Παιδιατρική | Τόμος 68 • Τεύχος 5 • Σεπτέμβριος -...

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

ISSN 0377-2551ISSN 0377-2551

Volume 68 ñ Number 5 ñ September-October 2005Volume 68 ñ Number 5 ñ September-October 2005

Exof Pediatr Sept-Oct 05 17-10-05 14:01 ™ÂÏ›‰·1

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË ÙË˜

EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

¶ÚfiÂ‰ÚÔ˜

∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹

¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

∫. ™ÙÂÊ·Ó›‰Ë˜

M¤ÏË

¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘

∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘

A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë

°. µ·ÚÏ¿ÌË˜

ª. ∫·Ó¿ÚÈÔ˘

∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë

A. K·ÙÙ¿ÌË˜

Ã. ∫ÒÛÙ·ÏÔ˜

¡. ¶··‰fiÔ˘ÏÔ˜

∞. ¶··‰ÔÔ‡ÏÔ˘

∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘

ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·

∂ÈÌ¤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ

I. K·Ú·‚Ú¿ÓÔ˘

EÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ

™. ¡¿ÎÔ˘

EÎ‰fiÙË˜

K. °ÚÈ‚¤·˜

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰fiÛÂˆ˜

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¶ÂÚÈÂ¯fiÌÂÓ·

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325 ∂Ó·ÚÎÙ‹ÚÈÔ˜ OÌÈÏ›· ÛÙÔ

43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ

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329 ¶·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎÒÓ

ÂÂÈÛÔ‰›ˆÓ ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ

∂. ∫·Ú·Ù˙¿-•ÈÊÈÏ›‰Ô˘, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿

337 ∞ÍÈÔÏfiÁËÛË ÙË˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜

ÚfiÎÏËÛË˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË

Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÏÏÂÚÁ›·˜

A. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË, G. Du Toit, G. Lack

342 ∏ ÈÓÔÌ˘·ÏÁ›· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

µ. ∆Û·ÁÚ‹˜, ∞. ∫ÈÙÛÔÔ‡ÏÔ˘, ∫. ª›¯·˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘-∫·Ú·ı›Ô˘

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

352 ™‡Ó‰ÚÔÌÔ Guillain-Barré. ŒÎ‚·ÛË ÙË˜

ÓfiÛÔ˘ ÛÂ ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÂ

ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜

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358 ∫›Ó‰˘ÓÔ˜ ·fi ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜

·ÙfiÌˆÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down Î·È

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∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

366 ¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË. ¶ÂÚÈÁÚ·Ê‹

ÚÒÙË˜ ÂÚ›ÙˆÛË˜ ÛÙËÓ ∂ÏÏ¿‰·

O. ¶··Ó‰Ú¤Ô˘, ∞. ∫ÏËÌÂÓÙÔÔ‡ÏÔ˘, ¡. ¶ÔÓËÚfi˜, ∞. ∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘, ∞. •˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë, N. Rachman, °. ÃÚÔ‡ÛÔ˜

372 ™‡Ó‰ÚÔÌÔ ÌÈÎÚÔÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11.2

ÛÂ ÔÈÎÔÁ¤ÓÂÈ· ÌÂ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ

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∞. ∞Ó‰Ú¤Ô˘, µ. ∞ÏÂÍ·Ó‰ÚÔÔ‡ÏÔ˘-∆ÛÈÎÚ›Î·, ∞. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘, ª. °Ô˘‰ÂÛ›‰Ô˘, §. ºÏˆÚÂÓÙ›Ó-∞Ú¿Ú

∂¶π∫∞πƒO £∂ª∞

377 ∏ Â›‰Ú·ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Ô˘

¯ÔÚËÁÔ‡ÓÙ·È Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô

ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘

∂. ªÔ‡˙·, ∫. ¶··Á·ÚÔ˘Ê¿ÏË˜

∂π¢π∫O ∞ƒ£ƒO

386 ¶ÚÔÏËÙÈÎfi˜ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È

ı¤Ì·Ù· ËıÈÎ‹˜

Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘

395 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

396 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

398 µπµ§π√¶∞ƒ√À™π∞™∏

∫ˆ‰ÈÎfi ̃¢ÈÂ‡ı˘ÓÛË ̃∂ÔÙÂ›· ̃ªª∂: 3889

ISSN 0377-2551

¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 68 ñ ∆Â‡¯Ô˜ 5 ñ ™ÂÙ¤Ì‚ÚÈÔ˜-OÎÙÒ‚ÚÈÔ˜ 2005

Pediatr Sept-Oct 05 17-10-05 16:50 ™ÂÏ›‰·1

Bimonthly Publication of

the Greek Paediatric Society

President

A. Constantopoulos

Editorial Board

Editor

C. Stefanidis

Members

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

Manuscript Editing

Greek Editing

I. Karavranou

English Editing

S. Nakou

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K. Griveas

Publishing Coordinator

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Contents

LETTER FROM THE EDITOR

325 Opening Lecture at the

43rd Panhellenic Paediatric Meeting

G. D. Babiniotis

REVIEW ARTICLES

336 Pathophysiology of vaso-occlusive crises

in sickle cell disease

E. Karatza-Xifilidou, M. Athanasiou-Metaxa

341 Evaluation of oral challenges for the

diagnosis of drug allergy

A. Sofianou-Katsoulis, G. Du Toit, G. Lack

351 Fibromyalgia in childhood

V. Tsagris, A. Kitsopoulou, C. Mihas, P. Nikolaidou-Karpathiou

ORIGINAL ARTICLES

357 Severe Guillain-Barré syndrome.

Outcome in children admitted to a PICU

A. Tsoutsou, D. Gionis, S. Mastroyianni, J. Papadatos

365 Risks of sports activities in individuals

with Down syndrome and atlantoaxial

instability

H. Hatzissevastou-Loukidou, M. Badouraki, P. Kambouridou, E. Sotiridou

CASE REPORTS

371 Juvenile hyaline fibromatosis.

The first case report in Greece

O. Papandreou, A. Klimentopoulou, N. Poniros, A. Konstantinidou, A. Xypolita-Zachariadi, N. Rachman, G. Chroussos

376 22q11.2 micro-deletion syndrome in a

family with variation in the phenotype.

Prenatal diagnosis

A. Andreou, V. Alexandropoulou-Tsikrika, A. Sakellaropoulou, M. Goudesidou, L. Florentin-Arar

CURRENT ISSUE

385 The effect of postnatal administration of

steroids on the developing brain

H. Bouza, C. Papagaroufalis

SPECIAL ARTICLE

394 Genetic preventive testing and ethical

issues

H. Hatzissevastou-Loukidou

395 LETTER TO THE EDITOR

396 NEWS FROM THE INTERNET

398 BOOK REVIEW

PaediatrikiVolume 68 ñ Number 5 ñ September-October 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¿.


K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ Î·È ÙËÓ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë ÛË-ÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ 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 ÂÈÛ·ÁˆÁ‹ Â-ÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Û˘-ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂ ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·-Ú·ÔÌ¤˜ Î·È 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· ·ÔÙÂÏ¤ÛÌ·Ù· Ú¤ÂÈÓ· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛËÚ¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡-ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó· ¤¯Ô˘ÓÎ·È ÙËÓ 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-mittedto Biomedical Journals, (http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ Cumulated IndexMedicus [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-likegrowth 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 DevelopmentConference. Neurofibromatosis conference statement. ArchNeurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

Schreiner GF, Lange L. Ethanol modulation ofmacrophage 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 nephroticsyndrome. 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 headand 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.

xii


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 Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ‰ÈÛÎ¤Ù· ‹ CD, 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.

9. Case reports.

10. News.

11. Brief reports.

12. Letters to the editor.

13. Abstracts.

14. Future congresses and events.

15. Book reviews.

The Editorial Board reserves the right to publish articles

of special scientific interest and articles on current issues

without observing submission order. In addition it publish-

es upon decision original papers presented at the Annual

Paediatric Conference, presentations of special interest - in

whole or in part, and letters - in whole or in part - referring

to scientific articles published in the journal.

Regarding papers on current issues, the author’s request

for immediate publication should be quoted on the first

page. The Editorial Board reserves the right to accept such

papers for immediate publication.

All manuscripts should not have been published previ-

ously, in whole or in part, and not be under consideration

by another publication. Manuscripts should acknowledge

any funding, sponsorship or other financial support. All

clinical research should have been conducted following in-

formed consent of participants or of their legal representa-

tives according to the Declarations of Helsinki and Tokyo.

In addition, the US National Institute of Health guide for

the care and use of laboratory animals (DHEW Publication,

NIH, 80-23) should have been observed. Clinical trials

should have been approved by the Ethics Committee of the

Hospital.

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

the Publisher of the journal do not necessarily approve the

content of the advertisements appearing in the journal.

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

atriki” and their reproduction in whole or in part is autho-

rized only following written consent of the journal.

B. Manuscript Preparation“Paediatriki” suggests compliance with the “Uniform

Requirements for Manuscripts Submitted to Biomedical

Journals”, recently modified and published on the web-

sites:

http://www.icmje.org and http://www.icmje.org/icmje.pdf

The entire paper (including figure legends and tables)

should be typed on one side of blank paper format A4(21x29.7 cm), double line spacing and minimum indent 2.5cm on both sides.

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.

The structure of all other articles is free, according to thejudgment of the authors.

Thanks or acknowledgements (reference to grants,sponsorships or other sources of financial support) shouldbe quoted at the end of the text, before references.

”


xviii

Units of measures of laboratory analyses

Laboratory analyses should be expressed in the Sys-tème International (SI) units and in the metric (Conven-tional) system in parentheses. See conversion tables on thewebsites: http://www.icmje.org and http://www.icmje.org/icmje.pdf

Abbreviations

All issues of the journal contain internationally estab-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.

References

The reference section contains all references numberedin 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. JOURNALS

All authors are cited if they are six or less; if they are 7or 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-likegrowth 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 DevelopmentConference. Neurofibromatosis conference statement. ArchNeurol 1988;45:575-578.

Article type specification:

Schreiner GF, Lange L. Ethanol modulation ofmacrophage 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. BOOKS

Chapter in book:

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.

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-ROM

Anderson SC, Poulsen KB. Anderson’s electronic atlas

of hematology [CD-ROM]. Philadelphia: Lippincott Wil-

liams & Wilkins; 2002.

IV. ON THE INTERNET

Article in journal

Abood S. Quality improvement initiative in nursing

homes: the ANA acts in an advisory role. Am J Nurs [Inter-

net]. 2002 Jun: Webpage: http://www.nursingworld.org/

AJN/2002/june/Wawatch.htm

Monograph

Foley 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

Websites

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

ciation of Cancer Online Resources, Inc.; 2002:

http://www.cancer-pain.org/

Tables and Figures

Three copies should be submitted (original plus 2

copies). Their width should either be equal to the width of

one column (7.5 cm) or to the width of the page (15.5 cm).

Their maximum length, titles included, should not exceed

22 cm.

Tables are numbered with Arabic numerals in the order

in which they appear in the text. They should have a short

title 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, at

the back of every picture, the number of the picture and the

name of the first author should be noted in pencil, with an

arrow showing the top of the picture. The identity of pa-

tients should not be recognizable from their pictures nor

should 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.


325∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏

¶·È‰È·ÙÚÈÎ‹ 2005;68:325-328

™ÙÔ 43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ Â›¯·ÌÂ ÙËÓ ÙÈÌ‹ Î·È ÙË ¯·Ú¿ Ó· ·Ú·ÎÔÏÔ˘ı‹ÛÔ˘ÌÂ ÙËÓ

ÔÌÈÏ›· ÙÔ˘ ¶Ú‡Ù·ÓË ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∫·ıËÁËÙ‹ °ÂˆÚÁ›Ô˘ ª·ÌÈÓÈÒÙË ÌÂ ı¤Ì·: “∂ÏÏË-

ÓÈÎ‹ ÁÏÒÛÛ·. ∏ Û˘Ì‚ÔÏ‹ ÙË˜ ÛÂ ‚·ÛÈÎ¤˜ ¤ÓÓÔÈÂ˜ ÙÔ‡ ∂˘Úˆ·˚ÎÔ‡ ÔÏÈÙÈÛÌÔ‡”.

∞ÓÙ·ÔÎÚÈÓfiÌÂÓÔÈ ÛÙÔ ·›ÙËÌ· ÔÏÏÒÓ Û˘Ó·‰¤ÏÊˆÓ, ‰ËÌÔÛÈÂ‡Ô˘ÌÂ ¤Ó· ·fiÛ·ÛÌ· ÙË˜ ÔÌÈÏ›·˜

ÙÔ˘ ∫·ıËÁËÙ‹, Ô˘ ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ ·ÔÙÂÏÂ› ¿ÓÙ· ¤Ó· Â›Î·ÈÚÔ Î·È ¯Ú‹ÛÈÌÔ ı¤Ì·.

ªÂ ÙËÓ Â˘Î·ÈÚ›· ·˘Ù‹ ı· ı¤Ï·ÌÂ Ó· Â˘¯·ÚÈÛÙ‹ÛÔ˘ÌÂ ÙÔÓ ∫·ıËÁËÙ‹, ÁÈ·Ù› Ì·˜ ‰È¤ıÂÛÂ ÙÔ ÎÂ›ÌÂÓÔ

ÙË˜ ÔÌÈÏ›·˜ ÙÔ˘.

°È· ÙË ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜

¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

∂¡∞ƒ∫∆∏ƒπO™ Oªπ§π∞ ÛÙÔ 43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ

∂ÏÏËÓÈÎ‹ ÁÏÒÛÛ·

∏ Û˘Ì‚ÔÏ‹ ÙË˜ ÛÂ ‚·ÛÈÎ¤˜ ¤ÓÓÔÈÂ˜ ÙÔ‡ ∂˘Úˆ·˚ÎÔ‡ ÔÏÈÙÈÛÌÔ‡

°ÂÒÚÁÈÔ˜ ¢. ª·ÌÈÓÈÒÙË˜

∫¿ıÂ ·ÓıÚÒÈÓË ÁÏÒÛÛ· Â›Ó·È ÌÈ· ÌÔÚÊ‹ Ù·ÍÈÓfiÌËÛË˜ ÙÔ‡ ÎfiÛÌÔ˘. ∫¿ıÂ ÂıÓÈÎ‹ ÁÏÒÛÛ·, Ë

ÁÏÒÛÛ· Ô˘ ÌÈÏ¿ÂÈ ¤Ó· ¤ıÓÔ˜ Â›Ó·È Ô ÙÚfiÔ˜ Ô˘ Û˘ÏÏ·Ì‚¿ÓÂÈ, ÂÂÍÂÚÁ¿˙ÂÙ·È Î·È Ù·ÍÈÓÔÌÂ› ÙÔÓ

ÎfiÛÌÔ Ô Ï·fi˜ Ù‹˜ ¯ÒÚ·˜ Ô˘ ÌÈÏ¿ÂÈ ·˘Ù‹ ÙË ÁÏÒÛÛ·. ŒÙÛÈ, Î¿ıÂ ÁÏÒÛÛ· - fiˆ˜ ÙÔ ¤¯ÂÈ ‰È‰¿ÍÂÈ Ô

Saussure - Â›Ó·È Î·È ÌÈ· ¿ÏÏË Ù·ÍÈÓfiÌËÛË ÙÔ‡ ÎfiÛÌÔ˘. ŒÓ·˜ ¿ÏÏÔ˜ ÙÚfiÔ˜ Ó· ‚Ï¤ÂÈ˜, Ó· ·ÈÛı¿-

ÓÂÛ·È Î·È Ó· ‚¿˙ÂÈ˜ ÛÂ Ù¿ÍË ÙÔÓ ÎfiÛÌÔ. ∫È ·˘Ùfi Á›ÓÂÙ·È ÌÂ ÁÏˆÛÛÈÎ¿ Ì¤Û·. ªÂ ÙÔÓ ÙÚfiÔ Ô˘ ¤Ó·˜

Ï·fi˜ Îˆ‰ÈÎÔÔÈÂ› ÁÏˆÛÛÈÎ¿ ÙÈ˜ ¤ÓÓÔÈÂ˜ ÛÂ ÛËÌ·Û›Â˜, ·˘Ù¤˜ Ô˘ ÂÈÏ¤ÁÂÈ Î¿ıÂ Ï·fi˜ ÁÈ· Ó· ÂÎÊÚ¿-

˙ÂÈ ÙÈ˜ ¤ÓÓÔÈÂ˜ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È. ŒÙÛÈ, Ë ÁÏˆÛÛÈÎ‹ ‰È·‰ÈÎ·Û›· Â›Ó·È ¿ÌÂÛË Û˘Ó¿ÚÙËÛË Ù‹˜ ÛÎ¤„Ë˜ Î·È

Ù‹˜ ÓÔÔÙÚÔ›·˜ Î¿ıÂ Ï·Ô‡.

∞˜ Ô‡ÌÂ ·fi ÙÒÚ· ÌÈ· ¿ÏÏË ‚·ÛÈÎ‹ ı¤ÛË: O ¿ÓıÚˆÔ˜ ÛÎ¤ÙÂÙ·È Ì¤Û· ·fi ÙÈ˜ Ï¤ÍÂÈ˜ Î·È Ì¤-

Û· ·fi ÙÈ˜ ÁÚ·ÌÌ·ÙÈÎ¤˜ ‰ÔÌ¤˜ Î·È ÛËÌ·Û›Â˜ ÌÂ ÙÈ˜ ÔÔ›Â˜ Â›Ó·È ÔÚÁ·ÓˆÌ¤ÓË Ë ÁÏÒÛÛ· ÙÔ˘. øÛÙfi-

ÛÔ, ·˘Ùfi˜ Ô “ÁÏˆÛÛÈÎfi˜ ÓÙÂÙÂÚÌÈÓÈÛÌfi˜”, ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ Ô ¿ÓıÚˆÔ˜ Â›Ó·È Î·È “‰Ô‡ÏÔ˜” Ù‹˜

ÁÏÒÛÛ·˜ ÙÔ˘, ÁÈ·Ù› ·ÎÚÈ‚Ò˜ Ë ÁÏÒÛÛ· ÙÔ‡ ·ÓıÚÒÔ˘ - fiˆ˜ ¤¯ÂÈ ‰È‰¿ÍÂÈ ÌÂ ¤ÌÊ·ÛË Ô N. Chomsky

- ¯·Ú·ÎÙËÚ›˙ÂÙ·È Î·Ù’ ÂÍÔ¯‹Ó ·fi ÌÈ· È‰ÈfiÙËÙ·, ÙË ‰ËÌÈÔ˘ÚÁÈÎfiÙËÙ· (creativity). ¢˘Ó¿ÌÂÈ ‰ËÏ. ‰ÂÓ

˘¿Ú¯ÂÈ Î·Ó¤Ó·˜ ÊÚ·ÁÌfi˜ ÛÙË ÁÏˆÛÛÈÎ‹ ¤ÎÊÚ·ÛË ÙÔ‡ ·ÓıÚÒÔ˘ , Ú¿ÁÌ· Ô˘ ÂÈ‚Â‚·ÈÒÓÂÈ Î·È

Ô Wittgenstein Ï¤ÁÔÓÙ·˜ ÙÔ ÂÚ›ÊËÌÔ “fi,ÙÈ ÌÔÚÒ Ó· Û˘ÏÏ¿‚ˆ Î·ı·Ú¿ ÌÂ ÙÔÓ ÓÔ˘ ÌÔ˘, ÌÔÚÒ Ó· ÙÔ ÂÎ-

ÊÚ¿Ûˆ Î·ı·Ú¿ Î·È ÌÂ ÙË ÁÏÒÛÛ· ÌÔ˘”, ÂÓÓÔÒÓÙ·˜ fiÙÈ ‰ÂÓ ÌÔÚÔ‡ÌÂ Ó· ÂÎÊÚ¿ÛÔ˘ÌÂ ÁÏˆÛÛÈÎ¿ ÌÂ Û·-

Ê‹ÓÂÈ· ÌfiÓÔÓ fi,ÙÈ ‰ÂÓ ¤¯Ô˘ÌÂ ÍÂÎ·ı·Ú›ÛÂÈ ÚÒÙ· ÛÙÔ Ì˘·Ïfi Ì·˜.

™˘Ì¤Ú·ÛÌ·: °ÏÒÛÛ· Î·È ‰È·ÓfiËÛË Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· Î·È ÛÙÂÓ¿ ÌÂ ÌÈ· Û¯¤ÛË, Ô˘ ‰ÂÓ Â›Ó·È

Û¯¤ÛË “˘ÔÙ·Á‹˜” Ù‹˜ Ì›·˜ ÛÙËÓ ¿ÏÏË (Ù‹˜ ÁÏÒÛÛ·˜ ÛÙË ‰È·ÓfiËÛË ‹ Ù‹˜ ‰È·ÓfiËÛË˜ ÛÙË ÁÏÒÛÛ·),

·ÏÏ¿ Û¯¤ÛË ·ÌÔÈ‚·ÈfiÙËÙ·˜, ÂÏÂ˘ıÂÚ›·˜ Î·È ‰ËÌÈÔ˘ÚÁÈÎfiÙËÙ·˜. ¢È·ÓÔÔ‡ÌÂı· ‰È¿ ÙˆÓ Ï¤ÍÂˆÓ, ·ÏÏ¿

Î·È ÚÈÓ Î·È ¤Ú· ·fi ÙÈ˜ Ï¤ÍÂÈ˜. ¢ÂÓ Â›Ó·È Ù˘¯·›Ô ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ŒÏÏËÓÂ˜, Û˘ÓÂÈ‰ËÙÔÔÈÒÓÙ·˜

ÙË ÛÙÂÓ‹ Û¯¤ÛË ÓfiËÛË˜ Î·È ÁÏÒÛÛ·˜, ¤ÊÙ·Û·Ó Ó· ¯ÚËÛÈÌÔÔÈ‹ÛÔ˘Ó ÙË Ï¤ÍË ÏfiÁÔ˜ ÌÂ ‰ÈÙÙ‹ ÛËÌ·-

Û›·: Ù‹˜ ÏÔÁÈÎ‹˜ ÛÎ¤„Ë˜ (ratio) Î·È Ù‹˜ ¤ÏÏÔÁË˜ ÁÏÒÛÛ·˜ (oratio).

∂ÏÏËÓÈÎ‹ ÁÏÒÛÛ·

∂›Ó·È ÁÓˆÛÙfi Î·È Â˘Ú‡ÙÂÚ· ·Ú·‰ÂÎÙfi fiÙÈ ÔÈ ŒÏÏËÓÂ˜ Î·Ù¿ ÙËÓ ·Ú¯·ÈfiÙËÙ· (È‰›ˆ˜ ÛÙÔ˘˜ ÏÂÁfi-

ÌÂÓÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ¯ÚfiÓÔ˘˜) ·Ó¤Ù˘Í·Ó ¤Ó·Ó ÔÏÈÙÈÛÌfi, ¤Ó· Û‡ÛÙËÌ· ·Ú¯ÒÓ Î·È ·ÍÈÒÓ ÌÂ ÂÈÙÂ‡Á-

Ì·Ù· ÛÙÔ˘˜ ıÂÛÌÔ‡˜ Î·È ÛÙÈ˜ Ù¤¯ÓÂ˜, ÙÈ˜ ÂÈÛÙ‹ÌÂ˜ Î·È Ù· ÁÚ¿ÌÌ·Ù·, Ô˘ ·ÂÙ¤ÏÂÛ·Ó ÙË ‚¿ÛË Î·È

ÛÊÚ¿ÁÈÛ·Ó fi,ÙÈ ÔÓÔÌ¿˙Ô˘ÌÂ Â˘Úˆ·˚Îfi ÔÏÈÙÈÛÌfi.

∞˘Ù‹ Ë “¤ÎÚËÍË” ÛÙÔÓ ÔÏÈÙÈÛÌfi ÙˆÓ ∂ÏÏ‹ÓˆÓ ‹Ù·Ó ·fiÚÚÔÈ· ÌÈ·˜ ÍÂ¯ˆÚÈÛÙ‹˜ ‰È·ÓÔËÙÈÎ‹˜

·Ó¿Ù˘ÍË˜ Ô˘ ÍÂÎ›ÓËÛÂ ·fi ÙÔ ÂÚÂ˘ÓËÙÈÎfi ÙÔ˘˜ ÓÂ‡Ì·, ·fi ÙËÓ ÂÈı˘Ì›· ÙÔ˘˜ Ó· ÁÓˆÚ›ÛÔ˘Ó


326 ∂Ó·ÚÎÙ‹ÚÈÔ˜ ÔÌÈÏ›·

ÙÔÓ ÎfiÛÌÔ Î·È ÙÔÓ Â·˘Ùfi ÙÔ˘˜, Ó· ÚÔ‚ÏËÌ·ÙÈÛÙÔ‡Ó ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ‡ ÎfiÛÌÔ˘, ÁÈ· ÙÔÓ £Âfi,

ÁÈ· Ù· Ú¿ÁÌ·Ù·, ÁÈ· ÙËÓ Ô˘Û›· Î·È ÙË ÌÔ›Ú· ÙÔ‡ ·ÓıÚÒÔ˘, ÁÈ· ÙÈ˜ Û¯¤ÛÂÈ˜ ÙˆÓ ·ÓıÚÒˆÓ ÌÂÙ·Í‡

ÙÔ˘˜ Î.Ï. OÈ ·Ó·˙ËÙ‹ÛÂÈ˜ ·˘Ù¤˜, ÚÔ¿ÓÙˆÓ Ë ÈÎ·ÓfiÙËÙ· Î·È Ë ÓÂ˘Ì·ÙÈÎ‹ ·ÓËÛ˘¯›· ÙÔ˘˜ Ó· ı¤-

ÙÔ˘Ó ÚÔ‚Ï‹Ì·Ù· Î·È ÂÚˆÙ‹Ì·Ù·, ÙÔ˘˜ ¤ÊÂÚ·Ó ÛÙËÓ ÂÈÛ‹Ì·ÓÛË ·Ú¯ÒÓ Î·È ·ÍÈÒÓ Ô˘ Ú¤ÂÈ Ó·

‰È¤Ô˘Ó ÙË ˙ˆ‹ ÙÔ‡ ·ÓıÚÒÔ˘ Î·È Ô˘ ‚Ú‹Î·Ó ÙËÓ ¤ÎÊÚ·Û‹ ÙÔ˘˜ ÛÙÔ˘˜ ÔÏÈÙÂÈ·ÎÔ‡˜ ıÂÛÌÔ‡˜ (ÙÈ

fiÚÈ· ı¤ÙÂÈ ÛÙÔ Û˘ÓÂÈ‰ËÙfi ÔÏ›ÙË Ë ·›ÛıËÛË Â˘ı‡ÓË˜ Ô˘ ÁÂÓÓ¿ Ë ‰ËÌÔÎÚ·Ù›·) ·ÏÏ¿ Î·È ÛÙÔ ‰Ú¿-

Ì· (ÔÈ· Â›Ó·È Ë Û¯¤ÛË Î·È ÔÈ· Â›Ó·È Ë ¿ÏË ÙÔ‡ ·ÓıÚÒÔ˘ ÌÂ ÙË ÌÔ›Ú· ÙÔ˘). ∆Ô˘˜ ‰›‰·Í·Ó fiÙÈ Â›-

Ó·È ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ¿ÓıÚˆÔ Ó· Î·ÏÏÈÂÚÁ‹ÛÂÈ ÙÔ ÓÂ‡Ì· ÙÔ˘, Ó· ·ÔÎÙ‹ÛÂÈ ·È‰Â›·, ·Ú¿ÏÏË-

Ï· ÌÂ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ‡ ÛÒÌ·ÙÔ˜, ÙËÓ ¿ÛÎËÛË Û˘Ó‰˘·ÛÌ¤ÓË ÌÂ ÙËÓ ¿ÌÈÏÏ·, ‰ËÏ. ÙÔÓ ·ıÏËÙÈÛÌfi.

∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ Ë Û‡ÏÏË„Ë Î·È Î·ıÈ¤ÚˆÛË ÙˆÓ OÏ˘ÌÈ·ÎÒÓ ·ÁÒÓˆÓ, ÂÛÙÈ·ÛÌ¤ÓˆÓ ·Ô-

ÎÏÂÈÛÙÈÎ¿ ÛÙËÓ Â˘ÁÂÓ‹ ¿ÌÈÏÏ· Î·È Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÌÂ ÙËÓ ·fi‰ÔÛË ‡„ÈÛÙˆÓ ÙÈÌÒÓ ÛÙÔ˘˜ OÏ˘-

ÌÈÔÓ›ÎÂ˜ Î·È ÌÂ ·‡ÛË ÙˆÓ Â¯ıÚÔÚ·ÍÈÒÓ, ‰ËÏ·‰‹ ÌÂ ¤ÓÙÔÓ· ÓÂ˘Ì·ÙÈÎfi Ì‹Ó˘Ì·, ·ÓÂÏÏ‹ÓÈ·

Û˘ÌÌÂÙÔ¯‹ Î·È ÎÏ›Ì· ÊÈÏ›·˜.

OÈ ÌÂÁ¿ÏÔÈ ÛÙÔ¯·ÛÙ¤˜, ÊÈÏfiÛÔÊÔÈ ‹ ÂÈÛÙ‹ÌÔÓÂ˜ ‹ ÔÈËÙ¤˜ ‹ ‰Ú·Ì·ÙÔ˘ÚÁÔ›, ÁÈ· Ó· ÂÎÊÚ¿ÛÔ˘Ó

ÙÈ˜ ‰È·ÓÔËÙÈÎ¤˜ ÙÔ˘˜ Û˘ÏÏ‹„ÂÈ˜, ¯ÚÂÈ¿˙ÔÓÙ·Ó ÌÈ· Î·ÏÏÈÂÚÁËÌ¤ÓË ÁÏÒÛÛ·, ÌÈ· ÁÏÒÛÛ· Ô˘ Ó·

ÚÔÛÊ¤ÚÂÙ·È ÛÙË ‰‹ÏˆÛË ÙÔ‡ ÏÔ‡ÙÔ˘ Ó¤ˆÓ ÂÓÓÔÈÔÏÔÁÈÎÒÓ Û˘ÏÏ‹„ÂˆÓ Î·È ÙˆÓ ·Ô¯ÚÒÛÂÒÓ

ÙÔ˘˜. O ÊÈÏÔÛÔÊÈÎfi˜ ÛÙÔ¯·ÛÌfi˜ ÚÔËÁÂ›Ù·È Î·È ‰ËÌÈÔ˘ÚÁÂ› ÙÔÓ ÊÈÏÔÛÔÊÈÎfi ÏfiÁÔ. OÈ ·Ó¿ÁÎÂ˜ ÙˆÓ

ÔÏÈÙÒÓ Ó· ·ÁÔÚÂ‡ÛÔ˘Ó ‰ËÌfiÛÈ· ÁÈ· Ù· ÎÔÈÓ¿ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙÔÓ ÔÏÈÙÈÎfi ÏfiÁÔ. OÈ ÂÈÛÙËÌÔÓÈÎ¤˜

·Ó·˙ËÙ‹ÛÂÈ˜ Î·È Ë ·Ó¿ÁÎË ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Ó· ÙÈ˜ ‰ËÏÒÛÔ˘Ó ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ÏfiÁÔ.

∏ Ô›ËÛË Î·È ÙÔ ‰Ú¿Ì· ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙÔÓ ˘„ËÏÒÓ ··ÈÙ‹ÛÂˆÓ ÏÔÁÔÙÂ¯ÓÈÎfi Î·È ıÂ·ÙÚÈÎfi ÏfiÁÔ. ∏ ·È-

‰Â›·, Ô ÔÏÈÙÈÛÌfi˜, Ë ‰È·ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍË Â›Ó·È Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙËÓ ·Ó¿ÁÎË Î·È ÙÈ˜ ÚÔ¸-

Ôı¤ÛÂÈ˜ ‡·ÚÍË˜ ÌÈ·˜ Î·ÏÏÈÂÚÁËÌ¤ÓË˜ ÁÏÒÛÛ·˜, ÌÈ·˜ Ú·ÁÌ·ÙÈÎ¿ ‰ËÌÈÔ˘ÚÁÈÎ‹˜ ÁÏÒÛÛ·˜ Ô˘

Ó· ÌÔÚÂ› Ó· ÂÎÊÚ¿˙ÂÈ ÙËÓ ÏÔ‡ÛÈ· ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ˘˜ ÙÔÌÂ›˜ Ù‹˜ ÂÈÛÙ‹ÌË˜ Î·È ÙÔ‡ ÔÏÈ-

ÙÈÛÌÔ‡. ∏ ÔÈÔÙÈÎ‹ Î·È ‰ËÏˆÙÈÎ‹ ·˘Ù‹ ÁÏÒÛÛ·, ¿·Í Î·È Û˘ÓÙÂÏÂÛıÂ›, ÙÚÔÊÔ‰ÔÙÂ› ÌÂ ÙË ÛÂÈÚ¿

ÙË˜ ÙË ‰È·ÓfiËÛË Î·È ÙËÓ ·Ú·ÎÈÓÂ› Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ ‰ËÌÈÔ˘ÚÁÈÎ¿.

OÈ ÌÂÁ¿ÏÔÈ ÛÙÔ¯·ÛÙ¤˜ (ÊÈÏfiÛÔÊÔÈ, ÔÈËÙ¤˜, ‰Ú·Ì·ÙÔ˘ÚÁÔ›, ÈÛÙÔÚÈÎÔ›, ÂÈÛÙ‹ÌÔÓÂ˜ Î.Ï.) Â›Ó·È ÂÍ

·Ó¿ÁÎË˜ Î·È ÌÂÁ¿ÏÔÈ ‰ËÌÈÔ˘ÚÁÔ› ÁÏÒÛÛ·˜. ∆Ô ÏÂÙfi, Û‡ÓıÂÙÔ, ··ÈÙËÙÈÎfi, ÚˆÙfiÙ˘Ô ÛÂ È‰¤Â˜ Î·È

ÛÎ¤„ÂÈ˜ ÂÚÈÂ¯fiÌÂÓÔ ÂÓfi˜ ÎÂÈÌ¤ÓÔ˘ ··ÈÙÂ› Î·È ·Ó¿ÏÔÁË ÔÈfiÙËÙ· ÁÏÒÛÛ·˜ Ô˘ Ó· ÙÔ ‰ËÏÒÓÂÈ.

ŒÙÛÈ Ï.¯. ÛÙÔ ÏÂÍÈÏfiÁÈÔ ÔÈ ŒÏÏËÓÂ˜ ‰È¤ıÂÙ·Ó ¤Ó·Ó ÏÂÍÈÏÔÁÈÎfi ÌË¯·ÓÈÛÌfi Ô˘ ÂÍ·ÛÊ¿ÏÈ˙Â ÛÙÔÓ

ÔÌÈÏËÙ‹ Ù‹˜ ∂ÏÏËÓÈÎ‹˜ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÍÂÈ‰ÈÎÂ‡ÂÈ ÙË ÛËÌ·Û›· ÙÔ‡ Ú‹Ì·ÙÔ˜ ÛÂ ÂÎÏËÎÙÈÎ‹ ÎÏ›-

Ì·Î·, ÙÚÔÔÔÈÒÓÙ·˜ ÏÈÁfiÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔ ‹ ÌÂÙ·‚¿ÏÏÔÓÙ·˜ ÙË ‚·ÛÈÎ‹ ÛËÌ·Û›· Ù‹˜ Ï¤ÍË˜.

∞˘Ùfi ÂÈÙ˘Á¯·ÓfiÙ·Ó ÌÂ ÙÔÓ ÌË¯·ÓÈÛÌfi ÙˆÓ ÚÔÚÚËÌ·ÙÈÎÒÓ, ÙˆÓ ÚÔı¤ÛÂˆÓ Ô˘ Û˘ÓÙ›ıÂÓÙÔ ÌÂ Ù·

Ú‹Ì·Ù·. Ã·Ú·ÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· Â›Ó·È ÙÔ Ú‹Ì· ‚¿ÏÏˆ Ù‹˜ ·Ú¯·›·˜ ∂ÏÏËÓÈÎ‹˜. ™ÙÔ ÏÂÍÈÎfi ÙˆÓ

Liddell-Scott-Jones ·Ú·‰›‰ÔÓÙ·È 104 Û‡ÓıÂÙ· Ú‹Ì·Ù· ÙÔ‡ ‚¿ÏÏˆ ÌÂ ÚÔÚÚËÌ·ÙÈÎ¿:

ÂÎ‚¿ÏÏˆ ÂÌ‚¿ÏÏˆ ÂÈÛ‚¿ÏÏˆ Û˘Ì‚¿ÏÏˆ ÚÔ‚¿ÏÏˆ ÚÔÛ‚¿ÏÏˆ

·Ó·‚¿ÏÏˆ Î·Ù·‚¿ÏÏˆ ‰È·‚¿ÏÏˆ ÌÂÙ·‚¿ÏÏˆ ·Ô‚¿ÏÏˆ ÂÚÈ‚¿ÏÏˆ

˘ÂÚ‚¿ÏÏˆ ·Ú·‚¿ÏÏˆ ˘Ô‚¿ÏÏˆ ·ÓÙÈ‚¿ÏÏˆ ÂÈ‚¿ÏÏˆ Î.Ô.Î.

∞˜ ÛËÌÂÈˆıÂ› fiÙÈ ÙÔ Ú‹Ì· ÙÔ Û‡ÓıÂÙÔ ÌÂ ¤Ó· ÚÔÚÚËÌ·ÙÈÎfi ÌÔÚÂ› Ó· ÂÍÂÈ‰ÈÎÂ‡ÂÙ·È ÂÚ·ÈÙ¤-

Úˆ ÌÂ ÂÈÏ¤ÔÓ ÚÔÚÚËÌ·ÙÈÎ¿:

ÂÈ-‚¿ÏÏˆ: Û˘Ó-ÂÈ‚¿ÏÏˆ ÚÔ-ÂÈ‚¿ÏÏˆ ·Ú-ÂÈ‚¿ÏÏˆ ÚÔÛ-ÂÈ‚¿ÏÏˆ

‰È·-‚¿ÏÏˆ: ÂÈ-‰È·‚¿ÏÏˆ ·ÓÙÈ-‰È·‚¿ÏÏˆ ÂÓ-‰È·‚¿ÏÏˆ Û˘Ó-‰È·‚¿ÏÏˆ

˘Ô-‰È·‚¿ÏÏˆ ÚÔ-‰È·‚¿ÏÏˆ ÚÔÛ-‰È·‚¿ÏÏˆ

∂Ó Û˘ÓÂ¯Â›· ı· ÂÚÈÔÚ›Ûˆ ÙÔÓ ÏfiÁÔ ÌÔ˘ ÛÂ ÌÂÚÈÎ¿ ‰Â›ÁÌ·Ù· Ï¤ÍÂˆÓ-ÂÓÓÔÈÒÓ Ù‹˜ ∂ÏÏËÓÈÎ‹˜ Ô˘

¤Ú·Û·Ó ÛÙÈ˜ Â˘Úˆ·˚Î¤˜ ÁÏÒÛÛÂ˜ (·ÁÁÏÈÎ‹, Á·ÏÏÈÎ‹, ÁÂÚÌ·ÓÈÎ‹, ÈÙ·ÏÈÎ‹, ÈÛ·ÓÈÎ‹ Î.¿.).

∂˘ÚÒË (Europe): ∆Ô fiÓÔÌ· Ù‹˜ ∂˘ÚÒË˜ Â›Ó·È Ë ÂÏÏËÓÈÎ‹ ÔÓÔÌ·Û›· ÂÓfi˜ Ì˘ıÔÏÔÁÈÎÔ‡ ÚÔ-

ÛÒÔ˘ Ô˘ Û‹Ì·ÈÓÂ Èı·ÓfiÙ·Ù· “·˘Ù‹Ó Ô˘ ¤¯ÂÈ Â˘ÚÂ›˜ Ò·˜, ÌÂÁ¿Ï· Ì¿ÙÈ·”. ∏ Ú›˙· Ô- ‚Ú›ÛÎÂÙ·È

ÛÂ Ï¤ÍÂÈ˜ fiˆ˜ ÔÙÈÎfi˜ (optical, optician), ÂÓÒ ·fi ÙÔ fiÓÔÌ· Ù‹˜ ∂˘ÚÒË˜ ÚÔ‹ÏıÂ Î·È Ë ÔÓÔÌ·Û›·

ÙÔ‡ Â˘Úˆ·˚ÎÔ‡ ÓÔÌ›ÛÌ·ÙÔ˜ euro (Â˘Úˆ), ÙÔ ÔÔ›Ô Ì¿ÏÈÛÙ· ÁÚ¿ÊÂÙ·È ¿Óˆ ÛÙÔ ¯·ÚÙÔÓfiÌÈÛÌ· Î·È

ÌÂ ÙËÓ ÂÏÏËÓÈÎ‹ ÁÚ·Ê‹ Ù‹˜ Ï¤ÍË˜.

¶·È‰È·ÙÚÈÎ‹ 2005;68:325-328


327∂Ó·ÚÎÙ‹ÚÈÔ˜ ÔÌÈÏ›·

ŒÓ·˜ ÂÓÓÔÈÔÏÔÁÈÎfi˜ ¯ÒÚÔ˜ fiÔ˘ ÔÈ ÂÏÏËÓÈÎ¤˜ ¤ÓÓÔÈÂ˜ ¤Ú·Û·Ó ÌÂ ÂÏÏËÓÈÎ¤˜ Ï¤ÍÂÈ˜ ÛÙÈ˜ Â˘Úˆ-

·˚Î¤˜ ÁÏÒÛÛÂ˜ Â›Ó·È ÙÔ ÂÓÓÔÈÔÏÔÁÈÎfi Â‰›Ô Ù‹˜ ÔÏÈÙÈÎ‹˜, ÙˆÓ ıÂÛÌÒÓ Î·È Ù‹˜ È‰ÂÔÏÔÁ›·˜:

ÔÏÈÙÈÎ‹ (politics): ∏ Ï¤ÍË ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ÂÏÏËÓÈÎfi ÔÏÈÙÈÎfi˜: ÔÏÈÙÈÎ‹ Ù¤¯ÓË ‹ ÂÈÛÙ‹ÌË

‹Ù·Ó ÔÈ Ú¿ÍÂÈ˜ Î·È ÔÈ ÁÓÒÛÂÈ˜ ÙÔ‡ ˘Â‡ı˘ÓÔ˘ Î·È ÂÓÂÚÁÔ‡ ÔÏ›ÙË ÛÙËÓ ¿ÌÂÛË ‰ËÌÔÎÚ·Ù›· Ù‹˜

·Ú¯·›·˜ ∞ı‹Ó·˜, ÙÔ‡ ÔÏ›ÙË, Ô˘ Â›Ó·È Ô Î¿ÙÔÈÎÔ˜ Ù‹˜ fiÏË˜ (Ù‹˜ fiÏË˜-ÎÚ¿ÙÔ˘˜ ÛÙËÓ ·Ú¯·›· ‰Ë-

ÌÔÎÚ·Ù›·).

‰ËÌÔÎÚ·Ù›· (democracy): ∞fi ÙÔ ‰‹ÌÔ˜ Î·È ÙÔ ÎÚ¿ÙÔ˜: ‰‹ÏˆÓÂ ÙË ‰‡Ó·ÌË, ÙËÓ ÂÍÔ˘Û›· ÙÔ‡ Ï·-

Ô‡, ÙˆÓ ÔÏÏÒÓ, ÙÔÓ ÔÏÈÙÒÓØ ·ÓÙÈÙÈı¤ÌÂÓÔ ÚÔ˜ ÙËÓ ·ÚÈÛÙÔÎÚ·Ù›· (aristocracy), ÙË ‰‡Ó·ÌË, ÙËÓ

ÂÍÔ˘Û›· ÙˆÓ ·Ú›ÛÙˆÓ, Ù‹˜ ÂÏ›Ù, Ô˘ Î·Ù¤ÏËÁÂ Ó· Â›Ó·È Ë ÂÍÔ˘Û›· ÙˆÓ Ï›ÁˆÓ. µ¿ÛË Ù‹˜ ‰ËÌÔÎÚ·Ù›·˜

‹Ù·Ó Ô ‰È¿ÏÔÁÔ˜ (dialogue) ·fi ÙÔ ‰È·Ï¤ÁÔÌ·È, “Û˘ÓÔÌÈÏÒ, Û˘˙ËÙÒ ÌÂ ÙÔ˘˜ ¿ÏÏÔ˘˜ ·Ó·˙ËÙÒÓÙ·˜

ÙËÓ ·Ï‹ıÂÈ·”. ∞fi ÙÔ ›‰ÈÔ Ú‹Ì· ÚÔ‹ÏıÂ Ë ‰È·ÏÂÎÙÈÎ‹ Ì¤ıÔ‰Ô˜ (dialectic) ÛÙË ÊÈÏÔÛÔÊ›·, Ë Ì¤-

ıÔ‰Ô˜ ·Ó·˙‹ÙËÛË˜ Ù‹˜ ·Ï‹ıÂÈ·˜ Ì¤Û· ·fi ÂÚˆÙ‹ÛÂÈ˜ Î·È ··ÓÙ‹ÛÂÈ˜, Ì¤Û· ·fi ÙÔÓ ‰È¿ÏÔÁÔ.

∞ÚÁfiÙÂÚ·, ÛÂ ÌÂÛ·ÈˆÓÈÎÔ‡˜ ¯ÚfiÓÔ˘˜, Ï¿ÛÙËÎÂ Î·È Ô ÌÔÓfiÏÔÁÔ˜ (ÌfiÓÔ˜ + ÏfiÁÔ˜, monologue) Ô˘

Â›¯Â ÂÍ·Ú¯‹˜ ·ÚÓËÙÈÎ‹ ÛËÌ·Û›·. ŸÏ· ·˘Ù¿ Â›Ó·È, ‚Â‚·›ˆ˜, ı¤Ì·Ù· ÔÏÈÙÈÎ‹˜ È‰ÂÔÏÔÁ›·˜/ideology),

ÌÈ·˜ ¿ÏÏË˜ ÁÓˆÛÙ‹˜ Ï¤ÍË˜ ÙÔ‡ ÔÏÈÙÈÎÔ‡ ÏÂÍÈÏÔÁ›Ô˘, Ë ÔÔ›· ÍÂÎÈÓ¿ÂÈ ·fi ÙËÓ ÔÏ‡ ÛËÌ·ÓÙÈÎ‹

ÂÏÏËÓÈÎ‹ Ï¤ÍË È‰¤·, ·˘Ù‹ Ô˘ ¤‰ˆÛÂ ÛÙÈ˜ Â˘Úˆ·˚Î¤˜ ÁÏÒÛÛÂ˜ fiÏÂ˜ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ Ï¤ÍÂÈ˜ (·ÁÁÏ.

idea, Á·ÏÏ. idée, ÁÂÚÌ. idee Î.Ï.). ∏ ·Ú¯ÈÎ‹ ÛËÌ·Û›· ÙÔ‡ È‰¤· Â›Ó·È “·˘Ùfi Ô˘ ‚Ï¤ˆ ÌÂ ÙÔÓ ÓÔ˘

ÌÔ˘, Ô˘ Û˘ÏÏ·Ì‚¿Óˆ ÌÂ ÙÔ Ì˘·Ïfi ÌÔ˘”, ÍÂÎÈÓ¿ÂÈ ‰ËÏ·‰‹ ·fi ÙËÓ fiÚ·ÛË ˆ˜ ËÁ‹ ÁÓÒÛÂˆ˜. ∞fi

ÙËÓ ›‰È· Ú›˙· Ù‹˜ ∂ÏÏËÓÈÎ‹˜ ÚÔ¤Ú¯ÔÓÙ·È ‰‡Ô ¿ÏÏÂ˜ ÛËÌ·ÓÙÈÎ¤˜ Ï¤ÍÂÈ˜: Ë ÈÛÙÔÚ›· (< ›ÛÙˆÚ “Ô ÁÓÒ-

ÛÙË˜”), ·Ú¯ÈÎ¿ “·˘Ùfi˜ Ô˘ ‚Ï¤ÂÈ ÌÂ Ù· Ì¿ÙÈ· ÙÔ˘ Î·È ÁÓˆÚ›˙ÂÈ Î·Ï¿” (‚. ·ÁÁÏ. history Î·È story,

Á·ÏÏ. histoire) ·ÏÏ¿ Î·È “·˘Ùfi Ô˘ Ê·›ÓÂÙ·È ¯ˆÚ›˜ Î·È Ó· Â›Ó·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·”, ÙÔ Â›‰ˆÏÔ

(·ÁÁÏ. idol, Á·ÏÏ. idole).

¶ÔÏÏ¤˜ Ï¤ÍÂÈ˜ ÂÏÏËÓÈÎ¤˜ ¤Ú·Û·Ó ·fi ÙËÓ ÂÈÛÙ‹ÌË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÁÏÒÛÛ· ÌÈ·˜ ÈÔ ··È-

ÙËÙÈÎ‹˜ ÌÔÚÊ‹˜ ÂÈÎÔÈÓˆÓ›·˜. ¶·Ú·‰Â›ÁÌ·Ù·:

ıÂˆÚ›· (theory), Ú·ÎÙÈÎ‹ (practice), ÂÌÂÈÚÈÎfi˜ (empirical), ÏÔÁÈÎ‹ (logic), Û‡ÛÙËÌ·

(system), Ì¤ıÔ‰Ô˜ (method), Î·ÙËÁÔÚ›· (category), ÈÂÚ·Ú¯›· (hierarchy), ˘fiıÂÛÈ˜ (hypothesis),

·Ó¿Ï˘ÛÈ˜-Û‡ÓıÂÛÈ˜ (analysis-synthesis), ÎÚÈÙ‹ÚÈ· (criteria), Úfi‚ÏËÌ· (problem), Û‡Ì‚ÔÏÔ, ·Í›ˆ-

Ì·-·ÍÈˆÌ·ÙÈÎfi˜ (axiom-axiomatic), fiÚÁ·ÓÔ (organ, organize, organism), ÚfiÁÚ·ÌÌ· (program),

ı¤Ì· (theme), ı¤ÛÈ˜ (thesis), ÙfiÔ˜/ÙÔÈÎfi˜ (topic), Ù‡Ô˜ (type), Ê¿ÛË (phase), ·Ú¿ÏÏËÏÔ˜

(parallel), ˙ÒÓË (zone), ÛÎÂÙÈÎfi˜ (skeptic/skepticism), ·ÓÈÎfi˜, Û‡ÌÙˆÌ· (symptom), ıÂÚ·-

Â›· (therapy), ÎÏ›ÓË/ÎÏÈÓÈÎfi˜ (clinic), ‰È¿ÁÓˆÛÈ˜ (diagnosis), Ê¿ÚÌ·ÎÔ (pharmacy), ÂÓ‰ËÌÈÎfi˜-

ÂÈ‰ËÌÈÎfi˜ (endemic-epidemic).

∆¤ÏÔ˜ ˘¿Ú¯ÂÈ ¤Ó·˜ ·ÚÎÂÙ¿ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ Ï¤ÍÂˆÓ Ô˘ Â›Ó·È ÂÏÏËÓÈÎ¤˜, ·ÏÏ¿ Ô˘ ‰ÂÓ ÙÈ˜

·Ó·ÁÓˆÚ›˙ÂÈ Ô ÌË ÂÈ‰ÈÎfi˜ ·Ì¤Ûˆ˜. ªÂÚÈÎ¿ ·Ú·‰Â›ÁÌ·Ù·: butter Â›Ó·È Ô “‚Ô‡Ù˘ÚÔ˜”, paper Â›Ó·È Ô

¿˘ÚÔ˜, church/Kirche Â›Ó·È ÙÔ Î˘ÚÈ·ÎfiÓ (‰ÒÌ·), sketch Â›Ó·È ÙÔ Û¯¤‰ÈÔ (> schizzo > ÛÎ›ÙÛÔ Î·È

ÛÎÂÙ˜), scene Â›Ó·È Ë ÛÎËÓ‹ (> scenario> ÛÂÓ¿ÚÈÔ), pain Â›Ó·È Ë ÔÈÓ‹, calm ÙÔ Î·‡Ì· (> Î¿ÏÌ·),

pirate Â›Ó·È Ô ÂÈÚ·Ù‹˜, priest/prêtre Â›Ó·È ÙÔ ÚÂÛ‚‡ÙÂÚÔ˜, clergy Î·È clerk Â›Ó·È ÙÔ ÎÏËÚÈÎfi˜, bishop

ÙÔ Â›ÛÎÔÔ˜, monk Ô ÌÔÓ·¯fi˜, card Î·È chart Ô ¯¿ÚÙË˜, bomb Ô ‚fiÌ‚Ô˜, buffalo Ô ‚Ô‡‚·ÏÔ˜,

diploma Î·È diplomat ÙÔ ‰›ÏˆÌ· (< ‰ÈÏÒÓˆ). ∞˜ ÛËÌÂÈˆıÂ› fiÙÈ ·ÎfiÌË Î·È ÂˆÓ˘Ì›Â˜ ÂÙ·ÈÚÂÈÒÓ

·Ó·ÙÚ¤¯Ô˘Ó ÛÂ ÂÏÏËÓÈÎ¿ ÔÓfiÌ·Ù·: NIKE (Ó›ÎË) ·ıÏËÙÈÎ¿ Â›‰Ë, PEPSI-COLA (¤„È˜), FANTA (Ê·-

ÓÙ·Û›·), MONOPOLY, LEGO “·Ú¯. Ï¤Áˆ = Û˘Ó·ÚÌÔÏÔÁÒ”, IKEA (“Ô›ÎÔ˜”), XEROX (ÍËÚfi˜),

ROLEX (ˆÚÔÏfiÁÈÔ), METRO.

ªÂ ÂÏ¿¯ÈÛÙ· ·Ú·‰Â›ÁÌ·Ù· ÚÔÛ¿ıËÛ· Ó· ‰Â›Íˆ ÔÈ· Â›Ó·È Ë ·ÚÔ˘Û›· Ù‹˜ ÂÏÏËÓÈÎ‹˜ ÁÏÒÛ-

Û·˜ Ì¤Û· ÛÙÔÓ Â˘Úˆ·˚Îfi ÔÏÈÙÈÛÌfi Î·È ÙËÓ Â˘Úˆ·˚Î‹ ÛÎ¤„Ë, fiˆ˜ ÂÎÊÚ¿˙ÂÙ·È ÌÂ ¤ÓÓÔÈÂ˜ Î·È

ÌÂ Ï¤ÍÂÈ˜ ÙˆÓ Â˘Úˆ·˚ÎÒÓ ÁÏˆÛÛÒÓ. £· ÌÔÚÔ‡Û· Ó· ·Ó·Ê¤Úˆ ¯ÈÏÈ¿‰Â˜ ÂÏÏËÓÈÎ¤˜ Ï¤ÍÂÈ˜, Ô˘ Â›-

Ó·È ‹‰Ë Û˘ÁÎÂÓÙÚˆÌ¤ÓÂ˜ ÛÂ ÂÈ‰ÈÎ¿ ¤ÚÁ· ÁÏˆÛÛÔÏfiÁˆÓ, ÊÈÏÔÏfiÁˆÓ Î·È ¿ÏÏˆÓ ÂÈÛÙËÌfiÓˆÓ Î·È Ô˘

ÌÔÚÂ› Ó· ‚ÚÂÈ Î·ÓÂ›˜ ÛÂ fiÏ· Ù· ¤ÁÎ˘Ú· ÏÂÍÈÎ¿ ÙˆÓ ÂÈÌ¤ÚÔ˘˜ Â˘Úˆ·˚ÎÒÓ ÁÏˆÛÛÒÓ.

£· ÛÙ·ıÒ ÌfiÓÔ ÛÂ ¤Ó· ¿ÚıÚÔ ÙÔ‡ ÔÏ‡ ÁÓˆÛÙÔ‡ ÕÁÁÏÔ˘ Î·ıËÁËÙ‹ Ù‹˜ °ÏˆÛÛÔÏÔÁ›·˜ David

Crystal, ÌÂ ÙÔÓ ·ÈÓÈÁÌ·ÙÈÎfi Ù›ÙÏÔ “∏ ∞ÁÁÏÈÎ‹ ˆ˜ ÎÏ·ÛÈÎ‹ ÁÏÒÛÛ·”. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi Ô D. Crystal ‰Â›-

¯ÓÂÈ fiÙÈ Ë ∞ÁÁÏÈÎ‹ Â›Ó·È ÌÈ· “ÎÏ·ÛÈÎ‹ ÁÏÒÛÛ·” ÌÂ ÙËÓ ¤ÓÓÔÈ· fiÙÈ ¿Óˆ ·fi Ù· 2/3 ÙÔ‡ ÏÂÍÈÏÔÁ›Ô˘

¶·È‰È·ÙÚÈÎ‹ 2005;68:325-328


328 ∂Ó·ÚÎÙ‹ÚÈÔ˜ ÔÌÈÏ›·

ÙË˜ ÚÔ¤Ú¯ÂÙ·È ·fi ‰‡Ô ÎÏ·ÛÈÎ¤˜ ÁÏÒÛÛÂ˜, ÙËÓ ∂ÏÏËÓÈÎ‹ Î·È ÙË §·ÙÈÓÈÎ‹! O Crystal ˘ÔÛÙËÚ›-˙ÂÈ Ì¿ÏÈÛÙ· ÙËÓ ¿Ô„Ë fiÙÈ Ë Â˘Ú‡Ù·ÙË Î˘ÚÈ·Ú¯›· Ù‹˜ ∞ÁÁÏÈÎ‹˜ ÔÊÂ›ÏÂÙ·È Î·Ù¿ ÔÏ‡ ÛÙÔ ÁÂÁÔ-Ófi˜ Ù‹˜ ÏÂÍÈÏÔÁÈÎ‹˜ ÙË˜ ÌÂ›ÍÂˆ˜, ÙÔ‡ ‰·ÓÂÈÛÌÔ‡ ‰ËÏ·‰‹ ·fi ÙÈ˜ ÎÏ·ÛÈÎ¤˜ Î˘Ú›ˆ˜ ÁÏÒÛÛÂ˜, Ô˘Î·ıÈÛÙ¿ ÙËÓ ∞ÁÁÏÈÎ‹ ÔÈÎÂ›· Î·È ·Ô‰ÂÎÙ‹ ·fi ÔÌÈÏËÙ¤˜ ¿ÏÏˆÓ ÁÏˆÛÛÒÓ. O Crystal ‰›ÓÂÈ ÛÙÔÎÏ·ÛÈÎfi ÏÂÍÈÏfiÁÈÔ ÌÈ· ¿ÏÏË ‰È¿ÛÙ·ÛË. ∆Ô ‚Ï¤ÂÈ ˆ˜ “ÂÓÔÔÈËÙÈÎ‹ ÈÛÙÔÚÈÎ‹ ·Ú¿‰ÔÛË” Ù‹˜ ∂˘ÚÒ-Ë˜, Ê¤ÚÂÈ ‰Â ÛÙÔ ÚÔÛÎ‹ÓÈÔ ÙÔÓ fiÚÔ “∂˘ÚˆÂÏÏËÓÈÎ‹”, ı¤ÏÔÓÙ·˜ Ì’ ·˘ÙfiÓ Ó· ‰ËÏÒÛÂÈ fiÙÈ Ë (·Ú¯·›·)∂ÏÏËÓÈÎ‹ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ÏÂÈÙÔ˘ÚÁÂ› ˆ˜ ˙ˆÓÙ·Ó‹ ÁÏÒÛÛ· Ù‹˜ ∂˘ÚÒË˜. π‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ‹ Â›-Ó·È Ë ·Ú·Ù‹ÚËÛË ÙÔ‡ Crystal fiÙÈ “ÔÈ ÎÏ·ÛÈÎ¤˜ ÁÏÒÛÛÂ˜ Û˘ÓÂ¯›˙Ô˘Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ∞ÁÁÏÈÎ‹ˆ˜ ‰˘Ó·ÌÈÎ‹ ËÁ‹ Ó¤ˆÓ Ï¤ÍÂˆÓ, ˆ˜ ËÁ‹ ÏÂÍÈÏÔÁÈÎ‹˜ ‰ËÌÈÔ˘ÚÁ›·˜ […] Â›Ó·È ÂÎÏËÎÙÈÎfi Ó· ‚Ï¤ÂÈ˜ fi-ÛÔ ÛÙËÚÈ˙fiÌ·ÛÙÂ ·ÎfiÌË ÛÙËÓ ∂ÏÏËÓÈÎ‹ Î·È ÙË §·ÙÈÓÈÎ‹, ÁÈ· Ó· ÌÈÏ‹ÛÔ˘ÌÂ ÁÈ· ÔÓÙfiÙËÙÂ˜ Î·È ÁÂÁÔÓfiÙ· Ô˘‚Ú›ÛÎÔÓÙ·È ÛÙËÓ Î·Ú‰È¿ Ù‹˜ Û‡Á¯ÚÔÓË˜ ˙ˆ‹˜”.

∆ÂÏÂÈÒÓÔÓÙ·˜ ı¤Ïˆ Ó· ÂÈÛÙ‹Ûˆ ÙËÓ ÚÔÛÔ¯‹ Û·˜ ÛÂ ÌÈ· ‚·ÛÈÎ‹ ÁÏˆÛÛÔÏÔÁÈÎ‹ ·Ú¯‹: Ë Û˘Ì-‚ÔÏ‹ ÌÈ·˜ ÁÏÒÛÛ·˜, ÂÓ ÚÔÎÂÈÌ¤Óˆ Ù‹˜ ∂ÏÏËÓÈÎ‹˜, ÛÂ ¿ÏÏË ‹ ¿ÏÏÂ˜ ÁÏÒÛÛÂ˜ ‰ÂÓ Â›Ó·È ı¤Ì· Ô-ÛÔÙÈÎfi. ∂›Ó·È ı¤Ì· ÔÈÔÙÈÎfi. ∂›Ó·È ¿ÏÏÔ Ú¿ÁÌ· ‰ËÏ. - ÛÂ Â›Â‰Ô ÂÈÎÔÈÓˆÓ›·˜, Î·ÏÏÈ¤ÚÁÂÈ·˜,ÓÔËÙÈÎ‹˜ ‰ÈÂÚÁ·Û›·˜ - Ó· ‰›ÓÂÈ˜ Ï.¯. Ï¤ÍÂÈ˜-¤ÓÓÔÈÂ˜ fiˆ˜ Ë ıÂˆÚ›·, Ë È‰¤·, Ë Ô›ËÛË, Ë ÙÂ¯ÓÔÏÔÁ›·, ËÔÏÈÙÈÎ‹, Ë ‰ËÌÔÎÚ·Ù›·, Ë Ê·ÓÙ·Û›·, Ô ‹Úˆ·˜, Ë ÌÔ˘ÛÈÎ‹, ÙÔ ı¤·ÙÚÔ, Ë ÈÛÙÔÚ›·, Î·È ¿ÏÏÔ Ó· ‰›ÓÂÈ˜ Ï¤-ÍÂÈ˜-¤ÓÓÔÈÂ˜ fiˆ˜ hamburger, fast-food, supermarket, kits, ÓÙÔÏÌ¿‰Â˜, Ì·ÚÌÔ‡ÙÈ ‹ Ï·ÌfiÁÈ·! °È·Ù› ËÔÈfiÙËÙ· Ù‹˜ ÛÎ¤„Ë˜ Î·È Ù‹˜ ¤ÎÊÚ·ÛË˜ Â›Ó·È Û˘Ó¿ÚÙËÛË Ù‹˜ ÔÈfiÙËÙ·˜ Ù‹˜ ÁÏÒÛÛ·˜ Î·È ÙÔ‡ ÛË-Ì·ÛÈÔÏÔÁÈÎÔ‡ ÊÔÚÙ›Ô˘ ÙˆÓ Ï¤ÍÂˆÓ. ∏ Û˘Ì‚ÔÏ‹ Ù‹˜ ÂÏÏËÓÈÎ‹˜ ÁÏÒÛÛ·˜ ÛÙÔÓ Â˘Úˆ·˚Îfi ÏfiÁÔ - ˆ˜ÛÎ¤„Ë Î·È ˆ˜ ÁÏÒÛÛ· - Â›Ó·È fiÙÈ ÚÔÛ¤‰ˆÛÂ ÛÙÔÓ Â˘Úˆ·˚Îfi ÏfiÁÔ ¤Ó· ¿ÏÏÔ “ÁÏˆÛÛÈÎfi ‹ıÔ˜”,¤Ó·Ó ÏfiÁÔ ÌÂ ÌÂÁ¿ÏË ‰ËÏˆÙÈÎ‹ ‰‡Ó·ÌË, ÌÂ ‰˘Ó·ÙfiÙËÙÂ˜ ÂÍ·ÈÚÂÙÈÎ‹˜ ·ÎÚ›‚ÂÈ·˜ Î·ıÒ˜ Î·È ÌÂÚˆÙfiÁÓˆÚË ÂÎÊÚ·ÛÙÈÎ‹ ÔÈÎÈÏ›· Î·È Â‡ÚÔ˜ ÛËÌ·ÛÈÔÏÔÁÈÎÒÓ ·Ô¯ÚÒÛÂˆÓ. ∆¤ÏÔ˜, Ë ÂÓÓÔÈÔÏfi-ÁËÛË Î·È ÏÂÍÈÎ‹ Û‹Ì·ÓÛË ÙÔ‡ ÎfiÛÌÔ˘ ÙˆÓ Ú·ÁÌ¿ÙˆÓ Î·È ÙÔ‡ Ê¿ÛÌ·ÙÔ˜ ÙˆÓ ·ÊËÚËÌ¤ÓˆÓ ÂÓÓÔÈ-ÒÓ Ô‰‹ÁËÛÂ ÛÙË ÁÓˆÛÙ‹ Î·È ÙÈÌËÙÈÎ‹ ÁÈ· ÙËÓ ÂÏÏËÓÈÎ‹ ÁÏÒÛÛ· Ú‹ÛË “The Greeks must have a wordfor it”! ∆Ô Ó· ¤¯ÂÈ˜ fiÌˆ˜ Ï¤ÍË ÁÈ· fiÏ· Ù· Ú¿ÁÌ·Ù· Î·È ÁÈ· Î¿ıÂ ¤ÓÓÔÈ· ÛËÌ·›ÓÂÈ Ó· ¤¯ÂÈ˜ ‰ÈÂ˘Ú‡-ÓÂÈ ÙfiÛÔ ÔÏ‡ Ù· fiÚÈ· Ù‹˜ ÁÓÒÛË˜ Î·È Ù‹˜ ÓfiËÛ‹˜ ÛÔ˘ Î·È Ó· ¤¯ÂÈ˜ ·ÎÔÓ›ÛÂÈ ÛÂ ÙfiÛË ¤ÎÙ·ÛË ÙÔÓÏfiÁÔ ÛÔ˘, ÒÛÙÂ Ó· ÌÔÚÂ›˜ Ó· ‰ËÏÒÓÂÈ˜ ÌÂ ÙË ÁÏÒÛÛ· ÔÏfiÎÏËÚÔ ÙÔ Ê¿ÛÌ· ÙÔ‡ ÎfiÛÌÔ˘ Ì·˜, ·ÊÔ‡- fiˆ˜ ¤¯ÂÈ ÂÈ ÔÏ‡ ·Ú·ÛÙ·ÙÈÎ¿ Ô Wittgenstein - Ô ÎfiÛÌÔ˜ Ì·˜ Â›Ó·È Ë ÁÏÒÛÛ· Ì·˜.

ªÈ· ÁÏÒÛÛ· fiˆ˜ Ë ∂ÏÏËÓÈÎ‹ Ô˘ Â˘Ù‡¯ËÛÂ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÚÔÊÔÚÈÎ¿ Î·È ÁÚ·Ù¿ 4.000¯ÚfiÓÈ· Î·È Ô˘ Â›¯Â ÙÔ ÚÔÓfiÌÈÔ Ó· Êı¿ÛÂÈ ÛÂ ÌÈ· ÚˆÙfiÁÓˆÚË Î·ÏÏÈ¤ÚÁÂÈ· ·fi Ù· ÁÈÁ¿ÓÙÂÈ·ÓÂ‡Ì·Ù· Ô˘ ÂÎÊÚ¿ÛÙËÎ·Ó Û’ ·˘Ù‹, ÌÈ· ÁÏÒÛÛ· Ô˘ Â› 25 Î·È Ï¤ÔÓ ·ÈÒÓÂ˜ ÛÌÈÏÂ‡ÂÙ·È ·Î·Ù¿-·˘ÛÙ· ÛÙÔÓ ¯ÒÚÔ Ù‹˜ ÂÈÛÙ‹ÌË˜ Î·È Ù‹˜ Ô›ËÛË˜ - ‰ÂÓ ˘¿Ú¯ÂÈ Ô‡ÙÂ ¤Ó·˜ ·ÈÒÓ·˜ Ô˘ Ó· ÌËÓ ¤¯ÂÈÁÚ·ÊÂ› Ô›ËÛË ÛÂ ÂÏÏËÓÈÎ‹ ÁÏÒÛÛ·, ¤ÏÂÁÂ Ô ∂Ï‡ÙË˜ - Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ, fiˆ˜ ÚÔÛ¿ıËÛ· Ó·‰Â›Íˆ, Ó· ¤¯ÂÈ ÏÔ˘Ù›ÛÂÈ ÙÔÓ Â˘Úˆ·˚Îfi ÏfiÁÔ ÌÂ ıÂÌÂÏÈÒ‰ÂÈ˜ ¤ÓÓÔÈÂ˜ Î·È Ï¤ÍÂÈ˜. ∏ ÂÏÏËÓÈÎ‹ ÁÏÒÛ-Û· ÙÂÏÈÎ¿ Â›Ó·È Ë ‰‡Ó·ÌË Î·È Ë ·‰˘Ó·Ì›· Ì·˜: ¢‡Ó·ÌË ÁÈ· ÙÔÓ ÂÎÊÚ·ÛÙÈÎfi ÏÔ‡ÙÔ, ÙË ÁÏˆÛÛÈÎ‹ÈÛ¯‡ Î·È ÙËÓ ÂÓ‰˘Ó¿ÌˆÛË Ù‹˜ ÛÎ¤„Ë˜ Ô˘ ÚÔÛÔÚ›˙ÂÈ Û’ ·˘ÙfiÓ Ô˘ ÙËÓ Î·Ù¤¯ÂÈ. ∞‰˘Ó·Ì›·, ÁÈ·-Ù› ¯ÚÂÈ¿˙ÔÓÙ·È ÛÙ¤ÚÂË ·È‰Â›·, Ì·ÎÚfi˜ ¯ÚfiÓÔ˜ Î·È ÙÂÚ¿ÛÙÈÔ˜ Ìfi¯ıÔ˜ ÁÈ· Ó· ÙËÓ Î·Ù·ÎÙ‹ÛÂÈ˜. ∞ÊÔ‡Ë Î·Ù¿ÎÙËÛË ÌÈ·˜ ÁÏÒÛÛ·˜, Î·È È‰›ˆ˜ Ù‹˜ ∂ÏÏËÓÈÎ‹˜, Â›Ó·È ¤ÚÁÔ ˙ˆ‹˜.

O ¶Ú‡Ù·ÓË˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∫·ıËÁËÙ‹˜ °ÂÒÚÁÈÔ˜ ¢. ª·ÌÈÓÈÒÙË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:325-328


329∞¡∞™∫O¶∏™∏

¶·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎÒÓ

ÂÂÈÛÔ‰›ˆÓ ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ

∂. ∫·Ú·Ù˙¿ - •ÈÊÈÏ›‰Ô˘1, ª. ∞ı·Ó·Û›Ô˘ - ªÂÙ·Í¿2

¶ÂÚ›ÏË„Ë

∏ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ¿ÏÏ·ÍË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÓÙÈÎ·Ù¿ÛÙ·-ÛË ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔÍ¤Ô˜ ·fi ÙÔ ·ÌÈÓÔÍ‡ ‚·Ï›ÓË ÛÙË ı¤ÛË 6 ÙË˜ ‚-·Ï‡ÛÔ˘ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜(‚6glu→val) Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ S (a2b2

S). ∞ÔÎÏÂÈÛÙÈÎ‹ È‰ÈfiÙËÙ· ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜S Â›Ó·È Ó· ÔÏ˘ÌÂÚ›˙ÂÙ·È fiÙ·Ó ·ÔÍ˘ÁÔÓÒÓÂÙ·È, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ·Ê˘‰·ÙˆÌ¤ÓˆÓ¿Î·ÌÙˆÓ ‰ÚÂ·ÓÔÎ˘ÙÙ¿ÚˆÓ. Œˆ˜ ÙÈ˜ ·Ú¯¤˜ ÙË˜ ÙÂÏÂ˘Ù·›·˜ ‰ÂÎ·ÂÙ›·˜ ıÂˆÚÔ‡ÓÙ·Ó fiÙÈ Ù· ¿Î·-ÌÙ· ‰ÚÂ·ÓÔÎ‡ÙÙ·Ú· Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË ÙˆÓ ÂÒ‰˘ÓˆÓ ıÚÔÌ‚ˆÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÙË˜ÓfiÛÔ˘. ¡ÂfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ·¤‰ÂÈÍ·Ó fiÙÈ Ù· ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi‰È· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÓÂÚÁÔÔ›-ËÛË˜ ÂÓfi˜ ÔÏ‡ÏÔÎÔ˘ ÔÏ˘·Ú·ÁÔÓÙÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡. ∆· ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÙÔ˘ stress ·Ú-¯ÈÎ¿ ÚÔÛÎÔÏÏÒÓÙ·È ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁÂ›ˆÓ ÙË˜ ÌÈÎÚÔÎ˘ÎÏÔÊÔÚ›·˜ Î·È, ·ÎÔÏÔ‡ıˆ˜, ·ÁÈ-‰Â‡Ô˘Ó Ù· ¿Î·ÌÙ· ‰ÚÂ·ÓÔÎ‡ÙÙ·Ú· ÁÈ· Ó· Ù· ·ÔÌ·ÎÚ‡ÓÔ˘Ó ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›·. ™ÙËÓ Â‰Ú·›-ˆÛË ÙÔ˘ ·Ú¯ÈÎÔ‡ ıÚfiÌ‚Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó: ·) ·Ú¿ÁÔÓÙÂ˜ ·fi ÙËÓ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹ ÌÂÌ‚Ú¿ÓË Ô˘¤¯ÂÈ ˘ÔÛÙÂ› ‚Ï¿‚Ë ÏfiÁˆ ÙË˜ ˘ÔÍ›·˜, Ù·˘Ùfi¯ÚÔÓ· ÌÂ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÔÚÈÛÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ‹ÍË˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, ‚) ·Ú¿ÁÔÓÙÂ˜ ·fi ÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁÂ›ˆÓ (·ÓÙ·ÁˆÓÈÛÌfi˜ ·ÁÁÂÈÔÛ˘-ÛÙ·ÏÙÈÎÒÓ Î·È ·ÁÁÂÈÔ‰È·ÛÙ·ÏÙÈÎÒÓ Ô˘ÛÈÒÓ), Á) ÂÈÊ·ÓÂÈ·Î¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜, ÙfiÛÔ ÙˆÓ ÂÓ-‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ stress Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ú-¯ÈÎ‹ ÚÔÛÎfiÏÏËÛË ÙˆÓ ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ, ‰) Ë ÂÓÂÚÁÔÔ›ËÛË Î·È ÚÔÛÎfiÏ-ÏËÛË Î·È ÙˆÓ ¿ÏÏˆÓ ¤ÌÌÔÚÊˆÓ ÛÙÔÈ¯Â›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ (·ÈÌÔÂÙ¿ÏÈ·-ÏÂ˘ÎÔÎ‡ÙÙ·Ú·). ∏ ÌÂÏ¤ÙËÙË˜ ·ÏÏËÏÂ›‰Ú·ÛË˜ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‚Ô‹ıËÛÂ ÛÙËÓ Î·Ù·ÓfiËÛË ÙË˜ ·ıÔÁ¤ÓÂÈ·˜ÙˆÓ ·ÁÁÂÈÔıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ï‡ÙÂÚË ·Ú·ÎÔÏÔ‡ıËÛË, ıÂÚ·Â˘ÙÈ-Î‹ ÚÔÛ¤ÁÁÈÛË, ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ.

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AÏÏËÏÔÁÚ·Ê›·:

∂Ï›˙· ∫·Ú·Ù˙¿-•ÈÊÈÏ›‰Ô˘ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô£ÂÛÛ·ÏÔÓ›ÎË˜ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂˆ˜ 49 ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 01-04-2005

¶·È‰È·ÙÚÈÎ‹ 2005;68:329-335

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

VCAM1 ∞ÁÁÂÈ·Î¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜

(Vascular cell adhesion molecules 1)

ICAM ∂Ó‰ÔÎ˘ÙÙ¿ÚÈ· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜

(Intercellular adhesion molecules)

VLA4 πÓÙÂÁÎÚ›ÓË ·4b1 (Very late antigen-4 ‹

integrin alpha 4 beta 1 ‹ a4‚1)

CD36 ‹ ªÂÌ‚Ú·ÓÈÎ‹ ·ÈÌÔÂÙ·ÏÈ·Î‹

GPIV ÁÏ˘ÎÔÚˆÙÂ˝ÓË πV (Platelet

glycoprotein IV)

GPIb °Ï˘ÎÔÚˆÙÂ˝ÓË Ib (Glycoprotein Ib)

GPIIb/IIIa °Ï˘ÎÔÚˆÙÂ˝ÓË (b3 ÈÓÙÂÁÎÚ›ÓË)

(Glycoprotein)

VNR ∂Ó‰ÔıËÏÈ·Îfi˜ ˘Ô‰Ô¯¤·˜ ÙË˜

‚ÈÙÚÔÓÂÎÙ›ÓË˜ (Vitronectin receptor)

CD44 ¶ÚˆÙÂÔÁÏ˘Î¿ÓË ÌÂ 5 ÈÛÔÌÂÚ‹

(Proteoglycan)

FcR ÀÔ‰Ô¯Â‡˜ ÂÓ‰ÔıËÏÈ·ÎÔ‡ Î˘ÙÙ¿ÚÔ˘

(Fragments counter receptor)

B-CAM/Lu ¶ÚˆÙÂ˚ÓÈÎfi ÌfiÚÈÔ ÚÔÛÎfiÏÏËÛË˜ ‚·ÛÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ (Basal celladhesion molecule/Lutheran protein)

ET1 ∂Ó‰ÔıËÏ›ÓË 1 (·ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈÎ‹)(Enthothelin 1)

PS ºˆÛÊ·ÙÈ‰ÈÏÔÛÂÚ›ÓË(Phosphatidylserine)

SPLA2 ºˆÛÊÔÏÈ¿ÛË ∞2 (Phospholipase A2) IL1 πÓÙÂÚÏÂ˘Î›ÓË 1 (Interleukin 1) IL4 πÓÙÂÚÏÂ˘Î›ÓË 4 (Interleukin 4) TNFa ¶·Ú¿ÁˆÓ Ó¤ÎÚˆÛË˜ fiÁÎÔ˘ ·

(Tumor necrosis factor a) IFNÁ πÓÙÂÊÂÚfiÓË Á (Interferone Á) ∏ªW À„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÔÏ˘ÌÂÚ‹ multimer ÙÔ˘ ·Ú¿ÁÔÓÙ· Von Willebrand vWF (High molecular weight multimer

Von Willebrand factor) NO ªÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘

(·ÁÁÂÈÔ‰È·ÛÙ·ÏÙÈÎfi) (Nitric oxide) MCHC ª¤ÛË Û˘ÁÎ¤ÓÙÚˆÛË ·ÈÌÔÛÊ·ÈÚ›ÓË˜

ÛÙ· ÂÚ˘ıÚ¿


330 ∂. ∫·Ú·Ù˙¿ - •ÈÊÈÏ›‰Ô˘ Î·È Û˘Ó.

∂ÈÛ·ÁˆÁ‹

∏ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ Â›Ó·È Ì›· ·fi

ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ÎÏËÚÔÓÔÌÈÎ¤˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ¿-

ıÂÈÂ˜. O Ingram, ÙÔ 1956, ·¤‰ÂÈÍÂ fiÙÈ Ë ÌÔÚÈ·-

Î‹ ‚Ï¿‚Ë ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙÔ˘

ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔÍ¤Ô˜ ·fi ÙË ‚·Ï›ÓË ÛÙË ı¤ÛË 6

ÙË˜ ‚-·Ï‡ÛÔ˘ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜, Ô˘ ·ÚÁfiÙÂ-

Ú· ·Ô‰Â›¯ıËÎÂ fiÙÈ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÛËÌÂÈ·-

Î‹˜ ÌÂÙ¿ÏÏ·ÍË˜ (ÛÙÔ Îˆ‰ÈÎfiÓÈÔ GAG ÛÂ GTG)

ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ı¤ÛË ÙË˜ ÚÒÙË˜ ÂÎÊÚ·˙fiÌÂ-

ÓË˜ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ ‚-ÁÔÓÈ‰›Ô˘ (1-4). ∞ÔÙ¤-

ÏÂÛÌ· ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ ·˘Ù‹˜ Â›Ó·È Ô Û¯ËÌ·ÙÈ-

ÛÌfi˜ ÙË˜ HbS, Ë ÔÔ›· ÛÂ Û˘Óı‹ÎÂ˜ ˘ÔÍ˘ÁÔ-

Ó·ÈÌ›·˜ ÂÌÊ·Ó›˙ÂÈ ÌÂÈˆÌ¤ÓË ‰È·Ï˘ÙfiÙËÙ·, Ô-

Ï˘ÌÂÚ›˙ÂÙ·È (ÂÏÈÎÔÂÈ‰Â›˜ ÓËÌ·ÙÔÂÈ‰Â›˜ Û¯ËÌ·-

ÙÈÛÌÔ›) Î·È Î·ıÈ˙¿ÓÂÈ ˘fi ÌÔÚÊ‹Ó ÂÓ‰ÔÎ˘ÙÙ¿-

ÚÈˆÓ ÎÚ˘ÛÙ¿ÏÏˆÓ (1,2). À„ËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜

ÔÏ˘ÌÂÚÒÓ ÚÔÎ·ÏÔ‡Ó ·Ú·ÌfiÚÊˆÛË ÙˆÓ

ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ¿Î·-

ÌÙˆÓ ‰ÚÂ·ÓÔÎ˘ÙÙ¿ÚˆÓ (2,5,6).

∏ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

Î˘Ú›ˆ˜ ·fi ÂÒ‰˘Ó· ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎ¿ ÂÂÈ-

Ûfi‰È·, Ô˘ fiÙ·Ó Û˘Ì‚Ô‡Ó ÛÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜ ‹

ÛÙÔ ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· (∫¡™) Â›Ó·È

·ÂÈÏËÙÈÎ¿ ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·Û¯fiÓÙˆÓ (1,2,5).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ·ıÔÊ˘ÛÈÔÏÔÁ›·

·˘ÙÒÓ ÙˆÓ ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ

¤ÁÈÓÂ ·ÓÙÈÎÂ›ÌÂÓÔ ÂÎÙÂÙ·Ì¤ÓˆÓ ÌÂÏÂÙÒÓ, Î·ı’

fiÛÔÓ ·Ô‰Â›¯ıËÎÂ fiÙÈ Ë Â¤ÏÂ˘Û‹ ÙÔ˘˜ ‰ÂÓ Â›-

Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·ÁÁÂÈ·Î‹˜ ·fiÊÚ·ÍË˜ Ìfi-

ÓÔ ·fi Ù· ¿Î·ÌÙ· ·Ú·ÌÔÚÊˆÌ¤Ó· ‰ÚÂ·ÓÔ-

Î‡ÙÙ·Ú·, ·ÏÏ¿ Î·È ÙË˜ ÂÓÂÚÁÔÔ›ËÛË˜ Î·È ·Ï-

ÏËÏÂ›‰Ú·ÛË˜ ÔÏÏÒÓ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ,

fiˆ˜ ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ stress, ÏÂ˘-

ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ·ÈÌÔÂÙ·Ï›ˆÓ, ÔÚÈÛÌ¤ÓˆÓ

·Ú·ÁfiÓÙˆÓ ÙË˜ ‹ÍË˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, ÙÔ˘

·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ Î·È ÙˆÓ Î·ÏÔ‡ÌÂÓˆÓ

ÂÈÊ·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ (4). OÈ

ÏÔÈÌÒÍÂÈ˜ Î·È Ë ˘ÔÍ›· ˘ÚÔ‰ÔÙÔ‡Ó ˆ˜ Â› ÙÔ

ÏÂ›ÛÙÔÓ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈ-

ÛÔ‰›ˆÓ Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ÈÛÙÈÎ‹ ÈÛ¯·ÈÌ›· Î·È fi-

ÓÔ ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚÈÔ¯‹ (1,2,7-9).

¶·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ‰ÚÂ¿ÓˆÛË˜

∆· ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi‰È· ÛÙË ‰ÚÂ·ÓÔÎ˘Ù-

Ù·ÚÈÎ‹ ÓfiÛÔ Û˘Ì‚·›ÓÔ˘Ó ˆ˜ Â› ÙÔ ÏÂ›ÛÙÔÓ

ÛÙÔ Â›Â‰Ô ÙË˜ ÌÈÎÚÔÎ˘ÎÏÔÊÔÚ›·˜, ÌÂ Î‡ÚÈ-

Ô˘˜ ˘Â‡ı˘ÓÔ˘˜ ÛÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘˜ Ù· ÏÈÁfiÙÂÚÔ

˘ÎÓ¿ Î·È ·Ú·ÌÔÚÊˆÌ¤Ó· ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡Ù-

Ù·Ú·, Ù· Î·ÏÔ‡ÌÂÓ· ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú·

(¢∂∫) ÙÔ˘ stress. ∆· ¢∂∫ ÙÔ˘ stress ÚÔÛÎÔÏ-

ÏÒÓÙ·È ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ÌÂÙ·ÙÚÈ¯ÔÂÈ‰ÒÓ

ÊÏÂ‚È‰›ˆÓ, ÚÔÎ·ÏÒÓÙ·˜ ·Ú¯ÈÎ¿ ÌÂ›ˆÛË ÙË˜

ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜, ·ÏÏ¿ fi¯È Ï‹ÚË ·fiÊÚ·ÍË.

∞ÎÔÏÔ‡ıˆ˜, Â¤Ú¯ÂÙ·È ÌË¯·ÓÈÎ‹ ·Á›‰Â˘ÛË

ÙˆÓ ‰ÚÂ·ÓÔÎ˘ÙÙ¿ÚˆÓ Î·È Ï‹ÚË˜ ·fiÊÚ·ÍË

ÙÔ˘ ·ÁÁÂ›Ô˘ (4,5,7,10).

¶ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÓ‰Ô-

ıËÏÈ·Î‹ ÚÔÛÎfiÏÏËÛË ÙˆÓ ¢∂∫ Î·È ÙˆÓ ‰ÚÂ-

·ÓÔÎ˘ÙÙ¿ÚˆÓ, Ô Û¯ËÌ·ÙÈÛÌfi˜ ıÚfiÌ‚Ô˘, Ë

·fiÊÚ·ÍË ÙÔ˘ ·ÁÁÂ›Ô˘ Î·È Ë Â·ÎfiÏÔ˘ıË ÈÛÙÈ-

Î‹ ÈÛ¯·ÈÌ›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÏÏËÏÂ›‰Ú·ÛË˜

ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ (7,8).

OÈ ·Ú¿ÁÔÓÙÂ˜ ·˘ÙÔ› Â›Ó·È:

·) ∆· ÂÈÊ·ÓÂÈ·Î¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜

ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ (Î˘Ú›ˆ˜ ÙˆÓ ¢∂∫) (cell

adhension molecules ‹ ICAM) Î·È ÙˆÓ ÂÓ‰ÔıË-

ÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (vascular cell adhesion

molecules ‹ VCAM1) (7,11,12). ∞fi ÙËÓ Î·ÙË-

ÁÔÚ›· ·˘Ù‹, ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ Û˘Ì-

ÌÂÙ¤¯Ô˘Ó: i) Ë ˘ÂÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÛÂÏÂÎÙÈÓÒÓ

(E Selectin, L selectin, P selectin) (7), ii) Ë ˘Â-

ÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ (IgG gene),

iii) ·fi ÙÈ˜ ÈÓÙÂÁÎÚ›ÓÂ˜, Î˘Ú›ˆ˜ Ë ‚1 ÈÓÙÂÁÎÚ›ÓË

(very late antigen 4, VLA4) ‹ ·4‚1, Ë ‚3 ÈÓÙÂ-

ÁÎÚ›ÓË (GPIIb/πππ·), Ë ÈÓÙÂÁÎÚ›ÓË GPπb Î·È Ô

˘Ô‰Ô¯¤·˜ ÙË˜ ‚ÈÙÚÔÓÂÎÙ›ÓË˜ (vitronectin

receptror ‹ VNR) (7,12,13) Î·È iv) ‰È¿ÊÔÚÂ˜ ¿Ï-

ÏÂ˜ ÔÌ¿‰Â˜ ÂÈÊ·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ, fiˆ˜ Ù·

CD36, CD44, ıÚÔÌ‚ÔÛÔÓ‰›ÓË Î·È ˘„ËÏÔ‡ ÌÔ-

ÚÈÎÔ‡ ‚¿ÚÔ˘˜ ÔÏ˘ÌÂÚ‹ ÙÔ˘ ·Ú¿ÁÔÓÙ· Von

Willebrand (∏ªW multimer vWF) (7,11-13)

(¶›Ó·Î·˜ 1).

‚) ∆Ô ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁÂ›ˆÓ. OÈ ·ÏÏËÏÂÈ-

‰Ú¿ÛÂÈ˜ ÙˆÓ ‰ÚÂ·ÓÔÎ˘ÙÙ¿ÚˆÓ Î·È ÂÓ‰ÔıËÏÈ·-

ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô‰ËÁÔ‡Ó ÛÂ ·ÏÏÔ›ˆÛË ÙÔ˘ ÂÓ‰Ô-

ıËÏ›Ô˘, ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙË˜ ·ÁÁÂÈÔÛ˘ÛÙ·Ï-

ÙÈÎ‹˜ ÂÓ‰ÔıËÏ›ÓË˜ 1 (Et1) Î·È ÌÂÈˆÌ¤ÓË ÙÔ˘ ·Á-

ÁÂÈÔ‰È·ÛÙ·ÏÙÈÎÔ‡ ÌÔÓÔÍÂÈ‰›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘

(¡O), ÂÈ‚Ú·‰‡ÓÔÓÙ·˜ ÌÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙË

ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÂÈ‰ÂÈÓÒÓÔÓÙ·˜ ÙÔ ıÚÔÌ-

‚ˆÙÈÎfi ÂÂÈÛfi‰ÈÔ (3,6,7,14,15). ™ÙËÓ ÂÈ‰Â›Óˆ-

ÛË ÙÔ˘ ıÚÔÌ‚ˆÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Â›Ó·È Èı·Ófi Ó·

Û˘Ì‚¿ÏÏÔ˘Ó Î·È Ù· ¯·ÌËÏ¿ Â›Â‰· ÙË˜ ·ÁÁÂÈÔ-

‰È·ÛÙ·ÏÙÈÎ‹˜ ÚÔÛÙ·Î˘ÎÏ›ÓË˜ (prostacyclin)

Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ·fi ‰ÚÂ-

·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ (5,10,14,15). ∏ ·‡ÍËÛË

ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ,

·ÎfiÌË Î·È ÛÂ Ê¿ÛÂÈ˜ ‡ÊÂÛË˜ ÙË˜ ÓfiÛÔ˘, ÂÈ‚Â-

‚·ÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏÈ·Î‹ ‚Ï¿‚Ë ‹ ÙËÓ ·ÏÏÔ›ˆÛË

ÙË˜ ÂÓ‰ÔıËÏÈ·Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ (5,10,16,17).

Á) ¶·Ú¿ÁÔÓÙÂ˜ Ï¿ÛÌ·ÙÔ˜: ÙÔ ÈÓˆ‰ÔÁfiÓÔ,

Ë ÊÈÌÚÔÓÂÎÙ›ÓË, Ë ıÚÔÌ‚ÔÛÔÓ‰›ÓË Î·È Ô

¶·È‰È·ÙÚÈÎ‹ 2005;68:329-335


331∞ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎ¿ ÂÂÈÛfi‰È· ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ

·Ú¿ÁˆÓ Von Willebrand (vWF). ™˘ÌÏ¤ÁÌ·Ù·

ıÚÔÌ‚›ÓË˜-·ÓÙÈıÚÔÌ‚›ÓË˜ ‚Ú¤ıËÎ·Ó ·˘ÍËÌ¤Ó·

ÛÙÔ Ï¿ÛÌ· ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎÒÓ ·ÛıÂÓÒÓ, ·Îfi-

ÌË Î·È ÛÂ Ê¿ÛÂÈ˜ ËÚÂÌ›·˜ ÙË˜ ÓfiÛÔ˘ (7,18,19).

‰) ∆· ÏÂ˘ÎÔÎ‡ÙÙ·Ú·, Â›ÛË˜, Û˘ÌÌÂÙ¤¯Ô˘Ó

ÛÙ· ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎ¿ ÂÂÈÛfi‰È· Â›ÙÂ ÌÂ ÙËÓ

ÚÔÛÎfiÏÏËÛ‹ ÙÔ˘˜ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ, Â›ÙÂ ÂÓÂÚ-

ÁÔÔÈÒÓÙ·˜ ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfi-

ÏËÛË˜ (20-22).

¶·Ú¿ÏÏËÏ· ÌÂ ÙÈ˜ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÂ˜ ÏÂÈÙÔ˘Ú-

ÁÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ (·ÏÏÔÈˆÌ¤ÓË ÔÏÈÎfiÙËÙ· HbS

ÏfiÁˆ ÙË˜ ˘‰ÚfiÊÔ‚Ë˜ ‚·Ï›ÓË˜ Î·È Û¯ËÌ·ÙÈÛÌfi˜

ÔÏ˘ÌÂÚÒÓ), Â¤Ú¯ÂÙ·È Î·È ‚Ï¿‚Ë ÙË˜ ÌÂÌ‚Ú¿-

ÓË˜ ÙÔ˘ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚÔ˘ ÌÂ ·ÒÏÂÈ· ÈfiÓÙˆÓ ∫+

Î·È ‡‰·ÙÔ˜, ·Ê˘‰¿ÙˆÛË ÙÔ˘ Î˘ÙÙ¿ÚÔ˘, ·‡ÍËÛË

ÙË˜ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ·˜ Û˘ÁÎ¤ÓÙÚˆÛË˜ Hb (MCHC)

Î·È Â›ÛÔ‰Ô˜ ÈfiÓÙˆÓ Ca++ Ô˘ ·ÔÙÂÏÂ› ÙÔÓ Î‡-

ÚÈÔ ·Ú¿ÁÔÓÙ· ÙË˜ ÌÂÈˆÌ¤ÓË˜ Â˘Î·ÌÙfiÙËÙ·˜

ÙˆÓ ‰ÚÂ·ÓÔÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ (2,4,7,11). ∆·˘Ùfi-

¯ÚÔÓ· ÌÂ ÙË ‰È·Ù·Ú·¯‹ ÙˆÓ ·ÓÙÏÈÒÓ ∫+, Ca++

Î·È ÙË˜ Û˘ÌÌÂÙ·ÊÔÚ¿˜ K-Cl, ‰È·Ù·Ú¿ÛÛÂÙ·È

Î·È Ô ‰›·˘ÏÔ˜ Gardos (Û‡ÛÙËÌ· ·ÒÏÂÈ·˜ ∫+

Î·È H2O ·fi ÙÔ Î‡ÙÙ·ÚÔ Ô˘ ÂÓÂÚÁÔÔÈÂ›Ù·È

·fi ÙËÓ ÚfiÛÎ·ÈÚË ÂÈÛÚÔ‹ ÈfiÓÙˆÓ Ca++ ÂÓÙfi˜

ÙÔ˘ Î˘ÙÙ¿ÚÔ˘) Î·È Â¤Ú¯ÂÙ·È ÂÚ·ÈÙ¤Úˆ ÂÈ-

‰Â›ÓˆÛË ÙË˜ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ·˜ ·Ê˘‰¿ÙˆÛË˜ Î·È

ÙË˜ ‰ÚÂ¿ÓˆÛË˜ (2,4,7,23) (∂ÈÎfiÓ· 1).

¡ÂfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Î·È ¿ÏÏÔÈ ·-

Ú¿ÁÔÓÙÂ˜ ÂÎÙfi˜ ·fi ÙÔ˘˜ ·ÓˆÙ¤Úˆ Û˘Ì‚¿Ï-

ÏÔ˘Ó ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ‰ÚÂ¿ÓˆÛË˜.∆· ÓÂ·Ú¿ ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· (ÏÈÁfiÙÂÚÔ ˘ÎÓ¿ Î·È·Ú·ÌÔÚÊˆÌ¤Ó·), Ù· ÔÓÔÌ·˙fiÌÂÓ· ¢∂∫ ÙÔ˘stress, ¤¯Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ ÚˆÙÂ˝ÓÂ˜(ÂÈÊ·ÓÂÈ·Î¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜) Ô˘ ¯ÚË-ÛÈÌÂ‡Ô˘Ó ÁÈ· ÙË ÌÂÙ·Í‡ ÙÔ˘˜ Û‡Ó‰ÂÛË ÛÙÔÓÌ˘ÂÏfi Î·È Ù· ÔÔ›· ‰ÂÓ ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÙËÓÂÈÊ¿ÓÂÈ· ÙˆÓ ÒÚÈÌˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ(4,5,7,13). ™˘ÁÎÂÎÚÈÌ¤Ó·, Ë ÈÓÙÂÁÎÚ›ÓË alpha 4beta 1 (·4‚1) ‹ VLA4 ·Ó·ÁÓˆÚ›˙ÂÈ ¿ÌÂÛ· Î·ÈÚÔÛÎÔÏÏ¿Ù·È ÛÙÔ VCAM1 ÌfiÚÈÔ ÙÔ˘ ÂÓÂÚÁÔ-ÔÈËÌ¤ÓÔ˘ ·fi Ù· ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÂÓ‰ÔıËÏÈ·-ÎÔ‡ Î˘ÙÙ¿ÚÔ˘ (Û·Ó ¤Ó· ¤ÙÂÚÔ ‹ÌÈÛ˘). ∏ VLA-4Â›Ó·È ÙÔ ÌfiÓÔ ÌfiÚÈÔ Ô˘ ·Ó·ÁÓˆÚ›˙ÂÙ·È ·fi Ù·VCAM1. ∆o ÌfiÚÈÔ CD36, Ô˘ ÔÓÔÌ¿˙ÂÙ·È Î·È·ÈÌÔÂÙ·ÏÈ·Î‹ ÁÏ˘ÎÔÚˆÙÂ˝ÓË (GPIV), ÂÎ-ÊÚ¿˙ÂÙ·È ÛÙ· ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÙÔ˘ stressÎ·È Û˘Ó‰¤ÂÙ·È ÌÂ ¤Ó· ¿ÏÏÔ ÌfiÚÈÔ CD36 ÙÔ˘ ÂÓ-‰ÔıËÏ›Ô˘ ‹ ÌÂ ÙÔÓ ÂÓ‰ÔıËÏÈ·Îfi VNR, ¯ÚËÛÈÌÔ-ÔÈÒÓÙ·˜ Û·Ó Á¤Ê˘Ú· ÙË ıÚÔÌ‚ÔÛÔÓ‰›ÓË Ô˘·Ú¿ÁÂÙ·È ·fi Ù· ÂÓÂÚÁÔÔÈËÌ¤Ó· ·ÈÌÔÂÙ¿-ÏÈ· (7,10,24). ∞˘Ù¤˜ ÔÈ ‰‡Ô ˘„ËÏ‹˜ Û˘Ó¿ÊÂÈ·˜·ÓÙÈ‰Ú¿ÛÂÈ˜ Â›Ó·È ÔÈ Ï¤ÔÓ ˘Â‡ı˘ÓÂ˜ ÁÈ· ÙËÓÚÔÛÎfiÏÏËÛË ÙˆÓ ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ÌÂÙ·ÙÚÈ¯ÔÂÈ‰ÈÎÒÓ ÊÏÂ‚È‰›ˆÓ.∂ÈÏ¤ÔÓ, ˘„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÌfiÚÈ· ÙÔ˘vWF Û˘ÌÌÂÙ¤¯Ô˘Ó ˆ˜ Á¤Ê˘ÚÂ˜ ÛÙËÓ ÚÔÛÎfiÏ-ÏËÛË ÙÔ˘ GPππb/πππ· ÂÈÊ·ÓÂÈ·ÎÔ‡ ÌÔÚ›Ô˘ÚÔÛÎfiÏÏËÛË˜ ÙÔ˘ ¢∂∫ ÌÂ ÙÔ GP1b ‹ ÙÔÓ VNR(ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ ÙÔ˘ ÂÓ‰ÔıËÏÈ·ÎÔ‡ Î˘Ù-Ù¿ÚÔ˘) (7,13,15) (∂ÈÎfiÓ· 2).

∏ ÚÔÛÎfiÏÏËÛË ÙˆÓ ÒÚÈÌˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿-ÚˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜¿ıÚÔÈÛË˜ ·ÚÓËÙÈÎÒÓ ÊÔÚÙ›ˆÓ ÛÙËÓ ·ÏÏÔÈˆÌ¤ÓËÎ˘ÙÙ·ÚÈÎ‹ ÌÂÌ‚Ú¿ÓË Î·È Û‡Ó‰ÂÛ‹˜ ÙÔ˘˜ Ì¤ÛˆÙË˜ IgG ·ÓÔÛÔÛÊ·ÈÚ›ÓË˜ ÌÂ ÙÔ˘˜ (FcR) ˘Ô‰Ô-¯Â›˜ ÙÔ˘ ÂÓ‰ÔıËÏÈ·ÎÔ‡ Î˘ÙÙ¿ÚÔ˘, ¯ˆÚ›˜ fiÌˆ˜·˘Ùfi Ó· ·›˙ÂÈ ·ÍÈfiÏÔÁÔ ÚfiÏÔ ÛÙËÓ ¤Ó·ÚÍË ÙÔ˘

¶·È‰È·ÙÚÈÎ‹ 2005;68:329-335

¶›Ó·Î·˜ 1. ∂ÈÊ·ÓÂÈ·Î¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛË˜ Ô˘ ÂÓÂÚÁÔ-ÔÈÔ‡ÓÙ·È ÛÙ· ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎ¿ ÂÂÈÛfi‰È· ÙË˜ ‰ÚÂ·ÓÔ-Î˘ÙÙ·ÚÈÎ‹˜ ÓfiÛÔ˘

™ÂÏÂÎÙ›ÓÂ˜ (Selectin superfamily) ∂ ™ÂÏÂÎÙ›ÓË (ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ) L ™ÂÏÂÎÙ›ÓË (ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ) ƒ ™ÂÏÂÎÙ›ÓË (ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·-Ï›ˆÓ) ÀÂÚÔÈÎÔÁ¤ÓÂÈ· ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ: Î·ÙËÁÔÚ›· ÌÔÚ›ˆÓÚÔÛÎfiÏÏËÛË˜ [Immunoglobulin gene superfamily ‹ IgG gene (C2

type)] ÀÂÚÔÈÎÔÁ¤ÓÂÈ· ÈÓÙÂÁÎÚÈÓÒÓ (Integrine superfamily)‚1 ÈÓÙÂÁÎÚ›ÓË ‹ alpha4 beta1 ‹ VLA4

‚3 ÈÓÙÂÁÎÚ›ÓË ‹ ÁÏ˘ÎÔÚˆÙÂ˝ÓË GPIIb/πππ· ‚3 ÈÓÙÂÁÎÚ›ÓË ‹ ÁÏ˘ÎÔÚˆÙÂ˝ÓË GPIb ÀÔ‰Ô¯Â‡˜ ÙË˜ ‚ÈÙÚÔÓÂÎÙ›ÓË˜ ‹ VNR ¢È¿ÊÔÚ· (Miscellaneous group) CD36 ‹ GPIV (·ÈÌÔÂÙ·ÏÈ·Î‹ ÁÏ˘ÎÔÚˆÙÂ˝ÓË) CD44 ‹ ÚˆÙÂÔÁÏ˘Î¿ÓË CD44

µ-CAM/Lu (ÌfiÚÈÔ ÚÔÛÎfiÏÏËÛË˜ ‚·ÛÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜) FcR (˘Ô‰Ô¯Â›˜ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ)Thrombospondin (ıÚÔÌ‚ÔÛÔÓ‰›ÓË)À„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÔÏ˘ÌÂÚ‹ ÙÔ˘ ·Ú¿ÁÔÓÙ·Von Willebrand (HMW-vWF)

�O2 �P∏HbS ÔÏ˘ÌÂÚ‹

H2O

¢›·˘ÏÔ˜ Gardos

K+Ca++� �

��

� K+Ca++

H2O H2O

™˘ÌÌÂÙ·ÊÔÚ¿ K-Cl

Cl-K+

Cl-K+

∂ÈÎfiÓ· 1. ªÂÙ·‚ÔÏ¤˜ ÙË˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ‹˜ ÌÂÌ‚Ú¿-ÓË˜ Ô˘ Ô‰ËÁÔ‡Ó ÛÙË ‰ÚÂ¿ÓˆÛË (∆ÚÔÔÔÈËÌ¤ÓÔ·fi: The Molecular Basis of Blood Diseases. Stamato-yannopoulos G et al. 3rd ed. 2001. p. 247).


332 ∂. ∫·Ú·Ù˙¿ - •ÈÊÈÏ›‰Ô˘ Î·È Û˘Ó.

ıÚÔÌ‚ˆÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (4,13,16). ∂ÈÏ¤ÔÓ,

‚Ú¤ıËÎÂ Û˘Ó¿ÊÂÈ· ·Ó¿ÌÂÛ· ÛÙÔ B-CAM/Lu

ÂÈÊ·ÓÂÈ·Îfi ÌfiÚÈÔ ÙÔ˘ ÒÚÈÌÔ˘ ‰ÚÂ·ÓÔÎ˘ÙÙ¿-

ÚÔ˘ Î·È ÙË˜ ˘ÂÓ‰ÔıËÏÈ·Î‹˜ Ï·ÌÈÓ›ÓË˜, ·Ô-

‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ ÂÌÏÔÎ‹ ÙË˜ ÂÓ‰ÔıËÏÈ·Î‹˜

‚Ï¿‚Ë˜ ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙË˜ ıÚÔÌ‚ˆÙÈÎ‹˜

ÎÚ›ÛË˜ (7,25,26). OÈ ·Ó·ÊÂÚıÂ›ÛÂ˜ ‰˘Ó¿ÌÂÈ˜

ÚÔÛÎfiÏÏËÛË˜ ‰ÚÔ˘Ó Û˘ÓÂÚÁÈÎ¿, Ô‰ËÁÒÓÙ·˜

ÛÙËÓ ·Ú¯ÈÎ‹ ÚÔÛÎfiÏÏËÛË ÙˆÓ ¢∂∫ stress Î·È

ÛÙËÓ ·ÎfiÏÔ˘ıË ·Á›‰Â˘ÛË ÙˆÓ ‰ÚÂ·ÓÔÎ˘ÙÙ¿-

ÚˆÓ (4,7,13).

∆·˘Ùfi¯ÚÔÓ· ÌÂ ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ ÂÚ˘-

ıÚÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ÂÓ‰ÔıËÏÈ·Î‹ ‚Ï¿‚Ë,

ÂÓÂÚÁÔÔÈÂ›Ù·È Î·È Ë ‰È·‰ÈÎ·Û›· ÙË˜ ‹ÍË˜.

∂ÎÙfi˜ ·fi ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ·Ú¿ÁÔÓÙ· vWF,

·˘ÍËÌ¤Ó· Â›Â‰· ÈÓˆ‰ÔÁfiÓÔ˘, ÊÈÌÚÔÓÂÎÙ›-

ÓË˜, ÚÔıÚÔÌ‚›ÓË˜ Î·È Û˘ÌÏÂÁÌ¿ÙˆÓ ıÚÔÌ‚›-

ÓË˜-·ÓÙÈıÚÔÌ‚›ÓË˜ πππ ‚Ú¤ıËÎ·Ó ÙfiÛÔ Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙˆÓ ıÚÔÌ‚ˆÙÈÎÒÓ ÎÚ›ÛÂˆÓ fiÛÔ Î·È

Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛË˜ ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜

(7,18,27). ™ÙËÓ ˘ÂÚËÎÙÈÎ‹ Î·Ù¿ÛÙ·ÛË Û˘Ì-

‚¿ÏÏÂÈ Ë Ù·˘Ùfi¯ÚÔÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔ-

ÂÙ·Ï›ˆÓ Î·È Ë ·˘ÍËÌ¤ÓË ·ÂÏÂ˘ı¤ÚˆÛË ·fi

·˘Ù¿ ıÚÔÌ‚ÔÛÔÓ‰›ÓË˜, ƒ ÛÂÏÂÎÙ›ÓË˜, ‚-ıÚÔÌ-

‚ÔÁÏÔ‚Ô˘Ï›ÓË˜ Î·È ÙÔ˘ ·ÈÌÔÂÙ·ÏÈ·ÎÔ‡ ·Ú¿-

ÁÔÓÙ· 4, Ô˘ ‰ÚÔ˘Ó Û˘ÓÂÚÁÈÎ¿ ÛÙËÓ ÂÈ‰Â›Óˆ-

ÛË ÙÔ˘ ıÚÔÌ‚ˆÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (4,27-30). ∆·

ÂÓÂÚÁÔÔÈËÌ¤Ó· Î·È Î˘ÎÏÔÊÔÚÔ‡ÓÙ· ÂÓ‰ÔıË-

ÏÈ·Î¿ Î‡ÙÙ·Ú· ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ·fi ‰ÚÂ·ÓÔ-

Î˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ, Ë ‰È·Ù·Ú·¯‹ ÙË˜ ·Û˘ÌÌÂÙÚ›·˜

ÙˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ ÙË˜ ÌÂÌ‚Ú¿ÓË˜ ÙˆÓ ‰ÚÂ-

·ÓÔÎ˘ÙÙ¿ÚˆÓ Î·È Ë ¤ÎıÂÛË ÙË˜ ·ÓÈÔÓÈÎ‹˜ Êˆ-

ÛÊ·ÙÈ‰ÈÏÔÛÂÚ›ÓË˜ (phosphatidylserine PS)

·ÔÙÂÏÔ‡Ó ¤Ó·Ó ÂÈÏ¤ÔÓ ÈÛÙÈÎfi ·Ú¿ÁÔÓÙ·,

˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙË˜ ‹ÍË˜ Î·È

ÙË “ıÚÔÌ‚ÔÊÈÏÈÎ‹ Î·Ù¿ÛÙ·ÛË” ÛÙË ‰ÚÂ·ÓÔ-

Î˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ (4,17,27,28).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ¿ÏÏ· ¤ÌÌÔÚÊ· ÛÙÔÈ¯Â›· ÙÔ˘

·›Ì·ÙÔ˜, ‚Ú¤ıËÎÂ fiÙÈ ‰ÂÓ Ì¤ÓÔ˘Ó ·Ì¤ÙÔ¯· ÛÙËÓ

ÂÎ‰‹ÏˆÛË ÙË˜ ÂÒ‰˘ÓË˜ ÎÚ›ÛË˜. ∆· ÔÏ˘ÌÔÚ-

ÊÔ‡ÚËÓ· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È Ù· ÌÔÓÔÎ‡ÙÙ·Ú·

Â›Ó·È Â›ÛË˜ ÂÓÂÚÁÔÔÈËÌ¤Ó· ÛÙË ‰ÚÂ·ÓÔÎ˘Ù-

Ù·ÚÈÎ‹ ÓfiÛÔ (20,22,31). ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ù·

ÏÂ˘ÎÔÎ‡ÙÙ·Ú· ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ ·-

Ú¿ÁÔ˘Ó ÙÔ˘˜ ‰È·Ï˘ÙÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÈÓÙÂÚÏÂ˘Î›-

ÓË 1 Î·È ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛË˜ fiÁÎÔ˘-a (IL1 Î·È

∆¡Fa), Ô˘ ‰ÈÂÁÂ›ÚÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÂÈÊ·-

ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ Î·È, ÛÙË Û˘Ó¤-

¯ÂÈ·, Ù· ÂÓÂÚÁÔÔÈËÌ¤Ó· Ô˘‰ÂÙÂÚfiÊÈÏ· ÚÔ-

ÛÎÔÏÏÒÓÙ·È ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÌÂ ÙË ÌÂÛÔÏ¿‚ËÛË

ÙˆÓ ÛÂÏÂÎÙÈÓÒÓ, È‰È·›ÙÂÚ· ÙË˜ ∂ ÛÂÏÂÎÙ›ÓË˜, ÙˆÓ

ÈÓÙÂÁÎÚÈÓÒÓ Î·È ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ (4,7,10,

21). ∂ÈÏ¤ÔÓ, ÔÈ ÈÓÙÂÁÎÚ›ÓÂ˜ Â›Ó·È ˘Â‡ı˘ÓÂ˜

ÙfiÛÔ ÁÈ· ÙË ÛÙ·ıÂÚ‹ ÚÔÛÎfiÏÏËÛË fiÛÔ Î·È ÁÈ·

ÙË ‰È·ÂÓ‰ÔıËÏÈ·Î‹ ÌÂÙ·Ó¿ÛÙÂ˘ÛË ÙˆÓ ÏÂ˘ÎÔ-

Î˘ÙÙ¿ÚˆÓ (14,32). ∏ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÔÏ˘-

ÌÔÚÊÔ‡ÚËÓˆÓ Î·È Ë ÚÔÛÎfiÏÏËÛ‹ ÙÔ˘˜ ÛÙÔ

ÂÓ‰Ôı‹ÏÈÔ Ô‰ËÁÂ› ÛÂ ÂÈ‚Ú¿‰˘ÓÛË ÙË˜ ÚÔ‹˜ ÙÔ˘

·›Ì·ÙÔ˜ ÛÙË ÌÈÎÚÔÎ˘ÎÏÔÊÔÚ›· (4,32). §fiÁˆ ·˘-

Ù‹˜ ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ

ÛÙ· ·ÁÁÂÈÔıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi‰È·, Ô ˘„ËÏfi˜

·ÚÈıÌfi˜ ÙÔ˘˜ ·ÔÙÂÏÂ› ¤Ó·Ó È‰È·›ÙÂÚ· ÂÈÎ›Ó‰˘-

ÓÔ ‰Â›ÎÙË ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ·fi ‰ÚÂ·ÓÔÎ˘ÙÙ·-

ÚÈÎ‹ ÓfiÛÔ (4,5,10,21,22).

™ÙÔ˘˜ ·ÓˆÙ¤Úˆ ·Ú¿ÁÔÓÙÂ˜ ÚÔÛÙ›ıÂÙ·È Ë

‰Ú¿ÛË ÙË˜ ÂÓ‰ÔıËÏ›ÓË˜ 1 (∂t1), Ô˘ ˘ÂÚ·Ú¿-

ÁÂÙ·È ·fi Ù· ·ÏÏÔÈˆÌ¤Ó· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·-

Ú· Î·È Ú˘ıÌ›˙ÂÈ ÙÔÓ ÙfiÓÔ ÙˆÓ ·ÁÁÂ›ˆÓ, ‰ÚÒÓÙ·˜

·ÁÁÂÈÔÛ˘Û·ÛÙÈÎ¿, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙË ÌÂÈˆÌ¤-

ÓË ·Ú·ÁˆÁ‹ ÙÔ˘ ·ÁÁÂÈÔ‰È·ÛÙ·ÏÙÈÎÔ‡ ÌÔÓÔÍÂÈ-

‰›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (¡O) (5,7,10,33).

O ÚfiÏÔ˜ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÛÙ· ıÚÔÌ‚ˆÙÈÎ¿

ÂÂÈÛfi‰È·

¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ Ë ¤ÎÊÚ·ÛË ÙˆÓ ÂÈ-

Ê·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ ÙˆÓ ÂÓ‰Ô-

ıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È È‰È·›ÙÂÚ· ÙÔ˘ VCAM1,

·˘Í¿ÓÂÙ·È fiÙ·Ó ÙÔ ÂÓ‰Ôı‹ÏÈÔ ÂÓÂÚÁÔÔÈËıÂ›

·fi ÙÈ˜ ÚÔÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î˘ÙÔÎ›ÓÂ˜ IL1 Î·È

TNFa, ÁÂÁÔÓfi˜ Ô˘ ‰ÈÎ·ÈÔÏÔÁÂ› ÙÔÓ ÌÂÁ¿ÏÔ

ÚfiÏÔ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›·

ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ÎÚ›ÛË˜ (7,10,16,34).

OÈ Î˘ÙÔÎ›ÓÂ˜ IL1 Î·È TNFa Ô˘ ·Ú¿ÁÔÓÙ·È

·fi Ù· ÏÂ˘ÎÔÎ‡ÙÙ·Ú· Î·È ‰ÈÂÁÂ›ÚÔ˘Ó ÙËÓ ¤Î-

ÊÚ·ÛË ÙˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏË-

ÛË˜, ‚Ú¤ıËÎ·Ó ÛÂ ·˘ÍËÌ¤Ó· Â›Â‰· ÛÂ ·ÛıÂ-

ÓÂ›˜ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ, ·ÎfiÌË Î·È ÛÂ

Ê¿ÛÂÈ˜ ‡ÊÂÛË˜ ÙË˜ ÓfiÛÔ˘, ·Ô‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ

¶·È‰È·ÙÚÈÎ‹ 2005;68:329-335

∂Ó‰

Ôı

ËÏ

È·Î

fi Î

‡ÙÙ

·Ú

Ô

¢∂

∫ S

tres

s

GPIb‹

VNR

CD36

‹VNR

GPIIb/IIIa

CD36

VCAM1 VLA4

HMWvWF

∂ÓÂÚÁÔÔÈËÌ¤Ó··ÈÌÔÂÙ¿ÏÈ·

£ÚÔÌ‚ÔÛÔÓ‰›ÓË

∂ÈÎfiÓ· 2. ¶ÚÔÛÎfiÏÏËÛË ÙˆÓ ¢∂∫ stress ÛÙÔ ·ÁÁÂÈ·ÎfiÂÓ‰Ôı‹ÏÈÔ (ÚˆÙÔÁÂÓÂ›˜ ˘„ËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ ·ÓÙÈ‰Ú¿-ÛÂÈ˜).



Ù· ·ÁÁÂ›· ÙˆÓ ·Û¯fiÓÙˆÓ ‚Ú›ÛÎÔÓÙ·È ÌfiÓÈÌ·

ÛÂ ÚÔÊÏÂÁÌÔÓÒ‰Ë Î·Ù¿ÛÙ·ÛË (7,10). ªÂ ÙËÓ

Â›ÛÔ‰Ô ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È ÙËÓ

¤Ó·ÚÍË ÙË˜ ÏÔ›ÌˆÍË˜ Â¤Ú¯ÂÙ·È ÂÓÂÚÁÔÔ›ËÛË

ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ·fi Ù· ÌÈÎÚÔ‚È·Î¿ ÚÔ˚fiÓÙ·

Î·È ·ÂÏÂ˘ı¤ÚˆÛË ÙË˜ πL1 Î·È ÙÔ˘ TNFa, ÂÓÒ

Ù· Î‡ÙÙ·Ú· ÊÔÓÂ›˜ (killer cells) ·ÂÏÂ˘ıÂÚÒ-

ÓÔ˘Ó ÙËÓ ÈÓÙÂÚÊÂÚfiÓË Á (IFNÁ) fiÙ·Ó Û˘Ó·ÓÙ‹-

ÛÔ˘Ó ÂÈ‰ÈÎ¿ ÌÈÎÚÔ‚È·Î¿ ·ÓÙÈÁfiÓ·. ∞˘Ù¤˜ ÔÈ

ÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î˘ÙÔÎ›ÓÂ˜ ‰ÈÂÁÂ›ÚÔ˘Ó, ÚÔ¿-

ÁÔ˘Ó Î·È Ú˘ıÌ›˙Ô˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ

ÚÔÛÎfiÏÏËÛË˜ Ì¤Û· ÛÂ Ï›ÁÂ˜ ÒÚÂ˜ (4 ¤ˆ˜ 6)

·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÏÔ›ÌˆÍË˜ Î·È ÙËÓ ¤ÎÎÚÈÛ‹

ÙÔ˘˜ (7,32).

∏ ·ÏÏÂÚÁÈÎ‹ ÊÏÂÁÌÔÓ‹, Â›ÛË˜, ÚÔ¿ÁÂÈ

ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ ¢∂∫ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÔÚÈ-

ÛÌ¤ÓˆÓ ·ÛıÂÓÒÓ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ.

∞˘Ùfi ÔÊÂ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙ· ·˘ÍËÌ¤Ó· Â›Â‰·

ÙˆÓ IgE ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜,

·ÊÂÙ¤ÚÔ˘ ÛÙËÓ ·˘ÍËÌ¤ÓË ÂÓ‰ÔıËÏÈ·Î‹ ¤ÎÊÚ·-

ÛË Î·È ÛÙ· ˘„ËÏ¿ Â›Â‰· ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ

ÚÔÛÎfiÏÏËÛË˜ ÛÙËÓ ·ÙÔ›· (7). ™˘ÁÎÂÎÚÈÌ¤Ó·,

Ë ÈÓÙÂÚÏÂ˘Î›ÓË 4 (IL4) Ô˘ ·Ú¿ÁÂÙ·È Î·Ù¿ ÙËÓ

·ÏÏÂÚÁÈÎ‹ ÊÏÂÁÌÔÓ‹, Ú˘ıÌ›˙ÂÈ ÙËÓ ¤ÎÊÚ·ÛË

ÙÔ˘ VCAM1 ÛÙ· ·ÁÁÂÈ·Î¿ ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·-

Ú· (31), ÂÓÒ Ù· ˘„ËÏ¿ Â›Â‰· IgE ÛÙËÓ ·ÙÔ-

›· Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂ-

Ù·Ï›ˆÓ Î·È ÛÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË ıÚÔÌ‚ÔÛÔÓ-

‰›ÓË˜ Ô˘ ÌÂÛÔÏ·‚Â› ÛÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ

¢∂∫ ÛÙ· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· (7).

Ÿˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, ÔÈ ÛÔ‚·ÚfiÙÂÚÂ˜

ÂÈÏÔÎ¤˜ ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ÓfiÛÔ˘

·ÊÔÚÔ‡Ó ÛÙ· ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎ¿ ÂÂÈÛfi‰È· ÙÔ˘

ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) Î·È

ÛÙÔ ÔÍ‡ ıˆÚ·ÎÈÎfi Û‡Ó‰ÚÔÌÔ.

£ÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi‰È· ÙÔ˘ ∫¡™

∞ÁÁÂÈÔÁÚ·ÊÈÎ¤˜ Î·È ÓÂÎÚÔÙÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜

ÛÂ ¿Û¯ÔÓÙÂ˜ ·fi ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ

·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ Ù· ·ÁÁÂÈ·Î¿

ÂÂÈÛfi‰È· ·ÊÔÚÔ‡Ó ÛÙ· ÌÂÁ¿Ï· ·ÁÁÂ›· Î·È fi¯È

ÛÙË ÌÈÎÚÔÎ˘ÎÏÔÊÔÚ›· (35). ™Ù· ÌÂÁ¿Ï· ·ÁÁÂ›·

Â¤Ú¯ÂÙ·È ÛÙ¤ÓˆÛË ÙÔ˘ ·˘ÏÔ‡ ÏfiÁˆ ˘ÂÚÏ·-

Û›·˜ ÙÔ˘ Ì¤ÛÔ˘ ¯ÈÙÒÓ·, ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ Î·È

ÙˆÓ ÏÂ›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ. ∏ ‚Ï¿‚Ë ÙÔ˘ Ì¤ÛÔ˘ ¯È-

ÙÒÓ· ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË ÌÂ Ù· ÚÔÛÎÔÏÏÒÌÂÓ·

‰ÚÂ·ÓÔÎ‡ÙÙ·Ú·, Ô˘ ·ÏÏÔÈÒÓÔ˘Ó ÙÔ ÂÓ‰Ôı‹-

ÏÈÔ Î·È ‰Â˘ÙÂÚÔÁÂÓÒ˜ ÚÔÎ·ÏÔ‡Ó ÂÓ·fiıÂÛË

·ÈÌÔÂÙ·Ï›ˆÓ. ∆· ·ÈÌÔÂÙ¿ÏÈ· ·ÂÏÂ˘ıÂÚÒ-

ÓÔ˘Ó ·ÈÌÔÂÙ·ÏÈ·ÎÔ‡˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜

Ô˘ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ˘ÂÚÏ·Û›· ÙÔ˘ Ì¤ÛÔ˘

¯ÈÙÒÓ· Ô˘ Ô‰ËÁÂ› ÛÙËÓ ·ÁÁÂÈ·Î‹ ÛÙ¤ÓˆÛË, ÙË

ÛÙÚÔ‚ÈÏÒ‰Ë ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜, ÛÙËÓ ÂÈÏ¤ÔÓ

‚Ï¿‚Ë ÙÔ˘ Ì¤ÛÔ˘ ¯ÈÙÒÓ· Î·È ÛÙËÓ ÂÈ‰Â›ÓˆÛË

ÙË˜ ·fiÊÚ·ÍË˜ (35-37).

OÍ‡ ıˆÚ·ÎÈÎfi Û‡Ó‰ÚÔÌÔ

∏ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÔÍ¤Ô˜ ıˆÚ·ÎÈÎÔ‡ Û˘Ó‰Úfi-

ÌÔ˘ ÔÊÂ›ÏÂÙ·È: ·) ÛÙËÓ È‰È·›ÙÂÚË Â˘·ÈÛıËÛ›·

ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÌÈÎÚÔÎ˘ÎÏÔÊÔÚ›·˜ ÛÙËÓ ˘Ô-

Í›· Î·È ‚) ÛÙËÓ ·Ú·ÁˆÁ‹ ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ

Î˘ÙÔÎÈÓÒÓ Î·È ÙËÓ ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙˆÓ ÂÈ-

Ê·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜ ÛÙ· ÓÂ˘-

ÌÔÓÈÎ¿ ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· ˆ˜ ·¿ÓÙËÛË

ÛÙËÓ ˘ÔÍ›· (7,9,38-42). ∂ÎÏ˘ÙÈÎfi˜ ·Ú¿ÁÔ-

ÓÙ·˜ ÁÈ· ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÔÍ¤Ô˜ ıˆÚ·ÎÈÎÔ‡ Û˘Ó-

‰ÚfiÌÔ˘ Â›Ó·È Ë ÏÔ›ÌˆÍË Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi

ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, Ë ·Ú·ÁˆÁ‹ Î˘ÙÔÎÈÓÒÓ, Ë

ÂÓ‰ÔıËÏÈ·Î‹ ÚÔÛÎfiÏÏËÛË Î·È Ë ıÚfiÌ‚ˆÛË

(9,42,43). ∞ÎÔÏÔ˘ıÂ› ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂÈÔÛ˘ÛÙÔ-

Ï‹, ÌÂ›ˆÛË ÙË˜ ·ÈÌ·ÙÈÎ‹˜ ÚÔ‹˜, ·Á›‰Â˘ÛË Î·È

·ÈÌfiÏ˘ÛË ‰ÚÂ·ÓÔÎ˘ÙÙ¿ÚˆÓ, ·Ú·ÁˆÁ‹ ÂÏÂ‡-

ıÂÚˆÓ ÚÈ˙ÒÓ Î·È ÂÈ‰Â›ÓˆÛË ÙË˜ ıÚÔÌ‚ˆÙÈÎ‹˜

ÎÚ›ÛË˜ (9).

∏ ÔÚÂ›· ·˘Ù‹ ÂÈ‚·Ú‡ÓÂÙ·È ÏfiÁˆ ¤ÏÏÂÈ-

„Ë˜ Î˘ÙÙ·ÚÔÚÔÛÙ·ÙÂ˘ÙÈÎÒÓ ÌÂÛÔÏ·‚ËÙÒÓ,

fiˆ˜ ÙÔ ¡√, ÙÔ˘ ÔÔ›Ô˘ Ë Û‡ÓıÂÛË ·fi ÙÔ ÂÓ-

‰Ôı‹ÏÈÔ ·Ó·ÛÙ¤ÏÏÂÙ·È ÏfiÁˆ ÙË˜ ˘ÔÍ›·˜ (44-

48). ∆·˘Ùfi¯ÚÔÓ·, ˘¿Ú¯ÂÈ ·˘ÍËÌ¤ÓË ‚ÚÔÁ¯ÈÎ‹

·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·, Ô˘ ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È

‰Â˘ÙÂÚÔÁÂÓ‹˜ ÏfiÁˆ ÙË˜ ˘ÔÎÏÈÓÈÎ‹˜ ÓÂ˘ÌÔ-

ÓÈÎ‹˜ ‚Ï¿‚Ë˜ ·fi Ù· ‰ÚÂ·ÓÔÎ‡ÙÙ·Ú· (9).

¶ÚfiÛÊ·Ù· ˘ÔÛÙËÚ›¯ıËÎÂ fiÙÈ, ÛÂ ¤Ó· ÈÎ·ÓÔ-

ÔÈËÙÈÎfi ÔÛÔÛÙfi, ÙÔ ÔÍ‡ ıˆÚ·ÎÈÎfi Û‡Ó‰ÚÔÌÔ

ÔÊÂ›ÏÂÙ·È ÛÂ ÓÂ˘ÌÔÓÈÎfi ¤ÌÊÚ·ÎÙÔ ‹ ÂÌ‚ÔÏ‹

·fi ÛÊ·ÈÚ›‰È· Ï›Ô˘˜ ‹ ÈÛÙÔÙÂÌ·¯›‰È· ·fi

Ì˘ÂÏÈÎ¿ ¤ÌÊÚ·ÎÙ· (40,41). ∂ÈÏ¤ÔÓ, ·Ó·Ê¤-

ÚÂÙ·È fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ·ÁÁÂÈÔıÚÔÌ‚ˆÙÈÎ‹ ÎÚ›-

ÛË ‚Ú›ÛÎÔÓÙ·È ÛÂ ÚÔÛÙ¿‰ÈÔ ÏÈÒ‰Ô˘˜ ÂÌ‚Ô-

Ï‹˜, ‰ÈfiÙÈ ˘¿Ú¯ÂÈ ·˘ÍËÌ¤ÓË ¤ÎÎÚÈÛË ÂÓfi˜

ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÌÂÛÔÏ·‚ËÙ‹ ÙË˜ ÊˆÛÊÔÏÈ¿-

ÛË˜ A2 (SPLA2) Ô˘ ·ÂÏÂ˘ıÂÚÒÓÂÈ ÂÏÂ‡ıÂÚ·

ÏÈ·Ú¿ ÔÍ¤·, ˘Â‡ı˘Ó· ÁÈ· ÙËÓ ÔÍÂ›· ‚Ï¿‚Ë

ÙÔ˘ ÓÂ‡ÌÔÓ· ÚÈÓ ÂÌÊ·ÓÈÛÙÂ› ÙÔ ÔÍ‡ ıˆÚ·ÎÈ-

Îfi Û‡Ó‰ÚÔÌÔ. ∏ ·ÓÂ‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤-

‰ˆÓ SPLA2 ÛÂ ¿Û¯ÔÓÙÂ˜ ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ÌÂ-

Ù¿ÁÁÈÛË˜ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‹ ·Ê·ÈÌ·ÍÔ-

ÌÂÙ¿ÁÁÈÛË˜ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÚÔÏËÊıÂ› ÔÍ‡

ıˆÚ·ÎÈÎfi Û‡Ó‰ÚÔÌÔ (49-51).

™˘ÌÂÚ¿ÛÌ·Ù·

∏ ÌÂÏ¤ÙË ÙË˜ ·ıÔÊ˘ÛÈÔÏÔÁ›·˜ ÙˆÓ ıÚÔÌ-

‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹

ÓfiÛÔ ÛÙÔ¯Â‡ÂÈ ÛÙËÓ ÚfiÏË„Ë Î·È ÌÂ›ˆÛË ÙË˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:329-335


334 ∂. ∫·Ú·Ù˙¿ - •ÈÊÈÏ›‰Ô˘ Î·È Û˘Ó.

Û˘¯ÓfiÙËÙ·˜ Î·È ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ÂÒ‰˘ÓˆÓ

ÎÚ›ÛÂˆÓ, ÌÂ ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÔÈfiÙËÙ·˜

˙ˆ‹˜ Î·È ÙËÓ ·Ú¿Ù·ÛË ÙË˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ·-

Û¯fiÓÙˆÓ (3,23,42,52,53). π‰È·›ÙÂÚË ÛËÌ·Û›·

¤¯ÂÈ Ë ¤ÁÎ·ÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÔÍ¤Ô˜ ıˆÚ·-

ÎÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Î·È ÙˆÓ ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈ-

ÛÔ‰›ˆÓ ÙÔ˘ ∫¡™, Ù· ÔÔ›· Â›Ó·È ‰˘Ó·ÙfiÓ Ó·

Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ÌfiÓÈÌË ·Ó·ËÚ›· ‹ ·ÎfiÌË Î·È

ÛÙÔÓ ı¿Ó·ÙÔ.

µÈ‚ÏÈÔÁÚ·Ê›·

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41. Maitre B, Habibi A, Roudot-Thoraval F, Bachir D,Belghiti DD, Galacteros F et al. Acute chest syn-drome in adults with sickle cell disease. Chest2000;117:1386-1392.

42. Hebbel RP. Blockade of adhesion of sickle cells toendothelium by monoclonal antibodies. N Engl JMed 2000;342:1910-1912.

43. Stuart MJ, Setty BN. Sickle cell acute chest syn-drome: pathogenesis and rationale for treatment.Blood 1999;94:1555-1560.

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45. Gross PL, Aird WC. The endothelium and throm-bosis. Semin Thromb Hemost 2000;26:463-478.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:329-335


336 REVIEW ARTICLE

1 3rd Paediatric Clinic,Aristotle University,Ippokration GeneralHospital, Thessaloniki

2 1st Paediatric Clinic,Aristotle University,Ippokration GeneralHospital, Thessaloniki

Correspondence:

∂. Karatza-Xifilidou Ippokration General Hospital 49 Konstantinoupoleos Str. 546 42, Thessaloniki

Date of submission: 03-09-2004Date of approval: 01-04-2005

Paediatriki 2005;68:336

Pathophysiology of vaso-occlusive crises in

sickle cell disease

E. Karatza - Xifilidou1, M. Athanasiou - Metaxa2

Abstract

Sickle cell disease is caused by a mutation which is characterized by the replacement of glutaminicacid by valine in the 6th position of the ‚-chain of haemoglobin (‚6glu→val) and the production ofhaemoglobin S (·2‚2

S). The exclusive characteristic of haemoglobin S, when deoxygenated, ispolymerization of the chains and, as a result, production of dehydrated rigid sickle cells. Until thebeginning of the past decade, the rigid sickle cells were thought to play the exclusive role in thepathogenesis of the painful thrombotic crises of the disease. Newer studies have proved thatthrombotic episodes are the result of the activation of a complex multifactorial mechanism. At theonset of these episodes, stress reticulocytes attach to the endothelium of the vessels in themicrocirculatory system and the rigid sickle cells become trapped in an attempt at their removalfrom circulation. The establishment of the initial thrombus is controlled by: a) factors from the redblood cell membrane, which is damaged by hypoxia, and parallel activation of the plasmacoagulation factors, b) factors from the endothelium of the vessels (antagonism between vasopressorand vasodilator factors), c) surface adhesion molecules of the endothelial cells and the stressreticulocytes, which contribute to the initial attachment of reticulocytes to the endothelium, and d)activation and attachment of other blood cells (platelets and white cells). Study of the interaction ofall these factors has helped in the understanding of the pathogenesis of vaso-occlusive episodes,resulting in better monitoring, treatment approaches, quality of life and survival of patients sufferingfrom sickle cell disease.

Key words

Sickle cell disease, stress reticulocytes, endothelium, vaso-occlusive crises.


337∞¡∞™∫O¶∏™∏

∞ÍÈÔÏfiÁËÛË ÙË˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÚfiÎÏËÛË˜

ÁÈ· ÙË ‰È¿ÁÓˆÛË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÏÏÂÚÁ›·˜

A. ™ÔÊÈ·ÓÔ‡ - ∫·ÙÛÔ‡ÏË1, G. Du Toit2, G. Lack2

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: OÈ Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÛÔ‚·Ú¤˜Î·È ‰˘ÓËÙÈÎÒ˜ ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹ ÂÚÈÙÒÛÂÈ˜, Ô˘ Û˘¯Ó¿ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Î·È ·ÓÙÈÌÂÙˆ›-˙ÔÓÙ·È ÏËÌÌÂÏÒ˜. ∞˘Ùfi ÔÊÂ›ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë ¤ÁÎ˘ÚˆÓ ‰È·ı¤ÛÈÌˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ì¤ÛˆÓ, Î·-ıÒ˜ Î·È ÚˆÙÔÎfiÏÏˆÓ ·ÓÙÈÌÂÙÒÈÛË˜.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ¶ÚfiÎÂÈÙ·È ÁÈ· ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙË 22 ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·fi ÙÔ˘ÛÙfiÌ·ÙÔ˜ ÚfiÎÏËÛË, ÌÂ ÛÎÔfi ÙË ‰È¿ÁÓˆÛË ·Ó·ÊÂÚfiÌÂÓË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÏÏÂÚÁ›·˜. OÈ ÚÔ-ÎÏ‹ÛÂÈ˜ ¤Ï·‚·Ó ¯ÒÚ· ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô St. Mary’s ÙÔ˘ §ÔÓ‰›ÓÔ˘. OÈ ÚÔÎÏ‹ÛÂÈ˜ ‹Ù·Ó Î˘Ú›ˆ˜ ·fi ÙÔÛÙfiÌ·, ÌÂ ÂÍ·›ÚÂÛË Ù· Ê¿ÚÌ·Î· ÏÈ‰ÔÎ·˝ÓË Î·È ÚÔÎ·˝ÓË, fiÔ˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ‰ÂÚÌ·ÙÈÎ¿ÙÂÛÙ. OÈ ÂÚÈÛÛfiÙÂÚÂ˜ ‰ÔÎÈÌ·Û›Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÂÓÈÎÈÏ›ÓË (40%). ¶ÔÛÔÛÙfi 75% ÙˆÓ‰ÔÎÈÌ·ÛÈÒÓ ‹Ù·Ó ÛÂ ¤Ó· Ê¿ÚÌ·ÎÔ, ÂÓÒ 25% ‹Ù·Ó ÛÂ Û˘Ó‰˘·ÛÌfi Ê·ÚÌ¿ÎˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∞fi ÙÔ˘˜ 6 ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó Î¿ÔÈ· ·ÓÙ›‰Ú·ÛË ÛÙËÓ ÚfiÎÏËÛË, ÛÙÔ˘˜ 5 ‹Ù·Ó¿ÌÂÛË Î·È ÛÙÔÓ ¤Ó·Ó Î·ı˘ÛÙÂÚËÌ¤ÓË. OÈ ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ÚÓËÙÈÎ‹ ÚfiÎÏËÛË ¤‰ÂÈ¯Ó·Ó Û›-ÁÔ˘ÚÔÈ ÌÂÙ¿ ÙÔ ·ÔÙ¤ÏÂÛÌ·. ™Â ·˘ÙÔ‡˜ Ô˘ Ù· ·È‰È¿ ÙÔ˘˜ Â›¯·Ó ıÂÙÈÎ‹ ÚfiÎÏËÛË, ·˘Í‹ıËÎÂ Ë·˘ÙÔÂÔ›ıËÛË ÁÈ· ÙË ¯Ú‹ÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ.

™˘ÌÂÚ¿ÛÌ·Ù·: OÈ Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜ Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÛÂ ÂÍÂÈ‰ÈÎÂ˘Ì¤-Ó· Î¤ÓÙÚ·, È‰È·›ÙÂÚ· Â¿Ó ÙÔ ÈÛÙÔÚÈÎfi Â›Ó·È ·ÌÊ›‚ÔÏÔ. ¶ÔÏÏ¤˜ ·fi ÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜ ‰È·ÁÓˆÛÙÈÎ¤˜‰ÔÎÈÌ·Û›Â˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÈÎ‡ÚˆÛË ÙË˜ ·Í›·˜ ÙÔ˘˜, ÚÈÓ ÙË ÁÂÓ›ÎÂ˘Û‹ ÙÔ˘˜. ∂˘Ú‡ÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜Â›Ó·È ··Ú·›ÙËÙÂ˜, ÒÛÙÂ Ó· Â‰Ú·ÈˆıÔ‡Ó Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ· ÙËÓ ÚfiÁÓˆÛË ·˘ÙÒÓ ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ.


º·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜, Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÏÏÂÚÁ›·, ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜.

1 ∂È‰ÈÎÂ˘fiÌÂÓË ¶·È‰È·ÙÚÈÎ‹˜,St. Mary’s Hospital, London, UK

2 ∆Ì‹Ì· ¶·È‰È·ÙÚÈÎ‹˜∞ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È∞ÓÔÛÔÏÔÁ›·˜, St. Mary’sHospital, London, UK


A. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË 42 Abbots Park, St. Albans Herts, UK AL1 1TW E-mail: [email protected]


¶·È‰È·ÙÚÈÎ‹ 2005;68:337-340

∂ÈÛ·ÁˆÁ‹

OÈ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ (∞∂) ·fi Ê¿Ú-Ì·Î· Â›Ó·È ¤Ó· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ‰ËÌfi-ÛÈ·˜ ˘ÁÂ›·˜, È‰È·›ÙÂÚ· ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏË-ı˘ÛÌfi. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· (3,6), Ë Û˘¯ÓfiÙËÙ·ÙˆÓ ∞∂ ÛÂ ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÂ ÂÍˆÙÂ-ÚÈÎ¿ È·ÙÚÂ›· ‹Ù·Ó 1,46%, ÂÓÒ ÛÂ ÓÔÛËÏÂ˘fiÌÂ-Ó· ·È‰È¿ ÌÂÙ·Í‡ 6,7% Î·È 9,53%, ÂÓÒ ÔÈ ∞∂Ô˘ ·Ô‚·›ÓÔ˘Ó ÌÔÈÚ·›Â˜ ·Ó¤Ú¯ÔÓÙ·È ÛÂ0,32%. ∆Ô 39% ÙˆÓ ∞∂ Ô˘ ··ÈÙÔ‡Ó ÓÔÛË-ÏÂ›·, Â›Ó·È ÛÔ‚·Ú¤˜ ‹ Î·È ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË˙ˆ‹ (6).

™Â Ì›· ·Ï·ÈfiÙÂÚË ÌÂÏ¤ÙË (3), ÔÈ Û˘¯ÓfiÙÂ-ÚÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙÔ˘˜ ·Îfi-ÏÔ˘ıÔ˘˜ ·Ú¿ÁÔÓÙÂ˜: ·ÌÔÍ˘ÎÈÏ›ÓË (ÛÂ ÔÛÔ-ÛÙfi 5,1%), ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË

(3,4%), ·ÌÈÎÈÏ›ÓË (3,3%), ·Ú¿ÁˆÁ· ·›Ì·ÙÔ˜(2,2%), ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ (2,1%), ËÌÈÛ˘ÓıÂÙÈ-Î¤˜ ÂÓÈÎÈÏ›ÓÂ˜ (2,1%), ÂÚ˘ıÚÔÌ˘Î›ÓË (2,0%)Î·È ÂÓÈÎÈÏ›ÓË G (1,8%) (1).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ó··Ú·ı¤ÛÂÈ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Ê·ÚÌ·ÎÂ˘ÙÈ-ÎÒÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÚÔÎÏ‹ÛÂˆÓ ÛÙÔ Û˘-ÁÎÂÎÚÈÌ¤ÓÔ ÙÌ‹Ì·, ÒÛÙÂ Ó· Î·Ù·‰ÂÈ¯ÙÔ‡Ó ÔÈÊ·ÚÌ·ÎÂ˘ÙÈÎ¤˜ Ô˘Û›Â˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÛÂ ÌÂ-Á·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜Î·È Ë ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜‰È·ÁÓˆÛÙÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜. ∂›ÛË˜, Ë ÂÚÁ·Û›··ÔÛÎÔÂ› ÛÙË Û‡ÁÎÚÈÛË ·˘ÙÒÓ ÙˆÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ ÌÂ Ù· Ï¤ÔÓ ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤Ó· ÛÙË‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ê·ÚÌ·ÎÂ˘ÙÈ-ÎÒÓ ·ÏÏÂÚÁÈÒÓ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÔÓÙÔÌ¤· ÙË˜ ·ÓÔÛÔ‰È¿ÁÓˆÛË˜.


338 A. ™ÔÊÈ·ÓÔ‡ - ∫·ÙÛÔ‡ÏË Î·È Û˘Ó.

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Î·È ∞ÓÔÛÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ St. Mary’s, ÙÔ ÔÔ›Ô

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Î·È ÂÓfi˜ ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ ·È‰Ô·ÏÏÂÚÁÈÔÏfiÁÔ˘.

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ÙÒÓ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ. ∂ÚˆÙ‹ıËÎ·Ó ÁÈ· ÙËÓ ‡·ÚÍË ‹ fi¯È

·ÓÙ›‰Ú·ÛË˜ ÛÂ ÌÂÙ¤ÂÈÙ· Â·Ê‹ ÌÂ Ê¿ÚÌ·ÎÔ ÛÙÔ ÔÔ›Ô

Ë ÚfiÎÏËÛË ‹Ù·Ó ·ÚÓËÙÈÎ‹. ™Â ·ÛıÂÓÂ›˜ Ô˘ ·Ô‰Â›-

¯ÙËÎÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÏÏÂÚÁ›·, ‰ÈÂÚÂ˘Ó‹ıËÎÂ Ù˘¯fiÓ

·ÓÙ›‰Ú·ÛË ÛÂ ÛÎÂ‡·ÛÌ· Ô˘ Û˘ÛÙ‹ıËÎÂ ·ÓÙ› ÙÔ˘ Ê·Ú-

Ì¿ÎÔ˘ Ô˘ ÚÔÎ·ÏÔ‡ÛÂ ·ÏÏÂÚÁ›·. ∂ÈÏ¤ÔÓ, ÂÍÂÙ¿ÛÙË-

Î·Ó Ù· Èı·Ó¿ „˘¯ÔÏÔÁÈÎ¿ ÔÊ¤ÏË ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·,

¤ÙÛÈ fiˆ˜ Î·Ù·ÁÚ¿ÊËÎ·Ó ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÔÓ¤ˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·

∏ ÛÂÈÚ¿ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 22 ·È‰È¿ (11

·ÁfiÚÈ· Î·È 11 ÎÔÚ›ÙÛÈ·), ËÏÈÎ›·˜ 3-16 ÂÙÒÓ

(Ì¤ÛË ÙÈÌ‹: 10 ¤ÙË, ‰È¿ÌÂÛÔ˜: 11 ¤ÙË). ∂ÓÓ¤·

·fi ·˘Ù¿ Â›¯·Ó Î¿ÔÈÔ ÈÛÙÔÚÈÎfi ·ÙÔ›·˜

(40,9%) Î·È 5 Â›¯·Ó Î¿ÔÈÔ ÈÛÙÔÚÈÎfi ·ÏÏÂÚ-

Á›·˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ ÙË˜ ÙÚÔÊÈÎ‹˜

(22,7%). ∆· ·Ó·ÊÂÚfiÌÂÓ· Û˘ÌÙÒÌ·Ù· Î·È Ù·

ÂÓÔ¯ÔÔÈÔ‡ÌÂÓ· Ê¿ÚÌ·Î· Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›-

Ó·Î· 1 Î·È ÛÙËÓ ∂ÈÎfiÓ· 1, ·ÓÙ›ÛÙÔÈ¯·.

OÈ ÚÔÎÏ‹ÛÂÈ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙ·

·ÎfiÏÔ˘ı· Ê¿ÚÌ·Î·: ÂÓÈÎÈÏ›ÓË V 9, ·ÌÔÍ˘ÎÈÏ›-

ÓË 5, ÂÚ˘ıÚÔÌ˘Î›ÓË 4, ·ÛÈÚ›ÓË 2, ÏÈ‰ÔÎ·˝ÓË 1,

ÚÔÎ·˝ÓË 1, ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË

1 Î·È ÎÏ·ÚÈıÚÔÌ˘Î›ÓË 1. ™˘Ó‰˘·˙fiÌÂÓÂ˜ ÚÔ-

ÎÏ‹ÛÂÈ˜ (ÚÔÎ·˝ÓË Î·È ÏÈ‰ÔÎ·˝ÓË, ·ÌÔÍ˘ÎÈÏ›ÓË

Î·È ÙÚÈÌÂıÔÚ›ÌË, ÂÓÈÎÈÏ›ÓË Î·È ÎÏ·ÚÈıÚÔÌ˘-

Î›ÓË ‹ ÂÚ˘ıÚÔÌ˘Î›ÓË) Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÂ

5 ·ÛıÂÓÂ›˜, ÌÂ ‰‡Ô ·Ó·ÊÂÚfiÌÂÓ· Û˘ÌÙÒÌ·Ù·

Ô˘ Î·ıÈÛÙÔ‡Û·Ó ÙËÓ ˘Ô„›· ·ÏÏÂÚÁÈÎ‹˜ ·ÓÙ›-

‰Ú·ÛË˜ ÈÛ¯˘ÚfiÙÂÚË Î·È ÛÙÔ˘˜ ÔÔ›Ô˘˜, ÙÂÏÈÎ¿,

·Ó·Ù‡¯ıËÎÂ ·ÓÙ›‰Ú·ÛË. ™Â ·˘Ù‹ ÙËÓ ÂÚ›-

ÙˆÛË, ÂÍÂÙ¿ÛÙËÎ·Ó ÙfiÛÔ ˆ˜ ÚÔ˜ ÙÔ ‡ÔÙÔ

ÛÎÂ‡·ÛÌ· fiÛÔ Î·È ÛÂ ¤Ó· ¿ÏÏÔ Ô˘ ı· ÌÔÚÔ‡-

ÛÂ Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÂÓ·ÏÏ·ÎÙÈÎ¿.

OÈ ÚÔÎÏ‹ÛÂÈ˜ ‹Ù·Ó ıÂÙÈÎ¤˜ ÛÂ 6 ·È‰È¿

(28%), ÛÂ 5 ÂÎ ÙˆÓ ÔÔ›ˆÓ Ë ·ÓÙ›‰Ú·ÛË ‹Ù·Ó

¿ÌÂÛË Î·È ÛÂ 1 ÌÂÙ¿ ·fi ÙÔ ÂÓı‹ÌÂÚÔ Û¯‹Ì·

¯ÔÚ‹ÁËÛË˜. ™Â ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ˘‹Ú¯Â

Û·Ê¤˜ ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜, Â›ÙÂ

‹È·˜ (ÎÓÈ‰ˆÙÈÎfi ÂÍ¿ÓıËÌ·) ‹ Ì¤ÙÚÈ·˜ (·Ó·-

ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·). ¶¤ÓÙÂ ·fi Ù· ·È‰È¿

·˘Ù¿ Â›¯·Ó ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ Î·È ‹Ù·Ó fiÏ· ËÏÈ-

Î›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 10 ÂÙÒÓ. ™Â ¤Ó· ·fi

·˘Ù¿ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·-

Û›· ÛÙË ÏÈÁÓÔÎ·˝ÓË Î·È ÚÔÎ·˝ÓË, ÏfiÁˆ ÈÛÙÔ-

ÚÈÎÔ‡ ·ÓÙ›‰Ú·ÛË˜ ÌÂÙ¿ ·fi Â·Ê‹ ÌÂ Á¿ÓÙÈ·

Ì›·˜ ¯Ú‹ÛË˜ (latex). ™Â ÙÚÂÈ˜ ÂÚÈÙÒÛÂÈ˜, Ë

¤Ó‰ÂÈÍË ÙË˜ ·Ú¯ÈÎ‹˜ ¯ÚËÛÈÌÔÔ›ËÛË˜ ÙÔ˘ ÂÓÔ-

¯ÔÔÈÔ‡ÌÂÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ‹Ù·Ó Ë ·ÓÙÈÌÂÙÒÈ-

ÛË ÏÔ›ÌˆÍË˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ‹ ÂÈÌÔÏ˘-

ÛÌ¤ÓÔ˘ ÂÎ˙¤Ì·ÙÔ˜, ÂÓÒ ÛÂ Ì›· ÂÚ›ÙˆÛË

‹Ù·Ó Ë ·ÓÙÈÌÂÙÒÈÛË ÌÔÏ˘ÛÌ·ÙÈÎÔ‡ ÎËÚ›Ô˘.

∫·Ì›· ·ÓÙ›‰Ú·ÛË ‰ÂÓ ‹Ù·Ó ÛÔ‚·Ú‹ Î·È fiÏÂ˜

·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ ¯ÏˆÚÊ·ÈÓÈÚ·Ì›ÓË ‹

Û·Ï‚Ô˘Ù·ÌfiÏË. ™Â ‰‡Ô ·ÛıÂÓÂ›˜ ¯ÔÚËÁ‹ıË-

Î·Ó ÛÙÂÚÔÂÈ‰‹ Î·Ù¿ ÙË ‰ÔÎÈÌ·Û›· Î·È ÛÂ ¤Ó·Ó

¶·È‰È·ÙÚÈÎ‹ 2005;68:337-340

¶›Ó·Î·˜ 1. ™˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ· Û˘ÌÙÒÌ·Ù· ÛÂ Ê·Ú-Ì·ÎÂ˘ÙÈÎ¤˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜

∂Í¿ÓıËÌ·, Ô›‰ËÌ· ÚÔÛÒÔ˘ 1∂Í¿ÓıËÌ· 1∂Í¿ÓıËÌ·, ¤ÌÂÙÔ˜ 7∫Ó›‰ˆÛË, Ô˘ÚÙÈÎ¿ÚÈ·, ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· 1∫·ı˘ÛÙÂÚËÌ¤ÓË ·ÓÙ›‰Ú·ÛË 1∫Ó›‰ˆÛË, Ô›‰ËÌ· ÚÔÛÒÔ˘ 5∫Ó›‰ˆÛË 4


339º·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜ ÛÂ ·È‰È¿

·‰ÚÂÓ·Ï›ÓË ÁÈ· ¯Ú‹ÛË ÂÎÙfi˜ ÓÔÛÔÎÔÌÂ›Ô˘ ÛÂÂÚ›ÙˆÛË ·Ó¿ÁÎË˜ (Epipen).

™Â ÔÎÙÒ ·fi Ù· ·È‰È¿ Ô˘ Â›¯·Ó ·ÚÓËÙÈÎ‹“ÚfiÎÏËÛË” ˘‹Ú¯Â ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ ‹ ÂÎ-˙¤Ì·ÙÔ˜. ŒÓ· ·È‰› ÂÍÂÙ¿ÛÙËÎÂ ÁÈ· Èı·Ó‹ ·Ï-ÏÂÚÁ›· ÛÙËÓ ÂÓÈÎÈÏ›ÓË ÌÂÙ¿ ·fi ¤Ó·ÚÍË ÚÔ-Ê˘Ï·ÎÙÈÎ‹˜ ‰fiÛË˜ Ô˘ Ï¿Ì‚·ÓÂ ÏfiÁˆ ·ÓÔÛÔ-Î·Ù·ÛÙÔÏ‹˜.

™ÙÔ follow-up Ô˘ ¤ÁÈÓÂ ÌÂ ÙËÏÂÊˆÓÈÎ‹Û˘Ó¤ÓÙÂ˘ÍË ÙˆÓ ÁÔÓ¤ˆÓ, ·ÓÙ·ÔÎÚ›ıËÎÂ ÙÔ73%. ¶¤ÓÙÂ ·È‰È¿ (22%) ¯ÚÂÈ¿ÛÙËÎ·Ó ·ÓÙÈ-‚ÈÔÙÈÎ¿ ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË Î·È Î·Ó¤Ó· ‰ÂÓÂÌÊ¿ÓÈÛÂ ·ÓÙ›‰Ú·ÛË. ∂Í¿ÏÏÔ˘, ÔÈ ÁÔÓÂ›˜ -fiÙ·Ó ÚˆÙ‹ıËÎ·Ó - ‰‹ÏˆÛ·Ó ÂÚÈÛÛfiÙÂÚÔ ·Ó·-ÎÔ˘ÊÈÛÌ¤ÓÔÈ ÌÂÙ¿ ÙÈ˜ ‰ÔÎÈÌ·Û›Â˜ Î·È ÈÔ Û›-ÁÔ˘ÚÔÈ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ›‰ÈÔ Ê¿ÚÌ·ÎÔ,Â¿Ó ·Ô‰Â›¯ÙËÎÂ “·ıÒÔ”, ‹ ÙÔ ·ÛÊ·Ï¤˜ ˘Ô-Î·Ù¿ÛÙ·Ùfi ÙÔ˘ ÛÙËÓ ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË. ™ÂÙ¤ÛÛÂÚÈ˜ ÂÚÈÙÒÛÂÈ˜, ˆÛÙfiÛÔ, ·Ó Î·È Ë ‰ÔÎÈ-Ì·Û›· ‹Ù·Ó ·ÚÓËÙÈÎ‹, ÔÈ ÁÔÓÂ›˜ ·Ú·‰¤¯ÙËÎ·ÓfiÙÈ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÌËÓ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔÊ¿ÚÌ·ÎÔ, Î˘Ú›ˆ˜ ÏfiÁˆ ÚÔËÁÔ‡ÌÂÓË˜ ÙÚ·˘-Ì·ÙÈÎ‹˜ ÂÌÂÈÚ›·˜.

™˘˙‹ÙËÛË

∏ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÏÏÂÚÁ›· Â›Ó·È Ì›· ÛÔ‚·-Ú‹ Î·È ‰˘ÓËÙÈÎÒ˜ ·ÂÈÏËÙÈÎ‹ ÁÈ· ÙË ˙ˆ‹ Î·-Ù¿ÛÙ·ÛË Î·È ÁÈ’ ·˘Ùfi ÙÔÓ ÏfiÁÔ ¯Ú‹˙ÂÈ Û˘ÛÙË-Ì·ÙÈÎ‹˜ ÎÏÈÓÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ Î·È ·ÓÙÈÌÂÙÒ-ÈÛË˜. ∆Ô ÈÛÙÔÚÈÎfi Î·È Ë ÚÔÛÂÎÙÈÎ‹ ÎÏÈÓÈÎ‹ÂÍ¤Ù·ÛË Â›Ó·È Ù· ÚÒÙ· ‚‹Ì·Ù· ÚÔ˜ ·˘Ù‹ÙËÓ Î·ÙÂ‡ı˘ÓÛË. ∂›ÛË˜, ÔÏ‡ ÛËÌ·ÓÙÈÎfi Â›-Ó·È Ó· ·Ô‰ÂÈ¯ÙÂ› Ë Û¯¤ÛË ÌÂÙ·Í‡ ÙÔ˘ ‡Ô-ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÙË˜ ·ÏÏÂÚÁ›·˜. ™ÙË ÛÂÈÚ¿ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ, ÔÈ ·ÛıÂÓÂ›˜Ô˘ Â›¯·Ó ıÂÙÈÎ‹ “ÚfiÎÏËÛË” ·Ó¤ÊÂÚ·Ó ÔÏ‡Û·Ê‹ Û˘ÌÙÒÌ·Ù·, Û˘Ì‚·Ù¿ ÌÂ ·Ó·Ê˘Ï·ÎÙÈ-Î‹ ·ÓÙ›‰Ú·ÛË.

∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÔÈ

ÎÏÈÓÈÎÔ› È·ÙÚÔ› Û˘ÓÈÛÙÔ‡Ó ·ÔÊ˘Á‹ ÙˆÓ Ê·Ú-

Ì¿ÎˆÓ Ô˘ ˘ÔÙ›ıÂÙ·È fiÙÈ ÚÔÎ¿ÏÂÛ·Ó “·Ï-

ÏÂÚÁÈÎ‹ ·ÓÙ›‰Ú·ÛË”, ¯ˆÚ›˜ ÚÔËÁÔ˘Ì¤Óˆ˜ Ó·

¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ÙËÓ ·Ú·¿Óˆ Û¯¤ÛË Î·È ¯ˆ-

Ú›˜ Ó· ·Ú·¤ÌÔ˘Ó ÙÔ˘˜ ÂÓ‰È·ÊÂÚfiÌÂÓÔ˘˜

ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË. ŒÙÛÈ, ·Ú·ÙËÚÂ›-

Ù·È Ì›· ÌÂ›ˆÛË ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ

‰ÔÎÈÌ·ÛÈÒÓ ÛÂ Û¯¤ÛË ÌÂ ÚÔËÁÔ‡ÌÂÓ· ¯ÚfiÓÈ·,

Ë ÔÔ›· Ê¿ÓËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË. ∆Ô

·ÔÙ¤ÏÂÛÌ· Â›Ó·È ÔÏÏÔ› ¿ÓıÚˆÔÈ Ó· ÔÓÔÌ¿-

˙ÔÓÙ·È “·ÏÏÂÚÁÈÎÔ›” ÂÓÒ ‰ÂÓ Â›Ó·È, ÌÂ Û˘Ó¤-

ÂÈ· Ó· ÛÙÂÚÔ‡ÓÙ·È ÙˆÓ ıÂÚ·Â˘ÙÈÎÒÓ È‰ÈÔÙ‹-

ÙˆÓ ÛËÌ·ÓÙÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ (9). ∂ÈÏ¤ÔÓ,

Ë ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ “‰Â‡ÙÂÚË˜ ÁÚ·ÌÌ‹˜” ÁÈ’

·˘Ùfi ÙÔÓ ÛÎÔfi ·˘Í¿ÓÂÈ Î·È ÙÔ ÔÏÔ¤Ó· ‰ÈÔ-

ÁÎÔ‡ÌÂÓÔ Úfi‚ÏËÌ· ÙË˜ “·ÓÙÔ¯‹˜” (3). ∏ ÛË-

Ì·Û›· ÙË˜ Ï‹ÚÔ˘˜ ‰ÈÂÚÂ‡ÓËÛË˜ ·˘ÙÒÓ ÙˆÓ

ÂÚÈÙÒÛÂˆÓ Ê·›ÓÂÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ

¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘

·Ú·¤ÌÊıËÎ·Ó ÁÈ· ‰ÈÂÚÂ‡ÓËÛË ¿Û¯ÂÈ ·fi

¿ÛıÌ·, ¤Î˙ÂÌ· Î·È ¿ÏÏÂ˜ ÓfiÛÔ˘˜ Ô˘ Û˘¯Ó¿

¯Ú‹˙Ô˘Ó ıÂÚ·Â›·˜ ÌÂ ·ÓÙÈ‚ÈÔÙÈÎ¿.

OÈ ‰ÔÎÈÌ·Û›Â˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Â›Ó·È

·ÛÊ·ÏÂ›˜ fiÙ·Ó Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÛÂ ÂÍÂÈ‰È-

ÎÂ˘Ì¤ÓÔ ÓÔÛÔÎÔÌÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, ÂÊfiÛÔÓ

˘¿Ú¯ÂÈ Ë ÂÙÔÈÌfiÙËÙ· Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó

·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ™ÙË ÛÂÈÚ¿ ÙË˜ ·-

ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‰ÂÓ ˘‹ÚÍ·Ó ÛÔ‚·Ú¤˜ ·Ó·Ê˘-

Ï·ÎÙÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜.

∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÔÈ ÁÔÓÂ›˜ ÙˆÓ ·È-

‰ÈÒÓ Ê·›ÓÂÙ·È Ó· ‰Â›¯ÓÔ˘Ó ÂÌÈÛÙÔÛ‡ÓË ÛÂ

·˘Ù¿ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·. ∞˘Ùfi ÂÓÈÛ¯‡ÂÙ·È ·fi

ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ÙÔ ›‰ÈÔ

Ê¿ÚÌ·ÎÔ ÌÂÙ¿ ·fi Ì›· ·ÚÓËÙÈÎ‹ ·ÓÙ›‰Ú·ÛË,

‰ÂÓ Â›¯·Ó ÂÚ·ÈÙ¤Úˆ ÚÔ‚Ï‹Ì·Ù·. µ¤‚·È·,

˘‹ÚÍÂ Î·È ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ‰˘ÛÈÛÙ›·˜, ÙÔ

ÔÔ›Ô - fiˆ˜ Ê¿ÓËÎÂ ·fi ÙÈ˜ ··ÓÙ‹ÛÂÈ˜ ÙˆÓ

ÁÔÓ¤ˆÓ - ‰ÂÓ Â›¯Â Ó· Î¿ÓÂÈ ÌÂ ÙËÓ ›‰È· ÙË ‰Ô-

ÎÈÌ·Û›·, ·ÏÏ¿ ÌÂ ÙËÓ ÚÔÛˆÈÎ‹ ÙÔ˘˜ ÛÙ¿ÛË.

¢ÈÂÚÂ˘ÓÒÓÙ·˜ ÙË Û‡Á¯ÚÔÓË ‚È‚ÏÈÔÁÚ·Ê›·

Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ‰Ô-

ÎÈÌ·Û›Â˜, Ï›ÁÂ˜ Â›Ó·È ·˘Ù¤˜ Ô˘ Â›Ó·È Â˘Ú¤ˆ˜

·Ô‰ÂÎÙ¤˜ Î·È ¤ÁÎ˘ÚÂ˜. ª›· ·fi ·˘Ù¤˜ Â›Ó·È Ë

‰ÔÎÈÌ·Û›· ÂÓÈÎÈÏ›ÓË˜ ÌÂ ˘Ô‰fiÚÈ· ‰ÂÚÌ·ÙÈ-

Î‹ ‰ÔÎÈÌ·Û›· (3), Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÓ-

‰Ô‰ÂÚÌÈÎfi - Â¿Ó ÙÔ ÚÒÙÔ Â›Ó·È ·ÚÓËÙÈÎfi - ÛÂ

·˘Í·ÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜. ∞˘Ù‹ Ë ‰ÔÎÈÌ·Û›· ¤¯ÂÈ

Î·Ï‹ ÂÈ‰ÈÎfiÙËÙ· Î·È Ì¤ÙÚÈ· Â˘·ÈÛıËÛ›· (5),

Ô˘ ·˘Í¿ÓÂÙ·È ÌÂ ÙË ¯Ú‹ÛË ÂÈÏ¤ÔÓ ·ÏÏÂÚ-

ÁÈÔÁfiÓˆÓ (9). °È· ÙÈ˜ ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ ¯ÚËÛÈ-

ÌÔÔÈÔ‡ÓÙ·È ·ÊÂÓfi˜ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÚÔ-

ÎÏ‹ÛÂÈ˜ ÛÂ ·˘Í·ÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜, ·ÊÂÙ¤ÚÔ˘

¶·È‰È·ÙÚÈÎ‹ 2005;68:337-340

∂ÓÔ¯ÔÔÈÔ‡ÌÂÓÔ Ê¿ÚÌ·ÎÔ

Erythromycin: 4

Septrin/Penicillin: 2

Ibuprufen: 1

Lidocaine: 1

Aspirin: 3

Clarithromycin: 1

PenicillinV: 4

Amoxicillin: 6

0

8

1 2 3 4 5 6 7

∂ÈÎfiÓ· 1. ™˘¯ÓfiÙÂÚ· ÂÓÔ¯ÔÔÈÔ‡ÌÂÓ· Ê¿ÚÌ·Î· ÁÈ·ÙËÓ ÚfiÎÏËÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ.


340 A. ™ÔÊÈ·ÓÔ‡ - ∫·ÙÛÔ‡ÏË Î·È Û˘Ó.

‰ÂÚÌ·ÙÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜ (1,2). ª›· ÚfiÛÊ·ÙËÂÚÁ·Û›· (10) ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈ-Ì·Û›Â˜ ÌÔÚÂ› Ó· Â›Ó·È ·ÚÓËÙÈÎ¤˜ ÛÂ ÂÚÈÙÒ-ÛÂÈ˜ ·ÏÏÂÚÁ›·˜ ÛÂ ‚-Ï·ÎÙ·ÌÈÎ¿ ·ÓÙÈ‚ÈÔÙÈÎ¿ÏfiÁˆ ·ÓÙÔ¯‹˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÔÈ ·fi ÙÔ˘ÛÙfiÌ·ÙÔ˜ ÚÔÎÏ‹ÛÂÈ˜ ıÂˆÚÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂ-ÚÔ ·ÍÈfiÈÛÙÂ˜. ∏ ‰È¿ÁÓˆÛË ÙË˜ ·ÏÏÂÚÁ›·˜ÛÙËÓ ·ÛÈÚ›ÓË Î·È Ù· ÌË ÛÙÂÚÔÂÈ‰‹ ·ÓÙÈÊÏÂÁ-ÌÔÓÒ‰Ë (ª™∞º) Á›ÓÂÙ·È Î˘Ú›ˆ˜ ÌÂ ·fi ÙÔ˘ÛÙfiÌ·ÙÔ˜ ÚÔÎÏ‹ÛÂÈ˜, ÂÓÒ ·Â˘·ÈÛıËÙÔÔ›Ë-ÛË ÚÔÙÂ›ÓÂÙ·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÔ‚·ÚÒÓ ·ÓÙÈ-‰Ú¿ÛÂˆÓ. OÈ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ÌÂÙ·Í‡ ·ÛÈÚ›ÓË˜ Î·È ª™∞º ‰ÂÓ ¤¯Ô˘Ó ÂÈ-‚Â‚·ÈˆıÂ›, ÁÈ’ ·˘Ùfi Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙Ô-ÓÙ·È ÌÂ ÂÈÊ‡Ï·ÍË (4). ∆¤ÏÔ˜, Ë ÚfiÎÏËÛË ÁÈ·ÙË ‰È¿ÁÓˆÛË ·ÏÏÂÚÁ›·˜ ÛÙ· ÙÔÈÎ¿ ·Ó·ÈÛıËÙÈ-Î¿ ‰ÂÓ ıÂˆÚÂ›Ù·È ··Ú·›ÙËÙË, ÂÎÙfi˜ Â¿Ó ÙÔÊ¿ÚÌ·ÎÔ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi (7). ™Â ·˘Ù‹ ÙËÓÂÚ›ÙˆÛË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ‰ÂÚÌ·ÙÈÎ‹ ‰Ô-ÎÈÌ·Û›· ÛÂ ·˘Í·ÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜ (8).

™Â ÂÚÂ˘ÓËÙÈÎfi Â›Â‰Ô ‚Ú›ÛÎÂÙ·È Ë Ì¤ÙÚË-ÛË ÂÈ¤‰ˆÓ ÏÂ˘ÎÔÙÚÈÂÓÒÓ ÌÂÙ¿ ·fi ‰È¤ÁÂÚ-ÛË ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ·fi ·ÏÏÂÚÁÈÔÁfiÓÔ(Cellular antigen stimulation test - CAST) ÁÈ·ÙË ‰È¿ÁÓˆÛË ·ÏÏÂÚÁ›·˜ ÛÂ ª™∞º. ∆· RASTÎ·È UniCAP ·ÓÈ¯ÓÂ‡Ô˘Ó ·ÓÙÈÛÒÌ·Ù· ÛÂ Ê¿Ú-Ì·Î·. ∆Ô ÙÂÛÙ “ÌÂÙ·ÌfiÚÊˆÛË˜ ÏÂ˘ÎÔÎ˘ÙÙ¿-ÚˆÓ” (Lymphocyte transformation test - LTT)ÂÊ·ÚÌfi˙ÂÙ·È ÛÙË ‰È¿ÁÓˆÛË ·ÓÙÈ‰Ú¿ÛÂˆÓ Ô˘ÚÔÎ·ÏÔ‡ÓÙ·È ·fi Ù‡Ô˘ πV ·ÓÔÛÔÏÔÁÈÎ¤˜·ÓÙÈ‰Ú¿ÛÂÈ˜ (2).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜“ÚÔÎÏ‹ÛÂÈ˜” ·ÔÙÂÏÔ‡Ó ·ÛÊ·ÏÂ›˜ ‰ÔÎÈÌ·-Û›Â˜, ÂÊfiÛÔÓ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÛÂ ÂÍÂÈ‰È-ÎÂ˘Ì¤ÓÔ ÓÔÛÔÎÔÌÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È ÌÂ Ï‹-„Ë Î·Ù¿ÏÏËÏˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· ÙÔÂÓ‰Â¯fiÌÂÓÔ ·Ó·Ê˘Ï·ÎÙÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜. ∞fiÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Ê¿-ÓËÎÂ fiÙÈ Ë ‰È¿ÁÓˆÛË ·ÏÏÂÚÁ›·˜ ÛÂ Û˘ÁÎÂÎÚÈ-Ì¤Ó· ÛÎÂ˘¿ÛÌ·Ù· ÌÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ Â›Ó·È·ÍÈfiÈÛÙË. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·ÓıÂ›, ˆÛÙfiÛÔ,fiÙÈ Ë ÛÂÈÚ¿ ·ÛıÂÓÒÓ ÛÙËÓ ÔÔ›· ‚·Û›˙ÂÙ·È ËÛ˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÏ¤ÙË Â›Ó·È ÌÈÎÚ‹. ∂ÔÌ¤Óˆ˜,ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÈÎ˘ÚˆıÂ› Ë ÂÁÎ˘ÚfiÙËÙ· ·˘-

ÙÒÓ ÙˆÓ ÚÔÎÏ‹ÛÂˆÓ Î·Ïfi ı· ‹Ù·Ó Ó· ˘¿Ú-

ÍÂÈ Ì›· ÌÂÁ·Ï‡ÙÂÚË ÌÂÏ¤ÙË Ô˘ ı· ÂÚÈÏ·Ì-

‚¿ÓÂÈ ÙË Û‡ÁÎÚÈÛ‹ ÙÔ˘˜ ÌÂ Ì›· ¿ÏÏË ‰ÔÎÈÌ·Û›·

Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙË ‰È¿ÁÓˆÛË Ê·ÚÌ·-

ÎÂ˘ÙÈÎÒÓ ·ÏÏÂÚÁÈÒÓ. ™Â Î¿ıÂ ÂÚ›ÙˆÛË È-

ı·Ó‹˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÏÏÂÚÁ›·˜ Ú¤ÂÈ Ó·

Ï·Ì‚¿ÓÂÙ·È ¤Ó· Î·Ïfi ÈÛÙÔÚÈÎfi, Ó· Ú·ÁÌ·ÙÔ-

ÔÈÂ›Ù·È ÚÔÛÂÎÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È ÛÂ

ÂÚ›ÙˆÛË Ô˘ ·fi ·˘Ù¿ ÚÔÎ‡ÙÂÈ ÈÛ¯˘Ú‹

˘Ô„›·, Ó· Á›ÓÂÙ·È ·Ú·ÔÌ‹ ÙˆÓ ·È‰ÈÒÓ

ÛÂ ÂÈ‰ÈÎfi ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË.


1. Gruchalla RS. Drug allergy. J Allergy Clin Immunol

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2. Primeau MN, Adkinson NF Jr. Recent advances in

the diagnosis of drug allergy. Curr Opin Allergy Clin

Immunol 2001;1:337-341.

3. Gruchalla RS. Understanding drug allergies. J Aller-

gy Clin Immunol 2000;105:637-644.

4. Grattan CE. Aspirin sensitivity and urticaria. Clin

Exp Dermatol 2003;28:123-127.

5. Torres MJ, Blanca M, Fernandez J, Romano A,

Weck A, Aberer W et al. EAACI Interest Group on

Drug Hypersensitivity. Diagnosis of immediate al-

lergic reactions to beta-lactam antibiotics. Allergy

2003;58:961-972.

6. Impicciatore P, Choonara I, Clarkson A, Provasi D,

Pandolfini C, Bonati M. Incidence of adverse drug

reactions in paediatric in/out-patients: a systematic

review and meta-analysis of prospective studies. Br J

Clin Pharmacol 2001;52:77-83.

7. deShazo RD, Kemp SF. Allergic reactions to drugs

and biologic agents. JAMA 1997;278:1895-1906.

8. Cetinkaya F. Sensitivity to local anaesthetics among

asthmatic children. Int J Paediatr Dent 2001;11:405-

408.

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tions after penicillin skin testing: multi-year follow-

up. Allergy 2002;57:1151-1158.

10. Aberer W, Bircher A, Romano A, Blanca M, Campi

P, Fernandez J et al. European Network for Drug Al-

lergy (ENDA). EAACI Interest Group on Drug

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agnosis of drug hypersensitivity reactions: general

considerations. Allergy 2003;58:854-863.

¶·È‰È·ÙÚÈÎ‹ 2005;68:337-340


341REVIEW ARTICLE

Evaluation of oral challenges for the diagnosis

of drug allergy

A. Sofianou - Katsoulis1, G. Du Toit2, G. Lack3

Abstract

Background: Allergic reactions to drugs in the paediatric population are serious and potentially lifethreatening events that are often poorly diagnosed and managed. This is due to a lack of validatedand readily available diagnostic tests, as well as of consensus guidelines for their management.

Methods: This was a retrospective study of 22 patients who underwent provocation tests for thediagnosis of reported drug allergy. The testing was made at St. Mary’s Hospital, London. The testswere predominantly oral challenges with the exception of lidocaine/procaine, for which a skin test wasperformed. Most of the tests were done to test penicillin allergy (40%). Three quarters were singlecompared to combined challenges.

Results: Six patients (28%) reacted, five of whom had an immediate and one a delayed reaction.None of them had a reaction upon re-exposure to a suggested medication. The parents of the childrenwho had a negative challenge felt that the outcome was reassuring. For those whose children had apositive outcome, it enhanced their confidence in the use of alternative drugs.

Conclusions: Drug challenges need to be performed at a specialized centre particularly in patientswhere the history is equivocal. Many of the present diagnostic tests need validation prior to theirgeneralization. Larger cohort studies are also required to establish the long-term prognosis in thesecases.

Key words

Drug challenges, drug allergy, adverse events.

1 Paediatric SpecialistRegistrar, St. Mary’sHospital, London, UK

2 Consultants in PaediatricAllergy, Department ofPaediatric Allergology andImmunology, St. Mary’sHospital, London, UK

Correspondence:

A. Sofianou-Katsoulis 42 Abbots Park, St. Albans Herts, UK AL1 1TWE-mail: [email protected]

Date of submission: 17-09-2004 Date of approval: 27-04-2005



342 ∞¡∞™∫O¶∏™∏

1 °’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô Ã·˚‰·Ú›Ô˘“∞ÙÙÈÎfiÓ”, ∞ı‹Ó·

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


µ·Û›ÏÂÈÔ˜ ∆Û·ÁÚ‹˜ °’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›ÔÃ·˚‰·Ú›Ô˘ “∞ÙÙÈÎfiÓ”ƒ›ÌÈÓÈ 1, Ã·˚‰¿ÚÈ, ∞ı‹Ó· E-mail: [email protected]


¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350

∏ ÈÓÔÌ˘·ÏÁ›· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

µ. ∆Û·ÁÚ‹˜1, ∞. ∫ÈÙÛÔÔ‡ÏÔ˘2, ∫. ª›¯·˜2, ¶. ¡ÈÎÔÏ·˝‰Ô˘ - ∫·Ú·ı›Ô˘1

¶ÂÚ›ÏË„Ë

∏ ÈÓÔÌ˘·ÏÁ›· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ·ÔÙÂÏÂ› Ì›· ·ÚÎÂÙ¿ Û˘Ó‹ıË, ÂÒ‰˘ÓË Ì˘ÔÛÎÂÏÂÙÈÎ‹ Û˘Ó‰ÚÔ-Ì‹, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi Â›ÌÔÓÔ ‰È¿¯˘ÙÔ fiÓÔ, ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ‰È·ÎÚÈÙÒÓ Â˘·›ÛıËÙˆÓÛËÌÂ›ˆÓ ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ‰˘ÛÎ·Ì„›·, ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ Î·È ÎfiˆÛË. ∏ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ Â›-Ó·È ¯ÚÔÓ›˙Ô˘Û· Î·È ÂËÚÂ¿˙ÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈÎ‹ ÈÎ·ÓfiÙËÙ· Î·È ÙËÓ „˘¯ÔÎÔÈÓˆÓÈÎ‹ ·Ó¿Ù˘ÍË ÙˆÓ ·-Û¯fiÓÙˆÓ ·È‰ÈÒÓ. ∞Ó Î·È Ë ·ÈÙÈÔÏÔÁ›· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, ıÂˆÚÂ›Ù·È fiÙÈ Ì›· ÏÂÈ¿‰· ·Ú·ÁfiÓÙˆÓÌÔÚÂ› Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÎÏÈÓÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜ ÓfiÛÔ˘. ∏ ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Â›Ó·È ÌË ÂÈ‰È-Î‹ Î·È ÔÏ‡ÏÂ˘ÚË, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ Ê·ÚÌ·ÎÔÏÔÁÈÎ¿ Î·È ÌË Ì¤ÙÚ·.


πÓÔÌ˘·ÏÁ›·, ·È‰È¿, fiÓÔ˜, ıÂÚ·Â›·, Ì˘ÔÛÎÂÏÂÙÈÎfi˜.

∂ÈÛ·ÁˆÁ‹

∞ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÈÙÈÔÏÔÁ›·, Ô fiÓÔ˜·ÔÙÂÏÂ› Ì›· Û˘¯Ó‹ ÂÌÂÈÚ›· ÛÙË ‰È¿ÚÎÂÈ· ÙË˜·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∞Ó Î·È ÛÙ· ÔÍ¤· ÂÒ‰˘Ó·Ì˘ÔÛÎÂÏÂÙÈÎ¿ Û‡Ó‰ÚÔÌ· Ë ·ÈÙ›· Â›Ó·È Û˘Ó‹ıˆ˜ÚÔÊ·Ó‹˜, ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ¯ÚfiÓÈˆÓ Û˘Ó-‰ÚfiÌˆÓ Ë ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Û˘¯Ó¿ ·Ô-‰ÂÈÎÓ‡ÂÙ·È ‰˘Û¯ÂÚ‹˜. O fiÓÔ˜ ·ÔÙÂÏÂ› Ì›·ÂÌÂÈÚ›· ÌÂ ‰È·ÛÙ¿ÛÂÈ˜ Ú·ÁÌ·ÙÈÎ¤˜ ÁÈ· ·˘ÙfiÓÔ˘ ÙË ‚ÈÒÓÂÈ, ˘Ô‚·ıÌ›˙ÂÈ ÛËÌ·ÓÙÈÎ¿ ÙËÓÔÈfiÙËÙ· ˙ˆ‹˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ·È‰ÈÔ‡ Î·È ÙË˜ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Ô‰ËÁÂ› ÛÂ Û˘¯Ó¤˜ Î·È ÂÓ‰Â¯Ô-Ì¤Óˆ˜ ·ÙÂÏ¤ÛÊÔÚÂ˜ ÂÈÛÎ¤„ÂÈ˜ ÛÂ Â·ÁÁÂÏÌ·-Ù›Â˜ ˘ÁÂ›·˜ ‰È·ÊfiÚˆÓ ÂÈ‰ÈÎÔÙ‹ÙˆÓ.

∏ ÈÓÔÌ˘·ÏÁ›· ·ÔÙÂÏÂ› ‰È·Ù·Ú·¯‹ ÌË ÊÏÂÁ-ÌÔÓÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ÚÔÂÍ¿Ú¯Ô˘Û· Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ‰È¿¯˘-ÙÔ˘ fiÓÔ˘ ‹/Î·È ‰˘ÛÎ·Ì„›·˜ Ì˘˚ÎÒÓ ÔÌ¿‰ˆÓ ‹Î·È ·ÚıÚÒÛÂˆÓ Î·È ·ÓÂ‡ÚÂÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓÛËÌÂ›ˆÓ ÂÓ Ùˆ ‚¿ıÂÈ Â˘·ÈÛıËÛ›·˜ Î·Ù¿ ÙËÓ ÎÏÈ-ÓÈÎ‹ ÂÍ¤Ù·ÛË. ∆·ÍÈÓÔÌÂ›Ù·È ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ÔÌ¿‰· ÙÔ˘ ‰È¿¯˘ÙÔ˘ È‰ÈÔ·ı‹ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡fiÓÔ˘. ¶ÚfiÛÊ·Ù·, ÂÈÛ‹¯ıË Ô ÂÚÈÁÚ·ÊÈÎfiÙÂ-ÚÔ˜ fiÚÔ˜ “ÓÂ·ÓÈÎfi ÚˆÙÔ·ı¤˜ Û‡Ó‰ÚÔÌÔ ÈÓÔ-Ì˘·ÏÁ›·˜”, ÛÙËÓ ÚÔÛ¿ıÂÈ· ·ÓÙÈ‰È·ÛÙÔÏ‹˜ÙˆÓ ‰È·ÊÔÚÒÓ ÙË˜ ÎÏÈÓÈÎ‹˜ ¤ÎÊÚ·ÛË˜ ÛÂ ·È-‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜, ·ÏÏ¿ Î·È ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓÈ‰È·ÈÙÂÚÔÙ‹ÙˆÓ. OÈ ·Ï·ÈfiÙÂÚÔÈ fiÚÔÈ “Ì˘·ÏÁ›·˘fi Ù¿ÛË”, “ÁÂÓÈÎÂ˘Ì¤ÓË ÙÂÓÔÓÙÔÌ˘Ô¿ıÂÈ·”,“ÈÓÔÌ˘ÔÛ›ÙÈ‰·” ‹ “ÈÓÔÛ›ÙÈ‰·”, ‡ÛÙÂÚ· ·fi ÂÈ-Û‹ÁËÛË ÙÔ˘ ∞ÌÂÚÈÎ·ÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ ƒÂ˘Ì·ÙÔ-ÏÔÁ›·˜ (∞∫ƒ), ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ï¤ÔÓ(1). °È· ÏfiÁÔ˘˜ ·ÏfiÙËÙ·˜ Î·È ·ÔÊ˘Á‹˜ Û‡Á-

¯˘ÛË˜, ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÙÔ˘ ·ÚfiÓÙÔ˜ ¿ÚıÚÔ˘Â¤ÏÂÍ·Ó ÙË ¯Ú‹ÛË ÙÔ˘ ‰È·¯ÚÔÓÈÎfiÙÂÚÔ˘ fiÚÔ˘“ÈÓÔÌ˘·ÏÁ›·”.

∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ fiÓÔ˘

O fiÓÔ˜ ‰È·ÎÚ›ÓÂÙ·È ÛÂ ‰‡Ô Î‡ÚÈÔ˘˜ Ù‡-Ô˘˜: ÙÔÓ “Ù·¯‡” fiÓÔ (ÔÍ‡˜ ‹ Ó˘ÁÌÒ‰Ë˜) Î·ÈÙÔÓ “‚Ú·‰‡” fiÓÔ (Î·˘ÛÙÈÎfi˜, ‚‡ıÈÔ˜, ¯ÚfiÓÈÔ˜‹ ÛÊ‡˙ˆÓ), Ô ÔÔ›Ô˜ Á›ÓÂÙ·È ·ÈÛıËÙfi˜ ÌÂÙ¿·fi 1 sec ‹ ÂÚÈÛÛfiÙÂÚÔ, ÌÂ ‚·ıÌÈ·›· ·‡ÍËÛËÙË˜ ¤ÓÙ·Û‹˜ ÙÔ˘. O Ù·¯‡˜ fiÓÔ˜ ·ÊÔÚ¿ Î˘-Ú›ˆ˜ ÛÙÔ ‰¤ÚÌ· Î·È ‰ÂÓ Á›ÓÂÙ·È ·ÈÛıËÙfi˜ ·fiÙÔ˘˜ ÂÓ Ùˆ ‚¿ıÂÈ ÈÛÙÔ‡˜ Î·È Ô ‚Ú·‰‡˜ fiÓÔ˜, ÔÔÔ›Ô˜ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ÈÓÔÌ˘·ÏÁ›·, ÌÔÚÂ›Ó· ÚÔ¤Ú¯ÂÙ·È ÙfiÛÔ ·fi ÙÔ ‰¤ÚÌ· fiÛÔ Î·È ·fiÔÔÈ·‰‹ÔÙÂ ÂÓ Ùˆ ‚¿ıÂÈ ‰ÔÌ‹. ¶·Ú¿ ÙÔ ÁÂÁÔ-Ófi˜ fiÙÈ fiÏÔÈ ÔÈ ˘Ô‰Ô¯Â›˜ fiÓÔ˘ Â›Ó·È ÂÏÂ‡ıÂ-ÚÂ˜ ÓÂ˘ÚÈÎ¤˜ ·ÔÏ‹ÍÂÈ˜, ÁÈ· ÙËÓ ·ÁˆÁ‹ ÙˆÓÓÂ˘ÚÈÎÒÓ ÒÛÂˆÓ ÚÔ˜ ÙÔ ∫¡™ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ‰‡Ô ÍÂ¯ˆÚÈÛÙ¤˜ ÓÂ˘ÚÈÎ¤˜ Ô‰Ô›, Ì›· ÁÈ· ÙÔÙ·¯‡, ÔÍ‡ ¿ÏÁÔ˜ Î·È Ì›· ÁÈ· ÙÔ ‚Ú·‰‡, ¯ÚfiÓÈÔ¿ÏÁÔ˜. ∆· Û‹Ì·Ù· ÁÈ· ÙÔ ‚Ú·‰‡ ¿ÏÁÔ˜ ÂÎÏ‡Ô-ÓÙ·È ·fi ¯ËÌÈÎÔ‡ Ù‡Ô˘ ÂÚÂı›ÛÌ·Ù· (‹ Î·Ù¿ÂÚ›ÙˆÛË ·fi Â›ÌÔÓ· ÌË¯·ÓÈÎ¿ ‹ ıÂÚÌÈÎ¿)Î·È ¿ÁÔÓÙ·È ÚÔ˜ ÙÔÓ ÓˆÙÈ·›Ô Ì˘ÂÏfi ÌÂ ÂÚÈ-ÊÂÚÈÎ¿ ÓÂ‡Ú· ·ÔÙÂÏÔ‡ÌÂÓ· ·fi ÙÈ˜ ÛÙÂÚÔ‡-ÌÂÓÂ˜ Ì˘ÂÏ›ÓË˜ ›ÓÂ˜ C. ™·Ó ÓÂ˘ÚÔ‰È·‚È‚·ÛÙ¤˜ÏÂÈÙÔ˘ÚÁÔ‡Ó ÙÔ ˘fiÛÙÚˆÌ· ƒ Î·È ÂÙ›‰È·Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ÁÔÓ›‰ÈÔ ÙË˜ Î·ÏÛÈÙÔÓ›-ÓË˜. ªÂÙ¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘˜ ÛÙÔÓ ÓˆÙÈ·›Ô Ì˘Â-Ïfi, Ù· ÂÚÂı›ÛÌ·Ù· fiÓÔ˘ ·ÎÔÏÔ˘ıÔ‡Ó ‰‡Ô ‰È·ÊÔÚÂÙÈÎ¤˜ Ô‰Ô‡˜ ÚÔ˜ ÙÔÓ ÂÁÎ¤Ê·ÏÔ: ÙË


343∏ ÈÓÔÌ˘·ÏÁ›· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

ÓÂÔÓˆÙÈ·ÈÔı·Ï·ÌÈÎ‹ Ô‰fi ÁÈ· ÙÔÓ Ù·¯‡ fiÓÔ

Î·È ÙËÓ ·Ï·ÈÔÓˆÙÈ·ÈÔı·Ï·ÌÈÎ‹ Ô‰fi ÁÈ· ÙÔÓ

‚Ú·‰‡ fiÓÔ, Ô˘ Î·Ù·Ï‹ÁÂÈ Î˘Ú›ˆ˜ ÛÙÔ ÂÁÎÂ-

Ê·ÏÈÎfi ÛÙ¤ÏÂ¯Ô˜ (2).

O ‚·ıÌfi˜ ·ÓÙ›‰Ú·ÛË˜ ÛÙÔÓ fiÓÔ ÔÈÎ›ÏÏÂÈ

ÛËÌ·ÓÙÈÎ¿ ·fi ¿ÙÔÌÔ ÛÂ ¿ÙÔÌÔ, ÁÂÁÔÓfi˜ ÙÔ

ÔÔ›Ô ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÈÎ·ÓfiÙËÙ·

ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ó· ÂÏ¤Á¯ÂÈ ÙËÓ Â›ÛÔ‰Ô

ÂÒ‰˘ÓˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ ÛÙÔ ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·,

Ì¤Ûˆ ÂÓfi˜ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó·ÏÁËÛ›·˜. ∂ÎÙfi˜ ·fi

ÙÈ˜ ·Ó·ÙÔÌÈÎ¤˜ ‰ÔÌ¤˜, ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÏÂÈ-

ÙÔ˘ÚÁ›· ·˘ÙÔ‡ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Î·Ù¤¯Ô˘Ó Ù·

ÂÓ‰ÔÁÂÓ‹ ÔÈÔÂÈ‰‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∆· ÚÒÙ·

ÔÈÔÂÈ‰‹, ÔÈ ÂÁÎÂÊ·Ï›ÓÂ˜, ÂÚÈÁÚ¿ÊËÎ·Ó ÙÔ

1975, ÌÂ Î‡ÚÈÔ ÂÎÚfiÛˆÔ ÙË ‚-ÂÓ‰ÔÚÊ›ÓË.

¶ÂÚÈÛÛfiÙÂÚ· ·fi 20 ÂÓ‰ÔÁÂÓ‹ ÔÈÔÂÈ‰‹ ÂÙ›-

‰È· ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Ì¤¯ÚÈ Û‹ÌÂÚ·, ÌÂ Ù· ÓÂfi-

ÙÂÚ· - ÂÓ‰ÔÌÔÚÊ›ÓÂ˜ Î·È ·ÏÁÔÛÙ·Ù›ÓË - Ó· ‚Ú›-

ÛÎÔÓÙ·È ÛÙÔ Â›ÎÂÓÙÚÔ ÙÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜. ™Â

ÔÏÏ¿ ÛËÌÂ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÂÓÙÔ›ÛÙËÎÂ Ë

·ÚÔ˘Û›· ˘Ô‰Ô¯¤ˆÓ ÁÈ· ÔÈÔÂÈ‰‹, È‰È·›ÙÂÚ·

ÛÙÈ˜ ÂÚÈÔ¯¤˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ Û‡-

ÛÙËÌ· ·Ó·ÏÁËÛ›·˜. OÈ ˘Ô‰Ô¯Â›˜ ·˘ÙÔ› ‰È·ÎÚ›-

ÓÔÓÙ·È ÛÂ ÙÚÂÈ˜ Î·ÙËÁÔÚ›Â˜: ÙÔ˘˜ Ì, Î Î·È ‰. ∞Ó

Î·È Ë ‰Ú¿ÛË ÙÔ˘ ‰ÂÓ ¤¯ÂÈ Â·ÎÚÈ‚Ò˜ Î·Ù·ÓÔË-

ıÂ›, Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó·ÏÁË-

Û›·˜ Â›Ó·È ‰˘Ó·Ùfi Ó· Î·Ù·ÛÙÂ›ÏÂÈ Ï‹Úˆ˜ ·ÚÎÂ-

Ù¿ ÂÒ‰˘Ó· ÂÚÂı›ÛÌ·Ù· Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔ

∫¡™ ·fi ÙËÓ ÂÚÈÊ¤ÚÂÈ· (3).

∂È‰ËÌÈÔÏÔÁ›·

∏ ÈÓÔÌ˘·ÏÁ›· ·ÔÙÂÏÂ› Ì›· ·fi ÙÈ˜ Û˘¯Ófi-

ÙÂÚÂ˜ ÚÂ˘Ì·ÙÈÎ¤˜ ·ı‹ÛÂÈ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜, ÌÂ Â-

Ú›Ô˘ 5 ÂÎ·ÙÔÌÌ‡ÚÈ· ¿ÙÔÌ· Ó· ÓÔÛÔ‡Ó ÌfiÓÔ

ÛÙÈ˜ ∏¶∞. ™Â ÏËı˘ÛÌÈ·Î‹ ÌÂÏ¤ÙË 900 ÂÓËÏ›-

ÎˆÓ, Ù˘¯·ÈÔÔÈËÌ¤ÓÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·fi ÙË ™Ô˘-

Ë‰›·, Ë Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ

ÛÙÔ 1% (4). ™Â ·ÓÙ›ÛÙÔÈ¯Â˜ ÌÂÏ¤ÙÂ˜ ·fi ÙÔ

πÛÚ·‹Ï, ÙÔ ªÂÍÈÎfi Î·È ÙË ºÈÓÏ·Ó‰›·, ‰È·È-

ÛÙÒıËÎÂ fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ ÙË˜ ÛÂ ·È‰È¿ Û¯ÔÏÈ-

Î‹˜ ËÏÈÎ›·˜ ·Ó¤Ú¯ÂÙ·È ÛÂ ÔÛÔÛÙfi 6,2%, 1,3%

Î·È 1,3%, ·ÓÙ›ÛÙÔÈ¯· (5-7). ™Â ÌÂÏ¤ÙÂ˜ ÚÔÂÚ-

¯fiÌÂÓÂ˜ ·fi ·È‰ÔÚÂ˘Ì·ÙÔÏÔÁÈÎ¿ Î¤ÓÙÚ· ÙˆÓ

∏¶∞, Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÙË˜ ÓfiÛÔ˘ ÌÂÙ·-

Í‡ ÙˆÓ Ó¤ˆÓ ‰È·ÁÓÒÛÂˆÓ ·˘Í¿ÓÂÙ·È ÚÔÔ‰Â˘-

ÙÈÎ¿, ÂÎÚÔÛˆÒÓÙ·˜ ÔÛÔÛÙfi 7% Â› ÙÔ˘ Û˘-

ÓfiÏÔ˘ (8). OÈ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ Ê‡ÏˆÓ Â›-

Ó·È ÛËÌ·ÓÙÈÎ¤˜, ÌÂ Ù· ÎÔÚ›ÙÛÈ· Ó· ÚÔÛ‚¿ÏÏÔ-

ÓÙ·È ÔÏ‡ Û˘¯ÓfiÙÂÚ· ·fi Ù· ·ÁfiÚÈ· (·Ó·ÏÔÁ›·

4:1 ‹ ·ÎfiÌË Î·È 9:1 ÛÂ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜). ∏

ÂÊË‚Â›· ·ÔÙÂÏÂ› ÙË Û˘ÓËı¤ÛÙÂÚË ËÏÈÎ›·

¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, ÂÓÒ Ë Ï¤ÔÓ ÚÒ-

ÈÌË ‰È¿ÁÓˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙË ‚È‚ÏÈÔ-

ÁÚ·Ê›· ·ÊÔÚ¿ ÛÂ ·È‰› ËÏÈÎ›·˜ 5 ÂÙÒÓ (9).

∞ÈÙÈÔÏÔÁ›·

∞Ó Î·È Ë ·ÈÙÈÔÏÔÁ›· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, Ë

‰È·ÊÔÚÂÙÈÎ‹ ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ Î·È ·ÓÙ·fiÎÚÈ-

ÛË ÛÙË ıÂÚ·Â›· ÛÙ· ·È‰È¿ ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹-

ÏÈÎÂ˜, ·ÏÏ¿ Î·È Ë ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÚÔ-

Û‚ÔÏ‹˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ¤Ó·ÓÙÈ ÙˆÓ ·ÁÔÚÈÒÓ,

ÂÈÙÚ¤Ô˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÔÏÏÒÓ ÂÈÎ·ÛÈÒÓ

Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·.

∆Ô Ì˘˚Îfi Û‡ÛÙËÌ·

Œ¯ÂÈ ÂÎÊÚ·ÛÙÂ› Ë ¿Ô„Ë fiÙÈ ‰È·Ù·Ú·¯¤˜ ÙË˜

·Ó·ÙÔÌÈÎ‹˜ ‰ÔÌ‹˜ Î·È ÙˆÓ ‰ÈÂÚÁ·ÛÈÒÓ ÂÈ‰ÈfiÚ-

ıˆÛË˜ ÙÔ˘ Ì˘˚ÎÔ‡ ÈÛÙÔ‡ Â›Ó·È Èı·Ófi Ó· Û˘ÓÂÈ-

ÛÊ¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙÔ˘

Û˘Ó‰ÚfiÌÔ˘. ªÂÏ¤ÙÂ˜ ÌÂ Ì·ÁÓËÙÈÎ‹ Ê·ÛÌ·ÙÔ-

ÛÎÔ›· Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ‰È·Ù·Ú·¯ÒÓ ÛÙÔ Û·Ú-

ÎfiÏ·ÛÌ· ÙˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ô˘ ÚÔÎ·-

ÏÔ‡Ó ÌÂÈˆÌ¤ÓË ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ÂÓÂÚÁÂÈ·-

ÎÒÓ ·ÔıÂÌ¿ÙˆÓ Î·È, ÙÂÏÈÎ¿, Î˘ÙÙ·ÚÈÎ‹ ˘Ô-

Í›· (10). ∏ ·ÒÏÂÈ· ÙÔ˘ ··Ú·›ÙËÙÔ˘ ÁÈ· ÙË

‰È·Ù‹ÚËÛË ÙË˜ ÛÙ·ıÂÚfiÙËÙ·˜ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ

ÌÂÌ‚Ú·ÓÒÓ ∞∆ƒ, Ë ÔÔ›· ÚÔÎ·ÏÂ›Ù·È ÛÙÔ

Ï·›ÛÈÔ ÙË˜ ˘ÔÍ›·˜, Ô‰ËÁÂ› ÛÂ Û˘Ó·ÎfiÏÔ˘ıË

Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Û·ÚÎÔÌÂÚÈ‰›ˆÓ. ∞˘Ù‹, ÌÂ ÙË

ÛÂÈÚ¿ ÙË˜, ÚÔÎ·ÏÂ› ·ÒÏÂÈ· ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˘

Î·Ï›Ô˘, ÙÔ ÔÔ›Ô ÂÓÂÚÁÔÔÈÂ› ÙÔ˘˜ ˘Ô‰Ô¯Â›˜

fiÓÔ˘, ÚÔÎ·ÏÒÓÙ·˜ ÙÔÈÎ¤˜ Û˘Û¿ÛÂÈ˜ Ì˘˚-

ÎÒÓ ÔÌ¿‰ˆÓ, ÔÈ ÔÔ›Â˜ ÂÓÈÛ¯‡Ô˘Ó ÂÚ·ÈÙ¤Úˆ

ÙËÓ ·ÒÏÂÈ· Î·Ï›Ô˘ Î·È Ô‰ËÁÔ‡Ó ÙÂÏÈÎ¿ ÛÂ

Ê·‡ÏÔ Î‡ÎÏÔ.

OÚÌÔÓÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ Î·È ‰È·Ù·Ú·¯¤˜

‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ

∏ ·ÓÂ‡ÚÂÛË ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ÂÏÂ‡ıÂÚË˜

ÎÔÚÙÈ˙fiÏË˜ Ô‡ÚˆÓ Î·È ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ËÌÂÚ‹-

ÛÈÔ˘ Ú˘ıÌÔ‡ ¤ÎÎÚÈÛË˜ ÎÔÚÙÈ˙fiÏË˜, Î·ıÒ˜ Î·È Ë

¤ÓÙÔÓË ¤ÎÎÚÈÛË ACTH ÌÂÙ¿ ·fi ÚfiÎÏËÛË

˘ÔÁÏ˘Î·ÈÌ›·˜, ¯ˆÚ›˜ ˆÛÙfiÛÔ ÙËÓ ·Ó·ÌÂÓfiÌÂ-

ÓË ¤ÎÎÚÈÛË ÎÔÚÙÈ˙fiÏË˜ ·fi Ù· ÂÈÓÂÊÚ›‰È·, Û˘-

ÓËÁÔÚÔ‡Ó ˘¤Ú Èı·Ó‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘

˘Ôı·Ï·ÌÈÎÔ‡-˘ÔÊ˘ÛÈ·ÎÔ‡-ÂÈÓÂÊÚÈ‰ÈÎÔ‡

¿ÍÔÓ·. ªÂÈˆÌ¤ÓË ‚Ú¤ıËÎÂ, Â›ÛË˜, Ë ¤ÎÎÚÈÛË

ÎÔÚÙÈ˙fiÏË˜ ÌÂÙ¿ ·fi ÚfiÎÏËÛË ÌÂ ¯ÔÚ‹ÁËÛË

CRH, ‰È·›ÛÙˆÛË Ô˘ Î·ıÈÛÙ¿ Èı·Ófi ÙÔ Úˆ-

ÙÔ·ı¤˜ ·›ÙÈÔ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÌ˘·ÏÁ›· Ó· Â›-

Ó·È Ë ‰È·Ù·Ú·¯‹ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ˘Ôı·Ï¿-

ÌÔ˘ (11-13). O ÌË¯·ÓÈÛÌfi˜, ˆÛÙfiÛÔ, ÌÂ ÙÔÓ

¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350


344 µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

ÔÔ›Ô ÔÈ ‰ÈÂÚÁ·Û›Â˜ ·˘Ù¤˜ Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ÛÙËÓ

ÂÎ‰‹ÏˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ Û˘Ó‰ÚÔÌ‹˜ ·Ú·Ì¤ÓÂÈ

·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ˜. OÈ Bennett Î·È Û˘Ó ‰È·›ÛÙˆ-

Û·Ó ÂÏ·ÙÙˆÌ¤Ó· Â›Â‰· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

(GH) ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÌ˘·ÏÁ›· (14,15). ¶Úfi-

ÎÂÈÙ·È ÁÈ· ÔÚÌfiÓË Ô˘ ÂÎÎÚ›ÓÂÙ·È ÛÂ ·˘ÍËÌ¤Ó·

Â›Â‰· Î·Ù¿ ÙÔ ÛÙ¿‰ÈÔ 4 ÙÔ˘ ‡ÓÔ˘, ‰È·‰Ú·-

Ì·Ù›˙ÔÓÙ·˜ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË

ÙˆÓ Ì˘ÒÓ Î·È Â˘Ô‰ÒÓÔÓÙ·˜ ÙÈ˜ ·Ó·‚ÔÏÈÎ¤˜

ÙÔ˘˜ ‰ÈÂÚÁ·Û›Â˜. ŒÙÛÈ, ÂÎÊÚ¿ÛÙËÎÂ Ë ¿Ô„Ë

·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ fiÙÈ Ë ÁÓˆÛÙ‹ ·fi ÙÔ ·-

ÚÂÏıfiÓ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÛÙ·‰›Ô˘ 4 ÙÔ˘ ‡ÓÔ˘ ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÌ˘·ÏÁ›·, Â›Ó·È ‰˘Ó·Ùfi Ó· ÂË-

ÚÂ¿ÛÂÈ ÙËÓ ¤ÎÎÚÈÛË ÙË˜ GH Î·È ·˘Ù‹, ÌÂ ÙË ÛÂÈ-

Ú¿ ÙË˜, ÙÈ˜ ‰ÈÂÚÁ·Û›Â˜ ·Ó·‰fiÌËÛË˜ ÙˆÓ Ì˘˚ÎÒÓ

ÈÓÒÓ (16,17). øÛÙfiÛÔ, Ë ·Ú·¿Óˆ ·ÈÙÈÔÏÔÁÈÎ‹

Û˘Û¯¤ÙÈÛË ·Ú·Ì¤ÓÂÈ ·ÌÊ›‚ÔÏË, Î·ıÒ˜ ·ÔÙÂ-

ÏÂ› ·ÓÙÈÎÂ›ÌÂÓÔ ‰È¯ÔÁÓˆÌ›·˜ ÙÔ ·Ó Ë ‰È·Ù·Ú·¯‹

ÙË˜ Ê˘ÛÈÔÏÔÁ›·˜ ÙÔ˘ ‡ÓÔ˘ ·ÔÙÂÏÂ› Ì›· Úˆ-

ÙÔ·ı‹ ‰È·Ù·Ú·¯‹ ‹ ·Ï¿ ÂÈÛ˘Ì‚·›ÓÂÈ ˆ˜

·ÓÙ›‰Ú·ÛË ÛÙÔÓ fiÓÔ Ô˘ ˘ÔÛ˘ÓÂ›‰ËÙ· ‚ÈÒ-

ÓÂÈ Ô ·ÛıÂÓ‹˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ∏ Úfi-

ÎÏËÛË ˘ÔÁÏ˘Î·ÈÌ›·˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÈÓ-

ÛÔ˘Ï›ÓË˜ ÛÂ ¿Û¯ÔÓÙÂ˜, Ô‰‹ÁËÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹

·‡ÍËÛË ÙË˜ ¤ÎÎÚÈÛË˜ GH, Î¿ÙÈ ÙÔ ÔÔ›Ô ‰ÂÓ

·Ú·ÙËÚ‹ıËÎÂ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÎÏÔÓÈ‰›-

ÓË˜, ‰È·›ÛÙˆÛË Ô˘ Ô‰‹ÁËÛÂ ÛÙËÓ ˘fiıÂÛË

fiÙÈ Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ¿ÍÔÓ· ÂÓÙÔ›˙ÂÙ·È Î·È Â‰Ò

ÛÙÔ Â›Â‰Ô ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘ (18). ™Â ÌÂÏ¤ÙÂ˜

ÛÂ ∂¡À ·Û¯fiÓÙˆÓ ·fi ÈÓÔÌ˘·ÏÁ›·, ‰È·ÈÛÙÒ-

ıËÎ·Ó ÂÏ·ÙÙˆÌ¤Ó· Â›Â‰· ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ

(5∏π∞∞, ÔÌÔ‚·Ó˘ÏÏÈÎfi ÔÍ‡, 3-ÌÂı˘Ï-4-˘‰ÚÔ-

Í˘˚Ó‰ÔÏÈÎfi ÔÍ‡) ÛÂ Û¯¤ÛË ÌÂ ˘ÁÈÂ›˜ Ì¿ÚÙ˘ÚÂ˜

(19,20). ™Â ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ‰È·ÈÛÙÒıËÎ·Ó

ÂÏ·ÙÙˆÌ¤Ó· Â›Â‰· ÛÂÚÔÙÔÓ›ÓË˜ Î·È ·˘ÍËÌ¤-

ÓÔ˜ ·ÚÈıÌfi˜ ˘Ô‰Ô¯¤ˆÓ Â·Ó·ÚfiÛÏË„Ë˜ ÛÂ-

ÚÔÙÔÓ›ÓË˜ ÛÙ· ·ÈÌÔÂÙ¿ÏÈ·. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë

ÛÂÚÔÙÔÓ›ÓË Â˘Ô‰ÒÓÂÈ ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË CRH

ÛÙÔÓ ˘Ôı¿Ï·ÌÔ Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÎÚÈÛË

˘ÔÛÙÚÒÌ·ÙÔ˜ ƒ ÛÙÔ ∂¡À, Ô˘Û›·˜ Ô˘ Û¯ÂÙ›-

˙ÂÙ·È ÌÂ ÙË ‰ÈÂÚÁ·Û›· ÚfiÎÏËÛË˜ ÙÔ˘ fiÓÔ˘

Î·È ÙË˜ ÔÔ›·˜ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙÔ ∂¡À ·-

Û¯fiÓÙˆÓ ¤¯Ô˘Ó ‚ÚÂıÂ› ·˘ÍËÌ¤ÓÂ˜ (21). ∞fi ·Ú-

ÎÂÙÔ‡˜ Û˘ÁÁÚ·ÊÂ›˜, Ù· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù·

ÂÓÔÔÈÔ‡ÓÙ·È ÛÙÔ Ï·›ÛÈÔ Ì›·˜ Â˘Ú‡ÙÂÚË˜ ıÂˆ-

Ú›·˜ ÌÂÈˆÌ¤ÓË˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ ·˘ÙfiÓÔ-

ÌÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (22).

∆Ô ·ÓÔÛÔÏÔÁÈÎfi ˘fi‚·ıÚÔ

∂Í·ÈÚÂÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÏ¤-

ÙÂ˜ Ô˘ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙËÓ Î·Ù·ÛÙÔÏ‹ ÙË˜ ‰Ú¿-

ÛË˜ ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ÔÈÔÂÈ‰ÒÓ, ‹ Ú˘ıÌÈÛÙÒÓ

ÙË˜ ‰Ú¿ÛË˜ ÙÔ˘˜, ·fi ·˘ÙÔ¿ÓÔÛÔ˘˜ ÌË¯·ÓÈ-

ÛÌÔ‡˜. Œ¯ÂÈ ‰È·Ù˘ˆıÂ› Ë ¿Ô„Ë fiÙÈ ·˘ÙÔ·ÓÙÈ-

ÛÒÌ·Ù· Â›Ó·È ‰˘Ó·Ùfi Ó· ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ ÙˆÓ

ÂÙÈ‰›ˆÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ Î·È Ó· Ù· Î·-

Ù·ÛÙÚ¤ÊÔ˘Ó ‹ Ó· ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›·

ÙÔ˘˜. ™ÙË ıÂˆÚ›· fiÙÈ ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ ÛÙËÓ ·È-

ÙÈÔ·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ì›·

‰È·Ù·Ú·¯‹ ÙË˜ Ô‰Ô‡ ÌÂÙ·‚›‚·ÛË˜ ÙÔ˘ fiÓÔ˘,

¤¯ÂÈ ÚfiÛÊ·Ù· ÂÚÈÏËÊıÂ› Ë Èı·Ó‹ ‰Ú¿ÛË ·˘-

ÙÔ¿ÓÔÛˆÓ ·Ú·ÁfiÓÙˆÓ, ÔÈ ÔÔ›ÔÈ ÛÙÚ¤ÊÔÓÙ·È

Î·Ù¿ ÓÂ˘ÚÔÂÙÈ‰›ˆÓ (fiˆ˜ ÙÔ ˘fiÛÙÚˆÌ· ƒ)

‹ ÔÚÌÔÓÒÓ ÙË˜ Ô‰Ô‡ ·˘Ù‹˜. ªÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ

·Ó›¯ÓÂ˘ÛË ·˘ÙÒÓ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ, ÙfiÛÔ

ÛÙÔÓ ÔÚfi fiÛÔ Î·È ÛÙÔ ∂¡À ·ÛıÂÓÒÓ ÌÂ ÈÓÔ-

Ì˘·ÏÁ›·, ‚Ú›ÛÎÔÓÙ·È ÛÂ ÂÍ¤ÏÈÍË (23-25).

°ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜

∏ Û˘¯ÓfiÙËÙ· ÙË˜ ÈÓÔÌ˘·ÏÁ›·˜ ÛÂ Û˘ÁÁÂÓÂ›˜

ÚÒÙÔ˘ ‚·ıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ ·Ó¤Ú¯ÂÙ·È ÛÂ Ô-

ÛÔÛÙfi 28-52%, ÂÓÒ ÛÂ ÌËÙ¤ÚÂ˜ ÓÔÛÔ‡ÓÙˆÓ ·È-

‰ÈÒÓ ÛÂ ÔÛÔÛÙfi 71% (26). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi

ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ıÂˆÚÈÒÓ Û¯ÂÙÈÎ¿ ÌÂ

ÙËÓ ‡·ÚÍË ÁÂÓÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÙË˜ Ófi-

ÛÔ˘. ∆Ô ÂÚÂ˘ÓËÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ, Û‹ÌÂÚ·,

ÂÛÙÈ¿˙ÂÙ·È ÛÙË Û˘Û¯¤ÙÈÛË ÙË˜ ÓfiÛÔ˘ ÌÂ Û˘ÁÎÂ-

ÎÚÈÌ¤Ó· ·ÓÙÈÁfiÓ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ HLA, Î·ıÒ˜

Î·È ÛÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÔÏ˘ÌÔÚ-

ÊÈÛÌÔ‡ (ÙË˜ ·ÚÔ˘Û›·˜, ‰ËÏ·‰‹, ÂÚÈÛÛfiÙÂ-

ÚˆÓ ÙË˜ Ì›·˜ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ) ÙÔ˘ ÁÔÓÈ‰›-

Ô˘ ÙË˜ 5-∏∆∆, ˘Â‡ı˘ÓÔ˘ ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙË˜

ÛÂÚÔÙÔÓ›ÓË˜ (27).

¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘

OÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

ÈÓÔÌ˘·ÏÁ›· ¤¯Ô˘Ó Â·ÚÎÒ˜ ÌÂÏÂÙËıÂ›, ˆÛÙfiÛÔ

Ë ‰È¿ÎÚÈÛË ÌÂÙ·Í‡ ·ÈÙ›Ô˘ Î·È ·ÈÙÈ·ÙÔ‡ ·Ú·Ì¤-

ÓÂÈ Î·È ÛÂ ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË ‰˘Û¯ÂÚ‹˜. ∂›Ó·È

ÁÓˆÛÙfi fiÙÈ Ë ‰È¤ÁÂÚÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÚÈÔ-

¯ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ

‡ÓÔ ÌÂ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÚfiÌÔÈ· ÌÂ ÂÎÂ›Ó·

ÙÔ˘ Ê˘ÛÈÎÔ‡. ∆¤ÙÔÈ· ÂÚÈÔ¯‹ ·ÔÙÂÏÂ› ·˘Ù‹

ÙˆÓ ˘Ú‹ÓˆÓ ÙË˜ Ú·Ê‹˜, ÛÙËÓ Î¿Ùˆ Á¤Ê˘Ú·

Î·È ÙÔÓ ÚÔÌ‹ÎË, ·fi fiÔ˘ ÍÂÎÈÓÔ‡Ó ÓÂ˘ÚÈÎ¤˜

›ÓÂ˜, ÔÈ ÔÔ›Â˜ ÂÎÙfi˜ ·fi ÙË ÏÂÈÙÔ˘ÚÁ›· ÙË˜

·Ó·ÛÙÔÏ‹˜ ÙˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ fiÓÔ˘ Ô˘ ÂÈÛ¤Ú-

¯ÔÓÙ·È ÛÙÔÓ ÓˆÙÈ·›Ô Ì˘ÂÏfi, ÂÈÙÂÏÔ‡Ó Î·È ·˘Ù‹

ÙË˜ ¤ÎÎÚÈÛË˜ ÛÂÚÔÙÔÓ›ÓË˜. ∏ ÛÂÚÔÙÔÓ›ÓË ·Ô-

ÙÂÏÂ› ÙËÓ Î˘ÚÈfiÙÂÚË ·fi ÙÈ˜ ÓÂ˘ÚÔ‰È·‚È‚·ÛÙÈ-

Î¤˜ Ô˘Û›Â˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË ÌÂ ÙËÓ ÚfiÎÏËÛË

ÙÔ˘ ‡ÓÔ˘ (¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔÏ¤ˆÓ ÙË˜ ÛÂ ÂÈ-

Ú·Ì·Ùfi˙ˆ· Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·¸Ó›· Ô˘ ‰È·Ú-

ÎÂ› ËÌ¤ÚÂ˜) Î·È Ù· Â›Â‰¿ ÙË˜ ¤¯Ô˘Ó ‰È·È-

ÛÙˆıÂ› ÂÏ·ÙÙˆÌ¤Ó· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÌ˘·ÏÁ›·.

¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ·ÛıÂÓ‹˜ ‰ÂÓ ·Ó·Ê¤ÚÂÈ

¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350



‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘, ÚÔÛÂÎÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË

·ÔÎ·Ï‡ÙÂÈ fiÙÈ Ô ‡ÓÔ˜ ‰ÂÓ ÙÔÓ ÍÂÎÔ˘Ú¿˙ÂÈ

(Ê·ÈÓfiÌÂÓÔ ÚˆÈÓ‹˜ ÎfiˆÛË˜), ÂÓÒ Ì·ÚÙ˘Ú›Â˜

·fi ¿ÙÔÌ· Ô˘ ÎÔÈÌÔ‡ÓÙ·È ÏËÛ›ÔÓ ·Ó·Ê¤-

ÚÔ˘Ó fiÙÈ Ô ·ÛıÂÓ‹˜ “ÛÙÚÈÊÔÁ˘Ú›˙ÂÈ Û˘ÓÂ¯Ò˜

ÛÙÔ ÎÚÂ‚¿ÙÈ ÙÔ˘” (Û‡Ó‰ÚÔÌÔ ·Ó‹Û˘¯ˆÓ Î¿Ùˆ

¿ÎÚˆÓ - restless legs syndrome). ™ËÌ·ÓÙÈÎ¤˜

‰È·Ù·Ú·¯¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ ÛÙ¿‰ÈÔ 4 ÙÔ˘

‡ÓÔ˘ ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ (‹ ÌË-REM ‡ÓÔ˘),

Î·ıÒ˜ ÛÙÔ ∏∂° ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÛÙ· Ê˘ÛÈÔ-

ÏÔÁÈÎ¿ Î‡Ì·Ù· ‰ (Î‡Ì·Ù· ¯·ÌËÏ‹˜ Û˘¯ÓfiÙËÙ·˜

2-3 ‹ Î·È 1 c/sec) ·ÚÂÌ‚¿ÏÏÔÓÙ·È Î‡Ì·Ù· ·

(Ú˘ıÌÈÎ¿ Î‡Ì·Ù· Û˘¯ÓfiÙËÙ·˜ 8-13 c/sec Ô˘

Ê˘ÛÈÔÏÔÁÈÎ¿ Â˘Ú›ÛÎÔÓÙ·È ÛÂ ÂÁÚ‹ÁÔÚÛË Î·È ÛÂ

Î·Ù¿ÛÙ·ÛË ‹ÚÂÌË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜).

¶·Ú’ fiÏ· ·˘Ù¿, Ô Ù‡Ô˘ ·-‰ ‡ÓÔ˜ ‰ÂÓ ·ÚÔ˘-

ÛÈ¿˙ÂÈ ˘„ËÏ‹ ÂÈ‰ÈÎfiÙËÙ· ÁÈ· ÙËÓ ÈÓÔÌ˘·ÏÁ›·

(28-30).

æ˘¯ÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜

∏ Î·Ù¿ÛÙ·ÛË ÙË˜ „˘¯ÈÎ‹˜ ˘ÁÂ›·˜ ÙˆÓ ÓÔ-

ÛÔ‡ÓÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜

¤¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÙÈ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi

ÚfiÏÔ. ∏ „˘¯ÔÏÔÁÈÎ‹ ÚÔÛ¤ÁÁÈÛË, ÙfiÛÔ ÙÔ˘

·È‰ÈÔ‡ fiÛÔ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (Ë ÔÔ›· Û˘-

¯Ó¿ ÓÔÛÂ›), ·ÔÎÙ¿ ÎÂÊ·Ï·ÈÒ‰Ë ÛËÌ·Û›·. ∏

Û˘ÌÂÚÈÊÔÚ¿ ÙË˜ ‰˘¿‰·˜ ÌËÙ¤Ú·˜-¿Û¯Ô˘Û·˜

ÎfiÚË˜ ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ‹: Ë

˘ÂÚÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ÌËÙ¤Ú· “ÂÚÈ‚¿ÏÏÂÈ” Û˘-

Ó·ÈÛıËÌ·ÙÈÎ¿ ÙËÓ ¿Û¯Ô˘Û· ÎfiÚË, ··ÓÙÒ-

ÓÙ·˜ Û˘¯Ó¿ ·ÓÙ’ ·˘Ù‹˜ ÛÂ ÂÚˆÙ‹ÛÂÈ˜ Ô˘ ·Â˘-

ı‡ÓÔÓÙ·È ÛÙËÓ ÙÂÏÂ˘Ù·›· Î·È ·ÊÔÚÔ‡Ó ÛÂ Û˘-

Ó·ÈÛı‹Ì·Ù· ‹ ‚ÈˆÌ·ÙÈÎ¤˜ ÂÌÂÈÚ›Â˜. ∆· ¿-

Û¯ÔÓÙ· ·È‰È¿ ·ÔÙÂÏÔ‡Ó Û˘Ó‹ıˆ˜ ¿ÙÔÌ· È‰È-

·›ÙÂÚ· ·Ô‰ÔÙÈÎ¿, ÙfiÛÔ ÛÙÔ Û¯ÔÏÈÎfi ÂÚÈ‚¿Ï-

ÏÔÓ fiÛÔ Î·È ÛÂ ÂÍˆÛ¯ÔÏÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜,

Ù· ÔÔ›· ÂÈ˙ËÙÔ‡Ó ÌÂıÔ‰ÈÎ¿ - Î·È Û˘¯Ó¿ ÂÈ-

Ù˘Á¯¿ÓÔ˘Ó - ÙÔÓ ¤·ÈÓÔ ÙˆÓ ÁÔÓ¤ˆÓ (31). ∞Ô-

ÙÂÏÂ› Â˘Ú¤ˆ˜ Â‰Ú·ÈˆÌ¤ÓË ÂÔ›ıËÛË fiÙÈ Ù·

„˘¯È·ÙÚÈÎ¿ ÓÔÛ‹Ì·Ù· ÂÈ‰ÚÔ‡Ó ÂÓÈÛ¯˘ÙÈÎ¿

ÛÙËÓ ÚfiÛÏË„Ë Î·È ·ÓÙ›ÏË„Ë ÙˆÓ ÂÚÂıÈÛÌ¿-

ÙˆÓ fiÓÔ˘ ·fi ÙÔ ¿ÙÔÌÔ, ÛÙÔÈ¯Â›Ô Ô˘ Ô‰ËÁÂ›

ÔÏÏÔ‡˜ Â·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜ Ó· ÚÔÛÂÁÁ›-

˙Ô˘Ó ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÌ˘·ÏÁ›· ·ÓÙÈÌÂÙˆ›-

˙ÔÓÙ·˜ ÚˆÙ·Ú¯ÈÎ¿ ÙË Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Û·

Î·Ù¿ıÏÈ„Ë, ıÂˆÚÒÓÙ·˜ ·˘Ù‹ ˆ˜ ÙËÓ ÚˆÙÔ·-

ı‹ ·ÈÙ›·. øÛÙfiÛÔ, Ë ÈÓÔÌ˘·ÏÁ›· ‰ÂÓ ·ÔÙÂÏÂ›

„˘¯È·ÙÚÈÎ‹ ÔÓÙfiÙËÙ·. ∞Ó Î·È Ë Û˘Ó‡·ÚÍË ·˘-

Ù‹ Â›Ó·È Û˘¯Ó‹ ÛÂ ÂÓ‹ÏÈÎÂ˜, ·Ú·Ì¤ÓÂÈ Ì¤¯ÚÈ

Û‹ÌÂÚ· ·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ Â¿Ó ·˘Ù‹ Ë Û˘Ó‡·ÚÍË

ÔÊÂ›ÏÂÙ·È ÛÂ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ‹

·Ï¿ ÂÈÛ˘Ì‚·›ÓÂÈ ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ‰Â˘ÙÂÚÔ-

·ıÒÓ ÂÎ‰ËÏÒÛÂˆÓ ÙË˜ ·Ú¯ÈÎ‹˜ ÓfiÛÔ˘. ∂È-

Ï¤ÔÓ, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿ Ô˘ Ó·

Û˘Û¯ÂÙ›˙Ô˘Ó ÙËÓ ÈÓÔÌ˘·ÏÁ›· ÌÂ ÙËÓ Î·Ù¿ıÏÈ„Ë.

¶ÚÔÎ·Ù·ÚÎÙÈÎ¿ ÛÙÔÈ¯Â›· ·fi ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ÌÂ-

Ï¤ÙÂ˜ ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ì¤Ûˆ

·ÂÈÎfiÓÈÛË˜ ÌÂ Ì·ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, Î·Ù·-

‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë Î·Ù¿ıÏÈ„Ë Î·È Ë ‰ÈÂÚÁ·Û›· ÙË˜

ÚfiÛÏË„Ë˜ Î·È ·ÓÙ›ÏË„Ë˜ ÙÔ˘ fiÓÔ˘ ·ÔÙÂ-

ÏÔ‡Ó ‰È·‰ÈÎ·Û›Â˜ ‰È·ÊÔÚÂÙÈÎ¤˜ Î·È ·ÓÂÍ¿ÚÙË-

ÙÂ˜ (32). ŒÙÛÈ, ·ÛıÂÓÂ›˜ ¿Û¯ÔÓÙÂ˜ ·fi ¯ÚfiÓÈÔ

¿ÏÁÔ˜ Î·È Î·Ù¿ıÏÈ„Ë ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó fiÛÔÓ ·ÊÔ-

Ú¿ ÛÙËÓ ÚfiÛÏË„Ë Î·È ÙËÓ ·ÓÙ›ÏË„Ë ÙÔ˘ fi-

ÓÔ˘ ·fi ÂÎÂ›ÓÔ˘˜ ÌÂ ¯ÚfiÓÈÔ ¿ÏÁÔ˜, ·ÏÏ¿ ¯ˆÚ›˜

Î·Ù¿ıÏÈ„Ë.

∆¤ÏÔ˜, Ë ‡·ÚÍË ÂÓfi˜ ÔÏ˘·Ú·ÁÔÓÙÈÎÔ‡

·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘, ÌÂ Û˘ÌÌÂÙÔ¯‹

ÙfiÛÔ ÂÓ‰ÔÁÂÓÒÓ (¯·ÌËÏfi˜ Ô˘‰fi˜ fiÓÔ˘, ı‹Ï˘

Ê‡ÏÔ, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·) fiÛÔ Î·È ÂÍˆÁÂÓÒÓ

ÌÂÙ·‚ÏËÙÒÓ (ÚÔËÁËıÂ›ÛÂ˜ ÂÌÂÈÚ›Â˜ fiÓÔ˘,

ÂÏÏÂÈÌÌ·ÙÈÎ‹ ÎÔÈÓˆÓÈÎ‹ ·ÏÏËÏÂ›‰Ú·ÛË, Ê˘-

ÛÈÎ‹ ‹ ÛÂÍÔ˘·ÏÈÎ‹ Î·ÎÔÔ›ËÛË, ÚfiÙ˘· ÁÔ-

ÓÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ ·¤Ó·ÓÙÈ ÛÙÔÓ fiÓÔ, Î·-

Î‹ Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË), ıÂˆÚÂ›Ù·È Èı·Ó‹. ∫·-

ıÒ˜ ÔÈ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙÂ˜ ÌÔÚÂ› Ó·

‰ÚÔ˘Ó ÌÂÌÔÓˆÌ¤Ó· ‹ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi, ÙÔ

¿ÙÔÌÔ ÌÔÚÂ› Ó· “‚ÈÒÓÂÈ” ÙËÓ ÂÌÂÈÚ›· ÙÔ˘

fiÓÔ˘ ÌÂ ÌÔÓÔÛ‹Ì·ÓÙÔ ‹ ÌË ÙÚfiÔ. °È· ·Ú¿-

‰ÂÈÁÌ·, Ë ÂÌÊ¿ÓÈÛË fiÓÔ˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ

ÛÂ ‰È·Ù·Ú·¯‹ ÙÔ˘ ‡ÓÔ˘, Ë ÔÔ›· fi¯È ÌfiÓÔ

ÂÈ‰ÂÈÓÒÓÂÈ ÂÚ·ÈÙ¤Úˆ ÙÔÓ fiÓÔ, ·ÏÏ¿ ÂÈ-

Ï¤ÔÓ ÚÔÎ·ÏÂ› ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜ ÔÈÎÔÁÂÓÂÈ-

·Î‹˜ ˙ˆ‹˜ (33,34).

∫ÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹ÚÂ˜ - ¢È¿ÁÓˆÛË

∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ù· ·È‰È¿ ÌÂ ÂÒ‰˘Ó· Ì˘Ô-

ÛÎÂÏÂÙÈÎ¿ Û‡Ó‰ÚÔÌ·, ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜,

·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ¯·ÚÔ‡ÌÂÓ·, ‹ÚÂÌ·, ·ÎfiÌ· Î·È

¯·ÌÔÁÂÏÒÓÙ·˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·Ó·Ê¤ÚÔ˘Ó ÛË-

Ì·ÓÙÈÎ‹˜ ¤ÓÙ·ÛË˜ fiÓÔ, ÚÔÎ·ÏÂ› ÂÓÙ‡ˆÛË. ∏

¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ·˘Ù‹ ·‰È·ÊÔÚ›· ÁÈ· ÙËÓ Î·Ù¿-

ÛÙ·Û‹ ÙÔ˘˜, Î·ÏÂ›Ù·È “la belle indifference”

(“ˆÚ·›· ·‰È·ÊÔÚ›·”). ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿

ÂÌÊ·Ó›˙Ô˘Ó Î·È ·ÏÏˆ‰˘Ó›·, Ë ÔÔ›· ‰È·ÈÛÙÒ-

ÓÂÙ·È ÌÂÙ¿ ·fi ··Ïfi ¿ÁÁÈÁÌ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹

‹È· ¤ÏÍË ‰ÂÚÌ·ÙÈÎ‹˜ Ù˘¯‹˜.

∏ ·‰˘Ó·Ì›· ÂÚÁ·ÛÙËÚÈ·Î‹˜ ‹ ÈÛÙÔÏÔÁÈÎ‹˜

ÂÈ‚Â‚·›ˆÛË˜ ÙË˜ ‰È¿ÁÓˆÛË˜ Ô‰‹ÁËÛÂ ÛÙË ı¤-

ÛÈÛË ÎÏÈÓÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ·fi ÙÔ

∞ÌÂÚÈÎ·ÓÈÎfi ∫ÔÏ¤ÁÈÔ ƒÂ˘Ì·ÙÔÏÔÁ›·˜, ÙÔ 1990,

ÌÂ ‚¿ÛË Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Â˘ÚÂ›·˜ ÔÏ˘ÎÂÓÙÚÈ-

Î‹˜ ÌÂÏ¤ÙË˜ (1). ŒÙÛÈ, ÛÂ ÂÓ‹ÏÈÎÂ˜, Ë ‰È¿ÁÓˆÛË

ÙÂÎÌËÚÈÒÓÂÙ·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ‰‡Ô ÌÂÈ˙fiÓˆÓ

¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350


346 µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

ÎÚÈÙËÚ›ˆÓ: ·) ÙËÓ ‡·ÚÍË ‰È¿¯˘ÙÔ˘ fiÓÔ˘ ÁÈ·

¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÌËÓÒÓ, Ô

ÔÔ›Ô˜ ·ÊÔÚ¿ Î·È ÛÙ· ‰‡Ô ËÌÈÌfiÚÈ· ÙÔ˘ ÛÒÌ·-

ÙÔ˜, ¿Óˆ Î·È Î¿Ùˆ ·fi ÙË Ì¤ÛË Î·È ‚) ÙËÓ

‡·ÚÍË Î·Ù’ ÂÏ¿¯ÈÛÙÔ 11 Â˘·›ÛıËÙˆÓ ÛËÌÂ›ˆÓ

(·fi Û‡ÓÔÏÔ 18 ÚÔÎ·ıÔÚÈÛÌ¤ÓˆÓ) Î·Ù¿ ÙËÓ

ÚÒÙË ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (∂ÈÎfiÓ· 1

Î·È ¶›Ó·Î·˜ 1). O ¤ÏÂÁ¯Ô˜ ‰ÈÂÓÂÚÁÂ›Ù·È ÌÂ ÙËÓ

ÂÊ·ÚÌÔÁ‹ ›ÂÛË˜ ÈÛÔ‰‡Ó·ÌË˜ ÌÂ 4 kg ·fi ÙÔÓ

ÂÍÂÙ·ÛÙ‹ ÛÙ· Â˘·›ÛıËÙ· ÛËÌÂ›· ÙÔ˘ ·ÛıÂÓÔ‡˜,

ÌÂ ÙË ‚Ô‹ıÂÈ· ÂÈ‰ÈÎÔ‡ ‰È·ÁÓˆÛÙÈÎÔ‡ ÂÚÁ·ÏÂ›Ô˘

(·ÏÁËÛ›ÌÂÙÚÔ), ·Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·-

ÊÂ›˜ Û˘ÌÊˆÓÔ‡Ó ÛÙÔ fiÙÈ ÂÍ›ÛÔ˘ ·ÍÈfiÈÛÙ· ·Ô-

ÙÂÏ¤ÛÌ·Ù· Ï·Ì‚¿ÓÔÓÙ·È Î·È ÌÂ ÙË ¯Ú‹ÛË ÙÔ˘

·ÓÙ›¯ÂÈÚ· (Ú·ÎÙÈÎ¿ ı· Ú¤ÂÈ Ó· ·ÛÚ›ÛÂÈ Ë

ÔÓ˘¯ÔÊfiÚÔ˜ Ê¿Ï·ÁÁ· ÙÔ˘ ·ÓÙ›¯ÂÈÚ· ÙÔ˘ ÂÍÂÙ·-

ÛÙ‹). °È· ÙËÓ ÂÍ¿ÏÂÈ„Ë ÙÔ˘ ÛÙÔÈ¯Â›Ô˘ ÙË˜ ˘Ô-

ÎÂÈÌÂÓÈÎfiÙËÙ·˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ Ì¿ÚÙ˘-

ÚÂ˜ 10 ÛËÌÂ›· (Ì¤ÙˆÔ, ‰ÂÍÈfi Î·È ·ÚÈÛÙÂÚfi

Ï¿ÁÈÔ, Ú·¯È·›· ÂÈÊ¿ÓÂÈ· ÂÚÈÊÂÚÈÎÔ‡ ÙÌ‹Ì·-

ÙÔ˜ ·ÓÙÈ‚Ú·¯›Ô˘ ·ÌÊÔÙÂÚfiÏÂ˘Ú·, ÔÓ˘¯ÔÊfiÚÔ˜

Ê¿Ï·ÁÁ· ÙˆÓ ·ÓÙÈ¯Â›ÚˆÓ, Ú·¯È·›· ÂÈÊ¿ÓÂÈ·

ÙÔ˘ ÙÚ›ÙÔ˘ ÌÂÙ·Ù·ÚÛ›Ô˘ ·ÌÊÔÙÂÚfiÏÂ˘Ú·, ÔÓ˘-

¯ÔÊfiÚÔ˜ Ê¿Ï·ÁÁ· 1Ô˘ ‰·ÎÙ‡ÏÔ˘ Ô‰ÈÔ‡ ·ÌÊÔ-

ÙÂÚfiÏÂ˘Ú·). ∏ ÙÂÎÌËÚ›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜ ıÂ-

ˆÚÂ›Ù·È ÂÈÛÊ·Ï‹˜ fiÙ·Ó ‰È·ÈÛÙÒÓÂÙ·È Â˘·È-

ÛıËÛ›· ÛÂ ÂÚÈÛÛfiÙÂÚ· ·fi 3 ÛËÌÂ›·-Ì¿ÚÙ˘-

ÚÂ˜. ™ËÌÂÈÒÓÂÙ·È Ë ·Ó¿ÁÎË ‰È¿ÎÚÈÛË˜ ÙˆÓ “Â˘-

·›ÛıËÙˆÓ” (tender) ·fi Ù· “˘ÚÔ‰ÔÙÔ‡ÓÙ·”

(trigger) ÛËÌÂ›·, Ô˘ Â›ÛË˜ ·Ú·ÙËÚÔ‡ÓÙ·È

ÛÙËÓ ÈÓÔÌ˘·ÏÁ›· Î·È Ù· ÔÔ›· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÂ

Â˘·›ÛıËÙÂ˜ ÂÚÈÔ¯¤˜ Ì˘ÒÓ, Ë ‰È¤ÁÂÚÛË ÙˆÓ

ÔÔ›ˆÓ Ô‰ËÁÂ› ÛÂ ·ÓÙ·Ó¿ÎÏ·ÛË ÙÔ˘ fiÓÔ˘ Î·È

ÛÙË ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ Û‡Û·ÛË ÙÔ˘ Ì˘fi˜. ∆· ÛË-

ÌÂ›· ·˘Ù¿, ˆÛÙfiÛÔ, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙË

‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË, Î·ıÒ˜ Î·Ù¿ ÙËÓ ·ÍÈÔ-

ÏfiÁËÛ‹ ÙÔ˘˜ ˘ÂÈÛ¤Ú¯ÂÙ·È ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi

Ô ·Ú¿ÁÔÓÙ·˜ ÙË˜ ˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·˜. ∞ÚÎÂÙÔ›

¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350

3 4

12

1817

11

9 10

1 26

875

15 16

1413

∂ÈÎfiÓ· 1, ¶›Ó·Î·˜ 1. ∆· 18 Â˘·›ÛıËÙ· ÛËÌÂ›· ÙË˜ ÈÓÔÌ˘·ÏÁ›·˜ Î·Ù¿ ÙÔ ∞ÌÂÚÈÎ·ÓÈÎfi ∫ÔÏ¤ÁÈÔ ƒÂ˘Ì·ÙÔÏÔÁ›·˜, 1990 (¶ËÁ‹:National Fibromyalgia Partnership, Inc.) Î·È ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘˜ ÛÙÔ ÎÏ·ÛÈÎfi ¤ÚÁÔ ÙÔ˘ ƒÔ‡ÌÂÓ˜ “∆ÚÂÈ˜ Ã¿ÚÈÙÂ˜” (ªÔ˘ÛÂ›ÔPrado, ª·‰Ú›ÙË. ÀÏÔÔ›ËÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ‚·ÛÈÛÌ¤ÓË ÛÂ È‰¤· ‰ËÌÔÛÈÂ˘ıÂ›Û· ÛÙÔ Arthritis and Rheumatism Journal,1990)

1,2. πÓÈ·Î‹ ÂÚÈÔ¯‹ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙÈ˜ ÚÔÛÊ‡ÛÂÈ˜ ÙˆÓ ˘ÈÓÈ·ÎÒÓ Ì˘ÒÓ3,4. ∫·ÙÒÙÂÚÔ ÙÌ‹Ì· ·˘¯¤Ó· ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÂÁÎ¿ÚÛÈˆÓ ·ÔÊ‡ÛÂˆÓ ÛÙÔ ‰È¿ÛÙËÌ· ∞5-∞75,6. ∆Ú·Â˙ÔÂÈ‰‹˜ Ì˘˜ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙË ÌÂÛfiÙËÙ· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ¯Â›ÏÔ˘˜ ÙÔ˘7,8. ÀÂÚ·Î¿ÓıÈÔ˜ Ì˘˜ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙËÓ ¤ÎÊ˘Û‹ ÙÔ˘, ÏËÛ›ÔÓ ÙÔ˘ ¤Ûˆ ¯Â›ÏÔ˘˜ ÙË˜ ˆÌÔÏ·ÙÈ·›·˜

¿Î·Óı·˜9,10. 2Ë ÏÂ˘Ú¿ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙË ÛÙÂÚÓÔÏÂ˘ÚÈÎ‹ Û˘Á¯fiÓ‰ÚˆÛË ÙË˜ 2Ë˜ ÏÂ˘Ú¿˜11,12. ŒÍˆ ÂÈÎfiÓ‰˘ÏÔ˜ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, 2 cm ÂÚÈÊÂÚÈÎfiÙÂÚ· ÙˆÓ ¤Íˆ ÂÈÎÔÓ‰‡ÏˆÓ 13,14. °ÏÔ˘ÙÔ› ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙÔ ¿Óˆ-¤Íˆ ÙÂÙ·ÚÙËÌfiÚÈfi ÙÔ˘˜, Î·Ù¿ ÙÔ ÚfiÛıÈÔ ¯Â›ÏÔ˜ ÙÔ˘

ÌÂ›˙ÔÓÔ˜ ÁÏÔ˘ÙÈ·›Ô˘ Ì˘fi˜ 15,16. ªÂ›˙ˆÓ ÙÚÔ¯·ÓÙ‹Ú·˜ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÂÏ¿¯ÈÛÙ· ÔÈÛı›ˆ˜ ÙÔ˘ ÌÂ›˙ÔÓÔ˜ ÙÚÔ¯·ÓÙËÚÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ 17,18. °fiÓ·ÙÔ ∞ÌÊÔÙÂÚfiÏÂ˘Ú·, ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÛÒÌ·ÙÔ˜, ÏËÛ›ÔÓ ÙË˜ ¤Ûˆ ·ÚıÚÈÎ‹˜

ÁÚ·ÌÌ‹˜



Û˘ÁÁÚ·ÊÂ›˜ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ÙË˜ ¿Ô„Ë˜ fiÙÈ

ÛÙ· ·È‰È¿ Ë ‰È¿ÁÓˆÛË ÌÔÚÂ› Ó· ÙÂÎÌËÚÈˆıÂ›

·ÎfiÌ· Î·È fiÙ·Ó ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ Â˘·›ÛıËÙˆÓ

ÛËÌÂ›ˆÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÈÛÎ¤„ÂˆÓ ÛÙÔÓ ·È-

‰›·ÙÚÔ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 11 (≥5 Î·Ù¿ ÙÔ˘˜

Yunus Î·È Masi), ÛÂ ·ÓÙÈ‰È·ÛÙÔÏ‹ ÌÂ ÙÔ˘˜ ÂÓ‹-

ÏÈÎÂ˜, fiÔ˘ ··ÈÙÂ›Ù·È Î·Ù¿‰ÂÈÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ

11 ÛËÌÂ›ˆÓ Î·Ù¿ ÙËÓ ÚÒÙË ÌfiÓÔ Â›ÛÎÂ„Ë

(35). ∞˘Ùfi ÚÔÙÂ›ÓÂÙ·È ÏfiÁˆ ÙË˜ ·ÙÂÏÔ‡˜ ¤Î-

ÊÚ·ÛË˜ ÙË˜ ÓfiÛÔ˘ ÛÙ· ·È‰È¿, Î·ıÒ˜ Î·È ÙË˜

ÈÎ·ÓÔÔÈËÙÈÎ‹˜ ·ÓÙ·fiÎÚÈÛ‹˜ ÙÔ˘˜ ÛÙË ıÂÚ·-

Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË, ˆÛÙfiÛÔ ‰ÂÓ Â›Ó·È Â·ÎÚÈ-

‚Ò˜ ÁÓˆÛÙfi Â¿Ó ÔÈ ·Ú·¿Óˆ ·ÈÙÈ¿ÛÂÈ˜ ·ÓÙ·-

ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ‹ ·ÏÒ˜

·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó ÌÂıÔ‰ÔÏÔÁÈÎ¤˜ ·‰˘Ó·Ì›Â˜

ÙˆÓ ÌÂÏÂÙÒÓ.

∆· Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·, Û‡ÌÊˆÓ· ÌÂ ÙË

ÌÂÏ¤ÙË ÙˆÓ Siegel Î·È Û˘Ó, ÙÔ 1998, ÛÂ 45 ·È-

‰È¿ ÌÂ ÈÓÔÌ˘·ÏÁ›· Î·È ÙˆÓ Gedalia Î·È Û˘Ó, ÙÔ

2000, ÛÂ 59 ·È‰È¿ ·ÓÙ›ÛÙÔÈ¯·, ÂÚÈÁÚ¿ÊÔÓÙ·È

ÛÙÔÓ ¶›Ó·Î· 2 (8,9). ¶ÚÔÎ·ÏÂ› ÂÓ‰È·Ê¤ÚÔÓ Ë

·Ú·ÙËÚÔ‡ÌÂÓË Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ÈÓÔ-

Ì˘·ÏÁ›·˜ Î·È ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ˘ÂÚÎÈÓËÙÈÎfiÙË-

Ù·˜, Î·ıÒ˜ ÛÂ ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ·È‰ÈÒÓ ÌÂ

ÈÓÔÌ˘·ÏÁ›· ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÏËÚÔ‡ÓÙ·È Î·È

Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜. ∞˘Ù‹ Ë ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë

Â›Ó·È Èı·Ófi Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ·ÚÔ˘Û›· ÂÓfi˜

ÎÔÈÓÔ‡ ·ÈÙÈÔÏÔÁÈÎÔ‡ ˘Ô‚¿ıÚÔ˘. ∫·ıÒ˜,

ˆÛÙfiÛÔ, ÔÈ ‰‡Ô ÎÏÈÓÈÎ¤˜ ÔÓÙfiÙËÙÂ˜ ÌÔÈ¿˙Ô˘Ó

ÛÂ ·ÚÎÂÙÔ‡˜ ÎÏÈÓÈÎÔ‡˜ ¯·Ú·ÎÙ‹ÚÂ˜ Î·È ‰È·Ê¤-

ÚÔ˘Ó ÌfiÓÔ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÚÔ˘Û›· Â˘·›-

ÛıËÙˆÓ ÛËÌÂ›ˆÓ (·Ô˘ÛÈ¿˙Ô˘Ó ÛÙÔ Û‡Ó‰ÚÔÌÔ

˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜), Ë ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ·˘-

Ù‹ ı· ÌÔÚÔ‡ÛÂ Ó· ·Ô‰ÔıÂ› ÛÙËÓ ·ÓÂ·ÚÎ‹

·ÍÈÔÏfiÁËÛË ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ·fi ·ÚÎÂÙÔ‡˜

Û˘ÁÁÚ·ÊÂ›˜.

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË

ƒÂ˘Ì·ÙÈÎfi ÓfiÛËÌ·, È‰È·›ÙÂÚ· ÚÂ˘Ì·ÙÔÂÈ-

‰‹˜ ·ÚıÚ›ÙÈ‰· ‹ Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·ÙÒ‰Ë˜

Ï‡ÎÔ˜, Û˘Ó˘¿Ú¯ÂÈ ÛÂ ÔÛÔÛÙfi 6% ÙˆÓ ÂÓËÏ›-

ÎˆÓ ÌÂ ÈÓÔÌ˘·ÏÁ›·. ∏ ÚÂ˘Ì·ÙÈÎ‹ ÔÏ˘Ì˘·Ï-

Á›· Î·È ÔÈ ·ÁÁÂÈ›ÙÈ‰Â˜ ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó

ÌÂ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ·ÚfiÌÔÈ· ÌÂ ÂÎÂ›ÓË ÙË˜ ÈÓÔ-

Ì˘·ÏÁ›·˜, ·ÏÏ¿ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ Â˘·›ÛıËÙˆÓ

ÛËÌÂ›ˆÓ Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ÔÙ¤ ‰ÂÓ

ÚÔÛÂÁÁ›˙ÂÈ ·˘Ùfi ÙË˜ ÈÓÔÌ˘·ÏÁ›·˜, ÂÎÙfi˜ Â¿Ó

Ë ÙÂÏÂ˘Ù·›· Û˘Ó˘¿Ú¯ÂÈ ˆ˜ ÍÂ¯ˆÚÈÛÙ‹ ÔÓÙfi-

ÙËÙ·. ∂ÈÏ¤ÔÓ, Ë ÚÂ˘Ì·ÙÈÎ‹ ÔÏ˘Ì˘·ÏÁ›· Â›-

Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÛÙ· ·È‰È¿. ™ÙË ‰È·ÊÔ-

ÚÈÎ‹ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë

Û·ÚÎÔÂ›‰ˆÛË, ÔÈ Û˘ÛÙËÌ·ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, Ù·

·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎ¿ Û‡Ó‰ÚÔÌ·, ÙÔ Û‡Ó‰ÚÔÌÔ

˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜, Ë ÚÒÈÌË ÛÔÓ‰˘ÏÔ·Ú-

ıÚÔ¿ıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ÚfiÛıÈÔ˘ ıˆÚ·-

ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜, Ë ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ‹ Û˘Ì·-

ıËÙÈÎ‹ ‰˘ÛÙÚÔÊ›· (‹ ÂÓÙÔÈÛÌ¤ÓÔ ÂÚÈÔ¯ÈÎfi

Û‡Ó‰ÚÔÌÔ fiÓÔ˘), Ë ÂÚÈÊÂÚÈÎ‹ ÌÔÓÔÓÂ˘ÚÔ-

¿ıÂÈ·, Ë ‰˘Û·˘ÙÔÓÔÌ›·, Ô ˘Ô- ‹ ˘ÂÚı˘ÚÂ-

ÔÂÈ‰ÈÛÌfi˜, Ô ˘ÂÚ·Ú·ı˘ÚÂÔÂÈ‰ÈÛÌfi˜ Î·È Ù·

ÊÏÂÁÌÔÓÒ‰Ë ÓÔÛ‹Ì·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘. ¶˘ÚÂ-

Ùfi˜, Ó˘ÎÙÂÚÈÓfi˜ È‰ÚÒÙ·˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜,

ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÔÚÁ·ÓÔÌÂÁ·Ï›·, Ê·ÈÓfiÌÂÓÔ

¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350

¶›Ó·Î·˜ 2. ∫ÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ÛÂ ·È‰È¿ ÌÂ ÈÓÔÌ˘·ÏÁ›· Î·Ù¿ Siegel Î·È Gedalia (8,9)

∫ÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ÛÂ ·È‰È¿ ™˘¯ÓfiÙËÙ· % Î·Ù¿ ™˘¯ÓfiÙËÙ· % Î·Ù¿ ÌÂ ÈÓÔÌ˘·ÏÁ›· Siegel Î·È Û˘Ó, 1998 (n=45) Gedalia Î·È Û˘Ó, 2000 (n=59)

¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘ 96 70∫ÂÊ·Ï·ÏÁ›· 71 76°ÂÓÈÎÂ˘Ì¤ÓË ÎfiˆÛË 62 20¶ÚˆÈÓ‹ ‰˘ÛÎ·Ì„›· 53 30¶ÚˆÈÓ‹ ÎfiˆÛË 49 -∫·Ù¿ıÏÈ„Ë 43 7∂È‰Â›ÓˆÛË ÌÂÙ¿ ·fi ¿ÛÎËÛË 42 -O›‰ËÌ· ·ÚıÚÒÛÂˆÓ 40 24∂˘ÂÚ¤ıÈÛÙÔ ¤ÓÙÂÚÔ 38 -¢˘ÛÌËÓfiÚÚÔÈ· 36 -ªÂÙ·‚ÔÏ¤˜ ÙË˜ ÓfiÛÔ˘ ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ Î·ÈÚfi 36 -¶·Ú·ÈÛı‹ÛÂÈ˜ 24 -ÕÁ¯Ô˜ 22 -“ ŒÏÏÂÈÌÌ· ÂÓ¤ÚÁÂÈ·˜” 18 -º·ÈÓfiÌÂÓÔ Raynaud 13 -∫ÔÈÏÈ·Îfi ¿ÏÁÔ˜ - 17ÀÂÚÎÈÓËÙÈÎfiÙËÙ· ·ÚıÚÒÛÂˆÓ 40 14


348 µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

Raynaud, ÓÂ˘ÚÔ¿ıÂÈ·, Ô›‰ËÌ· ‹ ÂÚÈÔÚÈÛÌfi˜

ÙË˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚıÚÒÛÂˆÓ, Î·ıÒ˜ Î·È

·ıÔÏÔÁÈÎ¿ ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·, ·ÔÙÂ-

ÏÔ‡Ó ÛÙÔÈ¯Â›· Ô˘ ı· Ú¤ÂÈ Ó· ÛÙÚ¤ÊÔ˘Ó ÙË

‰È·ÁÓˆÛÙÈÎ‹ ÛÎ¤„Ë ÛÂ ÔÓÙfiÙËÙÂ˜ ÂÎÙfi˜ ÙË˜

ÈÓÔÌ˘·ÏÁ›·˜. ™Â ·È‰È¿ ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ Ú¤-

ÂÈ, Â›ÛË˜, Ó· ·ÔÎÏÂ›ÂÙ·È Ë Â˘·ÈÛıËÛ›· ÛÂ

Ê¿ÚÌ·Î· fiˆ˜ ‰ÈÔ˘ÚËÙÈÎ¿, Î·ÊÂ˝ÓË, ·ÏÎÔfiÏ

‹ ·ÌÊÂÙ·Ì›ÓË, Ô˘ ÌÔÚÂ› Ó· ÚÔ‚¿ÏÏÂÈ ÌÂ

Û˘ÌÙÒÌ·Ù· ·ÚfiÌÔÈ· ÌÂ ÂÎÂ›Ó· ÙË˜ ÈÓÔ-

Ì˘·ÏÁ›·˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë ÈÓÔÌ˘·ÏÁ›· ‰ÂÓ

Â›Ó·È Û˘ÓÒÓ˘ÌË ÌÂ ÙÔÓ „˘¯ÔÁÂÓ‹ ÚÂ˘Ì·ÙÈÛÌfi,

ÛÙÔÓ ÔÔ›Ô Ô ·ÛıÂÓ‹˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ¯·Ú·-

ÎÙËÚÈÛÙÈÎ‹ “ÌË ÌÔ˘ ¿ÙÔ˘” Û˘ÌÂÚÈÊÔÚ¿ Î·È

ÂÌÊ·Ó›˙ÂÈ ıÂÙÈÎ¿ ÙfiÛÔ Ù· Â˘·›ÛıËÙ· fiÛÔ Î·È

Ù· ÛËÌÂ›·-Ì¿ÚÙ˘ÚÂ˜.

¶ÚfiÁÓˆÛË

¶ÔÏ˘¿ÚÈıÌÂ˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜ ·fi ‰È¿-

ÊÔÚÂ˜ ¯ÒÚÂ˜, Î·Ù·Ï‹ÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ

ÛÂ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ë ÚfiÁÓˆÛË ÙË˜

ÓfiÛÔ˘ Â›Ó·È Ùˆ¯‹, ÌÂ Ù· Û˘ÌÙÒÌ·Ù· Ó· ÂÈ-

Ì¤ÓÔ˘Ó ‰È¿ ‚›Ô˘ (36,37). ∂Ï¿¯ÈÛÙ· Â›Ó·È ÁÓˆÛÙ¿

Û¯ÂÙÈÎ¿ ÌÂ ÙË Ê˘ÛÈÎ‹ ÈÛÙÔÚ›· Î·È ÙË Ì·ÎÚÔ¯Úfi-

ÓÈ· ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ÛÂ ·È‰È¿, Î·ıÒ˜ ÛÙË

‚È‚ÏÈÔÁÚ·Ê›· ··ÓÙÒÓÙ·È ÙÚÂÈ˜ Û˘ÓÔÏÈÎ¿ ·Ó¿-

ÏÔÁÂ˜ ÌÂÏ¤ÙÂ˜, ÌÂ ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂÏ¤ÛÌ·-

Ù· Ô˘ Èı·ÓfiÓ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÌÂıÔ‰ÔÏÔÁÈÎ¤˜

·‰˘Ó·Ì›Â˜. ¶·Ú·Ì¤ÓÂÈ, ˆÛÙfiÛÔ, ÈÛ¯˘Ú‹ Ë ·›-

ÛıËÛË fiÙÈ Ë ÚfiÁÓˆÛË ÙË˜ ÓÂ·ÓÈÎ‹˜ ÌÔÚÊ‹˜

ÙË˜ ÓfiÛÔ˘ Â›Ó·È Â˘ÓÔ˚ÎfiÙÂÚË ·˘Ù‹˜ ÙˆÓ ÂÓËÏ›-

ÎˆÓ (38,39,4).

∞ÓÙÈÌÂÙÒÈÛË

ªÂ ÙÔ ·ÈÙÈÔÏÔÁÈÎfi ˘fi‚·ıÚÔ ÙË˜ ÓfiÛÔ˘ Ó·

‰ÈÂ˘Ú‡ÓÂÙ·È Û˘ÓÂ¯Ò˜, Ë ÛÙÚ·ÙËÁÈÎ‹ ıÂÚ·Â˘-

ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙËÓ ÈÓÔÌ˘·ÏÁ›· ·Ú·Ì¤ÓÂÈ

ÔÏ‡ÏÂ˘ÚË Î·È ÌÂ È‰È·›ÙÂÚ· ÂÎÙÂÙ·Ì¤ÓÔ Ê¿-

ÛÌ·. ∫·ıÒ˜ “Ì·ÁÈÎfi ¯¿È” ‰ÂÓ ˘¿Ú¯ÂÈ, Úˆ-

Ù·Ú¯ÈÎfi˜ ÛÙfi¯Ô˜ Â›Ó·È Ô ÂÚÈÔÚÈÛÌfi˜ ÛÙÔÓ Ì¤-

ÁÈÛÙÔ ‰˘Ó·Ùfi ‚·ıÌfi ÙË˜ ¤ÎÊÚ·ÛË˜ ÙˆÓ Û˘-

ÌÙˆÌ¿ÙˆÓ ÙË˜ ÓfiÛÔ˘. ∫·Ù’ ·Ó·ÏÔÁ›· ÌÂ ÙË

‰È·›ÛÙˆÛË fiÙÈ “Î·ÓÂ›˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›Ó·È

›‰ÈÔ˜” fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈÎ‹ ¤ÎÊÚ·ÛË ÙË˜

ÓfiÛÔ˘, Ë ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË Ú¤ÂÈ Ó·

ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È, ·ÔÙÂÏÒÓÙ·˜ - ÛÂ Î¿ıÂ ÂÚ›-

ÙˆÛË - ÚÔ˚fiÓ Ì›·˜ ÔÌ·‰ÈÎ‹˜, ‰ÈÂÈÛÙËÌÔÓÈ-

Î‹˜ ÚÔÛ¤ÁÁÈÛË˜. OÈ ‚·ÛÈÎ¤˜ ·Ú¯¤˜ ·˘Ù‹˜ ÙË˜

·ÓÙÈÌÂÙÒÈÛË˜ ·Ú·Ù›ıÂÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ·.

º·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹

∆· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ·

ÛÙËÓ ÈÓÔÌ˘·ÏÁ›· ÛÎÂ˘¿ÛÌ·Ù· Â›Ó·È “‰·ÓÂÈÎ¿”

·fi ¿ÏÏ· ÓÔÛ‹Ì·Ù·, Î·ıÒ˜ Î·Ó¤Ó· ÛÎÂ‡·ÛÌ·

‰ÂÓ ¤¯ÂÈ ÂÁÎÚÈıÂ› ·fi ÙÔÓ FDA ÌÂ ÂÈ‰ÈÎ‹ ÁÈ· ÙË

ÓfiÛÔ ¤Ó‰ÂÈÍË. ∏ Ù˘ÈÎ‹ ·È‰È·ÙÚÈÎ‹ Ê·ÚÌ·-

ÎÂ˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ¯ÔÚ‹ÁËÛË

Ì˘Ô¯·Ï·ÚˆÙÈÎÒÓ ÙˆÓ ÛÎÂÏÂÙÈÎÒÓ Ì˘ÒÓ (fiˆ˜

Ë Î˘ÎÏÔ‚ÂÓ˙·Ú›ÓË, Ë ÔÔ›· ‰ÂÓ Î˘ÎÏÔÊÔÚÂ›

ÛÙËÓ ÂÏÏËÓÈÎ‹ ·ÁÔÚ¿. ∂Ó·ÏÏ·ÎÙÈÎ¿, ÛÂ ·È‰È¿

ËÏÈÎ›·˜ >12 ÂÙÒÓ, ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈË-

ıÔ‡Ó Ë Î·ÚÈÛÔÚÔ‰fiÏË ‹ Ë ÔÚÊÂÓ·‰Ú›ÓË) ‹/Î·È

·ÓÙÈÎ·ıÏÈÙÈÎÒÓ (ÙÚÈÎ˘ÎÏÈÎÒÓ fiˆ˜ Ë ·ÌÈÙÚÈ-

Ù˘Ï›ÓË ‹ ÂÈÏÂÎÙÈÎÒÓ ·Ó·ÛÙÔÏ¤ˆÓ Â·Ó·-

ÚfiÛÏË„Ë˜ ÛÂÚÔÙÔÓ›ÓË˜ - SSRIs - fiˆ˜ Ë

ÊÏÔ˘ÔÍÂÙ›ÓË) ÛÂ ¯·ÌËÏ‹ ‰fiÛË. ™Â ÌÂÏ¤ÙË ÙÔ˘

1996 ÛÂ ÂÓ‹ÏÈÎÂ˜ ÌÂ ÈÓÔÌ˘·ÏÁ›·, ‰È·ÈÛÙÒıËÎÂ

fiÙÈ Ë Û˘Ó‰˘·ÛÌ¤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈÎ·Ù·ıÏÈÙÈ-

ÎÒÓ, ÙfiÛÔ ÙÚÈÎ˘ÎÏÈÎÒÓ fiÛÔ Î·È SSRIs, ¤¯ÂÈ Â˘-

ÂÚÁÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·, Î·ıÒ˜ ÂÌÊ·Ó›˙Ô˘Ó

‰˘Ó·ÌÈÎ‹ Û˘Ó¤ÚÁÂÈ· (9).

OÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÔ˘Ó ıÂÙÈÎ¿ ·Ô-

ÙÂÏ¤ÛÌ·Ù· ÌÂ ÙË ¯Ú‹ÛË ·Ó·ÏÁËÙÈÎÒÓ, fiˆ˜ Ë

·Ú·ÎÂÙ·ÌfiÏË, ‹ ÌË ÛÙÂÚÔÂÈ‰ÒÓ ·ÓÙÈÊÏÂÁÌÔ-

Óˆ‰ÒÓ (NSAIDs - .¯. È‚Ô˘ÚÔÊ¤ÓË, ÈÓ‰ÔÌÂı·-

Î›ÓË), ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ Î·È

Ì˘Ô¯·Ï·ÚˆÙÈÎ¿. ∏ ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ NSAIDs

¤ÁÎÂÈÙ·È ÛÙËÓ ·Ó·ÏÁËÙÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË, Î·ıÒ˜ Ë

ÈÓÔÌ˘·ÏÁ›· ‰ÂÓ ·ÔÙÂÏÂ› ÊÏÂÁÌÔÓÒ‰Â˜ ÓfiÛËÌ·.

¡ÂfiÙÂÚ· NSAIDs Ô˘ ÏÂÔÓÂÎÙÔ‡Ó fiÛÔÓ ·ÊÔÚ¿

ÛÙËÓ ÚfiÎÏËÛË Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ,

fiˆ˜ ÔÈ ·Ó·ÛÙÔÏÂ›˜ ÙÔ˘ Cox II ÂÓ˙˘ÌÈÎÔ‡ Û˘-

ÛÙ‹Ì·ÙÔ˜, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ ·È‰È¿, ÂÓÒ

ÙÂÏÂ˘Ù·›· ÂÎÊÚ¿˙ÔÓÙ·È ÂÈÊ˘Ï¿ÍÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ

ÙËÓ ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜ Î·È ÛÂ ÂÓ‹ÏÈÎÂ˜. ∏ ¯Ú‹ÛË ÛÂ

·È‰È¿ ·˘ÙÔÎfiÏÏËÙˆÓ ·Ó·ÏÁËÙÈÎÒÓ “ÂÌ‚·Ïˆ-

Ì¿ÙˆÓ” (patches), Ù· ÔÔ›· ÂÚÈ¤¯Ô˘Ó ÏÈ‰ÔÎ·˝ÓË

Î·È Û˘Ó‰˘¿˙Ô˘Ó Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙË˜ ·˘ÍËÌ¤-

ÓË˜ Û˘ÌÌfiÚÊˆÛË˜, ÙˆÓ ÌÂÈˆÌ¤ÓˆÓ Û˘ÛÙËÌ·ÙÈ-

ÎÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Î·È ÙË˜ ·˘ÍËÌ¤-

ÓË˜ ÙÔÈÎ‹˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜, ·ÚÔ˘ÛÈ¿-

˙ÂÈ ÂÓ‰È·Ê¤ÚÔÓ. ¢È¯ÔÁÓˆÌ›· ÂÈÎÚ·ÙÂ› ˆ˜ ÚÔ˜

ÙÔ ÛÎÂ‡·ÛÌ· Ô˘ Ú¤ÂÈ Ó· ÂÈÏ¤ÁÂÙ·È ̂ ˜ ÂÓ·Ú-

ÎÙ‹ÚÈÔ˜ ·ÁˆÁ‹, Î·ıÒ˜ ÔÚÈÛÌ¤ÓÔÈ Û˘ÁÁÚ·ÊÂ›˜

ÚÔÙÂ›ÓÔ˘Ó Ù· Ì˘Ô¯·Ï·ÚˆÙÈÎ¿, ÂÓÒ ¿ÏÏÔÈ Ù·

·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ ÛÂ ¯·ÌËÏ‹ ‰ÔÛÔÏÔÁ›· (9,34).

¶Ï‹ıÔ˜ ¿ÏÏˆÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ Ô˘ ¤¯Ô˘Ó ‰Ô-

ÎÈÌ·ÛÙÂ› ÛÂ ÂÓ‹ÏÈÎÂ˜, fiˆ˜ ‚ÂÓ˙Ô‰È·˙Â›ÓÂ˜,

Î·Ù·ÛÙ·ÏÙÈÎ¿ ÙÔ˘ ∫¡™, ·Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ˘Ô-

ÛÙÚÒÌ·ÙÔ˜ ƒ, ·ÓÙÈÂÈÏËÙÈÎ¿ ‹ ·ÎfiÌ· Î·È ·ÓÙÈ-

ÌÈÎÚÔ‚È·Î¿, ‰ÂÓ ÌÔÚÔ‡Ó Û‡ÌÊˆÓ· ÌÂ Ù· ‰È·-

ı¤ÛÈÌ· ‰Â‰ÔÌ¤Ó· Ó· ÂÓÙ·¯ıÔ‡Ó ÛÙËÓ Â›ÛËÌË

ıÂÚ·Â˘ÙÈÎ‹ Ê·Ú¤ÙÚ·. ¡ÂfiÙÂÚÔÈ ·Ú¿ÁÔÓÙÂ˜,

¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350



fiˆ˜ ·ÁˆÓÈÛÙ¤˜ ÓÙÔ·Ì›ÓË˜, ÂÎÏÂÎÙÈÎÔ› ·Ó·-

ÛÙÔÏÂ›˜ Â·Ó·ÚfiÛÏË„Ë˜ ÛÂÚÔÙÔÓ›ÓË˜ Î·È ÓÔ-

Ú·‰ÚÂÓ·Ï›ÓË˜ (fiˆ˜ Ë ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË ‰Ô˘-

ÏÔÍÂÙ›ÓË), Î·ıÒ˜ Î·È Û˘ÓıÂÙÈÎÔ› ÓÂ˘ÚÔÌÂÙ·‚È-

‚·ÛÙ¤˜ Ô˘ ÌÈÌÔ‡ÓÙ·È ÙË ‰Ú¿ÛË ÙÔ˘ GABA,

‚Ú›ÛÎÔÓÙ·È ÛÂ ÂÍ¤ÏÈÍË.

æ˘¯ÔÏÔÁÈÎ‹ ÚÔÛ¤ÁÁÈÛË

∏ ¯Ú‹ÛË ÁÓˆÛÈ·Î‹˜-Û˘ÌÂÚÈÊÔÚÈÎ‹˜ „˘-

¯ÔıÂÚ·Â›·˜ ¤¯ÂÈ Î·Ù¿ ÂÚÈÙÒÛÂÈ˜ ·Ô‰ÂÈ-

¯ıÂ› ¯Ú‹ÛÈÌË, ·Ó Î·È ‰ÂÓ ˘¿Ú¯ÂÈ Ô ÈÎ·Ófi˜

·ÚÈıÌfi˜ ÌÂıÔ‰ÔÏÔÁÈÎ¿ ÔÏÔÎÏËÚˆÌ¤ÓˆÓ ÌÂÏÂ-

ÙÒÓ ÛÂ ·È‰È¿ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÙÂÎÌËÚÈÒ-

ÛÔ˘Ó ÙË ¯ÚËÛÈÌfiÙËÙ¿ ÙË˜. ™Â Ì›· ÌÂÏ¤ÙË ·Ó·-

Ê¤ÚÂÙ·È fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ÁÓˆÛÈ·ÎÒÓ-Û˘ÌÂÚÈ-

ÊÔÚÈÎÒÓ ÙÂ¯ÓÈÎÒÓ Ô‰‹ÁËÛÂ ÛÂ ‡ÊÂÛË ÙˆÓ Û˘-

ÌÙˆÌ¿ÙˆÓ ÛÂ ‰È¿ÛÙËÌ· 4-24 ÌËÓÒÓ (40).

º˘ÛÈÎ‹ Î·È ÎÔÈÓˆÓÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË

º˘ÛÈÎÔıÂÚ·Â›·, ¯ÂÈÚÔÌ·Ï¿ÍÂÈ˜, ÔÛÙÂÔ·-

ıËÙÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜, ¯Ú‹ÛË ËÏÂÎÙÚÈÎ‹˜ ‰È·‰ÂÚÌÈ-

Î‹˜ ÓÂ˘ÚÈÎ‹˜ ‰È¤ÁÂÚÛË˜ (TENS), Î·ıÒ˜ Î·È

‰È·Ù·ÙÈÎ¤˜ Î·È ·ÂÚÔ‚ÈÎ¤˜ ·ÛÎ‹ÛÂÈ˜ ¤¯Ô˘Ó ‰ÔÎÈ-

Ì·ÛÙÂ› ÌÂ ÂÈÙ˘¯›· ÛÂ ÂÓ‹ÏÈÎÂ˜, ‰ÂÓ ˘¿Ú¯ÂÈ

fiÌˆ˜ ÛËÌ·ÓÙÈÎ‹ ÂÌÂÈÚ›· ÛÂ ·È‰È¿. ∏ ÂÈ-

ÛÙÚÔÊ‹ ÛÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÙÔ˘ ·È‰ÈÔ‡ Ô˘

‰È·ÎfiËÎ·Ó ÏfiÁˆ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙË˜ Ófi-

ÛÔ˘ (Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË Û¯ÔÏÂ›Ô˘, ÎÔÈ-

ÓˆÓÈÎ‹ ·ÏÏËÏÂ›‰Ú·ÛË, ·È¯Ó›‰È, ‹È· ¿ıÏË-

ÛË) Î·Ù¤¯ÂÈ ÚˆÙ·Ú¯ÈÎ‹ ÛËÌ·Û›·. ∫¿ÔÈÔÈ

Û˘ÁÁÚ·ÊÂ›˜, fiˆ˜ Ô Gedalia, ÚÔÙÂ›ÓÔ˘Ó Úfi-

ÁÚ·ÌÌ· ‹È·˜ ¿ÛÎËÛË˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÎÔ-

Ï‡ÌÈ, ÂÚ¿ÙËÌ· ‹ Ô‰ËÏ·Û›·, ÁÈ· ÙÔ˘Ï¿¯È-

ÛÙÔÓ ÌÈÛ‹ ÒÚ· ËÌÂÚËÛ›ˆ˜ (9).

™˘ÌÂÚ¿ÛÌ·Ù· - ÙÔ Ì¤ÏÏÔÓ

¶·Ú¿ ÙË ÛËÌ·ÓÙÈÎ‹ ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ ÛËÌÂÈ-

ˆıÂ› ÛÙË ‰È·‰ÈÎ·Û›· ÚÔÛ¤ÁÁÈÛË˜ Î·È Î·Ù·ÓfiË-

ÛË˜ ÙË˜ ÈÓÔÌ˘·ÏÁ›·˜ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘-

Ù·›ˆÓ ‰ÂÎ·ÂÙÈÒÓ, ÂÏ¿¯ÈÛÙ· ¤¯Ô˘Ó ÌÂÙ·‚ÏËıÂ›

fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ‹ ÛÙË

‰˘Ó·ÙfiÙËÙ· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹˜ Î·È ·ÛÊ·ÏÔ‡˜

·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙË˜. ¶·Ú·-

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350 µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:342-350


351REVIEW ARTICLE

Fibromyalgia in childhood

V. Tsagris1, A. Kitsopoulou2, C. Mihas2, P. Nikolaidou - Karpathiou1

Abstract

Fibromyalgia of childhood is a common musculoskeletal pain disorder characterized by widespreadpersistent pain, the presence of multiple discrete tender points on physical examination, stiffness,sleep disturbances and fatigue. Its course is unremitting and it has a restrictive effect on the functionalability and psychosocial development of the affected children. Although its exact aetiology remainsunknown, it is perceived that a number of factors can contribute to the clinical expression of thedisorder. The therapeutic intervention is non-specific and usually multidisciplinary.

Key words

Fibromyalgia, children, pain, treatment, musculoskeletal.

1 3rd Paediatric Clinic of theUniversity of Athens,“Attikon” UniversityHospital, Haidari, Athens

2 Paediatric Clinic,“Thriassio” GeneralHospital, Elefsina, Athens

Correspondence:

Vassilios Tsagris 3rd Paediatric Clinic of theUniversity of Athens“Attikon” University Hospital1 Rimini Str., Haidari, Athens E-mail: [email protected]




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·Ó·ÓÔ‹˜, Ë ÔÔ›· Î·È ıÂˆÚÂ›Ù·È ÂÈ‚·Ú˘ÓÙÈ-Îfi˜ ·Ú¿ÁÔÓÙ·˜ (1) fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Úfi-ÁÓˆÛË.

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ÌÂ-ÏÂÙËıÔ‡Ó Ù· ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, Ë ÔÚÂ›·Î·È Ë ¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ Û‡Ó‰ÚÔÌÔGuillain-Barré ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·-Â›·˜ (ª∂£).


ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿ Ù· È·ÙÚÈÎ¿ ·Ú¯Â›· fiÏˆÓÙˆÓ ·È‰ÈÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ GB Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËª∂£ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1986 ¤ˆ˜ ÙÔÓ π·ÓÔ˘¿ÚÈÔÙÔ˘ 2003. ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ Â›¯·Ó ÂÍÂÙ·ÛÙÂ› ·fi ·È‰Ô-ÓÂ˘ÚÔÏfiÁÔ. ∆· ·È‰È¿ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂ-Ï¤ÙË ÏËÚÔ‡Û·Ó Ù· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰Úfi-ÌÔ˘ GB Ô˘ ¤¯Ô˘Ó ıÂÛÈÛÙÂ› ·fi ÙÔ˘˜ Asbury Î·ÈCornblath (2).

∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ÛÙÔÈ-¯Â›·, Ë ·ÁˆÁ‹ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ, Î·ıÒ˜ Î·È Ë¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘. °È· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ‚·Ú‡ÙËÙ·˜ÙË˜ ÓfiÛÔ˘ Î·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ª∂£¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÎÏ›Ì·Î· Hughes (1). ™ËÌÂÈÒıË-Î·Ó, Â›ÛË˜, Ë ·ÚÔ˘Û›· ‹ fi¯È ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·-ÛÙÈÎÒÓ, Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ, ÔÈ ‰È·Ù·-Ú·¯¤˜ ÙÔ˘ ∞¡™, Î·ıÒ˜ Î·È ÙÔ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓË˜ÈÔÁÂÓÔ‡˜ ÏÔ›ÌˆÍË˜, Ô ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ù· Â˘-Ú‹Ì·Ù· ·fi ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À). ∆¤ÏÔ˜,Î·Ù·ÁÚ¿ÊËÎ·Ó Ë ‰È¿ÚÎÂÈ· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘,Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (ª∞) Î·È Ë ‰È¿Ú-ÎÂÈ· ÙË˜ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ª∂£ Î·È ÛÙÔ ÓÔ-ÛÔÎÔÌÂ›Ô. ∆· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘Guillain-Barré ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

£ÂˆÚ‹ıËÎÂ “Î·Ï‹ ¤Î‚·ÛË” Ë ÈÎ·ÓfiÙËÙ· ‚¿‰ÈÛË˜¯ˆÚ›˜ ‚Ô‹ıÂÈ· (score <2) Î·È “Î·Î‹ ¤Î‚·ÛË” Ë ·‰˘Ó·-Ì›· ‚¿‰ÈÛË˜ ¯ˆÚ›˜ ‚Ô‹ıÂÈ· (score 3-5).


Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÛıÂÓÒÓ

∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1986¤ˆ˜ ÙÔÓ π·ÓÔ˘¿ÚÈÔ 2003 ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËª∂£ 12 ·È‰È¿ ÌÂ Û‡Ó‰ÚÔÌÔ GB (5 ·ÁfiÚÈ·, 7ÎÔÚ›ÙÛÈ·), ËÏÈÎ›·˜ 22 ÌËÓÒÓ ¤ˆ˜ 15 ÂÙÒÓ (Ì¤ÛËËÏÈÎ›·: 8,04 ¤ÙË).

¶ÚÔËÁÔ‡ÌÂÓË ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË ·Ó·Ê¤ÚÂÙ·ÈÛÂ 8/12 ·È‰È¿ (ÏÔ›ÌˆÍË ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÛÂ 2,ÂÙÈÎÔ‡ ÛÂ 2, ¿ÏÏË ÂÌ‡ÚÂÙË ÏÔ›ÌˆÍË ÛÂ 3,ÈÏ·Ú¿ ÛÂ 1). ™Â 10/12 ·È‰È¿ ÂÏ‹ÊıË ¤ÏÂÁ¯Ô˜·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜‚Ú¤ıËÎÂ ÛÂ 6/10 ·È‰È¿ (Mycoplasma pneumo-niae ÛÂ 2, Èfi˜ ÈÏ·Ú¿˜ ÛÂ 1, Campylobacter spp ÛÂ1, Èfi˜ ·ÏÔ‡ ¤ÚËÙ· ÛÂ 1, Èfi˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜-˙ˆÛÙ‹Ú· ÛÂ 1).

¡Â˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜

∫·Ù¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘˜ ÛÙË ª∂£, fiÏÔÈ ÔÈ

·ÛıÂÓÂ›˜ Â›¯·Ó ÂÎÛÂÛËÌ·ÛÌ¤ÓË Ì˘˚Î‹ ·‰˘Ó·-

Ì›· (score ‚·Ú‡ÙËÙ·˜ 4 ‹ 5 ÌÂ ÙËÓ ÎÏ›Ì·Î·

Hughes). ∏ Ì˘˚Î‹ ·‰˘Ó·Ì›· ·ÊÔÚÔ‡ÛÂ Î·È

ÛÙÔ˘˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡˜ Ì‡Â˜.

∂›ÛË˜, fiÏ· Ù· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÌÂ›ˆ-

ÛË ‹ Î·Ù¿ÚÁËÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈ-

ÎÒÓ. ÀÂÚÂ˘·ÈÛıËÛ›· ‹ fiÓÔ ·Ó¤ÊÂÚ·Ó 6/12

·È‰È¿. ¶ÚÔÛ‚ÔÏ‹ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ Â›-

¯·Ó 11/12 ·È‰È¿, ÂÓÒ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ∞¡™

·ÚÔ˘Û›·Û·Ó 9/12 ·È‰È¿. ¶ÈÔ Û˘¯Ó‹ ÂÎ‰‹Ïˆ-

ÛË ·fi ÙÔ ∞¡™ ‹Ù·Ó Ë ˘¤ÚÙ·ÛË (8/12 ·È-

‰È¿) Ô˘ ‰‡ÛÎÔÏ· ÂÏÂÁ¯fiÙ·Ó ÌÂ ÙËÓ ·ÁˆÁ‹.

ÕÏÏÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ ∞¡™ ‹Ù·Ó Ë Â›-

Û¯ÂÛË Ô‡ÚˆÓ (4/12), Ë ‰˘ÛÎÔÈÏÈfiÙËÙ· (2/12),

Ë ¤ÓÙÔÓË ÂÊ›‰ÚˆÛË (4/12) Î·È Ë ‚Ú·‰˘Î·Ú‰›·

(1/12). ∫·Ó¤Ó· ·È‰› ‰ÂÓ ·ÚÔ˘Û›·ÛÂ ÂÈÎ›Ó-

‰˘ÓË ÁÈ· ÙË ˙ˆ‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ Î·Ú‰È·ÎÔ‡

Ú˘ıÌÔ‡. ∏ ‰È¿ÚÎÂÈ· ÙË˜ Ê¿ÛË˜ ÂÈ‰Â›ÓˆÛË˜

·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ Ì¤¯ÚÈ ÙË Ì¤ÁÈÛÙË

‚·Ú‡ÙËÙ· ‹Ù·Ó 1-20 ËÌ¤ÚÂ˜ (Ì¤ÛÔ˜ fiÚÔ˜: 7

ËÌ¤ÚÂ˜).

¶·È‰È·ÙÚÈÎ‹ 2005;68:352-356

¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Guillain-Barré

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Ô˘ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙË‰È¿ÁÓˆÛË ¶ÚÔÔ‰Â˘ÙÈÎ‹ ·‰˘Ó·Ì›· ÂÚÈÛÛfiÙÂÚˆÓ - ·fi ÙÔ ¤Ó·¿ÎÚÔ - ÌÂÏÒÓ ªÂ›ˆÛË/ÂÍ¿ÏÂÈ„Ë ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Ô˘ ÂÓÈÛ¯‡Ô˘Ó ÙË ‰È¿ÁÓˆÛË ∂Í¤ÏÈÍË ÛÂ ÂÚ›Ô˘ 4 Â‚‰ÔÌ¿‰Â˜ ™¯ÂÙÈÎ¿ Û˘ÌÌÂÙÚÈÎ‹ ÚÔÛ‚ÔÏ‹ ¶ÂÚÈÔÚÈÛÌ¤ÓË ÚÔÛ‚ÔÏ‹ ·ÈÛıËÙÈÎfiÙËÙ·˜ ¶ÚÔÛ‚ÔÏ‹ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ ŒÓ·ÚÍË ‚ÂÏÙ›ˆÛË˜ 2-4 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓÔÏÔÎÏ‹ÚˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜ ¢È·Ù·Ú·¯¤˜ ·fi ÙÔ ·˘ÙfiÓÔÌÔ ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· ∞Ô˘Û›· ˘ÚÂÙÔ‡ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ∞‡ÍËÛË ÏÂ˘ÎÒÌ·ÙÔ˜ ∂¡À Ì›· Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ∫‡ÙÙ·Ú· ∂¡À <10 (ÌÔÓÔÎ‡ÙÙ·Ú·) ∂Ï¿ÙÙˆÛË ÓÂ˘ÚÈÎ‹˜ ·ÁˆÁÈÌfiÙËÙ·˜

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Ô˘ ·ÌÊÈÛ‚ËÙÔ‡Ó ÙË ‰È¿ÁÓˆÛË ŒÓÙÔÓË, Â›ÌÔÓË ·Û˘ÌÌÂÙÚ›· ÙË˜ Ì˘˚Î‹˜ ·‰˘Ó·Ì›·˜ ∂›ÌÔÓË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î‡ÛÙË˜ ‹ ÂÓÙ¤ÚÔ˘ OÚıÔÎ˘ÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ∫‡ÙÙ·Ú· ∂¡À >50 (ÌÔÓÔÎ‡ÙÙ·Ú·) ‹ ·ÚÔ˘Û›·ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Ô˘ ·ÔÎÏÂ›Ô˘Ó ÙË ‰È¿ÁÓˆÛË ŒÓ‰ÂÈÍË ÌÂÙ·‚ÔÏÈÎÔ‡, ÏÔÈÌÒ‰Ô˘˜ ÓÔÛ‹Ì·ÙÔ˜ ‹‰ËÏËÙËÚ›·ÛË˜ ¶·ÚÔ˘Û›· ·ÌÈÁÒ˜ ·ÈÛıËÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ


354 ∞. ∆ÛÔ‡ÙÛÔ˘ Î·È Û˘Ó.

∏ O¡¶ ¤ÁÈÓÂ ÛÂ fiÏ· Ù· ·È‰È¿ Î·È Ô ¯·Ú·-

ÎÙËÚÈÛÙÈÎfi˜ ÏÂ˘ÎˆÌ·ÙÔÎ˘ÙÙ·ÚÈÎfi˜ ‰È¯·ÛÌfi˜

‚Ú¤ıËÎÂ ÛÂ 11/12 ·È‰È¿ (ÌÂÙ¿ ÙËÓ 7Ë ËÌ¤Ú·

ÙË˜ ÓfiÛÔ˘).

∞ÓÙÈÌÂÙÒÈÛË - £ÂÚ·Â›·

ŒÓÙÂÎ· ·È‰È¿ Ù¤ıËÎ·Ó ÛÂ ª∞ ÏfiÁˆ ÙË˜

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ‰È¿ÚÎÂÈ· ÙË˜

ÌË¯·ÓÈÎ‹˜ ˘ÔÛÙ‹ÚÈÍË˜ Î˘Ì¿ÓıËÎÂ ·fi 2 ¤ˆ˜

37 ËÌ¤ÚÂ˜ (Ì¤ÛÔ˜ fiÚÔ˜: 18,4 ËÌ¤ÚÂ˜). ™Â ÙÚ›·

·È‰È¿ ¤ÁÈÓÂ ÙÚ·¯ÂÈÔÛÙÔÌ›·, Ë ÔÔ›· ÎÚ›ıËÎÂ

ÛÎfiÈÌË ÏfiÁˆ ÙË˜ ·Ú·ÙÂÙ·Ì¤ÓË˜ ‰È·ÛˆÏ‹Óˆ-

ÛË˜ (22, 27 Î·È 37 ËÌ¤ÚÂ˜).

∂Ó‰ÔÊÏ¤‚È· Á-ÛÊ·ÈÚ›ÓË (IVIG) ¯ÔÚËÁ‹ıËÎÂ

ÛÂ 10/12 ·È‰È¿, ‰ËÏ·‰‹ ÛÂ fiÏ· Ù· ·È‰È¿ Ô˘

ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË ª∂£ ÌÂÙ¿ ÙÔ 1990. ™Â 8

·È‰È¿ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ Û¯‹Ì· 0,4

g/kg/ËÌ¤Ú· ÁÈ· ¤ÓÙÂ Û˘ÓÂ¯Â›˜ ËÌ¤ÚÂ˜ Î·È ÛÂ

‰‡Ô ·È‰È¿ ÙÔ Û¯‹Ì· 1 g/kg/ËÌ¤Ú· ÁÈ· ‰‡Ô Û˘-

ÓÂ¯Â›˜ ËÌ¤ÚÂ˜. ™Â ¤Ó· ·fi ·˘Ù¿ Ù· ‰‡Ô ·È‰È¿

ÙÔ Û¯‹Ì· Â·Ó·Ï‹ÊıËÎÂ ÌÂÙ¿ ·fi 15 ËÌ¤ÚÂ˜,

¯ˆÚ›˜ ıÂ·Ì·ÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∏ ˘fiÏÔÈË

·ÁˆÁ‹ ÂÚÈÂÏ¿Ì‚·ÓÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ Î·È ÎÈÓËÙÈ-

Î‹ Ê˘ÛÈÔıÂÚ·Â›·, ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË

ÙˆÓ ÏÔÈÌÒÍÂˆÓ, ·ÓÙÈÌÂÙÒÈÛË fiÓÔ˘, „˘¯ÔÏÔ-

ÁÈÎ‹ ˘ÔÛÙ‹ÚÈÍË, Î·ıÒ˜ Î·È ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË.

¶ÔÚÂ›· ÓfiÛÔ˘ - ŒÎ‚·ÛË - ∂ÈÏÔÎ¤˜

∏ ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË

ª∂£ Î˘Ì¿ÓıËÎÂ ·fi 2 ¤ˆ˜ 140 ËÌ¤ÚÂ˜.

∆Ô ·È‰› Ô˘ ·Ú¤ÌÂÈÓÂ 140 ËÌ¤ÚÂ˜ Â›¯Â

·ÚÔ˘ÛÈ¿ÛÂÈ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó·ÎÔ‹

Î·È ÂÈ‚›ˆÛÂ ÌÂ ‚·ÚÈ¿ ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹

(‚·ÚÈ¿ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·). ∂¿Ó ÂÍ·ÈÚÂıÂ› ·˘Ùfi

ÙÔ ·È‰›, Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ ÛÙË ª∂£

‹Ù·Ó 24,8 ËÌ¤ÚÂ˜. ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ ¤ÍÔ‰Ô ÙˆÓ

·ÛıÂÓÒÓ ·fi ÙË ª∂£ ·ÔÙÂÏÔ‡Û·Ó Ë ·Ó·-

ÓÂ˘ÛÙÈÎ‹ Â¿ÚÎÂÈ·, Ô ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ‚‹-

¯·˜ Î·È Ë ·Ô˘Û›· ÏÔ›ÌˆÍË˜. ∏ ·ÔÎ·Ù¿ÛÙ·ÛË

ÙË˜ Ì˘˚Î‹˜ ‰‡Ó·ÌË˜ ‰ÂÓ ·ÔÙÂÏÔ‡ÛÂ ··Ú·›-

ÙËÙË ÚÔ¸fiıÂÛË.

™ÙË Û˘Ó¤¯ÂÈ·, Ù· ·È‰È¿ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙÈ˜

·È‰È·ÙÚÈÎ¤˜ ÎÏÈÓÈÎ¤˜. ∏ Û˘ÓÔÏÈÎ‹ ·Ú·ÌÔÓ‹

ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î˘Ì¿ÓıËÎÂ ·fi 16 ¤ˆ˜

75 ËÌ¤ÚÂ˜. ªÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔ-

ÎÔÌÂ›Ô, Ù· ·È‰È¿ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÛÙ·

ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· Ì¤¯ÚÈ ÙËÓ Ï‹ÚË ·ÔÎ·Ù¿-

ÛÙ·Û‹ ÙÔ˘˜.

™ÙÔ˘˜ 6 Ì‹ÓÂ˜, Ù· 10/12 ·È‰È¿ ÂÚ·ÙÔ‡-

Û·Ó ¯ˆÚ›˜ ‚Ô‹ıÂÈ· (score <2). ∆· ˘fiÏÔÈ· 2

·È‰È¿ ·ÚÔ˘Û›·˙·Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ ˘ÔÏÂ›ÌÌ·-

Ù·. ∆Ô ¤Ó· ·È‰›, Ô˘ Â›¯Â ˘ÔÛÙÂ› Î·Ú‰ÈÔ·Ó·-

ÓÂ˘ÛÙÈÎ‹ ·Ó·ÎÔ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔ-

ÛËÏÂ›·˜, ·Ú¤ÌÂÈÓÂ ÌÂ ÂÈÎfiÓ· ‚·ÚÈ¿˜ ˘ÔÍ·ÈÌÈ-

Î‹˜-ÈÛ¯·ÈÌÈÎ‹˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜. ∆Ô ‰Â‡ÙÂÚÔ

·È‰› Â›¯Â ‰È·Ù·Ú·¯¤˜ ‚¿‰ÈÛË˜ (·ÛÙ¿ıÂÈ· ‚¿‰È-

ÛË˜). ∫·Ó¤Ó· ·È‰› ‰ÂÓ ·Â‚›ˆÛÂ Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘ ÛÙË ª∂£.

™˘˙‹ÙËÛË

∆Ô Û‡Ó‰ÚÔÌÔ Guillain-Barré ıÂˆÚÂ›Ù·È fiÙÈ

ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓÔÛÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹, ÌÂ ·Ô-

Ù¤ÏÂÛÌ· ÙË ÊÏÂÁÌÔÓÒ‰Ë ‰È‹ıËÛË ÙÔ˘ ÂÓ‰ÔÓÂ˘-

Ú›Ô˘, ÙÔ Ô›‰ËÌ· Î·È ÙËÓ ÙÌËÌ·ÙÈÎ‹ ·ÔÌ˘ÂÏ›-

ÓˆÛË (3). ™ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰Úfi-

ÌÔ˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙÂ˜,

Î·ÎÔ‹ıÂÈÂ˜, ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ Î·È ‰È¿-

ÊÔÚ· Ê¿ÚÌ·Î·. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ˘‹Ú¯Â

ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ÁÈ· ÚÔËÁÔ‡ÌÂÓË ÈÔÁÂÓ‹ ÏÔ›-

ÌˆÍË ÛÂ 8/12 ·È‰È¿, ÂÓÒ ÛÂ 6/12 ·È‰È¿ ‚Ú¤-

ıËÎÂ Ô Èı·Ófi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜.

∏ Î‡ÚÈ· ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

GB Â›Ó·È Ë Ì˘˚Î‹ ·‰˘Ó·Ì›·, Ô˘ Â›Ó·È Û˘ÌÌÂ-

ÙÚÈÎ‹ Î·È ÍÂÎÈÓ¿ÂÈ Û˘Ó‹ıˆ˜ ·fi Ù· Î¿Ùˆ ¿ÎÚ·,

¤¯ÔÓÙ·˜ ·ÓÈÔ‡Û· ÔÚÂ›·. ∏ Ì˘˚Î‹ ·‰˘Ó·Ì›·

Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÙË ÌÂ›ˆÛË/Î·Ù¿ÚÁËÛË ÙˆÓ

ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ (3). ∆· ·È‰È¿ ÙË˜

·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›¯·Ó fiÏ· Ì˘˚Î‹ ·‰˘Ó·Ì›·

(score ‚·Ú‡ÙËÙ·˜ 4-5 ÌÂ ÙËÓ ÎÏ›Ì·Î· Hughes)

Î·È Ï‹ÚË Î·Ù¿ÚÁËÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·-

ÎÏ·ÛÙÈÎÒÓ. ∂›ÛË˜, fiÏ· Ù· ·È‰È¿ ·ÚÔ˘Û›·-

Û·Ó ÚÔÛ‚ÔÏ‹ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Ì˘ÒÓ, ÌÂ

Â·ÎfiÏÔ˘ıÔ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·.

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÂÚ›Ô˘ 20-

30% ÙˆÓ ·ÛıÂÓÒÓ (·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜) ·-

ÚÔ˘ÛÈ¿˙ÂÈ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È ı·

¯ÚÂÈ·ÛÙÂ› ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜

(4,5). ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ó¿ÏÔÁÂ˜ ·Ó·ÊÔÚ¤˜ ÁÈ·

·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÂ ª∂£. ∏ ·Ó·-

ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Ì·˙› ÌÂ ÙÈ˜ ‰È·Ù·Ú·¯¤˜

ÙÔ˘ Î˘ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È Ù· Î‡ÚÈ·

·›ÙÈ· ÂÈÛ·ÁˆÁÒÓ ÛÂ ª∂£ (5).

∞fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Û˘ÓÈ-

ÛÙ¿Ù·È ÔÈ ·ÛıÂÓÂ›˜ Ó· ‰È·ÛˆÏËÓÒÓÔÓÙ·È ÓˆÚ›˜,

ÚÈÓ ÂÁÎ·Ù·ÛÙ·ıÂ› Ë ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿Ú-

ÎÂÈ· (3,5,6).

∏ ‰È·ÎÔ‹ ÙÔ˘ ª∞ ÂÈ¯ÂÈÚÂ›Ù·È ÛÙ·‰È·Î¿,

fiÙ·Ó Ë ˙ˆÙÈÎ‹ ¯ˆÚËÙÈÎfiÙËÙ· Â›Ó·È >10 ml/kg, Ë

·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È

¤¯Ô˘Ó Â·Ó¤ÏıÂÈ Ô ‚‹¯·˜ Î·È Ù· ÚÔÛÙ·ÙÂ˘ÙÈÎ¿

·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ (3).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ‰È¿ÚÎÂÈ· ÙË˜ ÌË¯·ÓÈ-

Î‹˜ ˘ÔÛÙ‹ÚÈÍË˜ Î˘Ì¿ÓıËÎÂ ·fi 2 ¤ˆ˜ 37 ËÌ¤-

ÚÂ˜ (Ì¤ÛÔ˜ fiÚÔ˜: 18,4 ËÌ¤ÚÂ˜). ™Â ·ÓÙ›ÛÙÔÈ¯Â˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:352-356


355™‡Ó‰ÚÔÌÔ Guillain-Barré

ÌÂÏ¤ÙÂ˜ ·È‰ÈÒÓ ·Ó·Ê¤ÚÔÓÙ·È ·ÚfiÌÔÈ· ÛÙÔÈ-

¯Â›· (6), ÂÓÒ Ë ‰È¿ÚÎÂÈ· ÙË˜ ÌË¯·ÓÈÎ‹˜ ˘ÔÛÙ‹-

ÚÈÍË˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ‰È·ÚÎÂ› ÂÚÈÛÛfiÙÂÚÔ (1).

™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ GB, Ë

ÚÔÛ‚ÔÏ‹ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ ·Ó·Ê¤ÚÂÙ·È

ÛÂ ÔÛÔÛÙfi ÂÚ›Ô˘ 35-45% (4). ∞fi Ù· ·È-

‰È¿ ÙË˜ ÛÂÈÚ¿˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ÚÔÛ‚Ô-

Ï‹ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ ·ÚÔ˘Û›·ÛÂ ÙÔ

91,6% (11/12) Î·È ‹Ù·Ó ¿ÓÙ· ·Ó·ÛÙÚ¤„ÈÌË.

¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ó¿ÏÔÁÂ˜ ·Ó·ÊÔÚ¤˜ ·fi ¿ÏÏÂ˜

ª∂£. º·›ÓÂÙ·È fiÙÈ fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ‚·-

Ú‡ÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÙfiÛÔ Û˘¯ÓfiÙÂÚË Â›Ó·È

Î·È Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ.

OÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ∞¡™ ‹Ù·Ó Û˘¯Ó¤˜ (9/12

·È‰È¿) Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË. ™ÙË ‚È‚ÏÈÔ-

ÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ˆ˜ ‰Â‡ÙÂÚË ·ÈÙ›· ÂÈÛ·Áˆ-

Á‹˜ ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ GB ÛÙË ª∂£. ∏

Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·Ó·ÎÔ‹ Ô˘ ·Ú·ÙËÚ‹-

ıËÎÂ ÛÂ ¤Ó·Ó ·ÛıÂÓ‹ ‹Ù·Ó ·ÔÙ¤ÏÂÛÌ· ˘ÔÍ·È-

Ì›·˜ Î·È ‰ÂÓ ÔÊÂÈÏfiÙ·Ó ÛÂ ‰È·Ù·Ú·¯‹ ÙÔ˘ ∞¡™

(.¯. ·ÚÚ˘ıÌ›·), ·Ó Î·È ·˘Ùfi ·Ó·Ê¤ÚÂÙ·È ÛÙË

‚È‚ÏÈÔÁÚ·Ê›· (6). ∞fi ÙÈ˜ ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ

∞¡™, Û˘¯ÓfiÙÂÚÂ˜ ‹Ù·Ó Ë ˘¤ÚÙ·ÛË, Ë ˘fiÙ·ÛË

Î·È ÔÈ ÂÓ·ÏÏ·Á¤˜ ˘¤ÚÙ·ÛË˜-˘fiÙ·ÛË˜.

™·Ó ÂÈ‰ÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË

ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ GB ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› Ë

ÎÔÚÙÈ˙fiÓË, Ë Ï·ÛÌ·Ê·›ÚÂÛË Î·È Ë IVIG. ∏

¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓË˜ ¤¯ÂÈ ÂÁÎ·Ù·ÏÂÈÊıÂ›, Î·-

ıÒ˜ ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ› fiÙÈ ‰ÂÓ ‚ÂÏÙÈÒÓÂÈ ÙËÓ

ÚfiÁÓˆÛË. ∏ Ï·ÛÌ·Ê·›ÚÂÛË - ·Ó Î·È ·Ó·Ê¤-

ÚÔÓÙ·È Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· - ‰ÂÓ ÚÔÙÈÌ¿Ù·È

ÛÙ· ·È‰È¿ ÏfiÁˆ ÙÂ¯ÓÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ∏ IVIG

ÂÊ·ÚÌfi˙ÂÙ·È ÂÎÙÂÙ·Ì¤Ó· ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·-

ÂÙ›·. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚÂ˘ÓËÙ¤˜ ˘ÔÛÙËÚ›-

˙Ô˘Ó fiÙÈ ¤¯ÂÈ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù·, ‰ÈfiÙÈ ÂÏ·Ù-

ÙÒÓÂÈ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÔÍ¤Ô˜ ÛÙ·‰›Ô˘, ‚ÂÏÙÈÒ-

ÓÂÈ ÙË Ì˘˚Î‹ ÈÛ¯‡ Î·È ‚Ú·¯‡ÓÂÈ ÙÔ ‰È¿ÛÙËÌ·

ÙÔ˘ ª∞ Î·È ÙË˜ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ

ÓÔÛÔÎÔÌÂ›Ô (3,7). OÈ ÌÂÏ¤ÙÂ˜, fiÌˆ˜, ·˘Ù¤˜

·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜. ™Ù· ·È‰È¿ ‰ÂÓ

˘¿Ú¯Ô˘Ó ÌÂÁ¿ÏÂ˜ ÛÂÈÚ¤˜ Ô˘ Ó· ÂÈ‚Â‚·ÈÒ-

ÓÔ˘Ó ÙËÓ ·Í›· ÙË˜ ¯ÔÚ‹ÁËÛË˜ IVIG (8,9). ªÂ-

ÚÈÎÔ› Û˘ÁÁÚ·ÊÂ›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ¯ÔÚ‹ÁË-

ÛË IVIG ÛÂ ·È‰È¿ ÌÔÚÂ› Ó· Â›Ó·È ÏÈÁfiÙÂÚÔ

·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·fi ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ‹ Ó· Â›Ó·È

·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÌfiÓÔ fiÙ·Ó ¯ÔÚËÁËıÂ› ÛÂ Û˘-

ÁÎÂÎÚÈÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ Î·È ÔÏ‡ ÓˆÚ›˜ ÛÙËÓ

ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ (8). O Û˘Ó‰˘·ÛÌfi˜ IVIG Î·È

Ï·ÛÌ·Ê·›ÚÂÛË˜ ‰ÂÓ ¤¯ÂÈ ÛËÌ·ÓÙÈÎ¿ Î·Ï‡ÙÂ-

Ú· ·ÔÙÂÏ¤ÛÌ·Ù· (10).

™Â fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘, ·˘Ù‹

Â›Ó·È Î·Ï‹ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ.

∆Ô 80-85% ÙˆÓ ·ÛıÂÓÒÓ ¤¯ÂÈ Ï‹ÚË ·ÔÎ·Ù¿-

ÛÙ·ÛË. ∆Ô ÔÛÔÛÙfi ÙË˜ ıÓËÙfiÙËÙ·˜, ·Ú¿ ÙÈ˜ÚÔfi‰Ô˘˜ ÛÙËÓ ÂÓÙ·ÙÈÎ‹ ÓÔÛËÏÂ›·, ÂÍ·ÎÔÏÔ˘-ıÂ› Ó· Î˘Ì·›ÓÂÙ·È ÛÂ 2-12%, ÂÓÒ ÙÔ 10-15%ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ÌfiÓÈÌË ·Ó·ËÚ›·(1,3,4). ÀÔÙÚÔ‹ - Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ófi-ÛÔ˘ ‹ ·ÚÁfiÙÂÚ· - ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 3-10% ÙˆÓ·ÛıÂÓÒÓ. ™Â ª∞ Ô‰ËÁÂ›Ù·È ÙÔ 20-30% ÙˆÓ·ÛıÂÓÒÓ Î·È ıÂˆÚÂ›Ù·È ÂÈ‚·Ú˘ÓÙÈÎfi˜ ·Ú¿ÁÔ-ÓÙ·˜ ÌÂ ıÓËÙfiÙËÙ· Ô˘ ÊÙ¿ÓÂÈ ÙÔ 20% (1).

∆· ÛÙÔÈ¯Â›· ÚÔ¤Ú¯ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÛÂÈÚ¤˜ÂÓËÏ›ÎˆÓ Î·È Â›Ó·È ÁÂÓÈÎÒ˜ ·Ô‰ÂÎÙfi fiÙÈ ÛÙ··È‰È¿ Ë ÚfiÁÓˆÛË Â›Ó·È Î·Ï‡ÙÂÚË. ™ÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, Ô˘ ·ÊÔÚÔ‡ÛÂ ÛÂ ·È‰È¿ ÌÂ ‚·-Ú‡ Û‡Ó‰ÚÔÌÔ Guillain-Barré, ‰ÂÓ ˘‹Ú¯Â Î·Ó¤-Ó·˜ ı¿Ó·ÙÔ˜, fiÌˆ˜ ‰‡Ô ·È‰È¿ ÂÌÊ¿ÓÈÛ·Ó ÌfiÓÈ-ÌÂ˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÈÏÔÎ¤˜. ™ÙÔ ÚÒÙÔ ·fi·˘Ù¿, Ë ÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘Ó‰ÚÔÌ‹ ‰ÂÓ ÔÊÂÈÏfiÙ·ÓÛÙËÓ ›‰È· ÙËÓ ¿ıËÛË, ·ÏÏ¿ ÛÙËÓ Î·Ú‰ÈÔ·Ó·-ÓÂ˘ÛÙÈÎ‹ ·Ó·ÎÔ‹ Ô˘ ˘¤ÛÙË. ∆Ô ‰Â‡ÙÂÚÔ·È‰› Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ‹‰Ë ‰‡Ô ˘ÔÙÚÔ¤˜fiÙ·Ó ÓÔÛËÏÂ‡ÙËÎÂ ÛÙÔ ÙÌ‹Ì·. O ¯ÚfiÓÔ˜ ·Ô-Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ÓÂ˘ÚÔÏÔÁÈÎÔ‡ ˘ÔÏÂ›ÌÌ·ÙÔ˜Â›Ó·È ÈÔ Û‡ÓÙÔÌÔ˜ ÛÙ· ·È‰È¿ ·fi fi,ÙÈ ÛÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ (1,8).

∏ ‰È¿ÚÎÂÈ· ÙË˜ ·ÔÎ·Ù¿ÛÙ·ÛË˜ ÛÙËÓ ÔÌ¿‰·ÙˆÓ ·È‰ÈÒÓ ÌÂ Î·Ï‹ ¤Î‚·ÛË Î˘Ì¿ÓıËÎÂ ·fi24 ¤ˆ˜ 79 ËÌ¤ÚÂ˜ (Ì¤ÛÔ˜ fiÚÔ˜: 51,7 ËÌ¤ÚÂ˜) Î·È‹Ù·Ó ÈÔ Û‡ÓÙÔÌË ·fi ÂÎÂ›ÓË Ô˘ ·Ó·Ê¤ÚÂÙ·ÈÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (4,8).


∆Ô Û‡Ó‰ÚÔÌÔ Guillain-Barré Â›¯Â Û¯ÂÙÈÎ¿Î·Ï‹ ¤Î‚·ÛË ÛÙ· ·È‰È¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤-ÙË˜ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË ª∂£, ·ÎfiÌ· Î·ÈÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ··ÈÙ‹ıËÎÂ ÌË¯·ÓÈÎ‹˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜ ÏfiÁˆ ÙË˜ ‚·Ú‡ÙË-Ù·˜ ÙË˜ ÓfiÛÔ˘.

∏ ‰È·ÛˆÏ‹ÓˆÛË Ú¤ÂÈ Ó· ·ÔÊ·Û›˙ÂÙ·ÈÂÁÎ·›Úˆ˜, ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ·Ó·ÔÙÂÏÂÛÌ·ÙÈ-ÎÔ‡ ‚‹¯·, Ì˘˚Î‹˜ ·‰˘Ó·Ì›·˜ ·Ó·ÓÂ˘ÛÙÈÎÒÓÌ˘ÒÓ Î·È ÚÔÛ‚ÔÏ‹ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ.

∞Ó Î·È ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ› ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜fiÙÈ Ë ¯ÔÚ‹ÁËÛË IVIG ÛÙ· ·È‰È¿ Â›Ó·È ÙfiÛÔ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ fiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ·Ú·Ì¤-ÓÂÈ Ë ÚÒÙË ÂÈÏÔÁ‹ Û·Ó ÂÈ‰ÈÎ‹ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ÓfiÛÔ˘.


1. Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF.Long-term outcome in patients with Guillain-Barré

¶·È‰È·ÙÚÈÎ‹ 2005;68:352-356


356 ∞. ∆ÛÔ‡ÙÛÔ˘ Î·È Û˘Ó.

syndrome requiring mechanical ventilation. Neu-rology 2000;54:2311-2315.

2. Asbury AK, Cornblath DR. Assessment of currentdiagnostic criteria for Guillain-Barré syndrome.Ann Neurol 1990;27 (Suppl):S21-S24.

3. Ropper AH. Critical care of Guillain-Barré syn-drome. In: Ropper AH, editor. Neurological andneurosurgical intensive care. 3rd ed. New York:Raven Press; 1993. p. 363.

4. Korinthenberg R, Monting JS. Natural history andtreatment effects in Guillain-Barré syndrome: amulticentre study. Arch Dis Child 1996;74:281-287.

5. Hund EF, Borel CO, Cornblath DR, Hanley DF,McKhann GM. Intensive management and treat-ment of severe Guillain-Barré syndrome. Crit CareMed 1993;21:433-446.

6. Bos AP, van der Meche FG, Witsenburg M, van derVoort E. Experiences with Guillain-Barré syndromein a pediatric intensive care unit. Intensive CareMed 1987;13:328-331.

7. van der Meche FG, Schmitz PI. Dutch Guillain-Bar-ré Study Group. A randomized trial comparing in-travenous immune globulin and plasma exchange in

Guillain-Barré syndrome. N Engl J Med 1992;326:1123-1129.

8. Graf WD, Katz JS, Eder DN, Smith AJ, Chun MR.Outcome in severe pediatric Guillain-Barré syn-drome after immunotherapy or supportive care.Neurology 1999;52:1494-1497.

9. Gurses N, Uysal S, Cetinkaya F, Islek I, Kalayci AG.Intravenous immunoglobulin treatment in childrenwith Guillain-Barré syndrome. Scand J Infect Dis1995;27:241-243.

10. Plasma Exchange/Sandoglobulin Guillain-BarréSyndrome Trial Group. Randomised trial of plasmaexchange, intravenous immunoglobulin, and com-bined treatments in Guillain-Barré syndrome.Lancet 1997;349:225-230.

11. Henderson RD, Lawn ND, Fletcher DD, McClellandRL, Wijdicks EF. The morbidity of Guillain-Barrésyndrome admitted to the intensive care unit. Neu-rology 2003;60:17-21.

12. Lawn ND, Fletcher DD, Henderson RD, WolterTD, Wijdicks EF. Anticipating mechanical ventila-tion in Guillain-Barré syndrome. Arch Neurol2001;58:893-898.

¶·È‰È·ÙÚÈÎ‹ 2005;68:352-356


357ORIGINAL ARTICLE

Severe Guillain-Barré syndrome. Outcome in

children admitted to a PICU

A. Tsoutsou, D. Gionis, S. Mastroyianni, J. Papadatos

Abstract

Background: Guillain-Barré syndrome (GBS) is a progressive symmetrical polyneuritis with acuteonset, evolution over days or weeks and a good outcome in most cases. The aim of this study was toanalyze the clinical course and outcome in children with GBS requiring hospitalization in a PaediatricIntensive Care Unit (PICU).

Methods: The medical records of all children admitted to the PICU between January 1986 andJanuary 2003 were reviewed. The clinical and laboratory features, therapy and outcome wererecorded.

Results: Twelve children, with GBS, 5 males, mean age 8.04 years (range 22 months - 15 years), wereadmitted to the PICU. In 8/12 patients a preceding viral illness was reported. In 10/12 patientsserological investigations were performed and the aetiological factor was found in 6/10. In additionto weakness and loss of tendon reflexes, 11/12 children presented with cranial nerve palsy and 9/12had autonomic dysfunction (mainly hypertension). All patients had a severity score (Hughes scale) of4 or 5. A lumbar puncture was performed in all patients, with positive findings when it was done 7days or more after the onset of symptoms. Eleven of the 12 patients required mechanical ventilationfor a mean period of 18.4 days (range 2-37 days) and 10 were given intravenous immunoglobulin(IVIG). The mean period of PICU hospitalization was 24.8 days (range 2-42 days). None of thepatients died, 10 had full recovery but two patients had neurological sequelae.

Conclusions: Guillain-Barré syndrome has a better outcome in children than in adults. Mechanicalventilation is not a risk factor for an adverse outcome.

Key words

Guillain-Barré syndrome, mechanical ventilation, intravenous immunoglobulin.

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

Correspondence:

Dimitrios Gionis “P. & A. Kyriakou” Children’sHospital, Thivon & Levadias Str. 115 27, Athens




358 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

1 ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞.¶.£., “πÔÎÚ¿ÙÂÈÔ”°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô,£ÂÛÛ·ÏÔÓ›ÎË

2 ¶·È‰Ô·ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·,“πÔÎÚ¿ÙÂÈÔ” °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô, £ÂÛÛ·ÏÔÓ›ÎË


Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜,∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£.,“πÔÎÚ¿ÙÂÈÔ” °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂˆ˜ 49 ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË


¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364

∫›Ó‰˘ÓÔ˜ ·fi ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜

·ÙfiÌˆÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down Î·È ·ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹

·ÛÙ¿ıÂÈ·

Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘1, ª. ª·ÓÙÔ˘Ú¿ÎË2, ¶. ∫·ÌÔ˘Ú›‰Ô˘1, ∂. ™ˆÙËÚ›‰Ô˘1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi ÙË˜ ÂÚÁ·Û›·˜ ·ÔÙ¤ÏÂÛÂ Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙË˜ ·ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹˜·ÛÙ¿ıÂÈ·˜ (∞∞∞) ÛÂ ÌË È‰Ú˘Ì·ÙÈÎ¿ ¿ÙÔÌ· ÌÂ Û‡Ó‰ÚÔÌÔ Down (DS) ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰· Î·È Ë ÎÏÈ-ÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∆Ô ˘ÏÈÎfi ·ÔÙ¤ÏÂÛ·Ó 171 ¿ÙÔÌ· ÌÂ DS ËÏÈÎ›·˜ 0-40 ÂÙÒÓ. ŸÏ· ÂÍÂÙ¿ÛÙËÎ·ÓÎÏÈÓÈÎ¿ ·Ó¿ ¤ÙÔ˜ ÁÈ· ÛËÌÂÈÔÏÔÁ›· ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ∞fi Ù· ¿ÙÔÌ· ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂ-ÚË˜ ÙˆÓ 3 ÂÙÒÓ, ÔÛÔÛÙfi 81% ˘Ô‚Ï‹ıËÎÂ ÛÂ ·ÎÙÈÓÔÁÚ·Ê›Â˜ (·/·) ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘-ÏÈÎ‹˜ ÛÙ‹ÏË˜ (∞ª™™), ÛÂ Ï¿ÁÈ· Ô˘‰¤ÙÂÚË ı¤ÛË Î·È ÂÈÏÂÎÙÈÎ¿ ÛÂ Ï¿ÁÈ· Î¿Ì„Ë. ∏ ·ÙÏ·ÓÙÔ·ÍÔ-ÓÈÎ‹ ·fiÛÙ·ÛË ÂÎÙÈÌ‹ıËÎÂ ˆ˜ ·ıÔÏÔÁÈÎ‹ fiÙ·Ó ‹Ù·Ó ¿Óˆ ÙˆÓ 4 mm ÁÈ· Ù· ·È‰È¿ ËÏÈÎ›·˜ ÌÈÎÚfi-ÙÂÚË˜ ÙˆÓ 15 ÂÙÒÓ Î·È ¿Óˆ ÙˆÓ 3 mm ÁÈ· Ù· ¿ÙÔÌ· ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 15 ÂÙÒÓ. ŸÏÂ˜ ÔÈ ·ÎÙÈ-ÓÔÁÚ·Ê›Â˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi ÙËÓ ›‰È· ·ÎÙÈÓÔÏfiÁÔ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ Û˘¯ÓfiÙËÙ· ÙË˜ ∞∞∞ ‹Ù·Ó ÔÏ‡ ˘„ËÏ‹ (42%) ÛÙ· ˘fi ¤ÚÂ˘Ó· ¿ÙÔÌ· ÌÂ DS, Û˘-¯ÓfiÙÂÚË ‹Ù·Ó ÛÙ· ·ÁfiÚÈ· (56%) Î·È ÛÙ· ¿ÙÔÌ· ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 15 ÂÙÒÓ (63%). ¶ÔÛÔÛÙfi 9,3% Â›-¯Â ˘ÔÎÂÈÌÂÓÈÎ¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ÀÔ‚Ï‹ıËÎ·Ó ÛÂ Ì·ÁÓË-ÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI) ∞ª™™ Î·È ÛÂ Î·Ó¤Ó· ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ›ÂÛË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡.

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ÙË˜ ¤ÚÂ˘Ó·˜ ÂÓÈÛ¯‡Ô˘Ó ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ∞ıÏËÙÈ·ÙÚÈÎ‹˜ ∂ÈÙÚÔ‹˜ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ ∞Î·‰ËÌ›·˜ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ (∞∞¶), Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¤ÏÂÁ¯Ô ÙˆÓ ·È‰ÈÒÓÌÂ DS ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 3 ÂÙÒÓ ÌÂ ·/· ∞ª™™ Î·Ù¿ ÙËÓ ÚÒÙË Â›ÛÎÂ„‹ ÙÔ˘˜ ÛÙÔÓ ·È‰›·ÙÚÔ, Û˘-ÛÙ¿ÛÂÈ˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÁÈ· Û˘ÌÌÂÙÔ¯‹ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ ÛÙ· ·ıÏ‹Ì·Ù· ÌÂ ·ÔÊ˘Á‹ ˘¤Ú-Î·Ì„Ë˜-˘ÂÚ¤ÎÙ·ÛË˜ ÙÔ˘ ·˘¯¤Ó·, Â·Ó¿ÏË„Ë ÙË˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· ÚÈÓ ÙËÛ˘ÌÌÂÙÔ¯‹ ÛÂ ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ Î·È ÎÏÈÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· Û˘ÌÙÒÌ·Ù· ›ÂÛË˜ ÙÔ˘ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ (·ÈÌˆ‰›Â˜, ÔÓÔÎÂÊ¿ÏÔ˘˜, fiÓÔ ÛÙÔÓ ·˘¯¤Ó·, ‰È·Ù·Ú·¯‹ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ Î‡-ÛÙË˜, ‰È·Ù·Ú·¯‹ ÛÙË ‚¿‰ÈÛË) ·fi ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi. ∏ ÛËÌÂÈÔÏÔÁ›· ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ·Ô-ÙÂÏÂ› ÙÔ ÎÚÈÙ‹ÚÈÔ Â·Ó¿ÏË„Ë˜ Î·È ‰ÈÂ‡Ú˘ÓÛË˜ ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘.


™‡Ó‰ÚÔÌÔ Down, ·ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹ ·ÛÙ¿ıÂÈ·, ·ÙÏ·ÓÙÔ·ÍÔÓÈÎfi ˘ÂÍ¿ÚıÚËÌ·, ·ÙÏ·ÓÙÔ·ÍÔÓÈÎfiÂÍ¿ÚıÚËÌ·, ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

DS ™‡Ó‰ÚÔÌÔ Down

∞∞∞ ∞ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹ ·ÛÙ¿ıÂÈ·

C-1 ¶ÚÒÙÔ˜ ·˘¯ÂÓÈÎfi˜ ÛfiÓ‰˘ÏÔ˜

C-2 ¢Â‡ÙÂÚÔ˜ ·˘¯ÂÓÈÎfi˜ ÛfiÓ‰˘ÏÔ˜

∞ª™™ ∞˘¯ÂÓÈÎ‹ ÌÔ›Ú· ÛÔÓ‰˘ÏÈÎ‹˜

ÛÙ‹ÏË˜

MRI ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·

CT ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·

∞∞¶ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜

AAP American Academy of Pediatrics

·/· ∞ÎÙÈÓÔÁÚ·Ê›·

AAI Atlantoaxial instability

™™ ™ÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË

∂ÈÛ·ÁˆÁ‹

∆· ·È‰È¿ ÌÂ ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË ¤¯Ô˘Ó ·Ó¿-

ÁÎË ·fi ·˘ÍËÌ¤ÓË ÚÔÛÔ¯‹, ÙfiÛÔ ÁÈ· ÙËÓ ÚÔ-

·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜ ÙÔ˘˜ fiÛÔ Î·È ÁÈ· ÙËÓ ÚfiÏË„Ë


359™‡Ó‰ÚÔÌÔ Down Î·È ·ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹ ·ÛÙ¿ıÂÈ·

ÛˆÌ·ÙÈÎÒÓ ·Ó·ËÚÈÒÓ. ¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó·,Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÓÔÛ‹Ì·Ù· ‹ ·Ó·Ë-Ú›Â˜, ÔÈ ÔÔ›Â˜ ÌÔÚÂ› Ó· Â·˘Í‹ÛÔ˘Ó Ù· ÚÔ-‚Ï‹Ì·Ù· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙË ÓÔËÙÈÎ‹ÙÔ˘˜ ˘ÛÙ¤ÚËÛË (1).

ŒÓ· ÂÈ‰ÈÎfi Úfi‚ÏËÌ· Â›Ó·È Ô Î›Ó‰˘ÓÔ˜ ÙˆÓ·ÙfiÌˆÓ ÌÂ Û‡Ó‰ÚÔÌÔ Down (DS) ·fi ‰È¿ÊÔ-ÚÂ˜ ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÏfiÁˆ ÙË˜ ·ÙÏ·-ÓÙÔ·ÍÔÓÈÎ‹˜ ·ÛÙ¿ıÂÈ·˜ (∞∞∞) (1,2). ø˜ ∞∞∞ ‹·ÙÏ·ÓÙÔ·ÍÔÓÈÎfi ˘ÂÍ¿ÚıÚËÌ· ¯·Ú·ÎÙËÚ›˙ÂÙ·ÈË ·˘ÍËÌ¤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÛÙËÓ ·ÙÏ·ÓÙÔ·ÍÔÓÈ-Î‹ ¿ÚıÚˆÛË [¿ÚıÚˆÛË ÌÂÙ·Í‡ ÙÔ˘ ÚÒÙÔ˘ (C-1) Î·È ÙÔ˘ ‰Â‡ÙÂÚÔ˘ (C-2) ·˘¯ÂÓÈÎÔ‡ ÛÔÓ‰‡-ÏÔ˘] (∂ÈÎfiÓ· 1) (3,4). ∆· ·›ÙÈ· ÙË˜ ∞∞∞ ‰ÂÓ¤¯Ô˘Ó Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›. ªÔÚÂ› Ó· ÂÓÔ¯Ô-ÔÈÔ‡ÓÙ·È ‰È·Ì·ÚÙ›Â˜ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ Ô˘ ‰È·-ÙËÚÔ‡Ó ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙË˜ ¿ÚıÚˆÛË˜ ÌÂÙ·Í‡ÙÔ˘ C-1 ‹ C-2 ÛÔÓ‰‡ÏÔ˘ ‹ ÔÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ÙˆÓ C-1 - C-2 ‹ Î·È Ù· ‰‡Ô (5-7).

¶ÔÏ‡ Û¿ÓÈ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÎÏËıÂ›·ÙÏ·ÓÙÔ·ÍÔÓÈÎfi ÂÍ¿ÚıÚËÌ·, ÙÔ ÔÔ›Ô Â›Ó·È·ÂÈÏËÙÈÎfi ÁÈ· ÙË ˙ˆ‹ Î·È ÂÌÊ·Ó›˙ÂÙ·È ÌÂ ÎÏÈ-ÓÈÎ¿ ÛËÌÂ›· Î·È Û˘ÌÙÒÌ·Ù· ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ-·›Ô˘ Ì˘ÂÏÔ‡, fiˆ˜ ·ÓÒÌ·ÏÔ ‚¿‰ÈÛÌ·, fiÓÔ Î·ÈÂÚÈÔÚÈÛÌ¤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ·˘¯¤Ó·, Ú·È‚fi-ÎÚ·ÓÔ, ·‰ÂÍÈfiÙËÙ·, ·Û˘Ó¤ÚÁÂÈ· Î·È ‰È·Ù·Ú·¯¤˜ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÛÊÈÁÎÙ‹ÚˆÓ. ∏ ÓÂ˘ÚÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË ÌÔÚÂ› Ó· ·ÔÎ·Ï‡„ÂÈ ·ÈÛıËÙÈÎ¤˜‰È·Ù·Ú·¯¤˜, Û·ÛÙÈÎfiÙËÙ·, ·˘ÍËÌ¤Ó· ·ÓÙ·Ó·-ÎÏ·ÛÙÈÎ¿, ÎÏfiÓÔ Î·È ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÛËÌÂ›Ô˘Babinski (3,8).

™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛËÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙË˜ ∞∞∞ ÛÂ ÌË È‰Ú˘Ì·ÙÈÎ¿¿ÙÔÌ· ÌÂ DS ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰· Î·È Ë ÎÏÈÓÈÎ‹·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜ ·Ó¿ ¤ÙÔ˜.


∆Ô ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó 171 ¿ÙÔÌ· ÌÂ DSËÏÈÎ›·˜ 0-40 ÂÙÒÓ, Ù· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÔÔ›· ÂÚÂ˘-

Ó‹ıËÎ·Ó ¯ÚˆÌÔÛˆÌÈÎ¿ ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂ-

ÙÈÎ‹˜ ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ∞.¶.£. ¶ÚÔ-

Û‹Ïı·Ó ÌÂ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤Ó· Ú·ÓÙÂ‚Ô‡ ÛÙ· ÂÍˆÙÂÚÈ-

Î¿ È·ÙÚÂ›· °ÂÓÂÙÈÎ‹˜ ∫·ıÔ‰‹ÁËÛË˜ ÁÈ· ÙÔÓ ÂÙ‹ÛÈÔ

ÚÔÏËÙÈÎfi ÙÔ˘˜ ¤ÏÂÁ¯Ô, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Û˘ÛÙ¿ÛÂÈ˜

ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ ∞Î·‰ËÌ›·˜ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜

(A∞¶). ∂ÍÂÙ¿ÛÙËÎ·Ó ÎÏÈÓÈÎ¿ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÛË-

ÌÂÈÔÏÔÁ›·˜ ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ™‡ÌÊˆÓ· ÌÂ

ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ∞ıÏËÙÈ·ÙÚÈÎ‹˜ ∂ÈÙÚÔ‹˜ ÙË˜ A∞¶,

˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·/· ÙË˜ ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ-

‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ (∞ª™™) Ù· ¿ÙÔÌ· ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 3

ÂÙÒÓ. OÈ ·Ï¤˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ ¤ÁÈÓ·Ó ÌÂ ÌË¯¿ÓËÌ·

Merate MMT90 ÛÂ Ï¿ÁÈ· ÚÔ‚ÔÏ‹, ÛÂ Ô˘‰¤ÙÂÚË ı¤ÛË

Î·È ÂÏ·ÊÚ¿ Î¿Ì„Ë, ÌÂ ·fiÛÙ·ÛË Ï˘¯Ó›·˜ ·fi ÙËÓ Î·-

Û¤Ù· ÂÚ›Ô˘ 1 m Î·È ÌÂ ÂÈÎ¤ÓÙÚˆÛË ÛÙÔ Â›Â‰Ô ∞3-

∞4 (ÌÂÛfiÙËÙ· ÂÚ›Ô˘ ∞ª™™). ∞ÎÙÈÓÔÏÔÁÈÎ¿, Ë ·ÙÏ·-

ÓÙÔ·ÍÔÓÈÎ‹ ·ÛÙ¿ıÂÈ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍËÌ¤ÓË

·fiÛÙ·ÛË ÌÂÙ·Í‡ ÙË˜ Ô›ÛıÈ·˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ Úfi-

ÛıÈÔ˘ ÙfiÍÔ˘ ÙÔ˘ ¿ÙÏ·ÓÙ· Î·È ÙË˜ Ô‰ÔÓÙÔÂÈ‰Ô‡˜ ·fi-

Ê˘ÛË˜. ¶·ıÔÏÔÁÈÎ‹ ÂÎÙÈÌ‹ıËÎÂ Ë ·ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹

·fiÛÙ·ÛË fiÙ·Ó ‹Ù·Ó ¿Óˆ ·fi 4 mm ÁÈ· Ù· ·È‰È¿

ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 15 ÂÙÒÓ Î·È ¿Óˆ ·fi 3 mm

ÁÈ· Ù· ¿ÙÔÌ· ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 15 ÂÙÒÓ. ŸÏÂ˜ ÔÈ ·ÎÙÈÓÔ-

ÁÚ·Ê›Â˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi ÙËÓ ›‰È· ·ÎÙÈÓÔÏfiÁÔ. ¢ÂÓ

˘‹Ú¯Â ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ Ô˘ ı· Û˘ÁÎÚ›ÓÔÓÙ·Ó ÌÂ Ù·

¿ÙÔÌ· ÌÂ DS. ∂ÈÏÂÎÙÈÎ¿, ÔÚÈÛÌ¤Ó· ·È‰È¿ ˘Ô‚Ï‹ıË-

Î·Ó ÛÂ CT Î·È MRI. OÈ ÂÍÂÙ¿ÛÂÈ˜ MRI ¤ÁÈÓ·Ó ÌÂ Ì·-

ÁÓËÙÈÎfi ÙÔÌÔÁÚ¿ÊÔ Siemens Expert plus, 1T Î·È Ï‹ÊıË-

Î·Ó ÂÁÎ¿ÚÛÈÂ˜ Î·È Ô‚ÂÏÈ·›Â˜ ÙÔÌ¤˜ ÌÂ ÂÈ‚¿Ú˘ÓÛË ∆1

Î·È ∆2 ·Ú·Ì¤ÙÚˆÓ ÛÂ Ô˘‰¤ÙÂÚË ı¤ÛË ÁÈ· ¤ÏÂÁ¯Ô ›Â-

ÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡.

°È· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙË˜ ·/· ˘‹Ú¯Â Ë ¤ÁÎÚÈÛË fiÏˆÓ

ÙˆÓ ÁÔÓ¤ˆÓ. ™ÙÔ˘˜ ÁÔÓÂ›˜ Ô˘ Ë ·ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹ ·fi-

ÛÙ·ÛË ÛÙËÓ ·/· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ˘ÂÚ¤‚·ÈÓÂ Ù· Ê˘-

ÛÈÔÏÔÁÈÎ¿ fiÚÈ·, ‰fiıËÎ·Ó Ô‰ËÁ›Â˜ ·ÔÊ˘Á‹˜ ÔÚÈÛÌ¤ÓˆÓ

ı¤ÛÂˆÓ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ıÏËÌ¿ÙˆÓ

ÁÈ· ÙËÓ ÚfiÏË„Ë ·Ù˘¯‹Ì·ÙÔ˜.


∆· 126/171 ¿ÙÔÌ· (74%) ‹Ù·Ó ËÏÈÎ›·˜ ¿Óˆ

ÙˆÓ 3 ÂÙÒÓ Î·È Ù· 102 (81%) ·fi ·˘Ù¿ ˘Ô-

‚Ï‹ıËÎ·Ó ÛÂ Ï¿ÁÈ· ·ÎÙÈÓÔÁÚ·Ê›· ∞ª™™. ™Â

43/102 (42%) ‰È·ÈÛÙÒıËÎÂ ∞∞∞ (∂ÈÎfiÓ· 2).

¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364

∂ÈÎfiÓ· 1·, ‚. ŒÛˆ ÎÚ·ÓÈÔ·˘¯ÂÓÈÎÔ› Û‡Ó‰ÂÛÌÔÈ: ·) Ô›ÛıÈ· fi„Ë: ‰Â›¯ÓÂÈ ÙÔ˘˜ Ï¿ÁÈÔ˘˜ ÙÂÚ˘ÁÔÂÈ‰Â›˜ Û˘Ó‰¤ÛÌÔ˘˜Î·È ‚) Ï¿ÁÈ· fi„Ë: ‰Â›¯ÓÂÈ ÙËÓ Î·Ï˘Ù‹ÚÈ· ÌÂÌ‚Ú¿ÓË (4).

·

ª¤ÛÔ˜ ·ÍÔÓÔÂÈ‰‹˜ ‹ÎÚÂÌ·ÛÙ‹ÚÈÔ˜ Û‡Ó‰ÂÛÌÔ˜

ÙÔ˘ ¿ÙÏ·ÓÙ·

¶Ï¿ÁÈÔÈ ÙÂÚ˘ÁÔÂÈ‰Â›˜Û‡Ó‰ÂÛÌÔÈ ÙÔ˘ Ô‰fiÓÙ·

∫·Ï˘Ù‹ÚÈÔ˜ ˘Ì¤Ó·˜

¶ÚfiÛıÈ· ÙfiÍ· ÙÔ˘ ¿ÙÏ·ÓÙ·

∂ÁÎ¿ÚÛÈÔ˜ Û‡Ó‰ÂÛÌÔ˜ ÙÔ˘ ¿ÙÏ·ÓÙ·

√›ÛıÈÔ˜ ÂÈÌ‹ÎË˜ Û‡Ó‰ÂÛÌÔ˜ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜

‚


360 Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘ Î·È Û˘Ó.

∞fi Ù· ¿ÙÔÌ· ÌÂ ∞∞∞, 19/43 (44%) ‹Ù·Ó ÎÔÚ›-

ÙÛÈ· (¶›Ó·Î·˜ 1, ∂ÈÎfiÓ· 3) Î·È 24/43 (56%)

·ÁfiÚÈ· (¶›Ó·Î·˜ 2, ∂ÈÎfiÓ· 3). ∏ Û¯¤ÛË ÎÔÚÈ-

ÙÛÈÒÓ/·ÁÔÚÈÒÓ ‹Ù·Ó 5/6. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈ-

Î›·, 27/43 (63%) ‹Ù·Ó ÌÈÎÚfiÙÂÚ· ÙˆÓ 15 ÂÙÒÓ

Î·È 16/43 (37%) ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 15 ÂÙÒÓ

(∂ÈÎfiÓ· 3). ∆· 4/43 (9,3%) ¿ÙÔÌ· ·Ó¤ÊÂÚ·Ó

ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· ‡ÔÙ· ÁÈ· ›ÂÛË

ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ∞˘Ù¿ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ

ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô ÙË˜ ∞ª™™ ÌÂ CT Î·È Û˘ÁÎÂ-

ÎÚÈÌ¤Ó· ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ·ÚÈıÌfi 7, 13, 19 ÙÔ˘ ¶›-

Ó·Î· 1 Î·È ÌÂ ·ÚÈıÌfi 24 ÙÔ˘ ¶›Ó·Î· 2. ∞fi ·˘-

ÙÔ‡˜, ‰‡Ô ˘Ô‚Ï‹ıËÎ·Ó ÛÂ MRI (ÔÈ ·ÛıÂÓÂ›˜

ÌÂ ·ÚÈıÌfi 13 ÙÔ˘ ¶›Ó·Î· 1 Î·È ÌÂ ·ÚÈıÌfi 24

ÙÔ˘ ¶›Ó·Î· 2). O ¤ÏÂÁ¯Ô˜ ‰ÂÓ ¤‰ÂÈÍÂ ÛÂ Î·Ó¤Ó·¿ÙÔÌÔ ÛËÌÂ›· ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡.

™˘˙‹ÙËÛË

∏ ¿ÚıÚˆÛË ÌÂÙ·Í‡ ÙÔ˘ C-1 Î·È ÙÔ˘ C-2ÛÔÓ‰‡ÏÔ˘, ÙÔ˘ ¿ÙÏ·ÓÙ· Î·È ÙÔ˘ ¿ÍÔÓ·, ·-ÚÔ˘ÛÈ¿˙ÂÈ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ·ÛÙ¿ıÂÈ·˜ ·ÎfiÌËÎ·È ÂÍ·ÚıÚ‹Ì·ÙÔ˜, ÚÔÎ·ÏÒÓÙ·˜ ÙËÓ ÚÔ˜ Ù·›Ûˆ ÌÂÙ·Î›ÓËÛË ÙË˜ Ô‰ÔÓÙÔÂÈ‰Ô‡˜ ·fiÊ˘ÛË˜ÙÔ˘ ¿ÍÔÓ·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ›ÂÛË ÙÔ˘ ÓˆÙÈ-·›Ô˘ Ì˘ÂÏÔ‡ (9,10). ∏ ·ÛÙ¿ıÂÈ· ÌÔÚÂ› Ó· ÚÔ-ÎÏËıÂ› ·fi ÙË ¯·Ï·ÚfiÙËÙ· ÙˆÓ Û˘Ó‰¤ÛÌˆÓÔ˘ Û˘ÁÎÚ·ÙÔ‡Ó ÙËÓ ¿ÚıÚˆÛË ÛÂ Ê˘ÛÈÔÏÔÁÈÎ‹Î·Ù¿ÛÙ·ÛË, ·fi ÔÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ·˘¯Â-ÓÈÎÒÓ ÛÔÓ‰‡ÏˆÓ ‹ Î·È ·fi Ù· ‰‡Ô (1,3).

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë Û˘¯Ófi-ÙËÙ· ÙË˜ ∞∞∞ ÛÙ· ¿ÙÔÌ· ÌÂ DS Î˘Ì·›ÓÂÙ·È ·fi10% ¤ˆ˜ 40% Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ËÏÈÎ›· Î·ÈÙÔ Ê‡ÏÔ ÙÔ˘˜ (11-20). ∏ ∞∞∞ ÌÔÚÂ› Ó· ‰È·È-ÛÙˆıÂ› fi¯È ÌfiÓÔ ÛÂ ¿ÙÔÌ· ÌÂ DS, ·ÏÏ¿ Î·È ÛÂÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÚÂ˘Ì·ÙÔÂÈ‰‹ ·ÚıÚ›ÙÈ-‰·, ÌÂ ‰È·Ì·ÚÙ›Â˜ ÙË˜ Ô‰ÔÓÙÔÂÈ‰Ô‡˜ ·fiÊ˘ÛË˜ÙÔ˘ ¿ÍÔÓ· Î·È ÛÂ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Ó·ÓÈÛÌÔ‡,ÂÓÒ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·È‰È¿ ·’ fi,ÙÈ ÛÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ (10). ™Ù· ˘fi ¤ÚÂ˘Ó· ¿ÙÔÌ· ÌÂ DSÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ‰È·ÈÛÙÒıËÎÂ ·ÎÙÈÓÔ-ÏÔÁÈÎ¿ ÛÂ ÔÛÔÛÙfi 42% (43/102), ‹Ù·Ó Û˘¯Ófi-ÙÂÚË ÛÙ· ·ÁfiÚÈ· (·ÁfiÚÈ·/ÎÔÚ›ÙÛÈ· 24/19, 56%)Î·È ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ËÏÈÎ›·˜ ÌÈ-ÎÚfiÙÂÚË˜ ÙˆÓ 15 ÂÙÒÓ (27/16, 63%). ∆· Â˘Ú‹-Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÌÊˆÓÔ‡Ó ÌÂÂÎÂ›Ó· ÙˆÓ ¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

∆Ô ·ÙÏ·ÓÙÔ·ÍÔÓÈÎfi ÂÍ¿ÚıÚËÌ·, ·Ó Î·È Â›Ó·ÈÔÏ‡ Û·ÓÈfiÙÂÚÔ ·fi ÙËÓ ·ÛÙ¿ıÂÈ·, Â›Ó·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364

23%

21%16%

40%

∞ÁfiÚÈ· <15 ÂÙÒÓ

∞ÁfiÚÈ· >15 ÂÙÒÓ

∫ÔÚ›ÙÛÈ· >15 ÂÙÒÓ

∫ÔÚ›ÙÛÈ· <15 ÂÙÒÓ

∂ÈÎfiÓ· 3. ∫·Ù·ÓÔÌ‹ Î·Ù¿ ËÏÈÎ›· Î·È Ê‡ÏÔ ·ÙfiÌˆÓ ÌÂDS Î·È ∞∞∞.

∞∞∞42%

∂ÈÎfiÓ· 2. ∫·Ù·ÓÔÌ‹ ÙˆÓ ·ÙfiÌˆÓ ÌÂ DS Î·È ∞∞∞.

¶›Ó·Î·˜ 1. ∫ÔÚ›ÙÛÈ· ÌÂ DS Î·È AA∞ [(n=19) (44%)]

OÌ¿‰· No ŸÓÔÌ· ∏ÏÈÎ›· ∞ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹(¤ÙË) ·fiÛÙ·ÛË (mm) -

ı¤ÛË ·/·

<15 ¤ÙË 1 ª. ∂. 8 5 Î¿Ì„Ë2 ™. ª. 6 5 Ô˘‰¤ÙÂÚË3 π. ª. 4 7 Ô˘‰¤ÙÂÚË4 µ. ª. 4 5 Ô˘‰¤ÙÂÚË5 £. ™. 4 7 Ô˘‰¤ÙÂÚË6 £. ¡. 11 5 Î¿Ì„Ë7* ∆. ¢. 11 9 Ô˘‰¤ÙÂÚË8 °. ª. 10 5 Ô˘‰¤ÙÂÚË

9** ™. ª. 8 6 Ô˘‰¤ÙÂÚË10 ¢. Ã. 7 5 Ô˘‰¤ÙÂÚË

>15 ¤ÙË 11 ∑. ¶. 26 6 Ô˘‰¤ÙÂÚË12 ª. °. 23 6 Î¿Ì„Ë13 §. ∂. 30 4 Ô˘‰¤ÙÂÚË14 ∑. ª. 29 7 Ô˘‰¤ÙÂÚË15 °. ∂. 17 8 Ô˘‰¤ÙÂÚË16 ª. °. 17 4 Ô˘‰¤ÙÂÚË17 ™. ™. 18 5 Ô˘‰¤ÙÂÚË18 ƒ. ª. 19 5 Ô˘‰¤ÙÂÚË19 °. ª. 30 4 Ô˘‰¤ÙÂÚË

* ∞ÛıÂÓ‹˜ ÙË˜ ∂ÈÎfiÓ·˜ 4 ** ∞ÛıÂÓ‹˜ ÙË˜ ∂ÈÎfiÓ·˜ 5



·ÂÈÏËÙÈÎfi ÁÈ· ÙË ˙ˆ‹. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ··È-ÙÂ›Ù·È ˘„ËÏ‹ Â˘·ÈÛıËÛ›· ÙˆÓ ÁÈ·ÙÚÒÓ ÁÈ· ÙËÓ·ÔÙÚÔ‹ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ›ÂÛËÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ∞fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Ù¤ÛÛÂÚÈ˜ ‰È·Ì·ÚÙ‡ÚÔÓÙ·ÓÁÈ· Û˘ÌÙÒÌ·Ù· ‡ÔÙ· ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘Ì˘ÂÏÔ‡. ∆· Û˘ÌÙÒÌ·Ù· ÂÚÈÂÏ¿Ì‚·Ó·Ó“Á‰Ô‡Ô” ·ÎÔ˘ÛÙfi Î·È ·fi ÙÔ˘˜ ÁÔÓÂ›˜ Î·È ·fiÙÔ ÎÔÚ›ÙÛÈ Î·Ù¿ ÙËÓ ÚÔÛıÈÔ›ÛıÈ· Î¿Ì„Ë ÙË˜

ÎÂÊ·Ï‹˜ ÙÔ˘ (·ÛıÂÓ‹˜ ÌÂ ·ÚÈıÌfi 7 ÙÔ˘ ¶›Ó·Î·1 Î·È ÌÂ ∞∞∞ 9 mm ÛÂ Ï¿ÁÈ· Ô˘‰¤ÙÂÚË ı¤ÛËÎ·È ÛÂ Î¿Ì„Ë, ∂ÈÎfiÓ· 4), ·˘¯ÂÓ·ÏÁ›· Î·Ù¿ ÙËÓÎ¿Ì„Ë ÙË˜ ÎÂÊ·Ï‹˜ Î·È ·ÈÌˆ‰›Â˜ ÙˆÓ ¿Óˆ¿ÎÚˆÓ ¿ÌÊˆ (ÛÙÈ˜ ·ÛıÂÓÂ›˜ ÌÂ ·ÚÈıÌfi 13 Î·È 19ÙÔ˘ ¶›Ó·Î· 1, ·ÓÙ›ÛÙÔÈ¯· - ÌÂ ∞∞∞ 4 mm ÛÂÏ¿ÁÈ· Ô˘‰¤ÙÂÚË ı¤ÛË, ·ÓÙ›ÛÙÔÈ¯·) Î·È, Ù¤ÏÔ˜,ÌË ‰È·ÁÓˆÛÌ¤Ó· ÏÈÔı˘ÌÈÎ¿ ÂÂÈÛfi‰È· ÛÙÔÓ·ÛıÂÓ‹ ÌÂ ·ÚÈıÌfi 24 ÙÔ˘ ¶›Ó·Î· 2 (ÌÂ ∞∞∞ 4mm ÛÂ Ï¿ÁÈ· Ô˘‰¤ÙÂÚË ı¤ÛË). ¢ÈÂÓÂÚÁ‹ıËÎÂCT Î·È MRI ÙË˜ ∞ª™™ Î·È ‰ÂÓ Ê¿ÓËÎÂ ›ÂÛËÙÔ˘ ÓˆÙÈ·›Ô˘ ÛˆÏ‹Ó· ÛÂ Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ Ù¤Û-ÛÂÚÈ˜ ·ÛıÂÓÂ›˜. ∆· ¿ÙÔÌ· ·˘Ù¿ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ

¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364

∂ÈÎfiÓ· 5. ¶Ï¿ÁÈ· ·/· ∞ª™™ ÙË˜ ·ÛıÂÓÔ‡˜ ™. ª., ËÏÈ-Î›·˜ 8 ÂÙÒÓ, ÌÂ ·ÚÈıÌfi 9 ÙÔ˘ ¶›Ó·Î· 1 ÛÂ: ·) Ô˘‰¤ÙÂÚËı¤ÛË ∞∞∞ 6 mm Î·È ‚) ÂÏ·ÊÚ¿ Î¿Ì„Ë ∞∞∞ 6 mm.

∂ÈÎfiÓ· 6. ¶Ï¿ÁÈ· ·/· ∞ª™™ Ùo˘ ·ÛıÂÓÔ‡˜ ª. ª., ËÏÈ-Î›·˜ 12 ÂÙÒÓ, ÌÂ ·ÚÈıÌfi 8 ÙÔ˘ ¶›Ó·Î· 2 ÛÂ: ·) Ô˘‰¤ÙÂ-ÚË ı¤ÛË ∞∞∞ 5 mm Î·È ‚) Î¿Ì„Ë ∞∞∞ 6 mm.

∂ÈÎfiÓ· 4. ¶Ï¿ÁÈ· ·/· ∞ª™™ ÙË˜ ·ÛıÂÓÔ‡˜ ∆. ¢., ËÏÈ-Î›·˜ 11 ÂÙÒÓ, ÌÂ ·ÚÈıÌfi 7 ÙÔ˘ ¶›Ó·Î· 1 ÛÂ: ·) Ô˘‰¤ÙÂ-ÚË ı¤ÛË AAA 9 mm Î·È ‚) ÂÏ·ÊÚ¿ Î¿Ì„Ë ∞∞∞ 9 mm.

¶›Ó·Î·˜ 2. ∞ÁfiÚÈ· ÌÂ DS Î·È AA∞ [n=24 (56%)]

OÌ¿‰· No ŸÓÔÌ· ∏ÏÈÎ›· ∞ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹(¤ÙË) ·fiÛÙ·ÛË (mm) -

ı¤ÛË ·/·

<15 ¤ÙË 1 ∆. ¢. 4 6 Ô˘‰¤ÙÂÚË2 µ. Ã. 4 7 Ô˘‰¤ÙÂÚË3 ∫. ∫. 4 5 Ô˘‰¤ÙÂÚË4 ¡. °. 3 6 Ô˘‰¤ÙÂÚË5 ∆. ™. 1 5 Ô˘‰¤ÙÂÚË6 ¶. ∫. 6 5 Î¿Ì„Ë7 º. ¢. 6 5 Î¿Ì„Ë8* ª. ª. 12 5 Ô˘‰¤ÙÂÚË9 ¶. °. 10 7 Ô˘‰¤ÙÂÚË

10 µ. ª. 12 5 Î¿Ì„Ë11 ™. ™. 11 5 Î¿Ì„Ë12 §. Ã. 11 6 Ô˘‰¤ÙÂÚË13 ¡. °. 11 7 Ô˘‰¤ÙÂÚË14 ¶. ¢. 10 5 Î¿Ì„Ë15 µ. ™. 7 5 Î¿Ì„Ë16 ¶. °. 7 5 Ô˘‰¤ÙÂÚË17 ∞. Ã. 14 5 Ô˘‰¤ÙÂÚË

>15 ¤ÙË 18 ¡. Ã. 40 4 Ô˘‰¤ÙÂÚË19 ∫. ∞. 25 4 Ô˘‰¤ÙÂÚË20 ¶. ∞. 20 7 Ô˘‰¤ÙÂÚË21 ∫. Ã. 17 8 Ô˘‰¤ÙÂÚË22 π. ∞. 17 4 Ô˘‰¤ÙÂÚË23 ∞. ª. 16 4 Ô˘‰¤ÙÂÚË24 °. µ. 22 4 Ô˘‰¤ÙÂÚË

* ∞ÛıÂÓ‹˜ ÙË˜ ∂ÈÎfiÓ·˜ 6


·ıÏÔ·È‰È¤˜ Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î¿Ì„Ë

Î·È ¤ÎÙ·ÛË ÙË˜ ÎÂÊ·Ï‹˜ Î·È Â›Ó·È ÛÂ È·ÙÚÈÎ‹

·Ú·ÎÔÏÔ‡ıËÛË.

∆Ô 1984, Ë ∞∞¶ ‰ËÌÔÛ›Â˘ÛÂ ÁÈ· ÚÒÙË ÊÔ-

Ú¿ Â›ÛËÌ· ÙË ı¤ÛË ÙË˜ ÁÈ· ÙÔÓ ÚÔÏËÙÈÎfi

¤ÏÂÁ¯Ô Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ∞∞∞ ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ DS

(8,20). ∆fiÙÂ, ˘ÔÛÙ‹ÚÈ˙Â ÙËÓ ¿Ô„Ë Ô˘ ÂÈÛ‹-

Á·Á·Ó ÙÔ 1983 ÔÈ Special Olympics, fiÙÈ ‰ËÏ·‰‹

Ù· ¿ÙÔÌ· ÌÂ DS ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ

Ï¿ÁÈ· ·/· ÙÔ˘ ·˘¯¤Ó· ÚÈÓ ·fi ÙË Û˘ÌÌÂÙÔ¯‹

ÙÔ˘˜ ÛÙÔ ‰ÈÂıÓ¤˜ ·ÓÙ·ÁˆÓÈÛÙÈÎfi ÚfiÁÚ·ÌÌ·

ÙˆÓ Special Olympics (7). ∆· ¿ÙÔÌ· ÌÂ ·ÎÙÈÓÔ-

ÏÔÁÈÎ¿ ‰È·ÈÛÙˆÌ¤ÓË ∞∞∞ ·ÔÎÏÂ›ÔÓÙ·Ó ·fi

Î¿ÔÈÂ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜, ÔÈ ÔÔ›Â˜ ÌÔÚÂ› Ó·

Û˘Ó‰¤ÔÓÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Î¿ÎˆÛË˜ ÙË˜

∞ª™™. ¶ÚfiÛÊ·Ù· ·Ó·ıÂˆÚ‹ıËÎÂ ·˘Ù‹ Ë ¿Ô-

„Ë, ‰ÈfiÙÈ Ë ∂ÈÙÚÔ‹ ∞ıÏËÙÈ·ÙÚÈÎ‹˜ Î·È

Fitness ÙË˜ AA¶ ·Ó·ÛÎfiËÛÂ Ù· ÛÙÔÈ¯Â›·, ‚¿-

ÛÂÈ ÙˆÓ ÔÔ›ˆÓ ÂÈÎÚ¿ÙËÛÂ ·˘Ù‹ Ë ı¤ÛË Î·È

·ÌÊÈÛ‚ËÙ‹ıËÎÂ Ë ·Í›· ÙË˜ ·/· ˆ˜ screening test

ÁÈ· Èı·Ó‹ Î¿ÎˆÛË ÙÔ˘ ·˘¯¤Ó· ÙˆÓ ·ıÏËÙÒÓ

ÌÂ DS (21).

∆· ÛÙÔÈ¯Â›· ÛÙ· ÔÔ›· ÛÙËÚ›¯ıËÎÂ Ë ·ÌÊÈ-

Û‚‹ÙËÛË Î·È Ë ·Ó·ıÂÒÚËÛË ‹Ù·Ó ÔÈ ·Û·ÊÂ›˜

ÁÓÒÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ·ÛÙ¿-

ıÂÈ·˜ Î·È ÙÔ˘ Èı·ÓÔ‡ ÂÍ·ÚıÚ‹Ì·ÙÔ˜, ÁÈ· ÙÔ ·Ó

Ë ·ÎÙÈÓÔÏÔÁÈÎ¿ ÙÂÎÌËÚÈˆÌ¤ÓË ·Û˘ÌÙˆÌ·ÙÈÎ‹

∞∞∞ ˘ÔÎÚ‡ÙÂÈ Î›Ó‰˘ÓÔ ÁÈ· ÚfiÎÏËÛË Û˘-

ÌÙˆÌ·ÙÈÎ‹˜ ·ÛÙ¿ıÂÈ·˜ ‹ Î·È ·ÎfiÌË ÛÔ‚·ÚfiÙÂ-

ÚË˜ Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ·ÙÏ·ÓÙÔ·ÍÔÓÈÎÔ‡ ÂÍ·ÚıÚ‹-

Ì·ÙÔ˜ Ô˘ Ô‰ËÁÂ› ÛÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi ÙÔ˘ ÓˆÙÈ-

·›Ô˘ Ì˘ÂÏÔ‡ Î·È Î˘Ú›ˆ˜ Ù·, ·ÚÈıÌËÙÈÎ¿, ÂÍ·ÈÚÂ-

ÙÈÎ¿ Ï›Á· ¿ÙÔÌ· ÌÂ Û‡Ó‰ÚÔÌÔ Down Î·È Û˘-

ÌÙˆÌ·ÙÈÎ‹ ∞∞∞ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ÈÂıÓ‹

‚È‚ÏÈÔÁÚ·Ê›·. ŒÓ· ÂÈÏ¤ÔÓ ÛÙÔÈ¯Â›Ô Ô˘ ÚÔ-

Î·ÏÂ› ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË Û‡Á¯˘ÛË Â›Ó·È Ë ÊÙˆ-

¯‹ Â·Ó·ÏË„ÈÌfiÙËÙ· ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙË˜ ∞∞∞

ÛÙÈ˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ (21), Î·ıÒ˜ Ë ·ÎÙÈÓÔÏÔÁÈÎ‹

ÂÈÎfiÓ· ·ÏÏ¿˙ÂÈ ·fi ÒÚ· ÛÂ ÒÚ· ·fi ·ıÔÏÔÁÈ-

Î‹ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ‡·ÚÍË ÙË˜ ∞∞∞ ÌÔÚÂ›

Ó· ÂÍ·Ê·ÓÈÛÙÂ› ÛÂ ÂfiÌÂÓÂ˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ Ô˘

Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙÔÓ ›‰ÈÔ ¯ÂÈÚÈÛÙ‹ ÛÙÔ ›‰ÈÔ ¿ÙÔ-

ÌÔ. ¢Â‰ÔÌ¤ÓˆÓ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ÚÔ‚ÏËÌ·ÙÈ-

ÛÌÒÓ, Ë ∞∞¶ ·Ó·Î¿ÏÂÛÂ ÙËÓ ·Ú¯ÈÎ‹ ÙË˜ Ô‰ËÁ›·

ÁÈ· ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·ÙfiÌˆÓ ÌÂ

DS ÌÂ ·ÎÙÈÓÔÁÚ·Ê›Â˜ ÙË˜ ∞ª™™ ÚÈÓ ÙË Û˘ÌÌÂ-

ÙÔ¯‹ ÙÔ˘˜ ÛÙ· ·ıÏ‹Ì·Ù·, ÙËÓ ÔÔ›· ÚfiÙÂÈÓÂ ÙÔ

1984. ∞ÓÙ›ıÂÙ·, ÙÒÚ· ÚÔÙÂ›ÓÂÈ ÔÈ ÎÏÈÓÈÎÔ› ÁÈ·-

ÙÚÔ› Ó· Ï·Ì‚¿ÓÔ˘Ó ÚÔÛÂÎÙÈÎ¿ ·Ó¿ ¤ÙÔ˜ ÙÔ

ÈÛÙÔÚÈÎfi Î·È ÌÂ ÙË ÏÂÙÔÌÂÚ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË

∂ÈÎfiÓ· 7·, ‚. π·ÙÚÈÎ‹ ‚Â‚·›ˆÛË Ô˘ ··ÈÙÂ›Ù·È ·fi ÙÔ˘˜ Special Olympics ÁÈ· Ù· ¿ÙÔÌ· ÌÂ DS Î·È ∞∞∞.


¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364



Ó· ·ÔÎÏÂ›Ô˘Ó ‹ Ó· ÚÔÛÂÁÁ›˙Ô˘Ó ÛÙË ÓÂ˘ÚÔÏÔ-ÁÈÎ‹ ÛËÌÂÈÔÏÔÁ›· ÙË˜ ›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘Â-ÏÔ‡. ∂ÈÏ¤ÔÓ, Û˘ÛÙ‹ÓÂÈ ÔÈ ÎÏÈÓÈÎÔ› ÁÈ·ÙÚÔ› Ó·ÂÎ·È‰Â‡Ô˘Ó ÙÔ˘˜ ÁÔÓÂ›˜ ÙˆÓ ·ÙfiÌˆÓ ÌÂ DS Ó··Ó·ÁÓˆÚ›˙Ô˘Ó ¤ÁÎ·ÈÚ· Ù· Û˘ÌÙÒÌ·Ù· ›ÂÛË˜ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, fiˆ˜ ÙÔ ·ÓÒÌ·ÏÔ ‚¿‰È-ÛÌ·, Ë ·˘ÍËÌ¤ÓË ·‰ÂÍÈfiÙËÙ· Î·È ÔÈ ‰È·Ù·Ú·¯¤˜ÙˆÓ ÛÊÈÁÎÙ‹ÚˆÓ (21).

∆· ·Û˘ÌÙˆÌ·ÙÈÎ¿ ¿ÙÔÌ· ÌÂ DS ÛÙ· ÔÔ›·‰È·ÁÓÒÛÙËÎÂ ·ÎÙÈÓÔÏÔÁÈÎ¿ ∞∞∞, ı· Ú¤ÂÈ Ó··Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÓÂ˘ÚÔÏÔÁÈÎ¿. ∂ÎÂ›Ó· Ô˘ÂÌÊ·Ó›˙Ô˘Ó Í·ÊÓÈÎ¿ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÛËÌÂÈÔÏÔÁ›·‹ ÂÈ‰Â›ÓˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ı· Ú¤ÂÈ Ó·˘Ô‚¿ÏÏÔÓÙ·È ÛÂ CT ‹ MRI ∞ª™™, ÚÔÎÂÈÌ¤-ÓÔ˘ Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› Ë ¤ÎÙ·ÛË ÙË˜ ›ÂÛË˜ ÙÔ˘ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ∂¿Ó ·Ô‰ÂÈ¯ıÂ› ·ÂÈÎÔÓÈÛÙÈ-Î¿ ›ÂÛË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, Ú¤ÂÈ Ó· ·-Ú·ÂÌÊıÔ‡Ó ÛÂ ÓÂ˘ÚÔ¯ÂÈÚÔ˘ÚÁfi ‹ ÔÚıÔ·È‰È-Îfi Ô˘ ı· ÛÙ·ıÂÚÔÔÈ‹ÛÂÈ ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÙÔ ¿ÓˆÙÌ‹Ì· ÙË˜ ™™, ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÂ› Ô ÙÚ·˘Ì·-ÙÈÛÌfi˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ (2,3,8,23).

øÛÙfiÛÔ, Ë ∂ÈÙÚÔ‹ ÙˆÓ Special OlympicsÂÍ·ÎÔÏÔ˘ıÔ‡ÛÂ Ì¤¯ÚÈ ÚfiÛÊ·Ù· Ó· ıÂˆÚÂ› ÂÍ›-ÛÔ˘ ··Ú·›ÙËÙÔ ÌÂ ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ÙÔÓ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙË˜ ∞ª™™ fiÏˆÓ ÙˆÓ ·Ùfi-ÌˆÓ ÌÂ DS ÚÈÓ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙ· ·ıÏ‹-Ì·Ù·. ∂¿Ó ‰È·ÈÛÙˆıÂ› ∞∞∞ ‰ÂÓ ÂÈÙÚ¤ÂÈ Ó·Ï¿‚Ô˘Ó Ì¤ÚÔ˜ ÛÂ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ Ô˘ ÚÔÎ·-ÏÔ‡Ó ˘ÂÚ¤ÎÙ·ÛË ÙÔ˘ ·˘¯¤Ó·, fiˆ˜ Î·Ù¿‰˘ÛË,ÎÔÏ‡Ì‚ËÛË-ÂÙ·ÏÔ‡‰·, Î·Ù¿‰˘ÛË ÛÙËÓ ¤Ó·Ú-ÍË ÙË˜ ÎÔÏ‡Ì‚ËÛË˜, Á˘ÌÓ·ÛÙÈÎ‹, ¿ÏÌ·Ù· ÌÂÁ¿-ÏÔ˘ ‡„Ô˘˜, ¤ÓÙ·ıÏÔ, Ô‰fiÛÊ·ÈÚÔ Î·È ·ÛÎ‹-ÛÂÈ˜ ÚÔı¤ÚÌ·ÓÛË˜, Î·ıÒ˜ ÚÔÎ·ÏÔ‡Ó ›ÂÛËÙˆÓ Ì˘ÒÓ ÙË˜ ÎÂÊ·Ï‹˜ Î·È ÙÔ˘ ·˘¯¤Ó·. ¢‡Ô¤ÊË‚Â˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Ô˘ Û˘ÌÌÂÙÂ›-¯·Ó ÛÙÔ˘˜ Special Olympics ÙÔ˘ 2003, ÌÂÙ·Í‡ÙˆÓ ¿ÏÏˆÓ ÂÓÙ‡ˆÓ ÁÈ· Û˘ÌÏ‹ÚˆÛË ÁÈ· ÙÔÓÈ·ÙÚÈÎfi ÙÔ˘˜ ¤ÏÂÁ¯Ô, ÚÔÛÎfiÌÈÛ·Ó Î·È ÊfiÚÌ·

ÚÔ˜ Û˘ÌÏ‹ÚˆÛË Î·È ˘ÔÁÚ·Ê‹ ·fi ÙÔÓ È·-ÙÚfi, ÙÔ ›‰ÈÔ ÙÔ ¿ÙÔÌÔ ÌÂ DS Î·È ÙÔÓ ÁÔÓ¤· Û¯Â-ÙÈÎ¿ ÌÂ ÙËÓ ∞∞∞ (∂ÈÎfiÓÂ˜ 7·, ‚ Î·È 8).

∆· ÂÚÈÛÛfiÙÂÚ· ¿ÙÔÌ· ·˘Ù‹˜ ÙË˜ ¤ÚÂ˘Ó·˜ÌÂ ∞∞∞ Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎ¿. ¢fiıËÎ·Ó Ô‰Ë-Á›Â˜ ÛÙÔ˘˜ ÁÔÓÂ›˜ Ó· ÚÔˆıÔ‡Ó Ù· ·È‰È¿ ÙÔ˘˜ÛÙÔÓ ·ıÏËÙÈÛÌfi, ÛÂ ·ıÏ‹Ì·Ù· Ô˘ ‰ÂÓ ÂÚÈ-Ï·Ì‚¿ÓÔ˘Ó ˘ÂÚ¤ÎÙ·ÛË ÙÔ˘ ·˘¯¤Ó·, fiˆ˜ÚÔ·Ó·Ê¤ÚıËÎÂ, Î·ıÒ˜ Â›ÛË˜ Î·È ·ÔÊ˘Á‹ı¤ÛÂˆÓ ˘ÂÚ¤ÎÙ·ÛË˜ ÙË˜ ÎÂÊ·Ï‹˜ ÛÂ Î·ıËÌÂ-ÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ fiˆ˜ Ë ˘ÂÚ¤ÎÙ·ÛË ÙË˜ÎÂÊ·Ï‹˜ ÛÙÔÓ ÏÔ˘Ù‹Ú· ÙÔ˘ ÎÔÌÌˆÙËÚ›Ô˘, Ó·Í·ÏÒÓÔ˘Ó fiÙ·Ó ÚfiÎÂÈÙ·È Ó· ‚¿ÏÏÔ˘Ó ÛÙ·Áfi-ÓÂ˜ ÛÙ· Ì¿ÙÈ·, Ó· ˘¿Ú¯ÂÈ ÛÙÔ Î¿ıÈÛÌ· ÙÔ˘ ·˘-ÙÔÎÈÓ‹ÙÔ˘ ÙÔ˘˜ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÚÔÛÎ¤Ê·ÏÔÁÈ· Ó· ÚÔÛÙ·ÙÂ‡ÔÓÙ·È ·fi ·fiÙÔÌÔ ÊÚÂÓ¿ÚÈ-ÛÌ· Î.Ï.

∆· Â˘Ú‹Ì·Ù· ÙË˜ ¤ÚÂ˘Ó·˜ ÂÓÈÛ¯‡Ô˘Ó ÙÈ˜Ô‰ËÁ›Â˜ ÙË˜ ∞ıÏËÙÈ·ÙÚÈÎ‹˜ ∂ÈÙÚÔ‹˜ ÙË˜∞∞¶, ‰ËÏ·‰‹ ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ·È‰ÈÒÓ ÌÂ DSËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 3 ÂÙÒÓ ÌÂ ·/· ÙË˜ ∞ª™™ Î·Ù¿ÙËÓ ÚÒÙË Â›ÛÎÂ„‹ ÙÔ˘˜ ÛÙÔÓ ·È‰›·ÙÚÔ, Û˘-ÛÙ¿ÛÂÈ˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÛÙ· ·ıÏ‹Ì·Ù· Î·È ·/· ÙË˜∞ª™™ ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· ÚÈÓ ÙË Û˘ÌÌÂÙÔ-¯‹ ÙÔ˘˜ ÛÂ ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜. O ÎÏÈÓÈ-Îfi˜ ÁÈ·ÙÚfi˜, ÌÂ ÙÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi Î·È ÙËÓÚÔÛÂÎÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, Ú¤ÂÈ Ó· ·Ó·˙Ë-Ù¿ Û˘ÌÙÒÌ·Ù· Î·È ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛËÌÂ›· ÙË˜›ÂÛË˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ (Â‡ÎÔÏË ÎfiˆÛË,‰È·Ù·Ú·¯¤˜ ÛÙË ‚¿‰ÈÛË, fiÓÔ ‹ ÂÚÈÔÚÈÛÌfi ÙË˜ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ·˘¯¤Ó·, Ú·È‚fiÎÚ·ÓÔ, ·Û˘-Ó¤ÚÁÂÈ· Î·È ·‰ÂÍÈfiÙËÙ·, ·ÈÛıËÙÈÎ¤˜ ‰È·Ù·Ú·-¯¤˜, Û·ÛÙÈÎfiÙËÙ· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÎÈÓËÙÈÎÔ‡ÓÂ˘ÚÒÓ·, ÌÂÙ·‚ÔÏ¤˜ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÛÊÈÁÎÙ‹-ÚˆÓ ÙË˜ Î‡ÛÙË˜ Î·È ÙÔ˘ ÚˆÎÙÔ‡). ∏ ÛËÌÂÈÔ-ÏÔÁ›· Ô˘ ·ÔÎ·Ï‡ÙÂÙ·È ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤-Ù·ÛË ·ÔÙÂÏÂ› ÙÔ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ Â·Ó¿ÏË„ËÙË˜ ·/· ÙË˜ ∞ª™™ Î·È ÙÔ˘ ÂÚ·ÈÙ¤Úˆ ÂÏ¤Á¯Ô˘ÌÂ CT ‹ MRI ÙË˜ ∞ª™™.

∂˘¯·ÚÈÛÙ›Â˜

£ÂÚÌ¤˜ Â˘¯·ÚÈÛÙ›Â˜ ÛÙÈ˜ ÙÂ¯ÓÔÏfiÁÔ˘˜ ·ÎÙÈÓÔÏfi-ÁÔ˘˜ Î. ¢. ∆ÛÔ˘Î·Ï¿ Î·È ∞. §ÂÔÓÙ·Ú›‰Ô˘ ÁÈ· ÙË Û˘Ì‚Ô-Ï‹ ÙÔ˘˜ ÛÙÔ ÙÂ¯ÓÈÎfi Ì¤ÚÔ˜ ÙË˜ ¤ÚÂ˘Ó·˜ Î·È ÁÈ· ÙÔ ÊÈÏÈ-Îfi ÎÏ›Ì· Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Û·Ó ÛÙ· ¿ÙÔÌ· ÌÂ DS Î·ÈÛÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘˜.


1. Cremers MJ, Bol E, de Roos F, van Gijn J. Risk ofsports activities in children with Down’s syndrome

¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364

∂ÈÎfiÓ· 8. ŒÊË‚Ë ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Î·Ù¿ ÙË ‚Ú¿-‚Â˘Û‹ ÙË˜ ÛÙÔ˘˜ Special Olympics ÛÙËÓ πÚÏ·Ó‰›· ÙÔ2003.


and atlantoaxial instability. Lancet 1993;342:511-514. 2. Pueschel SM, Scola FH. Atlantoaxial instability in in-

dividuals with Down syndrome: epidemiologic, ra-diographic, and clinical studies. Pediatrics 1987;80:555-560.

3. American Academy of Pediatrics. Committee onSports Medicine and Fitness. Atlantoaxial instabilityin Down syndrome: subject review. Pediatrics1995;96:151-154.

4. Stein SM, Kirchner SG, Horev G, Hernanz-Schul-man M. Atlanto-Ôccipital subluxation in Down syn-drome. Pediatr Radiol 1991;21:121-124.

5. Pueschel SM, Scola FH, Pezzullo JC. A longitudinalstudy of atlanto-dens relationships in asymptomaticindividuals with Down syndrome. Pediatrics 1992;89:1194-1198.

6. Selby KA, Newton RW, Gupta S, Hunt L. Clinicalpredictors and radiological reliability in atlantoaxialsubluxation in Down’s syndrome. Arch Dis Child1991;66:876-878.

7. Davidson RG. Atlantoaxial instability in individualswith Down syndrome: a fresh look at the evidence.Pediatrics 1988;81:857-865.

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14. Papadopoulos SM, Dickman CA, Sonntag VK. At-lantoaxial stabilization in rheumatoid arthritis. JNeurosurg 1991;74:1-7.

15. Roche CJ, Eyes BE, Whitehouse GH. The rheuma-toid cervical spine: signs of instability on plain cervi-cal radiographs. Clin Radiol 2002;57:241-249.

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17. Neva MH, Isomaki P, Hannonen P, Kauppi M, Kr-ishnan E, Sokka T. Early and extensive erosiveness inperipheral joints predicts atlantoaxial subluxationsin patients with rheumatoid arthritis. ArthritisRheum 2003;48:1808-1813.

18. ™Ô˘ÊÙ¿˜ µ, Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ Ã, °ÚfiÏÈÔ˜°, ∆Û›ÎÔ˘Ï·˜ π, ªÂÏ›‰Ë˜ ¢, µÂÚÁÔÔ‡ÏÔ˘ ™ Î·È Û˘Ó.¶ÚÔÏËÙÈÎfi˜ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÂ ·È‰È¿ ÌÂÛ‡Ó‰ÚÔÌÔ Down. ¶·È‰È·ÙÚÈÎ‹ µÔÚÂ›Ô˘ ∂ÏÏ¿‰Ô˜1991;3:191-200.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:358-364


365ORIGINAL ARTICLE

Risks of sports activities in individuals with

Down syndrome and atlantoaxial instability

H. Hatzissevastou - Loukidou1, M. Badouraki2, P. Kambouridou1, E. Sotiridou1

Abstract

Background: The prevalence of atlantoaxial instability (AAI) among persons with Down syndrome(DS) ranges from 10% to 40% and is related to age and sex. The aim of this study was to investigateAAI in non-institutional people with DS in Northern Greece and to monitor them annually.

Methods: A total of 171 persons with DS, aged 0-40 years, were enrolled in the study. The patientswere examined clinically in relation to the presence or absence of discomfort in the neck area andspinal cord compression. Eighty one per cent of those aged 3 years and older were screenedradiographically at the cervical spine. A lateral neck X-ray was made in the neutral position, and inflexion when necessary. An atlantoaxial distance of greater than 4 mm for children under 15 years ofage and greater than 3 mm for people over 15 years is suggested as the cut off point for AAI. All theX-rays were examined by the same radiologist.

Results: The prevalence of AAI was high (42%) in the group of people with DS, and it was morefrequent in boys (56%) and in those under 15 years (63%). Local symptoms were reported by 9.3%.Investigation by computed tomography (CT) suggested that none of these had spinal cordcompression.

Conclusions: The results of this study support the guidelines of Committee on Sports of AmericanAcademy of Pediatrics (AAP) which recommend screening of children over 3 years old with DS bycervical spine radiography at the initial visit to the paediatrician, and provision of guidance to thefamilies about the participation of the children in sports (i.e., avoidance of extreme flexion oroverstretching of the neck) and cervical X-ray screening before they start participation in sportsactivities. The physician should take a careful history and perform a thorough physical examination,looking for evidence of neurological signs and symptoms of spinal cord compression (easyfatiguability, difficulties in walking, abnormal gait, neck pain, limited neck mobility, torticollis orhead tilt, incoordination and clumsiness, sensory deficits, spasticity, hyperreflexia, clonus, extensor-plantar reflex, other upper motor neuron signs and changes in bowel or bladder control). Anyfindings on the physical examination should be investigated by repetition of cervical spineradiography, and further screening by MRI.

Key words

Down syndrome, atlantoaxial instability, atlantoaxial subluxation, atlantoaxial dislocation, X-ray,magnetic resonance imaging (MRI).

1 1st Paediatric Clinic ofAristotle University,“Ippokration” GeneralHospital, Thessaloniki

2 Paediatric Department ofRadiology, “Ippokration”General Hospital,Thessaloniki

Correspondence:

H. Hatzissevastou-LoukidouLaboratory of Cytogenetics, 1st Paediatric Clinic of Aristotle University, “Ippokration” General Hospital, 49 Konstantinoupoleos Str., 546 42, Thessaloniki




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4 Institute of Cancer Research, Surrey, UK


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N. Rachman4, °. ÃÚÔ‡ÛÔ˜1

¶ÂÚ›ÏË„Ë

∏ ÓÂ·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË (juvenile hyaline fibromatosis) Â›Ó·È Û¿ÓÈÔ ÓfiÛËÌ·, Èı·ÓÒ˜ ÙÔ˘Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ·Ô‰›‰ÂÙ·È ÛÂ ÁÔÓ›‰ÈÔ Ô˘¯·ÚÙÔÁÚ·ÊÂ›Ù·È ÛÙÔ 4q21 ¯ÚˆÌfiÛˆÌ·. ™ÙËÓ Ù˘ÈÎ‹ ÙË˜ ÌÔÚÊ‹ ÂÌÊ·Ó›˙ÂÙ·È Ù· ÚÒÙ· ¯ÚfiÓÈ· ÙË˜˙ˆ‹˜ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÔÏÏ·Ï¿ ·ÓÒ‰˘Ó· ˘Ô‰fiÚÈ· Ô˙›‰È·, Ô˙Ò‰ÂÈ˜ Î·È ˘·ÏÈÓÒ‰ÂÈ˜ ‰ÂÚ-Ì·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ‰È·ÊfiÚÔ˘ ÌÂÁ¤ıÔ˘˜, ˘ÂÚÙÚÔÊ›· ÙˆÓ Ô‡ÏˆÓ, Û˘ÁÎ¿„ÂÈ˜ ÙˆÓ ·ÚıÚÒÛÂˆÓ Î·È ÔÛÙÂ-ÔÂÓ›·. ¢ÂÓ ˘¿Ú¯ÂÈ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÛÏ·Á¯ÓÈÎÒÓ ÔÚÁ¿ÓˆÓ Î·È Ë ÓÔËÙÈÎ‹ ÂÍ¤ÏÈÍË Â›Ó·È Ê˘ÛÈÔÏÔ-ÁÈÎ‹. ¢ÂÓ ˘¿Ú¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ‚ÈÔ¯ËÌÈÎ¿ Â˘Ú‹Ì·Ù· Î·È Ë ÎÏÈÓÈÎ‹ ‰È¿ÁÓˆÛË ÂÈ‚Â‚·ÈÒÓÂÙ·ÈÌÂ ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ‚Ï·‚ÒÓ. ¢ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·, ÂÓÒ Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂ-ÛË ÔÏÏÒÓ ÔÁÎÈ‰›ˆÓ Á›ÓÂÙ·È ÁÈ· ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ Î·È ·ÈÛıËÙÈÎÔ‡˜ ÏfiÁÔ˘˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›Ùˆ-ÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈÎ›·˜ 4 ÂÙÒÓ, ÌÈÎÚfiÛˆÌÔ˘, ÌÂ Û˘ÁÎ¿„ÂÈ˜ ÙˆÓ ÌÂÁ¿ÏˆÓ Î·È ÌÈÎÚÒÓ ·ÚıÚÒÛÂˆÓ, ÂÎ-ÛÂÛËÌ·ÛÌ¤ÓË ‰˘ÛÎ·Ì„›· ÎÔÚÌÔ‡, ˘ÂÚÙÚÔÊ›· Ô‡ÏˆÓ, ˘Ô‰fiÚÈ· Ô˙›‰È· Î·È Ô˙Ò‰ÂÈ˜-‚Ï·ÙÈ‰Ò‰ÂÈ˜‰ÂÚÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ È‰›ˆ˜ ÛÙËÓ ÎÂÊ·Ï‹ Î·È ÛÙ· ‰¿ÎÙ˘Ï· ÙˆÓ ¿ÎÚˆÓ ÌÂ Û˘ÓÔ‰fi ÎÈÓËÙÈÎ‹ ·Ó·ËÚ›·.∏ ¯ÔÚ‹ÁËÛË Botox (Botulin toxinum A) ‚ÂÏÙ›ˆÛÂ ·ÈÛıËÙ¿ ÙË ‰È¿ÓÔÈÍË ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ‰ÈÂ˘Îfi-Ï˘ÓÂ ÙË Ì¿ÛËÛË ÛÙË ÌÈÎÚ‹ ·ÛıÂÓ‹.


O˙›‰È·, ‚Ï·Ù›‰Â˜, ÈÓˆÌ¿ÙˆÛË.

∂ÈÛ·ÁˆÁ‹

∏ ÓÂ·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË Â›Ó·È ÎÏË-ÚÔÓÔÌÈÎfi ÓfiÛËÌ· Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi ¯·Ú·ÎÙ‹Ú· Î·È ÙÔ ÁÔ-Ó›‰ÈÔ Â‰Ú¿˙ÂÙ·È ÛÙÔ 4q21 ¯ÚˆÌfiÛˆÌ· (1). ™˘-Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È Ù· ÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜,ÌÂ ‰ÂÚÌ·ÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ Î˘Ú›ˆ˜ ÛÙÔ ÎÚ·Ó›Ô,ÛÙ· ÒÙ·, Á‡Úˆ ·fi ÙË Ì‡ÙË Î·È ÛÙ· ¿ÎÚ·. OÈ·ÏÏÔÈÒÛÂÈ˜ Â›Ó·È ‚Ï·ÙÈ‰Ò‰ÂÈ˜ ‹ Î·È Ô˙Ò‰ÂÈ˜, ÌÂÙ¿ÛË ·‡ÍËÛË˜ ÛÂ ·ÚÈıÌfi Î·È Ì¤ÁÂıÔ˜ ÌÂ ÙËÓ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ™˘¯Ó¿ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘Ú-ÁÈÎ‹ ·Ú¤Ì‚·ÛË ÁÈ· ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ Î·È ·ÈÛıË-ÙÈÎÔ‡˜ ÏfiÁÔ˘˜.

∏ ˘ÂÚÏ·Û›· ÙˆÓ Ô‡ÏˆÓ Ù˘ÈÎ¿ ·Ó·Ù‡Û-ÛÂÙ·È Û˘Á¯ÚfiÓˆ˜ ÌÂ ÙÈ˜ ‰ÂÚÌ·ÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜Î·È ÂÓ›ÔÙÂ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛËÂÚÈÔ‰ÔÓÙÈÎÔ‡ ÈÛÙÔ‡ ÁÈ· ‰ÈÂ˘ÎfiÏ˘ÓÛË ÙË˜ Û›ÙÈ-ÛË˜ Î·È ÙË˜ ÔÌÈÏ›·˜. OÈ Û˘ÁÎ¿Ì„ÂÈ˜ ÙˆÓ ·Ú-ıÚÒÛÂˆÓ ÂÈ‰ÂÈÓÒÓÔÓÙ·È ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘¯ÚfiÓÔ˘ Î·È ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ Î›ÓËÛË ÛÂ Ù¤ÙÔÈÔ‚·ıÌfi ÒÛÙÂ Ù· ·È‰È¿ ·˘Ù¿ Ó· Î·Ù·Ï‹ÁÔ˘Ó ÛÂ·Ó·ËÚÈÎfi ·Ì·Í›‰ÈÔ.

∏ ÔÛÙÂÔÂÓ›· Â›Ó·È Û˘¯Ó‹. ∏ ÓÔËÙÈÎ‹ Î·È

ÁÏˆÛÛÈÎ‹ ·Ó¿Ù˘ÍË Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ‰È¿-ÁÓˆÛË ÂÈ‚Â‚·ÈÒÓÂÙ·È ·fi ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ Ô˙È‰›ˆÓ, fiÔ˘·ÓÂ˘Ú›ÛÎÂÙ·È Û˘ÛÛÒÚÂ˘ÛË ÔÌÔÁÂÓÔ‡˜ ¿ÌÔÚ-ÊÔ˘ ÔÍÂfiÊÈÏÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ ˘·ÏÈÓÈÎÔ‡ ˘ÏÈ-ÎÔ‡. ∏ Ê‡ÛË Î·È Ë ÚÔ¤ÏÂ˘ÛË ÙÔ˘ ˘·ÏÈÓÈÎÔ‡˘ÏÈÎÔ‡ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›. º·›ÓÂ-Ù·È, ˆÛÙfiÛÔ, fiÙÈ Û˘ÌÌÂÙ¤¯Ô˘Ó Î˘Ú›ˆ˜ ÙÔ ÎÔÏ-Ï·ÁfiÓÔ, ÔÈ ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿ÓÂ˜ Î·È ÔÈ ÁÏ˘ÎÔ-ÚˆÙÂ˝ÓÂ˜ (2).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 4 ÂÙÒÓ ·Ú·¤ÌÂÙ·È ÁÈ·ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ÏfiÁˆ ·‰˘Ó·Ì›·˜ ÛÙ‹ÚÈ-ÍË˜ Î·È ‚¿‰ÈÛË˜.

∂›Ó·È ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ, ÌËÛ˘ÁÁÂÓÒÓ ÁÔÓ¤ˆÓ, ÂÏÏËÓÈÎ‹˜ ÂıÓÈÎfiÙËÙ·˜, Ô˘Î·Ù¿ÁÔÓÙ·È ·fi ÙË £Ú¿ÎË. °ÂÓÓ‹ıËÎÂ - ÌÂÙ¿·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÁÎ˘-ÌÔÛ‡ÓË - ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÏfiÁˆ ·ÓÒÌ·ÏË˜ı¤ÛË˜ Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3 kg. ∞Ó·Ê¤ÚÔÓÙ·ÈÙÚÂÈ˜ ÚÔËÁËıÂ›ÛÂ˜ ·˘ÙfiÌ·ÙÂ˜ ·Ô‚ÔÏ¤˜ ÙË˜


367¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË

ÌËÙ¤Ú·˜. ∞fi ÙË Á¤ÓÓËÛË ‰È·ÈÛÙÒıËÎÂ Û‡-

ÁÎ·Ì„Ë ÙˆÓ ÁÔÓ¿ÙˆÓ Î·È ÙˆÓ ·ÁÎÒÓˆÓ ÔfiÙÂ

Î·È ÂÙ¤ıË Ë ‰È¿ÁÓˆÛË ÙË˜ ·ÚıÚÔÁÚ‡ˆÛË˜. ∆Ô

·È‰› ˘Ô‚Ï‹ıËÎÂ ÛÂ Ê˘ÛÈÎÔıÂÚ·Â˘ÙÈÎ‹ ·Áˆ-

Á‹ ¯ˆÚ›˜ ‚ÂÏÙ›ˆÛË. ™Â ËÏÈÎ›· 12 ÌËÓÒÓ ¤ÁÈÓÂ

ÔÚıÔ·È‰ÈÎ‹ ·Ú¤Ì‚·ÛË Î·È ÛÙ· ‰‡Ô ÁfiÓ·Ù· ÌÂ

ı˘Ï·ÎÔÙÔÌ‹ Î·È ÙÂÓÔÓÙÔÙÔÌ‹ ÙˆÓ Ô›ÛıÈˆÓ ÌË-

ÚÈ·›ˆÓ ¯ˆÚ›˜ ‚ÂÏÙ›ˆÛË. ªÂÙ¿ ·fi 6 Ì‹ÓÂ˜ ÂÈ-

¯ÂÈÚ‹ıËÎÂ ÂÎ Ó¤Ô˘ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ‰ÈfiÚıˆÛË ÙˆÓ

Û˘ÁÎ¿Ì„ÂˆÓ, Â›ÛË˜ ¯ˆÚ›˜ ·ÔÙ¤ÏÂÛÌ·.

∫·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË, Ë ÌÈÎÚ‹ ·ÛıÂ-

Ó‹˜ ·ÚÔ˘Û›·˙Â Ê˘ÛÈÔÏÔÁÈÎ‹, ÓÔËÙÈÎ‹ Î·È

ÁÏˆÛÛÈÎ‹ ·Ó¿Ù˘ÍË ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· ÙË˜

(Peabody test), ·ÏÏ¿ ÎÈÓËÙÈÎ‹ ·Ó·ËÚ›· ÌÂ

·‰˘Ó·Ì›· ÛÙ‹ÚÈÍË˜ Î·È ‚¿‰ÈÛË˜. O ÎÔÚÌfi˜

‹Ù·Ó ¿Î·ÌÙÔ˜, Ë Î›ÓËÛË ÙË˜ ÎÂÊ·Ï‹˜ ÂÚÈÔ-

ÚÈÛÌ¤ÓË (∂ÈÎfiÓ· 1), ÙÔ ÚÔÛˆÂ›Ô ·Ó¤ÎÊÚ·-

ÛÙÔ, ÌÂ ÌÂÁ¿ÏË ˘ÂÚÙÚÔÊ›· ÙˆÓ Ô‡ÏˆÓ, ¤ÏÏÂÈ-

„Ë ÌÈÌËÙÈÎÒÓ ÎÈÓ‹ÛÂˆÓ Î·È ÔÏ‡ ÌÈÎÚfi Â‡ÚÔ˜

Î›ÓËÛË˜ ÙË˜ ÎÚÔÙ·ÊÔÁÓ·ıÈÎ‹˜ ¿ÚıÚˆÛË˜ (∂È-

ÎfiÓ· 2). ∞ÓÂ˘Ú›ÛÎÔÓÙ·Ó ÔÈ ÓÂÔÁÈÏÔ› Ô‰fiÓÙÂ˜.¶·Ú·ÙËÚ‹ıËÎÂ ÂÎÛÂÛËÌ·ÛÌ¤ÓË Û‡ÁÎ·Ì„ËÙˆÓ ÁÔÓ¿ÙˆÓ ÛÂ ÔÚı‹ ÁˆÓ›·, ÂÓÒ fiÏÂ˜ ÔÈ ·Ú-ıÚÒÛÂÈ˜ ‹Ù·Ó ‰‡ÛÎ·ÌÙÂ˜ Î·È ÂÒ‰˘ÓÂ˜ ÛÙËÓ·ıËÙÈÎ‹ Î›ÓËÛË (∂ÈÎfiÓ· 1). OÈ ·ÚıÚÒÛÂÈ˜ ÙˆÓ¿Óˆ ¿ÎÚˆÓ ‚Ú›ÛÎÔÓÙ·Ó, Â›ÛË˜, ÛÂ Î¿Ì„Ë Î·È¤Ûˆ ÛÙÚÔÊ‹.

™ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÙÚÈ¯ˆÙÔ‡ ÙË˜ ÎÂÊ·Ï‹˜-ÒÙˆÓ-Ì‡ÙË˜, ÛÙ· ‰¿ÎÙ˘Ï· ¯ÂÈÚÒÓ Î·È Ô‰ÒÓÎ·È ÛÙËÓ ÂÚÈÚˆÎÙÈÎ‹ ¯ÒÚ· ˘‹Ú¯·Ó ÔÏÏ·-Ï¿ Ô˙›‰È· Î·È ‚Ï·Ù›‰Â˜ ‰È·ÊfiÚÔ˘ ÌÂÁ¤ıÔ˘˜(¤ˆ˜ Î·È 10 cm), ·ÓÒ‰˘Ó· Î·È Ì·Ï·Î‹˜ ˘Ê‹˜(∂ÈÎfiÓ· 3). ∞˘Ù¤˜ ÔÈ ·ÏÏÔÈÒÛÂÈ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜,Î·ıÒ˜ Î·È Ù· ˘Ô‰fiÚÈ· Ô˙›‰È· Ô˘ ‹Ù·Ó „ËÏ·-ÊËÙ¿ ÛÂ fiÏÔ ÙÔ ÛÒÌ· ÂÌÊ·Ó›ÛÙËÎ·Ó ·fi ÙËÓËÏÈÎ›· ÙˆÓ 3 ÂÙÒÓ, ÌÂ Ù¿ÛË ·‡ÍËÛË˜ ÛÙÔÓ ·ÚÈı-Ìfi Î·È ÛÙÔ Ì¤ÁÂıÔ˜. ∆Ô ‰¤ÚÌ· Â›¯Â ¯¿ÛÂÈ ÙËÛ·ÚÁ‹ ÙÔ˘. ◊Ù·Ó ·ÓÙÈÎÂÈÌÂÓÈÎ¿ ‰‡ÛÎÔÏÔ Ó·ÂÏÂÁ¯ıÂ› Ë Ì˘˚Î‹ ÈÛ¯‡˜, fiˆ˜ Î·È Ù· ÙÂÓfiÓÙÈ··ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ ÙÔ˘ ·È‰ÈÔ‡.

∞fi ÙÔÓ Ï‹ÚË ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfiÎ·È ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ÚÔ¤-Î˘„·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ¢ÂÓ ˘‹Ú¯·Ó·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙÔÓ Î·Ú‰ÈÔÏÔÁÈÎfi¤ÏÂÁ¯Ô, ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜, ÛÙËÓ·ÍÔÓÈÎ‹ Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘,ÛÙÔÓ ÔÊı·ÏÌÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È ÛÙËÓ Ù·¯‡ÙË-Ù· ·ÁˆÁ‹˜ ÓÂ‡ÚˆÓ. O Î·Ú˘fiÙ˘Ô˜ ‹Ù·Ó Ê˘ÛÈÔ-ÏÔÁÈÎfi˜ ı‹ÏÂÔ˜ (46ÃÃ).

¶·È‰È·ÙÚÈÎ‹ 2005;68:366-370

∂ÈÎfiÓ· 1. ¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË ÛÂ ÎÔÚ›ÙÛÈ ËÏÈ-Î›·˜ 4 ÂÙÒÓ: ·ÂÈÎÔÓ›˙ÂÙ·È Ô ¿Î·ÌÙÔ˜ ÎÔÚÌfi˜, ÔÈ Û˘-ÁÎ¿Ì„ÂÈ˜ ÛÂ ÔÚı‹ ÁˆÓ›· Î·È Ë Û˘Ó·ÎfiÏÔ˘ıË ·Ú·ÌfiÚ-ÊˆÛË ÙˆÓ ¿ÎÚˆÓ. OÈ ·ÚıÚÒÛÂÈ˜ ÙˆÓ ¿Óˆ ¿ÎÚˆÓ ‚Ú›-ÛÎÔÓÙ·È ÛÂ Î¿Ì„Ë Î·È ¤Ûˆ ÛÙÚÔÊ‹.

∂ÈÎfiÓ· 2. ¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË: Ê·›ÓÂÙ·È ÙÔ·Ó¤ÎÊÚ·ÛÙÔ ÚÔÛˆÂ›Ô, Ë ÌÂÁ¿ÏË ˘ÂÚÙÚÔÊ›· ÙˆÓ Ô‡-ÏˆÓ, ÔÈ ÂÚÈÛÙÔÌ·ÙÈÎ¤˜ ‚Ï·Ù›‰Â˜ Î·È ÙÔ Ô˙›‰ÈÔ ÛÙÔ·ÎÚÔÚÚ›ÓÈÔ.


368 O. ¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

™ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ÔÛÙÒÓ ‰È·-

ÈÛÙÒıËÎÂ ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÔÛÙÂÔÂÓ›· (∂ÈÎfi-

Ó· 4). ™ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË ÙˆÓ ‚ÏÂÓÓÔÔÏ˘-

Û·Î¯·ÚÈÙÒÓ Ô‡ÚˆÓ ‚Ú¤ıËÎÂ ÔÚÈ·Î‹ ·‡ÍËÛË

ÙË˜ ·¤ÎÎÚÈÛË˜ ÙË˜ ıÂÈÈÎ‹˜ ¯ÔÓ‰ÚÔ˚Ù›ÓË˜. ™ÙË

‚ÈÔ„›· ÙˆÓ Ô˙È‰›ˆÓ ‚Ú¤ıËÎÂ ÂÓ·fiıÂÛË ÎÔÏ-

Ï·ÁÔÓÔÔÈËÌ¤ÓÔ˘ ÈÓÒ‰Ô˘˜ ¿ÌÔÚÊÔ˘ ÔÍÂfiÊÈ-

ÏÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ ˘·ÏÈÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂ ÂÚÈÔ-

¯¤˜ ·˘ÍËÌ¤ÓË˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜. ¢ÂÓ ·Ú·ÙË-

Ú‹ıËÎÂ ÌÈÙˆÙÈÎ‹ ‹ ¿ÏÏË ·ÓÒÌ·ÏË ‰Ú·ÛÙËÚÈfi-

ÙËÙ· ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ˘Ú‹ÓˆÓ. OÈ ‚Ï¿‚Â˜

(Ô˙›‰È·) ‹Ù·Ó ˘Ô‰fiÚÈÂ˜ ÌÂ Â¤ÎÙ·ÛË ˆ˜ ÙËÓ

ÂÚÈÙÔÓ›·. ∏ ÓÂ˘ÚÔÁÂÓ‹˜ ÚÔ¤ÏÂ˘ÛË ÙÔ˘

ÈÛÙÔ‡ ·ÔÎÏÂ›ÛÙËÎÂ ÌÂ ÙË ‚Ô‹ıÂÈ· ·ÓÔÛÔ˚ÛÙÔ-

¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ Ô˘ ‚Ú¤ıËÎ·Ó ·ÚÓËÙÈÎÔ›

(S100, CD56, CD34). ∆· Â˘Ú‹Ì·Ù· ‹Ù·Ó Û˘Ì-

‚·Ù¿ ÌÂ Ù˘ÈÎ‹ ÂÈÎfiÓ· ˘·ÏÈÓÈÎ‹˜ ÈÓˆÌ¿ÙˆÛË˜

(∂ÈÎfiÓ· 5). °ÔÓÈ‰È·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓÂ ÛÙÔ

Institute of Cancer Research, Surrey, UK (Pr Dr

Nazneen Rachman), ·Ó·ÁÓÒÚÈÛÂ ÛÙËÓ ÔÈÎÔÁ¤-

ÓÂÈ· ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ÌÂÙ¿ÏÏ·ÍËÛÙËÓ CMG-2 ÚˆÙÂ˝ÓË. ∆Ô ·È‰› Â›Ó·È ÔÌfi˙˘-ÁÔ ÁÈ· Ì›· ÌÂÙ¿ÏÏ·ÍË Ì·Ù›ÛÌ·ÙÔ˜ (Splice-sitemutation IVS13+1 G>A), ÂÓÒ ÔÈ ÁÔÓÂ›˜ Â›Ó·ÈÂÙÂÚÔ˙˘ÁÒÙÂ˜.

™˘˙‹ÙËÛË

∞˘Ùfi ÙÔ Û‡Ó‰ÚÔÌÔ ÂÚÈÁÚ¿ÊËÎÂ ÚÒÙË ÊÔ-Ú¿ ·fi ÙÔÓ Murran, ÙÔ 1873, ˆ˜ molluscumfibrosum. ∏ ÓfiÛÔ˜ ÔÓÔÌ¿ÛÙËÎÂ ·Ú¯ÈÎ¿ “Û‡Ó-‰ÚÔÌÔ Murran” Î·È ÙÔ 1962 “Puretic syndrome”·fi ÙÔ fiÓÔÌ· ÂÎÂ›ÓÔ˘ Ô˘ ÙÔ ÂÚÈ¤ÁÚ·„Â ‰Â‡-ÙÂÚÔ˜. ∞fi ÙÔ˘˜ Kitano Î·È Û˘Ó, ÙÔ 1972, Î·-ıÈÂÚÒıËÎÂ Ô fiÚÔ˜ ÙË˜ ÓÂ·ÓÈÎ‹˜ ˘·ÏÈÓÈÎ‹˜ ÈÓˆ-Ì¿ÙˆÛË˜ (3). ∏ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÙË˜ ÓfiÛÔ˘Ê·›ÓÂÙ·È Ó· ·ÎÔÏÔ˘ıÂ› ·˘ÙÔÛˆÌ·ÙÈÎfi ˘ÔÏÂÈ-fiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi Ù··ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ· ÚÔÛ‚¿ÏÏÔÓÙ·È ÂÍ›ÛÔ˘.∆Ô 1/3 ÙˆÓ ÚÔÛ‚Â‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Â›Ó·È ‰›-‰˘Ì· (4) Î·È ÛÂ ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂÈ˜ ÔÈ ÁÔÓÂ›˜Â›Ó·È Û˘ÁÁÂÓÂ›˜. ¢ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ‰È·ÊÔÚ¤˜ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ·Ó¿ÏÔÁ· ÌÂ ÙË Ê˘-Ï‹, ÂÓÒ ˘¿Ú¯Ô˘Ó Ï›ÁÂ˜ ÌfiÓÔ ·Ó·ÊÔÚ¤˜ ÛÙË‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (5). ∞˘Ù‹ Â›Ó·È Ë ÚÒÙËÂÚÈÁÚ·Ê‹ ÌÂ ÁÔÓÈ‰È·Î‹ ÂÈ‚Â‚·›ˆÛË ÛÙËÓ∂ÏÏ¿‰·. ∆· ÚÒÙ· Û˘ÌÙÒÌ·Ù· ÛÙËÓ Ù˘ÈÎ‹ÌÔÚÊ‹ ÙË˜ ÓfiÛÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙ·ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, ÌÂÙ·Í‡ 3Ô˘ Ì‹Ó· Î·È 4Ô˘¤ÙÔ˘˜. ∆· Ù˘ÈÎ¿ ·ÓÙÈÎÂÈÌÂÓÈÎ¿ Â˘Ú‹Ì·Ù· Â-ÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ï·ÙÈ‰Ò‰ÂÈ˜ Î·È Ô˙Ò‰ÂÈ˜ ‰ÂÚÌ·-ÙÈÎ¤˜ ‚Ï¿‚Â˜, Î˘Ú›ˆ˜ ÛÙËÓ ÎÂÊ·Ï‹ Î·È Ù·

¶·È‰È·ÙÚÈÎ‹ 2005;68:366-370

∂ÈÎfiÓ· 3. ¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË: ÔÏÏ·Ï¿ Ô˙›-‰È· ‰È·ÊfiÚˆÓ ÌÂÁÂıÒÓ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚˆÓ, ¯·Ú·ÎÙË-ÚÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ÙË˜ ÓfiÛÔ˘.

∂ÈÎfiÓ· 4. ¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË: ÛÙÔÓ ·ÎÙÈÓÔ-ÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ÔÛÙÒÓ ·ÓÂ˘Ú›ÛÎÂÙ·È ÂÎÛÂÛËÌ·ÛÌ¤-ÓË ÔÛÙÂÔÂÓ›·.


369¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË

¿ÎÚ·, ÛÙ· ‰¿ÎÙ˘Ï· Î·È ÛÙËÓ ÂÚÈÓÂ˚Î‹ ÂÚÈÔ-¯‹, ˘ÂÚÙÚÔÊ›· ÙˆÓ Ô‡ÏˆÓ, Û˘ÁÎ¿Ì„ÂÈ˜, ·Ú¯È-Î¿ Î˘Ú›ˆ˜ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÚıÚÒÛÂˆÓ Î·È ÂÎÛÂ-ÛËÌ·ÛÌ¤ÓË ÔÛÙÂÔÂÓ›·. ∞‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˙È‰›ˆÓ ÌÂ ÙËÓ ¿ÚÔ‰ÔÙË˜ ËÏÈÎ›·˜ Ô‰ËÁÂ› Û˘¯Ó¿ ÛÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›-ÚÂÛË ÁÈ· ·ÈÛıËÙÈÎÔ‡˜ Î·È ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ Ïfi-ÁÔ˘˜. ∏ ÚÔÔ‰Â˘ÙÈÎ‹ ‰˘ÛÎ·Ì„›· Ô‰ËÁÂ› ÛÂ·‰˘Ó·Ì›· ‚¿‰ÈÛË˜-ÛÙ‹ÚÈÍË˜ Î·È Î·ı‹ÏˆÛË ÛÂ·Ó·ËÚÈÎfi ·Ì·Í›‰ÈÔ. ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ Û˘ÁÎ¿Ì-„ÂˆÓ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›. ∞Ô‰›‰Â-Ù·È Èı·Ó¿ ÛÂ ‰È‹ıËÛË ÙˆÓ ı˘Ï¿ÎˆÓ ·fi Ô˙›-‰È·. ∏ ÓÔËÙÈÎ‹ ·Ó¿Ù˘ÍË Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹,ÂÓÒ ‰ÂÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÏ·Á¯ÓÈÎ¿ fiÚÁ·Ó·. ∏·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘-ÎÚÈÓÈÛÙÂ› Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎ¿‚ÈÔ¯ËÌÈÎ¿ Â˘Ú‹Ì·Ù·. £ÂˆÚÂ›Ù·È ˆ˜ ‰È·Ù·Ú·¯‹ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘, ÁÈ·Ù› ÛÂÎ¿ÔÈÔ˘˜ ·ÛıÂÓÂ›˜ ¤¯Ô˘Ó ‰È·ÈÛÙˆıÂ› ·ıÔÏÔ-ÁÈÎ¿ Â˘Ú‹Ì·Ù· ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ III (6) Î·È ÙÔ˘ÎÔÏÏ·ÁfiÓÔ˘ VI (7). ∂ÓÙÔ‡ÙÔÈ˜, ·˘Ù¤˜ ÔÈ ‰È·Ù·-Ú·¯¤˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÛÙ·ıÂÚfi Â‡ÚËÌ·, ·ÊÔ‡¤¯Ô˘Ó ‚ÚÂıÂ› Î·È ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó Ê˘ÛÈÔ-ÏÔÁÈÎfi ÎÔÏÏ·ÁfiÓÔ. ÕÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜ ˘ÔÛÙËÚ›-˙Ô˘Ó fiÙÈ ÔÈ ÌË Ê˘ÛÈÔÏÔÁÈÎ¤˜ ›ÓÂ˜ ÎÔÏÏ·ÁfiÓÔ˘ÔÊÂ›ÏÔÓÙ·È ÛÂ ˘ÔÎÂ›ÌÂÓË ‰È·Ù·Ú·¯‹ ÛÙË ‚ÈÔ-Û‡ÓıÂÛË ÙˆÓ ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î·ÓÒÓ (8). ∞Îfi-ÌË, ÂÈÛËÌ·›ÓÔÓÙ·È ·ÓˆÌ·Ï›Â˜ ÛÙË ‚ÈÔÛ‡ÓıÂÛËÙË˜ ıÂÈÈÎ‹˜ ¯ÔÓ‰ÚÔ˚Ù›ÓË˜ Î·È/‹ ÙÔ˘ ˘·ÏÔ˘ÚÔÓÈ-ÎÔ‡ ÔÍ¤Ô˜, ÔÈ ÔÔ›Â˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÛÙ·ıÂÚfiÂ‡ÚËÌ· ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ (3,9,10). ∆¤-ÏÔ˜, Èı·ÓfiÙÂÚË ıÂˆÚÂ›Ù·È Ë ˘fiıÂÛË ÙË˜CMG-2 ÚˆÙÂ˝ÓË˜. ∏ ÚˆÙÂ˝ÓË ·˘Ù‹, ·Ó Î·È ÔÊ˘ÛÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙË˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘-ÎÚÈÓÈÛÙÂ› (11), Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ

ÙÚÈ¯ÔÂÈ‰ÈÎ‹ ÌÔÚÊÔÁ¤ÓÂÛË, ÛÙËÓ ÔÌÔÈÔÛÙ·Û›·

ÙË˜ ‰ÔÌ‹˜ Î·È ·Ú¯ÈÙÂÎÙÔÓÈÎ‹˜ ÙË˜ ‚·ÛÈÎ‹˜

ÌÂÌ‚Ú¿ÓË˜, ÛÙË Û‡Ó‰ÂÛË ÙË˜ Ï·ÌÈÓ›ÓË˜ ÌÂ ÙÔ

ÎÔÏÏ·ÁfiÓÔ IV, ÛÙË ‰Ú¿ÛË ÙÔ˘ von Willebrant A

·Ú¿ÁÔÓÙÔ˜ (vWA), ·ÏÏ¿ Î·È ˆ˜ Î˘ÙÙ·ÚÈÎfi˜

˘Ô‰Ô¯¤·˜ ÙË˜ ·ÓıÚ·ÎÈÎ‹˜ ÙÔÍ›ÓË˜ (11,12).

ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙÂ› 8 ÌÂÙ·Ï-

Ï¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙË Û˘ÁÎÂ-

ÎÚÈÌ¤ÓË ÚˆÙÂ˝ÓË Î·È Â‰Ú¿˙ÂÙ·È ÛÙÔ 4q21 ¯Úˆ-

ÌfiÛˆÌ·, ÌÂ ÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ÓÂ·ÓÈÎ‹˜ ˘·ÏÈ-

ÓÈÎ‹˜ ÈÓˆÌ¿ÙˆÛË˜.

∞Ó¿ÏÔÁË ÌÂÙ¿ÏÏ·ÍË ÌÂ ÙËÓ ·ÛıÂÓ‹ ÙË˜ ·-

ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ¤¯ÂÈ ‚ÚÂıÂ› ÛÂ ÙÚÂÈ˜ ·ÎfiÌË

·ÛıÂÓÂ›˜ ÌÂ ÓÂ·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË (2

ÛÙËÓ ∆Ô˘ÚÎ›· Î·È 1 ÛÙËÓ ∂˘ÚÒË) (12).

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È

·fi: ·) Û˘ÁÁÂÓ‹ ·ÚıÚÔÁÚ‡ˆÛË (‰ÂÓ ¤¯ÂÈ ‰ÂÚ-

Ì·ÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜), ‚) Û‡Ó‰ÚÔÌÔ Winchester

(ÌÈÎÚÔÛˆÌ›·, Û˘ÁÎ¿Ì„ÂÈ˜ ·fi ÙË Á¤ÓÓËÛË, ¯ˆ-

Ú›˜ ‰ÂÚÌ·ÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜, ÂÓÒ ˘Ê›ÛÙ·Ù·È ıfi-

ÏˆÛË ÙÔ˘ ÎÂÚ·ÙÔÂÈ‰Ô‡˜), Á) ÓfiÛÔ Fabry (ÛÊÈÁ-

ÁÔÏÈ›‰ˆÛË, Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ· ¯ˆÚ›˜ Û˘-

ÁÎ¿Ì„ÂÈ˜, ÌÂ ·ÁÁÂÈÔÎÂÚ·ÙÒÌ·Ù·, ÓÂ˘ÚÔ¿ıÂÈ·

Î·È ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÎÂÚ·ÌÈ‰¿ÛË) Î·È ‰)

‚ÚÂÊÈÎ‹ Û˘ÛÙËÌ·ÙÈÎ‹ ˘·Ï›ÓˆÛË - infantile

systematic hyalinosis (ÚfiÎÂÈÙ·È Èı·ÓÒ˜ ÁÈ· ÙÔ

›‰ÈÔ ÓfiÛËÌ·, ·ÏÏ¿ ÌÂ ‚·Ú‡Ù·ÙË ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·

·fi ÙË Á¤ÓÓËÛË, ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÛÏ·Á¯ÓÈ-

ÎÒÓ ÔÚÁ¿ÓˆÓ Î·È ÙË˜ Î·Ú‰È¿˜, ÌÂ ·ÓÔÛÔÏÔÁÈÎfi

¤ÏÏÂÈÌÌ· Î·È Â·ÎfiÏÔ˘ıÂ˜ ÏÔÈÌÒÍÂÈ˜ Î·È ı¿-

Ó·ÙÔ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜).

¢ÂÓ ˘¿Ú¯ÂÈ ·ÈÙÈÔÏÔÁÈÎ‹ ıÂÚ·Â›·. ™˘ÓÙË-

ÚËÙÈÎ¿ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ› Ú·‰ÈÔıÂÚ·Â›·, ¯Ë-

ÌÂÈÔıÂÚ·Â›·, ÚˆÙÂÔÏ˘ÙÈÎ¿ ¤Ó˙˘Ì· Î·È ÙÔÈ-

Î¤˜ ÂÁ¯‡ÛÂÈ˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ, ¯ˆÚ›˜ ·ÔÙ¤-

ÏÂÛÌ·. OÈ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ ‰›ÓÔ˘Ó

ÚÔÛˆÚÈÓ¤˜ Ï‡ÛÂÈ˜ ÛÂ ·ÈÛıËÙÈÎ¿ Î·È ÏÂÈÙÔ˘ÚÁÈ-

Î¿ ÚÔ‚Ï‹Ì·Ù·. ∏ ÚfiÁÓˆÛË Â›Ó·È È‰È·ÈÙ¤Úˆ˜

ÂÈÊ˘Ï·ÎÙÈÎ‹ ¤ˆ˜ ÂÈ‚·Ú˘Ì¤ÓË.

™ÙËÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ Ë

¯ÔÚ‹ÁËÛË Botulin toxinum A ÛÙËÓ ÎÚÔÙ·ÊÔ-

ÁÓ·ıÈÎ‹ ÂÚÈÔ¯‹ Î·È ÂÚÈÛÙÔÌ·ÙÈÎ¿ ‚ÂÏÙ›ˆÛÂ

·ÈÛıËÙ¿ ÙË ‰È¿ÓÔÈÍË ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ‰ÈÂ˘Îfi-

Ï˘ÓÂ ÙË Ì¿ÛËÛË. ∆Ô Û‡ÌÏÔÎÔ ÙË˜ ÓÂ˘ÚÔÙÔÍ›-

ÓË˜ Clostridium botulinum Ù‡Ô˘ ∞, ˆ˜ ÁÓˆ-

ÛÙfiÓ ·ÔÎÏÂ›ÂÈ ÙËÓ ÂÚÈÊÂÚÈÎ‹ ·ÂÏÂ˘ı¤ÚˆÛË

ÙË˜ ·ÎÂÙ˘ÏÔ¯ÔÏ›ÓË˜ ÛÙÈ˜ ÚÔÛ˘Ó·ÙÈÎ¤˜ ÓÂ˘-

ÚÈÎ¤˜ ·ÔÏ‹ÍÂÈ˜ Ì¤Ûˆ ÙË˜ ·Ô‰fiÌËÛË˜ ÙË˜

SNAP-25 ÚˆÙÂ˝ÓË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙÔÈÎ‹,

·ÚÔ‰ÈÎ‹ Î·È Ì˘Ô¯·Ï·ÚˆÙÈÎ‹ Â˘ÂÚÁÂÙÈÎ‹ ‰Ú¿-

ÛË ÁÈ· ÙËÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜.

ªÂÙ¿ ÙË ÁÓÒÛË ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜, Ë ‰˘Ó·Ùfi-

ÙËÙ· ÚÔÁÂÓÓËÙÈÎÔ‡ ¤ÏÂÁ¯Ô˘ ÛÂ ÂÓ‰Â¯fiÌÂÓË

¶·È‰È·ÙÚÈÎ‹ 2005;68:366-370

∂ÈÎfiÓ· 5. ¡Â·ÓÈÎ‹ ˘·ÏÈÓÈÎ‹ ÈÓˆÌ¿ÙˆÛË: ÛÙË ‚ÈÔ„›·Ô˙È‰›ˆÓ ·ÓÂ˘Ú›ÛÎÂÙ·È ÂÓ·fiıÂÛË ÎÔÏÏ·ÁÔÓÔÔÈËÌ¤ÓÔ˘ÈÓÒ‰Ô˘˜ ¿ÌÔÚÊÔ˘ ÔÍÂfiÊÈÏÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ ˘·ÏÈÓÈÎÔ‡ÈÛÙÔ‡ ÌÂ ÂÚÈÔ¯¤˜ ·˘ÍËÌ¤ÓË˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜. ¢ÂÓ·Ú·ÙËÚÂ›Ù·È ÌÈÙˆÙÈÎ‹ ‹ ¿ÏÏË ·ÓÒÌ·ÏË ‰Ú·ÛÙËÚÈfiÙË-Ù· ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ˘Ú‹ÓˆÓ.


370 O. ¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

ÌÂÏÏÔÓÙÈÎ‹ ÂÁÎ˘ÌÔÛ‡ÓË, ·ÔÙÂÏÂ› ÚÔ¸fiıÂ-ÛË ÁÈ· ÙËÓ ·fiÎÙËÛË ÂÓfi˜ ˘ÁÈÔ‡˜ ·È‰ÈÔ‡.


1. Rahman N, Dunstan M, Teare MD, Hanks S, EdkinsSJ, Hughes J et al. The gene for juvenile hyaline fi-bromatosis maps to chromosome 4q21. Am J HumGenet 2002;71:975-980.

2. Ishikawa H, Maeda H, Takamatsu H, Saito Y. Sys-temic hyalinosis (juvenile hyaline fibromatosis). Ul-trastructure of the hyaline with particular referenceto the cross-banded structure. Arch Dermatol Res1979;265:195-206.

3. Kitano Y, Horiki M, Aoki T, Sagami S. Two cases ofjuvenile hyalin fibromatosis. Some histological, elec-tron microscopic, and tissue culture observations.Arch Dermatol 1972;106:877-883.

4. Keser G, Karabulut B, Oksel F, Calli C, Ustun EE,Akalin T et al. Two siblings with juvenile hyaline fi-bromatosis: case reports and review of the literature.Clin Rheumatol 1999;18:248-252.

5. Allen PW. Selected case from the Arkadi M. RywlinInternational Pathology Slide Seminar: hyaline fi-bromatosis. Adv Anat Pathol 2001;8:173-178.

6. Lubec B, Steinert I, Breier F, Jurecka W, Pillwein K,Fang-Kircher S. Skin collagen defects in a patientwith juvenile hyaline fibromatosis. Arch Dis Child1995;73:246-248.

7. Kayashima K, Katagiri K, Shinkai H, Ono T. Is juve-nile hyaline fibromatosis a disease of type VI col-lagenosis? In: Ishibashi Y, Nakagawa H, Suzuki H,editors. Electron microscopy in dermatology: basicand clinical research. Amsterdam: Excerpta Medica;1994. p. 329-334.

8. Remberger K, Krieg T, Kunze D, Weinmann HM,Hubner G. Fibromatosis hyalinica multiplex (juve-nile hyalin fibromatosis). Light microscopic, elec-tron microscopic, immunohistochemical, and bio-chemical findings. Cancer 1985;56:614-624.

9. Iwata S, Horiuchi R, Maeda H, Ishikawa H. Systemichyalinosis or juvenile hyaline fibromatosis. Ul-trastructural and biochemical study of cultured skinfibroblasts. Arch Dermatol Res 1980;267:115-121.

10. Breier F, Fang-Kircher S, Wolff K, Jurecka W. Juve-nile hyaline fibromatosis: impaired collagen metab-olism in human skin fibroblasts. Arch Dis Child1997;77:436-440.

11. Dowling O, Difeo A, Ramirez MC, Tukel T, Narla G,Bonafe L et al. Mutations in capillary morphogene-sis gene-2 result in the allelic disorders juvenile hya-line fibromatosis and infantile systemic hyalinosis.Am J Hum Genet 2003;73:957-966.

12. Hanks S, Adams S, Douglas J, Arbour L, AthertonDJ, Balci S et al. Mutations in the gene encodingcapillary morphogenesis protein 2 cause juvenilehyaline fibromatosis and infantile systemic hyali-nosis. Am J Hum Genet 2003;73:791-800.

¶·È‰È·ÙÚÈÎ‹ 2005;68:366-370


371CASE REPORT

Juvenile hyaline fibromatosis.

The first case report in Greece

O. Papandreou1, A. Klimentopoulou1, N. Poniros2, A. Konstantinidou3, A. Xypolita - Zachariadi1,

N. Rachman4, G. Chroussos1

Abstract

Juvenile hyaline fibromatosis is a rare connective tissue disease with autosomal recessive inheritance.The gene is located on the 4q21 chromosome. It usually presents during the first years of life withmultiple painless subcutaneous nodules, hyalinous cutaneous lesions of various sizes, gingivalhypertrophy, limb contractures and low bone density. The visceral organs are not affected. Mentaldevelopment is normal. The diagnosis is confirmed by biopsy of the lesions. There is no specifictreatment other than numerous operations for functional and aesthetic reasons. The case is describedof a 4 year-old female with failure to thrive, limb contractures, rigid torsus, gingival hypertrophy,subcutaneous nodules, and cutaneous nodules and macules especially on the head, fingers and toes,causing considerable disability. Administration of Botox injections (Botulin toxinum A) hastemporarily improved the patient’s quality of life, rendering her able to chew and speak again, asbefore.

Key words

Nodules, macules, fibromatosis.

1 1st Paediatric Clinic of theUniversity of Athens,“Aghia Sophia” Children’sHospital, Athens

2 Plastic Surgery Clinic,“Aghia Sophia” Children’sHospital, Athens

3 Laboratory of Pathology-Anatomy, “Aghia Sophia”Children’s Hospital, Athens

4 Institute of CancerResearch, Surrey, UK

Correspondence:

Ourania Papandreou 1st Paediatric Clinic of theUniversity of Athens, “Aghia Sophia” Children’sHospital Thivon & Levadias, 115 27, Athens E-mail: [email protected]




372 ∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À,πÔÎÚ¿ÙÂÈÔ °¶¡£ÂÛÛ·ÏÔÓ›ÎË˜

2 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·,¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô §¿ÚÈÛ·˜

3 ∫¤ÓÙÚÔ ªÔÚÈ·Î‹˜µÈÔÏÔÁ›·˜ Î·È∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜,ª·ÈÂ˘Ù‹ÚÈÔ “§ËÙÒ”,∞ı‹Ó·


∞Ï¤Í·Ó‰ÚÔ˜ ∞Ó‰Ú¤Ô˘ÃÂÈÌˆÓ›‰Ô˘ 15∆.∫. 551 33, ∫·Ï·Ì·ÚÈ¿,£ÂÛÛ·ÏÔÓ›ÎË ∂-mail: [email protected]


¶·È‰È·ÙÚÈÎ‹ 2005;68:372-375

™‡Ó‰ÚÔÌÔ ÌÈÎÚÔÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11.2 ÛÂ

ÔÈÎÔÁ¤ÓÂÈ· ÌÂ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ Ê·ÈÓfiÙ˘Ô.

¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË

∞. ∞Ó‰Ú¤Ô˘1, µ. ∞ÏÂÍ·Ó‰ÚÔÔ‡ÏÔ˘ - ∆ÛÈÎÚ›Î·2, ∞. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘1, ª. °Ô˘‰ÂÛ›‰Ô˘2,

§. ºÏˆÚÂÓÙ›Ó - ∞Ú¿Ú3

¶ÂÚ›ÏË„Ë

¶ÂÚÈÁÚ¿ÊÂÙ·È Ì›· ÔÈÎÔÁ¤ÓÂÈ· ÌÂ Û‡Ó‰ÚÔÌÔ ÂÏÏÂ›ÌÌ·ÙÔ˜ ÙÔ˘ ¯ÚˆÌÔÛˆÌÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ 22q11.2 ÛÂÙÚ›· Ì¤ÏË ÙË˜ Î·È ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ Ê·ÈÓfiÙ˘Ô. ∫ÏÈÓÈÎ¿, ÙÔ Û‡Ó‰ÚÔÌÔ ÂÎ‰ËÏÒıËÎÂ ÛÙË ÌË-Ù¤Ú· ÌÂ ¤ÓÚÈÓË ÔÌÈÏ›· ÏfiÁˆ ˘ÂÚˆÈÔÊ·Ú˘ÁÁÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ÛÙÔ ÙÚ›ÙÔ ·È‰› ÌÂ ÎÏ·ÛÈÎfi Û‡Ó-‰ÚÔÌÔ DiGeorge, Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ ÎÔÈÓfi ·ÚÙËÚÈ·Îfi ÎÔÚÌfi Ù‡Ô˘ ππ, ˘·Û‚ÂÛÙÈ·ÈÌ›· Î·È ·Ï·-Û›· ÙÔ˘ ı‡ÌÔ˘ ÌÂ ÙÂÏÈÎ‹ Î·Ù¿ÏËÍË ÙÔÓ ı¿Ó·ÙÔ ·fi ‚·ÚÈ¿ Û‹„Ë, ÂÓÒ ÛÙÔ Ù¤Ù·ÚÙÔ ·È‰› ÌÂ ÌÈÎÚÔ-ÁÓ·ı›· Î·È ·ÚÔ‰ÈÎ‹ ˘·Û‚ÂÛÙÈ·ÈÌ›·. ∏ ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ·Ú¯ÈÎ¿ ÛÙÔ ÙÚ›ÙÔ ·È‰› Î·È ÌÂÙ¿ ÛÙË ÌË-Ù¤Ú·. ™ÙÔ Ù¤Ù·ÚÙÔ ·È‰› Ë ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ÚÔÁÂÓÓËÙÈÎ¿ ÌÂÙ¿ ·fi ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË. ™Â fiÏÂ˜ ÙÈ˜ÂÚÈÙÒÛÂÈ˜ Ë ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹ ÙÔ˘ ÊıÔÚ›˙ÔÓÙ· in situ ˘‚ÚÈ‰ÈÛÌÔ‡ (FISH).


™‡Ó‰ÚÔÌÔ ÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11, ÔÈÎÔÁÂÓ‹˜ ÂÌÊ¿ÓÈÛË, ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË, ÙÂ¯ÓÈÎ‹ FISH.

∂ÈÛ·ÁˆÁ‹

∆Ô Û‡Ó‰ÚÔÌÔ ÂÏÏÂ›ÌÌ·ÙÔ˜ ÛÙÔ ¯ÚˆÌfiÛˆÌ·

22q11 ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ·

ÛÙÔÓ Ê·ÈÓfiÙ˘Ô Î·È ÛÙÈ˜ Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ ·Óˆ-

Ì·Ï›Â˜ ·fi ÙËÓ Î·Ú‰È¿, ÙÔÓ ı‡ÌÔ Î·È ÙÔ˘˜ ·-

Ú·ı˘ÚÂÔÂÈ‰Â›˜ ·‰¤ÓÂ˜, ·ÎfiÌË Î·È ·Ó¿ÌÂÛ· ÛÂ

¿ÙÔÌ· ÙË˜ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (1-4). ∆· Ê·ÈÓÔÙ˘-

ÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, fiˆ˜ ÎÚ·ÓÈÔÚÔÛˆÈÎ¤˜,

Î·Ú‰È·ÁÁÂÈ·Î¤˜, ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈÎ¤˜, Ì˘Ô-

ÛÎÂÏÂÙÈÎ¤˜, ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎ¤˜ Î·È ·ÓÔÛÔÏÔÁÈÎ¤˜

·ÓˆÌ·Ï›Â˜, ÌÔÚÂ› Ó· ‰È·Ê¤ÚÔ˘Ó ·ÎfiÌË Î·È ÌÂ-

Ù·Í‡ ÌÔÓÔˆÔÁÂÓÒÓ ‰È‰‡ÌˆÓ (5). ∏ ‚·Ú‡ÙËÙ·

Ì¤Û· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÌÔÚÂ› Ó· ÔÈÎ›ÏÏÂÈ ·fi

·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ÁÔÓÂ›˜ Ì¤¯ÚÈ ÛÔ‚·Ú¿ Î·ı˘-

ÛÙÂÚËÌ¤Ó· Î·È ‰˘ÛÌÔÚÊÈÎ¿ ·È‰È¿ (3). ∏ ÂÚÈÔ-

¯‹ ÙÔ˘ ÂÏÏÂ›ÌÌ·ÙÔ˜ ÛÙË ¯ÚˆÌÔÛˆÌÈÎ‹ ı¤ÛË

22q11.2 ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÂÚÈÁÚ·Ê¤ÓÙ· ·Ï·Èfi-

ÙÂÚ· Û‡Ó‰ÚÔÌ· DiGeorge Î·È ˘ÂÚˆÈÔ-Î·Ú‰ÈÔ-

ÚÔÛˆÈÎfi (velo-cardio-facial), Î·ıÒ˜ Î·È ¿ÙÔ-

Ì· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ Û‡Ó‰ÚÔÌÔ conotruncal

abnormal face (6). ¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙÔ˘

Û˘Ó‰ÚfiÌÔ˘ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ Ï›Á· Û¯ÂÙÈÎ¿ Â-

ÚÈÛÙ·ÙÈÎ¿ (7,8).

¶ÂÚÈÁÚ¿ÊÂÙ·È, ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ÂÏÏË-

ÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ¤Ó· ÔÈÎÔÁÂÓ¤˜ Û‡Ó‰ÚÔÌÔ ÌÈ-

ÎÚÔÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11.2, Ô˘ ·ÊÔÚ¿ ÛÙË ÌËÙ¤-

Ú· Î·È ÛÙ· ‰‡Ô ·fi Ù· Ù¤ÛÛÂÚ· ·È‰È¿ ÙË˜. ™ÙÔ

‰Â‡ÙÂÚÔ ¿Û¯ÔÓ ·È‰› Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰Úfi-

ÌÔ˘ ¤ÁÈÓÂ ÚÔÁÂÓÓËÙÈÎ¿.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ

¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÔÈÎÔÁ¤ÓÂÈ· 3 ÁÔÓ¤ˆÓ (Ì›·

ÌËÙ¤Ú·, ‰‡Ô ·Ù¤ÚÂ˜) Î·È 4 ·È‰ÈÒÓ (‰‡Ô ·fi

Î¿ıÂ ·Ù¤Ú·). O ¤ÏÂÁ¯Ô˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ

ÌÂ ÙË Ì¤ıÔ‰Ô FISH ¤‰ÂÈÍÂ fiÙÈ Ë ÌËÙ¤Ú· Î·È Ù·

2 ·È‰È¿ ·fi ÙÔÓ ›‰ÈÔ ·Ù¤Ú·, ÙÔ ÙÚ›ÙÔ Î·È ÙÔ

Ù¤Ù·ÚÙÔ, Â›¯·Ó ÌÈÎÚÔ¤ÏÏÂÈÌÌ· ÛÙÔ ¯ÚˆÌfiÛˆÌ·

22q11.2. ∏ ÌËÙ¤Ú· (ËÏÈÎ›·˜ 37 ÂÙÒÓ) Î·È Ô ·-

Ù¤Ú·˜ (ËÏÈÎ›·˜ 40 ÂÙÒÓ) ÙˆÓ ‰‡Ô ·Û¯fiÓÙˆÓ

·È‰ÈÒÓ ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂÙ·Í‡ ÙÔ˘˜. O

¤ÏÂÁ¯Ô˜ ÁÈ· ¤ÏÏÂÈÌÌ· 22q11 ÛÙÔÓ ·Ù¤Ú· ÙˆÓ

‰‡Ô ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆·

¿ÏÏ· ‰‡Ô ·È‰È¿, ÙÔ ÚÒÙÔ Î·È ÙÔ ‰Â‡ÙÂÚÔ ·fi

‰È·ÊÔÚÂÙÈÎfi ·Ù¤Ú·, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿ Î·È Ô

¤ÏÂÁ¯Ô˜ ÌÂ FISH ÛÙÔ ¤Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜,

ÂÓÒ ÛÙÔ ¿ÏÏÔ ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌ·.

ªËÙ¤Ú·: ∏ ‰È¿ÁÓˆÛË ÛÙË ÌËÙ¤Ú· ¤ÁÈÓÂ ÌÂ-

Ù¿ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔ ÚÒÙÔ ¿-

Û¯ÔÓ ·È‰› ÙË˜. ∏ ÌËÙ¤Ú· Â›¯Â ¤ÓÚÈÓË ÔÌÈÏ›·

Î·È ·Ó¤ÊÂÚÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂÈ˜ ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›·. ∂›¯Â ÛÔ‚·Ú¤˜ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜

Î·È ·Ú·ÎÔÏÔ‡ıËÛÂ ÌfiÓÔ ÙÔ ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô.

¢ÂÓ ·Ó¤ÊÂÚÂ ÈÛÙÔÚÈÎfi Û·ÛÌÒÓ ‹ ÙÚfiÌÔ. ∞fi


373™‡Ó‰ÚÔÌÔ ÌÈÎÚÔÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11.2

fiÛÔ ı˘Ì¿Ù·È ‰ÂÓ ˘‹Ú¯·Ó ‰˘ÛÌÔÚÊ›Â˜, Û·-

ÛÌÔ›, Û˘¯Ó¤˜ ÏÔÈÌÒÍÂÈ˜, ˘·Û‚ÂÛÙÈ·ÈÌ›·, „˘-

¯ÔÎÔÈÓˆÓÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË ‹

„˘¯È·ÙÚÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÛÂ ¿ÏÏ· Ì¤ÏË ÙË˜ ÔÈ-

ÎÔÁ¤ÓÂÈ¿˜ ÙË˜.

∆Ú›ÙÔ ·È‰›: ¶ÚfiÎÂÈÙ·È ÁÈ· ı‹Ï˘ ÓÂÔÁÓfi, ÙÔ

ÚÒÙÔ ·È‰› Ê·ÈÓÔÌÂÓÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ Ô˘

ÌÂÙ·Ê¤ÚıËÎÂ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÂ ËÏÈÎ›· 3

ËÌÂÚÒÓ ÌÂ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Î·Ú‰È·Î‹˜ Î¿Ì-

„Ë˜. ∏ Î‡ËÛË (40 Â‚‰ÔÌ¿‰ˆÓ) Î·È Ô ÙÔÎÂÙfi˜

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ˘‰Ú¿-

ÌÓÈÔ Î·È Ë ÙÈÌ‹ ÙË˜ ·-ÂÌ‚Ú˘˚Î‹˜ ÚˆÙÂ˝ÓË˜

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ÂÍ¤Ù·ÛË ÁÈ· ÙËÓ ‡·ÚÍË

·˘ÛÙÚ·ÏÈ·ÓÔ‡ ·ÓÙÈÁfiÓÔ˘ ÛÙË ÌËÙ¤Ú· ‹Ù·Ó ıÂ-

ÙÈÎ‹. ∆Ô µ° ‹Ù·Ó 3200 g (~50‹ ∂£), Ë ¶∫ 34

cm (~50‹ ∂£) Î·È ÙÔ ª™ ‹Ù·Ó 49 cm (~50‹

∂£). ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 8 ÛÙÔ 1Ô ÏÂ-

Ùfi Î·È 10 ÛÙÔ 5Ô. ∞Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË

¯ÔÚËÁ‹ıËÎÂ ˘ÂÚ¿ÓÔÛÔ˜ ÛÊ·ÈÚ›ÓË Î·È Ì›· ‰fi-

ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·Ù¿ ÙË˜ Ë·Ù›ÙÈ‰·˜ µ. ∆Ë

2Ë ËÌ¤Ú· ˙ˆ‹˜ ÙÔ ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛÂ ˆ¯ÚfiÙËÙ·,

ÓˆıÚfiÙËÙ·, ¿ÚÓËÛË Ï‹„Ë˜ ÙÚÔÊ‹˜, „ËÏ·ÊË-

Ùfi ‹·Ú 3 cm Î·È Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· 1-2/6. O

˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ Î·Ú‰È¿˜ ¤‰ÂÈÍÂ

ÙËÓ ‡·ÚÍË ÎÔÈÓÔ‡ ·ÚÙËÚÈ·ÎÔ‡ ÎÔÚÌÔ‡ Ù‡Ô˘

ππ ÌÂ ÌÂÛÔÎÔÈÏÈ·Î‹ ÂÈÎÔÈÓˆÓ›·. ∫·Ù¿ ÙËÓ ÂÈ-

Û·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, ÙÔ ÓÂÔÁÓfi Â›¯Â Úfi‰È-

ÓÔ ¯ÚÒÌ·, Ù·¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›·, ¤ÓÙÔÓÔ ·’

ÙfiÓÔ, Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· ÂÍÒıËÛË˜ 1-2/6

·ÎÔ˘ÛÙfi ÛÙÈ˜ ÂÛÙ›Â˜ ·ÎÚfi·ÛË˜ ÙË˜ ÓÂ˘ÌÔÓÈ-

Î‹˜ Î·È ·ÔÚÙÈÎ‹˜ ‚·Ï‚›‰·˜, Î·Ï‹ ÂÚÈÊÂÚÂÈ·-

Î‹ Î˘ÎÏÔÊÔÚ›· Î·È ¤ÓÙÔÓÂ˜ ÂÚÈÊÂÚÈÎ¤˜ ÛÊ‡-

ÍÂÈ˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ¤‰ÂÈÍÂ ·˘ÍËÌ¤-

ÓË ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂ›ˆÛË. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜

Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÏÂ˘Î¿ 13900,

¶ 83,1%, § 11,4%, ª.ª. 5,5%, Ca++=0,73

mmol/l, Mg=1,4 mg/dl, P=9,1 mg/dl Î·È ·ÏÎ·-

ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË 142 IU/L. H PTH ‹Ù·Ó 71

pg/ml, ÌÂ ÙÈÌ‹ Ca++=0,93 mmol/l. ∆Ô ˘ÂÚË-

¯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ ˘ÔÏ·ÛÙÈÎfi ı‡ÌÔ, ÂÓÒ ÔÈ

·Ú·ı˘ÚÂÔÂÈ‰Â›˜ ‰ÂÓ ·ÂÈÎÔÓ›ÛÙËÎ·Ó. ∆Ô

˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÙˆÓ ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔ-

ÁÈÎfi. ™ÙÔÓ ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎÂ

·Ô˘Û›· ·ÓÔÛÔ˚Î·ÓÒÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, Ïfi-

Áˆ ÌË ‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜ ÛÂ ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜

ÏËı˘ÛÌÔ‡˜. O ¯ÚˆÌÔÛˆÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ

¯ÚˆÌfiÛˆÌ· 22 ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹ FISH Î·È ¯ÚË-

ÛÈÌÔÔÈÒÓÙ·˜ ÊıÔÚ›˙ÔÓÙ· DNA ·ÓÈ¯ÓÂ˘Ù‹

¤‰ÂÈÍÂ ÌÈÎÚÔ¤ÏÏÂÈÌÌ· ÛÙË ı¤ÛË 22q11.2. ∏

˘·Û‚ÂÛÙÈ·ÈÌ›· ·ÔÎ·Ù·ÛÙ¿ıËÎÂ ÙË 12Ë ËÌ¤-

Ú· ÓÔÛËÏÂ›·˜ ÌÂÙ¿ ·fi ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË

ÛÙÔÈ¯ÂÈ·ÎÔ‡ ·Û‚ÂÛÙ›Ô˘ Î·È ‚ÈÙ·Ì›ÓË˜ D ·fi

ÙÔ ÛÙfiÌ·. ™ÙÔ ÓÂÔÁÓfi ¤ÁÈÓÂ ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ

¯ÔÚËÁÔ‡ÌÂÓˆÓ ˘ÁÚÒÓ Î·È ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹-

ÁËÛË ÊÔ˘ÚÔÛÂÌ›‰Ë˜. ™Â ËÏÈÎ›· 18 ËÌÂÚÒÓ ¤ÁÈ-

ÓÂ ÌÂÙ·ÊÔÚ¿ ÛÂ ·È‰ÔÎ·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi Î¤-

ÓÙÚÔ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ‰ÈfiÚıˆÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜

Î·Ú‰ÈÔ¿ıÂÈ·˜. §›ÁÂ˜ ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ· Î·È

ÚÈÓ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË ·Ó¤Ù˘ÍÂ Û‹-

„Ë ·fi „Â˘‰ÔÌÔÓ¿‰· Î·È ·Â‚›ˆÛÂ.

∆¤Ù·ÚÙÔ ·È‰›: ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ, Ô˘ ÌÂ-

Ù·Ê¤ÚıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ ÛÂ ËÏÈÎ›· 28 ˆÚÒÓ Ïfi-

Áˆ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Û˘Ó‰ÚfiÌÔ˘ ÌÈ-

ÎÚÔÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11.2. ∞fi ÙÔ ÂÚÈÁÂÓÓËÙÈ-

Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ÌËÙ¤Ú· Â›¯Â ÌÈ-

ÎÚÔ·ÈÌÔÚÚ·Á›Â˜ ÛÙÔÓ 3Ô-4Ô Ì‹Ó· ÙË˜ ÂÁÎ˘ÌÔ-

Û‡ÓË˜. ∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ÌÂ

¯ÚˆÌÔÛˆÌÈÎ‹ ·Ó¿Ï˘ÛË ÌÂ ÙË Ì¤ıÔ‰Ô FISH ÛÂ

·ÌÓÈ·Î¿ Î‡ÙÙ·Ú· Ô˘ ÂÏ‹ÊıËÛ·Ó ÌÂ ·ÌÓÈÔÎ¤-

ÓÙËÛË ÙËÓ 23Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜. ∏ Á¤ÓÓËÛË

¤ÁÈÓÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ÌÂÙ¿ ·fi 38

Â‚‰ÔÌ¿‰Â˜ Î‡ËÛË˜. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ‹Ù·Ó

2630 g (75Ë ∂£ - 90‹ ∂£), Ë ¶∫ 36 cm (>90‹

∂£) Î·È ÙÔ ª™ 48 cm (~50‹ ∂£). ∏ ‚·ıÌÔÏÔ-

Á›· Apgar ‹Ù·Ó 8 ÛÙÔ 1Ô ÏÂÙfi Î·È 9 ÛÙÔ 5Ô.

∞Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ¯ÔÚËÁ‹ıËÎÂ ˘ÂÚ¿-

ÓÔÛÔ˜ Á-ÛÊ·ÈÚ›ÓË Î·È ÂÌ‚fiÏÈÔ Î·Ù¿ ÙË˜ Ë·Ù›-

ÙÈ‰·˜ µ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË

- ÂÎÙfi˜ ·fi ‹È· ÌÈÎÚÔÁÓ·ı›· - ‹Ù·Ó Ê˘ÛÈÔÏÔ-

ÁÈÎ‹. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÏÂ˘Î¿

12800, ¶ 67,1%, § 18,3%, ª.ª. 10,9%,

Ca++=0,95 mmol/l. ∏ ˘·Û‚ÂÛÙÈ·ÈÌ›· ·ÓÙÈÌÂ-

Ùˆ›ÛÙËÎÂ ÌÂ ¯ÔÚ‹ÁËÛË ·fi ÙÔ ÛÙfiÌ· ÁÏ˘ÎÔ-

ÓÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ ÁÈ· 14 ËÌ¤ÚÂ˜. ™ÙËÓ ·ÎÙÈÓÔ-

ÁÚ·Ê›· ıÒÚ·Î· ‰ÂÓ ·ÂÈÎÔÓÈ˙fiÙ·Ó Ô ı‡ÌÔ˜

·‰¤Ó·˜. ¢ÂÓ ¤ÁÈÓÂ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÙÔ˘ ı‡ÌÔ˘ Î·È ÙˆÓ ·Ú·ı˘ÚÂÔÂÈ‰ÒÓ ·‰¤ÓˆÓ. O

˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ Î·Ú‰È¿˜, ÙˆÓ

ÌÂÁ¿ÏˆÓ ·ÁÁÂ›ˆÓ Î·È ÙˆÓ ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔ-

ÏÔÁÈÎfi˜. O ·ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ÔÚÈ·-

Î¿ ¯·ÌËÏfi ÔÛÔÛÙfi ·ÓÔÛÔ˚Î·ÓÒÓ ∆-Î˘ÙÙ¿ÚˆÓ

Î·È ÙˆÓ ˘ÔÔÌ¿‰ˆÓ ÙÔ˘˜, Î·ıÒ˜ Î·È ÂÏ¿ÙÙˆÛË

ÙˆÓ ÔÛÔÛÙÒÓ ¤ÎÊÚ·ÛË˜ ÙˆÓ ÌÔÚ›ˆÓ ÚÔ-

ÛÎfiÏÏËÛË˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ. ∆Ô ÓÂÔÁÓfi ·-

ÚÔ˘Û›·ÛÂ ‰˘ÛÎÔÏ›· ÛÙË Û›ÙÈÛË Ù· ‰‡Ô ÚÒÙ·

24ˆÚ· ˙ˆ‹˜, ÌÂ ÂÏ·ÙÙˆÌ¤ÓË ÚfiÛÏË„Ë Á¿Ï·-

ÎÙÔ˜, Î·ıÒ˜ Î·È ÏÂÙfi ÙÚfiÌÔ ÙˆÓ ¿ÎÚˆÓ. ¡Ô-

ÛËÏÂ‡ÙËÎÂ 17 ËÌ¤ÚÂ˜ Î·È ÂÍ‹ÏıÂ ÌÂ Ô‰ËÁ›Â˜

ÁÈ· ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ·›Ì·ÙÔ˜ Î·È

ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿

‰È·ÛÙ‹Ì·Ù·, Î·ıÒ˜ Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÙÚÂ˜,

ÏÔÈÌÒÍÂˆÓ, ÂÌÊ¿ÓÈÛË˜ Â˘ÂÚÂıÈÛÙfiÙËÙ·˜, ÙÚfi-

ÌÔ˘ ‹ Û·ÛÌÒÓ. ª¤¯ÚÈ Û‹ÌÂÚ· (ËÏÈÎ›· 2 ÂÙÒÓ)

‰ÂÓ ·ÚÔ˘Û›·ÛÂ ÙÚfiÌÔ, Û·ÛÌÔ‡˜ ‹ Û˘¯Ó¤˜ ÏÔÈ-

ÌÒÍÂÈ˜ Î·È Ô Ù·ÎÙÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜

ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ

¶·È‰È·ÙÚÈÎ‹ 2005;68:372-375


374 ∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.

Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·Ó¿Ù˘Í‹ ÙÔ˘ Â›Ó·È Â›-

ÛË˜ Ê˘ÛÈÔÏÔÁÈÎ‹.

™˘˙‹ÙËÛË

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÏÏÂ›ÌÌ·ÙÔ˜

ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ 22q11 ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 1:4000-

6000 ÁÂÓÓ‹ÛÂÈ˜ ˙ˆÓÙ·ÓÒÓ ÓÂÔÁÓÒÓ (4,9). £Âˆ-

ÚÂ›Ù·È Ë ‰Â‡ÙÂÚË ÈÔ Û˘¯Ó‹ ¯ÚˆÌÔÛˆÌÈÎ‹ ·Óˆ-

Ì·Ï›· ÌÂÙ¿ ÙËÓ ÙÚÈÛˆÌ›· 21 (4,7,10). OÈ ÂÚÈÛ-

ÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ (ÂÚ›Ô˘ 90%) ÚÔÎ‡-

ÙÔ˘Ó de novo, ÂÓÒ ÔÛÔÛÙfi ÂÚ›Ô˘ 10% ÎÏË-

ÚÔÓÔÌÂ›Ù·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡-

ÓÙ· ¯·Ú·ÎÙ‹Ú· (4). ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰Úfi-

ÌÔ˘ ÛÂ ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ· ÙÔ˘

ÛÙÂÏÂ¯È·›Ô˘ ÎÒÓÔ˘ (conotruncal) Â›Ó·È 48%

(11). ™Â ÓÂÔÁÓ¿ ÌÂ ÙÂÙÚ·ÏÔÁ›· Fallot Â›Ó·È 13%

(8).

∏ ˘Ô„›· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ¤Ó·

Ê¿ÛÌ· Â˘ÚËÌ¿ÙˆÓ, Ô˘ ÌÔÚÂ› Ó· ÂÚÈÏ·Ì‚¿-

ÓÔ˘Ó ÔÚÈÛÌ¤ÓÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÙˆÓ ·ÎfiÏÔ˘ıˆÓ:

Û˘ÁÁÂÓ‹˜ Î·Ú‰ÈÔ¿ıÂÈ· Ù‡Ô˘ conotruncal

·ÓˆÌ·Ï›·˜, ·ÓˆÌ·Ï›Â˜ ÙË˜ ˘ÂÚÒ·˜, ˘·Û‚Â-

ÛÙÈ·ÈÌ›·, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔ-

Ï›Â˜ Î·È ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ÌÔÚÊÔ-

ÏÔÁÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÚÔÛÒÔ˘ (4,6).

∏ ‚·Ú‡ÙËÙ· Ì¤Û· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÔÈÎ›Ï-

ÏÂÈ ·fi ·Û˘ÌÙˆÌ·ÙÈÎ‹ ÂÌÊ¿ÓÈÛË ÛÙÔ˘˜ ÁÔ-

ÓÂ›˜ Ì¤¯ÚÈ ÛÔ‚·Ú¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È ‰˘ÛÌÔÚ-

Ê›Â˜ ÛÙ· ·È‰È¿ (3,4). ∏ ÎÏËÚÔÓÔÌÈÎ‹ ÌÂÙ·‚›-

‚·ÛË Â›Ó·È ÈÔ Û˘¯Ó‹ ·fi ÙË ÌËÙ¤Ú· Î·È Á›ÓÂ-

Ù·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·-

ÎÙ‹Ú·. ™˘Ó‹ıˆ˜, ÔÈ ÌËÙ¤ÚÂ˜ ÂÌÊ·Ó›˙Ô˘Ó ÂÏ¿Û-

ÛÔÓÂ˜ ÌÔÚÊÔÏÔÁÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÚÔÛÒÔ˘,

˘ÂÚˆ˚ÔÊ·Ú˘ÁÁÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·Ù·Ú·¯¤˜

ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈÎ‹ ÙÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿ Ô˘

ÔÈÎ›ÏÏÔ˘Ó ·fi ‹ÈÂ˜ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜

Ì¤¯ÚÈ ÛÔ‚·Ú‹ ·ÓÙÈÎÔÈÓˆÓÈÎ‹ ÚÔÛˆÈÎfiÙËÙ·

Î·È ‚·ÚÈ¤˜ „˘¯È·ÙÚÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜. ∆Ô Ì¤ÁÂ-

ıÔ˜ ÙË˜ ¤ÏÏÂÈ„Ë˜ ‰ÂÓ ıÂˆÚÂ›Ù·È ˘Â‡ı˘ÓÔ ÁÈ·

ÙË Ê·ÈÓÔÙ˘ÈÎ‹ ÔÈÎÈÏÔÌÔÚÊ›· (12). ¶Èı·ÓÔ-

ÏÔÁÂ›Ù·È fiÙÈ Î·È ¿ÏÏÔÈ ÂÍˆÁÂÓÂ›˜, ÌË ÁÂÓÂÙÈÎÔ›

·Ú¿ÁÔÓÙÂ˜ ·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ÔÈÎÈÏÔÌÔÚÊ›·

ÙˆÓ ÂÎ‰ËÏÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (2).

™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ë ÌÂÙ·‚›‚·ÛË

ÙË˜ ¯ÚˆÌÔÛˆÌÈÎ‹˜ ·ÓˆÌ·Ï›·˜ ¤ÁÈÓÂ ·fi ÙË

ÌËÙ¤Ú·, Ë ÔÔ›· ·ÚÔ˘Û›·˙Â ¤ÓÚÈÓË ÔÌÈÏ›·, Ì·-

ıËÛÈ·Î¿ ÚÔ‚Ï‹Ì·Ù· Î·È Â˘¿ıÂÈ· ÛÂ ÏÔÈÌÒ-

ÍÂÈ˜. ∆Ô ¤Ó· ·È‰› ÂÌÊ¿ÓÈÛÂ ÙËÓ ÎÏ·ÛÈÎ‹ ÙÚÈ¿-

‰· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ DiGeorge ÌÂ ·Ï·Û›· ÙÔ˘

ı‡ÌÔ˘ ·‰¤Ó·, ÛÔ‚·Ú‹ conotruncal Î·Ú‰È·Î‹

·ÓˆÌ·Ï›· (·ÚÙËÚÈ·Îfi ÎÔÚÌfi Ù‡Ô˘ ππ) Î·È ‚·-

ÚÈ¿ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Î·È ·Â‚›ˆÛÂ ÌÂÙ¿ ·fi

Û‹„Ë, ÂÓÒ ÙÔ ¿ÏÏÔ ·È‰› Â›¯Â ÌfiÓÔ ÌÈÎÚÔÁÓ·-

ı›· Î·È ·ÚÔ‰ÈÎ‹, ‹È· ˘·Û‚ÂÛÙÈ·ÈÌ›·.

OÈ Î·Ú‰È·Î¤˜ ·ÓˆÌ·Ï›Â˜ ··ÓÙÔ‡Ó ÛÙÔ 74%

ÙˆÓ ·Û¯fiÓÙˆÓ (12) Î·È Â›Ó·È Ù‡Ô˘ cono-

truncal, ÌÂ Û˘¯ÓfiÙÂÚË ÙËÓ ÙÂÙÚ·ÏÔÁ›· Fallot

(4). ¶ÔÛÔÛÙfi 69% ÙˆÓ ·Û¯fiÓÙˆÓ ¤¯ÂÈ ·ÓˆÌ·-

Ï›Â˜ ÙË˜ ˘ÂÚÒ·˜, Î˘Ú›ˆ˜ ˘ÂÚˆÈÔÊ·Ú˘ÁÁÈÎ‹

·ÓÂ¿ÚÎÂÈ· Ô˘ ÂÎ‰ËÏÒÓÂÙ·È ÌfiÓÔ ÌÂ ¤ÓÚÈÓË

ÔÌÈÏ›· (4).

∆Ô Ê¿ÛÌ· ÙË˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·Ú·ı˘-

ÚÂÔÂÈ‰ÒÓ ÛÙÔ 22q11 Û‡Ó‰ÚÔÌÔ ‰ÂÓ ¤¯ÂÈ Ï‹-

Úˆ˜ ‰ÈÂÚÂ˘ÓËıÂ›. Œ¯Ô˘Ó ·Ó·ÊÂÚıÂ›: ·) ·Ô˘-

Û›· ·Ú·ı˘ÚÂÔÂÈ‰ÈÎÔ‡ ÈÛÙÔ‡ ÌÂ ˘·Û‚ÂÛÙÈ·È-

Ì›·, ‚) ˘·Û‚ÂÛÙÈ·ÈÌÈÎfi˜ ˘Ô·Ú·ı˘ÚÂÔÂÈ‰È-

ÛÌfi˜ Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÂ ÂÓ‹-

ÏÈÎÂ˜, Á) ˘·Û‚ÂÛÙÈ·ÈÌÈÎfi˜ ˘Ô·Ú·ı˘ÚÂÔÂÈ-

‰ÈÛÌfi˜ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Ô˘ ‚ÂÏÙÈÒÓÂÙ·È

·˘ÙfiÌ·Ù· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È Â·Ó¤Ú¯Â-

Ù·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ Î·È ‰) ÓÔÚÌ·Û‚ÂÛÙÈ·ÈÌ›·

Ô˘ ÂÍÂÏ›ÛÛÂÙ·È ÛÂ ˘·Û‚ÂÛÙÈ·ÈÌÈÎfi ·Ú·ı˘-

ÚÂÔÂÈ‰ÈÛÌfi (8,12). ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¤ÏÏÂÈÌÌ·

22q11 Î·È ÓÔÚÌ·Û‚ÂÛÙÈ·ÈÌ›· Û˘ÛÙ‹ÓÂÙ·È Ì·-

ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË, ÏfiÁˆ ÙË˜ Ê˘ÛÈÎ‹˜

ÂÍ¤ÏÈÍË˜ ÛÂ ˘·Û‚ÂÛÙÈ·ÈÌÈÎfi ˘Ô·Ú·ı˘ÚÂÔ-

ÂÈ‰ÈÛÌfi (12).

∏ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÏ¿ÙÙˆ-

ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ÚÔÂÚ¯ÔÌ¤ÓˆÓ ·fi ÙÔÓ

ı‡ÌÔ ·‰¤Ó·, Î·ıÒ˜ Î·È ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ·ÓÂ¿Ú-

ÎÂÈÂ˜ ÙˆÓ ∆ Î·È µ Î˘ÙÙ¿ÚˆÓ (4).

∆Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆÂ›Ô ÂÚÈÏ·Ì‚¿-

ÓÂÈ ÌÈÎÚfi ÛÙfiÌ·, ÔÈ‰ËÌ·ÙÒ‰Ë Ì¿ÙÈ·, ÂÈ¤‰ˆ-

ÛË ÙË˜ Ú¿¯Ë˜ ÙË˜ Ì‡ÙË˜, ˘ÂÚˆÈÔÛ¯ÈÛÙ›·, ÌÈ-

ÎÚÔÁÓ·ı›·, ˘ÂÚÙÂÏÔÚÈÛÌfi, ·ÓˆÌ·Ï›Â˜ ÙÔ˘

ÙÂÚ˘Á›Ô˘ ÙˆÓ ·˘ÙÈÒÓ Î·È ÌÈÎÚ¤˜ ‚ÏÂÊ·ÚÈÎ¤˜

Û¯ÈÛÌ¤˜ (4,6,9). ™¯Â‰fiÓ fiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ

Û‡Ó‰ÚÔÌÔ ÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11 ÂÎ‰ËÏÒÓÔ˘Ó

‹È·, ·ÏÏ¿ Ù˘ÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÚÔÛÒÔ˘

(13), Ô˘ ·fi ÌfiÓ· ÙÔ˘˜ ‰ÂÓ Â›Ó·È ÈÎ·Ó¿ Ó· Î·-

ÙÂ˘ı‡ÓÔ˘Ó ÛÙËÓ ˘ÔÎÂ›ÌÂÓË ‰È¿ÁÓˆÛË (4). OÈ

ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¤ÏÏÂÈÌÌ·

22q11 ¤¯Ô˘Ó ‹ÈÔ˘ ÚÔ˜ Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ÓÔË-

ÙÈÎ‹ ˘ÛÙ¤ÚËÛË (4,8).

∂Ó‰Â›ÍÂÈ˜ ÁÈ· ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ·Ô-

ÙÂÏÔ‡Ó Ë ‡·ÚÍË ÂÓfi˜ ÁÔÓ¤· ÌÂ ·ÒÏÂÈ·

22q11, Ë ÚÔËÁËıÂ›Û· Á¤ÓÓËÛË ÂÓfi˜ ·È‰ÈÔ‡

ÌÂ ¤ÏÏÂÈÌÌ· 22q11, Î·ıÒ˜ Î·È Ù· ¤Ì‚Ú˘· ÛÙ·

ÔÔ›· Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Î·Ú‰ÈÔ¿ıÂÈ·˜ ÙÔ˘

ÛÙÂÏÂ¯È·›Ô˘ ÎÒÓÔ˘ (conotruncal) Î·È Û˘Ó‰Úfi-

ÌÔ˘ conotruncal abnormal face (8).

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Ï›ÁÂ˜ Â-

ÚÈÙÒÛÂÈ˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÙÔ˘ Û˘Ó-

‰ÚfiÌÔ˘ 22q11 (3,7,9). ¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË

¶·È‰È·ÙÚÈÎ‹ 2005;68:372-375


375™‡Ó‰ÚÔÌÔ ÌÈÎÚÔÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11.2

¤ÁÈÓÂ ÛÙÔ ‰Â‡ÙÂÚÔ ¿Û¯ÔÓ ·È‰› ÙË˜ ÔÈÎÔÁ¤-ÓÂÈ·˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ·ÊÔ‡ ÚÒÙ· ¤ÁÈÓÂ‰È¿ÁÓˆÛË ÛÙÔ ÚÒÙÔ ·È‰›. ∏ ÚÔÁÂÓÓËÙÈÎ‹‰È¿ÁÓˆÛË ÂÈÙÚ¤ÂÈ ÙË ÛˆÛÙ‹ ÁÂÓÂÙÈÎ‹ Û˘Ì-‚Ô˘Ï‹. ∂›Ó·È ¯Ú‹ÛÈÌË ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓÎ·È ÚÔÂÙÔÈÌ·ÛÈÒÓ ÁÈ· ÙËÓ ÂÂÚ¯fiÌÂÓË Á¤ÓÓ·,ÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ ÊÚÔÓÙ›‰·, ÙÔÓ Û¯Â‰È·ÛÌfiÙË˜ ¿ÌÂÛË˜ È·ÙÚÈÎ‹˜ ÊÚÔÓÙ›‰·˜ ÛÙË ÓÂÔÁÓÈÎ‹ÂÚ›Ô‰Ô Î·È ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÂÂ›ÁÔ˘Û·Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÛÂ ÂÚ›ÙˆÛË ÂÌ‚Ú˘˚ÎÔ‡ÛÙÚÂ˜ (8). ÃÚËÛÈÌÂ‡ÂÈ, Â›ÛË˜, ÁÈ· ÙÔÓ ÂÓÙÔÈ-ÛÌfi ¿ÏÏˆÓ ·Û¯fiÓÙˆÓ ÌÂÏÒÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ-·˜. ŸÌˆ˜, Ë ÚÔÁÂÓÓËÙÈÎ‹ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹·Ú·Ì¤ÓÂÈ ‰‡ÛÎÔÏË ÏfiÁˆ ÙË˜ ÎÏÈÓÈÎ‹˜ ÔÈÎÈ-ÏÔÌÔÚÊ›·˜ Ô˘ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÛÙÔ Û‡Ó‰ÚÔ-ÌÔ, Î·ıfiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ê·ÈÓfiÙ˘-Ô˘-ÁÔÓfiÙ˘Ô˘ Î·È Ù· Û˘ÌÙÒÌ·Ù· ÔÈÎ›Ï-ÏÔ˘Ó ·Ó¿ÌÂÛ· ÛÙÔ Û‡Ó‰ÚÔÌÔ DiGeorge, ÙËÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË Î·È ÙÈ˜ ‹ÈÂ˜ Ì·ıËÛÈ·Î¤˜‰˘ÛÎÔÏ›Â˜. ∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÂÈÙÚ¤-ÂÈ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡-ÓÔ˘ Â·ÓÂÌÊ¿ÓÈÛË˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™Â ÂÚÈ-ÙÒÛÂÈ˜ de novo ÂÌÊ¿ÓÈÛË˜ ÛÂ ¤Ó· ·È‰›, ÔÎ›Ó‰˘ÓÔ˜ Â·ÓÂÌÊ¿ÓÈÛË˜ ÛÂ ÂfiÌÂÓÔ ·È‰› Â›-Ó·È 1-3%. ¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ ·ÎfiÌ· Î·ÈfiÙ·Ó Î·Ó¤Ó·˜ ·fi ÙÔ˘˜ ÁÔÓÂ›˜ ¿Û¯ÔÓÙÔ˜ ·È-‰ÈÔ‡ ‰ÂÓ Ê¤ÚÂÈ ÙÔ ¤ÏÏÂÈÌÌ·, ˘¿Ú¯ÂÈ ÌÈÎÚfi˜Î›Ó‰˘ÓÔ˜ Â·ÓÂÌÊ¿ÓÈÛË˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÂÂfiÌÂÓÔ ·È‰›, ÂÂÈ‰‹ ‰ÂÓ ÌÔÚÂ› Ó· ·Ô-ÎÏÂÈÛÙÂ› Ë ÂÚ›ÙˆÛË ÌˆÛ·˚ÎÈÛÌÔ‡ ÙˆÓ ÁÔÓ¿-‰ˆÓ (3,8,14).

∏ ÚÒÈÌË ‰È¿ÁÓˆÛË Â›Ó·È ÛËÌ·ÓÙÈÎ‹ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. øÛÙfiÛÔ, Â›-Ó·È ‰‡ÛÎÔÏÔ Ó· ÔÚÈÛÙÔ‡Ó ÎÚÈÙ‹ÚÈ· ÁÈ· ÙÔ fiÙÂı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ÁÈ· ¤ÏÏÂÈÌÌ· 22q11. FISH ·Ó¿Ï˘ÛË ÁÈ· ÙÔ Û‡Ó-‰ÚÔÌÔ Û˘ÛÙ‹ÓÂÙ·È ÛÂ fiÏ· Ù· ·È‰È¿ Ô˘ ¤¯Ô˘ÓÎ·Ú‰ÈÔ¿ıÂÈ· Ù‡Ô˘ ‰È·ÎÔ‹˜ ·ÔÚÙÈÎÔ‡ Ùfi-ÍÔ˘, ÙÂÙÚ·ÏÔÁ›·˜ Fallot Î·È ·ÚÙËÚÈ·ÎÔ‡ ÎÔÚ-ÌÔ‡ Ù‡Ô˘ II, Î·ıÒ˜ Î·È ÛÂ ‚Ú¤ÊË Ô˘ ÂÌÊ·-Ó›˙Ô˘Ó ·ÓÂÍ‹ÁËÙË, Â›ÌÔÓË ˘·Û‚ÂÛÙÈ·ÈÌ›· ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ÂÏ·ÙÙˆÌ¤ÓÔ ·ÚÈıÌfi ∆-Î˘ÙÙ¿-ÚˆÓ Î·È ‰˘ÛÌÔÚÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. ŒÓ‰ÂÈÍËÁÈ· FISH ·Ó¿Ï˘ÛË ·ÔÙÂÏÂ› Î·È Ë ·ÚÔ˘Û›·¤ÓÚÈÓË˜ ÔÌÈÏ›·˜ ÛÂ ·È‰È¿ Ô˘ ·Ú¯›˙Ô˘Ó Ó·Û˘ÏÏ·‚›˙Ô˘Ó ¯ˆÚ›˜ Ó· Û˘Ó˘¿Ú¯Ô˘Ó ¿ÏÏÂ˜Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ (4,10), Î·ıÒ˜ Î·È ÛÂ ·È-‰È¿ ÌÂ ÌË ÏÂÎÙÈÎ¤˜ (non-verbal) Ì·ıËÛÈ·Î¤˜‰˘ÛÎÔÏ›Â˜ (4,10).


1. Kasprzak L, Der Kaloustian VM, Elliott AM, ShevellM, Lejtenyi C, Eydoux P. Deletion of 22q11 in twobrothers with different phenotype. Am J Med Genet1998;75:288-291.

2. Hillebrand G, Siebert R, Simeoni E, Santer R. DiGe-orge syndrome with discordant phenotype inmonozygotic twins. J Med Genet 2000;37:E23.

3. Levy-Mozziconacci A, Piquet C, Heurtevin PC,Philip N. Prenatal diagnosis of 22q11 microdeletion.Prenat Diagn 1997;17:1033-1037.

4. McDonald-McGinn DM, Kirschner R, GoldmuntzE, Sullivan K, Eicher P, Gerdes M et al. The Philadel-phia story: the 22q11.2 deletion: report on 250 pa-tients. Genet Couns 1999;10:11-24.

5. Goodship J, Cross I, Scambler P, Burn J. Monozygot-ic twins with chromosome 22q11 deletion and dis-cordant phenotype. J Med Genet 1995;32:746-748.

6. Matsuoka R, Takao A, Kimura M, Imamura S, Kon-do C, Joh-o K et al. Confirmation that the conotrun-cal anomaly face syndrome is associated with a dele-tion within 22q11.2. Am J Med Genet 1994;53:285-289.

7. Davidson A, Khandelwal M, Punnett HH. Prenataldiagnosis of the 22q11 deletion syndrome. PrenatDiagn 1997;17:380-383.

8. Oh DC, Min JY, Lee MH, Kim YM, Park SY, WonHS et al. Prenatal diagnosis of tetralogy of Fallot as-sociated with chromosome 22q11 deletion. J KoreanMed Sci 2002;17:125-128.

9. Driscoll DA, Salvin J, Sellinger B, Budarf ML,McDonald-McGinn DM, Zackai EH et al. Preva-lence of 22q11 microdeletions in DiGeorge and ve-locardiofacial syndromes: implications for geneticcounselling and prenatal diagnosis. J Med Genet1993;30:813-817.

10. Goodship J, Cross I, LiLing J, Wren C. A populationstudy of chromosome 22q11 deletions in infancy.Arch Dis Child 1998;79:348-351.

11. Iserin L, de Lonlay P, Viot G, Sidi D, Kachaner J,Munnich A et al. Prevalence of the microdeletion22q11 in newborn infants with congenitalconotruncal cardiac anomalies. Eur J Pediatr 1998;157:881-884.

12. Cuneo BF, Driscoll DA, Gidding SS, Langman CB.Evolution of latent hypoparathyroidism in familial22q11 deletion syndrome. Am J Med Genet 1997;69:50-55.

13. Digilio MC, Marino B, Giannotti A, Dallapiccola B.Search for 22q11 deletion in non-syndromicconotruncal cardiac defects. Eur J Pediatr 1996;155:619-620.

14. Sitch FL, James RS, Cockwell AE, Hatchwell E. Gon-adal mosaicism for a submicroscopic deletion ofchromosome region 22q11. Eur J Hum Genet1996;4:59.

¶·È‰È·ÙÚÈÎ‹ 2005;68:372-375


376 CASE REPORT

1 Neonatology Department¡∏π, Hippokration GeneralHospital, Thessaloniki

2 Neonatology Department,University Hospital ofLarissa

3 Molecular Biology andCytogenetics Center,“Leto” Maternity Clinic,Athens

Correspondence:

Alexandros Andreou 15 Heimonidou Str. 551 33, Kalamaria, Thessaloniki ∂-mail: [email protected]



22q11.2 micro-deletion syndrome in a family

with variation in the phenotype.

Prenatal diagnosis

A. Andreou1, V. Alexandropoulou - Tsikrika2, A. Sakellaropoulou1, M. Goudesidou2, L. Florentin - Arar3

Abstract

A family is described in which chromosome deletion 22q11.2 was identified in three of its members,with a great heterogeneity in the phenotype. The mother had velo-pharyngeal insufficiency with nasalvoice, the third child had DiGeorge syndrome with severe congenital cardiopathy, hypocalcaemia,and aplasia of the thymus gland and died of severe sepsis, and the fourth child had micrognathia andtransient hypocalcaemia. The diagnosis was established first in the third child and subsequently in themother. On the fourth child the diagnosis was made prenatally, after amniocentesis. In all cases thediagnosis was made with the FISH technique.

Key words

22q11 deletion syndrome, familial appearance, prenatal diagnosis, FISH technique.


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¶·È‰È·ÙÚÈÎ‹ 2005;68:377-384

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378 ∂. ªÔ‡˙· Î·È Û˘Ó.

ÊÏÂÁÌÔÓÒ‰Ë ·¿ÓÙËÛË Ô˘ Ô‰ËÁÂ› ÛÂ ¯ÚfiÓÈ·

ÓfiÛÔ ÙˆÓ ÓÂ˘ÌfiÓˆÓ.

∏ ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ-

‰ÒÓ - Î·È Î˘Ú›ˆ˜ Ë ‰ÂÍ·ÌÂı·˙fiÓË - ¤¯ÂÈ ¯ÚËÛÈ-

ÌÔÔÈËıÂ› Â˘Ú¤ˆ˜ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÁÈ·

ÙËÓ ÚfiÏË„Ë Î·È ÙË ıÂÚ·Â›· ÙË˜ ¯ÚfiÓÈ·˜ Ófi-

ÛÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ, ÂÍ·ÈÙ›·˜ ÙË˜ ÈÛ¯˘Ú‹˜ ·ÓÙÈ-

ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰Ú¿ÛË˜ ÙË˜.

¶Èı·ÓÔ› ÌË¯·ÓÈÛÌÔ› ÙË˜ ‰Ú¿ÛË˜ ÙˆÓ ÎÔÚÙÈ-

ÎÔÛÙÂÚÔÂÈ‰ÒÓ ÛÙÔÓ ÓÂ‡ÌÔÓ· ÙÔ˘ ÓÂÔÁÓÔ‡ Â-

ÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·‡ÍËÛË ÙË˜ Û‡ÓıÂÛË˜ ÙÔ˘ ÂÈ-

Ê·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÙËÓ ·‡ÍËÛË ÙË˜

·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÙËÓ ·Ó·ÛÙÔÏ‹

ÙË˜ Û‡ÓıÂÛË˜ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ Î·È ÏÂ˘ÎÔÙÚÈÂ-

ÓÒÓ, ÙË ÌÂ›ˆÛË ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÈÓÔÌ¤ÓˆÓ

Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÙÈ˜ Î˘ÙÙ·ÚÔÎ›ÓÂ˜ ÛÙÔÓ

ÓÂ‡ÌÔÓ·, ÙË ÌÂ›ˆÛË ÙÔ˘ ‡‰·ÙÔ˜ ÛÙÔÓ ÓÂ‡ÌÔ-

Ó· Î·È ÙË ÌÂÈˆÌ¤ÓË ‰È·‚·ÙfiÙËÙ· ÙÔ˘ ÓÂ‡ÌÔÓ·.

∂›ÛË˜, ¤¯ÂÈ ‰ÂÈ¯ıÂ› fiÙÈ Ù· ÓÂÔÁÓ¿ Ô˘ ·Ó·-

Ù‡ÛÛÔ˘Ó ¯ÚfiÓÈ· ÓfiÛÔ ÙˆÓ ÓÂ˘ÌfiÓˆÓ, ¤¯Ô˘Ó

¯·ÌËÏ¿ Â›Â‰· ÎÔÚÙÈ˙fiÏË˜ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË

ÌÂ ACTH Î·Ù¿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ (2).

OÈ ·Ú¯ÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂ ‰ÂÍ·ÌÂı·˙fiÓË, ¤Ó·

ÈÛ¯˘Úfi Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰¤˜,

ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ¯ÚfiÓÈ· ÓfiÛÔ ÙˆÓ ÓÂ˘Ìfi-

ÓˆÓ, ¤‰ÂÈÍ·Ó ¿ÌÂÛË ‚ÂÏÙ›ˆÛË ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜

ÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·È ÙË˜ ·ÓÙ·ÏÏ·Á‹˜ ÙˆÓ ·ÂÚ›ˆÓ

Î·È ÌÂ›ˆÛË ÙË˜ ‰È¿ÚÎÂÈ·˜ ÂÍ¿ÚÙËÛË˜ ·fi ÙÔÓ

ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi. ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘

Î·È ÌÂ ÙËÓ ·˘ÍËÌ¤ÓË ÂÈ‚›ˆÛË ÙˆÓ ÂÍ·ÈÚÂÙÈÎ¿

ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ, ˘‹Ú¯Â Ì›· Ù¿ÛË ÁÈ· ÚÒÈ-

ÌË ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓË˜ ÛÂ ÓÂÔÁÓ¿ ÌÂ fiÏÔ

Î·È ÌÈÎÚfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Î·È ‰È¿ÚÎÂÈ·

Î‡ËÛË˜. ∆È˜ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂÎ·ÂÙ›Â˜, Ì›· ÏË-

ıÒÚ· ÌÂÏÂÙÒÓ Î·Ù¤ÏËÍÂ ÛÙÔ Û˘Ì¤Ú·ÛÌ· ÙË˜

Â˘ÓÔ˚Î‹˜ ‰Ú¿ÛË˜ ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ (3,4).

∆ÂÏÂ˘Ù·›· ˘¿Ú¯ÂÈ ¤ÓÙÔÓË ·ÓËÛ˘¯›· ÏfiÁˆ

ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Ô˘ ‰Â›¯ÓÔ˘Ó ¤Ó·Ó ·˘-

ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ‚Ï·‚ÒÓ ·fi Ù· ÎÔÚÙÈÎÔÂÈ‰‹

Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô,

ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁÎ¤Ê·ÏÔ Î·È ÙË ÓÂ˘ÚÔ·-

Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË. ∂Í·ÈÙ›·˜ ·˘ÙÒÓ ÙˆÓ ÌÂÏÂ-

ÙÒÓ, Ë ‰ÂÍ·ÌÂı·˙fiÓË ¤¯ÂÈ Á›ÓÂÈ ¤Ó· ·fi Ù· ÈÔ

·ÌÊÈÏÂÁfiÌÂÓ· Ê¿ÚÌ·Î· ÛÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÌÔÓ¿-

‰Â˜ ÂÓÙ·ÙÈÎ‹˜ ÓÔÛËÏÂ›·˜ ÓÂÔÁÓÒÓ.

¶ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó·

ªÂÏ¤ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ·Ó Èı·Ó¤˜

‰˘ÛÌÂÓÂ›˜ Ì·ÎÚÔÚfiıÂÛÌÂ˜ ÂÈ‰Ú¿ÛÂÈ˜ ÙË˜ ¯Ô-

Ú‹ÁËÛË˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÛÙÔÓ ·Ó·Ù˘ÛÛfi-

ÌÂÓÔ ÂÁÎ¤Ê·ÏÔ ·fi ÙÔ 1968. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿

ÂÚÈÂÏ¿Ì‚·Ó·Ó ÌÂ›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜, ÙÔ˘ ‚¿-ÚÔ˘˜ Î·È ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ DNA ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÛÂÂÓ‹ÏÈÎ· ÔÓÙ›ÎÈ·, ÛÙ· ÔÔ›· Â›¯·Ó ¯ÔÚËÁËıÂ›ÎÔÚÙÈÎÔÂÈ‰‹ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô (5).

∞ÚÁfiÙÂÚ·, ¿ÏÏÂ˜ ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Â›-ÛË˜ ÛÂ ÔÓÙ›ÎÈ·, ¤‰ÂÈÍ·Ó ‚Ï¿‚Ë ÛÙË Ì˘ÂÏÈÓÔ-Ô›ËÛË, ‰È·›ÚÂÛË Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ÓÂ˘-ÚÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘ Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙË Û˘Ó·-ÙÔÁ¤ÓÂÛË ÛÙÔÓ ÊÏÔÈfi, ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛËÎÔÚÙÈÎÔÂÈ‰ÒÓ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô (6,7).

¶ÚfiÛÊ·Ù·, ÛÂ ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜, fiÔ˘ÂÍÂÙ¿ÛÙËÎÂ Ë ÓÂ˘ÚÔÙÔÍÈÎfiÙËÙ· ÙˆÓ ÎÔÚÙÈÎÔ-ÛÙÂÚÔÂÈ‰ÒÓ, ·Ú·ÙËÚ‹ıËÎÂ fiÙÈ Ë ¤ÎıÂÛË ÓÂÔ-Á¤ÓÓËÙˆÓ ÔÓÙÈÎÒÓ ÛÂ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ‰ÂÍ·ÌÂ-ı·˙fiÓË˜ ÚÔ‹Á·ÁÂ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ÓÂ˘ÚÒÓ· ÌÂÙÔÓ ÌË¯·ÓÈÛÌfi ÙË˜ ·fiÙˆÛË˜ (8).

∂Ó‰Â›ÍÂÈ˜ ÛÙÔ ÓÂÔÁÓfi

ªÂÏ¤ÙÂ˜ ÛÂ ÓÂÔÁÓ¿ ¤‰ÂÈÍ·Ó ÙËÓ Â›‰Ú·ÛËÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ ÛÙËÓ ·‡ÍËÛË ÙË˜ ÂÚÈÌ¤-ÙÚÔ˘ ÎÂÊ·Ï‹˜, ÛÙÔÓ fiÁÎÔ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ÂÁÎÂÊ¿ÏÔ˘ Î·È ÛÂ ‚Ï¿‚Â˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, fiˆ˜Ê·›ÓÔÓÙ·È ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘.

∆ÚÂÈ˜ ÌÂÏ¤ÙÂ˜ (9,10,21) ¤‰ÂÈÍ·Ó ÌÂÈˆÌ¤ÓË·‡ÍËÛË ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ÎÂÊ·Ï‹˜ ÌÂÙ¿ ¯ÔÚ‹ÁË-ÛË ‰ÂÍ·ÌÂı·˙fiÓË˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô.

∂ÈÏ¤ÔÓ, ÛÂ ‰‡Ô ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ·Ú·ÙËÚ‹-ıËÎÂ Ì›· Ù¿ÛË ÚÔ˜ Û˘¯ÓfiÙÂÚÂ˜ ‚Ï¿‚Â˜ ÛÙÔ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘ ÛÂ ÓÂÔÁÓ¿ Ô˘¤Ï·‚·Ó ‰ÂÍ·ÌÂı·˙fiÓË (11,12).

∆¤ÏÔ˜, ÛÂ Ì›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË (13) ÌÂ ÙË¯Ú‹ÛË ÙË˜ ÔÛÔÙÈÎ‹˜ ÔÁÎÔÌÂÙÚÈÎ‹˜ ÙÚÈÛ‰È¿-ÛÙ·ÙË˜ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ÛÙËÓ ÙÂÏÂÈfi-ÌËÓË ˆÚÈÌfiÙËÙ·, ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹Â›ÙˆÛË ÙË˜ ÂÓ‰ÔÊÏ¤‚È·˜ ¯ÔÚ‹ÁËÛË˜ ‰ÂÍ·ÌÂ-ı·˙fiÓË˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ÛÙËÓ ·‡ÍËÛË ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘, Ô˘ ·ÊÔÚÔ‡ÛÂ Î˘Ú›ˆ˜ ÛÙË Ê·È¿ Ô˘-Û›·. O fiÁÎÔ˜ ÙË˜ ÊÏÔÈÒ‰Ô˘˜ Ê·È¿˜ Ô˘Û›·˜ ‹Ù·ÓÌÂÈˆÌ¤ÓÔ˜ Î·Ù¿ 35% Î·È Ô ÔÏÈÎfi˜ fiÁÎÔ˜ ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó ÌÂÈˆÌ¤ÓÔ˜ Î·Ù¿ 30% ÛÂ Úfiˆ-Ú· ÓÂÔÁÓ¿ ÛÙ· ÔÔ›· Â›¯Â ¯ÔÚËÁËıÂ› ‰ÂÍ·ÌÂı·-˙fiÓË ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ‰ÂÓÂ›¯·Ó Ï¿‚ÂÈ ‰ÂÍ·ÌÂı·˙fiÓË, Î·ıÒ˜ Î·È ÌÂ ÙÂÏÂÈ-fiÌËÓ· ÓÂÔÁÓ¿ Ô˘ ÂÏ‹ÊıËÛ·Ó ˆ˜ Ì¿ÚÙ˘ÚÂ˜.

∫ÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜

∏ ÚÒÙË ÎÏÈÓÈÎ‹ ÌÂÏ¤ÙË ÛÙËÓ ÔÔ›· ‰È·È-ÛÙÒıËÎÂ Ë ‚Ï·ÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ ‰ÂÍ·ÌÂı·-˙fiÓË˜ ÛÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË, ‰ËÌÔÛÈ-Â‡ıËÎÂ ÌfiÏÈ˜ ÙÔ 1998. ™ÙË ÌÂÏ¤ÙË ÙˆÓ Yeh Î·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:377-384


379∫ÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È ÓÂÔÁÓÈÎfi˜ ÂÁÎ¤Ê·ÏÔ˜

Û˘Ó (14), ¯ÔÚËÁ‹ıËÎÂ ‰ÂÍ·ÌÂı·˙fiÓË ÛÙ· ÓÂÔ-

ÁÓ¿ ÓˆÚ›˜ (<12 ÒÚÂ˜ ˙ˆ‹˜) Î·È ÁÈ· 28 ËÌ¤ÚÂ˜.

™ÙËÓ ËÏÈÎ›· ÙˆÓ 2 ÂÙÒÓ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ-

Î‹ ·‡ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ

ÚÔ‚ÏËÌ¿ÙˆÓ (ÔÛÔÛÙfi 40% ÛÙËÓ ÔÌ¿‰· ÙË˜

‰ÂÍ·ÌÂı·˙fiÓË˜ ¤Ó·ÓÙÈ 17% ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜).

¢‡Ô ¿ÏÏÂ˜ ÌÂÁ¿ÏÂ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤-

ÙÂ˜ ÙˆÓ O’Shea Î·È Û˘Ó (15) Î·È Shinwell Î·È Û˘Ó

(12) ¤‰ÂÈÍ·Ó ÙÈ˜ ‰˘ÛÌÂÓÂ›˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ‰Â-

Í·ÌÂı·˙fiÓË˜ ÛÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË.

™ÙË ÌÂÏ¤ÙË ÙˆÓ O’Shea Î·È Û˘Ó (15), ¯ÔÚË-

Á‹ıËÎÂ ‰ÂÍ·ÌÂı·˙fiÓË ÛÙ· ÓÂÔÁÓ¿ ·ÚÁ¿ (ÌÂÙ¿

ÙË 2Ë Â‚‰ÔÌ¿‰· ˙ˆ‹˜) Î·È ÁÈ· 42 ËÌ¤ÚÂ˜. ™ÙËÓ

ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ·ÚÔ˘Û›·˙·Ó ÛËÌ·ÓÙÈÎ¿

·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜

(ÔÛÔÛÙfi 25% ÛÙËÓ ÔÌ¿‰· ÙË˜ ‰ÂÍ·ÌÂı·˙fi-

ÓË˜ ÛÂ ·ÓÙ›ıÂÛË ÌÂ 7% ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜). ∂›-

ÛË˜, ·ÚÔ˘Û›·˙·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË Û˘-

¯ÓfiÙËÙ· ·ıÔÏÔÁÈÎ‹˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÍ¤Ù·ÛË˜

(ÔÛÔÛÙfi 45% ÛÙËÓ ÔÌ¿‰· ÙË˜ ‰ÂÍ·ÌÂı·˙fi-

ÓË˜ ÛÂ ·ÓÙ›ıÂÛË ÌÂ 16% ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜). ™Â

·˘Ù‹ ÙË ÌÂÏ¤ÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜

ÛÙËÓ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô

ÔÌ¿‰ˆÓ.

™ÙË ÌÂÏ¤ÙË ÙˆÓ Shinwell Î·È Û˘Ó (12), Ë ‰Â-

Í·ÌÂı·˙fiÓË ¯ÔÚËÁ‹ıËÎÂ ÛÙ· ÓÂÔÁÓ¿ ÓˆÚ›˜

(<12 ÒÚÂ˜ ˙ˆ‹˜) Î·È ÁÈ· Ì›· ‚Ú·¯Â›· ÂÚ›Ô‰Ô 3

ËÌÂÚÒÓ. ™ÙËÓ ËÏÈÎ›· ÙˆÓ 4ó ÂÙÒÓ, Ù· ·È‰È¿

·˘Ù¿ ·ÚÔ˘Û›·˙·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË Û˘-

¯ÓfiÙËÙ· ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ (49% ÛÙËÓ

ÔÌ¿‰· ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ Î·È 15% ÛÙÔ˘˜ Ì¿Ú-

Ù˘ÚÂ˜) Î·È „˘¯ÔÎÈÓËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ (55%

ÛÙËÓ ÔÌ¿‰· ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ Î·È 29% ÛÙÔ˘˜

Ì¿ÚÙ˘ÚÂ˜).

™Â Î·Ì›· ·fi ÙÈ˜ ·Ú·¿Óˆ ÌÂÏ¤ÙÂ˜ ‰ÂÓ

‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ

·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊË-

Ì· ÂÁÎÂÊ¿ÏÔ˘ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô. ™Â ‰‡Ô,

fiÌˆ˜, ·fi ·˘Ù¤˜ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ Ù¿-

ÛË ÁÈ· ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÂÚÈÎÔÈÏÈ·Î‹˜

ÏÂ˘ÎÔÌ·Ï¿Î˘ÓÛË˜ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ¯ÔÚËÁ‹ıË-

ÎÂ ‰ÂÍ·ÌÂı·˙fiÓË (12,15).

™Â ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ ·Ú·¿Óˆ ÌÂÏ¤ÙÂ˜, ÔÈ

Vincer (16) Î·È Jones (17) ¤‰ÂÈÍ·Ó Ì›· ÌË ÛËÌ·-

ÓÙÈÎ‹ ·‡ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜

·Ú¿Ï˘ÛË˜, ÂÓÒ ‰‡Ô ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜, ÙˆÓ

Cummings (18) Î·È Romagnoli (19), ¤‰ÂÈÍ·Ó

fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈÎ¤˜ Ì·ÎÚÔÚfiıÂ-

ÛÌÂ˜ ÂÈÙÒÛÂÈ˜ ·fi ÙË ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·-

˙fiÓË˜ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô. OÈ Romagnoli Î·È

Û˘Ó (19) ¯ÔÚ‹ÁËÛ·Ó ÙË ‰ÂÍ·ÌÂı·˙fiÓË ÓˆÚ›˜

(ÙËÓ 4Ë ËÌ¤Ú· ˙ˆ‹˜) Î·È ÁÈ· 7 ËÌ¤ÚÂ˜. ™ÙËÓ

ËÏÈÎ›· ÙˆÓ 3 ÂÙÒÓ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ÔÌ¿‰·

ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¤Ï·‚·Ó ‰ÂÍ·ÌÂı·˙fiÓË Î·È Ë

ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ Â›¯·Ó ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ·

ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜, ÓÔËÙÈÎÔ‡ ËÏ›ÎÔ˘

Î·È ÛÔ‚·ÚÒÓ ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·ÎÒÓ ÚÔ‚ÏËÌ¿-

ÙˆÓ. ∂›ÛË˜, ÔÈ ‰‡Ô ÔÌ¿‰Â˜ Â›¯·Ó ÙËÓ ›‰È· Û˘-

¯ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ˘ÂÚË¯Ô-

ÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘. OÈ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ÌÂÏ¤-

ÙÂ˜ ıÂˆÚ‹ıËÎÂ fiÙÈ ‰ÂÓ Â›¯·Ó ·ÚÎÂÙ‹ ÛÙ·ÙÈÛÙÈ-

Î‹ ÈÛ¯‡, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ

Ô˘ Û˘ÌÌÂÙÂ›¯·Ó (20).

¡Â˘ÚÔ·Ó·Ù˘ÍÈ·Î¤˜ ÂÎÙÈÌ‹ÛÂÈ˜ ·È‰ÈÒÓ

Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÂ ÌÂÏ¤ÙÂ˜ ¯ÔÚ‹ÁËÛË˜ ‰ÂÍ·-

ÌÂı·˙fiÓË˜, Û˘ÓÂ¯›˙ÔÓÙ·È ·fi ‰È¿ÊÔÚÂ˜ ÔÌ¿‰Â˜

ÂÚÂ˘ÓËÙÒÓ. O Yeh, Ô˘ ‹Ù·Ó Ô ÚÒÙÔ˜ Ô˘

‰È·›ÛÙˆÛÂ ÙÈ˜ ÚÒÈÌÂ˜ ÂÈÙÒÛÂÈ˜ ·fi ÙË ¯Ô-

Ú‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓË˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ Â-

Ú›Ô‰Ô ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 2 ÂÙÒÓ, ÛÂ Ì›· Úfi-

ÛÊ·ÙË ÌÂÏ¤ÙË ÂÎÙ›ÌËÛÂ Ù· ›‰È· ·È‰È¿ ÛÂ Û¯Ô-

ÏÈÎ‹ ËÏÈÎ›· (21). ∏ Û˘¯ÓfiÙËÙ· ·ıÔÏÔÁÈÎÒÓ

ÓÂ˘ÚÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙË ÌÂÏ¤ÙË ·˘Ù‹

‹Ù·Ó ·˘ÍËÌ¤ÓË ÛÙËÓ ÔÌ¿‰· ÙË˜ ‰ÂÍ·ÌÂı·˙fi-

ÓË˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∆· ·È‰È¿ ÛÙ·

ÔÔ›· Â›¯Â ¯ÔÚËÁËıÂ› ‰ÂÍ·ÌÂı·˙fiÓË Â›¯·Ó ¯ÂÈ-

ÚfiÙÂÚË Â›‰ÔÛË ÛÙÈ˜ ‰ÂÍÈfiÙËÙÂ˜ Ô˘ ·ÊÔÚÔ‡-

Û·Ó ÛÙË ¯Ú‹ÛË ÙˆÓ ¯ÂÚÈÒÓ, ÛÙÔ ·È¯Ó›‰È ÌÂ ÙË

Ì¿Ï· Î·È ÛÙËÓ ÈÛÔÚÚÔ›· ÛÙÔ Movement ABC

test ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∂ÈÏ¤ÔÓ, Â›-

¯·Ó ¯ÂÈÚfiÙÂÚÔ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ, ÔÙÈ-

Î‹ ·ÓÙ›ÏË„Ë Î·È ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi,

Î·ıÒ˜ Î·È ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÔ ÔÏÈÎfi ÓÔËÙÈ-

Îfi ËÏ›ÎÔ, ÏÂÎÙÈÎfi ÓÔËÙÈÎfi ËÏ›ÎÔ Î·È ÓÔËÙÈÎfi

ËÏ›ÎÔ Ô˘ ·ÊÔÚÔ‡ÛÂ ÛÙËÓ ·fi‰ÔÛË. ∞˘Ù‹ Ë

‰È·ÊÔÚ¿ ÛÙÔ ÓÔËÙÈÎfi ËÏ›ÎÔ ‰ÂÓ Â›¯Â ‚ÚÂıÂ› ÛÂ

ÌÈÎÚfiÙÂÚË ËÏÈÎ›·. ∆· ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ ÙË˜

‰ÂÍ·ÌÂı·˙fiÓË˜ Â›¯·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË

‚·ıÌÔÏÔÁ›· ÛÙ· Ì·ıËÌ·ÙÈÎ¿ Î·È ÙË ÁÚ·ÌÌ·ÙÈ-

Î‹ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∏ ‰˘ÛÌÂÓ‹˜

ÂÍ¤ÏÈÍË ÛÙÈ˜ ÁÓˆÛÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Û˘Û¯ÂÙ›-

ÛÙËÎÂ ÌÂ ÌÂÈˆÌ¤ÓË ·‡ÍËÛË ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ÎÂ-

Ê·Ï‹˜ (21).

∞Ó·ÛÎÔ‹ÛÂÈ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ

O Barrington (22), ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÎÙÈÌ‹-

ÛÂÈ ÌÂ ÌÂÁ·Ï‡ÙÂÚË ·ÎÚ›‚ÂÈ· ÙÔ Èı·Ófi Ì¤ÁÂıÔ˜

ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙˆÓ ÂÈÙÒÛÂˆÓ ÙË˜ ‰ÂÍ·-

ÌÂı·˙fiÓË˜ ÛÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË,

Ú·ÁÌ·ÙÔÔ›ËÛÂ Ì›· Û˘ÛÙËÌ·ÙÈÎ‹ ·Ó·ÛÎfiË-

ÛË ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ Ô˘ Â›¯·Ó

‰ËÌÔÛÈÂ˘ıÂ› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∆Ô ·ÔÙ¤ÏÂÛÌ·

ÙË˜ ÌÂÙ·-·Ó¿Ï˘ÛË˜ ¤‰ÂÈÍÂ fiÙÈ Ë ıÂÚ·Â›· ÌÂ

ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô

¶·È‰È·ÙÚÈÎ‹ 2005;68:377-384


380 ∂. ªÔ‡˙· Î·È Û˘Ó.

Û¯ÂÙ›˙ÂÙ·È ÌÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ Û˘¯ÓfiÙË-

Ù·˜ ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ Î·È ÙË˜ „˘¯Ô-

ÎÈÓËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜.

O Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË

ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ Ô˘ ÂÍ¿ÁÂÙ·È ·fi ÌÂ-

Ï¤ÙÂ˜ ÌÂ contamination <30% Â›Ó·È 2,86 (95%

CI 1,95, 4,19). O Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌ-

Ê¿ÓÈÛË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·ÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ·fi

ÌÂÏ¤ÙÂ˜ ÌÂ ÚfiÛÌÈÍË (contamination) <30%

Â›Ó·È 1,66 (95%CI 1,26, 2,19).

∞fi ·˘Ù‹ ÙËÓ ˘ÔÔÌ¿‰· ÙˆÓ ÌÂÏÂÙÒÓ ÂÍ¿-

ÁÂÙ·È ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ Úfiˆ-

ÚˆÓ ÓÂÔÁÓÒÓ, ÛÙ· ÔÔ›· Ú¤ÂÈ Ó· ¯ÔÚËÁËıÂ›

ıÂÚ·Â˘ÙÈÎ¿ ‰ÂÍ·ÌÂı·˙fiÓË ÁÈ· Ó· ¤¯Ô˘ÌÂ ¤Ó·

·ÎfiÌË ·È‰› ÌÂ ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË (Number

needed to harm - NNH), Â›Ó·È 7. °È· Ó· ¤¯Ô˘ÌÂ

¤Ó· ·ÎfiÌË ·È‰› ÌÂ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î¿ ÚÔ‚Ï‹-

Ì·Ù·, Ô NNH Â›Ó·È 11. O Barrington Î·Ù·Ï‹ÁÂÈ

fiÙÈ Ë ̄ ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÁÈ· ÙËÓ Úfi-

ÏË„Ë Î·È ıÂÚ·Â›· ÙË˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ‰˘-

ÛÏ·Û›·˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô Û˘Ó‰¤ÂÙ·È

ÌÂ ‰Ú·Ì·ÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ

ÚÔ‚ÏËÌ¿ÙˆÓ Î·È Û˘ÓÈÛÙ¿ Ó· ÂÁÎ·Ù·ÏÂÈÊıÂ› Ë

¯Ú‹ÛË ÙÔ˘˜.

OÈ Halliday Î·È Û˘Ó ·Ó·ÛÎfiËÛ·Ó 37 Ù˘¯·È-

ÔÔÈËÌ¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÂÓ‰ÔÊÏ¤‚È·˜ ¯Ô-

Ú‹ÁËÛË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ ÛÂ 3 ‰È·ÊÔÚÂÙÈÎ¤˜

ÂÚÈfi‰Ô˘˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·: ÓˆÚ›˜

(<96 ÒÚÂ˜ ˙ˆ‹˜) (23), Û¯ÂÙÈÎ¿ ÓˆÚ›˜ (7Ë-14Ë

ËÌ¤Ú· ˙ˆ‹˜) (24) Î·È ·ÚÁ¿ (>3 Â‚‰ÔÌ¿‰Â˜ ˙ˆ-

‹˜) (25). ™Â ·˘Ù¤˜ ÙÈ˜ ÙÚÂÈ˜ ÌÂÙ·-·Ó·Ï‡ÛÂÈ˜

ÂÎÙÈÌ‹ıËÎÂ ÙÔ fiÊÂÏÔ˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÎfiÛÙÔ˜

ÙË˜ ¯ÔÚ‹ÁËÛË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜. ¶·Ú·ÙËÚ‹ıË-

ÎÂ ‚Ú·¯˘ÚfiıÂÛÌË ‚ÂÏÙ›ˆÛË ÙË˜ ·ÓÙ·ÏÏ·Á‹˜

ÙˆÓ ·ÂÚ›ˆÓ Î·È ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÓÂ˘Ìfi-

ÓˆÓ Î·È Ù·¯‡ÙÂÚË ·Ô‰¤ÛÌÂ˘ÛË ·fi ÙÔÓ ·Ó·-

ÓÂ˘ÛÙ‹Ú· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓË˜

ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈfi‰Ô˘˜. ∂›ÛË˜, ‚Ú¤ıËÎÂ ÌÂ›ˆ-

ÛË ÙË˜ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÛÙË

“ÓˆÚ›˜” Î·È ÙË “Û¯ÂÙÈÎ¿ ÓˆÚ›˜” ıÂÚ·Â›·. ∆¤-

ÏÔ˜, ÛËÌÂÈÒıËÎÂ ÌÂ›ˆÛË ÙË˜ ÓÂÔÁÓÈÎ‹˜ ıÓËÛÈ-

ÌfiÙËÙ·˜ ÌfiÓÔ ÛÙË Û¯ÂÙÈÎ¿ ÓˆÚ›˜ ¯ÔÚ‹ÁËÛË ÌÂ

¤Ó·Ó ÂÈÏ¤ÔÓ ÂÈ˙ÒÓÙ· ÁÈ· Î¿ıÂ 16 ÓÂÔÁÓ¿

ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ ‰ÂÍ·ÌÂı·˙fiÓË. ∏ ‰Â-

Í·ÌÂı·˙fiÓË Ô˘ ¯ÔÚËÁÂ›Ù·È Â›ÙÂ ÓˆÚ›˜, Â›ÙÂ

·ÚÁ¿ ‰ÂÓ ÂËÚÂ¿˙ÂÈ ÙËÓ ÂÈ‚›ˆÛË. ÕÌÂÛÂ˜ ÂÈ-

ÏÔÎ¤˜, fiˆ˜ ·‡ÍËÛË ÙË˜ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙÔ

ÂÙÈÎfi, ‰È¿ÙÚËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ (Ô˘ Û˘Ì‚·›-

ÓÂÈ Î˘Ú›ˆ˜ ÛÙË ÓˆÚ›˜ ¯ÔÚ‹ÁËÛË), ˘ÂÚÁÏ˘Î·È-

Ì›·, ˘¤ÚÙ·ÛË, ˘ÂÚÙÚÔÊÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿-

ıÂÈ· Î·È Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜ ‹Ù·Ó ÙÔ

ÎfiÛÙÔ˜ ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈfi‰Ô˘˜.

O Î›Ó‰˘ÓÔ˜ Ì·ÎÚÔÚfiıÂÛÌË˜ ·ıÔÏÔÁÈÎ‹˜

ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÍ¤Ù·ÛË˜ Î·È ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿-

Ï˘ÛË˜ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ˜, ·Ó Î·È Ë ÌÂ-

ıÔ‰ÔÏÔÁ›· ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ‹Ù·Ó ¿-

ÓÙ· ÈÎ·ÓÔÔÈËÙÈÎ‹ Î·È Ù· ·È‰È¿ ÂÎÙÈÌ‹ıËÎ·Ó

Î˘Ú›ˆ˜ ÚÈÓ ·fi ÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·.

§fiÁˆ ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Èı·Ó¤˜

‚Ú·¯˘ÚfiıÂÛÌÂ˜ Î·È Ì·ÎÚÔÚfiıÂÛÌÂ˜ ÂÈ-

ÏÔÎ¤˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ Èı·Ófi ‚Ú·¯˘ÚfiıÂ-

ÛÌÔ fiÊÂÏÔ˜, ÔÈ Halliday Î·È Û˘Ó Û˘ÓÈÛÙÔ‡Ó fiÙÈ

Ë ‰ÂÍ·ÌÂı·˙fiÓË ‰ÂÓ Ú¤ÂÈ ÔÙ¤ Ó· ¯ÔÚËÁÂ›-

Ù·È ÓˆÚ›˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙË˜ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘

ÙˆÓ ÓÂ˘ÌfiÓˆÓ. ¶Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÌfiÓÔ

Û¯ÂÙÈÎ¿ ÓˆÚ›˜, ‰ËÏ·‰‹ ÌÂÙ·Í‡ 7Ë˜-14Ë˜ ËÌ¤-

Ú·˜ Î·È Ú¤ÂÈ Ó· ‰È·Ê˘Ï¿ÛÛÂÙ·È ÌfiÓÔ ÁÈ· ÓÂ-

ÔÁÓ¿ Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ô‰ÂÛÌÂ˘ÙÔ‡Ó ·fi

ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú·, ÂÓÒ Ë ‰fiÛË Î·È Ë ‰È¿ÚÎÂÈ·

ÙË˜ ıÂÚ·Â›·˜ Ú¤ÂÈ Ó· Â›Ó·È ÔÈ ÂÏ¿¯ÈÛÙÂ˜

‰˘Ó·Ù¤˜.

¶ÚfiÛÊ·Ù·, Ë American Academy of Pedia-

trics Î·È Ë Canadian Pediatric Society (26) ·Ó·-

ÛÎfiËÛ·Ó ÙÈ˜ ÂÓ‰Â›ÍÂÈ˜ ÙË˜ Â›ÙˆÛË˜ ÙË˜ ¯Ô-

Ú‹ÁËÛË˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹

ÂÚ›Ô‰Ô - Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·ÒÙÂ-

ÚˆÓ ÂÈÏÔÎÒÓ ÛÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈ-

ÍË - Î·È ¤Î·Ó·Ó ÙÈ˜ ·ÎfiÏÔ˘ıÂ˜ Û˘ÛÙ¿ÛÂÈ˜:

·) ∏ Û˘ÛÙËÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊÏ¤‚È·˜

‰ÂÍ·ÌÂı·˙fiÓË˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ‹ ÙË ıÂÚ·-

Â›· ÙË˜ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÛÙ·

ÚfiˆÚ· ÓÂÔÁÓ¿ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È.

‚) ∏ ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊÏ¤‚È·˜ ‰ÂÍ·ÌÂı·˙fi-

ÓË˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ‹ ÙË ıÂÚ·Â›· ÙË˜ ¯Úfi-

ÓÈ·˜ ÓfiÛÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ Ú¤ÂÈ Ó· ÂÚÈÔÚ›-

˙ÂÙ·È ÛÂ Î·Ï¿ Û¯Â‰È·ÛÌ¤ÓÂ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜

ÌÂÏ¤ÙÂ˜ ÌÂ Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË.

Á) ∏ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÎÙ›ÌËÛË ÙˆÓ ÓÂÔ-

ÁÓÒÓ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÂ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂ-

Ï¤ÙÂ˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ ÂÓı·ÚÚ‡ÓÂÙ·È ıÂÚÌ¿.

‰) ∂›Ó·È ·Ó·ÁÎ·›Ô Ó· Á›ÓÔ˘Ó ÎÏÈÓÈÎ¤˜ Ù˘¯·È-

ÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ ¿ÏÏ· ÂÓ‰ÔÊÏ¤‚È· ‹ ÂÈ-

ÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹.

Â) ∂ÎÙfi˜ ·fi ÙÈ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜,

Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Ú¤ÂÈ

Ó· ÂÚÈÔÚ›˙ÂÙ·È ÛÂ È‰È·›ÙÂÚÂ˜ ÎÏÈÓÈÎ¤˜ ÂÚÈ-

ÙÒÛÂÈ˜ Î·È ÔÈ ÁÔÓÂ›˜ ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚÒ-

ÓÔÓÙ·È Ï‹Úˆ˜ Î·È Ó· Û˘ÌÊˆÓÔ‡Ó ÁÈ· ÙË ıÂ-

Ú·Â›·.

∂Ó·ÏÏ·ÎÙÈÎ¿ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, ˘¿Ú¯Ô˘Ó ÈÛ¯˘Ú¤˜ ÂÓ-

‰Â›ÍÂÈ˜ fiÙÈ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘

ÙˆÓ ÓÂ˘ÌfiÓˆÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ÊÏÂÁÌÔÓÒ‰ÂÈ˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:377-384



·Ú¿ÁÔÓÙÂ˜. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ÂÓ‰ÂÈÎÓ˘fiÌÂÓË

ıÂÚ·Â›· Â›Ó·È Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ∏ ‰ÂÍ·ÌÂ-

ı·˙fiÓË Â›Ó·È ¤Ó· ÈÛ¯˘Úfi ·ÓÙÈÊÏÂÁÌÔÓÒ‰Â˜ ÎÔÚ-

ÙÈÎÔÂÈ‰¤˜. OÈ Ê·ÚÌ·ÎÔÏÔÁÈÎ¤˜ ‰fiÛÂÈ˜ Ô˘ Û˘-

¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ Î·È ÛÙËÓ

Î·ı’ ËÌ¤Ú· Ú¿ÍË Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 10-

15 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ËÌÂ-

Ú‹ÛÈ·˜ ¤ÎÎÚÈÛË˜ ÙË˜ ÎÔÚÙÈ˙fiÏË˜ ÛÙÔ ÓÂÔÁÓfi.

∂›ÛË˜, Ô ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ ÙË˜ Â›Ó·È ·-

Ú·ÙÂÙ·Ì¤ÓÔ˜ ÛÙ· ÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜

Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿. À„ËÏ¿ Â›Â‰· ‰ÂÍ·ÌÂı·˙fi-

ÓË˜ ÌÔÚÂ› Ó· ·˘Í¿ÓÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈ-

ÏÔÎÒÓ.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ‰È¿ÊÔÚ· ÌfiÚÈ· ÙˆÓ ÎÔÚ-

ÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎ‹ ‰Ú¿ÛË. ∏

‰È·ÊÔÚÂÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ

ÂÍËÁÂ›Ù·È ÌÂ ÙË ıÂˆÚ›· ÙË˜ ÁÔÓÈ‰È·Î‹˜ - ÌË ÁÔ-

ÓÈ‰È·Î‹˜ ‰Ú¿ÛË˜. ∂›ÛË˜, ÔÈ ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÈ-

ÙÒÛÂÈ˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÎÔÚÙÈÎÔÂÈ‰ÒÓ ÛÙÔÓ

·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁÎ¤Ê·ÏÔ ¤¯Ô˘Ó ‰ÂÈ¯ıÂ› ÂÈ-

Ú·Ì·ÙÈÎ¿.

¶ÈÛÙÂ‡ÂÙ·È fiÙÈ Ù· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰‹ ‰ÚÔ˘Ó

Ì¤Ûˆ ÁÔÓÈ‰È·ÎÒÓ - ÌË ÁÔÓÈ‰È·ÎÒÓ ÌË¯·ÓÈÛÌÒÓ

(27). ªÂ ÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ÁÔÓÈ‰È·ÎÔ‡˜ ÌË¯·ÓÈ-

ÛÌÔ‡˜, Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ÂÚÓÔ‡Ó Ì¤Û· ·fi

ÙË ÌÂÌ‚Ú¿ÓË ÙÔ˘ Î˘ÙÙ¿ÚÔ˘, Û˘Ó‰¤ÔÓÙ·È ÛÂ ÂÈ‰È-

Î¤˜ ı¤ÛÂÈ˜ ÌÂ ÙÔ DNA, ·ÏÏËÏÂÈ‰ÚÔ‡Ó ÌÂ ˘ÚË-

ÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÌÂÙ·ÁÚ·Ê‹˜ (transcription

factors) Î·È ÚÔÎ·ÏÔ‡Ó ÌÂÙ·ÁÚ·Ê‹ ÙÔ˘ ÁÔÓÈ‰›Ô˘

(gene transcription).

ŸÙ·Ó Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ‰ÚÔ˘Ó Ì¤Ûˆ ÁÔ-

ÓÈ‰È·ÎÒÓ ÌË¯·ÓÈÛÌÒÓ, ¯ÚÂÈ¿˙ÔÓÙ·È ÙÔ˘Ï¿¯È-

ÛÙÔÓ 30 min Î·È Û˘¯Ó¿ ·ÚÎÂÙ¤˜ ÒÚÂ˜ ÁÈ·

Ó· ·Ú¯›ÛÔ˘Ó Ó· ‰ÚÔ˘Ó. ªÂ ÙÔ˘˜ ÌË ÁÔÓÈ‰È·-

ÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜, Ë ‰Ú¿ÛË ÙÔ˘˜ ·Ú¯›˙ÂÈ ÔÏ‡

ÈÔ ÁÚ‹ÁÔÚ·, Ì¤Û· ÛÂ ‰Â˘ÙÂÚfiÏÂÙ· ¤ˆ˜ Ï›Á·

ÏÂÙ¿. ∆· ÎÔÚÙÈÎÔÂÈ‰‹ ÌÂÙ·‚¿ÏÏÔ˘Ó ÙÈ˜ È‰Èfi-

ÙËÙÂ˜ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ Î·È ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ

Â›ÛÔ‰Ô Na Î·È Ca Ì¤Ûˆ ÙË˜ ÌÂÌ‚Ú¿ÓË˜, Ô˘

¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛË ÙÔ˘ ÂÓ‰ÔÎ˘Ù-

Ù¿ÚÈÔ˘ Ca.

∂›Ó·È ¯Ú‹ÛÈÌË Ë ÁÓÒÛË ÙË˜ Û¯ÂÙÈÎ‹˜ ÈÛ¯‡Ô˜

ÙˆÓ ‰È·ÊfiÚˆÓ ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰ÒÓ, fiÛÔÓ ·ÊÔÚ¿

ÛÙË ÁÔÓÈ‰È·Î‹ Î·È ÛÙË ÌË ÁÔÓÈ‰È·Î‹ ‰Ú¿ÛË. ∞fi

Ù· Û˘Ó‹ıˆ˜ ̄ ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ-

‰‹, ÙË ÌÂÁ·Ï‡ÙÂÚË Û¯ÂÙÈÎ‹ ÈÛ¯‡ - ÛÂ Û¯¤ÛË ÌÂ

·˘Ù‹ ÙË˜ ÚÂ‰ÓÈ˙ÔÏfiÓË˜ - ˆ˜ ÚÔ˜ ÙË ÁÔÓÈ‰È·Î‹

‰Ú¿ÛË, ¤¯Ô˘Ó Ë ‰ÂÍ·ÌÂı·˙fiÓË Î·È Ë ‚ËÙ·ÌÂı·-

˙fiÓË, Ë ÔÔ›· Â›Ó·È 6,25 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·˘-

Ù‹˜ ÙË˜ ÚÂ‰ÓÈ˙ÔÏfiÓË˜. ∆Ë ÌÂÁ·Ï‡ÙÂÚË Û¯ÂÙÈÎ‹

ÈÛ¯‡ ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›ÓË ÙË˜ ÚÂ‰ÓÈ˙ÔÏfiÓË˜ ˆ˜

ÚÔ˜ ÙË ÌË ÁÔÓÈ‰È·Î‹ ‰Ú¿ÛË ¤¯ÂÈ Ë ‰ÂÍ·ÌÂı·˙fi-

ÓË, Ë ÔÔ›· Â›Ó·È 2,9 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË, ÂÓÒ ÙË

ÌÈÎÚfiÙÂÚË ¤¯ÂÈ Ë ‚ËÙ·ÌÂı·˙fiÓË, Ë ÔÔ›· Â›Ó·È

0,56 ÊÔÚ¤˜ Ë ‰Ú¿ÛË ÙË˜ ÚÂ‰ÓÈ˙ÔÏfiÓË˜.

™‹ÌÂÚ·, ˘¿Ú¯ÂÈ Û¯ÂÙÈÎ‹ ·‚Â‚·ÈfiÙËÙ· ˆ˜

ÚÔ˜ ÙÔ Â›‰Ô˜ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Ô˘ ı·

¯ÚËÛÈÌÔÔÈËıÔ‡Ó. °È· ÂÓ‰ÔÊÏ¤‚È· ıÂÚ·Â›· ÌÂ

ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ÛÂ ÌÂÁ¿ÏÂ˜ ‰fiÛÂÈ˜ ıÂˆÚËÙÈ-

Î¿ Â›Ó·È ÚÔÙÈÌfiÙÂÚË Ì›· ÈÛÔÚÚÔ›· ÌÂÙ·Í‡ ÁÔ-

ÓÈ‰È·Î‹˜ - ÌË ÁÔÓÈ‰È·Î‹˜ ‰Ú¿ÛË˜. ÀÂÈÛ¤Ú¯Ô-

ÓÙ·È, fiÌˆ˜, ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ë ÂÈı˘ÌËÙ‹ Ù·-

¯‡ÙËÙ· ‰Ú¿ÛË˜, ÔfiÙÂ ÚÔÙÈÌÒÓÙ·È Ô˘Û›Â˜ ÌÂ

ÈÛ¯˘ÚfiÙÂÚË ÌË ÁÔÓÈ‰È·Î‹ ‰Ú¿ÛË ‹ ÔÈ ÂÈÏÔÎ¤˜

ÙˆÓ ‰È·ÊfiÚˆÓ Ô˘ÛÈÒÓ.

ÕÏÏÔ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÈ-

ÏÔÁ‹ ÙÔ˘ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰Ô‡˜ Ô˘ ı· ¯ÚËÛÈÌÔ-

ÔÈËıÂ›, ˘‹ÚÍÂ ÌÂÙ¿ ÙË ÌÂÏ¤ÙË ÙˆÓ Baud Î·È

Û˘Ó (8), fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÓÂ˘ÚÔÙÔÍÈÎfiÙËÙ· ÙˆÓ

‰È·ÊfiÚˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÛÙÔÓ ·Ó·Ù˘Û-

ÛfiÌÂÓÔ ÂÁÎ¤Ê·ÏÔ ÙÔ˘ ÔÓÙÈÎÔ‡.

™ÙÈ˜ in vitro ÌÂÏ¤ÙÂ˜ Î·ÏÏÈÂÚÁ‹ıËÎ·Ó ÓÂ˘-

ÚÒÓÂ˜ ÙÔ˘ ÊÏÔÈÔ‡ ·fi ¤Ì‚Ú˘· ÔÓÙ›ÎÈ·, Î·-

ıÒ˜ Î·È ·ÛÙÚÔÎ‡ÙÙ·Ú· ·fi ÓÂÔÁ¤ÓÓËÙ· ÔÓÙ›-

ÎÈ·, ÛÂ ˘ÏÈÎfi Ô˘ ÂÚÈÂ›¯Â ÛÎÂ‡·ÛÌ· ÙË˜ ‰Â-

Í·ÌÂı·˙fiÓË˜ (Ô˘ ÂÚÈÂ›¯Â ÛÔ˘ÏÊ›‰È· ˆ˜ Û˘-

ÓÙËÚËÙÈÎfi), ÛÎÂ‡·ÛÌ· ÙË˜ ‚ËÙ·ÌÂı·˙fiÓË˜,

Î·ı·Ú‹ ‰ÂÍ·ÌÂı·˙fiÓË, Î·ı·Ú‹ ‚ËÙ·ÌÂı·˙fiÓË

‹ ÌfiÓÔ ÛÔ˘ÏÊ›‰È·. ∆· Î‡ÙÙ·Ú· Î·ÏÏÈÂÚÁ‹ıË-

Î·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜, Î·ıÒ˜ Î·È ˘fi

ÙËÓ Â›‰Ú·ÛË ÓÂ˘ÚÔÙÔÍÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‹

˘ÔÍ›·˜.

µÚ¤ıËÎÂ fiÙÈ Ë ‚ÈˆÛÈÌfiÙËÙ· ÙˆÓ ÓÂ˘ÚÒÓˆÓ

‰ÂÓ ÂËÚÂ·˙fiÙ·Ó ·fi ÙËÓ Î·ı·Ú‹ ‰ÂÍ·ÌÂı·-

˙fiÓË, ÙËÓ Î·ı·Ú‹ ‚ËÙ·ÌÂı·˙fiÓË ‹ ÙÔ ÛÎÂ‡·-

ÛÌ· ÙË˜ ‚ËÙ·ÌÂı·˙fiÓË˜, ÂÓÒ ÙÔ ÛÎÂ‡·ÛÌ· ÙË˜

‰ÂÍ·ÌÂı·˙fiÓË˜ ‹ Ù· ÛÔ˘ÏÊ›‰È· ÂÈÙ¿¯˘Ó·Ó ÙÔÓ

ı¿Ó·ÙÔ ÙÔ˘ ÓÂ˘ÚÒÓ·. ∏ Î·ı·Ú‹ ‰ÂÍ·ÌÂı·˙fiÓË

Î·È Ë Î·ı·Ú‹ ‚ËÙ·ÌÂı·˙fiÓË ÂÏ¿ÙÙˆÓ·Ó Î·Ù¿

40-50% ÙÔÓ ı¿Ó·ÙÔ ÙˆÓ ÓÂ˘ÚÒÓˆÓ Ô˘ ÚÔÎ·-

ÏÔ‡ÓÙ·Ó ·fi ÓÂ˘ÚÔÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜

ÙÔ ¡-methyl-D-asparate (NMDA) Î·È Ë ˘ÔÍ›·,

ÂÓÒ ÙÔ ÛÎÂ‡·ÛÌ· ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ ‰ÂÓ ÌÂ›-

ˆÓÂ ÙÔÓ ı¿Ó·ÙÔ ÙˆÓ ÓÂ˘ÚÒÓˆÓ Ô˘ ÚÔÎ·ÏÔ‡-

ÓÙ·Ó ·fi ÙÔ˘˜ ÓÂ˘ÚÔÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ‹

ÙËÓ ˘ÔÍ›·. ∆¤ÏÔ˜, Ù· ÛÔ˘ÏÊ›‰È· ·‡Í·Ó·Ó ÛË-

Ì·ÓÙÈÎ¿ ÙËÓ ÙÔÍÈÎfiÙËÙ· ÙˆÓ ÓÂ˘ÚÔÙÔÍÈÎÒÓ ·-

Ú·ÁfiÓÙˆÓ.

™ÙË Û˘Ó¤¯ÂÈ·, ÛÙÈ˜ in vivo ÌÂÏ¤ÙÂ˜, ÔÈ ÂÚÂ˘-

ÓËÙ¤˜ ¤Î·Ó·Ó ¤Á¯˘ÛË ÛÎÂ˘¿ÛÌ·ÙÔ˜ ÙË˜ ‰ÂÍ·-

ÌÂı·˙fiÓË˜, ÛÎÂ˘¿ÛÌ·ÙÔ˜ ÙË˜ ‚ËÙ·ÌÂı·˙fiÓË˜,

Î·ı·Ú‹˜ ‰ÂÍ·ÌÂı·˙fiÓË˜, Î·ı·Ú‹˜ ‚ËÙ·ÌÂı·-

˙fiÓË˜ Î·È ÛÔ˘ÏÊÈ‰›ˆÓ ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ ÛÂ ÓÂÔ-

Á¤ÓÓËÙ· ÔÓÙ›ÎÈ·. ªÂ ÂÈ‰ÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜ ‰È·›-

ÛÙˆÛ·Ó ÙÔÓ ı¿Ó·ÙÔ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ ÙÔÓ ÌË-

¯·ÓÈÛÌfi ÙË˜ ·fiÙˆÛË˜ ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ ÙˆÓ

¶·È‰È·ÙÚÈÎ‹ 2005;68:377-384


382 ∂. ªÔ‡˙· Î·È Û˘Ó.

ÔÓÙÈÎÒÓ, Î˘Ú›ˆ˜ ÛÙÔÓ ÊÏÔÈfi Î·È ÙÔÓ ı¿Ï·ÌÔ.

µÚ‹Î·Ó ·˘ÍËÌ¤ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ ÛÙÔÓ

ÂÁÎ¤Ê·ÏÔ ÙˆÓ ÔÓÙÈÎÒÓ, ÛÙ· ÔÔ›· Â›¯Â Á›ÓÂÈ

¤Á¯˘ÛË ÛÎÂ˘¿ÛÌ·ÙÔ˜ ÙË˜ ‰ÂÍ·ÌÂı·˙fiÓË˜, ÂÓÒ

Ë Î·ı·Ú‹ ‰ÂÍ·ÌÂı·˙fiÓË, Ë Î·ı·Ú‹ ‚ËÙ·ÌÂı·-

˙fiÓË Î·È ÙÔ ÛÎÂ‡·ÛÌ· ÙË˜ ‚ËÙ·ÌÂı·˙fiÓË˜ ‰ÂÓ

ÂËÚ¤·Û·Ó ÙË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

∆Ô Û˘Ì¤Ú·ÛÌ· ‹Ù·Ó fiÙÈ ›Ûˆ˜ Ù· ÛÔ˘ÏÊ›‰È·

Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÙÔ ÛÎÂ‡·ÛÌ· ÙË˜ ‰ÂÍ·ÌÂı·-

˙fiÓË˜, ˆ˜ Û˘ÓÙËÚËÙÈÎfi, Â›Ó·È ‰˘ÓËÙÈÎ¿ ÙÔÍÈÎ¿

ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁÎ¤Ê·ÏÔ.

∂Í·ÈÙ›·˜ ÙË˜ ‰˘ÛÌÂÓÔ‡˜ Â›‰Ú·ÛË˜ ÙË˜ ‰Â-

Í·ÌÂı·˙fiÓË˜ ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁÎ¤Ê·ÏÔ,

¤¯Ô˘Ó ÚÔÙ·ıÂ› ÂÓ·ÏÏ·ÎÙÈÎ¿ ÌfiÚÈ· ÎÔÚÙÈÎÔ-

ÛÙÂÚÔÂÈ‰ÒÓ, Ù· ÔÔ›· ¤¯Ô˘Ó ¯ÔÚËÁËıÂ› Û˘ÛÙË-

Ì·ÙÈÎ¿ ‹ ÌÂ ÂÈÛÓÔ¤˜.

¶Èı·Ó¿ ÂÓ·ÏÏ·ÎÙÈÎ¿ ÛÙÂÚÔÂÈ‰‹, Ô˘ ¤¯Ô˘Ó

¯ÚËÛÈÌÔÔÈËıÂ› Û˘ÛÙËÌ·ÙÈÎ¿, Â›Ó·È Ë ÌÂı˘Ï-

ÚÂ‰ÓÈ˙ÔÏfiÓË, Ë ˘‰ÚÔÎÔÚÙÈ˙fiÓË Î·È Ë ‚ËÙ·-

ÌÂı·˙fiÓË.

∏ ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË ¤¯ÂÈ ¯ÔÚËÁËıÂ› ˆ˜

ıÂÚ·Â›· ÁÈ· Ó· ÂÈÙ·¯˘ÓıÂ› Ë ·Ô‰¤ÛÌÂ˘ÛË

·fi ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú·. ∏ ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfi-

ÓË Â›Ó·È ¤Ó· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰¤˜ ÌÂ ‚Ú·¯‡ÙÂÚË

Î·È ÌÈÎÚfiÙÂÚË ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË ·fi ÙË

‰ÂÍ·ÌÂı·˙fiÓË, ·ÌÂÏËÙ¤· ·Ï·ÙÔÎÔÚÙÈÎÔÂÈ‰‹

‰Ú¿ÛË, ÂÓÒ ÙÔ ÛÎÂ‡·ÛÌ¿ ÙË˜ ‰ÂÓ ÂÚÈ¤¯ÂÈ

ÛÔ˘ÏÊ›‰È·. Œ¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› ÌÂ Û¯ÂÙÈÎ‹

·ÛÊ¿ÏÂÈ· (28).

Ã·ÌËÏ¤˜ ‰fiÛÂÈ˜ ˘‰ÚÔÎÔÚÙÈ˙fiÓË˜ ¯ÔÚËÁ‹-

ıËÎ·Ó ÛÂ ÓÂÔÁÓ¿ ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ˙ˆ‹˜ ÁÈ·

ÙËÓ ÚfiÏË„Ë ÙË˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ‰˘-

ÛÏ·Û›·˜. ªÂÙ¿ ·fi ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜ ˘‰ÚÔÎÔÚ-

ÙÈ˙fiÓË˜ (1 mg/kg/ËÌ¤Ú·) ‚Ú¤ıËÎÂ fiÙÈ ÛÙ· ÓÂÔ-

ÁÓ¿ ·˘Ù¿ ·˘Í‹ıËÎÂ Î·Ù¿ ÙÈ˜ 2 ÚÒÙÂ˜ Â‚‰ÔÌ¿-

‰Â˜ ˙ˆ‹˜ Ë ÂÈ‚›ˆÛË ¯ˆÚ›˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹

‰˘ÛÏ·Û›·, ÂÓÒ ‰ÂÓ ˘‹Ú¯·Ó ¿ÌÂÛÂ˜ ‹ ·ÒÙÂ-

ÚÂ˜ ÂÈÏÔÎ¤˜ (2).

∏ ‚ËÙ·ÌÂı·˙fiÓË Èı·ÓÒ˜ Â›Ó·È ·ÛÊ·Ï¤ÛÙÂ-

ÚË ·fi ÙË ‰ÂÍ·ÌÂı·˙fiÓË. ¶ÂÈÚ¿Ì·Ù· ÛÂ ÔÓÙ›-

ÎÈ· Î·È Ë ÂÌÂÈÚ›· ·fi ÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ¯ÔÚ‹-

ÁËÛ‹ ÙË˜, Î·ıÈÛÙÔ‡Ó ÙË ‚ËÙ·ÌÂı·˙fiÓË ›Ûˆ˜ ÙÔ

È‰·ÓÈÎfi ÂÓ·ÏÏ·ÎÙÈÎfi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰¤˜ ·ÓÙ›

ÁÈ· ÙË ‰ÂÍ·ÌÂı·˙fiÓË, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂ-

Ù¤˜ Û˘ÁÎÚÈÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙ· ÓÂÔÁÓ¿. ™Â Ì›· ÌÈ-

ÎÚ‹ Ù˘¯·ÈÔÔÈËÌ¤ÓË ÌÂÏ¤ÙË, Ë ¯ÔÚ‹ÁËÛË ‚ËÙ·-

ÌÂı·˙fiÓË˜ ÛÂ ÌÈÎÚ¤˜ ‰fiÛÂÈ˜ Î·È ÁÈ· ‚Ú·¯‡ ‰È¿-

ÛÙËÌ· ‹Ù·Ó ÂÍ›ÛÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÌÂ ÙË ‰ÂÍ·-

ÌÂı·˙fiÓË, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ô‰¤ÛÌÂ˘ÛË ÙÔ˘

ÓÂÔÁÓÔ‡ ·fi ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú· ̄ ˆÚ›˜ ·ÓÂÈı‡-

ÌËÙÂ˜ ¿ÌÂÛÂ˜ ÂÈÏÔÎ¤˜ (29) ‹ ·ÒÙÂÚÂ˜ ÂÈ-

ÙÒÛÂÈ˜ ÛÙË ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË ÛÙËÓ

ËÏÈÎ›· ÙˆÓ 12 ÌËÓÒÓ (30). ¶·Ú’ fiÏ· ·˘Ù¿, Ë ›‰È·

ÌÂÏ¤ÙË ‰ÂÓ ¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓÂ˜ ·ÒÙÂÚÂ˜ ‰˘ÛÌÂ-ÓÂ›˜ ÂÈÙÒÛÂÈ˜ Ô‡ÙÂ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ ‰ÂÍ·ÌÂı·˙fiÓË.

¶ÚfiÛÊ·Ù·, Ù· ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔ-ÂÈ‰‹ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ· ÙË ıÂÚ·Â›· ‹ÙËÓ ÚfiÏË„Ë ÙË˜ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘ ÙˆÓ ÓÂ˘Ìfi-ÓˆÓ, ÂÂÈ‰‹ ıÂˆÚÂ›Ù·È fiÙÈ Ë ÙÔÈÎ‹ ‰Ú¿ÛË Û˘Ó-‰¤ÂÙ·È ÌÂ ÏÈÁfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜.

ª›· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË ÙˆÓ ÌÂÏÂÙÒÓÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Û˘Ì¤-Ú·ÓÂ fiÙÈ ÂÓÒ ˘‹Ú¯·Ó ‚Ú·¯˘ÚfiıÂÛÌ· Â˘ÓÔ˚Î¿·ÔÙÂÏ¤ÛÌ·Ù·, ÌÂ ‚ÂÏÙ›ˆÛË ÛÙËÓ ·Ó·ÓÂ˘ÛÙÈ-Î‹ ÏÂÈÙÔ˘ÚÁ›· Î·È ÌÂÈˆÌ¤ÓË ·Ó¿ÁÎË ÁÈ· ÌÂÙ¤-ÂÈÙ· Û˘ÛÙËÌ·ÙÈÎ¿ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ‰ÂÓ ‰È·-ÈÛÙÒıËÎÂ Ì·ÎÚÔÚfiıÂÛÌ· fiÊÂÏÔ˜ ˆ˜ ÚÔ˜ÙËÓ ÂÈ‚›ˆÛË ‹ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ¯ÚfiÓÈ· ÓfiÛÔÙÔ˘ ÓÂ‡ÌÔÓ· (31). ∆· ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔ-ÛÙÂÚÔÂÈ‰‹ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÏÈÁfiÙÂÚÂ˜ ·ÚÂ-Ó¤ÚÁÂÈÂ˜ (32), ·Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ Ó· ÂÏ¤Á¯Ô˘Ó ÙÈ˜ Ì·ÎÚÔ-ÚfiıÂÛÌÂ˜ ÂÈÙÒÛÂÈ˜ ÙÔ˘˜. ŒÙÛÈ, Ê·›ÓÂÙ·È fiÙÈÙ· ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ÌÔÚÂ› Ó·‚ÔËıÔ‡Ó ÛÂ ‹ÈÂ˜ ‹ Ì¤ÙÚÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ¯Úfi-ÓÈ·˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÓfiÛÔ˘, ·ÏÏ¿ ÛÙÈ˜ ‚·ÚÈ¤˜ÂÚÈÙÒÛÂÈ˜ Â›Ó·È ··Ú·›ÙËÙ· Ù· ÂÓ‰ÔÊÏ¤‚È·ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹.


∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ¤¯Ô˘Ó Â˘ÓÔ˚Î‹ ‰Ú¿ÛËÛÙË ¯ÚfiÓÈ· ·Ó·ÓÂ˘ÛÙÈÎ‹ ÓfiÛÔ, ·ÏÏ¿ Ë ‰ÂÍ·-ÌÂı·˙fiÓË Û˘Ó‰¤ÂÙ·È ÌÂ ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜.

°›ÓÔÓÙ·È Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· Ó·‚ÚÂıÂ› ÔÈÔ Â›Ó·È ÙÔ ÈÔ Î·Ù¿ÏÏËÏÔ ÁÏ˘ÎÔÎÔÚ-ÙÈÎÔÂÈ‰¤˜ Ô˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·ÈÔÈ· Â›Ó·È Ë ÌÈÎÚfiÙÂÚË ‰fiÛË Ô˘ ¤¯ÂÈ ıÂÙÈÎ¿‚Ú·¯˘ÚfiıÂÛÌ· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÂÏ¿¯ÈÛÙ··ÚÓËÙÈÎ¿ Ì·ÎÚÔÚfiıÂÛÌ·.

∏ American Academy of Pediatrics, ËCanadian Pediatric Society Î·È Ë EuropeanAssociation of Perinatal Medicine Û˘ÓÈÛÙÔ‡Ó Ó·ÂÓÙ·¯ıÔ‡Ó Ù· ÓÂÔÁÓ¿ Ô˘ Â›¯·Ó Ï¿‚ÂÈ ÎÔÚÙÈÎÔ-ÛÙÂÚÔÂÈ‰‹ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, Û˘ÌÌÂÙ¤-¯ÔÓÙ·˜ ÛÂ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜, ÛÂ ÏÂÙÔ-ÌÂÚ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË, ÒÛÙÂ Ó·ÂÎÙÈÌËıÂ› Ë Ú·ÁÌ·ÙÈÎ‹ Û¯¤ÛË ÎÈÓ‰‡ÓÔ˘ ÚÔ˜fiÊÂÏÔ˜ ÙË˜ ıÂÚ·Â›·˜ ÌÂ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹.


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5. Howard H. Reduction in size and total DNA of cere-brum and cerebellum in adult mice after corticos-teroid treatment in infancy. Exp Neurol 1968;22:191-208.

6. Howard E, Benjamins JA. DNA, ganglioside and sul-fatide in brains of rats given corticosterone in infan-cy, with an estimate of cell loss during development.Brain Res 1975;92:73-87.

7. Weichsel ME Jr. The therapeutic use of glucocorti-coid hormones in the perinatal period: potentialneurological hazards. Ann Neurol 1977;2:364-366.

8. Baud O, Laudenbach V, Evrard P, Gressens P. Neu-rotoxic effects of fluorinated glucocorticoid prepa-rations on the developing mouse brain: role ofpreservatives. Pediatr Res 2001;50:706-711.

9. Papile LA, Tyson JE, Stoll BJ, Wright LL, DonovanEF, Bauer CR et al. A multicenter trial of two dex-amethasone regimens in ventilator-dependent pre-mature infants. N Engl J Med 1998;338:1112-1118.

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12. Shinwell ES, Karplus M, Reich D, Weintraub Z,Blazer S, Yurman S et al. Early postnatal dexametha-sone treatment and increased incidence of cerebralpalsy. Arch Dis Child Fetal Neonatal Ed 2000;83:F177-F181.

13. Murphy BP, Inder TE, Huppi PS, Warfield S, Zien-tara GP, Kikinis R et al. Impaired cerebral corticalgray matter growth after treatment with dexametha-sone for neonatal chronic lung disease. Pediatrics2001;107:217-221.

14. Yeh TF, Lin YJ, Huang CC, Chen YJ, Lin CH, LinHC et al. Early dexamethasone therapy in preterminfants: a follow-up study. Pediatrics 1998;101:E7.

15. O’Shea TM, Kothadia JM, Klinepeter KL, GoldsteinDJ, Jackson BG, Weaver RG 3rd et al. Randomizedplacebo-controlled trial of a 42-day tapering courseof dexamethasone to reduce the duration of ventila-tor dependency in very low birth weight infants:outcome of study participants at 1-year adjustedage. Pediatrics 1999;104:15-21.

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trolled trial of dexamethasone in neonatal chroniclung disease: a 3-year follow-up. Pediatrics 1995;96:897-906.

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21. Yeh TF, Lin YJ, Lin HC, Huang CC, Hsieh WS, LinCH et al. Outcomes at school age after postnataldexamethasone therapy for lung disease of prematu-rity. N Engl J Med 2004;350:1304-1313.

22. Barrington KJ. The adverse neurodevelopmental ef-fects of postnatal steroids in the preterm infant: asystematic review of RCT’s. BMC Pediatrics2001;1:1. Available at:http://www.biomedcentral.com/1471-2431/1/1

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28. Andre P, Thebaud B, Odievre MH, Razafimahefa H,Zupan V, Dehan M et al. Methylprednisolone, an al-ternative to dexamethasone in very premature in-fants at risk of chronic lung disease. Intensive CareMed 2000;26:1496-1500.

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384 ∂. ªÔ‡˙· Î·È Û˘Ó.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:377-384


385CURRENT ISSUE

The effect of postnatal administration of

steroids on the developing brain

H. Bouza, C. Papagaroufalis

Abstract

Postnatal steroid therapy has been widely used for the prevention and treatment of chronic lungdisease (bronchopulmonary dysplasia) in preterm infants. Recently, the meta-analyses of theCochrane Collaboration suggest that the risks of therapy may outweigh the possible benefits,especially if treatment is started before 96 hours of age. The meta-analyses show that treatment at 7-14 days of life seems to have the best benefit to risk ratio. However, since steroids may haveneurotoxic effects on the developing brain, neonatologists must continue to search for alternativetherapies for infants with chronic lung disease. Meanwhile, despite the limitations of steroidtreatment, the European Association of Perinatal Medicine, the American Academy of Pediatrics andthe Canadian Pediatric Society guidelines provide the most realistic and balanced advice on its use forthe clinical neonatologist trying to clarify a confusing situation.

Key words

Corticosteroids, neonate, brain.

2nd Neonatal Intensive CareUnit, “Aghia Sophia”Children’s Hospital, Athens

Correspondence:

Helen Bouza 2nd Neonatal Intensive Care Unit, “Aghia Sophia” Children’sHospital, 115 27, Athens E-mail: [email protected]




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∂ÍÂÙ¿ÛÂÈ˜ DNA, ı¤Ì·Ù· ËıÈÎ‹˜, Î˘ÛÙÈÎ‹ ›ÓˆÛË, ·ÓÔÛÔÂÓÂÚÁfi˜ ıÚ˘„›ÓË, Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›·Duchenne.

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∏ ÚfiÛÊ·ÙË ÂÚ¿ÙˆÛË ÙË˜ ·Ó¿ÁÓˆÛË˜ ÙÔ˘·ÓıÚÒÈÓÔ˘ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜ Î·È ÔÈ Û¯ÂÙÈÎ¤˜ Úfi-Ô‰ÔÈ Ô˘ ÚÔÎ‡ÙÔ˘Ó ·fi ·˘Ù‹, ·‡ÍËÛ·Ó ÙÔÂÓ‰È·Ê¤ÚÔÓ ÛÙË ÁÂÓÂÙÈÎ‹. ¶·Ú·Ì¤ÓÂÈ, fiÌˆ˜,Ì›· Û‡Á¯˘ÛË ÌÂÙ·Í‡ ÙˆÓ ÁÈ·ÙÚÒÓ Î·È ÙË˜ ÎÔÈ-ÓˆÓ›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÚfiÏÔ ÙË˜ ÁÂÓÂÙÈÎ‹˜ÏËÚÔÊÔÚ›·˜ ÛÙËÓ È·ÙÚÈÎ‹ Ú¿ÍË (1).

™Â ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜, fiˆ˜ ÛÙËÓ Î˘ÛÙÈ-Î‹ ›ÓˆÛË (CF) Î·È ÛÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ Ófi-ÛÔ, ÔÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔÈ ÌÔÚÈ·ÎÔ› ÌË¯·ÓÈÛÌÔ› Â›Ó·È·ÚÎÂÙ¿ Î·Ù·ÓÔËÙÔ›. ŸÌˆ˜, ÛÂ ·ÚÎÂÙ¿ ¿ÏÏ·¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹-ÙË˜ Î·È Ë ˘¤ÚÙ·ÛË, Ù· Û¯ÂÙÈÎ¿ ÁÔÓ›‰È· - Ù·ÔÔ›· Û˘¯Ó¿ Â›Ó·È ÔÏÏ¿ - ·Ú¯›˙Ô˘Ó ÙÒÚ· Ó··Ó·ÁÓˆÚ›˙ÔÓÙ·È. §·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙÈ˜‰È·ÊÔÚÂÙÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ÙˆÓ ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓÁÔÓÈ‰›ˆÓ Î·È ÙËÓ ÂÚÈÔÚÈÛÌ¤ÓË ÁÓÒÛË, ‰ÂÓ·ÔÙÂÏÂ› ¤ÎÏËÍË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô fiÚÔ˜ “ÁÂÓÂ-ÙÈÎ‹ ÏËÚÔÊÔÚ›·” ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌÂ ‰È·ÊÔ-ÚÂÙÈÎ‹ ¤ÓÓÔÈ· ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜.ªÂÚÈÎ¤˜ ÊÔÚ¤˜, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÓÓÔÒÓÙ·˜ÙËÓ Â›‰Ú·ÛË fiÏÔ˘ ÙÔ˘ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜, ÂÓÒ ÈÔÛ˘¯Ó¿ ·Ó·Ê¤ÚÂÙ·È ÛÂ ·Ó·ÁÓˆÚÈÛÌ¤Ó· ÌÔÓÔÁÔ-ÓÈ‰È·Î¿ ÓÔÛ‹Ì·Ù· ‹ - ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó· - ÛÙ··ÔÙÂÏ¤ÛÌ·Ù· ÂÍÂÙ¿ÛÂˆÓ ‚·ÛÈÛÌ¤ÓˆÓ ÛÙÔDNA (2).

∏ ÚÒÙË Ú·ÎÙÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙË˜ ·Ó¿ÁÓˆ-ÛË˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜ ı· Â›Ó·È Ë·Ó¿Ù˘ÍË ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙË ıÂÚ·-Â›· ÙÔ˘˜, Î·ıÒ˜ Î·È Ë ‰ÈÂ‡Ú˘ÓÛË ÙˆÓ ‰˘Ó·ÙÔ-

Ù‹ÙˆÓ ÁÈ· ÁÂÓÂÙÈÎ¤˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜(tests), ÙfiÛÔ ÛÂ ·ÙÔÌÈÎfi Â›Â‰Ô fiÛÔ Î·È ÛÂÏËı˘ÛÌÈ·Î¿ ·ÓÈ¯ÓÂ˘ÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· (3).™ÙËÓ ÂfiÌÂÓË ‰ÂÎ·ÂÙ›· ‹ ÂÈÎÔÛ·ÂÙ›· Â›Ó·È Ô-Ï‡ Èı·Ófi Ó· “ÂÈÛ‚¿ÏÏÂÈ” Ë ÚÔÏËÙÈÎ‹ È·ÙÚÈ-Î‹, ÂÈÙÚ¤ÔÓÙ·˜ ÙÔÓ Î·Ù¿ÏÏËÏÔ ¤ÏÂÁ¯Ô ÙÔ˘-Ï¿¯ÈÛÙÔÓ ÂÈ‰ÈÎÒÓ ˘ÔÔÌ¿‰ˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ÁÈ· ÁÂÓÂÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜, ÔÈ ÔÔ›Â˜ ı· ·Ô-‚Ï¤Ô˘Ó ÛÂ ÂÂÌ‚¿ÛÂÈ˜ ÛÙÔ Î¿ıÂ ¿ÙÔÌÔ Î·È ı·‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ˘ÁÂ›· ÙÔ˘, ÚÔÏ·Ì‚¿ÓÔÓÙ·˜Ì›· ÓfiÛÔ. ªÂ Ù· Ó¤· ÂÈÙÂ‡ÁÌ·Ù· ÙË˜ ÁÂÓÂÙÈ-Î‹˜ ÙÂ¯ÓÔÏÔÁ›·˜, ı· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ¿ÙÔÌ· Â˘-·ı‹ ÛÂ Û˘¯Ó¿ ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë Î·Ú‰È·Î‹ÓfiÛÔ˜ (4), Ô ‰È·‚‹ÙË˜ (5), Ô Î·ÚÎ›ÓÔ˜ (6) Î·È ËÓfiÛÔ˜ Alzheimer (7-8), ÒÛÙÂ Ó· ÍÂÎÈÓ‹ÛÂÈ Ì›·ÚÔÛ¿ıÂÈ· ÚˆÙÔ‚¿ıÌÈ·˜ (.¯. ‰›·ÈÙ· Î·È¿ÛÎËÛË) ‹ ‰Â˘ÙÂÚÔ‚¿ıÌÈ·˜ ÚfiÏË„Ë˜ (ÚÒÈ-ÌË ‰È¿ÁÓˆÛË ‹ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË) (2).

∞Ó Î·È Ë ÁÂÓÂÙÈÎ‹ ¤ÚÂ˘Ó· ˘fiÛ¯ÂÙ·È ÔÏÏ¿fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚÔ·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜ ÙˆÓ·È‰ÈÒÓ, Ë ¯Ú‹ÛË ÙˆÓ Ó¤ˆÓ ÁÂÓÂÙÈÎÒÓ tests ÛÂ·˘Ù¿ Ú¤ÂÈ Ó· ÌÂÏÂÙËıÂ› ÌÂ ÚÔÛÔ¯‹. §·Ì‚¿-ÓÔÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ ·ÎfiÌË ‰ÂÓ ˘¿Ú¯ÂÈ ÚÈ˙ÈÎ‹Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â›· ‹ ÛÙÚ·ÙËÁÈÎ¤˜ÚfiÏË„Ë˜, ÌÔÚÂ› Ó· ÌËÓ ‰ÈÎ·ÈÔÏÔÁÔ‡ÓÙ·È Ù·ÁÂÓÂÙÈÎ¿ tests ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜(3,9-11). ∂ÈÏ¤ÔÓ, ÂÂÈ‰‹ Ù· ÌÈÎÚ¿ ·È‰È¿ ‰ÂÓÌÔÚÔ‡Ó Ó· ‰È·ÎÚ›ÓÔ˘Ó ÙËÓ ·Í›· ÙË˜ ÁÂÓÂÙÈÎ‹˜ÏËÚÔÊÔÚ›·˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ˙ˆ‹ ÙÔ˘˜, ÔÈ ÁÔÓÂ›˜Î·È ÔÈ ·È‰›·ÙÚÔÈ Ô˘ ·›ÚÓÔ˘Ó ÙËÓ ·fiÊ·ÛËÁÈ· Ù· ÁÂÓÂÙÈÎ¿ tests ÙˆÓ ·È‰ÈÒÓ ÔÊÂ›ÏÔ˘Ó Ó·Â›Ó·È ÚÔÛÂÎÙÈÎÔ›.

∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜


387¶ÚfiÏË„Ë Î·È ËıÈÎ‹

(∞∞¶) ÂÎÙÈÌ¿ fiÙÈ ÔÈ ·È‰›·ÙÚÔÈ Â›Ó·È ÂÎÂ›ÓÔÈ

Ô˘ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó - Î·Ï‡ÙÂÚ· ·fi

fiÏÔ˘˜ ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ - ÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓÂ›˜

ÙÔ˘ Ó· Î·Ù·ÓÔ‹ÛÔ˘Ó ÙÈ˜ ÁÂÓÂÙÈÎ¤˜ ÏËÚÔÊÔ-

Ú›Â˜, ‰È·ÛÊ·Ï›˙ÔÓÙ·˜ Â¯ÂÌ‡ıÂÈ· ÁÈ· Ù· ·ÔÙÂ-

Ï¤ÛÌ·Ù· ÙÔ˘ test. ∂›ÛË˜, ÂÎÙÈÌ¿ fiÙÈ Â›Ó·È ÔÈ

Î·Ù·ÏÏËÏfiÙÂÚÔÈ Ó· ‰ÒÛÔ˘Ó ÚˆÙÔ‚¿ıÌÈ· Û˘Ì-

‚Ô˘ÏÂ˘ÙÈÎ‹ ‹ Ó· ·Ú·¤Ì„Ô˘Ó ÙÔ ·È‰› ÁÈ·

‰Â˘ÙÂÚÔ‚¿ıÌÈ· ÁÂÓÂÙÈÎ‹ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹, ÌfiÓÔ

fiÙ·Ó ÙÔ ÁÂÓÂÙÈÎfi test Â›Ó·È ÁÈ· ÙÔ Û˘ÌÊ¤ÚÔÓ ÙÔ˘

‹ fiÙ·Ó ÚÔ¿ÁÂÙ·È ÙÔ Û˘ÌÊ¤ÚÔÓ ÙˆÓ ÁÔÓ¤ˆÓ ‹

ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ¯ˆÚ›˜ Ó· ÚÔÎ·ÏÂ›Ù·È ÔÔÈ·-

‰‹ÔÙÂ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ·È‰ÈÔ‡ (3).

°›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÂ ÙÚÂÈ˜ ÂÊ·ÚÌÔÁ¤˜ ÙˆÓ

ÁÂÓÂÙÈÎÒÓ tests Î·È ÙˆÓ ·ÓÈ¯ÓÂ˘ÙÈÎÒÓ ÚÔÁÚ·Ì-

Ì¿ÙˆÓ (screening) ÛÙ· ·È‰È¿: ÛÙ· ÓÂÔÁÓÈÎ¿

·ÓÈ¯ÓÂ˘ÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù·, ÛÙ· ·ÓÈ¯ÓÂ˘ÙÈÎ¿

ÚÔÁÚ¿ÌÌ·Ù· ÊÔÚ¤ˆÓ Î·È ÛÙÔÓ ÚÔÏËÙÈÎfi

¤ÏÂÁ¯Ô ÁÈ· ÓÔÛ‹Ì·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfi-

ÙÂÚ· ÛÙË ˙ˆ‹. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ ÂÊ·ÚÌÔÁ‹

ÙÔ˘˜, ˘¿Ú¯ÂÈ ÛÔ‚·Úfi˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ Î·-

ıÒ˜ ÚÔÎ‡ÙÔ˘Ó ËıÈÎ¿ ı¤Ì·Ù·, Á‡Úˆ ·fi Ù·

ÔÔ›· ·Ó·Ù‡ÛÛÂÙ·È ÌÂÁ¿ÏË Û˘˙‹ÙËÛË.

¡ÂÔÁÓÈÎ¿ ·ÓÈ¯ÓÂ˘ÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù·

πÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ˜

∏ ÚfiÎÏËÛË ·fi ÙËÓ ÚfiÔ‰Ô ÙˆÓ Ó¤ˆÓ ÁÂ-

ÓÂÙÈÎÒÓ tests Â›¯Â Ê¤ÚÂÈ ÛÙÔ ÚÔÛÎ‹ÓÈÔ ÙË Û˘-

˙‹ÙËÛË Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ Î·Ù·ÏÏËÏfiÙËÙ· ÙÔ˘ ÓÂ-

ÔÁÓÈÎÔ‡ screening ÛÙËÓ Î˘ÛÙÈÎ‹ ›ÓˆÛË. ∆Ô

1983, ¤Ó· ÂÚÒÙËÌ·-‰›ÏËÌÌ· ‹Ù·Ó Â¿Ó Ë ‰È¿-

ÁÓˆÛË ÙË˜ Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜ ÛÙË ÓÂÔÁÓÈÎ‹ Â-

Ú›Ô‰Ô Î·È Ë ¤ÁÎ·ÈÚË ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·-

Ù·Ï‹ÁÂÈ ÛÂ ÌÂ›ˆÛË ÙË˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ÛÂ ÂÈ-

Ì‹Î˘ÓÛË ÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ (12).

∞fi ÙÔ 1989 Ô˘ Ù·˘ÙÔÔÈ‹ıËÎÂ ÙÔ ÁÔÓ›‰ÈÔ

ÙË˜ Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜ (cystic fibrosis trans-

membrane conductance regulator - CFTR) Î·È

Ì¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó Ù·˘ÙÔÔÈËıÂ› ¿Óˆ ·fi

900 ‰È·ÊÔÚÂÙÈÎ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ‰ÈÂıÓÒ˜.

∆Ô ÁÂÓÂÙÈÎfi test ÙË˜ Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜ ÛÙË

ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË ÔÌÔ˙˘Áˆ-

ÙÒÓ ·Û¯fiÓÙˆÓ ÓÂÔÁÓÒÓ ‰ÂÓ ¤¯ÂÈ ÂÚÈÏËÊıÂ›

ÛÂ Î·Ì›· ¯ÒÚ· ÛÙ· ˘Ô¯ÚÂˆÙÈÎ¿ screening

tests. ™Â ÔÚÈÛÌ¤Ó· Î¤ÓÙÚ· ‰ÈÂÓÂÚÁÂ›Ù·È ÂÚÂ˘ÓË-

ÙÈÎ¿ Ë Ì¤ÙÚËÛË ÙË˜ ·ÓÔÛÔÂÓÂÚÁÔ‡ ıÚ˘„›ÓË˜

(immunoreactive trypsin - IRT) ÛÂ ÍËÚ¿ ÛÙ·Áfi-

Ó· ·›Ì·ÙÔ˜ ÛÂ Î¿ÚÙÂ˜ Guthrie Î·È Ë ÂÎÙ›ÌËÛË

Á›ÓÂÙ·È ÌÂ ·ÓÔÛÔÌÂÙÚ‹ÛÂÈ˜. ∆· fiÚÈ· ÙˆÓ Ê˘ÛÈÔ-

ÏÔÁÈÎÒÓ ÂÈ¤‰ˆÓ ÙË˜ IRT ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔ

kit Î·È Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ·ÓÙÈÛÒÌ·Ù· (13).

™Ù· ÓÂÔÁÓ¿ Ô˘ ·ÓÂ˘Ú›ÛÎÂÙ·È ·‡ÍËÛË ÙË˜ IRT

Ù›ıÂÙ·È ˘Ô„›· ÙË˜ ÓfiÛÔ˘. ∏ ÂÈ‚Â‚·›ˆÛ‹ ÙË˜

Á›ÓÂÙ·È ÌÂ DNA ·Ó¿Ï˘ÛË ·fi ÙÔ ›‰ÈÔ ‰Â›ÁÌ· ‹

·fi ‰Â‡ÙÂÚË ÍËÚ¿ ÛÙ·ÁfiÓ· ·›Ì·ÙÔ˜, ·Ó¿ÏÔÁ·

ÌÂ ÙÔ ÚˆÙfiÎÔÏÏÔ. ∆Ô ÔÛÔÛÙfi ‰È¿ÁÓˆÛË˜

ÔÌÔ˙˘ÁˆÙÒÓ ·Û¯fiÓÙˆÓ ÓÂÔÁÓÒÓ ÂÍ·ÚÙ¿Ù·È

·fi ÙËÓ ÂıÓÈÎfiÙËÙ· ÙÔ˘ ÏËı˘ÛÌÔ‡ Ô˘ ÂÚÂ˘-

Ó¿Ù·È Î·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ

Ô˘ ‰ÈÂÚÂ˘ÓÒÓÙ·È (14).

™Â ·˘ÍËÌ¤ÓË IRT:

·) ŒÓ· ÓÂÔÁÓfi ‰È·ÁÈÁÓÒÛÎÂÙ·È fiÙÈ ¤¯ÂÈ Î˘-

ÛÙÈÎ‹ ›ÓˆÛË Â¿Ó ‰È·ÈÛÙˆıÔ‡Ó ‰‡Ô ÌÂÙ·ÏÏ¿-

ÍÂÈ˜ ÙÔ˘ CFTR ÁÔÓÈ‰›Ô˘ Î·È Â¿Ó ÙÔ test È‰ÚÒÙ·

‰Â›ÍÂÈ Û˘ÁÎ¤ÓÙÚˆÛË ¯ÏˆÚÈÔ‡¯ˆÓ >60 mEq/L.

‚) ¡ÂÔÁÓfi ÛÙÔ ÔÔ›Ô ‰È·ÈÛÙÒÓÂÙ·È ÌfiÓÔ

Ì›· ÌÂÙ¿ÏÏ·ÍË, ı· Ú¤ÂÈ Ó· Î¿ÓÂÈ test È‰ÚÒÙ·,

ÂÂÈ‰‹ ÌÔÚÂ› Ó· ¤¯ÂÈ Î·È ‰Â‡ÙÂÚË ÌÂÙ¿ÏÏ·ÍË

Ë ÔÔ›· ‰ÂÓ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙÂ› Ì¤¯ÚÈ Û‹ÌÂÚ·.

∂¿Ó ÙÔ test È‰ÚÒÙ· Â›Ó·È ·ÚÓËÙÈÎfi, ÙÔ ÓÂÔÁÓfi

¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÊÔÚ¤·˜.

Á) ∂¿Ó ‰ÂÓ ‰È·ÈÛÙˆıÂ› Î·Ì›· ÌÂÙ¿ÏÏ·ÍË,

ÙfiÙÂ Â·Ó·Ï·Ì‚¿ÓÂÙ·È Ë IRT. ∂¿Ó ÙÔ ·ÔÙ¤ÏÂ-

ÛÌ· Â›Ó·È ·ÚÓËÙÈÎfi, ÙÔ ·È‰› ¯·Ú·ÎÙËÚ›˙ÂÙ·È

Ê˘ÛÈÔÏÔÁÈÎfi (13).

™ÙÔ˘˜ ÁÔÓÂ›˜ Ô˘ ¤¯Ô˘Ó ‹‰Ë ¤Ó· ¿Û¯ÔÓ

·È‰› ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË, Û˘ÓÈÛÙ¿Ù·È Î·È ÚÔ-

ÛÊ¤ÚÂÙ·È ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË. OÈ ÌÂÙ·ÏÏ¿-

ÍÂÈ˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó ‹‰Ë ÛÙÔ˘˜ ÁÔÓÂ›˜-ÊÔ-

ÚÂ›˜ ·Ó·˙ËÙÔ‡ÓÙ·È ÛÂ ‰Â›ÁÌ· ¯ÔÚÈ·Î‹˜ Ï¿¯ÓË˜

ÛÙÈ˜ 10 Â‚‰ÔÌ¿‰Â˜ ÙË˜ Î‡ËÛË˜ ‹ ÛÂ ·ÌÓÈ·Îfi

˘ÁÚfi ÛÙÈ˜ 17 Â‚‰ÔÌ¿‰Â˜ ÙË˜ Î‡ËÛË˜. ∂¿Ó ÙÔ ¤Ì-

‚Ú˘Ô ¤¯ÂÈ ‰‡Ô ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ CFTR ÁÔÓÈ‰›Ô˘,

ÔÈ ÁÔÓÂ›˜ Û˘Ó‹ıˆ˜ ÂÈÏ¤ÁÔ˘Ó ÙË ‰È·ÎÔ‹.

∂ÈÏ¤ÔÓ, ÙÔ test ÚÔ‚Ï¤ÂÈ ÙÔÓ ·ÓÈ¯ÓÂ˘ÙÈ-

Îfi ¤ÏÂÁ¯Ô ÛÙÔ˘˜ Û˘ÁÁÂÓÂ›˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ·È-

‰ÈÔ‡ Ô˘ ‰È·ÈÛÙÒıËÎÂ Ë ÌÂÙ¿ÏÏ·ÍË. ∂¿Ó ‚ÚÂ-

ıÂ› ¤Ó·˜ Û˘ÁÁÂÓ‹˜ ÊÔÚ¤·˜, ÙfiÙÂ Î·È Ô Û‡ÓÙÚÔ-

Êfi˜ ÙÔ˘ Ú¤ÂÈ Ó· ÂÚÂ˘ÓËıÂ› ÁÈ· ÙÈ˜ ÈÔ Û˘¯Ó¤˜

ÌÂÙ·ÏÏ¿ÍÂÈ˜.

∆Ô test ·Â˘ı‡ÓÂÙ·È ÛÂ ÓÂÔÁÓ¿ ÔÈÎÔÁÂÓÂÈÒÓ

·fi ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÌÂ ÂÏÂ‡ıÂÚÔ ÈÛÙÔÚÈ-

Îfi ÁÈ· ÙË ÓfiÛÔ Î·È ÌÂ ÙÔ ·ÈÙÈÔÏÔÁÈÎfi fiÙÈ Ë

¤ÁÎ·ÈÚË ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Î·Ù·Ï‹ÁÂÈ ÛÂ

fiÊÂÏÔ˜ ÙÔ˘ ·È‰ÈÔ‡, ÌÂ ÌÂ›ˆÛË ÙË˜ ÓÔÛËÚfiÙË-

Ù·˜ Î·È ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜ ÙÔ˘ (13).

∞Ó·‰ÚÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘

ÔÊ¤ÏÔ˘˜ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆ-

ÛË ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÓÂÔÁÓÈÎfi screening ÁÈ· ÙËÓ

Î˘ÛÙÈÎ‹ ›ÓˆÛË Ô‰‹ÁËÛÂ ÛÙËÓ Ô˘ÛÈ·ÛÙÈÎ‹ ÌÂ›ˆ-

ÛË ÙË˜ ËÏÈÎ›·˜ ‰È¿ÁÓˆÛË˜ (·fi 72 ÛÂ 12 Â‚‰Ô-

Ì¿‰Â˜, Û‡ÌÊˆÓ· ÌÂ ÙË ÌÂÏ¤ÙË ÙË˜ ÔÏÈÙÂ›·˜

Wisconsin), ÛÂ Ì›· ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ¯ÚfiÓÔ˘ Î·È

ÙË˜ ÔÈfiÙËÙ·˜ ÙË˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ, Î·ıÒ˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:386-393


388 Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘

Î·È ÛÂ ÌÂ›ˆÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜ ÙÔ˘˜ ÛÙÔ

ÓÔÛÔÎÔÌÂ›Ô Î·È ÙË˜ ÓÔÛËÚfiÙËÙ·˜ ÛÙ· ÚÒÙ·

¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜. ∏ ÙÂÏÂ˘Ù·›· ·Ô‰›‰ÂÙ·È ÛÙË

‰˘Ó·ÙfiÙËÙ· ‰ÈfiÚıˆÛË˜ ÙË˜ ‰›·ÈÙ·˜ Î·È ÙˆÓ ‚ÈÔ-

¯ËÌÈÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· ÓÂÔ-

ÁÓ¿ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË. ™Â ÌÂÏ¤ÙÂ˜ ·fi ÙÔ ›‰ÈÔ

ÂÚÂ˘ÓËÙÈÎfi Î¤ÓÙÚÔ ÙË˜ ÔÏÈÙÂ›·˜ Wisconsin, ÛÂ

Â·Ó¤ÏÂÁ¯Ô Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ·ÓıÚˆÔÌÂÙÚÈÎ¤˜

·Ú·Ì¤ÙÚÔ˘˜, Ê¿ÓËÎÂ fiÙÈ Ù· ÓÂÔÁÓ¿ Ô˘ ‰È·-

ÁÓÒÛÙËÎ·Ó ÌÂ ÙÔ ÓÂÔÁÓÈÎfi test Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi

‹Ù·Ó ÛÂ ÌÂÁ·Ï‡ÙÂÚË ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË fiÛÔÓ

·ÊÔÚ¿ ÛÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜ Î·È ÙËÓ ÂÚ›ÌÂÙÚÔ

ÎÂÊ·Ï‹˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È‰È¿ Ô˘ ‰ÂÓ Â›-

¯·Ó ‰È·ÁÓˆÛÙÂ› ÌÂ screening (13,14).

¶¤Ú·Ó ÙË˜ ‚ÂÏÙ›ˆÛË˜ ÙˆÓ ·ÓıÚˆÔÌÂÙÚÈ-

ÎÒÓ ·Ú·Ì¤ÙÚˆÓ, Ë Â›‰Ú·ÛË ÙË˜ Î·Ï‡ÙÂÚË˜

ıÚ¤„Ë˜ ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Ê¿ÓËÎÂ

ÛÙËÓ ¤ÚÂ˘Ó· ÙË˜ ¡¤·˜ ¡fiÙÈ·˜ O˘·Ï›·˜. ∏

ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ Î·Ï‡-

ÙÂÚË ÛÙ· ·È‰È¿ Ô˘ Â›¯·Ó ‰È·ÁÓˆÛÙÂ› ÌÂ

screening, ·fi ÂÎÂ›ÓË ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜

screening ÛÙËÓ ËÏÈÎ›· ÙˆÓ 5 Î·È 10 ÂÙÒÓ. ∏ ‰È·-

Ù‹ÚËÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È ıÂ-

ÌÂÏÈÒ‰Ë˜ ÁÈ· ÙËÓ ÔÈfiÙËÙ· ÙË˜ ˙ˆ‹˜ ÙˆÓ ·È-

‰ÈÒÓ Î·È Ë ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË

Û˘ÓÙÂÏÂ› ÛÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜

‚Ï¿‚Ë˜. OÈ ÌÂÏ¤ÙÂ˜ ÙË˜ πÙ·Ï›·˜, ÙË˜ °ÂÚÌ·Ó›·˜

Î·È ÙË˜ ∞˘ÛÙÚ·Ï›·˜ ·Ó¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·-

ÊÔÚ¤˜ ÛÙËÓ ÂÈ‚›ˆÛË Î·È ÛÙËÓ ÎÏÈÓÈÎ‹ ¤Î‚·ÛË

ÌÂÙ·Í‡ ‚ÚÂÊÒÓ ÌÂ Î·È ¯ˆÚ›˜ screening (15-17).

∆· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ screening ‰ÂÓ Â-

ÚÈÔÚ›˙ÔÓÙ·È ÛÙËÓ ÚÒÈÌË ıÂÚ·Â›· ÙÔ˘ ¿Û¯Ô-

ÓÙÔ˜ ·È‰ÈÔ‡. ∏ ÚÒÈÌË ‰È¿ÁÓˆÛË Î¿ÓÂÈ ‰˘Ó·-

Ù‹ ÙfiÛÔ ÙË ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË ÛÙÔ˘˜ Û˘ÁÁÂ-

ÓÂ›˜ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ÂÏ¤Á¯ıËÎÂ fiÛÔ Î·È ÙËÓ

ÂÈÏÔÁ‹ ÁÈ· ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË, ÌÂ ÛÎÔfi

ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÂÓfi˜ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘

ÂÌ‚Ú‡Ô˘.

∆· ‰È¿ÊÔÚ· Î¤ÓÙÚ· ÂÚÂ˘ÓÔ‡Ó ‰È·ÊÔÚÂÙÈÎfi

·ÚÈıÌfi ÌÂÙ·ÏÏ¿ÍÂˆÓ Î·È ÌÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÔÚÈ·-

Î¤˜ ÙÈÌ¤˜ ÙË˜ IRT, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔÎ‡-

ÙÔ˘Ó ËıÈÎ¿ ı¤Ì·Ù· ·fi ·È‰È¿ Ô˘ ‰ÂÓ ¤¯Ô˘Ó

‰È·ÁÓˆÛÙÂ›, ·fi ¿Ù˘Ô˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÌÂÙ·Ï-

Ï¿ÍÂˆÓ Î·È ·fi „Â˘‰Ò˜ ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·.

™ÙÔ ÚfiÁÚ·ÌÌ· ÙË˜ Brittany ÙË˜ °·ÏÏ›·˜,

ÌÂÙ¿ ÙËÓ ÂÓÙfiÈÛË Ì›·˜ ÌÂÙ¿ÏÏ·ÍË˜, Á›ÓÂÙ·È

‰ÈÂÍÔ‰ÈÎfi˜ ÌÔÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ∞˘Ù‹ Ë Ú·ÎÙÈ-

Î‹, Ë ÔÔ›· Ô‰ËÁÂ› ÛÙÔ Ì¤ÏÏÔÓ ÛÙËÓ Èı·Ó‹ ÂÓ-

ÛˆÌ¿ÙˆÛË ÛÙËÓ ÙÂ¯ÓÈÎ‹ ÙˆÓ DNA-chips, ¤¯ÂÈ

ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù·, Ù· ÔÔ›·

‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÓÙ· ÛÂ ¿ÏÏ· ÚÔÁÚ¿ÌÌ·Ù·

(13). ∏ ÂÎÙÂÓ‹˜ ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ CFTR

Ô‰ËÁÂ› ÛÙË ‰È·›ÛÙˆÛË Û¿ÓÈˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ,

ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÌÂÚÈÎÒÓ Ó¤ˆÓ, ÛÂ ÌÂÚÈÎ¿

·È‰È¿ Ô˘ ¤¯Ô˘Ó Ì›· ÔÚÈ·Î‹ Û˘ÁÎ¤ÓÙÚˆÛË

¯ÏˆÚÈÔ‡¯ˆÓ È‰ÚÒÙ· Î·È ÁÈ· Ù· ÔÔ›· Ë ÎÏÈÓÈÎ‹

¤Î‚·ÛË ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ‰‡ÛÎÔÏÔ Ó· ÚÔ‚ÏÂ-

ÊıÂ›. ŒÙÛÈ, ‰È·ÈÛÙÒÓÔÓÙ·È ·È‰È¿ ÌÂ ‰‡Ô ÌÂ-

Ù·ÏÏ¿ÍÂÈ˜ CFTR Î·È ÌÂ ¿Ù˘Ô ÁÔÓfiÙ˘Ô, Ô˘

Â›Ó·È ÂÏÂ‡ıÂÚ· Û˘ÌÙˆÌ¿ÙˆÓ. ¢ÂÓ Â›Ó·È ÚÔ˜

ÙÔ ·ÚfiÓ ‰˘Ó·ÙfiÓ Ó· ·ÔÎÏÂÈÛÙÂ› ÙÔ ÁÂÁÔÓfi˜

fiÙÈ ·˘ÙÔ› ÔÈ ÁÔÓfiÙ˘ÔÈ ··ÓÙÒÓÙ·È ÛÂ ‹È·

ÌÔÚÊ‹ ÙË˜ Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜, Ë ÔÔ›· ı· ·Ó·-

Ù˘¯ıÂ› ·ÚÁfiÙÂÚ· ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∏ ·‚¤-

‚·ÈË ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ ÌÔÚÂ› Ó· Â›Ó·È ÂÛÙ›·

¿Á¯Ô˘˜ ÁÈ· ÌÂÚÈÎ¿ ˙Â˘Á¿ÚÈ·, Ù· ÔÔ›· ˙Ô˘Ó ÌÂ

ÙËÓ ·ÁˆÓ›· ÙË˜ ÂÎ‰‹ÏˆÛË˜ ÙË˜ ÓfiÛÔ˘, Î·ıÈ-

ÛÙÒÓÙ·˜ ÙË ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË ˘¤ÚÙ·ÙË˜

ÛËÌ·Û›·˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·˘ÙÒÓ ÙˆÓ ÔÈÎÔ-

ÁÂÓÂÈÒÓ (18). ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, Ë ÚÒÈÌË ‰È¿-

ÁÓˆÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ CFTR Î·È, ÂÔÌ¤Óˆ˜,

ÂÓfi˜ ·È‰ÈÔ‡ ÌÂ ÁÔÓfiÙ˘Ô Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜ ·Ï-

Ï¿ ÂÏÂ‡ıÂÚÔ˘ Û˘ÌÙˆÌ¿ÙˆÓ, ÂÈÙÚ¤ÂÈ ÛÙ·

˙Â˘Á¿ÚÈ· Ó· ÚÔÁÚ·ÌÌ·Ù›˙Ô˘Ó ÙËÓ ·Ó··Ú·-

ÁˆÁ‹ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘˜, ÌÂÙ¿ ·fi ÔÏ‡ Î·-

Ï‹ ÏËÚÔÊfiÚËÛË. ∞˘Ùfi Ô‰ËÁÂ› ÌÂÚÈÎ¿ ˙Â˘Á¿-

ÚÈ· ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜

ÛÂ ÂfiÌÂÓË Î‡ËÛË, ÚÈÓ ·ÎfiÌË ÙÔ ·È‰› ÙÔ˘˜ -

Ô˘ ÂÏ¤Á¯ıËÎÂ ÌÂ screening test - ·ÚÔ˘ÛÈ¿ÛÂÈ

Î¿ÔÈ· Û˘ÌÙÒÌ·Ù· ÙË˜ ÓfiÛÔ˘. ∆¤ÏÔ˜, ÙÔ ÓÂÔ-

ÁÓÈÎfi screening ÂÈÙÚ¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜

ÛÙÔ˘˜ Û˘ÁÁÂÓÂ›˜ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ÂÍÂÙ¿ÛÙËÎÂ,

ÒÛÙÂ Ó· ˆÊÂÏËıÔ‡Ó ·fi ÙËÓ ÚÔÁÂÓÓËÙÈÎ‹

‰È¿ÁÓˆÛË, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ‰ÂÓ ı· ÁÓÒÚÈ˙·Ó ÌÂ

¿ÏÏÔ ÙÚfiÔ fiÙÈ ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ Ó· ·ÔÎÙ‹-

ÛÔ˘Ó ·È‰› ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË (13).

øÛÙfiÛÔ, ¤Ó· ·fi Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙË˜

ÛÙÚ·ÙËÁÈÎ‹˜ ÙË˜ ÂÎÙÂÙ·Ì¤ÓË˜ ÁÔÓÈ‰È·Î‹˜

¤ÚÂ˘Ó·˜ Â›Ó·È Ë ‰È·›ÛÙˆÛË ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÌÂ-

Ù·Í‡ ÙˆÓ ÂÏÂÁÌ¤ÓˆÓ ÓÂÔÁÓÒÓ. ∞˘Ù‹ Ë ÏËÚÔ-

ÊÔÚ›· ‰ËÌÈÔ˘ÚÁÂ› ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÔÈÎÔÁ¤-

ÓÂÈ·, ‰ÈfiÙÈ ÔÈ ÁÔÓÂ›˜ ÌÔÚÂ› Ó· ·Ú·ÓÔ‹ÛÔ˘Ó

ÙËÓ ¤ÓÓÔÈ· ÙÔ˘ Ó· Â›Ó·È Î¿ÔÈÔ˜ “ÂÙÂÚfi˙˘ÁÔ˜”

(‰ËÏ·‰‹ ÊÔÚ¤·˜) Î·È ÙÔ˘ Ó· Â›Ó·È “¿Û¯ˆÓ”.

∂›ÛË˜, ÌÂÙ¿ ·fi ·˘Ù‹ ÙË ‰È·›ÛÙˆÛË ·ÎÔÏÔ˘-

ıÔ‡Ó screening Î·Ù¿ÏÏËÏ· ÁÈ· ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË

ÔÈÎÔÁ¤ÓÂÈ·, ÁÂÁÔÓfi˜ Ô˘ ÚÔÎ·ÏÂ› ¿Á¯Ô˜ ÛÙ·

ÂÏÂÁ¯fiÌÂÓ· Ì¤ÏË (15).

∏ ·ÎÚ›‚ÂÈ· ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ screening ÂËÚÂ-

¿˙ÂÙ·È ·fi ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ Î·ÙÒÙÂÚˆÓ ÙÈÌÒÓ

ÙË˜ Ì¤ÙÚËÛË˜ ÙË˜ IRT. ∏ ·‡ÍËÛË ·˘ÙÔ‡ ÙÔ˘

ÔÚ›Ô˘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛË ÙÔ˘ ·ÚÈı-

ÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ú·¤ÌÔÓÙ·È ÁÈ· DNA

·Ó¿Ï˘ÛË Î·È, ÂÔÌ¤Óˆ˜, ÙË ÌÂ›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡

ÙˆÓ ‰È·ÁÓˆÛÌ¤ÓˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ. ªÔÚÂ›,

ÏÔÈfiÓ, ÌÂ ·˘Ùfi ÙÔ Â›Â‰Ô ÙË˜ Ì¤ÙÚËÛË˜ Ó·

¶·È‰È·ÙÚÈÎ‹ 2005;68:386-393



ÌË ‰È·ÁÓˆÛÙÔ‡Ó ‹ Ó· ¯·ıÔ‡Ó ·È‰È¿, Ù· ÔÔ›·

¤¯Ô˘Ó ‰‡Ô ‹ÈÂ˜ ÌÔÚÊ¤˜ CFTR ÌÂÙ·ÏÏ¿ÍÂˆÓ

Î·È Ô˘ ¤¯Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· Ó· ·Ó·Ù‡ÍÔ˘Ó

ÙË ÓfiÛÔ ·ÚÁfiÙÂÚ· Û·Ó ¤ÊË‚ÔÈ ‹ Û·Ó ÂÓ‹ÏÈÎÂ˜

(13). ∂ÈÏ¤ÔÓ, Ë ‰È¿ÁÓˆÛË ÙË˜ Î˘ÛÙÈÎ‹˜ ›Óˆ-

ÛË˜ ÛÂ ·˘Ù¿ Ù· ·È‰È¿ ÌÔÚÂ› Ó· Â›Ó·È ·ÎfiÌË

ÈÔ ‰‡ÛÎÔÏÔ Ó· Á›ÓÂÈ ÛÙÔ Ì¤ÏÏÔÓ, ÂÂÈ‰‹ ·˘Ù¿

·Ó‹ÎÔ˘Ó ÛÙË ÁÂÓÈ¿ ÙˆÓ “screened children” Î·È

oÈ ·È‰›·ÙÚÔÈ ÌÔÚÂ› ·ÚÁfiÙÂÚ· ÛÙË ˙ˆ‹ ÙÔ˘˜

Ó· ·ÔÚÚ›ÙÔ˘Ó ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘.

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÔÈ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÙˆÓ

·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó „Â˘‰Ò˜ ıÂÙÈÎ¿ ·ÔÙÂÏ¤-

ÛÌ·Ù· ÙË˜ IRT ÌÔÚÂ› Ó· ˘Ê›ÛÙ·ÓÙ·È „˘¯ÔÏÔ-

ÁÈÎfi ÙÚ·‡Ì· Î·È Ó· ‰È·Î·Ù¤¯ÔÓÙ·È ·fi ·ÈÛı‹-

Ì·Ù· ¿Á¯Ô˘˜ (9-13). ∂ÈÏ¤ÔÓ, ¤Ó· ÌÈÎÚfi Ô-

ÛÔÛÙfi ÙˆÓ ÁÔÓ¤ˆÓ ÌÔÚÂ› Ó· ¤¯ÂÈ Ì›· ÌfiÓÈÌË

·Ú·ÓfiËÛË fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È ÛÂ Î›Ó‰˘ÓÔ

Ó· ·Ó·Ù‡ÍÂÈ Î˘ÛÙÈÎ‹ ›ÓˆÛË ÌÂÙ¿ ·fi ¤Ó·

„Â˘‰Ò˜ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÓÂÔÁÓÈÎÔ‡

screening, ÂÓÒ Ù· „Â˘‰Ò˜ ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·-

Ù· ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÔ˘Ó ÙÈ˜ ÂÈÏÔÁ¤˜ ·Ó··-

Ú·ÁˆÁ‹˜ ÙˆÓ ÁÔÓ¤ˆÓ (16). ŸÏÂ˜ ÔÈ ÚÔ·Ó·ÊÂÚ-

ıÂ›ÛÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÂÍËÁÔ‡Ó ÙÔÓ ÏfiÁÔ ÁÈ· ÙÔÓ

ÔÔ›Ô ÙÔ ÓÂÔÁÓÈÎfi screening ÁÈ· ÙËÓ Î˘ÛÙÈÎ‹

›ÓˆÛË Â›Ó·È ·ÓÙÈÎÂ›ÌÂÓÔ Û˘˙‹ÙËÛË˜.

¶ÚÔ‚Ï‹Ì·Ù· ·ÎÔ‹˜

ŒÓ· ¿ÏÏÔ ÓÂÔÁÓÈÎfi test ÛÙÔ¯Â‡ÂÈ ÛÙË ¤ÁÎ·È-

ÚË ‰È¿ÁÓˆÛË ‚Ï·‚ÒÓ ÙË˜ ·ÎÔ‹˜. ∏ ·ÎÔ˘ÔÌÂ-

ÙÚ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ÓÂÔÁÓÈÎfi screening

ÁÈ· ·˘Ù¤˜ ÙÈ˜ ‚Ï¿‚Â˜. OÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ-

‰›Ô˘ ÙË˜ ÎÔÓÂÍ›ÓË˜ 26 (connexin 26) Â˘ı‡ÓÔ-

ÓÙ·È ÁÈ· ÙÔ 40% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙË˜

·ÒÏÂÈ·˜ ·ÎÔ‹˜ ÛÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·, ÌÂ Û˘-

¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ 3% (19-21). ∆Ô test ¤¯ÂÈ

‰‡Ô ÛÙ¿‰È·: ÙËÓ ·ÎÔ˘ÔÌÂÙÚ›·, ·Ú¯ÈÎ¿, ÙËÓ

ÔÔ›· ·ÎÔÏÔ˘ıÂ› DNA test ÁÈ· ¤ÏÂÁ¯Ô ÙˆÓ ÌÂ-

Ù·ÏÏ¿ÍÂˆÓ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ÎÔÓÂÍ›ÓË˜ 26. ∏

ÚÒÈÌË ‰È¿ÁÓˆÛË ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÙË˜

ÂÈıÂÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ

‰ÂÍÈÔÙ‹ÙˆÓ ÙÔ˘ ÏfiÁÔ˘ ÂÓfi˜ ·È‰ÈÔ‡, ÙËÓ ÂÌ-

Ê‡ÙÂ˘ÛË ÎÔ¯Ï›· ‹ Î·È ÙˆÓ ‰‡Ô.

ŒÓ· ÌfiÓÈÌÔ ËıÈÎfi ı¤Ì· ÛÙ· ÓÂÔÁÓÈÎ¿ ·ÓÈ-

¯ÓÂ˘ÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· Â›Ó·È Â¿Ó Ù· screening

ı· Ú¤ÂÈ Ó· Â›Ó·È ÂıÂÏÔÓÙÈÎ¿ ‹ ˘Ô¯ÚÂˆÙÈÎ¿.

ª›· ÂıÂÏÔÓÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ··ÈÙÂ› ÙÂÏÈÎ‹

·fiÊ·ÛË ·fi ÙÔ˘˜ ÁÔÓÂ›˜ ÌÂÙ¿ ·fi ÏËÚÔÊfi-

ÚËÛË, ÂÓÒ Ë ˘Ô¯ÚÂˆÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ·Ó·ÌÊ›-

‚ÔÏ· ÙÔ˘˜ ˘Ô‚¿ÏÏÂÈ ÛÂ ¿ÚÓËÛË.

∏ Î˘ÚÈfiÙÂÚË ËıÈÎ‹ ‰ÈÎ·ÈÔÏÔÁ›· Ô˘ ÚÔ-

‚¿ÏÏÂÙ·È ÁÈ· ÙÔÓ ˘Ô¯ÚÂˆÙÈÎfi ¤ÏÂÁ¯Ô Â›Ó·È ÙÔ

·Í›ˆÌ· fiÙÈ Î·ı‹ÎÔÓ ÙË˜ ÎÔÈÓˆÓ›·˜ Â›Ó·È Ó·

ÚÔ¿ÁÂÈ ÙËÓ ÔÈfiÙËÙ· ÙË˜ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡

Ì¤Ûˆ ÙË˜ ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆÛË˜ Î·È ıÂÚ·Â›·˜

ÔÚÈÛÌ¤ÓˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ, ˘ÔÎ·ıÈÛÙÒÓÙ·˜ ÙÔ

ÁÔÓÂ˚Îfi ‰ÈÎ·›ˆÌ· ÁÈ· ¿ÚÓËÛË (3). ŒÓ· ·ÓÙ›ıÂÙÔ

ÂÈ¯Â›ÚËÌ· ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ·Ú·‰ÔÛÈ·Î¿ ÔÈ

ÁÔÓÂ›˜ ¤¯Ô˘Ó ÙËÓ ·ÚÌÔ‰ÈfiÙËÙ· Ó· ÂÈÏ¤ÁÔ˘Ó

ÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ˘ÁÂ›· ÙÔ˘ ·È-

‰ÈÔ‡ ÙÔ˘˜. ∞Ó Î·È ÔÈ ÁÔÓÂ›˜ ‰ÂÓ ¤¯Ô˘Ó ÙÔ ‰ÈÎ·›-

ˆÌ· Ó· ·ÚÓÔ‡ÓÙ·È Ì›· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·-

Â›· ÁÈ· Î·Ù·ÛÙ¿ÛÂÈ˜ ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹

ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, ¤¯Ô˘Ó ˆÛÙfiÛÔ, ÙÔ ‰ÈÎ·›ˆÌ·

Ó· ÂÈÏ¤ÁÔ˘Ó ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ ÚÔÔÙÈÎÒÓ

ÁÈ· Î·Ù·ÛÙ¿ÛÂÈ˜ ÏÈÁfiÙÂÚÔ ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË

˙ˆ‹ ÙÔ˘. ªÂÚÈÎ¤˜ ÊÔÚ¤˜, Ì¿ÏÈÛÙ·, Î¿ÓÔ˘Ó Ù¤-

ÙÔÈÂ˜ ÂÈÏÔÁ¤˜, ÙÈ˜ ÔÔ›Â˜ ÌÂÚÈÎÔ› Â·ÁÁÂÏÌ·-

Ù›Â˜ ˘ÁÂ›·˜ ı· ıÂˆÚÔ‡Û·Ó ·Ú¿ÏÔÁÂ˜.

∞ÓÈ¯ÓÂ˘ÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· ÊÔÚ¤ˆÓ

∏ ÚfiÔ‰Ô˜ ÙË˜ È·ÙÚÈÎ‹˜ ÙÂ¯ÓÔÏÔÁ›·˜ ÂÈ-

ÙÚ¤ÂÈ ÙËÓ ·Ó·ÁÓÒÚÈÛË ·ÙfiÌˆÓ Ô˘ Â›Ó·È ÊÔ-

ÚÂ›˜ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÂ ÁÔÓ›‰È· ‰È·ÊfiÚˆÓ ÓÔÛË-

Ì¿ÙˆÓ, fiˆ˜ ÙË˜ ÓfiÛÔ˘ Tay-Sachs, ÙË˜ Ì˘˚Î‹˜

‰˘ÛÙÚÔÊ›·˜, ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜

‹ ÙË˜ ÌÂ›˙ÔÓÔ˜ ı·Ï·ÛÛ·ÈÌ›·˜.

∏ Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· Duchenne Â›Ó·È Ô ÈÔ

Û˘¯Ófi˜ Ù‡Ô˜ Ì˘˚Î‹˜ ‰˘ÛÙÚÔÊ›·˜ ÛÙ· ·È‰È¿.

∫ÏËÚÔÓÔÌÂ›Ù·È ÌÂ ¤Ó·Ó Ê˘ÏÔÛ‡Ó‰ÂÙÔ ÙÚfiÔ

Î·È - ÌÂ ÌÂÚÈÎ¤˜ ÂÍ·ÈÚ¤ÛÂÈ˜ - ÚÔÛ‚¿ÏÏÔÓÙ·È

ÌfiÓÔ ·ÁfiÚÈ·. ∆Ô ÁÔÓ›‰ÈÔ Duchenne-Becker Â›-

Ó·È ÁÓˆÛÙfi fiÙÈ Â›Ó·È ¤Ó· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ÁÔ-

Ó›‰È· ÙÔ˘ ·ÓıÚÒÔ˘ Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ¯Úˆ-

ÌfiÛˆÌ· Ã (Ãp21) (12,22,23). ∞˘Ùfi ÙÔ ÁÔÓ›‰ÈÔ

Îˆ‰ÈÎÔÔÈÂ› ÙËÓ ÚˆÙÂ˝ÓË ‰˘ÛÙÚÔÊ›ÓË, Ë

ÔÔ›· ¤¯ÂÈ ¤Ó·Ó ÚfiÏÔ-ÎÏÂÈ‰› ÛÙËÓ ·ÎÂÚ·ÈfiÙËÙ·

ÙË˜ ‰ÔÌ‹˜ ÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ. ™ÙËÓ ÏÂÈÔÓfiÙËÙ·

ÙˆÓ ·ÛıÂÓÒÓ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ÌÂÁ¿ÏË ÔÈÎÈ-

Ï›· ÌÂÙ·ÏÏ¿ÍÂˆÓ, ÌÂ Ï‹ÚË ‹ ÌÂÚÈÎ‹ ·ÒÏÂÈ·

ÙÔ˘ ÁÔÓÈ‰›Ô˘. ŒÓ·˜ ·Ú·ÏÏ·ÁÌ¤ÓÔ˜ Ù‡Ô˜ Â›Ó·È

Ë Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· Becker (BMD), Ë ÔÔ›· Â›-

Ó·È ÚÔÔ‰Â˘ÙÈÎ‹ ÓfiÛÔ˜ ÌÂ ÌÂÁ·Ï‡ÙÂÚË ÂÈ‚›ˆ-

ÛË. ¢ÂÓ ˘¿Ú¯ÂÈ ÚÈ˙ÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙËÓ DMD,

Ë ÔÔ›· ¤¯ÂÈ ÚÔÔ‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË, ÂÓÒ Ô

Î·ÓfiÓ·˜ Â›Ó·È Ô ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜ ÛÙË 2Ë-3Ë

‰ÂÎ·ÂÙ›· ÙË˜ ˙ˆ‹˜ (23).

™‹ÌÂÚ·, ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ¯ÒÚÂ˜ ÂÊ·ÚÌfi˙ÂÙ·È

ÂıÂÏÔÓÙÈÎfi˜ ÓÂÔÁÓÈÎfi˜ ·ÓÈ¯ÓÂ˘ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ

DNA ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ÓfiÛÔ˘, fiÔ˘

¯ÚËÛÈÌÔÔÈÂ›Ù·È ÍËÚ¿ ÛÙ·ÁfiÓ· ·›Ì·ÙÔ˜ ÛÂ

ÚÔÛÚÔÊËÙÈÎfi ¯·ÚÙ›. ™ÙÔ ÂıÂÏÔÓÙÈÎfi ÚfiÁÚ·Ì-

Ì· ÛÙË °ÂÚÌ·Ó›· ÂÍÂÙ¿˙ÔÓÙ·È ‚Ú¤ÊË ËÏÈÎ›·˜

ÌÂÙ·Í‡ 4 Â‚‰ÔÌ¿‰ˆÓ Î·È ÂÓfi˜ ¤ÙÔ˘˜. ∂›ÛË˜,

ÓÂÔÁÓ¿ ÂÏ¤Á¯ÔÓÙ·È ÌÂ ÈÏÔÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù·

¶·È‰È·ÙÚÈÎ‹ 2005;68:386-393


390 Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘

ÛÙË °·ÏÏ›· (Lyon), ÛÙÔ µ¤ÏÁÈÔ, ÛÙÔÓ ∫·Ó·‰¿

Î·È ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·.

O ¤ÏÂÁ¯Ô˜ ÛÙËÚ›˙ÂÙ·È, ·Ú¯ÈÎ¿, ÛÙÔÓ Î·ıÔÚÈ-

ÛÌfi ÙË˜ ÎÚÂ·Ù›ÓË˜ ÎÈÓ¿ÛË˜ (CK), ÌÂ ÂÎÙ›ÌËÛË

ÙÔ˘ ÊıÔÚÈÛÌÔ‡ ÛÂ ÍËÚ¿ ÛÙ·ÁfiÓ· ·›Ì·ÙÔ˜ ÙÔ˘

ÓÂÔÁÓÔ‡. º˘ÛÈÔÏÔÁÈÎ¿ ‰Â›ÁÌ·Ù· ‰ÂÓ ÊıÔÚ›-

˙Ô˘Ó, ÂÓÒ ‰Â›ÁÌ·Ù· ÌÂ Â›Â‰· CK >500 U/L

ÂÌÊ·Ó›˙Ô˘Ó ÊıÔÚÈÛÌfi. ∞ÎÔÏÔ˘ıÂ› ÂÎÙ›ÌËÛË

ÙË˜ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙË˜ CK ÛÙÔÓ ÔÚfi ÌÂ ·ÓÔÛÔ-

ÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ‰Ô. ™Ù· ·ıÔÏÔÁÈÎ¿ ‰Â›ÁÌ·Ù·

·ÎÔÏÔ˘ıÂ› ÌÔÚÈ·Î‹ ‰ÈÂÚÂ‡ÓËÛË ÁÈ· ÙËÓ ·Ó·˙‹-

ÙËÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (ÂÏÏÂ›„ÂˆÓ) ÙÔ˘ ÁÔÓÈ-

‰›Ô˘ ÙË˜ ‰˘ÛÙÚÔÊ›ÓË˜ ÌÂ ÙËÓ ÙÂ¯ÓÔÏÔÁ›· ÙË˜

·Ó¿Ï˘ÛË˜ ÙÔ˘ DNA. ∞ÚÓËÙÈÎ¿ Â˘Ú‹Ì·Ù· ·Ú·-

ÙËÚÔ‡ÓÙ·È ÂÚ›Ô˘ ÛÙÔ 30% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ

DMD, ÂÂÈ‰‹ Î¿ÔÈÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›-

Ô˘ ÙË˜ ‰˘ÛÙÚÔÊ›ÓË˜ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·È Ì¤¯ÚÈ

Û‹ÌÂÚ· ÌÂ ÙËÓ ·Ó¿Ï˘ÛË ÙÔ˘ DNA (23). ™Â Â-

ÚÈÙÒÛÂÈ˜ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ·Ó·ÁÓˆÚ›ÛÈÌÂ˜ ÌÂ-

Ù·ÏÏ¿ÍÂÈ˜, ·ÎÔÏÔ˘ıÂ› ‚ÈÔ„›· Ì˘ÒÓ ÁÈ· ÙËÓ

ÂÎÙ›ÌËÛË ÙË˜ Î·Ù¿ÛÙ·ÛË˜ ÙË˜ ‰˘ÛÙÚÔÊ›ÓË˜. ∏

‚ÈÔ„›· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙË˜ Ófi-

ÛÔ˘ Î·È, ÂÈÏ¤ÔÓ, Î·ıÔÚ›˙ÂÈ ÙËÓ ÈÔ ‚·ÚÈ¿

ÌÔÚÊ‹ DMD ·fi ÙËÓ BMD, fiÙ·Ó Ë DNA ÌÂ-

Ù¿ÏÏ·ÍË ‰ÂÓ Â›Ó·È ÏËÚÔÊÔÚÈ·Î‹.

∆Ô fiÊÂÏÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙË˜ ÔÈÎÔÁ¤ÓÂÈ¿˜

ÙÔ˘ Î·È ÙË˜ ÎÔÈÓˆÓ›·˜ ·Ú·Ì¤ÓÂÈ ¤Ó· ·ÌÊÈÏÂ-

ÁfiÌÂÓÔ ı¤Ì·, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙËÓ ·Ô˘-

Û›· - Ì¤¯ÚÈ Û‹ÌÂÚ· - Ì›·˜ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹˜ ıÂ-

Ú·Â›·˜. Œ¯Ô˘Ó ÚÔÎ‡„ÂÈ ÚÔ‚Ï‹Ì·Ù· Ô˘

·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ „˘¯ÔÏÔÁÈÎ‹ Î·È ÂÓ‰ÔÔÈÎÔ-

ÁÂÓÂÈ·Î‹ ÂÈ‚¿Ú˘ÓÛË ÛÂ ÂÚÈÙÒÛÂÈ˜ ÚÔÛ˘-

ÌÙˆÌ·ÙÈÎÒÓ ‰È·ÁÓÒÛÂˆÓ (ÔÛÔÛÙfi ÂÚ›Ô˘

40% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ì‚·›ÓÂÈ de novo, ‰Ë-

Ï·‰‹ ÛÂ ÔÈÎÔÁ¤ÓÂÈÂ˜ ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓ· ÚÔ-

Û‚Â‚ÏËÌ¤Ó· ¿ÙÔÌ·). ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿,

fiÌˆ˜, Ë ‰È·ıÂÛÈÌfiÙËÙ· ÙË˜ ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆ-

ÛË˜ ÌÔÚÂ› Ó· ÂÈÙÚ¤„ÂÈ ÛÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ Ó·

Î¿ÓÔ˘Ó Ú·ÎÙÈÎ¤˜ ÂÈÏÔÁ¤˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ˙ˆ‹

ÂÓfi˜ ·È‰ÈÔ‡ ÌÂ ÂÈ‰ÈÎ¤˜ ·Ó¿ÁÎÂ˜ Î·È Ó· ·Ô-

Ê‡ÁÔ˘Ó Ì›· ·Ú·ÙÂÙ·Ì¤ÓË “‰È·ÁÓˆÛÙÈÎ‹

Ô‰‡ÛÛÂÈ·”. ªÔÚÂ›, ·ÎfiÌË, ÁÈ· ÌÂÚÈÎ¤˜ ÔÈÎÔ-

Á¤ÓÂÈÂ˜ Ó· Â›Ó·È ˆÊ¤ÏÈÌË Ë ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹-

ÁËÛË Î·È Ô ¤ÏÂÁ¯Ô˜ ÌÂÏÒÓ ÙË˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È

ÛÂ Î›Ó‰˘ÓÔ (22,23).

OÈ ÂÚÂ˘ÓËÙ¤˜, ÌÂ ‚¿ÛË ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜,

ÚÔÙÂ›ÓÔ˘Ó Ó· Â›Ó·È ÚÔ·ÈÚÂÙÈÎ‹ Ë ¯Ú‹ÛË ÙË˜

‰È·ÁÓˆÛÙÈÎ‹˜ ÁÂÓÂÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜. ¶·Ú¿ÏÏË-

Ï·, ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘¿Ú¯ÂÈ ¤Ó· ·˘ÛÙËÚfi ÚˆÙfi-

ÎÔÏÏÔ ÁÈ· ÙËÓ ·ÚÔ¯‹ ˘ÔÛÙ‹ÚÈÍË˜ ÛÙÔ˘˜ ÁÔ-

ÓÂ›˜ Î·È ÛÙÔ ¿Û¯ÔÓ ·È‰›, ÙÔ ÔÔ›Ô ÂÈÙÚ¤ÂÈ

ÙË ‰È·ÛÊ¿ÏÈÛË ÂÈÎÔÈÓˆÓ›·˜ Î·È Û˘ÓÂÚÁ·Û›·˜

ÌÂÙ·Í‡ ÚˆÙÔ‚¿ıÌÈ·˜, ‰Â˘ÙÂÚÔ‚¿ıÌÈ·˜ Î·È

ÙÚÈÙÔ‚¿ıÌÈ·˜ ˘ËÚÂÛ›·˜. ∂È‰ÈÎfiÙÂÚ·, Â›Ó·È

··Ú·›ÙËÙË Ë ÔÏÔÎÏËÚˆÌ¤ÓË ˘ËÚÂÛ›· Û˘Ì-

‚Ô˘ÏÂ˘ÙÈÎ‹˜, Ë ·È‰È·ÙÚÈÎ‹ ˘ËÚÂÛ›· ÛÙ‹ÚÈ-

ÍË˜ Î·È ÂÈ‰ÈÎ¿ ÂÎ·È‰Â˘Ì¤Ó· ¿ÙÔÌ· ÁÈ· ÙÔÓ Û˘-

ÓÙÔÓÈÛÌfi ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ·ÓÈ¯ÓÂ˘ÙÈÎÔ‡ ÂÏ¤Á¯Ô˘.

ª¤¯ÚÈ Û‹ÌÂÚ·, Ô ¤ÏÂÁ¯Ô˜ ÊÔÚ¤ˆÓ ‹ Ô ÁÂÓÈ-

Îfi˜ ÏËı˘ÛÌÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ¤¯Ô˘Ó ÂÊ·ÚÌÔ-

ÛÙÂ› ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹-

‚Ô˘˜ ÛÙÈ˜ ∏.¶.∞. £ÂˆÚËÙÈÎ¿, Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘

¤Ï¤Á¯Ô˘ ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÛÂÍÔ˘·ÏÈÎ‹˜ ‰Ú·-

ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ, ı· ·‡Í·ÓÂ ÙÈ˜ ÂÈÏÔ-

Á¤˜ ·Ó··Ú·ÁˆÁ‹˜ ÛÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ı· ‰È·È-

ÛÙÒÓÔÓÙ·Ó ˆ˜ ÊÔÚÂ›˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÂÎÂ›ÓÔ˘˜

Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó ÛÙÔÓ ¤ÏÂÁ¯Ô ÛÙË ‰È¿ÚÎÂÈ·

ÙË˜ Î‡ËÛË˜. øÛÙfiÛÔ, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ

Ô˘ ÁÓˆÚ›˙Ô˘Ó fiÙÈ Â›Ó·È ÊÔÚÂ›˜, ÌÔÚÂ› Ó· Â›-

Ó·È „˘¯ÔÏÔÁÈÎ¿ ÈÔ Â˘¿ÏˆÙÔÈ ÛÂ Û‡ÁÎÚÈÛË ÌÂ

ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜. ¶·Ú·Ì¤ÓÂÈ ‰Â ·ÌÊ›‚ÔÏÔ Â¿Ó Ô

¤ÏÂÁ¯Ô˜ ÛÂ ÓÂ·ÚfiÙÂÚÂ˜ ËÏÈÎ›Â˜ ı· ÂÈÊ¤ÚÂÈ ÛÙÔ

Ì¤ÏÏÔÓ ·ÏÏ·Á¤˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙË˜ ·Ó··-

Ú·ÁˆÁ‹˜ ÙÔ˘˜ (3).

∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ ‰ÂÓ

˘ÔÛÙËÚ›˙ÂÈ ÙËÓ Â˘ÚÂ›· ¯Ú‹ÛË ÙˆÓ ·ÓÈ¯ÓÂ˘ÙÈ-

ÎÒÓ ÂÏ¤Á¯ˆÓ ÊÔÚ¤ˆÓ ÛÙ· ·È‰È¿ ‹ ÙÔ˘˜ ÂÊ‹-

‚Ô˘˜, ·ÏÏ¿ Û˘ÓÈÛÙ¿ Ó· ‰ÈÂÓÂÚÁÔ‡ÓÙ·È ÛÙÈ˜

¤ÁÎ˘Â˜ ÂÊ‹‚Ô˘˜ ‹ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ô˘ Û¯Â‰È¿-

˙Ô˘Ó Ì›· Î‡ËÛË Î·È ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó Ï‹Úˆ˜

ÏËÚÔÊÔÚËıÂ› ÁÈ· Ù· ÔÊ¤ÏË Î·È ÙÔ˘˜ ÎÈÓ‰‡-

ÓÔ˘˜ Ô˘ ÚÔÎ‡ÙÔ˘Ó ·fi ÙÔÓ ¤ÏÂÁ¯Ô.

¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÓÔÛ‹Ì·Ù· Ô˘

ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ· ÛÙË ˙ˆ‹

∏ ÁÂÓÂÙÈÎ‹ ÙÂ¯ÓÔÏÔÁ›· ‰È·ÛÊ·Ï›˙ÂÈ Ù· Ì¤Û·

ÁÈ· Ó· ‰È·ÁÓˆÛÙÔ‡Ó ÓÔÛ‹Ì·Ù· Ù· ÔÔ›· ÂÎ‰Ë-

ÏÒÓÔÓÙ·È ÌÂÙ¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ‹ ÌfiÓÔ ÛÙËÓ

ÂÓ‹ÏÈÎË ˙ˆ‹. ¶·Ú·‰Â›ÁÌ·Ù· ÓÔÛËÌ¿ÙˆÓ Ô˘

ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÌÂ ˘„ËÏfi

‚·ıÌfi ÚÔ‚ÏÂ„ÈÌfiÙËÙ·˜ ÌÂ ·Ó¿Ï˘ÛË DNA,

ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË Ì˘ÔÙÔÓÈÎ‹ ‰˘ÛÙÚÔÊ›·, ÙËÓ

·ÈÌÔ¯ÚˆÌ¿ÙˆÛË, ÙÔ˘˜ ÔÏ˘Î˘ÛÙÈÎÔ‡˜ ÓÂ-

ÊÚÔ‡˜, ÙË ÓfiÛÔ Huntington Î·È ÌÂÚÈÎ¿ Â›‰Ë

Î·ÚÎ›ÓÔ˘ (2). ∂ÈÏ¤ÔÓ, Û‹ÌÂÚ· Â›Ó·È ÂÊÈÎÙfi

Ó· ÂÓÙÔÈÛÙÔ‡Ó ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜, ÔÈ ÔÔ›-

ÔÈ ·˘Í¿ÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÎ‰‹ÏˆÛË˜ Û˘-

¯ÓÒÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Ë ÓfiÛÔ˜ ÙˆÓ ÛÙÂÊ·ÓÈ-

·›ˆÓ ·ÚÙËÚÈÒÓ, Ô ‰È·‚‹ÙË˜, Ù· ÂÁÎÂÊ·ÏÈÎ¿

ÂÂÈÛfi‰È·, ÔÈ ·ÁÁÂÈ·Î¤˜ ıÚÔÌ‚ÒÛÂÈ˜ ·fi ıÚÔÌ-

‚ÔÊÈÏ›· (ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÊÔÚÂ›·˜ ÙÔ˘ ›‰ÈÔ˘

·ÓÙ›ÁÚ·ÊÔ˘ ÙÔ˘ ÁÔÓÈ‰›Ô˘ V Leiden) (4), Ë

˘¤ÚÙ·ÛË (2,3), Ë ÓfiÛÔ˜ Alzheimer (8), ÔÚÈÛÌ¤-

ÓÔÈ Ù‡ÔÈ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ (6) Î·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:386-393



ÙÔ˘ Ì·ÛÙÔ‡ (6), ÌÂÚÈÎ¤˜ „˘¯È·ÙÚÈÎ¤˜ Î·Ù·ÛÙ¿-

ÛÂÈ˜ Î·È Î¿ÔÈ· ÚÂ˘Ì·ÙÈÎ¿ ÓÔÛ‹Ì·Ù· (3).

™·Ó ·Ú¿‰ÂÈÁÌ· ·Ó·Ê¤ÚÂÙ·È Ë ÓfiÛÔ˜

Huntington Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ·˘ÙÔÛˆÌ·-

ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·. ∂¿Ó ˘¿Ú¯ÂÈ Ë

ÌÂÙ¿ÏÏ·ÍË ÙË˜ ÓfiÛÔ˘, Ô Î›Ó‰˘ÓÔ˜ ÂÎ‰‹ÏˆÛË˜

ÁÈ· ÙË ÓfiÛÔ Â›Ó·È 100% ÛÂ Ì›· ÂÈ‚›ˆÛË Ê˘ÛÈÔ-

ÏÔÁÈÎ‹˜ ‰È¿ÚÎÂÈ·˜. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ

·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â›·, ·ÏÏ¿ Ô‡ÙÂ Î·È ÚÔ-

ÏËÙÈÎ‹. ∏ ·fiÊ·ÛË ÁÈ· ÙÔÓ ÚÔÎÏÈÓÈÎfi ¤ÏÂÁ-

¯Ô Â›Ó·È Î·ı·Ú¿ ÚÔÛˆÈÎ‹ Î·È Ù· ·ÔÙÂÏ¤-

ÛÌ·Ù¿ ÙÔ˘ ¤¯Ô˘Ó Èı·ÓfiÙËÙ· Ó· ÛÙÈÁÌ·Ù›ÛÔ˘Ó

‹ Ó· Î·Ù·‚¿ÏÏÔ˘Ó „˘¯ÔÏÔÁÈÎ¿ ÙÔ ¿ÙÔÌÔ. °È·

ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë ÚÔÛÂÎÙÈÎ‹ ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹-

ÁËÛË Â›Ó·È ··Ú·›ÙËÙË. ¢ÂÎ·ÂÙ‹˜ ÂÌÂÈÚ›·

·fi ÙË ª. µÚÂÙ·Ó›· ‰Â›¯ÓÂÈ fiÙÈ ÌfiÓÔ 20% Â-

Ú›Ô˘ ÙˆÓ ·ÙfiÌˆÓ ÛÂ Î›Ó‰˘ÓÔ ÁÈ· ÓfiÛÔ

Huntington ˙ËÙÔ‡Ó Ó· ÂÏÂÁ¯ıÔ‡Ó (23).

°È· Î¿ÔÈÂ˜ ·fi ·˘Ù¤˜ ÙÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, Ë

ÁÓÒÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ Ù·

¿ÙÔÌ· Ó· ÌÂÈÒÛÔ˘Ó ÙË ÓÔÛËÚfiÙËÙ· ‹ ÙÔÓ Î›Ó-

‰˘ÓÔ ÙË˜ ıÓËÛÈÌfiÙËÙ·˜. ∂ÈÏ¤ÔÓ, Ì¤ÏË ÙË˜

ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÂ Î›Ó‰˘ÓÔ ÌÔÚÂ› Ó· ˆÊÂÏËıÔ‡Ó

„˘¯ÔÏÔÁÈÎ¿ Â›ÙÂ Ì·ı·›ÓÔÓÙ·˜ fiÙÈ ‰ÂÓ Â›Ó·È ÊÔ-

ÚÂ›˜ ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜, Â›ÙÂ - ÂÂÈ‰‹ ı· ·‡ÛÂÈ Ë

·ÌÊÈ‚ÔÏ›· fiÙÈ ¤¯Ô˘Ó Èı·ÓÒ˜ ÙË ÓfiÛÔ - ·Ó ‰È·-

ÈÛÙˆıÂ› fiÙÈ Â›Ó·È ÌfiÓÔ ÊÔÚÂ›˜. °È· ÔÏÏ¤˜ Î·-

Ù·ÛÙ¿ÛÂÈ˜, fiÌˆ˜, ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Ë ÌÂ›ˆÛË

ÙË˜ ÓÔÛËÚfiÙËÙ·˜ ‹ ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ˆ˜ ·Ô-

Ù¤ÏÂÛÌ· ÂÓfi˜ ÁÂÓÂÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ Î·È ·Ú·Ì¤ÓÂÈ

·Û·Ê¤˜ Â¿Ó ÔÈ ·ÚÔ‡ÛÂ˜ ÚÔÙ¿ÛÂÈ˜ ÁÈ· ÙËÓ

ÚfiÏË„Ë ‹ ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ı· Â›Ó·È ·Ô-

ÙÂÏÂÛÌ·ÙÈÎ¤˜ ÛÂ ·˘ÙfiÓ ÙÔÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

ÏËı˘ÛÌfi (3). ∂ÈÏ¤ÔÓ, Ë ÁÓˆÛÙÔÔ›ËÛË ÙÔ˘

·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÔÚÂ› Ó· ÂÓÂÚÁÔÔÈÂ›

Ì›· ·ÓÙ›ıÂÙË „˘¯ÔÏÔÁÈÎ‹ ·¿ÓÙËÛË Î·È ÂÓ‰Â-

¯ÔÌ¤Óˆ˜ ÎÔÈÓˆÓÈÎ¤˜ ‰È·ÎÚ›ÛÂÈ˜. °È· ÙÔÓ ÏfiÁÔ

·˘Ùfi, Ô ÁÚ‹ÁÔÚÔ˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ

ÙˆÓ ÁÔÓÈ‰›ˆÓ BRCA 1/BRCA 2 (Ù· ÔÔ›· ÚÔ-

‰È·ı¤ÙÔ˘Ó ÛÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· Î·ÚÎ›ÓÔ

ÙÔ˘ Ì·ÛÙÔ‡ Î·È ÙˆÓ ˆÔıËÎÒÓ) Î·È ÙÔ˘ ÁÔÓÈ‰›Ô˘

HNPCC (‹ ÁÔÓÈ‰›Ô˘ ÙÔ˘ ÌË ÔÏ˘Ô‰È·ÛÈÎÔ‡

ÎÏËÚÔÓÔÌÈÎÔ‡ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘)

ÛÙËÓ ÎÏÈÓÈÎ‹ È·ÙÚÈÎ‹ ÙˆÓ ÂÓËÏ›ÎˆÓ ‹Ù·Ó ·Ô-

ı·ÚÚ˘ÓÙÈÎfi˜ (6). ∏ ÔÏ˘ÏÔÎfiÙËÙ· ÙˆÓ ÁÂÓÂ-

ÙÈÎÒÓ tests Î·È Ë ·‚Â‚·ÈfiÙËÙ· ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡-

ÓÔ˘˜ Î·È Ù· ÔÊ¤ÏË ·fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù·, ÂÈ-

‚Â‚·ÈÒÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ‰ÈÂÍÔ‰ÈÎ‹˜ ÁÂÓÂÙÈÎ‹˜

Î·ıÔ‰‹ÁËÛË˜ ÁÈ· ÙÔÓ ÚÔÏËÙÈÎfi ÁÂÓÂÙÈÎfi

¤ÏÂÁ¯Ô, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ÓÔÛ‹Ì·Ù· Ô˘ ÂÌÊ·-

Ó›˙ÔÓÙ·È ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›·. ¶ÔÏÏÔ› ÂÓ‹ÏÈ-

ÎÂ˜ ÂÈÏ¤ÁÔ˘Ó Ó· ÌËÓ ÂÏÂÁ¯ıÔ‡Ó, ÁÂÁÔÓfi˜ Ô˘

‰Â›¯ÓÂÈ fiÙÈ ‰ÂÓ ÌÔÚÂ› Ó· ıÂˆÚÂ›Ù·È ‰Â‰ÔÌ¤ÓÔ

fiÙÈ Ù· ·È‰È¿ ı· ‹ıÂÏ·Ó Ó· ÂÏÂÁ¯ıÔ‡Ó ‹ ı·

ˆÊÂÏÔ‡ÓÙ·Ó (3).

¶ÚfiÛÊ·Ù·, ‰‡Ô ÂÈÙÚÔ¤˜ ·fi ÙËÓ ∞ÌÂÚÈ-

Î·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ ¤¯Ô˘Ó ¿ÚÂÈ

ı¤ÛË ÁÈ· ÙÔÓ ÁÂÓÂÙÈÎfi ¤ÏÂÁ¯Ô ÛÙ· ·È‰È¿ Î·È

ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÁÈ· Ù· ÓÔÛ‹Ì·Ù· Ô˘ ÂÎ‰ËÏÒÓÔ-

ÓÙ·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (9). ∏ ÂÈÙÚÔ‹ ÙË˜ °Â-

ÓÂÙÈÎ‹˜ Û˘ÛÙ‹ÓÂÈ fiÙÈ ¿ÙÔÌ· ËÏÈÎ›·˜ ÌÈÎÚfiÙÂ-

ÚË˜ ÙˆÓ 18 ÂÙÒÓ Ú¤ÂÈ Ó· ÂÏ¤Á¯ÔÓÙ·È ÁÈ· Ù·

ÓÔÛ‹Ì·Ù· ·˘Ù¿ ÌfiÓÔ Â¿Ó Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÚÔÛÊ¤ÚÂÈ ¿ÌÂÛ· È·ÙÚÈÎ¿ ÔÊ¤ÏË ‹ Â¿Ó ¤Ó· ¿Ï-

ÏÔ Ì¤ÏÔ˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ˆÊÂÏËıÂ›, ÂÓÒ ‰ÂÓ

ÚÔ‚Ï¤ÂÙ·È ‚Ï¿‚Ë ÁÈ· ÙÔ ¿ÙÔÌÔ Ô˘ ÂÏ¤Á¯Â-

Ù·È. ∏ ÂÈÙÚÔ‹ ıÂˆÚÂ› ‚·ÛÈÎfi Ì¤ÚÔ˜ ÙË˜ ‰È·-

‰ÈÎ·Û›·˜ ÙË ÁÂÓÂÙÈÎ‹ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹ ÚÈÓ Î·È

ÌÂÙ¿ ÙËÓ ÂÍ¤Ù·ÛË (3).

∏ ÂÈÙÚÔ‹ ÙË˜ µÈÔËıÈÎ‹˜ ‰ÂÓ ˘ÔÛÙËÚ›˙ÂÈ

ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÊÔÚ¤ˆÓ

ÁÈ· ÓÔÛ‹Ì·Ù· Ô˘ ÂÎ‰ËÏÒÓÔÓÙ·È ·ÚÁfiÙÂÚ·

ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÂÎÙfi˜ ·fi ÙËÓ ÂÚ›ÙˆÛË

Ô˘ Ì›· ¤ÊË‚Ë Â›Ó·È ¤ÁÎ˘Ô˜ ‹ Û¯Â‰È¿˙ÂÈ Ì›·

ÂÁÎ˘ÌÔÛ‡ÓË, ÂÓÒ Â›Ó·È ·ÓÙ›ıÂÙË ÌÂ ÙÔÓ ÚÔÏË-

ÙÈÎfi ¤ÏÂÁ¯Ô ÛÂ ¿ÙÔÌ· ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ

18 ÂÙÒÓ (3).

∆¤ÏÔ˜, Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÂÏ¤Á¯Ô˘

ÌÔÚÂ› Ó· ‰ÒÛÂÈ ·ÚÔÛ‰fiÎËÙÂ˜ ÏËÚÔÊÔÚ›Â˜

Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÙÚfiÙËÙ·. ∏ ∞ÌÂÚÈÎ·ÓÈÎ‹

∂Ù·ÈÚÂ›· ∞ÓıÚÒÈÓË˜ °ÂÓÂÙÈÎ‹˜ ¤¯ÂÈ ÙËÓ ¿Ô-

„Ë fiÙÈ Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó·

ÏËÚÔÊÔÚÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÙÚfiÙËÙ·, ·Ú¿ Ìfi-

ÓÔ Â¿Ó Ô Î·ıÔÚÈÛÌfi˜ ÙË˜ ·ÙÚfiÙËÙ·˜ ‹Ù·Ó Ô

·ÔÎÏÂÈÛÙÈÎfi˜ ÛÎÔfi˜ ÙÔ˘ ÂÏ¤Á¯Ô˘ (5).

∂Í¿ÏÏÔ˘, ÛÙË ‰È·‰ÈÎ·Û›· ÙÔ˘ ÁÂÓÂÙÈÎÔ‡

ÂÏ¤Á¯Ô˘ ÁÈ· Ì›· ÓfiÛÔ, ÌÔÚÂ› Ó· ·ÔÎ·Ï˘ÊıÂ›

ÏËÚÔÊÔÚ›· Û¯ÂÙÈÎ¿ ÌÂ Ì›· ¿ÏÏË ÓfiÛÔ. ∏ ‰È¿-

ÁÓˆÛË ÙË˜ ‰Â‡ÙÂÚË˜ ÓfiÛÔ˘ ÌÔÚÂ› Ó· Â›Ó·È

·Úfi‚ÏÂÙË Î·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÔÈÎÔÁÂÓÂÈ·Î¿

Î·È ÎÔÈÓˆÓÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, Î·ıÒ˜ Î·È ÛÙÈÁÌ·-

ÙÈÛÌfi. ™ÙË Û˘ÁÎ·Ù¿ıÂÛË ı· Ú¤ÂÈ Ó· ÂÚÈ-

Ï·Ì‚¿ÓÂÙ·È ˘ÂÓı‡ÌÈÛË Û¯ÂÙÈÎ¿ ÌÂ Ù˘¯fiÓ

·ÚÔÛ‰fiÎËÙ· Â˘Ú‹Ì·Ù· (5).

¶ÚÔÙ¿ÛÂÈ˜ ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ ∞Î·‰ËÌ›·˜

¶·È‰È·ÙÚÈÎ‹˜

·) O ÁÂÓÂÙÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, fiˆ˜

ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ‹ ıÂÚ·Â˘ÙÈÎ¤˜

·ÚÂÌ‚¿ÛÂÈ˜ ÁÈ· Ù· ·È‰È¿, ··ÈÙÂ› Û˘ÁÎ·Ù¿-

ıÂÛË ·fi ÙÔ˘˜ ÏËÚÔÊÔÚËÌ¤ÓÔ˘˜ ÁÔÓÂ›˜ Î·È

Û˘Ó·›ÓÂÛË ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿.

‚) ¢ÂÓ ˘ÔÛÙËÚ›˙ÂÙ·È Ë Â˘ÚÂ›· ¯Ú‹ÛË ÙÔ˘

ÂÏ¤Á¯Ô˘ ‹ Ô ·ÓÈ¯ÓÂ˘ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÊÔÚ¤ˆÓ ÁÈ·

¶·È‰È·ÙÚÈÎ‹ 2005;68:386-393


392 Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘

·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, Î·ıÒ˜ ¯ÚÂÈ¿˙ÂÙ·È ÂÈÏ¤-

ÔÓ ¤ÚÂ˘Ó·. OÈ Î›Ó‰˘ÓÔÈ Î·È Ù· ÔÊ¤ÏË ÙÔ˘ ÂÏ¤Á-

¯Ô˘ ÊÔÚ¤ˆÓ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi ÚÈÓ

‰ÔıÔ‡Ó ÛÂ Â˘ÚÂ›· ÎÏ›Ì·Î·, ı· Ú¤ÂÈ Ó· ·ÍÈÔ-

ÏÔÁËıÔ‡Ó ÚÔÛÂÎÙÈÎ¿ ÌÂ ÂÏÂÁ¯fiÌÂÓÂ˜ ÎÏÈÓÈÎ¤˜

‰ÔÎÈÌ¤˜. ∆· ·ÓÈ¯ÓÂ˘ÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· ÂÏ¤Á¯Ô˘

ÊÔÚ¤ˆÓ ÌÔÚÂ› Ó· Â›Ó·È Î·Ù¿ÏÏËÏ· ÁÈ· ¤ÁÎ˘Â˜

ÂÊ‹‚Ô˘˜ ‹ ÁÈ· ÂÎÂ›ÓÂ˜ Ô˘ ÛÎ¤ÊÙÔÓÙ·È ÙËÓ ÙÂ-

ÎÓÔÔ›ËÛË.

Á) O ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÓÔÛ‹Ì·Ù· Ô˘

ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ· ÛÙË ˙ˆ‹, ÁÂÓÈÎ¿, ı·

Ú¤ÂÈ Ó· ·Ó·‚ÏËıÂ› Ì¤¯ÚÈ ÙËÓ ÂÓËÏÈÎ›ˆÛË ‹

Ì¤¯ÚÈ˜ fiÙÔ˘ Ô ¤ÊË‚Ô˜ Ô˘ ÂÓ‰È·Ê¤ÚÂÙ·È ı·

¤¯ÂÈ ·Ó·Ù‡ÍÂÈ ÙËÓ ˆÚÈÌfiÙËÙ· Ó· ¿ÚÂÈ ÙËÓ ÙÂ-

ÏÈÎ‹ ·fiÊ·ÛË. £ÂˆÚÂ›Ù·È fiÙÈ Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ-

¯Ô˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÁÈ· ÙËÓ Úfi-

ÏË„Ë ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfi-

ÙÂÚ· Â›Ó·È ·Î·Ù¿ÏÏËÏÔ˜, ·ÊÔ‡ Ë ÁÂÓÂÙÈÎ‹ ÏË-

ÚÔÊÔÚ›· ÛÙËÓ ·Ú¯‹ ÙË˜ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ‰ÂÓ

¤‰ÂÈÍÂ fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙË ÓÔÛËÚfiÙËÙ· Î·È ÙË

ıÓËÛÈÌfiÙËÙ· ÌÂ ÙËÓ ·Ú¤Ì‚·ÛË.

‰) ∂ÂÈ‰‹ Ù· ÁÂÓÂÙÈÎ¿ ·ÓÈ¯ÓÂ˘ÙÈÎ¿ ÚÔ-

ÁÚ¿ÌÌ·Ù· ÌÔÚÂ› Ó· ÌËÓ Á›ÓÔÓÙ·È Î·Ù·ÓÔËÙ¿,

ÔÈ ·È‰›·ÙÚÔÈ ¯ÚÂÈ¿˙ÂÙ·È Ó· ‰›ÓÔ˘Ó ÛÙÔ˘˜ ÁÔÓÂ›˜

ÌfiÓÔ ÙËÓ ·Ó·ÁÎ·›· ÏËÚÔÊfiÚËÛË Û¯ÂÙÈÎ¿ ÌÂ

ÙÈ˜ ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ÁÂÓÂÙÈÎ¤˜ ÁÓÒÛÂÈ˜ Î·È ıÂÚ·-

Â˘ÙÈÎ¤˜ ‰˘Ó·ÙfiÙËÙÂ˜ ÁÈ· ¤Ó·Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi

ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∂›ÛË˜, ˘¿Ú¯ÂÈ Èı·-

ÓfiÙËÙ· ÂÈ‚¿Ú˘ÓÛË˜, Ë ÔÔ›· ÌÔÚÂ› Ó· ÚÔ-

ÎÏËıÂ› ·fi ÙËÓ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓË ÁÂÓÂÙÈÎ‹ ÏËÚÔ-

ÊÔÚ›·, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ ÙË˜ Èı·ÓfiÙËÙ·˜

„˘¯ÔÏÔÁÈÎ‹˜ ‚Ï¿‚Ë˜ Î·È ÛÙÈÁÌ·ÙÈÛÌÔ‡. OÈ ·È-

‰›·ÙÚÔÈ ÌÔÚÂ› Ó· ‚ÔËıÔ‡Ó ÛÙÔÓ ¯ÂÈÚÈÛÌfi ÔÏ-

ÏÒÓ ıÂÌ¿ÙˆÓ Ô˘ ÚÔÎ‡ÙÔ˘Ó ·fi ÙÔÓ ÁÂÓÂÙÈ-

Îfi ¤ÏÂÁ¯Ô, ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙÔ˘˜ ÁÂÓÂÙÈÛÙ¤˜,

ÙÔ˘˜ ÁÂÓÂÙÈÛÙ¤˜ Û˘Ì‚Ô‡ÏÔ˘˜ Î·È fiÏÔ˘˜ fiÛÔ˘˜

·Ú¤¯Ô˘Ó ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË.

Â) ∏ ∞∞¶ Û˘ÓËÁÔÚÂ› ÛÙË ‰ÈÂ‡Ú˘ÓÛË ÙˆÓ

ÂÎ·È‰Â˘ÙÈÎÒÓ Â˘Î·ÈÚÈÒÓ ÛÙË ÁÂÓÂÙÈÎ‹ ÙÔ˘

·ÓıÚÒÔ˘ ÁÈ· ÙÔ˘˜ ÊÔÈÙËÙ¤˜ ÙË˜ È·ÙÚÈÎ‹˜,

ÙÔ˘˜ ÂÈ‰ÈÎÂ˘fiÌÂÓÔ˘˜ Î·È ÙÔ˘˜ Ú·ÎÙÈÎÔ‡˜

ÁÈ·ÙÚÔ‡˜ Î·È ÛÙË ‰ÈÂ‡Ú˘ÓÛË ÙˆÓ ÚÔÁÚ·ÌÌ¿-

ÙˆÓ ÂÈÌfiÚÊˆÛË˜ ÁÈ· ÙÔ˘˜ Â·ÁÁÂÏÌ·Ù›Â˜ ÁÂ-

ÓÂÙÈÛÙ¤˜ (11).


1. Guttmacher AE, Collins FS. Genomic medicine - a

primer. N Engl J Med 2002;347:1512-1520.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:386-393


394 SPECIAL ARTICLE

1st Paediatric Clinic, AristotleUniversity of Thessaloniki, “Ippokration” GeneralHospital, Thessaloniki

Correspondence:

H. Hatzissevastou-Loukidou Laboratory of Cytogenetics, 1st Paediatric Clinic, AristotleUniversity of Thessaloniki, “Ippokration” General Hospital, Thessaloniki 49 Konstantinoupoleos Str.,546 42, Thessaloniki



Genetic preventive testing and ethical issues

H. Hatzissevastou - Loukidou

Abstract

In the absence of clearly beneficial treatments or effective preventive strategies for many childhooddiseases, the use of new genetic technology for newborn screening, carrier testing and testing forsusceptibility to late-onset conditions must be considered carefully. Paediatricians will need toevaluate critically the diagnostic and prognostic implications of testing. Additional research andeducation in this developing area of medicine are encouraged.

Key words

DNA tests, ethical issues, cystic fibrosis, immunoreactive trypsinogen, Duchenne musculardystrophy.


395∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏ LETTER TO THE EDITOR

¶·È‰È·ÙÚÈÎ‹ 2005;68:395

∏ ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· Â›¯Â ÙË ¯·Ú¿ Ó· ·ÔÎÙ‹ÛÂÈ ¤Ó· ·ÍÈfiÏÔÁÔ ÓÙÔÎÈÌ·ÓÙ¤Ú ÙÔ˘ Î˘Ú›-Ô˘ ¡¤ÛÙÔÚ· ª¿ÙÛ·, Ô˘ Á˘Ú›ÛÙËÎÂ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ ’70, ÌÂ ı¤Ì·: “∞˘Ùfi ÙÔ ·È‰› ÁÂÓÓ‹ıËÎÂ ·‡ÚÈÔ”.

∆Ô ÓÙÔÎÈÌ·ÓÙ¤Ú ·˘Ùfi ÚÔ‚Ï‹ıËÎÂ ÛÙËÓ ÙÂÏÂÙ‹ Ï‹ÍË˜ ÙÔ˘ 43Ô˘ ¶·ÓÂÏÏËÓ›Ô˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘ÓÂ-‰Ú›Ô˘ ÛÙËÓ ∫ˆ, ÙÔ ÚÔÏfiÁÈÛÂ Ô ›‰ÈÔ˜ Ô Î‡ÚÈÔ˜ ª¿ÙÛ·˜ Î·È ·¤Û·ÛÂ Ù· Î·Ï‡ÙÂÚ· Û¯fiÏÈ·.

O Î‡ÚÈÔ˜ ª¿ÙÛ·˜ Ì¿˜ ¤ÛÙÂÈÏÂ ÙËÓ ·ÎfiÏÔ˘ıË ÂÈÛÙÔÏ‹.

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ ¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

∆Ô ·È‰› ·’ ÙÔÓ ·˘ÚÈ·Ófi ÎfiÛÌÔ

¡¤ÛÙÔÚ·˜ ª¿ÙÛ·˜

ŒÓ· Û˘Ó¤‰ÚÈÔ ¿ÏÏˆÓ ‰È·ÛÙ¿ÛÂˆÓ. ªÂ ÙÔ ÈÔ ÂÓ‰È·Ê¤ÚÔÓ ı¤Ì· Ô˘ ÌÔÚÂ› Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ Ë ÂÔ-¯‹ Ì·˜. ∆Ô ·È‰›. ∆Ô ·È‰› ÛÙËÓ ÒÚ· ÙË˜ ‰ÔÎÈÌ·Û›·˜, ÙË˜ ·ÚÚÒÛÙÈ·˜, ·ÏÏ¿ Î·È ÛÙËÓ ÒÚ· Ô˘ ÂÌÓ¤ÂÈ ÌÂÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÙÔÓ ÂÒÓ˘ÌÔ ‹ ·ÓÒÓ˘ÌÔ ‰ËÌÈÔ˘ÚÁfi ÁÈ· Ó· ÌÂÙÔ˘ÛÈÒÛÂÈ ÙË Û˘ÁÎ›ÓËÛ‹ ÙÔ˘ ÛÂ Ù¤¯ÓË.

∏ ·ÎÚÈÙÈÎ‹ ∫ˆ˜ ¤˙ËÛÂ ÁÈ· ÙÚÂÈ˜ ËÌ¤ÚÂ˜ ÙÔÓ ‰ËÌÈÔ˘ÚÁÈÎfi ˘ÚÂÙfi ·˘ÙÔ‡ ÙÔ˘ ™˘ÌÔÛ›Ô˘, Ô˘ ·Ó·ÊÂ-ÚfiÙ·Ó ÛÂ fiÏ· Ù· ÚÔ‚Ï‹Ì·Ù· ÙÔ˘ ·È‰ÈÔ‡, fiˆ˜ ·˘Ù¿ ‰È·ÌÔÚÊÒıËÎ·Ó Î·È ‰È·ÌÔÚÊÒÓÔÓÙ·È ÛÙÔ˘˜ Î·È-ÚÔ‡˜ Ì·˜.

∫ÔÚ˘Ê·›ÔÈ ·È‰›·ÙÚÔÈ, ·ÏÏ¿ Î·È ÓÂfiÙÂÚÔÈ ÂÈÛÙ‹ÌÔÓÂ˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È ÛÂ ‚¿ıÔ˜ ÌÂ ÙÔ ı¤Ì·, Î·-Ù¤ıÂÛ·Ó ÙÈ˜ ·fi„ÂÈ˜ ÙÔ˘˜, ¤ÙÛÈ ÒÛÙÂ Ó· ‰ËÌÈÔ˘ÚÁËıÂ› ¤Ó· ÎÏ›Ì· Â˘Ú‡Ù·ÙÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ Á‡Úˆ ·fiÙÔ ·È‰› Û‹ÌÂÚ·.

∆ËÓ ÔÚÁ¿ÓˆÛË Â›¯Â Ë ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· Î·È ‹Ù·Ó ·ÈÛ›ˆ˜ ÙÔ 43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. ™Â ·˘Ù¿ Ù· ¯ÚfiÓÈ·, Ô˘ ÚÔÛÂÁÁ›˙Ô˘Ó ÙÔÓ ÌÈÛfi ·ÈÒÓ·, Ë ¶·È‰È·ÙÚÈÎ‹ ÚÔ¯ÒÚËÛÂ ÌÂ ¿ÏÌ·Ù· ÛÂ ÙÔ-

ÌÂ›˜ Î·È ¯ÒÚÔ˘˜ Ô˘ ‰ÂÓ ı· ÙÔÏÌÔ‡Û·Ó Ó· ˘Ô„È·ÛÙÔ‡Ó Ô‡ÙÂ ÔÈ ÚˆÙÔfiÚÔÈ È‰Ú˘Ù¤˜ ÙË˜, fiÙ·Ó ·Ô-Ê¿ÛÈÛ·Ó ·fi ÎÔÈÓÔ‡ Ó· Û˘ÛÙ‹ÛÔ˘Ó ÙËÓ ∂Ù·ÈÚÂ›·. ™‹ÌÂÚ· Â›Ó·È ¤Ó·˜ ı·ÏÂÚfi˜ ÔÚÁ·ÓÈÛÌfi˜ ¤ÚÂ˘Ó·˜ Î·ÈÌÂÏ¤ÙË˜ ÙË˜ ·È‰È·ÙÚÈÎ‹˜, ÌÂ ¤Ó·Ó ‰ËÌÈÔ˘ÚÁÈÎfi ÚfiÂ‰ÚÔ, ÙÔÓ Î. ∞Ó‰Ú¤· ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ, ÛÙÔÓ ÔÔ›ÔÂÓ ÔÏÏÔ›˜, ·ÏÏ¿ Î·È ÛÙÔ˘˜ ·˘ÛÙËÚ¿ ÂÈÏÂÁÌ¤ÓÔ˘˜ Û˘ÓÂÚÁ¿ÙÂ˜ ÙÔ˘, ÔÊÂ›ÏÂÙ·È Ë ÂÈÙ˘¯›· ÙÔ˘ Û˘ÓÂ‰Ú›-Ô˘ ÌÂ ÙË Û˘ÌÌÂÙÔ¯‹ ¯ÈÏ›ˆÓ ÔÎÙ·ÎÔÛ›ˆÓ Û˘Ó¤‰ÚˆÓ!

°È· ÂÌ¿˜, ÙÔ˘˜ ¿Û¯ÂÙÔ˘˜ ı· ÙÔÏÌÔ‡Û· Ó· ˆ, ÌÂ ÙËÓ ÈÂÚfiÙËÙ· ÙÔ˘ ı¤Ì·ÙÔ˜, ·˘Ù‹ Ë ·ıÚfi· ÚÔÛ¤-ÏÂ˘ÛË Î·È Û˘ÌÌÂÙÔ¯‹ ‹Ù·Ó Ú·ÁÌ·ÙÈÎ¿ ¤Ó· ÁÂÁÔÓfi˜. ∫˘Ú›ˆ˜ ÔÈ ÂÈÛÙ‹ÌÔÓÂ˜ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó (Â›¯· ÙË¯·Ú¿ Ó· Û˘˙ËÙ‹Ûˆ ÌÂ ÌÂÚÈÎÔ‡˜ ·fi ·˘ÙÔ‡˜) ‹Ù·Ó Ó¤ÔÈ ¿ÓıÚˆÔÈ ÌÂ ÈÂÚfi ¿ıÔ˜ ÁÈ· ÙËÓ ÂÈÛÙ‹ÌË ÙÔ˘˜,ÌÈ· ÂÈÛÙ‹ÌË Ô˘ ‰ÂÓ ÛÙ·Ì·Ù¿ Ô˘ıÂÓ¿ Î·È ‰ÂÓ ı· ÛÙ·Ì·Ù‹ÛÂÈ Ô˘ıÂÓ¿.

™ÙÔÈ¯Â›Ô ·ÈÛÈfi‰ÔÍÔ ÁÈ· Î·ÈÚÔ‡˜ Ô˘, fiˆ˜ ÚÔ·Ó¤ÊÂÚ·, ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ¿ÚÓËÛË Î·È ·ÌÊÈÛ‚‹-ÙËÛË. µÏ¤ÔÓÙ¿˜ ÙÔ˘˜ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÌÂ ÙfiÛÔ ÂÓ‰È·Ê¤ÚÔÓ ÙÔ ™˘Ó¤‰ÚÈÔ Î·È Ó· Î¿ÓÔ˘Ó Î·›ÚÈÂ˜ ·Ó·-ÎÔÈÓÒÛÂÈ˜, ı˘ÌfiÌÔ˘Ó Î·È Í·Ó·ı˘ÌfiÌÔ˘Ó ÙÔÓ ÏfiÁÔ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÓıÚˆÈÛÙ‹ ÁÈ·ÙÚÔ‡ ∞Ï‚¤ÚÙÔ˘ ™‚¿È-ÙÛÂÚ: “O ÔÏÈÙÈÛÌfi˜ ÌÈ·˜ ¯ÒÚ·˜ ÂÎÊÚ¿˙ÂÙ·È ·fi ÙËÓ ·Á¿Ë Î·È ÙËÓ ÚÔÛÙ·Û›· Ô˘ ‰›ÓÂÈ ÛÙÔ ·È‰›”.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ™‚¿ÈÙÛÂÚ ÂÁÎ·Ù¤ÏÂÈ„Â Ì›· Ï·ÌÚ‹ Î·ÚÈ¤Ú· ÛÙËÓ ∂˘ÚÒË, Ô˘ ‹Ù·Ó ÂÍ›ÛÔ˘ ÛÔ˘-‰·›Ô˜ ÂÈÛÙ‹ÌÔÓ·˜ fiÛÔ Î·È ÌÔ˘ÛÈÎfi˜, ÁÈ· Ó· ·ÊÔÛÈˆıÂ› ÛÙ· ÏÂÚ¿ ·È‰È¿ ÙË˜ ∞ÊÚÈÎ‹˜. ∞‰È·ÊÔÚÒÓÙ·˜ÁÈ· fiÏ·, ÌÂÙÔ˘Û›ˆÛÂ ÙË ‰ˆÚÂ¿ Ô˘ ÙÔ˘ ¤‰ˆÛÂ Ô £Âfi˜ ÛÂ ÚÔÛÊÔÚ¿ ·Á¿Ë˜ ÁÈ· ÙÔ ·ÓÒÓ˘ÌÔ Ì·‡ÚÔ ·È-‰›, Ô˘ ˙Ô‡ÛÂ Î¿Ùˆ ·fi ÚˆÙfiÁÔÓÂ˜ Û˘Óı‹ÎÂ˜, ÌÂ ·Ê¿ÓÙ·ÛÙÂ˜ ÛÙÂÚ‹ÛÂÈ˜, ·ÎfiÌË Î·È ÌÂ ¤ÏÏÂÈ„Ë ÓÂÚÔ‡.

¢˘ÛÙ˘¯Ò˜, ÔÈ Û˘Óı‹ÎÂ˜, ı· ÚÔÛ¤ıÂÙ· ÂÁÒ, ‰ÂÓ ¿ÏÏ·Í·Ó ·fi ÙfiÙÂ Î·È Ù· ÛÙÂÚËÌ¤Ó· ·˘Ù¿ ·È‰È¿·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙÈ˜ ›‰ÈÂ˜ ‰ÔÎÈÌ·Û›Â˜ ÂÈ‚›ˆÛË˜, ÌÂ Ì›· ÚfiÛıÂÙË Ô˘ Â›Ó·È Î·È ¯ÂÈÚfiÙÂÚË: ÙËÓ ·ÁˆÓ›·ÙË˜ ·È‰ÂÚ·ÛÙ›·˜ ·fi Î·ÏÔ˙ˆÈÛÌ¤ÓÔ˘˜ ‚¿Ú‚·ÚÔ˘˜ ∂˘Úˆ·›Ô˘˜ Ô˘ ‰ÂÓ Û¤‚ÔÓÙ·È Ô‡ÙÂ ÙËÓ ÙÚ·Áˆ‰›··˘ÙÒÓ ÙˆÓ ‰˘ÛÙ˘¯ÈÛÌ¤ÓˆÓ fiÓÙˆÓ.

∫·Ù¿ ÙÔ‡ÙÔ, ·˘Ù¿ Ù· Û˘Ó¤‰ÚÈ·, ˆ˜ ¿ÌÂÛ· ‹ ¤ÌÌÂÛ·, ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ÈÔ Â˘·›ÛıËÙÔ, fiˆ˜ ÙÔ ¯·Ú·-ÎÙ‹ÚÈÛ·, ı¤Ì· ÙˆÓ Î·ÈÚÒÓ Ì·˜, ÙÔ ·È‰›, ÚÔÛÊ¤ÚÔÓÙ·˜ ¤Ó· Ì¤ÁÈÛÙÔ ËıÈÎfi Î·È ÎÔÈÓˆÓÈÎfi fiÊÂÏÔ˜ ÁÈ·ÙÔ˘˜ ÌË ÛÎÂÙfiÌÂÓÔ˘˜ ‹ ÙÔ˘˜ ·‰È·ÊÔÚÔ‡ÓÙÂ˜.

∆Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘ÌfiÛÈÔ ÙË˜ ∫ˆ, ÔÚÁ·ÓˆÌ¤ÓÔ ÌÂ ÙÔÓ ÈÔ ¿ÚÙÈÔ ÙÚfiÔ ·fi ÙÔÓ ¶ÚfiÂ‰ÚÔ Î·È ÙÔ ¢È-ÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, ‹Ù·Ó Ì›· ·ÊÔÚÌ‹ ÁÈ· ‚·ı‡ Î·È Ô˘ÛÈ·ÛÙÈÎfi ÚÔ‚ÏËÌ·-ÙÈÛÌfi Á‡Úˆ ·fi Ù· ı¤Ì·Ù· (Î·È Â›Ó·È ÙfiÛ· ÔÏÏ¿) Ô˘ ··Û¯ÔÏÔ‡Ó ÙÔ ¶·È‰› Î·È Â˘Ú‡ÙÂÚ· ÙËÓ ÂÓ ‰È·Ú-ÎÂ› ÂÍÂÏ›ÍÂÈ Î·È ¤ÚÂ˘Ó· ¶·È‰È·ÙÚÈÎ‹ ∂ÈÛÙ‹ÌË.

∆Ô ·È‰› Ô˘ ¤Ú¯ÂÙ·È ·’ ÙÔÓ ∞˘ÚÈ·Ófi ∫fiÛÌÔ ¤¯ÂÈ Î¿ıÂ ÓfiÌÈÌÔ ‰ÈÎ·›ˆÌ· ÛÂ ·˘Ù‹ ÙËÓ ·Í›ˆÛË.


396 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

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


¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜E-mail: [email protected]

¶·È‰È·ÙÚÈÎ‹ 2005;68:396-397

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

ª·ı·›ÓÔÓÙ·˜ ÙÔÓ ÎfiÛÌÔ ÙˆÓ ¡¤ˆÓ ∆Â¯ÓÔÏÔÁÈÒÓ - http://www.uptoten.com

ª›· ÔÌ¿‰· ·fi ÂÓıÔ˘ÛÈÒ‰ÂÈ˜ Â·ÁÁÂÏÌ·Ù›Â˜ÌÂ ¤‰Ú· ÙÚ›· ÛËÌÂ›· ÙË˜ ÁË˜ (∏¶∞, °·ÏÏ›· Î·Èª·˘Ú›ÎÈÔ) ÎÚ‡‚ÂÙ·È ›Ûˆ ·fi ÙÔÓ ‰ÈÎÙ˘·Îfi ÙfiÔUp∆oTen, ÌÂ ·ÓÙÈÎÂ›ÌÂÓÔ ÙËÓ ÂÎÌ¿ıËÛË Î·È ÙËÓ„˘¯·ÁˆÁ›· ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ Ì¤¯ÚÈ 10 ÂÙÒÓ.¢È·ÎÚ›ÓÂÙ·È ÛÂ 2 ‚·ÛÈÎ¤˜ Î·ÙËÁÔÚ›Â˜, “°È· °Ô-ÓÂ›˜” Î·È “°È· ¶·È‰È¿”, ÌÂ ‰È·ÊÔÚÂÙÈÎfi ÂÚÈÂ¯fi-ÌÂÓÔ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÎÔÈÓfi ÛÙÔ ÔÔ›Ô ·Â˘ı‡ÓÂ-Ù·È. ∏ ÈÛÙÔÛÂÏ›‰· “°È· °ÔÓÂ›˜” ÚÔÛÊ¤ÚÂÈ Î˘Ú›ˆ˜Ô‰ËÁ›Â˜ Î·È Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ‰È··È-‰·ÁÒÁËÛË ÙˆÓ ·È‰ÈÒÓ. ∏ ÈÛÙÔÛÂÏ›‰· ¤¯ÂÈ Î·Ù¿‚¿ÛË ÏËÚÔÊÔÚÈ·Îfi ¯·Ú·ÎÙ‹Ú· ÌÂ ‰È·ÏÂÎÙÈÎfiÙÚfiÔ Î·È Ú·ÎÙÈÎ¿ ˙ËÙ‹Ì·Ù· ÂÁÁÚ·Ê‹˜. ∏ Î·ÙË-ÁÔÚ›· “°È· ¶·È‰È¿” ·ÔÙÂÏÂ› Î·È ÙÔ ÎÂÓÙÚÈÎfiÛÙÔÈ¯Â›Ô ÙÔ˘ Up∆oTen. ¢‡Ô ‚·ÛÈÎÔ› ¯·Ú·ÎÙ‹ÚÂ˜,Ô Boowa - Ô ÔÔ›Ô˜ ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÙÔÓ ÂÓ‹ÏÈÎÔÌÂ ˘Â‡ı˘ÓË Î·È ÒÚÈÌË Û˘ÌÂÚÈÊÔÚ¿ - Î·È Ë ÌÈ-ÎÚ‹ Kwala - Ë ÔÔ›· Â›Ó·È ÈÔ ˙ˆËÚ‹ Î·È ÂÈÚÚÂ-‹˜ ÛÙÈ˜ ÛÎ·Ó‰·ÏÈ¤˜ - ÚˆÙ·ÁˆÓÈÛÙÔ‡Ó ÛÂ fiÏÂ˜ÙÈ˜ ˘ÔÎ·ÙËÁÔÚ›Â˜, ÔÈ ÔÔ›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰È·-‰ÈÎÙ˘·Î¿ ·È¯Ó›‰È·, ËÏÂÎÙÚÔÓÈÎfi Î·Ù¿ÛÙËÌ· ÌÂ·È¯Ó›‰È·, ÚÔ‡¯·, ‚È‚Ï›·, ·Ê›ÛÂ˜ Î.¿. O ÙÔÌ¤·˜

ÙˆÓ ·È¯ÓÈ‰ÈÒÓ Â›Ó·È È‰È·›ÙÂÚ· ·ÓÂÙ˘ÁÌ¤ÓÔ˜ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚÈÛÛfiÙÂÚ· ·fi 700 ÂÎ·È‰Â˘ÙÈ-Î¿ ·È¯Ó›‰È· ÌÂ ‰ˆÚÂ¿Ó ÚfiÛ‚·ÛË, Î·ıÒ˜ Î·È ÚÔÙ¿ÛÂÈ˜ ÁÈ· ‰Ú·ÛÙËÚÈfiÙËÙÂ˜, Ù· ÔÔ›· ·Â˘ı‡-ÓÔÓÙ·È ÛÂ ‰È¿ÊÔÚÔ˘˜ ËÏÈÎÈ·ÎÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜, ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ ··ÈÙ‹ÛÂÈ˜ ÙÔ˘ Î¿ıÂ ·È¯ÓÈ‰ÈÔ‡.

∏ ÏÔ‹ÁËÛË ÛÙÔÓ ÈÛÙfiÙÔÔ “°È· ¶·È‰È¿” Â›Ó·È ·Ï‹ Î·È ‰È·ÛÎÂ‰·ÛÙÈÎ‹, ÌÂ Ì›· Â‡¯ÚËÛÙË ªË-¯·Ó‹ ∞Ó·˙‹ÙËÛË˜ ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÂÓfiÙËÙÂ˜.

O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Up∆oTen ¤¯ÂÈ ÌÂÁ¿ÏË ÂÈÛÎÂ„ÈÌfiÙËÙ· (¿Óˆ ·fi 2 ÂÎ·ÙÔÌÌ‡ÚÈ· ¯Ú‹ÛÙÂ˜ÌËÓÈ·›ˆ˜) Î·È Û˘ÛÙ‹ÓÂÙ·È ·fi ‰ÈÂıÓÂ›˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÔÚÁ·ÓÈÛÌÔ‡˜ Î·È ·Ó·ÁÓˆÚÈÛÌ¤ÓÂ˜ ÂÙ·ÈÚÂ›-Â˜ ‰È·‰ÈÎÙ˘ÎÒÓ ÂÊ·ÚÌÔÁÒÓ.

Multimedia games ÁÈ· fiÏ· Ù· ÁÔ‡ÛÙ·! - http://www.shockwave.com

O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Shockwave.com ·ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ ÚˆÙÔfiÚÔ˘˜ÛÙÔÓ ÙÔÌ¤· ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ·È¯ÓÈ‰ÈÒÓ (multimedia games) Ì¤Ûˆ ÙÔ˘ ‰È·-

‰ÈÎÙ‡Ô˘. ∞Ó‹ÎÂÈ ÛÙÔÓ ·ÌÂÚÈÎ·ÓÈÎfi fiÌÈÏÔ AtomShockwave Corp, ÌÂ Ì¤ÛË ÌËÓÈ·›· ÂÈÛÎÂ„ÈÌfiÙËÙ·¿Óˆ ·fi 20 ÂÎ·ÙÔÌÌ‡ÚÈ· ¯Ú‹ÛÙÂ˜, ·ÔÙÂÏÒÓÙ·˜ ·ÁÎfiÛÌÈÔ ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙÔÓ ¯ÒÚÔ ÙË˜„ËÊÈ·Î‹˜ „˘¯·ÁˆÁ›·˜ Î·È ‰È·ÛÎ¤‰·ÛË˜. ∞Â˘ı‡ÓÂÙ·È ÛÂ ·È‰È¿ Î·È Ó¤Ô˘˜ Î¿ıÂ ËÏÈÎ›·˜ Î·È ÂÚÈ-Ï·Ì‚¿ÓÂÈ Ì›· Â˘ÚÂ›· ÁÎ¿Ì· ·È¯ÓÈ‰ÈÒÓ, Ù· ÔÔ›· ·Ó·ÓÂÒÓÔÓÙ·È ÛÂ Â‚‰ÔÌ·‰È·›· ‚¿ÛË. ∆· ·È¯Ó›‰È·

shockwave.com


397NEWS FROM THE INTERNET

Î·È ÔÈ ‰È·‰ÈÎÙ˘·Î¤˜ ÂÊ·ÚÌÔÁ¤˜ ‰È·ÎÚ›ÓÔÓÙ·È ·Ó¿ Î·ÙËÁÔÚ›· ÛÂ ·È¯Ó›‰È· ‰Ú¿ÛË˜ (action games),·È¯Ó›‰È· ÛÙÚ·ÙËÁÈÎ‹˜ (mind games), ·È¯Ó›‰È· ÌÂ ÔÏÏ·ÏÔ‡˜ ¯Ú‹ÛÙÂ˜ (multiplayer games), ÂÓÒ˘¿Ú¯ÂÈ Î·È ÚÔÙÂÈÓfiÌÂÓË Ï›ÛÙ· ÌÂ Ù· 5 ÂÚÈÛÛfiÙÂÚÔ ‰ËÌÔÊÈÏ‹. ¶·Ú¿ÏÏËÏ·, ˘¿Ú¯ÂÈ Ë ‰˘Ó·Ùfi-ÙËÙ· ÏÔ‹ÁËÛË˜ ÛÂ Û˘ÓÔ‰Â˘ÙÈÎfi ÔÙÈÎÔ·ÎÔ˘ÛÙÈÎfi ˘ÏÈÎfi, fiˆ˜ ÊˆÙÔÁÚ·Ê›Â˜, ‚›ÓÙÂÔ, ÌÔ˘ÛÈÎ‹, Â˘-¯ÂÙ‹ÚÈÂ˜ Î¿ÚÙÂ˜.

∏ ÚfiÛ‚·ÛË ÛÙ· ·È¯Ó›‰È· Â›Ó·È ‰ˆÚÂ¿Ó ÁÈ· ¯Ú‹ÛË Ì¤Ûˆ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, ÂÓÒ ·Ú¿ÏÏËÏ· Ô¯Ú‹ÛÙË˜ ÌÔÚÂ› Ó· ÚÔÌËıÂ˘ÙÂ› Ù· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ ·fi ÙÔ ÂÈ‰ÈÎfi Î·Ù¿ÛÙËÌ· ·ÁÔÚÒÓ, ÛÂÏÔÁÈÎ¤˜ ÙÈÌ¤˜.

∏ÏÂÎÙÚÔÓÈÎfi “Û¯ÔÏÂ›Ô” Ì·ıËÌ·ÙÈÎÒÓ ÁÈ· ÌÈÎÚÔ‡˜ Î·È ÌÂÁ¿ÏÔ˘˜ - ª·ıËÌ·ÙÈÎ¿ Ì¤Ûˆ

internet - http://www.primarygames.co.uk

O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Primary Games, ÚÔ˚fiÓ È‰ÈˆÙÈ-Î‹˜ ÚˆÙÔ‚Ô˘Ï›·˜ ÌÂ ¤‰Ú· ÙÔ ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ,ÚÔÛÊ¤ÚÂÈ ÏËıÒÚ· ‰˘Ó·ÙÔÙ‹ÙˆÓ ËÏÂÎÙÚÔÓÈÎ‹˜ ÂÎ-·›‰Â˘ÛË˜ ÛÙÈ˜ ‚·ÛÈÎ¤˜ ¤ÓÓÔÈÂ˜ ÙˆÓ Ì·ıËÌ·ÙÈÎÒÓ Ô˘‰È‰¿ÛÎÔÓÙ·È ÛÙÔ Û¯ÔÏÂ›Ô, ·fi ÙÈ˜ ÚÒÙÂ˜ Ù¿ÍÂÈ˜ ÙÔ˘¢ËÌÔÙÈÎÔ‡ - ÌÂ ·Ï¤˜ ÂÊ·ÚÌÔÁ¤˜ - Ì¤¯ÚÈ ÙÈ˜ ÙÂÏÂ˘Ù·›-Â˜ Ù¿ÍÂÈ˜ - ÌÂ ·È¯Ó›‰È· “·˘ÍËÌ¤ÓˆÓ” ··ÈÙ‹ÛÂˆÓ.¢È·ÎÚ›ÓÂÙ·È ÛÂ 6 ‚·ÛÈÎ¤˜ Î·ÙËÁÔÚ›Â˜, ÌÂ ÂÊ·ÚÌÔÁ¤˜ÂÎÌ¿ıËÛË˜ ÛÙÈ˜ ‚·ÛÈÎ¤˜ ¤ÓÓÔÈÂ˜ ÙˆÓ Ì·ıËÌ·ÙÈÎÒÓ,fiˆ˜ Â›Ó·È Ë ·ÚÈıÌËÙÈÎ‹, ÙÔ ¯Ú‹Ì· Î·È Ë Ì¤ÙÚËÛË ÙË˜ÒÚ·˜ Ì¤Û· ·fi “¤Í˘Ó·” Î·È ‰È·ÛÎÂ‰·ÛÙÈÎ¿ ·È¯Ó›-‰È·. ¶·Ú¿ÏÏËÏ·, ÚÔÛÊ¤ÚÂÈ ÛÙÔ˘˜ ÁÔÓÂ›˜ Î·È ÙÔ˘˜ ÂÎ-·È‰Â˘ÙÈÎÔ‡˜ ‰È·‰ÈÎÙ˘·Î¿ “·Î¤Ù·” ÚÔ˜ ÒÏËÛË ÌÂ·ÓÙ›ÛÙÔÈ¯Â˜ ‰È·‰Ú·ÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜ ÂÎÌ¿ıËÛË˜.

∏ ÈÛÙÔÛÂÏ›‰· ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ÌÂÁ¿ÏË ÔÈÎÈÏ›·ËÏÂÎÙÚÔÓÈÎÒÓ ·È¯ÓÈ‰ÈÒÓ, Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· ·Ô-ıËÎÂ˘ÙÔ‡Ó Î·È Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·È ÂÎÙfi˜ ‰È·‰È-ÎÙ‡Ô˘. ¶ÚÈÓ ÙËÓ ÂÎÎ›ÓËÛË ÂÓfi˜ Ó¤Ô˘ ·È¯ÓÈ‰ÈÔ‡, Ô¯Ú‹ÛÙË˜ ‰È·‚¿˙ÂÈ ÙÈ˜ Û‡ÓÙÔÌÂ˜ Ô‰ËÁ›Â˜ ¯Ú‹ÛË˜ Î·È ÂÓÛ˘ÓÂ¯Â›· Ì·›ÓÂÈ Î·ÙÂ˘ıÂ›·Ó ÛÙÔ ·È¯Ó›‰È. ∆· ·È¯Ó›-‰È· Â›Ó·È ·Ï¿ Î·È Û‡ÓÙÔÌ· ÛÂ ‰È¿ÚÎÂÈ·, ‰›ÓÔÓÙ·˜ ÙË‰˘Ó·ÙfiÙËÙ· ÛÙÔÓ ¯Ú‹ÛÙË Ó· ‰ÔÎÈÌ¿ÛÂÈ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓÂÚÈÛÛfiÙÂÚ·.

¶·È‰È·ÙÚÈÎ‹ 2005;68:396-397


¢È·Ù·Ú·¯¤˜ Û¯ÔÏÈÎ‹˜ Ì¿ıËÛË˜ Î·È „˘¯Ô·ıÔÏÔÁ›·

Àfi ¢.∫. ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ Î·È ∞.£. ™›ÓË

∂Î‰fiÛÂÈ˜ µ∏∆∞

∞ı‹Ó·, 2004

∆Ô ‚È‚Ï›Ô ÙˆÓ ¢.∫. ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ˘ Î·È ∞.£. ™›ÓË Ú·ÁÌ·ÙÂ‡Â-Ù·È ÙÔ ı¤Ì· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ Ì¿ıËÛË˜, ÁÓˆÛÙÒÓ ÛÙÔ Â˘Ú‡ ÎÔÈÓfiˆ˜ ‰˘ÛÏÂÍ›·. ∆Ô ı¤Ì· ·˘Ùfi ¤¯ÂÈ Ï¿‚ÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÔ‚·Ú¤˜ÎÔÈÓˆÓÈÎ¤˜ ‰È·ÛÙ¿ÛÂÈ˜. ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÁÔÓ¤ˆÓ, ·È‰ÈÒÓ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó Û¯ÔÏÈÎ‹ ·ÔÙ˘¯›·, Î·Ù·ÎÏ‡˙ÂÈ Ù· π·ÙÚÔ·È‰·ÁˆÁÈÎ¿ ∫¤-ÓÙÚ· Î·È Ù· ∫¤ÓÙÚ· ¢È¿ÁÓˆÛË˜, ∞ÍÈÔÏfiÁËÛË˜ Î·È ÀÔÛÙ‹ÚÈÍË˜(∫.¢.∞.À.) ÌÂ ·›ÙËÌ· Ó· ¿ÚÂÈ ÙÔ ·È‰› ÙÔ˘˜ ‚Â‚·›ˆÛË fiÙÈ ¤¯ÂÈ Úfi-‚ÏËÌ· ‰˘ÛÏÂÍ›·˜, ÔfiÙÂ - ‚¿ÛÂÈ ÙÔ˘ ÓfiÌÔ˘ - ¤¯ÂÈ ÙÔ ‰ÈÎ·›ˆÌ· Ó· ˙Ë-Ù‹ÛÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ÚÔÊÔÚÈÎ¿ ÛÙ· Ì·ı‹Ì·Ù· ÙÔ˘ Û¯ÔÏÂ›Ô˘.

OÈ ‰È·Ù·Ú·¯¤˜ ÙË˜ Ì¿ıËÛË˜ ÂÎ‰ËÏÒÓÔÓÙ·È ÌÂ ÂÈ‰ÈÎ¤˜ Î·È ÛËÌ·ÓÙÈ-Î¤˜ ‰˘ÛÎÔÏ›Â˜ ÛÙËÓ ÂÎÌ¿ıËÛË ÙË˜ ·Ó¿ÁÓˆÛË˜, ÙË˜ ÁÚ·Ê‹˜, ÙË˜ ÔÚıÔ-ÁÚ·Ê›·˜ Î·È ÔÚÈÛÌ¤ÓÂ˜ ÊÔÚ¤˜ Î·È ÙË˜ ·ÚÈıÌËÙÈÎ‹˜. OÈ ‰˘ÛÎÔÏ›Â˜ ·˘Ù¤˜‰ÂÓ ÔÊÂ›ÏÔÓÙ·È ÛÂ - ·Ó Î·È ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó - ÓÔËÙÈÎ‹ Î·ı˘-ÛÙ¤ÚËÛË, ·ÈÛıËÙËÚÈ·Î¤˜ ‚Ï¿‚Â˜, Û˘Ó·ÈÛıËÌ·ÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ¿ÏÏ·„˘¯È·ÙÚÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ÂÚÈ‚·ÏÏÔÓÙÈÎ‹ ·ÔÛÙ¤ÚËÛË, ¤ÏÏÂÈ„Ë Â˘-Î·ÈÚÈÒÓ ÁÈ· Ì¿ıËÛË ‹ ¿ÏÏÔ˘˜ ÔÏÈÙÈÛÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ∆· ·È‰È¿Ô˘ ¤¯Ô˘Ó Úfi‚ÏËÌ· ‰˘ÛÏÂÍ›·˜, Â¿Ó ‰È·ÁÓˆÛÙÔ‡Ó ¤ÁÎ·ÈÚ· Î·È ‰Â-¯ıÔ‡Ó ÙËÓ Î·Ù¿ÏÏËÏË „˘¯Ô·È‰·ÁˆÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË, ÌÔÚÔ‡Ó Ó·

ÔÏÔÎÏËÚÒÛÔ˘Ó ÌÂ ÂÈÙ˘¯›· ÙÈ˜ Û¯ÔÏÈÎ¤˜ ÙÔ˘˜ ˘Ô¯ÚÂÒÛÂÈ˜. OÈ Û˘ÁÁÚ·ÊÂ›˜ ÙÔ˘ ‚È‚Ï›Ô˘ ¤¯Ô˘Ó ‚·ıÈ¿ ıÂˆÚËÙÈÎ‹ ÁÓÒÛË, ·ÏÏ¿ Î·È ÙÂÚ¿ÛÙÈ· ÎÏÈÓÈÎ‹ ÂÌÂÈÚ›· Û¯ÂÙÈÎ¿

ÌÂ ÙÔ ı¤Ì· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ Ì¿ıËÛË˜. O Î‡ÚÈÔ˜ ∞Ó·ÁÓˆÛÙfiÔ˘ÏÔ˜ Â›Ó·È ·È‰Ô„˘¯›·ÙÚÔ˜, ˘Â‡ı˘ÓÔ˜ÙË˜ ÀËÚÂÛ›·˜ æ˘¯ÈÎ‹˜ ÀÁÂ›·˜ ¶·È‰ÈÒÓ Î·È ∂Ê‹‚ˆÓ ÙÔ˘ ∫ÔÈÓÔÙÈÎÔ‡ ∫¤ÓÙÚÔ˘ æ˘¯ÈÎ‹˜ ÀÁÈÂÈÓ‹˜ µ‡ÚˆÓ·-∫·ÈÛ·ÚÈ·Ó‹˜ ÙË˜ æ˘¯È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ∏ ‰È‰·ÎÙÔÚÈÎ‹ ÙÔ˘ ‰È·ÙÚÈ‚‹ ·ÊÔ-ÚÔ‡ÛÂ ÛÙÈ˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ Ì¿ıËÛË˜. ∏ Î˘Ú›· ™›ÓË Â›Ó·È „˘¯Ô·È‰·ÁˆÁfi˜ Î·È ÂÚÁ¿˙ÂÙ·È ÛÙËÓ ›‰È· ˘ËÚÂ-Û›· „˘¯ÈÎ‹˜ ˘ÁÂ›·˜ ÌÂ ÙÔÓ ÚÒÙÔ Û˘ÁÁÚ·Ê¤·. ∫‡ÚÈÔ ·ÓÙÈÎÂ›ÌÂÓÔ ÙË˜ ÂÚÁ·Û›·˜ ÙË˜ Â›Ó·È ·ÎÚÈ‚Ò˜ Ë ‰È¿-ÁÓˆÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ Ì¿ıËÛË˜ Î·È Ë „˘¯Ô·È‰·ÁˆÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. OÈ ‰‡Ô Û˘ÁÁÚ·ÊÂ›˜ Û˘-ÓÂÚÁ¿˙ÔÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ÌÂ ÚÔ‚Ï‹Ì·Ù· ÛÙË Û¯ÔÏÈÎ‹ Ì¿ıËÛË.

∆Ô ‚È‚Ï›Ô ¯ˆÚ›˙ÂÙ·È ÛÂ Ù¤ÛÛÂÚ· Ì¤ÚË. ™Ù· ÚÒÙ· ‰‡Ô Ì¤ÚË Á›ÓÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÛÎfiËÛË Û¯ÂÙÈ-Î¿ ÌÂ ÙÈ˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ Ì¿ıËÛË˜ Î·È ÂÍÂÙ¿˙ÔÓÙ·È - ÌÂÙ·Í‡ ¿ÏÏˆÓ - ı¤Ì·Ù· ÔÚÔÏÔÁ›·˜, ÂÈ‰ËÌÈÔÏÔÁ›·˜,‰È¿ÁÓˆÛË˜ Î·È ÚfiÁÓˆÛË˜ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ, Û˘ÓÓÔÛËÚfiÙËÙ·˜ Î.Ï. ™ÙÔ ÙÚ›ÙÔ Ì¤ÚÔ˜ Á›ÓÂÙ·È ·ÚÔ˘-Û›·ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÌÈ·˜ ¤ÚÂ˘Ó·˜ ÁÈ· ÙÈ˜ Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ¤ÁÈÓÂ ÌÂ ·È‰È¿ Ô˘ Â›¯·Ó ·-Ú·ÂÌÊıÂ› ÛÙÔ ∫ÔÈÓÔÙÈÎfi ∫¤ÓÙÚÔ æ˘¯ÈÎ‹˜ ÀÁÈÂÈÓ‹˜, fiÔ˘ ÂÚÁ¿˙ÔÓÙ·È ÔÈ Û˘ÁÁÚ·ÊÂ›˜. µ·ÛÈÎÔ› ÛÙfi¯ÔÈ ·˘Ù‹˜ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÁÚ·ÙÔ‡ ÏfiÁÔ˘ Î·È Ë ÂÌÊ¿ÓÈÛË Û˘ÓÓÔ-ÛËÚfiÙËÙ·˜. ™ÙÔ Ù¤Ù·ÚÙÔ Î·È ÙÂÏÂ˘Ù·›Ô Ì¤ÚÔ˜ ÙÔ˘ ‚È‚Ï›Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù¤ÛÛÂÚÈ˜ ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓÌÂ ‰È·Ù·Ú·¯¤˜ ÙË˜ Û¯ÔÏÈÎ‹˜ Ì¿ıËÛË˜, ÔÈ ÔÔ›Â˜ ‰Â›¯ÓÔ˘Ó ·Ó¿ÁÏ˘Ê· ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, fiˆ˜ ÙË ‚ÈÒÓÔ˘ÓÙ· ›‰È· Ù· ·È‰È¿.

∆Ô ‚È‚Ï›Ô ·˘Ùfi Î¿ÓÂÈ Ì›· Û˘ÓÔÙÈÎ‹, ·ÏÏ¿ Î·È ÛÊ·ÈÚÈÎ‹ ·ÚÔ˘Û›·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙˆÓ ‰È·Ù·Ú·¯ÒÓÙË˜ Ì¿ıËÛË˜, Û˘Ó‰˘¿˙ÔÓÙ·˜ ÌÈ· Î·Ï‹ ·Ó·ÛÎfiËÛË ÙË˜ ‰ÈÂıÓÔ‡˜ Î·È ÂÏÏËÓÈÎ‹˜ Û¯ÂÙÈÎ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÌÂÙË Ì·ÎÚfi¯ÚÔÓË ÎÏÈÓÈÎ‹ ÂÌÂÈÚ›· ÙˆÓ ‰‡Ô Û˘ÁÁÚ·Ê¤ˆÓ ÛÙË ‰È¿ÁÓˆÛË Î·È ÛÙËÓ „˘¯Ô·È‰·ÁˆÁÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ∆Ô Û‡ÁÁÚ·ÌÌ· ·˘Ùfi ı· ‰ÒÛÂÈ ÛÙÔÓ ·È‰›·ÙÚÔ Ì›· ÔÏÔÎÏËÚˆÌ¤ÓËÂÈÎfiÓ· ÙˆÓ Û‡Á¯ÚÔÓˆÓ ÁÓÒÛÂˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

∂˘ÊÚÔÛ‡ÓË ªfiÙÙË ∫·ıËÁ‹ÙÚÈ·, ∆Ì‹Ì· ºÈÏÔÛÔÊ›·˜, ¶·È‰·ÁˆÁÈÎ‹˜ Î·È æ˘¯ÔÏÔÁ›·˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ

398 µπµ§πO¶∞ƒOÀ™π∞™∏ BOOK REVIEW

∆Ì‹Ì· ºÈÏÔÛÔÊ›·˜,¶·È‰·ÁˆÁÈÎ‹˜ Î·Èæ˘¯ÔÏÔÁ›·˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ


∂˘ÊÚÔÛ‡ÓË ªfiÙÙË E-mail: [email protected]

¶·È‰È·ÙÚÈÎ‹ 2005;68:398


xxiii¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

22 OÎÙˆ‚Ú›Ô˘ 2005 1Ô ™˘ÌfiÛÈÔ ∂ıÓÈÎ‹˜ ∂ÈÙÚÔ‹˜ ∞ı‹Ó·

∫·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ∞Ó·˙ˆÔÁfiÓËÛË˜ (∂∂∫∞∞¡)

ÙÔ˘ ∫ÂÓÙÚÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘ ÀÁÂ›·˜ (∫∂™À)

∞ÌÊÈı¤·ÙÚÔ £. ∫·Ú·Ù˙¿, ∂ıÓÈÎ‹ ∆Ú¿Â˙· ∂ÏÏ¿‰Ô˜, ¶Ï·ÙÂ›· ∫ÔÙ˙È¿ ¶ÏËÚÔÊÔÚ›Â˜: Congress World ∆ËÏ.: (+30) 210 7210 001, 210 7211 845 Fax: (+30) 210 7215 082 E-mail: [email protected] Website: www.congressworld.gr

11-13 ¡ÔÂÌ‚Ú›Ô˘ 2005 15Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ™˘Ó¤‰ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ ∞ı‹Ó·

ª¤Á·ÚÔ ªÔ˘ÛÈÎ‹˜ ∞ıËÓÒÓ ¶ÏËÚÔÊÔÚ›Â˜: PRC Congress & Travel ∆ËÏ.: (+30) 210 7711 673, 210 7756 336 Fax: (+30) 210 7711 289 E-mail: [email protected]

26-28 π·ÓÔ˘·Ú›Ô˘ 2006 6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ ∞ı‹Ó·

•ÂÓÔ‰Ô¯Â›Ô Holiday Inn ¶ÏËÚÔÊÔÚ›Â˜: PRC Congress & Travel ∆ËÏ.: (+30) 210 7711 673, 210 7756 336 Fax: (+30) 210 7711 289 E-mail: [email protected]

18-19 ª·ÚÙ›Ô˘ 2006 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂÈ‰ÈÎÔÙ‹ÙˆÓ ∞ı‹Ó·

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26-29 ∞ÚÈÏ›Ô˘ 2006 XVIIth Annual Congress of the European Society ∞ı‹Ó·

for Paediatric Urology

•ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔÚ›Â˜: Erasmus Conferences Tours & Travel S.A. ∆ËÏ.: (+30) 210 7257 693 Fax: (+30) 210 7257 532 E-mail: [email protected] Website: www.espu2006.com


xxiv

2-5 ª·˝Ô˘ 2006 11o ¢ÈÂıÓ¤˜ ™˘Ó¤‰ÚÈÔ ∂Ù·ÈÚÂ›·˜ æ˘¯ÔÏÔÁÈÎ‹˜ ∞ı‹Ó·

æ˘¯È·ÙÚÈÎ‹˜ ∂ÓËÏ›ÎÔ˘ Î·È ¶·È‰ÈÔ‡ (∂ææ∂¶)

“ºÈÏ›· & ∂ÓfiÙËÙ·, æ˘¯ÔÏÔÁ›· & ∂ÈÎÔÈÓˆÓ›·”

•ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔÚ›Â˜: ∂Ù·ÈÚÂ›· æ˘¯ÔÏÔÁÈÎ‹˜ æ˘¯È·ÙÚÈÎ‹˜ ∂ÓËÏ›ÎÔ˘ Î·È ¶·È‰ÈÔ‡ ∆ËÏ.: (+30) 210 6842 663, 210 6857 319Fax: (+30) 210 6842 079 E-mail: [email protected] Website: www.epsep.org.gr

3-5 ª·˝Ô˘ 2006 24th Annual Meeting of the European Society Basel,

for Paediatric Infectious Diseases - ESPID Switzerland

¶ÏËÚÔÊÔÚ›Â˜: Kenes International / ESPID 2006 ∆ËÏ.: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: [email protected] Website: www.kenes.com/espid/index2006.asp

10-14 πÔ˘Ó›Ô˘ 2006 XXV Congress of the European Academy of Vienna,

Allergology and Clinical Immunology Austria

¶ÏËÚÔÊÔÚ›Â˜: Congrex Sweden ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: [email protected] Website: www.congrex.com/eaaci2006

30 πÔ˘Ó›Ô˘- 45th Annual Meeting of the European Society Rotterdam,

3 πÔ˘Ï›Ô˘ 2006 for Paediatric Endocrinology The Netherlands

¶ÏËÚÔÊÔÚ›Â˜: Congrex Sweden AB ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: [email protected] Website: www.espe2006.org

8-11 πÔ˘Ï›Ô˘ 2006 7th International Congress on Pediatric Montreal,

Pulmonology Canada

¶ÏËÚÔÊÔÚ›Â˜: Annie Bidart, MD ∆ËÏ.: +33 0 497 038 597 Fax: +33 0 497 038 598 E-mail: [email protected] Website: www.cipp-meeting.com


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