤Ú·˜, ·ÏÏ¿ ÛÂ Î¿ıÂ Î·Ù¿ÛÙ·ÛË··Ú·›ÙËÙË ÁÈ· ÙËÓ „˘¯ÔÏÔÁÈÎ‹ ÈÛÔÚÚÔ›· ÙÔ˘·ÙfiÌÔ˘ (46).

∞fi ÙÈ˜ „˘¯·Ó·Ï‡ÛÂÈ˜ ÂÓËÏ›ÎˆÓ Î·Ù·ıÏÈÙÈÎÒÓÊ·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ¿ÓÙ· Ì›· ÚÒÈÌË ÂÌÂÈÚ›··ÒÏÂÈ·˜, Â›ÙÂ ·˘Ù‹ Â›Ó·È Ú·ÁÌ·ÙÈÎ‹ Â›ÙÂ Ê·ÓÙ·-ÛÈˆÛÈÎ‹. ™ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, Ë ÌË Û˘Ó·ÈÛıËÌ·ÙÈÎ‹‰È·ıÂÛÈÌfiÙËÙ· ÙË˜ ÌËÙ¤Ú·˜ ‚ÈÒÓÂÙ·È Û·Ó ·ÒÏÂÈ·.∏ ‰È·ıÂÛÈÌfiÙËÙ· Î·È Ë ··ÓÙËÙÈÎfiÙËÙ· ÙË˜ ÌËÙ¤-Ú·˜ ·ÔÙÂÏÔ‡Ó Ù· ‰‡Ô ··Ú·›ÙËÙ· ÛÙÔÈ¯Â›· ÁÈ· Ì›·Û¯¤ÛË ·ÛÊ·Ï‹ Î·È ÛÙ·ıÂÚ‹. ªÂ ‚¿ÛË ·˘Ù‹ ÙË Û¯¤-ÛË, ÙÔ ·È‰› ı· ·Ó·Ù‡ÍÂÈ ÙÔ ·›ÛıËÌ· ÂÌÈÛÙÔÛ‡-ÓË˜ ÙÔ˘ Â·˘ÙÔ‡ ÙÔ˘.

ŸÙ·Ó Ë ÌËÙ¤Ú· ‰ÂÓ ˘¿Ú¯ÂÈ ‹ ‰ÂÓ ··ÓÙ¿, ÙÔ·È‰› ‚ÈÒÓÂÈ Ì›· ‰ÈÂÚÁ·Û›· ¤ÓıÔ˘˜, Ù· ÛÙ¿‰È· ÙË˜ÔÔ›·˜ ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ J. Bowlby (1973)(47). O ·Ô¯ˆÚÈÛÌfi˜ Â›Ó·È Ì›· Ú·ÁÌ·ÙÈÎ‹ ·ÒÏÂÈ·Ô˘ ÚÔÎ·ÏÂ› ·ÂÏÈÛ›·. ∏ ·ÂÈÏ‹ ÙË˜ ·ÒÏÂÈ·˜ÚÔÎ·ÏÂ› ¿Á¯Ô˜. ∆Ô ·È‰› ·ÓÙÈ‰Ú¿ ÛÙËÓ ·ÒÏÂÈ· ÌÂÌ›· ›‰È· ÛÂÈÚ¿ Û˘ÌÂÚÈÊÔÚÒÓ:

·) ∞ÂÏÈÛ›·: ÎÏ·›ÂÈ Î·È ÚÔÛ·ıÂ› Ó· Í·Ó·‚ÚÂ›ÙÔ ¯·Ì¤ÓÔ ·ÓÙÈÎÂ›ÌÂÓÔ.

‚) ∞Ôı¿ÚÚ˘ÓÛË: ÂÓ·ÏÏ·Á‹ Ï‡Ë˜ Î·È ı˘ÌÔ‡,‰È·ÈÛÙÒÓÂÈ ÙËÓ ·ÔÙ˘¯›· ÛÙÔ Ó· Â·Ó·Ê¤ÚÂÈ ÙËÌËÙ¤Ú· ÙÔ˘ Î·È Ì¤ÓÂÈ ¤ÎÏËÎÙÔ.

Á) ∞Ô‰¤ÛÌÂ˘ÛË: ÂÁÎ·Ù·ÏÂ›ÂÈ ÙÂÏÂ›ˆ˜ ÙË ‰ÈÂÎ-‰›ÎËÛË.

∏ „˘¯Ô·ıÔÏÔÁÈÎ‹ ÔÚÁ¿ÓˆÛË ÙÔ˘ ·È‰ÈÔ‡ÚÔ‰È·ı¤ÙÂÈ ÁÈ· Ì›· ÛÙ·ıÂÚ‹ ˘ÔÎÂ›ÌÂÓË Î·Ù·ıÏÈ-ÙÈÎ‹ ı¤ÛË, Ô˘ Â‡ÎÔÏ· ˘ÚÔ‰ÔÙÂ›Ù·È ·fi Ì›··ÒÏÂÈ· ‹ ÙËÓ ·ÂÈÏ‹ ·ÒÏÂÈ·˜ ÙÔ˘ ·ÓÙÈÎÂÈÌ¤ÓÔ˘.À¿Ú¯Ô˘Ó ¿ÓÙ· ·ÈÛı‹Ì·Ù· ˘ÔÙ›ÌËÛË˜ Î·È ÂÓÔ-¯‹˜. ∆Ô ·È‰› Î·Ù·ÏÔÁ›˙ÂÈ ÛÙÔÓ Â·˘Ùfi ÙÔ˘ ÙÈ˜ Ú¿-ÍÂÈ˜ Î·È Ù· Û˘Ó·ÈÛı‹Ì·Ù· Ô˘ ÚÔÎ·ÏÔ‡Ó Î·Ù¿ ÙËÁÓÒÌË ÙÔ˘ ÙËÓ ÂÁÎ·Ù¿ÏÂÈ„‹ ÙÔ˘ ·fi ÙÔ ·ÓÙÈÎÂ›ÌÂ-ÓÔ. OÈ Ó·ÚÎÈÛÛÈÛÙÈÎ¤˜ ÂÏÏÂ›„ÂÈ˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¤˜,‰ËÏ·‰‹ ˘ÔÏÂ›ÂÙ·È Ë Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È ··Ú·›ÙË-ÙË ·Á¿Ë ÁÈ· ÙÔÓ Â·˘Ùfi. ∆Ô ·È‰› Â›Ó·È ˘Ô¯ÚÂˆ-Ì¤ÓÔ Ó· Î¿ÓÂÈ Û¯¤ÛÂÈ˜ ·Ó·ÎÏËÙÈÎ¤˜, ‰ËÏ·‰‹ Ó··ÎÔ˘Ì¿, Ó· ÛÙËÚ›˙ÂÙ·È ÛÙÔ ·ÓÙÈÎÂ›ÌÂÓÔ ·fi ÙÔÔÔ›Ô ÂÚÈÌ¤ÓÂÈ ·ıËÙÈÎ¿ ÙËÓ ÈÎ·ÓÔÔ›ËÛË ÙˆÓ·Ó·ÁÎÒÓ ÙÔ˘. ∆Ô Î·Ù·ıÏÈÙÈÎfi ¿Á¯Ô˜ Â‡ÎÔÏ· ÚÔ-Î·ÏÂ›Ù·È ÛÂ ·˘Ùfi ÙÔ ·È‰›, ·¤Ó·ÓÙÈ ÛÙËÓ Èı·Ó‹ÂÁÎ·Ù¿ÏÂÈ„Ë ·fi ÙÔ ·ÓÙÈÎÂ›ÌÂÓÔ.

∂. µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ∆· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÏ·ÙÙˆ-

Ì¤ÓË ¤ÎÎÚÈÛË ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜, Ô˘ Èı·ÓfiÓÔÊÂ›ÏÂÙ·È ÛÂ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÂÓÙÚÈÎÒÓ ÓÔÚ·-‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ (48). OÚÈÛÌ¤ÓÔÈ ÂÚÂ˘ÓË-Ù¤˜ ÌÈÏÔ‡Ó ÁÈ· ˘ÂÚ¤ÎÎÚÈÛË ÙË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfi-

ÓË˜ ÛÙ· ·È‰È¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (49),·ÏÏ¿ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ Â·Ó·Ï‹ÊıËÎ·Ó ÛÂ ÓÂ-fiÙÂÚÂ˜ ¤ÚÂ˘ÓÂ˜ (50).

∆· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ ¤¯Ô˘Ó, Â›ÛË˜, ÌÂÁ·Ï‡-ÙÂÚË Â˘·ÈÛıËÛ›· ÛÙÔ test ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ ·’fi,ÙÈ ÔÈ ¤ÊË‚ÔÈ (58% Î·È 44%, ·ÓÙ›ÛÙÔÈ¯·) (51). ∞ÓÎ·È Û˘¯Ó¿ ˘¿Ú¯Ô˘Ó ·Ú¿ÔÓ· ÁÈ· ÚÔ‚Ï‹Ì·Ù·‡ÓÔ˘ ÛÙ· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿, ÔÈ ·ÓÙÈÎÂÈÌÂÓÈÎ¤˜∏∂° Î·Ù·ÁÚ·Ê¤˜ ‰ÂÓ ‚Ú‹Î·Ó ‰È·Ù·Ú·¯¤˜ ·ÓÙ›ÛÙÔÈ-¯Â˜ ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ÂÓËÏ›ÎˆÓ (52). ªfiÓÔ Ì›·¤ÚÂ˘Ó· ·Ó¤ÊÂÚÂ ÂÏ·ÙÙˆÌ¤ÓË REM latency Î·È ·˘-ÍËÌ¤ÓÔ ¯ÚfiÓÔ Â¤ÏÂ˘ÛË˜ ‡ÓÔ˘ ÛÂ ¤Ó· ‰Â›ÁÌ· ÓÔ-ÛËÏÂ˘fiÌÂÓˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ·È‰ÈÒÓ (53).

¶ÚfiÁÓˆÛË∏ Ì¤ÛË ‰È¿ÚÎÂÈ· ÂÓfi˜ Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘

ÛÙ· ·È‰È¿ Â›Ó·È 7-9 Ì‹ÓÂ˜. ¶ÂÚ›Ô˘ 90% ÙˆÓ ÂÂÈ-ÛÔ‰›ˆÓ ¤¯ÂÈ È·ıÂ› Ï‹Úˆ˜ ÌÂÙ¿ ·fi 1,5 ¤ˆ˜ 2 ¤ÙË,ÂÓÒ 6-10% ÙÂ›ÓÂÈ ÚÔ˜ ÙË ¯ÚÔÓÈfiÙËÙ·. ∞fi fiÏÂ˜ ÙÈ˜¤ÚÂ˘ÓÂ˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ë ÌÂ›˙ˆÓ Î·Ù·ıÏÈÙÈÎ‹‰È·Ù·Ú·¯‹ Â›Ó·È Ì›· ˘ÔÙÚÔÈ¿˙Ô˘Û· ‰È·Ù·Ú·¯‹ ÌÂ40% Èı·ÓfiÙËÙÂ˜ ˘ÔÙÚÔ‹˜ ÛÙ· 2 ¯ÚfiÓÈ· Î·È 70%ÛÙ· 5 ¯ÚfiÓÈ· (54,55).

∆· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ Ô˘ ˙Ô˘Ó ÛÂ Û˘ÁÎÚÔ˘-ÛÈ·Îfi ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ·ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜ ·fi ÂÎÂ›Ó· Ô˘ ˙Ô˘Ó ÛÂ ÔÈÎÔ-Á¤ÓÂÈÂ˜ ¯ˆÚ›˜ Û˘ÁÎÚÔ‡ÛÂÈ˜ (56).

∏ ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë Â›Ó·È Û˘Ó‰Â‰ÂÌ¤ÓË ÌÂ ·˘-ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ·˘ÙÔÎÙÔÓÈÎÒÓ Û˘ÌÂÚÈÊÔÚÒÓ Î·È¯Ú‹ÛË ·ÏÎÔfiÏ Î·È ¿ÏÏˆÓ Ô˘ÛÈÒÓ ÛÙËÓ ÂÊË‚Â›· Î·ÈÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (57,58). ¶ÚÔÔÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Â›-ÛË˜, ‰Â›¯ÓÔ˘Ó fiÙÈ Î·È ÌÂÙ¿ ÙËÓ ›·ÛË, Ù· Î·Ù·ıÏÈÙÈ-Î¿ ·È‰È¿ Û˘ÓÂ¯›˙Ô˘Ó Ó· ¤¯Ô˘Ó ·ÚÓËÙÈÎ¤˜ ÁÓˆÛ›Â˜,‰˘ÛÎÔÏ›Â˜ ÛÙÈ˜ ‰È·ÚÔÛˆÈÎ¤˜ Û¯¤ÛÂÈ˜, ÌÂÈˆÌ¤ÓËÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ·˘ÍËÌ¤ÓË ¯Ú‹ÛË Î·ÓÔ‡, ·˘ÍË-Ì¤Ó· ÛˆÌ·ÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·È ÚÒÈÌÂ˜ ÂÁÎ˘ÌÔ-Û‡ÓÂ˜ (59).

∆¤ÏÔ˜, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ÂÁÎ·Ù¿ÛÙ·ÛË˜ ÌÔÓÔ-ÔÏÈÎ‹˜ ‹ ‰ÈÔÏÈÎ‹˜ Û˘Ó·ÈÛıËÌ·ÙÈÎ‹˜ ‰È·Ù·Ú·¯‹˜.¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ì›· Ù¤ÙÔÈ· ÂÍ¤ÏÈÍË Â›Ó·È ËÌÈÎÚ‹ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙÔ˘ Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›-Ô˘, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰ÈÔÏÈÎ‹˜ ‹ ¿ÏÏË˜ Û˘-Ó·ÈÛıËÌ·ÙÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ Î·È Ë Û˘Ó‡·ÚÍË „˘¯Ô-ÎÈÓËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ ‹ „˘¯ˆÙÈÎÒÓ ¯·Ú·ÎÙËÚÈ-ÛÙÈÎÒÓ (60).

°È· ÙËÓ M. Covacs, Ë ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë ¤¯ÂÈ Â-Ú›Ô˘ ÙËÓ ›‰È· ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÌÂ ÙËÓ Î·Ù¿ıÏÈ„Ë ÂÓË-Ï›ÎˆÓ, ·ÏÏ¿ ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË (61). ∞Ó Î·È Ë ›·-ÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Â›Ó·È Û¯ÂÙÈÎ¿ Ù·¯‡ÙÂÚË ÛÙ· ·È-‰È¿ ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ¤Ó·˘„ËÏfi ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ ÛÂ Û¯ÂÙÈÎ¿ Û‡ÓÙÔÌÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

∂›ÛË˜, Ô Î›Ó‰˘ÓÔ˜ ÂÁÎ·Ù¿ÛÙ·ÛË˜ ‰ÈÔÏÈÎ‹˜

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‰È·Ù·Ú·¯‹˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙËÓ Î·Ù¿ıÏÈ„Ë ÌÂ¤Ó·ÚÍË ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ·’ fi,ÙÈ ÛÙËÓ ÂÓ‹ÏÈÎË˙ˆ‹. ∆· Î·Ù·ıÏÈÙÈÎ¿ ·È‰È¿ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÚÔ˘-ÛÈ¿ÛÔ˘Ó ‰ÈÔÏÈÎ‹ ‰È·Ù·Ú·¯‹ ÛÂ ÔÛÔÛÙfi 20-30%ÚÈÓ ÙËÓ ËÏÈÎ›· ÙˆÓ 20 ÂÙÒÓ (ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔ-ÛÙfi ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Â›Ó·È 10%). ∞Ô‰ÂÈÎÓ‡ÂÙ·È,¤ÙÛÈ, Ë ÛËÌ·Û›· ÙË˜ ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆÛË˜, ÙË˜ Ì·-ÎÚÔ¯ÚfiÓÈ·˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ Î·È ÙË˜·Ó¿Ù˘ÍË˜ ÚÔÏËÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ.

£ÂÚ·Â›·OÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔÈ ÙÚfiÔÈ ·ÓÙÈÌÂÙÒÈÛË˜

ÙË˜ ·È‰ÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ë „˘-¯ÔıÂÚ·Â›· Î·È Ë Ê·ÚÌ·ÎÔıÂÚ·Â›· ‹ Ô Û˘Ó‰˘·-ÛÌfi˜ ÙÔ˘˜.

∏ ÂÈÏÔÁ‹ ÙÔ˘ Ï·ÈÛ›Ô˘ (ÂÍˆÙÂÚÈÎfi˜ ·ÛıÂÓ‹˜,ÓÔÛÔÎÔÌÂ›Ô ËÌ¤Ú·˜, ÓÔÛËÏÂ›·) ı· ÂÍ·ÚÙËıÂ› ·fiÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜, ÙËÓ ÔÈÎÔ-ÁÂÓÂÈ·Î‹ ˘ÔÛÙ‹ÚÈÍË, Ù· Î›ÓËÙÚ· Î·È ÙË Û˘ÌÌfiÚ-ÊˆÛË ÚÔ˜ ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ıÂÚ·Â›·.

∏ „˘¯ÔıÂÚ·Â›· Ê·›ÓÂÙ·È Ó· Â›Ó·È Î·Ù¿ÏÏËÏËÁÈ· ÂÏ·ÊÚÈ¿˜ Î·È Ì¤ÛË˜ ‚·Ú‡ÙËÙ·˜ ÌÔÚÊ¤˜ Î·Ù¿-ıÏÈ„Ë˜. ™ÎÔfi˜ ÙË˜ „˘¯ÔıÂÚ·Â›·˜ Â›Ó·È Ó· Ì¿ıÂÈÙÔ ·È‰› Ó· Û˘Ó·ÏÏ¿ÛÛÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚ· ÌÂÛÙÚÂÛÔÁfiÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, Ó· ‚ÂÏÙÈÒÛÂÈ ÙÈ˜ ÎÔÈÓˆ-ÓÈÎ¤˜ ‰ÂÍÈfiÙËÙÂ˜ Î·È ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘, Ó· Î·-Ù·ÓÔ‹ÛÂÈ Î·Ï‡ÙÂÚ· ÙÔÓ Â·˘Ùfi ÙÔ˘ Î·È Ó· ·ÓÙÈÌÂÙˆ-›ÛÂÈ ÔÈÎÔÁÂÓÂÈ·Î¿, ÎÔÈÓˆÓÈÎ¿ Î·È Ì·ıËÛÈ·Î¿ ÚÔ-‚Ï‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ÙËÓ Î·Ù¿ıÏÈ„Ë.

™Â Î¿ıÂ „˘¯ÔıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ··ÈÙÂ›-Ù·È Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹ ÁÔ-Ó¤ˆÓ ¤¯ÂÈ ÛÎÔfi Ó· ‚ÔËı‹ÛÂÈ Ó· Î·Ù·ÓÔ‹ÛÔ˘Ó ÔÈÁÔÓÂ›˜ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· ·Ó·ÁÓˆÚ›-ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘ (.¯. Ó· ÌËÓ ·Ô‰›‰Ô˘ÓÙË Ì·ıËÛÈ·Î‹ ÙÔ˘ ·ÔÙ˘¯›· ÛÙËÓ ÙÂÌÂÏÈ¿). ∞˘Ùfiı· ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙÔÓ Û¯Â‰È·ÛÌfi ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜·ÓÙÈÌÂÙÒÈÛË˜ Î·È ı· ‚ÔËı‹ÛÂÈ Ó· ÂÁÎ·Ù·ÛÙ·ıÂ› ËıÂÚ·Â˘ÙÈÎ‹ Û˘ÌÌ·¯›· ÌÂ ÙÔ ·È‰›.

™˘¯Ó¿, Ë ·Ó·ÁÓÒÚÈÛË ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ÙÔ˘ ·È-‰ÈÔ‡ ‚ÔËı¿ÂÈ ÙÔ˘˜ ÁÔÓÂ›˜ Ó· ·Ó·Î·Ï‡„Ô˘Ó Ù· ‰ÈÎ¿ÙÔ˘˜ Î·Ù·ıÏÈÙÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È Ó· ˙ËÙ‹ÛÔ˘Ó‚Ô‹ıÂÈ· ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘˜. ÕÏÏÂ˜ ÊÔÚ¤˜, Ë ˘ÂÚ-ÚÔÛÙ·Û›· Î·È Ë ˘ÂÚ‚ÔÏÈÎ‹ ·ÓËÛ˘¯›· ÙˆÓ ÁÔÓ¤ˆÓÚÔÎ·ÏÔ‡Ó ÌÂÁ·Ï‡ÙÂÚÔ ¿Á¯Ô˜, ÂÓÔ¯¤˜ Î·È ÂÈıÂÙÈ-ÎfiÙËÙ· ÛÙÔ ·È‰›. OÈ ‰È·Ù·Ú·ÁÌ¤ÓÂ˜ ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ-·Î¤˜ Û¯¤ÛÂÈ˜ ÌÔÚÂ› Ó· ÚÔËÁÔ‡ÓÙ·È ‹ Ó· ¤ÔÓÙ·ÈÙÔ˘ Î·Ù·ıÏÈÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ∏ ·ÓÙÈÌÂÙÒÈÛ‹ÙÔ˘˜, ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË, ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·ÙÔÌÈÎ‹Î·È ÔÈÎÔÁÂÓÂÈ·Î‹ ÏÂÈÙÔ˘ÚÁ›·, Û˘ÓÙÂÏÂ› ÛÙËÓ ÔÏÔ-ÎÏ‹ÚˆÛË ÙË˜ ıÂÚ·Â›·˜ Î·È ‰Ú· ÚÔÏËÙÈÎ¿ ÁÈ·ÙÈ˜ ˘ÔÙÚÔ¤˜.

°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·È‰ÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› Ë ÁÓˆÛÈ·Î‹, Ë Û˘ÌÂÚÈÊÂÚÔ-

ÏÔÁÈÎ‹, Ë „˘¯Ô‰˘Ó·ÌÈÎ‹ Î·È Ë ÔÈÎÔÁÂÓÂÈ·Î‹ ‹ ‰È·-ÚÔÛˆÈÎ‹ „˘¯ÔıÂÚ·Â›·. OÈ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·-Û›Â˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ıÂÚ·-ÂÈÒÓ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·ÚÔ¤Ú¯ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÌÂÈÚ›·. OÈRitvo Î·È Papilsky ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÌÂÙ·-·Ó¿Ï˘-ÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÂ˘ÓËÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë „˘¯ÔıÂÚ·Â›· ÙË˜ ·È‰ÈÎ‹˜ Î·-Ù¿ıÏÈ„Ë˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ Ì¤ıÔ-‰Ô˜ (62). ¢˘ÛÙ˘¯Ò˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ Î·È·ÍÈfiÈÛÙ· ÂÚÂ˘ÓËÙÈÎ¿ ‰Â‰ÔÌ¤Ó· Ô˘ Ó· Û˘ÁÎÚ›ÓÔ˘ÓÎ·È Ó· ‰Â›¯ÓÔ˘Ó ÙËÓ ˘ÂÚÔ¯‹ ÙË˜ Ì›·˜ ÌÔÚÊ‹˜ „˘-¯ÔıÂÚ·Â›·˜ ¤Ó·ÓÙÈ ÙË˜ ¿ÏÏË˜ (.¯. ÁÓˆÛÈ·Î‹ ÚÔ˜„˘¯·Ó·Ï˘ÙÈÎ‹) (63).

¶·Ú¿ Ù·‡Ù·, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ÁÓˆÛÈ·Î‹ „˘-¯ÔıÂÚ·Â›· ¤¯ÂÈ Ù·¯‡ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·(64,65). ŸÏÂ˜, fiÌˆ˜, ÔÈ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰È·ÈÛÙÒ-ÓÔ˘Ó ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ Î·È Û˘ÌÂ-Ú·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË Û˘Ó¤¯ÈÛË˜ ÙË˜ ıÂÚ·Â›·˜ (64).

ªÂ ÙËÓ „˘¯Ô‰˘Ó·ÌÈÎ‹ „˘¯ÔıÂÚ·Â›·, ÙÔ ·È‰›ÌÔÚÂ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÂÈÎfiÓ· Ô˘ ¤¯ÂÈ ÁÈ· ÙÔÓÂ·˘Ùfi ÙÔ˘, Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Ù· Û˘Ó·ÈÛı‹Ì·Ù¿ ÙÔ˘,Ó· Û˘Ó·Ó·ÛÙÚ¤ÊÂÙ·È ÌÂ ÛˆÛÙfiÙÂÚÔ ÙÚfiÔ ÌÂÙÔ˘˜ ¿ÏÏÔ˘˜ Î·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÂÛˆÙÂÚÈÎ¤˜ ‹ÂÍˆÙÂÚÈÎ¤˜ Û˘ÁÎÚÔ‡ÛÂÈ˜. ∏ „˘¯Ô‰˘Ó·ÌÈÎ‹ ıÂÚ·-Â›·, fiÌˆ˜, Â›Ó·È Ì·ÎÚÔ¯ÚfiÓÈ· Î·È Ë Ú·ÁÌ·ÙÔ-Ô›ËÛ‹ ÙË˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘ÛÎÔÏ›Â˜. ∏ ·Ó·ÛÙÔÏ‹Î·È ÙÔ ÌÏÔÎ¿ÚÈÛÌ· ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ ÛÙ· Î·-Ù·ıÏÈÙÈÎ¿ ·È‰È¿ ··ÁÔÚÂ‡Ô˘Ó ÙË ÁÚ‹ÁÔÚË ÂÁÎ·-Ù¿ÛÙ·ÛË ÙË˜ ÌÂÙ·‚È‚·ÛÙÈÎ‹˜ Û¯¤ÛË˜. ŸÙ·Ó ÍÂÂ-Ú·ÛÙÔ‡Ó Ù· ÚÒÙ· ÂÌfi‰È·, ÙÔ ·È‰› ÂÎÊÚ¿˙ÂÈ¤ÓÙÔÓÂ˜ Û˘Ó·ÈÛıËÌ·ÙÈÎ¤˜ ·Ó¿ÁÎÂ˜ Î·È Êfi‚Ô·fiÚÚÈ„Ë˜.

À¿Ú¯Ô˘Ó Ï›ÁÂ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙË Ê·ÚÌ·ÎÔÏÔÁÈÎ‹·ÓÙÈÌÂÙÒÈÛË ÙË˜ Î·Ù¿ıÏÈ„Ë˜ ÛÙ· ·È‰È¿. ¢ÂÔÓÙÔ-ÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ¯Ú‹ÛË˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ·È‰ÈÎ‹ ËÏÈÎ›· Î·È ‰˘ÛÎÔÏ›Â˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓÂÚÂ˘ÓÒÓ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÔÈ ˘¿Ú¯Ô˘ÛÂ˜¤ÚÂ˘ÓÂ˜ Ó· Â›Ó·È ·ÓÔÈ¯Ù¤˜ Î·È, ¿Ú·, ÏÈÁfiÙÂÚÔ ·ÍÈfi-ÈÛÙÂ˜ Î·È Ó· ¤¯Ô˘Ó ÔÏÏ¿ ÌÂıÔ‰ÔÏÔÁÈÎ¿ ÚÔ‚Ï‹-Ì·Ù·. ∂›ÛË˜, ÙÔ ÂÚÂ˘ÓËÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ÂÚÈÔÚ›-˙ÂÙ·È ÛÙË ‚Ú·¯˘¯ÚfiÓÈ· ¯Ú‹ÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· ÙˆÓ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È ·ÁÓÔÂ›ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙÈ˜ ·ÚÂ-Ó¤ÚÁÂÈ¤˜ ÙÔ˘˜ (66).

∞fi ÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜ ÌÂÏ¤ÙÂ˜ Ê·›ÓÂÙ·È fiÙÈ Ù·ÙÚÈÎ˘ÎÏÈÎ¿ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ ‰ÂÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ·’ fi,ÙÈ Ù· placebo ÛÙËÓ ·È‰ÈÎ‹Î·Ù¿ıÏÈ„Ë. ¶Èı·Ó¤˜ ÂÍËÁ‹ÛÂÈ˜ ·ÊÔÚÔ‡Ó ÛÙË ÌËÏ‹ÚË ·Ó¿Ù˘ÍË ÙÔ˘ ÓÔÚ·‰ÚÂÓÂÚÁÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜ ÛÙ· ·È‰È¿ ‹ ÛÙÔÓ Ù·¯‡ÙÂÚÔ Ë·ÙÈÎfi ÌÂÙ·‚ÔÏÈ-ÛÌfi Ô˘ Ô‰ËÁÂ› ÛÙË ÁÚ‹ÁÔÚË ·Ô‚ÔÏ‹ ÙË˜ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹˜ Ô˘Û›·˜ (67).

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ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ù· ÓÂfiÙÂÚË˜ ÁÂÓÈ¿˜ ·ÓÙÈÎ·Ù·-ıÏÈÙÈÎ¿, ÔÈ ·Ó·ÛÙÔÏÂ›˜ Â·Ó·ÚfiÛÏË„Ë˜ ÙË˜ ÛÂ-ÚÔÙÔÓ›ÓË˜, ¤¯Ô˘Ó Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù·. ª›· ‰È-Ï‹ Ù˘ÊÏ‹ ÌÂÏ¤ÙË 8 Â‚‰ÔÌ¿‰ˆÓ ÛÂ ¤Ó· ÌÂÁ¿ÏÔ‰Â›ÁÌ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂ Î·Ù¿ıÏÈ„Ë ‰Â›¯ÓÂÈÛËÌ·ÓÙÈÎ¿ ÔÛÔÛÙ¿ ‚ÂÏÙ›ˆÛË˜ ÌÂ ÊÏÔ˘ÔÍÂÙ›ÓË¤Ó·ÓÙÈ ÙÔ˘ placebo (58% Î·È 32%, ·ÓÙ›ÛÙÔÈ¯·) (68).∏ ¯Ú‹ÛË ÙÔ˘˜ Â˘ÓÔÂ›Ù·È Î·È ·fi ÙÔÓ ÈÛ¯˘ÚÈÛÌfi fiÙÈ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜. ∂›Ó·È·ÎÚÈ‚¤˜ fiÙÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÈ˜ ›‰ÈÂ˜ ·ÓÂÈı‡ÌË-ÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÌÂ Ù· ·Ï·ÈfiÙÂÚ· ÙÚÈÎ˘ÎÏÈÎ¿ ·ÓÙÈÎ·-Ù·ıÏÈÙÈÎ¿. øÛÙfiÛÔ, Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ ‰ÂÓ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ ‰Â‰ÔÌ¤Ó· ÁÈ· ÙÔ ·Ó ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ¿ÏÏÔ˘ Â›‰Ô˘˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ Î·È, È‰È·›ÙÂÚ·, ÁÈ·ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ (66).

∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰ÈÎ‹˜ Î·È ∂ÊË‚È-Î‹˜ æ˘¯È·ÙÚÈÎ‹˜, ÛÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ÙË˜ ·È‰ÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜, ÌÂÙ·Í‡ ¿ÏÏˆÓ,·Ó·Ê¤ÚÂÈ: “…µ·ÛÈ˙fiÌÂÓÔÈ ÛÙË Ì¤¯ÚÈ Û‹ÌÂÚ· ÁÓˆ-ÛÙ‹ ‚È‚ÏÈÔÁÚ·Ê›· Î·È ÎÂÎÙËÌ¤ÓË ÎÏÈÓÈÎ‹ ÂÌÂÈÚ›·,Ë „˘¯ÔıÂÚ·Â›· Â›Ó·È Ë ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ· ÙÈ˜ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ Î·Ù¿ıÏÈ„Ë˜. ¶·Ú’ fiÏ··˘Ù¿, Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ÂÍÂÙ¿˙ÂÙ·È ÁÈ· ÂÎÂ›ÓÔ˘˜ ÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ „˘¯ˆÛÈÎ‹ Î·Ù¿ıÏÈ„Ë, ‰ÈÔÏÈÎ‹ ‰È·Ù·-Ú·¯‹, ÂÈÌ¤ÓÔ˘Û· ‚·ÚÈ¿ Î·Ù¿ıÏÈ„Ë Î·È ÁÈ· ÂÎÂ›-ÓÔ˘˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ „˘¯ÔıÂÚ·-Â›· ÌÂÙ¿ ·fi ¤ÁÎ˘ÚË Î·È Â·ÚÎ‹ ÛÔ‚·Ú‹ ÚÔ-Û¿ıÂÈ·…” (69).

™Â Î¿ıÂ ÂÚ›ÙˆÛË, Ë ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·È‰È-Î‹˜ Î·Ù¿ıÏÈ„Ë˜ ‰ÂÓ ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› ·Ï‹ÚÔÛ·ÚÌÔÁ‹ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ÙˆÓ ıÂÚ·Â˘ÙÈ-ÎÒÓ ÌÔÓÙ¤ÏˆÓ ÙˆÓ ÂÓËÏ›ÎˆÓ. O ıÂÚ·Â˘ÙÈÎfi˜ Û¯Â-‰È·ÛÌfi˜ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ - ÂÎÙfi˜ ÙˆÓ ¿Ï-ÏˆÓ - Î·È ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ·Ú¿ÁÔÓÙÂ˜: ·) ÙË Û˘-¯Ó‹ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÒÓ Î·È Û˘ÓÓÔÛËÚfiÙËÙ·˜, ‚)ÙË ÌÂÈˆÌ¤ÓË Û¯ÔÏÈÎ‹ Â›‰ÔÛË Î·È ÎÔÈÓˆÓÈÎ‹ ÚÔ-Û·ÚÌÔÁ‹, Á) ÙËÓ ÔÈfiÙËÙ· ÙˆÓ Û¯¤ÛÂˆÓ ÙˆÓ ÁÔÓ¤-ˆÓ Î·È ÙË Û˘¯Ó‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜Î·È ‰) ÙË Û˘Ó‡·ÚÍË ÛÔ‚·ÚÒÓ ·Ú·ÁfiÓÙˆÓstress.

¶ÚfiÏË„Ë∞Ó Î·È Ë ·È‰ÈÎ‹ Î·Ù¿ıÏÈ„Ë ÌÔÚÂ› Ó· ·Ô‰ÂÈ-

¯ıÂ› Ì›· ¯ÚfiÓÈ· ˘ÔÙÚÔÈ¿˙Ô˘Û· ‰È·Ù·Ú·¯‹ Î·È Ó·¤¯ÂÈ ÛÔ‚·Ú¤˜ Û˘Ó¤ÂÈÂ˜ ÛÙË ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡ Î·ÈÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Â›Ó·È Ï›ÁÂ˜ ÔÈ ¤ÚÂ˘ÓÂ˜ Ô˘ ·Ó·Ê¤-ÚÔÓÙ·È ÛÙËÓ ÚfiÏË„‹ ÙË˜.

°ÂÓÈÎ¿, Â›Ó·È ·Ô‰ÂÎÙfi fiÙÈ ÁÈ· ÙËÓ ˘ÁÈ‹ „˘¯ÔÛ˘-Ó·ÈÛıËÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Î·Ïfi Ó··ÔÊÂ‡ÁÔÓÙ·È ÔÈ ÚÒÈÌÔÈ ·Ô¯ˆÚÈÛÌÔ› (.¯. Ì·-ÎÚÔ¯ÚfiÓÈ· ·Ô˘Û›· ÙË˜ ÌËÙ¤Ú·˜, Ù·Í›‰È·, ÓÔÛË-ÏÂ›·). ™ÙËÓ ÂÚ›ÙˆÛË ı·Ó¿ÙÔ˘ ÙË˜ ÌËÙ¤Ú·˜, ÔÈ

ÊÚÔÓÙ›‰Â˜ Ú¤ÂÈ Ó· ·Ú¤¯ÔÓÙ·È ·fi ¤Ó· ¿ÏÏÔÛÙ·ıÂÚfi ÚfiÛˆÔ Î·È Ó· ÌËÓ ˘¿Ú¯ÂÈ Û˘¯Ó‹ ÂÓ·Ï-Ï·Á‹ Ï·ÈÛ›Ô˘ ‰È·ÌÔÓ‹˜.

OÈ ÂÚÁ·Û›Â˜ ÙÔ˘ Spitz Î·Ù¤‰ÂÈÍ·Ó ÙËÓ ·Ó·ÁÎ·Èfi-ÙËÙ· ÁÈ· Â¿ÚÎÂÈ·, ·ÏÏ¿ Î·È ÁÈ· ÌÔÓÈÌfiÙËÙ·, ÙÔ˘ÚÔÛˆÈÎÔ‡ ÙˆÓ È‰Ú˘Ì¿ÙˆÓ ·È‰ÈÎ‹˜ Ì¤ÚÈÌÓ·˜.∞˘Ù¤˜ ÔÈ Û˘Óı‹ÎÂ˜ ‰ÚÔ˘Ó ÚÔÏËÙÈÎ¿ ÁÈ· ÙËÓ ·Ô-Ê˘Á‹ ÙË˜ ·Ó·ÎÏËÙÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜.

OÚÈÛÌ¤ÓÂ˜ ÚÔÏËÙÈÎ¤˜ ÛÙÚ·ÙËÁÈÎ¤˜ ¤¯Ô˘Ó·Ó·Ù˘¯ıÂ› ÌÂ Î‡ÚÈÔ ÛÎÔfi ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË „˘¯ÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙ··È‰È¿ Î·Ù·ıÏÈÙÈÎÒÓ ÁÔÓ¤ˆÓ. OÈ Keitner Î·È MillerÚÔÙÂ›ÓÔ˘Ó ˘ÔÛÙ‹ÚÈÍË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ·ÚÔ-¯‹ Û˘Ì‚Ô˘ÏÒÓ ÛÙÔ˘˜ ÁÔÓÂ›˜ (70). O La Roche ıÂˆ-ÚÂ› fiÙÈ Ë ·Ú¤Ì‚·ÛË Ú¤ÂÈ Ó· ·ÊÔÚ¿ ÛÂ fiÏ· Ù·Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (71). OÈ Beardslee Î·È Û˘ÓÚÔÙÂ›ÓÔ˘Ó ÚÔÏËÙÈÎ‹ „˘¯ÔıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË, ÁÈ· Ó· ‚ÔËı‹ÛÂÈ ÙÔ ·È‰› Ó· Û˘Ó‰È·ÏÏ·ÁÂ›ÌÂ ÙÈ˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÔÈ Û˘Ó·ÈÛıËÌ·ÙÈ-Î¤˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘ (72).

µÚ·¯Â›Â˜ ÔÈÎÔÁÂÓÂÈ·Î¤˜ „˘¯Ô-ÂÎ·È‰Â˘ÙÈÎ¤˜·ÚÂÌ‚¿ÛÂÈ˜ Ê·›ÓÂÙ·È, Â›ÛË˜, Ó· ÂÏ·ÙÙÒÓÔ˘Ó ÙÈ˜Û˘Ó¤ÂÈÂ˜ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓÁÔÓ¤ˆÓ Î·È, Î·Ù¿ Û˘Ó¤ÂÈ·, ÙÔÓ Î›Ó‰˘ÓÔ ÓfiÛËÛË˜ÙˆÓ ·È‰ÈÒÓ (73).

ªÂÁ¿ÏË ÚÔÏËÙÈÎ‹ ÛËÌ·Û›· ¤¯ÂÈ Ë ·Ó›¯ÓÂ˘ÛËÛÙËÓ ÎÔÈÓfiÙËÙ· ·È‰ÈÒÓ Ô˘ Â›Ó·È Èı·Ófi Ó· ·Ó·-Ù‡ÍÔ˘Ó Î·Ù¿ıÏÈ„Ë. ∆· ·È‰È¿ ÌÂ ‰˘Ûı˘Ì›· ·ÚÔ˘-ÛÈ¿˙Ô˘Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÌÂ›˙ÔÓÔ˜ Î·Ù¿ıÏÈ„Ë˜2-3 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ‰˘Ûı˘Ì›·˜ (74).ŒÚÂ˘ÓÂ˜ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÌÂ ˘ÔÎÏÈÓÈÎ¿Û˘ÌÙÒÌ·Ù· Î·Ù¿ıÏÈ„Ë˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÌ¿‰Â˜ ÁÓˆ-ÛÈ·Î‹˜ Û˘ÌÂÚÈÊÂÚÔÏÔÁÈÎ‹˜ ıÂÚ·Â›·˜ ÌÔÚÂ› Ó·ÚÔÊ˘Ï¿ÍÔ˘Ó ·fi ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ‰È·Ù·Ú·¯‹˜ÁÈ· ÂÚ›Ô‰Ô ¤ˆ˜ 24 ÌËÓÒÓ (75).

OÈ Mesman Î·È Koot ‰È·ÈÛÙÒÓÔ˘Ó, ÛÂ ¤Ó· ‰Â›Á-Ì· 274 ·È‰ÈÒÓ ËÏÈÎ›·˜ 10-11 ÂÙÒÓ, fiÙÈ ÔÈ ‰¿ÛÎ·ÏÔÈ·Ó·ÁÓÒÚÈ˙·Ó ÈÔ Â‡ÎÔÏ· ·’ fi,ÙÈ ÔÈ ÁÔÓÂ›˜ ÙÈ˜ ÂÛˆ-ÙÂÚÈÎÂ˘Ì¤ÓÂ˜ ‰È·Ù·Ú·¯¤˜ ÏfiÁˆ ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ Î·ÈÌ·ıËÛÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ù· ·È-‰È¿ ÌÂ ¿Á¯Ô˜ ‹ Î·Ù¿ıÏÈ„Ë (76).

OÈ Û˘ÁÁÚ·ÊÂ›˜ Î·Ù·Ï‹ÁÔ˘Ó fiÙÈ ÙÔ Û¯ÔÏÂ›Ô ÚÔ-ÛÊ¤ÚÂÙ·È ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙË˜ Î·Ù¿ıÏÈ„Ë˜ Î·ÈÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ·Ó¿Ù˘ÍË˜ ÂÓfi˜ ÂÚˆÙË-Ì·ÙÔÏÔÁ›Ô˘, ÂÈ‰ÈÎ¿ Û¯Â‰È·ÛÌ¤ÓÔ˘ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘-ÛË - ·fi ÙÔ˘˜ ‰·ÛÎ¿ÏÔ˘˜ - ·È‰ÈÒÓ ÌÂ Î·Ù·ıÏÈÙÈ-Î‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·.

OÈ ›‰ÈÔÈ Û˘ÁÁÚ·ÊÂ›˜ ‰È·ÈÛÙÒÓÔ˘Ó ÙËÓ ÚÔÁÓˆ-ÛÙÈÎ‹ ·Í›· ÔÚÈÛÌ¤ÓˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÂÈÛËÌ¿Ó-ıËÎ·Ó ·fi ·È‰·ÁˆÁÔ‡˜ ÛÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·(·È‰› Ï˘ËÌ¤ÓÔ, ‰˘ÛÙ˘¯ÈÛÌ¤ÓÔ, ÌÔÓ·¯ÈÎfi, ÌÂ ·È-Ûı‹Ì·Ù· ÂÓÔ¯‹˜). ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ Û˘Ó‰¤ıË-Î·Ó ÌÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ Î·Ù¿ıÏÈ„Ë˜ 6 ¯ÚfiÓÈ·

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251


·ÚÁfiÙÂÚ·. ∂›ÛË˜, ÚÔÁÓˆÛÙÈÎ‹ ·Í›· Ê·›ÓÂÙ·È Ó·¤¯Ô˘Ó Î¿ÔÈ· ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Ô˘ ·Ú·ÙËÚÔ‡ÓÔÈ ·È‰·ÁˆÁÔ› Î·È ·ÊÔÚÔ‡Ó ÛÙËÓ ÎÔÈÓˆÓÈÎ‹ Û˘ÌÂ-ÚÈÊÔÚ¿ (Û˘ÌÂÚÈÊÔÚ¿ ·ÓÒÚÈÌË ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘,ÔÏ‡ ÂÍ·ÚÙËÌ¤ÓÔ, ·‰¤ÍÈÔ). ∂È‚Â‚·ÈÒÓÂÙ·È, ¤ÙÛÈ, Ë·Ú·Ù‹ÚËÛË fiÙÈ Ë Î·Ù¿ıÏÈ„Ë Û˘Ó‰¤ÂÙ·È ÌÂ ¤ÏÏÂÈ„ËÎÔÈÓˆÓÈÎÒÓ ÈÎ·ÓÔÙ‹ÙˆÓ, ·fiÚÚÈ„Ë ·fi Û˘ÓÔÌËÏ›-ÎÔ˘˜ Î·È ÎÔÈÓˆÓÈÎ‹ ·fiÛ˘ÚÛË (77).

∂ÔÌ¤Óˆ˜, Â›Ó·È ÛËÌ·ÓÙÈÎ‹ Ë ‚Ô‹ıÂÈ· ÙˆÓ ·È-‰·ÁˆÁÒÓ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ ÙË˜ Î·Ù¿ıÏÈ„Ë˜.

∏ ÚÒÈÌË ·Ó›¯ÓÂ˘ÛË ÚÔÛÙ·ÙÂ‡ÂÈ ÙÔ ·È‰› ·fiÙÈ˜ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ Û˘Ó¤ÂÈÂ˜ ÙË˜ Î·Ù¿ıÏÈ„Ë˜ Ô˘ÂËÚÂ¿˙Ô˘Ó ÙË Û¯ÔÏÈÎ‹ Â›‰ÔÛË, ÙÈ˜ Û¯¤ÛÂÈ˜ ÌÂÙÔ˘˜ ÁÔÓÂ›˜ Î·È ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ Î·È ·˘Í¿ÓÔ˘ÓÙÔÓ Î›Ó‰˘ÓÔ ·˘ÙÔÎÙÔÓ›·˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ‹ ÙËÓÂÊË‚Â›·.

™˘ÌÂÚ¿ÛÌ·Ù·∞fi ÙËÓ ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ê·›ÓÂ-

Ù·È fiÙÈ Ë Î·Ù¿ıÏÈ„Ë ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ·ÔÙÂÏÂ›¤Ó· ÛÔ‚·Úfi Î·È Û¯ÂÙÈÎ¿ Û˘¯Ófi Úfi‚ÏËÌ·. ÃÚ‹˙ÂÈ¿ÌÂÛË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜, ÙfiÛÔ ÁÈ· ÙËÓ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ fiÛÔÎ·È ÁÈ· ÙË ÌÂ›ˆÛË ÙˆÓ ˘ÔÙÚÔÒÓ ‹ ÙË˜ ÂÁÎ·Ù¿-ÛÙ·ÛË˜ ÙË˜ ·ıÔÏÔÁ›·˜ Ô˘ ı· Û˘ÓÔ‰Â‡ÂÈ ÙÔ ·È‰›ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

™ÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, ·Ó Î·È Ù· ÔÛÔÛÙ¿ ·È‰È-Î‹˜ Î·Ù¿ıÏÈ„Ë˜ Â›Ó·È ·ÚÎÂÙ¿ ˘„ËÏ¿, Â›Ó·È ÁÂÓÈÎ¿·Ú·‰ÂÎÙfi fiÙÈ ÔÈ ·Ú·ÔÌ¤˜ ÛÙÈ˜ ˘ËÚÂÛ›Â˜ „˘-¯ÈÎ‹˜ ˘ÁÂ›·˜ Â›Ó·È ÌÂÈˆÌ¤ÓÂ˜. ∞˘Ùfi ·Ô‰›‰ÂÙ·È ÛÂÛËÌ·ÓÙÈÎfi ‚·ıÌfi ·ÊÂÓfi˜ ÛÙË ‰˘ÛÎÔÏ›· ÙˆÓ ÁÔÓ¤-ˆÓ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ Ó· ·Ú·ÙËÚ‹ÛÔ˘Ó ÙÈ˜ ÂÛˆÙÂ-ÚÈÎÂ˘Ì¤ÓÂ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·È‰ÈÒÓ, ·ÊÂÙ¤ÚÔ˘ÛÙËÓ ·ÓÙ›ÛÙ·ÛË ÙˆÓ ÁÔÓ¤ˆÓ Ó· ‰Â¯ıÔ‡Ó fiÙÈ ÙÔ ·È-‰› ÙÔ˘˜ ¤¯ÂÈ Î·Ù¿ıÏÈ„Ë, ‰È·Ù·Ú·¯‹ Û˘Ó‰ÂfiÌÂÓË ÌÂ·ÚÓËÙÈÎ¿ ÁÂÁÔÓfiÙ· ˙ˆ‹˜, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Î˘-Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜.

OÊÂ›ÏÔ˘ÌÂ, Â›ÛË˜, Ó· ·Ú·ÙËÚ‹ÛÔ˘ÌÂ fiÙÈ ÙÈ˜›‰ÈÂ˜ ·ÓÙÈÛÙ¿ÛÂÈ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È Â·ÁÁÂÏÌ·Ù›Â˜ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ Ô˘ ¤Ú¯ÔÓÙ·È ÛÂ Â·Ê‹ÌÂ ÙÔ ·È‰›. ¶ÚÔÎ‡ÙÂÈ, ¤ÙÛÈ, Ë ·Ó¿ÁÎË ÏËÚÔÊfi-ÚËÛË˜ Î·È Â˘·ÈÛıËÙÔÔ›ËÛ‹˜ ÙÔ˘˜. O ÛÎÔfi˜ ÙË˜·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚÔ-Û¿ıÂÈ· Ó· Á›ÓÂÈ Â˘Ú‡ÙÂÚ· ·Ô‰ÂÎÙfi fiÙÈ Ù· “Ï˘Ë-Ì¤Ó· Î·È ‰˘ÛÙ˘¯ÈÛÌ¤Ó·” ·È‰È¿ ¤¯Ô˘Ó ‰ÈÎ·›ˆÌ· Î·ÈÌÔÚÔ‡Ó Ó· ˆÊÂÏËıÔ‡Ó ·fi ÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·-Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË.

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50. De Bellis MD, Dahl RE, Perel JM, Birmaher B, al-Shabbout M,Williamson DE et al. Nocturnal ACTH, cortisol, growthhormone, and prolactin secretion in prepubertal depression.J Am Acad Child Adolesc Psychiatry 1996;35:1130-1138.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË §·˙·Ú¿ÙÔ˘ ¢‹ÏÔ˘ 14, ∫·ÈÛ·ÚÈ·Ó‹, ∆.∫. 161 21, ∞ı‹Ó· E-mail: [email protected]

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∞ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·¢. π. ∑·ÊÂÈÚ›Ô˘, ª. OÈÎÔÓfiÌÔ˘

Strokes in childhoodD. I. Zafeiriou, M. Ikonomou

�¶ÂÚ›ÏË„Ë: ∏ ÂÎÙÂÙ·Ì¤ÓË ¤ÚÂ˘Ó· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ¯ÚfiÓˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌ-ÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿, ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÚÈÔÚÈÛÌfiÙË˜ ·Ï·ÈfiÙÂÚË˜ ‰È¿ÁÓˆÛË˜ ÙÔ˘ “È‰ÈÔ·ıÔ‡˜”ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘. øÛÙfiÛÔ, Ë Û·Ê‹˜ ·ÈÙ›··Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË ÛÂ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÚÈÙÒ-ÛÂˆÓ. ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓÛÙ· ·È‰È¿ ÔÈÎ›ÏÏÂÈ, ‰È·Ê¤ÚÔÓÙ·˜ ÛËÌ·ÓÙÈÎ¿ ·fi·˘Ù‹ ÙˆÓ ÂÓËÏ›ÎˆÓ. ™Â ÔÛÔÛÙfi 25%, Ù· ¤ÌÊÚ·ÎÙ·ÛÙ· ·È‰È¿ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔ·ı‹, ·ÊÔ‡ ‰ÂÓ ÌÔÚÂ›Ó· Î·ıÔÚÈÛÙÂ› Û˘ÁÎÂÎÚÈÌ¤ÓÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿-ÁÔÓÙ·˜. ∆· Î·Ú‰ÈÔÂÌ‚ÔÏÈÎ¿ ¤ÌÊÚ·ÎÙ· Â˘ı‡ÓÔÓÙ·ÈÁÈ· ÙÔ 1/3 ¤ˆ˜ 1/5 fiÏˆÓ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÁÎÂÊ·ÏÈ-ÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿, ÌÂ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙÈ˜Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜. ∞fi Ù· ·ÁÁÂÈ·Î¿ ·›ÙÈ·ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, Ô ·ÚÙËÚÈ·Îfi˜ ‰È·¯ˆÚÈ-ÛÌfi˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏÂ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·-Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿. ∏ ÓfiÛÔ˜ MoyamoyaÌÔÚÂ› Ó· Â›Ó·È È‰ÈÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜, ˆ˜ Â‡-ÚËÌ· Ô˘ Û˘ÓÔ‰Â‡ÂÈ ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Â›-Ó·È Ë ÓÂ˘ÚÔ˚ÓˆÌ¿ÙˆÛË, ÙÔ Û‡Ó‰ÚÔÌÔ Down Î·È Ë‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜. ∏ ÙÂÏÂ˘Ù·›· ·ÔÙÂÏÂ›Ì›· ·fi ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ·ÈÙ›Â˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿-ÎÙÔ˘, Ô Î›Ó‰˘ÓÔ˜ ÂÎ‰‹ÏˆÛË˜ ÙÔ˘ ÔÔ›Ô˘ Ê·›ÓÂÙ·ÈfiÙÈ Â›Ó·È 200-400 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙÔÓ ˘fiÏÔÈÔ ·È‰ÈÎfi ÏËı˘ÛÌfi. ∆¤ÏÔ˜, ÛËÌ·-ÓÙÈÎfi ·›ÙÈÔ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ·È‰ÈÎ‹Î·È ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ·ÔÙÂÏÔ‡Ó ÔÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ›·Ú¿ÁÔÓÙÂ˜, ÔÈ ÔÔ›ÔÈ ÚÔ‰È·ı¤ÙÔ˘Ó ÛÂ ‰È·Ù·Ú·¯‹ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ÙË˜ ‹ÍË˜, ÌÂ ÛÙÚÔÊ‹ ÙË˜ Ê˘ÛÈÔ-ÏÔÁÈÎ‹˜ ÈÛÔÚÚÔ›·˜ ÙË˜ ·ÈÌfiÛÙ·ÛË˜ ÚÔ˜ ÙËÓ Î·-ÙÂ‡ı˘ÓÛË ÙË˜ ıÚfiÌ‚ˆÛË˜. øÛÙfiÛÔ, ··ÈÙÔ‡ÓÙ·ÈÌÂÁ¿ÏÂ˜ ÔÏ˘ÎÂÓÙÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ· Ó· Î·ıÔÚÈ-ÛÙÔ‡Ó ÌÂ Û·Ê‹ÓÂÈ· ÔÈ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, Ë ‚¤Ï-ÙÈÛÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ·ÍÈÔÏfiÁËÛË

�Abstract: The extensive research that has beenconducted on childhood stroke during recent yearshas led to a significant increase in the diagnosis ofspecific aetiologic factors. The aetiology differs fromthat of adults, and in 25% of cases it is stillconsidered idiopathic. Cardiovascular causes andespecially congenital heart disease, account for 1/3to 1/5 of ischaemic childhood stroke incidents anda significant number of cases are due to arterialdissection. Moyamoya disease can be eitheridiopathic or secondary ÙÔ various disorders, suchas neurofibromatosis type I, Down syndrome andsickle cell disease. Sickling is one of the mostfrequent causes, with a risk estimated to be 200-400times higher than that in the general population.Further important causes of stroke are theprothrombotic disorders, which are characterizedby disturbed haemostasis and a shift towardsthrombosis. These disorders can be either inheritedor acquired after an infection, drug use or liver orrenal disease; their overall incidence varies from 10-50% according to different series. Regardingpreceding infections, of special interest is theassociation with the varicella-zoster virus, whichtypically results in basal ganglia infarcts. Largemulticentre studies are still needed, in order tomake an accurate estimate of risk factors and toformulate therapeutic interventions and providelong-term follow-up of this multifactorial disorder.

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘, £ÂÛÛ·ÏÔÓ›ÎË

1st Paediatric Clinic of Aristotelion University, Thessaloniki

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∂ÈÛ·ÁˆÁ‹ø˜ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ ÔÚ›˙ÂÙ·È Ë “Ù·¯¤ˆ˜

ÂÍÂÏÈÛÛfiÌÂÓË ÂÎ‰‹ÏˆÛË ÎÏÈÓÈÎÒÓ ÛËÌÂ›ˆÓ ÂÛÙÈ·-Î‹˜ ‹ ÁÂÓÈÎÂ˘Ì¤ÓË˜ ‰È·Ù·Ú·¯‹˜ ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜, ÌÂ ‰È¿ÚÎÂÈ· ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 24ˆÚÒÓ ‹ ÌÂ Â·ÎfiÏÔ˘ıÔ ÙÔÓ ı¿Ó·ÙÔ, ¯ˆÚ›˜ ¿ÏÏË ÂÌ-Ê·Ó‹ ·ÈÙ›· ÏËÓ ÙË˜ ·ÁÁÂÈ·Î‹˜ ÚÔ¤ÏÂ˘ÛË˜ ·˘ÙÔ‡”(1). ∏ ÂÎ‰‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Ê·›ÓÂÙ·ÈfiÙÈ ‰ÂÓ ··ÓÙ¿Ù·È ÙfiÛÔ Û¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·,fiÛÔ ıÂˆÚÔ‡ÓÙ·Ó ·ÏÈfiÙÂÚ·, ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ÊÙ¿ÓÂÈ ÙÈ˜ 7 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000 (2,3), ÂÓÒ Ë·Ó·ÊÂÚfiÌÂÓË Â›ÙˆÛË ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Â›Ó·ÈÂÚ›Ô˘ 1/4000 ÁÂÓÓ‹ÛÂÈ˜ ·Ó¿ ¤ÙÔ˜ (4). ¶·Ú¿ ÙÔÁÂÁÔÓfi˜ fiÙÈ Ë ÚfiÁÓˆÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿-ÎÙˆÓ ÛÙ· ·È‰È¿ Â›Ó·È Û·ÊÒ˜ Î·Ï‡ÙÂÚË ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈÎÔ‡‚·ıÌÔ‡ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, Î·ıÒ˜ Î·È Î›Ó-‰˘ÓÔ˜ Â·ÓÂÎ‰‹ÏˆÛË˜ ÂÌÊÚ¿ÎÙÔ˘.

∞ÈÙÈÔÏÔÁ›· Î·È ·ıÔÁ¤ÓÂÈ· ∆· ¤ÌÊÚ·ÎÙ· ·ÊÔÚÔ‡Ó ÛÂ ·fiÊÚ·ÍË ·ÚÙËÚÈ·-

ÎÒÓ ‹ ÊÏÂ‚ÈÎÒÓ ÎÏ¿‰ˆÓ. ∆· ·ÚÙËÚÈ·Î¿ ¤ÌÊÚ·ÎÙ·‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ÈÛ¯·ÈÌÈÎ¿, Ù· ÔÔ›· Â›Ó·È ·ÔÙ¤ÏÂ-ÛÌ· ÂÌ‚ÔÏ‹˜ ‹ ıÚfiÌ‚ˆÛË˜ Î·È ÛÂ ·ÈÌÔÚÚ·ÁÈÎ¿ ‹ˆ¯Ú¿. ∆· ÊÏÂ‚ÈÎ¿ ¤ÌÊÚ·ÎÙ· ·Ú·ÙËÚÔ‡ÓÙ·È Û·-ÓÈfiÙÂÚ·, ¿ÓÙ· ˆ˜ ·ÔÙ¤ÏÂÛÌ· ıÚfiÌ‚ˆÛË˜. ™ÙÔÓÔÚÈÛÌfi ÙˆÓ ÂÌÊÚ¿ÎÙˆÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È, Â›ÛË˜,ÔÈ ÂÚÈÙÒÛÂÈ˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ‹ ˘·Ú·¯ÓÔÂÈ‰Ô‡˜ ·È-ÌÔÚÚ·Á›·˜ (5).

∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ··È‰È¿ ÔÈÎ›ÏÏÂÈ, ‰È·Ê¤ÚÔÓÙ·˜ ÛËÌ·ÓÙÈÎ¿ ·fi ÂÎÂ›-ÓË ÙˆÓ ÂÓËÏ›ÎˆÓ, Î·ıÒ˜ ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ë ˘¤Ú-Ù·ÛË, Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜, ÙÔ Î¿ÓÈÛÌ· Î·È ËÎ·Ù¿¯ÚËÛË ·ÏÎÔfiÏ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓ ·È‰È-Î‹ ËÏÈÎ›·. ™Â ÔÛÔÛÙfi 25%, Ù· ¤ÌÊÚ·ÎÙ· ÛÙ· ·È-‰È¿ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔ·ı‹, Î·ıÒ˜ ‰ÂÓ ÌÔÚÂ› Ó· Î·-ıÔÚÈÛÙÂ› Û˘ÁÎÂÎÚÈÌ¤ÓÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜(7). OÈ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ÚÔ‰È·ı¤-ÙÔ˘Ó ÛÙËÓ ÂÎ‰‹ÏˆÛË ·ÚÙËÚÈ·ÎÔ‡ Î·È ÊÏÂ‚ÈÎÔ‡ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Ê·›ÓÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·ÎÂ˜1 Î·È 2, ·ÓÙ›ÛÙÔÈ¯·.

∆· Î·Ú‰ÈÔÂÌ‚ÔÏÈÎ¿ ¤ÌÊÚ·ÎÙ· Ê·›ÓÂÙ·È fiÙÈ Â˘-ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 1/3 ¤ˆ˜ 1/5 fiÏˆÓ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿, ÌÂ Û˘¯ÓfiÙÂÚË·ÈÙ›· ÙÈ˜ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ (™∫) (8). OÈ ™∫,ÔÈ ÔÔ›Â˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·Ó·ÈÌ›·, ·ÔÙÂÏÔ‡Ó·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÂÎ‰‹ÏˆÛË˜ ·ÚÙËÚÈ·ÎÔ‡ ÂÌ-

ÊÚ¿ÎÙÔ˘, ÂÓÒ ·˘Ù¤˜ Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ÔÏ˘ÂÚ˘-ıÚ·ÈÌ›· (Î˘·ÓˆÙÈÎ¤˜) ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÎ·Ï¤ÛÔ˘ÓÊÏÂ‚ÈÎ‹ ıÚfiÌ‚ˆÛË (5). ∫·Ú‰ÈÔ¿ıÂÈÂ˜ Û¯ÂÙÈ˙fiÌÂ-ÓÂ˜, Â›ÛË˜, ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿-ÎÙÔ˘ Â›Ó·È ÔÈ Â›ÎÙËÙÂ˜ ‚·Ï‚È‰Ô¿ıÂÈÂ˜ ÚÂ˘Ì·ÙÈ-Î‹˜, ÏÔÈÌÒ‰Ô˘˜, ÊÏÂÁÌÔÓÒ‰Ô˘˜, Ì˘ÍˆÌ·ÙÒ‰Ô˘˜,ÂÎÊ˘ÏÈÛÙÈÎ‹˜ ‹ ÙÚ·˘Ì·ÙÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜, ÔÈ ·ı‹-ÛÂÈ˜ ÙÔ˘ ÂÓ‰ÔÎ·Ú‰›Ô˘ Î·È ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, Î·ıÒ˜Î·È ÔÈ Î·Ú‰È·ÎÔ› fiÁÎÔÈ (5).

∞fi Ù· ·ÁÁÂÈ·Î¿ ·›ÙÈ· ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘,Ô ·ÚÙËÚÈ·Îfi˜ ‰È·¯ˆÚÈÛÌfi˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏÂ›ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿(5,6). O ‰È·¯ˆÚÈÛÌfi˜ ÂÍˆÎÚ¿ÓÈˆÓ ‹ ÂÓ‰ÔÎÚ¿ÓÈˆÓÙÌËÌ¿ÙˆÓ ÙˆÓ Î·ÚˆÙ›‰ˆÓ Î·È ÙˆÓ ÛÔÓ‰˘ÏÔ‚·ÛÈ-ÎÒÓ ·ÚÙËÚÈÒÓ ÌÔÚÂ› Ó· Û˘Ì‚Â› ·˘ÙfiÌ·Ù· ‹ ‰Â˘ÙÂ-ÚÔ·ıÒ˜, Â›ÙÂ ˆ˜ Â·ÎfiÏÔ˘ıÔ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Â›ÙÂÛÂ ·ÚÔ˘Û›· ˘ÔÎÂ›ÌÂÓË˜ ·ÁÁÂÈÔ¿ıÂÈ·˜.

∏ ÓfiÛÔ˜ Moyamoya (ªªD) ·ÔÙÂÏÂ› ·ÁÁÂÈÔ¿-ıÂÈ· ÔÚÈ˙fiÌÂÓË ·fi È‰È·›ÙÂÚ· ·ÁÁÂÈÔÁÚ·ÊÈÎ¿ Â˘Ú‹-Ì·Ù· Î·È ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi Ì›· ‚Ú·‰¤ˆ˜ ÂÍÂ-ÏÈÛÛfiÌÂÓË ÛÙ¤ÓˆÛË Î·È ·fiÊÚ·ÍË ÙˆÓ ÌÂÁ¿ÏˆÓ·ÁÁÂ›ˆÓ ÙË˜ ‚¿ÛÂˆ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∏ MMD ÌÔ-ÚÂ› Ó· Â›Ó·È È‰ÈÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜, ˆ˜ Â‡ÚËÌ·Ô˘ Û˘ÓÔ‰Â‡ÂÈ ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Â›Ó·È ËÓÂ˘ÚÔ˚ÓˆÌ¿ÙˆÛË, ÙÔ Û‡Ó‰ÚÔÌÔ Down Î·È Ë ‰ÚÂ·-ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ (9,10). §fiÁˆ ÙË˜ Èı·Ó‹˜ Û˘Ó‡-·ÚÍË˜ ÛÙÂÓÒÛÂˆÓ ÛÙ· ÌÂÁ¿Ï· ·ÁÁÂ›· ÙË˜ Î·Ú-‰È¿˜ Î·È ÙˆÓ ÓÂÊÚÒÓ, Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÛıÂÓÒÓ Ú¤-ÂÈ Ó· ÛÙÚ¤ÊÂÙ·È Î·È ÚÔ˜ ·˘Ù‹ ÙËÓ Î·ÙÂ‡ı˘ÓÛË.∂›ÛË˜, Â›Ó·È ··Ú·›ÙËÙÔ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÏÂ-ÙÔÌÂÚ‹˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ·ÈÌfiÛÙ·ÛË˜, Î·ıÒ˜ Ë ÓfiÛÔ˜¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ·ÓÂ¿ÚÎÂÈ· ÚÔıÚÔÌ‚ˆÙÈÎÒÓ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÚˆÙÂ˚ÓÒÓ SÎ·È C, ·ÚÔ˘Û›· FV Leiden Î.¿. (11).

OÈ ·ÁÁÂÈ·Î¤˜ ‰˘ÛÏ·Û›Â˜ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÂÎ‰‹ÏˆÛË˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÌ-ÊÚ¿ÎÙÔ˘ ÛÙ· ·È‰È¿ (12). OÈ ·ÚÙËÚÈÔÊÏÂ‚ÈÎ¤˜ ÂÈ-ÎÔÈÓˆÓ›Â˜ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÌË ÙÚ·˘-Ì·ÙÈÎ‹˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜ Î·È Ë ˘fiÓÔÈ·‡·ÚÍ‹˜ ÙÔ˘˜ ı· Ú¤ÂÈ Ó· Ù›ıÂÙ·È ¿ÓÙÔÙÂ ÛÂ Â-ÚÈÙÒÛÂÈ˜ ·ÓÂÍ‹ÁËÙÔ˘ ·ÚÂÁ¯˘Ì·ÙÈÎÔ‡ ·ÈÌ·ÙÒÌ·-ÙÔ˜. º·›ÓÂÙ·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·ÈÌÔÚÚ·Á›·˜ Ì›·˜ÚÔËÁÔ˘Ì¤Óˆ˜ ÌË ÚË¯ıÂ›Û·˜ ·ÚÙËÚÈÔÊÏÂ‚ÈÎ‹˜ÂÈÎÔÈÓˆÓ›·˜ Â›Ó·È ·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁÔ˜ ÙÔ˘ ÌÂ-Á¤ıÔ˘˜ ÙË˜, ÌÂ Èı·ÓfiÙËÙ· Ó¤·˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙÔÓÂfiÌÂÓÔ ¯ÚfiÓÔ 2-6% (5,13). ™Â ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ÂÓ‹ÏÈÎÂ˜, Ù· ·ÓÂ˘Ú‡ÛÌ·Ù· ‰ÂÓ ·ÔÙÂÏÔ‡Ó Û˘¯Ó‹

ÙË˜ ¤Î‚·ÛË˜ ÙË˜ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ·˘Ù‹˜ ‰È·Ù·-Ú·¯‹˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¤ÌÊÚ·ÎÙÔ, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfiÂÂÈÛfi‰ÈÔ, ·È‰È¿, ·ÈÙÈÔÏÔÁ›·, ÚfiÁÓˆÛË.

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

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·ÈÙ›· ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿. ¶ÔÛÔ-ÛÙfi ÂÚ›Ô˘ 1-2% ·˘ÙÒÓ Î·ı›ÛÙ·Ù·È Û˘ÌÙˆÌ·ÙÈÎfiÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ÂÓÒ Û˘¯ÓfiÙÂÚ· ·Ú·ÙËÚÔ‡-ÓÙ·È ÛÂ ·È‰È¿ ÌÂ ÛÙ¤ÓˆÛË ÙÔ˘ ÈÛıÌÔ‡ ÙË˜ ·ÔÚÙ‹˜‹ ÔÏ˘Î˘ÛÙÈÎ‹ ÓfiÛÔ ÙˆÓ ÓÂÊÚÒÓ (4,13).

∏ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ (SCD) ·ÔÙÂÏÂ› Ì›··fi ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ·ÈÙ›Â˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿-ÎÙÔ˘, Ô Î›Ó‰˘ÓÔ˜ ÂÎ‰‹ÏˆÛË˜ ÙÔ˘ ÔÔ›Ô˘ Ê·›ÓÂÙ·ÈfiÙÈ Â›Ó·È 200-400 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ÌÂ SCD ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔÓ ˘fiÏÔÈÔ ·È‰ÈÎfi ÏË-ı˘ÛÌfi (4). ∞Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ¤ÌÊÚ·ÎÙ· ·Ú·ÙË-ÚÔ‡ÓÙ·È Û˘ÓËı¤ÛÙÂÚ· ÚÈÓ ÙÔ 10Ô ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜(14). øÛÙfiÛÔ, ·fi fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ SCD, ÙÔ

1/10 ı· ÂÎ‰ËÏÒÛÂÈ Û˘ÌÙˆÌ·ÙÈÎfi ¤ÌÊÚ·ÎÙÔ Ì¤¯ÚÈÙÔ 20fi ¤ÙÔ˜ ÙË˜ ËÏÈÎ›·˜, ÂÓÒ ÙÔ 1/5 ÛÈˆËÏfi ¤Ì-ÊÚ·ÎÙÔ ÛÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ· (15).

™ËÌ·ÓÙÈÎfi ·›ÙÈÔ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ·È‰ÈÎ‹ Î·È ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ·ÔÙÂÏÔ‡Ó ÔÈ ÚÔ-ıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, ÔÈ ÔÔ›ÔÈ ¯·Ú·ÎÙËÚ›˙Ô-ÓÙ·È ·fi ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡ ÙË˜ ‹ÍË˜, ÌÂÛÙÚÔÊ‹ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÙË˜ ·ÈÌfiÛÙ·ÛË˜ ÚÔ˜ÙËÓ Î·ÙÂ‡ı˘ÓÛË ÙË˜ ıÚfiÌ‚ˆÛË˜. ∏ ÂÎ‰‹ÏˆÛË ÂÌ-ÊÚ¿ÎÙÔ˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙË˜ÚˆÙÂ˝ÓË˜ C, ÙË˜ ÚˆÙÂ˝ÓË˜ S, ÙË˜ ·ÓÙÈıÚÔÌ‚›ÓË˜πππ Î·È ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, ÌÂ ÙËÓ ·ÚÔ˘Û›· ÌÂÙ¿Ï-Ï·ÍË˜ ÙÔ˘ ·Ú¿ÁÔÓÙ· V Leiden, ÙË˜ ÚÔıÚÔÌ‚›ÓË˜G20210A ‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘ methylenetetrahydrofolatedehydrogenase (MTHFR), Î·ıÒ˜ Î·È ÌÂ ÙËÓ ·-ÚÔ˘Û›· ·ÓÙÈÊˆÛÊÔÏÈÈ‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (16,17).OÈ ÚÔıÚÔÌ‚ˆÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚÂ› Ó· Â›Ó·ÈÎÏËÚÔÓÔÌÈÎ¤˜ ‹ Â›ÎÙËÙÂ˜, Û˘Ó‹ıˆ˜ Â·ÎfiÏÔ˘ıÔÏÔÈÌÒÍÂˆÓ, ¯Ú‹ÛË˜ Ê·ÚÌ¿ÎˆÓ Î·È Ë·ÙÈÎ‹˜ ‹ ÓÂ-ÊÚÈÎ‹˜ ÓfiÛÔ˘ (5). H Û˘ÓÔÏÈÎ‹ Â›ÙˆÛË ÙˆÓ ÚÔ-ıÚÔÌ‚ˆÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÂ ·È‰È¿ ÌÂ ÈÛ¯·ÈÌÈÎ¿¤ÌÊÚ·ÎÙ· ÔÈÎ›ÏÏÂÈ ÛÂ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ·fi 10-50% (17-19).

∂ÎÙfi˜ ·fi ÙË ÌÂÙ¿ÏÏ·ÍË MTHFR, Ë ÔÔ›· Ô‰Ë-ÁÂ› ÛÂ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÔÌÔÎ˘ÛÙÂ˝ÓË˜,˘ÂÚÔÌÔÎ˘ÛÙÈÓ·ÈÌ›· ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ› ÛÙÔÏ·›ÛÈÔ ÙË˜ ÔÌÔÎ˘ÛÙÈÓÔ˘Ú›·˜, Ì›·˜ ÌÂÙ·‚ÔÏÈÎ‹˜‰È·Ù·Ú·¯‹˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÓÂ·ÚÎ‹ ‰Ú¿ÛËÙÔ˘ ÂÓ˙‡ÌÔ˘ cystathionine ‚-synthase, ‹ ˆ˜ Â·Îfi-ÏÔ˘ıÔ ‰È·ÙÚÔÊÈÎ‹˜ ¤ÏÏÂÈ„Ë˜ Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ Î·È ‚È-Ù·Ì›ÓË˜ µ6 ‹ µ12 (20-22).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜, ÔÈÎ›ÏÔÈ ÈÔÁÂÓÂ›˜

¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÚÙËÚÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ·È‰ÈÎ‹ ËÏÈÎ›·

∫·Ú‰È·Î¿™˘ÁÁÂÓ‹˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜™ËÙÈÎ‹ ÂÓ‰ÔÎ·Ú‰›ÙÈ‰·ª˘ÔÎ·Ú‰›ÙÈ‰·-Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜µ·Ï‚È‰Ô¿ıÂÈÂ˜ ŸÁÎÔÈ (Ì‡ÍˆÌ·) ∞ÁÁÂÈ·Î¿¡fiÛÔ˜ MoyamoyaπÓÔÌ˘˚Î‹ ‰˘ÛÏ·Û›·¡Â˘ÚÔ˚ÓˆÌ¿ÙˆÛË¢È·¯ˆÚÈÛÌfi˜ Î·ÚˆÙ›‰·˜∞ÁÁÂÈ·Î¤˜ ‰˘ÛÏ·Û›Â˜∞ÁÁÂÈ›ÙÈ‰· (™.∂.§., Ô˙Ò‰Ë˜ ÔÏ˘·ÚÙËÚ›ÙÈ‰·, ÓfiÛÔ˜ Kawasaki,·ÏÏÂÚÁÈÎ‹ ÔÚÊ‡Ú·)∞ÈÌ·ÙÔÏÔÁÈÎ¿¢ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ ¶ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· π.£.¶. ∞ÈÌÔÚÚÔÊÈÏ›· ∞ÓÂ¿ÚÎÂÈ· ÚˆÙÂ˝ÓË˜ C∞ÓÂ¿ÚÎÂÈ· ÚˆÙÂ˝ÓË˜ S ∞ÓÂ¿ÚÎÂÈ· ·ÓÙÈıÚÔÌ‚›ÓË˜ πππ ∞ÓÂ¿ÚÎÂÈ· Ï·ÛÌÈÓÔÁfiÓÔ˘ ªÂÙ¿ÏÏ·ÍË F II G20210A ªÂÙ¿ÏÏ·ÍË FV Leiden ªÂÙ¿ÏÏ·ÍË MTHFR ∞ÓÙÈÊˆÛÊÔÏÈÈ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ªÂÙ·‚ÔÏÈÎ¿OÌÔÎ˘ÛÙÈÓÔ˘Ú›·§ÔÈÌÒ‰Ëπfi˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ HIVª˘ÎfiÏ·ÛÌ· ÓÂ˘ÌÔÓ›·˜ ÃÏ·Ì‡‰È· ªÔÚ¤ÏÈ· ∂ÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡∞ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜º·ÚÌ·ÎÂ˘ÙÈÎ¿∫ÔÎ·˝ÓË ™˘Ì·ıËÙÈÎÔÌÈÌËÙÈÎ¿ ∆Ú·‡Ì·∞ÎÙÈÓÔ‚ÔÏ›·π‰ÈÔ·ı¤˜ ¤ÌÊÚ·ÎÙÔ

¶›Ó·Î·˜ 2. ∞›ÙÈ· ÊÏÂ‚ÈÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ·È‰ÈÎ‹ ËÏÈÎ›·

∫·Ú‰È·Î¿™˘ÁÁÂÓ‹˜ Î˘·ÓˆÙÈÎ‹ Î·Ú‰ÈÔ¿ıÂÈ· ™˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·∞ÈÌ·ÙÔÏÔÁÈÎ¿¶ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· ∞ÓÂ¿ÚÎÂÈ· ·ÓÙÈıÚÔÌ‚›ÓË˜ πππ ∞ÓÂ¿ÚÎÂÈ· Ï·ÛÌÈÓÔÁfiÓÔ˘ ∞ÓÂ¿ÚÎÂÈ· ÚˆÙÂ˝ÓË˜ C ∞ÓÂ¿ÚÎÂÈ· ÚˆÙÂ˝ÓË˜ S ªÂÙ¿ÏÏ·ÍË F II 20210∞ ªÂÙ¿ÏÏ·ÍË FV Leiden ªÂÙ¿ÏÏ·ÍË MTHFR ∞ÓÙÈÊˆÛÊÔÏÈÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù· §ÔÈÌÒ‰Ë øÙ›ÙÈ‰·-Ì·ÛÙÔÂÈ‰›ÙÈ‰· ¶·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰· ªËÓÈÁÁ›ÙÈ‰· ∆Ú·‡Ì· ∞Ê˘‰¿ÙˆÛË ¡ÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ∫·ıÂÙËÚÈ·ÛÌfi˜

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Î·È ‚·ÎÙËÚÈ·ÎÔ› ·Ú¿ÁÔÓÙÂ˜ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÛÙÔÏ·›ÛÈÔ ÂÎ‰‹ÏˆÛË˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, ÛÂÔÛÔÛÙfi Ô˘ ÍÂÂÚÓ¿ ÙÔ 30% (23) ÙˆÓ ·È‰È·ÙÚÈ-ÎÒÓ ·ÛıÂÓÒÓ. øÛÙfiÛÔ, Ë Û·Ê‹˜ Û˘Û¯¤ÙÈÛË ·ÈÙ›Ô˘-·ÔÙÂÏ¤ÛÌ·ÙÔ˜ Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏË. π‰È·›ÙÂÚÔ ÂÓ-‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÏÔ›ÌˆÍË ·fi ÙÔÓ Èfi ÙË˜·ÓÂÌÂ˘ÏÔÁÈ¿˜, Ô ÔÔ›Ô˜ Ù˘ÈÎ¿ ÚÔÎ·ÏÂ› ¤ÌÊÚ·ÎÙÔÂÓÙÔÈÛÌ¤ÓÔ ÛÙ· ‚·ÛÈÎ¿ Á¿ÁÁÏÈ· (24,25). ∞Ó Î·È ÔÌË¯·ÓÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›, Èı·ÓÔ-ÏÔÁÂ›Ù·È Ë ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë¿ÌÂÛË ‰ÈÂ›Û‰˘ÛË ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜, Ë ·-ÚÂÌ‚ÔÏ‹ ·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÁÁÂÈ·Î‹˜ ·¿ÓÙËÛË˜, Î·-ıÒ˜ Î·È Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÚˆÙÂ˚ÓÒÓC, S Î·È ÙË˜ ·ÓÙÈıÚÔÌ‚›ÓË˜ πππ (24,26). ŸÛÔÓ ·ÊÔÚ¿ÛÙËÓ ÂÎ‰‹ÏˆÛË ÊÏÂ‚ÈÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘,Î˘Ú›ˆ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂÈ˜ Ô˘ ÂÓÙÔ›˙Ô-ÓÙ·È ÛÙËÓ ÎÂÊ·Ï‹ Î·È ÙÔÓ ÙÚ¿¯ËÏÔ, fiˆ˜ Ë ÔÍÂ›·Ì¤ÛË ˆÙ›ÙÈ‰· Î·È Ë Ì·ÛÙÔÂÈ‰›ÙÈ‰· Ô˘ ÌÔÚÔ‡Ó Ó·ÚÔÎ·Ï¤ÛÔ˘Ó ıÚfiÌ‚ˆÛË ÙÔ˘ ÂÈÌ‹ÎÔ˘˜ ÎfiÏÔ˘,Î·ıÒ˜ Î·È ÔÈ ÏÔÈÌÒÍÂÈ˜ ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓÔ˘ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ıÚfiÌ‚ˆÛË ÙÔ˘ ÛË-Ú·ÁÁÒ‰Ô˘˜ ÎfiÏÔ˘ (3,27).

¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ∆˘ÈÎ¿, ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿-

ÎÙÔ˘ ‰È·ÈÛÙÒÓÂÙ·È ÎÏÈÓÈÎ¿ ËÌÈ¿ÚÂÛË, Ë ÔÔ›· Û˘-¯Ó¿ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ‰È·Ù·Ú·¯¤˜ ÙË˜ ·ÈÛıËÙÈÎfiÙË-Ù·˜ ‹ ÙË˜ fiÚ·ÛË˜ (28). ∫ÂÊ·Ï·ÏÁ›· ·Ú·ÙËÚÂ›Ù·ÈÛ˘Ó‹ıˆ˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ·ÚÙËÚÈ·ÎÔ‡ ‰È·¯ˆÚÈÛÌÔ‡‹ ÊÏÂ‚ÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ (29,30), ÂÓÒ Û·ÛÌÔ› ÂÎ‰Ë-ÏÒÓÔÓÙ·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ÊÏÂ‚ÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, È‰È-·›ÙÂÚ· Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· (30). ¢È·Ù·Ú·¯‹ ÙÔ˘ÂÈ¤‰Ô˘ Û˘ÓÂ›‰ËÛË˜ ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ÂÁÎÂÊ·ÏÈ-Î‹˜ ·ÈÌÔÚÚ·Á›·˜ (31), ÌÂÁ¿ÏˆÓ ÂÌÊÚ¿ÎÙˆÓ ÙË˜ Ì¤-ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ (32) ‹ ÂÌÊÚ¿ÎÙˆÓ ÙÔ˘Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ (33).

™ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌ-ÊÚ¿ÎÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÂÁÎÂÊ·ÏÈÎÔ› fiÁÎÔÈ, Ù·ÙÚ·˘Ì·ÙÈÎ¿ ÂÈÛÎÏËÚ›‰È· Î·È ˘ÔÛÎÏËÚ›‰È· ·ÈÌ·-ÙÒÌ·Ù·, ÔÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜, ÔÈ ·ÔÌ˘ÂÏÈÓˆÙÈÎ¤˜ ÓfiÛÔÈ Î·È Ë ËÌÈÎÚ·-Ó›· (28).

¶·Ï·ÈfiÙÂÚ·, ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ÂÌÊÚ¿ÎÙÔ˘, ÔÈ ·ÛıÂÓÂ›˜ ˘Ô‚¿ÏÏÔÓÙ·Ó ÛÂ Û˘Ì‚·ÙÈ-Î‹ ·ÁÁÂÈÔÁÚ·Ê›·. øÛÙfiÛÔ, Û‹ÌÂÚ· ÂÊ·ÚÌfi˙ÔÓÙ·ÈÌË ÂÂÌ‚·ÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ, fiˆ˜ Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· (MRI), Ë Ì·ÁÓËÙÈÎ‹ ·ÁÁÂÈÔÁÚ·Ê›· (MRA) Î·ÈË ˘ÂÚË¯ÔÁÚ·Ê›· Doppler, Ë ÔÔ›· ÌÔÚÂ› Ó· ¯ÚË-ÛÈÌÔÔÈËıÂ› Î·È Û·Ó ÂÍ¤Ù·ÛË screening ÛÂ ÏËı˘-ÛÌÔ‡˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Â›Ó·È ÔÈ ‰ÚÂ·ÓÔ-Î˘ÙÙ·ÚÈÎÔ› ·ÛıÂÓÂ›˜ (28,34). ™Â ÂÚ›ÙˆÛË Ô˘ ·˘-Ù¤˜ ÔÈ Ì¤ıÔ‰ÔÈ ÂÍ¤Ù·ÛË˜ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌÂ˜,··ÈÙÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ·ÍÔÓÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ÁÈ·ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÈÌÔÚÚ·Á›·˜. ∏ Û˘Ì‚·ÙÈÎ‹ ·ÁÁÂÈÔ-

ÁÚ·Ê›· ÙÂÏÂ›Ù·È Û˘Ó‹ıˆ˜ ÛÂ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ, Â›ÙÂÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÚÙËÚÈÔÊÏÂ‚ÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜,·ÓÂ˘Ú‡ÛÌ·ÙÔ˜ ‹ ÓfiÛÔ˘ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁÂ›ˆÓ, È‰È·›-ÙÂÚ· ÛÂ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë MRA Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹‹ ÌË ‰È·ÁÓˆÛÙÈÎ‹, Â›ÙÂ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÓ‰ÂÈÎÙÈÎ¤˜ÓfiÛÔ˘ Moyamoya ÁÈ· ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹˜ Â¤Ì‚·ÛË˜ (28).

°È· ÙË ‰È·›ÛÙˆÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜ ·ÈÙÈÔÏÔÁ›·˜Î·È ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ÚfiÁÓˆÛË˜ Î·È ÙË˜ ıÂÚ·-Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ··ÈÙÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ·ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÍÂÙ¿ÛÂˆÓ (¶›Ó·Î·˜ 3), ÔÈÔÔ›Â˜, ˆÛÙfiÛÔ, ı· ·ÔÎ·Ï‡„Ô˘Ó ÙËÓ ·ÎÚÈ‚‹ ·ÈÙ›·ÛÂ ¤Ó· Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ.

£ÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ™Â ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë

ÔÍÂ›· ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ıÚÔÌ‚fiÏ˘ÛË, ÛÙ· ·È‰È¿ Ë ¯Ú‹ÛËÙÔ˘ tissue plasminogen activator (t-PA) ‰ÂÓ ¤¯ÂÈ ˘È-ÔıÂÙËıÂ›. ∞ÎfiÌË Î·È ·Ó ¤Ó· ·È‰› ÚÔÛÎÔÌÈÛÙÂ› ÛÙÔÓÔÛÔÎÔÌÂ›Ô ÛÙÔ ÎÚ›ÛÈÌÔ ‰È¿ÛÙËÌ· ÙˆÓ ÙÚÈÒÓ ÚÒ-ÙˆÓ ˆÚÒÓ ·fi ÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘, ËÛ·ÓÈfiÙËÙ¿ ÙÔ˘, Ë ¯·ÌËÏ‹ ‰È·ÁÓˆÛÙÈÎ‹ ÂÈ‰ÈÎfiÙËÙ·ÙË˜ ·ÍÔÓÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ Î·È ÙÔ Â‡ÚÔ˜ ÙˆÓ Èı·-ÓÒÓ ‰È·ÁÓÒÛÂˆÓ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ¤¯Ô˘Ó, Û˘Ó‹-ıˆ˜, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ‰È¿-ÁÓˆÛË˜ (28,35). ∂Í¿ÏÏÔ˘, Î·ıÒ˜ Ë ıÓËÙfiÙËÙ· Â›Ó·È¯·ÌËÏfiÙÂÚË Î·È Ë ÚfiÁÓˆÛË Û·ÊÒ˜ Î·Ï‡ÙÂÚË Û˘-ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, Ë ¯Ú‹ÛË ÙÔ˘ t-PA ‰ÂÓÊ·›ÓÂÙ·È Ó· Â›Ó·È ‰ÈÎ·ÈÔÏÔÁËÌ¤ÓË, ÌÂ ÂÍ·›ÚÂÛË›Ûˆ˜ Î¿ÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ÔÈ ·ÛıÂÓÂ›˜ ÌÂ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜, ÔÈ ÔÔ›ÔÈÂÎ‰ËÏÒÓÔ˘Ó ¤ÌÊÚ·ÎÙÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÓ‰ÔÓÔÛÔ-ÎÔÌÂÈ·Î‹˜ ÓÔÛËÏÂ›·˜.

∏ ¤ÎÙ·ÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ Î·È Ë ÎÏÈÓÈÎ‹ ¤Î‚·ÛË¤¯ÂÈ Ê·ÓÂ› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ıÂÚÌÔÎÚ·Û›· ÛÒ-Ì·ÙÔ˜ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ ËÌÂÚÒÓ ÌÂÙ¿ ÙËÓÂÎ‰‹ÏˆÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ (36). ÃˆÚ›˜ ·˘Ùfi Ó· ¤¯ÂÈ·ÈÙÈÔÏÔÁÈÎ¿ ÙÂÎÌËÚÈˆıÂ›, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ‰È·Ù‹-ÚËÛË ÙË˜ ıÂÚÌÔÎÚ·Û›·˜ <37ÔC ·ÔÙÂÏÂ› ·˘Ù‹ ÙËÛÙÈÁÌ‹, Ô˘ÛÈ·ÛÙÈÎ¿, ÙÔ ÌfiÓÔ ‰È·ı¤ÛÈÌÔ Ì¤ÙÚÔ “ÓÂ˘-ÚÔÚÔÛÙ·Û›·˜”.

∂ÊfiÛÔÓ ÙÂıÂ› Ë ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË, Ë ·ÓÙÈÌÂÙÒ-ÈÛË ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÂÚ›ÙˆÛË.ŒÙÛÈ, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔÚÚ·ÁÈÎ¿ ¤ÌÊÚ·ÎÙ· ‹ ÌÂ-Á¿Ï· ÈÛ¯·ÈÌÈÎ¿ ¤ÌÊÚ·ÎÙ· ÙË˜ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜·ÚÙËÚ›·˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ¿ÌÂÛË ÓÂ˘-ÚÔ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË (28,32), ÂÓÒ ÔÈ ·ÛıÂÓÂ›˜ÌÂ ·ÚÙËÚÈ·Îfi ‰È·¯ˆÚÈÛÌfi, ÊÏÂ‚ÈÎ‹ ıÚfiÌ‚ˆÛË ‹ÚÔıÚÔÌ‚ˆÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ¯Ú‹˙Ô˘Ó ·ÓÙÈËÎÙÈ-Î‹˜ ·ÁˆÁ‹˜, ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÚÒÈÌË˜ Â·ÓÂÎ-‰‹ÏˆÛË˜ ÂÌÊÚ¿ÎÙÔ˘ (5,17,38). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜·˘Ù¤˜ ÂÓ‰Â›ÎÓ˘Ù·È Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË Ë·Ú›ÓË˜Î·È, ·ÎÔÏÔ‡ıˆ˜, ˆ˜ ÚÔÊ˘Ï·ÎÙÈÎ‹ ıÂÚ·Â›·, Ë

July August 04 07-10-04 13:52 ™ÂÏ›‰·257

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¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›ÓË˜ ÁÈ· ‰È¿ÛÙËÌ· 3-6 ÌËÓÒÓ,ÂÓÒ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÈÛ¯·ÈÌÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ¿ÏÏË˜·ÈÙÈÔÏÔÁ›·˜ Û˘ÓÈÛÙ¿Ù·È Ë ÚÔÊ˘Ï·ÎÙÈÎ‹ ¯ÔÚ‹ÁËÛË¯·ÌËÏÒÓ ‰fiÛÂˆÓ ·ÛÈÚ›ÓË˜ (1 mg/kg) (28,39).

ªÂ ÛÎÔfi ÙËÓ ÚÔÊ‡Ï·ÍË ·fi Ó¤· ˘ÔÙÚÔ‹ÛÂ ÂÚÈÙÒÛÂÈ˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ÓfiÛÔ˘, ÂÈ-‚¿ÏÏÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ ¯ÚfiÓÈÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂ-Ù·ÁÁ›ÛÂˆÓ (40,41), ÂÓÒ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÓfiÛÔMoyamoya - ·ÓÂÍ·ÚÙ‹Ùˆ˜ Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· Úˆ-ÙÔ·ıÂ›˜ ‹ ‰Â˘ÙÂÚÔ·ıÂ›˜ ÂÚÈÙÒÛÂÈ˜ - Û˘ÓÈÛÙ¿-Ù·È Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â·Ó·ÁÁÂ›ˆÛË (42,43). ∆¤ÏÔ˜, ÛÂ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÔÌÔÎ˘ÛÙÈÓ·ÈÌ›·, fiˆ˜ Â›Ó·È ÔÈÔÌÔ˙˘ÁÒÙÂ˜ ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ MTHFR, Û˘ÛÙ‹ÓÂÙ·È Ë¯ÔÚ‹ÁËÛË ‚ÈÙ·ÌÈÓÒÓ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ µ Î·È Ê˘Ï-ÏÈÎfi ÔÍ‡ (21).

¶ÚfiÁÓˆÛË ¶·Ï·ÈfiÙÂÚ·, Î¿ıÂ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ Î·Ù¿

ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ıÂˆÚÔ‡ÓÙ·Ó È‰ÈÔ·ı¤˜, Î·Ï‹˜ÚfiÁÓˆÛË˜ Î·È ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â·ÓÂÎ‰‹Ïˆ-ÛË˜. ∂›Ó·È, Ï¤ÔÓ, ÁÓˆÛÙfi fiÙÈ ÙÔ Â‡ÚÔ˜ ÙˆÓ Î·Ù·-ÛÙ¿ÛÂˆÓ Ô˘ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ¤Ó· Ù¤ÙÔÈÔÂÂÈÛfi‰ÈÔ Â›Ó·È ÔÏ‡ ÌÂÁ¿ÏÔ Î·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ıÓËÙfiÙËÙ·˜ Î·È ˘ÔÙÚÔ‹˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ÔÈÎ›Ï-ÏÂÈ ·Ó¿ÏÔÁ· (44).

™Â Ì›· ÌÂÁ¿ÏË ÌÂÏ¤ÙË, Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·ÓÂ402 ·È‰È¿ ÌÂ ·ÚÙËÚÈ·Îfi ÈÛ¯·ÈÌÈÎfi ¤ÌÊÚ·ÎÙÔ Î·È160 ·È‰È¿ ÌÂ ÊÏÂ‚ÈÎ‹ ıÚfiÌ‚ˆÛË, ‰È·ÈÛÙÒıËÎÂıÓËÙfiÙËÙ· ÛÂ ÔÛÔÛÙfi 12%, ·ÚÔ˘Û›· ÓÂ˘ÚÔÏÔÁÈ-ÎÔ‡ ÂÏÏÂ›ÌÌ·ÙÔ˜ Î·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô ÛÂ ÔÛÔÛÙfi61% Î·È ÂÎ‰‹ÏˆÛË Ó¤Ô˘ ÂÌÊÚ¿ÎÙÔ˘ ÛÂ ÔÛÔÛÙfi21,6% ÙˆÓ ·ÛıÂÓÒÓ (45). °ÂÓÈÎ¿, Ê·›ÓÂÙ·È fiÙÈ Ë

ÂÓÙfiÈÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ÛÙË Ì¤ÛË ÂÁÎÂÊ·ÏÈÎ‹ ·Ú-ÙËÚ›· ÌÂ ¤ÎÙ·ÛË ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ÌÂÁ·Ï‡ÙÂÚË ·fiÙÔ 10% ÙÔ˘ ÂÓ‰ÔÎÚ¿ÓÈÔ˘ fiÁÎÔ˘, Ë ·ÚÔ˘Û›· Û·-ÛÌÒÓ Î·È Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘ÓÂ›‰ËÛË˜Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆ-ÛË (46-49). ¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂÏÔ‡Ó, ·Îfi-ÌË, Ë ÌÈÎÚ‹ ËÏÈÎ›· ÂÎ‰‹ÏˆÛË˜ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ-‰›Ô˘, Ë ·ÚÔ˘Û›· ËÌÈ¿ÚÂÛË˜ Ô˘ ÂÈÌ¤ÓÂÈ ÁÈ· ‰È¿-ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÂÓfi˜ Ì‹Ó·, Ë ÊÏÔÈÈÎ‹ - Û˘-ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓ ˘ÔÊÏÔÈÈÎ‹ - ÂÓÙfiÈÛË ÙÔ˘ ÂÌÊÚ¿-ÎÙÔ˘, Î·ıÒ˜ Î·È Ë ·ÌÊÔÙÂÚfiÏÂ˘ÚË ·ÔÊÚ·ÎÙÈÎ‹ÓfiÛÔ˜ (50-52). ∏ Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÂÓfi˜ ÂÌ-ÊÚ¿ÎÙÔ˘, Ë ÔÔ›· Î·ıÔÚ›˙ÂÙ·È ·fi ÙËÓ ˘ÔÎÂ›ÌÂÓË·ÈÙ›·, ·Ó·Ê¤ÚÂÙ·È ÛÂ ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi20-40% (44,45,53).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÂÎÙÂÙ·Ì¤ÓË ¤ÚÂ˘Ó· ÙˆÓ ÙÂ-ÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË ÂÁÎÂ-Ê·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙ· ·È‰È¿ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÂÂÚÈÔÚÈÛÌfi ÙË˜ ·Ï·ÈfiÙÂÚË˜ ‰È¿ÁÓˆÛË˜ ÙÔ˘ “È‰ÈÔ-·ıÔ‡˜” ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘. øÛÙfiÛÔ, Ë Û·-Ê‹˜ ·ÈÙ›· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË ÛÂ ÌÂÁ¿ÏÔ ÔÛÔÛÙfiÂÚÈÙÒÛÂˆÓ. ∞·ÈÙÔ‡ÓÙ·È, ·ÎfiÌË, ÌÂÁ¿ÏÂ˜ ÔÏ˘-ÎÂÓÙÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ· Ó· Î·ıÔÚÈÛÙÔ‡Ó ÌÂ Û·Ê‹-ÓÂÈ· ÔÈ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, Ë ‚¤ÏÙÈÛÙË ıÂÚ·Â˘-ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ·ÍÈÔÏfiÁËÛË ÙË˜ ¤Î‚·ÛË˜ÙË˜ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ·˘Ù‹˜ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ·È‰ÈÎ‹ ËÏÈÎ›·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM,

Schroll M. Stroke incidence, case fatality, and mortality inthe WHO MONICA Project. World Health Organization

¶›Ó·Î·˜ 3. ¢ÈÂÚÂ‡ÓËÛË ·ÈÙÈÔÏÔÁ›·˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘

™Â fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ñ MRI, MRA - ÌÂ ÛÎÔfi Ù· ÂÍ‹˜: ·ÔÎÏÂÈÛÌfi ·ÈÌÔÚÚ·Á›·˜, ·ÔÎÏÂÈÛÌfi ·ÚÙËÚÈ·ÎÔ‡ ‰È·¯ˆÚÈÛÌÔ‡, Î·ıÔÚÈÛÌfi ·Ó·ÙÔÌ›·˜

ÂÍ·ÁÒÓÔ˘ ÙÔ˘ Willis Î·È ·ÁÁÂ›ˆÓ ÙÔ˘ ·˘¯¤Ó·, Î·ıÔÚÈÛÌfi ı¤ÛË˜ Î·È ¤ÎÙ·ÛË˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ñ CT - ÁÈ· ·ÔÎÏÂÈÛÌfi ·ÈÌÔÚÚ·Á›·˜, ÂÊfiÛÔÓ Ô MR ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌÔ˜ ñ ™˘Ì‚·ÙÈÎ‹ ·ÁÁÂÈÔÁÚ·Ê›· - ÛÂ ÂÚ›ÙˆÛË ·ÈÌÔÚÚ·Á›·˜ ¯ˆÚ›˜ ·ÚÔ˘Û›· ‰È·Ù·Ú·¯‹˜ ‹ÍË˜ ‹ ÂÊfiÛÔÓ Ô MR ¤ÏÂÁ¯Ô˜ Â›Ó·È

Ê˘ÛÈÔÏÔÁÈÎfi˜ ™Â ÂÚ›ÙˆÛË ·ÈÌÔÚÚ·Á›·˜ñ µ·ÛÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹ÍË˜-·ÈÌÔÂÙ·Ï›ˆÓ ñ ™˘Ì‚·ÙÈÎ‹ ·ÁÁÂÈÔÁÚ·Ê›· ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ËÎÙÈÎfi ¤ÏÂÁ¯Ô ™Â ÂÚ›ÙˆÛË ÂÌÊÚ¿ÎÙÔ˘ ·ÁÁÂÈ·Î‹˜ Î·Ù·ÓÔÌ‹˜ Î·È/‹ ·ÁÁÂÈÔÂÁÎÂÊ·ÏÈÎ‹˜ ÓfiÛÔ˘ñ ÀÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜ ñ °ÂÓÈÎ‹ ·›Ì·ÙÔ˜ - ∆∫∂ ñ ∏ÏÂÎÙÚÔÊfiÚËÛË ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ñ ¶·Ú¿ÁÔÓÙ·˜ von Willebrand (vWF), F VIII, F XII ñ ŒÏÂÁ¯Ô˜ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ: ÚˆÙÂ˝ÓË C, ÚˆÙÂ˝ÓË S, ·ÓÙÈıÚÔÌ‚›ÓË πππ, Ï·ÛÌÈÓÔÁfiÓÔ, Û˘Ó-·Ú¿ÁˆÓ Ë·Ú›ÓË˜ ππ,

FV Leiden - ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÚˆÙÂ˝ÓË C, ÁÔÓ›‰ÈÔ ÚÔıÚÔÌ‚›ÓË˜ 20210, ÁÔÓ›‰ÈÔ MTHFR, ·ÓÙÈÊˆÛÊÔÏÈÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈËÎÙÈÎfi ÙÔ˘ Ï‡ÎÔ˘, ·ÓÙÈÎ·Ú‰ÈÔÏÈÈÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·), anti-‚2GPI

ñ OÌÔÎ˘ÛÙÂ˝ÓË - Ê˘ÏÏÈÎfi ÔÍ‡, ‚ÈÙ·Ì›ÓË µ12 ñ ÃÔÏËÛÙÂÚfiÏË, ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÏÈÔÚˆÙÂ˝ÓË Lp(a) ñ ŒÏÂÁ¯Ô˜ Èı·Ó‹˜ ÏÔ›ÌˆÍË˜ (ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: mycoplasma, chlamydia, helicobacter, borrelia) ñ ŒÏÂÁ¯Ô˜ ÔÚÔ‡ Î·È ∂¡À ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ ™Â ÂÚ›ÙˆÛË ÂÌÊÚ¿ÎÙÔ˘ ÙÔ˘ ÛÔÓ‰˘ÏÔ‚·ÛÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ñ ∞ÎÙÈÓÔÁÚ·Ê›· ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜

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

OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Rb-1 ˆ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ ÛÙ· Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜* ∂.-∞. ª·ÚÎ¿ÎË, ∂. ¢ËÌËÙÚ›Ô˘, ª. ∆ÛÔ·ÓÔÌ›¯·ÏÔ˘, ∂. ™ÙÂÈ·Î¿ÎË, ¢. ™·ÓÙ›‰Ô˜, M. ∫·ÏÌ·ÓÙ‹

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

�¶ÂÚ›ÏË„Ë: ∆Ô ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ ÙÔ˘ ÚÂÙÈÓÔ-‚Ï·ÛÙÒÌ·ÙÔ˜ Rb-1 Â›Ó·È ÔÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎfi ÁÔÓ›‰ÈÔ,ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈÂ› ÁÈ· Ì›· ˘ÚËÓÈÎ‹ ÊˆÛÊÔÚˆ-ÙÂ˝ÓË 110 Kb. ¢Ú· ˆ˜ Ú˘ıÌÈÛÙ‹˜ ÙÔ˘ Î˘ÙÙ·ÚÈÎÔ‡ Î‡-ÎÏÔ˘ Î·È ÂÌÔ‰›˙ÂÈ ÙË ÌÂÙ¿‚·ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·fiÙË G0/G1 ÛÙËÓ S Ê¿ÛË ÙÔ˘ Î˘ÙÙ·ÚÈÎÔ‡ Î‡ÎÏÔ˘.∂ÎÊÚ¿˙ÂÙ·È Ê˘ÛÈÔÏÔÁÈÎ¿ ÛÙ· ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·-Ú·. ∞‰Ú·ÓÔÔÈÂ›Ù·È ÌÂ ··ÏÂ›„ÂÈ˜ Î·È ·Ó·Û˘Ó‰˘·-ÛÌÔ‡˜, Û˘¯ÓfiÙÂÚ· fiÌˆ˜ ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜, Ô˘ ·-Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÛÙ· ÂÍfiÓÈ· 20-24. ™ÎÔfi˜ ÙË˜·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ë ·ÔÙ‡ˆÛË ÙË˜ Û˘¯Ófi-ÙËÙ·˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ Rb-1 ÁÔÓ›‰ÈÔ˘ ÛÂ ·È-‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ÏÂ˘¯·ÈÌ›· Î·È ÓÂ˘ÚÔ‚Ï¿ÛÙˆ-Ì· Î·È Ë ÂÍ¤Ù·ÛË ÙË˜ ‰˘Ó·ÙfiÙËÙ·˜ ¯ÚËÛÈÌÔÔ›ËÛ‹˜ÙÔ˘ ˆ˜ ÚÔÁÓˆÛÙÈÎÔ‡ ‰Â›ÎÙË. ªÂÏÂÙ‹ıËÎ·Ó ÂÈ¯Ú›-ÛÌ·Ù· Ì˘ÂÏÔ‡, ÙË˜ ÂÚÈfi‰Ô˘ 1992-1997, ·fi ÙÔ ·Ú-¯Â›Ô ÙË˜ ∫ÏÈÓÈÎ‹˜, 26 ·È‰ÈÒÓ ÌÂ ÏÂ˘¯·ÈÌ›· ÛÙËÓÚˆÙÔ‰È¿ÁÓˆÛË (18 O§§, 8 Oª§) Î·È 4 ·È‰ÈÒÓ ÌÂÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·. ∆· ÂÍfiÓÈ· 20, 21 Î·È 22 ÂÓÈÛ¯‡ıË-Î·Ó ÌÂ ÙË ¯Ú‹ÛË ÙË˜ ÙÂ¯ÓÈÎ‹˜ PCR. °È· ÙËÓ ·Ó›¯ÓÂ˘-ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÂÊ·ÚÌfiÛÙËÎÂ Ì¤ıÔ‰Ô˜ ·Ó¿Ï˘ÛË˜ÛÙÂÚÂÔ‰È·ÌfiÚÊˆÛË˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÌÔÓ‹˜ ·Ï˘Û›-‰·˜ (SSCP) Î·È ÂÙÂÚÔ‰›ÎÏˆÓË˜ ·Ó¿Ï˘ÛË˜(heteroduplex). ∆Ô ·ÏÏÔÈˆÌ¤ÓÔ ÚfiÙ˘Ô Ô˘ ·ÓÈ-¯ÓÂ‡ÙËÎÂ ÌÂ ÙËÓ SSCP ·Ó¿Ï˘ÛË ·ÊÔÚÔ‡ÛÂ ÛÙÔÓ›‰ÈÔ Ù‡Ô ÌÂÙ¿ÏÏ·ÍË˜. ™ÙÈ˜ O§§ ·Ú·ÙËÚ‹ıËÎ·ÓÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÂÍfiÓÈÔ 20 ÛÂ ÔÛÔÛÙfi 11,11%, ÛÙÔÂÍfiÓÈÔ 21 ÛÂ ÔÛÔÛÙfi 5,56% Î·È ÛÙÔ ÂÍfiÓÈÔ 22 ÛÂÔÛÔÛÙfi 22,22%. ªÂÙ¿ÏÏ·ÍË ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÂ 25%ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Oª§, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ÂÈÙÂ‡-¯ıËÎÂ ‡ÊÂÛË Î·È ÛÙÔ 25% ·˘ÙÒÓ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆ-Ì· ÛÙ·‰›Ô˘ IV ÌÂ ‰È‹ıËÛË Ì˘ÂÏÔ‡. ŸÏÂ˜ ÔÈ ÌÂÙ·Ï-Ï¿ÍÂÈ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ ·È‰È¿ ÌÂ ÂÓ‰È¿ÌÂÛÔ˘-˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·, Ù· ÔÔ›· Â›ÙÂ

�Abstract: Rb-1 is a tumour suppressor genelocated in the 13q14 chromosome region andcomprising of 27 exons. The Rb-1 gene codes for a110 KD product, which is a nuclear phosphoproteinacting as a cell cycle regulator and blocking thetransition of normal cells from G0/G1 into the Sphase of the cycle, and it is normally expressed inhaematopoietic cells. It is inactivated by deletionsbut more often by mutations. Point mutations mayaffect most of the exons, but predominantly exons20-24. In haematopoietic malignancies, deletions orrearrangements of the Rb-1 gene have beenreported in 5 to 10% of acute leukemias in adults.The aim of this study was to correlate the Rb-1 genemutations with the prognosis and progression ofchildhood acute leukemia and neuroblastoma.Archival bone marrow slides, dating from 1992 to1997, from 26 children with leukemia [18 acutelyphocytic leukemia (ALL) and 8 acute myeloidleukemia (AML)] and 4 children with neuroblastomawere studied. Exons 20, 21 and 22 were amplifiedusing the PCR technique, resulting in products of350 bp, 518 bp and 363 bp respectively. SSCP andheteroduplex analysis were performed to detectmutations. In exon 20 two ALL samples (11.11%), inexon 21 one of the ALL samples (5.56%) and inexon 22 four ALL samples (22.22%), had alteredconformation. All but one of these patients wereclassified as high risk leukemias, who eitherrelapsed or never achieved remission. Two of theAML patients who did not achieve remission andone of the neuroblastoma cases with concomitantbone marrow infiltration also showed alteredconformation. The SSCP and heteroduplex analysis

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

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜, ∏Ú¿ÎÏÂÈÔ

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

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

July August 04 07-10-04 13:52 ™ÂÏ›‰·261

∂ÈÛ·ÁˆÁ‹∏ Î·ÚÎÈÓÈÎ‹ ÂÍ·ÏÏ·Á‹ ÂÓfi˜ Î‡ÙÙ·ÚÔ˘ Â›Ó·È ·Ô-

Ù¤ÏÂÛÌ· ÙË˜ ÔÏ˘ÛÙ·‰È·Î‹˜ ‰È·‰ÈÎ·Û›·˜, Î·Ù¿ ÙËÓÔÔ›· ÔÏÏ·ÏÔ› ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ··ÈÙÔ‡-ÓÙ·È ÁÈ· ÙË ÌÂÙ¿‚·ÛË ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË Ê˘ÛÈÔÏÔ-ÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ ·Ó¿Ù˘ÍË˜, ÛÂ Ì›·Î·Ù¿ÛÙ·ÛË ·ÒÏÂÈ·˜ ÙÔ˘ ÂÏ¤Á¯Ô˘ (1). ∆· ÁÔÓ›‰È·Ô˘ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ·‡-ÍËÛË˜ Î·È ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ Î˘ÙÙ¿ÚÔ˘, Î·Ù·-Ù¿ÛÛÔÓÙ·È ÛÂ ‰‡Ô ‚·ÛÈÎ¤˜ Î·ÙËÁÔÚ›Â˜, ÛÙ· ÔÁÎÔ-ÁÔÓ›‰È· Î·È ÛÙ· ÔÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ ÁÔÓ›‰È· (2). ∆·ÔÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ ÁÔÓ›‰È· ·ÔÙÂÏÔ‡Ó Ì›· Î·ÙËÁÔ-Ú›· ÁÔÓÈ‰›ˆÓ Ô˘ Ô‰ËÁÔ‡Ó ÛÂ Î·ÚÎÈÓÔÁ¤ÓÂÛË fiÙ·Ó¯¿ÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘˜, ‰ËÏ·‰‹ Ù· ÁÔÓ›-‰È· ·˘Ù¿ Ê˘ÛÈÔÏÔÁÈÎ¿ ‰ÚÔ˘Ó ˆ˜ ·ÚÓËÙÈÎÔ› Ú˘ıÌÈ-ÛÙ¤˜ ÙÔ˘ Î˘ÙÙ·ÚÈÎÔ‡ Î‡ÎÏÔ˘, ÌÂ ÙËÓ ¤ÓÓÔÈ· ÙË˜·Ó·ÛÙÔÏ‹˜ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ Î˘ÙÙ¿ÚÔ˘(3,4). OÈ ÌÂÏ¤ÙÂ˜ Û˘Û¯¤ÙÈÛË˜ ÔÁÎÔÁÔÓÈ‰›ˆÓ Î·È Î·Ú-Î›ÓÔ˘ ¿Ú¯ÈÛ·Ó ÛÙ· Ì¤Û· ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ 1970,·ÏÏ¿ ÌfiÏÈ˜ ÙÔ 1982 Ù·˘ÙÔÔÈ‹ıËÎÂ ÁÈ· ÚÒÙË ÊÔ-Ú¿ ÔÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎfi ÁÔÓ›‰ÈÔ ÛÂ ÎÏËÚÔÓÔÌÈÎfi ÚÂÙÈ-ÓÔ‚Ï¿ÛÙˆÌ· Î·È ÔÓÔÌ¿ÛÙËÎÂ ÁÔÓ›‰ÈÔ Â˘·ÈÛıËÛ›·˜ÁÈ· ÙÔ ÚÂÙÈÓÔ‚Ï¿ÛÙˆÌ· (Rb-1) (5,6). ∏ Ù·˘ÙÔÔ›ËÛË·˘ÙÔ‡ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÂÚÌ‹ÓÂ˘ÛÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙËÌÔÚÈ·Î‹ ‚¿ÛË ÙÔ˘ ÎÏËÚÔÓÔÌÈÎÔ‡ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·-ÙÔ˜, ÌÂ ÙÔÓ ÌË¯·ÓÈÛÌfi ÙË˜ ·‰Ú·ÓÔÔ›ËÛË˜ Î·È ÙˆÓ‰‡Ô ·ÏÏËÏfiÌÔÚÊˆÓ ÙÔ˘ ÁÔÓÈ‰›Ô˘ (7).

¶ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÁÔÓ›‰ÈÔ ·˘ÙfiÂ‰Ú¿˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiÛˆÌ· 13q14, ·ÔÙÂÏÂ›Ù·È ·fi27 ÂÍfiÓÈ· Ô˘ Î·Ù·Ï·Ì‚¿ÓÔ˘Ó 180 Kb ÛÙÔ ·ÓıÚÒ-ÈÓÔ ÁÔÓÈ‰›ˆÌ·, ÂÓÒ ÙÔ ÌÂÙ·ÁÚ·ÊÈÎfi ÙÔ˘ RNA, 4,8Kb, Îˆ‰ÈÎÔÔÈÂ› ÁÈ· Ì›· ˘ÚËÓÈÎ‹ ÊˆÛÊÔÚˆÙÂ˝ÓË,ÙËÓ p105 (8,9) (∂ÈÎfiÓ· 1). ∏ p105 Ú˘ıÌ›˙ÂÈ ÙÔÓ Î˘Ù-Ù·ÚÈÎfi Î‡ÎÏÔ ·Ó¿ÏÔÁ· ÌÂ ÙË ÊˆÛÊÔÚ˘Ï›ˆÛ‹ ÙË˜(10). ∆Ô Î‡ÙÙ·ÚÔ ‰ÂÓ ‰È·ÈÚÂ›Ù·È fiÛÔ Ë ÚˆÙÂ˝ÓË Â›-Ó·È ˘ÔÊˆÛÊÔÚ˘ÏÈˆÌ¤ÓË Î·È ÛÂ Û‡ÌÏÔÎÔ ÌÂ ÙÔÓÎ˘ÚÈfiÙÂÚÔ ÌÂÙ·ÁÚ·ÊÈÎfi ·Ú¿ÁÔÓÙ· E2F (11). ªÂÙË ÊˆÛÊÔÚ˘Ï›ˆÛË ÙË˜ p105 ·fi ÙËÓ D/CDK4,6·ÂÏÂ˘ıÂÚÒÓÂÙ·È Ô E2F, ÚÔÛ‰¤ÓÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ-Ì¤ÓË ·ÏÏËÏÔ˘¯›· ÙÔ˘ DNA, ÂÓÂÚÁÔÔÈÂ› Ù· ÚˆÙÔ-ÔÁÎÔÁÔÓ›‰È· myc, cdc-2 Î·È ÙËÓ DNA ÔÏ˘ÌÂÚ¿ÛË

ÁÈ· Ó· ·Ú¯›ÛÂÈ Ë ·ÓÙÈÁÚ·Ê‹ (12). ¶·Ú¿ÏÏËÏ·, Ë˘ÂÚÊˆÛÊÔÚ˘ÏÈˆÌ¤ÓË ÚˆÙÂ˝ÓË pppp-pRb ÚÔÛ-‰¤ÓÂÙ·È ÛÂ Î·ıÔÚÈÛÌ¤ÓË ·ÏÏËÏÔ˘¯›· ÙÔ˘ DNA Î·ÈÂÓÂÚÁÔÔÈÂ› ÙËÓ RNA ÔÏ˘ÌÂÚ¿ÛË ÁÈ· Ó· ·Ú¯›ÛÂÈ ËÌÂÙ·ÁÚ·Ê‹ (∂ÈÎfiÓ· 2). OÈ ÔÁÎÔÚˆÙÂ˝ÓÂ˜ ÙˆÓ ÈÒÓSV40 (T ·ÓÙÈÁfiÓÔ), ÙÔ˘ ·‰ÂÓÔ˚Ô‡ (∂π∞) Î·È ÙÔ˘ HPV-16 (E7 ·ÓÙÈÁfiÓÔ˘) Û˘Ó‰¤ÔÓÙ·È ÂÎÏÂÎÙÈÎ¿ ÌÂ ÙËÓ pRbÎ·È ÙËÓ ·‰Ú·ÓÔÔÈÔ‡Ó, ¯ˆÚ›˜ ‰ËÏ·‰‹ Ó· ··ÈÙÂ›Ù·ÈÊˆÛÊÔÚ˘Ï›ˆÛË, ÂÓÒ ÂÏÂ‡ıÂÚÔ˜ Ô E2F ÚÔÎ·ÏÂ›·ÓÂÍ¤ÏÂÁÎÙÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ (13-15). ∏ pRb, ÂÎÙfi˜ ·fi ÙÔÓ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÙË˜ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ,Û˘ÌÌÂÙ¤¯ÂÈ Î·È ÛÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘˜ (16).

∆Ô ÁÔÓ›‰ÈÔ Rb-1 ÂÎÊÚ¿˙ÂÙ·È ÛÂ fiÏ· Ù· Î‡ÙÙ·Ú·ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜. ∏ ·‰Ú·ÓÔÔ›ËÛ‹ ÙÔ˘ ÂÈ-Ù˘Á¯¿ÓÂÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜(mutations), ·ÏÏ¿ Î·È ÌÂ ··ÏÂ›„ÂÈ˜ (deletions) Î·È·Ó·Û˘Ó‰˘·ÛÌÔ‡˜ (rearrangements) (17). OÈ ÌÂÙ·Ï-Ï¿ÍÂÈ˜, ÂÓÒ ıÂˆÚËÙÈÎ¿ ÌÔÚÔ‡Ó Ó· Û˘Ì‚Ô‡Ó ÛÙ· Â-ÚÈÛÛfiÙÂÚ· ÂÍfiÓÈ·, ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ 90% ÛÙ·ÂÍfiÓÈ· 20-24 (18,19). ŒÓ·˜ ÂÚÈÔÚÈÛÌ¤ÓÔ˜ ·ÚÈıÌfi˜ÌÂÏÂÙÒÓ ÛÂ ÂÓ‹ÏÈÎÂ˜ ÌÂ Û˘Ì·ÁÂ›˜ fiÁÎÔ˘˜, fiˆ˜ÔÛÙÂÔÛ¿ÚÎˆÌ·, ÌÈÎÚÔÎ˘ÙÙ·ÚÈÎfi Î·ÚÎ›ÓÔ ÙÔ˘ ÓÂ‡-ÌÔÓ·, Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ÚÔÛÙ¿ÙË, ÙË˜ Î‡-ÛÙË˜, Î·ıÒ˜ Î·È ̆ „ËÏ‹˜ Î·ÎÔ‹ıÂÈ·˜ NHL, ¤¯ÂÈ ‰Â›ÍÂÈfiÙÈ Ë ·‰Ú·ÓÔÔ›ËÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ·˘ÙÔ‡ ÌÔÚÂ› Ó·Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÚfiÁÓˆÛË (20-25). ŸÛÔÓ ·ÊÔÚ¿ÛÙÈ˜ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ Î·ÎÔ‹ıÂÈÂ˜, ÔÈ ÌÂÏ¤ÙÂ˜ Ô˘¤¯Ô˘Ó Á›ÓÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÊÔÚÔ‡Ó ÛÙËÓ ¤ÎÊÚ·ÛËÙË˜ ÚˆÙÂ˝ÓË˜ p105 ÛÂ ÏÂÌÊÔ‚Ï·ÛÙÈÎ¤˜ Î·È Ì˘ÂÏÔ-ÁÂÓÂ›˜ ÏÂ˘¯·ÈÌ›Â˜ ÂÓËÏ›ÎˆÓ, ÛÙÈ˜ ÔÔ›Â˜ ¤¯ÂÈ ·Ú·-ÙËÚËıÂ› fiÙÈ Ë ÂÏ¿ÙÙˆÛË ‹ Ë ·Ô˘Û›· ¤ÎÊÚ·ÛË˜ ÙË˜ÚˆÙÂ˝ÓË˜ p105 ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› ·ÓÂÍ¿ÚÙËÙÔÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË (26-30). ¶ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙÂ˜·‰Ú·ÓÔÔ›ËÛË˜ ÙÔ˘ Rb-1 ÌÂ ··ÏÂ›„ÂÈ˜ ‹ ·Ó·‰È·Ù¿-ÍÂÈ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÌÔÚÔ‡Ó Ó· Û˘Ì‚Ô‡Ó ÛÂ ÔÛÔ-ÛÙfi 5-10% ÛÙÈ˜ Oª§ (31) Î·È O§§ (32) ÂÓËÏ›ÎˆÓ, Î·-ıÒ˜ Î·È ÛÙÈ˜ Ãª§ Î·Ù¿ ÙË ‚Ï·ÛÙÈÎ‹ ÎÚ›ÛË (33). ªÂ-Ï¤ÙÂ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÌÂÙ¿ÏÏ·ÍË ·˘ÙÔ‡ ÙÔ˘ ÁÔÓÈ-‰›Ô˘ Â›Ó·È ÂÏ¿¯ÈÛÙÂ˜ Î·È ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÈ˜ ¯Úfi-ÓÈÂ˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ¤˜ ÏÂ˘¯·ÈÌ›Â˜ ÙˆÓ ÂÓËÏ›ÎˆÓ (34).

ÂÌÊ¿ÓÈÛ·Ó Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ Â›ÙÂ˘ÍË ‡ÊÂÛË˜ ‹˘ÔÙÚÔ›·Û·Ó. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÙÔ˘ Rb-1 ÁÔÓÈ‰›Ô˘ ÌÔÚÔ‡Ó Ó· ·ÔÙÂÏ¤ÛÔ˘Ó ÚÔ-ÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÛÙÈ˜ ÏÂ˘¯·ÈÌ›Â˜ ÙˆÓ ·È‰ÈÒÓ, ÂÓÒ Ë·Ó›¯ÓÂ˘Û‹ ÙÔ˘˜ ÌÔÚÂ› Ó· ÙÚÔÔÔÈ‹ÛÂÈ ‹ Ó· ÂÓÙ·-ÙÈÎÔÔÈ‹ÛÂÈ ÙËÓ ·Ú¯ÈÎ‹ ıÂÚ·Â›·. ™ÙÔ˘˜ Û˘Ì·ÁÂ›˜fiÁÎÔ˘˜ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÌÔ-ÚÔ‡Ó Ó· ·ÔÙÂÏ¤ÛÔ˘Ó ‰Â›ÎÙË ÂÈıÂÙÈÎfiÙËÙ·˜ ÙË˜ÓfiÛÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Rb-1 ÁÔÓ›‰ÈÔ, ÚfiÁÓˆÛË, ÔÍÂ›· ÏÂ˘-¯·ÈÌ›·, ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ·È‰ÈÎ‹ ËÏÈÎ›·.

showed that all but one, who did not belong to thehigh risk group, had the same altered conformation.The exception may represent a leaky mutation.These data suggest that the Rb-1 gene couldpossibly be used as a prognostic factor in acuteleukemia of childhood, and be an indication forintensification of chemotherapy. In solid tumourswith bone marrow involvement it could play a roleas a marker of aggressive disease.

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

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™ÙËÓ ÔÍÂ›· ÏÂ˘¯·ÈÌ›· ÙˆÓ ·È‰ÈÒÓ, ·Ú¿ ÙÔ˘˜ÁÓˆÛÙÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ·ÊÂÓfi˜¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ¤¯ÂÈ ¤Î‚·ÛË ÌË Û˘Ì-‚·Ù‹ ÌÂ ÙËÓ ·Ú¯ÈÎ‹ ÚfiÁÓˆÛË, ·ÊÂÙ¤ÚÔ˘ ‰ÂÓ˘¿Ú¯Ô˘Ó ÌÔÚÈ·ÎÔ› ‰Â›ÎÙÂ˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ÔÈÔÔ›ÔÈ Ó· ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ·Ó›¯ÓÂ˘ÛË ÙË˜ ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘.°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ıÂˆÚ‹ıËÎÂ fiÙÈ Ë ÌÂÏ¤ÙË ÙË˜ ÌÂ-Ù¿ÏÏ·ÍË˜ ÙÔ˘ Rb-1 ÁÔÓÈ‰›Ô˘ ÛÂ ·˘Ù‹ ÙËÓ ·ÈÌ·ÙÔÏÔ-ÁÈÎ‹ Î·ÎÔ‹ıÂÈ· ÙˆÓ ·È‰ÈÒÓ, Ô˘ Â›Ó·È ÙfiÛÔ Ë Û˘-¯ÓfiÙÂÚË fiÛÔ Î·È ·˘Ù‹ ÌÂ ÂÍ·ÈÚÂÙÈÎ‹ ÚfiÁÓˆÛË,ÌÔÚÂ› Ó· Û˘ÓÂÈÛÊ¤ÚÂÈ fi¯È ÌfiÓÔ ÛÙËÓ ÚfiÁÓˆÛËÎ·È ÙÚÔÔÔ›ËÛË ÙË˜ ıÂÚ·Â›·˜, ·ÏÏ¿ Î·È ÛÙËÓ·ÍÈÔÏfiÁËÛË ÙË˜ ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó ÂÈ¯Ú›ÛÌ·Ù· Ì˘ÂÏÔ‡, ÌÂ ‹ ¯ˆÚ›˜ ¯ÚÒÛË,

·fi ÙÔ ·Ú¯Â›Ô ÙË˜ ∫ÏÈÓÈÎ‹˜ ÙË˜ ÂÚÈfi‰Ô˘ 1992-1997, 26 ·È-‰ÈÒÓ ÌÂ ÔÍÂ›· ÏÂ˘¯·ÈÌ›· ÛÙËÓ ÚˆÙÔ‰È¿ÁÓˆÛË (18 ·È‰È¿ ÌÂÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ Î·È 8 ÌÂ ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹), Î·ıÒ˜ Î·È 4ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·.

™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ O§§, 13 ‹Ù·Ó ·ÁfiÚÈ· Î·È 5‹Ù·Ó ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 3 ÌËÓÒÓ ¤ˆ˜ 15,5 ÂÙÒÓ. ªÂ ‚¿ÛË ÙÔÚˆÙfiÎÔÏÏÔ BFM-ALL, ¤Ó·˜ ·ÛıÂÓ‹˜ ·Ó‹ÎÂ ÛÙËÓ ÔÌ¿‰· ¯·-ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, 7 ·ÛıÂÓÂ›˜ ÛÙËÓ ÔÌ¿‰· ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡-ÓÔ˘, ÂÓÒ ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·Ó‹Î·Ó 10 ·ÛıÂÓÂ›˜.

∆Ú›· ·È‰È¿, Ô˘ ·Ú¯ÈÎ¿ Â›¯·Ó Î·Ù·Ù·ÁÂ› ÛÙËÓ ÔÌ¿‰· ÂÓ-‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘, ÛÙËÓ ÔÚÂ›· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘ ÏfiÁˆ ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘. ∞fi ·˘Ù¿, ¤Ó· ·-ÚÔ˘Û›·ÛÂ ˘ÔÙÚÔ‹ ÛÙÔ ∫¡™ ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·ÈÎ·Ù¤ÏËÍÂ. ∆Ô ‰Â‡ÙÂÚÔ ·È‰› ·ÚÔ˘Û›·ÛÂ ˘ÔÙÚÔ‹ ÛÙÔÓÌ˘ÂÏfi 3 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙË˜ ıÂÚ·Â›·˜. ÀÔ-‚Ï‹ıËÎÂ ÛÂ ªªO ·fi ÙÔÓ ·fiÏ˘Ù· ÈÛÙÔÛ˘Ì‚·Ùfi ·‰ÂÚÊfiÙÔ˘. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ªªO, ·ÚÔ˘Û›·ÛÂ ˘ÔÙÚÔ‹ ÛÙÔ∫¡™ Î·È ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™ÙÔ ÙÚ›ÙÔ ·È‰› ‰ÂÓ Â›¯Â ÂÈ-ÙÂ˘¯ıÂ› ‡ÊÂÛË ÙËÓ 33Ë ËÌ¤Ú· ÙË˜ ıÂÚ·Â›·˜ ÂÊfi‰Ô˘.

∏ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ Oª§ ÂÚÈÂÏ¿Ì‚·ÓÂ 6 ÎÔÚ›ÙÛÈ·Î·È 2 ·ÁfiÚÈ·. ∞fi ·˘Ù¿, ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 10,5 ÂÙÒÓ Ô˘˘Ô‚Ï‹ıËÎÂ ÛÂ ªªO Â›Ó·È ÂÏÂ‡ıÂÚÔ ÓfiÛÔ˘ 4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËªªO Î·È ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 14 ÂÙÒÓ ÛÙËÓ ÚˆÙÔ‰È¿ÁÓˆÛËÔ˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ Û˘Ì‚·ÙÈÎ‹ ¯ËÌÂÈÔıÂÚ·Â›·, Â›Ó·È Â›-

ÛË˜ ÂÏÂ‡ıÂÚÔ ÓfiÛÔ˘ 5 ¯ÚfiÓÈ· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ıÂÚ·Â›·˜. ∏ ÔÌ¿‰· ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÂÚÈÂÏ¿Ì‚·ÓÂ 4 ·È‰È¿,

2 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 3 ÌËÓÒÓ ¤ˆ˜ 2,5 ÂÙÒÓ. ∆ÚÂÈ˜·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Â›¯·Ó ÓfiÛÔ ÛÙ·‰›Ô˘ 4 (1 ÌÂ ‰È‹ıËÛË Ì˘Â-ÏÔ‡) Î·È Ô Ù¤Ù·ÚÙÔ˜ ÛÙ·‰›Ô˘ 4 S.

∂Î¯‡ÏÈÛË ÙÔ˘ DN∞ ∏ ÂÎ¯‡ÏÈÛË ÙÔ˘ DNA Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ·fi Ù· ÂÈ¯Ú›-

ÛÌ·Ù· ÙÔ˘ Ì˘ÂÏÔ‡. ∆· Í¤ÛÌ·Ù· ÙˆÓ ÂÈ¯ÚÈÛÌ¿ÙˆÓ ÌÂÙ·Ê¤-ÚÔÓÙ·È ÛÂ ÛˆÏËÓ¿ÚÈ· eppendorf. ¶ÚÔÛÙ›ıÂÙ·È ÚˆÙÂ˚Ó¿ÛË ∫Î·È 400 Ìl ‰È·Ï‡Ì·ÙÔ˜ Ï‡ÛË˜ (100 mM NaCl, 10 Mm Tris-HCL,pH 8, 25 mM EDTA, 0,5% SDS Î·È 100 Ìg/ml ÚˆÙÂ˚Ó¿ÛË ∫).∆· ‰Â›ÁÌ·Ù· Âˆ¿˙ÔÓÙ·È ÛÙÔ˘˜ 37ÔC ÁÈ· 24 ÒÚÂ˜. ∏ ·ÔÌ¿-ÎÚ˘ÓÛË ÙË˜ ÚˆÙÂ˚Ó¿ÛË˜ ∫ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂÙ¿ ·fi ÂÎ¯‡ÏÈ-ÛË ÌÂ Ê·ÈÓfiÏË-¯ÏˆÚÔÊfiÚÌÈÔ. ™ÙËÓ ˘‰·ÙÈÎ‹ Ê¿ÛË, ÚÔÛÙ›ıÂ-ÓÙ·È 1/20 ÙÔ˘ fiÁÎÔ˘ 5 ª NaCl Î·È 2,5 fiÁÎÔÈ „˘¯Ú‹˜ (-20ÔC)·fiÏ˘ÙË˜ ·Èı·ÓfiÏË˜ ÁÈ· ÙËÓ Î·Ù·ÎÚ‹ÌÓÈÛË ÙÔ˘ DNA. ∆ÔDNA Â·Ó·ÎÙ¿Ù·È ÌÂ Ê˘ÁÔÎ¤ÓÙÚËÛË ÛÙÈ˜ 13.000 ÛÙÚÔÊ¤˜ ÁÈ·15 ÏÂÙ¿ ÛÙÔ˘˜ 4ÔC, ÂÎÏ‡ÂÙ·È ÌÂ „˘¯Ú‹ ·Èı·ÓfiÏË 70%,·Ê‹ÓÂÙ·È Ó· ÛÙÂÁÓÒÛÂÈ Î·È Â·Ó·‰È·Ï‡ÂÙ·È ÛÂ 50 Ìl ·Ô-ÛÙ·ÁÌ¤ÓÔ˘ ‡‰·ÙÔ˜. ¶·Ú·Ì¤ÓÂÈ ÛÙÔ˘˜ 4ÔC ÁÈ· 24 ÒÚÂ˜ Î·È Î·-ÙfiÈÓ Ê˘Ï¿ÛÛÂÙ·È ÛÙÔ˘˜ -20ÔC. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ Û˘ÁÎ¤-ÓÙÚˆÛË˜ ÙÔ˘ DNA Á›ÓÂÙ·È ÌÂ ÊˆÙoÌ¤ÙÚËÛË ÛÙ· 260 nm.

∞Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÌÂ ÔÏ˘ÌÂÚ¿ÛË (PCR) ∞fi ÙÔ ÂÎ¯˘ÏÈÛÌ¤ÓÔ DNA Î¿ıÂ ‰Â›ÁÌ·ÙÔ˜, 0,5 Ìl ˘Ê›ÛÙ·-

Ù·È ÂÓ˙˘ÌÈÎ‹ ÂÓ›Û¯˘ÛË ÛÂ ÙÂÏÈÎfi fiÁÎÔ 50 Ìl (35). ∏ ·ÓÙ›‰Ú·-ÛË ÂÚÈÏ·Ì‚¿ÓÂÈ 5 Ìl Ú˘ıÌÈÛÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜, 200 ÌªdNTPs, 1,25 U Taq ÔÏ˘ÌÂÚ¿ÛË Î·È 0,5 Ìm ·fi Î¿ıÂ ÂÎÎÈÓË-Ù‹ (primer), Ë ·ÏÏËÏÔ˘¯›· ÙˆÓ ÔÔ›ˆÓ Û˘ÓÙ¤ıËÎÂ Û‡ÌÊˆÓ·ÌÂ ÙÔ˘˜ Hogg Î·È Û˘Ó (36).

OÈ primers ÁÈ· ÙÔ ÂÍfiÓÈÔ 23 Û¯Â‰È¿ÛÙËÎ·Ó ÂÍ·Ú¯‹˜ ‚¿ÛÂÈÙË˜ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 23 ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ·fi ÙËÁÔÓÈ‰È·Î‹ ÙÚ¿Â˙· (gene bank). ∞ÎÔÏÔ˘ıÔ‡Ó 35 Î‡ÎÏÔÈ ÂÓ›-Û¯˘ÛË˜ ˘fi ÙÈ˜ ÂÍ‹˜ Û˘Óı‹ÎÂ˜: ÛÙ¿‰ÈÔ ·Ô‰È¿Ù·ÍË˜(template denaturation) ÌÂ ıÂÚÌÔÎÚ·Û›· 96ÔC ÁÈ· 0,5 min,ÛÙ¿‰ÈÔ ·Ó·‰È¿Ù·ÍË˜ (primer annealing) ÌÂ ıÂÚÌÔÎÚ·Û›·

∂ÈÎfiÓ· 1. ¢ÔÌ‹ Î·È ÔÚÁ¿ÓˆÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 Î·È ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÙÔ˘ [ÙÚÔÔÔÈËÌ¤ÓÔ ·fi Rahman J (40)].

∂ÈÎfiÓ· 2. ¢È·ÁÚ·ÌÌ·ÙÈÎ‹ ·Ó··Ú¿ÛÙ·ÛË ÙË˜ ÊˆÛÊÔÚ˘Ï›ˆ-ÛË˜ ÙË˜ pRb Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Î˘ÙÙ·ÚÈÎÔ‡ Î‡ÎÏÔ˘ [ÙÚÔ-ÔÔÈËÌ¤ÓÔ ·fi Rahman J (40)].

∂ÎÎÈÓËÙ‹˜ÙÔ˘ RB1

mRNA4,7 kb

ª

∂2F

pRD

DNA Î˘ÎÏ›ÓË D, ECDK4/CDK6 pRBp

pRBpp

pRBpppp

S

G1 (ÚÒÈÌË)

G1 (fi„ÈÌË)

G2

¶ÚˆÙÂ˝ÓËpRB

105 kDa

¶ÂÚÈÔ¯‹‰ËÌÈÔ˘ÚÁ›·˜ÔÏÈÁÔÌÂÚÒÓ

NH2NH2P P PP P P PP P P P P

1 9 27

P: £¤ÛÂÈ˜ ÊˆÛÊÔÚ˘Ï›ˆÛË˜

COOH

¶ÂÚÈÔ¯‹Ê·Î¤ÏÔ˘

¶ÂÚÈÔ¯‹ÚfiÛ‰ÂÛË˜

DNA

G0

July August 04 07-10-04 13:52 ™ÂÏ›‰·263

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Î·Ù¿ÏÏËÏË ÁÈ· ÙÔ Î¿ıÂ ˙Â˘Á¿ÚÈ ÂÎÎÈÓËÙÒÓ (ÂÍfiÓÈÔ 20 ÛÙÔ˘˜60ÔC, ÂÍfiÓÈÔ 21 ÛÙÔ˘˜ 58ÔC Î·È ÂÍfiÓÈÔ 22 ÛÙÔ˘˜ 62ÔC) Î·ÈÛÙ¿‰ÈÔ ÂÈÌ‹Î˘ÓÛË˜ (primer extension) ÛÙÔ˘˜ 72ÔC ÁÈ· 1 min.

∆Ô Ì‹ÎÔ˜ ÙˆÓ ÂÓÈÛ¯˘Ì¤ÓˆÓ ÙÌËÌ¿ÙˆÓ Â›Ó·È 350, 518 Î·È363 ‚¿ÛÂÈ˜ (bp) ÁÈ· Ù· ÂÍfiÓÈ· 20, 21 Î·È 22, ·ÓÙ›ÛÙÔÈ¯·. ª¤-ÚÔ˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR ·Ó·Ï‡ÂÙ·È ÛÂ ‹ÎÙˆÌ· ·Á·Úfi˙Ë˜2% ÌÂ ¯ÚÒÛË ‚ÚˆÌÈÔ‡¯Ô˘ ·ÈıÈ‰›Ô˘ Î·È ÂÎÙ›ıÂÙ·È ÛÂ ˘ÂÚÈÒ-‰Ë ·ÎÙÈÓÔ‚ÔÏ›·, ÒÛÙÂ Ó· ‰È·ÈÛÙˆıÂ› Ë ÂÈı˘ÌËÙ‹ ÂÓ›Û¯˘ÛËÙˆÓ 350 bp, 518 bp Î·È 363 bp (∂ÈÎfiÓÂ˜ 3-6).

SSCP ·Ó¿Ï˘ÛË - Heteroduplex °È· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ, ÂÊ·ÚÌfi˙ÂÙ·È Ë ·Ó¿Ï˘ÛË

ÛÙÂÚÂÔ‰È·ÌfiÚÊˆÛË˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÌÔÓ‹˜ ·Ï˘Û›‰·˜(single stand conformational polymorphism analysis - SSCP)(37): 5 Ìl ·fi Î¿ıÂ PCR ÚÔ˚fiÓ ·Ó·ÌÂÈÁÓ‡ÂÙ·È ÌÂ 10 Ìl ·Ô-‰È·Ù·ÎÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ (¡aO∏ 10 mª, 2 ÌM EDTA, 95%

ÊÔÚÌ·Ì›‰Ë, 0,05% ‚ÚˆÌÔÊ·ÈÓfiÏË Î·È 0,05% Î˘·ÓÔ‡ ÙÔ˘ Í˘-Ï¤ÓÈÔ˘). ∞Ô‰È¿Ù·ÍË (denaturation) ÙÔ˘ DNA ÛÙÔ˘˜ 95ÔC ÁÈ· 5min, ¿ÌÂÛË ÙÔÔı¤ÙËÛË ÙˆÓ eppendorfs ÛÙÔÓ ¿ÁÔ Î·È ¿ÌÂ-ÛË ËÏÂÎÙÚÔÊfiÚËÛË ÛÂ 10% ‹ÎÙˆÌ· ÔÏ˘·ÎÚÈÏ·ÌÈ‰›Ô˘37,5/1 acrylamide/bisacrylamide. °È· ÙËÓ ÂÙÂÚÔ‰›ÎÏˆÓË ·Ó¿-Ï˘ÛË (Heteroduplex), Ù· PCR ÚÔ˚fiÓÙ· ·Ô‰È·Ù¿ÛÛÔÓÙ·ÈÛÙÔ˘˜ 95ÔC ÁÈ· 10 min Î·È ËÏÂÎÙÚÔÊÔÚÔ‡ÓÙ·È ÛÂ ‹ÎÙˆÌ· Ô-Ï˘·ÎÚÈÏ·ÌÈ‰›Ô˘ 10% ÛÂ ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ ÛÂ 260 V ÁÈ·4 ÒÚÂ˜. ∆Ô ÚÔ˚fiÓ ÙÔ˘ ÂÍÔÓ›Ô˘ 21, ÏfiÁˆ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘,ÁÈ· Ó· ÌÔÚ¤ÛÂÈ Ó· ˘ÔÛÙÂ› SSCP ·Ó¿Ï˘ÛË, ˘Ô‚¿ÏÏÂÙ·È ÛÂ¤„Ë ÌÂ ÙÔ Î·Ù¿ÏÏËÏÔ ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ NdeI, ÛÙÔ˘˜ 37ÔCÁÈ· 10 ÒÚÂ˜, ‰›ÓÔÓÙ·˜ ‰‡Ô ˘ÔÚÔ˚fiÓÙ· 180/338 bp.

OÈ ·Ï˘Û›‰Â˜ ÙÔ˘ DNA Ô˘ Ê¤ÚÔ˘Ó ÌÂÙ¿ÏÏ·ÍË, ˘‚ÚÈ‰›˙Ô-ÓÙ·È ÌÂ ·ÏÏÔÈˆÌ¤ÓÔ ÚfiÙ˘Ô ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜.

OÈ SSCP Î·È Heteroduplex ·Ó·Ï‡ÛÂÈ˜ (∂ÈÎfiÓ· 7) ¤ÁÈÓ·ÓÂÈ˜ ‰ÈÏÔ‡Ó Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi ‰‡Ô ‰È·ÊÔÚÂÙÈÎÔ‡˜ÂÚÂ˘ÓËÙ¤˜, ÒÛÙÂ Ó· ·ÔÎÏÂÈÛÙÂ› Ë Èı·ÓfiÙËÙ· Ù· ·ÏÏÔÈˆÌ¤-Ó· ÚfiÙ˘· ˘‚ÚÈ‰ÈÛÌÔ‡ Ó· ·ÊÔÚÔ‡Ó ÛÂ ÛÊ¿ÏÌ·Ù· ÙÂ¯ÓÈÎ‹˜.

∞ÔÙÂÏ¤ÛÌ·Ù· ∞ÏÏÔÈˆÌ¤ÓÔ ÚfiÙ˘Ô ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ ÂÍfiÓÈÔ

20 ÛÂ 2 ·È‰È¿ ÌÂ O§§ (11%), ÛÙÔ ÂÍfiÓÈÔ 21 ÛÂ 1

∂ÈÎfiÓ· 4. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ ÊˆÙÔÁÚ·Ê›· ·Ó¿Ï˘ÛË˜ ÚÔ˚fi-ÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 21 ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ÛÂ Á¤ÏË ·Á·Úfi-˙Ë˜ ÌÂ ¯ÚÒÛË ÌÂ ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ∆Ô ‚¤ÏÔ˜ ·ÓÙÈÛÙÔÈ¯Â›ÛÙË ı¤ÛË ÙˆÓ 518 ˙Â˘ÁÒÓ ‚¿ÛÂˆÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR. Lader123 bp.

∂ÈÎfiÓ· 5. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ ÊˆÙÔÁÚ·Ê›· ·Ó¿Ï˘ÛË˜ ÚÔ˚fi-ÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 21 ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ÛÂ Á¤ÏË ·Á·Úfi-˙Ë˜ ÌÂ ¯ÚÒÛË ÌÂ ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ, Î·ÙfiÈÓ ¤„Ë˜ ÙÔ˘ ÌÂ ÙÔÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ Nde. ∆· ‚¤ÏË ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙË ı¤ÛË ÙˆÓ180 Î·È 338 bp ÙˆÓ ‰‡Ô ˘ÔÚÔ˚fiÓÙˆÓ ÙË˜ ¤„Ë˜.

∂ÈÎfiÓ· 6. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ ÊˆÙÔÁÚ·Ê›· ·Ó¿Ï˘ÛË˜ ÚÔ˚fi-ÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 22 ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ÛÂ Á¤ÏË ·Á·Úfi-˙Ë˜ ÌÂ ¯ÚÒÛË ÌÂ ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ∆Ô ‚¤ÏÔ˜ ·ÓÙÈÛÙÔÈ¯Â›ÛÙË ı¤ÛË ÙˆÓ 363 ˙Â˘ÁÒÓ ‚¿ÛÂˆÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR. Lader123 bp.

∂ÈÎfiÓ· 3. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ ÊˆÙÔÁÚ·Ê›· ·Ó¿Ï˘ÛË˜ ÚÔ˚fi-ÓÙˆÓ PCR ÙÔ˘ ÂÍÔÓ›Ô˘ 20 ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ÛÂ Á¤ÏË ·Á·Úfi-˙Ë˜ ÌÂ ¯ÚÒÛË ÌÂ ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ∆Ô ‚¤ÏÔ˜ ·ÓÙÈÛÙÔÈ¯Â›ÛÙË ı¤ÛË ÙˆÓ 350 ˙Â˘ÁÒÓ ‚¿ÛÂˆÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ PCR. Lader123 bp, ‰ËÏ·‰‹ Î¿ıÂ ˙ÒÓË ÙÔ˘ ·ÓÙÈÛÙÔÈ¯Â› ÛÂ 123 ˙Â‡ÁË ‚¿-ÛÂˆÓ (bp).


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·È‰› ÌÂ O§§ (65%), ÛÙÔ ÂÍfiÓÈÔ 22 ÛÂ 4 ·È‰È¿ ÌÂO§§ (22,22%), ÛÂ 2 ·È‰È¿ ÌÂ Oª§ (25%) Î·È ÛÂ 1·È‰› ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· (25%) (¶›Ó·Î·˜ 1). ™ËÌÂÈ-ÒÓÂÙ·È, Â›ÛË˜, fiÙÈ ÛÂ ¤Ó·Ó ·ÛıÂÓ‹ ÌÂ Oª§, ‰Â˘ÙÂ-ÚÔÁÂÓ‹ ÌÂÙ¿ ·fi ıÂÚ·Â›· ÌÂ ÂÙÔÔÛ›‰Ë ÁÈ· ÔÛÙÂ-ÔÛ¿ÚÎˆÌ·, ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ÂÓÈÛ¯˘ıÂ› ÙÔÂÍfiÓÈÔ 20, ÂÓ‰ÂÈÎÙÈÎfi Èı·Ó‹˜ ·¿ÏÂÈ„‹˜ ÙÔ˘(deletion).

™˘ÓÔÏÈÎ¿ ·ÓÈ¯ÓÂ‡ıËÎ·Ó 7 ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÈ˜ ÔÍÂ›-Â˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ¤˜, 2 ÛÙÈ˜ Ì˘ÂÏÔÁÂÓÂ›˜ Î·È 1 ÌÂ-Ù¿ÏÏ·ÍË ÛÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·. ™˘Û¯ÂÙ›˙ÔÓÙ·˜ ÙÈ˜ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÌÂ ÙÔ ÛÙ¿‰ÈÔ-ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘ ÙË˜ Ófi-ÛÔ˘, ÔÈ 6 ·fi ÙÈ˜ 7 ÔÍÂ›Â˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ¤˜ ÏÂ˘¯·È-Ì›Â˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓÔÌ¿‰· ÂÓ‰È¿ÌÂÛÔ˘-˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2).™ÙËÓ ÔÌ¿‰· ÙˆÓ ÔÍÂÈÒÓ Ì˘ÂÏÔÁÂÓÒÓ ÏÂ˘¯·ÈÌÈÒÓ,fiÏÂ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÛÂ ·ÛıÂÓÂ›˜ Ô˘Î·Ù¤ÏËÍ·Ó. ™ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, Ë ÌÂÙ¿ÏÏ·ÍË Ô˘·ÓÈ¯ÓÂ‡ıËÎÂ ·ÊÔÚÔ‡ÛÂ ÛÙÔ ÌÔÓ·‰ÈÎfi ·È‰› ÌÂ ‰È‹-ıËÛË Ì˘ÂÏÔ‡, ÙÔ ÔÔ›Ô Î·Ù¤ÏËÍÂ (¶›Ó·Î·˜ 3).

™˘˙‹ÙËÛË∏ ÏÂ˘¯·ÈÌÔÁ¤ÓÂÛË ·ÔÙÂÏÂ› ÔÏ‡ÏÔÎË ‰È·‰ÈÎ·-

Û›·, ÌÂ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓÒÌ·ÏÔ˘·ÈÌÔÔÈËÙÈÎÔ‡ ÎÏÒÓÔ˘, Ô ÔÔ›Ô˜ ¤¯ÂÈ ·ÔÏ¤ÛÂÈ ÙËÓÈÎ·ÓfiÙËÙ· Ó· ÂÏ¤Á¯ÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi, Ì¤ÛˆÔÏÏ·ÏÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÙfiÛÔ ÛÙËÓÂÓÂÚÁÔÔ›ËÛË ÔÁÎÔÁÔÓÈ‰›ˆÓ fiÛÔ Î·È ÛÙËÓ ·‰Ú·ÓÔ-Ô›ËÛË ÙˆÓ ÔÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎÒÓ ÁÔÓÈ‰›ˆÓ (38).

∏ ÚˆÙÂ˝ÓË ÙÔ˘ Rb-1 ·ÔÙÂÏÂ› ¤Ó·Ó Î‡ÚÈÔ ÛË-Ì·ÙÔ‰fiÙË ÙÔ˘ Î˘ÙÙ·ÚÈÎÔ‡ Î‡ÎÏÔ˘.

∆· ÂÍfiÓÈ· Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÔ ÙÌ‹Ì· ÙË˜ Úˆ-ÙÂ˝ÓË˜ Ô˘ ÚÔÛ‰¤ÓÂÙ·È ÛÙÔ DNA, ·ÏÏ¿ Î·È Ô˘ ‰Â-ÛÌÂ‡Ô˘Ó ÙÔÓ Î·ıÔÚÈÛÙÈÎfi ÌÂÙ·ÁÚ·ÊÈÎfi ·Ú¿ÁÔÓÙ·E2F, Â›Ó·È Ù· ÂÍfiÓÈ· 20-23 (39). ™˘ÓÂÒ˜, ÔÈ ÌÂÙ·Ï-Ï¿ÍÂÈ˜ ÛÂ ·˘Ù¿ Ù· ÂÍfiÓÈ· Ô‰ËÁÔ‡Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›·Ì›·˜ ÌÂÙ·ÏÏ·ÁÌ¤ÓË˜ ÚˆÙÂ˝ÓË˜, Ë ÔÔ›· Â›Ó·È ÂÏ·Ù-ÙˆÌ·ÙÈÎ‹ ÛÙË ÊˆÛÊÔÚ˘Ï›ˆÛË, ·ÏÏ¿ Î·È ÛÙËÓ ˘-ÚËÓÈÎ‹ ÚfiÛ‰ÂÛ‹ ÙË˜, Â›Ó·È ÙÂÏÈÎ¿, ‰ËÏ·‰‹, Ì›· ÌËÏÂÈÙÔ˘ÚÁÈÎ‹ ÚˆÙÂ˝ÓË. ∏ ÂÏ·ÙÙˆÌ·ÙÈÎ‹ ¤ÎÊÚ·ÛËÙË˜ pRb ÌÔÚÂ› Ó· Û˘ÓÂ¿ÁÂÙ·È Â›ÙÂ ·ÓÂÍ¤ÏÂÁÎÙÔÔÏÏ·Ï·ÛÈ·ÛÌfi ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ ÏfiÁˆ ·Ú¤Ì‚·ÛË˜ÛÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ Ì›· Î·-ÎÔ‹ıË ÌÂÙ·ÙÚÔ‹, Â›ÙÂ de novo ·fiÎÙËÛË ÌÂÙ¿Ï-Ï·ÍË˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1, ÌÂ ·ÔÙ¤ÏÂÛÌ· ¿ÚÛË ÙË˜·Ó·ÛÙ·ÏÙÈÎ‹˜ ‰Ú¿ÛË˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ·˘ÙÔ‡ ÛÙÔÓÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È Ï¤ÔÓ ÂÈıÂÙÈÎ‹ ÓfiÛÔ.

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ·Ó›¯ÓÂ˘ÛË ÌÂÙ¿ÏÏ·ÍË˜ÛÙÔ Rb-1 ÛÙË Û˘¯ÓfiÙÂÚË Î·ÎÔ‹ıÂÈ· ÙˆÓ ·È‰ÈÒÓ,Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·Î‹ ÚfiÁÓˆÛË.

ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙ· ÂÍfiÓÈ· 20, 21 Î·È 22 ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÛÙÔ 35% ÙˆÓ ·È‰ÈÒÓÌÂ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·. ™Â ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘50%, ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ·ÊÔÚÔ‡Û·Ó ÛÂ ·È‰È¿ ÌÂ ·Ú¯ÈÎ¿ ‰˘ÛÌÂÓÂ›˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ‹

¶›Ó·Î·˜ 3. ™˘Û¯¤ÙÈÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÌÂ ÙËÓ ÚfiÁÓˆÛË ÙË˜ÓfiÛÔ˘

™Ù¿‰ÈÔ ÓfiÛÔ˘ ¢È¿ÁÓˆÛË ÀÔÙÚÔ‹ ⁄ÊÂÛË (-)

Ã·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 1 (1+) O§§ - -∂Ó‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ 7 (2+) O§§ - -À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 10 (4+) O§§ 2+ 1+

8 (2+) Oª§ 2+

(n+) ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÔÌ¿‰· Ô˘ ·Ú·-ÙËÚ‹ıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙ· ÂÍfiÓÈ· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ËÂÚ·ÈÙ¤Úˆ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ ÙÔ˘˜

∂ÈÎfiÓ· 7. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ ÊˆÙÔÁÚ·Ê›· ·Ó¿Ï˘ÛË˜ ÔÏ˘-ÌÔÚÊÈÛÌÔ‡ ÌÔÓfiÎÏˆÓË˜ ·Ï˘Û›‰·˜ (SSCP) Î·È ÂÙÂÚÔ‰ÈÌÂÚÒÓ(Heteroduplex). OÈ ·Ï˘Û›‰Â˜ ÙÔ˘ DNA Ô˘ ¤¯Ô˘Ó ·Ô‰È·Ù·-¯ıÂ›, ˘‚ÚÈ‰›˙Ô˘Ó ÌÂ ·ÏÏÔÈˆÌ¤ÓÔ ÚfiÙ˘Ô (‰Â›ÁÌ· ¡Ô 23), ÁÂ-ÁÔÓfi˜ Ô˘ Â›Ó·È ÂÌÊ·Ó¤˜ Î·Ù¿ ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË ÛÂ Á¤ÏËÔÏ˘·ÎÚ˘Ï·ÌÈ‰›Ô˘ ÌÂÙ¿ ·fi ¯ÚÒÛË ÌÂ ÓÈÙÚÈÎfi ¿ÚÁ˘ÚÔ.

¶›Ó·Î·˜ 1. ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙ· ÂÍfiÓÈ· 20, 21, 22 ÙÔ˘ Rb-1 ÁÔ-ÓÈ‰›Ô˘ ÛÂ ·È‰È¿ ÌÂ ÏÂ˘¯·ÈÌ›· Î·È ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·

∂ÍfiÓÈ· O§§ Oª§ ¡Â˘ÚÔ‚Ï¿ÛÙˆÌ·

20 2/18 (11%) 0/8 0/421 1/18 (6%) 0/8 0/4 22 4/18 (22%) 2/8 (25%) 1/4 (25%) ™‡ÓÔÏÔ 7/18 (39%) 2/8 (25%) 1/4 (25%)

¶›Ó·Î·˜ 2. ™˘Û¯¤ÙÈÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÌÂ ÙË ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ÓfiÛÔ˘

OÍÂ›Â˜ ™Ù·ıÂÚÔ‡ ∂Ó‰È¿ÌÂÛÔ˘-˘„ËÏÔ‡ ÏÂ˘¯·ÈÌ›Â˜ ÎÈÓ‰‡ÓÔ˘ ÎÈÓ‰‡ÓÔ˘

O§§ (7) 1 6Oª§ (2) 2

ÃˆÚ›˜ ‰È‹ıËÛË ªÂ ‰È‹ıËÛËÌ˘ÂÏÔ‡ Ì˘ÂÏÔ‡

¡Â˘ÚÔ‚Ï¿ÛÙˆÌ· (1) 0 1

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ÌÂÙ¤ÂÈÙ· ‰˘ÛÌÂÓ‹ ÔÚÂ›·. ™Â fiÏ· Ù· ·È‰È¿ Ô˘˘ÔÙÚÔ›·Û·Ó ‹ ÂÌÊ¿ÓÈÛ·Ó Î·ı˘ÛÙ¤ÚËÛË ‡ÊÂ-ÛË˜, ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂÈ˜. ∞fi ÙÈ˜ ˘fiÏÔÈ-Â˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ ÌÂÙ¿ÏÏ·ÍË,fiÏÂ˜ - ÏËÓ Ì›·˜ - ·ÊÔÚÔ‡Û·Ó ÛÂ ·ÛıÂÓÂ›˜ ÔÌ¿-‰·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ŸÏÂ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘·ÓÈ¯ÓÂ‡ıËÎ·Ó ÛÂ ·È‰È¿ ÌÂ Oª§, ·ÊÔÚÔ‡Û·Ó ÛÂÏÂ˘¯·ÈÌ›Â˜ ÛÙÈ˜ ÔÔ›Â˜ ‰ÂÓ ÂÈÙÂ‡¯ıËÎÂ ‡ÊÂÛË. ∏ÌÂÙ¿ÏÏ·ÍË Ô˘ ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È-‰ÈÒÓ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ·ÊÔÚÔ‡ÛÂ ÛÂ fiÁÎÔ ÌÂÙ·˘Ùfi¯ÚÔÓË ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡.

™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÙÈ˜ ÌÂÙ·ÏÏ¿-ÍÂÈ˜ Ê·›ÓÂÙ·È, ÌÂ ‚¿ÛË ÙËÓ SSCP ·Ó¿Ï˘ÛË, fiÙÈ ·˘-Ù¤˜ ¤¯Ô˘Ó Û˘Ì‚Â› ÛÙËÓ ›‰È· ·ÏÏËÏÔ˘¯›·, ·ÊÔ‡ ÂÌ-Ê·Ó›˙Ô˘Ó ÙÔ ›‰ÈÔ ·ÏÏÔÈˆÌ¤ÓÔ ÚfiÙ˘Ô.

µ¿ÛÂÈ ·˘ÙÒÓ ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ, Ë·Ó›¯ÓÂ˘ÛË ÌÂÙ¿ÏÏ·ÍË˜ ÙÔ˘ Rb-1 ÚÔÙÂ›ÓÂÙ·È Ó·¯ÚËÛÈÌÔÔÈËıÂ› ˆ˜ ¤Ó·˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ÛÙÈ˜ ÔÍÂ›Â˜ ÏÂ˘¯·ÈÌ›Â˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙÔ ÓÂ˘ÚÔ-‚Ï¿ÛÙˆÌ· Î·È ˆ˜ ‰Â›ÎÙË˜ ÁÈ· ·Ó›¯ÓÂ˘ÛË ÂÏ¿¯ÈÛÙË˜˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘, È‰È·›ÙÂÚ· ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜Ô˘ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ¯ÚˆÌÔÛˆÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·Ô-‰Â›¯ıËÎÂ fiÙÈ Ë ·ÚÔ˘Û›· ÌÂÙ·ÏÏ·ÁÌ¤ÓÔ˘ Rb-1 ÁÔ-ÓÈ‰›Ô˘ ÛÂ ÂÚÈÙÒÛÂÈ˜ O§§ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ÌÔÚÂ› Ó· ¯·Ú·ÎÙËÚ›ÛÂÈ ÙË ÓfiÛÔ Û·Ó ·˘ÍËÌ¤ÓÔ˘ÎÈÓ‰‡ÓÔ˘ ÌÂ ÚÔÔÙÈÎ‹ ÙËÓ ÂÓÙ·ÙÈÎÔÔ›ËÛË ÙË˜ ıÂ-Ú·Â›·˜ Î·È, ‚¤‚·È·, Ó· ·ÔÙÂÏ¤ÛÂÈ ‰Â›ÎÙË ·Ó›¯ÓÂ˘-ÛË˜ ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘, ÂÊfiÛÔÓ ·ÓÈ-¯ÓÂ˘ıÂ› ÛÙËÓ ÚˆÙÔ‰È¿ÁÓˆÛË. ∞˘Ùfi ÙÔ ÌÂÙ·ÏÏ·Á-Ì¤ÓÔ ÁÔÓ›‰ÈÔ Ê·›ÓÂÙ·È fiÙÈ ÂÓ¤¯ÂÙ·È Î·È ÛÂ Û˘Ì·-ÁÂ›˜ fiÁÎÔ˘˜ ÌÂ ÌÂÙ¿ÛÙ·ÛË ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ,fiˆ˜ ‰È·ÈÛÙÒıËÎÂ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÛÙÈ˜ Â-ÚÈÙÒÛÂÈ˜ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙ·‰›Ô˘ 4.

™‡ÌÊˆÓ· ÌÂ ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, ÚÔÙÂ›ÓÂÙ·È ËÌÂÏ¤ÙË ÙÔ˘ ÁÔÓÈ‰›Ô˘ Rb-1 ˆ˜ ÚÔÁÓˆÛÙÈÎÔ‡ ‰Â›ÎÙËÎ·È ˆ˜ ‰Â›ÎÙË ÌÂÏ¤ÙË˜ ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ÓfiÛÔ˘ ÛÙÈ˜ ÔÍÂ›Â˜ ÏÂ˘¯·ÈÌ›Â˜ ÙˆÓ ·È‰ÈÒÓ, ·ÏÏ¿ Î·ÈÛÂ fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ Î·ÎÔËıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜, È‰È·›ÙÂÚ· ÛÂ ·˘Ù¤˜ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ·ÈÌÔ-ÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÌÂ ÛÎÔfi ÙËÓ ·ÍÈÔÔ›ËÛ‹ÙÔ˘ ˆ˜ ‰Â›ÎÙË ÂÈıÂÙÈÎfiÙËÙ·˜ Û˘Ì·ÁÒÓ fiÁÎˆÓ.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ∫·ÏÌ·ÓÙ‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘ ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜ E-mail: [email protected]

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

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∂›‰Ú·ÛË ÙË˜ ·ÂÚfi‚È·˜ ¿ÛÎËÛË˜ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ ÛÂ ·È‰È¿ ÙË˜ ∫‡ÚÔ˘ ËÏÈÎ›·˜ 10-12 ÂÙÒÓX. Ã·Ù˙ËÁÂˆÚÁ›Ô˘, ª. Ã·Ù˙ËÈˆ¿ÓÓÔ˘, ª. ∆ÔÚÓ·Ú›ÙË˜, ∞. °È·ÁÎÔ˘Ï‹, ∂. ∫ˆÓÛÙ·ÓÙ›ÓÔ˘, µ. ¡Â¿Ú¯Ô˘, ™. ™¿‚‚·˜

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

�¶ÂÚ›ÏË„Ë: ™ÙËÓ ∫‡ÚÔ, fiˆ˜ Î·È ÛÂ fiÏÂ˜ ÙÈ˜ ·ÓÂ-Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·È‰È¿ ·˘ÍËÌ¤-ÓË Û˘¯ÓfiÙËÙ· ÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· Ù·¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜. OÈ ·Ú¿ÁÔÓÙÂ˜ ·˘ÙÔ› Û˘-Ó‹ıˆ˜ ·Ú·Ì¤ÓÔ˘Ó Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÌÂ Û˘Ó¤-ÂÈ· ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıËÚˆÌ¿ÙˆÛË, ÛÙÂÊ·ÓÈ-·›· ÓfiÛÔ ÙË˜ Î·Ú‰È¿˜ Î·È ÌÂÚÈÎ¤˜ ÌÔÚÊ¤˜ Î·ÚÎ›ÓÔ˘.∏ Î·ıÈÛÙÈÎ‹ ˙ˆ‹ Î·È Ë Î·Î‹ ‰È·ÙÚÔÊ‹ Â›Ó·È ÔÈ Î˘ÚÈfi-ÙÂÚÔÈ ÏfiÁÔÈ Ô˘ ‰ËÌÈÔ‡ÚÁËÛ·Ó ·˘Ù‹ ÙËÓ ÂÈÎfiÓ·. ™ÙËÓ·ÚÔ‡Û· ÌÂÏ¤ÙË ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ‰‡Ô ÔÌ¿‰Â˜·È‰ÈÒÓ ÙË˜ ›‰È·˜ ÁÂˆÁÚ·ÊÈÎ‹˜ ÂÚÈÔ¯‹˜ ÁÈ· 15 Ì‹-ÓÂ˜: Ì›· ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ Ô˘ ·ÛÎÔ‡ÓÙ·Ó 3 ÊÔÚ¤˜ÙËÓ Â‚‰ÔÌ¿‰· Â› 1-1,5 ÒÚ· Î¿ıÂ ÊÔÚ¿ Î·È Ì›· ÔÌ¿-‰· ·È‰ÈÒÓ Ô˘ ‰ÂÓ ·ÛÎÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈÎ¿. ŒÁÈÓÂ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈÈ‰›ˆÓ ·›Ì·ÙÔ˜ ÙË˜ ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›-·˜, ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ (‚¿ÚÔ˜, ‡„Ô˜ Î·È ˘ÔÏÔÁÈ-ÛÌfi˜ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, Î·ıÒ˜ Î·È Ì¤ÙÚËÛËÙË˜ ‰ÂÚÌ·ÙÈÎ‹˜ Ù˘¯‹˜ ÙÚÈÎ¤Ê·ÏÔ˘ Ì˘fi˜). ŒÁÈÓÂ¤ÏÂÁ¯Ô˜ ÙË˜ ·ıÏËÙÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂÙÔ Euro fit test ÛÙËÓ ·Ú¯‹ Î·È 15 Ì‹ÓÂ˜ ÌÂÙ¿ ·fi ÙËÓ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜. OÈ Ô‰ËÏ¿ÙÂ˜ (·ÁfiÚÈ·) Â›¯·Ó¯·ÌËÏfiÙÂÚ· Â›Â‰· TC (158,16/169,93, p=0,042)Î·È LDL-C (79,36/97,5, p<0,001) ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù··È‰È¿ Ô˘ ‰ÂÓ ·ÛÎÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈÎ¿. ∞ÎfiÌË, ÔÈÔ‰ËÏ¿ÙÂ˜ (ÎÔÚ›ÙÛÈ·) Â›¯·Ó Î·Ï‡ÙÂÚË ·fi‰ÔÛË ÛÙÔ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (4,68/3,42, p=0,042).º·›ÓÂÙ·È fiÙÈ Ë Â˘ÂÚÁÂÙÈÎ‹ ÁÈ· ÙËÓ ˘ÁÂ›· Â›‰Ú·ÛË ÙË˜¿ıÏËÛË˜, ÂÊfiÛÔÓ Û˘ÓÂ¯ÈÛÙÂ›, Èı·ÓfiÙ·Ù· ı· ÌÂÈÒÛÂÈÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÙË˜ Î·Ú‰È¿˜ Î·È ¿Ï-Ï· ÛÔ‚·Ú¿ ÓÔÛ‹Ì·Ù· ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¿ıÏËÛË, ·È‰È¿, ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·ÊıÔÚ¿˜.

�Abstract: In Cyprus there is a high prevalenceamong children of risk factors for chronic diseases.These factors tend to persist into adulthood andincrease the risk for hypertension, heart disease,cancer and other conditions. Reduced levels ofphysical activity and an unbalanced diet are themain reasons for this trend. This study followed twogroups of 10-12 year-old children in a suburbanarea of the district of Nicosia for 15 months. Groupµ consisted of regular cyclists and group ∞ ofchildren who do not exercise regularly. Testing wasmade at the beginning and after 15 months ofobservation. Blood lipids and glucose weremeasured and the ratios: TC/HDL-C and TC/LDL-Cwere estimated. Weight (kg) and height (m) weremeasured and the body mass index (BMI) wascalculated. The triceps skin fold was measured inmm. The physical level of the two groups wasexamined with four exercises of the Euro Fit Test(abdominals, flexibility, long jump and 20 mmultistage shuttle run test). The cyclists (boys) hadlower levels of TC (158.16/169.93, p=0.042) andLDL-C (79.36/97.5, p<0.001) than the group Achildren who do not exercise regularly. The cyclists(girls) had better results at 20 m test stage(4.68/3.42, p=0.042) than group ∞ children. Thesefindings suggest that in children exercise improvesthe risk factors for chronic diseases of adulthood.

Key words: exercise, children, chronic diseases.

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

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

™˘ÓÙÔÌÔÁÚ·Ê›Â˜™¡∫ ™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Î·Ú‰È¿˜

¶∆∞ ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ∞ªÃº ÕÏÌ· ÛÂ Ì‹ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ·

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∫O∞ ∫˘ÚÈ·Îfi˜ OÚÁ·ÓÈÛÌfi˜ ∞ıÏËÙÈÛÌÔ‡ TC OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË LDL-C Ã·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏË HDL-C À„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏË TG ∆ÚÈÁÏ˘ÎÂÚ›‰È· W ¶ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ H ¶ÂÚÈÊ¤ÚÂÈ· ÁÏÔ˘ÙÔ‡ ¢ª™ ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¢¶∆ ¢ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎ¤Ê·ÏÔ˘ Ì˘fi˜ ∂™∂∞¶ ∂ıÓÈÎfi ™‡ÛÙËÌ· ∂ÍˆÙÂÚÈÎ‹˜ ∞ÍÈÔÏfiÁËÛË˜

¶ÔÈfiÙËÙ·˜ WHO ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜ CDC ∫¤ÓÙÚÔ ∂Ï¤Á¯Ô˘ ∞ÛıÂÓÂÈÒÓ (∏¶∞)

∂ÈÛ·ÁˆÁ‹ ∞fi ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÚÔ‰È·ıÂ-

ÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜,fiˆ˜ ˘ÂÚÏÈÈ‰·ÈÌ›·, ·¯˘Û·ÚÎ›· Î·È ÂÏÏÈ‹˜ Ûˆ-Ì·ÙÈÎ‹ ¿ÛÎËÛË, Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È (1-11). ŸÛÔ ÂÚÈÛÛfiÙÂÚÔÈ Â›Ó·È ÔÈ ÚÔ‰È·ıÂÛÈÎÔ› ·-Ú¿ÁÔÓÙÂ˜, ÙfiÛÔ ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ·ıËÚˆ-Ì¿ÙˆÛË, Î·ıÒ˜ Î·È ÔÈ ‚Ï¿‚Â˜ ÛÙ· ÛÙÂÊ·ÓÈ·›· ·Á-ÁÂ›· ÙË˜ Î·Ú‰È¿˜ (7-10).

™ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, ˘¿Ú¯Ô˘Ó ÔÏÏ¤˜ ·Ó·ÊÔ-Ú¤˜ ÂÎÙ›ÌËÛË˜ ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÚÔ‰È·ıÂÛÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ ÛÙ· ∂ÏÏËÓfiÔ˘Ï·, Î˘Ú›ˆ˜ fiÛÔÓ ·ÊÔÚ¿ÛÙËÓ ˘ÂÚÏÈÈ‰·ÈÌ›·, ÙËÓ ·¯˘Û·ÚÎ›· Î·È ÙËÓ Î·Î‹‰È·ÙÚÔÊ‹ (5-9).

∏ ·¯˘Û·ÚÎ›· ÚÔÎ·ÏÂ› ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù·˘ÁÂ›·˜, ÙfiÛÔ ¿ÌÂÛ· („˘¯ÔÏÔÁÈÎ¿, ‹È· ÔÚıÔ·È‰ÈÎ¿Î.Ï.) fiÛÔ Î·È ÚÔ‚Ï‹Ì·Ù· ÌÂ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ÂÈ-ÙÒÛÂÈ˜ (·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÔÏ˘Î˘ÛÙÈÎ¤˜ˆÔı‹ÎÂ˜ ÛÙ· ÎÔÚ›ÙÛÈ·, ̆ ¤ÚÙ·ÛË, Ó˘¯ÙÂÚÈÓ‹ ¿ÓÔÈ·,Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Ù‡Ô˘ ππ, ·ıËÚˆÌ¿ÙˆÛË Î·ÈÌÂÙ¿ÙˆÛË ÛÂ ·¯˘Û·ÚÎ›· ÙˆÓ ÂÓËÏ›ÎˆÓ) (11-14).

™Ù· ·È‰È¿ ÙË˜ ∫‡ÚÔ˘, ÔÈ ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿-ÁÔÓÙÂ˜ ÁÈ· Ù· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ Â›Ó·È ·ÚÎÂ-Ù¿ Û˘¯ÓÔ›, Û‡ÌÊˆÓ· ÌÂ ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿ ËÏÈÎ›·˜6-18 ÂÙÒÓ (5,6,13-15).

∏ ¿ıÏËÛË ¤¯ÂÈ ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ ÛÙËÓ ÚfiÏË„ËÓÔÛËÌ¿ÙˆÓ ÙË˜ ÂÓ‹ÏÈÎË˜ ˙ˆ‹˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi,ıÂˆÚÂ›Ù·È ÔÏ‡ ÛËÌ·ÓÙÈÎfi Ó· Ì¿ıÔ˘Ó Ù· ·È‰È¿ Ó··ıÏÔ‡ÓÙ·È ·fi ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È Ó· ÁÓˆÚ›˙Ô˘ÓÙ· ÏÂÔÓÂÎÙ‹Ì·Ù· Ô˘ ÚÔÛÊ¤ÚÂÈ Ë ¿ÛÎËÛË (16-21). ¢˘ÛÙ˘¯Ò˜, Ë ÂÁÎ·Ù¿ÏÂÈ„Ë ÙË˜ ˘·›ıÚÔ˘ Î·È Ë·ÛÙÈÎÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡, Ë ÙËÏÂfiÚ·ÛË, ÔÈ ËÏÂ-ÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ Î·È Ù· ËÏÂÎÙÚÔÓÈÎ¿ ·È¯Ó›‰È·Ô˘ ¤¯Ô˘Ó ÂÈÛ¯ˆÚ‹ÛÂÈ ÛÙË ˙ˆ‹ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Û‹-ÌÂÚ·, ¤¯Ô˘Ó ÂÚÈÔÚ›ÛÂÈ Î·Ù¿ ÔÏ‡ ÙËÓ ·ıÏËÙÈÎ‹‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ (6,13,14,17-24).

∏ ÌÂÏ¤ÙË ·˘Ù‹ Û¯Â‰È¿ÛÙËÎÂ ·fi ÙÔ ÚfiÁÚ·ÌÌ·“ÀÁÂ›· ÙÔ˘ ¶·È‰ÈÔ‡”, ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙËÓ ÔÌÔ-ÛÔÓ‰›· Ô‰ËÏ·Û›·˜ ÙÔ˘ ∫˘ÚÈ·ÎÔ‡ OÚÁ·ÓÈÛÌÔ‡∞ıÏËÙÈÛÌÔ‡ (∫O∞). ™ÎÔfi˜ ÙË˜ ‹Ù·Ó Ó· ÌÂÏÂÙ‹ÛÂÈÙËÓ Â›‰Ú·ÛË ÙË˜ ·ÂÚfi‚È·˜ ¿ÛÎËÛË˜ Î·È Û˘ÁÎÂÎÚÈ-

Ì¤Ó· ÙË˜ Ô‰ËÏ·Û›·˜ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ ÛÂ ·È‰È¿ Î·È Ó· ÂÍ·-Á¿ÁÂÈ Û˘ÌÂÚ¿ÛÌ·Ù· Ù· ÔÔ›· Ó· ÌÔÚÔ‡Ó Ó· ¯ÚË-ÛÈÌÔÔÈËıÔ‡Ó ·fi ÙÔÓ ∫O∞ Î·È Ù· ÀÔ˘ÚÁÂ›· ÀÁÂ›-·˜ Î·È ¶·È‰Â›·˜-¶ÔÏÈÙÈÛÌÔ‡, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ¯·Ú·-¯ıÔ‡Ó ·ÚÂÌ‚¿ÛÂÈ˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Î·ÎÒÓÛ˘ÓıËÎÒÓ ‰È·‚›ˆÛË˜ ÙˆÓ Ó¤ˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆o ÚfiÁÚ·ÌÌ· “ÀÁÂ›· ÙÔ˘ ¶·È‰ÈÔ‡”, Ô˘ ÙÂÏÂ› ˘fi ÙËÓ

·ÈÁ›‰· ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ Î·È ¯ÚËÌ·ÙÔ‰ÔÙÂ›Ù·È ·fi ÙËÓÎ˘‚¤ÚÓËÛË Î·È ÙË §·˚Î‹ ÙÚ¿Â˙·, ÌÂÏ¤ÙËÛÂ - ÛÂ Û˘ÓÂÚÁ·Û›·ÌÂ ÙËÓ ÔÌÔÛÔÓ‰›· Ô‰ËÏ·Û›·˜ ÙÔ˘ ∫O∞ - ‰‡Ô ÔÌ¿‰Â˜ ·È-‰ÈÒÓ ÁÈ· 15 Ì‹ÓÂ˜ (π·ÓÔ˘¿ÚÈÔ˜ 2000 ¤ˆ˜ ª¿ÚÙÈÔ˜ 2001). ∏ÔÌ¿‰· ∞ ÂÚÈÂÏ¿Ì‚·ÓÂ ·È‰È¿ (72 ·ÁfiÚÈ· Î·È 62 ÎÔÚ›ÙÛÈ·)Ô˘ ÊÔÈÙÔ‡Û·Ó ÛÙË ™Ù’ Ù¿ÍË ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ, ËÏÈ-Î›·˜ 10-12 ÂÙÒÓ, Ù· ÔÔ›· ‰ÂÓ ·ıÏÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈÎ¿, ÂÓÒË ÔÌ¿‰· µ ÂÚÈÂÏ¿Ì‚·ÓÂ 40 ·È‰È¿ (25 ·ÁfiÚÈ· Î·È 15 ÎÔÚ›-ÙÛÈ·), Ù· ÔÔ›· ÍÂÎ›ÓËÛ·Ó Ô‰ËÏ·Û›· ÛÂ ËÏÈÎ›· 10-12 ÂÙÒÓ.∫·È ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ‰‹ÌÔ˘˜ ÙË˜Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜, ·fi Ì›· ËÌÈ·ÛÙÈÎ‹, ¤ÓÙÔÓ· ·Ó·Ù˘ÛÛfi-ÌÂÓË, ÂÚÈÔ¯‹ ÎÔÓÙ¿ ÛÙË §Â˘ÎˆÛ›·.

™ÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÂÊ·ÚÌfiÛÙËÎÂ ÙÔ ›‰ÈÔ ÚˆÙfi-ÎÔÏÏÔ ÂÚÁ·Û›·˜, ÙfiÛÔ ÛÙËÓ ·Ú¯‹ fiÛÔ Î·È ÌÂÙ¿ ·fi ÂÚ›Ô˘15 Ì‹ÓÂ˜ Î·È ÂÚÈÂÏ¿Ì‚·ÓÂ:

·) ∫ÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ì¤ÙÚËÛË ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ÛÙÔ·ÚÈÛÙÂÚfi ·ÓÙÈ‚Ú¿¯ÈÔ ÌÂ ˘‰Ú·ÚÁ˘ÚÈÎfi Ì·ÓfiÌÂÙÚÔ. °›ÓÔÓÙ·Ó 3ÌÂÙÚ‹ÛÂÈ˜ Î·È Î·Ù·ÁÚ·ÊfiÙ·Ó Ô 1Ô˜, 2Ô˜ Î·È 5Ô˜ ‹¯Ô˜ Î·Ù¿Korothof. ∆Ô ·È‰› ‚ÚÈÛÎfiÙ·Ó ÛÂ Î·ıÈÛÙ‹ ı¤ÛË Î·È Ë ÂÚÈ¯ÂÈ-Ú›‰· Î¿Ï˘ÙÂ Ù· 2/3 ÙÔ˘ ·ÓÙÈ‚Ú·¯›Ô˘. §·Ì‚·ÓfiÙ·Ó Ë Ì¤ÛË ÙÈ-Ì‹ ÙˆÓ ÙÚÈÒÓ ÌÂÙÚ‹ÛÂˆÓ.

‚) ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ [‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (kg), ‡„Ô˜ ÛÒÌ·-ÙÔ˜ (m), ‰ÂÚÌ·ÙÈÎ¤˜ Ù˘¯¤˜ (mm) ÙÚÈÎ¤Ê·ÏÔ˘ Î·È ‰ÈÎ¤Ê·ÏÔ˘Ì˘fi˜, Ï·ÁÔÓ›Ô˘, ˆÌÔÏ¿ÙË˜, ÂÚ›ÌÂÙÚÔ˜ ‚Ú·¯›ÔÓ·, ÂÚ›ÌÂ-ÙÚÔ˜ Ì¤ÛË˜ (W) Î·È ÂÚÈÊ¤ÚÂÈ· (H)]. °ÈÓfiÙ·Ó ˘ÔÏÔÁÈÛÌfi˜ÙˆÓ Û¯¤ÛÂˆÓ W/H Î·È ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) (¢ª™= ‚¿ÚÔ˜ (kg)/‡„Ô˜ (m)2. ∆Ô ‚¿ÚÔ˜ ÌÂÙÚ‹ıËÎÂ ÛÂ ˙˘Á·ÚÈ¿SECA ·ÎÚÈ‚Â›·˜ ±0,5 kg, ÌÂ ÙÔ ·È‰› ÂÏ·ÊÚ¿ ÓÙ˘Ì¤ÓÔ, ‰›¯ˆ˜·Ô‡ÙÛÈ·, ÂÓÒ ÙÔ ‡„Ô˜ ÌÂ ÊÔÚËÙfi ÌÂÙ·ÏÏÈÎfi ·Ó·ÛÙËÌfiÌÂ-ÙÚÔ SECA, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÂ Â›Â‰Ô ÙÔ›¯Ô. OÈ ‰ÂÚÌ·ÙÈÎ¤˜Ù˘¯¤˜ ÌÂÙÚ‹ıËÎ·Ó ÌÂ ‰ÂÚÌ·ÙÔÙ˘¯fiÌÂÙÚÔ Jammar, ·fi ÙÔÓ›‰ÈÔ ¿ÓÙÔÙÂ ÂÚÂ˘ÓËÙ‹, ÌÂ ·ÎÚ›‚ÂÈ· ¯ÈÏÈÔÛÙÔ‡.

Á) ∞ÈÌÔÏË„›·, ÁÈ· Ì¤ÙÚËÛË ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜(TC), ÙË˜ LDL-C, ÙË˜ HDL-C, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ (TG) Î·È ÙË˜ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜, Î·ıÒ˜ Î·È ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜(FBC). ∏ ·ÈÌÔÏË„›· ÁÈÓfiÙ·Ó ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙÂ›·, ·fi ÙËÌÂÛÔ‚·ÛÈÏÈÎ‹ - Î·Ù¿ Î·ÓfiÓ· - ÊÏ¤‚·, ÌÂ ÛˆÏËÓ¿ÚÈ· ÎÂÓÔ‡(vacutainer). §·Ì‚·ÓfiÙ·Ó ¤Ó· ‰Â›ÁÌ· 4-5 ml ·›Ì·ÙÔ˜ ÌÂ ·ÓÙÈ-ËÎÙÈÎfi EDTA ÁÈ· ÙÈ˜ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ Î·È 5 ml ·›-Ì·ÙÔ˜ ÛÂ ÛˆÏËÓ¿ÚÈÔ ‰›¯ˆ˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙÈ˜ ‚ÈÔ¯ËÌÈÎ¤˜·Ó·Ï‡ÛÂÈ˜. ∆· ‰Â›ÁÌ·Ù· ÙÔÔıÂÙÔ‡ÓÙ·Ó ÛÂ ÊÔÚËÙfi „˘ÁÂ›ÔÌÂ ·ÁÔÎ‡ÛÙÂÈ˜ Î·È ÌÂÙ·Ê¤ÚÔÓÙ·Ó ÛÙÔ ÃËÌÂ›Ô ÙÔ˘ °ÂÓÈÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘ §Â˘ÎˆÛ›·˜ Ì¤Û· ÛÂ 2-3 ÒÚÂ˜. OÈ ÂÍÂÙ¿ÛÂÈ˜

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Á›ÓÔÓÙ·Ó ÙËÓ ›‰È· ËÌ¤Ú· ÛÂ ·Ó·Ï˘Ù‹ HITACHI 717 ÙË˜Boeringer Mannheim. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ TC Î·È ÙˆÓ TGÁÈÓfiÙ·Ó ÌÂ ÂÓ˙˘ÌÈÎ‹ ¯ÚˆÌ·ÙÔÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô Î·È ÙË˜ HDL-CÌÂ ¿ÌÂÛË Ì¤ÙÚËÛË ÌÂ ÔÏ˘ÌÂÚ‹. H LDL-C ÚÔÛ‰ÈÔÚÈ˙fiÙ·Ó¤ÌÌÂÛ·, ‚¿ÛÂÈ ÙÔ˘ Ù‡Ô˘ ÙÔ˘ Freidewald LDL-C = TC-(HDL-C+TG/5). ∆o ÂÚÁ·ÛÙ‹ÚÈÔ ¤¯ÂÈ ÙfiÛÔ ÂÛˆÙÂÚÈÎfi (local,boeringer) fiÛÔ Î·È ÂÍˆÙÂÚÈÎfi ¤ÏÂÁ¯Ô ÔÈfiÙËÙ·˜, ÌÂ ÚÔÙ˘-ÔÔ›ËÛË ÙË˜ Murex, ÙÔ˘ International EOAS ÙË˜ WHO Î·ÈÙÔ˘ ∂™∂∞¶ (∂ıÓÈÎfi ™‡ÛÙËÌ· ∂ÍˆÙÂÚÈÎ‹˜ ∞ÍÈÔÏfiÁËÛË˜ ¶ÔÈfi-ÙËÙ·˜ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙËÓ ÎÏÈÓÈÎ‹ ¯ËÌÂ›· ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘∂˘·ÁÁÂÏÈÛÌfi˜, ∞ı‹Ó·).

‰) ŒÏÂÁ¯Ô ÙË˜ ·ıÏËÙÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ Ù¤Û-ÛÂÚÈ˜ ·ÛÎ‹ÛÂÈ˜ ÙÔ˘ Euro fit test: i) ‰ÔÎÈÌ·Û›· ‰›ÏˆÛË˜ ·fiÂ‰Ú·›· ı¤ÛË, ii) ·Ó·‰ÈÏÒÛÂÈ˜ ·fi ‡ÙÈ· Î·Ù¿ÎÏÈÛË (ÎÔÈÏÈ·-ÎÔ›), iii) ¿ÏÌ· ÂÈ˜ Ì‹ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ· (∞ªÃº) Î·È iv) ‰ÔÎÈÌ·Û›·ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂÍ›Ì·ÙÔ˜ ·ÓÙÔ¯‹˜ (¶∆∞) ÁÈ· ÙÔÓ ¤ÏÂÁ¯ÔÙË˜ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ. ∆Ô ¶∆∞ ıÂˆ-ÚÂ›Ù·È Î·Ïfi˜ ‰Â›ÎÙË˜ ÁÈ· ÙËÓ ¤ÌÌÂÛË ·ÍÈÔÏfiÁËÛË ÙË˜ Î·Ú‰ÈÔ-·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ (27). ∆· ·È‰È¿ ¯ˆÚ›ÛÙË-Î·Ó ÛÂ ÔÌ¿‰Â˜ ÙˆÓ 5 ·ÙfiÌˆÓ Î·È ÎÏ‹ıËÎ·Ó Ó· ‰È·Ó‡ÛÔ˘Ó Ì›··fiÛÙ·ÛË 20 Ì¤ÙÚˆÓ ÌÂ Û˘ÓÂ¯Ò˜ ·˘Í·ÓfiÌÂÓË Ù·¯‡ÙËÙ·, ‚¿-ÛÂÈ ÂÓfi˜ Ë¯ËÙÈÎÔ‡ ÌËÓ‡Ì·ÙÔ˜ Ô˘ ‹Ù·Ó ÚÔÙ˘ÔÔÈËÌ¤ÓÔ ÛÂ„ËÊÈ·Îfi ‰›ÛÎÔ Ô˘ ·Ó¤ÊÂÚÂ Î·È ÙÔ ÛÙ¿‰ÈÔ Ô˘ ¤Êı·ÛÂ ÙÔ ·È-‰›. ∆· ·È‰È¿ Î·Ù·Ù¿¯ÙËÎ·Ó ÛÂ ÎÏ›Ì·Î·, ÙËÓ ÔÔ›· ÂÙÔ›Ì·Û·ÓÛÂ ∂ÏÏËÓfiÔ˘Ï· ÔÈ °ÂˆÚÁÈ¿‰Ë˜ Î·È ∫ÏÂÈÛÔ‡Ú·˜, ÙÔ 1990 (27).

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ‰fiıËÎ·Ó ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÁÔÓÂ›˜ÙÔ˘˜ ÛÂ ÚÔÛˆÈÎfi Ê¿ÎÂÏÔ, ÛÙÔ Ï·›ÛÈÔ ÂÓËÌÂÚˆÙÈÎ‹˜ ‰È¿-ÏÂÍË˜ ÛÙÔ Û¯ÔÏÂ›Ô ÙˆÓ ·È‰ÈÒÓ. ™ÙË ‰È¿ÏÂÍË ÂÂÍËÁ‹ıËÎ·ÓÙ· ÛÙÔÈ¯Â›· Î·È ··ÓÙ‹ıËÎ·Ó Û¯ÂÙÈÎ¤˜ ÂÚˆÙ‹ÛÂÈ˜.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ∏ ÌË¯·ÓÔÁÚ¿ÊËÛË ÙˆÓ ÛÙÔÈ¯Â›ˆÓ ¤ÁÈÓÂ ÛÙÔ ÚfiÁÚ·ÌÌ·

Epi Info 6 (CDC, USA, WHO) Î·È Ù· ÛÙÔÈ¯Â›· ÌÂÙ·Ê¤ÚıËÎ·Ó

ÁÈ· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÛÙ· ÚÔÁÚ¿ÌÌ·Ù· EXCEL Î·ÈSPSS. ŒÁÈÓÂ ·Ó¿Ï˘ÛË Î·Ù¿ Mann-Whitney ÁÈ· Ó· ˘ÔÏÔÁÈÛÙÂ›Ë ÙÈÌ‹ p. ∆ÈÌ¤˜ p<0,05 ıÂˆÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜.

∞ÔÙÂÏ¤ÛÌ·Ù· ™ÙÔ˘˜ ¶›Ó·ÎÂ˜ 1 Î·È 2 Î·Ù·ÁÚ¿ÊÔÓÙ·È Ù· ·Ô-

ÙÂÏ¤ÛÌ·Ù· ·fi ÙÈ˜ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜ ·È‰ÈÒÓ. ∏ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ - Î·ÈÛÙÔ˘˜ ‰‡Ô ÂÏ¤Á¯Ô˘˜ Ô˘ ¤ÁÈÓ·Ó - ‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈ-Î‹, ÙfiÛÔ ÛÙÔ˘˜ Ô‰ËÏ¿ÙÂ˜ fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰·ÂÏ¤Á¯Ô˘. ∫·Ù¿ ÙÔÓ ‰Â‡ÙÂÚÔ ¤ÏÂÁ¯Ô, Ô ¢ª™ ‰ÂÓ ‰È¤-ÊÂÚÂ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ·fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ·. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ë Â-ÚÈÊ¤ÚÂÈ· Ì¤ÛË˜ (W) ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙÔ˘˜ Ô‰Ë-Ï¿ÙÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘, ¯ˆÚ›˜fiÌˆ˜ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿.

∏ Â›‰Ú·ÛË ÙË˜ ·ÂÚfi‚È·˜ ¿ÛÎËÛË˜ ÛÙËÓ ·ıÏËÙÈ-Î‹ Î·Ù¿ÛÙ·ÛË ÙˆÓ ·È‰ÈÒÓ Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙÔ˘˜ ¶›-Ó·ÎÂ˜ 3 Î·È 4. ∂›Ó·È ÂÌÊ·Ó‹ Ù· ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·ÙË˜ Û˘ÛÙËÌ·ÙÈÎ‹˜ ¿ıÏËÛË˜ ÛÙÔ˘˜ Ô‰ËÏ¿ÙÂ˜, ·ÊÔ‡Ë ·fi‰ÔÛË ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜ ÛÂ fiÏÂ˜ Û¯Â‰fiÓ ÙÈ˜·ÛÎ‹ÛÂÈ˜ ‹Ù·Ó Î·Ï‡ÙÂÚË, ÌÂ ÙË ÛËÌ·ÓÙÈÎfiÙÂÚË¿ÛÎËÛË - ÙÔ ¶∆∞ - Ó· ÏËÛÈ¿˙ÂÈ ÛÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ Û¯¤ÛË (0,08 ÛÙ· ·ÁfiÚÈ· Î·È 0,042 ÛÙ· ÎÔÚ›-ÙÛÈ·). O ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ-Ô‰ËÏ·ÙÒÓ ‹Ù·ÓÛ¯ÂÙÈÎ¿ ÌÈÎÚfi˜. ∆· ·ÁfiÚÈ· Ô‰ËÏ¿ÙÂ˜ Â›¯·Ó Î·Ï‡ÙÂ-ÚÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÙËÓ Â˘Ï˘ÁÈÛ›· Î·È ÙÔ˘˜ ÎÔÈÏÈ·ÎÔ‡˜(‰ÈÏÒÛÂÈ˜ ·fi ‡ÙÈ· Î·Ù¿ÎÏÈÛË) ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù·Û˘ÓÔÌ‹ÏÈÎ¿ ÙÔ˘˜ ·ÁfiÚÈ·. ∞ÎfiÌË, ÛÙËÓ ›‰È· ¿ÛÎËÛË(‰ÈÏÒÛÂÈ˜ ·fi ‡ÙÈ· Î·Ù¿ÎÏÈÛË), Ù· ÎÔÚ›ÙÛÈ· ‹Ù·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ Î·Ï‡ÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ Ù· ·Áfi-ÚÈ·, Â›ÙÂ ·˘Ù¿ ¤Î·Ó·Ó Ô‰ËÏ·Û›· Â›ÙÂ fi¯È.

¶›Ó·Î·˜ 2. ™ˆÌ·ÙÔÌÂÙÚÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ ·ÁÔÚÈÒÓ. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÂ Î·Ì›· ·Ú¿ÌÂÙÚÔ ÌÂÙ·-Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ

¶Ô‰ËÏ¿ÙÂ˜ OÌ¿‰· ÂÏ¤Á¯Ô˘n ª∆ ™∞ n ª∆ ™∞

∏ÏÈÎ›· 25 11,39 1,13 73 11,66 0,46µ¿ÚÔ˜ 25 44,28 11,56 72 44,47 11,23⁄„Ô˜ 25 147,75 8,66 72 147,33 7,08¢ª™ 25 20,07 3,82 72 20,31 4,12¶ÂÚÈÊ¤ÚÂÈ· Ì¤ÛË˜ 24 68,27 9,49 71 71,65 11,27¢¶∆ 25 15,84 5,31 72 14,59 4,84

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ ÎÔÚÈÙÛÈÒÓ


∏ÏÈÎ›· 14 12,01 0,928 63 11,79 0,344µ¿ÚÔ˜ 14 51,92 9,59 63 47,19 11,90⁄„Ô˜ 14 154,52 7,82 63 148,88* 8,44¢ª™ 14 21,58 2,069 63 21,06 4,07¶ÂÚÈÊ¤ÚÂÈ· Ì¤ÛË˜ 13 66,77 2,069 63 70,20 4,07¢¶∆ 13 16,85 3,52 63 16,04 5,46

* ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,027

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271


™ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔ ·›-Ì·, ˘‹Ú¯·Ó ÛËÌ·ÓÙÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜, ÔÈ ÔÔ›Â˜ Ê·›-ÓÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 5 Î·È 6. ™ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô,ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó Ô˘ÛÈ·ÛÙÈÎ¤˜ ‰È·-ÊÔÚ¤˜. øÛÙfiÛÔ, ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓÂ ÛÂ 15Ì‹ÓÂ˜ ÂÚ›Ô˘, Ë TC Î·È LDL-C ÙˆÓ Ô‰ËÏ·ÙÒÓ ·-ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÛÙ· ·Áfi-ÚÈ·. ∏ ·ÈÌÔÛÊ·ÈÚ›ÓË ·›Ì·ÙÔ˜ Î·È Ë ÁÏ˘Îfi˙Ë ÓËÛÙÂ›-·˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Î·È ‰ÂÓ ·-ÚÔ˘Û›·Û·Ó ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·È-‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (26).

™˘˙‹ÙËÛË OÈ Â˘ÂÚÁÂÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ ÙË˜ ·ÂÚfi‚È·˜ ¿ÛÎË-

ÛË˜ ÛÙÔ˘˜ ÚÔ‰È·ıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ¯ÚfiÓÈ·ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ ‹Ù·Ó Ê·ÓÂÚ¤˜ ÛÙ· ·È‰È¿ Ô˘·ıÏÔ‡ÓÙ·Ó Ù·ÎÙÈÎ¿. ∆· ·ÁfiÚÈ· Ô˘ ·ıÏÔ‡ÓÙ·Ó Û˘-ÛÙËÌ·ÙÈÎ¿ Â›¯·Ó Î·Ï‡ÙÂÚÔ ÏÈÈ‰·ÈÌÈÎfi ÚÔÊ›Ï ·fiÙÔ˘˜ ÌË ·ıÏÔ‡ÌÂÓÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ ÙÔ˘˜. ∂›¯·Ó¯·ÌËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ TC Î·È LDL-C Î·È ˘„ËÏfiÙÂÚÂ˜ÙÈÌ¤˜ HDL-C ÛÂ Û¯¤ÛË ÌÂ Ù· ¿ÙÔÌ· Ô˘ ‰ÂÓ Á˘ÌÓ¿-˙ÔÓÙ·Ó. ∞ÎfiÌË, Â›¯·Ó Â·ÚÎ‹ ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË.∂ÂÈ‰‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ô‰ËÏ·ÙÒÓ ‰ÂÓ‹Ù·Ó ÌÂÁ¿ÏÔ˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ÎÔÚÈÙÛÈÒÓ ‰ÂÓ ‰Â›¯ÓÔ˘Ó ÙfiÛÔ ÂÌÊ·ÓÂ›˜ ‰È·ÊÔÚ¤˜fiÛÔ ÛÙ· ·ÁfiÚÈ·.

OÈ ˘„ËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ ÛÙÔ ¶∆∞, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ·fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ·, Ê·ÓÂÚÒÓÔ˘Ó ÙËÓ Î·Ï‡ÙÂÚËÎ·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ¯‹ ÙˆÓ Ô‰ËÏ·ÙÒÓ ÛÂÛ¯¤ÛË ÌÂ ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘˜ (22).

OÈ Î·Ï‡ÙÂÚÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÙËÓ Â˘Ï˘ÁÈÛ›· Î·È ÛÙÈ˜·Ó·‰ÈÏÒÛÂÈ˜ ·fi ‡ÙÈ· Î·Ù¿ÎÏÈÛË ÛÙ· ·ÁfiÚÈ· Ê·-

ÓÂÚÒÓÔ˘Ó Î·Ï‡ÙÂÚË ÛˆÌ·ÙÈÎ‹ ‰È¿Ï·ÛË ÛÙ· ·È-‰È¿ Ô˘ ·ıÏÔ‡ÓÙ·È ÌÂ ·ÂÚfi‚È· ¿ÛÎËÛË.

OÈ ÏÈÔÚˆÙÂ˝ÓÂ˜ Î·È È‰È·›ÙÂÚ· Ë TC Î·È Ë LDL-C ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ÛÂ ÈÔ ¯·ÌËÏ¿ Â›Â-‰· ÛÙÔ˘˜ Ô‰ËÏ¿ÙÂ˜ (·ÁfiÚÈ·). ∞˘Ùfi ¤¯ÂÈ ÛËÌ·ÓÙÈ-Î¤˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ÚfiÏË„Ë ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜.∞ÊÔ‡ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Ë ‡·ÚÍË ·ıËÚˆÌ·ÙÈÎÒÓ ÈÓÈ-‰›ˆÓ ·fi ÙËÓ ÚÒÙË ·È‰ÈÎ‹ ËÏÈÎ›·, Ë ÚfiÏË„Ë ı·Ú¤ÂÈ Ó· ÍÂÎÈÓ‹ÛÂÈ ·fi Ù· ·È‰È¿ ÁÈ· Î·Ï‡ÙÂÚ··ÔÙÂÏ¤ÛÌ·Ù· (21-26).

∂ÏÏÈ‹˜ ¿ıÏËÛË ÙˆÓ ·È‰ÈÒÓ ÙË˜ ∫‡ÚÔ˘ fiÏˆÓÙˆÓ ËÏÈÎÈÒÓ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔ-ÛÙfi, ·ÊÔ‡ - Û‡ÌÊˆÓ· ÌÂ ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔËÁÔ‡-ÌÂÓˆÓ ÌÂÏÂÙÒÓ - ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 11-12ÂÙÒÓ ¤¯ÂÈ ¯·ÌËÏ‹ ¤ˆ˜ ÔÏ‡ ¯·ÌËÏ‹ ·fi‰ÔÛË ÛÙÔ¶∆∞ (24,26). ªfiÓÔ ÙÔ 20% ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÔÏ‡Î·Ï¤˜ ‹ ¿ÚÈÛÙÂ˜ ÂÈ‰fiÛÂÈ˜ ÛÙÔ ¶∆∞, ÂÓÒ ÙÔ ˘fi-ÏÔÈÔ 30% Î·Ù¤¯ÂÈ Ì¤ÙÚÈÂ˜ ı¤ÛÂÈ˜ (24).

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ ÈÛ¯‡Ô˘Ó Î·È ÁÈ· ÙÈ˜ ·ÛÙÈ-Î¤˜ Î·È ·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÙË˜ ∫‡ÚÔ˘, ÌÂ ÌfiÓË‰È·ÊÔÚ¿ ÙË ÌÈÎÚ‹ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È-‰ÈÒÓ ÌÂ ÔÏ‡ Î·Ï‹ ·fi‰ÔÛË (25%) ÌfiÓÔ ÛÙ· ·Áfi-ÚÈ· ÙˆÓ ·ÁÚÔÙÈÎÒÓ Â‰ÈÓÒÓ ÂÚÈÔ¯ÒÓ (24).

¶·ÚfiÌÔÈ· Î·Ù¿ÛÙ·ÛË ·Ú·ÙËÚÂ›Ù·È ÛÙ· Á˘ÌÓ¿-ÛÈ· Î·È Ù· Ï‡ÎÂÈ·, ÌÂ ÌÈÎÚ‹ ‚ÂÏÙ›ˆÛË ÛÙ· ·ÁfiÚÈ·ÛÙË ‰ÔÎÈÌ·Û›· ÙÔ˘ ¶∆∞ Î·È ÛÙÔ ¿ÏÌ· ÂÈ˜ Ì‹ÎÔ˜ ¯ˆ-Ú›˜ ÊfiÚ· (23,24).

∏ ¯ÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Ô˘ ·ÛÎÔ‡ÓÙ·È Ù· ·È‰È¿,ÙfiÛÔ ÛÙÔ Û¯ÔÏÂ›Ô fiÛÔ Î·È ÛÙÔÓ ÂÏÂ‡ıÂÚÔ ¯ÚfiÓÔÙÔ˘˜, ı· Ú¤ÂÈ Ó· ·˘ÍËıÂ›. ∏ ¿ÛÎËÛË ˆ˜ ·Ú¿ÁÔ-ÓÙ·˜ ÚÔ·ÁˆÁ‹˜ ÙË˜ ˘ÁÂ›·˜ ı· Ú¤ÂÈ Ó· Â·ÓÂÍÂ-Ù·ÛÙÂ› Î·È Ó· ÙÂıÂ› ÛÂ ÈÔ ÛˆÛÙ¤˜ ‚¿ÛÂÈ˜.

¶›Ó·Î·˜ 3. ∞ÔÙÂÏ¤ÛÌ·Ù· ·ıÏËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÙ· ÎÔÚ›ÙÛÈ·


∂˘Ï˘ÁÈÛ›· 8 21 7,34 63 16 7,11∞ªÃº 8 144,12 13,15 63 136,39 25,5∫ÔÈÏÈ·ÎÔ› 8 20,50 3,46 61 18,96 3,86¶∆∞ 8 4,68 1,83 62 3,42* 1,59

* ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,042

¶›Ó·Î·˜ 4. ∞ÔÙÂÏ¤ÛÌ·Ù· ·ıÏËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÙ· ·ÁfiÚÈ·


∂˘Ï˘ÁÈÛ›· 14 20,78 7,20 73 11,72* 6,80∞ªÃº 16 157,62 20,05 72 149,58 20,19∫ÔÈÏÈ·ÎÔ› 16 17,25 4,58 72 21,50* 4,14¶∆∞ 16 5,78 2,12 72 4,83** 1,81

* ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p<0,001 ** ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,08

July August 04 07-10-04 13:52 ™ÂÏ›‰·271

272


∏ Û˘Û¯¤ÙÈÛË ÙË˜ ¤ÓÙ·ÛË˜, ÙË˜ ‰È¿ÚÎÂÈ·˜ Î·È ÙÔ˘Â›‰Ô˘˜ ÙË˜ ¿ÛÎËÛË˜ ÌÂ Ù· Â˘ÂÚÁÂÙÈÎ¿ ·ÔÙÂÏ¤-ÛÌ·Ù· Ô˘ ¤¯ÂÈ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤ÚˆÌÂÏ¤ÙË˜ Î·È ·ÍÈÔÏfiÁËÛË˜.

∂˘¯·ÚÈÛÙ›Â˜ ∂˘¯·ÚÈÛÙÔ‡ÌÂ Ù· ˘Ô˘ÚÁÂ›· ÀÁÂ›·˜ Î·È ¶·È‰Â›·˜-¶ÔÏÈÙÈ-

ÛÌÔ‡ ÁÈ· ÙË Û˘ÓÂÚÁ·Û›· ÌÂ ÙÔ ÚfiÁÚ·ÌÌ¿ Ì·˜, Î·ıÒ˜ Î·È ÙË‰ÈÂ‡ı˘ÓÛË Î·È ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ÃËÌÂ›Ô˘ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔ-ÎÔÌÂ›Ô˘ §Â˘ÎˆÛ›·˜ ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓÂÍÂÙ¿ÛÂˆÓ.

∂›ÛË˜, Â˘¯·ÚÈÛÙÔ‡ÌÂ ÙÔÓ ∫O∞ Î·È, È‰È·›ÙÂÚ·, ÙËÓ ∞Î·-‰ËÌ›· Î·È ÙÔ˘˜ ÚÔÔÓËÙ¤˜ Ô‰ËÏ·Û›·˜ Î. ∞ÓÙÚ¤· ∫ˆÓÛÙ·-ÓÙ›ÓÔ˘, Î. ™ˆÙ‹ÚË ª·‡ÚÔ Î·È Î. ¢ËÌ‹ÙÚË ∫·‰‹ ÁÈ· ÙËÓ ÂÓÂÚ-Áfi Û˘ÌÌÂÙÔ¯‹ Î·È ‚Ô‹ıÂÈ¿ ÙÔ˘˜ ÛÙËÓ ÂÎÙ¤ÏÂÛË ÙË˜ ¤ÚÂ˘Ó·˜,Î·ıÒ˜ Î·È ÙÔ˘˜ ÁÔÓÂ›˜ Î·È Ù· ·È‰È¿ Ô˘ Ì·˜ ÂÌÈÛÙÂ‡ÙËÎ·ÓÎ·È Û˘ÌÌÂÙÂ›¯·Ó ÛÂ ·˘Ù‹ ÙË ÌÂÏ¤ÙË.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Chinn S, Rona RJ. Prevalence and trends in overweight

and obesity in three cross-sectional studies of Britishchildren, 1974-94. BMJ 2001;322:24-26.

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

3. American Academy of Pediatrics. Committee on Nutrition.Cholesterol in childhood. Pediatrics 1998;101:141-147.

4. Boreham C, Twisk J, Murray L, Savage M, Strain JJ, CranG. Fitness, fatness, and coronary heart disease risk inadolescents: the Northern Ireland Young Hearts Project.

Med Sci Sports Exerc 2001;33:270-274. 5. Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›ÙË˜ ª, ∫ˆÓÛÙ·ÓÙ›ÓÔ˘ ∂, Ã·Ù˙Ë-

Èˆ¿ÓÓÔ˘ ª, °È·ÓÎÔ˘Ï‹ ∞. ŒÏÂÁ¯Ô˜ ÂÈ¤‰Ô˘ ÏÈÔÚˆÙÂ˚-ÓÒÓ Î·È ·¯˘Û·ÚÎ›·˜ ÛÂ 1132 ·È‰È¿ ÙË˜ ™Ù’ Ù¿ÍË˜ ÙˆÓ ‰Ë-ÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÙË˜ Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜. ¶·È‰È·ÙÚÈÎ‹µÔÚÂ›Ô˘ ∂ÏÏ¿‰Ô˜ 1998;10:238-244.

6. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›ÙË˜ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚·, ™, Ã·Ù˙Ë-ÁÂˆÚÁ›Ô˘ Ã. ™˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙËÏÂı¤·ÛË˜ Î·È Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈÎ‹2001;64:595-603.

7. Maffeis C, Talamini G, Tato L. Influence of diet, physicalactivity and parents’ obesity on children's adiposity: a four-year longitudinal study. Int J Obes Relat Metab Disord1998;22:758-764.

8. ∫·‚·˙·Ú¿ÎË˜ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-Ã·Ù˙Ë·ÚÁ˘ÚÔ‡ ¢,ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈÎ‹˜¯ÔÏËÛÙÂÚfiÏË˜, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÂ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈÎ‹ 1998;61:148-160.

9. ∫·Ê¿ÙÔ˜ ∞, Christakis G, Hsia SL, Cassady J, ¶·Ó·ÁÈˆÙ·-ÎfiÔ˘ÏÔ˜ °. §È›‰È· ÔÚÔ‡ ÛÂ 1010 ·È‰È¿ ÙË˜ ∞ı‹Ó·˜ 10-14 ¯ÚÔÓÒÓ. π·ÙÚÈÎ‹ 1980;38:283-290.

10. Schulpis K, Karikas GA. Serum cholesterol and triglyceridedistribution in 7767 school-aged Greek children. Pediatrics1998;101:861-864.

11. American Academy of Pediatrics Committee on Nutrition.Cholesterol in childhood. Pediatrics 1998;101:141-147.

12. Lionis C, Kafatos A, Vlachonikolis J, Vakaki M, Tzortzi M,Petraki A. The effects of a health education interventionprogram among Cretan adolescents. Prev Med1991;20:685-699.

13. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›ÙË˜ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, Ã·Ù˙Ë-ÁÂˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∏ ·¯˘Û·ÚÎ›· ÛÂ ·È‰È¿

¶›Ó·Î·˜ 6. ∞ÔÙÂÏ¤ÛÌ·Ù· ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ Î·È ‚ÈÔ¯ËÌÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÙ· ·ÁfiÚÈ·


TC 25 158,16 20,68 72 169,93* 25,16HDL-C 25 64,64 19,80 72 60,68 11,02LDL-C 25 79,36 17,70 72 97,50** 21,49TG 25 71,00 43,90 72 72,00 86,05LDL/HDL 25 1,41 0,45 72 1,66 0,47GLUCOSE 25 83,20 5,82 72 83,73 6,43HGB 25 12,52 1,02 72 12,59 0,96

* ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p=0,042 ** ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· Ô‰ËÏ·ÙÒÓ, p<0,001

¶›Ó·Î·˜ 5. ∞ÔÙÂÏ¤ÛÌ·Ù· ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ Î·È ‚ÈÔ¯ËÌÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÙ· ÎÔÚ›ÙÛÈ·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔ-Ú¤˜ ÛÂ Î·Ì›· ·Ú¿ÌÂÙÚÔ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ


TC 14 169,78 16,91 63 164,31 31,20HDL-C 14 59,57 11,54 63 55,53 12,59LDL-C 14 96,35 16,14 63 90,57 26,00TG 14 69,28 16,14 63 99,66 103,49LDL/HDL 14 1,69 0,51 63 1,70 0,58GLUCOSE 14 81,57 10,45 63 85,07 8,50HGB 14 13,00 0,70 63 12,56 1,03

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ËÏÈÎ›·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ™ËÌ·ÓÙÈÎ‹ ·‡ÍËÛË Ù· ÙÂ-ÏÂ˘Ù·›· 8 ¯ÚfiÓÈ·. ¶·È‰È·ÙÚÈÎ‹ 2000;63:137-144.

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

15. Muhonen LE, Burns TL, Nelson RP, Lauer RM. Coronaryrisk factors in adolescents related to their knowledge offamilial coronary heart disease and hypercholesterolemia:the Muscatine Study. Pediatrics 1994;93:444-451.

16. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS,Stone EJ et al. Outcomes of a field trial to improvechildren's dietary patterns and physical activity. The Childand Adolescent Trial for Cardiovascular Health. CATCHcollaborative group. JAMA 1996;275:768-776.

17. Guillaume M, Lapidus L, Bjorntorp P, Lambert A. Physicalactivity, obesity, and cardiovascular risk factors in children.The Belgian Luxembourg Child Study II. Obes Res1997;5:549-556.

18. Walter HJ, Wynder EL. The development, implementation,evaluation, and future directions of a chronic diseaseprevention program for children: The “Know Your Body”studies. Prev Med 1989;18:59-71.

19. Walter HJ, Hofman A, Vaughan RD, Wynder EL.Modification of risk factors for coronary heart disease: five-year results of a school-based intervention trial. N Engl JMed 1988;318:1093-1100.

20. Kimm SY, Payne GH, Stylianou MP, Waclawiw MA,Lichtenstein C. National trends in the management ofcardiovascular disease risk factors in children: secondNHLBI survey of primary care physicians. Pediatrics1998;102:E50.

21. Harrell JS, Gansky SA, McMurray RG, Bangdiwala SI,Frauman AC, Bradley CB. School-based interventionsimprove heart health in children with multiple cardiovasculardisease risk factors. Pediatrics 1998;102:371-380.

22. Nader PR, Sellers DE, Johnson CC, Perry CL, Stone EJ,Cook KC et al. The effect of adult participation in a school-based family intervention to improve children’s diet andphysical activity: the Child and Adolescent Trial forCardiovascular Health. Prev Med 1996;25:455-464.

23. ™¿‚‚· ™, ∆ÔÚÓ·Ú›ÙË˜ ª, Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ∫Ô˘Ú›‰Ë˜ °,™È·ÌÔ‡ÓÎË ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚· ª. ∞˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·ÔÏÏ·ÏÒÓ ÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÓÔÛËÌ¿ÙˆÓ ÛÂ ·È‰È¿ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ¶·È‰È·ÙÚÈÎ‹1999;62:468-473.

24. Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›ÙË˜ ª, Ã·Ù˙ËÈˆ¿ÓÓÔ˘ ª, ∫Ô˘Ú›-‰Ë˜ °, ™¿‚‚· ™. ∞ıÏËÙÈÎ‹ Î·Ù¿ÛÙ·ÛË 800 Ì·ıËÙÒÓ 10-14¯ÚÔÓÒÓ ÙË˜ ∫‡ÚÔ˘. 40fi ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi Û˘Ó¤-‰ÚÈÔ: £ÂÛÛ·ÏÔÓ›ÎË; 2002. ÛÂÏ. 16. Abstract ∂∞ 026.

25. Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M,Chadjigeorgiou C, Kafatos A. Obesity in children andadolescents in Cyprus. Prevalence and predisposingfactors. Int J Obes 2002;26:1036-1045.

26. Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›ÙË˜ ª, ∫ˆÓÛÙ·ÓÙ›ÓÔ˘ ∂. ∫·Ù¿-ÛÙ·ÛË ‰È·ÙÚÔÊ‹˜ Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË ·›Ì·ÙÔ˜ ÛÂ 1130 ·È-‰È¿ ™Ù’ Ù¿ÍË˜ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÙË˜ Â·Ú¯›·˜ §Â˘-ÎˆÛ›·˜. ¶·È‰ ∂ÓËÌ¤ÚˆÛË ∫‡ÚÔ˜ 1999;3:6-21.

27. Georgiades G, Klissouras V. Assessment of youth fitness:the European perspective. Am J Clin Nutr 1989;49 (5Suppl):S1048-S1053.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã·Ú¿Ï·ÌÔ˜ Ã·Ù˙ËÁÂˆÚÁ›Ô˘™Ù·˘ÚÔ‡ 56, ™ÙÚfi‚ÔÏÔ˜ 2035 §Â˘ÎˆÛ›·, ∫‡ÚÔ˜ E-mail: [email protected]

July August 04 07-10-04 13:52 ™ÂÏ›‰·273

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

∂È‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÂ ¶·È‰È·ÙÚÈÎ‹ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜º. ¡ÈÎÔÏ¿Ô˘, º. ∫·Î·‚¿, ∫. ¶·¿˙ÔÁÏÔ˘, π. ¶··‰¿ÙÔ˜

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

�¶ÂÚ›ÏË„Ë: ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙË ‰Â‡ÙÂÚËÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· ÚÔÛ¤ÏÂ˘ÛË˜ ÙˆÓ ·È‰ÈÒÓ ÛÙ·ÙÌ‹Ì·Ù· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·È ÙËÓ ÚÒÙË·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂÙ¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô. ™ÎÔfi˜ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ÂÈ-‰ËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓÛÂ ·È‰È¿ ËÏÈÎ›·˜ 0-14 ÂÙÒÓ Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó ÛÂªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ (ª∂£). ¶ÚfiÎÂÈÙ·ÈÁÈ· ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙË Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ 394 ·È-‰È¿, Ù· ÔÔ›· ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË ª∂£ ÙÔ˘ ¡ÔÛÔÎÔ-ÌÂ›Ô˘ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ ‰ÂÎ·ÂÙ›·˜ 1991-2000. ∆Ô ·Ù‡¯ËÌ· ˆ˜ ·ÈÙ›· ÂÈ-Û·ÁˆÁ‹˜ ‰ÈÂÚÂ˘Ó‹ıËÎÂ ÛÂ Û¯¤ÛË ÌÂ ÙÔ Ê‡ÏÔ, ÙËÓËÏÈÎ›·, ÙËÓ ÂÙ‹ÛÈ· Î·È ÙËÓ ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹, ÙËÓ·ÈÙÈÔÏÔÁ›· Î·È ÙËÓ ÚÔÎ·ÏÔ‡ÌÂÓË Î¿ÎˆÛË, ÙË ıÓË-ÙfiÙËÙ· Î·È ÙË ÓÔÛËÚfiÙËÙ·. ∆· ·Ù˘¯‹Ì·Ù· Î¿Ï˘-Ù·Ó ÙÔ 19,4% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙË ª∂£ ÌÂ Û˘¯Ófi-ÙËÙ· ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ÙÔ Î·ÏÔÎ·›ÚÈ. ∏ ·Ó·-ÏÔÁ›· ·ÁÔÚÈÒÓ/ÎÔÚÈÙÛÈÒÓ ‹Ù·Ó 1,75:1. ™˘¯ÓfiÙÂÚ·‹Ù·Ó Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· (46,2%), Ô˘ ÛÙËÓÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ Û˘Ó¤‚ËÛ·Ó Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈÎ‹Î·È Û¯ÔÏÈÎ‹ ËÏÈÎ›·, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÙÒÛÂÈ˜(32,2%), ÔÈ ‰ËÏËÙËÚÈ¿ÛÂÈ˜ (5,8%), Ù· ÂÁÎ·‡Ì·Ù·(5,8%), Ë ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ (2,6%) Î·È ÔÓÈÁÌfi˜ (1,7%). ∫¿ÎˆÛË ÂÓfi˜ ·Ó·ÙÔÌÈÎÔ‡ Û˘ÛÙ‹-Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎÂ ÛÂ 264 ·È‰È¿, ‰‡Ô ·Ó·ÙÔÌÈ-ÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÛÂ 99 Î·È ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓÛÂ 31 ·È‰È¿. ∏ ÚˆÙÔÁÂÓ‹˜ Î¿ÎˆÛË ·ÊÔÚÔ‡ÛÂ ÛÂÔÛÔÛÙfi 69,8% ÙÔ ∫¡™ Î·È ·Ô‰Â›¯ıËÎÂ Ô ÛËÌ·-ÓÙÈÎfiÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ¤Î‚·ÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô, Ï‹ÚË˜›·ÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ 60,7% Î·È ˘ÔÏÂÈÌÌ·ÙÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹, Ô˘ ÂÎÙÈÌ‹ıËÎÂ ÌÂ ÙËÓ ∫Ï›-Ì·Î· ¶ÚfiÁÓˆÛË˜ ÙË˜ °Ï·ÛÎÒ‚Ë˜, ÛÙÔ 26,1% ÙˆÓ·ÛıÂÓÒÓ. ∏ ıÓËÙfiÙËÙ· ·Ó‹ÏıÂ ÛÂ 13,2% Î·È ·ÊÔ-ÚÔ‡ÛÂ Î˘Ú›ˆ˜ ÛÂ ·È‰È¿ Ô˘ ‰È·ÎÔÌ›ÛÙËÎ·Ó ·fi

�Abstract: Accident related injuries are the secondleading cause of emergency room visits and theleading cause of child death beyond the newbornperiod. The aim of this retrospective study was toinvestigate the epidemiology of the injured paediatricpopulation aged 0-14 years treated in the PaediatricIntensive Care Unit (PICU). During the period 1991-2000, out of a total of 2027 admissions to the PICU atthe “P. & A. Kyriakou” Children’s Hospital, 394admissions (251 boys, 143 girls) were due to injury.The gender, age, annual and seasonal distribution,the cause of accident, the resulting injury, themorbidity and the mortality were studied. Thepercentage of admissions to PICU as a result ofinjury was 19.4%. The highest frequency wasobserved in summer. There was a prevalence ofmales in a ratio of 1.75:1. Traffic accidents were themost frequent cause of injury (46.2%) mainly forpreschool and school age children, followed by falls(32.2%), poisonings (5.8%), burns (5.8%), foreignbody ingestion (2.5%) and drowning (1.7%). Oneanatomic system was injured in 264 children, twoanatomic systems in 99 and three or more in 31children. The central nervous system (CNS) wasmost commonly the primary injured system (69.8%)and CNS injuries were the principal determinant ofoutcome. On discharge, 60.7% of the children werecured and 26.1% had neurological disabilities thatwere assessed according to the Glasgow OutcomeScale. The mortality rate was 13.2%. The highestmortality rate was related to children who weretransferred from district hospitals. In conclusion, theincreasing frequency of childhood injuries and thenumber of deaths and neurological disabilitiesdemonstrate that the acute care of injured childrenbegins before the time of injury, with prevention, is

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

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

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∂ÈÛ·ÁˆÁ‹∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ ÚÒÙË ·ÈÙ›· ı·-

Ó¿ÙÔ˘ ÛÙ· ·È‰È¿ ÌÂÙ¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô (1-3). Oı¿Ó·ÙÔ˜ ÂÓfi˜ ·È‰ÈÔ‡ ·fi ·Ù‡¯ËÌ· ·ÓÙÈÛÙÔÈ¯Â› ÛÂÓÔÛËÏÂ›· 160 ·È‰ÈÒÓ Î·È ÛÂ 2000 ÂÈÛÎ¤„ÂÈ˜ ·È-‰ÈÒÓ ÛÂ ÙÌ‹Ì·Ù· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ (4) (∂È-ÎfiÓ· 1). ∏ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ‰ÈÎ·ÈÔÏÔÁÂ›Ù·È ·fi Ù· È‰È·›ÙÂÚ·Ê˘ÛÈÔÏÔÁÈÎ¿ Î·È „˘¯ÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜,fiˆ˜ Â›Ó·È ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ÙÔ ÌÈÎÚfi ÔÙÈÎfiÂ‰›Ô, Ë „˘¯ÔÎÈÓËÙÈÎ‹ ·ÓˆÚÈÌfiÙËÙ·, Ë ·˘ÍËÌ¤ÓËÂÚÈ¤ÚÁÂÈ·, Ë ¿ÁÓÔÈ· ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Ë ·ÚÔÚÌË-ÙÈÎfiÙËÙ·.

∏ ∂ÏÏ¿‰· Î·Ù¤¯ÂÈ ÙËÓ ¤ÌÙË ı¤ÛË ·Ó¿ÌÂÛ·ÛÙÈ˜ 10 ÌÂÁ·Ï‡ÙÂÚÂ˜ ¯ÒÚÂ˜ ÙË˜ ∂˘Úˆ·˚Î‹˜ ŒÓˆ-ÛË˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ· ·fi ·Ù˘¯‹Ì·Ù··ÙfiÌˆÓ ËÏÈÎ›·˜ 0-21 ÂÙÒÓ (5) (∂ÈÎfiÓ· 2). ™‡ÌÊˆÓ·ÌÂ Ù· ÛÙÔÈ¯Â›· ÙË˜ ∂ıÓÈÎ‹˜ ™Ù·ÙÈÛÙÈÎ‹˜ ÀËÚÂÛ›·˜,ÛÙËÓ ∂ÏÏ¿‰· Î·Ù·ÁÚ¿ÊÔÓÙ·È ÂÙËÛ›ˆ˜ ÂÚ›Ô˘ 140ı¿Ó·ÙÔÈ ·È‰ÈÒÓ ·fi ·Ù‡¯ËÌ·, ÂÓÒ 16.000-17.000·È‰È¿ ÓÔÛËÏÂ‡ÔÓÙ·È ÁÈ· ‰È¿ÊÔÚÂ˜ Î·ÎÒÛÂÈ˜. ∏ÚÒÙË ·ÈÙ›· ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ ÛÙËÓ ∂ÏÏ¿‰· Â›Ó·ÈÙ· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·. ∆Ë ‰ÈÂÙ›· 1997-1998, Ù·ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ÛÙ· ÔÔ›· ÂÌÏ¤ÎÔÓÙ·Ó ·È‰È¿Â›ÙÂ ˆ˜ ÂÈ‚¿ÙÂ˜, Â›ÙÂ ˆ˜ Â˙Ô›, Â˘ı‡ÓÔÓÙ·Ó ÁÈ· Ù·3/5 ÙˆÓ ı·Ó¿ÙˆÓ ·fi ·Ù‡¯ËÌ· ·È‰ÈÒÓ ËÏÈÎ›·˜ ¤ˆ˜14 ÂÙÒÓ (∂ÈÎfiÓ· 3).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡-ÓËÛË ÙˆÓ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ·Ù˘¯ËÌ¿ÙˆÓ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 0-14 ÂÙÒÓ Ô˘ ÓÔÛË-ÏÂ‡ÙËÎ·Ó ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ ÙÔ˘¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ÛÙË ‰È¿Ú-ÎÂÈ· Ì›·˜ ‰ÂÎ·ÂÙ›·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÚfiÎÂÈÙ·È ÁÈ· ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙË Ô˘ Û¯Â‰È¿ÛÙËÎÂ ÁÈ·

Ó· ÚÔÛÂÁÁ›ÛÂÈ ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ Ù· ·Ù˘¯‹Ì·Ù· ˆ˜ ·ÈÙ›· ÂÈÛ·-ÁˆÁ‹˜ ÙˆÓ ·È‰ÈÒÓ ÛÙË ª∂£. ∏ ÔÌ¿‰· ÌÂÏ¤ÙË˜ ÂÚÈÂÏ¿Ì‚·-ÓÂ 394 ·È‰È¿ (251 ·ÁfiÚÈ·, 143 ÎÔÚ›ÙÛÈ·) ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ2027 Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË ª∂£ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ Î·Ù¿ ÙÔ

¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1991 Ì¤¯ÚÈ ÙÔÓ ¢ÂÎ¤Ì-‚ÚÈÔ 2000, ÁÈ· ÔÈÎ›ÏÂ˜ ·ÈÙ›Â˜.

ªÂÏÂÙ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ ÓÔÛËÏÂ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Û˘-ÁÎÂÓÙÚÒıËÎ·Ó ÛÙÔÈ¯Â›· Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÂ ‰ËÌÔÁÚ·ÊÈÎ¿,ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ Î·È ÎÏÈÓÈÎ¿ ‰Â‰ÔÌ¤Ó·. OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ Î·-Ù·ÁÚ¿ÊËÎ·Ó Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ‹Ù·Ó ÙÔ Ê‡ÏÔ, Ë ËÏÈÎ›·, ËÂÙ‹ÛÈ· Î·È Ë ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ, Ë ·ÈÙ›· Î·È

Â·Ú¯È·Î¿ ÓÔÛÔÎÔÌÂ›·. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ·Ú·-ÙËÚÔ‡ÌÂÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ÙÔ ˘„Ë-Ïfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ Î·È ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓÂ˘ÚÔ-ÏÔÁÈÎ‹˜ Û˘Ó‰ÚÔÌ‹˜ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó fiÙÈ Ë ·ÓÙÈÌÂÙÒ-ÈÛË ÙÔ˘ ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ ·Ú¯›˙ÂÈ ÌÂ ÙËÓ Úfi-ÏË„Ë, Û˘ÓÂ¯›˙ÂÙ·È ÌÂ ÙËÓ ·ÚÔ¯‹ ÊÚÔÓÙ›‰·˜ ÚÈÓÎ·È ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÂ ÓÔÛÔÎÔÌÂ›Ô Î·È ÔÏÔÎÏË-ÚÒÓÂÙ·È ÛÂ Î¤ÓÙÚÔ ·ÔÎ·Ù¿ÛÙ·ÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·Ù˘¯‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜,·È‰ÈÎfi ÙÚ·‡Ì·, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ¤˜ Î·ÎÒÛÂÈ˜, Û˘-ÛÙ‹Ì·Ù· ÌÂÙ·ÊÔÚ¿˜.

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

Key words: childhood injuries, paediatric multipletrauma, head injury, paediatric transfer.

∂ÈÎfiÓ· 1. ¶˘Ú·Ì›‰· ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿ (Lancet2001;357:454).

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Ë Û¯ÂÙÈÎ‹ ÌÂ ·˘Ù‹ ÚÔÎ·ÏÔ‡ÌÂÓË Î¿ÎˆÛË, Ù· ÎÏÈÓÈÎ¿ ‰Â‰Ô-Ì¤Ó· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Î·È ÓÔÛËÏÂ›· ÙˆÓ ·È‰ÈÒÓ ÛÙË ª∂£,Ë ÓÔÛËÚfiÙËÙ· Î·È Ë ıÓËÙfiÙËÙ·. ∏ ÓÔÛËÚfiÙËÙ· ÂÎÙÈÌ‹ıËÎÂ ÛÂÛ¯¤ÛË ÌÂ ÙËÓ ‡·ÚÍË ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ Û˘Ó-‰ÚÔÌ‹˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË ª∂£.

∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó ÛÂ Ù¤ÛÛÂÚÈ˜ ‚·ÛÈÎ¤˜ ÔÌ¿‰Â˜ ËÏÈ-ÎÈÒÓ: ‚ÚÂÊÈÎ‹ ËÏÈÎ›· (0-1 ¤ÙÔ˘˜), ÓËÈ·Î‹ ËÏÈÎ›· (1-4 ÂÙÒÓ),ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›· (4-6 ÂÙÒÓ) Î·È Û¯ÔÏÈÎ‹ ËÏÈÎ›· (6-14 ÂÙÒÓ).∏ Î·Ù·ÓÔÌ‹ ¤ÁÈÓÂ ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ê‡ÏÔ ÁÈ· Î¿ıÂ ÔÌ¿‰· ËÏÈ-ÎÈÒÓ ÍÂ¯ˆÚÈÛÙ¿, ·ÏÏ¿ Î·È ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ.

∆· ·Ù˘¯‹Ì·Ù·, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘˜, Ù·ÍÈÓÔ-Ì‹ıËÎ·Ó ÛÂ ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ÙÒÛÂÈ˜, ÂÁÎ·‡Ì·Ù·, ‰ËÏË-ÙËÚÈ¿ÛÂÈ˜, ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜, ÓÈÁÌfi Î·È ‰È¿ÊÔÚ·¿ÏÏ· ·Ù˘¯‹Ì·Ù·.

∫·Ù·ÁÚ¿ÊËÎ·Ó ÁÈ· Î¿ıÂ ·È‰› ÍÂ¯ˆÚÈÛÙ¿ Ë ·ÈÙ›· ÙÔ˘ ·Ù˘-¯‹Ì·ÙÔ˜ Î·È Ë Î¿ÎˆÛË Ô˘ ÚÔÎÏ‹ıËÎÂ ·fi ·˘Ùfi, Î·ıÒ˜ Î·ÈÛÙÔÈ¯Â›· ·fi ÙËÓ ÚÒÙË ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ª∂£, fiˆ˜ Ë ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·Ó·-ÓÔ‹˜, Ë ÚÔËÁËıÂ›Û· ÂÂ›ÁÔ˘Û· ÂÓ‰ÔÙÚ·¯ÂÈ·Î‹ ‰È·ÛˆÏ‹Óˆ-ÛË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·Ú¯ÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜, Ë ‡·ÚÍË ÎÏÈÓÈÎÒÓÛËÌÂ›ˆÓ Î·Ù·ÏËÍ›·˜, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂÈ¤‰Ô˘ ÙË˜ Û˘ÓÂ›-‰ËÛË˜ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ó·ÙÔÌÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Ô˘ ¤·-Û¯·Ó. ∫·Ù·ÁÚ¿ÊËÎ·Ó, Â›ÛË˜, Ù· ˘ÔÛÙËÚÈÎÙÈÎ¿ Ì¤ÙÚ· Ô˘··ÈÙ‹ıËÎ·Ó, ‰ËÏ·‰‹ Ô ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, Ë ÂÂ›ÁÔ˘Û· ÌÂ-Ù¿ÁÁÈÛË ‹ Ë ¯ÔÚ‹ÁËÛË ÈÓÔÙÚfiˆÓ Ê·ÚÌ¿ÎˆÓ, Î·ıÒ˜ Î·È Ë ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË, fiÔ˘ ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ.

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ Ì¤Ûˆ ˘ÔÏÔÁÈÛÙ‹, ÌÂ ÙÔ Û‡-ÛÙËÌ· Microsoft Excel.

∞ÔÙÂÏ¤ÛÌ·Ù· ∏ ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙÔ Û‡-

ÓÔÏÔ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙË ª∂£ ·Ó¤Ú¯ÂÙ·È ÛÂ 19,4%.™ÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ, Ô ·ÚÈıÌfi˜ ÙˆÓ·ÁÔÚÈÒÓ ˘ÂÚÙÂÚÔ‡ÛÂ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÎÔÚÈÙÛÈÒÓÛÂ ·Ó·ÏÔÁ›· 1,75:1 (∂ÈÎfiÓ· 4). ™ÙËÓ ∂ÈÎfiÓ· 5 ·ÔÙ˘-ÒÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ Î·Ù¿ Ê‡ÏÔ Î·ÈËÏÈÎ›·, ÂÓÒ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ù· ·ÁfiÚÈ· Â›Ó·È ÂÚÈÛ-

ÛfiÙÂÚÔ ÂÈÚÚÂ‹ ÛÙ· ·Ù˘¯‹Ì·Ù· ÛÂ Û¯¤ÛË ÌÂ Ù· ÎÔ-Ú›ÙÛÈ·, ÌÂÙ¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·.

∏ ÂÙ‹ÛÈ· Î·Ù·ÓÔÌ‹ ¤‰ÂÈÍÂ Ì›· Û¯ÂÙÈÎ¿ ÛÙ·ıÂÚ‹ÔÚÂ›·, ·ÓÙ›ıÂÙ· ÌÂ ÙËÓ ÂÔ¯È·Î‹, fiÔ˘ ÙÔ 1/3 ÂÚ›-Ô˘ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÚÔÎÏ‹ıËÎÂ ÙÔ˘˜ Î·ÏÔÎ·ÈÚÈ-ÓÔ‡˜ Ì‹ÓÂ˜ (33,25%). ∞ÎÔÏÔ˘ıÔ‡Ó Ë ¿ÓÔÈÍË(23,85%) Î·È ÙÔ ÊıÈÓfiˆÚÔ (23,35%) ÛÙËÓ ›‰È· ÂÚ›-Ô˘ ·Ó·ÏÔÁ›·. ∏ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ·Ù˘¯ËÌ¿ÙˆÓ·Ú·ÙËÚ‹ıËÎÂ Î·Ù¿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜(19,55%) (∂ÈÎfiÓ· 6).

™ÙËÓ ∂ÈÎfiÓ· 7 ·ÂÈÎÔÓ›˙ÂÙ·È Ë Î·Ù·ÓÔÌ‹ Û˘¯ÓÔ-Ù‹ÙˆÓ ÙˆÓ 394 ·Ù˘¯ËÌ¿ÙˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ·ÈÙ›·.¶·Ú·ÙËÚÂ›Ù·È fiÙÈ Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Î·Ï‡ÙÔ˘ÓÙÔ 46,2% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ, ÔÈ ÙÒÛÂÈ˜ ÙÔ 32,2%, ÔÈ‰ËÏËÙËÚÈ¿ÛÂÈ˜ ÙÔ 5,8%, Ù· ÂÁÎ·‡Ì·Ù· ÙÔ 5,8%, ËÂÈÛÚfiÊËÛË Í¤ÓˆÓ ÛˆÌ¿ÙˆÓ ÙÔ 2,6% Î·È Ô ÓÈÁÌfi˜ ÙÔ1,7%. ™ÙÔ 60,5% ÙˆÓ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ, Ù· ·È-‰È¿ ‹Ù·Ó ÂÈ‚¿ÙÂ˜ ·˘ÙÔÎÈÓ‹ÙÔ˘, ÛÙÔ 26,9% ‹Ù·Ó Â-˙Ô› Ô˘ ·Ú·Û‡ÚıËÎ·Ó ·fi ‰ÈÂÚ¯fiÌÂÓÔ fi¯ËÌ· Î·ÈÛÙÔ 12,6% Ô‰ËÁÔ‡Û·Ó Ô‰‹Ï·ÙÔ Ô˘ ÂÎÙÚ¿ËÎÂÙË˜ ÔÚÂ›·˜ ÙÔ˘.

∆· ÂÁÎ·‡Ì·Ù· Î·È Ë Î·Ù¿ÔÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜‹Ù·Ó Ù· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ·Ù˘¯‹Ì·ÙÔ˜ ÛÙË ‚ÚÂÊÈÎ‹

∂ÈÎfiÓ· 3. £¿Ó·ÙÔÈ ·fi ·Ù˘¯‹Ì·Ù· Î·Ù¿ ÙË ‰ÈÂÙ›· 1997-1998(¶ËÁ‹: ∂™À∂).

70

60

50

40

30

20

10

0

∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù·∂ÁÎ·‡Ì·Ù·¶ÙÒÛÂÈ˜¢ËÏËÙËÚÈ¿ÛÂÈ˜ÕÏÏ· ·Ù˘¯‹Ì·Ù·

∏ÏÈÎ›· (¤ÙË)0-1 1-4 4-6 6-14

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∂ÈÎfiÓ· 4. ∫·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ Ê‡ÏÔ Î·È ËÏÈÎ›·.

300

250

200

150

100

50

0∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

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63,7%

36,3%

∂ÈÎfiÓ· 5. ∫·Ù·ÓÔÌ‹ Î·Ù¿ Ê‡ÏÔ Î·È ËÏÈÎ›·.

∞Û

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80

70

60

50

40

30

20

10

0 0-17 7

15

25

12

31

39

72

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July August 04 07-10-04 13:52 ™ÂÏ›‰·276

ËÏÈÎ›·. ™ÙË ÓËÈ·Î‹ ËÏÈÎ›·, ÙËÓ ÚÒÙË ı¤ÛË Î·ÙÂ›¯·ÓÔÈ Î·ÎÒÛÂÈ˜ ÌÂÙ¿ ·fi ÙÒÛË. ∆· ÙÚÔ¯·›· ·Ù˘¯‹Ì·-Ù· Â˘ı‡ÓÔÓÙ·Ó ÁÈ· ÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓÛÂ ·È‰È¿ ÙË˜ ÚÔÛ¯ÔÏÈÎ‹˜ Î·È Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Î·È·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÙÒÛÂÈ˜.

™Â 169 ·Ù˘¯‹Ì·Ù· (42,9%), Ë ÚÒÙË ÂÎÙ›ÌËÛË¤ÁÈÓÂ ÛÂ ÓÔÛÔÎÔÌÂ›Ô ÂÓËÏ›ÎˆÓ, Î˘Ú›ˆ˜ ÙË˜ Â·Ú¯›·˜.∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, Ù· 253 (64,2%) ˘Ô-‚Ï‹ıËÎ·Ó ÛÂ ÂÂ›ÁÔ˘Û· ÂÓ‰ÔÙÚ·¯ÂÈ·Î‹ ‰È·ÛˆÏ‹Óˆ-ÛË Ô˘ ÂÎÙÂÏ¤ÛÙËÎÂ ÛÙÔ ÚÒÙÔ Î¤ÓÙÚÔ ˘Ô‰Ô¯‹˜.∂‚‰ÔÌ‹ÓÙ· ‰‡Ô ·È‰È¿, Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙËª∂£, ‚Ú›ÛÎÔÓÙ·Ó ÛÂ Î·Ù¿ÛÙ·ÛË ÔÏÈÁ·ÈÌÈÎ‹˜ Î·Ù·-ÏËÍ›·˜ Î·È ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÂÂ›ÁÔ˘Û· ÌÂÙ¿ÁÁÈÛË·›Ì·ÙÔ˜. ™Â 53 ·fi ·˘Ù¿ ¯ÔÚËÁ‹ıËÎ·Ó ÂÈÏ¤ÔÓ Î·ÈÈÓÔÙÚfi· Ê¿ÚÌ·Î·.

∏ Û˘¯ÓfiÙËÙ· ÚˆÙÔ·ıÔ‡˜ ÚÔÛ‚ÔÏ‹˜ ·Ó¿·Ó·ÙÔÌÈÎfi Û‡ÛÙËÌ· Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 8. ∆Ô∫¡™ Î·Ù·Ï·Ì‚¿ÓÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi(69,8%) Î·È ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ÌÔÓ‹ÚË˜ Î¿ÎˆÛË ÛÙËÓÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ¶ÚÔÛ‚ÔÏ‹ ÂÓfi˜Û˘ÛÙ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎÂ ÛÂ 264 ·ÛıÂÓÂ›˜, ‰‡ÔÛ˘ÛÙËÌ¿ÙˆÓ ÛÂ 99 Î·È ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÛÂ 31·ÛıÂÓÂ›˜. ™ÙÔ˘˜ 99 ·ÛıÂÓÂ›˜ Ô˘ Ë Î¿ÎˆÛË ·ÊÔ-ÚÔ‡ÛÂ ÛÂ ‰‡Ô Û˘ÛÙ‹Ì·Ù·, ÙÔ ‰Â‡ÙÂÚÔ ·Ó·ÙÔÌÈÎfi

Û‡ÛÙËÌ· Î·Ù¿ Êı›ÓÔ˘Û· ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜ ‹Ù·Ó ÙÔÌ˘ÔÛÎÂÏÂÙÈÎfi, ÙÔ ÂÙÈÎfi, ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Î·È ÙÔÔ˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·.

∫·Ù¿ ÙË ÓÔÛËÏÂ›· ÙÔ˘˜ ÛÙË ª∂£, 85 ·È‰È¿ ˘Ô-‚Ï‹ıËÎ·Ó ÛÂ ÂÂ›ÁÔ˘Û· ‹ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË, ÙÔ Â›‰Ô˜ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓÔÔ›ˆÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ™Â ¤ÓÙÂ ÂÚÈ-ÙÒÛÂÈ˜ ··ÈÙ‹ıËÎÂ ‚ÚÔÁ¯ÔÛÎfiËÛË ÁÈ· ÙËÓ ·Ê·›-ÚÂÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ·fi ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜. ∂Ó‰ÔÓÔ-ÛÔÎÔÌÂÈ·Î‹ ÏÔ›ÌˆÍË ÂÎ‰ËÏÒıËÎÂ ÛÙÔ 4,06% ÙˆÓ·ÛıÂÓÒÓ Î·È ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ ÛÂ ÛÙÂÏ¤¯Ë ÛÙ·Ê˘-ÏfiÎÔÎÎÔ˘, „Â˘‰ÔÌÔÓ¿‰·˜ Î·È ÂÓÙÂÚÔ‚·ÎÙËÚÈ‰›Ô˘.∫·Ù·ÁÚ¿ÊËÎ·Ó, Â›ÛË˜, ÌÂÌÔÓˆÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜Û˘ÌÊ˘ÙÈÎÔ‡ ÂÈÏÂÔ‡, ÌÂÙ·ÙÚ·˘Ì·ÙÈÎ‹˜ ·ÁÎÚÂ·Ù›ÙÈ-‰·˜, ‰È·‡ËÛË˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ Î·È ‚·ÚÔ-ÙÚ·‡Ì·ÙÔ˜. O ‰È¿ÌÂÛÔ˜ (median) ¯ÚfiÓÔ˜ ÌË¯·ÓÈÎÔ‡·ÂÚÈÛÌÔ‡ Î·È ÓÔÛËÏÂ›·˜ ÛÙË ª∂£ ·Ó‹ÏıÂ ÛÂ 3 Î·È 5ËÌ¤ÚÂ˜, ·ÓÙ›ÛÙÔÈ¯·.

∏ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ·ÔÙ˘ÒÓÂÙ·È ÛÙËÓ ∂ÈÎfi-Ó· 9. ¶Ï‹ÚË˜ ›·ÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ 60,7% Î·È˘ÔÏÂÈÌÌ·ÙÈÎ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹ ÛÙÔ 26,1%. ∏‡·ÚÍË ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ Û˘Ó‰ÚÔÌ‹˜ÂÎÙÈÌ‹ıËÎÂ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∂£ Î·È Û‡ÌÊˆ-Ó· ÌÂ ÙËÓ ∫Ï›Ì·Î· ¶ÚfiÁÓˆÛË˜ ÙË˜ °Ï·ÛÎÒ‚Ë˜ (6). ∏ıÓËÙfiÙËÙ· ·Ó‹ÏıÂ ÛÙÔ 13,2%. ∏ Î˘Ú›· ·ÈÙ›· ı·Ó¿ÙÔ˘

¶›Ó·Î·˜ 1. ÃÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜

∂¤Ì‚·ÛË ∂Â›ÁÔ˘Û· ¶ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË

¶·ÚÔ¯¤ÙÂ˘ÛË 39ÂÓ‰ÔÂÁÎÂÊ·ÏÈÎÔ‡ ·ÈÌ·ÙÒÌ·ÙÔ˜™˘ÚÚ·Ê‹ ÛÏËÓfi˜ - 11ÛÏËÓÂÎÙÔÌ‹ ¡ÂÊÚÂÎÙÔÌ‹ 4™˘ÚÚ·Ê‹ Ú‹ÍË˜ ÂÓÙ¤ÚÔ˘ 3™˘ÚÚ·Ê‹ Ú‹ÍË˜ ‹·ÙÔ˜ 5ÃÂÈÚÔ˘ÚÁÈÎ‹ ·Ó¿Ù·ÍË 15Î·Ù·ÁÌ¿ÙˆÓÃÂÈÚÔ˘ÚÁÈÎfi˜ 8Î·ı·ÚÈÛÌfi˜ ÂÁÎ·˘Ì¿ÙˆÓ

∂ÈÎfiÓ· 6. ∂Ô¯È·Î‹ Î·Ù·ÓÔÌ‹ ·Ù˘¯ËÌ¿ÙˆÓ.

ÃÂÈÌÒÓ·˜ ÕÓÔÈÍË ∫·ÏÔÎ·›ÚÈ ºıÈÓfiˆÚÔ

¶ÔÛ

ÔÛÙfi

ÂÈÛ

·Áˆ

ÁÒÓ

(%)

35

30

25

20

15

10

5

0

19,55

23,85

33,25

23,35

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

¶Â˙Ô›26,9%∂È‚¿ÙÂ˜

60,5%

∆ÚÔ¯·›··Ù˘¯‹Ì·Ù·

46,2%¶ÙÒÛÂÈ˜32,2%

¢ËÏËÙËÚÈ¿ÛÂÈ˜5,8%

∂ÁÎ·‡Ì·Ù·5,8%

•¤ÓÔ ÛÒÌ·2,6%

¶ÓÈÁÌfi˜1,7%

ÕÏÏ· ·›ÙÈ·5,6%

¶Ô‰ËÏ¿ÙÂ˜12,6%

∂ÈÎfiÓ· 8. ™˘¯ÓfiÙËÙ· ÚˆÙÔÁÂÓÔ‡˜ ÚÔÛ‚ÔÏ‹˜ ·Ó¿ Û‡ÛÙËÌ·(N=394).

AÓ·ÓÂ˘ÛÙÈÎfi9,4%

ª˘ÔÛÎÂÏÂÙÈÎfi6,9%

∂ÁÎ·‡Ì·Ù·5,8%

¶ÂÙÈÎfi4,5%

∫·Ú‰È·ÁÁÂÈ·Îfi1,5%

O˘ÚÔÔÈËÙÈÎfi1,2%

K¿ÎˆÛË ÔÊı·ÏÌÒÓ

1,2%

K.N.™.69,8%

277


July August 04 07-10-04 13:52 ™ÂÏ›‰·277

278

‹Ù·Ó ÔÈ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ¤˜ Î·ÎÒÛÂÈ˜ (∫∂∫). OÈ Â-ÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ (36/52) ÛËÌÂÈÒıË-Î·Ó ÛÂ ·È‰È¿ Ô˘ ‰È·ÎÔÌ›ÛÙËÎ·Ó ·fi ÙËÓ Â·Ú¯›·.

™˘˙‹ÙËÛË ∆· ·Ù˘¯‹Ì·Ù· ÛÙ· ·È‰È¿ Î·È È‰È·›ÙÂÚ· ÙÔ ÙÚ·‡-

Ì·, ·ÔÙÂÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ›Ûˆ˜ ÚfiÎÏËÛË ÁÈ·ÙÈ˜ ª∂£. OÈ ÙÚ·˘Ì·ÙÈÎ¤˜ Î·ÎÒÛÂÈ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·ÈÁÈ· ÙÔ 50% ÙˆÓ ı·Ó¿ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 1-14 ÂÙÒÓÎ·È ·ÔÙÂÏÔ‡Ó, ÌÂÙ¿ ÙÈ˜ ÏÔÈÌÒÍÂÈ˜, ÙË ‰Â‡ÙÂÚË ÛÂÛ˘¯ÓfiÙËÙ· ·ÈÙ›· ÚÔÛ¤ÏÂ˘ÛË˜ ÛÙ· ∆Ì‹Ì·Ù· ∂ÂÈÁfi-ÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ (∆∂¶). ™ÙÈ˜ ∏¶∞, ÔÈ ÌÂÙ·ÊÔÚ¤˜ÛÙ· ∂ÍˆÙÂÚÈÎ¿ π·ÙÚÂ›· (∂π) ÙˆÓ ÓÔÛÔÎÔÌÂ›ˆÓ, ·ÏÏ¿Î·È ÛÙ· È‰ÈˆÙÈÎ¿ È·ÙÚÂ›·, ÌÂÙ¿ ·fi ·Ù‡¯ËÌ· Î·Ù·-Ï·Ì‚¿ÓÔ˘Ó ÙÔ 34,4% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÌÂÙ·ÊÔÚÒÓ(∆∂¶: 13,2%, ∂π: 2,6%, È‰ÈˆÙÈÎ¿ È·ÙÚÂ›·: 18,7%) (3).™ÙËÓ ›‰È· ¯ÒÚ·, ·fi Ù· ÛÙÔÈ¯Â›· Ô˘ Î·Ù·ÁÚ¿ÊËÎ·ÓÙÔ 2000 ÛÙÔ “Annual Summary of Vital Statistics”, Á›-ÓÂÙ·È Ì›· ·Ó·‰ÚÔÌ‹ ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓÙˆÓ ∏¶∞ Î·Ù¿ ÙÔÓ ÂÚ·ÛÌ¤ÓÔ ·ÈÒÓ· Î·È ·Ó·Ê¤ÚÂÙ·ÈfiÙÈ Ë ıÓËÙfiÙËÙ· ·fi ÏÔÈÌÒÍÂÈ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘-ÛÌfi ÙÔ 1900 ‹Ù·Ó 61,6%, ÂÓÒ ÙÔ 1998 ÂÏ·ÙÙÒıËÎÂÛÙÔ 2%. ∆Ô 1900, Ë ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ı·Ó¿-ÙˆÓ ·fi ·Ù˘¯‹Ì·Ù· ·ÓÂÚ¯fiÙ·Ó ÛÂ 6,3% ÙˆÓ ı·Ó¿-ÙˆÓ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÂÓÒ ÙÔ 1998 ·˘Í‹ıË-ÎÂ ÛÂ 43,9%, ÔÈ ÌÈÛÔ› ÂÎ ÙˆÓ ÔÔ›ˆÓ ·Ô‰fiıËÎ·Ó ÛÂÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· (7). ∆· ÛÙÔÈ¯Â›· ·˘Ù¿ ·ÔÙ˘Ò-ÓÔ˘Ó ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ‰Â›¯ÓÔ˘Ó fiÙÈ,ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ÙÔ ÙÚ·‡Ì· ÙÂ›ÓÂÈ Ó· Ï¿‚ÂÈÙË ÌÔÚÊ‹ ÂÈ‰ËÌÈÎ‹˜ ÓfiÛÔ˘, Ë ·ÓÙÈÌÂÙÒÈÛË ÙË˜ÔÔ›·˜ ··ÈÙÂ› ÙË Ï‹„Ë ¿ÌÂÛˆÓ Ì¤ÙÚˆÓ. ∆· Ì¤ÙÚ··˘Ù¿ ÎÈÓÔ‡ÓÙ·È ÛÂ ÙÚÂÈ˜ ¿ÍÔÓÂ˜: ÂÎ·›‰Â˘ÛË, ÙÂ¯ÓÔ-ÏÔÁ›· Î·È ÓÔÌÔıÂÛ›· (ÁÓˆÛÙÔ› ˆ˜ ∂∂∂ ·fi Ù· ·Ú¯È-Î¿ ÙˆÓ ·ÁÁÏÈÎÒÓ Ï¤ÍÂˆÓ education, engineering Î·Èlaw enforcement) (8).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÙÔ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÛÙÔÔÔ›Ô ÂÌÏ¤ÎÂÙ·È ÙÔ ·È‰› ˆ˜ Â˙fi˜ ‹ ÂÈ‚¿ÙË˜,Û˘ÁÎÂÓÙÚÒÓÂÈ Ù· ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ÓÔÛËÚfiÙË-Ù·˜ Î·È ıÓËÙfiÙËÙ·˜ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ fiÏÂ˜ ÙÈ˜ ¿ÏÏÂ˜·ÈÙ›Â˜ ·Ù˘¯‹Ì·ÙÔ˜. ∆· Â˘Ú‹Ì·Ù· ·˘Ù‹˜ ÙË˜ ÌÂÏ¤-ÙË˜ Â›Ó·È Û‡ÌÊˆÓ· ÌÂ ÂÎÂ›Ó· ÙË˜ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔ-ÁÚ·Ê›·˜ (1,2,9,10), Î·›ÙÔÈ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ÔÌ¿‰·‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ. °ÂÓÈÎ¿, ˘¿Ú¯ÂÈ ‰˘ÛÎÔÏ›·˘ÔÏÔÁÈÛÌÔ‡ ÙË˜ ·Ó·ÏÔÁ›·˜ ÙÔ˘ ‚·Ú¤Ô˜ ÙÚ·‡Ì·-

ÙÔ˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÙ·ÓÔÛÔÎÔÌÂ›·. ™‡ÌÊˆÓ· ÌÂ Ì›· ÌÂÏ¤ÙË Ô˘ ‰ËÌÔÛÈ-Â‡ÙËÎÂ ÚfiÛÊ·Ù·, Ë ÔÔ›· Û˘ÁÎÂÓÙÚÒÓÂÈ ÛÙÔÈ¯Â›··fi 50 Î¤ÓÙÚ· ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜, ÙÔ ÔÛÔÛÙfiÙˆÓ ·È‰ÈÒÓ ÌÂ ISS (injury severity score) >24·Ó¤Ú¯ÂÙ·È ÛÂ 6,5% (2). ∆· ·È‰È¿ ·˘Ù¿ ·ÔÙÂÏÔ‡ÓÙÔÓ ÏËı˘ÛÌfi ÙˆÓ ÙÚ·˘Ì·ÙÈÒÓ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·ÈÛÂ ª∂£.

°È· ÙËÓ ·‡ÍËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÙÚÔ¯·›ˆÓ·Ù˘¯ËÌ¿ÙˆÓ Â˘ı‡ÓÔÓÙ·È ÔÈ Ô‰ËÁÔ› (ÂÏÏÈ‹˜ ÂÎ·›-‰Â˘ÛË, ·‰˘Ó·Ì›· Ù‹ÚËÛË˜ ÙˆÓ Î·ÓfiÓˆÓ Ô‰ÈÎ‹˜ Î˘-ÎÏÔÊÔÚ›·˜, Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ), Ë ¤ÏÏÂÈ„Ë Ì¤-ÙÚˆÓ ÚÔÛÙ·Û›·˜ ÙÔ˘ ·È‰ÈÔ‡-ÂÈ‚¿ÙË Ì¤Û· ÛÙÔ·˘ÙÔÎ›ÓËÙÔ (Î·Ù¿ÏÏËÏË ı¤ÛË, ¯Ú‹ÛË ·È‰ÈÎÒÓ Î·-ıÈÛÌ¿ÙˆÓ, ˙ÒÓË ÚÔÛ·ÚÌÔÛÌ¤ÓË ÛÙËÓ ËÏÈÎ›· ÙÔ˘·È‰ÈÔ‡) Î·È Ù¤ÏÔ˜ Ë ¤ÏÏÂÈ„Ë ·ÛÊ¿ÏÂÈ·˜ ÛÙÔ˘˜‰ÚfiÌÔ˘˜ (10-12).

™Â fiÏÂ˜ ÙÈ˜ ËÏÈÎ›Â˜, ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÔ¯‹ ÙˆÓ·ÁÔÚÈÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÛÂ fi,ÙÈ ·ÊÔÚ¿ Ù··Ù˘¯‹Ì·Ù·. ∏ ÎÚ›ÛÈÌË ËÏÈÎ›· ÁÈ· Ù· ÙÚÔ¯·›· ·Ù˘¯‹-Ì·Ù· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë Û¯ÔÏÈÎ‹. ∞ÓÙ›ıÂÙ·, ÛÙ··È‰È¿ ÙË˜ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜, ÔÈ ÙÒÛÂÈ˜ ·ÔÙÂ-ÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜·fi ·Ù˘¯‹Ì·Ù· (13). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÈÎ·ÈÔÏÔÁÂ›-Ù·È ·fi ÙËÓ ·˘ÍËÌ¤ÓË ÂÚÈ¤ÚÁÂÈ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ËÏÈÎ›·, ÙËÓ ˘ÂÚÎÈÓËÙÈÎ‹ Û˘ÌÂÚÈ-ÊÔÚ¿ ÙˆÓ ÓË›ˆÓ, ·ÏÏ¿ Î·È ·fi ÙËÓ Èı·Ó‹ ·Ì¤ÏÂÈ·ÙˆÓ ÁÔÓ¤ˆÓ.

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfiÎ¿ÎˆÛË˜ Î·Ù¤Ï·‚Â ÙÔ ∫¡™. ∞˘Ùfi ·ÔÙÂÏÂ› ı¤ÛËÔÌÔÊˆÓ›·˜ ÙË˜ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘ ·Ó·-Ê¤ÚÂÙ·È ÛÙÔ ·È‰ÈÎfi ÙÚ·‡Ì·. ∏ ‡·ÚÍË ‚·ÚÈ¿˜∫∂∫ ÛÙÔ ÙÚ·‡Ì· ‰ÂÎ·Ï·ÛÈ¿˙ÂÈ ÙË ıÓËÙfiÙËÙ· Î·È·ÔÙÂÏÂ› ÙÔÓ Î‡ÚÈÔ ·Ú¿ÁÔÓÙ· ÙË˜ ÚfiÁÓˆÛË˜ (9).∏ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈÎ‹ Î¿ÎˆÛË ÛÙ· ·È‰È¿ ¤¯ÂÈ ÙËÌÔÚÊ‹ ‰È¿¯˘ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ‚Ï¿‚Ë˜ (ÂÁÎÂÊ·ÏÈÎfiÔ›‰ËÌ·, ‰È¿¯˘ÙË ·ÈÌÔÚÚ·ÁÈÎ‹ ıÏ¿ÛË). ∆· ÂÓ‰ÔÂÁÎÂ-Ê·ÏÈÎ¿, Î·ıÒ˜ Î·È Ù· ÂÈÛÎÏËÚ›‰È· Î·È ˘ÔÛÎÏËÚ›-‰È· ·ÈÌ·ÙÒÌ·Ù· ‰ÂÓ Â›Ó·È Û˘¯Ó¿. ™˘¯ÓfiÙÂÚ· ··-ÓÙ¿Ù·È ÙÔ ˘ÔÛÎÏËÚ›‰ÈÔ ·ÈÌ¿ÙˆÌ· Ô˘ ÂÌÊ·Ó›˙ÂÙ·ÈÎ˘Ú›ˆ˜ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙÔ˘ ÂÓfi˜¤ÙÔ˘˜, ÔÈ Ì‹ÓÈÁÁÂ˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÏÂÙ¤˜ Î·È Â‡-ıÚ·˘ÛÙÂ˜. O Î›Ó‰˘ÓÔ˜ ÁÈ· ÂÈÛÎÏËÚ›‰ÈÔ ·ÈÌ¿ÙˆÌ··˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· Î·È Û¿ÓÈ· ··ÓÙ¿-Ù·È ÛÂ ·È‰È¿ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 4 ÂÙÒÓ (9).

O ·ÚÈıÌfi˜ ÙˆÓ ıˆÚ·ÎÈÎÒÓ Î·ÎÒÛÂˆÓ, ÌÂ ÙËÓ¤ÓÓÔÈ· ÙË˜ ÌÂÌÔÓˆÌ¤ÓË˜ Î¿ÎˆÛË˜, ˘‹ÚÍÂ ÌÈÎÚfi˜.°ÂÓÈÎ¿, ÔÈ ÌÔÓ‹ÚÂÈ˜ ıˆÚ·ÎÈÎ¤˜ Î·ÎÒÛÂÈ˜ Â›Ó·È Û¿-ÓÈÂ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯Ô˘Ó ÌÂ∫∂∫ Î·È Î¿ÎˆÛË ÎÔÈÏ›·˜. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ÔÊÂ›ÏÔÓÙ·È ÛÂ ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Î·È ÙÒÛÂÈ˜. OÈÂÚÈÛÛfiÙÂÚÂ˜ Â›Ó·È ÎÏÂÈÛÙ¤˜ Î·ÎÒÛÂÈ˜ Ô˘ Û˘Ó‹-ıˆ˜ ˘ÔÂÎÙÈÌÔ‡ÓÙ·È, ÁÈ·Ù› Ë ÂÏ·ÛÙÈÎfiÙËÙ· ÙˆÓ

∂ÈÎfiÓ· 9. ŒÎ‚·ÛË ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ.

£¿Ó·ÙÔÈ13,2%

ÿ·ÛË60,7%

ÀÔÏÂÈÌÌ·ÙÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ ÓfiÛÔ˜

26,1%


July August 04 07-10-04 13:52 ™ÂÏ›‰·278

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ÏÂ˘ÚÒÓ Î·È Ë ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÛÙ··È‰È¿ ÙÈ˜ Î·ıÈÛÙÔ‡Ó ÎÏÈÓÈÎ¿ ÌË ÂÌÊ·ÓÂ›˜. °È· ÙÔÓÏfiÁÔ ·˘Ùfi, ‰ÂÓ ·ÔÎÏÂ›ÂÙ·È Ë ‡·ÚÍË ÓÂ˘ÌÔıÒ-Ú·Î·, ·ÈÌÔıÒÚ·Î· ‹ ÓÂ˘ÌÔÓÈÎ‹˜ ıÏ¿ÛË˜ Â›·Ô˘Û›·˜ ·ÎÙÈÓÔÏÔÁÈÎ¿ ÂÌÊ·ÓÔ‡˜ Î·Ù¿ÁÌ·ÙÔ˜ÏÂ˘ÚÒÓ. ∏ ıÓËÙfiÙËÙ· ÏfiÁˆ ıˆÚ·ÎÈÎÒÓ Î·ÎÒÛÂˆÓÂ›Ó·È ÌÈÎÚ‹, ·ÓÂÚ¯fiÌÂÓË ÛÂ ÔÛÔÛÙfi ÂÚ›Ô˘ 3%Î·È ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙË Û˘Ó‡·ÚÍË Î¿ÎˆÛË˜¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ, fiˆ˜ ÙÔ˘ ∫¡™ Î·È ÙÔ˘ ÂÙÈ-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (9).

OÈ ÂÓ‰ÔÎÔÈÏÈ·Î¤˜ Î·ÎÒÛÂÈ˜ ‰ÂÓ Â›Ó·È Û¿ÓÈÂ˜ÛÙ· ·È‰È¿. ∏ ·ÙÂÏ‹˜ ÔÛÙÂÔÔ›ËÛË ÙˆÓ ÏÂ˘ÚÒÓÎ·È ÙÔ ÌÈÎÚfi Ì¤ÁÂıÔ˜ ÙË˜ ÂÚÈÙÔÓ·˚Î‹˜ ÎÔÈÏfiÙËÙ·˜Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ ÚÔÛÊ¤-ÚÔ˘Ó ÌÈÎÚ‹ ÚÔÛÙ·Û›· ÛÙÔ ‹·Ú, ÙÔÓ ÛÏ‹Ó· Î·ÈÙÔ˘˜ ÓÂÊÚÔ‡˜, Ù· ÔÔ›· Â›Ó·È Â˘ÚfiÛ‚ÏËÙ· ÛÂ Î¿-ÎˆÛË. ™˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÔÓÙ·È ˆ˜ ˘ÔÎ¿„ÈÔ ·ÈÌ¿-ÙˆÌ· ÙÔ˘ ‹·ÙÔ˜, ÙÔ˘ ÛÏËÓfi˜ Î·È ÙˆÓ ÓÂÊÚÒÓ. OÈ‚·ÚÈ¤˜ Î·ÎÒÛÂÈ˜ ÙˆÓ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ, fiˆ˜Ú‹ÍÂÈ˜ ‹ ÌÂÁ¿ÏÂ˜ ıÏ¿ÛÂÈ˜, Â›Ó·È Û¿ÓÈÂ˜. ∏ ıÓËÙfi-ÙËÙ· ÏfiÁˆ ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ Î·ÎÒÛÂˆÓ Â›Ó·È Â›ÛË˜Û˘Ó¿ÚÙËÛË ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÛÙÔ ÙÚ·‡Ì· Î¿ÎˆÛË˜¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ ‹ Û˘ÛÙËÌ¿ÙˆÓ. π‰È·›ÙÂÚË ÛËÌ·Û›··ÚÔ˘ÛÈ¿˙ÂÈ Ë Ú‹ÍË ÛÏËÓfi˜, ‰ÈfiÙÈ Ë ÌÂÙ·ÙÚ·˘Ì·-ÙÈÎ‹ ·ÛÏËÓ›· ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙË˜ ÂÎ‰‹ÏˆÛË˜ ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ ÙË˜ ÌÂÙ¿ ÛÏËÓÂÎÙÔÌ‹ ÔÍÂ›·˜ ÎÂÚ·˘-ÓÔ‚fiÏÔ˘ Û‹„Ë˜. ∏ ÂÎ‰‹ÏˆÛË ÔÏÈÁ·ÈÌÈÎ‹˜ Î·Ù·ÏË-Í›·˜ Â› ÂÓ‰ÔÎÔÈÏÈ·Î‹˜ ·ÈÌÔÚÚ·Á›·˜ ÂÈ‚·Ú‡ÓÂÈ ÛË-Ì·ÓÙÈÎ¿ ÙËÓ ÚfiÁÓˆÛË. ∏ ÌÂÁ¿ÏË ·ÒÏÂÈ· ·›Ì·-ÙÔ˜, Ë ·Ú·ÙÂÈÓfiÌÂÓË ˘fiÙ·ÛË Î·È Ë Â·ÎfiÏÔ˘ıËÂÏ¿ÙÙˆÛË ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜ ¤¯Ô˘ÓÂÓÔ¯ÔÔÈËıÂ› ÁÈ· ‰Â˘ÙÂÚÔ·ı‹ ÂÁÎÂÊ·ÏÈÎ‹ ‚Ï¿‚ËÎ·È ˘ÔÍ·ÈÌÈÎ‹, ÈÛ¯·ÈÌÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·.

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈ 36 ·fi ÙÔ˘˜ 52 ı·Ó¿-ÙÔ˘˜ (69,2%) Û˘Ó¤‚ËÛ·Ó ÛÂ ·È‰È¿ Ô˘ ·ÓÙÈÌÂÙˆ›-ÛÙËÎ·Ó ·Ú¯ÈÎ¿ ÛÂ Â·Ú¯È·Î¿ ÓÔÛÔÎÔÌÂ›·. ∫¿ÔÈÔÈ·fi ·˘ÙÔ‡˜ ı· ÌÔÚÔ‡Û·Ó ›Ûˆ˜ Ó· ÚÔÏËÊıÔ‡Ó,Â¿Ó Ë ·ÓÙÈÌÂÙÒÈÛË ¿Ú¯È˙Â ÛÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹-Ì·ÙÔ˜ ·fi ÔÌ¿‰· ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓË ÛÙËÓ ÂÂ›ÁÔ˘Û·È·ÙÚÈÎ‹ Î·È Û˘ÓÂ¯È˙fiÙ·Ó ÌÂ ÙËÓ Ù·¯Â›· Î·È ·ÛÊ·Ï‹‰È·ÎÔÌÈ‰‹ ÙÔ˘ ÙÚ·˘Ì·Ù›· ÛÙÔ Î·Ù¿ÏÏËÏÔ Î¤ÓÙÚÔ,ÌÂ ‰›ÎÙ˘Ô ÌÂÙ·ÊÔÚ¿˜ ÛÙÂÏÂ¯ˆÌ¤ÓÔ ·fi ¤ÌÂÈÚÔ˘˜ÂÓÙ·ÙÈÎÔÏfiÁÔ˘˜ Î·È Û‡Á¯ÚÔÓÔ ÂÍÔÏÈÛÌfi. ∏ ÛËÌ·-Û›· ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÂ ÓÔÛÔ-ÎÔÌÂ›Ô ÙÔÓ›˙ÂÙ·È ÛÂ ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜. ∂Ó‰ÂÈÎÙÈÎ¿,·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ıÓËÙfiÙËÙ· ·È‰ÈÒÓ ÌÂ ‚·ÚÈ¿ ∫∂∫Ô˘ ÌÂÙ·Ê¤ÚÔÓÙ·È ¿ÌÂÛ· ·fi ÙÔÓ ÙfiÔ ÙÔ˘ ·Ù˘¯‹-Ì·ÙÔ˜ ÛÂ Î¤ÓÙÚÔ Î·Ù¿ÏÏËÏÔ Ó· Ù· ·ÓÙÈÌÂÙˆ›ÛÂÈ,·Ó¤Ú¯ÂÙ·È ÛÂ 26,8%, ÂÓÒ ·˘Í¿ÓÂÙ·È ÛÂ 50% fiÙ·Ó·ÚÂÌ‚¿ÏÏÂÙ·È ÂÓ‰È¿ÌÂÛÔ˜ ÛÙ·ıÌfi˜ (14-16). ∏·ÛÊ·Ï‹˜ ÌÂÙ·ÊÔÚ¿ ÛÂ ¯ÚfiÓÔ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 4ˆÚÒÓ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÚfiÁÓˆÛË Î·È ·ÔÙÂÏÂ› ÙÔÓÎÔÚÌfi ÂÓfi˜ ÔÚÁ·ÓˆÌ¤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ·ÊÔÚ¿˜

(17). ¶·Ú·Ì¤ÓÂÈ ÎÏ·ÛÈÎ‹ Ë ÌÂÏ¤ÙË ÙÔ˘ Trunkey Ô˘·¤‰ÂÈÍÂ, ÚÈÓ ·fi 20 ¯ÚfiÓÈ·, fiÙÈ Ë ÚÒÙË ÒÚ· ÌÂ-Ù¿ ÙÔ ·Ù‡¯ËÌ·, Ë ·ÔÎ·ÏÔ‡ÌÂÓË “¯Ú˘Û‹ ÒÚ·”, Â›-Ó·È Î·ıÔÚÈÛÙÈÎ‹ ÁÈ· ÙËÓ ¤Î‚·ÛË ÙÔ˘ ÙÚ·˘Ì·Ù›·: “OÛˆÛÙfi˜ ·ÛıÂÓ‹˜, ÛÙÔ ÛˆÛÙfi ÓÔÛÔÎÔÌÂ›Ô, ÙË Ûˆ-ÛÙ‹ ÒÚ·” (18).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ·ÚÔ‡Û· ÌÂÏ¤ÙË ÚÔÛÂÁÁ›-˙ÂÈ ÙËÓ È‰È·›ÙÂÚË ÔÌ¿‰· ·È‰ÈÒÓ ÌÂ ÙÚ·‡Ì· ÌÂÁ¿ÏË˜‚·Ú‡ÙËÙ·˜. ∆Ô 1/4 ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, Î·Ù¿ ÙËÓ ¤ÍÔ-‰Ô ·fi ÙË ª∂£, ·ÚÔ˘Û›·˙Â ˘ÔÏÂÈÌÌ·ÙÈÎ‹ ÓÂ˘ÚÔ-ÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹ Î·È ÓÔÛËÏÂ‡ÙËÎÂ ÛÙË ÃÂÈÚÔ˘ÚÁÈÎ‹∫ÏÈÓÈÎ‹ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ÁÈ· ¿ÏÏÔÙÂ ¿ÏÏÔ ¯ÚfiÓÔ.ŒÓ· ÔÛÔÛÙfi ÌÂÙ·Ê¤ÚıËÎÂ ÛÙÔ Û›ÙÈ ÌÂ Ô‰ËÁ›Â˜ ÁÈ·ÎÈÓËÙÈÎ‹ Ê˘ÛÈÎÔıÂÚ·Â›· Î·È ÊÚÔÓÙ›‰·. ∞˘Ùfi ÛËÌ·›-ÓÂÈ fiÙÈ ÙÔ ÙÚ·‡Ì· ¤¯ÂÈ ÂÈ‰Ú¿ÛÂÈ˜ fi¯È ÌfiÓÔ ÛÙÔ ›‰ÈÔÙÔ ·È‰›, ·ÏÏ¿ Î·È ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, ÛÙÔ˘˜ Ê›-ÏÔ˘˜ Î·È ÛÙÔÓ Â˘Ú‡ÙÂÚÔ ÎÔÈÓˆÓÈÎfi ÙÔ˘ ÂÚ›Á˘ÚÔ. ™ÂÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂÏ¤ÙË, ÚÔÂÚ¯fiÌÂÓË ·fiÙË µÔÛÙÒÓË, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ ÌÂÛÔ‚·Úfi ÙÚ·‡Ì· Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÛÂ ª∂£, ¯ÚÂÈ¿-˙ÂÙ·È ÂÈ‰ÈÎfi Û¯ÔÏÂ›Ô. ∆· 2/3 ÙˆÓ ·‰ÂÏÊÒÓ ÙˆÓ ·È-‰ÈÒÓ ·˘ÙÒÓ ·Ó·Ù‡ÛÛÔ˘Ó ·ÚÁfiÙÂÚ· ÂÈıÂÙÈÎ‹ Û˘-ÌÂÚÈÊÔÚ¿ Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û¯Ô-ÏÂ›Ô, ÂÓÒ ÙÔ 1/3 ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ·ÓÙÈÌÂÙˆ›˙ÂÈÚÔ‚Ï‹Ì·Ù· ÛÙË Û¯¤ÛË ÙÔ˘˜ (19). ∆· ·Ú·¿Óˆ˘ÔÁÚ·ÌÌ›˙Ô˘Ó ÙËÓ ‡·ÚÍË ÙË˜ “ÎÚ˘ÌÌ¤ÓË˜ ÓÔÛË-ÚfiÙËÙ·˜” ÙÔ˘ ‚·ÚÈ¿ ÙÚ·˘Ì·ÙÈÛÌ¤ÓÔ˘ ·È‰ÈÔ‡, ËÔÔ›· ÌÔÚÂ› Ó· Ê·ÓÂ› ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·. ∏ ·Ú·ÙË-ÚÔ‡ÌÂÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ÙÔ ˘„ËÏfiÔÛÔÛÙfi ı·Ó¿ÙˆÓ Î·È ̆ ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜Û˘Ó‰ÚÔÌ‹˜ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎË ‰ËÌÈÔ˘ÚÁ›·˜ÂÓfi˜ ÔÚıÔÏÔÁÈÎ¿ ÔÚÁ·ÓˆÌ¤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÓÙÈÌÂ-ÙÒÈÛË˜ ÙÔ˘ ·È‰ÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜. O Û¯Â‰È·ÛÌfi˜ÂÓfi˜ Ù¤ÙÔÈÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÔÌ¿‰·ÙÚ·‡Ì·ÙÔ˜, Û‡ÛÙËÌ· ·ÛÊ·ÏÔ‡˜ Î·È ÁÚ‹ÁÔÚË˜ ÌÂÙ·-ÊÔÚ¿˜ ÛÂ ªÔÓ¿‰· ∆Ú·‡Ì·ÙÔ˜ ÌÂ ‰˘Ó·ÙfiÙËÙ· Û˘ÓÔ-ÏÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌ¤ÓÔ˘ ·È‰ÈÔ‡Î·È ÂÈ‰ÈÎfi ∫¤ÓÙÚÔ ∞ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ÛÙfi¯Ô ÙËÓ ÎÔÈ-ÓˆÓÈÎ‹ Â·Ó¤ÓÙ·ÍË ÙÔ˘ ·È‰ÈÔ‡.

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ºÈÏÈ›· ¡ÈÎÔÏ¿Ô˘ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” T.K.115 23, ∞ı‹Ó·

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

µÚ¤ÊÔ˜ ÌÂ ‚·ÚÈ¿ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›·º. ∫·Î·‚¿, ™. ™Ù¤ÊÔ˜, ∞. ¶ÚÂ˙ÂÚ¿ÎÔ˘, ∞. ¢·Ú˙¤ÓÙ·˜, ∞. µ·ÛÈÏfiÔ˘ÏÔ˜

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

∂ÈÛ·ÁˆÁ‹∏ ÓÂ˘ÌÔÓ›· ·Ú·Ì¤ÓÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÓÔ-

ÛËÚfiÙËÙ·˜, ·ÏÏ¿ Î·È ıÓËÛÈÌfiÙËÙ·˜, ÛÙ· ·È‰È¿, Î˘-Ú›ˆ˜ ÛÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜.

∆Ô Â›‰Ô˜ ÙÔ˘ ·ıÔÁfiÓÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Ô˘ÚÔÎ·ÏÂ› ÙËÓ ÓÂ˘ÌÔÓ›· ¤¯ÂÈ Û¯¤ÛË ÌÂ ÙËÓ ËÏÈÎ›·,ÙËÓ ÂÔ¯‹, ·ÏÏ¿ Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ Î·Ù¿ÛÙ·ÛËÙÔ˘ ·ÛıÂÓÔ‡˜ (1-3). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓÓÂ˘ÌÔÓÈÒÓ ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ËÏÈÎ›Â˜ ÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ7 ÂÙÒÓ, ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Ó· ÂÎ‰ËÏÒÓÂ-Ù·È ÌÂÙ·Í‡ ÙˆÓ 2 Î·È 4 ÂÙÒÓ (7). ™ÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜¯ÒÚÂ˜, Ë ıÓËÙfiÙËÙ· ÙË˜ ÓÂ˘ÌÔÓ›·˜ Â›Ó·È ¯·ÌËÏ‹,ÂÓÒ ÛÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ·Ó¤Ú¯ÂÙ·È ÛÂ ÔÛÔÛÙfi10% (3).

∏ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›· Û˘Ó‹ıˆ˜ ÂÍÂÏ›Û-ÛÂÙ·È ‚·Ú¤ˆ˜, ÂÓÒ ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂÚ· Ù· ‚Ú¤-

ÊË Î·È Ù· ·ÓÔÛÔÎ·ÙÂÛÙ·ÏÌ¤Ó· ·È‰È¿ (1,7). ™˘¯Ó¿,Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÓÂ˘Ì·ÙÔÎ‹ÏÂ˜, ÓÂ˘ÌÔıÒÚ·Î·,˘ÔıÒÚ·Î· Î·È ·ÔÛÙ‹Ì·Ù·, Ô˘ ıÂˆÚÔ‡ÓÙ·È,ˆÛÙfiÛÔ, Ì¤ÚÔ˜ ÙË˜ ÓfiÛÔ˘ Î·È fi¯È ÂÈÏÔÎ¤˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ ËÏÈÎ›·˜ 5

ÌËÓÒÓ, ÌÂ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›·, Î·ıÒ˜ ·-ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ Ë ‚·Ú‡Ù·ÙË ÂÍ¤ÏÈ-ÍË ÙË˜ ÓfiÛÔ˘, Ë ÂÎ‰‹ÏˆÛË fiÏÔ˘ ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙˆÓÂÈÏÔÎÒÓ ÙË˜, Ë ·Ó¿ÁÎË ÁÈ· ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi Î·ÈË Î·Ï‹ ÙÂÏÈÎ‹ ¤Î‚·ÛË, ·Ú¿ ÙË ‚·Ú‡ÙËÙ¿ ÙË˜.

¶ÚfiÎÂÈÙ·È ÁÈ· ¿ÚÚÂÓ ‚Ú¤ÊÔ˜, ÙÔ ÔÔ›Ô ÂÈÛ‹¯ıËÛÂ ·È‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘, ÁÈ·Ù› ·fi48ÒÚÔ˘ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ˘ÚÂÙfi (38,5ÔC), ‚‹¯·Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·.

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜‚Ú¤ÊÔ˘˜, ËÏÈÎ›·˜ 5 ÌËÓÒÓ, ÌÂ ÈÛÙÔÚÈÎfi ·ÛıÌ·ÙÈ-ÎÒÓ ÎÚ›ÛÂˆÓ, ÙÔ ÔÔ›Ô ÚÔÛÎÔÌ›ÛÙËÎÂ ÌÂ ÎÏÈÓÈÎ‹ÂÈÎfiÓ· ÏÔ›ÌˆÍË˜ Î·È ‚·ÚÈ¿˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤-ÚÂÈ·˜, ÚÔÂÍ¿Ú¯ÔÓ Û‡ÌÙˆÌ· ÙË˜ ÔÔ›·˜ ‹Ù·Ó Ô¤ÓÙÔÓÔ˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˜. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ-¯Ô˜ ¤ıÂÛÂ ÙËÓ ˘Ô„›· ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔ-Ó›·˜. ∏ ÓfiÛÔ˜ ‰È¤‰Ú·ÌÂ ‚·Ú¤ˆ˜, ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË˘ÔıÒÚ·Î· Î·È ÓÂ˘ÌÔıÒÚ·Î·. ™ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ·ÙÔ˘ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ·ÔÌÔÓÒıËÎÂ ¯Ú˘Û›˙ˆÓÛÙ·Ê˘ÏfiÎÔÎÎÔ˜. ∏ ıÂÚ·Â›· Û˘ÌÂÚÈ¤Ï·‚Â ÌË¯·-ÓÈÎfi ·ÂÚÈÛÌfi, ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ˘ÔıÒÚ·Î· Î·ÈÓÂ˘ÌÔıÒÚ·Î·, ·ÓÙÈ‚ÈÔÙÈÎ¿ Î·È ÈÛ¯˘Ú‹ ·ÓÙÈ·ÛıÌ·-ÙÈÎ‹ ·ÁˆÁ‹. ¶·Ú¿ ÙË ‚·Ú‡Ù·ÙË ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘,Ë ¤Î‚·ÛË ‹Ù·Ó Î·Ï‹.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›·, ˘Ô-ıÒÚ·Î·˜, ÓÂ˘ÌÔıÒÚ·Î·˜, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜.

�Abstract: The case is described of a 5 month-oldboy with a history of asthma who was admitted tohospital with clinical signs of infection andrespiratory distress. Diffuse wheezes wereauscultated on lung examination. The chest X-raywas suggestive of Staphylococcal pneumonia. Thechild developed severe pneumonia withpneumothorax and empyema. Staphylococcusaureus was isolated from the pleural fluid.Treatment included mechanical ventilation,drainage of the pleural effusion, iv antibiotics andantiasthmatic drugs. The patient had a very goodoutcome despite the severe course of the disease.

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

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

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

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∂›Ó·È ÙÔ Ù¤Ù·ÚÙÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔ ÔÔ›ÔÁÂÓÓ‹ıËÎÂ ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË ‰›‰˘ÌË Î‡ËÛË, ÌÂÊ˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ™ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ˘¿Ú¯ÂÈ ÈÛÙÔ-ÚÈÎfi ¿ÛıÌ·ÙÔ˜ (·Ù¤Ú·˜ Î·È ‰‡Ô ·‰¤ÏÊÈ·), ÂÓÒ ÙÔ›‰ÈÔ ÙÔ ·È‰› ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ‰‡Ô ÂÂÈÛfi‰È··ÛıÌ·ÙÈÎ‹˜ ÎÚ›ÛË˜, ÁÈ· Ù· ÔÔ›· Â›¯Â ÓÔÛËÏÂ˘ÙÂ›ÛÂ ËÏÈÎ›· 3,5 Î·È 4 ÌËÓÒÓ Î·È Â›¯Â ÙÂıÂ› ÛÂ ·ÁˆÁ‹ÌÂ ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎ¿.

∆Ô ‚Ú¤ÊÔ˜, Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô, ‹Ù·Ó ÛÂ ÂËÚÂ·ÛÌ¤ÓË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË,ÌÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, Ù·¯‡ÓÔÈ·, ÁÔÁÁ˘-ÛÌfi, ÂÚÈÛÙÔÌ·ÙÈÎ‹ Î˘¿ÓˆÛË Î·È ·ÁÁÂÈÔÎÈÓËÙÈÎ¤˜‰È·Ù·Ú·¯¤˜.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ‡ÎÓˆÛË ‰ÂÍÈ-Ô‡ ¿Óˆ ÏÔ‚Ô‡ (¢∞§) ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·(∂ÈÎfiÓ· 1). O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ-¯Ô˜ ¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓÔ˘˜ ‰Â›ÎÙÂ˜ ÏÔ›ÌˆÍË˜: CRP: 86mg/L, WBC: 57.000/mm3 (GR: 75% ÌÂ ÙÔÍÈÎ‹ ÎÔÎ-Î›ˆÛË). ∆· ·¤ÚÈ· ·›Ì·ÙÔ˜ ÌÂ ¯ÔÚ‹ÁËÛË O2 40%¤‰ÂÈÍ·Ó pH: 7,19, pO2: 170 mmHg, pCO2: 53 mmHgÎ·È HCO3-: 20.

∆Ô ‚Ú¤ÊÔ˜ Ù¤ıËÎÂ ÛÂ ·ÁˆÁ‹ ÌÂ ‰ÈÎÏÔÍ·ÎÈÎÏ›ÓËÎ·È ÎÂÊÔÙ·Í›ÌË.

§›ÁÂ˜ ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÌÂÙ·Ê¤ÚıË-ÎÂ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜, ÂÂÈ‰‹ ·-ÚÔ˘Û›·ÛÂ ÂÈ‰Â›ÓˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÙÔ˘ ÂÈÎfiÓ·˜ Î·ÈÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜.

∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·È‰È-Ô‡ ÛÙË ª∂£ ¤‰ÂÈÍÂ ıÂÚÌÔÎÚ·Û›· 38,2ÔC, ·ÁÁÂÈÔÎÈ-ÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ‰¤ÚÌ·ÙÔ˜, ÁÔÁÁ˘ÛÌfi, ∞¶:106/53 mmHg, Ù·¯‡ÓÔÈ· (80 ·Ó·ÓÔ¤˜/min), Ù·¯˘-Î·Ú‰›· (190/min), ÂÈÛÔÏÎ¤˜ Â˘¤Ó‰ÔÙˆÓ ÛËÌÂ›ˆÓÙÔ˘ ıÒÚ·Î·, ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ Î·È Â-ÚÈÛÙÔÌ·ÙÈÎ‹ Î˘¿ÓˆÛË.

∞ÎÚÔ·ÛÙÈÎÒ˜, ¤ÁÈÓÂ Ê·ÓÂÚ‹ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘·Ó·ÓÂ˘ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ Î·Ù¿ ÙÔ ‰ÂÍÈfi ËÌÈıˆ-Ú¿ÎÈÔ Î·È Ë ·Ú¿Ù·ÛË ÂÎÓÔ‹˜ ÌÂ ÍËÚÔ‡˜ ÚfiÁ¯Ô˘˜(Û˘Ú›ÙÙÔÓÙÂ˜).

∆· ·¤ÚÈ· ·›Ì·ÙÔ˜ ÌÂ ¯ÔÚ‹ÁËÛË O2 60% ¤‰ÂÈÍ·ÓpH: 7,33, pO2: 61 mmHg, pCO2: 41 mmHg Î·ÈHCO3-: 21.

∏ ıÂÚ·Â›· ÛÙË ª∂£ ÂÚÈÂÏ¿Ì‚·ÓÂ ÙË ¯ÔÚ‹-ÁËÛË O2, ÙËÓ ÂÓ‰ÔÊÏ¤‚È· ÂÓ˘‰¿ÙˆÛË, ÙËÓ ·ÓÙÈ‚ÈÔ-ÙÈÎ‹ ·ÁˆÁ‹ (ÙÂïÎÔÏ·Ó›ÓË) Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ (Û·Ï‚Ô˘Ù·ÌfiÏË ÛÂ ÂÈÛÓÔ¤˜·Ó¿ ÌÈÛ‹ ¤ˆ˜ Ì›· ÒÚ·, ‚ÚÔÌÈÔ‡¯Ô ÈÚ·ÙÚfiÈÔ Î·ÈÎÔÚÙÈ˙fiÓË). ∆Ô ‚Ú¤ÊÔ˜, ÙÈ˜ ÂfiÌÂÓÂ˜ 10 ÒÚÂ˜ ÙË˜ÓÔÛËÏÂ›·˜ ÙÔ˘ ÛÙË ª∂£, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó·-ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ·ÚÔ˘Û›·ÛÂ Î˘Ì·ÈÓfiÌÂÓËÂÈÎfiÓ·, ÌÂ ÚÔÂÍ¿Ú¯ÔÓ, fiÌˆ˜, Û‡ÌÙˆÌ· ÙÔÓ‚ÚÔÁ¯fiÛ·ÛÌÔ Î·È ÙËÓ Ù·¯‡ÓÔÈ·. ¢Ò‰ÂÎ· ÒÚÂ˜ÂÚ›Ô˘ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙË ª∂£, ÙÔ ‚Ú¤ÊÔ˜·ÚÔ˘Û›·ÛÂ ÔÍÂ›· ÂÈ‰Â›ÓˆÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ (·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó·ÎÔ‹). ¢È·Ûˆ-ÏËÓÒıËÎÂ ·Ì¤Ûˆ˜ Î·È Ù¤ıËÎÂ ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈ-ÛÌfi (ª∞). ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ¤‰ÂÈÍÂ ÂÎÙÂÙ·-Ì¤ÓÔ ÓÂ˘ÌÔıÒÚ·Î· ‰ÂÍÈ¿, Ô ÔÔ›Ô˜ ·ÚÔ¯ÂÙÂ‡-ÙËÎÂ ÌÂ ÛˆÏ‹Ó· ıˆÚ·ÎÔÛÙÔÌ›·˜ (·¤ÚÈ· ·›Ì·ÙÔ˜ÛÂ ª∞ ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÛˆÏ‹Ó· ıˆÚ·ÎÔÛÙÔ-Ì›·˜ pH: 7,09, pO2: 93 mmHg, pCO2: 97 mmHg,HCO3-: 26) (∂ÈÎfiÓ· 2).

∏ ·ÎÙÈÓÔÁÚ·Ê›· Ô˘ ¤ÁÈÓÂ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÙÔ-Ôı¤ÙËÛË ÙÔ˘ ÛˆÏ‹Ó· ıˆÚ·ÎÔÛÙÔÌ›·˜, ¤‰ÂÈÍÂ ÌÂ-Á¿ÏË Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ, ÙÔÔÔ›Ô, fiÌˆ˜, ‰ÂÓ ·ÚÔ¯¤ÙÂ˘Â Ô ÛˆÏ‹Ó·˜ ıˆÚ·ÎÔ-ÛÙÔÌ›·˜ (∂ÈÎfiÓ· 3).

∆ÔÔıÂÙ‹ıËÎÂ ‰Â‡ÙÂÚÔ˜ ÛˆÏ‹Ó·˜, Ì¤Ûˆ ÙÔ˘ÔÔ›Ô˘ ·ÚÔ¯ÂÙÂ‡ÙËÎ·Ó ÂÚÈÛÛfiÙÂÚ· ·fi 300 ml

∂ÈÎfiÓ· 1. ¶‡ÎÓˆÛË ‰ÂÍÈÔ‡ ¿Óˆ ÏÔ‚Ô‡ ÌÂ ·ÚÔ˘Û›· ÓÂ˘Ì·-ÙÔÎ‹ÏË˜ (ÙfiÍÔ).

∂ÈÎfiÓ· 2. ∂ÎÙÂÙ·Ì¤ÓÔ˜ ÓÂ˘ÌÔıÒÚ·Î·˜ ‰ÂÍÈ¿ ÌÂ ·ÚÂÎÙfiÈ-ÛË ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÛÎÈ¿˜ ·ÚÈÛÙÂÚ¿ Î·È ‡ÎÓˆÛË ‰ÂÍÈÔ‡¿Óˆ ÏÔ‚Ô‡.

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˘Ò‰Ô˘˜ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘ÔÔ›Ô˘ ·Ó·Ù‡¯ıËÎÂ Staphylococcus aureus (·ÓıÂ-ÎÙÈÎfi ÛÙËÓ ÔÍ·ÎÈÏÏ›ÓË Î·È Â˘·›ÛıËÙÔ ÛÙËÓ ÙÂ˚ÎÔ-Ï·Ó›ÓË Î·È ‚·ÓÎÔÌ˘Î›ÓË).

ªÂÙ¿ ÙËÓ ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ÏÂ˘ÚÈÙÈÎÔ‡˘ÁÚÔ‡, ·ÎÙÈÓÔÁÚ·ÊÈÎ¿, Ô ‰ÂÍÈfi˜ ÓÂ‡ÌÔÓ·˜ Â·-ÓÂÙ‡¯ıËÎÂ, ·ÚÔ˘Û›·˙Â fiÌˆ˜ ·ÚÂÁ¯˘Ì·ÙÈÎ¤˜‚Ï¿‚Â˜ ÛÙÔÓ ‰ÂÍÈfi Ì¤ÛÔ, ‰ÂÍÈfi ¿Óˆ Î·È ‰ÂÍÈfi Î¿-Ùˆ ÏÔ‚fi (∂ÈÎfiÓ· 4).

∂ÓfiÛˆ ÙÔ ‚Ú¤ÊÔ˜ ‹Ù·Ó ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfiÎ·È ÌÂ ÙÔÓ ‰ÂÍÈfi ÓÂ‡ÌÔÓ· Ó· ¤¯ÂÈ ÂÎÙ˘¯ıÂ›, ÙÔÚÔÂÍ¿Ú¯ÔÓ Û‡ÌÙˆÌ· ‹Ù·Ó Ô ¤ÓÙÔÓÔ˜ ‚ÚÔÁ¯fi-Û·ÛÌÔ˜ Î·È Ë ÛÔ‚·Ú‹ ˘ÂÚÎ·Ó›· (·¤ÚÈ· ·›Ì·-ÙÔ˜ pH: 7,18, pO2: 93 mmHg, pCO2: 91 mmHg,HCO3-: 32).

∏ ·ÁˆÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·-ÛÌÔ˘ Î·È ÙË˜ ˘ÂÚÎ·Ó›·˜ ÂÚÈÂÏ¿Ì‚·ÓÂ ÙË ¯ÔÚ‹-ÁËÛË ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË˜ (2 mg/kg/24 h), ÙË Û˘-ÓÂ¯‹ ÂÓ‰ÔÊÏ¤‚È· ¤Á¯˘ÛË Û·Ï‚Ô˘Ù·ÌfiÏË˜ (‰fiÛË 2-4 Á/kg/min) Î·È ÙÔÓ ˘ÂÚ·ÂÚÈÛÌfi Ì¤Ûˆ ·Ó·ÓÂ˘-ÛÙ‹Ú·. ∆· ‰‡Ô ÚÒÙ· 24ˆÚ·, ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, Ô ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ ‹Ù·ÓÂ›ÌÔÓÔ˜ Î·È ·ÓıÂÎÙÈÎfi˜ ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹.OÈ ÙÈÌ¤˜ ÙË˜ ƒaCO2 Î˘Ì¿ÓıËÎ·Ó ·fi 50 mmHg ¤ˆ˜194 mmHg, ÂÓÒ Ë ƒaO2 ‰È·ÙËÚ‹ıËÎÂ ÛÙ·ıÂÚ¿ ÛÂÂ›Â‰· ¿Óˆ ·fi 90 mmHg. ∏ ÌÂÁ·Ï‡ÙÂÚË ¤Í·Ú-ÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Î·È Ë ·ÓÒÙÂÚË ÙÈÌ‹ ÙË˜PaCO2 (194 mmHg) (·¤ÚÈ· ·›Ì·ÙÔ˜ pH: 6,92, pO2:92 mmHg, pCO2: 194 mmHg, HCO3-: 30) ·Ú·ÙË-Ú‹ıËÎ·Ó 40 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÌË¯·ÓÈ-ÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ ÙË ¯ÔÚ‹ÁË-ÛË ÂÓ‰ÔÊÏÂ‚›ˆ˜ 2 ‰fiÛÂˆÓ MgSO4 (20 mg/kg/‰fi-ÛË), ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ· ¯ÔÚ‹ÁËÛË˜ ÙÈ˜ 2 ÒÚÂ˜. ™ÙÈ˜ÂfiÌÂÓÂ˜ ÒÚÂ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ MgSO4,˘‹ÚÍÂ ÛËÌ·ÓÙÈÎ‹ ÙÒÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ PaCO2 (·¤-

ÚÈ· ·›Ì·ÙÔ˜ pH: 7,42, pO2: 99 mmHg, pCO2: 52mmHg, HCO3-: 40).

ªÂÙ¿ ·fi 48 ÒÚÂ˜ ÓÔÛËÏÂ›·˜ ÛÙË ª∂£, Ô ‚ÚÔÁ-¯fiÛ·ÛÌÔ˜ Î·È Ë ˘ÂÚÎ·Ó›· ˘Ô¯ÒÚËÛ·Ó ÛËÌ·-ÓÙÈÎ¿ (ÙÈÌ¤˜ pCO2: 38-60 mmHg). ∏ ÂÓ‰ÔÊÏ¤‚È· ¤Á-¯˘ÛË ÙË˜ Û·Ï‚Ô˘Ù·ÌfiÏË˜ ‰È·ÎfiËÎÂ Î·È Ë ·ÁˆÁ‹Û˘ÓÂ¯›ÛÙËÎÂ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË˜,·ÌÈÓÔÊ˘ÏÏ›ÓË˜ ÛÂ Û˘ÓÂ¯‹ ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË Î·È ÂÈ-ÛÓÔÒÓ Û·Ï‚Ô˘Ù·ÌfiÏË˜ Î·È ‚ÚÔÌÈÔ‡¯Ô˘ ÈÚ·ÙÚfi-ÈÔ˘ Ì¤Ûˆ ÙÔ˘ ·Ó·ÓÂ˘ÛÙ‹Ú·.

∏ ˘Ô¯ÒÚËÛË ÙÔ˘ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Û˘Ó¤ÂÛÂ¯ÚÔÓÈÎ¿ ÌÂ ÙËÓ ‡ÊÂÛË ÙË˜ ÏÔ›ÌˆÍË˜. O ˘ÚÂÙfi˜˘Ô¯ÒÚËÛÂ ÛÙÈ˜ 48 ÒÚÂ˜ Î·È ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·-ÛÂ ÙÒÛË ÙË˜ CRP (43 mg/L).

∆Ô ‚Ú¤ÊÔ˜ ·Ú¤ÌÂÈÓÂ ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi 16ËÌ¤ÚÂ˜, ÂÓÒ Ô ÛˆÏ‹Ó·˜ ıˆÚ·ÎÔÛÙÔÌ›·˜ ·Ú¤ÌÂÈÓÂÂ› 30 ËÌ¤ÚÂ˜. ∆Ë 12Ë, 20‹ Î·È 23Ë ËÌ¤Ú· ÓÔÛËÏÂ›-·˜ ÛÙË ª∂£, ÂÌÊ¿ÓÈÛÂ Ó¤· ‰È·Ê˘Á‹ Î·È Û˘ÏÏÔÁ‹·¤Ú· ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ, Ë ÔÔ›· ·ÚÔ¯ÂÙÂ‡ÙË-ÎÂ, ÂÓÒ ÙË 12Ë ËÌ¤Ú· ·ÚÔ˘Û›·ÛÂ Î·È ˘Ô‰fiÚÈÔ ÂÌ-Ê‡ÛËÌ· ıÒÚ·Î·-ÙÚ·¯‹ÏÔ˘ Ô˘ ˘Ô¯ÒÚËÛÂ ÛÙ·-‰È·Î¿ ÛÂ 4-5 ËÌ¤ÚÂ˜ (∂ÈÎfiÓ· 5).

∆Ô ‚Ú¤ÊÔ˜ ÓÔÛËÏÂ‡ÙËÎÂ ÁÈ· 26 ËÌ¤ÚÂ˜ ÛÙËª∂£ Î·È, ÛÙË Û˘Ó¤¯ÂÈ·, ÁÈ· ¿ÏÏÂ˜ 8 ËÌ¤ÚÂ˜ ÛÂ ·È-‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹.

∂Í‹ÏıÂ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·-Ù¿ÛÙ·ÛË ÌÂ Â¿ÚÎÂÈ· ·Ó·ÓÂ˘ÛÙÈÎÔ‡, ‰ËÏ·‰‹ ¯ˆ-Ú›˜ ‰‡ÛÓÔÈ·, ·Ó·ÓÔ¤˜ 35-40/min Î·È Ê˘ÛÈÔÏÔÁÈÎfi·Ó·ÓÂ˘ÛÙÈÎfi „Èı‡ÚÈÛÌ·, ¯ˆÚ›˜ ·Ó¿ÁÎË ¯ÔÚ‹ÁË-ÛË˜ O2 (∂ÈÎfiÓ· 6).

¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Î¿ÔÈ· Â›ÙˆÛË ·fi ÙË ‚·-ÚÈ¿ ÔÍ¤ˆÛË (pH: 6,91) Î·È ˘ÂÚÎ·Ó›· (PaCO2:194 mmHg) Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Î·Ù¿ ÙËÓ ÂÍ¤ÏÈÍËÙË˜ ÓfiÛÔ˘.

∂ÈÎfiÓ· 3. ªÂÁ¿ÏË Û˘ÏÏÔÁ‹ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ÛÙÔ ‰ÂÍ› ËÌÈ-ıˆÚ¿ÎÈÔ.

∂ÈÎfiÓ· 4. ¶·ÚÂÁ¯˘Ì·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÛÙÔÓ ‰ÂÍÈfi Ì¤ÛÔ, Î¿Ùˆ Î·È¿Óˆ ÏÔ‚fi ÌÂÙ¿ ÙËÓ ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡. ¶·-ÚÔ˘Û›· ÛˆÏ‹Ó· ıˆÚ·ÎÔÛÙÔÌ›·˜.

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™˘˙‹ÙËÛË ∏ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›· ¤¯ÂÈ ˆ˜ ·›ÙÈÔ ÙÔÓ

¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ. ™˘Ó‹ıˆ˜ ÂÍÂÏ›ÛÛÂÙ·È‚·Ú¤ˆ˜ Î·È Ù·¯¤ˆ˜. ∂›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ ·fi ÙËÓÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ Î·È ÙËÓ ÈÔÁÂÓ‹ ÓÂ˘ÌÔÓ›·.

¢È·ÎÚ›ÓÔÓÙ·È ‰‡Ô ÌÔÚÊ¤˜: Ë ÚˆÙÔ·ı‹˜ Ô˘Â›Ó·È Ë ÈÔ Û˘¯Ó‹ Î·È ÚÔÎ·ÏÂ›Ù·È ÌÂ ÙËÓ Â›ÛÔ‰Ô Î·ÈÚÔÛ‚ÔÏ‹ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ·fi ÙÔ ÌÈÎÚfi‚ÈÔ Ì¤ÛˆÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Ô‰Ô‡ Î·È Ë ‰Â˘ÙÂÚÔ·ı‹˜ Ô˘ÔÊÂ›ÏÂÙ·È ÛÂ ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔÚ¿ Î·Ù¿ ÙË ‰È·-‰ÚÔÌ‹ ÂÓ‰ÔÎ·Ú‰›ÙÈ‰·˜ ‹ ÛË„·ÈÌ›·˜, ÂÓÒ Û˘Ó‹ıˆ˜Û˘Ó˘¿Ú¯ÂÈ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÂÛÙ›· ÛÙÔ ‰¤ÚÌ· ‹ÛÙ· Ì·Ï·Î¿ ÌfiÚÈ·. ∏ ÚˆÙÔ·ı‹˜ ÓÂ˘ÌÔÓ›· ÚÔ-Û‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ ·È‰È¿, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÚÔË-ÁÔ˘Ì¤Óˆ˜ ˘ÁÈ‹, ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙÔ˘ 1 ¤ÙÔ˘˜ÛÙ· 3/4 ÙˆÓ ÂÚÈÙÒÛÂˆÓ (1,3). ÕÏÏÔÈ ÚÔ‰È·ıÂÛÈ-ÎÔ› ·Ú¿ÁÔÓÙÂ˜ Â›Ó·È ÔÈ ¯ÚfiÓÈÂ˜ ÓÂ˘ÌÔÓÈÎ¤˜ ÓfiÛÔÈ(ÈÓÔÎ˘ÛÙÈÎ‹), Ë ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ÔÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘‰¤ÚÌ·ÙÔ˜ Î·È Ë ·ÚÔ˘Û›· Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ (1,7). πÔ-ÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ·‰ÂÓÔ˚-Ô‡˜ Î·È Î˘Ú›ˆ˜ ·fi ÙÔÓ Èfi ÙË˜ ÁÚ›Ë˜, ÚÔÎ·ÏÔ‡ÓÌ›· ÂÔ¯ÈÎ‹ ÎÔÚ‡ÊˆÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÓfiÛÔ˘(ÌÂÙ·Í‡ OÎÙˆ‚Ú›Ô˘ Î·È ª·˝Ô˘), Èı·ÓfiÙ·Ù· Ì¤ÛˆÙÚÔÔÔ›ËÛË˜ ÙˆÓ ÙÔÈÎÒÓ ·Ì˘ÓÙÈÎÒÓ ÌË¯·ÓÈÛÌÒÓÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (2,6,7). ∏ ÎÏÈÓÈÎ‹ÂÈÎfiÓ· ÙË˜ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔÓ›·˜ ÛÙËÓ Ù˘-ÈÎ‹ ÙË˜ ÌÔÚÊ‹, Û˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È ÌÂÙ¿ ·fiÌ›· ‹È· ÏÔ›ÌˆÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÚÂÙfi, ‚‹¯·, Ù·¯‡ÓÔÈ·Î·È ÁÔÁÁ˘ÛÌfi. ™˘¯Ó¤˜ Â›Ó·È ÔÈ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ‰È·-Ù·Ú·¯¤˜. ¶ÔÏ‡ Û‡ÓÙÔÌ· ·ÎÔÏÔ˘ıÂ› Ï‹ı·ÚÁÔ˜ Î·ÈÛÔ‚·Ú‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· ÌÂ ·Ó·¤Ù·ÛËÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ, ÂÈÛÔÏÎ‹ ÌÂÛÔÏÂ‡ÚÈˆÓ ‰È·ÛÙË-Ì¿ÙˆÓ Î·È Î˘¿ÓˆÛË. ∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·ı›ÛÙ·Ù·È‰Ú·Ì·ÙÈÎ‹ fiÙ·Ó ÂÎ‰ËÏÒÓÔÓÙ·È ÔÈ ÂÈÏÔÎ¤˜ (˘Ô-ÓÂ˘ÌÔıÒÚ·Î·˜) Î·È ÂÁÎ·ı›ÛÙ·Ù·È Ï¤ÔÓ ‚·ÚÈ¿

·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· Û˘Ó‹ıˆ˜ ··È-ÙÂ› ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜. ∆· ÙÂÏÂ˘-Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ Ù·˘ÙÔÔÈËıÂ› ‚·Ú‡Ù·ÙË ÌÔÚÊ‹ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔÓ›·˜ ÛÂ ·È‰È¿, Ë ÓÂÎÚˆ-ÙÈÎ‹ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›·, Ô˘ ¯·Ú·ÎÙËÚ›˙Â-Ù·È ·fi shock, ÏÂ˘ÎÔÂÓ›·, ·ÈÌfiÙ˘ÛË Î·È ˘„ËÏ‹ıÓËÙfiÙËÙ·. ¶ÚÔÎ·ÏÂ›Ù·È ·fi ÛÙÂÏ¤¯Ë ÙÔ˘ ¯Ú˘Û›˙Ô-ÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘ Ô˘ ·Ú¿ÁÔ˘Ó ÙË ÏÂ˘ÎÔÙÔÍ›ÓËPanton-Valentine (8).

™Ù· ÓÂÔÁÓ¿ Î·È ÛÙ· ‚Ú¤ÊË, Ë ÂÍ¤ÏÈÍË ÙË˜ ÛÙ·-Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔÓ›·˜ Â›Ó·È Ú·Á‰·›· Î·È Û˘Ó-‰˘¿˙ÂÙ·È ÌÂ ˘„ËÏ‹ ıÓËÙfiÙËÙ· Ì¤Û· ÛÂ Ï›ÁÂ˜ ÒÚÂ˜·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ.

∏ ·ÎÙÈÓÔÏÔÁÈÎ‹ ÂÈÎfiÓ· ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ Ó· ‰Â›¯ÓÂÈ ‰È¿Û·Ú-ÙÂ˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜, Û˘Ó‹ıˆ˜ ÂÙÂ-ÚfiÏÂ˘ÚÂ˜. ∂ÓÙfi˜ ˆÚÒÓ, ÔÈ ‚Ï¿‚Â˜ ÂÍÂÏ›ÛÛÔÓÙ·ÈÎ·È ÂÌÊ·Ó›˙ÔÓÙ·È ˘ÎÓÒÛÂÈ˜, ÓÂ˘Ì·ÙÔÎ‹ÏÂ˜, ÏÂ˘-ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ ‹ ·˘ÙfiÌ·ÙÔ˜ ÓÂ˘ÌÔıÒÚ·Î·˜. ™ÙÔÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ÚÒÙË ·ÎÙÈÓÔ-ÁÚ·Ê›· ¤‰ÂÈÍÂ ‡ÎÓˆÛË ‰ÂÍÈÔ‡ Î¿Ùˆ ÏÔ‚Ô‡ (¢∫§)ÌÂ ·ÚÔ˘Û›· ÓÂ˘Ì·ÙÔÎ‹ÏË˜. ƒ·Á‰·›·, ÂÓÙfi˜ 10ˆÚÒÓ, ÙfiÛÔ Ë ÎÏÈÓÈÎ‹ fiÛÔ Î·È Ë ·ÎÙÈÓÔÏÔÁÈÎ‹ ÂÈÎfi-Ó· ÙÔ˘ ·È‰ÈÔ‡ ÂÈ‰ÂÈÓÒıËÎ·Ó, ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ·˘-ÙfiÌ·ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î· Î·È ÏÂ˘ÚÈÙÈÎ‹˜ Û˘ÏÏÔ-Á‹˜. ∏ ·ÚÔ˘Û›· ÓÂ˘Ì·ÙÔÎËÏÒÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎ‹ÙË˜ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔÓ›·˜, fi¯È fiÌˆ˜ ·ıÔ-ÁÓˆÌÔÓÈÎ‹. ∂ÌÊ·Ó›˙ÔÓÙ·È ÛÂ ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔÙÔ˘ 50%. ™˘¯Ó¿, ·ÏÏ¿˙Ô˘Ó ÛÂ Ì¤ÁÂıÔ˜ Î·È ·ÚÈıÌfi.∂›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ó¤ÎÚˆÛË˜ Î˘„ÂÏ›‰ˆÓ Î·È‚ÚÔÁ¯ÈÔÏ›ˆÓ. ∞ÎÙÈÓÔÏÔÁÈÎ¿, ÌÔÚÂ› Ó· ·Ú·Ì¤ÓÔ˘Ó·ÎfiÌË Î·È Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙË˜ ıÂÚ·-Â›·˜. OÈ ÏÂ˘ÚÈÙÈÎ¤˜ Û˘ÏÏÔÁ¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÂ

∂ÈÎfiÓ· 5. ÀÔ‰fiÚÈÔ ÂÌÊ‡ÛËÌ· ıÒÚ·Î· Î·È ÙÚ·¯‹ÏÔ˘.

∂ÈÎfiÓ· 6. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·È‰ÈÔ‡.


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ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 70%, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‰ÂÌ¤ÚÔ˜ ÂÍ ·˘ÙÒÓ ÂÌÊ·Ó›˙ÂÙ·È ÓˆÚ›˜ Î·Ù¿ ÙËÓ ÂÍ¤ÏÈ-ÍË ÙË˜ ÓfiÛÔ˘.

OÈ Rebhan Î·È Edwards ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÛÔ-ÛÙfi 59% ÂÎ ÙˆÓ 329 ·ÛıÂÓÒÓ ÌÂ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ÓÂ˘ÌÔÓ›· ÂÌÊ¿ÓÈ˙Â ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ ÛÙËÓ ÚÒ-ÙË ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È, ÂÈÏ¤ÔÓ, ÔÛÔÛÙfi19% ·ÚÔ˘Û›·˙Â ÛÙË Û˘Ó¤¯ÂÈ· (4). OÈ Haggerty Î·ÈHendren ‰È·ÈÛÙÒÓÔ˘Ó fiÙÈ ÙÔ 71% ÙˆÓ ·ÛıÂÓÒÓ Â›-¯Â ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ Î·Ù¿ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘(5). ¶ÓÂ˘Ì·ÙÔÎ‹ÏÂ˜ Î·È ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ ÌÔÚÂ›Ó· ÚÔÎ·Ï¤ÛÔ˘Ó Î·È ¿ÏÏÂ˜ ‚·ÎÙËÚÈ·Î¤˜ ÓÂ˘ÌÔ-Ó›Â˜ (ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜, ÎÏÂÌÛÈ¤ÏÏ·, ·ÈÌfiÊÈÏÏÔ˜),·ÏÏ¿ Î·È ÙÔ ÓÂ˘ÌÔÓÈÎfi ·fiÛÙËÌ· ÌÂÙ¿ ·fi ÂÈÛÚfi-ÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ÌÔÚÂ› Ó· ‰ÒÛÂÈ ·ÚfiÌÔÈ··ÎÙÈÓÔÏÔÁÈÎ‹ ÂÈÎfiÓ·.

O ·˘ÙfiÌ·ÙÔ˜ ÓÂ˘ÌÔıÒÚ·Î·˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÂÔÛÔÛÙfi 25-50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. OÈ HaggertyÎ·È Hendren ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÙÔ 42% ÙˆÓ ·ÛıÂÓÒÓ·ÚÔ˘Û›·ÛÂ ·˘Ù‹ ÙËÓ ÂÈÏÔÎ‹ (5). ∏ Ú‹ÍË ÙˆÓÓÂ˘Ì·ÙÔÎËÏÒÓ Â›Ó·È ¤Ó·˜ ÂÎ ÙˆÓ ‰‡Ô ÌË¯·ÓÈÛÌÒÓÚfiÎÏËÛË˜ ÓÂ˘ÌÔıÒÚ·Î·. O ¿ÏÏÔ˜ Â›Ó·È Ë ‰ËÌÈ-Ô˘ÚÁ›· ‚ÚÔÁ¯ÔÏÂ˘ÚÈÙÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘. ∏ ÂÁÎ·Ù¿-ÛÙ·ÛË ·˘ÙfiÌ·ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î· Û˘Ó‹ıˆ˜ ÚÔÎ·-ÏÂ› ·ÈÊÓ›‰È· ÂÈ‰Â›ÓˆÛË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È Î˘-ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÌÔÚÂ› Ó· Á›ÓÂÈ ·ÂÈÏËÙÈ-Î‹ ÁÈ· ÙË ˙ˆ‹ Î·È ¯Ú‹˙ÂÈ ÂÂ›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈ-ÛË˜. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ÂÚÈÁÚ¿-ÊÂÙ·È, Ô ·˘ÙfiÌ·ÙÔ˜ ÓÂ˘ÌÔıÒÚ·Î·˜ ‹Ù·Ó Ë ·ÈÙ›·ÙË˜ ·ÈÊÓ›‰È·˜, ÔÍÂ›·˜ ÂÈ‰Â›ÓˆÛË˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈ-Î‹˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ (·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó·ÎÔ‹) Ô˘Û˘Ó¤‚Ë 10 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙË ª∂£Î·È Â¤‚·ÏÂ ÙËÓ ÂÂ›ÁÔ˘Û· ‰È·ÛˆÏ‹ÓˆÛË ÙË˜ ÙÚ·-¯Â›·˜, ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ÙËÓÙ·˘Ùfi¯ÚÔÓË ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î·.

∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î· ÛÂ ·ÛıÂ-ÓÂ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi ·ÚÔ˘-ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰˘ÛÎÔÏ›Â˜ ÏfiÁˆ ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ıÂ-ÙÈÎ‹˜ ›ÂÛË˜ Ì¤Ûˆ ÙÔ˘ ·Ó·ÓÂ˘ÛÙ‹Ú·. ∆Ô ÂÚÈÛÙ·-ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ·ÚÔ˘Û›·ÛÂ ·ÚÎÂÙ¤˜ ˘Ô-ÙÚÔ¤˜ ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î·, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó˘¿Ú¯ÔÓÙÔ˜ ‚ÚÔÁ¯fiÛ·-ÛÌÔ˘ ··ÈÙ‹ıËÎ·Ó ˘„ËÏ¤˜ ÂÈÛÓÂ˘ÛÙÈÎ¤˜ È¤ÛÂÈ˜ÁÈ· ÙÔÓ ·ÂÚÈÛÌfi ÙÔ˘. ∏ ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛËMgSO4 ÌÔÚÂ› Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ ‚·ÚÈ¿˜ ·ÛıÌ·ÙÈÎ‹˜ ÎÚ›ÛË˜.À¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ÙË ¯Ú‹-ÛË ÙÔ˘ ÙfiÛÔ ÛÂ ·È‰È¿ fiÛÔ Î·È ÛÂ ÂÓ‹ÏÈÎÂ˜ (9,10).

∏ ‰È¿ÁÓˆÛË ÙË˜ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔÓ›·˜ÂÈ‚Â‚·ÈÒÓÂÙ·È ÌÂ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, ÙÔ˘ ·›Ì·-ÙÔ˜ (fiˆ˜ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË) - Ë ÔÔ›· Û˘-Ó‹ıˆ˜ Â›Ó·È ·ÚÓËÙÈÎ‹ - ‹ ÛÙÔ ˘ÏÈÎfi ÙˆÓ ‚ÚÔÁ¯Ô·-Ó·ÚÚÔÊ‹ÛÂˆÓ. ∏ ·ÔÌfiÓˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔ

ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ¤ÎÏ˘Ì· ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈÎ‹. ∆ÔÏÂ˘ÚÈÙÈÎfi ˘ÁÚfi Â›Ó·È ÂÍÈ‰ÚˆÌ·ÙÈÎfi.

∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ ÌÂ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ÓÂ˘ÌÔÓ›· ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ÌfiÓÔ ÙËÓ ·ÓÙÈ‚ÈÔÙÈÎ‹·ÁˆÁ‹, ·ÏÏ¿ Î·È ÙËÓ ¤ÁÎ·ÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈ-ÏÔÎÒÓ, È‰È·›ÙÂÚ· ÙÔ˘ ÓÂ˘ÌÔıÒÚ·Î· Î·È ÙˆÓÏÂ˘ÚÈÙÈÎÒÓ Û˘ÏÏÔÁÒÓ, ÔÈ ÔÔ›Â˜ ÌÂÚÈÎ¤˜ ÊÔÚ¤˜··ÈÙÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡. OÈÏÂ˘ÚÈÙÈÎ¤˜ Û˘ÏÏÔÁ¤˜ Ú¤ÂÈ ¿ÓÙ· Ó· ·ÚÔ¯ÂÙÂ‡-ÔÓÙ·È ÌÂ Â˘Ú‡ ÛˆÏ‹Ó· ıˆÚ·ÎÔÛÙÔÌ›·˜, ·ÊÔ‡ ·˘ÙfiÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈÎ¿ ÙËÓ Èı·ÓfiÙËÙ· ·Ó¿Ù˘ÍË˜‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘.

∏ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ Â›Ó·È‚Ú·‰Â›·. O ˘ÚÂÙfi˜ ÌÔÚÂ› Ó· ÂÈÌ¤ÓÂÈ ÁÈ· ‰È¿ÛÙË-Ì· ÌÂÁ·Ï‡ÙÂÚÔ ÙË˜ Ì›·˜ Â‚‰ÔÌ¿‰·˜ (ÛÙÔ ·ÚfiÓÂÚÈÛÙ·ÙÈÎfi Ô ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛÂ ÛÂ 48 ÒÚÂ˜). ∏·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· Û˘ÓÂ¯›˙ÂÙ·È ÁÈ·‰È¿ÛÙËÌ· 3-4 Â‚‰ÔÌ¿‰ˆÓ, ·Ó¿ÏÔÁ· ÌÂ ÙË ‚·Ú‡ÙËÙ·ÙË˜ ÓfiÛÔ˘. ∆Ô ·Ú¯ÈÎfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· ÌÔÚÂ› Ó·ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ÎÂÊ·ÏÔÛÔÚ›ÓË ÙÚ›ÙË˜ ÁÂÓÈ¿˜ Î·ÈÌ›· ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ËÌÈÛ˘ÓıÂÙÈÎ‹ ÂÓÈÎÈÏ›ÓË(ÂÓÈÎÈÏÈÓ¿ÛË ·ÓıÂÎÙÈÎ‹), fiˆ˜ Ë ÔÍ·ÎÈÏÏ›ÓË.

¢Â‰ÔÌ¤ÓË˜, fiÌˆ˜, ÙË˜ ‚·Ú‡ÙËÙ·˜ Î·È ÙË˜ Ù·¯Â›-·˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘, ·ÏÏ¿ Î·È ÙË˜ Èı·ÓfiÙËÙ·˜ Ô¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ Ó· Â›Ó·È ·ÓıÂÎÙÈÎfi˜ ÛÙËÌÂıÈÎÈÏÏ›ÓË (MRSA), Ë ÔÍ·ÎÈÏÏ›ÓË ı· Ú¤ÂÈ Ó··ÓÙÈÎ·ı›ÛÙ·Ù·È ÌÂ ÙÂ˚ÎÔÏ·Ó›ÓË ‹ ‚·ÓÎÔÌ˘Î›ÓË. ∏·ÔÊÏÔ›ˆÛË ÙË˜ ˘Â˙ÔÎˆÙÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜ ‰ÂÓ ıÂ-ˆÚÂ›Ù·È Û‹ÌÂÚ· ··Ú·›ÙËÙË, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë Ì·-ÎÚÔÚfiıÂÛÌË ÚfiÁÓˆÛË Â›Ó·È ÔÏ‡ Î·Ï‹, ·Ú¿ ÙÔÁÂÁÔÓfi˜ fiÙÈ Ë Ï‹ÚË˜ ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ·ÚÂÁ-¯˘Ì·ÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ ÚÔÎ·ÏÂ› Ô ¯Ú˘Û›˙ˆÓ ÛÙ·-Ê˘ÏfiÎÔÎÎÔ˜ Â›Ó·È Î·ı˘ÛÙÂÚËÌ¤ÓË. ™Â ‰‡Ô ÌÂÁ¿ÏÂ˜ÛÂÈÚ¤˜ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ‰ÂÓ ‰È·È-ÛÙÒıËÎ·Ó ˘ÔÏÂÈÌÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÛÙÔÓ ÓÂ‡ÌÔÓ·,Ë ‰Â ıÓËÙfiÙËÙ· ÙË˜ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹˜ ÓÂ˘ÌÔÓ›·˜·Ó¤Ú¯ÂÙ·È ÛÂ 10% (3).

∂ÂÈ‰‹ Ë ÛÙ·Ê˘ÏÔÎÔÎÎÈÎ‹ ÓÂ˘ÌÔÓ›· Â›Ó·È Ì›·‚·ÚÈ¿ Î·È Ù·¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓË ÓfiÛÔ˜, ı· Ú¤ÂÈ¿ÓÙ· Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿-ÁÓˆÛË Î¿ıÂ ·È‰ÈÔ‡ ÌÂ ˘ÚÂÙfi Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹‰˘Û¯¤ÚÂÈ·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ª·ÙÛ·ÓÈÒÙË˜ ¡™, ∫·Ú¿ıÈÔ˜ £∂ Î·È Û˘Ó. ™Ù·Ê˘ÏÔÎÔÎÎÈÎ‹

ÓÂ˘ÌÔÓ›·. ¶·È‰È·ÙÚÈÎ‹; 1994. ∆fiÌÔ˜ 3. ÛÂÏ. 1431-1432. 2. Behrman RE, Kliegman RM, Arvin AM. Staphylococcal

pneumonia. Nelson Textbook of Pediatrics. 15th ed.Philadelphia: WB Saunders; 1996. p. 719-720.

3. Melish ME, Campbell KA. Coagulase-positivestaphylococcal infections. Textbook of Pediatric InfectiousDiseases. 4th ed. Philadelphia: WB Saunders; 1998. p.1048-1050.

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

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

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

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

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

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

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


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ºÂÏ›ÙÛÈ· ∫·Î·‚¿ ∞ı. º›ÏÈÔ˘ 3, ¡¤· ºÈÏÔı¤Ë, ∆.∫. 115 24, ∞ı‹Ó·


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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

Aspergillus niger ÛÂ ‰‡Ô ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿π. §·Ì·‰·Ú›‰Ë˜1, ∞. µÂÏÂÁÚ¿ÎË2, ª. £ÂÔ‰ˆÚ¿ÎË1, ∂. ¢ËÌËÙÚ›Ô˘3, ∂. ªÈ¯ÂÏ·Î¿ÎË3

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

∂ÈÛ·ÁˆÁ‹OÈ Ì˘ÎËÙÈ·ÛÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ¤¯Ô˘Ó ·Ó·‰ÂÈ¯ıÂ›, ÙÂ-

ÏÂ˘Ù·›·, ÛÂ ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ·˘ÍËÌ¤ÓË˜ ÓÔÛËÚfiÙË-

Ù·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙÈ˜ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛË-ÏÂ›·˜ ÓÂÔÁÓÒÓ (ª∂¡N). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 2-5%ÙˆÓ ÓÂÔÁÓÒÓ ÔÏ‡ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ı·

�¶ÂÚ›ÏË„Ë: ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ÓÂ-ÔÁÓÒÓ (∞ Î·È µ) ÔÏ‡ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜, ÛÙÔ·›Ì· ÙˆÓ ÔÔ›ˆÓ ·ÓÈ¯ÓÂ‡ıËÎÂ Î·È Ù·˘ÙÔÔÈ‹ıËÎÂAspergillus niger ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÂıfi‰ˆÓ·Ó›¯ÓÂ˘ÛË˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (PCR) Î·È Ì¤ÙÚËÛË˜ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ Ì‡ÎËÙ·. ™ÙËÓ ÚÒÙË ÂÚ›-ÙˆÛË, Ë ıÂÙÈÎ‹ PCR Û˘ÓÔ‰Â˘fiÙ·Ó ·fi ·˘ÍËÌ¤ÓÔÙ›ÙÏÔ ·ÓÙÈÁfiÓˆÓ Î·È ‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÌÂ ÚÔÔ-‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË, ÂÓÒ ÙÔ ÓÂÔÁÓfi Î·Ù¤ÏËÍÂ ÌÂ ÛË-ÙÈÎfi shock. ∞ÓÙ›ıÂÙ·, ÛÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, ËıÂÙÈÎ‹ PCR Û˘ÓÔ‰Â˘fiÙ·Ó ·fi Ê˘ÛÈÔÏÔÁÈÎfi Ù›ÙÏÔ·ÓÙÈÁfiÓˆÓ Î·È ‹È· ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, Ô˘ ‚ÂÏÙÈÒıËÎÂ¯ˆÚ›˜ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹˜ ·ÁˆÁ‹˜. ∂È-Ï¤ÔÓ, Ì›· ‰Â‡ÙÂÚË PCR ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ¯ÈÙÔ-ÙÚÈÔ˙È‰¿ÛË, ¤Ó· ¤Ó˙˘ÌÔ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÂÓÂÚÁÔ-ÔÈËÌ¤Ó· Ì·ÎÚÔÊ¿Á· Î·È ·˘Í¿ÓÂÙ·È ÛÙÈ˜ Ì˘ÎËÙÈ·ÛÈ-Î¤˜ ÏÔÈÌÒÍÂÈ˜, ·˘Í‹ıËÎÂ ÛÙ· Ô‡Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ ∞ÌfiÓÔ ÙË 14Ë ËÌ¤Ú· ˙ˆ‹˜, ÂÓÒ ÛÙÔ ÓÂÔÁÓfi µ ‚Ú¤ıË-Î·Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ·fiÙËÓ 1Ë ËÌ¤Ú· ˙ˆ‹˜. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡-Û·˜ ÂÚÁ·Û›·˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ‰È·ÊÔÚÂÙÈ-ÎÒÓ ÌÂıfi‰ˆÓ, ‰È·‰Ô¯ÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È Ë Û˘ÓÂÎÙ›-ÌËÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ‹˜ ÛËÌ·-Û›·˜ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ. ∏ ‰È·ÊÔ-ÚÂÙÈÎ‹ Û˘ÌÂÚÈÊÔÚ¿ ÙË˜ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜ ÛÙ· ‰‡ÔÓÂÔÁÓ¿ Èı·ÓfiÓ ˘Ô‰ËÏÒÓÂÈ ‰È·ÊÔÚÔÔ›ËÛË ˆ˜ÚÔ˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÙÔ˘˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞spergillus niger, PCR, Ù›ÙÏÔ˜ ·ÓÙÈ-ÁfiÓˆÓ, ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË.

�Abstract: The cases of two very low birth weightneonates (A and B) are presented in whichAspergillus niger was identified through thedetection of the DNA of the fungus by PCR, and thequantitation of its antigen titer. In neonate A, thepositive PCR was associated with an elevatedantigen titer and a severe clinical condition thatdeteriorated and culminated in death from septicshock. In neonate B, the positive PCR wasassociated with a normal antigen titer and a mildclinical condition that improved without antifungaltreatment. A second PCR test was normal.Chitotriosidase, an enzyme that increases duringfungal infection and is produced by activatedmacrophages, increased in the urine of neonate Aonly on the 14th day of life. On the other hand,increased levels were found in both plasma andurine of neonate B from the 1st day of life. Theresults of this study show the importance ofapplying different methods and serial analyses aswell as the need to interpret the results incombination with the clinical picture in thediagnosis of aspergillosis. The difference in thebehaviour of chitotriosidase in the two neonates ispossibly related to a different state of activation oftheir macrophages.

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

1 ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜, ¶ÂÈÚ·È¿˜

2 ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ª˘ÎËÙÈ¿ÛÂˆÓ, π·ÙÚÈÎ‹ ™¯ÔÏ‹, ∞ı‹Ó· 3 πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó·

1 Intensive Care Unit of Neonates, General Hospital of Nikaia, Piraeus

2 Mycology Reference Laboratory, Medical School, Athens 3 Institute of Child Health, Athens

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·Ó·Ù‡ÍÂÈ Ì˘ÎËÙÈ·ÛÈÎ‹ ÏÔ›ÌˆÍË ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ÓÔÛËÏÂ›·˜ ÙÔ˘, ÂÓÒ ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÈ˜ ÏÔÈ-ÌÒÍÂÈ˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ‰È·ÊÔÚÂÙÈÎ¿ Â›‰Ë Candida(1-3). ∞ÓÙ›ıÂÙ·, ÔÈ ·ÛÂÚÁÈÏÏÒÛÂÈ˜ ÛÙ· ÓÂÔÁÓ¿ Â›-Ó·È Û¿ÓÈÂ˜ Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘¤¯Ô˘Ó ·Ó·ÎÔÈÓˆıÂ› ·ÊÔÚÔ‡Ó ÛÂ Aspergillusfumigatus Î·È flavus, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÌfiÓÔÙ¤ÛÛÂÚ· ÂÚÈÛÙ·ÙÈÎ¿ Aspergillus niger (3-7).

∏ ¤ÁÎ·ÈÚË Î·È ¤ÁÎ˘ÚË ‰È¿ÁÓˆÛË ÙˆÓ Ì˘ÎËÙÈ·ÛÈ-ÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Î·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ·ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ. π‰È·›ÙÂÚ·, Ë ‰È¿ÁÓˆÛËÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ ·ÔÙÂÏÂ›, ·ÎfiÌ· Î·È Û‹ÌÂÚ·,ÛËÌ·ÓÙÈÎ‹ ÚfiÎÏËÛË Î·È Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔÁÂÁÔÓfi˜ fiÙÈ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ Ë ‰È¿-ÁÓˆÛË Ù¤ıËÎÂ ÌÂÙ¿ ı¿Ó·ÙÔÓ (3-6). ¶ÚfiÛÊ·Ù·, ÔÈ‰È·ÁÓˆÛÙÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜ ÂÌÏÔ˘Ù›ÛÙËÎ·Ó ÌÂ ÌÂıfi-‰Ô˘˜ ·Ó›¯ÓÂ˘ÛË˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (·Ï˘ÛÈ‰ˆÙ‹·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜ - PCR) Î·È ÌÂ ÌÂıfi‰Ô˘˜ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË Î·È ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfiÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ Ì‡ÎËÙ·. OÈ ÙÂ¯ÓÈÎ¤˜ ·˘Ù¤˜¤¯Ô˘Ó ‹‰Ë ÂÊ·ÚÌÔÛÙÂ› ÛÂ ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ (8,9).

™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÂÚÈ-ÙÒÛÂÈ˜ ‰‡Ô ÓÂÔÁÓÒÓ ÔÏ‡ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓË-ÛË˜, ÛÙ· ÔÔ›· ·ÓÈ¯ÓÂ‡ıËÎÂ Î·È Ù·˘ÙÔÔÈ‹ıËÎÂAspergillus niger ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ÌÂ-ıfi‰ˆÓ. ∂ÈÏ¤ÔÓ, Ù· ÓÂÔÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂ ÌÂ-ÙÚ‹ÛÂÈ˜ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜, ÂÓfi˜ ÂÓ˙‡ÌÔ˘ ÙÔ ÔÔ›Ô·˘Í¿ÓÂÙ·È ÛÙÈ˜ Ì˘ÎËÙÈ·ÛÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ (10,11).

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚ›ÙˆÛË ÚÒÙË¶ÚfiˆÚÔ ÓÂÔÁÓfi (ÓÂÔÁÓfi ∞), ËÏÈÎ›·˜ Î‡ËÛË˜ 25

Â‚‰ÔÌ¿‰ˆÓ, ÁÂÓÓ‹ıËÎÂ ÛÙÔ Û›ÙÈ ÌÂ ÎÔÏÈÎfi ÙÔÎÂ-Ùfi Î·È ÌÂ µ° 830 g. ∞Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÌÂ-Ù·Ê¤ÚıËÎÂ ÛÙË ª∂¡¡ ÌÂ ˘ÔıÂÚÌ›· (<35ÔC) Î·È‚Ú·‰˘Î·Ú‰›·. ŒÁÈÓÂ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó¿ÓË-„Ë, ‰È·ÛˆÏ‹ÓˆÛË Î·È ¯ÔÚ‹ÁËÛË ·‰ÚÂÓ·Ï›ÓË˜ ÂÓ-‰ÔÙÚ·¯ÂÈ·Î¿, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ILCOR.∆¤ıËÎÂ ÛÂ ÌË¯·ÓÈÎ‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË, ÔÏÈ-Î‹ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ Î·È ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·Áˆ-Á‹ (Amplicilline + Netilmicin), ÂÓÒ ¯ÔÚËÁ‹ıËÎÂ ‰‡ÔÊÔÚ¤˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÏfiÁˆ™∞¢. ∆ËÓ 4Ë ËÌ¤Ú· ˙ˆ‹˜ ÂÌÊ¿ÓÈÛÂ ˘ÂÚÁÏ˘Î·ÈÌ›·,Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›ÓË˜.

∆ËÓ 8Ë ËÌ¤Ú· ˙ˆ‹˜, ÏfiÁˆ ˘ÂÚÁÏ˘Î·ÈÌÈÒÓ Î·ÈÓˆıÚfiÙËÙ·˜, ¤ÁÈÓÂ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÏÔ›Ìˆ-ÍË˜. ∆Ë 10Ë ËÌ¤Ú· ˙ˆ‹˜, ÏfiÁˆ ÌË ÈÎ·ÓÔÔÈËÙÈÎ‹˜‚ÂÏÙ›ˆÛË˜ ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·ÈÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (20.500Î.Î.¯), ÙÚÔÔÔÈ‹ıËÎÂ ÙÔ Û¯‹Ì· ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓÛÂ Amikacin + Teicoplanine. ∆ËÓ 11Ë ËÌ¤Ú· ˙ˆ‹˜,ÙÔ ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛÂ ÂÈ‰Â›ÓˆÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜, ÌÂ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ÛÙÔÓ

·Ó·ÓÂ˘ÛÙ‹Ú· Î·È ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÂÓ‰ÂÈÎÙÈ-Î‹ ÓÂ˘ÌÔÓÔ¿ıÂÈ·˜.

∆Ë 12Ë ËÌ¤Ú· ˙ˆ‹˜ ¤ÁÈÓÂ ÁÓˆÛÙ‹ Ë ·Ó¿Ù˘ÍËÌ˘Î‹ÙˆÓ ÛÂ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ ÙË˜ 8Ë˜ ËÌ¤Ú·˜,ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÌfiÚÂÛ·Ó Ó· Ù·˘ÙÔÔÈËıÔ‡Ó Î·È ¯Ô-ÚËÁ‹ıËÎÂ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ ·ÁˆÁ‹ ÌÂ AmphotericinB Liposome + Flucytosine, ÂÓÒ ·Ú¿ÏÏËÏ· ‰È·Îfi-ËÎÂ Ë ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹. ∆Ô ÓÂÔÁÓfi ·ÚÔ˘-Û›·ÛÂ ÛÙ·‰È·Î‹ ÂÈ‰Â›ÓˆÛË ÙË˜ ÁÂÓÈÎ‹˜ ÙÔ˘ Î·Ù¿-ÛÙ·ÛË˜, ÂÌÊ·Ó›˙ÔÓÙ·˜ ˘ÚÂÙfi, ÔÈ‰‹Ì·Ù·, ˘fiÙ·-ÛË, ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ÛÂ ÔÍ˘ÁfiÓÔ Î·È ‚Ú·-‰˘Î·Ú‰›·. ÃÔÚËÁ‹ıËÎ·Ó Ï¿ÛÌ· (FFP) Î·È ÈÓfiÙÚÔ-·. ∫·Ù¤ÏËÍÂ ÙË 14Ë ËÌ¤Ú· ˙ˆ‹˜ ÌÂ ÂÈÎfiÓ· ÛË„·È-ÌÈÎÔ‡ shock.

∏ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË ÌÂÙÚ‹ıËÎÂ ÛÂ ‰Â›ÁÌ· Ï¿-ÛÌ·ÙÔ˜ Î·È Ô‡ÚˆÓ ÙË 2Ë, 10Ë Î·È 14Ë ËÌ¤Ú· ˙ˆ‹˜(¶›Ó·Î·˜ 1).

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË ¶ÚfiˆÚÔ ÓÂÔÁÓfi (ÓÂÔÁÓfi µ), ËÏÈÎ›·˜ Î‡ËÛË˜ 27

Â‚‰ÔÌ¿‰ˆÓ, ÁÂÓÓ‹ıËÎÂ ÌÂ ÎÔÏÈÎfi ÙÔÎÂÙfi Î·È µ°850 g (ÛÙË ÌËÙ¤Ú· Â›¯·Ó ¯ÔÚËÁËıÂ› ÙÚÂÈ˜ Î‡ÎÏÔÈÛÙÂÚÔÂÈ‰ÒÓ). ∆Ô ÓÂÔÁÓfi ·ÚÔ˘Û›·ÛÂ ·Ó·ÓÂ˘ÛÙÈÎ‹‰˘Û¯¤ÚÂÈ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞Ú¯ÈÎ¿, ¯ÔÚË-Á‹ıËÎÂ O2 ÛÂ Hood Î·È, ÛÙË Û˘Ó¤¯ÂÈ·, ¯ÚËÛÈÌÔÔÈ-‹ıËÎÂ ÚÈÓÈÎfi CPAP. ∫·ıÂÙËÚÈ¿ÛÙËÎ·Ó Ù· ÔÌÊ·ÏÈÎ¿·ÁÁÂ›· Î·È ÙÔÔıÂÙ‹ıËÎÂ ‰È·‰ÂÚÌÈÎfi˜ ÊÏÂ‚ÔÎ·ıÂ-Ù‹Ú·˜ ÂÚÈÊÂÚÈÎ¿. ∆Ô ÓÂÔÁÓfi Ù¤ıËÎÂ ÛÂ ÔÏÈÎ‹ ·-ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ ÌÂ Theophylline, Ampicilline +Netilmicin. ∆ËÓ 7Ë ËÌ¤Ú· ˙ˆ‹˜ ¿Ú¯ÈÛÂ ÛÙ·‰È·Î‹ Û›-ÙÈÛË, ÌÂ ÛÙ·ıÂÚ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÁÂÓÈÎ‹˜ ÙÔ˘ Î·Ù¿-ÛÙ·ÛË˜.

∆ËÓ 21Ë ËÌ¤Ú· ˙ˆ‹˜ ÂÌÊ¿ÓÈÛÂ ˘ÚÂÙfi, ·ÁÁÂÈÔÎÈ-ÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÓˆıÚfiÙËÙ· Î·È ˘fiÏÂÈÌÌ· ÛÙËÛ›ÙÈÛË. ∂Ï‹ÊıË Ï‹ÚË˜ ¤ÏÂÁ¯Ô˜ ÏÔ›ÌˆÍË˜ Î·È ¯Ô-ÚËÁ‹ıËÎÂ Amikacin + Cefotaxime, Ô˘ ÙÚÔÔÔÈ‹-ıËÎÂ, ÛÙË Û˘Ó¤¯ÂÈ·, ÛÂ Amikacin + TeicoplanineÏfiÁˆ ÙÔ˘ ·ÓÙÈ‚ÈÔÁÚ¿ÌÌ·ÙÔ˜, Î·ıÒ˜ ÛÙËÓ Î·ÏÏÈ¤Ú-ÁÂÈ· ·›Ì·ÙÔ˜ ·Ó·Ù‡¯ıËÎÂ Staphylococcusepidermidis.

∏ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË ÌÂÙÚ‹ıËÎÂ ÛÂ ‰Â›ÁÌ· Ï¿ÛÌ·-ÙÔ˜ Î·È Ô‡ÚˆÓ ÙËÓ 1Ë ËÌ¤Ú· ˙ˆ‹˜ Î·È, ‰È·‰Ô¯ÈÎ¿,ÙËÓ 21Ë, 24Ë, 36Ë Î·È 55Ë ËÌ¤Ú· ˙ˆ‹˜ (¶›Ó·Î·˜ 1).

∏ ·ÚÔ˘Û›· ÙÔ˘ Aspergillus niger Î·È ÛÙ· ‰‡ÔÓÂÔÁÓ¿ ·ÓÈ¯ÓÂ‡ıËÎÂ Î·È Ù·˘ÙÔÔÈ‹ıËÎÂ ÌÂ PCR (∂È-ÎfiÓ· 1), ÂÓÒ ÂÏ¤Á¯ıËÎÂ Î·È Ô Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ, ÛÙÔÓÂÔÁÓfi ∞ ÙËÓ ËÌ¤Ú· ı·Ó¿ÙÔ˘ Î·È ÛÙÔ ÓÂÔÁÓfi µ ÙËÓ27Ë ËÌ¤Ú· ˙ˆ‹˜ (¶›Ó·Î·˜ 1). ™ÙÔ ÓÂÔÁÓfi µ, ÏfiÁˆÙË˜ ÛÙ·ıÂÚ‹˜ Î·È Î·Ï‹˜ ÂÍ¤ÏÈÍ‹˜ ÙÔ˘, ‰ÂÓ ¯ÔÚËÁ‹-ıËÎÂ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ ·ÁˆÁ‹. O Â·Ó¤ÏÂÁ¯Ô˜ ÙË˜PCR ÙËÓ 55Ë ËÌ¤Ú· ˙ˆ‹˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∂Í‹ÏıÂÛÂ Î·Ï‹ Î·Ù¿ÛÙ·ÛË ÙËÓ 82Ë ËÌ¤Ú· ˙ˆ‹˜.

∏ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË ÌÂÙÚ‹ıËÎÂ ÌÂ ÙÔ ÊıÔÚ›˙ÔÓ˘fiÛÙÚˆÌ· ÌÂı˘ÏÔ˘ÌÂÏÏÈÊÂÚ˘Ï-‚-d-N,N’,N’’-

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

O Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÂÏ¤Á¯ıËÎÂ ÌÂ PlateliaAspergillus (Biorad). ∆Ô DNA ·ÔÌÔÓÒıËÎÂ Û‡Ì-ÊˆÓ· ÌÂ ÙË Ì¤ıÔ‰Ô ÙˆÓ Velegraki Î·È Û˘Ó (13). OÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙÔ˘ DNA ¤ÁÈÓÂ ÌÂ ÙË ¯Ú‹ÛË ÙˆÓ·Ú·Î¿Ùˆ ÂÎÎÈÓËÙÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ÁÔ-Ó›‰ÈÔ ÙË˜ ·ÛÂÚÁÈÏÏÔÂ„›ÓË˜ ÙÔ˘ Aspergillusfumigatus:

Pep 1 5’-TAGACAUUGGCACCACCCTC’-3’Pep 22 5’-CTATGCCTGAGGGGCGAA-3’. OÈ Û˘Óı‹ÎÂ˜ ÙÔ˘ PCR ‹Ù·Ó ·˘Ù¤˜ Ô˘ ÂÚÈÁÚ¿-

ÊÔÓÙ·È ·fi ÙÔ˘˜ Kambouris Î·È Û˘Ó (14) Î·È ÔÈ Â-ÚÈÔÚÈÛÙÈÎÔ› ¯¿ÚÙÂ˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘ PCR ¤ÁÈÓ·ÓÌÂ ÙË ¯Ú‹ÛË ÙÔ˘ ÂÚÈÔÚÈÛÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ MspI.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘ÙˆÓ ‰‡Ô ÓÂÔÁÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È ÛÙËÓ∂ÈÎfiÓ· 1.

™˘˙‹ÙËÛË£ÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· ÁÈ· Ì‡ÎËÙÂ˜, ¯ˆÚ›˜ fiÌˆ˜

Ù·˘ÙÔÔ›ËÛË, ˘‹Ú¯Â ÌfiÓÔ ÛÙÔ ÓÂÔÁÓfi ∞, ÙËÓ 8ËËÌ¤Ú· ˙ˆ‹˜. ∏ ¯Ú‹ÛË PCR ‹Ù·Ó Î·ıÔÚÈÛÙÈÎ‹ ÁÈ·

ÙËÓ ·Ó›¯ÓÂ˘ÛË Î·È ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Aspergillusniger. O Ì‡ÎËÙ·˜ ‚Ú¤ıËÎÂ ÛÙ· ÓÂÔÁÓ¿ ∞ Î·È µ ÙË12Ë Î·È ÙËÓ 27Ë ËÌ¤Ú· ˙ˆ‹˜, ·ÓÙ›ÛÙÔÈ¯·. ™ÙÔ ÓÂÔ-ÁÓfi ∞, Ë ‚·ÚÈ¿ ÂÈÎfiÓ· ÏÔ›ÌˆÍË˜ Û˘Ó‰˘·˙fiÙ·Ó fi¯ÈÌfiÓÔ ÌÂ ÙË ıÂÙÈÎ‹ ·ÈÌÔÎ·ÏÏÈ¤ÚÁÂÈ· Î·È ÙË ıÂÙÈÎ‹PCR, ·ÏÏ¿ Î·È ÌÂ ·˘ÍËÌ¤ÓÔ Ù›ÙÏÔ ·ÓÙÈÁfiÓˆÓ. ∏ Ú·-Á‰·›· ÂÈ‰Â›ÓˆÛË Î·È Ô ı¿Ó·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ‰ÂÓÂ¤ÙÚÂ„·Ó ÙËÓ Â·Ó¿ÏË„Ë ÙË˜ PCR Î·È ÙË ‰Â‡ÙÂÚËÌ¤ÙÚËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ. ∞ÓÙ›ıÂÙ·, ÛÙÔ ÓÂÔ-ÁÓfi µ, ÙÔ ÔÔ›Ô ‚ÂÏÙÈÒıËÎÂ ¯ˆÚ›˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹·ÁˆÁ‹, Ô Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·È‰ÂÓ ˘‹ÚÍÂ Î·ÏÏÈ¤ÚÁÂÈ· ıÂÙÈÎ‹ ÁÈ· Ì‡ÎËÙÂ˜. ∂È-Ï¤ÔÓ, Ì›· ‰Â‡ÙÂÚË PCR, 22 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ÚÒ-ÙË, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.

∞‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜ ÛÙÔÓÂÔÁÓfi ∞ ‚Ú¤ıËÎÂ ÌfiÓÔ ÛÙ· Ô‡Ú·, ÙË 14Ë ËÌ¤Ú·˙ˆ‹˜. ∞ÓÙ›ıÂÙ·, Ù· Â›Â‰· ÙË˜ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ µ ‹Ù·Ó ·˘ÍË-Ì¤Ó· ·fi ÙËÓ 1Ë ËÌ¤Ú· ˙ˆ‹˜ Î·È ÔÌ·ÏÔÔÈ‹ıËÎ·ÓÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ ÙÔ˘, ·Ú¿ÏÏË-Ï· ÌÂ ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÙÔ˘ ÂÈÎfiÓ·˜.

OÈ ·Û¤ÚÁÈÏÏÔÈ Â›Ó·È ·fi ÙÔ˘˜ Ï¤ÔÓ ‰È·‰Â‰Ô-Ì¤ÓÔ˘˜ Ì‡ÎËÙÂ˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ™ÙÔ Á¤ÓÔ˜ ·˘ÙfiÛ˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚ· ·fi 600 Â›‰Ë

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

HÌ¤Ú· ÃÈÙÔÙÚÈÔ˙È‰¿ÛË PCR ∆›ÙÏÔ˜ ∫·ÏÏÈ¤ÚÁÂÈ· §Â˘Î¿ CRP ENY˙ˆ‹˜ ¶Ï¿ÛÌ· O‡Ú· (OÏÈÎfi ·ÓÙÈÁfiÓˆÓ ·›Ì·ÙÔ˜ ·ÈÌÔÛÊ·›ÚÈ·/ (mg/dl)

(nmoles/ (nmoles/mg/ ·›Ì·) (ng/ml) ∞ÈÌÔÂÙ¿ÏÈ·ml/h) ÎÚÂ·Ù./h)

¡ÂÔÁÓfi ∞ (∏°: 25 Â‚‰ÔÌ¿‰Â˜, µ°: 830 g)2Ë 12 - - - ™ÙÂ›Ú· 21.100/ 4,8 -

313.0007Ë 6 80 - - ª‡ÎËÙÂ˜ 5

(‰ÂÓ Ù·˘ÙÔ-ÔÈ‹ıËÎ·Ó)

12Ë - - £ÂÙÈÎfi ÁÈ· 5,4 ™ÙÂ›Ú· 16.100/ 165 ∫: 50 Î.Î.¯.Aspergillus 142.000 §: 80 mg/dl

niger ™: 120 mg/dlÎ/·: ™ÙÂ›Ú·

14Ë 32 210 24.900/29.000 130

¡ÂÔÁÓfi µ (∏°: 27 Â‚‰ÔÌ¿‰Â˜, µ°: 850 g)1Ë 205 250 - - ™ÙÂ›Ú· 6.179/ <2

(5Ë ËÌ¤Ú·) 192.00021Ë 102 - - - ™ÙÂ›Ú· 7.800/ <2

Î.Ê.27Ë 76 437 £ÂÙÈÎfi ÁÈ· 0,85 Staphylococcus 6.500/ <2

Aspergillus epidermidis 330.000niger

36Ë 153 16 - - ™ÙÂ›Ú· Î/· 5.990/ 8,6(40‹ ËÌ¤Ú·) Ô‡ÚˆÓ: 320.000

ÛÙÂ›Ú·55Ë 65 7 ∞ÚÓËÙÈÎfi 9.500/ 2,3

(57Ë ËÌ¤Ú·) 486.000º˘ÛÈÔÏÔÁÈÎ¤˜ 25-70 0-70 <0,8 3-9ÙÈÌ¤˜ n=10 n=10

July August 04 07-10-04 13:52 ™ÂÏ›‰·289

Û·ÚÔÊ˘ÙÈÎÒÓ Î·È, Û˘Ó‹ıˆ˜, ÌË ·ıÔÁfiÓˆÓ Ì˘Î‹-ÙˆÓ, ÔÎÙÒ ·fi Ù· ÔÔ›· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ÁÈ· ÏÔÈ-ÌÒÍÂÈ˜ ÛÙÔÓ ¿ÓıÚˆÔ. ∆· Â›‰Ë Aspergillus fumigatusÎ·È flavus ıÂˆÚÔ‡ÓÙ·È Ù· Ï¤ÔÓ ·ıÔÁfiÓ· (15).

∞˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ·ÛÂÚÁÈÏÏÒÛÂˆÓ ·Ú·ÙË-ÚÂ›Ù·È ÛÂ Î·ÚÎÈÓÔ·ıÂ›˜ Î·È ·ÛıÂÓÂ›˜ ÌÂ Â›ÎÙËÙÂ˜Î·È ÁÂÓÂÙÈÎ¤˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈÏÔÈÌÒÍÂÈ˜ ·˘Ù¤˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÛÔ‚·Ú¤˜ Î·È ÛÙÈ˜ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ı·Ó·ÙËÊfiÚÂ˜ (16,17).

¶·Ú’ fiÏÔ Ô˘ ÔÈ ÏÔÈÌÒÍÂÈ˜ ·fi Ì‡ÎËÙÂ˜ ¤¯Ô˘Ó·Ó·‰ÂÈ¯ıÂ› ÛÂ È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙËÓÔÛËÏÂ›· ÓÂÔÁÓÒÓ ÛÂ ÂÓÙ·ÙÈÎ¤˜ ÌÔÓ¿‰Â˜, Ù· ÂÚÈ-ÛÙ·ÙÈÎ¿ ·ÛÂÚÁÈÏÏÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ›ÛÂ ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ Â›Ó·È ÔÏ‡ Ï›Á·(2,3,18). ∆· ÂÚÈÛÛfiÙÂÚ· ·ÊÔÚÔ‡Û·Ó ÛÙ· Â›‰ËAspergillus fumigatus Î·È flavus, ÂÓÒ ¤¯Ô˘Ó ÂÚÈ-ÁÚ·ÊÂ› ÌfiÓÔ 4 ÂÚÈÙÒÛÂÈ˜ ÌÂ Aspergillus niger,Ì›· ·fi ÙÈ˜ ÔÔ›Â˜ ·ÊÔÚÔ‡ÛÂ ÛÂ ÂÓ‰ÔÌ‹ÙÚÈ· ÏÔ›-ÌˆÍË Î·È ı¿Ó·ÙÔ (4,5).

™ÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ Groll Î·È Û˘Ó (3) ÂÚÈ-ÁÚ¿ÊÔÓÙ·È 44 ÂÚÈÛÙ·ÙÈÎ¿ ·ÛÂÚÁÈÏÏÒÛÂˆÓ, ÛÂ·È‰È¿ ËÏÈÎ›·˜ 0-90 ËÌÂÚÒÓ ˙ˆ‹˜, 14 ·fi Ù· ÔÔ›·Â›¯·Ó ‰È¿¯˘ÙË ·ÛÂÚÁ›ÏÏˆÛË, 11 ÚˆÙÔÁÂÓ‹ ‰ÂÚ-Ì·ÙÈÎ‹, 10 ‰ÈÂÈÛ‰˘ÙÈÎ‹ ÓÂ˘ÌÔÓÈÎ‹ Î·È 9 Â›¯·Ó·ÛÂÚÁ›ÏÏˆÛË ÂÓÙÔÈÛÌ¤ÓË ÛÙÔ ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfiÛ‡ÛÙËÌ·, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î.¿. ∏ ÏÔ›ÌˆÍË ‹Ù·Óı·Ó·ÙËÊfiÚ· ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ‰ÂÓ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ıÂÚ·Â˘ÙÈÎ¿. ∞ÓÙ›ıÂÙ·, ÙÔ 73%ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¤Ù˘¯·Ó ¤ÁÎ·ÈÚË˜ ıÂÚ·Â˘ÙÈÎ‹˜·ÓÙÈÌÂÙÒÈÛË˜ ÂÈ‚›ˆÛÂ.

∫·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ıÂÚ·Â˘ÙÈÎ‹·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ Â›Ó·È, ‚Â‚·›-ˆ˜, Ë ¤ÁÎ·ÈÚË Î·È ¤ÁÎ˘ÚË ‰È¿ÁÓˆÛ‹ ÙÔ˘˜, Ô˘·ÎfiÌË Î·È Û‹ÌÂÚ· ·Ú·Ì¤ÓÂÈ Ì›· ÚfiÎÏËÛË.

OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·fi ÛÙÂ›Ú· ‚ÈÔÏÔÁÈÎ¿ ˘ÏÈÎ¿ Î·ÈË ÈÛÙÔÏÔÁÈÎ‹/ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ‚ÈÔ„ÈÒÓ ·fiÌÔÏ˘ÛÌ¤ÓÔ˘˜ ÈÛÙÔ‡˜, Â›Ó·È ÔÈ Ì¤ıÔ‰ÔÈ ÂÈÏÔÁ‹˜ ÁÈ·ÙËÓ ·Ô‰Â‰ÂÈÁÌ¤ÓË ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ(19). øÛÙfiÛÔ, ÛÙËÓ Ú¿ÍË Î·È ÔÈ ‰‡Ô Ì¤ıÔ‰ÔÈ ÂÌÊ·-Ó›˙Ô˘Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ¤¯Ô˘ÓÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏ‹ Â˘·ÈÛıËÛ›·. ¶·Ú·ÙËÚÂ›Ù·È ÌÂÁ¿-ÏË Û˘¯ÓfiÙËÙ· Ï·Óı·ÛÌ¤ÓˆÓ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ, Ô˘ ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÁ‹ ·Ó¿-Ù˘ÍË ÙˆÓ ·ÛÂÚÁ›ÏÏˆÓ (20), ·ÏÏ¿ Î·È ÛÙËÓ Ù·¯Â›·Î¿ı·ÚÛË ÙˆÓ Ì˘Î‹ÙˆÓ ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›· (17).∂ÈÏ¤ÔÓ, ıÂÙÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ‰ÂÓ ÛËÌ·›ÓÔ˘Ó Î·Ù’·Ó¿ÁÎË ÓfiÛÔ, ‰ÈfiÙÈ ÌÔÚÂ› Ó· ÔÊÂ›ÏÔÓÙ·È Â›ÙÂ ÛÂ·ÔÈÎÈÛÌfi ÙÔ˘ ·ÛıÂÓÔ‡˜, fiˆ˜ ¤¯ÂÈ ·Ú·ÙËÚËıÂ›ÛÂ ·ÓÔÛÔÎ·ÙÂÛÙ·ÏÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜, Â›ÙÂ ÛÂ ÂÈÌÔ-Ï‡ÓÛÂÈ˜ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∏ Ï‹„Ë ‚ÈÔ„›·˜ ÛÙËÓÎ·ıËÌÂÚÈÓ‹ Ú¿ÍË Â›Ó·È ÂÊÈÎÙ‹ ÌfiÓÔ ÛÂ Î¿ÔÈÂ˜Û¿ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ·ÛÂÚÁ›ÏÏˆÛË˜, ÌÂ ÂÎ‰ËÏÒ-ÛÂÈ˜ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÂ Â‡ÎÔÏ· ÚÔÛ‚¿ÛÈÌÔ˘˜ÈÛÙÔ‡˜, ¤ÙÛÈ ÒÛÙÂ Ó· ÌËÓ ÂÈ‚·Ú‡ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ ËÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ∂ÈÏ¤ÔÓ, Ë ÌÈÎÚÔÛÎÔÈ-Î‹ ÂÍ¤Ù·ÛË ‰ÂÓ Â›Ó·È ¿ÓÙ· ·ÍÈfiÈÛÙË, ‰Â‰ÔÌ¤ÓÔ˘fiÙÈ ·ÚÎÂÙÔ› ÓËÌ·ÙÔÂÈ‰Â›˜ Ì‡ÎËÙÂ˜ ¤¯Ô˘Ó ·ÚfiÌÔÈ·ÌÔÚÊÔÏÔÁ›· ÌÂ ·˘Ù‹ ÙˆÓ ·ÛÂÚÁ›ÏÏˆÓ (9,17).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÛÙÈ˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ÌÂıfi-‰Ô˘˜ ¤¯ÂÈ ÚÔÛÙÂıÂ› Ë ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÁfiÓˆÓ Î·È ÁÂ-ÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ Ì‡ÎËÙ·. æÂ˘‰Ò˜ ıÂÙÈÎ¿ Î·È„Â˘‰Ò˜ ·ÚÓËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›ÌÂ ÙËÓ ÚÒÙË Ì¤ıÔ‰Ô Î·È „Â˘‰Ò˜ ıÂÙÈÎ¿ ÌÂ ÙË ‰Â‡-ÙÂÚË. ¶ÚfiÛÊ·Ù·, Â›ÛË˜, ¤¯ÂÈ ·Ó·Ù˘¯ıÂ› Ì¤ıÔ‰Ô˜·Ó›¯ÓÂ˘ÛË˜ Î·È Ì¤ÙÚËÛË˜ ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÁfiÓˆÓ ÌÂ¯Ú‹ÛË ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ, Ô˘ ¤¯ÂÈ Â˘·È-ÛıËÛ›· Î·È ÂÈ‰ÈÎfiÙËÙ· >90%. ¶ÚÔÙÂÈÓfiÌÂÓÔ ÎÚÈÙ‹-ÚÈÔ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ˆ˜ ıÂ-ÙÈÎfi, Â›Ó·È Ë ‡·ÚÍË ‰‡Ô ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓÌÂ Ù›ÙÏÔ >1,5 OD (21,22).

∆· „Â˘‰Ò˜ ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÙÈ˜ ÌÂıfi-‰Ô˘˜ PCR ıÂˆÚÂ›Ù·È fiÙÈ ‰ÂÓ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÂÈÌÔ-Ï‡ÓÛÂÈ˜. ∞ÓÙ›ıÂÙ·, ıÂˆÚÂ›Ù·È Èı·Ófi fiÙÈ ·ÓÙ·Ó·-ÎÏÔ‡Ó ·ÔÈÎÈÛÌfi ‹/Î·È ·ÚÔ‰ÈÎ‹ ·ÚÔ˘Û›· Ì˘Î‹-ÙˆÓ ÛÙÔ ·›Ì· ÙˆÓ ·ÛıÂÓÒÓ (9).

OÈ ÂÚÈÔÚÈÛÌÔ› Î·È ÔÈ ‰˘Ó·ÙfiÙËÙÂ˜ ÙˆÓ ·Ú·¿ÓˆÌÂıfi‰ˆÓ Ê·›ÓÔÓÙ·È ÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ Ô˘ ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, Ù· ÔÔ›· Î·È ·ÔÙÂ-ÏÔ‡Ó, fiÛÔ Â›Ó·È ÁÓˆÛÙfi, ÙÈ˜ ÚÒÙÂ˜ ÂÚÈÙÒÛÂÈ˜ ÓÂ-ÔÁÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÁÈ· ·ÛÂÚÁ›ÏÏˆÛË ÌÂ PCR.

™ÙÔ ÓÂÔÁÓfi ∞ ˘‹Ú¯Â ıÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· ÁÈ· Ì‡-ÎËÙÂ˜ Ô˘, fiÌˆ˜, ‰ÂÓ ÌfiÚÂÛ·Ó Ó· Ù·˘ÙÔÔÈËıÔ‡ÓÎ·Ù¿ ÙËÓ ·ÔÌfiÓˆÛË. O Ù›ÙÏÔ˜ ·ÓÙÈÁfiÓˆÓ ‹Ù·Ó Û·-ÊÒ˜ ·ıÔÏÔÁÈÎfi˜ Î·È Ë PCR ıÂÙÈÎ‹, Ô‰ËÁÒÓÙ·˜ÛÙËÓ Ù·˘ÙÔÔ›ËÛË Aspergillus niger. ∏ Î·Ù¿ÛÙ·ÛËÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó ‚·ÚÈ¿, ÂÍÂÏ›¯ıËÎÂ Ù·¯¤ˆ˜ Î·È‰ÂÓ Â¤ÙÚÂ„Â ÙË Ï‹„Ë Ó¤ˆÓ ‰ÂÈÁÌ¿ÙˆÓ.

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∂ÈÎfiÓ· 1. ∂Ó‰ÂÈÎÙÈÎÔ› ÂÚÈÔÚÈÛÙÈÎÔ› ¯¿ÚÙÂ˜ ÚÔ˚fiÓÙˆÓ ÂÓ›Û¯˘-ÛË˜ (RFLP’s) ·fi Î·ı·Ú¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ Î·È ÎÏÈÓÈÎ¿ ‰Â›ÁÌ·Ù·: ¶ÚÔ˚fiÓÙ· ÂÚÈÔÚÈÛÙÈÎÒÓ ¤„ÂˆÓ ƒ∂ƒ 1/22 Aspergillus sp. ÛÂ‹ÎÙˆÌ· ·Á·Úfi˙Ë˜ 3%. ¢È·‰ÚÔÌ‹: 1) flavus (Î·ı·Úfi Î·ÏÏÈ¤Ú-ÁËÌ·), 2) A. niger (Î·ı·Úfi Î·ÏÏÈ¤ÚÁËÌ·), 3) ∞. fumigatus (Î·-ı·Úfi Î·ÏÏÈ¤ÚÁËÌ·), 4) ∞. parasiticus (Î·ı·Úfi Î·ÏÏÈ¤ÚÁËÌ·),5) ∞. niger (·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÌË ÂÈ‰ÈÎ¤˜ ˙ÒÓÂ˜ fiÙ·Ó ÂÓÈÛ¯‡ÂÙ·ÈDNA Aspergillus spp. ·fi ‚ÈÔÏÔÁÈÎ¿ ˘ÁÚ¿ ÙˆÓ ·ÛıÂÓÒÓ), 6)¢Â›ÎÙË˜ ÌÔÚÈ·ÎÒÓ ÌÂÁÂıÒÓ pBR322XMsp I.

July August 04 07-10-04 13:52 ™ÂÏ›‰·290

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∞ÓÙ›ıÂÙ·, ÛÙÔ ÓÂÔÁÓfi µ, ÙÔ ÌfiÓÔ Â‡ÚËÌ· ‹Ù·Ó¤Ó· ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· PCR Ô˘, fiÌˆ˜, ‹Ù·Ó ·Ú-ÓËÙÈÎfi ÛÂ ¤Ó· ‰Â‡ÙÂÚÔ ‰Â›ÁÌ·. ∂ÈÏ¤ÔÓ, Ù· ÂÚÁ·-ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Û˘Ó‰˘¿˙ÔÓÙ·Ó ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfi-Ó· Û·ÊÒ˜ ËÈfiÙÂÚË ÙÔ˘ ÓÂÔÁÓÔ‡ ∞, ÂÓÒ Ë Î·Ù¿-ÛÙ·Û‹ ÙÔ˘ ‚ÂÏÙÈÒıËÎÂ ¯ˆÚ›˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ‹ ıÂ-Ú·Â›·. OÈ Û˘Óı‹ÎÂ˜ Ï‹„Ë˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Î·È ÙË˜PCR Î¿ÓÔ˘Ó È‰È·›ÙÂÚ· Èı·Ófi ÙÔ ÁÂÁÔÓfi˜ ÙÔ ·Ú¯ÈÎfiıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ÔÊÂ›ÏÂÙ·È ÛÂ ÂÈÌfiÏ˘Ó-ÛË, ·ÏÏ¿ Ó· ·ÓÙ·Ó·ÎÏ¿ ·ÔÈÎÈÛÌfi ‹/Î·È ·ÚÔ‰ÈÎ‹·ÚÔ˘Û›· ÙÔ˘ Ì‡ÎËÙ·, fiˆ˜ ¤¯ÂÈ ÚÔÙ·ıÂ› Î·È ÛÙÔ·ÚÂÏıfiÓ (9). º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ‰È·ÊÔ-ÚÂÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È ‰È·‰Ô¯ÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È ËÛ˘ÓÂÎÙ›ÌËÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ‹˜ÛËÌ·Û›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÛÂÚÁÈÏÏÒÛÂˆÓ.

∏ ·ÓıÚÒÈÓË ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË Â›Ó·È ¤Ó· ÚfiÛÊ·-Ù· ·Ó·ÁÓˆÚÈÛÌ¤ÓÔ ¤Ó˙˘ÌÔ ÌÂ ¯ÈÙÈÓÔÏ˘ÙÈÎ‹ ‰Ú¿ÛË,Ô˘ ·Ú¿ÁÂÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ·fi ÂÓÂÚÁÔÔÈË-Ì¤Ó· Ì·ÎÚÔÊ¿Á·. ™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜ ÛÂ ÓÂÔ-ÁÓ¿, ÚÈÓ Î·È ÛÙË ‰È¿ÁÓˆÛË ÏÔ›ÌˆÍË˜ ·fi Candidaalbicans. ∆· Â›Â‰· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒıËÎ·Ó ‹ ·˘-Í‹ıËÎ·Ó ·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÙˆÓ·ÛıÂÓÒÓ (10,11).

∞‡ÍËÛË ÙË˜ ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜, Ô˘ fiÌˆ˜ ‹Ù·Ó¯·ÌËÏfiÙÂÚË ÙˆÓ ·˘Í‹ÛÂˆÓ Ô˘ ·Ú·ÙËÚ‹ıËÎ·ÓÛÂ ÏÔÈÌÒÍÂÈ˜ ·fi Candida albicans ·ÓÙ›ÛÙÔÈ¯Ë˜ ‚·-Ú‡ÙËÙ·˜ (11), ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ ÓÂÔÁÓfi ∞ ÌfiÓÔ ÙË14Ë ËÌ¤Ú· ˙ˆ‹˜. ∞ÓÙ›ıÂÙ·, ÙÔ ÓÂÔÁÓfi µ, Ô˘ ‰ÂÓ·Ó¤Ù˘ÍÂ ÏÔ›ÌˆÍË, Â›¯Â ·˘ÍËÌ¤Ó· Â›Â‰· ·fi ÙËÓ1Ë ËÌ¤Ú· ˙ˆ‹˜.

∆· Ì·ÎÚÔÊ¿Á· ¤¯Ô˘Ó ‚·ÛÈÎfi ÚfiÏÔ ÛÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ÙË˜ ÏÔ›ÌˆÍË˜ ·fi ·Û¤ÚÁÈÏÏÔ, ·ÊÔ‡ Ê·-ÁÔÎ˘ÙÙ·ÚÒÓÔ˘Ó Î·È Î·Ù·ÛÙÚ¤ÊÔ˘Ó ÙÔ˘˜ ÛfiÚÔ˘˜ÙˆÓ Ì˘Î‹ÙˆÓ, ·ÔÙÚ¤ÔÓÙ·˜ ÙË ‚Ï¿ÛÙËÛ‹ ÙÔ˘˜(23). ∂ÈÏ¤ÔÓ, Ù· Ì·ÎÚÔÊ¿Á· ·ÔÙÂÏÔ‡Ó ÛÙfi¯ÔÙË˜ ‰Ú¿ÛË˜ ÙÔÍÈÎÒÓ ÚÔ˚fiÓÙˆÓ Ô˘ ·Ú¿ÁÔ˘Ó Î˘-Ú›ˆ˜ ÔÈ Aspergillus fumigatus Î·È niger, ‰È·‰ÈÎ·Û›·Ô˘ Â›Ó·È Î·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÛÙË ÏÔÈÌÔÁfiÓÔ‰Ú¿ÛË ÙˆÓ Ì˘Î‹ÙˆÓ (24).

∏ ‰È·ÊÔÚÂÙÈÎ‹ Û˘ÌÂÚÈÊÔÚ¿ ÙË˜ ¯ÈÙÔÙÚÈÔ˙È‰¿-ÛË˜ ÛÙ· ‰‡Ô ÓÂÔÁÓ¿ ˘Ô‰ËÏÒÓÂÈ ‰È·ÊÔÚÔÔ›ËÛËˆ˜ ÚÔ˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÙÔ˘˜.∆· ·›ÙÈ· ·˘Ù‹˜ ÙË˜ ‰È·ÊÔÚÔÔ›ËÛË˜ ‰ÂÓ Â›Ó·È Û·-Ê‹. ∆Ô ÓÂÔÁÓfi ∞ ÁÂÓÓ‹ıËÎÂ ÛÙÔ Û›ÙÈ Î·È ‰ÂÓ ˘¿Ú-¯Ô˘Ó ÛÙÔÈ¯Â›· ÁÈ· ÙËÓ Î‡ËÛË Î·È ÙÔÓ ÙÔÎÂÙfi. ¶·Ú’fiÏ· ·˘Ù¿, Â›Ó·È Èı·Ófi Ë ‰È·ÊÔÚÔÔ›ËÛË ·˘Ù‹ Ó·˘‹ÚÍÂ Î·ıÔÚÈÛÙÈÎ‹ ÛÙË ÏÔÈÌÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘ Ì‡-ÎËÙ·, ÌÂ Û˘Ó¤ÂÈ· ‰È¿¯˘ÙË ÏÔ›ÌˆÍË ÛÙÔ ÓÂÔÁÓfi ∞.

µÈ‚ÏÈÔÁÚ·Ê›·1. Ng PC. Systemic fungal infections in neonates. Arch Dis

Child 1994;71:F130-F135.2. Bendel CM, Hostetter MK. Systemic candidiasis and other

fungal infections in the newborn. Semin Pediatr Infect Dis1994;5:35-41.

3. Groll AH, Jaeger G, Allendorf A, Herrmann G, Schloesser R,von Loewenich V. Invasive pulmonary aspergillosis in acritically ill neonate: case report and review of invasiveaspergillosis during the first 3 months of life. Clin Infect Dis1998;27:437-452.

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

5. Rowen JL, Atkins JT, Levy ML, Baer SC, Baker CJ. Invasivefungal dermatitis in the ≤1000-gram neonate. Pediatrics1995;95:682-687.

6. Bruyere A, Bourgeois J, Cochat P, Bethenod M. Entérocoliteulcero-nécrotique néonatale et aspergillose. Pediatrie1983;38:185-189.

7. Ben Rejeb A, Boubaker S, Turki I, Massaoudi L, Chibani M,Khouja H. Placental aspergillosis: myth or reality? Apropos ofa case with fetal death in utero. J Gynecol Obstet Biol Reprod1993;22:85-89.

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

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

10. §·Ì·‰·Ú›‰Ë˜ π, ¢ËÌËÙÚ›Ô˘ ∂, £ÂÔ‰ˆÚ¿ÎË ª, Ã›˙· ∞, ™·‚-‚¿Ï· ª, ªÈ¯ÂÏ·Î¿ÎË ∂. ∂›Â‰· ¯ÈÙÔÙÚÈÔ˙È‰¿ÛË˜ ÛÂ ‰‡Ô ÓÂ-ÔÁÓ¿ ÌÂ Ì˘ÎËÙÈ·ÛÈÎ‹ ÏÔ›ÌˆÍË ·fi Candida albicans. ¶·È‰È·-ÙÚÈÎ‹ 2000;63:309-313.

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

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

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

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

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

16. Abbasi S, Shenep JL, Hughes WT, Flynn PM. Aspergillosis inchildren with cancer. A 34-year experience. Clin Infect Dis1999;29:1210-1219.

17. Muller FM, Groll AH, Walsh TJ. Current approaches todiagnosis and treatment of fungal infections in childreninfected with human immunodeficiency virus. Eur J Pediatr1999;158:187-199.

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

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intensive care unit. Mycoses 1998;41:223-227. 19. Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert

F et al. Defining opportunistic invasive fungal infections inimmunocompromised patients with cancer andhematopoietic stem cell transplants: an internationalconsensus. Clin Infect Dis 2002;34:7-14.

20. Denning DW. Diagnosis and management of invasiveaspergillosis. Curr Clin Top Infect Dis 1996;16:277-299.

21. Verweij PE, Poulain D, Obayashi T, Patterson TF, DenningDW, Ponton J. Current trends in the detection ofantigenaemia, metabolites and cell wall markers for thediagnosis and therapeutic monitoring of fungal infections.Med Mycol 1998;36 (Suppl 1):S146-S155.

22. Maertens J, Verhaegen J, Demuynck H, Brock P, Verhoef G,Vandenberghe P et al. Autopsy-controlled prospectiveevaluation of serial screening for circulating galactomannanby a sandwich enzyme-linked immunosorbent assay forhematological patients at risk for invasive Aspergillosis. J ClinMicrobiol 1999;37:3223-3228.

23. Schaffner A, Douglas H, Braude A. Selective protectionagainst conidia by mononuclear and against mycelia bypolymorphonuclear phagocytes in resistance to Aspergillus.J Clin Invest 1982;69:617-631.

24. Kamei K, Watanabe A, Nishimura K, Miyaji M. Cytotoxicity ofAspergillus fumigatus culture filtrate against macrophages.Nippon Ishinkin Gakkai Zasshi 2002;43:37-41.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË ªÈ¯ÂÏ·Î¿ÎË ¢ÈÂ‡ı˘ÓÛË ∂Ó˙˘ÌÔÏÔÁ›·˜ Î·È ∫˘ÙÙ·ÚÈÎ‹˜ §ÂÈÙÔ˘ÚÁ›·˜ πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ E-mail: [email protected]

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∂π¢π∫O ∞ƒ£ƒO SPECIAL ARTICLE

∆· ‰ÈÎ·ÈÒÌ·Ù· ÙË˜ ·ÙÚÈÎ‹˜ ÂÍÔ˘Û›·˜ Â› ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰· ∫. ∆·Ì¿ÎË1, £. ∆·Ì¿ÎË˜2

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

�¶ÂÚ›ÏË„Ë: O ÂÚ¯ÔÌfi˜ ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ÛÙÔÓ ·Ú-¯·›Ô ÂÏÏËÓÈÎfi Ô›ÎÔ ‹Ù·Ó Î¿ÙÈ ·Ú·¿Óˆ ·fi Â˘-ÚfiÛ‰ÂÎÙÔ˜. ∆Ô Ì¤ÁÂıÔ˜, fiÌˆ˜, ÙË˜ Ì¤ÛË˜ ÔÈÎÔÁ¤-ÓÂÈ·˜ ˘·ÁÔÚÂ˘fiÙ·Ó Î˘Ú›ˆ˜ ·fi ÔÈÎÔÓÔÌÈÎÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜. ŒÓ·˜ ÁÈÔ˜ Î·È, ›Ûˆ˜, Ì›· ı˘Á·Ù¤Ú· ‹Ù·ÓÙÔ È‰·ÓÈÎfi ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∆· ‰ÈÎ·ÈÒÌ·Ù· ÙË˜ ·-ÙÚÈÎ‹˜ ÂÍÔ˘Û›·˜, fiˆ˜ ‰È·ÁÚ¿ÊÔÓÙ·È ÙËÓ ÂÔ¯‹ÂÎÂ›ÓË, ÂÚÈÂÏ¿Ì‚·Ó·Ó: ·) £·Ó¿ÙˆÛË ÙÔ˘ ÓÂÔÁ¤ÓÓË-ÙÔ˘. O ·Ù¤Ú·˜ Ê·Ó¤ÚˆÓÂ ÙËÓ ÚfiıÂÛ‹ ÙÔ˘ Ó· ÂÓÙ¿-ÍÂÈ ÙÔ ÓÂÔÁ¤ÓÓËÙÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ ÙÂÏÂÙ‹˜ ÙˆÓ ∞ÌÊÈ‰ÚÔÌ›ˆÓ. OÈ ŒÏÏËÓÂ˜ Û‡˙˘ÁÔÈÏfiÁˆ ÊÙÒ¯ÂÈ·˜, ÂÁˆÈÛÌÔ‡ ‹ Â‡ÎÔÏË˜ ÈÎ·ÓÔÔ›ËÛË˜ÙˆÓ ÛÂÍÔ˘·ÏÈÎÒÓ ÙÔ˘˜ ÂÓÛÙ›ÎÙˆÓ ÂÎÙfi˜ ÙÔ˘ ÛÈÙÈÔ‡,ÊÔ‚Ô‡ÓÙ·Ó Ó· ·Ó·ıÚ¤„Ô˘Ó ÔÏÏ¿ Ù¤ÎÓ·, ÂÓÒ Ë ·-ÙÚÈÎ‹ ÎÏËÚÔÓÔÌÈ¿ ÌÂÈˆÓfiÙ·Ó ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ. ‚)¶ÒÏËÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘. O ·Ù¤Ú·˜ Â›¯Â ‰ÈÎ·›ˆÌ·fi¯È ÌfiÓÔ Ó· Ô˘Ï‹ÛÂÈ ÙÔ ·È‰› ÙÔ˘, ·ÏÏ¿ ·ÎfiÌË Î·ÈÓ· ÙÔ ˘ÔıËÎÂ‡ÛÂÈ. Á) ŒÎıÂÛË. ∏ ÂÁÎ·Ù¿ÏÂÈ„Ë ÙÔ˘ÓÂÔÁ¤ÓÓËÙÔ˘ ‹Ù·Ó ¤Ó· Ê·ÈÓfiÌÂÓÔ Û‡ÓËıÂ˜, ·Ó Î·È ÙÔ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ¤ÎıÂÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ Ú¤ÂÈÓ· ·ÊÔÚÔ‡ÛÂ ÛÂ ÂÍÒÁ·Ì·, Ófiı·, ·È‰È¿ ‰Ô‡ÏˆÓ,ÂÙ·›ÚˆÓ Î·È ÈÂÚfi‰Ô˘ÏˆÓ. O ÂÂÚ¯fiÌÂÓÔ˜ ÃÚÈÛÙÈ·ÓÈ-ÛÌfi˜, ÌÂ ÙËÓ ¤ÌÊ·ÛË Ô˘ ¤‰ˆÛÂ ÛÙËÓ ÈÂÚfiÙËÙ· ÙË˜˙ˆ‹˜, ‹ÚıÂ ÛÂ ·ÓÙ›ıÂÛË ÌÂ ·˘Ù¤˜ ÙÈ˜ Ú·ÎÙÈÎ¤˜ ÙÔ˘·ÚÂÏıfiÓÙÔ˜. ¶¤Ú·Û·Ó ÔÏÏÔ› ·ÈÒÓÂ˜ ÁÈ· Ó· Î·Ù·-¯ˆÚËıÔ‡Ó ÓÔÌÈÎ¿ ÔÈ ·ÙÚÈ·Ú¯ÈÎ¤˜ ·ÓÙÈÏ‹„ÂÈ˜ ¤Ó·ÓÙÈÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ·È‰ÈÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞Ú¯·›· ∂ÏÏ¿‰·, ·ÙÚÈÎ¿ ‰ÈÎ·ÈÒÌ·-Ù·, ÂÁÎ·Ù¿ÏÂÈ„Ë, ‚ÚÂÊÔÎÙÔÓ›·.

�Abstract: In the ancient Greek home the arrival ofan infant was more than welcome. The number ofmembers in an average family was mainlydetermined by economic factors. One son, andperhaps a daughter, was considered the idealnumber of children in a family, and the father’sauthority determined the fate of the children. Themajor rights of paternal authority exercised duringthat period of history were: a) Execution. The fathershowed his intention to accept the newborn infantinto his family during a ceremony called“Amfidromia”. Many Greek husbands, due topoverty, egoism or ease of satisfaction of their sexualinstincts outside their home, were reluctant to raise alarge number of children. Another reason was thatpaternal inheritance was becoming less. Infanticidewas an accepted practice. b) Sale. The father had theright not only to sell his child but also to use it forpurposes of mortgage. c) Exposure. Abandonmentof infants was rather a common practice, althoughthe greatest proportion of abandoned babies mayhave been illegitimate or adopted, servants’ or evenprostitutes’ babies. The advent of Christianity, due tothe emphasis that religion placed on the sanctity oflife, contradicted all such practices of the past. Manycenturies were to pass before paternal attitudestowards infants became legalized.

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

∏ ·È‰ÈÎ‹ ÈÛÙÔÚ›· ·Ú¯›˙ÂÈ ÌÂ ¤Ó·Ó ‚·ı‡ ‡ÓÔÔ˘ ‰È‹ÚÎÂÛÂ ·ÈÒÓÂ˜ Î·È ·fi ÙÔÓ ÔÔ›Ô ÌfiÏÈ˜ ÙÒÚ··Ú¯›Û·ÌÂ Ó· Í˘Ó¿ÌÂ. OÈ ÁÓÒÛÂÈ˜ Ì·˜ Â›Ó·È Û¯Â‰fiÓ·Ó‡·ÚÎÙÂ˜ Î·È ıÂˆÚÂ›Ù·È ÔÏ‡ Èı·Ófi fiÙÈ Ù· ÓÂÔ-

Á¤ÓÓËÙ· ‰ÔÏÔÊÔÓÔ‡ÓÙ·Ó, ı˘ÛÈ¿˙ÔÓÙ·Ó, ÂÁÎ·Ù·ÏÂ›-ÔÓÙ·Ó, ˘ÈÔıÂÙÔ‡ÓÙ·Ó, ÙÚÔÌÔÎÚ·ÙÔ‡ÓÙ·Ó, Í˘ÏÔÎÔ-Ô‡ÓÙ·Ó, ·ÔÏ·ÓÔ‡ÓÙ·Ó ÛÂÍÔ˘·ÏÈÎ¿ Î·È, ÁÂÓÈÎ¿,Î·ÎÔÔÈÔ‡ÓÙ·Ó.

1 ™¯ÔÏ‹ ∫·ÏÒÓ ∆Â¯ÓÒÓ, ∆Ì‹Ì· ªÔ˘ÛÈÎÒÓ ™Ô˘‰ÒÓ, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜

2 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ª.∂.¡. ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË˜

1 School of Fine Arts, Faculty of Musical Studies, Aristotelion University, Thessaloniki

2 Department of Neonatology, Intensive Care Unit, University Hospital of Alexandroupolis

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∆Ô ·È‰›, ÛÙÔ˘˜ ÚˆÙfiÁÔÓÔ˘˜ Ï·Ô‡˜, ‰ÂÓ Â›¯Â‰ÈÎ·ÈÒÌ·Ù·, ‰ÂÓ ˘ÔÏÔÁÈ˙fiÙ·Ó ˆ˜ ·˘ı‡·ÚÎÙÔ¿ÙÔÌÔ. Œˆ˜ Î¿ÔÈ· ÂÔ¯‹, ‹Ù·Ó ¿ÁÓˆÛÙÔ˜ ·ÎfiÌËÎ·È Ô Ê˘ÛÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ ¿Ó‰Ú· ÛÙËÓ ·Ó··Ú·Áˆ-Á‹. ∏ Á¤ÓÓËÛË ÂÈÙ˘Á¯·ÓfiÙ·Ó ÌÂ ÙË ‚Ô‹ıÂÈ· ÙˆÓÓÂ˘Ì¿ÙˆÓ Î·È, ¤ÙÛÈ, Ô ÚfiÏÔ˜ ÙÔ˘ ·Ù¤Ú· ‹Ù·Ó Í¤-ÓÔ˜. ∆· ·È‰È¿ ·Ó‹Î·Ó ÛÙË ÌËÙ¤Ú· Î·È ÛÙÔ Á¤ÓÔ˜ÙË˜. ŸÙ·Ó Î·Ù·ÓÔ‹ıËÎÂ Ë ·fiÚÚÔÈ· ÙË˜ ÛÂÍÔ˘·ÏÈ-Î‹˜ Ú¿ÍË˜, ÙfiÙÂ Ë ı¤ÛË ÙÔ˘ ¿Ó‰Ú· ¿ÏÏ·ÍÂ Î·È ‰Ë-ÌÈÔ˘ÚÁ‹ıËÎÂ Ë ·ÙÚÈ·Ú¯ÈÎ‹ ÔÈÎÔÁ¤ÓÂÈ·. ™Â ·˘Ù‹, Ù··È‰È¿ ·Ó‹Î·Ó ÛÙÔÓ ·Ù¤Ú·, Ô ÔÔ›Ô˜ ÔÏ‡ Û˘¯Ó¿Â›¯Â ‰ÈÎ·›ˆÌ· ˙ˆ‹˜ ‹ ı·Ó¿ÙÔ˘. ∆Ô ·È‰› Â›¯Â ÌÈÎÚfi-ÙÂÚË ·Í›· ·fi ¤Ó· ·ÓÙÈÎÂ›ÌÂÓÔ ‹ ¤Ó· ˙ÒÔ (1).

∏ Û‡Á¯ÚÔÓË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ¤¯ÂÈ ·Û¯ÔÏËıÂ›È‰È·›ÙÂÚ· ÌÂ ÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì·. ∂›Ó·È Û¯Â‰fiÓ¿ÁÓˆÛÙÔ ÔÈ· ‹Ù·Ó Ë ı¤ÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘, ÚÔ-¿ÓÙˆÓ fiÙ·Ó ‹Ù·Ó Á¤ÓÔ˘˜ ıËÏ˘ÎÔ‡, ÛÙËÓ ·Ú¯·›·∂ÏÏ¿‰·. OÈ ËÁ¤˜ Ô˘ ˘¿Ú¯Ô˘Ó ‰ÂÓ Â›Ó·È ·ÚÎÂÙ¤˜ÁÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙÂ› ÙÔ ÛÙ›ÁÌ· ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘.

∏ ·Ú¯·›· ÂÏÏËÓÈÎ‹ ÔÈÎÔÁ¤ÓÂÈ· ÂÈı˘ÌÔ‡ÛÂ Ó··ÔÎÙ‹ÛÂÈ ÔˆÛ‰‹ÔÙÂ ¤Ó·Ó ÁÈÔ ÁÈ· ÙË ‰È·Ù‹ÚËÛËÙÔ˘ Ô›ÎÔ˘ ‹, ÙÔ ÔÏ‡, ¤Ó·Ó ÁÈÔ Î·È Ì›· ÎfiÚË. ¶›-ÛÙÂ˘·Ó fiÙÈ Ô ÁÈÔ˜ ‰È·ÈÒÓÈ˙Â ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ˘Â-Ú¿ÛÈ˙Â ÙËÓ ‡·ÚÍ‹ ÙË˜, ÙfiÛÔ ÛÙÔ Â‰›Ô ÙË˜ Ì¿¯Ë˜fiÛÔ Î·È ÛÙËÓ ·ÁÔÚ¿. OÈ ı˘Á·Ù¤ÚÂ˜ Û˘ÓÂ¿ÁÔÓÙ·ÓÂÚÈÛÛfiÙÂÚÂ˜ Â˘ı‡ÓÂ˜ (ÚÔ›Î·, ‰È·Ê‡Ï·ÍË ·ÁÓfi-ÙËÙ·˜ Î.Ï.).

OÈ ÔÏÏ¤˜ ÁÂÓÓ‹ÛÂÈ˜, ÂÓÒ ÛÙËÓ fiÏË-ÌËÙ¤Ú· ıÂ-ˆÚÔ‡ÓÙ·Ó Ì¿ÛÙÈÁ· Î·È Î›Ó‰˘ÓÔ˜, ÛÙËÓ ·ÔÈÎ›· ıÂˆ-ÚÔ‡ÓÙ·Ó ÂÈÙ·ÎÙÈÎ‹ ·Ó¿ÁÎË. ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈı-Ìfi˜ ·È‰ÈÒÓ ·ÔÙÂÏÔ‡ÛÂ ÂÁÁ‡ËÛË ÁÈ· ÙÔ Ì¤ÏÏÔÓ.∞ÓÙÈÎ·ÙÔÙÚ›˙ÔÓÙ·˜ ÙÔ ÓÂ‡Ì· ÙË˜ ÂÔ¯‹˜ ÙÔ˘, Ô¶Ï¿ÙˆÓ ·Ó·Ê¤ÚÂÈ: “¶·›‰ˆÓ ‰Â ÈÎ·ÓfiÙË˜ ·ÎÚÈ‚‹˜¿ÚÚËÓ Î·È ı‹ÏÂÈ· ¤ÛÙˆ Ùˆ ÓfiÌˆ”, ‰ËÏ·‰‹ Ô ·ÚÈı-Ìfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·fi ÙÔÓ ÓfiÌÔ Ú¤ÂÈ Ó· ıÂˆ-ÚÂ›Ù·È ·ÚÎÂÙfi˜ ·˜ Â›Ó·È ¤Ó· ·ÁfiÚÈ Î·È ¤Ó· ÎÔÚ›ÙÛÈ(¡fiÌÔÈ, 1∞ 930d). ™Â ¿ÏÏÔ ÙÔ˘ ¤ÚÁÔ Î·È, Û˘ÁÎÂÎÚÈ-Ì¤Ó·, ÛÙÔÓ “∫ÚÈÙ›·” ÁÚ¿ÊÂÈ ÁÈ· ÙÈ˜ ÎÚ˘Ê¤˜, ·ÓÂÎ-Ï‹ÚˆÙÂ˜ ÂÈı˘Ì›Â˜ ÙÔ˘: “O ÚÔÛÙ¿ÙË˜ ÙË˜ ∞ÙÏ·-ÓÙ›‰·˜, Ô ıÂfi˜ ¶ÔÛÂÈ‰ÒÓ·˜, ÌÂ ÙË ıÓËÙ‹ ∫ÏÂÈÙÒ·¤ÎÙËÛ·Ó ‰¤Î· ÁÈÔ˘˜” (2,3).

OÈ ÂÏÏËÓÈÎÔ› Á¿ÌÔÈ ‰ÂÓ ‹Ù·Ó Î·ıfiÏÔ˘ ÁfiÓÈÌÔÈ,ÁÈ· ‰‡Ô ÏfiÁÔ˘˜: ·) Ô Û‡˙˘ÁÔ˜ ÈÎ·ÓÔÔÈÔ‡ÛÂ Â‡ÎÔ-Ï· Ù· ÛÂÍÔ˘·ÏÈÎ¿ ÙÔ˘ ¤ÓÛÙÈÎÙ· Î·È ¤Íˆ ·fi ÙÔ Û›-ÙÈ Î·È ‚) ÔÈ ŒÏÏËÓÂ˜ ÊÔ‚Ô‡ÓÙ·Ó ÏfiÁˆ ÊÙÒ¯ÂÈ·˜ Î·ÈÂÁˆÈÛÌÔ‡ Ó· ¤¯Ô˘Ó Î·È Ó¤· Ì¤ÏË Ó· ·Ó·ıÚ¤„Ô˘Ó.∞ÎfiÌË, ›ÛÙÂ˘·Ó fiÙÈ Ë ·ÙÚÈÎ‹ ÎÏËÚÔÓÔÌÈ¿ ı·¤ÚÂÂ Ó· ÌÔÈÚ·ÛÙÂ› ÛÂ ÔÏÏÔ‡˜ ÎÏËÚÔÓfiÌÔ˘˜, ÌÂ·ÔÙ¤ÏÂÛÌ· ÙÔ ÌÂÚ›‰ÈÔ Ó· ÌÂÈÒÓÂÙ·È Û˘ÓÂ¯Ò˜.

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Û˘ÁÎÏ›ÓÔ˘ÛÂ˜ Â›Ó·È ÔÈ ·fi„ÂÈ˜ÔÏÏÒÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙË˜ ÂÔ¯‹˜ ÂÎÂ›ÓË˜ ÌÂ ÎÔÚ˘-Ê·›· ÂÎÂ›ÓË ÙÔ˘ ∏Û›Ô‰Ô˘: “ŒÓ· ·È‰›, ·ÁfiÚÈ, Â›Ó·È·ÚÎÂÙfi ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·”. ¶ÚÔÙÈÌÔ‡ÛÂ “·ÎfiÌË Î·È

Ó· ÛÎÔÙˆıÂ› ÛÂ Î¿ÔÈÔÓ fiÏÂÌÔ, ·fi ÙÔÓ Î›Ó‰˘ÓÔÓ· ÌÔÈÚ·ÛÙÂ› Ë ÔÈÎÔÁÂÓÂÈ·Î‹ ÂÚÈÔ˘Û›· ÛÂ ÂÚÈÛ-ÛfiÙÂÚ· ·È‰È¿” (ŒÚÁ· Î·È ∏Ì¤Ú·È, 375-385).

™ÙËÓ ∞ı‹Ó·, fiÏÔÈ ÔÈ ÓfiÌÈÌÔÈ ÁÈÔÈ ÎÏËÚÔÓÔÌÔ‡Û·ÓÙË ÁË ÛÂ ›Û· ÌÂÚ›‰È·. ŒÙÛÈ, ÌÂÙ¿ ·fi ·ÏÏÂ¿ÏÏËÏÂ˜‰È·ÈÚ¤ÛÂÈ˜, Ë ÔÈÎÔÁÂÓÂÈ·Î‹ ÂÚÈÔ˘Û›· Î·Ù·ÌÂÚÈ˙fi-Ù·Ó ÛÂ Ù¤ÙÔÈÔ ‚·ıÌfi, ÒÛÙÂ Î¿ıÂ ÎÏËÚÔÓfiÌÔ˜ Î·Ù¤-ÏËÁÂ ÌÂ ¤Ó· ÌÈÎÚfi ÎÔÌÌ¿ÙÈ ÁË˜, ÙÔ ÔÔ›Ô ÌÂ ‰˘ÛÎÔ-Ï›· Î¿Ï˘ÙÂ ÙÈ˜ ‚ÈÔÙÈÎ¤˜ ÙÔ˘ ·Ó¿ÁÎÂ˜ (4).

™‡ÌÊˆÓ·, fiÌˆ˜, ÌÂ ÙÔÓ Â‚Ú·˚Îfi ÓfiÌÔ, ÌfiÓÔ ÔÚÒÙÔ˜ ÁÈÔ˜ ÎÏËÚÔÓÔÌÂ› ÙËÓ ÂÚÈÔ˘Û›· (5).

∆Ô ÓÂÔÁ¤ÓÓËÙÔ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰· ‹Ù·Ó Ï‹-Úˆ˜ ÂÍ·ÚÙËÌ¤ÓÔ ·fi ÙÔÓ ·Ù¤Ú· ÙÔ˘, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· Ó· ·ÔÊ·Û›˙ÂÈ ÂÎÂ›ÓÔ˜ ·Ó ı· ¤ÌÂÓÂ ‹ fi¯È ÛÙËÓÔÈÎÔÁ¤ÓÂÈ·. O ·Ù¤Ú·˜ Ê·Ó¤ÚˆÓÂ ÙËÓ ÚfiıÂÛ‹ ÙÔ˘Ó· ÙÔ ÂÓÙ¿ÍÂÈ ÛÂ ·˘Ù‹, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÙÂÏÂ-Ù‹˜ ÙˆÓ ∞ÌÊÈ‰ÚÔÌ›ˆÓ, Ë ÔÔ›· ‰ÈÂÍ·ÁfiÙ·Ó ÙËÓÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛË. O ·Ù¤Ú·˜, ÌÂÙË ‚¿ÙÈÛË, ÙÔ ·Ó·ÁÓÒÚÈ˙Â Ï¤ÔÓ ˆ˜ ÓfiÌÈÌÔ ·fi-ÁÔÓÔ. ™ÙÔ Ï·›ÛÈÔ ÙË˜ ÂÔÚÙ‹˜ ÙˆÓ ∞ÌÊÈ‰ÚÔÌ›ˆÓ, ËÙÔÔı¤ÙËÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ÁË, ‰›Ï· ÛÙËÓ ÂÛÙ›·,Ì¤Û· ÛÙÔÓ Î‡ÎÏÔ Ô˘ ¯·Ú¿¯ıËÎÂ ÌÂ ÙÔ ÈÂÚÔ˘ÚÁÈÎfiÙÚ¤ÍÈÌÔ Á‡Úˆ ·fi ·˘Ù‹, ·›ÚÓÂÈ ÙËÓ ·Í›· Ì›·˜ ‰Ô-ÎÈÌ·Û›·˜ ÓÔÌÈÌÔÔ›ËÛË˜ (6).

∆· ‰ÈÎ·ÈÒÌ·Ù· ÙË˜ ·ÙÚÈÎ‹˜ ÂÍÔ˘Û›·˜, fiˆ˜‰È·ÁÚ¿ÊÔÓÙ·È ÛÙÔ ‰›Î·ÈÔ ÙË˜ ÂÔ¯‹˜, ‹Ù·Ó:

·) £·Ó¿ÙˆÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ™ÙËÓ ÂÏÏËÓÈÎ‹ Ì˘ıÔÏÔÁ›·, Û˘Ó·ÓÙ¿Ù·È Û˘¯Ó¿ Ë

Ú¿ÍË ÙË˜ ·È‰ÔÎÙÔÓ›·˜. O O˘Ú·Ófi˜ ‚˘ı›˙ÂÈ Ù· Ù¤-ÎÓ· ÙÔ˘ ÛÙ· ¤ÁÎ·Ù· ÙË˜ ÁË˜ (∏ÛÈfi‰Ô˘ £ÂÔÁÔÓ›·154-160). O ∫ÚfiÓÔ˜ Î·Ù·‚ÚÔ¯ı›˙ÂÈ fiÛ· ¤Ú¯ÔÓÙ·ÈÓ· ·Ó··˘ıÔ‡Ó ÛÙ· ÁfiÓ·Ù¿ ÙÔ˘ (§Ô˘ÎÈ·ÓÔ‡ ¶ÂÚ›£˘ÛÈÒÓ 5). O ◊Ê·ÈÛÙÔ˜ Î·Ù·ÎÚËÌÓ›˙ÂÙ·È ·fi ÙÔÓŸÏ˘ÌÔ ·fi ÙÔÓ ¢›· ‹ ÙËÓ ◊Ú·, ÁÈ·Ù› Â›Ó·È ‰‡-ÛÌÔÚÊÔ˜. O §¿ÈÔ˜ ‰È·Ù¿ÛÛÂÈ Ó· ÂÍ·ÁÓÈÛÙÂ› Ô ÁÈÔ˜Ô˘ ÁÂÓÓ‹ıËÎÂ ·fi ÙËÓ πÔÎ¿ÛÙË, ÂÓÒ Ô ¶ÂÚÛÂ‡˜ Ú›-¯ÓÂÙ·È ÛÙË ı¿Ï·ÛÛ· ·fi ÙÔÓ ·Ô‡ ÙÔ˘.

™ÙËÓ Ú·ÁÌ·ÙÈÎ‹ πÛÙÔÚ›· ÛËÌÂÈÒÓÂÙ·È fiÙÈ ÔÕÙÙ·ÏÔ˜, Ô ‚·ÛÈÏÈ¿˜ ÙË˜ ¶ÂÚÁ¿ÌÔ˘ Î·È Û‡˙˘ÁÔ˜ÙË˜ ™ÙÚ·ÙÔÓ›ÎË˜, ¯‹Ú·˜ ÙÔ˘ ·‰ÂÏÊÔ‡ ÙÔ˘, ı·Ó·-ÙÒÓÂÈ fiÏ· Ù· Ù¤ÎÓ· ÙÔ˘ ÌfiÏÈ˜ ÁÂÓÓÈÔ‡ÓÙ·È, ·fi·‰ÂÏÊÈÎ‹ ·Á¿Ë, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÌËÓ ÊÔ‚¿Ù·È Ô·ÓÈ„Èfi˜ ÙÔ˘ ·fi ÂÓ‰Â¯fiÌÂÓÔ ·ÓÙ·ÁˆÓÈÛÌfi ÛÙË ‚·-ÛÈÏÂ›· (§˘Û. 16, ¶ÏÔ˘Ù¿Ú¯Ô˘ §˘ÎÔ‡ÚÁÔ˜ 16).

™ÙË ™¿ÚÙË, ÙÔ ÎÚ¿ÙÔ˜ ··ÁfiÚÂ˘Â ÚËÙ¿ ÛÙÔÓ·Ù¤Ú· Ó· ·Ó·ıÚ¤„ÂÈ ‰‡ÛÌÔÚÊÔ ‹ ·ÛıÂÓ¤˜ ÓÂÔ-ÁÓfi. ∏ ı·Ó¿ÙˆÛË ÛÙË ™¿ÚÙË Â›¯Â ¯·Ú·ÎÙ‹Ú· ÎÔÈ-ÓˆÓÈÎfi, ÂÈ‚·ÏÏfiÙ·Ó ÁÈ· ÂÍ˘Á›·ÓÛË ÙË˜ ÎÔÈÓˆÓ›·˜,fiˆ˜ ÛÙËÓ ∫·Ú¯Ë‰fiÓ· Î·È Â›¯Â ıÚËÛÎÂ˘ÙÈÎfi ¯·Ú·-ÎÙ‹Ú·. ∂ÎÂ›, ı·Ó¿ÙˆÓ·Ó Ù· ÚˆÙfiÙÔÎ· ·ÁfiÚÈ·. ™ÙË™¿ÚÙË, Û‡ÌÊˆÓ· ÌÂ ÙÔ˘˜ ¡fiÌÔ˘˜ ÙÔ˘ §˘ÎÔ‡Ú-ÁÔ˘, Ô ·Ù¤Ú·˜ ‹Ù·Ó ˘Ô¯ÚÂˆÌ¤ÓÔ˜ Ó· ÚÔÛÎÔÌ›-ÛÂÈ ÙÔ ·È‰› ÙÔ˘ ÛÙÔ˘˜ Á¤ÚÔÓÙÂ˜ ÙË˜ Ê˘Ï‹˜ ÁÈ· Ó·

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ÙÔ ÂÍÂÙ¿ÛÔ˘Ó. ∞Ó ·˘Ùfi ·ÚÔ˘Û›·˙Â Û˘ÁÁÂÓÂ›˜ ·Óˆ-Ì·Ï›Â˜ ‹ ‹Ù·Ó ·ÛıÂÓÈÎfi, ÙÔ ÂÙÔ‡Û·Ó ÛÂ Ì›· ·fi-ÙÔÌË ¯·Ú¿‰Ú· ÙÔ˘ ∆·¸Á¤ÙÔ˘, ÙÔ˘˜ ∞Ôı¤ÙÂ˜(¶ÏÔ˘Ù¿Ú¯Ô˘ §˘ÎÔ‡ÚÁÔ˜ 16).

∆fiÛÔ Ô ∞ÚÈÛÙÔÙ¤ÏË˜ fiÛÔ Î·È Ô ‰¿ÛÎ·Ïfi˜ ÙÔ˘, Ô¶Ï¿ÙˆÓ, ˙ËÙÔ‡Û·Ó ÙË ‰È¿ ÓfiÌÔ˘ ¤ÎıÂÛË ÛÙË ÊˆÙÈ¿ÂÎÂ›ÓˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ Â›¯·Ó ÔÏÏ·Ï¤˜ ‰˘-ÛÌÔÚÊ›Â˜. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ë ÂÈÛÙËÌÔÓÈÎ‹ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÎÂÊ·Ï·›Ô˘ ÙÂÚ·ÙÔÁ¤ÓÂÛË ¤ÁÈÓÂ·fi ÙÔÓ ∞ÚÈÛÙÔÙ¤ÏË Î·È ÙÔÓ πÔÎÚ¿ÙË. ª¤¯ÚÈ ÙfiÙÂ,Î˘ÚÈ·Ú¯Ô‡ÛÂ Ë ‰ÂÈÛÈ‰·ÈÌÔÓ›· Î·È Ë Ì·ÁÂ›· (7).

O ¶ÔÏ‡‚ÈÔ˜ ıÂˆÚÔ‡ÛÂ Î·Ù¿Ú· Ó· ı·Ó·ÙÒÓÔ-ÓÙ·È Ù· ÓÂÔÁ¤ÓÓËÙ·, Î·ıÒ˜ ÛÙËÓ ÂÔ¯‹ ÙÔ˘ Ë ∂ÏÏ¿-‰· ˘¤ÊÂÚÂ ·fi ¤ÏÏÂÈ„Ë ·È‰ÈÒÓ, ‰ËÏ·‰‹ ˘ÔÁÂÓ-ÓËÙÈÎfiÙËÙ·.

∏ ı·Ó¿ÙˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡, Ë ÔÔ›· Û˘Ó¤‚·ÈÓÂÛ¿ÓÈ· fiÙ·Ó ·˘Ùfi ‹Ù·Ó ÚˆÙfiÙÔÎÔ ·ÁfiÚÈ, ‹Ù·Ó Ì›·Ú¿ÍË ¯ˆÚ›˜ ÛËÌ·Û›·, Î·ıÒ˜ ÙÔ ·È‰› ‰ÂÓ ·Ó‹ÎÂ·ÎfiÌË ÛÙÔ ÎÔÈÓˆÓÈÎfi Û‡ÓÔÏÔ. ¢ÂÓ Â›¯·Ó Á›ÓÂÈ ÔÈ Î·-ıÔÚÈÛÌ¤ÓÂ˜ ÈÂÚÔÙÂÏÂÛÙ›Â˜ Ô˘ ÙÔ˘ ‰›ÓÔ˘Ó, ÙÔ˘Ï¿-¯ÈÛÙÔÓ, ÙËÓ ·Ú¯‹ Î¿ÔÈ·˜ ÚÔÛˆÈÎfiÙËÙ·˜. ∂È‰È-ÎfiÙÂÚ·, Ì¿ÏÈÛÙ·, ·ÊÔ‡ ‰ÂÓ ¤¯ÂÈ Ï¿‚ÂÈ fiÓÔÌ·, ‰ÂÓ¤¯ÂÈ Ú·ÁÌ·ÙÈÎ‹ ‡·ÚÍË. O ı¿Ó·Ùfi˜ ÙÔ˘ ÚÔ-Û‚¿ÏÏÂÈ ÌfiÓÔÓ Ù· Ê˘ÛÈÎ¿ Û˘Ó·ÈÛı‹Ì·Ù·. ¢ÂÓ ÛÎfi-ÙˆÓ·Ó ÙÔ ÓÂÔÁÓfi Ô˘ ‰ÂÓ ‹ıÂÏ·Ó Ó· ·Ó·ıÚ¤„Ô˘Ó,·ÏÏ¿ ÙÔ ¿ÊËÓ·Ó ¤Íˆ, Ì¤Û· ÛÂ ¤Ó· ‰Ô¯Â›Ô ‹ ÛÂ Ì›·¯‡ÙÚ· ·fi ¿ÚÁÈÏÔ fiÔ˘ ı· ÁÈÓfiÙ·Ó Ô Ù¿ÊÔ˜ ÙÔ˘(∞ÚÈÛÙÔÊ¿ÓË £ÂÛÌÔÊÔÚÈ¿˙Ô˘ÛÂ˜ 505-509, µ¿ÙÚ·-¯ÔÈ 1190).

∏ ‚ÚÂÊÔÎÙÔÓ›·, fiÌˆ˜, ‹ Ô ı¿Ó·ÙÔ˜ ÌÂÁ·Ï‡ÙÂ-ÚÔ˘ ÛÂ ËÏÈÎ›· ·È‰ÈÔ‡ ‰ÂÓ ·ÔÙÂÏÂ› ÂÏ·ÊÚ˘ÓÙÈÎfi·Ú¿ÁÔÓÙ· Î·È ‰ÂÓ ÂÌÔ‰›˙ÂÈ Ó· ¯·Ú·ÎÙËÚÈÛÙÂ› ËÚ¿ÍË ˆ˜ ÎÔÈÓfi˜ ÊfiÓÔ˜.

∏ ÚÔ‚ÏÂfiÌÂÓË ÔÈÓ‹ ·fi ÙÔÓ ÓfiÌÔ ˘Ô¯ÚÂÒ-ÓÂÈ ÙÔÓ ‰Ú¿ÛÙË Ó· ·˘ÙÔÂÍÔÚÈÛÙÂ›, ÂÓÒ ÙÔ˘ ··ÁÔ-ÚÂ‡ÂÈ Î·È Ó· ·Ú·ÛÙÂ› ÛÙËÓ ÎË‰Â›· ÙÔ˘ ı‡Ì·Ùfi˜ÙÔ˘ (8). O ¶Ï¿ÙˆÓ ÛÙÔ˘˜ “¡fiÌÔ˘˜” ÙÔ˘ ÂÈ‚¿ÏÏÂÈÛÙÔÓ ¤ÓÔ¯Ô ·Ù¤Ú· ‹ ÌËÙ¤Ú· - ÂÎÙfi˜ ÙˆÓ ÚÔ·Ó·-ÊÂÚı¤ÓÙˆÓ - ÙËÓ ˘Ô¯ÚÂˆÙÈÎ‹ ‰È¿Ï˘ÛË ÙÔ˘ Á¿ÌÔ˘Î·È ÙËÓ ·ÒÏÂÈ· Î¿ıÂ ‰ÈÎ·ÈÒÌ·ÙÔ˜ ¿Óˆ ÛÙ· Ù¤ÎÓ·Ô˘ ˙Ô˘Ó. ∂¿Ó ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡ Â¤ÊÂÚÂÔÔÈÔÛ‰‹ÔÙÂ ¿ÏÏÔ˜, Ë Ú¿ÍË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó,Â›ÛË˜, ˆ˜ ÊfiÓÔ˜.

∏ ı·Ó¿ÙˆÛË ÙÔ˘ ·È‰ÈÔ‡, ˆÛÙfiÛÔ, .¯. Ë ı˘Û›·ÙË˜ πÊÈÁ¤ÓÂÈ·˜, ıÂˆÚÂ›Ù·È Î¿ÙÈ ·Úˆ¯ËÌ¤ÓÔ, fiˆ˜Ì·˜ ÏËÚÔÊÔÚÂ› Î·È Ô Ú‹ÙÔÚ·˜ ∞ÈÛ¯›ÓË˜, ÌË Â·-Ó·Ï·Ì‚·ÓfiÌÂÓÔ ÛÙÔ˘˜ ¯ÚfiÓÔ˘˜ ÙÔ˘ (∫·Ù¿ ∆ÈÌ¿Ú-¯Ô˘ 182). ™ÙÔ ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙÔÓ ™fiÏˆÓ·, ‰ÂÓ Û˘-Ó·ÓÙ¿Ù·È Î·Ó¤Ó· ÂÚÈÛÙ·ÙÈÎfi ı·Ó¿ÙˆÛË˜.

µ¤‚·È·, fiÏ· ·˘Ù¿ ›Û¯˘·Ó ÁÈ· ÙÔ˘˜ ÂÏÂ‡ıÂÚÔ˘˜ÔÏ›ÙÂ˜. °È· ÙÔ˘˜ ‰Ô‡ÏÔ˘˜, Ù· Ú¿ÁÌ·Ù· ‹Ù·Ó ÙÂ-ÏÂ›ˆ˜ ‰È·ÊÔÚÂÙÈÎ¿. ∫¿ıÂ ‰Ô˘ÏÔÎÙ‹ÙË˜ ‹Ù·Ó ÂÏÂ‡-ıÂÚÔ˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÓÂÔÁÓÔ‡ ·fi ‰Ô‡-

ÏË ÙÔ˘, Ó· ÙÔ ÛÎÔÙÒÛÂÈ Î·È Ó· ÙÔ ÂÎı¤ÛÂÈ, Ú¿ÁÌ·Ô˘ Û˘Ó¤‚·ÈÓÂ ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÊÔÚ¤˜. ∏ ÁÓÒÌËÙÔ˘ ·Ù¤Ú· ‰Ô‡ÏÔ˘ ‹Ù·Ó ·Ó‡·ÚÎÙË. ◊Ù·Ó ÔÏ‡ÈÔ Û˘ÌÊ¤ÚÔÓ Ó· ·ÁÔÚ¿˙ÂÙ·È ‰Ô‡ÏÔ˜ ÈÎ·Ófi˜ ÁÈ· Î¿-ıÂ ÂÚÁ·Û›· ·fi ÙÔ Ó· ·Ó·ÙÚ¤ÊÔÓÙ·È Ù· ·È‰È¿ ÙˆÓ‰Ô‡ÏˆÓ (6). ∂¿Ó ÏËÊıÂ› ˘’ fi„ÈÓ fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ‰Ô‡ÏˆÓ ÛÙËÓ ∞ÙÙÈÎ‹ ÙÔ 300 .X., Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ËÁ¤˜, ‹Ù·Ó 400.000, ÂÓÒ ÔÈ ÂÏÂ‡ıÂÚÔÈ ∞ıËÓ·›ÔÈÔÏ›ÙÂ˜ ·Ó¤Ú¯ÔÓÙ·Ó ÌfiÏÈ˜ ÛÂ 21.000, Á›ÓÂÙ·È ·ÓÙÈ-ÏËÙfi fiÙÈ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ ı·Ó¿ÙˆÛË˜ ÙˆÓ ÓÂÔ-ÁÓÒÓ ‹ ÙË˜ ¤ÎıÂÛË˜ ‹Ù·Ó ·ÚÎÂÙ¿ Û‡ÓËıÂ˜ (14).

‚) ¶ÒÏËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ O ·Ù¤Ú·˜ Â›¯Â ÙÔ ‰ÈÎ·›ˆÌ· fi¯È ÌfiÓÔ Ó· Ô˘Ï‹-

ÛÂÈ ÙÔ ·È‰› ÙÔ˘, ·ÏÏ¿ ·ÎfiÌË Î·È Ó· ÙÔ ˘ÔıËÎÂ‡-ÛÂÈ. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·Ó·Ê¤ÚÂÙ·È ·fi ÔÏÏÔ‡˜Û˘ÁÁÚ·ÊÂ›˜, fiˆ˜ Ô ¶ÏÔ‡Ù·Ú¯Ô˜: “... ¶ÔÏÏÔ› ‰Â·›‰·˜ È‰›Ô˘˜ ËÓ·ÁÎ¿˙ÔÓÙÔ ˆÏÂ›Ó... Ô˘‰Â›˜ Á·ÚÓfiÌÔ˜ ÂÎÒÏ˘ÂÓ” (™fiÏˆÓ 13,5). ™ÙËÓ ÂÚ›ÙˆÛË ÙË˜˘Ôı‹ÎÂ˘ÛË˜ ·Ó·Ê¤ÚÂÙ·È Ô πÛÔÎÚ¿ÙË˜ ÛÙÔ ¤ÚÁÔÙÔ˘ ¶Ï·Ù·˚Îfi˜ 14,48. µ¤‚·È·, fiÏ· ·˘Ù¿ Û˘Ó¤‚·ÈÓ·ÓÔÏ‡ ÚÈÓ ÙËÓ ÂÔ¯‹ ÙÔ˘ ™fiÏˆÓ·, Î·ıÒ˜ ·˘Ùfi˜‹Ù·Ó Ô˘ Ù· Î·Ù‹ÚÁËÛÂ ‰È¿ ÓfiÌÔ˘, ÂÓÒ Â¤ÙÚÂ„ÂÌfiÓÔ ÙËÓ ÒÏËÛË ÎÔÚÈÙÛÈÒÓ, fiÙ·Ó ÔÈ ÌËÙ¤ÚÂ˜ Â›¯·ÓÛ˘Ó¿„ÂÈ ÂÍÒÁ·ÌÂ˜ Û¯¤ÛÂÈ˜ ÌÂ Í¤ÓÔ˘˜ ¿Ó‰ÚÂ˜.

O ª¤Ó·Ó‰ÚÔ˜ ÁÚ¿ÊÂÈ fiÙÈ ÌÂÙ·Í‡ ÙˆÓ £Ú·ÎÒÓ›Û¯˘Â Ë ÔÏ˘Á·Ì›·, ÁÂÁÔÓfi˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÛÂ ‰Ë-ÌÔÁÚ·ÊÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÌÂ È‰ÈfiÙ˘Â˜ ÎÔÈÓˆÓÈÎ¤˜ÚÔÂÎÙ¿ÛÂÈ˜ (.¯. ıÚ‹ÓÔÈ Î·Ù¿ ÙË Á¤ÓÓËÛË ÙˆÓ ·È-‰ÈÒÓ, ¯·Ú¤˜ Î·È ¯ÔÚÔ› fiÙ·Ó Î¿ÔÈÔ˜ ¤ı·ÈÓÂ, ÒÏË-ÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ).

øÛÙfiÛÔ, Ù· ·È‰È¿ ˆÏÔ‡ÓÙ·È Î·È Û‹ÌÂÚ· (˘ÈÔ-ıÂÛ›·). ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ›Û¯˘Â Î·È ÛÙËÓ ·Ú¯·Èfi-ÙËÙ·. O ÚˆÙ·Ú¯ÈÎfi˜ ÛÎÔfi˜ ÙË˜ ˘ÈÔıÂÛ›·˜ ‹Ù·Ó Ë·ÚÔ¯‹ ÓfiÌÈÌË˜ Ô‰Ô‡ ÁÈ· ÙË ‰È·ÈÒÓÈÛË Ì›·˜ ¿ÎÏË-ÚË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È fi¯È Ë ·ÚÔ¯‹ ÁÔÓÈÎ‹˜ ÚÔÛÙ·-Û›·˜ ÛÂ ¤Ó· ·È‰› Ô˘ ÛÂ ‰È·ÊÔÚÂÙÈÎ‹ ÂÚ›ÙˆÛËı· Â›¯Â ÛÙÂÚËıÂ›. ∏ Ú¿ÍË ·˘Ù‹ ‹Ù·Ó ÁÓˆÛÙ‹ ÛÂfiÏË ÙËÓ ÂÏÏËÓÈÎ‹ ÂÈÎÚ¿ÙÂÈ· Î·È ÂÊ·ÚÌÔ˙fiÙ·Ó Û˘-ÛÙËÌ·ÙÈÎ¿ ÛÙÔ˘˜ ÂÏÂ‡ıÂÚÔ˘˜ ÔÏ›ÙÂ˜. ∞Ó Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ˘ÈÔıÂÛ›·˜ ÁÂÓÓÈfiÙ·Ó ·ÁfiÚÈ, Ë ˘ÈÔıÂÛ›·ÚÔ¯ˆÚÔ‡ÛÂ, ¯ˆÚ›˜ fiÌˆ˜ Ô ˘ÈÔıÂÙËÌ¤ÓÔ˜ Ó· ·Ô-Ï·Ì‚¿ÓÂÈ ÎÏËÚÔÓÔÌÈÎÒÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ (9,10).

Á) ŒÎıÂÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ O ·Ù¤Ú·˜ ‹ Î¿ÔÈÔ˜ ÂÎÚfiÛˆfi˜ ÙÔ˘, .¯.

‰Ô‡ÏÔ˜, ÌÔÚÔ‡ÛÂ Ó· ÂÁÎ·Ù·ÏÂ›„ÂÈ ÙÔ ÓÂÔÁ¤ÓÓËÙfiÙÔ˘, ¯ˆÚ›˜ Ó· ÂÓ‰È·Ê¤ÚÂÙ·È ÁÈ· ÙËÓ Î·Ù¿ÏËÍ‹ ÙÔ˘.∞˘Ùfi ÁÈÓfiÙ·Ó ÂÂÈ‰‹ ‰ÂÓ ıÂˆÚÔ‡ÓÙ·Ó ÛÎfiÈÌË Ë·Ó·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ, .¯. Ë ÂÚ›ÙˆÛË ¤ÎıÂÛË˜ÙÔ˘ OÈ‰›Ô‰·. ¶ÏÂ›ÛÙ· ·Ú·‰Â›ÁÌ·Ù· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙÔ˘˜ ÎˆÌˆ‰ÈÔÁÚ¿ÊÔ˘˜ ÙË˜ ÂÔ¯‹˜ ÂÎÂ›ÓË˜,ÌÂ ÚÒÙÔ ÙÔÓ ∞ÚÈÛÙÔÊ¿ÓË.

∞Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÌÂÛÂ˜ Ì·ÚÙ˘Ú›Â˜ ÁÈ· ÙËÓÚ·ÎÙÈÎ‹ ÙË˜ ¤ÎıÂÛË˜ ÛÙË ÓÔÌÔıÂÛ›· ÙË˜ ÂÔ¯‹˜,

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ÂÎÙfi˜ ·fi ·Ó·ÊÔÚ¤˜ ÛÙÔ ‰ÈÎ·›ˆÌ· ÙË˜ ÌËÙ¤Ú·˜ Ó·ÂÎı¤ÛÂÈ Ë ›‰È· ÙÔ ·È‰› ·Ó ‹Ù·Ó ¯ˆÚÈÛÌ¤ÓË Î·È ·Ó ÔÚÒËÓ ¿Ó‰Ú·˜ ‰ÂÓ ÙÔ ·Ó·ÁÓÒÚÈ˙Â (10), ÂÓÙÔ‡ÙÔÈ˜,ÙÔ ÁÂÁÔÓfi˜ ÂÈ‚Â‚·ÈÒÓÂÙ·È ¤ÌÌÂÛ· ÛÙË ÏÔÁÔÙÂ-¯Ó›·, ÙË Ì˘ıÔÏÔÁ›· ‹ ·ÎfiÌË Î·È ÛÙËÓ ·ÏÏËÏÔÁÚ·-Ê›·. ŒÙÛÈ, ÛÙ· ıÂ·ÙÚÈÎ¿ ¤ÚÁ·, Â›ÙÂ ÚfiÎÂÈÙ·È ÁÈ·ÎˆÌˆ‰›Â˜ ÙÔ˘ ∞ÚÈÛÙÔÊ¿ÓË, Â›ÙÂ ÁÈ· ÙÚ·Áˆ‰›Â˜ ÙÔ˘∂˘ÚÈ›‰Ë, Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ô ·Ù¤Ú·˜ Ó· ÂÎ-ı¤ÙÂÈ ÙÔ ·È‰› ÙÔ˘, ÂÓÒ ·˘Ù‹ Ë Ú¿ÍË ıÂˆÚÂ›Ù·È ˆ˜Î¿ÙÈ ·fiÏ˘Ù· Ê˘ÛÈÔÏÔÁÈÎfi. ™ÙËÓ ÂÏÏËÓÈÎ‹ Ì˘ıÔÏÔ-Á›·, Û˘¯Ó¿, ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂÈ˜ ¤ÎıÂÛË˜·Ó¿ÌÂÛ· ÙfiÛÔ ÛÙÔ˘˜ ıÂÔ‡˜ fiÛÔ Î·È ÛÙÔ˘˜ ‹ÚˆÂ˜.∞fi ÙÔÓ ¢›· Ì¤¯ÚÈ ÙÔÓ OÈ‰›Ô‰·, ÔÏÏÔ› ÂÎÙ¤ıËÎ·Ó·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ ‹, Â¿Ó ‹Ù·Ó ıÓËÙÔ›,·Ê¤ıËÎ·Ó ·fi ÙÔÓ ·Ù¤Ú· ÙÔ˘˜ Ó· Âı¿ÓÔ˘Ó (∞ÚÈ-ÛÙÔÊ¿ÓË µ¿ÙÚ·¯ÔÈ 1190-6). ∆¤ÏÔ˜, Û‡ÌÊˆÓ· ÌÂ¤Ó· ÁÚ¿ÌÌ· Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÂÏÏËÓÈÛÙÈÎ‹ÂÔ¯‹, ¤Ó·˜ ¿Ó‰Ú·˜ Û˘Ì‚Ô˘ÏÂ‡ÂÈ ÙË Á˘Ó·›Î· ÙÔ˘:“™Â ÚÔÙÚ¤ˆ Î·È ÛÂ ÂÎÏÈ·ÚÒ Ó· Â›Û·È ÚÔÛÂÎÙÈ-Î‹ ÌÂ ÙÔ ·È‰›... ·Ó Â›Ó·È ·ÚÛÂÓÈÎfi ¿ÊËÛ¤ ÙÔ Ó· ˙‹-ÛÂÈ, ·Ó Â›Ó·È ıËÏ˘Îfi ¿ÊËÛ¤ ÙÔ ¤ÎıÂÙÔ” (4,12).

∂ÍÂÙ¿˙ÔÓÙ·˜ ÙËÓ Ú·ÎÙÈÎ‹ ÙË˜ ¤ÎıÂÛË˜ ·fi Ì›·ÁÂÓÈÎfiÙÂÚË ıÂÒÚËÛË, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë fiÚıÈ· ÛÙ¿-ÛË ‰ÂÓ ¤¯ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙË˜ ÔÚÈ˙fiÓÙÈ·˜ ı¤ÛË˜,Ô˘ ·Ú·‰›ÓÂÈ ÂÓÙÂÏÒ˜ ÙÔÓ ¿ÓıÚˆÔ ÛÙÈ˜ ¯ıfiÓÈÂ˜‰˘Ó¿ÌÂÈ˜. °È’ ·˘Ùfi, ·ÎfiÌË Î·È fiÙ·Ó ÂÎı¤ÙÔ˘Ó ¤Ó· ÓÂ-ÔÁ¤ÓÓËÙÔ, ‰ÂÓ ÙÔ ÂÁÎ·Ù·ÏÂ›Ô˘Ó ÛÙË ÁË. ∏ ¤ÎıÂÛËÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ Û˘ÓÔ‰Â˘fiÙ·Ó ¿ÓÙ· ·fi ÙË Ï¿ÚÓ·-Î·, ÙÔ Ï›ÎÓÔ ‹ ÙË ¯‡ÙÚ·. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ªˆ¸Û‹‹Ù·Ó ¤Ó· Î·Ï¿ıÈ. ªÂ ÙËÓ Ú¿ÍË ·˘Ù‹, Ë ÂÁÎ·Ù¿ÏÂÈ„ËÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ÁÈÓfiÙ·Ó ·Ó·ÁÎ·ÛÙÈÎ¿ ÛÂ ÂÚËÌÈÎfi Ì¤-ÚÔ˜, ÌÂ ÙËÓ ÂÏ›‰· fiÙÈ ı· ÂÈ˙‹ÛÂÈ (13).

O ÛÔ˘‰·›Ô˜ ÌÂÏÂÙËÙ‹˜ ÙË˜ ·Ú¯·ÈfiÙËÙ·˜ R.Flacieliere ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ ÛÙÂ›ÚÂ˜ Á˘Ó·›ÎÂ˜ Û˘¯Ó¿ÂÚÈÌ¿˙Â˘·Ó Î¿ÔÈÔ ¤ÎıÂÙÔ, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÈÎ·ÓÔ-ÔÈ‹ÛÔ˘Ó ÙË Ï·¯Ù¿Ú· ÙÔ˘˜ ÁÈ· ·È‰›. ¶·Ú›ÛÙ·Ó·ÓÙÈ˜ ÂÁÎ˘ÌÔÓÔ‡ÛÂ˜ ÁÈ· Ó· ÍÂÁÂÏ¿ÛÔ˘Ó ÙÔÓ Û‡˙˘ÁÔ,‰›ÓÔÓÙ¿˜ ÙÔ˘ ÙÔÓ ÁÈÔ Ô˘ ÂÈı˘ÌÔ‡ÛÂ (11).

∏ ·fiıÂÛË ‹Ù·Ó Î¿ÙÈ ÂÓÙÂÏÒ˜ ‰È·ÊÔÚÂÙÈÎfi. ∂ÓÒÛÙËÓ ¤ÎıÂÛË ÔÈ ÏfiÁÔÈ ‹Ù·Ó ÎÔÈÓˆÓÈÎÔ›, ÛÙËÓ ·fiıÂ-ÛË ‹Ù·Ó ıÚËÛÎÂ˘ÙÈÎÔ›. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, ÂÈ-ÏÂÁfiÙ·Ó ÂÚËÌÈÎ‹ ÙÔÔıÂÛ›·, ÌÂ ÛÎÔfi ÙÔÓ ¯·ÌfiÙÔ˘ ÓÂÔÁÓÔ‡. ™ÙÔÓ “ÿˆÓ·” ÙÔ˘ ∂˘ÚÈ›‰Ë ·Ó·Ê¤ÚÂ-Ù·È fiÙÈ ÂÁÎ·Ù¤ÏÂÈ„·Ó ÙÔÓ ÿˆÓ· ÛÂ Ì›· ÂÚËÌÈÎ‹ ÛË-ÏÈ¿ (1494), “ÙÔÓ ¤‰ˆÛ·Ó ÙÚÔÊ‹ ÛÙ· Ô˘ÏÈ¿” (504-505) Î·È “ÙÔÓ ÂÁÎ·Ù¤ÏÂÈ„·Ó ÛÙ· ıËÚ›·” (951).

¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÓıÚˆÔÎÙÔÓ›· ‹Ù·Ó ÙÔÛÔ‚·ÚfiÙÂÚÔ ·‰›ÎËÌ· ÁÈ· ÙËÓ ·Ú¯·›· ÂÏÏËÓÈÎ‹ fi-ÏË, ÔÈ ‰ËÌfiÛÈÔÈ ·ÍÈˆÌ·ÙÔ‡¯ÔÈ ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó·˘Ô‚¿ÏÔ˘Ó Ì‹Ó˘ÛË Î·Ù¿ ÙÔ˘ ‰ÔÏÔÊfiÓÔ˘. ∞˘Ùfi ÁÈ-ÓfiÙ·Ó ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘ ı‡Ì·ÙÔ˜. ™ÙËÓ ÂÚ›-ÙˆÛË ÙË˜ ¤ÎıÂÛË˜, ÔÈ Û˘ÁÁÂÓÂ›˜ ÙÔ˘ ·È‰ÈÔ‡¤ÚÂÂ Ó· Î·Ù·ÁÁÂ›ÏÔ˘Ó ÙËÓ Ú¿ÍË. ¶Ú¤ÂÈ ·ÎfiÌË

Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ô ÁÈÔ˜ ÌÔÚÔ‡ÛÂ Ó· ˙ËÙ‹ÛÂÈ ·fiÙÔ ‰ÈÎ·ÛÙ‹ÚÈÔ, ÌÂ ÙËÓ ˘ÔÎ›ÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ·Ó‹Ù·Ó ·Ó‹ÏÈÎÔ˜, Ó· ˘Ô¯ÚÂÒÛÂÈ ÙÔÓ ·Ù¤Ú· ÙÔ˘ Ó·ÙÔÓ ÂÓÙ¿ÍÂÈ ÛÙË Ê˘Ï‹ ˆ˜ ÁÈÔ ÙÔ˘ Î·È ÛÙËÓ fiÏËfiÙ·Ó ÂÓËÏÈÎÈˆıÂ› (8-10).

∂ÎÙfi˜ ·fi ÙËÓ ∂ÏÏ¿‰·, ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ ¤ÎıÂ-ÛË˜ ‹Ù·Ó Û‡ÓËıÂ˜ ÛÙËÓ ∞›Á˘ÙÔ Î·È ÙË ƒÒÌË. ™ÙËƒÒÌË, ÙÔ ‰ÈÎ·›ˆÌ· ÙË˜ ¤ÎıÂÛË˜ ÙˆÓ ·È‰ÈÒÓ Û‹-Ì·ÈÓÂ Ú·ÎÙÈÎ¿ ÙÔ ‰ÈÎ·›ˆÌ· ÙÔ˘ ·Ù¤Ú· Ó· ÂÎı¤ÙÂÈÙËÓ ÎfiÚË ÙÔ˘. ∞ÎfiÌ· Î·È ÔÈ ÊÙˆ¯fiÙÂÚÔÈ, Û¿ÓÈ·¿ÊËÓ·Ó ¤ÎıÂÙÔ ¤Ó·Ó ÁÈÔ, ÁÈ·Ù› Ô ÁÈÔ˜ ÌÔÚÔ‡ÛÂ -ÚÈÓ ·ÎfiÌË ÂÓËÏÈÎÈˆıÂ› - Ó· ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ÔÈÎÔ-Á¤ÓÂÈ¿ ÙÔ˘. ∏ ÎfiÚË, ·ÓÙ›ıÂÙ·, ÌÔÚÔ‡ÛÂ ›Ûˆ˜ Ó·‚ÔËı‹ÛÂÈ ÛÙÔ ÓÔÈÎÔÎ˘ÚÈfi ¤ˆ˜ fiÙÔ˘ ·ÓÙÚÂ˘ÙÂ›. ∆fi-ÙÂ, ¤ÚÂÂ Ó· ÚÔÈÎÈÛÙÂ›, ‰ËÏ·‰‹ Ó· ·ÔÚÚÔÊ‹ÛÂÈÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙË˜ ÔÈÎÔÁÂÓÂÈ·Î‹˜ ÂÚÈÔ˘Û›·˜. ∞ÓÙ›-ıÂÙ·, ÔÈ ∂‚Ú·›ÔÈ, fiˆ˜ Ì·˜ ÏËÚÔÊÔÚÂ› Ô º›ÏˆÓ,·Ó Î·È ‰ÂÓ ÂÈ‰ÔÎ›Ì·˙·Ó ÙË Á¤ÓÓËÛË ÎÔÚÈÙÛÈÔ‡, ‰ÂÓÙÔ ÂÍ¤ıÂÙ·Ó (º›ÏˆÓÔ˜ π, ÃÃV, 119).

¶Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ·Ó·ÊÂÚıÂ› Î·È Ë ÛÙ·‰È·ÎÒ˜·˘Í·ÓfiÌÂÓË Â›‰Ú·ÛË ÙˆÓ ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ, ÙË˜“Ó¤·˜ ËıÈÎ‹˜”, ÛÙÔ È·ÙÚÈÎfi Â¿ÁÁÂÏÌ·-ÏÂÈÙÔ‡ÚÁË-Ì·. O ÃÚÈÛÙÈ·ÓÈÛÌfi˜, ÌÂ ÙËÓ ¤ÌÊ·ÛË Ô˘ ¤‰ˆÛÂÛÙËÓ ÈÂÚfiÙËÙ· ÙË˜ ˙ˆ‹˜, ‹ÚıÂ ÛÂ ·ÓÙ›ıÂÛË ÌÂ ·˘-Ù¤˜ ÙÈ˜ Ú·ÎÙÈÎ¤˜ ÙÔ˘ ·ÚÂÏıfiÓÙÔ˜. OÈ ·Ù¤ÚÂ˜ÙË˜ ÂÎÎÏËÛ›·˜ ‹Ù·Ó È‰È·›ÙÂÚ· Â˘·›ÛıËÙÔÈ ·¤Ó·ÓÙÈÛÙÈ˜ ·Á·ÓÈÛÙÈÎ¤˜ ·˘Ù¤˜ Ú¿ÍÂÈ˜ Î·È ÚÔÛ¿ıËÛ·ÓÓ· ÚÔÛÙ·Ù¤„Ô˘Ó ÌÂ Î¿ıÂ ÙÚfiÔ ÙÔ ÓÂÔÁ¤ÓÓËÙÔ. OÈÃÚÈÛÙÈ·ÓÔ› Û˘ÁÁÚ·ÊÂ›˜ Û˘¯Ó¿ ·¤‰È‰·Ó ÙËÓ Î·ÙË-ÁÔÚ›· ÙË˜ ·ÓıÚˆÔÎÙÔÓ›·˜ ÛÂ ·˘ÙÔ‡˜ Ô˘ Î·Ù¤-ÛÙÚÂÊ·Ó ÙÔÓ “Î·Úfi ÙË˜ ÎÔÈÏÈ¿˜”.

¶¤Ú·Û·Ó ÔÏÏÔ› ·ÈÒÓÂ˜ ÁÈ· Ó· Î·ÙÔ¯˘ÚˆıÔ‡ÓÓÔÌÈÎ¿ ÔÈ ¯ÚÈÛÙÈ·ÓÈÎ¤˜ ·ÓÙÈÏ‹„ÂÈ˜ ÁÈ· ÙË ı·Ó¿ÙˆÛË,ÙËÓ ÒÏËÛË ‹ ÙËÓ ¤ÎıÂÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘. OÈ Î·È-ÚÔ› Î·È ÔÈ ›‰ÈÔÈ ÔÈ ¿ÓıÚˆÔÈ ‰È·ÌÔÚÊÒÓÔ˘Ó ÙÈ˜ Û˘Ó-ı‹ÎÂ˜. Ÿ,ÙÈ Ï¿‚ÂÈ ¤Ó· ·È‰›, Î¿ÔÈ· Ì¤Ú· ı· ÙÔ ÂÈ-ÛÙÚ¤„ÂÈ. Ÿ,ÙÈ ÛÙÂÚËıÂ›, ı· ÙÔ ÛÙÂÚ‹ÛÂÈ Î·È ·˘Ùfi ÌÂÙË ÛÂÈÚ¿ ÙÔ˘. ∆Ô Î·Îfi Ô˘ ¤¯ÂÈ ˘ÔÛÙÂ›, ÌÔÚÂ› Ó·ÙÔ Â·Ó·Ï¿‚ÂÈ. ∞ÏÏ¿, Â¿Ó ÁÂÌ›ÛÂÈ Ë ÓÂ·Ú‹ „˘¯‹ ÙÔ˘ÌÂ ÙËÓ ÓÔ‹ ÙË˜ ÂÏÂ˘ıÂÚ›·˜, ÙË˜ ‰‡Ó·ÌË˜ Î·È ÙË˜ÁÓÒÛË˜, ÙfiÙÂ ÌÔÚÂ› Ó· ·ÚÌÂÓ›ÛÂÈ Î·È Ó· Ì¿ıÂÈ Ó··ÓÙÈÌÂÙˆ›˙ÂÈ ÙÈ˜ ı‡ÂÏÏÂ˜ ÙË˜ ˙ˆ‹˜. °È·Ù›, Û‡ÌÊˆ-Ó· ÌÂ ÙË ª·Ú›· §·Ì·‰·Ú›‰Ô˘-¶fiıÔ˘ ÛÙÔ ‚È‚Ï›ÔÙË˜ “°Ú¿ÌÌ· ÛÙÔÓ ÁÈÔ ÌÔ˘ ÎÈ ¤Ó· ¿ÛÙÚÔ”: “¡· ı˘-Ì¿Û·È ¿ÓÙ· ÙÔ ı·‡Ì· fiÙÈ ÁÂÓÓ‹ıËÎÂ˜! ∫È ·Ó ÔÈ Î·È-ÚÔ› Ì·˜ Â›Ó·È ·Ó¿ÍÈÔÈ ÁÈ· ¤Ó· Ù¤ÙÔÈÔ ı·‡Ì·, ÌËÓ ÍÂ-¯¿ÛÂÈ˜ ÔÙ¤ ˆ˜ ÙÔ˘˜ Î·ÈÚÔ‡˜ ÙÔ˘˜ ÊÙÈ¿¯ÓÔ˘Ó ¿Ó-ıÚˆÔÈ Î·È ¿ÓıÚˆÔÈ ÙÔ˘˜ ·ÏÏ¿˙Ô˘Ó”.

µÈ‚ÏÈÔÁÚ·Ê›·1. ∆·Ì¿ÎË˜ £∫. ∆Ô ·È‰› ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ¢ÂÏÙ›Ô ∞’ ¶·È-

‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1996;43:31-36. 2. Faure P. ∏ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ ÛÙÈ˜ ÂÏÏËÓÈÎ¤˜ ·ÔÈÎ›Â˜. ∂Î‰. ¢.

¡. ¶··‰‹Ì·: ∞ı‹Ó·; 1998. ÛÂÏ. 49, 180.

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3. ∆·Ì¿ÎË˜ £∫. ∆Ô ·È‰› ÛÙÈ˜ ·Ú¯·›Â˜ ÂÏÏËÓÈÎ¤˜ ·ÔÈÎ›Â˜.¶·È‰È·ÙÚÈÎ‹ 1996;59:297-302.

4. §·ÌÚÔÔ‡ÏÔ˘ µ. ∆Ô ‰›Î·ÈÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙÔ˘ ÓÂÔÁ¤ÓÓË-ÙÔ˘ ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ∂Î‰. ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; 1990.

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

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

7. Ã·ÚÔÎfiÔ˜ ™. ∆Ô ·È‰› Î·È Ô ∞ÚÈÛÙÔÙ¤ÏË˜. ¶·È‰È·ÙÚÈÎ‹ 1979;42:402-417.

8. Mac Dowell DM. The law in classical Athens. Ithaca: CornellUniversity Press; 1978. p. 78, 86.

9. Smith HM. Intercourse and moral responsibility for the fetus.In: Bondeson WB, Englehardt HT, Spicker S, Winship DH,editors. Abortion and the status of the fetus. Vol. 13 of theseries “Philosophy of Medicine”. Dordrecht, Holland/Boston,Massachusetts: D. Reidel; 1983. p. 229-245.

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

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

12. ∆·Ì¿ÎË˜ £∫. ∆Ô ·È‰› ·fi ÙË ‚ÚÂÊÈÎ‹ ˆ˜ ÙË Û¯ÔÏÈÎ‹ ËÏÈ-Î›· ÛÙËÓ ·Ú¯·›· ∂ÏÏ¿‰·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1998;45:51-56.

13. Lacey WK. The family in classical Greece. London; 1968. p.210.

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


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: £Ú·Û‡‚Ô˘ÏÔ˜ ∆·Ì¿ÎË˜ §. ¢ËÌÔÎÚ·Ù›·˜ 368, ∆.∫. 681 00, ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË

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∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∆Ô “∞ÓÔÈ¯Ùfi ¶·ÓÂÈÛÙ‹ÌÈÔ” ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜! - http://www.abp.org/abpfr1024.htm

∆Ô ÚˆÙÔÔÚÈ·Îfi ÛÙÔÈ¯Â›Ô ÙË˜ ÈÛÙÔÛÂÏ›‰·˜ ÙÔ˘ American Board ofPediatrics Â›Ó·È Ë ‰˘Ó·ÙfiÙËÙ· Û˘ÓÂ¯È˙fiÌÂÓË˜ ÂÎ·›‰Â˘ÛË˜ Î·È ÂÎÌ¿-ıËÛË˜ Ì¤Ûˆ ‰ÈÎÙ‡Ô˘, Ë ÔÔ›· ÈÛÙÔÔÈÂ›Ù·È Â›ÛËÌ· ÌÂ ¢›ÏˆÌ·-¶È-

ÛÙÔÔÈËÙÈÎfi °ÓÒÛË˜ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹. ™Ùfi¯Ô˜ ÙÔ˘ American Board of Pediatrics Â›Ó·È Ë ÚÔ-ÒıËÛË ÙË˜ ·È‰È·ÙÚÈÎ‹˜ ıÂˆÚ›·˜ Î·È ¤ÚÂ˘Ó·˜ ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÈÛÙËÌÔÓÈÎ‹ ÎÔÈÓfiÙËÙ·, ÌÂ ÙËÓ·Ú¿ÏÏËÏË ·ÍÈÔÏfiÁËÛË ÙˆÓ ÈÎ·ÓÔÙ‹ÙˆÓ, ÙˆÓ ‰ÂÍÈÔÙ‹ÙˆÓ Î·È ÙË˜ ÂÌÂÈÚ›·˜ ÙˆÓ ÂÈÛÙËÌfiÓˆÓÛÂ fiÏÂ˜ ÙÈ˜ ˘ÔÂÈ‰ÈÎfiÙËÙ¤˜ ÙË˜. ∆Ô ÚfiÁÚ·ÌÌ· ÂÎÌ¿ıËÛË˜ ·ÎÔÏÔ˘ıÂ› ÛÂÈÚ¿ ÂÍÂÙ¿ÛÂˆÓ ÛÂ˘ÔÂÈ‰ÈÎfiÙËÙÂ˜ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜, fiˆ˜ ÛÙË Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›·, ÙËÓ ·ÈÌ·ÙÔÏÔÁ›·, ÙËÓ ÂÓ‰Ô-ÎÚÈÓÔÏÔÁ›· Î·È ÙË ÓÂ˘ÚÔÏÔÁ›·. ∏ ·Ú¿‰ÔÛË ÙˆÓ Ì·ıËÌ¿ÙˆÓ Á›ÓÂÙ·È ËÏÂÎÙÚÔÓÈÎ¿ - Ì¤ÛˆInternet - Î·È ÔÏÔÎÏËÚÒÓÂÙ·È ·fi ÂÍÂÙ¿ÛÂÈ˜ ·ÍÈÔÏfiÁËÛË˜, ÏÂÈÙÔ˘ÚÁÒÓÙ·˜ ¤ÙÛÈ ˆ˜ “∞ÓÔÈ¯Ùfi¶·ÓÂÈÛÙ‹ÌÈÔ” ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜. ∂ÎÙfi˜ ·fi Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂÎÌ¿ıËÛË˜, ÙÔ American Boardof Pediatrics ÚÔÛÊ¤ÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÙË˜ ™˘ÓÂ¯È˙fiÌÂÓË˜ π·ÙÚÈÎ‹˜ ∂Î·›‰Â˘ÛË˜ Ì¤Û· ·fi ÂÈ-‰ÈÎÂ˘Ì¤Ó· Û¯¤‰È· ‰Ú¿ÛË˜ Î·È ÌÂÏ¤ÙÂ˜ ‰È¿ÚÎÂÈ·˜ ÙÚÈÒÓ ÂÙÒÓ.

ªÔÓÙ¤ÚÓ· ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙË˜, ÌÂ ÏÂÈÙÔ˘ÚÁÈÎ‹ Î·È Â˘ÎÚÈÓ‹ ÏÔ‹ÁËÛË, Ë ÈÛÙÔÛÂÏ›‰· ÙÔ˘American Board of Pediatrics ÚÔÛÊ¤ÚÂÈ, Â›ÛË˜, ÏÔ‡ÛÈÔ ˘ÏÈÎfi ·fi Û¯ÂÙÈÎÔ‡˜ Û˘Ó‰¤ÛÌÔ˘˜,Î·Ï‡ÙÔÓÙ·˜ ÙÔ Â˘Ú‡ Ê¿ÛÌ· ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜.

Ambulatory Pediatric Association - ™ÙËÓ ˘ËÚÂÛ›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘! -http://www.ambpeds.org/site/index.htm

™Ùfi¯Ô˜ ÙÔ˘ Ambulatory Pediatric Association Â›Ó·È Ë ·ÚÔ¯‹ ¯Ú‹-ÛÈÌˆÓ Û˘Ì‚Ô˘ÏÒÓ Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË Î·È Ë „˘¯ÔÏÔÁÈÎ‹ ˘ÔÛÙ‹-ÚÈÍË ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÂÊ‹‚ˆÓ ·ÏÏ¿ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÁÂÓÈÎfiÙÂÚ·,

ÛÂ ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ˘ÁÂ›· Î·È ÛÙËÓ ÔÌ·Ï‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘. ∂È-‰ÈÎÂ˘Ì¤ÓÔÈ ÂÈÛÙ‹ÌÔÓÂ˜ ·fi ÙÔÓ ¯ÒÚÔ ÙË˜ ∞Î·‰ËÌ·˚Î‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ÚÔÛÊ¤ÚÔ˘Ó ÙÈ˜ ÁÓÒÛÂÈ˜Î·È ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜, ÙfiÛÔ ÛÂ Û˘Ó‹ıÂÈ˜ fiÛÔ Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ¤ÎÙ·ÎÙË˜ ·Ó¿ÁÎË˜ Ô˘ ÚÔÎ‡-ÙÔ˘Ó ÛÙÔ Ï·›ÛÈÔ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜, Ì¤Û· ·fi ÂÌÂÚÈÛÙ·ÙˆÌ¤ÓË ¤ÚÂ˘Ó·, ÚÔÛÊ¤ÚÔÓÙ·˜ Ù·˘-Ùfi¯ÚÔÓ· Î·È ˘ËÚÂÛ›Â˜ ÚÔÛÙ·Û›·˜ ÙˆÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ.

O Û¯Â‰È·ÛÌfi˜ ÙË˜ ÈÛÙÔÛÂÏ›‰·˜ ÙÔ˘ Ambulatory Pediatric Association Â›Ó·È Î·Ïfi˜ Î·È Â‡¯ÚË-ÛÙÔ˜, ¯ˆÚ›˜ È‰È·›ÙÂÚÂ˜ ÂÎÏ‹ÍÂÈ˜, ÌÂ ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ÏÔ‹ÁËÛË ÛÙÈ˜ ‚·ÛÈÎ¤˜ Î·ÙËÁÔÚ›Â˜ ÙˆÓÈ·ÙÚÈÎÒÓ websites. ∂Ó‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Î·ÙËÁÔÚ›· “¶ÚÔÛÊÔÚ¿ ∂ÚÁ·Û›·˜”, ÂÓÒ - ÂÎÙfi˜·fi ÙÈ˜ Û¯ÂÙÈÎ¤˜ ÂÎ‰fiÛÂÈ˜ - ÙÔ Ambulatory Pediatric Association ÚÔÛÊ¤ÚÂÈ Î·È ˘ÔÙÚÔÊ›Â˜ ÛÂÓ¤Ô˘˜ ÂÈÛÙ‹ÌÔÓÂ˜ ÁÈ· ÙËÓ ÚÔÒıËÛË ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Û¯ÂÙÈÎfi ÂÈÛÙËÌÔÓÈÎfi Â‰›Ô.

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ª›· Û‡Á¯ÚÔÓË ËÏÂÎÙÚÔÓÈÎ‹ ‚È‚ÏÈÔı‹ÎË ÁÈ· ÙËÓ ¶·È‰È·ÙÚÈÎ‹! -http://www.vh.org/pediatric/index.html

∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÈÛÙ‹ÌÔÓÂ˜ ·È‰›·ÙÚÔÈ ÂÓ‰È·Ê¤ÚÔÓÙ·È ÁÈ· ÙË Û˘-ÓÂ¯‹ ÂÓËÌ¤ÚˆÛË Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÓÂfiÙÂÚÂ˜ ÂÍÂÏ›ÍÂÈ˜ ÛÙÔÓ ÙÔÌ¤· ÙË˜ Û‡Á-¯ÚÔÓË˜ ¶·È‰È·ÙÚÈÎ‹˜. ¶·Ú¿ÏÏËÏ·, Î‡ÚÈÔ Ì¤ÏËÌ· ÙˆÓ ÁÔÓ¤ˆÓ Â›Ó·È Ë ·Ó·-˙‹ÙËÛË Ì›·˜ Î·Ï‡ÙÂÚË˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜, ÙfiÛÔ ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ fiÛÔ Î·È ÁÈ·

Ù· ·È‰È¿ ÙÔ˘˜. ∆Ô ÚÒÙÔ “∂ÈÎÔÓÈÎfi ¶·È‰ÈÎfi ¡ÔÛÔÎÔÌÂ›Ô” ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ ÁÈ· Ó· Î·Ï‡„ÂÈ ·˘-Ù¤˜ ·ÎÚÈ‚Ò˜ ÙÈ˜ ·Ó¿ÁÎÂ˜, ÚÔÛÊ¤ÚÔÓÙ·˜ Ì›· Â˘ÚÂ›· ÁÎ¿Ì· ÏËÚÔÊÔÚÈÒÓ Î·È Û˘Ì‚Ô˘ÏÒÓ Ì¤-Û· ·fi ÙË ÏÂÈÙÔ˘ÚÁ›· ÏÔ‡ÛÈ·˜ ËÏÂÎÙÚÔÓÈÎ‹˜ ‚È‚ÏÈÔı‹ÎË˜ Û¯ÂÙÈÎ¿ ÌÂ ı¤Ì·Ù· ˘ÁÂ›·˜, ‰È·-ÙÚÔÊ‹˜, Î·ıÒ˜ Î·È ÛˆÌ·ÙÈÎ‹˜ Î·È „˘¯ÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘.

∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ Children’s Virtual Hospital ·Ó‹ÎÂÈ ÛÙÔÓ Â˘Ú‡ÙÂÚÔ ‰ÈÎÙ˘·Îfi ÙfiÔ VirtualHospital, Ô ÔÔ›Ô˜ ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ ·fi ÙÔ ÂÚÂ˘ÓËÙÈÎfi È·ÙÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙË˜∞˚fi‚· Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÏÔ‡ÛÈÔ ˘ÏÈÎfi ÛÂ ı¤Ì·Ù· ÁÂÓÈÎ‹˜ È·ÙÚÈÎ‹˜. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈÏÂÈÙÔ˘ÚÁÂ› Î·È ÙÌ‹Ì· ÌÂÙ·ÊÚ¿ÛÂˆÓ ÛÂ 5 ÁÏÒÛÛÂ˜.


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¶·È‰È·ÙÚÈÎ‹ 2004;67:300 Paediatriki 2004;67:300

∞¡∞∫Oπ¡ø™∏ ANNOUNCEMENT

µÚ·‚Â˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜

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

∞’ Ãøƒ∂ª∂πO ∂¶∞£§O“™˘¯Ó¿ ÂÏÏÂ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÛÂ ·È‰È¿ ÌÂ Ê˘ÏÂÙÈÎfi ÌˆÛ·˚ÎÈÛÌfi: ¤Ó·˜ Èı·Ófi˜ ·ıÔÁÂÓÂÙÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ê˘ÏÂÙÈÎÔ‡ ·ÓÂ˘ÏÔÂÈ‰ÈÛÌÔ‡”

Ã. Ã·Ù˙Ë·ı·Ó·Û›Ô˘, ∫. ™ÈÛÌ¿ÓË, ∫. ∆Û›ÁÎÔ˜, ∞. °·ÏÏ¿, ¡. ™ÎÔÚ‰‹˜, ∑. ∫ÔÛÌ·˝‰Ô˘, º. ¶·ÙÛ¿ÏË˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∆Ì‹Ì· ∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜, πÓÛÙÈÙÔ‡ÙÔ ¡Â˘ÚÔÏÔÁ›·˜ Î·È °ÂÓÂÙÈÎ‹˜ ∫‡ÚÔ˘ ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎ‹ ªÔÓ¿‰· ª·Î¿ÚÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ §Â˘ÎˆÛ›·˜ ∆Ì‹Ì· °ÂÓÂÙÈÎ‹˜, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”

µ’ Ãøƒ∂ª∂πO ∂¶∞£§O“∫ÏÈÓÈÎ‹ Î·È ÌÔÚÈ·Î‹ ‰ÈÂÚÂ‡ÓËÛË 50 ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Williams ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi”

™. ∞Ì¤ÓÙ·, Ã. ™ÔÊÔÎÏ¤Ô˘˜, ∞. ∫ÔÏÈ·Ï¤ÍË, §. £ˆÌ·˝‰Ô˘, ∞. ª·‡ÚÔ˘, ™. ∫›ÙÛÈÔ˘, ∂. ∫·Ó·‚¿ÎË˜, ∂. ºÚ˘Û›Ú·

∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

“∂›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ ˘ÔÏËı˘ÛÌÔ‡˜ ÙˆÓ ∆ Î˘ÙÙ¿ÚˆÓ ÓÂÔÁÓÒÓ ÌË·ÙÔÈÎÒÓ ÁÔÓ¤ˆÓ”

µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, µ. ∆˙ÈÌÔ‡ÏË, Ã. ¡Ô‡ÙÛÈ·, ∞. ∆·¿ÚÎÔ˘, ¶. ª·˘Ú›‰Ë˜, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜, º. ∫·Ó·ÎÔ‡‰Ë-∆Û·Î·Ï›‰Ô˘

∞’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜

µƒ∞µ∂πO ∫Oπ¡ø¡π∫∏™ ¶∞π¢π∞∆ƒπ∫∏™“¶ÚfiÁÚ·ÌÌ· ÚÔÛÙ·Û›·˜ ÙË˜ ˘ÁÂ›·˜ ∆ÛÈÁÁ·ÓÔ·›‰ˆÓ”

¶. ™˘Ú›‰Ë˜, ∞. ∞ÙÙÈÏ¿ÎÔ˜, ¢. ¢ÔÁ¿ÓË˜, ª. §·Ú›Ô˘, ª. Ã·ÓÙ·ÚÂ¿Ó, ∫. ∞Ï¤ÛÙ·˜, ∂. ™ˆÙËÚÔÔ‡ÏÔ˘, ¢. ¶ÂÂÏ¿ÛË˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· °ÂÓÈÎ‹ °Ú·ÌÌ·ÙÂ›· ¶ÚfiÓÔÈ·˜

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13-16 OÎÙˆ‚Ú›Ô˘ 2004 XIX European Congress of Perinatal Medicine ∞ı‹Ó· •ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔÚ›Â˜: C&C International S.A.∆ËÏ.: +30 210 68 89 100Fax: +30 210 68 44 777E-mail: [email protected] Website: www.perinatal2004.gr

6-7 ¡ÔÂÌ‚Ú›Ô˘ 2004 24Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ™ÂÌÈÓ¿ÚÈÔ ¶·È‰È·ÙÚÈÎ‹˜ ∞ı‹Ó·∞›ıÔ˘Û· £Â¿ÙÚÔ˘ ∫ÔÏÂÁ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔÚ›Â˜: µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”∆ËÏ.: +30 210 77 93 000 E-mail: [email protected]

11-14 ¡ÔÂÌ‚Ú›Ô˘ 2004 14Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ™˘Ó¤‰ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ Î·È π·ÙÚÈÎ‹˜ ∞ÂÈÎfiÓÈÛË˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜ ∞ÌÊÈı¤·ÙÚÔ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜ ¶ÏËÚÔÊÔÚ›Â˜: PRC Congress & Travel ∆ËÏ.: +30 210 77 11 673 Fax: +30 210 77 11 289 E-mail: [email protected]

13-14 ¡ÔÂÌ‚Ú›Ô˘ 2004 4Ë ∏ÌÂÚ›‰· ÙË˜ ∂Ù·ÈÚÂ›·˜ ∫ÔÈÓˆÓÈÎ‹˜ ∆Ú›Î·Ï· ¶·È‰È·ÙÚÈÎ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜ (¶·Ú¿ÚÙËÌ· £ÂÛÛ·Ï›·˜) Î·È 1Ë ∏ÌÂÚ›‰· ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∆ÚÈÎ¿ÏˆÓ¶ÓÂ˘Ì·ÙÈÎfi ∫¤ÓÙÚÔ ¢‹ÌÔ˘ ∆ÚÈÎ·›ˆÓ¶ÏËÚÔÊÔÚ›Â˜: ∞Ó·ÛÙ·Û›Ô˘ ∞Ó·ÛÙ·Û›· ∆ËÏ.: 6937 676725, 24210 35574∞ÁÔÚ›ÙÛ· ™ÔÊ›·∆ËÏ.: 24310 23652 (ÂÛˆÙ. 162)E-mail: [email protected] ¶ÏËÚÔÊÔÚ›Â˜ ÁÈ· ‰È·ÌÔÓ‹: ∫ˆÓ/ÓÔ˜ OÈÎÔÓfiÌÔ˘∆ËÏ.: 24310 79680Fax: 24310 79682

22-23 ¡ÔÂÌ‚Ú›Ô˘ 2004 4th European Conference on Paediatric Amsterdam, Netherlands Asthma & Allergy ¶ÏËÚÔÊÔÚ›Â˜: Tania Unsworth ∆ËÏ.: +44 2 075 016 747Fax: +44 2 079 788 322E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

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27 ¡ÔÂÌ‚Ú›Ô˘ 2004 3Ë ∏ÌÂÚ›‰· ∂ÏÏËÓÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ∞ı‹Ó·¶·È‰È·ÙÚÈÎ‹˜ ¢ÂÚÌ·ÙÔÏÔÁ›·˜∞ÌÊÈı¤·ÙÚÔ ¶ÔÏÂÌÈÎÔ‡ ªÔ˘ÛÂ›Ô˘ ¶ÏËÚÔÊÔÚ›Â˜: ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ∆ËÏ.: +30 210 67 55 437 Fax: +30 210 67 45 117 E-mail: [email protected]

2-5 ¢ÂÎÂÌ‚Ú›Ô˘ 2004 13Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶ÓÂ˘ÌÔÓÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ ¶¿ÙÚ· ™˘ÓÂ‰ÚÈ·Îfi Î·È ¶ÔÏÈÙÈÛÙÈÎfi ∫¤ÓÙÚÔ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ¶ÏËÚÔÊÔÚ›Â˜: Frei S.A. Travel-Congress∆ËÏ.: +30 210 32 15 600 Fax: +30 210 32 19 296 E-mail: [email protected] Website: www.frei.gr

8-11 ¢ÂÎÂÌ‚Ú›Ô˘ 2004 6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜ £ÂÛÛ·ÏÔÓ›ÎË ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· ∞ÓÔÛÔÏÔÁ›·˜ •ÂÓÔ‰Ô¯Â›Ô Electra Palace ¶ÏËÚÔÊÔÚ›Â˜: ¢π∞™∆∞™∏ Travel ∆ËÏ.: +30 2310 88 92 44-5 Fax: +30 2310 88 92 46 E-mail: [email protected]

5-7 ª·˝Ô˘ 2005 8th Congress of the European Society of Budapest, Hungary Paediatric Dermatology Hilton Budapest Congress Center ¶ÏËÚÔÊÔÚ›Â˜: Convention Budapest Ltd ∆ËÏ.: (361) 2990 184-6 Fax: (361) 2990 187 E-mail: [email protected]

[email protected] Website: www.convention.hu

4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005 ESPGHAN Summer School on Nutrition ∞Ó¿‚˘ÛÛÔ˜“Research Challenges in Clinical Nutrition”European Society for Paediatric Gastroenterology, Hepatology and Nutrition Eden Beach Hotel Club ¶ÏËÚÔÊÔÚ›Â˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 77 26 355, 6945 29 30 71 E-mail: [email protected]

11-15 ™ÂÙÂÌ‚Ú›Ô˘ 2005 29th UMEMPS - Union of Middle Eastern and Istanbul, TurkeyMediterranean Pediatric Societies Congress ¶ÏËÚÔÊÔÚ›Â˜: Pynar Aytac ∆ËÏ.: 90 2 163 473 535 Fax: 90 2 163 477 850 E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

xiv

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xix

™˘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

July August 04 07-10-04 13:52 ™ÂÏ›‰·309

xx

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

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

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