Παιδιατρική | Τόμος 68 • Τεύχος 6 • Νοέμβριος -...

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

ISSN 0377-2551ISSN 0377-2551

Volume 68 ñ Number 6 ñ November-December 2005Volume 68 ñ Number 6 ñ November-December 2005

Exof Pediatr Nov-Dec 05 12-12-05 14:05 ™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›‰ËA. 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¤ÓˆÓI. K·Ú·‚Ú¿ÓÔ˘

EÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ™. ¡¿ÎÔ˘

EÎ‰fiÙË˜

K. °ÚÈ‚¤·˜

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰fiÛÂˆ˜

E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.∞ÚÙ¤ÌÈ‰Ô˜ 3 151 25 M·ÚÔ‡ÛÈTËÏ.: 210 87 78 810Fax: 210 87 78 822

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¶ÂÚÈÂ¯fiÌÂÓ·

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399 ¢È·ÙÚÔÊ‹ Î·È ¿ÛıÌ· ÛÙ· ·È‰È¿ ¢. ¶··Ó‰Ú¤Ô˘, M. ∂ÌÔÚÈ¿‰Ô˘

409 ∂ÈÏÔÎ¤˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Î·È ÂÚÈÊÂÚÈÎfiÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÔÌfi˙˘ÁË‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·A. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË, G. Du Toit, G. Lack

417 ¶ÚfiÔ‰ÔÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜°. ¢ËÌËÙÚ›Ô˘, Ã. ∞Á·Î›‰Ë˜

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425 ∫·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ÓÂ˘ÌÔÓ›·.™˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË 40 ·È‰ÈÒÓ ÓÔÛËÏÂ˘fiÌÂÓˆÓ ÛÂ ÓÔÛÔÎÔÌÂ›Ô°. ™. µ·ÚÏ¿ÌË˜, ¡. ∞Ú‚·ÓÈÙ›‰Ë˜, ™. ∫·Ú·Ì¤ÚË˜, ª. ∂ÌÔÚÈ¿‰Ô˘, ™. °·‚ÚÈÈÏ›‰Ë˜

433 ¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ·¯˘Û·ÚÎ›·˜ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ÛÙËÓ ·ÎÚÈÙÈÎ‹ ÂÚÈÔ¯‹ ÙÔ˘ ¡ÔÌÔ‡ £ÂÛÚˆÙ›·˜¶. ¢. ∞ÁÁÂÏfiÔ˘ÏÔ˜, π. ª·ÓÈfi˜, Ã. π. ªËÏÈÒÓË˜

∂∂¡¡¢¢ππ∞∞ºº∂∂ƒƒOOÀÀ™™∂∂™™ ¶¶∂∂ƒƒππ¶¶∆∆øø™™∂∂ππ™™

440 ÕÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· ÛÂ ¿Û¯ÔÓÙÂ˜·fi ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ∞. ∫Ô‡ÛË, ª. OÈÎÔÓfiÌÔ˘, ¢. ∫·Û›ÌÔ˜, ¶. ¶ÏÈ¿ÎË, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿

446 ªÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· ÙÔ˘ ‹·ÙÔ˜.∞Ó·ÊÔÚ¿ ÛÂ Ì›· ÂÚ›ÙˆÛËª. Ã·ÛÈÒÙÔ˘, ∂. ™·ÌÌÔ‡ÙË, ¶. ¶ÔÏ˘‚›Ô˘, ∂. ∫ÔÛÎÈÓ¿

450 ™‡Ó‰ÚÔÌÔ ÂÈÛÚfiÊËÛË˜ ÎÂ¯ÚˆÛÌ¤ÓÔ˘·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ ˆ˜ ÚÒÙË ÂÎ‰‹ÏˆÛË·ÙÚËÛ›·˜ ÂÓÙ¤ÚÔ˘µ- ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, §. µÔÁÈ·Ù˙‹, π. ∂˘‰ˆÚ›‰Ô˘, £. ™Ù·ıÔÔ‡ÏÔ˘, ∂. ¢È·Ì·ÓÙ‹

¶¶ƒƒ∞∞∫∫∆∆ππ∫∫∞∞ ££∂∂ªª∞∞∆∆∞∞

454 ∫·Ú‰È·ÁÁÂÈ·Î¿ ·›ÙÈ· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘Î·Ù¿ ÙËÓ ¿ÛÎËÛË ÛÂ ·È‰È¿, ÂÊ‹‚Ô˘˜Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜. ¶ÚÔ·ıÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜¢. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜, ∫. ¢Ô‡ÚÔ˜

461 ∫∫§§ππ¡¡ππ∫∫√√ ∫∫√√ÀÀππ∑∑

462 ¡¡∂∂∞∞ ∞∞¶¶√√ ∆∆√√ ¢¢ππ∞∞¢¢ππ∫∫∆∆ÀÀ√√

467 ¡¡∂∂∞∞ ∞∞¶¶√√ ™™ÀÀ¡¡∂∂¢¢ƒƒππ∞∞

471 µµππµµ§§ππ√√¶¶∞∞ƒƒ√√ÀÀ™™ππ∞∞™™∏∏

472 ∂∂ÀÀƒƒ∂∂∆∆∏∏ƒƒππ√√ ∫∫ƒƒππ∆∆øø¡¡ ∆∆√√ÀÀ ∆∆√√ªª√√ÀÀ 6688

473 ∂∂ÀÀƒƒ∂∂∆∆∏∏ƒƒππ√√ ™™ÀÀ°°°°ƒƒ∞∞ºº∂∂øø¡¡ ∆∆√√ÀÀ ∆∆√√ªª√√ÀÀ 6688

475 ∂∂ÀÀƒƒ∂∂∆∆∏∏ƒƒππ√√ §§∂∂••∂∂øø¡¡ ∫∫§§∂∂ππ¢¢ππøø¡¡ ∆∆√√ÀÀ ∆∆√√ªª√√ÀÀ 6688

∫ˆ‰ÈÎfi ̃¢ÈÂ‡ı˘ÓÛË ̃∂ÔÙÂ›· ̃ªª∂: 3889

ISSN 0377-2551

¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 68 ñ ∆Â‡¯Ô˜ 6 ñ ¡Ô¤Ì‚ÚÈÔ˜-¢ÂÎ¤Ì‚ÚÈÔ˜ 2005

Pediatr Nov-Dec 05 12-12-05 15:16 ™ÂÏ›‰·1

Bimonthly Publication ofthe Greek Paediatric Society

PresidentA. Constantopoulos

Editorial Board

EditorC. Stefanidis

MembersP. Avgoustidou-SavvopoulouH. AntonopoulouA. Vazeou-GerasimidiG. VarlamisM. Kanariou∂. Katsarou-PectasidesA. KattamisCh. CostalosN. Papadopoulos∞. PapadopoulouA. Siamopoulou-MavridouM. Tsolia-Pasparaki

Manuscript Editing

Greek EditingI. Karavranou

English EditingS. Nakou

Publisher

K. Griveas

Publishing Coordinator

SCIENTIFIC PUBLICATIONS Ltd3 Artemidos str. GR - 151 25, MaroussiTel.: +30 210 87 78 810 Fax: +30 210 87 78 822

Owner

Greek Paediatric Society©

92 Michalakopoulou str.GR - 115 28, AthensTel.: +30 210 7771 140

+30 210 7771 663Fax: +30 210 7758 354e-mail: [email protected]

Annual SubscriptionAll foreign countries: US $ 50

Contents

RREEVVIIEEWW AARRTTIICCLLEESS

408 Diet and asthma in childrenD. Papandreou, M. Emboriadou

416 Central and peripheral nervous systemcomplications in patients with beta-thalassaemia majorD. Zafeiriou, M. Oikonomou, M. Athanassiou-Metaxa

424 Advances in the management ofcongenital diaphragmatic herniaG. Dimitriou, C. Agakidis

OORRIIGGIINNAALL AARRTTIICCLLEESS

432 Cardiac involvement in pneumonia.Comparative study in 40 hospitalizedchildrenG. S. Varlamis, N. Arvanitidis, S. Karaberis, M. Emboriadou, S. Gavriilidis

439 Risk factors for obesity in elementaryschool children in the Greek borderregion of Thesprotia P. D. Angelopoulos, J. Manios, H. J. Milionis

CCAASSEE RREEPPOORRTTSS

445 Immune haemolytic anaemia in patientswith beta-thalassaemia. Case reportA. Kousi, M. Oikonomou, D. Kassimos, P. Pliaki, M. Athanassiou-Metaxa

449 Liver mesenchymal hamartoma. A case reportM. Hasiotou, E. Sammouti, P. Poliviou, E. Koskina

453 Intestinal atresia presenting at birthwith aspiration of meconium-like-stained amniotic fluidV. Drossou-Agakidou, L. Bogiatzi, I Eudoridou,T. Stathopoulou, E. Diamanti

PPRRAACCTTIICCAALL IISSSSUUEE

460 Cardiovascular conditions associatedwith sudden death during exercise inchildren, adolescents and young adults.Preparticipation evaluationD. Georgakopoulos, K. Douros

461 CCLLIINNIICCAALL QQUUIIZZ

462 NNEEWWSS FFRROOMM TTHHEE IINNTTEERRNNEETT

467 CCOONNGGRREESSSS NNEEWWSS

471 BBOOOOKK RREEVVIIEEWW

472 RREEVVIIEEWWEERRSS OOFF MMAANNUUSSCCRRIIPPTTSSIINNDDEEXX,, VVOOLLUUMMEE 6688

473 AAUUTTHHOORRSS IINNDDEEXX,, VVOOLLUUMMEE 6688

475 SSUUBBJJEECCTT IINNDDEEXX,, VVOOLLUUMMEE 6688

PaediatrikiVolume 68 ñ Number 6 ñ November-December 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·ÊËÛ˘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 ManuscriptsSubmitted 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 ÙˆÓÈÓ¿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·ÈÂÚÈıÒÚÈ· 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˜ ÛÂ 1500-2500 Ï¤ÍÂÈ˜ Î·È ÙÈ˜

ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÛÂ 1000-1500 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 (<5Ï¤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¤ÓËÛÙÈ˜ 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·ÔÌÒÓI. ¶∂ƒπO¢π∫∞

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

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

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

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

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

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

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

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

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

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

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

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

II. µπµ§π∞∫ÂÊ¿Ï·ÈÔ ÛÂ ‚È‚Ï›Ô:

Clark AG, Barratt TM. Steroid-responsive 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 head

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

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

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

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

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

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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 osmolep 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


xvi INSTRUCTIONS TO AUTHORS

Paediatriki 2005;68:16

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

triki”, its official scientific journal, which is distributed toits members. Its objectives are the publication of paediatricscientific work and the continuing education of paediatri-cians. For this purpose, it publishes a variety of articles, andin 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 articlesof special scientific interest and articles on current issueswithout observing submission order. In addition it publish-es upon decision original papers presented at the AnnualPaediatric Conference, presentations of special interest - inwhole or in part, and letters - in whole or in part - referringto scientific articles published in the journal.

Regarding papers on current issues, the author’s requestfor immediate publication should be quoted on the firstpage. The Editorial Board reserves the right to accept suchpapers for immediate publication.

All manuscripts should not have been published previ-ously, in whole or in part, and not be under considerationby another publication. Manuscripts should acknowledgeany funding, sponsorship or other financial support. Allclinical 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 forthe care and use of laboratory animals (DHEW Publication,NIH, 80-23) should have been observed. Clinical trialsshould have been approved by the Ethics Committee of theHospital.

Authors’ opinions and conclusions expressed in thepublished papers do not necessarily reflect those of the jour-nal. The Greek Paediatric Society, the Editorial Board andthe Publisher of the journal do not necessarily approve thecontent 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 BiomedicalJournals”, 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 1500-2500 words and case reports

1000-1500 words; ñ brief reports 1000-1500 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.

AbstractsThe 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 250

words. 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.

TextOriginal articles include: introduction, methods, results

and discussion. The introduction includes the latest researchdata on the subject and the main references and the objec-tives of the paper. The description of the methods should beprecise and detailed so as to enable reproduction by other re-searchers. In addition, the statistical methods of analysis andevaluation of the results should be described. Results shouldbe presented clearly, together with the appropriate statisticalanalysis. Discussion should cover the results ensuing fromthe research, their significance and possible associations withthe observations of other researchers.

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.


xvii

Units of measures of laboratory analysesLaboratory 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

AbbreviationsAll 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.

ReferencesThe reference section contains all references numbered

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

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

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

Examples of reference style

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

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

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

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

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

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

No author:National Institutes of Health Consensus Development

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

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

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

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

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

II. BOOKSChapter in book:

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

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

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

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

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

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

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

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

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

IV. ON THE INTERNETArticle in journal

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

MonographFoley KM, Gelband H, editors. Improving palliative

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

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

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

Tables and FiguresThree copies should be submitted (original plus 2

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

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

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


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.

xviii


xix∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏

∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ,

∆Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ Î·È Ë ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹ÙË˜ «¶·È‰È·ÙÚÈÎ‹˜» Û·˜ Â‡¯ÔÓÙ·È Î·Ï¿ ÃÚÈÛÙÔ‡ÁÂÓÓ· Î·È Â˘Ù˘¯ÈÛÌ¤ÓÔ Î·È ‰ËÌÈÔ˘ÚÁÈÎfi ÙÔ 2006.

£· ‹ıÂÏ· Î·È ¿ÏÈ Ó· Û·˜ Â˘¯·ÚÈÛÙ‹Ûˆ ÁÈ· ÙÔ ÂÓ‰È·Ê¤ÚÔÓ Û·˜ ÁÈ· ÙÔ ÂÚÈÔ‰ÈÎfi. µÏ¤ÔÓÙ·˜ Ù·ÙÂ‡¯Ë ÙÔ˘ 2005 ‰È·›ÛÙˆÛ· ÌÂ ¯·Ú¿ ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙˆÓ Û˘ÓÂ¯ÒÓ ÚÔÛ·ıÂÈÒÓ ÙË˜ ™˘ÓÙ·ÎÙÈÎ‹˜∂ÈÙÚÔ‹˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ Î·È ÙˆÓ “∂ÈÛÙËÌÔÓÈÎÒÓ ∂Î‰fiÛÂˆÓ” ÁÈ· ÙËÓ ÂÈÌÂ-ÏËÌ¤ÓË ÂÌÊ¿ÓÈÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ŸÏ· Ù· ¿ÚıÚ· ‚ÂÏÙÈÒıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂ Ù· ÂÔÈÎÔ‰ÔÌËÙÈÎ¿Û¯fiÏÈ· ÙˆÓ ÎÚÈÙÒÓ Î·È ÙÔ˘˜ Â˘¯·ÚÈÛÙÔ‡ÌÂ ıÂÚÌ¿. ™Â ·˘Ùfi ‚Ô‹ıËÛÂ Î·È Ë Ó¤· ÔÚÁ·ÓˆÙÈÎ‹ ‰ÔÌ‹ ÌÂÙÈ˜ ÚˆÙÔ‚Ô˘Ï›Â˜ ÙˆÓ ˘Â‡ı˘ÓˆÓ Û‡ÓÙ·ÍË˜ Î¿ıÂ ÂÍÂÈ‰›ÎÂ˘ÛË˜.

™Ù· ÙÂ‡¯Ë ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜” ÙÔ˘ 2005 ‰ËÌÔÛÈÂ‡ıËÎ·Ó:19 ·Ó·ÛÎÔ‹ÛÂÈ˜12 ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜18 ÂÓ‰È·Ê¤ÚÔÓÙ· ÂÚÈÛÙ·ÙÈÎ¿3 Ú·ÎÙÈÎ¿ ı¤Ì·Ù· ÁÈ· ÙÔ˘˜ «Î·Ú‰ÈÔÏÔÁÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÛÙË ·È‰È·ÙÚÈÎ‹ Ú¿ÍË», ÁÈ· Ù· «Î·Ú-

‰È·ÁÁÂÈ·Î¿ ·›ÙÈ· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ÛÂ ·È‰È¿, ÂÊ‹‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜»Î·È ÁÈ· «ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ ÛÙ· ·È‰È¿»

2 ÂÈ‰ÈÎ¿ ¿ÚıÚ· ÁÈ· «ÙÔÓ ÚÔÏËÙÈÎfi ÁÂÓÂÙÈÎfi ¤ÏÂÁ¯Ô Î·È ı¤Ì·Ù· ËıÈÎ‹˜» Î·È ÁÈ· «ÙËÓ ·ÂÈÎfi-ÓÈÛË ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙË ÓÂÔÂÏÏËÓÈÎ‹ ÏÔÁÔÙÂ¯Ó›·».

1 Â›Î·ÈÚÔ ı¤Ì· ÁÈ· «ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È Î·Ù¿ ÙË ÓÂÔÁÓÈ-Î‹ ÂÚ›Ô‰Ô ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘».

1 ÔÌÈÏ›· ÙÔ˘ ∫·ıËÁËÙ‹ ª·ÌÈÓÈÒÙË ÁÈ· ÙËÓ «∂ÏÏËÓÈÎ‹ ÁÏÒÛÛ·».1 ÁÚ·Ùfi ™˘ÌfiÛÈÔ ÁÈ· «ÙÔÓ ¤ÊË‚Ô ÌÂ ¯ÚfiÓÈÔ ÓfiÛËÌ·».∆¤ÏÔ˜ Û·˜ Â˘¯·ÚÈÛÙÔ‡ÌÂ ÁÈ· Ù· Â˘ÁÂÓÈÎ¿ Û·˜ Û¯fiÏÈ· ÁÈ· Ù· «¡¤· ·fi ÙÔ ‰È·‰›ÎÙ˘Ô» Î·È Ù·

«∫ÏÈÓÈÎ¿ Quiz».

∞fi ÙÈ˜ 57 ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÙÔ˘ 2005 ÔÈ:21 (37%) ‹Ù·Ó ·fi ∫ÏÈÓÈÎ¤˜ ÙÔ˘ ∂™À ÙË˜ ∞ı‹Ó·˜.12 (21%) ·fi ÙÈ˜ ¶·È‰È·ÙÚÈÎ¤˜ ¶·ÓÂÈÛÙËÌÈ·Î¤˜ ∫ÏÈÓÈÎ¤˜ ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ (1 ÛÂ Û˘ÓÂÚÁ·Û›·

ÌÂ ∫ÏÈÓÈÎ¤˜ ÙÔ˘ ∂™À).10 (18%) ·fi ¶·ÓÂÈÛÙËÌÈ·Î¤˜ ∫ÏÈÓÈÎ¤˜ ÙË˜ ∞ı‹Ó·˜ (2 ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ∫ÏÈÓÈÎ¤˜ ÙÔ˘ ∂™À), 4 ·fi ÙË ¶·È‰È·ÙÚÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·Î‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ∏Ú·ÎÏÂ›Ô˘.3 ·fi ÙË ¶·È‰È·ÙÚÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·Î‹ ∫ÏÈÓÈÎ‹ ÙˆÓ πˆ·ÓÓ›ÓˆÓ.3 ·fi Ù· ∆∂π ∞ı‹Ó·˜. 1 ·fi ÙË ¶·È‰È·ÙÚÈÎ‹ ¶·ÓÂÈÛÙËÌÈ·Î‹ ∫ÏÈÓÈÎ‹ §¿ÚÈÛ·˜.1 ·fi ÙË ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∂™À ¶¿ÙÚ·˜.2 ·fi ∫ÏÈÓÈÎ¤˜ ÂÎÙfi˜ ∂ÏÏ¿‰·˜.

∂Ï›˙ˆ fiÙÈ Î·È Ë ÂfiÌÂÓË ¯ÚÔÓÈ¿ ÌÂ ÙË ‰ÈÎ‹ Û·˜ Û˘Ì‚ÔÏ‹ ı· Â›Ó·È ÙÔ ›‰ÈÔ ‰ËÌÈÔ˘ÚÁÈÎ‹ Î·È ÌÂÛ˘Ó¤¯ÂÈ· ÙË˜ ÚÔÛ¿ıÂÈ·˜ ÁÈ· ÔÈÔÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

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¶ÂÚ›ÏË„Ë∏ Â›‰Ú·ÛË ÙË˜ ‰›·ÈÙ·˜ ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÙË˜ ÛÔ‚·ÚfiÙËÙ·˜ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Â›Ó·È·‚¤‚·ÈË. ∂È‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù· ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿, ÙÔ Ì·ÁÓ‹ÛÈÔ Î·È Ë Î·Ù·-Ó¿ÏˆÛË ÏÈÒÓ ÌÔÚÂ› Ó· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜, ·Ú’ fiÏÔ Ô˘ ËÛËÌ·Û›· ·˘ÙÒÓ ÙˆÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ‰ÂÓ Â›Ó·È ·ÎfiÌË ÍÂÎ¿ı·ÚË. ¢È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ÚÔ-Û·ıÔ‡Ó Ó· Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ·ÔÛ·Ê‹ÓÈÛË ÙË˜ ÛËÌ·Û›·˜ ÙË˜ ‰›·ÈÙ·˜ ÛÙÔ˘˜ ·ÛıÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜,ÂÓÒ ÚfiÛÊ·ÙÂ˜ ¤ÚÂ˘ÓÂ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù· ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿ ·fi ÌfiÓ· ÙÔ˘˜ ÌÔÚÂ› Ó· Â›Ó·È ÔÏ‡ˆÊ¤ÏÈÌ·. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ‰È·ÈÙËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÌÔÚÂ› Ó· Â›Ó·È ÛËÌ·ÓÙÈÎÔ› ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘¿ÛıÌ·ÙÔ˜ ·ÔÙ¤ÏÂÛÂ ÛËÌ·ÓÙÈÎfi ı¤Ì· ÌÂÏ¤ÙË˜ Ù· ÙÂÏÂ˘Ù·›· 10-15 ¯ÚfiÓÈ·, ÂÓÒ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ÌÂÏ¤ÙÂ˜ ÂÓ¤ÏÂÍ·Ó ‰È¿ÊÔÚ· È¯ÓÔÛÙÔÈ¯Â›·, ‚ÈÙ·Ì›ÓÂ˜ Î·È ÏÈ·Ú¿ ÔÍ¤· ÛÙËÓ ˘fiıÂÛË ·˘Ù‹.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿ÕÛıÌ·, ·È‰ÈÎ‹ ËÏÈÎ›·, ‰È·ÙÚÔÊ‹, ‰›·ÈÙ·, Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹.

µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ£ÂÛÛ·ÏÔÓ›ÎË˜

AÏÏËÏÔÁÚ·Ê›·:ª·Ú›· ∂ÌÔÚÈ¿‰Ô˘ µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£. ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞ ™Ù. ∫˘ÚÈ·Î›‰Ë 1, ∆.∫. 546 36,£ÂÛÛ·ÏÔÓ›ÎË

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-11-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 27-04-2005

¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407

∂ÈÛ·ÁˆÁ‹

∆Ô ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· (µ∞) ·ÔÙÂÏÂ› ¤Ó· ·fiÙ· Û˘¯ÓfiÙÂÚ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ËÏÈÎ›·˜ (1,2) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·fiÊÚ·-ÍË ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ÌÂ ·Ó·ÛÙÚ¤„ÈÌÔ ¯·-Ú·ÎÙ‹Ú· (3). ªÂ ‚¿ÛË Ù· ÈÔ ÚfiÛÊ·Ù· ‰Â‰Ô-Ì¤Ó·, ÙÔ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· ÔÚ›˙ÂÙ·È ˆ˜ “¯ÚfiÓÈ·ÊÏÂÁÌÔÓÒ‰Ë˜ ‰È·Ù·Ú·¯‹ ÙˆÓ ·ÂÚÔÊfiÚˆÓÔ‰ÒÓ, Ë ÔÔ›· Ô‰ËÁÂ› ÛÙËÓ ·‡ÍËÛË ÙË˜ ‚ÚÔÁ¯È-Î‹˜ ˘ÂÚ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó·ÂÌÊ·Ó›˙ÔÓÙ·È ‰È¿ÊÔÚ· ÂÂÈÛfi‰È·, Ù· ÔÔ›· Û˘-Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÎÙÂÙ·Ì¤ÓË ·ÏÏ¿ÔÈÎ›ÏÔ˘ ‚·ıÌÔ‡ ·fiÊÚ·ÍË ÙˆÓ ·ÂÚÔÊfiÚˆÓÔ‰ÒÓ Ô˘ ÌÔÚÂ› Ó· ·Ó·ÛÙÚ·ÊÂ› ·˘ÙfiÌ·Ù· ‹ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ıÂÚ·Â›·˜” (4).

∞fi Ù· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· ‰È·Êfi-ÚˆÓ ¯ˆÚÒÓ ÚÔÎ‡ÙÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÂÎ‰‹-ÏˆÛË˜ ÙÔ˘ µ∞ ·˘Í¿ÓÂÙ·È Î·È ÔÈÎ›ÏÏÂÈ ÌÂÙ·Í‡‰È·ÊfiÚˆÓ ÏËı˘ÛÌÒÓ ·fi 0% ¤ˆ˜ 30% (4),ÂÓÒ Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ófi ÛÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜¯ÒÚÂ˜, fiÔ˘ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘ ÏËı˘-ÛÌÔ‡ Â›Ó·È ·ÁÚÔÙÈÎfi. ∏ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ·ÂÓÂÚÁÔ‡ ·È‰ÈÎÔ‡ µ∞ Î·Ù·ÁÚ¿ÊËÎÂ ÛÙËÓ ∞˘-ÛÙÚ·Ï›·, ÙË ¡¤· ∑ËÏ·Ó‰›· Î·È ÙËÓ ∞ÁÁÏ›· (5),ÂÓÒ Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î˘Ì·›ÓÂÙ·ÈÛÂ 7-10%, fiˆ˜ Î·È ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·ÓÂ-Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ (4). À¿Ú¯Ô˘Ó ÛÙÔÈ¯Â›· Ô˘ÂÈÛËÁÔ‡ÓÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜·ÎÔÏÔ˘ıÂ› ·˘ÍËÙÈÎ‹ ÔÚÂ›· (6,7). ¶ÚfiÛÊ·Ù·‰È·ÈÛÙÒıËÎÂ ·fi ÔÚÈÛÌ¤ÓÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Ù¿ÛË

ÛÙ·ıÂÚÔÔ›ËÛË˜ ÛÙË Û˘¯ÓfiÙËÙ· ÂÎ‰‹ÏˆÛË˜Î·È ÙË ıÓËÙfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ·È‰ÈÎ‹ËÏÈÎ›· (8-10). ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ Ô‰ËÁÂ› ÛÂÌ›· Ó¤· ÚfiÎÏËÛË: ÙË ÌÂ›ˆÛË ÙË˜ ÓÔÛËÚfiÙËÙ·˜Î·È ÙË˜ ıÓËÙfiÙËÙ·˜ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÙÔ µ∞, ÌÂÙËÓ ÂÊ·ÚÌÔÁ‹ Ì¤ÙÚˆÓ ÚÒÈÌË˜ ·Ú¤Ì‚·ÛË˜Î·È ıÂÚ·Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ (11).

∏ ÂÎ‰‹ÏˆÛË ÙÔ˘ µ∞ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·ÈÛÙÂ‡ÂÙ·È fiÙÈ Î·ıÔÚ›˙ÂÙ·È ·fi ‰È¿ÊÔÚÔ˘˜ ·-Ú¿ÁÔÓÙÂ˜, ÔÈ ÔÔ›ÔÈ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ÂÓ‰ÔÁÂÓÂ›˜Î·È ÂÍˆÁÂÓÂ›˜. OÈ ÚÒÙÔÈ ·ÔÙÂÏÔ‡Ó Û˘ÁÁÂÓ‹ ‹Â›ÎÙËÙ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÙfiÌˆÓ Ô˘·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜(¶›Ó·Î·˜ 1) (12,13). OÈ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿-ÁÔÓÙÂ˜ ÙÚÔÔÔÈÔ‡Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈ-ÛË˜ ¿ÛıÌ·ÙÔ˜ ÛÂ ¿ÙÔÌ· ÌÂ ÚÔ‰È¿ıÂÛË, ÂÓÒÔÚÈÛÌ¤ÓÔÈ ·fi ·˘ÙÔ‡˜ ÚÔÎ·ÏÔ‡Ó Î·È ¤Í·ÚÛËÙˆÓ ·ÛıÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÂÚÈÁÚ¿ÊÔ-ÓÙ·È ˆ˜ ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ (¶›Ó·Î·˜ 2)(2,14).

∏ Û¯¤ÛË ÌÂÙ·Í‡ ‰›·ÈÙ·˜ Î·È ¿ÛıÌ·ÙÔ˜·ÔÙÂÏÂ› ·ÓÙÈÎÂ›ÌÂÓÔ ÌÂÏ¤ÙË˜ ÌÂ ÔÏÏ¤˜

¶›Ó·Î·˜ 1. ∂Ó‰ÔÁÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË¿ÛıÌ·ÙÔ˜

º˘ÏÂÙÈÎÔ›-ÂıÓÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ °ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi º‡ÏÔ ∂Ó‰ÔÌ‹ÙÚÈÔÈ Î·È ÂÚÈÁÂÓÓËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ £ËÏ·ÛÌfi˜ ∞ÙÔ›·


400 ¢. ¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

‰È·ÛÙ¿ÛÂÈ˜. Œ¯ÂÈ ‚ÚÂıÂ› fiÙÈ ˘¿Ú¯ÂÈ Û˘Û¯ÂÙÈ-ÛÌfi˜ ÙÔ˘ ÂÈ¤‰Ô˘ ıÚ¤„Ë˜ Î·È ÙË˜ Û˘¯ÓfiÙË-Ù·˜ ÂÎ‰‹ÏˆÛË˜ ¿ÛıÌ·ÙÔ˜, ·ÏÏ¿ Î·È ÙˆÓ ·ÙÔ-ÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÁÂÓÈÎfiÙÂÚ· (15,16). ∞ÚÎÂ-ÙÔ› ÂÚÂ˘ÓËÙ¤˜ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙËÓ Èı·Ó‹Û¯¤ÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÌÂ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛËÛÂ ‰È¿ÊÔÚÂ˜ ÙÚÔÊ¤˜. ∏ Û¯¤ÛË ÙË˜ Â˘·ÈÛıË-Û›·˜ ÛÙÈ˜ ÙÚÔÊ¤˜ Î·È ÙË˜ ·Ó¿Ù˘ÍË˜ ¿ÛıÌ·ÙÔ˜‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ‚¤‚·ÈË, ˘¿Ú¯Ô˘Ó ˆÛÙfiÛÔÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ë ÂÎ‰‹ÏˆÛË ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙËÓ ÂÌ-Ê¿ÓÈÛË ¿ÛıÌ·ÙÔ˜. ∆· ·È‰È¿ ÌÂ ·ÏÏÂÚÁÈÎ¤˜ÂÓÙÂÚÔ¿ıÂÈÂ˜ ÂÌÊ·Ó›˙Ô˘Ó ¿ÛıÌ· ÌÂ ÌÂÁ·Ï‡-ÙÂÚË Û˘¯ÓfiÙËÙ· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ¿ÏÏ· ·È‰È¿,ÈÛÙÂ‡ÂÙ·È fiÌˆ˜ fiÙÈ ·˘Ùfi ·ÓÙ·Ó·ÎÏ¿ ÙË ÁÂÓÈ-ÎfiÙÂÚË ÚÔ‰È¿ıÂÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Ó··Ó·Ù‡ÍÔ˘Ó ·ÏÏÂÚÁ›Â˜ Î·È fi¯È ÙÔ ÁÂÁÔÓfi˜ fiÙÈÎ¿ÔÈ· ÙÚÔÊ‹ ÌÔÚÂ› Ó· Â˘ı‡ÓÂÙ·È ÁÈ· ÙÔ¿ÛıÌ· (15,16).

∏ ÌÂÏ¤ÙË ÙˆÓ ·ÈÙ›ˆÓ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ¤¯ÂÈÔ‰ËÁ‹ÛÂÈ ÛÙËÓ ¤ÚÂ˘Ó· ÁÂÓÂÙÈÎÒÓ, ·ÙÔÈÎÒÓ,ÈÔÁÂÓÒÓ Î·È ‰È·ÈÙËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (17). ∫·-Ù¿ ÙÈ˜ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜, ¤Ó·˜ ·ÚÈıÌfi˜ÌÂÏÂÙÒÓ ¤¯ÂÈ ÂÈÎÂÓÙÚˆıÂ› ÂÈ‰ÈÎ¿ ÛÙË ‰È·ÙÚÔ-Ê‹ Î·È ÙÔ ¿ÛıÌ· (18-23). OÈ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜·Ó·Ê¤ÚÔÓÙ·È ÛÙË Û¯¤ÛË ÙË˜ ‰È·ÙÚÔÊ‹˜ ˆ˜ ·È-Ù›· ¿ÛıÌ·ÙÔ˜ Î·È ÛÙË ¯ÔÚ‹ÁËÛË ÂÈ‰ÈÎ‹˜ ‰›·ÈÙ·˜ÁÈ· ÙË ıÂÚ·Â›· ÙÔ˘. ∂›ÛË˜, ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ›fiÙÈ ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙË ‰È·ÈÙËÙÈÎ‹ ÚfiÛÏË„Ë Û˘-ÁÎÂÎÚÈÌ¤ÓˆÓ Ô˘ÛÈÒÓ, fiˆ˜ ÔÈ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¤˜Ô˘Û›Â˜, ÙÔ Ì·ÁÓ‹ÛÈÔ Î·È Ù· ÏÈ·Ú¿ ÔÍ¤·, ÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È ÛÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÂ› Ó·ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·ÂÎ‰‹ÏˆÛË˜ ¿ÛıÌ·ÙÔ˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ· (3,24).

∂›‰Ú·ÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÙÔ ¿ÛıÌ·

OÈ ÌÂÏ¤ÙÂ˜ Ô˘ ÂÍÂÙ¿˙Ô˘Ó ÙËÓ Â›‰Ú·ÛËÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙÔÓ ·ÂÚÈÛÌfi ÙˆÓ ÓÂ˘Ìfi-ÓˆÓ, ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (25-28).™Â ·˘Ù¤˜ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› ‰È·Ù·Ú·¯‹ ÛÙÈ˜ ÏÂÈ-

ÙÔ˘ÚÁÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ·ÂÚÈÛÌÔ‡ ÙˆÓ ÓÂ˘Ìfi-ÓˆÓ, Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ ‚·ıÌfi ÙË˜·¯˘Û·ÚÎ›·˜, ÙÔ Ê‡ÏÔ Î·È ÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘Ï›Ô˘˜. ªÂÙ¿ ‰Â ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·Ú·ÙË-ÚÂ›Ù·È ·‡ÍËÛË ÙË˜ ˙ˆÙÈÎ‹˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ Î·ÈÙÔ˘ ÂÎÓÂ˘ÛÙÈÎÔ‡ fiÁÎÔ˘ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ·Ú¯È-Î¤˜ ÌÂÙÚ‹ÛÂÈ˜, ·ÎfiÌË Î·È ÛÂ ÂÎÂ›ÓÔ˘˜ ÌÂ ÌÈ-ÎÚfiÙÂÚÔ˘ ‚·ıÌÔ‡ ·¯˘Û·ÚÎ›· Î·È ÌÂ Ê˘ÛÈÔÏÔ-ÁÈÎ¤˜ ÙÈÌ¤˜ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Î·Ù¿ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô. øÛÙfiÛÔ, Ù· Û˘ÌÂÚ¿ÛÌ·Ù··fi ÌÂÏ¤ÙÂ˜ ÛÂ ·¯‡Û·ÚÎÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ‰ÂÓÌÔÚÂ› Ó· ıÂˆÚËıÂ› fiÙÈ ÈÛ¯‡Ô˘Ó Î·È ÁÈ· ·¯‡-Û·ÚÎ· ·È‰È¿, Î·ıÒ˜ Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· ‰È·Ê¤ÚÂÈ ·fiÂÎÂ›ÓË ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ê‡-ÏÔ. ∂›Ó·È Èı·Ófi Ë Â›‰Ú·ÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ÛÙÔÓ ıÒÚ·Î· Î·È ÙÔ ‰È¿ÊÚ·ÁÌ· Ó· ÂËÚÂ¿˙ÂÈÙÈ˜ ·Ó·ÓÂ˘ÛÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·Ù¿ ‰È·ÊÔÚÂ-ÙÈÎfi ÙÚfiÔ ÛÙ· ·È‰È¿ ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜(25-28).

∏ Â›‰Ú·ÛË ÙÔ˘ ‚¿ÚÔ˘˜, Î·Ù¿ ÙË Á¤ÓÓËÛËÎ·È ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘¿ÛıÌ·ÙÔ˜ ¤¯ÂÈ Á›ÓÂÈ ·ÓÙÈÎÂ›ÌÂÓÔ ÔÏÏÒÓ ÌÂÏÂ-ÙÒÓ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (29-31). À¿Ú¯Ô˘ÓÛÙÔÈ¯Â›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘¿ÛıÌ·ÙÔ˜ ·˘Í¿ÓÂÙ·È ÌÂ ÙËÓ ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙËÌ¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (29).ªÂÏ¤ÙÂ˜ ÛÂ ÏËı˘ÛÌÔ‡˜ ÙË˜ µfiÚÂÈ·˜ ∞ÌÂÚÈ-Î‹˜ Î·È ÙË˜ ∂˘ÚÒË˜ ‰È·›ÛÙˆÛ·Ó fiÙÈ Ù· ˘¤Ú-‚·Ú· ¿ÙÔÌ· ÂÌÊ·Ó›˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ·ÛıÌ·ÙÈÎ¿Û˘ÌÙÒÌ·Ù· (30,31). ∂›ÛË˜, ¤ÚÂ˘ÓÂ˜ ÛÂ ÏË-ı˘ÛÌÔ‡˜ ÙË˜ ∞ÊÚÈÎ‹˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÛÙÈ˜ Â-ÚÈÔ¯¤˜ ÌÂ ¯·ÌËÏ¿ ÔÛÔÛÙ¿ ‚ÚÔÁ¯ÈÎ‹˜ ˘ÂÚ·-ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù· ¿ÙÔÌ· Â›Ó·È ¯·ÌËÏÔ‡ ·Ó·-ÛÙ‹Ì·ÙÔ˜ Î·È ÂÏÏÈÔ‚·Ú‹ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ÂÚÈÔ¯¤˜ Ô˘ Ë ÂÎ‰‹ÏˆÛË ‚ÚÔÁ¯ÈÎ‹˜ ˘ÂÚ·-ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·˜ Â›Ó·È Û˘¯ÓfiÙÂÚË (30,31).¶·Ú’ fiÏ· ·˘Ù¿, ‚Ú¤ıËÎÂ fiÙÈ ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ÛÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÂÙÒÓ ‰ÂÓ ÂËÚÂ¿˙ÂÈ ÙËÓ·Ó¿Ù˘ÍË ÙÔ˘ ¿ÛıÌ·ÙÔ˜. OÈ ·Ú·ÙËÚ‹ÛÂÈ˜ ·˘-Ù¤˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ÙË ıÂˆÚ›· fiÙÈ ÔÈ ·Ú¿ÁÔÓÙÂ˜Ô˘ ‚Ï¿ÙÔ˘Ó ÙËÓ ÂÌ‚Ú˘˚Î‹ ·Ó¿Ù˘ÍË ÌÔ-ÚÔ‡Ó Ó· ÂËÚÂ¿ÛÔ˘Ó ÙÔÓ ˘ÔÎÂ›ÌÂÓÔ Î›Ó‰˘ÓÔÂÎ‰‹ÏˆÛË˜ ¿ÛıÌ·ÙÔ˜, ÂÓÒ Ë Û¯¤ÛË ÌÂÙ·Í‡ ÙÔ˘·˘ÍËÌ¤ÓÔ˘ ¢ª™ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È ÙÔ˘¿ÛıÌ·ÙÔ˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÂÚÌËÓÂ˘ÙÂ›. ∂ÈÏ¤-ÔÓ, ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ‚ÂÏÙÈÒÓÂÈÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, Ù· Û˘ÌÙÒÌ·Ù·,ÙË ıÓËÛÈÌfiÙËÙ· Î·È ÂÓ Á¤ÓÂÈ ÙËÓ Î·Ù¿ÛÙ·ÛËÙË˜ ˘ÁÂ›·˜ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·ÛıÂÓÒÓ ÌÂ¿ÛıÌ·, ÁÂÁÔÓfi˜ Ô˘ ÂÓÈÛ¯‡ÂÈ ÙËÓ ¿Ô„Ë fiÙÈ Ë·¯˘Û·ÚÎ›· ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓÒÓÂÈ Ù· Û˘ÌÙÒ-Ì·Ù· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ (32,33).

¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407

¶›Ó·Î·˜ 2. ¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿-Ù˘ÍË ¿ÛıÌ·ÙÔ˜

∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ∞ÏÏÂÚÁÈÎ‹ Â˘·ÈÛıËÙÔÔ›ËÛË ¶·ıËÙÈÎfi Î¿ÓÈÛÌ· ∂·ÁÁÂÏÌ·ÙÈÎ‹ ¤ÎıÂÛË ∞ÙÌÔÛÊ·ÈÚÈÎ‹ Ú‡·ÓÛË §ÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¢›·ÈÙ·


401¢È·ÙÚÔÊ‹ Î·È ¿ÛıÌ· ÛÙ· ·È‰È¿

¢È·ÈÙËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂËÚÂ¿˙Ô˘ÓÙÔ ¿ÛıÌ·

∞ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿ ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ ÔÈ ÔÍÂÈ‰ˆÙÈÎ¤˜ ‰È·‰ÈÎ·Û›Â˜

Ô˘ Á›ÓÔÓÙ·È ÛÂ Î¿ıÂ Î‡ÙÙ·ÚÔ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜Î·È ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ‰È¿ÊÔÚÂ˜ ‚Ï¿-‚Â˜ (34). Œ¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ù· ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿,fiˆ˜ Ë ‚ÈÙ·Ì›ÓË C Î·È Ë ‚ÈÙ·Ì›ÓË ∂, ÌÔÚÔ‡ÓÓ· ÚÔÏ¿‚Ô˘Ó ·˘Ù¤˜ ÙÈ˜ ÔÍÂÈ‰ˆÙÈÎ¤˜ ‚Ï¿‚Â˜,ÙfiÛÔ ÛÙÔ ¿ÛıÌ· fiÛÔ Î·È ÛÙË ¯ÚfiÓÈ· ·Ó·ÓÂ˘-ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·. ™Â Ì›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË·fi ÙËÓ ∫›Ó· ·Ú·ÙËÚ‹ıËÎÂ Ì›· ÛËÌ·ÓÙÈÎ‹Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ ‰È·ÈÙËÙÈÎ‹˜ ÚfiÛÏË„Ë˜ ‚È-Ù·Ì›ÓË˜ C Î·È ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜(35). ™ÙË ÌÂÏ¤ÙË ·˘Ù‹ ‚Ú¤ıËÎÂ fiÙÈ Ë ·˘ÍËÌ¤ÓËÚfiÛÏË„Ë ‚ÈÙ·Ì›ÓË˜ C Î·Ù¿ 100 mg ËÌÂÚË-Û›ˆ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·‡ÍËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘fiÁÎÔ˘ Î·Ù¿ ÚÔÛ¤ÁÁÈÛË 22 ml ÙÔ ÚÒÙÔ ‰Â˘ÙÂ-ÚfiÏÂÙÔ (FEV1) Î·È Î·Ù¿ 25 ml ÙË˜ ˙ˆÙÈÎ‹˜¯ˆÚËÙÈÎfiÙËÙ·˜ (FVC). ™˘Á¯ÚfiÓˆ˜, Ì›· ¿ÏÏË¤ÚÂ˘Ó· ·fi ÙËÓ ∂Ï‚ÂÙ›· ÂÈ‚Â‚·›ˆÛÂ ÙË Û¯¤ÛËÌÂÙ·Í‡ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ FEV1 Î·ÈFVC Î·È ÙË˜ ÚfiÛÏË„Ë˜ ‚ÈÙ·Ì›ÓË˜ C Î·È ‚-Î·-ÚÔÙÂÓ›ˆÓ (36).

∆Ô 1999, ÔÈ Bodner Î·È Û˘Ó ·fi ÙË ™ÎˆÙ›·,¤‰ÂÈÍ·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌÂÈˆÌ¤Ó· Â›Â‰· Úfi-ÛÏË„Ë˜ ‚ÈÙ·Ì›ÓË˜ ∂, ÌÂ ÌÂÈˆÌ¤Ó· Â›Â‰· ‚È-Ù·Ì›ÓË˜ C ÛÙÔ Ï¿ÛÌ· Î·È ÌÂ ÌÂÈˆÌ¤ÓË ·Ó·ÏÔ-Á›· ·-ÙÔÎÔÊÂÚfiÏË˜/ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ (37). ¶·-Ú·ÙËÚ‹ıËÎÂ, ‰ËÏ·‰‹, fiÙÈ Ë ÚfiÛÏË„Ë ‚ÈÙ·ÌÈ-ÓÒÓ C Î·È ∂, Ù· Â›Â‰· ·ÛÎÔÚ‚ÈÎÔ‡ ÛÙÔ Ï¿-ÛÌ· Î·È Ë ·Ó·ÏÔÁ›· ·-ÙÔÎÔÊÂÚfiÏË˜/ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ ÙÔ˘ ÔÚÔ‡ Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙ›ÛÙÚÔÊ· ÌÂÙÔÓ Î›Ó‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜ ¿ÛıÌ·ÙÔ˜, È‰È·›ÙÂÚ·ÛÙÔ˘˜ Î·ÓÈÛÙ¤˜.

¶·Ï·ÈfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ (37,38) ·Ó¤ÊÂÚ·Ó Ì›·Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ ¯·ÌËÏ‹˜ ÚfiÛÏË„Ë˜ ÊÚÔ‡-ÙˆÓ Î·È ‚ÈÙ·Ì›ÓË˜ C Î·È ÙË˜ ÌÂÈˆÌ¤ÓË˜ ·Ó·-ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜. ¶·Ú·ÙËÚ‹ıËÎÂ fiÙÈ Ë·‡ÍËÛË ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ Î·Ù¿ 10%ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÌÂ›ˆÛË ÙˆÓ ÔÛÔÛÙÒÓ¯ÚfiÓÈˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ·ı‹ÛÂˆÓ Î·Ù¿ 51%.ª›· ÈÔ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ Ù· ¿ÙÔÌ·Ô˘ ÌÂ›ˆÛ·Ó ÙËÓ Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ ÁÈ· 7¯ÚfiÓÈ· ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘FEV1 ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· Ô˘ ‰ÂÓ Î·Ù·Ó¿ÏˆÓ·ÓÛ˘¯Ó¿ ÊÚÔ‡Ù· (39). ¶·Ú’ fiÏ· ·˘Ù¿, Ù· ¿ÙÔÌ·Ô˘ Â›¯·Ó Û˘ÓÂ¯Ò˜ ¯·ÌËÏ‹ ÚfiÛÏË„Ë ÊÚÔ‡-ÙˆÓ ·ÚÔ˘Û›·Û·Ó ÙËÓ ›‰È· ÌÂ›ˆÛË ÙË˜ ·Ó·-ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂ Ù· ¿ÙÔÌ· Ô˘ Â›¯·Ó

˘„ËÏfiÙÂÚÂ˜ ÚÔÛÏ‹„ÂÈ˜. ∏ ·Ú·Ù‹ÚËÛË ·˘Ù‹Â›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎ‹, Î·ıÒ˜ ‰Â›¯ÓÂÈ fiÙÈ ÔÈˆÊ¤ÏÈÌÂ˜ ÂÈ‰Ú¿ÛÂÈ˜ ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙËÓ ·Ó·-ÓÂ˘ÛÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌÂ˜ (39).∏ ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙËÓÂÌÊ¿ÓÈÛË ·ÛıÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ·Ú·ÙË-Ú‹ıËÎÂ Î·È ·fi ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜, fiÌˆ˜ Ë‰Ú¿ÛË ·˘Ù‹ Ê¿ÓËÎÂ Ó· Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓËÛÙÔ˘˜ ÚÒËÓ Î·È Ó˘Ó Î·ÓÈÛÙ¤˜, Èı·ÓÒ˜ ÏfiÁˆÙË˜ ¤ÎıÂÛË˜ ÛÙÔÓ Î·Ófi (40).

ª›· ¿ÏÏË ÔÌ¿‰· ÙÚÔÊ›ÌˆÓ ÏÔ‡ÛÈ· ÛÂÔÍÂÈ‰ˆÙÈÎ¿ Â›Ó·È Ù· Ï·¯·ÓÈÎ¿. OÈ Grievink Î·ÈÛ˘Ó ¤‰ÂÈÍ·Ó fiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ‚ÈÙ·Ì›ÓË˜ C Î·È‚ÈÙ·Ì›ÓË˜ ∂ ÌÂ ‹ ¯ˆÚ›˜ ‚-Î·ÚÔÙ¤ÓÈ· ÁÈ· ÂÚ›-Ô˘ 3 Ì‹ÓÂ˜, ÌÂ›ˆÛÂ ÙË ÛÙ¤ÓˆÛË ÙˆÓ ‚ÚfiÁ¯ˆÓ·fi ÙÔ fi˙ÔÓ ÛÂ Ô‰ËÏ¿ÙÂ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË(41,42), ÂÓÒ ÛÂ Ì›· ¿ÏÏË ¤ÚÂ˘Ó· ÛÙÔ ªÂÍÈÎfi,fiÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘ÌÏËÚÒÌ·Ù· ‚ÈÙ·-Ì›ÓË˜ C, ‚ÈÙ·Ì›ÓË˜ ∂ Î·È ‚-Î·ÚÔÙÂÓ›ˆÓ, ·Ú·-ÙËÚ‹ıËÎÂ fiÙÈ ·˘Ù¿ ÂÌfi‰ÈÛ·Ó ÙË ÌÂ›ˆÛË ÙË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÂ ÂÚÁ¿ÙÂ˜ Ô˘ÂÎÙ›ıÂÓÙ·È ÛÙÔ fi˙ÔÓ (43). º·›ÓÂÙ·È Î·È Â‰Ò fiÙÈË Î·Ù·Ó¿ÏˆÛË ÙˆÓ Ï·¯·ÓÈÎÒÓ Û¯ÂÙ›˙ÂÙ·È ·ÓÙ›-ÛÙÚÔÊ· ÌÂ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Î·È ËÂ›‰Ú·ÛË ÙˆÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÒÓ ÛÙËÓ ÚfiÏË„ËÙË˜ ÛÙ¤ÓˆÛË˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ Ô˘ ÚÔÎ·ÏÂ›Ù·È·fi ÙËÓ ¤ÎıÂÛË ÛÙÔ fi˙ÔÓ ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ˘fiıÂÛË fiÙÈ ÂÍˆÁÂÓ‹ ÔÍÂÈ‰ˆÙÈÎ¿ Û˘ÌÌÂÙ¤¯Ô˘ÓÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜. ∆· ·ÓÙÈÔÍÂÈ-‰ˆÙÈÎ¿, ÂÔÌ¤Óˆ˜, Â›Ó·È Ì›· Î·ÙËÁÔÚ›· ıÚÂÙÈ-ÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Ô˘ ·Í›˙ÂÈ Ó· ‰ÔıÂ› ÌÂÁ·Ï‡ÙÂ-ÚË ÚÔÛÔ¯‹.

ª·ÁÓ‹ÛÈÔ ∏ Â›‰Ú·ÛË ÙÔ˘ ‰È·ÈÙËÙÈÎÔ‡ Ì·ÁÓËÛ›Ô˘ ÛÙÔ

¿ÛıÌ· ÚÔÛ¤ÏÎ˘ÛÂ ÙËÓ ÚÔÛÔ¯‹ ÔÏÏÒÓ ÂÚÂ˘-ÓËÙÒÓ (34,43,44). µÚ¤ıËÎÂ, ÏÔÈfiÓ, fiÙÈ Ë Úfi-ÛÏË„Ë ÙÔ˘ ‰È·ÈÙËÙÈÎÔ‡ Ì·ÁÓËÛ›Ô˘ (·Ì‡Á‰·Ï·,ÊÈÛÙ›ÎÈ·, Û·Ó¿ÎÈ, ÛÔÎÔÏ¿Ù· Î.¿.) Û¯ÂÙ›˙ÂÙ·ÈÌÂ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Î·È ÙË ‚ÚÔÁ¯È-Î‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÚÔÎ·ÏÂ› ‚ÚÔÁ¯Ô‰È·-ÛÙÔÏ‹ ÛÂ ·ÛıÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜. ™Â Ì›· ¤ÚÂ˘Ó·Ô˘ ¤ÁÈÓÂ ÛÂ ·ÛıÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Î·È ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÚÈÓ›ÙÈ‰· ‚Ú¤ıËÎÂ Ì›· ·ÓÙ›ÛÙÚÔÊËÛ¯¤ÛË ÌÂÙ·Í‡ ÙË˜ ‚ÚÔÁ¯ÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˘ Ì·ÁÓËÛ›-Ô˘ (44), ÂÓÒ Ì›· ·ÚfiÌÔÈ· Û¯¤ÛË ÌÂÙ·Í‡ ÙˆÓ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ Ì·ÁÓËÛ›Ô˘ Ì¤Û· ÛÙÔÓ ÈÛÙfiÎ·È ÙË˜ ˘ÂÚÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ ·Ú·ÙË-Ú‹ıËÎÂ ÛÂ Ì›· ·ÎfiÌË ÌÂÏ¤ÙË Ô˘ ¤ÁÈÓÂ ÛÂ·ÛıÌ·ÙÈÎ¿ Î·È ÌË ¿ÙÔÌ· (45). ™ÙËÓ ›‰È· ¤ÚÂ˘-Ó·, Ô Emelyanov (45) ¤‰ÂÈÍÂ fiÙÈ ˘¿Ú¯ÂÈ ·˘ÍË-Ì¤ÓË Î·Ù·ÎÚ¿ÙËÛË Ì·ÁÓËÛ›Ô˘ ÛÙ· ·ÛıÌ·ÙÈÎ¿

¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407


402 ¢. ¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

¿ÙÔÌ· fiÙ·Ó ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ¤ÏÂÁ¯Ô ‰ÔÎÈÌ·-Û›·˜ Ì·ÁÓËÛ›Ô˘, ·Ô‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ ˘¿Ú¯ÂÈÂ›ÙÂ Ì›· Èı·Ó‹ ‰È·ÈÙËÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Â›ÙÂ ·˘-ÍËÌ¤ÓÂ˜ ·Ó¿ÁÎÂ˜ ÙˆÓ ·ÙfiÌˆÓ ÛÂ Ì·ÁÓ‹ÛÈÔÂÍ·ÈÙ›·˜ ÙË˜ ·ıÔÁ¤ÓÂÛË˜ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ (45).

ø-3 Î·È ˆ-6 ÏÈ·Ú¿ ÔÍ¤· Î·È Ë Û¯¤ÛËÙÔ˘˜ ÛÙÔ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· ∆· ˆ-3 Î·È ˆ-6 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·

ıÂˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ· ÛÙÔÈ¯Â›· ÛÙË ‰›·ÈÙ·ÙÔ˘ ·ÓıÚÒÔ˘. øÛÙfiÛÔ, ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÔ fiÛÔ Û˘Ì‚¿ÏÏÔ˘Ó ÔÈ ‰È¿-ÊÔÚÂ˜ ÙÚÔÊ¤˜ ÛÙËÓ ÚfiÛÏË„‹ ÙÔ˘˜ (46).

∞ÚÎÂÙ¤˜ ÎÏÈÓÈÎ¤˜ ·Ú·ÙËÚ‹ÛÂÈ˜ ÛÂ ·ÓıÚÒ-Ô˘˜ ÛÙËÚ›˙Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· Ó· ˘¿Ú¯ÂÈÛ¯¤ÛË ÌÂÙ·Í‡ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÙË˜ ‰È·ÙÚÔ-Ê‹˜ Î·È ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ı‹ÛÂˆÓ. ∞Ó·Ê¤-ÚÂÙ·È fiÙÈ ÛÙ· ·ÙÔÈÎ¿ ¿ÙÔÌ· Ë Û¯¤ÛË ˆ-3/ˆ-6ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Â›Ó·È ÌÈÎÚfiÙÂ-ÚË ·fi Ù· ÌË ·ÙÔÈÎ¿ ˘ÁÈ‹ ¿ÙÔÌ· (47). ∆Ô ÂÓ-‰È·Ê¤ÚÔÓ ÁÈ· ÙËÓ ‡·ÚÍË Û¯¤ÛË˜ ÌÂÙ·Í‡ ÙˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÙË˜ ‰›·ÈÙ·˜ Î·È ÙÔ˘ ·ÓÔÛÔÔÈË-ÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛËÌÂÈÒıËÎÂ ÚÈÓ ÔÏÏ¿¯ÚfiÓÈ· (48), ·ÏÏ¿ ¤ÁÈÓÂ ÂÓÙÔÓfiÙÂÚÔ ÌÂÙ¿ ÙËÓ·ÔÛ·Ê‹ÓÈÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ ÂÈÎÔÛ·ÓÔÂÈ‰ÒÓ·Ú·ÁÒÁˆÓ ÙÔ˘ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜ ÛÙË Ú‡ı-ÌÈÛË ÙË˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÙË˜ ·ÓÔÛ›·˜ Î·È ÙËÁÓÒÛË fiÙÈ Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙÔ˘ ·Ú·¯È‰ÔÓÈÎÔ‡ÔÍ¤Ô˜ ÌÔÚÂ› Ó· ·Ó·ÛÙ·ÏÂ› ·fi ÙÔ ÂÈÎÔÛÈÂ-ÓÙ·ÂÓÔ˚Îfi (∂ƒ∞) Î·È ÙÔ ÂÈÎÔÛÈ‰ÈÂÍ·ÂÓÔ˚Îfi ÔÍ‡(DHA) (49). ™ÙË ÌÂÏ¤ÙË ÙˆÓ Haby Î·È Û˘Ó (50)‚Ú¤ıËÎÂ fiÙÈ Ë ˘„ËÏ‹ Î·Ù·Ó¿ÏˆÛË ÔÏ˘·ÎfiÚÂ-ÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ·ÔÙÂÏÂ› ·Ú¿ÁÔÓÙ· ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÚÔ-Û¯ÔÏÈÎ‹ ËÏÈÎ›· Î·È ÚÔÙ¿ıËÎÂ fiÙÈ Ë ÌÂ›ˆÛËÙË˜ Î·Ù·Ó¿ÏˆÛË˜ Ù¤ÙÔÈˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÌÔ-ÚÂ› Ó· ‚ÂÏÙÈÒÛÂÈ Ù· ÔÛÔÛÙ¿ ¿ÛıÌ·ÙÔ˜. ¶·Ú’fiÏ· ·˘Ù¿, Ê·›ÓÂÙ·È fiÙÈ Ù· ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙË Û‡ÛÙ·ÛË ÙˆÓ ÔÏ˘·-ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È fi¯È ·fi ÙË Û˘ÓÔ-ÏÈÎ‹ ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ ÛÙË ‰›·ÈÙ·. ∆Ô Úfi-‚ÏËÌ· ËÁ¿˙ÂÈ Î˘Ú›ˆ˜ ·fi ÙËÓ ·ÓÈÛÔÚÚÔ›·ÙˆÓ ˆ-6 Î·È ˆ-3 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ. ∏ ·˘ÍËÌ¤ÓËÚfiÛÏË„Ë ˆ-3 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÌÂ ÙË ‰È·ÙÚÔÊ‹Ô‰ËÁÂ› ÛÂ ÂÏ¿ÙÙˆÛË ÙË˜ Û˘ÁÎ¤ÓÙÚˆÛË˜ ÙÔ˘·Ú·¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜ Î·È ÌÂ›ˆÛË ÙË˜ ·Ú·Áˆ-Á‹˜ ÙˆÓ ‰Ú·ÛÙÈÎÒÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚Ë-ÙÒÓ. ∂ÈÏ¤ÔÓ, ÈÛÙÂ‡ÂÙ·È fiÙÈ ÔÚÈÛÌ¤Ó· ÏÈ·-Ú¿ ÔÍ¤· ‰ÚÔ˘Ó ¿ÌÂÛ· ˆ˜ ‰È·‚È‚·ÛÙ¤˜ Î·È ÂË-ÚÂ¿˙Ô˘Ó ÙÈ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ (51,52).

™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ(53) ‚Ú¤ıËÎÂ fiÙÈ ˘¿Ú¯ÂÈ Û¯¤ÛË ÌÂÙ·Í‡ ‰›·ÈÙ·˜(ˆ-3/ˆ-6 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ) Î·È ¿ÛıÌ·ÙÔ˜. ∂È‰È-

ÎfiÙÂÚ·, ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ Â›Â-‰· ÌÂÈˆÌ¤ÓÔ˘ ·-ÏÈÓÔÏÂ˚ÎÔ‡ ÔÍ¤Ô˜ (18:3ˆ-3),Î·ıÒ˜ Î·È ·˘ÍËÌ¤ÓÔ˘ ∂ƒ∞ (20:5ˆ-3), ÂÈÎÔÛÈ‰È-ÂÓÙ·ÂÓÔ˚ÎÔ‡ ÔÍ¤Ô˜ (22:5ˆ-3) Î·È DHA (22:6ˆ-3) ÛÙÔ Ï¿ÛÌ· ÙˆÓ ·È‰ÈÒÓ ÌÂ ¿ÛıÌ· ÛÂ Û¯¤ÛËÌÂ ˘ÁÈ‹ ·È‰È¿. ŸÌˆ˜, Ô Û¯ÂÙÈÎ¿ ÂÚÈÔÚÈÛÌ¤ÓÔ˜·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ‰ÂÓÂÈÙÚ¤ÂÈ ·ÎfiÌË Ô‰ËÁ›Â˜ ·ÏÏ·Á‹˜ ‰È·ÈÙËÙÈÎÒÓÛ˘ÓËıÂÈÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙ· ·È‰È¿.

¶ÏÔ‡ÛÈ· ËÁ‹ ÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·-ÚÒÓ ÔÍ¤ˆÓ EPA Î·È DHA ·ÔÙÂÏÔ‡Ó Ù· È¯ı˘¤-Ï·È·. ∏ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÛÙÔÓ ¿ÓıÚˆÔ Ô‰ËÁÂ›ÛÂ ·‡ÍËÛË ÙË˜ ÔÛfiÙËÙ·˜ ∂ƒ∞ Î·È DHA ÛÙÈ˜ÌÂÌ‚Ú¿ÓÂ˜ ÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ, ÙˆÓ Ì·ÎÚÔÊ¿-ÁˆÓ Î·È ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (54,55). ¶·Ú¿Ï-ÏËÏ·, ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙË˜ ÂÚÈÂÎÙÈÎfi-ÙËÙ·˜ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÛÂ ·Ú·¯È‰Ô-ÓÈÎfi ÔÍ‡. ŒÙÛÈ, ÌÂÈÒÓÂÙ·È Ë ÔÛfiÙËÙ· ÙÔ˘ ·Ú·-¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜ Ô˘ Â›Ó·È ‰È·ı¤ÛÈÌÔ ˆ˜ ˘fi-ÛÙÚˆÌ· ÁÈ· ÙË Û‡ÓıÂÛË ÂÈÎÔÛ·ÓÔÂÈ‰ÒÓ, ÂÓÒ ÙÔ∂ƒ∞ ·ÔÙÂÏÂ› ÂÈÏ¤ÔÓ ·Ó·ÛÙÔÏ¤· ÙÔ˘ ÌÂÙ·-‚ÔÏÈÛÌÔ‡ ÙÔ˘ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔÍ¤Ô˜, ¤¯ÔÓÙ·˜¤ÙÛÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓÛ˘ÌÙˆÌ¿ÙˆÓ.

OÈ Sakai Î·È Û˘Ó (1990) Î·È ÔÈ Okuyama Î·ÈÛ˘Ó (1992) ÂÈÛËÁ‹ıËÎ·Ó ÙËÓ ¿Ô„Ë fiÙÈ Ë ·‡-ÍËÛË ÙË˜ Û¯¤ÛË˜ ÙˆÓ ˆ-3/ˆ-6 ÏÈ·ÚÒÓ ÔÍ¤ˆÓÛÙÈ˜ ÙÚÔÊ¤˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙË ÌÂ›ˆÛËÙË˜ ·ÏÏÂÚÁÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜. ∆· ˆ-3 Î·È ˆ-6 ÏÈ-·Ú¿ ÔÍ¤· ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È·ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ (56,57). ∫·Ù¿ Û˘Ó¤ÂÈ·, Ù·ˆ-3 Î·È ˆ-6 ÏÈ·Ú¿ ÔÍ¤· ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚË-ÛÈÌÔÔÈËıÔ‡Ó Ù·˘Ùfi¯ÚÔÓ· ÁÈ· ÙË ıÂÚ·Â›· ÙË˜·ÙÔ›·˜. ŒÙÛÈ, Ë ÈÛÔÚÚÔ›· ÙˆÓ ˆ-3 Î·È ˆ-6 ÏÈ-·ÚÒÓ ÔÍ¤ˆÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ·ÔÙÂÏÂ› ÛËÌ·-ÓÙÈÎfi ı¤Ì· ÛÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜.

™ÙË ¢ÈÂıÓ‹ ŒÚÂ˘Ó· ÙÔ˘ ÕÛıÌ·ÙÔ˜ Î·È ÙˆÓ∞ÏÏÂÚÁÈÒÓ ÛÙËÓ ¶·È‰ÈÎ‹ ∏ÏÈÎ›· (58) ‚Ú¤ıËÎÂÌ›· ÈÛ¯˘Ú‹ Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ Ê˘-ÙÈÎÒÓ ÂÏ·›ˆÓ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÏÈÓÔÏÂ˚ÎÔ‡ÔÍ¤Ô˜ ÛÙÔÓ ÔÚfi ÌÂ Ù· Û˘ÌÙÒÌ·Ù· ¿ÛıÌ·ÙÔ˜,ÚÈÓ›ÙÈ‰·˜ Î·È ÂÎ˙¤Ì·ÙÔ˜ ÛÙ· ·È‰È¿. ∂›ÛË˜,‚Ú¤ıËÎÂ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ÂıÓÈÎ‹˜ÚfiÛÏË„Ë˜ trans ÏÈ·ÚÒÓ ÔÍ¤ˆÓ - Ù· ÔÔ›·‚Ú›ÛÎÔÓÙ·È ÛÙ· ˘‰ÚÔÁÔÓˆÌ¤Ó· Ê˘ÙÈÎ¿ Ï›Ë(fiˆ˜ Ë Ì·ÚÁ·Ú›ÓË) Î·È ÛÙ· Á·Ï·ÎÙÔÎÔÌÈÎ¿ÚÔ˚fiÓÙ· - Î·È ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÛıÌ·ÙÈ-ÎÒÓ Î·È ·ÏÏÂÚÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÂ ·È‰È¿ÛÂ 10 ¯ÒÚÂ˜ ÙË˜ ∂˘ÚÒË˜ (59). øÛÙfiÛÔ, ÛÙËÓ›‰È· ÌÂÏ¤ÙË ‰ÂÓ ‚Ú¤ıËÎÂ Î·Ì›· ·ÚfiÌÔÈ· Û˘-Û¯¤ÙÈÛË ÌÂ ÙËÓ ÚfiÛÏË„Ë ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ-·ÚÒÓ ÔÍ¤ˆÓ.

¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407



∏ ˘fiıÂÛË fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ Î·È ÔÈËÁ¤˜ ÏÔ‡ÛÈÂ˜ ÛÂ ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ÔÍ¤· ÌÔÚÔ‡Ó Ó· ÚÔÛÙ·ÙÂ‡ÛÔ˘Ó ·fi ·Ó·-ÓÂ˘ÛÙÈÎ¿ Û˘ÌÙÒÌ·Ù· ¤ÁÈÓÂ ÛÙfi¯Ô˜ Ì›·˜ ÌÂ-Ï¤ÙË˜ (60), ÛÙËÓ ÔÔ›· ‰ÂÓ ‚Ú¤ıËÎÂ Î·Ì›· ÛË-Ì·ÓÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ „·-ÚÈÒÓ Î·È ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ.∞ÓÙ›ıÂÙ·, Ë ªÂÏ¤ÙË ÙˆÓ ∂Ù¿ ÃˆÚÒÓ ‚Ú‹ÎÂfiÙÈ ˘¿Ú¯ÂÈ Ì›· ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛË ÙË˜ Î·-Ù·Ó¿ÏˆÛË˜ „·ÚÈÒÓ ÛÙË ıÓËÛÈÌfiÙËÙ· ·fi ¯Úfi-ÓÈ· ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÒÛÙÂ Î¿ıÂ ·‡-ÍËÛË ÛÙËÓ Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ Î·Ù¿ 10% ı·ÌÔÚÔ‡ÛÂ Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÌÂ›ˆÛË ÙË˜ ıÓËÛÈÌfi-ÙËÙ·˜ Î·Ù¿ 3% (38).

∆ÚÔÊ¤˜ ÏÔ‡ÛÈÂ˜ ÛÂ ÎÔÚÂÛÌ¤Ó· ÏÈ·Ú¿ÔÍ¤·, fiˆ˜ ÙÔ Ï·Ú‰›, ÙÔ ‚Ô‰ÈÓfi Ï›Ô˜ Î·È ÙÔ˘‰ÚÔÁÔÓˆÌ¤ÓÔ Ï¿‰È ÙË˜ Î·Ú‡‰·˜, ¤¯Ô˘Ó ¯ÚËÛÈ-ÌÔÔÈËıÂ› ÛÂ ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ‰È·ÈÙËÙÈÎ‹˜ ·-Ú¤Ì‚·ÛË˜ (61). ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜, fiÌˆ˜, ÂÚÈ-ÙÒÛÂÈ˜ Á›ÓÔÓÙ·È Û˘ÁÎÚ›ÛÂÈ˜ ÌÂ ‰›·ÈÙÂ˜ ¯·ÌË-Ï‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÛÂ Ï›Ô˜ Î·È fi¯È ÌÂ ‰›·È-ÙÂ˜ ÌÂ ÛËÌ·ÓÙÈÎ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ ·ÎfiÚÂÛÙ·‹ ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈÙ· ÎÔÚÂÛÌ¤Ó· ÏÈ·Ú¿ ÔÍ¤· ‰ÂÓ ·ÛÎÔ‡Ó ÛËÌ·-ÓÙÈÎ‹ Â›‰Ú·ÛË ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ÛÙËÓ ·Ú·ÁˆÁ‹ Î˘ÙÔÎÈÓÒÓÙ‡Ô˘ Th1 ‹ Th2 Î·È ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓÎ˘ÙÙ¿ÚˆÓ Ê˘ÛÈÎÒÓ ÊÔÓ¤ˆÓ (61,62).

∂›‰Ú·ÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙÔ ¿ÛıÌ· ∆· Ì¤¯ÚÈ Û‹ÌÂÚ· ‰Â‰ÔÌ¤Ó· ÁÈ· ÙËÓ Â›‰Ú·-

ÛË ÙË˜ ‰È·ÙÚÔÊ‹˜ ÛÙÔ ¿ÛıÌ· ·ÊÔÚÔ‡Û·Ó ÛÂÛ˘ÁÎÂÎÚÈÌ¤Ó· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ ÙÚÔÊ›-ÌˆÓ (3,24). ¶ÚfiÛÊ·Ù·, ÚÔ¤Î˘„Â Ë ·Ó¿ÁÎË‰ÈÂÚÂ‡ÓËÛË˜ ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙÔ

¿ÛıÌ·. OÈ Rosalie Woods Î·È Û˘Ó, ÛÙËÓ ¤ÚÂ˘Ó¿ÙÔ˘˜ Ô˘ ‰ÈÂÍ‹¯ıË ÙÔ 2003, ‰ÈÂÚÂ‡ÓËÛ·Ó Â¿Ó ÔÈÚÔÛÏ‹„ÂÈ˜ ÙÚÔÊ›ÌˆÓ Î·È ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈ-ÎÒÓ ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·ÙfiÌˆÓ ‰È·Ê¤ÚÔ˘Ó ·fiÂÎÂ›ÓÂ˜ ÙˆÓ ·ÙfiÌˆÓ ¯ˆÚ›˜ ¿ÛıÌ·. OÈ Î·ÙËÁÔ-Ú›Â˜ ÙÚÔÊ›ÌˆÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ¯ˆÚ›ÛÙËÎ·ÓÛÂ 3 ÔÌ¿‰Â˜ ÌÂ ‚¿ÛË ÙË Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ÙÔ¿ÛıÌ· (ıÂÙÈÎ‹, ·ÚÓËÙÈÎ‹ Î·È Ô˘‰¤ÙÂÚË Û˘Û¯¤-ÙÈÛË) Î·È Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∞fi ÙË ÌÂ-Ï¤ÙË ‚Ú¤ıËÎÂ fiÙÈ ÔÚÈÛÌ¤Ó· ÙÚfiÊÈÌ· - Î·È fi¯ÈÛ˘ÁÎÂÎÚÈÌ¤Ó· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ - Û¯ÂÙ›˙Ô-ÓÙ·È ÌÂ ÙÔ ¿ÛıÌ·. ∏ Û¯¤ÛË Ô˘ ·Ú·ÙËÚ‹ıËÎÂÌÂÙ·Í‡ ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ Î·ÈÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹Ù·Ó ·ÚÔÛ‰fiÎËÙË. ¶ÈÔ Û˘ÁÎÂ-ÎÚÈÌ¤Ó·, ‚Ú¤ıËÎÂ fiÙÈ ÙÔ Ï‹ÚÂ˜ Á¿Ï· Î·È ÙÔ‚Ô‡Ù˘ÚÔ Û¯ÂÙ›˙ÔÓÙ·È ·ÚÓËÙÈÎ¿ ÌÂ ÙÔ ¿ÛıÌ·,ÂÓÒ ¿ÏÏ· ÙÚfiÊÈÌ·, fiˆ˜ Ù· ·Ó·„˘ÎÙÈÎ¿ Ûfi-ÁÈ·˜, ÙÔ Ù˘Ú› ÚÈÎfiÙ· Î·È Ù· Ù˘ÚÈ¿ ¯·ÌËÏÒÓ ÏÈ-·ÚÒÓ, Û¯ÂÙ›˙ÔÓÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔ ¿ÛıÌ·. ª›·Èı·Ó‹ ÂÍ‹ÁËÛË ·˘ÙÒÓ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Â›Ó·ÈfiÙÈ ÛÙ· ¿ÙÔÌ· ÌÂ ¿ÛıÌ· Ô˘ ·ÏÏ¿˙Ô˘Ó ÙÔ Â›‰Ô˜ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ Ô˘ Î·Ù·Ó·-ÏÒÓÔ˘Ó ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË ÙË˜ ¿ıËÛË˜ (.¯.·ÓÙÈÎ·ıÈÛÙÔ‡Ó ÙÔ Ï‹ÚÂ˜ Á¿Ï· ÌÂ ·Ó·„˘ÎÙÈÎ¿ÛfiÁÈ·˜ Î·È Ù˘ÚÈ¿ ¯·ÌËÏÒÓ ÏÈ·ÚÒÓ), ·Ú·ÙË-ÚÂ›Ù·È ‚ÂÏÙ›ˆÛË ÙË˜ Î·Ù¿ÛÙ·Û‹˜ ÙÔ˘˜.

¶ÔÏÏÔ› ÂÚÂ˘ÓËÙ¤˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ù· ¿ÙÔÌ·ÌÂ ˘„ËÏ‹ ÚfiÛÏË„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ(Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Î·È ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÒÓ) ÂÌÊ·-Ó›˙Ô˘Ó ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘ÍË˜ Î·ÚÎ›ÓÔ˘Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ. ¶·Ú’ fiÏ· ·˘Ù¿,Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ô‰ÔıÂ› ·˘Ù‹ Ë ÚÔÛÙ·ÙÂ˘-ÙÈÎ‹ ‰Ú¿ÛË ÌfiÓÔ ÛÙ· ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¿, ‰ÈfiÙÈ Ù·ÊÚÔ‡Ù· Î·È Ù· Ï·¯·ÓÈÎ¿ ÂÚÈ¤¯Ô˘Ó Î·È ÔÏÏ¿¿ÏÏ· Û˘ÛÙ·ÙÈÎ¿, Ô ÚfiÏÔ˜ ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ ¤¯ÂÈ

¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407

¶›Ó·Î·˜ 3. ™˘Û¯¤ÙÈÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ÌÂ ÙÔ ¿ÛıÌ·

™˘Û¯¤ÙÈÛË

£ÂÙÈÎ‹ ∞ÚÓËÙÈÎ‹ O˘‰¤ÙÂÚËñ °¿Ï· ÛfiÁÈ·˜ ñ ¶Ï‹ÚÂ˜ Á¿Ï· ñ ¢ËÌËÙÚÈ·Î¿ ÚˆÈÓÔ‡, Ú‡˙È, ˙˘Ì·ÚÈÎ¿, „ˆÌ›, ÎÚ¿ÎÂÚ, ÌÈÛÎfiÙ·ñ ∆˘ÚÈ¿ ¯·ÌËÏÒÓ ÏÈ·ÚÒÓ ñ ª‹Ï· Î·È Î¤ÈÎ, ›ÙÛ· Î·È hamburgerñ ∆˘Ú› ÚÈÎfiÙ· ñ ∞¯Ï¿‰È· ñ ∫Ú¤Ì· Á¿Ï·ÎÙÔ˜ Î·È ÁÈ·Ô‡ÚÙÈ

ñ ¡ÙÔÌ¿ÙÂ˜ ñ ∫fiÎÎÈÓÔ ÎÚ¤·˜, ÎÔÙfiÔ˘ÏÔ, ¿ÏÏ· ÎÚ¤·Ù·, ·˘Á¿, ÍËÚÔ› Î·ÚÔ›ñ µÔ‡Ù˘ÚÔ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ Î·È ÙÔ˘ ÊÈÛÙÈÎÔ‚Ô‡Ù˘ÚÔ˘), fiÛÚÈ· ñ æ¿ÚÈ· ñ ŸÏ·, ÂÛÂÚÈ‰ÔÂÈ‰‹, ‚ÂÚ›ÎÔÎ·, ÚÔ‰¿ÎÈÓ·, ·‚ÔÎ¿ÓÙÔ, Ì·Ó¿ÓÂ˜,

ÎÂÚ¿ÛÈ·, ÂfiÓÈ·, Ì‹Ï·, ·¯Ï¿‰È·, ÙÚÔÈÎ¿ ÊÚÔ‡Ù· (·Ó·Ó¿˜, Ì¿ÓÁÎÔ),¿ÏÏ· (ÎÔÓÛÂÚ‚ÔÔÈËÌ¤Ó·, Î·ÙÂ„˘ÁÌ¤Ó·) Î·È ¯˘ÌÔ› ÊÚÔ‡ÙˆÓ

ñ ŸÏ·, Ú›˙Â˜ (·Ù¿ÙÂ˜, ·ÓÙ˙¿ÚÈ·, Î·ÚfiÙ·), ÌÚfiÎÔÏÔ, ÎÔ˘ÓÔ˘›‰È,Ï¿¯·ÓÔ, Ú¿ÛÈÓ· Ê˘ÏÏÒ‰Ë (Ì·ÚÔ‡ÏÈ, ·ÓÙ›‰È), ·ÁÁÔ‡ÚÈ, ÎÔÏÔÎ‡ıÈ, Û¤ÏÈÓÔ, ‚ÔÏ‚Ô› (ÛÎfiÚ‰Ô, ÎÚÂÌÌ‡‰È), ÏÔ‚Ô› (·Ú·Î¿˜, Ê·ÛfiÏÈ·), ÈÂÚÈ¤˜ Î·È Ì·ÓÈÙ¿ÚÈ·

ñ ŸÏ·, Ì‡Ú·, ÎÚ·Û› Î·È ¿ÏÏ· ñ ™ÔÎÔÏ¿Ù·, ·Ù·Ù¿ÎÈ· ÌÂ ÓÈÊ¿‰Â˜ Î·Ï·ÌÔÎÈÔ‡, ·ÚˆÌ·ÙÈÎfi Á¿Ï·,

˙¿¯·ÚË, Ì·ÚÌÂÏ¿‰·, Ì¤ÏÈ


404 ¢. ¶··Ó‰Ú¤Ô˘ Î·È Û˘Ó.

·ÎfiÌ· ÂÚÂ˘ÓËıÂ› (63). ™ÙËÓ ·Ú·¿Óˆ ¤ÚÂ˘Ó·‚Ú¤ıËÎÂ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ fiˆ˜ Ù·Ì‹Ï· Î·È Ù· ·¯Ï¿‰È·, ÚÔÛÙ·ÙÂ‡ÂÈ ·fi ÙÔ¿ÛıÌ·, ÂÓÒ ‰ÂÓ ‚Ú¤ıËÎÂ Î·Ì›· Û˘Û¯¤ÙÈÛË ÌÂ-Ù·Í‡ ÙˆÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÒÓ Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜.

∂›ÛË˜, ‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜Î·Ù·Ó¿ÏˆÛË˜ „·ÚÈÒÓ Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜. ™Ù·›‰È· Û˘ÌÂÚ¿ÛÌ·Ù· Î·Ù¤ÏËÍÂ Î·È Ì›· ÌÂÁ¿ÏËÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË ÛÙÈ˜ ∏ÓˆÌ¤ÓÂ˜ ¶ÔÏÈ-ÙÂ›Â˜ (2nd National Health and NutritionExamination Survey) (64). ∞ÓÙ›ıÂÙ·, Ì›· ÚÔ-ÛÙ·ÙÂ˘ÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ Î·Ù·Ó¿ÏˆÛË˜È¯ı˘ÂÏ·›ˆÓ Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‚Ú¤ıËÎÂ ÛÂ ·È-‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÛÙËÓ ∞˘ÛÙÚ·Ï›· (65).

∂›‰Ú·ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡ ÛÙÔ ¿ÛıÌ·

™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¿ÛıÌ·-ÙÔ˜ ·›˙ÂÈ Ë ‰È·ÙÚÔÊ‹ ÙË˜ ÌËÙ¤Ú·˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. Œ¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ë ‰›·ÈÙ··ÔÊ˘Á‹˜ ·ÓÙÈÁfiÓˆÓ ‰ÂÓ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔÁ¤ÓÓËÛË˜ ·ÙÔÈÎÒÓ ·È‰ÈÒÓ, ÂÓÒ ÂÎÊÚ¿˙ÔÓÙ·ÈÊfi‚ÔÈ ÁÈ· ÙÈ˜ ÂÈÙÒÛÂÈ˜ Ì›·˜ Ù¤ÙÔÈ·˜ ‰›·ÈÙ·˜ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ·ÏÏ¿ Î·È ÙË˜ ÌËÙ¤-Ú·˜ (66). ∫·Ù¿ Î·ÈÚÔ‡˜ ¤¯Ô˘Ó ÚÔÙ·ıÂ› ‰È¿ÊÔ-ÚÂ˜ ·fi„ÂÈ˜ ÁÈ· ÙÈ˜ ıÂÙÈÎ¤˜ Î·È ·ÚÓËÙÈÎ¤˜ ÂÈ-ÙÒÛÂÈ˜ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÛÙÔ ¿ÛıÌ·. ™Â Ì›· ·Ó·-ÛÎfiËÛ‹ ÙÔ˘˜, ÔÈ Kramer Î·È Û˘Ó (67) ÙfiÓÈÛ·ÓÙ· ÔÊ¤ÏË ÙÔ˘ ıËÏ·ÛÌÔ‡, ÛÙ· ÔÔ›· Û˘ÌÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È Ë ÌÂÈˆÌ¤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈ-ÛË˜ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ Î·È ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈ-ÌÒÍÂˆÓ, Ë ‚ÂÏÙ›ˆÛË ÙË˜ Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ÛÈ‰‹-ÚÔ˘ Î·È Ë Ù·¯‡ÙÂÚË ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÙË˜ ÌËÙ¤-Ú·˜, ÂÓÒ ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó Î·Ì›· ÛËÌ·ÓÙÈÎ‹ÌÂ›ˆÛË ÛÙËÓ ÂÌÊ¿ÓÈÛË ¿ÛıÌ·ÙÔ˜ ÛÂ ÌÂÏ¤ÙÂ˜Ô˘ ¤ÁÈÓ·Ó ÛÙË ºÈÓÏ·Ó‰›· Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·.

OÈ Stabell Î·È Û˘Ó (68) ÂÍ¤Ù·Û·Ó ÙË Û¯¤ÛËÙÔ˘ ıËÏ·ÛÌÔ‡ Î·È ÙË˜ ÂÌÊ¿ÓÈÛË˜ ·ÙÔÈÎ‹˜‰ÂÚÌ·Ù›ÙÈ‰·˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 18 ÚÒÙˆÓÌËÓÒÓ ÙË˜ ˙ˆ‹˜ ÛÂ 15.430 ·È‰È¿, ÌÂ ‹ ¯ˆÚ›˜ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜. ¶·Ú·Ù‹ÚË-Û·Ó fiÙÈ Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ÁÈ· ÙÔ˘Ï¿-¯ÈÛÙÔÓ 4 Ì‹ÓÂ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘-ÓÔ ÂÌÊ¿ÓÈÛË˜ ·ÙÔÈÎ‹˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜ ÛÙ· ·È-‰È¿ ÌÂ ÁÔÓÂ›˜ ¯ˆÚ›˜ ·ÏÏÂÚÁ›Â˜, ·ÏÏ¿ fi¯È ÛÙ··È‰È¿ ÌÂ ¤Ó·Ó ‹ ‰‡Ô ·ÏÏÂÚÁÈÎÔ‡˜ ÁÔÓÂ›˜. °ÂÓÈ-Î¿, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›· Ô˘ÛÈ·ÛÙÈÎ‹ Â›-‰Ú·ÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ‹ ÙÔ˘ ÂÓ Ì¤ÚÂÈ ıËÏ·-ÛÌÔ‡ ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ·ÙÔÈÎ‹˜ ‰ÂÚ-Ì·Ù›ÙÈ‰·˜. ¶·Ú’ fiÏ· ·˘Ù¿, Ë Â›‰Ú·ÛË ÙÔ˘ ·Ô-ÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÁÈ· 4 Ì‹ÓÂ˜ ‹ ÂÚÈÛÛfiÙÂ-ÚÔ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ï-

ÏÂÚÁÈÒÓ (2). OÈ Oddy Î·È Û˘Ó ÙÔ 2004, ·ÊÔ‡ ÌÂ-Ï¤ÙËÛ·Ó ÙË Û¯¤ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡, ÙÔ˘ ¿ÛıÌ·-ÙÔ˜ Î·È ÙË˜ ·ÙÔ›·˜ ÌÂ ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·-ÙÔ˜ (¢ª™) 2.195 ·È‰ÈÒÓ ÛÙËÓ ∞˘ÛÙÚ·Ï›·, Î·-Ù¤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÌÈÎÚfiÙÂÚË‰È¿ÚÎÂÈ· ıËÏ·ÛÌÔ‡ ·˘Í¿ÓÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘¿ÛıÌ·ÙÔ˜ Î·È ÙË˜ ·ÙÔ›·˜ ÛÙ· ·È‰È¿, ÂÓÒ Ô˘„ËÏfi˜ ¢ª™ ·ÔÙÂÏÂ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ÁÈ· ¿ÛıÌ· (69). ™ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ô ·Ô-ÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ÌÔÚÂ› Ó· ÚÔÛÙ·ÙÂ‡ÂÈ·fi ÙÔ ¿ÛıÌ· Î·È Ó· ÌÂÈÒÓÂÈ Ù· ÂÂÈÛfi‰È· ·Ó·-ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Î·Ù¤ÏËÍ·Ó Î·È ¿ÏÏÂ˜ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ (70-72). ¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤-Ó·, ÔÈ Kull Î·È Û˘Ó (72), ·ÊÔ‡ ·Ú·ÎÔÏÔ‡ıËÛ·Ó4.089 ·È‰È¿ ÁÈ· 4 ¯ÚfiÓÈ·, ¤‰ÂÈÍ·Ó fiÙÈ Ô ·Ô-ÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ÁÈ· 4 ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜Ì‹ÓÂ˜ ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜¿ÛıÌ·ÙÔ˜ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4 ÂÙÒÓ. ∏ Û¯¤ÛË ·˘-Ù‹ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔ ÈÛ¯˘Ú‹ ÛÙ· ·È‰È¿ ¯ˆÚ›˜ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁÈÒÓ. ∫·Ù¤ÏËÍ·Ó,ÏÔÈfiÓ, ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ô ıËÏ·ÛÌfi˜ ÌÂÈÒ-ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ¿ÛıÌ·ÙÔ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ4 ÚÒÙˆÓ ÂÙÒÓ.

Œˆ˜ fiÙÔ˘, fiÌˆ˜, ·ÔÛ·ÊËÓÈÛÙÂ› Ô ÚfiÏÔ˜ÙÔ˘ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜,Î·Ïfi ı· ‹Ù·Ó Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ Ô‰ËÁ›Â˜ ÙË˜∞ÏÏÂÚÁÈÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜, Ë ÔÔ›· Û˘ÓÈÛÙ¿ÁÈ· Ù· ¿ÙÔÌ· ÌÂ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜·ÔÎÏÂÈÛÙÈÎfi ıËÏ·ÛÌfi ¤ˆ˜ ÙÔÓ 4Ô Ì‹Ó·, ÌÂ·Ú¿ÏÏËÏË ‰›·ÈÙ· ·ÔÊ˘Á‹˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓÙÚÔÊÒÓ ·fi ÙË ÌËÙ¤Ú·.

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∏ Â›‰Ú·ÛË ÙË˜ ‰È·ÙÚÔÊ‹˜ ÛÙÔ ¿ÛıÌ· Â›Ó·ÈÔÏ‡ÏÔÎË Î·È - fiˆ˜ ‰Â›¯ÓÔ˘Ó ÚfiÛÊ·ÙÂ˜ÌÂÏ¤ÙÂ˜ - Èı·ÓÒ˜ ÂÌÏ¤ÎÔÓÙ·È ÔÏÏ¿ ‰È·ÊÔ-ÚÂÙÈÎ¿ ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿. ∂›ÛË˜, Ù· ıÚÂÙÈ-Î¿ Û˘ÛÙ·ÙÈÎ¿ ÌÔÚÂ› Ó· ·ÏÏËÏÂÈ‰ÚÔ‡Ó ÌÂÙ·-Í‡ ÙÔ˘˜, fiˆ˜ Ë ÚÔÛÙ·Û›· ÙˆÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈ-ÎÒÓ ÛÙËÓ ÔÍÂ›‰ˆÛË ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ. ∂È-ÚfiÛıÂÙ·, ˘¿Ú¯Ô˘Ó Ì·ÚÙ˘Ú›Â˜ fiÙÈ Ù· ÙÚfiÊÈÌ·Î·È fi¯È Ù· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ Û˘Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ÙÔ ¿ÛıÌ· ÛÙ· ·È‰È¿. µ¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ,Ì›· ÈÛÔÚÚÔËÌ¤ÓË ‰È·ÙÚÔÊ‹ ÏÔ‡ÛÈ· ÛÂ ÊÚÔ‡-Ù· Î·È Ï·¯·ÓÈÎ¿, Ì›· Ì¤ÙÚÈ· ÚfiÛÏË„Ë ÏÈ·-ÚÒÓ ÔÍ¤ˆÓ Î·È Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿-ÚÔ˘˜ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· ÌÔÚÂ› Ó· Â›Ó·ÈÔÏ‡ ˆÊ¤ÏÈÌ·. ∞·ÈÙÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ÂÚÈÛ-ÛfiÙÂÚˆÓ ÌÂÏÂÙÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ıÚÂÙÈÎ¿Û˘ÛÙ·ÙÈÎ¿ Î·È ÛÙ· ÙÚfiÊÈÌ· Î·È ÙÈ˜ ·ÏÏËÏÂÈ-‰Ú¿ÛÂÈ˜ ÙÔ˘˜ ÛÙÔ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· ÛÂ ·È‰È¿ Î·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407



Ó¤Ô˘˜, fiˆ˜ Â›ÛË˜ Î·È ÁÈ· ÙÔÓ ÚfiÏÔ ÙÔ˘ ıËÏ·-ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:399-407


408 REVIEW ARTICLE

2nd Paediatric Clinic,Aristotle University,Thessaloniki

Correspondence:Maria Emboriadou 2nd Paediatric Clinic, Aristotle University, AHEPA Hospital 1 Kyriakidi Str., 546 36, Thessaloniki

Date of submission: 15-11-2004Date of approval: 27-04-2005


Diet and asthma in children D. Papandreou, M. Emboriadou

AbstractThe effect of the diet in determining the cause and clinical severity of asthma is uncertain.Epidemiological studies suggest that antioxidants, magnesium and fat consumption may have animportant role in the aetiology, although the relative importance of these individual nutrients is notclear. Interventional studies are beginning to clarify the importance of diet in patients with asthma,and early studies suggest that antioxidants in particular may be beneficial. The concept that dietaryfactors may be implicated in the aetiology of asthma has attracted a great deal of attention in the last10-15 years, and epidemiologic studies have revealed associations with various minerals, vitaminsand fatty acids in this context.

Key wordsAsthma, childhood, nutrition, diet, wheezing.


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∏ ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· (‚-ª∞) Â›Ó·È Ì›·ÁÂÓÂÙÈÎ¿ Î·ıÔÚÈ˙fiÌÂÓË ¯ÚfiÓÈ· ·ÈÌÔÏ˘ÙÈÎ‹·Ó·ÈÌ›·, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÔ›·˜··ÈÙÂ›Ù·È Ë ‰È¿ ‚›Ô˘ ˘Ô‚ÔÏ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÂ

ÚfiÁÚ·ÌÌ· ÌÂÙ·ÁÁ›ÛÂˆÓ Î·È ·ÔÛÈ‰‹ÚˆÛË˜. ∏ÂÊ·ÚÌÔÁ‹ ·˘Ù‹˜ ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ÚÔÛ¤ÁÁÈ-ÛË˜ Ô‰‹ÁËÛÂ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÂ ÂÍ·ÈÚÂÙÈ-Î‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÚfiÁÓˆÛË˜ ÙË˜ ÓfiÛÔ˘, ÌÂÙ·˘Ùfi¯ÚÔÓË ‚ÂÏÙ›ˆÛË ÙË˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ. øÛÙfiÛÔ, Ë ÂÎ‰‹ÏˆÛËÂÈÏÔÎÒÓ ·fi ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ÂÍ·ÎÔ-ÏÔ˘ıÂ› Ó· ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ·, ·Îfi-ÌË Î·È ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fiÙ·ÎÙÈÎ‹ È·ÙÚÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ·ÚÔ˘-ÛÈ¿˙Ô˘Ó ÈÎ·ÓÔÔÈËÙÈÎ‹ Û˘ÌÌfiÚÊˆÛË ÛÙ· ··È-ÙÔ‡ÌÂÓ· ıÂÚ·Â˘ÙÈÎ¿ Û¯‹Ì·Ù·.

∏ ‚-ª∞ ·ÔÙÂÏÂ› ÙÔ ÛÔ‚·ÚfiÙÂÚÔ ÂÎ ÙˆÓÎ·ÏÔ‡ÌÂÓˆÓ ÌÂÛÔÁÂÈ·ÎÒÓ ‹ ı·Ï·ÛÛ·ÈÌÈÎÒÓ


410 ¢. ∑·ÊÂÈÚ›Ô˘ Î·È Û˘Ó.

Û˘Ó‰ÚfiÌˆÓ, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó Ì›· ÂÙÂÚÔÁÂ-Ó‹ ÔÌ¿‰· ÎÏËÚÔÓÔÌÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ, ·ıÔ-ÏÔÁÈÎÒÓ ˆ˜ ÚÔ˜ ÙË Û‡ÓıÂÛË ÙÔ˘ ÌÔÚ›Ô˘ ÙË˜·ÈÌÔÛÊ·ÈÚ›ÓË˜. O ˘Â‡ı˘ÓÔ˜ ÌÔÚÈ·Îfi˜ ÌË¯·-ÓÈÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Ì¤Û· ‹ Á‡Úˆ·fi Ù· ÁÔÓ›‰È·, ÔÈ ÔÔ›Â˜ ÌÔÚÂ› Ó· Â›Ó·È ÌÂÁ¿-ÏÂ˜ ‹ ÌÈÎÚ¤˜ ÂÏÏÂ›„ÂÈ˜, ÛËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿-ÍÂÈ˜, ÌÈÎÚ¤˜ ÚÔÛı‹ÎÂ˜ ‹ ‰ÈÏ·ÛÈ·ÛÌÔ› (1).∞ÔÙ¤ÏÂÛÌ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È Ë ‰È·Ù·-Ú·¯‹ ÙË˜ Û‡ÓıÂÛË˜ ÙˆÓ · ‹ ‚ ·Ï‡ÛÂˆÓ ÙË˜ ·È-ÌÔÛÊ·ÈÚ›ÓË˜, Ë ÔÔ›· Ô‰ËÁÂ› ·ÓÙ›ÛÙÔÈ¯· ÛÂ ÂÎ-‰‹ÏˆÛË ·- ‹ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜. ™ÙÔÓ ÂÏ-ÏËÓÈÎfi ÏËı˘ÛÌfi ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÂÚÈÛÛfi-ÙÂÚÂ˜ ·fi 40 ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ‚ ÁÔÓ›‰ÈÔ Î·È Â-ÚÈÛÛfiÙÂÚÂ˜ ·fi 10 ÁÂÓÂÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÛÙÔ ·(2-5). O È‰È·›ÙÂÚ· ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÂÙ·ÏÏ¿ÍÂ-ˆÓ, Ë ÂÚÈÔ¯‹ ÛÙËÓ ÔÔ›· Â‰Ú¿˙ÔÓÙ·È ·˘Ù¤˜,Î·ıÒ˜ Î·È Ô ÏÂÈÙÔ˘ÚÁÈÎfi˜ ÙÔ˘˜ ÚfiÏÔ˜ Ô‰ËÁÔ‡ÓÛÂ ÌÂÁ¿ÏË ÔÈÎÈÏ›· Ê·ÈÓÔÙ˘ÈÎ‹˜ ¤ÎÊÚ·ÛË˜.∫‡ÚÈÔ˘˜ ÎÏÈÓÈÎÔ‡˜ Ê·ÈÓÔÙ‡Ô˘˜ ÙË˜ ‚-ª∞·ÔÙÂÏÔ‡Ó Ë ÂÙÂÚfi˙˘ÁË, Ë ÂÓ‰È¿ÌÂÛË Î·È Ë ÌÂ›-˙ˆÓ ‚-ª∞, Ë ÙÂÏÂ˘Ù·›· ÂÎ ÙˆÓ ÔÔ›ˆÓ ·ÔÙÂ-ÏÂ› ÙË ÛÔ‚·ÚfiÙÂÚË Û˘ÁÁÂÓ‹ ¯ÚfiÓÈ· ·ÈÌÔÏ˘ÙÈÎ‹·Ó·ÈÌ›·.

¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù·ÎÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·-ÙÔ˜ ÌÂÙ·ÁÁ›ÛÂˆÓ-·ÔÛÈ‰‹ÚˆÛË˜, ÔÈ ¿Û¯ÔÓÙÂ˜·fi ‚-ª∞ Î·Ù¤ÏËÁ·Ó ÔÏ‡ ÓˆÚ›˜, Û˘¯Ó¿ ÚÈÓÙË ‰Â‡ÙÂÚË ‰ÂÎ·ÂÙ›· ÙË˜ ˙ˆ‹˜ (6). ªÂ ÙËÓ ¿-ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ Û¯ËÌ¿ÙˆÓÌÂÙ¿ÁÁÈÛË˜ Î·È Î˘Ú›ˆ˜ Ë ÂÈÛ·ÁˆÁ‹ ÙË˜ ·ÔÛÈ-‰‹ÚˆÛË˜ Ô‰‹ÁËÛ·Ó ÛÂ ‰Ú·Ì·ÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ÔÛÔÛÙÔ‡ ÂÈ‚›ˆÛË˜, ˆÛÙfiÛÔ, Î‡ÚÈÂ˜ ·ÈÙ›Â˜ı·Ó¿ÙÔ˘ ·Ú¤ÌÂÈÓ·Ó Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·(60%), ÔÈ ÏÔÈÌÒÍÂÈ˜ (13%) Î·È Ë Ë·ÙÈÎ‹ ÓfiÛÔ˜(6%) (7). ™‹ÌÂÚ·, Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÂÍ·-ÎÔÏÔ˘ıÂ› Ó· Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘,ÌÂ ·Ó·ÊÂÚfiÌÂÓÔ ÔÛÔÛÙfi Ô˘ Êı¿ÓÂÈ ÙÔ 50%ÙˆÓ ·ÛıÂÓÒÓ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 35 ÂÙÒÓÛÂ ÔÚÈÛÌ¤Ó· Î¤ÓÙÚ· (8).

∏ ˘ÈÔı¤ÙËÛË Ó¤ˆÓ, Â˘·›ÛıËÙˆÓ, ÌË-ÂÂÌ-‚·ÙÈÎÒÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ, fiˆ˜ Â›Ó·ÈË Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI), Î·ıÈÛÙ¿ ‰˘Ó·-Ù‹ ÙËÓ ¤ÁÎ·ÈÚË ·Ó›¯ÓÂ˘ÛË ÙË˜ ·ÈÌÔÛÈ‰‹ÚˆÛË˜ÚÈÓ ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ÔÚÁ·ÓÈÎ‹˜ ‰˘ÛÏÂÈÙÔ˘Ú-Á›·˜ (9). H ¯Ú‹ÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·˘ÙÒÓÙÂ¯ÓÈÎÒÓ, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ó¤-ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ, Ô˘ ÂÚÈÏ·Ì‚¿-ÓÔ˘Ó ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ËÏÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜Î·È ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ Î·Ï‡ÙÂÚË Û˘ÌÌfiÚÊˆÛËÛÙË ıÂÚ·Â›· ·ÔÛÈ‰‹ÚˆÛË˜, ·Ó·Ì¤ÓÂÙ·È Ó·Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË, ÙfiÛÔ ÙË˜ÚfiÁÓˆÛË˜ ÙË˜ ÓfiÛÔ˘ fiÛÔ Î·È ÙË˜ ÔÈfiÙËÙ·˜˙ˆ‹˜ ÙˆÓ ı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ.

∂ÈÏÔÎ¤˜ ·fi ÙÔ ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· ÛÙË‚-ª∞

∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ‚-ª∞ Â›¯Â ‹‰Ë ÂÚÈÁÚ·ÊÂ› ·fi Ù·ÚÒÙ· ¯ÚfiÓÈ· Û˘ÛÙËÌ·ÙÈÎ‹˜ ÌÂÏ¤ÙË˜ ÙË˜ Ófi-ÛÔ˘ (10). °È· ÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ ÂÈÏÔÎÒÓ·˘ÙÒÓ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó ÔÈÎ›ÏÔÈ ·Ú¿ÁÔÓÙÂ˜,fiˆ˜ Ë ¯ÚfiÓÈ· ˘ÔÍ›·, Ë ·ÈÌÔÛÈ‰‹ÚˆÛË Î·È ËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ÙÔÍÈÎfiÙËÙ· ÙË˜ ıÂÚ·Â›·˜ ·Ô-ÛÈ‰‹ÚˆÛË˜ ÌÂ ‰ÂÛÊÂÚÚÈÔÍ·Ì›ÓË (DFO).

ÀÔÍ›· ™Â ·ÓÂ·ÚÎÒ˜ ÌÂÙ·ÁÁÈ˙fiÌÂÓÔ˘˜ ı·Ï·ÛÛ·È-

ÌÈÎÔ‡˜ ·ÛıÂÓÂ›˜, Ë ¯ÚfiÓÈ· ·Ó·ÈÌ›· Ô‰ËÁÂ› ÛÂÌ·˙ÈÎ‹ Â¤ÎÙ·ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ËÔÔ›· ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÂÎ‰‹ÏˆÛË ‰È·Ù·-Ú·¯ÒÓ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÙË Û˘Ì›ÂÛË ÓÂ‡ÚˆÓ,ÙfiÛÔ ÎÚ·ÓÈ·ÎÒÓ fiÛÔ Î·È ÂÚÈÊÂÚÈÎÒÓ (11,12).¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·-ÙÔ˜ ÌÂÙ·ÁÁ›ÛÂˆÓ, Û˘ÓËı¤ÛÙÂÚË ‹Ù·Ó Ë ‚È‚ÏÈÔ-ÁÚ·ÊÈÎ‹ ·Ó·ÊÔÚ¿ ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·ÎÔ‹˜, ÔÈÔÔ›Â˜ ·ÚÔ˘Û›·˙·Ó ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ÙËÓ ˘Ô-‚ÔÏ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÂ Ù·ÎÙÈÎ¤˜ ÌÂÙ·ÁÁ›ÛÂÈ˜(13,14).

∏ ¯ÚfiÓÈ· ˘ÔÍ›· Ê·›ÓÂÙ·È Ó· Â˘ı‡ÓÂÙ·È,Â›ÛË˜, ÁÈ· ÙËÓ ÚÔÛ‚ÔÏ‹ ·ÓÒÙÂÚˆÓ ÊÏÔÈÈÎÒÓÏÂÈÙÔ˘ÚÁÈÒÓ. OÈ Logothetis Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘ÓfiÙÈ ÛÂ ¤ÏÂÁ¯Ô ·ÛıÂÓÒÓ ÌÂ ÔÌfi˙˘ÁË ‚-ª∞ ‰È·-›ÛÙˆÛ·Ó ÙËÓ ·ÚÔ˘Û›· ¯·ÌËÏfiÙÂÚÔ˘ ÓÔËÙÈ-ÎÔ‡ ËÏ›ÎÔ˘ ÌÂÙ·Í‡ ı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓÔ˘ ÌÂÙ·ÁÁ›˙ÔÓÙ·Ó ·ÓÂ·ÚÎÒ˜ (15). ∞ÔÙ¤ÏÂ-ÛÌ· ÙË˜ ¯ÚfiÓÈ·˜ ˘ÔÍ›·˜ ıÂˆÚÂ›Ù·È, Â›ÛË˜, ËÂÌÊ¿ÓÈÛË ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔ ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ·ÛıÂÓÒÓ ÌÂ ‚-ª∞(16). ∆¤ÏÔ˜, ÔÚÈÛÌ¤ÓÔÈ ÂÚÂ˘ÓËÙ¤˜ ·Ô‰›‰Ô˘ÓÂÚÈÙÒÛÂÈ˜ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈ-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÈÛ¯·ÈÌÈÎÒÓ ‹·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ˆ˜Û˘Ó¤ÂÈ· ÙË˜ ¯ÚfiÓÈ·˜ ˘ÔÍ›·˜ Ô˘ ·Ú·ÙËÚÂ›-Ù·È ÛÙÔ˘˜ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (17,18).

∞ÈÌÔÛÈ‰‹ÚˆÛË ∏ Â›‰Ú·ÛË ÙÔ˘ ÏÂÔÓ¿˙ÔÓÙÔ˜ ÛÈ‰‹ÚÔ˘

ÛÙÈ˜ ÓÂ˘ÚÈÎ¤˜ Ô‰Ô‡˜ ·ÛıÂÓÒÓ ÌÂ ‚-ª∞ ·Ú¯ÈÎ¿ÂÓÙÔ›ÛÙËÎÂ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÓÂ˘ÚÔ·ÈÛıËÙË-ÚÈ·Î‹˜ ‚·ÚËÎÔ˝·˜, Ë ÔÔ›· ·Ô‰fiıËÎÂ ÛÙËÓÂÓ·fiıÂÛË ÛÈ‰‹ÚÔ˘ ÛÙÔÓ ÎÔ¯Ï›· (19).

∏ ¯Ú‹ÛË ÓÂfiÙÂÚˆÓ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ÌÂ-ıfi‰ˆÓ ÂÍ¤Ù·ÛË˜, fiˆ˜ Ù· ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿,Î·Ù¤ÛÙËÛÂ ‰˘Ó·Ù‹ ÙËÓ ·Ó›¯ÓÂ˘ÛË ˘ÔÎÏÈÓÈÎÒÓÓÂ˘ÚÔÏÔÁÈÎÒÓ ‚Ï·‚ÒÓ ÛÂ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜·ÛıÂÓÂ›˜, ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ ÔÔ›ˆÓ ÂÓÔ¯Ô-

¶·È‰È·ÙÚÈÎ‹ 2005;68:409-415


411∂ÈÏÔÎ¤˜ ·fi ÙÔ ∫¡™ Î·È ÙÔ ¶¡™ ÛÂ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜ ·ÛıÂÓÂ›˜

ÔÈ‹ıËÎÂ - ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓ Ì¤ÚÂÈ - Ë ÙÔÍÈÎ‹Â›‰Ú·ÛË ÙÔ˘ ÛÈ‰‹ÚÔ˘ (20).

¶ÚfiÛÊ·Ù·, Ë ¯Ú‹ÛË ÙË˜ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔ-ÁÚ·Ê›·˜ ÂÈ‚Â‚·›ˆÛÂ ÂÚÁ·ÛÙËÚÈ·Î¿ ÙËÓ ÂÓ·-fiıÂÛË ÛÈ‰‹ÚÔ˘ ÛÂ ÂÁÎÂÊ·ÏÈÎ¤˜ ‰ÔÌ¤˜ ·ÛıÂ-ÓÒÓ ÌÂ ‚-ª∞, fiˆ˜ Ô ÊÏÔÈfi˜, ÙÔ Î¤Ï˘ÊÔ˜ ÙÔ˘Ê·ÎÔÂÈ‰Ô‡˜ ˘Ú‹Ó· Î·È Ô ÎÂÚÎÔÊfiÚÔ˜ ˘Ú‹-Ó·˜ (21).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓÙˆÓ ·ÓÒÙÂÚˆÓ ÓÔËÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ, Ù· ‚È-‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Ô˘ ·ÊÔÚÔ‡Ó ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ‚-ª∞ Â›Ó·È ÂÚÈÔÚÈÛÌ¤Ó· Î·È ·ÓÙÈÎÚÔ˘-fiÌÂÓ·, ˆÛÙfiÛÔ, ÙÔ ·˘ÍËÌ¤ÓÔ ÊÔÚÙ›Ô ÛÈ‰‹ÚÔ˘Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔ. ™ÙËÓ ÈÔ Úfi-ÛÊ·ÙË ·fi ÙÈ˜ Û¯ÂÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÔÈ MonasteroÎ·È Û˘Ó Î·Ù·‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·ÚÔ˘Û›· ‰È·Ù·Ú·-¯ÒÓ ·ÓÙ›ÏË„Ë˜ ÛÂ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi, Î˘Ú›ˆ˜ÛÂ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ÛËÌÂ›· ¤ÓÙÔ-ÓË˜ ·ÈÌÔÛÈ‰‹ÚˆÛË˜ (22).

∆¤ÏÔ˜, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ÁÏ˘Îfi˙Ë˜, ÔÈ ÔÔ›Â˜ ˆ˜ ÁÓˆÛÙfiÓ ÔÊÂ›ÏÔÓÙ·ÈÛÙËÓ ÂÓ·fiıÂÛË ÛÈ‰‹ÚÔ˘ ÛÙÔ ¿ÁÎÚÂ·˜, ·ÔÙÂ-ÏÔ‡Ó ¤Ó·Ó ·ÎfiÌË ·Ú¿ÁÔÓÙ· ÂÎ‰‹ÏˆÛË˜ ÂÈ-ÏÔÎÒÓ ·fi ÙÔ ÎÂÓÙÚÈÎfi Î·È/‹ ÙÔ ÂÚÈÊÂÚÈÎfiÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ‚-ª∞ (23).

∆ÔÍÈÎfiÙËÙ· DFO ∏ ‰ÂÛÊÂÚÚÈÔÍ·Ì›ÓË ÂÍ·ÎÔÏÔ˘ıÂ›, ÚÔ˜ ÙÔ

·ÚfiÓ, Ó· ·ÔÙÂÏÂ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÛÙËıÂÚ·Â›· ÙˆÓ ı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ, ·Ú¿ÙÈ˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ÂÓ¤¯ÂÈ Ë ‰È¿ ‚›Ô˘ Û˘ÌÌfiÚ-ÊˆÛË ÛÙËÓ ·ÚÂÓÙÂÚÈÎ‹ ¯ÔÚ‹ÁËÛ‹ ÙË˜ Î·È ÙÔ˘„ËÏfi ÎfiÛÙÔ˜ ÙË˜ ıÂÚ·Â›·˜. ª¤¯ÚÈ Ó· Á›ÓÂÈÂ˘Ú¤ˆ˜ ÚÔÛÈÙ‹ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ Ì˘ÂÏÔ‡ÙˆÓ ÔÛÙÒÓ ‹ Ó· Á›ÓÂÈ Ú·ÁÌ·ÙÈÎfiÙËÙ· Ë ÁÔÓÈ-‰È·Î‹ ıÂÚ·Â›·, Ë ·ÔÛÈ‰‹ÚˆÛË ·ÔÙÂÏÂ› ÙÔÌÔÓ·‰ÈÎfi Ì¤ÛÔ ÚfiÏË„Ë˜ ÙˆÓ ı·Ó·ÙËÊfiÚˆÓÂÈÏÔÎÒÓ ÙË˜ ÓfiÛÔ˘. øÛÙfiÛÔ, Ë ıÂÚ·Â›· ÌÂDFO ‰ÂÓ Â›Ó·È ¿ÌÔÈÚË ÎÈÓ‰‡ÓˆÓ, Î·ıÒ˜ ¤¯ÂÈÂÓÔ¯ÔÔÈËıÂ› ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÂÈÏÔÎÒÓ·fi ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· (24). ∏ ¯Ú‹ÛË ˘„Ë-ÏÒÓ ‰fiÛÂˆÓ DFO, ·ÏÏ¿ Î·È Ë ¯Ú‹ÛË Û˘ÓËıÈ-ÛÌ¤ÓˆÓ ‰fiÛÂˆÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¯·ÌËÏfi ÊÔÚÙ›ÔÛÈ‰‹ÚÔ˘, ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛËÔÈÎ›ÏˆÓ ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÔÈÔÔ›Â˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÂ˜ Î·È·Ó·ÛÙÚ¤„ÈÌÂ˜ ÌÂÙ¿ ÙËÓ ·ÚÔ‰ÈÎ‹ ‰È·ÎÔ‹ ‹ÙËÓ ÙÚÔÔÔ›ËÛË ÙË˜ ‰ÔÛÔÏÔÁ›·˜ ÙÔ˘ Ê·ÚÌ¿-ÎÔ˘ (25). ∏ ÓÂ˘ÚÔÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜ DFO ¤¯ÂÈ·Ô‰ÔıÂ› ÛÂ ‰È¿ÊÔÚÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜, fiˆ˜ ÛÂÌÂÙ·‚ÔÏ¤˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ··Ó·ÁÎ·›ˆÓ ÛÈ‰ËÚÔÂÍ·ÚÙÒÌÂÓˆÓ ÂÓ˙‡ÌˆÓ (26),ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙÔÓ ÔÚÁ·-

ÓÈÛÌfi ··Ú·›ÙËÙˆÓ ÛÙÔÈ¯Â›ˆÓ ÂÎÙfi˜ ÙÔ˘ ÛÈ‰‹-ÚÔ˘ fiˆ˜ Â›Ó·È Ô ¯·ÏÎfi˜ Î·È Ô „Â˘‰¿ÚÁ˘ÚÔ˜(27,28), Î·ıÒ˜ Î·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÂÏÂ‡ıÂÚˆÓÚÈ˙ÒÓ (29). ™ËÌ·ÓÙÈÎ‹ Ê·›ÓÂÙ·È Ó· Â›Ó·È Î·È ËÛ˘ÌÌÂÙÔ¯‹ È‰ÈÔÛ˘ÛÙ·ÛÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÔÈÔÔ›ÔÈ Î·ıÈÛÙÔ‡Ó ÙË ‰Ú¿ÛË ÙË˜ DFO ·Úfi‚ÏÂ-ÙË Î·È ‰È·ÊÔÚÂÙÈÎ‹ ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË (30).∞ÓÂÍ·ÚÙ‹Ùˆ˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÌË¯·ÓÈÛÌÔ‡, ËÙÔÍÈÎ‹ Â›‰Ú·ÛË ÙË˜ DFO Ê·›ÓÂÙ·È Ó· Â›Ó·È‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Î·È Ó· ÌËÓ ÔÊÂ›ÏÂÙ·È ÛÙËÛ˘ÛÛÒÚÂ˘Û‹ ÙË˜, ˆ˜ Û˘Ó¤ÂÈ· ¯·ÌËÏÔ‡ Ú˘ı-ÌÔ‡ Î¿ı·ÚÛË˜ ·˘Ù‹˜ (31).

OÈ ·Ó·ÊÂÚfiÌÂÓÂ˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÈÏÔÎ¤˜ÙË˜ DFO ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙË ÌÂÌÔÓˆÌ¤ÓË ‹Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ ÙË˜ fiÚ·ÛË˜Î·È ÙË˜ ·ÎÔ‹˜ (32-34). OÈ ÂÎ‰ËÏÒÛÂÈ˜ ·˘Ù¤˜ÂÚÈÁÚ¿ÊÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Ì·ÎÚÔ-¯ÚfiÓÈ· Ï‹„Ë ˘„ËÏÒÓ ‰fiÛÂˆÓ DFO Î·È Î·Ù’ÂÍÔ¯‹Ó ¯·ÌËÏfi ÊÔÚÙ›Ô ÛÈ‰‹ÚÔ˘, ˆÛÙfiÛÔ,˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂÈ˜ ÔÍ¤ˆÓ ‚Ï·‚ÒÓ ÌÂÙ¿·fi ÌÂÌÔÓˆÌ¤ÓÂ˜ ‰fiÛÂÈ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (35).

OÈ ÔÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ·Ô‰›‰ÔÓÙ·È ÛÙËÓÙÔÍÈÎ‹ Â›‰Ú·ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÈ˜ ›ÓÂ˜ ÙÔ˘ÔÙÈÎÔ‡ ÓÂ‡ÚÔ˘ (32). ∏ ‰Ú¿ÛË ÙË˜ DFO Ô‰ËÁÂ›ÛÙËÓ ÂÌÊ¿ÓÈÛË Û¯ÂÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ ÛÙËÌÂÙ¿‰ÔÛË ÙÔ˘ ÔÙÈÎÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜, ÂÓ‰¤¯ÂÙ·ÈˆÛÙfiÛÔ Ó· ÚÔÎ·Ï¤ÛÂÈ ·ÎfiÌË Î·È Ï‹ÚË ·Ò-ÏÂÈ· ÙË˜ fiÚ·ÛË˜. OÈ Orton Î·È Û˘Ó ÂÚÈÁÚ¿-ÊÔ˘Ó ÙËÓ ÂÚ›ÙˆÛË ‰‡Ô ·‰ÂÏÊÒÓ ÌÂ ÂÎ‰‹Ïˆ-ÛË ÔÙÈÎ‹˜ ÓÂ˘ÚÔ¿ıÂÈ·˜ ·Ô‰È‰fiÌÂÓË˜ ÛÙËÓÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜ DFO, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ô ¤Ó·˜·ÚÔ˘Û›·ÛÂ Ï‹ÚË ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ‚Ï¿‚Ë˜ÌÂÙ¿ ÙËÓ ·ÚÔ‰ÈÎ‹ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘,ÂÓÒ Ô ‰Â‡ÙÂÚÔ˜ ÂÌÊ¿ÓÈÛÂ ÌË ·Ó·ÛÙÚ¤„ÈÌË ÂÙÂ-ÚfiÏÂ˘ÚË ·ÒÏÂÈ· ÙË˜ fiÚ·ÛË˜ (36).

™¯ÂÙÈÎ¿ ÌÂ ÙËÓ ˆÙÔÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜ DFO,Ì·ÎÚÔ¯ÚfiÓÈ· ·ÎÔ˘ÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË, Ë ÔÔ›·Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ªÔÓ¿‰· ªÂÛÔÁÂÈ·Î‹˜∞Ó·ÈÌ›·˜ ÙÔ˘ ÂÏÏ·‰ÈÎÔ‡ ¯ÒÚÔ˘, ·ÔÎ¿Ï˘„ÂÙËÓ ·ÚÔ˘Û›· ÂÙÂÚfiÏÂ˘ÚË˜ ‹ ·ÌÊÔÙÂÚfiÏÂ˘-ÚË˜ ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹˜ ‚·ÚËÎÔ˝·˜ ÛÙÔ 27%ÙˆÓ ·ÛıÂÓÒÓ, ÌÂ ·ÎfiÏÔ˘ıË ·ÔÎ·Ù¿ÛÙ·ÛË ‹·Ó·ÛÙÔÏ‹ ÙË˜ ÂÈ‰Â›ÓˆÛË˜ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÌÂÙ¿ ÙËÓ ·ÚÔ‰ÈÎ‹ ‰È·-ÎÔ‹ ‹ ÌÂ›ˆÛË ÙË˜ ‰fiÛË˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (37).∆· ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Û˘ÌÊˆÓÔ‡ÓÌÂ ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, Î·Ù·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙË Û˘Ì-ÌÂÙÔ¯‹ ÙË˜ DFO ÛÙËÓ ÂÎ‰‹ÏˆÛË ·ÎÔ˘ÔÏÔÁÈÎÒÓ‰È·Ù·Ú·¯ÒÓ, ·ÎfiÌË Î·È fiÙ·Ó ·˘Ù‹ ¯ÔÚËÁÂ›Ù·ÈÛÂ ‰fiÛÂÈ˜ Ô˘ ıÂˆÚÔ‡ÓÙ·È ÌË ÙÔÍÈÎ¤˜ (38). ∞Í›-˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÔÙÈÎÒÓ Î·È ·ÎÔ˘ÛÙÈÎÒÓÓÂ˘ÚÈÎÒÓ Ô‰ÒÓ Á›ÓÔÓÙ·È ·ÓÙÈÏËÙ¤˜ ÌfiÓÔ Î·Ù¿

¶·È‰È·ÙÚÈÎ‹ 2005;68:409-415


412 ¢. ∑·ÊÂÈÚ›Ô˘ Î·È Û˘Ó.

ÙËÓ ÂÍ¤Ù·ÛË ÌÂ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎ¤˜ ÌÂıfi‰Ô˘˜ÂÏ¤Á¯Ô˘, ¯ˆÚ›˜ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÓÙ›ÛÙÔÈ-¯Â˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ (39,40).

∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂ˘ÚÔ-ÙÔÍÈÎfiÙËÙ·˜ Ô˘ ·Ô‰›‰ÔÓÙ·È ÛÙË ¯Ú‹ÛË DFO,ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ‚·ıÌfi ÙË˜ ‚Ï¿‚Ë˜. ™Â Î·Ù·-ÛÙ¿ÛÂÈ˜ ·Û˘ÌÙˆÌ·ÙÈÎ¤˜ ‹ Û˘ÓÔ‰Â˘fiÌÂÓÂ˜·fi ‹ÈÂ˜ ÌfiÓÔ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎ¤˜ ‰È·Ù·-Ú·¯¤˜ Û˘ÓÈÛÙ¿Ù·È Ë ÌÂ›ˆÛË ÙË˜ ¯ÔÚËÁÔ‡ÌÂÓË˜‰ÔÛÔÏÔÁ›·˜, ÌÂ Ù·ÎÙÈÎ‹ ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙË-ÚÈ·Î‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ (41).∞ÓÙ›ıÂÙ·, ÛÂ ÂÚÈÙÒÛÂÈ˜ ·ÚÔ˘Û›·˜ ÎÏÈÓÈÎ‹˜Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ‹ ÂÈ‰Â›ÓˆÛË˜ ÙË˜ ÂÚÁ·-ÛÙËÚÈ·Î‹˜ ÂÈÎfiÓ·˜ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË Ë ‰È·-ÎÔ‹ ¯ÔÚ‹ÁËÛË˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÌÂ ÚÔÛÂÎÙÈ-Î‹ Â·Ó·¯ÔÚ‹ÁËÛË ÛÂ ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜.

∆¤ÏÔ˜, ÂÈÚfiÛıÂÙ· ÙË˜ ÁÓˆÛÙ‹˜ Î·È Î·Ï¿ÌÂÏÂÙËÌ¤ÓË˜ ·ÎÔ˘ÛÙÈÎ‹˜ Î·È ÔÙÈÎ‹˜ ÓÂ˘ÚÔÙÔ-ÍÈÎfiÙËÙ·˜ ÙË˜ DFO, ·Ó·Ê¤ÚÂÙ·È Û˘Û¯¤ÙÈÛË ÙË˜ıÂÚ·Â›·˜ ·ÔÛÈ‰‹ÚˆÛË˜ ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛËÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÔ¿ıÂÈ·˜ ÛÂ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜·ÛıÂÓÂ›˜ (42-44). ø˜ Û˘ÓÔ‰¤˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰Ë-ÏÒÛÂÈ˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ·ÈÌˆ‰›Â˜, ‰È·Ù·Ú·¯¤˜ÙË˜ ·ÈÛıËÙÈÎfiÙËÙ·˜, Ì˘·ÏÁ›Â˜ Î·È Ì˘˚Î‹ ·‰˘-Ó·Ì›·, ÂÓÒ ·Ó·Ê¤ÚÔÓÙ·È ·ÎfiÌË ÂÚÈÙÒÛÂÈ˜·Û˘ÌÙˆÌ·ÙÈÎ‹˜ ÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÈÎ‹˜ ‚Ï¿-‚Ë˜, ·ÓÈ¯ÓÂ‡ÛÈÌË˜ ÌfiÓÔ Î·Ù¿ ÙÔÓ ÓÂ˘ÚÔÊ˘ÛÈÔ-ÏÔÁÈÎfi ¤ÏÂÁ¯Ô (45).

¡Â˘ÚÔÊ˘ÛÈÔÏÔÁ›· - ¡Â˘ÚÔ„˘¯ÔÏÔÁ›·

¶ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ Î·È ‚-ª∞ ∆· ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ ·ÔÙÂÏÔ‡Ó Ì›·

·Ó·›Ì·ÎÙË ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎ‹ Ì¤ıÔ‰Ô ÂÍ¤Ù·-ÛË˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜(∫¡™). ∂Ê·ÚÌfi˙ÔÓÙ·È Â˘Ú¤ˆ˜ ·fi ÙË ‰ÂÎ·ÂÙ›·ÙÔ˘ 1970, Î˘Ú›ˆ˜ ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ·ÔÌ˘ÂÏÈ-ÓˆÙÈÎÒÓ ÓfiÛˆÓ Î·È ÂÍÂÚÁ·ÛÈÒÓ ÙË˜ Á¤Ê˘Ú·˜Î·È ÙÔ˘ ÛÙÂÏ¤¯Ô˘˜, ÂÓÒ Ë ¯Ú‹ÛË ÙÔ˘˜ ÛÙÔÓ ÓÂ˘-ÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ ·Ó·-Ê¤ÚÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ·fi Ù· Ì¤Û· ÙË˜ ‰ÂÎ·-ÂÙ›·˜ ÙÔ˘ 1980 (46). ∏ ÌÂÁ¿ÏË Û˘Ì‚ÔÏ‹ ÙˆÓÚÔÎÏËÙÒÓ ‰˘Ó·ÌÈÎÒÓ ÛÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ∫¡™¤ÁÎÂÈÙ·È ÛÙË ‰˘Ó·ÙfiÙËÙ· ÚÒÈÌË˜ ·Ó›¯ÓÂ˘ÛË˜˘ÔÎÏÈÓÈÎÒÓ ‚Ï·‚ÒÓ.

°È· ÙËÓ ·ÚÔ˘Û›· ·ıÔÏÔÁÈÎÒÓ ÔÙÈÎÒÓ(VEP) Î·È ÛÙÂÏÂ¯È·›ˆÓ ·ÎÔ˘ÛÙÈÎÒÓ ÚÔÎÏËÙÒÓ‰˘Ó·ÌÈÎÒÓ (BAEP) ÂÓÔ¯ÔÔÈÂ›Ù·È ‚È‚ÏÈÔÁÚ·ÊÈ-Î¿, Î˘Ú›ˆ˜ Ë ÓÂ˘ÚÔÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜ DFO(23,39,40,45). Ã·Ú·ÎÙËÚÈÛÙÈÎ¿, ÛÙË ÌÂÏ¤ÙË ÙˆÓTriantafyllou Î·È Û˘Ó (40) ·Ó·Ê¤ÚÔÓÙ·È ·ıÔ-ÏÔÁÈÎ¿ VEP Î·È BAEP ÛÂ ÔÛÔÛÙfi 32,5% Î·È

17,5%, ·ÓÙ›ÛÙÔÈ¯·. OÈ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎ¤˜ ‰È·-Ù·Ú·¯¤˜ ·Ô‰›‰ÔÓÙ·È ÛÙËÓ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜DFO Î·È Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌÂ˜ - ÛÙËÓ ÏÂÈÔÓfiÙË-Ù· ÙˆÓ ÂÚÈÙÒÛÂˆÓ - ÌÂÙ¿ ÙËÓ ÙÚÔÔÔ›ËÛËÙÔ˘ ‰ÔÛÔÏÔÁÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ‹ ÙËÓ ·ÚÔ‰ÈÎ‹‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜ ·ÔÛÈ‰‹ÚˆÛË˜.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÍ¤Ù·ÛË ÙˆÓ ÛˆÌ·ÙÔ·È-ÛıËÙÈÎÒÓ ÚÔÎÏËÙÒÓ ‰˘Ó·ÌÈÎÒÓ (SEP), Ë Û¯Â-ÙÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÂÚÈÔÚÈ-ÛÌ¤ÓË. ™ÙË ÌÂÏ¤ÙË ÙˆÓ Wong Î·È Û˘Ó (23) ·Ó·-Ê¤ÚÂÙ·È Ë Î·Ù·ÁÚ·Ê‹ ·ıÔÏÔÁÈÎÒÓ SEP ÛÂ 4·fi 34 Û˘ÓÔÏÈÎ¿ ÂÍÂÙ·˙fiÌÂÓÔ˘˜ ı·Ï·ÛÛ·ÈÌÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜, ‰ËÏ·‰‹ ÛÂ ÔÛÔÛÙfi 11,76%.∞fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·,ÔÈ 2 ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ¿Û¯ÔÓÙÂ˜ ·fi Û·Î¯·ÚÒ-‰Ë ‰È·‚‹ÙË, Ë ·ÚÔ˘Û›· ÙÔ˘ ÔÔ›Ô˘ Ê·›ÓÂÙ·ÈÓ· Û¯ÂÙ›˙ÂÙ·È ÛÙ·ÙÈÛÙÈÎ¿ ÌÂ ÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓÛˆÌ·ÙÔ·ÈÛıËÙÈÎÒÓ ÓÂ˘ÚÈÎÒÓ Ô‰ÒÓ.

∆·¯‡ÙËÙÂ˜ ·ÁˆÁÈÌfiÙËÙ·˜ Î·È ‚-ª∞ ∆· ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ

ÂÍ¤Ù·ÛË ÙˆÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓÛÂ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Â›Ó·È ÔÏ‡ ÂÚÈÔ-ÚÈÛÌ¤Ó·. OÈ Papanastasiou Î·È Û˘Ó, ÌÂÏÂÙÒÓÙ·˜¿Û¯ÔÓÙÂ˜ ÙfiÛÔ ·fi ÔÌfi˙˘ÁË fiÛÔ Î·È ·fi ÂÓ-‰È¿ÌÂÛË ‚-ª∞, ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ÎÏÈ-ÓÈÎÒÓ Î·È ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Â-ÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÔ¿ıÂÈ·˜, ÂÓÙÔÈ˙fiÌÂÓË˜ Î˘-Ú›ˆ˜ ÛÙ· Î¿Ùˆ ¿ÎÚ·, ÛÂ ÔÛÔÛÙfi 20% (43).™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÓÂ˘ÚÈÎÒÓÔ‰ÒÓ ÂÚÈÁÚ¿ÊÂÙ·È Ë ÌÂÌÔÓˆÌ¤ÓË ·ÚÔ˘Û›··ıÔÏÔÁÈÎÒÓ ÎÈÓËÙÈÎÒÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfi-ÙËÙ·˜ ÓÂ‡ÚˆÓ ¯ˆÚ›˜ ·ÓÙ›ÛÙÔÈ¯Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ·ÈÛıËÙÈÎÒÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfiÙËÙ·˜, ·Ó·Ê¤-ÚÂÙ·È fiÌˆ˜ ·ÎfiÌË ·ÚÔ˘Û›· ÙÈÌÒÓ ÎÈÓËÙÈÎÒÓÎ·È ·ÈÛıËÙÈÎÒÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡-ÚˆÓ ÏËÛ›ÔÓ ÙÔ˘ ·ÓÒÙ·ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ - ‚¿-ÛÂÈ ÙË˜ ÔÌ¿‰·˜ Ì·ÚÙ‡ÚˆÓ - ÛÂ ÌÂÁ¿ÏÔ ·ÚÈıÌfi·ÛıÂÓÒÓ. OÈ Û˘ÁÁÚ·ÊÂ›˜ Û˘Ó‰¤Ô˘Ó Ù· ·ıÔÏÔ-ÁÈÎ¿ Â˘Ú‹Ì·Ù· ÌÂ ÙËÓ ·ÚÔ˘Û›· ¯·ÌËÏÒÓ ÂÈ-¤‰ˆÓ ·ÈÌ·ÙÔÎÚ›ÙË, ‰ËÏ·‰‹ ÌÂ ÙËÓ ·ÚÔ˘Û›·˘ÔÍ›·˜, Î·ıÒ˜ Î·È ÌÂ ÙËÓ ÚfiÔ‰Ô ÙË˜ ËÏÈÎ›·˜,Ë ÔÔ›· ÚÔÊ·ÓÒ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓËÂÓ·fiıÂÛË ÛÈ‰‹ÚÔ˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi.

OÈ Wong Î·È Û˘Ó ÂÚÈÁÚ¿ÊÔ˘Ó ÌÂÌÔÓˆÌ¤ÓËÎ·Ù·ÁÚ·Ê‹ ·ıÔÏÔÁÈÎÒÓ ·ÈÛıËÙÈÎÒÓ Ù·¯˘Ù‹-ÙˆÓ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓ ÛÂ 7 ·fi 34 ÂÍÂÙ·-˙fiÌÂÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÔÌfi˙˘ÁË ‚-ª∞(20,59%), 3 ÂÎ ÙˆÓ ÔÔ›ˆÓ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ¿-Û¯ÔÓÙÂ˜ ·fi Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (23). ™ÙËÓ ÂÓÏfiÁˆ ÌÂÏ¤ÙË, Ë ·ÚÔ˘Û›· ·ıÔÏÔÁÈÎÒÓ Â˘ÚË-Ì¿ÙˆÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÛÙ·ÙÈÛÙÈÎ¿ ÌÂ ÙËÓ ·ÈÌÔÛÈ-‰‹ÚˆÛË, Â›ÙÂ ·˘Ù‹ Ô‰ËÁÂ› ÛÂ ‰È·Ù·Ú·¯‹ ÙÔ˘

¶·È‰È·ÙÚÈÎ‹ 2005;68:409-415



ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ÁÏ˘Îfi˙Ë˜ Â›ÙÂ fi¯È. ∆· ·Ú·-¿Óˆ ÔÛÔÛÙ¿ ÎÈÓÔ‡ÓÙ·È ÛÙËÓ ›‰È· ÎÏ›Ì·Î· ÌÂÙÔ 25% ÙˆÓ ·ıÔÏÔÁÈÎÒÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfi-ÙËÙ·˜ ÓÂ‡ÚˆÓ Ô˘ ‰È·ÈÛÙÒÓÔ˘Ó ÛÂ ÌÂÏ¤ÙËÙÔ˘˜ ÔÈ Zafeiriou Î·È Û˘Ó (45). ™ÙË ÌÂÏ¤ÙË ·˘-Ù‹ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Û˘Û¯¤ÙÈÛË ÙˆÓ ·ıÔÏÔÁÈ-ÎÒÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfiÙËÙ·˜ ÌÂ Î¿ÔÈÔÓ ÂÈ-‚·Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ·fi ÙËÓ ›‰È· ÙË ÓfiÛÔ ‹ÙË ıÂÚ·Â›·, ÏËÓ ÙˆÓ ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ¯·ÏÎÔ‡ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜.

¡Â˘ÚÔ„˘¯ÔÏÔÁ›· Î·È ‚-ª∞ ∏ ÓÂ˘ÚÔ„˘¯ÔÏÔÁ›· ÂÏ¤Á¯ÂÈ ÙÔ ÓÔËÙÈÎfi Ë-

Ï›ÎÔ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÂÈ‰ÈÎ¤˜ „˘¯ÔÌÂÙÚÈÎ¤˜ÌÂıfi‰Ô˘˜, fiˆ˜ Â›Ó·È ÔÈ ∫Ï›Ì·ÎÂ˜ ¡ÔËÌÔÛ‡-ÓË˜ Wechsler ÁÈ· ·È‰È¿, ÔÈ ÔÔ›Â˜ ·ÔÙÂÏÔ‡ÓÙÔ ÙÂÛÙ WISC (Weschler Intelligence Scale forChildren - WISC) (47,48). ¶·Ú¿ ÙËÓ ÂÎÙÂÙ·Ì¤-ÓË, ÛÂ ‰ÈÂıÓ¤˜ Â›Â‰Ô, ¯Ú‹ÛË ÙÔ˘ WISC ˆ˜Ì¤ÛÔ ÌÂÏ¤ÙË˜ ÂÁÎÂÊ·ÏÈÎÒÓ ‰˘ÛÏÂÈÙÔ˘ÚÁÈÒÓ ÛÂÔÈÎ›ÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Î·È ·ı‹ÛÂÈ˜, Û˘ÌÂÚÈ-Ï·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜·Ó·ÈÌ›·˜ (49), ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ·Ó·ÊÔÚ¿ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÙÂÛÙ ÛÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÓÔËÙÈ-Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÛıÂÓÒÓ ÌÂ ‚-ª∞. ∂ÈÚfi-ÛıÂÙ·, Ë Ì¤¯ÚÈ Û‹ÌÂÚ· Û¯ÂÙÈÎ‹ ‰ÈÂıÓ‹˜ ‚È‚ÏÈÔ-ÁÚ·Ê›· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÂÚÈÔÚÈÛÌ¤ÓË, ¯ÚÔÓÈÎ¿ÍÂÂÚ·ÛÌ¤ÓË Î·È fi¯È ¿ÓÙ· „˘¯ÔÌÂÙÚÈÎ¿ “ÛÙ·-ÓÙ·ÚÈÛÌ¤ÓË”, ÂÓÒ Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ ÙË˜ Â›Ó·È·ÓÙÈÎÚÔ˘fiÌÂÓ· (15,22,50-53).

™ÙË ÌÔÓ·‰ÈÎ‹, ›Ûˆ˜, Û˘ÛÙËÌ·ÙÈÎ‹ ÓÂ˘ÚÔ„˘-¯ÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË ı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ, ÔÈMonastero Î·È Û˘Ó ÂÓÔ¯ÔÔÈÔ‡Ó ÁÈ· Ù· ·ıÔ-ÏÔÁÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÙËÓ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÙÔ˘ÛÈ‰‹ÚÔ˘, Î·Ù·‰ÂÈÎÓ‡ÔÓÙ·˜ ·ÚÔ˘Û›· ‰È·Ù·Ú·-¯ÒÓ ·ÓÙ›ÏË„Ë˜ ÛÂ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi Î˘Ú›ˆ˜ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ÌÂ ÛËÌÂ›· ¤ÓÙÔÓË˜ ·ÈÌÔÛÈ‰‹-ÚˆÛË˜ (22).


∫·ıÒ˜ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛË˜ ÙˆÓ ı·-Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ Û˘ÓÂ¯Ò˜ ·˘Í¿ÓÂÈ, Ë ¯Ú‹-ÛË ÙˆÓ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ Î·È ÓÂ˘ÚÔ„˘¯ÔÏÔ-ÁÈÎÒÓ ÌÂıfi‰ˆÓ ÂÍ¤Ù·ÛË˜ ·ÔÎÙ¿ È‰È·›ÙÂÚË ÛË-Ì·Û›·, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ¤ÁÎ·ÈÚË ‰È·›ÛÙˆÛËÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÓÂ˘ÚÈÎÒÓ Ô‰ÒÓ Î·È Î·ıÈÛÙÒ-ÓÙ·˜ ‰˘Ó·Ù‹ ÙË ÛˆÛÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ·ÛıÂÓÒÓ Î·È ÙËÓ ·Ó¿ÏÔÁË ÙÚÔÔÔ›ËÛË ÙË˜ ıÂ-Ú·Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜, ÌÂ ·ÒÙÂÚÔ¿ÓÙ· ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ÁÈ· ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ.


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¶·È‰È·ÙÚÈÎ‹ 2005;68:409-415


416 REVIEW ARTICLE

1st Paediatric Clinic ofAristotelion University,“Ippokration” GeneralHospital, Thessaloniki

Correspondence:Dimitrios Zafeiriou “Ippokration” General Hospital 49 Konstantinoupoleos Str., 546 42, Thessaloniki E-mail: [email protected]

Date of submission: 03-09-2004 Date of approval: 27-04-2005


Central and peripheral nervous systemcomplications in patients with beta-thalassaemia major D. Zafeiriou, M. Oikonomou, M. Athanassiou - Metaxa

AbstractBeta-thalassaemia major (BTM) is the most severe form in a group of inherited disorders ofhaemoglobin. Thalassaemic patients require regular red cell transfusions and concomitant ironchelation therapy in order to eliminate anaemia and the complications of haemosiderosis. Duringrecent decades, there have been several reports of involvement of the nervous system in BTMpatients. Neurological complications have been attributed to chronic hypoxia, iron overload anddesferrioxamine (DFO) chelation treatment. In most cases, the neurological involvement does notpresent with overt relevant signs or symptoms and can only be detected by neurophysiologicaltesting. Evoked potential study is a non-invasive method, capable of selectively exploring thefunction of specific brain structures, thus enabling the discovery of abnormalities in the sub-clinicalphase. Evoked potential investigation has been applied in the neurological evaluation of patientswith thalassaemia since the mid 1980s. In contrast, literature concerning nerve conduction velocitystudies in BTM patients remains limited. Equally scarce are reports concerning theneuropsychological profile of thalassaemic patients, with results that are conflicting and not alwayspsychometrically standardized. As the life expectancy of BTM patients increases, application ofneurophysiology and neuropsychology becomes of the utmost importance, in order to detect earlyinvolvement of the neural pathways and institute appropriate care for this group of patients.

Key wordsBeta-thalassaemia, desferrioxamine, neurotoxicity, evoked potentials, nerve conduction velocity,neurophysiology, neuropsychology, intelligent quotient.


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¶ÚfiÔ‰ÔÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜°. ¢ËÌËÙÚ›Ô˘, Ã. ∞Á·Î›‰Ë˜

¶ÂÚ›ÏË„Ë∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) Â›Ó·È Ì›· ‰˘ÓËÙÈÎ¿ ı·Ó·ÙËÊfiÚ· ‰È·Ù·Ú·¯‹ ÙË˜ ÂÓ‰ÔÌ‹ÙÚÈ·˜·Ó¿Ù˘ÍË˜ ÌÂ Û˘¯ÓfiÙËÙ· 1 ·Ó¿ 2.000-5.000 ÁÂÓÓ‹ÛÂÈ˜. ªÂ ÙËÓ Â˘ÚÂ›· ¯Ú‹ÛË ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜, Ë ‰È¿ÁÓˆÛ‹ ÙË˜ Á›ÓÂÙ·È fiÏÔ Î·È Û˘¯ÓfiÙÂÚ· ÚÔÁÂÓÓËÙÈÎ¿. O ÚfiÏÔ˜ ÙˆÓ ÂÓ-‰ÔÌ‹ÙÚÈˆÓ ÂÂÌ‚¿ÛÂˆÓ Î·È ÙˆÓ Ó¤ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÌÂıfi‰ˆÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, fiˆ˜ Â›Ó·È Ô ˘„›-Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜, ÙÔ ÂÈÛÓÂfiÌÂÓÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘, Ë ÂÍˆÛˆÌ·ÙÈÎ‹ ÔÍ˘ÁfiÓˆÛË ÌÂ ÙË ¯Ú‹-ÛË ÌÂÌ‚Ú¿ÓË˜ Î·È Ô ·ÂÚÈÛÌfi˜ ÌÂ ˘ÁÚfi, ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈ‚›ˆÛË˜ ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ› ·ÎfiÌË.ªÂÏÏÔÓÙÈÎÔ› ÛÙfi¯ÔÈ Â›Ó·È Ë ‚ÂÏÙ›ˆÛË ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Î·È Ô Î·ıÔÚÈÛÌfi˜ ÈÔ ·ÍÈfiÈ-ÛÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ‰ÂÈÎÙÒÓ, ÒÛÙÂ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È¿ÎÚÈÛË ÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÂ ™¢∫ Ô˘ ı· ÌÔ-ÚÔ‡Û·Ó Ó· ÂˆÊÂÏËıÔ‡Ó ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ·Ú¤Ì‚·ÛË, Î·ıÒ˜ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓıÂÚ·Â˘ÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔ ‚·ÚÔ-/ÔÁÎÔÙÚ·‡Ì·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿¢È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ¤Ì‚Ú˘Ô, ÂÌ‚Ú˘˚Î‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹, ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, ÔÍ˘ÁfiÓˆÛË.

Guy’s, Kings’ & St. Thomas’School of Medicine, London, UK

AÏÏËÏÔÁÚ·Ê›·:Ã·Ú¿Ï·ÌÔ˜ ∞Á·Î›‰Ë˜ °ÏËÓÔ‡ 28, ∆.∫. 543 52,£ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]


¶·È‰È·ÙÚÈÎ‹ 2005;68:417-423

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ ™¢∫ ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ¡O ªÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ ECMO ∂ÍˆÛˆÌ·ÙÈÎ‹ ÔÍ˘ÁfiÓˆÛË ÌÂ ÙË ¯Ú‹ÛË

ÌÂÌ‚Ú¿ÓË˜ ¢¶/¢∫ §fiÁÔ˜ ÙË˜ ‰È·Ì¤ÙÚÔ˘ ÓÂ‡ÌÔÓ· ÚÔ˜ ÙË

‰È¿ÌÂÙÚÔ ÙË˜ ÎÂÊ·Ï‹˜

∂ÈÛ·ÁˆÁ‹

∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) Â›Ó·ÈÌ›· ‰˘ÓËÙÈÎ¿ ı·Ó·ÙËÊfiÚ· ‰È·Ù·Ú·¯‹ ÙË˜ ÂÓ-‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘ÍË˜ ÌÂ Û˘¯ÓfiÙËÙ· 1 ·Ó¿2.000-5.000 ÁÂÓÓ‹ÛÂÈ˜ (1,2). ∏ ·ÚÈÛÙÂÚ‹ ÂÓÙfi-ÈÛË ÙË˜ ™¢∫, Ô˘ ¤¯ÂÈ ÙË ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆ-ÛË, ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ(3). ¶·Ú’ fiÏË ÙËÓ ÙÂ¯ÓÔÏÔÁÈÎ‹ ÚfiÔ‰Ô, Ë Û˘-ÓÔÏÈÎ‹ ıÓËÙfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫ Â›Ó·ÈÂÚ›Ô˘ 40% (8-79%) (2,4). ∆· ÙÂÏÂ˘Ù·›· ¯Úfi-ÓÈ·, ¤¯Ô˘Ó ÂÊ·ÚÌÔÛÙÂ› ‰È¿ÊÔÚÂ˜ Ó¤Â˜ ıÂÚ·-Â˘ÙÈÎ¤˜ ·ÚÂÌ‚¿ÛÂÈ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ™¢∫, fiˆ˜ Ô ˘„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜, ÙÔ ÂÈ-ÛÓÂfiÌÂÓÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (¡O), ËÂÍˆÛˆÌ·ÙÈÎ‹ ÔÍ˘ÁfiÓˆÛË ÌÂ ÌÂÌ‚Ú¿ÓË(extracorporeal membrane oxygenation -ECMO), Ô ·ÂÚÈÛÌfi˜ ÌÂ ˘ÁÚfi Î·È ÔÈ ÂÓ‰ÔÌ‹-ÙÚÈÂ˜ ÂÂÌ‚¿ÛÂÈ˜. øÛÙfiÛÔ, ··ÈÙÔ‡ÓÙ·È Î·Ï¿ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÚÔÎÂÈ-Ì¤ÓÔ˘ Ó· ÂÎÙÈÌËıÂ› Ô ÚfiÏÔ˜ ÙˆÓ ıÂÚ·Â˘ÙÈÎÒÓ

·˘ÙÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈ-‚›ˆÛË˜ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫.

¶ÚÔÁÂÓÓËÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË

¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ªÂ ÙËÓ Â˘ÚÂ›· ¯Ú‹ÛË ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡

˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜, Ë ‰È¿ÁÓˆÛË ÙË˜ ™¢∫ Á›-ÓÂÙ·È ÚÔÁÂÓÓËÙÈÎ¿ fiÏÔ Î·È Û˘¯ÓfiÙÂÚ· Î·È Ì¿-ÏÈÛÙ· ÛÂ ÚÒÈÌÔ ÛÙ¿‰ÈÔ ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜. ∆˘-ÈÎfi Â‡ÚËÌ· ·ÔÙÂÏÂ› Ë ·ÚÔ˘Û›· ÙÔ˘ ÛÙÔÌ¿-¯Ô˘ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ (·ÚÈÛÙÂÚ‹ ‰È·-ÊÚ·ÁÌ·ÙÔÎ‹ÏË) ÌÂ ·ÚÂÎÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆ-Ú·Î›Ô˘ ÛÙËÓ ·ÓÙ›ıÂÙË ÏÂ˘Ú¿. √È ™¢∫ Ô˘ÂÛÙÈ¿˙ÔÓÙ·È ‰ÂÍÈ¿ Â›Ó·È ÈÔ ‰‡ÛÎÔÏÔ Ó· ‰È·-ÁÓˆÛÙÔ‡Ó, Î·ıÒ˜ Ë ‰È¿ÁÓˆÛË ÌÔÚÂ› Ó· ‰È·Ê‡-ÁÂÈ, Â¿Ó ÙÔ ÛÙÔÌ¿¯È ‹ ÙÔ ‹·Ú ‰ÂÓ ‚Ú›ÛÎÂÙ·ÈÛÙÔÓ ıÒÚ·Î· ÙË ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ Ô˘ ‰ÈÂÍ¿ÁÂÙ·ÈÔ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∏ ÚÔÁÂÓÓËÙÈÎ‹‰È¿ÁÓˆÛË ÙË˜ ™¢∫ ·ÔÙÂÏÂ› ÙÔ ¤Ó·˘ÛÌ· ÁÈ·ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË Û¯ÂÙÈÎ¿ ÌÂ ¯ÚˆÌÔÛˆÌÈ-Î¤˜ ‹ ¿ÏÏÂ˜ ÌÂ›˙ÔÓÂ˜ ·ÓˆÌ·Ï›Â˜. ∏ ™¢∫ Û¿-ÓÈ· ·ÔÙÂÏÂ› ÌÂÌÔÓˆÌ¤ÓË ‰È·Ù·Ú·¯‹, Î·ıÒ˜ ÛÂ40-50% ÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÂ ™¢∫ Û˘Ó˘¿Ú¯Ô˘Ó Î·È¿ÏÏÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ (3).

∏ ·Ó¿Ù˘ÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÂÓÓËÙÈ-ÎÒÓ ÎÚÈÙËÚ›ˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÚfiÁÓˆÛË ÙË˜¤Î‚·ÛË˜ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫ ÌÂÙ¿ ÙË Á¤ÓÓËÛË


418 °. ¢ËÌËÙÚ›Ô˘ Î·È Û˘Ó.

Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ·ÎÚÈ‚‹ Î·È ÏÂÙÔÌÂ-Ú‹ ÚÔÁÂÓÓËÙÈÎ‹ Î·ıÔ‰‹ÁËÛË. ø˜ ÚÔÁÂÓÓËÙÈ-ÎÔ› ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜ ¤Î‚·ÛË˜ ¤¯Ô˘Ó ÚÔ-Ù·ıÂ› ÔÏÏ¿ ÚÔÁÂÓÓËÙÈÎ¿ ·ÂÈÎÔÓÈÛÙÈÎ¿ Â˘-Ú‹Ì·Ù·, fiˆ˜ ÙÔ ÔÏ˘˘‰Ú¿ÌÓÈÔ, Ë ·ÚÔ˘Û›·ÛÙfiÌ·¯Ô˘ ‹ ‹·ÙÔ˜ ÛÙÔÓ ıÒÚ·Î·, Ô ÏfiÁÔ˜ ‰È·-Ì¤ÙÚÔ˘ ÓÂ‡ÌÔÓ· ÚÔ˜ ÙË ‰È¿ÌÂÙÚÔ ÎÂÊ·Ï‹˜(¢¶/¢∫) Î·È Ô ÏfiÁÔ˜ ÓÂ‡ÌÔÓ· ÚÔ˜ ÙËÓÂÁÎ¿ÚÛÈ· ‰È¿ÌÂÙÚÔ ÙÔ˘ ıÒÚ·Î·. °È· ÙÔ˘˜ ‰Â›-ÎÙÂ˜ ·˘ÙÔ‡˜, Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈ‚Â‚·Èˆ-ıÂ› Ë ·ÍÈÔÈÛÙ›· ÙÔ˘˜ ˆ˜ ÚÔÁÓˆÛÙÈÎÒÓ ‰ÂÈ-ÎÙÒÓ ÙË˜ ¤Î‚·ÛË˜ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫ ÌÂÙ¿ÙË Á¤ÓÓËÛË, Ì¤Û· ·fi ÔÏ˘ÎÂÓÙÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜(5,6). ¶ÔÏÏ¿ Î¤ÓÙÚ· ıÂˆÚÔ‡Ó ÙÔÓ Û˘Ó‰˘·ÛÌfiÙÔ˘ ÏfiÁÔ˘ ¢¶/¢∫ <1,0 ÌÂ ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ‹·-ÙÔ˜ ÛÙÔÓ ıÒÚ·Î· ˆ˜ Î·Îfi ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË(7,8). Œ¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÛÂ ¤Ì‚Ú˘· ÌÂ ™¢∫ ËÙÈÌ‹ ÙÔ˘ ‰Â›ÎÙË ¢¶/¢∫ <0,6 Û¯ÂÙ›˙ÂÙ·È ÌÂ ıÓË-ÙfiÙËÙ· 100% (9,10). ¶ÚfiÛÊ·ÙÂ˜ ÂÍÂÏ›ÍÂÈ˜ ÛÙËÓÚÔÁÂÓÓËÙÈÎ‹ ·ÂÈÎÔÓÈÛÙÈÎ‹, Ô˘ ÂÚÈÏ·Ì‚¿-ÓÔ˘Ó ÙËÓ ÂÌ‚Ú˘˚Î‹ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· Î·ÈÙËÓ ÂÌ‚Ú˘˚Î‹ ˘ÂÚË¯ÔÁÚ·Ê›·, ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ fiÁÎÔ˘, ÙË˜Ì¿˙·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙË˜ ‰È·Ì¤ÙÚÔ˘ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜ ˆ˜ ÚÔÁÓˆÛÙÈÎÔ‡˜‰Â›ÎÙÂ˜ ¤Î‚·ÛË˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÂ ™¢∫ (11,12).

¶ÚÔÁÂÓÓËÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÛÙÂÚÔÂÈ‰ÒÓ √È ÓÂ‡ÌÔÓÂ˜ ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÌÂ ™¢∫ ·-

ÚÔ˘ÛÈ¿˙Ô˘Ó ‚ÈÔ¯ËÌÈÎ‹ Î·È ÌÔÚÊÔÏÔÁÈÎ‹ ·Óˆ-ÚÈÌfiÙËÙ·. ∂›Ó·È Ï¤ÔÓ ·Ô‰Â‰ÂÈÁÌ¤ÓÔ fiÙÈ Ë ¯Ô-Ú‹ÁËÛË ÎÔÚÙÈÎÔÂÈ‰ÒÓ ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿, fiˆ˜Î·È ÛÂ ˙Ò·, ÌÂ ™¢∫ ÚÔ¿ÁÂÈ ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ÓÂ‡ÌÔÓ· (14). øÛÙfiÛÔ, Ë ˆÊ¤ÏÂÈ· ÙˆÓ ÎÔÚÙÈ-ÎÔÂÈ‰ÒÓ ÛÂ ÓÂÔÁÓ¿ ÌÂ ™¢∫ ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ›(15). ª›· ÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË Â›Ó·È ÛÂ ÂÍ¤ÏÈ-ÍË, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔ ·ÔÙ¤ÏÂ-ÛÌ· ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ¯ÔÚ‹ÁËÛË˜ ÛÂ ·ÓıÚÒ-ÈÓ· ¤Ì‚Ú˘· ÌÂ ™¢∫ (15).

∂Ì‚Ú˘˚Î‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹∏ ·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ·

ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫ ÒıËÛÂ ÙÔ˘˜ ·È‰Ô¯ÂÈ-ÚÔ˘ÚÁÔ‡˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· ÚÔÁÂÓÓËÙÈÎ‹˜·ÓÙÈÌÂÙÒÈÛË˜. ∂›¯Â ‰È·Ù˘ˆıÂ› Ë ˘fiıÂÛË fiÙÈË ·Ó¿Ù·ÍË ÙË˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ ÛÙÔ ¤Ì‚Ú˘Ôı· Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ¿ÚÛË ÙˆÓ Û˘ÌÈÂ-ÛÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÓÂ‡-ÌÔÓ· Î·È ı· Â¤ÙÚÂÂ ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘ Î·È,Î·Ù¿ Û˘Ó¤ÂÈ·, ı· ‚ÂÏÙ›ˆÓÂ ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ‚ÚÂÊÒÓ ÌÂ ™¢∫. √È ·Ú¯ÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ·¤Ù˘¯·ÓÓ· ·Ô‰Â›ÍÔ˘Ó Î¿ÔÈÔ fiÊÂÏÔ˜ ÛÙËÓ ÂÈ‚›ˆÛËÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÎÏ·ÛÈÎ‹ - ÌÂÙ¿ ÙË Á¤ÓÓËÛË

- ·ÓÙÈÌÂÙÒÈÛË. ∆· ·ÔÁÔËÙÂ˘ÙÈÎ¿ ·ÔÙÂÏ¤-ÛÌ·Ù· ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ Î·ıÈ-ÛÙÔ‡Ó ·‰ÈÎ·ÈÔÏfiÁËÙË ÙËÓ ¤ÎıÂÛË ·˘Ù‹˜ ÙË˜ÔÌ¿‰·˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙË˜ÚÔÁÂÓÓËÙÈÎ‹˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ Â¤Ì‚·ÛË˜ (16-18). ∏ ·Ú·Ù‹ÚËÛË fiÙÈ Ù· ÓÂÔÁÓ¿ ÌÂ ·ÙÚËÛ›·Ï¿Ú˘ÁÁ· Â›¯·Ó ‰ÈÔÁÎˆÌ¤ÓÔ˘˜ ˘ÂÚÏ·ÛÙÈÎÔ‡˜ÓÂ‡ÌÔÓÂ˜ Ô‰‹ÁËÛÂ ÛÙËÓ ·Ó¿Ù˘ÍË ÔÈÎ›ÏˆÓÌÂıfi‰ˆÓ Ô˘ ‚·Û›˙ÔÓÙ·Ó ÛÙËÓ ·Ú¯‹ “ÂÈˆ-Ì¿ÙÈÛÂ ÙÔÓ ÓÂ‡ÌÔÓ· Ì¤¯ÚÈ Ó· ÌÂÁ·ÏÒÛÂÈ”(PLUG) (19). ∏ ‚ÂÏÙ›ˆÛË ÙˆÓ ÂÏ¿¯ÈÛÙ· ÂÂÌ-‚·ÙÈÎÒÓ ÙÂ¯ÓÈÎÒÓ Â¤ÙÚÂ„Â ÙËÓ ÂÌ‚Ú˘ÔÛÎÔÈ-Î‹ ÙÔÔı¤ÙËÛË Û˘ÛÎÂ˘ÒÓ ·fiÊÚ·ÍË˜ ÙË˜ ÙÚ·-¯Â›·˜, Ô˘ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛË ÙÔ˘·ÚÈıÌÔ‡ ÙˆÓ ÚfiˆÚˆÓ ÙÔÎÂÙÒÓ, ÌÂ Û˘Ó·Îfi-ÏÔ˘ıË Û˘Ó¤¯ÈÛË ÙË˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ÓÂ˘Ìfi-ÓˆÓ (7). ∏ ÂÌ‚Ú˘˚Î‹ ÙÚ·¯Â›· ·ÔÊÚ¿ÛÛÂÙ·È ÂÓ-‰ÔÌ‹ÙÚÈ· Î·È ·Ú·Ì¤ÓÂÈ ÎÏÂÈÛÙ‹ Ì¤¯ÚÈ ÙË ‰ÈÂ-Í·ÁˆÁ‹ ÙË˜ ‰È·‰ÈÎ·Û›·˜ EXIT (ex-uterointrapartum treatment), Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·ÈÌÂ ÂÎÏÂÎÙÈÎ‹ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ (20). ¶·Ú’ fiÏÔÔ˘ ÔÈ ·ÚÂÌ‚¿ÛÂÈ˜ ·˘Ù¤˜ Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓÂÚÈÔÚÈÛÌ¤ÓÂ˜, Ì›· ˘ÔÔÌ¿‰· ÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÂÛÔ‚·Ú‹ ÌÔÚÊ‹ ™¢∫ ı· ÌÔÚÔ‡ÛÂ Èı·ÓfiÙ·Ù·Ó· ˆÊÂÏËıÂ› ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· Â¤Ì‚·ÛË.

∞ÓÙÈÌÂÙÒÈÛË ÌÂÙ¿ ÙË Á¤ÓÓËÛË

∆· ÛÔ‚·ÚfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÓÂÔÁÓÒÓÌÂ ™¢∫ Â›Ó·È Ë ˘ÔÏ·Û›· ÙÔ˘ ÓÂ‡ÌÔÓ· Î·È ËÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË. ∏ ·ÓÙÈÌÂÙÒÈÛË ÛÙÔ-¯Â‡ÂÈ ÛÙËÓ È‰·ÓÈÎ‹, fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ, ·ÓÙ·ÏÏ·Á‹ÙˆÓ ·ÂÚ›ˆÓ Î·È ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÓÂ˘ÌÔÓÈ-ÎÒÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ ÌÂ ÙË ÌÈÎÚfiÙÂÚË‰˘Ó·Ù‹ ‚Ï¿‚Ë ÙˆÓ ÓÂ˘ÌfiÓˆÓ ·fi ÙË ¯Ú‹ÛËÙÔ˘ ·Ó·ÓÂ˘ÛÙ‹Ú·.

ÕÌÂÛË ·ÓÙÈÌÂÙÒÈÛË∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ™¢∫ Â›Ó·È

ÔÏ‡ÙÈÌË. ªÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Ë ‰È¿ÁÓˆÛË ÙÂÎ-ÌËÚÈÒÓÂÙ·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ÛÎ·ÊÔÂÈ‰Ô‡˜ ÎÔÈ-Ï›·˜, ÙËÓ ·Ô˘Û›· ·Ó·ÓÂ˘ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·-ÙÔ˜ ÂÙÂÚfiÏÂ˘Ú·, ÙË ÌÂÙ·ÙfiÈÛË ÙË˜ Î·Ú‰È·-Î‹˜ ÒÛË˜ Î·È ÙËÓ ‡·ÚÍË ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘-Û¯¤ÚÂÈ·˜ Î·È Î˘¿ÓˆÛË˜.

∫·Ù¿ ÙÔÓ ÙÔÎÂÙfi ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆ-ÛË, ÙÔ ÓÂÔÁÓfi Ú¤ÂÈ Ó· ‰È·ÛˆÏËÓˆıÂ› ¿ÌÂÛ·,ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÂ› Ô ·ÂÚÈÛÌfi˜ ÌÂ Ì¿ÛÎ· Î·È·ÛÎfi (ambu). ∂›ÛË˜, Ú¤ÂÈ Ó· ÙÔÔıÂÙËıÂ›ÚÈÓÔÁ·ÛÙÚÈÎfi˜ Î·ıÂÙ‹Ú·˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·Ô-Û˘ÌÊÔÚËıÂ› ÙÔ ÙÌ‹Ì· ÙÔ˘ ÂÙÈÎÔ‡ ÛˆÏ‹Ó·Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔÓ ıÒÚ·Î·. ∏ ÚfiÎÏËÛË

¶·È‰È·ÙÚÈÎ‹ 2005;68:417-423


419™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË

ÓÂ˘ÌÔıÒÚ·Î· ÛÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ËÌÈıˆÚ¿ÎÈÔ·ÔÙÂÏÂ› ÔÏ‡ ÁÓˆÛÙ‹ ÂÈÏÔÎ‹ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ·Ó¿ÓË„Ë˜.

¢Â›ÎÙÂ˜ ¤Î‚·ÛË˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Œ¯Ô˘Ó Á›ÓÂÈ ÔÏÏ¤˜ ÚÔÛ¿ıÂÈÂ˜ ÚÔÎÂÈÌ¤-

ÓÔ˘ Ó· ÂÎÙÈÌËıÂ› Ë ÛÔ‚·ÚfiÙËÙ· ÙË˜ ™¢∫ ÌÂÙ¿ÙË Á¤ÓÓËÛË Î·È Ó· ÚÔ‚ÏÂÊıÂ› ÂÓ‰Â¯fiÌÂÓË Î·-Î‹ ¤Î‚·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡, ÌÂ ÛÎÔfi ÙËÓ Î·Ï‡ÙÂ-ÚË Î·ıÔ‰‹ÁËÛË. Œ¯Ô˘Ó ÚÔÙ·ıÂ› ‰È¿ÊÔÚÂ˜ Ì¤-ıÔ‰ÔÈ, Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰È·›ÛÙˆÛË ¯·-ÌËÏ‹˜ ˙ˆÙÈÎ‹˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ ‹ ÂÓ‰ÔÙÈÎfiÙË-Ù·˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (21,22),ÙÔÓ ˘„ËÏfi ‰Â›ÎÙË ·ÂÚÈÛÌÔ‡ ‹ Ù¿ÛË ‰ÈÔÍÂÈ‰›Ô˘ÙÔ˘ ¿ÓıÚ·Î· (23-25) Î·È ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ÛÙÔÌ¿¯Ô˘ ÛÙÔ Û‡ÛÙÔÈ¯Ô ËÌÈıˆÚ¿ÎÈÔ (26). ∏Û‡ÁÎÚÈÛË ÙˆÓ ‰ÂÈÎÙÒÓ ·˘ÙÒÓ ·ÔÎ·Ï‡ÙÂÈ fiÙÈË ¯·ÌËÏ‹ ÙÈÌ‹ ÙË˜ ÂÓ‰ÔÙÈÎfiÙËÙ·˜ ÙÔ˘ ·Ó·-ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È Ô ÈÔ ·ÍÈfiÈÛÙÔ˜‰Â›ÎÙË˜ Î·Î‹˜ ¤Î‚·ÛË˜. ∂ÈÏ¤ÔÓ, Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù· ÙˆÓ ‰È·‰Ô¯ÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÙË˜ ÂÓ‰Ô-ÙÈÎfiÙËÙ·˜ ·Ô‰Â›¯ÙËÎ·Ó ÈÔ ¯Ú‹ÛÈÌ· ·fi ÙÔÓfiÁÎÔ ÙÔ˘ ÓÂ‡ÌÔÓ· ÛÙËÓ Úfi‚ÏÂ„Ë ÙË˜ ¤Î‚·-ÛË˜ (28). ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘fiÁÎÔ˘ ÓÂ‡ÌÔÓ·, Ô˘ Á›ÓÂÙ·È ÌÂ ·Ó¿Ï˘ÛË Ì¤Ûˆ˘ÔÏÔÁÈÛÙ‹ ÙË˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ÓÂ‡ÌÔÓ·ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·, ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈ-Îfi ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÛÂ ÓÂÔÁÓ¿ ÌÂ ™¢∫ (29).ª›· ÔÌ¿‰· ÌÂÏ¤ÙË˜ ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·-ÙÔÎ‹ÏË˜, Ô˘ ‰ËÌÔÛ›Â˘ÛÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù··fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ 71 Î¤ÓÙÚˆÓ,¤‰ÂÈÍÂ fiÙÈ ÔÈ ÈÔ ÛËÌ·ÓÙÈÎÔ› ‰Â›ÎÙÂ˜ ÙË˜ ¤Î‚·-ÛË˜ ‹Ù·Ó ÙÔ Apgar score ÛÙÔ 5Ô ÏÂÙfi Î·È ÙÔ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ (30).

™ÙÚ·ÙËÁÈÎ¤˜ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ O ÛÙfi¯Ô˜ ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Â›Ó·È Ó·

ÂÈÙ‡¯ÂÈ Â·ÚÎ‹ ÔÍ˘ÁfiÓˆÛË ÌÂ ÙË ¯·ÌËÏfiÙÂÚË‰˘Ó·Ù‹ ÙÈÌ‹ ıÂÙÈÎ‹˜ ÂÈÛÓÂ˘ÛÙÈÎ‹˜ ›ÂÛË˜(PIP). O ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ ÛÙfi¯Ô˜ Â›Ó·È Ë ‰È·Ù‹-ÚËÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡ ÚÈÓ ·fi ÙÔÓ ·ÚÙËÚÈ·ÎfifiÚÔ ÛÂ Â›Â‰· ÌÂÁ·Ï‡ÙÂÚ· ÙÔ˘ 85%, ÂÊ·Ú-Ìfi˙ÔÓÙ·˜ PIP ÌÈÎÚfiÙÂÚË ·fi 25-30 cm H2O(31). ∏ ÛÙÚ·ÙËÁÈÎ‹ ÙË˜ ÂÈÙÚÂfiÌÂÓË˜ ˘ÂÚ-Î·Ó›·˜ ÂÏ·ÙÙÒÓÂÈ ÙË ‚Ï¿‚Ë Ô˘ ÚÔÎ·ÏÂ› ÔÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ ÛÙÔÓ ÓÂ‡ÌÔÓ·, ˆÛÙfiÛÔÚ¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È Ë ·Ó¿Ù˘ÍË ÔÍ¤ˆÛË˜.¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊÂ˘¯ıÂ› Ë ÂÎ‰‹ÏˆÛËÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜, Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ·Ó· ‰È·ÙËÚÂ›Ù·È ÙÔ p∏ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰·,ÂÓÒ ·Ú¿ÏÏËÏ· ÔÈ ¯ÂÈÚÈÛÌÔ› ÛÙÔ ÓÂÔÁÓfi ÂÚÈÔ-Ú›˙ÔÓÙ·È ÛÙÔ˘˜ ÂÏ¿¯ÈÛÙÔ˘˜ ··Ú·›ÙËÙÔ˘˜. ∏Î·ıÈÂÚˆÌ¤ÓË ÂÊ·ÚÌÔÁ‹ Î·Ù·ÛÙÔÏ‹˜ ÌÂ ‹ ¯ˆ-

Ú›˜ Ì˘Ô¯¿Ï·ÛË ÂÚÈÔÚ›˙ÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ÓÂÔÁÓÔ‡ ¤Ó·ÓÙÈ ÙÔ˘ ·Ó·ÓÂ˘ÛÙ‹Ú· Î·È ÂÏ·¯È-ÛÙÔÔÈÂ› ÙÈ˜ ÎÚ›ÛÂÈ˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜.∏ ÂÏ¿ÙÙˆÛË ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂÓÔ˘ ÔÍ˘ÁfiÓÔ˘ Ú¤-ÂÈ Ó· Á›ÓÂÙ·È ÛÙ·‰È·Î¿, ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿-Ù˘ÍË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜. ™ÙËÓ ÂÚ›-ÙˆÛË Ô˘ Ô Û˘Ì‚·ÙÈÎfi˜ ·ÂÚÈÛÌfi˜ ‰ÂÓ Â·Ú-ÎÂ› ÁÈ· ÙËÓ ÈÎ·ÓÔÔÈËÙÈÎ‹ ÔÍ˘ÁfiÓˆÛË ÙÔ˘ ÓÂÔ-ÁÓÔ‡, ÙfiÙÂ ÂÈÚfiÛıÂÙ· ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔ-ÔÈËıÂ› ÙÔ ÂÈÛÓÂfiÌÂÓÔ NO, Ô ˘„›Û˘¯ÓÔ˜ ·ÂÚÈ-ÛÌfi˜ ‹ Î·È Ë ECMO.

∂ÈÛÓÂfiÌÂÓÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ ∆Ô ÂÈÛÓÂfiÌÂÓÔ ¡O ·ÔÙÂÏÂ› ÂÎÏÂÎÙÈÎfi

‰È·ÛÙÔÏ¤· ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ. Œ¯ÂÈ·Ô‰ÂÈ¯ÙÂ› fiÙÈ ÌÂÈÒÓÂÈ ÙËÓ ·Ó¿ÁÎË ¯Ú‹ÛË˜ ÙË˜ECMO ÛÂ ÓÂÔÁÓ¿ ÌÂ ·Ú·Ì¤ÓÔ˘Û· ÓÂ˘ÌÔÓÈÎ‹˘¤ÚÙ·ÛË (33). øÛÙfiÛÔ, ÌÂÏ¤ÙÂ˜ ÛÂ ÓÂÔÁÓ¿ ÌÂ™¢∫ ‰Â›¯ÓÔ˘Ó Ì›· ÈÔ ÔÈÎ›ÏË ·¿ÓÙËÛË ÛÙÔ¡O, ÌÂ ÔÏÏ¿ ·fi ·˘Ù¿ Ó· ÌËÓ ˆÊÂÏÔ‡ÓÙ·ÈÎ·ıfiÏÔ˘. O ÚfiÏÔ˜ ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÁÁÂÈÔ-‰È·ÛÙ·ÏÙÈÎÒÓ Ô˘ÛÈÒÓ, fiˆ˜ ÙË˜ ÙÔÏ·˙ÔÏ›ÓË˜,ÙÔ˘ ıÂÈÈÎÔ‡ Ì·ÁÓËÛ›Ô˘ Î·È ÙË˜ ÚÔÛÙ·Î˘ÎÏ›-ÓË˜, Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÔ˜. ŸÏ· Ù· ·ÁÁÂÈÔ‰È·-ÛÙ·ÏÙÈÎ¿ Ê¿ÚÌ·Î· ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÔ˘Ó Û˘-ÛÙËÌ·ÙÈÎ‹ ˘fiÙ·ÛË, ÔfiÙÂ Â›Ó·È ··Ú·›ÙËÙË Ë˘ÔÛÙ‹ÚÈÍË ÙË˜ Î˘ÎÏÔÊÔÚ›·˜ ÌÂ ÈÓfiÙÚÔ·Ê¿ÚÌ·Î· (35).

À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ O ˘„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ·ÔÙÂÏÂ› Ì›· ÂÏÎ˘-

ÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÈÛÙÚ·-ÙÂ˘ÙÔ‡Ó fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÂ˜ Î˘„ÂÏ›-‰Â˜ Î·È Ó· ÂÚÈÔÚÈÛÙÂ› ÙÔ ‚·ÚÔÙÚ·‡Ì· Î·ÈÔÁÎÔÙÚ·‡Ì· ÙÔ˘ ÓÂ‡ÌÔÓ· ÛÂ ÓÂÔÁÓ¿ ÌÂ ™¢∫.∏ Î·Ï‡ÙÂÚË ÂÈÛÙÚ¿ÙÂ˘ÛË ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓÎ˘„ÂÏ›‰ˆÓ Û˘ÓÙÂÏÂ› Î·È ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙÂÚË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ¡O ÛÙ· ÓÂ˘ÌÔÓÈÎ¿ ·ÁÁÂ›·(36). ¢È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÓÂÔÁÓ¿ÌÂ ™¢∫, ÛÙ· ÔÔ›· ÂÊ·ÚÌfiÛÙËÎÂ ˘„›Û˘¯ÓÔ˜·ÂÚÈÛÌfi˜, Â›¯·Ó Î·Ï‡ÙÂÚË ¤Î‚·ÛË (37,38).øÛÙfiÛÔ, ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ‚Ú¤ıËÎÂ Î·Ì›·‰È·ÊÔÚ¿ (39,40). ¶ÔÏÏ¿ Î¤ÓÙÚ· ÂÊ·ÚÌfi˙Ô˘ÓÙÔÓ ˘„›Û˘¯ÓÔ ·ÂÚÈÛÌfi ˆ˜ ‡ÛÙ·ÙË ıÂÚ·Â›· ÛÂÓÂÔÁÓ¿ ÌÂ ™¢∫.

∂ÍˆÛˆÌ·ÙÈÎ‹ ÔÍ˘ÁfiÓˆÛË ÌÂ ÙË ¯Ú‹ÛËÌÂÌ‚Ú·ÓÒÓ ∏ ECMO ÚˆÙÔÂÌÊ·Ó›ÛÙËÎÂ ÛÙ· Ù¤ÏË ÙË˜

‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’70. ∞ÊÔÚÔ‡ÛÂ ÛÙË ¯Ú‹ÛË ÌÂÚÈ-Î‹˜ Î·Ú‰ÈÔÓÂ˘ÌÔÓÈÎ‹˜ ·Ú¿Î·Ì„Ë˜, Ô˘Â¤ÙÚÂÂ ÛÙÔÓ ÓÂ‡ÌÔÓ· Ó· ÍÂÎÔ˘Ú·ÛÙÂ› Î·ÈÓ· ÌÂÈˆıÔ‡Ó ÔÈ ÓÂ˘ÌÔÓÈÎ¤˜ ·ÓÙÈÛÙ¿ÛÂÈ˜, ÂÓÒ Ë

¶·È‰È·ÙÚÈÎ‹ 2005;68:417-423



ÔÍ˘ÁfiÓˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÁÈÓfiÙ·Ó Ì¤Ûˆ ÙÂ¯ÓË-Ù‹˜ Î˘ÎÏÔÊÔÚ›·˜. ∏ Î‡ÚÈ· ¤Ó‰ÂÈÍË ÁÈ· ÙË ¯Ú‹-ÛË ÙË˜ ECMO ‹Ù·Ó Ë ·ÔÙ˘¯›· ÙË˜ Û˘Ì‚·ÙÈ-Î‹˜ ıÂÚ·Â›·˜, fiˆ˜ ÔÚÈ˙fiÙ·Ó ·fi ÙÈÌ¤˜ ÙÔ˘‰Â›ÎÙË ÔÍ˘ÁfiÓˆÛË˜ >40 (‰Â›ÎÙË˜ ÔÍ˘ÁfiÓˆÛË˜= Ì¤ÛË ›ÂÛË ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ x FiO2 x100/PaO2 ÌÂÙ¿ ÙÔÓ ·ÚÙËÚÈ·Îfi fiÚÔ) (41). ∆··ÔÙÂÏ¤ÛÌ·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙË ¯Ú‹ÛË ‹ ÌË ÙË˜ECMO ÛÙË ™¢∫ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·. ∏ Û˘ÓÔ-ÏÈÎ‹ ÂÈ‚›ˆÛË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫ Ô˘ ·Ó·-Ê¤ÚÂÈ Ô OÚÁ·ÓÈÛÌfi˜ ∂ÍˆÛˆÌ·ÙÈÎ‹˜ ÀÔÛÙ‹ÚÈ-ÍË˜ ÙË˜ ∑ˆ‹˜ (Extracorporeal Life SupportOrganization - ELSO) Â›Ó·È ÂÚ›Ô˘ 60%, Ô-ÛÔÛÙfi Ô˘ Â›Ó·È ÙÔ ¯·ÌËÏfiÙÂÚÔ ÌÂÙ·Í‡ ÙˆÓ ÓÂ-ÔÁÓÒÓ ÌÂ ÔÍÂ›· ˘ÔÍ·ÈÌÈÎ‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ-¿ÚÎÂÈ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ˘ÔÛÙ‹ÚÈÍË ·fi ÙËÓECMO (31). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· Ì›·˜ ÔÏ˘ÎÂ-ÓÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ÛÙË ª. µÚÂÙ·Ó›· ¤‰ÂÈÍ·Ó fiÙÈ Ë¯Ú‹ÛË ÙË˜ ECMO ˆÊ¤ÏËÛÂ Ù· ·È‰È¿ ÌÂ ·Ó·-ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÂÓÒ ‰ÂÓ Â›¯Â Î·Ó¤Ó·fiÊÂÏÔ˜ ÁÈ· Ù· ÓÂÔÁÓ¿ ÌÂ ™¢∫ (41). Œ¯ÂÈ ÚÔÙ·-ıÂ› fiÙÈ Ë ECMO Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·ÈÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÚÔÂÍ¿Ú¯ÂÈ Ë ÓÂ˘ÌÔÓÈ-Î‹ ˘¤ÚÙ·ÛË, ·ÏÏ¿ fi¯È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ fiÔ˘˘¿Ú¯ÂÈ ‚·ÚÈ¿ ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›· (42).

∂ÍˆÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡·Ú¿ÁÔÓÙ· ¶·Ú’ fiÏÔ Ô˘ ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰Â›-

¯ÓÔ˘Ó ·ÓˆÚÈÌfiÙËÙ· ÛÙË Û‡ÛÙ·ÛË ÙÔ˘ ÂÈÊ·-ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙ· ÓÂÔÁÓ¿ ÌÂ ™¢∫,‰ÂÓ ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› Â¿Ó ÛÙ· ÓÂÔÁÓ¿ ·˘Ù¿ ¤¯ÂÈ¤Ó‰ÂÈÍË Ë ¯ÔÚ‹ÁËÛË ÂÍˆÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·-ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ª›· Ù˘¯·ÈÔÔÈËÌ¤ÓË ÌÂÏ¤-ÙË Û¯ÂÙÈÎ¿ ÌÂ ÙË ¯Ú‹ÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡·Ú¿ÁÔÓÙ· ‰ÂÓ ¤‰ÂÈÍÂ ÂÌÊ·Ó‹ ÔÊ¤ÏË ÛÂ ÓÂÔ-ÁÓ¿ ÌÂ ™¢∫ (44). ¶·ÚfiÌÔÈ·, Ì›· ÔÌ¿‰· ÌÂÏ¤-ÙË˜ ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜, Ô˘ÚfiÛÊ·Ù· ‰ËÌÔÛ›Â˘ÛÂ ‰Â‰ÔÌ¤Ó· 2.284 ·ÛıÂ-ÓÒÓ ·fi 81 Î¤ÓÙÚ·, 67 ÛÙÈ˜ ∏¶∞ Î·È 14 ÂÎÙfi˜∏¶∞, ‰ÂÓ ‰È·›ÛÙˆÛÂ Î·Ó¤Ó· ÛËÌ·ÓÙÈÎfi fiÊÂ-ÏÔ˜ ·fi ÙË ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·-Ú¿ÁÔÓÙ· ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ ÚÔÁÂÓÓËÙÈ-Î‹ ‰È¿ÁÓˆÛË ™¢∫ (45).

∞ÂÚÈÛÌfi˜ ÌÂ ˘ÁÚfi ∏ ¯Ú‹ÛË ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÌÂ ˘ÁÚfi ÛÙËÓ ÎÏÈÓÈÎ‹

Ú¿ÍË ˘fiÛ¯ÂÙ·È ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈ‚›ˆÛË˜ ÙˆÓÓÂÔÁÓÒÓ ÌÂ ™¢∫. £ÂˆÚËÙÈÎ¿, ÙÔ ÏÂÔÓ¤ÎÙËÌ·ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÌÂ ˘ÁÚfi Â›Ó·È fiÙÈ - ·ÓÙ›ıÂÙ· ÌÂ Ù··¤ÚÈ· - ÙÔ ˘ÁÚfi ‰È·Ó¤ÌÂÙ·È ÔÌÔÈfiÌÔÚÊ· ÛÙÔÓÓÂ‡ÌÔÓ·, ÂÓÒ ·Ú¿ÏÏËÏ· ÂÏ·ÙÙÒÓÂÈ ÙfiÛÔ ÙËÓÂÓ‰È¿ÌÂÛË Ê¿ÛË (interface) ·¤Ú·-˘ÁÚÔ‡ fiÛÔ Î·È

ÙËÓ ÂÈÊ·ÓÂÈ·Î‹ Ù¿ÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ. √È ÌÂÏ¤-ÙÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ¯Ú‹ÛË ÙË˜ ÌÂıfi‰Ô˘ ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ™¢∫ ‚Ú›ÛÎÔÓÙ·È ·ÎfiÌË ÛÂÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ (46). ª¤¯ÚÈ Û‹ÌÂÚ·, Ù··ÔÙÂÏ¤ÛÌ·Ù· ‰ÂÓ ‹Ù·Ó È‰È·›ÙÂÚ· ÈÎ·ÓÔÔÈËÙÈ-Î¿, ·Ó Î·È Â›Ó·È ÂÓÙ˘ˆÛÈ·Î‹ Ë ·Ó¿Ù˘ÍË ÙˆÓÓÂ˘ÌfiÓˆÓ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂÙ¿ ÙË Á¤ÓÓË-ÛË ÌÂ ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË Ì¤ıÔ‰Ô (47).

ÃÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ™¢∫ ¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ¯ÂÈÚÔ˘Ú-

ÁÈÎ‹ ‰ÈfiÚıˆÛË ÙË˜ ·Ó·ÙÔÌÈÎ‹˜ ‚Ï¿‚Ë˜ ‰ÂÓ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ (31).∞ÓÙ›ıÂÙ·, ÌÔÚÂ› ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿ Ó· ˘¿ÚÍÂÈ·ÎfiÌ· Î·È ÂÈ‰Â›ÓˆÛË ÙË˜ ÌË¯·ÓÈÎ‹˜ ÙË˜ ·Ó·-ÓÔ‹˜ (22). ¶ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ Â›Ó·È Ë Î·Ï‹ Î·Ú-‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ÚÔÂÁ¯ÂÈÚËÙÈÎ¿ (48).

∏ ÂÁ¯Â›ÚËÛË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì¤Ûˆ Ì›·˜˘ÔÏÂ‡ÚÈ·˜ ÙÔÌ‹˜, ·Ó Î·È ÛÂ ‚Ï¿‚Â˜ Ô˘Â‰Ú¿˙ÔÓÙ·È ‰ÂÍÈ¿ Û¿ÓÈ· ÂÎÙÂÏÂ›Ù·È ıˆÚ·ÎÔ-ÙÔÌ‹. ∞Ú¯ÈÎ¿, ÙÔ ¤ÏÏÂÈÌÌ· Û˘ÁÎÏÂ›ÂÙ·È fiÔ˘Â›Ó·È ‰˘Ó·Ùfi. ∂¿Ó ÙÔ ¤ÏÏÂÈÌÌ· Â›Ó·È ÌÂÁ¿ÏÔ,ÌÔÚÂ› Ó· ¯ÚÂÈ·ÛÙÂ› ÚfiÛıÂÙÔ ÙÂÌ¿¯ÈÔ. ∂¿Ó ÔÊ˘ÛÈÎfi˜ ÈÛÙfi˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ‰ÂÓ Â·ÚÎÂ›, ÙfiÙÂÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÚÔÛıÂÙÈÎ¿ ˘ÏÈ-Î¿, fiˆ˜ GoretexTM (WL Gore, Flagstaff, AZ)ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÎÏÂ›ÛÂÈ ÙÔ ¤ÏÏÂÈÌÌ· (49). ™¿-ÓÈ·, ·ÓÙ› ÙË˜ Û˘ÚÚ·Ê‹˜ ÙˆÓ Ì˘ÒÓ, ·Ê‹ÓÂÙ·È·ÓÔÈÎÙfi ÙÔ ÙÚ·‡Ì· ÙË˜ Ï··ÚÔÙÔÌ›·˜, ÚÔÎÂÈ-Ì¤ÓÔ˘ Ó· ·ÔÊÂ˘¯ıÂ› Ë ·Ó¿Ù˘ÍË ˘„ËÏ‹˜ ÂÓ-‰ÔÎÔÈÏÈ·Î‹˜ ›ÂÛË˜ ÌÂÙ¿ ÙËÓ ·Ó¿Ù·ÍË ÙˆÓ ÂÓ-‰ÔÎÔÈÏÈ·ÎÒÓ ÔÚÁ¿ÓˆÓ ·fi ÙÔÓ ıÒÚ·Î·. ™ÙËÓÂÚ›ÙˆÛË ·˘Ù‹, ÙÔÔıÂÙÂ›Ù·È ÚÔÛıÂÙÈÎfi˘ÏÈÎfi ÛÙÔ ÙÚ·‡Ì·.

ª·ÎÚÔÚfiıÂÛÌË ¤Î‚·ÛË

∆· ÓÂÔÁÓ¿ ÌÂ ™¢∫ Ô˘ ÙÂÏÈÎ¿ ÂÈ‚ÈÒÓÔ˘Ó,·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ· Ô˘ÔÊÂ›ÏÂÙ·È ÛÙË ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹ ‰˘ÛÏ·Û›·(50,51), ÛÙËÓ ·ÔÊÚ·ÎÙÈÎ‹ ÓÂ˘ÌÔÓÔ¿ıÂÈ·(51), ÛÙÈ˜ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡(52), ÛÙË ÌË ÈÎ·ÓÔÔÈËÙÈÎ‹ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜Î·È ÛÙË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË(53,54), ÛÙËÓ ˘ÔÙÚÔ‹ ÙË˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹-ÏË˜ (55) Î·È ÛÙËÓ ÂÓÙÂÚÈÎ‹ ·fiÊÚ·ÍË (55).∂ÈÏ¤ÔÓ, ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ ˘¿Ú¯Ô˘ÓÛÔ‚·Ú¤˜ ·Ó·ËÚ›Â˜, fiˆ˜ ËÌÈÏËÁ›· (56) ‹ Î·-ı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË (55). ∆¤ÏÔ˜, ··-Ú·›ÙËÙË Â›Ó·È Ë Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛËÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÈ‚ÈÒÓÔ˘Ó (55).

¶·È‰È·ÙÚÈÎ‹ 2005;68:417-423



ªÂÏÏÔÓÙÈÎ¤˜ ÚÔÔÙÈÎ¤˜

∏ ‚ÂÏÙ›ˆÛË ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜Î·È Ô Î·ıÔÚÈÛÌfi˜ ÈÔ ·ÍÈfiÈÛÙˆÓ ÚÔÁÓˆÛÙÈ-ÎÒÓ ‰ÂÈÎÙÒÓ, ÒÛÙÂ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È¿ÎÚÈÛËÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÂ ™¢∫ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó·ÂˆÊÂÏËıÔ‡Ó ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ·Ú¤Ì‚·-ÛË, ·ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ ÂÏÈ‰ÔÊfiÚ· ÚÔÔÙÈ-Î‹. ∏ ÛˆÛÙ‹ ÂÈÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ÁÈ· ÚÔÁÂÓ-ÓËÙÈÎ‹ ·Ú¤Ì‚·ÛË ··ÈÙÂ› ÈÔ ·ÍÈfiÈÛÙÔ˘˜ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜ Î·Î‹˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜¤Î‚·ÛË˜. ∏ ÂÓ‰ÔÌ‹ÙÚÈ· Â¤Ì‚·ÛË Î¿Ùˆ ·fiÂÓ‰ÔÛÎÔÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÌ‚Ú‡Ô˘, Â›Ó·È Èı·-Ófi Ó· ·ÔÙÂÏÂ› ÙËÓ È‰·ÓÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÁÈ·ÙÈ˜ ™¢∫ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ë ‰È¿ÁÓˆÛË ÙˆÓÔÔ›ˆÓ Á›ÓÂÙ·È ÚÔÁÂÓÓËÙÈÎ¿. ∏ È‰¤· ÙË˜ ·fi-ÊÚ·ÍË˜ ÙË˜ ÙÚ·¯Â›·˜ ÁÈ· Ó· ÚÔÏËÊıÂ› Ë ÓÂ˘-ÌÔÓÈÎ‹ ˘ÔÏ·Û›·, ·ÔÙÂÏÂ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂ-ÚÔ ÌÂÏÏÔÓÙÈÎfi ÛÙfi¯Ô.

ªÂÙ¿ ÙË Á¤ÓÓËÛË, Ë ÂÊ·ÚÌÔÁ‹ ıÂÚ·Â˘ÙÈ-ÎÒÓ Ì¤ÛˆÓ Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔ ‚·ÚÔ-/ÔÁÎÔÙÚ·‡-Ì· ÌÔÚÂ› Ó· ÛÒÛÂÈ Ù· ÓÂÔÁ¤ÓÓËÙ· ÌÂ ÌÈÎÚ‹˜‚·Ú‡ÙËÙ·˜ ˘ÔÏ·Û›· ÙˆÓ ÓÂ˘ÌfiÓˆÓ. O Úfi-ÏÔ˜ ÙÔ˘ ÂÈÛÓÂfiÌÂÓÔ˘ ¡O Ú¤ÂÈ Ó· ‰ÈÂ˘ÎÚÈ-ÓÈÛÙÂ› ÌÂ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÒÛÙÂ Ó· Î·ıÈÂÚˆ-ıÔ‡Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏ-Ï·. ∂ÈÏ¤ÔÓ, Û˘ÓÂ¯›˙ÂÙ·È Ë ¤ÚÂ˘Ó· ÁÈ· Ê·ÚÌ·-ÎÂ˘ÙÈÎ¤˜ Ô˘Û›Â˜ ÌÂ ‰Ú¿ÛË ÛÙËÓ ·ÓÙ›ÛÙ·ÛË ÙˆÓÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ.

∏ ÊÏÂ‚Ô-ÊÏÂ‚ÈÎ‹ ÂÍˆÛˆÌ·ÙÈÎ‹ ÔÍ˘ÁfiÓˆ-ÛË, Èı·ÓÒ˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ‰È¿Ù·ÛË ÙˆÓÓÂ˘ÌfiÓˆÓ ÌÂ ÂÚÊÏÔ˘ÔÚ¿ÓıÚ·ÎÂ˜, ›ÛÔ˜ Ó··ÔÙÂÏ¤ÛÂÈ ÙËÓ È‰·ÓÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤Á-ÁÈÛË ÁÈ· ÓÂÔÁÓ¿ ÌÂ ™¢∫ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔ-ÓÙ·È ÛÂ ÏÈÁfiÙÂÚÔ ÂÈıÂÙÈÎ¤˜ ıÂÚ·Â›Â˜.


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¶·È‰È·ÙÚÈÎ‹ 2005;68:417-423


424 REVIEW ARTICLE

Guy’s, Kings’ & St. Thomas’School of Medicine, London, UK

Correspondence:Charalambos Agakidis 28 Glinou, Str., 543 52, Thessaloniki E-mail: [email protected]



Advances in the management of congenitaldiaphragmatic hernia G. Dimitriou, C. Agakidis

AbstractCongenital diaphragmatic hernia (CDH) is a life-threatening malformation with an incidence of 1 in2,000-5,000 live births. With the widespread use of antenatal ultrasound CDH is being diagnosedprenatally with increasing frequency. The benefits of prenatal intervention and postnatal use of newtherapeutic modalities, including high frequency oscillation, inhaled nitric oxide, extracorporealmembrane oxygenation and liquid ventilation, have not yet been proved. Future directions forimproving the outcome include improved antenatal diagnosis and definition of more accurateindicators to identify the fetuses with CDH who might benefit from fetal intervention, as well as betterassessment of the role of postnatal therapies in reducing the baro-/volume-trauma and thepulmonary vascular resistance.

Key wordsDiaphragmatic hernia, fetus, fetal surgery, mechanical ventilation, oxygenation.


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Úfi‚ÏËÌ·, Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÛÂ ÓÔÛÔÎÔÌÂ›ÔÁÈ· ÓÂ˘ÌÔÓ›·, ÌÂ ÙË ¯Ú‹ÛË ÌË ·ÈÌ·ÙËÚÒÓ ‰È·-ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ªÂÏÂÙ‹ıËÎ·Ó 40 ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË ¢’¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£. ÁÈ· ÓÂ˘ÌÔÓ›·, 22 ·ÁfiÚÈ·(55%) Î·È 18 ÎÔÚ›ÙÛÈ· (45%), ËÏÈÎ›·˜ 1-13 ÂÙÒÓ (Ì¤ÛËËÏÈÎ›·: 5,83 ± 3,46 ¤ÙË). ŸÏÔÈ ÔÈ ÁÔÓÂ›˜ ÂÓËÌÂÚÒıËÎ·ÓÁÈ· ÙÔ ÛÎÔfi ÙË˜ ÌÂÏ¤ÙË˜ Î·È ‰ÂÓ ˘‹ÚÍÂ Î·Ì›· ·ÓÙ›Ú-ÚËÛË. ∏ ‰È¿ÁÓˆÛË ÙË˜ ÓÂ˘ÌÔÓ›·˜ ‚·Û›ÛÙËÎÂ ÛÙ· ÎÏ·-ÛÈÎ¿ ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· (14,15). ªÂ ‚¿ÛË ÙÔÓ ÙË-ÚÔ‡ÌÂÓÔ Ê¿ÎÂÏÔ ÓÔÛËÏÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÁÓˆÛÙÔ‡˜·ÛıÂÓÂ›˜ ‹ ÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È ÙÔÓ ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÁÈ· ·ÛıÂÓÂ›˜ Ô˘ ÂÈÛ¿ÁÔÓÙ·Ó ÁÈ·ÚÒÙË ÊÔÚ¿, ·ÔÎÏÂ›ÛÙËÎ·Ó ·fi ÙË ÌÂÏ¤ÙË Ù· ·È‰È¿ÛÙ· ÔÔ›· ˘‹Ú¯Â Û˘ÁÁÂÓ‹˜ Î·Ú‰ÈÔ¿ıÂÈ·, ¯ÚfiÓÈ·ÓÂ˘ÌÔÓÔ¿ıÂÈ·, ÚÔˆÚfiÙËÙ·, ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹ ‰˘-ÛÏ·Û›·, ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹-Ì·Ù· Î·È ÓÂ˘ÚÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·. ∫·Ù·ÁÚ¿ÊËÎ·ÓÎ·È ·Ó·Ï‡ıËÎ·Ó ÔÈ ÙÈÌ¤˜ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓÊÏÂÁÌÔÓ‹˜, ÙˆÓ ‰ÂÈÎÙÒÓ ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘‚·ıÌÔ‡ ‰‡ÛÓÔÈ·˜, ÙÔ˘ ÎÔÚÂÛÌÔ‡ ÛÂ O2 ÙË˜ ·ÈÌÔÛÊ·È-Ú›ÓË˜ ÌÂ ÛÊ˘ÁÌÈÎ‹ ÔÍ˘ÌÂÙÚ›· Î·È ÔÈ ÙÈÌ¤˜ ÙˆÓ Ë¯ÔÎ·Ú-‰ÈÔÁÚ·ÊÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ·fi ÙË ÌÔÚÊÔÏÔÁÈÎ‹-·ÂÈ-ÎÔÓÈÛÙÈÎ‹ ÂÍ¤Ù·ÛË Î·È ·fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜Î·È ‰È·ÛÙÔÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∏ÂÍ¤Ù·ÛË ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓÂ ÛÂ ÙÚ›· ÛÙ¿‰È·: Î·Ù¿ ÙËÓ ÂÈ-Û·ÁˆÁ‹, Î·Ù¿ ÙË 15Ë ËÌ¤Ú· ÓfiÛËÛË˜ Î·È Î·Ù¿ ÙËÓ 60‹ËÌ¤Ú·. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·È Û¯ÔÏÈ¿˙ÔÓÙ·È Ù· Â˘Ú‹Ì·Ù·ÙË˜ ÚÒÙË˜ ÂÍ¤Ù·ÛË˜ (Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹).

ªÂ ÎÏÈÓÈÎ¿, ÔÚÔÏÔÁÈÎ¿ Î·È ÌÈÎÚÔ‚ÈÔÏÔÁÈÎ¿ ÎÚÈÙ‹-ÚÈ· ·Ô‰Â›¯ÙËÎ·Ó: ·) ÈÔÁÂÓ‹˜ ·ÈÙÈÔÏÔÁ›· ÛÂ 13 ·ÛıÂ-ÓÂ›˜, ‚) Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÛÂ 5 Î·È Á) ÌÈÎÚÔ-‚È·Îfi˜ ·Ú¿ÁˆÓ ÛÂ 22 ·ÛıÂÓÂ›˜. ∏ ·ÈÙÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË¤ÁÈÓÂ ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ªÈÎÚÔ‚ÈÔÏÔÁ›·˜ Î·È πÔÏÔÁ›·˜ ÙÔ˘∞.¶.£. ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙÔ˘˜·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

∏ Î·Ú‰ÈÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÂÚÈÂÏ¿Ì‚·ÓÂ ÎÏÈÓÈÎ‹ÂÍ¤Ù·ÛË, ∏∫°, ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· Î·È Ë¯ÔÎ·Ú‰ÈÔ-ÁÚ¿ÊËÌ· m-mode, ‰ÈÛ‰È¿ÛÙ·ÙÔ Î·È Doppler, Û˘Ì‚·ÙfiÎ·È ¤Á¯ÚˆÌÔ, ÌÂ ‰È·ıˆÚ·ÎÈÎ‹ ÚÔÛ¤Ï·ÛË. ∏ Ë¯ÔÎ·Ú-‰ÈÔÁÚ·ÊÈÎ‹ ÂÍ¤Ù·ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ·fi ÙÔÓ ›‰ÈÔ¿ÓÙÔÙÂ ÂÍÂÙ·ÛÙ‹. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÌÔÚÊÔÙÚÔÂ›˜ÙˆÓ 5 Î·È 2,8 MHz, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· Î·È ÙË Ì¿˙·ÛÒÌ·ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÛÂ Î·Ì›· ÂÚ›-ÙˆÛË ‰ÂÓ ··ÈÙ‹ıËÎÂ ¯ÔÚ‹ÁËÛË ËÚÂÌÈÛÙÈÎÒÓ. °È· ÙËÓÂÎÙ›ÌËÛË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÏÂÈÙÔ˘Ú-Á›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÌÂÙÚ‹ıËÎ·Ó Î·È Î·Ù·ÁÚ¿-ÊËÎ·Ó: Ë ‰È·ÛÙÔÏÈÎ‹ (LVPWd) Î·È Û˘ÛÙÔÏÈÎ‹(LVPWs) ‰È¿ÌÂÙÚÔ˜ ÙÔ˘ Ô›ÛıÈÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜ ·ÚÈ-ÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (∞∫), Ë ‰È·ÛÙÔÏÈÎ‹ (LVDd) Î·È Û˘ÛÙÔ-ÏÈÎ‹ (LVDs) ‰È¿ÌÂÙÚÔ˜ ÙË˜ ∞∫, Ë ‰È·ÛÙÔÏÈÎ‹ (IVSd)Î·È Û˘ÛÙÔÏÈÎ‹ (IVSs) ‰È¿ÌÂÙÚÔ˜ ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡‰È·ÊÚ¿ÁÌ·ÙÔ˜, Ô ‰È·ÛÙÔÏÈÎfi˜ (DV) Î·È Û˘ÛÙÔÏÈÎfi˜(SV) fiÁÎÔ˜ ÙË˜ ∞∫, Ô ‰Â›ÎÙË˜ ‚Ú¿¯˘ÓÛË˜ ÈÓÒÓ (SF), ÙÔÎÏ¿ÛÌ· ÂÍÒıËÛË˜ (EF), Ô Û˘ÛÙÔÏÈÎfi˜ fiÁÎÔ˜ ÂÍÒıËÛË˜(SVã) ÙË˜ ∞∫, Ë Ì¤ÁÈÛÙË Ù·¯‡ÙËÙ· ÚˆÙÔ‰È·ÛÙÔÏÈÎ‹˜ÚÔ‹˜ (E), Ë Ì¤ÁÈÛÙË Ù·¯‡ÙËÙ· ÙÂÏÔ‰È·ÛÙÔÏÈÎ‹˜ ÚÔ‹˜

(A), Ô ¯ÚfiÓÔ˜ ˘ÛÙ¤ÚËÛË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÚÔ‹˜ (drt) Î·È ËÛ¯¤ÛË ∂/∞, ·fi ÙË ÌÂÏ¤ÙË ÌÂ Doppler ÙË˜ ‰È·ÌÈÙÚÔÂÈ-‰ÈÎ‹˜ ÚÔ‹˜. ∞fi ÙÈ˜ ‰‡Ô ÌÂÙÚ‹ÛÂÈ˜ Ô˘ Á›ÓÔÓÙ·Ó ÁÈ·Î¿ıÂ ·ÛıÂÓ‹, Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ·ÓÒÙÂÚÂ˜ ÙÈÌ¤˜.

∏ ‰È¿ÁÓˆÛË ÙË˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·˜ Î·È ÙË˜ ÂÚÈÎ·Ú‰›-ÙÈ‰·˜ ÛÙËÚ›¯ÙËÎÂ ÛÙ· ÎÏÈÓÈÎ¿, ·ÎÙÈÓÔÏÔÁÈÎ¿, ËÏÂÎÙÚÔ-Î·Ú‰ÈÔÁÚ·ÊÈÎ¿ Î·È Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙË˜‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ (9,10,16-19) Ô˘ ¯ÚËÛÈÌÔÔ›-ËÛ·Ó Î·È ¿ÏÏÔÈ Û˘ÁÁÚ·ÊÂ›˜.

ªÂ ÎÚÈÙ‹ÚÈÔ Ù· ıÂÙÈÎ¿ ‹ Ù· ·ÚÓËÙÈÎ¿ Â˘Ú‹Ì·Ù·, Ù·ÂÓ‰ÂÈÎÙÈÎ¿ ‹ ·Ô‰ÂÈÎÙÈÎ¿ ÁÈ· Ì˘ÔÎ·Ú‰›ÙÈ‰· ‹ ÂÚÈÎ·Ú-‰›ÙÈ‰· ‹ ÌÈÎÙ‹ Î·Ú‰È·Î‹ ‚Ï¿‚Ë, ÔÈ ·ÛıÂÓÂ›˜ ¯ˆÚ›ÛÙË-Î·Ó ÛÂ ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· ∞ (20 ·ÛıÂÓÂ›˜ ÌÂ Î·Ú-‰È·Î‹ Û˘ÌÌÂÙÔ¯‹) Î·È ÙËÓ ÔÌ¿‰· µ (20 ·ÛıÂÓÂ›˜ ¯ˆÚ›˜Î·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹).

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÂÚÈÂÏ¿Ì‚·ÓÂ: ·) ¤ÏÂÁ¯Ô ÙË˜ÔÌ·Ï‹˜ Î·Ù·ÓÔÌ‹˜ fiÏˆÓ ÙˆÓ ÔÛÔÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ(“ÌË ·Ú·ÌÂÙÚÈÎ‹ ‰ÔÎÈÌ·Û›· ÙˆÓ Kolmogorow-Smirnoff”), ‚) ˘ÔÏÔÁÈÛÌfi ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜, ÙË˜ ÛÙ·ıÂ-Ú‹˜ ·fiÎÏÈÛË˜ Î·È ÙÔ˘ ÛÙ·ıÂÚÔ‡ ÛÊ¿ÏÌ·ÙÔ˜, Á) ‰ÔÎÈ-Ì·Û›· t (“student-t test ÁÈ· ·ÓÂÍ¿ÚÙËÙ· ‰Â›ÁÌ·Ù·”), ‰)ÂÎÙ›ÌËÛË ÙˆÓ Û˘ÓÙÂÏÂÛÙÒÓ Û˘Û¯¤ÙÈÛË˜ [¯ÚËÛÈÌÔÔÈ‹-ıËÎÂ Ë ÛÙ·ÙÈÛÙÈÎ‹ ‰¤ÛÌË SPSS for Windows 98 (1998,SPSS Inc)] Î·È Â) ÛÙ·ÙÈÛÙÈÎ‹ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓÙˆÓ Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ·fi ÙËÓ Ë¯ÔÎ·Ú-‰ÈÔÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ‰È·ÛÙÔÏÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ∞ Î·È µ, ÌÂÙ¿ ·fi ÂÍ·›ÚÂÛË ÙÔ˘ ÌÔÓ·‰ÈÎÔ‡ ·ÛıÂÓÔ‡˜ÙË˜ ÔÌ¿‰·˜ ∞ ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰·, ÙÔ˘ ÔÔ›Ô˘ ÔÈ ÙÈÌ¤˜ ·-ÚÔ˘Û›·˙·Ó ÌÂÁ¿ÏË ·fiÎÏÈÛË ·fi ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙˆÓ˘fiÏÔÈˆÓ ·ÛıÂÓÒÓ ÙË˜ ›‰È·˜ ÔÌ¿‰·˜ (20).

ŸÙ·Ó ÙÔ p ‚Ú¤ıËÎÂ >0,05 Ë ÛÙ·ÙÈÛÙÈÎ‹ ‰È·ÊÔÚ¿ ıÂ-ˆÚ‹ıËÎÂ ˆ˜ ÌË ÛËÌ·ÓÙÈÎ‹, fiÙ·Ó ‹Ù·Ó p<0,05 ıÂˆÚ‹-ıËÎÂ ˆ˜ ÛËÌ·ÓÙÈÎ‹ Î·È fiÙ·Ó p<0,001 ˆ˜ ÔÏ‡ ÛËÌ·-ÓÙÈÎ‹.

∞ÔÙÂÏ¤ÛÌ·Ù·

∫ÏÈÓÈÎ¿ Î·È ·ÈÌ·ÙÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· OÈ ·ÛıÂÓÂ›˜ ÚÔÛÎÔÌ›˙ÔÓÙ·Ó Î·Ù¿ Ì¤ÛÔ

fiÚÔ ÙËÓ 4Ë-5Ë ËÌ¤Ú· ÙË˜ ÓfiÛÔ˘, ÌÂ Î‡ÚÈÔ ÎÚÈ-Ù‹ÚÈÔ ÙÔÓ ˘ÚÂÙfi. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜˘‹Ú¯·Ó: ˘ÚÂÙfi˜ >38ÔC, ‚‹¯·˜, ·‡ÍËÛË ÙË˜∆∫∂ (30-85 ÙËÓ 1Ë ÒÚ·) Î·È ·‡ÍËÛË ÙË˜ C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜. ¶ÚÔÊ·Ó‹˜ ·ÓËÛ˘¯›·Î·È ÂÚÂıÈÛÙÈÎfiÙËÙ· ˘‹Ú¯Â ÛÙÔ 68,4% ÙˆÓ ·È-‰ÈÒÓ ÙË˜ ÔÌ¿‰·˜ ∞ Î·È ÛÙÔ 50% ÙË˜ ÔÌ¿‰·˜ µ.™Ô‚·Ú‹ ‰‡ÛÓÔÈ·, ¯ˆÚ›˜ Î˘¿ÓˆÛË, Û˘ÓÔ‰Â˘fi-ÌÂÓË ·fi Ù·¯˘Î·Ú‰›·, Ë·ÙÔÌÂÁ·Ï›· Î·È Î·Ú-‰ÈÔıˆÚ·ÎÈÎfi ‰Â›ÎÙË >0,60 Â›¯Â Ô ·ÛıÂÓ‹˜ ÙË˜ÔÌ¿‰·˜ A ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰·. ª¤ÙÚÈÔ˘ ‚·ıÌÔ‡‰‡ÛÓÔÈ· (score 5-7) ÌÂ Î·Ú‰ÈÔıˆÚ·ÎÈÎfi ‰Â›-ÎÙË 0,55-0,599 ÂÌÊ¿ÓÈÛ·Ó 4/20 ·ÛıÂÓÂ›˜ ÙË˜ÔÌ¿‰·˜ ∞ (12,5%), ÛÂ ‰‡Ô ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Ë·ÈÙ›· ÙË˜ ÓÂ˘ÌÔÓ›·˜ ‹Ù·Ó ÈÔÁÂÓ‹˜ Î·È ÛÂ ‰‡ÔÌ˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜. ∆· ËÏÂÎÙÚÔÎ·Ú-‰ÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· ‹Ù·Ó ÂÓ‰ÂÈÎÙÈÎ¿ ÁÈ·

¶·È‰È·ÙÚÈÎ‹ 2005;68:425-431


427∫·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ÓÂ˘ÌÔÓ›·

ÂÚÈÎ·Ú‰›ÙÈ‰· Î·È Ì˘ÔÎ·Ú‰›ÙÈ‰· ÛÂ 1 ·ÛıÂÓ‹Î·È ÁÈ· ÂÚÈÎ·Ú‰›ÙÈ‰· ÛÂ 4/19 (21,05% ÙË˜ ÔÌ¿-‰·˜ ∞, 10% ÙÔ˘ Û˘ÓfiÏÔ˘). ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜‰ÂÓ ·ÚÔ˘Û›·ÛÂ ·ÚÚ˘ıÌ›·.

∫·Ú‰ÈÔÏÔÁÈÎ‹ ‰È¿ÁÓˆÛË O ·ÛıÂÓ‹˜ ÙË˜ ÔÌ¿‰·˜ ∞ ÌÂ ÎÏÈÓÈÎ¿ ÛËÌÂ›·

Ì˘ÔÎ·Ú‰›ÙÈ‰·˜ ÏËÚÔ‡ÛÂ Ù· Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ÎÚÈÙ‹ÚÈ· ÙË˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·˜ Î·È ÙË˜ ÂÚÈÎ·Ú-‰È·Î‹˜ Û˘ÏÏÔÁ‹˜. ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓÂ˘ÌÔÓ›·˜ÙÔ˘ ‹Ù·Ó ÌÈÎÚÔ‚È·Î‹. ∆Ô ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ ÙË˜·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó 46%Î·È Ë ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÌÈÙÚÔÂÈ‰Ô‡˜ ‚·Ï‚›‰·˜‹Ù·Ó 3Ô˘ ÛÙ·‰›Ô˘. OÈ ˘fiÏÔÈÔÈ ·ÛıÂÓÂ›˜ ÙË˜ÔÌ¿‰·˜ ∞ Â›¯·Ó Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ ÎÚÈÙ‹ÚÈ· Â-ÚÈÎ·Ú‰È·Î‹˜ Û˘ÏÏÔÁ‹˜. ∞fi ·˘ÙÔ‡˜, ÛÂ 15 Ë Ô-ÛfiÙËÙ· ÙÔ˘ ÂÚÈÎ·Ú‰È·ÎÔ‡ ˘ÁÚÔ‡ ‹Ù·Ó ÌÂÙÚ›ˆ˜·˘ÍËÌ¤ÓË, ÂÓÒ ÛÂ 4 ÔÏ‡ ·˘ÍËÌ¤ÓË, ¯ˆÚ›˜ ÎÚÈ-Ù‹ÚÈ· Î·Ú‰È·ÎÔ‡ ÂÈˆÌ·ÙÈÛÌÔ‡.

ªÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ÙË˜ ‰È·ÛÙÔ-ÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ OÈ ÙÈÌ¤˜ ÙˆÓ Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎÒÓ ÛÙ·ıÂÚÒÓ

·fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ÙË˜ ‰È·ÛÙÔ-ÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÙÔ˘·ÛıÂÓÔ‡˜ (ÙË˜ ÔÌ¿‰·˜ ∞) ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰·,Ô˘ ÂÍ·ÈÚ¤ıËÎÂ ·fi ÙË Û‡ÁÎÚÈÛË, ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1, ÂÓÒ ÙˆÓ ˘fiÏÔÈˆÓ ·ÛıÂ-ÓÒÓ ÙË˜ ÔÌ¿‰·˜ ∞ Î·È ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ÔÌ¿‰·˜

µ ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 2 Î·È 3, ·ÓÙ›ÛÙÔÈ¯·. ™ÙÔÓ ÌÔÓ·‰ÈÎfi ·ÛıÂÓ‹ ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰· Î·È

ÂÚÈÎ·Ú‰È·Î‹ Û˘ÏÏÔÁ‹, ÔÈ ·Ú¿ÌÂÙÚÔÈ: ‰È·ÛÙÔ-ÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ Ô›ÛıÈÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜ ·ÚÈ-ÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (∞∫) (LVPWd), ‰È·ÛÙÔÏÈÎ‹‰È¿ÌÂÙÚÔ˜ ∞∫ (LVDs), Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (ª∫¢) (IVSd),Û˘ÛÙÔÏÈÎfi˜ fiÁÎÔ˜ ∞∫ (SV) Î·È ‰È·ÛÙÔÏÈÎfi˜fiÁÎÔ˜ ∞∫ (DV) ‹Ù·Ó ·ÓÒÙÂÚÂ˜ ·fi ÙÈ˜ Ì¤ÛÂ˜ÙÈÌ¤˜ ÙˆÓ ·ÛıÂÓÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, ÂÓÒ ÔÈ·Ú¿ÌÂÙÚÔÈ: Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ Ô›ÛıÈÔ˘ÙÔÈ¯ÒÌ·ÙÔ˜ ∞∫ (LVPWs), ‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂ-ÙÚÔ˜ ª∫¢ (IVSd), fiÁÎÔ˜ ÂÍÒıËÛË˜ (SVã), ÎÏ¿-ÛÌ· ÂÍÒıËÛË˜ (EF) Î·È ‰Â›ÎÙË˜ ‚Ú¿¯˘ÓÛË˜ÈÓÒÓ ÙË˜ ∞∫ (SF) ‹Ù·Ó Î·ÙÒÙÂÚÂ˜ ·fi ÙÈ˜ ·ÓÙ›-ÛÙÔÈ¯Â˜ ÙÈÌ¤˜ ÙˆÓ ˘fiÏÔÈˆÓ ·ÛıÂÓÒÓ.

∞fi ÙË ÛÙ·ÙÈÛÙÈÎ‹ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈ-ÌÒÓ ÙˆÓ Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎÒÓ ÛÙ·ıÂÚÒÓ Î·È·fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ‰È·ÛÙÔÏÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÌÂÙ·Í‡ ÙˆÓÔÌ¿‰ˆÓ ∞ (n=19) Î·È µ (n=20) (¶›Ó·ÎÂ˜ 2 Î·È3) ‚Ú¤ıËÎÂ:

·) ªË ÛËÌ·ÓÙÈÎ‹ ÛÙ·ÙÈÛÙÈÎ¿ ‰È·ÊÔÚ¿(p>0,05) ˆ˜ ÚÔ˜ ÙÈ˜ ÙÈÌ¤˜ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ:‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ Ô›ÛıÈÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ∞∫(LVPWd), Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ Ô›ÛıÈÔ˘ ÙÔÈ-¯ÒÌ·ÙÔ˜ ∞∫ (LVPWs), ‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜∞∫ (LVDd), Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ ∞∫ (LVDs),Û˘ÛÙÔÏÈÎfi˜ fiÁÎÔ˜ ∞∫ (SV), ‰È·ÛÙÔÏÈÎfi˜ fiÁÎÔ˜

¶·È‰È·ÙÚÈÎ‹ 2005;68:425-431

¶›Ó·Î·˜ 1. ¶·Ú¿ÌÂÙÚÔÈ ·fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ÙË˜ ÔÌ¿‰·˜ ∞ ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰· Î·È ÂÚÈÎ·Ú‰›ÙÈ‰· (ÂÍ·ÈÚ¤ıËÎ·Ó ·fi ÙË ÛÙ·ÙÈÛÙÈÎ‹ Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ)

¶·Ú¿ÌÂÙÚÔ˜ ª¤ÛË ™Ù·ıÂÚfi ¢È¿ÌÂÛË ™Ù·ıÂÚ‹ ¢È·Î‡Ì·ÓÛË ∂Ï¿¯ÈÛÙË ª¤ÁÈÛÙË ÙÈÌ‹ ÛÊ¿ÏÌ· ÙÈÌ‹ ·fiÎÏÈÛË ÙÈÌ‹ ÙÈÌ‹

LVPWd 1 0 1 # 0 1 1LVDd 3,8 0 3,8 # 0 3,8 3,8IVSd 0,64 0 0,64 # 0 0,64 0,64LVPWs 0,92 0 0,92 # 0 0,92 0,92LVDs 2,94 0 2,94 # 0 2,94 2,94IVSs 2,94 0 2,94 # 0 2,94 2,94DV 61,95 0 61,95 # 0 61,95 61,95SV 33,31 0 33,31 # 0 33,31 33,31SF 22,63 0 22,63 # 0 22,63 22,63EF 46,23 0 46,23 # 0 46,23 46,23SVã 28,64 0 28,64 # 0 28,64 28,64E 0,74 0 0,74 # 0 0,74 0,74A 0,53 0 0,53 # 0 0,53 0,53dt 148 0 148 # 0 148 148E/A 1,39 0 1,39 # 0 1,39 1,39

LVPWd: ‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ Ô›ÛıÈÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (∞∫), LVDd: ‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ ∞∫,IVSd: ‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (ª∫¢), LVPWs: Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ Ô›ÛıÈÔ˘ ÙÔÈ¯Ò-Ì·ÙÔ˜ ∞∫, LVDs: Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ ∞∫, IVSs: Û˘ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ ª∫¢, DV: ‰È·ÛÙÔÏÈÎfi˜ fiÁÎÔ˜ ∞∫, SV: Û˘-ÛÙÔÏÈÎfi˜ fiÁÎÔ˜ ∞∫, SF: ‰Â›ÎÙË˜ ‚Ú¿¯˘ÓÛË˜ ÈÓÒÓ, EF: ÎÏ¿ÛÌ· ÂÍÒıËÛË˜, SVã: ÂÍˆıËÙÈÎfi˜ fiÁÎÔ˜, E: Ì¤ÁÈÛÙË Ù·¯‡-ÙËÙ· ÚˆÙÔ‰È·ÛÙÔÏÈÎ‹˜ ÚÔ‹˜, A: Ì¤ÁÈÛÙË Ù·¯‡ÙËÙ· ÙÂÏÔ‰È·ÛÙÔÏÈÎ‹˜ ÚÔ‹˜ dt: ¯ÚfiÓÔ˜ ˘ÛÙ¤ÚËÛË˜ ‰È·ÛÙÔÏÈÎ‹˜ÚÔ‹˜ E/A: Û¯¤ÛË Î‡Ì·ÙÔ˜ ∂ /∞


428 °. ™. µ·ÚÏ¿ÌË˜ Î·È Û˘Ó.

∞∫ (DV), ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ (EF), ‰Â›ÎÙË˜ ‚Ú¿-¯˘ÓÛË˜ ÈÓÒÓ ∞∫ (SF). ¢ÂÓ ˘‹Ú¯Â, Â›ÛË˜, ÛÙ·-ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡ÔÔÌ¿‰ˆÓ, ˆ˜ ÚÔ˜ ÙË Ì¤ÁÈÛÙË ÙÂÏÔ‰È·ÛÙÔÏÈÎ‹Ù·¯‡ÙËÙ· ÙË˜ ‰È·ÌÈÙÚÔÂÈ‰ÈÎ‹˜ ÚÔ‹˜ (Î‡Ì· ∞ÙÔ˘ Û˘Ì‚·ÙÈÎÔ‡ ÛÊ˘ÁÌÈÎÔ‡ Doppler), ˆ˜ ÚÔ˜ÙÔÓ ¯ÚfiÓÔ Î·ı˘ÛÙ¤ÚËÛË˜ ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÚÔ‹˜ÙË˜ ÌÈÙÚÔÂÈ‰Ô‡˜ (dt) Î·È ˆ˜ ÚÔ˜ ÙÔÓ ‰Â›ÎÙË∂/∞ (p>0,05).

‚) ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ (p<0,05)˘‹Ú¯Â ˆ˜ ÚÔ˜ ÙÈ˜ ÙÈÌ¤˜ ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ‰È·-Ì¤ÙÚÔ˘ ÙÔ˘ ª∫¢ (IVSd), ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ ‰È·-Ì¤ÙÚÔ˘ ÙÔ˘ ª∫¢ (IVSs) Î·È ÙÔ˘ Û˘ÛÙÔÏÈÎÔ‡fiÁÎÔ˘ ÂÍÒıËÛË˜ (SVã). ∆¤ÏÔ˜, Ë Ì¤ÛË ÙÈÌ‹ ÙË˜Ì¤ÁÈÛÙË˜ Ù·¯‡ÙËÙ·˜ ÚˆÙÔ‰È·ÛÙÔÏÈÎ‹˜ Ï‹-ÚˆÛË˜ ÙË˜ ‰È·ÌÈÙÚÔÂÈ‰ÈÎ‹˜ ÚÔ‹˜ (Î‡Ì· ∂ ÙÔ˘Û˘Ì‚·ÙÈÎÔ‡ ÛÊ˘ÁÌÈÎÔ‡ Doppler) ‹Ù·Ó ÌÂÁ·Ï‡-ÙÂÚË ÛÙËÓ ÔÌ¿‰· ∞ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓ ÔÌ¿‰· µ,

¶·È‰È·ÙÚÈÎ‹ 2005;68:425-431

¶›Ó·Î·˜ 3. ¶·Ú¿ÌÂÙÚÔÈ ·fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓÙË˜ ÔÌ¿‰·˜ µ (n=20) ¯ˆÚ›˜ Ì˘ÔÎ·Ú‰›ÙÈ‰·, Ô‡ÙÂ ÂÚÈÎ·Ú‰›ÙÈ‰·

¶·Ú¿ÌÂÙÚÔ˜* ª¤ÛË ™Ù·ıÂÚfi ¢È¿ÌÂÛË ™Ù·ıÂÚ‹ ¢È·Î‡Ì·ÓÛË ∂Ï¿¯ÈÛÙË ª¤ÁÈÛÙË p**ÙÈÌ‹ ÛÊ¿ÏÌ· ÙÈÌ‹ ·fiÎÏÈÛË ÙÈÌ‹ ÙÈÌ‹

LVPWd 0,682 0,033 0,7 0,15 0,6 0,4 1 >0,05LVDd 3,499 0,142 3,57 0,637 2,47 2,61 5,08 >0,05IVSd 0,633 0,031 0,59 0,138 0,46 0,44 0,9 <0,05LVPWs 1,018 0,041 1,045 0,187 0,71 0,56 1,27 >0,05LVDs 2,355 0,116 2,415 0,52 2,08 1,6 3,68 >0,05IVSs 0,951 0,038 0,88 0,174 0,57 0,68 1,25 <0,05DV 51,193 5,311 48,485 23,751 104,56 24,84 129,4 >0,05SV 24,291 4,543 20,485 20,318 86,97 7,17 94,14 >0,05SF 32,879 1,188 33,035 5,315 16,21 26,24 42,45 >0,05EF 62,306 1,684 62,72 7,534 22,76 52,55 75,31 >0,05SVã 32,313 2,953 29,105 13,206 51,24 13,97 65,21 <0,05E 0,797 0,022 0,79 0,101 0,34 0,64 0,98 <0,05A 0,5145 0,023 0,51 0,107 0,41 0,32 0,73 >0,05dt 127,45 3,026 127 13,535 50 105 155 >0,05E/A 1,584 0,098 1,575 0,442 1,96 0,32 2,28 >0,05

* ∏ ÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ ÛÙÔÓ ¶›Ó·Î· 1** p: ·Ó·Ê¤ÚÂÙ·È ÛÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ (‚Ï. Î·È ¶›Ó·Î· 2)

¶›Ó·Î·˜ 2. ¶·Ú¿ÌÂÙÚÔÈ ·fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓÙË˜ ÔÌ¿‰·˜ ∞ (n=19) ÌÂ ÂÚÈÎ·Ú‰›ÙÈ‰·

¶·Ú¿ÌÂÙÚÔ˜* ª¤ÛË ™Ù·ıÂÚfi ¢È¿ÌÂÛË ™Ù·ıÂÚ‹ ¢È·Î‡Ì·ÓÛË ∂Ï¿¯ÈÛÙË ª¤ÁÈÛÙË p**ÙÈÌ‹ ÛÊ¿ÏÌ· ÙÈÌ‹ ·fiÎÏÈÛË ÙÈÌ‹ ÙÈÌ‹

LVPWd 1 0 1 # 0 1 1LVPWd 0,696 0,055 0,65 0,241 1 0,35 1,35 >0,05LVDd 3,475 0,157 3,3 0,687 3,17 1,78 4,95 >0,05IVSd 0,728 0,043 0,7 0,188 0,71 0,44 1,15 <0,05LVPWs 1,076 0,066 1,05 0,29 1,12 0,68 1,8 >0,05LVDs 2,167 0,122 2,12 0,536 2,61 0,34 2,95 >0,05IVSs 1,116 0,084 1 0,367 1,71 0,72 2,43 <0,05DV 53,725 4,065 46,76 17,719 58,92 31,13 90,05 >0,05SV 17,692 1,469 14,5 6,406 23,59 10 33,59 >0,05SF 38,47 3,335 35,28 14,537 69,88 24,84 94,72 >0,05EF 64,82 1,668 65,67 7,273 28,85 50,59 79,44 >0,05SVã 35,283 2,984 32,35 13,01 45,65 19,79 65,44 <0,05E 0,887 0,037 0,84 0,161 0,56 0,61 1,17 <0,05A 0,556 0,039 0,52 0,172 0,53 0,39 0,92 >0,05dt 130,21 2,907 130 12,673 43 107 150 >0,05E/A 1,664 0,079 1,6 0,346 1,02 1,18 2,2 >0,05

* ∏ ÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ ÛÙÔÓ ¶›Ó·Î· 1 ** p: ·Ó·Ê¤ÚÂÙ·È ÛÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ



ÌÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ (p<0,05)(∂ÈÎfiÓ· 1·,‚).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙ·ÙÈÛÙÈÎ¿ ÔÏ‡ ÛËÌ·ÓÙÈ-Î‹ ‰È·ÊÔÚ¿ ‰ÂÓ ‚Ú¤ıËÎÂ ÛÂ Î·Ì›· ·Ú¿ÌÂÙÚÔ,ÂÓÒ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ‚Ú¤ıËÎÂ ÛÂ4 Ë¯Ô·Ú·Ì¤ÙÚÔ˘˜: ‰È·ÛÙÔÏÈÎ‹ Î·È Û˘ÛÙÔÏÈÎ‹‰È¿ÌÂÙÚÔ˜ ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜,Û˘ÛÙÔÏÈÎfi˜ fiÁÎÔ˜ ÂÍÒıËÛË˜ Î·È Ì¤ÁÈÛÙË Ù·¯‡-ÙËÙ· ÙË˜ ÚˆÙÔ‰È·ÛÙÔÏÈÎ‹˜ Ï‹ÚˆÛË˜.

™˘˙‹ÙËÛË

∆ËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›· ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ›·ıÔÁÂÓÂÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÈÔÁÂÓÔ‡˜ Ì˘ÔÎ·Ú-‰›ÙÈ‰·˜ Î·È ‰È·Ù·ÙÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜(7,8,21), ÂÓÒ ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ÙÂ› ÂÚÈÙÒÛÂÈ˜ÌÂ ·ÈÙÈÔÏÔÁÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÓÂ˘ÌÔÓÈÎÒÓ ÏÔÈ-ÌÒÍÂˆÓ Î·È Ì˘Ô- ‹ ÂÚÈÎ·Ú‰›ÙÈ‰·˜ (1,6) ÛÙ··È‰È¿. ™ÙËÓ ·ÚÔ‡Û· ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË ÌÂ-Ï¤ÙË ‰ÈÂÚÂ˘Ó‹ıËÎÂ Ë Èı·ÓfiÙËÙ· Û˘ÌÌÂÙÔ¯‹˜ÙË˜ Î·Ú‰È¿˜ ÛÂ ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÁÈ·ÓÂ˘ÌÔÓ›·, ‚¿ÛÂÈ ÎÏ·ÛÈÎ‹˜ Î·È Ë¯ÔÎ·Ú‰ÈÔÁÚ·-ÊÈÎ‹˜ ‰È·ÁÓˆÛÙÈÎ‹˜ ÂÎÙ›ÌËÛË˜.

µ·ÛÈÎ¿ ÁÓˆÚ›ÛÌ·Ù· ÙË˜ Û‡Á¯ÚÔÓË˜ Ë¯ÔÎ·Ú-‰ÈÔÁÚ·Ê›·˜ Â›Ó·È fiÙÈ ·ÔÙÂÏÂ› ÌË ·ÈÌ·ÙËÚ‹‰È·ÁÓˆÛÙÈÎ‹ Ì¤ıÔ‰Ô, ÌÂ ÌÂÁ¿ÏË Â˘ÎÔÏ›· ÂÊ·Ú-ÌÔÁ‹˜ Î·È Â·Ó¿ÏË„Ë˜ Î·È ‰È·ÁÓˆÛÙÈÎ‹ ·ÎÚ›-‚ÂÈ·, Ô˘ ÁÈ· ÙËÓ ÂÚÈÎ·Ú‰›ÙÈ‰· Â›Ó·È ÂÍ·ÈÚÂÙÈ-Î¿ ÌÂÁ¿ÏË (·ÁÁ›˙ÂÈ ÙÔ 100%) (19). ø˜ ÚÔ˜ ÙËÌ˘ÔÎ·Ú‰›ÙÈ‰·, Ë ÂÓ‰ÔÌ˘ÔÎ·Ú‰È·Î‹ ‚ÈÔ„›· Â›-Ó·È ·Ô‰ÂÎÙ‹ ˆ˜ Ë Î·Ï‡ÙÂÚË ‰È·ÁÓˆÛÙÈÎ‹ Ì¤-ıÔ‰Ô˜, ·ÏÏ¿ ÚÔ˜ ÙÔ ·ÚfiÓ ˘¿Ú¯Ô˘Ó ÂÈÊ˘-Ï¿ÍÂÈ˜ ÁÈ· ÙËÓ Â˘ÚÂ›· ÂÊ·ÚÌÔÁ‹ ÙË˜, È‰È·›ÙÂÚ·ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (13,22).

∫ÏÈÓÈÎ¿ Î·È ·ÈÌ·ÙÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· OÚÈÛÌ¤ÓÔÈ Û˘ÁÁÚ·ÊÂ›˜ (2,22) ·Ó·Ê¤ÚıËÎ·Ó

ÛÙËÓ ·ÈÙÈÔÏÔÁÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÔÍÂ›·˜ ‚ÚÔÁ¯ÈÔ-Ï›ÙÈ‰·˜ Î·È Î·Ú‰›ÙÈ‰·˜, ÂÓÒ ÛÂ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜(23-26) ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÛËÌÂ›ˆÓÎ·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ·ÔÙÂÏÂ› ÙÔ ‰È·ÁÓˆÛÙÈ-Îfi ÎÏÂÈ‰› Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ¯‹˜. µ¿ÛÂÈ ÙˆÓ Â˘-ÚËÌ¿ÙˆÓ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ÙÔ ›‰ÈÔ ÌÔÚÂ›Ó· ıÂˆÚËıÂ› Î·È ÁÈ· ÙËÓ ÓÂ˘ÌÔÓ›·. ™ÙÔÓ ·ÛıÂ-Ó‹ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰· Î·ÈÂÚÈÎ·Ú‰È·Î‹ Û˘ÏÏÔÁ‹, fiˆ˜ Î·È ÛÙÔ˘˜ 4/15ÙË˜ ÔÌ¿‰·˜ ∞ ÌÂ ÌÂÁ¿ÏË ÂÚÈÎ·Ú‰È·Î‹ Û˘ÏÏÔ-Á‹, Ù· ÛËÌÂ›· Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÔÈ˘„ËÏÔ› ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó ·ÚÎÂÙ¿ ÁÈ· ÙËÓ˘fiÓÔÈ· ÙË˜ ‰È¿ÁÓˆÛË˜, Ô˘ ÂÈ‚Â‚·ÈÒıËÎÂË¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿. ™ÙÔ˘˜ 15 ·ÛıÂÓÂ›˜ ÙË˜ ÔÌ¿-‰·˜ ∞ ÌÂ Â˘Ú‹Ì·Ù· ‹È·˜ ÂÚÈÎ·Ú‰›ÙÈ‰·˜, ËÎÏÈÓÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ¯‹˜‰ÂÓ ‹Ù·Ó ÚÔÊ·Ó‹˜, ·ÏÏ¿ Ù· Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈ-Î¿ ÎÚÈÙ‹ÚÈ· ‹Ù·Ó ·Ó·ÌÊÈÛ‚‹ÙËÙ·.

∏ ·ÈÌ·ÙÔÏÔÁÈÎ‹ ÂÈÎfiÓ· (ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË,ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË, ˘„ËÏ¤˜ ÙÈÌ¤˜ ∆∫∂ Î·ÈC-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜ Î.Ï.) Î·Ù¿ ÙËÓ ÂÈÛ·-ÁˆÁ‹, ÁÓˆÛÙ‹ ˆ˜ Û˘ÓÔ‰fi˜ ÂÈÎfiÓ· ÙË˜ ›‰È·˜ ÙË˜ÓÂ˘ÌÔÓ›·˜, ‰ÂÓ ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ‰È·ÁÓˆ-ÛÙÈÎfi ÎÏÂÈ‰› ÁÈ· ˘fiÓÔÈ· Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ-¯‹˜, ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È·. ™Â ÚfiÛÊ·ÙÂ˜ ‰ËÌÔÛÈ-Â‡ÛÂÈ˜ ·Ó·Ê¤ÚÂÙ·È ÏÂ˘ÎÔÂÓ›· ÛÂ ·È‰› ÌÂÏÂ˘¯·ÈÌ›· Î·È ÏÂ˘ÚÔÂÚÈÎ·Ú‰›ÙÈ‰·(25) Î·È˘„ËÏ¤˜ ÙÈÌ¤˜ CK-MB ÛÂ ÔÛÔÛÙfi 68%, ÛÂ ·È-‰È¿ ·Ó¿ÏÔÁË˜ - ÌÂ ÙËÓ ·ÚÔ‡Û· - ÌÂÏ¤ÙË˜ (26).∏ Èı·ÓfiÙËÙ· ÛÔ‚·Ú‹˜ ÂÚÈÎ·Ú‰È·Î‹˜ Û˘ÏÏÔ-Á‹˜ 12,5% ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÌÔÚÂ› Ó·ıÂˆÚËıÂ› ˆ˜ ‚¿ÛË ÂÚ·ÈÙ¤Úˆ ÌÂÏÂÙÒÓ Î·È Û˘-ÁÎÚ›ÛÂˆÓ.

∏ÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ∏ ÂÌÊ¿ÓÈÛË ·ÚÚ˘ıÌÈÒÓ ‹ ¿ÏÏˆÓ ËÏÂÎÙÚÔ-

Î·Ú‰ÈÔÁÚ·ÊÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙË ‰È¿ÚÎÂÈ·ÓÂ˘ÌÔÓÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ÁÓˆÛÙ‹ (2,27-30). ™Â ÌÈÎÚ¿ ·È‰È¿ ÌÂ ÔÍÂ›· ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·, Ë

¶·È‰È·ÙÚÈÎ‹ 2005;68:425-431

100

50

0

EF1·

1

Series 1

Series 2

Series 3

3

2

1

0

IVSd=1, IVSs=2, Î‡Ì· ∂=31‚

2 31

Series 1

Series 2

Series 3

∂ÈÎfiÓ· 1. ¢È·ÁÚ·ÌÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓÙˆÓ ·Ú·Ì¤ÙÚˆÓ EF (∂ÈÎfiÓ· 1·), IVSd, IVSs Î·È Î‡Ì·-ÙÔ˜ ∂ (∂ÈÎfiÓ· 1‚) ÙË˜ ‰È·ÌÈÙÚÔÂÈ‰ÈÎ‹˜ ÚÔ‹˜ ·fi ÙËÓ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Î·ÈÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜: i)ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰· ÙË˜ ÔÌ¿‰·˜ ∞ (ÛÂÈÚ¿1), ii) ÙˆÓ ˘fiÏÔÈˆÓ 19 ·ÛıÂÓÒÓ ÙË˜ ÔÌ¿‰·˜ ∞ (ÛÂÈÚ¿2) Î·È iii) ÙˆÓ 20 ·ÛıÂÓÒÓ ÙË˜ ÔÌ¿‰·˜ µ (ÛÂÈÚ¿ 3). ™ÙÈ˜·Ú·Ì¤ÙÚÔ˘˜ ·˘Ù¤˜ ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹‰È·ÊÔÚ¿ (p<0,05). °È· ÙËÓ ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÔÌÔ-ÁÚ·ÊÈÒÓ ‚Ï. ÛÙÔÓ ¶›Ó·Î· 1.


430 °. ™. µ·ÚÏ¿ÌË˜ Î·È Û˘Ó.

Û˘¯ÓfiÙËÙ· ·ÚÚ˘ıÌ›·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 0% ¤ˆ˜2% (23,24), ·Ú¿ ÙË ÛËÌ·ÓÙÈÎ‹ Û˘¯ÓfiÙËÙ·(9,8%) (24) Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ¯‹˜. ™ÙËÓ ·-ÚÔ‡Û· ÂÚÁ·Û›·, Ë Û˘¯ÓfiÙËÙ· ËÏÂÎÙÚÔÎ·Ú‰ÈÔ-ÁÚ·ÊÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÂÓ‰ÂÈÎÙÈÎÒÓ Èı·Ó‹˜Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ¯‹˜ (‰È·Ù·Ú·¯¤˜ ÙÔ˘ ∆)‹Ù·Ó 21,05%, ÔÏ‡ ÌÈÎÚfiÙÂÚË ·fi ÂÎÂ›ÓË ÙˆÓIlten Î·È Û˘Ó (26) (68% ·È‰ÈÒÓ ËÏÈÎ›·˜ 2-24ÌËÓÒÓ ÌÂ ÓÂ˘ÌÔÓ›·), ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ·ÚÚ˘ı-ÌÈÒÓ ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‹Ù·Ó ÌË‰ÂÓÈÎ‹.

∏¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· OÈ ÏËÚÔÊÔÚ›Â˜ ˆ˜ ÚÔ˜ ÙÈ˜ ‰È·ÛÙ¿ÛÂÈ˜ Î·È

ÙË ÏÂÈÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ Î·È ÙË˜ ‰ÂÍÈ¿˜ÎÔÈÏ›·˜ ÛÂ ÛÔ‚·Ú‹ ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈ-ÎÔ‡ Â›Ó·È Ï›ÁÂ˜ Î·È ‰È·Ê¤ÚÔ˘Ó ÛÙÔ˘˜ ‰È¿ÊÔ-ÚÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ (17,18,23,24,26). ™Â ·Ó·‰ÚÔ-ÌÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ Goldberg Î·È Û˘Ó (12), ÛÙËÓÏÂÈÔÓfiÙËÙ· ·fi 19 ¿Û¯ÔÓÙÂ˜ ÌÂ ‰È·Ù·ÙÈÎ‹Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ 17 Â›-¯·Ó ËÏÈÎ›· 5 ËÌÂÚÒÓ ¤ˆ˜ 16 ÂÙÒÓ, ˘‹Ú¯Â ·Ó·-ÌÓËÛÙÈÎfi ÓÂ˘ÌÔÓÈÎ‹˜ ÏÔ›ÌˆÍË˜ Î·È ÛÂ ÔÚÈ-ÛÌ¤ÓÔ˘˜ ·Ó·ÌÓËÛÙÈÎfi ÓÂ˘ÌÔÓ›·˜. ∞fi ·‰Ë-ÌÔÛ›Â˘ÙË ·Ó·‰ÚÔÌ‹ ÛÙÔ ∞Ú¯Â›Ô ÙÔ˘ ∂ÚÁ·ÛÙË-Ú›Ô˘, ÛÂ 12 ·fi 15 ·È‰È¿ ÌÂ ‰È·Ù·ÙÈÎ‹ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ·, ËÏÈÎ›·˜ 3 ÌËÓÒÓ ¤ˆ˜ 12 ÂÙÒÓ,Î·Ù¿ ÙËÓ ÚÒÙË ‰È¿ÁÓˆÛË, ˘‹Ú¯Â ·Ó·ÌÓËÛÙÈ-Îfi ÛÔ‚·Ú‹˜ ÓÂ˘ÌÔÓ›·˜ ‹ ÔÍÂ›·˜ ‚ÚÔÁ¯ÈÔÏ›ÙÈ-‰·˜. √È Nissen Î·È Û˘Ó (5) ÂÚÈ¤ÁÚ·„·Ó ÂÚ›-ÙˆÛË ÓÂ˘ÌÔÓÈÎ‹˜ ÏÔ›ÌˆÍË˜ ·fi Ì˘ÎfiÏ·-ÛÌ·, fiÔ˘ Ô ·ÛıÂÓ‹˜ ÙÔ˘˜ ÂÌÊ¿ÓÈÛÂ Ë¯ÔÎ·Ú-‰ÈÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú-‰ÈÔ¿ıÂÈ·˜. ÕÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜ (30,31) ‚Ú‹Î·ÓÊ˘ÛÈÔÏÔÁÈÎ‹ ÙÂÏÔ‰È·ÛÙÔÏÈÎ‹ ‰È¿ÌÂÙÚÔ ÛÂ ·È-‰› Ô˘ ¤·Û¯Â ·fi ÈÔÁÂÓ‹ Ì˘ÔÎ·Ú‰›ÙÈ‰· ÌÂ Ô-Ï‡ ¯·ÌËÏfi ÎÏ¿ÛÌ· ÂÍÒıËÛË˜.

∞fi ÙË ÌÂÏ¤ÙË ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂ-Ú‹˜ ÎÔÈÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·-Û›·˜, ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˘‹Ú¯Â ˆ˜ ÚÔ˜ ÙÈ˜ ‰È·Ì¤-ÙÚÔ˘˜ ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ·Îfi-ÌË Î·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ ‹È· ÂÚÈÎ·Ú‰›ÙÈ-‰·. ™˘ÓÂÒ˜, ‚¿ÛÂÈ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Û˘-ÌÂÚ·›ÓÂÙ·È fiÙÈ ·Ú¿ Ù· ÂÓ‰ÂÈÎÙÈÎ¿ ÁÈ· Èı·Ó‹Î·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹ ÎÏÈÓÈÎ¿ ‰Â‰ÔÌ¤Ó·, ÔÈ ‰È·-ÛÙ¿ÛÂÈ˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÌÔÚÔ‡Ó Ó· ·-Ú·Ì¤ÓÔ˘Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜. ∂›Ó·È Èı·Ófi, ˆÛÙfiÛÔ,Ó· ˘¿Ú¯Ô˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ÛÙÈ˜ ‰È·ÛÙ¿ÛÂÈ˜ ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿Á-Ì·ÙÔ˜ Î·È ÛÙÔÓ Û˘ÛÙÔÏÈÎfi fiÁÎÔ ÂÍÒıËÛË˜.

∆Ô ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ Î·È Ô ‰Â›ÎÙË˜ ‚Ú¿¯˘Ó-ÛË˜ ÈÓÒÓ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÂËÚÂ¿ÛÙËÎ·ÓÛÙÔÓ ·ÛıÂÓ‹ ÌÂ Î·ıÔÏÈÎ‹ Û˘ÌÌÂÙÔ¯‹ ÙË˜ Î·Ú-

‰È¿˜ Î·È ÏÈÁfiÙÂÚÔ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Ì·˙ÈÎ‹ ·‡-ÍËÛË ÙË˜ ÔÛfiÙËÙ·˜ ÙÔ˘ ÂÚÈÎ·Ú‰È·ÎÔ‡ ˘ÁÚÔ‡.∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÙÈÌ¤˜ ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒ-ıËÛË˜ (EF) Î·È ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡ Â›Ó·È ·ÚÎÂÙ¿·ÍÈfiÈÛÙÔÈ ‰Â›ÎÙÂ˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ·ÏÏ¿ ÂÍ·ÚÙÒ-ÓÙ·È ·fi ÙÔÓ ÙÂÏÔÛ˘ÛÙÔÏÈÎfi Î·È ÙÂÏÔ‰È·ÛÙÔÏÈ-Îfi fiÁÎÔ ·›Ì·ÙÔ˜, ·fi ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· Î·È ·fiÙÔ ‚·ıÌfi ‰È¿Ù·ÛË˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ™˘-ÓÂÒ˜, ‰ÂÓ Â›Ó·È ·fiÏ˘ÙÔÈ ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›-ÎÙÂ˜, ÁÂÁÔÓfi˜ ÌÂ ÙÔ ÔÔ›Ô Û˘ÌÊˆÓÔ‡Ó Î·È Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜. ªÔ-ÚÔ‡Ó, fiÌˆ˜, Ó· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓÂÎÙ›ÌËÛË ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÙË˜Î·Ú‰È¿˜ ÛÂ ÓÂ˘ÌÔÓÈÎ‹ ÏÔ›ÌˆÍË (9,10).

∏ ·ÓÂ‡ÚÂÛË ÚÒÈÌË˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙË˜ ÌÈ-ÙÚÔÂÈ‰Ô‡˜ ÛÂ ·È‰È¿ ÌÂ Ì˘ÔÎ·Ú‰›ÙÈ‰·, fiˆ˜‰È·ÈÛÙÒÛ·ÌÂ ÛÙÔÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÌÂ-Ï¤ÙË˜, Â›Ó·È Û˘¯Ó‹, ·ÏÏ¿ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜·Ó·ÊÔÚ¤˜ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·-ÓÂ˘ÛÙÈÎÔ‡ (31). Œ¯Ô˘Ó ‰ËÌÔÛÈÂ˘ÙÂ› ÌÂÌÔÓˆ-Ì¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓ ÌÂ ·ÓÂ¿ÚÎÂÈ· ÌÈ-ÙÚÔÂÈ‰Ô‡˜, Ô˘ ‰È·ÈÛÙÒıËÎÂ ÛÙË ‰È¿ÚÎÂÈ·ÓÂ˘ÌÔÓÈÎ‹˜ ÏÔ›ÌˆÍË˜ ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ÓÂ˘ÌÔÓ›·˜ Î·È ÈÔ‡˜ (5,29).

∆¤ÏÔ˜, Ë Û˘¯ÓfiÙËÙ· ÌÂÌÔÓˆÌ¤ÓË˜ ÛËÌ·ÓÙÈ-Î‹˜ ÂÚÈÎ·Ú‰È·Î‹˜ Û˘ÏÏÔÁ‹˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ÓÂ˘ÌÔÓ›·˜ ‰ÂÓ Â›Ó·È Î·ıÔÚÈÛÌ¤ÓË. ™ÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, Ë Û˘¯ÓfiÙËÙ· (50%) Û˘ÌÌÂÙÔ¯‹˜ÁÂÓÈÎ¿ ÙÔ˘ ÂÚÈÎ·Ú‰›Ô˘ Î·È ÂÈ‰ÈÎfiÙÂÚ· (10%)ÛËÌ·ÓÙÈÎ‹˜ ÂÚÈÎ·Ú‰È·Î‹˜ Û˘ÏÏÔÁ‹˜ Â›Ó·È ÌÂ-Á¿ÏË Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ Û˘ÁÁÚ·-Ê¤ˆÓ (5,29,32), ·ÏÏ¿ ÔÈ Roodpeyma Î·È Û˘Ó (33)ÛÂ ·Ó·‰ÚÔÌÈÎ‹ ÙÔ˘˜ ÌÂÏ¤ÙË ·Ó·Ê¤ÚÔ˘Ó ·ÎÚÈ‚Ò˜ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ·. ¶Èı·Ó‹ ÂÍ‹ÁËÛË ÙË˜ ÛËÌ·-ÓÙÈÎ‹˜ Û˘¯ÓfiÙËÙ·˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ¤ÛÙˆ ÁÈ··Ï‹ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÂÚÈÎ·Ú‰›Ô˘, Â›Ó·È fiÙÈ ÔÈ40 ·ÛıÂÓÂ›˜ ·ÔÙÂÏÔ‡Ó ÂÈÏÂÁÌ¤ÓÔ ÏËı˘ÛÌfi,‰ËÏ·‰‹ ·È‰È¿ ÌÂ ÛËÌ·ÓÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈ‚¿Ú˘Ó-ÛË ‰Â‰ÔÌ¤ÓË˜ ¯ÚÔÓÈÎ‹˜ ÂÚÈfi‰Ô˘, Ô˘ Â›¯·Ó·Ó¿ÁÎË ÓÔÛËÏÂ›·˜ ÛÂ ÓÔÛÔÎÔÌÂ›Ô.


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¶·È‰È·ÙÚÈÎ‹ 2005;68:425-431


432 ORIGINAL ARTICLE

1 Laboratory of PaediatricCardiology, 4th PaediatricClinic, AristotelionUniversity of Thessaloniki,AHEPA Hospital,Thessaloniki

2 1st Cardiology Clinic,Aristotelion University ofThessaloniki, AHEPAHospital, Thessaloniki

Correspondence:G. S. Varlamis 85 Vas. Olgas Str., 546 42, Thessaloniki E-mail: [email protected]



Cardiac involvement in pneumonia.Comparative study in 40 hospitalized children G. S. Varlamis1, N. Arvanitidis1, S. Karaberis1, M. Emboriadou1, S. Gavriilidis2

Abstract

Background: The purpose of this study was to estimate the clinical and echocardiographic incidenceof cardiac involvement in children with pneumonia.

Methods: The clinical, haematological, biochemical and echocardiographic findings were comparedon the day of admission and during the hospitalization of 40 children with pneumonia and with nopreexisting systemic disease. Statistical comparison was made of the parameters of systolic anddiastolic function of the left ventricle between two groups: A (n=20) and B (n=20) with and withoutcardiac involvement, respectively. The findings of the initial examination are presented here.

Results: Cardiac involvement was established in half of the 40 patients. One patient had myocarditisand pericarditis, 4/19 had severe pericardial effusion presenting with clinical signs, while in 15/19 amild pericardial effusion was diagnosed by echocardiography. No patient presented arrhythmia. In21% of the patients the ECG indicated possible cardiac involvement, while the echocardiogram wasdiagnostic in 100% of the cases with cardiac involvement. Comparing the left ventricular function inthe two groups, statistically significant differences were found in the thickness of the interventricularseptum, the systolic ejection volume and the maximum velocity of the rapid ventricular filling period.

Conclusions: Cardiac involvement is a possibility in children hospitalized with pneumonia andshould always be checked. In the study group, clinical and electrocardiographic indications wereapparent in the severe forms. The echocardiogram on admission may accurately detect the caseswithout cardiac involvement. Left ventricular is severely affected in cases of myocarditis, whilepericarditis affects the thickness of the interventricular septum, the systolic ejection volume and themaximum velocity of the rapid ventricular filling period.

Key wordsCardiac involvement, pneumonia, children.


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∏ ·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· ·ÔÙÂÏÂ› È·ÙÚÈÎfiÎ·È ÎÔÈÓˆÓÈÎfi Úfi‚ÏËÌ· ÙË˜ Û‡Á¯ÚÔÓË˜ ÂÔ-¯‹˜ Î·È ¤¯ÂÈ ¿ÚÂÈ ÌÂÁ¿ÏÂ˜ ‰È·ÛÙ¿ÛÂÈ˜ ÛÂ fiÏÔÙÔÓ ‰˘ÙÈÎfi ÎfiÛÌÔ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜(1,2). ∏ ¤ÁÎ·ÈÚË ·Ó·ÁÓÒÚÈÛË Î·È Ë ÌÂıÔ‰ÈÎ‹·ÓÙÈÌÂÙÒÈÛ‹ ÙË˜ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎÔ›·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙË Ê˘ÛÈÎ‹, ÙËÓ ÎÔÈÓˆÓÈÎ‹ Î·ÈÙËÓ „˘¯ÈÎ‹ ˘ÁÂ›· ÙˆÓ ·È‰ÈÒÓ (3-5).

O ¡ÔÌfi˜ £ÂÛÚˆÙ›·˜ ·ÔÙÂÏÂ› Ì›· Û¯ÂÙÈÎ¿·ÔÌÔÓˆÌ¤ÓË Î·È ÌË ‚ÈÔÌË¯·ÓÔÔÈËÌ¤ÓË Â-

ÚÈÔ¯‹ ÙË˜ ∂ÏÏ¿‰·˜ Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌÂÙËÓ Â›ÛÔ‰Ô ÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ, ‚ÈÒÓÂÈ Ì›· ÛËÌ·-ÓÙÈÎ‹ ÌÂÙ·‚ÔÏ‹ ÙË˜ Û‡ÓıÂÛË˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ÙË˜, fiˆ˜ ·˘Ùfi ·ÓÙ·Ó·ÎÏ¿ ÛÙË Û¯ÔÏÈÎ‹ ÎÔÈÓfi-ÙËÙ·. ™˘ÓÂÒ˜, ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤-ÚÔÓ Ë ¤ÚÂ˘Ó· Î·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÚÔÙ‡ˆÓ‰È·ÙÚÔÊÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ·¯˘Û·ÚÎ›·, ÒÛÙÂ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ÂÎfiÓËÛËÚÔÁÚ·ÌÌ¿ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ·ÁˆÁ‹˜ ˘ÁÂ›-·˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÚÔ-Ù‡ˆÓ ·˘ÙÒÓ (6,7).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÈÏÔÙÈÎ‹˜ ÌÂÏ¤ÙË˜


434 ¶. ¢. ∞ÁÁÂÏfiÔ˘ÏÔ˜ Î·È Û˘Ó.

‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ,ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜ Î·È ÙË˜ Î·ıËÌÂÚÈÓ‹˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ÙËÓÂÌÊ¿ÓÈÛË ·¯˘Û·ÚÎ›·˜ ÛÂ ·È‰È¿ ÙË˜ Û¯ÔÏÈÎ‹˜ËÏÈÎ›·˜ ÛÂ Û¯ÔÏÂ›· ÙË˜ ·ÎÚÈÙÈÎ‹˜ ˙ÒÓË˜ ÙÔ˘¡ÔÌÔ‡ £ÂÛÚˆÙ›·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ÂÙ¿ÔÏÈÁÔı¤ÛÈ· (ÌÔÓÔı¤ÛÈ· Î·È ‰Èı¤ÛÈ·) ‰ËÌÔÙÈÎ¿ Û¯ÔÏÂ›·ÙÔ˘ ¢‹ÌÔ˘ ºÈÏÈ·ÙÒÓ ÙÔ˘ ¡ÔÌÔ‡ £ÂÛÚˆÙ›·˜ Î·Ù¿ ÙÔÛ¯ÔÏÈÎfi ¤ÙÔ˜ 2002-2003. ∏ ÌÂÏ¤ÙË ·ÊÔÚÔ‡ÛÂ ÛÂ fiÏ· Ù·‰ËÌÔÙÈÎ¿ Û¯ÔÏÂ›· ÙË˜ ·ÎÚÈÙÈÎ‹˜ ˙ÒÓË˜ ÙÔ˘ ÓÔÌÔ‡ ÛÂ¤Ó· Û‡ÓÔÏÔ 33 ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ £Â-ÛÚˆÙ›·˜. ™˘ÌÌÂÙÂ›¯·Ó 73 Ì·ıËÙ¤˜ (39 ·ÁfiÚÈ· Î·È 34ÎÔÚ›ÙÛÈ·) ËÏÈÎ›·˜ 7-12 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈÎ›·: 9 ¤ÙË). ∏Î·Ù·ÁÚ·Ê‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓÂ ÌÂÙ¿ ·fi ÂÓËÌ¤ÚˆÛËÙˆÓ ÁÔÓ¤ˆÓ Î·È ÂÍ·ÛÊ·Ï›ÛÙËÎÂ Ë Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘™˘ÏÏfiÁÔ˘ °ÔÓ¤ˆÓ Î·È ∫Ë‰ÂÌfiÓˆÓ Î¿ıÂ Û¯ÔÏÂ›Ô˘ ÁÈ·ÙË ÛÙ·ÙÈÛÙÈÎ‹ ÙÔ˘˜ ÂÂÍÂÚÁ·Û›·.

™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ Ô ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ·fi ÙÔÓ

Ù‡Ô: ¢ª™ = ‚¿ÚÔ˜ (kg) / ‡„Ô˜ (m)2 Î·È Ë ÂÚÈÊ¤ÚÂÈ·ÙË˜ Ì¤ÛË˜ [¶ª (cm)]. ∆Ô ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÌÂÙÚ‹ıËÎÂÌÂ ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡ ˙˘ÁÔ‡ Â‰¿ÊÔ˘˜ (Secaalpha) ÌÂ ·ÎÚ›‚ÂÈ· 100 g. ∏ Ì¤ÙÚËÛË Ú·ÁÌ·ÙÔÔÈ‹ıË-ÎÂ ¯ˆÚ›˜ ˘Ô‰‹Ì·Ù· Î·È ÌÂ ÂÏ·ÊÚ‡ ÈÌ·ÙÈÛÌfi. ∏ Ì¤-ÙÚËÛË ÙÔ˘ ‡„Ô˘˜ ¤ÁÈÓÂ ÛÂ fiÚıÈ· ÛÙ¿ÛË, ¯ˆÚ›˜ ˘Ô‰‹-Ì·Ù·, ÌÂ ÙÔ˘˜ ÒÌÔ˘˜ ÛÂ ı¤ÛË ·Ó¿·˘ÛË˜ Î·È Ù· ¿Óˆ¿ÎÚ· Ó· ·ÈˆÚÔ‡ÓÙ·È ÂÏÂ‡ıÂÚ·. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ ·Ó·-ÛÙËÌfiÌÂÙÚÔ ÛÂ Â›Â‰Ô ÙÔ›¯Ô, Ô˘ Û¯ËÌ¿ÙÈ˙Â ÌÂ ÙÔ‰¿Â‰Ô ÔÚı‹ ÁˆÓ›·. O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ‡„Ô˘˜ ¤ÁÈÓÂÛÙÔ ÏËÛÈ¤ÛÙÂÚÔ 0,5 cm. ∏ ÂÚ›ÌÂÙÚÔ˜ ÙË˜ Ì¤ÛË˜ ÌÂ-ÙÚ‹ıËÎÂ ÌÂ Ï·ÛÙÈÎ‹ ÌÂÙÚÔÙ·ÈÓ›· (Seca) ÛÙÔ ‡„Ô˜ ÙÔ˘ÔÌÊ·ÏÔ‡ Î·È Î¿Ùˆ ·fi ÙÔ ÏÂ˘ÚÈÎfi ÙfiÍÔ (ÛÙÔ Ì¤ÛÔÙË˜ ·fiÛÙ·ÛË˜ ÌÂÙ·Í‡ ÏÂ˘ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁfiÓÈ·˜·ÎÚÔÏÔÊ›·˜) (8).

¢ÂÓ ¤ÁÈÓÂ Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÛÙ·‰›Ô˘ ÂÊË‚Â›·˜ Î·Ù¿Tanner, ÏfiÁˆ ¯ÚÔÓÈÎÔ‡ ÂÚÈıˆÚ›Ô˘ Î·È ‰È·ı¤ÛÈÌÔ˘ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡ (Ê˘ÛÈÎ¿, ·˘Ùfi ·ÔÙÂÏÂ›·‰˘Ó·Ì›· ÙË˜ ÌÂÏ¤ÙË˜).

∂ÚˆÙËÌ·ÙÔÏfiÁÈ· ™Â fiÏ· Ù· ·È‰È¿ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó Î·Ù·ÁÚ¿ÊËÎ·Ó

·Ú¿ÌÂÙÚÔÈ fiˆ˜ Ë ËÏÈÎ›·, Ë Û¯ÔÏÈÎ‹ Ù¿ÍË, ÙÔ Ê‡ÏÔ, ËÎ·Ù·ÁˆÁ‹ (ŒÏÏËÓÂ˜ ‹ ·ÏÏÔ‰·Ô›) Î·È ÙÔ Â›Â‰Ô ÌfiÚ-ÊˆÛË˜ ÙˆÓ ÁÔÓ¤ˆÓ. ŸÏ· Ù· ·È‰È¿ ÁÂÓÓ‹ıËÎ·Ó ÛÙËÓ∂ÏÏ¿‰· ÂÎÙfi˜ ·fi 3 (1 ·ÁfiÚÈ Î·È 2 ÎÔÚ›ÙÛÈ·) Î·È ÁÓÒ-ÚÈ˙·Ó Î·Ï¿ ÙËÓ ÂÏÏËÓÈÎ‹ ÁÏÒÛÛ·. ™ÙË Û˘Ó¤¯ÂÈ·, ¤ÁÈÓÂÎ·Ù·ÁÚ·Ê‹ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È ÙˆÓ ‰Ú·-ÛÙËÚÈÔÙ‹ÙˆÓ ÙˆÓ Ì·ıËÙÒÓ ÌÂ ÙË ÌÔÚÊ‹ ÂÚˆÙËÌ·ÙÔ-ÏÔÁ›Ô˘. ™˘ÁÎÂÎÚÈÌ¤Ó·, ‰fiıËÎÂ ÛÙÔ˘˜ Ì·ıËÙ¤˜ ÂÚˆÙË-Ì·ÙÔÏfiÁÈÔ Û˘¯ÓfiÙËÙ·˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ Î·ÈÎ·Ù·ÁÚ·Ê‹˜ ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÙÔ ÔÔ›ÔÛ˘ÌÏËÚÒıËÎÂ ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ Û¯ÔÏÂ›Ô˘ ÌÂ ÙË ‚Ô‹-ıÂÈ· ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ. ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘¯Ófi-ÙËÙ·˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ ‹Ù·Ó ÚfiÙ˘Ô, ÚÔ-Û·ÚÌÔÛÌ¤ÓÔ ÛÙ· È‰È·›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÏË-

ı˘ÛÌÔ‡ Î·È ‰È·ÌÔÚÊÒıËÎÂ ÌÂ ‚¿ÛË ÙÈ˜ È‰È·›ÙÂÚÂ˜ ÁÓˆ-ÛÙÈÎ¤˜ ÈÎ·ÓfiÙËÙÂ˜, ·ÏÏ¿ Î·È ÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ··ÈÙ‹ÛÂÈ˜ÙÔ˘˜ ÛÂ ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘¯ÓfiÙËÙ·˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓÙˆÓ Willett Î·È Û˘Ó, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙ· ‰Â‰ÔÌ¤Ó·ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÂÚÈÔ¯‹˜ (9). ∞Ú¯ÈÎ¿, Ë ÏÂÈÙÔ˘ÚÁ›·ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÂÏ¤Á¯ıËÎÂ ÛÂ 15 Ì·ıËÙ¤˜, ·fiÙÔ˘˜ ÔÔ›Ô˘˜ ˙ËÙ‹ıËÎÂ Î·È Ì›· 24ˆÚË ·Ó¿ÎÏËÛË Î·-Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ Ô˘ Û˘ÌÏËÚÒıËÎÂ ÛÙÔÓ ¯ÒÚÔÙÔ˘ Û¯ÔÏÂ›Ô˘ ·fi ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜, ÒÛÙÂ Ó· ÈÛÙÔÔÈ-ËıÂ› Ë ·ÍÈÔÈÛÙ›· ÙÔ˘.

∂È‰ÈÎfiÙÂÚ·, Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÂÚˆÙ‹ÛÂÈ˜ Û¯ÂÙÈÎ¿ÌÂ ÙË Ï‹„Ë ÚˆÈÓÔ‡ ÁÂ‡Ì·ÙÔ˜, ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔ-Ê‹˜ ÛÙ· ‰È·ÏÂ›ÌÌ·Ù· Î·È ÙËÓ ‡·ÚÍË Î˘ÏÈÎÂ›Ô˘, ÂÓÒ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Û˘ÁÎÂÎÚÈÌ¤Ó· ÙÚfiÊÈÌ· ÁÈ· Ù· ÔÔ›· ÔÎ¿ıÂ Ì·ıËÙ‹˜ ·Ó¤ÊÂÚÂ ÙË Û˘¯ÓfiÙËÙ· Î·Ù·Ó¿ÏˆÛË˜ ÛÂÛ˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ¯ÚÔÓÈÎ¤˜ ÂÚÈfi‰Ô˘˜. ∆¤ÏÔ˜, ÂÎÙÈÌ‹ıËÎÂË Î·ıËÌÂÚÈÓ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Ì·ıËÙÒÓ Î·È Î·Ù·-ÁÚ¿ÊËÎ·Ó ·Ú¿ÌÂÙÚÔÈ, fiˆ˜ ÔÈ ÒÚÂ˜ ·Ó¿·˘ÛË˜, ÌÂ-Ï¤ÙË˜, ¿ıÏËÛË˜, ·È¯ÓÈ‰ÈÔ‡, ÂÚÈ¿ÙÔ˘, ·Ú·ÎÔÏÔ‡-ıËÛË˜ ÙËÏÂfiÚ·ÛË˜ Î·È ‚Ú·‰ÈÓÔ‡ ‡ÓÔ˘.

∏ ‰È·ÛÙ·‡ÚˆÛË ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ Î·È ÙÈ˜ Î·ıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfi-ÙËÙÂ˜ ÙˆÓ Ì·ıËÙÒÓ (ÂÏÂ‡ıÂÚÔ˜ ¯ÚfiÓÔ˜, ·Ú·ÎÔÏÔ‡ıË-ÛË ÙËÏÂfiÚ·ÛË˜ Î.Ï.), Î·ıÒ˜ Î·È ÌÂ ÙËÓ ÔÈÎÔÁÂÓÂÈ·Î‹Î·Ù¿ÛÙ·ÛË Î·È ÙÔ ÌÔÚÊˆÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ, ¤ÁÈ-ÓÂ ÌÂ ÙË Û˘ÌÏ‹ÚˆÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Î·È ÛÙÔ Û›ÙÈ,ÌÂ ÙË Û˘ÓÂÚÁ·Û›· ÙˆÓ ÁÔÓ¤ˆÓ.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ŸÏ· Ù· ·È‰È¿ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË Ù·ÍÈÓÔ-

Ì‹ıËÎ·Ó ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜,˘¤Ú‚·Ú· Î·È ·¯‡Û·ÚÎ·) ÌÂ ÙË ¯ÚËÛÈÌÔÔ›ËÛË ‰ÈÂ-ıÓÒÓ ÛÙ·ÙÈÛÙÈÎÒÓ ÔÚ›ˆÓ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ·È-‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡-ÏÔ (10) (¶›Ó·Î·˜ 1). OÈ Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ ·Ú·-Ì¤ÙÚˆÓ, fiˆ˜ Ô ¢ª™ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÙË˜ Ì¤ÛË˜, ¤ÁÈ-ÓÂ ÌÂ ÙË ¯Ú‹ÛË ÙË˜ ÌÂÙ·‚ÏËÙ‹˜ Û˘Û¯¤ÙÈÛË˜ ÙÔ˘ Pearson(Pearson correlation coefficient). ™ÙË Û˘Ó¤¯ÂÈ·, ÌÂÏÂÙ‹-ıËÎ·Ó ÔÈ Û˘Û¯ÂÙ›ÛÂÈ˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÌÂ Èı·ÓÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÚÔ‰È·ı¤ÙÔ˘Ó ÛÂ ·˘Ù‹, ÌÂ ÙË ¯ÚËÛÈ-ÌÔÔ›ËÛË ÛÙ·ÙÈÛÙÈÎÒÓ ÌÔÓÙ¤ÏˆÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜·Ó¿Ï˘ÛË˜ ÏÔÁÈÛÙÈÎ‹˜ ÂÍ¿ÚÙËÛË˜ (logistic regression

¶·È‰È·ÙÚÈÎ‹ 2005;68:433-438

¶›Ó·Î·˜ 1. ∆ÈÌ¤˜ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™,kg/m2) ÁÈ· ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ·È‰ÈÒÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ (10)

∏ÏÈÎ›· (¤ÙË) À¤Ú‚·Ú· ¶·¯‡Û·ÚÎ·∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

7 17,92 17,75 20,63 20,637,5 18,16 18,03 21,09 21,098 18,44 18,35 21,60 21,608,5 18,76 18,69 22,17 22,179 19,10 19,07 22,77 22,779,5 19,46 19,45 23,39 23,3910 19,84 19,86 24,00 24,0010,5 20,20 20,29 24,57 24,5711 20,55 20,74 25,10 25,1011,5 20,89 21,20 25,58 25,5812 21,22 21,68 26,02 26,67


435¶·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· Î·È ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘

analysis), fiÔ˘ Ë ·ÚÔ˘Û›· ·¯˘Û·ÚÎ›·˜ ·ÔÙ¤ÏÂÛÂÙËÓ ÂÍ·ÚÙËÌ¤ÓË ÌÂÙ·‚ÏËÙ‹ (dependent variable) Î·È˘ÔÏÔÁ›ÛÙËÎ·Ó ÔÈ Û¯ÂÙÈÎÔ› ÏfiÁÔÈ Û˘ÌÏËÚˆÌ·ÙÈÎÒÓÈı·ÓÔÙ‹ÙˆÓ (odds ratio - OR) Î·È Ù· ·ÓÙ›ÛÙÔÈ¯· 95%‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡ÓË˜ (confidence interval) ÁÈ· ÙÈ˜Û˘ÌÌÂÙ·‚ÏËÙ¤˜ (covariates).

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÌÂ ÙË‚Ô‹ıÂÈ· ÙˆÓ ÛÙ·ÙÈÛÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ SPSS 10.0 forWindows (SPSS Inc., 1989-1999) Î·È Statistica (1998,Statsoft, Inc. Tulsa, OK, USA).

∞ÔÙÂÏ¤ÛÌ·Ù·

∏ Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì·ıËÙÒÓ Ô˘ Û˘ÌÌÂÙÂ›-¯·Ó ÛÙË ÌÂÏ¤ÙË, Û‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ, ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. OÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂÙ·Í‡ ·ÁÔÚÈÒÓ Î·ÈÎÔÚÈÙÛÈÒÓ. ™˘ÁÎÂÎÚÈÌ¤Ó·, Ô ¢ª™ ‹Ù·Ó 18,5±4,9kg/m2 ÛÙ· ·ÁfiÚÈ· Î·È 18,4±5 kg/m2 ÛÙ· ÎÔÚ›-ÙÛÈ·, ÂÓÒ Ë ¶ª ‹Ù·Ó 66±13 cm ÛÙ· ·ÁfiÚÈ· Î·È65±12 cm ÛÙ· ÎÔÚ›ÙÛÈ·.

À‹Ú¯Â ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘¢ª™ Î·È ÙË˜ ¶ª (r=0,92331, p<0,0001) (∂È-ÎfiÓ· 1).

∂Ó‰È·Ê¤ÚÔÓÙ· Â˘Ú‹Ì·Ù· ÚÔ¤Î˘„·Ó ·fiÙË ÌÂÏ¤ÙË ‰‡Ô ÌÔÓÙ¤ÏˆÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜·Ó¿Ï˘ÛË˜ ÏÔÁÈÛÙÈÎ‹˜ ÂÍ¿ÚÙËÛË˜ (backwardstepwise likelihood ratio) (¶›Ó·Î·˜ 3):

™ÙÔ ÚÒÙÔ ÌÔÓÙ¤ÏÔ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÔÈ·Ú¿ÌÂÙÚÔÈ: ËÏÈÎ›·, Ê‡ÏÔ, Ù¿ÍË, ÌÔÚÊˆÙÈÎfiÂ›Â‰Ô ÁÔÓ¤ˆÓ, Î·Ù·ÁˆÁ‹, ÒÚÂ˜ ÌÂÏ¤ÙË˜,ÂÏÂ‡ıÂÚÔ˜ ¯ÚfiÓÔ˜/·È¯Ó›‰È, ¯ÚfiÓÔ˜ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ ÙËÏÂfiÚ·ÛË˜. ¶·Ú·ÙËÚ‹ıËÎÂ Û˘-Û¯¤ÙÈÛË ÙË˜ ÂÌÊ¿ÓÈÛË˜ ·¯˘Û·ÚÎ›·˜ ÌÂ ÙËÛ¯ÔÏÈÎ‹ Ù¿ÍË [OR 1,950, 95% CI (1,165-3,265), p=0,011] Î·È ÙÈ˜ ÒÚÂ˜ ·Ú·ÎÔÏÔ‡ıË-ÛË˜ ÙË˜ ÙËÏÂfiÚ·ÛË˜ [OR 1,425, 95% CI(1,026-1,979), p=0,035], ÂÓÒ ÔÈ ÂÍˆÛ¯ÔÏÈÎ¤˜‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÛÙÔÓ ÂÏÂ‡ıÂÚÔ ¯ÚfiÓÔ ¤ÙÂÈÓ·ÓÓ· ¤¯Ô˘Ó Â˘ÂÚÁÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙË ‰È·Ù‹ÚËÛËÂÈı˘ÌËÙÔ‡ ÁÈ· ÙËÓ ËÏÈÎ›· ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜[OR 0,243, 95% CI (0,053-1,116), p=0,069].

™ÙÔ ‰Â‡ÙÂÚÔ ÌÔÓÙ¤ÏÔ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·ÓÔÈ ·Ú¿ÌÂÙÚÔÈ: ËÏÈÎ›·, Ê‡ÏÔ, Î·Ù·Ó¿ÏˆÛË ÛÔ-ÎÔÏ¿Ù·˜ (·ÚÈıÌfi˜/ËÌ¤Ú·), Á¿Ï· (ÔÙ‹ÚÈ·/ËÌ¤-Ú·), ÙÔÛÙ, Ï‹„Ë ÚˆÈÓÔ‡ ÁÂ‡Ì·ÙÔ˜, Î·Ù·Ó¿Ïˆ-ÛË ÙËÁ·ÓËÙÒÓ ·Ù·ÙÒÓ, ·˘ÁÒÓ Î·È ÊÚÔ‡ÙˆÓ.µÚ¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÛÔÎÔ-Ï¿Ù·˜ [OR 1,071, 95% CI (1,014-1,131),p=0,014] Î·È ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÔÛÙ [OR 1,058,95% CI (1,012-1,106), p=0,013], ÂÓÒ Ê¿ÓËÎÂfiÙÈ Ë Ï‹„Ë ÚˆÈÓÔ‡ ÁÂ‡Ì·ÙÔ˜ ¤¯ÂÈ ÚÔÛÙ·ÙÂ˘-ÙÈÎfi ÚfiÏÔ [OR 0,183, 95% CI (0,033-1,020),p=0,05]. ∏ ÙÂÏÂ˘Ù·›· Û˘Û¯¤ÙÈÛË ‹Ù·Ó ÛÙ· fiÚÈ·ÙË˜ ÛÙ·ÙÈÛÙÈÎ‹˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜.

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜ Û˘Û¯ÂÙ›-ÛÂÈ˜ ˆ˜ ÚÔ˜ ÙËÓ Î·Ù·Ó¿ÏˆÛË ¿ÏÏÔ˘ Â›‰Ô˘˜ÙÚÔÊ›ÌˆÓ (.¯. ÎfiÎÎÈÓÔ˘ ÎÚ¤·ÙÔ˜, Ô˘ÏÂÚÈ-ÎÒÓ, „·ÚÈÒÓ, Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, ÂÏ·ÈfiÏ·‰Ô˘).∞fi ÙË ÌÂÏ¤ÙË ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Ú·Ì¤ÙÚˆÓÔ˘ Î·Ù·ÁÚ¿ÊËÎ·Ó, ÒÛÙÂ Ó· ÏËÊıÔ‡Ó ˘’ fi„ÈÓÛ˘Á¯˘ÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÂ› Ó· ÂËÚÂ-¿˙Ô˘Ó ÙÈ˜ Û˘Û¯ÂÙ›ÛÂÈ˜, ‰ÂÓ ÚÔ¤Î˘„·Ó ÛËÌ·-ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜.

¶·È‰È·ÙÚÈÎ‹ 2005;68:433-438

¶›Ó·Î·˜ 3. ∞ÔÙÂÏ¤ÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ÏÔÁÈÛÙÈÎ‹˜ ÂÍ¿ÚÙËÛË˜ ·¯‡Û·ÚÎˆÓ Î·È ÓÔÚÌÔ‚·ÚÒÓ ·È-‰ÈÒÓ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ (backward stepwise likelihood ratio)

¶·Ú¿ÌÂÙÚÔÈ Odds ratio (95% CI)* p

ªÔÓÙ¤ÏÔ 1™¯ÔÏÈÎ‹ Ù¿ÍË 1,950 (1,165-3,265) 0,011ÃÚfiÓÔ˜ ÙËÏÂı¤·ÛË˜ (ÒÚÂ˜) 1,425 (1,026-1,979) 0,035∂ÏÂ‡ıÂÚÔ˜ ¯ÚfiÓÔ˜ (ÒÚÂ˜) 0,243 (0,053-1,116) 0,069ªÔÓÙ¤ÏÔ 2∫·Ù·Ó¿ÏˆÛË ÛÔÎÔÏ¿Ù·˜ 1,071 (1,014-1,131) 0,014∫·Ù·Ó¿ÏˆÛË ÙÔÛÙ 1,058 (1,012-1,106) 0,013§‹„Ë ÚˆÈÓÔ‡ ÁÂ‡Ì·ÙÔ˜ 0,183 (0,033-1,020) 0,05

BMI vs. WAISTWAIST= .21937 + .02364 * BMI

r= .92331

BMI

10

1,1

1,0

0,9

0,8

0,7

0,6

0,5

0,414 18 22 26 30 34 38

WA

IST

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜(BMI) Î·È ÂÚÈÊ¤ÚÂÈ·˜ Ì¤ÛË˜ (WAIST).

¶›Ó·Î·˜ 2. ™ˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÏËı˘-ÛÌÔ‡ ÙË˜ ÌÂÏ¤ÙË˜ (n=73)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔn (%) n (%) n (%)

À¤Ú‚·Ú· 13 (33) 11 (32) 24 (33)¶·¯‡Û·ÚÎ· (¢ª™) 9 (23) 8 (23) 17 (23)¶·¯‡Û·ÚÎ· (¶ª) 6 (15) 5 (15) 11 (15)¶ÏËı˘ÛÌfi˜ ÙË˜ ÌÂÏ¤ÙË˜ 39 (53) 34 (47) 73 (100)



™˘˙‹ÙËÛË

OÈ ·ÏÏ·Á¤˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·È Ë ˘ÈÔı¤ÙË-ÛË ‰˘ÙÈÎÒÓ ÚÔÙ‡ˆÓ ‰È·ÙÚÔÊ‹˜ ¤¯Ô˘Ó ÂÓÔ¯Ô-ÔÈËıÂ› ÁÈ· ÙËÓ ·‡ÍËÛË ÙË˜ Â›ÙˆÛË˜ ÙË˜·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ÛÙËÓ ∂ÏÏ¿‰· (2). ∆··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ÂÈ‚Â‚·ÈÒÓÔ˘Ó Ù·Â˘Ú‹Ì·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ, Ù· ÔÔ›·‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ Úfi‚ÏËÌ· ÙË˜ ·È‰ÈÎ‹˜ ·¯˘-Û·ÚÎ›·˜ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙÈ˜ ·ÛÙÈÎ¤˜ÂÚÈÔ¯¤˜, ·ÏÏ¿ ·ÊÔÚ¿ Î·È ÛÙÈ˜ ·ÔÌ·ÎÚ˘ÛÌ¤-ÓÂ˜ ·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜ Ì·˜ (11,12).

°È· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·Ú-Î›·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙfiÛÔ Ô Î·ıÈÂÚˆÌ¤ÓÔ˜¢ª™ fiÛÔ Î·È Ë ¶ª. À¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ë¶ª ·ÔÙÂÏÂ› ÔÏ‡ Î·Ïfi ‰Â›ÎÙË ÙË˜ Î·Ù·ÓÔ-Ì‹˜ Ï›Ô˘˜ Î·È ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ·ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘Ó˘¿Ú¯ÔÓÙÂ˜·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Ë ‰˘ÛÏÈÈ‰·ÈÌ›·, Ë˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· Î·È Ë ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓÙÈÌÒÓ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (11,13-16). ™¯ÂÙÈÎ¿ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤Ó· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¶ª ·Ô-ÙÂÏÂ› ÙÔÓ Î·Ï‡ÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÙÔ˘ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔÓ ·È‰È·ÙÚÈÎfiÏËı˘ÛÌfi (17). øÛÙfiÛÔ, ·Ú·Ì¤ÓÂÈ ·Ó·¿ÓÙË-ÙÔ ÙÔ ÂÚÒÙËÌ· Â¿Ó Ë ¶ª ·ÔÙÂÏÂ› ÂÍ›ÛÔ˘ Î·-Ïfi ‰Â›ÎÙË ÌÂ ÙÔÓ ¢ª™ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈ-Î‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ¶ª Î·È ÙÔ˘ ¢ª™ ÛÙ··È‰È¿. ¶Ú¿ÁÌ·ÙÈ, ÛÂ Ì›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÛÂ·È‰È¿ ÙË˜ ·ÁÚÔÙÈÎ‹˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙË˜∫Ú‹ÙË˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë ¶ª ¤¯ÂÈ ÛÙÂÓ‹Û¯¤ÛË ÌÂ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÙ··È‰È¿ - fiˆ˜ Î·È Ô ¢ª™ - Î·È Â›Ó·È È‰È·›ÙÂÚ·Â‡¯ÚËÛÙÔ˜ ‰Â›ÎÙË˜ Î·ıÒ˜ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ·ÙË˜ Â‡ÎÔÏË˜ Ì¤ÙÚËÛË˜ (8,11). ™‡ÌÊˆÓ· ÌÂ Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, fiÙ·ÓÂÏ‹ÊıË ˘’ fi„ÈÓ Ë ¶ª, ·ÓÈ¯ÓÂ‡ÙËÎ·Ó 6 ·fi Ù·9 ·¯‡Û·ÚÎ· ·ÁfiÚÈ· Î·È 5 ·fi Ù· 8 ÎÔÚ›ÙÛÈ· ‹11 ·fi Ù· 17 Û˘ÓÔÏÈÎ¿ ·¯‡Û·ÚÎ· ·È‰È¿. ¢Ë-Ï·‰‹, Ë Â˘·ÈÛıËÛ›· ÙË˜ ÌÂıfi‰Ô˘ ˘ÔÏÔÁ›˙ÂÙ·ÈÛÙÔ 64,7%, ÂÓÒ Ë ÂÈ‰ÈÎfiÙËÙ¿ ÙË˜ Â›Ó·È ÔÏ‡˘„ËÏ‹, Î·ıÒ˜ fiÏ· Ù· ·È‰È¿ Ô˘ Â›¯·Ó ¶ª ·˘-ÍËÌ¤ÓË Â›¯·Ó Î·È ·ıÔÏÔÁÈÎfi ¢ª™. ™˘ÓÂÒ˜,Ë ¶ª ‰ÂÓ ÌÔÚÂ› Ó· ·ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ ÙÔÓ ¢ª™ÛÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·¯˘Û·ÚÎ›·˜, ÂÓÒ ÙÔ Ì¤ÁÂ-ıÔ˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÈÏÔÙÈ-Î‹˜ ÌÂÏ¤ÙË˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙË ‰È·Ù‡ˆÛË ÔÚÈ-ÛÙÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. ∞Ó Î·È Ë ¶ª ıÂˆÚÂ›-Ù·È ·fi ÔÚÈÛÌ¤ÓÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ ÂÚÈÛÛfiÙÂÚÔ ÂÈ-‰ÈÎfi˜ ‰Â›ÎÙË˜ ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÂÎÙ›-ÌËÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Î·È Û˘Û¯Â-

Ù›˙ÂÙ·È ÌÂ ·Ú¿ÁÔÓÙÂ˜ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡-ÓÔ˘ ÈÔ ÈÛ¯˘Ú¿ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔÓ ¢ª™(11,13-17), ·˘Ùfi ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌË ·Ô‰Â-ÎÙfi. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ‰ÂÓ ÂÎÙÈÌ‹ıËÎ·Ó¿ÏÏ· ÛÙÔÈ¯Â›· ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ÏËÓ ÙË˜ ·¯˘Û·ÚÎ›·˜. ÕÚ·, Ë ¶ª ÌÔÚÂ› Ó·Â›Ó·È ¤Ó·˜ ¯Ú‹ÛÈÌÔ˜ ‰Â›ÎÙË˜ Î·È Ó· Ï·Ì‚¿ÓÂÙ·È·Ú¿ÏÏËÏ· ÌÂ ÙÔÓ ¢ª™, ˆÛÙfiÛÔ ‰ÂÓ ÌÔÚÂ› Ó··ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ ÙÔÓ ¢ª™ ÛÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ÌÂÏ¤ÙÂ˜.

O Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜, Ë ÂÚÈÔÚÈÛÌ¤ÓËÊ˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Ë ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤-ˆÓ Î·È ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ÛÂ ı¤Ì·Ù· ‰È·ÙÚÔ-Ê‹˜ ·ÔÙÂÏÔ‡Ó ‚·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙËÓ˘ÈÔı¤ÙËÛË ˘ÁÈÂÈÓÒÓ ‰È·ÈÙËÙÈÎÒÓ ÚÔÙ‡ˆÓ·fi Ù· ·È‰È¿. O ÂÈÔÏ·ÛÌfi˜ ÙË˜ ·¯˘Û·Ú-Î›·˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ ÙˆÓ ÌÂÁ·Ï‡-ÙÂÚˆÓ Ù¿ÍÂˆÓ ÙÔ˘ Û¯ÔÏÂ›Ô˘. º·›ÓÂÙ·È fiÙÈ Ë ·‡-ÍËÛË ÙˆÓ Û¯ÔÏÈÎÒÓ ˘Ô¯ÚÂÒÛÂˆÓ Î·È Ô ÂÚÈÔ-ÚÈÛÌfi˜ ÙÔ˘ ÂÏÂ‡ıÂÚÔ˘ ¯ÚfiÓÔ˘ Î·È ÙË˜ ÛˆÌ·ÙÈ-Î‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙË ÌÂ-Ù·‚ÔÏ‹ ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ, ·ÔÙÂ-ÏÔ‡Ó ‰˘ÛÌÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜ ÌÂ ·ıÚÔÈÛÙÈÎ‹‰Ú¿ÛË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚÎ›·˜ ÛÙ· ·È-‰È¿ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ËÏÈÎÈÒÓ.

™‡ÌÊˆÓ· ÌÂ Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ÌÂÏ¤ÙË˜, Ë ‡·ÚÍË ÂÏÂ‡ıÂÚÔ˘ ¯ÚfiÓÔ˘ ·ÔÙÂ-ÏÂ› È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙË ÌÂ›-ˆÛË ÙË˜ ·¯˘Û·ÚÎ›·˜. ∆Ô Â‡ÚËÌ· ·˘Ùfi Â›Ó·ÈÏÔÁÈÎfi, Î·ıÒ˜ Ë ÂÓ·Û¯fiÏËÛË ÌÂ ÙÔ ·È¯Ó›‰È Î·ÈÙÈ˜ ·ıÏÔ·È‰È¤˜ Î·È Ë ÌÂ›ˆÛË ÙË˜ Û˘ÓÂ¯Ô‡˜ÚfiÛÏË„Ë˜ ÌÈÎÚÔÁÂ˘Ì¿ÙˆÓ ‚ÔËıÔ‡Ó ÛÙË ‰È·-Ù‹ÚËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (18,19). ∞ÓÙ›-ıÂÙ·, ÛÙË ÌÂÏ¤ÙË ÂÈ‚Â‚·ÈÒÓÂÙ·È fiÙÈ Ë ˘ÈÔı¤-ÙËÛË ÙˆÓ Û‡Á¯ÚÔÓˆÓ ÚÔÙ‡ˆÓ ÙË˜ Î·ıÈÛÙÈ-Î‹˜ ˙ˆ‹˜ - ÙÔ ÏÂÁfiÌÂÓÔ “Û‡Ó‰ÚÔÌÔ ÙÔ˘ Î·Ó·-¤” - Î·È Ë ·‡ÍËÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔÏÔ‡ıË-ÛË˜ ÙËÏÂfiÚ·ÛË˜ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘ÍËÌ¤ÓÔÎ›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ·¯˘Û·ÚÎ›·˜ (20,21).

π‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ Â›Ó·È Ù· ÚfiÙ˘· ‰È·-ÙÚÔÊ‹˜ Î·È ÔÈ Û˘Ó‹ıÂÈÂ˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (7). ∏·Ú¿ÏÂÈ„Ë ÙÔ˘ ÚˆÈÓÔ‡ ÁÂ‡Ì·ÙÔ˜ ·ÔÙÂÏÂ›ÎÔÈÓ‹ Ú·ÎÙÈÎ‹ ÌÂÙ·Í‡ ÙˆÓ ·È‰ÈÒÓ ÙË˜ Û¯ÔÏÈ-Î‹˜ ËÏÈÎ›·˜. Ÿˆ˜ ‰È·ÈÛÙÒÓÂÙ·È ·fi Ù· ‰Â‰Ô-Ì¤Ó· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Ë ÂÈÌÔÓ‹ ÛÙËÏ‹„Ë ÚˆÈÓÔ‡ ÁÂ‡Ì·ÙÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈ-ÌË ÁÈ· Ù· ·È‰È¿ Î·È ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿-ÓÈÛË˜ ·¯˘Û·ÚÎ›·˜ (22,23). ∆· ·È‰È¿ Ô˘·›ÚÓÔ˘Ó ÚˆÈÓfi Û˘Ó‹ıˆ˜ ‰ÂÓ ÂÈ‰›‰ÔÓÙ·ÈÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÚÔ˚fiÓÙˆÓ ÙÔ˘ Î˘ÏÈÎÂ›Ô˘ÙÔ˘ Û¯ÔÏÂ›Ô˘, ¤¯Ô˘Ó Â·ÚÎ‹ ıÂÚÌÈ‰ÈÎ‹ Úfi-ÛÏË„Ë Î·È ÈÎ·ÓÔÔÈËÙÈÎfi ·›ÛıËÌ· ÎÔÚÂÛÌÔ‡.

¶·È‰È·ÙÚÈÎ‹ 2005;68:433-438


437¶·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· Î·È ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘

∞ÓÙ›ıÂÙ·, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë Î·Ù·Ó¿Ïˆ-ÛË ÛÔÎÔÏ¿Ù·˜ Î·È ÙÔÛÙ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ‰È·ÏÂÈÌÌ¿ÙˆÓ Û˘Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË·¯˘Û·ÚÎ›·˜ (24).

O ÂÈÔÏ·ÛÌfi˜ ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜, ·ÎfiÌË Î·È ÛÙÈ˜·ÎÚÈÙÈÎ¤˜ ·Ú·ÌÂıfiÚÈÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜Ì·˜. ∏ ˘ÈÔı¤ÙËÛË ÙˆÓ ‰˘ÙÈÎÒÓ ÚÔÙ‡ˆÓ ‰È·-ÙÚÔÊ‹˜, Ë ÌÂ›ˆÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ Î·È ÙÔ˘ ÂÏÂ‡ıÂÚÔ˘ ¯ÚfiÓÔ˘, Ë Î·ıÈÛÙÈÎ‹˙ˆ‹ Î·È Ë ·˘ÍËÌ¤ÓË ¤ÎıÂÛË ÛÙËÓ ÙËÏÂfiÚ·ÛË·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚÎ›·˜ ÛÙÔ˘˜ Ì·ıËÙ¤˜ÙÔ˘ Û¯ÔÏÂ›Ô˘. ∂›Ó·È, ÏÔÈfiÓ, ÚÔÊ·Ó‹˜ Ë ·Ó·-ÁÎ·ÈfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÓËÌ¤-ÚˆÛË˜ ÁÔÓ¤ˆÓ, ·È‰ÈÒÓ Î·È ÂÎ·È‰Â˘ÙÈÎÒÓ Î·È·Ó¿Ù˘ÍË˜ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ·ÁˆÁ‹˜ ˘ÁÂ›·˜ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ Û¯ÔÏÂ›Ô˘.

∞Ó·ÁÓÒÚÈÛË

∏ ÌÂÏ¤ÙË ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËÎÂ ·fi ÙÔ ÿ‰Ú˘Ì· ∂ıÓÈ-Î‹˜ ¡ÂfiÙËÙ·˜ (π∂¡).


1. Schwartz MB, Puhl R. Childhood obesity: a societalproblem to solve. Obes Rev 2003;4:57-71.

2. Mamalakis G, Kafatos A. Prevalence of obesity inGreece. Int J Obes Relat Metab Disord 1996;20:488-492.

3. Dietz WH. Childhood weight affects adult morbidi-ty and mortality. J Nutr 1998;128 (2 Suppl):S411-S414.

4. Serdula MK, Ivery D, Coates RJ, Freedman DS, Wil-liamson DF, Byers T. Do obese children becomeobese adults? A review of the literature. Prev Med1993;22:167-177.

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

8. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, Ã·Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π,ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó.∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∞ÁˆÁ‹˜ ÀÁÂ›·˜ ÌÂÙ¿·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙ·‰ËÌÔÙÈÎ¿ Û¯ÔÏÂ›· ÙË˜ ∫Ú‹ÙË˜. ¶·È‰È·ÙÚÈÎ‹1998;61:483-497.

9. Willett WC, Sampson L, Stampfer MJ, Rosner B,Bain C, Witschi J et al. Reproducibility and validityof a semiquantitative food frequency questionnaire.Am J Epidemiol 1985;122:51-65.

10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Estab-lishing a standard definition for child overweightand obesity worldwide: international survey. BrMed J 2000;320:1240-1243.

11. ªÔÛ¯·Ó‰Ú¤· π, Ã·Ù˙‹˜ Ã, ª·ÌÌ¿˜ π, ªÂÚÙÛÈ¿˜ °,§ÈÓ·Ú‰¿ÎË˜ ª, ∫˘ÚÈ·Î¿ÎË˜ ª Î·È Û˘Ó. ¢Â›ÎÙÂ˜·¯˘Û·ÚÎ›·˜ Î·È ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È‰È¿·ÁÚÔÙÈÎ‹˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜.¶·È‰È·ÙÚÈÎ‹ 2003;66:264-277.

12. Krassas GE, Tzotzas T, Tsametis C, KonstantinidisT. Prevalence and trends in overweight and obesityamong children and adolescents in Thessaloniki,Greece. J Pediatr Endocrinol Metab 2001;14 (5 Sup-pl):S1319-S1326.

13. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Ta-to L. Waist circumference and cardiovascular riskfactors in prepubertal children. Obes Res2001;9:179-187.

14. Savva SC, Tornaritis M, Savva ME, Kourides Y,Panagi A, Silikiotou N et al. Waist circumferenceand waist-to-height ratio are better predictors ofcardiovascular disease risk factors in children thanbody mass index. Int J Obes Relat Metab Disord2000;24:1453-1458.

15. Freedman DS, Serdula MK, Srinivasan SR, BerensonGS. Relation of circumferences and skinfold thick-nesses to lipid and insulin concentrations in chil-dren and adolescents: the Bogalusa Heart Study. AmJ Clin Nutr 1999;69:308-317.

16. Dobbelsteyn CJ, Joffres MR, MacLean DR, Flow-erdew G. A comparative evaluation of waist circum-ference, waist-to-hip ratio and body mass index asindicators of cardiovascular risk factors. The Cana-dian Heart Health Surveys. Int J Obes Relat MetabDisord 2001;25:652-661.

17. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A,Bueno M. Waist circumference for the screening ofthe metabolic syndrome in children. Acta Paediatr2002;91:1307-1312.

18. Manios Y, Kafatos A, Mamalakis G. The effects of ahealth education intervention initiated at first gradeover a 3 year period: physical activity and fitness in-dices. Health Educ Res 1998;13:593-606.

19. Tremblay MS, Willms JD. Is the Canadian child-hood obesity epidemic related to physical inactivity?Int J Obes Relat Metab Disord 2003;27:1100-1105.

20. Robinson TN. Television viewing and childhoodobesity. Pediatr Clin North Am 2001;48:1017-1025.

21. Lowry R, Wechsler H, Galuska DA, Fulton JE, KannL. Television viewing and its associations with over-weight, sedentary lifestyle, and insufficient con-sumption of fruits and vegetables among US highschool students: differences by race, ethnicity, andgender. J Sch Health 2002;72:413-421.

22. Siega-Riz AM, Popkin BM, Carson T. Trends inbreakfast consumption for children in the UnitedStates from 1965-1991. Am J Clin Nutr1998;67:S748-S756.

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23. Ortega RM, Requejo AM, Lopez-Sobaler AM, Quin-tas ME, Andres P, Redondo MR et al. Difference inthe breakfast habits of overweight/obese and normalweight schoolchildren. Int J Vitam Nutr Res1998;68:125-132.

24. Matthiessen J, Fagt S, Biltoft-Jensen A, Beck AM,Ovesen L. Size makes a difference. Public HealthNutr 2003;6:65-72.

¶·È‰È·ÙÚÈÎ‹ 2005;68:433-438


439ORIGINAL ARTICLE

Risk factors for obesity in elementary schoolchildren in the Greek border region ofThesprotia P. D. Angelopoulos1, J. Manios2, H. J. Milionis1

Abstract

Background: Lack of physical activity and the adoption of unhealthy dietary habits constitute theprincipal risk factors for children’s obesity in the developed countries. This is a pilot study recordingdietary habits and physical activity and their correlations with obesity in children of school age in theborder area of the Prefecture of Thesprotia.

Methods: A total 73 students (39 boys and 34 girls), aged 7-12 years, pupils of seven municipalelementary schools in the Prefecture of Thesprotia, participated in the study during the school period2002-2003. Body mass index (BMI) and waist circumference (WC) were measured in all participants.In addition, a questionnaire on the frequency of consumption of various foods and physical activitywas completed for each child.

Results: A positive correlation was found between BMI and WC (r=0.92331, p<0.0001). Inmultivariate logistic regression analysis, obesity was positively associated with the school class [oddsratio - OR 1.950, 95% confidence interval - CI (1.165-3.265), p=0.01], television-viewing hours [OR1.425, 95% CI (1.026-1.979), p=0.03], toast [OR 1.058, 95% CI (1.012-1.106), p=0.01] and chocolateconsumption [OR 1.071, 95% CI (1.014-1.131), p=0.014]. Eating breakfast appeared to haveprotective role [OR 0.183, 95% CI (0.033-1.020), p=0.05].

Conclusions: Adoption of unhealthy dietary habits, decrease in physical activity, sedentary lifestyleand increase in television-viewing time constitute significant predictors of obesity in children ofschool age in the rural border regions of Greece.

Key wordsObesity, risk factors, body mass index, waist circumference, diet, free time, television-viewing.

1 Department of InternalMedicine, Medical School,University of Ioannina

2 Department of Dieteticsand Nutritional Science,Harokopio University ofAthens

Correspondence:Haralampos J. Milionis Department of Pathology, Medical School, University ofIoannina451 10, Ioannina E-mail: [email protected]




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¶·È‰È·ÙÚÈÎ‹ 2005;68:440-444

ÕÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· ÛÂ ¿Û¯ÔÓÙÂ˜ ·fi ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ∞. ∫Ô‡ÛË1, ª. OÈÎÔÓfiÌÔ˘1, ¢. ∫·Û›ÌÔ˜2, ¶. ¶ÏÈ¿ÎË3, ª. ∞ı·Ó·Û›Ô˘ - ªÂÙ·Í¿1

¶ÂÚ›ÏË„Ë¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓ ÌÂ ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· Î·È ÂÎ‰‹ÏˆÛË ¿ÓÔÛË˜·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜ (·ÏÏÔ- Î·È ·˘ÙÔ¿ÓÔÛË˜, ·ÓÙ›ÛÙÔÈ¯·). ™ÎÔfi˜ ÙË˜ ÂÚÈÁÚ·Ê‹˜ Â›Ó·È Ó· ÙÔÓÈ-ÛÙÔ‡Ó Ë ÛÔ‚·ÚfiÙËÙ· ÙË˜ Û˘Ó‡·ÚÍË˜ ¿ÓÔÛË˜ ÌÂ Û˘ÁÁÂÓ‹ ¯ÚfiÓÈ· ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· Î·È Ù· ÎÏÈÓÈ-Î¿ Î·È ıÂÚ·Â˘ÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Ô˘ ÚÔÎ‡ÙÔ˘Ó Î·Ù¿ ÙË Û˘Ó‡·ÚÍË ÙˆÓ ‰‡Ô ÓÔÛÔÏÔÁÈÎÒÓÔÓÙÔÙ‹ÙˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿‚-ªÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·, ·ÏÏÔ·ÓÔÛÔÔ›ËÛË, ·˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·, ·ÓÙ›‰Ú·ÛË Coombs.

∂ÈÛ·ÁˆÁ‹

∏ ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· (‚-ª∞) Â›Ó·È Ì›·ÁÂÓÂÙÈÎ¿ Î·ıÔÚÈ˙fiÌÂÓË ¯ÚfiÓÈ· ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·È-Ì›·, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÔ›·˜ ··ÈÙÂ›Ù·ÈË ÂÊ·ÚÌÔÁ‹ ‰È¿ ‚›Ô˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÙ·ÁÁ›ÛÂ-ˆÓ. ™Â ÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜, ÔÈ Ù·ÎÙÈÎ¤˜ ÌÂÙ·Á-Á›ÛÂÈ˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·Ó¿Ù˘ÍË ·ÓÙÈÛˆÌ¿ÙˆÓ¤Ó·ÓÙÈ ÙˆÓ Í¤ÓˆÓ ÚÔ˜ ÙÔÓ ÔÚÁ·ÓÈÛÌfi ÂÚ˘ıÚÒÓ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ù·ÛÙÚÔÊ‹ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ‰fiÙË Î·È ÙËÓ Â›Ù·ÛËÙË˜ ‹‰Ë ˘¿Ú¯Ô˘Û·˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜. ∏·ÏÏÔ·ÓÔÛÔÔ›ËÛË ÛÂ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ¿ ·ÓÙÈÁfi-Ó·, ÂÎÙfi˜ ÙˆÓ ∞µ√ Î·È D, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Û˘-¯Ó‹ ÛÂ ÔÏ˘ÌÂÙ·ÁÁÈ˙fiÌÂÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔ-ÛÊ·ÈÚÈÓÔ¿ıÂÈÂ˜ (1,2). ∞ÓÂÍ·ÚÙ‹Ùˆ˜ ÙÔ˘ ÎÈÓ‰‡-ÓÔ˘ ·ÏÏÔ·ÓÔÛÔÔ›ËÛË˜ ÏfiÁˆ ÌÂÙ¿ÁÁÈÛË˜ ·›Ì·-ÙÔ˜ ·Û‡Ì‚·ÙÔ˘ ˆ˜ ÚÔ˜ Î¿ÔÈÔ ·ÓÙÈÁÔÓÈÎfi Û‡-ÛÙËÌ·, ÔÈ ı·Ï·ÛÛ·ÈÌÈÎÔ› ·ÛıÂÓÂ›˜ ÂÓ‰¤¯ÂÙ·È Ó··ÚÔ˘ÛÈ¿ÛÔ˘Ó ·˘ÙÔ·ÓÔÛÔÔ›ËÛË ¤Ó·ÓÙÈ ÙˆÓÈ‰›ˆÓ ÙÔ˘˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ (3). ∞ÓÎ·È Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ·Ú·ÙËÚÔ‡ÓÙ·È ÏÈÁfiÙÂ-ÚÔ Û˘¯Ó¿ ÛÂ Û¯¤ÛË ÌÂ Ù· ·ÏÏÔ·ÓÙÈÛÒÌ·Ù·, Ë ·-ÚÔ˘Û›· ÙÔ˘˜ ‰‡Ó·Ù·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÌÂ›ˆÛË ÙË˜˙ˆ‹˜ ÙˆÓ ÌÂÙ·ÁÁÈ˙fiÌÂÓˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ, ÌÂÎÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË ·ÈÌfiÏ˘ÛË˜ (4).

∞ÎÔÏÔ˘ıÂ› Ë ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ·È‰ÈÒÓ ÌÂ ‚-ª∞ Î·È ÂÎ‰‹ÏˆÛË ·ÏÏÔ- Î·È ·˘-ÙÔ·ÓÔÛÔÔ›ËÛË˜, ·ÓÙ›ÛÙÔÈ¯·, ÌÂ ÛÎÔfi Ó· ÙÔ-ÓÈÛÙÔ‡Ó Ù· ÎÏÈÓÈÎ¿ Î·È ıÂÚ·Â˘ÙÈÎ¿ ÚÔ‚Ï‹-Ì·Ù· Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÎ‡„Ô˘Ó ·fi ÙË Û˘-Ó‡·ÚÍË ¿ÓÔÛË˜ ÌÂ Û˘ÁÁÂÓ‹ ¯ÚfiÓÈ· ·ÈÌÔÏ˘ÙÈ-Î‹ ·Ó·ÈÌ›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ

¶ÂÚ›ÙˆÛË ÚÒÙË ∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 6 ÂÙÒÓ, ÌÂ ÚfiÛÊ·Ù· ‰È·-

ÁÓˆÛÌ¤ÓË ‚-ª∞, ·Ú·¤ÌÊıËÎÂ ·fi ÂÚÈÊÂ-ÚÈÎfi ÓÔÛÔÎÔÌÂ›Ô ÙË˜ µ. ∂ÏÏ¿‰·˜. ¶ÚfiÎÂÈÙ·È ÁÈ·ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÌÂÓÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ,ÂÎ ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ·Ó·Ê¤ÚÂÙ·È ÊÔÚ¤·˜ ‚-ª∞ Î·È Ô ·Ù¤Ú·˜ Ê˘ÛÈÔÏÔÁÈÎfi˜. ∞fi ÙÔ ·ÙÔ-ÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È ¤ÏÂÁ¯Ô˜ ÛÏË-ÓÔÌÂÁ·Ï›·˜ Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÛÂ ÓÔÛÔÎÔ-ÌÂ›Ô ÙË˜ °ÂÚÌ·Ó›·˜, ÛÙËÓ fiÏË fiÔ˘ Ë ÌÈÎÚ‹·ÛıÂÓ‹˜ ÁÂÓÓ‹ıËÎÂ Î·È ‰È¤ÌÂÓÂ Ù· ÚÒÙ· ¯Úfi-ÓÈ· ÙË˜ ˙ˆ‹˜ ÙË˜, ÌÂ ‰È¿ÁÓˆÛË ÂÙÂÚfi˙˘ÁË˜ ‚-ª∞. ∏ ·ÚÔ‡Û· ÓfiÛÔ˜ ÍÂÎ›ÓËÛÂ 20 ËÌ¤ÚÂ˜ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ÎÏÈÓÈÎ‹, ÌÂ ÙË ‰È·›-ÛÙˆÛË - ·fi È‰ÈÒÙË ·È‰›·ÙÚÔ - ˆ¯ÚfiÙËÙ·˜,ÛÏËÓÔÌÂÁ·Ï›·˜ Î·È ÚÔÛˆÂ›Ô˘ ‚-ª∞. ∏·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹, fiÔ˘‰È·ÈÛÙÒıËÎÂ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÌÔÁÁÔÏÔÂÈ‰¤˜ÚÔÛˆÂ›Ô, ÎÔÓÙfi ·Ó¿ÛÙËÌ· (Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜104 cm, <3Ë ∂£), Ë·ÙÔÌÂÁ·Ï›· (4 cm) Î·ÈÛÏËÓÔÌÂÁ·Ï›· (9 cm). ∫·Ù¿ ÙÔÓ ÂÚÁ·ÛÙËÚÈ·-Îfi ¤ÏÂÁ¯Ô, Ë ËÏÂÎÙÚÔÊfiÚËÛË ‹Ù·Ó Ù˘ÈÎ‹ÔÌfi˙˘ÁË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ (HbF98,5%, HbA2 1,5%) Î·È Ô ÁÔÓÈ‰È·Îfi˜ ¤ÏÂÁ¯Ô˜·ÔÎ¿Ï˘„Â ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓcodon 39/IVS-1n.1 (‚0/‚0). ∏ ·ÎÙÈÓÔÁÚ·Ê›·ÎÚ·Ó›Ô˘ ¤‰ÂÈÍÂ ÁÂÓÈÎÂ˘Ì¤ÓË ·Ê·Ï¿ÙˆÛË ÌÂ„ËÎÙÚÔÂÈ‰‹ ·Ú˘Ê‹, ÂÈÎfiÓ· ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ÙË˜ ÔÌfi˙˘ÁË˜ ‚-ª∞, ÂÓÒ Ë ÔÛÙÈÎ‹ ËÏÈÎ›··ÓÙÈÛÙÔÈ¯Ô‡ÛÂ ÛÂ ·È‰› ËÏÈÎ›·˜ 3 ÂÙÒÓ. OÈ·ÓÙÈ‰Ú¿ÛÂÈ˜ Coombs, ¿ÌÂÛË Î·È ¤ÌÌÂÛË, ‹Ù·Ó


441ÕÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·

·ÚÓËÙÈÎ¤˜. ∏ ËÏÂÎÙÚÔÊfiÚËÛË Hb ·ÌÊfiÙÂÚˆÓÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó Ù˘ÈÎ‹ ÂÙÂÚfi˙˘ÁË˜ ‚-ª∞.

ªÂ ‚¿ÛË ÙËÓ ÔÌ¿‰· ·›Ì·ÙÔ˜ ÙË˜ ·ÛıÂÓÔ‡˜[O Rh(-) ce Du(-) Cw(-) K(-)] Î·È Û‡ÌÊˆÓ· ÌÂÙÈ˜ ‰ÈÂıÓÂ›˜ Ô‰ËÁ›Â˜, ÍÂÎ›ÓËÛÂ ÚfiÁÚ·ÌÌ· ÌÂ-Ù¿ÁÁÈÛË˜ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Û˘Ì‚·ÙÒÓˆ˜ ÚÔ˜ Ù· ·ÓÙÈÁÔÓÈÎ¿ Û˘ÛÙ‹Ì·Ù· ∞µO, Rh Î·ÈKell, ¯ˆÚ›˜ ˆÛÙfiÛÔ, ¿ÓÔ‰Ô ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜Hb (4,5-5 g/dl). ŒÓ·Ó Ì‹Ó· ÌÂÙ¿ Î·È ·ÊÔ‡ Â›¯·ÓÚÔËÁËıÂ› ÙÚÂÈ˜ ÌÂÙ·ÁÁ›ÛÂÈ˜ Û˘Ì˘ÎÓˆÌ¤ÓˆÓÂÚ˘ıÚÒÓ, Ë ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ıÂÙÈÎÔ-ÔÈ‹ıËÎÂ [C3d (+)], fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·-Î· 1. ∏ ·ÓÂ‡ÚÂÛË Û˘Ì‚·ÙÒÓ ÌÔÓ¿‰ˆÓ ·›Ì·ÙÔ˜¤ÁÈÓÂ ÂÍ·ÈÚÂÙÈÎ¿ ‰˘Û¯ÂÚ‹˜ Î·È ÌÂ ÙË ‰È¿ÁÓˆÛËÈı·Ó‹˜ ·˘ÙÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜·ÔÊ·Û›ÛÙËÎÂ Ë ÂÓ‰ÔÊÏ¤‚È· ¤Á¯˘ÛË Á-ÛÊ·ÈÚ›-ÓË˜ (3 g/kg) Î·È Ë ¤Ó·ÚÍË ıÂÚ·Â›·˜ ÌÂ ÌÂı˘Ï-ÚÂ‰ÓÈ˙ÔÏfiÓË (pulse therapy: 30 mg/kg/ËÌ¤Ú·ÁÈ· 3 ËÌ¤ÚÂ˜), ÌÂ ·ÎfiÏÔ˘ıË ¯ÔÚ‹ÁËÛË ÚÂ‰ÓÈ-˙ÔÏfiÓË˜ per os (2 mg/kg/ËÌ¤Ú·). ªÂÙ¿ ÙËÓ ¿-ÚÔ‰Ô Ì›·˜ Â‚‰ÔÌ¿‰·˜ ıÂÙÈÎÔÔÈ‹ıËÎÂ Î·È Ë ¤Ì-ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs, ¯ˆÚ›˜ Ó· Â›Ó·È ‰˘Ó·Ù‹Ë Ù·˘ÙÔÔ›ËÛË Î¿ÔÈÔ˘ ·ÓÙÈÛÒÌ·ÙÔ˜. ¶·Ú¿ÙËÓ ·ÁˆÁ‹ Î·È ÙÈ˜ Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ÌÂÙ·ÁÁ›ÛÂÈ˜,Ù· Â›Â‰· ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ·Ú¤ÌÂÓ·Ó ÛÂ¯·ÌËÏ¿ Â›Â‰·. ∏ ·ÛıÂÓ‹˜ ¤Ï·‚Â ÂÍÈÙ‹ÚÈÔ 12ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ÂÓÒ Ë·ÈÌÔÛÊ·ÈÚ›ÓË ÂÍ·ÎÔÏÔ˘ıÔ‡ÛÂ Ó· Â›Ó·È ¯·ÌËÏ‹(8 g/dl) Î·È ÔÈ ·ÓÙÈ‰Ú¿ÛÂÈ˜ Coombs - ¿ÌÂÛË Î·È¤ÌÌÂÛË - ıÂÙÈÎ¤˜. ∏ ¿ÌÂÛË Coombs ·ÚÓËÙÈÎÔ-ÔÈ‹ıËÎÂ ÙËÓ 60‹ ËÌ¤Ú· ÙË˜ ÓfiÛÔ˘, ÂÓÒ ·-Ú¿ÏÏËÏ· ÛÙËÓ ¤ÌÌÂÛË ‰ÔÎÈÌ·Û›· Coombs ·ÓÈ-¯ÓÂ‡ıËÎÂ Ë ·ÚÔ˘Û›· ·ÏÏÔ·ÓÙÈÛÒÌ·ÙÔ˜ ·ÓÙÈ-kidd a, ı¤ÙÔÓÙ·˜, ÙÂÏÈÎ¿, ÙË ‰È¿ÁÓˆÛË ÙË˜ ·ÏÏÔ-¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜. ∞ÎÔÏÔ‡ıËÛÂÛÙ·‰È·Î‹ ‰È·ÎÔ‹ ÙË˜ ·ÁˆÁ‹˜ ÌÂ ÎÔÚÙÈ˙fiÓË Î·È

Ù·˘Ùfi¯ÚÔÓË ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÙ·ÁÁ›-ÛÂˆÓ ·ÔÎÏÂÈÛÙÈÎÒ˜ Î·È ÌfiÓÔÓ ÌÂ Û˘Ì˘ÎÓˆ-Ì¤Ó· ÂÚ˘ıÚ¿ kidd a ·ÚÓËÙÈÎ¿, ÌÂ ÚÔÔ‰Â˘ÙÈÎ‹¿ÓÔ‰Ô ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ Hb ÙË˜ ·ÛıÂÓÔ‡˜ ÛÂÂÈı˘ÌËÙ¿ Â›Â‰· ≥9 g/dl (¶›Ó·Î·˜ 1).

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË ∞ÁfiÚÈ ËÏÈÎ›·˜ 2ó ÂÙÒÓ ·Ú·¤ÌÊıËÎÂ ·fi

ÂÚÈÊÂÚÈÎfi ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ Èı·Ó‹˜ ÔÌfi˙˘-ÁË˜ ‚-ª∞ Î·È ·˘ÙÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·È-Ì›·˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ¤ÎÙÔ ·È‰› ÔÈÎÔÁ¤ÓÂÈ·˜ÌÔ˘ÛÔ˘ÏÌ¿ÓˆÓ. OÈ ÁÔÓÂ›˜ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ÁÓˆÛÙÔ› ÊÔÚÂ›˜ ‚-ª∞ Î·È ¤Ó·˜ ·fi ÙÔ˘˜ ÌÂÁ·-Ï‡ÙÂÚÔ˘˜ ·‰ÂÏÊÔ‡˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ˆ˜ ¿Û¯ˆÓ·fi ÔÌfi˙˘ÁË ‚-ª∞, ˘Ô‚·ÏÏfiÌÂÓÔ˜ ÛÂ Ù·ÎÙÈ-Îfi ÚfiÁÚ·ÌÌ· ÌÂÙ·ÁÁ›ÛÂˆÓ. ∞fi ÙÔ ·ÙÔÌÈÎfi·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È ·ÚÔ˘Û›· ÈÎÙÂÚÈÎ‹˜¯ÚÔÈ¿˜ ‰¤ÚÌ·ÙÔ˜ ·fi ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÌÂ‰È¿ÁÓˆÛË ÂÙÂÚfi˙˘ÁË˜ ‚-ª∞.

∏ ·ÚÔ‡Û· ÓfiÛÔ˜ ÍÂÎ›ÓËÛÂ ¤Ó·Ó Ì‹Ó· ÚÈÓÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ÎÏÈÓÈÎ‹, ÌÂ ¤ÏÂÁ¯Ô ÙÔ˘ ÌÈ-ÎÚÔ‡ ·ÛıÂÓÔ‡˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ÓÔÛÔÎÔÌÂ›Ô Ïfi-Áˆ ˆ¯ÚfiÙËÙ·˜, fiÔ˘ ‚¿ÛÂÈ ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚË-Ì¿ÙˆÓ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Èı·Ó‹˜ ÔÌfi˙˘ÁË˜‚-ª∞, ¯ˆÚ›˜ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ÂÚÁ·ÛÙËÚÈ·Î‹ÂÈ‚Â‚·›ˆÛ‹ ÙË˜. ¶·Ú¿ ÙËÓ ¤Ó·ÚÍË ÌÂÙ·ÁÁ›ÛÂ-ˆÓ Û˘Ì‚·ÙÒÓ ˆ˜ ÚÔ˜ Ù· ·ÓÙÈÁÔÓÈÎ¿ Û˘ÛÙ‹Ì·-Ù· ∞µO, Rh Î·È Kell, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÈÎ·ÓÔ-ÔÈËÙÈÎ‹ ¿ÓÔ‰Ô˜ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜, ÂÓÒ Ô¤ÏÂÁ¯Ô˜ Ô˘ ·ÎÔÏÔ‡ıËÛÂ ·ÔÎ¿Ï˘„Â ÙËÓ ·-ÚÔ˘Û›· ıÂÙÈÎ‹˜ ¿ÌÂÛË˜ ·ÓÙ›‰Ú·ÛË˜ CoombsÎ·È Ô ·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËÎÂ ÁÈ· ÂÚ·ÈÙ¤Úˆ¤ÏÂÁ¯Ô Î·È ·ÓÙÈÌÂÙÒÈÛË.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‰È·ÈÛÙÒıËÎÂ ÈÎÙÂÚÈÎ‹¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜ Î·È ÂÈÂÊ˘ÎfiÙˆÓ, Ë·ÙÔ-ÛÏËÓÔÌÂÁ·Ï›· (4 cm Î·È 7 cm, ·ÓÙ›ÛÙÔÈ¯·) Î·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:440-444

¶›Ó·Î·˜ 1. ¶ÔÚÂ›· ·ÛıÂÓÔ‡˜ ÌÂ ‚-ª∞ Î·È ·ÏÏÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·

∏Ì¤Ú· ÓfiÛÔ˘ 10Ë 35Ë 38Ë 45Ë 50‹ 65Ë 100‹

Hb (g/dl) 4,5 4,7 5,7 4,1 8 8,3 >9Ht (%) 13,7 14 16 12 23 25 >28ÕÌÂÛË Coombs (-) (+) C3d (+) C3d (+) C3d (+) C3d (-) (-)ŒÌÌÂÛË Coombs (-) (-) (+) ÌÂ ¤Ó˙˘ÌÔ (+) ÌÂ ¤Ó˙˘ÌÔ (+) ÌÂ ¤Ó˙˘ÌÔ ∞ÓÙÈ- (-)

·ÓÛ˘ÁÎfiÏÏËÛË ·ÓÛ˘ÁÎfiÏÏËÛË ·ÓÛ˘ÁÎfiÏÏËÛË kidd a (+)¢È¿ÁÓˆÛË ∞˘ÙÔ¿ÓÔÛË ∞ÏÏÔ¿ÓÔÛË

·ÈÌÔÏ˘ÙÈÎ‹ ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· ·Ó·ÈÌ›·

∞ÓÙÈÌÂÙÒÈÛË � � �� *∫ÔÚÙÈ˙fiÓË i.v. ÎÔÚÙÈ˙fiÓË ∂ÍÈÙ‹ÚÈÔ µ·ıÌÈ·›· IVIG per os ‰È·ÎÔ‹

ÎÔÚÙÈ˙fiÓË˜

�: ªÂÙ¿ÁÁÈÛË Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Û‡ÌÊˆÓ· ÌÂ ÁÔÓfiÙ˘Ô*: ªÂÙ¿ÁÁÈÛË ÌÂ Û˘Ì˘ÎÓˆÌ¤Ó· ÂÚ˘ıÚ¿ kidd a (-)

™ËÌÂ›ˆÛË: ˆ˜ 1Ë ËÌ¤Ú· ÓfiÛÔ˘ ˘ÔÏÔÁ›˙ÂÙ·È Ë ËÌÂÚÔÌËÓ›· ‰È¿ÁÓˆÛË˜ ÙË˜ ‚-ª∞


442 ∞. ∫Ô‡ÛË Î·È Û˘Ó.

ÚÔÛˆÂ›Ô ÔÌfi˙˘ÁË˜ ‚-ª∞. ∂ÚÁ·ÛÙËÚÈ·Î¿‰È·ÈÛÙÒıËÎ·Ó Hb 7,6 g/dl, Ht 24,7%, ¢∂∫1,4%, ·ıÔÏÔÁÈÎ‹ ÌÔÚÊÔÏÔÁ›· ÂÚ˘ıÚÔÎ˘ÙÙ¿-ÚˆÓ ÌÂ ¤ÓÙÔÓË ·ÓÈÛÔ- ÔÈÎÈÏÏÔ- ÛÙÔ¯ÔÎ˘ÙÙ¿-ÚˆÛË, ÂÓÒ Ë ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ ‹Ù·Ó ¯·Ú·-ÎÙËÚÈÛÙÈÎ‹ ÔÌfi˙˘ÁË˜ ‚-ª∞. OÈ ÚÔËÁËıÂ›ÛÂ˜ÌÂÙ·ÁÁ›ÛÂÈ˜ Î·ıÈÛÙÔ‡Û·Ó ·‰‡Ó·ÙË ÙË ÛˆÛÙ‹·ÍÈÔÏfiÁËÛË ÙË˜ ËÏÂÎÙÚÔÊfiÚËÛË˜ Hb. ¶·Ú¿ÙËÓ ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘-ÚËÌ¿ÙˆÓ Û˘Ì‚·ÙÒÓ ÌÂ ÔÌfi˙˘ÁË ‚-ª∞, Ô ¤ÏÂÁ-¯Ô˜ ÙˆÓ ‚ ÁÔÓÈ‰›ˆÓ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ÙË˜ ÎÏÈÓÈ-Î‹˜ ·ÔÎ¿Ï˘„Â ÙËÓ ·ÚÔ˘Û›· ÌfiÓÔÓ ÙË˜ ÌÂ-Ù¿ÏÏ·ÍË˜ codon 39 (‚0), ¯ˆÚ›˜ Ó· Â›Ó·È ‰˘Ó·Ù‹Ë ·Ó›¯ÓÂ˘ÛË Ì›·˜ ‰Â‡ÙÂÚË˜ ÌÂÙ¿ÏÏ·ÍË˜, ÌÂÙ·-Í‡ ·˘ÙÒÓ Ô˘ Û˘Ó·ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔÓ ÂÏ-ÏËÓÈÎfi ÏËı˘ÛÌfi. ∞ÓÙ›ÛÙÔÈ¯·, Ë ÌÂÙ¿ÏÏ·ÍË ‚0

39 ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÙÔÓ ·Ù¤Ú·, ÂÓÒ ‰ÂÓ ‹Ù·Ó ‰˘-Ó·Ù‹ Ë Ù·˘ÙÔÔ›ËÛË ÌÂÙ¿ÏÏ·ÍË˜ ‚ ÁÔÓÈ‰›ˆÓÛÙË ÌËÙ¤Ú·, ·Ó Î·È Ë ËÏÂÎÙÚÔÊfiÚËÛ‹ ÙË˜ ‹Ù·ÓÙ˘ÈÎ‹ ÂÙÂÚfi˙˘ÁË˜ ‚-ª∞. ¶ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜ ÙÔ˘ ¶·ÓÂ-ÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ·ÔÎ¿Ï˘„Â ÙËÓ ·ÚÔ˘Û›·ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ codon 8 (‚0), ÙfiÛÔ ÛÙÔÓ ·ÛıÂ-Ó‹ fiÛÔ Î·È ÛÙË ÌËÙ¤Ú· ÙÔ˘, Ì›· ÌÂÙ¿ÏÏ·ÍË Ô˘··ÓÙ¿Ù·È Î˘Ú›ˆ˜ ÛÙÔÓ ÙÔ˘ÚÎÈÎfi ÏËı˘ÛÌfi.ø˜ ÚÔ˜ ÙÈ˜ ‰ÔÎÈÌ·Û›Â˜ Coombs, Ë ¿ÌÂÛË ‚Ú¤-ıËÎÂ ·ÛıÂÓÒ˜ ıÂÙÈÎ‹ Î·È Ë ¤ÌÌÂÛË ·ÚÓËÙÈÎ‹ÛÙÔ Û˘ÌÏ‹ÚˆÌ· (¶›Ó·Î·˜ 2).

O ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ÌÂÙ·ÁÁ›ÛÂÈ˜Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ, ÌÂ Û¯ÂÙÈÎ¿ ‚Ú·‰Â›·¿ÓÔ‰Ô ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ Hb Î·È ÂÎ Ó¤Ô˘ ÙÒ-ÛË ÛÙ· 5 g/dl ÙË 12Ë ËÌ¤Ú· ÓÔÛËÏÂ›·˜. ∆·˘Ùfi-¯ÚÔÓ·, Ë ¿ÌÂÛË Coombs ¤ÁÈÓÂ ÂÓÙfiÓˆ˜ ıÂÙÈÎ‹ÛÙÔ Û˘ÌÏ‹ÚˆÌ·, ÂÓÒ ıÂÙÈÎÔÔÈ‹ıËÎÂ - ·ÚÔ-‰ÈÎ¿ - Î·È Ë ¤ÌÌÂÛË Coombs. ªÂ ÙË ‰È¿ÁÓˆÛËÙË˜ ·˘ÙÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜ ·ÔÊ·-Û›ÛÙËÎÂ Ë ¤Á¯˘ÛË Á-ÛÊ·ÈÚ›ÓË˜ (2 g/kg) Î·È Ë¯ÔÚ‹ÁËÛË, ·Ú¯ÈÎ¿, ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË˜ (pulse

therapy: 30 mg/kg/ËÌ¤Ú·, ÁÈ· 3 ËÌ¤ÚÂ˜) Î·È, ÛÙËÛ˘Ó¤¯ÂÈ·, ÚÂ‰ÓÈ˙ÔÏfiÓË˜ per os (2 mg/kg/ËÌ¤-Ú·) (¶›Ó·Î·˜ 2). ∆· Â›Â‰· ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜·Ó‹Ïı·Ó, ÙÂÏÈÎ¿, ÛÙ· ÂÈı˘ÌËÙ¿ Â›Â‰· ÌÂÙ¿ÙËÓ 20‹ ËÌ¤Ú· ÓfiÛÔ˘ Î·È Ô ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ,ÂÓÒ Ë ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ·Ú¤ÌÂÓÂ ıÂ-ÙÈÎ‹. O ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËÎÂ ÛÂ ÌÂÙ¿Á-ÁÈÛË Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Î¿ıÂ 15 ËÌ¤ÚÂ˜,ÌÂ ‰È·Ù‹ÚËÛË Ì¤ÛÔ˘ fiÚÔ˘ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ~9g/dl Î·È Ë ÎÔÚÙÈ˙fiÓË ‰È·ÎfiËÎÂ ÛÙ·‰È·Î¿. ∏¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ‰ÂÓ ·ÚÓËÙÈÎÔÔÈ‹-ıËÎÂ, ·Ú¿ ¤ÓÙÂ Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·.

™˘˙‹ÙËÛË

∏ ·ÏÏÔ¿ÓÔÛË Î·È Ë ·˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹·Ó·ÈÌ›· Û˘ÓÈÛÙÔ‡Ó ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌË¯·ÓÈÛÌÔ‡·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÓÔ¯‹˜, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÂ˜ ÂÚ-Á·ÛÙËÚÈ·Î¿ ·fi ÙËÓ ·ÚÔ˘Û›· ıÂÙÈÎ‹˜ ÙË˜ ‰Ô-ÎÈÌ·Û›·˜ ·ÓÙÈÛÊ·ÈÚÈÓÈÎÔ‡ ÔÚÔ‡, Ë ÔÔ›· Â›Ó·ÈÂ˘Ú¤ˆ˜ ÁÓˆÛÙ‹ ˆ˜ ·ÓÙ›‰Ú·ÛË Coombs. MÂ ÙËÓ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ·ÔÎ·Ï‡ÙÂÙ·È Ë·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ, ÂÓÒ ÌÂ ÙËÓ ¤ÌÌÂÛË ‰ÔÎÈÌ·-Û›· ·ÓÈ¯ÓÂ‡ÂÙ·È Ë ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓÔÚfi ÙÔ˘ ·ÛıÂÓÔ‡˜ (5).

Œ¯ÂÈ ˘ÔÏÔÁÈÛÙÂ› fiÙÈ ··ÈÙÔ‡ÓÙ·È ÂÚÈÛÛfi-ÙÂÚ· ·fi 100 ÌfiÚÈ· ·ÓÙÈÛÒÌ·ÙÔ˜ ÛÙË ÌÂÌ‚Ú¿-ÓË Î¿ıÂ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚÔ˘ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·Ô-‚Â› ıÂÙÈÎ‹ Ë ¿ÌÂÛË Coombs (6). ∂ÓÙÔ‡ÙÔÈ˜,ÔÚÈÛÌ¤Ó· ·ÓÙÈÛÒÌ·Ù· ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘ÓÛÂ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÂÚ˘ıÚÒÓ, ·ÎfiÌË Î·È ÌÂ ˘-ÎÓfiÙËÙ· ÙË˜ Ù¿ÍË˜ ÙˆÓ 10 ÌÔÚ›ˆÓ ·Ó¿ ÂÚ˘ıÚfi.™˘ÓÂÒ˜, ·ÈÌfiÏ˘ÛË ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ Î·È ÌÂ·ÚÓËÙÈÎ‹ ÙË ‰ÔÎÈÌ·Û›· Coombs (7). ∞ÓÙ›ÛÙÚÔ-Ê·, Ë ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙ· ÂÚ˘ıÚ¿ ‰ÂÓÔ‰ËÁÂ› ¿ÓÙÔÙÂ ÛÂ ÌÂ›ˆÛË ÙË˜ ÂÈ‚›ˆÛ‹˜ ÙÔ˘˜.

¶·È‰È·ÙÚÈÎ‹ 2005;68:440-444

¶›Ó·Î·˜ 2. ¶ÔÚÂ›· ·ÛıÂÓÔ‡˜ ÌÂ ‚-ª∞ Î·È ·˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·

∏Ì¤Ú· ÓfiÛÔ˘ 1Ë 4Ë 6Ë 8Ë 9Ë 12Ë 15Ë 19Ë 20‹ 21Ë 150‹

Hb (g/dl) 7,5 5,1 6,6 7,8 9 5,0 4,8 5,3 7,9 10,5 9,5Ht (%) 24,7 17 21,5 25,2 29 16,1 15 18,2 26 33,6 28ÕÌÂÛË Coombs (±) (±) (+) C3d (+) (+) (-)ŒÌÌÂÛË Coombs (-) (-) (+) ÌÂ ¤Ó˙˘ÌÔ (±) (±) (-)

·ÓÛ˘ÁÎfiÏÏËÛË¢È¿ÁÓˆÛË ∞˘ÙÔ¿ÓÔÛË

·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·

∞ÓÙÈÌÂÙÒÈÛË � � � ∫ÔÚÙÈ˙fiÓË i. v. � � �IVIG ∫ÔÚÙÈ˙fiÓË

per os

�: ªÂÙ¿ÁÁÈÛË Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Û‡ÌÊˆÓ· ÌÂ ÁÔÓfiÙ˘Ô


443ÕÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·

ŒÙÛÈ, Ë ¿ÌÂÛË ‰ÔÎÈÌ·Û›· Coombs ·Ó·Ê¤ÚÂÙ·ÈıÂÙÈÎ‹ ÛÂ Û˘¯ÓfiÙËÙ· 1:10.000 ÌÂÙ·Í‡ Ê˘ÛÈÔÏÔ-ÁÈÎÒÓ ·ÈÌÔ‰ÔÙÒÓ (8,9).

¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÚÔ˘Û›· ıÂÙÈÎ‹˜¿ÌÂÛË˜ ·ÓÙ›‰Ú·ÛË˜ Coombs ¯·Ú·ÎÙËÚ›˙ÂÈ Û˘-Ó‹ıˆ˜ ÙËÓ ·˘ÙÔ¿ÓÔÛË, ÂÓÒ Ë ·ÚÔ˘Û›· ¤ÌÌÂ-ÛË˜ ÙËÓ ·ÏÏÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·, ·˘Ùfi‰ÂÓ ·ÔÙÂÏÂ› Î·ÓfiÓ·. ™˘¯Ó¿, ·ÌÊfiÙÂÚÂ˜ ÔÈ·ÓÙÈ‰Ú¿ÛÂÈ˜ ‚Ú›ÛÎÔÓÙ·È ıÂÙÈÎ¤˜ Î·È, ÙfiÙÂ, Ìfi-ÓÔÓ Ë ÂÈÎÚ¿ÙËÛË ÙË˜ Ì›·˜ ÂÎ ÙˆÓ ‰‡Ô ‹ Ë Ù·˘-ÙÔÔ›ËÛË Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ·ÏÏÔ- ‹ ·˘ÙÔ·ÓÙÈÛÒ-Ì·ÙÔ˜, ÛÙËÓ ÔÚÂ›· ÙÔ˘ ¯ÚfiÓÔ˘, ı¤ÙÂÈ ÙË ‰È¿-ÁÓˆÛË ÌÂ ‚Â‚·ÈfiÙËÙ· - fiˆ˜ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó. ™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË, Ë·ÚÔ˘Û›· ıÂÙÈÎ‹˜ ¿ÌÂÛË˜ Coombs ·Ú·Ï¿-ÓËÛÂ ·ÚÔ‰ÈÎ¿, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· Ë ÂÈÎÚ¿ÙË-ÛË ÙË˜ ¤ÌÌÂÛË˜ ·ÓÙ›‰Ú·ÛË˜ Î·È Ë Ù·˘ÙÔÔ›ËÛËÙÔ˘ ·ÏÏÔ·ÓÙÈÛÒÌ·ÙÔ˜ ·ÓÙÈ-kidd a ¤ıÂÛ·Ó ÙË‰È¿ÁÓˆÛË ÙË˜ ·ÏÏÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·È-Ì›·˜. ∞ÓÙ›ıÂÙ·, ÛÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ë ·È-ÌfiÏ˘ÛË ÔÊÂÈÏfiÙ·Ó ÛÂ ·˘ÙÔ·ÓÔÛÔÔ›ËÛË, ÌÂ·ÚÔ‰ÈÎ‹ ÌfiÓÔÓ ıÂÙÈÎÔÔ›ËÛË ÙË˜ ¤ÌÌÂÛË˜Coombs Î·È ÂÈÎÚ¿ÙËÛË ÙË˜ ¿ÌÂÛË˜ ·ÓÙ›‰Ú·-ÛË˜, Ë ÔÔ›· ·Ú¤ÌÂÈÓÂ ıÂÙÈÎ‹ ÁÈ· ‰È¿ÛÙËÌ·ÔÏÏÒÓ ÌËÓÒÓ.

∏ Û˘¯ÓfiÙËÙ· ÂÎ‰‹ÏˆÛË˜ ·ÏÏÔ¿ÓÔÛË˜ ·Ó·È-Ì›·˜ ÛÙÔ˘˜ ŒÏÏËÓÂ˜ ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜ ·ÛıÂÓÂ›˜·Ó·Ê¤ÚÂÙ·È ÛÂ ÔÛÔÛÙfi 5-20% (10-12), ÂÓÒ‰ÂÓ ˘¿Ú¯ÂÈ Â›ÛËÌË Î·Ù·ÁÚ·Ê‹ Û¯ÂÙÈÎ¿ ÌÂÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Û˘¯ÓfiÙËÙ· ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ ·È-ÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜.

™‡ÌÊˆÓ· ÌÂ ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ÔÈ Î˘-ÚÈfiÙÂÚÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓÂÎ‰‹ÏˆÛË ·ÏÏÔ·ÓÔÛÔÔ›ËÛË˜ ÛÂ ¿ÙÔÌ· Ô˘˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ÌÂÙ·ÁÁ›ÛÂÈ˜ Â›Ó·È Ë ·Û˘Ì‚·-ÙfiÙËÙ· ÙÔ˘ ÌÂÙ·ÁÁÈ˙fiÌÂÓÔ˘ ·›Ì·ÙÔ˜ - ˆ˜ ÚÔ˜ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎ¿ ·ÓÙÈÁÔÓÈÎ¿ Û˘ÛÙ‹Ì·Ù· ÁÈ· Ù·ÔÔ›· ‰ÂÓ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ¤ÏÂÁ¯Ô˜ ÛÙËÓ Î·ı’ËÌ¤Ú· Ú¿ÍË, Ë ·ÓÔÛÔÏÔÁÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘‰¤ÎÙË Î·È, Ù¤ÏÔ˜, Ë ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎ‹ Â›-‰Ú·ÛË ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂÓÔ˘ ·›Ì·ÙÔ˜ (13).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ¯ÔÚ‹ÁËÛË ·›Ì·ÙÔ˜Û˘Ì‚·ÙÔ‡ ˆ˜ ÚÔ˜ Ù· ·ÓÙÈÁÔÓÈÎ¿ Û˘ÛÙ‹Ì·Ù·∞µ√, Rh Î·È Kell ÛÂ fiÏÂ˜ ÙÈ˜ ÔÚÁ·ÓˆÌ¤ÓÂ˜ ÌÔ-Ó¿‰Â˜ - fiˆ˜ Î·È ÛÂ ·˘Ù‹ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›-ÙˆÛË˜ - ¤¯ÂÈ ÂÚÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈÎ¿ ÙË Û˘¯Ófi-ÙËÙ· ÂÎ‰‹ÏˆÛË˜ ·ÏÏÔ·ÓÔÛÔÔ›ËÛË˜ ÛÙÔ˘˜ Ô-Ï˘ÌÂÙ·ÁÁÈ˙fiÌÂÓÔ˘˜ ·ÛıÂÓÂ›˜ (13). À„ËÏ‹ Û˘-¯ÓfiÙËÙ· ·Ó·Ê¤ÚÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ÛÂ ¯ÒÚÂ˜ÌÂ ·ÓÔÌÔÈÔÁÂÓÂ›˜ ÏËı˘ÛÌÔ‡˜, fiÔ˘ Ë ÂÚ˘ıÚÔ-Î˘ÙÙ·ÚÈÎ‹ ·ÓÙÈÁÔÓÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· Â›Ó·È ÌÂÁ¿ÏË(13,15). ™Â ÂÚ›ÙˆÛË ·ÏÏÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈ-Î‹˜ ·Ó·ÈÌ›·˜, Ë ·ÚÔ˘Û›· ıÂÙÈÎ‹˜ ¤ÌÌÂÛË˜

·ÓÙ›‰Ú·ÛË˜ Coombs ‰‡Ó·Ù·È Ó· ÂÈÌ¤ÓÂÈ ÁÈ·ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙËÓ ÎÏÈÓÈÎ‹‚ÂÏÙ›ˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, ÂÓÒ Ë ÌÂÙ¿ÁÁÈÛË ·›Ì·-ÙÔ˜ ·Û‡Ì‚·ÙÔ˘ ˆ˜ ÚÔ˜ ÙÔ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎfi·ÓÙÈÁfiÓÔ Ô˘ ÚÔÎ¿ÏÂÛÂ ÙËÓ ·ÓÙ›‰Ú·ÛË ÂÓ‰¤-¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÎ Ó¤Ô˘ ıÂÙÈÎÔÔ›ËÛ‹ ÙË˜,ÌÂ ÂÎ‰‹ÏˆÛË ÎÏÈÓÈÎ¿ ¤ÓÙÔÓË˜ ·ÈÌfiÏ˘ÛË˜ (6).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Û¯¤ÛË ÌÂÙ·Í‡ ·ÓÔÛÔÏÔÁÈ-Î‹˜ Î·Ù¿ÛÙ·ÛË˜ ·ÛıÂÓÔ‡˜ Î·È ÂÎ‰‹ÏˆÛË˜ ·Ï-ÏÔ¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜, ÛËÌ·ÓÙÈÎfiÚfiÏÔ ÛÙÔ˘˜ ÔÏ˘ÌÂÙ·ÁÁÈ˙fiÌÂÓÔ˘˜ ı·Ï·ÛÛ·ÈÌÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ Ë ·ÚÔ˘Û›· ‹fi¯È ÛÏËÓÂÎÙÔÌ‹˜. ∏ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ·Ï-ÏÔ·ÓÔÛÔÔ›ËÛË˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó˘ÔÛÙÂ› ÛÏËÓÂÎÙÔÌ‹, ÂÍËÁÂ›Ù·È ·fi ÙÔ ÁÂÁÔ-Ófi˜ fiÙÈ ÛÂ ·Ô˘Û›· ÙÔ˘ ÛÏ‹Ó·, ÙË˜ ı¤ÛË˜ ‰Ë-Ï·‰‹ fiÔ˘ ˘fi Ê˘ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜ ÊÈÏ-ÙÚ¿ÚÔÓÙ·È Ù· Í¤Ó· ·ÓÙÈÁfiÓ·, Ë ·ÓÔÛÔÏÔÁÈÎ‹·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙ· ÂÈÛÂÚ¯fiÌÂÓ··ÓÙÈÁfiÓ· ÂÈÙÂ›ÓÂÙ·È (13).

∂›ÛË˜, Ë ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ ÌÂÙ·ÁÁ›ÛÂˆÓÊ·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË ·ÏÏÔ-¿ÓÔÛË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜. OÈ ÂÚÂ˘ÓËÙ¤˜Û˘ÌÊˆÓÔ‡Ó fiÙÈ Ë ¤Ó·ÚÍË ÂÊ·ÚÌÔÁ‹˜ ÌÂÙ·ÁÁ›-ÛÂˆÓ ÛÂ ÌÈÎÚ‹ ËÏÈÎ›·, ›Ûˆ˜ ÌÈÎÚfiÙÂÚË ·ÎfiÌËÎ·È ÙˆÓ 12 ÌËÓÒÓ, Ô‰ËÁÂ› ÛÂ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÔ-¯‹ Î·È ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙË˜ ·ÏÏÔ·ÓÔÛÔÔ›Ë-ÛË˜ (11,12).

∆¤ÏÔ˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ·-ÓÔÛÔÔ›ËÛË˜ Î·È ¿ÏÈ ÂÓÔ¯ÔÔÈÂ›Ù·È Ë ·Ô˘-Û›· ÙÔ˘ ÛÏ‹Ó· ÏfiÁˆ ÂÚÈÔÚÈÛÌ¤ÓË˜ ·ÔÌ¿-ÎÚ˘ÓÛË˜ ÙˆÓ ÌË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿-ÚˆÓ, ·ÏÏ¿ Î·È Ë ¤ÎıÂÛË ÛÂ ÌË ÏÂ˘Î·Ê·ÈÚÂÌ¤Ó·ÌÂÙ·ÁÁÈ˙fiÌÂÓ· ÂÚ˘ıÚÔÎ‡ÙÙ·Ú·, ÌÂ ÌË¯·ÓÈÛÌfifi¯È Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓÔ (17,18).

µ¿ÛÂÈ ·˘ÙÒÓ, ÔÈ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿-ÊÔÓÙ·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó È‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ,‰ÈfiÙÈ ·ÊÔÚÔ‡Ó ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Â›¯·ÓÚÔËÁÔ˘Ì¤Óˆ˜ ˘Ô‚ÏËıÂ› ÛÂ ÛÏËÓÂÎÙÔÌ‹Î·È ÔÈ ÔÔ›ÔÈ ·ÚÔ˘Û›·Û·Ó ·ÈÌfiÏ˘ÛË ¿ÓÔÛË˜·ÈÙÈÔÏÔÁ›·˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ÌÂ-Ù·ÁÁ›ÛÂˆÓ.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ ¿Û¯ÔÓÙÂ˜ ·fi ‚-ª∞,fiˆ˜ fiÏÔÈ ÔÈ ÔÏ˘ÌÂÙ·ÁÁÈ˙fiÌÂÓÔÈ ·ÛıÂÓÂ›˜,ÂÓ‰¤¯ÂÙ·È Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÏÏÔ- ‹ ·˘ÙÔ¿ÓÔ-ÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·. ∏ ÎÏÈÓÈÎ‹ ÛËÌ·Û›· ÙË˜Û˘Ó‡·ÚÍË˜ Û˘ÁÁÂÓÔ‡˜ ¯ÚfiÓÈ·˜ ·ÈÌfiÏ˘ÛË˜ ÌÂ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· Â›Ó·È ÌÂÁ¿ÏË, Î·ıÒ˜Ô‰ËÁÂ› ÛÂ Â›Ù·ÛË ÙË˜ ‹‰Ë ÌÂÈˆÌ¤ÓË˜ ÂÈ‚›ˆ-ÛË˜ ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ Î·È ‰˘Û¯ÂÚ·›ÓÂÈ ÙËÓ·ÓÂ‡ÚÂÛË ·›Ì·ÙÔ˜ Û˘Ì‚·ÙÔ‡ ÚÔ˜ ÌÂÙ¿ÁÁÈÛË,Î·ıÈÛÙÒÓÙ·˜ ÂÍ·ÈÚÂÙÈÎ¿ ‰‡ÛÎÔÏË ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜ ·ÛıÂÓÒÓ.

¶·È‰È·ÙÚÈÎ‹ 2005;68:440-444


444 ∞. ∫Ô‡ÛË Î·È Û˘Ó.


1. Blumberg N, Ross K, Avila E, Peck K. Should chron-ic transfusions be matched for antigens other thanABO and Rho(D)? Vox Sang 1984;47:205-208.

2. Weatherall DJ, Clegg JB, editors. The thalassaemiasyndromes. 4th ed. Oxford: Blackwell Science; 2001.p. 630-685.

3. Argiolu F, Diana G, Arnone M, Batzella MG, Piras P,Cao A. High-dose intravenous immunoglobulin inthe management of autoimmune hemolytic anemiacomplicating thalassaemia major. Acta Haematol1990;83:65-68.

4. Smit Sibinga CT. Immune effects of blood transfu-sion. Curr Opin Hematol 1999;6:442-445.

5. Nathan DG, Oski FA. Hematology of infancy andchildhood. 5th ed. Philadelphia: WB Saunders Co;1998. p. 496-522.

6. Jandl J. Blood: Textbook of Hematology. 1st ed. Bos-ton: Little, Brown and Company; 1987. p. 281-319.

7. Lee GR, Bithell TC, Foerster J, Athens JW, LukensJN. Wintrobe’s Clinical Hematology. 9th ed.Philadelphia: Lea and Febiger; 1993. p. 1170-1193.

8. Bareford D, Longster G, Gilks L, Tovey LA. Follow-up of normal individuals with a positive antiglobu-lin test. Scand J Haematol 1985;35:348-353.

9. Win N, Islam SI, Peterkin MA, Walker ID. Positivedirect antiglobulin test due to antiphospholipid an-tibodies in normal healthy blood donors. Vox Sang1997;72:182-184.

10. Economidou J, Constantoulakis M, Augoustaki O,Adinolfi M. Frequency of antibodies to various anti-genic determinants in polytransfused patients withhomozygous thalassaemia in Greece. Vox Sang1971;20:252-258.

11. Michail-Merianou V, Pamphili-Panousopoulou L,Piperi-Lowes L, Pelegrinis E, Karaklis A. Alloimmu-nization to red cell antigens in thalassemia: compar-ative study of usual versus better-match transfusionprogrammes. Vox Sang 1987;52:95-98.

12. Spanos T, Karageorga M, Ladis V, Peristeri J, Hatzil-iami A, Kattamis C. Red cell alloantibodies in pa-tients with thalassemia. Vox Sang 1990:58:50-55.

13. Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P,Vichinsky EP. Alloimmunization and erythrocyteautoimmunization in transfusion-dependent tha-lassemia patients of predominantly Asian descent.Blood 2000;96;3369-3373.

14. Hmida S, Mojaat N, Maamar M, Bejaoui M, Me-diouni M, Boukef K. Red cell alloantibodies in pa-tients with haemoglobinopathies. Nouv Rev Fr He-matol 1994;36:363-366.

15. Ameen R, Al-Shemmari S, Al-Humood S, Chowd-hury RI, Al-Eyaadi O, Al-Bashir A. RBC alloimmu-nization and autoimmunization among transfu-sion-dependent Arab thalassemia patients. Transfu-sion 2003;43:1604-1610.

16. Blajchman MA. Immunomodulatory effects of allo-geneic blood transfusions: clinical manifestations andmechanisms. Vox Sang 1998;74 (Suppl 2):S315-S319.

17. Hodge G, Lloyd JV, Hodge S, Story C, Han P. Func-tional lymphocyte immunophenotypes observed inthalassaemia and haemophilia patients receivingcurrent blood product preparations. Br J Haematol1999;105:817-825.

18. Pistillo MP, Tazzari PL, Gaudiano C, Cilla V, KatoT, Matsui T et al. Patients with neoplastic and non-neoplastic hematologic diseases acquire CTLA-4 an-tibodies after blood transfusion. Transfusion2001;41:462-469.

¶·È‰È·ÙÚÈÎ‹ 2005;68:440-444


445CASE REPORT

Immune haemolytic anaemia in patients withbeta-thalassaemia. Case report A. Kousi1, M. Oikonomou1, D. Kassimos2, P. Pliaki3, M. Athanasiou - Metaxa1

AbstractTwo cases of beta-thalassaemia with immune haemolytic anaemia (allo- and autoimmune,respectively) are described. The objective is to emphasize the possible co-existence and interaction ofimmune haemolysis with chronic congenital haemolytic anemia, and to highlight the clinical andtherapeutic problems that may arise in such cases.

Key wordsBeta-thalassaemia, alloimmunization, autoimmune haemolytic anemia, Coombs test.

1 Thalassaemia Unit, 1st Paediatric Clinic ofAristotelion University,Ippokration GeneralHospital, Thessaloniki

2 Paediatric Clinic,Dimokritio UniversityHospital, Thrace

3 Blood Center, IppokrationGeneral Hospital,Thessaloniki

Correspondence:Miranda Athanasiou-Metaxa 1st Paediatric Clinic, Ippokration General Hospital 49 Konstantinoupoleos Str. 546 42, Thessaloniki E-mail: [email protected]




446 ∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

1 ∆Ì‹Ì· ∞ÍÔÓÈÎÔ‡ Î·Èª·ÁÓËÙÈÎÔ‡ ∆ÔÌÔÁÚ¿ÊÔ˘,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›·™ÔÊ›·”, ∞ı‹Ó·

2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›·™ÔÊ›·”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:∂. ™·ÌÌÔ‡ÙË ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·


¶·È‰È·ÙÚÈÎ‹ 2005;68:446-448

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

∞ÁfiÚÈ ËÏÈÎ›·˜ 8 ÌËÓÒÓ ÌÂÙ·Ê¤ÚıËÎÂ ÛÙÔÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ Ù·¯Â›·˜ ‰ÈfiÁÎˆÛË˜ ÙË˜ ÎÔÈ-ÏÈ¿˜ ÙÔ˘ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ 20 ËÌ¤ÚÂ˜. OÈ ÁÔÓÂ›˜·Ó¤ÊÂÚ·Ó ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÂÚ›Ô˘ 500 g. ∞fiÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ˘‹Ú¯Â ÂÎÛÂÛËÌ·ÛÌ¤ÓËË·ÙÔÌÂÁ·Ï›·. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· (US)¤‰ÂÈÍÂ Ë·ÙÔÌÂÁ·Ï›· Î·È ·ÚÔ˘Û›· ÔÏ‡¯ˆÚÔ˘Î˘ÛÙÈÎÔ‡ ÌÔÚÊÒÌ·ÙÔ˜ ÛÙÔÓ ‰ÂÍÈfi Ë·ÙÈÎfi ÏÔ-‚fi, ‰È·ÛÙ¿ÛÂˆÓ 14,3 x 13,4 x 8,2 cm.

∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¤‰ÂÈÍÂ ÂÎÙÂÙ·Ì¤ÓËÂÍÂÚÁ·Û›·, Ë ÔÔ›· ‰ÈËıÔ‡ÛÂ Î·ı’ ÔÏÔÎÏËÚ›·ÓÙÔÓ ‰ÂÍÈfi Ë·ÙÈÎfi ÏÔ‚fi. ∂›¯Â ÔÏÏ·ÏÔ‡˜ Î˘-ÛÙÈÎÔ‡˜ ¯ÒÚÔ˘˜ Û˘ÚÚ¤ÔÓÙÂ˜, Ô˘ ‰È·¯ˆÚ›˙Ô-ÓÙ·Ó ÌÂ ÏÂÙ¿ ‰È·ÊÚ·ÁÌ¿ÙÈ·. ∆Ô ‰ÈÔÁÎˆÌ¤ÓÔ‹·Ú ·ˆıÔ‡ÛÂ Ù· ÁÂÈÙÔÓÈÎ¿ fiÚÁ·Ó· (¿ÁÎÚÂ-·˜, ¤ÓÙÂÚÔ, ‰ÂÍÈfi ÓÂÊÚfi).

ªÂÙ¿ ÙËÓ ÂÓ‰ÔÊÏ¤‚È· (∂º) ¯ÔÚ‹ÁËÛË ÛÎÈ·-ÁÚ·ÊÈÎÔ‡ ·Ú·ÙËÚ‹ıËÎÂ ÂÓ›Û¯˘ÛË ÛÙÔ ÙÔ›¯ˆ-Ì· Î·È Ù· ‰È·ÊÚ¿ÁÌ·Ù· ÙË˜ ÂÍÂÚÁ·Û›·˜ (∂ÈÎfiÓ·1). ¢ÂÓ ˘‹Ú¯·Ó ‰ÈÔÁÎˆÌ¤ÓÔÈ ÏÂÌÊ·‰¤ÓÂ˜ Ô‡ÙÂÂÚÈÙÔÓ·˚Î‹ Û˘ÏÏÔÁ‹.

OÈ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ Î·È ÔÈ ÙÈÌ¤˜ ·-ÊÂÙÔÚˆÙÂ˝ÓË˜ Î·È ‚-¯ÔÚÈ·Î‹˜ ÁÔÓ·‰ÔÙÚÔ›-ÓË˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜.

∞ÊÔ‡ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÚˆÙÔ·ıÔ‡˜ ÓÂ-ÔÏ¿ÛÌ·ÙÔ˜ ÙÔ˘ ‹·ÙÔ˜, ¤ÁÈÓÂ ·ÓÔÈ¯Ù‹ ‚ÈÔ„›·Î·È Ë ÈÛÙÔÏÔÁÈÎ‹ ‰È¿ÁÓˆÛË ‹Ù·Ó ÌÂÛÂÁ¯˘Ì·ÙÈ-Îfi Ë·ÙÈÎfi ·Ì¿ÚÙˆÌ·.

ŒÁÈÓÂ Â˘ÚÂ›· ËÌÈË·ÙÂÎÙÔÌ‹ Î·È Ô fiÁÎÔ˜·Ê·ÈÚ¤ıËÎÂ Ï‹Úˆ˜. ªÂÙÂÁ¯ÂÈÚËÙÈÎ¿ ‰ÂÓ

˘‹Ú¯·Ó ÂÈÏÔÎ¤˜. ∆Ô ·È‰› - 3 ¤ÙË ÌÂÙ¿ - Â›-Ó·È Î·Ï¿.

™˘˙‹ÙËÛË

∆Ô Î˘ÛÙÈÎfi ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· Â›Ó·ÈÛ¿ÓÈÔ˜ fiÁÎÔ˜ (1,3,4). ∞ÔÙÂÏÂ›Ù·È ·fi ¯·Ï·-Úfi ÔÈ‰ËÌ·ÙÒ‰Ë ÈÛÙfi, ·ÈÌÔÊfiÚ· ·ÁÁÂ›·, ÌÈÎÚ¤˜ÔÌ¿‰Â˜ Ë·ÙÔÎ˘ÙÙ¿ÚˆÓ Î·È ¯ÔÏËÊfiÚ· (3).Œ¯ÂÈ Ù·¯Â›· ·Ó¿Ù˘ÍË Î·È ÂÎ‰ËÏÒÓÂÙ·È ÎÏÈÓÈÎ¿ÌÂ ·ÓÒ‰˘ÓË ‰ÈfiÁÎˆÛË ÙË˜ ¿Óˆ ÎÔÈÏ›·˜ (1). ™ÙÔ

∂ÈÎfiÓ· 1. ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÌÂÙ¿ ·fi ÂÓ‰ÔÊÏ¤‚È·¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡. ∫˘ÛÙÈÎ‹ ÔÏ‡¯ˆÚË ÂÍÂÚÁ·-Û›·, ÌÂ ÂÓ›Û¯˘ÛË ÌfiÓÔ ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ Î·È ÙˆÓ ‰È·-ÊÚ·ÁÌ·Ù›ˆÓ ÙË˜ ÂÍÂÚÁ·Û›·˜.

ªÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· ÙÔ˘ ‹·ÙÔ˜. ∞Ó·ÊÔÚ¿ ÛÂ Ì›· ÂÚ›ÙˆÛËª. Ã·ÛÈÒÙÔ˘1, ∂. ™·ÌÌÔ‡ÙË2, ¶. ¶ÔÏ˘‚›Ô˘2, ∂. ∫ÔÛÎÈÓ¿2

¶ÂÚ›ÏË„ËOÈ ÚˆÙÔ·ıÂ›˜ fiÁÎÔÈ ÙÔ˘ ‹·ÙÔ˜ ÛÙ· ·È‰È¿ Â›Ó·È Û¿ÓÈÔÈ. ∞fi ·˘ÙÔ‡˜ Û˘¯ÓfiÙÂÚÔÈ Â›Ó·È ÔÈ Î·-ÎÔ‹ıÂÈ˜ (Ë·ÙÔ‚Ï¿ÛÙˆÌ·) ÌÂ ˘„ËÏfi ÔÛÔÛÙfi ıÓËÛÈÌfiÙËÙ·˜. ∞fi ÙÔ˘˜ Î·ÏÔ‹ıÂÈ˜ Û˘¯ÓfiÙÂÚÔ˜ Â›-Ó·È ÙÔ ·ÈÌ·ÁÁÂÈÔÂÓ‰ÔıËÏ›ˆÌ·, ÂÓÒ ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· Â›Ó·È Û¿ÓÈÔ. ∆Ô ÙÂÏÂ˘Ù·›Ô ÌÔ-ÚÂ› Ó· ·ÚÈÛÙ¿ Î·È Û˘ÁÁÂÓ‹ ‰˘ÛÏ·Û›·. OÈ ÚfiÔ‰ÔÈ ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÙÂ¯ÓÈÎÒÓ Î·È ÙË˜ ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹˜ ÙÔ˘ ‹·ÙÔ˜ ÚÔÛÊ¤ÚÔ˘Ó Ï¤ÔÓ ÂÍ·ÈÚÂÙÈÎ‹ ÚfiÁÓˆÛË ÛÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ·.¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡ ËÏÈÎ›·˜ 8 ÌËÓÒÓ ÌÂ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· ÙÔ˘ ‹·-ÙÔ˜ Î·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿¶·È‰È¿, ‹·Ú, ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ·, ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·.


447ªÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· ÙÔ˘ ‹·ÙÔ˜

·È‰› Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ ÔÈ ÁÔÓÂ›˜ ·Ú·Ù‹ÚË-Û·Ó ÙË ‰ÈfiÁÎˆÛË ÙË˜ ÎÔÈÏÈ¿˜ Î·Ù¿ ÙÔ ÙÂÏÂ˘Ù·›Ô20‹ÌÂÚÔ.

∆Ô Î·ÏfiËıÂ˜ ÌÂÛÂÁ¯˘Ì·ÙÔÁÂÓ¤˜ ·Ì¿ÚÙˆÌ··ÊÔÚ¿ ÛÂ Ó‹È· ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 3 ÂÙÒÓÎ·È ÛÂ ‰ÈÏ¿ÛÈÔ ÔÛÔÛÙfi ÛÙ· ·ÁfiÚÈ· (3), ·Ó Î·È˘¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ fiÙÈ Ë ÚÔÛ‚ÔÏ‹ ·ÊÔÚ¿ÂÍ›ÛÔ˘ ÛÂ ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (4,5).

À¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ ÁÈ· ‰È¿ÁÓˆÛË ÌÂÛÂÁ¯˘-Ì·ÙÔÁÂÓÔ‡˜ ·Ì·ÚÙÒÌ·ÙÔ˜ Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹-ÙÚÈÔ ·Ó¿Ù˘ÍË (1,5). √È ·Ó·ÊÔÚ¤˜ ÁÈ· ÌÂÛÂÁ¯˘-Ì·ÙÔÁÂÓ¤˜ ·Ì¿ÚÙˆÌ· ÛÂ ÂÓ‹ÏÈÎÂ˜ Â›Ó·È Ï›ÁÂ˜(4). ∏ ÂÍÂÚÁ·Û›· ¤¯ÂÈ Ù·¯Â›· ·Ó¿Ù˘ÍË, ÂÚÈ¤-¯ÂÈ ÔÏÏ·Ï¤˜ Î˘ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ Î·È ·ÊÔÚ¿Î·ı’ ˘ÂÚÔ¯‹Ó ÛÙÔÓ ‰ÂÍÈfi ÏÔ‚fi (>80%). ™ÙÔÓ‰ÂÍÈfi Ë·ÙÈÎfi ÏÔ‚fi ÂÓÙÔÈ˙fiÙ·Ó Ë ÂÍÂÚÁ·Û›·Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË.

∏ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ÌÂÛÂÁ¯˘Ì·ÙÈÎÔ‡ Ë·ÙÈ-ÎÔ‡ ·Ì·ÚÙÒÌ·ÙÔ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓÒÌ·ÏË ·Ó¿-Ù˘ÍË ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ÌÂÛÂÁ¯‡Ì·ÙÔ˜. ∂ÔÌ¤-Óˆ˜, Ë ÂÍÂÚÁ·Û›· ·ÊÔÚ¿ ÛÂ ·ÓÙÈ‰Ú·ÛÙÈÎ‹, ÌËÓÂÔÏ·ÛÌ·ÙÈÎ‹ ·ÏÏÔ›ˆÛË (4). ™ÙË ‚È‚ÏÈÔÁÚ·-Ê›·, ˆÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó Î·È ·Ó·ÊÔÚ¤˜ Ô˘ Û˘-Û¯ÂÙ›˙Ô˘Ó ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· ÌÂ ÙÔÌÂÛÂÁ¯˘Ì·ÙÈÎfi Û¿ÚÎˆÌ· (4). ™Â ·˘Ù‹ ÙËÓ ÂÚ›-ÙˆÛË, Ë Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË ÙÔ˘ fiÁÎÔ˘·ÔÎ·Ï‡ÙÂÈ ÌÂÙ¿ıÂÛË ÙË˜ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 19 (6).

OÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ˘ÂÚË¯ÔÁÚ¿ÊË-Ì·, ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· Â›Ó·È Ô˘ÛÈ·ÛÙÈÎ¤˜ ÁÈ· ÙËÓ ÚÔÂÁ¯ÂÈÚËÙÈ-Î‹ ‰È¿ÁÓˆÛË (1,3).

™ÙÔ US ·Ó·‰ÂÈÎÓ‡ÂÙ·È Ì›· ÔÏ˘ÏÔ‚ˆÙ‹ Ì¿-˙· ÌÂ ÔÏÏ·Ï¤˜ ¿ÓË¯Â˜ ÂÚÈÔ¯¤˜ (Î‡ÛÙÂÈ˜)Î·È ·ÚÔ˘Û›· ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Û˘Ì·ÁÒÓÙÌËÌ¿ÙˆÓ. ŸÙ·Ó Ô fiÁÎÔ˜ ¤¯ÂÈ ÂÍˆÊ˘ÙÈÎ‹ ·Ó¿-Ù˘ÍË, Â›Ó·È ‰‡ÛÎÔÏÔ Ó· Î·ıÔÚÈÛÙÂ› Ë Ë·ÙÈÎ‹ÙÔ˘ ÚÔ¤ÏÂ˘ÛË (7).

∆Ô Ì¤ÁÂıÔ˜ ÙË˜ ÂÍÂÚÁ·Û›·˜ Î˘Ì·›ÓÂÙ·È ·fi5 cm ¤ˆ˜ 30 cm, ÌÂ ÔÏÏ·Ï¤˜ Î‡ÛÙÂÈ˜ ‰È·Ì¤-ÙÚÔ˘ ·fi Ï›Á· ¯ÈÏÈÔÛÙ¿ Ì¤¯ÚÈ 10 cm.

OÈ Î‡ÛÙÂÈ˜ ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¤¯Ô˘Ó˘ÎÓfiÙËÙ· ·Ó¿ÏÔÁË ÌÂ ÙËÓ ·ÚÔ˘Û›· Û˘Ì·-ÁÒÓ ÛÙÔÈ¯Â›ˆÓ. ªÂÙ¿ ÙËÓ ∂º ¯ÔÚ‹ÁËÛË ÙÔ˘ÛÎÈ·ÁÚ·ÊÈÎÔ‡, ÂÓ›Û¯˘ÛË ·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ ÛÙ·ÙÌ‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ‹ ·ÁÁÂ›ˆÛË (4,7).

™ÙË Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ÙÔ Ì·ÁÓËÙÈÎfiÛ‹Ì· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÌÂÛÂÁ-¯˘Ì·ÙÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ Î·È ÙËÓ ·ÚÔ˘Û›· ÚˆÙÂ-˚ÓÒÓ ÛÙÔ˘˜ Î˘ÛÙÈÎÔ‡˜ ¯ÒÚÔ˘˜. ∂›Ó·È Ì›· ÂÙÂÚÔ-ÁÂÓ‹˜ Ì¿˙· ÌÂ ¯·ÌËÏ‹ ¤ÓÙ·ÛË Û‹Ì·ÙÔ˜ ÛÙÈ˜ ∆1·ÎÔÏÔ˘ı›Â˜ Î·È ˘„ËÏ‹ ÛÙÈ˜ ∆2 ·ÎÔÏÔ˘ı›Â˜. ∏‰ÈfiÁÎˆÛË ÙË˜ Ë·ÙÈÎ‹˜ ·ÚÙËÚ›·˜ Î·È ÙÔ˘

˘ÂÚÎÂ›ÌÂÓÔ˘ ÙÌ‹Ì·ÙÔ˜ ÙË˜ ÎÔÈÏÈ·Î‹˜ ·ÔÚÙ‹˜·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ fiÙ·Ó Ô fiÁÎÔ˜ ¤¯ÂÈ ÛËÌ·ÓÙÈ-Î‹ ·ÁÁÂ›ˆÛË (1,3,7).

™ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi·Ì¿ÚÙˆÌ· ÂÌÊ·Ó›˙ÂÙ·È Û·Ó ¤ÏÏÂÈÌÌ· Ï‹Úˆ-ÛË˜.

™ÙËÓ ·ÁÁÂÈÔÁÚ·Ê›· ·Ú·ÙËÚÔ‡ÓÙ·È ·ÁÁÂ›·ÌÈÎÚ‹˜ ‰È·Ì¤ÙÚÔ˘ ÛÙÔ ÂÛˆÙÂÚÈÎfi ·Ó¿ÁÁÂÈˆÓ(Î˘ÛÙÈÎÒÓ) ÂÚÈÔ¯ÒÓ, Ô˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘ÓÙ· ·ÁÁÂ›· ÙˆÓ ‰È·ÊÚ·ÁÌ·Ù›ˆÓ.

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË (8,9) Ú¤ÂÈ Ó· Á›ÓÂÈ·fi ÙÔ Î·ÎfiËıÂ˜ ÌÂÛÂÁ¯‡ÌˆÌ·, ÙÔ Ë·ÙÔ‚Ï¿-ÛÙˆÌ· Î·È ÙÔ ·ÈÌ·ÁÁÂÈÔÂÓ‰ÔıËÏ›ˆÌ·. ∆Ô ÙÂ-ÏÂ˘Ù·›Ô ‰È·ÁÈÁÓÒÛÎÂÙ·È ÛÂ ÚˆÈÌfiÙÂÚË ËÏÈÎ›·(Û˘¯Ó¿ ÙÔÓ ÚÒÙÔ Ì‹Ó· ˙ˆ‹˜), ‰ÈfiÙÈ ÌÔÚÂ› Ó·Û˘ÓÔ‰Â‡ÂÙ·È, ÂÎÙfi˜ ·fi ÙËÓ Ë·ÙÔÌÂÁ·Ï›·,·fi Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·, ·È-ÌÔÚÚ·Á›· Î·È ‰ÂÚÌ·ÙÈÎ¿ ·ÈÌ·ÁÁÂÈÒÌ·Ù·. ∆ÔË·ÙÔ‚Ï¿ÛÙˆÌ· ·ÊÔÚ¿ ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿(Û˘Ó‹ıˆ˜ Ì¤¯ÚÈ ¤ÓÙÂ ÂÙÒÓ) ÌÂ ˘„ËÏ¤˜ ÙÈÌ¤˜·-ÊÂÙÔÚˆÙÂ˝ÓË˜. ∏ ÂÍÂÚÁ·Û›· ·˘Ù‹ ¤¯ÂÈ ·ÓÔ-ÌÔÈÔÁ¤ÓÂÈ· ÌÂ Û˘Ì·Á‹ ÛÙÔÈ¯Â›·, ÂÚÈÔ¯¤˜ Ó¤-ÎÚˆÛË˜, ·ÔÙÈÙ·ÓÒÛÂÈ˜ Î·È ÛÙÂ¿ÙˆÛË. ∆· Â›-Â‰· ÙË˜ ·-ÊÂÙÔÚˆÙÂ˝ÓË˜ ÛÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi·Ì¿ÚÙˆÌ· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ¿ (7). ∆Ô Î·ÎfiËıÂ˜ÌÂÛÂÁ¯‡ÌˆÌ· ·ÊÔÚ¿ Û˘Ó‹ıˆ˜ ÛÂ ·È‰È¿ ËÏÈ-Î›·˜ 5-10 ÂÙÒÓ. ∞ÂÈÎÔÓÈÛÙÈÎ¿, Ô fiÁÎÔ˜ ¤¯ÂÈ ÌÂ-Á¿ÏÂ˜ Î˘ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÌÂ ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·ÈÙÔÈ¯ˆÌ·ÙÈÎ¿ Ô˙›‰È·.

∏ ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË ÈÛÙÔÔÈÂ›Ù·È ·fi ÙËÓÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, Â›ÙÂ ÛÂ ÚÔÂÁ¯ÂÈÚËÙÈÎ‹‚ÈÔ„›· Â›ÙÂ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜·Ê·›ÚÂÛË˜ ÙÔ˘ fiÁÎÔ˘ ÛÙËÓ Ù·¯Â›· ‚ÈÔ„›· (4).

∏ ıÂÚ·Â›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ÂÍ·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ··fi ÙËÓ ÂÓÙfiÈÛË Î·È ÙËÓ ¤ÎÙ·ÛË ÙË˜ ‚Ï¿‚Ë˜Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÎ˘Ú‹ÓÈÛË ÙÔ˘ fiÁÎÔ˘, ËÌÈË-·ÙÂÎÙÔÌ‹ Î·È - Û¿ÓÈ· - ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·-ÙÔ˜ (1,4,10,11). ªÂÙ¿ ÙËÓ Ï‹ÚË ·Ê·›ÚÂÛË ÙÔ˘fiÁÎÔ˘, Ë ÚfiÁÓˆÛË Â›Ó·È ÂÍ·ÈÚÂÙÈÎ‹ Î·È ‰ÂÓ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂÈ˜ ˘ÔÙÚÔ‹˜ (3,4).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi Ë·ÙÈ-Îfi ·Ì¿ÚÙˆÌ· Â›Ó·È ¤Ó·˜ Û¿ÓÈÔ˜ Î·ÏÔ‹ıË˜fiÁÎÔ˜. ∏ ÂÈÙ˘¯‹˜ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ ÔÊÂ›ÏÂ-Ù·È ÛÙËÓ ÂÍ¤ÏÈÍË ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÙÂ¯ÓÈÎÒÓÎ·È ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ÙÔ˘ ‹·ÙÔ˜.


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2. Okada A, Fukuzawa M, Oue T, Kohmoto Y, Kusa-fuka T, Fukui Y et al. Thirty-eight years experience

¶·È‰È·ÙÚÈÎ‹ 2005;68:446-448


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of malignant hepatic tumors in infants and child-hood. Eur J Pediatr Surg 1998;8:17-22.

3. Horton KM, Bluemke DA, Hruban RH, Soyer P,Fishman EK. CT and MR imaging of benign hepaticand biliary tumors. Radiographics 1999;19:431-451.

4. Balmer B, Le Coultre C, Feldges A, Hanimann B.Mesenchymal liver hamartoma in a newborn. Casereport. Eur J Pediatr Surg 1996;6:303-305.

5. Bartho S, Schulz HJ, Bollmann R, Specht U. Prena-tally diagnosed mesenchymal hamartoma of the liv-er. Zentralbl Pathol 1992;138:141-144.

6. Mascarello JT, Krous HF. Second report of atranslocation involving 19q13.4 in a mesenchymalhamartoma of the liver. Cancer Genet Cytogenet1992;58:141-142.

7. von Schweinitz D, Gluer S, Mildenberger H. Livertumors in neonates and very young infants: diag-

nostic pitfalls and therapeutic problems. Eur J Pedi-atr Surg 1995;5:72-76.

8. Men S, Hekimoglu B, Tuzun M, Arda IS, Pinar A.Unusual US and CT findings in hepatoblastoma: acase report. Pediatr Radiol 1995;25:507-508.

9. Kaufman RA. Is cystic mesenchymal hamartoma ofthe liver similar to infantile hemangioendotheliomaand cavernous hemangioma on dynamic computedtomography? Pediatr Radiol 1992;22:582-583.

10. Shuto T, Kinoshita H, Yamada C, Hirohashi K,Shiokawa C, Kubo S et al. Bilateral lobectomy ex-cluding the caudate lobe for giant mesenchymalhamartoma of the liver. Surgery 1993;113:215-222.

11. Tepetes K, Selby R, Webb M, Madariaga JR, Iwatsu-ki S, Starzl TE. Orthotopic liver transplantation forbenign hepatic neoplasms. Arch Surg 1995;130:153-156.

¶·È‰È·ÙÚÈÎ‹ 2005;68:446-448


449CASE REPORT

Liver mesenchymal hamartoma. A case report M. Hasiotou1, E. Sammouti2, P. Poliviou2, E. Koskina2

AbstractPrimary liver tumours are rare in children, and most are malignant (hepatoblastoma) and associatedwith a high mortality rate. Of the benign tumours the most common is haemangioendothelioma.Benign mesenchymal hamartoma is a rare entity, seen mainly in children under the age of two years,which probably represents a developmental anomaly, rather than a true neoplasm. Recent progress inimaging techniques and operating procedures offer, in this case, an excellent prognosis. The case isdescribed of an 8 month-old boy with mesenchymal hamartoma, including the diagnostic approachand the surgical procedure.

Key wordsChildren, liver, mesenchymal hamartoma, computed tomography.

1 Department of CT andMRI Imaging, “Aghia Sophia” Children’sHospital, Athens

2 Department of Radiology,“Aghia Sophia” Children’sHospital, Athens

Correspondence:E. Sammouti Department of Radiology, “Aghia Sophia” Children’sHospital, Athens




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¶ÂÚ›ÏË„Ë¶ÂÚÈÁÚ¿ÊÂÙ·È Û¿ÓÈ· ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ ÌÂ ÎÂ¯ÚˆÛÌ¤ÓÔ ·ÌÓÈ·Îfi ˘ÁÚfi (∫∞À) Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹‰˘Û¯¤ÚÂÈ·, ÌÂ ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Û˘Ó‰ÚfiÌÔ˘ ÂÈÛÚfiÊËÛË˜ ÌËÎˆÓ›Ô˘ (™∂ª), Ô˘ ÔÊÂ›ÏÔÓÙ·ÓÛÂ ¯ÔÏÒ‰ÂÈ˜ ÂÌ¤ÙÔ˘˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÏfiÁˆ ·ÙÚËÛ›·˜ ÂÓÙ¤ÚÔ˘ Î·È ÌËÎˆÓÈ·Î‹˜ „Â˘‰ÔÎ‡ÛÙË˜. ∆Ô ÓÂÔ-ÁÓfi ‹Ù·Ó ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÔÈÏÈ¿. ∏ ˘Ô„›· ÙË˜ÌËÎˆÓÈ·Î‹˜ „Â˘‰ÔÎ‡ÛÙË˜ Ù¤ıËÎÂ ·fi ÙËÓ „ËÏ¿ÊËÛË ˘fiÛÎÏËÚË˜ Ì¿˙·˜ ˘ÂÚÔÌÊ·ÏÈÎ¿. ∏ ‰È¿-ÁÓˆÛË ÙË˜ ·ÙÚËÛ›·˜ ÂÓÙ¤ÚÔ˘ ÂÈ‚Â‚·ÈÒıËÎÂ ÌÂ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi Î·È ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ¯ÂÈÚÔ˘ÚÁÈÎ¿. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ÔÚÂ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È ÙÔ ÓÂÔÁÓfi ÂÍ‹ÏıÂ ÛÂ Î·-Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿ªËÎˆÓÈ·Î‹ „Â˘‰ÔÎ‡ÛÙË, ¯ÔÏÒ‰ÂÈ˜ ¤ÌÂÙÔÈ, Û‡Ó‰ÚÔÌÔ ÂÈÛÚfiÊËÛË˜ ÌËÎˆÓ›Ô˘.

∂ÈÛ·ÁˆÁ‹

∏ ·ÚÔ˘Û›· ÎÂ¯ÚˆÛÌ¤ÓÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡(∫∞À) ·ÔÙÂÏÂ› Ì›· ·fi ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ÂÚÈ-ÁÂÓÓËÙÈÎ¤˜ ÂÈÏÔÎ¤˜, Ô˘ ··ÈÙÂ› ÙËÓ ·ÚÔ˘-Û›· ÓÂÔÁÓÔÏfiÁÔ˘ ‹ ÂÎ·È‰Â˘Ì¤ÓÔ˘ ·È‰È¿ÙÚÔ˘ÛÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡. ∆Ô ∫∞À ·Ú·ÙËÚÂ›Ù·ÈÛÂ 6-25% ÙˆÓ ÙÔÎÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÂ ÙÂÏÂÈ-fiÌËÓ· ‹ ·Ú·Ù·ÛÈ·Î¿ ÓÂÔÁÓ¿, ÂÓÒ ÛÂ ÚfiˆÚ·ÓÂÔÁÓ¿ Û˘Ó·ÓÙ¿Ù·È Û·ÓÈfiÙÂÚ· (1). ∏ Û˘Ó‹ıË˜·ÈÙ›· Â›Ó·È Ë ÂÓ‰ÔÌ‹ÙÚÈ· ‹ ÂÚÈÁÂÓÓËÙÈÎ‹ ·Ô-‚ÔÏ‹ ÌËÎˆÓ›Ô˘, Ô˘ ÌÔÚÂ› Ó· Û˘Ó‰¤ÂÙ·È ÌÂÙËÓ ‡·ÚÍË ÂÌ‚Ú˘˚Î‹˜ ‰˘ÛÚ·Á›·˜. ∆Ô ∫∞ÀÚ¤ÂÈ Ó· ‰È·¯ˆÚ›˙ÂÙ·È ·fi ÙÔ ˘Ò‰Â˜ ·ÌÓÈ·-Îfi ˘ÁÚfi ÏfiÁˆ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÏÔ›ÌˆÍË˜. ∞ÎfiÌË,¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Û¿ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜, ÛÙÈ˜ÔÔ›Â˜ ÙÔ ∫∞À ÔÊÂ›ÏÂÙ·È fi¯È ÛÂ ÂÓ‰ÔÌ‹ÙÚÈ··Ô‚ÔÏ‹ ÌËÎˆÓ›Ô˘, ·ÏÏ¿ ÛÂ ¯ÔÏÒ‰ÂÈ˜ ÂÌ¤ÙÔ˘˜ÙÔ˘ ÂÌ‚Ú‡Ô˘ (2-5).

¶ÂÚÈÁÚ¿ÊÂÙ·È Û¿ÓÈ· ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ÌÂ ∫∞À Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ÌÂ ·ÎÙÈ-ÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Û˘Ó‰ÚfiÌÔ˘ ÂÈÛÚfiÊËÛË˜ÌËÎˆÓ›Ô˘ (™∂ª), Ô˘ ÔÊÂ›ÏÔÓÙ·Ó ÛÂ ¯ÔÏÒ‰ÂÈ˜ÂÌ¤ÙÔ˘˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÏfiÁˆ ·ÙÚËÛ›·˜ ÂÓÙ¤ÚÔ˘Î·È ÌËÎˆÓÈ·Î‹˜ „Â˘‰ÔÎ‡ÛÙË˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

¶ÚfiˆÚÔ ÓÂÔÁÓfi, ·ÁfiÚÈ, ÁÂÓÓ‹ıËÎÂ ÛÙÔ πÔ-ÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ ·fi ‰Â˘ÙÂ-

ÚÔÙfiÎÔ ÌËÙ¤Ú·, ÌÂ ÁÔÓÂ›˜ Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÂ›˜,¯ˆÚ›˜ Û˘ÁÁ¤ÓÂÈ· ÌÂÙ·Í‡ ÙÔ˘˜. ∏ ÌËÙ¤Ú·, Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜, Â›¯Â Ù·ÎÙÈÎ‹ ·Ú·ÎÔ-ÏÔ‡ıËÛË ÛÙ· ∂ÍˆÙÂÚÈÎ¿ π·ÙÚÂ›· ÙÔ˘ ¡ÔÛÔÎÔ-ÌÂ›Ô˘ Î·È ‰ÂÓ ·ÚÔ˘Û›·ÛÂ È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·-Ù·. ∫·Ù¿ ÙÔÓ ÎÔÏÈÎfi ÙÔÎÂÙfi, ·Ú·ÙËÚ‹ıËÎÂÎÂ¯ÚˆÛÌ¤ÓÔ ·ÌÓÈ·Îfi ˘ÁÚfi. ∆Ô ÓÂÔÁÓfi Â›¯Â∞pgar score 1 ÛÙÔ 1Ô ÏÂÙfi Î·È ˘Ô‚Ï‹ıËÎÂ ÛÂÂÓ‰ÔÙÚ·¯ÂÈ·Î‹ ‰È·ÛˆÏ‹ÓˆÛË Î·È ·Ó·ÚÚfiÊËÛË,Ë ÔÔ›· ·¤‰ˆÛÂ ·ÌÓÈ·Îfi ˘ÁÚfi ÎÈÙÚÈÓÔÚ¿ÛÈ-ÓË˜ ¯ÚÔÈ¿˜. ∆Ô ∞pgar score ÛÙÔ 5Ô ÏÂÙfi ‹Ù·Ó 8.ªÂÙ·Ê¤ÚıËÎÂ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›-·˜ ¡ÂÔÁÓÒÓ (ª∂¡¡), fiÔ˘ ÂÊ·ÚÌfiÛÙËÎÂ ÌË-¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜. ∏ ·/· ıÒÚ·ÎÔ˜ ¤‰ÂÈÍÂ ÓÂ˘-ÌÔÓÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜ ¿ÌÊˆ, Û˘Ì‚·Ù¤˜ ÌÂ ™∂ª.∞fi ÙÈ˜ ÚÒÙÂ˜ ÒÚÂ˜ ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘ ÓÂÔ-ÁÓÔ‡ ·Ú·ÙËÚ‹ıËÎ·Ó ÎÈÙÚÈÓÔÚ¿ÛÈÓ· Á·ÛÙÚÈÎ¿˘ÁÚ¿, Ô˘ ·Ô‰fiıËÎ·Ó ÛÂ Î·Ù¿ÔÛË ÌËÎˆÓ›Ô˘Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô 2Ô ÂÈÎÔÛÈÙÂÙÚ¿ˆÚÔ ÙË˜ ÓÔ-ÛËÏÂ›·˜, ÔÈ ¯ÔÏÒ‰ÂÈ˜ Á·ÛÙÚÈÎ¤˜ ÂÎÎÚ›ÛÂÈ˜ Â¤-ÌÂÓ·Ó. ∫·Ù¿ ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ÙË˜ ÎÔÈÏ›·˜ ‰ÂÓ‰È·ÈÛÙÒıËÎÂ ÌÂÙÂˆÚÈÛÌfi˜ ‹ Â˘·ÈÛıËÛ›·, ·ÏÏ¿„ËÏ·Ê‹ıËÎÂ ‰ÈÛÎÔÂÈ‰‹˜ ˘fiÛÎÏËÚË Ì¿˙· ·ÚÈ-ÛÙÂÚ¿ ˘ÂÚÔÌÊ·ÏÈÎ¿, ‰È·Ì¤ÙÚÔ˘ ÂÚ›Ô˘ 2 cm.¢ÂÓ Â›¯Â ·Ú·ÙËÚËıÂ› Ì¤¯ÚÈ ÙfiÙÂ ·Ô‚ÔÏ‹ ÌË-ÎˆÓ›Ô˘. ™ÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜ ‰È·È-ÛÙÒıËÎÂ Â·Û‚ÂÛÙˆÌ¤ÓÔ ÌfiÚÊˆÌ· ÌÂÁ¤ıÔ˘˜ÂÚ›Ô˘ 3 cm, ÌÂ ·Ô˘Û›· ·¤Ú· ÛÙËÓ Î¿Ùˆ ÎÔÈ-Ï›·. ªÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ÎÔÈÏ›·˜ Î·È ÙË ‰È¿‚·ÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÂ ÛÎÈ·ÛÙÈ-Îfi, Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙË˜ ·ÙÚËÛ›·˜ ÏÂÙÔ‡


451™‡Ó‰ÚÔÌÔ ÂÈÛÚfiÊËÛË˜ ÎÂ¯ÚˆÛÌ¤ÓÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡

ÂÓÙ¤ÚÔ˘ ÛÙÔ ‡„Ô˜ ÙË˜ Ó‹ÛÙÈ‰·˜, ÌÂ Èı·Ó‹ ÌË-ÎˆÓÈ·Î‹ Î‡ÛÙË ÛÙÔ ÛËÌÂ›Ô ÙË˜ ·ÙÚËÛ›·˜ (∂ÈÎfi-Ó· 1). ∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË ¤‰ÂÈÍÂ ÌËÎˆÓÈ·-Î‹ ÂÚÈÙÔÓ›ÙÈ‰· ÌÂ Û¯ËÌ·ÙÈÛÌfi „Â˘‰ÔÎ‡ÛÙË˜Î·È ÔÏÏ·Ï¤˜ Û˘ÌÊ‡ÛÂÈ˜, Î·ıÒ˜ Î·È ·ÙÚËÛ›·ÛÙË ÌÂÛfiÙËÙ· ÙË˜ Ó‹ÛÙÈ‰·˜. ∞Ê·ÈÚ¤ıËÎÂ Ë ·Ô-ÙÈÙ·ÓˆÌ¤ÓË ÌËÎˆÓÈ·Î‹ Î‡ÛÙË, Ï‡ıËÎ·Ó ÔÈ Û˘Ì-Ê‡ÛÂÈ˜ Î·È ¤ÁÈÓÂ ÙÂÏÈÎÔÏ¿ÁÈ· ·Ó·ÛÙfiÌˆÛË ÙÔ˘ÂÁÁ‡˜ Î·È ÙÔ˘ ¿ˆ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ªÂÙ¿·fi 26 ËÌ¤ÚÂ˜ ÓÔÛËÏÂ›·˜, ÙÔ ÓÂÔÁÓfi ÂÍ‹ÏıÂ ÛÂÎ·Ï‹ Î·Ù¿ÛÙ·ÛË. O ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘ÁÁÂÓÂ›˜ ÏÔÈ-ÌÒÍÂÈ˜ Î·È Ô ÁÔÓÈ‰È·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Î˘ÛÙÈÎ‹›ÓˆÛË ‹Ù·Ó ·ÚÓËÙÈÎÔ›.

™˘˙‹ÙËÛË

∆Ô ™∂ª ÔÊÂ›ÏÂÙ·È Û˘Ó‹ıˆ˜ ÛÂ ÂÓ‰ÔÌ‹ÙÚÈ·‹ ÂÚÈÁÂÓÓËÙÈÎ‹ ÂÈÛÚfiÊËÛË ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡Ô˘ ÂÚÈ¤¯ÂÈ ÌËÎÒÓÈÔ. ªÔÚÂ›, fiÌˆ˜, Ó· ÔÊÂ›-ÏÂÙ·È Î·È ÛÂ ÂÈÛÚfiÊËÛË ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Ô˘ÂÚÈ¤¯ÂÈ ¯ÔÏ‹ ÏfiÁˆ ÂÓ‰ÔÌ‹ÙÚÈˆÓ ¯ÔÏˆ‰ÒÓÂÌ¤ÙˆÓ. ∏ ‰È¿ÁÓˆÛË ·˘Ù‹ Â›Ó·È Èı·ÓfiÙÂÚË ÛÂÂÚÈÙÒÛÂÈ˜ fiÔ˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·Ô‚ÔÏ‹ÌËÎˆÓ›Ô˘ ÛÙ· ÚÒÙ· ‰‡Ô ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ÙË˜

˙ˆ‹˜ Î·È È‰È·›ÙÂÚ· ÛÂ ÂÚÈÙÒÛÂÈ˜ ÚfiˆÚˆÓÓÂÔÁÓÒÓ, ÛÙ· ÔÔ›· ÂÓ‰ÔÌ‹ÙÚÈ· ·Ô‚ÔÏ‹ ÌË-ÎˆÓ›Ô˘ Û˘Ì‚·›ÓÂÈ Û·ÓÈfiÙÂÚ·. ∏ Û˘¯ÓfiÙËÙ·ÙÔ˘ ∫∞À ÏfiÁˆ ¯ÔÏˆ‰ÒÓ ÂÌ¤ÙˆÓ ‰ÂÓ Â›Ó·È ÁÓˆ-ÛÙ‹, ÁÈ·Ù› Ë ‰È¿ÁÓˆÛË ÌÔÚÂ› Ó· Á›ÓÂÈ ÌfiÓÔ Â¿Ó·ÔÎÏÂÈÛÙÂ› ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ô-‚ÔÏ‹˜ ÌËÎˆÓ›Ô˘. ∂ÔÌ¤Óˆ˜, ÙÔ ∫∞À ÌÔÚÂ› Ó··Ô‰ÔıÂ› ÛÂ ÂÓ‰ÔÌ‹ÙÚÈÔ˘˜ ¯ÔÏÒ‰ÂÈ˜ ÂÌ¤ÙÔ˘˜ÌfiÓÔ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÌÂ ·fiÊÚ·ÍË ÙÔ˘ ÂÓÙ¤-ÚÔ˘, fiˆ˜ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË. ∂Ó‰Â¯Ô-Ì¤Óˆ˜, ·˘Ùfi˜ Â›Ó·È Ô ÏfiÁÔ˜ ÁÈ· ÙÔÓ ÔÔ›Ô ÂÏ¿-¯ÈÛÙÂ˜ ÂÚÈÙÒÛÂÈ˜ ∫∞À ÏfiÁˆ ¯ÔÏˆ‰ÒÓ ÂÌ¤-ÙˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·-Ê›· (2-5). OÈ Griffiths Î·È Burge (5) ÂÚÈ¤ÁÚ·-„·Ó ÙÚÂÈ˜ ÂÚÈÙÒÛÂÈ˜ ÓÂÔÁÓÒÓ ÌÂ ∫∞À Ô˘Â›¯·Ó ÂÓÙÂÚÈÎ‹ ·fiÊÚ·ÍË Î·È ·¤‰ˆÛ·Ó ÙÔ∫∞À ÛÂ ÂÓ‰ÔÌ‹ÙÚÈÔ˘˜ ¯ÔÏÒ‰ÂÈ˜ ÂÌ¤ÙÔ˘˜.

∆· ¯ÔÏÈÎ¿ ¿Ï·Ù· Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÙÔ ÌË-ÎÒÓÈÔ Û˘Ì‚¿ÏÏÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ·Ó·ÓÂ˘-ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· ÙÔ˘ ™∂ª, ÁÈ·Ù› Û˘ÌÌÂÙ¤¯Ô˘ÓÛÙËÓ ·Ó¿Ù˘ÍË ¯ËÌÈÎ‹˜ ÓÂ˘ÌÔÓ›ÙÈ‰·˜, ·Ó·-ÛÙ¤ÏÏÔÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· ÙË ‰Ú¿ÛË ÙÔ˘ ÂÈÊ·-ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (6). ªÂ ÙÔ˘˜ ›‰ÈÔ˘˜ÌË¯·ÓÈÛÌÔ‡˜, Ë ‡·ÚÍË ¯ÔÏ‹˜ ÛÙÔ ÂÈÛÚÔÊËı¤Ó·ÌÓÈ·Îfi ˘ÁÚfi ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ·Ó·ÓÂ˘-ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·.

∏ ·Í›· ÙË˜ ‰È·ÊÔÚÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÌÂÙ·Í‡∫∞À ÏfiÁˆ ·Ô‚ÔÏ‹˜ ÌËÎˆÓ›Ô˘ Î·È ∫∞À ÏfiÁˆ¯ÔÏˆ‰ÒÓ ÂÌ¤ÙˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ¤ÁÎÂÈÙ·È ÛÙËÓ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘Ô-ÎÂ›ÌÂÓË˜ Î·Ù¿ÛÙ·ÛË˜. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›Ùˆ-ÛË, Ë ·Ú¯ÈÎ‹ ‰È¿ÁÓˆÛË ‹Ù·Ó ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘-Û¯¤ÚÂÈ· ·fi ™∂ª, ÏfiÁˆ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ô‚Ô-Ï‹˜ ÌËÎˆÓ›Ô˘. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ë ÂÓ‰ÔÌ‹ÙÚÈ··Ô‚ÔÏ‹ ÌËÎˆÓ›Ô˘ ıÂˆÚ‹ıËÎÂ ‰Â‰ÔÌ¤ÓË Â›¯Âˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ‰È¿ÁÓˆ-ÛË˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ·fiÊÚ·ÍË˜ ÁÈ· 24 ÂÚ›Ô˘ÒÚÂ˜, ÂÓÒ Ë ·Ô‚ÔÏ‹ ¯ÔÏˆ‰ÒÓ ÂÎÎÚ›ÛÂˆÓ ·fiÙÔÓ ÛÙÔÌ·ÙÔÁ·ÛÙÚÈÎfi Î·ıÂÙ‹Ú· ·Ú¯ÈÎ¿ ·Ô‰fi-ıËÎÂ ÛÙËÓ Î·Ù¿ÔÛË ∫∞À. ™ÙËÓ Î·ı˘ÛÙ¤ÚËÛËÙË˜ ‰È¿ÁÓˆÛË˜ Û˘Ó¤‚·Ï·Ó, Â›ÛË˜, Ë Î·Ï‹ ÁÂ-ÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È Ë ¤ÏÏÂÈ„Ë‰È¿Ù·ÛË˜ ‹ ¿ÏÏˆÓ ÂÌÊ·ÓÒ˜ ·ıÔÏÔÁÈÎÒÓ Â˘-ÚËÌ¿ÙˆÓ ·fi ÙËÓ ÎÔÈÏÈ¿. ∏ ˘Ô„›· ·ıÔÏÔÁÈ-Î‹˜ Î·Ù¿ÛÙ·ÛË˜ ·fi ÙÔ ¤ÓÙÂÚÔ Ù¤ıËÎÂ fiÙ·ÓÎ·Ù¿ ÙË Û¯ÔÏ·ÛÙÈÎ‹ „ËÏ¿ÊËÛË ÙË˜ ÎÔÈÏÈ¿˜‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ÌÈÎÚ‹˜ „ËÏ·ÊËÙ‹˜Ì¿˙·˜. ∏ ·ÓÂ‡ÚÂÛË ÂÓÙÔÈÛÌ¤ÓˆÓ Â·Û‚ÂÛÙÒ-ÛÂˆÓ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏÈ¿˜ ¤ıÂÛÂÙËÓ ˘Ô„›· ÌËÎˆÓÈ·Î‹˜ „Â˘‰ÔÎ‡ÛÙË˜, Ô˘ÂÈ‚Â‚·ÈÒıËÎÂ ÌÂ ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈ-Ï›·˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ‰È¿‚·ÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘·ÔÎ¿Ï˘„Â ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ÂÈÏÂÔ‡.

¶·È‰È·ÙÚÈÎ‹ 2005;68:450-452

∂ÈÎfiÓ· 1. ∂˘Ú‹Ì·Ù· ·fi ÙË ‰È¿‚·ÛË ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘.¢È·ÎÚ›ÓÂÙ·È ÙÔ ÌÈÎÚfiÎÔÏÔ ÏfiÁˆ ÙË˜ ·fiÊÚ·ÍË˜ ÙÔ˘ ÂÈ-ÏÂÔ‡ Î·È Ë Â·Û‚ÂÛÙˆÌ¤ÓË ÌËÎˆÓÈ·Î‹ „Â˘‰ÔÎ‡ÛÙËÛÙÔ ÛËÌÂ›Ô ‰È·ÎÔ‹˜ ÙË˜ Û˘Ó¤¯ÂÈ·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘.


452 µ. ¢ÚfiÛÔ˘ - ∞Á·Î›‰Ô˘ Î·È Û˘Ó.

∏ ÌËÎˆÓÈ·Î‹ „Â˘‰ÔÎ‡ÛÙË ·ÔÙÂÏÂ› ÂÓÙÔ-ÈÛÌ¤ÓË ÌÔÚÊ‹ ÙË˜ ÌËÎˆÓÈ·Î‹˜ ÂÚÈÙÔÓ›ÙÈ‰·˜(7). ∏ ÌËÎˆÓÈ·Î‹ ÂÚÈÙÔÓ›ÙÈ‰· Â›Ó·È ¿ÛËÙËÊÏÂÁÌÔÓ‹ - ÏfiÁˆ ÂÍfi‰Ô˘ ÌËÎˆÓ›Ô˘ ÛÙËÓ ÂÚÈ-ÙÔÓ·˚Î‹ ÎÔÈÏfiÙËÙ· - Î·È ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈÛÙËÓ ·Ó¿Ù˘ÍË ÌËÎˆÓÈ·Î‹˜ „Â˘‰ÔÎ‡ÛÙË˜,‰È¿¯˘ÙË˜ ÌËÎˆÓÈ·Î‹˜ ÂÚÈÙÔÓ›ÙÈ‰·˜ ‹ ·ÛÎ›ÙË·fi ÌËÎÒÓÈÔ fiÙ·Ó ‰È¿ÙÚËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û˘Ì-‚Â› Ï›ÁÂ˜ ÌfiÓÔ ËÌ¤ÚÂ˜ ÚÈÓ ÙÔÓ ÙÔÎÂÙfi. ∂¿Ó Ë‰È¿ÙÚËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ˘Ê›ÛÙ·-Ù·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÌÔÚÂ› Ó· Â¤ÏıÂÈ ÌÈÎÚÔ-‚È·Î‹ ÂÈÌfiÏ˘ÓÛË ÙË˜ ÌËÎˆÓÈ·Î‹˜ ÂÚÈÙÔÓ›ÙÈ-‰·˜ Î·È ÂÈ‚¿Ú˘ÓÛË ÙË˜ ÁÂÓÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜Î·È ÙË˜ ÚfiÁÓˆÛË˜ (7).

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÔÈÎ›ÏÏÂÈ ÛÂ ‚·Ú‡ÙËÙ·,·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· ÌÂ ÓÂ˘-ÌÔÓÈÎ‹ ˘ÔÏ·Û›· Ì¤¯ÚÈ ÙË Á¤ÓÓËÛË ·Û˘ÌÙˆ-Ì·ÙÈÎÔ‡ ÓÂÔÁÓÔ‡ ÌÂ Ù˘¯·›· ‰È·›ÛÙˆÛË Â·-Û‚ÂÛÙÒÛÂˆÓ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏÈ¿˜ (8).™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ˘‹Ú¯·Ó ÂÏ¿¯ÈÛÙ·Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÔÈÏÈ¿. Ã·Ú·ÎÙËÚÈÛÙÈÎfi·ÎÙÈÓÔÁÚ·ÊÈÎfi Â‡ÚËÌ· Â›Ó·È ÔÈ Â·Û‚ÂÛÙÒÛÂÈ˜,Ô˘ ÌÔÚÂ› Ó· ÂÓÙÔ›˙ÔÓÙ·È fi¯È ÌfiÓÔ ÛÙËÓ Â-ÚÈÙÔÓ·˚Î‹, ·ÏÏ¿ Î·È ÛÙË ıˆÚ·ÎÈÎ‹ ÎÔÈÏfiÙËÙ·Î·È ÛÙÔ fiÛ¯ÂÔ ÌÂ ÙË ÌÔÚÊ‹ ˘‰ÚÔÎ‹ÏË˜ (9,10).

ŒÓ· ¿ÏÏÔ ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ‹Ù·Ó Ë ·È-Ù›· ÙË˜ ÂÓÙÂÚÈÎ‹˜ ·fiÊÚ·ÍË˜ Î·È ÙË˜ ÌËÎˆÓÈ·-Î‹˜ ÂÚÈÙÔÓ›ÙÈ‰·˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÛËÌ·ÓÙÈÎfi·›ÙÈÔ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÂÓÙÂÚÈÎ‹˜ ·fiÊÚ·ÍË˜ ·ÔÙÂ-ÏÂ› Ë Î˘ÛÙÈÎ‹ ›ÓˆÛË. ∏ Â›ÙˆÛ‹ ÙË˜ ÛÂ ÓÂÔÁÓ¿ÌÂ ÌËÎˆÓÈ·Î‹ ÂÚÈÙÔÓ›ÙÈ‰· ÔÈÎ›ÏÏÂÈ ·fi 15%¤ˆ˜ 40% (11). O Î˘ÚÈfiÙÂÚÔ˜ ÌË¯·ÓÈÛÌfi˜ ÂÓÙÂÚÈ-Î‹˜ ·fiÊÚ·ÍË˜ Â›Ó·È Ô ÂÈÏÂfi˜ ·fi ÌËÎÒÓÈÔ, Ô˘·ÔÙÂÏÂ› ÙËÓ Ù˘ÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘. ∏Î˘ÛÙÈÎ‹ ›ÓˆÛË ·Ó·Ê¤ÚÂÙ·È Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜·ÙÚËÛ›·˜ ÂÓÙ¤ÚÔ˘ ÌÂ Â›ÙˆÛË 5-12% (11).∂ÔÌ¤Óˆ˜, fiÏ· Ù· ÓÂÔÁÓ¿ ÌÂ ÂÓÙÂÚÈÎ‹ ·fiÊÚ·-ÍË Ú¤ÂÈ Ó· ÂÏ¤Á¯ÔÓÙ·È ÁÈ· Î˘ÛÙÈÎ‹ ›ÓˆÛË, ËÔÔ›· Û˘Ó‰¤ÂÙ·È ÌÂ ‚·ÚÈ¿ ÚfiÁÓˆÛË. ™ÙËÓ ·-ÚÔ‡Û· ÂÚ›ÙˆÛË ¤ÁÈÓÂ ÁÔÓÈ‰È·Îfi˜ ¤ÏÂÁ¯Ô˜,ÛÙÔÓ ÔÔ›Ô ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Î¿ÔÈ· ÁÓˆÛÙ‹ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜. ∏·fiÊÚ·ÍË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·Ô‰fiıËÎÂ ÛÂ Û˘ÁÁÂÓ‹·ÙÚËÛ›· ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, ÂÓÒ Î·Ù¿ ÙËÓ Â¤Ì‚·-ÛË ·ÔÎÏÂ›ÛÙËÎ·Ó ¿ÏÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, fiˆ˜ Â›-Ó·È Ë ·ÙÂÏ‹˜ ÂÚÈÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘(malrotation) Î·È Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ (volvulus), Ô

ÂÁÎÔÏÂ·ÛÌfi˜ Î·È Ë ·ÚÔ˘Û›· Ù·ÈÓÈÒÓ ÙÔ˘ Ladd. ∞fi ÙËÓ ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·Ù·-

‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ë ·ÚÔ˘Û›· ÎÂ¯ÚˆÛÌ¤ÓÔ˘ ·ÌÓÈ·-ÎÔ‡ ˘ÁÚÔ‡ ‰ÂÓ ÔÊÂ›ÏÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙËÓ‡·ÚÍË ÌËÎˆÓ›Ô˘, ·ÏÏ¿ Î·È ÛÂ ¿ÏÏ· ·›ÙÈ·, fiˆ˜·ÚÔ˘Û›· ¯ÔÏ‹˜ ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi ÏfiÁˆ ·fi-ÊÚ·ÍË˜ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ÂÓÙ¤ÚÔ˘, Ô˘ ·Ó ‰ÂÓ ‰È·-ÁÓˆÛÙÂ› ¤ÁÎ·ÈÚ·, ÌÔÚÂ› Ó· ¤¯ÂÈ Î·Î‹ ¤Î‚·ÛË.


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¶·È‰È·ÙÚÈÎ‹ 2005;68:450-452


453CASE REPORT

Intestinal atresia presenting at birth withaspiration of meconium-like-stained amnioticfluid V. Drossou - Agakidou, L. Bogiatzi, I. Eudoridou, T. Stathopoulou, E. Diamanti

AbstractA rare case is reported of a neonate born with meconium-like-stained amniotic fluid (M-L-SAF), whopresented with respiratory distress and radiological findings compatible with meconium aspirationsyndrome. The M-L-SAF was attributed to bilious vomiting in utero secondary to intestinal atresiaand the formation of a meconium pseudocyst. The baby’s general condition was good. Themeconium pseudocyst was suspected on palpation of a mass in the supra-umbilical region. Theintestinal atresia and pseudocyst were confirmed by ultrasound and X-ray examination and weretreated surgically. The baby had an uneventful post-operative course and was discharged home ingood condition.

Key wordsMeconium pseudocyst, bilious vomiting, meconium aspiration syndrome.

1st Department ofNeonatology andNeonatal Intensive Care Unitof Aristotle University,Ippokration GeneralHospital, Thessaloniki

Correspondence:Vassiliki Drossou-Agakidou 28 Glinou Str., 543 52,Thessaloniki E mail: [email protected]




454 ¶ƒ∞∫∆π∫√ £∂ª∞

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¶·È‰È·ÙÚÈÎ‹ 2005;68:454-459

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∂ÈÛ·ÁˆÁ‹

O ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ·Ô-ÙÂÏÂ› ·‰È·ÊÈÏÔÓ›ÎËÙ· ¤Ó· ÙÚ·ÁÈÎfi ÁÂÁÔÓfi˜, ÙÔÔÔ›Ô - ·Ó Î·È Û¿ÓÈÔ - Û˘ÁÎÏÔÓ›˙ÂÈ ÙËÓ ÎÔÈÓ‹ÁÓÒÌË, ‰ÈfiÙÈ ·ÊÂÓfi˜ Û˘Ì‚·›ÓÂÈ Û˘Ó‹ıˆ˜ ÛÂ ÓÂ-·Ú¿ ¿ÙÔÌ·, Ù· ÔÔ›· ÏfiÁˆ ÙË˜ ÂÓ·Û¯fiÏËÛ‹˜ÙÔ˘˜ ÌÂ ÙÔÓ ·ıÏËÙÈÛÌfi ıÂˆÚÔ‡ÓÙ·È ÚfiÙ˘·˘ÁÂ›·˜, ·ÊÂÙ¤ÚÔ˘ ÛÙË ÛËÌÂÚÈÓ‹ ÂÔ¯‹ ÙË˜ “ÙË-ÏÂÔÙÈÎ‹˜ Î˘ÚÈ·Ú¯›·˜” ÔÏ‡ Û˘¯Ó¿ ÙÔ ÎÔÈÓfiÎ·ı›ÛÙ·Ù·È Ì¿ÚÙ˘Ú·˜ ÙË˜ ˙ˆÓÙ·Ó‹˜ ·Ó·ÌÂÙ¿-‰ÔÛË˜ ÙÔ˘ ı·Ó¿ÙÔ˘ ÂÓfi˜ ·ıÏËÙ‹. ª›· ¿ÏÏË ·-Ú¿ÌÂÙÚÔ˜ Ô˘ ‰ÈÎ·ÈÔÏÔÁÂ› ÙÔ ˙ˆËÚfi ÂÓ‰È·Ê¤-ÚÔÓ Â›Ó·È Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ fiÏÔ Î·È ÂÚÈÛÛfiÙÂ-Ú· ÓÂ·Ú¿ ¿ÙÔÌ·, ·fi ÌÈÎÚ‹ Ì¿ÏÈÛÙ· ËÏÈÎ›·,·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙÔÓ ·ıÏËÙÈÛÌfi. ∏ ÂÓ·Û¯fiÏËÛË·˘Ù‹, ÂÊfiÛÔÓ ‚¤‚·È· Á›ÓÂÙ·È ÛÂ ÔÚÁ·ÓˆÌ¤Ó·

·ıÏËÙÈÎ¿ Î¤ÓÙÚ· Î·È ˘fi ·Ú·ÎÔÏÔ‡ıËÛË,ÚÔÛÊ¤ÚÂÈ ÔÏÏ¿ ÔÊ¤ÏË ÛÙÔ ·È‰›, ÙfiÛÔ ¿ÌÂÛ·fiÛÔ Î·È Ì·ÎÚÔÚfiıÂÛÌ·. ∆Ô ÂÚÒÙËÌ·, fiÌˆ˜,Ô˘ ‰ÈÎ·ÈÔÏÔÁËÌ¤Ó· ··Û¯ÔÏÂ› ÙÔ˘˜ ÁÔÓÂ›˜ Â›-Ó·È fiÛÔ ·ÛÊ·Ï‹˜ Â›Ó·È Ë ¿ıÏËÛË ÂÓ Á¤ÓÂÈ Î·ÈÙÈ Ú¤ÂÈ Ó· Á›ÓÂÈ ÒÛÙÂ Ó· ÚÔÏËÊıÔ‡Ó Ù· -Û¿ÓÈ· ¤ÛÙˆ - ÂÚÈÛÙ·ÙÈÎ¿ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘.∂›Ó·È ‚¤‚·ÈÔ fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ ÙË˜ Úfi-ÏË„Ë˜ ı· ÙÔ ÂˆÌÈÛÙÔ‡Ó ÔÈ ÁÂÓÈÎÔ› È·ÙÚÔ›, ÔÈ·ıÔÏfiÁÔÈ Î·È ÔÈ ·È‰›·ÙÚÔÈ, ÂÓÒ ÔÈ ·È‰ÔÎ·Ú-‰ÈÔÏfiÁÔÈ Î·È ÔÈ Î·Ú‰ÈÔÏfiÁÔÈ ı· ·ÔÙÂÏ¤ÛÔ˘ÓÙË ‰Â‡ÙÂÚË ÁÚ·ÌÌ‹ ¿Ì˘Ó·˜, ÂÏ¤Á¯ÔÓÙ·˜ ÂÈÏÂÁ-Ì¤Ó· ÂÚÈÛÙ·ÙÈÎ¿. ™˘ÓÂÒ˜, ÁÈ· Ó· ÌÔÚ¤ÛÔ˘ÓÔÈ ÂÓ‰È·ÊÂÚfiÌÂÓÔÈ È·ÙÚÔ› Ó· Ú·ÁÌ·ÙÔÔÈ‹-ÛÔ˘Ó ¤Ó·Ó fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂ-ÚÔ ÚÔ·ıÏËÙÈÎfi ¤ÏÂÁ¯Ô, ı· Ú¤ÂÈ Ó· ÁÓˆÚ›-˙Ô˘Ó ÔÈ· Â›Ó·È Ù· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ·ÈÊÓ›‰ÈÔ˘


455ÕÛÎËÛË Î·È ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜

ı·Ó¿ÙÔ˘ Î·Ù¿ ÙËÓ ¿ÛÎËÛË, Ò˜ Â›Ó·È ‰˘Ó·ÙfiÓ· ÙÂıÂ› Ë ‰È¿ÁÓˆÛË ‹ ¤ÛÙˆ Ë ˘Ô„›· ÁÈ· ÙËÓ‡·ÚÍ‹ ÙÔ˘˜ Î·È Ò˜ ÂÓ Á¤ÓÂÈ Ú¤ÂÈ Ó· ÔÚÁ·-ÓˆıÂ› ¤Ó· ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ÂÏ¤Á-¯Ô˘ ÌÂ ÙË Û˘ÓÂÚÁ·Û›· ·ıÔÏfiÁˆÓ, ·È‰È¿ÙÚˆÓ,Î·Ú‰ÈÔÏfiÁˆÓ Î·È ·È‰ÔÎ·Ú‰ÈÔÏfiÁˆÓ.

OÚÈÛÌfi˜ - ™˘¯ÓfiÙËÙ·

ø˜ ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ÔÚ›-˙ÂÙ·È Ô ı¿Ó·ÙÔ˜ Ô˘ Â›Ó·È ÌË ·Ó·ÌÂÓfiÌÂÓÔ˜Î·È Â¤Ú¯ÂÙ·È Û˘Ó‹ıˆ˜ ¯ˆÚ›˜ Úfi‰ÚÔÌ· Û˘-ÌÙÒÌ·Ù·, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¿ıÏËÛË˜, ÙË˜ÚÔfiÓËÛË˜ ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿. °ÂÓÈÎ¿, ‰ÂÓ ˘¿Ú-¯Ô˘Ó Ï‹ÚË Î·È Û·Ê‹ ÛÙÔÈ¯Â›· ÁÈ· ÙË Û˘¯ÓfiÙË-Ù¿ ÙÔ˘, ·ÎfiÌË Î·È ÛÂ ÚÔËÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ fiˆ˜ÔÈ ∏¶∞. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 5/100.000 ·ıÏËÙ¤˜¿Û¯Ô˘Ó ·fi Î¿ÔÈ· ¿ıËÛË, Ë ÔÔ›· ‰˘ÓËÙÈ-Î¿ ı· ÌÔÚÔ‡ÛÂ Ó· ÚÔÎ·Ï¤ÛÂÈ ·ÈÊÓ›‰ÈÔ ı¿Ó·-ÙÔ (1). ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ1:100.000 - 1:300.000 ·ıÏËÙ¤˜ ·Ó¿ ¤ÙÔ˜ (2) ÌÂÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Ó· Û˘ÌÊˆÓÔ‡ÓÛÂ Ì›· Ì¤ÛË Û˘¯ÓfiÙËÙ· 1:200.000 ÂÚÈÛÙ·ÙÈÎ¿·Ó¿ ¤ÙÔ˜ (1). ™ÙÈ˜ ∏¶∞ Î¿ıÂ ¯ÚfiÓÔ Û˘ÌÌÂÙ¤-¯Ô˘Ó ÛÂ ÔÚÁ·ÓˆÌ¤ÓÂ˜ ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙË-ÙÂ˜ ÂÚ›Ô˘ 6.000.000 ¿ÙÔÌ· ÚÔÂÊË‚ÈÎ‹˜ Î·ÈÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ (Ô˘ ÊÔÈÙÔ‡Ó ÛÂ Á˘ÌÓ¿ÛÈÔ ‹ÎÔÏ¤ÁÈÔ) (3) Î·È ÙÂÏÈÎ¿ Û˘Ì‚·›ÓÔ˘Ó 25-30 ÂÚÈ-ÛÙ·ÙÈÎ¿ ÂÙËÛ›ˆ˜ (4). °È· ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú-¯Ô˘Ó Â·ÚÎ‹ ·ÓÙ›ÛÙÔÈ¯· ÛÙÔÈ¯Â›·, ·ÏÏ¿ ÌÂ ‚¿-ÛË Ù· ·ÓˆÙ¤Úˆ Ë ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· Ú¤ÂÈ Ó·Â›Ó·È 1 ÂÚÈÛÙ·ÙÈÎfi ·Ó¿ ¤ÙÔ˜. À¿Ú¯ÂÈ, ¿ÓÙˆ˜,ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô Ê‡Ï·, ÌÂ ÙËÛ˘¯ÓfiÙËÙ· ÛÙÔ˘˜ ¿Ó‰ÚÂ˜ Ó· Î˘Ì·›ÓÂÙ·È ÛÂ1:133.000 Û‡ÌÊˆÓ· ÌÂ Ì›· ÌÂÏ¤ÙË (5), ÂÓÒ ÛÙÈ˜Á˘Ó·›ÎÂ˜ ·ÓÙ›ÛÙÔÈ¯· ÌÂÈÒÓÂÙ·È ÛÂ 1:769.000.

∞›ÙÈ· - ∂È‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó·

∆· Û˘¯ÓfiÙÂÚ· Î·Ú‰È·Î¿ ·›ÙÈ· ·ÈÊÓ›‰ÈÔ˘ ı·-Ó¿ÙÔ˘ ÛÂ ¿ÙÔÌ· ÓÂ·Ú‹˜ ËÏÈÎ›·˜ (Î¿Ùˆ ÙˆÓ 35ÂÙÒÓ) Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (6). ªÂÙ¿ ÙËÓËÏÈÎ›· ÙˆÓ 35-40 ÂÙÒÓ, ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Â›-Ó·È Û·ÊÒ˜ Ë ÈÛ¯·ÈÌÈÎ‹ Î·Ú‰ÈÔ¿ıÂÈ·. ∂ÎÙfi˜,fiÌˆ˜, ·fi Ù· Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÚÔ¤ÏÂ˘ÛË˜ ·›-ÙÈ·, ˘¿Ú¯Ô˘Ó Î·È ÂÍˆÎ·Ú‰È·Î¿, Ù· ÔÔ›··Ó¤Ú¯ÔÓÙ·È ÛÙÔ 15% ÙÔ˘ Û˘ÓfiÏÔ˘. ™ÙËÓ Î·ÙË-ÁÔÚ›· ·˘Ù‹ ˘¿ÁÔÓÙ·È Ë Î·Ù¿¯ÚËÛË Ô˘ÛÈÒÓ(Ó·ÚÎˆÙÈÎ¿, ·Ó·‚ÔÏÈÎ¿), Ë ıÂÚÌÔÏËÍ›·, ËÓÈÁÌÔÓ‹, Ô ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ Î·È ÙÔ ÎÙ‡ËÌ·ÛÙÔ ÚÔÎ¿Ú‰ÈÔ, Â›ÙÂ ·fi Ì¿Ï· Â›ÙÂ ·fi Úfi-

ÛÎÚÔ˘ÛË ÌÂ ¿ÏÏÔ ·ıÏËÙ‹. ™ÙËÓ ÂÚ›ÙˆÛË ·˘-Ù‹, Ô ı¿Ó·ÙÔ˜ Ê·›ÓÂÙ·È fiÙÈ ÔÊÂ›ÏÂÙ·È ÛÙËÓ Úfi-ÎÏËÛË ÎÔÈÏÈ·Î‹˜ ·ÚÚ˘ıÌ›·˜. ∆· ÂÚÈÛÛfiÙÂÚ·ÂÚÈÛÙ·ÙÈÎ¿ Û˘Ì‚·›ÓÔ˘Ó ÂÚ› ÙËÓ ËÏÈÎ›· ÙˆÓ17 ÂÙÒÓ. ™ÙË Û˘ÓÙÚÈÙÈÎ‹ ÙÔ˘˜ ÏÂÈÔ„ËÊ›·ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ· (90%) Î·È ÙÔ 70% ÙˆÓ Â-ÚÈÙÒÛÂˆÓ ·ÊÔÚ¿ ÛÂ ·ıÏËÙ¤˜ ÙÔ˘ Ô‰ÔÛÊ·›-ÚÔ˘ Î·È ÙË˜ Î·Ï·ıÔÛÊ·›ÚÈÛË˜. ∆Ô 90% ÙˆÓ ı·-Ó¿ÙˆÓ Â‹ÏıÂ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ‹ ·Ì¤Ûˆ˜ ÌÂ-Ù¿, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 10% ÛÂ ¿ÙÔÌ· Ô˘ ·Û¯Ô-ÏÔ‡ÓÙ·Ó ÌÂÓ Û˘ÛÙËÌ·ÙÈÎ¿ ÌÂ ÙÔÓ ·ıÏËÙÈÛÌfi,·ÏÏ¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‹È·˜ ¿ÛÎËÛË˜ (Û˘Ó‹-ıˆ˜ ¯·Ï·Úfi ÙÚ¤ÍÈÌÔ) Ô˘ ‰ÂÓ Â›¯Â ¿ÌÂÛË Û¯¤-ÛË ÌÂ ÙÔ ¿ıÏËÌ·. ∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ Ù· 2/3ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (64%) Û˘Ó¤‚ËÛ·Ófi¯È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Î¿ÔÈÔ˘ ·ÁÒÓ·, ·ÏÏ¿ Î·-Ù¿ ÙËÓ ÚÔfiÓËÛË. ∂›Ó·È ÛËÌ·ÓÙÈÎfi fiÙÈ ÌfiÓÔÙÔ 10% ÙˆÓ ·Ôı·ÓfiÓÙˆÓ Â›¯Â ÂÌÊ·Ó›ÛÂÈ Úfi-‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· Ï›ÁÔ ÚÈÓ ·fi ÙÔ Û˘Ì‚¿Ó(ÚÔÎ¿Ú‰ÈÔ ¿ÏÁÔ˜, ˙¿ÏË, ‰‡ÛÓÔÈ·, Ì˘˚Î‹ ·‰˘-Ó·Ì›·). ∂›ÛË˜, Î·Ù¿ ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ ‰Â-Î·ÔÎÙÒ Ì‹ÓÂ˜, ÔÛÔÛÙfi ÌfiÓÔ 18% Â›¯Â ·Ú·-ÔÓÂıÂ› ÁÈ· Î¿ÔÈÂ˜ ·fi ÙÈ˜ ÚÔ·Ó·ÊÂÚıÂ›ÛÂ˜ÂÓÔ¯Ï‹ÛÂÈ˜ Î·Ù¿ ÙËÓ ¿ÛÎËÛË, ¯ˆÚ›˜ fiÌˆ˜ Ó·ÙÔ˘˜ ‰ÔıÂ› Ë ··Ú·›ÙËÙË ÚÔÛÔ¯‹. ∞fi ÙÈ˜ÂÓÔ¯Ï‹ÛÂÈ˜, Ë Û˘¯ÓfiÙÂÚË ‹Ù·Ó Ë ˙¿ÏË (ÙÔ ‹ÌÈ-Û˘ ÙˆÓ ·ÙfiÌˆÓ ·˘ÙÒÓ, ‰ËÏ·‰‹ ÙÔ 9%, Â›¯Â ÂÌ-Ê·Ó›ÛÂÈ 1-10 ÂÂÈÛfi‰È·). ™ÙÈ˜ Á˘Ó·›ÎÂ˜, ÛÂ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ¿Ó‰ÚÂ˜, ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ‰ÂÓ Â›Ó·È Ë ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·(15%), ·ÏÏ¿ ÔÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÙÂ-Ê·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ (40%).

Ÿˆ˜ ÚÔ·Ó·Ê¤ÚıËÎÂ, ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ - Î·È Ì¿ÏÈÛÙ· ÌÂ ‰È·ÊÔÚ¿ -Â›Ó·È Ë ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· (1).µ¤‚·È·, ÙÔ Ú·ÁÌ·ÙÈÎfi ÔÛÔÛÙfi ÌÔÚÂ› Ó· Â›-Ó·È ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚÔ Î·È Ó· ÊÙ¿ÓÂÈ ÙÔ

¶·È‰È·ÙÚÈÎ‹ 2005;68:454-459

¶›Ó·Î·˜ 1. ∫·Ú‰È·ÁÁÂÈ·Î¿ ·›ÙÈ· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘

∞›ÙÈ· ™˘¯ÓfiÙËÙ·

ÀÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· 36%™˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÂÊ·ÓÈ·›ˆÓ 19%·ÚÙËÚÈÒÓ∞‡ÍËÛË Î·Ú‰È·Î‹˜ Ì¿˙·˜ 10%ƒ‹ÍË ·ÓÂ˘Ú‡ÛÌ·ÙÔ˜ ·ÔÚÙ‹˜ 5%™Ù¤ÓˆÛË ·ÔÚÙÈÎ‹˜ ‚·Ï‚›‰·˜ 5%π‰ÈÔ·ı‹˜ ›ÓˆÛË 3%ª˘ÔÎ·Ú‰›ÙÈ‰· 3%¢È·Ù·ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· 3%∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰ÂÍÈ¿ ÎÔÈÏ›· 3%¶ÚfiÙˆÛË ÌÈÙÚÔÂÈ‰Ô‡˜ 2%™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ 2%™˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ 1,5%¢È¿ÊÔÚ· 1,5%


456 ¢. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜ Î·È Û˘Ó.

46%, Â¿Ó Û˘Ó˘ÔÏÔÁÈÛÙÔ‡Ó Î·È ÔÈ ÂÚÈÙÒ-ÛÂÈ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ·‡ÍËÛË ÙË˜ Î·Ú‰È·-Î‹˜ Ì¿˙·˜ (10%). ¶ÚfiÎÂÈÙ·È ÁÈ· ÂÚÈÙÒÛÂÈ˜ÛÙÈ˜ ÔÔ›Â˜, Î·Ù¿ ÙË ÓÂÎÚÔ„›·, ‰È·ÈÛÙÒÓÂÙ·È˘ÂÚÙÚÔÊ›· ÙË˜ Î·Ú‰È¿˜ ¯ˆÚ›˜ Î¿ÔÈÔ ·ÓÈ-¯ÓÂ‡ÛÈÌÔ ·›ÙÈÔ, ·ÏÏ¿ Î·È ¯ˆÚ›˜ Û·Ê‹ ÈÛÙÔÏÔÁÈ-Î‹ ÂÈÎfiÓ· ˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ È‰È·›-ÙÂÚË Î·ÙËÁÔÚ›·. ∏ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ-¿ıÂÈ· Â›Ó·È ÓfiÛÔ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÌÂ ·˘Ùfi-ÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ·ÏÏ¿ ÌÂ ÌÂ-Ù·‚ÏËÙ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·. ∞Ó·ÙÔÌÈÎ¿ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ÂÓÙÔÈÛÌ¤ÓË, ·Û‡ÌÌÂÙÚË˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Û˘ÓËı¤-ÛÙÂÚ· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜.πÛÙÔÏÔÁÈÎ¿ ·Ú·ÙËÚÂ›Ù·È ·ÓÒÌ·ÏË ‰È¿Ù·ÍËÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ (myocardial disarray). §fiÁˆÙË˜ ˘ÂÚÙÚÔÊ›·˜ ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·-ÊÚ¿ÁÌ·ÙÔ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔÎÏËıÂ› ‰˘Ó·-ÌÈÎ‹ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ÙË˜ ·ÚÈÛÙÂ-Ú‹˜ ÎÔÈÏ›·˜, Û˘ÓËı¤ÛÙÂÚ· Î·Ù¿ ÙËÓ ¿ÛÎËÛË.™˘¯Ó¤˜ Â›Ó·È, Â›ÛË˜, ÔÈ ÎÔÈÏÈ·Î¤˜ ·ÚÚ˘ıÌ›Â˜Î·È, Ì¿ÏÈÛÙ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÚÔ˘Û›·Î·È ÙÔÓ ‚·ıÌfi ÙË˜ ·fiÊÚ·ÍË˜. OÈ ·ÚÚ˘ıÌ›Â˜·˘Ù¤˜ ıÂˆÚÔ‡ÓÙ·È Î·Ù’ ÂÍÔ¯‹Ó ˘Â‡ı˘ÓÂ˜ ÁÈ·Ù· ÂÂÈÛfi‰È· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘. ∂ÂÈ‰‹ fiÏÔÈÔÈ ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿-ıÂÈ· ‰ÂÓ ¤¯Ô˘Ó ÙÈ˜ ›‰ÈÂ˜ Èı·ÓfiÙËÙÂ˜ ÁÈ· ·ÈÊ-Ó›‰ÈÔ ı¿Ó·ÙÔ, ¤¯Ô˘Ó Á›ÓÂÈ ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ÙËÓ·Ó›¯ÓÂ˘ÛË ·Ú·ÁfiÓÙˆÓ Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔÓÎ›Ó‰˘ÓÔ ·˘Ùfi (7). ∆¤ÙÔÈÔÈ ·Ú¿ÁÔÓÙÂ˜ ıÂˆ-ÚÔ‡ÓÙ·È: ·) ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰È-Ô˘ ı·Ó¿ÙÔ˘, ‰ËÏ·‰‹ ‰‡Ô ÂÂÈÛfi‰È· ÛÂ Û˘ÁÁÂ-ÓÂ›˜ ·ã ‚·ıÌÔ‡ ËÏÈÎ›·˜ <40 ÂÙÒÓ, ‚) ¤Ó· ÙÔ˘-Ï¿¯ÈÛÙÔÓ Û˘ÁÎÔÙÈÎfi ÂÂÈÛfi‰ÈÔ ·ÁÓÒÛÙÔ˘ ·È-ÙÈÔÏÔÁ›·˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜, Á) ÌËÂÈÌ¤ÓÔ˘Û· ÎÔÈÏÈ·Î‹ Ù·¯˘Î·Ú‰›· ÛÙÔ HolterÚ˘ıÌÔ‡ (3 ÙÔ˘Ï¿¯ÈÛÙÔÓ Û˘ÌÏ¤ÁÌ·Ù· QRS ÌÂÛ˘¯ÓfiÙËÙ· >120/min, ‰È¿ÚÎÂÈ·˜ <30 sec), ‰)ÌË Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ ÛÙË ‰ÔÎÈÌ·Û›· ÎÔÒÛÂˆ˜ (ÙÒÛË ‹ ÌË·‡ÍËÛË) Î·È Â) ¿¯Ô˜ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·-ÊÚ¿ÁÌ·ÙÔ˜ ≥30 mm. ∏ ·ÚÔ˘Û›· ‰‡Ô ÙÔ˘Ï¿-¯ÈÛÙÔÓ ·Ú·ÁfiÓÙˆÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÂÙ‹ÛÈÔÎ›Ó‰˘ÓÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ 4-5%, ·ÓÂÍ¿ÚÙËÙ··fi ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÛÂ ·ıÏËÙÈÎ¤˜ ‰Ú·ÛÙË-ÚÈfiÙËÙÂ˜.

ŒÓ· ÔÏ‡ ÂÓ‰È·Ê¤ÚÔÓ Î·È Û˘¯Ó¿ ‰˘ÛÂ›Ï˘-ÙÔ Úfi‚ÏËÌ· Â›Ó·È Ë ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË·Ó¿ÌÂÛ· ÛÙËÓ ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·Î·È ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ˘ÂÚÙÚÔÊ›· Ô˘ ·Ú·-ÙËÚÂ›Ù·È ÛÂ ÌÂÚÈÎÔ‡˜ ·ıÏËÙ¤˜ ˘„ËÏÒÓ ÂÈ‰fi-ÛÂˆÓ (8). ∞ıÏËÙ¤˜ Ô˘ Á˘ÌÓ¿˙ÔÓÙ·È ÁÈ· ÌÂÁ¿-

ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÂ Â›Â‰Ô ÚˆÙ·ıÏËÙÈ-ÛÌÔ‡, ÂÌÊ·Ó›˙Ô˘Ó Ì›· Ê˘ÛÈÔÏÔÁÈÎ‹ ¿¯˘ÓÛËÙˆÓ Î·Ú‰È·ÎÒÓ ÙÔÈ¯ˆÌ¿ÙˆÓ Ì¤Û· ÛÙÔ Ï·›ÛÈÔÙË˜ ÚÔÛ·ÚÌÔÁ‹˜ ÛÙÈ˜ ··ÈÙ‹ÛÂÈ˜ ÙË˜ ¤ÓÙÔ-ÓË˜ ¿ÛÎËÛË˜. ∂È‰ÈÎ¿ ÛÂ ÔÚÈÛÌ¤Ó· ·ıÏ‹Ì·Ù·,fiˆ˜ ÔÈ ‰ÚfiÌÔÈ ÌÂÁ¿ÏˆÓ ·ÔÛÙ¿ÛÂˆÓ, Ë ÎÔ-Ï‡Ì‚ËÛË, Ë Ô‰ËÏ·Û›· Î·È Ë ÎˆËÏ·Û›·, ËÊ˘ÛÈÔÏÔÁÈÎ‹ ·˘Ù‹ ˘ÂÚÙÚÔÊ›· Â›Ó·È ÈÔ ÛË-Ì·ÓÙÈÎ‹ Î·È ÈÔ Û˘¯Ó‹. ™ÙÔÈ¯Â›· Ù· ÔÔ›·‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË Â›Ó·È Ù··ÎfiÏÔ˘ı·:

·) ™ÙÔ˘˜ ·ıÏËÙ¤˜ Û˘Ó‹ıˆ˜ Ë ˘ÂÚÙÚÔÊ›·Â›Ó·È Û˘ÌÌÂÙÚÈÎ‹.

‚) ŸÙ·Ó Ë ˘ÂÚÙÚÔÊ›· ·ÊÔÚ¿ ÌfiÓÔ ÛÙÔ ÌÂ-ÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ·, ÙfiÙÂ Û˘Ó‹ıˆ˜ ‰ÂÓ˘ÂÚ‚·›ÓÂÈ Ù· 12-13 mm, ÂÓÒ ÛÙËÓ ˘ÂÚÙÚÔÊÈ-Î‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Û˘Ó‹ıˆ˜ Â›Ó·È ≥16 mm.

Á) ªfiÓÔ ÛÙÔ 2ò ÙˆÓ ·ıÏËÙÒÓ ¤¯ÂÈ ‰È·È-ÛÙˆıÂ› ¿¯Ô˜ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜>13 mm Î·È ·˘Ùfi ·ÊÔÚÔ‡ÛÂ ·ÔÎÏÂÈÛÙÈÎ¿ ÛÂ·ıÏËÙ¤˜ ·Û¯ÔÏÔ‡ÌÂÓÔ˘˜ ÌÂ ÙËÓ Ô‰ËÏ·Û›· Î·ÈÙËÓ ÎˆËÏ·Û›·.

‰) ™Â Î·Ì›· Á˘Ó·›Î·-·ıÏ‹ÙÚÈ· ‰ÂÓ ¤¯ÂÈ ‰È·-ÈÛÙˆıÂ› ¿¯Ô˜ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜>13 mm.

Â) ™ÙÔ ∏∫° Â› ˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ-¿ıÂÈ·˜ Û˘Ó‹ıˆ˜ ˘¿Ú¯Ô˘Ó ‚·ıÈ¿ Q Î·È ·ÚÓË-ÙÈÎ¿ ∆.

ÛÙ) ™ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·, Ë ÙÂÏÔ‰È·ÛÙÔ-ÏÈÎ‹ ‰È¿ÌÂÙÚÔ˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Â›Ó·È Û˘-Ó‹ıˆ˜ >55 mm, ÂÓÒ ÛÙËÓ ˘ÂÚÙÚÔÊÈÎ‹ <45mm.

˙) ™ÙÔ Doppler ÙË˜ ÌÈÙÚÔÂÈ‰Ô‡˜ ÛÙËÓ ˘ÂÚ-ÙÚÔÊÈÎ‹ Ë Û¯¤ÛË ÙË˜ ÚÒÈÌË˜ (Î‡Ì· ∂) ÚÔ˜ÙËÓ ÎÔÏÈÎ‹ ÚÔ‹ (Î‡Ì· ∞) Â›Ó·È Û˘Ó‹ıˆ˜ <1.

∂ÊfiÛÔÓ ÌÂ Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· ‰ÂÓ ÌÔ-ÚÂ› Ó· ÙÂıÂ› ÌÂ ‚Â‚·ÈfiÙËÙ· Ë ‰È¿ÁÓˆÛË, ÙfiÙÂ ËÌfiÓË ·ÛÊ·Ï‹˜ Ï‡ÛË Â›Ó·È Ë ‰È·ÎÔ‹ ÙË˜ ¿ÛÎË-ÛË˜ ÁÈ· 2-3 Ì‹ÓÂ˜, ÔfiÙÂ Â¿Ó Ë ˘ÂÚÙÚÔÊ›· Â›-Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ¿ıÏËÛË˜ ı· ˘Ô¯ˆÚ‹ÛÂÈÎ·Ù¿ 2-5 mm. ∆¤ÏÔ˜, Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ ÛÂÓÂ·Ú¿ ¿ÙÔÌ·, ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 18 ÂÙÒÓ,Â›Ó·È ‰˘Ó·ÙfiÓ Ë ˘ÂÚÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿-ıÂÈ· Ó· ÌËÓ ¤¯ÂÈ ÂÎ‰ËÏˆıÂ› Ï‹Úˆ˜ Ê·ÈÓÔÙ˘È-Î¿ Î·È Ó· ÌËÓ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ˘ÂÚÙÚÔÊ›·ÛÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·, ÂÓÒ ˘Ê›ÛÙ·ÓÙ·È fiÏÔÈÔÈ Î›Ó‰˘ÓÔÈ ·fi ÙË ÓfiÛÔ.

∞fi ÙÈ˜ ˘fiÏÔÈÂ˜ ·ÈÙ›Â˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿-ÙÔ˘, Û˘¯ÓfiÙÂÚË Â›Ó·È ÔÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ, ÔÈ ÔÔ›Â˜ Â›Ó·È˘Â‡ı˘ÓÂ˜ ÁÈ· ÙÔ 19% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ™˘-Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ·ÓÒÌ·ÏË ¤ÎÊ˘ÛË ÙË˜ ·ÚÈ-ÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ ·fi ÙÔÓ ‰ÂÍÈfi

¶·È‰È·ÙÚÈÎ‹ 2005;68:454-459



ÎfiÏÔ ÙÔ˘ Valsalva. O ı¿Ó·ÙÔ˜ ·Ô‰›‰ÂÙ·ÈÛÙËÓ ÈÛ¯·ÈÌ›· Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙË Û˘-Ì›ÂÛË ÙË˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜, ¤ÙÛÈ fiˆ˜ÔÚÂ‡ÂÙ·È ·Ó¿ÌÂÛ· ·fi ÙËÓ ·ÔÚÙ‹ Î·È ÙËÓÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›·. ¢˘ÛÙ˘¯Ò˜, Û·Ó›ˆ˜ ‰›ÓÂÈÛ˘ÌÙÒÌ·Ù· Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Â›Ó·È ÔÏ‡ ‰‡-ÛÎÔÏÔ Ó· ‰È·ÁÓˆÛÙÂ›. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ Û˘-ÌÙˆÌ·ÙÔÏÔÁ›· Î·Ù¿ ÙËÓ ¿ÛÎËÛË, ·˘Ù‹ Ú¤-ÂÈ Ó· ·ÍÈÔÏÔÁËıÂ› ÌÂ ÚÔÛÔ¯‹ Î·È ÙfiÙÂ Ë ‰È¿-ÁÓˆÛË ÌÔÚÂ› Ó· ÙÂıÂ› ÌÂ ‰ÔÎÈÌ·Û›· ÎfiˆÛË˜Î·È Ó· ÂÈ‚Â‚·ÈˆıÂ› ÌÂ ÛÙÂÊ·ÓÈÔÁÚ·Ê›· ‹ Ì·-ÁÓËÙÈÎ‹ ·ÁÁÂÈÔÁÚ·Ê›·. ŸÙ·Ó Ô ·ÛıÂÓ‹˜ ¤¯ÂÈÎ·Ï¿ Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ ·Ú¿ı˘Ú·, Â›Ó·È ‰˘-Ó·Ùfi Ó· ·ÓÈ¯ÓÂ˘ÙÂ› Ë ¤ÎÊ˘ÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ·ÚÙËÚÈÒÓ ·fi ÙÔ˘˜ ÎfiÏÔ˘˜ ÙÔ˘ Valsalva,Ú¤ÂÈ fiÌˆ˜ Ó· Á›ÓÂÙ·È ÂÈ‚Â‚·›ˆÛË ÌÂ ·ÁÁÂÈ-ÔÁÚ·Ê›·.

∆· ˘fiÏÔÈ· ·›ÙÈ· - ·Ó Î·È Û¯ÂÙÈÎ¿ Û¿ÓÈ·- ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÓ‰È·Ê¤ÚÔÓ, ‰ÈfiÙÈ ÛÂ ÔÏÏ¿·fi ·˘Ù¿ Ë ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ùfi Ó· Á›ÓÂÈÂÁÎ·›Úˆ˜, ·ÚÎÂ› Ó· ˘¿Ú¯ÂÈ ˘„ËÏfi˜ ‚·ıÌfi˜Â·ÁÚ‡ÓËÛË˜. ∆Ô ·ÓÂ‡Ú˘ÛÌ· ÙË˜ ·ÓÈÔ‡Û·˜·ÔÚÙ‹˜ (5%) Û˘Ó‹ıˆ˜ ·ÓÂ˘Ú›ÛÎÂÙ·È ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Marfan, ÔfiÙÂ ÌÂ ÙËÓ ÂÈ-ÛÎfiËÛË Î·È ÌfiÓÔ Â›Ó·È Â‡ÎÔÏÔ Ó· ˘¿ÚÍÂÈ Ë˘Ô„›· Î·È Ó· Á›ÓÂÈ ·Ú·ÔÌ‹ ÁÈ· Î·Ú‰ÈÔÏÔ-ÁÈÎfi ¤ÏÂÁ¯Ô. ∏ ÛÙ¤ÓˆÛË ÙË˜ ·ÔÚÙÈÎ‹˜ ‚·Ï‚›‰·˜(5%) ÌÔÚÂ› Â›ÛË˜ Ó· ‰È·ÁÓˆÛÙÂ› Û¯ÂÙÈÎ¿ Â‡-ÎÔÏ·, ‰ÈfiÙÈ ˘¿Ú¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Û˘ÛÙÔÏÈÎfiÊ‡ÛËÌ·, ÙÔ ÔÔ›Ô ÛÂ Î·Ì›· ÂÚ›ÙˆÛË ‰ÂÓÂÈÙÚ¤ÂÙ·È Ó· ÂÎÏËÊıÂ› ˆ˜ ·ıÒÔ. ∆Ô Ë¯ÔÎ·Ú-‰ÈÔÁÚ¿ÊËÌ· ı· ÂÈ‚Â‚·ÈÒÛÂÈ ÙË ‰È¿ÁÓˆÛË Î·ÈÙÔÓ ‚·ıÌfi ÙË˜ ÛÙ¤ÓˆÛË˜.

™Â ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ ‰‡Ô ÚÔËÁÔ‡ÌÂÓÂ˜ Î·Ù·-ÛÙ¿ÛÂÈ˜, Ë Ì˘ÔÎ·Ú‰›ÙÈ‰· Î·È ÏÈÁfiÙÂÚÔ Ë ‰È·Ù·-ÙÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· Â›Ó·È ‡Ô˘ÏÂ˜ ·Ûı¤ÓÂÈ-Â˜, ÔÈ ÔÔ›Â˜ ÌÔÚÔ‡Ó Ó· ‰È·Ï¿ıÔ˘Ó ÙË˜ ÚÔ-ÛÔ¯‹˜. ŸÙ·Ó ÙÂıÂ› Ë ˘Ô„›·, Ë ‰È¿ÁÓˆÛË Â›Ó·ÈÂ‡ÎÔÏË ÌÂ ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·. ™Â Ì›· ÌÂÏ¤-ÙË (6), ·fi ÙÔ˘˜ Ù¤ÛÛÂÚÈ˜ ·ÛıÂÓÂ›˜ ÌÂ ‰È·Ù·ÙÈ-Î‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, ÌfiÓÔ ¤Ó·˜ Â›¯Â ÂÌÊ·Ó›ÛÂÈÚfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· ÌÂ ÙË ÌÔÚÊ‹ ÂÂÈÛÔ-‰›ˆÓ ÎÔÏÈÎ‹˜ Ì·ÚÌ·Ú˘Á‹˜, Ù· ÔÔ›· fiÌˆ˜ ‰ÂÓ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛˆÛÙ¿.

∏ ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ÎÔÈÏ›·˜ (9,10) Â›Ó·È Ì›· Û¿ÓÈ· ¿ıËÛË, ËÔÔ›· ÛÙÔ 1/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÎÏËÚÔÓÔÌÂ›-Ù·È ÌÂ ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·.πÛÙÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÏÈÒ‰Ë ‰È‹ıË-ÛË ÙˆÓ ÙÔÈ¯ˆÌ¿ÙˆÓ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÌÂ Û˘-Ó¤ÂÈ· ÙË ‰È¿Ù·Û‹ ÙË˜ Î·È ÙËÓ ˘ÔÛ˘ÛÙ·ÏÙÈÎfi-ÙËÙ¿ ÙË˜. ∫ÏÈÓÈÎ¿ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ·ÚÚ˘ıÌ›Â˜Î·È Û˘ÁÎÔÙÈÎ¿ ÂÂÈÛfi‰È· ÛÂ ÂÊ‹‚Ô˘˜ Î·È ÓÂ·-

ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜. ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ·-ÚÔ˘Û›· ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ,ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ÛÙÈ˜ ËÏÂ-ÎÙÚÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (·ÚÓËÙÈÎ¿Â¿ÚÌ·Ù· ∆ ÛÙÈ˜ ‰ÂÍÈ¤˜ ÚÔÎ¿Ú‰ÈÂ˜ ··ÁˆÁ¤˜)Î·È ÛÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·, ÙÔ ÔÔ›Ô ‰Â›¯ÓÂÈÌ›· ‰È·ÙÂÙ·Ì¤ÓË Î·È ÌÂ ¯·ÌËÏ‹ Û˘ÛÙ·ÏÙÈÎfiÙË-Ù· ‰ÂÍÈ¿ ÎÔÈÏ›·, ÂÓÒ Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· Û˘Ó‹-ıˆ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·-Ê›· ‚ÔËı¿ÂÈ ÛÙË ‰È¿ÁÓˆÛË, ‰Â›¯ÓÔÓÙ·˜ - ÂÎÙfi˜ÙˆÓ ¿ÏÏˆÓ - Î·È ÙË ÏÈÒ‰Ë ‰È‹ıËÛË ÙˆÓ ÙÔÈ¯ˆ-Ì¿ÙˆÓ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜. ª›· ·Ú·ÏÏ·Á‹ ÙË˜·ÚÚ˘ıÌÈÔÁfiÓÔ˘ ‰˘ÛÏ·Û›·˜ ÌÂ È‰È·›ÙÂÚÔ ÂÓ-‰È·Ê¤ÚÔÓ ÁÈ· ÙËÓ ∂ÏÏ¿‰· Â›Ó·È Ë ÓfiÛÔ˜ ÙË˜ ¡¿-ÍÔ˘ (11,12), Ë ÔÔ›· ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÛˆÌ·ÙÈ-Îfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ÌÂ ˘„ËÏ‹ ‰ÈÂÈÛ-‰˘ÙÈÎfiÙËÙ· Î·È ÌÂ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô(˘ÂÚÎÂÚ¿ÙˆÛË ·Ï·ÌÒÓ Î·È ÂÏÌ¿ÙˆÓ Î·ÈÈ‰ÈfiÌÔÚÊ· Î·ÙÛ·Ú¿ Ì·ÏÏÈ¿ Ô˘ ˘¿Ú¯Ô˘Ó ·fiÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·).

∏ ÚfiÙˆÛË ÙË˜ ÌÈÙÚÔÂÈ‰Ô‡˜ (13) Â›Ó·ÈÔÏ‡ Û˘¯Ó‹ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (5%). ™˘-ÓÔÏÈÎ¿, ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ¤¯Ô˘Ó ·Ó·-ÊÂÚıÂ› 60 ÂÚÈÛÙ·ÙÈÎ¿ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÚfiÙˆÛË ÌÈÙÚÔÂÈ‰Ô‡˜, ÙÚ›· ·fiÙ· ÔÔ›· Û˘Ó¤‚ËÛ·Ó Î·Ù¿ ÙËÓ ¿ÛÎËÛË. øÛÙfi-ÛÔ, Î·È ÛÙÈ˜ ÙÚÂÈ˜ ·˘Ù¤˜ ÂÚÈÙÒÛÂÈ˜ ‰È·È-ÛÙÒıËÎ·Ó ÛÙË ÓÂÎÚÔ„›· Î·È ¿ÏÏÂ˜ ·ÓˆÌ·Ï›Â˜(˘ÔÏ·Û›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙË-Ú›·˜, ·‡ÍËÛË ÙË˜ Î·Ú‰È·Î‹˜ Ì¿˙·˜), ÔÈ ÔÔ›Â˜ı· ‹Ù·Ó ‰˘Ó·Ùfi Ó· ¤¯Ô˘Ó ÚÔÎ·Ï¤ÛÂÈ ÙÔÓ ı¿-Ó·ÙÔ. ¶·Ú’ fiÏ· ·˘Ù¿, Û˘ÓÈÛÙ¿Ù·È ·Ô¯‹ ·fiÙËÓ ¿ÛÎËÛË fiÙ·Ó: ·) ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù·Î·Ù¿ ÙËÓ ¿ÛÎËÛË (È‰›ˆ˜ Û˘ÁÎÔÙÈÎ¿ ÂÂÈÛfi-‰È·), ‚) Û˘Ó˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·ÓÂ-¿ÚÎÂÈ· ÌÈÙÚÔÂÈ‰Ô‡˜ ÌÂ ‰È¿Ù·ÛË ÙË˜ ·ÚÈÛÙÂ-Ú‹˜ ÎÔÈÏ›·˜ Î·È Á) ˘¿Ú¯ÂÈ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘.

∏ ·ıËÚˆÌ¿ÙˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙË-ÚÈÒÓ (2%) Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË-‚ÈÎ‹ ËÏÈÎ›· Î·È ÂÍ·ÈÚÂÙÈÎ¿ ‰‡ÛÎÔÏÔ Ó· ‰È·ÁÓˆ-ÛÙÂ›, fiˆ˜ Î·È ÔÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÙÂ-Ê·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ, ÂÎÙfi˜ Â¿Ó ˘¿Ú¯Ô˘Ó Úfi-‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· Î·È ·˘Ù¿ ¤¯Ô˘Ó ·ÍÈÔÏÔÁË-ıÂ› ÛˆÛÙ¿.

∆¤ÏÔ˜, Ì›· ÂÓ‰È·Ê¤ÚÔ˘Û· ÔÓÙfiÙËÙ·, ÌËÔÊÂÈÏfiÌÂÓË fiÌˆ˜ ÛÂ ·ıÔÏÔÁÈÎ¿ Î·Ú‰È·Î¿ ·›-ÙÈ·, Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ·fi ÎÙ‡ËÌ·ÛÙÔ ÚÔÎ¿Ú‰ÈÔ (Ì¿Ï· ‹ ‚›·ÈË ÚfiÛÎÚÔ˘ÛË‰‡Ô ·ıÏËÙÒÓ), Ô ÔÔ›Ô˜ ·Ô‰›‰ÂÙ·È ÛÙËÓ Úfi-ÎÏËÛË ÎÔÈÏÈ·Î‹˜ Ì·ÚÌ·Ú˘Á‹˜ (14) ‹ ÂÌÊÚ¿Á-Ì·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (15), ÛÂ ¤‰·ÊÔ˜ fiÌˆ˜Ê˘ÛÈÔÏÔÁÈÎ‹˜ Î·Ú‰È·Î‹˜ ·Ó·ÙÔÌ›·˜.

¶·È‰È·ÙÚÈÎ‹ 2005;68:454-459


458 ¢. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜ Î·È Û˘Ó.

∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÂÏ¤Á¯Ô˘

∞fi Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Ê·›ÓÂÙ·ÈfiÙÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÚÔ·ıÏËÙÈÎÔ‡ÂÏ¤Á¯Ô˘ ‰ÂÓ Â›Ó·È ÈÎ·ÓÔÔÈËÙÈÎ‹. ™Â Û˘ÁÎÂ-ÓÙÚˆÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ (5), Â› Û˘ÓfiÏÔ˘ 5.500·ıÏËÙÒÓ Ô˘ ÂÏ¤Á¯ıËÎ·Ó ÌÂ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊË-Ì·, ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Ô‡ÙÂ Ì›· ÂÚ›ÙˆÛË˘ÂÚÙÚÔÊÈÎ‹˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·˜. ∆Ô Û˘¯ÓfiÙÂ-ÚÔ Â‡ÚËÌ· ‹Ù·Ó Ë ÚfiÙˆÛË ÙË˜ ÌÈÙÚÔÂÈ‰Ô‡˜(9) Î·È Ì¿ÏÈÛÙ· ÛÂ ·Û˘Ó‹ıÈÛÙ· ˘„ËÏ¿ ÔÛÔÛÙ¿(10% ÙˆÓ ·Ó‰ÚÒÓ Î·È 20% ÙˆÓ Á˘Ó·ÈÎÒÓ). ∏‰ÔÎÈÌ·Û›· ÎÔÒÛÂˆ˜, Â›ÛË˜, ‰ÂÓ ÂÓ‰Â›ÎÓ˘Ù·Èˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓË Ì¤ıÔ‰Ô˜ ÏËı˘ÛÌÈ·ÎÔ‡ ÂÏ¤Á-¯Ô˘, ÏfiÁˆ ÙË˜ ÌÈÎÚ‹˜ Â›ÙˆÛË˜ ÙË˜ ÛÙÂÊ·ÓÈ-·›·˜ ÓfiÛÔ˘ ÛÙÈ˜ ËÏÈÎ›Â˜ ·˘Ù¤˜ (9). µÂ‚·›ˆ˜, ÂÓ-‰Â›ÎÓ˘Ù·È ÛÂ Î¿ıÂ ÂÚ›ÙˆÛË Ô˘ ˘¿Ú¯ÂÈ¤ÛÙˆ Î·È Ë ·Ú·ÌÈÎÚ‹ ·ÌÊÈ‚ÔÏ›· (‡ÔÙÔ ËÏÂ-ÎÙÚÔÎ·Ú‰ÈÔÁÚ·ÊÈÎfi Â‡ÚËÌ· ‹ Û‡ÌÙˆÌ· Î·Ù¿ÙËÓ ¿ÛÎËÛË). ∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ ÛÂ Ì›· ÌÂÏ¤-ÙË 134 ÂÚÈÙÒÛÂˆÓ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (6), ÔÈ130 ·ıÏËÙ¤˜ Â›¯·Ó ˘Ô‚ÏËıÂ› ÛÂ ÚÔ·ıÏËÙÈÎfi¤ÏÂÁ¯Ô. ∞fi ·˘ÙÔ‡˜ ÔÈ 15 (11%) Â›¯·Ó ·Ú·-ÂÌÊıÂ› ÛÂ Î·Ú‰ÈÔÏfiÁÔ ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯ÔÏfiÁˆ ˘¿ÚÍÂˆ˜ Ê˘Û‹Ì·ÙÔ˜. ∏ ÛˆÛÙ‹ ‰È¿ÁÓˆ-ÛË Â›¯Â ÙÂıÂ› ÌÂ ÙÔ Ë¯ÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· ÛÂ 7·fi ÙÔ˘˜ 15 ·ÛıÂÓÂ›˜ (ÛÙ¤ÓˆÛË ·ÔÚÙÈÎ‹˜ ‚·Ï-‚›‰·˜), ÔÈ ÔÔ›ÔÈ fiÌˆ˜ - ·Ú¿ ÙË ‰È¿ÁÓˆÛË -Û˘Ó¤¯ÈÛ·Ó Ó· ·ıÏÔ‡ÓÙ·È. ∞fi ÙÔ˘˜ 115 ·ıÏË-Ù¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÌfiÓÔ ÎÏÈÓÈÎ¿, ÛÂ ¤Ó·Ó Ù¤-ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Marfan ÌÂ‚¿ÛË ÙÔÓ Ê·ÈÓfiÙ˘Ô, ·ÏÏ¿ Ô ·ÛıÂÓ‹˜ fi¯È ÌfiÓÔ‰ÂÓ ÂÍÂÙ¿ÛÙËÎÂ ·fi Î·Ú‰ÈÔÏfiÁÔ, ·ÏÏ¿ Û˘Ó¤¯È-ÛÂ Ó· Á˘ÌÓ¿˙ÂÙ·È Ì¤¯ÚÈ˜ fiÙÔ˘ Û˘Ó¤‚Ë ÙÔ ÌÔÈ-Ú·›Ô. ¢È·ÈÛÙÒÓÂÙ·È, Û˘ÓÂÒ˜, fiÙÈ Ô ÚÔ·ıÏË-ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜, ·ÎfiÌË Î·ÈÛÂ ÚÔËÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ‰ÂÓ ¤¯ÂÈ Ù· ·Ó·ÌÂÓfiÌÂ-Ó· ·ÔÙÂÏ¤ÛÌ·Ù·.

™˘ÓÈÛÙÒÌÂÓÔ˜ ¤ÏÂÁ¯Ô˜

∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ ÙÔ˘ ÂÏ¤Á¯Ô˘ ·Ó·fi-ÊÂ˘ÎÙ· ı· ÙÔ ÂˆÌÈÛÙÔ‡Ó ÔÈ ·È‰›·ÙÚÔÈ, ÔÈÔÔ›ÔÈ ı· ÂÍÂÙ¿ÛÔ˘Ó ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓÎ·È ÙˆÓ ÂÊ‹‚ˆÓ Ì›·˜ ÂÚÈÔ¯‹˜ Î·È ı· ·Ú·-¤Ì„Ô˘Ó ÛÙÔÓ ·È‰ÔÎ·Ú‰ÈÔÏfiÁÔ ÂÈÏÂÁÌ¤Ó·ÂÚÈÛÙ·ÙÈÎ¿. O ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· ÂÛÙÈ¿˙Â-Ù·È ÛÂ ÏÂÙÔÌÂÚ‹ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÙfiÛÔÙÔ˘ ·ÙÔÌÈÎÔ‡ fiÛÔ Î·È ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡, Î·-ıÒ˜ Î·È ÛÂ ÚÔÛÂÎÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË.

∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi Ú¤ÂÈ Ó· ‰›‰ÂÙ·ÈÌÂÁ¿ÏË ‚·Ú‡ÙËÙ· ÛÙËÓ ·Ó·˙‹ÙËÛË Û˘ÌÙˆÌ¿-

ÙˆÓ Î·Ù¿ ÙËÓ ¿ÛÎËÛË, fiˆ˜ ÚÔÎ¿Ú‰ÈÔ ¿ÏÁÔ˜,˙¿ÏË, ·›ÛıËÌ· ÚÔÎ¿Ú‰ÈˆÓ ·ÏÌÒÓ, Ì˘˚Î‹·‰˘Ó·Ì›· Î·È ‰‡ÛÓÔÈ·. π‰È·›ÙÂÚË ÛËÌ·Û›·¤¯Ô˘Ó Ë ˙¿ÏË Î·È ÙÔ ÚÔÎ¿Ú‰ÈÔ ¿ÏÁÔ˜, Ù· ÔÔ›·ı· Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È ÌÂ ÚÔÛÔ¯‹.

∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·˙ËÙÂ›Ù·ÈË ‡·ÚÍË ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÂ ¿ÙÔÌÔ ÙÔ˘ ÛÙÂ-ÓÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ËÏÈÎ›·˜ ÌÈ-ÎÚfiÙÂÚË˜ ÙˆÓ 40 ÂÙÒÓ (ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ÙÔ Û‡ÓËıÂ˜ ·›ÙÈÔ Â›Ó·È Ë ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜),Î·ıÒ˜ Î·È Ë ·ÚÔ˘Û›· ·ÛıÂÓÂÈÒÓ fiˆ˜ Ë ˘ÂÚ-ÙÚÔÊÈÎ‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·, ÙÔ Ì·ÎÚfi Q-T ‹ ÙÔÛ‡Ó‰ÚÔÌÔ Marfan.

∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ÂÎÙfi˜ ·fi Ù· ˘fiÏÔÈ·Û˘ÛÙ‹Ì·Ù·, Ù· ÔÔ›· ‰ÂÓ Ú¤ÂÈ Ó· ·Ú·‚Ï¤-ÔÓÙ·È, ÂÈÎÂÓÙÚÒÓÂÙ·È fiˆ˜ Â›Ó·È Ê˘ÛÈÎfiÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi. ∏ ÂÈÛÎfiËÛË Â›Ó·È ÛËÌ·-ÓÙÈÎ‹, ‰ÈfiÙÈ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó›¯ÓÂ˘ÛË ˆ¯ÚfiÙË-Ù·˜, Î˘¿ÓˆÛË˜, ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜,ÛÎÂÏÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÌÔÚÂ› Ó· ı¤ÛÂÈÙËÓ ˘Ô„›· ÁÈ· ÙË ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌˆÓ,fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Marfan. ∏ Ì¤ÙÚËÛË ÙË˜·ÚÙËÚÈ·Î‹˜ È¤ÛÂˆ˜ Î·È Ë „ËÏ¿ÊËÛË ÙˆÓ ÌË-ÚÈ·›ˆÓ ÛÊ‡ÍÂˆÓ Ú¤ÂÈ Ó· ·ÔÙÂÏÔ‡Ó ·Ó·fi-Û·ÛÙÔ ÙÌ‹Ì· ÙË˜ ÂÍ¤Ù·ÛË˜ Î·È ‰ÂÓ Ú¤ÂÈ Ó··Ú·ÏÂ›ÔÓÙ·È ÛÂ Î·Ì›· ÂÚ›ÙˆÛË. ∆¤ÏÔ˜, Ë·ÎÚfi·ÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂ ÚÔÛÔ¯‹ Î·ÈÛ˘ÁÎ¤ÓÙÚˆÛË, ÛÂ ‹Û˘¯Ô ÂÚÈ‚¿ÏÏÔÓ. ∞ÎÚÔ¿-Ù·È ÔÏfiÎÏËÚÔ ÙÔ ÚÔÎ¿Ú‰ÈÔ ÛÂ Î·Ù·ÎÂÎÏÈÌ¤ÓËÎ·È fiÚıÈ· ı¤ÛË, ·Ó·˙ËÙÔ‡ÓÙ·È Ô ÚÒÙÔ˜ Î·È Ô‰Â‡ÙÂÚÔ˜ ÙfiÓÔ˜, Ë ·ÚÔ˘Û›· Ê˘ÛËÌ¿ÙˆÓ Î·È ËÌÂÙ·‚ÔÏ‹ ÙÔ˘˜ ÌÂ ÙË ı¤ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜. ŸÙ·Ó˘¿Ú¯ÂÈ ¤ÛÙˆ Î·È ÌÈÎÚ‹ ·ÌÊÈ‚ÔÏ›· ÁÈ· ÙË Ê‡-ÛË ÂÓfi˜ Ê˘Û‹Ì·ÙÔ˜, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ·-Ú·¤ÌÂÙ·È ÁÈ· Î·Ú‰ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, Ô˘ -ÂÎÙfi˜ ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË - ÂÚÈÏ·Ì‚¿-ÓÂÈ ∏∫° Î·È Ë¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ‹ ÂÍ¤Ù·ÛË. ∞Ó¿-ÏÔÁ· ÌÂ Ù· Â˘Ú‹Ì·Ù· Â›Ó·È ‰˘Ó·Ùfi Ó· Û˘ÛÙ·-ıÂ› Î·È ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÌÂ ‰ÔÎÈÌ·Û›· Îfi-ˆÛË˜, ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· 24ÒÚÔ˘(Holter Ú˘ıÌÔ‡), ·ÎfiÌË Î·È ÛÙÂÊ·ÓÈÔÁÚ·Ê›· ‹Ì·ÁÓËÙÈÎ‹ ·ÁÁÂÈÔÁÚ·Ê›·.

ŒÓ· ˙‹ÙËÌ· Ô˘ ‰ÂÓ ¤¯ÂÈ ··ÓÙËıÂ› ÌÂ Û·-Ê‹ÓÂÈ· Î·È ÔÌÔÊˆÓ›· ·ÊÔÚ¿ ÛÙÔ fiÛÔ Û˘¯Ó¿Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ô ÚÔ·ıÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·ÈÙÈ ·ÎÚÈ‚Ò˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ (2). ™Â Î¿-ıÂ ÂÚ›ÙˆÛË, Ù· ·È‰È¿ Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·ÈÛÙËÓ ·Ú¯‹ ÙË˜ Û¯ÔÏÈÎ‹˜ ¯ÚÔÓÈ¿˜ ·fi ÙÔÓ ·È-‰›·ÙÚfi ÙÔ˘˜ Î·È Ó· ·Ú·¤ÌÔÓÙ·È ÛÙÔÓ Î·Ú-‰ÈÔÏfiÁÔ Â¿Ó ˘¿Ú¯Ô˘Ó ‡ÔÙ· Û˘ÌÙÒÌ·Ù· ‹Â˘Ú‹Ì·Ù·. ∂›ÛË˜, Î·Ïfi Â›Ó·È Ó· ÂÏ¤Á¯ÔÓÙ·È·fi Î·Ú‰ÈÔÏfiÁÔ ·ÓÂÍ·ÚÙ‹Ùˆ˜ Â˘ÚËÌ¿ÙˆÓ ÛÙËÓ·Ú¯‹ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È ÙÔ˘ Ï˘ÎÂ›Ô˘, Î·ıÒ˜ Î·È

¶·È‰È·ÙÚÈÎ‹ 2005;68:454-459



fiÙ·Ó ÚfiÎÂÈÙ·È Ó· ·Ú¯›ÛÔ˘Ó Î¿ÔÈÔ ¿ıÏËÌ·¤Ú·Ó ÙË˜ Û¯ÔÏÈÎ‹˜ Á˘ÌÓ·ÛÙÈÎ‹˜.


O ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Î·Ù¿ ÙËÓ ¿ÛÎËÛË Â›Ó·ÈÛ¿ÓÈÔ˜. øÛÙfiÛÔ, Â›Ó·È Ú·ÎÙÈÎ¿ ·Ó¤ÊÈÎÙÔ ÛÂÏËı˘ÛÌÈ·Îfi Â›Â‰Ô Ó· ÚÔÏËÊıÔ‡Ó fiÏ· Ù·ÂÚÈÛÙ·ÙÈÎ¿, Â›ÙÂ ‰ÈfiÙÈ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ··È-ÙÂ› ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÂ˜ ÂÍÂÙ¿ÛÂÈ˜ Ô˘ ‰ÂÓ Â›Ó·È ‰˘-Ó·Ùfi Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÛÂ ÁÂÓÈÎÂ˘Ì¤ÓË ÎÏ›Ì·Î·(.¯. Ë ‰ÔÎÈÌ·Û›· ÎfiˆÛË˜) Â›ÙÂ ‰ÈfiÙÈ ÏfiÁˆ ÙË˜Ê˘ÛÈÎ‹˜ ÈÛÙÔÚ›·˜ ÙË˜ ÓfiÛÔ˘ ÌÔÚÂ› Ó· ÌËÓ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ ÙËÓ Ï‹ÚË ÂÈÎfiÓ· ÙË˜ ·fiÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (.¯. Ë ˘ÂÚÙÚÔÊÈÎ‹ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ·). O ÚÔ·ıÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú¤-ÂÈ Ó· Á›ÓÂÙ·È ÌÂ ÚÔÛÔ¯‹ Î·È Ó· ‰›‰ÂÙ·È ÌÂÁ¿-ÏË ÛËÌ·Û›· ÛÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÙfiÛÔ ÙÔ˘·ÙÔÌÈÎÔ‡ fiÛÔ Î·È ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡, Î·ıÒ˜Î·È ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË. µ¤‚·È·, Ô ÂÍÂÈ‰ÈÎÂ˘-Ì¤ÓÔ˜ Î·Ú‰ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ı· Ú·ÁÌ·ÙÔ-ÔÈÂ›Ù·È ÛÂ ÂÈÏÂÁÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ‹ ¯ÚÔÓÈ-Î¤˜ ÂÚÈfi‰Ô˘˜ (.¯. ¤Ó·ÚÍË Û˘ÛÙËÌ·ÙÈÎ‹˜ ÂÓ·-Û¯fiÏËÛË˜ ÌÂ Î¿ÔÈÔ ¿ıÏËÌ·). ¶Ú¤ÂÈ Ó· ‰›‰Â-Ù·È È‰È·›ÙÂÚË ‚·Ú‡ÙËÙ· ÛÙ· Û˘ÌÙÒÌ·Ù· Î·Ù¿ÙËÓ ÒÚ· ÙË˜ ¿ıÏËÛË˜ Î·È Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÔÈ·ıÏËÙ¤˜ ÁÈ· ÙË ÛËÌ·Û›· ·˘ÙÒÓ ÙˆÓ Û˘ÌÙˆÌ¿-ÙˆÓ, ÒÛÙÂ Ó· ÌÔÚÔ‡Ó Ó· Ù· ·Ó·ÁÓˆÚ›˙Ô˘Ó Î·ÈÓ· ‰È·ÎfiÙÔ˘Ó ÂÁÎ·›Úˆ˜ ÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜.ªÂ ÙÔÓ ÚÔÛÂÎÙÈÎfi Î·È Û˘ÛÙËÌ·ÙÈÎfi ¤ÏÂÁ¯Ô Â›-Ó·È Èı·Ófi fiÙÈ ·˘Ù¿ Ù· ‰˘Û¿ÚÂÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ı· ÌÂÈˆıÔ‡Ó ÛÙÔ ÂÏ¿¯ÈÛÙÔ.


1. Hillis WS, McIntyre PD, Maclean J, Goodwin JF,McKenna WJ. ABC of sports medicine. Suddendeath in sport. BMJ 1994;309:657-660.

2. Maron BJ, Thompson PD, Puffer JC, McGrew CA,Strong WB, Douglas PS et al. Cardiovascularpreparticipation screening of competitive athletes. Astatement for health professionals from the SuddenDeath Committee (clinical cardiology) and Congen-ital Cardiac Defects Committee (cardiovascular dis-ease in the young), American Heart Association.Circulation 1996;94:850-856.

3. Group on Science and Technology, American Med-ical Association. Athletic preparticipation examina-tions for adolescents. Report of the Board of Trus-tees. Arch Pediatr Adolesc Med 1994;148:93-98.

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5. Thompson PD. The cardiovascular complications ofvigorous physical activity. Arch Intern Med1996;156:2297-2302.

6. Maron BJ, Shirani J, Poliac LC, Mathenge R, RobertsWC, Mueller FO. Sudden death in young competi-tive athletes. Clinical, demographic, and pathologi-cal profiles. JAMA 1996;276:199-204.

7. Elliott PM, Poloniecki J, Dickie S, Sharma S, Mon-serrat L, Varnava A et al. Sudden death in hyper-trophic cardiomyopathy: identification of high riskpatients. J Am Coll Cardiol 2000;36:2212-2218.

8. Maron BJ, Pellicia A, Spirito P. Cardiac disease inyoung trained athletes. Insights into methods fordistinguishing athlete’s heart from structural heartdisease, with particular emphasis on hypertrophiccardiomyopathy. Circulation 1995;91:1596-1601.

9. McKenna WJ, Thiene G, Nava A, Fontaliran F, Blom-strom-Lundqvist C, Fontaine G et al. Diagnosis of ar-rhythmogenic right ventricular dysplasia/cardiomy-opathy. Task Force of the Working Group Myocar-dial and Pericardial Disease of the European Societyof Cardiology and of the Scientific Council on Car-diomyopathies of the International Society and Fed-eration of Cardiology. Br Heart J 1994;71:215-218.

10. Fontaine G, Fontaliran F, Lascault G, Aouate P,Tonet J, Frank R. Arrhythmogenic right ventriculardysplasia. In: Zipes DP, Jalife J, editors. Cardiac elec-trophysiology: from cell to bedside. 2nd ed.Philadelphia: WB Saunders Co; 1995. p. 754-769.

11. ∆Û·ÙÛÔÔ‡ÏÔ˘ ∞, ¶ÚˆÙÔÓÔÙ¿ÚÈÔ˜ ¡, ∞Ó·ÛÙ·Û¿-ÎË˜ Õ, £ÂÔ›ÛÙÔ˘ Õ, ∫·Ú‚Ô‡ÓË ∂, ™ËÏÈÔÔ‡ÏÔ˘Ã Î·È Û˘Ó. ¡Â·ÓÈÎfi˜ ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, ·ÚÚ˘ıÌÈÔ-ÁfiÓÔ˜ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È Ófi-ÛÔ˜ ÙË˜ ¡¿ÍÔ˘. ¶·È‰È·ÙÚÈÎ‹ 1998;61:402-407.

12. ¶ÚˆÙÔÓÔÙ¿ÚÈÔ˜ ¡, ∆Û·ÙÛÔÔ‡ÏÔ˘ ∞. ∞ÚÚ˘ıÌÈÔÁfi-ÓÔ˜ Ì˘ÔÎ·Ú‰Ô¿ıÂÈ·/‰˘ÛÏ·Û›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈ-Ï›·˜ Î·È ÓfiÛÔ˜ ¡¿ÍÔ˜. ∂ÏÏËÓÈÎ‹ ∫·Ú‰ÈÔÏÔÁÈÎ‹∂ÈıÂÒÚËÛË 2004;45:423-432.

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¶·È‰È·ÙÚÈÎ‹ 2005;68:454-459


460 PRACTICAL ISSUE

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

2 3rd Paediatric Clinic, University of Athens “Attikon” University Hospital, Haidari, Athens

Correspondence:Dimitris Georgakopoulos 16 Iridanou Str., 115 28,Athens E-mail: [email protected]



Cardiovascular conditions associated withsudden death during exercise in children,adolescents and young adults. Preparticipation evaluation D. Georgakopoulos1, K. Douros2

AbstractThe sudden death of a young athlete is a tragic and unexpected event with an impact on both thepublic and the medical community. Most of the episodes are due to cardiovascular conditions.Understanding of the causes of sudden death can help in the organization of a more effective protocolfor preparticipation evaluation. The incidence of sudden death in this group is estimated at 1:200,000young athletes per year. The most common cause of sudden death in young persons (<35 years) ishypertrophic cardiomyopathy (36%), followed by congenital abnormalities of the coronary arteries(19%). In the majority of cases no prodromal symptoms had been reported, either in the monthspreceding or immediately before death, which occurred suddenly and unexpectedly either during acompetition or, more frequently, during a training session (64%). When present, the most commonsymptoms are dizziness or syncope. A detailed medical history, both family and personal, and carefulclinical examination of the cardiovascular system constitute the cornerstone of preathletic evaluation.Special attention must be given to the detection of symptoms during exercise and to a history ofsudden death in a close relative at young age. Evaluation by a paediatric cardiologist is advised whenindicated by the history, symptoms or findings, and on specific occasions (e.g., before startingsystematic participation in athletic activity, particularly in competition sports). The usualcardiological examination includes ECG and echocardiography. More specific tests, such as Holtermonitoring, exercise test or magnetic resonance imaging may be required depending on initialfindings.

Key wordsExercise, sudden death, preparticipation evaluation.


461∫§π¡π∫O ∫OÀπ∑ CLINICAL QUIZ

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¡ÔÛÔÎÔÌÂ›Ô §¿ÚÓ·Î·˜,∫‡ÚÔ˜

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

AÏÏËÏÔÁÚ·Ê›·:∫ˆÓÛÙ·ÓÙ›ÓÔ˜ π. ™ÙÂÊ·Ó›‰Ë˜E-mail: [email protected]

¶·È‰È·ÙÚÈÎ‹ 2005;68:461

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ıÂ› ÛÙË ÛÂÏ›‰· 464

µÚ¤ÊÔ˜ ÌÂ ˘ÔÎ·ÏÈ·ÈÌÈÎ‹ ˘Ô¯ÏˆÚ·ÈÌÈÎ‹ ÌÂÙ·‚ÔÏÈÎ‹ ·ÏÎ¿ÏˆÛË Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜ÛÒÌ·ÙÔ˜

∞‰¿ÌÔ˜ Ã·Ù˙Ë·Ó·Á‹˜1, ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜2

∞ÁfiÚÈ ËÏÈÎ›·˜ ¤ÍÈ ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙÔ ¡ÔÛÔ-ÎÔÌÂ›Ô ÏfiÁˆ ÈÛÙÔÚÈÎÔ‡ ÚfiÛÊ·ÙË˜ ·ÒÏÂÈ·˜‚¿ÚÔ˘˜. √È ÁÔÓÂ›˜ ·Ó¤ÊÂÚ·Ó fiÙÈ ·ÚÔ˘Û›·˙ÂÛËÌ·ÓÙÈÎ¿ ÂÏ·ÙÙˆÌ¤ÓË Ï‹„Ë ÙÚÔÊ‹˜ ÙÔÓ ÙÂ-ÏÂ˘Ù·›Ô Ì‹Ó· Î·È ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î·Ù¿ ÙËÓÂÈÛ·ÁˆÁ‹ ‹Ù·Ó 5,6 kg (sds: -3,2), ÂÓÒ ¤Ó· Ì‹Ó·ÚÈÓ ‹Ù·Ó 6,9 kg (sds: -1,4) Î·È Â›¯Â Ì‹ÎÔ˜ 66cm (sds: - 0,7). ∂›Ó·È ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘-ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ ÌÂ ÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi. °ÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfiÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ Î‡ËÛË (‰ÂÓ ·Ó·Ê¤ÚÂÙ·ÈÔÏ˘‰Ú¿ÌÓÈÔ). ∏ ËÏÈÎ›· Î‡ËÛË˜ ‹Ù·Ó 39 Â‚‰Ô-Ì¿‰Â˜ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3,7 kg. ™ÙËÓ ·ÓÙÈ-ÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‰È·È-ÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ·Ê˘‰¿ÙˆÛË Î·È ˘ÔÙÔÓ›·.∏ ·ÚÙËÚÈ·Î‹ ›ÂÛË ‹Ù·Ó 85/57 mmHg Î·È Â›¯Â110 ÛÊ‡ÍÂÈ˜/ÏÂÙfi.

√ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ·ÈÌÔÛÊ·È-Ú›ÓË 11,4 g/dl, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 15.300/mm3,·ÈÌÔÂÙ¿ÏÈ· 362.000/mm3, ÎÚÂ·ÙÈÓ›ÓË 0,7mg/dl, Ô˘Ú›· 45 mg/dl, Ó¿ÙÚÈÔ 125 mEq/L, Î¿-ÏÈÔ 2,4 mEq/L, ¯ÏÒÚÈÔ 66 mEq/L, Ô˘ÚÈÎfi ÔÍ‡10,8 mg/dl, ·Û‚¤ÛÙÈÔ 10 mg/dl, ÊÒÛÊÔÚÔ˜ 6,1mg/dl, pH 7,47, PO2 96.3 mmHg, PCO2 27mmHg Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎ¿ 32 mmol/L. ∆Ô ÂÈ‰È-

Îfi ‚¿ÚÔ˜ Ô‡ÚˆÓ ‹Ù·Ó 1003 Î·È ÔÈ ËÏÂÎÙÚÔÏ‡ÙÂ˜Ô‡ÚˆÓ ‹Ù·Ó: Î¿ÏÈÔ 85 m∂q/L, Ó¿ÙÚÈÔ 12 m∂q/L,¯ÏÒÚÈÔ 7,4 m∂q/L. ∏ ÚÂÓ›ÓË ÔÚÔ‡ ‹Ù·Ó >77ng/dl ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ Ì¤¯ÚÈ 2 ng/dl, ÂÓÒË ·Ï‰ÔÛÙÂÚfiÓË ÔÚÔ‡ ‹Ù·Ó 290 ng/dl ÌÂ Ê˘ÛÈÔ-ÏÔÁÈÎ¤˜ ÙÈÌ¤˜ Ì¤¯ÚÈ 60 ng/dl. ∆Ô ˘ÂÚË¯ÔÁÚ¿-ÊËÌ· ÓÂÊÚÒÓ ‰ÂÓ ¤‰ÂÈÍÂ ÓÂÊÚ·Û‚¤ÛÙˆÛË ‹ Î¿-ÔÈÔ ¿ÏÏÔ ·ıÔÏÔÁÈÎfi Â‡ÚËÌ·.

¶·ÚfiÙÈ ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÊÏ¤‚È· ˘ÁÚ¿ Î·ÈËÏÂÎÙÚÔÏ‡ÙÂ˜, Ù· ‚ÈÔ¯ËÌÈÎ¿ Â˘Ú‹Ì·Ù· ÙË ‰Â‡-ÙÂÚË ËÌ¤Ú· ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ·Ú¤ÌÂÈÓ·Ó ·ıÔ-ÏÔÁÈÎ¿: ÎÚÂ·ÙÈÓ›ÓË 0,6 mg/dl, Ô˘Ú›· 18 mg/dl,Ó¿ÙÚÈÔ 129 mEq/L, Î¿ÏÈÔ 2,8 mEq/L, ¯ÏÒÚÈÔ 77mEq/L, Ì·ÁÓ‹ÛÈÔ 0,98 mg%. ∆ËÓ ÙÚ›ÙË ËÌ¤Ú·ÙË˜ ÓÔÛËÏÂ›·˜, Ë fiÚÂÍË ÙÔ˘ ·È‰ÈÔ‡ Â›¯Â ‚ÂÏ-ÙÈˆıÂ› ÛËÌ·ÓÙÈÎ¿ Î·È Ì›· Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹Ù·Ó 6,3 KgÎ·È ÔÈ ÙÈÌ¤˜ ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ ÛÙÔÓ ÔÚfi Â›¯·ÓÂ·Ó¤ÏıÂÈ ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰·. ∆Ô ‚Ú¤-ÊÔ˜, ¤Ó·Ó ¯ÚfiÓÔ ·ÚÁfiÙÂÚ·, Â›¯Â Ê˘ÛÈÔÏÔÁÈÎfi‚¿ÚÔ˜ Î·È Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜, Î·ıÒ˜ Î·È ‚ÈÔ¯ËÌÈ-Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓÔÚ›ˆÓ, ¯ˆÚ›˜ Î·Ì›· Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹.

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜:1. ™‡Ó‰ÚÔÌÔ Bartter2. ™‡Ó‰ÚÔÌÔ Gitleman3. ™‡Ó‰ÚÔÌÔ „Â˘‰Ô-Bartter


462 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

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

AÏÏËÏÔÁÚ·Ê›·:¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜E-mail: [email protected]

¶·È‰È·ÙÚÈÎ‹ 2005;68:462-463

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

¶Ú·ÎÙÈÎfi˜ √‰ËÁfi˜ ∂ÁÎ˘ÌÔÛ‡ÓË˜ - http://www.apregnancyguide.com/

∏ ÈÛÙÔÛÂÏ›‰· apregnancyguide.com/ ÌÂ ¤‰Ú· ÙÔ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ, ·ÔÙÂÏÂ› ¤Ó·Ó Ï‹ÚË ËÏÂÎÙÚÔ-ÓÈÎfi Ô‰ËÁfi ÌÂ ÏËÚÔÊÔÚ›Â˜, Ô‰ËÁ›Â˜ Î·È ¯Ú‹ÛÈÌÂ˜Û˘Ì‚Ô˘Ï¤˜ ÁÈ· fiÏ· Ù· ÛÙ¿‰È· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, Î·-ıÒ˜ Î·È ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ÌËÙÚfiÙËÙ·˜. ™ÙÈ˜ÂÈÌ¤ÚÔ˘˜ ÂÓfiÙËÙÂ˜ ˘¿Ú¯ÂÈ ÏÔ‡ÛÈÔ ÏËÚÔÊÔÚÈ·-Îfi ˘ÏÈÎfi ·fi ÌÈ· Â˘ÚÂ›· ÁÎ¿Ì· ıÂÌ¿ÙˆÓ ˘ÁÂ›·˜ Î·È˘ÁÂÈÈÓ‹˜ Ô˘ ··Û¯ÔÏÔ‡Ó ÙË Ì¤ÏÏÔ˘Û· ÌËÙ¤Ú·,fiˆ˜ Â›Ó·È Ë ÁÔÓÈÌfiÙËÙ·, Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù·ÂÁÎ˘ÌÔÛ‡ÓË˜ Î·È Û˘Ì‚Ô˘Ï¤˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜,ÔÈÎÔÁÂÓÂÈ·Îfi˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜, ‰È·ÙÚÔÊ‹ ÁÈ· ‰‡Ô,ÂÁÎ˘ÌÔÛ‡ÓË Î·È ·Ûı¤ÓÂÈÂ˜, ıËÏ·ÛÌfi˜ Î·È ÂÈ‰ÈÎ¤˜ÂÚÈÙÒÛÂÈ˜ ‰‡ÛÎÔÏË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜. ∂ÎÙfi˜ ·fiÙËÓ ÂÓËÌ¤ÚˆÛË, ·Ú¤¯ÂÙ·È Î·È ËÏÂÎÙÚÔÓÈÎfi ËÌÂÚÔ-ÏfiÁÈÔ ÁÈ· fiÏ· Ù· ÛÙ¿‰È· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ Î·ıÒ˜ Î·ÈËÏÂÎÙÚÔÓÈÎ‹ ·ÁÔÚ¿ ‚È‚Ï›ˆÓ, CDs, DVDs Ì¤Û· ·fi‰È·Û‡Ó‰ÂÛË ÌÂ ÂÍˆÙÂÚÈÎfi ‰ÈÎÙ˘·Îfi ÙfiÔ.

∏ ÈÛÙÔÛÂÏ›‰· Â›Ó·È ·ÚÎÂÙ¿ ·Ï‹ ÛÙËÓ ÏÔ‹ÁËÛ‹ ÙË˜ ÌÂ Â˘‰È¿ÎÚÈÙÂ˜ ÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÂÓfiÙËÙÂ˜ ÁÈ·ÁÚ‹ÁÔÚË Î·È Â‡ÎÔÏË Â˘ÚÂÙËÚ›·ÛË, ÂÓÒ ÚÔÛÊ¤ÚÂÈ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ‰ˆÚÂ¿Ó Û˘Ì‚Ô˘ÏÒÓ Î·È ¿ÌÂ-ÛË˜ ÂÈÎÔÈÓˆÓ›·˜ ÌÂ ÂÈÛÙËÌÔÓÈÎ¿ ÎÂÓÙÚ· ·È‰È·ÙÚÈÎ‹˜.

∏ÏÂÎÙÚÔÓÈÎ¿ Ì·ı‹Ì·Ù· ÙÔÎÂÙÔ‡ - http://www.birth.com.au/

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ www.birth.com.au, ÌÂ ÌÔÓÙ¤ÚÓ··ÈÛıËÙÈÎ‹ Î·È Û¯Â‰È·ÛÌfi, ·ÔÙÂÏÂ› ÙÔ ÚÔ˚fiÓ ÌÈ·˜ ·-Ú¤·˜ ÁÔÓ¤ˆÓ ·fi ÙËÓ ∞˘ÛÙÚ·Ï›·, ÔÈ ÔÔ›ÔÈ ı¤ÏËÛ·Ó Ó·ÚÔÛÊ¤ÚÔ˘Ó fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÏËÚ¤ÛÙÂÚË ÏËÚÔÊfiÚË-ÛË Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË Î·È ÙÔÓ ÙÔÎÂÙfi. ŒÙÛÈ ‰Ë-ÌÈÔ‡ÚÁËÛ·Ó ÙÔ ‰ÈÎÙ˘·Îfi ÙfiÔ birth.com Ô ÔÔ›Ô˜ ‰›ÓÂÈ¤ÌÊ·ÛË ÛÙËÓ ËÏÂÎÙÚÔÓÈÎ‹ ÂÎ·›‰Â˘ÛË ÌÂ “Ì·ı‹Ì·Ù·”ÁÈ· fiÏ· Ù· ÛÙ¿‰È· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, ÙÔ˘ ÙÔÎÂÙÔ‡ Î·ÈÙËÓ ÚÒÙË ÂÚ›Ô‰Ô ÙË˜ ÌËÙÚfiÙËÙ·˜. ∆· Ì·ı‹Ì·Ù·, ÔÚ-Á·ÓˆÌ¤Ó· ÛÂ ‰È·ÎÚÈÙ¤˜ Î·ÙËÁÔÚ›Â˜ ÁÈ· Â‡ÎÔÏË ·Ó·˙‹-ÙËÛË, ÚÔÛÊ¤ÚÔÓÙ·È ‰ˆÚ¤·Ó ÛÙÔ˘˜ ¯Ú‹ÛÙÂ˜ ·ÊÔ‡ ÂÁ-ÁÚ·ÊÔ‡Ó ÚÒÙ· ˆ˜ Ì¤ÏË. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·Ó·Ï˘ÙÈÎ‹ÂÚÈÁÚ·Ê‹ fiÏˆÓ ÙˆÓ Ê¿ÛÂˆÓ ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, ·fiÙÔÓ ÚÒÙÔ ÎÈfiÏ·˜ Ì‹Ó· ÙË˜ Î‡ËÛË˜, Î·È Û˘Ì‚Ô˘Ï¤˜ÚÔ˜ ÙË Ì¤ÏÏÔ˘Û· ÌËÙ¤Ú· ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ·fi Ù·


463NEWS FROM THE INTERNET

‰˘Û¿ÚÂÛÙ· Û˘ÌÙÒÌ·Ù· ÚÈÓ, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Î·È ÌÂÙ¿ ÙË Á¤ÓÓ·. ∂ÎÙfi˜ ·fi ÙËÓ ÂÎ·›‰Â˘ÛË, Ô ‰È-ÎÙ˘·Îfi˜ ÙfiÔ˜ birth.com ÚÔÛÊ¤ÚÂÈ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ·ÓÔÈ¯Ù‹˜ ÁÚ·ÌÌ‹˜ ÂÈÎÔÈÓˆÓ›·˜ Ì¤Û· ·fiÙËÓ ÂÓfiÙËÙ· birthtalk ÁÈ· ÂÚÈÛÛfiÙÂÚË ÏËÚÔÊfiÚËÛË Ì¤Û· ·fi ËÏÂÎÙÚÔÓÈÎ¤˜ ÂÊ·ÚÌÔÁ¤˜, fiˆ˜message boards Î·È chatrooms, ËÏÂÎÙÚÔÓÈÎfi Newsletter Î·È Â‚‰ÔÌ·‰È·›· ·ÔÛÙÔÏ‹ ËÏÂÎÙÚÔÓÈÎÔ‡Ù·¯˘‰ÚÔÌÂ›Ô˘ ÛÙ· ÂÁÁÂÁÚ·Ì¤Ó· Ì¤ÏË ÙË˜.

O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÂÓËÌÂÚÒÓÂÙ·È ÛÂ Ù·ÎÙÈÎ‹ ‚¿ÛË Î·È ·ÔÙÂÏÂ› ¤Ó· ·fi Ù· ÈÔ ‰ËÌÔÊÈÏ‹ ÂÚ-Á·ÏÂ›· ÂÓËÌ¤ÚˆÛË˜ ÛÂ ı¤Ì·Ù· ÂÁÎ˘ÌÔÛ‡ÓË˜ Î·È ÙÔÎÂÙÔ‡ ÛÙËÓ ∞˘ÛÙÚ·Ï›·.

ªÂ Â›ÎÂÓÙÚÔ ÙÔ ·È‰› - http://www.babycentre.co.uk/

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ babycentre.co.uk ÚÔÛÊ¤ÚÂÈÂÓËÌ¤ÚˆÛË ÚÔ˜ ÙÔ˘˜ Ó¤Ô˘˜ ÁÔÓÂ›˜ ÂÈ‰ÈÒÎÔÓÙ·˜ Ó·Î·Ï‡„ÂÈ Î·›ÚÈ· ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÛËÌ·ÓÙÈÎfiÁÂÁÔÓfi˜ ÙË˜ Á¤ÓÓËÛË˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÈ˜ ·ÏÏ·Á¤˜ Ô˘·˘Ùfi ÂÈÊ¤ÚÂÈ ÛÙË ˙ˆ‹ ÙÔ˘˜. √È ‚·ÛÈÎ¤˜ ıÂÌ·ÙÈÎ¤˜Ô˘ Î·Ï‡ÙÔ˘Ó Â›Ó·È Ë ÂÈÛÙËÌÔÓÈÎ‹ ÂÓËÌ¤ÚˆÛË Î·ÈÂÎ·›‰Â˘ÛË ÛÂ ı¤Ì·Ù· Î‡ËÛË˜ Î·È ÙÔÎÂÙÔ‡ Î·È Ë ¤ÓÙ·-ÍË ÙÔ˘ ¯Ú‹ÛÙË ÛÂ ÌÈ· “ÎÔÈÓfiÙËÙ· ÁÔÓ¤ˆÓ” ÔÈ ÔÔ›ÔÈÌÔÚÔ‡Ó Ó· ÂÈÎÔÈÓˆÓÔ‡Ó Ì¤Ûˆ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘‰ÈÎÙ˘·ÎÔ‡ ÎfiÌ‚Ô˘. ∂È‰ÈÎfiÙÂÚ·, Ë ÔÌ¿‰· ÙÔ˘babycentre.co.uk ÛÙÔ¯Â‡ÂÈ ÛÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓÚÔ˜ ÙÔ˘˜ Ì¤ÏÏÔÓÙÂ˜ ÁÔÓÂ›˜ Ì¤Û· ·fi ¤Ó· ÔÏ˘‰È¿-ÛÙ·ÙÔ ÂÚÁ·ÏÂ›Ô ÂÓËÌ¤ÚˆÛË˜. ∂ÎÙfi˜ ·fi ÙÈ˜ ıÂÌ·ÙÈÎ¤˜ÂÓfiÙËÙÂ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ ÚÔÁÂÓÓËÙÈÎfi ÛÙ¿‰ÈÔ, ÙÔÓÙÔÎÂÙfi Î·È ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙË Á¤ÓÓ·, ÛÙÔbabycentre.co.uk ÌÔÚÂ› Ó· ‚ÚÂÈ Î·ÓÂ›˜ ‰È·‰Ú·ÛÙÈÎ¤˜ÂÊ·ÚÌÔÁ¤˜, fiˆ˜ ‰ËÌÔÛÎÔ‹ÛÂÈ˜, ÎÔ˘›˙, ËÏÂÎÙÚÔÓÈÎfi

ËÌÂÚÔÏfiÁÈÔ, ÂÚÁ·ÏÂ›Ô ÂÈÏÔÁ‹˜ ÔÓfiÌ·ÙÔ˜ Î·ıÒ˜ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ‰ËÌÈÔ˘ÚÁ›·˜ ÚÔÛˆÈÎ‹˜ÈÛÙÔÛÂÏ›‰·˜ ÁÈ· ÙËÓ ÂÓËÌ¤ÚˆÛË ÙˆÓ Ê›ÏˆÓ Î·È Û˘ÁÁÂÓÒÓ ÁÈ· ÙÔ ÂÂÚ¯fiÌÂÓÔ ÁÂÁÔÓfi˜.

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÂÓËÌÂÚÒÓÂÙ·È ÛÂ Ù·ÎÙÈÎ‹ ‚¿ÛË Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÏ‡ ˘„ËÏ‹ ÂÈÛÎÂ„È-ÌfiÙËÙ·.

¶·È‰È·ÙÚÈÎ‹ 2005;68:462-463


464

¶·È‰È·ÙÚÈÎ‹ 2005;68:464-466

∫§π¡π∫O ∫OÀπ∑ CLINICAL QUIZ

∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏

™‡Ó‰ÚÔÌÔ „Â˘‰Ô-Bartter

∆· ‚ÈÔ¯ËÌÈÎ¿ Â˘Ú‹Ì·Ù· ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·ÈÛ˘Ì‚·Ù¿ ÌÂ ˘ÔÎ·ÏÈ·ÈÌÈÎ‹ ˘Ô¯ÏˆÚ·ÈÌÈÎ‹ ÌÂ-Ù·‚ÔÏÈÎ‹ ·ÏÎ¿ÏˆÛË Ô˘ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÊ˘ÛÈÔÏÔÁÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ı· ÌÔÚÔ‡Û·ÓÓ· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Bartter ‹ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ „Â˘‰Ô-Bartter, ÛÙÔ ÔÔ›Ô ‰ÂÓ‰È·ÈÛÙÒÓÂÙ·È ÚˆÙÔ·ı‹˜ ÓÂÊÚÈÎ‹ ÓfiÛÔ˜ Î·ÈÙÔ ¯ÏÒÚÈÔ ÙˆÓ Ô‡ÚˆÓ Â›Ó·È ¯·ÌËÏfi (Û˘Ó‹ıˆ˜<10 mEq/L).

∆Ô Û‡Ó‰ÚÔÌÔ ˘ÔÎ·ÏÈ·ÈÌÈÎ‹˜ ˘Ô¯ÏˆÚ·È-ÌÈÎ‹˜ ÌÂÙ·‚ÔÏÈÎ‹˜ ·ÏÎ¿ÏˆÛË˜ ‹ Û‡Ó‰ÚÔÌ·Bartter Â›Ó·È Ì›· ÔÌ¿‰· Û·Ó›ˆÓ ·ı‹ÛÂˆÓ,Ô˘ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È ÌÂ ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔÛˆÌ·ÙÈÎfi ¯·Ú·ÎÙ‹Ú· Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fiÙË ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙË˜ Â·Ó·ÚÚfiÊËÛË˜ÙÔ˘ Ó·ÙÚ›Ô˘ Î·È ÙÔ˘ ¯ÏˆÚ›Ô˘ ÛÙÔ ·¯‡ ÙÌ‹Ì·ÙË˜ ·ÁÎ‡ÏË˜ ÙÔ˘ Henle. √È ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Bartter ¤¯Ô˘Ó ·ÚÎÂÙ¿ ÎÔÈÓ¿ Â˘-Ú‹Ì·Ù·, ·ÏÏ¿ Î·È ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ (1,2,3).∆· ÎÔÈÓ¿ Â˘Ú‹Ì·Ù· Â›Ó·È:

1. ∏ ·˘ÍËÌ¤ÓË ÓÂÊÚÈÎ‹ ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘Î·È ¯ÏˆÚ›Ô˘ (>20 mEq/L), Ô˘ ÚÔÎ·ÏÂ› ÂÏ¿Ù-ÙˆÛË ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘ Î·È ÂÓÂÚÁÔÔ›Ë-ÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜-·Ï‰ÔÛÙÂÚfiÓË˜.

2. √È ˘„ËÏ¤˜ ÙÈÌ¤˜ ÚÂÓ›ÓË˜ Î·È ·Ï‰ÔÛÙÂÚfi-ÓË˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË. ™ÙËÓ ·‡-ÍËÛË ÙË˜ ·Ï‰ÔÛÙÂÚfiÓË˜ ÔÊÂ›ÏÂÙ·È ÙfiÛÔ Ë ÌÂ-Ù·‚ÔÏÈÎ‹ ·ÏÎ¿ÏˆÛË fiÛÔ Î·È Ë ˘ÔÎ·ÏÈ·ÈÌ›·.

3. ∏ ˘ÔÎ·ÏÈ·ÈÌÈÎ‹ ÌÂÙ·‚ÔÏÈÎ‹ ·ÏÎ¿ÏˆÛË.√ÚÈÛÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÂÚ·Û‚Â-ÛÙÈÔ˘Ú›· Î·È ÓÂÊÚ·Û‚¤ÛÙˆÛË,

™‹ÌÂÚ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÂÈ˜ ‰È·ÊÔÚÂÙÈÎÔ›Ê·ÈÓfiÙ˘ÔÈ ¤¯Ô˘Ó Ù·˘ÙÔÔÈËıÂ›:

π. ∆Ô ÎÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ Bartter∆· ÚÒÙ· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ÎÏ·ÛÈÎÔ‡ Û˘Ó-

‰ÚfiÌÔ˘ Bartter ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙ· ‰‡ÔÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜. ™˘¯Ó¿ ˘¿Ú¯ÂÈ ÈÛÙÔÚÈ-Îfi ÔÏ˘‰Ú·ÌÓ›Ô˘ Î·È ÚÔˆÚfiÙËÙ·˜ (1,2,3).∂ÎÙfi˜ ·fi Ù· ÎÏ·ÛÈÎ¿ Â˘Ú‹Ì·Ù· Û˘Ó‹ıˆ˜ ‰È·-ÈÛÙÒÓÂÙ·È:

1. ¶ÔÏ˘‰È„›· Î·È ÔÏ˘Ô˘Ú›·, Ô˘ Â›Ó·È·ÔÙ¤ÏÂÛÌ· ÙË˜ ‰È·Ù·Ú·¯‹˜ ÙË˜ Û˘Ì‡ÎÓˆÛË˜ÙˆÓ Ô‡ÚˆÓ, Ô˘ ÚÔÎ·ÏÂ› Ë ˘ÔÎ·ÏÈ·ÈÌ›·. ∫fi-ˆÛË Î·È Ì˘˚Î‹ ·‰˘Ó·Ì›·, Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙËÓ˘ÔÎ·ÏÈ·ÈÌ›·. ∞ÓÂ·ÚÎ‹˜ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜Î·È ÙÔ˘ ‡„Ô˘˜ Î·È ·Ó·Ù˘ÍÈ·Î‹ Î·ı˘ÛÙ¤ÚËÛË.

2. ∏ ·¤ÎÎÚÈÛË ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Â›Ó·È Ê˘ÛÈÔ-ÏÔÁÈÎ‹ ‹ Ï›ÁÔ ·˘ÍËÌ¤ÓË Î·È ‰ÂÓ ‰È·ÈÛÙÒÓÂÙ·ÈÓÂÊÚ·Û‚¤ÛÙˆÛË.

3. ÀÔÌ·ÁÓËÛÈ·ÈÌ›· ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ 20%ÙˆÓ ·ÛıÂÓÒÓ, fiÌˆ˜, fiÙ·Ó ‰È·ÈÛÙÒÓÂÙ·È ı·Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·fi ÙÔÛ‡Ó‰ÚÔÌÔ Gitelman.

∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ÙÔ˘ ÎÏ·ÛÈÎÔ‡ Û˘Ó‰Úfi-ÌÔ˘ Bartter ÛÙËÓ ∂ÏÏ¿‰· ¤ÁÈÓÂ ÚÈÓ ·fi 20¯ÚfiÓÈ· (4) Î·È ·Ú·Ì¤ÓÂÈ ¤Ó· Û¿ÓÈÔ Úfi‚ÏË-Ì·. ªÂ ÙÈ˜ ÙÂ¯ÓÈÎ¤˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ ¤¯ÂÈ‰È·ÈÛÙˆıÂ› fiÙÈ Û˘Ó‹ıˆ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ·Ï-Ï¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙÔÓ ‰›·˘ÏÔ¯ÏˆÚ›Ô˘ ClC-Kb (∂ÈÎfiÓ· 1,3) (5).

ππ. ∆Ô Û‡Ó‰ÔÌÔ Gitelman ™˘¯Ó¿ Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÛÙËÓ ÂÓ‹ÏÈÎË

˙ˆ‹, ·ÊÔ‡ Û˘Ó‹ıˆ˜ ÛÙ· ·È‰È¿ ‰ÂÓ ˘¿Ú¯Ô˘ÓÛ˘ÌÙÒÌ·Ù· ÌÂ ÂÍ·ÈÚ¤ÛÂÈ˜ ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÔ-‰ÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Ì˘˚Î‹˜ ·‰˘Ó·Ì›·˜, ÎÔÈÏÈ·ÎÒÓfiÓˆÓ Î·È ÙÂÙ·Ó›·˜ (1,2,3). ∏ ÔÏ˘Ô˘Ú›· Î·È Ë·ÓÂ·ÚÎ‹˜ ·‡ÍËÛË ÌÔÚÂ› Ó· ÌË ‰È·ÈÛÙÒÓÔ-ÓÙ·È ‹ Ó· Â›Ó·È ‹ÈÂ˜. ¢ÂÓ ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi Ô-Ï˘‰Ú·ÌÓ›Ô˘ ‹ ÚÔˆÚfiÙËÙ·˜. ∏ ˘ÔÌ·ÁÓËÛÈ·È-Ì›· Î·È Ë ÂÏ·ÙÙˆÌ¤ÓË ÓÂÊÚÈÎ‹ ·¤ÎÎÚÈÛË ·Û‚Â-ÛÙ›Ô˘ Â›Ó·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘(1,2,3). ™˘Ó‹ıˆ˜ ‰È·ÈÛÙÒÓÔÓÙ·È ÌÂÙ·ÏÏ¿ÍÂÈ˜

∂ÈÎfiÓ· 1. ªÔÚÈ·Î¤˜ ‚Ï¿‚Â˜ ÛÙ· Û‡Ó‰ÚÔÌ· µartter.1 Î·È 2: ÓÂÔÁÓÈÎÔ‡ Ù‡Ô˘ Û‡Ó‰ÚÔÌÔ µartter, 3: ÎÏ·ÛÈÎfiÛ‡Ó‰ÚÔÌÔ µartter, 4: Û‡Ó‰ÚÔÌÔ Gitelman (11)

√‡Ú·£ÂÈ·˙›‰Ë

∞›Ì·

√‡Ú·

ÊÔ˘ÚÔÛÂÌ›‰Ë

∞›Ì·

CIC-Kb

CIC-Kb

NCCT

N∫CC2

ROMK

Cl-

Cl-

Cl-2Cl-

Cl-

Na+

Na+

1

2

3

4

Na+

K+

K+K+

Na*

Ca2+Ca2+

Ca2+

Mg2+


465∫§π¡π∫O ∫OÀπ∑ CLINICAL QUIZ

ÛÙÔ ÁÔÓ›‰ÈÔ Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙÔÓ Â˘·›ÛıËÙÔÛÙË ¯ÏˆÚÔıÂÈ·˙›‰Ë ÌÂÙ·ÊÔÚ¤· Ó·ÙÚ›Ô˘ Î·È¯ÏˆÚ›Ô˘, ÙÔÓ ‰›·˘ÏÔ ¯ÏˆÚ›Ô˘ (¡CCT), Ô ÔÔ›-Ô˜ ‚Ú›ÛÎÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ¿ˆ ÂÛÂÈÚ·ÌÌ¤ÓÔÛˆÏËÓ¿ÚÈÔ (∂ÈÎfiÓ· 1,4) (5).

πππ. ¡ÂÔÁÓÈÎÔ‡ Ù‡Ô˘ Û‡Ó‰ÚÔÌÔ BartterŸˆ˜ Î·È ÛÙÔ ÎÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ Bartter

‰È·ÈÛÙÒÓÂÙ·È ÈÛÙÔÚÈÎfi ÛÔ‚·ÚÔ‡ ÔÏ˘‰Ú·ÌÓ›-Ô˘ Î·È ÚÔˆÚfiÙËÙ·˜. ¢È·ÎÚ›ÓÔÓÙ·È ‰‡Ô ÌÔÚ-Ê¤˜: ∆Ô Û‡Ó‰ÚÔÌÔ Bartter Ù‡Ô˘ π, Ô˘ ‰È·È-ÛÙÒıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ÌÂÙ·-ÊÔÚ¤· ÙÔ Ó·ÙÚ›Ô˘-Î·Ï›Ô˘-¯ÏˆÚ›Ô˘ (NKCC2)(∂ÈÎfiÓ· 1,1) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ·fiÙËÓ ÂÌÊ¿ÓÈÛË ÛÔ‚·Ú‹˜ ·Ê˘‰¿ÙˆÛË˜ ÌÂ ÔÏ˘-Ô˘Ú›· ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜ (4,6). ™¯Â-‰fiÓ ¿ÓÙ· Û˘Ó˘¿Ú¯ÂÈ ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›· ÌÂÓÂÊÚ·Û‚¤ÛÙˆÛË Î·È Û˘¯Ó¿ ÂÂÈÛfi‰È· ‰È·ÚÚÔ˚-ÎÒÓ ÎÂÓÒÛÂˆÓ, Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·˘-ÍËÌ¤ÓË˜ ·Ú·ÁˆÁ‹˜ ÚÔÛÙ·ÁÏ·Ó‰›ÓË˜ ∂2.∞ÓÙ›ıÂÙ·, ÙÔ Û‡Ó‰ÚÔÌÔ Bartter Ù‡Ô˘ ππ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ‹È· ÓÂÊÚÈÎ‹ ·¤ÎÎÚÈÛË Ó·ÙÚ›-Ô˘ Î·È ¯ÏˆÚ›Ô˘ Î·È Û˘¯Ó¿ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·‰È·ÈÛÙÒÓÂÙ·È ˘ÂÚÎ·ÏÈ·ÈÌ›·. √ÊÂ›ÏÂÙ·È ÛÂÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ÌÂÙ·ÊÔÚ¤· ÙÔ˘Î·Ï›Ô˘ (ROMK) (∂ÈÎfiÓ· 1,3).

™‡Ó‰ÚÔÌÔ „Â˘‰Ô-Bartter™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È

·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó ÙËÓ ÎÏ·ÛÈÎ‹ ÂÈÎfiÓ· ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ Bartter, ‰ËÏ·‰‹ ˘ÔÎ·ÏÈ·ÈÌ›·, ÌÂ-Ù·‚ÔÏÈÎ‹ ·ÏÎ¿ÏˆÛË, ·˘ÍËÌ¤ÓË ·Ï‰ÔÛÙÂÚfiÓËÎ·È ÚÂÓ›ÓË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ›ÂÛË, ¯ˆÚ›˜ fiÌˆ˜Ó· ÂÌÊ·Ó›˙Ô˘Ó ÚˆÙÔ·ı‹ ‚Ï¿‚Ë ÛÙ· ÓÂÊÚÈÎ¿ÙÔ˘˜ ÛˆÏËÓ¿ÚÈ·. Ã·Ú·ÎÙËÚÈÛÙÈÎfi Â‡ÚËÌ· Â›-Ó·È ÙÔ ¯·ÌËÏfi ¯ÏÒÚÈÔ Ô‡ÚˆÓ. ∆Ô ÛÙÔÈ¯Â›Ô ·˘-Ùfi ‚Ô‹ıËÛÂ ÛÙÔ Ó· ÙÂıÂ› Ë ˘Ô„›· ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ „Â˘‰Ô-Bartter ÛÙÔÓ ·ÛıÂÓ‹. ∆· ÈÔÛ˘ÓËıÈÛÌ¤Ó· ÓÔÛ‹Ì·Ù· Ô˘ ÚÔÎ·ÏÔ‡Ó ÙÔÛ‡Ó‰ÚÔÌÔ Â›Ó·È:

·. ∏ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ˜ (7), Ô˘ ·ÔÎÏÂ›-ÛıËÎÂ ÌÂÙ¿ ·fi ÁÂÓÂÙÈÎ‹ ÌÂÏ¤ÙË.

‚. ∏ ¯ÚfiÓÈ· ¯Ú‹ÛË ‰ÈÔ˘ÚËÙÈÎÒÓ (8), Ô˘·ÔÎÏÂ›ÛıËÎÂ ·fi ÙÔ ÈÛÙÔÚÈÎfi.

Á. √È Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ (2), Ô˘ ·ÔÎÏÂ›ÛıË-Î·Ó ·fi ÙÔ ÈÛÙÔÚÈÎfi.

‰. ∏ ¯ÔÚ‹ÁËÛË Î·ı·ÚÙÈÎÒÓ (9,10).

ªÂÙ¿ ·fi ÏÂÙÔÌÂÚ‹ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡,Ë ÌËÙ¤Ú· ·Ó¤ÊÂÚÂ fiÙÈ ÌÂ ‰ÈÎ‹ ÙË˜ ÚˆÙÔ‚Ô˘-Ï›·, ÛÂ ‰È¿ÛÙËÌ· ÙÚÈÒÓ Â‚‰ÔÌ¿‰ˆÓ ÚÈÓ ·fiÙËÓ ÂÈÛ·ÁˆÁ‹, Â›¯Â ¯ÔÚËÁ‹ÛÂÈ ÛÙÔ ‚Ú¤ÊÔ˜ ÂÓ-Ó¤· ÎÏ‡ÛÌ·Ù· ÌÂ sodium citrate dehydrate Î·Èsodium lauryl sulphate.

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ˘Ì¤Ó··Ó¿ÏÔÁ· ÂÚÈÛÙ·ÙÈÎ¿ ÛÂ ÂÓ‹ÏÈÎÂ˜, fiÌˆ˜ ·˘Ù‹Â›Ó·È Ë ÚÒÙË ÂÚÈÁÚ·Ê‹ ÛÂ ·È‰›.

¶·È‰È·ÙÚÈÎ‹ 2005;68:464-466


1. Guay-Woodford LM. Bartter syndrome: unravelling

the pathophysiologic enigma. Am J Med 1998;

105(2):151-161.

2. Rodr›guez-Soriano J. Bartter and related syndromes;

the puzzle is almost solved. Pediatr Nephrol

1998;12:315-327.

3. Hebert SC. Bartter syndrome. Curr Opin Nephrol

Hypertens 2003;12(5):527-532.

4. µ·‚·Ï¤· ™, ™ÙÂÊ·Ó›‰Ë˜ ∫, ¶··‰ËÌËÙÚ›Ô˘ ª,XÚÈÛÙÔÊÔÚ¿ÎË ª, ª·ÚÙ˙fiÎ·˜ Ã: ™‡Ó‰ÚÔÌÔ Bart-ter Ù‡Ô˘ π. Materia Medica Greca 1985;13:95-100.

5. Peters M, Jeck N, Reinalter S, Leonhardt A, Ton-shoff B, Klaus GG, Konrad M, Seyberth HW. Clini-cal presentation of genetically defined patients withhypokalemic salt-losing tubulopathies. Am J Med2002 Feb 15;112(3):183-190.

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

7. Kurlandsky LE. Failure to recognize the association

¶›Ó·Î·˜ 1. ¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙˆÓ Û˘Ó‰ÚfiÌˆÓ µartter (1)

KÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ ™‡Ó‰ÚÔÌÔ Gitelman NÂÔÁÓÈÎÔ‡ Ù‡Ô˘ Û‡Ó‰ÚÔÌÔBartter Bartter

∏ÏÈÎ›· ‰È¿ÁÓˆÛË˜ ¡ÂÔÁÓÈÎ‹ / ·È‰ÈÎ‹ ¶·È‰ÈÎ‹ / ÂÊË‚ÈÎ‹ ∂Ì‚Ú˘˚Î‹ / ÓÂÔÁÓÈÎ‹¶ÔÏ˘‰Ú¿ÌÓÈÔ / ÚÔˆÚfiÙËÙ· + - ++∞ÓÂ·ÚÎ‹˜ ·‡ÍËÛË ++ +/- +++¶ÔÏ˘Ô˘Ú›· / ÔÏ˘‰È„›· ++ + +++∆ÂÙ·Ó›· ™¿ÓÈ· ++ -∂Ï·ÙÙˆÌ¤ÓÔ Mg ÔÚÔ‡ 20% ·ÛıÂÓÒÓ 100% ·ÛıÂÓÒÓ ™¿ÓÈ·Ca Ô‡ÚˆÓ º˘ÛÈÔÏÔÁÈÎfi ‹ ·˘ÍËÌ¤ÓÔ Ã·ÌËÏfi ¶ÔÏ‡ ·˘ÍËÌ¤ÓÔ¡ÂÊÚ·Û‚¤ÛÙˆÛË +/- - ++PGE2 Ô‡ÚˆÓ ∞˘ÍËÌ¤ÓË º˘ÛÈÔÏÔÁÈÎ‹ ¶ÔÏ‡ ·˘ÍËÌ¤ÓË


466 ∫§π¡π∫O ∫OÀπ∑ CLINICAL QUIZ

of cystic fibrosis and metabolic alkalosis. Clin Pedi-atr 2002 Nov-Dec;41(9):715-719.

8. Colussi G, Rombolà G, Airaghi C, De Ferrari ME,Minetti L. Pseudo-Bartter's syndrome from surrep-titious diuretic intake: differential diagnosis withtrue Bartter's syndrome. Nephrol Dial Transplant1992;7:896-901.

9. Meyers AM, Feldman C, Sonnekus MI, Ninin DT,Margolius LP, Whalley NA. Chronic laxativeabusers with pseudo-idiopathic oedema and au-

tonomous pseudo-Bartter's syndrome. A spectrumof metabolic madness, or new lights on an old dis-ease? S Afr Med J 1990;178(11):631-636.

10. S. Zacharieva, E. Natchev, M. Orbetzova. ¢Â˘ÙÂÚÔ-ÁÂÓ¤˜ Û‡Ó‰ÚÔÌÔ „Â˘‰Ô-µartter ·Ô ÚÔÎÏËÙÔ‡˜ÂÌ¤ÙÔ˘˜ Î·È Î·Ù¿¯ÚËÛË ˘·ÎÙÈÎÒÓ. AÚ¯Â›· ∂ÏÏË-ÓÈÎ‹˜ π·ÙÚÈÎ‹˜ 1999;16: 68-71.

11. Reinalter SC, Jeck N, Peters M, Seyberth HW: Phar-macotyping of hypokalaemic salt-losing tubular dis-orders. Acta Physiol Scand 2004;181:513-521.

¶·È‰È·ÙÚÈÎ‹ 2005;68:464-466


467¡∂∞ ∞¶√ ™À¡∂¢ƒπ∞

§¤ÎÙÔÚ·˜ µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

¶·È‰È·ÙÚÈÎ‹ 2005;68:467-470

∂Ì‚fiÏÈÔ ÚÔÙ·˚Ô‡

√ ÚÔÙ·˚fi˜ ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ Á·-ÛÙÚÂÓÙÂÚ›ÙÈ‰·˜ ÌÂ ÛËÌ·ÓÙÈÎ‹ ÓÔÛËÚfiÙËÙ· Î·ÈıÓËÙfiÙËÙ·. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙÂ› fiÙÈ Ô Èfi˜ ÚÔÎ·-ÏÂ› Î¿ıÂ ¯ÚfiÓÔ ÂÚ›Ô˘ 1,9 ÂÎ·ÙÔÌÌ‡ÚÈ· ÂÈÛ·-ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È 440.000 ı·Ó¿ÙÔ˘˜ÛÙ· ·È‰È¿, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜.√È ¯ÒÚÂ˜ ·˘Ù¤˜ ·Ó·Ì¤ÓÂÙ·È fiÙÈ ı· ¤¯Ô˘Ó ÛËÌ·-ÓÙÈÎfi fiÊÂÏÔ˜ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·-ÛÌÔ‡. ™ÙËÓ ∂˘ÚÒË ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Ô ÚÔÙ·˚-fi˜ ÚÔÎ·ÏÂ› 100.000 ÂÈÛ·ÁˆÁ¤˜ ·È‰ÈÒÓ ËÏÈ-Î›·˜ <5 ÂÙÒÓ Î·È 300 ÂÚ›Ô˘ ı·Ó¿ÙÔ˘˜ ÙÔÓ¯ÚfiÓÔ. √ ÚÔÙ·˚fi˜ ·ÔÙÂÏÂ› Î·È ÛËÌ·ÓÙÈÎfi ÓÔ-ÛÔÎÔÌÂÈ·Îfi ·ıÔÁfiÓÔ, Î˘Ú›ˆ˜ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·, ÚÔÎ·ÏÒÓÙ·˜ ·ÎfiÌË ÌÂÁ·-Ï‡ÙÂÚÔ ‚¿ÚÔ˜ ÛÙÔ Û‡ÛÙËÌ· ˘ÁÂ›·˜ ÌÈ·˜ ¯ÒÚ·˜.

∆o 1998 Î˘ÎÏÔÊfiÚËÛÂ ÙÔ ÚÒÙÔ ÂÌ‚fiÏÈÔÎ·Ù¿ ÙÔ˘ ÚÔÙ·˚Ô‡ (Rotashiled) ÙÔ ÔÔ›Ô ÂÚÈÂ›-¯Â ÛÙÂÏ¤¯Ë rhesus Ô˘ Â›¯·Ó ÚÔ¤ÏıÂÈ ·fi ·Ó¿-ÌÈÍË Î·È ·Ó·‰È¿Ù·ÍË (reassortment) ÙÔ˘ ÁÂÓÂÙÈ-ÎÔ‡ ÙÔ˘˜ ˘ÏÈÎÔ‡ ÌÂ ·ÓıÚÒÈÓ· ÛÙÂÏ¤¯Ë. ∆Ô ÂÌ-‚fiÏÈÔ fiÌˆ˜ ·˘Ùfi ·ÔÛ‡ÚıËÎÂ ÙÔ 1999 ‰ÈfiÙÈ Û˘-Û¯ÂÙ›ÛÙËÎÂ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÁÎÔÏÂ·ÛÌÔ‡ ÛÂ‚Ú¤ÊË. ¢‡Ô Ó¤· ÂÌ‚fiÏÈ· Î·Ù¿ ÙÔ˘ ÚÔÙ·˚Ô‡ ‰Ô-ÎÈÌ¿˙ÔÓÙ·È Û‹ÌÂÚ·. ∆Ô ¤Ó· Â›Ó·È ÙÔ ÂÓÙ·‰‡Ó·-ÌÔ ÂÌ‚fiÏÈÔ Rota-Teq ÙË˜ Merck (G1, G2, G3,G4, P) Î·È ÙÔ ¿ÏÏÔ ÙÔ ÌÔÓÔ‰‡Ó·ÌÔ (Rotarix, ÙË˜GSK) Ô˘ ÂÚÈ¤¯ÂÈ ·ÓıÚÒÈÓÔ, ˙ˆÓÙ·Ófi ÂÍ·-ÛıÂÓËÌ¤ÓÔ ÛÙ¤ÏÂ¯Ô˜ (RIX4414) Ô˘ ÚÔ¤Ú¯Â-Ù·È ·fi ÙÔ ÛÙ¤ÏÂ¯Ô˜ GIP1A. To ÙÂÏÂ˘Ù·›Ô ·˘ÙfiÂÌ‚fiÏÈÔ ¯ÔÚËÁÂ›Ù·È ÛÂ ‰‡Ô ‰fiÛÂÈ˜ Î·È ‰ÔÎÈÌ¿-ÛÙËÎÂ ÛÂ ÂÚÈÛÛfiÙÂÚ· ·fi 9.400 ·È‰È¿ ÛÂ ÌÂ-Ï¤ÙÂ˜ Ê¿ÛË˜ π Î·È ππ ÛÙËÓ ∂˘ÚÒË, ÙËÓ ∞Û›·, ÙËµfiÚÂÈ· Î·È ÙË ¡fiÙÈ· ∞ÌÂÚÈÎ‹. ªÂÏÂÙ¿Ù·È Û‹ÌÂ-Ú· ÛÂ ÌÂÏ¤ÙÂ˜ Ê¿ÛË˜ πππ Î·È ¤¯ÂÈ ¯ÔÚËÁËıÂ› ÛÂÂÚÈÛÛfiÙÂÚ· ·fi 63.000 ·È‰È¿. ∆· ·ÔÙÂÏ¤-ÛÌ·Ù· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ ·˘Ùfi, fiÙ·Ó¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÛÙfiÌ· ÛÙ· ‚Ú¤ÊË ÛÂ ‰‡Ô ‰fi-ÛÂÈ˜, Â›Ó·È ·ÛÊ·Ï¤˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÛÙËÓÚfiÏË„Ë ÙË˜ ‰È¿ÚÚÔÈ·˜ ·fi ÚÔÙ·˚fi. ∞Ó Î·È ÙÔÂÌ‚fiÏÈÔ ÂÚÈ¤¯ÂÈ ÚÔÙ·˚fi Ù‡Ô˘ G1 Ê·›ÓÂÙ·È fiÙÈ

·Ú¤¯ÂÈ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ÚÔÛÙ·Û›· Î·È ¤Ó·ÓÙÈÙˆÓ ¿ÏÏˆÓ ÔÚÔÙ‡ˆÓ ÙÔ˘ ÈÔ‡. ∏ ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 90%ÁÈ· ÛÔ‚·Ú‹ ‰È¿ÚÚÔÈ· Î·È ÛÂ 73% ·fi ÔÔÈ·‰‹-ÔÙÂ ‰È¿ÚÚÔÈ· ÚÔÎ·ÏÔ‡ÌÂÓË ·fi ÙÔ ÚÔÙ·˚fi.¢ÂÓ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· ·‡ÍËÛËÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÂÁÎÔÏÂ·ÛÌÔ‡ (Abstracts¡Ô 1, 7, 31, 32, 51).

∏ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÂÓÙ·‰‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘,Â›ÛË˜, ‰ÔÎÈÌ¿ÛÙËÎÂ ÛÂ 70.301 ‚Ú¤ÊË ËÏÈÎ›·˜6 ¤ˆ˜ 12 Â‚‰ÔÌ¿‰ˆÓ, ·fi Ù· ÔÔ›· Ù· ÌÈÛ¿¤Ï·‚·Ó ·fi ÙÔ ÛÙfiÌ· 3 ‰fiÛÂÈ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÌÂ‰È·ÊÔÚ¿ 4 ¤ˆ˜ 10 Â‚‰ÔÌ¿‰ˆÓ Î·È ÛÙ· ˘fiÏÔÈ-· ¯ÔÚËÁ‹ıËÎÂ ÂÈÎÔÓÈÎfi ÂÌ‚fiÏÈÔ (placebo). ∏·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ‚ÚÂÊÒÓ ¤‰ÂÈÍÂ fiÙÈ ‰ÂÓÛËÌÂÈÒıËÎÂ ·‡ÍËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÁÎÔÏÂ-·ÛÌÔ‡ (Abstract No 46).

∂Ì‚fiÏÈÔ ÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘

∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ‰ÈÂÈÛ‰˘ÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ·fi ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ ÌÂÏÂÙ‹ıËÎÂ ÛÂ ¯ÒÚÂ˜fiˆ˜ Ë °ÂÚÌ·Ó›·, Ë √ÏÏ·Ó‰›· Î·È Ë πÛ·Ó›·fiÔ˘ ÂÊ·ÚÌfi˙ÂÙ·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ ÙÔ Û˘-˙Â˘ÁÌ¤ÓÔ ÂÙ·‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Î·È ‰È·ÈÛÙÒ-ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË.

™Â Ì›· ÌÂÏ¤ÙË ·fi ÙËÓ πÙ·Ï›· (Principi N,Abstract No 13) ¯ÔÚËÁ‹ıËÎÂ ÂÍ·‰‡Ó·ÌÔ ÂÌ‚fi-ÏÈÔ ÛÂ ‚Ú¤ÊË ÛÙËÓ ËÏÈÎ›· ÙˆÓ 3, 5 Î·È 11 ÌË-ÓÒÓ. ™Ù· ÌÈÛ¿ ‚Ú¤ÊË ¯ÔÚËÁ‹ıËÎÂ Ù·˘Ùfi¯ÚÔÓ·Û˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘. ∆··È‰È¿ ·˘Ù¿ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ‰‡Ô ¯Úfi-ÓÈ· Î·È ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓÂÂÈÛÔ‰›ˆÓ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ (29% vs48%) Î·È ÓÂ˘ÌÔÓ›·˜ (3,3% vs 8,8%) ÛÙ· ·È-‰È¿ Ô˘ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó Î·Ù¿ ÙÔ˘ ÓÂ˘ÌÔÓÈÔ-ÎfiÎÎÔ˘.

™Â ¿ÏÏË ·ÚÔ˘Û›·ÛË (Dagan R, Abstract No25) Û¯ÔÏÈ¿ÛÙËÎÂ Ë Â›‰Ú·ÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ÌÂ ÙÔ ÂÙ·‰‡Ó·ÌÔ Û˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÛÙËÓÔÈÎÔÏÔÁ›· ÙˆÓ ·ÓıÂÎÙÈÎÒÓ ÛÙÂÏÂ¯ÒÓ. √È ˘¿Ú-¯Ô˘ÛÂ˜ ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·-

¡ÂfiÙÂÚ· ·fi ÙÔ 23Ô ∂Ù‹ÛÈÔ ™˘Ó¤‰ÚÈÔ ÙË˜ ∂˘Úˆ·˚Î‹˜ ∂Ù·ÈÚÂ›·˜ ¶·È‰È·ÙÚÈÎÒÓ §ÔÈÌÒÍÂˆÓ

µ·Ï¤ÓıÈ·, πÛ·Ó›·, ª¿ÈÔ˜ 2005

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468 CONGRESS NEWS

¶·È‰È·ÙÚÈÎ‹ 2005;68:467-470

ÛÌfi ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈÎ¿ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ‰È-ÂÈÛ‰˘ÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ, ‰ÂÓ Û˘Ì‚·›ÓÂÈ fiÌˆ˜ ÙÔ›‰ÈÔ ÌÂ ÙËÓ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰· Î·È ÙÔÓ ·ÔÈÎÈ-ÛÌfi ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·. ŸÏÂ˜ ÔÈ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÌÂÈÒÓÂÙ·È Ë Û˘-¯ÓfiÙËÙ· ·ÔÈÎÈÛÌÔ‡ ÌÂ ·ÓıÂÎÙÈÎ¿ ÛÙÂÏ¤¯ËÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÚÔÙ‡Ô˘˜Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ. ∂ÓÒ ·ÚÎÂÙ¤˜ ÌÂ-Ï¤ÙÂ˜ ¤‰ÂÈÍ·Ó ·Ú¯ÈÎ¿ fiÙÈ ÌÂÈÒÓÂÙ·È Ë Û˘ÓÔÏÈÎ‹Û˘¯ÓfiÙËÙ· ·ÔÈÎÈÛÌÔ‡ ÌÂ ·ÓıÂÎÙÈÎ¿ ÛÙÂÏ¤¯Ë,·˘Ùfi ‰ÂÓ ÂÈ‚Â‚·ÈÒÓÂÙ·È ÛÙÈ˜ ÈÔ ÚfiÛÊ·ÙÂ˜ÂÚÁ·Û›Â˜. √È ÙÂÏÂ˘Ù·›Â˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ·Ó Î·ÈÌÂÈÒÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ·ÔÈÎÈÛÌÔ‡ ÌÂ ·ÓıÂÎÙÈ-Î¿ ÛÙÂÏ¤¯Ë ÔÚÔÙ‡ˆÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·˘Í¿ÓÂÙ·ÈË Û˘¯ÓfiÙËÙ· ·ÔÈÎÈÛÌÔ‡ ÌÂ ·ÓıÂÎÙÈÎ¿ ÛÙÂÏ¤¯Ë¿ÏÏˆÓ ÔÚÔÙ‡ˆÓ Ô˘ ‰ÂÓ ÂÚÈ¤¯ÔÓÙ·È ÛÙÔ ÂÌ-‚fiÏÈÔ. ¶·Ú·ÙËÚÂ›Ù·È ‰ËÏ·‰‹ Ê·ÈÓfiÌÂÓÔ ·ÓÙÈ-Î·Ù¿ÛÙ·ÛË˜, ÙfiÛÔ ÛÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÚÈÓÔÊ¿-Ú˘ÁÁ· fiÛÔ Î·È ÛÙËÓ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰·. √·ÔÈÎÈÛÌfi˜ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· ÌÂ ÔÚÈÛÌ¤ÓÔ˘˜·ÓıÂÎÙÈÎÔ‡˜ ÔÚÔÙ‡Ô˘˜ Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÙÔÂÌ‚fiÏÈÔ, fiˆ˜ ÔÈ 19F, 19∞ Î·È 6∞ ‰ÂÓ ÌÂÈÒÓÂ-Ù·È ÛËÌ·ÓÙÈÎ¿. ¢È·ÈÛÙÒıËÎÂ ‰Â, fiÙÈ ÂÌÊ·Ó›˙Ô-ÓÙ·È Û˘¯Ó¿ ·ÓıÂÎÙÈÎÔ› ÎÏÒÓÔÈ Ô˘ ·Ó‹ÎÔ˘ÓÛÙÔ˘˜ ÔÚfiÙ˘Ô˘˜ 6∞, 10A, 19∞, 15A Î·È 15C,35B, 33F ÔÚÈÛÌ¤ÓÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯Ô˘Ó ÙÔ‰˘Ó·ÌÈÎfi Ó· ÚÔÎ·Ï¤ÛÔ˘Ó √ªø ·ÏÏ¿ Î·È ‰È-ÂÈÛ‰˘ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ (Abstract No 280). º·›-ÓÂÙ·È ÂÔÌ¤Óˆ˜ fiÙÈ ÁÈ· Ó· ÌÂÈˆıÂ› Ë ·ÓÙÔ¯‹‰ÂÓ ·ÚÎÂ› Ë ¯Ú‹ÛË ÂÌ‚ÔÏ›ˆÓ, ·ÏÏ¿ ı· Ú¤ÂÈÓ· ÌÂÈˆıÂ› Î·È Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ.

™˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ C

∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ·fi ÙËÓ ÔÚÔÔ-Ì¿‰· C ¤¯ÂÈ ÌÂÈˆıÂ› ‰Ú·Ì·ÙÈÎ¿ ÛÙÈ˜ ¯ÒÚÂ˜fiÔ˘ ÂÊ·ÚÌfiÛÙËÎÂ Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ (AbstractsNo 17, 18, 22). ¶ÚfiÛÊ·Ù·, fiÌˆ˜, ‰È·ÈÛÙÒıËÎÂÛÙË ª. µÚÂÙ·Ó›· (Abstract No 16) fiÙÈ Ô ‚·ÎÙË-ÚÈÔÎÙfiÓÔ˜ Ù›ÙÏÔ˜ ÙÔ˘ ÔÚÔ‡ ÌÂÈÒÓÂÙ·È ÌÂ ÙËÓ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi.™ÙËÓ ›‰È· ¯ÒÚ· ÛËÌÂÈÒıËÎÂ ÌÂ›ˆÛË ÙË˜ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ ÙËÓ ÂÌ-Ê¿ÓÈÛË ÂÚÈÙÒÛÂˆÓ ÓfiÛÔ˘ ÛÂ ÂÌ‚ÔÏÈ·ÛÌ¤Ó··È‰È¿. ∏ ÌÂ›ˆÛË ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‰È·ÈÛÙÒıËÎÂ Î˘Ú›ˆ˜ ÛÂ ·È-‰È¿ Ô˘ Â›¯·Ó ÂÌ‚ÔÏÈ·ÛÙÂ› ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·,ÛÙÔÓ 2Ô, 3Ô Î·È 4Ô Ì‹Ó· ÙË˜ ˙ˆ‹˜, ¯ˆÚ›˜ ÙË ¯Ô-Ú‹ÁËÛË ·Ó·ÌÓËÛÙÈÎ‹˜ ‰fiÛË˜. √È ÎÏÈÓÈÎ¤˜ ·Ô-Ù˘¯›Â˜ ÛÂ ÌÈÎÚ¿ ·È‰È¿ ÛËÌÂÈÒıËÎ·Ó ·Ú¿ ÙËÓ·Ó¿Ù˘ÍË ·ÓÔÛÈ·Î‹˜ ÌÓ‹ÌË˜ ·fi ÙÔÓ ·Ú¯ÈÎfiÂÌ‚ÔÏÈ·ÛÌfi ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜. ∞ÓÙ›ıÂÙ·,

·È‰È¿ Ô˘ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó ¤ÛÙˆ Î·È ÌÂ Ì›· ‰fi-ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜˙ˆ‹˜ Ê¿ÓËÎÂ fiÙÈ ‰È·ÙËÚÔ‡Û·Ó Î·Ï‡ÙÂÚ· ÚÔ-ÛÙ·ÙÂ˘ÙÈÎfi Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÚÔÛÙ·Û›··fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∆›ıÂÙ·È, ÂÔÌ¤Óˆ˜, ÙÔÂÚÒÙËÌ· Â¿Ó ˘¿Ú¯ÂÈ ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛË˜ ·Ó·-ÌÓËÛÙÈÎ‹˜ ‰fiÛË˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ·˘ÙÔ‡.

¶ÚfiÛÊ·Ù· ¤¯ÂÈ ·Ó·Ù˘¯ıÂ› Î·È ¤¯ÂÈ ‰ÔÎÈÌ·-ÛÙÂ› ÛÂ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÙÂÙÚ·‰‡Ó·ÌÔ Û˘˙Â˘Á-Ì¤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ Ô˘ ÂÚÈ¤¯ÂÈÙÈ˜ ÔÚÔÔÌ¿‰Â˜ A,C,Y Î·È W135. ™Â ÌÂÏ¤ÙË Ô˘·ÚÔ˘ÛÈ¿ÛÙËÎÂ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë ·ÓÙÈÛˆÌ·-ÙÈÎ‹ ·¿ÓÙËÛË ÌÂÙ¿ ·fi ÂÌ‚ÔÏÈ·ÛÌfi ÌÂ ÙÔ ÙÂ-ÙÚ·‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ ‹Ù·Ó ÔÏ‡ Î·Ï‹ ÁÈ· fiÏÂ˜ÙÈ˜ ÔÚÔÔÌ¿‰Â˜ ÛÂ ¿ÙÔÌ· Ô˘ Â›¯·Ó ÚÔËÁÔ˘Ì¤-Óˆ˜ ÂÌ‚ÔÏÈ·ÛÙÂ› ÌÂ ÙÔ ÌÔÓÔ‰‡Ó·ÌÔ Û˘˙Â˘ÁÌ¤-ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ (Abstract No26). ™ÙÈ˜ ∏.¶.∞. Û˘ÓÈÛÙ¿Ù·È Û‹ÌÂÚ· Ô Î·ıÔÏÈ-Îfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ ÙÂÙÚ·‰‡Ó·ÌÔÛ˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘.

∂ÚˆÙËÌ·ÙÈÎ¿ Û¯ÂÙÈÎ¿ ÌÂ Ù· Û˘˙Â˘ÁÌ¤Ó·ÂÌ‚fiÏÈ·

∏ ÚfiÛÊ·ÙË ÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ÙˆÓÛ˘˙Â˘ÁÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ Haemophilus influenzaetype b Î·È ÌËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ C ÛÙË ªÂÁ¿ÏËµÚÂÙ·Ó›· ¤‰ÂÈÍÂ ÙË ÛËÌ·Û›· ÙÔ˘ ¯ÚÔÓÔ‰È·-ÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙˆÓ ÂÌ‚Ô-ÏÈ·ÛÌÒÓ ÌÂ Ù· Û˘˙Â˘ÁÌ¤Ó· ÂÌ‚fiÏÈ· ÁÈ· ÙËÓ·Ó¿Ù˘ÍË Î·È ‰È·Ù‹ÚËÛË Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÚÔ-ÛÙ·Û›·˜. ∏ ÂÌÂÈÚ›· Î·È ÌÂ Ù· ‰‡Ô ·˘Ù¿ ÂÌ‚fi-ÏÈ· ¤‰ÂÈÍÂ fiÙÈ Ë ·ÓÔÛÔÁÔÓÈÎfiÙËÙ· ÙˆÓ Û˘˙Â˘Á-Ì¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË fiÙ·Ó ÙÔ ÂÌ-‚fiÏÈÔ Á›ÓÂÙ·È ÛÂ ·È‰È¿ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÛÙÈ˜ ËÏÈÎ›Â˜ 2, 3 Î·È4 ÌËÓÒÓ Ô˘ Á›ÓÂÙ·È ÛÙË ª. µÚÂÙ·Ó›·. ∂‰Â›¯ıËÂ›ÛË˜, ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ Hib, fiÙÈ Ë ¯ÔÚ‹-ÁËÛË ·Ó·ÌÓËÛÙÈÎ‹˜ ‰fiÛË˜ ÌÂÙ¿ ÙÔÓ ¯ÚfiÓÔ Â›-Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ì·ÎÚÔ¯Úfi-ÓÈ·˜ ·ÓÔÛ›·˜. ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ ÚÒÙˆÓ ‰fiÛÂˆÓÙˆÓ ÂÌ‚ÔÏ›ˆÓ ·˘ÙÒÓ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Ô‰Ë-ÁÂ› ÛÙËÓ ·Ú·ÁˆÁ‹ ·ÓÔÛÈ·Î‹˜ ÌÓ‹ÌË˜ ÛÙÔ˘˜ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔ˘˜. ∞Ô‰Â›¯ıËÎÂ fiÌˆ˜, fiÙÈ ÁÈ·Ó· ˘¿Ú¯ÂÈ ÈÎ·ÓÔÔÈËÙÈÎ‹ ÚÔÛÙ·Û›· Ë ·ÓÔ-ÛÈ·Î‹ ÌÓ‹ÌË ‰ÂÓ Â›Ó·È ·ÚÎÂÙ‹, ·ÏÏ¿ ··ÈÙÂ›Ù·ÈË ‰È·Ù‹ÚËÛË Î·È ·ÚÔ˘Û›· ˘„ËÏÔ‡ Ù›ÙÏÔ˘·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi Î·Ù¿ ÙË ÛÙÈÁÌ‹ ¤ÎıÂÛË˜ÂÓfi˜ ·ÙfiÌÔ˘ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ·ıÔÁfiÓÔ.(Abstracts ¡Ô 16, 24).

∏ ÂÌÂÈÚ›· ÌÂ ÙÔÓ Hib ¤‰ÂÈÍÂ Â›ÛË˜, fiÙÈ ËÌÂ›ˆÛË ÙË˜ ÌÈÎÚÔ‚ÈÔÊÔÚÂ›·˜ ÛÙÔ ÚÈÓÔÊ¿Ú˘ÁÁ·


469¡∂∞ ∞¶√ ™À¡∂¢ƒπ∞

¶·È‰È·ÙÚÈÎ‹ 2005;68:467-470

ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ÌÔÚÂ› Ó· ¤¯ÂÈ Û˘Ó¤ÂÈÂ˜ÛÙË Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·Ù‹ÚËÛË ÙË˜ ·ÓÔÛ›·˜. ∏ÌÂ›ˆÛË ÙË˜ ÌÈÎÚÔ‚ÈÔÊÔÚÂ›·˜ Â›Ó·È ÌÂ›˙ÔÓ ÏÂ-ÔÓ¤ÎÙËÌ· ÙˆÓ Û˘˙Â˘ÁÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È ÛÂ·˘Ù‹ ÔÊÂ›ÏÂÙ·È Ë Ù·¯Â›· Â›ÙÂ˘ÍË Û˘ÏÏÔÁÈÎ‹˜·ÓÔÛ›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·, ·ÎfiÌË Î·È fiÙ·Ó ÙÔÂ›Â‰Ô ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‰ÂÓ Â›Ó·È ÔÏ‡ ˘„ËÏfi. ∏ÂÎÚ›˙ˆÛË fiÌˆ˜ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ ·fi ÙÔÓÚÈÓÔÊ¿Ú˘ÁÁ· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛËÙË˜ Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÛÙËÓ ÎÔÈÓfiÙËÙ· Î·È ÂÔ-Ì¤Óˆ˜ ÙË ÌÂ›ˆÛË ÙˆÓ Â˘Î·ÈÚÈÒÓ ÁÈ· ÂÓ›Û¯˘ÛËÙË˜ ·ÓÔÛ›·˜ ÌÂ Èı·Ó‹ Û˘Ó¤ÂÈ· ÙË ÌÂ›ˆÛË ÙË˜‰È¿ÚÎÂÈ¿˜ ÙË˜.

°È· fiÏÔ˘˜ ÙÔ˘˜ ˆ˜ ¿Óˆ ÏfiÁÔ˘˜, ··ÈÙÂ›Ù·ÈÛ˘ÓÂ¯‹˜ Â·ÁÚ‡ÓËÛË Î·È ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ÂÈÙ‹ÚËÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÁÈ· Ù· ÔÔ›· ÂÊ·Ú-Ìfi˙ÂÙ·È ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ Û˘˙Â˘ÁÌ¤Ó· ÂÌ‚fiÏÈ·.

∆· ÂÌ‚fiÏÈ· ·˘Ù¿ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÂÓÙÂÏÒ˜ÔÌÔÈÔÁÂÓ‹ ÔÌ¿‰· Î·È Ë ‰È·ÊÔÚÂÙÈÎ‹ ÔÈÎÔÏÔÁ›·ÙˆÓ ÂÏ˘ÙÚÔÊfiÚˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (Hib,ÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘ Î·È ÌËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘) Û˘-ÓÂ¿ÁÂÙ·È ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·ÊÔÚÂÙÈÎÒÓ Û˘ÓÂ-ÂÈÒÓ ·fi ÙËÓ Â˘ÚÂ›· ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Î·ıÂÓfi˜·fi Ù· ÂÌ‚fiÏÈ· ·˘Ù¿ (Abstract ¡Ô24).

∂Ì‚fiÏÈÔ ·ÓÂÌÂ˘ÏÔÁÈ¿˜

∆Ô ÔÏ˘‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Ô˘ ÂÚÈ¤¯ÂÈ ÙÔÓÛ˘Ó‰˘·ÛÌfi ÂÌ‚ÔÏ›Ô˘ ÈÏ·Ú¿˜-ÂÚ˘ıÚ¿˜-·ÚˆÙ›-ÙÈ‰·˜ (MMR) Î·È ·ÓÂÌÂ˘ÏÔÁÈ¿˜ (V) (ProQuad)Â›Ó·È ·ÛÊ·Ï¤˜ Î·È ¤¯ÂÈ ÈÛÔ‰‡Ó·ÌË ·ÓÔÛÔÁÔÓÈ-ÎfiÙËÙ· ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ·˘ÙÒÓ¯ˆÚÈÛÙ¿ (Abstracts No 3, 52). ∆o ÛÎÂ‡·ÛÌ· ÙÔ˘ÂÌ‚ÔÏ›Ô˘ ·˘ÙÔ‡ Ô˘ ‰È·ÙËÚÂ›Ù·È ÛÙË Û˘ÓÙ‹ÚË-ÛË Â›Ó·È ÈÛÔ‰‡Ó·ÌÔ ÌÂ ÙÔ ‰È·ÙËÚÔ‡ÌÂÓÔ ÛÙËÓÎ·Ù¿„˘ÍË. √ÔÈÔ‰‹ÔÙÂ ·fi Ù· ÛÎÂ˘¿ÛÌ·Ù··˘Ù¿ ÌÔÚÂ› Ó· ·ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ Ù· ÂÌ‚fiÏÈ·MMR Î·È V Î·È Ó· Î·Ù·ÛÙ‹ÛÂÈ Â˘ÎÔÏfiÙÂÚÔ ÙÔÓÎ·ıÔÏÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Î·Ù¿ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ·˘ÙÒÓ.

∂Ì‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÚÔÒÚˆÓ

∆· ÚfiˆÚ· ÓÂÔÁ¤ÓÓËÙ· ·ÔÙÂÏÔ‡Ó È‰È·›ÙÂÚËÔÌ¿‰· ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÏÔÈÌÒÍÂÈ˜. ∂ÎÙ›-ıÂÓÙ·È ÛÂ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ıÔÁfiÓˆÓ ÛÂ ¯ÚÔÓÈÎ‹ÂÚ›Ô‰Ô Î·Ù¿ ÙËÓ ÔÔ›· ÙÔ ·ÓÔÛÈ·Îfi ÙÔ˘˜ Û‡-ÛÙËÌ· Â›Ó·È ·ÓÒÚÈÌÔ, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ¤¯Ô˘Ó ÌÈ-ÎÚfiÙÂÚË ÚÔÛÙ·Û›· ·fi Ù· ÌËÙÚÈÎ¿ ·ÓÙÈÛÒÌ·Ù·ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁ¤ÓÓËÙ·. √ÙÚfiÔ˜ ÌÂ ÙÔÓ ÔÔ›Ô Ë ÚÔˆÚfiÙËÙ· ÂËÚÂ¿˙ÂÈ

ÙËÓ ÂÓ‰ÔÁÂÓ‹ ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË ‰ÂÓ Â›Ó·È·ÎÚÈ‚Ò˜ ÁÓˆÛÙfi˜. Œ¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÙÈ Ù· Úfi-ˆÚ· ·Ú¿ÁÔ˘Ó ¯·ÌËÏfiÙÂÚÔ˘˜ Ù›ÙÏÔ˘˜ ·ÓÙÈÛˆ-Ì¿ÙˆÓ fiÙ·Ó ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤Ó-ÓËÛË Î·È ·˘Ùfi ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ¤¯Ô˘Ó ·ÓÔÛÔÏÔ-ÁÈÎ‹ ·ÓˆÚÈÌfiÙËÙ· Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂÙËÓ ËÏÈÎ›· Î˘‹ÛÂˆ˜. ∞Ì¤Ûˆ˜, fiÌˆ˜, ÌÂÙ¿ ÙËÁ¤ÓÓËÛË ÙÔ ·ÓÔÛÈ·Îfi Û‡ÛÙËÌ· ÙˆÓ ÚÔÒÚˆÓˆÚÈÌ¿˙ÂÈ ÁÚ‹ÁÔÚ· ˘fi ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÂÍˆÙÂ-ÚÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ. Œ¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÙÈ Ù·ÚfiˆÚ· ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi ∆ Î·È µ ÏÂÌÊÔ-Î˘ÙÙ¿ÚˆÓ. ∆· ‚Ï·ÛÙÈÎ¿ Î¤ÓÙÚ· ¤¯Ô˘Ó ÌÂÈˆÌ¤ÓË··ÓÙËÙÈÎ‹ ÈÎ·ÓfiÙËÙ· Î·È ÙÔ ›‰ÈÔ Û˘Ì‚·›ÓÂÈ ÌÂÙ· ı˘Ï·ÎÈÎ¿ ‰ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú·. ∂›ÛË˜ Â›Ó·ÈÁÓˆÛÙfi fiÙÈ Î¿ıÂ Â‚‰ÔÌ¿‰· ÙË˜ Î‡ËÛË˜ Ô Ù›ÙÏÔ˜·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÌÂÙ·Ê¤ÚÔÓÙ·È ·fi ÙË ÌËÙ¤Ú··˘Í¿ÓÂÈ Î·Ù¿ 10%.

∆ÂÏÂ˘Ù·›· ·Ú·ÙËÚ‹ıËÎÂ fiÙÈ Ù· ÔÏ‡ ÌÈ-ÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÚfiˆÚ· ÓÂÔÁ¤ÓÓËÙ·ÂÌÊ·Ó›˙Ô˘Ó Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ÂÈ‚¿Ú˘ÓÛË(¿ÓÔÈ·, ‚Ú·‰˘Î·Ú‰›·, ·˘ÍËÌ¤ÓË ·Ó¿ÁÎË ÁÈ·ÔÍ˘ÁfiÓÔ) ÌÂÙ¿ ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∏ ÂÈ‚¿-Ú˘ÓÛË ·˘Ù‹ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È· Î·È Ù· ÂÂÈÛfi-‰È· ˘Ô¯ˆÚÔ‡Ó ·˘ÙfiÌ·Ù· ‹ ÌÂ Û‡ÓÙÔÌÔ ÂÚÂıÈ-ÛÌfi. ∆· ÂÂÈÛfi‰È· Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÂÈ-‚¿Ú˘ÓÛË˜ Â›Ó·È ÈÔ Û˘¯Ó¿ ÛÂ ·È‰È¿ ÌÂ ‚·ÚÈ¿ÎÏÈÓÈÎ‹ ÔÚÂ›· ‹ ÛÂ ·˘Ù¿ Ô˘ ÂÍ·ÎÔÏÔ˘ıÔ‡ÓÓ· ¤¯Ô˘Ó Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·Î·Ù¿ ÙË ÛÙÈÁÌ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∆· ÂÂÈÛfi‰È··˘Ù¿ ÂÎ‰ËÏÒÓÔÓÙ·È ÂÓÙfi˜ 48 ˆÚÒÓ ·fi ÙÔÓ ÂÌ-‚ÔÏÈ·ÛÌfi ÛÂ ‚Ú¤ÊË Ô˘ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÓÔ-ÛËÏÂ‡ÔÓÙ·È ÛÙËÓ ËÏÈÎ›· ÙˆÓ 60 ËÌÂÚÒÓ. ™Â ·˘-Ù¿ Ù· ‚Ú¤ÊË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·Ú·ÎÔÏÔ‡-ıËÛË ÙË˜ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ¶ÚfiˆÚ· ÓÂÔÁ¤ÓÓËÙ·Ô˘ Â›¯·Ó ÔÌ·Ï‹ ÔÚÂ›· Î·È ¤¯Ô˘Ó ¿ÂÈ Û›ÙÈÛÙËÓ ËÏÈÎ›· ·˘Ù‹ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· Â·ÓÂÈÛ¿-ÁÔÓÙ·È ÁÈ· Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó ˘fi ·Ú·ÎÔÏÔ‡-ıËÛË. (Abstracts ¡Ô 29, 53).

¶ÔÈÔ Â›Ó·È ÙÔ ÛˆÛÙfi Ì¤ÁÂıÔ˜ ‚ÂÏfiÓË˜ ÁÈ·ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ‚ÚÂÊÒÓ;

™Â ÌÈ· ÌÂÏ¤ÙË ·fi ÙË ª. µÚÂÙ·Ó›· Û˘ÁÎÚ›-ıËÎÂ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÙÔÈÎÒÓ ·ÓÂÈı‡ÌËÙˆÓ·ÓÙÈ‰Ú¿ÛÂˆÓ ÛÂ ‚Ú¤ÊË Ô˘ ÂÌ‚ÔÏÈ¿ÛÙËÎ·ÓÛÙËÓ ËÏÈÎ›· ÙˆÓ 2, 3 Î·È 4 ÌËÓÒÓ ÌÂ ÙÂÙÚ·‰‡-Ó·ÌÔ ÂÌ‚fiÏÈÔ DTwP/Hib ‰È·ÈÛÙÒıËÎÂ ÌÂ Ì¤-ÁÂıÔ˜ ‚ÂÏfiÓË˜ 23G Î·È Ì‹ÎÔ˜ 25mm ÂÌÊ·Ó›-˙Ô˘Ó ÏÈÁfiÙÂÚÂ˜ ÙÔÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ·˘Ù¿ Ô˘ ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È ÌÂ ‚ÂÏfiÓË 23GÎ·È Ì‹ÎÔ˜ 16mm (Abstract ¡Ô 47).


∂Ì‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙÔ˘ ·ÓıÚÒÈÓÔ˘·ÈÏÏÒÌ·ÙÔ˜ (human papilloma virus,HPV)

O Èfi˜ ÙÔ˘ ·ÈÈÏÏÒÌ·ÙÔ˜ ÚÔÎ·ÏÂ› ÙËÓ ÂÌ-Ê¿ÓÈÛË ÎÔÓ‰˘ÏˆÌ¿ÙˆÓ ÛÙË ÁÂÓÓËÙÈÎ‹ ÂÚÈÔ¯‹Î·È Â›Ó·È ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÙÔ˘ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ÙÚ·-¯‹ÏÔ˘ ÙË˜ Ì‹ÙÚ·˜. ™ÙËÓ ∂˘ÚÒË 33.500 Á˘Ó·›-ÎÂ˜ ÂÌÊ·Ó›˙Ô˘Ó Î·ÚÎ›ÓÔ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ ÙË˜ Ì‹-ÙÚ·˜ Î¿ıÂ ¯ÚfiÓÔ Î·È 15.000 Âı·›ÓÔ˘Ó ·fi ÙËÓfiÛÔ ·˘Ù‹. √È Ù‡ÔÈ 6 Î·È 11 ÙÔ˘ ÈÔ‡ ÚÔÎ·-ÏÔ‡Ó ÙÔ 70% ÎÔÓ‰˘ÏˆÌ¿ÙˆÓ ÛÙË ÁÂÓÓËÙÈÎ‹ Â-ÚÈÔ¯‹ Î·È ÔÈ Ù‡ÔÈ 16 Î·È 18 ÚÔÎ·ÏÔ‡Ó ÙÔ 90%ÙˆÓ Î·ÚÎ›ÓˆÓ ÙÔ˘ ÙÚ·¯‹ÏÔ˘. ¶ÚfiÛÊ·Ù· ·Ó·-Ù‡¯ıËÎÂ ÙÂÙÚ·‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ ÌÂ ÙÔ˘˜ Ù‡-Ô˘˜ 6, 11, 16 Î·È 18 ÙÔ˘ ÈÔ‡, ÙÔ ÔÔ›Ô ‚Ú¤ıËÎÂfiÙÈ ‹Ù·Ó ·ÛÊ·Ï¤˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ¤Ó·ÓÙÈÙˆÓ ÓfiÛˆÓ Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÙÔÓ Èfi ·˘Ùfi.∆Ô ÂÌ‚fiÏÈÔ ·˘Ùfi ı· ÂÈÛ·¯ıÂ› ÛÙÔ Ì¤ÏÏÔÓ ÛÙËÓÎÏÈÓÈÎ‹ Ú¿ÍË ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ÎÔÚÈ-ÙÛÈÒÓ ÚÔÂÊË‚ÈÎ‹˜ Î·È ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ·ÏÏ¿Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ. ∞Ú¯ÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›-ÍÂÈ fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ·ÛÊ·Ï¤˜ Î·È ¤¯ÂÈ ·ÓÔ-ÛÔÁÔÓÈÎ‹ ÈÎ·ÓfiÙËÙ·. ∆Ô ÂÌ‚fiÏÈÔ ·˘Ùfi ı· Â›Ó·ÈÙÔ ÚÒÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Î·ÎÔ‹ıÔ˘˜ ÓfiÛÔ˘ Ô˘ı· ÂÈÛ·¯ıÂ› ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË (Abstracts ¡Ô4, 34).

∂Ì‚fiÏÈÔ Î·Ù¿ ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜

∂ÚÂ˘ÓËÙ¤˜ ·fi ÙËÓ ∆ÛÂ¯›· ÛÂ Û˘ÓÂÚÁ·Û›·ÌÂ ÙËÓ GlaxoSmithKline Biologics ·ÚÔ˘Û›·-Û·Ó ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙË ÌÂÏ¤ÙË ÂÓfi˜ Ó¤Ô˘ÓÂ˘ÌÔÓÈÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÁÈ· ÙËÓ ÔÍÂ›· Ì¤-ÛË ˆÙ›ÙÈ‰·. ∆Ô ÂÌ‚fiÏÈÔ ÂÚÈ¤¯ÂÈ ÔÏ˘Û·Î¯·-Ú›ÙÂ˜ ·fi 11 ÔÚÔÙ‡Ô˘˜ ÓÂ˘ÌÔÓÈÔÎfiÎÎÔ˘Û˘˙Â˘ÁÌ¤ÓÔ˘˜ ÌÂ ÚˆÙÂ˝ÓË D Ô˘ Â›Ó·È Û˘-ÛÙ·ÙÈÎfi ÙÔ˘ Î˘ÙÙ·ÚÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙÔ˘Haemophilus influenzae. ¶ÂÚ›Ô˘ 5.000 ·È‰È¿ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó Ù˘¯·ÈÔÔÈËÌ¤Ó· ÌÂ ÙÔ ÂÌ‚fi-ÏÈÔ ·˘Ùfi ‹ ÌÂ ÂÌ‚fiÏÈÔ Ë·Ù›ÙÈ‰·˜ ∞. ∏ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ 11-‰‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘‹Ù·Ó 57% ÁÈ· ÔÔÈ·‰‹ÔÙÂ √ªø ·fi ÛÙÂÏ¤-¯Ë ÓÂÌÔÓÈÔÎfiÎÎÔ˘ Ô˘ ·Ó‹Î·Ó ÛÂ ÔÚÔÙ‡-Ô˘˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·È 35% ÁÈ· √ªø ·fi ÌËÙ˘ÔÔÈÔ‡ÌÂÓÔ Haemophilus influenzae. ∏·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÁÈ· Î¿ıÂ√ªø ‹Ù·Ó 33,6%. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ Â›-

Ó·È ÔÏ‡ ÂÓı·ÚÚ˘ÓÙÈÎ¿, ·Ó ÂÈ‚Â‚·ÈˆıÔ‡Ó Î·È·fi ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜.

¡¤Â˜ ÙÂ¯ÓÔÏÔÁ›Â˜ Î·È ÂÊ·ÚÌÔÁ¤˜ ÛÙËÓ¤ÚÂ˘Ó· Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓÂÌ‚ÔÏÈ·ÛÌÒÓ

∫¿ıÂ ¯ÚfiÓÔ ÛËÌÂÈÒÓÔÓÙ·È 4,1 ÂÎ·ÙÔÌÌ‡ÚÈ·ı¿Ó·ÙÔÈ ·È‰ÈÒÓ ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ ·fiÙÔ˘˜ ÔÔ›Ô˘˜ Ù· 2,5 ÂÎ·ÙÔÌÌ‡ÚÈ· ÚÔÎ·ÏÔ‡-ÓÙ·È ·fi ÓÔÛ‹Ì·Ù· Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· ÚÔ-ÏËÊıÔ‡Ó ÌÂ ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜. ∞Ó·˙ËÙÔ‡ÓÙ·ÈÂÔÌ¤Óˆ˜ ÙÚfiÔÈ ÌÂ ÙÔ˘˜ ÔÔ›Ô˘˜ ı· ‰ÈÂ˘ÎÔ-Ï˘ÓıÂ› Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÌÂ Ù·‰È·ı¤ÛÈÌ· ÂÌ‚fiÏÈ·, ÂÓÒ Á›ÓÔÓÙ·È Î·È ÚÔÛ¿-ıÂÈÂ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ¿ÏÏˆÓ ÓÂfiÙÂÚˆÓÂÌ‚ÔÏ›ˆÓ, fiˆ˜ ·˘Ù¿ ÙË˜ Ê˘Ì·Ù›ˆÛË˜, ÙË˜ÂÏÔÓÔÛ›·˜, ÙË˜ HIV ÏÔ›ÌˆÍË˜, Î·È ¿ÏÏ·. ¶ÚÔ-ÎÂÈÌ¤ÓÔ˘ Ó· ·ÏÔÔÈËıÂ› Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ˘·Ú¯fiÓÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ, Â›Ó·È ÂÈı˘ÌËÙfi Ó·˘¿ÚÍÔ˘Ó ÂÌ‚fiÏÈ· Ô˘ ‰ÂÓ ı· ÂËÚÂ¿˙ÔÓÙ·È·fi ÙË ıÂÚÌÔÎÚ·Û›· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÒÛÙÂÓ· Â›Ó·È ··Ú·›ÙËÙË Ë ‰È·Ù‹ÚËÛË˜ „˘¯Ú‹˜·Ï˘Û›‰·˜, ı· Â›Ó·È ¤ÙÔÈÌ· ÁÈ· ¯ÔÚ‹ÁËÛË, ÒÛÙÂÓ· ÌËÓ ··ÈÙÂ›Ù·È ·Ó·Û‡ÛÙ·ÛË Î·È ı· ÌÔÚÔ‡ÓÓ· ¯ÔÚËÁÔ‡ÓÙ·È ¯ˆÚ›˜ ÙË ¯Ú‹ÛË ‚ÂÏfiÓË˜. ∂È-ı˘ÌËÙfi Â›Ó·È Â›ÛË˜, Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÌ-‚fiÏÈ· Ô˘ ·Ú¿ÁÔ˘Ó ·ÓÔÛ›· ÌÂ Ì›· ÌfiÓÔ ‰fiÛË,Î·ıÒ˜ Î·È ÔÏ˘‰‡Ó·Ì· ÂÌ‚fiÏÈ·. ªÂÏÂÙ¿Ù·ÈÏÔÈfiÓ Ë ¯ÔÚ‹ÁËÛË ÂÌ‚ÔÏ›ˆÓ ÌÂ ÚÔÁÂÌÈÛÌ¤ÓËÛ˘ÛÎÂ˘‹ ¤ÓÂÛË˜ ÌÈ·˜ ¯Ú‹ÛË˜ Ô˘ ¤¯ÂÈ, fiÌˆ˜,Î¿ˆ˜ ˘„ËÏfiÙÂÚÔ ÎfiÛÙÔ˜. ™ÙÔ ªÂÍÈÎfi ¯ÔÚË-Á‹ıËÎÂ ÂÌ‚fiÏÈÔ ÈÏ·Ú¿˜ ˘fi ÌÔÚÊ‹ ·ÂÚÔÛfiÏË˜ÛÂ ‚Ú¤ÊË ÌÂ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ÌÂÏÂÙ¿Ù·ÈË ¯ÔÚ‹ÁËÛË Î·È ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙË˜ ÂÚ˘ıÚ¿˜. ∏¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙË˜ ÁÚ›Ë˜ ·ÔÙÂÏÂ›Î·Ïfi ·Ú¿‰ÂÈÁÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ ÚÈÓÈÎfi „Â-Î·ÛÌfi, Ô˘ ÌÔÚÂ› Ó· ÂÂÎÙ·ıÂ› Î·È ÛÂ ¿ÏÏ·ÂÌ‚fiÏÈ·. ∂ÍÂÙ¿˙ÂÙ·È, Â›ÛË˜, Ë ÂÓ‰Ô‰ÂÚÌÈÎ‹¯ÔÚ‹ÁËÛË ·ÓÙÈÁfiÓˆÓ ÌÂ ÌÈÎÚÔÛ˘ÛÎÂ˘¤˜ Ô˘‰È·ı¤ÙÔ˘Ó ÌÈÎÚÔ‚ÂÏfiÓÂ˜ Î·È ÂÎı¤ÙÔ˘Ó ¿ÌÂÛ·ÙÔ ·ÓÙÈÁfiÓÔ ÛÙ· ·ÓÙÈÁoÓÔ-·ÚÔ˘ÛÈ·ÛÙÈÎ¿ Î‡Ù-Ù·Ú· ÙË˜ ‰ÂÚÌ›‰·˜ ‹ ÌÂ ‚·ÏÏÈÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜¯ÔÚ‹ÁËÛË ÍËÚÔ‡ ÂÌ‚ÔÏ›Ô˘ ¯ˆÚ›˜ ·Ó·Û‡ÛÙ·ÛË.ªÂÏÂÙ¿Ù·È Ë ·Ó¿Ù˘ÍË ÂÌ‚ÔÏ›ˆÓ Ô˘ ÌÂ Ì›·¤ÓÂÛË ı· ¯ÔÚËÁÂ›Ù·È Ù·˘Ùfi¯ÚÔÓ· Ë ·Ú¯ÈÎ‹ ‰fi-ÛË Î·È Ë ·Ó·ÌÓËÛÙÈÎ‹ (booster) ÌÂ ‚Ú·‰Â›··ÂÏÂ˘ı¤ÚˆÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘.

470 CONGRESS NEWS

¶·È‰È·ÙÚÈÎ‹ 2005;68:467-470


471µπµ§πO¶∞ƒOÀ™π∞™∏ BOOK REVIEW

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ“∞ÏÂÍ¿Ó‰Ú·”

AÏÏËÏÔÁÚ·Ê›·:Ã. ∫ÒÛÙ·ÏÔ˜ E-mail: [email protected]

¶·È‰È·ÙÚÈÎ‹ 2005;68:471

¶Ú·ÎÙÈÎfi˜ Ô‰ËÁfi˜ ·Ó¿ÓË„Ë˜ ÙÔ˘ ÓÂÔÁÓÔ‡

Àfi ¡. ¡ÈÎÔÏ·˝‰Ë, ∞. ¡·Ô‡Ì

ªÂ È‰È·›ÙÂÚË ÈÎ·ÓÔÔ›ËÛË ‰¤¯ıËÎ· ¤Ó· ·Ó¿Ù˘Ô ÙÔ˘‚È‚Ï›Ô˘ “¶Ú·ÎÙÈÎfi˜ O‰ËÁfi˜ ∞Ó¿ÓË„Ë˜ ÙÔ˘ ¡ÂÔÁÓÔ‡”ÙˆÓ ÓÂÔÁÓÔÏfiÁˆÓ Î. ¡ÈÎÔÏ·˝‰Ë Î·È Î. ¡·Ô‡Ì. ¶ÚfiÎÂÈÙ·ÈÁÈ· ÔÏ‡ ÂÈÌÂÏËÌ¤ÓË ÌÂÙ¿ÊÚ·ÛË ·fi Ù· ·ÁÁÏÈÎ¿ ÙÔ˘‚È‚Ï›Ô˘ Ô˘ ÂÍ¤‰ˆÛÂ Ë ∂ÈÙÚÔ‹ ∞Ó¿ÓË„Ë˜ ÙÔ˘ ∏Óˆ-Ì¤ÓÔ˘ µ·ÛÈÏÂ›Ô˘. ∏ ·fi‰ÔÛË ÙÔ˘ ‚È‚Ï›Ô˘ ÛÙ· ÂÏÏËÓÈÎ¿Â›Ó·È ÂÍ·ÈÚÂÙÈÎ‹. ª¤Û· ÛÙÈ˜ 135 ÛÂÏ›‰Â˜ ÙÔ˘ ÂÚÈ¤¯ÂÙ·ÈÙfiÛÔ Ë Ê˘ÛÈÔÏÔÁ›· ÙË˜ ÓÂÔÁÓÈÎ‹˜ ˘ÔÍ·ÈÌ›·˜ fiÛÔ Î·È Ù·‚·ÛÈÎ¿ ‚‹Ì·Ù· ÙË˜ ·Ó¿ÓË„Ë˜. ∂ÈÏ¤ÔÓ, ˘¿Ú¯Ô˘Ó ¯ˆ-ÚÈÛÙ¿ ÎÂÊ¿Ï·È· Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ÚfiÁÓˆÛË ÓÂÔ-ÁÓÒÓ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›·, ÛÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔ-ÁÓÔ‡ ÌÂÙ¿ ÙËÓ ·Ú¯ÈÎ‹ ·Ó¿ÓË„Ë, fiˆ˜ Î·È ÛÙËÓ ÂÈÎÔÈ-ÓˆÓ›· ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘ ÓÂÔÁÓÔ‡.

∆Ô ‚È‚Ï›Ô ‰È·‚¿˙ÂÙ·È ÔÏ‡ Â˘¯¿ÚÈÛÙ·, ¯¿ÚË ÛÙ· ÌÂ-Á¿Ï· ÙÔ˘ ÁÚ¿ÌÌ·Ù·, ÛÙË ¯ÚËÛÈÌÔÔ›ËÛË Ï‹ıÔ˘˜ ÂÈÎfi-ÓˆÓ Î·È Û¯ËÌ¿ÙˆÓ, ÛÙËÓ ·Ó·ÊÔÚ¿ ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙÔ˘ÎÂÊ·Ï·›Ô˘ ÛÙËÓ ·Ú¯‹ Î¿ıÂ ÂÓfi˜ ·fi ·˘Ù¿, ÛÙË ¯ÚËÛÈÌÔ-Ô›ËÛË ÎfiÎÎÈÓÔ˘ ¯ÚÒÌ·ÙÔ˜ ÁÈ· ÙÔÓ ÙÔÓÈÛÌfi ÛËÌ·ÓÙÈÎÒÓ

ÛËÌÂ›ˆÓ, Î·ıÒ˜ Î·È ÛÙÔ ÛÈÚ¿Ï ‰¤ÛÈÌfi ÙÔ˘. ŒÚ¯ÂÙ·È ¤ÙÛÈ Ó· Î·Ï‡„ÂÈ ¤Ó· ÎÂÓfi Ô˘ ˘¿Ú¯ÂÈ ÛÙËÓÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· ¿Óˆ ÛÂ ¤Ó· ÙfiÛÔ ÎÚ›ÛÈÌÔ ÎÂÊ¿Ï·ÈÔ fiˆ˜ Â›Ó·È Ë ·Ó¿ÓË„Ë, ÂÓÒ ·ÔÙÂÏÂ›Û˘ÌÏ‹ÚˆÌ· ÙÔ˘ ÚÒÙÔ˘ ÂÈÙ˘¯ËÌ¤ÓÔ˘ ‚È‚Ï›Ô˘ ÙˆÓ ›‰ÈˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ˘fi ÙÔÓ Ù›ÙÏÔ “∂ÓÙ·ÙÈÎ‹¡ÔÛËÏÂ›· ¡ÂÔÁÓÒÓ”.

™Â ÌÂÏÏÔÓÙÈÎ‹ ÙÔ˘ ¤Î‰ÔÛË ›Ûˆ˜ ı· Ú¤ÂÈ Ó· ÚÔÛÙÂıÂ› ¤Ó· ÌÈÎÚfi Û˘ÌÏ‹ÚˆÌ·, ÛÙÔ ÔÔ›Ô ı··Ó·Ê¤ÚÂÙ·È Ë ‰È¿ÚÎÂÈ· ÙË˜ ·Ó¿ÓË„Ë˜ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ Ô˘ ÙÔ ÓÂÔÁÓfi ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·ÈÛÙÈ˜ ÚÔÛ¿ıÂÈ¤˜ Ì·˜, fiˆ˜ Î·È ¤Ó·˜ ›Ó·Î·˜ ÌÂ ·ı‹ÛÂÈ˜ Ô˘ ıÂˆÚÔ‡ÓÙ·È ·Û‡Ì‚·ÙÂ˜ ÌÂ ÙË ˙ˆ‹.

ªÂ ‰Â‰ÔÌ¤ÓÔ fiÙÈ ‰ÂÓ ÓÔÂ›Ù·È Û‹ÌÂÚ· ·È‰›·ÙÚÔ˜ Ô˘ Ó· ÌËÓ Î·Ù¤¯ÂÈ Ù· ‚·ÛÈÎ¿ ÙË˜ ·Ó¿ÓË„Ë˜ÙÔ˘ ÓÂÔÁÓÔ‡, ÈÛÙÂ‡ˆ fiÙÈ ÙÔ ÌÈÎÚfi ·˘Ùfi ‚È‚Ï›Ô ı· Ú¤ÂÈ Ó· ÌËÓ ÏÂ›ÂÈ ·fi Î·Ó¤Ó· ¶·È‰È·ÙÚÈÎfi∆Ì‹Ì·.

Ã. ∫ÒÛÙ·ÏÔ˜ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶° ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ “∞ÏÂÍ¿Ó‰Ú·”


472 ∂Àƒ∂∆∏ƒπ√ ∫ƒπ∆ø¡

¶·È‰È·ÙÚÈÎ‹ 2005;68:472

∂˘¯·ÚÈÛÙ›Â˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ ÙË˜ «¶·È‰È·ÙÚÈÎ‹˜»

∏ ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹ Â˘¯·ÚÈÛÙÂ› ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ «¶·È‰È·ÙÚÈÎ‹» Ô˘ ÚÔ-Û¤ÊÂÚ·Ó ÙËÓ Â›Ú· Î·È ÙÔÓ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›Ûo˘Ó Û˘ÛÙËÌ·ÙÈÎ¤˜, ÙÂÎÌËÚÈˆÌ¤ÓÂ˜ Î·È ·ÓÙÈ-ÎÂÈÌÂÓÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜ ÁÈ· ÙÈ˜ ÂÈÛÙËÌÔÓÈÎ¤˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2005.

∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 68 ÙÔ˘ ¤ÙÔ˘˜ 2005

∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º·Ó‹∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ªÈÚ¿ÓÙ·∞˚‚¿˙Ë˜ µ›ÎÙˆÚ∞˚‚¿˙ÔÁÏÔ˘ £Âfi‰ˆÚÔ˜∞Ó·ÁÓˆÛÙ¿ÎË˜ ¢ËÌ‹ÙÚÈÔ˜∞Ó·ÁÓˆÛÙ¿ÎË˜ πˆÛ‹Ê∞Ó‰Ú¤Ô˘ ∞Ï¤Í·Ó‰ÚÔ˜∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹∞ÓÙˆÓÈ¿‰Ë˜ ™Ù˘ÏÈ·Ófi˜∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘ πˆ¿ÓÓ·∞ÓÙˆÓÔÔ‡ÏÔ˘ ∂Ï¤ÓË∞ÚÁ˘ÚÔÔ‡ÏÔ˘ ª·Ú›·∞ÚÒÓË-µÔ˘ÚÓ¿ ™ÔÊ›·∞˘ÁÔ˘ÛÙ›‰Ô˘ ¶ÂÚÛÂÊfiÓËµ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›·µ·ÚÏ¿ÌË˜ °ÂÒÚÁÈÔ˜µ¤ÎÈÔ˘-™·Ì·Ú¿ ∞ıËÓ¿µÏ·¯Ô··‰ÔÔ‡ÏÔ˘ ∂Ï›‰·µÔ‡‰ÚË˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜°·Ï¿-µ·Ì‚Ô˘Ú¿ÎË ∞ÁÁÂÏÈÎ‹°·Ï·Ó¿ÎË˜ ∂ÌÌ·ÓÔ˘‹Ï°·ÏÏ‹-∆ÛÈÓÔÔ‡ÏÔ˘ ∞ÛËÌ›Ó·°·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞Ó·ÛÙ·Û›·°ÂˆÚÁ¿ÎË-∞ÁÁÂÏ¿ÎË ∂Ï¤ÓË°ÂˆÚÁÔ‡ÏË ∂Ï¤ÓË°ÈÔ˘ÚÔ‡ÎÔ˜ ™ˆÙ‹ÚÈÔ˜°Ú·Ê¿ÎÔ˜ ™Ù¤ÏÈÔ˜°ÚËÁÔÚ¤·˜ ÃÚ‹ÛÙÔ˜¢ËÌËÙÚ›Ô˘ πˆ¿ÓÓË˜¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ·ÛÈÏÈÎ‹∏Ï›· ª·Ú›·∏ÏÈ¿‰Ô˘-§·˙ÔÔ‡ÏÔ˘ ¢¤ÛÔÈÓ·∫·‚·˙·Ú¿ÎË˜ ∂ÌÌ·ÓÔ˘‹Ï∫·‚·ÏÈÒÙË˜ πˆ¿ÓÓË˜∫·ÏÔÁÈ¿ÓÓË˜ ¡ÈÎfiÏ·Ô˜∫·Ó·‚¿ÎË˜ ∂ÌÌ·ÓÔ˘Ï‹∫·Ó¿ÚÈÔ˘ ª·Ú›·∫·Ô˘Ï¤·˜ °ÂÒÚÁÈÔ˜∫·Ú·ÁÈ¿ÓÓË ÃÚÈÛÙ›Ó·∫·Ú·ÁÎÈfi˙ÔÁÏÔ˘-§·ÌÔ‡‰Ë £ˆÌ·‹∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ ¢ËÌ‹ÙÚÈÔ˜∫·Ú·Ó›Î·˜ ∏Ï›·˜∫·ÙÚÈÔ‡-¡ÈÎÔÏ·Î¿ÎË ¢ˆÚÔı¤·

∫·ÙÛ·Ú‰‹˜ Ã·Ú¿Ï·ÌÔ˜∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›·∫·ÙÙ¿ÌË˜ ∞ÓÙÒÓË˜∫·ÊÂÙ˙‹˜ ¢ËÌ‹ÙÚÈÔ˜∫·ÊÚ›ÙÛ· ¶·Ó·ÁÈÒÙ·∫ÂÚ·Ì›‰·˜ ¢ËÌ‹ÙÚÈÔ˜∫ÂÚ·ÛÈÒÙË-∫·Ú·Î·ÙÛ¿ÓË ∑ˆ‹∫›ÙÛÈÔ˘-∆˙¤ÏË ™ÔÊ›·∫Ô‚¿ÓË˜ ∞ı·Ó¿ÛÈÔ˜∫Ô˝‰Ô˘ ∞ÊÚÔ‰›ÙË∫ÔÏ·˝ÙË˜ °ÂÚ¿ÛÈÌÔ˜∫ÔÏÏÈfi˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜∫ÔÌÈ·ÓÔ‡ ºÈÏ·‰¤ÏÊÂÈ·∫ÔÛÌ›‰Ë-µ·ÛÈÏ¿ÙÔ˘ ∂Ï¤ÓË∫Ô˘Ú¿ÎË˜ °ÂÒÚÁÈÔ˜∫Ô˘Ú‹ ∞Á·ı‹∫Ô˘ÙÛÔ˘ÏÈ¤ÚË˜ ∏Ï›·˜∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜∫ÒÛÙ·ÏÔ˜ ÃÚ‹ÛÙÔ˜§··ÙÛ¿ÓË˜ ¶¤ÙÚÔ˜§È·ÎÔÔ‡ÏÔ˘ ª¿Á‰·§È¿Ë-∞‰·Ì›‰Ô˘ °ÂˆÚÁ›·ª·ıÈÔ˘‰¿ÎË˜ πˆ¿ÓÓË˜ª¿Ó‰ËÏ·-∫Ô˘ÛÔ˘Ó‹ ª·Ú›·ª·ÓÔ˘Û¿ÎË˜ ª·ÓÒÏË˜ª·ÓˆÏ¿ÎË ¡›Ó·-∞Ú¯ÔÓÙ›·ª·ÚfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜ª·ÛÙÚÔÁÈ¿ÓÓË ™ˆÙËÚ›·ªfiÙÙË ºÚfiÛˆªÂÚ¿ÙË˜ ¡ÈÎfiÏ·Ô˜ªÏ¿ÎÌÂÚÓ-¡¿ÎÔ˘ ™›Ó·ªÚÈ·ÛÔ‡ÏË˜ °ÂÒÚÁÈÔ˜¡·Ó¿˜ ÃÚ‹ÛÙÔ˜¡ÈÎÔÏ·˝‰Ô˘ ¶ÔÏ˘Í¤ÓË¡ÈÎÔÏ¿Ô˘-¶··Ó·ÁÈÒÙÔ˘ ∞ÏÂÍ¿Ó‰Ú·¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË ™¿ÓÙ·¡Ù·Ú›ÏË˜ ∂ÌÌ·ÓÔ˘‹Ï¡ÙfiÏ·Ù˙·˜ £Âfi‰ˆÚÔ˜•¿ÓıÔ˘ ª·ÚÈ¤ÙÙ·•Â··‰¿ÎË ¶·Ú·ÛÎÂ˘‹√ÈÎÔÓÔÌfiÔ˘ÏÔ˜ ÃÚ‹ÛÙÔ˜¶¿ÈÎÔ˜ ¶¤ÙÚÔ˜¶·Ó·ÁÈˆÙfiÔ˘ÏÔ˜ ∆¿ÎË˜

¶·Ó·ÁÈÒÙÔ˘ πˆ¿ÓÓË˜¶·Ó·ÁÈÒÙÔ˘-∞ÁÁÂÏ·ÎÔÔ‡ÏÔ˘ πˆ¿ÓÓ·¶·ÓÙÂÏÈ¿‰Ë˜ ÃÚ‹ÛÙÔ˜¶··ÁÈ¿ÓÓË˜ πˆ¿ÓÓË˜¶··ÁÚËÁÔÚ›Ô˘-£ÂÔ‰ˆÚ›‰Ô˘ ª·Ú›·¶··‰¿ÎË˜ µ·Û›ÏÂÈÔ˜¶··‰¿ÙÔ˘ ¢·Ó¿Ë¶··‰ËÌËÙÚ›Ô˘ ∞Ó·ÛÙ¿ÛÈÔ˜¶··‰ÔÔ‡ÏÔ˘ ∞ÏÂÍ¿Ó‰Ú·¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑ˆ‹¶··‰fiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜∆Ú¿·ÏË ÃÚÈÛÙ›Ó·¶··Â˘·ÁÁ¤ÏÔ˘ µ¿Ó·¶ÂÙÚ›‰Ô˘-™Î·ÏÎ›‰Ô˘ ∂Ï¤ÓË¶Ú›ÊÙË˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ ∫ÔÚ›Ó·ƒ¿ÌÌÔ˜ ™˘Ú›‰ˆÓƒÔ‡ÛÛÔ˘ ∞ÏÂÍ¿Ó‰Ú·™·ÍÒÓË-¶··ÁÂˆÚÁ›Ô˘ ºˆÙÂÈÓ‹™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞ÓÙÈÁfiÓË™ÎÂÓÙ¤ÚË˜ ¡ÈÎfiÏ·Ô˜™ÎÈ·‰¿˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜™˘Ú›‰Ë˜ ¶·Ó·ÁÈÒÙË˜™Ù·ÌÔÁÈ¿ÓÓÔ˘-ª·˘ÚÔÂÈ‰‹ §¤Ï·™Ù·ÌÔ˘Ï·Î¿ÙÔ˘ ∞Ï¤Î·™˘Ú›ÁÔ˘-¶··‚·ÛÈÏÂ›Ô˘ ∞ÓÙÈÁfiÓË∆·Ú·ÓÙ˙‹ ¶ÔÏ˘Í¤ÓË∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘ ºˆÙÂÈÓ‹∆Û·Ó¿Î·˜ πˆ¿ÓÓË˜∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ·∆ÛÈÏÈÁÈ¿ÓÓË˜ £ÂÔÊ¿ÓË˜∆ÛÈÏÈÌÈÁÎ¿ÎË ∞Ì·Ï›·∆Û›ÙÔ˘Ú· ™Ù¤ÏÏ·∆ÛfiÏ·˜ °ÂÒÚÁÈÔ˜∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ª·Ú›˙·ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂Ï¤ÓËºˆÙfiÔ˘ÏÔ˜ ™˘Ú›‰ˆÓÃ·Ù˙Ë·ı·Ó·Û›Ô˘ Ã·Ú¿Ï·ÌÔ˜Ã·Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ Ã·Ú›ÎÏÂÈ·ÃÈˆÙ›ÓË˜ ÃÚ‹ÛÙÔ˜ÃÚËÛÙfiÔ˘ÏÔ˜-°ÂÚÔ˘Ï¿ÓÔ˜ °ÂÒÚÁÈÔ˜


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C. van Viet-∫ˆÛÙ·ÓÙÈÓ›‰Ô˘ 133Du Toit G. 337Lack G. 337Rachman N. 366

∞∞Á·Î›‰Ë˜ Ã. 417∞ÁÁÂÏfiÔ˘ÏÔ˜ ¶. ¢. 433∞ı·Ó·ÛÈ¿‰Ô˘ º. 74∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. 329, 409, 440∞ÏÂÍ·Ó‰ÚÔÔ‡ÏÔ˘-∆ÛÈÎÚ›Î· µ. 372∞ÏÈÊÈÂÚ¿ÎË ∆. 308∞Ó·ÛÙ·ÛÈ¿‰Ë˜ °. 62∞Ó‰Ú¤Ô˘ ∞. 372∞ÓÙˆÓÈ¿‰Ë˜ ™. 155, 301∞ÔÛÙfiÏÔ˘ ∂. 120∞ÔÛÙfiÏÔ˘ ª. 150∞Ú‚·ÓÈÙ›‰Ë˜ ¡. 425ÕÚÛÔ˜ °. 112∞˘ÏˆÓ›ÙË˜ ™. 289

µµ·ÁÈ¿ÎÔ˘ ∂. 210µ·Î¿ÎË ª. 62, 133µ·ÚÏ¿ÌË˜ °. ™. 204, 425µÂÏÂÁÚ¿ÎË ∞. 74µÂÏ¤ÓÙ˙·˜ ¶. 29µÏ·¯¿ÎË °. 120µÔÁÈ·Ù˙‹ §. 450µÔ‡‰ÚË˜ ∫. ∞. 93, 210µÚ¿ÓÔ˘ ª. 62

°°·‚ÚÈÈÏ›‰Ë˜ ™. 425°·Ï·Ó¿ÎË˜ ∂. 85, 120°·ÏÏ¿-µÔ˘Ì‚Ô˘Ú¿ÎË ∞. 53, 245°ÂˆÚÁ·ÎfiÔ˘ÏÔ˜ ¢. 454°È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. 85°ÎÈÒÓË˜ ¢. 352°Ô˘‰ÂÛ›‰Ô˘ ª. 372°Ô‡Ó·ÚË˜ ∞. 1°Ú·ÌÌ·ÙÈÎ¿ÎË˜ π. 128

¢¢·Ú˙¤ÓÙ·˜ ∞. 222¢·ÛÔÔ‡ÏÔ˘ ª. 150¢ÂÛ‡ÚË˜ ¡. 37¢ËÌËÙÚ›Ô˘ °. 417¢ËÌËÙÚ›Ô˘ ∂. 103¢È·Ì·ÓÙ‹ ∂. 450¢È·Ì·ÓÙfiÔ˘ÏÔ˜ ¡. 257¢Ô‡ÚÔ˜ ∫. 454¢Ô‡ÙÛË˜ √. 217¢ÚÂ‚ÂÏ¤ÁÎ·˜ ∞. 74¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ. 450

∂∂ÌÔÚÈ¿‰Ô˘ ª. 399, 425∂˘‰ˆÚ›‰Ô˘ π. 450∂˘Ù‡¯Ë Ã. 245

∑∑·ÊÂÈÚ›Ô˘ ¢. 409

££ˆÌ·˝‰Ë˜ £. 37

ππÔ˘ÏÈ·Ófi˜ ∞. 245

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§§¿ÁÁ·˜ ¢. 37§·˙·Ú›‰Ô˘ ™. 204§··ÙÛ¿ÓË˜ ¢. 279§È·ÎÔÔ‡ÏÔ˘ ª. 308§Ô˘Î¿ÙÔ˘ ∂. 150§Ô˘Ú›‰· ∞. 145

ªª·Î·‚fi˜ ∞. 112ª·Î¤‰Ô˘ ∞. 204ª·Î¤‰Ô˘ ∫. 204ª·ÓÈ·‰¿ÎË ∫. 45ª·ÓÈfi˜ π. 433ª·ÓÈfi˜ ¡. 296ª·ÓÔ˘Ú¿ ∞. 85

∂˘ÚÂÙ‹ÚÈÔ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘ ∆fiÌÔ˘ 68


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ª·ÓÙ˙Ô˘Ú¿ÓË ∂. 128ª·ÓˆÏ¿ÎË ¡. 145ª·Ú¿ÎË ™. 120ª·ÛÙÚÔÁÈ¿ÓÓË ™. 352ª·Ù·ÊÈ¿ °. 140ª¿ÙÛ·˜ ¡. 395ª·‡ÚÔ˘ ∞. 53ªÂÚÌ›ÚË ¢. 18ªÂÛÛ·ÚÈÙ¿ÎË Õ. 69ªËÏÈÒÓË˜ Ã. π. 433ªËÙÛÈÒÓË ∞. 8ªÈÎÚ¿ÎË µ. 140ªÈ¯·ËÏ›‰Ô˘ ∂. 128ªÈ¯·Ï¤ÙÔ˘ ∂. 112ª›¯·˜ ∫. 342ªÈ¯ÂÏ·Î¿ÎË ∂. 150ªfiÓÙË ∫. 296ªfiÙÙË ∂. 398ªÔ˘Ï¿˜ ∞. 279ª¿Ï·˜ ∫. 103ª·ÌÈÓÈÒÙË˜ °. ¢. 325ª·ÓÙÔ˘Ú¿ÎË ª. 358ª·ÚÔ‡ÙË˜ °. 150ª·ÚÙÛfiÎ·˜ Ã. ™. 164ª¤ÛÈ·˜ ¡. 62ªfiÓÔ˘ ¶. 222ªÔ‡˙· ∂. 377

¡¡ÈÎÔÏ·˝‰Ô˘-∫·Ú·ı›Ô˘ ¶. 342¡ÙÂÏ›ÎÔ˘ ™. 289

••˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë ∞. 366

√√ÈÎÔÓfiÌÔ˘ ª. 409, 440

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396, 462¶·¿˙ÔÁÏÔ˘ ∫. 222¶··Ó‰Ú¤Ô˘ ¢. 399¶··Ó‰Ú¤Ô˘ √. 366¶·ÙÛ·Ï‹˜ º. ∫. 245¶·˘Ï›‰Ô˘ ∂. 112¶ÂÚÁ¿ÓÙÔ˘ ∂. 62¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË Ã. 199¶ÂÙÚ›‰Ô˘ ∂. 37, 226¶ÈÙÛÔ˘Ï¿ÎË˜ °. 133¶Ï·ÙÔÎÔ‡ÎË ∂. 62¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘ ∂. 308

¶ÏÈ¿ÎË ¶. 440¶ÔÏ˘‚›Ô˘ ¶. 446¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. 189¶ÔÓËÚfi˜ ¡. 366¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ Œ. 226¶Ô˘ÏfiÔ˘ÏÔ˜ ¶. 69¶Ú›ÊÙË˜ ∫. 18¶ÚÔ‰ÚfiÌÔ˘ º. 289¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ ∫. 62, 69

™™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘ ∞. 372™·Ï·‚Ô‡Ú· ∞. 53™·ÌÌÔ‡ÙË ∂. 133, 446™ÂÚ‚ÈÙ˙fiÁÏÔ˘ ª. 210™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. 279™ÈÛÌ¿ÓË ∫. 245™ÈÒÌÔ˘ ∞. 240, 268, 279™Î·Ú‰Ô‡ÙÛÔ˘ ∞. 180, 210™ÎÂÓÙ¤ÚË˜ ¡. 140™ÎÔÚ‰‹˜ ¡. 245+™Ì˘Ú¿ÎÈ˜ ™. 120™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË ∞. 337™Ô‡ÏÔ˘ µ. 199™˘Ú›‰Ë˜ ¶. 163™Ù·ıÔÔ‡ÏÔ˘ £. 450™Ù¿ÌÔ˘ ª. 74™Ù·˘Ú›‰Ë˜ °. 245™ÙÂÈ·Î¿ÎË ∂. 103™ÙÂÊ·Ó¿ÎË ™. 120™ÙÂÊ·Ó›‰Ë˜ ∫. 82, 240, 461™Ù¤ÊÔ˜ ∂. 210™ˆÙËÚ›‰Ô˘ ∂. 358

∆∆˙ËÙËÚ›‰Ô˘ ª. 112∆˙Ô‡ÊË ª. 279∆Ú·ÁÈ·ÓÓ›‰Ë˜ ∞. 74∆Û·ÁÚ‹˜ µ. 342∆ÛÈÏÈÌÈÁÎ¿ÎË ∞. 120∆Û›ÙÛÈÎ· Õ. 145∆ÛfiÏ·˜ °. 169∆ÛÔÏÈ¿ ª. 466∆ÛÔ˘Ì¿Î·˜ ∫. 217∆ÛÔ‡ÙÛÔ˘ ∞. 352

ººÏˆÚÂÓÙ›Ó-∞Ú¿Ú §. 372ºÚ˘Û›Ú· ∂. 53, 145

ÃÃ·ÏÈ¿ÛÔ˜ ¡. 279Ã·ÏÈÒÙË˜ º. 289Ã¿ÏÏ· Õ. 268, 279Ã·ÛÈÒÙÔ˘ ª. 133, 446Ã·Ù˙Ë·ı·Ó·Û›Ô˘ Ã. °. 245Ã·Ù˙Ë·Ó·Á‹˜ ∞. 461Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ Ã. 358, 386Ã·Ù˙ÔÔ‡ÏÔ˘ µ. 140ÃÔÏ¤‚·˜ µ. 279ÃÚÔ‡ÛÔ˜ °. 366


475∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡

¶·È‰È·ÙÚÈÎ‹ 2005;68:475-476

AZF 245Campylobacter jejuni 128Corona Èfi˜ 199DGS/VCFS 53FISH 53IgA ÓÂÊÚÔ¿ıÂÈ· 8Listeria monocytogenes 289PAR2 245SARS 199

∞∞ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎ¿ ÂÂÈÛfi‰È· 329∞‰ÂÓÔ˚fi˜ 69∞ıËÚÔÛÎÏ‹ÚˆÛË 204∞ıËÚˆÌ¿ÙˆÛË 169∞ÈÌ·ÁÁÂ›ˆÌ· 145∞ÈÌÔÚÚ·ÁÈÎ¤˜ ‰È·ı¤ÛÂÈ˜ 308∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ 155, 454∞ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ 358∞ÏÏÔ·ÓÔÛÔÔ›ËÛË 440∞Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· 150∞ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ 337∞ÓÔÛÔÂÓÂÚÁfi˜ ıÚ˘„›ÓË 386∞ÓÔÛÔÎ·Ù·ÛÙÔÏ‹ 289∞ÓÙ›‰Ú·ÛË Coombs 440∞ÓÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ· 189∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· 446∞ÂÈÎfiÓÈÛË 133ÕÛıÌ· 399ÕÛÎËÛË 454∞ÛÂÚÁ›ÏÏˆÛË ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ 74∞ÙÏ·ÓÙÔ·ÍÔÓÈÎ‹ ·ÛÙ¿ıÂÈ· 358∞ÙÏ·ÓÙÔ·ÍÔÓÈÎfi ÂÍ¿ÚıÚËÌ· 358∞ÙÏ·ÓÙÔ·ÍÔÓÈÎfi ˘ÂÍ¿ÚıÚËÌ· 358∞Ù‡¯ËÌ· 37∞‡ÍËÛË 268∞˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· 440

µµÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙÂ˜ 268, 279µÏ·ÈÛfi˜ Ì¤Á·˜ ‰¿¯Ù˘ÏÔ˜ Ô‰ÈÔ‡ 217µÏ·Ù›‰Â˜ 366‚-ªÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· 440µÚÂÊÈÎ‹ ·ÏÏ·ÓÙ›·ÛË 222µÚÂÊÈÎ‹ ËÏÈÎ›· 128

°°ÓˆÛÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ 112°ÔÓÂ˚Î‹ Û˘ÌÂÚÈÊÔÚ¿ 37°ÔÓÈÎ¤˜ ·ÓÙÈÏ‹„ÂÈ˜ 45

¢¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ 433¢ÂÛÊÂÚÚÈÔÍ·Ì›ÓË 409¢›·ÈÙ· 399¢È·ÙÚÔÊ‹ 1, 399, 433¢È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË 417¢ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÙÔ˘ stress 329¢ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ 329

¢˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÚÙËÚÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ 169¢‡ÛÓÔÈ· 189

∂∂ÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· 289∂ÁÎ¤Ê·ÏÔ˜ 377ŒÎÙÔË ÔÛÙÂÔÔ›ËÛË 217ŒÏÂÁ¯Ô˜ 155∂ÏÂ‡ıÂÚÔ˜ ¯ÚfiÓÔ˜ 433ŒÏÏÂÈÌÌ· 22q11.2 53∂ÏÏËÓÈÎ‹ ÏÔÁÔÙÂ¯Ó›· 226∂ÏÏÈÔ‚·Ú¤˜ 1∂Ì‚fiÏÈ· 120 ∂Ì‚Ú˘˚Î‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹ 417ŒÌ‚Ú˘Ô 417∂Ì‡ËÌ· 18∂Ó‰Ôı‹ÏÈÔ 329∂Ó‰ÔÊÏ¤‚È· Á-ÛÊ·ÈÚ›ÓË 352∂Ó‰ÔÊÏ¤‚ÈÂ˜ ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ 180∂ÍÂÙ¿ÛÂÈ˜ DNA 386∂Â›ÁÔ˘Û· È·ÙÚÈÎ‹ 29∂È‰ËÌÈÔÏÔÁ›· 120∂ÈÏË„›· 93, 112, 257, 308 ∂ÙÈ‰ÚÔÓ¿ÙË 217∂ÊË‚Â›· 308

∏∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· 93◊·Ú 446

££¤Ì·Ù· ËıÈÎ‹˜ 386£ÂÚ·Â›· 199, 342£ÂÚ·Â›· ÌÂ ÛÙÂÚÔÂÈ‰‹ 180

ππÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ˜ 308πÓÔÌ˘·ÏÁ›· 342πÓÙÂÚÊÂÚfiÓË-· 145πÓˆÌ¿ÙˆÛË 366ÿÚÈ‰· 296

∫∫·Ú‰È·Î¤˜ ‚Ï¿‚Â˜ 425∫·Ú‰ÈÔÏÔÁÈÎfi Úfi‚ÏËÌ· 155∫·Ú‰ÈÔÏÔÁÈÎÔ› Î›Ó‰˘ÓÔÈ 301∫·ÙÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ· 189∫ÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ 53∫ÔÏfi‚ˆÌ· 296∫ÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ 279, 377∫Ú‹ÙË 120∫˘ÎÏÔÛÔÚ›ÓË 289∫‡ÛÙÂÈ˜ ¯ÔÏË‰fi¯Ô˘ 140∫˘ÛÙÈÎ‹ ›ÓˆÛË 386

§§È›‰È· 204§Ô›ÌˆÍË 85§Ô›ÌˆÍË ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ 289

∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍÂˆÓ-ÎÏÂÈ‰ÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 68


476 ∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡

¶·È‰È·ÙÚÈÎ‹ 2005;68:475-476

ªª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· 358ª·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ 112ªÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ· 446ªÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· 409ªÂÙ·ÏÔÈÌÒ‰Ë˜ Ì˘ÂÏ›ÙÈ˜ 180ªËÎˆÓÈ·Î‹ „Â˘‰ÔÎ‡ÛÙË 450ªËÓÈÁÁ›ÙÈ‰· 120ªËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ 120ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ 222, 352, 417ª˘˚Î‹ ‰˘ÛÙÚÔÊ›· Duchenne 386ª˘ÔÛÎÂÏÂÙÈÎfi˜ 342

¡¡ÂÔÁÓÈÎ‹ ËÏÈÎ›· 85¡ÂÔÁÓfi 150, 377¡ÂÔÏ¿ÛÌ·Ù· 189¡Â˘ÚÔÙÔÍÈÎfiÙËÙ· 409¡Â˘ÚÔÊ˘ÛÈÔÏÔÁ›· 409¡Â˘ÚÔ„˘¯ÔÏÔÁ›· 409¡ÔËÙÈÎfi ËÏ›ÎÔ 409¡ÔÛ‹Ì·Ù· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ 259¡fiÛÔ˜ Berger 8¡fiÛÔ˜ Caroli 140¡fiÛÔ˜ Crohn 128

√√¢∂ª 69√˙›‰È· 366√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi 204√ÈÎÔÁÂÓ‹˜ ÂÌÊ¿ÓÈÛË 372√ÈÎÔÁÂÓ‹˜ ˘Ô¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· 169√ÍÂ›· ‰È¿¯˘ÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›ÙÈ‰· 69√ÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· 74, 103√ÍÂ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË 180√ÍÎ·Ú‚·˙Â›ÓË 112√Í˘ÁfiÓˆÛË 417√ÛÙÈÎfi˜ ·Ó·Û¯ËÌ·ÙÈÛÌfi˜ 268√Êı·ÏÌÈÎ¤˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ 296√Êı·ÏÌÔÏÔÁÈÎ¤˜ ·ı‹ÛÂÈ˜ 145

¶¶·È‰È¿ 8, 69, 93, 133, 155,

199, 204, 210, 268,279, 342, 425, 446

¶·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ 37¶·È‰È·ÙÚÈÎ‹ 29¶·È‰È·ÙÚÈÎ‹ Ú¿ÍË 301¶·È‰ÈÎ¿ ·Ù˘¯‹Ì·Ù· 226¶·È‰ÈÎ‹ ‰È·ÙÚÔÊ‹ 45 ¶·È‰ÈÎ‹ ËÏÈÎ›· 62, 74, 103, 189, 226, 399¶·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· 45¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ 204, 433¶·Ú·ÓÂ˘ÌÔÓÈÎ‹ Û˘ÏÏÔÁ‹ 18¶·ÚÔ¯¤ÙÂ˘ÛË 18¶·¯˘Û·ÚÎ›· 433¶ÂÚÈÊ¤ÚÂÈ· Ì¤ÛË˜ 433

¶Ï·ÛÌ·Ê·›ÚÂÛË 180¶ÓÂ˘ÌÔÓ›· 18, 425¶ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË 145¶ÓÂ˘ÌÔÓÔ¿ıÂÈ· 217¶fiÓÔ˜ 342¶ÚÂ‰ÓÈ˙ÔÏfiÓË 289¶ÚÔ·ıÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ 454¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË 372¶ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ 62¶ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ 409¶ÚfiÏË„Ë 155¶ÚfiˆÚÔ ÓÂÔÁÓfi 1¶ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰· 29¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ› 210¶˘ÚÂÙfi˜ ¿ÁÓˆÛÙË˜ ·ÈÙÈÔÏÔÁ›·˜ 128

™™·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ 308™Ë„·ÈÌ›· 85™ÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ 217™Ô‚·Úfi ÔÍ‡ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ 199™Ù·Ù›ÓÂ˜ 169™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ 169™˘ÁÁÂÓ‹˜ Ë·ÙÈÎ‹ ›ÓˆÛË 140™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÂÈÓÂÊÚÈ‰›ˆÓ 150™˘ÌÙÒÌ·Ù· 199™‡Ó‰ÚÔÌÔ Dandy-Walker 145™‡Ó‰ÚÔÌÔ Down 358™‡Ó‰ÚÔÌÔ Guillain-Barré 180, 352™‡Ó‰ÚÔÌÔ ÂÈÛÚfiÊËÛË˜ ÌËÎˆÓ›Ô˘ 450™‡Ó‰ÚÔÌÔ ÂÏÏÂ›ÌÌ·ÙÔ˜ 22q11 372™˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ 399

∆∆·¯‡ÙËÙÂ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓ 409∆Â¯ÓÈÎ‹ FISH 372∆ËÏÂfiÚ·ÛË 257, 433∆ËÏÂÊˆÓÈÎ¿ Î¤ÓÙÚ· 29∆ËÏÂÊˆÓÈÎ‹ È·ÙÚÈÎ‹ 29∆Ú·¯ËÏÈÎ¿ ÙÂÚ·ÙÒÌ·Ù· 133∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù· 226

ÀÀ ¯ÚˆÌfiÛˆÌ· 245ÀÔÙÚÔ‹ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ 210

ºº·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜ 337º·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÏÏÂÚÁ›· 337º·ÛÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË 103ºÏÂ‚ÈÎ‹ ıÚfiÌ‚ˆÛË 62º˘ÏÂÙÈÎfi˜ ÌˆÛ·˚ÎÈÛÌfi˜ 245ºˆÙÔÂ˘·ÈÛıËÛ›· 257

ÃÃËÌÂÈÔÎ›ÓÂ˜ 85ÃÔÏÒ‰ÂÈ˜ ¤ÌÂÙÔÈ 450


xxiii¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

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]

4 ºÂ‚ÚÔ˘·Ú›Ô˘ - ¶ÚfiÁÚ·ÌÌ· ∫·Ù¿ÚÙÈÛË˜ ∂·ÁÁÂÏÌ·ÙÈÒÓ ÀÁÂ›·˜ ∞ı‹Ó· 17 ™ÂÙÂÌ‚Ú›Ô˘ 2006 ÛÙËÓ ∞Ó·ÎÔ˘ÊÈÛÙÈÎ‹ ºÚÔÓÙ›‰· ¶·È‰ÈÒÓ

ÌÂ ∞ÂÈÏËÙÈÎ‹ ∞ÚÚÒÛÙÈ· ¶ÏËÚÔÊÔÚ›Â˜: ª∂ƒπª¡∞ ∂Ù·ÈÚÂ›· ÁÈ· ÙË ºÚÔÓÙ›‰· ¶·È‰ÈÒÓ Î·È √ÈÎÔÁÂÓÂÈÒÓ ÛÙËÓ ∞ÚÚÒÛÙÈ· Î·È ÛÙÔ £¿Ó·ÙÔ, Î. µ¿Ó· ∑¿¯Ô˘ ∆ËÏ.: +30 210 6452013Fax: +30 210 6463367∂-mail: [email protected] Website: www.merimna.org.gr

7-9 ºÂ‚ÚÔ˘·Ú›Ô˘ 2006 8th UAE International Congress for Pediatrics Dubai, Al Habtoor Grand Resort and SPA, Dubai, United Arab United Arab Emirates Emirates¶ÏËÚÔÊÔÚ›Â˜: Infomed Events, Sheikh Rached Building, Al Mamzar, next to the Labor Office / Ministry of Labor, Deira, Dubai - UAE∆ËÏ.: +971 4 2689040Fax: +971 4 2689030E-mail: [email protected]: www.infomedweb.com/ourevents/uaeiac2005.htm

18-19 ª·ÚÙ›Ô˘ 2006 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂÈ‰ÈÎÔÙ‹ÙˆÓ ∞ı‹Ó· ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜•ÂÓÔ‰Ô¯Â›Ô Divani Caravel ¶ÏËÚÔÊÔÚ›Â˜: C&C International, Conventions and Congresses ∆ËÏ.: (+30) 210 6889 100 Fax: (+30) 210 6844 777 E-mail: [email protected] Website: www.ped-subspec2006.gr

7-9 ∞ÚÈÏ›Ô˘ 2006 1Ô ¶·ÓÂÏÏ‹ÓÈÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó· •ÂÓÔ‰Ô¯Â›Ô Ledra Marriott ¶ÏËÚÔÊÔÚ›Â˜: Triaena Tours ∆ËÏ.: (+30) 210 7499 300 Fax: (+30) 210 7705 752 E-mail: [email protected]

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

7-10 √ÎÙˆ‚Ú›Ô˘ 2006 European Academy of Paediatrics – CESP 2006 Barcelona, Centre Convencions Internacional Barcelona Spain¶ÏËÚÔÊÔÚ›Â˜: Kenes International / Europaediatrics 2006 17 Rue du CendrierPO Box 1726, CH-1211Geneva 1, SwitzerlandTel: +41 22 908 0488Fax: +41 22 732 2850E-mail: [email protected]: www.kenes.com/europaediatrics


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