Παιδιατρική | Τόμος 68 • Τεύχος 2 • Μάρτιος - Απρίλιος 2005

TfiÌÔ˜ 68 ñ ∆Â‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2005TfiÌÔ˜ 68 ñ ∆Â‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2005

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www.paediatriki.edu.grwww.paediatriki.edu.gr

ISSN 0377-2551ISSN 0377-2551

Volume 68 ñ Number 2 ñ March-April 2005Volume 68 ñ Number 2 ñ March-April 2005

Exof Paed March-April 05 19-04-05 19:58 ™ÂÏ›‰·1

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

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85 OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ÛÙÈ˜ ÓÂÔÁÓÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜∞. ª·ÓÔ˘Ú¿, ∂. °·Ï·Ó¿ÎË˜, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

93 ∏ ÛËÌ·Û›· ÙÔ˘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹-Ì·ÙÔ˜ ÛÙË ÌÂÏ¤ÙË ÙË˜ ·È‰ÈÎ‹˜ ÂÈÏË„›·˜∫. ∞. µÔ‡‰ÚË˜

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™πA

103 ∏ Ê·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÛÙË ÌÂÏ¤ÙË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÔÍÂ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ÏÂ˘¯·ÈÌ›·˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ¡. ∫·Ù˙ËÏ¿ÎË˜, ∂. ™ÙÂÈ·Î¿ÎË, ∞. ¶··‰¿ÎË˜,∂. ¢ËÌËÙÚ›Ô˘, ∫. ª¿Ï·˜, ª. ∫·ÏÌ·ÓÙ‹

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

112 °ÓˆÛÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÛÂ ·È‰È¿ ÌÂ ÂÛÙÈ·Î¤˜ ÂÈÏË„›Â˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ·ıÂÚ·Â›· ÌÂ ÔÍÎ·Ú‚·˙Â›ÓË ª. ∆˙ËÙËÚ›‰Ô˘, £. ¶¿ÓÔ˘, ∂. ¶·˘Ï›‰Ô˘, °. ÕÚÛÔ˜, A. ª·Î·‚fi˜, ∂. ªÈ¯·Ï¤ÙÔ˘, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜

120 ∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË ∂. ∞ÔÛÙfiÏÔ˘, ∂. °·Ï·Ó¿ÎË˜, °. µÏ·¯¿ÎË, ™. ™ÙÂÊ·Ó¿ÎË, ™. ª·Ú¿ÎË, ∂. ∫fiÎÔÚË, ∞. ∆ÛÈÏÈÌÈÁÎ¿ÎË, ™. ™Ì˘Ú¿ÎÈ˜

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

128 ¡fiÛÔ˜ Crohn ÛÂ ‚ÚÂÊÈÎ‹ ËÏÈÎ›·: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∂. ¶··‰ÔÔ‡ÏÔ˘, ∂. ∫·ÙÛÈÁÈ·ÓÓ¿ÎË, ∂. ªÈ¯·ËÏ›‰Ô˘, π. °Ú·ÌÌ·ÙÈÎ¿ÎË˜, ∂. ª·ÓÙ˙Ô˘Ú¿ÓË

133 ∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ª. Ã·ÛÈÒÙÔ˘, ∂. ™·ÌÌÔ‡ÙË, °. ¶ÈÙÛÔ˘Ï¿ÎË˜,ª. µ·Î¿ÎË, C. Van Viet-∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘, ∂. ∫Ô˘‰Ô˘ÌÓ¿ÎË˜

140 ¡fiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË.¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∂. ¶··‰ËÌËÙÚ›Ô˘, °. ª·Ù·ÊÈ¿, µ. Ã·Ù˙ÔÔ‡ÏÔ˘, µ. ªÈÎÚ¿ÎË, ¡. ™ÎÂÓÙ¤ÚË˜

145 ¶ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ ÌÂ Û‡Ó‰ÚÔÌÔ PHACEÕ. ∆Û›ÙÛÈÎ·, ∂. ºÚ˘Û›Ú·, ∞. §Ô˘Ú›‰·, ¡. ª·ÓˆÏ¿ÎË

150 ™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÂÈÓÂÊÚÈ‰›ˆÓ ÌÂ ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ ÛÔ‚·Ú‹˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ª. ¢·ÛÔÔ‡ÏÔ˘, ª. ∞ÔÛÙfiÏÔ˘, °. ª·ÚÔ‡ÙË˜, ∂. ªÈ¯ÂÏ·Î¿ÎË, ∂. §Ô˘Î¿ÙÔ˘, Ã. ∫ÒÛÙ·ÏÔ˜

¶ƒ∞∫∆π∫O £∂ª∞

155 ∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿ ™. ∞ÓÙˆÓÈ¿‰Ë˜

162 ∫§π¡π∫√ ∫√Àπ∑

163 ¡∂∫ƒ√§√°π∞

164 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

166 NEA ∞¶√ ∆√ ¢π∞¢π∫∆À√

∫ˆ‰ÈÎfi ̃¢ÈÂ‡ı˘ÓÛË ̃∂ÔÙÂ›· ̃ªª∂: 3889

ISSN 0377-2551

¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 68 ñ ∆Â‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2005

Paediatriki Mar-Apr 05 21-04-05 14:58 ™ÂÏ›‰·1

Bimonthly Publication ofthe Greek Paediatric Society

PPrreessiiddeenntt

A. Constantopoulos

Editorial Board

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S. Haidas

AAssssiissttaanntt EEddiittoorr

C. Stefanidis

MMeemmbbeerrss

P. Avgoustidou-Savvopoulou

H. Antonopoulou

A. Vazeou-Gerasimidi

G. Varlamis

M. Kanariou

∂. Katsarou-Pectasides

A. Kattamis

Ch. Costalos

N. Papadopoulos

∞. Papadopoulou

A. Siamopoulou-Mavridou

M. Tsolia-Pasparaki

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Contents

REVIEW ARTICLES

92 Chemokines in neonatal infectionsA. Manoura, E. Galanakis, C. Giannakopoulou

102 Electroencephalographic investigation of children with epilepsy K. A. Voudris

AWARD-WINNING ARTICLE

111 Spectral imaging study of normallymphocytes and lymphoblasts of acutelymphoblastic leukaemia in childhood N. Katzilakis, E. Stiakaki, A. Papadakis, H. Dimitriou, K. Balas, M. Kalmanti

ORIGINAL ARTICLES

119 Cognitive functions in children with focal epilepsy and long-termoxcarbazepine therapyM. Tzitiridou, T. Panou, E. Pavlidou, G. Arsos,A. Makavos, E. Michaletou, C. Panteliadis

127 Meningococcal disease in Crete E. Apostolou, E. Galanakis, G. Vlahaki, S. Stefanaki, S. Maraki, E. Kokori, A. Tsilimigaki, S. Sbyrakis

CASE REPORTS

132 Crohn’s disease in infancy: a case report E. Papadopoulou, E. Katsiyiannaki, E. Mihailidou, I. Grammatikakis, E. Mantzouranis

139 The neck: a rare site of teratoma in children M. Hasiotou, ∂. Sammouti, G. Pitsoulakis, M. Vakaki, C. van Viet-Konstadinidou, E. Koudoumnakis

144 Caroli’s disease with congenital hepaticfibrosis. A case report E. Papadimitriou, G. Matafia, V. Hatzopoulou, V. Mikraki, N. Skenteris

149 An infant with PHACE syndrome A. Tsitsika, H. Fryssira, A. Lourida, N. Manolaki

154 Congenital adrenal hypoplasiapresenting as severe respiratory failure.Case report M. Dasopoulou, M. Apostolou, G. Baroutis, H. Michelakakis, E. Loukatou, C. Costalos

PRACTICAL ISSUE

161 Sudden death in children S. Antoniadis

162 CLINICAL QUIZ

163 OBITUARY

164 LETTER TO THE EDITOR

166 NEWS FROM THE INTERNET

PaediatrikiVolume 68 ñ Number 2 ñ March-April 2005


xi√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™

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˜ ™˘ÓÙ·-ÎÙÈÎ‹˜ EÈÙÚÔ‹˜).

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

10. ™‡ÓÙÔÌ· Ó¤·.11. µÚ·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜.12. ∂ÈÛÙÔÏ¤˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.13. ¶ÂÚÈÏ‹„ÂÈ˜ ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.14. ∞Ó·ÎÔÈÓÒÛÂÈ˜ ÚÔÛÂ¯ÒÓ Û˘ÓÂ‰Ú›ˆÓ Î·È ÂÈÛÙËÌÔÓÈ-

ÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈÎ‹ Ó¤ˆÓ ÂÎ‰fiÛÂˆÓ, ÂÏÏËÓÈÎÒÓ

Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜.

H ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‰È·ÙËÚÂ› ÙÔ ‰ÈÎ·›ˆÌ· Ó· ‰Ë-ÌÔÛÈÂ‡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· ÙËÚÂ›Ù·È ËÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›ÛË˜, ÌÔÚÂ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰Ë-ÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙÂ› ÛÙÔ ÂÙ‹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 ÔÏÈÎ‹ ‹ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ‰ËÌÔ-ÛÈÂ˘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˜.

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ· ÎÚ›ÛË ÛÂ ¿ÏÏÔÂÚÈÔ‰ÈÎfi. ∂ÈÏ¤ÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤-ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘Ô-ÛÙ‹ÚÈÍË˜. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈÌÂÙ¿ ·fi ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙÂ¯fiÓÙˆÓ ‹ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ‰È·ÎËÚ‡-ÍÂÈ˜ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›ÛË˜, Ú¤ÂÈ Ó· ¤¯Ô˘ÓÙËÚËıÂ› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙˆÓ ∏¶∞ (DHEWPublication, NIH, 80-23). OÈ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ú¤ÂÈ Ó·¤¯Ô˘Ó ÂÁÎÚÈıÂ› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔÏÔ-Á›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘.

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·¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈÔˆÛ‰‹ÔÙÂ ¤ÁÎÚÈÛË ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓEÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·, ÙË ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹‹ ·fi ÙÔÓ EÎ‰fiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔÎÙË-Û›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹” Î·È Ë ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹

·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË

Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚÔ-

‰È·ÁÚ·Ê¤˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ µÈÔ˚·-

ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿” (Uniform Requirements for Manuscripts

Submitted to Biomedical Journals), ÔÈ ÔÔ›Â˜ ÙÚÔÔÔÈ‹-

ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÙÈ˜ ‰ÈÂ˘ı‡ÓÛÂÈ˜:

http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

TÔ 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 Ù˘-

ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë ÏÂ˘ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4

(21x29,7 cm), ÌÂ ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ ÙˆÓ ÁÚ·ÌÌÒÓ Î·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: ÛÂ-

Ï›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈÎ¿ Î·È Ù·

·ÁÁÏÈÎ¿, Î·Ù¿ÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ÎÂ›ÌÂÓÔ, Â˘¯·ÚÈ-

ÛÙ›Â˜ Î·ıÒ˜ Î·È ·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿Ï-

ÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜,

Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ. 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·:

ñ ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ 2000-3000 Ï¤ÍÂÈ˜.

ñ ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈ-

ÙÒÛÂÈ˜ ÛÂ 1500-2500 Ï¤ÍÂÈ˜.

ñ ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000-1500 Ï¤ÍÂÈ˜.

ñ ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-500 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘

¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:ñ ÙÔÓ Ù›ÙÏÔ (<14 Ï¤ÍÂÈ˜), Î·ıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5

Ï¤ÍÂÈ˜) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂÈ˜.

ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁÚ·Ê¤· ÛÙËÓ ÔÓÔ-

Ì·ÛÙÈÎ‹.

ñ 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·ÌÔÓ‹˜

ÙÔ˘/ÙÔ˘˜.

ñ 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˜.

ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 Ï¤ÍÂÈ˜,

fiÌˆ˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜.

ñ ∏ 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·È Ù·

ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙ· ·ÁÁÏÈÎ¿. TÔ ÂÚÈÂ¯fiÌÂÓÔ

ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈÌ¤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌËÌ¤ÓÔ ÛÂ: ÂÈ-

Û·ÁˆÁ‹ (background), Ì¤ıÔ‰ÔÈ (methods), ·ÔÙÂÏ¤ÛÌ·-

Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË-

„Ë ÛÙ· ·ÁÁÏÈÎ¿ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›-

ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈÎ¿.


xii

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ Î·È ÙËÓ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë ÛË-ÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ ÏÏ¤¤ÍÍÂÂÈÈ˜̃ ÎÎÏÏÂÂÈÈ‰‰ÈÈ¿¿ Ô˘ ı· ¯ÚËÛÈ-ÌÔÔÈËıÔ‡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 ÂÂÈÈÛÛ··ÁÁˆ̂ÁÁ‹‹ 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 ÙÔÓ ÛÎÔfi ÙË˜ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂ-Ú‹˜, ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿Ï-ÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜. ∂›ÛË˜, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÌÂ ÏÂ-ÙÔÌ¤ÚÂÈÂ˜ ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ·Ó¿Ï˘ÛË˜ Î·È ·ÍÈÔÏfi-ÁËÛË˜ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ··ÔÔÙÙÂÂÏÏ¤¤ÛÛÌÌ··ÙÙ·· Ú¤ÂÈ Ó··ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fiÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H ÛÛ˘̆˙̇‹‹ÙÙËËÛÛËË Ú¤-ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡ÙÔ˘Ó·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó· ¤¯Ô˘Ó Î·ÈÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ·Ú·ÙËÚ‹ÛÂÈ˜ ¿ÏÏˆÓÂÚÂ˘ÓËÙÒÓ.

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

T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿ ÙËÓÎÚ›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¤ÂÈ Ó··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· ÂÎ-

ÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·ÈÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· Ì¤Û· ÛÂ·Ú¤ÓıÂÛË. ¶›Ó·ÎÂ˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÈ˜‰ÈÂ˘ı‡ÓÛÂÈ˜:http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

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

‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡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‰È-Îfi 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 ÌfiÓÔÛÙÈ˜ ÂÚÈÏ‹„ÂÈ˜.

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

ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ÌÂ ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤-ÚÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ™ÙÔ ÎÂ›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·-Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÛÂ ·-Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó·˘ÂÚ‚·›ÓÔ˘Ó:

ñ ÙÈ˜ 70 ÛÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜. ñ ÙÈ˜ 30 ÛÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜. ñ ÙÈ˜ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜

ÂÚÈÙÒÛÂÈ˜. ñ ÙÈ˜ 5 ÛÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ Î·È ÙÈ˜ ÂÈÛÙÔÏ¤˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·ÈÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚfiÛÊ·Ù· ÙÚÔÔÔÈËÌ¤ÓÂ˜ ÚÔ‰È·ÁÚ·-Ê¤˜ ÙË˜ International Committee of Medical Journal

Editors/ Uniform Requirements for Manuscripts Sub-mitted to Biomedical Journals, (http://www.icmje.org Î·Èhttp:// www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›Ù-ÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ CumulatedIndex Medicus [List of Journals Indexed in Index Medicus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶∂ƒπO¢π∫∞

AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ,ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒ-ÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

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

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

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

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

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

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

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

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:Schreiner GF, Lange L. Ethanol modulation of

macrophage influx in glomerulonephritis [Abstract]. J AmSoc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of in-haled corticosteroids in asthma? [Editorial]. Am J RespirCrit Care Med 1998;158:1697-1701.

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

II. µπµ§π∞

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

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

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

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

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

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

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

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


xiii

Kaplan SJ. Post hospital home health care: the elderly’saccess and utilization [dissertation]. St. Louis (Mo): Wash-ington Univ.; 1995.

πππ. CD-ROMAnderson SC, Poulsen KB. Anderson’s electronic atlas

of hematology [CD-ROM]. Philadelphia: LippincottWilliams & Wilkins; 2002.

IV. ™∆O ¢π∞¢π∫∆ÀOÕÚıÚÔ ÛÂ ÂÚÈÔ‰ÈÎfi:

Abood S. Quality improvement initiative in nursinghomes: the ANA acts in an advisory role. Am J Nurs[Internet]. 2002 Jun: Webpage:http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

ªÔÓÔÁÚ·Ê›·:Foley KM, Gelband H, editors. Improving palliative

care for cancer [Monograph, Internet]. Washington:National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html

πÛÙÔÛÂÏ›‰Â˜:Cancer-Pain.org [Webpage, Internet]. New York:

Association of Cancer Online Resources, Inc.; 2002:http://www.cancer-pain.org/

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

ÊˆÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ Ï¿-ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ fiÏË˜ ÙË˜ ÛÂ-Ï›‰·˜ (15,5 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¿Ùˆ Ì¤-ÚÔ˜. ™ÙÔ˘˜ ›Ó·ÎÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ Î¿ıÂÙÂ˜ÁÚ·ÌÌ¤˜.

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

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈ-

ÏÔ‡Ó Î·È ÓÓ·· ÛÛ˘̆ÓÓÔÔ‰‰ÂÂ‡‡ÔÔÓÓÙÙ··ÈÈ ··fifi ‰‰ÈÈÛÛÎÎ¤¤ÙÙ·· ‹‹ CCDD, Î·ıÒ˜ Î·È·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›·‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏË-ıÂ› ÁÈ· ÎÚ›ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ-Î‹”. ∂ÈÏ¤ÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹-ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘-ÏÔÁÚ·ÊËÌ¤ÓÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·-ÎÙÈÎ‹ EÈÙÚÔ‹, Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi ‰ÈÛÎ¤Ù· ‹ CD Ô˘ Ó·ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· ÛÂ ÚfiÁÚ·ÌÌ· Word, Î·ıÒ˜Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ ÔÈ ÙÚÔÔ-ÔÈ‹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‹.

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.

OÈ 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:

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

¶ÚÈÓ ·ÔÛÙÂ›ÏÂÙÂ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚Â‚·ÈˆıÂ›ÙÂ fiÙÈÂÚÈÏ·Ì‚¿ÓÂÈ:

1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó·Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜.

2. ¢ÈÛÎ¤Ù· ‹ CD ÌÂ fiÏÔ ÙÔ ˘ÏÈÎfi ÙË˜ ÂÚÁ·Û›·˜ (ÎÂ›ÌÂÓÔ, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜).

3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜‰ËÌÔÛ›Â˘ÛË˜ 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‹, ‰ÔÌËÌ¤ÓË ÛÙÈ˜ ÂÍ‹˜

·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, Ì¤ıÔ‰ÔÈ, ·ÔÙÂÏ¤ÛÌ·Ù·Î·È Û˘ÌÂÚ¿ÛÌ·Ù·, Î·ıÒ˜ Î·È Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏfi‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈ-ÛÙ‹ 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˜ ÙÚÈ-ÏÔ‡Ó.

11. ∂ÈÎfiÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›-¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó.

12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.


xiv ™À¡∆√ª√°ƒ∞ºπ∂™ ABBREVIATIONS

Ao

angstrom angstromcal ıÂÚÌ›‰· caloriecm ÂÎ·ÙÔÛÙfi centimetercm2 ÙÂÙÚ·ÁˆÓÈÎfi ÂÎ·ÙÔÛÙfi square centimetercm3 Î˘‚ÈÎfi ÂÎ·ÙÔÛÙfi cubic centimeteroC ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ degree Celsiusg ÁÚ·ÌÌ¿ÚÈÔ gramh ÒÚ· hourIU ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· international unitkg ¯ÈÏÈfiÁÚ·ÌÌÔ kilograml Ï›ÙÚÔ literm Ì¤ÙÚÔ metermg ¯ÈÏÈfiÁÚ·ÌÌÔ milligrammin ÏÂÙfi minutemm ¯ÈÏÈÔÛÙfiÌÂÙÚÔ millimetermol ÁÚ·ÌÌÔÌfiÚÈÔ molen ·ÚÈıÌfi˜ numberNS ‹ ª™ ÌË ÛËÌ·ÓÙÈÎfi not significantosm ÔÛÌÒÏÈÔ osmole

p Èı·ÓfiÙËÙ· probabilitySD ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË standard deviationSE ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· standard errorsec ‰Â˘ÙÂÚfiÏÂÙÔ secondU ÌÔÓ¿‰· unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· Combining prefixes

tera- (1012) Tgiga- (109) Gmega- (106) Mkilo- (103) khector- (102) hdeca- (101) dadeci- (10-1) dcenti- (10-2) cmilli- (10-3) mmicro- (10-6) Ìnano- (10-9) npico- (10-12) pfemto- (10-15) fatto- (10-18) a


xviiINSTRUCTIONS TO AUTHORS

A. General InformationThe Greek Paediatric Society is the owner of “Paedia-

triki”, its official scientific journal, which is distributed to

its members. Its objectives are the publication of paediatric

scientific work and the continuing education of paediatri-

cians. For this purpose, it publishes a variety of articles, and

in particular:

1. Editorials (upon invitation by the Editorial Board).

2. Review articles.

3. Award-winning articles.

4. Original articles.

5. Clinical Quiz

6. Round tables.

7. Current issues.

8. Issues of healthcare management and education.

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15. Book reviews.

The Editorial Board reserves the right to publish articles

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Regarding papers on current issues, the author’s request

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In addition, the US National Institute of Health guide for

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Authors’ opinions and conclusions expressed in the

published papers do not necessarily reflect those of the jour-

nal. The Greek Paediatric Society, the Editorial Board and

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content of the advertisements appearing in the journal.

The copyright of all published papers is held by “Paedi-

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Requirements for Manuscripts Submitted to Biomedical

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sites:

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The entire paper (including figure legends and tables)

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The paper should have the following structure: title page,short title, abstract in Greek and English, list of abbrevia-tions, text, acknowledgements and quoting of grants, spon-sorships or other financial support sources, references, ta-bles, figures, figure legends. Each of these sections should bestarted on a new page. Pages should be numbered consecu-tively, beginning with the title page.

Text length shall be: ñ review articles 2000-3000 words;ñ original articles and case reports 1500-2500 words; ñ brief reports1000-1500 words; ñ letters 250-500 words.

The title page should include:ñ the title (<14 words) and the short title (<5 words) of

the article. No abbreviations are permitted in the title;ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of

the paper. If there is no affiliation with a specific centre,the status of the author(s) should be cited (e.g., privatepaediatrician) and home address;

ñ the complete address, e-mail and telephone number ofthe author to whom correspondence should be addressed.

Abstracts

The abstract should summarize the objectives, method-ology, main results and conclusions of the study.

ñ It should contain at least 200 words, and not exceed 250words.

ñ It should consist of the following paragraphs: back-ground, methods, results and conclusions.

The English abstract should cite at the beginning the ti-tle of the paper and the authors’ names in English. The con-tent of the text should consist of the following paragraphs:background, methods, results and conclusions. The abstractin English should not differ in content from the correspond-ing Greek abstract.

Beneath the Greek and English abstracts, three to fivekey words in the respective language should be supplied, tobe used in the thematic index.

Text

Original articles include: introduction, methods, resultsand discussion. The introduction includes the latest re-search data on the subject and the main references and theobjectives of the paper. The description of the methods

should be precise and detailed so as to enable reproductionby other researchers. In addition, the statistical methods ofanalysis and evaluation of the results should be described.Results should be presented clearly, together with the ap-propriate statistical analysis. Discussion should cover theresults ensuing from the research, their significance andpossible associations with the observations of other re-searchers.

Case reports comprise a short introduction, case de-scription and brief discussion, with emphasis on differentialdiagnosis.

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xviii

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lished abbreviations. Complex or long terms often repeatedin the text may be replaced by abbreviations explained bythe authors in a list submitted with the paper. Abbreviationsare reported in parentheses only in abstracts.

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in the order in which they appear in the text. In the text, ref-erences are to be indicated by Arabic numerals in parenthe-ses. References should be no more than:

ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.

In listing references follow the recently modified stan-dards of the International Committee of Medical Journal Edi-tors/Uniform Requirements for Manuscripts Submitted toBiomedical Journals, (http://www.icmje.org and http://www.icmje.org/icmje.pdf). Abbreviated names of journalsshould conform to the Cumulated Index Medicus [List ofJournals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style

I. JOURNALSAll authors are cited if they are six or less; if they are 7

or more, the first six are cited, followed by “et al”.

Regular edition:Proesmans W. Bartter syndrome and its neonatal vari-

ant. Eur J Pediatr 1997;156:669-679.

Supplement issue:Flyvbjerg A. Role of growth hormone, insulin-like

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

No author:National Institutes of Health Consensus Development

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

Article type specification:Schreiner GF, Lange L. Ethanol modulation of

macrophage influx in glomerulonephritis [Abstract]. J AmSoc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of in-haled corticosteroids in asthma? [Editorial]. Am J RespirCrit Care Med 1998;158:1697-1701.

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

II. BOOKSChapter in book:

Clark AG, Barratt TM. Steroid-responsive nephroticsyndrome. In: Barratt TM, Arner ED, Harmon WE, editors.Pediatric Nephrology. 4th ed. Baltimore: Lippincott Wil-liam Wilkins; 1999. p. 742.

Book or monograph:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the

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

Publication in a volume of proceedings:Bauer AW. The two definitions of bacterial resistance.

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

Doctoral dissertation:Kaplan SJ. Post hospital home health care: the elderly’s

access and utilization [dissertation]. St. Louis (Mo): Wash-ington Univ.; 1995.

πππ. CD-ROMAnderson SC, Poulsen KB. Anderson’s electronic atlas

of hematology [CD-ROM]. Philadelphia: Lippincott Wil-liams & Wilkins; 2002.

IV. ON THE INTERNETArticle in journal

Abood S. Quality improvement initiative in nursinghomes: the ANA acts in an advisory role. Am J Nurs [Inter-net]. 2002 Jun: Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

MonographFoley KM, Gelband H, editors. Improving palliative

care for cancer [Monograph, Internet]. Washington: Na-tional Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html

WebsitesCancer-Pain.org [Webpage, Internet]. New York: Asso-

ciation of Cancer Online Resources, Inc.; 2002:http://www.cancer-pain.org/

Tables and FiguresThree copies should be submitted (original plus 2

copies). Their width should either be equal to the width ofone column (7.5 cm) or to the width of the page (15.5 cm).Their maximum length, titles included, should not exceed22 cm.

Tables are numbered with Arabic numerals in the orderin which they appear in the text. They should have a shorttitle and abbreviations should be listed at the bottom. Ver-tical lines in tables should be avoided.

All illustration material is considered as figures (graphs,pictures, etc.). They should be of excellent quality. Also, atthe back of every picture, the number of the picture and thename of the first author should be noted in pencil, with anarrow showing the top of the picture. The identity of pa-tients should not be recognizable from their pictures norshould their names be stated.


xix

C. Manuscript Submission and PublicationAll manuscripts should be accompanied by a floppy

disk or CD, as well as by a letter, signed by all the authors,in which it is stated that the paper has not been published inpart or in whole, or is not under consideration by anotherjournal and that the authors accept its publication in “Pae-diatriki”. Any funding, sponsorship or other financial sup-port should be acknowledged.

Once the manuscript has been accepted, the correctedversion, rewritten according to the reviewers’ recommenda-tions should be submitted to the Editorial Board accompa-nied by a floppy disk or CD, containing the paper in Wordformat, along with a covering letter specifying in detail themodifications or objections to the reviewers’ suggestions.

Delay in submission of the modified paper exceeding30 days entails new submission.

Authors will be charged film and reprint expenses, paidupon dispatch of the first proof directly to the printer.

Manuscripts of papers which have not been approvedfor publication are not returned to the author. The accom-panying figures and photographs can be returned upon re-quest within six months.

Manuscripts submitted for review and publication in“Paediatriki” should be sent in three copies to the followingaddress:

Editorial BoardGreek Paediatric Society92, Michalakopoulou Street115 28 Athens, Greece

Before submitting your paper, make sure it contains:1. 3 copies of the text of the paper, printed according to

instructions.2. A floppy disk or CD with the entire material of the pa-

per (text, tables, pictures).3. A covering letter and a statement that the paper has not

been previously published.4. The title page (on a separate page), which includes:

a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and tele-

phone number; 5. English and Greek abstracts, with the following struc-

ture: background, methods, results and conclusions(double space, separate page) and keywords.

6. List of abbreviations (double space, separate page).7. Text (double space, separate page).8. Acknowledgements and reference to funding, sponsor-

ships or other financial sources.9. References (double space, separate page).

10. Tables (one per page) in three copies.11. Figures with an arrow at the back showing the top,

numbered, in two copies.12. Figure titles (double space - on separate pages) in three

copies.


85∞¡∞™∫O¶∏™∏

OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ÛÙÈ˜ ÓÂÔÁÓÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ∞. ª·ÓÔ˘Ú¿1, ∂. °·Ï·Ó¿ÎË˜2, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘1

¶ÂÚ›ÏË„ËOÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÂÓ‰È·Ê¤ÚÔ˘Û· ÔÈÎÔÁ¤ÓÂÈ· ÚˆÙÂ˚ÓÒÓ ÌÂ ÔÈÎ›ÏÂ˜ ‚ÈÔÏÔÁÈÎ¤˜ ‰Ú¿ÛÂÈ˜. ∏Î·Ù·ÓfiËÛË ÙË˜ ÛËÌ·Û›·˜ ÙÔ˘˜ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ‰È·ÊfiÚˆÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ ·ÔÙÂÏÂ›·ÓÙÈÎÂ›ÌÂÓÔ ÂÓÙ·ÙÈÎ‹˜ ¤ÚÂ˘Ó·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ fiÏ· Ù· ÛÙ¿‰È· ·Ó¿Ù˘ÍË˜ Î·È ÂÍ¤-ÏÈÍË˜ ÙˆÓ ÓÂÔÏ·ÛÈÒÓ Î·È Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ ¯ÚfiÓÈˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÓfiÛˆÓ. ∫·-ıÒ˜ Ì›· ·fi ÙÈ˜ ‰Ú¿ÛÂÈ˜ ÙÔ˘˜ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ ÙË˜ ¯ËÌÂÈÔÙ·Í›·˜ ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ Ô˘ ·ÔÙÂÏÂ› Û˘-ÓÈÛÙÒÛ· Î·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÛÙË ‰È·‰ÈÎ·Û›· ÙË˜ ÊÏÂÁÌÔÓ‹˜, ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÏÔ›ÌˆÍË˜, ÂÓÒ ·Ú¿ÏÏËÏ· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ‚Ï¿‚Ë˜ ÙˆÓÔÚÁ¿ÓˆÓ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÂ ÂÚÈÙÒÛÂÈ˜ Û‹„Ë˜. ∂›Ó·È Èı·Ófi fiÙÈ Ë ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË Ô˘ÛÙÔ¯Â‡ÂÈ ÛÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË Î¿ÔÈˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ ÌÔÚÂ› Ó· ·Ó·ÛÙÂ›ÏÂÈ ÙËÓÂÍ¤ÏÈÍË ÙË˜ ÛË„·ÈÌ›·˜. π‰È·›ÙÂÚ· ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Ô˘ ÔÈ ÏÔÈÌÒÍÂÈ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¤¯Ô˘Ó ÌÂÁ¿-ÏË ıÓËÙfiÙËÙ·, Ë Î·Ù·ÓfiËÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÚÔÛÂÁ-Á›ÛÂˆÓ ı· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ¤Î‚·ÛË˜ ÙˆÓ ÂÚÈÁÂÓÓËÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿ÃËÌÂÈÔÎ›ÓÂ˜, ÏÔ›ÌˆÍË, ÛË„·ÈÌ›·, ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·.

1 ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜,∏Ú¿ÎÏÂÈÔ

2 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜,∏Ú¿ÎÏÂÈÔ

AÏÏËÏÔÁÚ·Ê›·:ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 115 27∏Ú¿ÎÏÂÈÔ E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-06-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 04-03-2005

¶·È‰È·ÙÚÈÎ‹ 2005;68:85-91

∂ÈÛ·ÁˆÁ‹

∏ ¯ËÌÂÈÔÙ·Í›·, Ë ÚÔÛ¤ÏÎ˘ÛË ‰ËÏ·‰‹ ÙˆÓÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜, ·ÔÙÂÏÂ› Û˘-ÓÈÛÙÒÛ· Î·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÛÙË ‰È·‰ÈÎ·Û›·ÙË˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÛÙËÓ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÍÂÓÈÛÙ‹ÛÙË ÏÔ›ÌˆÍË (1). ∏ ÚÔÛ¤ÏÎ˘ÛË ·˘Ù‹ ÙˆÓ ÏÂ˘-ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ Ú˘ıÌ›˙ÂÙ·È ·fiÙÈ˜ ¯ËÌÂÈÔÎ›ÓÂ˜, Ì›· ÛÂÈÚ¿ ·fi ¯ËÌÂÈÔÙ·ÎÙÈÎ¤˜Î˘ÙÙ·ÚÔÎ›ÓÂ˜, Ë ÛËÌ·Û›· Î·È Ô ÚfiÏÔ˜ ÙˆÓ ÔÔ›ˆÓ·ÔÙÂÏÔ‡Ó ·ÓÙÈÎÂ›ÌÂÓÔ ÂÓÙ·ÙÈÎ‹˜ ¤ÚÂ˘Ó·˜ Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ· (1,2). ™Â ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈ-ÎÂ˜, fiÔ˘ Ë ÛËÌ·Û›· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ¤¯ÂÈ ÌÂÏÂ-ÙËıÂ› ÈÎ·ÓÔÔÈËÙÈÎ¿, Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜ÙË˜ ÓÂÔÁÓÈÎ‹˜ ËÏÈÎ›·˜ Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓ ÛÙÔ·Ú¯ÈÎfi ·ÎfiÌË ÛÙ¿‰ÈÔ ÙË˜ ¤ÚÂ˘Ó·˜.

™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂÚÈÁÚ¿ÊÔÓÙ·ÈÌÂ Û˘ÓÙÔÌ›· Ë ‰ÔÌ‹ Î·È ÔÈ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ ¯ËÌÂÈ-ÔÎÈÓÒÓ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÁÓÒÛÂÈ˜ÁÈ· ÙË ÛËÌ·Û›· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ ÛÙË ÊÏÂÁÌÔÓ‹Î·È ÔÈ Èı·Ó¤˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÚÔÔÙÈÎ¤˜ ÙÔ˘˜ Î·ÈÂÈ¯ÂÈÚÂ›Ù·È Ì›· ÚÔÛ¤ÁÁÈÛË ÁÈ· ÙÔÓ ÚfiÏÔ ÙÔ˘˜ÛÙË ÓÂÔÁÓÈÎ‹ ÏÔ›ÌˆÍË.

¢ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ

OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ Â›Ó·È ÌÈÎÚ¿ ÚˆÙÂ˚ÓÈÎ¿ ÌfiÚÈ·ÌÂ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 8-12 kD (1,2). OÈ Ì¤¯ÚÈ Û‹ÌÂÚ·ÁÓˆÛÙ¤˜ ¤¯Ô˘Ó ·ÚfiÌÔÈ· ‰ÔÌ‹ Î·È ÂÚÈ¤¯Ô˘ÓÙÔ˘Ï¿¯ÈÛÙÔÓ 4 ·ÌÈÓÔÍ¤· Î˘ÛÙÂ˝ÓË˜ ÛÂ Î·ıÔÚÈÛÌ¤-

ÓÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÌÔÚ›Ô˘ ÙÔ˘˜ (2). ∞Ó¿ÏÔÁ· ÌÂ ÙË

ı¤ÛË ÙˆÓ ‰‡Ô ÚÒÙˆÓ ·ÌÈÓÔÙÂÏÈÎÒÓ ·ÌÈÓÔÍ¤ˆÓ

Î˘ÛÙÂ˝ÓË˜ ÛÙÔ ÌfiÚÈÔ, ‰È·ÎÚ›ÓÔÓÙ·È 4 ÔÈÎÔÁ¤ÓÂÈÂ˜,

·fi ÙÈ˜ ÔÔ›Â˜ ÔÈ ·- Î·È ÔÈ ‚-¯ËÌÂÈÔÎ›ÓÂ˜ ¤¯Ô˘Ó

Ù· ÂÚÈÛÛfiÙÂÚ· Ì¤ÏË (1) (¶›Ó·Î·˜ 1). ∏ ÔÓÔÌ·-

ÙÔÏÔÁ›· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Â›Ó·È ·ÚÎÂÙ¿ Û˘ÁÎÂ¯˘-

Ì¤ÓË, ·Ó Î·È ÚfiÛÊ·Ù· ¤¯ÂÈ ÚÔÙ·ıÂ› Ë ·ÓÙÈÎ·Ù¿-

ÛÙ·ÛË ÙˆÓ ÔÈÎ›ÏˆÓ ÔÓÔÌ¿ÙˆÓ ÙÔ˘˜ ·fi Ì›· Û˘-

ÛÙËÌ·ÙÈÎ‹ ÔÓÔÌ·ÙÔÏÔÁ›·, Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È

ÛÙÔÓ ¶›Ó·Î· 1 (3,4). ∏ ÚÔÙÂÈÓfiÌÂÓË ÔÓÔÌ·ÙÔÏÔ-

Á›· ÛÙËÚ›˙ÂÙ·È ÛÔ˘˜ Îˆ‰ÈÎÔ‡˜ CC, CXC, CX3C

Î·È XC, Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÙÔ ÁÚ¿ÌÌ· L

(ligand) ÁÈ· Ù· ÌfiÚÈ· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙÔ ÁÚ¿Ì-

Ì· R (receptor) ÁÈ· ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ ÙÔ˘˜, ÛÂ Û˘Ó-

‰˘·ÛÌfi ÌÂ ¤Ó·Ó ·‡ÍÔÓÙ· ·ÚÈıÌfi ÁÈ· Î¿ıÂ Ì¤ÏÔ˜

ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (4,5). ¶ÔÏÏ¿ ·fi Ù· ÁÔÓ›‰È· Ô˘

Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÈ˜ ¯ËÌÂÈÔÎ›ÓÂ˜ ¤¯Ô˘Ó ÂÓÙÔÈÛÙÂ›.

∆· ÁÔÓ›‰È· ÙˆÓ CC ¯ËÌÂÈÔÎÈÓÒÓ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ

17q11.2-12 Î·È ÙˆÓ CXC ¯ËÌÂÈÔÎÈÓÒÓ ÛÙÔ 4q (2).

∏ ·ÏÏËÏÔ˘¯›· ÙˆÓ ·ÌÈÓÔÍ¤ˆÓ ÛÙÔ ·ÌÈÓÔÙÂÏÈ-

Îfi ¿ÎÚÔ, Ù· ÔÔ›· ÚÔËÁÔ‡ÓÙ·È ÙË˜ Î˘ÛÙÂ˝ÓË˜,

·ÔÙÂÏÂ› ÙÔÓ Î·ıÔÚÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÙË˜ ‚ÈÔÏÔ-

ÁÈÎ‹˜ ÙÔ˘˜ ‰Ú¿ÛË˜ Î·È ÙË˜ ¯ËÌÈÎ‹˜ ÙÔ˘˜ Û˘ÁÁ¤-

ÓÂÈ·˜ (1). ŒÙÛÈ, ÔÈ ·-¯ËÌÂÈÔÎ›ÓÂ˜ ÌÔÚÔ‡Ó Ó· ‰È·-

¯ˆÚÈÛÙÔ‡Ó ÛÂ fiÛÂ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·ÏÏËÏÔ˘-

¯›· ÁÏÔ˘Ù·ÌÈÎfi ÔÍ‡-ÏÂ˘Î›ÓË-·ÚÁÈÓ›ÓË ÎÔÓÙ¿ ÛÙÔ

·ÌÈÓÔÙÂÏÈÎfi ¿ÎÚÔ ÙÔ˘˜ Î·È ·ÛÎÔ‡Ó ‰Ú¿ÛË ÛÙ· Ô-

Ï˘ÌÔÚÊÔ‡ÚËÓ· (ELR-CXC ¯ËÌÂÈÔÎ›ÓÂ˜) Î·È ÛÂ

fiÛÂ˜ ‰ÂÓ ÙËÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È ‰ÚÔ˘Ó ÛÙ· ÏÂÌ-

ÊÔÎ‡ÙÙ·Ú· (1). ¶ÚfiÙ˘Ô ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ

·-¯ËÌÂÈÔÎÈÓÒÓ (CXC) ·ÔÙÂÏÂ› Ë ÈÓÙÂÚÏÂ˘Î›ÓË-8,


86 ∞. ª·ÓÔ˘Ú¿ Î·È Û˘Ó.

Ô˘ ·Ú¿ÁÂÙ·È ·fi ÌÂÁ¿ÏË ÔÈÎÈÏ›· Î˘ÙÙ¿ÚˆÓ,Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ‰È·‰ÈÎ·Û›· ÚÔÛÎfiÏÏËÛË˜ ÙˆÓÔ˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ, ·ÚÔ˘ÛÈ¿˙ÂÈ ·Á-ÁÂÈÔÁÂÓÂÙÈÎ‹ ‰Ú¿ÛË Î·È ÂÌÏ¤ÎÂÙ·È ÛÙËÓ ¤ÎÏ˘ÛËÈÛÙ·Ì›ÓË˜ ·fi Ù· ‚·ÛÂfiÊÈÏ· Î·È ÙËÓ ÚÔÛ¤ÏÎ˘ÛË∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (2). ÕÏÏ· Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ-·˜ ÙˆÓ ·-¯ËÌÂÈÔÎÈÓÒÓ, Î·ıÒ˜ Î·È Ù· Î‡ÙÙ·Ú·-ÛÙfi¯ÔÈ ÙÔ˘˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.

OÈ ‚-¯ËÌÂÈÔÎ›ÓÂ˜ ‰ÂÓ ‰ÚÔ˘Ó ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ·,·ÏÏ¿ ÚÔÛÂÏÎ‡Ô˘Ó ÌÔÓÔÎ‡ÙÙ·Ú·, ËˆÛÈÓfiÊÈÏ·, ‚·-ÛÂfiÊÈÏ· Î·È ÏÂÌÊÔÎ‡ÙÙ·Ú· (1). ÃˆÚ›˙ÔÓÙ·È ÛÂ ‰‡Ô˘ÔÔÌ¿‰Â˜ (1), Ë ÚÒÙË ·fi ÙÈ˜ ÔÔ›Â˜ ÂÚÈÏ·Ì-‚¿ÓÂÈ ¤ÓÙÂ ¯ËÌÂÈÔÙ·ÎÙÈÎ¤˜ ÚˆÙÂ˝ÓÂ˜ ÁÈ· Ù· ÌÔ-ÓÔÎ‡ÙÙ·Ú· (MCP-1 ¤ˆ˜ MCP-5) Î·È ÙËÓ ËˆÙ·Í›ÓË,ÂÓÒ fiÏÂ˜ ÔÈ ̆ fiÏÔÈÂ˜ ·ÔÙÂÏÔ‡Ó ÙË ‰Â‡ÙÂÚË ̆ Ô-ÔÌ¿‰· (¶›Ó·Î·˜ 3). ∏ ÚˆÙÂ˝ÓË MCP-1 Â›Ó·È ÙÔÚÒÙÔ Ì¤ÏÔ˜ Ô˘ ·ÔÌÔÓÒıËÎÂ, ¤¯ÂÈ ¯ËÌÂÈÔÙ·ÎÙÈ-Î‹ ‰Ú¿ÛË ÛÙ· ÌÔÓÔÎ‡ÙÙ·Ú·, Â¿ÁÂÈ ÙËÓ ¤ÎÊÚ·ÛËÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ, ÚÔÛÂÏÎ‡ÂÈ Ù· ÂÓÂÚÁÔÔÈËÌ¤Ó·CD4 Î·È CD8 ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È Â¿ÁÂÈ ÙËÓ¤ÎÏ˘ÛË ÈÛÙ·Ì›ÓË˜ ·fi Ù· ‚·ÛÂfiÊÈÏ· (2,7-9).

OÈ ˘Ô‰Ô¯Â›˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ

OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ·ÛÎÔ‡Ó ÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÙ·Î‡ÙÙ·Ú·-ÛÙfi¯Ô˘˜ Ì¤Ûˆ ˘Ô‰Ô¯¤ˆÓ (1). O ‰ÂÛÌfi˜¯ËÌÂÈÔÎ›ÓË˜ Î·È ˘Ô‰Ô¯¤· Ô‰ËÁÂ› ÛÂ Ì›· ÛÂÈÚ¿Î˘ÙÙ·ÚÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË‰ËÌÈÔ˘ÚÁ›· ÙÚÈÊˆÛÊÔÚÈÎ‹˜ ÈÓÔÛÈÙfiÏË˜, ÙËÓ ¤ÍÔ-‰Ô ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘, ÙËÓ ÂÓÂÚÁÔÔ›ËÛËÙË˜ ÚˆÙÂ˚ÓÈÎ‹˜ ÎÈÓ¿ÛË˜ C Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛËÙˆÓ Rho-ÚˆÙÂ˚ÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÎÈÓË-ÙÈÎfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1).

Œˆ˜ Û‹ÌÂÚ· ¤¯Ô˘Ó Ù·˘ÙÔÔÈËıÂ› ¤ÍÈ ˘Ô‰Ô¯Â›˜ÁÈ· ÙÈ˜ ·-¯ËÌÂÈÔÎ›ÓÂ˜ (CXCR1-CXCR6), ÂÓÓ¤·˘Ô‰Ô¯Â›˜ ÁÈ· ÙÈ˜ ‚-¯ËÌÂÈÔÎ›ÓÂ˜ (CCR1-CCR9)Î·È ·fi ¤Ó·˜ ˘Ô‰Ô¯¤·˜ ÁÈ· ÙÈ˜ CXXXC- Î·È XC-¯ËÌÂÈÔÎ›ÓÂ˜ (CX3CR1, XCR1) (1,3,5). OÈ ˘Ô‰Ô-¯Â›˜ ·˘ÙÔ› ÂÎÊÚ¿˙ÔÓÙ·È ÛÂ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ÏÂ˘-ÎÔÎ˘ÙÙ¿ÚˆÓ. ÕÏÏÔÈ ÂÎÊÚ¿˙ÔÓÙ·È ÛÂ ¤Ó·Ó ÌfiÓÔ Ù‡-Ô ÏÂ˘ÎÔÎ˘ÙÙ¿ÚÔ˘, ÂÓÒ ¿ÏÏÔÈ ¤¯Ô˘Ó ÈÔ Â˘ÚÂ›·

Î·Ù·ÓÔÌ‹ (1). ¶ÔÏÏÔ› Ù‡ÔÈ Î˘ÙÙ¿ÚˆÓ ÂÎÊÚ¿˙Ô˘ÓÙÔ˘˜ ˘Ô‰Ô¯Â›˜ ÌfiÓÔ ÌÂÙ¿ ·fi Â·ÁˆÁ‹ ·fi Î¿-ÔÈÔ ÂÚ¤ıÈÛÌ·, ÂÓÒ ÛÂ ¿ÏÏ· Î‡ÙÙ·Ú· Î¿ÔÈÔÈ ÌÂ-ÛÔÏ·‚ËÙ¤˜ ÌÂÈÒÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ̆ Ô‰Ô¯¤ˆÓ·˘ÙÒÓ Î·È Ù· Î‡ÙÙ·Ú· ¯¿ÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘˜ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ¯ËÌÂÈÔÎ›ÓË (1). ∂ÎÙfi˜ ÙˆÓ ÏÂ˘ÎÔ-Î˘ÙÙ¿ÚˆÓ, ˘Ô‰Ô¯Â›˜ ¯ËÌÂÈÔÎÈÓÒÓ ¤¯Ô˘Ó ‚ÚÂıÂ›Î·È ÛÂ ÏÂ›ÛÙ· ¿ÏÏ· Î‡ÙÙ·Ú·, fiˆ˜ ÛÂ ÓÂ˘ÚÒÓÂ˜,·ÛÙÚÔÎ‡ÙÙ·Ú·, ÂÈıËÏÈ·Î¿ Î·È ÂÓ‰ÔıËÏÈ·Î¿ Î‡Ù-Ù·Ú·, Â‡ÚËÌ· Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜¤¯Ô˘Ó Î·È ÏÂ›ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ÚfiÏÔ˘˜, ·Ú¿ÏÏËÏ·ÌÂ ÙË ¯ËÌÂÈÔÙ·ÎÙÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË ÛÙ· ÏÂ˘ÎÔÎ‡ÙÙ·-Ú· (1). OÈ ˘Ô‰Ô¯Â›˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‰ÂÓ Â›Ó·È ÂÈ-‰ÈÎÔ› ÁÈ· Ì›· ÌfiÓÔ ̄ ËÌÂÈÔÎ›ÓË, ̂ ÛÙfiÛÔ ÌÔÚÔ‡Ó Ó·‰ÂÛÌÂ‡Ô˘Ó ÌfiÓÔ Ì¤ÏË ÙË˜ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (1,2).

O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜

O ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙËÓÔÍÂ›· ÏÔ›ÌˆÍË Â›Ó·È ÁÓˆÛÙfi˜. ªÂ ÙË Ê·ÁÔÎ˘ÙÙ¿-ÚˆÛË Î·È ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË ÔÈÎ›ÏˆÓ ÂÈ‰ÈÎÒÓ Î·ÈÌË ÂÈ‰ÈÎÒÓ ‚·ÎÙËÚÈÔÎÙfiÓˆÓ Ô˘ÛÈÒÓ, Ù· Ô˘‰ÂÙÂÚfi-ÊÈÏ· ·Ì‡ÓÔÓÙ·È ÂÓ¿ÓÙÈ· ÛÙÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ‡˜ (10,11). ∆Ë Û˘ÁÎ¤ÓÙÚˆÛË Î·È ÙËÓÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙËÓ ÂÚÈÔ¯‹ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÂÏ¤Á¯Ô˘Ó ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÔÈ¯ËÌÂÈÔÎ›ÓÂ˜ (2). ∏ ÌÂÁ¿ÏË ·‡ÍËÛË ÙË˜ ¤ÎÎÚÈÛË˜¯ËÌÂÈÔÎÈÓÒÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ¤¯ÂÈ ˆ˜·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÎÏÂÎÙÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÏÂ˘ÎÔ-Î˘ÙÙ¿ÚˆÓ (2). ∆ËÓ ¤ÎÎÚÈÛË ·˘Ù‹ Â¿ÁÔ˘Ó ÔÈ ÚÔ-ÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î˘ÙÙ·ÚÔÎ›ÓÂ˜, fiˆ˜ Ë ÈÓÙÂÚÏÂ˘Î›-ÓË 1 (IL-1) Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛË˜ fiÁÎˆÓ ¿Ï-Ê· (TNF-·), ÚÔ˚fiÓÙ· ‚·ÎÙËÚÈ‰›ˆÓ fiˆ˜ ÔÈ Ô-Ï˘Û·Î¯·Ú›ÙÂ˜ Î·È ÈÔ› (1,2). ∂ÈÏ¤ÔÓ, ÔÈ ¯ËÌÂÈÔÎ›-ÓÂ˜ Â¿ÁÔÓÙ·È ·fi ÙËÓ ÈÓÙÂÚÊÂÚfiÓË-Á Î·È ÙËÓÈÓÙÂÚÏÂ˘Î›ÓË-4, ÚÔ˚fiÓÙ· ÙˆÓ ∆1 Î·È ∆2 ‚ÔËıËÙÈ-ÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ·ÓÙ›ÛÙÔÈ¯· (2). ∏ Û˘Û¯¤ÙÈÛËÙË˜ ¤ÎÊÚ·ÛË˜ ÙˆÓ ̄ ËÌÂÈÔÎÈÓÒÓ ÌÂ ÙÈ˜ ·ıÔÊ˘ÛÈÔ-ÏÔÁÈÎ¤˜ ‰ÈÂÚÁ·Û›Â˜ ¤¯ÂÈ ÂÈÙÂ˘¯ıÂ› ÌÂ ÌÂÏ¤ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· (1,12). ªÂ ÙËÓ ÂÈÚ·Ì·ÙÈÎ‹

¶·È‰È·ÙÚÈÎ‹ 2005;68:85-91

¶¶››ÓÓ··ÎÎ··˜̃ 11.. OÈ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ

OOÈÈÎÎÔÔÁÁ¤¤ÓÓÂÂÈÈ·· ¢¢ÔÔÌÌ‹‹ ∫∫‡‡ÚÚÈÈ·· ‰‰ÚÚ¿¿ÛÛËË ¶¶ÚÚfifiÙÙ˘̆ÔÔ ÌÌ¤¤ÏÏÔÔ˜̃

·-ÃËÌÂÈÔÎ›ÓÂ˜ ∆· ‰‡Ô ÚÒÙ· ·ÌÈÓÔÍ¤· Î˘ÛÙÂ˝ÓË˜ O˘‰ÂÙÂÚfiÊÈÏ· πÓÙÂÚÏÂ˘Î›ÓË-8(CXC) ¯ˆÚ›˙ÔÓÙ·È ·fi ¤Ó· ‰È·ÊÔÚÂÙÈÎfi ·ÌÈÓÔÍ‡ §ÂÌÊÔÎ‡ÙÙ·Ú·

‚-ÃËÌÂÈÔÎ›ÓÂ˜ ∆· ‰‡Ô ÚÒÙ· ·ÌÈÓÔÍ¤· Î˘ÛÙÂ˝ÓË˜ ªÔÓÔÎ‡ÙÙ·Ú· MCP-1(CC) Û˘Ó‰¤ÔÓÙ·È ÌÂÙ·Í‡ ÙÔ˘˜ ∏ˆÛÈÓfiÊÈÏ·

µ·ÛÂfiÊÈÏ·§ÂÌÊÔÎ‡ÙÙ·Ú·

XC ¢‡Ô ÌfiÓÔ ·ÌÈÓÔÍ¤· Î˘ÛÙÂ˝ÓË˜ ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· §ÂÌÊÔÙ·ÎÙ›ÓË(lymphotactin)

CXXXC ‹ ∆· ‰‡Ô ÚÒÙ· ·ÌÈÓÔÍ¤· Î˘ÛÙÂ˝ÓË˜ º˘ÛÈÎ¿ Î‡ÙÙ·Ú·-ÊÔÓÂ›˜ ºÚ·ÎÙ·ÏÎ›ÓËCX3C ¯ˆÚ›˙ÔÓÙ·È ·fi ÙÚ›· ·ÌÈÓÔÍ¤· ªÔÓÔÎ‡ÙÙ·Ú· (fractalkine)


87ÃËÌÂÈÔÎ›ÓÂ˜ Î·È ÓÂÔÁÓÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜

·‰Ú·ÓÔÔ›ËÛË, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ÙË˜ ¯ËÌÂÈÔÎ›ÓË˜

ªπƒ-2 ¤¯ÂÈ ‰ÂÈ¯ıÂ› fiÙÈ Ë ¯ËÌÂÈÔÎ›ÓË ·˘Ù‹ Â›Ó·È ÛË-

Ì·ÓÙÈÎ‹ ÁÈ· ÙË Û˘ÁÎ¤ÓÙÚˆÛË Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È

ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ‚·ÎÙËÚÈ‰›ˆÓ ÛÂ ÂÈÚ·Ì·ÙÈ-

Îfi ÌÔÓÙ¤ÏÔ ÓÂ˘ÌÔÓ›·˜ ·fi Klebsiella (13).

º·›ÓÂÙ·È fiÙÈ ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙÔÓ

Û¯ËÌ·ÙÈÛÌfi ÎÔÎÎÈÒÌ·ÙÔ˜ Î·È ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙÔ˘

Ì˘ÎÔ‚·ÎÙËÚÈ‰›Ô˘ ÙË˜ Ê˘Ì·Ù›ˆÛË˜ Î·È ¤¯ÂÈ ‰ÂÈ¯ıÂ›

fiÙÈ Ë ÌfiÏ˘ÓÛË Ì·ÎÚÔÊ¿ÁˆÓ ÌÂ ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ

Â¿ÁÂÈ ÙËÓ ¿ÌÂÛË ¤ÎÎÚÈÛË ¯ËÌÂÈÔÎÈÓÒÓ Ô˘ ÌÔ-

ÚÔ‡Ó Ó· ·ÓÈ¯ÓÂ˘ıÔ‡Ó ÌfiÏÈ˜ 2 ÒÚÂ˜ ÌÂÙ¿ (14,15).

∂ÎÙfi˜ ·fi Ù· Ì·ÎÚÔÊ¿Á·, ¿ÏÏ· Î‡ÙÙ·Ú· Â›ÛË˜,

fiˆ˜ Ù· ·ÓıÚÒÈÓ· ÂÈıËÏÈ·Î¿ Î˘„ÂÏÈ‰ÈÎ¿ Î‡ÙÙ·-

Ú·, ·Ú¿ÁÔ˘Ó ¯ËÌÂÈÔÎ›ÓÂ˜ ˆ˜ ·¿ÓÙËÛË ÛÙË ÏÔ›-

ÌˆÍË ·fi ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Î·È Û˘ÌÌÂÙ¤¯Ô˘Ó

¤ÙÛÈ ÛÙË Û˘ÛÛÒÚÂ˘ÛË Î˘ÙÙ¿ÚˆÓ ÛÙË ı¤ÛË ÙË˜

ÊÏÂÁÌÔÓ‹˜ (14). ∏ Â˘·ÈÛıËÛ›· ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÏÔÈ-

ÌÒÍÂÈ˜ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· ÌÂ ÙËÓ ¤Ï-

ÏÂÈ„Ë Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ¯ËÌÂÈÔÎÈÓÒÓ. OÈ ·ıÔÁfiÓÔÈ

ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Û˘Ó‰¤ÔÓÙ·È ÌÂ ˘Ô‰Ô¯Â›˜ ÙˆÓ

ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÁÈ· Ó· ‚ÚÔ˘Ó ‰›Ô‰Ô ÚÔ˜ ÙÔ Î˘ÙÙ·-

ÚfiÏ·ÛÌ· Î·È ÙÔÓ ˘Ú‹Ó· ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1). OÈ

¯ËÌÂÈÔÎ›ÓÂ˜ ¤¯Ô˘Ó ÎÔÈÓÔ‡˜ ˘Ô‰Ô¯Â›˜ ÌÂ ‰‡Ô ÙÔ˘-

Ï¿¯ÈÛÙÔÓ ÛËÌ·ÓÙÈÎÔ‡˜ ·ıÔÁfiÓÔ˘˜ ÁÈ· ÙÔÓ ¿ÓıÚˆ-

Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, ÙÔÓ Èfi ÙË˜ ·ÓıÚÒÈÓË˜ ·ÓÔ-

ÛÔ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÙÔ Ï·ÛÌÒ‰ÈÔ ÙË˜ ÂÏÔÓÔÛ›·˜

(1). OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ÙÔ˘˜ Û˘ÁÎÂ-

ÎÚÈÌ¤ÓÔ˘˜ ˘Ô‰Ô¯Â›˜ (RANTES, MIP-1·, MIP-1‚)

Î·Ù·Ï·Ì‚¿ÓÔ˘Ó ÙÈ˜ ı¤ÛÂÈ˜ Û‡Ó‰ÂÛË˜ ÙÔ˘ ÈÔ‡ ÙË˜

·ÓıÚÒÈÓË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÂÌÔ‰›˙Ô˘Ó

¤ÙÛÈ ÙËÓ ÚÔÛÎfiÏÏËÛË Î·È ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÛÙ· Î‡Ù-

Ù·Ú· (16,17). ÕÙÔÌ· ÌÂ ˘„ËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ·˘-

ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ ÌÔÏ‡ÓÔÓÙ·È ·fi ÙÔÓ Èfi,

·Ú¿ ÙËÓ Â·ÓÂÈÏËÌÌ¤ÓË ¤ÎıÂÛ‹ ÙÔ˘˜ ÛÂ ·˘ÙfiÓ

(18). ∫·È ¿ÏÏÔÈ ÈÔ›, fiˆ˜ ÔÚÈÛÌ¤ÓÔÈ ÂÚËÙÔ˚Ô›, ÂÎ-

ÊÚ¿˙Ô˘Ó ˘Ô‰Ô¯Â›˜ ÔÌfiÏÔÁÔ˘˜ ÌÂ ÙÔ˘˜ ˘Ô‰Ô¯Â›˜

ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ. O ÂÚËÙÔ˚fi˜-8 ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ

Îˆ‰ÈÎÔÔÈÂ› ¤Ó·Ó ÂÓÂÚÁfi ˘Ô‰Ô¯¤· ¯ËÌÂÈÔÎÈÓÒÓ

Ô˘ ‰ÈÂÁÂ›ÚÂÈ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ÔÏÏ·Ï·ÛÈ·ÛÌfi (19).

∏ Î·Ù·ÓfiËÛË ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ̄ ËÌÂÈÔÎÈÓÒÓ

ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜ ¤¯ÂÈ ˆ˜ ‰˘ÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙËÓ

Èı·Ó‹ ıÂÚ·Â˘ÙÈÎ‹ ÙÔ˘˜ ¯Ú‹ÛË. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ

ÔÈ ÌË ÂÈ‰ÈÎÔ› ÌË¯·ÓÈÛÌÔ› ¿Ì˘Ó·˜ Î·Ù¿ ÙˆÓ ·ıÔÁfi-

ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë

·ÂÏÂ˘ı¤ÚˆÛË ÂÏÂ‡ıÂÚˆÓ ÚÈ˙ÒÓ, ÚÔÎ·ÏÔ‡Ó ‚Ï¿-

‚Ë Î·È ÛÙÔÓ ÍÂÓÈÛÙ‹, ‚Ï¿‚Ë Ô˘ ÌÔÚÂ› Ó· Â›Ó·È ÛË-

Ì·ÓÙÈÎ‹ (20). ∏ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡-

ÚËÓˆÓ Â›Ó·È Ô˘ÛÈÒ‰Ë˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ì›·˜

ÏÔ›ÌˆÍË˜, ·ÏÏ¿ ·Ú¿ÏÏËÏ· Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ÂÌ-

Ê¿ÓÈÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÈÙÒÛÂˆÓ, fiˆ˜ ÙÔ Û‡Ó-

‰ÚÔÌÔ ÔÏ˘ÔÚÁ·ÓÈÎ‹˜ ¤ÎÙˆÛË˜ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ

ÔÍÂ›·˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (21,22). ™ÙÔÓ

ÔÚfi ·ÛıÂÓÒÓ ÌÂ ÛË„·ÈÌ›· ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› ·˘ÍË-

Ì¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ, fiˆ˜ ÙË˜ IL-8,

ÙÔ˘ GRO-· Î·È ÙÔ˘ MIP-1·, ÂÓÒ ÛËÌ·ÓÙÈÎfiÙÂÚË

·‡ÍËÛË ÛÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘ MIP-1· ‚Ú¤ıËÎÂ ÛÂ

ÔÚfi ·ÛıÂÓÒÓ ÌÂ Û‹„Ë Ô˘ Î·Ù¤ÏËÍ·Ó (23-25).

OˆÛ‰‹ÔÙÂ, Ë ‰È·‰Ô¯ÈÎ‹ ¤ÎÎÚÈÛË Î·È ÂÓÂÚÁÔÔ›-

ËÛË ÔÈÎ›ÏˆÓ ÌÂÛÔÏ·‚ËÙÒÓ ‰˘Û¯ÂÚ·›ÓÂÈ ÙfiÛÔ ÙËÓ

Ï‹ÚË Î·Ù·ÓfiËÛË ÙË˜ ‰È·‰ÈÎ·Û›·˜ fiÛÔ Î·È ÙË ıÂ-

Ú·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË (26). øÛÙfiÛÔ, ÌÂÏ¤ÙÂ˜ ÛÂ

ÂÓ‹ÏÈÎÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô ¤ÏÂÁ¯Ô˜ ÙË˜ ¯ËÌÂÈÔÙ·Í›·˜

ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÂÈÙÂÏÂ›Ù·È Ì¤Ûˆ ‰‡Ô Î˘-

Ú›ˆ˜ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ, ÙÔ˘ CXCR1 Î·È

ÙÔ˘ CXCR2 (5,27,28). ∏ Î˘ÚÈ·Ú¯›· ÙÔ˘ ÂÓfi˜ ÌfiÓÔ

˘Ô‰Ô¯¤·, ÙÔ˘ CXCR1, Î·Ù¿ ÙË ÛË„·ÈÌ›· ˘Ô‰ÂÈ-

ÎÓ‡ÂÈ fiÙÈ Èı·ÓfiÓ Ì›· ıÂÚ·Â˘ÙÈÎ‹ ‰¤ÛÌÂ˘ÛË ÙÔ˘

˘Ô‰Ô¯¤· ·˘ÙÔ‡ ı· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÈˆ-

Ì¤ÓË ¯ËÌÂÈÔÙ·Í›· ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÚÔ˜

Ù· ‰È¿ÊÔÚ· fiÚÁ·Ó· Î·È, Î·Ù¿ Û˘Ó¤ÂÈ·, ÙÔÓ ÂÚÈÔ-

ÚÈÛÌfi ÙË˜ ‚Ï¿‚Ë˜ ÙÔ˘˜ (29).

O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÂ ¿ÏÏÂ˜ ·ıÔ-Ê˘ÛÈÔÏÔÁÈÎ¤˜ ‰ÈÂÚÁ·Û›Â˜

∂ÎÙfi˜ ·fi ÙÈ˜ ÏÔÈÌÒÍÂÈ˜, ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜ Û˘Ì-

ÌÂÙ¤¯Ô˘Ó ÛÂ ÔÈÎ›ÏÂ˜ ¿ÏÏÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ Î·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:85-91

¶¶››ÓÓ··ÎÎ··˜̃ 22.. °ÓˆÛÙ¿ Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ·-¯ËÌÂÈÔÎÈÓÒÓ (ÙÚÔÔÔÈËÌ¤ÓÔ ·fi ‚È‚ÏÈÔÁÚ·Ê›Â˜ 1,2,4)

¶¶ÚÚÔÔÙÙÂÂÈÈÓÓfifiÌÌÂÂÓÓÔÔ fifiÓÓÔÔÌÌ·· ∂∂ÌÌÂÂÈÈÚÚÈÈÎÎfifi fifiÓÓÔÔÌÌ·· ∫∫‡‡ÙÙÙÙ··ÚÚ··--ÛÛÙÙfifi¯̄ÔÔÈÈ

CXCL1 GRO-· (MGSA) O˘‰ÂÙÂÚfiÊÈÏ·, Î‡ÙÙ·Ú· ÌÂÏ·ÓÒÌ·ÙÔ˜ (? ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·) CXCL2 GRO-‚ (MIP-2a) O˘‰ÂÙÂÚfiÊÈÏ· (? ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·)CXCL3 GRO-Á (MIP-2b) O˘‰ÂÙÂÚfiÊÈÏ· (? ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·)CXCL4 Platelet factor-4 πÓÔ‚Ï¿ÛÙÂ˜, ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·CXCL5 ENA-78 O˘‰ÂÙÂÚfiÊÈÏ·CXCL6 GCP-2 O˘‰ÂÙÂÚfiÊÈÏ·CXCL7 NAP-2 O˘‰ÂÙÂÚfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·CXCL8 IL-8 O˘‰ÂÙÂÚfiÊÈÏ·, ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·, ‚·ÛÂfiÊÈÏ· (? ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·)CXCL9 MIG ¢ÈÂÁÂÚÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·CXCL10 IP-10 ¢ÈÂÁÂÚÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, ? ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·CXCL11 SCYB9B (IP-9)CXCL12 SDF-1 ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, CD34+ ÚÔ‰ÚÔÌÈÎ¿ Î‡ÙÙ·Ú·, µ ÏÂÌÊÔÎ‡ÙÙ·Ú· ?CXCL13 BLC (BCA-1) µ ÏÂÌÊÔÎ‡ÙÙ·Ú·CXCL14 BRAK


88 ∞. ª·ÓÔ˘Ú¿ Î·È Û˘Ó.

·ıÔÏÔÁÈÎ¤˜ ‰ÈÂÚÁ·Û›Â˜. OÈ CXC ¯ËÌÂÈÔÎ›ÓÂ˜

¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË Î·È Ë

‰Ú¿ÛË ÙÔ˘˜, ·Ó·ÛÙ·ÏÙÈÎ‹ ‹ ÚÔ·ÁˆÁÈÎ‹, ÂÍ·ÚÙ¿-

Ù·È ·fi ÙËÓ ‡·ÚÍË ÙË˜ ·ÏÏËÏÔ˘¯›·˜ ELR (3). OÈ

ELR-CXC ¯ËÌÂÈÔÎ›ÓÂ˜ Â›Ó·È ÈÛ¯˘ÚÔ› ·ÁÁÂÈÔÁÂÓÂÙÈ-

ÎÔ› ·Ú¿ÁÔÓÙÂ˜, ÂÓÒ ÔÈ ˘fiÏÔÈÂ˜ CXC ¯ËÌÂÈÔÎ›-

ÓÂ˜ ¤¯Ô˘Ó ·Ó·ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË ÛÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË

(2,3). ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÔÈ ÓÂÔÏ·Û›Â˜ Î·È ÔÚÈÛÌ¤-

ÓÂ˜ ¯ÚfiÓÈÂ˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÓfiÛÔÈ ¤¯Ô˘Ó Û˘Û¯ÂÙÈ-

ÛÙÂ› ÌÂ ÙË ‰È·Ù·Ú·¯‹ ÙË˜ ÈÛÔÚÚÔ›·˜ ÌÂÙ·Í‡ ÚÔ-

·ÁˆÁ‹˜ Î·È ·Ó·ÛÙÔÏ‹˜ ÙË˜ ·ÁÁÂÈÔÁ¤ÓÂÛË˜ (30-32).

™Â ¯ÚfiÓÈÂ˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÓfiÛÔ˘˜, Ë Û˘ÛÛÒ-

ÚÂ˘ÛË ‰È·ÊfiÚˆÓ Ù‡ˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜

Î·ıÔÚ›˙ÂÙ·È ·fi ÙËÓ ¤ÎÎÚÈÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ¯Ë-

ÌÂÈÔÎÈÓÒÓ (1). ™ÙË Û·ÚÎÔÂ›‰ˆÛË ¤¯ÂÈ ‰È·ÈÛÙˆ-

ıÂ› ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ ¯ËÌÂÈÔÎ›ÓË˜ IP-

10, ÙfiÛÔ ÛÙÔÓ ÔÚfi fiÛÔ Î·È ÛÂ ‚ÚÔÁ¯ÔÎ˘„ÂÏÈ‰ÈÎfi

¤ÎÏ˘Ì·, fiÔ˘ Ë ·‡ÍËÛË Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ

·ÚÈıÌfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

(1). ™ÙËÓ ·ÏÏÂÚÁÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·, ÙËÓ ·ÏÏÂÚÁÈÎ‹

ÚÈÓ›ÙÈ‰· Î·È ÙÔ ¿ÛıÌ·, fiÔ˘ ˘¿Ú¯ÂÈ ÂÎÏÂÎÙÈÎ‹

Û˘ÁÎ¤ÓÙÚˆÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ËˆÛÈÓÔÊ›ÏˆÓ Î·È

Ì·ÛÙÔÎ˘ÙÙ¿ÚˆÓ, Ë ËˆÙ·Í›ÓË Î·È ÔÈ ¯ËÌÂÈÔÙ·ÎÙÈ-

Î¤˜ ÚˆÙÂ˝ÓÂ˜ ÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ (MCP-1 ¤ˆ˜

MCP-4) Ê·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ Î·È

·ÔÙÂÏÔ‡Ó Èı·ÓÒ˜ ÙÔÓ ÌÔÚÈ·Îfi Û‡Ó‰ÂÛÌÔ ÌÂÙ·-

Í‡ ÙË˜ ¿ÓÔÛË˜ ·ÓÙ›‰Ú·ÛË˜ ÛÙÔ ·ÓÙÈÁfiÓÔ Î·È ÙË˜

ÌÂÙ·Ó¿ÛÙÂ˘ÛË˜ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜

(33-35). ™ÙËÓ ÂÏÎÒ‰Ë ÎÔÏ›ÙÈ‰· Î·È ÙË ÓfiÛÔ

Crohn, ÙËÓ „ˆÚ›·ÛË, ÙË ÚÂ˘Ì·ÙÔÂÈ‰‹ ·ÚıÚ›ÙÈ‰·

Î·È ÙËÓ ·ıËÚÔÛÎÏ‹Ú˘ÓÛË ¤¯Ô˘Ó ‰È·ÈÛÙˆıÂ› ·˘-

ÍËÌ¤Ó· Â›Â‰· ‰È·ÊfiÚˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Ô˘ Ê·›-

ÓÂÙ·È fiÙÈ Î·ıÔÚ›˙Ô˘Ó ÙÔÓ Ù‡Ô ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘

‰ÈËıÔ‡Ó ÙÔ˘˜ ÈÛÙÔ‡˜ ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË

(1,36,37). ∏ ÂÍ¤ÏÈÍË ÙˆÓ ‰È·ÊfiÚˆÓ ·˘ÙÒÓ ·ı‹-

ÛÂˆÓ ÌÔÚÂ›, ıÂˆÚËÙÈÎ¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ, Ó· ÙÚÔÔ-

ÔÈËıÂ› ÌÂ ÙË ‚Ô‹ıÂÈ· ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ ·ÓÙ›-

ÛÙÔÈ¯ˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ (3).

Œ¯ÂÈ ‰ÂÈ¯ıÂ› ÚfiÛÊ·Ù· fiÙÈ ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜ Î·È ÔÈ

˘Ô‰Ô¯Â›˜ ÙÔ˘˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ fiÏ· Ù· ÛÙ¿‰È·

·Ó¿Ù˘ÍË˜ Î·È ÂÍ¤ÏÈÍË˜ ÙˆÓ ÓÂÔÏ·ÛÈÒÓ, ·fi ÙËÓ

Î·ÚÎÈÓÈÎ‹ ÌÂÙ·ÙÚÔ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤¯ÚÈ ÙË ‰È‹-

ıËÛË ·ÈÌÔÊfiÚˆÓ Î·È ÏÂÌÊÔÊfiÚˆÓ ·ÁÁÂ›ˆÓ ·fi ÓÂ-

ÔÏ·ÛÌ·ÙÈÎ¿ Î‡ÙÙ·Ú· Î·È ÙË ÌÂÙ¿ÛÙ·ÛË ÛÂ ¿ÏÏ·

fiÚÁ·Ó· (3,38). ◊‰Ë ¤¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ô ÂÚËÙÔ˚-

fi˜-8 Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ Û¿ÚÎˆÌ· Caposi, Îˆ‰È-

ÎÔÔÈÂ› ¤Ó·Ó ÂÓÂÚÁfi ˘Ô‰Ô¯¤· ¯ËÌÂÈÔÎÈÓÒÓ. OÚÈ-

ÛÌ¤ÓÂ˜ CXC ¯ËÌÂÈÔÎ›ÓÂ˜ Ê·›ÓÂÙ·È fiÙÈ ‰ÈÂÁÂ›ÚÔ˘Ó

Û˘ÓÂ¯Ò˜ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ˘Ô‰Ô¯¤· CXCR2, Ô‰Ë-

ÁÒÓÙ·˜ ÙÂÏÈÎ¿ ÛÂ Î·ÚÎÈÓÈÎ‹ Î˘ÙÙ·ÚÈÎ‹ ÌÂÙ·ÙÚÔ‹.

OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ CXCL8 (IL-8) Î·È GRO-·, -‚, -Á

Ê·›ÓÂÙ·È fiÙÈ ‰ÚÔ˘Ó ˆ˜ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ·

ÔÚÈÛÌ¤Ó· Î·ÎÔ‹ıË Î‡ÙÙ·Ú· (38-41). ∏ ·Ó¿Ù˘ÍË

ÙˆÓ Û˘Ì·ÁÒÓ fiÁÎˆÓ ÛÂ ‰È¿ÌÂÙÚÔ ÌÂÁ·Ï‡ÙÂÚË ·fi

¶·È‰È·ÙÚÈÎ‹ 2005;68:85-91

¶¶››ÓÓ··ÎÎ··˜̃ 33.. °ÓˆÛÙ¿ Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ‚-¯ËÌÂÈÔÎÈÓÒÓ (ÙÚÔÔÔÈËÌ¤ÓÔ ·fi ‚È‚ÏÈÔÁÚ·Ê›Â˜ 1,2,4)

¶¶ÚÚÔÔÙÙÂÂÈÈÓÓfifiÌÌÂÂÓÓÔÔ fifiÓÓÔÔÌÌ·· ∂∂ÌÌÂÂÈÈÚÚÈÈÎÎfifi fifiÓÓÔÔÌÌ·· ∫∫‡‡ÙÙÙÙ··ÚÚ··--ÛÛÙÙfifi¯̄ÔÔÈÈ

CCL1 I-309 ªÔÓÔÎ‡ÙÙ·Ú· CCL2 MCP-1 ªÔÓÔÎ‡ÙÙ·Ú·, ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· ÌÓ‹ÌË˜, ‚·ÛÂfiÊÈÏ·, ·ÈÌÔÔÈËÙÈÎ¿

ÚÔ‰ÚÔÌÈÎ¿ Î‡ÙÙ·Ú·CCL3 MIP-1· ªÔÓÔÎ‡ÙÙ·Ú·, ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, Î‡ÙÙ·Ú·-ÊÔÓÂ›˜, ‚·ÛÂfiÊÈÏ·,

ËˆÛÈÓfiÊÈÏ·, ‰ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú·, ·ÈÌÔÔÈËÙÈÎ¿ ÚÔ‰ÚÔÌÈÎ¿ Î‡ÙÙ·Ú· CCL4 MIP-1‚ ªÔÓÔÎ‡ÙÙ·Ú·, ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, ‰ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú·, Î‡ÙÙ·Ú·-

ÊÔÓÂ›˜, ·ÈÌÔÔÈËÙÈÎ¿ ÚÔ‰ÚÔÌÈÎ¿ Î‡ÙÙ·Ú·CCL5 RANTES ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· ÌÓ‹ÌË˜, ËˆÛÈÓfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·, Î‡ÙÙ·Ú·-ÊÔÓÂ›˜,

‰ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú·CCL7 MCP-3 ªÔÓÔÎ‡ÙÙ·Ú·, ËˆÛÈÓfiÊÈÏ·, ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· ÌÓ‹ÌË˜, ‰ÂÓ‰ÚÈÙÈÎ¿

Î‡ÙÙ·Ú·, Î‡ÙÙ·Ú·-ÊÔÓÂ›˜CCL8 MCP-2 ªÔÓÔÎ‡ÙÙ·Ú·, ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, ËˆÛÈÓfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·,

Î‡ÙÙ·Ú·-ÊÔÓÂ›˜CCL11 Eotaxin ∏ˆÛÈÓfiÊÈÏ·CCL13 MCP-4 ªÔÓÔÎ‡ÙÙ·Ú·, ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, ËˆÛÈÓfiÊÈÏ·CCL14 HCC-1 ªÔÓÔÎ‡ÙÙ·Ú·, ·ÈÌÔÔÈËÙÈÎ¿ ÚÔ‰ÚÔÌÈÎ¿ Î‡ÙÙ·Ú·CCL15 ∏CC-2/MIP-1‰CCL16 ∏CC-4/LECCCL17 TARC ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·CCL18 DK-CK1 / PARC/AMAC-1 ¢ÈÂÁÂÚÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·CCL19 MIP-3‚/ELC / Exodus 3 ¢ÈÂÁÂÚÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·CCL20 MIP-3· /LARC/ Exodus-1 ¢ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú·CCL21 SLC/Exodus-2 ¢ÈÂÁÂÚÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·CCL22 MDC/STCP-1 ¢ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú·CCL23 MPIF-1CCL24 MPIF-2/Eotaxin-2 ∏ˆÛÈÓfiÊÈÏ·CCL25 TECKCCL26 Eotaxin-3CCL27 CTACK/ILC



2 ¯ÈÏÈÔÛÙ¿ Î·È Ë ÂÚ·ÈÙ¤Úˆ Ù·¯Â›· ÙÔ˘˜ ·‡ÍËÛËÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Â·ÚÎ‹ ·ÈÌ¿ÙˆÛ‹ ÙÔ˘˜, Ô˘Ú˘ıÌ›˙ÂÙ·È ·fi ÙË Û¯ÂÙÈÎ‹ ¤ÎÎÚÈÛË CXC ·Ó·ÛÙ·Ï-ÙÈÎÒÓ Î·È ‰ÈÂÁÂÚÙÈÎÒÓ ÙË˜ ·ÁÁÂÈÔÁ¤ÓÂÛË˜ ¯ËÌÂÈÔ-ÎÈÓÒÓ ·fi Ù· Î‡ÙÙ·Ú· ÙÔ˘ fiÁÎÔ˘ Î·È ÙÔ˘ ÛÙÚÒÌ·-Ùfi˜ ÙÔ˘˜ (stroma) (38,42). ∏ ‰ÈËıËÙÈÎfiÙËÙ· ÙˆÓfiÁÎˆÓ ÂÍ·ÚÙ¿Ù·È Î·È ·fi ÙËÓ ÈÎ·ÓfiÙËÙ· ÙˆÓ Î·Ú-ÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ó· ·Ú¿ÁÔ˘Ó ÚˆÙÂÔÏ˘ÙÈÎ¿ ¤Ó-˙˘Ì·, ÙËÓ ·Ú·ÁˆÁ‹ Î·È ¤ÎÎÚÈÛË ÙˆÓ ÔÔ›ˆÓ Ê·›-ÓÂÙ·È fiÙÈ Â¿ÁÔ˘Ó ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜ (38).

∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙË ‰ËÌÈÔ˘Ú-Á›· Î·È ÂÍ¿ÏˆÛË ÙˆÓ ÓÂÔÏ·ÛÈÒÓ ‰ËÌÈÔ˘ÚÁÂ›‰˘Ó·ÙfiÙËÙÂ˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ·ÊÂÓfi˜ÌÂ ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ ·˘ÙÒÓ ÁÈ·ÂÓ›Û¯˘ÛË ÙË˜ ·ÓÙÈÎ·ÚÎÈÓÈÎ‹˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÓÙ›-‰Ú·ÛË˜ ÙÔ˘ ÍÂÓÈÛÙ‹ ‹ ÁÈ· ÙÚÔÔÔ›ËÛË ÙË˜ ÓÂÔ-·ÁÁÂ›ˆÛË˜ ÛÙÔ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ fiÁÎÔ˘ Î·È·ÊÂÙ¤ÚÔ˘ ÌÂ ÙË ‚Ô‹ıÂÈ· ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ ˘Ô-‰Ô¯¤ˆÓ ÙÔ˘˜, ÌÂ ÛÎÔfi ÙËÓ ·Ú¤Ì‚·ÛË ÛÙÔ˘˜ ¯Ë-ÌÂÈÔÙ·ÎÙÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜ Ô˘ Î·ıÔÚ›˙Ô˘Ó ÙËÌÂÙ¿ÛÙ·ÛË ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (38).

ÃËÌÂÈÔÙ·Í›· Î·È ¯ËÌÂÈÔÎ›ÓÂ˜ ÛÙË ÓÂÔÁÓÈÎ‹ËÏÈÎ›·

∆· ÓÂÔÁÓ¿ ˆ˜ ÁÓˆÛÙfiÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÈÔÓÂ-ÎÙÈÎ‹ ·ÓÙ›‰Ú·ÛË ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜ ÛÂ Û¯¤ÛË ÌÂ Ù·ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (43). ∏ÂÏ·ÙÙˆÌ¤ÓË ¯ËÌÂÈÔÙ·Í›· ÙˆÓ ÓÂÔÁÓÈÎÒÓ ÔÏ˘-ÌÔÚÊÔ‡ÚËÓˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÊÏÂÁÌ·›-ÓÔÓÙÂ˜ ÈÛÙÔ‡˜ ·ÔÙÂÏÂ› ÙË ÛËÌ·ÓÙÈÎfiÙÂÚË ›Ûˆ˜ÏÂÈÙÔ˘ÚÁÈÎ‹ ·ÓˆÌ·Ï›· ÙÔ˘˜ (43). ∏ ‰È·›‰˘ÛËÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ·fi ÙÔ ·›Ì· ÚÔ˜ ÙÔ˘˜ÈÛÙÔ‡˜ Â›Ó·È Ì›· Û‡ÓıÂÙË ‰È·‰ÈÎ·Û›· Ô˘ ··ÈÙÂ›Û˘Á¯ÚÔÓÈÛÌ¤ÓË ·ÏÏËÏÂ›‰Ú·ÛË ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓÎ·È ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (1) Î·È Ë ÔÔ›· Ú˘ı-Ì›˙ÂÙ·È ·fi ÙÚÂÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÔÚ›ˆÓ, ÙÈ˜ ÈÓÙÂ-ÁÎÚ›ÓÂ˜, ÙÈ˜ ÛÂÏÂÎÙ›ÓÂ˜ Î·È ÙÈ˜ ¯ËÌÂÈÔÎ›ÓÂ˜ (1).∫·È ÔÈ ÙÚÂÈ˜ ·˘Ù¤˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ¤¯ÂÈ ‰ÂÈ¯ıÂ› fiÙÈ Â›-Ó·È ·ÓÂ·ÚÎÂ›˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·.

OÈ ÛÂÏÂÎÙ›ÓÂ˜ Ú˘ıÌ›˙Ô˘Ó ÙË Û‡ÏÏË„Ë ÙˆÓ ÏÂ˘-ÎÔÎ˘Ù¿ÚˆÓ ·fi ÙÔ ·›Ì· ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÂÓ‰Ô-ıËÏ›Ô˘ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÌÂÛÔÏ·‚ËÙ¤˜ ÁÈ· ÙË‰ËÌÈÔ˘ÚÁ›· ¯·Ï·ÚÒÓ ‰ÂÛÌÒÓ ÚÔÛÎfiÏÏËÛË˜ ÌÂÙ· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· (1,43). Œ¯ÂÈ ·Ô‰ÂÈ¯ıÂ›fiÙÈ Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔ-ÁÓÒÓ ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ ÏÈÁfiÙÂÚÔ·fi ÙÔ 50% ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ ˘Ô‰Ô-¯¤ˆÓ L-ÛÂÏÂÎÙ›ÓË˜ ÙˆÓ ÂÓËÏ›ÎˆÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ·ÙË ÌÂÈÔÓÂÎÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ¯·Ï·Ú‹˜ ÚÔÛÎfiÏÏË-Û‹˜ ÙÔ˘˜ ÛÙ· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· (43-45). OÈ‚2-ÈÓÙÂÁÎÚ›ÓÂ˜ ÌÂ ÙË ÛÂÈÚ¿ ÙÔ˘˜ Â›Ó·È ˘Â‡ı˘ÓÂ˜ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ‰ÂÛÌÒÓ ˘„ËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ ÙˆÓÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÚÔ˜ ÙÔ ÂÓ‰Ôı‹ÏÈÔ, ‰È·‰ÈÎ·-Û›· ··Ú·›ÙËÙË ÁÈ· ÙË ‰È·›‰˘ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ

ÚÔ˜ ÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙÂ˜ ÈÛÙÔ‡˜ (1,43). ªÂÏ¤ÙÂ˜ÛÂ ÓÂÔÁÓ¿ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·ÂÎÊÚ¿˙Ô˘Ó ÛÂ ËÚÂÌ›· ÔÏ‡ ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi˘Ô‰Ô¯¤ˆÓ ÙˆÓ ‚2-ÈÓÙÂÁÎÚ›ÓˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ Î·È fiÙÈ Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ‰ÂÓ ·˘Í¿ÓÂÈ ÛË-Ì·ÓÙÈÎ¿ ÛÂ ÂÚ›ÙˆÛË ‰È¤ÁÂÚÛË˜ (43).

OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ıÂˆÚÂ›Ù·È fiÙÈ ‰›ÓÔ˘Ó ÙÔ Û‹Ì·ÁÈ· ÌÂÙ·ÙÚÔ‹ ÙˆÓ ‰ÂÛÌÒÓ ¯·ÌËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÌÂ Ù· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú·,ÛÂ ‰ÂÛÌÔ‡˜ ˘„ËÏ‹˜ Û˘Ó¿ÊÂÈ·˜, ÌÂ ÌÂÛÔÏ·‚ËÙ¤˜ÙÈ˜ ÈÓÙÂÁÎÚ›ÓÂ˜ (1). ŸÙ·Ó Ù· ÏÂ˘ÎÔÎ‡ÙÙ·Ú· Ô˘ÎÈÓÔ‡ÓÙ·È ¿Óˆ ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ· ÌÂ ÙÔ˘˜‰ÂÛÌÔ‡˜ ¯·ÌËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ ÙˆÓ ÛÂÏÂÎÙÈÓÒÓ, Û˘-Ó·ÓÙ‹ÛÔ˘Ó ˘„ËÏ‹ Û˘ÁÎ¤ÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ,·˘Í¿ÓÂÙ·È (upregulate) Ë Û˘Ó¿ÊÂÈ· ÌÂ ÙÈ˜ ÈÓÙÂ-ÁÎÚ›ÓÂ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ÛÙ·ıÂÚ‹ ÚÔÛÎfiÏÏË-ÛË ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÛÙ· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·-Ú· Î·È ÙÂÏÈÎ¿ ÙËÓ ÂÍ·ÁÁÂ›ˆÛ‹ ÙÔ˘˜ ÛÙËÓ ÂÚÈÔ¯‹·˘Ù‹ (1,2). ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ÂÍ·ÁÁÂÈˆÌ¤Ó· ÏÂ˘-ÎÔÎ‡ÙÙ·Ú· ÎÈÓÔ‡ÓÙ·È ·ÎÔÏÔ˘ıÒÓÙ·˜ Ì›· Û˘ÓÂ¯Ò˜·˘Í·ÓfiÌÂÓË Û˘ÁÎ¤ÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ Î·È Î·Ù·-Ï‹ÁÔ˘Ó ÛÙË ı¤ÛË ÙË˜ Ì¤ÁÈÛÙË˜ Û˘ÁÎ¤ÓÙÚˆÛ‹˜ÙÔ˘˜ (1). ™Ù· ÂÚÈÛÛfiÙÂÚ· fiÚÁ·Ó·, ÛÙÔ˘˜ ÓÂ-ÊÚÔ‡˜, ÛÙ· ·ÁÁÂ›·, ÛÙÈ˜ ·ÚıÚÒÛÂÈ˜, ÛÙÔ˘˜ ÓÂ‡-ÌÔÓÂ˜, ÛÙÔ ‰¤ÚÌ·, ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ, ÛÙÈ˜ Ì‹ÓÈÁÁÂ˜Î·È ÛÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ÛˆÏ‹Ó· ¤¯Ô˘Ó ·ÓÈ¯ÓÂ˘ÙÂ›¯ËÌÂÈÔÎ›ÓÂ˜ fiÙ·Ó ÊÏÂÁÌ·›ÓÔ˘Ó.

∏ ÈÓÙÂÚÏÂ˘Î›ÓË 8 Â›Ó·È Ë ÌÔÓ·‰ÈÎ‹ ¯ËÌÂÈÔÎ›ÓËÔ˘ ¤¯ÂÈ ÌÂÏÂÙËıÂ› ÈÎ·ÓÔÔÈËÙÈÎ¿ ÛÙË ÓÂÔÁÓÈÎ‹ËÏÈÎ›·. ∆fiÛÔ Ù· ÙÂÏÂÈfiÌËÓ· fiÛÔ Î·È Ù· ÚfiˆÚ·ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÙËÓ ÈÎ·ÓfiÙËÙ· Ó· ÂÎÎÚ›ÓÔ˘Ó ÙËÓ ¯Ë-ÌÂÈÔÎ›ÓË ·˘Ù‹ ÛÂ ÂÚ›ÙˆÛË ÏÔ›ÌˆÍË˜ Î·È ¤¯ÂÈ‹‰Ë ÌÂÏÂÙËıÂ› Û·Ó ÚÒÈÌÔ˜ ‰Â›ÎÙË˜ ÏÔ›ÌˆÍË˜(46-49). ∞ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂ-ÚÔ˘˜ ¯ËÌÂÈÔÙ·ÎÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘‰ÂÙÂÚfiÊÈ-ÏˆÓ ÛÙÔÓ ÓÂ‡ÌÔÓ· Î·È Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·ıÔÊ˘-ÛÈÔÏÔÁ›· ÙË˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ‰˘ÛÏ·Û›·˜(50,51). ªÂ ÙËÓ ÂÍ·›ÚÂÛË ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 8, ËÛ˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ ‰È·ÊfiÚˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙÔÓÔÚfi ÙˆÓ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ‰ÂÓ¤¯ÂÈ ÌÂÏÂÙËıÂ› Â·ÚÎÒ˜ Ô‡ÙÂ ÛÂ ˘ÁÈ‹ ÓÂÔÁÓ¿ Ô‡-ÙÂ ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜ ÏÔ›ÌˆÍË˜ (52-54). OÈ ÌÂÈˆÌ¤-ÓÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Î·Ù¿ ÙËÓ ËÚÂÌ›· Î·È Ë ÌÂÈˆÌ¤-ÓË Â·ÁˆÁ‹ ¤ÎÎÚÈÛË˜ Î·Ù¿ ÙË ÏÔ›ÌˆÍË Û˘Ì‚¿Ï-ÏÔ˘Ó Â˘ÏfiÁˆ˜ ÛÙËÓ ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂ-ÔÁÓÒÓ ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜. ™Â Ì›· ÌÂÏ¤ÙË ‰ÂÓ ‰È·È-ÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘ÁÎ¤ÓÙÚˆ-ÛË ÙˆÓ ∂¡∞-78, GRO-a, RANTES, MIP-1· Î·È ÙË˜ËˆÙ·Í›ÓË˜, ÌÂÙ·Í‡ ÙˆÓ ˘ÁÈÒÓ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈ-fiÌËÓˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ÂÓËÏ›ÎˆÓ, ÂÓÒ ÛÂ ¿ÏÏËÌÂÏ¤ÙË ‰È·ÈÛÙÒıËÎ·Ó ÌÂÈˆÌ¤ÓÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ËˆÙ·Í›ÓË˜ Î·È ∂¡∞-78 (52,53). ªÂÈˆÌ¤ÓË ¤ÎÎÚÈ-ÛË ÔÚÈÛÌ¤ÓˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› Î·ÈÛÂ ÌÔÓÔÎ‡ÙÙ·Ú· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ (53).

∂È‰ÈÎfiÙÂÚ· ÁÈ· ÙË ÏÔ›ÌˆÍË ·fi ÙÔÓ Èfi ÙË˜·ÓıÚÒÈÓË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, Â›Ó·È ÁÓˆÛÙfi fiÙÈ

¶·È‰È·ÙÚÈÎ‹ 2005;68:85-91


90 ∞. ª·ÓÔ˘Ú¿ Î·È Û˘Ó.

Ù· ÓÂÔÁÓ¿ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ÏÔ›ÌˆÍË ÂÌÊ·Ó›˙Ô˘ÓÈÔ ÁÚ‹ÁÔÚË ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ Î·È ¯ÂÈÚfiÙÂÚËÚfiÁÓˆÛË ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ (55,56). ∞Ó·Ê¤ÚıËÎÂ ‹‰Ë fiÙÈ ¿ÙÔÌ· ÌÂ˘„ËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓRANTES, MIP-1·, MIP-1‚ ‰ÂÓ ÌÔÏ‡ÓÔÓÙ·È ·fiÙÔÓ Èfi, ·Ú¿ ÙËÓ Â·ÓÂÈÏËÌÌ¤ÓË ¤ÎıÂÛ‹ ÙÔ˘˜ ÛÂ·˘ÙfiÓ (18). ™Â ÌÂÏ¤ÙË ÙË˜ ¤ÎÎÚÈÛË˜ ÙˆÓ ¯ËÌÂÈÔ-ÎÈÓÒÓ ·˘ÙÒÓ ·fi ÌÔÓÔ‡ÚËÓ· Î‡ÙÙ·Ú· ÔÌÊ¿ÏÈÔ˘ÏÒÚÔ˘, ‚Ú¤ıËÎÂ ÌÂÈˆÌ¤ÓË ¤ÎÎÚÈÛË Î˘Ú›ˆ˜ ÙË˜¯ËÌÂÈÔÎ›ÓË˜ RANTES (54). ∏ ÌÂÈÔÓÂÍ›· ·˘Ù‹ ÙˆÓÌÔÓÔ‡ÚËÓˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÌÔÚÂ› Ó· ÂÍËÁ‹ÛÂÈÙËÓ ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂÔÁÓÒÓ ÛÙË ÏÔ›-ÌˆÍË ÌÂ ÙÔÓ Èfi ÙË˜ ·ÓıÚÒÈÓË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ-·˜ (53). ™ÙÔÓ ÔÚfi ÓÂÔÁÓÒÓ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ¤Î-ıÂÛË ÛÙÔÓ Èfi Ô˘ ‰ÂÓ ÌÔÏ‡ÓıËÎ·Ó, ‚Ú¤ıËÎ·Ó ÛË-Ì·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· Â›Â‰· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓRANTES, MIP-1· Î·È MIP-1‚ ÛÂ Û¯¤ÛË ÌÂ Ù· ÓÂ-ÔÁÓ¿ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ÏÔ›ÌˆÍË, Ô˘ ˘Ô‰ËÏÒÓÂÈÙËÓ Èı·Ó‹ ÛËÌ·Û›· ÙË˜ ¤ÎÎÚÈÛË˜ ÙˆÓ ¯ËÌÂÈÔÎÈ-ÓÒÓ ·˘ÙÒÓ ÛÙËÓ ·ÔÙÚÔ‹ ÙË˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ÌÂÙ¿‰ÔÛË˜ ÙË˜ ÓfiÛÔ˘ (57).

O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙË ÓÂÔÁÓÈÎ‹ ÛË-„·ÈÌ›· ¤¯ÂÈ ÌÂÏÂÙËıÂ› ÂÏ¿¯ÈÛÙ·. ∏ ÛËÌ·Û›· ÙˆÓÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ÙˆÓ ÔÈÎ›ÏˆÓ ÌÂÛÔÏ·-‚ËÙÒÓ Â›Ó·È ÔˆÛ‰‹ÔÙÂ Ô˘ÛÈ·ÛÙÈÎ‹ (26). ªÂÏ¤-ÙÂ˜ ÌÂ ÂÈÚ·Ì·Ùfi˙ˆ· ÓÂÔÁÓÈÎ‹˜ ËÏÈÎ›·˜ ÛÂ Û‹„Ë‰Â›¯ÓÔ˘Ó ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓÛÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜, ·Ó¿ÏÔÁË ÌÂ ÂÎÂ›ÓË Ô˘ ·Ú·-ÙËÚÂ›Ù·È ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È ·Ó¿ÏÔÁË Û˘ÛÛÒÚÂ˘-ÛË ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ (23). ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›·ÙË˜ ÛË„·ÈÌ›·˜ ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌË Î·Ù·ÓÔËÙ‹,ˆÛÙfiÛÔ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ·ÔÙÂÏÔ‡ÓÎ·È ÛÙ· ÓÂÔÁÓ¿, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ‚·ÛÈÎ‹Û˘ÓÈÛÙÒÛ· ÙË˜ ·ıÔÏÔÁÈÎ‹˜ ‰ÈÂÚÁ·Û›·˜.

™˘ÌÂÚ¿ÛÌ·Ù·

OÈ ¯ËÌÂÈÔÎ›ÓÂ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÂÓ‰È·Ê¤ÚÔ˘Û·ÔÈÎÔÁ¤ÓÂÈ· ÚˆÙÂ˚ÓÒÓ ÌÂ ÔÈÎ›ÏÂ˜ ‚ÈÔÏÔÁÈÎ¤˜‰Ú¿ÛÂÈ˜. ∏ Î·Ù·ÓfiËÛË ÙË˜ ÛËÌ·Û›·˜ ÙÔ˘˜ ÛÙÈ˜‰È¿ÊÔÚÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ¿Ú¯ÈÛÂ ÌfiÏÈ˜ÚfiÛÊ·Ù·. O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙË ÏÔ›Ìˆ-ÍË Â›Ó·È Ô˘ÛÈÒ‰Ë˜, Î·ıÒ˜ - Û·Ó ¯ËÌÂÈÔÙ·ÎÙÈÎ¤˜Î˘ÙÙ·ÚÔÎ›ÓÂ˜ - ÂÏ¤Á¯Ô˘Ó ÙËÓ Î›ÓËÛË ÙˆÓ ÏÂ˘ÎÔ-Î˘ÙÙ¿ÚˆÓ Î·È Î·ıÔÚ›˙Ô˘Ó ÙË Û˘ÁÎ¤ÓÙÚˆÛ‹ ÙÔ˘˜ÛÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙÂ˜ ÈÛÙÔ‡˜. ¶·Ú¿ÏÏËÏ·, Û˘ÌÌÂ-Ù¤¯Ô˘Ó ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ‚Ï¿‚Ë˜ ÙˆÓ ÔÚ-Á¿ÓˆÓ Ô˘ Û˘ÓÙÂÏÂ›Ù·È Î·Ù¿ ÙË ‰È·‰ÈÎ·Û›· ÙË˜Û‹„Ë˜. ∂›Ó·È Èı·Ófi fiÙÈ Ë ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·-ÛË Ô˘ ÛÙÔ¯Â‡ÂÈ ÛÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË Î¿ÔÈˆÓ ¯Ë-ÌÂÈÔÎÈÓÒÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ ÌÔÚÂ› Ó· ·Ó·-ÛÙÂ›ÏÂÈ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ Û‹„Ë˜. π‰È·›ÙÂÚ· ÛÙË ÓÂÔ-ÁÓÈÎ‹ ËÏÈÎ›· Ô˘ ÔÈ ÏÔÈÌÒÍÂÈ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó·¤¯Ô˘Ó ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·, Ë Î·Ù·ÓfiËÛË ÙÔ˘ ÚfiÏÔ˘

ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ ıÂÚ·Â˘-ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ ı· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‚ÂÏÙ›ˆ-ÛË ÙË˜ ¤Î‚·ÛË˜ ÙˆÓ ÂÚÈÁÂÓÓËÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›·

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¶·È‰È·ÙÚÈÎ‹ 2005;68:85-91


92 REVIEW ARTICLE

1 Neonatology Clinic,University of Crete,Heraklion

2 Paediatric Clinic, Universityof Crete, Heraklion

Correspondence:Christine Giannakopoulou 37 Atlantidos str., 115 27, Heraklion, Crete E-mail: [email protected]

Date of submission:03-06-2004 Date of approval:04-03-2005

Paediatriki 2005;68:92

Chemokines in neonatal infections A. Manoura1, E. Galanakis2, C. Giannakopoulou1

AbstractChemokines, a fascinating family of proteins, appear to be involved in a number of physiological andpathological processes. Their role in the pathophysiology of various diseases is under extensiveinvestigation. They are involved at all stages of tumour development. Chemokines can also modulateangiogenesis, which is associated with several chronic inflammatory diseases. Their role in host responseto infection is essential, since they control the attraction of leucocytes to tissues. Chemokines may also beinvolved in the undesirable sequelae of sepsis, including the multiple organ dysfunction syndrome. Thereis evidence that neutralization of chemokine activity may be of therapeutic value in the septic process.Especially in the neonatal period, when sepsis-related morbidity and mortality is high, the understandingof the role of chemokines in the pathophysiology of the septic process along with the new therapeutictargets that this understanding may provide, is expected to improve the prognosis of perinatal infections.

Key wordsChemokines, infection, sepsis, neonate.


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ÌÏ¤ÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜ (∂ÈÎfiÓ· 1) (1).

∏ ·È¯Ì‹ Â›Ó·È ¤Ó· Î‡Ì· ÌÂ ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· (10-

70 ms) Î·È ÌÂ ÌÂÁ¿ÏÔ ‰˘Ó·ÌÈÎfi ÌÔÓÔ-, ‰È- ‹ ÙÚÈ-

Ê·ÛÈÎfi. ∏ ‚Ú·‰Â›· ·È¯Ì‹ ‹ ÙÔ ·È¯ÌËÚfiÌÔÚÊÔ Î‡-

Ì· Â›Ó·È ¤Ó· Î‡Ì· ÙÔ˘ ÔÔ›Ô˘ Ë ‰È¿ÚÎÂÈ· Î˘Ì·›-

ÓÂÙ·È ÌÂÙ·Í‡ 70 Î·È 200 ms Î·È ÂÍ·ÈÙ›·˜ ·˘ÙÔ‡

·›ÚÓÂÈ Ì›· ÌÔÚÊ‹ ÏÈÁfiÙÂÚÔ ÔÍÂ›·. ∏ ÔÏ˘·È¯Ì‹


¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101

Â›Ó·È Ì›· ·ÎÔÏÔ˘ı›· ÔÏÏÒÓ ·È¯ÌÒÓ. ∆Ô Û‡-

ÌÏÂÁÌ· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ·ÔÙÂÏÂ›Ù·È ·fi Ì›·

·È¯Ì‹ ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ¤Ó· ‚Ú·‰‡ Î‡Ì·. ∂¿Ó

Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜

Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 2,5 Hz, ÔÓÔÌ¿˙ÂÙ·È ‚Ú·‰‡

Û‡ÌÏÂÁÌ· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜. ∆Ô Û‡ÌÏÂÁÌ· Ô-

Ï˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜ Â›Ó·È Ì›· ·ÎÔÏÔ˘ı›· Ì›·˜ Ô-

Ï˘·È¯Ì‹˜ Î·È ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ‚Ú·‰¤ˆÓ Î˘-

Ì¿ÙˆÓ. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ Î·Ù·ÁÚ¿ÊÂÙ·È Î·Ù¿

ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÈÏËÙÈÎ‹˜ ÎÚ›ÛË˜ ‹ ÌÂÛÔÎÚÈÙÈ-

Î¿, ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ Î·È ÙÔ

ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ, ·ÏÏ¿ ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ Ë

ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ‹ ÂÈÎfiÓ· ÔÈÎ›ÏÏÂÈ ‹

·ÎfiÌË Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ (1-3). £· Ú¤ÂÈ Ó· ÛË-

ÌÂÈˆıÂ› fiÙÈ ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ·-

Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÛÂ ¤Ó· Ô-

ÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 1,4% ¤ˆ˜ 4%. ªÔÏÔ-

ÓfiÙÈ Ë ·Ô˘Û›· ÂÈÏËÙfiÌÔÚÊË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜

ÛÙÔ ∏∂° ÂÓÈÛ¯‡ÂÈ ÙË ÌË ÂÈÏËÙÈÎ‹ Ê‡ÛË ÂÓfi˜

·ÚÔÍ˘ÛÌÈÎÔ‡ Ê·ÈÓÔÌ¤ÓÔ˘ (4,5), ·ÚÎÂÙÔ› ·ÛıÂ-

ÓÂ›˜ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›· ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó

ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙ· ‰È·ÁÚ¿ÌÌ·-

Ù¿ ÙÔ˘˜ (6,7). OÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ÂÎ-

‰ËÏÒÛÂÈ˜ ÙË˜ ÂÈÏË„›·˜, fiˆ˜ Î·È Ë ÓfiÛÔ˜,

¤¯Ô˘Ó ‰È·ÏÂ›ÔÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È, ÂÔÌ¤Óˆ˜,

ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Î·Ù·ÁÚ·ÊÂ› ÂÈÏËÙfiÌÔÚÊË

‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ ∏∂° ÂÓfi˜ ·ÛıÂÓÔ‡˜ ÌÂ ÂÈÏË-

„›·, ··ÈÙÔ‡ÓÙ·È Â·ÓÂÈÏËÌÌ¤ÓÂ˜ Î·Ù·ÁÚ·Ê¤˜.

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ ÌfiÓÔ 50% ÙˆÓ ÂÈÏËÙÈÎÒÓ

·ÛıÂÓÒÓ ÌÂ ÚÒÙË ÂÈÏËÙÈÎ‹ ÎÚ›ÛË ¤¯ÂÈ ÂÈÏË-

ÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ ∏∂° Ô˘ Á›ÓÂÙ·È

ÌÂÙ¿ ·fi Ì›· Â‚‰ÔÌ¿‰· ·fi ÙËÓ ÎÚ›ÛË, ·ÏÏ¿, ÙÂ-

ÏÈÎ¿, ÙÔ 92% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÂÈÏË„›· Ô˘ ı·

˘Ô‚ÏËıÔ‡Ó Â·ÓÂÈÏËÌÌ¤Óˆ˜ ÛÂ ËÏÂÎÙÚÔÂÁÎÂ-

Ê·ÏÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ¤ÙÔ˜,

ı· ÂÌÊ·Ó›ÛÂÈ ÛÂ Î¿ÔÈ· Ê¿ÛË ÂÈÏËÙfiÌÔÚÊË

‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ ∏∂°. ∂ÈÏ¤ÔÓ, ÁÈ· Ó· ·˘ÍË-

ıÂ› Ë Èı·ÓfiÙËÙ· Î·Ù·ÁÚ·Ê‹˜ ÂÈÏËÙfiÌÔÚÊË˜

‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂°, ··ÈÙÂ›Ù·È Ë ÂÊ·ÚÌÔÁ‹

ÂÈ‰ÈÎÒÓ ÙÂ¯ÓÈÎÒÓ, fiˆ˜ Ë ‰ÔÎÈÌ·Û›· ˘¤ÚÓÔÈ·˜

Î·È Ù· ‰È·ÏÂ›ÔÓÙ· ÊˆÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· (¢º∂), Ë

ÛÙ¤ÚËÛË ‡ÓÔ˘ Î·È Ô ‡ÓÔ˜, Ë ·Ú·ÙÂÙ·Ì¤ÓË ‹‚›ÓÙÂÔ-ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ‹ Î·Ù·ÁÚ·Ê‹Î.Ï. (1-3).

∆Ô ∏∂°, fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ‚›ÓÙÂÔ-ÔÏ˘-ÁÚ·ÊÈÎ¤˜ Î·Ù·ÁÚ·Ê¤˜, ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ÂÈ-ÏËÙÈÎÒÓ ‹ ÌË Ê·ÈÓÔÌ¤ÓˆÓ, ÛÙËÓ Ù·ÍÈÓfiÌËÛËÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·È ÙˆÓ ÂÈÏËÙÈÎÒÓÛ˘Ó‰ÚfiÌˆÓ Î·È ÛÙËÓ ·ÔÎ¿Ï˘„Ë ˘ÔÎÏÈÓÈÎÒÓÎÚ›ÛÂˆÓ, ·ÏÏ¿ ı· Ú¤ÂÈ ÔÈ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜Ó· Â›Ó·È Û˘¯Ó¤˜ ÁÈ· Ó· Î·Ù·ÁÚ·ÊÔ‡Ó (3,8,9). £·Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ë ·Ú·ÙÂÙ·Ì¤ÓË ÌÂ ‚›-ÓÙÂÔ-ÔÏ˘ÁÚ·ÊÈÎ‹ Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∂° ·ÔÙÂÏÂ›ÙËÓ Ï¤ÔÓ ¯Ú‹ÛÈÌË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∂° ÁÈ· ÙËÌÂÏ¤ÙË ·È‰ÈÒÓ ÌÂ ÂÈÏË„›·. ∏ 24ˆÚË ·Ï‹ Î·-Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∂° ¤¯ÂÈ ÂÚÈÔÚÈÛÌ¤ÓË ·Í›· ÛÙ··È‰È¿, ‰ÈfiÙÈ ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ÙÔ˘ ·È‰ÈÔ‡ ÛÙÈ˜ ÎÚ›ÛÂÈ˜ Î·È ‰ÈfiÙÈ ÔÈ ÏËÚÔÊÔÚ›Â˜Ô˘ ·Ú¤¯ÂÈ Â›Ó·È ¤ÌÌÂÛÂ˜. ∂›ÛË˜, Ë ¯·ÚÙÔÁÚ¿-ÊËÛË ÙÔ˘ ∏∂° ¤¯ÂÈ ÌÈÎÚfi ÎÏÈÓÈÎfi fiÊÂÏÔ˜ ÛÙË ÌÂ-Ï¤ÙË ÙË˜ ÂÈÏË„›·˜. ∆Ô Û˘Ì‚·ÙÈÎfi ∏∂° ˘ÛÙÂÚÂ›ÂÌÊ·ÓÒ˜ ÙË˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·-ÊÈÎ‹˜ Î·Ù·ÁÚ·Ê‹˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó¿‰ÂÈÍËÙˆÓ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Ì›·˜ ÂÈ-ÏËÙÈÎ‹˜ ÎÚ›ÛË˜. ŒÙÛÈ, ÛÂ ÂÛÙÈ·Î¤˜ ÂÈÏËÙÈÎ¤˜ÎÚ›ÛÂÈ˜ ÌÂ ¿ÌÂÛË ÁÂÓ›ÎÂ˘ÛË, Ë ÂÓ‰ÔÎÚ¿ÓÈ· Î·Ù·-ÁÚ·Ê‹ ÌÔÚÂ› Ó· Î·Ù·‰Â›ÍÂÈ ÙËÓ ÂÛÙÈ·Î‹ ¤Ó·ÚÍËÙË˜ ÎÚ›ÛË˜, Ë ÔÔ›· ÌÔÚÂ› Ó· ÌËÓ ¤¯ÂÈ Î·Ù·ÁÚ·-ÊÂ› ·fi ÙÔ Û˘Ì‚·ÙÈÎfi ∏∂°. ∆Ô ÂÓ‰ÔÎÚ¿ÓÈÔ ∏∂°,fiÌˆ˜, Â›Ó·È ÂÂÌ‚·ÙÈÎ‹ Ì¤ıÔ‰Ô˜ Î·È Û˘ÓÈÛÙ¿Ù·ÈÌfiÓÔ ÁÈ· ÙËÓ ÚÔÂÁ¯ÂÈÚËÙÈÎ‹ ÌÂÏ¤ÙË ÂÈÏËÙÈ-ÎÒÓ ·ÛıÂÓÒÓ (1).

∆Ô ∏∂° ÛÙ· ‚Ú¤ÊË Î·È ÛÙ· ·È‰È¿ ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ·fi ·Ó¿ÌÈÎÙÂ˜ Û˘¯ÓfiÙËÙÂ˜. ∞˘Ù‹ Ë ÔÈÎÈ-ÏÔÌÔÚÊ›· Û˘¯ÓÔÙ‹ÙˆÓ ‰ËÌÈÔ˘ÚÁÂ› Û˘Ó‰˘·ÛÌÔ‡˜Ù·¯¤ˆÓ Î·È ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ Î·È Û˘¯Ó¿ ÂÎÏ·Ì-‚¿ÓÂÙ·È ˆ˜ ·ıÔÏÔÁÈÎ‹ ·fi ÌË ¤ÌÂÈÚÔ˘˜ ÛÙÔ·È‰ÈÎfi ∏∂° (1). ∂›ÛË˜, Ë ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛËÌÂÙ·Í‡ Ì›·˜ ·È¯Ì‹˜ ‹ ÂÓfi˜ ·È¯ÌËÚÔ‡ ÛÙÔÈ¯Â›Ô˘Î·È ÂÓfi˜ ·Ú¿ÛÈÙÔ˘ (artifact) ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂ-Ê·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ‰ÂÓ Â›Ó·È ¿ÓÙÔÙÂ Â‡ÎÔ-ÏË. ∂¿Ó ÌÂÙ¿ ÙËÓ ·È¯Ì‹ ·ÎÔÏÔ˘ıÂ› ‚Ú·‰‡ Î‡Ì· ‹Â¿Ó ÙÔ ·È¯ÌËÚfi ÛÙÔÈ¯Â›Ô ‰ÂÓ ÁÚ¿ÊÂÙ·È ÌfiÓÔ ·fi¤Ó· ËÏÂÎÙÚfi‰ÈÔ ·ÏÏ¿ Î·È ·fi ¿ÏÏ· ÁÂÈÙÔÓÈÎ¿ ËÏÂ-ÎÙÚfi‰È·, ÙfiÙÂ Â›Ó·È Èı·Ófi ÙÔ ·È¯ÌËÚfi ÛÙÔÈ¯Â›ÔÓ· Â›Ó·È ÂÁÎÂÊ·ÏÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ (1,2).

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ë ·ÚÔ˘Û›· ÂÈÏËÙfiÌÔÚ-ÊË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂° ·ÛıÂÓÒÓ ÌÂ ÚÒÙÔÂÂÈÛfi‰ÈÔ ·‡ÚÂÙˆÓ Û·ÛÌÒÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘-ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÌÂÏÏÔÓÙÈÎ‹˜ ˘ÔÙÚÔ‹˜ ÙˆÓ ÂÈ-ÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ (10,11). ∂›ÛË˜, ÛÂ ÁÂÓÈÎ¤˜ÁÚ·ÌÌ¤˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È ËÈı·ÓfiÙËÙ· Ó· ÂÌÊ·Ó›˙ÂÈ ÙÔ ∏∂° ÂÈÏËÙfiÌÔÚÊ·ÛÙÔÈ¯Â›·. £· Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ›, fiÌˆ˜, fiÙÈ ÌÔ-ÏÔÓfiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ-ÚÈÎ¤˜ ÊÔÚ¤˜ ÌÂ ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜ ÂÈÏË„›·˜,

94 ∫. ∞. µÔ‡‰ÚË˜

∂∂ÈÈÎÎfifiÓÓ·· 11.. ∏ ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· Û˘Ó›ÛÙ·Ù·È Î˘-Ú›ˆ˜ ·fi ·È¯Ì¤˜, Û˘ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜, ÔÏ˘·È¯-Ì¤˜ Î·È Û˘ÌÏ¤ÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜.


¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101

·˘Ùfi ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ, ÁÈ·Ù› Î·ÏÔ‹ıË Û‡Ó-‰ÚÔÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, fiˆ˜ Â›Ó·È ÔÈ Ù˘È-Î¤˜ ·Ê·ÈÚ¤ÛÂÈ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Î·È Ë ÚÔÏ¿Ó-‰ÂÈ· ÂÈÏË„›·, Û˘¯Ó¿ ¤¯Ô˘Ó ¿ÊıÔÓÂ˜ ÂÈÏËÙÈÎ¤˜ÂÎÊÔÚÙ›ÛÂÈ˜ ÛÙÔ ∏∂° (1).

∏ ·ÚÔ˘Û›· ‚Ú·‰˘ÚÚ˘ıÌÈÒÓ ‹ ¿ÏÏˆÓ ·ÓˆÌ·-ÏÈÒÓ ÛÙÔ ∏∂° ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈ-ÏË„›·, È‰È·›ÙÂÚ· Â¿Ó ÂÓÙÔ›˙ÔÓÙ·È ÛÙ·ıÂÚ¿ ÛÂ Ì›·ÂÚÈÔ¯‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ Â›Ó·È ¿ÊıÔÓ·, ÌÔÚÂ›Ó· ÛËÌ·ÙÔ‰ÔÙÂ› ÙËÓ ·ÚÔ˘Û›· ˘ÔÎÂ›ÌÂÓÔ˘ ÓÔÛ‹-Ì·ÙÔ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ÚÔÎ·ÏÂ› ÂÈÏËÙÈÎ¤˜ÎÚ›ÛÂÈ˜ (1-3). ∂ÈÏ¤ÔÓ, Ë ‡·ÚÍË ·˘ÙÒÓ ÙˆÓ ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ÌÂÛÔÎÚÈ-ÙÈÎfi ‰È¿ÁÚ·ÌÌ· ÂÓfi˜ ·ÛıÂÓÔ‡˜ ÌÂ ÂÈÏË„›·, ‰ÂÓ·ÔÙÂÏÂ› Î·Ïfi ÚÔÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô fiÛÔÓ ·ÊÔÚ¿ÛÙÔÓ Ï‹ÚË ¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ ÌÂ ÙË ¯ÔÚ‹ÁËÛË·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ‹ ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓÎÚ›ÛÂˆÓ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ·ÓÙÈÂÈÏËÙÈÎ‹˜ıÂÚ·Â›·˜.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË ÙË˜ ÂÈÏË„›·˜,·˘Ù‹ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙÔ ˘ÔÎÂ›ÌÂÓÔ ÂÈ-ÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ (3). ∫·ıÒ˜, fiÌˆ˜, ÙÔ ∏∂°‚ÔËı¿ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘ ÂÈÏË-ÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙËÓ ÂÎÙ›ÌËÛËÙË˜ ÚfiÁÓˆÛË˜, ÌÔÏÔÓfiÙÈ Ë ÛÔ‚·ÚfiÙËÙ· ÙË˜ ÂÈ-ÏË„›·˜ ÔÈÎ›ÏÏÂÈ Û˘¯Ó¿ ÌÂÙ·Í‡ ·ÛıÂÓÒÓ ÌÂ ÙÔ›‰ÈÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ. ∏ ·ÓÂ‡ÚÂÛË ÛÙÔ ∏∂°ÂÈ‰ÈÎÒÓ ÂÈÎfiÓˆÓ, fiˆ˜ ÔÈ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ ÂÎÊÔÚÙ›-ÛÂÈ˜ ·fi Û˘ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ 3 Hz ÛÙÈ˜Ù˘ÈÎ¤˜ ·Ê·ÈÚ¤ÛÂÈ˜ Î·È ÔÈ ÚÔÏ¿Ó‰ÂÈÂ˜ ·È¯Ì¤˜,·ÔÙÂÏÔ‡Ó Î·Ïfi ÚÔÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÛÂ fi,ÙÈ·ÊÔÚ¿ ÙËÓ ·¿ÓÙËÛË ÛÙËÓ ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹Î·È ÛÙË ÁÂÓÈÎfiÙÂÚË ÂÍ¤ÏÈÍË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ ·˘-Ù¤˜ ÙÈ˜ ÌÔÚÊ¤˜ ÂÈÏË„›·˜.

™Â ÂÈÏËÙÈÎ¿ Û‡Ó‰ÚÔÌ· fiˆ˜ ÔÈ Ù˘ÈÎ¤˜·Ê·ÈÚ¤ÛÂÈ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, fiÔ˘ Ë ÂÌÊ¿ÓÈ-ÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓÔÛfiÙËÙ· ÙˆÓ ÂÈÏËÙfiÌÔÚÊˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ, ÙÔ∏∂° ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÂÈ ÙËÓ ·fiÊ·ÛË ÁÈ· ÌÂ›ˆ-ÛË ‹ ‰È·ÎÔ‹ ÙË˜ ·ÓÙÈÂÈÏËÙÈÎ‹˜ Ê·ÚÌ·ÎÂ˘ÙÈ-Î‹˜ ·ÁˆÁ‹˜ (12,13). ™Â ÂÛÙÈ·Î¤˜ ÂÈÏË„›Â˜ ÌÂÂÈÌ¤ÓÔ˘ÛÂ˜ ÂÛÙÈ·Î¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜, Ë ·fiÊ·ÛËÁÈ· ÌÂ›ˆÛË ‹ ‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ ‰ÂÓ Ú¤ÂÈ Ó· ÛÙËÚ›˙ÂÙ·È ÌfiÓÔ ÛÂ ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù·, ·ÏÏ¿ ı· Ú¤-ÂÈ Ó· ÂÎÙÈÌÒÓÙ·È Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜ ·fi ÙÔÈÛÙÔÚÈÎfi, Î·ıÒ˜ Î·È Ù· ÎÏÈÓÈÎ¿ Î·È ¿ÏÏ· ÂÚÁ·ÛÙË-ÚÈ·Î¿ ‰Â‰ÔÌ¤Ó· ÙÔ˘ ·È‰ÈÔ‡ ÌÂ ÂÈÏË„›·.

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ÙˆÓÎ˘ÚÈfiÙÂÚˆÓ ÌÔÚÊÒÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·ÈÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜

™ÙÔ˘˜ ÓÂÔÁÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÙÔ ∏∂° ÌÔÚÂ›Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ‰È¿ÊÔÚÂ˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·-ÊÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (∂ÈÎfiÓ· 2) ‹ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ-Îfi, ·ÎfiÌË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÈÏËÙÈÎ‹˜

ÎÚ›ÛË˜. ∏ Û˘¯ÓfiÙÂÚË ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ‹

·ÓˆÌ·Ï›· ÛÙÔ˘˜ Î·ÏÔ‹ıÂÈ˜ ÓÂÔÁÓÈÎÔ‡˜ Û·ÛÌÔ‡˜

Â›Ó·È ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜ Î˘Ì¿ÙˆÓ ı‹Ù·, Î˘Ú›ˆ˜ ÂÚÈ-

ÚÔÏ·Ó‰ÈÎ¿, ÔÈ ÔÔ›Â˜ Â›Ó·È Û˘¯Ó¿ ·Û‡Á¯ÚÔÓÂ˜.

™ÙËÓ ÚÒÈÌË Ì˘ÔÎÏÔÓÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Î·È

ÛÙÔ Û‡Ó‰ÚÔÌÔ Ohtahara, ÙÔ ∏∂° ¤¯ÂÈ ÂÈÎfiÓ· Ù‡-

Ô˘ ÂÎÊfiÚÙÈÛË-Ù·Â›ÓˆÛË (∂ÈÎfiÓ· 3) (14).

∏ ÎÏ·ÛÈÎ‹ ÌÂÛÔÎÚÈÙÈÎ‹ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·-

ÊÈÎ‹ ·ÓˆÌ·Ï›· ÛÙÔ˘˜ ‚ÚÂÊÈÎÔ‡˜ Û·ÛÌÔ‡˜ Â›Ó·È Ë

˘„·ÚÚ˘ıÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û˘ÓÂ¯‹,

˘„ËÏÔ‡ ‰˘Ó·ÌÈÎÔ‡ ‚Ú·‰¤· ‰¤ÏÙ· Î‡Ì·Ù·, ·Ó¿ÌÈ-

ÎÙ· ÌÂ ·È¯Ì¤˜ ‹ ·È¯ÌËÚ¿ Î‡Ì·Ù·, ¿ÏÏÔÙÂ ¿ÏÏË˜

ÂÓÙfiÈÛË˜ ‹ ËÌÈÛÊ·ÈÚÈÎ‹˜ ÂÈÎÚ¿ÙËÛË˜ (∂ÈÎfiÓ· 4)

(1,3). O ¯·Ú·ÎÙËÚÈÛÌfi˜ ·Ô‰ÈÔÚÁ·ÓˆÌ¤ÓÔ ‹ ¯·Ô-

ÙÈÎfi ∏∂° Ù·ÈÚÈ¿˙ÂÈ ·fiÏ˘Ù· ÌÂ ·˘ÙfiÓ ÙÔÓ Û˘Ó‰˘·-

ÛÌfi ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ.

∏ ˘„·ÚÚ˘ıÌ›· ÌÔÚÂ› Ó· Â›Ó·È ·Û‡ÌÌÂÙÚË ‹ Ó·

¶¶

™™

∂¶§À∞º¡

*

95∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È ·È‰ÈÎ‹ ÂÈÏË„›·

∂∂ÈÈÎÎfifiÓÓ·· 22.. ¢È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ ÂÈÏËÙfiÌÔÚÊË˜ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·.

∂∂ÈÈÎÎfifiÓÓ·· 33.. ∂ÈÎfiÓ· Ù‡Ô˘ ÂÎÊfiÚÙÈÛË-Ù·Â›ÓˆÛË (burst-suppression).


Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÂÛÙÈ·Î¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜ (15). ∏ ÛÙ·-

ıÂÚ¿ ·Û‡ÌÌÂÙÚË ÂÌÊ¿ÓÈÛ‹ ÙË˜ ‹ Ë ·ÚÔ˘Û›·

ÂÛÙÈ·ÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ Û˘Ó‰¤ÔÓÙ·È Û˘¯Ó¿ ÌÂ ˘Ô-

ÎÂ›ÌÂÓË ÂÛÙÈ·Î‹ ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∏ ÂÈÎfiÓ·

ÙË˜ ̆ „·ÚÚ˘ıÌ›·˜ ÌÔÚÂ› Ó· ·ÏÏ¿˙ÂÈ Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙÔ˘ ‡ÓÔ˘ Î·È ÔÈ ·ÚÔÍ˘ÛÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Ó·

ÁÚ¿ÊÔÓÙ·È Î·Ù¿ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ ÚÈ¤˜ ÌÂ Û¯ÂÙÈÎ‹

ÌÂ›ˆÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÌÂÙ·Í‡ ÙˆÓ ÚÈÒÓ. ∫·Ù¿

ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‚ÚÂÊÈÎÒÓ Û·ÛÌÒÓ, ÛÙÔ ∏∂° ÂÌ-

Ê·Ó›˙ÂÙ·È ÁÂÓÈÎÂ˘Ì¤ÓË ‚Ú·¯Â›· ÚÈ‹ ·fi ‚Ú·‰¤·

·È¯ÌËÚ¿ Î‡Ì·Ù· ÌÂÁ¿ÏË˜ Ù¿ÛË˜, Ô˘ ·ÎÔÏÔ˘ıÂ›-

Ù·È ·fi ÌÂ›ˆÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂ ‹ ¯ˆÚ›˜

ÙÒÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ Î·È ÌÂÁ¿ÏË˜ Û˘¯ÓfiÙËÙ·˜

Î‡Ì·Ù· (∂ÈÎfiÓ· 5).

™Â ·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Lennox-Gastaut, Î·-

Ù·ÁÚ¿ÊÔÓÙ·È ÂÎÊÔÚÙ›ÛÂÈ˜ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-

Î‡Ì·ÙÔ˜ ÌÂ Û˘¯ÓfiÙËÙ· ÌÈÎÚfiÙÂÚË ·fi 2,5 Hz,

¯ˆÚ›˜ ·ÈÊÓ›‰È· ¤Ó·ÚÍË Î·È ÙÂÚÌ·ÙÈÛÌfi (∂ÈÎfiÓ· 6)

(1-3). ∞˘Ù¤˜ ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜ Â›Ó·È ·ÌÊÔÙÂÚfiÏÂ˘-

ÚÂ˜ ÌÂ Î‡ÚÈ· ÂÓÙfiÈÛË ÛÙÈ˜ ÚfiÛıÈÂ˜ ÂÚÈÔ¯¤˜

ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Û˘¯Ó¿ ·Û‡ÌÌÂÙÚÂ˜, ÂÓÒ Ë

ÌÔÚÊÔÏÔÁ›· ÙÔ˘˜, ÙÔ ‡„Ô˜ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ Î·È Ë

Û˘¯ÓfiÙËÙ· ÌÔÚÂ› Ó· ÔÈÎ›ÏÏÔ˘Ó ·ÎfiÌË Î·È ÛÙËÓ

›‰È· ÚÈ‹ ÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ. ∏ ˘¤ÚÓÔÈ· Î·È Ù·

¢º∂ ‰ÂÓ ÂÈ‰ÚÔ‡Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÒÓ ÙˆÓ ÂÎ-

ÊÔÚÙ›ÛÂˆÓ, ·ÏÏ¿ Ô ‡ÓÔ˜ ÌÔÚÂ› Ó· ÙÈ˜ ÂÈ‰ÂÈÓÒ-

ÛÂÈ. ∆Ô ‚·ÛÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿-ÁÚ·ÌÌ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Lennox-GastautÂ›Ó·È ‚Ú·‰˘ÚÚ˘ıÌÈÎfi Î·È ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ ÂÈ-ÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û¯Â‰fiÓ ÛÂfiÏÔ˘˜ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜, Î˘Ú›ˆ˜ ÙÔÓÈÎÔ› Û·-ÛÌÔ›, ¿Ù˘Â˜ ·Ê·ÈÚ¤ÛÂÈ˜ Î·È ·ÙÔÓÈÎ¤˜ ÎÚ›ÛÂÈ˜(16). ∏ ÂÌÊ¿ÓÈÛË ¿Ù˘ˆÓ ·Ê·ÈÚ¤ÛÂˆÓ Û˘ÓÔ‰Â‡Â-Ù·È Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ·ÓˆÙ¤Úˆ·Ó·ÊÂÚı¤ÓÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ ÛÙÔ ∏∂°, ÂÓÒ Ë ·-ÚÔ˘Û›· ÙÔÓÈÎÒÓ Û·ÛÌÒÓ Û˘ÓÔ‰Â‡ÂÙ·È Û˘¯Ó¿ ·fiÂÎÊÔÚÙ›ÛÂÈ˜ ·fi Î‡Ì·Ù· Û˘¯ÓfiÙËÙ·˜ 8-30 Hz,Î˘Ú›ˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ (∂ÈÎfiÓ· 7), ‹ ·fi ·ÈÊÓ›‰È·ÌÂ›ˆÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂°. ∆Ô ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ÛÙÈ˜ ·ÙÔÓÈÎ¤˜ÎÚ›ÛÂÈ˜ ÌÔÚÂ› Ó· ÂÌÊ·Ó›˙ÂÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ÔÏ˘-·È¯ÌÒÓ ‹ Û˘ÌÏÂÁÌ¿ÙˆÓ ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ‹Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜.

∆Ô ÂÈÏËÙÈÎfi Ì˘ÔÎÏÔÓÈÎfi Ê·ÈÓfiÌÂÓÔ ¤¯ÂÈÛ˘Ó‰ÂıÂ› - ·fi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ‹ ¿Ô„Ë- ÌÂ ÙÈ˜ ÂÎÊÔÚÙ›ÛÂÈ˜ ÔÏ˘·È¯ÌÒÓ (1-3). ∆Ô ∏∂°ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ Ì˘ÔÎÏÔÓÈÎ‹˜ ÂÈÏË„›·˜ ‹ÛÂ ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· ÌÂ ÂÈÏËÙÈÎ¤˜ Ì˘ÔÎÏÔÓ›Â˜·ÚÔ˘ÛÈ¿˙ÂÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ÌÂ ÔÏ˘·È¯Ì¤˜ ‹ Û˘-ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ‹ ÔÏ˘·È¯Ì‹˜-Î‡Ì·-ÙÔ˜ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜, Û‡Á¯ÚÔÓÂ˜ ÌÂ ÌÂÙˆÈ·›· ÂÈ-ÎÚ¿ÙËÛË, ÔÈ ÔÔ›Â˜ Û˘¯Ó¿ Û˘ÓÔ‰Â‡ÔÓÙ·È ÎÏÈÓÈÎ¿·fi Ì˘ÔÎÏÔÓ›Â˜ (∂ÈÎfiÓ· 8). ∞˘Ù¤˜ ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜

∂∂ÈÈÎÎfifiÓÓ·· 55.. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‚ÚÂÊÈÎÒÓ Û·ÛÌÒÓ ÛÙÔ∏∂°, ÂÌÊ·Ó›˙ÂÙ·È ÁÂÓÈÎÂ˘Ì¤ÓË ‚Ú·¯Â›· ÚÈ‹ ·fi ‚Ú·‰¤··È¯ÌËÚ¿ Î‡Ì·Ù· ÌÂÁ¿ÏË˜ Ù¿ÛË˜, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fiÌÂ›ˆÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂ ‹ ¯ˆÚ›˜ ÙÒÛË ÙÔ˘ ‰˘Ó·-ÌÈÎÔ‡ Î·È ÌÂÁ¿ÏË˜ Û˘¯ÓfiÙËÙ·˜ Î‡Ì·Ù·.

∂∂ÈÈÎÎfifiÓÓ·· 77.. OÈ ÙÔÓÈÎÔ› Û·ÛÌÔ› ÛÙÔ Û‡Ó‰ÚÔÌÔ Lennox-Gastaut Û˘ÓÔ‰Â‡ÔÓÙ·È Û˘¯Ó¿ ·fi ÁÂÓÈÎÂ˘Ì¤Ó· Î‡Ì·Ù· Û˘-¯ÓfiÙËÙ·˜ 8-30 Hz.

96 ∫. ∞. µÔ‡‰ÚË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101

∂∂ÈÈÎÎfifiÓÓ·· 44.. ∂ÈÎfiÓ· ˘„·ÚÚ˘ıÌ›·˜.

∂∂ÈÈÎÎfifiÓÓ·· 66.. ™ÙÔ Û‡Ó‰ÚÔÌÔ Lennox-Gastaut ·Ú·ÙËÚÔ‡ÓÙ·È‚Ú·‰¤· Û˘ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ÌÂ ÂÈÎÚ¿ÙËÛËÛÙÈ˜ ÚfiÛıÈÂ˜ ÂÚÈÔ¯¤˜.



ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÌfiÓÂ˜ ÙÔ˘˜ ÛÂ Î·Ù¿ Ù·

¿ÏÏ· Ê˘ÛÈÔÏÔÁÈÎfi ∏∂°, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÂ ‰È¿-

ÊÔÚ· Î·ÏÔ‹ıË Ì˘ÔÎÏÔÓÈÎ¿ ÂÈÏËÙÈÎ¿ Û‡Ó‰ÚÔ-

Ì·, ‹ ÌÂ ¿ÏÏÂ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ‚Ú·‰¤· Û˘-

ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ‹ Û˘ÌÏ¤ÁÌ·Ù· Ô-

Ï˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜, fiˆ˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Lennox-

Gastaut, ‹ ÌÂ ¿ÊıÔÓÂ˜ ‚Ú·‰˘ÚÚ˘ıÌ›Â˜ ÛÂ ‰È¿ÊÔ-

ÚÂ˜ ÂÍÂÏÈÎÙÈÎ¤˜ Î·È ÌÂÙ·‚ÔÏÈÎ¤˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ-

Â˜ (1). OÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ·˘Ù¤˜ ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓˆ-

ıÔ‡Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ˘¤ÚÓÔÈ·˜, ÛÙËÓ

˘ÓËÏ›· Î·È ÛÙË ‰ÔÎÈÌ·Û›· ÙˆÓ ¢º∂. OÈ ÂÎÊÔÚÙ›-

ÛÂÈ˜ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ‹ ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜

ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ·ÓÈÎ‹ Ì˘ÔÎÏÔÓÈÎ‹ ÂÈÏË„›·

Â›Ó·È Û˘¯Ó¿ ¿Ù˘Â˜, ¤¯Ô˘Ó Û˘¯ÓfiÙËÙ· 3 Hz ‹ ÌÂ-

Á·Ï‡ÙÂÚË, ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙË Ê¿ÛË ÙË˜

˘ÓËÏ›·˜ Î·È ÛÙÔÓ ‡ÓÔ Î·È ÌÔÚÂ› ÎÏÈÓÈÎ¿ Ó·

Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÙÈÓ¿ÁÌ·Ù·. ∆Ô ‚·ÛÈÎfi ‰È¿-

ÁÚ·ÌÌ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ·ÓÈÎ‹ Ì˘ÔÎÏÔÓÈÎ‹ ÂÈ-

ÏË„›· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi Î·È Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ

ÊˆÙÔÂ˘·ÈÛıËÛ›·.

∏ ÊˆÙÔ·ÚÔÍ˘ÛÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, Ô˘ ¯·-

Ú·ÎÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ∏∂° ·fi ·ÌÊÔÙÂÚfiÏÂ˘-

ÚÂ˜ Î·È Û‡Á¯ÚÔÓÂ˜ ÂÎÊÔÚÙ›ÛÂÈ˜ ·fi ÔÏ˘·È¯Ì¤˜ ‹

Û˘ÌÏ¤ÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜ (∂ÈÎfiÓ· 9), ÂÌ-

Ê·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÈ˜ Û˘¯ÓfiÙËÙÂ˜ 14-18 ÊˆÙÂÈÓÒÓ

ÂÚÂıÈÛÌ¿ÙˆÓ ·Ó¿ ‰Â˘ÙÂÚfiÏÂÙÔ Î·È ÌÂ ÙÔ ÎÏÂ›ÛÈÌÔ

ÙˆÓ ÔÊı·ÏÌÒÓ (1). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂ-

Ê·ÏÔÁÚ·ÊÈÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ Â›Ó·È ‰È·ÊÔÚÂÙÈÎ‹

·fi ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÊˆÙÂÈÓÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È

ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ÌÔÚÂ› Ó· ÂÈÌ¤ÓÔ˘Ó Ó· ÂÌÊ·Ó›˙Ô-

ÓÙ·È Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ ¢º∂. ºˆÙÔ·ÚÔÍ˘-

ÛÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·-

ÛÌÔ‡˜, Ì˘ÔÎÏÔÓ›Â˜ ‹ ·Ê·ÈÚ¤ÛÂÈ˜ Î·È, Û·ÓÈfiÙÂÚ·,

ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÂÛÙÈ·Î¤˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜. ∏

·ÚÔ˘Û›· ÊˆÙÔ·ÚÔÍ˘ÛÌÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜

‰Â›¯ÓÂÈ fiÙÈ ÔÈ ÚˆÙÔ·ıÂ›˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ Û·ÛÌÔ›

ÌÔÚÂ› Ó· ÚÔÎÏËıÔ‡Ó ·fi ¢º∂. £· Ú¤ÂÈ Ó·

ÛËÌÂÈˆıÂ›, ˆÛÙfiÛÔ, fiÙÈ ÊˆÙÔ·ÚÔÍ˘ÛÌÈÎ‹ ‰Ú·-

ÛÙËÚÈfiÙËÙ· ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·È Ù· Ê˘ÛÈÔ-

ÏÔÁÈÎ¿ ¿ÙÔÌ· Î·È Ë ·ÚÔ˘Û›· ÙË˜ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÂ›

Î·Ù’ ·Ó¿ÁÎË ÙËÓ ÂÌÊ¿ÓÈÛË ÂÈÏË„›·˜ (17).

∆Ô ÌÂÛÔÎÚÈÙÈÎfi ∏∂° ÛÙÈ˜ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ Úˆ-ÙÔ·ıÂ›˜ ÙÔÓÈÎÔÎÏÔÓÈÎ¤˜ ÎÚ›ÛÂÈ˜, fiÙ·Ó ‰ÂÓ Â›Ó·ÈÊ˘ÛÈÔÏÔÁÈÎfi, ÌÔÚÂ› Ó· ÂÚÈ¤¯ÂÈ ÂÈÎfiÓÂ˜ ·fi fiÏÔÙÔ Ê¿ÛÌ· ÙË˜ ÂÈÏËÙfiÌÔÚÊË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜,fiˆ˜ ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜, ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ Î·È Û˘Ì-ÌÂÙÚÈÎ¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-Î‡-Ì·ÙÔ˜, Û˘ÌÏÂÁÌ¿ÙˆÓ ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜, ‹ÌË ÂÈ‰ÈÎ¤˜ ÂÈÎfiÓÂ˜, fiˆ˜ ·ÚÔÍ˘ÛÌÈÎ¤˜ ÂÎÊÔÚÙ›-ÛÂÈ˜ ·fi ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜ Î·È Û˘ÌÌÂÙÚÈÎ¤˜ ‚Ú·-‰˘ÚÚ˘ıÌ›Â˜ (1-3). ™Â ·˘Ù¤˜ ÙÈ˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›-ÛÂÈ˜ ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓÂÎÊÔÚÙ›ÛÂˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ÌÂ ·Ï-Ï·Á‹ Û˘¯Ó¿ ÙË˜ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘˜. ªÔÚÂ› Ó·˘¿Ú¯ÂÈ ıÂÙÈÎ‹ ·ÓÙ·fiÎÚÈÛË Î·Ù¿ ÙË ‰ÔÎÈÌ·Û›·ÙˆÓ ¢º∂ Î·È Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓÂÓÈÛ¯‡ÂÈ ÙË ‰È¿ÁÓˆÛË ÙˆÓ ÂÛÙÈ·ÎÒÓ ÂÈÏËÙÈÎÒÓÎÚ›ÛÂˆÓ ÌÂ ‰Â˘ÙÂÚÔ·ı‹ ÁÂÓ›ÎÂ˘ÛË.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ Ù˘ÈÎ¤˜ ·Ê·ÈÚ¤ÛÂÈ˜ ÙË˜ ·È-‰ÈÎ‹˜ ËÏÈÎ›·˜, Ë ·ÓÂ‡ÚÂÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ı¤ÙÂÈ ÌÂ·ÛÊ¿ÏÂÈ· ÙË ‰È¿ÁÓˆÛË (1-3). ∆Ô ∏∂° Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ·Ê·›ÚÂÛË˜ (∂ÈÎfiÓ· 10) ÂÌÊ·Ó›˙ÂÈÁÂÓÈÎÂ˘Ì¤ÓÂ˜ Î·È Û˘ÌÌÂÙÚÈÎ¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜ Û˘-ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ÌÂ Û˘¯ÓfiÙËÙ· 2,5-4Hz, Û˘ÓËı¤ÛÙÂÚ· 3 Hz. ∆· ‰˘Ó·ÌÈÎ¿ ¤¯Ô˘Ó ÌÂÁ·-Ï‡ÙÂÚÔ ‡„Ô˜ ÛÙÈ˜ ÌÂÙˆÈ·›Â˜ ÂÚÈÔ¯¤˜, Ë Û˘¯Ófi-ÙËÙ¿ ÙÔ˘˜ ÌÂÈÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÎÚ›ÛË˜Î·È ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ÂÌÊ·Ó›˙ÔÓÙ·È Î·È ÂÚ·ÙÒÓÔ-ÓÙ·È ·fiÙÔÌ·, ¯ˆÚ›˜ ÙËÓ Î·Ù·ÁÚ·Ê‹ ÌÂÙ·ÎÚÈÙÈ-ÎÒÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ Ê·ÈÓÔÌ¤ÓˆÓ.™ÙÔ ÌÂÛÔÎÚÈÙÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿-ÁÚ·ÌÌ· ·ÙfiÌˆÓ ÌÂ Ù˘ÈÎ¤˜ ·Ê·ÈÚ¤ÛÂÈ˜, ÂÌÊ·Ó›-˙ÔÓÙ·È Î·Ù¿ ‰È·ÛÙ‹Ì·Ù· ÔÈ ·ÓˆÙ¤Úˆ ÂÎÊÔÚÙ›ÛÂÈ˜,ÌÂ ¯·ÌËÏfiÙÂÚÔ fiÌˆ˜ ÙÔ ‡„Ô˜ ÙˆÓ ‰˘Ó·ÌÈÎÒÓÙÔ˘˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ÔÈ ÂÎÊÔÚÙ›-ÛÂÈ˜ Â›Ó·È ÏÈÁfiÙÂÚÔ ÔÌ·Ï¤˜ Î·È Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101

∂∂ÈÈÎÎfifiÓÓ·· 88.. ™ÙË Ì˘ÔÎÏÔÓÈÎ‹ ÂÈÏË„›· ·Ú·ÙËÚÔ‡ÓÙ·È Û˘-¯Ó¿ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ ÂÎÊÔÚÙ›ÛÂÈ˜ ÔÏ˘·È¯ÌÒÓ Î·È Ù·¯¤ˆÓ Û˘-ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜.

∂∂ÈÈÎÎfifiÓÓ·· 99.. ∫·Ù¿ ÙË ÊˆÙÔ·ÚÔÍ˘ÛÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, ·-Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÂÎÊÔÚÙ›ÛÂÈ˜ ·fi Û˘ÌÏ¤ÁÌ·Ù· ·È¯-Ì‹˜-Î‡Ì·ÙÔ˜ ‹ ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜, Ë Û˘¯ÓfiÙËÙ· ÙˆÓÔÔ›ˆÓ Â›Ó·È ‰È·ÊÔÚÂÙÈÎ‹ ·fi ÂÎÂ›ÓË ÙˆÓ ¢º∂ Î·È ‰È·Ú-ÎÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ·˘Ù¿.


ÌÂÈÒÓÂÙ·È. ™ÙÔ ‰È¿ÁÚ·ÌÌ· ÌÔÚÂ› Ó· ÂÚÈ¤¯ÔÓÙ·ÈÂÛÙÈ·Î¤˜ ‹ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ ‚Ú·‰˘ÚÚ˘ıÌ›Â˜ ‹ Î·È¿ÏÏÂ˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ÔÈÔÔ›Â˜ Û˘¯Ó¿ ÂÓ·ÏÏ¿ÛÛÔÓÙ·È ÛÙ· ‰‡Ô ËÌÈÛÊ·›ÚÈ·ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·ÏÏ¿ Ë ‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·ÌÂÙ·Í‡ ÙˆÓ ÂÈÏËÙfiÌÔÚÊˆÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·ÈÊ˘ÛÈÔÏÔÁÈÎ‹. OÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ÛÙÈ˜ Ù˘ÈÎ¤˜ ·Ê·È-Ú¤ÛÂÈ˜ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· Î·Ù¿ ÙË ‰ÔÎÈÌ·-Û›· ÙË˜ ˘¤ÚÓÔÈ·˜ Î·È ÁÈ’ ·˘Ùfi Ë ‰ÔÎÈÌ·Û›·˘¤ÚÓÔÈ·˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂ fiÏ· Ù· ·È-‰È¿ ÌÂ ·Ê·ÈÚ¤ÛÂÈ˜. ™ÙÈ˜ ·Ê·ÈÚ¤ÛÂÈ˜ ÙË˜ ÂÊË‚ÈÎ‹˜ËÏÈÎ›·˜, ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜ Û˘Ó‹ıˆ˜ Â›Ó·È Û˘¯ÓfiÙË-Ù·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 3 Hz Î·È ‰È·ÚÎÔ‡Ó ÏÈÁfiÙÂÚÔÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘Ù¤˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜.

™ÙÈ˜ ÂÛÙÈ·Î¤˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ ÌÂ ÛÙÔÈ¯ÂÈ-Ò‰Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, ÙÔ ∏∂° ÌÔÚÂ› Ó· Â›Ó·ÈÊ˘ÛÈÔÏÔÁÈÎfi, ·ÎfiÌË Î·È ·Ó Î·Ù·ÁÚ¿ÊÂÙ·È Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÎÚ›ÛË˜. ∞˘Ùfi ÔÊÂ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜fiÙÈ Ë ı¤ÛË ÙË˜ ÂÈÏËÙÔÁfiÓÔ˘ ÂÛÙ›·˜ ÌÔÚÂ› Ó·Â›Ó·È ‚·ıÈ¿ ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ Ô‡Ùˆ˜ ÒÛÙÂ Ó· ÌËÓÌÔÚÂ› Ó· Î·Ù·ÁÚ·ÊÂ› ·fi Ù· ÂÈÊ·ÓÂÈ·Î¿ ËÏÂ-ÎÙÚfi‰È· ÙÔ˘ Û˘Ì‚·ÙÈÎÔ‡ ∏∂°. ™˘¯ÓfiÙÂÚ· ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ·˘Ù¤˜ ÙÈ˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ (∂ÈÎfiÓ· 11) Â›Ó·È Ë·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ·È¯ÌÒÓ ‹ Û·ÓÈfiÙÂÚ· ·È¯ÌË-ÚÒÓ ÛÙÔÈ¯Â›ˆÓ, Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜,

Û˘ÌÏÂÁÌ¿ÙˆÓ ÔÏ˘·È¯Ì‹˜-Î‡Ì·ÙÔ˜ Î·È Ë ÂÓÙÔ-ÈÛÌ¤ÓË ·ÚÔ˘Û›· ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ ‹ Ù·¯¤ˆÓÚ˘ıÌÒÓ (1-3). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÈÏËÙÈÎÒÓÎÚ›ÛÂˆÓ, ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜ ·ÏÏ¿˙Ô˘Ó ÛÙ·‰È·Î¿ ÌÔÚ-ÊÔÏÔÁ›· ‹/Î·È Û˘¯ÓfiÙËÙ· Î·È ·˘Ùfi ‚ÔËı¿ ÛÙË‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ·fi ¿ÏÏÂ˜ Î·ÏÔ‹ıÂÈ˜ ÂÛÙÈ·Î¤˜ ·È¯-ÌËÚfiÌÔÚÊÂ˜ Î·Ù·ÁÚ·Ê¤˜ (18). §fiÁˆ ÙË˜ ·ÊıÔ-Ó›·˜ ÙˆÓ ‰ÈËÌÈÛÊ·ÈÚÈÎÒÓ Û˘Ó‰¤ÛÂˆÓ, ·˘Ù¤˜ ÔÈËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÌÔÚÂ› Ó·Î·Ù·ÁÚ¿ÊÔÓÙ·È Î·È ÛÙËÓ ÔÌfiÏÔÁË ÂÚÈÔ¯‹ ÙÔ˘¿ÏÏÔ˘ ËÌÈÛÊ·ÈÚ›Ô˘. OÈ ÂÛÙÈ·Î¤˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›-ÛÂÈ˜ ÌÂ ÛÙÔÈ¯ÂÈÒ‰Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Û˘¯Ó¿ ÁÂ-ÓÈÎÂ‡ÔÓÙ·È Î·È ÙÔ ∏∂° ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ Ó·‰È·¯ˆÚÈÛÙÔ‡Ó ·fi ÙÈ˜ ÚˆÙÔÁÂÓÂ›˜ ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ÙÔÓÈÎÔÎÏÔÓÈÎ¤˜ ÎÚ›ÛÂÈ˜.

™ÙÔ ÌÂÛÔÎÚÈÙÈÎfi ∏∂° ÙˆÓ ÂÛÙÈ·ÎÒÓ ÎÚ›ÛÂˆÓÌÂ Û‡ÓıÂÙË Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, ·Ú·ÙËÚÔ‡ÓÙ·ÈÎ˘Ú›ˆ˜ ·È¯Ì¤˜ ‹ ·È¯ÌËÚ¿ ÛÙÔÈ¯Â›· ÛÙÈ˜ ÎÚÔÙ·ÊÈ-Î¤˜ ÂÚÈÔ¯¤˜ (∂ÈÎfiÓ· 12), ÂÙÂÚfiÏÂ˘Ú· ‹ ·ÌÊÔ-ÙÂÚfiÏÂ˘Ú· Î·È Û˘¯ÓfiÙÂÚ· ÛÙÈ˜ ÚfiÛıÈÂ˜ ÎÚÔÙ·-ÊÈÎ¤˜ ÂÚÈÔ¯¤˜ (1-3). ªÔÚÂ›, fiÌˆ˜, Û·ÓÈfiÙÂÚ·ÙÔ ∏∂° Ó· ÂÚÈ¤¯ÂÈ ÂÛÙÈ·Î¤˜ ‹ ‰È¿¯˘ÙÂ˜ ‚Ú·‰˘Ú-Ú˘ıÌ›Â˜ ‹ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, fiˆ˜ Û˘¯Ó¿ ·-Ú·ÙËÚÂ›Ù·È ÛÙ· ·È‰È¿ (19). O ‡ÓÔ˜ Î·È - ÏÈÁfiÙÂ-ÚÔ Û˘¯Ó¿ - Ë ˘¤ÚÓÔÈ· ‰ÈÂ˘ÎÔÏ‡ÓÔ˘Ó ÙËÓ ÂÌÊ¿-ÓÈÛË ·˘ÙÒÓ ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ ·Óˆ-Ì·ÏÈÒÓ Î·È ÁÈ’ ·˘Ùfi ÙÔÓ ÏfiÁÔ, fiÙ·Ó ÙÔ ∏∂° ÂÁÚ‹-ÁÔÚÛË˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È∏∂° ‡ÓÔ˘.

™ÙÔ ∏∂° ÙË˜ Î·ÏÔ‹ıÔ˘˜ ÂÛÙÈ·Î‹˜ ÂÈÏË„›·˜ÌÂ ÎÂÓÙÚÔÎÚÔÙ·ÊÈÎ¤˜ (ÚÔÏ¿Ó‰ÂÈÂ˜) ·È¯Ì¤˜, Ô˘·ÔÙÂÏÂ› ÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙË˜ ·È‰ÈÎ‹˜ÂÈÏË„›·˜, ·Ú·ÙËÚÔ‡ÓÙ·È ¿ÊıÔÓÂ˜ ÛÙÂÚÂfiÙ˘Â˜·È¯Ì¤˜ ˘„ËÏÔ‡ ‰˘Ó·ÌÈÎÔ‡ ÌÂ ÔÌ·Ï‹ ÎÔÚ˘Ê‹, Û˘-¯Ó¿ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ‚Ú·‰‡ Î‡Ì· ÂÚÈÚÔÏ·Ó‰ÈÎ¿(∂ÈÎfiÓ· 13) (1,3,20). OÈ ÚÔÏ¿Ó‰ÂÈÂ˜ ·È¯Ì¤˜ ÌÔÚÂ›Ó· ÁÚ¿ÊÔÓÙ·È ÂÙÂÚfiÏÂ˘Ú·, ·ÓÂÍ¿ÚÙËÙ· ·ÌÊÔÙÂ-ÚfiÏÂ˘Ú· ‹ Û·ÓÈfiÙÂÚ· Û‡Á¯ÚÔÓ· Î·È ·ÌÊÔÙÂÚfi-ÏÂ˘Ú·. OÈ ÚÔÏ¿Ó‰ÂÈÂ˜ ·È¯Ì¤˜ ÁÚ¿ÊÔÓÙ·È Û˘¯Ófi-ÙÂÚ· ÛÙÔÓ ‡ÓÔ (21) Î·È Ë Û˘¯Ó‹ Î·È ¿ÊıÔÓË ·-ÚÔ˘Û›· ÙÔ˘˜ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË Û¯ÂÙÈÎ¿ Û¿ÓÈ·ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ. ∆Ô ‚·ÛÈÎfi ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ·ÚÔ˘ÛÈ¿˙ÂÈ

∂∂ÈÈÎÎfifiÓÓ·· 1111.. ∂ÛÙÈ·Î¤˜ ·È¯Ì¤˜ ÂÓÙÔÈ˙fiÌÂÓÂ˜ ÛÙÈ˜ ‰ÂÍÈ¤˜ÚfiÛıÈÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

∂∂ÈÈÎÎfifiÓÓ·· 1122.. ∞È¯Ì¤˜ Î·È ‚Ú·‰¤· Î‡Ì·Ù· ÂÓÙÔÈ˙fiÌÂÓ· ÛÙË‰ÂÍÈ¿ ÎÚÔÙ·ÊÈÎ‹ ÂÚÈÔ¯‹ ÛÂ ·ÛıÂÓ‹ ÌÂ Û‡ÓıÂÙÂ˜ ÂÛÙÈ·Î¤˜ÎÚ›ÛÂÈ˜.

98 ∫. ∞. µÔ‡‰ÚË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101

∂∂ÈÈÎÎfifiÓÓ·· 1100.. ™ÙÈ˜ Ù˘ÈÎ¤˜ ·Ê·ÈÚ¤ÛÂÈ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÁÂÓÈ-ÎÂ˘Ì¤ÓÂ˜, Û‡Á¯ÚÔÓÂ˜ Î·È Û˘ÌÌÂÙÚÈÎ¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜ ·fiÛ˘ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜, Û˘¯Ó¿ Û˘¯ÓfiÙËÙ·˜ 3 Hz, ÌÂÎ‡ÚÈ· ÂÓÙfiÈÛË ÛÙÈ˜ ÚfiÛıÈÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.



Î·Ï‹ ÔÚÁ¿ÓˆÛË ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓÔ‡˜. ∞˘-Ù¤˜ ÔÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ·ÓˆÌ·Ï›Â˜˘Ô¯ˆÚÔ‡Ó, fiˆ˜ Î·È ÔÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Ì¤-¯ÚÈ ÙËÓ ÂÊË‚Â›·. OÈ ÚÔÏ¿Ó‰ÂÈÂ˜ ·È¯Ì¤˜ ·Ú·ÙË-ÚÔ‡ÓÙ·È Û˘¯Ó¿ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· ‹ ÛÂ Û˘ÁÁÂ-ÓÂ›˜ ·ÛıÂÓÒÓ ÌÂ ÚÔÏ¿Ó‰ÂÈ· ÂÈÏË„›· Î·È Ë ·ÓÂ‡-ÚÂÛ‹ ÙÔ˘˜ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÂ› Î·Ù’ ·Ó¿ÁÎË ÙË ÌÂÏ-ÏÔÓÙÈÎ‹ ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ.

™ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˘ Î·ÈÛÙËÓ ·È‰ÈÎ‹ ÈÓÈ·Î‹ ÂÈÏË„›· ÙÔ˘ Gastaut (3),‰‡Ô Î·ÏÔ‹ıË Û‡Ó‰ÚÔÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜,ÁÚ¿ÊÔÓÙ·È Û˘¯Ó¿ ÂÎÊÔÚÙ›ÛÂÈ˜ ·fi ·È¯Ì¤˜ ‹ Û˘-ÌÏ¤ÁÌ·Ù· ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ (∂ÈÎfiÓ· 14), Î˘Ú›ˆ˜ÛÙÈ˜ Ô›ÛıÈÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È È‰›ˆ˜ÈÓÈ·Î¿, ÔÈ ÔÔ›Â˜ Û˘¯Ó¿ ÂÍ·Ê·Ó›˙ÔÓÙ·È ÌÂ ÙÔ¿ÓÔÈÁÌ· ÙˆÓ ÔÊı·ÏÌÒÓ. ∞˘Ù¤˜ ÔÈ ÂÎÊÔÚÙ›ÛÂÈ˜

ÁÚ¿ÊÔÓÙ·È ÂÙÂÚfiÏÂ˘Ú·, ·ÓÂÍ¿ÚÙËÙ· ·ÌÊÔÙÂÚfi-ÏÂ˘Ú· ‹ Û‡Á¯ÚÔÓ· Î·È ·ÌÊÔÙÂÚfiÏÂ˘Ú· ÛÙËÓÈÓÈ·Î‹ ¯ÒÚ· ÌÂ Û˘¯Ó‹ Â¤ÎÙ·ÛË ÛÙË ‚ÚÂÁÌ·ÙÈÎ‹Î·È Ô›ÛıÈ· ÎÚÔÙ·ÊÈÎ‹ ÂÚÈÔ¯‹ Î·È ÂÈ‰ÂÈÓÒÓÔ-ÓÙ·È Û˘¯Ó¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ¶·Úfi-ÌÔÈÂ˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ·Ï-Ï¿ ÌÂ ÙËÓ ·ÚÔ˘Û›· ‚Ú·‰˘ÚÚ˘ıÌÈÒÓ ‹ ‰È·Ù·Ú·-¯ÒÓ ÙÔ˘ ‚·ÛÈÎÔ‡ Ú˘ıÌÔ‡ Û‡ÛÙÔÈ¯·, ·Ú·ÙËÚÔ‡-ÓÙ·È Û˘¯Ó¿ ÛÂ ÂÈÏËÙÈÎ¿ ¿ÙÔÌ· ÌÂ ÈÓÈ·Î¤˜ ‚Ï¿-‚Â˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (22).

∞ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó ÂÈÏËÙfiÌÔÚÊÂ˜ ÂÎÊÔÚ-Ù›ÛÂÈ˜ ·fi ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚ›· ÌË ÁÂÈÙÔÓÈÎ¿ ËÏÂ-ÎÙÚfi‰È· Î·È ÌÂ Ì›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÛÙ›· ÛÂ Î¿ıÂËÌÈÛÊ·›ÚÈÔ, ıÂˆÚÔ‡ÓÙ·È fiÙÈ ¤¯Ô˘Ó ËÏÂÎÙÚÔÂÁÎÂ-Ê·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ÔÏÏ·ÏÒÓ ·ÓÂÍ¿ÚÙË-ÙˆÓ ÂÈÏËÙÈÎÒÓ ÂÛÙÈÒÓ. ™¯Â‰fiÓ fiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ÌÂ ·˘Ù¤˜ ÙÈ˜ ·ÓˆÌ·Ï›Â˜ ¤¯Ô˘Ó ÂÈÏËÙÈÎ¤˜ ÎÚ›-ÛÂÈ˜, Û˘Ó‹ıˆ˜ ÔÏÏ·ÏÒÓ ÌÔÚÊÒÓ Î·È ·ÚÔ˘-ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ÓÔË-ÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË (23).

™ÙËÓ Â›ÎÙËÙË ÂÈÏËÙÈÎ‹ ·Ê·Û›· ‹ Û‡Ó‰ÚÔ-ÌÔ Landau-Kleffner Î·È ÛÙËÓ ÂÈÏË„›· ÌÂ Û˘ÓÂ-¯Â›˜ ÂÎÊÔÚÙ›ÛÂÈ˜ “·È¯Ì‹˜-Î‡Ì·ÙÔ˜” ÛÙÔÓ non-REM ‡ÓÔ, ÂÌÊ·Ó›˙ÔÓÙ·È ‰È¿¯˘ÙÂ˜, Û˘ÓÂ¯Â›˜·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ù‡Ô˘ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (∂ÈÎfiÓ· 15) (24,25). ™ÙÔ ∏∂°ÂÁÚ‹ÁÔÚÛË˜ ÌÔÚÂ› Ó· ˘¿Ú¯Ô˘Ó ÂÛÙÈ·Î¤˜ ÂÈ-ÏËÙÈÎ¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜, Î˘Ú›ˆ˜ ÛÙÈ˜ ÎÚÔÙ·ÊÈÎ¤˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101

∂∂ÈÈÎÎfifiÓÓ·· 1144.. ∞È¯Ì¤˜ ÂÓÙÔÈ˙fiÌÂÓÂ˜ ÛÙË ‰ÂÍÈ¿ ÈÓÈ·Î‹ ÂÚÈÔ¯‹ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

∂∂ÈÈÎÎfifiÓÓ·· 1155.. ÕÊıÔÓÂ˜ ÂÎÊÔÚÙ›ÛÂÈ˜ ·fi ·È¯Ì¤˜ Î˘Ú›ˆ˜ ÛÙÈ˜Ì¤ÛÂ˜ Î·È Ô›ÛıÈÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ÛÂ ·È‰› ÌÂ ÂÈ‰ÂÈÓÔ‡ÌÂÓË ‰˘ÛÊ·Û›·.

∂∂ÈÈÎÎfifiÓÓ·· 1133.. ƒÔÏ¿Ó‰ÂÈÂ˜ ·È¯Ì¤˜ ÂÓÙÔÈ˙fiÌÂÓÂ˜ ÛÙÔ ‰ÂÍÈfiËÌÈÛÊ·›ÚÈÔ.


ÂÚÈÔ¯¤˜. OÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ ÛÙÔ ∏∂° Û˘¯Ó¿˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ·fi ÌÂÚÈÎ¿ ¯ÚfiÓÈ·.

¶ÂÚÈÔ‰ÈÎ¤˜, Û¯ÂÙÈÎ¿ ÛÙÂÚÂfiÙ˘Â˜, ÂÛÙÈ·Î¤˜‹/Î·È ‰È¿¯˘ÙÂ˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ·Óˆ-Ì·Ï›Â˜, fiˆ˜ ·È¯Ì¤˜, ÔÏ˘·È¯Ì¤˜, ÔÍ‡·È¯Ì· ‹·ÎfiÌË Î·È ‚Ú·‰¤· Î‡Ì·Ù·, ·Ú·ÙËÚÔ‡ÓÙ·È ÛÂ‰È¿ÊÔÚÂ˜ ÔÍÂ›Â˜ ‹ ˘ÔÍÂ›Â˜ Î·Ù·ÛÙ¿ÛÂÈ˜, fiˆ˜Â›Ó·È Ë ˘ÔÍÂ›· ÛÎÏËÚ˘ÓÙÈÎ‹ ·ÓÂÁÎÂÊ·Ï›ÙÈ‰·Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙÔÓ Èfi ÙË˜ ÈÏ·Ú¿˜ (∂ÈÎfiÓ· 16). ∏ÂÓÙfiÈÛË Î·È Ë Î·Ù·ÓÔÌ‹ ÂÍ·ÚÙÒÓÙ·È Î˘Ú›ˆ˜ ·fiÙËÓ ˘ÔÎÂ›ÌÂÓË ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (26).

∆Ô ∏∂° ÛÙÔ˘˜ ·ÏÔ‡˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ Î·È ‰ÂÓ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆ-ÛË ‹ ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Î·È ‰ÂÓ ÌÔÚÂ› Ó·‚ÔËı‹ÛÂÈ ÛÙËÓ Úfi‚ÏÂ„Ë ÌÂÏÏÔÓÙÈÎ‹˜ ÂÌÊ¿ÓÈ-ÛË˜ ÂÈÏË„›·˜ (1). µÚ·‰¤· Î‡Ì·Ù·, Î˘Ú›ˆ˜ ÛÙÈ˜Ô›ÛıÈÂ˜ ÂÁÎÂÊ·ÏÈÎ¤˜ ÂÚÈÔ¯¤˜, ÂÌÊ·Ó›˙ÔÓÙ·ÈÛ˘¯Ó¿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (27). °ÂÓÈÎÂ˘Ì¤ÓÂ˜ ÂÎ-ÊÔÚÙ›ÛÂÈ˜ ·fi ÁÂÓÈÎÂ˘Ì¤Ó· Û˘ÌÏ¤ÁÌ·Ù· ·È¯-Ì‹˜-Î‡Ì·ÙÔ˜ ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÂ ÌÂÚÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜, Î˘Ú›ˆ˜ÛÂ ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 4 ÂÙÒÓ. ∏ ·ÚÔ˘Û›·ÂÈÏËÙfiÌÔÚÊˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó·Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·-ÛÌÒÓ ‹ ÙËÓ ÂÌÊ¿ÓÈÛË ÌÂÏÏÔÓÙÈÎ‹˜ ÂÈÏË„›·˜.¶ÈÛÙÂ‡ÂÙ·È, fiÌˆ˜, fiÙÈ Ë ·ÚÔ˘Û›· ÁÂÓÈÎÂ˘Ì¤ÓˆÓÂÎÊÔÚÙ›ÛÂˆÓ ÙÔ˘ Ù‡Ô˘ ·È¯Ì‹˜-Î‡Ì·ÙÔ˜ ÛÂ ·È-‰È¿ ÌÂ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ÙˆÓ 2 ÂÙÒÓ ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛËÌ˘ÔÎÏÔÓÈÎ‹˜ ÂÈÏË„›·˜ (28). Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈÛÙÔ˘˜ Û‡ÓıÂÙÔ˘˜ ‹ ÂÈÂÏÂÁÌ¤ÓÔ˘˜ ˘ÚÂÙÈÎÔ‡˜Û·ÛÌÔ‡˜, ÙÔ ∏∂° ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·Ó›-¯ÓÂ˘ÛË ÂÈÏË„›·˜ ‹ ¿ÏÏÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘ ÓÔÛ‹Ì·-ÙÔ˜, Â¿Ó Á›ÓÂÈ ÌÂÙ·ÎÚÈÙÈÎ¿ Î·È Î·Ù·ÁÚ¿„ÂÈ ÂÛÙÈ·-Î¤˜ ‚Ú·‰˘Ú˘ıÌ›Â˜ ‹ ·È¯ÌËÚ¿ Î‡Ì·Ù·, ·ÏÏ¿ Ë Ï‹-„Ë ÙÔ˘ ∏∂° ÛÂ Û‡ÓıÂÙÔ˘˜ ‹ ÂÈÂÏÂÁÌ¤ÓÔ˘˜ÂÍ·ÚÙ¿Ù·È ·fi Ù· ÎÏÈÓÈÎ¿ ‰Â‰ÔÌ¤Ó· Î·È ÙËÓ ÎÚ›ÛËÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÙÔ ∏∂° Â›Ó·È Ì›· ·Î›Ó‰˘ÓËÎ·È Û¯ÂÙÈÎ¿ ÊıËÓ‹ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎ‹ Ì¤ıÔ‰Ô˜Ô˘ ¤¯ÂÈ Ó· ÚÔÛÊ¤ÚÂÈ ÔÏÏ¿ ÛÙË ÌÂÏ¤ÙË ÙË˜

·È‰ÈÎ‹˜ ÂÈÏË„›·˜. øÛÙfiÛÔ, ı· Ú¤ÂÈ Ó· Á›ÓÂ-Ù·È ·fi ¤ÌÂÈÚÔ˘˜ ÙÂ¯ÓÈÎÔ‡˜, Ó· ÌÂÏÂÙ¿Ù·È ·fi¤ÌÂÈÚÔ˘˜ ÛÙÔ ·È‰ÈÎfi ∏∂° È·ÙÚÔ‡˜ Î·È Ó· Û˘-Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛËÎ·È ¿ÏÏÂ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜.


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16. Blume WT, David RB, Gomez MR. Generalized sharp andslow wave complexes. Associated clinical features andlong-term follow-up. Brain 1973;96:289-306.

17. Doose H, Gerken H, Hien-Volpel KF, Volzke E. Geneticsof photosensitive epilepsy. Neuropadiatrie 1969;1:56-73.

18. Blume WT, Young GB, Lemieux JF. EEG morphology ofpartial epileptic seizures. Electroencephalogr Clin Neuro-physiol 1984;57:295-302.

19. Dinner DS, Luders H, Rothner AD, Erenberg G. Complexpartial seizures of childhood onset: a clinical and en-cephalographic study. Cleve Clin Q 1984;51:287-291.

20. de Weerd AW, Arts WF. Significance of centro-temporalspikes on the EEG. Acta Neurol Scand 1993;87:429-433.

∂∂ÈÈÎÎfifiÓÓ·· 1166.. ¶ÂÚÈÔ‰ÈÎ¿, ÁÂÓÈÎÂ˘Ì¤Ó· Û˘ÌÏ¤ÁÌ·Ù· ·fi‚Ú·‰¤· Î·È ·È¯ÌËÚ¿ Î‡Ì·Ù· ÌÂÁ¿ÏË˜ Ù¿ÛË˜ ÛÂ ·ÛıÂÓ‹ ÌÂ˘ÔÍÂ›· ÛÎÏËÚ˘ÓÙÈÎ‹ ·ÓÂÁÎÂÊ·Ï›ÙÈ‰·, ÔÊÂÈÏfiÌÂÓË ÛÂ ÈfiÈÏ·Ú¿˜.

100 ∫. ∞. µÔ‡‰ÚË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101



21. Blom S, Heijbel J. Benign epilepsy of children with centro-temporal EEG foci. Discharge rate during sleep. Epilepsia1975;16:133-140.

22. Maher J, Ronen GM, Ogunyemi AO, Goulden KJ. Occipi-tal paroxysmal discharges suppressed by eye opening: vari-ability in clinical and seizure manifestations in childhood.Epilepsia 1995;36:52-57.

23. Blume WT. Clinical and electroencephalographic corre-lates of the multiple independent spike foci pattern in chil-dren. Ann Neurol 1978;4:541-547.

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25. Hirsch E, Marescaux C, Maquet P, Metz-Lutz MN, Kies-mann M, Salmon E et al. Landau-Kleffner syndrome: a clin-ical and EEG study of five cases. Epilepsia 1990;31:756-767.

26. Garg BP, Patel H, Markand ON. Clinical correlation of pe-riodic lateralized epileptiform discharges in children. Pedi-atr Neurol 1995;12:225-229.

27. Frantzen E, Lennox-Buchthal M, Nygaard A. LongitudinalEEG and clinical study of children with febrile convulsions.Electroencephalogr Clin Neurophysiol 1968;24:197-212.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:93-101


102 REVIEW ARTICLE

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

Correspondence:Konstantinos A. Voudris Department of Neurology,“P. & A. Kyriakou” Children’s Hospital Thivon & Levadias str., 115 27, Athens E-mail: [email protected]

Date of submission: 24-03-2004 Date of approval: 12-11-2004


Electroencephalographic investigation ofchildren with epilepsyK. A. Voudris

AbstractElectroencephalography is the basic technique for the neurophysiological investigation of epilepsy and mayhelp in the diagnosis, study and prognosis of epilepsy. Although epilepsy is a clinical diagnosis,electroencephalographic data may play an important role in support of the clinical impression.Electroencephalography in paediatric epilepsy may be useful for confirmation of the diagnosis, recognitionof the types of seizures and underlying epileptic syndromes, and for prediction, both of response toantiepileptic treatment and recurrence of seizures after discontinuation of antiepileptic treatment.Synchronized video-electroencephalographic monitoring offers improvements in the study of epilepticchildren with persistent epilepsy, and, in particular, may help in the differential diagnosis between epilepticand non-epileptic paroxysmal clinical events. Electroencephalography is a harmless and relativelyinexpensive technique, which may be of great benefit for children with epilepsy when it is performed byexperienced technicians and interpreted by specialized doctors, and the findings are correlated with clinicaland other laboratory data.

Key wordsElectroencephalogram, epilepsy, children.


103µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞

∏ Ê·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÛÙË ÌÂÏ¤ÙË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÔÍÂ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜* ¡. ∫·Ù˙ËÏ¿ÎË˜1, ∂. ™ÙÂÈ·Î¿ÎË1, ∞. ¶··‰¿ÎË˜2, ∂. ¢ËÌËÙÚ›Ô˘1, ∫. ª¿Ï·˜2, ª. ∫·ÏÌ·ÓÙ‹1

¶ÂÚ›ÏË„Ë∂ÈÛ·ÁˆÁ‹: ™Â ·˘Ù‹ ÙË ÌÂÏ¤ÙË ÚÔÙÂ›ÓÂÙ·È Ì›· Ó¤· Ì¤ıÔ‰Ô˜ ‰È¿ÎÚÈÛË˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓÎ·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 ÔÍÂ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ (O§§) ÌÂ ÙË Ê·ÛÌ·ÙÈÎ‹ ·Ó¿Ï˘-ÛË Î·È ·ÂÈÎfiÓÈÛË. ∂ÂÈ‰‹ ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ Ë ÌÔÚÊÔÏÔÁÈÎ‹ ‰È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘Ù-Ù¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 Â›Ó·È ‰˘Û¯ÂÚ‹˜ ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ, Ë ‰È¿ÎÚÈÛË Î·È Ù·-ÍÈÓfiÌËÛË Á›ÓÂÙ·È ÌÂ ‚¿ÛË Î˘ÙÙ·ÚÔ¯ËÌÈÎ¿ Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ÌÔÚÈ·Î¿ ‰Â‰ÔÌ¤Ó· Î·È·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∏ ÂÎÙ›ÌËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛË˜ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ·È-ÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÔÚÂ› Ó· Á›ÓÂÈ ÌÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ Ô˘ ‚·Û›˙ÂÙ·È ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ Ê·-ÛÌ·ÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜. ∆Ô ÌÈÎÚÔÛÎfiÈÔ ·˘Ùfi Â›Ó·È ÈÎ·Ófi Ó· ·ÂÈÎÔÓ›ÛÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi Ê·ÛÌ·ÙÈÎÒÓ Â-ÚÈÔ¯ÒÓ ·ÔÚÚfiÊËÛË˜ ÛÂ Î¿ıÂ ¤Ó· ÛËÌÂ›Ô ÙË˜ ÂÈÎfiÓ·˜ ÛÂ Ì›· Â˘ÚÂ›· Ê·ÛÌ·ÙÈÎ‹ ÂÚÈÔ¯‹, Ë ÔÔ›· ÂÎÙÂ›-ÓÂÙ·È ·fi Ù· 400 nm ÛÙ· 1000 nm. ªÂ ÛÎÔfi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÎÙ›ÌËÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿-ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 O§§, ÌÂÏÂÙ‹ıËÎ·Ó ÌÂ Ê·ÛÌ·ÙÈÎ‹ ·Ó¿Ï˘ÛË ÂÈ¯Ú›ÛÌ·Ù· Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ 30 ·È‰ÈÒÓ ËÏÈÎ›·˜ 2-14 ÂÙÒÓ (12 ·È‰ÈÒÓ ÌÂ O§§ Î·È 18 ·È‰ÈÒÓ ÌÂ ÌË Î·ÎÔ‹ıË ÓÔÛ‹-Ì·Ù·, ÛÙ· ÔÔ›· ¤ÁÈÓÂ Ì˘ÂÏfiÁÚ·ÌÌ· ÛÙÔ Ï·›ÛÈÔ ‰ÈÂÚÂ‡ÓËÛË˜ ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ÂÌ‡ÚÂÙÔ˘ ‹ ·Ó·ÈÌ›·˜‹ ıÚÔÌ‚ÔÂÓ›·˜ ‹ Ô˘‰ÂÙÂÚÔÂÓ›·˜), ÌÂÙ¿ ·fi ¯ÚÒÛË ÌÂ May-Grunwald-Giemsa (MGG) ¯ÚˆÛÙÈÎ‹.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹‰È·ÊÔÚ¿ (p<0,00005) ÛÂ Û¯¤ÛË ÌÂ Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· ÛÙËÓ ·Ó›¯ÓÂ˘ÛË, Ù·˘ÙÔÔ›ËÛË Î·È¯·ÚÙÔÁÚ¿ÊËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛË˜ ÛÙ· ‰È¿ÊÔÚ· Ì‹ÎË Î‡Ì·ÙÔ˜.∞Ó·Ï˘ÙÈÎfiÙÂÚ·, Ë Ì¤ÁÈÛÙË Ê·ÛÌ·ÙÈÎ‹ ·ÔÚÚfiÊËÛË ÁÈ· Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· ·Ú·ÙËÚ‹ıËÎÂÛÙ· 535 nm Î·È Ë ·ÓÙ›ÛÙÔÈ¯Ë ·ÔÚÚfiÊËÛË ÁÈ· ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ· 545 nm. ∏ Ì¤ÁÈ-ÛÙË ‰Â ÌÂÙ·Í‡ ÙÔ˘˜ ‰È·ÊÔÚÔÔ›ËÛË Î·Ù·ÁÚ¿ÊËÎÂ ÛÙ· 630 nm.

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·Ó¤‰ÂÈÍ·Ó ÙË ‰˘Ó·ÙfiÙËÙ· ÙË˜ Ê·ÛÌ·ÙÈÎ‹˜ ·ÂÈÎfiÓÈÛË˜ ÁÈ· ·ÚÔ¯‹ÏËÚÔÊÔÚÈÒÓ Ô˘ ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜ ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ Î·È ÔÈ ÔÔ›Â˜ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ‚ÈÔ¯ËÌÈ-Î‹, ÏÂÈÙÔ˘ÚÁÈÎ‹ Î·È ‰ÔÌÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ‰Â‰ÔÌ¤ÓÔ Ô˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ÂÊ·ÚÌÔ-Á‹ Ì›·˜ ·ÎfiÌË ÌÂıfi‰Ô˘ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË Î·È Ù·ÍÈÓfiÌËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿º·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË, ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·, ·È‰ÈÎ‹ ËÏÈÎ›·.

* µ’ ÃˆÚ¤ÌÂÈÔ Œ·ıÏÔ 40fi ¶·ÓÂÏÏ‹ÓÈÔ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ,2002

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘,¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜

2 πÓÛÙÈÙÔ‡ÙÔ ∏ÏÂÎÙÚÔÓÈÎ‹˜¢ÔÌ‹˜ Î·È Laser, ÿ‰Ú˘Ì·∆Â¯ÓÔÏÔÁ›·˜ Î·È ŒÚÂ˘Ó·˜(π.∆.∂.), ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

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

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110


O§§ OÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·

MGG May-Grunwald-Giemsa

∂ÈÛ·ÁˆÁ‹

∏ ÔÍÂ›· ÏÂ˘¯·ÈÌ›· ·ÔÙÂÏÂ› ÙÔ 35-40% ÙˆÓ

Î·ÎÔËıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. Ã·Ú·ÎÙËÚ›˙Â-

Ù·È ·fi ÙËÓ ÂÈÎÚ¿ÙËÛË ¿ˆÚˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ

Î˘ÙÙ¿ÚˆÓ ‹ ÚÔ‰ÚÔÌÈÎÒÓ ÌÔÚÊÒÓ ÙË˜ ÏÂÌÊÈÎ‹˜

ÛÂÈÚ¿˜. ∆·ÍÈÓÔÌÂ›Ù·È ÌÔÚÊÔÏÔÁÈÎ¿, ·Ó¿ÏÔÁ· ÌÂ

ÙËÓ ÚÔ¤ÏÂ˘ÛË ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÎÏÒÓÔ˘, ÛÂ ÏÂÌ-

ÊÔ‚Ï·ÛÙÈÎ‹ Î·È Ì˘ÂÏÔÁÂÓ‹, ·ÓÙ›ÛÙÔÈ¯·. ™ÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›·, ÂÚ›Ô˘ ÙÔ 80% ÙË˜ ÔÍÂ›·˜ ÏÂ˘-

¯·ÈÌ›·˜ Â›Ó·È ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ Î·È ÙÔ 15% Ì˘ÂÏÔ-

ÁÂÓ‹˜, ÂÓÒ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÂÚÈÙÒÛÂˆÓ Ù·-

ÍÈÓÔÌÂ›Ù·È ˆ˜ ·‰È·ÊÔÚÔÔ›ËÙË.


104 ¡. ∫·Ù˙ËÏ¿ÎË˜ Î·È Û˘Ó.

∆· ÌÔÚÊÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ÔÍÂ›·˜ÏÂ˘¯·ÈÌ›·˜ Â›Ó·È ·˘Ù¿ ÙˆÓ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ,‰ËÏ·‰‹ Û¯ÂÙÈÎ¿ ·‰È·ÊÔÚÔÔ›ËÙÔ Î‡ÙÙ·ÚÔ ÌÂ ‰È¿-¯˘ÙË Î·Ù·ÓÔÌ‹ ˘ÚËÓÈÎ‹˜ ¯ÚˆÌ·Ù›ÓË˜ ÌÂ ¤Ó· ‹ÂÚÈÛÛfiÙÂÚ· ˘Ú‹ÓÈ· Î·È ‚·ÛÂfiÊÈÏÔ Î˘ÙÙ·ÚfiÏ·-ÛÌ·. ∏ ÔÍÂ›· ÏÂ˘¯·ÈÌ›· Ù·ÍÈÓÔÌÂ›Ù·È - ÂÎÙfi˜ ·fiÙ· ÌÔÚÊÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ - Î·È ÌÂ Î˘ÙÙ·ÚÔ-¯ËÌÈÎ¿, Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ Î·È ÌÔÚÈ·Î¿ ‰Â‰ÔÌ¤Ó·,Î·ıÒ˜ Î·È ÌÂ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË (1).

™˘ÁÎÂÎÚÈÌ¤Ó· ÎÚÈÙ‹ÚÈ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ·ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ ·fi ÙÔ˘˜Ì˘ÂÏÔ‚Ï¿ÛÙÂ˜, ÂÓÒ Î·È Ë ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ Î·È ËÌ˘ÂÏÔÁÂÓ‹˜ ÏÂ˘¯·ÈÌ›· Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÂÚ·ÈÙ¤ÚˆÛÂ ˘ÔÔÌ¿‰Â˜ Û‡ÌÊˆÓ· ÌÂ ÙË French-American-British (FAB) Ù·ÍÈÓfiÌËÛË. ∂È‰ÈÎfiÙÂÚ·, Ë O§§‰È·ÎÚ›ÓÂÙ·È ÌÔÚÊÔÏÔÁÈÎ¿ ÛÂ 3 ˘ÔÔÌ¿‰Â˜ (L1, L2,L3). ∞fi ·˘Ù¤˜, Ë L1 Â›Ó·È Ë Û˘¯ÓfiÙÂÚË, ÛÂ ÔÛÔ-ÛÙfi 85% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (2).

ªÔÚÊÔÏÔÁÈÎ¿, ÔÈ L1 ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ Â›Ó·È ÌÈÎÚ¿Î‡ÙÙ·Ú· ÌÂ ÔÌÔÈÔÁÂÓ‹ ¯ÚˆÌ·Ù›ÓË ÙÔ˘ ˘Ú‹Ó· ¯ˆ-Ú›˜ ÔÚ·Ù¿ ‹ ÌfiÏÈ˜ ˘ÔÛËÌ·ÈÓfiÌÂÓ· ˘Ú‹ÓÈ·, ÔÌÔÈ-fiÌÔÚÊÔ Û¯‹Ì·, ÂÏ¿¯ÈÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ·, ‹È· ‹Ì¤ÙÚÈ· ‚·ÛÂfiÊÈÏÔ. ∏ ÚÔÛ¿ıÂÈ· Ó· Û˘ÌÂÚÈÏË-ÊıÂ› Ë ÌÔÚÊÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÏÂÌÊÔ‚Ï·-ÛÙÒÓ ÛÙË ıÂÚ·Â˘ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ ‰ÂÓ ¤¯ÂÈ ·Ô-‰ÒÛÂÈ ÏfiÁˆ ÙË˜ ÂÚÈÔÚÈÛÌ¤ÓË˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÙˆÓÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ·Ïfi ÌÈÎÚÔÛÎfiÈÔ, ÙˆÓ ˘ÔÎÂÈÌÂÓÈ-ÎÒÓ ‰È·ÊÔÚÒÓ ÌÂÙ·Í‡ ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ˘ÔÙ‡-ˆÓ Î·È ÙË˜ ÊÙˆ¯‹˜ Û˘Û¯¤ÙÈÛË˜ ÙˆÓ ˘ÔÙ‡ˆÓ ÌÂÙËÓ ÎÏÈÓÈÎ‹ ¤Î‚·ÛË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë Û‡Á¯ÚÔÓË‰È·ÁÓˆÛÙÈÎ‹ ÙË˜ O§§ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔÓ ·ÓÔ-ÛÔÊ·ÈÓfiÙ˘Ô Î·È ÙÔÓ ÁÔÓfiÙ˘Ô ÙˆÓ Î˘ÙÙ¿ÚˆÓ (3).

∏ ·ÎÚ›‚ÂÈ· Î·È Ë ¯ÚËÛÈÌfiÙËÙ· ÙÔ˘ ·ÓÔÛÔÊ·È-ÓfiÙ˘Ô˘ ÛÙË ‰È¿ÁÓˆÛË ÙË˜ O§§ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿-ÛÂÈ ÛËÌ·ÓÙÈÎ‹ ÚfiÔ‰Ô ÌÂ ÙË ‰È¿ıÂÛË ÌÂÁ¿ÏÔ˘·ÚÈıÌÔ‡ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓÏÂ˘ÎÔÎ˘ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ, ÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ·ÓÙÈ‰Ú·ÛÙËÚ›ˆÓ ÊıÔÚÈÛÌÔ‡ ÁÈ· ÙË Û‹Ì·ÓÛË ÙˆÓÎ˘ÙÙ¿ÚˆÓ Î·È ÙÔÓ Û¯Â‰È·ÛÌfi Î˘ÙÙ·ÚÔÌÂÙÚ›·˜ÚÔ‹˜. ∞Ó Î·È Â›Ó·È ‰È·ı¤ÛÈÌ· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈ-ÛÒÌ·Ù· ¤Ó·ÓÙÈ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÌÔÚ›ˆÓ ‰È·ÊÔ-ÚÔÔ›ËÛË˜ ÙˆÓ ·ÓıÚÒÈÓˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ, Ï›-Á· ÌfiÓÔ ·fi ·˘Ù¿ ¤¯Ô˘Ó ÂÈ‰ÈÎfiÙËÙ· ÁÈ· Û˘ÁÎÂÎÚÈ-Ì¤ÓÂ˜ ÛÂÈÚ¤˜, ÁÂÁÔÓfi˜ Ô˘ ‰ËÌÈÔ˘ÚÁÂ› ·Ó·ÁÎ·Èfi-ÙËÙ· ÂÈÏÔÁ‹˜ Ì›·˜ ÛÂÈÚ¿˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂ ÙÔÓÎ·ıÔÚÈÛÌfi ÙË˜ ‰È¿ÁÓˆÛË˜ Î·È ÙË ‰È¿ÎÚÈÛË ÙˆÓ·ÓÔÛÔÏÔÁÈÎÒÓ ˘ÔÔÌ¿‰ˆÓ.

¶·Ú¿ ÙÔ fiÙÈ Ë ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ÌÂÏ¤ÙË ÙˆÓÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎ‹ ·-Ú¿ÌÂÙÚÔ ÛÙË ‰È¿ÁÓˆÛË Î·È Ù·ÍÈÓfiÌËÛË ÙË˜ O§§ÛÂ ˘ÔÔÌ¿‰Â˜, ÌÔÚÊÔÏÔÁÈÎ¿ ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔ-ÛÎfiÈÔ Ë ‰È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿-ÚˆÓ ·fi ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ L1 ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒ-ÛÂÈ˜ Â›Ó·È È‰È·›ÙÂÚ· ‰˘Û¯ÂÚ‹˜.

ªÂ ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ¯ÚËÛÈÌÔÔÈÔ‡-

ÓÙ·È Ì¤ıÔ‰ÔÈ Ê·ÛÌ·ÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ Ì¤Ûˆ Û‡Á-¯ÚÔÓˆÓ Û˘ÛÙËÌ¿ÙˆÓ ·Ó¿Ï˘ÛË˜ ÂÈÎfiÓ·˜ ÌÂÙ¿ ·fiÂ›ÛÙÚˆÛË Î·È ¯ÚÒÛË, fiˆ˜ ·˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ÁÈ· ÌÂÏ¤ÙË ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ.

∏ ¯ÚÒÛË ÙˆÓ ·Ú·ÛÎÂ˘·ÛÌ¿ÙˆÓ ÌÂ ÂÈ‰ÈÎ¤˜¯ÚˆÛÙÈÎ¤˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û˘ÁÎÂÎÚÈÌ¤Ó· Ê¿-ÛÌ·Ù· ·ÔÚÚfiÊËÛË˜, Ù· ÔÔ›· ÂÚÈ¤¯Ô˘Ó ·Ó·Ï˘-ÙÈÎ‹ ÏËÚÔÊÔÚ›· ÁÈ· ÙË ‚ÈÔ¯ËÌÈÎ‹ Î·Ù¿ÛÙ·ÛËÙË˜ ‰ÔÌ‹˜ ÌÂÙ¿ ÙË ¯ÚÒÛË. °È· Ó· Î·Ù·ÁÚ·ÊÔ‡ÓÎ·È Ó· ÌÂÏÂÙËıÔ‡Ó ÔÛÔÙÈÎ¿ Î·È Û˘ÁÎÚÈÙÈÎ¿ Ù·Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛË˜ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÌÂÙ¿ ÙË¯ÚÒÛË, ··ÈÙÔ‡ÓÙ·È ÙÂ¯ÓÈÎ¤˜ Ê·ÛÌ·ÙÈÎ‹˜ ·ÂÈ-ÎfiÓÈÛË˜, ÔÈ ÔÔ›Â˜ ı· ÌÔÚÔ‡Ó Ó· ·Ú¤¯Ô˘Ó Ê·-ÛÌ·ÙÈÎ‹ ÏËÚÔÊÔÚ›· ˘„ËÏ‹˜ ·Ó¿Ï˘ÛË˜ ÁÈ· Î¿ıÂÛËÌÂ›Ô ÙË˜ ÂÈÎfiÓ·˜.

°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ Ê·-ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ, ÌÂ ‰˘Ó·ÙfiÙËÙ· Ï‹„Ë˜ ÌÂ-Á¿ÏÔ˘ ·ÚÈıÌÔ‡ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ Î·È ·ÚÔ¯‹˜Ê¿ÛÌ·ÙÔ˜ ˘„ËÏ‹˜ ·Ó¿Ï˘ÛË˜ ÁÈ· Î¿ıÂ ¤Ó· ÛËÌÂ›ÔÙË˜ ÂÈÎfiÓ·˜. ∆Ô Û‡ÛÙËÌ· Â›Ó·È ÈÎ·Ófi Ó· ·Ó·‰Â›ÍÂÈÙÈ˜ ÌÈÎÚ¤˜ Ê·ÛÌ·ÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ Î˘ÙÙ·ÚÈ-ÎÒÓ ‰ÔÌÒÓ ÌÂÙ¿ ·fi ¯ÚÒÛË, ÔÈ ÔÔ›Â˜ ‰ÂÓ Â›Ó·ÈÔÚ·Ù¤˜ ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ Î·È ÌÂ ÙËÓ Î·-Ù¿ÏÏËÏË ÂÈÏÔÁ‹ Ê·ÛÌ·ÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Ó· Î·Ù·-ÁÚ¿ÊÂÙ·È Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚ¿ ÛÙ· Ê·ÛÌ·ÙÈÎ¿ ¯·-Ú·ÎÙËÚÈÛÙÈÎ¿ ·˘ÙÒÓ ÙˆÓ ‰ÔÌÒÓ.

∆Ô ·Ú·¿Óˆ Û‡ÛÙËÌ· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ·ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ·ÔÚÚfiÊËÛË˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿·fi ¯ÚÒÛË ÌÂ MGG Î·È ÙË ‰È¿ÎÚÈÛË ÌÂÙ·Í‡ Ê˘-ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓÌÔÚÊÔÏÔÁ›·˜ L1 ÛÙËÓ O§§.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

º·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ º·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ¤ÁÈÓÂ ÌÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔ-

ÛÎfiÈÔ, ÙÔ ÔÔ›Ô ‚·Û›˙ÂÙ·È ÛÂ ¤Ó· Û‡ÛÙËÌ· ÊˆÙÈÛÌÔ‡ ÌÂÌÂÙ·‚ÏËÙfi Ê›ÏÙÚÔ Ô˘ ÙÔÔıÂÙÂ›Ù·È ÛÙË ‰È·‰ÚÔÌ‹ ÊˆÙÈ-ÛÌÔ‡ ÙÔ˘ ÌÈÎÚÔÛÎÔ›Ô˘. ∆Ô ÌÂÙ·‚ÏËÙfi Ê›ÏÙÚÔ ‰È·‰›‰ÂÈÊˆ˜ ÛÙËÓ ÂÚÈÔ¯‹ 400 nm-1000 nm. ª›· ÂÍˆÙÂÚÈÎ‹ Ï¿-Ì· ·ÏÔÁfiÓÔ˘ ÈÛ¯‡Ô˜ 150 W ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙÔÓ Êˆ-ÙÈÛÌfi. ¢‡Ô fiÌÔÈÂ˜ Û˘ÛÙÔÈ¯›Â˜ ÔÙÈÎÒÓ ÈÓÒÓ ¯ÚËÛÈÌÔÔÈ-Ô‡ÓÙ·È ÁÈ· Ó· ÌÂÙ·Ê¤ÚÔ˘Ó ÙÔ Êˆ˜ ·fi ÙËÓ ËÁ‹ ÛÙÔ Ê›Ï-ÙÚÔ Î·È ·fi ÙÔ Ê›ÏÙÚÔ ÛÙË ‰È·‰ÚÔÌ‹ ÊˆÙÈÛÌÔ‡ ÙÔ˘ ÌÈÎÚÔ-ÛÎÔ›Ô˘. ∏ Ï‹„Ë ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ Á›ÓÂÙ·È ÌÂ ÙË‚Ô‹ıÂÈ· Ì›·˜ 8-bit ·ÛÚfiÌ·˘ÚË˜ Î¿ÌÂÚ·˜ ˘„ËÏ‹˜ ·Ó¿Ï˘-ÛË˜, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂÓ›Û¯˘ÛË ÙË˜ ÔÔ›·˜ ÂÏ¤Á¯ÔÓÙ·È·fi ÙÔÓ ˘ÔÏÔÁÈÛÙ‹ (∂ÈÎfiÓ· 1).

∆Ô Û‡ÛÙËÌ· ÏÂÈÙÔ˘ÚÁÂ› ÛÂ ‰‡Ô Ê¿ÛÂÈ˜ (Ê·ÛÌ·ÙÔÛÎÔ-›· Î·È Ê·ÛÌ·ÙÔÌÂÙÚ›·). ∏ ÚÒÙË ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÙË˜ÂÈÏÔÁ‹˜ ÙÔ˘ Ì‹ÎÔ˘˜ Î‡Ì·ÙÔ˜ ·ÂÈÎfiÓÈÛË˜ Î·È ÙË˜ ·Ó¿-‰ÂÈÍË˜ ÙË˜ ÂÈı˘ÌËÙ‹˜ Ê·ÛÌ·ÙÈÎ‹˜ ÂÈÎfiÓ·˜, ÂÓÒ Ë ‰Â‡ÙÂ-ÚË Î¿ÓÂÈ Û˘ÓÙÔÓÈÛÌ¤ÓË Ê·ÛÌ·ÙÈÎ‹ Û¿ÚˆÛË, Ï‹„Ë ÂÈÎfiÓˆÓÎ·È ÙÂÏÈÎfi ˘ÔÏÔÁÈÛÌfi ÂÓfi˜ Ï‹ÚÔ˘˜ Ê¿ÛÌ·ÙÔ˜ ·ÔÚÚfi-ÊËÛË˜ ÛÂ Î¿ıÂ ÛËÌÂ›Ô ÙË˜ ÂÈÎfiÓ·˜. ™ÙË Ê¿ÛË Ê·ÛÌ·ÙÔÌÂ-ÙÚ›·˜, ÙÔ Û‡ÛÙËÌ· ÂÎÙÂÏÂ› Û˘Á¯ÚÔÓÈÛÌ¤ÓË Ú‡ıÌÈÛË Ì‹ÎÔ˘˜Î‡Ì·ÙÔ˜ ÌÂ Ï‹„Ë Î·È ·Ôı‹ÎÂ˘ÛË ÙË˜ ˘fi ·Ó¿Ï˘ÛË Â-ÚÈÔ¯‹˜. ∞fi ÙÔ ·ÔıËÎÂ˘Ì¤ÓÔ Û‡ÓÔÏÔ ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110


105º·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÛÂ ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ÏÂÌÊÔ‚Ï¿ÛÙÂ˜

ÂÈÎfiÓˆÓ (Ê·ÛÌ·ÙÔÛÎÔ›·) ¤Ó· Ê¿ÛÌ· ·ÔÚÚfiÊËÛË˜ (Ê·-

ÛÌ·ÙÔÌÂÙÚ›·) ÌÔÚÂ› Ó· ˘ÔÏÔÁÈÛÙÂ› Î·È Ó· ÂÈ‰ÂÈ¯ÙÂ› ÁÈ·

Î¿ıÂ ÛËÌÂ›Ô ÙË˜ ÂÈÎfiÓ·˜. ªÂ ÙËÓ ÂÚÈÁÚ·ÊfiÌÂÓË ‰È¿Ù·ÍË

Â›Ó·È ‰˘Ó·Ùfi Ó· ÏËÊıÔ‡Ó Î·È Ó· ˘ÔÛÙÔ‡Ó ÂÂÍÂÚÁ·Û›·

¤Ó· ÂÎ·ÙÔÌÌ‡ÚÈÔ Ê¿ÛÌ·Ù· ÛÂ ÂÚ›Ô˘ ¤Ó· ÏÂÙfi (4-7).

¶ÔÛÔÙÈÎ‹ ÂÎÙ›ÌËÛË Ê·ÛÌ·ÙÈÎÒÓ ‰È·ÊÔÚÒÓ ∆Ô Û‡ÛÙËÌ· Î¿ÓÂÈ ·˘ÙfiÌ·ÙË Ê·ÛÌ·ÙÈÎ‹ Û¿ÚˆÛË ÙÔ˘

˘fi ÂÍ¤Ù·ÛË ·Ú·ÛÎÂ˘¿ÛÌ·ÙÔ˜ Î·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfi-

ÊËÛË˜ ÛÙËÓ ÂÚÈÔ¯‹ 400 nm-1000 nm ÌÂÙÚÔ‡ÓÙ·È ÁÈ· Î¿-

ıÂ ¤Ó· ÛËÌÂ›Ô ÙË˜ ÂÈÎfiÓ·˜. ∂›ÛË˜, Ê·ÛÌ·ÙÈÎ¤˜ ÂÈÎfiÓÂ˜

ÌÔÚÔ‡Ó Ó· ‰ÂÈ¯ÙÔ‡Ó ÛÂ Î¿ıÂ Ì‹ÎÔ˜ Î‡Ì·ÙÔ˜. ªÂ ‚¿ÛË Ù·

Ê¿ÛÌ·Ù· Ô˘ ÌÂÙÚÔ‡ÓÙ·È, Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· Î·ıÔÚ›ÛÂÈ

ÙÈ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙË Ì¤ÁÈ-

ÛÙË ·ÔÚÚfiÊËÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ‰ÔÌÒÓ Ô˘ ÙÔÓ ÂÓ‰È·-

Ê¤ÚÔ˘Ó Î·È ÛÙË Ì¤ÁÈÛÙË ·ÓÙ›ıÂÛË ÌÂÙ·Í‡ Î˘ÙÙ·ÚÈÎÒÓ ‰Ô-

ÌÒÓ ÌÂ ‰È·ÊÔÚÂÙÈÎ‹ ‚ÈÔ¯ËÌÈÎ‹ Û‡ÓıÂÛË.

∞ÊÔ‡ Î·ıÔÚÈÛÙÔ‡Ó ÔÈ Ê·ÛÌ·ÙÈÎ¤˜ ÂÚÈÔ¯¤˜ (400 nm-

1000 nm), ÔÈ Ê·ÛÌ·ÙÈÎ¤˜ ÂÈÎfiÓÂ˜ ÛÂ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÔ¯¤˜

·Ó·Î·ÏÔ‡ÓÙ·È ·fi ÙÔ ·ÔıËÎÂ˘Ì¤ÓÔ Û‡ÓÔÏÔ Ê·ÛÌ·ÙÈÎÒÓ

ÂÈÎfiÓˆÓ Î·È Ë Ê·ÛÌ·ÙÈÎ‹ ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛË˜ Ar(x,y) ‹

ÈÛÔ‰‡Ó·Ì· Ô ÏÔÁ¿ÚÈıÌÔ˜ ÙÔ˘ ÏfiÁÔ˘ ÙˆÓ ÂÓÙ¿ÛÂÒÓ ÙÔ˘˜,

˘ÔÏÔÁ›˙ÂÙ·È ÌÂ ‚¿ÛË ÙËÓ ·ÎfiÏÔ˘ıË ÂÍ›ÛˆÛË:

Ar(x,y) = AÏi(x,y) - AÏj(x,y) = log IÏi(x,y) (1),IÏj(x,y)

fiÔ˘ ∞Ïi(x,y), ∞Ïj(x,y) Î·È IÏi(x,y), IÏj(x,y) Â›Ó·È ÔÈ Î·Ù·ÓÔ-

Ì¤˜ ·ÔÚÚfiÊËÛË˜ Î·È ¤ÓÙ·ÛË˜ ·ÓÙ›ÛÙÔÈ¯·, ÙˆÓ Ê·ÛÌ·ÙÈ-

ÎÒÓ ÂÈÎfiÓˆÓ Ô˘ ¤¯Ô˘Ó ÌÂÙÚËıÂ› ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜ Ïi Î·È

Ïj, ·ÓÙ›ÛÙÔÈ¯· (8-12).

∂È¯Ú›ÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (¯ÚÒÛË May-Grunwald-Giemsa, MGG)

ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÈ¯Ú›ÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ

·fi 30 ·È‰È¿ ËÏÈÎ›·˜ 2-14 ÂÙÒÓ (12 ·È‰È¿ ÌÂ O§§ ÛÙËÓ

ÚˆÙÔ‰È¿ÁÓˆÛË Î·È 18 ·È‰È¿ ÛÙ· ÔÔ›· ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ·

Â›¯Â Á›ÓÂÈ ÁÈ· ‰ÈÂÚÂ‡ÓËÛË ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ÂÌ‡ÚÂÙÔ˘ ‹

·Ó·ÈÌ›·˜ ‹ ıÚÔÌ‚ÔÂÓ›·˜ ‹ Ô˘‰ÂÙÂÚÔÂÓ›·˜). ∏ ¯ÚÒÛË

MGG ÙˆÓ ÂÈ¯ÚÈÛÌ¿ÙˆÓ ¤ÁÈÓÂ ÛÂ ·ÈÌ·ÙÔÏÔÁÈÎfi ÂÚÁ·ÛÙ‹-

ÚÈÔ ÌÂ ÙÔ Û‡ÓËıÂ˜ ÚˆÙfiÎÔÏÏÔ.

∏ ¯ÚˆÛÙÈÎ‹ May-Grunwald ·ÔÙÂÏÂ›Ù·È ·fi Î˘·ÓÔ‡Ó

ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (methylene blue - MB) Î·È ËˆÛ›ÓË À (eosinY - EY) ÛÂ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜. ∏ ¯ÚˆÛÙÈÎ‹Giemsa ·ÔÙÂÏÂ›Ù·È ·fi Ù· ›‰È· Û˘ÛÙ·ÙÈÎ¿ ÌÂ ÙÔ ÚÒÙÔÎ·È ÂÈÏ¤ÔÓ ÔÍÂÈ‰ˆÙÈÎ¿ ·Ú¿ÁˆÁ· ÙÔ˘ Î˘·ÓÔ‡ ÙÔ˘ ÌÂı˘-ÏÂÓ›Ô˘ (MB azures), fiˆ˜ ÙÔ Î˘·ÓÔ‡Ó ÙË˜ ·ÓÈÏ›ÓË˜ (azureB). ∆Ô ÂÚÈÂ¯fiÌÂÓÔ ÙË˜ Giemsa ÛÂ ÔÍÂÈ‰ˆÙÈÎ¿ ·Ú¿ÁˆÁ·ÙÔ˘ Î˘·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ Î·ıÔÚ›˙ÂÈ Ù· ·ÎÚÈ‚‹ Ê·ÛÌ·ÙÈ-Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ·ÔÚÚfiÊËÛ‹˜ ÙË˜ (13).

OÈ ¯ÚˆÛÙÈÎ¤˜ ·fi ÙË MGG ÚÔÛÎÔÏÏÒÓÙ·È ÛÙÈ˜ Î˘Ù-Ù·ÚÈÎ¤˜ ‰ÔÌ¤˜ ÌÂ ËÏÂÎÙÚÔÛÙ·ÙÈÎ¤˜ Î·È ˘‰ÚÔÊÔ‚ÈÎ¤˜·ÓÙÈ‰Ú¿ÛÂÈ˜ Î·È ÙÔ ÔÛfi ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË˜ ¯ÚˆÛÙÈ-Î‹˜ Î·ıÔÚ›˙ÂÙ·È ·fi Ù· ‚ÈÔ¯ËÌÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓÎ˘ÙÙ¿ÚˆÓ (14,15).

µ¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ, Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛË˜ Î˘ÙÙ·-ÚÈÎÒÓ ‰ÔÌÒÓ ÌÂ ÙËÓ ·Ú·¿Óˆ ¯ÚÒÛË ÂÍ·ÚÙÒÓÙ·È ·fi Ù·‚ÈÔ¯ËÌÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÙÔ˘˜. ∏ ÂÎÙ›ÌËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·-Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛË˜ ‰›ÓÂÈ ÛËÌ·ÓÙÈÎ‹ ÏËÚÔÊÔÚ›·ÁÈ· ÙË ‚ÈÔ¯ËÌÈÎ‹ Î·È ‰ÔÌÈÎ‹ Î·Ù¿ÛÙ·Û‹ ÙÔ˘˜ Ô˘ ‰ÂÓ Â›Ó·È‰˘Ó·ÙfiÓ Ó· ‰È·ÎÚÈıÂ› ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ Ó· ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ·Ú¿ÌÂÙÚÔÁÈ· ÙËÓ Ù˘ÔÔ›ËÛË Î·È Ù·ÍÈÓfiÌËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·

º·ÛÌ·ÙÈÎ‹ ·Ó¿Ï˘ÛË ÌÂÙ¿ ·fi ¯ÚÒÛË ÙˆÓÎ˘ÙÙ¿ÚˆÓ ÌÂ MGG

∞Ú¯ÈÎ¿ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfi-ÊËÛË˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÙË˜ MGG ¯ÚˆÛÙÈÎ‹˜ Î·È‰È·ÊfiÚˆÓ Î˘ÙÙ¿ÚˆÓ ·fi ÂÈ¯Ú›ÛÌ·Ù· Ì˘ÂÏÔ‡ÙˆÓ ÔÛÙÒÓ ·È‰ÈÒÓ ¯ˆÚ›˜ Î·ÎÔ‹ıÂÈ·. ŒÓ· Ï‹ÚÂ˜Ê¿ÛÌ· ·ÔÚÚfiÊËÛË˜ ÁÈ· Î¿ıÂ ÛËÌÂ›Ô ÙË˜ ÂÈÎfi-Ó·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË ˘ÔÏÔÁ›ÛÙË-ÎÂ ÌÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ.

™ÙËÓ ∂ÈÎfiÓ· 2 Ê·›ÓÂÙ·È ÙÔ Ê¿ÛÌ· ·ÔÚÚfiÊË-ÛË˜ ÙˆÓ May-Grunwald Î·È Giemsa ¯ÚˆÛÙÈÎÒÓ.™ÙË ¯ÚÒÛË May-Grunwald, Ë ËˆÛ›ÓË À (∂À)·ÔÚÚÔÊ¿ ÛÙ· 515 nm, ÂÓÒ ÛÙË Giemsa ÛÙ· 518nm. ∆Ô Î˘·ÓÔ‡Ó ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (ªµ) ·ÔÚÚÔÊ¿

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110

∂∂ÈÈÎÎfifiÓÓ·· 11.. ™‡ÛÙËÌ· Ê·ÛÌ·ÙÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘.

ªÂÙ·‚ÏËÙfi Ê›ÏÙÚÔ

√ÙÈÎ¤˜ ›ÓÂ˜

√ÙÈÎ¤˜ ›ÓÂ˜

™‡ÛÙËÌ· ÊˆÙÈÛÌÔ‡

§¿Ì·

➝∫¿ÌÂÚ·


106

ÛÙËÓ MG ÛÙ· 660 nm, ÂÓÒ ÛÙË Giemsa Ù· ÔÍÂÈ‰ˆ-

ÙÈÎ¿ ·Ú¿ÁˆÁ· ÙÔ˘ Î˘·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (ªµ

azure) ÛÙ· 558 nm Î·È 625 nm.

∏ ∂ÈÎfiÓ· 3 ‰Â›¯ÓÂÈ ¤Ó· Â‰›Ô ·ÈÌ·ÙÔÏÔÁÈÎÔ‡

·Ú·ÛÎÂ˘¿ÛÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ·È‰›

¯ˆÚ›˜ Î·ÎÔ‹ıÂÈ· ÌÂÙ¿ ·fi ¯ÚÒÛË ÌÂ MGG. ∆Ô

Â‰›Ô ÂÚÈ¤¯ÂÈ ÏÂÌÊÔÎ‡ÙÙ·ÚÔ, ÂÚ˘ıÚÔ‚Ï¿ÛÙË,

ÌÔÓÔÎ‡ÙÙ·ÚÔ, ËˆÛÈÓfiÊÈÏÔ, ÔÏ˘ÌÔÚÊÔ‡ÚËÓÔ,

ÂÚ˘ıÚoÎ‡ÙÙ·ÚÔ. ∏ ÔÛÔÙÈÎ‹ Ì¤ÙÚËÛË ÙÔ˘ ¯ÚˆÌ·-

ÙÈÛÌÔ‡ ·Ó·‰ÂÈÎÓ‡ÂÙ·È ·fi ÙÔ Ê¿ÛÌ· ·ÔÚÚfiÊË-

ÛË˜ Ô˘ ÔÚ›˙ÂÙ·È ÁÈ· ÙÔ Î¿ıÂ ÛËÌÂ›Ô ÙË˜ ÂÈÎfiÓ·˜.

™ÙËÓ ∂ÈÎfiÓ· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ê¿ÛÌ·Ù·

·ÔÚÚfiÊËÛË˜ ÙÔ˘ ˘Ú‹Ó· Î·È ÙÔ˘ Î˘ÙÙ·ÚÔÏ¿-

ÛÌ·ÙÔ˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙË˜ ∂ÈÎfiÓ·˜ 3. ∆· Ê¿ÛÌ·-

Ù· ‰ÂÓ ¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ·ÔÚÚfiÊËÛË ÌÂÙ¿

Ù· 800 nm. ∏ Û‡ÁÎÚÈÛË ÙˆÓ Ê·ÛÌ¿ÙˆÓ ·ÔÚÚfi-

ÊËÛË˜ ÙË˜ MG Î·È Giemsa ÌÂ Ù· Ê¿ÛÌ·Ù· ·ÔÚ-ÚfiÊËÛË˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·Ó¤‰ÂÈÍÂ ÙÈ˜ ·ÏÏ·Á¤˜ ÙˆÓÈ‰ÈÔÙ‹ÙˆÓ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ fiÙ·Ó Û˘Ó‰¤ÔÓÙ·È ÌÂ Ù·Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ Î˘ÙÙ¿ÚˆÓ. OÈ ‰È·ÎÚÈÙ¤˜ ÎÔÚ˘Ê¤˜(pick) ÙˆÓ Î·Ì˘ÏÒÓ ÙˆÓ Ê·ÛÌ¿ÙˆÓ ·ÔÚÚfiÊË-ÛË˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ ÌÂÙ·Û¯ËÌ·-Ù›ÛÙËÎ·Ó ÛÂ Ì›· ÌÔÓ·‰ÈÎ‹ ÎÔÚ˘Ê‹ Â˘ÚÂ›·˜ ÂÚÈÔ-¯‹˜ ÌÂÙ·Í‡ 530-570 nm fiÙ·Ó ·˘Ù¤˜ ¤¯Ô˘Ó ·ÓÙÈ-‰Ú¿ÛÂÈ ÌÂ Ù· Î‡ÙÙ·Ú· (∂ÈÎfiÓÂ˜ 2 Î·È 4).

™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ì‹ÎË Î‡-Ì·ÙÔ˜ Ì¤ÁÈÛÙË˜ Ê·ÛÌ·ÙÈÎ‹˜ ·ÔÚÚfiÊËÛË˜ ˘Ú‹-Ó· Î·È Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ÁÈ· Î¿ıÂ Î‡ÙÙ·ÚÔ. ™Ù·ÂÚ˘ıÚoÎ‡ÙÙ·Ú·, Ë ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÔÚÚÔÊ¿ ÛÙ·420 nm, Ë ËˆÛ›ÓË À ÛÙ· 530 nm Î·È Ù· ÔÍÂÈ‰ˆÙÈ-Î¿ ·Ú¿ÁˆÁ· ÙÔ˘ Î˘·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (ªµazures) ÛÙ· 630 nm.

∞fi Ù· ·Ú·¿Óˆ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÏfiÁˆÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÙˆÓÊ˘ÛÈÔÏÔÁÈÎÒÓ Ù‡ˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË,Â›Ó·È ‰È·ÊÔÚÂÙÈÎ¿ Î·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ‹˜ÙÔ˘˜. ¢È·ÊÔÚ¤˜ ÛÙ· ‚ÈÔ¯ËÌÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿˘¿Ú¯Ô˘Ó ÙfiÛÔ ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ù‡ˆÓÊ˘ÛÈÔÏÔÁÈÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÛÙËÓ ÂÚ›ÙˆÛËÓÂÔÏ·ÛÌ·ÙÈÎ‹˜ ÂÍ·ÏÏ·Á‹˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

¢È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓÎ·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 ÌÂ ÙË Ê·-ÛÌ·ÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ Ì¤ıÔ‰Ô˜ ÙË˜ Ê·ÛÌ·ÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ ¯ÚËÛÈ-ÌÔÔÈ‹ıËÎÂ ÁÈ· ÙË ‰È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌ-ÊÔÎ˘ÙÙ¿ÚˆÓ ·fi ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ ÌÔÚÊÔÏÔÁ›·˜ L1

ÛÂ ·Ú·ÛÎÂ˘¿ÛÌ·Ù· Ô˘ Â›¯·Ó ÂÈÛÙÚˆıÂ› Î·È‚·ÊÂ› ÁÈ· ÌÂÏ¤ÙË ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ. ∏ Ì¤-ıÔ‰Ô˜ ‚·Û›ÛÙËÎÂ ÛÙË Û˘ÁÎÚÈÙÈÎ‹ ÂÎÙ›ÌËÛË ÙˆÓÊ·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110

400 450 500 550 600 650 700 750 800

1,0

0,8

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EY515 nm

EY518 nm

MB/Azure558 nm

MB/Azure625 nm

MB660 nm

ª‹ÎÔ˜ Î‡Ì·ÙÔ˜ (nm)

∞

ÔÚ

Úfi

ÊË

ÛË

May-GrunwaldGiemsa

➝

➝

➝

➝

∂∂ÈÈÎÎfifiÓÓ·· 22.. ∆· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛË˜ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ May-Grunwald Î·È Giemsa.

∂∂ÈÈÎÎfifiÓÓ·· 33.. ¶Â‰›Ô Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ·Ú·-ÛÎÂ˘¿ÛÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.

¡. ∫·Ù˙ËÏ¿ÎË˜ Î·È Û˘Ó.



ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÂ Û¯¤ÛË ÌÂ

ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ ÌÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfi-

ÈÔ. °È· Ó· Î·ıÔÚÈÛÙÔ‡Ó Ù· Ê·ÛÌ·ÙÈÎ¿ ¯·Ú·ÎÙË-

ÚÈÛÙÈÎ¿ ÙˆÓ ·Ú·¿Óˆ ‰‡Ô Î˘ÙÙ·ÚÈÎÒÓ Ù‡ˆÓ

ÌÂÙÚ‹ıËÎ·Ó Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛË˜ ÌÂÁ¿ÏÔ˘

·ÚÈıÌÔ‡ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌ-

ÊÔ‚Ï·ÛÙÒÓ. ∏ Ì¤ÛË ÙÈÌ‹ Ê·ÛÌ·ÙÈÎ‹˜ ·ÔÚÚfi-

ÊËÛË˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ì‹ÎÔ˜ Î‡Ì·ÙÔ˜ Ê·›ÓÂÙ·È

ÛÙËÓ ∂ÈÎfiÓ· 5.

∫¿ıÂ Î·Ì‡ÏË ·ÔÙ¤ÏÂÛÂ ÙË Ì¤ÛË ÙÈÌ‹ ·fi

Ê¿ÛÌ·Ù· ÛËÌÂ›ˆÓ ÙË˜ ÂÈÎfiÓ·˜ ·fi 150 ÏÂÌÊÔ-

Î‡ÙÙ·Ú· ·È‰ÈÒÓ ¯ˆÚ›˜ Î·ÎÔ‹ıÂÈ· Î·È Ê¿ÛÌ·Ù·

·fi 150 ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ ·È‰ÈÒÓ ÌÂ O§§. ∆· Ê¿-

ÛÌ·Ù· ·ÔÚÚfiÊËÛË˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÂÈÎ·-

Ï‡ÙÔ˘Ó ·˘Ù¿ ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÛÂ fiÏË ÙËÓ Â-

ÚÈÔ¯‹, ¤¯ÔÓÙ·˜ ÌfiÓÔ ÌÈÎÚ¤˜ Ê·ÛÌ·ÙÈÎ¤˜ ‰È·ÊÔ-

Ú¤˜. ∏ Ì¤ÁÈÛÙË ·ÔÚÚfiÊËÛË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙ· 535 nm Î·È ÙˆÓ ÏÂÌÊÔ‚Ï·-

ÛÙÒÓ ÛÙ· 545 nm. ∆· ÏÂÌÊÔÎ‡ÙÙ·Ú· ¤¯Ô˘Ó ·˘ÍË-

Ì¤ÓË Ì¤ÛË ·ÔÚÚfiÊËÛË ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÏÂÌÊÔ-

‚Ï¿ÛÙÂ˜ Î·È ÛÙ· 630 nm Ë ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙÔ˘˜

¤¯ÂÈ ÙË Ì¤ÁÈÛÙË ÙÈÌ‹. ™Â ·˘Ù‹ ÙË Ê·ÛÌ·ÙÈÎ‹ Â-ÚÈÔ¯‹ Î·Ù·ÁÚ¿ÊÂÙ·È Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚÔÔ›ËÛËÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê·ÛÌ¿ÙˆÓ. ∂ÈÏ¤ÔÓ, Ë ÛÙ·ıÂÚ‹·fiÎÏÈÛË (standard deviation) ÙË˜ ·ÔÚÚfiÊËÛË˜·›ÚÓÂÈ ÙËÓ ÂÏ¿¯ÈÛÙË ÙÈÌ‹. ∏ Ê·ÛÌ·ÙÈÎ‹ ÂÈÎfiÓ·ÙË˜ Ï·Ì‚·ÓfiÌÂÓË˜ ‰È·ÊÔÚ¿˜ ÌÂÙ·Í‡ Ê˘ÛÈÔÏÔÁÈ-ÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ O§§Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 6.

™ÙËÓ ÂÈÎfiÓ· ·˘Ù‹ ·ÂÈÎÔÓ›˙ÔÓÙ·È Ê˘ÛÈÔÏÔÁÈ-Î¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· (2∞), O§§ ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ (2µ)Î·È ¤Ó· ˘ÔÛ‡ÓÔÏÔ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ ÛÙ· 420nm, 535 nm, 545 nm, 630 nm Î·È 700 nm. ªÂ ‚¿-ÛË ÙÈ˜ Ê·ÛÌ·ÙÈÎ¤˜ Î·Ì‡ÏÂ˜ ÙË˜ ∂ÈÎfiÓ·˜ 4, ÔÈ ÂÈ-ÎfiÓÂ˜ ÛÙ· 535 nm Î·È 545 nm ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÌ¤ÁÈÛÙË Ê·ÛÌ·ÙÈÎ‹ ·ÔÚÚfiÊËÛË ÁÈ· ÏÂÌÊÔÎ‡Ù-Ù·Ú· Î·È ÏÂÌÊÔ‚Ï¿ÛÙÂ˜, ·ÓÙ›ÛÙÔÈ¯·. ™Ù· 630 nmÎ·Ù·ÁÚ¿ÊÂÙ·È Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂÙ·Í‡ÙÔ˘˜. ¶·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙË˜ Ê·ÛÌ·ÙÈÎ‹˜·ÔÚÚfiÊËÛË˜ ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÛÂ Û¯¤ÛË ÌÂÂÎÂ›ÓË ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ.

™Â ÌÈÎÚfiÙÂÚ· Î·È ÌÂÁ·Ï‡ÙÂÚ· Ì‹ÎË Î‡Ì·ÙÔ˜,Ë ·ÔÚÚfiÊËÛË ÚÔÔ‰Â˘ÙÈÎ¿ ÌÂÈÒÓÂÙ·È. ∞˘Ùfi Â›-Ó·È ÂÌÊ·Ó¤˜ ÛÙÈ˜ ÂÈÎfiÓÂ˜ ÌÂ 420 nm Î·È 700 nm.∆· ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· Î·Ù·ÁÚ¿ÊÔÓÙ·È ÌÂ Ì¤ÁÈÛÙË·ÓÙ›ıÂÛË ÛÙ· 420 nm ÂÍ·ÈÙ›·˜ ÙË˜ ·˘ÍËÌ¤ÓË˜·ÔÚÚfiÊËÛË˜ ·fi ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË.

°È· Ó· ÂÎÙÈÌËıÔ‡Ó ÔÛÔÙÈÎ¿ ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ‰‡Ô Î˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÌÂÙÚ‹ıËÎÂ Ë ‰È·ÊÔÚ¿ÛÙË Ê·ÛÌ·ÙÈÎ‹ ·ÔÚÚfiÊËÛË (Ar) ÌÂ ‚¿ÛË ÙËÓ ÂÍ›-ÛˆÛË 1 ÛÂ 150 Î‡ÙÙ·Ú· ·fi 18 ·È‰È¿ ¯ˆÚ›˜ Î·-ÎÔ‹ıÂÈ· Î·È ÛÂ 150 Î‡ÙÙ·Ú· ·fi 12 ·È‰È¿ ÌÂ O§§.∂ÈÏ¤¯ıËÎÂ Ë ‰È·ÊÔÚ¿ ÛÙËÓ ·ÔÚÚfiÊËÛË ÛÙ· Ì‹-ÎË Î‡Ì·ÙÔ˜ 545 nm Î·È 630 nm. ™ÙËÓ ∂ÈÎfiÓ· 7

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110

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0,1 400 450 500 550 600 650 700 750 800

∏ˆÛÈÓfiÊÈÏÔ 0,8

0,7

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0,3

0,2

0,1 400 450 500 550 600 650 700 750 800

∂Ú˘ıÚÔÎ‡ÙÙ·ÚÔ


A

ÔÚ

Úfi

ÊË

ÛË

∂∂ÈÈÎÎfifiÓÓ·· 44.. ∏ ·ÔÚÚfiÊËÛË ˘Ú‹Ó· Î·È Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ‰È·ÊfiÚˆÓ Ù‡ˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË ÌÂ MGG ÁÈ· ÙÔ·ÓÙ›ÛÙÔÈ¯Ô Ì‹ÎÔ˜ Î‡Ì·ÙÔ˜.

¶¶››ÓÓ··ÎÎ··˜̃ 11.. ª‹ÎË Î‡Ì·ÙÔ˜ (nm) ÌÂ Ì¤ÁÈÛÙË Ê·ÛÌ·ÙÈÎ‹·ÔÚÚfiÊËÛË ÙÔ˘ ˘Ú‹Ó· Î·È ÙÔ˘ Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ‰È·-ÊfiÚˆÓ Ù‡ˆÓ Î˘ÙÙ¿ÚˆÓ

∆∆‡‡ÔÔ˜̃ ÎÎ˘̆ÙÙÙÙ¿¿ÚÚÔÔ˘̆ ¶¶˘̆ÚÚ‹‹ÓÓ··˜̃ ∫∫˘̆ÙÙÙÙ··ÚÚfifiÏÏ··ÛÛÌÌ··

§ÂÌÊÔÎ‡ÙÙ·ÚÔ 535 570¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓÔ 545 535ªÔÓÔÎ‡ÙÙ·ÚÔ 550 560∂Ú˘ıÚÔ‚Ï¿ÛÙË 545 570∏ˆÛÈÓfiÊÈÏÔ 530, 640 550∂Ú˘ıÚÔÎ‡ÙÙ·ÚÔ - 420, 530, 630


108 ¡. ∫·Ù˙ËÏ¿ÎË˜ Î·È Û˘Ó.

Ê·›ÓÂÙ·È ÙÔ ÈÛÙfiÁÚ·ÌÌ· ÙË˜ ˘ÔÏÔÁÈ˙fiÌÂÓË˜ ‰È·-

ÊÔÚ¿˜ ·ÔÚÚfiÊËÛË˜ ÁÈ· ÙÔ˘˜ ‰‡Ô ÏËı˘ÛÌÔ‡˜.

∆Ô ÈÛÙfiÁÚ·ÌÌ· ¤‰ÂÈÍÂ fiÙÈ Ù· Î‡ÙÙ·Ú· ‰È·¯ˆ-

Ú›˙ÔÓÙ·È ÛÂ 2 ÌÂ›˙ÔÓÂ˜ ÏËı˘ÛÌÔ‡˜ ÌÂ ‚¿ÛË ÙË

Ê·ÛÌ·ÙÈÎ‹ ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛË˜ ÛÙÔ 545 nm

Î·È 630 nm. ∏ Ì¤ÛË ÙÈÌ‹ ‚Ú¤ıËÎÂ Ó· Â›Ó·È 0,149

(SD: 0,064) ÁÈ· Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È

0,352 (SD: 0,055) ÁÈ· ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙÂ˜. ∏ ‰È·-

ÊÔÚ¿ ·˘Ù‹ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿

ÛËÌ·ÓÙÈÎ‹ (p<0,00005).

™ÙËÓ ∂ÈÎfiÓ· 8 ‰È·ÎÚ›ÓÔÓÙ·È ÌÂ ÙÂ¯ÓËÙfi ¯Úˆ-

Ì·ÙÈÛÌfi („Â˘‰Ô¯ÚˆÌ·ÙÈÎ‹ ÂÈÎfiÓ·) ÔÈ ‰È·ÊÔÚ¤˜

Ê·ÛÌ·ÙÈÎ‹˜ ·ÔÚÚfiÊËÛË˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

(3A) Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ (3µ) ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜

545 nm Î·È 630 nm, ÔÈ ÔÔ›Â˜ Î˘Ì·›ÓÔÓÙ·È fiˆ˜

Ê·›ÓÂÙ·È Î·È ÛÙËÓ ∂ÈÎfiÓ· 7 ÛÂ ÎÏ›Ì·Î· ·fi 0 ¤ˆ˜

0,5 Ô˘ ÛÙËÓ ¤Á¯ÚˆÌË ÂÈÎfiÓ· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÓ

ÂÚÈÔ¯‹ ·fi ÙÔ ÌÏÂ ¤ˆ˜ ÙÔ ÎfiÎÎÈÓÔ. ∆· Ê˘ÛÈÔ-

ÏÔÁÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ ¤¯Ô˘Ó

ÌÈÎÚ‹ ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛË˜ (Ì¤ÛË ÙÈÌ‹: 0,149)

ÏËÛÈ¤ÛÙÂÚ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÏÂ, ÂÓÒ ÔÈ ÏÂÌ-

ÊÔ‚Ï¿ÛÙÂ˜ ÌÂÁ·Ï‡ÙÂÚË ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛË˜

(Ì¤ÛË ÙÈÌ‹: 0,352) Î·È ÏËÛÈ¤ÛÙÂÚ· ÛÙËÓ ÂÚÈÔ¯‹

ÙÔ˘ ÎfiÎÎÈÓÔ˘.

™˘˙‹ÙËÛË

∏ ‰ÔÌ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÈ‰ÈÎfiÙÂÚ· ÙÔ˘ ˘-

Ú‹Ó·, Ô˘ÛÈ·ÛÙÈÎ¿ ·ÓÙ·Ó·ÎÏ¿ ÙË ÌÂÙ·‚ÔÏÈÎ‹ Î·Ù¿-

ÛÙ·ÛË Î·È ÙË Ê˘ÛÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ

Û˘ÛÙ·ÙÈÎÒÓ ÙÔ˘. ™ÙËÓ Î·ÎÔ‹ıË ÂÍ·ÏÏ·Á‹ Ï·Ì‚¿-

ÓÂÈ ¯ÒÚ· Ì›· ÛÂÈÚ¿ ·fi ‰ÔÌÈÎ¤˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ÌÂ-

Ù·‚ÔÏ¤˜ ÛÙÔ DNA, ÛÙÔ RNA, ÛÙÈ˜ ÚˆÙÂ˝ÓÂ˜ Î·È

ÛÙ· ·ÓfiÚÁ·Ó· ˘ÏÈÎ¿ ÙˆÓ Î˘ÙÙ¿ÚˆÓ. ∞˘Ù¤˜ ÔÈ ÌÂÙ·-

‚ÔÏ¤˜, ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜, ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜

ÌÂÙ¿ ·fi ¯ÚÒÛË ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ (16).

ªÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ Î·È ÙË Ì¤ıÔ‰Ô

Ê·ÛÌ·ÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ Â›Ó·È ÂÊÈÎÙ‹ Ë ‰È¿ÎÚÈÛË

‰È·ÊfiÚˆÓ Ù‡ˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ ‚¿ÛË ÙËÓ ·Ó›¯ÓÂ˘-

ÛË, Ù·˘ÙÔÔ›ËÛË Î·È ¯·ÚÙÔÁÚ¿ÊËÛË ÙË˜ Î·Ù·ÓÔ-

Ì‹˜ ÙˆÓ ·ÔÚÚÔÊÔ‡ÌÂÓˆÓ ¯ÚˆÛÙÈÎÒÓ ·fi Ù·

Î‡ÙÙ·Ú·, Î·ıÒ˜ Î·È ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈ-

ÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ‹˜ ÙÔ˘˜. ∏ ÏËÚÔÊÔÚ›· Ô˘

Ï·Ì‚¿ÓÂÙ·È ‚·Û›˙ÂÙ·È ÛÙË ‚ÈÔ¯ËÌÈÎ‹, ÏÂÈÙÔ˘ÚÁÈ-

Î‹ Î·È ‰ÔÌÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ Î·È ‰›ÓÂÈ

¤ÙÛÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó¿‰ÂÈÍË˜ ‰È·ÊÔÚÒÓ ÛÂ ·-

Ú·Ï‹ÛÈ· Ì‹ÎË Î‡Ì·ÙÔ˜ Ô˘ ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜ ÌÂ

ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ.

∆Ô Û˘ÁÎÂÎÚÈÌ¤ÓÔ Û‡ÛÙËÌ·, Ô˘ ‚·Û›˙ÂÙ·È ÛÙË

Û‡Á¯ÚÔÓË ÙÂ¯ÓÔÏÔÁ›·, ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈÎ¿ ÏÂÔ-

ÓÂÎÙ‹Ì·Ù· ÌÂ Î˘ÚÈfiÙÂÚ· ÙËÓ Â˘ÚÂ›· Ê·ÛÌ·ÙÈÎ‹

ÂÚÈÔ¯‹ ÏÂÈÙÔ˘ÚÁ›·˜, ÙËÓ ˘„ËÏ‹ ‰È·ÂÚ·ÙfiÙËÙ·

Î·È Ê·ÛÌ·ÙÈÎ‹ ·Ó¿Ï˘ÛË ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ Ù·-

¯‡Ù·ÙË Ï‹„Ë ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfi-

ÓˆÓ. ∞˘Ùfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÚÔ¯‹ ÏË-

ÚÔÊÔÚ›·˜ ÌÂ ÌÔÚÊ‹ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÈÎfiÓˆÓ. OÈ

ÂÈÎfiÓÂ˜ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÚÈÔ¯¤˜

Ì‹ÎÔ˘˜ Î‡Ì·ÙÔ˜, ÔÈ ÔÔ›Â˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ·

ÙË Ï‹„Ë ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤Ó· ÂÎ·ÙÔÌÌ‡ÚÈÔ Ê·-

ÛÌ¿ÙˆÓ, ÌÂ Î¿ıÂ ¤Ó· Ó· ·ÓÙÈÛÙÔÈ¯Â› ÛÂ ¤Ó· ÛËÌÂ›Ô

ÙË˜ ÂÈÎfiÓ·˜ (17).

∞˘Ùfi ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È ÛËÌ·ÓÙÈÎfi ÁÈ·

ÙËÓ ·Ó¿Ï˘ÛË ·ÓÔÌÔÈÔÁÂÓÒÓ ÌÈÎÚÔÛÎÔÈÎÒÓ ˘ÏÈ-

ÎÒÓ, ·ÊÔ‡ Ë ·Ó·Ï˘ÙÈÎ‹ ÏËÚÔÊÔÚ›· ÌÔÚÂ› Ó·

ÚÔ¤ÏıÂÈ ·fi Î¿ıÂ ÛËÌÂ›Ô ÙÔ˘ ÂÍÂÙ·˙fiÌÂÓÔ˘

‰Â›ÁÌ·ÙÔ˜.

∏ ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ¯ÚˆÛÙÈÎÒÓ Ô˘ ÌÔÚÔ‡Ó

Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ‰Â›ÎÙÂ˜, Â›Ó·È ¤Ó· ·fi

Ù· ÈÔ ÈÛ¯˘Ú¿ ÂÚÁ·ÏÂ›· ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÔÚÁ·ÓÈ-

ÎÒÓ ÈÛÙÒÓ. ∏ Ù·¯Â›· ·Ó¿Ù˘ÍË Ó¤ˆÓ Î·È ÂÚÈÛ-

ÛfiÙÂÚÔ ÔÏ‡ÏÔÎˆÓ, ÔÏÏ·ÏÒÓ ¯ÚˆÌ¿ÙˆÓ,

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110

1,0

0,9

0,8

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0,3

0,2

0,1 400 450 500 550 600 650 700 750 800

A

ÔÚ

Úfi

ÊË

ÛË


§ÂÌÊÔÎ‡ÙÙ·Ú·§ÂÌÊÔ‚Ï¿ÛÙÂ˜ (√§§)

545 nm

630 nm

∂∂ÈÈÎÎfifiÓÓ·· 55.. ª¤ÛÔ˜ fiÚÔ˜ Ê·ÛÌ¿ÙˆÓ ·ÔÚÚfiÊËÛË˜ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ.



ÊıÔÚÈ˙fiÓÙˆÓ ¯ÚˆÛÙÈÎÒÓ ¤¯ÂÈ ‰ÒÛÂÈ ÌÂÁ¿ÏË ÒıË-

ÛË ÛÙÈ˜ ÌÂıfi‰Ô˘˜ ÌÈÎÚÔÛÎÔ›·˜ ÊıÔÚÈÛÌÔ‡. ∏

Ê·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈÎ¿ ÏÂÔ-

ÓÂÎÙ‹Ì·Ù· ÛÙËÓ ·ÂÈÎfiÓÈÛË ÊıÔÚÈÛÌÔ‡ ¤Ó·ÓÙÈ

¿ÏÏˆÓ ÎÏ·ÛÈÎÒÓ ÌÂıfi‰ˆÓ Ô˘ ‚·Û›˙ÔÓÙ·È ÛÂ Ê›Ï-

ÙÚ·. ∆· Î˘ÚÈfiÙÂÚ· Â›Ó·È Ë Ì¤ÙÚËÛË Ï‹ÚÔ˘˜ Ê¿-

ÛÌ·ÙÔ˜, Ë ÔÔ›· ‰›ÓÂÈ ÔÏ‡ ÌÂÁ·Ï‡ÙÂÚË ÏËÚÔ-

ÊÔÚ›· (ÔÛÔÙÈÎ‹) ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÌÔ-

Ú›ˆÓ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ ÛÙÔ ˘fi ÂÍ¤Ù·ÛË ‰Â›ÁÌ·, Ë

·ÏÔ‡ÛÙÂ˘ÛË ÙË˜ Ï‹„Ë˜ ÙË˜ ÂÈÎfiÓ·˜ ÊıÔÚÈÛÌÔ‡,

·Ú¤¯ÔÓÙ·˜ ÙË ‰˘Ó·ÙfiÙËÙ·, ÌÂ Ì›· ÌfiÓÔ Ì¤ÙÚË-

ÛË, ‰È·¯ˆÚÈÛÌÔ‡ Î·È ¯·ÚÙÔÁÚ¿ÊËÛË˜ ÔÏÏÒÓ Ê·-

ÛÌ·ÙÈÎ¿ ÂÈÎ·Ï˘ÙfiÌÂÓˆÓ ÊıÔÚÈ˙fiÓÙˆÓ ‰ÂÈÎÙÒÓ

Î·È, Ù¤ÏÔ˜, Ë Â›Ï˘ÛË ÔÏÏÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ fi¯È ÂÈı˘ÌËÙfi ÂÈÏ¤ÔÓ ÊˆÙÈÛÌfi

(background). ∂Ê·ÚÌfi˙ÔÓÙ·˜ ÔÏ‡ÏÔÎÔ˘˜ ·Ï-

ÁfiÚÈıÌÔ˘˜ ·Ó¿Ï˘ÛË˜ ‰Â‰ÔÌ¤ÓˆÓ, ·Ó·Ï‡ÔÓÙ·È

Ù·˘Ùfi¯ÚÔÓ· ÔÏÏ¤˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È

Ê·ÛÌ·ÙÈÎ¿.

OÈ Î˘ÙÙ·ÚÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ‚·Û›˙ÔÓÙ·È ÛÂ ÎÈ-

Ó‹ÛÂÈ˜ ÌÔÚ›ˆÓ ‰È·Ì¤ÛÔ˘ ÌÂÌ‚Ú·ÓÒÓ, Ì¤Û· ÛÙÈ˜

Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ¤˜ ‰ÔÌ¤˜ Î·È ·Ó¿ÌÂÛ· ÛÙ·

Î‡ÙÙ·Ú· (‰È·Î˘ÙÙ·ÚÈÎ‹ ÂÈÎÔÈÓˆÓ›·). ∏ Ê·ÛÌ·-

ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÌÂ ÙË ‚Ô‹ıÂÈ· Î·Ù¿ÏÏËÏˆÓ ÊıÔ-

ÚÈ˙fiÓÙˆÓ ‰ÂÈÎÙÒÓ ¤¯ÂÈ Î·ıÈÂÚˆıÂ› ÛÙË ÌÂÏ¤ÙË Î·È

Î·Ù·ÓfiËÛË Ù·¯¤ˆÓ ‰˘Ó·ÌÈÎÒÓ ‰ÈÂÚÁ·ÛÈÒÓ, ÔÈ

ÔÔ›Â˜ ‰ÈÂÓÂÚÁÔ‡ÓÙ·È Ì¤Û·, ·ÏÏ¿ Î·È ·Ó¿ÌÂÛ·,

ÛÙ· Î‡ÙÙ·Ú· (18).

∏ Ê·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË, Â›ÛË˜, ¤¯ÂÈ ‰ÒÛÂÈ

ÒıËÛË ÛÙËÓ ·Ó¿Ï˘ÛË Î·È ‰È¿ÁÓˆÛË ¯ÚˆÌÔÛˆÌÈ-

ÎÒÓ ·ÏÏÔÈÒÛÂˆÓ ÌÂ ÙË ¯Ú‹ÛË ÊıÔÚ›˙ÔÓÙÔ˜ ˘‚ÚÈ-

‰ÈÛÌÔ‡ (FISH). ∏ ÙÂ¯ÓÈÎ‹ FISH Â›Ó·È Ì›· Î˘ÙÙ·-

ÚÔÁÂÓÂÙÈÎ‹ ÙÂ¯ÓÈÎ‹ Î·È ÌÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ Ê·ÛÌ·-

ÙÈÎ‹˜ ·ÂÈÎfiÓÈÛË˜ Â›Ó·È ‰˘Ó·Ùfi˜ Ô Ê·ÛÌ·ÙÈÎfi˜

‰È·¯ˆÚÈÛÌfi˜ ‰È·ÊÔÚÂÙÈÎÒÓ ÊıÔÚÈ˙fiÓÙˆÓ ‰ÂÈÎÙÒÓ

ÛÙÔ ˘fi ÂÍ¤Ù·ÛË ÁÂÓÂÙÈÎfi ˘ÏÈÎfi Î·È, Î·Ù¿ Û˘Ó¤-

ÂÈ·, Ë ·Ú·Ù‹ÚËÛË ‰È·ÊÔÚÂÙÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿-

ÙˆÓ ¯ˆÚ›˜ ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ô˘ ÂÈ‚¿ÏÏÔ˘Ó Ù·

Ê›ÏÙÚ· (19).

ª¤¯ÚÈ Û‹ÌÂÚ·, Ë Ê·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÂÏ¿-

¯ÈÛÙ· ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ· ‰È¿ÎÚÈÛË Î˘ÙÙ¿ÚˆÓ

(20). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÌÂ ÙÔ Û‡Á¯ÚÔÓÔ Û‡-

ÛÙËÌ· Ê·ÛÌ·ÙÈÎ‹˜ ·ÂÈÎfiÓÈÛË˜ ÁÈ· ÚÒÙË ÊÔÚ¿

¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ ÌÔÚÊÔÏÔÁ›·˜

L1 O§§ Ô˘ ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ Â›Ó·È ‰‡ÛÎÔ-

ÏÔ Ó· ‰È·ÎÚÈıÔ‡Ó ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÏÂÌÊÔÎ‡Ù-

Ù·Ú· ÌÂ ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ. ¶ÂÚÈÁÚ¿ÊËÎÂ Ë

‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ ·fi ÏÂÌÊÔ‚Ï¿ÛÙÂ˜ L1 Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ

‰È·ÊÔÚ¤˜ ÙÔ˘˜ ÌÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ.

¢È·ÈÛÙÒıËÎÂ fiÙÈ Ù· 535 nm Î·È 545 nm ·ÓÙÈÛÙÔÈ-

¯Ô‡Ó ÛÙË Ì¤ÁÈÛÙË ·ÔÚÚfiÊËÛË ÁÈ· ÏÂÌÊÔÎ‡ÙÙ·Ú·

Î·È ÏÂÌÊÔ‚Ï¿ÛÙÂ˜, ·ÓÙ›ÛÙÔÈ¯·. ™Ù· 630 nm Î·Ù·-

ÁÚ¿ÊËÎÂ Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂÙ·Í‡ ÙÔ˘˜.

∆· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÓËÁÔ-

ÚÔ‡Ó ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ì¤ıÔ‰Ô˜ ÙË˜ Ê·ÛÌ·ÙÈÎ‹˜

·ÂÈÎfiÓÈÛË˜ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È·ÁÓˆÛÙÈÎ‹

¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110

∂∂ÈÈÎÎfifiÓÓ·· 66.. ∂ÈÎfiÓ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (∞), ÏÂÌÊÔ‚Ï·ÛÙÒÓ ·fi O§§ (µ) Î·È Ê·ÛÌ·ÙÈÎ¤˜ ÂÈÎfiÓÂ˜ ·ÔÚÚfiÊËÛË˜ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜ 420 nm, 535 nm, 545 nm, 630 nm Î·È 700 nm.

(∞) 420 nm 535 nm 630 nm 700 nm

(B) 420 nm 545 nm 630 nm 700 nm

60

50

40

30

20

10

0 0,0 0,1 0,2 0,3 0,4 0,5

¢È·ÊÔÚ¿ Ê·ÛÌ·ÙÈÎ‹˜ ·ÔÚÚfiÊËÛË˜ (∞r)

§ÂÌÊÔÎ‡ÙÙ·Ú·§ÂÌÊÔÊÏ¿ÛÙÂ˜ (√§§)

AÚ

ÈıÌ

fi˜

Î˘

ÙÙ¿

Úˆ

Ó

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110 ¡. ∫·Ù˙ËÏ¿ÎË˜ Î·È Û˘Ó.

ÌÂ ÙËÓ Î·Ù·ÁÚ·Ê‹ Î·È ‰È¿ÎÚÈÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘‰Â›ÁÌ·ÙÔ˜, ˆ˜ ·ÓÙ·Ó¿ÎÏ·ÛË ÙË˜ ‰ÔÌ‹˜ ÙÔ˘ ˘Ú‹-Ó· Î·È ÙË˜ ÔÚÁ¿ÓˆÛË˜ ÙË˜ ¯ÚˆÌ·Ù›ÓË˜. ∂›Ó·È ‰˘-Ó·ÙfiÓ, ÂÔÌ¤Óˆ˜, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È ÌÂ ÙÈ˜ ˘¿Ú-¯Ô˘ÛÂ˜ ÌÂıfi‰Ô˘˜, Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ‹ Î·È Ó· ·ÓÈ-¯ÓÂ‡ÛÂÈ ÙËÓ ‡·ÚÍË ÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ‹·ÎfiÌË Î·È ÙÔÓ ‚·ıÌfi ‰È‹ıËÛË˜ ÛÂ ‰È¿ÊÔÚÂ˜ Ê¿-ÛÂÈ˜ ÙË˜ ıÂÚ·Â›·˜ ·È‰ÈÒÓ ÌÂ ÔÍÂ›· ÏÂ˘¯·ÈÌ›·,ÛÙÈ˜ ÔÔ›Â˜ Ë ̆ ÔÙÚÔ‹ ‰ÂÓ Â›Ó·È ÔÚ·Ù‹ ÌÂ ÏÔÈ¤˜Û˘Ì‚·ÙÈÎ¤˜ ÌÂıfi‰Ô˘˜.


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539-547.

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12. Rothmann C, Cohen AM, Malik Z. Chromatin condensa-

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tochem 1997;45:1097-1108.

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bourne, New York: Churchill Livingstone; 2001. p. 50.

14. Friedrich K, Seiffert W, Zimmermann HW. Romanowsky

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traction analysis of a standardized procedure. J Microsc

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jective malignancy grading: a review with emphasis on new,

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¶·È‰È·ÙÚÈÎ‹ 2005;68:103-110

∂∂ÈÈÎÎfifiÓÓ·· 88.. æÂ˘‰Ô¯ÚˆÌ·ÙÈÎ‹ ÂÈÎfiÓ· Ê·ÛÌ·ÙÈÎ‹˜ ‰È·ÊÔÚ¿˜ ·ÔÚÚfiÊËÛË˜ (∞r) ÁÈ· Ê˘ÛÈÔÏÔÁÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· (∞) Î·È ÏÂÌ-

ÊÔ‚Ï¿ÛÙÂ˜ O§§ (µ). √È ÌÏÂ ÂÚÈÔ¯¤˜ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÂ ÌÈÎÚ‹, ÂÓÒ ÔÈ ÎfiÎÎÈÓÂ˜ ÂÚÈÔ¯¤˜ ÛÂ ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ Ê·ÛÌ·ÙÈÎ‹˜·ÔÚÚfiÊËÛË˜ (∞r).

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111AWARD-WINNING ARTICLE

* 2nd Choremio Award 40th Panhellenic PaediatricMeeting, 2002

1 Department of PaediatricHaematology-Oncology,University of Crete,Heraklion, Crete

2 Institute of ElectronicStructure and Laser,Foundation for Researchand Technology,Heraklion, Crete

Correspondence:Maria Kalmanti Department of Paediatric Haematology-Oncology University Hospital of Heraklion 711 10, Heraklion, Crete ∂-mail: [email protected]


Spectral imaging study of normal lymphocytesand lymphoblasts of acute lymphoblasticleukaemia in childhood*N. Katzilakis1, E. Stiakaki1, A. Papadakis2, H. Dimitriou1, K. Balas2, M. Kalmanti1

AbstractBackground: In this study a new method is proposed for distinction between normal lymphocytes and L1

lymphoblasts of acute lymphoblastic leukaemia (ALL), using spectral analysis and imaging. In many casesthe morphological distinction of normal lymphocytes from L1 lymphoblasts using light microscopy isdifficult. The differentiation and classification is based mainly on cytochemical features and onimmunologic, cytogenetic and molecular characteristics.

Methods: The method, which is based on the principles of spectral microscope and imaging, assesses thespectral absorbance characteristics of blood cells with variant biochemical composition, which uptake dyein different ways on routine cytological staining. The spectral microscope system is capable of performingimaging of absorbance in a variety of spectral bands, at any spatial point of the image, in a wide spectralrange from 400 nm to 1000 nm. Spectral analysis was performed on bone marrow smears of 30 childrenaged 2-14 years, 12 with ALL and 18 with non malignant disease (prolonged fever, anaemia, thrombopeniaor neutropenia) following staining with May-Grunwald-Giemsa stain (MGG).

Results: The analysis showed a statistically significant difference (p<0.00005) between normal lymphocytesand lymphoblasts, based on the detection, identification and mapping of their spectral absorbance. Thewavelengths of 535 nm and 545 mn corresponded with the maximum absorbance for lymphocytes andlymphoblasts respectively. The maximum spectral differentiation was observed at the wavelength of 630 nm.

Conclusions: The results of this study support the potential of spectral imaging to provide newquantitative indices correlated with the biochemical, functional and structural status of the cell, andconsequently suggest a new method for cell differentiation and classification in acute leukaemia.

Key wordsSpectral imaging, acute lymphoblastic leukaemia, childhood.


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Î·È ÂÁÎ˘ÚfiÙËÙ· ÙˆÓ „˘¯ÔÌÂÙÚÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ,

Ë ÂÈÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë ÔÏ˘ÏÔÎfiÙËÙ·

ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹-

Ì·ÙÔ˜ ‹Ù·Ó ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÌfi‰ÈÛ·Ó ÙËÓ ÂÍ·-

ÁˆÁ‹ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ∂ÈÏ¤ÔÓ,

‰ÂÓ ‚Ú¤ıËÎÂ ·fi ÙÈ˜ Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂÏ¤ÙÂ˜ Î¿-

ÔÈÔ ‰Â›ÁÌ· ÁÓˆÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÂ Û˘ÁÎÂ-

ÎÚÈÌ¤ÓË ÌÔÚÊ‹ ÂÈÏË„›·˜. O ÛÙfi¯Ô˜ ÙË˜ ·ÓÙÈÂ-

ÈÏËÙÈÎ‹˜ ıÂÚ·Â›·˜ ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÌfiÓÔ

Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ Î·È Ë ·ÔÊ˘Á‹ ·ÓÂÈı‡-

ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, ·ÏÏ¿ Î·È Ë ‰È·Ù‹ÚËÛË ÙË˜ „˘-

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ÙÔ˘ ·ÛıÂÓ‹ (5).

OÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÓÂ˘ÚÔ„˘¯ÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜

¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹ ÂËÚÂ¿˙ÂÈ

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113∂ÛÙÈ·Î¤˜ ÂÈÏË„›Â˜ Î·È ÔÍÎ·Ú‚·˙Â›ÓË

ÙË ÏÂÎÙÈÎ‹ ÈÎ·ÓfiÙËÙ·, ÂÓÒ ¿ÏÏÂ˜ Û˘Ó‰¤ÔÓÙ·È ÌÂÌ·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ (8-10). ∆¤ÙÔÈÂ˜ ‰È·Ù·Ú·-¯¤˜ ÌÔÚÔ‡Ó Ó· ·Ú·ÙËÚËıÔ‡Ó ÙfiÛÔ ÛÂ ÌÔÓÔıÂ-Ú·Â›· fiÛÔ Î·È ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ıÂÚ·Â‡ÔÓÙ·ÈÌÂ ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· ∞∂º ‹ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ˘„ËÏ¿ Â›Â‰· ÙˆÓ ∞∂º ÛÙÔÓ ÔÚfi (11).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤ÁÈÓÂ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÓˆ-ÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÌÂ ‰È¿ÊÔÚ· „˘¯ÔÌÂÙÚÈÎ¿ ÙÂ-ÛÙ ÛÂ ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·ÛıÂÓÒÓ ÌÂ È‰ÈÔ·ıÂ›˜ÂÛÙÈ·Î¤˜ ÂÈÏË„›Â˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·Â›· ÌÂÔÍÎ·Ú‚·˙Â›ÓË (¤Ó· Û¯ÂÙÈÎ¿ Î·ÈÓÔ‡ÚÁÈÔ ∞∂º‰Â‡ÙÂÚË˜ ÁÂÓÈ¿˜, ÙÔ ÔÔ›Ô ¯ÔÚËÁÂ›Ù·È ÛÂ ÂÛÙÈ·Î¤˜ÂÈÏË„›Â˜ ÌÂ ‹ ¯ˆÚ›˜ ÁÂÓ›ÎÂ˘ÛË) (12,13). ¶·Ú¿-ÁÔÓÙÂ˜ Ô˘ Û˘ÓÂÙ¤ÏÂÛ·Ó ÛÙË ‰ÈÂÍ·ÁˆÁ‹ ·˘Ù‹˜ÙË˜ ¤ÚÂ˘Ó·˜ ‹Ù·Ó Ë ÚÔÛˆÈÎ‹ ÂÌÂÈÚ›· Î·È ÔÈÛ˘ÛÙËÌ·ÙÈÎ¤˜ ·Ú·ÙËÚ‹ÛÂÈ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÂÈÏË„›·, ÔÈ ÔÔ›-Â˜ ¤‰ÂÈ¯Ó·Ó fiÙÈ ˘¿Ú¯Ô˘Ó ÂÈÙÒÛÂÈ˜ ÛÙÔ Â›Â-‰Ô ÙË˜ Û˘ÁÎ¤ÓÙÚˆÛË˜, ÙË˜ ÚÔÛÔ¯‹˜ Î·È ÙË˜ Ì·-ıËÛÈ·Î‹˜ Â›‰ÔÛË˜.


∫ÏÈÓÈÎfi˜-ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ∫·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1998 ¤ˆ˜

ÙÔ 2002 ÂÏ¤Á¯ıËÎ·Ó 43 ·ÛıÂÓÂ›˜ (25 ·ÁfiÚÈ· Î·È 18 ÎÔÚ›-ÙÛÈ·) ËÏÈÎ›·˜ 5 ÂÙÒÓ Î·È 8 ÌËÓÒÓ ¤ˆ˜ 13 ÂÙÒÓ Î·È 9 ÌËÓÒÓ(Ì¤ÛË ËÏÈÎ›· Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ 8 ¤ÙË Î·È 9Ì‹ÓÂ˜) ÌÂ È‰ÈÔ·ıÂ›˜ ÂÛÙÈ·Î¤˜ ÂÈÏË„›Â˜ Î·È 45 ̆ ÁÈÂ›˜ Ì¿Ú-Ù˘ÚÂ˜ (23 ·ÁfiÚÈ· Î·È 22 ÎÔÚ›ÙÛÈ·). ∞ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜Â›¯·Ó Ù· ›‰È· ‰ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ˆ˜ ÚÔ˜ ÙÔ Ê‡-ÏÔ Î·È ÙËÓ ËÏÈÎ›· Î·È ·Ó‹Î·Ó ÛÙÔ ›‰ÈÔ ÎÔÈÓˆÓÈÎfi Î·È ÔÏÈ-ÙÈÛÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ∆ÚÈ¿ÓÙ· ÙÚÂÈ˜ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ÌÂÏ¤ÙË˜ Â›¯·Ó Î·ÏÔ‹ıË ÂÛÙÈ·Î‹ ÂÈÏË„›· ÌÂ ÎÂÓÙÚÔÎÚÔÙ·-ÊÈÎ‹ ÂÛÙ›· (ƒÔÏ¿Ó‰ÂÈÔ) Î·È ‰¤Î· ·Ï¤˜ ÂÛÙÈ·Î¤˜ ÎÚ›ÛÂÈ˜. ∏ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙË˜ ÂÈÏË„›·˜ ‹Ù·Ó 5 ¤ÙË Î·È 6 Ì‹ÓÂ˜ ¤ˆ˜12 ¤ÙË Î·È 6 Ì‹ÓÂ˜ (Ì¤ÛË ËÏÈÎ›· ¤Ó·ÚÍË˜ 8 ¤ÙË Î·È 2 Ì‹ÓÂ˜).∞fi ÙË ÌÂÏ¤ÙË ·ÔÎÏÂ›ÛÙËÎ·Ó ·È‰È¿ ÌÂ Û˘ÌÙˆÌ·ÙÈÎ¤˜ ‹ÎÚ˘ÙÔÁÂÓÂ›˜ ÂÈÏË„›Â˜ Î·È ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‹ ÓÂ˘ÚÔÌÂÙ·‚Ô-ÏÈÎ¤˜ ·ı‹ÛÂÈ˜, Î·ıÒ˜ Î·È ·ÛıÂÓÂ›˜ ÌÂ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹-Ì·Ù· ÛÙË Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRπ). ™‡Ì-ÊˆÓ· ÌÂ ÙÔ ÚˆÙfiÎÔÏÏÔ, ÛÂ fiÏ· Ù· ·È‰È¿ (ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜) ÂÏ‹ÊıËÂÚÈÁÂÓÓËÙÈÎfi, ÓÂÔÁÓÈÎfi, ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈ-Îfi, ¤ÁÈÓÂ ÏÂÙÔÌÂÚ‹˜ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, ËÏÂÎÙÚÔÂÁÎÂ-Ê·ÏÔÁÚ¿ÊËÌ· (ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ∏∂°) ÌÂ ÛÙ¤ÚËÛË ‡ÓÔ˘Î·È ÙÔÔı¤ÙËÛË 20 ÙÔ˘Ï¿¯ÈÛÙÔÓ ËÏÂÎÙÚÔ‰›ˆÓ Û‡ÌÊˆÓ· ÌÂÙÔ ‰ÈÂıÓ¤˜ Û‡ÛÙËÌ· 10-20, Ï‹ÚË˜ ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·-ÛË Î·È ¤ÏÂÁ¯Ô˜ ·ÎÔ˘ÛÙÈÎÒÓ ÚÔÎÏËÙÒÓ ‰˘Ó·ÌÈÎÒÓ. ™Â fiÏ·Ù· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ ¤ÁÈÓÂ MRπ ÂÁÎÂÊ¿ÏÔ˘, ÂÓÒ MRIÂÁÎÂÊ¿ÏÔ˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ù˘¯·›· Î·È ÛÂ 32 ·È‰È¿ ÙË˜ÔÌ¿‰·˜ ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ, ÌÂ ÙË Û‡ÌÊˆÓË ÁÓÒÌË ÙˆÓÁÔÓ¤ˆÓ ÙÔ˘˜, ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ ÙË˜ ÌÂÏ¤ÙË˜. ™ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜ ¤ÁÈÓÂ ÂÈÏ¤ÔÓ ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ËÏÂÎÙÚÔ-Ï‡ÙÂ˜, Ë·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ (ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›-·˜) Î·È Î·Ù·ÁÚ·Ê‹ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÌÂÙ¿ ÙËÓ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. ∏ ‰fiÛË ÙË˜ ÔÍÎ·Ú‚·˙Â›ÓË˜ Î˘Ì·È-ÓfiÙ·Ó ÌÂÙ·Í‡ 14,5-23 mg/kg µ™ (Ì¤ÛÔ˜ fiÚÔ˜: 16,8 mg/kgµ™). OÈ ÂfiÌÂÓÔÈ ÎÏÈÓÈÎÔ› Î·È ÂÚÁ·ÛÙËÚÈ·ÎÔ› ¤ÏÂÁ¯ÔÈ ¤ÁÈ-Ó·Ó ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ ÙÂÏÈÎ‹ ‰fiÛË Î·È, ·ÎÔÏÔ‡ıˆ˜, Î¿ıÂ6 Ì‹ÓÂ˜ ÌÂ ÙÔ ›‰ÈÔ ÚˆÙfiÎÔÏÏÔ.

OÈ Ù‡ÔÈ ÙË˜ ÂÈÏË„›·˜ Î·ıÔÚ›ÛÙËÎ·Ó Û‡ÌÊˆÓ· ÌÂ ÙË‰ÈÂıÓ‹ Ù·ÍÈÓfiÌËÛË (ILAE 1989) (14). ∏ ‰È¿ÁÓˆÛË ÙË˜ ÂÈ-ÏË„›·˜ ÛÙËÚ›¯ıËÎÂ ÛÙ· Ù˘ÈÎ¿ ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ· Î·È ÛÙ·¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ÙÔ˘ ∏∂°.

æ˘¯ÔÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∂ÍÂÙ¿ÛÙËÎ·Ó 43 ·È‰È¿-·ÛıÂÓÂ›˜, ËÏÈÎ›·˜ 6-14 ÂÙÒÓ,

ÌÂ ÙËÓ „˘¯ÔÌÂÙÚÈÎ‹ ‰ÔÎÈÌ·Û›· WISC-III (WechslerIntelligence Scale) (ÂÏÏËÓÈÎ‹ ÎÏ›Ì·Î·) ÚÈÓ ÙË ¯ÔÚ‹ÁËÛËÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ (ÚÒÙÔ ÙÂÛÙ), ÒÛÙÂ Ó· ÂÚÂ˘-ÓËıÔ‡Ó Ô Û˘ÓÔÏÈÎfi˜ ‰Â›ÎÙË˜ ÓÔËÌÔÛ‡ÓË˜, Ô ‰Â›ÎÙË˜ ÓÔË-ÌÔÛ‡ÓË˜ ÙË˜ ÏÂÎÙÈÎ‹˜ Î·È Ú·ÎÙÈÎ‹˜ ÎÏ›Ì·Î·˜ Î·È Ë Â›-‰ÔÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÏ›Ì·ÎÂ˜ (15). ∆Ô ›‰ÈÔÙÂÛÙ ÂÊ·ÚÌfiÛÙËÎÂ Î·È ÛÙ· 45 ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ ÙˆÓÌ·ÚÙ‡ÚˆÓ. ∆o WISC-III Â·Ó·Ï‹ÊıËÎÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜14 Ì‹ÓÂ˜ ÌÂÙ¿ ÙË Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (‰Â‡ÙÂÚÔ ÙÂÛÙ),ÒÛÙÂ Ó· ÂÍÂÙ·ÛÙÂ› Ë Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ Î·È ÙËÓ Â›‰Ú·ÛË ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈ-Î‹˜ ·ÁˆÁ‹˜.

™˘ÁÎÂÎÚÈÌ¤Ó·, ÂÚÂ˘Ó‹ıËÎ·Ó ÔÈ ˘ÔÎÏ›Ì·ÎÂ˜ ÙË˜ ÏÂ-ÎÙÈÎ‹˜ ÎÏ›Ì·Î·˜ (“¶ÏËÚÔÊÔÚ›Â˜”, “OÌÔÈfiÙËÙÂ˜”, “∞ÚÈı-ÌËÙÈÎ‹”, “§ÂÍÈÏfiÁÈÔ”, “∫·Ù·ÓfiËÛË”) Î·È ÙË˜ Ú·ÎÙÈÎ‹˜ÎÏ›Ì·Î·˜ (“™˘ÌÏ‹ÚˆÛË ÂÈÎfiÓˆÓ”, “∫ˆ‰ÈÎÔÔ›ËÛË”,“™ÂÈÚÔı¤ÙËÛË ÂÈÎfiÓˆÓ”, “™¯¤‰È· ÌÂ Î‡‚Ô˘˜”, “™˘Ó·ÚÌÔ-ÏfiÁËÛË ·ÓÙÈÎÂÈÌ¤ÓˆÓ”) ÙÔ˘ WISC-III.

™ÙËÓ ¤ÚÂ˘Ó· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ, Â›ÛË˜, ÙÔ ÙÂÛÙBender-Santucci (16), ÙfiÛÔ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ fiÛÔ Î·È 14 Ì‹ÓÂ˜ ÌÂÙ¿, ÌÂ ÙÔ ÔÔ›Ô ÂÏ¤Á-¯ıËÎ·Ó Ë ·ÓÙÈÏËÙÈÎ‹ ÔÚÁ¿ÓˆÛË Ì¤Û· ·fi ÙÔ Û‡ÓÔÏfi ÙË˜,·ÏÏ¿ Î·È ·fi ÙÔ˘˜ ÂÈÌ¤ÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ (Û¯ÂÙÈÎ‹ ı¤ÛË,ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜, ÁˆÓ›Â˜), Ô ÔÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈ-ÛÌfi˜ Î·È Ë ÈÎ·ÓfiÙËÙ· Û˘ÁÎ¤ÓÙÚˆÛË˜ ÙË˜ ÚÔÛÔ¯‹˜. ∆Ô›‰ÈÔ ÙÂÛÙ ‰fiıËÎÂ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜.

°È· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ¯ÔÚË-Á‹ıËÎÂ ÙÔ ∞ıËÓ¿ ∆ÂÛÙ ¢È¿ÁÓˆÛË˜ ¢˘ÛÎÔÏÈÒÓ ª¿ıËÛË˜,Ô˘ ·ÔÙÂÏÂ› ÙËÓ ÂÏÏËÓÈÎ‹ ÛÙ¿ıÌÈÛË ÙÔ˘ Illinois Test æ˘-¯ÔÁÏˆÛÛÈÎÒÓ πÎ·ÓÔÙ‹ÙˆÓ - ITPA (17), ÙÔ ÔÔ›Ô ÂÏ¤Á¯ÂÈÛ˘ÁÎÂÎÚÈÌ¤ÓÔ˘˜ ÙÔÌÂ›˜ ·Ó¿Ù˘ÍË˜, fiˆ˜: ·) ÓÔËÙÈÎ‹ ÈÎ·-ÓfiÙËÙ·, ‚) ÌÓ‹ÌË ·ÎÔÏÔ˘ıÈÒÓ, Á) ÔÏÔÎÏ‹ÚˆÛË ·Ú·ÛÙ¿-ÛÂˆÓ, ‰) ÁÚ·ÊÔ-ÊˆÓÔÏÔÁÈÎ‹ ÂÓËÌÂÚfiÙËÙ· Î·È Â) ÓÂ˘ÚÔ-„˘¯ÔÏÔÁÈÎ‹ ˆÚÈÌfiÙËÙ·, fiˆ˜ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈ-ÛÌfi˜, ÏÂ˘Ú›ˆÛË Î·È ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∆Ô∞ıËÓ¿ ∆ÂÛÙ ‰fiıËÎÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯Ô-Ú‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ ÌÂ ÙËÓ ¤Ó·ÚÍËÙË˜ ÌÂÏ¤ÙË˜.

ªÂ ÙËÓ ¤Ó·ÚÍË ÙË˜ ¤ÚÂ˘Ó·˜ (ÚÈÓ ÙË ıÂÚ·Â›·) ÂÏ‹-ÊıË ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, fiÔ˘ ¯ÚËÛÈÌÔ-ÔÈ‹ıËÎ·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ DSM-IV (18) ÁÈ· ÙËÓ ‡·ÚÍË„˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‹ Û˘ÌÂÚÈÊÔÚÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·È ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∏ ›‰È· ‰È·‰ÈÎ·Û›· ·ÎÔ-ÏÔ˘ı‹ıËÎÂ ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ 14 Ì‹ÓÂ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛËÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

O ¤ÏÂÁ¯Ô˜ ÙˆÓ „˘¯ÔÌÂÙÚÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ (WISC-III,∞ıËÓ¿ ∆ÂÛÙ, DSM-IV) Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ 1-2 Â‚‰ÔÌ¿‰Â˜ÌÂÙ¿ ÙÔ ÚÒÙÔ ‹ Ù· ÂfiÌÂÓ· ÂÈÏËÙÈÎ¿ ÂÂÈÛfi‰È·. ∂È‰È-ÎfiÙÂÚ·, ÛÂ 31 ·ÛıÂÓÂ›˜ Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÌÂÙ¿ ÙÔ ÚÒÙÔÂÂÈÛfi‰ÈÔ, ÛÂ 11 ÌÂÙ¿ ÙÔ ‰Â‡ÙÂÚÔ ÂÂÈÛfi‰ÈÔ Î·È ÛÂ 1 ÌÂÙ¿ÙÔ ÙÚ›ÙÔ. ∏ ÂÍ¤Ù·ÛË ÁÈÓfiÙ·Ó ·fi ÙÔÓ ›‰ÈÔ „˘¯ÔÏfiÁÔ, ÙËÓ›‰È· ÂÚ›Ô˘ ÚˆÈÓ‹ ÒÚ·. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÂÛÙ Bender-Santucci ¤ÁÈÓÂ ·fi ÙÔÓ ›‰ÈÔ ÂÚÁÔıÂÚ·Â˘Ù‹.

°È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔ-ÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈÎ‹ ÛÙ·ÙÈÛÙÈÎ‹ ‰ÔÎÈÌ·Û›· Mann-Whitney, ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÙˆÓ Û˘ÓÂ¯ÒÓÌÂÙ·‚ÏËÙÒÓ. ∂›ÛË˜, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‰ÔÎÈÌ·Û›· ¯2 ÁÈ·ÙË Û‡ÁÎÚÈÛË ÙˆÓ Û˘¯ÓÔÙ‹ÙˆÓ. OÈ ‰È·ÊÔÚ¤˜ ıÂˆÚÔ‡ÓÙ·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ÁÈ· ÙÈÌ¤˜ ÙÔ˘ p<0,05.

¶·È‰È·ÙÚÈÎ‹ 2005;68:112-118


114 ª. ∆˙ËÙËÚ›‰Ô˘ Î·È Û˘Ó.


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ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ù· ∏∂° ÛÙËÓ ÔÌ¿‰·

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ÛÙÂÚfi Î·È ÛÂ 11 ·ÛıÂÓÂ›˜ Î·È ÛÙ· ‰‡Ô ËÌÈÛÊ·›ÚÈ·

(¿ÏÏÔÙÂ ‰ÂÍÈ¿, ¿ÏÏÔÙÂ ·ÚÈÛÙÂÚ¿ ÌÂ Ù¿ÛË ÁÂÓ›ÎÂ˘-

ÛË˜). ÀÔÙÚÔ¤˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ·-

Ú·ÙËÚ‹ıËÎ·Ó ÛÂ 9/43 ·ÛıÂÓÂ›˜, ÔÈ ÔÔ›Â˜ ÂÏ¤Á-

¯ıËÎ·Ó ÌÂ ÌÈÎÚ‹ ·‡ÍËÛË ÙË˜ ËÌÂÚ‹ÛÈ·˜ ‰fiÛË˜.

∞ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜, fiˆ˜ ÎÂÊ·Ï·ÏÁ›·, Û˘-

¯ÓÔ˘Ú›·, ˘ÓËÏ›·, ÓÂ˘ÚÈÎfiÙËÙ· Î·È ·‡ÍËÛË ÙË˜

fiÚÂÍË˜, ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ 10 ·È‰È¿ Î·È ‹Ù·Ó

·ÚÔ‰ÈÎ¤˜. ™Â 35 ·fi Ù· ·È‰È¿ Ô˘ Ï¿Ì‚·Ó·Ó

ÔÍÎ·Ú‚·˙Â›ÓË, Ë ıÂÚ·Â›· ‰È·ÎfiËÎÂ ÌÂÙ¿ ·fi

3-4 ¯ÚfiÓÈ·, ÌÂ ‚¿ÛË ÙËÓ ÔÚÂ›·, ÙÔ ÂÏÂ‡ıÂÚÔ ÎÚ›-

ÛÂˆÓ ‰È¿ÛÙËÌ· Î·È ÙËÓ ÔÌ·ÏÔÔ›ËÛË ÙÔ˘ ∏∂°.

æ˘¯ÔÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÓÔËÙÈÎ‹˜

ÂÎÙ›ÌËÛË˜ ÙÔ˘ °ÂÓÈÎÔ‡ ¢Â›ÎÙË ¡ÔËÌÔÛ‡ÓË˜ (¢¡)

Î·È ÙˆÓ ¢ÂÈÎÙÒÓ ÙË˜ §ÂÎÙÈÎ‹˜ Î·È ¶Ú·ÎÙÈÎ‹˜ ÎÏ›-

Ì·Î·˜ (¶›Ó·Î·˜ 1), ·Ó¿ÌÂÛ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂ-

ÓÒÓ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÛÙËÓ

ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ·ÙÈÛÙÈÎ¿

ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙË

ÛËÌ·ÓÙÈÎ‹ ÔÌÔÈfiÙËÙ· ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ (p<0,118).

ªÂ ‚¿ÛË ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ WISC-III ÙˆÓ

·ÛıÂÓÒÓ, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ

ÎÚ›ÛÂˆÓ Î·È ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈ-

Î‹˜ ·ÁˆÁ‹˜, ÌfiÓÔ 5 ·ÛıÂÓÂ›˜ Â›¯·Ó °ÂÓÈÎfi ¢¡ Î¿-Ùˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· Î·È 4 ·fi ÙËÓÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ (¶›Ó·Î·˜ 1). øÛÙfiÛÔ, ·Ú’fiÏÔ Ô˘ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Â›-¯Â Ê˘ÛÈÔÏÔÁÈÎfi ¢¡, ·ÚÎÂÙ¿ ·È‰È¿ ·ÚÔ˘Û›·˙·Ó¯·ÌËÏ‹ Â›‰ÔÛË ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ˘ÔÎÏ›Ì·ÎÂ˜ ÙË˜§ÂÎÙÈÎ‹˜ Î·È ¶Ú·ÎÙÈÎ‹˜ ÎÏ›Ì·Î·˜, ÁÂÁÔÓfi˜ Ô˘ÈÛÙÔÔÈÂ› ÙËÓ ‡·ÚÍË ÁÓˆÛÙÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ.

™˘ÁÎÂÎÚÈÌ¤Ó·, Î·Ù¿ Ì¤ÛÔ fiÚÔ 15/43 ·ÛıÂÓÂ›˜Â›¯·Ó Â›‰ÔÛË Î¿Ùˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰·(¢¡ <79) ÛÙÈ˜ ˘ÔÎÏ›Ì·ÎÂ˜ “OÌÔÈfiÙËÙÂ˜”-“∞ÚÈıÌËÙÈÎ‹”, ÔÌÔ›ˆ˜ ÛÙÈ˜ ˘ÔÎÏ›Ì·ÎÂ˜ “∫Ò‰È-ÎÂ˜”-“™¯¤‰È· ÌÂ Î‡‚Ô˘˜” (¶›Ó·ÎÂ˜ 2 Î·È 3). ™ÙËÓÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÔÈ ‰˘ÛÎÔÏ›Â˜ ÂÈÎÂÓÙÚÒÓÔ-ÓÙ·Ó ÛÙÈ˜ ˘ÔÎÏ›Ì·ÎÂ˜ “∞ÚÈıÌËÙÈÎ‹”, “∫Ò‰ÈÎÂ˜”,“™¯¤‰È· ÌÂ Î‡‚Ô˘˜”.

™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙËÓÂ›‰ÔÛË ÙˆÓ ·ÛıÂÓÒÓ ·Ú·ÙËÚÂ›Ù·È ÛÙÈ˜ ˘ÔÎÏ›-Ì·ÎÂ˜ “OÌÔÈfiÙËÙÂ˜” (p<0,043), “∫Ò‰ÈÎÂ˜”(p<0,047) Î·È “™¯¤‰È· ÌÂ Î‡‚Ô˘˜” (p<0,076), fiÔ˘ÔÈ ·ÛıÂÓÂ›˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ ‰˘ÛÎÔÏ›Â˜ÛÙËÓ ·ÊËÚËÌ¤ÓË ÏÔÁÈÎ‹ ÛÎ¤„Ë, ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓË-ÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ÛÙËÓ ÔÙÈÎÔ-·ÓÙÈÏËÙÈÎ‹ ÈÎ·Ófi-ÙËÙ· Î·È ÛÙËÓ ÔÙÈÎ‹ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË. ™ÙËÓÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÔÈ ‰˘ÛÎÔÏ›Â˜ ÂÈÎÂÓÙÚÒÓÔ-ÓÙ·Ó ÛÙÔÓ ·ÚÈıÌËÙÈÎfi Û˘ÏÏÔÁÈÛÌfi Î·È ÛÙËÓ ÈÎ·Ófi-ÙËÙ· ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡.

ªÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·ÙËÚÂ›-Ù·È (¶›Ó·Î·˜ 4) ‚ÂÏÙ›ˆÛË ÛÙËÓ ÈÎ·ÓfiÙËÙ· ¯ÂÈÚÈ-ÛÌÔ‡ ·ÊËÚËÌ¤ÓˆÓ ÂÓÓÔÈÒÓ Î·È ÛÙË ‰È·ÏÔÁÈÛÙÈÎ‹ÈÎ·ÓfiÙËÙ· (“OÌÔÈfiÙËÙÂ˜”, p<0,043). ∏ ÌÈÎÚ‹ ·˘-Ù‹ ‚ÂÏÙ›ˆÛË ÂÍËÁÂ›Ù·È ·fi ÙË ÁÓˆÛÙÈÎ‹ ˆÚ›Ì·Ó-ÛË Ô˘ Û˘ÓÙÂÏÂ›Ù·È ÌÂ ÙË ‚ÈÔÏÔÁÈÎ‹ ·Ó¿Ù˘ÍËÙÔ˘ Î¿ıÂ ·È‰ÈÔ‡. ∂›ÛË˜, ·Ú·ÙËÚÂ›Ù·È ‚ÂÏÙ›ˆ-ÛË ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ÌÂ ‚ÂÏÙ›ˆ-ÛË ÙË˜ Ù·¯‡ÙËÙ·˜ ÂÎÙ¤ÏÂÛË˜ Î·È ÁÓˆÛÙÈÎ‹˜ ÂÂ-ÍÂÚÁ·Û›·˜ ÙˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È ÛÙË ÛÂÈÚÔıÂÙÈÎ‹ÈÎ·ÓfiÙËÙ· (“™˘ÌÏ‹ÚˆÛË ÂÈÎfiÓˆÓ”, p<0,047,“™ÂÈÚÔı¤ÙËÛË ÂÈÎfiÓˆÓ”, p<0,033).

∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÙÂÛÙ Bender-Santucci ÚÈÓÙË ̄ ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ¤‰ÂÈÍÂ fiÙÈ 26/43 ·ÛıÂ-ÓÂ›˜ ·ÚÔ˘Û›·˙·Ó ‰˘ÛÎÔÏ›Â˜ ÛÙËÓ ÈÎ·ÓfiÙËÙ· ÔÙÈ-ÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ÛÙÔÓ ̄ ˆÚÈÎfi ÚÔÛ·Ó·-ÙÔÏÈÛÌfi Î·È ÛÙËÓ ÈÎ·ÓfiÙËÙ· Û˘ÁÎ¤ÓÙÚˆÛË˜. ∞ÓÙ›-ÛÙÔÈ¯·, ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, 24/45 ÂÌÊ¿ÓÈ-˙·Ó ‰˘ÛÎÔÏ›Â˜, ÂÓÒ Ë Â›‰ÔÛË ÛÂ 4 ·fi ·˘ÙÔ‡˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:112-118

¶¶››ÓÓ··ÎÎ··˜̃ 11.. ™˘ÁÎÚÈÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ¢ÂÈÎÙÒÓ ¡ÔËÌÔÛ‡ÓË˜ WISC-IIπ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜

¡¡ÔÔËËÙÙÈÈÎÎ¤¤˜̃ °°ÂÂÓÓÈÈÎÎ‹‹ ÓÓÔÔËËÌÌÔÔÛÛ‡‡ÓÓËË §§ÂÂÎÎÙÙÈÈÎÎ‹‹ ÓÓÔÔËËÌÌÔÔÛÛ‡‡ÓÓËË ¶¶ÚÚ··ÎÎÙÙÈÈÎÎ‹‹ ÓÓÔÔËËÌÌÔÔÛÛ‡‡ÓÓËËÎÎ··ÙÙËËÁÁÔÔÚÚ››ÂÂ˜̃ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜

n=43 n=45 n=43 n=45 n=43 n=45

110-119 13 12 7 14 14 1290-109 22 25 29 21 19 2880-89 3 4 4 6 4 170-79 4 4 2 4 4 4<69 1 - 1 - 2 -



Î˘Ì·ÈÓfiÙ·Ó ÂÎÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (Ô °ÂÓÈ-

Îfi˜, ¶Ú·ÎÙÈÎfi˜ Î·È §ÂÎÙÈÎfi˜ ¢¡ ÙˆÓ ÙÂÛÛ¿ÚˆÓ

·˘ÙÒÓ ·È‰ÈÒÓ ‹Ù·Ó <79). ™ÙÔ˘˜ 14 Ì‹ÓÂ˜ ÌÂÙ¿ ÙË

Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÔÈ ÂÈ‰fiÛÂÈ˜ ÙˆÓ ·ÛıÂÓÒÓ

ÛÙÔ Bender-Santucci ‚ÂÏÙÈÒıËÎ·Ó ÛÙ· 19/26 ·È-

‰È¿ Ô˘ ÂÌÊ¿ÓÈ˙·Ó ‰˘ÛÎÔÏ›Â˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË

ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÈ˜ ·Ú·¿Óˆ ‰ÔÎÈÌ·Û›Â˜, ÂÓÒ

ÛÙ· 7/26 ·È‰È¿ Ë Â›‰ÔÛË Î˘Ì·ÈÓfiÙ·Ó ÂÎÙfi˜ Ê˘-

ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ

·fi ÙÔ˘˜ ·Ú·¿Óˆ 7 ·ÛıÂÓÂ›˜, ÔÈ 5 Â›¯·Ó °ÂÓÈÎfi,

§ÂÎÙÈÎfi Î·È ¶Ú·ÎÙÈÎfi ¢¡ <79 Û‡ÌÊˆÓ· ÌÂ ÙÔ

WISC-III, ÔfiÙÂ ‰ÈÎ·ÈÔÏÔÁÂ›Ù·È Î·È Ë ¯·ÌËÏ‹ Â›-

‰ÔÛ‹ ÙÔ˘˜ ÛÙÔ Bender-Santucci ÙÂÛÙ.

OÈ ·Ó·Ï‡ÛÂÈ˜ ÙˆÓ ÂÓ‰Ô·ÙÔÌÈÎÒÓ ‰È·ÊÔÚÒÓ

Î¿ıÂ ·È‰ÈÔ‡ Û‡ÌÊˆÓ· ÌÂ ÙÔ ∞ıËÓ¿ ∆ÂÛÙ ‰Â›-

¯ÓÔ˘Ó ÙËÓ ‡·ÚÍË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÂ

6/43 ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ ÙˆÓ ·ÛıÂÓÒÓ (13,95%)

Î·È ÛÂ 3/45 ÙË˜ ÔÌ¿‰·˜ Ì·ÚÙ‡ÚˆÓ (6,67%). ŸÏ·

Ù· ·È‰È¿ ÂÌÊ¿ÓÈ˙·Ó ‰˘ÛÎÔÏ›Â˜ ÛÙË ‰È¿ÎÚÈÛË

ÁÚ·ÊËÌ¿ÙˆÓ, ÛÙË ‰È¿ÎÚÈÛË Î·È Û‡ÓıÂÛË ÊıfiÁ-

ÁˆÓ, ÛÙÈ˜ ÁÏˆÛÛÈÎ¤˜ ·Ó·ÏÔÁ›Â˜ Î·È ÛÙË ÌÓ‹ÌË

·ÚÈıÌÒÓ Î·È ÂÈÎfiÓˆÓ. ∂›ÛË˜, 3 ·fi ÙÔ˘˜ ·ÛıÂ-

ÓÂ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Â›¯·Ó

‰˘ÛÎÔÏ›Â˜ ÏÂ˘Ú›ˆÛË˜ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘-

ÓÙÔÓÈÛÌÔ‡. ∆· ·È‰È¿ (·ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜) ÌÂ

Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ ÂÍÂÙ¿ÛÙËÎ·Ó Î·È ÛÂ Â›-

Â‰Ô ·Ó¿ÁÓˆÛË˜ Î·È ÁÚ·Ê‹˜, fiÔ˘ ‰È·ÁÓÒÛÙËÎÂ

‰È·Ù·Ú·¯‹ ÙË˜ ·Ó¿ÁÓˆÛË˜ (Ù‡Ô˘ ‰˘ÛÏÂÍ›·˜) ÛÂ

2 ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜. ™‡ÌÊˆÓ· ÌÂ ÙË ÛÙ·ÙÈÛÙÈÎ‹

·Ó¿Ï˘ÛË ÙÔ˘ test ¯2, Ë ‰È·ÊÔÚ¿ ÛÙ· ‰‡Ô ‰Â›ÁÌ·Ù·

‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p<0,438). ∆Ô

·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ Ë ‡·ÚÍË Ì·ıËÛÈ·-

ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ·ÔÙÂ-

ÏÂ› Ù˘¯·›Ô ÁÂÁÔÓfi˜. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ

fiÏ· Ù· ·È‰È¿ ÌÂ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Â›¯·Ó

Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡ÓË˜ Î·È ÛÙÈ˜ ÙÚÂÈ˜

ÎÏ›Ì·ÎÂ˜ ÙÔ˘ WISC-III (°ÂÓÈÎfi˜, §ÂÎÙÈÎfi˜, ¶Ú·-

ÎÙÈÎfi˜ ¢¡ >95). ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ

ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·ÙËÚ‹ıËÎÂ

fiÙÈ ÛÙ· 6 ·È‰È¿ ÔÈ ‰˘ÛÎÔÏ›Â˜ Ì·ıËÛÈ·ÎÔ‡ Ù‡Ô˘

ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ˘¿Ú¯Ô˘Ó.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ DSM-IV Î·È ÛÙÈ˜ ‰‡Ô

ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ, ÙfiÛÔ ÌÂ ÙËÓ ¤Ó·ÚÍË ÙË˜

¤ÚÂ˘Ó·˜ fiÛÔ Î·È ÌÂÙ¿ ·fi 14 Ì‹ÓÂ˜, ‰ÂÓ ‰Â›¯ÓÔ˘Ó

ÙËÓ ‡·ÚÍË „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‹ Û˘ÌÂÚÈÊÔ-

ÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

™˘˙‹ÙËÛË

OÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÓÂ˘ÚÔ„˘¯ÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜

·Û¯ÔÏ‹ıËÎ·Ó ÌÂ ÙËÓ ÂÈÏË„›· ·È‰ÈÒÓ Î·È ÂÊ‹-

‚ˆÓ Î·È ÙÈ˜ ÂÈÙÒÛÂÈ˜ ÙË˜ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ıÂÚ·-

Â›·˜ ÛÙË ÓÔËÌÔÛ‡ÓË Î·È ÙË Û¯ÔÏÈÎ‹ Â›‰ÔÛË. ∆Ô

Ì¤ÁÂıÔ˜, fiÌˆ˜, ÙˆÓ ÂÈÙÒÛÂˆÓ ÛÙÈ˜ ÁÓˆÛÙÈÎ¤˜

ÏÂÈÙÔ˘ÚÁ›Â˜ ÂÍ·ÚÙ¿Ù·È Î·Ù¿ Î·ÓfiÓ· ·fi ÙÔÓ Ù‡Ô

ÙË˜ ÂÈÏË„›·˜, ÙÔ Â›‰Ô˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÙËÓ ˘Ô-

ÎÂ›ÌÂÓË ‚Ï¿‚Ë Î·È ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓ‹. OÈ Ù‡-

ÔÈ ÂÈÏË„›·˜ Ô˘ ÂÈÏ¤¯ıËÎ·Ó ÁÈ· ÙËÓ ·ÚÔ‡Û·

ÌÂÏ¤ÙË ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

(14-16% ÂÚ›Ô˘), ¤¯Ô˘Ó Ù˘ÈÎ‹ ÎÏÈÓÈÎ‹ ÛËÌÂÈÔ-

ÏÔÁ›· Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎ¤˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:112-118

¶¶››ÓÓ··ÎÎ··˜̃ 22.. ™˘ÁÎÚÈÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ¢ÂÈÎÙÒÓ ¡ÔËÌÔÛ‡ÓË˜ ÛÙÈ˜ ˘ÔÎÏ›Ì·ÎÂ˜ ÙË˜ §ÂÎÙÈÎ‹˜ ∫Ï›Ì·Î·˜ ÙÔ˘ WISC-IIπ ÚÈÓÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜

¡¡ÔÔËËÙÙÈÈÎÎ¤¤˜̃ ¶¶ÏÏËËÚÚÔÔÊÊÔÔÚÚ››ÂÂ˜̃ OOÌÌÔÔÈÈfifiÙÙËËÙÙÂÂ˜̃ ∞∞ÚÚÈÈııÌÌËËÙÙÈÈÎÎ‹‹ §§ÂÂÍÍÈÈÏÏfifiÁÁÈÈÔÔ ∫∫··ÙÙ··ÓÓfifiËËÛÛËËÎÎ··ÙÙËËÁÁÔÔÚÚ››ÂÂ˜̃ ((IInnffoorrmmaattiioonn)) ((SSiimmiillaarriittiieess)) ((AArriitthhmmeettiiccaall)) ((VVooccaabbuullaarryy)) ((CCoommpprreehheennssiioonn))

∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45

110-119 3 9 1 2 1 3 4 4 4 790-109 16 21 20 26 15 23 27 24 31 2580-89 14 8 12 11 13 11 8 9 4 970-79 5 4 10 5 10 8 4 6 4 3<69 5 3 - 1 4 - - 2 - 1

¶¶››ÓÓ··ÎÎ··˜̃ 33.. ™˘ÁÎÚÈÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ¢ÂÈÎÙÒÓ ¡ÔËÌÔÛ‡ÓË˜ ÛÙÈ˜ ˘ÔÎÏ›Ì·ÎÂ˜ ÙË˜ ¶Ú·ÎÙÈÎ‹˜ ∫Ï›Ì·Î·˜ ÙÔ˘ WISC-IIIÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜

¡¡ÔÔËËÙÙÈÈÎÎ¤¤˜̃ ™™˘̆ÌÌÏÏ‹‹ÚÚˆ̂ÛÛËË ∫∫ÒÒ‰‰ÈÈÎÎÂÂ˜̃ ™™ÂÂÈÈÚÚÔÔıı¤¤ÙÙËËÛÛËË ™™¯̄¤¤‰‰ÈÈ·· ™™˘̆ÓÓ··ÚÚÌÌÔÔÏÏfifiÁÁËËÛÛËË ÎÎ··ÙÙËËÁÁÔÔÚÚ››ÂÂ˜̃ ÂÂÈÈÎÎfifiÓÓˆ̂ÓÓ ((CCooddiinngg)) ÂÂÈÈÎÎfifiÓÓˆ̂ÓÓ ÌÌÂÂ ÎÎ‡‡‚‚ÔÔ˘̆˜̃ ··ÓÓÙÙÈÈÎÎÂÂÈÈÌÌ¤¤ÓÓˆ̂ÓÓ

((PPiiccttuurree ccoommpplleettiioonn)) ((PPiiccttuurree aarrrraannggeemmeenntt)) ((BBlloocckk ddeessiiggnn)) ((OObbjjeecctt aasssseemmbbllyy))

∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜ ∞ÛıÂÓÂ›˜ ª¿ÚÙ˘ÚÂ˜n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45

110-119 6 15 4 6 6 8 4 4 2 290-109 15 21 19 15 20 18 17 25 23 2480-89 13 7 8 14 10 13 12 8 11 1170-79 6 2 9 5 6 5 8 4 1 6<69 3 - 3 5 1 1 2 4 6 2


116 ª. ∆˙ËÙËÚ›‰Ô˘ Î·È Û˘Ó.

·ÏÏÔÈÒÛÂÈ˜ (19) Î·È Â›Ó·È ÎÏ·ÛÈÎfi ·Ú¿‰ÂÈÁÌ· ÁÈ·¤ÏÂÁ¯Ô ÁÓˆÛÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ (20). ∂ÈÏ¤ÔÓ,ÔÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ˘Ê›-ÛÙ·ÓÙ·È ÁÈ· ÌÂÁ¿ÏË ¯ÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Î·È ·ÔÙÂ-ÏÔ‡Ó ÛÙÔÈ¯Â›Ô ÂÓ‰Â¯fiÌÂÓË˜ Â›‰Ú·ÛË˜, fiˆ˜ÈÛ¯˘Ú›˙ÔÓÙ·È ÔÚÈÛÌ¤ÓÔÈ Û˘ÁÁÚ·ÊÂ›˜ (21,22).∂ÚÁ·Û›Â˜ ÂÏ¤Á¯Ô˘ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÛÂ·ÛıÂÓÂ›˜ ÚÈÓ ÙË Ï‹„Ë ıÂÚ·Â›·˜ ‰ÂÓ ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÛÂ35 ·È‰È¿ Ô˘ Ï¿Ì‚·Ó·Ó ÔÍÎ·Ú‚·˙Â›ÓË Ë ıÂÚ·-Â›· ‰È·ÎfiËÎÂ ÌÂ ‚¿ÛË ÙËÓ ÔÚÂ›·, ÙÔ ÂÏÂ‡ıÂÚÔÎÚ›ÛÂˆÓ ‰È¿ÛÙËÌ· Î·È ÙËÓ ÔÌ·ÏÔÔ›ËÛË ÙÔ˘∏∂°. ∏ ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ ÛÙÔ˘˜ ·Ú·¿Óˆ·ÛıÂÓÂ›˜ (35/43) Î˘Ì·ÈÓfiÙ·Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ·È‰ÈÒÓ ÌÂ ƒÔÏ¿Ó‰ÂÈ· ÂÈÏË„›· ·fi 2 ¤ˆ˜ 3,5¯ÚfiÓÈ·, ÂÓÒ ÛÙ· ·È‰È¿ ÌÂ ·Ï¤˜ ÂÛÙÈ·Î¤˜ ÎÚ›ÛÂÈ˜ÛÂ 3-4 ¯ÚfiÓÈ·.

™ÙÈ˜ ÌÂÏ¤ÙÂ˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ Û˘ÌÙˆÌ·ÙÈÎ‹ ÂÈÏË„›· ‚Ú¤ıËÎÂ fiÙÈÚ¿ÁÌ·ÙÈ ˘¿Ú¯Ô˘Ó ÂÏÏÂ›ÌÌ·Ù· ÛÙÈ˜ ÁÓˆÛÙÈÎ¤˜·Ú·Ì¤ÙÚÔ˘˜, ÌÂ ‰Â›ÎÙË ÓÔËÌÔÛ‡ÓË˜ ¯·ÌËÏfiÙÂ-ÚÔ ·’ fi,ÙÈ ÛÂ ·È‰È¿ ÌÂ È‰ÈÔ·ıÂ›˜ ÂÈÏË„›Â˜(1,10). OÈ ·ÛıÂÓÂ›˜ ÌÂ È‰ÈÔ·ıÂ›˜ ÂÈÏË„›Â˜ Î·ÈÂÈ‰ÈÎfiÙÂÚ· ÌÂ ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· (ÎÂÓÙÚÔÎÚÔ-Ù·ÊÈÎ‹ ÂÛÙ›·) Â›¯·Ó Î·Ù¿ Ì¤ÛÔ fiÚÔ Ê˘ÛÈÔÏÔÁÈÎfi¢¡ (21). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ô ¤ÏÂÁ¯Ô˜ (ÎÏÈÓÈ-Îfi˜ Î·È ÓÔËÙÈÎfi˜) ¤ÁÈÓÂ ÛÂ ÌÂÁ¿ÏË ÔÌ¿‰· ·È‰ÈÒÓÌÂ È‰ÈÔ·ıÂ›˜ ÂÛÙÈ·Î¤˜ ÂÈÏË„›Â˜ ÌÂ ÌÔÓÔıÂÚ·-Â›· ÌÂ ÔÍÎ·Ú‚·˙Â›ÓË (OXC) ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈ-Îfi ‰È¿ÛÙËÌ·. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÙÔÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ ÚÈÓ ÙË ¯ÔÚ‹-

ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›¯Â Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙËÓÔËÌÔÛ‡ÓË˜ (35/43 ·È‰È¿ Â›¯·Ó °ÂÓÈÎfi ¢¡ >90)Î·È fiÙÈ ‰ÂÓ ÂËÚÂ¿˙ÔÓÙ·È Î·Ù¿ Î·ÓfiÓ· ÔÈ ÁÓˆÛÙÈ-Î¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË ¿ÌÂÛ· ÌÂ ÙËÛ¯ÔÏÈÎ‹ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ. ∆Ô Û˘Ì¤Ú·ÛÌ··˘Ùfi Û˘ÌÊˆÓÂ› ÌÂ ÂÎÂ›Ó· ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜(7,23-25). ∂›ÛË˜, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈ-Î¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ Ì·ÚÙ‡ÚˆÓÎ·È ÙˆÓ ·ÛıÂÓÒÓ ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜.

™Â Ì›· ‰ÈÏ‹ Ù˘ÊÏ‹ ÌÂÏ¤ÙË ÂÏ¤Á¯ıËÎ·Ó ÔÈÁÓˆÛÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÛÂ 12 ˘ÁÈÂ›˜ ÂıÂÏÔÓÙ¤˜ Ì›·Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Ï‹„Ë OXC, ÛÂ ‰fiÛÂÈ˜ ÙˆÓ 150mg, 300 mg Î·È 600 mg/ËÌ¤Ú·, ·Ú¿ÏÏËÏ· ÌÂplacebo. ™Â Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ ÂıÂÏÔÓÙ¤˜ ‰ÂÓ ·-Ú·ÙËÚ‹ıËÎ·Ó ‰È·Ù·Ú·¯¤˜ ÙË˜ ·ÓÙ›ÏË„Ë˜, ÙË˜ÁÚ·Ê‹˜ Î·È ÙÔ˘ ÂÈ¤‰Ô˘ ÂÁÚ‹ÁÔÚÛË˜ (24). ™Â ‰È-Ï‹ Ù˘ÊÏ‹ Û˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ÌÂ ÌÔÓÔıÂÚ·Â›·ÌÂ OXC Î·È ˘‰·ÓÙÔ˝ÓË ÛÂ 29 ·ÛıÂÓÂ›˜, ¤Ó·Ó ¯Úfi-ÓÔ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ·Ú·¿Óˆ Ê·ÚÌ¿ÎˆÓ‰ÂÓ ‚Ú¤ıËÎÂ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê·ÚÌ¿ÎˆÓfiÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ „˘¯ÔÎÈÓËÙÈÎ¤˜ ÂÈ‰fiÛÂÈ˜, ÙËÌÓ‹ÌË Î·È ÙËÓ ÚÔÛÔ¯‹ (25). ™Â ¿ÏÏË ÂÚÁ·Û›·Ô˘ ¤ÁÈÓÂ ÛÂ 10 ·ÛıÂÓÂ›˜ ÌÂ ıÂÚ·Â›· ÌÂ OXC(960 mg/ËÌ¤Ú·) ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›· ‰È·ÊÔ-Ú¿ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÚÈÓÎ·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË (12). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤-ÙË, Û‡ÌÊˆÓ· ÌÂ ÙÔ WISC-III, ÔÈ ·ÛıÂÓÂ›˜ 14 Ì‹-ÓÂ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ ·ÓÙÈÂÈÏËÙÈÎ‹˜ ·Áˆ-Á‹˜ ‚ÂÏÙ›ˆÛ·Ó ÛËÌ·ÓÙÈÎ¿ ÙËÓ ÈÎ·ÓfiÙËÙ· ¯ÂÈÚÈ-ÛÌÔ‡ ·ÊËÚËÌ¤ÓˆÓ ÂÓÓÔÈÒÓ Î·È ÙË ‰È·ÏÔÁÈÛÙÈÎ‹ÈÎ·ÓfiÙËÙ·. ∏ ÌÈÎÚ‹ ·˘Ù‹ ‚ÂÏÙ›ˆÛË ‰ÂÓ ÌÔÚÂ› Ó·

¶·È‰È·ÙÚÈÎ‹ 2005;68:112-118

¶¶››ÓÓ··ÎÎ··˜̃ 44.. ™Ù·ÙÈÛÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ WISC-III ÙË˜ Â›‰ÔÛË˜ ·ÛıÂÓÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜·ÁˆÁ‹˜

WWIISSCC--IIIIII ¶¶··ÚÚ¿¿ÌÌÂÂÙÙÚÚÔÔÈÈ 11ËË ÂÂÍÍ¤¤ÙÙ··ÛÛËË 22ËË ÂÂÍÍ¤¤ÙÙ··ÛÛËË ppÂÂÏÏ¤¤ÁÁ¯̄ÔÔ˘̆ mmeeaann ((SSDD)) mmeeaann ((SSDD))

°ÂÓÈÎfi˜ ¢¡ 97,78 (17,33) 104,72 (14,94) <0,030§ÂÎÙÈÎfi˜ ¢¡ 98,39 (18,19) 102,50 (10,61) NS¶ÏËÚÔÊÔÚ›Â˜ §ÂÎÙÈÎ‹ Î·Ù·ÓfiËÛË, Ì·ÎÚfi¯ÚÔÓË

ÌÓ‹ÌË, ÈÎ·ÓfiÙËÙ· Ì¿ıËÛË˜ 87,22 (11,01) 92,22 (10,03) NSOÌÔÈfiÙËÙÂ˜ §ÔÁÈÎ‹ ·Ê·ÈÚÂÙÈÎ‹ ÛÎ¤„Ë,

ÏÂÎÙÈÎ‹ Î·Ù·ÓfiËÛË 83,61 (11,35) 89,72 (12,77) <0,043∞ÚÈıÌËÙÈÎ‹ ∞ÚÈıÌËÙÈÎfi˜ Û˘ÏÏÔÁÈÛÌfi˜,

Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË 83,89 (13,99) 87,22 (13,42) NS§ÂÍÈÏfiÁÈÔ §ÂÎÙÈÎ‹ Î·Ù·ÓfiËÛË,

ÏÔÁÈÎ‹ ·Ê·ÈÚÂÙÈÎ‹ ÛÎ¤„Ë 93,89 (15,86) 92,50 (8,45) NS∫·Ù·ÓfiËÛË §ÂÎÙÈÎ‹ Î·Ù·ÓfiËÛË 95,83 (15,55) 98,33 (14,95) NS¶Ú·ÎÙÈÎfi˜ ¢¡ 98,11 (18,19) 105,61 (17,67) <0,048™˘ÌÏ‹ÚˆÛË ÂÈÎfiÓˆÓ OÙÈÎÔ-¯ˆÚÈÎ‹ ÔÚÁ¿ÓˆÛË,

Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË 90,56 (21,27) 98,89 (12,19) <0,047∫ˆ‰ÈÎÔÔ›ËÛË OÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜,

ÔÙÈÎÔ-¯ˆÚÈÎ‹ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË 85,00 (15,72) 83,61 (19,01) NS™¯¤‰È· ÌÂ Î‡‚Ô˘˜ OÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜,

ÔÙÈÎÔ-¯ˆÚÈÎ‹ ÔÚÁ¿ÓˆÛË 90,00 (13,93) 92,00 (26,95) NS™ÂÈÚÔı¤ÙËÛË ÂÈÎfiÓˆÓ OÙÈÎÔ-¯ˆÚÈÎ‹ ÔÚÁ¿ÓˆÛË,

ÛÂÈÚÔıÂÙÈÎ‹ ÈÎ·ÓfiÙËÙ·, ÔÙÈÎ‹ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË 86,67 (18,63) 98,33 (20,44) <0,033

™˘Ó·ÚÌÔÏfiÁËÛË OÙÈÎÔ-¯ˆÚÈÎ‹ ÔÚÁ¿ÓˆÛË,·ÓÙÈÎÂÈÌ¤ÓˆÓ ÛÂÈÚÔıÂÙÈÎ‹ ÈÎ·ÓfiÙËÙ· 86,67 (18,63) 95,56 (15,52) NS



·Ô‰ÔıÂ› ÛÙÔ Ê¿ÚÌ·ÎÔ, Î·ıÒ˜ ÂÍËÁÂ›Ù·È ·fi ÙËÁÓˆÛÙÈÎ‹ ˆÚ›Ì·ÓÛË Ô˘ Û˘ÓÙÂÏÂ›Ù·È ÌÂ ÙË ‚ÈÔÏÔ-ÁÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ Î¿ıÂ ·È‰ÈÔ‡.

OÈ Tich Î·È Pereon (3) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù·∞∂º Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ ÌÔÓÔıÂÚ·Â›·(ÂÎÙfi˜ ·fi ÙË Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË) ‰ÂÓ ÂËÚÂ¿˙Ô˘ÓÙË ÁÓˆÛÙÈÎ‹ Î·È ‚ÈÔÏÔÁÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰È-Ô‡. ™Â ¿ÏÏË ÌÂÏ¤ÙË fiÔ˘ ¯ÔÚËÁ‹ıËÎÂ ÌÔÓÔıÂÚ·-Â›· ÛÂ ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·ÛıÂÓÒÓ ÌÂ ÂÛÙÈ·Î‹ ÂÈ-ÏË„›· (Ê·ÈÓ˘ÙÔ˝ÓË, Î·Ú‚·Ì·˙Â›ÓË Î·È ÔÍÎ·Ú‚·-˙Â›ÓË), ÔÈ ÂÚÂ˘ÓËÙ¤˜ Î·Ù¤ÏËÍ·Ó fiÙÈ Ë ÔÌ¿‰· ÙˆÓ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·ÓÂ Ê·ÈÓ˘ÙÔ˝ÓË ·ÚÔ˘Û›·ÛÂÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÛÙËÓ ÈÎ·ÓfiÙËÙ· ÙË˜ ÏÂÎÙÈÎ‹˜·ÔÌÓËÌfiÓÂ˘ÛË˜ Î·È ÛÙËÓ ÈÎ·ÓfiÙËÙ· ÚÔÛÔ¯‹˜Î·È Û˘ÁÎ¤ÓÙÚˆÛË˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÔÌ¿‰Â˜ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó OXC (22). ™ÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, Û‡ÌÊˆÓ· ÌÂ ÙÔ ÙÂÛÙ Bender-Santucci, ÔÈ ·ÛıÂÓÂ›˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ ·Áˆ-Á‹˜ Â›¯·Ó ÛÂ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ‰˘ÛÎÔÏ›Â˜ ÛÙËÓÈÎ·ÓfiÙËÙ· ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ Î·È ‰˘-ÛÎÔÏ›Â˜ ÏÂ˘Ú›ˆÛË˜. ∞˘Ù¤˜ ÌÔÚÂ› Ó· ·Ô‰Ô-ıÔ‡Ó ÙfiÛÔ ÛÙËÓ ÂÈÏË„›· fiÛÔ Î·È ÛÂ ÓÔËÙÈÎ‹·ÓˆÚÈÌfiÙËÙ· (26-28). ™ÙÔ˘˜ 14 Ì‹ÓÂ˜ ÌÂÙ¿ ÙË ¯Ô-Ú‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‚ÂÏÙÈÒıËÎ·Ó ÔÈ ÂÈ‰fiÛÂÈ˜ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi,ÛÙËÓ ·ÓÙÈÏËÙÈÎ‹ ÔÚÁ¿ÓˆÛË, ÛÙËÓ ÔÙÈÎÔ-¯ˆÚÈ-Î‹ ÈÎ·ÓfiÙËÙ· Î·È ÛÙËÓ ÔÙÈÎ‹ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹-ÌË. ∏ ‚ÂÏÙ›ˆÛË ·Ô‰›‰ÂÙ·È ÛÙËÓ ËÏÈÎÈ·Î‹ ÂÍ¤ÏÈ-ÍË, ÛÙË ÓÔËÙÈÎ‹ ˆÚ›Ì·ÓÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙÔÓ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ.

OÈ Picirilli Î·È Û˘Ó (8,22) ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ ÙÔ˘˜ ÛÂ·È‰È¿ ÌÂ ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· ‰È·›ÛÙˆÛ·Ó fiÙÈÛÂ ÂÛÙÈ·Î¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈÛÊ·È-Ú›Ô˘ ˘¿Ú¯Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·ÓÙÈÏËÙÈÎ‹ÈÎ·ÓfiÙËÙ·, ·’ fi,ÙÈ ÛÂ ÂÛÙÈ·Î¤˜ ÙÔ˘ ‰ÂÍÈÔ‡ ËÌÈ-ÛÊ·ÈÚ›Ô˘ ‹ ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂ-Ï¤ÙË ·Ú·ÙËÚ‹ıËÎÂ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÌÂÛË Û˘-Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÂÛÙ›· ÙË˜ ÂÈÏËÙÈÎ‹˜ÎÚ›ÛË˜ Î·È ÛÙËÓ ÈÎ·ÓfiÙËÙ· ÁÓˆÛÙÈÎ‹˜ ÂÂÍÂÚÁ·-Û›·˜ ÙˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ. øÛÙfiÛÔ, ·Ú·ÙËÚÂ›Ù·È Ì›·Ù¿ÛË Ù· ·È‰È¿ ÌÂ ÂÛÙ›· ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔÓ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰˘ÛÎÔÏ›Â˜ ÛÙËÓ ÈÎ·ÓfiÙËÙ· ÁÈ··Ó·Ï˘ÙÈÎfi, ÛÂÈÚÔıÂÙÈÎfi Î·È ÏÔÁÈÎfi ÙÚfiÔ ÂÂÍÂÚ-Á·Û›·˜ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ, ‰ÈÂÚÁ·Û›· ÁÈ· ÙËÓÔÔ›· ˘Â‡ı˘ÓÔ Â›Ó·È ÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ.

∏ ·Ó¿Ï˘ÛË ÙˆÓ ÂÓ‰Ô·ÙÔÌÈÎÒÓ ‰È·ÊÔÚÒÓ ÌÂ‚¿ÛË ÙÔ ∞ıËÓ¿ ∆ÂÛÙ ¤‰ÂÈÍÂ fiÙÈ 6/43 ·ÛıÂÓÂ›˜ Â›-¯·Ó Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜. ∞˘Ù‹ Ë ÔÌ¿‰· ÙˆÓ·È‰ÈÒÓ ·ÚÔ˘Û›·˙Â ÛËÌ·ÓÙÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜ ÛÙË‰È¿ÎÚÈÛË ÁÚ·ÊËÌ¿ÙˆÓ, ÛÙË ‰È¿ÎÚÈÛË Î·È Û‡ÓıÂÛËÊıfiÁÁˆÓ, ÛÙÈ˜ ÁÏˆÛÛÈÎ¤˜ ·Ó·ÏÔÁ›Â˜, ÛÙË ÌÓ‹ÌË·ÚÈıÌÒÓ Î·È ÂÈÎfiÓˆÓ, ÛÙËÓ ÈÎ·ÓfiÙËÙ· ÁÈ· Ì·ıËÌ·-ÙÈÎÔ‡˜ Û˘ÏÏÔÁÈÛÌÔ‡˜ Î·È ÛÙË ÏÔÁÈÎ‹ ·Ê·ÈÚÂÙÈÎ‹ÛÎ¤„Ë. ∂›ÛË˜, 3 ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÌÊ¿ÓÈ-˙·Ó Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Â›¯·Ó ‰˘ÛÎÔÏ›Â˜ ÏÂ˘-Ú›ˆÛË˜ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡. ¶·Úfi-

ÌÔÈÂ˜ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ‰È¿-ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÂ·È‰È¿ ÌÂ ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· (5,6,9,10,26,28-30).∂ÈÏ¤ÔÓ, ·Ú·ÙËÚ‹ıËÎ·Ó ‰˘ÛÎÔÏ›Â˜ ÛÙË Ì·ÎÚfi-¯ÚÔÓË ÌÓ‹ÌË, ÔÈ ÔÔ›Â˜ Èı·ÓfiÓ ‰ÈÎ·ÈÔÏÔÁÔ‡ÓÙ·È·fi Ù· ¯·ÌËÏ¿ Î›ÓËÙÚ· Â›ÙÂ˘ÍË˜ Î·È ÙË Û¯ÔÏÈÎ‹·‰È·ÊÔÚ›·. ∆· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘Û›·˙·Ó ‰˘ÛÎÔ-Ï›Â˜ ÛÙËÓ ÔÙÈÎ‹ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË, ÛÙËÓ ÔÙÈÎ‹ÛÂÈÚÔı¤ÙËÛË Î·È ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ‰˘ÛÎÔÏ›· ÛÙËÓ·ÓÙ›ÏË„Ë ÙË˜ ¤ÓÓÔÈ·˜ ÙÔ˘ ¯ÚfiÓÔ˘. ™Â 2 ·fi ÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜‰È·ÁÓÒÛÙËÎÂ ‰È·Ù·Ú·¯‹ ÙË˜ ·Ó¿ÁÓˆÛË˜ (Ù‡Ô˘‰˘ÛÏÂÍ›·˜) Î·È Û˘ÛÙ‹ıËÎÂ ÛÙÈ˜ ÔÈÎÔÁ¤ÓÂÈ¤˜ ÙÔ˘˜Ó· ·Ú·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÂÈ‰ÈÎfi ÂÎ·È‰Â˘ÙÈÎfi Úfi-ÁÚ·ÌÌ·. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ fiÏ· Ù· ·È-‰È¿ ÌÂ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi‰Â›ÎÙË ÓÔËÌÔÛ‡ÓË˜.

∏ ÂÊ·ÚÌÔÁ‹ ·ÍÈfiÈÛÙˆÓ „˘¯ÔÌÂÙÚÈÎÒÓ ‰ÔÎÈ-Ì·ÛÈÒÓ, ÛÙ·ıÌÈÛÌ¤ÓˆÓ ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi,

¤‰ˆÛÂ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· ÏÂÙÔÌÂÚ‹ ¤ÏÂÁ¯Ô ÙˆÓÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÛÂ ·È‰È¿ ÌÂ ÂÛÙÈ·Î¤˜

ÂÈÏË„›Â˜. ∏ ÁÓˆÛÙÈÎ‹ Î·È Ì·ıËÛÈ·Î‹ ÂÎÙ›ÌËÛË·Ó¤‰ÂÈÍÂ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ ÛÂ 6 ·È‰È¿ ·fi

ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Î·È ÛÂ 3 ·fi ÙËÓ ÔÌ¿‰·ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∞˘Ù¤˜, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ·Ó¿Ï˘ÛË

ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ÂÓ Â›¯·Ó ¿ÌÂÛË Û¯¤ÛË ÌÂÙËÓ ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹ Î·È ÌÔÚÂ› Ó· ·Ú·-

ÙËÚËıÔ‡Ó ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ Ì·ıËÙÈÎÔ‡ ÏËı˘-ÛÌÔ‡. ∏ ‰È¿ÁÓˆÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ ·˘ÙÒÓ Û˘Ó¤‚·-

ÏÂ ÛÙËÓ ÂÓËÌ¤ÚˆÛË Î·È Î·ıÔ‰‹ÁËÛË ÙˆÓ ÁÔÓ¤ˆÓÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔ-

ÏÈÒÓ Î·È ÛÙËÓ „˘¯ÔÏÔÁÈÎ‹ ÂÓ›Û¯˘Û‹ ÙÔ˘˜. ¶·Ú·-Ì¤ÓÂÈ Ô ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÛÙËÓ ÂÈÛÙËÌÔÓÈÎ‹ ÎÔÈ-

ÓfiÙËÙ· ÁÈ· Î·ıÈ¤ÚˆÛË Ì›·˜ ÛÙÚ·ÙËÁÈÎ‹˜ ÂÏ¤Á¯Ô˘ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Ì¤Û· ·fi „˘¯ÔÌÂ-

ÙÚÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÌÂÂÛÙÈ·Î¤˜ Î·È È‰ÈÔ·ıÂ›˜ ÂÈÏË„›Â˜, ÌÂ ÛÙfi¯Ô Ó·

‰È·ÁÓˆÛÙÔ‡Ó ÚÒÈÌ· Î·È Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó·ÔÙÂÏÂÛÌ·ÙÈÎ¿.


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119ORIGINAL ARTICLE

1 3rd Paediatric Clinic ofAristotle University,Ippokration GeneralHospital, Thessaloniki

2 Laboratory of NuclearMedicine, AristotleUniversity, IppokrationGeneral Hospital,Thessaloniki

3 Learning DisabilitiesMedical Service,Ippokration GeneralHospital, Thessaloniki

Correspondence:Christos Panteliadis 4 K. Palama str., 551 33, Thessaloniki



Cognitive functions in children with focalepilepsy and long-term oxcarbazepine therapyM. Tzitiridou1, T. Panou1, E. Pavlidou1, G. Arsos2, A. Makavos3, E. Michaletou3, C. Panteliadis1

AbstractBackground: Children with epilepsy function quite satisfactorily with appropriate antiepileptic therapy,but they are reported to be at risk of developing cognitive disabilities.

Methods: This study was conducted during the period 1998-2002 in order to evaluate the effect ofoxcarbazepine (OXC) on the cognitive function of school-age children with new onset epilepsy. This studyincluded 43 children aged 6-14 years, suffering from either simple idiopathic or focal epilepsy, and 45matched controls. Cognitive functions were evaluated by two tests: a) WISC-III, and b) Bender-Santucci.The patients and the children in the control group were examined neurologically, both clinically and byCT, MRI imaging, with normal findings. All the tests were performed at the beginning of the study andrepeated after 14 months, during which the children with epilepsy were being treated with OXC. Nodifferences were found between the patients and the control group on IQ evaluation pre-treatment.

Results: Six of the 43 patients and three of the 45 children in the control group had learning disabilities.These children had deficits in computational skill and in visual short-term memory and had poor readingskills. Scores for total, verbal and performance IQ of the children with learning disabilities were within thenormal range. At re-examination 14 months later both groups showed improvement in logical abstractthinking and in verbal comprehension, which are dependent on cognitive and mental maturation. Thesefindings show that OXC does not effect long-term acquisition and information retrieval. The Bender-Santucci test showed increase in the opticokinetic perception, as the children became familiar with the test.

Conclusions: In summary, no effect of OXC on cognitive function was detected. Learning disabilities ina few children were unrelated occurrences.

Key wordsEpilepsy, oxcarbazepine, cognitive functions, learning disabilities.


120 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

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

4 ∂ÚÁ·ÛÙ‹ÚÈÔµ·ÎÙËÚÈÔÏÔÁ›·˜-¶·Ú·ÛÈÙÔÏÔÁ›·˜-∑ˆÔÓfiÛˆÓ Î·È°ÂˆÁÚ·ÊÈÎ‹˜ π·ÙÚÈÎ‹˜,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘∫Ú‹ÙË˜

5 ª∂£ ¶·›‰ˆÓ,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘∫Ú‹ÙË˜

AÏÏËÏÔÁÚ·Ê›·:∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜ ∆Ì‹Ì· π·ÙÚÈÎ‹˜,¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜ ∆.£. 2208, T.K. 710 03,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜ E-mail: [email protected]


¶·È‰È·ÙÚÈÎ‹ 2005;68:120-126

∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË ∂. ∞ÔÛÙfiÏÔ˘1, ∂. °·Ï·Ó¿ÎË˜1, °. µÏ·¯¿ÎË2, ™. ™ÙÂÊ·Ó¿ÎË3, ™. ª·Ú¿ÎË4, ∂. ∫fiÎÔÚË2,

∞. ∆ÛÈÏÈÌÈÁÎ¿ÎË3, †™. ™Ì˘Ú¿ÎÈ˜1,5

¶ÂÚ›ÏË„Ë∂ÈÛ·ÁˆÁ‹: O ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ·ÔÙÂÏÂ› Ì›· ÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È ‚·ÎÙËÚÈ·ÈÌ›·˜ Î·È ·-Ú¿ ÙÈ˜ ·‰È·ÌÊÈÛ‚‹ÙËÙÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÚÔfi‰Ô˘˜, ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ıÓËÙfiÙËÙ·. ™ÎÔ-fi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ì·ÎÚÔ¯ÚfiÓÈˆÓ Ù¿ÛÂˆÓ ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÙËÓ∫Ú‹ÙË.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó Ù· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ 67 ·È‰ÈÒÓ·fi ÙÔ˘˜ ÓÔÌÔ‡˜ ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏÂ›Ô˘ Î·È §·ÛÈı›Ô˘ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔÛÂ ÙÚÂÈ˜ ¶·È‰È·ÙÚÈÎ¤˜ ∫ÏÈÓÈÎ¤˜ Î·È Ì›· ª∂£ ¶·›‰ˆÓ, Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 13 ÂÙÒÓ 1990-2002. ∏ ËÏÈ-Î›· ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·fi 1 ÌËÓfi˜ ¤ˆ˜ 13 ÂÙÒÓ (Ì¤ÛË ËÏÈÎ›· 4,66 ¤ÙË).

∞ÔÙÂÏ¤ÛÌ·Ù·: ªÂÁ·Ï‡ÙÂÚË ÓÔÛËÚfiÙËÙ· ÛËÌÂÈÒıËÎÂ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜. ∏ Ì¤ÛË ÂÙ‹ÛÈ· Â›-ÙˆÛË ÙË˜ ÓfiÛÔ˘ ‹Ù·Ó 5,54/100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Î·È, ·Ó·Ï˘ÙÈÎfiÙÂÚ·, ÁÈ· ÙÔ˘˜ ÓÔÌÔ‡˜ ƒÂı‡-ÌÓÔ˘, ∏Ú·ÎÏÂ›Ô˘ Î·È §·ÛÈı›Ô˘ ‹Ù·Ó 7,85/100.000, 5,26/100.000 Î·È 4,23/100.000 ÏËı˘ÛÌÔ‡, ·ÓÙ›ÛÙÔÈ-¯·. ∏ Â›ÙˆÛË ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË ÛÙ· ‚Ú¤ÊË, fiÔ˘ ÂÈÎÚ·ÙÔ‡ÛÂ Ë ÔÚÔÔÌ¿‰· µ. ∞fi Ù· 29ÂÚÈÛÙ·ÙÈÎ¿ ÛÙ· ÔÔ›· ¤ÁÈÓÂ Ù˘ÔÔ›ËÛË ÙÔ˘ ÛÙÂÏ¤¯Ô˘˜, Ù· 14 (48%) ·Ô‰fiıËÎ·Ó ÛÙËÓ ÔÚÔÔÌ¿‰· µÎ·È ¿ÏÏ· 12 (41,3%) ÛÙËÓ ÔÚÔÔÌ¿‰· C. ¢È·ÈÛÙÒıËÎ·Ó ‰‡Ô ÂÚ›Ô‰ÔÈ ·˘ÍËÌ¤ÓË˜ Â›ÙˆÛË˜, Ë ÚÒÙËÎ·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999 ÌÂ ÂÈÎÚ¿ÙËÛË ÙË˜ ÔÚÔÔÌ¿‰·˜ C Î·È Ë ‰Â‡ÙÂÚË ÙÔ 2002 ÌÂ ÂÈÎÚ¿ÙËÛË ÙË˜ÔÚÔÔÌ¿‰·˜ µ. ∏ ıÓËÙfiÙËÙ· ·Ó‹ÏıÂ ÛÙÔ 9% ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂ Î¿ÔÈ· Û˘ÁÎÂÎÚÈÌ¤ÓË ÔÚÔ-ÔÌ¿‰·.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘ÔÏÔÁ›ÛÈÌË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·ÛÙÔ˘˜ ÙÚÂÈ˜ ÓÔÌÔ‡˜ ÙË˜ ∫Ú‹ÙË˜ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙË˜ ÌÂÏ¤ÙË˜. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈ‰ËÌÈÔÏÔÁÈ-ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ÙˆÓ Ù¿ÛÂˆÓ ÙË˜ Â›ÊÔ‚Ë˜ ·˘Ù‹˜ ÏÔ›ÌˆÍË˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ÛˆÛÙ‹ ¯Ú‹ÛËÙˆÓ ÂÌ‚ÔÏ›ˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿∂Ì‚fiÏÈ·, ÂÈ‰ËÌÈÔÏÔÁ›·, ∫Ú‹ÙË, ÌËÓÈÁÁ›ÙÈ‰·, ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜.

∂ÈÛ·ÁˆÁ‹

O ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ (Neisseria meningitidis)

·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È ‚·-

ÎÙËÚÈ·ÈÌ›·˜ ·ÁÎÔÛÌ›ˆ˜ Î·È Ë ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈ-

Î‹ ÓfiÛÔ˜ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ıÓËÙfi-

ÙËÙ·. ∏ ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ÙfiÛÔ ÌÂ ÂÓ‰ËÌÈÎ‹

ÌÔÚÊ‹, fiÛÔ Î·È ÌÂ Û˘ÛÛˆÚÂ‡ÛÂÈ˜ ÎÚÔ˘ÛÌ¿ÙˆÓ

Î·È ÂÈ‰ËÌ›Â˜. ∏ ÂÙ‹ÛÈ· Â›ÙˆÛ‹ ÙË˜ ˘ÔÏÔÁ›-

˙ÂÙ·È ÛÂ 0,9-1,5/100.000 ÏËı˘ÛÌÔ‡ ÛÙÈ˜ ∏¶∞

Î·È 1-3/100.000 ÛÙËÓ ∂˘ÚÒË, ÂÓÒ ÛÂ Î¿ÔÈÂ˜

¯ÒÚÂ˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘ Êı¿ÓÂÈ ¤ˆ˜ 10-

25/100.000 (1-3). O ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ¤¯ÂÈ ÙÔ˘-

Ï¿¯ÈÛÙÔÓ 13 ÔÚÔÔÌ¿‰Â˜, 20 ÔÚÔÙ‡Ô˘˜, 10 ÔÚÔ¸-

ÔÙ‡Ô˘˜ Î·È 13 ·ÓÔÛÔÙ‡Ô˘˜ (1,4). ™Â ·ÁÎfi-

ÛÌÈ· ÎÏ›Ì·Î·, ÔÈ ÔÚÔÔÌ¿‰Â˜ Ô˘ Â˘ı‡ÓÔÓÙ·È Û˘-

¯ÓfiÙÂÚ· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È ÔÈ A,

B, C, Y Î·È W135 ÌÂ ÁÂˆÁÚ·ÊÈÎ¤˜, ÂÔ¯È·Î¤˜ Î·ÈËÏÈÎÈ·Î¤˜ ‰È·ÊÔÚÔÔÈ‹ÛÂÈ˜ (5,6). ™ÙÈ˜ ·ÓÂÙ˘Á-Ì¤ÓÂ˜ ¯ÒÚÂ˜, Ë ÓfiÛÔ˜ ÔÊÂ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙÈ˜ÔÚÔÔÌ¿‰Â˜ µ Î·È C, ÂÓÒ Ë ÔÚÔÔÌ¿‰· ∞ Î·È ÚÔ-ÛÊ¿Ùˆ˜ ÔÈ Y Î·È W135 Î˘ÚÈ·Ú¯Ô‡Ó ÛÙÈ˜ ¯ÒÚÂ˜ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘ (2,4,6). ∏ ÓfiÛÔ˜ Â›Ó·È Û˘¯Ófi-ÙÂÚË ÛÙ· ‚Ú¤ÊË (7). ∏ ıÓËÙfiÙËÙ·, ·Ú¿ ÙËÓ‡·ÚÍË ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ,ÔÈÎ›ÏÏÂÈ ·fi 6% ¤ˆ˜ 21% Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜Ô˘ Ë ÓfiÛÔ˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi Î·Ù·ÏËÍ›· ÌÔ-ÚÂ› Ó· ÊÙ¿ÛÂÈ ÙÔ 20-45% (8-11). ∆· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ·, ÙÔ ÂÓ‰È·Ê¤ÚÔÓ ¤¯ÂÈ ÛÙÚ·ÊÂ› ÛÙËÓ ÚÔ-Û¿ıÂÈ· ÚfiÏË„Ë˜ ÙË˜ ÓfiÛÔ˘ ÌÂ ÙË ¯Ú‹ÛË ·Ô-ÙÂÏÂÛÌ·ÙÈÎÒÓ ÂÌ‚ÔÏ›ˆÓ (2,12).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂÏ¤-ÙË ÙË˜ ÂÈ‰ËÌÈÔÏÔÁ›·˜ Î·È ÙˆÓ Ù¿ÛÂˆÓ ÙË˜ ÌË-ÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏË-ı˘ÛÌfi ÙË˜ ∫Ú‹ÙË˜ Ù· ÙÂÏÂ˘Ù·›· 13 ¤ÙË.


121ªËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË


∏ ÌÂÏ¤ÙË ‹Ù·Ó ·Ó·‰ÚÔÌÈÎ‹ Î·È ÂÚÈ¤Ï·‚Â fiÏ· Ù· ‚Ú¤-

ÊË Î·È Ù· ·È‰È¿ ËÏÈÎ›·˜ ·fi 1 ÌËÓfi˜ ¤ˆ˜ 14 ÂÙÒÓ, Ô˘

ÓÔÛËÏÂ‡ÙËÎ·Ó ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ Î·Ù¿ ÙÔ ¯ÚÔÓÈ-

Îfi ‰È¿ÛÙËÌ· 01-01-1990 ¤ˆ˜ 31-12-2002 ÛÂ ÙÚÂÈ˜ ¶·È‰È·-

ÙÚÈÎ¤˜ ∫ÏÈÓÈÎ¤˜ Î·È Ì›· ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜

(ª∂£) ¶·›‰ˆÓ ÛÙËÓ ∫Ú‹ÙË. ™ÙÈ˜ ÙÚÂÈ˜ ¶·È‰È·ÙÚÈÎ¤˜ ∫ÏÈ-

ÓÈÎ¤˜ (¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∏Ú·ÎÏÂ›-

Ô˘, ∞’ Î·È µ’ µÂÓÈ˙¤ÏÂÈÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∏Ú·ÎÏÂ›-

Ô˘) ÓÔÛËÏÂ‡ÔÓÙ·È ·È‰È¿ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ ·fi

ÙÚÂÈ˜ ÓÔÌÔ‡˜ ÙË˜ ∫Ú‹ÙË˜ (ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏÂ›Ô˘, §·ÛÈı›-

Ô˘) Î·È ÛÙË ª∂£ ¶·›‰ˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔ-

ÌÂ›Ô˘ ·È‰È¿ ·fi fiÏË ÙËÓ ∫Ú‹ÙË. ∏ ÌÂÏ¤ÙË ‰ÂÓ Û˘ÌÂÚÈ¤-

Ï·‚Â ÓÂÔÁÓ¿, Ô‡ÙÂ ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÌÂÓ ÛÙ· ·-

Ú·¿Óˆ ∆Ì‹Ì·Ù·, ·ÏÏ¿ ‰ÂÓ ‹Ù·Ó Î¿ÙÔÈÎÔÈ ÙˆÓ ÙÚÈÒÓ ·˘-

ÙÒÓ ÓÔÌÒÓ ÙË˜ ∫Ú‹ÙË˜. ∫·Ù¿ Ù· ÙÂÏÂ˘Ù·›· 4 ¤ÙË ÙË˜ ÌÂ-

Ï¤ÙË˜ ¤ÁÈÓÂ ‰È·ÛÙ·‡ÚˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÙË˜ ÓfiÛÔ˘ ÌÂ

Ù· ÛÙÔÈ¯Â›· ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∂È‰ËÌÈÔÏÔÁÈÎ‹˜ ¶·Ú·-

ÎÔÏÔ‡ıËÛË˜ Î·È ¶·Ú¤Ì‚·ÛË˜ (∂∫∂¶∞¶) (13).

∏ ‰È¿ÁÓˆÛË ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ‚·Û›ÛÙË-

ÎÂ ÛÙË Û˘Ì‚·Ù‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ·Ô-

ÌfiÓˆÛË ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ·fi ¤Ó· Ê˘ÛÈÔÏÔÁÈÎ¿ ÛÙÂ›-

ÚÔ ˘ÏÈÎfi, fiˆ˜ Â›Ó·È ÙÔ ·›Ì·, ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi

(∂¡À) ‹ ¿ÏÏÔ ¿ÛËÙÔ ˘ÏÈÎfi, ÙËÓ ·ÓÂ‡ÚÂÛË Gram(-) ‰È-

ÏfiÎÔÎÎˆÓ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi, ÙÔÓ ıÂÙÈÎfi ÔÚÔÏÔ-

ÁÈÎfi ¤ÏÂÁ¯Ô (Latex) Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·Ï˘ÛÈ‰ˆÙ‹˜

·ÓÙ›‰Ú·ÛË˜ ÙË˜ ÔÏ˘ÌÂÚ¿ÛË˜ (polymerase chain reaction -

PCR) ÙÔ˘ ∂¡À ‹ ÙÔ˘ ·›Ì·ÙÔ˜ (14,15). ªËÓÈÁÁ›ÙÈ‰· ÔÚ›ÛÙË-

ÎÂ Ë ·ÚÔ˘Û›· >10 ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô

˘ÁÚfi Î·È/‹ ·Ô‰Â‰ÂÈÁÌ¤ÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈ-

ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·fi ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, fiˆ˜ ıÂÙÈÎ‹ Î·Ï-

ÏÈ¤ÚÁÂÈ· ∂¡À, ıÂÙÈÎ‹ PCR, gram-¯ÚÒÛË ÙÔ˘ ∂¡À ‹ ·Ó›-

¯ÓÂ˘ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡. ™ÙË ÌÂÏ¤ÙË

Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Î·È 4 ·È‰È¿ ÌÂ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜

ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘, ‰ËÏ·‰‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Û‹„Ë˜

‹ ÌËÓÈÁÁ›ÙÈ‰·˜ ÌÂ ÙÔ Ù˘ÈÎfi ·ÈÌÔÚÚ·ÁÈÎfi-ÂÙÂ¯ÂÈÒ‰Â˜

ÂÍ¿ÓıËÌ·, ·ÏÏ¿ ¯ˆÚ›˜ Ù·˘ÙÔÔ›ËÛË Ô‡ÙÂ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-

ÎÔ˘ Ô‡ÙÂ ¿ÏÏÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·.

ŸÏÂ˜ ÔÈ ÂÚÈÙÒÛÂÈ˜ Â›¯·Ó ·ÓÙÈÌÂÙˆÈÛÙÂ› ÎÏÈÓÈÎ¿

·fi ¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ·ÙÚfi ÙË˜ ÂÚÂ˘ÓËÙÈÎ‹˜ ÔÌ¿‰·˜.

∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ‰ËÌÔÁÚ·ÊÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ ·ÛıÂÓÒÓ, ÔÈ

ÔÚÔÔÌ¿‰Â˜ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ô˘ ·ÔÌÔÓÒıËÎ·Ó

Î·È Ë ¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘ ÙˆÓ ·ÛıÂÓÒÓ. °È· ÙÔÓ ˘ÔÏÔÁÈÛÌfi

ÙË˜ Â›ÙˆÛË˜ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ

¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ·ÓÙ›ÛÙÔÈ¯· ‰È¿ÌÂÛ· ÏËı˘ÛÌÈ·Î¿

‰Â‰ÔÌ¤Ó· ÌÂ ‚¿ÛË ÙÈ˜ ·ÔÁÚ·Ê¤˜ ÙÔ˘ 1991 Î·È ÙÔ˘ 2001.

°È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔ-

ÔÈ‹ıËÎ·Ó Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡ÓË˜ ÁÈ· ÙË ÌÂÏ¤-

ÙË ÙË˜ Â›ÙˆÛË˜ Î·È Ë ‰ÔÎÈÌ·Û›· ¯2 ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÔÈ-

ÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ.


∫·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 01-01-1990 ¤ˆ˜ 31-12-2002 Î·Ù·ÁÚ¿ÊËÎ·Ó 67 Û˘ÓÔÏÈÎ¿ ÂÚÈÙÒÛÂÈ˜ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·-ÎÏÂ›Ô˘, ƒÂı‡ÌÓÔ˘ Î·È §·ÛÈı›Ô˘. ∏ Ì¤ÛË ÂÙ‹ÛÈ·Â›ÙˆÛË ÁÈ· ÙÔ˘˜ ÙÚÂÈ˜ ·˘ÙÔ‡˜ ÓÔÌÔ‡˜ ˘ÔÏÔÁ›-ÛÙËÎÂ ÛÂ 5,54/100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ (¶›-Ó·Î·˜ 1). ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È, Â›ÛË˜,ÔÈ ÂÈÙÒÛÂÈ˜ Î·Ù¿ Ê‡ÏÔ, ËÏÈÎÈ·Î‹ ÔÌ¿‰· Î·È ÓÔ-Ìfi ‰È·ÌÔÓ‹˜.

OÈ ËÏÈÎ›Â˜ ÙˆÓ ·È‰ÈÒÓ Î˘Ì·›ÓÔÓÙ·Ó ·fi 1Ì‹Ó· ¤ˆ˜ 13 ¤ÙË, ÌÂ Ì¤ÛË ËÏÈÎ›· Ù· 4,66 ¤ÙË. ∏Î·Ù·ÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈ-Î›· ÙˆÓ ·È‰ÈÒÓ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ∏ Û˘-¯ÓfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÙ· ‚Ú¤ÊËËÏÈÎ›·˜ 1 ÌËÓfi˜ ¤ˆ˜ 1 ¤ÙÔ˘˜, (17 ÂÚÈÙÒÛÂÈ˜,25,4% ÙÔ˘ Û˘ÓfiÏÔ˘) Î·È ·ÚÔ˘Û›·˙Â ÂÌÊ·Ó‹ ÌÂ›-ˆÛË ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÂÙÒÓ. ∆Ô ›‰ÈÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ·, ÔÈ ÂÚÈÙÒÛÂÈ˜ ‚·ÎÙËÚÈ·Î‹˜ ÌËÓÈÁÁ›ÙÈ-‰·˜ ÛÙÔÓ ›‰ÈÔ ·È‰ÈÎfi ÏËı˘ÛÌfi ·fi ÓÂ˘ÌÔÓÈfi-ÎÔÎÎÔ Î·È ·ÈÌfiÊÈÏÔ ÙË˜ ÈÓÊÏÔ˘¤Ó˙·˜ Ù‡Ô˘ b‹Ù·Ó 17 Î·È 14, ·ÓÙ›ÛÙÔÈ¯·.

O ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ·ÔÌÔÓÒıËÎÂ ·fi ÙËÓÎ·ÏÏÈ¤ÚÁÂÈ· ∂¡À ÛÂ 19 (28,3%) ÂÚÈÙÒÛÂÈ˜ Î·È·fi ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ ÛÂ 13 (19,4%), ÂÓÒÛÂ 6 (8,9%) ÂÚÈÙÒÛÂÈ˜ ·ÔÌÔÓÒıËÎÂ ÙfiÛÔ ·fiÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ fiÛÔ Î·È ∂¡À. Gram(-)‰ÈÏfiÎÔÎÎÔ˜ ‚Ú¤ıËÎÂ ÛÙÔ ¿ÌÂÛÔ ·Ú·ÛÎÂ‡·ÛÌ·ÙÔ˘ ∂¡À ÛÂ 6 (8,9%) ÂÚÈÙÒÛÂÈ˜ Î·È ÛÂ ‰ÂÚÌ·-ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÛÂ 3 (4,5%). ™Â 16 ·È‰È¿ (23,9%) ÔÈÎ·ÏÏÈ¤ÚÁÂÈÂ˜ ‹Ù·Ó ÛÙÂ›ÚÂ˜ Î·È ÔÈ ¯ÚÒÛÂÈ˜ ·ÚÓËÙÈ-Î¤˜, ·ÏÏ¿ Ë PCR ·›Ì·ÙÔ˜ ‹Ù·Ó ıÂÙÈÎ‹. ™Â 4 (5,9%)ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ ·ÓÈ¯ÓÂ‡ıËÎÂ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˜. ªÂ ‚¿ÛË ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È ÙËÓ ·Ó›-¯ÓÂ˘ÛË ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘, ÚÔÛ‚ÔÏ‹ ÙˆÓÌËÓ›ÁÁˆÓ ÌÂ ‹ ¯ˆÚ›˜ Û‹„Ë ÂÎÙÈÌ‹ıËÎÂ fiÙÈ ˘‹Ú-¯Â ÛÙÈ˜ 64 ÂÚÈÙÒÛÂÈ˜ (95,5%). ∂ÎÙÈÌ‹ıËÎÂ·‰Ú¿ fiÙÈ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÛË„·ÈÌ›· ÌÂ ‹ ¯ˆ-Ú›˜ ÌËÓÈÁÁ›ÙÈ‰· Â›¯·Ó 42 (62,7%) ·È‰È¿. O ·Ú·-¿Óˆ ˘ÔÏÔÁÈÛÌfi˜ ÂÚÈ¤¯ÂÈ ÙÔÓ Â˘ÓfiËÙÔ ÂÚÈÔ-ÚÈÛÌfi fiÙÈ ÛÙË ÏÔ›ÌˆÍË ·fi ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ Â›-Ó·È Û˘¯Ó‹ Ë ÂÈÎ¿Ï˘„Ë ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ ÌË-ÓÈÁÁ›ÙÈ‰·˜ Î·È ÛË„·ÈÌ›·˜. ∂ÂÈ‰‹ ‰ÂÓ Â›Ó·È ¿ÓÙ·

¶·È‰È·ÙÚÈÎ‹ 2005;68:120-126

¶¶››ÓÓ··ÎÎ··˜̃ 11.. ∂›ÙˆÛË ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÂ ÙÚÂÈ˜ ÓÔÌÔ‡˜ ÙË˜ ∫Ú‹ÙË˜ Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· 1990-2002

¶¶ÂÂÚÚÈÈÙÙÒÒÛÛÂÂÈÈ˜̃ ((%%)) ¶¶ÏÏËËıı˘̆ÛÛÌÌfifi˜̃ ∂∂››ÙÙˆ̂ÛÛËË//110000..000000 9955%% ‰‰ÈÈ··ÛÛÙÙ‹‹ÌÌ··ÙÙ·· ÂÂÌÌÈÈÛÛÙÙÔÔÛÛ‡‡ÓÓËË˜̃

™‡ÓÔÏÔ ·È‰ÈÒÓ 0-14 ÂÙÒÓ 67 (100) 93.031 5,54 4,29-7,10∞ÁfiÚÈ· 40 (60) 47.794 6,44 4,59-8,76∫ÔÚ›ÙÛÈ· 27 (40) 45.237 4,6 3,02-6,680-4 ÂÙÒÓ 38 (56,7) 27.213 10,74 7,6-14,75-9 ÂÙÒÓ 18 (26,9) 31.151 4,44 2,63-7,0210-14 ÂÙÒÓ 11 (16,4) 34.667 2,44 1,21-4,36ƒ¤ı˘ÌÓÔ 16 (23,8) 15.676 7,85 4,48-12,8∏Ú¿ÎÏÂÈÔ 43 (64,2) 62.809 5,26 3,81-7,09§·Û›ıÈ 8 (12) 14.546 4,23 1,83-8,34


122 ∂. ∞ÔÛÙfiÏÔ˘ Î·È Û˘Ó.

Â‡ÎÔÏÔ˜ ·˘Ùfi˜ Ô ‰È·¯ˆÚÈÛÌfi˜, Ë ÏÔ›ÌˆÍË ·fiÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ ·Ó·Ê¤ÚÂÙ·È ˆ˜ ÌËÓÈÁÁÈÙÈ‰Ô-ÎÔÎÎÈÎ‹ ÓfiÛÔ˜ (1). ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¿ÏÏÂ˜ ÂÎ-‰ËÏÒÛÂÈ˜ ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘, fiˆ˜¯ÚfiÓÈ· ‚·ÎÙËÚÈ·ÈÌ›·.

∆˘ÔÔ›ËÛË ÙÔ˘ ÛÙÂÏ¤¯Ô˘˜ ¤ÁÈÓÂ ÛÂ 29(48%) ÂÚÈÙÒÛÂÈ˜. ∞ÓÈ¯ÓÂ‡ÙËÎ·Ó 14 (48,3%)ÛÙÂÏ¤¯Ë ÙË˜ ÔÚÔÔÌ¿‰·˜ µ Î·È 12 (41,4%) ÙË˜ÔÚÔÔÌ¿‰·˜ C. ∞ÓÈ¯ÓÂ‡ÙËÎ·Ó, Â›ÛË˜, 2 (6,9%)ÛÙÂÏ¤¯Ë ÙË˜ ÔÚÔÔÌ¿‰·˜ ∞ Î·È 1 (3,4%) ÙË˜ ÔÚÔ-ÔÌ¿‰·˜ W135.

∏ ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹ ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈ-Î‹˜ ÓfiÛÔ˘ ¤‰ÂÈÍÂ ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË Î·Ù¿ÙÔ˘˜ ÊıÈÓÔˆÚÈÓÔ‡˜ Î·È ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜. ∆ÔÂÍ¿ÌËÓÔ ™ÂÙ¤Ì‚ÚÈÔ˜-ºÂ‚ÚÔ˘¿ÚÈÔ˜ ·Ú·ÙËÚ‹-ıËÎ·Ó 43 (64%) ÂÚÈÙÒÛÂÈ˜, ¤Ó·ÓÙÈ 20 (36%)ÂÚÈÙÒÛÂˆÓ Î·Ù¿ ÙÔ ÂÍ¿ÌËÓÔ ª¿ÚÙÈÔ˜-∞‡ÁÔ˘-ÛÙÔ˜ (∂ÈÎfiÓ· 2). ∫·Ù¿ ÙÔ ‰È¿ÛÙËÌ· ÙË˜ ÌÂÏ¤ÙË˜,·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÂÚ›Ô‰ÔÈ ·˘ÍËÌ¤ÓË˜ Â›-ÙˆÛË˜ ÙË˜ ÓfiÛÔ˘ (∂ÈÎfiÓ· 3), Ë ÚÒÙË Î·Ù¿ ÙË‰ÈÂÙ›· 1998-1999, ÌÂ Ì¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË9,6/100.000 Î·È Ë ‰Â‡ÙÂÚË Î·Ù¿ ÙÔ ¤ÙÔ˜ 2002 fiÙ·Ó

Ë Â›ÙˆÛË ·Ó‹ÏıÂ ÛÙÔ 19,34/100.000 ÏËı˘-ÛÌÔ‡. ∫·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999, 75% ÙˆÓ Ù·˘ÙÔ-ÔÈËÌ¤ÓˆÓ ÛÙÂÏÂ¯ÒÓ ·Ó‹ÎÂ ÛÙËÓ ÔÚÔÔÌ¿‰· C(∂ÈÎfiÓ· 4). ∆Ô ¤ÙÔ˜ 2002 ·fi Ù· 10 ÛÙÂÏ¤¯Ë Ô˘Ù·˘ÙÔÔÈ‹ıËÎ·Ó, 6 (60%) ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· µ,2 (20%) ÛÙËÓ ÔÚÔÔÌ¿‰· C Î·È ·fi 1 ÛÙÈ˜ ÔÌ¿‰Â˜∞ Î·È W135.

¶·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎÈ·Î‹ ÔÌ¿‰·.™Ù· ‚Ú¤ÊË (1-12 ÌËÓÒÓ), ·fi Ù· 8 ÛÙÂÏ¤¯Ë Ô˘Ù·˘ÙÔÔÈ‹ıËÎ·Ó, Ù· 6 ·Ó‹Î·Ó ÛÙËÓ ÔÚÔÔÌ¿‰· µ,ÂÓÒ ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ ¿Óˆ ÙÔ˘ 1 ¤ÙÔ˘˜ Ù·˘ÙÔ-ÔÈ‹ıËÎ·Ó 23 ÛÙÂÏ¤¯Ë, ·fi Ù· ÔÔ›· ÌfiÓÔ Ù· 7·Ó‹Î·Ó ÛÙËÓ ÔÚÔÔÌ¿‰· µ (75% ¤Ó·ÓÙÈ 30,4%,p<0,05).

™Â 6 (8,95%) ·È‰È¿, Ë ÓfiÛÔ˜ Â›¯Â ÌÔÈÚ·›·¤Î‚·ÛË. ∆· ·È‰È¿ Ô˘ ·Â‚›ˆÛ·Ó ‹Ù·Ó Ê˘ÛÈÔÏÔ-ÁÈÎ¿ Î·Ù¿ Ù· ¿ÏÏ· Î·È ‰ÂÓ Â›¯Â ·Ó·ÊÂÚıÂ› Î¿ÔÈÔ˘ÔÎÂ›ÌÂÓÔ ÓfiÛËÌ·. ∆· ·È‰È¿ Ô˘ ·Â‚›ˆÛ·Ó‹Ù·Ó ËÏÈÎ›·˜ 1-13 ÂÙÒÓ (Ì¤ÛË ËÏÈÎ›· 6 ¤ÙË). ∏ıÓËÙfiÙËÙ· ‰ÂÓ Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂ Î¿ÔÈ· Û˘ÁÎÂÎÚÈ-Ì¤ÓË ÔÚÔÔÌ¿‰·, ·ÏÏ¿ ÔÈ 4 ·fi ÙÔ˘˜ 6 ı·Ó¿ÙÔ˘˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:120-126

1

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2

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8 9 10 11 12 13 14

∂∂ÈÈÎÎfifiÓÓ·· 11.. ∏ÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÂ 67 ·È‰È¿.

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ºÂ‚. ª¿Ú. ∞Ú. ª¿ÈÔ˜ πÔ‡Ó. πÔ‡Ï. ∞‡Á. ™Â. √ÎÙ. ¡Ô¤Ì. ¢ÂÎ.

∂∂ÈÈÎÎfifiÓÓ·· 22.. ∂Ô¯È·Î‹ Î·Ù·ÓÔÌ‹ ÙˆÓ 67 ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ÌÂÏ¤ÙË˜.



Û˘Ó¤‚ËÛ·Ó ÙË ‰ÈÂÙ›· 1997-1998. ∞˘Ù‹ ÙË ¯ÚÔÓÈÎ‹

ÂÚ›Ô‰Ô Ù· ·È‰È¿ Ô˘ ·Â‚›ˆÛ·Ó ‹Ù·Ó ËÏÈÎ›·˜

3-8 ÂÙÒÓ (Ì¤ÛË ËÏÈÎ›· 5,5 ¤ÙË) Î·È Ú¤ÂÈ Ó· ÛË-

ÌÂÈˆıÂ› fiÙÈ Î·Ó¤Ó· ·fi Ù· 4 ·È‰È¿ ‰ÂÓ Â›¯Â ÂÌ-

‚ÔÏÈ·ÛÙÂ› ÌÂ ÙÔ ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi ÂÌ‚fiÏÈÔ. ™Â

¤Ó· ·È‰› Ô˘ ·Â‚›ˆÛÂ ÙÔ 2001, ËÏÈÎ›·˜ 1 ¤ÙÔ˘˜,

·ÔÌÔÓÒıËÎÂ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ÙË˜ ÔÌ¿‰·˜ µ.

™Ù· 5 ·fi Ù· 6 ·È‰È¿, Ô ı¿Ó·ÙÔ˜ Â‹ÏıÂ ÌÂÙ¿

·fi ÎÂÚ·˘ÓÔ‚fiÏÔ ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË, ÛÂ ‰È¿ÛÙË-

Ì· Ï›ÁˆÓ ˆÚÒÓ ·fi ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô,

ÂÓÒ ÛÂ ¤Ó· ·È‰› ÌÂÙ¿ ·fi ‰‡Ô 24ˆÚ· ÓÔÛËÏÂ›·˜.

™˘˙‹ÙËÛË

∏ Â›ÙˆÛË ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘

‰ÂÓ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ÛËÌ·ÓÙÈÎ¿ Ù· ÙÂÏÂ˘Ù·›· 30 ¯Úfi-

ÓÈ· Î·È ÔÈÎ›ÏÏÂÈ ·fi 1-3/100.000 ÛÙÈ˜ ÂÚÈÛÛfiÙÂ-

ÚÂ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ¤ˆ˜ 10-25/100.000 ÏË-

ı˘ÛÌÔ‡ ÛÙÈ˜ ¯ÒÚÂ˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘ (1-3). ™ÙË

“˙ÒÓË ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜” ÛÙÈ˜ ¯ÒÚÂ˜ Î¿Ùˆ ·fi

ÙËÓ ¤ÚËÌÔ ™·¯¿Ú·, Ô˘ ÂÎÙÂ›ÓÂÙ·È ·fi ÙË ∑¿-

ÌÈ· ˆ˜ ÙËÓ ∞ÈıÈÔ›·, ·Ú·ÙËÚÔ‡ÓÙ·È ÂÈ‰ËÌ›Â˜

Î¿ıÂ 8-12 ¯ÚfiÓÈ·, ÌÂ ÙËÓ Â›ÙˆÛË Ó· ÊÙ¿ÓÂÈ ¤ˆ˜

1.000/100.000 ÏËı˘ÛÌÔ‡ (2,6).

O ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ‹Ù·Ó Ô Î‡ÚÈÔ˜ ·ÈÙÈÔÏÔÁÈ-

Îfi˜ ·Ú¿ÁÔÓÙ·˜ ‚·ÎÙËÚÈ·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙÔ˘˜

ÙÚÂÈ˜ ÓÔÌÔ‡˜ ÙË˜ ∫Ú‹ÙË˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó. O ÌË-

ÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ·ÔÙÂÏÔ‡ÛÂ ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ‚·-

ÎÙËÚÈ·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È ÛÙ· ·È‰È¿ ÙË˜ ˘fi-

ÏÔÈË˜ ∂ÏÏ¿‰·˜ Î·È ÙË˜ ∂˘ÚÒË˜ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘

1990 Î·È ‹Ù·Ó Ì¿ÏÈÛÙ· ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÙËÓ ÙÂÏÂ˘-

Ù·›· ÂÓÙ·ÂÙ›·, ÌÂÙ¿ ·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙ·-

ÙË ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·Ù¿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘

¶·È‰È·ÙÚÈÎ‹ 2005;68:120-126

1990

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0

2

4

6

8

10

12

14

16

20

18

1991 1992 1993 1994 1995 1996

ŒÙÔ˜

1997 1998 1999 2000 2001 2002

∂∂ÈÈÎÎfifiÓÓ·· 33.. ∫·Ù·ÓÔÌ‹ 67 ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ Î·Ù¿ ¤ÙÔ˜ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏÂ›Ô˘, ƒÂı‡ÌÓÔ˘ Î·È §·-ÛÈı›Ô˘, 1990-2002 (‰È·ÁÓˆÛÙÈÎ‹ ¯Ú‹ÛË ÙË˜ PCR ÌÂÙ¿ ÙÔ 2001).

12

10

8

6

4

2

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µ C A, Y, W135, ·Ù·˘ÙÔÔ›ËÙÔÈ

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

∂∂ÈÈÎÎfifiÓÓ·· 44.. ∂Ù‹ÛÈ· Î·Ù·ÓÔÌ‹ ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘: 67 ÂÚÈÙÒÛÂÈ˜ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏÂ›Ô˘Î·È §·ÛÈı›Ô˘.



ÙË˜ ÁÚ›Ë˜ Ù‡Ô˘ b (14,16-21). ∏ ˘ÔÏÔÁÈ˙fiÌÂÓËÌ¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ∞ı‹Ó·˜Â›Ó·È 10,7 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000 ·È‰È¿ ËÏÈÎ›·˜<14 ÂÙÒÓ (15,22). π‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿-˙ÂÈ Ë Ù¿ÛË ·‡ÍËÛË˜ ÙË˜ ÓfiÛÔ˘ Ù· ÙÂÏÂ˘Ù·›· ¯Úfi-ÓÈ·. ™ÙËÓ ∂ÏÏ¿‰· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙË˜ Â›-ÙˆÛË˜ ÙË˜ ÓfiÛÔ˘ ·fi ÙÔ 1993-1997, ˘ÂÚ‚·›ÓÔ-ÓÙ·˜ ÙÈ˜ 3 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000 ÏËı˘ÛÌÔ‡Î·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999, ÂÓÒ Ë ¯ÒÚ· Ì·˜ Î·Ù·-Ù¿ÛÛÂÙ·È ÛÙÈ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜ ˘„ËÏ‹˜ Â›Ùˆ-ÛË˜, Ì·˙› ÌÂ ÙËÓ ∞ÁÁÏ›·, ÙË ™ÎˆÙ›·, ÙÔ µ¤ÏÁÈÔ, ÙËÓOÏÏ·Ó‰›· Î·È ÙË ª¿ÏÙ· (16,17,23). ¶·Ú·Ì¤ÓÂÈ·Ó·¿ÓÙËÙÔ ÂÚÒÙËÌ· Î·Ù¿ fiÛÔ ·˘Ù‹ Ë ·‡ÍËÛËÂ›Ó·È Ú·ÁÌ·ÙÈÎ‹ ‹ Â›Ó·È ·fiÙÔÎÔ˜ ÙË˜ Î·Ï‡ÙÂÚË˜Î·Ù·ÁÚ·Ê‹˜ Î·È ÙˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ ‰È·ÁÓˆÛÙÈÎÒÓÌÂıfi‰ˆÓ, fiˆ˜ Â›Ó·È Ë PCR Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ·Ó›¯ÓÂ˘ÛË ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ·ÎfiÌ· Î·È ÛÂÂÚÈÙÒÛÂÈ˜ ÌÂ ·ÚÓËÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· (15,24,25).™ËÌÂÈÒÓÂÙ·È fiÙÈ Î·È ÔÈ 16 ÂÚÈÙÒÛÂÈ˜ Ô˘ ·ÓÈ-¯ÓÂ‡ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÌÂ PCR ‰È·ÁÓÒ-ÛÙËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¤ÙË 2001-2002.

π‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ·Ó·ÊÔÚ¿ÙˆÓ ∫·ÓÈÙÛ¿ÎË Î·È Û˘Ó (19) ÁÈ· ÙË ÓÔÛËÚfiÙËÙ·ÛÙÔ ÓÔÌfi Ã·Ó›ˆÓ, ÙÔÓ Ù¤Ù·ÚÙÔ ‰ËÏ·‰‹ ÓÔÌfi ÙË˜∫Ú‹ÙË˜, Ô˘ ‰ÂÓ ¤¯ÂÈ Û˘ÌÂÚÈÏËÊıÂ› ÛÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË. ¶ÂÚ›Ô˘ ÛÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙË-Ì·, ÛÙÔ ÓÔÌfi Ã·Ó›ˆÓ Î·Ù·ÁÚ¿ÊËÎ·Ó 3,9 ÎÚÔ‡-ÛÌ·Ù· ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÂÙËÛ›ˆ˜Ô˘ - ÌÂ ‚¿ÛË ÙÔÓ ÙÔÈÎfi ·È‰ÈÎfi ÏËı˘ÛÌfi -·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÂ Â›ÙˆÛË 13,6/100.000/¤ÙÔ˜. ∏Â›ÙˆÛË ·˘Ù‹ Â›Ó·È Ë ˘„ËÏfiÙÂÚË ÁÈ· ÙËÓ ∫Ú‹ÙËÎ·È ‰Â›¯ÓÂÈ Ì›· ·‡ÍËÛË ÙË˜ ÓÔÛËÚfiÙËÙ·˜ ·fi Ù··Ó·ÙÔÏÈÎ¿ ÚÔ˜ Ù· ‰˘ÙÈÎ¿ ÙÔ˘ ÓËÛÈÔ‡.

∂È‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·ÈÛÙË ÌÔÚÈ·Î‹ ÁÂÓÂÙÈÎ‹, ‰Â›¯ÓÔ˘Ó fiÙÈ Û˘ÁÎÂÎÚÈÌ¤Ó·Û˘ÌÏ¤ÁÌ·Ù· ·fi ˘ÂÚÏÔÈÌÔÁfiÓ· ÛÙÂÏ¤¯Ë ¤¯Ô˘ÓÚÔÎ·Ï¤ÛÂÈ ÂÈ‰ËÌ›Â˜ ÛÂ fiÏÔ ÙÔÓ ÎfiÛÌÔ ÙËÓ ÙÂ-ÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· (2). ¶ÚfiÛÊ·Ù· ¤¯Ô˘Ó ·Ú·ÙË-ÚËıÂ› ÂÈ‰ËÌ›Â˜ ·fi ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ ÙË˜ ÔÌ¿-‰·˜ ∞ ÛÙÈ˜ ¯ÒÚÂ˜ ÙË˜ ∞ÊÚÈÎ‹˜, Î·ıÒ˜ Î·È ·‡ÍËÛËÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙËÓ ÔÚÔÔÌ¿‰· W135 ÛÂÚÔÛÎ˘ÓËÙ¤˜ ÛÙË ª¤ÎÎ· (1,2,4). Œ¯ÂÈ, Â›ÛË˜,ÂÚÈÁÚ·ÊÂ› ˘ÂÚÂÓ‰ËÌÈÎ‹ Î·È ÂÓ‰ËÌÈÎ‹ ÓfiÛÔ˜·fi ÛÙÂÏ¤¯Ë ÙË˜ ÔÚÔÔÌ¿‰·˜ µ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔÛ‡ÌÏÂÁÌ· ∂∆-5. ∆Ë ‰ÂÎ·ÂÙ›· ÙÔ˘ 1990 ·Ú·ÙË-Ú‹ıËÎÂ ·‡ÍËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ·fi ÙËÓ ÔÚÔÔÌ¿‰· C ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ∂∆-37, ËÔÔ›· ÂÌÊ·Ó›ÛÙËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙÔÓ ∫·Ó·‰¿Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÛÂ fiÏÔ ÙÔÓ ÎfiÛÌÔ (15,26).

™ÙËÓ ∫Ú‹ÙË ·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô Î‡Ì·Ù· ·˘-ÍËÌ¤ÓË˜ Â›ÙˆÛË˜. ∫·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999ÂÈÎÚ¿ÙËÛÂ Ë ÔÚÔÔÌ¿‰· C. ∆ËÓ ›‰È· ¯ÚÔÓÈÎ‹ Â-Ú›Ô‰Ô, Û‡ÌÊˆÓ· ÌÂ Ù· ‰Â‰ÔÌ¤Ó· ÙÔ˘ ∫¤ÓÙÚÔ˘∞Ó·ÊÔÚ¿˜ ªËÓÈÁÁ›ÙÈ‰·˜, ‰È·ÈÛÙÒıËÎÂ ·‡ÍËÛËÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÏÔ›ÌˆÍË˜ÛÂ fiÏË ÙËÓ ∂ÏÏ¿‰·, Ô˘ ÔÊÂÈÏfiÙ·Ó ÛÙËÓ ÔÚÔÔÌ¿-

‰· C Î·È È‰È·›ÙÂÚ· ÛÙÔ˘˜ ÔÚÔÙ‡Ô˘˜ 2a:P1,2 Î·ÈP1,5 ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ∂∆-15/∂∆-37 (15,17,18,26,27). ∞˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÙË˜ ÔÚÔÔÌ¿‰·˜ C·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÂ ¿ÏÏÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ∂˘ÚÒ-Ë˜ Î·È ÙË˜ ∞ÌÂÚÈÎ‹˜ Î·Ù¿ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1990(26,28,29), ˆÛÙfiÛÔ ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜, fiˆ˜ Ë πÙ·-Ï›·, ·Ú·ÙËÚ‹ıËÎÂ ÂÈÎÚ¿ÙËÛË ÙË˜ ÔÚÔÔÌ¿‰·˜ µ(30). ∫·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ·˘Ù‹ ÂÚ›Ô‰Ô, Ó¤ÔÈ ÔÚfiÙ˘-ÔÈ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ·ÔÌÔÓÒıËÎ·Ó ÙfiÛÔ ÛÙËÓ∂ÏÏ¿‰· fiÛÔ Î·È ÛÙËÓ ∆ÛÂ¯›· Î·È ÙËÓ ∞ÁÁÏ›· Î·ÈÛ˘ÁÎÂÎÚÈÌ¤Ó· Ô ÎÏÒÓÔ˜ ∂∆-15 Ô˘ ÚÔ‹ÏıÂ ·fiÙÔ ÛÙ¤ÏÂ¯Ô˜ ∂∆-37 (4,15,17,31). ™ÙË ‰Â‡ÙÂÚË¤Í·ÚÛË ÙË˜ ÓfiÛÔ˘, Î·Ù¿ ÙÔ ¤ÙÔ˜ 2002, ·Ú·ÙËÚ‹-ıËÎÂ Û¯ÂÙÈÎ‹ ÂÈÎÚ¿ÙËÛË ÙË˜ ÔÚÔÔÌ¿‰·˜ µ, ·ÏÏ¿Î·È ·ÔÌfiÓˆÛË, ÁÈ· ÚÒÙË ÊÔÚ¿, ÙË˜ ÔÚÔÔÌ¿‰·˜W135 Î·È ÌË Ù˘ÔÔÈ‹ÛÈÌˆÓ ÛÙÂÏÂ¯ÒÓ. ∞˘Ù‹ Ë·‡ÍËÛË ÙË˜ Â›ÙˆÛË˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ Î·Ù¿fiÛÔ Â›Ó·È Ú·ÁÌ·ÙÈÎ‹ ‹ ÔÊÂ›ÏÂÙ·È ÛÙËÓ Î·Ï‡ÙÂ-ÚË Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ, ·ÊÔ‡ ·fi ÙÔ¤ÙÔ˜ 2001 ÂÊ·ÚÌfi˙ÂÙ·È Ë Ì¤ıÔ‰Ô˜ PCR. ∆· ÂÚÈ-ÛÙ·ÙÈÎ¿ ÌÂ ÌË Ù˘ÔÔÈ‹ÛÈÌ· ÛÙÂÏ¤¯Ë, Î·ıÒ˜ Î·È·˘Ù¿ ÙË˜ ÔÌ¿‰·˜ W135 ‰È·ÁÓÒÛÙËÎ·Ó ÌÂ ÙË Ì¤-ıÔ‰Ô PCR (15).

ªÂÙ¿ ÙËÓ ¤Í·ÚÛË ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ Ófi-ÛÔ˘ ÙË ‰ÈÂÙ›· 1998-1999, ·Ú·ÙËÚ‹ıËÎÂ ÛÙËÓ∂ÏÏ¿‰· ·‡ÍËÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ ÙÔ ˘¿Ú¯ÔÓÙfiÙÂ ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈ-ÙÈ‰fiÎÔÎÎÔ˘ C. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ÌÂÏ¤ÙË˜ ˘ÔÏÔÁ›ÛÙËÎÂ fiÙÈ ÛÙËÓ ·Ú¯‹ ÙÔ˘ 1999 ÙÔ31% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 2-6 ÂÙÒÓ Î·È ÙÔ 52% ÙˆÓ·È‰ÈÒÓ ËÏÈÎ›·˜ 7-14 ÂÙÒÓ Â›¯·Ó Ï¿‚ÂÈ ÙÔ ·Ïfi Ô-Ï˘Û·Î¯·ÚÈ‰ÈÎfi ÂÌ‚fiÏÈÔ (A+C) (33). ∆Ô ÁÂÁÔÓfi˜·˘Ùfi Û˘Ó‰˘¿ÛÙËÎÂ ÌÂ ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙˆÓÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ·˘Ù‹ ÙËÓ ÔÚÔÔÌ¿‰· ÛÙ· ÂfiÌÂ-Ó· ¤ÙË, ÙfiÛÔ ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÚÈÔ¯‹ fiÛÔ Î·È ÛÂ¿ÏÏÂ˜ ̄ ÒÚÂ˜ ÙË˜ ∂˘ÚÒË˜ (16,17,33,34). ∞Í›˙ÂÈ ‚Â-‚·›ˆ˜ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ë ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ Ófi-ÛÔ˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙÔÓ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ ÙË˜ÔÌ¿‰·˜ C ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÓ‰ËÌÈÎ‹ Î·È ˘ÂÚÂÓ‰ËÌÈ-Î‹ ÌÔÚÊ‹, Ë ÔÔ›· ÌÔÚÂ› Ó· ÎÚ·Ù‹ÛÂÈ ÁÈ· ÔÏÏ¿¯ÚfiÓÈ· Î·È ‰ÂÓ ÌÔÚÂ› Ó· ÚÔ‚ÏÂÊıÂ› Ô ÙÂÚÌ·ÙÈ-ÛÌfi˜ ÙË˜ (2,15). ∂›Ó·È Èı·Ófi Ë ÂÏ¿ÙÙˆÛË ÙˆÓ Â-ÚÈÙÒÛÂˆÓ ÏÔ›ÌˆÍË˜ ·fi ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ ÙË˜ÔÚÔÔÌ¿‰·˜ C, Ô˘ ‰È·ÈÛÙÒıËÎÂ Ù· ·Ì¤Ûˆ˜ Âfi-ÌÂÓ· ¤ÙË, Ó· ÌËÓ ‹Ù·Ó ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÂÌ‚ÔÏÈ·-ÛÌÔ‡, ·ÏÏ¿ Â›ÙÂ ÙË˜ ÂÚÈÔ‰ÈÎfiÙËÙ·˜ ÙÔ˘ ÌËÓÈÁÁÈÙÈ-‰fiÎÔÎÎÔ˘, Â›ÙÂ ÙË˜ Û˘ÏÏÔÁÈÎ‹˜ ·ÓÔÛ›·˜ Ô˘ ·Ó·-Ù‡¯ıËÎÂ ÛÙÔÓ ÏËı˘ÛÌfi ÌÂÙ¿ ·fi ÙËÓ ¤ÎıÂÛË ÛÂ·˘Ùfi ÙÔÓ ÔÚfiÙ˘Ô (15,31,33).

∫·ıÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¤ÙË ¤¯Ô˘Ó ·Ú·ÙËÚËıÂ›ÂÈ‰ËÌ›Â˜ ·fi W135 ÛÙË “˙ÒÓË ÙË˜ ÌËÓÈÁÁ›ÙÈ-‰·˜” ÛÙËÓ ∞ÊÚÈÎ‹, ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fiÙÔÓ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ À ÛÙËÓ AÌÂÚÈÎ‹ (1,6) Î·È ·fi ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘˜ Ô˘ ‰ÂÓ ·Ó‹ÎÔ˘ÓÛÙÈ˜ ÁÓˆÛÙ¤˜ ÔÚÔÔÌ¿‰Â˜, ¤¯ÂÈ ÂÎÊÚ·ÛÙÂ› Êfi‚Ô˜fiÙÈ Ô Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ›Ûˆ˜ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ

¶·È‰È·ÙÚÈÎ‹ 2005;68:120-126



ÂÈÎÚ¿ÙËÛË ¿ÏÏˆÓ ÔÚÔÔÌ¿‰ˆÓ (2,34,35). O ÌË-ÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ ‰È·ı¤ÙÂÈ ÌÂÁ¿ÏË ÈÎ·ÓfiÙËÙ· ÁÂ-ÓÂÙÈÎ‹˜ ‰È·ÊÔÚÔÔ›ËÛË˜ Î·È ÔÚÈ˙fiÓÙÈ·˜ ÁÂÓÂÙÈ-Î‹˜ ·ÓÙ·ÏÏ·Á‹˜ ÁÔÓÈ‰›ˆÓ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ¤Ó-˙˘Ì· ˘Â‡ı˘Ó· ÁÈ· ÙË Û‡ÓıÂÛË ÙË˜ Î¿„·˜. ∞˘Ù‹Ë È‰ÈfiÙËÙ· ÂÈÙÚ¤ÂÈ ÙËÓ ·ÓÙÈÁÔÓÈÎ‹ ‰È·ÊÔÚÔ-Ô›ËÛË ÙˆÓ ÎÏÒÓˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÍ¿-ÏˆÛË˜ ÙË˜ ÓfiÛÔ˘ Î·È ·˘Ùfi ¤¯ÂÈ ‹‰Ë ÙÂÎÌËÚÈˆ-ıÂ› ÌÂÙ·Í‡ ÙˆÓ µ Î·È C ÛÙÂÏÂ¯ÒÓ (35-37). ™Â ¯Ò-ÚÂ˜ fiÔ˘ ÂÊ·ÚÌfi˙ÂÙ·È ‹‰Ë Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·-ÛÌfi˜ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ C, fiˆ˜ Ë∞ÁÁÏ›· Î·È Ë πÛ·Ó›·, ‰ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› ÚÔ˜ÙÔ ·ÚfiÓ Î¿ÙÈ Ù¤ÙÔÈÔ (39,40).

∏ ıÓËÙfiÙËÙ· ·fi ÙË ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔÂÍ·ÚÙ¿Ù·È ÙfiÛÔ ·fi ÙÔÓ ÔÚfiÙ˘Ô ÙÔ˘ ÌËÓÈÁÁÈÙÈ-‰fiÎÔÎÎÔ˘ fiÛÔ Î·È ·fi ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ Î·Ù¿-ÛÙ·ÛË ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È ·Ú·Ì¤ÓÂÈ ˘„ËÏ‹, ·ÎfiÌ·Î·È ÌÂ Ù· Û‡Á¯ÚÔÓ· ıÂÚ·Â˘ÙÈÎ¿ Î·È ˘ÔÛÙËÚÈ-ÎÙÈÎ¿ Ì¤Û·. ∏ ıÓËÙfiÙËÙ· ‰ÈÂıÓÒ˜ ˘ÔÏÔÁ›˙ÂÙ·ÈÛÂ 7% ÁÈ· fiÏÂ˜ ÙÈ˜ ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜, ·ÏÏ¿ ÊÙ¿ÓÂÈ¤ˆ˜ ÙÔ 21% ÛÂ ÌÂÏ¤ÙÂ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÂ ·È‰È¿Î·È ÌÔÚÂ› Ó· ÊÙ¿ÛÂÈ ÙÔ 40% fiÙ·Ó Ë ÓfiÛÔ˜ Û˘ÓÔ-‰Â‡ÂÙ·È ·fi Î·Ù·ÏËÍ›· (8,11,41). ∏ ıÓËÙfiÙËÙ·ÛÂ ÔÛÔÛÙfi 8,95% ÙË˜ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ÌÂÏ¤ÙË˜ Â›Ó·È ·Ó¿ÏÔÁË ÌÂ ÙË Ì¤ÛË Â˘Úˆ·˚Î‹(16,20,23,24,26,38,41).

¶ÚfiÛÊ·Ù·, ÙÔ ÂÓ‰È·Ê¤ÚÔÓ ¤¯ÂÈ ÂÛÙÈ·ÛÙÂ› È‰È-·›ÙÂÚ· ÛÙË ‰ËÌÈÔ˘ÚÁ›· ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÂÌ‚Ô-Ï›ˆÓ ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ·fi ÙÔÓ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ. ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÔÓÔ‰‡Ó·ÌÔ˘ Û˘˙Â˘ÁÌ¤ÓÔ˘ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ ÙË˜ ÔÚÔÔÌ¿‰·˜ C ·ÔÙ¤ÏÂÛÂ ÛË-Ì·ÓÙÈÎ‹ ÚfiÔ‰Ô. ∏ ∞ÁÁÏ›· ‹Ù·Ó Ë ÚÒÙË ¯ÒÚ·Ô˘ ÂÈÛ‹Á·ÁÂ ÙÔÓ Ì·˙ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÌÂ ÙÔ Û˘-˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ C,ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ıÂ·Ì·ÙÈÎ‹ ÂÏ¿ÙÙˆÛË Î·È ÙË˜ÓÔÛËÚfiÙËÙ·˜ (¤ˆ˜ 86,7%) Î·È ÙË˜ ıÓËÙfiÙËÙ·˜·fi ·˘Ù‹ ÙËÓ ÔÚÔÔÌ¿‰· (39). ∞ÎÔÏÔ‡ıËÛ·Ó Î·È¿ÏÏÂ˜ ¯ÒÚÂ˜, fiˆ˜ Ë πÛ·Ó›·, ÌÂ ·Ó¿ÏÔÁ· ÂÓı·Ú-Ú˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· (39,40,42). ª¤¯ÚÈ Û‹ÌÂÚ·‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ‰˘Ó·Ù‹ Ë ·Ú·ÛÎÂ˘‹ Î¿ÔÈÔ˘ ÈÎ·-ÓÔÔÈËÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ ÙË˜ ÔÚÔÔÌ¿‰·˜ µ,fiÔ˘ Ë ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙË˜ ÂÍˆ-ÙÂÚÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ ÙˆÓ ÛÙÂÏÂ¯ÒÓ, ‰ÂÓ ÂÈÙÚ¤ÂÈÓ· Û˘ÌÂÚÈÏËÊıÔ‡Ó fiÏÂ˜ ÛÂ ¤Ó· ÂÌ‚fiÏÈÔ (1,2,43).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙË˜ ÌÂÏ¤-ÙË˜ Ë ÓÔÛËÚfiÙËÙ· ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ Ófi-ÛÔ˘ ÛÙËÓ ∫Ú‹ÙË ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹, ÂÓÒ Ë ıÓËÙfiÙË-Ù· ‹Ù·Ó Ë ·Ó·ÌÂÓfiÌÂÓË ÁÈ· Ù· Â˘Úˆ·˚Î¿ Â›Â-‰·. ¶·Ú¿ ÙËÓ ‡·ÚÍË ÈÛ¯˘ÚÒÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ,Ë ·ÂÈÏ‹ ÙË˜ ÓfiÛÔ˘ ı· ÂÍ·ÎÔÏÔ˘ı‹ÛÂÈ Ó· ·Ú·-Ì¤ÓÂÈ, ¤ˆ˜ fiÙÔ˘ ÂÊ·ÚÌÔÛÙÂ› Î·ıÔÏÈÎfi˜ ÂÌ‚ÔÏÈ·-ÛÌfi˜ ÌÂ ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÂÌ‚fiÏÈ·, fiˆ˜ ¤¯ÂÈ Á›-ÓÂÈ ‹‰Ë ÂÊÈÎÙfi ÌÂ ÙÔÓ H. influenzae type b (44,45).∏ Î·Ù·ÓfiËÛË Î·È Ë ÌÂÏ¤ÙË ÙˆÓ ÙÔÈÎÒÓ ‰È·ÊÔ-ÚÔÔÈ‹ÛÂˆÓ ÙË˜ ÂÈ‰ËÌÈÔÏÔÁ›·˜ Î·È ÙË˜ Î·Ù·ÓÔ-Ì‹˜ ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ·-

Ú¤¯Ô˘Ó ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ Î·È Î·ÙÂ˘ı‡ÓÛÂÈ˜ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ·˘ÙÔ‡ ÙÔ˘ ÛËÌ·ÓÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ˘ÁÂ›· Î·È ÙË ˙ˆ‹ ÙˆÓ ·È‰ÈÒÓ.


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¶·È‰È·ÙÚÈÎ‹ 2005;68:120-126


127ORIGINAL ARTICLE

Meningococcal disease in Crete E. Apostolou1, E. Galanakis1, G. Vlahaki2, S. Stefanaki3, S. Maraki4, E. Kokori2, A. Tsilimigaki3, †S. Sbyrakis1,5

AbstractBackground: Neisseria meningitidis is a common cause of meningitis and septicaemia worldwide.Despite significant progress in its management, invasive meningococcal disease remains a threat forchildren of all ages. The aim of this study was to investigate the incidence of meningococcal disease in Creteover a 13-year period.

Methods: The study included all 67 children, residents of the prefectures of Iraklio, Rethimno and Lasithi,who were hospitalized for meningococcal disease in the three local Paediatric Departments and thePaediatric Intensive Care Unit in the period 1990-2002. The children were aged from 1 month to 13 years(mean age 4.66 years).

Results: Morbidity was increased during the winter months. The mean annual incidence was estimated at5.54/100,000. The local rates for the prefectures of Rethimno, Iraklio and Lasithi were 7.85/100,000,5.26/100,000 and 4.23/100,000 respectively. The prevalence was higher in infants, where serogroup B wasmore common. The serogroups was determined in 29 cases, serogroups B and C accounting for 48% and41.3% respectively. Two periods of increased incidence of meningococcal disease were observed, the firstin 1998-1999 with a predominance of serogroup C, and the second in 2002 with a predominance of groupB. The fatality rate was estimated at 9%, with no correlation with the serogroup.

Conclusions: Meningococcal disease caused considerable morbidity and mortality in the three prefecturesof Crete studied. Monitoring of the epidemiologic trends of this threatening infection is required to ensurerational use of the new vaccines.

Key wordsEpidemiology, Crete, meningitis, Neisseria meningitidis, vaccination.

1 Paediatric Clinic, UniversityGeneral Hospital ofHeraklion, Crete

2 1st Paediatric Clinic,Venizelion GeneralHospital of Heraklion,Crete

3 2nd Paediatric Clinic,Venizelion GeneralHospital of Heraklion,Crete

4 Department of ClinicalBacteriology-Parasitology-Zoonosis and GeographicalMedicine, UniversityGeneral Hospital ofHeraklion, Crete

5 Children’s Intensive CareUnit, University GeneralHospital of Heraklion,Crete

Correspondence:Emmanouil Galanakis School of Medicine, University of Crete P.O. Box 2208 710 03, Heraklion, Crete E-mail: [email protected]




128 ∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

2 °·ÛÙÚÂÓÙÂÚÔÏÔÁÈÎfi ∆Ì‹Ì·µ’ ¶·ıÔÏÔÁÈÎÔ‡ ∆ÔÌ¤·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

3 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜∞ÂÈÎfiÓÈÛË˜¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

AÏÏËÏÔÁÚ·Ê›·:∂ÏÂ˘ıÂÚ›· ¶··‰ÔÔ‡ÏÔ˘ O‡Ï·Ê ¶¿ÏÌÂ 228 ∆.∫. 714 10, ∏Ú¿ÎÏÂÈÔ∫Ú‹ÙË˜ E-mail: [email protected]


¶·È‰È·ÙÚÈÎ‹ 2005;68:128-131

¡fiÛÔ˜ Crohn ÛÂ ‚ÚÂÊÈÎ‹ ËÏÈÎ›·: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∂. ¶··‰ÔÔ‡ÏÔ˘1, ∂. ∫·ÙÛÈÁÈ·ÓÓ¿ÎË2, ∂. ªÈ¯·ËÏ›‰Ô˘1, π. °Ú·ÌÌ·ÙÈÎ¿ÎË˜3, ∂. ª·ÓÙ˙Ô˘Ú¿ÓË1

¶ÂÚ›ÏË„Ë∏ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘ Crohn ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Â›Ó·È È‰È·›ÙÂÚ· Û¿ÓÈ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜, ËÏÈÎ›·˜ ÔÎÙÒ ÌËÓÒÓ, Ô˘ ‰ÈÂÚÂ˘Ó‹ıËÎÂ ÁÈ· ˘ÚÂÙfi ¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ·Ò-ÏÂÈ· ‚¿ÚÔ˘˜ Î·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó·. ∏ ÂÌÊ¿ÓÈÛË ‚ÏÂÓÓÔ·ÈÌ·ÙËÚÒÓ ÎÂÓÒÛÂˆÓ Ô‰‹ÁËÛÂ ÛÙËÓ ÂÎÙ¤ÏÂ-ÛË ÎÔÏÔÓÔÛÎfiËÛË˜ Î·È ÛÙË Ï‹„Ë ˘ÏÈÎÔ‡ ÁÈ· ‚ÈÔ„›· ·fi ÙÔ ·¯‡ ¤ÓÙÂÚÔ (Ù˘ÊÏfi-ÔÚıfi) ÙËÓ 35Ë ËÌ¤-Ú· ÓÔÛËÏÂ›·˜, ÌÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ È‰ÈÔ·ı‹ ÊÏÂÁÌÔÓÒ‰Ë ÂÓÙÂÚÔ¿ıÂÈ·. ∆ËÓ 45Ë ËÌ¤Ú· ÓÔÛËÏÂ›-·˜ ·ÔÌÔÓÒıËÎÂ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÎÔÚ¿ÓˆÓ Campylobacter jejuni. ÃÔÚËÁ‹ıËÎÂ ·ÌÈÎÈÏÏ›ÓË/ÎÏ·‚Ô˘-Ï·ÓÈÎfi ÔÍ‡ ÌÂ ‚¿ÛË ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ· ÁÈ· Ù¤ÛÛÂÚÈ˜ ËÌ¤ÚÂ˜ ¯ˆÚ›˜ ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË. ∆ËÓ 50‹ ËÌ¤Ú·ÓÔÛËÏÂ›·˜ ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ÛÈÚÔÊÏÔÍ·Û›ÓË˜ Î·È ÌÂÙÚÔÓÈ‰·˙fiÏË˜ Î·È 10 ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ· ÙÔ‚Ú¤ÊÔ˜ ¤ÌÂÈÓÂ ·‡ÚÂÙÔ. ∆Ë 12Ë ËÌ¤Ú· ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ‰ÈÏÔ‡ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÚÔÛÙ¤ıË-ÎÂ ÛÔ˘ÏÊ·Û·Ï·˙›ÓË. ∆Ô ‚Ú¤ÊÔ˜ ¤Ï·‚Â ÙÔ ‰ÈÏfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· ÁÈ· ÙÚÂÈ˜ Ì‹ÓÂ˜ Î·È Û˘ÓÂÛÙ‹ıË ÛÔ˘Ï-Ê·Û·Ï·˙›ÓË ÁÈ· ¤Ó· ¯ÚfiÓÔ. ¶·Ú¤ÌÂÈÓÂ ·‡ÚÂÙÔ, ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜ Î·È ÌÂ ÈÎ·ÓÔÔÈËÙÈÎ‹ Úfi-ÛÏË„Ë ‚¿ÚÔ˘˜ ÁÈ· ÔÎÙÒ Ì‹ÓÂ˜, ÔfiÙÂ ·ÚÔ˘Û›·ÛÂ ÂÎ Ó¤Ô˘ ˘ÚÂÙfi Î·È ‰È·ÚÚÔ˚Î¤˜ ÎÂÓÒÛÂÈ˜. ŒÁÈÓÂ ÂÓ-‰ÔÛÎfiËÛË Î·È Ï‹„Ë ˘ÏÈÎÔ‡ ÁÈ· ‚ÈÔ„›· ·fi ÙÔ ÏÂÙfi Î·È ·¯‡ ¤ÓÙÂÚÔ, Ô˘ ÂÈ‚Â‚·›ˆÛÂ ÙË ‰È¿ÁÓˆÛËÙË˜ ÓfiÛÔ˘ Crohn. O ·ÛıÂÓ‹˜, ¤ÎÙÔÙÂ, Ï·Ì‚¿ÓÂÈ ÌÂÛ·Ï·˙›ÓË Î·È ·Ú·Ì¤ÓÂÈ ÂÏÂ‡ıÂÚÔ˜ Û˘ÌÙˆÌ¿ÙˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿¡fiÛÔ˜ Crohn, ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ˘ÚÂÙfi˜ ¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜, Campylobacter jejuni.

∂ÈÛ·ÁˆÁ‹

∏ ÓfiÛÔ˜ Crohn ·ÔÙÂÏÂ› ¯ÚfiÓÈ·, È‰ÈÔ·ı‹ÊÏÂÁÌÔÓÒ‰Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ¢ÂÓ Â›Ó·ÈÛ˘¯Ó‹ ÛÙËÓ ÚÒÙË ·È‰ÈÎ‹ ËÏÈÎ›· Î·È ıÂˆÚÂ›Ù·ÈÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÛÙ· ‚Ú¤ÊË. O ˘ÚÂÙfi˜ Î·È ËÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜ ÂÓ›ÔÙÂ ÚÔ¸¿Ú¯Ô˘Ó ÛÂÛ¯¤ÛË ÌÂ ÙËÓ ·ÚÔ˘Û›· ÛÔ‚·ÚÒÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓÛ˘ÌÙˆÌ¿ÙˆÓ. ™Â ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜, Ë ÔÚÈÛÙÈ-Î‹ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi Ì·ÎÚfi¯ÚÔÓË·Ú·ÎÔÏÔ‡ıËÛË, ÏfiÁˆ ·Ô˘Û›·˜ ·ıÔÏÔÁÈÎÒÓÂ˘ÚËÌ¿ÙˆÓ Î·Ù¿ ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ‹ ÙÔÓ ÂÚÁ·-ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô (1).

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¿ÓÈ· ÂÚ›ÙˆÛË ÙË˜ ÓfiÛÔ˘Crohn ÛÂ ‚Ú¤ÊÔ˜ ËÏÈÎ›·˜ ÔÎÙÒ ÌËÓÒÓ, Ô˘ ÂÈÛ‹-¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ‰ÈÂÚÂ‡ÓËÛË ÛÙ·ÛÈÌfiÙË-Ù·˜ ‚¿ÚÔ˘˜, ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ˘ÚÂÙÔ‡ Î·È ‚ÏÂÓ-ÓÔ·ÈÌ·ÙËÚÒÓ ÎÂÓÒÛÂˆÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ‰È·ÁÓˆ-ÛÙÈÎ‹ ÚÔÛ¤Ï·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Á›ÓÂÙ·È ·Ó·-ÊÔÚ¿ ÛÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È È‰È·›ÙÂÚ·ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ÛÙÔÈ¯Â›· Ô˘ Û¯Â-Ù›˙ÔÓÙ·È ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË Î·È ÙËÓ ÚfiÁÓˆÛË ÙË˜ÓfiÛÔ˘ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

ÕÚÚÂÓ ‚Ú¤ÊÔ˜ ËÏÈÎ›·˜ ÔÎÙÒ ÌËÓÒÓ ÂÈÛ‹¯ıËÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÏfiÁˆ ÂÌ‡ÚÂÙÔ˘ ÓÔ-

Û‹Ì·ÙÔ˜ Î·È ÛÙ·ÛÈÌfiÙËÙ·˜ ‚¿ÚÔ˘˜. ∏ ·ÚÔ‡Û·ÓfiÛÔ˜ Â›¯Â ·Ú¯›ÛÂÈ 18 ËÌ¤ÚÂ˜ ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜,ÌÂ ÂÌÊ¿ÓÈÛË Î·ıËÌÂÚÈÓ‹˜ ˘ÚÂÙÈÎ‹˜ Î›ÓËÛË˜¤ˆ˜ 38,2ÔC ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ÏÔ›ÌˆÍË˜, ·ÓÔÚÂ-Í›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∞Ó·Ê¤ÚıËÎÂ Ë ·ÚÔ˘Û›·¯·Ï·ÚÒÓ ÎÂÓÒÛÂˆÓ ÌÂ ÙËÓ ¤Ó·ÚÍË ÙË˜ Û˘Ó‰ÚÔ-Ì‹˜, Ô˘ fiÌˆ˜ ˘Ô¯ˆÚÔ‡Û·Ó ÛÙË Û˘Ó¤¯ÂÈ·. ∂›Ó·ÈÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. ∆Ô·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚıËÎÂ ÂÏÂ‡ıÂÚÔ. ∏·ÓÙÈÎÂÈÌÂÓÈÎ‹ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ÂÍ¤Ù·ÛË ‰ÂÓ ·Ô-Î¿Ï˘„Â ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∆Ô ‚Ú¤ÊÔ˜ ÂÎÙfi˜˘ÚÂÙÔ‡ ‹Ù·Ó ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. ¢È·È-ÛÙÒıËÎÂ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹-Ó· ÌÂ ÙÒÛË ÙË˜ Î·Ì‡ÏË˜ ·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜·fi ÙËÓ 90‹ ∂£ ÛÙÔÓ 7Ô Ì‹Ó·, ÌÂÙ·Í‡ 25Ë˜ Î·È50‹˜ ∂£ ÛÙÔÓ 8Ô Ì‹Ó· (∂ÈÎfiÓ· 1). ∆Ô ‡„Ô˜ Î·È ËÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ‚Ú›ÛÎÔÓÙ·Ó ÛÙËÓ 90‹ Î·ÈÙËÓ 75Ë ∂£, ·ÓÙ›ÛÙÔÈ¯·.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘ ÂÈ‚Â‚·È-ÒıËÎÂ Ë Î·ıËÌÂÚÈÓ‹ ÂÌÊ¿ÓÈÛË ˘ÚÂÙÔ‡ Î·È ÂÎÙÂ-Ï¤ÛÙËÎÂ ÂÎÙÂÙ·Ì¤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔÏ·›ÛÈÔ ‰ÈÂÚÂ‡ÓËÛË˜ ˘ÚÂÙÔ‡ ¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔ-Á›·˜. O ·‰Úfi˜ ·Ú¯ÈÎfi˜ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜¤‰ÂÈÍÂ ·ÈÌÔÛÊ·ÈÚ›ÓË 10,8 g/dL, ·ÈÌ·ÙÔÎÚ›ÙË 32,7%,RDW 16,1%, MCV 80,6 fl, MCH 26,5 pg, ·ÚÈıÌfiÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ 12.900/mm3 (26% Ô˘‰ÂÙÂ-ÚfiÊÈÏ·, 69% ÏÂÌÊÔÎ‡ÙÙ·Ú·, 3% ÌÔÓÔÎ‡ÙÙ·Ú· Î·È2% ËˆÛÈÓfiÊÈÏ·), ·ÈÌÔÂÙ¿ÏÈ· 493.000/mm3, ¢∂∫


129¡fiÛÔ˜ Crohn ÛÂ ‚Ú¤ÊÔ˜

0,7% Î·È Coombs (-). O ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ÈÔ-

ÓÙfiÁÚ·ÌÌ·, Ì¤ÙÚËÛË ÏÂ˘ÎˆÌ¿ÙˆÓ ÔÚÔ‡) ‹Ù·Ó Ê˘-

ÛÈÔÏÔÁÈÎfi˜ Î·È ÔÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ

·ÚÓËÙÈÎ¤˜. ∏ Mayer ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈÎ‹. OÈ

‰Â›ÎÙÂ˜ ÔÍÂ›·˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó Û¯ÂÙÈÎ¿ ˘„ËÏÔ›

(TKE: 43 mm, ·2 Ì·ÎÚÔÛÊ·ÈÚ›ÓË: 456 mg/dl Î·È

·ÙÔÛÊ·ÈÚ›ÓË: 335 mg/dl). ∏ ·/· ıÒÚ·Î· ‹Ù·Ó

Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È Ë Mantoux ·ÚÓËÙÈÎ‹. OÈ Î·Ï-

ÏÈ¤ÚÁÂÈÂ˜ Î·È ÔÈ ·Ú·ÛÈÙÔÏÔÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÎÔ-

Ú¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈÎ¤˜. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÁÈ· ÈÔ‡˜, ‚·ÎÙËÚ›‰È·, ÛÂÈÚÔ¯·›ÙÂ˜, ¯Ï·Ì‡‰È·, ÚÈ-

Î¤ÙÛÈÂ˜, Ì‡ÎËÙÂ˜ Î·È ·Ú¿ÛÈÙ· ‹Ù·Ó ·ÚÓËÙÈÎfi˜.

¢ÂÓ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ·ÓÙÈÛÒÌ·Ù· Î·Ù¿ ·ÌÔÈ‚¿-

‰ˆÓ. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·˘ÙÔ¿ÓÔÛ· Û˘ÛÙËÌ·ÙÈÎ¿ ÓÔ-

Û‹Ì·Ù· (∞¡∞, ∞¡CA, anti-DNA, Î‡ÙÙ·Ú· Ï‡ÎÔ˘,

C3, C4, RF, ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ IgM, IgA Î·È IgG)

‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∏ ËÏÂÎÙÚÔÊfiÚËÛË ÚˆÙÂ˚ÓÒÓ

¤‰ÂÈÍÂ ÌÈÎÚ‹ ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ ·2-ÛÊ·È-

ÚÈÓÒÓ (15,9%) Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ

Á-ÛÊ·ÈÚÈÓÒÓ (9,8%). O ¤ÏÂÁ¯Ô˜ ÁÈ· ÈÚÈ‰ÔÎ˘ÎÏ›ÙÈ‰·

ÌÂ Û¯ÈÛÌÔÂÈ‰‹ Ï˘¯Ó›· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆Ô Ì˘ÂÏfi-

ÁÚ·ÌÌ· Î·È Ë Ì¤ÙÚËÛË VMA ÛÂ 24ˆÚË Û˘ÏÏÔÁ‹

Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ∏ ‰ÔÎÈÌ·Û›· È‰ÚÒÙ·

‹Ù·Ó ‰‡Ô ÊÔÚ¤˜ ·ÚÓËÙÈÎ‹ ÁÈ· ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ, ÌÂ

Â·ÚÎ‹ ÔÛfiÙËÙ· È‰ÚÒÙ·. O ·ÂÈÎÔÓÈÛÙÈÎfi˜

¤ÏÂÁ¯Ô˜ (˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Î·Ú‰È¿˜,

MRI ÂÁÎÂÊ¿ÏÔ˘/ÎÔÈÏ›·˜) ‰ÂÓ ·ÔÎ¿Ï˘„Â ·ıÔ-

ÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÎÏÈÓÈÎ‹˜ Î·È ÂÚÁ·ÛÙË-

ÚÈ·Î‹˜ ‰ÈÂÚÂ‡ÓËÛË˜, Ô ·ÛıÂÓ‹˜ Û˘Ó¤¯ÈÛÂ Ó· ÂÌ-

Ê·Ó›˙ÂÈ ˘ÚÂÙfi Î·ıËÌÂÚÈÓ¿, ¯ˆÚ›˜ ¿ÏÏ· Û˘-

ÌÙÒÌ·Ù· ‹ ÌÂÙ·‚ÔÏ‹ ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜. ∂›-

ÎÔÛÈ Ù¤ÛÛÂÚÈ˜ ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘,

·ÚÔ˘Û›·ÛÂ ¤Í·ÚÛË ÙÔ˘ ˘ÚÂÙÔ‡ ÌÂ Ù·˘Ùfi¯ÚÔÓË

·ÚÔ˘Û›· ‚ÏÂÓÓÔ·ÈÌ·ÙËÚÒÓ ÎÂÓÒÛÂˆÓ. ∏ ÔÏÈÎ‹

IgE Î·È Ë ÂÈ‰ÈÎ‹ IgE ÛÂ ÙÚÔÊ¤˜ (RAST) ‹Ù·Ó Ê˘-

ÛÈÔÏÔÁÈÎ¤˜. ∞ÓÙÈÛÒÌ·Ù· ÁÈ· ÎÔÈÏÈÔÎ¿ÎË (·ÓÙÈ-

ÁÏÔÈ·‰ÈÓÈÎ¿, ¤Ó·ÓÙÈ ÙÔ˘ ÂÓ‰ÔÌ‡ÈÔ˘ Î·È ÙË˜ ‰È-

ÎÙ˘ˆÙ‹˜ Ô˘Û›·˜) ‹Ù·Ó ·ÚÓËÙÈÎ¿. ∂ÎÙÂÏ¤ÛÙËÎÂ

ÎÔÏÔÓÔÛÎfiËÛË, Ë ÔÔ›· ¤‰ÂÈÍÂ Ô›‰ËÌ· Î·È ÂÈ-

Ê·ÓÂÈ·Î¤˜ Î·Ù¿ ÙfiÔ˘˜ ÂÍÂÏÎÒÛÂÈ˜ ÛÙÔ ·ÓÈfiÓ,

ÂÁÎ¿ÚÛÈÔ Î·È Î·ÙÈfiÓ ÎfiÏÔÓ Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÙËÓ

ÂÚÈÔ¯‹ ÙË˜ ÂÈÏÂÔÙ˘ÊÏÈÎ‹˜ ‚·Ï‚›‰·˜. ∏ ‚ÈÔ„›·

ÂÓÙ¤ÚÔ˘ ‹Ù·Ó ÂÓ‰ÂÈÎÙÈÎ‹ ÁÈ· È‰ÈÔ·ı‹ ÊÏÂÁÌÔ-

ÓÒ‰Ë ÂÓÙÂÚÔ¿ıÂÈ·. ™Â Ó¤Â˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔ-

Ú¿ÓˆÓ ·ÔÌÔÓÒıËÎÂ Campylobacter jejuni. ªÂ

‚¿ÛË ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·, ¯ÔÚËÁ‹ıËÎÂ ÙËÓ 45Ë

ËÌ¤Ú· ÓÔÛËÏÂ›·˜ ·ÌÈÎÈÏÏ›ÓË ÌÂ ÎÏ·‚Ô˘Ï·ÓÈÎfi

ÔÍ‡, ¯ˆÚ›˜ fiÌˆ˜ ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÌÂÙ¿ ·fi

ÙÂÙÚ·‹ÌÂÚË ·ÁˆÁ‹. ÃÔÚËÁ‹ıËÎÂ, ÙfiÙÂ, Û˘Ó‰˘·-

ÛÌfi˜ ÛÈÚÔÊÏÔÍ·Û›ÓË˜-ÌÂÙÚÔÓÈ‰·˙fiÏË˜ ÁÈ· 10

ËÌ¤ÚÂ˜ Ô˘ Ô‰‹ÁËÛÂ ÛÂ ·˘ÚÂÍ›· ÌÂÙ¿ ·fi 79

ËÌ¤ÚÂ˜ ˘ÚÂÙÔ‡.

O ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·-

ÛË, ÌÂ Ô‰ËÁ›Â˜ Ó· Ï¿‚ÂÈ ÙÔ ‰ÈÏfi ·ÓÙÈ‚ÈÔÙÈÎfi

Û¯‹Ì· ÁÈ· ÙÚÂÈ˜ Ì‹ÓÂ˜, Î·ıÒ˜ Î·È ÛÔ˘ÏÊ·Û·Ï·˙›-

ÓË (50 mg/kg/24 h ÛÂ ‰‡Ô ‰fiÛÂÈ˜) ÁÈ· ¤Ó· ¯ÚfiÓÔ.

O Ù·ÎÙÈÎfi˜ ÌËÓÈ·›Ô˜ Â·Ó¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ÈÎ·ÓÔ-

ÔÈËÙÈÎ‹ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (∂ÈÎfiÓ· 1), ÂÓÒ Ô

·ÛıÂÓ‹˜ ¤ÌÂÈÓÂ ·‡ÚÂÙÔ˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÎÂÓÒ-

ÛÂÈ˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-

Îfi˜ ÌÂ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜, ÙˆÓ

ÚˆÙÂ˚ÓÒÓ ÔÍÂ›·˜ Ê¿ÛË˜ Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ

ËÏÂÎÙÚÔÊfiÚËÛË˜ ÚˆÙÂ˚ÓÒÓ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿

Â›Â‰·.

OÎÙÒ Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·, Ô ·ÛıÂÓ‹˜ Â·ÓÂÌÊ¿-

ÓÈÛÂ ˘ÚÂÙfi, ‚ÏÂÓÓÔ·ÈÌ·ÙËÚ¤˜ ÎÂÓÒÛÂÈ˜ Î·È ·ÓÔ-

ÚÂÍ›·. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈÎ¤˜

Î·È ‰ÂÓ ¯ÔÚËÁ‹ıËÎÂ ·ÓÙÈ‚›ˆÛË. ∏ ‰È¿‚·ÛË ÙÔ˘

ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ¤‰ÂÈÍÂ ÔÌ·Ï‹ ÌÔÚÊÔÏÔÁ›· Î·È

‚·ÙfiÙËÙ· ÌÂ ·ÂÈÎfiÓÈÛË ÛÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi (ÛÂ

¤ÎÙ·ÛË 3-4 cm ·fi ÙËÓ ÂÈÏÂÔÙ˘ÊÏÈÎ‹ ‚·Ï‚›‰·)

¶·È‰È·ÙÚÈÎ‹ 2005;68:128-131

16000

14000

12000

10000

8000

6000

4000

2000

01 3 5 7 9 11

∏ÏÈÎ›· ÛÂ Ì‹ÓÂ˜

13 15 17 19 21 23

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∂∂ÈÈÎÎfifiÓÓ·· 11.. ∫·Ì‡ÏË ‚¿ÚÔ˘˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙË Á¤ÓÓËÛË Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 23 ÌËÓÒÓ. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ‚¤ÏÔ˜ ˘Ô‰ÂÈ-ÎÓ‡ÂÈ ÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙÔ ÌÈÎÚfiÙÂÚÔ ÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙË˜ ·ÁˆÁ‹˜ ÌÂ ÛÈÚÔÊÏÔÍ·Û›ÓË/ÌÂ-ÙÚÔÓÈ‰·˙fiÏË Î·È ÛÔ˘ÏÊ·Û·Ï·˙›ÓË.


130 ∂. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

ÂÚÈÔ¯‹˜ ÌÂ ÌfiÏÈ˜ ˘ÔÛËÌ·ÈÓfiÌÂÓË ¿¯˘ÓÛË

ÙˆÓ Ù˘¯ÒÓ Î·È Û˘Ó˘¿Ú¯Ô˘Û· ÌÈÎÚÔÔ˙Ò‰Ë ‰È·-

ÌfiÚÊˆÛË ÙË˜ ‚ÏÂÓÓÔÁÔÓÈÎ‹˜ ·Ú˘Ê‹˜ ÙÔ˘ ÂÓÙ¤-

ÚÔ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi ‹Ù·Ó Û˘Ì‚·Ùfi ÌÂ ÚÒÈÌË

·ÂÈÎÔÓÈÛÙÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ÓfiÛÔ˘ Crohn (∂ÈÎfi-

Ó· 2). ∞fi ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÚÔ¤Î˘„Â ÂÈ-

ÎfiÓ· ¯ÚÔÓ›˙Ô˘Û·˜, Ì¤ÙÚÈ·˜ ÔÈÛÔÊ·Á›ÙÈ‰·˜ ÌÂ ÌÈ-

ÎÚÔ‡ ¤ˆ˜ Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ·‡ÍËÛË ÙË˜ ·Ó·ÁÂÓ-

ÓËÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÌÂ ˘ÂÚ·ÈÌ›·. ∂›-

ÛË˜, ÂÈÎfiÓ· ‹È·˜, ÌË ÂÈ‰ÈÎ‹˜ Á·ÛÙÚ›ÙÈ‰·˜ ÌÂ

ÂÛÙÈ·Î¿ Ê·ÈÓfiÌÂÓ· ·ÚfiÍ˘ÓÛË˜ (focally en-

hanced gastritis). µÏÂÓÓÔÁfiÓÔ˜ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘

ÌÂ ÙÌ‹Ì· ÙÔ˘ ˘Ô‚ÏÂÓÓÔÁÔÓ›Ô˘ ÌÂ ·ÚÔ˘Û›·

ÔÏÏÒÓ Á·ÁÁÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ¶·Ú·ÙËÚ‹ıËÎÂ

‹È· ˆ˜ Ì¤ÙÚÈ· ¯ÚÔÓ›˙Ô˘Û· ‰ˆ‰ÂÎ·‰·ÎÙ˘Ï›ÙÈ‰·

Ô˘ ‹Ù·Ó ÂÛÙÈ·Î¿ ÈÔ ¤ÓÙÔÓË. OÈ ‚ÈÔ„›Â˜ ÙÔ˘

·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ¯fiÚÈÔ ·ÚÔ˘Û›·-

˙Â Ì¤ÙÚÈÔ ¤ˆ˜ ÛËÌ·ÓÙÈÎfi Ô›‰ËÌ· ÌÂ ·ÈÌÔÚÚ·ÁÈ-

Î¤˜ ‰ÈËı‹ÛÂÈ˜. ∆· ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È Ù· Ï·-

ÛÌ·ÙÔÎ‡ÙÙ·Ú· ‹Ù·Ó Ì¤ÙÚÈ· ¤ˆ˜ ÛËÌ·ÓÙÈÎ¿ ·˘-

ÍËÌ¤Ó· ÌÂ ·ÓÔÌÔÈÔÁÂÓ‹ Î·Ù·ÓÔÌ‹ Î·È ÌÂ ‡·Ú-

ÍË ·ÚÎÂÙÒÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ. ¶·Ú·ÙËÚ‹ıË-

Î·Ó ‰È¿Û·ÚÙÂ˜ ÌÈÎÚÔÔÌ¿‰Â˜ ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÓ

Ô˘ Û¯ËÌ¿ÙÈ˙·Ó ÎÔÎÎÈÒÌ·Ù·, ÂÈÎfiÓ· ÂÓ‰ÂÈÎÙÈÎ‹

ÙË˜ ÓfiÛÔ˘ Crohn.

∂ÈÏ¤¯ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ÌÂÛ·Ï·˙›ÓË˜ (60

mg/kg/24 h), ÌÂ ‰Â‰ÔÌ¤ÓË ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÏÂ-

ÙÔ‡ ÂÓÙ¤ÚÔ˘, Î·ıÒ˜ Î·È ÙÔ˘ ÌÈÎÚfiÙÂÚÔ˘ ÔÛÔ-

ÛÙÔ‡ ·ÓÙÈ‰Ú¿ÛÂˆÓ ˘ÂÚÂ˘·ÈÛıËÛ›·˜ Û˘ÁÎÚÈÙÈÎ¿

ÌÂ ÙË ÛÔ˘ÏÊ·Û·Ï·˙›ÓË (2) Î·È Ë ·ÓÙ·fiÎÚÈÛË

‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈÎ‹. ∏ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜

¤Ó· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ· ·Ú·Ì¤ÓÂÈ Î·Ï‹, ¯ˆÚ›˜ Û˘-

ÌÙˆÌ·ÙÔÏÔÁ›· ·fi ÙÔ ÂÙÈÎfi ‹ ¿ÏÏÂ˜ ÂÍˆÂ-

ÓÙÂÚÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, ÂÓÒ Ë ÚfiÛÏË„Ë ‚¿ÚÔ˘˜

Â›Ó·È Â·ÚÎ‹˜ (∂ÈÎfiÓ· 1).

™˘˙‹ÙËÛË

∏ È‰ÈÔ·ı‹˜ ÊÏÂÁÌÔÓÒ‰Ë˜ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤-ÚÔ˘ ÂÚÈÁÚ¿ÊÂÙ·È Û¿ÓÈ· Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·Î·È Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ú·Ì¤ÓÔ˘Ó ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ÔÈÁÓÒÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ ÛÂËÏÈÎ›Â˜ Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ (3,4). ∏ Û˘¯ÓfiÙËÙ· ÙË˜ÓfiÛÔ˘ Crohn ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 3-4/100.000 Î·È Ô ÂÈÔÏ·ÛÌfi˜ ÙË˜ 30-100/100.000(5). ™Â Â˘Úˆ·˚Î‹ ÌÂÏ¤ÙË, Ë Û˘¯ÓfiÙËÙ· ÙË˜ Ófi-ÛÔ˘ Crohn ÛÙËÓ ∫Ú‹ÙË ‚Ú¤ıËÎÂ 7,5/100.000 Î·ÈÛÙ· πˆ¿ÓÓÈÓ· 1/100.000 (6).

ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙÔ 25-30% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ Ë ‰È¿ÁÓˆÛË ·ÊÔÚ¿ ÛÂ ·È‰È¿ (4). ∏ ÓfiÛÔ˜ ¤¯ÂÈÌ¤ÁÈÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÛÙÔÓ ·È‰È·ÙÚÈÎfiÏËı˘ÛÌfi Î·Ù¿ ÙË Ì¤ÛË Î·È ÚÔ¯ˆÚËÌ¤ÓË ÂÊË-‚Â›·, ÂÓÒ ·fi ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË, Ô˘ ¤ÁÈÓÂÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, ÚÔÎ‡ÙÂÈ fiÙÈ ÔÛÔÛÙfi Ìfi-ÏÈ˜ 4% ÙˆÓ ·È‰ÈÒÓ ÌÂ È‰ÈÔ·ı‹ ÊÏÂÁÌÔÓÒ‰Ë Ófi-ÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Â›Ó·È ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 5ÂÙÒÓ (7). ™Â ÚfiÛÊ·ÙË Î·Ó·‰ÈÎ‹ ÌÂÏ¤ÙË ·Ó·ÛÎÔ-‹ıËÎ·Ó 830 ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓ ÌÂ ÊÏÂÁÌÔÓÒ-‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÙÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1978-2000. ™Â 7 ·fi Ù· ·È‰È¿·˘Ù¿ (4 ı‹ÏÂ· Î·È 3 ¿ÚÚÂÓ·) Â›¯Â ÙÂıÂ› Ë ‰È¿ÁÓˆÛËÙË˜ ÓfiÛÔ˘ Crohn ÚÈÓ Ù· 2 ¤ÙË ˙ˆ‹˜, ÔÛÔÛÙfi Ô˘·ÓÙÈÛÙÔÈ¯Â› ÛÙÔ 1% ÂÚ›Ô˘ ÙÔ˘ Û˘ÓfiÏÔ˘, ÂÓÒ ËÌ¤ÛË ËÏÈÎ›· Î·Ù¿ ÙÔÓ ¯ÚfiÓÔ ÙË˜ ÈÛÙÔÏÔÁÈÎ‹˜ ‰È¿-ÁÓˆÛË˜ ‹Ù·Ó 9,2 Ì‹ÓÂ˜ (Â‡ÚÔ˜ 2-21 Ì‹ÓÂ˜). ∞fiÙËÓ ›‰È· ¤ÚÂ˘Ó· Ê·›ÓÂÙ·È fiÙÈ Û˘ÌÙÒÌ·Ù· ÌÔÚÂ›Ó· ÂÎ‰ËÏˆıÔ‡Ó Î·È ÛÂ ‚Ú¤ÊË Ô˘ ‰È·ÙÚ¤ÊÔÓÙ·È·ÔÎÏÂÈÛÙÈÎ¿ ÌÂ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (8). OÈ CohenÎ·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ÙÂÛÛ¿ÚˆÓ ÂÚÈ-ÛÙ·ÙÈÎÒÓ ‚ÚÂÊÈÎ‹˜ ÓfiÛÔ˘ Crohn ÛÂ ÔÈÎÔÁ¤ÓÂÈ·µÂ‰Ô˘›ÓˆÓ (9). À¿Ú¯Ô˘Ó, Â›ÛË˜, ‰‡Ô ÛÎ·Ó‰ÈÓ·-‚ÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ·Ú¤¯Ô˘Ó Û¯ÂÙÈÎ¿ ÂÈ‰ËÌÈÔÏÔ-ÁÈÎ¿ ÛÙÔÈ¯Â›·. ™Â ÛÔ˘Ë‰ÈÎ‹ ÌÂÏ¤ÙË ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È 639 ·È‰È¿ ÌÂ ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘,3 ÂÎ ÙˆÓ ÔÔ›ˆÓ (0,5%) ‹Ù·Ó ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ÙˆÓ 2 ÂÙÒÓ. ŒÓ· ·fi ·˘Ù¿ Â›¯Â ÓfiÛÔ Crohn (10). ™Â·Ó¿ÏÔÁË ‰·ÓÈÎ‹ ÌÂÏ¤ÙË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÛÂ Û‡ÓÔÏÔ103 ÓÔÛÔ‡ÓÙˆÓ ·È‰ÈÒÓ, 5 ·fi ·˘Ù¿ (5%), Û˘ÌÂ-ÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ ÂÓfi˜ ÌÂ ÓfiÛÔ Crohn, ‹Ù·Ó ËÏÈ-Î›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 2 ÂÙÒÓ (11). ∂›ÛË˜, ˘¿Ú¯ÂÈ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÊÔÚ¿ ·fi ÙËÓ πÙ·Ï›· ÓfiÛÔ˘Crohn ÌÂ ¤Ó·ÚÍË ÙÔÓ ÚÒÙÔ Ì‹Ó· ÙË˜ ˙ˆ‹˜ (12).

ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ÁÂÓÂÙÈÎÔ›,ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› Î·È ·ÓÔÛÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜,·ÏÏ¿ Ë ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ Crohn ·Ú·Ì¤ÓÂÈÌ¿ÏÏÔÓ ·Û·Ê‹˜ (5). ∂È‰ÈÎfiÙÂÚ· ‰Â ¤Ó·˜ ÌÂÁ¿ÏÔ˜·ÚÈıÌfi˜ ÏÔÈÌˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ (˘ÂÚÛ›ÓÈ·, Ì˘ÎÔ-‚·ÎÙËÚ›‰ÈÔ, Î·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ, ¯Ï·Ì‡‰È· Î.¿.)Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ Ófi-ÛÔ˘, ¯ˆÚ›˜ fiÌˆ˜ Ó· ¤¯ÂÈ ÂÈ‚Â‚·ÈˆıÂ› ÁÈ· Î·Ó¤Ó··fi ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ·˘ÙÔ‡˜ Ë ·ÔÎÏÂÈÛÙÈÎfiÙËÙ·ÙË˜ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎ‹˜ ·˘Ù‹˜ Û˘Û¯¤ÙÈÛË˜ (13).

¶·È‰È·ÙÚÈÎ‹ 2005;68:128-131

∂∂ÈÈÎÎfifiÓÓ·· 22.. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ ÂÈÎfiÓ· ·fi ÙË ‰È¿‚·ÛË ÙÔ˘ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, Ô˘ ·ÂÈÎÔÓ›˙ÂÈ ÛÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi Î·È ÛÂ¤ÎÙ·ÛË 3-4 cm ·fi ÙËÓ ÂÈÏÂÔÙ˘ÊÏÈÎ‹ ‚·Ï‚›‰· ÂÚÈÔ¯‹ ÌÂÌfiÏÈ˜ ˘ÔÛËÌ·ÈÓfiÌÂÓË ¿¯˘ÓÛË ÙˆÓ Ù˘¯ÒÓ Î·È Û˘Ó˘-¿Ú¯Ô˘Û· ÌÈÎÚÔÔ˙Ò‰Ë ‰È·ÌfiÚÊˆÛË ÙË˜ ‚ÏÂÓÓÔÁÔÓÈÎ‹˜·Ú˘Ê‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘.


131¡fiÛÔ˜ Crohn ÛÂ ‚Ú¤ÊÔ˜

ªÂ ‚¿ÛË ÙËÓ ˘fiıÂÛË ÙË˜ “ÌÔÚÈ·Î‹˜ ·ÔÌ›ÌË-ÛË˜” (molecular mimicry), Ë Â›ÛÔ‰Ô˜ ÛÙÔÓ ÔÚÁ·ÓÈ-ÛÌfi Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ·ıÔÁfiÓˆÓ, Ô˘ ÂÚÈ¤¯Ô˘ÓÚˆÙÂ˝ÓÂ˜ (·ÓÙÈÁfiÓ·) ÌÂ ÛËÌ·ÓÙÈÎ‹ ÔÌÔÏÔÁ›· ÌÂ·ÓıÚÒÈÓÂ˜ ÚˆÙÂ˝ÓÂ˜ (Helicobacter pylori ‹Campylobacter jejuni - Ô˘ ·ÔÌÔÓÒıËÎÂ Î·È ÛÙËÓ·ÚÔ‡Û· ÂÚ›ÙˆÛË), ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÙÂÏÈÎ¿ÛÂ Ì›· ·˘ÙÔ¿ÓÔÛË ‰È·‰ÈÎ·Û›· (14). ™Â ¤Ó· ¿ÙÔÌÔÌÂ ÁÂÓÂÙÈÎ‹ ÚÔ‰È¿ıÂÛË, Ë Ú‡ıÌÈÛË ÙË˜ Î·Ù·ÛÙÔ-Ï‹˜ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÛÙÔ ÙÔ›¯ˆÌ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙË‰È¿ÚÎÂÈ· ÙË˜ ÏÔ›ÌˆÍË˜ Á›ÓÂÙ·È ·ÓÂ·ÚÎÒ˜ Î·È ·˘-Ùfi ˘ÚÔ‰ÔÙÂ› Ì›· ·˘ÙÔ¿ÓÔÛË ‰È·‰ÈÎ·Û›· ·˘ÙÔ·˘-Í·ÓfiÌÂÓË˜ ÙÚÔÊÔ‰fiÙËÛË˜ (13). £ÂˆÚÂ›Ù·È Èı·-ÓfiÓ fiÙÈ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ·ÓÔÛÔÏÔÁÈÎ‹ ÈÛÔÚÚÔ›·ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È È‰È·›ÙÂÚ· Ë Û¯ÂÙÈ˙fiÌÂÓË ÌÂ Ù· ∆1-‚ÔËıËÙÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· (15,16). ∞Ó·ÊÔÚ¤˜ Û¯Â-ÙÈ˙fiÌÂÓÂ˜ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘ ÛÙË ‚ÚÂÊÈÎ‹ËÏÈÎ›· Èı·Ó¿ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙÈ˜ ÚÔ-Û¿ıÂÈÂ˜ Î·Ù·ÓfiËÛË˜ ÙË˜ ·ıÔÁ¤ÓÂÈ¿˜ ÙË˜, Î·ıÒ˜Î·È ·Ó·ÁÓÒÚÈÛË˜ ÙˆÓ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Ô˘ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ ÚÒÈÌË ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘.

¶·Ú¿ ÙË Û·ÓÈfiÙËÙ¿ ÙË˜, Ë È‰ÈÔ·ı‹˜ ÊÏÂÁ-ÌÔÓÒ‰Ë˜ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿-ÓÂÙ·È ˘’ fi„ÈÓ ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÛÂ ÌÈÎÚ¿‚Ú¤ÊË, Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· fiˆ˜¯ÚfiÓÈ· ‹ ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿ÚÚÔÈ·, ‰˘Û·ÔÚÚfiÊËÛËÎ·È Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ·‡ÍËÛË ‚¿ÚÔ˘˜ ‹ ˘ÚÂÙfi¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜. ™ËÌÂÈÒÓÂÙ·È, fiÌˆ˜, fiÙÈÛÙË ÓfiÛÔ Crohn Ô ˘ÚÂÙfi˜ ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ›·Ô˘Û›· ÛÔ‚·ÚÒÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓÎ·È Ó· ‰È·ÁÓˆÛÙÂ› ·Ú¯ÈÎ¿ ˆ˜ “˘ÚÂÙfi˜ ¿ÁÓˆÛÙË˜·ÈÙÈÔÏÔÁ›·˜”. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÏÎÒ‰Ë ÎÔÏ›ÙÈ‰· Ô˘ÚÂÙfi˜ ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Î·Ù¿ ÙËÓ ·ÚÔ˘Û›·ÎÂÚ·˘ÓÔ‚fiÏÔ˘ ÓfiÛÔ˘ (1). ∏ Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ·‡ÍËÛË ‚¿ÚÔ˘˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ 20-30% ÙˆÓ ·È-‰ÈÒÓ ÌÂ ÓfiÛÔ Crohn Î·È ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈÙËÓ ·Ú¯ÈÎ‹ ÙË˜ ÂÎ‰‹ÏˆÛË (1).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË,Ê·›ÓÂÙ·È fiÙÈ Ë ÛÈÚÔÊÏÔÍ·Û›ÓË ÌfiÓË ÙË˜ ‹ ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ÙË ÌÂÙÚÔÓÈ‰·˙fiÏË ÌÔÚÂ› Ó· ·›-ÍÂÈ ÚfiÏÔ ˆ˜ Ê¿ÚÌ·ÎÔ ÚÒÙË˜ ÁÚ·ÌÌ‹˜ ÛÙË ıÂÚ·-Â›· ÙË˜ ÓfiÛÔ˘ Crohn. ™Â ÂÓ‹ÏÈÎÂ˜ ·ÛıÂÓÂ›˜, Ô˘··ÓÙÔ‡Ó ÛÂ Û¯‹Ì· Û˘Á¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ ÁÈ· 3 Ì‹-ÓÂ˜, Èı·Ó¿ Ô ÌË¯·ÓÈÛÌfi˜ Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌÂ›ˆ-ÛË ÙÔ˘ ·ÓÙÈÁÔÓÈÎÔ‡ ÊÔÚÙ›Ô˘ Î·È, ÂÔÌ¤Óˆ˜, ÌÂ›ˆ-ÛË Î·È ÙË˜ ÂÓÙÂÚÈÎ‹˜ ÊÏÂÁÌÔÓ‹˜, ÂÓÒ Ô ·Ú·ÙÂ-Ù·Ì¤ÓÔ˜ ·˘Ùfi˜ Û˘Ó‰˘·ÛÌfi˜ ÌÔÚÂ› Ó· ·ÔÙÂÏ¤-ÛÂÈ ÂÓ·ÏÏ·ÎÙÈÎ‹ ıÂÚ·Â›· ÛÙ· ÛÙÂÚÔÂÈ‰‹ Î·Ù¿ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘. ∂›ÛË˜, Ë ÛÈÚÔÊÏÔ-Í·Û›ÓË ıÂˆÚÂ›Ù·È fiÙÈ ¤¯ÂÈ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ¤˜È‰ÈfiÙËÙÂ˜ Ô˘ ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÔ˘Ó ÙË ÊÏÂÁÌÔ-ÓÒ‰Ë ‰Ú·ÛÙËÚÈfiÙËÙ· (17,18).

∆fiÛÔ ·fi ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·ÈfiÛÔ Î·È ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ÚÔ·Ó·Ê¤ÚıËÎ·ÓÊ·›ÓÂÙ·È fiÙÈ Ë ÌÈÎÚ‹ ËÏÈÎ›· Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‰ÂÓÛ˘Ó‰¤ÂÙ·È ··Ú·›ÙËÙ· ÌÂ ÊÙˆ¯‹ ÚfiÁÓˆÛË (8).

¶Èı·ÓÒ˜, fiˆ˜ ÈÛ¯‡ÂÈ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜, ÙfiÛÔ Ë ¤ÎÙ·ÛË fiÛÔ Î·È Ë‚·Ú‡ÙËÙ¿ ÙË˜ Â›Ó·È ·˘Ù¤˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ¤Î‚·Û‹ ÙË˜.


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2. Hyams JS. The digestive system. In: Behrman R, KliegmanR, Jenson H, editors. Inflammatory bowel disease. NelsonTextbook of Pediatrics. 17th ed. Philadelphia: W.B. Saun-ders; 2004. p. 1252-1255.

3. Farmer RG, Michener WM. Prognosis of Crohn’s diseasewith onset in childhood or adolescence. Dig Dis Sci1979;24:752-757.

4. Harboe ZB, Paerregaard A, Hansen BF, Hesselfeldt P.Crohn disease in early childhood. J Pediatr GastroenterolNutr 2001;32:224-225.

5. Hyams JS. Crohn’s disease in children. Pediatr Clin NorthAm 1996;43:255-277.

6. Shivananda S, Lennard-Jones J, Logan R, Fear N, Price A,Carpenter L et al. Incidence of inflammatory bowel diseaseacross Europe: is there a difference between north andsouth? Results of the European Collaborative Study on In-flammatory Bowel Disease (EC-IBD). Gut 1996;39:690-697.

7. Sawczenko A, Sandhu BK, Logan RF, Jenkins H, Taylor CJ,Mian S et al. Prospective survey of childhood inflammatorybowel disease in the British Isles. Lancet 2001;357:1093-1094.

8. Marx G, Seidman EG, Martin SR, Deslandres C. Outcomeof Crohn’s disease diagnosed before two years of age. J Pe-diatr 2002;140:470-473.

9. Cohen Z, Weizman Z, Kurtzbart E, Newman N, KapullerV, Maor E et al. Infantile colonic Crohn’s disease: a reportof four cases in one family. J Pediatr Gastroenterol Nutr2000;30:461-463.

10. Lindberg E, Lindquist B, Holmquist L, Hildebrand H. In-flammatory bowel disease in children and adolescents inSweden, 1984-1995. J Pediatr Gastroenterol Nutr 2000;30:259-264.

11. Langholz E, Munkholm P, Krasilnikoff PA, Binder V. In-flammatory bowel diseases with onset in childhood. Clini-cal features, morbidity, and mortality in a regional cohort.Scand J Gastroenterol 1997;32:139-147.

12. Baldi A, Di Marino MP, Vicidomini G, Baldi F. Crohn’sdisease in infancy: a case report. Int Surg 1998;83:154-156.

13. Karlinger K, Gyorke T, Mako E, Mester A, Tarjan Z. Theepidemiology and the pathogenesis of inflammatory bow-el disease. Eur J Radiol 2000;35:154-167.

14. Moran AP, Prendergast MM. Molecular mimicry inCampylobacter jejuni and Helicobacter pylori lipopolysac-charides: contribution of gastrointestinal infections to au-toimmunity. J Autoimmun 2001;16:241-256.

15. Shi HN, Walker A. Bacterial colonization and the develop-ment of intestinal defences. Can J Gastroenterol 2004;18:493-500.

16. Ohkusa T, Nomura T, Sato N. The role of bacterial infec-tion in the pathogenesis of inflammatory bowel disease. In-tern Med 2004;43:534-539.

17. Prantera C, Zannoni F, Scribano ML, Berto E, Andreoli A,Kohn A et al. An antibiotic regimen for the treatment ofactive Crohn’s disease: a randomized, controlled clinicaltrial of metronidazole plus ciprofloxacin. Am J Gastroen-terol 1996;91:328-332.

18. Ishikawa T, Okamura S, Oshimoto H, Kobayashi R, MoriM. Metronidazole plus ciprofloxacin therapy for activeCrohn’s disease. Intern Med 2003;42:318-321.

¶·È‰È·ÙÚÈÎ‹ 2005;68:128-131


132 CASE REPORT

1 Paediatric Clinic of theUniversity of Crete,Heraklion

2 Department ofGastroenterology, 2ndClinic of Internal Medicine,“Aghia Sophia” Children’sHospital, Athens

3 Laboratory of ClinicalImaging, University ofCrete, Heraklion

Correspondence:Eleftheria Papadopoulou 228 Ulof Palme str., 714 10, Heraklion, Crete E-mail: [email protected]



Crohn’s disease in infancy: a case report E. Papadopoulou1, E. Katsiyiannaki2, E. Mihailidou1, I. Grammatikakis3, E. Mantzouranis1

AbstractCrohn’s disease is very rare in infancy. The case is presented of an 8 month-old boy who was hospitalizedbecause of fever of undetermined origin and weight loss over the preceding month. A colonoscopy wascarried out on the 35th day of hospitalization after episodes of bloody diarrhoea. The biopsy specimenswere indicative of inflammatory bowel disease. Campylobacter jejuni was isolated from the stool cultureon the 45th day of the hospitalization. Amoxycillin/clavulanic acid was administered for four days, basedon the antibiotic sensitivity test, with no clinical response. On the 50th day of hospitalization ciproxin plusmetronidazole treatment was started, and the infant became afebrile after ten days. Sulphasalazine wasadded 12 days later. The ciproxin plus metronidazole was continued for three months and sulphasalazinefor one year. The infant remained without fever for eight months, with normal stools and normal weightgain. After a relapse he was rehospitalized at which time colonoscopy and biopsy confirmed the diagnosisof Crohn’s disease. Since then the patient has been under treatment with mesalazine, and has remainedsymptom-free.

Key wordsCrohn’s disease, infancy, fever of unknown origin, Campylobacter jejuni.


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∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ ª. Ã·ÛÈÒÙÔ˘1, ∂. ™·ÌÌÔ‡ÙË2, °. ¶ÈÙÛÔ˘Ï¿ÎË˜1, ª. µ·Î¿ÎË2, C. van Viet - ∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘3, ∂. ∫Ô˘‰Ô˘ÌÓ¿ÎË˜4

¶ÂÚ›ÏË„Ë∆· Û˘ÁÁÂÓ‹ ÙÂÚ·ÙÒÌ·Ù· ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Â›Ó·È Û¿ÓÈ· ÓÂÔÏ¿ÛÌ·Ù·. ∞ÊÔÚÔ‡Ó ÛÂ ¤Ó· ÔÛÔÛÙfi 3% ÙˆÓÙÂÚ·ÙˆÌ¿ÙˆÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∞Ó Î·È ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ·ÊÔÚÔ‡Ó ÛÂ Î·ÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·,Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ˘„ËÏfi ÔÛÔÛÙfi ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙ· ÈÂÛÙÈÎ¿ Ê·ÈÓfiÌÂÓ· Ô˘ ÚÔÎ·ÏÔ‡ÓÛÙËÓ ·ÂÚÔÊfiÚÔ Ô‰fi. ∏ ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ, Ù· ÔÔ›· ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÌÂ-Á¿ÏÔ Ì¤ÁÂıÔ˜, Â›Ó·È Ë Ï‹ÚË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛ‹ ÙÔ˘˜. O ÚÔÂÁ¯ÂÈÚËÙÈÎfi˜ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ·ÎÚÈ‚‹ ‰È¿ÁÓˆÛË Î·È ÙÔÓ ¯ÂÈÚÔ˘ÚÁÈÎfi Û¯Â‰È·ÛÌfi. ™Â ·˘Ù‹ ÙËÓ ·Ó·‰ÚÔÌÈÎ‹ÌÂÏ¤ÙË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ·ÂÈÎÔÓÈÛÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ 5 ·È‰ÈÒÓ (4 ·ÁfiÚÈ·, 1 ÎÔÚ›ÙÛÈ) ÌÂ ÙÚ·¯ËÏÈ-Îfi ÙÂÚ¿ÙˆÌ·. ŸÏ· Ù· ·È‰È¿ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ¿ÌÂÛ· ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Î·È Ë ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË¤‰ÂÈÍÂ ÙÂÚ¿ÙˆÌ·. ¢‡Ô ·È‰È¿ ·Â‚›ˆÛ·Ó ÛÂ Û‡ÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿∆Ú·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù·, ·È‰È¿, ·ÂÈÎfiÓÈÛË.


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“∞Á›· ™ÔÊ›·” ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1993-2003.

∞Ó·Ê¤ÚÔÓÙ·È, Â›ÛË˜, ÙÔ Ê‡ÏÔ, Ë ËÏÈÎ›·, ÛÙÔÈ¯Â›·

·fi ÙËÓ Î‡ËÛË Î·È ÙÔÓ ÙÔÎÂÙfi, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·

ÙˆÓ ÓÂÔÁÓÒÓ, Ë ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È Ù·

ÈÛÙÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·.

OÈ ·ÛıÂÓÂ›˜ ‹Ù·Ó ¤ÓÙÂ. ŸÏ· Ù· ÓÂÔÁÓ¿ ·ÓÙÈ-

ÌÂÙˆ›ÛÙËÎ·Ó ÌÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÙÔ˘ ÙÂ-

Ú·ÙÒÌ·ÙÔ˜ (4 ÔÏÈÎ‹, 1 ˘ÊÔÏÈÎ‹). ∆· ‰‡Ô ÓÂÔÁÓ¿

·Â‚›ˆÛ·Ó Û‡ÓÙÔÌ· ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì-

‚·ÛË (¶›Ó·Î·˜ 1).

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ

¶ÂÚ›ÙˆÛË ÚÒÙË ÕÚÚÂÓ ÓÂÔÁÓfi, 40 Â‚‰ÔÌ¿‰ˆÓ Î˘‹ÛÂˆ˜, ÁÂÓ-

Ó‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓË-

ÛË˜ 3400 g. ∏ Î‡ËÛË ‹Ù·Ó ÔÌ·Ï‹. ∫·Ù¿ ÙÔÓ ÙÔÎÂ-

Ùfi ·Ó·Ê¤ÚÂÙ·È Ú‹ÍË ·ÌÓ›Ô˘.

∂ÈÛÎÔÈÎÒ˜, Î·Ù¿ ÙË Á¤ÓÓËÛË ·Ú·ÙËÚ‹ıË-

ÎÂ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ· ÛÎÏËÚ‹ ‰Èfi-

ÁÎˆÛË ‰È·ÛÙ¿ÛÂˆÓ 8x5 cm ÂÚ›Ô˘. ∆Ô ÓÂÔÁÓfi

‰ÂÓ ·ÚÔ˘Û›·˙Â ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·. ªÂÙ·-

Ê¤ÚıËÎÂ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.

ŒÁÈÓÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘ Ô˘ ¤‰ÂÈÍÂ

ÔÏ‡¯ˆÚÔ Î˘ÛÙÈÎfi ÌfiÚÊˆÌ· ÛÙËÓ ·ÚÈÛÙÂÚ‹

ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ· ÌÂ ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·È Èı·Ó‹


134 ª. Ã·ÛÈÒÙÔ˘ Î·È Û˘Ó.

‰È¿ÁÓˆÛË ÏÂÌÊ·ÁÁÂÈÒÌ·ÙÔ˜ (∂ÈÎfiÓ· 1). ∞ÎÔÏÔ‡-ıËÛÂ ¤ÏÂÁ¯Ô˜ ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘Ô˘ ¤‰ÂÈÍÂ ¯ˆÚÔÎ·Ù·ÎÙËÙÈÎ‹ ÂÍÂÚÁ·Û›· 9x6 cmÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ· ÌÂ Î˘ÛÙÈÎ¿ Î·ÈÛ˘Ì·Á‹ ÛÙÔÈ¯Â›·. ∂›ÛË˜, ˘‹Ú¯·Ó ˘¤Ú˘ÎÓ·(·ÈÌÔÚÚ·ÁÈÎ¿) ÛÙÔÈ¯Â›· Î·È Â˘ÌÂÁ¤ıË˜ ·ÔÙÈÙ¿-ÓˆÛË. ™ÙÔ ‡„Ô˜ ÙÔ˘ ı˘ÚÂÔÂÈ‰Ô‡˜ ·‰¤Ó·, Ë ÂÍÂÚ-Á·Û›· ÂÚÓÔ‡ÛÂ ÙË Ì¤ÛË ÁÚ·ÌÌ‹ Î·È ·ˆıÔ‡ÛÂÙËÓ ÙÚ·¯Â›· ÚÔ˜ Ù· ‰ÂÍÈ¿. ∏ Èı·Ó‹ ‰È¿ÁÓˆÛË‹Ù·Ó ÙÂÚ¿ÙˆÌ· ÙÔ˘ ÙÚ·¯‹ÏÔ˘ (∂ÈÎfiÓ· 2). ∏ ÙÈÌ‹ÙË˜ ·-ÊÂÙÔÚˆÙÂ˝ÓË˜ ‹Ù·Ó 1815 ng/ml, ÂÓÒ Ù·Â›Â‰· ÙË˜ ‚-¯ÔÚÈ·Î‹˜ ÁÔÓ·‰ÔÙÚÔ›ÓË˜ ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎ¿.

∞ÎÔÏÔ‡ıËÛÂ Ï‹ÚË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛËÙÔ˘ fiÁÎÔ˘ Î·È Ë ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ¿ˆÚÔÛ˘ÁÁÂÓ¤˜ ÙÂÚ¿ÙˆÌ·. ∆Ô ÓÂÔÁÓfi ÂÍ‹ÏıÂ ·fi ÙÔ ÓÔ-ÛÔÎÔÌÂ›Ô ÌÂÙ¿ ·fi 15 ËÌ¤ÚÂ˜.

¶·È‰È·ÙÚÈÎ‹ 2005;68:133-138

∂∂ÈÈÎÎfifiÓÓ·· 22.. ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘. ∂˘ÌÂÁ¤ıË˜ ÙÚ·-¯ËÏÈÎ‹ ÂÍÂÚÁ·Û›· ÌÂ Î˘ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜, ·ÈÌÔÚÚ·ÁÈÎ¿ ÛÙÔÈ-¯Â›· Î·È ÌÈÎÚÔ·ÔÙÈÙ·ÓÒÛÂÈ˜ ÛÙÔÓ ÚÔÛÔÓ‰˘ÏÈÎfi ¯ÒÚÔ.

∂∂ÈÈÎÎfifiÓÓ·· 11.. ÀÂÚË¯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘. ¶ÔÏ‡¯ˆÚÔ Î˘ÛÙÈ-Îfi ÌfiÚÊˆÌ· ÌÂ ‰È·ÊÚ·ÁÌ¿ÙÈ· ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹¯ÒÚ·.

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135∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË £‹Ï˘, 38 Â‚‰ÔÌ¿‰ˆÓ Î˘‹ÛÂˆ˜, ÁÂÓÓ‹ıËÎÂ ÌÂ

Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3400 g.∞fi ÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÙÔÈ¯Â›· ˘ÂÚˆÚÈÌfiÙËÙ·˜ ÙÔ˘ Ï·ÎÔ‡ÓÙ·. ∏ÌËÙ¤Ú· ·Ó¤ÊÂÚÂ fiÙÈ ÓfiÛËÛÂ ·fi ·ÓÂÌÔ‚ÏÔÁÈ¿ Î·-Ù¿ ÙÔÓ ÚÒÙÔ Ì‹Ó· ÙË˜ Î‡ËÛË˜.

∆Ô ÓÂÔÁÓfi ÌÂÙ·Ê¤ÚıËÎÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ÙË Á¤ÓÓËÛ‹ ÙÔ˘ ÌÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, Ïfi-Áˆ ÌÔÚÊÒÌ·ÙÔ˜ Ô˘ ÚÔ¤‚·ÏÂ ·fi ÙË ÛÙÔÌ·ÙÈÎ‹ÎÔÈÏfiÙËÙ·.

∞fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÂÓÙÔ›ÛÙËÎ·Ó ÙÚ›·ÂÓ‰ÔÛÙÔÌ·ÙÈÎ¿ ÌÔÚÊÒÌ·Ù·, ÙÔ ÚÔ¤¯ÔÓ ÛÙËÓ Â-ÚÈÔ¯‹ ÙË˜ Î¿Ùˆ ÁÓ¿ıÔ˘ Î·È ‰‡Ô ·Ó·ÏfiÁÔ˘ ˘Ê‹˜,ÌÈÎÚfiÙÂÚ·, ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ.

ŒÁÈÓÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›-Ô˘, Ô˘ ¤‰ÂÈÍÂ ÌfiÚÊˆÌ· ‰È·ÛÙ¿ÛÂˆÓ 4,5x3,5x2,5cm, ÌÂ Î˘ÛÙÈÎ¿ Î·È Û˘Ì·Á‹ ÛÙÔÈ¯Â›· ÛÙÔÓ ˘Ô-ÁÏÒÛÛÈÔ ¯ÒÚÔ Î·È Ï¤Ù˘ÓÛË ÙÔ˘ ÎÏ¿‰Ô˘ ÙË˜ Î¿-Ùˆ ÁÓ¿ıÔ˘ ·ÚÈÛÙÂÚ¿.

∞ÎÔÏÔ‡ıËÛÂ Ï‹ÚË˜ ·Ê·›ÚÂÛË fiÏˆÓ ÙˆÓ ÌÔÚ-ÊˆÌ¿ÙˆÓ. ∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ¿ˆÚÔÛ˘ÁÁÂÓ¤˜ ÙÂÚ¿ÙˆÌ· ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. ∆Ô ÓÂÔÁÓfiÂÍ‹ÏıÂ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ ·fi 12 ËÌ¤ÚÂ˜.

¶ÂÚ›ÙˆÛË ÙÚ›ÙË ÕÚÚÂÓ ÓÂÔÁÓfi, 35 Â‚‰ÔÌ¿‰ˆÓ Î˘‹ÛÂˆ˜, ÁÂÓ-

Ó‹ıËÎÂ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÏfiÁˆ ÔÏ˘˘‰Ú·ÌÓ›Ô˘,ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 1170 g. ∏ ÌËÙ¤Ú· Ô‰ËÁ‹ıËÎÂÛÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ÏfiÁˆ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ-·˜. ∞Ó·Ê¤ÚÔÓÙ·È ‰‡Ô ÂÓ‰ÔÌ‹ÙÚÈ· ˘ÂÚË¯ÔÁÚ·-Ê‹Ì·Ù· Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ‰˘ÛÌÔÚÊ›· Î˘‹Ì·ÙÔ˜.

ªÂÙ¿ ÙË Á¤ÓÓËÛË ·Ú·ÙËÚ‹ıËÎÂ ÎÈÓËÙfi ÌfiÚ-ÊˆÌ· Ô˘ ÂÍÂÚ¯fiÙ·Ó ·fi ÙË ÛÙÔÌ·ÙÈÎ‹ ÎÔÈÏfiÙË-Ù· Î·È ¤ÊÂÚÂ Ì›Û¯Ô Ì‹ÎÔ˘˜ ÂÚ›Ô˘ 2 cm (∂ÈÎfiÓ·3). ¶ÂÚÈÁÚ¿ÊÂÙ·È fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂ-ÙÔ‡ ·fi ÙË ÌËÙ¤Ú· ÂÍ‹ÏıÂ ÌfiÚÊˆÌ· ÌÂ ¯¤ÚÈ, Ô˘Èı·ÓfiÓ ÂÚfiÎÂÈÙÔ ÁÈ· ¤Ì‚Ú˘Ô ÛÂ ¤Ì‚Ú˘Ô. ∆Ô ÓÂ-ÔÁÓfi ÛÂ ‚·ÚÈ¿ Î·Ù¿ÛÙ·ÛË ÌÂÙ·Ê¤ÚıËÎÂ ÛÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô. ™˘Ó˘‹Ú¯Â Û¯ÈÛÙ›· ˘ÂÚÒ·˜, Ï·ÁÒ¯ÂÈÏÔ

Î·È ‰˘Û¯¤ÚÂÈ· ‰Èfi‰Ô˘ ÙÔ˘ Î·ıÂÙ‹Ú· ·fi ÙÔÓ ‰ÂÍÈfiÚÒıˆÓ·. ∞ÎÔÏÔ‡ıËÛÂ ‰È·ÛˆÏ‹ÓˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡Î·È Î·ıÂÙËÚÈ·ÛÌfi˜ ÙË˜ ÔÌÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜.

∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘/ıÒÚ·Î·¤‰ÂÈÍÂ ÌfiÚÊˆÌ· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ·ÚÈÛÙÂÚ‹ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ· ÌÂ Â˘ÌÂÁ¤ıÂÈ˜ ·ÔÙÈÙ·ÓÒÛÂÈ˜(∂ÈÎfiÓ· 4). ∞ÎÔÏÔ‡ıËÛÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘ Ô˘ ¤‰ÂÈÍÂ ¯ˆÚÔÎ·Ù·ÎÙËÙÈ-Î‹ ÂÍÂÚÁ·Û›· ‰È·ÛÙ¿ÛÂˆÓ 7x4,5x4 cm ÌÂ Û˘Ì·-Á‹ ÛÙÔÈ¯Â›·, ·ÔÙÈÙ·ÓÒÛÂÈ˜, ÂÚÈÔ¯¤˜ Ï›Ô˘˜ Î·È·Ó¿‰ÂÈÍË ‰ÔÌÒÓ Ô˘ ı‡ÌÈ˙·Ó ÂÁÎÂÊ·ÏÈÎfi ·Ú¤Á-¯˘Ì· Î·È Èı·Ó‹ ‰È¿ÁÓˆÛË ÙÂÚ·ÙÒÌ·ÙÔ˜.

∞ÎÔÏÔ‡ıËÛÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÙË˜ ÂÍÂÚ-Á·Û›·˜ (∂ÈÎfiÓ· 5) Î·È ‰È·ÈÛÙÒıËÎÂ Ï‹ÚË˜ ÂÈ-ÎÔÈÓˆÓ›· ÛÙÔÌ·ÙÈÎ‹˜ Î·È ÚÈÓÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜. ∏ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ÒÚÈÌÔ ÙÂÚ¿ÙˆÌ· ÚÈÓÔ-Ê¿Ú˘ÁÁ·. ∆Ô ÓÂÔÁÓfi ·ÈÌÔÚÚ·ÁÔ‡ÛÂ Û˘ÓÂ¯Ò˜, ÂÌ-Ê¿ÓÈÛÂ ‚Ú·‰˘Î·Ú‰›· Î·È Î·Ù¤ÏËÍÂ 8 ÒÚÂ˜ ÌÂÙ¿ ÙËÓÂ¤Ì‚·ÛË (∂ÈÎfiÓ· 5). O ı¿Ó·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡Ú¤ÂÈ Ó· ·Ô‰ÔıÂ› ÛÙËÓ ¤ÓÙÔÓË ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿-ıÂÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Ô˘ Ô‰‹ÁËÛÂ ÛÂ Î·Ú‰È·Î‹ Î¿Ì-„Ë, ÛÙÈ˜ Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ Î·ÈÛÙÈ˜ ÌÂÁ¿ÏÂ˜ ‰È·ÛÙ¿ÛÂÈ˜ ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜, ·Ú¿ÛÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô (ÒÚÈÌÔ) ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜.

¶ÂÚ›ÙˆÛË Ù¤Ù·ÚÙË ÕÚÚÂÓ ÓÂÔÁÓfi, ËÏÈÎ›·˜ 25 ËÌÂÚÒÓ, ÌÂÙ·Ê¤ÚıË-

ÎÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÙÚ·¯ËÏÈÎ‹˜ ‰ÈfiÁÎˆÛË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:133-138

∂∂ÈÈÎÎfifiÓÓ·· 44.. ∞ÎÙÈÓÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘-ıÒÚ·ÎÔ˜. ªfiÚÊˆÌ·Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ· ÌÂ Â˘-ÌÂÁ¤ıË ·ÔÙÈÙ¿ÓˆÛË.

∂∂ÈÈÎÎfifiÓÓ·· 33.. ∂˘Ì¤ÁÂıÂ˜ ÌfiÚÊˆÌ· Ô˘ ÂÍ¤Ú¯ÂÙ·È ·fi ÙËÛÙÔÌ·ÙÈÎ‹ ÎÔÈÏfiÙËÙ· ÌÂ ÙÚ›¯Â˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘. ∆Â-Ú¿ÙˆÌ·.



‰ÂÍÈ¿ Î·È ‰˘Û¯¤ÚÂÈ· Û›ÙÈÛË˜. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıË-ÎÂ ÌÂÙ¿ Î‡ËÛË 40 Â‚‰ÔÌ¿‰ˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔ-ÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3200 g.

ŒÁÈÓÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘ Ô˘ ¤‰ÂÈÍÂÌfiÚÊˆÌ· ÌÈÎÙ‹˜ Û˘ÛÙ¿ÛÂˆ˜ ÛÙË ‰ÂÍÈ¿ ÙÚ·¯ËÏÈÎ‹¯ÒÚ·, ÌÂ Î¿ıÔ‰Ô ÚÔ˜ ÙË ıˆÚ·ÎÈÎ‹ ÎÔÈÏfiÙËÙ·.À‹Ú¯·Ó ÛÙÈÎÙ¤˜ ·ÔÙÈÙ·ÓÒÛÂÈ˜. ∏ Èı·Ó‹ ‰È¿-ÁÓˆÛË ‹Ù·Ó ÙÂÚ¿ÙˆÌ· ‹ Î˘ÛÙÈÎfi ‡ÁÚˆÌ· (∂ÈÎfiÓ·6). ∞ÎÔÏÔ‡ıËÛÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· Ô˘ ¤‰ÂÈÍÂ‰›¯ˆÚË ÂÍÂÚÁ·Û›· ‰È·ÛÙ¿ÛÂˆÓ 7x5,5x3,5 cm ÛÙË‰ÂÍÈ¿ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ· ÌÂ Î˘ÛÙÈÎ¿, Û˘Ì·Á‹ ÛÙÔÈ-¯Â›· Î·È ·ÔÙÈÙ·ÓÒÛÂÈ˜. ∆Ô ¤Ó· ÙÌ‹Ì· ÙÔ˘ fiÁÎÔ˘Î·ÙÂÚ¯fiÙ·Ó ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Ì¤¯ÚÈ ÙÔ ‡„Ô˜ ÙÔ˘‰È¯·ÛÌÔ‡ ÙË˜ ÙÚ·¯Â›·˜ ‰ÂÍÈ¿ Î·È ÙÔ ¿ÏÏÔ ÚÔ˜ ÙËÌ·Û¯·ÏÈ·›· ÎÔÈÏfiÙËÙ·. ™ÙÔ ‡„Ô˜ ÙˆÓ ÎÏÂÈ‰ÒÓ, ËÂÍÂÚÁ·Û›· ÂÚÓÔ‡ÛÂ ÙË Ì¤ÛË ÁÚ·ÌÌ‹ Î·È ·ˆ-ıÔ‡ÛÂ ÙÔÓ ÔÈÛÔÊ¿ÁÔ Î·È ÙËÓ ÙÚ·¯Â›· ·ÚÈÛÙÂÚ¿ Î·ÈÙÔÓ ı‡ÌÔ ÚÔÛı›ˆ˜. ∏ Èı·Ó‹ ‰È¿ÁÓˆÛË ‹Ù·ÓÙÚ·¯ËÏÈÎfi ÙÂÚ¿ÙˆÌ· ÌÂ Î·ıÔ‰ÈÎ‹ ÔÚÂ›· ÚÔ˜ÙË ıˆÚ·ÎÈÎ‹ ÎÔÈÏfiÙËÙ·.

∞ÎÔÏÔ‡ıËÛÂ Ï‹ÚË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË. ∏ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ¿ˆÚÔ ÙÂÚ¿ÙˆÌ·. ∆Ô·È‰› ÂÍ‹ÏıÂ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ ·fi 12ËÌ¤ÚÂ˜.

¶ÂÚ›ÙˆÛË ¤ÌÙË ÕÚÚÂÓ ÓÂÔÁÓfi, ËÏÈÎ›·˜ 38 Â‚‰ÔÌ¿‰ˆÓ, ÁÂÓÓ‹-

ıËÎÂ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÏfiÁˆ ÔÏ˘˘‰Ú·ÌÓ›Ô˘ Î·È‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 2900 g. ∆o ÓÂÔÁÓfi Â›¯Â ·Ó·ÓÂ˘-ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Î·È ˘‹Ú¯Â ÌfiÚÊˆÌ· Ô˘ ÚÔ¤-‚·ÏÂ ·fi ÙË ÛÙÔÌ·ÙÈÎ‹ ÎÔÈÏfiÙËÙ·. ∆Ô ÓÂÔÁÓfi ÌÂ-Ù·Ê¤ÚıËÎÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ‰È·ÛˆÏËÓÒıËÎÂ.

ŒÁÈÓÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›-Ô˘ Ô˘ ¤‰ÂÈÍÂ ¯ˆÚÔÎ·Ù·ÎÙËÙÈÎ‹ ÂÍÂÚÁ·Û›· ‰È·-ÛÙ¿ÛÂˆÓ 6x4x3 cm ÌÂ ·Û·Ê‹ fiÚÈ· ÛÙÔÓ ‰ÂÍÈfi˘ÔÁÏÒÛÛÈÔ ¯ÒÚÔ, ÌÂ Â¤ÎÙ·ÛË ·ÊÂÓfi˜ ÚÔ˜ ÙËÓ˘ÔÁÂÓÂ›‰È· ÂÚÈÔ¯‹ Î·È ·ÊÂÙ¤ÚÔ˘ ÚÔ˜ ÙÔÓÛÙÂÚÓÔÎÏÂÈ‰ÔÌ·ÛÙÔÂÈ‰‹ Ì˘. ∏ ÂÍÂÚÁ·Û›· ‹Ù·Ó·ÓÔÌÔÈÔÁÂÓ‹˜, ÌÂ ˘fi˘ÎÓÂ˜ ÂÚÈÔ¯¤˜ Î·È ÛÙÔÈ-¯Â›· Ï›Ô˘˜. ∞ˆıÔ‡ÛÂ Î·È ›Â˙Â ÙÔÓ Î¿ıÂÙÔÎÏ¿‰Ô ÙË˜ Î¿Ùˆ ÁÓ¿ıÔ˘ ‰ÂÍÈ¿, ÙË Ì·Ï·Î‹ ˘ÂÚÒ·Î·È ÙË ÁÏÒÛÛ· ÚÔ˜ Ù· ¿Óˆ Î·È ÚfiÛˆ (∂ÈÎfiÓ· 7).

∞ÎÔÏÔ‡ıËÛÂ ˘ÊÔÏÈÎ‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛËÎ·È Ë ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ÒÚÈÌÔ ÙÂÚ¿ÙˆÌ·.∆Ô ÓÂÔÁÓfi ·Â‚›ˆÛÂ 8 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘Ú-ÁÂ›Ô. ∏ ·ÈÙ›· ı·Ó¿ÙÔ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ Ú¤ÂÈ Ó··Ô‰ÔıÂ› ÛÙËÓ ·‰˘Ó·Ì›· ¿ÚÛÂˆ˜ ÙˆÓ ÈÂÛÙÈÎÒÓÊ·ÈÓÔÌ¤ÓˆÓ Â› ÙË˜ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ·fi ÙÔ ÙÂ-Ú¿ÙˆÌ· ÏfiÁˆ ı¤ÛÂˆ˜ ÛÙÔ˘˜ ÂÓ Ùˆ ‚¿ıÂÈ ÈÛÙÔ‡˜Î·È ÙË˜ ˘ÊÔÏÈÎ‹˜ ÂÍ·›ÚÂÛ‹˜ ÙÔ˘.

™˘˙‹ÙËÛË

∆· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· Â›Ó·È Û¿-ÓÈ· Î·È ·ÔÙÂÏÔ‡Ó ÔÛÔÛÙfi ÂÚ›Ô˘ 3% ÙÔ˘ Û˘-ÓfiÏÔ˘ ÙˆÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ. ∆· ¤ÓÙÂ ÂÚÈÛÙ·ÙÈÎ¿

¶·È‰È·ÙÚÈÎ‹ 2005;68:133-138

∂∂ÈÈÎÎfifiÓÓ·· 55.. ÃÂÈÚÔ˘ÚÁÈÎfi ·Ú·ÛÎÂ‡·ÛÌ·. ∆ÂÚ¿ÙˆÌ· ÚÈÓÔ-Ê¿Ú˘ÁÁ·.

∂∂ÈÈÎÎfifiÓÓ·· 66.. ÀÂÚË¯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘. ∂ÈÌ‹ÎË˜ ÙÔÌ‹.ªfiÚÊˆÌ· ÌÂ Û˘Ì·Á‹ Î·È Î˘ÛÙÈÎ¿ ÛÙÔÈ¯Â›·. ¶·ÚÔ˘Û›··ÔÙÈÙ·ÓÒÛÂˆÓ ÌÂ ·ÎÔ˘ÛÙÈÎ‹ ÛÎÈ¿.

∂∂ÈÈÎÎfifiÓÓ·· 77.. ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘. ∂ÍÂÚ-Á·Û›· ÛÙÔÓ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· ‰ÂÍÈ¿ ÌÂ Î˘ÛÙÈÎ¿ Î·È Û˘Ì·-Á‹ ÛÙÔÈ¯Â›·. ∞ÒıËÛË ÙË˜ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ·ÚÈÛÙÂÚ¿ Î·ÈÈÂÛÙÈÎfi ÂÓÙ‡ˆÌ· ÛÙÔÓ ÎÏ¿‰Ô ÙË˜ ÁÓ¿ıÔ˘ ‰ÂÍÈ¿.


137∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜

Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·ÊÔÚÔ‡ÓÛÂ ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 10 ÂÙÒÓ (1993-2003).ªÂÁ¿Ï· ÙÂÚ·ÙÒÌ·Ù· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÙÚ·¯‹ÏÔ˘Â›Ó·È ·ÈÙ›· ÁÈ· ÛÔ‚·Ú‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·Î·È Â›Ó·È ‰˘ÓËÙÈÎ¿ ı·Ó·ÙËÊfiÚ· (1). ∆Ô ˘„ËÏfiÔÛÔÛÙfi ıÓËÛÈÌfiÙËÙ·˜ Î·Ù¿ ÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ÂÚ›Ô‰Ô ÔÊÂ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙ· ¤ÓÙÔÓ· ÈÂÛÙÈÎ¿Ê·ÈÓfiÌÂÓ· Â› ÙË˜ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡, ÛÙÈ˜ Û˘Ó˘-¿Ú¯Ô˘ÛÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ÏÈÁfiÙÂÚÔÛÙËÓ ÈÛÙÔÏÔÁÈÎ‹ Ê‡ÛË ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜ (ÒÚÈÌÔ ‹¿ˆÚÔ). ™Ô‚·Ú‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Î·È ¿ÌÂ-ÛË ·Ó¿ÁÎË ‰È·ÛˆÏ‹ÓˆÛË˜ ˘‹Ú¯Â ÛÂ 3 ·fi Ù· 5ÓÂÔÁÓ¿ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜. ∆· ‰‡Ô ÓÂÔÁÓ¿·Â‚›ˆÛ·Ó ÙÔ ¤Ó· 8 ÒÚÂ˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô Î·ÈÙÔ ¿ÏÏÔ ÙËÓ 8Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ËÌ¤Ú·.

∂¿Ó Ù· ÙÚ·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· ‰ÂÓ ·ÓÙÈÌÂÙˆ-ÈÛÙÔ‡Ó ¤ÁÎ·ÈÚ· ÌÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË, ÙÔÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ Â›Ó·È ÔÏ‡ ˘„ËÏfi Î·È ÊÙ¿-ÓÂÈ ÙÔ 80-100% (1,7). ∆Ô ÔÏ˘˘‰Ú¿ÌÓÈÔ Î·È Ô‚·ıÌfi˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜. ªÂÁ¿ÏÂ˜ ÂÍÂÚ-Á·Û›Â˜ ÚÔÎ·ÏÔ‡Ó ˘ÂÚ¤ÎÙ·ÛË ÙÔ˘ ·˘¯¤Ó· ÙÔ˘ÂÌ‚Ú‡Ô˘ Î·È Ô‰ËÁÔ‡Ó ÛÂ ·fiÊÚ·ÍË ÙÔ˘ ÔÈÛÔÊ¿-ÁÔ˘, ‰È·Ù·Ú·¯‹ ÛÙËÓ Î·Ù¿ÔÛË Î·È ·ÚÔ˘Û›·ÔÏ˘˘‰Ú·ÌÓ›Ô˘ (4-6).

∆Ô ÔÏ˘˘‰Ú¿ÌÓÈÔ ·Ó·Ê¤ÚÂÙ·È ÛÂ ÔÛÔÛÙfi19% ·fi ÙÈ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜ (6,8).™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·ÊÔÚÔ‡ÛÂ ÛÙ· 2 ·fi Ù· 5ÓÂÔÁÓ¿ (ÔÛÔÛÙfi 40%), Ù· ÔÔ›· Â›¯·Ó Û¯ÂÙÈÎ¿ÌÂÁ¿ÏˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ì¿˙Â˜ ÌÂ ÂÓ‰ÔÛÙÔÌ·ÙÈÎ‹ÂÓÙfiÈÛË Î·È ÛÙ· ÔÔ›·, ·Ú¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ÂÍ·›ÚÂÛË ÙË˜ Ì¿˙·˜, Ë ÂÍ¤ÏÈÍË ‹Ù·Ó ‰˘ÛÌÂÓ‹˜(ı¿Ó·ÙÔ˜).

πÛÙÔÏÔÁÈÎÒ˜, Ù· ÙÂÚ·ÙÒÌ·Ù· Â›Ó·È fiÁÎÔÈ ÂÎ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÚÈ¤¯Ô˘Ó ÛÙÔÈ¯Â›· Î·È·fi Ù· ÙÚ›· ‚Ï·ÛÙÈÎ¿ ‰¤ÚÌ·Ù· ÌÂ ÚÔ¤¯ÔÓÙ· Ù·ÓÂ˘ÚÈÎ¿ ÛÙÔÈ¯Â›· (1,3). πÛÙÔÏÔÁÈÎ‹ ·ÓˆÚÈÌfiÙËÙ·‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·ÎÔ‹ıÂÈ· (1). ™Ù· 2 ÓÂÔÁÓ¿Ô˘ ·Â‚›ˆÛ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ÈÛÙÔÏÔ-ÁÈÎ‹ ‰È¿ÁÓˆÛË ¤‰ÂÈÍÂ “ÒÚÈÌÔ ÙÂÚ¿ÙˆÌ·”. ∫·ÎÔ‹-ıÂÈ· ÛÙ· ÙÚ·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· ··ÓÙ¿ ÛÂ ¤Ó·ÔÛÔÛÙfi ÂÚ›Ô˘ 10% Î·È ·ÊÔÚ¿ Û˘Ó‹ıˆ˜ ÛÂ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚˆÓ ËÏÈÎÈÒÓ Î·È ÛÂ ÂÓ‹ÏÈÎÂ˜ (3).™Â ÔÚÈÛÌ¤ÓÂ˜ ·fi ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·Ó·Ê¤-ÚÂÙ·È Î·È ·ÚÔ˘Û›· ÌÂÙ·ÛÙ¿ÛÂˆÓ ÓÂ˘ÌÔÓÈÎÒÓÎ·È Ë·ÙÈÎÒÓ (3,4).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÙÚ›· ÙÂÚ·ÙÒÌ·Ù· ¯·-Ú·ÎÙËÚ›ÛÙËÎ·Ó ·fi ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ˆ˜¿ˆÚ·. ∏ ·ÚÔ˘Û›· ·ÒÚˆÓ ÂÌ‚Ú˘˚ÎÒÓ ÛÙÔÈ¯Â›ˆÓÛÂ ¤Ó· ÙÂÚ¿ÙˆÌ· Î·ıÈÛÙ¿ ··Ú·›ÙËÙÔ ÙÔÓ ÂÚÈÔ-‰ÈÎfi ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Î·È ÙË Ì¤ÙÚËÛË ÙË˜ ·-ÊÂÙÔÚˆÙÂ˝ÓË˜ (9). ∂›ÛË˜, Ë ÈÛÙÔÏÔÁÈÎ‹ ‰È¿ÁÓˆ-ÛË “¿ˆÚÔ ÙÂÚ¿ÙˆÌ·” ··ÈÙÂ› ÛÙ·‰ÈÔÔ›ËÛË ÁÈ·Ù˘¯fiÓ ÌÂÙ·ÛÙ·ÙÈÎ‹ ÓfiÛÔ, ·Ó Î·È Ë Î·ÎÔ‹ıË˜ÂÍ·ÏÏ·Á‹ ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ··ÓÙ¿-Ù·È ÛÂ ·È‰È¿ ¤Ú·Ó ÙË˜ ÓÂÔÁÓÈÎ‹˜ ËÏÈÎ›·˜ (3). ™Â

¤Ó· ·fi Ù· ÓÂÔÁÓ¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Ë ·-ÊÂÙÔÚˆÙÂ˝ÓË Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó ÛÂ ˘„ËÏ¿Â›Â‰·.

∆· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· Û˘¯Ó¿‰È·ÁÈÁÓÒÛÎÔÓÙ·È ·fi ÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· (3,4,10). ∞Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÛÙËÓ Â-ÚÈÔ¯‹ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‰Â›-¯ÓÂÈ Ì¿˙· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÌÂ ·ÚÔ˘Û›· ·ÔÙÈÙ·-ÓÒÛÂˆÓ ÛÂ ÔÛÔÛÙfi ÂÚ›Ô˘ 50% (3,8). ™ÙËÓ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Ô˘ ¤ÁÈÓÂ ÛÂ ¤Ó· ·fi Ù· ÓÂÔ-ÁÓ¿ ˘‹Ú¯Â ÌÂÁ¿ÏË Ì¿˙· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈÎ‹ ¯ÒÚ·, ÌÂ ·ÔÙÈÙ·ÓˆÌ¤ÓÔÌfiÚÊˆÌ· ÌÂ ÌÔÚÊÔÏÔÁ›· ÛÔÓ‰‡ÏÔ˘.

∆· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· ÚÔ‚¿Ï-ÏÔ˘Ó ˆ˜ ÌÔÓ‹ÚË˜ ÙÚ·¯ËÏÈÎ‹ ‰ÈfiÁÎˆÛË. ∞Ó·Ê¤ÚÔ-ÓÙ·È fiÌˆ˜ Î·È ÔÏ˘ÂÛÙÈ·Î¤˜ (11) ÂÓÙÔ›ÛÂÈ˜,fiˆ˜ ÛÂ ¤Ó· ·fi Ù· ÓÂÔÁÓ¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤-ÙË˜ fiÔ˘ Ë ÚÔ¤¯Ô˘Û· ÂÍÂÚÁ·Û›· ‹Ù·Ó ÛÙËÓ Â-ÚÈÔ¯‹ ÙË˜ Î¿Ùˆ ÁÓ¿ıÔ˘, ·ÏÏ¿ Û˘Ó˘‹Ú¯·Ó ‰‡Ô ÌÈ-ÎÚfiÙÂÚÂ˜ ·Ó¿ÏÔÁË˜ ÈÛÙÔÏÔÁÈÎ‹˜ ˘Ê‹˜ Ì¿˙Â˜ ÛÙËÓ¿Óˆ ÁÓ¿ıÔ. £· Ú¤ÂÈ Ó· Á›ÓÂÈ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆ-ÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ Î˘-Ú›ˆ˜ ·fi ÙÔ Î˘ÛÙÈÎfi ‡ÁÚˆÌ· Î·È Û¿ÓÈ· ·fi ÓÂÔ-Ï¿ÛÌ·Ù· ÂÎ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Ô˘ ··ÓÙÒÓÙ·ÈÛ˘Ó‹ıˆ˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¿Â›Ó·È Û˘Ì·ÁÔ‡˜ ˘Ê‹˜ ÂÍÂÚÁ·Û›Â˜. ∏ ‰È·ÊÔÚÈÎ‹‰È¿ÁÓˆÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ·fi Î˘ÛÙÈÎfi ‡ÁÚˆÌ· ‰ÂÓÂ›Ó·È ¿ÓÙÔÙÂ Â˘¯ÂÚ‹˜, ·Ó ÏËÊıÂ› ˘’ fi„ÈÓ fiÙÈ Î·ÈÙ· ‰‡Ô ÓÂÔÏ¿ÛÌ·Ù· ·ÊÔÚÔ‡Ó ÛÂ ·ÛıÂÓÂ›˜ ÙË˜›‰È·˜ ËÏÈÎ›·˜, ¤¯Ô˘Ó ·ÚfiÌÔÈÔ Ì¤ÁÂıÔ˜, ·ÚfiÌÔÈ·ÂÓÙfiÈÛË, ÎÔÈÓ‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È ·ÚfiÌÔÈ··ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù· (1-3,12).

∞Ó Î·È Ù· ÏÂÌÊ·ÁÁÂÈÒÌ·Ù· Û˘Ó‹ıˆ˜ ÂÍÔÚÌÒ-ÓÙ·È ·fi ÙÔ Ô›ÛıÈÔ ÙÚ·¯ËÏÈÎfi ÙÚ›ÁˆÓÔ, fiÙ·Ó¤¯Ô˘Ó ÌÂÁ¿ÏÂ˜ ‰È·ÛÙ¿ÛÂÈ˜ ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ Ó· ‚ÚÂ-ıÂ› ÙÔ ·ÎÚÈ‚¤˜ ÛËÌÂ›Ô ÂÍÔÚÌ‹ÛÂÒ˜ ÙÔ˘˜. ∆fiÛÔ Ù·ÙÂÚ·ÙÒÌ·Ù· fiÛÔ Î·È Ù· ÏÂÌÊ·ÁÁÂÈÒÌ·Ù· ·ÔÙÂ-ÏÔ‡ÓÙ·È ·fi Î˘ÛÙÈÎ¿ Î·È Û˘Ì·Á‹ ÛÙÔÈ¯Â›·. ∞˘Ù‹ÙË ÌÔÚÊÔÏÔÁ›· ·ÚÔ˘Û›·˙Â ·ÂÈÎÔÓÈÛÙÈÎ¿ (˘ÂÚË-¯ÔÁÚ¿ÊËÌ·-·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·) ÙÔ Û‡ÓÔÏÔ ÙˆÓÂÍÂÚÁ·ÛÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜.

∆Ô ÙÚ·¯ËÏÈÎfi ÙÂÚ¿ÙˆÌ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈ-Û¤Ú¯ÂÙ·È ÛÙË ıˆÚ·ÎÈÎ‹ ÎÔÈÏfiÙËÙ·, fiˆ˜ ÛÂ Ì›··fi ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ‹ Ó·ÂÚÓ¿ ÙË Ì¤ÛË ÁÚ·ÌÌ‹, fiˆ˜ ÛÂ ‰‡Ô ·fi ÙÈ˜ ·Ó·-ÊÂÚfiÌÂÓÂ˜ ÂÚÈÙÒÛÂÈ˜. ∏ ·ÚÔ˘Û›· ÂÚÈÔ¯ÒÓÏ›Ô˘˜ Î·È ·ÔÙÈÙ·ÓÒÛÂˆÓ ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙË ‰È·-ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ·fi Î˘ÛÙÈÎfi‡ÁÚˆÌ·. ™Ù· ÙÚ·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· ·Ó·Ê¤ÚÔ-ÓÙ·È ·ÔÙÈÙ·ÓÒÛÂÈ˜ ÛÂ ÔÛÔÛÙfi 50% (3,8). ™ÙËÓ·ÚÔ‡Û· ÌÂÏ¤ÙË ·ÔÙÈÙ·ÓÒÛÂÈ˜ ˘‹Ú¯·Ó ÛÂ 3 ÓÂ-ÔÁÓ¿ (ÔÛÔÛÙfi 60%) Î·È ÂÚÈÔ¯¤˜ Ï›Ô˘˜ ÛÂ 2(ÔÛÔÛÙfi 40%).

¶ÚÒÙË ·ÂÈÎÔÓÈÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ Â›Ó·È ÙÔ ˘Â-ÚË¯ÔÁÚ¿ÊËÌ·. ∞ÎÔÏÔ˘ıÂ› Ë ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·ÙÔ˘ ÙÚ·¯‹ÏÔ˘. ∫·È ÔÈ ‰‡Ô Ì¤ıÔ‰ÔÈ ÂÎÙÈÌÔ‡Ó ÙÔ

¶·È‰È·ÙÚÈÎ‹ 2005;68:133-138


Ì¤ÁÂıÔ˜ Î·È ÙËÓ ˘Ê‹ ÙË˜ ÂÍÂÚÁ·Û›·˜. ∆Ô ˘„ËÏfiÔÛÔÛÙfi ·ÚÔ˘Û›·˜ ·ÔÙÈÙ·ÓÒÛÂˆÓ ÛÙ· ÙÚ·¯Ë-ÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· Î·ıÈÛÙ¿ ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·-Ê›· Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ Û˘Á-ÁÂÓÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙÔ˘ ÙÚ·¯‹ÏÔ˘. ™ÙÔ Û‡ÓÔÏÔÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Ë ‰È¿-ÁÓˆÛË ·fi ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· Û˘ÌÊˆÓÔ‡ÛÂÌÂ ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ‰È¿ÁÓˆÛË (1-4).

°È· ÙËÓ Î·Ï‡ÙÂÚË ÚÔÂÁ¯ÂÈÚËÙÈÎ‹ ¯·ÚÙÔÁÚ¿-ÊËÛË, Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚÂ› Ó· Û˘-ÌÏËÚˆıÂ› ÌÂ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘Ô˘ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÔÏ˘Â›Â‰Ë˜ ·ÂÈÎfi-ÓÈÛË˜ ÌÂ ˘„ËÏ‹ ÈÛÙÈÎ‹ ‰È·ÎÚÈÙÈÎ‹ ‰˘Ó·ÙfiÙËÙ·,¯ˆÚ›˜ Ó· ÂÎı¤ÙÂÈ ÙÔ ÓÂÔÁÓfi ÛÂ ·ÎÙÈÓÔ‚ÔÏ›· (1,13).∏ Ï‹ÚË˜ Î·È ¤ÁÎ·ÈÚË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË Â›-Ó·È Ë ÂÓ‰Â‰ÂÈÁÌ¤ÓË ıÂÚ·Â›· ÛÙ· Û˘ÁÁÂÓ‹ ÙÚ·¯Ë-ÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù·. ™˘ÓÂÒ˜, Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜¤ÏÂÁ¯Ô˜ Â›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙË ‰È¿ÁÓˆÛËÎ·È ÙÔÓ ÚÔÂÁ¯ÂÈÚËÙÈÎfi Û¯Â‰È·ÛÌfi.


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4. Hassab MH, Shadi SM, Al-Olayet YF, Al-Bassam AR. Tenyears’ experience in the management of cervical teratomas.Pediatr Surg Int 1996;11:536-538.

5. Hajdu SI, Faruque AA, Hajdu EO, Morgan WS. Teratomaof the neck in infants. Am J Dis Child 1966;111:412-416.

6. Rothschild MA, Catalano P, Urken M, Brandwein M, SomP, Norton K et al. Evaluation and management of congen-ital cervical teratoma. Case report and review. Arch Oto-laryngol Head Neck Surg 1994;120:444-448.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:133-138


139CASE REPORT

The neck: a rare site of teratoma in childrenM. Hasiotou1, ∂. Sammouti2, G. Pitsoulakis1, M. Vakaki2, C. van Viet - Konstadinidou3, E. Koudoumnakis4

AbstractCongenital cervical teratomas are rare, representing 3% of teratomas in childhood. Although mostlybenign, because of their location they are associated with a high mortality rate due to respiratory distress,and require immediate surgical excision. Imaging investigation is essential for the exact diagnosis and toassist in preoperative planning. The imaging characteristics of 5 cases (4 boys and 1 girl) of cervicalteratoma are presented. All children were operated on and histopathology confirmed the diagnosis ofteratoma. Two of the children died soon after surgery.

Key wordsCervical teratomas, children, imaging.

1 CT and MRI Department,“Aghia Sophia” Children’sHospital, Athens

2 Radiology Department,”Aghia Sophia” Children’sHospital, Athens

3 Pathology Department,”Aghia Sophia” Children’sHospital, Athens

4 Department ofOtolaryngology, ”Aghia Sophia” Children’sHospital, Athens

Correspondence:Maria Hasiotou 55 Peloponisou str., 153 41, Ag. Paraskevi, Athens




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§¤ÍÂÈ˜ ÎÏÂÈ‰È¿¡fiÛÔ˜ Caroli, Û˘ÁÁÂÓ‹˜ Ë·ÙÈÎ‹ ›ÓˆÛË, Î‡ÛÙÂÈ˜ ¯ÔÏË‰fi¯Ô˘.

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ÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (100:1).

™ÙÔ Û‡Ó‰ÚÔÌÔ Caroli ÚÔÛÙ›ıÂÙ·È ÛÙ· ·Ú·¿Óˆ

Î·È Ë ˘Ï·›· ˘¤ÚÙ·ÛË.

∏ Ì¤ÛË ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ

Â›Ó·È ÂÚ›Ô˘ Ù· 20 ¤ÙË, ˆÛÙfiÛÔ Â›Ó·È ‰˘Ó·Ù‹ Ë

ÂÎ‰‹ÏˆÛ‹ ÙÔ˘˜ Î·È ÓˆÚ›ÙÂÚ·, ·ÎfiÌË Î·È Î·Ù¿ ÙË

ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, ÂÈ‰ÈÎ¿ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘

˘¿Ú¯ÂÈ Î·È Û˘ÁÁÂÓ‹˜ Ë·ÙÈÎ‹ ›ÓˆÛË.

À¿Ú¯Ô˘Ó ‰‡Ô ·Ó·ÊÔÚ¤˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔ-

ÁÚ·Ê›· ÛÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘

Caroli (1,2).

∆Ô Û‡Ó‰ÚÔÌÔ Caroli ıÂˆÚÂ›Ù·È Û˘¯ÓfiÙÂÚÔ ÙË˜

ÓfiÛÔ˘ Î·È ÂÌÊ·Ó›˙ÂÙ·È ÌÂ ˘Ï·›· ˘¤ÚÙ·ÛË Û˘-

Ó‹ıˆ˜ ÛÙÔ Ù¤ÏÔ˜ ÙË˜ ÓËÈ·Î‹˜ ‹ ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›·.

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ÌÂ Ófi-

ÛÔ Caroli, Ë ÔÔ›· ‰È·ÁÓÒÛÙËÎÂ Î·Ù¿ ÙË ‰ÈÂÚÂ‡-

ÓËÛË ÂÌ‡ÚÂÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.


∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 11 ÂÙÒÓ, Ô˘ÎÚ·ÓÈÎ‹˜ Î·Ù·Áˆ-

Á‹˜, ÚÔÛÎÔÌ›ÛÙËÎÂ ÛÙÔ ∆Ì‹Ì· ∂ÂÈÁfiÓÙˆÓ ¶Â-

ÚÈÛÙ·ÙÈÎÒÓ ÙË˜ ∫ÏÈÓÈÎ‹˜ ÏfiÁˆ ˘„ËÏÔ‡, ·Ú·ÙÂÈ-

ÓfiÌÂÓÔ˘ ˘ÚÂÙÔ‡ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. ∂Úfi-

ÎÂÈÙÔ ÁÈ· ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ

ÁÔÓ¤ˆÓ. ∏ Î‡ËÛË, Ô ÙÔÎÂÙfi˜ Î·È Ë ÂÚÈÁÂÓÓËÙÈÎ‹

ÂÚ›Ô‰Ô˜ ·Ó·Ê¤ÚÔÓÙ·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ∞fi ÙËÓ

ËÏÈÎ›· ÙˆÓ 3 ÌËÓÒÓ ÂÌÊ¿ÓÈ˙Â Û˘¯Ó¿ ÂÂÈÛfi‰È·

Ô˘ÚÔÏÔÈÌÒÍÂˆÓ Î·È Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÛÙËÓ O˘ÎÚ·Ó›· ¤ıÂÛÂ ÙË ‰È¿ÁÓˆÛË ‰˘ÛÏ·ÛÙÈ-

ÎÒÓ ÓÂÊÚÒÓ. ™Â ËÏÈÎ›· 2,5 ÂÙÒÓ ÂÌÊ¿ÓÈÛÂ Ë·ÙÔ-

ÌÂÁ·Ï›·, Ë ÔÔ›· ·Ô‰fiıËÎÂ ÛÂ ÙÔÍÈÎ‹ Ë·Ù›ÙÈ-

‰·. ∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È


141¡fiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË

Î›ÚÚˆÛË ‹·ÙÔ˜ ÛÙÔÓ ·Ô‡ Î·È ÙË ıÂ›· ÙÔ˘·È‰ÈÔ‡ ·fi ÙËÓ ÏÂ˘Ú¿ ÙË˜ ÌËÙ¤Ú·˜.

∏ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·ÔÎ¿Ï˘„Â fiÙÈ ÙÔÎÔÚ›ÙÛÈ Â›¯Â Î·Ï‹ ·Ó¿Ù˘ÍË, ‹Ù·Ó ˆ¯Úfi Î·È Î·ÎÔ-‰È¿ıÂÙÔ, ÌÂ ÛÏ‹Ó· „ËÏ·ÊËÙfi ~8 cm, ÛÎÏËÚ‹˜˘Ê‹˜ Î·È ÂÒ‰˘ÓÔ Î·È ‹·Ú Â›ÛË˜ „ËÏ·ÊËÙfi ~5cm Î·È ·ÓÒ‰˘ÓÔ. ∞ÛÙ·ı¤˜ Â‡ÚËÌ· ‹Ù·Ó Â˘·ÈÛıË-Û›· ÛÙËÓ Ï‹ÍË ÙË˜ ÓÂÊÚÈÎ‹˜ ¯ÒÚ·˜ ·ÚÈÛÙÂÚ¿ [Û.Giordano (±)]. ∞fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ˘‹Ú¯·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∆Ë ‰Â‡ÙÂÚË ËÌ¤-Ú· ÓÔÛËÏÂ›·˜ ÙÔ ·È‰› ¤ÌÂÈÓÂ ·‡ÚÂÙÔ, ¯ˆÚ›˜ Ó·¤¯ÂÈ ÂÓÙÔÈÛÙÂ› Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÛÙ›· ÏÔ›ÌˆÍË˜.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‚Ú¤ıËÎÂ ÌÂ›ˆ-ÛË fiÏˆÓ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙ·Î·ÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· Î·È ÂÏ·ÊÚ¿ ·Ú¿Ù·-ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›ÓË˜. O ÏÔÈfi˜ ‚ÈÔ¯ËÌÈ-Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·,fiˆ˜ ‹Ù·Ó Î·È Ë ÁÂÓÈÎ‹ Î·È Ë Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ.™˘ÁÎÂÎÚÈÌ¤Ó·: §Â˘Î¿: 5400/mm3 (¶: 77%, §:13%, ªª: 8%), Hb: 11,1 g/dl, Ht: 34,5%, PLT:130000/mm3, ∆∫∂: 7 mm/1Ë ÒÚ·, CRP: 1,54mg/dl, Û·Î¯.: 85 mg/dl, Ô˘Ú›·: 41 mg/dl, ÎÚÂ·ÙÈÓ›-ÓË: 0,86 mg/dl, SGOT: 16 U/L, SGPT: 13 U/L, Á-GT: 29 U/L, ÔÏÈÎ‹/¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 0,9/0,13mg/dl, ALP: 174 U/L, Na+: 139 mmol/L, K+: 3,9mmol/L, ÏÂ˘ÎÒÌ·Ù· ÔÏÈÎ¿: 8,0 g/dl, ÏÂ˘ÎˆÌ·Ù›-ÓË: 5,21 g/dl, PT: 13,25 sec, INR: 1,31, APPT: 28sec, ÈÓˆ‰ÔÁfiÓÔ: 382,8 mg/dL).

™Â ˘ÂÚË¯ÔÙÔÌÔÁÚ¿ÊËÌ· (U/S) ¿Óˆ ÎÔÈÏ›·˜-ÓÂÊÚÒÓ ·Ú·ÙËÚ‹ıËÎÂ ‰È¿Ù·ÛË ÙˆÓ ÂÓ‰ÔË·ÙÈ-ÎÒÓ ¯ÔÏËÊfiÚˆÓ ÌÂ ÔÏÏ·Ï¤˜ Î˘ÛÙÈÎ¤˜ ‰È·Ù¿-ÛÂÈ˜. ∆· ÂÍˆË·ÙÈÎ¿ ¯ÔÏËÊfiÚ· Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎ‹‰È¿ÌÂÙÚÔ Î·È ‰ÂÓ ˘‹Ú¯Â ·›ÙÈÔ ·fiÊÚ·ÍË˜. ∆ÔË·ÙÈÎfi ·Ú¤Á¯˘Ì· ·ÚÔ˘Û›·˙Â ·‰Ú‹ Ë¯Ô‰ÔÌ‹ ÌÂÛ¯ÂÙÈÎ¿ ·˘ÍËÌ¤ÓÂ˜ ·Ó·ÎÏ¿ÛÂÈ˜ Ô˘ ¤ıÂÙ·Ó ÙËÓ˘fiÓÔÈ· ›ÓˆÛË˜, ÂÓÒ ÛÙÔ ÚfiÛıÈÔ Î¿Ùˆ ÙÌ‹Ì· ÙÔ˘‰ÂÍÈÔ‡ ÏÔ‚Ô‡ ÙÔ˘ ‹·ÙÔ˜ ˘‹Ú¯Â ÛÙÚÔÁÁ˘Ïfi˜˘fiË¯Ô˜ fi˙Ô˜ ÌÂ ‰È¿ÌÂÙÚÔ 1,75 cm Î·È Û·Ê‹ fiÚÈ·.µÚ¤ıËÎÂ ÈÎ·ÓÔ‡ ‚·ıÌÔ‡ ÛÏËÓÔÌÂÁ·Ï›· ¯ˆÚ›˜ÂÛÙÈ·Î¤˜ ·ÏÏÔÈÒÛÂÈ˜, ÂÓÒ ·fi ÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙËÎ·È ÙÔ ¿ÁÎÚÂ·˜ ‰ÂÓ ˘‹Ú¯·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹-Ì·Ù·. ∞ÌÊfiÙÂÚÔÈ ÔÈ ÓÂÊÚÔ› Â›¯·Ó ·˘ÍËÌ¤ÓÔ Ì¤ÁÂ-ıÔ˜, ‰È¿Û·ÚÙÂ˜ ·ÔÙÈÙ·ÓÒÛÂÈ˜ ÛÙË Ì˘ÂÏÒ‰Ë ÌÔ›-Ú· ÙÔ˘˜ Î·È Î·Ù¿ ÙfiÔ˘˜ Ï¤Ù˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡. OÈÎ˘ÛÙÈÎ¤˜ ‰È·Ù¿ÛÂÈ˜ ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ÂÈÎfiÓ· ÙˆÓ ÛÔÁÁÔÂÈ‰ÒÓ ÓÂ-ÊÚÒÓ ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Caroli.∏ ˘ÔÏÔÁÈÛÙÈÎ‹ (CT) Î·È Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·(MRI) Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó, ÂÈ‚Â‚·›ˆÛ·Ó Ù· Â˘Ú‹-Ì·Ù· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ (∂ÈÎfiÓ· 1).

§fiÁˆ ÙË˜ ¿ÚÈÛÙË˜ ÁÂÓÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘·È‰ÈÔ‡, Ë ÌËÙ¤Ú· ·ÚÓ‹ıËÎÂ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡-ÓËÛË Î·È ‰ÂÓ ÚÔÛÎfiÌÈÛÂ ÙËÓ ·ÛıÂÓ‹ ÁÈ· ÚÔ-ÁÚ·ÌÌ·ÙÈÛÌ¤ÓÔ Â·Ó·ÏËÙÈÎfi ¤ÏÂÁ¯Ô.

ŒÓ·Ó ¯ÚfiÓÔ ·ÚÁfiÙÂÚ· Ë ·ÛıÂÓ‹˜ ÂÌÊ¿ÓÈÛÂ¤ÓÙÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÂÓÙÔÈÛÌ¤ÓÔ ÛÙÔ (∞)

˘Ô¯fiÓ‰ÚÈÔ Î·È ÛÙÔÓ (∞) Ï·ÁfiÓÈÔ ‚fiıÚÔ, Û˘ÓÔ-‰Â˘fiÌÂÓÔ ·fi ÔÛÊ˘˚Îfi ¿ÏÁÔ˜ (∞) Î·È ‹È· Ó·˘-Ù›·, ¯ˆÚ›˜ ÂÌ¤ÙÔ˘˜ Î·È ˘ÚÂÙfi. ∞fi ÙËÓ ·ÓÙÈÎÂÈ-ÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ ·‡ÍËÛË ÙˆÓ ÔÚ›ˆÓÙÔ˘ ‹·ÙÔ˜ (~5 cm) Î·È ÙÔ˘ ÛÏËÓfi˜ (~10 cm),ÂÓÒ ÙÔ Û. Giordano ‹Ù·Ó ¤ÓÙÔÓ· ıÂÙÈÎfi (∞). ∞fiÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ·˘Ù‹ ÙË ÊÔÚ¿ ‰È·È-ÛÙÒıËÎÂ Û·Ê‹˜ ·ÁÎ˘ÙÙ·ÚÔÂÓ›· [§Â˘Î¿:1900/mm3, (¶: 63%, §: 27%, ªª: 8%, ∏: 2%),Hb: 10,0 g/dL, Ht: 30,4%, PLT: 77000/mm3, ¢∂∫:1,25%], ÂÓÒ ·fi ÙÔÓ ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ÚÔ¤-Î˘„·Ó ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Ë·ÙÈÎ‹ Î·È ÓÂÊÚÈÎ‹ ÏÂÈ-ÙÔ˘ÚÁ›·. ™ÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ ‚Ú¤ıËÎ·Ó Ï›Á· ˘Ô-ÛÊ·›ÚÈ· Î·È ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· Î·È Ë Î·ÏÏÈ¤Ú-ÁÂÈ· Ô‡ÚˆÓ ‹Ù·Ó ÛÙÂ›Ú·.

∫‡ÚÈ· Â˘Ú‹Ì·Ù· ÙÔ˘ Â·Ó·ÏËÙÈÎÔ‡ ˘ÂÚË-¯ÔÙÔÌÔÁÚ·Ê‹Ì·ÙÔ˜ ‹Ù·Ó Ë ‰È¿¯˘Ù· ·‰ÚÔÎÔÎÎÒ-‰Ë˜ ˘Ê‹ ÙÔ˘ Ë·ÙÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È ÔÈ ·˘-ÍËÌ¤ÓÂ˜ - Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ¤ÏÂÁ¯Ô- ‰È·ÛÙ¿ÛÂÈ˜ ÙÔ˘ ˘fi˘ÎÓÔ˘ ÌÔÚÊÒÌ·ÙÔ˜(2,4x2,7x2 cm). ∆Ô Doppler ¤‰ÂÈÍÂ fiÙÈ Ô ÛÏËÓÔ-˘Ï·›Ô˜ ¿ÍÔÓ·˜ ‹Ù·Ó ‚·Ùfi˜, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi Â‡-ÚÔ˜ (1,1 cm), Ê˘ÛÈÔÏÔÁÈÎfi Ê¿ÛÌ· Î·È Ê˘ÛÈÔÏÔÁÈ-Î‹ Î·ÙÂ‡ı˘ÓÛË ÚÔ‹˜ ·›Ì·ÙÔ˜. OÈ Ë·ÙÈÎ¤˜ ÊÏ¤-‚Â˜ ‚Ú¤ıËÎ·Ó ‚·Ù¤˜, ÌÂ ·Ú¯fiÌÂÓÂ˜ ‰È·Ù·Ú·¯¤˜Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ Ù‡Ô˘ ÙˆÓ ‰È¿¯˘ÙˆÓ ÈÓÔÛÎÏËÚ˘-ÓÙÈÎÒÓ Ë·ÙÈÎÒÓ ÓfiÛˆÓ. OÈ ÓÂÊÚÔ› ·ÚÔ˘Û›·˙·Ó·˘ÍËÌ¤ÓÔ Ì¤ÁÂıÔ˜ Î·È Â˘Ú‹Ì·Ù· ¤ÓÙÔÓË˜ ÓÂÊÚ·-Û‚¤ÛÙˆÛË˜.

∂ÈÏ¤ÔÓ, ¤ÁÈÓÂ Á·ÛÙÚÔÛÎfiËÛË Ô˘ ·Ó¤‰ÂÈ-ÍÂ ÎÈÚÛÔ‡˜ ÔÈÛÔÊ¿ÁÔ˘ 1Ô˘ ‚·ıÌÔ‡ Î·È ÔÏÏ·Ï¿ÂÈÊ·ÓÂÈ·Î¿ ¤ÏÎË ÛÙÔÓ ‚ÔÏ‚fi ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡-ÏÔ˘. µÈÔ„›· ÁÈ· H. pylori ‰ÂÓ ÂÏ‹ÊıË ÏfiÁˆ ‰È·Ù·-Ú·¯ÒÓ ËÎÙÈÎfiÙËÙ·˜.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜, Ë ·ÛıÂÓ‹˜Ù¤ıËÎÂ ÛÂ Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË Û·ÛÌÔÏ˘ÙÈ-ÎÒÓ Î·È ·Ó·ÏÁËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ. ∫·Ù¿ ÙËÓ ¤ÍÔ‰fiÙË˜, Û˘ÛÙ‹ıËÎÂ ·ÁˆÁ‹ ÌÂ ·Ó·ÛÙÔÏÂ›˜ ÙË˜·ÓÙÏ›·˜ ÚˆÙÔÓ›ˆÓ ÁÈ· ‰È¿ÛÙËÌ· 2 ÌËÓÒÓ, Î·ıÒ˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:140-143

∂∂ÈÈÎÎfifiÓÓ·· 11.. ÀÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¿Óˆ-Î¿Ùˆ ÎÔÈÏ›·˜ Î·ÈÔÈÛıÔÂÚÈÙÔÓ·›Ô˘. ¶·Ú·ÙËÚÔ‡ÓÙ·È Î˘ÛÙÈÎ¤˜ ‰È·Ù¿ÛÂÈ˜Ô˘ ÂÈÎÔÈÓˆÓÔ‡Ó ÌÂ Ù· ÂÓ‰ÔË·ÙÈÎ¿ ¯ÔÏËÊfiÚ· ·ÁÁÂ›·.


142 ∂. ¶··‰ËÌËÙÚ›Ô˘ Î·È Û˘Ó.

Î·È ¯ÔÚ‹ÁËÛË ¿ÊıÔÓˆÓ ˘ÁÚÒÓ. ∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·ÙË˜ ·ÛıÂÓÔ‡˜ ‚ÂÏÙÈÒıËÎÂ ÂÓ Ì¤ÚÂÈ, ¯ˆÚ›˜ fiÌˆ˜Ï‹ÚË ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. ∏ ·ÛıÂÓ‹˜ ·-Ú·ÎÔÏÔ˘ıÂ›Ù·È ·Ó¿ 6 Ì‹ÓÂ˜ Î·È Â›Ó·È ÛÂ ÚfiÁÚ·Ì-Ì· ÌÂÏÏÔÓÙÈÎ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ‹·ÙÔ˜.

™˘˙‹ÙËÛË

∏ ÓfiÛÔ˜ Caroli Â›Ó·È Ì›· Û¿ÓÈ· Û˘ÁÁÂÓ‹˜ ‰È·-Ù·Ú·¯‹ ÌÂ Û˘¯ÓfiÙËÙ· 1:1.000.000 (3). À¿Ú¯Ô˘Ó‰‡Ô Ù‡ÔÈ ÙË˜ ÓfiÛÔ˘ Caroli. O Ù‡Ô˜ Ô˘ ·Ú¯ÈÎ¿ÂÚÈÁÚ¿ÊËÎÂ ·fi ÙÔÓ Caroli (4), ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi Î˘ÛÙÈÎ‹, ÌË ·ÔÊÚ·ÎÙÈÎ‹ ‰È¿Ù·ÛË ÙˆÓ ÂÓ-‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ Î·È ·Ú·ÙËÚÂ›Ù·ÈÛÙÔ 13% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5). √ ÈÔ ÎÔÈÓfi˜ Ù‡-Ô˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË Î·È·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Û·ÓÈfiÙÂÚ· ̂ ˜ Û‡Ó-‰ÚÔÌÔ Caroli (5) Î·È Û˘¯ÓfiÙÂÚ·, ˆ˜ ÓfiÛÔ˜ CaroliÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË. ∂›ÛË˜, ÌÔÚÂ› Ó·ÔÚ›˙ÂÙ·È ‚¿ÛÂÈ ÙË˜ Ù·ÍÈÓfiÌËÛË˜ Todani ÙˆÓ ¯ÔÏË-‰fi¯ˆÓ Î‡ÛÙÂˆÓ ˆ˜ Ù‡Ô˜ V ‹ ˆ˜ Ù‡Ô˜ IV ∞ ÛÙËÓÂÚ›ÙˆÛË Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂÍˆË·ÙÈÎ¤˜ Î‡-ÛÙÂÈ˜ ¯ÔÏË‰fi¯Ô˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô Û˘Ì‚·›ÓÂÈ ÛÙÔ21% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5,6), ‹ ÌÔÚÂ› Ó· ÂÓÙÔ›-˙ÂÙ·È ÌfiÓÔ ÛÂ ¤Ó· ÏÔ‚fi ‹ ÙÌ‹Ì· ÙÔ˘ ‹·ÙÔ˜, Û˘-¯ÓfiÙÂÚ· ·ÚÈÛÙÂÚ¿ (7). ŸÙ·Ó ÂÓÙÔ›˙ÂÙ·È ÛÙÔÓ ¤Ó·ÏÔ‚fi, Ë ÓfiÛÔ˜ Caroli Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·ÈÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË (8).

O Ù‡Ô˜ ÙË˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÔÈÎ›ÏÏÂÈ (9).¶ÔÏÏÔ› ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë ÂÓÙÔÈÛÌ¤ÓË ÓfiÛÔ˜ Caroli‰ÂÓ Â›Ó·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓË Î·È ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·ÈÌÂ ÓÂÊÚÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ Ë ÓfiÛÔ˜ Caroli ÌÂÛ˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË ÌÔÚÂ› Ó· ÌÂÙ·‚È‚¿˙ÂÙ·ÈÌÂ ÙÔÓ ·˘ÙfiÛˆÌÔ, ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·ÈÓ· Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÓÂÊÚÈÎ¤˜ ‚Ï¿‚Â˜ Ô˘ ÔÈÎ›Ï-ÏÔ˘Ó ·fi ÙË ÛˆÏËÓ·ÚÈ·Î‹ ÂÎÙ·Û›· ¤ˆ˜ ÙÔÓ ÔÏ˘-Î˘ÛÙÈÎfi ÓÂÊÚfi, ‹ Ó· ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ·˘Ùfi-ÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (10). ∏ ·ıÔÁ¤-ÓÂÈ· ÙË˜ ÓfiÛÔ˘ ÈÛÙÂ‡ÂÙ·È fiÙÈ ÔÊÂ›ÏÂÙ·È ÛÂ ‰È·ÎÔ-‹ ÙË˜ ·Ó·‰fiÌËÛË˜ ÙÔ˘ ÂÌ‚Ú˘ÔÓÈÎÔ‡ fiÚÔ˘ ÙˆÓÌÂÁ¿ÏˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ (9).

∏ Ì¤ÛË ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›-Ó·È ÂÚ›Ô˘ Ù· 20 ¤ÙË (10), ˆÛÙfiÛÔ, Â›Ó·È ‰˘Ó·Ù‹Ë ÂÎ‰‹ÏˆÛ‹ ÙÔ˘˜ Î·È Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô(11), ÂÈ‰ÈÎ¿ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë ÓfiÛÔ˜ Û˘ÓÔ-‰Â‡ÂÙ·È ·fi Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË.

∏ ¯ÔÏ·ÁÁÂÈ›ÙÈ‰· Â›Ó·È ÙÔ ÚÔÂÍ¿Ú¯ÔÓ Û‡-ÌÙˆÌ· ÛÙÔ 64% ÙˆÓ ·ÛıÂÓÒÓ, Ë ˘Ï·›· ˘¤ÚÙ·-ÛË ÛÙÔ 22%, ÙÔ ˘ÔÙÚÔÈ¿˙ÔÓ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ÛÙÔ‰ÂÍÈfi ¿Óˆ ÙÂÙ·ÚÙËÌfiÚÈÔ ÛÙÔ 18%, Ë ˘ÂÏÔÓÂÊÚ›-ÙÈ‰·, Ë ·ÚÙËÚÈ·Î‹ ˘¤ÚÙ·ÛË Î·È Ë ·ÈÌ·ÙÔ˘Ú›·ÛÙÔ 2% (10). øÛÙfiÛÔ, ÌÂÚÈÎÔ› ·ÛıÂÓÂ›˜ - ÂÈ‰ÈÎ¿fiÛÔÈ ‰ÂÓ Ê¤ÚÔ˘Ó Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË - ÌÔÚÂ›Ó· ·Ú·ÌÂ›ÓÔ˘Ó ·Û˘ÌÙˆÌ·ÙÈÎÔ› Ì¤¯ÚÈ ÙËÓ ËÏÈ-Î›· ÙˆÓ 70 ÂÙÒÓ (7). ∏ Ë·ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ÌÔ-

ÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ¯ÔÏÔ-

ÛÙ·ÙÈÎ‹ ÂÈÎfiÓ·.

∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ·ÓÂ‡ÚÂÛË ·ÓË¯Ô˚-

ÎÒÓ Î˘ÛÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÂÓ‰ÔË·ÙÈÎ¿ ÛÙËÓ ˘Â-

ÚË¯ÔÁÚ·ÊÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ‹·ÙÔ˜, ‹ ˘‰ÚÈÎ‹˜ ˘-

ÎÓfiÙËÙ·˜ Î‡ÛÙÂˆÓ ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ÔÈ

ÔÔ›Â˜ ¿ÓÙÔÙÂ ÂÈÎÔÈÓˆÓÔ‡Ó ÌÂ ÙÔ ¯ÔÏËÊfiÚÔ

‰¤Ó‰ÚÔ, ÛÙÔÈ¯Â›Ô ÙÔ ÔÔ›Ô Â›Ó·È ÛËÌ·ÓÙÈÎfi ÛÙË

‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·Ó¿ÌÂÛ· ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË

ÔÓÙfiÙËÙ· Î·È ¿ÏÏÂ˜ fiˆ˜ ÙËÓ ÔÏ˘Î˘ÛÙÈÎ‹ Ë·-

ÙÈÎ‹ ÓfiÛÔ, ÙÈ˜ ·Ï¤˜ Ë·ÙÈÎ¤˜ Î‡ÛÙÂÈ˜, ÙÔ ÏÂÌ-

Ê·ÁÁÂ›ˆÌ· ‹ Ù· ÔÏÏ·Ï¿ Ë·ÙÈÎ¿ ·ÔÛÙ‹Ì·Ù·.

∆Ô ·Ú·¿Óˆ Â‡ÚËÌ· ÂÈ‚Â‚·ÈÒÓÂÙ·È Û˘Ó‹ıˆ˜

ÌÂ ¯ÔÏÔË·ÙÈÎfi HIDA ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ÌÂ

¿ÌÂÛË ÂÈÛÎfiËÛË ÙÔ˘ ¯ÔÏËÊfiÚÔ˘ ‰¤Ó‰ÚÔ˘ ÌÂ

ÂÓ‰ÔÛÎÔÈÎ‹ ¯ÔÏ·ÁÁÂÈÔ·ÁÎÚÂ·ÙÔÁÚ·Ê›· (ERCP)

‹ ÌÂ ˘Ô‰fiÚÈ· ‰ÈË·ÙÈÎ‹ ¯ÔÏ·ÁÁÂÈÔÁÚ·Ê›·

(PTC). ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÌÂÚÈÎÔ›

ÌÂÏÂÙËÙ¤˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ERCP ‹ PTC ‰ÂÓ ı· Ú¤-

ÂÈ Ó· Á›ÓÔÓÙ·È ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ

ÓfiÛÔ Caroli, ‰ÈfiÙÈ ˘¿Ú¯ÂÈ ·˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜

¯ÔÏËÊfiÚÔ˘ Û‹„Ë˜ (12). ª›· Ó¤·, ÌË ÂÂÌ‚·ÙÈÎ‹

Ì¤ıÔ‰Ô˜, ÈÎ·Ó‹ Ó· ·ÂÈÎÔÓ›ÛÂÈ ÙÔ ¯ÔÏËÊfiÚÔ Û‡-

ÛÙËÌ· Â›Ó·È Ë MRI (13).

∏ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ·ÚÔ˘ÛÈ¿˙ÂÈ

ÂÈÎfiÓ· Û˘Ì‚·Ù‹ ÌÂ “ÛÔÁÁÔÂÈ‰‹ ÓÂÊÚfi”, Î‡ÛÙÂÈ˜

(ÂÎÙ·Û›Â˜) ÙË˜ ÚÔ-ÊÏÔÈÈÎ‹˜ ÌÔ›Ú·˜, Î·ıÒ˜ Î·È

·ÔÙÈÙ·ÓÒÛÂÈ˜ ÙË˜ ıËÏÒ‰Ô˘˜ ÌÔ›Ú·˜. ∂›Ó·È ÂÓ-

‰È·Ê¤ÚÔÓ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›Ùˆ-

ÛË Î˘ÚÈ·Ú¯Ô‡Ó Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Ô˘ÚÔÔÈ-

ËÙÈÎfi ÂÓÒ Ù· Â˘Ú‹Ì·Ù· ÙË˜ ˘Ï·›·˜ ˘¤ÚÙ·ÛË˜

ÂÚÈÔÚ›˙ÔÓÙ·È ÛÂ ÎÈÚÛÔ‡˜ ÔÈÛÔÊ¿ÁÔ˘ 1Ô˘ ‚·ı-

ÌÔ‡, ÛÏËÓÔÌÂÁ·Ï›· Î·È ·ÈÌ·ÙÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·

˘ÂÚÛÏËÓÈÛÌÔ‡.

™ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÚ›ÙˆÛË, Ë ˘fiÓÔÈ· ÙË˜

ÓfiÛÔ˘ Ù¤ıËÎÂ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·È ˘ÔÏÔÁÈ-

ÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, fiÔ˘ Ë ‰È¿Ù·ÛË ÙˆÓ ÂÓ‰ÔË·-

ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ Î·È Ë ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ

Î˘ÛÙÈÎÒÓ ¯ÒÚˆÓ ıÂˆÚÂ›Ù·È ·ıÔÁÓˆÌÔÓÈÎ‹ (6)

Î·È ÙÂÎÌËÚÈÒıËÎÂ ÌÂ MRI ¯ÔÏ·ÁÁÂÈÔÁÚ·Ê›·.

∏ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ¯ÔÏ·ÁÁÂÈÔÎ·ÚÎÈÓÒ-

Ì·ÙÔ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÓfiÛÔ Caroli Â›Ó·È 100 ÊÔÚ¤˜

ÌÂÁ·Ï‡ÙÂÚË ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi.

°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Â¿Ó Ë ÓfiÛÔ˜ ÂÚÈÔÚ›˙ÂÙ·È ÛÂ

¤Ó·Ó ÏÔ‚fi, Ë ÌÂÚÈÎ‹ Ë·ÙÂÎÙÔÌ‹ ·ÔÙÂÏÂ› ÙÂÏÈÎ‹

ıÂÚ·Â›·, ÂÓÒ ÛÙÈ˜ ‰È¿¯˘ÙÂ˜ ˆ˜ Èı·Ó‹ Ï‡ÛË ·Ó·-

Ê¤ÚÂÙ·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (12). ∏ ·ÛıÂÓ‹˜

ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ·Ó¿

6 Ì‹ÓÂ˜ Î·È Ù¤ıËÎÂ ÛÂ ÚfiÁÚ·ÌÌ· ÌÂÏÏÔÓÙÈÎ‹˜

ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ‹·ÙÔ˜.


1. Bratu I, Laberge JM, Khalife S, Sinsky A. Regression of an-

tenatally diagnosed localized Caroli’s disease. J Pediatr

¶·È‰È·ÙÚÈÎ‹ 2005;68:140-143


143¡fiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈÎ‹ ›ÓˆÛË

¶·È‰È·ÙÚÈÎ‹ 2005;68:140-143

Surg 2000;35:1390-1393. 2. Stringer MD, Dhawan A, Davenport M, Mieli-Vergani G,

Mowat AP, Howard ER. Choledochal cysts: lessons from a20 year experience. Arch Dis Child 1977;73:528-531.

3. Gillet M, Favre S, Fontolliet C, Halkic N, Mantion G, HeydB. Monolobar Caroli's disease. Apropos of 12 cases.Chirurgie 1999;124:13-19.

4. Caroli J, Couinaud C, Soupault R, Porcher P, Eteve J. Anew disease, undoubtedly congenital, of the bile ducts:unilobar cystic dilation of the hepatic ducts. Sem HopParis 1958;34:496-502.

5. Barros JL, Polo JR, Sanabia J, Garcia-Sabrido JL, Gomez-Lorenzo FJ. Congenital cystic dilatation of the intrahepaticbile ducts (Caroli’s disease): report of a case and review ofthe literature. Surgery 1995;85:589-592.

6. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K.Congenital bile duct cysts: classification, operative proce-dures, and review of thirty-seven cases including cancerarising from choledochal cyst. Am J Surg 1977;134:263-269.

7. Taylor AC, Palmer KR. Caroli’s disease. Eur J Gastroen-terol Hepatol 1998;10:105-108.

8. Boyle MJ, Doyle GD, McNulty JG. Monolobar Caroli’s dis-ease. Am J Gastroenterol 1989;84:1437-1444.

9. Desmet VJ. Pathogenesis of ductal plate abnormalities.Mayo Clin Proc 1998;73:80-89.

10. Tsuchida Y, Sato T, Sanjo K, Etoh T, Hata K, Terawaki Ket al. Evaluation of long-term results of Caroli’s disease: 21years’ observation of a family with autosomal “dominant”inheritance, and review of the literature. Hepatogastroen-terology 1995;42:175-181.

11. Pinto RB, Lima JP, da Silveira TR, Scholl JG, de Mello ED,Silva G. Caroli’s disease: report of 10 cases in children andadolescents in southern Brazil. J Pediatr Surg 1998;33:1531-1535.

12. Sans M, Rimola A, Navasa M, Grande L, Garcia-ValdecasasJC, Andreu H et al. Liver transplantation in patients withCaroli’s disease and recurrent cholangitis. Transpl Int1997;10:241-244.

13. Guibaud L, Lachaud A, Touraine R, Guibal AL, PelizzariM, Basset T et al. MR cholangiography in neonates and in-fants: feasibility and preliminary applications. AJR Am JRoentgenol 1998;170:27-31.


144 CASE REPORT

Paediatric Clinic of theUniversity of Thessaly

Correspondence:Eleni Papadimitriou 14 Georgiou Stavrou str. 412 21, Larissa



Caroli’s disease with congenital hepaticfibrosis. A case reportE. Papadimitriou, G. Matafia, V. Hatzopoulou, V. Mikraki, N. Skenteris

AbstractCaroli’s disease is a rare congenital disorder consisting of non-communicating cystic dilatation of theintrahepatic biliary ducts, very often associated with congenital hepatic fibrosis and polycystic kidneys. Itis rarely diagnosed during childhood, usually presenting with symptoms of liver or kidney dysfunction.The case is presented of a girl of Ukrainian origin with a history of recurrent urinary tract infections duringinfancy. Imaging studies had at that time revealed large dysplastic kidneys. At the age of 2.5 years shepresented with hepatomegaly of undetermined origin. She was referred for the first time to our clinic at theage of 11 years, for evaluation of prolonged fever. She was well developed, and her physical examinationwas unremarkable except for hepatosplenomegaly. The liver and kidney blood biochemistry findings werewithin the normal range, but the CT and MRI findings were consistent with Caroli’s disease. The patienthas follow-up visits every six months. She has developed portal hypertension with first degree oesophagealvarices and mild cytopenias due to hypersplenism. She is scheduled to undergo liver transplantation sinceCaroli’s disease carries an increased risk of development of bile duct carcinoma.

Key wordsCaroli’s disease, congenital hepatic fibrosis, choledochal cysts.


145∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

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¶·È‰È·ÙÚÈÎ‹ 2005;68:145-148

¶ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ ÌÂ Û‡Ó‰ÚÔÌÔ PHACE Õ. ∆Û›ÙÛÈÎ·, ∂. ºÚ˘Û›Ú·, ∞. §Ô˘Ú›‰·, ¡. ª·ÓˆÏ¿ÎË

¶ÂÚ›ÏË„Ë∆· Â˘ÌÂÁ¤ıË ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ÌÂ ‰˘ÛÏ·Û›Â˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜, ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Î·È ÙˆÓ ÔÊı·ÏÌÒÓ (Û‡Ó‰ÚÔÌÔ PHACE). ∏ ÔÓÔÌ·Û›· PHACE ÚÔÎ‡-ÙÂÈ ·fi Ù· ·Ú¯ÈÎ¿ ÁÚ¿ÌÌ·Ù· ÙˆÓ Ï¤ÍÂˆÓ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙÈ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·ÁÁÏÈ-Î‹ ÁÏÒÛÛ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈÎ›·˜ 8 ÌËÓÒÓ ÌÂ ÂÙÂÚfiÏÂ˘ÚÔ, ÌÂÁ¿ÏË˜ ¤ÎÙ·ÛË˜ ·È-Ì·ÁÁÂ›ˆÌ· ÚÔÛÒÔ˘, Û‡Ó‰ÚÔÌÔ Dandy-Walker, ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË, ÛÙÚ·‚ÈÛÌfi Î·È ‚ÏÂÊ·ÚfiÙˆÛËÛ˘ÛÙÔ›¯ˆ˜. ™ÙÔ ·È‰› Â›¯Â ¯ÔÚËÁËıÂ› ıÂÚ·Â›· ÌÂ ÎÔÚÙÈÎÔÂÈ‰¤˜ Î·È ˘‹ÚÍÂ ·ÚÔ‰ÈÎ‹ ‚ÂÏÙ›ˆÛË Î·È ·Ó·-ÛÙÔÏ‹ ÙË˜ Â¤ÎÙ·ÛË˜ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜. ªÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ·ÁˆÁ‹˜, ·Ú·ÙËÚ‹ıËÎÂ ˘ÔÙÚÔ‹ Î·ÈÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙÂ› ÂÎ Ó¤Ô˘. ÃÔÚËÁ‹ıËÎÂ ÈÓÙÂÚÊÂÚfiÓË-· ˘Ô‰ÔÚ›ˆ˜ÛÂ ‰fiÛË 3x106 U/M2 ÁÈ· ¤Ó· ¤ÙÔ˜, ÌÂ ÈÎ·ÓÔÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ¶·Ú¿ÏÏËÏ·, ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÔÈÏÔÈ¤˜ Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ ·ÓˆÌ·Ï›Â˜. O ·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· Î·È ·Ó·-ÎÔÈÓÒÓÂÙ·È ˆ˜ Èı·Ófi Û‡Ó‰ÚÔÌÔ PHACE, ÂÓÒ Û˘˙ËÙÔ‡ÓÙ·È Ë ·ıÔÁ¤ÓÂÈ·, Ù· ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ÔÈ‰È·ÁÓˆÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ Î·È Ë ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË Û¯ÂÙÈÎ¿ ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÙÔÓ›-˙ÂÙ·È fiÙÈ Ù· ÂÙÂÚfiÏÂ˘Ú·, ÁÈÁ·ÓÙÈ·›· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ ÂÓ‰¤¯ÂÙ·È Ó· Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ÙÈ˜ ·-Ú·¿Óˆ ‰˘ÛÏ·Û›Â˜ Î·È Û˘ÓÂÒ˜, Ô ¤ÏÂÁ¯Ô˜ ÛÂ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ı· Ú¤ÂÈ ··Ú·ÈÙ‹Ùˆ˜ Ó· ÂÚÈ-Ï·Ì‚¿ÓÂÈ ·ÂÈÎÔÓÈÛÙÈÎ‹ ÂÁÎÂÊ¿ÏÔ˘, Î·Ú‰ÈÔÏÔÁÈÎ‹ Î·È ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿AÈÌ·ÁÁÂ›ˆÌ·, Û‡Ó‰ÚÔÌÔ Dandy-Walker, ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË, ÔÊı·ÏÌÔÏÔÁÈÎ¤˜ ·ı‹ÛÂÈ˜, ÈÓÙÂÚÊÂÚfiÓË-·.

∂ÈÛ·ÁˆÁ‹

∆· ÂÎÙÂÙ·Ì¤Ó· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ ÌÔ-ÚÂ› Û¿ÓÈ· Ó· Û˘Ó‰˘¿˙ÔÓÙ·È Î·È ÌÂ ¿ÏÏÔ˘ Ù‡Ô˘‰˘ÛÏ·Û›Â˜. ªÂÙ¿ ·fi ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÛÎfiË-ÛË 43 ÎÏÈÓÈÎÒÓ ÂÚÈÙÒÛÂˆÓ ÌÂ ÁÈÁ·ÓÙÈ·›· ·ÈÌ·Á-ÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ Î·È Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ ·ÓˆÌ·-Ï›Â˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· (Î˘Ú›ˆ˜·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ Î·È ÂÈ‰ÈÎ¿ ÙÔ Û‡Ó-‰ÚÔÌÔ Dandy-Walker), ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·Î·È ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÚÔÙ¿ıËÎÂ Ë ÔÓÔÌ·Û›·PHACE ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ ·ÛıÂÓÒÓ Ô˘ ÏËÚÔ‡Ó Ù··Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·. ∆Ô ·ÎÚˆÓ‡ÌÈÔ PHACE Û¯Ë-Ì·Ù›˙ÂÙ·È ·fi Ù· ·Ú¯ÈÎ¿ ÁÚ¿ÌÌ·Ù· ÙˆÓ Ï¤ÍÂˆÓ Ô˘ÂÚÈÁÚ¿ÊÔ˘Ó ÙÈ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·ÁÁÏÈÎ‹ ÁÏÒÛÛ·: Posterior fossamalformations, Hemangiomas, Arterial anomalies,Coarctation of the aorta - cardiac defects, Eyeabnormalities (1). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË ‚Ú¤-ÊÔ˘˜ ÌÂ ÙÔ ·Ú·¿Óˆ Û‡Ó‰ÚÔÌÔ.


∞ÁfiÚÈ ËÏÈÎ›·˜ 8 ÌËÓÒÓ, ÙÔ ÚÒÙÔ ·È‰› ÓÂ·-ÚÒÓ Î·È ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ¯ˆÚ›˜ Û˘ÁÁÂÓÈÎ‹ Û¯¤ÛËÌÂÙ·Í‡ ÙÔ˘˜ Î·È ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ÁÂÓÂÙÈÎ‹˜ ÂÈ‚¿-Ú˘ÓÛË˜ ÛÙÈ˜ ‰‡Ô ÔÈÎÔÁ¤ÓÂÈÂ˜, ÁÂÓÓ‹ıËÎÂ ÙÂÏÂÈfi-

ÌËÓÔ, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ¯ˆÚ›˜ ÂÈÏÔÎ¤˜.

∞Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·Ú·ÙËÚ‹ıËÎÂ ÌÈÎÚ‹˜

¤ÎÙ·ÛË˜ ·ÈÌ·ÁÁÂ›ˆÌ· (1x2 cm) ÛÙË ‰ÂÍÈ¿ ·ÚÂÈ¿,

‚ÏÂÊ·ÚfiÙˆÛË Î·È ÛÙÚ·‚ÈÛÌfi˜ ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘

ÔÊı·ÏÌÔ‡. OÈ ÁÔÓÂ›˜ ·Ó¤ÊÂÚ·Ó Â¤ÎÙ·ÛË ÙÔ˘ ·È-

Ì·ÁÁÂÈÒÌ·ÙÔ˜ Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ Â‚‰ÔÌ¿‰Â˜ ˙ˆ‹˜

Î·È ÚÔÔ‰Â˘ÙÈÎ‹ Î¿Ï˘„Ë fiÏË˜ ÙË˜ ‰ÂÍÈ¿˜ ·ÚÂÈ-

·Î‹˜ ¯ÒÚ·˜ ÛÂ ËÏÈÎ›· ‰‡Ô ÌËÓÒÓ. ™ÙË Ê¿ÛË ·˘-

Ù‹ ¤ÁÈÓÂ Ë ÚÒÙË ÂÎÙ›ÌËÛË ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ ¡Ô-

ÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ÙË˜ ÂÚÈÔ¯‹˜ fiÔ˘ ‰È¤ÌÂÓÂ.

§fiÁˆ ÙÔ˘ ÂÍ·ÈÚÂÙÈÎ¿ ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·È-

Ì·ÁÁÂÈÒÌ·ÙÔ˜, Û˘ÛÙ‹ıËÎÂ Î·È ¤ÁÈÓÂ ·ÂÈÎÔÓÈÛÙÈ-

Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÁÎÂÊ¿ÏÔ˘ ÌÂ Ì·ÁÓËÙÈÎfi Û˘ÓÙÔÓÈ-

ÛÌfi (MRI) ÚÔ˜ ·ÔÎÏÂÈÛÌfi ÂÓ‰ÔÎÚ·ÓÈ·ÎÒÓ ·È-

Ì·ÁÁÂÈˆÌ¿ÙˆÓ Î·È ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·ÛÈÒÓ. ¢È·-

ÈÛÙÒıËÎÂ ·Ú·ÏÏ·Á‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Dandy-

Walker (˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËÎÔ˜ ÙË˜ ·ÚÂÁÎÂ-

Ê·Ï›‰·˜ ÌÂ Î˘ÛÙÈÎ‹ ‰È·ÌfiÚÊˆÛË ÙÔ˘ Ô›ÛıÈÔ˘

ÎÚ·ÓÈ·ÎÔ‡ ‚fiıÚÔ˘ ÛÂ ÂÈÎÔÈÓˆÓ›· ÌÂ ÙËÓ 4Ë ÎÔÈ-

Ï›·), Î·ıÒ˜ Î·È ·Ú¯fiÌÂÓÔ˜ ˘‰ÚÔÎ¤Ê·ÏÔ˜ (∂ÈÎfiÓ·

1). ∆Ô ‚Ú¤ÊÔ˜ ˘Ô‚Ï‹ıËÎÂ ÛÂ Â¤Ì‚·ÛË ÎÔÈÏÈÔ-

ÂÚÈÙÔÓ·˚Î‹˜ ·ÚÔ¯¤ÙÂ˘ÛË˜, ÚÔ˜ ·ÔÊ˘Á‹Ó

ÂÈÏÔÎÒÓ ÏfiÁˆ ÙË˜ Èı·Ó‹˜ ÂÍ¤ÏÈÍË˜ ÙÔ˘ ˘‰ÚÔ-

ÎÂÊ¿ÏÔ˘. ¶·Ú¿ÏÏËÏ·, ˘Ô‚Ï‹ıËÎÂ ÛÂ ·ÁˆÁ‹ ÌÂ

ÎÔÚÙÈÎÔÂÈ‰‹ (ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË 2 mg/kg µ™

ËÌÂÚËÛ›ˆ˜ per os) ÁÈ· ‰È¿ÛÙËÌ· 4 ÌËÓÒÓ. ¶·Ú¿

ÙËÓ ·Ú¯ÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈÎfiÓ·˜ Î·Ù¿ ÙËÓ ¤Ó·Ú-

ÍË ÙË˜ ıÂÚ·Â›·˜, ÙÔ ·ÈÌ·ÁÁÂ›ˆÌ· Û˘Ó¤¯ÈÛÂ Ó·


146 Õ. ∆Û›ÙÛÈÎ· Î·È Û˘Ó.

ÂÂÎÙÂ›ÓÂÙ·È Î·È ·ÚÔ˘Û›·ÛÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË

ÙˆÓ ‰È·ÛÙ¿ÛÂÒÓ ÙÔ˘, Î˘Ú›ˆ˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹

ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

O ·ÛıÂÓ‹˜ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ ÛÂ ËÏÈÎ›· 8

ÌËÓÒÓ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Á›ÓÂÈ Â·ÓÂÎÙ›ÌËÛË Î·È Ó¤·

ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙË˜ Î·Ù¿ÛÙ·Û‹˜ ÙÔ˘. ∫·-

Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, ‰È·ÈÛÙÒıËÎÂ ÁÈÁ·-

ÓÙÈ·›Ô ·ÈÌ·ÁÁÂ›ˆÌ· Ô˘ Î¿Ï˘ÙÂ ÙÔ ‰ÂÍÈfi ËÌÈÌfiÚÈÔ

ÙÔ˘ ÚÔÛÒÔ˘ ÌÂ Â¤ÎÙ·ÛË ÛÙË Û‡ÛÙÔÈ¯Ë Ï¿ÁÈ·

ÙÚ·¯ËÏÈÎ‹ ̄ ÒÚ·. ∏ ‚Ï¿‚Ë Â›¯Â ·ÓÔÌÔÈÔÁÂÓ¤˜ ÛÎÔ‡-

ÚÔ ÂÚ˘ıÚfi ¯ÚÒÌ· Î·È ·ÚÔ˘Û›·˙Â ÂÏ·ÊÚ¿ ˘¤ÁÂÚ-

ÛË Î·ı’ fiÏË ÙËÓ ¤ÎÙ·Û‹ ÙË˜ (∂ÈÎfiÓ· 2). ∂ÈÏ¤ÔÓ,

·Ú·ÙËÚ‹ıËÎÂ ‚ÏÂÊ·ÚfiÙˆÛË, Ô›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ

Î·È ·ÔÎÏ›ÓˆÓ ÛÙÚ·‚ÈÛÌfi˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡.

∆· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÛÙÔÈ¯Â›· ÙÔ˘ ‹Ù·Ó ·Ô‰ÂÈ-

ÎÙÈÎ¿ ·ÓÂ·ÚÎÔ‡˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ (‚¿ÚÔ˜

ÛÒÌ·ÙÔ˜: 6 kg, <3Ë ∂£, Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜: 62 cm,

<3Ë ∂£ Î·È ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜: 41 cm, 3Ë ∂£),

Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·Ó ·fi ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ˘ÔÙÔÓ›·

Î·È ‹È· ÎÈÓËÙÈÎ‹ ·Ó·Ù˘ÍÈ·Î‹ Î·ı˘ÛÙ¤ÚËÛË. ¢ÂÓ

‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈÎ¿ ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·

·fi ÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

(·Ô˘Û›· Ê˘Û‹Ì·ÙÔ˜, Ê˘ÛÈÔÏÔÁÈÎfi˜ ÂÚÈÊÂÚÈÎfi˜

ÛÊ˘ÁÌfi˜ Î·È Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ·ÚÙËÚÈ·Î‹˜ ›Â-

ÛË˜ Î·È ÛÙ· Ù¤ÛÛÂÚ· ¿ÎÚ·).

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜, Ë ·ÎÙÈÓÔ-ÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ÃˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·‹Ù·Ó Î·È Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ Î·Ú˘fiÙ˘Ô. ™ÙÔ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜ ‰È·ÈÛÙÒıËÎÂ ÓÂ˘-ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË (ÙÈÌ‹ ›ÂÛË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜: 45mmHg ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· 20-25 mmHg), ËÔÔ›· ¯·Ú·ÎÙËÚ›ÛÙËÎÂ ‹È· Î·È Û˘ÛÙ‹ıËÎÂ ÌfiÓÔÙ·ÎÙÈÎ‹ Î·Ú‰ÈÔÏÔÁÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ˘Â-ÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜.

∏ ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÂÈ‚Â‚·›ˆÛÂ ÙËÓ‹‰Ë ‰È·ÈÛÙˆıÂ›Û· ‚ÏÂÊ·ÚfiÙˆÛË ÌÂ ÌÂ›ˆÛËÙË˜ ‚ÏÂÊ·ÚÈÎ‹˜ Û¯ÈÛÌ‹˜ Î·È ÙÔÓ ·ÔÎÏ›ÓÔÓÙ·ÛÙÚ·‚ÈÛÌfi. ¢ÂÓ ‚Ú¤ıËÎ·Ó ‰˘ÛÏ·Û›Â˜ ·ÁÁÂ›ˆÓÙÔ˘ ÔÊı·ÏÌÔ‡. ™˘ÛÙ‹ıËÎÂ Î¿Ï˘„Ë ÙÔ˘ ˘ÁÈÔ‡˜ÔÊı·ÏÌÔ‡ ÁÈ· 2-3 ÒÚÂ˜ ËÌÂÚËÛ›ˆ˜ ÚÔÎÂÈÌ¤ÓÔ˘Ó· ·ÔÊÂ˘¯ıÂ› Ë ·Ì‚Ï˘ˆ›· Î·È Ë ·ÒÏÂÈ· fiÚ·-ÛË˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÔÊı·ÏÌÔ‡.

¢Â‰ÔÌ¤ÓË˜ ÙË˜ Î·Î‹˜ ·ÓÙ·fiÎÚÈÛË˜ ÛÙ· ÎÔÚ-ÙÈÎÔÂÈ‰‹, ¯ÔÚËÁ‹ıËÎÂ ÈÓÙÂÚÊÂÚfiÓË-· ÛÂ ËÌÂÚ‹-ÛÈ· ‰fiÛË 3x106 U/M2 ˘Ô‰ÔÚ›ˆ˜. O ·ÛıÂÓ‹˜ ÂÍÂ-Ù·˙fiÙ·Ó ÌËÓÈ·›ˆ˜ Î·È ÁÈÓfiÙ·Ó Ô ··Ú·›ÙËÙÔ˜ ÂÚ-Á·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ∏ ıÂÚ·Â›· ‹Ù·Ó Î·ÏÒ˜·ÓÂÎÙ‹ Î·È Û˘ÓÂ¯›ÛÙËÎÂ ÁÈ· 12 Ì‹ÓÂ˜. ∫·Ù¿ ÙÔÓÂÚÈÔ‰ÈÎfi Â·Ó¤ÏÂÁ¯Ô, ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÂÚ·È-Ù¤Úˆ Â¤ÎÙ·ÛË ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜, ÂÓÒ Ë ˘¿Ú-¯Ô˘Û· ÂÛÙ›· ÛÙ·‰È·Î¿ ·ÚÔ˘Û›·ÛÂ ÂÚÈÔ¯¤˜ Ï‡-ÛË˜. ∫·Ù¿ ÙËÓ Î·Ú‰ÈÔÏÔÁÈÎ‹ Â·ÓÂÎÙ›ÌËÛË (ÌÂÙ¿·fi 6 Î·È 12 Ì‹ÓÂ˜), ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú-‰È¿˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ·‡ÍËÛË ÙË˜ ›ÂÛË˜ ÙË˜‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È Ë ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË ÙË˜ Î·Ú-‰È¿˜ Î·È ÙˆÓ ·ÁÁÂ›ˆÓ ‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈÎ‹. O·ÛıÂÓ‹˜ Â›Ó·È ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, ˆÛÙfiÛÔ·Ú·Ì¤ÓÔ˘Ó Ù· ÚÔ‚Ï‹Ì·Ù· ·Ó¿Ù˘ÍË˜ Î·È „˘-¯ÔÎÈÓËÙÈÎ‹˜ ÂÍ¤ÏÈÍË˜.

™˘˙‹ÙËÛË

∆· ·ÈÌ·ÁÁÂÈÒÌ·Ù· Â›Ó·È Î·ÏÔ‹ıÂÈ˜ fiÁÎÔÈ Ô˘·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÚÎÂÙ¿ Û˘¯Ó¿ ÛÙ· ·È‰È¿ (·Ú·-ÙËÚÔ‡ÓÙ·È ÛÂ 3-5% ÙˆÓ ÓÂÔÁÓÒÓ Î·È 10% ÙˆÓ ‚ÚÂ-ÊÒÓ ÚÈÓ Û˘ÌÏËÚÒÛÔ˘Ó ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜).™˘ÓÂÒ˜, Î¿ıÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ ÌÂÛ˘Ó˘¿Ú¯Ô˘ÛÂ˜ ‰˘ÛÏ·Û›Â˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó·Î·Ù·ÁÚ¿ÊÂÙ·È Î·È Ó· ÂÚÈÁÚ¿ÊÂÙ·È ÌÂ ¤ÌÊ·ÛË (2).

∏ Û˘Ó‡·ÚÍË ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ Î·È ‰˘ÛÏ·-ÛÈÒÓ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™)·Ó·ÎÔÈÓÒıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1978 ·fi ÙÔÓPascual-Castroviejo (3). ™Ù· ¯ÚfiÓÈ· Ô˘ ·ÎÔÏÔ‡-ıËÛ·Ó, Ë ·Ú·¿Óˆ Û¯¤ÛË (Î·›ÙÔÈ Û¿ÓÈ·) ÂÓÈ-Û¯‡ıËÎÂ Î·È ·fi ¿ÏÏÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜,ÂÓÒ ·Ú¿ÏÏËÏ· ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÁÚ¿-ÊËÎ·Ó ÔÚÈÛÌ¤ÓÂ˜ ÂÈÏ¤ÔÓ ·ÓˆÌ·Ï›Â˜ (4-6). ∆o1996, ÌÂÙ¿ ·fi ÌÂÏ¤ÙË 43 ÂÚÈÙÒÛÂˆÓ (41 ÂÚÈ-ÙÒÛÂÈ˜ ·Ó·ÊÂÚfiÌÂÓÂ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È ‰‡Ô

¶·È‰È·ÙÚÈÎ‹ 2005;68:145-148

∂∂ÈÈÎÎfifiÓÓ·· 11.. ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘. ∂˘ÌÂÁ¤ıË˜Î‡ÛÙË ÙÔ˘ ‰ÂÍÈÔ‡ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ ÛÂ ·Â˘ıÂ›·˜ ÂÈÎÔÈ-ÓˆÓ›· ÌÂ ÙËÓ 4Ë ÎÔÈÏ›·. ∞ˆıÂ› ÙÔ ‰ÂÍÈfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈ-ÛÊ·›ÚÈÔ ÚÔÛı›ˆ˜ Î·È ¿Óˆ. O ÛÎÒÏËÎ·˜ ·Ô˘ÛÈ¿˙ÂÈ. ™˘-Ó˘¿Ú¯ÂÈ ˘‰ÚÔÎ¤Ê·ÏÔ˜.


147µÚ¤ÊÔ˜ ÌÂ Û‡Ó‰ÚÔÌÔ PHACE

Ô˘ ·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜), ¯ÚË-

ÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ·ÎÚˆÓ‡ÌÈÔ PHACE ÁÈ· ÙËÓ ÔÓÔ-

Ì·Û›· Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÓˆÌ·Ï›Â˜

·fi ÙÔ ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· (Î˘Ú›ˆ˜ ·Óˆ-

Ì·Ï›Â˜ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘), ÙËÓ Î·Ú‰È¿, Ù· ·Á-

ÁÂ›· Î·È ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÌÂÁ¿-

ÏË˜ ¤ÎÙ·ÛË˜ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘. ∆Ô Û‡Ó-

‰ÚÔÌÔ Èı·ÓÒ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ÂÓ‰ÔÌ‹ÙÚÈ· ·ÓˆÌ·-

Ï›· ÙË˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·Ù¿ ÙÔÓ ÙÚ›ÙÔ

Ì‹Ó· ÙË˜ Î‡ËÛË˜, fiÙ·Ó Û¯ËÌ·Ù›˙ÔÓÙ·È Ù· ·ÁÁÂ›·, Ô

ÛÎÒÏËÎ·˜ ÙË˜ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È Ë ÔÙÈÎ‹ Û¯È-

ÛÌ‹ (1). £· Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê¤˜ fiÙÈ fiÏ· Ù· ·È-

Ì·ÁÁÂÈÒÌ·Ù· ‰ÂÓ Â›Ó·È ÙÔ ›‰ÈÔ ‡ÔÙ· ÁÈ· ˘ÔÎÂ›-

ÌÂÓÂ˜ ·ÓˆÌ·Ï›Â˜. ™˘Ó‹ıˆ˜ Ù· ÁÈÁ·ÓÙÈ·›·, ÂÙÂÚfi-

ÏÂ˘Ú· Î·È ÌÂ ˘¤ÁÂÚÛË ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒ-

Ô˘ Â›Ó·È ÂÎÂ›Ó· Ô˘ Ú¤ÂÈ Ó· ıÔÚ˘‚Ô‡Ó Î·È

ÌÔÚÂ› Ó· ˘ÔÎÚ‡ÙÔ˘Ó Û‡Ó‰ÚÔÌÔ PHACE (7). O

·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ÏËÚÔ› Ù· Â-

ÚÈÛÛfiÙÂÚ· ·fi Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· Î·È ÂÚÈ-

ÁÚ¿ÊÂÙ·È ˆ˜ Èı·Ófi Û‡Ó‰ÚÔÌÔ PHACE.

∆Ô Û‡Ó‰ÚÔÌÔ PHACE Ê·›ÓÂÙ·È Ó· ·ÊÔÚ¿ Û·-

ÓÈfiÙÂÚ· ÛÙ· ·ÁfiÚÈ·, ·ÊÔ‡ ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈ-

ÙÒÛÂÈ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÂ ÎÔÚ›-

ÙÛÈ·. ∏ Û˘¯ÓfiÙÂÚË ·Ó·ÊÂÚfiÌÂÓË ‰˘ÛÏ·Û›· ÙÔ˘

∫¡™ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ Dandy-Walker, fiˆ˜ Î·È

ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË (1). ∆o Û‡Ó‰ÚÔÌÔ

Dandy-Walker ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÁÂÓÂÛ›· ‹

˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËÎ· ÙË˜ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È

Î˘ÛÙÈÎ‹ ‰È·ÌfiÚÊˆÛË ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ ÛÂ ÂÈ-

ÎÔÈÓˆÓ›· ÌÂ ÙËÓ 4Ë ÎÔÈÏ›·. ¶ÔÏÏÔ› ·fi ÙÔ˘˜ ·ÛıÂ-

ÓÂ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ÎÚÔÎÂÊ·Ï›· ÏfiÁˆ ÙÔ˘ ˘‰ÚÔ-

ÎÂÊ¿ÏÔ˘, Ô ÔÔ›Ô˜ ·ÔÙÂÏÂ› ÂÍ·ÈÚÂÙÈÎ¿ Û˘¯Ó‹ ÂÈ-

ÏÔÎ‹, ·Ú’ fiÙÈ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙ· ‚·ÛÈÎ¿

¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. O ˘‰ÚÔÎ¤Ê·ÏÔ˜

‰ËÌÈÔ˘ÚÁÂ›Ù·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÌÂ ÌÂÁ·Ï‡ÙÂÚË

Â›ÙˆÛË ÛÙÔ˘˜ ÙÚÂÈ˜ Ì‹ÓÂ˜ ˙ˆ‹˜ Î·È Û˘Ó‹ıˆ˜

··ÈÙÂ›Ù·È Â¤Ì‚·ÛË ÎÔÈÏÈÔÂÚÈÙÔÓ·˚Î‹˜ ·ÚÔ¯¤-

ÙÂ˘ÛË˜ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙÂ›. °ÂÓÂÙÈÎ¤˜

·ÓˆÌ·Ï›Â˜ Û¿ÓÈ· ÂÌÏ¤ÎÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÈ·

ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Dandy-Walker, ÂÓÒ ‰ÂÓ ¤¯Ô˘Ó Î·-

Ù·ÁÚ·ÊÂ› ÔÈÎÔÁÂÓÂ›˜ ÂÚÈÙÒÛÂÈ˜ ‹ ÎÏËÚÔÓÔÌÈÎfi-

ÙËÙ· Î¿ÔÈÔ˘ Ù‡Ô˘. O Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·Ú˘fiÙ˘Ô˜ÙÔ˘ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ‚Ú›ÛÎÂÙ·ÈÛÂ Û˘ÌÊˆÓ›· ÌÂ Ù· ·Ú·¿Óˆ. ∏ ‹È· ˘ÔÙÔÓ›·Î·È Ë Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ÎÈÓËÙÈÎ‹˜ ÂÍ¤ÏÈÍË˜ Ô˘·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Èı·Ófi-Ù·Ù· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ Dandy-WalkerÎ·È ¤¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ› ˆ˜ Û˘¯Ó¤˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒ-ÛÂÈ˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∞Ó Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ÛÔ‚·Ú¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÛÎÒÏËÎ·,·˘Ùfi ‰ÂÓ ÂÎÊÚ¿˙ÂÙ·È ÎÏÈÓÈÎ¿ ÌÂ ‚¿ÛË ÙÈ˜ ÂÚÈÙÒ-ÛÂÈ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ·ÏÏ¿ Î·ÈÙËÓ ÂÌÂÈÚ›· Ì·˜. ¡ÔËÙÈÎfi ËÏ›ÎÔ (IQ) >80 ÛË-ÌÂÈÒıËÎÂ ÛÂ ÔÛÔÛÙfi 60% ÛÂÈÚ¿˜ ·ÛıÂÓÒÓ ÌÂÛ‡Ó‰ÚÔÌÔ Dandy-Walker ÌÂÙ¿ ·fi Ì·ÎÚ¿ ·Ú·-ÎÔÏÔ‡ıËÛË, fiÌˆ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ó¿ÏÔÁ· ÛÙÔÈ¯Â›·ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ PHACE (8).

∏ ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË Ô˘ ·Ú·ÙËÚ‹ıËÎÂÛÙÔÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ·Ô‰›‰Â-Ù·È ÛÂ ‰ÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›-ˆÓ. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¿ÏÏÔ˘ Ù‡Ô˘ ‰˘ÛÏ·Û›Â˜ÙË˜ Î·Ú‰È¿˜ ‹ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁÂ›ˆÓ, ÛÂ ·ÓÙ›ıÂÛËÌÂ ÔÏÏ¤˜ ·fi ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó‚È‚ÏÈÔÁÚ·ÊÈÎ¿: ÔÛÔÛÙfi 26% ÛÂÈÚ¿˜ ·ÛıÂÓÒÓ ÌÂPHACE ·ÚÔ˘Û›·˙Â ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ Î·Ú‰È¿ ‹ÙËÓ ·ÔÚÙ‹ (Î˘Ú›ˆ˜ ÈÛıÌÈÎ‹ ÛÙ¤ÓˆÛË), ÂÓÒ 41%ÙË˜ ›‰È·˜ ÛÂÈÚ¿˜ Â›¯Â ‰˘ÛÏ·Û›Â˜ ÛÙ· ·ÁÁÂ›· ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘ (1). ∏ ‰È¿ÁÓˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ·ÓˆÌ·ÏÈÒÓ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó Á›ÓÂÙ·È ÌÂ Î·ıÂÙË-ÚÈ·ÛÌfi ÙË˜ Î·Ú‰È¿˜ ‹/Î·È ·ÁÁÂÈÔÁÚ·Ê›· Î·ÚˆÙ›-‰ˆÓ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ ·fi ÙÔÓ ÎÏÈÓÈÎfi,ÙÔÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ‹ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô.™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ù· ·Ú¯ÈÎ¿ Â˘Ú‹Ì·Ù··fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ ‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈÎ¿ (·Ô˘Û›· Ê˘Û‹Ì·-ÙÔ˜, Ê˘ÛÈÔÏÔÁÈÎfi˜ ÂÚÈÊÂÚÈÎfi˜ ÛÊ˘ÁÌfi˜ Î·È Ê˘-ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ÛÙ· Ù¤Û-ÛÂÚ· ¿ÎÚ·), ÂÓÒ ‰ÂÓ ˘‹Ú¯·Ó ·ÓˆÌ·Ï›Â˜ ·ÁÁÂ›ˆÓÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘. ∫·Ù¿ ÙËÓ Î·Ú‰ÈÔÏÔÁÈÎ‹Â·ÓÂÎÙ›ÌËÛË (ÌÂÙ¿ ·fi 6 Î·È 12 Ì‹ÓÂ˜), ‰ÂÓ ‰È·-ÈÛÙÒıËÎÂ ·‡ÍËÛË ÙË˜ ›ÂÛË˜ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜Î·È ‰Â‰ÔÌ¤ÓË˜ ÙË˜ ·Ô˘Û›·˜ ·ıÔÏÔÁÈÎÒÓ ÎÏÈÓÈ-ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ·ÎÙÈÓÔÁÚ·-Ê›·˜ ıÒÚ·ÎÔ˜, Ô ¤ÏÂÁ¯Ô˜ ‰ÂÓ ÚÔ¯ÒÚËÛÂ ÂÚ·ÈÙ¤-Úˆ. OÈ ·È‰ÔÎ·Ú‰ÈÔÏfiÁÔÈ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ ÚÔ-¯ˆÚÔ‡Ó ÛÂ Î·ıÂÙËÚÈ·ÛÌfi Î·È ıÂÚ·Â›· fiÙ·Ó Ë›ÂÛË ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ˘ÂÚ‚·›ÓÂÈ Ù· 50 mmHg.øÛÙfiÛÔ, ÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ˙‹ÙËÌ· ÚÔ‚ÏËÌ·Ù›˙ÂÈÎ·È ÙÔ ·È‰› ı· Â·ÓÂÎÙÈÌ¿Ù·È ÂÚÈÔ‰ÈÎ¿, Â›Ó·È ‰ÂÔÏ‡ Èı·Ófi Ó· ˘Ô‚ÏËıÂ› Û‡ÓÙÔÌ· ÛÂ Î·ıÂÙË-ÚÈ·ÛÌfi Î·Ú‰È¿˜ Â¿Ó Ë Î·Ù¿ÛÙ·ÛË ‰ÂÓ ‚ÂÏÙÈˆıÂ›.

∆Ô Û‡Ó‰ÚÔÌÔ PHACE Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ·-ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·fi ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜: ÔÛÔ-ÛÙfi 23% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ·fiÙÔ˘˜ Frieden Î·È Û˘Ó Â›¯Â Ù¤ÙÔÈÂ˜ ·ÓˆÌ·Ï›Â˜ (1).∆· ÈÔ Û˘¯Ó¿ ÔÊı·ÏÌÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Â›Ó·È ÔÌÈÎÚfiÊı·ÏÌÔ˜, Ô Î·Ù·ÚÚ¿ÎÙË˜, Ë ˘ÔÏ·Û›· ÙÔ˘

¶·È‰È·ÙÚÈÎ‹ 2005;68:145-148

∂∂ÈÈÎÎfifiÓÓ·· 22.. ∂ÎÙÂÙ·Ì¤ÓÔ ·ÈÌ·ÁÁÂ›ˆÌ· ‰ÂÍÈÔ‡ ËÌÈÌÔÚ›Ô˘ÚÔÛÒÔ˘ ÛÂ ËÏÈÎ›· 8 ÌËÓÒÓ.


148 Õ. ∆Û›ÙÛÈÎ· Î·È Û˘Ó.

ÔÙÈÎÔ‡ ÓÂ‡ÚÔ˘, Ô ÛÙÚ·‚ÈÛÌfi˜ Î·È Ë ‚ÏÂÊ·Úfi-ÙˆÛË (5). ∞Ó Î·È ÙÔ ÁÏ·‡ÎˆÌ· ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚ-ıÂ› ÛÙÈ˜ ÔÊı·ÏÌÔÏÔÁÈÎ¤˜ ·ı‹ÛÂÈ˜ ÙÔ˘ PHACE,ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ‡ÙËÎÂ Ë Û˘Ó‡·ÚÍË ÁÏ·˘ÎÒ-Ì·ÙÔ˜ ÌÂ ÙÈ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ (9). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ‰È·ÈÛÙÒ-ıËÎÂ ÛÙÚ·‚ÈÛÌfi˜ Î·È ‚ÏÂÊ·ÚfiÙˆÛË Î·È ÂÊ·ÚÌfi-ÛÙËÎÂ Î¿Ï˘„Ë ÙÔ˘ ˘ÁÈÔ‡˜ ÔÊı·ÏÌÔ‡ ÚÔÎÂÈÌ¤ÓÔ˘Ó· ·ÔÊÂ˘¯ıÂ› Ë ·ÒÏÂÈ· fiÚ·ÛË˜ ÏfiÁˆ ·Ì‚Ï˘ˆ-›·˜, Ì›·˜ Û˘¯Ó‹˜ ÔÊı·ÏÌÔÏÔÁÈÎ‹˜ ÂÈÏÔÎ‹˜Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· (10).

∏ ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË ‰ÂÓ ÂËÚÂ¿˙ÂÙ·È ¿-ÓÙÔÙÂ ÛÙÔ Û‡Ó‰ÚÔÌÔ PHACE. ∏ Ì·ÎÚÔÎÂÊ·Ï›·Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹ Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂ ˘ÔÎÂ›ÌÂÓÔ˘‰ÚÔÎ¤Ê·ÏÔ, ÂÓÒ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È ÔÚÈÛÌ¤ÓÂ˜ÂÚÈÙÒÛÂÈ˜ ÌÂ ¯·ÌËÏ¿ ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÛÙÔÈ¯Â›·,fiˆ˜ Î·È ÛÙÔÓ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ·ÛıÂÓ‹ (1,7,11).™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ÔÈ ÁÔÓÂ›˜ ·Ó¤ÊÂÚ·Ó·ÓÔÚÂÍ›·, ˆÛÙfiÛÔ ‰ÂÓ ˘‹ÚÍ·Ó ¤ÌÂÙÔÈ, fiˆ˜ ÛÂÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Dandy-Walker(8). ∏ ıÂÚ·Â›· ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹ Ô˘ Â›¯Â ÚÔËÁË-ıÂ›, ·Ó Î·È Û‡ÓÙÔÌË, ÂÓ‰¤¯ÂÙ·È Ó· ·ÔÙÂÏÂ› ÂÈ-Ï¤ÔÓ ·Ú¿ÁÔÓÙ· Î·ı˘ÛÙ¤ÚËÛË˜ ÙË˜ ÛˆÌ·ÙÈÎ‹˜·Ó¿Ù˘ÍË˜ ÛÂ ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË. °ÂÓÈÎfiÙÂÚ·,Ô Ê·ÈÓfiÙ˘Ô˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ PHACE Ê·›ÓÂÙ·ÈÓ· ¤¯ÂÈ ÌÂÁ¿ÏÔ Ê¿ÛÌ· ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓÎ·È ÔÏÏ·ÏÔ› Û˘Ó‰˘·ÛÌÔ› ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ·˘ÙÒÓ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÔ‡Ó. ¶ÚfiÛÊ·ÙË Â›Ó·ÈË ÂÓÙ˘ˆÛÈ·Î‹ ÂÚÈÁÚ·Ê‹ ·ÛıÂÓÔ‡˜ ÌÂ ÎÏÈÓÈÎ¿Â˘Ú‹Ì·Ù· Û˘Ó‰˘·ÛÌÔ‡ Û˘Ó‰ÚfiÌˆÓ Marfan Î·ÈPHACE (12).

∏ ıÂÚ·Â›· ÌÂ ÈÓÙÂÚÊÂÚfiÓË-· (INF-·) ¤¯ÂÈÂÊ·ÚÌÔÛÙÂ› ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÈıÂÙÈÎÒÓ ·ÈÌ·ÁÁÂÈ-ˆÌ¿ÙˆÓ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË ¯ÔÚ‹ÁËÛËÎÔÚÙÈÎÔÂÈ‰ÒÓ. O ÌË¯·ÓÈÛÌfi˜ Â˘·ÈÛıËÛ›·˜ ÙˆÓ ·È-Ì·ÁÁÂÈˆÌ¿ÙˆÓ ÛÙËÓ ÈÓÙÂÚÊÂÚfiÓË-· ‰ÂÓ ¤¯ÂÈ ·Ô-Ï‡Ùˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›, Ê·›ÓÂÙ·È ˆÛÙfiÛÔ Ó· Û¯ÂÙ›˙Â-Ù·È ÌÂ ÙËÓ È‰ÈfiÙËÙ¿ ÙË˜ Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙË ÌÂÁ¿ÏË·Ó¿Ù˘ÍË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ¯·-Ú·ÎÙËÚ›˙ÂÈ Ù· ·ÈÌ·ÁÁÂÈÒÌ·Ù· (13,14). ∏ ÚÔÙÂÈ-ÓfiÌÂÓË ‰fiÛË Â›Ó·È 3 ÂÎ·ÙÔÌÌ‡ÚÈ· U/M2 ˘Ô‰Ô-Ú›ˆ˜, ¿·Í ËÌÂÚËÛ›ˆ˜, ÂÓÒ Ë ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·-Â›·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË Î·ÈÙÈ˜ Èı·Ó¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ∏ ¯ÔÚ‹-ÁËÛË ÈÓÙÂÚÊÂÚfiÓË˜-· ·ÔÊ·Û›ÛÙËÎÂ ÛÙËÓ ·ÚÔ‡-Û· ÂÚ›ÙˆÛË ÏfiÁˆ ÙÔ˘ ÁÈÁ·ÓÙÈ·›Ô˘ ÌÂÁ¤ıÔ˘˜ Î·ÈÙË˜ Ù·¯‡Ù·ÙË˜ ÂÍ¤ÏÈÍË˜ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜, Î·-ıÒ˜ Î·È ÙË˜ ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ·Ú-¯ÈÎ‹˜ ıÂÚ·Â›·˜ ÌÂ ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË. ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·-ÚÂÓ¤ÚÁÂÈÂ˜ Î·È ‰ÂÓ ˘‹ÚÍÂ ÌÂÙÚ‹ÛÈÌË Â¤ÎÙ·ÛËÙË˜ ˘¿Ú¯Ô˘Û·˜ ÂÛÙ›·˜. ªÂÙ¿ ·fi 12 Ì‹ÓÂ˜ ıÂ-Ú·Â›·˜ ÌÂ ÙËÓ ·Ú·¿Óˆ ‰fiÛË, Ë ‚Ï¿‚Ë Â›Ó·ÈÛ·ÊÒ˜ ÏÈÁfiÙÂÚÔ ¤ÓÙÔÓË Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÔ¯¤˜Ï‡ÛË˜. πÎ·ÓÔÔÈËÙÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÛÂ ·Ó¿ÏÔÁË

·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (1,7). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ê·›ÓÂÙ·È fiÙÈ Ë Ù·ÎÙÈÎ‹ ·-

Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ ÌÂ Â˘ÌÂÁ¤ıË ·ÈÌ·ÁÁÂÈÒÌ·-Ù· ÚÔÛÒÔ˘ Â›Ó·È ÛËÌ·ÓÙÈÎ‹. ∏ ÏÂÙÔÌÂÚ‹˜ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË, Ë Ù·ÎÙÈÎ‹ Ì¤ÙÚËÛË ÙË˜ÂÚÈÌ¤ÙÚÔ˘ ÎÂÊ·Ï‹˜ Î·È Ë ÚÔÛÂÎÙÈÎ‹ ÂÍ¤Ù·ÛËÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û˘ÛÙ‹ÓÔÓÙ·ÈÂÌÊ·ÙÈÎ¿. ∏ ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË Â›Ó·È, Â›-ÛË˜, ÂÍ›ÛÔ˘ ··Ú·›ÙËÙË. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·ıÔ-ÏÔÁÈÎÒÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ‹/Î·È Ù·¯¤ˆ˜ ÂÍÂ-ÏÈÛÛfiÌÂÓˆÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ ı· Ú¤ÂÈ Ó· Á›ÓÂ-Ù·È ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ∫¡™, ÙË˜ Î·Ú‰È¿˜,ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁÂ›ˆÓ Î·È ÙˆÓ ÔÊı·ÏÌÒÓ ¤¯ÔÓÙ·˜¿ÓÙ· ˘’ fi„ÈÓ ÙÔ Û‡Ó‰ÚÔÌÔ PHACE.


1. Frieden IJ, Reese V, Cohen D. PHACE syndrome. The as-sociation of posterior fossa brain malformations, heman-giomas, arterial anomalies, coarctation of the aorta andcardiac defects, and eye abnormalities. Arch Dermatol1996;132:307-311.

2. Burns AJ, Kaplan LC, Mulliken JB. Is there an associationbetween hemangioma and syndromes with dysmorphicfeatures? Pediatrics 1991;88:1257-1267.

3. Pascual-Castroviejo I. Vascular and nonvascular intracra-nial malformation associated with external capillary he-mangiomas. Neuroradiology 1978;16:82-84.

4. Reese V, Frieden IJ, Paller AS, Esterly NB, Ferriero D, LevyML et al. Association of facial hemangiomas with Dandy-Walker and other posterior fossa malformations. J Pediatr1993;122:379-384.

5. Fernandez GR, Munoz FJ, Padron C, Munoz M. Microph-thalmos, facial capillary hemangioma and Dandy-Walkermalformation. Acta Ophthalmol Scand 1995;73:173-175.

6. Goh WH, Lo R. A new 3C syndrome: cerebellar hypopla-sia, cavernous haemangioma and coarctation of the aorta.Dev Med Child Neurol 1993;35:637-641.

7. Quecedo E, Gil-Mateo MP, Pont V, Febrer MI, Aliaga A.Giant hemifacial angioma and PHACE syndrome. Br JDermatol 1997;136:649-650.

8. Hirsch JF, Pierre-Kahn A, Renier D, Sainte-Rose C,Hoppe-Hirsch E. The Dandy-Walker malformation. A re-view of 40 cases. J Neurosurg 1984;61:515-522.

9. Coats DK, Paysse EA, Levy ML. PHACE: a neurocutaneoussyndrome with important ophthalmologic implications:case report and literature review. Ophthalmology1999;106:1739-1741.

10. Haik BG, Karcioglu ZA, Gordon RA, Pechous BP. Capil-lary hemangioma (infantile periocular hemangioma). SurvOphthalmol 1994;38:399-426.

11. Rizzo R, Micali G, Incorpora G, Parano E, Pavone L. A veryaggressive form of facial hemangioma. Pediatr Dermatol1988;5:263-265.

12. Slavotinek AM, Dubovsky E, Dietz HC, Lacbawan F. Re-port of a child with aortic aneurysm, orofacial clefting, he-mangioma, upper sternal defect, and marfanoid features:possible PHACE syndrome. Am J Med Genet 2002;110:283-288.

13. White CW, Wolf SJ, Korones DN, Sondheimer HM, TosiMF, Yu A. Treatment of childhood angiomatous diseaseswith recombinant interferon alfa-2a. J Pediatr 1991;118:59-66.

14. Brouty-Boye D, Zetter BR. Inhibition of cell motility by in-terferon. Science 1980;208:516-518.

¶·È‰È·ÙÚÈÎ‹ 2005;68:145-148


149CASE REPORT

An infant with PHACE syndrome A. Tsitsika, H. Fryssira, A. Lourida, N. Manolaki

AbstractLarge facial haemangiomas may be found in combination with dysplasias of the central nervous system(primarily, the Dandy-Walker malformation), the cardiovascular system and the eyes. The name PHACE(an acronym) was proposed for the syndrome of patients whose deformities meet the above criteria. Thecase reported is of an 8 month-old boy who had a giant, unilateral, plaque-like facial haemangioma, witha coexisting Dandy-Walker variant malformation, pulmonary hypertension, eyelid ptosis and strabismusof the eye on the affected side. The child had received oral corticosteroids as treatment for the rapidlygrowing facial lesion and at first a slight improvement was observed. After discontinuation of treatmentthere was a relapse and the baby was referred for further evaluation and treatment. Interferon-alfa wasadministered at daily dosage of 3x106 U/M2 subcutaneously for 12 months with satisfying results. Thecoexisting anomalies were also treated. This patient is described as a possible PHACE case, and thepathogenesis, the clinical features, the diagnosis and the treatment options of the syndrome are discussed.It is emphasized that large, unilateral facial haemangiomas may be associated with the anomalies described,and in cases of abnormal findings or rapidly progressing haemangiomatosis further brain, cardiac andocular investigation is indicated, as the diagnosis of PHACE syndrome must be considered.

Key wordsHaemangiomas, Dandy-Walker malformation, pulmonary hypertension, interferon-alfa.

1st Paediatric Clinic of theUniversity of Athens, “Aghia Sophia” Children’sHospital, Athens

Correspondence:Artemis Tsitsika 33 Alamanas & Erexthiou str., 174 55, Kalamaki, Athens




150 ∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô"∞ÏÂÍ¿Ó‰Ú·", ∞ı‹Ó·

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¶·È‰È·ÙÚÈÎ‹ 2005;68:150-153

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∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ ÌÂ ‰È·ÈÛÙˆÌ¤ÓÔÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ-Î‹, ·ÊÔ‡ Ë ÓfiÛÔ˜ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› - ·Ó Î·ÈÛ¿ÓÈ· - ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÌÂ ¿Ù˘Ë ÛËÌÂÈ-ÔÏÔÁ›·, Ô˘ ÌÔÚÂ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÌÙÒÌ·-Ù· ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛËÔ˘ ÂÚÈÁÚ¿ÊÂÙ·È. ∏ ˘Ô„›· ÙË˜ ÓfiÛÔ˘ Ú¤ÂÈÓ· ÎÈÓËÙÔÔÈÂ› ¤ÁÎ·ÈÚ· ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi ÁÈ·ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ¤Ó·ÚÍË ıÂÚ·Â›·˜ ˘ÔÎ·-Ù¿ÛÙ·ÛË˜ ÌÂ ÎÔÚÙÈÎÔÂÈ‰‹, Ë ÔÔ›· ÌÔÚÂ› Ó··Ô‚Â› ÛˆÙ‹ÚÈ· ÁÈ· ÙÔ ÓÂÔÁÓfi.


¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÙÂÏÂÈfiÌËÓÔ˘ ¿Ú-ÚÂÓÔ˜ ÓÂÔÁÓÔ‡, ËÏÈÎ›·˜ Î‡ËÛË˜ 41 Â‚‰ÔÌ¿‰ˆÓ,ÙÔ ÔÔ›Ô ÁÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ·fiÁÔÓÂ›˜ ÌÔÏ‰·‚È·Ó‹˜ Î·Ù·ÁˆÁ‹˜, ÔÈ ÔÔ›ÔÈ Â›¯·ÓÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi.¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ‰Â‡ÙÂÚÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜.∆Ô ÚÒÙÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ı‹Ï˘, Î·ı’fiÏ· ˘ÁÈ¤˜. ∆Ô ÓÂÔÁÓfi ·ÚÔ˘Û›·ÛÂ ‹È· ·Ó·ÓÂ˘-ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È¯ÚÂÈ¿ÛÙËÎÂ ÔÍ˘ÁfiÓÔ 30% Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ‰‡Ô ÚÒÙˆÓ ËÌÂÚÒÓ ÙË˜ ˙ˆ‹˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›·ıÒÚ·Î· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ¶·ÚÔ˘Û›·ÛÂ Ê˘ÛÈÔ-ÏÔÁÈÎfi ›ÎÙÂÚÔ, Ô ÔÔ›Ô˜ ˘Ô¯ÒÚËÛÂ ÙËÓ 6Ë ËÌ¤-

Ú· ˙ˆ‹˜, ÔfiÙÂ Î·È ÂÍ‹ÏıÂ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô.

∆Ô ÓÂÔÁÓfi Â·ÓÂÈÛ‹¯ıË ÙË 10Ë ËÌ¤Ú· ˙ˆ‹˜ ÌÂÙ·¯‡ÓÔÈ·, ›ÎÙÂÚÔ, ˘¤Ú¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜, ˘fi-

Ù·ÛË (∞¶: 34/29, ª∞¶: 32) Î·È ÂÌ¤ÙÔ˘˜. O ·Ú¯È-Îfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 1) ÂÚÈÂÏ¿Ì‚·ÓÂ Ï‹ÚË

ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÏÔ›ÌˆÍË˜, Û˘ÌÂÚÈÏ·Ì‚·-ÓÔÌ¤ÓË˜ O¡¶ Î·È ˘ÂÚË‚ÈÎ‹˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ Ô‡-

ÚˆÓ, Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ¶·Ú¿ ÙËÓ ¤Ó·ÚÍË·ÓÙÈÛË„·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜, Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÓÂÔ-

ÁÓÔ‡ Û˘Ó¤¯È˙Â Ó· ÂÈ‰ÂÈÓÒÓÂÙ·È. O ¤ÏÂÁ¯Ô˜ ÁÈ·Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ (ÙÔÍfiÏ·ÛÌ·, ÌÂÁ·ÏÔÎ˘Ù-

Ù·ÚÔ˚fi˜, ÂÚ˘ıÚ¿, ¤ÚË˜), HIV Î·È Ë·Ù›ÙÈ‰· µÎ·È C ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∏ ÔÍÂÔ‚·ÛÈÎ‹ ÈÛÔÚÚÔ›·

¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi pH ·›Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ‰È·ÙË-Ú‹ıËÎÂ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›·˜ Ê¿ÛË˜

ÙË˜ ÓfiÛÔ˘. ∆Ô ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-Îfi, ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈ˜ ÙÈÌ¤˜ Na, K Î·È Cl (98

mmol/l) ÛÙÔÓ ÔÚfi. O ·Ú¯ÈÎfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„Â

˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·. ∆· Ë·ÙÈÎ¿ ¤Ó˙˘Ì· ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎ¿, ÌÂ ·˘ÍËÌ¤Ó· Ù· Â›Â‰· ÙˆÓ ÁGT,

LDH, CPK Î·È ALP, Ô˘ Â·Ó‹Ïı·Ó ÛÙ· Ê˘ÛÈÔ-ÏÔÁÈÎ¿ fiÚÈ· Ì›· Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂ-

Ú·Â›·˜. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ‹·ÙÔ˜ Î·È ÂÍˆË-·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ∫·Ù¿

ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·˙Â ˘Ô-ÁÏ˘Î·ÈÌ›·, Ô˘ fiÌˆ˜ ‰ÂÓ Â·Ó·Ï‹ÊıËÎÂ ÛÙ·

ÂfiÌÂÓ· ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘ ÙÔ˘ ÏfiÁˆ ¯ÔÚ‹ÁËÛË˜‰È·Ï‡Ì·ÙÔ˜ ÁÏ˘Îfi˙Ë˜ ÂÓ‰ÔÊÏÂ‚›ˆ˜. ∂›ÛË˜, ·-Ú¿ ÙË ¯ÔÚ‹ÁËÛË ËÏÂÎÙÚÔÏ˘ÙÒÓ ÂÓ‰ÔÊÏÂ‚›ˆ˜ Î·È

ÂÓÒ ÙÔ ÈÔÓÙfiÁÚ·ÌÌ· ÂÈÛfi‰Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi,


¿Ú¯È˙Â Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔÔ‰Â˘ÙÈÎ¿ ˘ÔÓ·ÙÚÈ·È-Ì›· ÌÂ ˘ÂÚÎ·ÏÈ·ÈÌ›· Î·È ¯·ÌËÏ‹ Ô˘Ú›·. OÈ ËÏÂ-ÎÙÚÔÏ˘ÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ·˘Í‹ıËÎ·Ó ·fi ÙÔ ÙÚ›ÙÔ24ˆÚÔ ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘, Î·ıÒ˜ Ë ÎÏÈÓÈÎ‹ Î·Ù¿-ÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÂÈ‰ÂÈÓˆÓfiÙ·Ó (Na: 125mmol/l, K: 4,7 mmol/l, Ô˘Ú›·: 6 mg/dl). ∆· Â›Â-‰· ·ÌÌˆÓ›·˜ ÙÔ˘ ÔÚÔ‡ ‚Ú¤ıËÎ·Ó ˘„ËÏ¿, ÌÂ Ê˘-ÛÈÔÏÔÁÈÎfi Ô˘ÚÈÎfi ÔÍ‡ Î·Ù¿ ÙËÓ ÚÒÈÌË Ê¿ÛË ÙË˜ÓfiÛÔ˘, fiÔ˘ ÙÔ ÓÂÔÁÓfi ÂÍ·ÎÔÏÔ˘ıÔ‡ÛÂ ÂÓ Ì¤ÚÂÈÓ· ÙÚ¤ÊÂÙ·È ÂÓÙÂÚÈÎ¿. ŒÁÈÓÂ ÂÎÙÂÓ‹˜ ¤ÏÂÁ¯Ô˜ ÁÈ·‰È·Ù·Ú·¯¤˜ ÙÔ˘ Î‡ÎÏÔ˘ ÙË˜ Ô˘Ú›·˜, Î·ıÒ˜ Î·È‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛË˜. ∆· ·ÌÈÓÔÍÂÔÁÚ¿ÌÌ·-Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿, Î·ıÒ˜Î·È Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛË˜. ∆·ÏÈ›‰È· ÔÚÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿ (ÙÚÈÁÏ˘ÎÂÚ›‰È·:35 Ìg/dl, HDL: 58 mg/dl, LDL: 39 mg/dl).

∞fi ÙÔÓ ˘fiÏÔÈÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÔÈ·Ó·ÁˆÁÈÎ¤˜ Ô˘Û›Â˜ Ô‡ÚˆÓ ‹Ù·Ó ·ÚÓËÙÈÎ¤˜, ÔÈ ÎÂ-ÙfiÓÂ˜ Ô‡ÚˆÓ ·ÚÓËÙÈÎ¤˜ Î·È ÙÔ pH Ô‡ÚˆÓ 6,0. O¤ÏÂÁ¯Ô˜ ÁÈ· Ï˘ÛÔÛˆÌÈ·Î¿ Î·È ˘ÂÚÔÍÂÈÛˆÌÈ·Î¿ÓÔÛ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, Ë Î·ÚÓÈÙ›ÓË ÔÚÔ‡

‹Ù·Ó 74,18 nmol/ml (73±20) Î·È Ë ÂÏÂ‡ıÂÚËÎ·ÚÓÈÙ›ÓË 40 nmol/ml (58±15), ·ÔÎÏÂ›ÔÓÙ·˜¤ÙÛÈ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·1-·ÓÙÈıÚ˘„›ÓË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ÔÊı·ÏÌÔÏÔ-ÁÈÎ‹ ÂÍ¤Ù·ÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ªÂ ÙËÓ ˘Ô„›·ÂÈÓÂÊÚÈ‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ¤ÁÈÓÂ ‰ÔÎÈÌ·Û›·ÚfiÎÏËÛË˜ ÌÂ ACTH (Synacten test), ÂÓÒ Ë ÎÏÈ-ÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÂÈ‰ÂÈÓˆÓfiÙ·ÓÛÙ·ıÂÚ¿ Î·È Ô ·ÛıÂÓ‹˜ ¤Ì·ÈÓÂ Ï¤ÔÓ ÛÙËÓ ÙÂ-ÏÈÎ‹ Ê¿ÛË Î·Ù¤ÚÚÂÈ„Ë˜. ∆Ô ÓÂÔÁÓfi ÚÔÔ‰Â˘ÙÈÎ¿Ô‰ËÁ‹ıËÎÂ ÛÂ ÎÒÌ·, ·ÚÔ˘Û›·ÛÂ Û·ÛÌÔ‡˜ Î·È·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· ÂÎ‰ËÏÒıËÎÂÌÂ ÚÔÔ‰Â˘ÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ÛÂÔÍ˘ÁfiÓÔ.

ÃÚÂÈ¿ÛÙËÎÂ ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·-ÓÔ‹˜, ÂÓÒ ·Ú¿ÏÏËÏ· ÍÂÎ›ÓËÛÂ ıÂÚ·Â›· ÌÂ˘‰ÚÔÎÔÚÙÈ˙fiÓË 25-50 mg/m2, ÊıÔÚÈÔ-˘‰ÚÔÎÔÚ-ÙÈ˙fiÓË 0,1 mg/ËÌÂÚËÛ›ˆ˜ Î·È NaCl, ˆ˜ ıÂÚ·Â›·˘ÔÎ·Ù¿ÛÙ·ÛË˜, Î·ıÒ˜ ÙÔ Na ¤ÊÙ·ÛÂ ÛÙÔ ¯·ÌË-ÏfiÙÂÚÔ Â›Â‰Ô (Na: 100 mmol/l), ¯ˆÚ›˜ Ó· ¤¯ÂÈ·ÎfiÌË ÙÂıÂ› Ë ÙÂÏÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘. ∆Ô

¶¶››ÓÓ··ÎÎ··˜̃ 11.. ¶›Ó·Î·˜ ·Ú·ÎÏÈÓÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ

ñ °ÂÓÈÎ‹ ·›Ì·ÙÔ˜:GB: 15,1, HCT: 45,6%, WBC: 10.600 (Gr: 34%, L: 47,85), PLT:420.000 OÏÈÎ‹ ¯ÔÏÂÚ˘ıÚ›ÓË: 17,4 mg/dl ÕÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 2,7 mg/dl SGOT: 32 U/L, SGPT: 11 U/L, ÁGT: 842 U/L, LDH: 1029 U/L, CPK: 1682 U/L, ALP: 73 U/L∏ÏÂÎÙÚÔÏ‡ÙÂ˜ ÂÈÛfi‰Ô˘: K: 5,7 mmol/l, Na: 142, Ô˘Ú›·: 25 mg/dl, ÎÚÂ·ÙÈÓ›ÓË: 0,1 mg/dl, ÁÏ˘Îfi˙Ë ÔÚÔ‡: 30mg/dl Î/· ·›Ì·ÙÔ˜: ÛÙÂ›Ú·

ñ °ÂÓÈÎ‹ ∂¡À: Î‡ÙÙ·Ú·: 10, ÁÏ˘Îfi˙Ë ÔÚÔ‡: 43 mg/dl, ÏÂ‡ÎˆÌ·: 135 mg/dlÎ/· ∂¡À: ÛÙÂ›Ú·

ñ Î/· Ô‡ÚˆÓ: ÛÙÂ›Ú· ñ OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÍfiÏ·ÛÌ·, ÌÂÁ·ÏÔÎ˘ÙÙ·ÚÔ˚fi, ÂÚ˘ıÚ¿, ¤ÚËÙ·, HIV, Ë·Ù›ÙÈ‰· µ Î·È C: ·ÚÓËÙÈÎfi˜

ñ OÍÂÔ‚·ÛÈÎ‹ ÈÛÔÚÚÔ›·: pH: 7,41 mmHg, PCO2: 32,7 mmHg, PO2: 64,3 mmHg, Bic: 20,7, BE: -2,4Ã¿ÛÌ· ·ÓÈfiÓÙˆÓ: 12 mmol/l ∞ÌÌˆÓ›·: 113-173 Ìmol/l O˘ÚÈÎfi ÔÍ‡: 1,3 mg/dl∞Ó·ÁˆÁÈÎ¤˜ Ô‡ÚˆÓ: ·ÚÓËÙÈÎ¤˜ ∫ÂÙfiÓÂ˜ Ô‡ÚˆÓ: ·ÚÓËÙÈÎ¤˜ pH Ô‡ÚˆÓ: 6,0

ñ ∞ÌÈÓÔÍÂfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ: Ê˘ÛÈÔÏÔÁÈÎfi ñ ŒÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛË˜: ·ÚÓËÙÈÎfi˜ ñ ·1-·ÓÙÈıÚ˘„›ÓË: 121 mg/dl ñ ∫·ÚÓÈÙ›ÓË ÔÚÔ‡: 74,18 nmol/ml

∂ÏÂ‡ıÂÚË Î·ÚÓÈÙ›ÓË: 40 nmol/ml ñ ŒÏÂÁ¯Ô˜ ÁÈ· Ï˘ÛÔÛÛˆÌÈ·Î¿ Î·È ˘ÂÚÔÍÂÈÛˆÌÈ·Î¿ ÓÔÛ‹Ì·Ù·: ·ÚÓËÙÈÎfi˜ñ OÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË: Ê˘ÛÈÔÏÔÁÈÎ‹ñ ÀÂÚË¯ÔÁÚ¿ÊËÌ· ‹·ÙÔ˜, ¯ÔÏËÊfiÚˆÓ: Ê˘ÛÈÔÏÔÁÈÎfi

ñ ∏ÏÂÎÙÚÔÏ‡ÙÂ˜ Î·Ù¿ ÙËÓ 5Ë ËÌ¤Ú· ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹: ∫: 5,9 mmol/l, ¡a: 100 mmol/l, Cl: 119 mmol/l, Ô˘Ú›·: 12 mg/dl, ÎÚÂ·ÙÈÓ›ÓË 0,1 mg/dl

ñ ¢ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ ÌÂ ACTH (Synacten test): ACTH ÚÈÓ ÙËÓ ÚfiÎÏËÛË: 893 pg/ml, ACTH ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË: >1500 pg/ml ∫ÔÚÙÈ˙fiÏË ÔÚÔ‡ ÚÈÓ ÙËÓ ÚfiÎÏËÛË: 57,1 nmol/l, ÎÔÚÙÈ˙fiÏË ÔÚÔ‡ ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË: 67 nmol/l

ñ ŒÏÂÁ¯Ô˜ ÁÈ· ·ÔÎÏÂÈÛÌfi Û˘ÁÁÂÓÔ‡˜ ˘ÂÚÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ S-DHA: 25 ng/ml, DHEA: 0,25 ng/ml, 17-OH ÚÔÁÂÛÙÂÚfiÓË: 0,30 ng/ml, ÚÔÁÂÛÙÂÚfiÓË: 0,30 ng/ml, ÙÂÛÙÔÛÙÂÚfiÓË: 48ng/ml, ·Ó‰ÚÔÛÙÂÓÂ‰ÈfiÓË: 0,15 ng/ml, 11-‰ÂÔÍ˘ÎÔÚÙÈ˙fiÏË: 2,80 ng/ml, ÚÂÓ›ÓË Ï¿ÛÌ·ÙÔ˜: 759 pg/ml, ·Ï‰ÔÛÙÂÚfiÓË Ï¿-ÛÌ·ÙÔ˜: 9 ng/ml

ñ ÀÂÚË¯ÔÁÚ¿ÊËÌ· ÂÈÓÂÊÚÈ‰›ˆÓ: Ê˘ÛÈÔÏÔÁÈÎfiñ MRI ÂÁÎÂÊ¿ÏÔ˘: Ê˘ÛÈÔÏÔÁÈÎ‹ ˘fiÊ˘ÛË

151™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ ÛÂ ÓÂÔÁÓfi ÌÂ ÔÍÂ›· ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·

¶·È‰È·ÙÚÈÎ‹ 2005;68:150-153


152 ª. ¢·ÛÔÔ‡ÏÔ˘ Î·È Û˘Ó.

ÓÂÔÁÓfi ·ÓÙ·ÔÎÚ›ıËÎÂ ¿ÌÂÛ· ÛÙË ıÂÚ·Â›·, ÌÂÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÙÔ˘ÏÂÈÙÔ˘ÚÁ›·˜. ∆Ô ÌˆÚfi ·ÔÛˆÏËÓÒıËÎÂ 24 ÒÚÂ˜·ÚÁfiÙÂÚ·, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·Ú·ÙËÚ‹ıËÎÂ ¿ÓÔ-‰Ô˜ ÙË˜ ÙÈÌ‹˜ ÙÔ˘ Na ÛÙÔÓ ÔÚfi. ∆Ô ÂfiÌÂÓÔ24ˆÚÔ ‹Ù·Ó ˙ˆËÚfi, ÌÂ Î·Ï‹ ·˘ÙfiÌ·ÙË ÎÈÓËÙÈÎfi-ÙËÙ·, ··ÓÙÔ‡ÛÂ ÛÙ· ÂÚÂı›ÛÌ·Ù· Î·È Â›¯Â Î·Ï¤˜ıËÏ·ÛÙÈÎ¤˜ ÎÈÓ‹ÛÂÈ˜. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙË‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ ÌÂ ACTH ÂÈ‚Â‚·›ˆÛ·Ó ÙË‰È¿ÁÓˆÛË ÙË˜ ÂÈÓÂÊÚÈ‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÌÂ¯·ÌËÏ¿ ‚·ÛÈÎ¿ Â›Â‰· ÎÔÚÙÈ˙fiÏË˜ ÔÚÔ‡ ÚÈÓÎ·È ÌÂÙ¿ ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜. ∆Ô ÓÂÔÁÓfi˘Ô‚Ï‹ıËÎÂ ‰‡Ô ÊÔÚ¤˜ ÛÂ ¤ÏÂÁ¯Ô ÁÈ· Û˘ÁÁÂÓ‹˘ÂÚÏ·Û›· ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ Ô˘ ·Â‰Â›¯ıË·ÚÓËÙÈÎfi˜. ∏ ÚÂÓ›ÓË Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó ·˘ÍËÌ¤ÓËÎ·È Ë ·Ï‰ÔÛÙÂÚfiÓË Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó ¯·ÌËÏ‹. ∆Ô˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ·ÔÎ¿Ï˘„Â Ê˘ÛÈÔÏÔÁÈ-Î¿ ÂÈÓÂÊÚ›‰È· Î·È Ë MRI ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍÂ Ê˘-ÛÈÔÏÔÁÈÎ‹ ˘fiÊ˘ÛË. ™ÙË Ê¿ÛË ÙË˜ ·Ó¿ÚÚˆÛË˜,¤ÁÈÓÂ ÚÔÛ¿ıÂÈ· Ó· ÂÏ·ÙÙˆıÂ› ÚÔÔ‰Â˘ÙÈÎ¿ Ë‰fiÛË ÙË˜ ˘‰ÚÔÎÔÚÙÈ˙fiÓË˜, ·ÏÏ¿ ÙÔ ÓÂÔÁÓfi ·-ÚÔ˘Û›·ÛÂ È‰ÚÒÙÂ˜, ÂÌ¤ÙÔ˘˜, ˘ÂÚ˘ÚÂÍ›·, ·‰˘Ó·-Ì›· ÚfiÛÏË„Ë˜ ‚¿ÚÔ˘˜ Î·È ‰È¿ÚÚÔÈÂ˜.

∏ ·‡ÍËÛË ÙË˜ ÊıÔÚÈÔ-˘‰ÚÔÎÔÚÙÈ˙fiÓË˜ ÛÂ ‰È-Ï¿ÛÈ· ‰fiÛË ÙË˜ Û˘Ó‹ıÔ˘˜ (0,1 mg ‰‡Ô ÊÔÚ¤˜ ÙËÓËÌ¤Ú·), ‚ÂÏÙ›ˆÛÂ ÙËÓ ·ÓÙ·fiÎÚÈÛ‹ ÙÔ˘ ÛÙË ıÂÚ·-Â›·. ∆ÂÏÈÎ¿, Ë ıÂÚ·Â›· ÌÂ ˘‰ÚÔÎÔÚÙÈ˙fiÓË 10-20mg/m2/ËÌÂÚËÛ›ˆ˜ ÛÂ ÙÚÂÈ˜ ‰È·ÈÚÂÌ¤ÓÂ˜ ‰fiÛÂÈ˜,Ì·˙› ÌÂ 9·-ÊıÔÚÈÔ-˘‰ÚÔÎÔÚÙÈ˙fiÓË (Florinef) 0,1mg/ËÌÂÚËÛ›ˆ˜ ÛÂ ‰‡Ô ‰È·ÈÚÂÌ¤ÓÂ˜ ‰fiÛÂÈ˜ Û˘ÓÂ¯›-ÛÙËÎÂ ÛÙË Ê¿ÛË ÛÙ·ıÂÚÔÔ›ËÛË˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ÌÂ ÂÈÙ˘¯›·. ™Â ËÏÈÎ›· 3 Î·È 6 ÌËÓÒÓ ÂÌÊ¿ÓÈÛÂ ¿Ï-Ï· ‰‡Ô ÂÂÈÛfi‰È· Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÂÌ¤ÙˆÓ, ÂÊ›-‰ÚˆÛË˜ Î·È ÙÒÛË˜ ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ¯ˆÚ›˜fiÌˆ˜ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Î·È ÔÈ‰fiÛÂÈ˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ¯ÚÂÈ¿ÛÙËÎ·Ó ÂÚÈÛÙ·ÛÈ·Î¿·Ó·ÚÔÛ·ÚÌÔÁ‹ ÌÂ ·‡ÍËÛË ÙË˜ ÊıÔÚÈÔ- Î·È ˘‰ÚÔ-ÎÔÚÙÈ˙fiÓË˜. ŒÎÙÔÙÂ, ÙÔ ·È‰› Â›Ó·È Î·Ï¿ Î·È ÛÈÙ›-˙ÂÙ·È ÌÂ ÂÈÙ˘¯›·.

™˘˙‹ÙËÛË

∏ Û˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ, ·ÓÎ·È Û¿ÓÈ· ÓfiÛÔ˜, Ú¤ÂÈ Ó· ·ÔÙÂÏÂ› Ì¤ÚÔ˜ ÙË˜‰È·ÊÔÚÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÛÂ ÂÚ›ÙˆÛË ÔÍÂ›·˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÌÂ ËÏÂÎÙÚÔÏ˘ÙÈÎ¤˜‰È·Ù·Ú·¯¤˜ ‹/Î·È ˘ÔÁÏ˘Î·ÈÌ›· ÛÂ ‚·ÚÈ¿ ÓÔÛÔ‡ÓÓÂÔÁÓfi. ∏ ¤ÁÎ·ÈÚË ¤Ó·ÚÍË ÙË˜ Î·Ù¿ÏÏËÏË˜ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ Â›Ó·È ˙ˆÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ·ÙËÓ ¤Î‚·ÛË ÙˆÓ ·Û¯fiÓÙˆÓ ÓÂÔÁÓÒÓ. ∏ ÓfiÛÔ˜ıÂˆÚÂ›Ù·È Ê˘ÏÔÛ‡Ó‰ÂÙË ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ÁÂÈÙÔÓÈÎÔ‡ ÁÔÓÈ‰›Ô˘ Î·È Û˘ÓÔ‰Â‡ÂÙ·È ·fi Ì˘˚Î‹‰˘ÛÙÚÔÊ›· (ÓfiÛÔ˜ ÙÔ˘ Duchenne) ‹/Î·È ·ÓÂ¿Ú-ÎÂÈ· ÙË˜ ÎÈÓ¿ÛË˜ ÙË˜ ÁÏ˘ÎÂÚfiÏË˜ (1,2). ∂›ÛË˜,¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› Ë ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÌÂ

·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· (3) ‹ ˘ÔÏÂÈfiÌÂÓÔÙ‡Ô, Î·ıÒ˜ Î·È Ë Ê˘ÏÔÛ‡Ó‰ÂÙË ÌÔÚÊ‹ ÙË˜ Ófi-ÛÔ˘, Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ¤ÏÏÂÈ„Ë ‹ ÛËÌÂÈ·Î‹ ÌÂ-Ù¿ÏÏ·ÍË ÙÔ˘ DAX-1 ÁÔÓÈ‰›Ô˘, ÌÂ Ù· Ù˘ÈÎ¿ ÌÂ-Á¿Ï· ÎÂÓÔÙfiÈ· ÛÙ· ÂÈÓÂÊÚÈ‰È·Î¿ Î‡ÙÙ·Ú·,·Ó¿ÏÔÁ· ÂÌ‚Ú˘˚ÎÒÓ ÂÈÓÂÊÚÈ‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ,Î·ıÒ˜ Î·È ÙËÓ ·Ô˘Û›· ‰È·¯ˆÚÈÛÙÈÎ‹˜ ÁÚ·ÌÌ‹˜ÙÔ˘ ÂÈÓÂÊÚÈ‰È·ÎÔ‡ ÊÏÔÈÔ‡ (4-6). ∆Ô ÓÂÔÁÓfiÔ˘ ÂÚÈÁÚ¿ÊËÎÂ Èı·ÓfiÙ·Ù· Â›¯Â ÙË Ê˘ÏÔÛ‡Ó-‰ÂÙË ÌÔÚÊ‹ (DAX-1 gene) ÙË˜ ÓfiÛÔ˘, ·Ó Î·È Ù··˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ ÎÚÂ·ÙÈÓÈÎ‹˜ ÎÈÓ¿ÛË˜ÌÔÚÂ› Ó· ˘Ô‰ËÏÒÓÔ˘Ó ÙË ÌÔÚÊ‹ ÙË˜ ÓfiÛÔ˘Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙÔ ÁÂÈÙÔÓÈÎfi ÁÔÓ›‰ÈÔ (contiguousgene syndrome).

∏ ÔÍÂ›· ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ÂÚÈ-ÁÚ·ÊÂ› ÚfiÛÊ·Ù· ÛÂ Ì›· ·ÎfiÌË ÂÚ›ÙˆÛË, ˆ˜ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ (7) Î·È ÁÈ’ ·˘Ùfi ÙÔÓ ÏfiÁÔ ÙÔ Â-ÚÈÛÙ·ÙÈÎfi ıÂˆÚÂ›Ù·È Û¿ÓÈÔ. ∂›ÛË˜, ˘¿Ú¯ÂÈ·Ó·ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÙË˜ Û˘Û¯¤ÙÈÛË˜ ÌÂÙ·-Í‡ ÙË˜ Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓÎ·È ÙË˜ ¯ÚfiÓÈ·˜ ÂÍ¿ÚÙËÛË˜ ·fi ÙÔ ÔÍ˘ÁfiÓÔ (8) ‹ÙË˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ‰˘ÛÏ·Û›·˜ (9) ÛÂ ÔÏ‡ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿. ∏ ¤ÎÎÚÈÛË ÎÔÚÙÈ˙fiÏË˜ÌÔÚÂ› ÙÂÏÈÎ¿ Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÏ-ÏÔÓÙÈÎ‹ ·Ó¿Ù˘ÍË Î·È ˆÚ›Ì·ÓÛË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈ-ÎÔ‡ Î·Ù¿ ÙËÓ ÚÒÈÌË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, ·ÏÏ¿ ·˘-Ùfi ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË˜.

O ÌÈÎÚfi˜ ·ÛıÂÓ‹˜, ·Ó Î·È ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfiÔ˘ ÁÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ·Ó¤Ù˘ÍÂ‹È· ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÁ¤ÓÓËÛË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›·˜ Ê¿ÛË˜ÙË˜ ÓfiÛÔ˘ ÙÔ˘ Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·ÓÂ˘-ÛÙÈÎfi ‹Ù·Ó Ù· ÂÈÎÚ·ÙÔ‡ÓÙ·. ∏ ˘ÔÁÏ˘Î·ÈÌ›·, ·ÓÎ·È ¤Î‰ËÏË ÛÂ Ì›· ÌfiÓÔ Ê¿ÛË ÙË˜ ÔÚÂ›·˜ ÙË˜ Ófi-ÛÔ˘, ‰ÂÓ ÚÔÂÍ‹Ú¯Â ˆ˜ Â‡ÚËÌ·. ∆Ô ÚÔÂÍ¿Ú¯ÔÓÂÚÁ·ÛÙËÚÈ·Îfi Â‡ÚËÌ· ‹Ù·Ó Ë ˘ÔÓ·ÙÚÈ·ÈÌ›·,ÂÍ·ÈÙ›·˜ ÙË˜ ·ÒÏÂÈ·˜ ¿Ï·ÙÔ˜. ∂›ÛË˜, ¯·Ú·ÎÙË-ÚÈÛÙÈÎ‹ ‹Ù·Ó Ë ˘¤Ú¯ÚˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ™ÙË ‚È-‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÎÚ˘-„ÔÚ¯›·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘ÔÁÔÓ·‰ÔÙÚÔÈÎfi ˘Ô-ÁÔÓ·‰ÈÛÌfi (10), ·ÏÏ¿ Ô ·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ÂÚ›ÙˆÛË˜ ‰ÂÓ ·ÚÔ˘Û›·˙Â ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ˘˜fiÚ¯ÂÈ˜. O ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ›ÎÙÂÚÔ˜ ‹Ù·Ó Â›ÛË˜¤Ó· ·fi Ù· ¿Ù˘· Û˘ÌÙÒÌ·Ù·.

∏ Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÚ›ÙˆÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·ÈÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÙÔÓÈÛÙÂ› Ë ·Ó·ÁÎ·ÈfiÙËÙ· ¿ÌÂÛË˜¤Ó·ÚÍË˜ ıÂÚ·Â›·˜ ÌÂ ˘‰ÚÔÎÔÚÙÈ˙fiÓË ÛÂ ˘Ô„›·Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ, ¯ˆÚ›˜Ó· ·Ó·Ì¤ÓÂÙ·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÔÚÌÔÓÔÏÔÁÈ-ÎÔ‡ ÂÏ¤Á¯Ô˘ Ô˘ ı· ÂÈ‚Â‚·ÈÒÛÂÈ ÙË ‰È¿ÁÓˆÛË.O Û˘ÓÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ‹Ù·Ó ÂÍ·ÈÚÂÙÈ-Î¿ ‚Ú·¯‡˜, ·ÊÔ‡ Ë ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÂÏ¤Á¯Ô˘Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 5 ËÌÂ-ÚÒÓ Î·È Ë ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ ÌÂ ACTH ¤ÁÈÓÂ

¶·È‰È·ÙÚÈÎ‹ 2005;68:150-153


153™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ ÛÂ ÓÂÔÁÓfi ÌÂ ÔÍÂ›· ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·

¶·È‰È·ÙÚÈÎ‹ 2005;68:150-153

¤ÁÎ·ÈÚ· ÛÙË Ê¿ÛË ·‰˘Ó·Ì›·˜ ·ÔÎ·Ù¿ÛÙ·ÛË˜ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ¤¯ÔÓÙ·˜ ·Ô-ÎÏÂ›ÛÂÈ ¿ÏÏ· ÓÔÛ‹Ì·Ù·.


1. Cole DE, Clarke LA, Riddell DC, Samson KA, Seltzer WK,Salisbury S. Congenital adrenal hypoplasia, Duchennemuscular dystrophy, and glycerol kinase deficiency: im-portance of laboratory investigations in delineating a con-tiguous gene deletion syndrome. Clin Chem 1994;40:2099-2103.

2. McCabe ER, Towbin J, Chamberlain J, Baumbach L,Witkowski J, van Ommen GL et al. Complementary DNAprobes for the Duchenne muscular dystrophy locus demon-strate a previously undetectable deletion in a patient withdystrophic myopathy, glycerol kinase deficiency, and con-genital adrenal hypoplasia. J Clin Invest 1989;83:95-99.

3. Ferey S, Merzoug V, Linglart A, Chaussain JL, Kalifa G. Apeculiar form of neonatal adrenal insufficiency: the IMAGeassociation. Two new cases. J Radiol 2003;84:323-325.

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5. Tabarin A. Congenital adrenal hypoplasia and DAX-1 genemutations. Ann Endocrinol 2001;62:202-206.

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154 CASE REPORT

1 Department ofNeonatology, "Alexandra"University Hospital, Athens

2 Department ofEnzymology and CellularFunction, Institute of ChildHealth, "Aghia Sophia"Children’s Hospital, Athens

Correspondence:Maria Dasopoulou 11 Papadiamantopoulou str., 115 28, Ilissia, Athens E-mail: [email protected]



Congenital adrenal hypoplasia presenting assevere respiratory failure. Case report M. Dasopoulou1, M. Apostolou1, G. Baroutis1, H. Michelakakis2, E. Loukatou1, C. Costalos1

AbstractCongenital adrenal hypoplasia is a rare condition, which occurs with an incidence of approximately 1 in12,500 live births, usually presenting with hypoglycaemic convulsions, vomiting, failure to thrive or evencollapse in early life. Links between early adrenal insufficiency and adverse respiratory outcome or evenbronchopulmonary dysplasia in very low birth weight neonates have also been described. Respiratoryproblems in the early postnatal period are a rare manifestation of congenital adrenal hypoplasia and couldbe fatal unless early diagnosis is established, followed by prompt treatment. Aggressive treatment withcorticosteroids should start immediately because of the unpredictable outcome of such a serious condition.

Key wordsCongenital adrenal hypoplasia, newborn, respiratory distress.


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∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿ ™. ∞ÓÙˆÓÈ¿‰Ë˜

¶ÂÚ›ÏË„ËO ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ·ÔÙÂÏÂ› ¤Ó· ·fi Ù· ÛÔ‚·ÚfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ™ÙË Û˘ÓÙÚÈ-ÙÈÎ‹ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ, Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È Î·Ú‰ÈÔÏÔÁÈÎ‹. ∆· ÂÚÈÛÙ·ÙÈÎ¿ ÌÔÚÂ› Ó· Â›Ó·È‰È·ÁÓˆÛÌ¤ÓÂ˜ ‹ ÌË Î·È ¯ÂÈÚÔ˘ÚÁËÌ¤ÓÂ˜ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ ÌÂ ÔÛÔÛÙ¿ ı·Ó¿ÙÔ˘ È‰È·›ÙÂÚ· ·˘ÍË-Ì¤Ó·. ™Â fiÛÔ˘˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ‰‡ÛÎÔÏ·, Ô ı¿Ó·ÙÔ˜ Û˘¯ÓfiÙÂÚ· Û˘Ì‚·›ÓÂÈÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¿ıÏËÛË˜ ‹ ‚·ÚÈ¿˜ ÛˆÌ·ÙÈÎ‹˜ ÎfiˆÛË˜. OÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ - Î·È Î˘Ú›ˆ˜ Ë ˘ÂÚ-ÙÚÔÊÈÎ‹ - ·ÔÙÂÏÔ‡Ó Ì›· È‰È·›ÙÂÚ· ÂÈÎ›Ó‰˘ÓË Î·ÙËÁÔÚ›·, ÂÓÒ ÔÈ Â›ÎÙËÙÂ˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ ·ÔÙÂÏÔ‡ÓÂ›ÛË˜ ¤Ó· ÛËÌ·ÓÙÈÎfi ÙÌ‹Ì· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ∂ÎÙfi˜, fiÌˆ˜, ·fi ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ·˘Ù¤˜, ÛÂ Î¿ıÂ ÂÚ›-ÙˆÛË ÔÈ ·ÚÚ˘ıÌ›Â˜ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· Ô˘ ÚÔÎ·ÏÂ› ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜.∞ÎfiÌË Î·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜ (Î·È ÌÂÙ¿ ÙË ÓÂÎÚÔÙÔÌÈÎ‹ ÂÍ¤Ù·-ÛË), ıÂˆÚÂ›Ù·È fiÙÈ ÔÈ ·ÚÚ˘ıÌ›Â˜ ·›˙Ô˘Ó Î˘Ú›·Ú¯Ô ÚfiÏÔ. ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Ù·ÎÙÈÎ‹ ·-Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË ıÂÚ·Â›· ÙˆÓ ÁÓˆÛÙÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ·ÏÏ¿ Î˘Ú›ˆ˜ ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô. ¶Ú¤-ÂÈ ··Ú·ÈÙ‹Ùˆ˜ Ó· ÂÏ¤Á¯ÂÙ·È Î¿ıÂ ·È‰› Ô˘ ı· ·Û¯ÔÏËıÂ› ÌÂ ÙÔÓ ·ıÏËÙÈÛÌfi-ÚˆÙ·ıÏËÙÈÛÌfi, Î·ıÒ˜Î·È Î¿ıÂ ÂÚ›ÙˆÛË ÛÙËÓ ÔÔ›· Ô ·È‰›·ÙÚÔ˜ ‰È·ÈÛÙÒÓÂÈ Î¿ÙÈ ‡ÔÙÔ (Ê‡ÛËÌ·, Èı·Ó‹ ‰È·Ù·Ú·¯‹Ú˘ıÌÔ‡) ‹ ·Ó·Ê¤ÚÂÙ·È - ·fi ÙÔ ·È‰› ‹ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ - Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ‹ Û˘Ì‚¿ÓÙ· fiˆ˜ ÏÈ-Ôı˘Ì›·, ÚÔÎ¿Ú‰È· ¿ÏÁË Î.Ï. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÓˆÛÙ‹˜ ¿ıËÛË˜ ‹ ‡·ÚÍË˜ ·ÈÊÓ›‰ÈÔ˘ ı·-Ó¿ÙÔ˘ Ï·Ì‚¿ÓÂÙ·È, Â›ÛË˜, ÛÔ‚·Ú¿ ˘’ fi„ÈÓ. ∏ ˘ÔÁÚ·Ê‹ ÈÛÙÔÔÈËÙÈÎÔ‡ ÁÈ· ¿ıÏËÛË, ·ÏÏ¿ Î·È Î¿ıÂ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ·fi ·È‰ÔÎ·Ú‰ÈÔÏfiÁÔ, ÌÂ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙˆÓ ··Ú·›ÙËÙˆÓ ÂÍÂÙ¿ÛÂˆÓ,fiˆ˜ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·, ¤Á¯ÚˆÌÔ Doppler (Triplex), Èı·Ófi 24ˆÚÔ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·(Holter) Î·È fi,ÙÈ ¿ÏÏÔ ÎÚÈıÂ› fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È. ∏ ¤Î‰ÔÛË ÈÛÙÔÔÈËÙÈÎÒÓ Î·È Ë Èı·Ó‹ ‰È¿ÁÓˆÛË ·fi ÌËÂÈ‰ÈÎÔ‡˜ ÎÚ›ÓÂÙ·È È‰È·›ÙÂÚ· ÂÈÎ›Ó‰˘ÓË. ¶ÚÔÛˆÚÈÓ¿, Ô ¤ÏÂÁ¯Ô˜ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ıÂˆÚÂ›Ù·È ··-Ú·›ÙËÙÔ˜. øÛÙfiÛÔ, Ë Èı·ÓfiÙËÙ· Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙË˜ ¯ÚËÛÈÌfiÙËÙ¿˜ ÙÔ˘ ı· ÂÍ·ÚÙËıÔ‡Ó ·fi Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù· ÙˆÓ ÌÂÁ¿ÏˆÓ ÚÔÔÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÂÍ¤ÏÈÍË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿¶·È‰È¿, ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, Î·Ú‰ÈÔÏÔÁÈÎfi Úfi‚ÏËÌ·, ¤ÏÂÁ¯Ô˜, ÚfiÏË„Ë.

∂ÈÛ·ÁˆÁ‹

∫¿ıÂ ¯ÚfiÓÔ ¤Ó·˜ fi¯È Â˘Î·Ù·ÊÚfiÓËÙÔ˜ ·ÚÈı-

Ìfi˜ ·È‰ÈÒÓ Âı·›ÓÔ˘Ó ÛÙË ¯ÒÚ· Ì·˜ Î˘Ú›ˆ˜ Î·-

Ù¿ ÙË ‰È¿ÚÎÂÈ· ¿ıÏËÛË˜, ·ÏÏ¿ Î·È ÛÂ ËÚÂÌ›·. ™ÙË

ÛËÌÂÚÈÓ‹ ÂÔ¯‹, ÌÂ ÙË ÁÂÓÈÎfiÙÂÚË ¤ÌÊ·ÛË Ô˘

¤¯ÂÈ ‰ÔıÂ› ÛÙÔÓ ·ıÏËÙÈÛÌfi, Ë ·Ó·ÛÎfiËÛË ÙÔ˘

Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ı¤Ì·ÙÔ˜ Î·È Ë ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ·È-

Ù›ˆÓ ›Ûˆ˜ Â›Ó·È Â›Î·ÈÚË ÂÚÈÛÛfiÙÂÚÔ ·fi Î¿ıÂ

¿ÏÏË ÊÔÚ¿.

™˘¯ÓfiÙËÙ·

O ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ‰ÂÓ

Â›Ó·È È‰È·›ÙÂÚ· Û˘¯Ófi˜. ¶·Ú’ fiÏ· ·˘Ù¿, ÔÛÔÛÙfi

10% ÙˆÓ ı·Ó¿ÙˆÓ ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜

Â›Ó·È ·ÈÊÓ›‰ÈÔÈ. OÈ ÌÈÛÔ› ·fi ·˘ÙÔ‡˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ

ÚÔËÁÔ˘Ì¤Óˆ˜ ÁÓˆÛÙ¿ ·›ÙÈ·, Î˘Ú›ˆ˜ Î·Ú‰ÈÔ¿ıÂÈ-

Â˜. ∂›ÛË˜, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ Î·Ù·Ù¿ÛÛÂÙ·È

ÛÂ ı·Ó¿ÙÔ˘˜ ¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜ ÏfiÁˆ ·Ô˘Û›·˜Â˘ÚËÌ¿ÙˆÓ ÛÙË ÓÂÎÚÔ„›·. ∂¿Ó, fiÌˆ˜, ÏËÊıÂ› ˘’fi„ÈÓ fiÙÈ Ë ·ÚÚ˘ıÌ›· ‰ÂÓ ·Ê‹ÓÂÈ ÓÂÎÚÔÙÔÌÈÎ¿ ÛË-Ì¿‰È·, ÂÓÒ ·ÔÙÂÏÂ› Ì›· ·fi ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ·ÈÙ›Â˜,Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ Ë Î·Ú‰ÈÔÏÔÁÈÎ‹ ·ÈÙÈÔÏÔÁ›··˘Í¿ÓÂÙ·È Î·Ù·ÎfiÚ˘Ê· Û·Ó Èı·ÓfiÙËÙ· (1-4).

∞›ÙÈ·

∂ÂÈ‰‹, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ù· Î·Ú‰ÈÔÏÔ-ÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ Î˘ÚÈfiÙÂÚË Î·ÈÛ˘¯ÓfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿,ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‰›ÓÂÙ·È È‰È·›ÙÂÚË ¤ÌÊ·ÛËÛÙÔ Ê¿ÛÌ· ÙˆÓ ·ı‹ÛÂˆÓ Ô˘ ÌÔÚÂ› Ó· ·ÔÙÂ-Ï¤ÛÔ˘Ó ·›ÙÈÔ ÚfiÎÏËÛË˜.

π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ, Â›ÛË˜, Ë ËÏÈÎ›·. ™Ù·ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË, ÔÈ ·ı‹ÛÂÈ˜ ÙÔ˘ Î˘ÎÏÔÊÔ-ÚÈÎÔ‡ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·, fiÌˆ˜ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ ˘ÔÛÎÂÏ›˙Ô-ÓÙ·È ·fi ÙÈ˜ ÔÏ‡ Û˘¯ÓfiÙÂÚÂ˜ ÏÔÈÌÒÍÂÈ˜ ‹ ·ÎfiÌ·


156 ™. ∞ÓÙˆÓÈ¿‰Ë˜

Î·È ·fi ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆ-ÛÙÂ› Â·ÚÎÒ˜. ªÂÙ¿ ·fi ·˘Ù¤˜ ÙÈ˜ ËÏÈÎ›Â˜, ÔÈÎ·Ú‰ÈÔ¿ıÂÈÂ˜ Î·Ù¤¯Ô˘Ó ÙËÓ ÚÒÙË ı¤ÛË (5,6).

∞Ú¯ÈÎ¿, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ‰È¿ÎÚÈÛË ÛÂ ¤ÓÙÂ‚·ÛÈÎ¤˜ Î·ÙËÁÔÚ›Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÔÚÂ› Ó··Ô‚ÈÒÛÔ˘Ó ·ÈÊÓ›‰È· ·fi Î·Ú‰ÈÔÏÔÁÈÎ¿ ·›ÙÈ·: ·)ÂÎÂ›Ó· Ô˘ ¤¯Ô˘Ó Î·Ú‰ÈÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·È‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙÂ›, ‚) ·È‰È¿ ÌÂ ÌË ¯ÂÈÚÔ˘Ú-ÁËÌ¤ÓË Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ·, Á) ·È‰È¿ ÌÂ ¯ÂÈ-ÚÔ˘ÚÁËÌ¤ÓË Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ·, ‰) ·È‰È¿ ÌÂÌ˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ Î·È Â) ·È‰È¿ ÌÂ ·ÚÚ˘ıÌ›Â˜.

¶·È‰È¿ ÌÂ ·‰È¿ÁÓˆÛÙÔ Î·Ú‰ÈÔÏÔÁÈÎfi Úfi‚ÏËÌ·

O ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ·˘Ù‹ÙËÓ Î·ÙËÁÔÚ›· ‰È·ÚÎÒ˜ ÌÂÈÒÓÂÙ·È ÏfiÁˆ ÙË˜ ÛË-Ì·Û›·˜ Ô˘ ‰›ÓÂÙ·È ·fi ÙË Û‡Á¯ÚÔÓË ·È‰È·ÙÚÈÎ‹ÛÙËÓ ÚfiÏË„Ë, ÙˆÓ ˘Ô¯ÚÂˆÙÈÎÒÓ ÚÔÏËÙÈÎÒÓÂÏ¤Á¯ˆÓ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ (Ú¿ÛÈÓÔ ¯·Ú-Ù›), ·ÏÏ¿ Î·È ÏfiÁˆ ÙË˜ ··›ÙËÛË˜ ·fi ÔÏÏ¿·ıÏËÙÈÎ¿ ÛˆÌ·ÙÂ›· Î·È Û˘ÏÏfiÁÔ˘˜ ÁÈ· ÚÔÛÎfiÌÈ-ÛË ÈÛÙÔÔÈËÙÈÎÒÓ ·fi ·È‰ÔÎ·Ú‰ÈÔÏfiÁÔ. ∂›Ó·ÈÁÂÁÔÓfi˜ fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌÂ ÙËÓ Â˘·ÈÛıË-ÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Ê˘-ÛËÌ¿ÙˆÓ - ·ÎfiÌË Î·È ·˘ÙÒÓ Ô˘ Ê·›ÓÔÓÙ·È ·ıÒ·- ·ÏÏ¿ Î·È ÌÂ ÙÔÓ ¤ÏÂÁ¯Ô Î¿ıÂ ·ıÏËÙ‹ ‹ ÌÂÏÏÔ-ÓÙÈÎÔ‡ ÚˆÙ·ıÏËÙ‹, Ù· Ú¿ÁÌ·Ù· ¤¯Ô˘Ó Û·ÊÒ˜‚ÂÏÙÈˆıÂ› (7-9). ∏ ˘Â˘ı˘ÓfiÙËÙ· ÙˆÓ Á˘ÌÓ·-ÛÙÒÓ-ÚÔÔÓËÙÒÓ ·›˙ÂÈ, Â›ÛË˜, ÛËÌ·ÓÙÈÎfi Úfi-ÏÔ. ∆¤ÏÔ˜, ·ÎfiÌË Î·È ÔÈ ›‰ÈÔÈ ÔÈ ÁÔÓÂ›˜, ÛÂ ÛËÌ·-ÓÙÈÎfi ÔÛÔÛÙfi Ï¤ÔÓ, ¤¯Ô˘Ó ·ÔÎÙ‹ÛÂÈ ÙËÓ Â-Ô›ıËÛË ÙÔ˘ ··Ú·›ÙËÙÔ˘ ÂÏ¤Á¯Ô˘ ·fi ÂÈ‰ÈÎfiÚÈÓ È¤ÛÔ˘Ó ÙÔ ·È‰› ÙÔ˘˜ ÁÈ· ·ıÏ‹Ì·Ù· Î·È ÂÈ-‰fiÛÂÈ˜ (10,11). º˘ÛÈÎ¿, Ë ÂÎÙ¤ÏÂÛË ÙˆÓ ÂÍÂÙ¿ÛÂ-ˆÓ ·fi ÂÈ‰ÈÎÔ‡˜ ıÂˆÚÂ›Ù·È “ÂÎ ÙˆÓ ˆÓ Ô˘Î ¿ÓÂ˘”.

OÈ Î˘ÚÈfiÙÂÚÂ˜ ·ı‹ÛÂÈ˜ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ·˘Ù‹ÙËÓ Î·ÙËÁÔÚ›· Â›Ó·È ÔÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ Î·È ÔÈÚˆÙÔ·ıÂ›˜ ·ÚÚ˘ıÌ›Â˜, Ô˘ ÂÂÈ‰‹ Û˘Ó‹ıˆ˜ ‰ÂÓ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·, ·ÔÙÂÏÔ‡Ó ·-Á›‰· ÁÈ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜. ÕÏÏË Û˘¯Ó‹ ·ÈÙ›· Â›Ó·ÈË ÛÙ¤ÓˆÛË ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈ-Ï›·˜ (‚·Ï‚È‰ÈÎ‹, ˘Ô- ˘ÂÚ-‚·Ï‚È‰ÈÎ‹ ÛÙ¤ÓˆÛËÙË˜ ·ÔÚÙ‹˜, Û‡Ó‰ÚÔÌÔ Williams), Ô˘ ÛÂ ÔÚÈÛÌ¤Ó·ÂÚÈÛÙ·ÙÈÎ¿ ÌÔÚÂ› Ó· ‰È·Ê‡ÁÂÈ. ∆¤ÏÔ˜, ÔÈ ·ÓˆÌ·-Ï›Â˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Â›Ó·È ÌÂÓ Û¿ÓÈÂ˜, ·ÏÏ¿ Ô-Ï‡ ÂÈÎ›Ó‰˘ÓÂ˜, fiÌˆ˜ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ Â›Ó·È ‰‡-ÛÎÔÏË Î·È Û˘¯Ó¿ ·ÔÙÂÏÔ‡Ó ÓÂÎÚÔÙÔÌÈÎfi Â‡ÚËÌ·.

¶·È‰È¿ ÌÂ ÌË ¯ÂÈÚÔ˘ÚÁËÌ¤ÓË Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ·

∏ Èı·ÓfiÙËÙ· ı·Ó¿ÙÔ˘ ÛÂ ·È‰› ÌÂ ÁÓˆÛÙ‹Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ·, Ô˘ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·-ÎÙÈÎ¿ ·fi ·È‰ÔÎ·Ú‰ÈÔÏfiÁÔ, Â›Ó·È ÌÈÎÚ‹. ¶·Ú’fiÏ· ·˘Ù¿, ˘¿Ú¯ÂÈ ¤Ó·˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ô˘ Â-ı·›ÓÔ˘Ó Â›ÙÂ ÁÈ·Ù› ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Ó ÈÛÙ¿ ÙÈ˜ Ô‰Ë-Á›Â˜ ÙÔ˘ ÁÈ·ÙÚÔ‡, Î˘Ú›ˆ˜ ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÙËÓ Îfiˆ-

ÛË, ¿ıÏËÛË Î.Ï., Â›ÙÂ ÁÈ·Ù› ·ÌÂÏÔ‡Ó ÙËÓ Ù·ÎÙÈÎ‹·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜. °È· Ù· ·Ú·¿Óˆ Û˘¯Ó¿Â˘ı‡ÓÂÙ·È Ë „˘¯ÔÏÔÁ›·, Î˘Ú›ˆ˜ ÙˆÓ ÂÊ‹‚ˆÓ ‹ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ÛÂ ËÏÈÎ›· ·ÛıÂÓÒÓ, ·ÏÏ¿ Î·È ËÎÔ‡Ú·ÛË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Ù· ÚÔ‚Ï‹Ì·Ù· ·fi-ÛÙ·ÛË˜, Ë ÂÈÏÔÁ‹ ÌË Î·Ù¿ÏÏËÏˆÓ ÁÈ·ÙÚÒÓ ‹·ÎfiÌ· Î·È Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÎÔÈÓˆÓÈÎ¤˜, ÔÈÎÔÓÔÌÈ-Î¤˜ Î·È ÔÈÎÔÁÂÓÂÈ·Î¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜. ∏ ·Ú·Ì¤ÏË-ÛË ‹ Ë ÌË Ù·ÎÙÈÎ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È Ë ·ÚÔ-ı˘Ì›· ÁÈ· Î¿ÔÈ· ÂÍ¤Ù·ÛË (.¯. ·ÈÌÔ‰˘Ó·ÌÈÎ‹ ÌÂ-Ï¤ÙË) ÏfiÁˆ Êfi‚Ô˘, ÌÔÚÂ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘ÓÂÈÚfiÛıÂÙ· ÚÔ‚Ï‹Ì·Ù· (12).

¶·È‰È¿ ÌÂ ¯ÂÈÚÔ˘ÚÁËÌ¤ÓË Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ·

™‹ÌÂÚ·, Ô˘ Ë Û˘ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›· ÙˆÓÛ˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ ÌÔÚÂ› Ó· ·ÓÙÈÌÂÙˆÈ-ÛÙÂ› ÂÂÌ‚·ÙÈÎ¿ ‹ ¯ÂÈÚÔ˘ÚÁÈÎ¿, Ô ·ÚÈıÌfi˜ ÙˆÓ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›·ÔÏÔ¤Ó· Î·È ·˘Í¿ÓÂÙ·È.

∂›Ó·È Ê˘ÛÈÎ¿ Â˘ÓfiËÙÔ fiÙÈ fiÛÔ ÈÔ Û‡ÌÏÔÎËÂ›Ó·È Ë ¿ıËÛË Î·È fiÛÔ ÈÔ ÌÈÎÚ‹ Â›Ó·È Ë ËÏÈÎ›·ÙÔ˘ ·ÛıÂÓ‹ Î·Ù¿ ÙËÓ Â¤Ì‚·ÛË ÙfiÛÔ ÂÚÈÛÛfiÙÂ-Ú· Â›Ó·È Ù· ÚÔ‚Ï‹Ì·Ù·. ∆Ô Â›Â‰Ô ÙË˜ ·È‰Ô-Î·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ Î·È Ô ‚·ıÌfi˜ ÂÈÙ˘¯›·˜ ÙˆÓÂÂÌ‚¿ÛÂˆÓ ÛÙËÓ ÂÎ¿ÛÙÔÙÂ ¯ÒÚ· ·ÔÙÂÏÔ‡ÓÂÈÚfiÛıÂÙÔ ·Ú¿ÁÔÓÙ·. ∂›ÛË˜, Ú¤ÂÈ ¿ÓÙ·Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ·ÚÎÂ› Ë ·Ó·ÙÔÌÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË, ·ÏÏ¿ ¤¯Ô˘Ó¿Ú· ÔÏ‡ ÌÂÁ¿ÏË ÛËÌ·Û›· Î·È ÔÈ Èı·Ó¤˜ ‚Ï¿-‚Â˜ Ô˘ ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËıÂ› ‹ ÔÈ ÌÈÎÚÔÏÂÙÔÌ¤-ÚÂÈÂ˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó Ú˘ıÌÈÛÙÂ› ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚË‰˘Ó·Ù‹ ·ÎÚ›‚ÂÈ·, ÔÈ ÂÈÙÒÛÂÈ˜ ÙˆÓ ÔÔ›ˆÓ ı·Ê·ÓÔ‡Ó ÌÂ ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘.

∏ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ· ¯ÂÈ-ÚÔ˘ÚÁËÌ¤Ó· ·È‰È¿, Ô˘ ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ· Î·ÈÙËÓ ÔÌ¿‰· ˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È ÔÈ ÌÂÙÂÁ-¯ÂÈÚËÙÈÎ¤˜ ·ÚÚ˘ıÌ›Â˜ (13), ÔÈ ÔÔ›Â˜ Â›Ó·È ‰˘Ó·-ÙfiÓ Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÌÂÙ¿ ·fi Ï›Á· ‹ ÂÚÈÛÛfi-ÙÂÚ· ¯ÚfiÓÈ· (ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹). OÈ ·ÚÚ˘ıÌ›Â˜·˘Ù¤˜ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ·ÈÊÓ›‰È· Î·È Ó·ÚÔÎ·Ï¤ÛÔ˘Ó ÙÔÓ ı¿Ó·ÙÔ, ·ÏÏ¿ Ô ı¿Ó·ÙÔ˜ ÌÔÚÂ›Ó· Û˘Ì‚Â› ·ÎfiÌ· Î·È ÛÂ ·È‰È¿ ‹ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈ-ÎÂ˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÌÂ ÂÈÌ¤ÏÂÈ·. ∞ÈÙ›··ÔÙÂÏÂ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·ÚÚ˘ıÌ›Â˜ ·˘Ù¤˜ ·ÓÙÈ-ÌÂÙˆ›˙ÔÓÙ·È ÔÏ‡ ‰‡ÛÎÔÏ· ÌÂ Ù· ·ÓÙÈ·ÚÚ˘ıÌÈ-Î¿ Ê¿ÚÌ·Î·, ·Ú’ fiÏÂ˜ ÙÈ˜ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ÂÓ·ÏÏ·-Á¤˜ ‹ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜.

OÈ Î˘ÚÈfiÙÂÚÂ˜ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ Ô˘‰ËÌÈÔ˘ÚÁÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Â›Ó·È: ·)Ë ÙÂÙÚ·ÏÔÁ›· Fallot, ÛÙËÓ ÔÔ›· - fiˆ˜ Ê·›ÓÂÙ·È -¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· Ë ·ÏÈÓ‰ÚfiÌËÛË ÛÙËÓÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›· Î·È ÔÈ ÂÈÙÒÛÂÈ˜ ÙË˜ ÛÙË ‰Â-ÍÈ¿ ÎÔÈÏ›· (14), ‚) Ë ÌÂÙ¿ıÂÛË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁÂ›-ˆÓ, Î˘Ú›ˆ˜ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ¤¯ÂÈ Á›ÓÂÈ ËÂ¤Ì‚·ÛË Senning ‹ Mustard, fiˆ˜ Û˘ÓËıÈ˙fiÙ·Ó

¶·È‰È·ÙÚÈÎ‹ 2005;68:155-160


157∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿

·Ï·ÈfiÙÂÚ· (ÏÈÁfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓÂ›˜ÌÂÙ¿ ÙËÓ ·Ú¤ÏÂ˘ÛË Ì›·˜ ÂÓÙ·ÂÙ›·˜ ¤¯Ô˘Ó Ê˘-ÛÈÔÏÔÁÈÎfi Ú˘ıÌfi) (15) Î·È Á) Ë ÌÔÓ‹ÚË˜ ÎÔÈÏ›· ÌÂ-Ù¿ ·fi ÂÁ¯Â›ÚËÛË Fontan (16). OÈ ·ı‹ÛÂÈ˜ ÙË˜·ÔÚÙÈÎ‹˜ ‚·Ï‚›‰·˜, Ë ÈÛıÌÈÎ‹ ÛÙ¤ÓˆÛË ÙË˜ ·ÔÚ-Ù‹˜, Ë ·ÙÚËÛ›· ÓÂ˘ÌÔÓÈÎ‹˜ ‚·Ï‚›‰·˜, Ë ‰ÈÏÔ¤-ÍÔ‰Ë ‰ÂÍÈ¿ ÎÔÈÏ›·, Ë ‰ÈÔÚıˆÌ¤ÓË ÌÂÙ¿ıÂÛË ÙˆÓÌÂÁ¿ÏˆÓ ·ÁÁÂ›ˆÓ, Ë ·ÓˆÌ·Ï›· Ebstein ·ÏÏ¿ Î·È ¿Ï-ÏÂ˜ Û·ÓÈfiÙÂÚÂ˜ ·ı‹ÛÂÈ˜ Ê·›ÓÂÙ·È fiÙÈ ‰ËÌÈÔ˘Ú-ÁÔ‡Ó ÛËÌ·ÓÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓÔÔ›ˆÓ ı· Ê·ÓÂ› ÛÂ ÂÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ‰ÈÂ-ÚÂ˘ÓÔ‡Ó ·˘Ùfi ÙÔ ı¤Ì·, ÙfiÛÔ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·fiÛÔ Î·È ÛÙÔ˘˜ ÓÂ·ÚÔ‡˜ ‹ ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÂÓ‹ÏÈÎÂ˜.

ª˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜ ªÂÙ·Í‡ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ Ì˘ÔÎ·Ú‰ÈÔ¿-

ıÂÈ·˜ ÛÙÔ ı¤Ì· ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, Î˘Ú›·Ú¯ÔÚfiÏÔ ¤¯ÂÈ Ë ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· (17-21). ™ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ı·Ó¿-ÙˆÓ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ÌÂÁ¿ÏÔ, ·˘Í¿ÓÂÙ·È fiÌˆ˜ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ∏ ÂÌÊ¿ÓÈÛË Û˘ÁÎÔ-ÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÔÈ ÎÔÈÏÈ·Î¤˜ ·ÚÚ˘ıÌ›Â˜ Î·ıÒ˜Î·È Ë ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ÎÔÈÏ›·˜ ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙÂ˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡-ÓÔ˘. ∆· ·È‰È¿ Û˘Ó‹ıˆ˜ Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎ¿,ÂÓÒ Ô ÌÂÁ¿ÏÔ˜ Î›Ó‰˘ÓÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ¿ıÏËÛË˜, Á˘ÌÓ·ÛÙÈÎ‹˜ ‹ È‰È·›ÙÂÚË˜ Îfi-ˆÛË˜ (22). ™Â ÂÚÈÙÒÛÂÈ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ËÙÔÔı¤ÙËÛË ·˘ÙfiÌ·ÙˆÓ ·ÈÓÈ‰ˆÙÒÓ Ê·›ÓÂÙ·È fiÙÈ¤¯ÂÈ Ù· Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù·. ™Â Î¿ıÂ ÎÏÈÓÈÎ‹‹ ÓÂÎÚÔÙÔÌÈÎ‹ ‰È¿ÁÓˆÛË ˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú-‰ÈÔ¿ıÂÈ·˜ ı· Ú¤ÂÈ Ó· ÂÏ¤Á¯ÔÓÙ·È Î·È Ù· ˘fi-ÏÔÈ· Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÏfiÁˆ ÎÏËÚÔÓÔÌÈÎfi-ÙËÙ·˜ ÙË˜ ÓfiÛÔ˘, ·Ú’ fiÏÔ Ô˘ ÌÔÚÂ› Ë ÂÚ›-ÙˆÛË Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ¿ÏÏ·ÍË Î·È Ó· ÌËÓ ‚ÚÂ-ıÂ› ¿ÏÏÔ Ì¤ÏÔ˜ Ô˘ ¿Û¯ÂÈ (23,24).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ¿ÏÏÂ˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜,ÛÙË ‰È·Ù·ÙÈÎ‹ Ô ı¿Ó·ÙÔ˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È ·ÈÊ-Ó›‰ÈÔ˜ (25-32). ∏ Û˘ÌÊÔÚËÙÈÎ‹ Â›Ó·È Û¿ÓÈ· ÛÙ··È‰È¿, ÂÓÒ ÔÈ ¿ÏÏÂ˜ ÌÔÚÊ¤˜, fiˆ˜ Ë ·ÚÚ˘ıÌÈÔ-ÁfiÓÔ˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ‹ ÙÔÌË Û˘Ì·Á¤˜ Ì˘ÔÎ¿Ú‰ÈÔ, Â›Ó·È ·ÎfiÌ· Û·ÓÈfiÙÂ-ÚÂ˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î˘Ú›ˆ˜ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ (33-36).

∆¤ÏÔ˜, Ë Ì˘ÔÎ·Ú‰›ÙÈ‰·, ·fi ÙËÓ ÔÔ›· ÌÔÚÂ›Ó· ÚÔÛ‚ÏËıÂ› ¤Ó· ·È‰› ÌÂ ÚÔËÁÔ˘Ì¤Óˆ˜ ˘ÁÈ‹Î·Ú‰È¿, ÌÔÚÂ› Â›ÛË˜ Ó· ·ÔÙÂÏ¤ÛÂÈ ·ÈÙ›· ·ÈÊÓ›-‰ÈÔ˘ ı·Ó¿ÙÔ˘ Î˘Ú›ˆ˜ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÚ˘ı-ÌÈÒÓ, ÔÈ ÔÔ›Â˜ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·ÈÚÔÛÂÎÙÈÎ¿ Î·È Ù·ÎÙÈÎ¿, ÌÂ ÙÔÔı¤ÙËÛË 24ˆÚÔ˘ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ·Ê‹Ì·ÙÔ˜ (Holter) Î·È ¿ÏÏÂ˜ÌÂıfi‰Ô˘˜ (37-39).

∞ÚÚ˘ıÌ›Â˜ ∞ÔÙÂÏÔ‡Ó Ì›· ·fi ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ·ÈÙ›Â˜ ·ÈÊ-

Ó›‰ÈÔ˘ ı·Ó¿ÙÔ˘. º·›ÓÂÙ·È fiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›·

ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfiÎ·È ¯ˆÚ›˜ ÓÂÎÚÔÙÔÌÈÎ¿ Â˘Ú‹Ì·Ù·, Ô ı¿Ó·ÙÔ˜ÔÊÂ›ÏÂÙ·È ÛÂ ·ÚÚ˘ıÌ›· (40). ∂ÎÙfi˜ ·fi ÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ ÌÂ Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ· Î·È ¯ÂÈÚÔ˘ÚÁÈ-Î¤˜ ‹ ¿ÏÏÂ˜ ÂÂÌ‚¿ÛÂÈ˜, ÔÈ ·‰È¿ÁÓˆÛÙÂ˜ ÔÏÏ¤˜ÊÔÚ¤˜, ÚˆÙÔ·ıÂ›˜ ·ÚÚ˘ıÌ›Â˜ ÌÔÚÂ› Ó· ‰ËÌÈ-Ô˘ÚÁ‹ÛÔ˘Ó ÔÏ‡ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (41-44).

∞fi ÙÈ˜ ÚˆÙÔ·ıÂ›˜ ·ÚÚ˘ıÌ›Â˜, ÔÈ Û˘¯ÓfiÙÂ-ÚÂ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È ·˘Ù¤˜ Ô˘ ÔÊÂ›ÏÔ-ÓÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Wolff-Parkinson-White(WPW). øÛÙfiÛÔ, ·Ú¿ ÙËÓ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·,Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ Û¿ÓÈ· Î·È ÔÊÂ›-ÏÂÙ·È Î˘Ú›ˆ˜ ÛÂ ÎÔÈÏÈ·Î‹ Ì·ÚÌ·Ú˘Á‹ (45,46). ™ÂÂÚÈÛÙ·ÙÈÎ¿ Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÌÙÒÌ·-Ù·, ÙÔ Û‡Ó‰ÚÔÌÔ ÌÔÚÂ› Ó· ·Ú·ÌÂ›ÓÂÈ ·‰È¿ÁÓˆ-ÛÙÔ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ·. ¶ÔÏ‡ Û˘¯Ó¿ ·Ó·ÁÓˆÚ›˙ÂÙ·ÈÛÂ ·Û˘ÌÙˆÌ·ÙÈÎ¿ ·È‰È¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘-¯·›·˜ ÂÍ¤Ù·ÛË˜ ÁÈ· ¤Î‰ÔÛË ÈÛÙÔÔÈËÙÈÎÒÓ ‹ ÌÂÙËÓ Â˘Î·ÈÚ›· Î¿ÔÈÔ˘ Ê˘Û‹Ì·ÙÔ˜. ™Ù· ·È‰È¿ ·˘-Ù¿ Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛË (47,48).™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù·(Ù·¯˘Î·Ú‰›Â˜), ¯ÚÂÈ¿˙ÂÙ·È Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·. ŸÙ·Ó fiÌˆ˜ Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ‰ÂÓ Â›Ó·È ÈÎ·-ÓÔÔÈËÙÈÎ¿ ·Ú’ fiÏË ÙËÓ ÂÈÌÔÓ‹ Î·È ÙËÓ ·ÏÏ·Á‹Ê·ÚÌ¿ÎˆÓ, ÌÔÚÂ› Ó· Á›ÓÂÈ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎ‹ÌÂÏ¤ÙË Î·È Èı·ÓÒ˜ Î·Ù¿Ï˘ÛË. ∂ÂÈ‰‹, fiÌˆ˜, ËÎ·Ù¿Ï˘ÛË Â›Ó·È Ì›· ÂÂÌ‚·ÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÛÙËÓÔÔ›· ˘¿Ú¯Ô˘Ó ÛÔ‚·ÚÔ› Î›Ó‰˘ÓÔÈ, ı· Ú¤ÂÈ Ó·ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ÒÚÈÌË ÛÎ¤„Ë, ÛÂ Î·-Ù¿ÏÏËÏÔ Î¤ÓÙÚÔ Î·È ·fi ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ ·È‰Ô-Î·Ú‰ÈÔÏfiÁÔ Î·È ÔÌ¿‰· (49-51).

∆Ô Û‡Ó‰ÚÔÌÔ ÙÔ˘ Ì·ÎÚÔ‡ QT Â›Ó·È Ì›· ¿ÏÏËÚˆÙÔ·ı‹˜ ÔÏÏ¤˜ ÊÔÚ¤˜ Û˘ÁÁÂÓ‹˜ (39%)ÔÓÙfiÙËÙ· Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤Î·ÓÂ È‰È·›ÙÂ-ÚË ·›ÛıËÛË ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÎfiÛÌÔ. ™ÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ Ô˘ ·ÓÂ˘Ú›ÛÎÂÙ·È ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ÌÂ-Ù·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÁÈ’·˘Ùfi Î·È ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÛÙËÓ ÔÈÎÔ-Á¤ÓÂÈ·. ŸÙ·Ó ‰ÂÓ ·Ó·Î·Ï‡ÙÂÙ·È ÎÏËÚÔÓÔÌÈÎfiÙË-Ù·, ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ÌÂÙ¿ÏÏ·ÍË˜. ™Â Î¿ıÂ Â-Ú›ÙˆÛË, ÚÈÓ ÙÂıÂ› Ë ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó··ÔÎÏÂ›ÔÓÙ·È ¿ÏÏ· Èı·Ó¿ ·›ÙÈ· ÁÈ· ÙËÓ ÂÈÌ‹-Î˘ÓÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ QT, fiˆ˜ Ù· ÌÂÙ·‚ÔÏÈÎ¿Î·È Ù· Ê¿ÚÌ·Î· (Â›ÎÙËÙÔ Û‡Ó‰ÚÔÌÔ Ì·ÎÚÔ‡ QT)(52,53). O ı¿Ó·ÙÔ˜ ÌÔÚÂ› Ó· ÚÔÎ‡„ÂÈ ·ÈÊÓ›‰È·ÏfiÁˆ ÎÔÈÏÈ·Î‹˜ Ù·¯˘Î·Ú‰›·˜. O Î›Ó‰˘ÓÔ˜ Û˘Ó‹-ıˆ˜ Â›Ó·È ÌÂÁ¿ÏÔ˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ÌÔÚÂ› Ó· Á›-ÓÂÈ ÌÂ Ê¿ÚÌ·Î·, fiˆ˜ ‚-·Ó·ÛÙÔÏÂ›˜, ·ÏÏ¿ ÛÂ ÔÚÈ-ÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› ·ÎfiÌ· Î·È Ó· ¯ÚÂÈ·-ÛÙÂ› Ë ÙÔÔı¤ÙËÛË ‚ËÌ·ÙÔ‰fiÙË ‹ ·˘ÙfiÌ·ÙÔ˘·ÈÓÈ‰ˆÙ‹ (Ô ‚ËÌ·ÙÔ‰fiÙË˜ ÂÌÊ˘ÙÂ‡ÂÙ·È ÏfiÁˆÙË˜ ‚Ú·‰˘Î·Ú‰È·Î‹˜ ‰Ú¿ÛË˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·Èfi¯È ˆ˜ ıÂÚ·Â›·) (54,55).

ª›· ¿ÏÏË ·ÚÎÂÙ¿ Û˘¯Ó‹ ·ÈÙ›· Ô˘ ÌÔÚÂ› Ó·ÚÔÎ·Ï¤ÛÂÈ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

¶·È‰È·ÙÚÈÎ‹ 2005;68:155-160


158 ™. ∞ÓÙˆÓÈ¿‰Ë˜

Â›Ó·È Ô Ï‹ÚË˜ ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜.¶·Ú’ fiÏÔ Ô˘ Û‹ÌÂÚ· Û˘Ó‹ıˆ˜ Ë ‰È¿ÁÓˆÛË Ù›ıÂ-Ù·È ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ (Û˘¯Ó‹ ·ÈÙ›· Ô ÂÚ˘ıËÌ·ÙÒ‰Ë˜Ï‡ÎÔ˜ ÙË˜ ÌËÙ¤Ú·˜), ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂÈ˜Ô˘ ‰È·ÊÂ‡ÁÔ˘Ó Î·È ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ï›ÁÔ ‹ ÔÏ‡·ÚÁfiÙÂÚ·. O Î›Ó‰˘ÓÔ˜ Û¯ÂÙ›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂ ÙËÓÎ·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·. ™˘¯ÓfiÙËÙÂ˜ ÌÈÎÚfiÙÂÚÂ˜ÙˆÓ 55/min ÛÙ· ‚Ú¤ÊË Î·È ÙˆÓ 50/min ÛÙ· ÌÂÁ·-Ï‡ÙÂÚ· ·È‰È¿ ··ÈÙÔ‡Ó ÙËÓ ÙÔÔı¤ÙËÛË ‚ËÌ·-ÙÔ‰fiÙË, ·ÎfiÌË Î·È ÛÙ· ÙÂÏÂ›ˆ˜ ·Û˘ÌÙˆÌ·ÙÈÎ¿·È‰È¿. º˘ÛÈÎ¿, Ù· ·È‰È¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘-ÌÙÒÌ·Ù·, Â›ÛË˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÙÔ Ù·¯‡ÙÂÚÔ ‚Ë-Ì·ÙÔ‰fiÙË, ‰ÈfiÙÈ ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË Ë Èı·ÓfiÙË-Ù· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Â›Ó·È ˘·ÚÎÙ‹ Î·È ÛËÌ·ÓÙÈ-Î‹. OÈ ˘fiÏÔÈÂ˜ ·ÚÚ˘ıÌ›Â˜ Â›Ó·È ÔÏ‡ Û¿ÓÈÂ˜ÛÙ· ·È‰È¿ Î·È ÁÈ’ ·˘Ùfi ‰ÂÓ ıÂˆÚÂ›Ù·È ÛÎfiÈÌË ËÂÚÈÁÚ·Ê‹ ÙÔ˘˜ (56,57).

§ÈÔı˘ÌÈÎ¿ (Û˘ÁÎÔÙÈÎ¿) ÂÂÈÛfi‰È· ∆· ÂÂÈÛfi‰È· ·ÒÏÂÈ·˜ Û˘ÓÂ›‰ËÛË˜ ÌÂ ÙÈ˜

‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜, ÙË ‰È¿ÚÎÂÈ· Î·È ÙÈ˜ È‰È·ÈÙÂÚfi-ÙËÙ¤˜ ÙÔ˘˜, ·ÔÙÂÏÔ‡Ó Û˘¯Ó¿ Úfi‚ÏËÌ· ÛÙËÓ Î·-ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜Ô˘ ÙÔ ÌÔÓ·‰ÈÎfi ÂÂÈÛfi‰ÈÔ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ·ÈÌÔÏË„›·˜ ‹ ÛÂ ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜, .¯.ÛÙËÓ ÂÎÎÏËÛ›· ÚÈÓ ·fi ÙË ÌÂÙ¿ÏË„Ë, ÌÂ ¿‰ÂÈÔÛÙÔÌ¿¯È, ÌÂÙ¿ ·fi ÓËÛÙÂ›· Î.Ï., ÌÔÚÂ› Ë Î·Ù¿-ÛÙ·ÛË Ó· ÌËÓ Â›Ó·È È‰È·›ÙÂÚ· ÛÔ‚·Ú‹, ·ÊÔ‡ ˘¿Ú-¯ÂÈ Î¿ÔÈ· ·ÈÙÈÔÏÔÁ›·. ™Â Î¿ıÂ ÂÚÈÛÙ·ÙÈÎfi,fiÌˆ˜, Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÈÙÈÔÏÔÁ›· Î·È ÙÔ ÔÔ›ÔÛ˘Ì‚·›ÓÂÈ ·ÈÊÓ›‰È· - Î˘Ú›ˆ˜ Î·Ù¿ ‹ ÌÂÙ¿ ·fi Îfi-ˆÛË - ‹ ˘¿Ú¯ÂÈ ·›ÛıËÌ· ·ÏÌÒÓ, ÂÈ‚¿ÏÏÂÙ·ÈÏ‹ÚË˜ ¤ÏÂÁ¯Ô˜. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Î¿ıÂ ·È-‰› Ô˘ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓ ˘¿Ú¯ÂÈÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ‹ ·ÎÔ‡ÁÂÙ·È Î¿ÔÈÔÊ‡ÛËÌ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â¿Ó ÌÔÈ¿˙ÂÈ ÌÂ ÏÂÈ-ÙÔ˘ÚÁÈÎfi ‹ fi¯È. ™Â fiÏÂ˜ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Â›-Ó·È Â˘ÓfiËÙÔ fiÙÈ Ô Ï‹ÚË˜ ·È‰ÔÓÂ˘ÚÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜ ÁÈ· ·ÔÎÏÂÈÛÌfi ÂÈÏË„›·˜ ‹ ¿ÏÏÔ˘ ÚÔ-‚Ï‹Ì·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ (58-62). O ¤ÏÂÁ¯Ô˜ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ÂÈ‰ÈÎfi ·È‰ÔÎ·Ú‰ÈÔÏfiÁÔ,ÌÂ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· Î·È¤Á¯ÚˆÌÔ ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· (Triplex). ∂¿ÓÎÚÈıÂ› ÛÎfiÈÌÔ, È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ‹ Â›Ó·È Î·È ËÙÔÔı¤ÙËÛË 24ˆÚÔ˘ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ·Ê‹Ì·ÙÔ˜(Holter). ∆Ô ÙÂÛÙ ÎfiˆÛË˜, Â¿Ó ‰ÈÂÓÂÚÁËıÂ› ÌÂÚÔÛÔ¯‹, ÌÔÚÂ› Â›ÛË˜ Ó· ‚ÔËı‹ÛÂÈ.

∆· Î˘ÚÈfiÙÂÚ· ·›ÙÈ· Â›Ó·È ÔÈ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈÂ˜(Î˘Ú›ˆ˜ Ë ˘ÂÚÙÚÔÊÈÎ‹), Ë ÛÙ¤ÓˆÛË ÙË˜ ·ÔÚÙÈ-Î‹˜ ‚·Ï‚›‰·˜ Î·È Ë ÈÛıÌÈÎ‹ ÛÙ¤ÓˆÛË ÙË˜ ·ÔÚÙ‹˜.OÈ ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ ·ÚÚ˘ıÌ›·˜ ·ÔÙÂÏÔ‡Ó, Â›-ÛË˜, ¤Ó· Û˘¯Ófi Î·È ÂÈÎ›Ó‰˘ÓÔ ·›ÙÈÔ. ™Â Î¿ıÂ Â-Ú›ÙˆÛË, ı· Ú¤ÂÈ Ó· ÙÂıÂ› Ë Ï‹ÚË˜ ‰È¿ÁÓˆÛË‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ - Î·Ù¿ ÙÔ ÂÊÈÎÙfi - Ô ·ÔÎÏÂÈÛÌfi˜·ıÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ Î·È Ó· ÂÊ·ÚÌÔÛÙÂ› Ë·ÓÙÈÌÂÙÒÈÛË Ô˘ ¯ÚÂÈ¿˙ÂÙ·È (63-67).

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∏ Î˘ÚÈfiÙÂÚË Î·È Û˘¯ÓfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ı·Ó¿ÙÔ˘, ÙfiÛÔ ÛÙÈ˜ ‰È·ÁÓˆÛÌ¤ÓÂ˜ fiÛÔ Î·È ÛÙÈ˜·‰È¿ÁÓˆÛÙÂ˜ ÂÚÈÙÒÛÂÈ˜, Â›Ó·È Ë ·ÚÚ˘ıÌ›·. OÈ·ÚÚ˘ıÌ›Â˜ Â›Ó·È È‰È·›ÙÂÚ· ÂÈÎ›Ó‰˘ÓÂ˜ ÏfiÁˆ ÙË˜ÌË Â‡ÎÔÏË˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜, Î˘Ú›ˆ˜ ÛÙÈ˜¯ÂÈÚÔ˘ÚÁËÌ¤ÓÂ˜ ÁÈ· Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ· ÂÚÈ-ÙÒÛÂÈ˜ (·Ï¤˜ ‹ Û‡ÌÏÔÎÂ˜). ªÂ ÙËÓ ÚfiÔ‰ÔÙË˜ ·È‰ÔÎ·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ‹˜, Ô ·ÚÈıÌfi˜ ÙˆÓ·È‰ÈÒÓ ·˘ÙÒÓ ÔÏÔ¤Ó· Î·È ·˘Í¿ÓÂÙ·È, ÂÓÒ ‰ÂÓ˘¿Ú¯Ô˘Ó Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ÛÙ·ÙÈÛÙÈÎ¤˜ ·ÊÔ‡ ÔÏ-Ï¤˜ ·fi ·˘Ù¤˜ ÙÈ˜ ÂÂÌ‚¿ÛÂÈ˜ ‰ÂÓ ¤¯Ô˘Ó ·ÚÂÏ-ıfiÓ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 20-25 ¯ÚfiÓˆÓ. ∂›ÛË˜, ÔÎ›Ó‰˘ÓÔ˜ ·˘Í¿ÓÂÙ·È Î·È ·fi ÙËÓ ·Ó˘·ÚÍ›·, Ô-Ï‡ Û˘¯Ó¿, ÚÔÂÈ‰ÔÔÈËÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹Â˘ÚËÌ¿ÙˆÓ. °›ÓÂÙ·È, ÂÔÌ¤Óˆ˜, ·ÓÙÈÏËÙ‹ Ë ÌÂ-Á¿ÏË ÛËÌ·Û›· Ô˘ ¤¯ÂÈ Ë ÚÔÛÂÎÙÈÎ‹, Ù·ÎÙÈÎ‹Î·È ÛˆÛÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË. ¶·ÚÔÌÔ›ˆ˜, Ë ‡·Ú-ÍË ·ÚÚ˘ıÌ›·˜ ÛÂ ·È‰È¿ ¯ˆÚ›˜ Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ-¿ıÂÈ·, fiˆ˜ ‹‰Ë ·Ó·Ï‡ıËÎÂ, ÌÔÚÂ› Ó· ‰ËÌÈ-Ô˘ÚÁ‹ÛÂÈ ÌÂÁ¿ÏÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ÌÂ Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ· ÂÏÏÔ¯Â‡Ô˘Ó ¿ÏÏÔÙÂÌÂÁ·Ï‡ÙÂÚÔÈ (.¯. ÛÙ¤ÓˆÛË ·ÔÚÙÈÎ‹˜ ‚·Ï‚›‰·˜)Î·È ¿ÏÏÔÙÂ ÌÈÎÚfiÙÂÚÔÈ, ·ÏÏ¿ ¿ÓÙ· ˘·ÚÎÙÔ›,Î›Ó‰˘ÓÔÈ. µ¤‚·È·, ÔÈ Â›ÎÙËÙÂ˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ Â›-Ó·È Â›ÛË˜ ÂÈÎ›Ó‰˘ÓÂ˜ (Û‡Ó‰ÚÔÌÔ Kawasaki).ŸÏÂ˜ ÔÈ Î·ÙËÁÔÚ›Â˜ ·˘ÙÒÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓÚ¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÌÂ ÌÂÁ¿ÏË ÚÔÛÔ-¯‹, Ì¤¯ÚÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ‹Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∆Ô ›‰ÈÔ ÈÛ¯‡-ÂÈ Î·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÏÈÔı˘ÌÈÎ¿ ÂÂÈÛfi‰È· ¯ˆÚ›˜ ÂÌÊ·Ó‹·ÈÙÈÔÏÔÁ›·.

∂›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎfi Ó· ÙÔÓÈÛÙÂ› fiÙÈ Î¿ıÂ·È‰› Ô˘ ·Ó‹ÎÂÈ ÛÂ Ì›· ·fi ÙÈ˜ ÂÈÎ›Ó‰˘ÓÂ˜ Î·-ÙËÁÔÚ›Â˜, ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈ-Î¿ Î·È ÌÂ ÌÂÁ¿ÏË ÚÔÛÔ¯‹ ·fi ·È‰ÔÎ·Ú‰ÈÔÏfi-ÁÔ. øÛÙfiÛÔ, Î·ıÒ˜ ·ÚÎÂÙ¤˜ ·fi ÙÈ˜ ÂÚÈÙÒÛÂÈ˜Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÈ˜ ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ÌÔÚÂ› Ó· ÌËÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ‹ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ‹ Î·È Ó· ˘¿Ú¯ÂÈ ¤Ó· Ê·ÈÓÔÌÂ-ÓÈÎ¿ ·ıÒÔ Ê‡ÛËÌ· ‹ Ì›· ÏÈÔı˘Ì›·, ı· Ú¤ÂÈÎ·È ÛÂ ·˘Ù¿ Ó· Ï·Ì‚¿ÓÔÓÙ·È Ù· ··Ú·›ÙËÙ· Ì¤-ÙÚ·. ∞˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔÓ Ï‹ÚË ¤ÏÂÁ¯ÔfiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ı· ·Û¯ÔÏËıÔ‡Ó ÌÂ ·ıÏË-ÙÈÛÌfi, ÚˆÙ·ıÏËÙÈÛÌfi ‹ ¤ÓÙÔÓË Á˘ÌÓ·ÛÙÈÎ‹,·ÊÔ‡ Ù· fiÚÈ· ‰ÂÓ Â›Ó·È ÔÏÏ¤˜ ÊÔÚ¤˜ ·fiÏ˘Ù·Î·ıÔÚÈÛÌ¤Ó·. O ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ fiÏˆÓ·ÓÂÍ·ÈÚ¤Ùˆ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÌÂÁ¿ÏÂ˜ ÏËı˘-ÛÌÈ·Î¤˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ ÔÏ‡ ÚfiÛÊ·Ù·,ÁÈ’ ·˘Ùfi Î·È ·ÎfiÌË ‰ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê‹ Û˘ÌÂ-Ú¿ÛÌ·Ù·. ¶·Ú’ fiÏ· ·˘Ù¿, ÛÂ Î¿ıÂ ÂÚ›ÙˆÛËÔ˘ ˘¿Ú¯ÂÈ Î¿ÙÈ ‡ÔÙÔ ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË‹ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ô ¤ÏÂÁ¯Ô˜ ‰ÂÓ ıÂˆ-ÚÂ›Ù·È ˘ÂÚ‚ÔÏ‹ (68).

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161PRACTICAL ISSUE

Sudden death in children S. Antoniadis

AbstractIn sudden death in childhood the cause, in the vast majority of cases, is of cardiac origin. In many cases theunderlying cause is congenital heart disease, which may or may not have been diagnosed, and may or maynot have been operated on. The death rate is particularly high in post-operative patients where themanagement is difficult. Sudden death usually occurs during sports or in conditions of extreme fatigue.The cardiomyopathies and especially the hypertrophic form, constitute another high risk category.Acquired heart diseases also play a major part. Apart from these diagnosed causes, it is well known thatarrhythmias carry the highest risk in incidents of sudden death when the aetiology remains unknown evenafter necropsy. For management of the problem, the follow up and treatment of patients known to haveheart disease is of paramount importance, along with general preventive measures. A cardiovascular checkup is absolutely necessary in every child who is going to be involved in competitive sports andchampionships, and in any child when the paediatricians have identified suspicious findings includingheart murmurs, rhythm disturbances, symptoms or events such as chest pain, syncope, etc. Also a familyhistory of heart disease or sudden death should be taken into account. All the evaluations should beperformed and the relevant certificates be issued by a specialist paediatric cardiologist, after clinicalexamination and tests such as electrocardiogram, colour Doppler and, whenever necessary, 24-hour Holtermonitoring or other tests. The issue of certificates given by doctors unrelated to paediatric cardiologycould be dangerous. For the time being, screening tests for all children are not considered necessary, butthis will be reconsidered following the findings of various large-scale projects currently in progress on thesubject.

Key wordsChildren, sudden death, cardiac problem, follow up, prevention.

Paediatric Cardiologist,Professor of the HighestTechnological EducationalInstitution of Athens

Correspondence:Stilianos Antoniadis 4 Iraklitou str., Kolonaki 106 73, Athens E-mail: [email protected]




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¡ÂÔÁ¤ÓÓËÙÔ ·ÁfiÚÈ ËÏÈÎ›·˜ 9 ËÌÂÚÒÓ ÚÔÛÎÔ-Ì›˙ÂÙ·È ·fi ÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘ ÛÙ· ÂÂ›ÁÔÓÙ· ÙÔ˘ÂÊËÌÂÚÂ‡ÔÓÙÔ˜ ÓÔÛÔÎÔÌÂ›Ô˘ ÏfiÁˆ ·ÈÊÓ›‰È·˜Î·Ù¤ÚÂÈ„Ë˜.

ππÛÛÙÙÔÔÚÚÈÈÎÎfifi:: ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËÎÂ ÙÂÏÂÈfiÌËÓÔ,ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛË˜‹Ù·Ó 3400 g Î·È ÙÔ Apgar score 9 ÛÙÔ 1Ô ÏÂÙfi˙ˆ‹˜. ◊Ù·Ó ÙÔ ‰Â‡ÙÂÚÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜.∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ∆Ô ÓÂ-ÔÁÓfi ¤Ï·‚Â ÌËÙÚÈÎfi Á¿Ï· Î·È, ÂÎÙfi˜ ·fi ÙËÓ ÂÌ-Ê¿ÓÈÛË ÂÏ·ÊÚÔ‡ ÈÎÙ¤ÚÔ˘, Ë ÔÚÂ›· ÙÔ˘ ÛÙÔ Ì·È-Â˘Ù‹ÚÈÔ ‹Ù·Ó Î·Ï‹. ∂Í‹ÏıÂ ÙËÓ 4Ë ËÌ¤Ú· ˙ˆ‹˜.™ÙÔ Û›ÙÈ Û˘Ó¤¯ÈÛÂ Ó· ıËÏ¿˙ÂÈ ·fi ÙÔ ÛÙ‹ıÔ˜Î¿ıÂ 2-3 ÒÚÂ˜ Î·È Â›¯Â Ù·ÎÙÈÎ¤˜ ÎÂÓÒÛÂÈ˜. ∆ËÓËÌ¤Ú· ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ·ÚÔ˘Û›·ÛÂ ÓˆıÚfiÙËÙ·,·ÛıÂÓ¤˜ ÎÏ¿Ì·, ˆ¯ÚfiÙËÙ· Î·È ¿ÚÓËÛË ıËÏ·ÛÌÔ‡Ô˘ ÂÍÂÏ›¯ıËÎÂ ÛÂ Ï‹ı·ÚÁÔ.

∫·Ù¿ ÙËÓ ··ÓÓÙÙÈÈÎÎÂÂÈÈÌÌÂÂÓÓÈÈÎÎ‹‹ ÂÂÍÍ¤¤ÙÙ··ÛÛËË, ÙÔ ‚Ú¤ÊÔ˜Â›¯Â fi„Ë ¿Û¯ÔÓÙÔ˜, ‹Ù·Ó ˆ¯Úfi ÌÂ Î˘·ÓˆÙÈÎ¿¿ÎÚ· Î·È ·ÓÙÈ‰ÚÔ‡ÛÂ ÂÏ¿¯ÈÛÙ· ÛÙ· ÂÚÂı›ÛÌ·Ù·.∏ ıÚ¤„Ë ÙÔ˘ ‹Ù·Ó Î·Ï‹, ·ÚÔ˘Û›·˙Â fiÌˆ˜ Ù·-¯‡ÓÔÈ· (·Ó·ÓÔ¤˜ 72/min) ÌÂ ·Ó·¤Ù·ÛË ÙˆÓÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ. ∏ ıÂÚÌÔÎÚ·Û›· ÔÚıÔ‡ ‹Ù·Ó37,4ÔC. ¢ÂÓ Â›¯Â ‰ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ·. ∆· ¿ÎÚ·ÙÔ˘ ‹Ù·Ó Î˘·ÓˆÙÈÎ¿ Î·È „˘¯Ú¿, ÌÂ ·ÛıÂÓÂ›˜ Â-ÚÈÊÂÚÈÎ¤˜ ÛÊ‡ÍÂÈ˜ Î·È Î·Î‹ ÂÚÈÊÂÚÈÎ‹ Î˘ÎÏÔ-ÊÔÚ›· (¯ÚfiÓÔ˜ Â·Ó·Ï‹ÚˆÛË˜ >5ãã). ∏ ·ÚÙË-ÚÈ·Î‹ ›ÂÛË ‹Ù·Ó 35/18. ¶·ÚÔ˘Û›·˙Â, Â›ÛË˜,Ù·¯˘Î·Ú‰›· (ÛÊ‡ÍÂÈ˜ 185/min). OÈ Î·Ú‰È·ÎÔ›ÙfiÓÔÈ ‹Ù·Ó ‚‡ıÈÔÈ, ¯ˆÚ›˜ fiÌˆ˜ Ê˘Û‹Ì·Ù·. ¢ÂÓ

Â›¯Â „ËÏ·ÊËÙÔ‡˜ ÏÂÌÊ·‰¤ÓÂ˜. OÈ ÓÂ‡ÌÔÓÂ˜‹Ù·Ó Î·ı·ÚÔ›. ∆Ô ‹·Ú ‹Ù·Ó „ËÏ·ÊËÙfi 5 cm, ÔÛÏ‹Ó·˜ fiÌˆ˜ ‰ÂÓ ‹Ù·Ó „ËÏ·ÊËÙfi˜.

∞∞ÓÓÙÙÈÈÌÌÂÂÙÙÒÒÈÈÛÛËË:: ∆Ô ‚Ú¤ÊÔ˜ ‰È·ÛˆÏËÓÒıËÎÂ¿ÌÂÛ· Î·È Ù¤ıËÎÂ ÛÂ ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜·Ó·ÓÔ‹˜ ÌÂ 100% ÔÍ˘ÁfiÓÔ. ∏ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ÂÓÈÛ¯‡ıËÎÂ ÌÂ ÈÛfiÙÔÓÔ ‰È¿Ï˘Ì· ¯ÏˆÚÈÔ‡¯Ô˘ Ó·-ÙÚ›Ô˘ Î·È, ÛÙË Û˘Ó¤¯ÂÈ·, ÌÂ ÔÏÈÎfi ·›Ì·. ÃÔÚËÁ‹-ıËÎÂ, Â›ÛË˜, ÓÙÔ·Ì›ÓË ÂÓ‰ÔÊÏ¤‚È·, Î·ıÒ˜ Î·È·ÌÈÎÈÏÏ›ÓË ÌÂ ÓÂÙÚÔÌ˘Î›ÓË.

∂∂ÚÚÁÁ··ÛÛÙÙËËÚÚÈÈ··ÎÎ¤¤˜̃ ÂÂÍÍÂÂÙÙ¿¿ÛÛÂÂÈÈ˜̃:: ∫·ÏÏÈ¤ÚÁÂÈÂ˜ ·›-Ì·ÙÔ˜, ∂¡À, Ô‡ÚˆÓ ·ÚÓËÙÈÎ¤˜. °ÂÓÈÎ‹ ·›Ì·ÙÔ˜:·ÈÌÔÛÊ·ÈÚ›ÓË 13 g/dL, ÏÂ˘Î¿ 8600 (45% ÔÏ˘-ÌÔÚÊÔ‡ÚËÓ·), ·ÈÌÔÂÙ¿ÏÈ· 145.000. ∂¡À: Î‡Ù-Ù·Ú· 25 (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 40%), ÏÂ‡ÎˆÌ· 90mg, ÁÏ˘Îfi˙Ë 45 mg. CPK 783 U/L, ·ÏÎ·ÏÈÎ‹ Êˆ-ÛÊ·Ù¿ÛË 170 U, AST 51 U, ALT 50 U. ¡¿ÙÚÈÔ135, Î¿ÏÈÔ 5,9, ¯ÏÒÚÈÔ 103, ·Û‚¤ÛÙÈÔ 8,5 mg, Êˆ-ÛÊfiÚÔ˜ 4,5 mg, Ô˘Ú›· 15 mg, ÏÂ˘ÎÒÌ·Ù· 7,1 g,ÁÏ˘Îfi˙Ë 59 mg, Á·Ï·ÎÙÈÎfi 13,5, ·ÌÌˆÓ›· 85Ìg/dL. ∆Ô ∏∫° ¤‰ÂÈÍÂ ÙÒÛË ÙÔ˘ ST Î·È ¯·ÌËÏ¿R ÛÙÈ˜ ·ÚÈÛÙÂÚ¤˜ ÚÔÎ¿Ú‰ÈÂ˜ ··ÁˆÁ¤˜. ∆Ô ˘Â-ÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜ (∂ÈÎfiÓ·) ¤‰ÂÈÍÂ ‰È¿Ù·ÛËÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ‰˘ÛÎÈÓËÛ›· ÙÔ˘ ‰È·-ÊÚ¿ÁÌ·ÙÔ˜ ÔÊÂÈÏfiÌÂÓË ÛÂ Ô˘Ï‹. ∆Ô ÎÏ¿ÛÌ·‚Ú¿¯˘ÓÛË˜ ‹Ù·Ó 10% (Ê˘ÛÈÔÏÔÁÈÎ¿ >30%). ™Â·˘Ù‹ ÙË Ê¿ÛË, ¤ÁÈÓÂ Ì›· ÂÈ‰ÈÎ‹ ÂÍ¤Ù·ÛË Ô˘ ¤ıÂ-ÛÂ ÙË ‰È¿ÁÓˆÛË.

∫∫ÏÏÈÈÓÓÈÈÎÎ‹‹ ÔÔÚÚÂÂ››··:: ¶·Ú¿ ÙÈ˜ ÚÔÛ¿ıÂÈÂ˜, ÙÔ ÓÂ-ÔÁÓfi Î·Ù¤ÏËÍÂ 6 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘.

∏∏ ··¿¿ÓÓÙÙËËÛÛËË ··ÎÎÔÔÏÏÔÔ˘̆ııÂÂ›› ÛÛÙÙËË ÛÛÂÂÏÏ››‰‰·· 116688

∂∂ÈÈÎÎfifiÓÓ··.. ÀÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜.


163¡∂∫ƒO§O°π∞ OBITUARY

¶·È‰È·ÙÚÈÎ‹ 2005;68:163

°°ÈÈ¿¿ÓÓÓÓËË˜̃ ªª··ııÈÈÔÔ˘̆‰‰¿¿ÎÎËË˜̃ ∂∂››ÎÎÔÔ˘̆ÚÚÔÔ˜̃ ∫∫··ııËËÁÁËËÙÙ‹‹˜̃ ¶¶··ÈÈ‰‰ÈÈ··ÙÙÚÚÈÈÎÎ‹‹˜̃

ŒÊ˘ÁÂ ·fi ÎÔÓÙ¿ Ì·˜, Û˘ÓÔ‰Â‡ÔÓÙ·˜ ÙËÓ ·Á·ËÌ¤ÓË ÙÔ˘ Û‡˙˘-ÁÔ ∂Ï¤ÓË, Ô ÂÎÏÂÎÙfi˜ Û˘Ó¿‰ÂÏÊÔ˜, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·-ÙÚÈÎ‹˜, °È¿ÓÓË˜ ª·ıÈÔ˘‰¿ÎË˜.

∏ Â›‰ËÛË ¤ÂÛÂ Û·Ó ÎÂÚ·˘Ófi˜ ÛÂ ÂÌ¿˜ ÙÔ˘˜ Ê›ÏÔ˘˜ Î·È Û˘ÓÂÚ-Á¿ÙÂ˜ ÙË˜ µ’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,·ÏÏ¿ Î·È ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” Î·È ÛÂ ÔÏfi-ÎÏËÚË ÙËÓ È·ÙÚÈÎ‹ ÂÈÛÙËÌÔÓÈÎ‹ ÎÔÈÓfiÙËÙ·.

∆Ô ÎÂÓfi Ô˘ ¿ÊËÛÂ ›Ûˆ ÙÔ˘ Ô °È¿ÓÓË˜ Â›Ó·È ‰˘Û·Ó·Ï‹ÚˆÙÔ. ∏ Â˘ı‡ÙËÙ·, Ë Â˘ı˘ÎÚÈÛ›·, Â˘Á¤ÓÂÈ· Î·È ÙÔ ‹ıÔ˜ ÙÔ˘ ˆ˜ ÁÈ·ÙÚÔ‡

Î·È ˆ˜ ‰·ÛÎ¿ÏÔ˘ ı· ·ÔÙÂÏÔ‡Ó ÊˆÙÂÈÓfi ·Ú¿‰ÂÈÁÌ· ÁÈ· fiÛÔ˘˜ ÙÔÓÁÓÒÚÈ˙·Ó, ÁÈ· fiÛÔ˘˜ ‰Ô‡ÏÂ„·Ó Ì·˙› ÙÔ˘.

∆Ô ¿ıÔ˜ ÙÔ˘ ÁÈ· ÙËÓ ÂÎ·›‰Â˘ÛË Î·È Ë ÔÈfiÙËÙ· ÙË˜ ‰È‰·ÛÎ·-Ï›·˜ ÙÔ‡ ¤‰ˆÛ·Ó ‰ÈÎ·ÈˆÌ·ÙÈÎ¿ fiÏË ÙËÓ Â˘ı‡ÓË ÙË˜ ÂÎ·›‰Â˘ÛË˜ ÙË˜ ÎÏÈÓÈÎ‹˜, Ì›· Â˘ı‡ÓË Ô˘ ‰ÂÓ ÙÔ˘·Ú·¯ÒÚËÛÂ Î·ÓÂ›˜, ·ÏÏ¿ ÙËÓ ‹ÚÂ ÌfiÓÔ˜ ÙÔ˘.

ŒÊ˘ÁÂ ÙËÓ ËÌ¤Ú· ÙË˜ ÁÈÔÚÙ‹˜ ÙÔ˘, Û˘ÓÔ‰Â‡ÔÓÙ·˜ ÙË Û‡˙˘Áfi ÙÔ˘ Ô˘ ¤Ê˘ÁÂ ‰‡Ô ËÌ¤ÚÂ˜ ÓˆÚ›ÙÂÚ· Î·ÈÂÌÂ›˜ ÌÂ›Ó·ÌÂ ›Ûˆ ÛÙÔÓ ¯ÒÚÔ ÙË˜ ‰Ô˘ÏÂÈ¿˜, ÁÈ· Ó· ÙÔÓ ı˘ÌfiÌ·ÛÙÂ ¿ÓÙ· ˆ˜ Ì›· ÁÏ˘ÎÈ¿ ·Ó¿ÌÓËÛË.

¶·Ó. ™˘Ú›‰Ë˜ ∞Ó. ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈÎ‹˜


164 ∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏

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

¶·È‰È·ÙÚÈÎ‹ 2005;68:164-165

∆· 32 ¯ÚfiÓÈ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹”

ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛfiÎ·˜

£· ‹ıÂÏ· Ó· Û·˜ Û˘Á¯·ÚÒ ÁÈ· ÙËÓ ·Ó·‚¿ıÌÈÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Î·È ÌÂ ÙËÓ Â˘Î·ÈÚ›· ·˘Ù‹ Ó· Û·˜ ˘ÂÓ-

ı˘Ì›Ûˆ Î¿ÔÈ· ÂÓ‰È·Ê¤ÚÔÓÙ· ÛÙÔÈ¯Â›· ·fi ÙËÓ ÈÛÙÔÚ›· ÙÔ˘. ∆Ô ÂÚÈÔ‰ÈÎfi ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜

∂Ù·ÈÚÂ›·˜, Ô˘ Î˘ÎÏÔÊÔÚÂ› Û‹ÌÂÚ· ÌÂ ÙËÓ ÂˆÓ˘Ì›· “¶·È‰È·ÙÚÈÎ‹”, Û˘ÌÏ‹ÚˆÛÂ 72 ¯ÚfiÓÈ· ˙ˆ‹˜ ÛÙÈ˜ 20

∞˘ÁÔ‡ÛÙÔ˘ 2004.

Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ë ›‰Ú˘ÛË ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ·ÔÊ·Û›ÛÙËÎÂ ÛÙÈ˜ 25 ºÂ‚ÚÔ˘·-

Ú›Ô˘ 1931 ·fi 22 ·È‰È¿ÙÚÔ˘˜, ÔÈ ÔÔ›ÔÈ Û˘ÁÎÂÓÙÚÒıËÎ·Ó ÛÙÔ ÁÚ·ÊÂ›Ô ÙÔ˘ °ÂˆÚÁ›Ô˘ ¡. ª·ÎÎ¿, ∫·ıËÁË-

Ù‹ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, ÛÙÈ˜ 29 ∞ÚÈÏ›Ô˘ 1931, ÛÂ Ó¤· Û˘ÁÎ¤-

ÓÙÚˆÛË, ÂÁÎÚ›ıËÎÂ ÙÔ Î·Ù·ÛÙ·ÙÈÎfi, ÙÔ ÔÔ›Ô Î˘ÚÒıËÎÂ ·fi ÙÔ ÂÓ ∞ı‹Ó·È˜ ¶ÚˆÙÔ‰ÈÎÂ›Ô, ·fiÊ·ÛË ˘’

·ÚÈı. 4648 ÙË˜ 19Ë˜ ª·˝Ô˘ 1931.

∆Ô ÚÒÙÔ ‰ÈÔÈÎËÙÈÎfi Û˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂¶∂ ··ÚÙ›ÛÙËÎÂ ·fi ÙÔÓ ∫·ıËÁËÙ‹ °. ª·ÎÎ¿ ˆ˜ ¶ÚfiÂ‰ÚÔ, ÙÔÓ

™. §Ô‡ÚÔ, ∞ÓÙÈÚfiÂ‰ÚÔ, ÙÔÓ ¶. ªËÙÚfiÔ˘ÏÔ, ∆·Ì›·, ÙÔÓ ∫. ™·ÚfiÁÏÔ˘, °ÂÓÈÎfi °Ú·ÌÌ·Ù¤·, ÙÔÓ ∑. ∫ÔÎ-

ÎÈÓ¿ÎË, ∂È‰ÈÎfi °Ú·ÌÌ·Ù¤· Î·È ÙÔ˘˜ ™. µ¤Ú·, ª. ¶·Ï·ÈÔÏfiÁÔ Î·È °. £. ™·ÓÔ‡‰Ë ˆ˜ ™˘Ì‚Ô‡ÏÔ˘˜.

∞ÎÔÏÔ‡ıËÛ·Ó Ù¤ÛÛÂÚÈ˜ ÊÈÏÈÎ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÂ Ù·‚¤ÚÓ· ÙË˜ Ô‰Ô‡ ∞¯·ÚÓÒÓ Î·È Ù¤ÛÛÂÚÈ˜ Ù·ÎÙÈÎ¤˜ -

Î·È Ì›· ¤ÎÙ·ÎÙË - ÂÈÛÙËÌÔÓÈÎ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜. ™‡ÌÊˆÓ· ÌÂ ÙÔ Î·Ù·ÛÙ·ÙÈÎfi, ÔÈ ÂÈÛÙËÌÔÓÈÎ¤˜ ·Ó·ÎÔÈ-

ÓÒÛÂÈ˜ ÙˆÓ Û˘ÓÂ‰ÚÈ¿ÛÂˆÓ ÙË˜ ∂Ù·ÈÚÂ›·˜ ¤ÚÂÂ Ó· ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÂÓÙfi˜ ÌËÓfi˜ ·fi ÙË˜ ·Ó·ÎÔÈÓÒÛÂÒ˜

ÙÔ˘˜. ™Â ¿ÚıÚÔ Û˘ÓÙ¿ÍÂˆ˜ ÙÔ˘ ÚÒÙÔ˘ ÙÂ‡¯Ô˘˜ ÙÔ˘ ¢ÂÏÙ›Ô˘ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ (1)

·Ó·Ê¤ÚÂÙ·È ˆ˜ ·›ÙÈÔ ÙË˜ Î·ı˘ÛÙÂÚËÌ¤ÓË˜ ‰ËÌÔÛÈÂ‡ÛÂˆ˜ “Ë ‰È·Ù¿Ú·ÍË ÙˆÓ ÁÂÓÈÎÒÓ ÔÈÎÔÓÔÌÈÎÒÓ Û˘ÓıË-ÎÒÓ” Î·È ÂÎÊÚ¿˙ÂÙ·È Ë ÂÏ›‰· fiÙÈ ı· ÚÔ¯ˆÚ‹ÛÂÈ Û‡ÓÙÔÌ· Ë ‰ËÌÔÛ›Â˘ÛË ÙˆÓ ·Ó·ÎÔÈÓÒÛÂˆÓ ÙÔ˘ ÚÔË-

ÁÔ‡ÌÂÓÔ˘ ¤ÙÔ˘˜.

™ÙÔ Î·Ù·ÛÙ·ÙÈÎfi ÙË˜ ∂¶∂ ˘¿Ú¯Ô˘Ó ‰‡Ô ·Ó·ÊÔÚ¤˜ ÛÙÔ ¢ÂÏÙ›Ô. ™‡ÌÊˆÓ· ÌÂ ÙÔ ¿ÚıÚÔ 4, ·Ú¿ÁÚ·-

ÊÔ˜ Á, ÙÔ˘ ∫ÂÊ·Ï·›Ô˘ ∞ã ÙÔ˘ Î·Ù·ÛÙ·ÙÈÎÔ‡ ÙË˜ ∂¶∂ ·Ó·Ê¤ÚÂÙ·È fiÙÈ: “Á) ‰ËÌÔÛÈÂ‡ÂÈ Ù· Ú·ÎÙÈÎ¿ ÙˆÓÂÈÛÙËÌÔÓÈÎÒÓ Û˘ÓÂ‰ÚÈ¿ÛÂˆÓ ·˘Ù‹˜ ÂÈ˜ ÙÂ‡¯Ë ÂÓÙfi˜ ÙÔ˘ ÚÒÙÔ˘ ÌÂÙ¿ ÙËÓ Û˘ÓÂ‰Ú›·ÛÈÓ ÙÔ˘ ÌËÓfi˜ Î·È‰È·Ó¤ÌÂÈ Ù·‡Ù· ‰ˆÚÂ¿Ó”.

™ÙÔ ÎÂÊ¿Ï·ÈÔ πã (¶fiÚÔÈ ÙË˜ ∂Ù·ÈÚÂ›·˜), ¿ÚıÚÔ 1, ·Ú¿ÁÚ·ÊÔ˜ Á: “∆· ¤ÛÔ‰· ÙÔ˘ ¢ÂÏÙ›Ô˘ ÙˆÓ ¶Ú·-ÎÙÈÎÒÓ ÙË˜ ™˘ÓÂ‰ÚÈ¿ÛÂˆ˜ (‰ËÌÔÛÈÂ‡ÛÂÈ˜, ·ÁÁÂÏ›·È)...”.

ŒÙÛÈ, ÛÙÈ˜ 20 ∞˘ÁÔ‡ÛÙÔ˘ 1932 Î˘ÎÏÔÊÔÚÂ› ÙÔ ÚÒÙÔ ÙÂ‡¯Ô˜ ÙÔ˘ ¢ÂÏÙ›Ô˘ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜

∂Ù·ÈÚÂ›·˜. ∏ ÚÒÙË ÂÚÁ·Û›· Ô˘ ‰ËÌÔÛÈÂ‡ÂÙ·È Â›Ó·È ÙˆÓ °. ¡. ª·ÎÎ¿ Î·È ¡. °. ∑ÂÚ‚Ô‡ ÌÂ ı¤Ì·: “ªÂÙ·-

‰ÈÊıÂÚÈÙÈÎ·› ·Ú·Ï‡ÛÂÈ˜ Î·È ıÂÚ·Â›· ·˘ÙÒÓ” (2). ∏ ÂÚÁ·Û›· ·˘Ù‹ ·ÊÔÚ¿ ÛÂ ·Ó·ÎÔ›ÓˆÛË ÛÙË Û˘ÓÂ‰Ú›·-

ÛË ÙË˜ ∂¶∂ ÛÙÈ˜ 25 ¡ÔÂÌ‚Ú›Ô˘ 1931.

™ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ÛÂÏ›‰Â˜ Î¿ıÂ ÙÂ‡¯Ô˘˜ ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÂÚÈÏ‹„ÂÈ˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ, Î¿Ùˆ ·fi ÙÔÓ Á·ÏÏÈ-

Îfi Ù›ÙÏÔ: “Bulletin de la Société Hellénique de Pédiatrie”.

∞fi ÙfiÙÂ, ÙÔ ¢ÂÏÙ›Ô ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ÂÎ‰È‰fiÙ·Ó ÛÂ Ù·ÎÙ¿ ‰È·ÛÙ‹Ì·Ù·, ÌÂ ÌÈ-

ÎÚ‹ Î·ı˘ÛÙ¤ÚËÛË ÛÙ· ‰‡ÛÎÔÏ· ¯ÚfiÓÈ· ÙË˜ Î·ÙÔ¯‹˜, ÔfiÙÂ Î·È ÔÈ ÂÚÈÏ‹„ÂÈ˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ ‹Ù·Ó ÛÙ·

ÁÂÚÌ·ÓÈÎ¿.

ÃˆÚ›˜ ÂÈÙÚÔ‹ Û‡ÓÙ·ÍË˜, ÔÈ ÂÚÁ·Û›Â˜ ·Ú·‰›‰ÔÓÙ·Ó ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ·Ó·ÎÔ›ÓˆÛ‹ ÙÔ˘˜ ÁÈ· ‰ËÌÔ-

Û›Â˘ÛË, Â›ÙÂ ÛÙÔÓ °Ú·ÌÌ·Ù¤· ÙÔ˘ ¢ÈÔÈÎËÙÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘ ÙË˜ ∂¶∂, Â›ÙÂ ÛÙÔÓ ˘¿ÏÏËÏÔ ÙË˜ ∂Ù·ÈÚÂ›·˜,

Ô ÔÔ›Ô˜ ÊÚfiÓÙÈ˙Â ÁÈ· ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘˜ ÛÙÔ Ù˘ÔÁÚ·ÊÂ›Ô Î·È ÙËÓ ÚÔÒıËÛË ÁÈ· ‰ÈfiÚıˆÛË ÙˆÓ ‰ÔÎÈ-

Ì›ˆÓ ÛÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜.

∏ ÌÂÙ·ÔÏÂÌÈÎ‹ Â·Ó¿ÛÙ·ÛË ÛÙÈ˜ ÂÍÂÏ›ÍÂÈ˜ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ Î·ıÈÛÙ¿ ¤Î‰ËÏË ÙËÓ ·Ó¿ÁÎË ‰ËÌÈÔ˘Ú-

Á›·˜ ÂÓfi˜ ÔÚÁ¿ÓÔ˘ ÂÈÛÙËÌÔÓÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜ ÙˆÓ ·È‰È¿ÙÚˆÓ. ∆Ô ÌÔÓ·‰ÈÎfi ·È‰È·ÙÚÈÎfi ÂÚÈÔ‰ÈÎfi,

ÂÎÙfi˜ ÙÔ˘ ¢ÂÏÙ›Ô˘ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, Â›Ó·È ÙÔ ¢ÂÏÙ›Ô ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘

¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. øÛÙfiÛÔ, ·fi ÙÔ ¢ÂÏÙ›Ô ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ·Ô˘ÛÈ¿˙ÂÈ Ë ÔÈ-

fiÙËÙ·, Ë ÎÚ›ÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙˆÓ ÂÚÁ·ÛÈÒÓ Î·È, ‰˘ÛÙ˘¯Ò˜, ÔÈ ‰ÈÔÚıˆÙÈÎ¤˜ ‚ÂÏÙÈÒÛÂÈ˜ ÙˆÓ ÎÂÈÌ¤ÓˆÓ

ÙˆÓ ‰ËÌÔÛÈÂ˘ÔÌ¤ÓˆÓ ÂÚÁ·ÛÈÒÓ, ÂÊfiÛÔÓ Ô˘ÛÈ·ÛÙÈÎ¿ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Ú·ÎÙÈÎ¿ ·Ó·ÎÔÈÓÒÛÂˆÓ.

∆ÂÏÈÎ¿, ÙÔ 1973, ÙÔ ˘fi ÙËÓ ÚÔÂ‰Ú›· ÙË˜ ÀÊËÁ‹ÙÚÈ·˜ Î. §‹‰·˜ ∑¿ÓÓÔ˘-ª·ÚÈÔÏ¤· Û˘Ì‚Ô‡ÏÈÔ ÙË˜

∂¶∂, ·ÔÊ·Û›˙ÂÈ ÙËÓ ·ÈÛıËÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ¤Î‰ÔÛË˜, ÙËÓ ÚÔÛı‹ÎË ÂÚÈÏ‹„ÂˆÓ ÂÈ˜ ÙËÓ ·ÁÁÏÈÎ‹, ÙË

ÌÂÙÔÓÔÌ·Û›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÛÂ “¶·È‰È·ÙÚÈÎ‹” Î·È ÙËÓ ·Ó¿ıÂÛË ÙË˜ Û‡ÓÙ·ÍË˜ ÛÙÔÓ ÃÚ. ª·ÚÙÛfiÎ·, Ô

ÔÔ›Ô˜ ÌÂÙ¿ ·fi 10 ¯ÚfiÓÈ· ·Ú¤‰ˆÛÂ ÙË ÛÎ˘Ù¿ÏË ÛÙË Û˘Ó¿‰ÂÏÊÔ ∂Ï¤ÓË µ·Ï¿ÛÛË-∞‰¿Ì.

™ÙÔ Ï·›ÛÈÔ ÙË˜ ·ÈÛıËÙÈÎ‹˜ ‚ÂÏÙ›ˆÛË˜ ¤ÚÂÂ Ó· “Î·ÏÏˆÈÛÙÂ›” Î·È ÙÔ ÂÍÒÊ˘ÏÏÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ªÂÙ¿ ·fi ÂÚÈËÁ‹ÛÂÈ˜ ÙË˜ Î. ∑¿ÓÓÔ˘ Î·È ÙÔ˘ Î. ª·ÚÙÛfiÎ· ÛÙ· ªÔ˘ÛÂ›· ÙˆÓ ∞ıËÓÒÓ, ÂÂÏ¤ÁË Ó· Â-

ÚÈÏËÊıÂ› ÂÈÎfiÓ· ·Á·ÏÌ·ÙÈ‰›Ô˘ Á˘Ó·›Î·˜ Ô˘ ÎÚ·Ù¿ ‚Ú¤ÊÔ˜, ÛÂ Á·Ï¿˙ÈÔ ÊfiÓÙÔ (3).


165LETTER TO THE EDITOR

¶·È‰È·ÙÚÈÎ‹ 2005;68:164-165

∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ·fi ÙÔ ÚÒÙÔ ÙÂ‡¯Ô˜ ÙÔ˘ 1974 Ë “¶·È-‰È·ÙÚÈÎ‹” Û˘ÓÂ¯Ò˜ ‚ÂÏÙÈÒÓÂÙ·È, Î·Ù¤¯Ô˘Û· Ï¤ÔÓ Â›˙ËÏËı¤ÛË ÌÂÙ·Í‡ ÙˆÓ ÂÏÏËÓÈÎÒÓ È·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ. ∆· ¿ÚıÚ·Ô˘ ‰ËÌÔÛÈÂ‡ÔÓÙ·È Â›Ó·È ˘„ËÏÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ÂÈ¤‰Ô˘Î·È ÙÔ ÂÚÈÔ‰ÈÎfi Ì·˜ ‰ÂÓ ¤¯ÂÈ Ó· ˙ËÏ¤„ÂÈ ÛÂ ÂÌÊ¿ÓÈÛË Î¿ÙÈ·fi Ù· Í¤Ó· ÂÚÈÔ‰ÈÎ¿.

∏ ÂÚÈÔÚÈÛÌ¤ÓË, fiÌˆ˜, ¯Ú‹ÛË ÙË˜ ÂÏÏËÓÈÎ‹˜ ÁÏÒÛÛ·˜·Ó¿ ÙÔÓ ÎfiÛÌÔ ·ÔÙÂÏÂ› ÙÔ ÌÂÁ¿ÏÔ ÌÂÈÔÓ¤ÎÙËÌ· ÁÈ· ÙË ‰ÈÂ-ıÓ‹ ÚÔ‚ÔÏ‹ ÙË˜ ÂÏÏËÓÈÎ‹˜ ·È‰È·ÙÚÈÎ‹˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓÚÔÛ¤ÏÎ˘ÛË ‰ËÌÔÛÈÂ‡ÛÂˆÓ ·fi ¿ÏÏÂ˜ ¯ÒÚÂ˜. ∂›Ó·È ·Ù¿ Ù·ÂÈÙ˘¯‹ ·Ú·‰Â›ÁÌ·Ù· ¿ÏÏˆÓ ¯ˆÚÒÓ, fiˆ˜ Ë ∆Ô˘ÚÎ›·, Ô˘ÂÎ‰›‰Ô˘Ó ·ÁÁÏfiÊˆÓ· ·È‰È·ÙÚÈÎ¿ ÂÚÈÔ‰ÈÎ¿, ·ÏÏ¿ Î·È ÙË˜∂ÏÏËÓÈÎ‹˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, Ë ÔÔ›· ÌÂ ÙÔ Â-ÚÈÔ‰ÈÎfi “Hormones” ¤¯ÂÈ ÂÈÙ‡¯ÂÈ ÛËÌ·ÓÙÈÎ¿ ‚‹Ì·Ù· ÚÔ-ÎÂÈÌ¤ÓÔ˘ Ó· Û˘ÌÂÚÈÏËÊıÂ› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·.

∆È ̄ ÚÂÈ¿˙ÂÙ·È Ë “¶·È‰È·ÙÚÈÎ‹”; ∫·Ù¿ ÙËÓ Ù·ÂÈÓ‹ ÌÔ˘ ÁÓÒ-ÌË ı· Ú¤ÂÈ ·Ú¿ÏÏËÏ· Ó· ÂÎ‰›‰ÔÓÙ·È ÙÂ‡¯Ë ˘„ËÏÔ‡ ÂÈ-ÛÙËÌÔÓÈÎÔ‡ ÂÈ¤‰Ô˘ ÛÙËÓ ·ÁÁÏÈÎ‹ ÁÏÒÛÛ·, ÌÂ ·˘ÛÙËÚ‹ ÎÚÈ-ÙÈÎ‹ ÂÈÏÔÁ‹ ÙˆÓ ‰ËÌÔÛÈÂ˘ÔÌ¤ÓˆÓ ÂÚÁ·ÛÈÒÓ. ∂›Ó·È ··Ú·›ÙË-

ÙÔ Ë ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È Ó· ¯ÚËÛÈÌÔÔÈÂ› ˆ˜ ÎÚÈÙ¤˜ ÂÚÁ·ÛÈÒÓ Î·Ù·ÍÈˆÌ¤ÓÔ˘˜ŒÏÏËÓÂ˜ ·È‰È¿ÙÚÔ˘˜ ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡. ªfiÓÔ ÌÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ı· ˘¿ÚÍÂÈ ‰È¤ÍÔ‰Ô˜ ÙË˜ ÂÏÏËÓÈÎ‹˜ ·È-‰È·ÙÚÈÎ‹˜ ÛÙË ‰ÈÂıÓ‹ ÂÈÛÙËÌÔÓÈÎ‹ ·Ú¤Ó·!


1. ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·. ¢ÂÏÙ›Ô ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ 1932;1:1-2. 2. ª·ÎÎ¿ °¡, ∑ÂÚ‚Ô‡ ¡°. ªÂÙ·‰ÈÊıÂÚÈÙÈÎ·› ·Ú·Ï‡ÛÂÈ˜ Î·È ıÂÚ·Â›· ·˘ÙÒÓ. ¢ÂÏÙ›Ô ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·˜

1932;1:13-22. 3. ∏ ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹. ∆Ë˜ Û˘ÓÙ¿ÍÂˆ˜. ¶·È‰È·ÙÚÈÎ‹ 1974;37:1-2.


166 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

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

AÏÏËÏÔÁÚ·Ê›·:¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜E-mail: [email protected]

¶·È‰È·ÙÚÈÎ‹ 2005;68:166-167

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

NAPNAP - °È· ˘„ËÏ‹˜ ÂÍÂÈ‰›ÎÂ˘ÛË˜ ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi - http://www.napnap.org

¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔÓ ‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ·ÌÂÚÈÎ·ÓÈ-ÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡, ÌË-ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·,National Association of Pediatric Nurse Practitioners(NAPNAP), ÌÂ ·ÓÙÈÎÂ›ÌÂÓÔ ÙËÓ ÂÓËÌ¤ÚˆÛË Î·È ÂÎ-·›‰Â˘ÛË ÛÂ ı¤Ì·Ù· °ÂÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜, fiˆ˜ ËÚfiÏË„Ë Î·È Ë ıÂÚ·Â›· ÙˆÓ ·È‰ÈÎÒÓ ÓfiÛˆÓ. ∏ÈÛÙÔÛÂÏ›‰· ÙÔ˘ NAPNAP ÚÔÛÊ¤ÚÂÈ ÏËÚÔÊÔÚÈ·Îfi˘ÏÈÎfi Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ‰Ú¿ÛÂÈ˜ Î·È Ù· ÚÔÁÚ¿ÌÌ·Ù·ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, fiˆ˜ ÙÔ “NAPNAP PreventionInitiative”, ÁÈ· ÙËÓ ÂÎ·›‰Â˘ÛË ÛÂ Ó¤Â˜ ÌÂıfi‰Ô˘˜·ÓÔÛÔÔ›ËÛË˜ ÂÓ¿ÓÙÈ· ÛÙ· Û˘ÓËı¤ÛÙÂÚ· ·È‰ÈÎ¿ÓÔÛ‹Ì·Ù·. ∂ÈÏ¤ÔÓ, ÛÙËÓ ÎÂÓÙÚÈÎ‹ ÛÂÏ›‰· ÙÔ˘NAPNAP ˘¿Ú¯Ô˘Ó ÂÈ‰ÈÎ¿ ·ÊÈÂÚÒÌ·Ù· ÛÂ ‰È·ÊÔ-ÚÂÙÈÎ¿ Î¿ıÂ ÊÔÚ¿ ÓÔÛ‹Ì·Ù·, Î·ıÒ˜ Î·È Û˘Ì‚Ô˘Ï¤˜ÛÂ ı¤Ì·Ù· ·È‰ÈÎ‹˜ ‰È·ÙÚÔÊ‹˜ Î·È ¿ÛÎËÛË˜.

ª¤Ûˆ ÙË˜ ËÏÂÎÙÚÔÓÈÎ‹˜ ·ÚÔ˘Û›·˜ ÙÔ˘, Ô ÔÚÁ·ÓÈÛÌfi˜ NAPNAP ÛÙÔ¯Â‡ÂÈ ÛÙËÓ Î¿Ï˘„Ë Ì›·˜ Â˘ÚÂ›-·˜ ÁÎ¿Ì·˜ ıÂÌ¿ÙˆÓ Ú·ÎÙÈÎ‹˜ ·È‰È·ÙÚÈÎ‹˜ ÁÈ· ÙÔ˘˜ Â·ÁÁÂÏÌ·Ù›Â˜ ÓÔÛËÏÂ˘Ù¤˜ ·È‰ÈÒÓ. ™ÙÔ Ï·›ÛÈÔ·˘Ùfi, Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ‚ÚÂÈ ·Ó·ÊÔÚ¤˜ ÛÙÔ˘˜ ‚·ÛÈÎÔ‡˜ ÓfiÌÔ˘˜ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜, ÎÔ˘›˙ ÚÔÊ‡Ï·ÍË˜·fi ÙË ÁÚ›Ë, Ô‰ËÁ›Â˜ ·Ó·˙‹ÙËÛË˜ ¯ÔÚËÁÈÒÓ Î·È Û˘ÓÂÚÁ·Û›·˜ ÌÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ‚ÈÔÌË¯·Ó›Â˜, È·ÙÚÈÎ¤˜Û˘‚Ô˘Ï¤˜ ÚÔ˜ ÙÔ˘˜ ÁÔÓÂ›˜ ·ÏÏ¿ Î·È ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. OÈ Â·ÁÁÂÏÌ·Ù›Â˜ ¤¯Ô˘Ó ÂÈÏ¤ÔÓ ÙË ‰˘-Ó·ÙfiÙËÙ· Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙÈ˜ ‰Ú¿ÛÂÈ˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ì¤Û· ·fi ÂÈ‰ÈÎ‹ ıÂÌ·ÙÈÎ‹ ÂÓfiÙËÙ·(Clinical Expert Panel), ÂÓÒ ÛÙÔ ∫¤ÓÙÚÔ ™˘ÓÂ¯È˙fiÌÂÓË˜ ∂Î·›‰Â˘ÛË˜ ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌÔ ˘ÏÈÎfi, ÚÔ-ÁÚ¿ÌÌ·Ù· Î·È ËÏÂÎÙÚÔÓÈÎ¤˜ ÂÊËÌÂÚ›‰Â˜ ¶·È‰È·ÙÚÈÎ‹˜. ¶·Ú¿ ÙÈ˜ ·‰˘Ó·Ì›Â˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓÏÔ‹ÁËÛË Î·È ÙËÓ ÂÓËÌ¤ÚˆÛË - Î¿ÔÈÂ˜ ˘ÔÂÓfiÙËÙÂ˜ ‰ÂÓ ÏÂÈÙÔ˘ÚÁÔ‡Ó Ï‹Úˆ˜ - Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙÔ˘NAPNAP ·ÔÙÂÏÂ› ¤Ó· ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÏËÚÔÊfiÚËÛË˜ Î·È ·Ú¿‰ÂÈÁÌ· ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÂÍÂÈ‰›ÎÂ˘-ÛË˜ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ¡ÔÛËÏÂ˘ÙÈÎ‹.

Infectious Diseases in Children - ∆· ÏÔÈÌÒ‰Ë ÓÔ-Û‹Ì·Ù· ÛÙÔ ÌÈÎÚÔÛÎfiÈÔ -http://idinchildren.com

∏ ËÏÂÎÙÚÔÓÈÎ‹ ¤Î‰ÔÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ InfectiousDiseases in Children ¤¯ÂÈ ˆ˜ ·ÓÙÈÎÂ›ÌÂÓÔ Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹-Ì·Ù· Î·È ·Â˘ı‡ÓÂÙ·È ÛÂ Â·ÁÁÂÏÌ·Ù›Â˜ Î·È ÂÚÂ˘ÓËÙ¤˜ ÙË˜¶·È‰È·ÙÚÈÎ‹˜. ∏ Û˘ÓÙ·ÎÙÈÎ‹ ÔÌ¿‰· ·ÔÙÂÏÂ›Ù·È ·fi ‰È·ÎÂ-ÎÚÈÌ¤ÓÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Î·È Â·ÁÁÂÏÌ·Ù›Â˜ ·fi ÙÔÓ ¯ÒÚÔ ÙË˜¶·È‰È·ÙÚÈÎ‹˜ ÛÙÈ˜ ∏¶∞, ÔÈ ÔÔ›ÔÈ ·Ó·ÓÂÒÓÔ˘Ó ÙÔ ÂÚÈÂ¯fi-ÌÂÓÔ ÙË˜ ÈÛÙÔÛÂÏ›‰·˜ ÛÂ ÌËÓÈ·›· ‚¿ÛË. ∏ ÏÔ‹ÁËÛË ÛÙÔÓ‰ÈÎÙ˘·Îfi ÙfiÔ ÙË˜ ÂÊËÌÂÚ›‰·˜ Â›Ó·È Â‡ÎÔÏË Î·È ¿ÌÂÛË, ·Ï-Ï¿ ‰ˆÚÂ¿Ó ·Ú¤¯ÂÙ·È ÌfiÓÔ ÙÔ ÚÒÙÔ Â›Â‰Ô ÙË˜ ÏËÚÔ-ÊÔÚ›·˜, ‰ËÏ·‰‹ Ù· ÂÚÈÂ¯fiÌÂÓ· ÙÔ˘ ÙÚ¤¯ÔÓÙÔ˜ ÙÂ‡¯Ô˘˜. ∏


167¡EWS FROM THE INTERNET

¶·È‰È·ÙÚÈÎ‹ 2005;68:166-167

Ï‹ÚË˜ ÚfiÛ‚·ÛË ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÛÂ Û˘Ó‰ÚÔÌËÙ¤˜. π‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÓfiÙËÙ· ÁÈ·ÙË ™˘ÓÂ¯È˙fiÌÂÓË π·ÙÚÈÎ‹ ∂Î·›‰Â˘ÛË, Â˘Ú¤ˆ˜ ÚÔÛ‚¿ÛÈÌË, fiÔ˘ Ô ¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ‚ÚÂÈ Ì›· ‚È-‚ÏÈÔı‹ÎË ıÂÌ¿ÙˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÂÍÂÏ›ÍÂÈ˜ Î·È ÙÈ˜ ÚÔÔÙÈÎ¤˜ ÛÙ· ·È‰ÈÎ¿ ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·. ∂ÎÙfi˜·fi ÙÔ ÂÚÈÂ¯fiÌÂÓÔ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ ÙÂ‡¯Ô˘˜ ÙË˜ ÂÊËÌÂÚ›‰·˜, ˘¿Ú¯ÂÈ Î·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó·˙‹ÙËÛË˜·Ï·ÈfiÙÂÚˆÓ ¿ÚıÚˆÓ - ·fi ÙÔ 1996 - Ì¤Û· ·fi ÙÔ ·Ú¯Â›Ô.

Archives of Disease in Childhood - ª›· ‰ÈÂÈÛ‰˘ÙÈÎ‹ Ì·ÙÈ¿ ÛÙ· ·Ú¯Â›· ÙË˜ ·È‰È·ÙÚÈÎ‹˜ -http://adc.bmjjournals.com

¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ËÏÂÎÙÚÔÓÈÎ‹ ¤Î‰ÔÛË ÙÔ˘ ÁÓˆÛÙÔ‡ÛÂ fiÏÔ˘˜ ÂÚÈÔ‰ÈÎÔ‡ Archives of Disease in ChidlhoodÙÔ˘ Royal College of Paediatrics and Child Health. ∞Â˘-ı‡ÓÂÙ·È ÛÙÔ˘˜ Â·ÁÁÂÏÌ·Ù›Â˜ Î·È ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ ·fiÙÔÓ ¯ÒÚÔ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜. ∂Í·ÈÚÂÙÈÎ¿ ÂÓ‰È·Ê¤ÚÔ˘Û·Â›Ó·È Ë ÂÓfiÙËÙ· “∞Ú¯Â›·” ÛÙËÓ ÎÂÓÙÚÈÎ‹ ÛÂÏ›‰· ÙÔ˘ Â-ÚÈÔ‰ÈÎÔ‡, fiÔ˘ Â›Ó·È ‰È·ı¤ÛÈÌ· ÙÂ‡¯Ë ·fi ÙÔ 1974. ∂È-Ï¤ÔÓ, Ô ¯Ú‹ÛÙË˜ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÚÔÂÈÛÎfiËÛË˜ÙÔ˘ ÂfiÌÂÓÔ˘ ÙÂ‡¯Ô˘˜, ÂÓÒ ÌÔÚÂ› Ó· ‰ÂÈ Î·È ÛÙ·ÙÈÛÙÈ-Î¤˜ ·Ó·ÊÔÚ¤˜ ÁÈ· Ù· 10 ÈÔ ‰ËÌÔÊÈÏ‹ ¿ÚıÚ· ÙÔ˘ ÂÚ·-ÛÌ¤ÓÔ˘ ¤ÙÔ˘˜. °È· ÙÔ˘˜ Â›‰ÔÍÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, ÂÎÙfi˜·fi Ô‰ËÁ›Â˜ Û˘ÁÁÚ·Ê‹˜ ¿ÚıÚˆÓ, ˘¿Ú¯ÂÈ Î·È ÂÈ‰ÈÎfiÙÂ-ÚË ·Ó·ÊÔÚ¿-Ô‰ËÁ›· ÛÂ fiÛÔ˘˜ ÂÈı˘ÌÔ‡Ó Ó· Û˘Ì‚¿Ï-ÏÔ˘Ó ÛÙË µ·ÛÈÛÌ¤ÓË ÛÂ ¢Â‰ÔÌ¤Ó· ¶·È‰È·ÙÚÈÎ‹. ∆ÔArchives, ‚¤‚·È·, Â›Ó·È Ì¤ÏÔ˜ ÙÔ˘ ÔÌ›ÏÔ˘ British MedicalJournal (BMJ) Î·È ÚÔÛÊ¤ÚÂÈ ·Â˘ıÂ›·˜ Û‡Ó‰ÂÛË ÛÂfiÏ· Ù· ÂÚÈÔ‰ÈÎ¿ ÙÔ˘ BMJ, Î·ıÒ˜ Î·È ÚfiÛ‚·ÛË ÛÙÔ ÙÌ‹Ì· ÙË˜ ∏ÏÂÎÙÚÔÓÈÎ‹˜ µÈ‚ÏÈÔı‹ÎË˜ ÁÈ· ÙËÓ ÎÏÈ-ÓÈÎ‹ ¤ÚÂ˘Ó·. Ÿˆ˜ ÛÂ fiÏÂ˜ ÙÈ˜ ÈÛÙÔÛÂÏ›‰Â˜ ÙÔ˘ ÔÌ›ÏÔ˘, Ë ÏÔ‹ÁËÛË Â›Ó·È ÔÌ·Ï‹ Î·È ·ÚfiÛÎÔÙË.


168 CLINICAL QUIZ

¶·È‰È·ÙÚÈÎ‹ 2005;68:162,168

∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏

∏ ÂÈ‰ÈÎ‹ ÂÍ¤Ù·ÛË Ô˘ ¤ÁÈÓÂ ‹Ù·Ó Ë ·Ó›¯ÓÂ˘ÛËÙÔ˘ RNA ÂÓÙÂÚÔ˚ÒÓ ÌÂ PCR ÛÙÔ ·›Ì· Î·È ÙÔ ∂¡ÀÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ÂÍ¤Ù·ÛË ·¤‚Ë ıÂÙÈÎ‹ ÁÈ· ÙÔÓ ÈfiCoxsackie B1. O Ù›ÙÏÔ˜ ÙˆÓ ÂÈ‰ÈÎÒÓ IgM ·ÓÙÈÛˆ-Ì¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÛÙÔÓ ÔÚfi ÙË˜ ÌËÙ¤Ú·˜ ‹Ù·Ó,Â›ÛË˜, ıÂÙÈÎfi˜. OÈ ÂÓÙÂÚÔ˚Ô› Î·È ÂÈ‰ÈÎ¿ ÔCoxsackie Û˘¯Ó¿ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛËÌ˘ÔÎ·Ú‰›ÙÈ‰·˜, ÂÚÈÎ·Ú‰›ÙÈ‰·˜ Î·È ÏÂ˘ÚÔ‰˘-Ó›·˜. ∏ ÌÂÈˆÌ¤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· Î·È ‰È¿Ù·ÛËÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, fiˆ˜ Î·È Ë ·ÚÔ˘Û›· Ô˘-Ï‹˜ ÛÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ·, Û˘ÓËÁÔÚÔ‡ÓÁÈ· Û˘ÁÁÂÓ‹ ÈÔÁÂÓ‹ Ì˘ÔÎ·Ú‰›ÙÈ‰· ˆ˜ ·ÈÙ›· ÙË˜ Î·-Ù¤ÚÂÈ„Ë˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ÕÏÏ· ·›ÙÈ· Î·Ù¤ÚÂÈ„Ë˜ ÛÂ·˘Ù‹ ÙËÓ ËÏÈÎ›· Â›Ó·È Ë ÛË„·ÈÌ›·, Ë ÂÚÈÁÂÓÓËÙÈ-

Î‹ ·ÛÊ˘Í›·, Ë ·ÓÒÌ·ÏË ¤ÎÊ˘ÛË ÙË˜ ·ÚÈÛÙÂÚ‹˜ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜, Ë ˘ÔÏ·ÛÙÈÎ‹ ·ÚÈÛÙÂÚ‹ÎÔÈÏ›·, ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·, ÂÈÓÂÊÚÈ‰È·Î‹·ÓÂ¿ÚÎÂÈ· Î·È Î·Ú‰È·Î¤˜ ·ÚÚ˘ıÌ›Â˜.

∏ ÚfiÁÓˆÛË ÙË˜ ¿ıËÛË˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ‚·ıÌfi ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∂¿Ó ÚÔ-Û‚¿ÏÏÂÙ·È ÌfiÓÔ Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·, ÙfiÙÂ ¯ÔÚË-ÁÂ›Ù·È ÚÔÛÙ·ÁÏ·Ó‰›ÓË ∂1 ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰È·-ÙËÚËıÂ› ·ÓÔÈÎÙfi˜ Ô ‚ÔÙ¿ÏÂÈÔ˜ fiÚÔ˜, Ì¤Ûˆ ÙÔ˘ÔÔ›Ô˘ ÙÚÔÊÔ‰ÔÙÂ›Ù·È Ë Û˘ÛÙËÌ·ÙÈÎ‹ Î˘ÎÏÔÊÔ-Ú›· ¤ˆ˜ fiÙÔ˘ ·Ó·ÚÚÒÛÂÈ Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·. ™ÂÛÔ‚·Ú‹ ˘ÔÍ·ÈÌ›·, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÍˆÛˆÌ·ÙÈ-Î‹ ÔÍ˘ÁfiÓˆÛË. ™‹ÌÂÚ·, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·È ÙÔÂÈ‰ÈÎfi ·ÓÙÈÈÎfi Ê¿ÚÌ·ÎÔ pleconaril.


1. Inwald D, Franklin O, Cubitt D, Peters M, Goldman A,Burch M. Enterovirus myocarditis as a cause of neonatalcollapse. Arch Dis Child Fetal Neonatal Ed 2004;89:F461-F462.


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4-8 ª·˝Ô˘ 2005 17Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ °ÂÓÈÎ‹˜ π·ÙÚÈÎ‹˜ ∫·ÏÏÈı¤· •ÂÓÔ‰Ô¯Â›Ô Athos Palace Ã·ÏÎÈ‰ÈÎ‹˜ ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· °ÂÓÈÎ‹˜ π·ÙÚÈÎ‹˜ ¶ÏËÚÔÊÔÚ›Â˜: Œ„ÈÏÔÓ Congress ∆ËÏ.: +30 210 7254 360-2 Fax: +30 210 7254 363 E-mail: [email protected]

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10-15 ª·˝Ô˘ 2005 3Ô ¢ÈÂıÓ¤˜ π·ÙÚÈÎfi πÔÚ‰·ÓÔÂÏÏËÓÈÎfi ™˘Ó¤‰ÚÈÔ Amman, ¶ÏËÚÔÊÔÚ›Â˜: Morning Star Travel Agency Jordan ∆ËÏ.: +30 2310 227 251, 2310 229 863, 2310 227 891 Fax: +30 2310 280 537

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17-21 ª·˝Ô˘ 2005 31Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó· •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔÚ›Â˜: π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ∞ıËÓÒÓ ∆ËÏ.: +30 210 7211 845, 210 7243 161 Fax: +30 210 7215 082 E-mail: [email protected] Website: http://www.mednet.gr

1-4 πÔ˘Ó›Ô˘ 2005 14Ô ¶·ÓÂ˘Úˆ·˚Îfi ™˘Ó¤‰ÚÈÔ ¶·¯˘Û·ÚÎ›·˜ ECO 2005 ∞ı‹Ó· ª¤Á·ÚÔ ªÔ˘ÛÈÎ‹˜ ∞ıËÓÒÓ ∂ÏÏËÓÈÎ‹ π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ¶·¯˘Û·ÚÎ›·˜¶ÏËÚÔÊÔÚ›Â˜: Triaena Tours ∆ËÏ.: +30 210 7499 300 Fax: +30 210 7705 752 E-mail: [email protected]

17-19 πÔ˘Ó›Ô˘ 2005 43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∫ˆ˜ •ÂÓÔ‰Ô¯Â›Ô Kipriotis Village ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ¶ÏËÚÔÊÔÚ›Â˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100 Fax. +30 210 6844 777 E-mail: [email protected] Website: http://www.pediatric2005.gr

26 πÔ˘Ó›Ô˘- World Allergy Congress 2005 Munich, 1 πÔ˘Ï›Ô˘ 2005 ¶ÏËÚÔÊÔÚ›Â˜: Congrex Sweden AB Germany

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7-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005 The History of Diabetes Mellitus ¢ÂÏÊÔ› ¢ÔÚ˘ÊÔÚÈÎfi ™˘ÌfiÛÈÔ ÚÈÓ ·fi ÙÔ ÂÙ‹ÛÈÔ Û˘Ó¤‰ÚÈÔ ÙË˜ EASD ¶ÏËÚÔÊÔÚ›Â˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100Fax: +30 210 6844 777E-mail: [email protected] Website: http://www.easdsymposium2005.com

9-11 ™ÂÙÂÌ‚Ú›Ô˘ 2005 1Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ¢È·ÓÔÛÔÎÔÌÂÈ·Îfi ÃÂÚÛfiÓËÛÔ˜, ™˘Ó¤‰ÚÈÔ °˘Ó·ÈÎÔÏÔÁ›·˜ ∫Ú‹ÙË •ÂÓÔ‰Ô¯Â›Ô “∫·ÏËÌ¤Ú· ∫Ú‹ÙË” ¶ÏËÚÔÊÔÚ›Â˜: PRC Congress & Travel ∆ËÏ.: +30 210 7711 673, 210 7756 336 Fax: +30 210 7711 289 E-mail: [email protected]

14-18 ™ÂÙÂÌ‚Ú›Ô˘ 2005 29th UMEMPS - Union Middle Eastern & Istanbul, Mediterranean Pediatric Societies Congress Turkey •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔÚ›Â˜: Pr. Enver Hasanoglu Fax: +90 312 2237 469, +90 216 3477 095 E-mail: [email protected] Website: http://www.istanbul-umemps2005.org

25-27 ™ÂÙÂÌ‚Ú›Ô˘ 2005 1Ô ¢ÈÂıÓ¤˜ ∂ÈÛÙËÌÔÓÈÎfi ™˘ÌfiÛÈÔ & £ÂÛ/Ó›ÎË 7Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ÁÈ· ÙË ™ÎÏ‹Ú˘ÓÛË Î·Ù¿ ¶Ï¿Î·˜ •ÂÓÔ‰Ô¯Â›Ô Hyatt Regency ¶ÏËÚÔÊÔÚ›Â˜: Artion Conferences & Events ∆ËÏ.: +30 2310 250 927, 2310 252 330 Fax: +30 2310 277 964, 2310 272 276 E-mail: [email protected] Website: http://www.greekmssociety.gr

28 ™ÂÙÂÌ‚Ú›Ô˘- Pre-event to 1st European Conference on ∂Ú¤ÙÚÈ· 1 √ÎÙˆ‚Ú›Ô˘ 2005 Injury Prevention and Safety Promotion

“Increasing efficiency in injury prevention”•ÂÓÔ‰Ô¯Â›Ô Malaconda ¶ÏËÚÔÊÔÚ›Â˜: ∫∂¶¶∞ ∆ËÏ.: +30 210 7462 187Fax: +30 210 7462 105 E-mail: [email protected] Website: http://www.cc.uoa.gr/health/socmed/hygien/pre_event

22 √ÎÙˆ‚Ú›Ô˘ 2005 8th Athens Breast Cancer Symposium ∞ı‹Ó· ∞ÌÊÈı¤·ÙÚÔ ¡πª∆™ ªÔÓ¿‰· ª·ÛÙÔ‡ ÙË˜ µ’ ¶ÚÔ·È‰Â˘ÙÈÎ‹˜ ÃÂÈÚÔ˘ÚÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔÚ›Â˜: PRC Congress & Travel ∆ËÏ.: +30 210 7711 673Fax: +30 210 7711 289 E-mail: [email protected]


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