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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA
HELLENIC PAEDIATRIC SOCIETY
¶AI¢IATPIKH
PAEDIATRIKI
TfiÌÔ˜ 63, T‡¯Ô˜ 1Ô π·Ó.-ºÂ‚Ú. 2000
Volume 63, No. 1, Jan.-Feb. 2000
¶EPIEÃOMENA
CONTENTS ™ÂÏ.
AP£PA ™YNTA•H™
H ·ÔÊ˘Á‹ Ù˘ ÚfiÎÏËÛ˘ fiÓÔ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ì·˜ Ú·ÎÙÈ΋
Page
EDITORIALS
Managing children's pain F. Athanassiadou-Piperopoulou
º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘
1
1
™ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Ì ‚·ı˘Ù¿ÙË ÂÎÙ›ÌËÛË! E. B·Ï¿ÛÛË- A‰¿Ì
To the reviewers of the journal, with deep appreciation! E. Valassi-Adam
2
2
H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ˆ˜ ̤ÛÔ ‰È¿ÁÓˆÛ˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ Ó¢ÌÔÓ›·˜ ÙˆÓ ·È‰ÈÒÓ ¶. NÈÎÔÏ·˝‰Ô˘
Chest radiographs in the diagnosis and follow-up of pneumonia in children 6
P. Nikolaidou
6
REVIEW ARTICLE
A¡∞™∫O¶∏™∏
Granulomatous hepatitis
KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ· ¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘
9
D. Alexiou, O. Grafakou
9
ARTICLE OF SPECIAL INTEREST
Aƒ£ƒO ∂π¢π∫OÀ ∂¡¢π∞º∂ƒO¡∆O™
The treatment of pain in children with sickle cell disease
H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË
17
M. Athanasiou-Metaxa, A. Koussi
17
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™
ORIGINAL PAPERS
™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Ê·ÈÓfiÙ˘Ô Û ·È‰ÈÎfi ÏËı˘ÛÌfi
Gilbert’s syndrome: Genotype analysis and correlation with phenotype in children
A. TÛ¤˙Ô˘, M. T˙¤ÙË, ™. K›ÙÛÈÔ˘, A. °·ÏÏ¿, E. K·‚·˙·Ú¿Î˘, A. X·Ù˙ˉËÌԇϷ, E. ¶·ÙÂÚ¿ÎË, A. ¢Ú·Î¿ÙÔ˜, E. K·Ó·‚¿Î˘, £.K·Ú¿ıÈÔ˜
A. Tsesou, M. Tzeti, S. Kitsiou, A. Galla, E. Kavasarakis, A. Hatzidimoula, E. Pateraki, A. Drakatos, E. Kanavakis, T. Karpathios
21
Comparison of sensitisation to aeroallergens in British and Greek school children aged 5 to 7.5 years
™‡ÁÎÚÈÛË Â˘·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ Ù˘ EÏÏ¿‰·˜ Î·È Ù˘ AÁÁÏ›·˜ ËÏÈΛ·˜ 5-7,5 ¯ÚfiÓˆÓ ™. TÛ›ÙÔ˘Ú·, K. NÂÛÙÔÚ›‰Ô˘, N. ¶··‰ÔÔ‡ÏÔ˘, ¶. MfiÙ˘, H. Arshad, T. Dean, S. Matthews, B. Mealy
27
34
™˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ ·È‰È΋ ËÏÈΛ· E. PÔËÏ›‰Ë˜, X. M·ÓÙÈÔ‡-°ÎÚ¿Ù˙ÈÔ˘, £. ¶··ÛÙ·‡ÚÔ˘, X. ¶·ÓÙÂÏÈ¿‰Ë˜, M. Aı·Ó·Û›Ô˘, B. K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó·
27
C. Costalos, A. Tsakiris, A. Constandinidou, M. Daniilidou, A. Gounaris
34
Systemic manifestations of Coxsackie B virus infections in childhood 38
∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™
E. Roilides, C. Mantiou-Gratziou, T. Papastavrou, C. Panteliadis, M. Athanasiou, V. Kyriazopoulou-Dalaina
38
CASE REPORTS
ŒÌÊÚ·ÎÙÔ Ì¤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·fi Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ B. º·Ï·˝Ó·, B. ¶··Â˘·ÁÁ¤ÏÔ˘, B. ™˘ÚÈÔÔ‡ÏÔ˘, M. £ÂÔ‰ˆÚ›‰Ô˘
S. Tsitoura, K. Nestoridou, N. Papadopoulou, P.Botis, H. Arshad, T.Dean, S. Matthews, B. Mealy
Blood and urine anion gap in newborn infants
X¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜/ Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿ X KÒÛÙ·ÏÔ˜, A T۷ΛÚ˘, A KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M ¢·ÓÈËÏ›‰Ô˘, A °Ô‡Ó·Ú˘
21
Occlusion of the middle cerebral artery and Bell's palsy associated with Mycoplasma pneumoniae infection 43
V. Falaina, V. Papaevangelou, V. Syriopoulou, M. Theodoridou
43
Continued
™˘Ó¯›˙ÔÓÙ·È
iii
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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA
HELLENIC PAEDIATRIC SOCIETY
¶AI¢IATPIKH
PAEDIATRIKI
TfiÌÔ˜ 63, T‡¯Ô˜ 1Ô π·Ó.-ºÂ‚Ú. 2000
Volume 63, No. 1, Jan.-Feb. 2000
OÍ›· ·ÁÎÚ·ٛÙȉ· Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. £Âڷ›· Ì octreotide
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A. HÏ›·˜, K. ™ÙÂÊ·Ó›‰Ë˜, A. MËÙÛÈÒÓË, ¢. ™È·¤Ú·, A. ¶··‰ÔÔ‡ÏÔ˘, K. Mȯ¤Ï˘
48
¶Ó¢ÌÔÓÈ΋ Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Î·È M. avium Û ·ÈÌÔÚÚÔÊÈÏÈÎfi ·ÛıÂÓ‹ Ì AIDS ¢. M¿ÓÙ˙ÈÔ˘, °. MÔÛÙÚÔ‡, B. ¶··Â˘·ÁÁ¤ÏÔ˘, E. ¶Ï·ÙÔÎÔ‡ÎË, A. BÂÏÂÁÚ¿ÎË, M. £ÂÔ‰ˆÚ›‰Ô˘
Octreotide treatment of acute pancreatitis in a child with end stage renal disease A. Elias, C. Stefanidis, A. Mitsioni, D. Siapera, A. Papadopoulou, K. Michelis
Page
48
Concurrent pulmonary infection with Aspergillus fumigatus and Mycobacterium avium in an HIVinfected hemophiliac patient 50
D. Mantziou, G. Mostrou, V. Papaevangelou, E. Platokouki, A. Velegraki, M. Theodoridou
50
™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Û ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
Congenital lobar emphysema in an adolescent. Case report
I. K·Ï¤ÁÈ·˜, M. TÛÔÏÈ¿, K. ¶··ÁˆÚÁ›Ô˘, £. ¢fiÛÈÔ˜, E. K·‚·˙·Ú¿Î˘
I. Kaleyias, M. Tsolia, K. Papageorgiou, T. Dosios, E. Kavasarakis
55
A¶EIKONI™TIKH ¶EPI¶Tø™H
¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ÈÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans £. ¶··ÁˆÚÁ›Ô˘, º. Aı·Ó·ÛÈ¿‰Ô˘, A. X·ÚÈÙ¿ÓÙË, ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡, ¢. K·ÙÚÈÔ‡
60
¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY ™TOY™ °ONEI™
TÔ ÂÓ‰ÔÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡ K. ¶Ú›ÊÙ˘
RADIOLOGICAL CASE OF THE ISSUE
Case report of a child with Langerhans cell histiocytosis T. Papageorgiou, F. Athanasiadou, A. Haritandi, M. Hatzistilianou, D. Katriou
60
PAEDIATRICIANS’ PRACTICAL ADVICE TO PARENTS K. Priftis
63
63
LETTERS
∂¶π™∆O§∂™ ∞ÁˆÁ‹ ÀÁ›·˜ ™. ¡¿ÎÔ˘
55
64
S. ¡akou
64
65
S. Andronikou
65
¶ÔÈfi˜ ‰ÈηÈÔ‡Ù·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ Û˘ÁÁڷʤ·; ™. AÓ‰ÚÔÓ›ÎÔ˘
PAEDIATRIC NEWS
¶∞π¢π∞∆ƒπ∫H ENHMEPø™H ¶∞π¢π∞∆ƒπ∫∏ - AÔÏÔÁÈÛÌfi˜ 1999 ∂. µ·Ï¿ÛÛË - ∞‰¿Ì
66 68
Paediatriki - Report 1999 E. Valassi-Adam
∫ÚÈÙ¤˜ 1999 EÈÛÎfiËÛË ∂ÏÏËÓÈÎÔ‡ π·ÙÚÈÎÔ‡ ¶ÂÚÈÔ‰ÈÎÔ‡ ∆‡Ô˘ 1999 69 ÁÈ· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡
Reviewers 1999 68 Scanning of the Greek Medical Peers for articles in child health 69
πƒπ™-Online: µ¿ÛË ÂÏÏËÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ http://www.ich.gr
IRIS- Online: Greek bibliography on child health http://www.ich.gr
¶. ∞. ∫ÔÎÎÈÓ›‰Ë˜
71
∞Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ηÚΛÓÔ ∞Ú¯¤˜ Ù˘ ¶OÀ
75
µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË ™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ·È‰› Ô˘ ıÚËÓ› ÙÔ ı¿Ó·ÙÔ ·Á·Ë̤ÓÔ˘ ÙÔ˘ ÚÔÛÒÔ˘ ™. ∆Û›ÙÔ˘Ú·
¢. ∫·ÙÚÈÔ‡, º. ∞ı·Ó·ÛÈ¿‰Ô˘, Ã. ∞ÁÁÔ˘Úȉ¿ÎË, £. ¶··ÁÚˆÚÁ›Ô˘, µ. ∆Û·‚‰·Ú›‰Ô˘, ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ 80
iv
Pain relief in children with cancer WHO
75
Book review
77
∂·Ó·‰ËÌÔÛ›Â˘ÛË ∂›Â‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ sICAM-1, sVCAM-1 Û ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ
¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ· ™˘ÓÙÔÌÔÁڷʛ˜
71
Republication Levels of the soluble adhesion molecules sICAM-1 and sVCAM-1 in children with systemic lupus erythematosus D. Catriou, F. Athanasiadou, C. Aggouridaki, T. Papageorgiou, V. Tsabdaridou, M. Hatzistilianou 80
Forthcoming meetings Abbreviations
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·9
O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ H ¶AI¢IATPIKH Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ (E ¶ E ). Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ·) ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ‚) ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ηıÒ˜ Î·È Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Á) ÙË ‰È¢ÎfiÏ˘ÓÛË Ù˘ ‰È·Î›ÓËÛ˘ ÙˆÓ È‰ÂÒÓ Î·È Ù˘ ·Ó¿Ù˘Í˘ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Â‰›Ô Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ‰) ÙËÓ ÚfiÔ‰Ô Ù˘ ÂÏÏËÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ ̤ۈ Ù˘ ÎÚÈÙÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÎÂÈÌ¤ÓˆÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË Â) ÙËÓ ÂÓı¿ÚÚ˘ÓÛË Î·È Î·ÏÏȤÚÁÂÈ· Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ· °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ,›ηÈÚ· ı¤Ì·Ù·, ¿ÚıÚ· ÂȉÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜, ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜, ÎÏÈÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ, Ú·ÎÙÈο ı¤Ì·Ù·, ÁÂÓÈο ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘ Î·È ˘Á›·˜, Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÔ‡ ÙÚ·Â˙ÈÔ‡, ÎÏÈÓÈÎÔ·ıÔÏÔÁÈΤ˜ Û˘˙ËÙ‹ÛÂȘ, ÛÂÌÈÓ¿ÚÈ·, Û˘ÌfiÛÈ·, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ¿ÚıÚ· Û˘Ó¯È˙fiÌÂÓ˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙËÌÔÓÈ΋ ÂȉËÛÂÔÁÚ·Ê›· fiˆ˜ ÂÓË̤ڈÛË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Û˘Ó‰ڛˆÓ, Û˘ÌÔÛ›ˆÓ Î·È ÁÈ· ‰Ú·ÛÙËÚÈfiÙËÙ˜ Û¯ÂÙÈΤ˜ Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡. OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi ¶AI¢IATPIKH ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 11528 Aı‹Ó· H ¶AI¢IATPIKH ·ÎÔÏÔ˘ı› ÙȘ KÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· XÂÈÚfiÁÚ·Ê· Ô˘ YÔ‚¿ÏÏÔÓÙ·È Û BÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο Ô˘ ‰È·ÌÔÚÊÒıËÎ·Ó ·fi ÙËÓ ICMJE (International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals. N Eng J Med 1997;337:309315,http://jama.ama-assn.org/info/auinst-req.htlm) ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ô˘ Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›·: ·) ÂÚÈÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈο Ë Û˘Ì‚ÔÏ‹ ÂοÛÙÔ˘ ÙˆÓ Û˘ÁÁڷʤˆÓ (ۯ‰ȷÛÌfi˜, ·Ó¿Ï˘ÛË, ÂÚÌËÓ›· ¢ÚËÌ¿ÙˆÓ,Û˘ÏÏÔÁ‹ ‰Â‰Ô̤ӈÓ, Û˘ÁÁÚ·Ê‹ ÂÚÁ·Û›·˜, ·Ó·ÌfiÚʈÛË ÎÂÈ̤ÓÔ˘), ‚) ‰ËÏÒÓÂÙ·È fiÙÈ fiÏÔÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó Î·È ÌÔÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙÔ ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË Î›ÌÂÓÔ ‹ ÙÌ‹Ì· ÙÔ˘, Á) ‰ËÏÒÓÂÙ·È Ë ÚԤϢÛË Ù˘ ¯ÚËÌ·ÙÔ‰fiÙËÛ˘ ÁÈ· ÙË
Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›· (£· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÚÁ·Û›·˜), ‰) ‰ËÏÒÓÂÙ·È ·Ó ÔÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó οÔÈ· ÔÈÎÔÓÔÌÈ΋ Û¯¤ÛË Ì ÂÙ·ÈÚ›· ‹ ÔÚÁ·ÓÈÛÌfi Ô˘ ¤¯ÂÈ ÔÈÎÔÓÔÌÈÎfi ÂӉȷʤÚÔÓ ÁÈ· Ù· Â˘Ú‹Ì·Ù· ‹ ÙȘ ·fi„ÂȘ ÙÔ˘ Û˘ÁÁڷʤ· (·˘Ùfi ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÓÙ·ÎÙÒÓ ·ÏÏ¿ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÁÓˆÛÙfi ÛÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜), Â) ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢Ù› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ EÏÏËÓÈÎfi ÂÚÈÔ‰ÈÎfi. H ¶AI¢IATPIKH ÂÓı·ÚÚ‡ÓÂÈ ÙËÓ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‹‰Ë ‰ËÌÔÛÈ¢Ù› ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ Û ÍÂÓfiÁψÛÛ· ÂÚÈÔ‰Èο Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ Û˘Ó˘Ô‚¿ÏÏÔ˘Ó ÊˆÙÔ·ÓÙ›ÁÚ·ÊÔ Ù˘ ÍÂÓfiÁψÛÛ˘ ‰ËÌÔÛ›Â˘Û˘ Î·È ÙËÓ ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ ÙÔ˘ ÍÂÓfiÁψÛÛÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¶AI¢IATPIKH Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ¢È¢ı˘ÓÙ‹ Ù˘ E.™.E. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó Û‡Ìʈӷ Ì ÙË ‰È·Î‹Ú˘ÍË ÙÔ˘ EÏÛ›ÓÎÈ ÙÔ˘ 1975 fiˆ˜ ·Ó·ıˆڋıËΠÙÔ 1983, Î·È Û‡Ìʈӷ Ì ÙË ™‡Ì‚·ÛË ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙËÓ ¶AI¢IATPIKH ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο, ÛËÌÂ›Ô ÚÔ˜ ÛËÌ›Ô, ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. T· ¤ÍÔ‰· ÙˆÓ ÊÈÏ̘ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.
vii
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·10
™‡ÓÙ·ÍË ÙˆÓ ÂÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (22X28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢ڤ˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘. H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 Î·È ÁÈ· Ù· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) Î·È ÙÔ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë ÙˆÓ ÂÚ¢ÓËÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË. N· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ·) ÙÔ˘˜ ÛÙfi¯Ô˘˜, ‚) ÙË ÌÂıÔ‰ÔÏÔÁ›·, Á) Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È ‰) Û¯fiÏÈ· ‹ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi. ¶ÂÚ›ÏË„Ë ‰ÂÓ ¤¯Ô˘Ó ÔÈ Ô‰ËÁ›Â˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë. K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ. K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ˘ÏÈÎfi Î·È ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘
viii
¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙÔ˘ ˘ÏÈÎÔ‡ Î·È ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional - ™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA ÙÔ˘ 1986 (255:23292339). ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ. BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. H ·Ó·ÊÔÚ¿ ÂÏÏËÓÈÎÒÓ ‰ËÌÔÛȇÛÂˆÓ ıˆÚÂ›Ù·È ··Ú·›ÙËÙË. H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ National Library of Medicine (H¶A) Î·È Ù˘ International Committee of Medical Journal Editors (N Eng J Med 1997;337:309315,http://jama.ama-assn.org/info/auinst-req.htlm). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Index Medicus (List of Journals Indexed in Index Medicus http://www.nlm.nih.gov).
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¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”. T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ™ÙÂÊ·Ó›‰Ë˜ A, KÔÚÈÙÛÈ¿‰Ë˜ ™, Mȯ·‹Ï B, AÓ‰ÚÔ˘Ï·Î¿Î˘ ºA. O˘ÚÔ‰˘Ó·ÌÈο Â˘Ú‹Ì·Ù· Û ·ÛıÂÓ›˜ Ì ·ÏȤ˜ ‚·Ï‚›‰Â˜ Ù˘ ÔÈÛı›·˜ Ô˘Ú‹ıÚ·˜. AÚ¯ EÏÏ I·ÙÚ 1988;15:448-455. Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with an increased risk for pancreatobiliary disease. Ann Intern Med 1996;124:980-983. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Llach F. Parathyroidectomy in chronic renal failure: Indications, surgical approach and the use of calcitriol. Kidney Int 1990; 38 (29 suppl):S62-S68. XˆÚ›˜ Û˘ÁÁڷʤ·: Coffee drinking and cancer of the pancreas [editorial]. BMJ 1981;283:628. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: §ÂΤ· B, M·ÎԇϷ X, M·ÙÛ·ÓÈÒÙ˘ N. ¢È·ÓÔÛÔÎÔÌÂȷΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·. TÈ ˘Ô‰ÂÈÎÓ‡Ô˘Ó; ¶ÂÚÈÏ. 78, 26Ô ¶·ÓÂÏ. ¶·È‰. ™˘Ó. Iˆ¿ÓÓÈÓ· 28-29 M·˚Ô˘ 1988. Spargo PM, Manners JM. DDAVP and open heart surgery [letter]. Anaesthesia 1989;44:363-364. II. BÈ‚Ï›· KÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Schuster V. Renal clearance. In: Seldin DW, Giebich G, eds. The kidney: physiology and pathophysiology. 2nd ed. New York: Raven Press, 1992:943-978. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: M·Ú¿ÙÔ˘-AÏÈÚ¿ÓÙË §. OÈÎÔÁ¤ÓÂÈ· ÛÙËÓ Aı‹Ó·: OÈÎÔÁÂÓÂȷο ÚfiÙ˘· Î·È Û˘˙˘ÁÈΤ˜ Ú·ÎÙÈΤ˜. Aı‹Ó·: EıÓÈÎfi K¤ÓÙÚÔ KÔÈÓˆÓÈÎÒÓ EÚ¢ÓÒÓ 1995. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 2931; New York: International Society of Chemotherapy, 1963:484-500.
¶›Ó·Î˜ Î·È ÂÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜ ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™˘ÛÙ‹ÓÂÙ·È ÛÙ· Û¯‹Ì·Ù· Ó· ·ÔʇÁÔÓÙ·È ÔÈ ÛÎÈ¿ÛÂȘ ÛÙÔ ÊfiÓÙÔ Î·È ÙÔ Î›ÌÂÓÔ Ì¤Û· ÛÙËÓ ÂÈÎfiÓ·. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο. ¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ - ‰‹ÏˆÛË fiÙÈ ‰ÂÓ ¤¯ÂÈ ˘Ô‚ÏËı› Û˘Á¯ÚfiÓˆ˜ Û ¿ÏÏÔ EÏÏËÓÈÎfi ÂÚÈÔ‰ÈÎfi Î·È ‰ÂÓ ¤¯ÂÈ ‹‰Ë ‰ËÌÔÛÈ¢Ù›. - ·Ó¿Ù˘Ô Î·È ÂÈÛÙÔÏ‹ ¤ÁÎÚÈÛ˘ ÙÔ˘ ‰È¢ı˘ÓÙ‹ Û‡ÓÙ·Í˘ Û ÂÚ›ÙˆÛË Ô˘ ¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› Û ÍÂÓfiÁψÛÛÔ ÂÚÈÔ‰ÈÎfi - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ - fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: MÂÓ¤ÙÔ˘-M·Ú·ÓÙ›‰Ô˘ A. XÚËÛÈÌÔÔ›ËÛË ÔÏÏ·ÏÒÓ ÂȉÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÌÔÏ˘‚‰È¿Ûˆ˜ ÛÙÔ K.N.™. ·È‰ÈÒÓ (¢È‰·ÎÙ. ¢È·ÙÚ.). Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ 1988.
ix ÕÚıÚ· Û ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹: Morse SS. Factors in the emergence of infectious diseases.Emerg Infect Dis [serial online]1995 JanMar[cited 1996 June 5];1(1):[24 screens].Available from :URL: http://www.cdc.gov/ncidod/EID/eid.htm
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H ·ÔÊ˘Á‹ Ù˘ ÚfiÎÏËÛ˘ fiÓÔ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ì·˜ Ú·ÎÙÈ΋ º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘
F. Athanassiadou - Piperopoulou. Managing children's pain. Paediatriki 2000;63:1-2 000000000
basic human right and everyday paediatric practice offers many opportunities for reducing or preventing pain and the anxiety with which it is associated.
● Abstract: Many childhood illnesses and paediatric procedures are accompanied by pain. There has been a tendency for paediatricians to ignore or minimize this aspect of child care. Pain relief is a
∫ey words: pain, chronic illness, painful episodes, children.
M ·ÊÔÚÌ‹ ÙË ‰ËÌÔÛ›Â˘ÛË Û ·˘Ùfi ÙÔ Ù‡¯Ô˜ ÙÔ˘ ¿ÚıÚÔ˘ "H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ" ÙˆÓ M. Aı·Ó·Û›Ô˘ Î·È A. KÔ‡ÛË (1), ηıÒ˜ ›Û˘ Î·È ÙȘ Ô‰ËÁ›Â˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ YÁ›·˜ (WHO), ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ηÚΛÓÔ, Ô˘ ÂÈÌÂÏ‹ıËÎÂ Ë ™. TÛ›ÙÔ˘Ú· (2), ı· ‹ıÂÏ· ·fi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ·È‰È¿ÙÚÔ˘ Ó· ˘ÂÚıÂÌ·Ù›Ûˆ ÙËÓ Ú·ÎÙÈ΋ ÙÔ˘ "ÌË fiÓÔ˘", fi¯È ÌfiÓÔ ÁÈ· ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ·ı‹ÛÂȘ, ·ÏÏ¿ Î·È ÁÈ· fiÏ· ÂΛӷ Ù· ÓÂÔÁÓ¿, ‚Ú¤ÊË Î·È ·È‰È¿ Ô˘ ‚ÈÒÓÔ˘Ó ÂÒ‰˘Ó˜ ÂÌÂÈڛ˜. TÔ ÂÚÈÔÚÈṲ̂ÓÔ ÎÏÈÓÈÎfi Î·È ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ ÁÈ· ÙÔÓ fiÓÔ ÛÙ· ·È‰È¿, ‰ËÌÈÔ‡ÚÁËÛ ÏËıÒÚ· "̇ıˆÓ", ÌÂÚÈÎÔ‡˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ú·ı¤Ùˆ. T· ·È‰È¿ ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ fiÓÔ fiˆ˜ ÔÈ ÂÓ‹ÏÈΘ, ‰ÂÓ ı˘ÌÔ‡ÓÙ·È ÙȘ ÂÒ‰˘Ó˜ ÂÌÂÈڛ˜ ÙÔ˘˜, ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ·ÓÙÔ¯‹ ÛÙÔÓ fiÓÔ, Î·È Ù¤ÏÔ˜ Âı›˙ÔÓÙ·È Â˘ÎÔÏfiÙÂÚ· ÛÙ· Ó·ÚΈÙÈο-·Ó·ÏÁËÙÈο. M ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ÔÈ Ì‡ıÔÈ ·˘ÙÔ› ηٷÚÚ›ÊıËÎ·Ó Î·È ·Ô‰Â›¯ıËΠÙÂÏÈο fiÙÈ ·ÎfiÌË Î·È ¤Ì‚Ú˘·, ·fi ÙÔ 2Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, Â›Ó·È ·Ó·ÙÔÌÈο Î·È Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈο Èηӿ Ó· ÓÔÈÒÛÔ˘Ó fiÓÔ Î·È ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ ÚÔÛ·ıÔ‡Ó Î·È Ó· ÙÔÓ ·ÔʇÁÔ˘Ó. (3) H ·Ó·ÎÔ‡ÊÈÛË ·fi ÙÔÓ fiÓÔ, ¤Ó· Û‡ÓıÂÙÔ ÔÏ˘·Ú·ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ, ·ÔÙÂÏ› ‚·ÛÈÎfi ·ÓıÚÒÈÓÔ ‰Èη›ˆÌ· Ô˘ Ú¤ÂÈ Ó· ÚÔÛÂÁÁ›˙ÂÙ·È ·ÓÂÍ¿ÚÙËÙ· ·fi ËÏÈΛ·. ¢ÂÓ ‰ÈηÈÔÏÔÁԇ̷ÛÙÂ Û˘ÓÂÒ˜ ˆ˜ ÁÈ·ÙÚÔ› Ó· ÌËÓ ‰ËÌÈÔ˘ÚÁԇ̠ÚÔ¸Ôı¤ÛÂȘ "ÌË fiÓÔ˘" Û οı ÂÚ›ÙˆÛË Ô˘ ÁÓˆÚ›˙Ô˘Ì ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ fiÙÈ ı· ÙÔÓ ÚÔηϤÛÔ˘ÌÂ, ÂÍ·ÈÙ›·˜ ÌÈ·˜
ÂÒ‰˘Ó˘ Ù¯ÓÈ΋˜ Ô˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌfiÛÔ˘ÌÂ. O ηı¤Ó·˜ Ì·˜ ¤¯ÂÈ ÙÚ·˘Ì·ÙÈΤ˜ ÂÌÂÈڛ˜ ‹ ÚÔÛˆÈΤ˜ ‹ ·fi ÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ (·Ó¿Ù·ÍË Î·Ù¿ÁÌ·ÙÔ˜, Û˘ÚÚ·Ê‹ ÙÚ·‡Ì·ÙÔ˜, Î.¿). TÔ Ò˜ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÔÈ ÂÌÂÈڛ˜ ·˘Ù¤˜, ‰ÂÓ Â›Ì·È Ô‡Ù Ôχ Û›ÁÔ˘ÚË Ô‡Ù ·ÈÛÈfi‰ÔÍË fiÙÈ ÙȘ ·Ó·Î·Ïԇ̠ÛÙË ÌÓ‹ÌË Ì·˜ ‰È·ÚÎÒ˜ ÒÛÙ ӷ ÌËÓ ÚÔÍÂÓ‹ÛÔ˘Ì fiÓÔ ÂÌ›˜ ÔÈ ›‰ÈÔÈ. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÂ Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ ÔÈ Û˘ÁÎÂÎÚÈ̤Ó˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ, Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÛÙÔ ¿ÚıÚÔ ÙÔ˘˜ ÔÈ M. Aı·Ó·Û›Ô˘ Î·È A. KÔ‡ÛË, ·ÏÏ¿ Î·È ÛÙ· ·È‰È¿ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ȉȷ›ÙÂÚ· ÛÙÔ Î·Ù·ÏËÎÙÈÎfi ÛÙ¿‰ÈÔ, fiˆ˜ ·Ó·Ï‡ÂÙ·È ÛÙÔ poster Ù˘ WHO, ·ÔÙÂÏ› ȉȷ›ÙÂÚÔ ·ÓÙÈΛÌÂÓÔ Î·È Â˘ı‡ÓË ÔÌ¿‰·˜ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜, Ô˘ ı· ÂÊ·ÚÌfiÛÔ˘Ó fiÏ· Ù· Û‡Á¯ÚÔÓ· ̤۷ ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.(1,2) H ÂÚÈÔ¯È΋ ·Ó·ÈÛıËÛ›· Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÙÔÈ΋ ›ıÂÛË ·Ó·ÈÛıËÙÈÎÒÓ ÎÚÂÌÒÓ, fiˆ˜ Ô Û˘Ó‰˘·ÛÌfi˜ ÏȉÔη˝Ó˘ÚÈÏÔη˝Ó˘, Ô ‰È·‰ÂÚÌÈÎfi˜ ËÏÂÎÙÚÈÎfi˜ Ó¢ÚÔÂÚÂıÈÛÌfi˜ Ì ·ÚÔ¯‹ ËÏÂÎÙÚÈÎÔ‡ Ú‡̷ÙÔ˜ ¯·ÌËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ Î·È ÌÈÎÚ‹˜ Ù¿Û˘, Ë Ú·¯È·›· ·Ó·ÈÛıËÛ›· Ì ¤Á¯˘ÛË ·Ó·ÈÛıËÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÛÙÔÓ ˘·Ú·¯ÓÔÂȉ‹ ¯ÒÚÔ, Ë Û˘Ó¯‹˜ ÂÈÛÎÏËÚ›‰È· ·Ó·ÈÛıËÛ›· Î·È Ë ÛÙÂϯȷ›· ·Ó·ÈÛıËÛ›·, ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ· ÌÂÚÈΤ˜ ‡ÎÔϘ Ú·ÎÙÈΤ˜ ÁÈ· ·È‰È¿ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙÔ NÔÛÔÎÔÌ›Ô.(4,5) TÔ Â›Â‰Ô Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ fiÓÔ˘ ÛÙ· NÔÛÔÎÔÌ›· ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÛÙÈÎÒÓ Î¤ÓÙÚˆÓ Â›Ó·È Î·Ïfi, ÌÔÚ› fï˜ Ó· Á›ÓÂÈ ·ÎfiÌ· ηχÙÂÚÔ. EΛÓÔ Ô˘ ·Ú·ÁÓˆÚ›˙ÂÙ·È Û˘ÛÙËÌ·ÙÈο, Â›Ó·È Ë ÚfiÏË„Ë ÙÔ˘ fiÓÔ˘ Ô˘ ‚ÈÒÓÔ˘Ó Î·ıËÌÂÚÈÓ¿ Ù·
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8
ÕÚıÚ· ™‡ÓÙ·Í˘
ÓÂÔÁÓ¿, ‚Ú¤ÊË Î·È ·È‰È¿ ·fi ·Ï¤˜ È·ÙÚÈΤ˜ Ú·ÎÙÈΤ˜, fiˆ˜ ÊÏ‚ÔÎÂÓÙ‹ÛÂȘ, ÂÌ‚ÔÏÈ·ÛÌÔ‡˜, ÙÔÔı¤ÙËÛË Î·ıÂÙ‹ÚˆÓ, ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ, Î.Ï. (6) ø˜ ‰ÈηÈÔÏÔÁ›· ÚÔ‚¿ÏÏÂÙ·È Û˘Ó‹ıˆ˜ ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ÔÈ È·ÙÚÈΤ˜ ·˘Ù¤˜ Ú¿ÍÂȘ Â›Ó·È ÙȘ ÈÔ ÔÏϤ˜ ÊÔÚ¤˜ ›ÁÔ˘Û˜ ÛÙ· ·È‰È¿, ¤ÙÛÈ ÒÛÙ ‰ÂÓ ˘¿Ú¯ÂÈ ¯ÚfiÓÔ˜ ÚÔÂÙÔÈÌ·Û›·˜ Ì ʿÚ̷η ‹ „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË. ¶Ú¿ÁÌ·ÙÈ, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Ô˘ Â›Ó·È Â›ÁÔ˘Û˜, Ô ÁÈ·ÙÚfi˜ ÛÙ·ıÌ›˙ÂÈ ÙÔ fiÊÂÏÔ˜ ·fi ÌÈ· ÁÚ‹ÁÔÚË ‰È¿ÁÓˆÛË ¤Ó·ÓÙÈ ÙÔ˘ fiÓÔ˘ Ô˘ ı· ÚÔηϤÛÂÈ. ™Â fiϘ fï˜ ÙȘ ÂÚÈÙÒÛÂȘ ˘¿Ú¯ÂÈ ÙÚfiÔ˜ Ó· ÌÂÙÚÈ¿ÛÔ˘Ì ÙÔÓ fiÓÔ, fiÙ·Ó ·Ê‹ÛÔ˘Ì ÙË ÌËÙ¤Ú· Ó· ÎÚ·Ù¿ÂÈ ÙÔ ¯¤ÚÈ ÙÔ˘ ·È‰ÈÔ‡ Ù˘ ‹ ¤Ó·Ó ¿ÏÏÔ ÁÈ·ÙÚfi Ó· ··Û¯ÔÏ› ÙÔ ·È‰›. TÈ Á›ÓÂÙ·È fï˜ Ì ÙËÓ Î·ıËÌÂÚÈÓ‹ ¿ÛÎËÛË Ù˘ ·È‰È·ÙÚÈ΋˜ ÛÙÔ È·ÙÚ›Ô, ÙÔ K¤ÓÙÚÔ YÁ›·˜ ‹ ÙÔ AÁÚÔÙÈÎfi I·ÙÚ›Ô; TÈ Á›ÓÂÙ·È fiÙ·Ó ÙÔ ·È‰› ·ÚÓÂ›Ù·È Ó· ¿ÂÈ ÛÙÔ ÁÈ·ÙÚfi ÁÈ· Ó· οÓÂÈ ÂÌ‚fiÏÈÔ, ÁÈ·Ù› ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ fiÓÂÛÂ; H ·¿ÓÙËÛË Â›Ó·È ·Ï‹. £· Ú¤ÂÈ Ó· ·ÊÈÂÚÒÓÔ˘Ì ϛÁÔ ¯ÚfiÓÔ ·Ú·¿Óˆ ÁÈ· οı ·È‰›, Ó· ·ÍÈÔÔÈԇ̠ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ÛˆÛÙ¿, Ó· ‰ÈÂÈÛ‰‡Ô˘Ì ÛÙË ‰ÔÌ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (‰È·˙‡ÁÈÔ, ÌÔÓÔÁÔÓÂ˚΋ ÔÈÎÔÁ¤ÓÂÈ·, ·ÒÏÂÈ· ·È‰ÈÔ‡) ÁÈ· Ó· ÎÂÚ‰›ÛÔ˘Ì ÙËÓ ÂÌÈÛÙÔÛ‡ÓË ÁÔÓÈÔ‡ Î·È ·È‰ÈÔ‡. N· ÂÊ·ÚÌfi˙Ô˘Ì fiϘ ÂΛӘ ÙȘ ÌÂıfi‰Ô˘˜ „˘¯ÔÏÔÁÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ô˘ ıˆÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘, ›Ù ˆ˜ ·ÓÂÍ¿ÚÙËÙ˜ ›Ù ÛÂ Û˘Ó‰˘·ÛÌfi Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹. OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜ ÂÌϤÎÔ˘Ó Î·È ÙÔ˘˜ ÁÔÓ›˜, ÔÈ ÔÔ›ÔÈ ı· Ú¤ÂÈ Ó· ÚÔÂÙÔÈÌ¿˙Ô˘Ó ÙÔ ·È‰› ÙÔ˘˜ ÁÈ· οı ȷÙÚÈ΋ Ú¿ÍË Î·È Ó· ÙÔ „˘¯·ÁˆÁÔ‡Ó Ì·˙› Ì ÙÔÓ ÁÈ·ÙÚfi, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‰È¿ÊÔÚ· ·È¯Ó›‰È· ‹ ‚È‚Ï›· ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘. °È· Ó· ʤÚÔ˘Ó fiϘ ·˘Ù¤˜ ÔÈ Ú·ÎÙÈΤ˜ ÙÔ ÂÈı˘ÌËÙfi ·ÔÙ¤ÏÂÛÌ·, ı· Ú¤ÂÈ Ô ÁÈ·ÙÚfi˜ Ó· ·ÊÈÂÚÒÛÂÈ ·ÚÎÂÙfi ¯ÚfiÓÔ ÛÙÔ Ó· ÂÓËÌÂÚÒÛÂÈ ÙÔ˘˜ ‹ ÙÔÓ ÁÔÓ¤· ÁÈ· ÙË ÛÎÔÈÌfiÙËÙ·
Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘. ¶·ÚfiÏÔ Ô˘ Ô ¯ÚfiÓÔ˜ Â›Ó·È ÔχÙÈÌÔ˜, ÔÏÏÔ› ·È‰›·ÙÚÔÈ Â˘Ù˘¯Ò˜, ÂÓËÌÂÚÒÓÔ˘Ó ÙÔ˘˜ ÁÔÓ›˜ ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ·˘Ùfi Â›Ó·È Ôχ ÂÓı·ÚÚ˘ÓÙÈÎfi. ™‹ÌÂÚ·, Ô˘ Ë ÂÈÏÔÁ‹ Ù˘ ÂȉÈÎfiÙËÙ·˜ ‰ÂÓ Á›ÓÂÙ·È Ù˘¯·›·, ·ÏÏ¿ Ô ÁÈ·ÙÚfi˜ Ì ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ· Î·È Û˘ÓÂÎÙÈÌÒÓÙ·˜ ÙÔ ¯ÚfiÓÔ ·Ó·ÌÔÓ‹˜ ÁÈ· ¤Ó·ÚÍË Ù˘ ÂȉÈÎfiÙËÙ·˜ ÙËÓ ÂÈϤÁÂÈ, ÓÔÌ›˙ˆ, fiÙÈ ÔÈ Û‡Á¯ÚÔÓÔÈ ·È‰›·ÙÚÔÈ ı· Á›ÓÔ˘Ó Î·Ï‡ÙÂÚÔÈ ·fi Ì·˜. £· Ú¤ÂÈ ‚¤‚·È· Î·È ÂÌ›˜ ˆ˜ ‰¿ÛηÏÔÈ Ó· ÙÔ˘˜ ‰È‰¿ÍÔ˘ÌÂ Î·È Ó· ÙÔ˘˜ ‰Â›ÍÔ˘Ì Ì ÙÔ ·Ú¿‰ÂÈÁÌ¿ Ì·˜, fiÙÈ ÂÎÙfi˜ ·fi ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ÙË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ¿ÏÏ· Ô˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙËÓ ¿ÛÎËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁ‹Ì·Ùfi˜ Ì·˜. ŒÓ· ·fi ·˘Ù¿, Ë Ì¤ÚÈÌÓ· ÁÈ· ÙË ÌË ÚfiÎÏËÛË fiÓÔ˘ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏ› ηı‹ÎÔÓ Î·È ˘Ô¯Ú¤ˆÛË fiÏˆÓ Ì·˜. BÈ‚ÏÈÔÁÚ·Ê›· 1. Aı·Ó·Û›Ô˘-MÂÙ·Í¿ M, KÔ‡ÛË A. AÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ Ì ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ. ¶·È‰È·ÙÚÈ΋ 2000;63:17-20. 2. TÛ›ÙÔ˘Ú· ™. Afi‰ÔÛË Ô‰ËÁÈÒÓ Ù˘ WHO. Cancer pain relief and palliative care in children. ¶·È‰È·ÙÚÈ΋ 2000;63:75-76 3. Schechter NL, Berde CB, Yaster M. Pain in infants, children and adolescents. Williams & Wilkins. 1993. 4. Collins MJ. A child’s pain. JAMA 1997;277:21. 5. Taddio A et al. Efficacy and safety of lidocaine-prilacaine cream for pain during circumcision. New Eng J Med, 1997; 336:17, 1197-1201. 6. Derbyshire SWG, Furedi A. Do fetuses feel pain? BMJ 1996; 313: 796-799. 7. M˘ÚˆÓ›‰Ô˘-T˙Ô˘‚ÂϤÎË M, T˙Ô˘‚ÂϤ΢ °. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿. EÈÛÙËÌÔÓÈ΋ EÂÙËÚ›‰· TÌ‹Ì·ÙÔ˜ I·ÙÚÈ΋˜ A.¶.£. 1997;23:1, 51-63. º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ MËÙÚÔfiψ˜ 55, 54623 £ÂÛÛ·ÏÔÓ›ÎË
™ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Ì ‚·ı˘Ù¿ÙË ÂÎÙ›ÌËÛË! EϤÓË B·Ï¿ÛÛË- A‰¿Ì
E. Valassi-Adam. To the reviewers of the journal, with deep appreciation! Paediatriki 2000;63:2-6
paediatrics. The benefits, weaknesses and difficulties of peer reviewing in biomedical journals are discussed.
● Abstract: A tribute is paid to the reviewers of PAEDIATRIKI for their major contribution to Greek
∫ey words: peer review, Paediatriki.
2
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30-05-03
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™ÂÏ›‰·3
¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8
™ÙË ÛÂÏ›‰· 68 ηٷÁÚ¿ÊÔÓÙ·È Ù· ÔÓfiÌ·Ù· ÙˆÓ ÎÚÈÙÒÓ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛÂ Ë ¶AI¢IATPIKH ÙÔ 1999. E›ıÈÛÙ·È Ó· ·Ú·Ù›ıÂÓÙ·È Ù· ÔÓfiÌ·Ù¿ ÙÔ˘˜ Ì ÙȘ ¢¯·ÚÈÛٛ˜ ÙÔ˘ ‰È¢ı˘ÓÙ‹ ™‡ÓÙ·Í˘. H ¢ÁÂÓÈ΋, ·fiÚÈÛÙË Î·È Û˘ÁÎÚ·ÙË̤ÓË ·Ó·ÊÔÚ¿ ÛÙË Û˘Ì‚ÔÏ‹ ÙˆÓ ÎÚÈÙÒÓ, ÚÔÛÏ·Ì‚¿ÓÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ ·Ï‹ ·‚ÚÔÊÚÔÛ‡ÓË Ù˘ ™‡ÓÙ·Í˘! ºÔ‚Ô‡Ì·È Ì‹ˆ˜ ·Ó·ÈÛı‹Ùˆ˜, ˘Ô‚·ıÌ›˙ÂÈ ÙÔÓ Ú·ÁÌ·ÙÈÎfi ÚfiÏÔ ÙˆÓ ÎÚÈÙÒÓ ÛÙÔÓ È·ÙÚÈÎfi Ù‡Ô. H ϤÍË "ÎÚ›ÛË" Â›Ó·È ·ÚÂÍËÁË̤ÓË. ¶·Ú·¤ÌÂÈ Û ‰È·ÁˆÓÈÛÌfi, ‰ÈÂΉ›ÎËÛË ı¤Û˘, Û ÛÙ›ڷ ·ÍÈÔÏfiÁËÛË Í¤ÓÔ˘ ¤ÚÁÔ˘, Û ‚·ıÌÔÏÔÁ›· ·fi ı¤ÛË ÂÍÔ˘Û›·˜. A˘Ù‹ Ë ÎÚ›ÛË Â›Ó·È, ‚¤‚·È·, ÌÈ· ÂÈÛÙËÌÔÓÈο ¿¯ÚËÛÙË ‰È·‰Èηۛ·. O˘‰Â›˜ ‚ÂÏÙÈÒıËΠÂÈÛÙËÌÔÓÈο ‰È·‚¿˙ÔÓÙ·˜ ÂÈÛ‹ÁËÛË ÁÈ· ‚Ú¿‚¢ÛË ‹ ÁÈ· Ï‹ÚˆÛË ı¤Ûˆ˜! ™ÙËÓ ÂÚ›ÙˆÛË ÂÓfi˜ ¿ÚıÚÔ˘ ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË, Ë ÎÚ›ÛË ¤¯ÂÈ ÂÓÙÂÏÒ˜ ¿ÏÏÔ ÓfiËÌ·, ¿ÏÏÔ˘˜ ÛÙfi¯Ô˘˜ ÎÈ ¿ÏÏË ‰È·‰Èηۛ·. OÈ ÎÚÈÙ¤˜ ‰ÂÓ ÎÚ›ÓÔ˘Ó ÌfiÓÔ ·Ó Ë ÂÚÁ·Û›· Â›Ó·È Î·Ï‹ ‹ ÏÈÁfiÙÂÚÔ Î·Ï‹, ‰ËÌÔÛȇÛÈÌË ‹ fi¯È, ‰ÂÓ ‚·ıÌÔÏÔÁÔ‡Ó ·ÏÒ˜. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÎÚÈÙ¤˜ Ô˘ ÁÓÒÚÈÛ· ˆ˜ Û˘ÓÙ¿ÎÙ˘ Î·È ˆ˜ Û˘ÁÁڷʤ·˜, οÓÔ˘Ó Î¿ÙÈ Û·Ó "ÂÈ̤ÏÂÈ·" Î·È Û˘¯Ó¿ Ôχ ÂÚÈÛÛfiÙÂÚ· (1). ¶ÚÔÙ›ÓÔ˘Ó ÙÚÔÔÔÈ‹ÛÂȘ, ‰È¢ÎÚÈÓ›ÛÂȘ, ‰ÈÔÚıÒÛÂȘ, Û˘ÌÏËÚÒÛÂȘ! OÈ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘˜, ‰˘ÓËÙÈο ÂËÚ¿˙Ô˘Ó ÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ¿ÚıÚÔ˘. ™˘¯Ó¿ ÂËÚ¿˙Ô˘Ó Î·È ÙÔÓ Û˘ÁÁڷʤ·-ÂÚ¢ÓËÙ‹. TÔÓ Î¿ÓÔ˘Ó Ó· ÔÚÁ·ÓÒÛÂÈ Î·È Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ Î·Ï‡ÙÂÚ· ÙË ‰Ô˘ÏÂÈ¿ ÙÔ˘ ÎÈ fi¯È ÌfiÓÔ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›·. ¢ËÏ·‰‹, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰ÂÓ Û˘Ì‚¿ÏÏÔ˘Ó ÌfiÓÔ ÛÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÂÈÎÔÈÓˆÓ›· ·ÏÏ¿ ÛÙËÓ ›‰È· ÙËÓ ÂÈÛÙ‹ÌË. O ÎÚÈÙ‹˜ ÙÔ˘ ¿ÚıÚÔ˘ ‰ÂÓ ‰Ú· ·fi ı¤ÛË ÂÍÔ˘Û›·˜. E›Ó·È Û˘ÓÂÚÁ¿Ù˘ - Û‡ÌÌ·¯Ô˜ ÙÔ˘ Û˘ÁÁڷʤ·-ÂÚ¢ÓËÙ‹ Î·È Û˘Á¯ÚfiÓˆ˜ ÙÔ˘ ¢È¢ı˘ÓÙ‹ ™‡ÓÙ·Í˘ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ¢Ú· Î·È ˆ˜ ÚÔÛٷ٢ÙÈÎfi˜ ÎÏÔÈfi˜ ÁÈ· Ó· ÌË ‚ÚÂı› Ô ·Ó·ÁÓÒÛÙ˘ ÂÎÙÂıÂÈ̤ÓÔ˜ Û η΋, ·Ó·Ú΋ ‹ ‰˘ÛÓfiËÙË ÏËÚÔÊÔÚ›· (2,3). H ÎÚ›ÛË Â›Ó·È ‚¤‚·È·, ¤ÚÁÔ Ô˘ Á›ÓÂÙ·È ÛÙÔ ·Ú·Û΋ÓÈÔ Î·È Ô˘‰¤ÔÙ ·Ó·ÁÓˆÚ›˙ÂÙ·È. §¤Ì "Ï·ÌÚfi˜ ÎÏÈÓÈÎfi˜", "ÛÔ˘‰·›Ô˜ ÂÚ¢ÓËÙ‹˜", "ηÏfi˜ ‰¿ÛηÏÔ˜". ¢ÂÓ Â›·Ì ÁÈ· Î·Ó¤Ó·Ó "ÛÔ˘‰·›Ô˜ ÎÚÈÙ‹˜". T· ÛÔ‚·Ú¿ ÂÚÈÔ‰Èο ÛÙËÚ›˙ÔÓÙ·È ÛÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘˜.(2) OÈ Û˘ÓÙ¿ÎÙ˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÙË ÁÓÒÌË Î·ı' ‡ÏËÓ ·ÚÌfi‰ÈˆÓ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó ÂÁ΢ÚfiÙËÙ· Î·È ·Ó·ÁÓˆÛÈÌfiÙËÙ· ÛÙÔ ÂÚÈÔ‰ÈÎfi ÙÔ˘˜. MÔÚ› fiÏÔÈ Ó· ÁÎÚÈÓÈ¿˙Ô˘Ó ÁÈ· ÙȘ ·‰˘Ó·Ì›Â˜ Ô˘ ÂÓ¤¯ÂÈ Ë ÎÚ›ÛË, ÌÔÚ› ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ (70%) Ó· ÌË ‰ÂÛ̇ÔÓÙ·È ÛÙȘ ·ÔÊ¿ÛÂȘ ÙÔ˘˜ ·ÏÏ¿ ÂȉÈÒÎÔ˘Ó Ó· ¤¯Ô˘Ó ÔÏÏÔ‡˜ Î·È Î·ÏÔ‡˜ ÎÚÈÙ¤˜ (2-5).
ÕÚıÚ· ™‡ÓÙ·Í˘
H Ù¤¯ÓË ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÎÚÈÙÒÓ, ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, Ì·ı·›ÓÂÙ·È ·fi ÙÔÓ Û˘ÓÙ¿ÎÙË Ì ÙË Ì¤ıÔ‰Ô "‰ÔÎÈÌ‹˜ Î·È Ï¿ıÔ˘˜" Î·È ·Ú·‰ÔÛȷο, ÌÂÙ·‰È‰fiÙ·Ó ÛÙÔÓ ÂfiÌÂÓÔ Û˘ÓÙ¿ÎÙË ‰È· "·Ú·ÁÁÂϛ˘ Î·È ¯Ú‹Ûˆ˜" ‹ "Û˘ÓÙ¯ÓÈ·ÎÔ‡ ÎÔ˘ÙÛÔÌÔÏÈÔ‡". MfiÓÔ Ù· ÙÂÏÂ˘Ù·›· 10 ¯ÚfiÓÈ· Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Ó· Ù˘ÔÔÈËı› Î·È Ó· ÛÙ·ıÌÈÛÙ› Î·È ·˘Ù‹ Ë ‰È·‰Èηۛ· fiˆ˜ fiϘ ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (6). ¶ÔȘ Â›Ó·È ÔÈ ··Ú·›ÙËÙ˜ ȉÈfiÙËÙ˜ ÙÔ˘ ηÏÔ‡ ÎÚÈÙ‹; ¶ÚˆÙ·Ú¯ÈÎfi ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ Â›Ó·È Ë ÁÓÒÛË ÙÔ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘. A·Ú·›ÙËÙË, ·ÏÏ¿ ‰ÂÓ ·ÚΛ. ¢Â‡ÙÂÚË Û ÛÂÈÚ¿ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ȉÈfiÙËÙ· Â›Ó·È -ÈÛÙ‡ˆ- Ë ·›ÛıËÛË ÈÛÔÚÚÔ›·˜ ¢ı˘ÓÒÓ ·¤Ó·ÓÙÈ ÛÙÔÓ Û˘ÁÁڷʤ·, ÙÔÓ Û˘ÓÙ¿ÎÙË ,ÙÔÓ ·Ó·ÁÓÒÛÙË. ¢ÂÓ ÙËÓ ‰È·ı¤ÙÔ˘Ó fiÏÔÈ. TÚ›ÙÔ ı· ¤‚·˙· ÙÔ ÎÚÈÙÈÎfi Ì˘·Ïfi Î·È Ù¤Ù·ÚÙË ÙË ıÂÙÈ΋ ‰È¿ıÂÛË, ÙËÓ ÂÔ›ıËÛË fiÙÈ Ù· Ú¿ÁÌ·Ù· Âȉ¤¯ÔÓÙ·È ‚ÂÏÙ›ˆÛË. H Ù·¯‡ÙËÙ· ÛÙËÓ ·¿ÓÙËÛË, Ë Â˘Á¤ÓÂÈ· Î·È Ë Û·Ê‹ÓÂÈ· ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ ·Ó·Ê¤ÚÔÓÙ·È ·fi ÔÏÏÔ‡˜ Û˘ÓÙ¿ÎÙ˜ Î·È Û˘ÁÁÚ·Ê›˜ (2,3). ™Â ÌÈ· ¤Ú¢ӷ ·ÍÈÔÏÔÁ‹ıËÎ·Ó 507 ÎÚ›ÛÂȘ Î·È ÎÚÈÙ¤˜ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ¿ÚıÚˆÓ Î·È ·fi ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ ÙÔ˘ BMJ. BÚ¤ıËΠfiÙÈ Ë ÔÈfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ ‹Ù·Ó ηχÙÂÚË Û ÎÚÈÙ¤˜ Ô˘ ›¯·Ó Âη›‰Â˘ÛË Û ÂȉËÌÈÔÏÔÁ›· Î·È ÛÙ·ÙÈÛÙÈ΋, Û ÓÂÒÙÂÚÔ˘˜ Û ËÏÈΛ· Î·È ‚ÂÏÙȈÓfiÙ·Ó ·Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈÂÚˆÓfiÙ·Ó ÛÙËÓ ÎÚ›ÛË ·ÏÏ¿ ̤¯ÚÈ 3 ÒÚ˜. OÈ ÎÚÈÙ¤˜Ì¤ÏË Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ ›¯·Ó ¯·ÌËÏfiÙÂÚ˜ ‚·ıÌÔÏÔÁ›Â˜ (6). A˜ ¿ÚÔ˘Ì ٷ Â˘Ú‹Ì·Ù· ¤Ó·-¤Ó·: 1- TÔ Â‡ÚËÌ· fiÙÈ ÔÈ Û˘ÓÙ¿ÎÙ˜ Â›Ó·È ¯ÂÈÚfiÙÂÚÔÈ ÎÚÈÙ¤˜ ‰ÂÓ ÓÔÌ›˙ˆ Ó· ·ÊÔÚ¿ ÙËÓ EÏÏ¿‰·. ¶Èı·ÓfiÓ Ó· Û˘Ì‚·›ÓÂÈ Û ÂÚÈÔ‰Èο Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Ó ·ÚÎÂÙÔ‡˜ Â͈ÙÂÚÈÎÔ‡˜ ÎÚÈÙ¤˜ (7,8) ÔfiÙÂ Ô ÊfiÚÙÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ë Â·ÁÁÂÏÌ·ÙÈ΋ ÂÍ¿ÓÙÏËÛË (ı· ÙËÓ ¤ÏÂÁ· ‚·ÚÂÌ¿Ú·) οÓÂÈ ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ Ó· ÁÚ¿ÊÔ˘Ó ÏÈÁfiÙÂÚÔ Ô˘ÛÈ·ÛÙÈΤ˜ ÎÚ›ÛÂȘ (6). AÛÊ·ÏÒ˜ Â›Ó·È ÈÔ ··ÈÙËÙÈÎÔ› Û ı¤Ì·Ù· Û˘ÌÌfiÚʈÛ˘ ÛÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ô˘ Û˘Ó‹ıˆ˜ ÔÈ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ Ù· ıˆÚÔ‡Ó ¿ÍÈ· ÏfiÁÔ˘. ÿÛˆ˜ ÙÔ˘˜ È¿ÓÂÈ ÙÔ ·Ú¿ÔÓÔ, ÙÔ ·›ÚÓÔ˘Ó ÚÔÛˆÈο Î·È ÌÂÚÔÏËÙÔ‡Ó fiÙ·Ó Ô Û˘ÁÁڷʤ·˜ ·ÁÓÔ› ÙȘ Ô‰ËÁ›Â˜ Î·È ı›ÁÂÈ ÙÔ Î‡ÚÔ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. 2- H Û‡ÛÙ·ÛË ÛÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ BMJ Ó· ·ÊÈÂÚÒÓÔ˘Ó ÛÙËÓ ÎÚ›ÛË ÌfiÓÔ Ì¤¯ÚÈ 3 ÒÚ˜ ( 6) Â͈ڷÁÌ·ÙÈ΋ ÌÔ˘ Ê·›ÓÂÙ·È! (1) YÔÏÔÁ›˙ˆ fiÙÈ ÌfiÓÔ Û ÌÈ· ηϋ ÂÚÁ·Û›· ¯ÚÂÈ¿˙ÂÙ·È Î·Ó›˜ 3-4 ÒÚ˜ ÁÈ· Ó· ÎÚ›ÓÂÈ Î·È Ó· ‰È·Ù˘ÒÛÂÈ ÂÁÁڿʈ˜ ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘. AÓ ¯ÚÂÈ·ÛÙ› Ó· ÂϤÁÍÂÈ Î¿ÔÈ· ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹, Ó· ·ÓÔ›ÍÂÈ ÙÔ MEDLINE ‹ οÔÈÔ ·ÏÈfi Ù‡¯Ô˜ Ù˘ ¶AI¢IATPIKH™, ¯ÚÂÈ¿˙ÂÙ·È
3
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·4
¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8
ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ. AÓ Ë ÂÚÁ·Û›· ÂÚÈÁÚ¿ÊÂÈ ÌÈ· ηϋ ÂÚ¢ÓËÙÈ΋ ‰Ô˘ÏÂÈ¿ ·ÏÏ¿ Â›Ó·È Î·ÎÔÁÚ·Ì̤ÓË (Ú¿ÁÌ· fi¯È Û¿ÓÈÔ) ¤Ó·˜ Â˘Û˘Ó›‰ËÙÔ˜ ÎÚÈÙ‹˜ ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› ‰‡Ô ÔÏfiÎÏËÚ· ·ÔÁ‡̷ٷ. AÓ ÚfiÎÂÈÙ·È ÁÈ· ηϋ ·ÏÏ¿ ηÎÔ·ÚÔ˘ÛÈ·Ṳ̂ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ‰ÂÓ ÊÙ¿ÓÔ˘Ó Ù· ‰‡Ô ·ÔÁ‡̷ٷ ÁÈ· Ó· ÚÔÙ›ÓÂÈ ¯Ú‹ÛÈ̘ ‰ÈÔÚıÒÛÂȘ. 3- ¢ÂÓ ÂÎÏ‹ÛÛÂÈ Ô˘ ÎÚÈÙ¤˜ Ì ·È‰Â›· ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· Î·È ÛÙË ÛÙ·ÙÈÛÙÈ΋ ıˆڋıËÎ·Ó ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ fiÙÈ Î¿ÓÔ˘Ó Î·Ï‡ÙÂÚ˜ ÎÚ›ÛÂȘ. EΛ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÔÈ Û˘ÁÁÚ·Ê›˜ fiÙÈ ¯ˆÏ·›ÓÔ˘Ó Î·È ‰¤¯ÔÓÙ·È Ì ¢ÁÓˆÌÔÛ‡ÓË ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙˆÓ "ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ". (9) E›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Ë ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÎÚ›ÛÂˆÓ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ¤ÁÈÓ·Ó ·Ô‰ÂÎÙ¿ Î·È ·˘ÙÒÓ Ô˘ ·ÔÚÚ›ÊıËηÓ. EÍ¿ÏÏÔ˘ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ ·ÍÈÔÔÈÔ‡Ó ÙȘ ÎÚ›ÛÂȘ ÁÈ· Ó· ÙÚÔÔÔÈ‹ÛÔ˘Ó ÙËÓ ÂÚÁ·Û›· ÙÔ˘˜ Î·È Ó· ÙËÓ ˘Ô‚¿ÏÔ˘Ó Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi ‚ÂÏÙȈ̤ÓË. M¤Û· Û 3-6 ¯ÚfiÓÈ· ›¯·Ó ‰ËÌÔÛÈ¢Ù› Û ¿ÏÏ· ÂÚÈÔ‰Èο 85% ÙˆÓ ¿ÚıÚˆÓ Ô˘ ·ÔÚÚ›ÊıËÎ·Ó ·fi ÙÔ New England Journal of Medicine Î·È ÙÔ Journal of Clinical Investigation Î·È 68% ·fi ÙÔ British Medical Journal. (4) Afi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ÎÚÈÙ‹, ÔÈ ÂÚÁ·Û›Â˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÂȉËÌÈÔÏÔÁÈ΋ ÌÂıÔ‰ÔÏÔÁ›· Î·È ÛÙ·ÙÈÛÙÈ΋ Â›Ó·È Û˘Ó‹ıˆ˜ ¢ÎÔÏfiÙÂÚÔ Ó· ÎÚÈıÔ‡Ó. AÓÙ›ıÂÙ·, Ë ·ÓÂΉÔÙÔÏÔÁÈ΋ ·Ó·ÊÔÚ¿ Î·È Ë ¤ÏÏÂÈ„Ë Û¯Â‰È·Ṳ̂Ó˘ ÁÓˆÛÙ‹˜ ÌÂıÔ‰ÔÏÔÁ›·˜ ¯ÚÂÈ¿˙ÔÓÙ·È Ôχ ÂÚÈÛÛfiÙÂÚË ‰Ô˘ÏÂÈ¿ Î·È "‰È·›ÛıËÛË". O ÎÚÈÙ‹˜ ÓÈÒıÂÈ ·Ó·ÛÊ¿ÏÂÈ· fiÙ·Ó ÎÚ›ÓÂÈ ÌÈ· "ηÎÔÊÙÈ·Á̤ÓË" ÂÚÁ·Û›·. ºÔ‚¿Ù·È fiÙÈ ·ÔÚÚ›ÙÔÓÙ¿˜ ÙËÓ ÌÔÚ› Ó· ·‰ÈΛ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ó· ηı˘ÛÙÂÚ› ÙËÓ ÎÔÈÓÔÔ›ËÛË ÌÈ·˜ ¯Ú‹ÛÈÌ˘ ÁÓÒÛ˘. A˜ ¿ÚÔ˘Ì ÁÈ· ·Ú¿‰ÂÈÁÌ· ÙËÓ ·ÎÚ·›· ÂÚ›ÙˆÛË ÌÈ·˜ ÂÚÁ·Û›·˜ fiÔ˘ ¤Ó·˜ ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜ ÁÚ¿ÊÂÈ: "¤‰ˆÛ· ÂÚ˘ıÚÔÌ˘Î›ÓË Û fiÏ· Ù· ÓÂÔÁÓ¿ ÙÔ˘ Ì·È¢ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÁÈ·Ù› ›¯· ¤Ó· ÎÚÔ‡ÛÌ· ÎÔΛÙË, ›‰· 7 ÂÚÈÙÒÛÂȘ Û˘ÁÁÂÓÔ‡˜ ˘ÏˆÚÔÛÙ¤ÓˆÛ˘ Û ¤Ó· ¯ÚfiÓÔ, Î·È ÓÔÌ›˙ˆ fiÙÈ ÊÙ·›ÂÈ Ë ÂÚ˘ıÚÔÌ˘Î›ÓË". TÔ ·ÊÂϤ˜ Î·È ·ÙÂÎÌËÚ›ˆÙÔ Û˘Ì¤Ú·ÛÌ· οÓÂÈ ÙÔÓ ÎÚÈÙ‹ Ó· ·ÌÊÈÛ‚ËÙ‹ÛÂÈ, ‰›Î·È·, ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÛΤ„Ë ÙÔ˘ Û˘ÁÁڷʤ·. A˘Ùfi ÙÔÓ ·Ú·Û‡ÚÂÈ fï˜, Ó· ·ÁÓÔ‹ÛÂÈ ÙËÓ Ô˘Û›· Ù˘ ·Ú·Ù‹ÚËÛ˘ Ô˘ ‰ÂÓ ·ÌÊÈÛ‚ËÙ›ٷÈ: ÂÌÊ·Ó›ÛÙËÎ·Ó ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ÌÈ·˜ Û¿ÓÈ·˜ ηٿÛÙ·Û˘ Û ¤Ó· ÌÈÎÚfi ÓÔÛÔÎÔÌÂ›Ô Î·È ÙÔ ÁÂÁÔÓfi˜ Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı›. TÔ ¿ÚıÚÔ ·ÔÚÚ›ÙÂÙ·È. MÂÙ¿ ·fi ·ÚÎÂÙ¿ ¯ÚfiÓÈ· Ô ÎÚÈÙ‹˜ ‰È·‚¿˙ÂÈ ÛÙÔ Lancet ÂÚÁ·Û›· fiÔ˘ ÙÂÎÌËÚÈÒÓÂÙ·È ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË ÂÚ˘ıÚÔÌ˘Î›Ó˘ Î·È ˘ÏˆÚÔÛÙ¤ÓˆÛ˘ (!) Î·È Í¤ÚÂÈ fiÙÈ ·˘Ùfi˜ "¤ı·„Â" ÙÔÓ ÚÒÙÔ Ô˘ ¤Î·Ó ÙËÓ ·Ú·Ù‹ÚËÛË. (10)
4
ÕÚıÚ· ™‡ÓÙ·Í˘
ŸÌˆ˜ Î·È Ë Î·ÏÔÊÙÈ·Á̤ÓË ÂÚÁ·Û›· ¤¯ÂÈ ·Á›‰Â˜ Ô˘ ÌÔÚ› Ó· ·Ú·Û‡ÚÔ˘Ó ÙÔÓ ÎÚÈÙ‹ Ì·ÎÚÈ¿ ·fi ÙËÓ Ô˘Û›·. MÈ· Ù¤ÏÂÈ· ·ÚÔ˘ÛÈ·Ṳ̂ÓË ÂÚÁ·Û›· fiÔ˘ ¤Ó·˜ ÛÙ·ÙÈÛÙÈÎfi˜ ¤¯ÂÈ ÂÂÍÂÚÁ·ÛÙ› ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ì ·‰È¿‚ÏËÙ˜ ÌÂıfi‰Ô˘˜, ·Ú·ı¤ÙÂÈ risk factors, correlation coefficient, multivariate analysis ÎÏ, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ù˘ ÔÌ¿‰·˜ Û ·fiÏ˘Ù· ÛˆÛÙ¿ Û˘ÌÂÚ¿ÛÌ·Ù· ÙÔ˘ Ù‡Ô˘ "Ë ‰È·ÊÔÚ¿ ‚¿ÚÔ˘˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ÙˆÓ ·¯‡Û·ÚÎˆÓ Î·È ÏÈfiÛ·ÚÎˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, ‹ Ë ÔÌ¿‰· ÙˆÓ ·ÁÔÚÈÒÓ Â›¯Â ÌÂÁ·Ï‡ÙÂÚÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ Ó· ÂÌÊ·Ó›ÛÂÈ ÎÚ˘„ÔÚ¯›· ·fi fiÙÈ Ë ÔÌ¿‰· ÙˆÓ ÎÔÚÈÙÛÈÒÓ, ‹ Ë ‰È·ÊÔÚ¿ ÛÙËÓ ËÌÂÚ‹ÛÈ· ηٷӿψÛË ÛÈÁ·Ú¤ÙˆÓ ÌÂٷ͇ ηÓÈÛÙÚÈÒÓ Î·È ÌË Î·ÓÈÛÙÚÈÒÓ ÌËÙ¤ÚˆÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋". (T· ·Ú·‰Â›ÁÌ·Ù· ‰ÂÓ Â›Ó·È ·Ô΢‹Ì·Ù· Ê·ÓÙ·Û›·˜, Â›Ó·È ·fi ÎÚ›ÛÂȘ ¿ÚıÚˆÓ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÓÙ·ÂÙ›·˜). ¢‡ÛÎÔϘ ηٷÛÙ¿ÛÂȘ: AÓ·ÛÎfiËÛË Î·ÏÔÁÚ·Ì̤ÓË, ÂÎÙÂÓ‹˜, Û ÂӉȷʤÚÔÓ ı¤Ì·, ·fi Û˘Ó¿‰ÂÏÊÔ Ô˘ ‰ÂÓ ¤¯ÂÈ ·Û¯ÔÏËı› Ì ÙÔ ·ÓÙÈΛÌÂÓÔ. TÔ ¿ÚıÚÔ ‰ÂÓ ¤¯ÂÈ Ï¿ıË ·ÏÏ¿ ¤¯ÂÈ ÙËÓ ·ÌÂÛfiÙËÙ· ͤÓÔ˘ ÎÂÈ̤ÓÔ˘ ÌÂÙ·ÊÚ·Ṳ̂ÓÔ˘ ·fi ‰ËÌfiÛÈ· ˘ËÚÂÛ›·! O ÎÚÈÙ‹˜ ‰ÂÓ ¤¯ÂÈ Î¿ÙÈ Û˘ÁÎÂÎÚÈ̤ÓÔ Ó· ÚÔÛ¿„ÂÈ. ¢ÂÓ ¤¯ÂÈ Î·ÌÈ¿ ÚfiÙ·ÛË Ó· οÓÂÈ. H ¢ı‡ÓË ÙÔ˘ ·¤Ó·ÓÙÈ ÛÙÔ ÂÚÈÔ‰ÈÎfi ÙÔÓ ÂÌÔ‰›˙ÂÈ Ó· ÂÁÎÚ›ÓÂÈ ÙÔ ¿ÚıÚÔ. H Û˘Ì¿ıÂÈ¿ ÙÔ˘ ÛÙËÓ Ôχ ηϋ ÚÔÛ¿ıÂÈ· ÙÔ˘ Û˘ÁÁڷʤ· ÙÔÓ ÂÌÔ‰›˙ÂÈ Ó· ÚÔÙ›ÓÂÈ ·fiÚÚÈ„Ë. AÌÊÈÙ·Ï·ÓÙ‡ÂÙ·È. ¢ÂÓ Í¤ÚÂÈ Ò˜ Ó· ÙÂÎÌËÚÈÒÛÂÈ ÙËÓ ·ÓÙ›‰Ú·Û‹ ÙÔ˘: T¤ÙÔÈ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ‰ÂÓ ÁÚ¿ÊÔÓÙ·È Â‡ÎÔÏ·. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÎÚÈÙ¤˜ ÂÌÈÛÙ‡ÔÓÙ·È ÙÔ˘˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ ÙÔ˘˜ ÛÙÔ Û˘ÓÙ¿ÎÙË Ô˘ fiÔÈ· ·fiÊ·ÛË ÎÈ ·Ó ¿ÚÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ı· Ì›ÓÂÈ ÙÂÏÈο Ì ÙȘ ·ÌÊÈ‚Ôϛ˜ ÙÔ˘. ÿÛˆ˜ ÙÔ Úfi‚ÏËÌ· ı· ·ÚÔ˘ÛÈ·˙fiÙ·Ó Û·ÓÈfiÙÂÚ· ·Ó Ù· ‰Â˘ÙÂÚÔÁÂÓ‹ ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÁÚ¿ÊÔÓÙ·Ó ÌfiÓÔ ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË. A˘Ùfi fï˜ ı· ÂÚÈfiÚÈ˙ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙȘ ÁÓˆÛÙ¤˜ ηٷÍȈ̤Ó˜ ·˘ıÂÓٛ˜ Î·È ı· ÛÙÂÚÔ‡Û ÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜ ·fi ÙËÓ ·Ó·ÓˆÙÈ΋ ·ÚÔ˘Û›· ÙÔ˘ ηÈÓÔ‡ÚÁÈÔ˘ Û˘ÁÁڷʤ·. Afi ÙËÓ ¿ÏÏË, ÓÔÌ›˙ˆ fiÙÈ ÔÈ ·Ó·ÁÓÒÛÙ˜ ‰ÂÓ ı· ‹ıÂÏ·Ó Ó· ‰È·ÎÈÓ‰˘Ó‡ÛÔ˘Ó Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· Ù· ÙÂÏÂ˘Ù·›· ÂÈÙ‡ÁÌ·Ù· Ù˘ Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·fi οÔÈÔÓ ·Ó·Ù˘ÍÈÔÏfiÁÔ, Ô‡Ù ÁÈ· ÙȘ ÂÍÂÏ›ÍÂȘ ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ˘Á›· ·fi ÂÈÌÂÏËÙ‹ A' MÔÓ¿‰·˜ EÓÙ·ÙÈ΋˜ NÔÛËÏ›·˜ (2,4). TÔ ÂÚÒÙËÌ· ·Ó Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ó ÔÈ ÎÚÈÙ¤˜ Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ Ôχ ÙÔÓ È·ÙÚÈÎfi Ù‡Ô (5,11). Afi 269 ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘ ¤ÁÎÚÈÙˆÓ BÔÚÂÈÔ·ÌÂÚÈηÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ ÌfiÓÔ 46% ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·fiÎÚ˘„Ë ÙˆÓ
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·5
¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8
ÔÓÔÌ¿ÙˆÓ ÙˆÓ Û˘ÁÁڷʤˆÓ (5). YÔÙ›ıÂÙ·È fiÙÈ ·˘Ùfi Á›ÓÂÙ·È ÁÈ· Ó· ÚÔÊ˘Ï·¯ıÔ‡Ó ÔÈ Û˘ÁÁÚ·Ê›˜ ·fi ÙË ÌÂÚÔÏË„›· ÙÔ˘ ÎÚÈÙ‹, ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ‰È·ÊÔÚ¿ ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ÎÚ›Û˘ (5,11). ™ÙËÓ ¶AI¢IATPIKH ·ÎÔÏÔ˘ıÂ›Ù·È Ë ·fiÎÚ˘„Ë Ì ϋÚË Â›ÁÓˆÛË fiÙÈ Â›Ó·È ÂÓÙÂÏÒ˜ ¿ÛÎÔË: Ô ¯ÒÚÔ˜ Â›Ó·È ÌÈÎÚfi˜ Î·È Ô ÎÚÈÙ‹˜, ˆ˜ ÂȉÈÎfi˜, ÁÓˆÚ›˙ÂÈ Ôχ ηϿ ÔÈÔ˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ÂÈÚ·Ì·ÙÈο ÙÔ X Ê¿ÚÌ·ÎÔ ÛÙËÓ æ ·Ûı¤ÓÂÈ·, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙÔ ¤¯ÂÈ ‹‰Ë ·ÎÔ‡ÛÂÈ ˆ˜ Úfi‰ÚÔÌË ·Ó·ÎÔ›ÓˆÛË ÛÂ Û˘Ó¤‰ÚÈÔ Î·È Â›Ó·È Û ı¤ÛË Ó· ˘ÔÏÔÁ›ÛÂÈ ·ÎfiÌË Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÈϤÔÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ËÌÔÛ›Â˘ÛË. T· ÔÓfiÌ·Ù· ÙˆÓ ÎÚÈÙÒÓ ‰ÂÓ ÎÔÈÓÔÔÈÔ‡ÓÙ·È ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ·ÚfiÏÔ Ô˘ ÌÂÚÈÎÔ› Û˘ÓÙ¿ÎÙ˜ ı· ÙÔ ‹ıÂÏ·Ó (5,7), Î·È ÔÏÏÔ› ÎÚÈÙ¤˜ ·Ó ÚˆÙËıÔ‡Ó ‰ÂÓ ¤¯Ô˘Ó ·ÓÙ›ÚÚËÛË.(11) AÚÎÂÙÔ› ÎÚÈÙ¤˜ Ù˘ ¶AI¢IATPIKH™ fiÙ·Ó Î¿ÓÔ˘Ó ÂÚ›ÏÔΘ Î·È ‰˘ÛÎÔÏÔÂÊ¿ÚÌÔÛÙ˜ ÚÔÙ¿ÛÂȘ ÁÈ· ÙÚÔÔÔÈ‹ÛÂȘ, ÚÔÛʤÚÔÓÙ·È Ó· Û˘ÓÂÚÁ·ÛÙÔ‡Ó Û ÚÔÛˆÈ΋ ·ʋ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Â¿Ó ·˘ÙÔ› ÙÔ ÂÈı˘ÌÔ‡Ó. H ÚfiÙ·ÛË ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·Ô‰ÂÎÙ‹ ̤¯ÚÈ ÛÙÈÁÌ‹˜ ·fi ηӤӷ Û˘ÁÁڷʤ·. H ··ÙËÏ‹ ‰ËÌÔÛ›Â˘ÛË Â›Ó·È Ô ÂÊÈ¿ÏÙ˘ ÙˆÓ ‰È¢ı˘ÓÙÒÓ Û‡ÓÙ·Í˘.(2,3,5,13) K·Ù¿ÏÏËÏ· ÂÈÏÂÁ̤ÓÔÈ ÎÚÈÙ¤˜ Î·È Û˘ÓÙ¿ÎÙ˜ Â›Ó·È Ë ÌfiÓË ÂÍ·ÛÊ¿ÏÈÛË. ™ÙËÓ ¶AI¢IATPIKH Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ "·¿ÙË" ·ÏÏ¿ οÔÈÔ ıfiψ̷ ÙˆÓ ÛÙÔȯ›ˆÓ: .¯. ϤÁÂÙ·È fiÙÈ "ηٿ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ‹Û·Ó ˘ÁÈ›˜" Î·È ·ÔÛȈ¿Ù·È fiÙÈ ·Ú·ÎÔÏÔ˘ı‹ıËΠÌfiÓÔ ÙÔ 62%. ◊ ·ÔÛȈ¿Ù·È fiÙÈ Ë ÂÚÁ·Û›· ¤¯ÂÈ ˘Ô‚ÏËı› Î·È Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ™ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÎÚÈÙÒÓ ··Û¯ÔÏ› ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ Ë Èı·Ó‹ Û‡ÁÎÚÔ˘ÛË Û˘ÌÊÂÚfiÓÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ Î·È ÔÈÎÔÓÔÌÈÎÒÓ (3,5). °È· ÙÔÓ ‰ÈÎfi Ì·˜ ¯ÒÚÔ, Ë Î·Ï‹ ¯ˆÚÔÙ·ÍÈ΋ ηٷÓÔÌ‹ ÙˆÓ ÌÂÏÒÓ Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ Â›Ó·È ·Ôχو˜ ··Ú·›ÙËÙË ÁÈ· Ó· ·ÔʇÁÔÓÙ·È ÔÏÈÛı‹Ì·Ù· fiˆ˜ Ë ÂÈÏÔÁ‹ ÎÚÈÙ‹ Ô˘ Â›Ó·È Û˘ÓÂÚÁ¿Ù˘, ˘ÊÈÛÙ¿ÌÂÓÔ˜ ‹ ÚÔ˚ÛÙ¿ÌÂÓÔ˜ ÙˆÓ Û˘ÁÁڷʤˆÓ ‹ ÙÔ ¯ÂÈÚfiÙÂÚÔ, ÚÔۂϤÂÈ ÛÙËÓ ›‰È· ·Î·‰ËÌ·˚΋ ı¤ÛË Ì ÙÔÓ Û˘ÁÁڷʤ·. T· ÛÊ¿ÏÌ·Ù· Ô˘ ÛËÌÂÈÒıËÎ·Ó ÛÙËÓ ¶AI¢IATPIKH ÂÚÈÔÚ›˙ÔÓÙ·È Û ÂÚÈÙÒÛÂȘ fiÔ˘ ˙ËÙ‹ıËΠÎÚ›ÛË ·fi Û˘Ó·‰¤ÏÊÔ˘˜ Ô˘ ıˆÚÔ‡Û·Ó ‰ÂÔÓÙÔÏÔÁÈο ··Ú¿‰ÂÎÙÔ fiÙÈ ‰ÂÓ Â›¯Â ÂÚÈÏËÊı› ÙÔ fiÓÔÌ¿ ÙÔ˘˜ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‹ Ô˘ fiÓÙ·˜ ·Ï·ÈÔ› Û˘ÓÂÚÁ¿Ù˜ ÙˆÓ Û˘ÁÁڷʤˆÓ ‰È·ÊˆÓÔ‡Û·Ó Ì ÙÔ ¯ÂÈÚÈÛÌfi Ù˘ ˘fi ÎÚ›ÛÈÓ ÂÚÁ·Û›·˜. AÚÓ‹ıËÎ·Ó Â˘ÁÂÓÈο ÙËÓ ÎÚ›ÛË Ì οÔÈÔ ÚfiÛ¯ËÌ·. H ÛÎÔÈÌfiÙËÙ· Ù˘ ÎÚ›Û˘ ¿ÚıÚˆÓ ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËı› (3-5,13). M¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜
ÕÚıÚ· ™‡ÓÙ·Í˘
ÙÔ˘ '80 ‰ÂÓ ˘‹Ú¯Â ۯ‰fiÓ Î·ÌÈ¿ ÙÂÎÌËÚ›ˆÛË ÁÈ· Ù· ˆÊ¤ÏË Ù˘ ‰È·‰Èηۛ·˜ ÎÚ›Û˘ ÂÓÒ ˘‹Ú¯·Ó ·ÚÎÂÙ¿ ÛÙÔȯ›· ÁÈ· ÙȘ ·‰˘Ó·Ì›Â˜: ÎfiÛÙÔ˜, ¯ÚÔÓÈ΋ ηı˘ÛÙ¤ÚËÛË, ·ÓÔȯً Û ÌÂÚÔÏË„›Â˜ Î·È Û ÂÎÌÂÙ¿ÏÏ¢ÛË, ¤ÓÙÔÓ· ÂÈÊ˘Ï·ÎÙÈ΋ Û Ӥ˜ ȉ¤Â˜, ·Ó·Ú΋˜ ÛÙÔÓ ¤ÏÂÁ¯Ô ÂÈÛÙËÌÔÓÈ΋˜ ·¿Ù˘, Û˘¯Ó¿ ¯ÔÓ‰ÚÔÂȉҘ ÂÏÏÈ‹˜. (ŒÓ· ¿ÚıÚÔ Ô˘ ÂÚÈ›¯Â 8 ηٷÛ΢·Ṳ̂ӷ Ï¿ıË ÛÙ¿ÏıËΠ۠420 ÎÚÈÙ¤˜. Afi fiÛÔ˘˜ ·¿ÓÙËÛ·Ó, Ô˘‰Â›˜ ÂÂÛ‹Ì·Ó ÂÚÈÛÛfiÙÂÚ· ·fi 5 Ï¿ıË Î·È 16% ‰ÂÓ ‚Ú‹Î·Ó Ô‡Ù ¤Ó·!) (3) M ÙËÓ ÂͤÏÈÍË ÙÔ˘ Internet ÌÂÚÈÎÔ› ¤Êı·Û·Ó Ó· ÚÔÊËÙ‡ÛÔ˘Ó ÙÔ ı¿Ó·ÙÔ ÙÔ˘ ‚ÈÔ˚·ÙÚÈÎÔ‡ Ù‡Ô˘ (Ì ÙË ÛËÌÂÚÈÓ‹ ÙÔ˘ ÌÔÚÊ‹ Ù˘ ÂÏÂÁ̤Ó˘ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊÔÚ›·˜ Ô˘ ¤¯ÂÈ ÂÏÂÁ¯ı›, ÊÈÏÙÚ·ÚÈÛÙ›, ·Ó·ÌÔÚʈı›, ·fi οÔÈÔ ˘Â‡ı˘ÓÔ ÂÈÛÙËÌÔÓÈÎfi ÛÒÌ· Î·È ·Ú·‰›‰ÂÙ·È ¤ÙÔÈÌË ÛÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ·Ó·ÁÓÒÛÙË). (3,14) ŸÌˆ˜, ·Ú¿ ÙȘ ÂÈÊ˘Ï¿ÍÂȘ, ÔÈ Û˘ÓÙ¿ÎÙ˜ ÎÈÓ‹ıËÎ·Ó ÚÔ˜ ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ Ù‡Ô˘. ™ÙË ›‰È· ‰ÂηÂÙ›· Ù˘ ·ÌÊÈÛ‚‹ÙËÛ‹˜ Ù˘, Ë ‰È·‰Èηۛ· Ù˘ ÎÚ›Û˘ ÂÓfi˜ ÂÈÛÙËÌÔÓÈÎÔ‡ ¿ÚıÚÔ˘ ¤·„ ȷ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Û·Ó ÂÚ·ÛÈÙ¯ÓÈ΋ ··Û¯fiÏËÛË. AÓ·ÁÓˆÚ›ÛÙËΠˆ˜ ÓÂ˘Ì·ÙÈ΋ ¿ÛÎËÛË ·Ó¿ÏÔÁË ÚÔ˜ ÙȘ ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜, Ì ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· (4,13). ¢ËÏÒÓÂÙ·È fiÙÈ ‚Ú›ÛÎÂÙ·È "ÛÙËÓ Î·Ú‰È¿ Ù˘ ÂÈÛÙ‹Ì˘".(3) OÈ ÔÚÁ·ÓˆÌ¤Ó˜ ¤Ú¢Ó˜ Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·ÓÙÈΛÌÂÓÔ, ÚfiÛÊÂÚ·Ó ÙÂÎÌËÚȈ̤ӷ ÛÙÔȯ›· ÁÈ· Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ "ÊÈÏÙÚ·Ú›ÛÌ·ÙÔ˜" Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊÔÚ›·˜ Î·È ‚·ıÌÈ·›· Ê·›ÓÂÙ·È Ó· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÔÈ ÎÚ›ÛÂȘ ÛÙÔÓ ‚ÈÔ˚·ÙÚÈÎfi Ù‡Ô Î·È ÛÙËÓ ËÏÂÎÙÚÔÓÈ΋ ÂÈÎÔÈÓˆÓ›· ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ô‡Ù ÛÎfiÈÌÔ Ó· ηٷÚÁËıÔ‡Ó. AÏÒ˜ ı· ÌÂÙÂÍÂÏȯıÔ‡Ó, ı· Á›ÓÔ˘Ó ·ÓÔÈÎÙ¤˜, ›Ûˆ˜ ÈÔ ‰˘Ó·ÌÈΤ˜. ◊‰Ë οÔÈ· ¤ÁÎÚÈÙ· ÍÂÓfiÁψÛÛ· ÂÚÈÔ‰Èο ¿ÓÔÈÍ·Ó ÂχıÂÚÔ Â‰›Ô ÛÙÔ ‰È·‰›ÎÙ˘Ô fiÔ˘ ηÏÂ›Ù·È ÙÔ ÎÔÈÓfi Ó· ‰È·Ù˘ÒÓÂÈ ÎÚ›ÛÂȘ ÁÈ· ¿ÚıÚ· ÚÈÓ ·fi ÙËÓ ÙÂÏÈ΋ ÙÔ˘˜ ‰ËÌÔÛ›Â˘ÛË. (3) OÈ ÎÚÈÙ¤˜, ̤¯ÚÈ ÙÒÚ· ·˘ÙÔ‰›‰·ÎÙÔÈ, Âηȉ‡ÔÓÙ·È Û ÂȉÈο Û˘Ó¤‰ÚÈ·, ·ÎÔÏÔ˘ıÔ‡Ó ÏÂÙÔÌÂÚ›˜ Ô‰ËÁ›Â˜ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ (4,12,13), ı¤ÙÔ˘Ó ÂÚ¢ÓËÙÈο ÂÚˆÙ‹Ì·Ù· Î·È ÔÚÁ·ÓÒÓÔ˘Ó ÙË ÌÂıÔ‰ÔÏÔÁ›· ÙˆÓ ÎÚ›ÛÂˆÓ Ì ٷ ÎÚÈÙ‹ÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÁÈ· οı ÂÈÛÙËÌÔÓÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. Ÿ¯È! TÔ Internet ‰ÂÓ ÂÎÙfiÈÛ ÙÔ˘˜ ÎÚÈÙ¤˜. TÔ˘˜ ¤‰ˆÛ ÙÔ ¤Ó·˘ÛÌ· Ó· Á›ÓÔ˘Ó "ÂÈÛÙ‹ÌÔÓ˜" Î·È "·ÁÁÂÏ̷ٛ˜"! BÈ‚ÏÈÔÁÚ·Ê›· 1. B·Ï¿ÛÛË-A‰¿Ì E. KÚÈÙÒÓ ÂÁÎÒÌÈÔ. EÈÛÙÔÏ‹, Aگ›· EÏÏËÓ I·ÙÚ 1989,6: 489-490. 2. Goldbeck-Wood S. What makes a good reviewer of manuscripts? BMJ 1998;316:86.
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3. Smith R. Peer review: reform or revolution? BMJ 1997; 315:759-760. 4. °ÂÚÌÂÓ‹˜ AE. Afi ÙÔÓ °Ô˘ÙÂÌ‚¤ÚÁÈÔ ÛÙÔ Internet, KÚÈÙ¤˜ Î·È ™‡ÓÙ·ÍË. EΉfiÛÂȘ ¶··˙‹ÛË, Aı‹Ó· 1999. 5. Wilkes MS, Kravitz RL. Policies,practices, and attitudes of North American medical journal editors. J Gen Intern Med 1995;10:443-450. 6. Black N,van Rooyen S, Godlee F, Smith R, Evans S. What makes a good reviewer and a good review for a general medical journal? JAMA 1998;280:231-233. 7. Garrow J, Butterfield M, Marshall J,Williamson A. The reported training and experience of editors in chief of specialist clinical medical journals. JAMA 1998;280:286287. 8. Howard L, Wilkinson G. Peer review and editorial decisionmaking . Br J Psychiatry 1998;173:110-113. 9. Garfunkel JM, Lawson EE, Hamrick HL, Ulshen MH. Effect of acceptance or rejection on the author’s evaluation of peer review of medical manuscripts. JAMA 1990; 263:1376-1378. 10. Honein MA,Paulozzi LJ,Himelright IM,LeeB, Cragan JD,
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Patterson L et al. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: a case review and cohort study. Lancet 1999;354:2101-2105. van Rooyen S,Godlee F, Evans S,Black N,Smith R Effect of open peer review on quality of reviews and on reviewers' recommendations: a randomised trial. BMJ 1999;318:23-27. ™Ôω¿ÙÔ˜ KP. ™˘ÓÙ·ÎÙÈÎfi ¤ÚÁÔ. ™Ùfi¯ÔÈ Î·È ‰È·‰Èηۛ·. ÛÙÔ °Ú·Ùfi Û˘ÌfiÛÈÔ: ¶Ò˜ ÁÚ¿ÊÂÙ·È ¤Ó· È·ÙÚÈÎfi ¿ÚıÚÔ. Aگ›· EÏÏ I·ÙÚ 1995,12215-217. Rennie D. Editorial Peer Review in Biomedical Publication: The First International Congress in Guarding the Guardians. Research on Editorial Peer Review. Selected Proceedings JAMA 1990;263:1317 La Porte RE, Marler E, Akazawa S, Sauer F, Gamboa C,Shenton C et al Death of biomedical journals. BMJ 1995;310:1387-1390.
E. µ·Ï¿ÛÛË-∞‰¿Ì πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ª. ∞Û›·˜ 76, 115 27 ∞ı‹Ó·
H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ˆ˜ ̤ÛÔ ‰È¿ÁÓˆÛ˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ Ó¢ÌÔÓ›·˜ ÙˆÓ ·È‰ÈÒÓ ¶ÔÏ˘Í¤ÓË NÈÎÔÏ·˝‰Ô˘
P. Nikolaidou. Chest radiographs in the diagnosis and follow-up of pneumonia in children. Paediatriki 2000;63:6-8
radiographs are discussed with respect to childhood pneumonia. ∫ey words: radiographs, pneumonia.
● Abstract: The indications and limitations of chest
ø˜ Ó¢ÌÔÓ›· ÔÚ›˙ÂÙ·È Ë ÊÏÂÁÌÔÓ‹ ÙˆÓ Î˘„ÂÏ›‰ˆÓ ·fi ÏÔÈÌÔÁfiÓ· ·›ÙÈ·. ¢È·ÎÚ›ÓÂÙ·È, ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘, Û ÏÔ‚Ò‰Ë, ÙÌËÌ·ÙÈ΋, Î·È ˘ÔÙÌËÌ·ÙÈ΋ ‹ ‚ÚÔÁ¯ÔÓ¢ÌÔÓ›·. ¢È·ÎÚ›ÓÂÙ·È ·ÎfiÌË, ·Ó¿ÏÔÁ· Ì ÙÔÓ ÙfiÔ ÚÔ¤Ï¢Û˘ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·, Û Ó¢ÌÔÓ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ Î·È Û ÓÔÛÔÎÔÌÂȷ΋. A˘Ùfi ÙÔ ¿ÚıÚÔ Û‡ÓÙ·Í˘ ·Ó·Ê¤ÚÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙËÓ Ó¢ÌÔÓ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ Î·È ·ÔÛÎÔ› ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚfiÏÔ˘ Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒڷη ÛÙË ‰È¿ÁÓˆÛË Ù˘ Î·È ÙËÓ Èı·ÓÔÏfiÁËÛË ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· Ô˘ ÙËÓ ÚÔοÏÂÛÂ.
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H Ó¢ÌÔÓ›· Ù˘ ÎÔÈÓfiÙËÙ·˜ ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂÚ· ‚Ú¤ÊË Î·È Ó‹È· (4 ÂÂÈÛfi‰È· ÙÔÓ ¯ÚfiÓÔ ·Ó¿ 100 ‚Ú¤ÊË Î·È Ó‹È·), ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (2 ÂÂÈÛfi‰È· ÙÔÓ ¯ÚfiÓÔ ·Ó¿ 100 ·È‰È¿) Î·È ·ÎfiÌË ÈÔ Û¿ÓÈ· ÂÊ‹‚Ô˘˜ (1 ÂÂÈÛfi‰ÈÔ ÙÔÓ ¯ÚfiÓÔ ·Ó¿ 100 ÂÊ‹‚Ô˘˜). H ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, ÂÎÙfi˜ ·fi ÙË Û˘¯ÓfiÙËÙ·, ηıÔÚ›˙ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·. ŒÙÛÈ, Ë Ó¢ÌÔÓ›· ÙÔ˘ ÓÂÔÁÓÔ‡ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ‚·ÎÙ‹ÚÈ· (‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ B, ÏÈÛÙ¤ÚÈ·, ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ·ÚÓËÙÈο ηٿ Gram ‚·ÎÙ‹ÚÈ·), ·ÏÏ¿ Û ÈÔ‡˜ (.¯.
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:1-8
CMV, Èfi˜ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·). H Ó¢ÌÔÓ›· ÛÙ· ‚Ú¤ÊË ÂÓfi˜ ¤ˆ˜ ÙÚÈÒÓ ÌËÓÒÓ Û˘¯Ó¿ ÔÊ›ÏÂÙ·È ÛÙÔ ¯Ï·Ì‡‰ÈÔ ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜, ÙÔ Ô˘Ú¿ϷÛÌ· urealyticum, ÙÔ Ì˘ÎfiÏ·ÛÌ· hominis ·ÏÏ¿ Î·È Û ÈÔ‡˜ (CMV, RSV, ÈÔ› Ù˘ Áڛ˘ Î·È Ù˘ ·Ú·Áڛ˘, ·‰ÂÓÔ˚Ô›). H Ó¢ÌÔÓ›· ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 4 ÌËÓÒÓ Ì¤¯ÚÈ 5 ÂÙÒÓ Û˘¯ÓfiÙÂÚ· ÔÊ›ÏÂÙ·È Û ÈÔ‡˜ (RSV, ÈÔ› Áڛ˘, ·Ú·Áڛ˘, ·‰ÂÓÔ˚Ô›) Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ‚·ÎÙ‹ÚÈ· (Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, ·ÈÌfiÊÈÏÔ˜ Ù˘ Áڛ˘, ηٷÚÚÔ˚΋ ÌÔڷͤϷ). H Ó¢ÌÔÓ›· ÛÙË Û¯ÔÏÈ΋ Î·È ÙËÓ ÂÊË‚È΋ ËÏÈΛ· (6-21 ÂÙÒÓ) ΢ڛˆ˜ ÔÊ›ÏÂÙ·È Û ‚·ÎÙËÚȷο ·›ÙÈ· (Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È· Ó¢ÌÔÓ›·˜) (1). H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÔÙÂÏ› ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜. TÔÓ›˙ÂÙ·È fï˜, fiÙÈ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Û οı ÂÚ›ÙˆÛË, ÛÙËÓ ÔÔ›· Ì ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· Èı·ÓÔÏÔÁÂ›Ù·È Ó¢ÌÔÓ›· (1,2) ‰ÈfiÙÈ: ·) ·ÚÎÂÙ¿ Û˘¯Ó¿, ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, Ë Ó¢ÌÔÓ›· Ô˘ ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ‚¿ÛË ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È ·ÎÙÈÓÔÏÔÁÈο, ‚) Ë ÂÈ‚¿Ú˘ÓÛË ·fi ÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒڷη Â›Ó·È ˘ÔÏÔÁ›ÛÈÌË, ȉȷ›ÙÂÚ· ·Ó ¤¯Ô˘Ó Á›ÓÂÈ ÚÔËÁÔ˘Ì¤Óˆ˜ ·ÎÙÈÓÔÁڷʛ˜ ÁÈ· ÙÔÓ ›‰ÈÔ ‹ ¿ÏÏÔ ÏfiÁÔ, Î·È Á) ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Ó¢ÌÔÓÈÒÓ ÛÙ· ·È‰È¿ Â›Ó·È ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÂÔ̤ӈ˜ Ë ·ÂÈÎÔÓÈÛÙÈ΋ ÂȂ‚·›ˆÛË ‰ÂÓ ÚÔÛʤÚÂÈ ıÂڷ¢ÙÈ΋ ‚Ô‹ıÂÈ·. AÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÂÈ‚¿ÏÏÂÙ·È Ó· Á›ÓÂÙ·È (1,3) fiÙ·Ó: ·) ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ÛÙËı·ÎÔ˘ÛÙÈο Â˘Ú‹Ì·Ù· Ù˘ Ó¢ÌÔÓ›·˜ ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ‚·ÎÙËÚȷ΋˜ Ó¢ÌÔÓ›·˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÂÓ ÂÈÛËÁÔ‡ÓÙ·È Û·ÊÒ˜ ÈÔÁÂÓ‹ ÚԤϢÛË Ù˘ (.¯. ÂÁηٿÛÙ·ÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ·ÈÊÓ›‰È· Ì ˘„ËÏfi ˘ÚÂÙfi, ·Ô˘Û›· ÂΉËÏÒÛÂˆÓ ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ÛÙËı·ÎÔ˘ÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ), ‚) Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÂËÚ·Ṳ̂ÓË, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Èı·ÓÔÏÔÁÔ‡ÌÂÓÔ ·›ÙÈÔ (Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ·˘Ù‹˜ ı· ·ÔÙÂϤÛÔ˘Ó ÛÙÔȯ›· ·Ó·ÊÔÚ¿˜ ÁÈ· ÙËÓ ·ÂÈÎÔÓÈÛÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘), Î·È Á) Ë ·ÓÙÈ‚›ˆÛË Ô˘ ‹‰Ë ¤¯ÂÈ ¯ÔÚËÁËı› ¤¯ÂÈ ·ÔÙ‡¯ÂÈ. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ë ·ÎÙÈÓÔÁÚ·Ê›· Â›Ó·È ÂӉ¯fiÌÂÓÔ Ó· ·Ôηχ„ÂÈ ˘¿Ú¯Ô˘Û· ÂÈÏÔ΋ fiˆ˜ Â̇ËÌ· ‹ ·fiÛÙËÌ·.
ÕÚıÚ· ™‡ÓÙ·Í˘
H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÂÎÙfi˜ ·fi ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Ù˘ Ó¢ÌÔÓ›·˜, ‚ÔËı¿ ÛËÌ·ÓÙÈο ÛÙËÓ Èı·ÓÔÏfiÁËÛË ÙÔ˘ ·ÈÙ›Ô˘ Ù˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÈÔÁÂÓ‹ Ó¢ÌÔÓ›· Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤¯ÂÈ ·ÌÊÔÙÂÚfiÏ¢ڷ ‰È¿Û·ÚÙ· Â˘Ú‹Ì·Ù· Ô˘ Û˘Ó›ÛÙ·ÓÙ·È Û ˘ÔÙÌËÌ·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ, Û˘Ó‹ıˆ˜ ηٿ ÙËÓ ‡ÏË, ·ÙÂÏÂÎٷۛ˜ Î·È ÂÛٛ˜ ˘ÂÚ·ÂÚÈÛÌÔ‡ (4,5). ™ÙË ‚·ÎÙËÚȷ΋ Ó¢ÌÔÓ›· ÎÏ·ÛÈÎfi ·ÎÙÈÓÔÏÔÁÈÎfi ‡ÚËÌ· Â›Ó·È Ë ‰È‹ıËÛË ÙÌ‹Ì·ÙÔ˜ ‹ ÔÏfiÎÏËÚÔ˘ ÏÔ‚Ô‡ Ó‡ÌÔÓ· (6). MÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ·fiÛÙËÌ·, ÓÂ˘Ì·ÙÔ΋ÏË ‹ Î·È ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹. H Ì˘ÎÔÏ·ÛÌÈ΋ Î·È Ë ¯Ï·Ì˘‰È·Î‹ Ó¢ÌÔÓ›· ‰È·Ê¤ÚÔ˘Ó ·ÂÈÎÔÓÈÛÙÈο, fiˆ˜ ÂÍ¿ÏÏÔ˘ Î·È ÎÏÈÓÈο, ·fi ÙȘ ¿ÏϘ ‚·ÎÙËÚȷΤ˜ Ó¢ÌÔӛ˜ Î·È Ù· Â˘Ú‹Ì·Ù· ÌÔÈ¿˙Ô˘Ó Ì Ù˘ ÈÔÁÂÓÔ‡˜, Ù˘ ‚·ÎÙËÚȷ΋˜ Ó¢ÌÔÓ›·˜ ‹ Î·È ÙˆÓ ‰‡Ô Ì·˙› (7,8). ŒÙÛÈ, Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ù˘ Ì˘ÎÔÏ·ÛÌÈ΋˜ ‹ Ù˘ ¯Ï·Ì˘‰È·Î‹˜ Ó¢ÌÔÓ›·˜ ÌÔÚ› Ó· Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢Ú˜ ‰È¿Û·ÚÙ˜ ÂÚÈ‚ÚÔÁ¯ÈΤ˜ ‹ ÂÚÈ·ÁÁÂȷΤ˜ ‰ÈËı‹ÛÂȘ ‹ ÂÙÂÚfiÏ¢Ú˜ ÙÌËÌ·ÙÈΤ˜ ˘ÎÓÒÛÂȘ. ™˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ‰ÈfiÁΈÛË ÙˆÓ ˘Ï·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹, Û˘Ó‹ıˆ˜ ÌÈÎÚ‹. H ÂӉ‰ÂÈÁ̤ÓË ÚÔ‚ÔÏ‹ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È Ë ÚÔÛıÔ›ÛıÈ· (9). ¶ÚfiÛıÂÙ˜ ·ÎÙÈÓÔÁڷʛ˜ (.¯. Ï¿ÁȘ, ÏÔͤ˜) ÌÔÚ› Ó· ‰ÒÛÔ˘Ó ÂÈϤÔÓ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÂÓÙfiÈÛË Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ Ó¢ÌÔÓ›·˜ ÌfiÓÔ Û ÔÛÔÛÙfi Ô˘ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 3% Î·È ÁÈ' ·˘Ùfi ÛÙËÓ Ú¿ÍË Û¿ÓÈ· ¯ÚÂÈ¿˙ÔÓÙ·È. E·Ó¿ÏË„Ë Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒڷη Á›ÓÂÙ·È ÌfiÓÔ ÛÙȘ ‚·ÎÙËÚȷΤ˜ Ó¢ÌÔӛ˜, ‰ËÏ·‰‹ ÛÙȘ ÏÔ‚Ò‰ÂȘ ‹ ÙÌËÌ·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ, ÁÈ· Ó· ‚‚·Èˆı› Î·È ·ÂÈÎÔÓÈÛÙÈο Ë ·ÔηٿÛÙ·ÛË Ù˘ ‚Ï¿‚˘ Î·È Î˘Ú›ˆ˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› ÙÔ ÂӉ¯fiÌÂÓÔ Ó· ÚÔ¸‹Ú¯Â ·Ó·ÙÔÌÈ΋ ‚Ï¿‚Ë (.¯. Û˘ÁÁÂÓ‹˜ ·ÛÙË, ·fiÏ˘Ì·) (1,10). M ‰Â‰Ô̤ÓÔ fiÙÈ ÔÈ ·ÎÙÈÓÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ Ó¢ÌÔÓ›·˜ ·Ôηı›ÛÙ·ÓÙ·È Û ‰È¿ÛÙËÌ· Ô˘ ÌÔÚ› Ó· Êı¿ÛÂÈ ÙȘ 8 ‚‰ÔÌ¿‰Â˜, Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ ·ӤÏÂÁ¯Ô˜ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ‰‡Ô Ì‹Ó˜ ÂÚ›Ô˘ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜. BÈ‚ÏÈÔÁÚ·Ê›· 1. Schidlow DV, Callahan CW. Pneumonia Pediatr Rev 1997; 17: 300-309. 2. Swingler GH, Hussey GD, Zwarenstein MZ. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet 1998; 351: 404-408. 3. Redd SC, Patrick E, Vreuls R, Metsing M, Moteetee M. Comparison of the clinical and radiographic diagnosis of
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paediatric pneumonia. Trans R Soc Trop Med Hyg 1994; 88: 307-310. Han BK, Yoon HK, Lee SI. Epidemic adenoviral lower respiratory tract infection in pediatric patients: radiographic and clinical characteristics. AJR Am J Roentgenol 1998; 170: 1077-1080. Wahlgren H, Mortensson W, Eriksson M, Finkel Y, Forsgren M. Radiographic patterns and viral studies in childhood pneumonia at various ages. Pediatr Radiol 1995; 25: 627-630. Davies HD, Wang EE, Manson D, Babyn P, Shuckett B. Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. Pediatr Infect Dis J 1996; 15:600-604. Castriota-Scanderbeg A, Popolizio T, Sacco M, Coppi M, Scarale MG, Cammisa M. Diagnosis of mycoplasma pneumonia in children: which is the role of thoracic radiography? Radiol Med 1995; 89: 782-786.
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8. Kauppinen MT, Lahde S, Syrjala H. Roentgenographic findings of pneumonia caused by Chlamydia pneumoniae. A comparison with streptococcus pneumonia. Arch Intern Med 1996; 156: 1851-1856. 9. Patenaude Y, Blais C, Leduc CP. Reliability of frontal chest x-ray in diagnosing pulmonary opacities in children. Invest Radiol 1995; 30: 44-48. 10. Heaton P, Arthur K. The utility of chest radiography in the follow-up of pneumonia. N Z Med J 1998; 111: 315-317.
¶ÔÏ˘Í¤ÓË NÈÎÔÏ·˝‰Ô˘ ∞’ ¶·È‰. ∫ÏÈÓÈ΋ ¶·Ó. ∞ıËÓÒÓ ¡ÔÛ. ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·», 115 27 ∞ı‹Ó·
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16
ANA™KO¶H™H
KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ· ¢ËÌÔÛı¤Ó˘ AÏÂ͛Ԣ, ŸÏÁ· °Ú·Ê¿ÎÔ˘
● ¶ÂÚ›ÏË„Ë: ÕÚıÚÔ ·Ó·ÛÎfiËÛ˘ ·Ó·ÊÔÚÈο Ì ÙË Û˘¯ÓfiÙËÙ·, ÙË Û˘Ìو̷ÙÔÏÔÁ›·, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È ÙËÓ ·ÈÙÈÔÏÔÁ›·, ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ȉÈÔ·ıÔ‡˜ (ÚˆÙÔ·ıÔ‡˜) Î·È Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÔÎÎȈ̿وÛ˘ ÙÔ˘ ‹·ÙÔ˜. ¶·È‰È·ÙÚÈ΋ 2000;63:9-16. §¤ÍÂȘ ÎÏÂȉȿ: Ë·Ù›Ùȉ·, ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜, ÎÔÎÎÈÒÌ·Ù· ‹·ÙÔ˜. D. Alexiou, O. Grafakou. Granulomatous Hepatitis. Paediatriki 2000;63:9-16. ● Abstract: This paper presents a review of the frequency, the clinical and laboratory findings and the histological features, as well as the pathogenesis and the treatment of idiopathic and secondary granulomatous hepatitis. Key words: hepatitis, prolonged fever of unknown origin, hepatic granulomata.
EÈÛ·ÁˆÁ‹ EÏ·ÊÚ¿ ‰È·Ù·Ú·¯‹ ÙˆÓ Û˘Ó‹ıˆÓ Ë·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, fiˆ˜ ÌÈÎÚ¿ ·‡ÍËÛË, ̤¯ÚÈ 200 IU/l, ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ Á-GT Î·È Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ Û˘¯Ó¿ Û ‰È¿ÊÔÚ˜ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ (1). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ë ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‹·ÙÔ˜ ‰ÂÓ Â›Ó·È Û˘¯Ó‹, ÂÓÒ ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ Û¿ÓÈÔ ·ÏÏ¿ ˘·ÚÎÙfi ‡ÚËÌ· Â›Ó·È ÙÔ ÎÔÎΛˆÌ·. ¶·Ï·ÈfiÙÂÚ·, ·Ó·ÊÂÚfiÙ·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ÎÔÎÎÈˆÌ¿ÙˆÓ Û ˘ÏÈÎfi ‚ÈÔ„ÈÒÓ ‹·ÙÔ˜ ÁÂÓÈÎÔ‡ ÓÔÛÔÎÔÌ›Ԣ ·ÓÂÚ¯fiÙ·Ó Û 3-10% (2). OÈ Mac Cluggage Î·È Sloam (3) Û ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Î¿Ï˘Ù·Ó ÂÚ›Ô‰Ô 13 ¯ÚfiÓˆÓ (1980-92) ·Ú·Ù‹ÚËÛ·Ó ÂÈıËÏȷο ÎÔÎÎÈÒÌ·Ù· ÛÙÔ 4%. EÚfiÎÂÈÙÔ ‰ËÏ·‰‹ ÁÈ· ÂÚÈÙÒÛÂȘ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ Ë·Ù›Ùȉ·˜ (KH) Ô˘ ‚Ú¤ıËÎ·Ó ˆ˜ ‰Â˘ÙÂÚÔ·ı›˜ ÂΉËÏÒÛÂȘ οÔÈ·˜ ·ıÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÌÂ Û˘¯ÓfiÙÂÚË ÙËÓ ÚˆÙÔ·ı‹ ¯ÔÏÈ΋ ΛÚÚˆÛË (55%) Î·È ÙË Û·ÚÎÔ›‰ˆÛË (19%). ÕÏϘ ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ·Èٛ˜ ‹Ù·Ó Ë Ê˘Ì·Ù›ˆÛË, Ë ÓfiÛÔ˜ ÙÔ˘ Crohn, Ë ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ Ë·Ù›Ùȉ·, Ë ˘ÂÚ¢·ÈÛıËÛ›· Û ʿÚ̷η Î·È Ë Â͈˷ÙÈ΋ ·fiÊÚ·ÍË ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ. ™Â 11 ·ÛıÂÓ›˜ (ÔÛÔÛÙfi 75%) Ë KH ıˆڋıËΠȉÈÔ·ı‹˜. ™ÙÔÓ ›Ó·Î· 1 Ê·›ÓÔÓÙ·È Ù· ·ıÔÁÂÓÂÙÈο ·›ÙÈ· Ù˘ KH Û ¿ÏÏË ÌÂϤÙË.
¶›Ó·Î·˜ 1. A›ÙÈ· ÚfiÎÏËÛ˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ηٿ ÛÂÈÚ¿ Êı›ÓÔ˘Û·˜ Û˘¯ÓfiÙËÙ·˜. ™·ÚÎÔ›‰ˆÛË º˘Ì·Ù›ˆÛË §ÔÈÌÒÍÂȘ (ÌÈÎÚԂȷΤ˜, ÈÔÁÂÓ›˜, Ì˘ÎËÙÈ·ÛÈΤ˜, ÚÈÎÂÙÛÈÒÛÂȘ) XÚfiÓȘ Ë·ÙÔ¿ıÂȘ Î·È ÈÔÁÂÓ›˜ Ë·Ù›Ùȉ˜ (ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË, Ë·Ù›Ùȉ· A Î·È C) º¿Ú̷η IÛÙÔÏ¿Û̈ÛË •¤Ó˜ ÚÔ˜ ÙÔÓ ÔÚÁ·ÓÈÛÌfi Ô˘Û›Â˜ (¯·ÏÎfi˜, ‚ËÚ‡ÏÏÈÔ, Ù·ÏÎ Î·È ¿ÏÏ· ̤ٷÏÏ·) Vial Î·È Descotes 1993, ÙÚÔÔ. (4).
™Â ·Ó¿ÏÔÁË ¤Ú¢ӷ ·fi ÙË BfiÚÂÈÔ IÙ·Ï›· (5) Û 1523 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û 5 ¯ÚfiÓÈ·, ÎÔÎÎÈÒÌ·Ù· ‚Ú¤ıËÎ·Ó ÛÙÔ 1%, ‰ËÏ·‰‹ Û 15 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 43-71 ¯ÚfiÓˆÓ (̤ÛË ËÏÈΛ· 57 ¯ÚfiÓÈ·). T· Â˘Ú‹Ì·Ù· ·Ô‰fiıËÎ·Ó Î˘Ú›ˆ˜ Û ÏÔÈÌÒ‰ÂȘ ÓfiÛÔ˘˜. ¢È·¯ÚÔÓÈο, ÔÏÏÔ› Û˘ÁÁÚ·Ê›˜ ‰È·›ÛÙˆÛ·Ó ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÏÔÈÌÒ‰Ë ‹ ÌË ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ‹ ÛÂ
B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ
9
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·10
¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16
‰È¿ÊÔÚ˜ ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ fiˆ˜, Û¯ÈÛÙÔۈ̛·ÛË, ÓfiÛÔ˜ ÙÔ˘ Hodgkin, ·ÎÙÈÓÔ‚ÔÏ›·, ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË, ¯ËÌÂÈÔıÂڷ›· Î·È Ê¿Ú̷η. ÕÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ Û˘Ó‰ÂfiÙ·Ó Ì ÙËÓ ·Ó‡ÚÂÛË ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú ‹Ù·Ó: fiÁÎÔÈ ÂÓÙÔÈṲ̂ÓÔÈ ÛÙËÓ ÎÔÈÏȷ΋ ¯ÒÚ·, fiˆ˜ ηÚΛӈ̷ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Î·È ÌË Hodgkin ϤÌʈ̷ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. TÔ 1991, ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ›‰ÈÔ˘ ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ Û ˘ÏÈÎfi ·fi ÙË Mayo Clinic ÁÈ· Ì›· ÂÚ›Ô‰Ô 13 ¯ÚfiÓˆÓ, ·ÔÎ¿Ï˘„ 88 ÂÚÈÙÒÛÂȘ ÎÔÎÎÈˆÌ¿ÙˆÓ (6). ™ÙÔ ˘ÏÈÎfi ·˘Ùfi Ë È‰ÈÔ·ı‹˜ KH ·ÔÙÂÏÔ‡Û ÙÔ 50% Î·È ·fi Ù· ˘fiÏÔÈ· ·›ÙÈ·, ÙÔ 22% Ë Û·ÚÎÔ›‰ˆÛË Î·È 6% Ù· Ê¿Ú̷η. TÔ 28% ÔÊÂÈÏfiÙ·Ó Û ¿ÏÏ· ·›ÙÈ·. H KH ˆ˜ ÈÛÙÔÏÔÁÈÎfi ‡ÚËÌ· ·Ú·ÙËÚÂ›Ù·È Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÌÂÏÈÙ·›Ô˜, Î·È Ï¤Ú· (7). Afi ¿Ô„Ë Û˘¯ÓfiÙËÙ·˜, ÛÙȘ ·ÏÈfiÙÂÚ˜ ÂÚÁ·Û›Â˜ Ë ‰Â˘ÙÂÚÔ·ı‹˜ ·fi Ê¿Ú̷η KH ·Ó·ÊÂÚfiÙ·Ó fiÙÈ ·Ó¤Ú¯ÂÙ·È Û 1-2% (8), ÂÓÒ Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ÂÚÁ·Û›Â˜, ÙÔ ÔÛÔÛÙfi ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·ÓÂÚ¯fiÌÂÓÔ Û 6-29% (6). Afi Ù· ·ÓˆÙ¤Úˆ Â›Ó·È ÚÔÊ·Ó¤˜, fiÙÈ Û˘¯ÓfiÙÂÚË Â›Ó·È Ë ‰Â˘ÙÂÚÔ·ı‹˜ KH ·Ú·ÙËÚÔ‡ÌÂÓË Î˘Ú›ˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÏÔÈÌÒ‰Ë ‹ ÌË ·›ÙÈ·. TÔ Ï›ÛÙÔ ÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ó·ÊÔÚÒÓ ÛÙËÓ KH ·ÊÔÚÔ‡Ó Û ÂÓ‹ÏÈΘ. TÂÏÂ˘Ù·›·, Û fiÏÔ Î·È ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ‰Â˘ÙÂÚÔ·ı›˜ Û ÏÔÈÌÒÍÂȘ ÂÚÈÙÒÛÂȘ, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿. ¶ÚÔÊ·Ó¤˜ Â›Ó·È fiÙÈ Ë KH Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌfiÏȘ ÙÒÚ· ·Ú¯›˙ÂÈ Ó· ·ÔηχÙÂÙ·È. AÈÙÈÔÏÔÁ›· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÔÎÎȈ̿وÛ˘ ÙÔ˘ ‹·ÙÔ˜ ¶ÔÏÏ¿ Î·È ÔÈΛϷ Â›Ó·È Ù· ·›ÙÈ· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH. H Ï›ÛÙ· ÙˆÓ ·ÈÙ›ˆÓ ·˘Í¿ÓÂÈ Û˘Ó¯Ҙ Ì ÙËÓ ÚÔÛı‹ÎË ·Û˘Ó‹ıˆÓ ·fi ¿Ô„Ë ·ÈÙÈÔÏÔÁ›·˜ ÂÚÈÙÒÛˆÓ. ·) §ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ¶ÔÏÏ¿ Â›Ó·È Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÛÙ· ÔÔ›· ·Ú·ÙËÚ‹ıËÎ·Ó ÎÔÎÎÈÒÌ·Ù· ÛÙÔ ‹·Ú. OÈ ÂÚÈÙÒÛÂȘ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È, fiÛÔ Ë KH Á›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÁÓˆÛÙ‹. O ›Ó·Î·˜ ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË KH ÚԂϤÂÙ·È fiÙÈ ı· ÏÔ˘Ù›˙ÂÙ·È ÛÙ· ÂfiÌÂÓ· ¯ÚfiÓÈ·. ¶ÂÚÈÛÙ·Ûȷο ÂÚÈÁÚ¿ÊÙËÎ·Ó Î·È ¿ÏÏ· ÓÔÛ‹Ì·Ù· ÛÙ· ÔÔ›· ‰È·ÈÛÙÒıËΠKH Û ‚ÈÔ„›Â˜, fiˆ˜ Ë ·ÌÔÈ‚¿‰ˆÛË (9), Ë ÔÔ›· ÛÙÔ ‹·Ú ‰ËÌÈÔ˘ÚÁ› ΢ڛˆ˜ ·ÔÛÙ‹Ì·Ù·, Ë ‚ÚԢΤÏψÛË (10), Ô Ù˘ÊÔÂȉ‹˜ ˘ÚÂÙfi˜ (11) Î·È Ë ÛÏ·¯ÓÈ΋ ÏÂ˚ÛÌ·Ó›·ÛË (12). KÔÎÎȈ̷ÙÒ‰ÂȘ ‚Ï¿‚˜ ÛÙÔ ‹·Ú ·Ó·Ê¤ÚıËÎ·Ó Â›Û˘ Û Ïԛ̈ÍË ·fi EB (13), Î·È CMV (14,15), fiˆ˜ Î·È Û ÁÂÓÈÎÂ˘Ì¤ÓË ÛÙ·Ê˘ÏÔÎÔÎÎÈ΋ Ïԛ̈ÍË (16). TÔ ÂӉȷʤÚÔÓ ÛÙȘ ÂÚÈÙÒÛÂȘ CMV Â›Ó·È fiÙÈ Ù· Ù˘Èο Û˘ÌÙÒÌ·Ù·
10
¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘
Ù˘ ÓfiÛÔ˘ ·Ú·ÙËÚ‹ıËÎ·Ó 3 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú. KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ÓfiÛËÛË ·fi Ë·Ù›Ùȉ· A Î·È ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C. º˘Ì·Ù›ˆÛË Î·È ‰È·ÛÔÚ¿ BCG: H ‰È·ÛÔÚ¿ ÙÔ˘ ‚·Î›ÏÔ˘ Calmette-Guerin (BCG) Ì ÚfiÎÏËÛË KH ‹ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘ Â›Ó·È ÁÓˆÛÙ‹ Î·È ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ Û ·È‰È¿ Ì ·ÓÔÛÔÏÔÁÈ΋ ÌÂÈÔÓÂÎÙÈÎfiÙËÙ·, ÌÂÙ¿ ·fi ÂÓ‰Ô‰ÂÚÌÈ΋ ¤Á¯˘ÛË ÚÔÎÂÈ̤ÓÔ˘ ÂÚ› ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·ÏÏ¿ Î·È Û ÂÓ‹ÏÈΘ fiÔ˘ ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ¿ ·fi ÂÓ‰Ô΢ÛÙÈ΋ ¤Á¯˘ÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÂÈ ÌË ÂȉÈ΋ ·ÁˆÁ‹, ΢ڛˆ˜ ηٿ ÙÔ˘ ÂÈÔÏ‹˜ ηÚΛÓÔ˘ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ (17). H ‰È·ÛÔÚ¿ ÚÔηÏÂ›Ù·È ÏfiÁˆ οΈÛ˘ Ù˘ Ô˘Ú‹ıÚ·˜ ‹ ·ÎfiÌ· Î·È ·Ô˘Û›· οΈÛ˘. ™ÙÔ Ï›ÛÙÔ ÙˆÓ ·ÛıÂÓÒÓ, Ë ‰È·ÛÔÚ¿ ·ÎÔÏÔ˘ı› Ù· Ê·ÈÓfiÌÂÓ· ÙÔÍÈÎfiÙËÙ·˜ Î·È ˘„ËÏÔ‡ ˘ÚÂÙÔ‡ Ô˘ ÂΉËÏÒıËÎ·Ó Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÓ‰Ô΢ÛÙÈΤ˜ ÂÁ¯‡ÛÂȘ BCG (18). ¶ÂÚ›ÙˆÛË ‰È·ÛÔÚ¿˜ ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ "mycobacterium scrofulatum" ·Ó·Ê¤ÚıËΠ۠¿ÙÔÌ· Ì AIDS ‹ Ì ¿ÏÏË ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Â ÂÓ‹ÏÈη ·ÛıÂÓ‹ ÂÌÊ·Ó›ÛÙËÎ·Ó ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ίÚÔÂȉԇ˜ Ê˘Ì·Ù›ˆÛ˘, ÏÂÌÊ·‰ÂÓ›Ùȉ·, ˘Ô‰fiÚÈ· ·ÔÛÙ‹Ì·Ù· Î·È KH (19). Afi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ ¤¯ÂÈ ·Ó·ÊÂÚı› Û˘Ó‰˘·ÛÌfi˜ ˘ÚÈÙ›·Û˘ (silicosis), ίÚÔÂȉԇ˜ Ê˘Ì·Ù›ˆÛ˘ Î·È KH (20). TÂÏÂ˘Ù·›· (21) ·ÈÙÈÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÙÔ˘ ‹·ÙÔ˜ ¤‰ÂÈÍ fiÙÈ, Û˘ÁÎÚÈÙÈο Ì ÙÔ ·ÚÂÏıfiÓ, ÔÈ ÂÚÈÙÒÛÂȘ KH fiˆ˜ Î·È ÔÈ ÂÚÈÙÒÛÂȘ Ê˘Ì·Ù›ˆÛ˘ ÙÔ˘ ‹·ÙÔ˜ ·˘Í‹ıËÎ·Ó ÛÙÔ˘˜ HIV ıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜. NfiÛÔ˜ ·fi ·Ì˘¯¤˜ Á¿Ù·˜: EÎÙfi˜ ·fi ÙȘ Ù˘ÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Û 5% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ¿Ù˘Â˜ ÂΉËÏÒÛÂȘ ÛÙȘ Ôԛ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÂÁÎÂÊ·Ï›Ùȉ·, ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ Parinaud Î·È Ë KH. OÈ ÂÚÈÙÒÛÂȘ KH ·Ó·Ê¤ÚÔÓÙ·È Û ·È‰È¿ Ì ·‰ÂÓ›Ùȉ·, ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÔÏÏ·Ï¿ ÎÔÎÎÈÒÌ·Ù· ÛÙÔ ‹·Ú Î·È ÙÔ ÛÏ‹Ó·. ™Â 28 ·È‰È¿ Ì ÓfiÛÔ ·fi ·Ì˘¯¤˜ Á¿Ù·˜ Ô˘ ÓÔÛËχÙËÎ·Ó ÂÓ ÛÂÈÚ¿ ÛÙË B' ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, KH ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 15,4%. H ÓfiÛÔ˜ ·fi ·Ì˘¯¤˜ Á¿Ù·˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜, ÌÂÙ¿ ÙËÓ ÔÍ›· ÓfiÛËÛË ·fi ˘ÚÂÙfi Q ·Èٛ˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH ·fi Ïԛ̈ÍË. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È 40 Î·È Ï¤ÔÓ ÂÚÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ Ì ·Ó¿Ù˘ÍË ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú (22). OÍ›· ÓfiÛËÛË ·fi ˘ÚÂÙfi Q: H ÓfiÛÔ˜ Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÂÏ·ÊÚ¤˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ‹·ÙÔ˜, ·ÏÏ¿ KH ··ÓÙ¿Ù·È Û·ÓÈfiÙÂÚ·. H KH, ˆ˜ ÌÔÓ·‰È΋ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Û¿ÓÈ· ·Ó Î·È ·Ú·ÙËÚÔ‡ÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û˘¯ÓfiÙËÙ·˜ ·fi ¯ÒÚ· Û ¯ÒÚ·. ™ÙË °·ÏÏ›· .¯. ÙÔ 61,9% ÙˆÓ ÔͤˆÓ ÂÚÈÙÒÛÂˆÓ ˘ÚÂÙÔ‡ Q ·ÚÔ˘-
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·11
¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16
ÛÈ¿˙Ô˘Ó Ë·Ù›Ùȉ·, ÂÓÒ ÛÙÔÓ K·Ó·‰¿ ·ÔÎÏÂÈÛÙÈ΋ ۯ‰fiÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë Ó¢ÌÔÓ›· (23,24). ¶ÂÚÈÁÚ¿ÊËΠÂÚ›ÙˆÛË ÔÍ›·˜ ÓfiÛËÛ˘ ·fi coxciella burnetti Ë ÔÔ›· ÂΉËÏÒıËΠˆ˜ KH. ™˘Ó‰˘·ÛÌfi˜ ˘ÚÂÙÔ‡ Q, Ô˙Ò‰Ô˘˜ ÂÚ˘ı‹Ì·ÙÔ˜ Î·È KH Û ¿ÙÔÌÔ Ì ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÂÚÈÁÚ¿ÊÙËΠ·fi ¿ÏÏÔ˘˜ (25). ™¯ÈÛÙÔۈ̛·ÛË: ™ÙË ™·Ô˘‰È΋ AÚ·‚›· Ë Û¯ÈÛÙÔۈ̛·ÛË Â›Ó·È Û˘¯Ó‹ ÓfiÛÔ˜. ™Â 404 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËηÓ, KH ‚Ú¤ıËΠ۠ÔÛÔÛÙfi 14,6%. H ·ÈÙÈÔÏÔÁÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù· ÎÔÎÎÈÒÌ·Ù· ÔÊÂÈÏfiÙ·Ó ÛÙË ÓfiÛÔ 54,2%) (11). ‚) MË ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ¶ÚfiÎÂÈÙ·È Î˘Ú›ˆ˜ ÁÈ· ÓÔÛ‹Ì·Ù· ÙÔ˘ ÏÂÌÊÔÔÈËÙÈÎÔ‡ ÈÛÙÔ‡, ηÎÔ‹ıÂȘ Î·È ÓÔÛ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡. ™·ÚÎÔ›‰ˆÛË: E›Ó·È ‰˘Ó·ÙfiÓ, ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ Ù˘ÈÎÒÓ Î·È ¿Ù˘ˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ÓfiÛÔ˘ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Î·È ‚Ï¿‚˜ KH. °ÂÓÈο, Ë Û·ÚÎÔ›‰ˆÛË Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓË ÎÔÎÎȈ̷Ù҉˘ ÓfiÛÔ˜ Ô˘ Û˘ÓËı¤ÛÙÂÚ· ÚÔÛ‚¿ÏÏÂÈ ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Î·È ÙÔ˘˜ ·‰¤Ó˜ ÙÔ˘ ÌÂÛÔÓ¢ÌfiÓÈÔ˘. H ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ÛÏ‹Ó· Â›Ó·È Û˘Ó‹ı˘ ·Ó Î·È ·Ô‰ÂÈÎÓ‡ÂÙ·È ÌfiÓÔ ·fi ÙȘ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜. H ‚ÈÔ„›· ÙÔ˘ ÛÏ‹Ó· Ì ‚ÂÏfiÓ· Û ·ÛıÂÓ›˜ Ì ۷ÚÎÔ›‰ˆÛË ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ Û ÔÛÔÛÙfi 24-29% Î·È ÛÙÔ ‹·Ú Û ÔÛÔÛÙfi 24-79%, ÂÓÒ Ë ‰ÈÂÚ‡ÓËÛË Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·ÔηχÙÂÈ ÎÔÎÎȈ̷ÙÒ‰ÂȘ ‚Ï¿‚˜ Û ÔÛÔÛÙfi ÌfiÓÔ 5-15%. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ACE (angiotensin converting enzyme) ‚ÔËı¿ ÛÙËÓ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË (26), ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó Ó¢ÌÔÓÈΤ˜ ‚Ï¿‚˜. ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜: H KH, ˆ˜ Û¿ÓÈ· ·ÈÙ›· ‰È·Ù·Ú·¯‹˜ Ù˘ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ¤¯ÂÈ ·Ó·ÊÂÚı› ÙfiÛÔ ÛÙÔÓ ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (27) fiÛÔ Î·È ÛÙË ÓfiÛÔ Crohn (28). Á) º¿Ú̷η ‹ ̤ٷÏÏ· H ÎÈÓȉ›ÓË, Ë ·ÏÏÔÔ˘ÚÈÓfiÏË Î·È Ë Î·Ú‚·Ì·˙›ÓË Î·È Ôχ Û·ÓÈfiÙÂÚ· Ù· ·ÓÙÈ‚ÈÔÙÈο Â›Ó·È Ê¿Ú̷η Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH. °ÂÓÈÎfiÙÂÚ·, ÔÏÏ¿ Î·È ÔÈΛϷ Â›Ó·È Ù· Ê¿Ú̷η Ô˘ ηÙËÁÔÚ‹ıËÎ·Ó fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÈÏÔ΋ ·˘Ù‹. ¶Ï‹Ú˘ ηٿÏÔÁÔ˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ Vial Î·È Descombe (4) ÁÈ· ‰Â Ù· ·ÓÙÈ‚ÈÔÙÈο ÛÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ Georges Î·È Grawford (29). KÈÓ›ÓË-KÈÓȉ›ÓË: E›Ó·È ·ÓıÂÏÔÓÔÛȷο Ê¿Ú̷η Ô˘ ηÙËÁÔÚ‹ıËÎ·Ó fiÙÈ ÚÔηÏÔ‡Ó KH. H ·ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú Â›Ó·È Û˘¯Ófi ‡ÚËÌ· ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ Î·È ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 70% ÙˆÓ
KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ·
·ÛıÂÓÒÓ (30). H ÂÈÏÔ΋ ·Ú·ÙËÚÂ›Ù·È Ì fiÏ· Ù· ¿Ï·Ù· Ù˘ ÎÈÓȉ›Ó˘, ÂÓÒ Â›Ó·È Ôχ Û·ÓÈfiÙÂÚË Û ϋ„Ë ÎÈÓ›Ó˘ (31). KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ϋ„Ë Û˘Ó‰˘·ÛÌÔ‡ ˘ÚÈÌÂı·Ì›Ó˘-¯ÏˆÚÔΛÓ˘ (32). AÏÏÔÔ˘ÚÈÓfiÏË: KH ÂÚÈÁÚ¿ÊÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ 50% ÙˆÓ ·ÙfiÌˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙÔ Ê¿ÚÌ·ÎÔ (33). T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Â›Ó·È ·˘Ù¿ Ù˘ ¯ÔÏfiÛÙ·Û˘ ‹ Â˘Ú‹Ì·Ù· ÌÈÎÙÔ‡ Ù‡Ô˘. H ÔÚ›· Â›Ó·È Î·ÏÔ‹ı˘ ·Ú¿ ÙÔ fiÙÈ ¤¯ÂÈ ·Ó·ÊÂÚı› Û˘Ó‡·ÚÍË ˘¤ÚÙ·Û˘ Ù˘ ˘Ï·›·˜ Ì ·Ó¿Ù˘ÍË ·ÛΛÙË. K·Ú‚·Ì·˙›ÓË: EÌÊ¿ÓÈÛË KH ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÙ· ËÏÈÎȈ̤ӷ ¿ÙÔÌ· AÓ¢ڛÛÎÂÙ·È Û >75% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙÔ Ê¿ÚÌ·ÎÔ (34). AÓÙÈ‚ÈÔÙÈο: OÈ Ë·ÙÔÙÔÍÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Ôχ Û¿ÓȘ ÌÂ Û˘¯ÓfiÙËÙ· ˘ÔÏÔÁÈ˙fiÌÂÓË Û 5 Ì 10/100.000 Ï‹„ÂȘ ÁÈ· ÙÔ Ï›ÛÙÔ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ. AÓ Î·È Û˘Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ¯·Ú·ÎÙËÚÈÛÙÈ΋ ·ÓˆÌ·Ï›·, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ‰˘Ó·ÙfiÓ ÙÔ ›‰ÈÔ Ê¿ÚÌ·ÎÔ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÏÏÒÓ ÂȉÒÓ ·ÚÂÓ¤ÚÁÂȘ ·fi ÙÔ ‹·Ú fiˆ˜ ÔÍ›· Ë·Ù›Ùȉ·, KH ‹ ¯ÚfiÓÈ· ÂÓÂÚÁfi Ë·Ù›Ùȉ·. ÕÏÏ· Ê¿Ú̷η: AӷʤÚıËÎ·Ó ÂÚÈÛÙ·Ûȷο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÚÔη˚Ó·Ì›‰Ë, fiÔ˘ Ù· Û˘ÌÙÒÌ·Ù· ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÁÚ‹ÁÔÚ· (Û ̛· Ë̤ڷ) ‹ ·ÚÁ¿ (ÌÂÙ¿ ·fi 6 ‚‰ÔÌ¿‰Â˜ ¯ÔÚ‹ÁËÛ˘), Ë ÙÈÎÏÔȉ›ÓË (35) Î·È Ë 2', 3' dideoxyinosine (ddl), Ë ¯ÔÚ‹ÁËÛË Ù˘ ÔÔ›·˜ Û ·È‰È¿ Ô˘ ¤·Û¯·Ó ·fi AIDS ›¯Â ˆ˜ ·ÚÂÓ¤ÚÁÂÈ· ÙËÓ ÂÌÊ¿ÓÈÛË KH Û ÔÛÔÛÙfi 17,6% (36). TÔ Ê¿ÚÌ·ÎÔ glyburine ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË KH, fiˆ˜ Î·È Ë ·Ú·ÎÂÙ·ÌfiÏË. ŒÚ¢ӷ ÛÙË ™Ô˘Ë‰›· ·ÔÎ¿Ï˘„ fiÙÈ Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›· ηٷÁÚ¿ÊËΠ̛· ÂÚ›ÙˆÛË KH Ô˘ ÔÊÂÈÏfiÙ·Ó ÛÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (37). AÓ¿Ù˘ÍË KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Ì ÙË Ï‹„Ë Û˘Ó‰˘·ÛÌÔ‡ ·ÛÈÚ›Ó˘-Έ‰Â˝Ó˘ Ô˘ ·Ô‰fiıËΠ۠·Ú·ÙÂٷ̤ÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓˆÙ¤Úˆ ‰‡Ô Ê·ÚÌ¿ÎˆÓ (38). XÚfiÓÈ· ‚˘ÚÈÏÏ›ˆÛË: ¶ÚfiÎÂÈÙ·È ÁÈ· ‰Â˘ÙÂÚÔ·ı‹ ÎÔÎÎȈ̿وÛË ÙÔ˘ Ó‡ÌÔÓ· Ô˘ ÂÚÈÁÚ¿ÊÙËΠÙÔ 1946. ™Â ¯ÚfiÓÈ· ¤ÎıÂÛË ÚÔÛ‚¿ÏÏÂÙ·È Î·È ÙÔ ‹·Ú. T· Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Â›Ó·È ˘ÚÂÙfi˜, ‚‹¯·˜, ·ÓÔÚÂÍ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. T· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ· Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ. H ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ÎÔÎÎÈÒÌ·ÙÔ˜ Î·È ÙËÓ ¤Ó‰ÂÈÍË fiÙÈ ·˘Ùfi ÚÔÎÏ‹ıËΠ·fi ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ ÙÔ˘ ‹·ÙÔ˜ ·¤Ó·ÓÙÈ ÛÙÔ Ì¤Ù·ÏÏÔ ‚˘Ú›ÏÏÈÔ. KÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ KH, ·ÊÔ‡ ÛÙÔ ÈÛÙÔÚÈÎfi Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ΢ÚÈ·Ú¯Ô‡Ó Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ù˘ ÚˆÙÔ·ıÔ‡˜ ÓfiÛÔ˘, ÛÙ·
11
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·12
¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16
ÔÔ›· ÚÔÛÙ›ıÂÓÙ·È Ù· Â˘Ú‹Ì·Ù· Ù˘ ÎÔÎÎȈ̿وÛ˘. E›Û˘ ‰È·Ê¤ÚÂÈ Ë ÔÚ›· Î·È Ë ÚfiÁÓˆÛË. ·) ¢Â˘ÙÂÚÔ·ı‹˜ KH E›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÛÙË ‰Â˘ÙÂÚÔ·ı‹ KH ÙfiÛÔ Ë Û˘Ìو̷ÙÔÏÔÁ›·, fiÛÔ Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· Ì ÙËÓ ˘ÔΛÌÂÓË ÚˆÙÔ·ı‹ ·ÈÙ›· Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ÏÔÈÌ҉˜ ·›ÙÈÔ, Û·ÓÈfiÙÂÚ· Ë Ï‹„Ë Ê·ÚÌ¿ÎÔ˘ Î·È Û ۿÓȘ ÂÚÈÙÒÛÂȘ ̤ٷÏÏ· ‹ ¿ÏϘ Ô˘Û›Â˜. H ‰Â˘ÙÂÚÔ·ı‹˜ KH ‰˘Ó·ÙfiÓ Ó· ·Ú·Ì¤ÓÂÈ ·Ê·Ó‹˜ ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ÂΉËÏÒÛÂˆÓ Ù˘ ΢ڛ·˜ ÓfiÛÔ˘ ‹ Ó· ÂΉËÏÒÓÂÙ·È Ì Âȉ›ӈÛË ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Ë ·ÓÙ›‰Ú·ÛË ·›ÚÓÂÈ ÛÔ‚·Ú‹ ÙÚÔ‹ Ì ÂΉ‹ÏˆÛË ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘, fiˆ˜ ·Ú·ÙËÚ‹ıËΠ̠ÔÚÈṲ̂ӷ Ê¿Ú̷η (30,39,40) Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙÔ ı¿Ó·ÙÔ. ¶ÚfiÎÂÈÙ·È ÁÈ· ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘, ÂÓ›ÔÙÂ Û˘Ó‰˘·˙fiÌÂÓ˘ Ì ·ÁÁÂÈ˝Ùȉ· (41). ™˘¯ÓfiÙÂÚË Â›Ó·È Ë Ù˘¯·›· ·ÔÎ¿Ï˘„Ë ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÎÔÎÎȈ̿وÓ, ·ÊÔ‡ ÛÙÔ 25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ‹·ÙÔ˜ ·Ú·Ì¤ÓÂÈ ·Û˘Ìو̷ÙÈ΋ Ì ÌfiÓË ÂΉ‹ÏˆÛË ÙËÓ ÂÏ·ÊÚ¿ ‰È·Ù·Ú·¯‹ ÙˆÓ Ë·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ. ™ÙÔÓ Ô͇ Ù‡Ô Ù˘ Û˘Ìو̷ÙÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÓÙ›‰Ú·Û˘, Ë KH ·Ú·ÙËÚÂ›Ù·È 2-4 ‚‰ÔÌ¿‰Â˜ ̤¯ÚÈ 4 Ì‹Ó˜ ·fi ÙËÓ ·Ú¯‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. T· Û˘ÌÙÒÌ·Ù· ‰ÂÓ Â›Ó·È ÂȉÈο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¿ÓÔ‰Ô ÙÔ˘ ˘ÚÂÙÔ‡, ηÎԉȷıÂÛ›·, Ú›ÁË, ·ÓÔÚÂÍ›· Î·È ÎÔÈÏȷο ¿ÏÁË. H ÂÌÊ¿ÓÈÛË ›ÎÙÂÚÔ˘ Â›Ó·È ÂÚÈÛÙ·Ûȷ΋ Î·È Û˘¯Ó¿ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡. ™ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Û˘¯Ó¿ ·Ó¢ڛÛÎÂÙ·È Ì¤ÙÚÈ· Ë·ÙÔÌÂÁ·Ï›· ‹/ Î·È ÛÏËÓÔÌÂÁ·Ï›·. T· Â˘Ú‹Ì·Ù· ‰ÂÓ ÚÔ‰Èο˙Ô˘Ó ÙË Ê‡ÛË Ù˘ ˘ÔΛÌÂÓ˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘. O Ù‡Ô˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Â›Ó·È Û˘¯ÓfiÙÂÚ· ˘¤Ú Ù˘ ¯ÔÏÔÛÙ·ÙÈ΋˜ ‚Ï¿‚˘ Ì ¿ÓÔ‰Ô Ù˘ ÁGT Î·È Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘. EÓ›ÔÙÂ, ÚÔËÁÔ‡ÓÙ·È ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÛËÌ›· ˘ÂÚ¢·ÈÛıËÛ›·˜, fiˆ˜ ÂÍ¿ÓıËÌ·, ˘ÚÂÙfi˜, ·ÚıÚ·ÏÁ›Â˜, ˈÛÈÓÔÊÈÏ›·, ȉȷ›ÙÂÚ· Û ¯ÔÚ‹ÁËÛË ÛÔ˘ÏÊÔÓ·ÌȉÒÓ, ηڂ·Ì·˙›Ó˘, ·ÏÏÔÔ˘ÚÈÓfiÏ˘ Î·È ÎÈÓ›Ó˘. AÔÊÔÏȉˆÙÈ΋ ‰ÂÚÌ·Ù›Ùȉ·, ·ÁÁÂÈ˝Ùȉ·, ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· ‹ Ï¢ÎÔÂÓ›· Â›Ó·È ‰˘Ó·Ùfi Ó· Û˘ÓÔ‰Â‡Ô˘Ó ÙȘ Ë·ÙÈΤ˜ ‚Ï¿‚˜ (30,39,40,42). H ‰È·ÎÔ‹ Ï‹„˘ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ·ÎÔÏÔ˘ıÂ›Ù·È ÂÓÙfi˜ 10Ë̤ÚÔ˘ ·fi ‡ÊÂÛË ÙˆÓ Û˘Ìو̿وÓ. T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ˘Ô¯ˆÚÔ‡Ó ·ÚÁfiÙÂÚ·, Û ‰È¿ÛÙËÌ· ÌÂÚÈÎÒÓ Â‚‰ÔÌ¿‰ˆÓ ̤¯ÚÈ Î·È 1 ¤ÙÔ˜. ‚) ¶ÚˆÙÔ·ı‹˜ (ȉÈÔ·ı‹˜) KH ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· Ë·Ù›Ùȉ· Ô˘ ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔ-
12
¢. AÏÂ͛Ԣ, O. °Ú·Ê¿ÎÔ˘
Á›·˜. Afi ¿Ô„Ë Û˘¯ÓfiÙËÙ·˜, ÙÔ ÔÛÔÛÙfi Ù˘ ȉÈÔ·ıÔ‡˜ Î˘Ì·›ÓÂÙ·È Û ¢ڤ· Ï·›ÛÈ· ·Ó¿ÏÔÁ· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È Ù˘ ÁˆÁÚ·ÊÈ΋˜ ÂÚÈÔ¯‹˜. OÈ Mir Madjlessi Î·È Û˘Ó.(43) ·Ó·Ê¤ÚÔ˘Ó ÔÛÔÛÙfi ȉÈÔ·ıÔ‡˜ KH ·ÓÂÚ¯fiÌÂÓÔ Û 36%, ÔÈ Bunnim Î·È Û˘Ó.(44) ÌfiÓÔ 3% Î·È ÔÈ Sartin Î·È Û˘Ó. (6) Û 50%, ÂÓÒ Ù¤ÏÔ˜ ÔÈ Mc Luggage Î·È Û˘Ó.(3) Û ÔÛÔÛÙfi 7,6%. H ¿ıËÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ˘ÚÂÙfi Î·È ·fi ÙËÓ ·Ó‡ÚÂÛË Ù˘ÈÎÒÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙËÓ ‚ÈÔ„›· ‹·ÙÔ˜. ¶ÚÔÛ¿ıÂȘ Ô˘ ¤ÁÈÓ·Ó ÁÈ· ·ÔÛ·Ê‹ÓÈÛË Ù˘ ·ÎÚÈ‚Ô‡˜ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘, ‰ÂÓ Î·Ù¤ÏËÍ·Ó Û ۷ʋ Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·Ó¢ڛÛÎÂÙ·È ÌÈÎÚÔ‡ ‚·ıÌÔ‡ Ë·ÙÔÌÂÁ·Ï›· ‹/ Î·È ÛÏËÓÔÌÂÁ·Ï›·, ÂÓÒ Ë ÂͤٷÛË ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ·Ô‚·›ÓÂÈ ·ÚÓËÙÈ΋. ÕÏÏ· Û˘ÌÙÒÌ·Ù· Ù˘ ȉÈÔ·ıÔ‡˜ KH Â›Ó·È Ë Î·ÎԉȷıÂÛ›·, Ë ·ÓÔÚÂÍ›·, Ë ÎfiˆÛË, Ô fiÓÔ˜ ÛÙËÓ ·ÓÒÙÂÚË ‰ÂÍÈ¿ ÎÔÈÏȷ΋ ¯ÒÚ·, ÛÂ Û˘Ó‰˘·ÛÌfi ‹ fi¯È Ì ˷ÙÔÌÂÁ·Ï›·, ÂÓÒ Ó·˘Ù›·, ¤ÌÂÙÔ˜ ‹ ‰È¿ÚÚÔÈ· ·Ú·ÙËÚÔ‡ÓÙ·È Û·ÓÈfiÙÂÚ·. ¶ÔÛÔÛÙfi 26% ÙˆÓ ·ÛıÂÓÒÓ ·Ú·Ì¤ÓÔ˘Ó ·Û˘Ìو̷ÙÈÎÔ›. ŒÙÛÈ ÛÙËÓ È‰ÈÔ·ı‹ KH Ë ‚·ÛÈ΋ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Â›Ó·È Ô ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜ ‰È¿ÚÎÂÈ·˜ > 3 Ì‹Ó˜ (7). OÈ Satrin Î·È Û˘Ó.(6) ·Ó·Ê¤ÚÔ˘Ó Ì¤ÛË ‰È¿ÚÎÂÈ· Û˘ÌÙˆÌ¿ÙˆÓ 19 Î·È Ï¤ÔÓ Ì‹Ó˜. ™Â >50% ÙˆÓ ÂÚÈÙÒÛˆÓ, Ù· Ë·ÙÈο ¤Ó˙˘Ì· Â›Ó·È ·˘ÍË̤ӷ Î·È Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi Ë TKE. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È ÔÈ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ·Ú·Ì¤ÓÔ˘Ó ·ÚÓËÙÈΤ˜. T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÚÔÛ·Ó·ÙÔÏ›˙Ô˘Ó ÚÔ˜ Ë·ÙÔ¯ÔÏÈ΋ ‰È·Ù·Ú·¯‹ Ì ·‡ÍËÛË Ù˘ Á-GT Î·È Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ‹ ÚÔ˜ ÌÈÎÙ‹ ‚Ï¿‚Ë Ì ·‡ÍËÛË Î·È ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ¯ˆÚ›˜ ˆÛÙfiÛÔ ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ó· Â›Ó·È ¤Î‰ËϘ. H ÂͤٷÛË Ô˘ ÚÔÛ·Ó·ÙÔÏ›˙ÂÈ ÂÚÈÛÛfiÙÂÚÔ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Ë·ÙÈ΋˜ ¯ÒÚ·˜ Ì ˘ÂÚ‹¯Ô˘˜ (45). AÓ¢ڛÛÎÔÓÙ·È ‰È¿Û·ÚÙ˜ ηÏÒ˜ ·ÊÔÚÈ˙fiÌÂÓ˜ ˘Ô˯ÔÁfiÓ˜ ÂÚÈÔ¯¤˜ ‰È·Ì¤ÙÚÔ˘ ÌÂÚÈÎÒÓ mm. AÓ¿ÏÔÁ· Â›Ó·È Ù· Â˘Ú‹Ì·Ù· Î·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (9,46). H ‚ÈÔ„›· ‹·ÙÔ˜ Â›Ó·È Ë ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ Ì ÙËÓ ÔÔ›· Ù›ıÂÙ·È Ë ÛÊÚ·Á›‰· Ù˘ ‰È¿ÁÓˆÛ˘ Ì ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡ ÂÈıËÏÈÔÂȉԇ˜ ÓÂÎÚˆÙÈÎÔ‡ ÎÔÎÎÈÒÌ·ÙÔ˜. °È· ÙÔÓ ÏfiÁÔ ·˘ÙfiÓ, Û˘ÓÈÛÙ¿Ù·È Û‹ÌÂÚ· Ë ‰ÈÂÓ¤ÚÁÂÈ· ‚ÈÔ„›·˜ ‹·ÙÔ˜ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ™Â 70 ·ÛıÂÓ›˜ Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‚ÈÔ„›· ‹·ÙÔ˜ KH, ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 42,8% (46). I‰ÈÔ·ı‹˜ KH ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ÌÔۯ‡̷ٷ ‹·ÙÔ˜ ÌÂÙ¿ ÂÓÙ·ÂÙ›· ·fi ÙËÓ ÂÈÙ˘¯‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË (47). OÈ Klatsin Î·È Û˘Ó.(48) Û 5500 ‚ÈÔ„›Â˜ ‹·ÙÔ˜ ·Ú·Ù‹ÚËÛ·Ó 550
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·13
¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16
ÂÚÈÙÒÛÂȘ KH (ÔÛÔÛÙfi 10%). ™Â 17 ·fi ÙȘ ‚ÈÔ„›Â˜ (ÔÛÔÛÙfi 3,1%) ÂÚfiÎÂÈÙÔ ÁÈ· ¿ÙÔÌ· Ì ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë È‰ÈÔ·ı‹˜ KH Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ÓfiÛÔ˜ Ì ·ÚÈ· ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÙÔÓ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ¶¿ÓÙˆ˜, ·ÎfiÌ· Î·È Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ¿Ï˘Ù· ÚÔ‚Ï‹Ì·Ù·, ȉȷ›ÙÂÚ· ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, Î·È ÂÚ·ÈÙ¤Úˆ Û˘ÛÙËÌ·ÙÈ΋ ÚÔÔÙÈ΋ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ¤¯Ô˘Ì ÙÂÎÌËÚȈ̤ӷ ·ÔÙÂϤÛÌ·Ù·. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË AÓ Î·È Ë ‚ÈÔ„›· ‹·ÙÔ˜ ÂȂ‚·ÈÒÓÂÈ Î·Ù·Ú¯‹Ó ÙË ‰È¿ÁÓˆÛË Ù˘ KH, ‰ÂÓ ÚÔÛʤÚÂÈ ÔÏÏ¿ ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘, ·ÊÔ‡ Ë ›‰È· ÈÛÙÔÏÔÁÈ΋ ‚Ï¿‚Ë ‰˘Ó·ÙfiÓ Ó· ·ÓÙ·ÔÎÚ›ÓÂÙ·È Û ÏËıÒÚ· ·ÈÙ›ˆÓ. O ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘˜ ‚·Û›˙ÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, Ù· ·ÓÙÈÎÂÈÌÂÓÈο Â˘Ú‹Ì·Ù· Î·È ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. TÂÏÈο, Ë ‰È¿ÁÓˆÛË Ù˘ ȉÈÔ·ıÔ‡˜ KH Ù›ıÂÙ·È Ì ·ÔÎÏÂÈÛÌfi ÙˆÓ ‰È·ÊfiÚˆÓ ·ÈÙ›ˆÓ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Û˘ÓÈÛÙ¿Ù·È Ë ÂÌÂÈÚÈ΋ ·ÓÙÈ-TB ·ÁˆÁ‹ ÁÈ· ‰È·ÁÓˆÛÙÈ΋ ‚Ô‹ıÂÈ· (46). ¢È·ÁÓÒÛÂȘ Ô˘ ÂÚÈÛÙ·Ûȷο ·Ó·Ê¤ÚıËÎ·Ó Â›Ó·È Ë ÁÂÓÈÎÂ˘Ì¤ÓË ‚·ÎÙËÚȷ΋ ‹ Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË Î·È Î˘Ú›ˆ˜ Ë Î¯ÚÔÂȉ‹˜ Ê˘Ì·Ù›ˆÛË Ì ÂÓÙfiÈÛË ÛÙÔ ‹·Ú. Œ¯Ô˘Ó ›Û˘ ·Ó·ÊÂÚı› Ë Ó·ÓÈ΋ ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ·, Ë ÛÏ·¯ÓÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ·fi ·Ì˘¯¤˜ Á¿Ù·˜, Ô Ù˘ÊÔÂȉ‹˜ ˘ÚÂÙfi˜, Ë ¯ÚfiÓÈ· ÎÔÎÎȈ̷Ù҉˘ ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È ÔÈÎÈÏ›· ÏÔÈÌÒ͈Ó, fiˆ˜ ‚ÚԢΤÏψÛË, Ïԛ̈ÍË ·fi ˘ÂÚÛ›ÓÈ·, Î·È Ë ÁÂÓÈÎÂ˘Ì¤ÓË ·ÎÙÈÓÔÌ˘ÎËÙ›·ÛË. Afi ÙȘ ηÎÔ‹ıÂȘ ·Ó·Ê¤ÚÔÓÙ·È Ë Û·ÚÎÔ›‰ˆÛË, ÙÔ ÂÈıËÏÂÈÔÂȉ¤˜ Û¿ÚΈ̷, Ù· ÏÂÌÊÒÌ·Ù· Î·È Ë ÓfiÛÔ˜ Hodgkin. M ‚¿ÛË ÙȘ ·Ó·ÊÂÚı›Û˜ ·ÈÙÈÔÏÔÁ›Â˜ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH Ë ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÙȘ ηÏÏȤÚÁÂȘ ÁÈ· ‚·ÎÙËÚ›‰È·, ÌÈÎÚfi‚È· Î·È Ì‡ÎËÙ˜ Î·È ÙȘ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ. Afi ¿Ô„Ë ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ KH, Ù· ÂÈıËÏÈÔÂȉ‹ ÎÔÎÎÈÒÌ·Ù· Ô˘ ÔÊ›ÏÔÓÙ·È Û ʿÚ̷η ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù˘ÚÔÂȉ‹ ÎÂÓÙÚÈ΋ Ó¤ÎÚˆÛË (11). H ηٷÓÔÌ‹ ÙÔ˘˜ Â›Ó·È ÏԂ҉˘ Î·È Û˘Ó˘¿Ú¯ÂÈ ÔχÌÔÚÊÔ˜ ˘Ï·›· ‹ ÂÚÈ˘Ï·›· ÊÏÂÁÌÔÓ҉˘ ‰È‹ıËÛË, Û˘ÓÈÛÙ¿ÌÂÓË ·fi ÏÂÌÊÔ·ÙÙ·Ú·, ÈÛÙÈÔ·ÙÙ·Ú· Î·È ËˆÛÈÓfiÊÈÏ·. H ·ÚÔ˘Û›· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ, Û ·ÚÈıÌfi 5-10/ÎÔÎΛˆÌ·, Â›Ó·È ¤Ó‰ÂÈÍË KH ·fi Ê¿Ú̷η Î·È ÂÓ·ÓÙ›ÔÓ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ Û·ÚÎÔ›‰ˆÛ˘ ‹ Ù˘ Ê˘Ì·Ù›ˆÛ˘. AÓÙ›ıÂÙ·, ÎÔÎΛˆÌ· Ì ÎÂÓÙÚÈ΋ ÏÈÒ‰Ë ‰È‹ıËÛË Ô˘ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ÂÚÈÊÂÚÈÎfi ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ
KÔÎÎȈ̷Ù҉˘ Ë·Ù›Ùȉ·
Â›Ó·È ˘¤Ú Ù˘ KH ÏÔÈÌÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜ (4). ™˘Ó‡·ÚÍË ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú Ì ÎÔÎÎÈÒÌ·Ù· ÛÙÔ Ì˘ÂÏfi, ÙÔ ÛÏ‹Ó·, ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ÙÔ Ì˘ÔοډÈÔ ·Ó·Ê¤ÚıËÎ·Ó Ì ÙË ¯Ú‹ÛË ÔÚÈÛÌ¤ÓˆÓ Ê·Ú̿ΈÓ. ŸÙ·Ó Ù· ÎÔÎÎÈÒÌ·Ù· ÔÊ›ÏÔÓÙ·È Û ʿÚ̷η Ì ÙË ‰È·ÎÔ‹ Ù˘ Ï‹„˘ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ÔÈ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ ˘Ô¯ˆÚÔ‡Ó Û 1 ¤ˆ˜ 6 Ì‹Ó˜ ¯ˆÚ›˜ Ó· ·Ê‹ÛÔ˘Ó ˘ÔÏ›ÌÌ·Ù·, ·Ó Î·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÚÈÁÚ¿ÊËÎ·Ó ¯ÚfiÓȘ ÌÔÚʤ˜. H Ï‹„Ë ÙÔ˘ ›‰ÈÔ˘ Ê·ÚÌ¿ÎÔ˘ ÚÔηÏ› ÙËÓ Ù·¯Â›· ·ÓÂÌÊ¿ÓÈÛË Î·È ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ ‹·Ú. °ÂÓÈο, Ë Ê·Ú̷΢ÙÈ΋˜ ÚÔ¤Ï¢Û˘ KH Â›Ó·È Î·ÏÔ‹ı˘, ÂÓÒ Ë ·Ú·ÙÂÈÓfiÌÂÓË ÌÔÚÊ‹ Ù˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·, fiˆ˜ Î·È ÔÈ ı·Ó·ÙËÊfiÚ˜ ÌÔÚʤ˜. EÎÙfi˜ Ù˘ ‚ÈÔ„›·˜ ‹·ÙÔ˜, ¿ÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Ô˘ ‚ÔËıÔ‡Ó ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÔÈ Î·ÏÏȤÚÁÂȘ Î·È ÔÈ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ÁÈ· ·ÔÎÏÂÈÛÌfi ÙÔ˘ ÔͤԘ ˘ÚÂÙÔ‡ Q, Ù˘ ‚ÚԢΤÏψÛ˘ Î·È Ù˘ Ê˘Ì·Ù›ˆÛ˘ (50). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ‰È·ÛÔÚ¿˜ ÙÔ˘ ‚·Î›ÏÔ˘ Calmette Guerin, ÙÔ ÈÛÙÔÚÈÎfi, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÌ˘ÎÔ‚·ÎÙËÚÈ·ÎÒÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ë ÂÓ‰ÔÛÎfiËÛË ‚ÔËıÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË. Afi ÎÏÈÓÈ΋ ¿Ô„Ë ·Ú·ÙËÚÂ›Ù·È ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜ ÂÌÊ·ÓÈ˙fiÌÂÓÔ˜ ÂÓÙfi˜ 6 ‚‰ÔÌ¿‰ˆÓ ·fi ÙËÓ ÂÓ‰Ô΢ÛÙÈ΋ ¤Á¯˘ÛË, ÂÓÒ ÙÔ˘ ˘ÚÂÙÔ‡ ¿ÓÙ· ÚÔËÁÔ‡ÓÙ·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ ‰È·Ù·Ú·¯‹˜ Ù˘ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ™ÙË ‚ÈÔ„›· ‹·ÙÔ˜ ·Ó¢ڛÛÎÔÓÙ·È ÂÈıËÏÈÔÂȉ‹ ÎÔÎÎÈÒÌ·Ù· Ô˘ ÂÓ›ÔÙÂ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÎÂÓÙÚÈ΋ Ó¤ÎÚˆÛË ‹ Ù˘ÚÔÂȉÔÔ›ËÛË. OÈ ‚Ï¿‚˜ ÚÔ¤Ú¯ÔÓÙ·È Â›Ù ·fi ‰È·ÛÔÚ¿ ÙˆÓ ‚·Î›ÏÔ˘ Ì ۯËÌ·ÙÈÛÌfi ÎÔÎÎÈÒÌ·ÙÔ˜, ›ÙÂ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔÈ΋˜ ˘ÂÚÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÂÓ·ÓÙ›ÔÓ ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ‚·Î›ÏÔ˘. H ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙËÓ ·Ó·˙‹ÙËÛË Ù˘ ·ÈÙ›·˜ ÛÙÔ ›‰ÈÔ ÙÔ ÎÔÎΛˆÌ· Ì ÏÂÙÔÌÂÚ‹ ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‹ ·ÎfiÌ· Î·È ÙË ¯Ú‹ÛË ËÏÂÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘. ¶·ıÔÁ¤ÓÂÈ· O Ì˯·ÓÈÛÌfi˜ ÚfiÎÏËÛ˘ Ù˘ KH ÂÓÙ¿ÛÛÂÙ·È ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·ÓÔÛÔ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÈÛÙÔ‡ Û ‰È¿ÊÔÚ· ·ÓÙÈÁfiÓ·. O Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ıˆÚÂ›Ù·È ÈÛÔ‰‡Ó·ÌÔ˜ Ù˘ ˘ÂÚÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÂÈ‚Ú·‰˘ÓfiÌÂÓÔ˘ Ù‡Ô˘ ÛÙËÓ ÔÔ›· ÂӉȿÌÂÛÔ˜ ÌÂÙ·‚ÔÏ›Ù˘ ·›˙ÂÈ ÙÔ ÚfiÏÔ Ù˘ ·Ù›Ó˘. ¢ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ‰ÔÎÈÌ·Û›· Ë ÔÔ›· ÌÔÚ› Ó· ·Ô‰Â›ÍÂÈ ÙË Û¯¤ÛË ·ÈÙ›Ô˘-·ÔÙÂϤÛÌ·ÙÔ˜. H ÂÚÈÛÙ·Ûȷ΋ ·Ó‡ÚÂÛË ·ÓÙÈÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ‹ ·ÓÙÈ˘ÚËÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ȉȷ›ÙÂÚË ÛËÌ·Û›·. ø˜ ·ÈÙ›· ·Ó¿Ù˘Í˘ ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ·Ó·Ê¤ÚıËÎÂ Î·È Ë ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙÔ ÂÓ‰Ô-
13
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·14
¶∞π¢π∞∆ƒπ∫∏ 2000;63:9-16
ı‹ÏÈÔ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ÎfiÏˆÓ ÙÔ˘ ‹·ÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔÈ΋˜ Ó¤ÎÚˆÛ˘ (50,51). ¶ÚfiÛÊ·Ù˜ ÂÈÚ·Ì·ÙÈΤ˜ ÂÚÁ·Û›Â˜ ·Ó·ÊÔÚÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ Î·È Ù˘ KH ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÁÈ· ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ηÏÈÎÚ½Ó˘-ÎÈÓ›Ó˘ Ë ÔÔ›· Úԉȷı¤ÙÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÎÔÎÎȈ̿وÛ˘ ÛÙÔ ¤ÓÙÂÚÔ Î·È ÙÔ ‹·Ú. ¶ÚfiÎÂÈÙ·È ÁÈ· ‰ÈÊ·ÛÈ΋ ·Ú·ÙÂٷ̤ÓË ‰ÈÂÚÁ·Û›· Ì ·˘ÙfiÌ·ÙË Î·Ù¿ ÙË 14Ë Ë̤ڷ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‰ËÌÈÔ˘ÚÁ›·˜ ÎÔÎÎȈ̿وÛ˘ Ô˘ ‰È·ÚΛ ̤¯ÚÈ Î·È 16 ‚‰ÔÌ¿‰Â˜ (52). IÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· O Bernstein Î·È Û˘Ó.(51) ‹Û·Ó ÔÈ ÚÒÙÔÈ Ô˘ ÂÚȤÁÚ·„·Ó ÙËÓ ·ÚÔ˘Û›· ·Û˘Ó‹ıˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ Û ÂÚÈÙÒÛÂȘ ÔÍ›·˜ Ïԛ̈͢ ·fi coxiella Burnetti (ÔÍ›· ÚÔ‚ÔÏ‹ ˘ÚÂÙÔ‡ Q) (26). OÈ ‚Ï¿‚˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÙËÓ ·ÚÔ˘Û›· ÎÂÓÙÚÈÎÔ‡ ÏÈÒ‰Ô˘˜ ÎÂÓÔÙÔ›Ô˘ Ô˘ ÂÚÈ‚·ÏÏfiÙ·Ó ·fi ÈÓ҉˜ ‰·ÎÙ‡ÏÈÔ, ·ÚÔ˘Û›· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È Ì·ÎÚÔÊ¿ÁˆÓ. H ·ÚÔ˘Û›· ÎÔÎÎÈˆÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÚÂÙfi Q ÂȂ‚·ÈÒıËΠÛÙË Û˘Ó¤¯ÂÈ· Î·È ·fi ¿ÏÏÔ˘˜, ÒÛÙ ηٷگ‹Ó Ó· ıˆÚÂ›Ù·È ˆ˜ ÂȉÈÎfi ‡ÚËÌ· Ù˘ Ïԛ̈͢ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘. MÂÙ·ÁÂÓ¤ÛÙÂÚ· ·Ô‰Â›¯ÙËΠfiÙÈ Â›Ó·È Â‡ÚËÌ· Ô˘ ··ÓÙ¿Ù·È Î·È Û ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ. KÔÎÎÈÒÌ·Ù· ‰˘Ó·ÙfiÓ Ó· ‚ÚÂıÔ‡Ó Î·È ÛÙÔ˘˜ ̇˜ Û ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÔÎÎȈ̿وÛ˘. ™ÙËÓ È‰ÈÔ·ı‹ KH ·Ó¢ڛÛÎÔÓÙ·È Û˘Ó‹ıˆ˜ ÔÏÏ·Ï¿ ÎÔÎÎÈÒÌ·Ù· ·fi ÂÈıËÏÈÔÂȉ‹ ·ÙÙ·Ú· Ô˘ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Ì ÔÏ˘˘ÚËÓÈο ÁÈÁ·ÓÙÔ·ÙÙ·Ú· Î·È ÂÚÈ‚¿ÏÏÔÓÙ·È ·fi ÌÈÎÚ¿ ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ. EÓÙfi˜ ÙÔ˘ ‹·ÙÔ˜ ÔÈ ‚Ï¿‚˜ Â›Ó·È ‰È¿¯˘Ù· ‰ÈÂÛ·Ṳ́Ó˜. ™Â ‰Â˘ÙÂÚÔ·ı‹ KH ·fi Ïԛ̈ÍË, ÔÈ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ Û‡ÁÎÂÈÓÙ·È ·fi Ô˘‰ÂÙÂÚfiÊÈÏÔ ÎÔÎÎȈ̷ÙÒ‰Ë ‰È‹ıËÛË Ì ۯËÌ·ÙÈÛÌfi ÎÂÓÙÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜. H ‰È¿ÌÂÙÚÔ˜ ÙˆÓ ‚Ï·‚ÒÓ ·Ó¤Ú¯ÂÙ·È Û ÌÂÚÈο ¯ÈÏÈÔÛÙ¿ (2-5 mm). £Âڷ›· K·Ù¿ Ù˘ ÓfiÛÔ˘ ·Ï·ÈfiÙÂÚ· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ë ·ÛÈÚ›ÓË Î·È Ù· ÌË ÛÙÂÚÈÓÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η (53), ‚·ÛÈο fï˜ Ë ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘ (54) Ë ÔÔ›· ·Ô‰Â›¯ÙËΠÔχ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÙfiÛÔ ÛÙËÓ ‡ÊÂÛË ÙÔ˘ ˘ÚÂÙÔ‡, fiÛÔ Î·È ÛÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÔ ‹·Ú. EÓÙÔ‡ÙÔȘ, ÔÚÈṲ̂ÓÔÈ ·ÛıÂÓ›˜ ‰ÂÓ ··ÓÙÔ‡Ó ‹ ¯ÚÂÈ¿˙ÂÙ·È Ë ¯ÔÚ‹ÁËÛË Ôχ ˘„ËÏÒÓ ‰fiÛÂˆÓ ÎÔÚÙÈ˙fiÓ˘ ÁÈ· Ì·ÎÚ‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ¤¯Ô˘Ì ¢ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù·, ÔfiÙ ÚÔ·ÙÂÈ ı¤Ì· ÂÈÏÔÎÒÓ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ Ù˘. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë ¯ÔÚ‹ÁËÛË Ù˘ ÎÔÚÙÈ˙fiÓ˘ ‰È·ÎfiÙÂÙ·È ÛÙÔ˘˜ 6 Ì‹Ó˜. E› ·ÓÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û˘Ìو̿وÓ, ÌÂÙ¿ ÙË ‰È·-
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ÎÔ‹ Ù˘, ‰ÔÎÈÌ¿ÛÙËÎÂ Ë ÌÂıÔÙÚÂÍ¿ÙË Î·È Ë ˘‰ÚԯψÚÔΛÓË. H ÌÂıÔÙÚÂÍ¿ÙË ¤¯ÂÈ ‚Ú·‰Â›· ·¿ÓÙËÛË, ·ÏÏ¿ ηϿ ·ÔÙÂϤÛÌ·Ù· (55), ·Ó Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠ۠ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ. H ¯ÔÚ‹ÁËÛ‹ Ù˘ Á›ÓÂÙ·È Û ÌÈÎÚ¤˜ ‰fiÛÂȘ ÁÈ· Ó· ÌÂȈı› Ë Èı·ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ·ÚÂÓÂÚÁÂÈÒÓ, ‰ËÏ·‰‹ Û ‰fiÛË 0,20 mg/kg B™ ‚‰ÔÌ·‰È·›·. A˘ÚÂÍ›· ÂÈÙ˘Á¯¿ÓÂÙ·È Û 3 ÂÚ›Ô˘ Ì‹Ó˜ ·fi ÙËÓ ·Ú¯‹ Ù˘ ¯ÔÚ‹ÁËÛ˘. M ÙË ‰fiÛË ·˘Ù‹ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂȘ ‹ ·ÔÙ˘¯›Â˜. H ˘‰ÚÔ͢¯ÏˆÚÔΛÓË, Û ‰fiÛË 400 mg/24ˆÚÔ ¯ÔÚËÁ‹ıËΠ۠ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ Ì KH. O Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ Ù˘ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. º·›ÓÂÙ·È fiÙÈ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Ì¤Ûˆ ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÚÔηÏÔ‡ÌÂÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÏfiÁˆ ·Ó·ÛÙÔÏ‹˜ Ù˘ ·ÂÏ¢ı¤ÚˆÛ˘ ·Ú·ÁfiÓÙˆÓ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ¤Ó·ÚÍË Î·È ‰È·Ù‹ÚËÛË Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-1 (56). H ‰Ú¿ÛË ·˘Ù‹ ‰˘Ó·ÙfiÓ Ó· ·Ó·ÛÙ›ÏÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Ô˘ Â›Ó·È ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ÎÔÎÎÈˆÌ¿ÙˆÓ (57). ÕÏÏ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ È‰ÈÔ·ı‹ KH ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î˘ÎÏÔʈÛÊ·Ì›‰Ë, ÙËÓ ‚ÈÌÏ·ÛÙ›ÓË Î·È ÙËÓ ¯ÏˆÚ·ÌԢΛÏË. Afi ÙÔ˘˜ Knox Î·È Û˘Ó.(55) ÚÔÙ¿ıËΠÙÔ ·ÎfiÏÔ˘ıÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì·. K·Ù·Ú¯‹Ó, Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÊ˘Ì·ÙÈ΋˜ ·ÁˆÁ‹˜ ÛÙ· ¿ÙÔÌ· Ì ıÂÙÈ΋ mantoux ‹ Ì ·ÓÂÚÁ›· Ì ÛÎÔfi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î¯ÚÔÂȉԇ˜ Ê˘Ì·Ù›ˆÛ˘. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· Û˘ÌÙÒÌ·Ù· Û˘Ó¯›˙ÔÓÙ·È, ¯ÔÚËÁÂ›Ù·È Ú‰ÓÈ˙fiÓË. AÓ Ë ··ÈÙÔ‡ÌÂÓË ÁÈ· ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰fiÛË Â›Ó·È ÌÂÁ¿ÏË, Ù· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉ‹ ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi ÙË ¯ÔÚ‹ÁËÛË ÌÂıÔÙÚÂÍ¿Ù˘ ÛÙËÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓË ‰fiÛË. BÈ‚ÏÈÔÁÚ·Ê›· 1. Camath PS. Clinical approach to the patient with abnormal liver tests. Mayo Clin Proc 1996;11:1086-1094. 2. Edmonson HA. Needle biopsy in differential diagnosis of acute liver disease. JAMA 1965;191:480-486. 3. Mc Cluggage WG,Sloam JM. Hepatic granulomas in Northern Ireland: a thirteen year review. Histopath 1994; 25: 219-28. 4. Vial T, Descotes J. Hepatities granulomateuses medicamenteuses. Gastroentrol Clin Biol 1993;17:H44-8. 5. Guglielmi V, Manghisi OG, Pirelli M, Caruso ML. Granulomatous hepatitis in a hospital population in southern Italy. Patol 1994;86:271-278. 6. Satrin JS, Walker RC. Granulomatous hepatitis: a retrospective review of 88 cases at the Mayo Clinic. Mayo Clin Proc 1991;66: 914-918. 7. Karat ABA, Job CK, Rao PSS. Liver in leprosy: histological and biochemical findings. BMJ 1971;1: 307-10.
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8. Harrington PT, Guttierez JJ, Ramirez Ronda CH, Quinones Soto R, Bermudes JJ, Chaffey J. Granulomatous hepatitis. Rev Infect Dis 1982;4:638-55. 9. Giovagnoni A, Gabrielli O, Coppa GV, Catassi C, Giorgi P. MRI appearances in amoebic granulomatous hepatitis: a case report. Pediat Radio 1993; 23:536-537. 10. Villaverde M, Gurini L, Gonzalez A, Cohen R, Febrile syndrome; myocarditis and brucellosis Medicina B Aires 1995;55:145-146. 11. Satti BM, Al Feihi H, Ezzeldin M, Abu Melha IA, Al Ghassab FG, et al. Granuloma in Saudi Arabia. A clinicopathological study of 50 cases. Am J Gastrenterol 1990;85: 669-674. 12. Moreno A, Marazuala M, Yebra M, Hernandez M, Hellin T et al. Hepatic fibrin ring granulomas in visceral leishmaniasis. Gastroenterol 1988;95: 1123-26. 13. Miller MH, Urowitz MB, Gladman DD, Blendis LM. The liver in systemic lupus erythematosus. Quart J Med 1984;211: 401-409. 14. Heyries L, Perreau M, Monges D, Chrestian MA, Gerolani A. Hepatic granulomatosis associated with mononucleosis syndrome secondary to cytomegalovirus infection: a propos of 2 cases in healthy adults. Rev Med Intern 1994;15: 744-746. 15. Lorenzo DA, de Asanza GC, Duran GF, Piqueeras B, Romero et al. Cytomegalovirus infection as a cause of granulomatous hepatitis in an immunocompetent patient. Rev Esp Enferm Dig 1996;88: 295-297. 16. Font J, Bruguera M, Perez Villa F, Ingelmo M. Hepatic fibrin ring granulomas caused by staphylococcus epidermidis generalized infection (letter) Gastroenterol 1987;93: 1449-51. 17. Proctor DD, Chopra S, Rubenstein SC, Jokela JA, Uhlt . Mycobacteremia and granulomatous hepatitis following initial intravesical bacillus Calmette Guerin instillation for bladder carcinoma. Am J Gastroenterol 1993;88: 11121115. 18. Deresiewicz PL, Stone RM, Aster JC. Fatal disseminated mycobacterial infection following intravesical bacillus Calmette Guerin J Urol 144; 1331: 1990. 19. Hsueh PR, Hsiue TR, Jarn JJ, Ho SW, Hsieh WC. Disseminated infection due to Mycobacterium scrofulatum in an immunocompetent host. Clin Infect Dis 1996;22: 159161. 20. Rogler G, Balle C, Antoiniou E, Heinissch A, Bocker T et al. Miliary tuberculosis and silicosis with predominantly cerebral symptoms Dtsch Med Wochenschr 1996;121: 588-592. 21. Rey Diaz Rubio E, Toxonera Samso C, Real Martinez Y, Diaz Rubio M. Changes in the use of percutaneous liver biopsy over time. Rev Esp Enferm Dig 1995; 87: 375-378. 22. Dangman BC, Albanese BA, Kacica MA, Lepow ML, Wallach MT. Cat scratch disease in two children presenting with fever of unknown origin; imaging features and association with a new causative agent, Rochalimaea Henselae. Pediatrics 1995; 95: 767-771. 23. Langley JM, Marrie TJ, Covert A, Waag DM, Williams JC. Poker players pneumonia. An urban outbreak following exposure to a parturient cat. N Engl J Med 1988; 319: 354-356.
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24. Marrie TJ, Durrant H, Williams JC, Mintz E, Waag DM. Exposure to particular cats is a risk factor for acquisition of Q fever in Maritime Canada. J Infect Dis 1988; 158: 101-106. 25. Lopez VF, Rippe ML, Soler T, Rodriquez A, Arribas JM et al. Erythema nodosum and acute Q fever. Report of a case with granulomatous hepatitis and immunological abnormalities (letter). Acta Derm Venereol 1997; 77: 73-74. 26. Orenstein MS, Tavitian A, York B, et al. Hepatic granulomas: experience over a ten year period in the west of Scotland Q J Med 1982;51: 162-170. 27. Leebek FW, Ouwendijk RJ, Kolk AH, Dees A, Meek JC et al Granulomatous hepatitis caused by bacillus Calmette Guerin (BCG) infection after bladder instillation. Gut 1996;38: 616-618. 28. Hilzenrat N, Lamoureay E, Sherker A, Cohen A. Cholestasis in Crohn’s disease: a diagnostic challenge. Can J Gastroenterol 1997; 11: 35-37. 29. George DK, Crawford DH. Antibacterial induced hepatotoxicity: incidence and management. Drug Saf 1996;15:79-85. 30. Knobler H, Levu IS, Gavish D, Chajek Shaul T. Quinidine induced hepatitis. A common and reversible hypersensitivity reaction. Arch Intern Med 1986; 1’46: 526-528. 31. Horney E, Lagerstedt C, Waderwik H. A case report. Thrombocytopenia and granulomatous hepatitis caused by quinine. Lakartidnihgen 1996; 93: 361-364. 32. Van Everdingen Bongers JJ, Janssen P, Lammens M, Stricker BH, Bravenboer B. Granulomatous hepatitis attributed to the combination of pyrimethamine and chloroquine. Ne D Tijdsch Geneeskd 1996; 140: 320-322. 33. Ramond MJ, Nouel O, Degott C, Lebrec D, Benhamou JD. Hepatite a l’allopurinol. Etude d'un cas et revue de la litterature. Gastroenterol Clin Biol 1982; 6: 138-142. 34. Levy M, Goodman MW, van Dyke BJ, Summer HW. Granulomatous hepatitis secondary to carbamazepine. Ann Intern Med 1981; 95: 64-65. 35. Ruiz-Valverde P, Zaron C, Seggara A, Ribera R, Pierra L. Ticlopidine induced granulomatous hepatitis (letter). Ann Pharmacother 1995; 29: 633-634. 36. Lacaille F, Ortigas MB, Debre M, Rousioux C, Brousse N et al. Hepatic toxicity associated with 2'3'dideoxyinosine in children with AIDS. J Pediatr Gastroenterol Nutr;20: 287-290. 37. Lindgren A, Aldenborg F, Norkans G, Olaison L, Olsson R. Paracetamol induced cholestatic and granulomatous liver injuries. J Intern Med 1997;241: 435-439. 38. Elzouki AN, Lindgren S. Granulomatous hepatitis induced by aspirin-codeine analgesics. J Intern Med 1996;239: 279-281. 39. Mathur S, Dooley J, Scheuer PJ. Quinine induced granulomatous hepatitis and vasculitis. BMJ 1990; 300613. 40. Ingelmo M, Vivancos J, Bruguera M, Sierra J, Balcells A. Hypersensitivity angeitis and granulomatous hepatitis induced by glibenclamide: a propos of one case. Med Clin 1980;75: 306-308. 41. Pariente EA, Maitre F, Marchant JP. Hepatite due a la quinidine. Etude dun cas et review de la litterature.
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Gastronterol Clin Biol 1986;10: 255-258. 42. Guillou L, Breaud P. Hepatitie granulomateuse et dermatite exfoliative secondaire a un traitement par la carmabazepine. Gastrenterol Clin Biol 1991;15: 170-1 43. Mir Madjlessi SH, Farmer RG, Hawk WA: Granulomatous hepatitis: a review of 50 cases. Am J Gastronetrol 1973; 60: 122-134. 44. Bunim JJ, Kinberg DV, Thomas KB, Van Scott EJ, Klatskin G. The syndrome of sarcoidosis, psorasis, and gout: combined clinical staff conference at the National Institute of Health. Ann Intern Med 1962;57: 1018-1040 45. Mills P, Saverymuttu S, Fellowfield M, Nussey S, Joseph AEA. Ultrasound in the diagnosis of granulomatous liver disease. Clin Radiol 1990; 41: 113-115. 46. Vilades C, Ferre R, Martin-Urda A, Vidal F, Mayayo E, Richard C. Granulomatous hepatitis and fever of unknown origin. Ann Intern Med 1994; 11: 334-337. 47. Pappo O, Ramos H, Starzi J, Demetris AJ. Structural integrity and identification of causes of liver allograft dysfunction occuring more than 5 years after transplantation. Am J Surg Pathol 1995; 19: 192-206. 48. Klatsin G. Hepatic granulomata: problems in interpretation. Ann NY Acad Sci 1976;278: 427-432. 49. Pelegrin M, Delsol G, Auvernat JC, et al. Granulomatous hepatitis in Q fever. Hum Pathol 1980;11: 51-57.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-11 -98 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢. AÏÂ͛Ԣ B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ
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50. Bearer EA, Savides TJ, Mc Cutchan JA. Endoscopic diagnosis and management of hepatobiliary tuberculosis. Am J Gastroenterol 1996;91: 2602-2604. 51. Bernstein M, Edmonson HA, Barbour BH. The liver lesion in Q fever. Clinical and pathological features. Arch Intern Med 1965;116: 491-498. 52. Vanterstigel M, Zafrani S, Lejonc JL, Chaeffer A, Postos JL. Allopurinol hypersensitivity syndrome as a cause of hepatic fibrin ring granulomas. Gastroenterol 1986;90: 188-190. 53. Sartor RB, De La Cadera RA, Green KD, Stadnicki A Davis SW, Achwab JH et al. Selective kallikrein kinine system activation in inbred rats differentially susceptible to granulomatous enterocolitis. Gastroenterol 1996; 110: 1467-1481. 54. Berlin CM, Boal DK, Zaino RJ, Karl SR. Hepatic granulomata presenting with prolonged fever. Clin Pediatr 1990; 29: 339-342. 55. Knox TA, Kaplan MM, Gelfland SM. Metronidazole treatment of idiopathic granulomatous disease Ann Intern Med 1955; 122: 592-595. 56. Salmeron G, Lipsky PE. Immunosuppressive potential of antibacterials. Am J Med 1983;75: 19-24. 57. Soskel NT, Fox R. Sarcoidosis ... or something like it. South Med J 1990;83: 1190-1202.
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● ¶ÂÚ›ÏË„Ë: OÈ ÂÒ‰˘Ó˜ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ‰Ú·ÓÔ΢ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓ›˜. O fiÓÔ˜ Ù˘ ıÚÔÌ‚ˆÙÈ΋˜ ÎÚ›Û˘ Â›Ó·È Ô͇˜ Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙ· Ì·ÎÚ¿ ÔÛÙ¿, ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË Î·È ÛÙȘ Ï¢ڤ˜. E›Ó·È ÔÏ˘ÂÛÙÈ·Îfi˜, ·ÌÊÔÙÂÚfiÏ¢ÚÔ˜ ‹ ÌÂÙ·Ó·ÛÙ¢ÙÈÎfi˜. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂÈÛ‡‰Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜ ÂÒ‰˘Ó˘ ÎÚ›Û˘ ıˆÚÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂȘ, Ô ˘ÚÂÙfi˜, Ë ·Ê˘‰¿ÙˆÛË, Ë ·ÏÏ·Á‹ ıÂÚÌÔÎÚ·Û›·˜, ÙÔ ˘„fiÌÂÙÚÔ Î.¿. H ·ÓÙ›ÏË„Ë Î·È Ë ¤ÎÊÚ·ÛË ÙÔ˘ fiÓÔ˘ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ ηıÒ˜ Î·È ·fi ÎÔÈÓˆÓÈÎÔ‡˜ Î·È „˘¯ÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. H ÂÏ·ÊÚ¿ ˆ˜ ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ Ì ÍÂÎÔ‡Ú·ÛË, ·ÂÚÈfiÚÈÛÙË Ï‹„Ë ˘ÁÚÒÓ, ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏÏ›Ó˘ Î·È ÌË ÔÈÔÂȉÒÓ ·Ó·ÏÁËÙÈÎÒÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÏ·ÊÚ¿ ËÚÂÌÈÛÙÈο. IÛ¯˘Úfi˜ fiÓÔ˜ ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 48 ˆÚÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÈÛ·ÁˆÁ‹ ÛÙÔ NÔÛÔÎÔÌÂ›Ô fiÔ˘ ¯ÔÚËÁÔ‡ÓÙ·È ÂÓ‰ÔÊϤ‚È· ˘ÁÚ¿, ·ÓÙÈ‚›ˆÛË Î·È ÔÈÔÂȉ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌË ÛÙÂÚÔÂȉ‹ ·Ó·ÏÁËÙÈο Î·È ËÚÂÌÈÛÙÈο. ¶·È‰È·ÙÚÈ΋ 2000;63:17-20. §¤ÍÂȘ ÎÏÂȉȿ: ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜, ÂÒ‰˘ÓË ÎÚ›ÛË, ·ÓÙÈÌÂÙÒÈÛË. M. Athanasiou - Metaxa, A. Koussi. The treatment of pain in children with sickle cell disease. Paediatriki 2000;63:17-20. ● Abstract: The painful crisis is one of the most characteristic manifestations of sickle cell disease. The pain is acute and is usually bilateral and symmetrical, and located most frequently in the long bones, lumbar vertebrae and ribs. Multiple sites are commonly affected simultaneously. Several precipitating factors such as cold, infection, acidosis, sleep apnoea, high altitude and emotional stress may immediately precede the painful crisis. Management of the painful crisis is one of the commonest clinical problems facing physicians, and the patients and their parents. The response to pain is heavily influenced by psychological, social and cultural factors and a multidisciplinary approach is required. Mild to moderate pain often responds to paracetamol, non steroid antiinflammatory drugs and sedatives. Severe pain may require oral analgesia with pethidine or codeine. Persistence of pain in spite of the above treatment necessitates hospital admission and additional therapy with iv administration of fluids, and pethidine or morphine in standard doses, always taking side-effects into consideration. Psychological support for these children and their families is always helpful and should never be omitted. Key words: sickle cell disease, painful crisis, treatment.
OÈ ÂÒ‰˘Ó˜ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ‰Ú·ÓÔ΢ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓ›˜ (13). O fiÓÔ˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÛÙËÓ ¿ÛËÙË Ó¤ÎÚˆÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Ô˘ Û˘Ì‚·›ÓÂÈ ÏfiÁˆ ·fiÊڷ͢ Ù˘ ÙÂÏÈÎÔ‡ Ù‡Ô˘ ·ÁÁ›ˆÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.(1) ™‹ÌÂÚ· ÈÛÙ‡ÂÙ·È fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÙˆÓ ·ÁÁÂÈÔ·ÔÊÚ·ÎÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÏÏËÏ›‰Ú·Û˘ ηÈ
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EÓ‰ÔÌ˘˚ο EÓ‰ÔÊϤ‚È· Afi ÙÔ ÛÙfiÌ· Afi ÙÔ ÔÚıfi P˘ıÌÈ˙fiÌÂÓË ·fi ÙÔÓ ·ÛıÂÓ‹ ·Ó·ÏÁËÛ›· ∞Ê·ÈÌ·ÍÔÌÂÙ¿ÁÁÈÛË
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A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ A.¶.£.
17
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·18
¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20
ÛÙÚ¤„ÈÌˆÓ ‰Ú·ÓÔ΢ÙÙ¿ÚˆÓ. EÓÔ¯ÔÔÈÔ‡ÓÙ·È ·Ú¿ÁÔÓÙ˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ fiˆ˜ ÔÈ ÚˆÙ½Ó˜ ÔÍ›·˜ Ê¿Ûˆ˜, Ù· ·ÈÌÔÂÙ¿ÏÈ·, Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· Î·È Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (1). O fiÓÔ˜ Ù˘ ıÚÔÌ‚ˆÙÈ΋˜ ÎÚ›Û˘ Â›Ó·È Ô͇˜, ÂÓÙÔ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙ· Ì·ÎÚ¿ ÔÛÙ¿, ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË Î·È ÙȘ Ï¢ڤ˜. ™Ù· ·È‰È¿ ̤¯ÚÈ ÙËÓ ËÏÈΛ· 10-12 ¯ÚfiÓˆÓ ÂÓÙÔ›˙ÂÙ·È Û˘¯Ó¿ ÛÙȘ ÌÂٷʇÛÂȘ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ fiÔ˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ú¿Ï¢ÚË Î˘ÎÏÔÊÔÚ›·. ™ÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ Ô fiÓÔ˜ Â›Ó·È ÔÏ˘ÂÛÙÈ·Îfi˜ ·ÌÊÔÙÂÚfiÏ¢ÚÔ˜ ‹ ÌÂÙ·Ó·ÛÙ¢ÙÈÎfi˜ Î·È Ë ‰È¿ÚÎÂÈ¿ ÙÔ˘ Î˘Ì·›ÓÂÙ·È ·fi 3-10 Ë̤Ú˜. ™˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi ̤ÙÚÈ· ˘ÚÂÙÈ΋ ΛÓËÛË (38ÔC) ÂÓÒ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ˘Ô‰fiÚÈ· ÊÏÂÁÌÔÓ‹ ÛÙÔ ÛËÌÂ›Ô ÙÔ˘ fiÓÔ˘. ¶ÔÏÏÔ› ·ÛıÂÓ›˜ ·Ó·Ê¤ÚÔ˘Ó ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ fiÓÔ˘ Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· fiˆ˜ ÌÔ‡‰È·ÛÌ· ‹ ˘·ÈÛıËÛ›· Ù˘ ÂÚÈÔ¯‹˜, ‰È¿ÚÎÂÈ·˜ 24 ˆÚÒÓ ÂÚ›Ô˘ Ô˘ Èı·ÓfiÓ ÛËÌ·›ÓÔ˘Ó ÙËÓ ¤Ó·ÚÍË Ù˘ Ó¤ÎÚˆÛ˘ ÙÔ˘ ÈÛÙÔ‡. H Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÒ‰˘ÓˆÓ ÎÚ›ÛÂˆÓ Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ·ÛıÂÓÔ‡˜. Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÌÂٷ͇ 15 Î·È 25 ¯ÚfiÓˆÓ ÔÓÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ Ù· ·ÁfiÚÈ·. MÂÙ¿ Ù· 30 ¯ÚfiÓÈ· Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÒ‰˘ÓˆÓ ÎÚ›ÛÂˆÓ ·Ú·ÈÒÓÂÈ (1). ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂÈÛ‡‰Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜ ÂÒ‰˘Ó˘ ÎÚ›Û˘ ıˆÚÔ‡ÓÙ·È ÔÈ ÏÔÈÌÒÍÂȘ, Ô ˘ÚÂÙfi˜, Ë ·Ê˘‰¿ÙˆÛË, Ë ·fiÙÔÌË ·ÏÏ·Á‹ ıÂÚÌÔÎÚ·Û›·˜ (ÎÚ‡Ô-˙ÂÛÙfi), ÙÔ ˘„fiÌÂÙÚÔ, Ë ˘ÔÍ›·, Ë ¤ÓÙÔÓË ¿ÛÎËÛË Î·È Û˘ÁÎÈÓËÛÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ (1,3,4). ™Ù· ·È‰È¿ ·ÓÔ˚ο ÂÂÈÛfi‰È· ÙËÓ Ó‡¯Ù· ·fi ·fiÊÚ·ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (˘ÂÚÙÚÔÊ›· ·‰ÂÓÔÂȉÒÓ, ·Ì˘Á‰·ÏÒÓ) ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÂÒ‰˘ÓË ÎÚ›ÛË ÏfiÁˆ ÂÏ¿ÙÙˆÛ˘ ÙÔ˘ ÎÔÚÂÛÌÔ‡ ÙÔ˘ Ô͢ÁfiÓÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (5). °ÂÓÈο Ë ·ÓÙ›ÏË„Ë Î·È Ë ¤ÎÊÚ·ÛË ÙÔ˘ fiÓÔ˘ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ ηıÒ˜ Î·È ·fi ÎÔÈÓˆÓÈÎÔ‡˜ Î·È „˘¯ÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (1,6) ÂÓÒ Ë ¤ÓÙ·ÛË Î·È Ë ‰È¿ÚÎÂÈ· ÙÔ˘ fiÓÔ˘ ı· Ô‰ËÁ‹ÛÔ˘Ó ÙÔÓ ‰Ú·ÓÔ΢ÙÙ·ÚÈÎfi ·ÛıÂÓ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Â›Ó·È ¤Ó· ‰‡ÛÎÔÏÔ Úfi‚ÏËÌ· ÙfiÛÔ ÁÈ· ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙÔ˘˜ ÓÔÛËÏÂ˘Ù¤˜, fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜. °ÂÓÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ô fiÓÔ˜ ÛÙ· ·È‰È¿ ˘ÔıÂڷ‡ÂÙ·È (7). B·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ÂÈÙ˘¯‹ Î·È ·ÛÊ·Ï‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ ·ÔÙÂÏ› Ë ÔχÏ¢ÚË ÚÔÛ¤ÁÁÈÛË Ô˘ Ú¤ÂÈ Ó· Û˘Ó‰˘¿˙ÂÈ ÙË ÁÓÒÛË ÙˆÓ È‰ÈÔÙ‹ÙˆÓ ÙˆÓ ¯ÔÚËÁÔ˘Ì¤ÓˆÓ Ê·Ú̿ΈÓ, ÙÔ˘˜ ‰˘Ó·ÙÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ì ‚¿ÛÂÈ ¿ÓÙ· ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ ·ÏÏ¿ Î·È ÙËÓ ÂÈı·Ú¯›· ÙfiÛÔ ÙÔ˘ ȉ›Ô˘ fiÛÔ Î·È ÙÔ˘ ·Ú·˚·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡. A·Ú·›ÙËÙË ÎÚ›ÓÂÙ·È Ë ÂÓË̤ڈÛË ·ÛıÂÓÒÓ Î·È ÁÔÓ¤ˆÓ Î·È Ë „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ¿Á¯Ô˘˜ Ô˘ ÂȉÂÈÓÒÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ fiÓÔ˘. H ÏÂÙÔÌÂÚ‹˜ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ ηÈ
18
M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË
Ë ÚÔÛÂÎÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ·ÛıÂÓ‹ ıˆÚÂ›Ù·È ‚·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙÔ Û¯Â‰È·ÛÌfi Ù˘ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜. °ÂÓÈΤ˜ ·Ú¯¤˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ Û›ÙÈ ‹ ÛÙÔ NÔÛÔÎÔÌÂ›Ô ·ÔÙÂÏÔ‡Ó Ë ÂÓ˘‰¿ÙˆÛË, Ë ·ÓÙÈÌÂÙÒÈÛË Û˘Ó˘¿Ú¯Ô˘Û·˜ Ïԛ̈͢ ‹ ¿ÏÏ˘ ÂÈÏÔ΋˜ Î·È Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ (1,8). T· ·Ó·ÏÁËÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Ù˘ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ ÎÚ›Û˘ ‰È·ÎÚ›ÓÔÓÙ·È Û ÌË ÔÈÔÂȉ‹ (¶›Ó·Î·˜ 1) Î·È ÔÈÔÂȉ‹ (¶›Ó·Î·˜ 2). H ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·ÎÔÏÔ˘ı› ÚÔԉ¢ÙÈ΋ ÔÚ›· ·fi ‹È· ·Ó·ÏÁËÙÈο Û ̤ÙÚÈ· Î·È ÙÂÏÈο Û ÈÛ¯˘Ú¿ ÔÈÔÂȉ‹ (9,10). MÈ· ÂÏ·ÊÚ¿ ˆ˜ ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ Ì ÌË ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο Ê¿Ú̷η ·fi ÙÔ ÛÙfiÌ·. H ‰Ú¿ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ Â›Ó·È ÂÚÈÊÂÚÈ΋, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙË Û‡ÓıÂÛË ÙˆÓ ÚÔÛÙ·ÁÏ·‰ÈÓÒÓ Ô˘ ·Ú¿ÁÔÓÙ·È ·fi ÙËÓ ÊÏÂÁÌÔÓ‹ ÙˆÓ ÈÛÙÒÓ (11). ™Â ¤ÓÙÔÓÔ fiÓÔ Ù· ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο ·ÔÙÂÏÔ‡Ó Ù· ·ÚÈ· Ê¿Ú̷η ·Ó·ÏÁËÛ›·˜. H ‰Ú¿ÛË ÙÔ˘˜ Â›Ó·È ÎÂÓÙÚÈ΋ ̤ۈ ˘Ô‰Ô¯¤ˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (9). OÈÔÂȉ‹ ·Ó·ÏÁËÙÈο ·fi ÙÔ ÛÙfiÌ· fiˆ˜ Έ‰Â˝ÓË ‹ Âıȉ›ÓË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘ÔÛÙËÚÈÎÙÈ΋ ıÂڷ›· ‰˘Ó·ÙfiÓ Ó· ÂÏ·ÙÙÒÛÂÈ ÙÔÓ fiÓÔ Î·È Ó· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ NÔÛÔÎÔÌ›Ô. AÓÙÈÌÂÙÒÈÛË ÛÙÔ Û›ÙÈ: H ÂÏ·ÊÚ¿ ˆ˜ ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÛÙÔ Û›ÙÈ Ì ÍÂÎÔ‡Ú·ÛË Û ˙ÂÛÙfi ÂÚÈ‚¿ÏÏÔÓ, ·ÂÚÈfiÚÈÛÙË Ï‹„Ë ˘ÁÚÒÓ ·fi ÙÔ ÛÙfiÌ·. XÔÚ‹ÁËÛË ÂÓÈÎÈÏ›Ó˘ Ì ‹ ¯ˆÚ›˜ ·ÚÔ˘Û›· Ïԛ̈͢, Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ÌË ÔÈÔÂȉÒÓ ·Ó·ÏÁËÙÈÎÒÓ ÌfiÓ· ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌÔ‡˜, ÂÏ·ÊÚ¿ ËÚÂÌÈÛÙÈο (·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ ‚ÂÓ˙ԉȷ˙›Ó˜) ·Ó¿ÏÔÁ· Ì ÙËÓ È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·ÛıÂÓ‹ (¶›Ó·Î·˜ 1). IÛ¯˘Úfi˜ fiÓÔ˜, ÔÏ˘ÂÛÙÈ·Îfi˜ ‹ ÂÓÙÔÈ˙fiÌÂÓÔ˜ ÛÙÔ ıÒڷη ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 48 ˆÚÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. AÓÙÈÌÂÙÒÈÛË ÛÙÔ NÔÛÔÎÔÌ›Ô: ÕÌÂÛË ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ¯·Ú·ÎÙ‹ÚˆÓ ÙÔ˘ fiÓÔ˘ Û ۇÁÎÚÈÛË Ì ÚÔËÁÔ‡ÌÂÓ· ÂÂÈÛfi‰È·, ¤ÏÂÁ¯Ô˜ ÁÈ· Ù˘¯fiÓ Û˘Ó‡·ÚÍË Ïԛ̈͢ Î·È ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: °ÂÓ. ·›Ì·ÙÔ˜, ¢EK, CRP, ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Û ˘ÚÂÙfi ¿Óˆ ÙˆÓ 38,5oC, ·¤ÚÈ· ·›Ì·ÙÔ˜ Î·È ·/· ıÒڷη Û ıˆÚ·ÎÈÎfi ‹ ÔÏ˘ÂÛÙÈ·Îfi fiÓÔ Î·È Ïԛ̈ÍË ·Ó·Ó¢ÛÙÈÎÔ‡, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Û ÎÔÈÏȷο ¿ÏÁË. H Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈο ÂÓ˘‰¿ÙˆÛË Ì ÂÓ‰ÔÊϤ‚È· (IV) ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ‰È·Ï‡Ì·ÙÔ˜ (1+4) ‚¿ÛÂÈ ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ +50% Î·È ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏ›Ó˘ ‹ ¿ÏÏˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·Ù¿ ÂÚ›ÙˆÛË. ™Â ̤ÙÚÈ· ÂÒ‰˘ÓË ÎÚ›ÛË ÂÎÙfi˜ ·fi Ù· ÁÂÓÈο ̤ÙÚ· ¯ÔÚËÁÔ‡ÓÙ·È ·Ú¯Èο ·Ú·ÎÂÙ·ÌfiÏË Î·È ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ÛÙȘ ·ÓÒٷ٘ ‰fiÛÂȘ
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·19
¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20
∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘
¶›Ó·Î·˜ 1. MË ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο O‰fi˜ ºAPMAKA ¯ÔÚ‹ÁËÛ˘
¢fiÛË mg/Kg
AÓÒÙÂÚË ‰fiÛË (mg) AÓÒÙÂÚË ‰fiÛË (mg) ¶·È‰È¿ ∂Ó‹ÏÈΘ
¶APAKETAMO§H Dolal, Panadol, Lonarid
PO, Sup
15-20/4 ÒÚ˜
3-6¯Ú. 500/24 ÒÚ˜
PO
5-6/6 ÒÚ˜
500/8 ÒÚ˜
N·ÚÔͤÓË Naprosyn
PO, Sup
5-8/12 ÒÚ˜
500/12 ÒÚ˜
IÌÔÚÔ˘Ê·›ÓË µrufen
PO, Sup
3-10/6 ÒÚ˜
500/6 ÒÚ˜
PO, Sup,IM
1-2/8-12 ÒÚ˜
50/8 ÒÚ˜
PO
3-5/6/8 ÒÚ˜
200/8 ÒÚ˜
2500/24 ÒÚ˜
ªH ™TEPOEI¢H ANTIº§E°MONø¢H ªÂÊ·ÈÓ·ÌÈÎfi Ô͇ Ponstan
IÓ‰ÔÌÂı·Î›ÓË Indocid ∆ÔÏÊ·ÈÓ·ÌÈÎfi Ô͇ Gantil ¢ÈÎÏÔÊ·ÈÓ¿ÎË Ó·ÙÚÈÔ‡¯Ô˜ Voltaren À‰ÚÔ͢˙›ÓË Atarax
PO Sup,IM PO, π.ª.
¶›Ó·Î·˜ 2. OÈÔÂȉ‹ ·Ó·ÏÁËÙÈο O‰fi˜ ºAPMAKA ¯ÔÚ‹ÁËÛ˘ Kˆ‰Â˝ÓË ºˆÛÊÔÚÈ΋
150/24 ÒÚ˜ 1/24 ÒÚ˜
¢fiÛË mg/Kg
2-6 ¯Ú. 50/24 ÒÚ˜ 6-12 ¯Ú. 100/24 ÒÚ˜
50-100/6 ÒÚ˜
AÓÒÙÂÚË ‰fiÛË (mg) AÓÒÙÂÚË ‰fiÛË (mg) ¶·È‰È¿ ∂Ó‹ÏÈΘ
PO, πª
0,5-3/4-6 ÒÚ˜
¢È¸‰ÚÔΈ‰Â˝ÓË Dolcontin
PO
1/4-6 ÒÚ˜
™À¡¢À∞™ªOÿ Kø¢∂´¡∏˜ Kˆ‰Â˝ÓË+·Ú·ÎÂÙ·ÌfiÏË Depon plus Lonalgal Medamol
PO PO, Sup PO, Sup
∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË
∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË
∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË
Kˆ‰Â˝ÓË+·Ú·ÎÂÙ·ÌfiÏË+ ∫·Ê½ÓË Lonarid N
PO, Sup
∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË
∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË
∞Ó¿ÏÔÁ· ÌÂ ÙË Û‡ÓıÂÛË
PO, IM IV
1 tabl(65mg)/6-8 ÒÚ˜ 1 amp(75mg)/8-12 ÒÚ˜
300/24 ÒÚ˜
600/24 ÒÚ˜
PO(powder) IM IV Bolus
25-50/3-4 ÒÚ˜ 1-5/2 ÒÚ˜ 0,2-0,6/1 ÒÚ· 0,5-1/2 ÒÚ˜
¢ÂÍÙÚÔÚÔÔÍ˘Ê·›ÓË Romidon Zideron ¶Âıȉ›ÓË ˘‰ÚԯψÚÈ΋ ªeperidine
ªÔÚÊ›ÓË Sulfate Morficontin (tabl 100 mg) PO Mongol (caps 10,30,60,100 mg) PO ªÔÚÊ›ÓË ˘‰ÚԯψÚÈ΋ Morficontin (tabl 100 mg)
πª ‹ Sub IV *Bolus,*PCA
60/12 ÒÚ˜
0,3-0,6/12 ÒÚ˜ 0,2-0,5/4-6 ÒÚ˜ 0,1-0,2/3-4 ÒÚ˜ 0,01-0,06/1 ÒÚ·
*¶ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔ Î›ÌÂÓÔ Î·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· Ì ۇÁ¯ÚÔÓË ¯ÔÚ‹ÁËÛË ËÚÂÌÈÛÙÈÎÒÓ (¶›Ó·Î·˜ 1). E¿Ó Ô fiÓÔ˜ ÂÈ̤ÓÂÈ ‹ ÂȉÂÈÓÒÓÂÙ·È ¯ÔÚËÁÔ‡ÓÙ·È ÔÈÔÂȉ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌË ÛÙÂÚÔÂȉ‹ ·Ó·ÏÁËÙÈο Î·È ËÚÂÌÈÛÙÈο.
™Â ‚·ÚÈ¿ ÎÚ›ÛË ¯ÔÚËÁÔ‡ÓÙ·È ÚÔԉ¢ÙÈο Έ‰Â˝ÓË ‹ Û˘Ó‰˘·ÛÌÔ› Ù˘, ‰ÂÍÙÚÔÚÔÔÍ˘Ê·›ÓË, Âıȉ›ÓË ‹ ÌÔÚÊ›ÓË Î·Ù¿ ÂÚ›ÙˆÛË, ·Ú¯Èο ·fi ÙÔ ÛÙfiÌ· ‹ ÙÔ ÔÚıfi Î·È Û ÌË ·ÓÙ·fiÎÚÈÛË, ˘Ô‰fiÚÈ· ‹ IV ‹ bolus
19
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·20
¶∞π¢π∞∆ƒπ∫∏ 2000;63:17-20
¤Á¯˘ÛË, ‹ Ú˘ıÌÈ˙fiÌÂÓË ·fi ÙÔÓ ·ÛıÂÓ‹ ·Ó·ÏÁËÛ›· Ì ·ÓÙÏ›· (PCA) Ì ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· (9,12,13). XÚÂÈ¿˙ÂÙ·È ÚÔÛÔ¯‹ ÛÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÔÈÔÂȉÒÓ ·Ó·ÏÁËÙÈÎÒÓ Î·È ÂÍ·ÙƠ̂΢ÛË ÙˆÓ ‰fiÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙÔ ıÂڷ¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÏfiÁˆ ÙˆÓ ÂÌÊ·ÓÈ˙fiÌÂÓˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ (·ÁÁÂÈԉȷÛÙÔÏ‹, ¿ÚÂÛË Ï›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ, Û·ÛÌÔ›, ·Ú·ÈÛı‹ÛÂȘ, ηٷÛÙÔÏ‹ ·Ó·ÓÔ‹˜) ÔÈ Ôԛ˜ ÌÔÚ› Ó· Â›Ó·È ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓ‹ (9). £ÂˆÚÂ›Ù·È ÛÎfiÈÌË Ë ÂÚÈÁÚ·Ê‹ ·Ó·Ï˘ÙÈο Ù˘ bolus Î·È Ù˘ ÂÏÂÁ¯fiÌÂÓ˘ ·fi ÙÔÓ ·ÛıÂÓ‹ ‹ ÙÔ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘. ¶·Ú·Û΢¿˙ÂÙ·È ‰È¿Ï˘Ì· ÌÔÚÊ›Ó˘ 1 mg/kg Û 50ml ÔÚÔ‡ 5% Dextrose. ™ÙË ‚·ÛÈ΋ bolus ¤Á¯˘ÛË ÌÔÚÊ›Ó˘ ¯ÔÚËÁÔ‡ÓÙ·È 5ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÂÊ¿·Í ‚Ú·‰¤ˆ˜. E¿Ó Ô fiÓÔ˜ ÂÈ̤ÓÂÈ ¯ÔÚËÁÔ‡ÓÙ·È 2,5 ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÌÂÙ¿ 10-15'. E·Ó¿ÏË„Ë Ù˘ ›‰È·˜ ‰fiÛ˘, ·Ó ¯ÚÂÈ¿˙ÂÙ·È ÌÂÙ¿ 10-15'. AÎÔÏÔ˘ı› Ë ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ Ì ¯ÔÚ‹ÁËÛË 1ml ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ·Ó¿ ÒÚ· ̤¯ÚÈ ÛËÌ·ÓÙÈ΋˜ ˘Ô¯ÒÚËÛ˘ ÙÔ˘ fiÓÔ˘ Ì ‚·ıÌÈ·›· ÂÏ¿ÙÙˆÛË Ù˘ ‰fiÛ˘ ¤ˆ˜ 0,5ml/h. H IV ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ Ì PCA ÂÊ·ÚÌfi˙ÂÙ·È Û ·È‰È¿ ¿Óˆ ·fi 7 ¯ÚfiÓˆÓ Î·È Ú˘ıÌ›˙ÂÙ·È ·fi ÙÔ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ·ÛıÂÓ‹ (9). XÔÚËÁÂ›Ù·È 1ml/h ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ¤ˆ˜ 12h ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË. E¿Ó Ô fiÓÔ˜ ÂÈ̤ÓÂÈ ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÈ Û˘Ó‰˘·ÛÌfi˜ IV Î·È bolus ¤Á¯˘ÛË 1ml οı 10’. AÓÙ›‰ÔÙÔ Ù˘ ÌÔÚÊ›Ó˘ Â›Ó·È Ë ˘‰ÚԯψÚÈ΋ Ó·ÏÔÍfiÓË (Narcan) Ô˘ ¯ÔÚËÁÂ›Ù·È IV Û ‰fiÛË 0,1-0,4 mg /2'- 3'. ¶ÚÔÙÈÌ¿Ù·È Ë IV ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·Ú̿ΈÓ, ··ÈÙÂ›Ù·È fï˜ ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈfiÙÈ ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ ·ÚÂÓÂÚÁÂÈÒÓ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ·‡ÍËÛË Ù˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ Ô˘ ‰˘Ó·ÙfiÓ Ó· Úԉȷı¤ÙÔ˘Ó Û Ô͇ ıˆÚ·ÎÈÎfi ‹ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (1,14).O Êfi‚Ô˜ ÙÔ˘ Èı·ÓÔ‡ ÂıÈÛÌÔ‡ ÛÙ· ÔÈÔÂȉ‹ Â›Ó·È ·‚¿ÛÈÌÔ˜. H ÔÈÔÊÔ‚›· ‚·Û›˙ÂÙ·È ÛÙË Û‡Á¯˘ÛË Ô˘ ˘¿Ú¯ÂÈ ÌÂٷ͇ Ê˘ÛÈ΋˜ ÂÍ¿ÚÙËÛ˘ Î·È ÂıÈÛÌÔ‡. H Û˘¯ÓfiÙËÙ· ÙÔ˘ ÂıÈÛÌÔ‡ ·fi ¯Ú‹ÛË ÔÈÔÂȉÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·Ó¤Ú¯ÂÙ·È ÛÙÔ 0,03% (9). ™ÙË ‚·ÚÈ¿ ÂÒ‰˘ÓË ÎÚ›ÛË Ô˘ ÂÈ̤ÓÂÈ ¿Óˆ ·fi 48 ÒÚ˜ Î·È ‰ÂÓ ÂϤÁ¯ÂÙ·È Ì ÔÈÔÂȉ‹ ·Ó·ÏÁËÙÈο Ë ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ ‹ Ë ·Ê·ÈÌ·ÍÔÌÂÙ¿ÁÁÈÛË (AºM) ·Ó·Ê¤ÚÂÙ·È fiÙÈ ‰˘Ó·ÙfiÓ Ó· ‚ÔËı‹ÛÂÈ Ï·Ì‚¿ÓÔÓÙ·˜ ¿ÓÙ· ˘fi„Ë Ù· ˘¤Ú Î·È Ù· ηٿ ÌÈ·˜ ÌÂÙ¿ÁÁÈÛ˘ (1). E›Û˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÂÒ‰˘ÓË ıÚÔÌ‚ˆÙÈ΋ ÎÚ›ÛË Ô˘ ‰ÂÓ ÂϤÁ¯ıËΠ̠ÙËÓ ¯ÔÚ‹ÁËÛË ÔÈÔÂȉÒÓ ·ÓÙÈÌÂÙˆ›ÛÙËΠÂÈÙ˘¯Ò˜ ÌÂ Û˘Ó¯‹ ÂÈÛÎÏËÚ›‰ÈÔ ·Ó·ÏÁËÛ›· (3,15).
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-07-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-09-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M. Aı·Ó·Û›Ô˘ AÁ. ™ÔÊ›·˜ 30, £ÂÛÛ·ÏÔÓ›ÎË 546 22
20
M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË
MÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓ‹ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Û˘ÓÈÛÙ¿Ù·È ·Ô¯‹ ·fi ÙÔ Û¯ÔÏÂ›Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 3 Ë̤Ú˜ Î·È ‚·ıÌÈ·›· ‰È·ÎÔ‹ ÙˆÓ ·Ó·ÏÁËÙÈÎÒÓ. H ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÂÍ·ÎÔÏÔ˘ı› ̤¯ÚÈ Û‹ÌÂÚ· Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi Î·È ‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ· Ù˘ È·ÙÚÈ΋˜. H ÂÈÙ˘¯‹˜ Î·È ·ÛÊ·Ï‹˜ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ˘˜ ‰Ú·ÓÔ΢ÙÙ·ÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ÔχÏ¢ÚË ÚÔÛ¤ÁÁÈÛ‹ ÙÔ˘, ı· ÌÔÚÔ‡Û ӷ ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÙfiÌˆÓ ·˘ÙÒÓ. BÈ‚ÏÈÔÁÚ·Ê›· 1. Serjeant G. The painful crisis. In: Serjeant G. Sickle cell disease 2nd ed. Oxford University Press 1992: 245-260. 2. Platt S, Thorington D, Brambilla J, Milner F, Rosse F, Vichinsky E et al. Pain in sickle cell disease: rates and risk factors. N Engl J Med 1991; 325:11-16. 3. Evans J. Practical management of sickle cell diseases. Arch Dis Child 1989; 64:1748-1751. 4. Shapiro B. The management of pain in sickle cell disease. Pediatr Clin North Am 1989; 36:1029-1045. 5. Samuels M, Stebbens V, Davies S, Picton-Johnes E, Southall D. Sleep related upper airway obstruction and hypoxaemia in sickle cell disease. Arch Dis Child 1992; 67:925-929. 6. McGrath J, McAlpine L. Psychologic perspectives on pediatric pain. J Pediatr 1993; 122:52-57. 7. Pain relief in children (editorial) BMJ 1998; 316:1552. 8. Ware M, Hableton I, Ochaya I, Serjeant G. Day Care management of sickle cell painful crisis in Jamaica: a model applicable elsewhere? B J Haemat. 1999;104:93-96. 9. M˘ÚˆÓ›‰Ô˘-T˙Ô˘‚ÂϤÎË M, T˙Ô˘‚ÂϤ΢ °. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿. EÈÛÙËÌÔÓÈ΋ ÂÂÙËÚ›‰· TÌ‹Ì·ÙÔ˜ I·ÙÚÈ΋˜ A.¶.£. 1996; 23:1:51-63. 10. Goldman A, Pain management. Arch Dis Child 1993; 68:423-425. 11. £. §È·ÎÔÔ‡ÏÔ˘. MË ÛÙÂÚÈÓÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η. ™ÙËÓ 27Ë ¶·È‰È·ÙÚÈ΋ £Âڷ¢ÙÈ΋ ÂÓË̤ڈÛË; 1994 M¿ÈÔ˜ 7-8, Aı‹Ó·: ¢ÂÏÙ›Ô A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ 1994 (™˘ÌÏËÚ.) 47-51. 12. Trentadue O, Kachoyeanos K, Lea G. A comparison of two regimens of patient-controlled analgesia for children with sickle cell disease. J Pediatr Nurs 1998; 13 (1):15-19. 13. Grundy R, Howard R, Evans J. Practical management of pain in sickling disorders. Arch Dis Child 1993; 69:256-259. 14. Rucknagel L, Kalinya KA, Gelfand J. Rib infarcts and acute chest syndrome in sickle cell diseases. Lancet 1991; 80:833-840. 15. Yaster M, Tobin JR, Billett C, Casella JF, Dover G. Epidural analgesia in the management of severe vaso-occlusive sickle-cell crisis. Pediatrics 1994; 93:310-315.
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™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Ê·ÈÓfiÙ˘Ô Û ·È‰ÈÎfi ÏËı˘ÛÌfi AÛ·Û›· TÛ¤˙Ô˘1, M·Ú›· T˙¤ÙË2, ™ÔÊ›· K›ÙÛÈÔ˘1, AÁÁÂÏÈ΋ °·ÏÏ¿1, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿Î˘1, AÓ‰ÚÔÓ›ÎË X·Ù˙ˉËÌԇϷ1, EÏ¢ıÂÚ›· ¶·ÙÂÚ¿ÎË1, AÓÙÒÓÈÔ˜ ¢Ú·Î¿ÙÔ˜3, EÌÌ·ÓÔ˘‹Ï K·Ó·‚¿Î˘2, £ÂÌÈÛÙÔÎÏ‹˜ K·Ú¿ıÈÔ˜1.
● ¶ÂÚ›ÏË„Ë: TÔ Û‡Ó‰ÚÔÌÔ Gilbert (Û. G.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÂÈÛfi‰È· ηÏÔ‹ıÔ˘˜ ¤ÌÌÂÛ˘ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ UDP-ÁÏ˘ÎÔ˘ÚÔÓ˘Ï-ÙÚ·ÓÛÊÂÚ¿Û˘ 1 (ÂÍfiÓÈ· 1-5 ‹ ÂÎÎÈÓËÙ‹˜ TATAA box) ÛÙÔ ¯ÚˆÌfiۈ̷ 2q37. H ÌÂϤÙË ÛÎÔ‡ÂÈ ÛÙËÓ ·Ó‡ÚÂÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û.G. ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ (ÂÈÛ·ÁˆÁ¤˜ ÙÔ ÚÒÙÔ ÂÓı‹ÌÂÚÔ Î¿ı ÌËÓfi˜) Î·È ÛÙË Û˘Û¯¤ÙÈÛË ÁÔÓfiÙ˘Ô˘/ Ê·ÈÓfiÙ˘Ô˘. MÂÏÂÙ‹ıËÎ·Ó 285 ·È‰È¿ (¿Óˆ ÙˆÓ 24 ÌËÓÒÓ) ·ÊÔ‡ ·ÔÎÏ›ÛÙËÎÂ Ë Ë·ÙÈ΋ ‚Ï¿‚Ë, Ë ·Ó·ÈÌ›· Î·È Ë Ï‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ì ‚¿ÛË ÙÔ ÈÛÙÔÚÈÎfi, ÙȘ ‚ÈÔ¯ËÌÈΤ˜ Î·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜. M ÎÚÈÙ‹ÚÈÔ ÙË Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ >1 mg/dl ‰È·ÈÛÙÒıËÎÂ Û˘¯ÓfiÙËÙ· Û.G. 12,3% (35/285 ·È‰È¿). ™ÙË Û˘Ó¤¯ÂÈ· ¤ÁÈÓ ·Ó¿Ï˘ÛË ÙÔ˘ DNA Û 118 ·È‰È¿ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) Ì ‰‡Ô ÂÎÎÈÓËÙ¤˜-ÔÏÈÁÔÓÔ˘ÎÏÂÔÙ›‰È· Î·È ·ÎÔÏÔ‡ıËÛ ·˘ÙfiÌ·ÙË ·Ó¿Ï˘ÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ Â·Ó·Ï·Ì‚·ÓÔÌ¤ÓˆÓ TA ‰ÈÓÔ˘ÎÏÂÔÙȉ›ˆÓ ÛÙÔ TATAA box ÙÔ˘ ÁÔÓȉ›Ô˘, ÒÛÙ ӷ ‰È·ÈÛÙˆı› Ù˘¯fiÓ ÌÂÙ¿ÏÏ·ÍË, ‰ËÏ·‰‹ (TA)7 ·ÓÙ› ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (TA)6. ™Â ÔÌ¿‰· 71/285 Ù˘¯·›· ÂÈÏÂÁÌ¤ÓˆÓ ·È‰ÈÒÓ (1:4 ·È‰È¿) ‰È·ÈÛÙÒıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi˜ ÁÔÓfiÙ˘Ô˜ (TA)6/(TA)6 Û 35 (4,3%), ÂÙÂÚÔ˙˘ÁÒÙ˜ (TA)6/(TA)7 Û 23 (32,4%) Î·È ÔÌÔ˙˘ÁÒÙ˜ (TA)7/(TA)7 Û 13 (18,3%), ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. ·Ó¢ڛÛÎÂÙ·È ˘„ËÏfiÙÂÚË Ì ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜. ™Â ¿ÏÏË ÔÌ¿‰· 35/285 ·È‰È¿ Ô˘ ›¯·Ó ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl ‚Ú¤ıËÎ·Ó ÁÔÓfiÙ˘ÔÈ: (TA)6/(TA)6, (TA)6/(TA)7 Î·È (TA)7/(TA)7 Û 8,6%, 31,4% Î·È 57,1% ·ÓÙÈÛÙÔ›¯ˆ˜ ÂÓÒ ‰È·ÈÛÙÒıËÎÂ Î·È Ì›· ÂÚ›ÙˆÛË Ì ÙÔÓ Û·ÓÈfiÙ·ÙÔ ÁÔÓfiÙ˘Ô (TA)6/(TA)8. T¤ÏÔ˜, Û ¿ÏÏË ÔÌ¿‰· 83/285 ·È‰ÈÒÓ Ô˘ ›¯·Ó ¯ÔÏÂÚ˘ıÚ›ÓË ≤1mg/dl ‰È·ÈÛÙÒıËÎ·Ó ÁÔÓfiÙ˘ÔÈ (TA)6/(TA)6, (TA)6/(TA)7 Î·È (TA)7/(TA)7 Û 51,9%, 37,3% Î·È 10,8% ·ÓÙÈÛÙÔ›¯ˆ˜. H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÓˆÙ¤Úˆ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ (Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘) Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘ (p <0.001). ¶·È‰È·ÙÚÈ΋ 2000;63: 21-26. §¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Gilbert, ÁÔÓfiÙ˘Ô˜, Ê·ÈÓfiÙ˘Ô˜. A. Tsesou, M. Tzeti, S. Kitsiou, A. Galla, E. Kavasarakis, A. Hatzidimoula, E. Pateraki, A. Drakatos, E. Kanavakis, T. Karpathios. Gilbert’s syndrome: Genotype analysis and correlation with phenotype in children. Paediatriki 2000;63: 21-26 . ● Abstract: Gilbert’s syndrome (GS) is characterized by mild unconjugated hyperbilirubinaemia due to mutations of UDP-glucuronosyltransferase 1 (UGT1A1) gene mapped on the human chromosome at 2q37. The aim of this study was the determination of GS frequency in a random sample of children (admissions on the first 5 days of every month) and the correlation between genotype and phenotype. The 285 children studied had no history of hepatitis, anaemia or anticonvulsant therapy based on haematological and biochemical tests. The frequency of GS based on a level of serum total bilirubin (STB) > 1 mg/dl was 12.3% (35/285 children). In these children, genotypic analysis in the promoter region (TATAA box) of the UGT1A1 gene was performed in order to detect the presence of (TA)7 repeats. In a random group of 1:4 children (71/285) it was observed that 35 children (49.3%) had the (TA)6/(TA)6 genotype, 23 children (32.4%) were
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B' ¶·È‰/΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - EÚÁ·ÛÙ‹ÚÈÔ K˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" A' ¶·È‰/΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - XˆÚ¤ÌÂÈÔ EÚ¢ÓËÙÈÎfi EÚÁ·ÛÙ‹ÚÈÔ / MÔÓ¿‰· MÔÚȷ΋˜ I·ÙÚÈ΋˜ NÔÛ. ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" BÈÔ¯ËÌÈÎfi EÚÁ·ÛÙ‹ÚÈÔ NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡"
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A. TÛ¤˙Ô˘ Î·È Û˘Ó.
heterozygotes (TA)6/(TA)7 and 13 (18.3%) had the (TA)7/(TA)7 genotype, indicating that GS frequency is found to be higher when studied by DNA analysis. In the GS group of 35 children it was observed that 8.6% had the 6/6 genotype, 31.4% had the (TA)6/(TA)7 and 57.1% had the (TA)7/(TA)7 genotype, while the rare genotype (TA)6/(TA)8 was found in one child. Finally, in a group of 83/285 children with STB ≤1 mg/dl, the (TA)6/(TA)6 genotype was observed in 51.9%, (TA)6/(TA)7 in 37.3% and (TA)7/(TA)7 in 10.8%. Statistical evaluation of these results showed a significant association between phenotype (STB levels) and genotype (p <0.001). Key words: Gilbert’s syndrome, genotype, phenotype.
EÈÛ·ÁˆÁ‹ TÔ Û‡Ó‰ÚÔÌÔ Gilbert (Û.G.) Â›Ó·È Ì›· ηÏÔ‹ı˘ ¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· ¯ˆÚ›˜ ÛÙÔȯ›· Ë·ÙÔ¿ıÂÈ·˜ ‹ ÂÌÊ·ÓÔ‡˜ ·ÈÌfiÏ˘Û˘ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÂÈÛfi‰È· ÂÏ·ÊÚÔ‡ Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ÈÎÙ¤ÚÔ˘ Ì ·Ó·ÏÔÁ›· ·Ó‰ÚÒÓ/ Á˘Ó·ÈÎÒÓ 4:1 (1-3). MÂٷ͇ ÙˆÓ ÎÏËÚÔÓÔÌÔ˘Ì¤ÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÙÔ Û.G. ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ˘ÔηÙËÁÔÚ›· ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 2-12% Û ‰È¿ÊÔÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (46). AÍ›˙ÂÈ Ó· ÛËÌÂȈı›, fiÙÈ ÙÔ Û. G Û˘¯Ó¿ ˘Ô‰È·ÁÈÁÓÒÛÎÂÙ·È ÏfiÁˆ Ù˘ ËÈfiÙËÙ·˜ ÙˆÓ Û˘Ìو̿وÓ. ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ Ù‡Ô Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ï·ÈfiÙÂÚ˜ ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ÔÈÎÔÁÂÓÂÈÒÓ Ì Û.G. ¤‰ÂÈÍ·Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi ÓfiÛËÌ· Ì ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, Ì ‚¿ÛË ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ ÌfiÓÔ Û 27,5% ÙˆÓ ·‰ÂÏÊÒÓ ·Û¯fiÓÙˆÓ Î·È Û 16,2% ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ‰È·ÈÛÙÒıËΠÛ.G. (3,7). ¶ÚfiÛÊ·Ù· ÔÈ Owens Î·È Ritter (1992) ÂͤÊÚ·Û·Ó ÙËÓ ¿Ô„Ë ÙÔ˘ ·˘ÙÔۈ̷ÙÈÎÔ‡ ˘ÔÏÂÈfiÌÂÓÔ˘ Ù‡Ô˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ó Î·È ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ÁÈ· ÙÔ Û.G. (UDP-glucuronosyltransferase-1, UGT1A1) Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ÙÂÏÔÌÂÚȉȷÎfi ¿ÎÚÔ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 2 (2q37), ÂȂ‚·›ˆÛ ÙÔÓ ÂÈÎÚ·ÙËÙÈÎfi Ù‡Ô (6,8). TÔ ÁÔÓ›‰ÈÔ UGT1 (Ì‹ÎÔ˘˜ ÂÚ›Ô˘ 85 Kb) (EÈÎfiÓ· 1) ·ÔÙÂÏÂ›Ù·È ·fi ¤ÓÙ ÂÍfiÓÈ·, ÙÔ ÚÒÙÔ ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÚȤ¯ÂÈ ¤ÍÈ ˘ÔÌÔÓ¿‰Â˜ (1A ¤ˆ˜ 1F), ÔÈ Ôԛ˜ Î·È Î·ıÔÚ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÈÛÔÂÓ˙‡ÌˆÓ (isoforms) Ù˘ UDPglucuronosyltranferase. I‰È·›ÙÂÚ·, ÙÔ ¤Ó˙˘ÌÔ UDPglucuronosyltransferase Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Â›Ó·È ÚÔ˚fiÓ ÙˆÓ ‰‡Ô ˘ÔÌÔÓ¿‰ˆÓ 1A Î·È 1D ÙÔ˘ ÂÍÔÓ›Ô˘ 1. T· ˘fiÏÔÈ· ÂÍfiÓÈ· ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1 (2 ¤ˆ˜ 5) Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÎÔÈÓ¤˜ ÙÂÏÈΤ˜ ÂÚÈÔ¯¤˜ ηڂÔÍ˘Ï›ˆÓ fiÏˆÓ ÙˆÓ ÈÛÔÂÓ˙‡ÌˆÓ Ù˘ ÙÚ·ÓÛÊÂÚ¿Û˘ (9-11). ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙȘ Έ‰ÈÎÔÔÈÔ‡Û˜ ÂÚÈÔ¯¤˜ (ÂÍfiÓÈ· 1 ¤ˆ˜ 5) ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1 ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ¿ÙÔÌ· Ì Û.G. ÌfiÓÔ Û ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ÌÂÏÂÙÒÓ ·fi ÙËÓ I·ˆÓ›·, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ·˘Ù¤˜ ÂÚÈÔÚ›˙ÔÓÙ·È
22
Û ¿ÙÔÌ· AÛÈ·ÙÈ΋˜ ηٷÁˆÁ‹˜ (12-15). AÓÙ›ıÂÙ·, fiϘ ÔÈ ÌÔÚȷΤ˜ ÌÂϤÙ˜ Û ¿ÙÔÌ· Ì Û.G. Ù˘ Ï¢΋˜ Ê˘Ï‹˜ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙȘ Έ‰ÈÎÔÔÈÔ‡Û˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘, ·ÏÏ¿ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ô ÂÎÎÈÓËÙ‹˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 1A (TATAA box) ÛÙ· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ÂÚȤ¯ÂÈ ¤ÍÈ Â·Ó·Ï‹„ÂȘ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ [A(TA)6TAA], ÂÓÒ ÛÙ· ¿ÙÔÌ· Ì ÙÔ Û.G. ·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· TA Ì ·ÔÙ¤ÏÂÛÌ· 7 ·ÓÙ› ÙˆÓ Û˘Ó‹ıˆÓ 6 ·ӷϋ„ÂˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ (6,11). ™Â ·˘ÙfiÓ ·ÎÚÈ‚Ò˜ ÙÔÓ ÔÏ˘ÌÔÚÊÈÛÌfi ÙÔ˘ DNA ÔÊ›ÏÂÙ·È Ë ÌÂȈ̤ÓË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Î·È ·Ô‰›‰ÔÓÙ·È Ù· ·˘ÍË̤ӷ ›‰· ¯ÔÏÂÚ˘ıÚ›Ó˘ ÛÙÔ Û.G. ™Â ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ̤¯ÚÈ ÛÙÈÁÌ‹˜ ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G., fiˆ˜ ·˘Ùfi ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ‚¿ÛË, ›Ù ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, ›Ù ÙË ÁÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË. ™ÙËÓ ·-
EÈÎfiÓ· 1. ¢ÔÌ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Ì ÂÈΤÓÙÚˆÛË ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹. T· ÂÍfiÓÈ· ‰È·¯ˆÚ›˙ÔÓÙ·È ·fi ÌË Îˆ‰ÈÎÔÔÈÔ‡Û˜ ·ÏÏËÏÔ˘¯›Â˜. Afi Ù· ˙‡ÁË ÂÎÎÈÓËÙÒÓ A/B Î·È C/D ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÓ PCR ÌfiÓÔ ÙÔ ˙‡ÁÔ˜ C/D.
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·23
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋/ Ê·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË
ÚÔ‡Û· ÌÂϤÙË ‰ÈÂÚ¢ӋıËÎÂ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. Û ÓÔÛËÏ¢fiÌÂÓ· ·È‰È¿ Ì ÛÎÔfi: ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ (›‰· ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ -ʇÏÔ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ Î.¿.) Ì ÙÔÓ ÁÔÓfiÙ˘Ô.
H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙȘ ‰ÔÎÈ̷ۛ˜: ·) ·Ó¿Ï˘ÛË ÌÂÙ·‚ÏËÙfiÙËÙ·˜, ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘ Î·È Ê·ÈÓÔÙ‡Ô˘ (Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘) Î·È ‚) t-test ÁÈ· Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘ Î·È Ê‡ÏÔ˘ (·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·).
YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 285 ·È‰È¿ (145 ·ÁfiÚÈ·, 140 ÎÔÚ›ÙÛÈ·) ¿Óˆ ÙˆÓ 24 ÌËÓÒÓ Ô˘ ÓÔÛËχÔÓÙ·Ó ÛÙË B’ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ Î·È ‹Ù·Ó Û ı¤ÛË Ó· ·Ú·Ì›ÓÔ˘Ó ÓËÛÙÈο › 12ˆÚÔ ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·. °È· Ó· ÂÍ·ÛÊ·ÏÈÛÙ› Ô Ù˘¯·›Ô˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ÛÙËÓ ÔÌ¿‰· ηÙÂÙ¿ÁËÛ·Ó ÌfiÓÔ ·È‰È¿ Ô˘ ÂÈÛ¿ÁÔÓÙ·Ó ÙÔ ÚÒÙÔ ÂÓı‹ÌÂÚÔ Î¿ı ÌËÓfi˜. ™ÙÔ Ê‡ÏÏÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ οı ·È‰ÈÔ‡ ηٷÁÚ¿ÊÔÓÙ·Ó ÛÙÔȯ›· ·fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi (·Ó·ÈÌ›·, ›ÎÙÂÚÔ˜, Ë·Ù›Ùȉ·, Ï‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ) Î·È ·fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi (ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ¿ÏÏË ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂÈ·, ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘ G6PD) ηıÒ˜ Î·È Ë Ù˘¯fiÓ Ï‹„Ë ‰È·ÊfiÚˆÓ Ê·ÚÌ¿ÎˆÓ Î·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 7 Ë̤Ú˜ ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·. ™Â fiÏ· Ù· ·ÓˆÙ¤Úˆ ·È‰È¿, Ë ·ÈÌÔÏË„›· ¤ÁÈÓ Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛıÔ‡Ó (1) Ë Ë·Ù›Ùȉ· Î·È Ë ·Ó·ÈÌ›· (Hb, Ht, ÏÂ˘Î¿-Ù‡Ô˜, ·ÈÌÔÂÙ¿ÏÈ·, ¢EK, SGOT, SGPT, ÁGT, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË, ÔÏÈο Ï¢ÎÒÌ·Ù· ÔÚÔ‡, ÏÂ˘ÎˆÌ·Ù›Ó˜, ÛÊ·ÈÚ›Ó˜) Î·È (2) Ó· ÂÏÂÁ¯ı› Ë Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ (ÔÏÈ΋, ¿ÌÂÛË, ¤ÌÌÂÛË). H ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤ÁÈÓ Û 118 ·È‰È¿ ÌÂÙ¿ ·fi ·ÔÌfiÓˆÛË ÙÔ˘ ÁÔÓȉȈ̷ÙÈÎÔ‡ DNA (genomic DNA) ·fi ÏÂÌÊÔ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. °È· ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ¯ÚËÛÈÌÔÔÈ‹ıËΠPUROGENE DNA extraction kit (Gentra Systems). T· ‰Â›ÁÌ·Ù· ÙÔ˘ DNA ÔÏÏ·Ï·ÛÈ¿ÛıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) Ì ‰˘Ô ÂÎÎÈÓËÙ¤˜ - Û˘ÓıÂÙÈο ÔÏÈÁÔÓÔ˘ÎÏÂÔÙ›‰È· (primers): C - 5' -GTCACGTGACACAGTCAAAC-3' Î·È D - 5' -TTTGCTC-CTGCCAGAGGTT-3' Ù· ÔÔ›· ÔÏÏ·Ï·ÛÈ¿˙Ô˘Ó ÙÌ‹Ì·Ù· DNA ÌÂÁ¤ıÔ˘˜ 98-100 ˙¢ÁÒÓ ‚¿ÛÂˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘. O ÂÎÎÈÓËÙ‹˜ D ‹Ù·Ó ÛËÌ·Ṳ̂ÓÔ˜ Ì ÙË ÊıÔÚÈÔ¯ÚˆÛÙÈ΋ Ô˘Û›· Texas Red. OÈ Û˘Óı‹Î˜ Ù˘ ·ÓÙ›‰Ú·Û˘ PCR ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó 35 ·ÎÏÔÈ ·Ú¯›˙ÔÓÙ·˜ Ì 40ÔC ÁÈ· 40'', 72ÔC ÁÈ· 40'' Î·È 95ÔC ÁÈ· 30''. H ·Ó¿Ï˘ÛË Ù˘ ·ÏÏËÏÔ˘¯›·˜ ÙˆÓ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹, ¤ÁÈÓ ÌÂÙ¿ ·fi ËÏÂÎÙÚÔÊfiÚËÛË Û ‹Îو̷ ·ÎÚ˘Ï·Ì›‰Ë˜ (6%), Ì ÙË ¯Ú‹ÛË Û˘Û΢‹˜ ·˘ÙfiÌ·Ù˘ ·Ó¿Ï˘Û˘ Ù˘ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ DNA (VISTRA 725 version 2.0). T· 100 ˙‡ÁË ‚¿ÛÂˆÓ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ ·ÏÏËÏfiÌÔÚÊÔ A(TA)7TAA.
AÔÙÂϤÛÌ·Ù· ™ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ 285 ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ Ô˘ ÂϤÁ¯ıËÎ·Ó Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÌÂıfi‰Ô˘˜ ‰È·ÈÛÙÒıËΠfiÙÈ 35/285 ›¯·Ó ̤ÛË Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ >1 mg/dl (12,3%), ¤Ó· ·fi Ù· ··Ú·›ÙËÙ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û.G. H ÌÔÚȷ΋ ·Ó¿Ï˘ÛË Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ÌÂϤÙË Ù˘ ·ÏÏËÏÔ˘¯›·˜ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹ A (TA)nTAA ÙÔ˘ ÂÍÔÓ›Ô˘ 1A ¤ÁÈÓ Û 3 ÔÌ¿‰Â˜ ·È‰ÈÒÓ. K·Ù·Ú¯‹Ó, ‰È·ÈÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÚÒÙË ÔÌ¿‰· 71/285 ·È‰ÈÒÓ (Ù˘¯·›Ô ‰Â›ÁÌ·, 1:4 ·È‰›) ‰È·ÈÛÙÒıËΠÔÌÔ˙˘ÁˆÙÈÛÌfi˜ ÁÈ· ÙÔ Û.G. (TA)7/TA)7 Û 13 ·È‰È¿ (18,3%), ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi˜ (TA)6/(TA)7 Û 23 (32,4%) Î·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ÁÔÓfiÙ˘Ô˜ (TA)6/(TA)6 Û 35 ·È‰È¿ (49,3%) (¶›Ó·Î·˜ 1). ¶›Ó·Î·˜ 1. °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·ÛıÂÓÒÓ (n = 71/285). °ONOTY¶O™
¶AI¢IA
(n = 71)
n
%
6/6
35
49,3
6/7
23
32,4
7/7
13
18,3
H ‰Â‡ÙÂÚË Î·È ÙÚ›ÙË ÔÌ¿‰· ·ÊÔÚÔ‡Û·Ó 35 Î·È 83 ·È‰È¿ ·ÓÙÈÛÙÔ›¯ˆ˜ Ù· ÔÔ›· Ù·ÍÈÓÔÌ‹ıËÎ·Ó ·Ó¿ÏÔÁ· Ì ÙË Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ >1 mg/dl Î·È ≤1 mg/dl. T· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÁÔÓÔÙ‡ˆÓ ÙˆÓ 35/285 ·È‰ÈÒÓ Ù˘ ‰Â‡ÙÂÚ˘ ÔÌ¿‰·˜ Ì ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl, ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ 57,1% ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· (TA)7/(TA)7 Î·È ÙÔ 31,4% ÂÙÂÚÔ˙˘ÁÒÙ˜ (TA)6/TA)7. E›Ó·È ‰Â ÂӉȷʤÚÔÓ fiÙÈ ÛÙËÓ ÔÌ¿‰· ·˘Ù‹ ‰ÂÓ ‰È·ÁÓÒÛıËΠÔÌÔ˙˘ÁˆÙÈÛÌfi˜ ‹ ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi˜ ÛÙÔ 8,6% ÙˆÓ ·È‰ÈÒÓ ·ÚfiÏÔ Ô˘ Ë Û˘ÁΤÓÙÚˆÛË ¯ÔÏÂÚ˘ıÚ›Ó˘ ‹Ù·Ó >1 mg/dl. E›Û˘ Ú¤ÂÈ Ó· Û¯ÔÏÈ·ÛÙ› fiÙÈ Û ¤Ó·Ó ·ÛıÂÓ‹ Ù˘ ÔÌ¿‰·˜ ·˘Ù‹˜ ‚Ú¤ıËΠÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi˜ ÁÈ· ÙË Û¿ÓÈ· ÌÂÙ¿ÏÏ·ÍË (TA)6/(TA)8 (¶›Ó·Î·˜ 2). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÔÌ¿‰· ÙˆÓ 83/285 ·È‰ÈÒÓ Ì ¯ÔÏÂÚ˘ıÚ›ÓË ≤1 mg/dl Â›Ó·È ÂÓÙ˘ˆÛÈ·Îfi fiÙÈ ÂÓÒ fiˆ˜ ·Ó·ÌÂÓfiÙ·Ó Ô ÁÔÓfiÙ˘Ô˜ ‰È·ÈÛÙÒıËÎÂ
23
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
A. TÛ¤˙Ô˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 2. °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Ù·ÍÈÓfiÌËÛË ·È‰ÈÒÓ Ì ÎÚÈÙ‹ÚÈÔ ÙËÓ ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘. XO§EPY£. > 1 mg/dl (n = 35)
XO§EPY£. ≤ 1 mg/dl (n = 83)
°ÔÓfiÙ˘Ô˜
n
%
°ÔÓfiÙ˘Ô˜
n
%
6/6
3
8,6
6/6
43
51,9
6/7
11
31,4
6/7
31
37,3
7/7
20
57,1
7/7
9
10,8
6/8
1
2,9
Ê˘ÛÈÔÏÔÁÈÎfi˜ ÛÙÔ 51,9% ÂÚ›Ô˘, ÂÓÙÔ‡ÙÔȘ 37,3% ‚Ú¤ıËÎ·Ó ÂÙÂÚÔ˙˘ÁÒÙ˜ (TA)6/(TA)7 Î·È 10,8% ÔÌÔ˙˘ÁÒÙ˜ (TA)7/(TA)7 (¶›Ó·Î·˜ 2). H Û˘Û¯¤ÙÈÛË Ù˘ ̤Û˘ ÙÈÌ‹˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ Ì ÙÔ ÁÔÓfiÙ˘Ô ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÁÔÓfiÙ˘Ô˘ (TA)6/(TA)6 Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘ (TA)7/(TA)7 (p<0.001), ηıÒ˜ Î·È ÌÂٷ͇ ÙˆÓ ÁÔÓÔÙ‡ˆÓ (TA)6/(TA)7 Î·È (TA)7/(TA)7 (p < 0.001) (¶›Ó·Î·˜ 2). ™ÙÔ ÈÛÙfiÁÚ·ÌÌ· (EÈÎfiÓ· 2) Ê·›ÓÔÓÙ·È ·Ú·ÛÙ·ÙÈο Ù· ·ÓˆÙ¤Úˆ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ 2 ÔÌ¿‰Â˜ ·È‰ÈÒÓ Ì ¯ÔÏÂÚ˘ıÚ›ÓË >1 mg/dl (·ÚÈÛÙÂÚ¿) Î·È ≤1 mg/dl (‰ÂÍÈ¿). ™ÙËÓ EÈÎfiÓ· 3, ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Ì¤ÛË Î·È ÔÈ ·ÎÚ·›Â˜ ÙÈ̤˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ Û ۯ¤ÛË Ì ÙÔ ÁÔÓfiÙ˘Ô. ÕÙÔÌ· Ì ÔÌÔ˙˘ÁˆÙÈÛÌfi (TA)7/(TA)7, ¤¯Ô˘Ó ̤ÛË ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘ 1,5 mg/dl Ì ·ÓÒÙ·ÙË ÙÈÌ‹ 1,8 mg/dl ÂÓÒ, ÔÈ ÂÙÂÚÔ˙˘ÁÒÙ˜ ¤¯Ô˘Ó ̤ÛË ÙÈÌ‹ 0.9 mg/dl Ì ·ÓÒÙ·ÙË ÙÈÌ‹ ÂÚ›Ô˘ 1,1 mg/dl. T· ·Ôχو˜ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ˆ˜ ÚÔ˜ ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓfiÙ˘Ô (TA)6/(TA)6, ¤¯Ô˘Ó ¯ÔÏÂÚ˘ıÚ›ÓË Ì¤¯ÚÈ 0,7 mg/dl. º·›ÓÂÙ·È Â›Û˘ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÂÈ-
Î¿Ï˘„Ë ÙˆÓ ÏËı˘ÛÌÒÓ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. A˜ ÛËÌÂȈı›, fiÙÈ ÌÂÙ¿ ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ ʇÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ ÁÔÓfiÙ˘Ô ÁÈ· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÌÂÙ¿ÏÏ·ÍË, ‰ÂÓ ‚Ú¤ıËΠ‰È·ÊÔÚ¿. Ÿˆ˜ ›Û˘, ‰ÂÓ ‚Ú¤ıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ, fiÙ·Ó ÙÔ Û.G. ‰È·ÁÓÒÛıËΠ̠‚¿ÛË ÙÔ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘.
EÈÎfiÓ· 2. IÛÙfiÁÚ·ÌÌ· Ì ٷ ·ÔÙÂϤÛÌ·Ù·
EÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÁÔÓfiÙ˘Ô˘ Î·È Û˘ÁΤÓÙÚˆÛ˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (± fiÚÈÔ ÂÌÈÛÙÔÛ‡Ó˘ 95%).
ÙÔ˘ ¶›Ó·Î· 2.
24
™˘˙‹ÙËÛË H ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È Ù˘¯·›· ÌÂÙ¿ ·fi ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÓËÛÙ›·˜ (fiˆ˜ Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ), Û·ÓÈfiÙÂÚ· ‰Â, ÛÙ· Ï·›ÛÈ· ‰ÈÂÚ‡ÓËÛ˘ ›ÌÔÓˆÓ ‰È·ÏÂÈfiÓÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÓÔ¯ÏËÌ¿ÙˆÓ (1,2). ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÌÂÙ·‚ÔϤ˜ ÛÙÔ Ú˘ıÌfi ·Ú·ÁˆÁ‹˜ ¯ÔÏÂÚ˘ıÚ›Ó˘, ÛÙËÓ ·Ú·ÁˆÁ‹ Ë·ÙÈ΋˜ ·›Ì˘ Î·È ÛÙËÓ Ë·ÙÈ΋ ÚfiÛÏË„Ë ¯ÔÏÂÚ˘ıÚ›Ó˘ (2). §fiÁˆ Ù˘ ηÏÔ‹ıÔ˘˜ ʇÛ˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ¤¯ÂÈ ÂÎÊÚ·Ûı› Ë ¿Ô„Ë Ó· ıˆÚÂ›Ù·È ÙÔ Û‡Ó‰ÚÔÌÔ ˆ˜ ÌÈ· Ê˘ÛÈ΋ ÁÂÓÂÙÈ΋ ·Ú·ÏÏ·Á‹ ·Ú¿ ˆ˜ ·Ûı¤ÓÂÈ·.
JAN.-FEB.2000
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋/ Ê·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË
TÔ ·ıÔÁÂÓÂÙÈÎfi ˘fi‚·ıÚÔ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert Â›Ó·È Ë ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ÁÏ˘ÎÔ˘ÚÔÓÔÔ›ËÛ˘ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Ë ÔÔ›· ÂȉÂÈÓÒÓÂÙ·È Û ÔÚÈṲ̂Ó˜ ηٷÛÙ¿ÛÂȘ (fiˆ˜ ÓËÛÙ›·, ·Ûı¤ÓÂȘ ‹ ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ) Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ›ÎÙÂÚÔ (¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·) (16). H ¤ÌÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË Â›Ó·È ÙÔÍÈÎfi ÌfiÚÈÔ Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙÔ Ô˘ÚȉÈÓÔ-‰ÈʈÛÊÔ-ÁÏ˘ÎÔ˘ÚÔÓÈÎfi Ô͇, ·ÓÙ›‰Ú·ÛË Ë ÔÔ›· ηٷχÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ·fi ÙÔ Ë·ÙÈÎfi ÌÈÎÚÔÛˆÌÈ·Îfi ¤Ó˙˘ÌÔ bilirubin UGT, (uridine diphosphoglucuronosyltransferase (UGT)), ÙÔ ÔÔ›Ô ·Ó·ÚΛ Û ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙ· ¿ÙÔÌ· Ì ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert. OÈ ÙÈ̤˜ Ù˘ ¤ÌÌÂÛ˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÛÙ· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Gilbert Ô˘ ‰ÂÓ ˘Ô‚Ï‹ıËÎ·Ó Û ÓËÛÙ›· Â›Ó·È ÂÏ·ÊÚÒ˜ ·˘ÍË̤Ó˜ (>1 mg/dl) Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ÍÂÂÚÓÔ‡Ó Ù· 2,9 mg/dl, ÂÎÙfi˜ ·fi ÂÚÈÙÒÛÂȘ ÓËÛÙ›·˜, ·Ûı¤ÓÂÈ·˜ ‹ ¯ÔÚ‹ÁËÛ˘ Ê·Ú̿ΈÓ, ÂÓÒ ÙÔ Û. Gilbert ‰ÂÓ Û˘Ó‰¤ÂÙ·È Ì ΛӉ˘ÓÔ ˘ÚËÓÈÎÔ‡ ÈÎÙ¤ÚÔ˘ (17-18). ÕÙÔÌ· Ì ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ¤¯Ô˘Ó ÔÈÎÈÏÔÌÔÚʛ˜ (ÌÂÙ·ÏÏ¿ÍÂȘ) ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ TATAA box ÙÔ˘ ÁÔÓȉȷÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ UGT1, ‰ËÏ·‰‹ ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· Ù· ÔÔ›· ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ¤Ó·ÚÍË ÌÂÙ·ÁÚ·Ê‹˜ (transcription initiation) (6,11). E›Ó·È ‰Â ÂӉȷʤÚÔÓ fiÙÈ Ì ÙË DNA ·Ó¿Ï˘ÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfïÓ, ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ›ÎÙÂÚÔ˘ Î·È ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ (·ÓÒÙÂÚË ÙÈÌ‹ 1 mg/dl) ˘ÔÏÔÁ›ÛıËΠ۠40% Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ÁÈ· ÙËÓ ÂÈÌËΤÛÙÂÚË ÂÚÈÔ¯‹ TATAA (11), ÂÓÒ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÎÏÈÓÈ΋˜-‚ÈÔ¯ËÌÈ΋˜ ‰È¿ÁÓˆÛ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ‰ÂÓ ÍÂÂÚÓ¿ÂÈ ÙÔ 12% (4-6). E›Ó·È ÛËÌ·ÓÙÈÎfi fï˜ Ó· ÙÔÓÈÛı› fiÙÈ ÔÈ ÁÔÓȉȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉȷÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ UGT1 Â›Ó·È ÌÂÓ ·Ó·Áη›· ÚÔ¸fiıÂÛË Û ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ ÌÂÙ·ÏÏ¿ÍÂȘ Û οÔÈÔ ÂÍfiÓÈÔ, ·ÏÏ¿ fi¯È ÈηӋ ÁÈ· ÙËÓ Ï‹ÚË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤¯ÂÈ ıˆÚËı› ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ¿ÏÏˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ‹ ›ÎÙËÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÂÈÚÔÛı¤Ùˆ˜ Ì ÙË ÌÂȈ̤ÓË ÁÏ˘ÎÔ˘ÚÔÓÔÔ›ËÛË (11). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ÙˆÓ ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ [(TA)7/(TA)7], ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Û 57,1% ÙˆÓ ·È‰ÈÒÓ Ì Û.G., ÁÂÁÔÓfi˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙË Û˘ÌÌÂÙÔ¯‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ Û.G. E›Û˘, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ̤Û˘ ÙÈÌ‹˜ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È ÙÔ˘ ÁÔÓfiÙ˘Ô˘. ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ó ‰È·ÈÛÙˆı› Î·È ·fi ÙÔ˘˜ Monaghan Î·È Û˘Ó. (1996) Î·È Bosma ηÈ
Û˘Ó. (1995) (6,11). E›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·fi ÙË ÁÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÙÔ˘ Ù˘¯·›Ô˘ ‰Â›ÁÌ·ÙÔ˜ (n=71) ·Ú·ÙËÚ‹ıËΠfiÙÈ ÙÔ 18,3% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË (TA)7/(TA)7, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û.G. Û ¿ÏϘ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜, fiˆ˜ ÚԷӷʤÚıËÎÂ, ‰ÂÓ ÍÂÂÚÓ¿ ÙÔ 12% (4-6). ™ÙË ÌÂϤÙË Ì·˜ ›Û˘ ‚Ú¤ıËΠfiÙÈ 1 ·È‰› ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 118 ›¯Â ÔÏÈ΋ ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘ 2,5 mg/dl, Ô ‰Â ÁÔÓfiÙ˘Ô˜ ‹Ù·Ó (TA)6/(TA)8. A˘Ù‹ Â›Ó·È Ë ‰Â‡ÙÂÚË ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÊÔÚ¿ Û ¿ÙÔÌÔ Ï¢΋˜ Ê˘Ï‹˜ ÌÂÙ¿ ÙÔ˘˜ Iolascon Î·È Û˘Ó. (1999) (19). T¤ÏÔ˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÁÔÓÔÙ‡ˆÓ Î·È ÙÔ˘ ʇÏÔ˘ ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. H ·Ú·Ù‹ÚËÛË ·˘Ù‹ ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÙȘ ÌÂϤÙ˜ ÙˆÓ Monaghan Î·È Û˘Ó. (1996) Î·È Bancroft Î·È Û˘Ó. (1998) Î·È ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙÔ fiÙÈ ‰ÈÂÚ¢ӋıËÎ·Ó ¿ÙÔÌ· Ó·ڋ˜ ËÏÈΛ·˜ Î·È ÂÔ̤ӈ˜ ÂÏ·¯ÈÛÙÔÔÈ‹ıËÎÂ Ë Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ê¿Ú̷η, ·ÏÎÔfiÏ Î.¿. ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (6,20). ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÚfiÛÊ·Ù· ¤¯ÂÈ Û˘Ó‰Âı› Ë ·ÚÔ˘Û›· Ù˘ ÔÈÎÈÏÔÌÔÚÊ›·˜ ÛÙÔÓ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ Ì ÙËÓ ·Ú·ÙËÚÔ‡ÌÂÓË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· Û ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ (21) ۯ‰ȿ˙ÂÙ·È Ë Â¤ÎÙ·ÛË ÙÔ˘ ÂϤÁ¯Ô˘ ÙÔ˘ Û.G. Ì ÛÎÔfi ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÌÂÙ¿ÏÏ·Í˘ (TA)7/(TA)7 Ì ÙÔÓ ÁÔÓfiÙ˘Ô Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi. BÈ‚ÏÈÔÁÚ·Ê›· 1. Fevery J. Pathogenesis of Gilbert syndrome. Eur J Clin Invest 1981; 11:417-418. 2. Watson KJR, Collan JL. Gilbert’s syndrome. Baillieres Clin Gastroenterol 1989; 3:337-355. 3. Powel LW, Hemingway E, Billing BH, Sherlock S. Idiopathic unconjugated hyperbilirubinemia (Gilbert’s syndrome): a study of 42 families. N. Engl J Med 1967; 277:1108-1112. 4. Bailey A, Robinson D, Dawson AM. Does Gilberts disease exist? Lancet 1977; 1:931-933. 5. Owens D, Evans J. Population studies on Gilberts syndrome. J Med Genet 1975; 12:152-156. 6. Monaghan G, Ryan M, Sedon R, Hume R, Burchell B. Genetic variation in bilirubin UDP-glucuronosyltransferase gene promoter and Gilbert’s syndrome. Lancet 1996; 347:578-581. 7. Thompson RPH. Genetic transmission of Gilbert’s syndrome and drug metabolism. Clin Pharmacokinet 1981; 4:223-232. 8. Owens IS, Ritter JK. The novel bilirubinphenol UDPglucuronyl transferase UGT1 locus: implications for multiple nonhemolytic familial hyperbilirubinemia phenotypes. Pharmacogenetics 1992; 2:93-108. 9. Ritter JK, Chen F, Sheen YY, Tran HM, Kimura S, Yeatman
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MT et al. A novel complex locus UGT1 encodes human bilirubin phenol, and other UDP-glucoronosyltransferase isoenzymes with identical carboxyl termini. J Biological Chemistry 1992; 267:3257-3261. 10. Seppen J, Bosma PJ, Goldhoorn BG, Bokker CTM, Chowdhury JR, Chowdhury NR, et al. Discrimination between Crigler-Najjar Type I and II by Expression of mutant bilirubin uridine diphosphate glucuronosyltransferase. J Clin Invest 1994; 94:2385-2391. 11. Bosma PJ, Chowdhury JR, Bakker C, Gantla S, DeBoer A, Oostra BA, et al. The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert’s syndrome. N Engl J Med 1995; 333(18):1171-1175. 12. Aono S, Adachi Y, Uyama E, Yamada Y, Keino H, Nanno T, et al. Analysis of genes for bilirubin UDPglucuronosyltranferase in Gilbert’s syndrome. Lancet 1995; 345:58-59.
A. TÛ¤˙Ô˘ Î·È Û˘Ó.
13. Koiwai O, Nishizawa M, Hasada K, Aono S, Adachi Y, Mamiya N, et al. Gilberts syndrome is caused by a heterozygous missense mutation in the gene for bilirubin UDP-glucuronosyltransferase. Hum Molec Genet 1995; 4:1183-1186. 14. Soeda Y, Yamamoto K, Adachi Y, Hori T, Aono S, Koiwai O, et al. Predicted homozygous missense mutation in Gilbert’s syndrome. Lancet 1995; 346:1494. 15. Sato H, Adachi Y, Koiwai O. The genetic basis of Gilbert’s syndrome. Lancet 1996; 345:557-558.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· K›ÙÛÈÔ˘, B' ¶·È‰/΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ - NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" 11527, Aı‹Ó·.
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™‡ÁÎÚÈÛË Â˘·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ Ù˘ EÏÏ¿‰·˜ Î·È Ù˘ AÁÁÏ›·˜ ËÏÈΛ·˜ 5 - 7,5 ¯ÚfiÓˆÓ ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·1, K·ÙÂÚ›Ó· NÂÛÙÔÚ›‰Ô˘1, N·Ù¿Û· ¶··‰ÔÔ‡ÏÔ˘1, ¶·Ó·ÁÈÒÙ˘ MfiÙ˘1, Hassan Arshad2, Taraneh Dean2, Sharron Matthews2, Bearny Mealy2
● ¶ÂÚ›ÏË„Ë: MÂϤÙ˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·È ÛÙÔ ÛÙ·ıÌÈṲ̂ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ISAAC Û ‰È·ÊÔÚÂÙÈο ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ Â˘Ú›· ÔÈÎÈÏ›· ÛÙÔÓ ÂÈÔÏ·ÛÌfi ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ Û˘Ìو̿وÓ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ·È‰ÈÒÓ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜, Û ‰‡Ô ¯ÒÚ˜ Ù˘ BfiÚÂÈ·˜ Î·È NfiÙÈ·˜ E˘ÚÒ˘. ™Ù· Ï·›ÛÈ· ÌÈ·˜ ÌÂϤÙ˘ ÚfiÏ˄˘ ¿ÛıÌ·ÙÔ˜ Û ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (SPACE), ÌÂÏÂÙ‹ıËÎ·Ó 1439 ·È‰È¿ ·fi ÙËÓ EÏÏ¿‰· Î·È 364 ·È‰È¿ ·fi ÙËÓ AÁÁÏ›·, ËÏÈΛ·˜ 5 - 7,5 ¯ÚfiÓˆÓ. Afi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ˙ËÙ‹ıËΠӷ Û˘ÌÏËÚÒÛÔ˘Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ ‡·ÚÍË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜. E¿Ó ‹Ù·Ó ıÂÙÈÎfi, ÁÈÓfiÙ·Ó ÛÙ· ·È‰È¿ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÁÈ· ‰‡Ô ÎÔÈÓ¿ ·Î¿Ú· (Der Pteronyssinus Î·È Der Farinae), ÁÈ· Ì›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ Î·È ÙÚ›¯ˆÌ· Á¿Ù·˜. ¢ÔÎÈÌ¿ÛÙËÎ·Ó Â›Û˘ ‰‡Ô ÚfiÛıÂÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÂȉÈο Û οı ÂÚÈÔ¯‹ Û‡Ìʈӷ Ì ÙȘ ÁÓˆÛÙ¤˜ ·ÏÏÂÚÁÈΤ˜ ¢·ÈÛıËۛ˜ Û ·˘Ù¤˜ ÙȘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜. E˘·ÈÛıËÙÔÔÈË̤ӷ Û ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÏÂÚÁÈÔÁfiÓ· ‚Ú¤ıËÎ·Ó 140 (9,7%) ·È‰È¿ ÛÙËÓ EÏÏ¿‰· Î·È 92 (25,3%) ·È‰È¿ ÛÙËÓ AÁÁÏ›· (p<0,001). ÕÏÏÔ ÂÓÙ˘ˆÛÈ·Îfi ‡ÚËÌ· ‹Ù·Ó Ë Ôχ ¯·ÌËÏ‹ ¢·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ÛÙ· EÏÏËÓfiÔ˘Ï· (Der P1: 1,81%, Der f1: 1,25%) Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ù˘ AÁÁÏ›·˜, fiÔ˘ ·˘Ùfi ‹Ù·Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ (Der P1: 14,8%, Der f1: 5,2%). H ¢·ÈÛıËÙÔÔ›ËÛË Û Ì›ÁÌ· Á‡Ú˘ ÁÚ·ÛȉÈÔ‡ ‹Ù·Ó 4,4% Î·È Û ÙÚ›¯ˆÌ· Á¿Ù·˜ 4,1% ÛÙ· ·È‰È¿ Ù˘ EÏÏ¿‰·˜, ÂÓÒ ÛÙ· ·È‰È¿ Ù˘ AÁÁÏ›·˜ ÔÈ ÙÈ̤˜ ‹Ù·Ó 13,2% Î·È 10,2% ·ÓÙ›ÛÙÔȯ·. ŸÏ˜ ÔÈ Û˘ÁÎÚ›ÛÂȘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ (p<0,001). ™˘ÌÂÚ·›ÓÔ˘Ì fiÙÈ Ë ·ÏÏÂÚÁÈ΋ ¢·ÈÛıËÙÔÔ›ËÛË Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Â›Ó·È Ôχ ¯·ÌËÏfiÙÂÚË ÛÙËÓ EÏÏ¿‰· Û ۇÁÎÚÈÛË Ì ÙËÓ AÁÁÏ›·. TÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È ÙÔ ÎÔÈÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ AÁÁÏ›·, ·ÏÏ¿ fi¯È Û˘¯Ófi ÛÙËÓ EÏÏ¿‰·. ¶·È‰È·ÙÚÈ΋ 2000;63:27-33. §¤ÍÂȘ ÎÏÂȉȿ: ¢·ÈÛıËÙÔÔ›ËÛË, ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·, ·Î¿Ú·, ·È‰È¿. S. Tsitoura, K. Nestoridou, N. Papadopoulou, P. Botis, H. Arshad, T. Dean, S. Matthews, B. Mealy. Comparison of sensitisation to aeroallergens in British and Greek school children aged 5 to 7.5 years. Paediatriki 2000;63:27-33. ● Abstract: ISAAC studies from different parts of the world have shown wide variations in the prevalence of allergic symptoms according to response to a standardised questionnaire. We studied the prevalence of sensitisation in 57.5 year-old children with a family history of atopy, by skin prick tests to common aeroallergens, in two countries, Great Britain and Greece, in Northern and Southern Europe respectively. As a part of a study on prevention of allergy in at risk children (SPACE), parents of school children aged 5 to 7.5 years were asked to complete a questionnaire on the presence of family atopy. If the atopy history was positive, the children were tested by skin prick to two, common house dust mites (Der pteronyssinus: Der P1 and Der farinae: Der f1), grass pollen and cat. Two additional allergens specific to each country were also tested, according to the known allergen sensitivities in those geographical locations. We studied 1439 Greek and 364 British children, of which 140 (9.7%) Greek children were sensitised to one or more allergens, compared to 92 (25.3%) British children (p<0.001). A striking finding
1 2
TÌ‹Ì· KÔÈÓˆÓÈ΋˜ I·ÙÚÈ΋˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡", Aı‹Ó· The David Hide Asthma & Allergy Research Centre, St. Mary's Hospital, Isle of Wight, UK
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™. TÛ›ÙÔ˘Ú· Î·È Û˘Ó.
was the very low sensitisation to house dust mites in Greek children (Der P1: 1.81%, Der f1: 1.25%) compared to British children in whom this was the commonest allergen (Der P1: 14.8%, Der f1: 5.2%). Sensitisation to grass pollen mix was 4.4% and cat 4.1% in Greek children, whereas for British children the respective values were 13.2% and 10.2%. All the differences were highly significant (p<0.001). We conclude that allergic sensitisation in primary school age children is much lower in Greece than in Britain. House dust mite was the commonest allergen in Britain, but rare in Greece. Key words: sensitisation, aeroallergens, mites, children.
EÈÛ·ÁˆÁ‹ ™ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ ÔÏϤ˜ ¯ÒÚ˜ ›¯·Ó ÙËÓ ÂÌÂÈÚ›· ·‡ÍËÛ˘ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ (Û 20-30%) Î·È Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. TËÓ ›‰È· ÂÚ›Ô‰Ô, Ô ÏËı˘ÛÌfi˜ ÙÔ˘ ·Ó·Ù˘Á̤ÓÔ˘ ÎfiÛÌÔ˘ ¿ÏÏ·Í ÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ‹˜ ÙÔ˘ (1). H ÌfiÓˆÛË ÙˆÓ Î·ÙÔÈÎÈÒÓ Â›Ó·È Î·Ï‡ÙÂÚË Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·Ù‹ÚËÛË ÛÙ·ıÂÚ¿ ıÂÚÌÔ‡ ·ÏÏ¿ Î·È ˘ÁÚÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ·Ú¤¯ÂÈ È‰·ÓÈΤ˜ Û˘Óı‹Î˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ÁÈ· ÌÂÁ¿Ï˜ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜ οı ¤ÙÔ˜. O ηÎfi˜ ·ÂÚÈÛÌfi˜ ›Û˘ ·˘Í¿ÓÂÈ ÙË Û˘ÁΤÓÙÚˆÛË ‰È·ÊfiÚˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ Ú‡ˆÓ, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·˘Í¿ÓÔÓÙ·È ÔÈ Î¿ÙÔ¯ÔÈ Î·ÙÔÈΛ‰ÈˆÓ ˙ÒˆÓ. ŒÎıÂÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË Û ·ÏÏÂÚÁÈÔÁfiÓ· Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ¤¯ÂÈ ·Ô‰Âȯı› ˆ˜ ·ÚÈ· ·ÈÙ›· ·Ó¿Ù˘Í˘ ¿ÛıÌ·ÙÔ˜ Û ÔÏÏ¿ ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘ (2-10). ¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ Û ÂÚÈÔ¯¤˜ Ì ¯·ÌËÏ¿ ›‰· ·Î¿ÚÂˆÓ ·¤‰ÂÈÍ·Ó ÙËÓ ÛËÌ·Û›· Ù˘ ¤ÎıÂÛ˘ Û ¿ÏÏ· ÂÓ‰ÔÔÈÎȷο ·ÏÏÂÚÁÈÔÁfiÓ·, ÂȉÈο ·˘Ù¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi Á¿Ù˜, Û·ÏÔ˘˜ Î·È Î·ÙÛ·Ú›‰Â˜ (11,12). P˘·ÓÙ¤˜, fiˆ˜ ÙÔ fi˙ÔÓ Î·È ÙÔ ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ı›Ԣ, Ê·›ÓÂÙ·È fiÙÈ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ IgE (13,14) Î·È Ù· ·È‰È¿ ÙˆÓ Î·ÓÈÛÙÒÓ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÙÔÈ΋ ÓfiÛÔ (15). EÔ̤ӈ˜, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙÔ Â›‰Ô˜ Î·È ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË. H ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ÛÙ· Ï·›ÛÈ· ÌÈ·˜ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ ÚfiÏ˄˘ ·ÏÏÂÚÁ›·˜ ÛÙ· ·È‰È¿ Ù˘ E˘ÚÒ˘ (SPACE - Study on Prevention of Allergy in Children in Europe). ™ÎÔfi˜ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ‰È¿ÊÔÚ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·È‰ÈÒÓ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ Ô˘ ˙Ô˘Ó Û ¯ÒÚ˜ Ì ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ (AÁÁÏ›·-N‹ÛÔ˜ Wight Î·È EÏÏ¿‰·-Aı‹Ó·). YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™Â ÁÔÓ›˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 5-7,5 ¯ÚfiÓˆÓ, Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙÔ ÚfiÁÚ·ÌÌ· ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ÓËÈ·ÁˆÁ›ˆÓ, ȉȈÙÈÎÒÓ Î·È ‰ËÌÔÛ›ˆÓ Û¯ÔÏ›ˆÓ ÙÔ˘
28
¶›Ó·Î·˜ 1. EÚˆÙËÌ·ÙÔÏfiÁÈÔ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÏÏÂÚÁ›·˜ (ISAAC) ÁÈ· ÌËÙ¤Ú·, ·Ù¤Ú·, ·‰ÂÏÊfi/‹. 1. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ¿ÛıÌ·; 2. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· Âԯȷ΋ ·ÏÏÂÚÁÈ΋ ÚÈÓÔ-ÂÈÂÊ˘Î›Ùȉ· (·ÚÈÓfi ηٿÚÚÔ˘); 3. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÂÍ¿ÓıËÌ· Ì ʷÁÔ‡Ú· Ô˘ Ó· ÂÌÊ·Ó›˙ÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 6 Ì‹Ó˜; 4. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÔÔÈ·‰‹ÔÙ ÛÙÈÁÌ‹ ÛÙÔ ·ÚÂÏıfiÓ; 5. E›¯Â ÔÙ¤ οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ¿ÙÔÌ· ÊÙÂÚÓ›ÛÌ·Ù·, ‚Ô˘ÏˆÌ¤ÓË Ì‡ÙË ‹ Û˘Ó¿¯È (¯ˆÚ›˜ fï˜ Ó· ¤¯ÂÈ ÎÚ˘ÔÏfiÁËÌ· ‹ ÁÚ›Ë) ηÈ/‹ ÚËṲ̂ӷ Ì¿ÙÈ· Ô˘ Ó· ¤¯Ô˘Ó Ê·ÁÔ‡Ú·; ¢ڇÙÂÚÔ˘ ΤÓÙÚÔ˘ ÙˆÓ AıËÓÒÓ, ‰È·ÓÂÌ‹ıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ISAAC ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜ (›Ó·Î·˜ 1). E¿Ó Ë ·¿ÓÙËÛË ‹Ù·Ó ıÂÙÈ΋, ›Ù ÁÈ· ¤Ó· ÁÔÓ¤·, ›Ù ÁÈ· ·‰ÂÏÊfi/‹, ÙÔ ·È‰› ÂÓÙ·ÛÛfiÙ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ·. M ÁÚ·Ù‹ Û˘Ó·›ÓÂÛË, ‡ÛÙÂÚ· ·fi ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓ¤ˆÓ, ¤ÁÈÓ·Ó Û 1439 ·È‰È¿ (63,1% ·ÁfiÚÈ·) Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜, ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ (SPT) ÁÈ· 6 ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·, [Dermatophagoides Pteronyssinus (Der P1), Dermatophagoides Farinae (Der f1), Ì›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ, ÙÚ›¯ˆÌ· Á¿Ù·˜] Î·È ‰‡Ô ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÁÈ· ÙËÓ EÏÏ¿‰· ‹Ù·Ó Á‡ÚË ÂÏÈ¿˜ Î·È parietaria. M ·Ó¿ÏÔÁÔ ÙÚfiÔ ¤ÁÈÓÂ Ë ÂÈÏÔÁ‹ 364 ·È‰ÈÒÓ (59,4% ·ÁfiÚÈ·) ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ÛÙËÓ Ó‹ÛÔ Wight Ù˘ AÁÁÏ›·˜. T· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÁÈ· Ù· ·È‰È¿ ·˘Ù¿ ‹Ù·Ó ÙÔ ÙÚ›¯ˆÌ· ÙÔ˘ Û·ÏÔ˘ Î·È Ë Á‡ÚË ‰¤ÓÙÚˆÓ. T· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÂÈϤ¯ıËÎ·Ó Û‡Ìʈӷ Ì ٷ ÈÔ ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· Û οı ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹.
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T· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂÎÙÈÌ‹ıËÎ·Ó ÌÂÙ¿ ·fi 15 min Î·È ÌÂÙ¿ ·fi Û‡ÁÎÚÈÛË Ì ıÂÙÈÎfi Î·È ·ÚÓËÙÈÎfi Ì¿ÚÙ˘Ú·. ø˜ ıÂÙÈÎfi˜ Ì¿ÚÙ˘Ú·˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰È˘‰ÚԯψÚÈ΋ ÈÛÙ·Ì›ÓË 1mg%. £ÂÙÈ΋ ¯·-
E˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·
Ú·ÎÙËÚ›ÛÙËÎÂ Ë ·ÓÙ›‰Ú·ÛË Ì ̤ÛË ‰È¿ÌÂÙÚÔ ≥ 2 ¯ÈÏ. ™ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ì ıÂÙÈ΋ ‰ÂÚÌ·ÙÈ΋ ‰ÔÎÈÌ·Û›· ‰È·ÓÂÌ‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ٷ Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ ̤¯ÚÈ ÂΛÓË ÙË ÛÙÈÁÌ‹ (›Ó·Î·˜ 2).
¶›Ó·Î·˜ 2. EÚˆÙËÌ·ÙÔÏfiÁÈÔ. 1. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ¿ÛıÌ·; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 6) 2. Œ‚·Ï ÔÙ¤ ÁÈ·ÙÚfi˜ ÙË ‰È¿ÁÓˆÛË Ó¢ÌÔÓ›·˜ ÛÙÔ ·È‰› Û·˜; AÓ Ó·›, fiÛ˜ ÊÔÚ¤˜;
Ô Ó·È
Ô fi¯È
3. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·; Ô Ó·È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÚÈÓ›Ùȉ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 6)
Ô fi¯È
4. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ¤Î˙ÂÌ·; Ô Ó·È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ¤Î˙ÂÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 7)
Ô fi¯È
5. NÔÛËχÙËΠÔÙ¤ ÙÔ ·È‰› Û·˜ Û ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· Ë̤Ú˜; Ô Ó·È AÓ Ó·È, ÔÈfi˜ ‹Ù·Ó Ô ÏfiÁÔ˜ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘;
Ô fi¯È
6. E›¯Â ÔÙ¤ ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÛÙÔ ·ÚÂÏıfiÓ; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 1) AÓ ¤¯ÂÙ ··ÓÙ‹ÛÂÈ "OXI" ·Ú·Î·ÏÒ ËÁ·›ÓÂÙ ÛÙËÓ ÂÚÒÙËÛË 11 7. E›¯Â ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜: Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 2) AÓ ¤¯ÂÙ ··ÓÙ‹ÛÂÈ "OXI" ·Ú·Î·ÏÒ ËÁ·›ÓÂÙ ÛÙËÓ ÂÚÒÙËÛË 11 8.¶fiÛ˜ ÊÔÚ¤˜ ›¯Â ÙÔ ·È‰› Û·˜ ‚Ú¿ÛÈÌÔ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜: Ô Î·Ì›· Ô 1 ¤ˆ˜ 2 Ô 3 ¤ˆ˜12 Ô ÂÚÈÛÛfiÙÂÚ˜ ·fi 12 (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 3) 9. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜, fiÛÔ Û˘¯Ó¿, ηٿ ̤ÛÔ fiÚÔ, Ô ‡ÓÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ‰È·Ù·Ú¿¯ıËΠÂÍ·ÈÙ›·˜ ÙÔ˘ ‚ڷ̷ۛÙÔ˜; Ô ÔÙ¤ ‰ÂÓ Í‡ÓËÛ Ì ‚Ú¿ÛÈÌÔ Ô ÏÈÁfiÙÂÚÔ ·fi ¤Ó· ‚Ú¿‰˘ ÙËÓ Â‚‰ÔÌ¿‰· Ô ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ‚Ú¿‰È· ÙËÓ Â‚‰ÔÌ¿‰· (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 4) 10. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜ ÙÔ ‚Ú¿ÛÈÌÔ ‹Ù·Ó ÔÙ¤ ·ÚÎÂÙ¿ ÛÔ‚·Úfi ÒÛÙ ӷ ÂÚÈÔÚ›ÛÂÈ ÙËÓ ÔÌÈÏ›· ÙÔ˘ ·È‰ÈÔ‡ Û·˜ Û ÌÈ· ‹ ‰‡Ô ϤÍÂȘ ·Ó¿ÌÂÛ· Û ‰‡Ô ·Ó·ÓÔ¤˜; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7ÂÙÒÓ. EÚÒÙËÛË 5) 11. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜, ¤‚Ú·˙ ÙÔ ÛÙ‹ıÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Û·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ‹ ÌÂÙ¿ ·fi ¿ÛÎËÛË: Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 7) 12. TÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜, ›¯Â ÙÔ ·È‰› Û·˜ ÍËÚfi‚˯· ÙÔ ‚Ú¿‰˘, ÂÍ·ÈÚÔ˘Ì¤ÓÔ˘ ÙÔ˘ ‚‹¯· Ô˘ ÔÊ›ÏÂÙ·È Û ÎÚ˘ÔÏfiÁËÌ· ‹ Ïԛ̈ÍË ÙˆÓ Ó¢ÌfiÓˆÓ; Ô Ó·È Ô fi¯È (ISAAC: KÂÓÙÚÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ‚Ú¿ÛÈÌÔ Î·È ¿ÛıÌ· ÁÈ· ËÏÈ˘ 6 Î·È 7 ÂÙÒÓ. EÚÒÙËÛË 8) 13. E›Ó·È ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎfi Û ÙÚÔʤ˜; ¶·Ú·Î·ÏÒ ÁÚ¿„Ù ÔȘ ÙÚÔʤ˜: TÈ ¤Î·Ó ÙÔ ·È‰› Û·˜ fiÙ·Ó ¤Ê·Á ·˘Ù‹ ÙË ÙÚÔÊ‹; 14. E›Ó·È ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎfi ÛÙ· ˙Ò·; AÓ Ó·È, Û ÔÈ· ˙Ò·; 15. ¶ÔÈÔ˜ Û˘ÌÏ‹ÚˆÛ ·˘Ùfi ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ;
Ô Ó·È Ô ¤ÌÂÙÔ Ô ‚Ú¿ÛÈÌÔ
Ô ‰È¿ÚÚÔÈ· Ô ÎÔÏÈÎfi Ô Ó·È
Ô ÌËÙ¤Ú· Ô ÌËÙ¤Ú· Î·È ·Ù¤Ú·˜
Ô fi¯È Ô ÂÍ¿ÓıËÌ· Ô ¿ÏÏ· Û˘ÌÙÒÌ·Ù·: Ô fi¯È Ô ·Ù¤Ú·˜ Ô ¿ÏÏÔ˜
29
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·30
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
AÔÙÂϤÛÌ·Ù· Afi Ù· 1439 ·È‰È¿ Ô˘ ÂϤÁ¯ıËÎ·Ó Ì ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ Aı‹Ó·, 140 (9,7%) ‹Ù·Ó ¢·ÈÛıËÙÔÔÈË̤ӷ Û ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÏÂÚÁÈÔÁfiÓ·, ÂÓÒ ·fi Ù· 364 ·È‰È¿ ÛÙË Ó‹ÛÔ Wight ¢·ÈÛıËÙÔÔÈË̤ӷ ‹Ù·Ó 92 (25,3%) (p<0.001). H ¢·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ Aı‹Ó·˜ ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ÙˆÓ ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Der P1 Î·È Der f1 ‹Ù·Ó 1,8% Î·È 1,2%, ÂÓÒ ÛÙ· ·È‰È¿ Ù˘ Ó‹ÛÔ˘ Wight ‹Ù·Ó 14,8% Î·È 5,2% ·ÓÙ›ÛÙÔȯ·, Ì ÙÔ Der P1 ˆ˜ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. TÔ ‰Â‡ÙÂÚÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙË Ó‹ÛÔ Wight ‹Ù·Ó ÙÔ Ì›ÁÌ· ·ÁÚÔÛÙˆ‰ÒÓ (13,2%) Î·È ·ÎÔÏÔ˘ıÔ‡Û ÙÔ ÙÚ›¯ˆÌ· Ù˘ Á¿Ù·˜ (10,2%). °È· Ù· ·È‰È¿ Ù˘ Aı‹Ó·˜ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·ÓˆÙ¤Úˆ ·ÏÏÂÚÁÈÔÁfiÓ· ‹Ù·Ó 4,4% Î·È 4,1% ·ÓÙ›ÛÙÔȯ·. ŸÏ˜ ÔÈ Û˘ÁÎÚ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ¢ÚËÌ¿ÙˆÓ ÙˆÓ ‰‡Ô ÂÚÈÔ¯ÒÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (p<0,001). ™Ù· ÚfiÛıÂÙ· ·ÏÏÂÚÁÈÔÁfiÓ·, ÛÙËÓ Aı‹Ó·, Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙË Á‡ÚË ÂÏÈ¿˜ ‹Ù·Ó 3,1% Î·È ÛÙËÓ parietaria 1,6%. ™ÙË Ó‹ÛÔ Wight Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ÙÚ›¯ˆÌ· ÙÔ˘ Û·ÏÔ˘ ‹Ù·Ó 6,3% Î·È ÛÙË Á‡ÚË ÙˆÓ ‰¤Ó‰ÚˆÓ ‹Ù·Ó 2,2%. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È Û ‰È¿ÁÚ·ÌÌ· Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ÛÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ıËηÓ. ŸÛÔÓ ·ÊÔÚ¿ Ù· Û˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁ›·˜ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ· 2, ‹Ù·Ó Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ Ù˘ Ó‹ÛÔ˘ Wight Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ù˘ Aı‹Ó·˜. H Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹Ù·Ó ˘ÂÚ‰ÈÏ¿ÛÈ· (46,9%) ÛÙ· ·È‰È¿ Ù˘ Ó‹ÛÔ˘ Wight, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ù˘ Aı‹Ó·˜ (22,5%). ŒÎ˙ÂÌ· fiˆ˜ Î·È ‚Ú¿ÛÈÌÔ ‹ ÛʇÚÈÁÌ· ÛÙÔ ÛÙ‹ıÔ˜ ›¯Â ›Û˘ 56,3% ÙˆÓ ·È‰ÈÒÓ Ù˘ Ó‹ÛÔ˘ Wight, ÂÓÒ 34,2% Î·È 29,7% ·ÓÙ›ÛÙÔȯ· ÙˆÓ AıËÓÒÓ. BÚÔÁ¯fiÛ·ÛÌÔ ÌÂÙ¿ ·fi ¿ÛÎËÛË ·ÚÔ˘Û›·˙ 34,4%
EÈÎfiÓ· 1. ¶ÔÛÔÛÙ¿ ¢·ÈÛıËÙÔÔÔ›ËÛ˘ ÛÙ· ÂÏÂÁ¯ı¤ÓÙ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· Û Aı‹Ó· Î·È Wight.
30
™. TÛ›ÙÔ˘Ú· Î·È Û˘Ó.
EÈÎfiÓ· 2. ™˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁ›·˜ Û ·È‰È¿ 5- 7,5 ¯ÚfiÓˆÓ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜. ÙˆÓ ·È‰ÈÒÓ Ù˘ Ó‹ÛÔ˘ Wight Î·È 7,2% ÙˆÓ ·È‰ÈÒÓ Ù˘ Aı‹Ó·˜. •ËÚfi ‚‹¯· ÙÔ ‚Ú¿‰˘ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ÎÚ˘ÔÏÔÁ‹Ì·ÙÔ˜ 43,8% Î·È 33,3% ÙˆÓ ·È‰ÈÒÓ ·ÓÙ›ÛÙÔȯ· ÛÙȘ ‰‡Ô ÂÚÈÔ¯¤˜. OÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ ‹Ù·Ó ›Û˘ Û˘¯ÓfiÙÂÚ˜ ÛÙËÓ AÁÁÏ›· 21,9%, Û ۯ¤ÛË Ì ÙËÓ Aı‹Ó· 15,3%. ™Ù· Ï·›ÛÈ· ÙÔ˘ ÂϤÁ¯Ô˘ ¿ÏÏˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ¢ÓÔÔ‡Ó ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙËÓ ÂΉ‹ÏˆÛË ·ÙÔÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‚Ú¤ıËΠfiÙÈ Ù· ·È‰È¿ ÛÙËÓ Aı‹Ó· ÂÎÙ›ıÂÓÙÔ Û ηÓfi ÙÛÈÁ¿ÚÔ˘ ÂÓ‰ÔÌ‹ÙÚÈ· Û ÔÛÔÛÙfi 14,4% Î·È ÛÙÔ ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Û ÔÛÔÛÙfi 50,4%. T· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÛÙËÓ Ó‹ÛÔ Wight ‹Ù·Ó 6,3% Î·È 18,8% (›Ó·Î·˜ 3). ¶›Ó·Î·˜ 3. ŒÎıÂÛË ÙˆÓ ·È‰ÈÒÓ Û οÓÈÛÌ·. N‹ÛÔ˜ Wight
Aı‹Ó·
EÓ‰ÔÌ‹ÙÚÈ·
6,3%
14,4%
™ÙÔ Û›ÙÈ
18,8%
50,4%
™˘˙‹ÙËÛË ¢ÂÓ ˘¿Ú¯ÂÈ ÌÂϤÙË ·Ó¿ÏÔÁÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ EÏÏ¿‰·. ™Â ·Ï·ÈfiÙÂÚË ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡ÛÂ Ù˘¯·›Ô ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ÂÏÏËÓÈÎÔ‡ ÂÓ‹ÏÈÎÔ˘ ÏËı˘ÛÌÔ‡ (20-60 ¯ÚfiÓˆÓ) ‚Ú¤ıËÎ·Ó ıÂÙÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Û 31,5% Î·È Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ Der P1 13,7%. ™Ù· ·È‰È¿, ÔÈ ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ ÛÙË ¯ÒÚ· Ì·˜, ·ÊÔÚÔ‡Ó ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ‹‰Ë ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Î·È ‰Â›¯ÓÔ˘Ó ıÂÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Û ÔÛÔÛÙfi 68%, Ì ¢·ÈÛıËÙÔÔ›ËÛË ÛÙÔ Der P1 22,6-27,7%, ÛÙ· ·ÁÚÔÛÙÒ‰Ë 21,3-38,6% Î·È ÛÙÔ ÙÚ›¯ˆÌ· Ù˘ Á¿Ù·˜ 21,1-44% (16,17). H ¯·ÌËÏ‹
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·31
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
¢·ÈÛıËÙÔÔ›ËÛË Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· (9,7%) Î·È È‰È·›ÙÂÚ· ÛÙÔ Der P1 (1,8%) ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ˘ÏÈÎfi Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÊÔÚÔ‡ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ ÌÈÎÚ‹˜ ËÏÈΛ·˜ (5-7,5 ¯ÚÔÓÒÓ) Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜. O ÏfiÁÔ˜ Ô˘ ÂÈϤ¯ıËΠ·˘Ùfi ÙÔ ‰Â›ÁÌ· ‹Ù·Ó Ó· ÂÈÎÂÓÙÚˆıԇ̠۠¤Ó·Ó ÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË ·ÏÏÂÚÁ›·˜ ÒÛÙ ӷ ·˘Í‹ÛÔ˘Ì ÙȘ Èı·ÓfiÙËÙ˜ Ó· ·Ú·ÙËÚ‹ÛÔ˘Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ÛÙÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘. °È· ÙȘ ‰È·ÊÔÚ¤˜ Ô˘ ¤¯Ô˘Ó ‚ÚÂı› ÛÙËÓ Û˘¯ÓfiÙËÙ· ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚÈÔ¯‹ ‰È·ÌÔÓ‹˜ ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚ˜ ÂÚÌËÓ›˜. EÓÔ¯ÔÔÈÔ‡ÓÙ·È ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË, ÛÙÂÓfi˜ Û˘Á¯ÚˆÙÈÛÌfi˜, ÔÏÈÙÈÛÌÈΤ˜ ‰È·ÊÔÚ¤˜. H ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ‰È¿ÊÔÚ· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙȘ ‰‡Ô ¯ÒÚ˜ Î·È È‰È·›ÙÂÚ· ÛÙÔ Der pteronyssinus (14,8% Î·È 1,8% ·ÓÙ›ÛÙÔȯ·) ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. E›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È Ë ˘ÁÚ·Û›· ÙÔ˘ ·¤Ú· Î·È fiÙÈ ¤¯Ô˘Ó ‚ÚÂı› Û ÔÏϤ˜ ÌÂϤÙ˜ ıÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ·Ó¿ÌÂÛ· ÛÙ· ›‰· ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙˆÓ ·Î¿ÚÂˆÓ Î·È ÙËÓ Û¯ÂÙÈ΋ ‹ ·fiÏ˘ÙË ˘ÁÚ·Û›· ÙÔ˘ ·¤Ú· ÛÙÔ Û›ÙÈ (18). MÂÁ·Ï‡ÙÂÚÔÈ ÏËı˘ÛÌÔ› ·Î¿ÚÂˆÓ ÔÈÎȷ΋˜ ÛÎfiÓ˘ ·Ó·Ù‡ÛÛÔÓÙ·È fiÙ·Ó Ë ·fiÏ˘ÙË ˘ÁÚ·Û›· ÙÔ˘ ·¤Ú· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi 7 g/kg Î·È Ë Û¯ÂÙÈ΋ ˘ÁÚ·Û›· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi 45% (ȉ·ÓÈΤ˜ ÙÈ̤˜ Û¯ÂÙÈ΋˜ ˘ÁÚ·Û›·˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·Î¿ÚÂˆÓ Â›Ó·È 70-90%) (19). H ̤ÛË Û¯ÂÙÈ΋ ˘ÁÚ·Û›· ÁÈ· ÙËÓ ÂÚÈÔ¯‹ Ù˘ AÙÙÈ΋˜ ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· ‹Ù·Ó 67,8% Ì ‰È·Î˘Ì¿ÓÛÂȘ ÌÂٷ͇ ÌÂÁ›ÛÙ˘ 70-78% (¢ÂΤ̂ÚÈÔ˜) Î·È ÂÏ·¯›ÛÙ˘ 45-56% (IÔ‡ÏÈÔ˜) (16). AÓÙ›ıÂÙ· Ë Ó‹ÛÔ˜ Wight, ÛÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÙ·È Ë ·ÚÔ‡Û· ÌÂϤÙË, ¤¯ÂÈ ‹ÈÔ Î·È ˘ÁÚfi Îϛ̷, Ì ۯÂÙÈ΋ ˘ÁÚ·Û›· Ô˘ ‰È·Î˘Ì·›ÓÂÙ·È ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÌÂٷ͇ ÌÂÁ›ÛÙ˘ 92% Î·È ÂÏ·¯›ÛÙ˘ 84% Î·È ÙÔÓ IÔ‡ÏÈÔ ÌÂٷ͇ 92% Î·È 55% ·ÓÙ›ÛÙÔȯ· (ÛÙÔȯ›· ·fi ÙË MÂÙˆÚÔÏÔÁÈ΋ YËÚÂÛ›· AÁÁÏ›·˜), ÛÙÔ ÔÔ›Ô Ù· ·Î¿Ú· ·Ó·Ù‡ÛÛÔÓÙ·È fiÏÔ ÙÔ ¯ÚfiÓÔ (20). ¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ Â›Â‰Ô ÙˆÓ ·Î¿ÚÂˆÓ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È Ô ÂÍ·ÂÚÈÛÌfi˜, Ô ÎÏÈÌ·ÙÈÛÌfi˜, ÔÈ ÌÔΤÙ˜ Î·È Ù· ¯·ÏÈ¿, Ë Û˘¯ÓfiÙËÙ· ηı·ÚÈÛÌÔ‡, Ù· ηÙÔÈΛ‰È· ˙Ò·, ÔÈ ‚·ÚȤ˜ ÎÔ˘ÚÙ›Ó˜ Î·È Ù· ˘Ê·ÛÌ¿ÙÈÓ· ¤ÈÏ· ηıÒ˜ Î·È Ù· ¯ÓÔ˘‰ˆÙ¿ ·È¯Ó›‰È· (18). OÈ Û˘Óı‹Î˜ ˙ˆ‹˜ ÛÙȘ ‰‡Ô ¯ÒÚ˜ Â›Ó·È ‰È·ÊÔÚÂÙÈΤ˜ Î·È ·˘Ùfi ÌÔÚ› Ó· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ‰È·ÊÔÚÂÙÈ΋ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ·Î¿ÚˆÓ. E›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Â›Ó·È Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿-
E˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·
ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È fiÙÈ fiÛÔ ˘„ËÏfiÙÂÚË Â›Ó·È Ë Û˘ÁΤÓÙÚˆÛË ·Î¿ÚÂˆÓ (>2 Ìg/gr) ÙfiÛÔ ·˘Í¿ÓÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ·Ó¿Ù˘ÍË ¿ÛıÌ·ÙÔ˜ (21). EÊfiÛÔÓ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙÔ Der P1 Î·È ÛÙÔ Der f1 Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙË Ó‹ÛÔ Wight ‰ÈηÈÔÏÔÁÂ›Ù·È Ô ·˘ÍË̤ÓÔ˜ ÂÈÔÏ·ÛÌfi˜ Û˘ÌÙˆÌ¿ÙˆÓ ·ÙÔ›·˜ Û ۯ¤ÛË Ì ·˘Ùfi ÙˆÓ ·È‰ÈÒÓ Ù˘ Aı‹Ó·˜. OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¤Ó·ÚÍË ¿ÛıÌ·ÙÔ˜ Â›Ó·È Î·È ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ›. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ·È‰È¿ ¯·ÌËÏfiÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ¿ÛıÌ·ÙÔ˜ (22,23). Y¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ·›˙Ô˘Ó ÚfiÏÔ Ë ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË (24,25), ÙÔ ÌËÙÚÈÎfi οÓÈÛÌ· ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË (26) Î·È ÙÔ ·ıËÙÈÎfi οÓÈÛÌ· (27). T¤ÏÔ˜, ÔÈ ·ÙÔÌÈΤ˜ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙˆÓ ·È‰ÈÒÓ, ·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ¤ÎıÂÛË Û ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È ·ÏÏÂÚÁÈÔÁfiÓ˜ Ô˘Û›Â˜ ·ÏÏ¿ Î·È ÛÙÔÓ ‚·ıÌfi Ù˘ ¤ÎıÂÛ˘ ÛÙËÓ ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË (28-31). T· ·È‰È¿ Ù˘ Aı‹Ó·˜, ·Ú¿ ÙËÓ ¤ÎıÂÛË Û ÌÂÁ·Ï‡ÙÂÚË ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË Î·È Û οÓÈÛÌ· (ÂÓ‰ÔÌ‹ÙÚÈ· Î·È ÂÓ‰ÔÔÈÎȷο), ›¯·Ó Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·ÏÏÂÚÁÈο ÓÔÛ‹Ì·Ù·. ÕÚ· Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ¤Ó·ÚÍË ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È Ë ÚÒÈÌË Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·Î¿Ú· Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë ÚÒÈÌË Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙ· ·Î¿Ú· ‰ÂÓ ·ÚÓËÙÈÎÔÔÈÂ›Ù·È ·ÚÁfiÙÂÚ· Î·È fiÙÈ Ù· ·È‰È¿ Ô˘ ›¯·Ó ıÂÙÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 5 ¯ÚfiÓˆÓ, ›¯·Ó Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 11 ¯ÚfiÓˆÓ (4). T· ·È‰È¿ Ù˘ Aı‹Ó·˜ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ ¤¯Ô˘Ó Ôχ ¯·ÌËÏ‹ ¢·ÈÛıËÙÔÔ›ËÛË ÛÙÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘. EÔ̤ӈ˜, Ô ¯ÂÈÚÈÛÌfi˜ ÙÔ˘ ÂÓ‰ÔÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÒÛÙ ӷ ÌËÓ ·Ó·Ù‡ÛÛÔÓÙ·È ÏËı˘ÛÌÔ› ·Î¿ÚÂˆÓ ı· ·Ô‰Â›ÍÂÈ ·Ó ·˘Ù‹ Â›Ó·È Ë Î·Ï‡ÙÂÚË ÚÔÛ¤ÁÁÈÛË ÁÈ· Ó· ÚÔÏËÊı› Ë ·ÏÏÂÚÁÈ΋ ÓÔÛËÚfiÙËÙ· Û ‰È·ÊÔÚÂÙÈο ›‰·: ÚfiÏË„Ë Â˘·ÈÛıËÙÔÔ›ËÛ˘ (ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë), ÚfiÏË„Ë Û˘ÌÙˆÌ¿ÙˆÓ (‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë) Î·È ÚfiÏË„Ë ¯ÚÔÓÈfiÙËÙ·˜ ÓfiÛÔ˘ (ÙÚÈÙÔÁÂÓ‹˜ ÚfiÏË„Ë). ™˘ÌÂÚ¿ÛÌ·Ù· H ¤ÚÂ˘Ó¿ Ì·˜ ¤‰ÂÈÍ fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË Û ·È‰È¿ ËÏÈΛ·˜ 5 - 7,5 ¯ÚfiÓˆÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ Â›Ó·È Ôχ ¯·ÌËÏfiÙÂÚË ÛÙËÓ EÏÏ¿‰· Û ۇÁÎÚÈÛË Ì ÙËÓ AÁÁÏ›·. TÔ ¿Î·ÚÈ Ù˘ ÔÈÎȷ΋˜ ÛÎfiÓ˘ Der P1 Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·ÏÏÂÚÁÈÔÁfiÓÔ ÛÙËÓ AÁÁÏ›·, ·ÏÏ¿ fi¯È ÛÙËÓ EÏÏ¿‰·. ™ËÌ·ÓÙÈο ·ÏÏÂÚÁÈÔÁfiÓ· ÁÈ· ÙËÓ AÁÁÏ›· Â›Ó·È ÙÔ ÙÚ›¯ˆÌ· Ù˘ Á¿Ù·˜ Î·È Ù· ·ÁÚÔÛÙÒ‰Ë Ô˘ ÁÈ· ÙËÓ EÏÏ¿‰· Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿. H Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È
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JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·32
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ AÁÁÏ›· ·fi ÙËÓ EÏÏ¿‰·. EÓÒ Ë ·ÙÔÈ΋ ÚԉȿıÂÛË ˘‹Ú¯Â Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ¯ˆÚÒÓ, Ê·›ÓÂÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fiÙÈ ÙÔ ÌÈÎÚÔ- Î·È ÙÔ Ì·ÎÚÔ-ÂÚÈ‚¿ÏÏÔÓ ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÙË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ÙËÓ ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÁfiÓÔ˘ Ì ÂΉ‹ÏˆÛË ·ÙÔÈ΋˜ ÓfiÛÔ˘ ‰È·ÊÔÚÂÙÈ΋˜ Û˘¯ÓfiÙËÙ·˜. H ÚÔ‰ÚÔÌÈ΋ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÙȘ ‰‡Ô ¯ÒÚ˜ ı· ··ÓÙ‹ÛÂÈ ÛÙËÓ ÛËÌ·ÓÙÈ΋ ÂÚÒÙËÛË ·Ó Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÓ‰ÔÔÈÎÈ·ÎÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÌÔÚ› Ó· ÂÏ·ÙÙÒÛÂÈ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙËÓ ¤ÎÊÚ·Û‹ Ù˘ Û ·ÏÏÂÚÁÈ΋ ÓfiÛÔ. E˘¯·ÚÈÛٛ˜ £¤ÏÔ˘Ì ӷ ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÙȘ Û˘ÓÂÚÁ¿Ùȉ˜ Ì·˜ ∞ÈηÙÂÚ›ÓË ¢ËÌÔÔ‡ÏÔ˘, AÈÌÈÏ›· ¶·Ó¿ÁÔ˘ Î·È K·ÙÂÚ›Ó· NÈÎÔÏ¿Ô˘ ÁÈ· ÙË Û˘Ó‰ÚÔÌ‹ ÙÔ˘˜. £¤ÏÔ˘Ì ›Û˘ Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÙËÓ ÂÙ·ÈÚ›· ALK Scherax, Hamburg Germany ÁÈ· ÙËÓ ÚÔÛÊÔÚ¿ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙȘ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜. EȉÔÙ‹ÛÂȘ H ·ÚÔ‡Û· ¤Ú¢ӷ ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙËÓ E˘Úˆ·˚΋ ŒÓˆÛË, ·fi ÙÔ ÚfiÁÚ·ÌÌ· BIOMED 2, grant No PL 1211.
™. TÛ›ÙÔ˘Ú· Î·È Û˘Ó.
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paediatrics 13. Edinburgh: Churchill Livingstone, 1995:4558. Henderson FW, Henry MM, Ivins SS, Morris R, Neebe EC, Leu SY, et al. Correlates of recurrent wheezing in schoolage children. Am J Respir Crit Care Med 1995; 151:17861793. Sears MR, Herbison GP, Holdaway MD, Hewitt CJ, Flannery EM, Silva PA. The realtive risk of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy 1989;19:419-424. Kuehr J, Frischer T, Meinert R, et al. Sensitisation to mite allergens is a risk factor for early and late onset of asthma and for the persistence of asthmatic signs in children. J Allergy Clin Immunol 1995;95:655-662. Rosenstreich DL, Eggleston P, Katton M, Baker D, Slavin RG, Gergen P et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner city children with asthma. N Engl J Med 1997;336:1356-1363. Ingram JM, Sporik R, Rose G, Honsinger R, Chapman MD, Platts-Mills TA. Quantitative assessment of exposure to dog (Can f1) and cat (Fel d1) allergens: Relationship to sensitisation and asthma among children living in Los Alamos, New Mexico. J Allergy Clin Immunol 1995;69:449456. Osebold J, Gershwin L, Zee Y. Studies on the enhancement of allergic lung sensitisation by inhalation of ozone and sulfuric acid aerosol. J Environ Pathol Toxicol 1980;3:221-234. Gershwin L, Osebold J, Zee Y. Immunoglobulin Econtaining cells in mouse lung following allergen inhalation and ozone exposure. Int Arch Allergy Appl Immunol 1981;65:266-277. Ferguson DM, Horwood LJ, Shannon FT. Parental smoking and respiratory illness in infancy. Arch Dis Child 1980;55:358-361. ¶Ú›ÊÙ˘ K, Z‹‚· M, M·ıÈÔ˘‰¿Î˘ °, HÏ›· M, °Ú˘¿ÚË M, AÓ·ÁÓˆÛÙ¿Î˘ I, ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º. E˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ ÛÙ· ÎÔÈÓ¿ ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ·. E›‰Ú·ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. I·ÙÚÈ΋ 1990;58(2):161-166. Z‹‚· - ¶ÂÙÚÔÔ‡ÏÔ˘ M, ¶È¤ÚÔ˘ B, £¤ÌÂÏË-¢È·Á·Ï¿ÎË K, K·˝Ú˘ ¢, KÔ‡ÙÛÈ·-K·ÚÔ‡˙Ô˘ X, ¶··‰¿ÎÔ˘ §·ÁÔÁÈ¿ÓÓË ™. ŒÏÂÁ¯Ô˜ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ· ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Ù˘ N.A. AÙÙÈ΋˜ Ì ·Ó›¯Ó¢ÛË ÂȉÈÎÒÓ IgE ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi. ¶·È‰È·ÙÚÈ΋ 1995;158:176-182. Hart B J. Life cycle and reproduction of house-dust mites: environmental factors influencing mite populations. Allergy 1998;53 (Suppl 48):13-17. Arlian LG. Water balance and humidity requirements of house dust mites. Exp Appl Acarol 1992;16:15-36. Arshad SH, Hide DW. Effect of environmental factors on the development of allergic disorders in infancy. J Allergy Clin Immunol 1992;90:235-241. Marks GB. House dust mite exposure as a risk factor for asthma: benefits of avoidance. Allergy 1998; 53 Suppl. 48:108-114.
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22. Wissow LS, Gittlesohn AM, Szklo M, Starfield B, Mussman M. Poverty, race and hospitalization for childhood asthma. Am J Public Health 1988;78:777-782. 23. Taylor B. Social factors and related influences on lower respiratory illness of early childhood. Resp Dis in Practice 1983 (1):30-35. 24. Wardlow AJ. The role of air pollution in asthma. Clin Exp Allergy 1993;23:81-96. 25. M·ıÈÔ˘‰¿Î˘ °, ¶Ú›ÊÙ˘ K, E˘·ÁÁÂÏÔÔ‡ÏÔ˘ E, TÚÈ·ÓÙ·Ê˘ÏÏÔÔ‡ÏÔ˘ X. ¢˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ Ú˘¿ÓÛˆ˜ Ù˘ ·ÙÌfiÛÊ·ÈÚ·˜ ÙˆÓ AıËÓÒÓ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. AÚ¯ EÏÏËÓ I·ÙÚ 1990, 7®159-162. 26. Taylor B, Wadsworth J. Maternal smoking during pregancy and lower respirarory illness of early life. Arch Dis Child 1987;62:786-791. 27. Fergusson DM, Horwood LJ, Shannon FT. Parental smoking and respiratory illness in infancy. Arch Dis Child 1980;55:358-361.
E˘·ÈÛıËÙÔÔ›ËÛË ·È‰ÈÒÓ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·
28. Moschandreas DJ. Exposure to pollutants and daily time budgets of people. Bull N Y Acad Med 1981;57:845-859. 29. ™Ù·Ì·ÙÈ¿‰Ë˜ ¢, X·Ù˙ˉ¿ÎȘ ¢. AÍÈÔÏfiÁËÛË ÙˆÓ ÂȤ‰ˆÓ Ú‡·ÓÛ˘ ·fi ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ı›Ԣ Î·È Î·Ófi ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ Ù˘ Aı‹Ó·˜. AÚ¯ EÏÏËÓ I·ÙÚ 1990;7:109-116. 30. TÔ˘ÏÔ‡ÌË °, K·ÙÛÔ˘ÁÈ¿ÓÓË K. AÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË ÛÙÔ ÏÂηÓÔ¤‰ÈÔ AıËÓÒÓ: ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ, ËÌÂÚ‹ÛȘ ‰È·Î˘Ì¿ÓÛÂȘ Î·È Û˘Ó‰È·Î‡Ì·ÓÛË ÙˆÓ Ú‡ˆÓ. AÚ¯ EÏÏËÓ I·ÙÚ 1990;7:97-103. 31. N¿ÎÔ˘ ™, K·ÙÛÔ˘ÁÈ¿ÓÓË KÏ. AÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË Î·È ·È‰È΋ ÓÔÛËÚfiÙËÙ·. EÚÁ·ÛÙ‹ÚÈÔ YÁÈÂÈÓ‹˜ & EȉËÌÈÔÏÔÁ›·˜ ÙÔ˘ ¶·Ó/Ì›Ô˘ AıËÓÒÓ, IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. TÂÏÈ΋ ¤ÎıÂÛË M¿ÈÔ˜ 1994.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú· TÌ‹Ì· KÔÈÓˆÓÈ΋˜ I·ÙÚÈ΋˜, NÔÛ. ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡" MÂÛÔÁ›ˆÓ 24, 115 27 Aı‹Ó·
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X¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ ÛÙ· ÓÂÔÁÓ¿ XÚ‹ÛÙÔ˜ KÒÛÙ·ÏÔ˜, AÓ·ÛÙ¿ÛÈÔ˜ T۷ΛÚ˘, AÈηÙÂÚ›ÓË KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M·Ú›· ¢·ÓÈËÏ›‰Ô˘, AÓÙÒÓÈÔ˜ °Ô‡Ó·Ú˘
● ¶ÂÚ›ÏË„Ë: O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¯¿ÛÌ·ÙÔ˜ ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) Î·È Ô‡ÚˆÓ (XAO) ‚ÔËı¿ÂÈ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAA Î·È XAO Û ÚfiˆÚ· Î·È Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÁÚ¿„Ô˘Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜. MÂÏÂÙ‹ıËÎ·Ó 35 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (ÔÌ¿‰· A: ËÏÈΛ· οو ÙˆÓ 15 ËÌÂÚÒÓ-ÔÌ¿‰· B: ËÏÈΛ· 16-30 ËÌÂÚÒÓ) ηıÒ˜ Î·È 15 ÚfiˆÚ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ οو ÙˆÓ 21 ËÌÂÚÒÓ. EÎÙÈÌ‹ıËÎ·Ó Ù· ›‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ·›Ì·ÙÔ˜ ηıÒ˜ Î·È Ù· ›‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·Ï›Ô˘ ÛÙ· Ô‡Ú·. T· ›‰· Ó·ÙÚ›Ô˘ Î·È ¯ÏˆÚ›Ô˘ ·›Ì·ÙÔ˜ Ù˘ ÔÌ¿‰·˜ A ‹Ù·Ó ˘„ËÏfiÙÂÚ· Û ۯ¤ÛË Ì ·˘Ù¿ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È °. AÓÙ›ıÂÙ·, ÙÔ XAA ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÛÙ· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ °. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú· ÙÔ Ó¿ÙÚÈÔ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ A, ÂÓÒ ÙÔ Î¿ÏÈÔ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· B. ¢ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÙÈÌ‹ ÙÔ˘ XAO ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ XAA ·fi fiÙÈ Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ÂÓÒ Û fiÙÈ ·ÊÔÚ¿ ÛÙÔ XAO ·˘Ùfi ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ËÏÈΛ· ·ËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. H ·¤ÎÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú· ·˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ Ë̤ڷ ˙ˆ‹˜, Î·È Ì ÙËÓ ËÏÈΛ· ·ËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈ΋ 2000;63:34-37. §¤ÍÂȘ ÎÏÂȉȿ: ÓÂÔÁÓfi, ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË, ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ. C. Costalos, A. Tsakiris, A. Constandinidou, M. Daniilidou, A. Gounaris. Blood and urine anion gap in newborn infants. Paediatriki 2000;63:34-37. ● Abstract: The estimation of the blood (BAG) and urine (UAG) anion gap can help in the investigation of the cause of metabolic acidosis.The aim of this study was to assess BAG and UAG in healthy preterm and term neonates.Thirty five term and 15 preterm infants were studied. Term babies were divided into 2 groups according to their postnatal age (group A <15 days, group B: 16-30 days). The preterm infants (group C) were all under 21 days of life. Blood sodium, chloride and bicarbonate levels, and urine chloride, potassium and sodium levels were estimated. From these values the BAG and UAG were calculated. Blood sodium and chloride values were higher in group A than in groups B and C, but the BAG was higher in group C. With regard to urine findings, sodium was higher in infants of group A while potassium was higher in group B.There was no significant difference in the UAG values among the three groups. In conclusion, preterm infants have a higher BAG than term infants but a similar UAG. Potassium excretion increases with both gestational and postnatal age. Key words: newborn infant, metabolic acidosis, renal tubular acidosis, anion gap.
EÈÛ·ÁˆÁ‹ O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¯¿ÛÌ·ÙÔ˜ ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ‚ÔËı¿ÂÈ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÈÙ›Ô˘ ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘ (1,2). ø˜ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) ıˆÚԇ̠ÙË ‰È·ÊÔÚ¿ Ô˘ ÚÔ·ÙÂÈ, fiÙ·Ó ·fi ÙËÓ ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ÙÔ˘ ·›Ì·ÙÔ˜, ·Ê·ÈÚ¤ÛÔ˘Ì ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘
NÂÔÁÓÔÏÔÁÈÎfi TÌ‹Ì· ÙÔ˘ ¶°N N›Î·È·˜, ¶ÂÈÚ·È¿˜
34
¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ. TÔ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ Ô‡ÚˆÓ (XAO) ·ÔÙÂÏ› ·‰Úfi ‰Â›ÎÙË Ù˘ ·¤ÎÎÚÈÛ˘ ·Ì̈ӛ·˜ ÛÙ· Ô‡Ú· Î·È ‚ÔËı¿ÂÈ ÛÙÔÓ Î·ıÔÚÈÛÌfi ·Ó ÌÈ· ˘ÂگψڷÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË Â›Ó·È ÓÂÊÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ fi¯È. K·ıÔÚ›˙ÂÙ·È ·˘Ùfi fiÙ·Ó ·fi ÙÔ ¿ıÚÔÈÛÌ· Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Î·Ï›Ô˘ Î·È Ó·ÙÚ›Ô˘ ÛÙ· Ô‡Ú· ·Ê·ÈÚÂı› Ë ÙÈÌ‹ ÙÔ˘ ¯ÏˆÚ›Ô˘ ÙˆÓ Ô‡ÚˆÓ (3, 4).
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ÿÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ηıÔÚÈÛı› Ë Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ÙÔ˘ XAA ηıÒ˜ Î·È ÙÔ˘ XAO ÙfiÛÔ Û ÚfiˆÚ· fiÛÔ Î·È Û ÙÂÏÂÈfiÌËÓ· ˘ÁÈ‹ ÓÂÔÁÓ¿. YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ MÂÏÂÙ‹ıËÎ·Ó 35 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ - 27 ËÏÈΛ·˜ οو ÙˆÓ 15 ËÌÂÚÒÓ (ÔÌ¿‰· A) Î·È 8 ÌÂٷ͇ 16-30 ËÌÂÚÒÓ (ÔÌ¿‰· B) - ηıÒ˜ Î·È 15 ÚfiˆÚ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ οو ÙˆÓ 21 ËÌÂÚÒÓ (ÔÌ¿‰· °). H ̤ÛË ËÏÈΛ· ˙ˆ‹˜ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ A ‹Ù·Ó 7,2 (±3) Ë̤Ú˜, ÂÓÒ ÁÈ· Ù· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ B Ë ·ÓÙ›ÛÙÔÈ¯Ë ËÏÈΛ· ‹Ù·Ó 21 (±5) Ë̤Ú˜. H ̤ÛË ËÏÈΛ· ·ËÛ˘ ÛÙ· ÚfiˆÚ· Ù˘ ÔÌ¿‰·˜ ° ‹Ù·Ó 34±1 ‚‰ÔÌ¿‰Â˜ Î·È Ì¤ÛË ËÏÈΛ· ˙ˆ‹˜ 13 ±2 Ë̤Ú˜. ŸÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· ‹Ù·Ó ˘ÁÈ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ Î·È ÛÈÙ›˙ÔÓÙ·Ó Ì ͤÓÔ Á¿Ï· Û ÙÚ›ˆÚË ‚¿ÛË (Almiron 1 Ì ÂÚÈÂÎÙÈÎfiÙËÙ· ۠χΈ̷ 1.4 g%). H ÌÂϤÙË ¤ÁÈÓ ÙÔ Úˆ› ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Á‡̷ÙÔ˜. EÏ‹ÊıË ‰Â›ÁÌ· ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ ¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ, ÂÓÒ ·Ú¿ÏÏËÏ· ÙÔÔıÂÙ‹ıËΠԢÚÔÛ˘ÏϤÎÙ˘ ÁÈ· ÙË Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ Î·È ÙË Ì¤ÙÚËÛË ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ Î·Ï›Ô˘ Î·È ÙÔ˘ ¯ÏˆÚ›Ô˘. T· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ, ÂÛÙ¿ÏËÛ·Ó ÛÙÔ ‚ÈÔ¯ËÌÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ ÁÈ· ¿ÌÂÛÔ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ, ÂÓÒ Ù· ‰ÈÙÙ·ÓıÚ·ÎÈο ·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ Ì ·Ó·Ï˘Ù‹ ·ÂÚ›ˆÓ AVL. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ t test. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ıˆڋıËΠÙÔ ·ÔÙ¤ÏÂÛÌ· ÂÊfiÛÔÓ ÙÔ p < 0.05. AÔÙÂϤÛÌ·Ù· ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Â˘Ú‹Ì·Ù· ·fi ÙÔ ·›Ì·, Ù· ›‰· Ó·ÙÚ›Ô˘ Î·È ¯ÏˆÚ›Ô˘ ÙˆÓ ÓÂÔÁÓÒÓ Ù˘ ÔÌ¿‰·˜ A ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È ° (p<0.01 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È °, p<0.05 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È B ÁÈ· ÙÔ Ó¿ÙÚÈÔ,Î·È p<0.01 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ A Î·È B ÁÈ· ÙÔ ¯ÏÒÚÈÔ). AÓÙ›ıÂÙ·, ÙÔ
XAA ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ° (p<0.05 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ B Î·È °). T· ›‰· Î·Ï›Ô˘ Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜. (¶›Ó·Î·˜ 1). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú·, Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· A Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ° (p<0.01), ·ÓÙ›ıÂÙ·, ÙÔ Î¿ÏÈÔ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· B Û ۇÁÎÚÈÛË ÙfiÛÔ Ì ÙËÓ ÔÌ¿‰· A (p<0.05) fiÛÔ Î·È Ì ÙËÓ ÔÌ¿‰· ° (p<0.05). Y„ËÏfiÙÂÚÔ ‹Ù·Ó Î·È ÙÔ ¯ÏÒÚÈÔ ÛÙËÓ ÔÌ¿‰· B Û ۇÁÎÚÈÛË Ì ÙȘ ‰‡Ô ¿ÏϘ ÔÌ¿‰Â˜, Ë ‰È·ÊÔÚ¿ fï˜ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. TÔ XAO ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ° Û ۯ¤ÛË Ì ÙȘ ‰‡Ô ¿ÏϘ ÔÌ¿‰Â˜, fï˜ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ô‡Ù ‰Ò. (¶›Ó·Î·˜ 2). ™˘˙‹ÙËÛË ™ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ÌÈ·˜ ‰È·Ù·Ú·¯‹˜ Ù˘ ÔÍÂÔ‚·ÛÈ΋˜ ÈÛÔÚÚÔ›·˜ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÌÔÚ› Ó· ·ÓÙÏ‹ÛÂÈ Î·Ó›˜ ÂÍÂÙ¿˙ÔÓÙ·˜ Ù· ›‰· ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ ¯ÏˆÚ›Ô˘ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙÔ 85-90% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÙÈfiÓÙˆÓ Î·È ÙˆÓ ·ÓÈfiÓÙˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ (1,5). ø˜ ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ (XAA) ıˆÚÂ›Ù·È Ë ‰È·ÊÔÚ¿ Ô˘ ÚÔ·ÙÂÈ fiÙ·Ó ·fi ÙËÓ ÙÈÌ‹ ÙÔ˘ Ó·ÙÚ›Ô˘ ·Ê·ÈÚ¤ÛÔ˘Ì ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ ¯ÏˆÚ›Ô˘ Ì ٷ ‰ÈÙÙ·ÓıÚ·ÎÈο. H ‰È·ÊÔÚ¿ ·˘Ù‹ Ê˘ÛÈÔÏÔÁÈο Â›Ó·È 816 (̤ÛË ÙÈÌ‹ 12), Î·È ÔÊ›ÏÂÙ·È Û ÌË ÚÔÛ‰ÈÔÚÈ˙fiÌÂÓ· ·ÓÈfiÓÙ· .¯. ʈÛÊÔÚÈο, ıÂÈÈο, Á·Ï·ÎÙÈο, ÚˆÙ½Ó˜ (6). K·Ù·ÛÙ¿ÛÂȘ Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔ XAA Â›Ó·È ÔÚÈṲ̂Ó˜ Û‡ÌÊ˘Ù˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ·ÌÈÓÔͤˆÓ, ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ. ŒÙÛÈ, Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAA ÌÔÚ› Ó· ‰ÒÛÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ·›ÙÈ· ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘ (7). ™ÙÔ ÓÂÔÁ¤ÓÓËÙÔ Î·È ÂȉÈο ÛÙÔ ÚfiˆÚÔ, ÙÔ XAA Ê˘ÛÈÔÏÔÁÈο Î˘Ì·›ÓÂÙ·È Á‡Úˆ ÛÙÔ 16 (8).
¶›Ó·Î·˜ 1. BÈÔ¯ËÌÈΤ˜ ÙÈ̤˜ (x±SD) ·›Ì·ÙÔ˜ Û mmol/l (ÔÈ ÙÈ̤˜ Û mEq/l Â›Ó·È Ù·˘ÙfiÛË̘). N¿ÙÚÈÔ
K¿ÏÈÔ
XÏÒÚÈÔ
¢ÈÙÙ·ÓıÚ·ÎÈο
XAA
OÌ¿‰· A
143,5±5,1
5,3±0,7
109,9±5,2
20,6±2,3
10,9±3,7
OÌ¿‰· B
138,0±2,1
4,6±1,8
103,6±1,9
22,2±2,9
9,2±2,9
OÌ¿‰· °
139,3±3,3
5,3±0,6
107,5±4,0
20,8±2,5
13,4±3,7
¶›Ó·Î·˜ 2. BÈÔ¯ËÌÈΤ˜ ÙÈ̤˜ (x±SD ) Ô‡ÚˆÓ Û mmol/l (ÔÈ ÙÈ̤˜ Û mEq/l Â›Ó·È Ù·˘ÙfiÛË̘). N¿ÙÚÈÔ
K¿ÏÈÔ
XÏÒÚÈÔ
XAO
OÌ¿‰· A
15,5±8,7
15,7±10,1
25,9±9,7
3,5±8,0
OÌ¿‰· B
14,0±25,8
29,6±21,2
34,5±26,7
1,4±10,4
OÌ¿‰· °
7,5± 7,2
16,7± 6,1
20,2±8,5
4,7±12,1
35
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·36
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
ŸÌˆ˜, Î·È Ë ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ ·Ú¤¯ÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ٷ ·›ÙÈ· ÌÈ·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘. H ÂÎÙ›ÌËÛË ÙÔ˘ Ú˘ıÌÔ‡ ·¤ÎÎÚÈÛ˘ ·Ì̈ӛ·˜ ÛÙ· Ô‡Ú· Â›Ó·È ··Ú·›ÙËÙË ÚÔÎÂÈ̤ÓÔ˘ Ó· ηıÔÚ›ÛÂÈ Î·Ó›˜ ·Ó ÌÈ· ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË ÔÊ›ÏÂÙ·È Û ÓÂÊÚÈο ‹ Â͈ÓÂÊÚÈο ·›ÙÈ·. AÓ Ë ·¤ÎÎÚÈÛË ·Ì̈ӛ·˜ ÛÙ· Ô‡Ú· Â›Ó·È ¯·ÌËÏ‹, ·ÚÔ˘Û›· ÔͤˆÛ˘, ·˘Ùfi Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi fiÙÈ Ë ÔͤˆÛË ÔÊ›ÏÂÙ·È Û ÓÂÊÚÈο ·›ÙÈ· (3). EÂȉ‹ fï˜ Ë ¿ÌÂÛË Ì¤ÙÚËÛË Ù˘ ·Ì̈ӛ·˜ Â›Ó·È Â›ÔÓË, ¤Ó·˜ ¤ÌÌÂÛÔ˜ ÙÚfiÔ˜ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÂȤ‰ˆÓ Ù˘ Â›Ó·È Ë Ì¤ÙÚËÛË ÙÔ˘ XAO. O ˘ÔÏÔÁÈÛÌfi˜ ·˘Ùfi˜ ÛÙËÚ›˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Î·ı·Úfi ¿ıÚÔÈÛÌ· ÙˆÓ Î·ÙÈfiÓÙˆÓ Î·È ÙˆÓ ·ÓÈfiÓÙˆÓ ÛÙ· Ô‡Ú· Ú¤ÂÈ Ó· Â›Ó·È 0. EÂȉ‹ Ê˘ÛÈÔÏÔÁÈο Ë Û˘ÁΤÓÙÚˆÛË ÔÚÈÛÌ¤ÓˆÓ Î·ÙÈfiÓÙˆÓ Î·È ·ÓÈfiÓÙˆÓ (ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ) Â›Ó·È ÂÏ¿¯ÈÛÙË, ·˘Ù¿ Ù· ÈfiÓÙ· ÌÔÚÔ‡Ó Ó· ·ÁÓÔËıÔ‡Ó Î·È ¤ÙÛÈ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ XAO ÌÂÙÚ¿Ì ÌfiÓÔ ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ó·ÙÚ›Ô˘, ÙÔ˘ Î·Ï›Ô˘ Î·È ÙÔ˘ ¯ÏˆÚ›Ô˘ (Ô˘ ·ÔÙÂÏ› Î·È ÙÔ Î‡ÚÈÔ ·ÓÈfiÓ Ô˘ Û˘Óԉ‡ÂÈ ÙÔ ·ÌÌÒÓÈÔ) (9). H ÂÎÙ›ÌËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ·ÌÌˆÓ›Ô˘ ÛÙ· Ô‡Ú· ÌÔÚ› Ó· Á›ÓÂÈ Ì ‚¿ÛË ÙËÓ Â͛ۈÛË (Ó¿ÙÚÈÔ Ô‡ÚˆÓ + οÏÈÔ Ô‡ÚˆÓ) - ¯ÏÒÚÈÔ. Yfi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ Ó·ÙÚ›Ô˘ Î·È ÙÔ˘ Î·Ï›Ô˘ ˘ÂÚ‚·›ÓÂÈ ·˘Ùfi ÙÔ˘ ¯ÏˆÚ›Ô˘ ÎÈ ¤ÙÛÈ ÙÔ XAO Â›Ó·È ÂÏ¿¯ÈÛÙ· ıÂÙÈÎfi. ™Â ÔͤˆÛË ÌË ÓÂÊÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ¯ÏˆÚ›Ô˘ ÛÙ· Ô‡Ú· ˘ÂÚ‚·›ÓÂÈ ÙÔ ¿ıÚÔÈÛÌ· Ó¿ÙÚÈÔ + οÏÈÔ. ¢ËÏ·‰‹ ÙÔ XAO Â›Ó·È ·ÚÓËÙÈÎfi. ™Â ÔͤˆÛË Ù¤ÏÔ˜ ÓÂÊÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (Ì ÂÍ·›ÚÂÛË ÙËÓ Ù‡Ô˘ II ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË fiÔ˘ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ·ÒÏÂÈ· ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÙ· Ô‡Ú·) ÙÔ XAO Â›Ó·È ıÂÙÈÎfi (2,9,10). AÓ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ XAO ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÓËϛΘ, Ë ÂÌÂÈÚ›· ÛÙ· ÓÂÔÁÓ¿ Â›Ó·È ÂÏ¿¯ÈÛÙË. OÈ Sulyok Î·È Guignard (11) Â›Ó·È ÔÈ ÌfiÓÔÈ Ô˘ ÌÂϤÙËÛ·Ó ÙÔ XAO Û ÌÈÎÚfi ·ÚÈıÌfi ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ Ì ̤ÛË ËÏÈΛ· ·ËÛ˘ 31,8 ‚‰ÔÌ¿‰Â˜ ηıÒ˜ Î·È Û ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ 7 ËÌÂÚÒÓ. K·Ù' ·˘ÙÔ‡˜, ÙÔ XAO ·ÔÙÂÏ› ·ÍÈfiÈÛÙÔ ‰Â›ÎÙË ÙÔ˘ Ú˘ıÌÔ‡ ·¤ÎÎÚÈÛ˘ ·Ì̈ӛ·˜ ÌÂÙ¿ fï˜ ·fi ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ˙ˆ‹˜, ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙÂÏÂÈfiÌËÓ· Î·È ÌÂÙ¿ ÙËÓ 3Ë Â‚‰ÔÌ¿‰· ˙ˆ‹˜ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÚfiˆÚ· ÓÂÔÁÓ¿. H ÌÂϤÙË Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ì ›¯Â Û·Ó ÛÙfi¯Ô Ó· ÌÂÏÂÙ‹ÛÂÈ ÙÔ XAA Î·È XAO Û ϤÔÓ ÒÚÈÌ· ÚfiˆÚ· ·ÏÏ¿ Î·È Û ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 7 ËÌÂÚÒÓ. T· ·ÔÙÂϤÛÌ·Ù· Ì·˜ ‰Â›¯ÓÔ˘Ó ÌÂȈ̤ӷ ›‰· Ó·ÙÚ›Ô˘, ¯ÏˆÚ›Ô˘ Î·È Î·Ï›Ô˘ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 15 ËÌÂÚÒÓ Û ۇÁÎÚÈÛË Ì ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ οو ÙˆÓ 15 ËÌÂÚÒÓ. H ÙÒÛË ·˘Ù‹ ÙÔ˘ Î·Ï›Ô˘ ·›Ì·ÙÔ˜ ÛÙ· ÓÂÔÁÓ¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È ·Ô‰›‰ÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË ·¤Î-
36
Ã. ∫ÒÛÙ·ÏÔ˜ Î·È Û˘Ó.
ÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú·. AÓÙ›ıÂÙ·, ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ÛÙ· ÙÂÏÂÈfiÌËÓ· οو ÙˆÓ 15 ËÌÂÚÒÓ Ë ·¤ÎÎÚÈÛË Î·Ï›Ô˘ Â›Ó·È ÌÂȈ̤ÓË, ÏfiÁˆ ÌÂȈ̤Ó˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ N·+-K+ ATP¿ÛË ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· Î·È ÌÂȈ̤Ó˘ ¢·ÈÛıËÛ›·˜ ÛÙË ‰Ú¿ÛË Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ (12,13). H ·Ú·ÙËÚÔ‡ÌÂÓË ÙÒÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ¯ÏˆÚ›Ô˘ Ì ·Ú¿ÏÏËÏË ÂÏ·ÊÚ¿ ·‡ÍËÛË ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÙÔ ·›Ì· ÓÂÔÁÓÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, ÔÊ›ÏÂÙ·È Û Ì›ˆÛË ÙÔ˘ Ô˘‰Ô‡ ·¤ÎÎÚÈÛ˘ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÙ· Ô‡Ú· ÛÙ· ÈÔ ÒÚÈÌ· ÓÂÔÁÓ¿, Ì ·Ú¿ÏÏËÏË ·‡ÍËÛË Ù˘ ·Ô‚ÔÏ‹˜ ¯ÏˆÚ›Ô˘ (14,15). TÔ XAA ‹Ù·Ó ›Û˘ ÂÏ·ÊÚ¿ ÌÈÎÚfiÙÂÚÔ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ÓÂÔÁÓ¿ Î·È ·˘Ùfi Â›Ó·È Û‡ÌʈÓÔ Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›· (8,16). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· Ô‡Ú·, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ ·Ô‚ÔÏ‹˜ Î·Ï›Ô˘ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË Û ۇÁÎÚÈÛË Ì ٷ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜ ÙÂÏÂÈfiÌËÓ· ·ÏÏ¿ Î·È Ì ٷ ÚfiˆÚ· ‚Ú¤ÊË. T· ÚfiˆÚ· ÓÂÔÁÓ¿ fï˜ ›¯·Ó ÂÏ·ÊÚ¿ ˘„ËÏfiÙÂÚË ·Ô‚ÔÏ‹ Î·Ï›Ô˘ Û ۯ¤ÛË Ì ٷ ÌÈÎÚ‹˜ ËÏÈΛ·˜ ÙÂÏÂÈfiÌËÓ·. A˘Ùfi, fiˆ˜ ÚԷӷʤÚıËÎÂ, ÔÊ›ÏÂÙ·È ÛÙËÓ ÚÔԉ¢ÙÈ΋ ˆÚ›Ì·ÓÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ·ıÚÔÈÛÙÈÎÔ‡ ÛˆÏËÓ·Ú›Ô˘ Ë ÔÔ›· ¤¯ÂÈ Û¯¤ÛË fi¯È ÌfiÓÔ Ì ÙÔ ‚·ıÌfi ˆÚÈÌfiÙËÙ·˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ ÙË Á¤ÓÓËÛË ·ÏÏ¿ Î·È Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ÓÂÔÁÓÔ‡ (12). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ XAO, ·˘Ùfi ‹Ù·Ó ÂÏ·ÊÚ¿ ıÂÙÈÎfi Î·È ÛÙȘ 3 ÔÌ¿‰Â˜. H ÙÈÌ‹ ÙÔ˘ ¿ÓÙˆ˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ÈÔ ÒÚÈÌ· ÓÂÔÁÓ¿ (ÛËÌÂ›Ô ÌÂÁ·Ï‡ÙÂÚ˘ ·¤ÎÎÚÈÛ˘ ·ÌÌˆÓ›Ô˘ ÛÙ· Ô‡Ú·). ŸÌˆ˜ Ë ‰È·ÊÔÚ¿ ·fi ÙȘ ¿ÏϘ 2 ÔÌ¿‰Â˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. OÈ ÙÈ̤˜ Ô˘ ‚Ú¤ıËÎ·Ó ‹Ù·Ó ¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ Sulyok Î·È Guignard (11), ÙfiÛÔ ÁÈ· Ù· ÚfiˆÚ· fiÛÔ Î·È ÁÈ· Ù· ÙÂÏÂÈfiÌËÓ· ËÏÈΛ·˜ ÂÙ¿ ËÌÂÚÒÓ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ÚfiˆÚ·, Â›Ó·È Èı·ÓfiÓ Ë ‰È·ÊÔÚ¿ Ì·˜ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ‰Èο Ì·˜ ‹Ù·Ó ÈÔ ÒÚÈÌ· ·fi ·˘Ù¿ ÙˆÓ ·Ú·¿Óˆ ÂÚ¢ÓËÙÒÓ. ™Â fiÙÈ ·ÊÔÚ¿ ÛÙ· ÙÂÏÂÈfiÌËÓ· fï˜ ‰ÂÓ ˘¿Ú¯ÂÈ Èı·Ó‹ ÂÍ‹ÁËÛË. ÿÛˆ˜ fï˜ Ë ‰È·ÊÔÚ¿ ÛÙÔ XAO Ó· ÔÊ›ÏÂÙ·È ÛÙË ¯ÚËÛÈÌÔÔ›ËÛË ·fi ÙÔ˘˜ Sulyok Î·È Guignard Á¿Ï·ÎÙÔ˜ Ì ‰È·ÊÔÚÂÙÈ΋ ÂÚÈÂÎÙÈÎfiÙËÙ· ۠χΈ̷ ·fi ÙÔ ‰ÈÎfi Ì·˜ (ÙÔ Â›‰Ô˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ÂÚÁ·Û›·). ™˘ÌÂÚ·ÛÌ·ÙÈο Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ XAA ·fi fiÙÈ Ù· ÙÂÏÂÈfiÌËÓ·. AÓÙ›ıÂÙ·, Ë ËÏÈΛ· ·ËÛ˘ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙÔ XAO. H ·¤ÎÎÚÈÛË Î·Ï›Ô˘ ÛÙ· Ô‡Ú· ηıÔÚ›˙ÂÙ·È ÙfiÛÔ ·fi ÙËÓ ËÏÈΛ· ·ËÛ˘ fiÛÔ Î·È ·fi ÙËÓ ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ÙÔ˘ ÓÂÔÁÓÔ‡. BÈ‚ÏÈÔÁÚ·Ê›· 1. Narins RG, Emmett M. Simple and mixed acid-base disorders. A practical approach. Medicine 1980;59:161169. 2. Battle DC, Hizon M, Cohen G, Gutterman C, Gupta R. The use of the urinary anion gap in the diagnosis of
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hyperchloremic metabolic acidosis. N Engl J Med 1988;318:594-599. Hanna JD,Scheinman JI, Chan JCM. The kidney in acidbase balance. Pediatr Clin North Am 1995;42:1365-1395. Carlisle EJF, Donnelly SM, Halperin MC. Renal tubular acidosis (RTA): Recognize the ammonium defect and forget the urine pH. Pediatr Nephrol 1991;5:242-246. Halperin MC, Jungas RL. The metabolic production and renal dÈsposal of hydrogen ions. Kidney Int 1983;24:709713. Gabows PA, Kaehny WD. The anion gap: Its meaning and clinical utility. Kidney Int 1977;12:5-11. Oh MS, Carroll JH. The anion gap. N Engl J Med 1979;297:814-820. Brewer ED. Disorders of acid-base balance. Pediatr Clin North Am 1990;37:429-447. Goldstein MB,Bear R, Richardson RMA, Mardsen RA, Halperin ML. The urine anion gap: a clinically useful index of ammonium excretion. Am J Med Sci 1986;29:198-202. Hatemi N, Mc Cance RA. Renal aspects of acid-base control in the newly born III. Response to acidifying drugs. Acta Paediatr Uppsala 1961;50:603-616.
ÿÛÌ· ·ÓÈfiÓÙˆÓ ·›Ì·ÙÔ˜ / Ô‡ÚˆÓ
11. Sulyok E, Guignard JP. Relationship of urinary anion gap to urinary ammonium excretion in the neonate. Biol Neonate 1990;57:98-106. 12. Segal S, Smith I. Delineation of cystine and cysteine transport systems in rat kidney cortex by developmental patterns. Proc Natl Acad Sci 1969;63:926-933. 13. Stephenson G, Hammett M, Hardaway G. Ontogeny of renal mineralocorticoid receptors and urinary electrolyte responses in the rat. Am J Physiol 1984;247:F651-F665. 14. Edelmann CM Jr, Rodriguez-Soriano J, Boichis H. Renal bicarbonate reabsorption and hydrogen ion excretion in normal infants. J Clin Invest 1967;46:1309-1314. 15. Tudvad FH, Mc Namara H, Barnett HL. Renal response of premature infants to administration of bicarbonate and potassium. Pediatrics 1954;13:4-10. 16. Usha Raj J, Franco G. Acid/base fluid and electrolyte management. In Shaffer and Averys Diseases of the Newborn. Sixth ed, Taeusch HW, Ballard RA, Avery ME eds. Philadelphia: WB Saunders Co. 1991: 260-275.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 03-09-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: X. KÒÛÙ·ÏÔ˜ AÚÙ¤ÌȉԘ 130, ¶·Ï·Èfi º¿ÏËÚÔ 17562
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™˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ ·È‰È΋ ËÏÈΛ· EÌÌ·ÓÔ˘‹Ï PÔËÏ›‰Ë˜1, XÚ˘Û·Ê¤ÓÈ· M·ÓÙÈÔ‡-°ÎÚ¿Ù˙ÈÔ˘1, £ÂÔ‰Ô‡ÏË ¶··ÛÙ·‡ÚÔ˘1, XÚ‹ÛÙÔ˜ ¶·ÓÙÂÏÈ¿‰Ë˜1, MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘2, B·ÛÈÏÈ΋ K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó·3 ● ¶ÂÚ›ÏË„Ë: AÓ·ÛÎÔÔ‡ÓÙ·È ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ Ïԛ̈͢ ·fi Èfi Coxsackie B Û 11 ·È‰È¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÚfiÛÊ·Ù· ÛÙÔ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô ·fi I·ÓÔ˘¿ÚÈÔ 1996 ̤¯ÚÈ M¿ÈÔ 1997. O ÈÔ Û˘¯Ófi˜ Ù‡Ô˜ ‹Ù·Ó Ô B4 Î·È ÔÈ Î˘Ú›·Ú¯Â˜ ÂΉËÏÒÛÂȘ ‹Ù·Ó ·ÚıÚ›Ùȉ·, Ó¢ÌÔÓ›·, Ì˘Ôηډ›Ùȉ· Î·È ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ. §fiÁˆ ȉȷÈÙÂÚfiÙËÙ·˜ Î·È ‚·Ú‡ÙËÙ·˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ·fi ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜. O ÚÒÙÔ˜ ·ÛıÂÓ‹˜ ·Ú¯Èο ·ÚÔ˘Û›·Û ÌÈ· ÌË ÂȉÈ΋ Â̇ÚÂÙË Î·Ù¿ÛÙ·ÛË, ·ÏÏ¿ ÛÙË Û˘Ó¤¯ÂÈ· ÂΉ‹ÏˆÛ ˷ٛÙȉ·, Ó¢ÌÔÓ›·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· Î·È ·ÚıÚ›Ùȉ·. O ‰Â‡ÙÂÚÔ˜ ·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËΠÁÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ÂÚ›Ô˘ ‰‡Ô Ì‹Ó˜ ÚÈÓ. H ÂÌÊ¿ÓÈÛË ·˘ÙÒÓ ÙˆÓ ÂΉËÏÒÛÂˆÓ Î·È ÛÙ· ‰˘Ô ·È‰È¿ Û˘Û¯ÂÙ›ÛÙËΠÔÚÔÏÔÁÈο Ì ÚfiÛÊ·ÙË Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. ™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ó Î·È Û¿ÓÈ·, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÚÔ˘ÛÈ·ÛÙ› Û ·È‰È¿ ÁÂÓÈÎÂ˘Ì¤ÓË Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. ¶·È‰È·ÙÚÈ΋ 2000;63:38-42 . §¤ÍÂȘ ÎÏÂȉȿ: Coxsackie B, ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ. E. Roilides, C. Mantiou-Gratziou, T. Papastavrou, C. Panteliadis, M. Athanasiou, V. Kyriazopoulou-Dalaina. Systemic manifestations of Coxsackie B virus infections in childhood. Paediatriki 2000;63:38-42. ● Abstract: The systemic manifestations are reviewed of generalized Coxsackie B virus infection in 11 children hospitalized between January 1996 and May 1997. The most common serological type was B4 and the predominant manifestations were arthritis, pneumonia, myocarditis and thrombocytopenic purpura. Two of the cases are described in detail because of their unique characteristics and severity. The first presented with a febrile illness, and subsequently developed hepatitis, pneumonia, glomerulonephritis and arthritis. The second suffered from neutropenia and hepatosplenomegaly which had developed two months prior to admission. These manifestations in the two patients were associated with serological evidence of concurrent Coxsackie B virus infection. Although uncommon, multisystem manifestations due to Coxsackie B virus infections can occur in childhood. Key words: Coxsackie B, clinical manifestations.
EÈÛ·ÁˆÁ‹ OÈ ÈÔ› Coxsackie B ÚÔηÏÔ‡Ó Î˘Ú›ˆ˜ ·Û˘Ìو̷ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ‹ ÌË ÂȉÈΤ˜ Â̇ÚÂÙ˜ ηٷÛÙ¿ÛÂȘ, ·ÚfiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡Ó Î·È ÔÈ ¿ÏÏÔÈ ÂÓÙÂÚo˚Ô› (1,2). EÈϤÔÓ, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÈΛÏÏÂÈ ·fi ·Û˘Ìو̷ÙÈ΋ ̤¯ÚÈ ÌÔÈÚ·›· ÁÈ· ÙÔÓ ·ÛıÂÓ‹. A˘Ùfi ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ Ù‡Ô ÙÔ˘ ÈÔ‡ Î·È ÙË ÏÔÈÌÔÁfiÓÔ ‰‡Ó·Ì‹ ÙÔ˘, ·ÏÏ¿ Î·È ·fi ÙËÓ ËÏÈΛ· Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓ‹. Afi fiÏÔ˘˜ ÙÔ˘˜ ÂÓÙÂÚÔÈÔ‡˜, ÔÈ ÈÔ› Coxsackie B Â›Ó·È ·˘ÙÔ› Ô˘
1 2 3
°' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, A.¶.£. A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, A.¶.£. EÚÁ·ÛÙ‹ÚÈÔ MÈÎÚÔ‚ÈÔÏÔÁ›·˜, A.¶.£.
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Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ Ì ÚÔÛ‚ÔÏ‹ Ù˘ ηډȿ˜, ÙˆÓ Ó¢ÌfiÓˆÓ, ÙÔ˘ ‹·ÙÔ˜, ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Î·È ÙÔ˘ K.N.™. (2). T· ÈÔ ÎÔÈÓ¿ Â˘Ú‹Ì·Ù· Û ·˘Ù¤˜ ÙȘ ηٷÛÙ¿ÛÂȘ ‹Ù·Ó Ì˘ÔÂÚÈηډ›Ùȉ·, ÂÚÈηډ›Ùȉ·, Ï¢ÚÔ‰˘Ó›·, ÌËÓÈÁÁ›Ùȉ· Î·È ·ÁÎÚ·ٛÙȉ·. ™Â ÌÈ· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÈÔ‡˜ Coxsackie B ÛÙËÓ BfiÚÂÈ· EÏÏ¿‰·, Ë ÈÔ Û˘¯Ó‹ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ‹Ù·Ó Ë Ì˘ÔÂÚÈηډ›Ùȉ· (3). KÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ ·ÚıÚ›Ùȉ·, Ë·Ù›Ùȉ·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÈÔ‡˜
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Coxsackie B Û ÌÂÚÈΤ˜ ·Ó·ÊÔÚ¤˜ (4,6), ÂÓÒ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ‰ÂÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ̤¯ÚÈ ÙÒÚ·. ™Â ·˘Ù‹Ó ÙË ÌÂϤÙË, ·Ó·ÛÎÔÔ‡ÌÂ Û˘ÓÔÙÈο fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Ô˘ ÓÔÛËχÙËÎ·Ó ÚfiÛÊ·Ù· ÛÙÔ NÔÛÔÎÔÌÂ›Ô Ì·˜ Î·È ÂÚÈÁÚ¿ÊÔ˘Ì ÏÂÙÔÌÂÚÒ˜ ‰˘Ô ·fi ·˘Ù¤˜ ÏfiÁˆ ȉȷÈÙÂÚfiÙËÙ·˜ Î·È ‚·Ú‡ÙËÙ·˜. YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ MÂÏÂÙ‹Û·Ì ٷ ÈÛÙÔÚÈο 11 ·ÛıÂÓÒÓ Ô˘ ÓÔÛËχÙËÎ·Ó ·fi ÙÔÓ I·ÓÔ˘¿ÚÈÔ 1996 ̤¯ÚÈ ÙÔÓ M¿ÈÔ 1997 ÏfiÁˆ ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Î·È ÂÌÊ¿ÓÈÛ˘ Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛˆÓ. H ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 15 Ì‹Ó˜ ̤¯ÚÈ 11 ¯ÚfiÓÈ· (̤ÛË ËÏÈΛ· 4,8 ¯ÚfiÓÈ·). H ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· ‹Ù·Ó 1,75:1. ø˜ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ıˆڋıËÎÂ Ë ·Ó›¯Ó¢ÛË ÂȉÈÎÒÓ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B1-6. H ·Ó›¯Ó¢ÛË ÁÈÓfiÙ·Ó Ì ̤ıÔ‰Ô ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ì ÙÔ kit ÂÌÔÚ›Ô˘ Ù˘ Bios GmbH Labordiagnostik (Munchen, Germany). H ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ kit ·ÏÏ¿ Î·È fiÏˆÓ fiÛˆÓ Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ ‰ÂÓ ‰›‰ÂÙ·È ·fi ÙȘ ÂÙ·ÈÚ›˜. TÔ‡ÙÔ, ‰ÈfiÙÈ Ë Ì¤ıÔ‰Ô˜ ·Ó·ÊÔÚ¿˜ (ÂÍÔ˘‰ÂÙÂÚˆÙÈ΋ ‰ÔÎÈÌ·Û›·) Ì ÙËÓ ÔÔ›· Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÔÈ Û˘ÁÎÚ›ÛÂȘ Â›Ó·È ÂÚÁ҉˘, ¯ÚÔÓÔ‚fiÚ·, ›ÔÓË Î·È ‰··ÓËÚ‹ Î·È ‰ÂÓ ÚÔÛʤÚÂÙ·È. ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›·, Ë ‰ÔÎÈÌ·Û›· ÂÌ̤ÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ϤÔÓ ·ÍÈfiÈÛÙË Î·È ÚÔÙÈÌ‹ıËΠ·fi ÙȘ ·ÓÔÛÔÂÓ˙˘ÌÈΤ˜ ÌÂıfi‰Ô˘˜ ÂÂȉ‹ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Â›Ó·È ÏÈÁfiÙÂÚÔ Â˘·›ÛıËÙË ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ÂȉÈ΋, ÁÂÁÔÓfi˜ Ô˘ ÙËÓ Î·ıÈÛÙ¿ ÏÂÔÓÂÎÙÈ΋ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÛÎÔÔ‡˜. E›Û˘ ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B1-6 ·ÓȯÓ‡ÔÓÙ·Ó ÙfiÛÔ ÛÙÔÓ ÔÚfi Ù˘ ÔÍ›·˜ Ê¿Û˘ fiÛÔ Î·È Î·Ù¿ ÙËÓ ·Ó¿ÚÚˆÛË. E› ıÂÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ ÔÈ ÔÚÔ› ·ÓÂÍÂÙ¿˙ÔÓÙ·Ó Ì ·ÓÙÈÁfiÓ· ÂȉÈο ÁÈ· οı ¤Ó· ·fi ÙÔ˘˜ Ù‡Ô˘˜ B1-B6 ÙˆÓ ÈÒÓ Coxsackie B Î·È ¤ÙÛÈ ¤ÌÌÂÛ· ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ Ù‡ÔÈ ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÈ· ÙË Ïԛ̈ÍË ÈÒÓ. AÔÙÂϤÛÌ·Ù· Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔ 1996 ̤¯ÚÈ ÙÔ M¿ÈÔ 1997, 11 ·È‰È¿ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ 2 ·È‰ÈÒÓ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ì ÏÂÙÔÌÂÚÒ˜ ÈÔ Î¿Ùˆ, ÓÔÛËχÙËÎ·Ó ÛÙȘ ‰‡Ô ¶·È‰È·ÙÚÈΤ˜ KÏÈÓÈΤ˜ ÙÔ˘ IÔÎÚ·Ù›Ԣ NÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢ Ì ÂÈÎfiÓ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋˜ Ïԛ̈͢ Ô˘ ÔÊÂÈÏfiÙ·Ó Û ÈÔ‡˜ Coxsackie B. H ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 15 Ì‹Ó˜ ̤¯ÚÈ 11 ¯ÚfiÓÈ· (̤ÛË ËÏÈΛ· 4,8 ¯ÚfiÓÈ·). H ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· ‹Ù·Ó 1,75:1. ™Ù· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿, Ô ˘ÚÂÙfi˜ ‹Ù·Ó ÙÔ Î˘Ú›·Ú¯Ô Û‡Ìو̷. OÈ Ù‡ÔÈ ÙˆÓ ÈÒÓ Coxsackie B, Ô˘ ÚÔοÏÂÛ·Ó ·˘Ù¤˜ ÙȘ ÏÔÈÌÒÍÂȘ, ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘
§ÔÈÌÒÍÂȘ Coxsackie B
Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ·˘Ù¤˜ Î·È Ë ÂͤÏÈÍË ÙˆÓ ·ÛıÂÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. Afi Ù· 11 ÈÛÙÔÚÈο ·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰˘Ô ÏÂÙÔÌÂÚ¤ÛÙÂÚ· ÏfiÁˆ ȉȷÈÙÂÚfiÙËÙ·˜ Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È/ ‹ ‚·Ú‡ÙËÙ·˜ ÂΉËÏÒÛˆÓ. ¶ÂÚ›ÙˆÛË 1Ë AÁfiÚÈ ËÏÈΛ·˜ 8 ¯ÚÔÓÒÓ, ÚÔÛÎÔÌ›ÛÙËΠÛÙË °' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ IÔÎÚ¿ÙÂÈÔ˘ NÔÛÔÎÔÌ›Ԣ Ì Â̇ÚÂÙÔ ‰È¿ÚÎÂÈ·˜ 2 ËÌÂÚÒÓ Î·È ÌÂ Û˘ÓÔ‰fi Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Î·È ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË (ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 18.500/mm3 Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ 16.650). K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰ÂÓ ·ÔÎ¿Ï˘„ ٛÔÙ· ÙÔ ·ıÔÏÔÁÈÎfi, ÂÎÙfi˜ ·fi ıÂÚÌÔÎÚ·Û›· 39C. T· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ‹Ù·Ó 12.000/mm3 Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ 9.960, Ë TKE 91mm/1Ë ÒÚ· Î·È Ë CRP > 20 mg/l. TË ‰Â‡ÙÂÚË Ë̤ڷ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ (4Ë Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘), Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÈÎfiÓ· Ë·Ù›Ùȉ·˜. TÔ ‹·Ú ‚Ú¤ıËΠ‰ÈÔÁΈ̤ÓÔ. H SGPT ‹Ù·Ó 117 IU/l, (Ê.Ù. 15-40 IU/l) Î·È Ë Á-GT ‹Ù·Ó 128 U/l (Ê.Ù. 5-32 U/l). O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÙË ‰ÈfiÁΈÛË ÙÔ˘ ÔÚÁ¿ÓÔ˘ ¯ˆÚ›˜ fï˜ ÂÛÙȷΤ˜ ·ÏÏÔÈÒÛÂȘ. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰È‹ÚÎÂÛ·Ó 2 Ë̤Ú˜. TËÓ 5Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, ÙÔ ·È‰› ·ÚÔ˘Û›·Û ‚‹¯·. K·Ù¿ ÙËÓ ·ÎÚfi·ÛË ÙÔ˘ ıÒڷη ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙ˜ ÚfiÁ¯ÔÈ ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ. H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ‰È¿ÌÂÛË Ó¢ÌÔÓ›Ùȉ· Ì ·ÙÂÏÂÎÙ·Û›· ÛÙÔ ‰ÂÍÈfi Ó‡ÌÔÓ·. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ‹Ù·Ó ·ÚÓËÙÈΤ˜ ÁÈ· ÌÈÎÚfi‚È· Î·È Ì‡ÎËÙ˜. TËÓ 7Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·, Ì ›¯ÓË Ï¢ÎÒÌ·ÙÔ˜ ÛÙ· Ô‡Ú·. H ÎÚ·ÙÈÓ›ÓË ÙÔ˘ ÔÚÔ‡ ‹Ù·Ó 88 Ìmol (1 mg/dl), Ë ÔÔ›· Â›Ó·È Î·È Ë ·ÓÒÙÂÚË Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘. H ‰ÈÔ‡ÚËÛ‹ ÙÔ˘ ‹Ù·Ó <1 ml/kg/ÒÚ·, ÂÓÒ Ë ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó Û˘Ó¯Ҙ 130/90 mmHg, ÍÂÂÚÓÒÓÙ·˜ Ù· ·ÓÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘. H ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ ÂÚ˘ıÚÒÓ Û ÚfiÛÊ·Ù· Ô‡Ú· ·ÔÎ¿Ï˘„ ÙËÓ ÛÂÈÚ·Ì·ÙÈ΋ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜. H TKE ·˘Í‹ıËΠ(113 mm/1Ë ÒÚ·) Î·È Ô Ù›ÙÏÔ˜ ASTO ‹Ù·Ó 58 U Todd. A˘Ù‹ Ë ‹È· ÂÈÎfiÓ· ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜ ‰È‹ÚÎÂÛ 3 Ë̤Ú˜. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ¤ÁÈÓ ÙËÓ 8Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚Ô‡, ·‰ÂÓÔ˚ÒÓ, Epstein-Barr, ÈÒÓ Ë·Ù›Ùȉ·˜ B Î·È C, ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘Á΢ÙÈ·ÎÔ‡ ÈÔ‡, ÈÒÓ ECHO, Î·È ÂÓ·ÓÙ›ÔÓ Toxoplasma gondii, ‹Ù·Ó ·ÚÓËÙÈÎfi˜. AÓÙ›ıÂÙ·, Ô ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÈÔ‡˜ Coxsackie B ¤‰ÂÈÍ ÚfiÛÊ·ÙË Ïԛ̈ÍË ÏfiÁˆ Ù˘ ·Ó›¯Ó¢Û˘ ÂȉÈÎÒÓ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi Û ˘„ËÏÔ‡˜ Ù›ÙÏÔ˘˜ Î·È È¯ÓÒÓ IgG. TËÓ 12Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, Ô ·ÛıÂÓ‹˜ ‹Ù·Ó ·‡-
39
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·40
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
E.PÔËÏ›‰Ë˜ Î·È Û˘Ó.
¶›Ó·Î·˜ 1. ™˘ÛÙËÌ·ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B. AÚÈıÌfi˜ AÚ¯Èο HÏÈΛ· T‡Ô˜ ÈÔ‡ KÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ·ÛıÂÓ‹ ·ÛıÂÓ‹ (¯ÚfiÓÈ·) Coxsackie B*
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1
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3
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2
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4
B4
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AÓ¿ÚÚˆÛË
3
TX
1,25
B1 + B5
AÚıÚ›Ùȉ·
AÓ¿ÚÚˆÛË
4
KK
8
B4
H·Ù›Ùȉ·, Ó¢ÌÔÓ›·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·, ·ÚıÚ›Ùȉ·
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5
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3,5
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AÓ¿ÚÚˆÛË
6
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6
B4
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7
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5
B2
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8
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1,5
AηıfiÚÈÛÙÔ˜
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9
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7
AηıfiÚÈÛÙÔ˜
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10
MK
11
B5
£ÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ
AÓ¿ÚÚˆÛË
11
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4,5
B1 + B4
¶Ó¢ÌÔÓ›· ̠ϢڛÙȉ·, ÂÍ¿ÓıËÌ·
AÓ¿ÚÚˆÛË
* ŒÌÌÂÛÔ˜ ηıÔÚÈÛÌfi˜ Ì ·Ó›¯Ó¢ÛË ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÂÓfi˜ ÂοÛÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Coxsackie B1-B6 ** AÓ›¯Ó¢ÛË ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ B1-B6 *** O ·ÛıÂÓ‹˜ ›¯Â ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ÚÂÙÔ˜ Î·È Â¤ÛÙÚ„ ÛÙÔ Û›ÙÈ ÙÔ˘ ÌÂÙ¿ ·fi Ï‹ÚË ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ. TËÓ 16Ë Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, ÌÂÙ¿ ·fi ÌÈ· ÂÚ›Ô‰Ô 4 ËÌÂÚÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù·, Ô ·ÛıÂÓ‹˜ ·Ú·ÔÓ¤ıËΠÁÈ· ¿ÏÁÔ˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ Ô‰ÔÎÓËÌÈ΋ ¿ÚıÚˆÛË, Ë ÔÔ›· ˘Ô¯ÒÚËÛ Û 4 Ë̤Ú˜, ·ÏÏ¿ ·ÎÔÏÔ‡ıËÛ ¿ÏÁÔ˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ηٿ ÁfiÓ˘ ¿ÚıÚˆÛË. H ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·ÔÎ¿Ï˘„ ·ÚıÚ›Ùȉ· Ë ÔÔ›· ÂȂ‚·ÈÒıËÎÂ Î·È Ì ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. H ·ÚıÚ›Ùȉ· ‰È‹ÚÎÂÛ ÂÚ›Ô˘ 2 ‚‰ÔÌ¿‰Â˜. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È fiÏË Ë Û˘Ìو̷ÙÔÏÔÁ›· ÙÔ˘ ·ÛıÂÓ‹. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B, Ô˘ ¤ÁÈÓ 3 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÚÒÙË ÂͤٷÛË ¤‰ÂÈÍ ›¯ÓË IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÔÚÔÌÂÙ·ÙÚÔ‹ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ B4. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿, Ô ·ÛıÂÓ‹˜ Â›Ó·È Û Ôχ ηϋ ηٿÛÙ·ÛË. ¶ÂÚ›ÙˆÛË 2Ë AÁfiÚÈ, ËÏÈΛ·˜ 3 ¯ÚÔÓÒÓ, ·Ú·¤ÌÊıËΠÛÙÔ Â͈ÙÂÚÈÎfi AÈÌ·ÙÔÏÔÁÈÎfi I·ÙÚÂ›Ô Ù˘ A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÁÈ· ¤ÏÂÁ¯Ô Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Ë·ÙÔÛÏËÓÔ-
40
ÌÂÁ·Ï›·˜ Ù· ÔÔ›· ·Ó·Î·Ï‡ÊıËÎ·Ó Ù˘¯·›· ÚÔ ‰ÈÌ‹ÓÔ˘. ™ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙÔ˘ ·ÛıÂÓÔ‡˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Û˘Ó¯›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÂȂ‚·›ˆÛ ÙË ‰ÈfiÁΈÛË ‹·ÙÔ˜ Î·È ÛÏËÓfi˜ Î·È ·ÔÎ¿Ï˘„ „ËÏ·ÊËÙÔ‡˜ ÙÚ·¯ËÏÈÎÔ‡˜ ÏÂÌÊ·‰¤Ó˜. O ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ Ԣ‰ÂÙÂÚÔÂÓ›· (ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 4.500/mm3 Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ 450) Î·È ıÂÙÈ΋ ÙËÓ ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs. TÔ Ì˘ÂÏfiÁÚ·ÌÌ· ¤‰ˆÛÂ Ê˘ÛÈÔÏÔÁÈο ·ÔÙÂϤÛÌ·Ù·. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·¤‚Ë ·ÚÓËÙÈÎfi˜ ÁÈ· ·ÓÔÛÔ·Ó¿ÚÎÂÈ·. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚Ô‡, ÙÔ˘ ÈÔ‡ Epstein-Barr, ÙÔ˘ ÈÔ‡ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·, ·‰ÂÓÔ˚ÒÓ Î·È ÙÔ˘ Toxoplasma gondii ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÚfiÛÊ·ÙË Ïԛ̈ÍË. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ Coxsackie B ¤‰ÂÈÍ IgM ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi, ÂÓÒ Ù· IgG ‹Ù·Ó ÂÏ·ÊÚ¿ ·˘ÍË̤ӷ. ¢‡Ô Ì‹Ó˜ ·ÚÁfiÙÂÚ·, Ë Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· ›¯Â ˘Ô¯ˆÚ‹ÛÂÈ Î·È Ë ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs ‹Ù·Ó ·ÚÓËÙÈ΋.T· IgG ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ
JAN.-FEB.2000
30-05-03
12:56
™ÂÏ›‰·41
¶∞π¢π∞∆ƒπ∫∏ 2000;63:21-42
Coxsackie B ‚Ú¤ıËÎ·Ó ÙÂÙÚ·Ï¿ÛÈ· ·˘ÍË̤ӷ ÛÙÔÓ ÔÚfi ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ B1-B6. T¤ÛÛÂÚȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· Ù· IgM ·ÓÙÈÛÒÌ·Ù· ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·Ó Î·ıfiÏÔ˘ ÛÙÔÓ ÔÚfi. H Ô˘‰ÂÙÂÚÔÂÓ›· fï˜ ·Ú¤ÌÂÈÓÂ Î·È ÌÂÙ¿ 8 Ì‹Ó˜, Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ډÓÈ˙ÔÏfiÓË Û ‰fiÛË 2 mg/kg ËÌÂÚ‹ÛÈ· ÁÈ· 15 Ë̤Ú˜ Î·È ÛÙ·‰È·Î‹ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È Â·ÓÂÈÏËÌ̤ӷ Û¯‹Ì·Ù· ÂÓ‰ÔÊϤ‚È·˜ Á-ÛÊ·ÈÚ›Ó˘ Û ‰fiÛË 2 gr/kg ÂÊ¿·Í. MÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·ÔηٷÛÙ¿ıËÎÂ Î·È Ô ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ¿ÚÈÛÙË Î·Ù¿ÛÙ·ÛË Ì¤¯ÚÈ Û‹ÌÂÚ·. ™˘˙‹ÙËÛË ™Â ·˘Ù‹Ó ÙË ÌÂϤÙË, ·Ó·ÛÎÔÔ‡ÓÙ·È 11 ÂÚÈÙÒÛÂȘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Ô˘ Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ. OÈ ‰‡Ô ϤÔÓ ¿Ù˘Â˜ ‹ ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÂȉÈÎfiÙÂÚ·. AÓ Î·È ÏÔÈÌÒÍÂȘ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ÈÔ‡˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÚÔËÁÔ‡ÌÂÓ·, ÏÔÈÌÒÍÂȘ Ì ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó Ôχ ÏÈÁfiÙÂÚÔ ÙÂÎÌËÚȈı›, Î·È Ë ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ·ÊÔÚ¿ ΢ڛˆ˜ ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ (4,5,7-10). I‰È·›ÙÂÚ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÔÈ ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B Â›Ó·È Û¿ÓȘ Î·È ·ÊÔÚÔ‡Ó ÈÔ Û˘¯Ó¿ ÓÂÔÁÓ¿ Î·È ÌÈÎÚ¿ ‚Ú¤ÊË, ÛÙ· ÔÔ›· ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·Ô‚·›ÓÔ˘Ó ÌÔÈÚ·›Â˜ (2). H ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·ÊÔÚ¿ Û¯ÂÙÈο ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·È‰ÈÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. O ÈÔ Û˘¯Ófi˜ Ù‡Ô˜ Ô˘ ‚Ú¤ıËΠÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó Ô B4 (‚Ú¤ıËΠ۠4 ·fi ÙÔ˘˜ 7 ·ÛıÂÓ›˜ Ô˘ ÂϤÁ¯ıËηÓ). A˘Ùfi ÙÔ Â‡ÚËÌ· Û˘ÌʈÓ› Ì ÚÔËÁÔ‡ÌÂÓ· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÂÚÈÔ¯‹ Ì·˜ fiÙÈ Ô ÈÔ Û˘¯Ó¿ ÂÌÊ·ÓÈ˙fiÌÂÓÔ˜ Ù‡Ô˜ ÈÔ‡ Coxsackie B ÛÙË BfiÚÂÈÔ EÏÏ¿‰· Â›Ó·È Ô B4 (3). ™Â ·ÓÙ›ıÂÛË, Ô B3 ‰ÂÓ ‚Ú¤ıËΠ۠ηӤӷ ·fi Ù· ·È‰È¿. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ 2 ·fi Ù· 7 ·È‰È¿ Ô˘ ÂϤÁ¯ıËÎ·Ó Â›¯·Ó Û‡Á¯ÚÔÓË Ïԛ̈ÍË ·fi 2 ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ù‡Ô˘˜ ÈÒÓ Coxsackie B (›Ó·Î·˜ 1). ™Â Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ (1,5,8,9) ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÈÔ‡ Coxsackie B ‰ÈfiÙÈ ·ÓȯÓ‡ıËÎ·Ó ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ Ù‡ˆÓ (B1-6) Î·È ÛÙÔÓ ›‰ÈÔ Ù›ÙÏÔ. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÂÓ Â›Ó·È Û¿ÓÈÔ Û ÈÔ‡˜ Ô˘ ÌÔÈÚ¿˙ÔÓÙ·È ÎÔÈÓ¿ ·ÓÙÈÁfiÓ· fiˆ˜ ÔÈ ÈÔ› Coxsackie B. ™ÙÔÓ ›Ó·Î· 1, ‰›‰ÂÙ·È ‹‰Ë Ë ÂÍ‹ÁËÛË ·˘Ù‹. O ·ÛıÂÓ‹˜ Ù˘ ÂÚ›ÙˆÛ˘ 1 (›Ó·Î·˜ 1: ·ÛıÂÓ‹˜ 4) ·Ó¤Ù˘Í ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ Î·È, ·Ú¿ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ‹·ÙÔ˜, Ó¢ÌfiÓˆÓ, ÓÂÊÚÒÓ Î·È ·ÚıÚÒÛˆÓ, Ë ÓfiÛÔ˜ ›¯Â ‹È· ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÂͤÏÈÍË. °È· ÚÒÙË ÊÔÚ¿ ·Ó·Ê¤ÚÂÙ·È Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B Ì ÙfiÛÔ ÁÂÓÈÎÂ˘Ì¤ÓË Û˘ÌÌÂÙÔ¯‹. I‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂΉ‹ÏˆÛË Ù˘ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜ Û ·˘ÙfiÓ ÙÔÓ ·ÛıÂÓ‹ Ô˘ ›¯Â Û¯¤ÛË Ì Ïԛ̈ÍË ·fi Èfi Coxsackie B4. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·,
§ÔÈÌÒÍÂȘ Coxsackie B
˘¿Ú¯Ô˘Ó Û¿ÓȘ ·Ó·ÊÔÚ¤˜ ÓÂÊÚ›Ùȉ·˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔ˘˜ ÂÓÙÂÚÔ˚Ô‡˜ (2). O ÓÂÊÚÔÙÚÔÈÛÌfi˜ ÙˆÓ ÈÒÓ Coxsackie B4 Â›Ó·È ·fi ηÈÚfi ÁÓˆÛÙfi˜. O Bayatpour Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ÂÚȤÁÚ·„·Ó ÂÚ›ÙˆÛË ÔÍ›·˜ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜ Û ·ÁfiÚÈ 9 ¯ÚÔÓÒÓ Ì ÛÔ‚·Ú¤˜ ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘ Û˘Û¯ÂÙ›ÛÙËΠ̠ÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË Ïԛ̈͢ ·fi Èfi Coxsackie B4. EÓÙÔ‡ÙÔȘ, ·˘Ùfi˜ Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ Û˘Á¯ÚfiÓˆ˜ Î·È ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ASTO (7). Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Ô Burch Î·È Colcolough ÂÚȤÁÚ·„·Ó ÌÈ· ÂÚ›ÙˆÛË ÚÔԉ¢ÙÈ΋˜ ·Óηډ›Ùȉ·˜ Î·È ÓÂÊÚ›Ùȉ·˜ Û ·ÛıÂÓ‹ Ì Ïԛ̈ÍË ·fi Èfi Coxsackie B4 (9). ¶ÈÔ ÚfiÛÊ·Ù·, Ô Kamiyama Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ·¤‰ÂÈÍ·Ó ÙË ÓÂÊÚÈÙȉÔÁfiÓÔ È‰ÈfiÙËÙ· ÙÔ˘ Coxsackie B4 ÚÔηÏÒÓÙ·˜ ÛÂÈÚ·Ì·ÙoÓÂÊÚ›Ùȉ· ÙÔ˘ Ù‡Ô˘ ÙˆÓ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ Û ÔÓÙ›ÎÈ· (6). EÈÚfiÛıÂÙ·, Ô Yoshida Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ÚÔοÏÂÛ·Ó ¿ÏÈ Û ÔÓÙ›ÎÈ· IgA ÓÂÊÚÔ¿ıÂÈ· ·fi Èfi Coxsackie B4 Ì ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ (11). O ·ÛıÂÓ‹˜ Ù˘ ÂÚ›ÙˆÛ˘ 2, (›Ó·Î·˜ 1: ·ÛıÂÓ‹˜ 1) ·ÚÔ˘Û›·Û Ԣ‰ÂÙÂÚÔÂÓ›·, Ë ÔÔ›·, Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, Û˘Û¯ÂÙ›ÛÙËΠ̠Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B. H Ô˘‰ÂÙÂÚÔÂÓ›· ÚÔÎÏ‹ıËΠ̿ÏÏÔÓ ·fi οÔÈÔ ÌË Î·Ï¿ ηٷÓÔËÙfi ·˘ÙÔ¿ÓÔÛÔ Ì˯·ÓÈÛÌfi, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙË ıÂÙÈ΋ ¿ÌÂÛË ·ÓÙ›‰Ú·ÛË Coombs. A' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, Ô˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÔÍ›· Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı›. AÓÙ›ıÂÙ·, ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ¤ÊË‚Ô, ÂÚ›ÙˆÛË Û˘Ó‰ÚfiÌÔ˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ Ô˘ ÂΉËÏÒıËΠ̠ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ê·Ú˘ÁÁ›Ùȉ·, ÌËÓÈÁÁÔÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·, Ë·Ù›Ùȉ· Î·È ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, Ô˘ ÔÊÂÈÏfiÙ·Ó Û Ïԛ̈ÍË Ì Èfi Coxsackie Ù‡Ô˘ B3 (8). ¢˘ÛÙ˘¯Ò˜, Î·È ÛÙÔÓ ·ÛıÂÓ‹ ·˘ÙfiÓ ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÈÔ‡ Coxsackie B ‰ÈfiÙÈ ·ÓȯÓ‡ıËÎ·Ó ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ Ù‡ˆÓ (B1-6) Î·È ÛÙÔÓ ›‰ÈÔ Ù›ÙÏÔ. H ·ÚıÚ›Ùȉ· Î·È Ë Ó¢ÌÔÓ›· ‹Ù·Ó ÔÈ ÈÔ Û˘¯Ó¤˜ ÂΉËÏÒÛÂȘ Ïԛ̈͢ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë Î·ıÂÌ›· ¯ˆÚÈÛÙ¿ ÂÌÊ·Ó›ÛÙËΠÛÙÔ˘˜ 3 ·fi ÙÔ˘˜ 11 ·ÛıÂÓ›˜ Ì·˜ (›Ó·Î·˜ 1). OÈ ÈÔ› Coxsackie A Î·È B ¢ı‡ÓÔÓÙ·È ÁÈ· ·Ó·ÏÔÁ›· <1% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÈÔÁÂÓÔ‡˜ Ó¢ÌÔÓ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (2). Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Û ·Ï·ÈfiÙÂÚ˜ ·Ó·ÊÔÚ¤˜ Û˘Û¯ÂÙ›ÛÙËÎÂ Ë ·ÚıÚ›Ùȉ· Ì Ïԛ̈ÍË ·fi ÈÔ‡˜ Coxsackie B (4,5,12). ™Â ÌÈ· ·Ó·ÊÔÚ¿, Û˘Û¯ÂÙ›ÛÙËÎÂ Ë ÂÌÊ¿ÓÈÛË ÓÔÛ‹Ì·ÙÔ˜ Ô˘ ¤ÌÔÈ·˙ Ì ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· Û 2 ·ÛıÂÓ›˜ (¤Ó·Ó ¤ÊË‚Ô Î·È ¤Ó·Ó ÂÓ‹ÏÈη) Ì Ïԛ̈ÍË ·fi Èfi Coxsackie B4. ™ÙË ÌÂϤÙË ·˘Ù‹, ÔÈ 2 ·fi ÙÔ˘˜ 3 ·ÛıÂÓ›˜ Ì ·ÚıÚ›Ùȉ· ›¯·Ó Ïԛ̈ÍË ·fi Èfi Coxsackie B4. OÈ ÂÚÈÙÒÛÂȘ, Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Û ·˘Ù‹ ÙË ÌÂϤÙË, ÙÔÓ›˙Ô˘Ó ÙË ÛËÌ·Û›· Î·È ÔÈÎÈÏ›· ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ïԛ̈͢ ·fi ÈÔ‡˜ Coxsackie B.
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EÈÎfiÓ· 1. ™˘Ìو̷ÙÔÏÔÁ›· ·ÛıÂÓ‹ 1. OÈ ÈÔ› ·˘ÙÔ› ÂÚÈÛÙ·Ûȷο ÚÔηÏÔ‡Ó ÁÂÓÈÎÂ˘Ì¤Ó˜ ÏÔÈÌÒÍÂȘ Ì ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÔÚ›·, Û ηٿ Ù· ¿ÏÏ· ˘ÁÈ‹ ·È‰È¿, ·ÏÏ¿ ›Û˘ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó Î·È ÂÌ̤ÓÔ˘Û· Ô˘‰ÂÙÂÚÔÂÓ›·. T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û¯ÂÙ›˙ÔÓÙ·È Â›Ù Ì ÙËÓ ˘„ËÏ‹ ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ù‡ˆÓ ÙˆÓ ÈÒÓ Coxsackie B, ‹ Ì ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ‰ÂÓ Â›Ó·È Â·ÚÎÒ˜ ηıÔÚÈṲ̂ÓÔÈ Ì¤¯ÚÈ Û‹ÌÂÚ·. BÈ‚ÏÈÔÁÚ·Ê›· 1. Modlin JF. Coxsackie viruses, ECHO viruses and enteroviruses. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. New York: Churchill Livingstone, 1995: 1620-1636. 2. Cherry JD. Enteroviruses: Coxsackieviruses, Echoviruses and Polioviruses. In: Feigin RD, Cherry JD, ed. Textbook of Pediatric Infectious Diseases. Philadelphia: Saunders,4th Ed. 1998: 1787-1839. 3. K˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó· B,ºÚ·ÓÙ˙›‰Ô˘-A‰·ÌÔÔ‡ÏÔ˘ º, ™Ô‡ÏÈÔ˘-™˘Ìˆӛ‰Ô˘ E, ™˘Ìˆӛ‰Ë˜ °, ¶··‚·ÛÈÏ›Ԣ ¶. IÔ› Coxsackie B Î·È ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜. EÏÏËÓÈ΋ I·ÙÚÈ΋ 1991;57, 5: 334-338. 4. Heaton DC, Moller PW. Still’s disease associated with Coxsackie infection and haemophagocytic syndrome. Ann Rheum Dis 1985;44:341-344. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-10-98 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: E. PÔËÏ›‰Ë˜ °' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ A.¶.£. IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô KˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, 54642 £ÂÛÛ·ÏÔÓ›ÎË
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5. David JJ, Dietz FR, Jones MM. Coxsackie B monoarthritis with hepatitis. A case report. J Bone Joint Surg Am 1993;75:1685-1686. 6. Kamiyama S. Experimental glomerulonephritis induced by Coxsackie B4 virus in mice-glomerular changes associated with intermittent viral inoculations. Nippon Jinzo Gakkai Shi 1990;32:939-948. 7. Bayatpour M, Zbitnew A, Dempster G. Role of Coxsackie virus B4 in the pathogenesis of acute glomerulonephritis. Can Med Assoc J 1973;109:873-875. 8. Begovac J, Puntaric V, Borcic D, Barsic B, Zrinscak J, Beus I, et al. Mononucleosis-like syndrome associated with a multisystem Coxsackie virus type B3 infection in adolescence. Eur J Pediatr 1988;147:426-427. 9. Burch GE, Colcolough HL. Progressive Coxsackie viral pancarditis and nephritis. Ann Intern Med 1969;71:963-970. 10. Hurst NP, Martynoga AG, Nuki G, Sewell JR, Mitchell A, Hughes GR. Coxsackie B infection and arthritis. BMJ 1983;286:605-607. 11. Yoshida K, Suzuki J, Suzuki S, Kume K, Mutoh S, Kato K, et al. Experimental IgA nephropathy induced by Coxsackie B4 virus in mice. Am J Nephrol 1997;17:81-88. 12. Huppertz HI, Niki NP, Chantler JK. Susceptibility of normal human joint tissue to viruses. J Rheumatol 1991;18:699-704.
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● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 4 ÂÙÒÓ Ô˘ ÂÈÛ‹¯ıË ÛÙË ÎÏÈÓÈ΋ Ì·˜ Ì ˘ÚÂÙfi, ‚‹¯· Î·È ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙ˜ Û ·ÌÊfiÙÂÚ· Ù· Ó¢ÌÔÓÈο ‰›·. TËÓ 3Ë Ì¤Ú· ÓÔÛËÏ›·˜ Ù˘, ˘fi ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›·, ÂÌÊ¿ÓÈÛ ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·. T¤ÛÛÂÚȘ Ë̤Ú˜ ·ÚÁfiÙÂÚ· Î·È ÂÓÒ Ô ˘ÚÂÙfi˜ ›¯Â ˘ÊÂı›, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ¿ÚÂÛË ÙÔ˘ ‰ÂÍÈÔ‡ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. T· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙÔ˘ ENY ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (CT Î·È MRI ÂÁÎÂÊ¿ÏÔ˘) ¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο Ì ·ÁÁÂȷ΋ ηٷÓÔÌ‹, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ¤ÌÊÚ·ÎÙÔ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. H ÔÚ›· Ù˘ ·ÛıÂÓÔ‡˜ Ì ·ÓÙÈÌÈÎÚԂȷ΋ Î·È Û˘Ìو̷ÙÈ΋ ·ÁˆÁ‹ ÂÍÂÏ›¯ıËΠÈηÓÔÔÈËÙÈο Ì ϋÚË ·ÔηٿÛÙ·ÛË Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ 10 ̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·Û‹ Ù˘. H ÂÚ›ÙˆÛË ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ·Ù› Ë ÂÓÙÔÈṲ̂ÓË ·ÁÁÂÈ›Ùȉ· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÔÙÂÏ› Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜. ¶·È‰È·ÙÚÈ΋ 2000;63:43-47. §¤ÍÂȘ ÎÏÂȉȿ: ¿ÚÂÛË ÚÔÛˆÈÎÔ‡, ¤ÌÊÚ·ÎÙÔ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜. V. Falaina, V. Papaevangelou, V. Syriopoulou, M. Theodoridou. Occlusion of the middle cerebral artery and Bell's palsy associated with Mycoplasma pneumoniae infection. Paediatriki 2000;63:43-47. ● Abstract: A four-year old girl, with an unremarkable past medical history, was admitted with fever, cough and respiratory distress. On the third day of hospitalization, she developed a diffuse maculopapular rash. Four days later, she had an episode of partial seizures with clonic contractions of the left corner of her mouth with no loss of consciousness, which was accompanied by a right-sided Bell’s palsy. The CSF examination was normal and brain CT and MRI revealed a hypopyknotic area in the right fronto-temporal region indicating infarction due to occlusion of the middle cerebral artery. Serum antibodies tested by both Elisa and complement fixation indicated recent M. pneumoniae infection. There was complete remission of the Bell’s palsy within 10 days. This is a rare case of cerebral infarction following Mycoplasma pneumoniae infection. The pathogenesis, clinical presentation and prognosis of the neurologic complications of M. pneumoniae infection are discussed. Key words: Bell’s palsy, M. pneumoniae infection, cerebral infarction.
EÈÛ·ÁˆÁ‹ H Ó¢ÌÔÓ›· ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ Î·È ÛËÌ·ÓÙÈ΋ ÂΉ‹ÏˆÛË Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. YÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ Ì˘ÎfiÏ·ÛÌ· ¢ı‡ÓÂÙ·È ÁÈ· ÂÚ›Ô˘ 20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ó¢ÌÔÓ›·˜ Ù˘ ÎÔÈÓfiÙËÙ·˜. H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· (0,1%),
·ÏÏ¿ ·˘Í¿ÓÂÈ ·Ú¿ÏÏËÏ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ Ó¢ÌÔÓ›·˜, ·ÊÔ‡ ÊÙ¿ÓÂÈ ÛÙÔ 7% ÛÙÔ˘˜ ÓÔÛËÏ¢fiÌÂÓÔ˘˜ Ì Ó¢ÌÔÓ›· ·fi Ì˘ÎfiÏ·ÛÌ· (1). H ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ Â›Ó·È Û˘¯ÓfiÙÂÚË Û Ó·ڿ ¿ÙÔÌ· (< 20 ÂÙÒÓ) Î·È È‰È·›ÙÂÚ· Û ¿ÚÚÂÓ˜, ÂÌÊ·Ó›˙ÂÙ·È ‰Â ηٿ ̤ÛÔ fiÚÔ 10 ̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ (2-4) .
A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·".
43
JAN.-FEB.2000
30-05-03
12:57
™ÂÏ›‰·44
¶∞π¢π∞∆ƒπ∫∏ 2000;63:43-47
H ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ· ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÂÈÏÔ΋. ™·ÓÈfiÙÂÚ· ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂÁÎÂÊ·Ï›Ùȉ·, ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·, Ó¢ڛÙȉ·, Û‡Ó‰ÚÔÌÔ ·Ó¿ÏÔÁÔ Ì ÙËÓ ÔÏ˘ÔÌ˘ÂÏ›Ùȉ·, Û‡Ó‰ÚÔÌÔ GuillainBarré Î·È „‡¯ˆÛË. H ‰È¿ÁÓˆÛË Ù˘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ Û˘Ó‹ıˆ˜ Ù›ıÂÙ·È Ì ÙȘ ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ÂÙÒÓ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÌÂÙ¿ ·fi Ïԛ̈ÍË Ì ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ KÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Ì ˘ÚÂÙfi, ‚‹¯· Î·È ‹È· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. TÔ ·ÙÔÌÈÎfi, ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÔÓÙ·È ÂχıÂÚ·. H ·ÛıÂÓ‹˜ Ù¤ÛÛÂÚȘ ̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi ¤ˆ˜ 39ÔC Î·È ÍËÚfi ‚‹¯·. ¶ÚÔԉ¢ÙÈο, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ·ÛıÂÓÔ‡˜ ÂȉÂÈÓÒıËΠÏfiÁˆ ÂÈÌÔÓ‹˜ ÙÔ˘ ˘ÚÂÙÔ‡ Î·È ÂÌÊ¿ÓÈÛ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ . K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ·ÛıÂÓ‹˜ ‹Ù·Ó Û ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ›˙ÔÓÙ˜ Û ·ÌÊfiÙÂÚ· Ù· Ó¢ÌÔÓÈο ‰›·, ¯ˆÚ›˜ ¿ÏÏ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙˆÓ ˘ÔÏÔ›ˆÓ Û˘ÛÙËÌ¿ÙˆÓ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍÂ: Hb: 12,2 gr/dl, Ht:37,5%, §Â˘Î¿: 6.900/mm3 (¶ÔÏ˘/69%, §ÂÌÊÔ/21%, MÔÓÔ/5%), AÈÌÔÂÙ¿ÏÈ·: 260.000/mm3, T.K.E.: 65mm/1Ë ÒÚ·, C.R.P.: 42,2 mg/lt. O ·‰Úfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, Ë ‰Â ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÛÙ›ڷ. H ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ‡ÎÓˆÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡ Î·È ‰È¿ÌÂÛ· ÛÙÔȯ›· ¿Ìʈ. M ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜ ¯ÔÚËÁ‹ıËÎ·Ó ·ÌÔ͢ÎÈÏÏ›ÓË-ÎÏ·‚Ô˘Ï·ÓÈÎfi i.v. Î·È ÂÚ˘ıÚÔÌ˘Î›ÓË p.o.s. TËÓ 7Ë Ì¤Ú· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜, Ë ·ÛıÂÓ‹˜ Û˘Ó¤¯È˙ ӷ ˘Ú¤ÛÛÂÈ Î·È Ù· ·ÎÚÔ·ÛÙÈο Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ‹Ù·Ó ·ÌÂÙ¿‚ÏËÙ·. ™ÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÚÔÛÂÙ¤ıË ·Ú·Èfi ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·, ηıÒ˜ Î·È ÂÓ¿ÓıËÌ· ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. EÛÙ¿ÏË ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤Ó·ÓÙÈ ÈÒÓ Î·È ‚·ÎÙËÚȉ›ˆÓ Ô˘ ÂÌϤÎÔÓÙ·È Û ·ÚfiÌÔÈ· Û˘Ìو̷ÙÔÏÔÁ›· fiˆ˜ ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, Ô Èfi˜ Epstein-Barr, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Î·È Ô Èfi˜ ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·. TËÓ 11Ë Ì¤Ú· Ù˘ ÓfiÛÔ˘ Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÛËÌ·ÓÙÈο ‚ÂÏÙȈ̤ÓË Î·È Ô ˘ÚÂÙfi˜ ›¯Â ˘ÊÂı›. H ·ÛıÂÓ‹˜, ÂÓÒ ‰È·ÙËÚÔ‡Û ¿ÚÈÛÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘, ·ÚÔ˘Û›·Û ÎÏÔÓÈΤ˜ Û˘Û¿ÛÂȘ
44
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
Ù˘ ·ÚÈÛÙÂÚ‹˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ‰È¿ÚÎÂÈ·˜ ÂÚ›Ô˘ 1-2 ÏÂÙÒÓ Î·È ÂÓ Û˘Ó¯›· ÂÌÊ¿ÓÈÛ ·Û˘ÌÌÂÙÚ›· ÚÔÛÒÔ˘, Ì ÙÒÛË Ù˘ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰ÂÍÈ¿. H ÛËÌÂÈÔÏÔÁ›· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. H ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ Â›ÎÙËÙˆÓ ·ÈÙÈÒÓ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜, ÏÔÈÌÒÍÂȘ, ÂÓ‰ÔÎÚ¿ÓÈÔ˘˜ fiÁÎÔ˘˜ ‹ ¤ÌÊÚ·ÎÙ·, ˘¤ÚÙ·ÛË, ÙÔ͛Ә Î·È ÙË Ì˘·Ûı¤ÓÂÈ· Gravis. °È· ÙËÓ ·ÈÙÈÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË ·ÎÔÏÔ‡ıËÛ·Ó ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. H ÂͤٷÛË ÙÔ˘ E.N.Y. ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ fï˜, ¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο Ì ¢Ú›· ÂÚÈÊÂÚÈ΋ ‚¿ÛË Î·È ·ÁÁÂȷ΋ ηٷÓÔÌ‹, ÂÈÎfiÓ· Ô˘ Û˘ÓËÁÔÚ› ˘¤Ú ÂÌÊÚ¿ÎÙÔ˘ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ (ÂÈÎfiÓ· 1). H ·ÛıÂÓ‹˜, Ô˘ ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, ÂÙ¤ıË Û ·ÔȉËÌ·ÙÈ΋ ·ÁˆÁ‹ Ì ̷ÓÈÙfiÏË Î·È ‰ÂÍ·ÌÂı·˙fiÓË. T·˘Ùfi¯ÚÔÓ·, ·fi ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‚Ú¤ıËΠÂÍ·ÈÚÂÙÈο ·˘ÍË̤ÓÔ˜ Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ Ì ÙË Ì¤ıÔ‰Ô Û‡Ó‰ÂÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ IgG> 1/1024, fiˆ˜ Î·È Ì ÙËÓ ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (Elisa) IgM > 1/2560 Î·È IgG > 1/2560 ·ÓÙ›ÛÙÔȯ·. TÔ Â‡ÚËÌ· ·˘Ùfi ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ Úfi-
EÈÎfiÓ· 1. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ fiÔ˘ Ê·›ÓÂÙ·È ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο.
JAN.-FEB.2000
30-05-03
12:57
™ÂÏ›‰·45
¶∞π¢π∞∆ƒπ∫∏ 2000;63:43-47
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
EÈÎfiÓ˜ 2,3. M·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, T1 Î·È T2 Ï‹„Ë ·ÓÙ›ÛÙÔȯ·, fiÔ˘ ÂȂ‚·ÈÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ ¤ÌÊÚ·ÎÙÔ˘ Ù˘ ‰ÂÍÈ¿˜ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜ (Ê·›ÓÂÙ·È ÛÙÔ ·ÚÈÛÙÂÚfi ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜). ÛÊ·Ù˘ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÂÚȤϷ‚Â Î·È ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ıÚfiÌ‚ˆÛË Ù˘ ¤Ûˆ ηڈٛ‰·˜ Î·È ÎÏ¿‰ˆÓ ·˘Ù‹˜ fiˆ˜ Â›Ó·È Ë Û˘Ó‡·ÚÍË Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜, ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ ‹ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜. AÎfiÌ· ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ¿ÏÏˆÓ Èı·ÓÒÓ ·ÈÙ›ˆÓ ıÚfiÌ‚ˆÛ˘ ÌÂÁ¿Ï˘ ·ÚÙËÚ›·˜. ™˘ÁÎÂÎÚÈ̤ӷ, ¤ÁÈÓ ÔÛÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ III, ÚˆÙ½Ó˘ C Î·È S, Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÂÓÂÚÁÔÔÈË̤ÓË ÚˆÙ½ÓË C, η¶›Ó·Î·˜ 1. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜. ∂ÈÛ·ÁˆÁ‹
3 ‚‰ÔÌ¿‰Â˜
3 Ì‹Ó˜
ÌÂÙ¿
ÌÂÙ¿
M¤ıÔ‰Ô˜ ELISA IgG
1/ 2560
1/ 2560
1/ 2160
IgM
1/ 2560
1/ 320
1/ 220
M¤ıÔ‰Ô˜ Û‡Ó‰ÂÛ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ IgG
1/ 1024
1/ 1024
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ıÒ˜ Î·È ¤ÏÂÁ¯Ô˜ ÔÌÔ΢ÛÙÈÓ·ÈÌ›·˜. K·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ ·›ÙÈ· ıÚÔÌ‚ÔÊÈÏ›·˜ ‰ÂÓ ÂȂ‚·ÈÒıËÎÂ. H ·ÛıÂÓ‹˜ ‰ÂÓ ÂÌÊ¿ÓÈÛ ͷӿ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È Ë ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ·ÂηٷÛÙ¿ıË Ï‹Úˆ˜ ÌÂÙ¿ 10 ̤Ú˜. TÔ ÎÔÚ›ÙÛÈ ÂÍ‹Ïı ·fi ÙË ÎÏÈÓÈ΋ Ì·˜ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË. H Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ¤ÁÈÓ ¤Ó· Ì‹Ó· ·ÚÁfiÙÂÚ·, ¤‰ÂÈÍÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ· (ÂÈÎfiÓ˜ 2,3). O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ·ÓÂÏ‹ÊıË 1 Î·È 3 Ì‹Ó˜ ·ÚÁfiÙÂÚ·, ÂȂ‚·›ˆÛ ÙËÓ ÔÍ›· Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ÛÙËÓ ·ÛıÂÓ‹ Ì·˜. (¶›Ó·Î·˜ I) O Û˘Ó‰˘·ÛÌfi˜ Ù˘ ÂÚÁ·ÛÙËÚȷο ÙÂÎÌËÚȈ̤Ó˘ ÔÍ›·˜ Ïԛ̈͢ ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜, ÙÔ˘ Â˘Ú‹Ì·ÙÔ˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ ÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô ·ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ·ÈÙ›ˆÓ ıÚÔÌ‚ÔÊÈÏ›·˜ ÛÙÔȯÂÈÔıÂÙÔ‡Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÓÙÔÈṲ̂Ó˘ ·ÁÁÂÈ›Ùȉ·˜ ÙÔ˘ KN™ ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ™˘˙‹ÙËÛË H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ ÌÂÙ¿ ·fi Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË Â›Ó·È Û¿ÓÈ· (0,1%). ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÌÂÙ¿ ·fi
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ÔÍ›· Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ (5-7). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË ‰ÈÂÁÓÒÛıË Ì ‚¿ÛË ÙË Û˘Ìو̷ÙÔÏÔÁ›· Î·È ÛËÌÂÈÔÏÔÁ›· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ·ÏÏ¿ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘. H ·ÛıÂÓ‹˜ Ì·˜ Ì ÂχıÂÚÔ Ó¢ÚÔÏÔÁÈÎfi ÈÛÙÔÚÈÎfi, ÂÌÊ¿ÓÈÛ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ·ÚÈÛÙÂÚÔ‡ ÚÔÛÒÔ˘ Î·È ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘, ‰ÂÍÈ¿ ÙËÓ 11Ë Ì¤Ú· Ù˘ ÓfiÛÔ˘. AÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ Â›¯Â ÎÏÈÓÈ΋ ‹ ÂÚÁ·ÛÙËÚȷ΋ ¤Ó‰ÂÈÍË ÌËÓÈÁÁ›Ùȉ·˜. Afi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ê¿ÓËΠfiÙÈ Ë ÔÍ›· ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· ÙÔ˘ ·È‰ÈÔ‡ ÔÊ›ÏÂÙÔ Û ¤ÌÊÚ·ÎÙÔ Ù˘ ‰ÂÍÈ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, Èı·Ófiٷٷ Û ¤‰·ÊÔ˜ ÚfiÛÊ·Ù˘ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ (8). EÈϤÔÓ, Ô Û˘ÌÏËڈ̷ÙÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ Î·Ù¿‰ÂÈÍË ¿ÏÏˆÓ Èı·ÓÒÓ ·ÈÙ›ˆÓ ıÚfiÌ‚ˆÛ˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. H ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ KN™ ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ˜. øÛÙfiÛÔ, ¤¯Ô˘Ó ÚÔÙ·ı› ÙÚÂȘ Èı·ÓÔ› Ì˯·ÓÈÛÌÔ› (2,4, 9-14). OÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ë ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÙÔ˘ KN™ ÔÊ›ÏÂÙ·È Û ¤ÎÙ·ÛË Ù˘ ÌfiÏ˘ÓÛ˘ Î·È ¿ÌÂÛË ‰È›ۉ˘ÛË ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÛÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi. Y¤Ú ·˘Ù‹˜ Ù˘ ¿Ô„˘ Û˘ÓËÁÔÚ› Ë ·ÔÌfiÓˆÛË ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Ù˘ Ó¢ÌÔÓ›·˜ (Ì ηÏÏȤÚÁÂÈ· Î·È PCR) Û ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi (9,10,13). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ó¢ÚÔÙÔÍÈÓÒÓ (4,11,12) ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ÂÓÒ Ù¤ÏÔ˜ ¤¯ÂÈ ÚÔÙ·ı› Î·È ·˘ÙÔ¿ÓÔÛÔ˜ Ì˯·ÓÈÛÌfi˜ Ì ·Ú·ÁˆÁ‹ ·˘ÙÔ·ÓÙÈۈ̿وÓ, Û¯ËÌ·ÙÈÛÌfi ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ, ‹ Î·È Ì¤Ûˆ ·˘ÙÔ¿ÓÔÛ˘ ·ÁÁ›Ùȉ·˜ (11). º·›ÓÂÙ·È fiÙÈ Ë Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Û˘Óԉ‡ÂÙ·È ·fi ·Ú·ÁˆÁ‹ ÔÏÏ·ÏÒÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ, ·ÎfiÌ· Î·È ¤Ó·ÓÙÈ ·ÓÙÈÁÔÓÈÎÒÓ ÛÙÔȯ›ˆÓ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (14). T· ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· Èı·ÓfiÓ ÂÓ·ÔÙ›ıÂÓÙ·È ÛÙÔ ÂÈı‹ÏÈÔ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ ÙÔ˘ KN™ Î·È Ô‰ËÁÔ‡Ó Û ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜. M¤Ûˆ Û¯ËÌ·ÙÈÛÌÔ‡ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÂÍËÁÂ›Ù·È ¿ÏψÛÙÂ Î·È Ë ÂÌÊ¿ÓÈÛË ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜, ηډ›Ùȉ·˜, ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ·ÚıÚ›Ùȉ·˜ ÌÂÙ¿ ·fi Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË (12). BÈÔ„›Â˜ ÂÁÎÂÊ·ÏÈÎÔ‡ ÈÛÙÔ‡ Û ·È‰È¿ Ì ÂÁÎÂÊ·Ï›Ùȉ· ÌÂÙ¿ ·fi Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜, ÂÌÊ·Ó›˙Ô˘Ó Ô›‰ËÌ·, ÌÈÎÚÔıÚÔÌ‚ÒÛÂȘ, ÂÚÈ·ÁÁÂȷΤ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÓÙȉڿÛÂȘ Î·È ·fiÊÚ·ÍË ÌÈÎÚÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ Ô˘ ÂÍËÁÔ‡Ó ÙËÓ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ (7,15). ™ÙËÓ ·ÛıÂÓ‹ Ì·˜ Ô Û¯ËÌ·ÙÈÛÌfi˜ ÂÌÊÚ¿ÎÙÔ˘ ÛÙËÓ ‰ÂÍÈ¿
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̤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› Û ÂÓÙÔÈṲ̂ÓË ·ÁÁÂÈ›Ùȉ· ·ÊÔ‡ Ô ÏÂÙÔÌÂÚ‹˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ Ô˘ ¤ÁÈÓ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÙËÓ Û˘Ó‡·ÚÍË ¿ÏÏÔ˘ ·›ÙÈÔ˘ ıÚÔÌ‚ÔÊÈÏ›·˜. °È· ÙË ıÂڷ›· ÙˆÓ ÂÈÏÔÎÒÓ ·fi ÙÔ KN™ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› Ù· ÎÔÚÙÈÎÔÂȉ‹, Ù· ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, Ù· ‰ÈÔ˘ÚËÙÈο ·ÏÏ¿ Î·È Ë Ï·ÛÌ·Ê·›ÚÂÛË Ì ·ÏÏËÏÔ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· (11). H ÚfiÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ Ù˘ ÂÈÏÔ΋˜. H ıÓËÙfiÙËÙ· ÊÙ¿ÓÂÈ ÙÔ 10% (5). H ·ÔηٿÛÙ·ÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Û˘Ó‹ıˆ˜ Â›Ó·È Ù·¯Â›· (12,15). ™Â ·Ï·ÈfiÙÂÚË ÌÂϤÙË (4), ÛËÌ·ÓÙÈ΋ ˘ÔÏÂÈÌÌ·ÙÈ΋ ÓfiÛÔ˜ ‚Ú¤ıËΠÛÙÔ ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ. ¢˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË Â›¯·Ó ·ÛıÂÓ›˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 14 ÂÙÒÓ Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÁÎÂÊ·Ï›Ùȉ·˜ ‹ ÔÏ˘Ó¢ڛÙȉ·˜. H ·ÛıÂÓ‹˜ Ì·˜ ¤Ï·‚ ·ÔȉËÌ·ÙÈ΋ ·ÁˆÁ‹ ÛÙËÓ ÔÔ›· ·ÓÙ·ÔÎÚ›ıËΠ·fiÏ˘Ù· ÈηÓÔÔÈËÙÈο Ì ٷ¯‡Ù·ÙË Î·È Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡. H Ïԛ̈ÍË ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È Ôχ Û˘¯Ó‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Û˘Ó‹ıˆ˜ ‰È·‰Ú¿ÌÂÈ ¯ˆÚ›˜ ÂÈÏÔΤ˜. H ÂÚ›ÙˆÛË ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÙË Û·ÓÈfiÙËÙ¿ Ù˘, ·ÏÏ¿ Î·È ÁÈ· Ó· ÙÔÓÈÛÙ› fiÙÈ ·Ú¿ ÙË ıÔÚ˘‚Ò‰Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ ıÚfiÌ‚ˆÛ˘ Ù˘ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, Ë Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Ù˘ ·ÛıÂÓÔ‡˜ Ì·˜ ÁÚ‹ÁÔÚ· ·ÂηÙÂÛÙ¿ıË Ï‹Úˆ˜. BÈ‚ÏÈÔÁÚ·Ê›· 1. Lehtokoski - Lehtiniemi E, Koskiniemi ML.Mycoplasma pneumonia encephalitis a severe entity in children. Pediatr Infect Dis J 1989; 8: 651-653. 2. Behan P, Feldman R, Segerra J, Draper I. Neurological aspects of mycoplasma infection. Acta Neurol Scand 1986;74:314-322. 3. Rothstein T, Kenny G. Cranial neuropathy, myeloradiculopathy, and myositis complications of Mycoplasma pneumoniae infection. Arch Neurol 1979; 36:476-477. 4. Lerer R, Kalavsky S. Central nervous system disease associated with Mycoplasma pneumoniae infection report of five cases and review of the literature. Pediatrics 1973;52:658-668. 5. Visudhiphan P, Chiemchanya S, Sirinavin S. Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection. Pediatr Neurol 1992;8(3):237-239. 6. Fu M, Wong KS, Lam WW, Wong GW. Middle cerebral artery occlusion after recent Mycoplasma pneumoniae infection. J Neurol Sci 1998; 157(1): 113-115. 7. Parker P, Puck J, Fernandez F. Cerebral infarction associated with Mycoplasma pneumoniae. Pediatrics 1981;67:373-375. 8. Francis DA, Brown A, Miller DH, Wiles CM, Bennet ED and Leigh N. MRI appearances of the CNS manifestations of Mycoplasma pneumoniae: a report of two cases. J Neurol
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1988;235:441-443. 9. Abramovitz P, Schuartzman P, Harel D, Lis I, Naot Y. Direct invasion of the CNS by Mycoplasma pneumoniae: a report of two cases. J Infect Dis 1987;155:482-487. 10. Hata D, Kuze F, Mochizuki Y, Ohkubo H, Kanazashi S, Maeda S et al: Evaluation of DNA probe test for rapid diagnosis of Mycoplasma pneumoniae infections. J Pediatr 1990;116:273-276. 11. Koskiniemi ML. CNS manifestations associated with Mycoplasma pneumoniae infections. Summary of cases at the University of Helsinki and review. Clin Infect Dis 1993;17(suppl 1): S52-57. 12. Fernandez CV, Bortolussi R, Gordon K, Lee SHS, Gatien JG, Shahdrabadi MS. Mycoplasma pneumoniae infection associated with central nervous system complications. J Child Neurol 1993;8:27-31. 13. Narita M, Matsuzono Y, Togashi T and Kajii N. DNA diagnosis of central nervous system infection by Mycoplasma pneumoniae. Pediatrics 1992;90:250-253.
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14. Cimolai N, Mah D, Roland E. Anticentriolar autoantibodies in children with central nervous system manifestations of Mycoplasma pneumoniae infection. J Neurol Neurosurg Psychiatry 1994;57:638-639. 15. Rawitt L, Hills W. Childhood focal encephalitis associated with positive cold agglutinin titers. Amer J Dis Child 1971;121:248-249.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘, A' ¶·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, TÌ‹Ì· EȉÈÎÒÓ §ÔÈÌÒ͈Ó, NÔÛ. ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·", £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, °Ô˘‰›, Aı‹Ó· 11527
OÍ›· ·ÁÎÚ·ٛÙȉ· Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. £Âڷ›· Ì octreotide A‚Ú·¿Ì HÏ›·˜1, KˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜1, AÓ‰ÚÔÌ¿¯Ë MËÙÛÈÒÓË1, ¢‹ÌËÙÚ· ™È·¤Ú·1, AÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘2, K˘ÚÈ¿ÎÔ˜ Mȯ¤Ï˘1 ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ËÏÈΛ·˜ 6,5 ÂÙÒÓ, Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Î·È ÈÛÙÔÚÈÎfi ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, ·fi ËÏÈΛ·˜ 10 ÌËÓÒÓ. ¶·Ú¿ ÙË Û˘Ó‹ıË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ù˘ ·ÛıÂÓÔ‡˜. TËÓ 5Ë Ë̤ڷ ÓÔÛËÏ›·˜, ¯ÔÚËÁ‹ıËΠ¤Ó· ·Ó¿ÏÔÁÔ Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘, Ë Ôctreotide (9 Ìg/Kg/24ˆÚÔ ˘Ô‰fiÚÈ·). Afi ÙÔ ÙÚ›ÙÔ 24ˆÚÔ ıÂڷ›·˜ ‰È·ÈÛÙÒıËΠ‚·ıÌÈ·›· ÂÏ¿ÙÙˆÛË ÙˆÓ ·ÁÎÚ·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ÙÔ fiÁ‰ÔÔ 24ˆÚÔ Â›¯·Ó ˘Ô¯ˆÚ‹ÛÂÈ Ù· Û˘ÌÙÒÌ·Ù·. Afi ÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÚÔ·ÙÂÈ fiÙÈ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË ¯ÔÚ‹ÁËÛ˘ Ù˘ Ôctreotide Û ·È‰› Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Î·È ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ¶·È‰È·ÙÚÈ΋ 2000;63:47-50. §¤ÍÂȘ ÎÏÂȉȿ: ÔÍ›· ·ÁÎÚ·ٛÙȉ·, ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, octreotide. A. Elias, C. Stefanidis, A. Mitsioni, D. Siapera, A. Papadopoulou, K. Michelis. Octreotide treatment of acute pancreatitis in a child with end stage renal disease. Paediatriki 2000;63:47-50. ● Abstract: The case of a 6.5 year-old girl admitted with end stage renal disease which she had had since the age of 10 months, and acute pancreatitis is described. There had been no clinical improvement with conventional supportive management. Treatment with a somatostatin analogue octreotide (9Ìg/kg/24h SC) was initiated on the fifth day after admission. Serum amylase levels started to decline three days after initiation of treatment and the pain resolved after eight days. Octreotide was discontinued on 18th day. This is the first report of octreotide administration in a child with acute pancreatitis and end stage renal disease. Key words: acute pancreatitis, chronic renal failure, octreotide.
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NÂÊÚÔÏÔÁÈÎfi TÌ‹Ì·, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ AıËÓÒÓ "¶. & A. K˘ÚÈ·ÎÔ‡". ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, TÌ‹Ì· NÔÛËÏ¢ÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ.
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30-05-03
12:57
™ÂÏ›‰·48
¶∞π¢π∞∆ƒπ∫∏ 2000;63:47-50
EÈÛ·ÁˆÁ‹ H ÔÍ›· ·ÁÎÚ·ٛÙȉ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‰ÂÓ Â›Ó·È ÙfiÛÔ Û¿ÓÈ· fiÛÔ Â›¯Â ıˆÚËı› ·Ï·ÈfiÙÂÚ· (1). YÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1:50.000 Î·È Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ‰È·Ê¤ÚÂÈ Û ۇÁÎÚÈÛË Ì ·˘Ù‹ ÙˆÓ ÂÓËϛΈÓ. TÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ÛÙ· ·È‰È¿ Â›Ó·È ÙÔ ÙÚ·‡Ì· Ù˘ ÎÔÈÏȷ΋˜ ¯ÒÚ·˜, ÂÓÒ ÛÙÔ 1/4 ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·ÁÓˆÚÈÛÙ› ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, ÔfiÙÂ Ë ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ȉÈÔ·ı‹˜ (2). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, Ë ÔÍ›· ·ÁÎÚ·ٛÙȉ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Î·È Ôχ ˘„ËÏ‹ ıÓËÙfiÙËÙ· (3), ÂÔ̤ӈ˜ ··ÈÙÂ›Ù·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂڷ¢ÙÈ΋ ·Ú¤Ì‚·ÛË. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› ¤Ó· ·Ó¿ÏÔÁÔ Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘, Ë Ôctreotide, ÁÈ· ÙË ıÂڷ›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·È‰› ËÏÈΛ·˜ 9 ÂÙÒÓ Ì ·Ó·ÊÂÚfiÌÂÓË Èı·Ó‹ ¢ÓÔ˚΋ ›‰Ú·ÛË ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (4). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ËÏÈΛ·˜ 6,5 ÂÙÒÓ, Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· › ‰¿ÊÔ˘˜ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. §fiÁˆ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ¯ÔÚËÁ‹ıËΠÛÙËÓ ·ÛıÂÓ‹ Ôctreotide. H ÔÚ›· ÓfiÛÔ˘ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÔÌ·Ï‹ Î·È ¯ˆÚ›˜ ÂÈÏÔΤ˜. Afi ÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÚÔ·ÙÂÈ fiÙÈ ·˘Ù‹ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË ıÂڷ›·˜ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Ì Ôctreotide, Û ·È‰› Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ H ·ÛıÂÓ‹˜ ËÏÈΛ·˜ 6,5 ÂÙÒÓ ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ÂÌ¤ÙˆÓ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. H ·ÚÔ‡Û· ÓfiÛÔ˜ ·Ú¯›˙ÂÈ 24 ÒÚ˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ Ì ›ÌÔÓÔ˘˜ Â̤ÙÔ˘˜, Ô˘ 6 ÒÚ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤ÁÈÓ·Ó Á·ÛÙÚÔÏËÁÈÎÔ›. ¶·Ú¿ÏÏËÏ· ·Ó·Ê¤ÚÂÙ·È ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Ì ·ÚÈ· ÂÓÙfiÈÛË ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ Î·È ÂÚÈÔÌÊ·ÏÈο. E›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. Afi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û ËÏÈΛ· 10 ÌËÓÒÓ ·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi Î·È ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠Â͈ÓÂÊÚÈ΋ οı·ÚÛË. ™Â ËÏÈΛ· 11 ÌËÓÒÓ, ˘o‚Ï‹ıËΠ۠‰È·‰ÂÚÌÈ΋ ‚ÈÔ„›· ÓÂÊÚÔ‡ Î·È ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÚˆÙÔ·ı‹˜ ÓfiÛÔ˜ ‹Ù·Ó ·ÈÌÔÏ˘ÙÈÎfi Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ. H ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‰ÂÓ ·ÔηٷÛÙ¿ıËÎÂ Î·È ¤ÎÙÔÙ ˘Ô‚¿ÏÏÂÙ·È ÛÂ Û˘Ó¯‹ ÊÔÚËÙ‹ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË. ¶·ÚÔ˘Û›·Û ÂÂÈÛfi‰È· ÂÚÈÙÔÓ›Ùȉ·˜ Û ËÏÈΛ· 2,5, 3,5 Î·È 5,5 ÂÙÒÓ Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ Ì ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ™Â ËÏÈΛ· 6 ÂÙÒÓ, ˘o‚Ï‹ıËΠ۠ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi و̷ÙÈÎfi ‰fiÙË ËÏÈΛ·˜ 10 ÂÙÒÓ. ¶·ÚÔ˘Û›·Û fï˜ ÔÍ›· ·fiÚÚÈ„Ë, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ 21Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ Ó· ·Ê·ÈÚÂı› ÙÔ ÌfiÛ¯Â˘Ì·. K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ÛÙËÓ KÏÈÓÈ΋ ‹Ù·Ó ÛÂ
48
∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
Û¯ÂÙÈο ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ·‡ÚÂÙË, ¯ˆÚ›˜ ÛËÌ›· ·Ê˘‰¿ÙˆÛ˘. ¶·ÚÔ˘Û›·˙ ۈ̷ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Ì ‚¿ÚÔ˜ Î·È ‡„Ô˜ ÛÒÌ·ÙÔ˜ οو ·fi ÙËÓ 3Ë ÂηÙÔÛÙÈ·›· ı¤ÛË. H ÎÔÈÏÈ¿ ‹Ù·Ó ̷Ϸ΋ Ì ‰È¿¯˘ÙË Â˘·ÈÛıËÛ›· Î·È ·Ú·ÈÔ‡˜ ÂÓÙÂÚÈÎÔ‡˜ ‹¯Ô˘˜, ÂÓÒ ·fi ÙËÓ ÂÈ̤ÚÔ˘˜ ÂͤٷÛË ÙˆÓ ÏÔÈÒÓ Û˘ÛÙËÌ¿ÙˆÓ ‰ÂÓ ·ÚÔ˘Û›·˙ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. °È· ÙË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Ù˘ ·ÓÙÈÌÂÙˆÈ˙Ô̤Ó˘ Ì οı·ÚÛË ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÂÏ¿Ì‚·Ó ÂÚ˘ıÚÔÔÈËÙ›ÓË, ·ÓıÚ·ÎÈÎfi ·Û‚¤ÛÙÈÔ, ˘‰ÚÔ͢¯ÔÏËηÏÛÈÊÂÚfiÏË, ·˘ÍËÙÈ΋ ÔÚÌfiÓË Î·È Î·ÙÔÚ›ÏË. ™ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ë ÔÍ›· ÈÔÁÂÓ‹˜ Á·ÛÙÚ›ÙÈÙȉ·, Ë ÂÚÈÙÔÓ›Ùȉ· Î·È Ë ÔÍ›· ·ÁÎÚ·ٛÙȉ·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÛÙÚ¿ÊËΠÚÔ˜ ·ÔÎÏÂÈÛÌfi ‹ ÂȂ‚·›ˆÛË ÌÈ·˜ ·fi ÙȘ ÈÔ ¿Óˆ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ô ·ÎfiÏÔ˘ıÔ˜: ·ÈÌÔÛÊ·ÈÚ›ÓË 12,4 g/dL, ÏÂ˘Î¿ 23700/mmÑ, Ù‡Ô˜ Ï¢ÎÒÓ: ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 85%, ÏÂÌÊÔ·ÙÙ·Ú· 10%, ÌÔÓÔ‡ÚËÓ· 5%, ·ÈÌÔÂÙ¿ÏÈ· 515.000/mmÑ, CRP(-), Ô˘Ú›· 47 mg/dL, ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 4,3 mg/dL, K 2,1 mEq/L, Na 129 mEq/L, Ca 11,4 mg/dL, P 2,4 mg/dL, ALP 181 IU/L, SGOT 22 IU/L, SGPT 10 IU/L, ÔÏÈο Ï¢ÎÒÌ·Ù· ÔÚÔ‡ 5,6 g/100mL, ·Ï‚Ô˘Ì›ÓË 2,7 g/100mL, ·Ì˘Ï¿ÛË ÔÚÔ‡ 840 IU/L, ÏÈ¿ÛË ÔÚÔ‡ 1540 IU/L, ·Ì˘Ï¿ÛË ÂÚÈÙÔÓ·˚ÎÔ‡ ˘ÁÚÔ‡ 25 IU/L, ·ÙÙ·Ú· Î·È Î·ÏÏȤÚÁÂÈ· ÂÚÈÙÔÓ·˚ÎÔ‡ ˘ÁÚÔ‡ ·ÚÓËÙÈο. O ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜, ÂÓÒ ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÙÔ ¿ÁÎÚ·˜ ›¯Â ·˘ÍË̤Ó˜ ‰È·ÛÙ¿ÛÂȘ. M ‚¿ÛË Ù· ·Ú·¿Óˆ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠıÂڷ¢ÙÈο Ì ‰È·ÎÔ‹ Û›ÙÈÛ˘ Î·È ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·, ‰ÈfiÚıˆÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ¯ÔÚ‹ÁËÛË Ú·ÓÈÙȉ›Ó˘ Î·È ¤Ó·ÚÍË ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. EÈÚfiÛıÂÙ·, ‰È·ÎfiËÎÂ Ë ıÂڷ›· Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ·ÚfiÏÔ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛ‹ Ù˘ Ì ÙËÓ ·Ó¿Ù˘ÍË ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ (5,6). H ηٿÛÙ·ÛË Ù˘ ·ÛıÂÓÔ‡˜ ·Ú¤ÌÂÈÓ ·ÌÂÙ¿‚ÏËÙË Ì ÂÈÌÔÓ‹ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È ·Ú¿ÏÏËÏË ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË Ù˘ ·Ì˘Ï¿Û˘ ÔÚÔ‡. TËÓ 5Ë Ë̤ڷ ÓÔÛËÏ›·˜ ·ÔÊ·Û›ÛÙËÎÂ Ë ¤Ó·ÚÍË ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜ Ì Ôctreotide Û ‰fiÛË 9 Ìg/kg/24ˆÚÔ ˘Ô‰fiÚÈ·. ¶·Ú·ÙËÚ‹ıËΠ‡ÊÂÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Ì ϋÚË ˘Ô¯ÒÚËÛË ÙÔ˘ ÙË 12Ë Ë̤ڷ ÓÔÛËÏ›·˜, ÂÓÒ Ë ·Ì˘Ï¿ÛË ¿Ú¯ÈÛ ӷ ˘Ô¯ˆÚ› ·fi ÙË 13Ë Ë̤ڷ ÓÔÛËÏ›·˜. H Ôctreotide ‰È·ÎfiËΠÙËÓ 18Ë Ë̤ڷ ıÂڷ›·˜. H ·Ì˘Ï¿ÛË ÔÚÔ‡ ·ÚÔ˘Û›·Û ·ÓÒÙ·ÙË ÙÈÌ‹ (2140 IU/L) ÙËÓ 7Ë Ë̤ڷ ÓÔÛËÏ›·˜ (2 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂڷ›·˜ Ì Ôctreotide) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ú·ÙËÚ‹ıËΠÂÓÙ˘ˆÛȷ΋ ÙÒÛË Ù˘ (Û¯‹Ì· 1). TËÓ 3Ë Â‚‰ÔÌ¿‰· ÓÔÛËÏ›·˜ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·
JAN.-FEB.2000
30-05-03
12:57
™ÂÏ›‰·49
¶∞π¢π∞∆ƒπ∫∏ 2000;63:47-50
EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
¶›Ó·Î·˜ 1. ™‡ÛÙËÌ· ‚·ıÌÔÏÔÁ›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. E‡ÚËÌ·
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1
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1
AÌ˘Ï¿ÛË ÔÚÔ‡ ÌÂٷ͇ -3x-6xAºT*
1
AÌ˘Ï¿ÛË ÔÚÔ‡ >6xAºT*
2
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2
IÛÙÔÏÔÁÈ΋ ÂȂ‚·›ˆÛË
3
*AºT: AÓÒÙÂÚË Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ™¯‹Ì· 1. ¢È·Î‡Ì·ÓÛË ·Ì˘Ï¿Û˘ ÔÚÔ‡ ·Ó¿ Ë̤ڷ ÓÔÛËÏ›·˜. ·ÁÎÚ¤·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. MÂÙ¿ ·fi ¤Ó·Ó ÂÚ›Ô˘ Ì‹Ó· ÓÔÛËÏ›·˜, Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. H ıÂڷ›· Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ¿Ú¯ÈÛ ¿ÏÈ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi Ù˘, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËı› ˘ÔÙÚÔ‹ Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™˘˙‹ÙËÛË H ÔÍ›· ·ÁÎÚ·ٛÙȉ· Û ·ÛıÂÓ›˜ Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, ·ÔÙÂÏ› ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· Ì ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο. H ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· (¤ˆ˜ Î·È 58 ÊÔÚ¤˜) ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· (3). OÈ ·ÎÚȂ›˜ ÏfiÁÔÈ Ù˘ ·˘ÍË̤Ó˘ ·˘Ù‹˜ Û˘¯ÓfiÙËÙ·˜, ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙÔ› ·Ó Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ù· ÔÏÏ¿ Ê¿Ú̷η Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ›, ηıÒ˜ Î·È Ë Û˘ÓÔ‰fi˜ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· (7), Ô ‰Â˘ÙÂÚÔ·ı‹˜ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ (3) Î·È Ë ˘ÂÚÏÈȉ·ÈÌ›·. º·›ÓÂÙ·È fiÙÈ Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ Î·È Èı·ÓÒ˜ Î·È ·˘ÙÔ¿ÓÔÛÔÈ ·Ú¿ÁÔÓÙ˜, ˘ÚÔ‰ÔÙÔ‡Ó Ì˯·ÓÈÛÌÔ‡˜ ·˘ÙÔ„›·˜ Î·È Î·Ù·ÛÙÚÔÊ‹˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜. H ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈΤ˜ ‰˘ÛÎÔϛ˜. A˘Ùfi ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ fiÙÈ Ù· ¤Ó˙˘Ì· ‰È¿ÁÓˆÛ˘ Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ·˘ÍË̤ӷ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, Ë ·Ì˘Ï¿ÛË Û ÔÛÔÛÙfi 80% Î·È Ë ÏÈ¿ÛË 60%, › ·Ô˘Û›·˜ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ (3,8). °È· Ó· ·ÔÊ¢¯ı› Ë Èı·ÓfiÙËÙ· Ï·Óı·Ṳ̂Ó˘ ‰È¿ÁÓˆÛ˘, ¤¯ÂÈ ÚÔÙ·ı› ¤Ó· Û‡ÛÙËÌ· ‚·ıÌÔÏÔÁ›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· (›Ó·Î·˜ 1). °È· ÙË ‰È¿ÁÓˆÛË Â›Ó·È ··Ú·›ÙËÙÔ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‚·ıÌÒÓ Ó· Â›Ó·È 3 ‹ ÂÚÈÛÛfiÙÂÚÔ (9). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, ÙÔ ¿ıÚÔÈÛÌ· ‚·ıÌÔÏÔÁ›·˜ Ù˘ ·ÛıÂÓÔ‡˜ Ì·˜ ‹Ù·Ó 6,
ÔfiÙÂ Ë ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ‹Ù·Ó ‚¤‚·ÈË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ‰ÂÓ ÎÚ›ıËΠ·Ó·Áη›· Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÂͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘. EÎÙfi˜ ·fi ÙȘ ‰˘ÛÎÔϛ˜ ÛÙË ‰È¿ÁÓˆÛË, ÔÈ ·ÛıÂÓ›˜ Ì ÔÍ›· ·ÁÎÚ·ٛÙȉ· Û ¤‰·ÊÔ˜ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ôχ ·˘ÍË̤ÓË ıÓËÙfiÙËÙ· Ô˘ Êı¿ÓÂÈ Î·È ÙÔ 33%, Û ·ÓÙ›ıÂÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÔ˘ Ë ıÓËÙfiÙËÙ· Â›Ó·È ÌfiÏȘ 3,5% (3). H ıÂڷ›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È·ÎÔ‹ Ù˘ Û›ÙÈÛ˘, ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·, ·ÔηٿÛÙ·ÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Â¿Ó ˘¿Ú¯Ô˘Ó, ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ, H2 ·ÓÙ·ÁˆÓÈÛÙÒÓ Î·È ¯ÔÚ‹ÁËÛË ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. EÈϤÔÓ, ‰˘Ó·ÙfiÓ Ó· ¯ÔÚËÁËı› Ë ÛˆÌ·ÙÔÛÙ·Ù›ÓË ‹ ÙÔ ·Ó¿ÏÔÁfi Ù˘ Ë Ôctreotide. H ۈ̷ÙÔÛÙ·Ù›ÓË Â›Ó·È ¤Ó· ‰ÂηÙÂÙÚ·ÂÙ›‰ÈÔ ÂÓÒ Ë Ôctreotide ¤Ó· ÔÎÙ·ÂÙ›‰ÈÔ Ì ·ÚfiÌÔÈÔ ÙÚfiÔ ‰Ú¿Û˘, Ì ÌÂÁ·Ï‡ÙÂÚÔ fï˜ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, Ú¿ÁÌ· Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ¯ÔÚ‹ÁËÛ‹ Ù˘ Î·È ˘Ô‰fiÚÈ· (10). O ΢ÚÈfiÙÂÚÔ˜ ÙÚfiÔ˜ ‰Ú¿Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ÛÙË ıÂڷ›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, Â›Ó·È Ì¤Ûˆ Ù˘ ·Ó·ÛÙÔÏ‹˜ Ù˘ ·ÁÎÚ·ÙÈ΋˜ ¤ÎÎÚÈÛ˘. EÈÚfiÛıÂÙ· Ê·›ÓÂÙ·È fiÙÈ ‰ÈÂÁ›ÚÔ˘Ó Î·È ÙË Ê·ÁÔ΢ÙÙ¿ÚˆÛË ·fi ÙÔ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·Îfi Û‡ÛÙËÌ·, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ Ù·¯‡ÙÂÚË ˘Ô¯ÒÚËÛË Ù˘ ÊÏÂÁÌÔÓ‹˜. ¶·ÚfiÏÔ Ô˘ Ë ÛˆÌ·ÙÔÛÙ·Ù›ÓË ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ıÂڷ›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ÙÔ 1975, ÂÓÙÔ‡ÙÔȘ ̤¯ÚÈ Î·È Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ (10-12). øÛÙfiÛÔ ·fi ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ ÚÔ·ÙÂÈ fiÙÈ: ÌÂÈÒÓÂÈ ÙȘ ·Ó¿ÁΘ ¯ÔÚ‹ÁËÛ˘ ·Ó·ÏÁËÙÈÎÒÓ, ÌÂÈÒÓÂÈ Ù·¯‡ÙÂÚ· ÙËÓ ·Ì˘Ï¿ÛË ÔÚÔ‡,
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ÌÂÈÒÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÔÈÎÒÓ ÂÈÏÔÎÒÓ, ÂÓÒ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙË ıÓËÙfiÙËÙ· Ù˘ ÓfiÛÔ˘ (12). H Ôctreotide ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ıÂڷ›· Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌfiÏȘ ÙÔ 1995 Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 9 ÂÙÒÓ Ì ·Ó·ÊÂÚfiÌÂÓ· ηϿ ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (4), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙËÓ ÚÔÛÈÙ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ‰ËÌÔÛÈÂ˘Ì¤ÓË ÂÚÁ·Û›· ¯ÔÚ‹ÁËÛ˘ Ù˘ Û ·È‰› Ì ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. H ·Ó¿ÁÎË ·Ó·˙‹ÙËÛ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚˆÓ ıÂڷ¢ÙÈÎÒÓ Ì¤ÛˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, ȉȷ›ÙÂÚ· Û ·ÛıÂÓ›˜ Ì ˘fiÛÙڈ̷ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, Â›Ó·È ÂȂ‚ÏË̤ÓË, ÏfiÁˆ Ù˘ Ôχ ÌÂÁ¿Ï˘ ıÓËÙfiÙËÙ·˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÓfiÛÔ˜. H ¯ÔÚ‹ÁËÛË Ù˘ Ôctreotide ÛÙËÓ ·ÛıÂÓ‹ Ì·˜ Ê·›ÓÂÙ·È Ó· ¤‰Ú·Û ¢ÓÔ˚ο ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘. OˆÛ‰‹ÔÙ fï˜, ÂÚ·ÈÙ¤Úˆ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ Ù˘. BÈ‚ÏÈÔÁÚ·Ê›· 1. Weizman Z, Durie P. Acute pancreatitis in childhood. J Pediatr 1988;113: 24-29. 2. Mader T, McHugh T. Acute pancreatitis in children. Ped Emer Care 1992;8: 157-161. 3. Pitchumoni C, Arguello P, Agarwal N, Yoo J. Acute pancreatitis in chronic renal failure. Am J Gastroenterol 1996;91: 2477-2482. 4. Rosenberg A, Hutchinson T. Octreotide treatment of acute pancreatitis in a child. Am J Gastroenterol 1995;90: 1701.
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5. Allen D. Safety of human growth hormone therapy: current topics. J Pediatr 1996;128: 8-13. 6. Berard E, Crosnier H, Beneton A, Chevallier T, Cochat P, Broyer M. Recombinant human growth hormone treatment of children on hemodialysis. Pediatr Nephrol 1998;12: 304-310. 7. Osorio A, Seidel F, Warady A. Hypercalcemia and pancreatitis in a child with adynamic bone disease. Pediatr Nephrol 1997;11: 223-225. 8. Royse V, Jensen D, Corwin H. Pancreatic enzymes in chronic renal failure. Arch Intern Med 1987;147: 537-539. 9. Padilla B, Pollak V, Pesce A, Kant S, Gilinsky N, Deddens J. Pancreatitis in patients with end-stage renal disease. Medicine(Baltimore) 1994;73: 8-20. 10. Paran H, Neufeld D, Mayo A, Shwartz I, Singer P, Kaplan O, et al. Preliminary report of a prospective randomized study of Octreotide in the treatment of severe acute pancreatitis. J Am Coll Surg 1995;181: 121-124. 11. McKay C, Imrie C, Baxter J. Somatostatin and somatostatin analogues- are they indicated in the management of acute pancreatitis? Gut 1993; 34: 16221626. 12. Planas M, Perez A, Iglesia R, Porta I, Masclans J, Bermejo B. Severe acute pancreatitis: treatment with somatostatin. Intensive Care Med 1998; 24: 37-39. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: A‚Ú·¿Ì HÏ›·˜ NÂÊÚÔÏÔÁÈÎfi TÌ‹Ì· NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ AıËÓÒÓ "¶. & A. K˘ÚÈ·ÎÔ‡". £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜ °Ô˘‰› 11527 Aı‹Ó·
¶Ó¢ÌÔÓÈ΋ Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Î·È M. avium Û ·ÈÌÔÚÚÔÊÈÏÈÎfi ·ÛıÂÓ‹ Ì AIDS ¢ÒÚ· M¿ÓÙ˙ÈÔ˘1, °Ï˘ÎÂÚ›· MÔÛÙÚÔ‡1, B·ÛÈÏÈ΋ ¶··Â˘·ÁÁ¤ÏÔ˘1, EϤÓË ¶Ï·ÙÔÎÔ‡ÎË2, AÚÈÛÙ¤· BÂÏÂÁÚ¿ÎË3, M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘1. ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÌÈÎÙ‹˜ Ó¢ÌÔÓÈ΋˜ Ïԛ̈͢ ·fi Aspergillus fumigatus Î·È ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (Mycobacterium avium intracellulare, Mycobacterium avium) Û ·ÛıÂÓ‹ ËÏÈΛ·˜ 16 ÂÙÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· Î·È AIDS. O ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ›ÌÔÓÔ ÍËÚfi ‚‹¯· Î·È ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË ·fi ¤Ó· Ì‹Ó·. M ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠӢÌÔÓÈ΋ Ì¿˙· ·Ú·˘Ï·›· ‰ÂÍÈ¿. H ‰È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË ÔÏÔÎÏËÚÒıËΠ̠ϋ„Ë ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎÔ‡ ÂÎχ̷ÙÔ˜ Î·È ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›· Ù˘ Ì¿˙·˜. O ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËΠ̠·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ Î·È ·ÓÙÈÌ˘ÎÔ‚·ÎÙËÚȉȷ΋ ıÂڷ›·, Ì ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ¶·È‰È·ÙÚÈ΋ 2000;63:50-55. §¤ÍÂȘ ÎÏÂȉȿ: AIDS, ·ÛÂÚÁ›ÏψÛË, M. avium.
A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" 1, MÔÓ¿‰· EȉÈÎÒÓ §ÔÈÌÒÍÂˆÓ - AIDS
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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
D. Mantziou, G. Mostrou, V. Papaevangelou, E. Platokouki, A. Velegraki, M. Theodoridou. Concurrent pulmonary infection with Aspergillus fumigatus and Mycobacterium avium in an HIV-infected haemophiliac patient. Paediatriki 2000;63:50-55. ● Abstract: A 16 year-old boy with haemophilia A and AIDS presented with a one month history of dry cough and low grade fever. The initial investigation revealed a pulmonary mass in the right perihilar area. The diagnosis was established by bronchoscopy, bronchioalveolar lavage and biopsy of the mass which revealed concurrent invasive infection with Aspergillus fumigatus and Mycobacterium avium. He was treated aggressively with a combination of antifungal and antimycobacterial therapy for a prolonged period and responded successfully to the treatment. Key words: AIDS, aspergillosis, M. avium.
EÈÛ·ÁˆÁ‹ H Ì›ˆÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ÈηÓfiÙËÙ·˜ ÙÔ˘ HIVÔÚÔıÂÙÈÎÔ‡ ·ÛıÂÓ‹ ·˘Í¿ÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ·ÏÏ¿ Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÏÔÈÌÒ͈Ó. H Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¢ηÈÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ·ÛıÂÓ›˜ Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi CD4 T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 200/ml. (1) ™˘¯ÓfiÙÂÚ˜ ¢ηÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Ù· ·È‰È¿ Ì HIV Ïԛ̈ÍË Â›Ó·È Ë Ó¢ÌÔÓ›· ·fi pneumocystis carinii (PCP), Ë Û˘ÛÙËÌ·ÙÈ΋ Ïԛ̈ÍË ·fi Candida albicans (.¯. ÔÈÛÔÊ·Á›Ùȉ·), Ë ‰È¿Û·ÚÙË Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (MAC) Î·È Ë ÙÔÍÔÏ·ÛÌÈ΋ ÂÁÎÂÊ·Ï›Ùȉ·. (1) H Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ÌÔÚ› ÎÏÈÓÈο Ó· ÚÔ‚¿ÏÏÂÈ ˆ˜ ÂÓÙÔÈṲ̂ÓË ÏÂÌÊ·‰ÂÓ›Ùȉ· ‹ Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ·ÏÏ¿ Û˘ÓËı¤ÛÙÂÚ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì AIDS ‰È·ÁÈÁÓÒÛÎÂÙ·È ˆ˜ ‰È¿Û·ÚÙË ÓfiÛÔ˜ (Ì˘ÎÔ‚·ÎÙËÚÈ·ÈÌ›·). (1,2) Afi ÙȘ Û˘ÛÙËÌ·ÙÈΤ˜ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÔÈ Ï¤ÔÓ Û˘Ó‹ıÂȘ Â›Ó·È Ë ÔÈÛÔÊ·Á›Ùȉ· ·fi Candida albicans Î·È Ë ÎÚ˘ÙÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›ÙȘ. (1) H ·ÛÂÚÁ›ÏψÛË ·ÔÙÂÏ› ı·Ó·ÙËÊfiÚÔ Ïԛ̈ÍË Û ·ÛıÂÓ›˜ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ‹ ‰È·Ù·Ú·¯‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ™·ÓÈfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÚfiÓÈ· ıÂڷ›· Ì ÎÔÚÙÈÎÔÂȉ‹ ‹ ·ÓÙÈ‚ÈÔÙÈο Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜. (3) H Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Â›Ó·È Û¿ÓÈ· Û ·ÛıÂÓ›˜ Ì AIDS, ηıÒ˜ Ë ·ÓÔÛȷ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÓfiÛÔ˘ ·ÊÔÚ¿ Ù· T-ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ì·ÎÚÔÊ¿Á· Î·È fi¯È Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· Ô˘ Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙËÓ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ηٿ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘. (4,5) K‡ÚÈÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÛÂÚÁ›ÏψÛ˘ Û ·ÛıÂÓ‹ Ì AIDS, ·ÔÙÂÏ› Ë ·Ú·ÙÂٷ̤ÓË Ô˘‰ÂÙÂÚÔÂÓ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›· ‹ ÚÔ¸¿Ú¯Ô˘Û· Ïԛ̈ÍË Ó¢ÌfiÓˆÓ ·fi P.carinii, ÎÔÈÓ¿ ÌÈÎÚfi‚È· ‹ ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·. (5,6) ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Ù·˘Ùfi¯ÚÔÓ˘ Ó¢ÌÔÓÈ΋˜ Ïԛ̈͢ ·fi A. fumigatus Î·È M. avium Û ·ÛıÂÓ‹ ËÏÈΛ·˜ 16 ÂÙÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· A Î·È AIDS.
™˘ÓÙÔÌÔÁڷʛ˜: AIDS: Acquired Immunodeficiency Syndrome HIV: Human Immunodeficiency Virus CD4 T lymphocytes: T4 ‚ÔËıËÙÈο ÏÂÌÊÔ·ÙÙ·Ú·
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ AÁfiÚÈ ËÏÈΛ·˜ 16 ÂÙÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· A Î·È AIDS ÂÈÛ‹Ïı ÛÙÔ ÙÌ‹Ì· ÂȉÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "H AÁ›· ™ÔÊ›·" ÏfiÁˆ ›ÌÔÓÔ˘ ‚‹¯·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. TÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ù˘ ÙÂÙÚ·ÌÂÏÔ‡˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ÂχıÂÚÔ. H ‰È¿ÁÓˆÛË Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ ÂÙ¤ıË Û ËÏÈΛ· 11 ÌËÓÒÓ ÔfiÙ ¿Ú¯ÈÛ ıÂڷ›· ˘ÔηٿÛÙ·Û˘ ÌÂ Û˘Ì‚·ÙÈÎfi Û˘Ì˘Îӈ̤ÓÔ ·Ú¿ÁÔÓÙ· VIII. ™Â ËÏÈΛ· 3 ÂÙÒÓ ·ÚÔ˘Û›·Û ÚÒÈÌË ‰È·Ù·Ú·¯‹ „˘¯È΋˜ ÂͤÏÈ͢ Ô˘ ·Ô‰fiıËΠÛÙËÓ ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·Ù˘¯ËÌ¿ÙˆÓ. TÔ 1985 Û ·Ó·‰ÚÔÌÈÎfi ¤ÏÂÁ¯Ô ÔÚÔ‡ ·›Ì·ÙÔ˜ Ô‡ ›¯Â Ê˘Ï·¯ı› ÛÙË MÔÓ¿‰· AÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ Î·È AÈÌfiÛÙ·Û˘, ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ·È‰› ›¯Â ÌÔÏ˘Óı› Ì ÙÔÓ Èfi HIV ¤Ó· ¯ÚfiÓÔ ÓˆÚ›ÙÂÚ·, Û ËÏÈΛ· 4 ÂÙÒÓ. H ÎÏÈÓÈ΋ ÂͤÏÈÍË Ù˘ HIV Ïԛ̈͢ ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 9 ÂÙÒÓ ‹Ù·Ó ÔÌ·Ï‹ Î·È ÔÈ ·ÓÔÛÔÏÔÁÈÎÔ› ÙÔ˘ ‰Â›ÎÙ˜ ÈηÓÔÔÈËÙÈÎÔ› (CD4>500/mm3). ™Â ËÏÈΛ· 9 ÂÙÒÓ ¿Ú¯ÈÛ ӷ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÏÏ¿ Î·È ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ fiˆ˜ ˆÙ›Ùȉ·, ÈÁÌÔÚ›Ùȉ· Î·È Ó¢ÌÔÓ›·. ¶·Ú¿ÏÏËÏ· ÂÌÊ¿ÓÈÛ ÛÙ·‰È·Î‹ ¤ÎÙˆÛË Ù˘ ·ÓÔÛȷ΋˜ ÙÔ˘ ηٿÛÙ·Û˘ (CD4<100/mm3) ·Ú¿ ÙËÓ ¤Ó·ÚÍË ·ÓÙÈÚÂÙÚÔ˚΋˜ ·ÁˆÁ‹˜. TÚ›· ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ÓÔÛËχÙËΠÛÙÔ ·È‰Ô„˘¯È·ÙÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ ÏfiÁˆ ¤ÓÙÔÓˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÔfiÙ ÂȂ‚·ÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ·È‰È΋˜ „‡¯ˆÛ˘ ÁÈ· ÙËÓ ÔÔ›· ÂÙ¤ıË Û ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. ™ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÂÙÒÓ, ÔfiÙÂ Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ CD4 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ‹Ù·Ó <50/mm3, ·-
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ÚÔ˘Û›·Û ›ÌÔÓË Î·È ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì˘ÎËÙÈ·ÛÈ΋ ÛÙÔÌ·Ù›Ùȉ· Ì ÌÂÚÈ΋ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ÙÔÈ΋ Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹. §›ÁÔ˘˜ Ì‹Ó˜ ·ÚÁfiÙÂÚ· ÂÌÊ¿ÓÈÛ ÙËÓ ÚÒÙË Â˘Î·ÈÚȷ΋ Ïԛ̈ÍË, ÔÈÛÔÊ·Á›Ùȉ· ·fi C. albicans, ηٿÛÙ·ÛË Ô˘ ¯·Ú·ÎÙ‹ÚÈÛ ÙË ÌÂٿوۋ ÙÔ˘ Û ÓfiÛÔ AIDS. MÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ·ÁˆÁ‹ Ì ÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË B Û˘Ó¤¯ÈÛ ¯ËÌÂÈÔÚÔʇϷÍË Ì ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÈÙÚ·ÎÔÓ·˙fiÏË ‚¿ÛÂÈ Ì˘ÎËÙÔÁÚ¿ÌÌ·ÙÔ˜. K·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋, Û ËÏÈΛ· 16 ÂÙÒÓ, ·Ó¤ÊÂÚ ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË Î·È Â›ÌÔÓÔ ÌË ·Ú·ÁˆÁÈÎfi ‚‹¯· ÁÈ· ¤Ó· Ì‹Ó· ÂÚ›Ô˘. TȘ ÙÂÏÂ˘Ù·›Â˜ 2-3 ̤Ú˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÚÔÛÂÙ¤ıË Î·È Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹. EÚfiÎÂÈÙÔ ÁÈ· ¤Ó· ηϿ ·Ó·Ù˘Á̤ÓÔ ·‰‡Ó·ÙÔ ·ÁfiÚÈ Ì ȉÈfiÙ˘Ë Û˘ÌÂÚÈÊÔÚ¿. Afi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÙÚ·¯‡ÙËÙ· ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ Ì ·Ú¿Ù·ÛË ÂÎÓÔ‹˜ ηıÒ˜ ›Û˘ Î·È Ì˘ÎËÙÈ·ÛÈ΋ ÛÙÔÌ·Ù›Ùȉ·. Afi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ù˘ ÂÈÛ·ÁˆÁ‹˜, Ë ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Ë ‰Â ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÛÙ›ڷ. AÍÈÔÛËÌ›ˆÙË ‹Ù·Ó Ë ·‡ÍËÛË ÙˆÓ ÛÊ·ÈÚÈÓÒÓ, IgG: 2751mg/dl, IgM: 977mg/dl, IgA: 546mg/dl Î·È Ô ¯·ÌËÏfi˜ ·ÚÈıÌfi˜ ÙˆÓ CD4 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ: 4% (25/mm3). TÔ ÈÈÎfi ÊÔÚÙ›Ô Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó: 30,5 x 103 vc/ml. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT) ıÒÚ·ÎÔ˜ (EÈÎfiÓ· 1, 2) ·ÂÎ¿Ï˘„ ÛÙÚÔÁÁ‡ÏË ÛΛ·ÛË ·Ú·˘Ï·›· ‰ÂÍÈ¿, ÌÂÁ›ÛÙ˘ ‰È·Ì¤ÙÚÔ˘ 4 ÂÎ. Ì ·Û·Ê‹ ‰ÈËıËÙÈο fiÚÈ· ÚÔ˜ ÙÔ ÁÂÈÙÔÓÈÎfi ·Ú¤Á¯˘Ì·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ıÔÏÔÁÈο ‰ÈÔÁΈ̤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ‹ ÙȘ Ì·Û¯·ÏÈ·›Â˜ ¯ÒÚ˜. M ÙËÓ Èı·Ó‹ ‰È¿ÁÓˆÛË ÏÂÌÊÒÌ·ÙÔ˜ ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ Î·È ÂÁÎÂÊ¿ÏÔ˘. ™ÙËÓ CT ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıËÎ·Ó ÌÈÎÚÔ› ÌÂÛÂÓÙ¤ÚÈÔÈ ÏÂÌÊ·‰¤Ó˜ Î·È Ë CT ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ¤ÏÂÁ¯Ô˜ Û˘Ó¯›ÛıËΠ̠ÎÚÈÙ‹ÚÈ· ·ÈÙÈÔÏÔÁÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘ Ó¢ÌÔÓÈ΋˜ Ì¿˙·˜ Û ·ÛıÂÓ›˜ Ì AIDS. EÎÙfi˜ ·fi ϤÌʈ̷, Ó¢ÌÔÓÈ΋ Ì¿˙· Û ÛÔ‚·Ú¿ ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ ·ÛıÂÓ‹ ı· ÌÔÚÔ‡Û ӷ ÚÔÎÏËı› ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi Mycobacterium tuberculosis, M. avium, C. albicans, Aspergillus species, Nocardia, Cryptococcus neoformans, P. carinii, ‹ Ù¤ÏÔ˜ ÎÔÈÓ¿ ‚·ÎÙ‹ÚÈ·. ™ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË ‰È·ÈÛÙÒıËΠ‡·ÚÍË ÂÓ‰Ô‚ÚÔÁ¯È΋˜ Ì¿˙·˜ Ô˘ ÚÔηÏÔ‡Û ‰È‡ڢÓÛË Ù˘ ‰Â˘ÙÂÚÂ‡Ô˘Û·˜ ÙÚfiȉ·˜ ÌÂٷ͇ ÙÔ˘ ¿Óˆ Î·È ‰È¿ÌÂÛÔ˘ ÏÔ‚·›Ô˘ ‚ÚfiÁ¯Ô˘, ·¤ÊÚ·Û ۯ‰fiÓ Ï‹Úˆ˜ ÙÔÓ ‰È¿ÌÂÛÔ Î·È ÚÔηÏÔ‡Û ÌÂÁ¿ÏË ÛÙ¤ÓˆÛË ÙÔ˘ ¿Óˆ ÏÔ‚·›Ô˘ ‚ÚfiÁ¯Ô˘. EÏ‹ÊıË ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ¤ÎÏ˘Ì· (BAL) ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÔÔ›Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ¿ÊıÔÓÔÈ Ì‡ÎËÙ˜ A. fumigatus. H ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË ÂÙ¤ıË Ì ‰Â‡ÙÂÚË ‚ÚÔÁ¯ÔÛÎfiËÛË Î·È
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EÈÎfiÓ· 1. A/· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ fiÔ˘ Ê·›ÓÂÙ·È ÛÙÚÔÁÁ‡ÏË ÛΛ·ÛË ‰ÂÍÈ¿ ·Ú·˘Ï·›·.
EÈÎfiÓ· 2. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, fiÔ˘ Ê·›ÓÂÙ·È Ì¿˙· ÌÂÁ›ÛÙ˘ ‰È·Ì¤ÙÚÔ˘ 4 ÂÎ. Ì ·Û·Ê‹ fiÚÈ·. ¢ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ‰ÈÔÁΈ̤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ‹ ÙȘ Ì·Û¯·ÏÈ·›Â˜ ¯ÒÚ˜. ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›· Ù˘ Ì¿˙·˜. ™ÙÔ ˘ÏÈÎfi Ù˘ ‚ÈÔ„›·˜ ‚Ú¤ıËΠÊÏÂÁÌÔÓ҉˘ ÈÛÙfi˜, ¿ÊıÔÓ· ÔÍ¿ÓÙÔ¯· ‚·ÎÙËÚ›‰È· Ù‡Ô˘ M. avium Î·È Ì‡ÎËÙ˜. ™ÙË ¯ÚÒÛË Î·Ù¿ Ziel-Nielsen ‚Ú¤ıËÎ·Ó ¿ÊıÔÓ· ÈÛÙÈÔ·ÙÙ·Ú· Ì ÂÓ‰Ô΢ÙÙ¿ÚÈ· ıÂÙÈ΋ ¯ÚÒÛË, ¯ˆÚ›˜ ÙËÓ ‡·ÚÍË ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÈÛÙÔ‡. H Ù·˘ÙÔÔ›ËÛË ÙˆÓ Ì˘Î‹ÙˆÓ ·Ó¤‰ÂÈÍ ·ÏËı›˜ ˘Ê¤˜ A. fumigatus. ™ÙȘ ηÏÏȤÚÁÂȘ ÙÔ˘ BAL, ›Û˘ ·ÔÌÔÓÒıËΠ·Û¤ÚÁÈÏÏÔ˜. ™ÙÔȯ›· ηÎÔ‹ıÂÈ·˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛÙÔ ˘ÏÈÎfi Ù˘ ‚ÈÔ„›·˜ Ô‡Ù ÛÙÔ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ¤ÎÏ˘Ì·. ÕÙ˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ÔÌÔÓÒıË-
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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
Î·Ó ·fi Ù· Ù‡ÂÏ· ÙÔ˘ ·ÛıÂÓ‹, ÂÓÒ ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ M. avium ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ·fi ÙȘ ·ÓÂÈÏËÌ̤Ó˜ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓ‹. EÚfiÎÂÈÙÔ ÏÔÈfiÓ ÁÈ· Ù·˘Ùfi¯ÚÔÓË Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Î·È ·Û¤ÚÁÈÏÏÔ. TÔ ·È‰› ·Ú¯Èο ¤Ï·‚ ‰ÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹ Ì ·ÌÊÔÙÂÚÈΛÓË B ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÊÏԢ΢ÙÔÛ›ÓË Î·ıÒ˜ Î·È ÙÂÙÚ·Ïfi Û¯‹Ì· ÁÈ· ÙË Ïԛ̈ÍË ·fi M. avium (·˙ÈıÚÔÌ˘Î›ÓË, ÚÈÊ·ÌÔ˘Ù›ÓË, ÛÈÚÔÊÏÔÍ·Û›ÓË, ·ÌÈηۛÓË). H ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË Î·È Ô ‚‹¯·˜ ÂÌÊ¿ÓÈÛ·Ó ÛÙ·‰È·Î‹ ˘Ô¯ÒÚËÛË, Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· fï˜ ·Ú¤ÌÂÈÓ·Ó ·ÌÂÙ¿‚ÏËÙ· ·ÎfiÌ· Î·È ¤ÓÙ ̋Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Î·È ÂÓÒ Û˘Ó¯È˙fiÙ·Ó Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÌÊÔÙÂÚÈΛÓ˘ B ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Î·È ÙÚÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹. H ÂÓÙfiÈÛË Ù˘ Ì¿˙·˜ ‹Ù·Ó ··ÁÔÚ¢ÙÈ΋ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË. ™ÙË ‰Â‡ÙÂÚË ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›· ‰È·ÈÛÙÒıËÎ·Ó ·ÏÏÔÈÒÛÂȘ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜. EÓÙÔ›ÛıËÎ·Ó Ï›Á· ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÔÍ¿ÓÙÔ¯· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·ÏÏ¿ ‰ÂÓ ·Ó¢ڤıËÛ·Ó Ì‡ÎËÙ˜ ‹ ÛÙÔȯ›· ηÎÔ‹ıÂÈ·˜. M ٷ ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù· ¯ÔÚËÁ‹ıËΠ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ıÂڷ›· Û˘ÓÙ‹ÚËÛ˘ ÁÈ· ÙË Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Ì ÈÙÚ·ÎÔÓ·˙fiÏË. ™‹ÌÂÚ· 2,5 ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, Ô ·ÛıÂÓ‹˜ Â›Ó·È Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË ˘fi ¯ËÌÂÈÔÚÔʇϷÍË Ì ÈÙÚ·ÎÔÓ·˙fiÏË Î·È ·˙ÈıÚÔÌ˘Î›ÓË. ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›ÛÂÈ ¿ÏÏË Â˘Î·ÈÚȷ΋ Ïԛ̈ÍË Î·È Ë ·ÎÙÈÓÔÏÔÁÈ΋ ÙÔ˘ ÂÈÎfiÓ· Â›Ó·È ‚ÂÏÙȈ̤ÓË. MfiÓÔ Úfi‚ÏËÌ¿ ÙÔ˘ ·Ú·Ì¤ÓÂÈ Ë ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì˘ÎËÙÈ·ÛÈ΋ ÛÙÔÌ·Ù›Ùȉ· Î·È ÙÔ ·˘ÍË̤ÓÔ ÈÈÎfi ÊÔÚÙ›Ô ·Ú¿ ÙËÓ ÙÚÈÏ‹ ·ÓÙÈÚÂÙÚÔ˚΋ ·ÁˆÁ‹. ™˘˙‹ÙËÛË TÔ AIDS ÂÚÈÁÚ¿ÊËΠ۠·ÛıÂÓ›˜ Ì ·ÈÌÔÚÚÔÊÈÏ›· ÙÔ 1982. (7) TÔ 1985, Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂϤÁ¯Ô˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ HIV ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 40-90% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ Â›¯·Ó ÌÔÏ˘Óı› ̤ۈ Ù˘ ıÂڷ›·˜ ˘ÔηٿÛÙ·Û˘ (Û˘Ì‚·ÙÈÎÔ› Û˘Ì˘Îӈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜). (8) H ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÚÔÌÂÙ·ÙÚÔÒÓ Û˘Ó¤‚Ë Î·Ù¿ Ù· ¤ÙË 1982 Î·È 1983. (9) H ÔÚ›· Ù˘ HIV Ïԛ̈͢ Û ·ÈÌÔÚÚÔÊÈÏÈο ·È‰È¿ Â›Ó·È Èfi Ì·ÎÚfi¯ÚÔÓË ·fi fiÙÈ Û ·È‰È¿ Ì οıÂÙË HIV Ïԛ̈ÍË, ÂÓÒ ÔÈ Î·ÎÔ‹ıÂȘ Î·È ÔÈ Â˘Î·ÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ Â›Ó·È Î·ıÔÚÈÛÙÈΤ˜ ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ Î·È ÙË ıÓËÙfiÙËÙ· (10,11). O ·ÛıÂÓ‹˜ Ì·˜ ÌÔχÓıËΠ̠ÙÔÓ HIV Û ËÏÈΛ· 4 ÂÙÒÓ Î·È ·ÚÔ˘Û›·Û ÙËÓ ÚÒÙË ÙÔ˘ ¢ηÈÚȷ΋ Ïԛ̈ÍË Û ËÏÈΛ· 15 ÂÙÒÓ. H Û˘¯ÓfiÙËÙ· Ïԛ̈͢ ·fi M. avium Û ·È‰È¿ Ì AIDS ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Â›Ó·È ÂÚ›Ô˘ ›‰È· Ì ·˘Ù‹ ÙˆÓ ÂÓËϛΈÓ, ‰ËÏ·‰‹ 1,1-4 %. K·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ïԛ̈͢ ·fi M. avium ıˆÚÂ›Ù·È Ë ÙÒÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4
ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î¿Ùˆ ·fi 100/mm3 (1). EÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ ‰È¿Û·ÚÙË Ïԛ̈ÍË (Ì˘ÎÔ‚·ÎÙËÚÈ·ÈÌ›·) Ì ˘ÚÂÙfi, ·Ó·ÈÌ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. øÛÙfiÛÔ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÓÙÔÈṲ̂Ó˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ Ó‡ÌÔÓ˜ ‹ Î·È Û ¿ÏÏ· fiÚÁ·Ó· (‰¤ÚÌ·, ÏÂÌÊ·‰¤Ó˜). H ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔʇϷ͢ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ Èı·ÓfiÙËÙ· Ïԛ̈͢ ·fi M. avium Û ·ÛıÂÓ›˜ Ì HIV Ïԛ̈ÍË Î·È CD4 ÏÂÌÊÔ·ÙÙ·Ú· οو ·fi 100/mm3. (1,2)
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H ‰ÈËıËÙÈ΋ Ó¢ÌÔÓÈ΋ ·ÛÂÚÁ›ÏψÛË ÂÌÊ·Ó›˙ÂÙ·È Û ¿ÙÔÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ·ÓÔÛÔηٷÛÙÔÏ‹ ÏfiÁˆ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÂȉÒÓ, Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‹ ¤¯Ô˘Ó ÏÂÈÙÔ˘ÚÁÈ΋ ‰È·Ù·Ú·¯‹ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (3). ™Â ·ÛıÂÓ›˜ Ì AIDS ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¿ÓÈ· ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ ˘ÔÏÔÁ›˙ÂÙ·È ÛÙÔ 0,7% (6) Î·È ÛÙ· ·È‰È¿ ÛÙÔ 1,5% (5). §fiÁˆ Ù˘ ‰‡ÛÎÔÏ˘ ÙÂÎÌËÚ›ˆÛ˘ Ù˘ Ïԛ̈͢ Û˘¯Ó¿ Ë ‰È¿ÁÓˆÛË ‰È·Ê‡ÁÂÈ, ¤ÙÛÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ÛÙËÚ›˙ÔÓÙ·È Û ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi (6). ø˜ Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜ ÌfiÏ˘ÓÛ˘ ·Ó·Ê¤ÚÂÙ·È Ë ÂÈÛÓÔ‹ ÎÔÓȉ›ˆÓ ·Û¤ÚÁÈÏÏÔ˘. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ù· Ì·ÎÚÔÊ¿Á· ÂÈÙ˘Á¯¿ÓÔ˘Ó ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÓȉ›ˆÓ, ·Ó fï˜ Ë Ïԛ̈ÍË ‰ÂÓ ÂÚÈÔÚÈÛÙ›, ·Ú¯›˙ÂÈ Ë ‰È·‰Èηۛ· ·Ó¿Ù˘Í˘ Ì˘ÎËÏ›ˆÓ. (3) OÈ ·ÛıÂÓ›˜ Ì AIDS Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ·Û¤ÚÁÈÏÏÔ Û˘Ó‹ıˆ˜ ‚Ú›ÛÎÔÓÙ·È Û ‚·ÚÈ¿ ·ÓÔÛÔηٷÛÙÔÏ‹. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ·ÛÂÚÁ›ÏψÛË Û ·ÛıÂÓ›˜ Ì AIDS ·ÔÙÂÏÔ‡Ó Ë Ô˘‰ÂÙÂÚÔÂÓ›·, Ë ¯ÚfiÓÈ· ıÂڷ›· Ì ÎÔÚÙÈÎÔÂȉ‹, Ë Ì·ÎÚÔ¯ÚfiÓÈ· ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›· ¢ڤˆ˜ Ê¿ÛÌ·ÙÔ˜ fiˆ˜ Î·È Ë ˘ÔΛÌÂÓË Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜. H ÏÂÈÙÔ˘ÚÁÈ΋ ‰È·Ù·Ú·¯‹ ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ê·›ÓÂÙ·È ÔÙÈ ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì AIDS Ô˘ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·.(4,5) O ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ ÂÌÊ¿ÓÈ˙ Ԣ‰ÂÙÂÚÔÂÓ›· ·ÏÏ¿ Ë ÚÔ¸¿Ú¯Ô˘Û· Ó¢ÌÔÓÈ΋ Ïԛ̈ÍË ·fi M. avium Èı·ÓfiÓ Ó· ·ÔÙ¤ÏÂÛ ÙÔÓ Î‡ÚÈÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘. H ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ηÏÏȤÚÁÂÈ· ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎÔ‡ ÂÎχ̷ÙÔ˜ Î·È ‚ÈÔ„›· Ó‡ÌÔÓÔ˜, ÂÓÒ ÔÈ ÔÚÔÏÔÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ·Ó›¯Ó¢Û˘ ·ÓÙÈÁfiÓÔ˘ Î·È ·ÓÙiÛÒÌ·ÙÔ˜ ηٿ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ ¤¯Ô˘Ó ¯·ÌËÏ‹ ·ÍÈÔÈÛÙ›·. (3,12) ™ÙË ÂÚ›ÙˆÛË Ì·˜ Ë ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Ù˘ Ì¿˙·˜ ¤‰ÂÈÍ ·ÏËı›˜ ˘Ê¤˜, ÁÂÁÔÓfi˜ Ô˘ ÂÓÈÛ¯‡ÂÈ ÙËÓ ‰È¿ÁÓˆÛË Ù˘ ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘, ·ÊÔ‡ Ô A. fumigatus ‹Ù·Ó Ô ÌfiÓÔ˜ ̇ÎËÙ·˜ o‡ ·Ó·Ù‡-
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¯ıËΠÛÙȘ ηÏÏȤÚÁÂȘ ·fi ÙÔ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ¤ÎÏ˘Ì·. £Âڷ›· ÂÎÏÔÁ‹˜ ıˆÚÂ›Ù·È Ë ·ÌÊÔÙÂÚÈΛÓË B, ¤¯Ô˘Ó fï˜ ¯ÚËÛÈÌÔÔÈËı› Ì ÂÈÙ˘¯›· Î·È ¿ÏÏ· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο Ê¿Ú̷η fiˆ˜ Â›Ó·È ÔÈ ·˙fiϘ Î·È Ë ÊÏԢ΢ÙÔÛ›ÓË, Û˘Ó‹ıˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÌÊÔÙÂÚÈΛÓË B (3,5,6,13). H ÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË B ÚÔÙÈÌ¿Ù·È Û ÂÚÈÙÒÛÂȘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¯ÔÚ‹ÁËÛ˘ ÏfiÁˆ ÌÈÎÚfiÙÂÚ˘ ÙÔÍÈÎfiÙËÙ·˜ (13,14). XÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ Ì˘ÎËÙÈ·ÛÈ΋˜ Ì¿˙·˜ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ì ηϿ ·ÔÙÂϤÛÌ·Ù· (15) ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ fï˜ Ù¤ÙÔÈ· ¤̂·ÛË ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹ ÏfiÁˆ Ù˘ ÂÓÙfiÈÛ˘ Ù˘ Ì¿˙·˜. O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·ÛÂÚÁ›ÏψÛ˘ ·fi ÙË ÌÂٿوÛË Ù˘ HIV Ïԛ̈͢ Û AIDS Â›Ó·È 10 Ì‹Ó˜, (6) fiÛÔ ‹Ù·Ó Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜. H ÚfiÁÓˆÛË Ù˘ ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ Û ·ÛıÂÓ›˜ Ì AIDS ¤›Ó·È Ôχ η΋, Ë ıÓËÙfiÙËÙ· Êı¿ÓÂÈ ÙÔ 70-90%, (5) Ô ‰Â ̤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛ˘ ·Ó¤Ú¯ÂÙ·È Û ϛÁ˜ ‚‰ÔÌ¿‰Â˜ (5). O ·ÛıÂÓ‹˜ Ì·˜ Â›Ó·È Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË ÂÚÈÛÛfiÙÂÚÔ ·fi ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË, ÁÂÁÔÓfi˜ Ô˘ ÙÔ˘ ÂÈÙÚ¤ÂÈ Û¯Â‰fiÓ Ê˘ÛÈÔÏÔÁÈ΋ ˙ˆ‹. ¶ÈÛÙ‡ԢÌ fiÙÈ Û ·˘Ùfi Û˘ÓÂÙ¤ÏÂÛÂ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ‰ÈÏ‹˜ Ó¢ÌÔÓÈ΋˜ Ïԛ̈͢ ηıÒ˜ Î·È Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÂÓÙ·ÙÈ΋ ıÂڷ›·. EӉȷʤÚÔÓÙ· ÛËÌ›· ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È Ë Û¿ÓÈ· ÂÓÙfiÈÛË Ù˘ ÂÓ‰Ô‚ÚÔÁ¯È΋˜ Ïԛ̈͢ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Î·È ·Û¤ÚÁÈÏÏÔ, ηıÒ˜ ›Û˘ Î·È Ë ¿ÚÈÛÙË ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ·ÛıÂÓ‹ ÛÙËÓ ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. BÈ‚ÏÈÔÁÚ·Ê›· 1. Pizzo Ph. The challenge of HIV infection in infants, children and adolescents. In Wilfert C ed. 2nd ed. William and Wilkins 1996. 2. Rubin D, Rahal J. Mycobacterium-Avium Complex. Infect Dis Clinics N Am 1994;8:413-425. 3. Blum M, Wiedermann B. Fungal diseases.Aspergillus In: Feigin & Cherry Eds. Textbook of Pediatric Infectious Diseases. 3rd Ed. Saunders Company 1992;1891-1898. 4. Lorthclary O, Meyohas M-C, Dupont B, Cadranel J, Salmon-Ceron D, Peyramond D et al. Invasive aspergillosis in patients with acquired immunodeficiency syndrome: Report of 33 cases. Am J Med 1993;95:177187. 5. Shetty D, Giri N, Gonzalez C, Pizzo P, Walsh T. Invasive aspergillosis in human immunodeficiency virus infected children. Pediatr Infect Dis J 1997;16:216-221 6. Minamoto G, Bazlam T, Vander Els N. Invasive aspergillosis in patients with AIDS. Clin Infect Dis 1992;14:66-74. 7. Centers for Disease Control. Update on acquired immunodeficiency syndrome(AIDS) among patients with haemophilia A. MMWR 1982;31:664. 8. Ramsey B, Palmer L, McDougal S. Antibody to
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14. Meunier F, Prentice HG, Ringden O. Liposomal Amphotericin B(Ambisome): safety data from a phase ii/iii clinical trial. J Antimicrob Chemother 1991;28(B suppl):S83-S91. 15. Robinson L, Reed E, Galbraith T, Alonso A, Moulton A, Fleming W. Pulmonary resection for invasive aspergillus infection in immunocompromised patients. J Thor Cardiovasc Surg 1995;109(6):1182-1197.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M·Ú›· £ÂÔ‰ˆÚ›‰Ô˘, A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, MÔÓ¿‰· EȉÈÎÒÓ §ÔÈÌÒ͈Ó, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·", £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, °Ô˘‰›.
™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Û ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ IˆÛ‹Ê K·Ï¤ÁÈ·˜1, M·Ú›˙· TÛÔÏÈ¿1, KˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··ÁˆÚÁ›Ô˘2, £ÂÔ‰fiÛ˘ ¢fiÛÈÔ˜, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿Î˘1 ● ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ Ô˘ ‰È·ÁÓÒÛıËΠ۠·ÁfiÚÈ ËÏÈΛ·˜ 14 ÂÙÒÓ, ÙÔ ÔÔ›Ô ·fi ËÏÈΛ·˜ 2 ÂÙÒÓ ·ÚÔ˘Û›·˙ ÂÂÈÛfi‰È· ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒ͈Ó. H ıÂڷ›· ‹Ù·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Ì ÂÎÙÔÌ‹ ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜. H ÎÏÈÓÈ΋ ˘Ô„›· ÁÈ· ÙÔ Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂڷ›·. ¶·È‰È·ÙÚÈ΋ 2000;63:55-59. §¤ÍÂȘ ÎÏÂȉȿ: Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ·, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. I. Kaleyias, M. Tsolia, K. Papageorgiou, T. Dosios, E. Kavasarakis. Congenital lobar emphysema in an adolescent. Case report. Paediatriki 2000;63:55-59. ● Abstract: This is a case report of a boy with congenital lobar emphysema diagnosed and treated surgically at the age of 14 years. From the age of two years he had episodes of respiratory distress and recurrent pulmonary infections. Clinical awareness of congenital lobar emphysema is important for prompt diagnosis and effective surgical treatment. Key words: congenital lobar emphysema, respiratory distress.
EÈÛ·ÁˆÁ‹ ¢È·Ù·Ú·¯¤˜ ηٿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË ÙˆÓ Ó¢ÌfiÓˆÓ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¢ڇ Ê¿ÛÌ· ·ÓˆÌ·-
1 2 3
ÏÈÒÓ ÔÈ Ôԛ˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È·Ù·Ú·¯‹ Ù˘ ‰ÔÌ‹˜ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Â›Ó·È Û¿ÓȘ ÛÂ Û˘¯ÓfiÙËÙ·, ·ÏÏ¿ ÂӉ¯Ô̤ӈ˜ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË
B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ Aı‹Ó·˜, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶.& A.K˘ÚÈ·ÎÔ‡" ¶·ıÔÏÔÁÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ KÏÈÓÈ΋ IÔÎÚ·Ù›Ԣ NÔÛÔÎÔÌ›Ԣ B' ¶. XÂÈÚÔ˘ÚÁÈ΋ KÏÈÓÈ΋ §·˚ÎÔ‡ NÔÛÔÎÔÌ›Ԣ
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˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ (1,2). TÔ Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· (™§E) ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ Ì ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÌÔÚ› Ó· ‰È·ÁÓˆÛı› ÛÙË ÌÂÙ¤ÂÈÙ· ‚ÚÂÊÈ΋ ËÏÈΛ· (5%), ÂÓÒ ÛÔÚ·‰Èο ÂÚÈÛÙ·ÙÈο ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·È‰È΋, ÂÊË‚È΋ ‹ Î·È ÂÓ‹ÏÈÎÔ ˙ˆ‹ (3). H ËÏÈΛ· ‰È¿ÁÓˆÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ‚·ıÌfi Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ÚÔηÏ›ٷÈ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ŒÊË‚Ô˜ 14 ÂÙÒÓ, ·ÚÔ˘Û›·Û ˘ÚÂÙfi Î·È ‚‹¯· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰‡ÛÓÔÈ·, ·ÓÙÈÏËÙ‹ ˆ˜ Ù·¯‡ÓÔÈ·. M ·˘Ù‹ ÙËÓ ÂÈÎfiÓ· ÂÈÛ‹¯ıË Û NÔÛÔÎÔÌÂ›Ô fiÔ˘ ÛÙË ÁÂÓfiÌÂÓË ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·ÈÛÙÒıËΠ˘Âډȷ‡Á·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿ (ÂÈÎfiÓ· 1). TÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. Afi ËÏÈΛ·˜ 2 ÂÙÒÓ ·ÚÔ˘Û›·˙ ‹È· ÂÂÈÛfi‰È· ·Ó·Ó¢ÛÙÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ˆ˜ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· ‹/ Î·È ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Â ËÏÈΛ· 9 ÂÙÒÓ ÓÔÛËχÙËΠÁÈ· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ·fi ÙfiÙ ¿Ú¯ÈÛ ӷ ¯ÚËÛÈÌÔÔÈ› ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ¯ˆÚ›˜ fï˜ ÂÌÊ·Ó‹ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË. ¢ÂÓ ·Ó¤ÊÂÚ Ӣ¯ÙÂÚÈÓfi ‚‹¯· ‹ ‚‹¯· ÌÂÙ¿ ·fi ¿ÛÎËÛË. TÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. TÔ ·È‰› ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ù· ۈ̷ÙÔÌÂÙÚÈο ÙÔ˘ ÛÙÔȯ›· ‹Ù·Ó ÛÙËÓ 95Ë ÂηÙÔ-
EÈÎfiÓ· 1. AÎÙÈÓÔÁÚ·Ê›· £Òڷη Û ËÏÈΛ· 14 ÂÙÒÓ: ˘Âډȷ‡Á·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿
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∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ
ÛÙÈ·›· ı¤ÛË. H ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘ ‹Ù·Ó ÌÂȈ̤ÓË Ì ˘ÂÚÛ·Ê‹ Ù˘Ì·ÓÈÎfi ‹¯Ô, ÔÈ ÊˆÓËÙÈΤ˜ ‰ÔÓ‹ÛÂȘ Î·È ÙÔ ·Ó·Ó¢ÛÙÈÎfi „Èı‡ÚÈÛÌ· ‹Ù·Ó ÌÂȈ̤ӷ ·ÚÈÛÙÂÚ¿, ÂÓÒ ‰ÂÍÈ¿ ˘‹Ú¯Â ΢„ÂÏȉÈÎfi „Èı‡ÚÈÛÌ· Ì ÚfiÛıÂÙÔ˘˜ ·¯Â›˜ ˘ÁÚÔ‡˜ ‹¯Ô˘˜ Î·È Û˘Ú›ÙÔÓÙ˜. H ÂÎÙ›ˆ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ÂÈÎfiÓ· ˘ÂÚ·ÂÚÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿. O Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ÛËÌÂÈÔÏÔÁÈÎÒÓ Î·È ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘ÓËÁÔÚÔ‡Û ˘¤Ú ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜. Afi Ù· ·›ÙÈ· Ô˘ ÚÔηÏÔ‡Ó ÏԂ҉˜ ÂÌʇÛËÌ· ˆ˜ ÂÚÈÛÛfiÙÂÚÔ Èı·Ó¿ ıˆڋıËÎ·Ó Ë ÌÂÚÈ΋ ·fiÊÚ·ÍË ÏfiÁˆ ¿ÛıÌ·ÙÔ˜ ‹ ·fi ͤÓÔ ÛÒÌ·, ÙÔ ™§E Î·È ÙÔ Û‡Ó‰ÚÔÌÔ SweyerJames-MacLeod (Û.SJML). ÕÏÏ· ·›ÙÈ· ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ ÂÓ‰Ô·˘ÏÈο ‹ Â͈·˘ÏÈο, ·Ó Î·È ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ·ÔÎÏÂÈÛÙÔ‡Ó, ıˆڋıËÎ·Ó ÏÈÁfiÙÂÚÔ Èı·Ó¿. H ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·Ó ·ÚfiÌÔÈ· ÂΛӢ Ô˘ ›¯Â Û ËÏÈΛ· 9 ÂÙÒÓ Î·Ù¿ ÙËÓ ÙfiÙ ÓÔÛËÏ›· ÙÔ˘ ·È‰ÈÔ‡ Û NÔÛÔÎÔÌÂ›Ô (ÂÈÎfiÓ· 2). O ·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıËΠ̠ÙȘ ·ÎfiÏÔ˘ı˜ ÂÍÂÙ¿ÛÂȘ. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ Ë ÔÔ›· ¤‰ÂÈÍ ÙÌËÌ·ÙÈÎfi ÂÌʇÛËÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡ ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆı› ·Á›‰Â˘ÛË ·¤Ú· ‹ ‚ÚÔÁ¯ÂÎٷۛ˜ (ÂÈÎfiÓ· 3), ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ -·¤ÚˆÛ˘ ·fi ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËΠ·Ô˘Û›· ·ÈÌ¿ÙˆÛ˘ Î·È ·¤ÚˆÛ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ ÔÏ˘ÂÛÙȷΤ˜ ‚Ï¿‚˜ (ÂÈÎfiÓ· 4), ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·
EÈÎfiÓ· 2. AÎÙÈÓÔÁÚ·Ê›· £Òڷη Û ËÏÈΛ· 9 ÂÙÒÓ: ˘ÂÚ·ÂÚÈÛÌfi˜ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ÌÂÙ¿ıÂÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿ (Â˘Ú‹Ì·Ù· ·ÚfiÌÔÈ· Ì ·˘Ù¿ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· Ô˘ ¤ÁÈÓ Û ËÏÈΛ· 14 ÂÙÒÓ).
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EÈÎfiÓ· 3. AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ (HRCT): TÌËÌ·ÙÈÎfi ÂÌʇÛËÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡.
Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. H ‰˘Ó·ÌÈ΋ ÛÈÚÔ̤ÙÚËÛË (FEV1=86%, FEVC=87%, FEV1/ FEVC=84%, MMF=64%) Î·È Ë ·ÚÓËÙÈ΋ ‰ÔÎÈÌ·Û›· ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹˜ Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú ÌË ·Ó·ÛÙÚ¤„ÈÌ˘ ·fiÊڷ͢ ÙˆÓ ÌÈÎÚÒÓ ·ÂÚ·ÁˆÁÒÓ. T· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È Ù˘ ÛÈÚÔ̤ÙÚËÛ˘ ·ÔÌ¿ÎÚ˘Ó·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜. H ·Ô˘Û›· ÂÌÊ·ÓÔ‡˜ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÂÈÎfiÓ· ηٿ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (·Ô˘Û›· ‚ÚÔÁ¯ÂÎÙ·ÛÈÒÓ, ÌË ‰È·›ÛÙˆÛË ·Á›‰Â˘Û˘ ·¤Ú·) ·ÔÌ¿ÎÚ˘Ó·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ SJML (4). ø˜ Èı·ÓfiÙÂÚË ‰È¿ÁÓˆÛË ıˆڋıËΠÂΛÓË ÙÔ˘ ™§E. H ‚ÚÔÁ¯ÔÛÎfiËÛË ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ͤÓÔ˘ ÛÒÌ·ÙÔ˜ ‹ ¿ÏÏÔ˘ ÂÓ‰Ô·˘ÏÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ‰ÂÓ ÎÚ›ıËΠÛÎfiÈÌË ÂÂȉ‹ ı· ÌÔÚÔ‡Û ӷ ÚÔηϤÛÂÈ Ú‹ÍË Ù˘¯fiÓ ÂÌÊ˘ÛËÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜. ø˜ ηٷÏÏËÏfiÙÂÚË ÎÚ›ıËÎÂ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË. ŒÁÈÓ ·ÚÈÛÙÂÚ‹ ¿Óˆ ÏÔ‚ÂÎÙÔÌ‹ Î·È ÙÌËÌ·ÙÂÎÙÔÌ‹ ÙÔ˘ ÎÔÚ˘Ê·›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡. H ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Ô˘ ·Ê·ÈÚ¤ıËΠ¤‰ÂÈÍ ˘ÂÚ·ÂÚÈÛÌfi ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ú‹ÍË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ (ÂÈÎfiÓ· 5). TÔ ÙÔ›¯ˆÌ· ÙˆÓ ‚ÚfiÁ¯ˆÓ ‰ÂÓ ‹Ù·Ó ·¯˘Ṳ̂ÓÔ Î·È ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‚ÚÔÁ¯ÂÎÙ·ÛÈΤ˜ ·ÏÏÔÈÒÛÂȘ (ÂÈÎfiÓ· ıˆڋıËÎÂ Û˘Ì‚·Ù‹ Ì ™§E). MÂÙÂÁ¯ÂÈÚËÙÈο Ô ·ÚÈÛÙÂÚfi˜ οو ÏÔ‚fi˜ ÂÎÙ‡¯ıËΠϋڈ˜ (ÂÈÎfiÓ· 6). ™˘˙‹ÙËÛË TÔ ™§E ۯ‰fiÓ ¿ÓÙ· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ Î·È ÚÔ‚¿ÏÏÂÈ Ì ÙËÓ ÂÈ-
EÈÎfiÓ· 4. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ Î·È ·¤ÚˆÛ˘ Ó¢ÌfiÓˆÓ: ·Ô˘Û›· ·ÈÌ¿ÙˆÛ˘ Î·È ·¤ÚˆÛ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ÏÔ‚Ô‡ ¯ˆÚ›˜ ÔÏ˘ÂÛÙȷΤ˜ ‚Ï¿‚˜.
EÈÎfiÓ· 5. IÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ·Ê·ÈÚÂı¤ÓÙÔ˜ ÙÌ‹Ì·ÙÔ˜ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜: ˘ÂÚ·ÂÚÈÛÌfi˜ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ú‹ÍË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ.
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EÈÎfiÓ· 6. AÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÌÂÙÂÁ¯ÂÈÚËÙÈο: ¶Ï‹Ú˘ ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡. ÎfiÓ· ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ‹/ Î·È Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. Y¿Ú¯Ô˘Ó ÛÔÚ·‰Èο ÂÚÈÛÙ·ÙÈο ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÛÙË ·È‰È΋, ÂÊË‚È΋ ‹ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (1,5,6). Y¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ ™§E Ô ÌÔÓÔÂÛÙÈ·Îfi˜ Î·È Ô ÔÏ˘ÂÛÙÈ·Îfi˜. H ÂÚ›ÙˆÛË Ì·˜ ·Ó‹ÎÂÈ ÛÙÔ ÌÔÓÔÂÛÙÈ·Îfi Ù‡Ô (2). ¢È·Ù·Ú·¯¤˜ ηٿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË ÙˆÓ Ó¢ÌfiÓˆÓ, fiˆ˜ Ë ‰˘ÛÏ·Û›· ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ ‹ /Î·È Ô ÌÂȈ̤ÓÔ˜ ·ÚÈıÌfi˜ ΢„ÂÏ›‰ˆÓ, Ô‰ËÁÔ‡Ó Û ™§E (2,3). AÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ™§E Â›Ó·È Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, Ë ÔÔ›· ÛÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË ¤ıÂÛ ÈÛ¯˘Ú‹ ˘Ô„›· ÁÈ· ÙÔ ÓfiÛËÌ·. O ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıËΠ̠·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜, ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘- ·¤ÚˆÛ˘, ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·. M ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÓÈÛ¯‡ÂÙ·È Ë ‰È¿ÁÓˆÛË. TÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·¤ÚˆÛ˘- ·ÈÌ¿ÙˆÛ˘ ¤ÁÈÓ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛı› Ù˘¯fiÓ ÔÏ˘ÂÛÙÈ·Îfi ™§E (8-11). ŒÁÈÓ ›Û˘ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ‹ ·ÓˆÌ·Ï›·˜ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi Û˘Ó˘¿Ú¯Ô˘Ó Û ÔÛÔÛÙfi 14% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ì ™§E (10) Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘Ï›Ô˘. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ì ™§E ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ¯ÂÈÚÔ˘ÚÁÈο Ì ÂÎÙÔÌ‹ ÙÔ˘ ˘Ô·ÂÚÈ˙fiÌÂÓÔ˘ ÈÛÙÔ‡ (1,11-14). ŸÌˆ˜, ·Ó Î·È Â›Ó·È ÁÂÓÈο ·Ú·‰ÂÎÙfi fiÙÈ Ë ·Ê·›ÚÂÛË ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Â›Ó·È ÛˆÙ‹ÚÈ· Û ÓÂÔÁÓ¿ Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÔÈ ÂӉ›ÍÂȘ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Û ÌÂÙÚ›ˆ˜ ‰˘ÛÓÔÔ‡ÓÙ· ‹ ¢ÓÔ˚ο ‚Ú¤ÊË Î·È ·È‰È¿ Â›Ó·È ·Û·Ê›˜. H Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·Ú·-
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οÌÙÂÈ ‚¤‚·È· ÙÔ˘˜ ¿ÌÂÛÔ˘˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ·ÏÏ¿ Ô ·ÛıÂÓ‹˜ ·Ú·Ì¤ÓÂÈ Û ˘„ËÏfi ΛӉ˘ÓÔ ÏfiÁˆ Èı·ÓÔ‡ ·˘ÙfiÌ·ÙÔ˘ Ó¢ÌÔıÒڷη. ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ ÚÔÙÈÌ‹Û·Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ ÂÌÊ˘ÛËÌ·ÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜, Ë ÔÔ›· ·fi ÙË Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ÈÂıÓ‹ ÂÌÂÈÚ›· ıˆÚÂ›Ù·È ÚÔÙÈÌfiÙÂÚË. ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ë ·Ê·›ÚÂÛË Ù˘ ÂÌÊ˘ÛËÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÁÈ·Ù› ÂÈÙÚ¤ÂÈ ÙËÓ ·ÔÛ˘Ì›ÂÛË ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Èı·ÓÒ˜ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË Ó¤Ô˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ Ì ÙËÓ ·Ó·Á¤ÓÓËÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ·ÔÙÚ¤ÂÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ Ó¢ÌÔÓÈΤ˜ ÏÔÈÌÒÍÂȘ. ¶·Ú¿ÏÏËÏ·, ·ÔʇÁÂÙ·È Ë ·ÈÊÓ›‰È· Ú‹ÍË Î·È ÚfiÎÏËÛË ·˘ÙfiÌ·ÙÔ˘ Ó¢ÌÔıÒڷη. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ ™§E Ô˘ Â›Ó·È ¤Ó· Û¿ÓÈÔ ÓfiÛËÌ·, Û˘Ó‹ıˆ˜ ÚÔ‚¿ÏÏÂÈ Ì ıÔÚ˘‚Ò‰Ë ÂÈÎfiÓ· ·fi ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, Û ۿÓȘ fï˜ ÂÚÈÙÒÛÂȘ ·Ú·Ì¤ÓÂÈ Ì ·Ì‚Ï˯ڋ Û˘Ìو̷ÙÔÏÔÁ›· ̤¯ÚÈ ÙË ÌÂÁ·Ï‡ÙÂÚË ·È‰È΋ ‹ Î·È ÂÊË‚È΋ ËÏÈΛ· fiˆ˜ ÛÙÔ Ó·Úfi ·ÛıÂÓ‹ Ì·˜. H ·fiÊ·ÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÛÙË ÂÚ›ÙˆÛË Ô˘ ÚÔ‚¿ÏÏÂÈ Ì ̤ÙÚÈ· Û˘Ìو̷ÙÔÏÔÁ›· Â›Ó·È ‰‡ÛÎÔÏË Î·È Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌËıÔ‡Ó ÔÈ Î›Ó‰˘ÓÔÈ ·Ú·ÌÔÓ‹˜ Ù˘ ‰È·Ì·ÚÙ›·˜ Û ۯ¤ÛË Ì ÙȘ Èı·Ó¤˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜. M ‚¿ÛË ÙËÓ ˘¿Ú¯Ô˘Û· ÂÌÂÈÚ›·, ·È‰È¿ ÌÂ Û˘Ìو̷ÙÈÎfi ™§E Ú¤ÂÈ Ó· ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜, ·ÏÏ¿ Î·È ÁÈ· Ó· ˘ÂÓı˘Ì›ÛÂÈ ÛÙÔÓ ·ÛÎÔ‡ÓÙ· ¶·È‰›·ÙÚÔ fiÙÈ ÛÙËÓ ‹È· ·ÏÏ¿ ›ÌÔÓË ·Ó·Ó¢ÛÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Ú¤ÂÈ Ó· ·Ó·˙ËÙÔ‡ÓÙ·È Î·È Ù· Û·ÓÈfiÙÂÚ· ·›ÙÈ·. BÈ‚ÏÈÔÁÚ·Ê›· 1. Wesley JR. Diagnosis and management of congenital cystic disease of the lung in children. J Pediatr Surg 1986; 1:202-207. 2. Bailey PV. Congenital bronchopulmonary malformations. J Thorac Cardiovasc Surg1990; 99:597-603. 3. Critchley PS. Adult congenital lobar emphysema in pregnancy. Thorax 1995; 50:909-910. 4. Ghossain MA. Sweyer-James Syndrome documented by spiral CT angiography and high resolution inspiratory and expiratory CT: an accurate single modality exploration. J Comput Assist Tomogr 1997;21:616-618. 5. Wegener WA. Ventilation-perfusion scintigraphy in congenital lobar emphysema. Clin Nucl Med 1990; 15:683-687. 6. Mc Donald. Congenital lobar emphysema requiring surgery in adult life. Aust NZ J Med 1986; 16:501-505. 7. Stigers KB. The clinical and imaging spectrum of findings in patients with congenital lobar emphysema. Pediatr
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Pulmonology 1992; 14:160-170. 8. Markowitz R. Congenital lobar emphysema. The roles of CT and V/Q scan. Scan Clin Pediatr 1989; 1:19-23. 9. McGinnis HD. Bubbly intrapleural mucous simulating congenital lobar emphysema. Ped Radiology 1993; 23:386-7. 10. Hugosson C. Congenital bilobar emphysema. Ped Pulmonology 1995; 25:649-651. 11. Kennedy D. Lobar emphysema: Long-term imaging follow-up. Radiology 1991; 180:189-193. 12. Loockman Saim. Congenital lobar emphysema case with bronchial septum. Ped Oto Rhino Laryngology 1994; 28:241-246.
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13. Eigen H. Congenital lobar emphysema: long-term evaluation of surgically and conservatively treated children. Am Rev Resp Dis 1976; 113:823-830. 14. Roghair GD. Nonoperative management of lobar emphysema. Long-term follow-up. Ped Radiology 1972; 102:125-127.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: IˆÛ‹Ê K·Ï¤ÁÈ·˜ XÚ˘Û·Óı¤ÌˆÓ 79, 15772 Aı‹Ó·
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¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ÈÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘1, º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘1, AÊÚÔ‰›ÙË X·ÚÈÙ¿ÓÙË2, ª·Ú›· ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1, ¢ˆÚÔı¤· K·ÙÚÈÔ‡1
T. Papageorgiou, F. Athanasiadou, A. Haritandi, M. Hatzistylianou, D. Katriou. Case report of a child with Langerhans cell histiocytosis. Paediatriki 2000;63:60-62. ● Abstract: A female child was admitted at the age of 18 months with seborrhoeic dermatitis, splenic enlargement and water deprivation. No organ dysfunction was established. Multiple typical osteolytic areas were observed on the skull X-ray. The diagnosis of diabetes insipidus was confirmed by the magnetic resonance imaging (MRI) of the pituitary gland on which the typical morphological changes were demonstrated. The diagnosis of Langerhans cell histiocytosis was confirmed by skin lesion biopsy. The child was treated with methotraxate, etoposide, vinblastine, 6-mercaptopurine and prednisone according to an intensive chemotherapeutic protocol and achieved complete remission. Three years after the cessation of chemotherapy the only residual problem was diabetes insipidus. Key words: Langerhans cell histiocytosis, histiÔcytosis-X.
KÔÚ›ÙÛÈ ËÏÈΛ·˜ 18 ÌËÓÒÓ, ¿Û¯Ô˘Û· ·fi ÂÙÂÚfi˙˘ÁË-‚ ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È ¤ÏÏÂÈ„Ë G-6PD ÂÌÊ¿ÓÈÛ ‰ÂÚÌ·Ù›Ùȉ· ÛÙË ÌËÚÔ˚ÁÓȷ΋ Î·È ÙËÓ ÔÛÊ˘˚΋ ¯ÒÚ·, ηıÒ˜ Î·È ÛÙÔ ÙÚȯˆÙfi Ù˘ ÎÂÊ·Ï‹˜. H ·ÁˆÁ‹ Ô˘ Û˘ÓÂÛÙ‹ıË ·fi ‰ÂÚÌ·ÙÔÏfiÁÔ ‰ÂÓ Â¤ÊÂÚ η̛· ‚ÂÏÙ›ˆÛË. ™Â ÂͤٷÛË ÚÔ˘Ù›Ó·˜ ÛÙÔ Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ÙÔ˘ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËΠfiÙÈ ÂÎÙfi˜ ·fi ÙË ‰ÂÚÌ·Ù›Ùȉ·, ÂÌÊ¿ÓÈ˙ ÛÏËÓÔÌÂÁ·Ï›· (ÂÚ›Ô˘ 10 ÂηÙÔÛÙ¿), ‰È¿Ù·ÛË Ù˘ ÎÔÈÏÈ¿˜ Î·È ¤ÓÙÔÓË ÔÏ˘‰È„›·. M Èı·Ó‹ ‰È¿ÁÓˆÛË ÙËÓ ÈÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans ˘Ô‚Ï‹ıËΠ۠ϋÚË ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, Ì ·Ï¤˜ ·ÎÙÈÓÔÁڷʛ˜, ˘ÔÏÔÁÈÛÙÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ·ÔÎÏ›ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ˘ÂÚÛÏËÓÈÛÌfi Î·È ÙËÓ Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. OÈ ·/· ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È Ë ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· η٤‰ÂÈÍ·Ó ÔÏϷϤ˜ ÔÛÙÂÔÏ˘ÙÈΤ˜ ÂÛٛ˜ Ì ηٷÛÙÚÔÊ‹ Ù˘ ‰ÈÏfi˘ Î·È ÙˆÓ ÂÙ¿ÏˆÓ ¯ˆÚ›˜ ÛÎÏËÚ˘ÓÙÈο fiÚÈ· (ÂÈÎfiÓ· 1). H ·/· Î·È Ë ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›·
1 2
B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ∞¶£ ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞
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EÈÎfiÓ· 1. AÏ‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ ÚÈÓ ·fi ÙËÓ ·ÁˆÁ‹. ¢È·ÎÚ›ÓÔÓÙ·È Â˘ÌÂÁ¤ıÂȘ ÔÛÙÂÔÏ˘ÙÈΤ˜ ÂÚÈÔ¯¤˜ ¯ˆÚ›˜ ÛÎÏËÚ˘ÓÙÈο fiÚÈ·.
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IÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans
ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ η٤‰ÂÈÍ·Ó Î·ı›˙ËÛË Î·È ÛÊËÓÔÂȉ‹ ·Ú·ÌfiÚʈÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘ Ì ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ÌÂÛÔÛÔÓ‰˘Ï›ˆÓ ‰›ÛÎˆÓ Î·È ·Ô˘Û›· Ì¿˙·˜ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ (ÂÈÎfiÓ· 2). H Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI) ¤‰ÂÈÍ ¿¯˘ÓÛË Î·È ¤ÓÙÔÓÔ ÂÌÏÔ˘ÙÈÛÌfi ÙÔ˘ Ì›Û¯Ô˘ Ù˘ ˘fiÊ˘Û˘, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¿ÔÈÔ˘ ‰È·‚‹ÙË (ÂÈÎfiÓ· 3). H ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË Ù˘ IÛÙÈÔ·ÙÙˆÛ˘ ·fi ·ÙÙ·Ú· Langerhans. T¤ıËΠ۠·ÁˆÁ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÛÙ·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (VP16,VBL,6MP, PDN, MTX) Û‡Ìʈӷ Ì ÂȉÈÎfi ÚˆÙfiÎÔÏÏÔ (1). H ¯ËÌÂÈÔıÂڷ›· Û˘ÌÏËÚÒıËΠ̠·ÎÙÈÓÔ‚ÔÏ›· ÙÔ˘ ÎÚ·Ó›Ô˘ Û 6 Û˘Ó‰ڛ˜. H ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›· ‹Ù·Ó ı·̷ÙÈ΋, ·ÊÔ‡ ÔÈ Ï˘ÙÈΤ˜ ÂÛٛ˜ ÛÙÔ ÎÚ·Ó›Ô ·ÔηٷÛÙ¿ıËηÓ, ÂÎÙfi˜ ·fi ¤Ó· ÌÈÎÚfi ¤ÏÏÂÈÌÌ· ·ÚÈÛÙÂÚ¿ ÎÚÔÙ·ÊÈο. O £12 ÛfiÓ‰˘ÏÔ˜ ·ÔηٷÛÙ¿ıËΠÛËÌ·ÓÙÈο ÙfiÛÔ ˆ˜ ÚÔ˜ ÙÔ ‡„Ô˜ fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙË Û‡ÛÙ·ÛË (ÂÈÎfiÓ· 4). O ¿ÔÈÔ˜ ‰È·‚‹Ù˘ ÂϤÁ¯ÂÙ·È ÈηÓÔÔÈËÙÈο Ì ÙË ¯Ú‹ÛË ÂÈÛÓÂfiÌÂÓÔ˘ Û΢¿ÛÌ·ÙÔ˜ ¢ÂÛÌÔÚÂÛ›Ó˘ (Defirin) 0,05mg x2/ Ë̤ڷ.
EÈÎfiÓ· 2. AÏ‹ ·ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÚÈÓ ·fi ÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. K·ı›˙ËÛË ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘.
EÈÎfiÓ· 3. M·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ˘ÔʇÛˆ˜. O‚ÂÏÈ·›Ô Â›Â‰Ô T1W1, ÌÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·Ú·Ì·ÁÓËÙÈ΋˜ Ô˘Û›·˜. ¶·Ú·ÙËÚÂ›Ù·È ·ıÔÏÔÁÈ΋ ¿¯˘ÓÛË Î·È ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ Ì›Û¯Ô˘ Ù˘ ˘fiÊ˘Û˘.
™˘˙‹ÙËÛË H IÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans, Ô˘ ̤¯ÚÈ ÚfiÛÊ·Ù· ·Ó·ÊÂÚfiÙ·Ó ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ ÈÛÙÈÔ·ÙÙˆÛË-X, ÂÎÊÚ¿˙ÂÈ ÙȘ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ Ô˘ ÛÙ· ÚÔËÁÔ‡ÌÂÓ· ¯ÚfiÓÈ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó ÛÙÔ˘˜ fiÚÔ˘˜ "HˆÛÈÓfiÊÈÏÔ ÎÔÎΛˆÌ·", ÓfiÛÔ˜ HandSchueller-Christian Î·È ÓfiÛÔ˜ Abt-Letterer-Siwe. K·È ÔÈ ÙÚÂȘ ·Ûı¤ÓÂȘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È‹ıËÛË ÙˆÓ
EÈÎfiÓ· 4. AÏ‹ ·ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂڷ›·˜. ™·Ê‹˜ ‚ÂÏÙ›ˆÛË ÙÔ˘ ‡„Ô˘˜, ÙÔ˘ Û¯‹Ì·ÙÔ˜ Î·È ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙÔ˘ £12 ÛÔÓ‰‡ÏÔ˘.
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ÚÔۂ‚ÏËÌ¤ÓˆÓ ÈÛÙÒÓ Ì ÈÛÙÈÔ·ÙÙ·Ú· (2). T· ÈÛÙÈÔ·ÙÙ·Ú· Â›Ó·È ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· Ì ʷÈÓfiÙ˘Ô Î˘ÙÙ¿ÚˆÓ Langerhans, Ù· ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È Ê˘ÛÈÔÏÔÁÈο ÛÙÔ ‰¤ÚÌ·. H ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·, ΢ڛˆ˜ fï˜ Û ·È‰È¿ ·fi 1-3 ¯ÚÔÓÒÓ. ¶ÚÔÛ‚¿ÏÏÂÈ ÔÔÈÔ‰‹ÔÙ fiÚÁ·ÓÔ ‹ ÈÛÙfi, ÛÙ· ÔÔ›· Ê˘ÛÈÔÏÔÁÈο ·Ó¢ڛÛÎÔÓÙ·È ÌÔÓÔ‡ÚËÓ· Ê·ÁÔ·ÙÙ·Ú·. MÔÚ› Ó· ÚÔÛ‚ÏËı› ÙÔ ‰¤ÚÌ· (·ÙÙ·Ú· Langerhans), Ù· ÔÛÙ¿ (ÔÛÙÂÔÎÏ¿ÛÙ˜), ÙÔ ‹·Ú (·ÙÙ·Ú· Kupffer) Ô ÂÁΤʷÏÔ˜ (ÌÈÎÚÔÁÏÔȷο ·ÙÙ·Ú·),ÙÔ ·›Ì· (ÌÔÓÔ·ÙÙ·Ú·), Ô ÛÏ‹Ó·˜, Ô ı‡ÌÔ˜, ÔÈ ÏÂÌÊ·‰¤Ó˜, Ù· ̷Ϸο ÌfiÚÈ·, Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ (ÈÛÙÈο Ì·ÎÚÔÊ¿Á·) Î·È ÔÈ Ó‡ÌÔÓ˜ (΢„ÂÏȉÈο Ì·ÎÚÔÊ¿Á·) (3). H ÓfiÛÔ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚¿ÏÂÈ Û¯Â‰fiÓ Î¿ı fiÚÁ·ÓÔ, Ì ·ÎfiÏÔ˘ıÔ Ó· ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈο Ì ÔÈÎÈÏ›· Û˘Ìو̿وÓ. X·Ú·ÎÙËÚ›˙ÂÙ·È: ·) ˆ˜ ÌÔÓÔÂÛÙȷ΋, ·Ó ÂΉËÏÒÓÂÙ·È Ì ÌÔÓ‹ÚË ÔÛÙÈ΋ ·ÏÏÔ›ˆÛË, ‹ ÂÓÙÔÈṲ̂ÓË ‰ÂÚÌ·ÙÈ΋ ‰È‹ıËÛË ‹ Ì ÚÔÛ‚ÔÏ‹ ÂÓfi˜ ÏÂÌÊ·‰¤Ó·, ‚) ˆ˜ ÔÏ˘ÂÛÙȷ΋, ·Ó ÂΉËÏÒÓÂÙ·È Ì ÔÏϷϤ˜ ÔÛÙÈΤ˜ Ï˘ÙÈΤ˜ ÂÛٛ˜ ‹ ÚÔÛ‚ÔÏ‹ ÔÏÏ·ÏÒÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È Á) ˆ˜ ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋, ·Ó ÚÔÛ‚ÏËıÔ‡Ó ÔÏÏ¿ fiÚÁ·Ó· Ù·˘Ùfi¯ÚÔÓ·. T· ÚÔÛ‚ÏËı¤ÓÙ· fiÚÁ·Ó· Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÌÊ·Ó›˙Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ Ó· ‰˘ÛÏÂÈÙÔ˘ÚÁÔ‡Ó. ™˘¯ÓfiÙÂÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È Ù· ÔÛÙ¿ (79%) Î·È ÙÔ ‰¤ÚÌ· (25%). AÎÔÏÔ˘ıÔ‡Ó ÙÔ ‹·Ú (11%), Ô ÛÏ‹Ó·˜ (9%), Ù· ·˘ÙÈ¿, ÔÈ Ó‡ÌÔÓ˜, Ë ˘fiÊ˘ÛË (¿ÔÈÔ˜ ‰È·‚‹Ù˘), ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È Ù· Ì¿ÙÈ· (4). ŸÙ·Ó Ë ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È Ì ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ·ÔÎÏÂÈÛıÔ‡Ó ¿ÏϘ ·ı‹ÛÂȘ fiˆ˜ Ë ‰ÂÚÌ·Ù›Ùȉ· ·fi Ù· Û¿ÚÁ·Ó· Î·È Ë ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·. H ˘fiÓÔÈ· Ù˘ ‡·Ú͢ ¿ÔÈÔ˘ ‰È·‚‹ÙË, ··ÈÙ› ¿ÓÙÔÙ ÙË ‰ÈÂÚ‡ÓËÛË Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI), ÁÈ· Ó· ·ÔÎÏÂÈÛıÔ‡Ó fiÁÎÔÈ ÙÔ˘ KN™ Ì ‰È‹ıËÛË Ù˘ ˘fiÊ˘Û˘. H ÚÔÛ‚ÔÏ‹ ÙˆÓ ÔÛÙÒÓ ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈο ·Ó¿ÏÔÁ· Ì ÙÔ ÛËÌÂ›Ô Ù˘ ÚÔÛ‚ÔÏ‹˜. ŸÙ·Ó ÚÔÛ‚¿ÏÏÂÙ·È Ë ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË, Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÂΉËψı› Ì fiÓÔ Î·È Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ ·fi ›ÂÛË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. H ·ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ó· ·ÔÎÏÂÈÛıÔ‡Ó fiÁÎÔÈ Î·È ¿ÏϘ ·ı‹ÛÂȘ Ù˘ ÂÚÈÔ¯‹˜ Ô˘ ÂΉËÏÒÓÔÓÙ·È
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-11-99 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-11-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘ µ’ ¶·È‰. ∫ÏÈÓÈ΋ ∞¶£ ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË
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Ì ·ÚfiÌÔÈ· Û˘Ìو̷ÙÔÏÔÁ›·. H ›ÌÔÓË ‰ÂÚÌ·Ù›Ùȉ· ÛÙË ‰È΋ Ì·˜ ·ÛıÂÓ‹ Ô˘ ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó ·ÓÂÈÙ˘¯Ò˜ Ì ʷÚ̷΢ÙÈο Û΢¿ÛÌ·Ù· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi ·fi ÙÔ ÔÔ›Ô ÂÓÙÔ›ÛÙËÎÂ Ë ÔÏ˘Ô˘Ú›· Î·È Ë ÔÏ˘‰È„›· ηıÒ˜ ›Û˘ Î·È Ë ‰ÈfiÁΈÛË ÙˆÓ ˘Ô¯ÔÓ‰Ú›ˆÓ ÛÏ¿¯ÓˆÓ Ì·˜ Ô‰‹ÁËÛ·Ó ÛÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË. H ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÔÈΛÏÂÈ ·Ó¿ÏÔÁ· Ì ÙË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘. AÛıÂÓ›˜ Ì ÌÔÓÔÂÛÙȷ΋ ÓfiÛÔ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·˘ÙfiÌ·ÙË ‡ÊÂÛË Î·È ÁÂÓÈο ηÏÔ‹ıË ÔÚ›·. OÛÙÈΤ˜ Ï˘ÙÈΤ˜ ÂÛٛ˜ ΢ڛˆ˜ ÛÙË ™.™, Ì ΛӉ˘ÓÔ ·˘ÙfiÌ·ÙÔ˘ ηٿÁÌ·ÙÔ˜, ‹ Ì ¤ÓÙÔÓÔ fiÓÔ Û˘Ó‹ıˆ˜ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ ¤Á¯˘ÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÙÔÈο, ‹ ¯·ÌËÏ‹˜ ‰fiÛ˘ ·ÎÙÈÓÔ‚ÔÏ›· (5). AÛıÂÓ›˜ Ì ÚÔÛ‚ÔÏ‹ ÌÔÓ‹ÚÔ˘˜ ÏÂÌÊ·‰¤Ó· ‹ Ì ÂÓÙÔÈṲ̂ÓË ÙÔÈ΋ ‰È‹ıËÛË ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÂÈÙ˘¯Ò˜ Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜. ¶·È‰È¿ Ì ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ ıÂڷ‡ÔÓÙ·È Û‹ÌÂÚ· Ì ÙË ¯Ú‹ÛË ÂÓÙ·ÙÈÎÒÓ ¯ËÌÂÈÔıÂڷ¢ÙÈÎÒÓ ÚˆÙÔÎfiÏψÓ. H ¯Ú‹ÛË Ù˘ ÂÙÔÔÛ›‰Ë˜, Ù˘ ÌÂıÔÙÚÂÍ¿Ù˘, Ù˘ ‚ÈÓÌÏ·ÛÙ›Ó˘, Ù˘ ÌÂÚηÙÔÔ˘Ú›Ó˘ Î·È Ù˘ Ú‰ÓÈ˙fiÓ˘ ÛÂ Û˘Ó‰˘·ÛÌfi, ·‡ÍËÛ ÙËÓ ÂÈ‚›ˆÛË ÛÙÔ 79% ÙˆÓ ·È‰ÈÒÓ Û ·ÓÙ›ıÂÛË Ì ٷ Û˘ÓÙËÚËÙÈο ÚˆÙfiÎÔÏÏ·, Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÔ›ˆÓ ÂÈÙ‡Á¯·Ó ÂÈ‚›ˆÛË ÛÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ (1). BÈ‚ÏÈÔÁÚ·Ê›· 1. Gadner H, Heitger A, Grois N, Gatterer-Menz I, Ladisch S. Treatment strategy for disseminated Langerhans cell histiocytosis. DAL HX-83 Study Group. Med Pediatr Oncology 1994;23: 72-80. 2. Linchtenstein L. Histiocytosis X; integration of eosinophilic granulation of bone, Letterer-Siwe Disease and SchuellerChristian disease as related manifestations of a single nosologic entity. Arch Pathol 1953; 56-84. 3. Groopman J, Golde D. The histiocytic disorders; a pathophysiologic analysis. Ann Intern Med 1981; 94-95. 4. Gadner H, Grois N. Langerhans cell histiocytosis In: Voute PA, Kalifa C, Barre A, eds. Cancer in children, clinical management. SIOP 4th edition Oxford University Press, 1998:154-169. 5. Engeler RM,Neglia JP, Puccetti DM, Brennan CA, Nesbit ME. Association of Langerhans cell histiocytosis with malignant neoplasms. Cancer (1993);71: 865-873.
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¶∞π¢π∞∆ƒπ∫∏ 2000;63:63
¶ƒ∞∫∆π∫∂™ O¢∏°π∂™ ∆OÀ ¶∞π¢π∞∆ƒOÀ ™∆OÀ™ °O¡∂π™
TÔ ÂÓ‰ÔÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡ KÒÛÙ·˜ ¶Ú›ÊÙ˘ H ÊÚÔÓÙ›‰· ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡ ¤¯ÂÈ Í¯ˆÚÈÛÙ‹ ÛËÌ·Û›·. M¤Û· ÛÙÔ Û›ÙÈ ÂÚÓ¿ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÙÔ˘ 24ÒÚÔ˘ Î·È Â›Ó·È ÁÓˆÛÙfi fiÙÈ Û˘ÁÎÂÎÚÈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜ ÙÔ˘ ÂÓ‰ÔÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ˆ˜ ˘Â‡ı˘ÓÔÈ ÁÈ· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ·È‰ÈÎÒÓ ·ÏÏÂÚÁÈÒÓ. O ·Ú¿ÁÔÓÙ·˜ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· Â›Ó·È Ô Î·Ófi˜ ÙÔ˘ ÙÛÈÁ¿ÚÔ˘. E›Ó·È ÁÓˆÛÙfi fiÙÈ ÁÈ· Ó· ÚÔÛٷهÛÔ˘Ì ٷ ·È‰È¿ ·fi ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Û οÔÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ Î·È Ó· ÂÏ·ÙÙÒÛÔ˘Ì ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÛıÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ, Ú¤ÂÈ ÔÈ ÂÓ‹ÏÈÎÔÈ Ó· ·‡ÛÔ˘Ì ӷ ηӛ˙Ô˘ÌÂ. ¶Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Ë Î·‡ÛË Ì¤Û· ÛÙÔ ‰ˆÌ¿ÙÈÔ ÂÙÚÂÏ·›Ô˘, Î¿Ú‚Ô˘ÓÔ˘, ͇ÏÔ˘ Î·È ·Ú·Ê›Ó˘, ÁÈ·Ù› ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙË Û˘ÁΤÓÙÚˆÛË ÂÚÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ. N· ·ÔʇÁÔÓÙ·È ÔÈ ˘ÁÚ·ÓÙ‹Ú˜ ÁÈ·Ù› ‰ËÌÈÔ˘ÚÁÔ‡Ó Û˘Óı‹Î˜ ¢ÓÔ˚Τ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·Î¿ÚÂˆÓ Î·È ÙˆÓ Ì˘Î‹ÙˆÓ. N· ·ÔʇÁÂÙ·È Â›Û˘ Ë ˘ÁÚ·Û›· ÛÙÔ˘˜ ÙÔ›¯Ô˘˜, Ù·‚¿ÓÈ·, ‰¿Â‰· Î·È Ó· Ï·Ì‚¿ÓÔÓÙ·È Ì¤ÙÚ· ÂÚÈÔÚÈÛÌÔ‡ Ù˘. XÚÂÈ¿˙ÂÙ·È Î·Ïfi˜ ·ÂÚÈÛÌfi˜ ÙÔ˘ ÛÈÙÈÔ‡. H ·Ó·Ó¤ˆÛË ÙÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ·¤Ú· ÛÙ· ηÈÓÔ‡ÚÁÈ· ÎÙ›ÚÈ· Ô˘ ¤¯Ô˘Ó ηϋ ÌfiÓˆÛË Î·È ‰ÈÏ¿ ·Ú¿ı˘Ú· Â›Ó·È ÂÏÏÈ‹˜. T· Ê›ÏÙÚ· ·¤Ú· ÌÂÈÒÓÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ¿Ú· Î·È ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. OÈ ÈÔÓÈÛÙ¤˜ ›Ûˆ˜ ‚ÔËıÔ‡Ó, ·Ó Î·È ıˆÚÂ›Ù·È fiÙÈ ·˘Í¿ÓÔ˘Ó Ù· ›‰· ÙÔ˘ fi˙ÔÓÙÔ˜ Ô˘ ÌÔÚ› Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ ÂÚÂıÈÛÙÈο. ™˘ÓÈÛÙ¿Ù·È Û¯ÔÏ·ÛÙÈÎfi˜ ·ÂÚÈÛÌfi˜ ÙˆÓ ÎÏÈÓÔÛηÛÌ¿ÙˆÓ ÂÂȉ‹ Ù· ·Î¿Ú· ˆ˜ ·ÚÈ· ÙÚÔÊ‹ ÙÔ˘˜ ¤¯Ô˘Ó ÙÔ ˘ÏÈÎfi Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ·ÔϤÈÛË Ù˘ ÂȉÂÚÌ›‰·˜ ÙˆÓ ·ÓıÚÒˆÓ. BÚ›ÛÎÔÓÙ·È Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ÂΛ Ô˘ Û˘ÁÎÂÓÙÚÒÓÂÙ·È ÛÎfiÓË. T· ¤ÈÏ· Ó· Â›Ó·È Ì ·Ï¤˜ ÁÚ·Ì̤˜, ¯ˆÚ›˜ ÔÏÏ¿ ·ÓÙÈΛÌÂÓ· Ô˘ Û˘ÁÎÚ·ÙÔ‡Ó ÛÎfiÓË. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÚÈÛÛfiÙÂÚÔ ˘ÁÈÂÈÓÒÓ Û˘ÓıËÎÒÓ ÛÙÔ Û›ÙÈ ÙÔ˘ ·ÏÏÂÚÁÈÎÔ‡ ·È‰ÈÔ‡, ÚÔÙ›ÓÔ˘Ì ÙȘ ·Ú·Î¿Ùˆ Ô‰ËÁ›Â˜: 1. ¢È·Îfi„Ù ÙÔ Î¿ÓÈÛÌ· Î·È ÌËÓ ÂÈÙÚ¤ÂÙ Û ¿ÏÏÔ˘˜ Ó· ηӛ˙Ô˘Ó fiÙ·Ó ÂÈÛΤÙÔÓÙ·È ÙÔ Û›ÙÈ Û·˜. 2. EÍ·ÛÊ·Ï›ÛÙ ·Ú΋ ·ÂÚÈÛÌfi ÙÔ˘ ÛÈÙÈÔ‡. 3. AÂÚ›˙ÂÙÂ Î·È ÏÈ¿˙ÂÙ ٷ ÎÏÈÓÔÛοÛÌ·Ù· ηıËÌÂÚÈÓ¿, ϤÓÂÙ¤ Ù· Ì η˘Ùfi ÓÂÚfi (>55ÔC) οı 7-10 Ë̤Ú˜. 4. MËÓ ¤¯ÂÙ ÔÏÏ¿ ·ÓÙÈΛÌÂÓ· ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡. •ÂÛÎÔÓ›˙ÂÙ ÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘ ηıËÌÂÚÈÓ¿ (Óˆfi ÍÂÛÎÔÓfi·ÓÔ). XÚËÛÈÌÔÔț٠ËÏÂÎÙÚÈ΋ ÛÎÔ‡· οı ‚‰ÔÌ¿‰· (Ó· Ï›ÂÈ ·fi ÙÔ Û›ÙÈ ÙÔ ·È‰›). 5. °È· ÙÔ ‰¿Â‰Ô Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ ÙÔ Í‡ÏÔ Î·È ÙÔ Ï·Î¿ÎÈ. MËÓ ÙÔ Î·Ï‡ÙÂÙ Ì ÌÔΤٷ ·fi ÙÔ›¯Ô Û ÙÔ›¯Ô. 6. H ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ ηٿ ÙÔ˘˜ „˘¯ÚÔ‡˜ Ì‹Ó˜ Ó· Â›Ó·È Ì¤¯ÚÈ 18ÔC Î·È Ë Û¯ÂÙÈ΋ ˘ÁÚ·Û›· ̤¯ÚÈ 50% (ȉ·ÓÈ΋ 25-40%). ¢ÂÓ Û˘ÓÈÛÙÒÓÙ·È Ù· ·ÂÚfiıÂÚÌ·. K·Ï‡ÙÂÚ· Â›Ó·È Ù· ËÏÂÎÙÚÈο ÛÒÌ·Ù· Î·È Ù· ηÏÔÚÈʤÚ. ¶ÚÔÙÈÌ¿Ù·È Ë ÂÓ‰Ô‰·¤‰È· ı¤ÚÌ·ÓÛË. 7. MË ¯ÚËÛÈÌÔÔț٠˘ÁÚ·ÓÙ‹Ú·. EϤÁÍÙ ÙȘ ÛˆÏËÓÒÛÂȘ (Ì¿ÓÈÔ˘-ÎÔ˘˙›Ó·˜) ÁÈ· Ù˘¯fiÓ ‰È·ÚÚÔ¤˜. MËÓ ¤¯ÂÙÂ Ê˘Ù¿ ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘ Ô˘ Û˘ÓÙËÚÔ‡Ó ˘ÁÚ·Û›·. 8. MËÓ ¤¯ÂÙ ˙Ò· (.¯. Á¿Ù·) ̤۷ ÛÙÔ Û›ÙÈ. AÓ ·˘Ùfi Â›Ó·È ·‰‡Ó·ÙÔÓ, ϤÓÂÙ¤ Ù· Û˘¯Ó¿. AÔÌ·ÎÚ‡ÓÂÙ ٷ Ô˘Ô˘Ï¤ÓÈ· Ì·ÍÈÏ¿ÚÈ·.
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∂¶π™∆O§∂™ ∞ÁˆÁ‹ ˘Á›·˜ ™Î¤ÊÙËη fiÙÈ ÔÈ Û˘Ó¿‰ÂÏÊÔ› Ì·˜ ı· ‹ıÂÏ·Ó Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙËÓ ÚˆÙÔÔÚȷ΋ ̤ıÔ‰Ô ·ÁˆÁ‹˜ ˘Á›·˜ Ô˘ ÔÚÁ·ÓÒÓÂÈ ÙÔ EıÓÈÎfi ™‡ÛÙËÌ· YÁ›·˜ (NHS) ÛÙË BÚÂÙ·Ó›·. MÈ· Ê›ÏË ÌÔ˘, Ô˘ Â›Ó·È ÔÈÎÔÁÂÓÂȷ΋ ÁÈ·ÙÚfi˜ ÛÙËÓ AÁÁÏ›·, ÌÔ˘ ¤ÛÙÂÈÏ ÙȘ ¢¯¤˜ Ù˘ ÁÈ· ÙË ÁÈÔÚÙ‹ ÌÔ˘ Û ηÚÙÔÛÙ¿Ï ÙÔ˘ NHS Ô˘ ÂÈÛ˘Ó¿ÙÂÙ·È.
H οÚÙ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔÓ "Î. AÓÙÈ‚ÈÔÙÈÎfi" Ó· ·ÚÓÂ›Ù·È Ó· ¤̂ÂÈ Û ̇ÙË Ô˘ ÛÙ¿˙ÂÈ. TÔ Ì‹Ó˘Ì· ÁÚ¿ÊÂÈ "T· ·ÓÙÈ‚ÈÔÙÈο ¢EN ¢OY§EYOYN ÛÙ· ÎÚ˘ÔÏÔÁ‹Ì·Ù·... Ô‡Ù ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‚‹¯· Î·È ÔÓfiÏ·ÈÌÔ˘. NHS". ™ÙÔ ›Ûˆ ̤ÚÔ˜, ÂΛ Ô˘ Ô ·ÔÛÙÔϤ·˜ ÁÚ¿ÊÂÈ ÙÔ Ì‹Ó˘Ì¿ ÙÔ˘, ÁÚ¿ÊÂÈ Ì ÈÔ ÌÈÎÚ¿ ÁÚ¿ÌÌ·Ù· "T· ÎÚ˘ÔÏÔÁ‹Ì·Ù· Î·È ÔÏϤ˜ ÊÔÚ¤˜ Ô ‚‹¯·˜ Î·È Ô ÔÓfiÏ·ÈÌÔ˜ ÔÊ›ÏÔÓÙ·È Û ÈÔ‡˜, Î·È Ù· ·ÓÙÈ‚ÈÔÙÈο ‰ÂÓ ‚ÔËıÔ‡Ó Î·ıfiÏÔ˘. T· ·ÓÙÈ‚ÈÔÙÈο ۯ‰ȿÛÙËÎ·Ó ÁÈ· ÙË ıÂڷ›· ÙˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ fiˆ˜ Â›Ó·È Ë Ó¢ÌÔÓ›·. ŸÔÙ ¯ÚÂÈ·ÛÙÔ‡Ó, ÌËÓ ·ÓËÛ˘¯Â›˜, Ô ÁÈ·ÙÚfi˜ ÛÔ˘ ı· ÛÔ˘ ÁÚ¿„ÂÈ ÌÈ· Û˘ÓÙ·Á‹ ÁÈ· ·ÓÙÈ‚ÈÔÙÈο. °È· ÙÔÓ ·Ïfi ‚‹¯·, ÎÚ˘ÔÏfiÁËÌ· ‹ ÔÓfiÏ·ÈÌÔ fï˜, Ë Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ÔÏÏ¿ ˘ÁÚ¿ Î·È ÍÂÎÔ‡Ú·ÛË. K·È ÌË Í¯¿ÛÂȘ fiÙÈ ÌÔÚ›˜ Ó· ¿ÚÂȘ οÔÈ· ¿ÏÏ· Ê¿Ú̷η ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ Û˘Ìو̿وÓ. Z‹ÙËÛ ÙË Û˘Ì‚Ô˘Ï‹ ÙÔ˘ Ê·ÚÌ·ÎÔÔÈÔ‡. NHS". ™›Ó· N¿ÎÔ˘ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ª. ∞Û›·˜ 76, 115 27 ∞ı‹Ó·
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¶ÔÈfi˜ ‰ÈηÈÔ‡Ù·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ Û˘ÁÁڷʤ·; ...MÈ· ·fi ÙȘ ÛΤ„ÂȘ Ô˘ ¤¯ˆ οÓÂÈ Â›Ó·È fiÙÈ ›Ûˆ˜ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏËÊı› ÛÙȘ Ô‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Î¿ÔÈÔ˜ ÂÚÈÔÚÈÛÌfi˜ ÛÙÔÓ ·ÚÈıÌfi ÙÔ˘˜ .¯. fiÙÈ ı· ‹Ù·Ó ÂÈı˘ÌËÙfi Ó· ÌËÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ 6. E¿Ó Â›Ó·È ÂȂ‚ÏË̤ÓË Ë Û˘ÌÌÂÙÔ¯‹ ÂÚÈÛÛfiÙÂÚˆÓ, 8 Â›Ó·È ÓÔÌ›˙ˆ ¤Ó·˜ ÏÔÁÈÎfi˜ ·ÚÈıÌfi˜. ÿÛˆ˜ ı· ¤Ú ӷ ·ÎÔÏÔ˘ı‹ÛÂÈ Î¿ÔÈÔ Û¯fiÏÈÔ ÁÈ·Ù› Î·È ÔÈfi˜ ı· ¤Ú ӷ ÔÓÔÌ¿˙ÂÙ·È Û˘ÁÁڷʤ·˜. Y¿Ú¯ÂÈ ·ÁÎÔÛÌ›ˆ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÁÈ· ÙÔ ÔÈÔ˜ Ú¤ÂÈ Ó· ¯·Ú·ÎÙËÚ›˙ÂÙ·È “Û˘ÁÁڷʤ·˜” Û ÌÈ· ÌÂϤÙË. E›Ó·È Ô fiÚÔ˜ Û˘Ó-Û˘ÁÁڷʤ·˜ ‹ Û˘Ó-ÂÚ¢ÓËÙ‹˜ ÈÔ ‰fiÎÈÌÔ˜; ∆È ÛËÌ·›ÓÂÈ Û˘ÌÌÂÙÔ¯‹ Û ÌÈ· ÌÂϤÙË; ™‡Ìʈӷ Ì ÙË ‰ÈÂıÓ‹ EÈÙÚÔ‹ EΉÔÙÒÓ I·ÙÚÈÎÒÓ ¶ÂÚÈÔ‰ÈÎÒÓ(1), ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ Û˘ÁÁڷʤ· ‰ÈηÈÔ‡ÓÙ·È fiÛÔÈ ÏËÚÔ‡Ó ÙȘ ·ÎfiÏÔ˘ı˜ ÚÔ¸Ôı¤ÛÂȘ: ·) Û‡ÏÏË„Ë Î·È Û¯Â‰È·ÛÌfi˜ ÌÂϤÙ˘ ‹ ·Ó¿Ï˘ÛË Î·È ÂÎÙ›ÌËÛË ‰Â‰ÔÌ¤ÓˆÓ ‚) ۯ‰ȷÛÌfi˜ Î·È ÎÚÈÙÈ΋ ·Ó·ÛÎfiËÛË ÙÔ˘ ¿ÚıÚÔ˘ ÁÈ· ÙËÓ Ô˘Û›· ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Á) ÙÂÏÈ΋ ÂȉÔÎÈÌ·Û›· ÙÔ˘ ¿ÚıÚÔ˘ ÁÈ· ‰ËÌÔÛ›Â˘ÛË. §fiÁÔÈ fiˆ˜ Ë “·Ó¿ÁÎË” ÁÈ· “‚Ô‹ıÂÈ·” ÂÓfi˜ Ó¤Ô˘ Û˘Ó·‰¤ÏÊÔ˘, ‹ Ë ·ÚÔ¯‹ ·ÛıÂÓÒÓ Î·È ÙˆÓ ÈÛÙÔÚÈÎÒÓ ÙÔ˘˜ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÛÙÔÓ Û¯Â‰È·ÛÌfi ‹ ÙËÓ ‰ÈÂÎÂÚ·›ˆÛË Ù˘ ÌÂϤÙ˘ ‰ÂÓ ‰ÈηÈÔÏÔÁÔ‡Ó Î·Ù¿ ÁÂÓÈ΋ ÔÌÔÏÔÁ›· ÙÔÓ ¯·Ú·ÎÙËÚÈÛÌfi ÙÔ˘ Û˘ÁÁڷʤ·. O Gulio J d’ Angio(2) ÂΉfiÙ˘ ÙÔ˘ Medical and Pediatric Oncology ÙÔ ¤ıÂÛ Ôχ ˆÚ·›· fiÙÈ ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô‰ËÁÔ‡Ó Û ۇÌʈÓÔ Û˘ÁÁڷʤˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Ó-Û˘ÁÁÚ·Ê›˜ Ó· ˘ÂÚ‚·›ÓÔ˘Ó Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙË ÌÂϤÙË ·ÛıÂÓÒÓ. O ›‰ÈÔ˜ ÂΉfiÙ˘ ηÏ› ÙÔ˘˜ ¢È¢ı˘ÓÙ¤˜ TÌËÌ¿ÙˆÓ Ó· ·Ó·ıˆڋÛÔ˘Ó ÙËÓ Ú·ÎÙÈ΋ Ù˘ ·Ó·ÊÔÚ¿˜ ÙÔ˘˜ Û·Ó Û˘Ó-Û˘ÁÁÚ·Ê›˜ fiÙ·Ó ·˘Ùfi Â›Ó·È ·fiÚÚÔÈ· Ù˘ ı¤Û˘ Î·È fi¯È Ù˘ Ô˘ÛÈ·ÛÙÈ΋˜ Û˘ÌÂÙÔ¯‹˜ ÙÔ˘˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi, ‰ÈÂÎÂÚ·›ˆÛË Î·È Û˘ÁÁÚ·Ê‹ Ù˘ ÌÂϤÙ˘. K·Ù·Ï‹ÁÂÈ ‰Â fiÙÈ Ô Û˘Ó-Û˘ÁÁڷʤ·˜ Ú¤ÂÈ Ó· Â›Ó·È Î·È Û˘Ó-ÂÚ¢ÓËÙ‹˜. E›Ó·È ηχÙÂÚ· Ó· ·ÔÊ¢¯ı› Ë ‰ËÌÈÔ˘ÚÁ›· Ù˘ ΢ÓÈ΋˜ ÓÔÔÙÚÔ›·˜ ÛÙÔ˘˜ Ó¤Ô˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÁÈ· “free rides” Ô˘ Û ÂχıÂÚË ÌÂÙ¿ÊÚ·ÛË ÛËÌ·›ÓÂÈ Û˘ÁÁڷʤ·˜ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈ΋ Û˘Ì‚ÔÏ‹. M ÂÎÙ›ÌËÛË ™Ù¤ÏÏ· AÓ‰ÚÔÓ›ÎÔ˘ AÓ. K·ıËÁ‹ÙÚÈ· TÔ̤·˜ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¶·ÓÂÈÛÙ‹ÌÈÔ Iˆ·ÓÓ›ÓˆÓ T.£. 1186 45332 Iˆ¿ÓÓÈÓ·
1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. NEJM 1997;337:309-315. 2. D’ Angio G. J Multiple authorship (Editorial) Medical and Pediatric Oncology, 1998.
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¶∞π¢π∞∆ƒπ∫∏ E¡∏ª∂ƒø™∏ ¶AI¢IATPIKH - AÔÏÔÁÈÛÌfi˜ 1999
¶AI¢IATPIKH, 1998; ÙfiÌÔ˜ 61, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ 1. K˘ÎÏÔÊfiÚËÛ ÙÔÓ M¿ÚÙÈÔ 1999 Ì 15 Ù›ÙÏÔ˘˜, 125 ÛÂÏ›‰Â˜ Î·È ıÂÌ·ÙÔÏÔÁ›· ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ™˘ÓÙ·ÎÙÈ΋ ÂÈ̤ÏÂÈ· X. KÒÛÙ·ÏÔ˜, K. ¶Ú›ÊÙ˘, A. X·Ù˙‹˜. ¶AI¢IATPIKH, 1999; ÙfiÌÔ˜ 62, T‡¯Ë 6. - K˘ÎÏÔÊÔÚ›·: EÌÚfiıÂÛÌË. ™˘Ó‹ıˆ˜, Ù‡¯Ë ·Ú·‰›‰ÔÓÙ·È ÛÙ· ÁÚ·Ê›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ÙÔ ÚÒÙÔ ‰Âη‹ÌÂÚÔ ÙÔ˘ ‰ÈÌ‹ÓÔ˘ ÛÙÔ ÔÔ›Ô ·ÓÙÈÛÙÔȯ› ÙÔ Ù‡¯Ô˜ Î·È ·Ú·Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙÔ˘˜ Û˘Ó‰ÚÔÌËÙ¤˜ Ù·¯˘‰ÚÔÌÈο ÙÔ ÙÚ›ÙÔ ‰Âη‹ÌÂÚÔ. - ™ÂÏ›‰Â˜: 510 - T›ÙÏÔÈ: 119 (54 ÚˆÙÔÁÂÓ›˜ ÂÚÁ·Û›Â˜) ¶›Ó·Î·˜ 1
¶›Ó·Î·˜ 1. AÚÈıÌfi˜ Î·È Â›‰Ô˜ ¿ÚıÚˆÓ Î·Ù¿ Ù‡¯Ô˜ (¶AI¢IATPIKH, TfiÌÔ˜ 62, 1999) E›‰Ô˜ ¿ÚıÚÔ˘
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË ÕÏÏ· ™‡ÓÔÏÔ
ŒÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ‰ËÌÔÛȇÔÓÙ·È ¿ÚıÚ· Ì ÙÔ ›‰ÈÔ ı¤Ì· ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜. Afi 105 ΛÌÂÓ· Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÙÔ 1999, Ù· 36 ‹Ù·Ó ηÙfiÈÓ ÚÔÛÎÏ‹Ûˆ˜ ›Ù ÁÈ· Ó· Û¯ÔÏÈ·ÛÙ› οÔÈ· ÂÚÁ·Û›· (K¿ÓÈÛÌ·, ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ 6Ô Ù‡¯Ô˜, AÈÌÔÚ·ÁÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ 1Ô, AÏÏÂÚÁ›· ·fi Ê˘ÛÈÎfi Ï¿ÛÙÈ¯Ô ÛÙÔ 2Ô Î.¿.) ›Ù ÁÈ· Ó· Î·Ï˘Êı› ¤Ó· ›ηÈÚÔ ı¤Ì· (¶·È‰È¿ ÙÔ˘ ÔϤÌÔ˘, ·È‰È¿ ·ÏÏÔ‰·ÒÓ ÚÔÛʇÁˆÓ ÛÙËÓ EÏÏ¿‰·, ‰ÈÔ͛Ә ÛÙÔ 4Ô Ù‡¯Ô˜. N· ÌË Ì¿ıÔ˘Ì ӷ ˙ԇ̠·ıËÙÈο Ì ÙÔ˘˜ ÛÂÈÛÌÔ‡˜ ÛÙÔ 5Ô Î.¿.).
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
- ™˘ÁÁÚ·Ê›˜: 258, ÔÈ 52 Ì 2-7 Ù›ÙÏÔ˘˜. EÙ¿ ·fi ÙȘ 30 ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 6 Û˘ÁÁÚ·Ê›˜ Î·È 8 ÛÙȘ 18 ÂÚÈÁڷʤ˜ ÂÚÈÙÒÛÂˆÓ ˘ÔÁÚ¿ÊÔÓÙ·È ·fi ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 5 Û˘ÁÁÚ·Ê›˜.(‚Ϥ ÂÈÛÙÔÏ‹ ÛÂÏ. 65 Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜). - M¤ÛÔ˜ ¯ÚfiÓÔ˜ ·¿ÓÙËÛ˘ ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙȘ ÚÔÙÂÈÓfiÌÂÓ˜ ‰ÈÔÚıÒÛÂȘ: 38 Ë̤Ú˜. - BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜: 1807, ·fi ·˘Ù¤˜ 35 ÛÙËÓ ¶AI¢IATPIKH Î·È 162 Û ¿ÏÏ· ÂÏÏËÓÈο ÂÚÈÔ‰Èο. ™ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È ÁÈ· ÙÔ˘˜ ÎÚÈÙ¤˜ Ë ¶AI¢IATPIKH ‰ËÏÒÓÂÈ fiÙÈ ‰˘ÛÎÔχÂÙ·È Ó· ‰Â¯ı› ÂÚÁ·Û›Â˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÏÏËÓÈΤ˜ ·Ú·Ô̤˜. H ÊÚ¿ÛË “ÂÎ Ù˘ ÚÔÛÈÙ‹˜ ÚÔ˜ ËÌ¿˜ ‚È‚ÏÈÔÁÚ·Ê›·˜” ηٷÚÁ‹ıËΠÁÈ· ÙËÓ Í¤ÓË ‚È‚ÏÈÔÁÚ·Ê›· ·fi ÙfiÙ Ԣ ˘¿Ú¯ÂÈ Â‡ÎÔÏË ÚfiÛ‚·ÛË ÛÙÔ Medline. TÒÚ· Â›Ó·È ÚÔÛÈÙ‹ ηٿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ Î·È Ë ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ̤ۈ IATPOTEK (www.mednet.gr/iatrotek) Î·È ÔÈ ÂÏÏËÓÈΤ˜ ‰ËÌÔÛȇÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ ̤ۈ “IPI™” (www.ich.gr). BϤ ÛÂÏ. 86 Î·È ÛÂÏ. 71. H ¤ÏÏÂÈ„Ë ÂÏÏËÓÈÎÒÓ ·Ó·ÊÔÚÒÓ ‰ÂÓ ÌÔÚ› È· Ó· ‰ÈηÈÔÏÔÁÂ›Ù·È ˆ˜ ·‰˘Ó·Ì›·. X·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÚÈÊÚfiÓËÛË ÚÔËÁÔ‡ÌÂÓÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ Ô˘ ‰ÂÓ Ú¤ÂÈ Ô ·È‰È·ÙÚÈÎfi˜ ÎfiÛÌÔ˜ Ó· ÙËÓ ÂÈÙÚ¤ÂÈ. - M¤ÛÔ˜ ¯ÚfiÓÔ˜ ·fi ÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜ ̤¯ÚÈ ÙËÓ ¤ÁÎÚÈÛË/·fiÚÚÈ„Ë: 5 Ì‹Ó˜. - XÚfiÓÔ˜ ·fi ÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜ ̤¯ÚÈ ÙË ‰ËÌÔÛ›Â˘ÛË: M¤ÛÔ˜ ¯ÚfiÓÔ˜ 8,26 Ì‹Ó˜, 25% ÙˆÓ ¿ÚıÚˆÓ ‰ËÌÔÛȇÙËÎ·Ó Û ÏÈÁfiÙÂÚÔ ·fi 6 Ì‹Ó˜, 50% Û 6 ̤¯ÚÈ 10 Ì‹Ó˜ Î·È 25% Û ÂÚÈÛÛfiÙÂÚÔ ·fi 10 Ì‹Ó˜. - KÚÈÙ¤˜: ™ÙÔ ‰È¿ÛÙËÌ· 1-1-1999 ̤¯ÚÈ 15-12-1999 Ë ¶AI¢IATPIKH ˙‹ÙËÛ 147 ÎÚ›ÛÂȘ ·fi 81 ÎÚÈÙ¤˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ 11 ÌÂÏÒÓ Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ (35 ÎÚÈÙ¤˜ ÚfiÛÊÂÚ·Ó 2-6 ÎÚ›ÛÂȘ). BϤ ÔÓÔÌ·ÛÙÈÎfi ηٿÏÔÁÔ ÛÂÏ. 68 Î·È Û¯ÂÙÈÎfi ¿ÚıÚÔ Û‡ÓÙ·Í˘ ÛÂÏ. 2-6. OÈ ÎÚ›ÛÂȘ ÂÈÛÙÚ¿ÊËÎ·Ó ÛÙËÓ ¶AI¢IATPIKH 5-138 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘˜. AÓ·Ï˘ÙÈο ÂÈÛÙÚ¿ÊËηÓ: 38% Û ÏÈÁfiÙÂÚÔ ·fi 30 Ë̤Ú˜, 26% Û 30-60, 21% Û 61-90, 15% Û ÂÚÈÛÛfiÙÂÚÔ ·fi 90 Ë̤Ú˜. K·Ù¿ ÂÚ›ÙˆÛË ÌÂϤÙË ÙˆÓ ÎÚ›ÛÂˆÓ Ô˘ ηı˘ÛÙ¤ÚËÛ·Ó ¤Ú·Ó ÙˆÓ ÙÚÈÒÓ ÌËÓÒÓ, ·ÔηχÙÂÈ ÛÂ Û˘ÓÙÚÈÙÈÎfi ÔÛÔÛÙfi ‰˘ÛÎÔÏ›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÎÚÈÙÒÓ Ó· ‰È·Ù˘ÒÛÔ˘Ó ·ÔÚÚÈÙÈΤ˜ ÎÚ›ÛÂȘ ‹ ÚÔÛ¿ıÂÈ· Ó· ÛÎÂÊÙÔ‡Ó ÙÚfiÔ˘˜ ÚÈ˙È΋˜ ·Ó·ÌfiÚʈÛ˘ Ù˘ ˘fi ÎÚ›ÛË ÂÚÁ·Û›·˜ ÒÛÙ ӷ Á›ÓÂÈ ‰ËÌÔÛȇÛÈÌË. OÈ ÎÚÈÙ¤˜ Ô˘ ηı˘ÛÙÂÚÔ‡Ó ÙȘ ÎÚ›ÛÂȘ ÂÎ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·‰ÈηÈÔÏfiÁËÙ· Â›Ó·È ÂÏ¿¯ÈÛÙÔÈ. - KÚ›ÛÂȘ: OÈ ÂÈ̤ÚÔ˘˜ ÎÚ›ÛÂȘ ¤ÁÈÓ·Ó ·Ô‰ÂÎÙ¤˜ Û ÔÛÔÛÙfi 80%. H ÔÚıfiÙËÙ· ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ ÙˆÓ ÎÚÈÙÒÓ Î·È ÙÔ ÂÊÈÎÙfi ÙˆÓ ˙ËÙÔ‡ÌÂÓˆÓ ÙÚÔÔÔÈ‹ÛÂˆÓ ·ÌÊÈÛ‚ËÙ‹ıËΠ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 20% Î·È 25%, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙÂÎÌËÚȈ̤ӷ. H ÂÁ΢ÚfiÙËÙ· ÙˆÓ ÎÚÈÙÒÓ ·ÌÊÈÛ‚ËÙ‹ıËΠ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ‰‡Ô ÂÚÈÙÒÛÂȘ. - EÚÁ·Û›Â˜ Ô˘ ·ÔÚÚ›ÊıËηÓ/·ÔÛ‡ÚıËηÓ: 8 H ·fiÚÚÈ„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÂÎÙfi˜ ÂÏ¿¯ÈÛÙˆÓ ÂÍ·ÈÚ¤ÛˆÓ, ‰ÂÓ ÔÊ›ÏÂÙ·È Û ¯·ÌËÏ‹ ÔÈfiÙËÙ· Ù˘ ÂÚÁ·Û›·˜ ·ÏÏ¿ Û ·Ù˘¯Â›˜ Û˘ÁÎ˘Ú›Â˜ .¯. ·Ó·ÛÎfiËÛË ˘„ËÏfiÙ·ÙÔ˘ ÂȤ‰Ô˘ ‰ÂÓ ¤ÁÈÓ ‰ÂÎÙ‹ ÁÈ·Ù› ¤Êı·Û ÛÙ· ÁÚ·Ê›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÂÓÒ Â›¯Â ‹‰Ë ÂÁÎÚÈı› ÌÂÙ¿ ·fi ÔÏϤ˜ ÙÚÔÔÔÈ‹ÛÂȘ ¿ÏÏË ·Ó·ÛÎfiËÛË ÛÙÔ ›‰ÈÔ ı¤Ì·. - EΉÔÙÈο Ï¿ıË/·ÚÔÚ¿Ì·Ù·: ™Â ÙÚ›· Ù‡¯Ë ¤ÁÈÓ·Ó ÛÔ‚·Ú¿ ÂΉÔÙÈο Ï¿ıË (Ï¿ıÔ˜ ÎÂÊ·Ï›‰· Û ÂÚÁ·Û›·, ÌË ‰ËÌÔÛ›Â˘ÛË ÈÓ¿ÎˆÓ Î·È ÂÈÎfiÓ·˜, ÌË ‰ËÌÔÛ›Â˘ÛË ıÂÌ·ÙÈÎÔ‡ ηٷÏfiÁÔ˘ ÙÔ˘ Û˘ÌÏËڈ̷ÙÈÎÔ‡ Ù‡¯Ô˘˜ ÙÔ˘ 1998). T· Ï¿ıË Û ¿ÏÏ· Ù‡¯Ë ‹Ù·Ó ÌÈÎÚfiÙÂÚ˘ ÛËÌ·Û›·˜. - ™˘ÓÂÚÁ·Û›· Ì E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.: AÚÌÔÓÈ΋
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
- °Ú·ÌÌ·ÙÂȷ΋ ˘ÔÛÙ‹ÚÈÍË: Õ„ÔÁË. H ΢ڛ· PԇϷ ¢¿Ó·ÛË Ù‹ÚËÛ ÌÂ Û˘Ó¤ÂÈ·, Û¯ÔÏ·ÛÙÈÎfiÙËÙ·, ˘ÔÌÔÓ‹ Î·È ÂÈÌÔÓ‹, ÙÔ ·Ú¯Â›Ô ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÙÔ˘˜ ʷΤÏÔ˘˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÙËÓ ·ÏÏËÏÔÁÚ·Ê›·, “ÛÙ¿ÛË ÙÛÈÌÔ˘ÚÈÔ‡” Ì ÙÔ˘˜ ÎÚÈÙ¤˜ Ô˘ ηı˘ÛÙÂÚÔ‡Ó, “ÛÙ¿ÛË K¤Ú‚ÂÚÔ˘” Ì ÙÔ˘˜ Û˘ÓÙ¿ÎÙ˜ Ô˘ ·Ó·Î·ÙÂ‡Ô˘Ó ÙÔ˘˜ ʷΤÏÏÔ˘˜ Î·È ÛÙ¿ÛË “¢OMH™” Ì fiÛÔ˘˜ ı¤ÙÔ˘Ó ÔÔÈÔ‰‹ÔÙ ÂÚÒÙËÌ· (fiÙ ı· Á˘Ú›ÛÂÈ Ô X ÎÚÈÙ‹˜ ·fi ÙÔ Û˘Ó¤‰ÚÈÔ,ÔÈÔ˜ ¤ÎÚÈÓ ÙÈ, fiÙÂ Î·È ÁÈ·Ù› ηı˘ÛÙ¤ÚËÛÂ, ÔÈÔ ÙÔ ÌÈÎÚfi fiÓÔÌ· ÙÔ˘ Û˘ÁÁڷʤ· æ, Û ÔÈÔ ÓÔÛÔÎÔÌÂ›Ô ÂÚÁ¿˙ÂÙ·È ÙÒÚ· Ë Î˘Ú›· Xæ ÎÏ ÎÏ.). - ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ T· ̤ÏË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ÌÔÈÚ¿ÛÙËÎ·Ó ÙÔ Û˘ÓÙ·ÎÙÈÎfi ¤ÚÁÔ. ™˘ÌÌÂÙ›¯·Ó ÛÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÙˆÓ Ù¢¯ÒÓ, ÛÙËÓ ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ, ÛÙËÓ ÂÈÏÔÁ‹ ıÂÌ¿ÙˆÓ, Û˘ÁÁڷʤˆÓ Î·È ÎÚÈÙÒÓ, ÛÙȘ ·ÔÊ¿ÛÂȘ ÁÈ· ÙËÓ ÌÔÚÊ‹ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÛÙË ‰È·ÌfiÚʈÛË ÂÛˆÙÂÚÈÎÔ‡ ηÓÔÓÈÛÌÔ‡ ÏÂÈÙÔ˘ÚÁ›·˜, Ô‰ËÁÈÒÓ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ. AÊÈ¤ÚˆÛ·Ó ÛÙËÓ ¶AI¢IATPIKH ¯ÚfiÓÔ ·Ô‰ÔÙÈÎfi Î·È Ôχ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙȘ 12 ÙÚ›ˆÚ˜ Û˘Ó‰ÚÈ¿ÛÂȘ Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜. 18.12.1999 EϤÓË B·Ï¿ÛÛË-A‰¿Ì ¢È¢ı˘ÓÙ‹˜ Ù˘ E.™.E.
Κριτές 1999 Aθανασιάδου-Πιπεροπούλου Φανή Aθανασίου-Mεταξά Mιράντα Aϊβάζης Bίκτωρας Aναγνωστάκης ∆ηµήτριος Aναστασέα-Bλάχου Kαλλιόπη Aνδρονίκου Στυλιανή Aντύπας Σπύρος Aντωνιάδου-Kουµάτου Iωάννα Aρώνη-Bουρνά Σοφία Bαλάσση-Aδάµ Eλένη Bατόπουλος Aλκιβιάδης Bοσκάκη-Bούλγαρη Eιρήνη Γαλανάκης Eµµανουήλ Γιαννούλια-Kαραντανά Aγλαΐα Γιουρούκος Σωτήριος Γκατζόλα Mάγδα Γυφτοδήµου-Kαράγιωργα Γιολάντα ∆ελλαγραµµάτικας Hρακλής ∆ρόσου-Aγακίδου Bασιλική Zέης Πέτρος Zερβός Γεράσιµος Θεοδωρίδης Xαράλαµπος Kαβαζαράκης Eµµανουήλ Kαλπογιάννης Nικόλαος Kαράγιωργα-Λαγανά Mαρκησία Kαραµπούλα Aικατερίνη Kαρανίκας Hλίας
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Kαρής Xρίστος Kαρπάθιος Θεµιστοκλής Kασσιού-Προύντζου Kυριακή Kατσαρού-Πεκτασίδη Eυσταθία Kαττάµης Xρήστος Kαφάτος Aντώνης Kίτσιου-Tζέλη Σοφία Kοντόπουλος Eλευθέριος Kοσµίδη-Bασιλάτου Eλένη Λαµπαδαρίδης Iωάννης Mαθιουδάκης Iωάννης Mανταγός Στέφανος Mανωλάκη Nίνα Mιχελακάκη Eλένη Mπαζίγου-Φωτοπούλου Eλένη Mπαζοπούλου Eυτέρπη Mπαρτσόκας Xρήστος Mπένος Aλέξανδρος Mπλάκµπερν-Nάκου Σίνα Nούσια-Aρβανιτάκη Σάντα Ξάνθου Mαριέτα Παναγιωτόπουλος Tάκης Παπαβασιλείου Στάθης Παπαγρηγορίου-Θεοδωρίδου Mαρία Παπαδάτου ∆ανάη Παπαδηµητρίου Aναστάσιος Παπαδοπούλου Φρειδερίκη
Παπαχατζή-Kαλµαντή Mαρία Παπαχρήστου Φώτιος Πετρίδου-Σκαλκίδου Eλένη Pούσσου Eιρήνη Pώµα-Γιαννίκου Eλευθερία Σαξώνη-Παπαγεωργίου Φωτεινή Σαραφίδου Γιασεµή Σκαρδούτσου Aγγελική Σκεντέρης Nίκος Σούλπη Kλεοπάτρα Σπηλιώτη-Γκρέκα Bασιλική Σπυρίδης Παναγιώτης Σταµογιάννου-Mαυροειδή Λέλα Στεφανίδης Kωνσταντίνος Συρίγου-Παπαβασιλείου Aντιγόνη Συριοπούλου Bασιλική Συρογιαννόπουλος Γεώργιος Tούντας Iωάννης Tσαγκαροπούλου-Στίγγα Hρακλεία Tσανίρα Eιρήνη Tσίτουρα Στέλλα Tσόλας Γεώργιος Φρετζάγιας Aνδρέας Xαροκόπος Eυστάθιος Xατζηµιχάλης Σωκράτης Ψύχου-Kόρκα Φωτεινή
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
EÈÛÎfiËÛË EÏÏËÓÈÎÔ‡ I·ÙÚÈÎÔ‡ ¶ÂÚÈÔ‰ÈÎÔ‡ T‡Ô˘ 1999 ÁÈ· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ ηٷÏÔÁÔÁÚ·ÊÔ‡ÓÙ·È ·fi ÙÔ ÂÈÙÂÏÂ›Ô ÙÔ˘ IÓÛÙÈÙÔ‡ÙÔ˘ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÙË ‚¿ÛË IPI™ (IPI™ B¿ÛË EÏÏËÓÈ΋˜ BÈ‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡, ¶AI¢IATPIKH 1999,62:247 Î·È 2000,63:71-74). ŸÔÈÔ˜ ÂӉȷʤÚÂÙ·È ÁÈ· ÙË Û¯ÂÙÈ΋ EÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂÈÎÔÛ·ÂÙ›·˜, ÌÔÚ› Ó· οÓÂÈ ıÂÌ·ÙÈ΋ ·Ó·˙‹ÙËÛË Ì ϤÍÂȘ ÎÏÂȉȿ Î·È ·Ó·˙‹ÙËÛË Û˘ÁÁڷʤˆÓ, ›Ù ÂÈÎÔÈÓˆÓfiÓÙ·˜ Ì ÙÔ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÙËÏÂʈÓÈο (01-7719733), Ì fax (01-7700111), e-mail (inchildh@otenet.gr) ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ‹ ·Â˘ı›·˜ ̤۷ ·fi ÙÔ ‰È·‰›ÎÙ˘Ô (www.ich.gr). °È· Ó· ¤¯Ô˘Ó ÔÈ ·Ó·ÁÓÒÛÙ˜ Ù˘ ¶AI¢IATPIKH™ ÌÈ· ÁÂÓÈÎfiÙÂÚË ÂÔÙ›· Ù˘ ·È‰È·ÙÚÈ΋˜ Û˘ÁÁÚ·ÊÈ΋˜ ·Ú·ÁˆÁ‹˜ ·Ú·ı¤ÙÔ˘Ì ÂÓËÌÂÚˆÙÈο ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ÂÈÛËÌ¿ÓıËÎ·Ó ÛÙ· Ù‡¯Ë ÙˆÓ ·Ú·Î¿Ùˆ ÂÚÈÔ‰ÈÎÒÓ Ô˘ ›¯·Ó ΢ÎÏÔÊÔÚ‹ÛÂÈ Ì¤¯ÚÈ 20 ¢ÂÎÂÌ‚Ú›Ô˘ 1999. I·ÙÚÈ΋, IÔ‡ÏÈÔ˜ 1999 Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜, M¿ÈÔ˜-IÔ‡ÓÈÔ˜ 1999, EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›·, AÚ›ÏÈÔ˜-IÔ‡ÓÈÔ˜ 1999 M·È¢ÙÈο XÚÔÓÈο, IÔ‡ÏÈÔ˜-™Â٤̂ÚÈÔ˜ 1999 °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘, I·Ó-IÔ‡ÓÈÔ˜ 1999 ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜, I·Ó-ºÂ‚Ú-M¿ÚÙÈÔ˜ 1999, ¢ÂÏÙ›Ô A’ ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, AÚ›ÏÈÔ˜ -IÔ‡ÓÈÔ˜ 1999, ¶·È‰Ô‰ÔÓÙ›·, AÚ›ÏÈÔ˜ - IÔ‡ÓÈÔ˜ 1999. YÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙ· ·Ú·¿Óˆ ÂÚÈÔ‰Èο ‰ËÌÔÛȇÔÓÙ·È ÂÙËÛ›ˆ˜ ÂÚ›Ô˘ 100 ¿ÚıÚ· Ô˘ ÂӉȷʤÚÔ˘Ó ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜. A˘Ù¿, Ì·˙› Ì ÙȘ ÂÚ›Ô˘ 100 ‰ËÌÔÛȇÛÂȘ ÛÙËÓ ¶AI¢IATPIKH ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÚ›Ô˘ 80% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Ó·ÊÔÚÒÓ ÛÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡, ÛÙÔÓ ÂÏÏËÓÈÎfi ‚ÈÔ˚·ÙÚÈÎfi ÂÚÈÔ‰ÈÎfi Ù‡Ô. ™Ù· Ù‡¯Ë ÙˆÓ ·Ú·¿Óˆ ÂÚÈÔ‰ÈÎÒÓ ÂÈÛËÌ¿Ó·Ì 48 ¿ÚıÚ· Û¯ÂÙÈο Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡. (29 Û ·È‰È·ÙÚÈο ÂÚÈÔ‰Èο Î·È 19 Û ¿ÏÏ·).
EÚÁ·Û›Â˜ (13) - ¢ËÏËÙËÚÈ¿ÛÂȘ ·fi ‰‹ÁÌ·Ù· ÊȉÈÒÓ ÛÙËÓ EÏÏ¿‰·. K ºÔ˘ÓÙ¿˜, ¶ BÏ¿¯Ô˜, H B·ÏÙ‹, E T˙ÒÏ·, E Z·ÊÂÈÚ›Ô˘. I·ÙÚÈ΋ 1999;75: 503-507. - A˘ÍË̤ӷ ›‰· ‰ÂÈÎÙÒÓ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ·È‰È¿ Ì ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ º K·Ó·ÎÔ‡‰Ë-T۷ηϛ‰Ô˘, M. Aı·Ó·Û›Ô˘MÂÙ·Í¿, B. T˙ÈÌÔ‡ÏË, A. KÔ‡ÛË, A. T·¿ÚÎÔ˘, M TÚ·¯·Ó¿, I TÛ¿ÙÚ·. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:147-153. - ¶·ÓÂÏÏ·‰È΋ ÌÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. T ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜, E B·Ï¿ÛÛË-A‰¿Ì, E ™·Ú·Ê›‰Ô˘, A M·Ó‰¤ÎË, Z ™ÙÚ·Ù›ÎË, A M¤ÓÔ˜, ¢ A‰·Ì›‰Ë˜, A KÔ‡Ù˘, X §ÈÔÓ‹˜. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:154-162. - ¢ÈÂÚ‡ÓËÛË Ù˘ οıÂÙ˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ C. ° º·ÚÌ¿ÎË, B ¶··Â˘·ÁÁ¤ÏÔ˘, E K·‰¿, ° ¶··Â˘·ÁÁ¤ÏÔ˘. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:249-252. - AÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË ÌËÙÚÈ΋ ΢ÎÏÔÊÔÚ›· Ì ̷ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi, ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ¯ÚÒÛË Î·È FISH. A M·‡ÚÔ˘, A KÔÏȷϤÍË, ° TÛ·ÁοÚ˘, A AÓÙÛ·ÎÏ‹˜, E ¢·Ê¤ÚÌÔ˘, X TÛÂÁ΋, A MÂٷ͈ÙÔ‡. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:40-48. - °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔ Ê·ÈÓfiÙ˘Ô. ™ K›ÙÛÈÔ˘, E K·‚·˙·Ú¿Î˘, A TÛ¤-
˙Ô˘, A °·ÏÏ¿, ¢ °Ô˘ÚÁÈÒÙ˘, X £ÂÔ‰ˆÚ›‰Ë˜, X X·Ù˙Ëı·Ó·Û›Ô˘, X K·Ú‹˜, º ¶·ÙÛ·Ï‹˜, K ™ÈÛÌ¿ÓË, A ¶·Û·Ï¿ÎË, N MÔÛ¯ÔÓ¿˜. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:49-54. - EÈÔÏ·ÛÌfi˜ ÙÂÚˉfiÓ·˜ Î·È ·Ó¿ÁΘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÂÚ›ı·Ï„˘ ·È‰ÈÒÓ ËÏÈΛ·˜ -12 ÂÙÒÓ ÛÙËÓ ·Ó·ÙÔÏÈ΋ ·گ›· £Ë‚ÒÓ ÙÔ˘ ÓÔÌÔ‡ BÔȈٛ·˜. I º·Ó‰Ú›‰Ë˜, ¢ ¢ÂÏ‚ÂÓ·ÎÈÒÙ˘ ¶·È‰Ô‰ÔÓÙ›· 1999;13:55-63. - ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Û ·È‰È¿ ·fi ÙËÓ E˘ÚÒË Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙËÓ KÚ‹ÙË. E °·Ï·Ó¿Î˘, E ¶·Ú·Ûο΢, ™ MÔ˘ÎÔ˘‚·Ú¿Î˘, N K·Ù˙ËÏ¿Î˘, ™ ™Ì˘Ú¿ÎȘ. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999; 11: 28-31. - EȉËÌ›· ÈÏ·Ú¿˜ 1996: EÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ. X °È·ÓÓ·ÎÔÔ‡ÏÔ˘, X MfiÚ·, ¢ N·ÌÔÓÈÙÔ‡, B KÔ˘ÎÔ‡, § §È¿Ë, O °Ú·Ê¿ÎÔ˘, ¢ °Ô˘ÚÁÈÒÙ˘, ¢ AÏÂ͛Ԣ. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:32-36. - A˘ÙfiÌ·ÙË ‰È¿ÙÚËÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÛÙ· ÓÂÔÁÓ¿. ¢ AÓ·ÁÓˆÛÙfiÔ˘ÏÔ˜, • ™ÈÓˆ›‰Ë˜, K T˙È·Ì›Ú˘, M KÔÎÎfiÏË, X º·ÚÌ¿Î˘, X ¢ËÌfiÔ˘ÏÔ˜. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11: 37-39. - MÂϤÙË Ù˘ Ó·ÓÈ΋˜ ¯ÚfiÓÈ·˜ ·ÚıÚ›Ùȉ·˜ Û ŒÏÏËÓ˜. X ¢Ú¿ÎÔ˘, N KˆÛÙ·ÓÙÈÓ›‰Ô˘, A KˆÛÙ·ÓÙfiÔ˘ÏÔ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:78-83.
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- £Âڷ›· Î·È ÚfiÁÓˆÛË ÓÂÔÁÓÒÓ Ì ·Ú·Ì¤ÓÔ˘Û· Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË (¶¶Y) A °Ô‡Ó·Ú˘, A KˆÛÙ·ÓÙÈÓ›‰Ô˘, X ¶ÂÙÚÔÔ‡ÏÔ˘, N AÏÂ͛Ԣ, A X›˙·, I §·Ì·‰·Ú›‰Ë˜, X KÒÛÙ·ÏÔ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:84-88. - AÈÌÔÏ˘ÙÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ·ÓÔÛÔÔ›ËÛË ÛÙ· “ÂÏ¿ÛÛÔÓ·” ·ÓÙÈÁfiÓ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Rhesus T ™È·¯·Ó›‰Ô˘, N M¿Ó‰˘Ï·, X AÓ·ÛÙ·Û›Ô˘, ¢ AÓ·ÁÓˆÛÙ¿Î˘. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:89-94.
¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ (9) - MËÙÚÈ΋ Î·È Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË. ¶ T·Ì·ÎÔ‡‰Ë˜, º T˙‚ÂϤ΢, K PÒÛÈÔ˘, I K·Ï·¯¿Ó˘, ¶ MÈ˙›Ì˘, E AÓ·ÁÓÒÛÙÔ˘, ¶ ¶ÏÈ¿ÎË, E KÔÏ·Í›‰Ô˘, A AÓ‰Ú¤Ô˘, ™ M·ÓÙ·ÏÂÓ¿Î˘. EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1999;11(2)197-202. - º·ÈÓÔÙ˘È΋ ¤ÎÊÚ·ÛË Ù˘ ÌÂÙ¿ÏÏ·Í˘ P25OR ÙÔ˘ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ Û ·ÛıÂÓ‹ Ì ÔÈÎÔÁÂÓ‹ ÎÚ·ÓÈÔÛ˘ÓÔÛÙ¤ˆÛË. E ºÚ˘Û›Ú·, A K·˚‰¿Ú·, W Paznekas, E Wang Jabs, ¢ ¶··ı·Ó·Û›Ô˘ -KÏÒÓÙ˙·, E K·Ó·‚¿Î˘. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999; 1: 55-60. - A˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ· Û ¤Ó· ¤Ì‚Ú˘Ô Ì ·ÙÂÏ‹ ÔÛÙÂÔÁ¤ÓÂÛË Ù‡Ô˘ IIA. A K·ÒÓ˘, ° M·ÎÚ˘‰‹ÌÔ˜, ¢ §ÒÏ˘. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999;1:61-66. - Ÿ„ÈÌË ÂΉ‹ÏˆÛË ·Ó¿ÚÎÂÈ·˜ Ù˘ ÔÚÓÈıÈÓÔÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘-Û˘Û¯¤ÙÈÛË ÁÔÓfiÙ˘Ô˘ Ì ʷÈÓfiÙ˘Ô. ¶ A˘ÁÔ˘ÛÙ›‰Ô˘™·‚‚ÔÔ‡ÏÔ˘, ° K·Ù˙fi˜, M TÚ·¯·Ó¿. °ÂÓÂÙÈ΋ ÙÔ˘ AÓıÚÒÔ˘ 1999;1: 67-72. - ™˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÓ Ùˆ ‚¿ıÂÈ ÙÚ·¯ËÏÈÎÒÓ ·ÔÛÙËÌ¿ÙˆÓ M MÈÙÛÈÒÚË, I °ÂÚÌ·Ó¿Î˘, E °·Ï·Ó¿Î˘, I MÈ˙¿Î˘, M ¢·ÛηÏÔÁÈ·ÓÓ¿ÎË, E KfiÎÎÔÚË, ™ ™Ì˘Ú¿ÎȘ. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:52-54. - ™ÔÓ‰˘Ï›Ùȉ· Û ·È‰› Ì ‚ÚԢΤÏψÛË. A M·‡ÚË, A MÂÛÛ·ÚÈÙ¿ÎË, E K·‚·˙·Ú¿Î˘. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:56-58 - ¶ÂÚ›ÙˆÛË ·ÁÎÚ·ٛÙȉ·˜ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ¯ÚfiÓˆÓ. H °ÎÈÔ˘Ï¤Î·˜, ¶ K·Ú‰·Ú¿˜, K ™‡ÚÔÁÏÔ˘, I TÈÔ‡Ú˘. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999; 11:59-62. - ¢Â˘ÙÂÚÔ·ı‹˜ ·ÌËÓfiÚÚÔÈ· Î·È ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ Ë·Ù›Ùȉ· Û ·È‰› Ì ÓfiÛÔ Wilson. A °È·ÓÓÔ‡ÏÈ·-K·Ú·ÓÙ·Ó¿, £ °ÂˆÚÁ·ÎÔÔ‡ÏÔ˘, N M·ÓˆÏ¿ÎË, E X·ÚÔÎfiÔ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:95-98. - NfiÛÔ˜ Kawasaki Ì ÁÈÁ·ÓÙÈ·›· ·Ó¢ڇÛÌ·Ù· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ Î·È ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ E K·Ú·Ó¿ÛÈÔ˜, ° ¶··‰fiÔ˘ÏÔ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:99-103.
AÓ·ÛÎÔ‹ÛÂȘ-EÈÛËÁ‹ÛÂȘ- EÓËÌÂÚˆÙÈο ¿ÚıÚ· ÕÚıÚ· ™‡ÓÙ·Í˘ (26) - AÒÙÂÚÔÈ Î›Ó‰˘ÓÔÈ ·fi ÙÔÓ ÚfiˆÚÔ ÙÔÎÂÙfi. ¢ PÔ‡ÛÛÔ˜, ¢ ¶·Ó›‰Ë˜, M M·ÌfiÔ˘ÏÔ˜. EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1999; 11(2) 148-154. - ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Î·È ÂÁ΢ÌÔÛ‡ÓË: ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÁ·Ԣ Î·È Â›‰Ú·ÛË ÛÙÔ ¤Ì‚Ú˘Ô. ¢ PÔ‡ÛÛÔ˜, M M·ÌfiÔ˘ÏÔ˜. EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1999; 11(1) 44-52. - H ÂͤÏÈÍË Ù˘ ·ËÛ˘ Î·È Ë ˘Á›· ÙˆÓ ·È‰ÈÒÓ ·fi ÙȘ ÌÂıfi‰Ô˘˜ Ù˘ ‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜. ° °ÎÚÈÌ›˙˘. EÏÏËÓÈ΋ M·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1999;11(1) 89-96.
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
- KÔÈÏÈÔοÎË ÛÙËÓ ·È‰È΋ ËÏÈΛ·. E Mȯ·ËÏ›‰Ë, ¶ ¶·Û·Ï¿ÎË. I·ÙÚÈ΋ 1999;75:(2):290-297. - ¢È·ÙÚÔÊ‹ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ. M ¶··‰ËÌËÙÚ›Ô˘. I·ÙÚÈ΋ 1999;75(4):298-304 - ¶ÚÔÏ·Îٛӈ̷ ÛÙËÓ ÂÚÈÂÊË‚È΋ ËÏÈΛ·. K M·˘ÚÔ˘‰‹˜, ¶ ¶··¤ÙÚÔ˘. I·ÙÚÈ΋ 1999;75:155-160 - °ÂÓÂÙÈ΋ ÚԉȿıÂÛË ÛÙÔ ÓÂÊÚÔ‚Ï¿Ûو̷ Î·È ‰˘Ó·ÙfiÙËÙ˜ ÚÔÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ™ ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ -AÓ‰ÚÔ˘Ï·Î¿ÎË, º A AÓ‰ÚÔ˘Ï·Î¿Î˘. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:111-113. - °ÂÓÈΤ˜ ·Ú¯¤˜ Ú·ÁÌ·ÙÔÁÓˆÌÔÛ‡Ó˘ ·ÙÚfiÙËÙ·˜. T M·Ó‰·Ï¿ÎË-°È·ÓÓÈÙÛÈÒÙË, A °È·ÏÂÚ¿ÎË, A TÛÔ˘Î·Ï¿. Aگ›· EÏÏËÓÈ΋˜ I·ÙÚÈ΋˜ 1999;16:239-242. - ¢È·ÙÚÔÊ‹ ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡.TÔ Ó¤Ô Â›Ó·È ··Ú·›ÙËÙ· ηχÙÂÚÔ; X KÒÛÙ·ÏÔ˜. I·ÙÚÈ΋ 1999;75(6)482-486. - H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÌ·ÙÈÎÔ‡ ·È‰ÈÔ‡ ÛÙÔ Ô‰ÔÓÙÈ·ÙÚ›Ô. E TÛ·ÁηÚÔ˘Ï¿ÎË, A MfiÚÊË. ¶·È‰Ô‰ÔÓÙ›· 1999;13:64-70. - º˘Ì·ÙÈ҉˘ ÌfiÏ˘ÓÛË Î·È ÓfiÛÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· M EÌÔÚÈ¿‰Ô˘, K X·˚‰ÔÔ‡ÏÔ˘. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999; 11:15-24. - YÂÚ˯ÔÁÚ·ÊÈ΋ ÌÂϤÙË ÙÔ˘ ¯ÚfiÓÔ˘ Á·ÛÙÚÈ΋˜ ΤӈÛ˘ ‰‡Ô ‰È·ÊÔÚÂÙÈÎÒÓ Û ıÂÚÌ›‰Â˜ Á·Ï¿ÙˆÓ Û ÚfiˆÚ· ÓÂÔÁÓ¿. A °Ô‡Ó·Ú˘, E B·Ú¯·Ï·Ì¿, º KfiÎÎÔÚË, N AÏÂ͛Ԣ, X ¶ÂÙÚÔÔ‡ÏÔ˘, X KÒÛÙ·ÏÔ˜. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:25-27. - KÔÈÓˆÓÈ΋ ¤ÓÙ·ÍË ÙÔ˘ ·È‰ÈÔ‡ Ì ΢ÛÙÈ΋ ›ÓˆÛË. N ™ÎÂÓÙ¤Ú˘. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:40-44. - TÔ ·È‰› Ô˘ ‰ÂÓ ·Á·¿ ÙÔ Û¯ÔÏ›Ô. ¶ K·Ú‰·Ú¿˜, A M·Ï¿Ûη. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:45-51. - BÚ·¯Â›· ·Ó·ÛÎfiËÛË ÙÚ¤¯Ô˘Û·˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. I £ K·‚·ÏÈÒÙ˘. ¶·È‰È·ÙÚÈ΋ BÔÚ›Ԣ EÏÏ¿‰Ô˜ 1999;11:63-64. - £Âڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·ÈÌÔÛȉ‹ÚˆÛ˘ Î·È ·ÈÌԯڈ̿وÛ˘. X K·ÙÙ¿Ì˘. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:2-14. - ™‡Á¯ÚÔÓË ÌË ÂÂÌ‚·ÙÈ΋ ıÂڷ›· ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ X K·ÙÙ¿Ì˘. ¢ÂÏÙ›Ô ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:49-54. - K˘ÙÙ·ÚÈ΋ ·fiÙˆÛË Û ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·. ° £ TÛ·ÁοÚ˘. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:39-48. - £ÚÔÌ‚Ô΢ÙÙ¿ÚˆÛË Î·È ıÚÔÌ‚ÔÊÈÏ›· ÛÙ· ·È‰È¿ I ¶ ¶·Ó·ÁÈÒÙÔ˘. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:27-33. - æ˘¯ÔÏÔÁÈΤ˜ ÂÈÙÒÛÂȘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜. ¢ ¶¿ÓÈÙ˜. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:15-25. - ¢ÈÂÚ‡ÓËÛË ÎÔÈÏȷ΋˜ Ì¿˙·˜ ÛÙ· ·È‰È¿. A ° ¶Ô˘ÚÙÛ›‰Ë˜. ¢ÂÏÙ›Ô A’ ¶·È‰ A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:34-38. - IÛÙÈÔ·ÙÙˆÛË ·fi ·ÙÙ·Ú· Langerhans. E MÔψӿÎË. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:55-60. - ¶ÚˆÙÔ·ı‹ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. I ¶·Ó·ÁÈÒÙÔ˘, ™ ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ -AÓ‰ÚÔ˘Ï·Î¿ÎË. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:65-71. - ¶˘ÏˆÚÈ΋ ÛÙ¤ÓˆÛË £ °ÂˆÚÁ·ÎÔÔ‡ÏÔ˘, ¢ AÓ·ÁÓˆÛÙ¿Î˘. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:72-77 - XÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ Ì ÂÈÛÓÔ¤˜: B·ÛÈΤ˜ ·Ú¯¤˜ Î·È Û˘Û΢¤˜ ¯ÔÚ‹ÁËÛ˘ ™ MÔ˘ÛÌԢΛÏÈ·-NÙ·ÏÙ·ÁÈ¿ÓÓË. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:104-111. - OÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ·fi ÎÔÈÓˆÓÈ΋ ¿Ô„Ë A ¶··˚ˆ¿ÓÓÔ˘. ¢ÂÏÙ›Ô A’ ¶·È‰ KÏÈÓ ¶·Ó Aı 1999;46:111-114.
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IPI™-Online: B¿ÛË ÂÏÏËÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ http://www.ich.gr ¶·Ó·ÁÈÒÙ˘ A. KÔÎÎÈÓ›‰Ë˜ To IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (IY¶) ¤¯ÂÈ ‹‰Ë ·fi ÙÔ 1979 Û˘ÁÎÚÔÙ‹ÛÂÈ ÙËÓ ‚¿ÛË ÂÏÏËÓÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡. H ‚¿ÛË ·˘Ù‹ ÂÌÏÔ˘Ù›˙ÂÙ·È Û˘Ó¯Ҙ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ÁÈ· ÙȘ ÂÏÏËÓÈΤ˜ ‰ËÌÔÛȇÛÂȘ Û ÂÚÈÔ‰Èο Î·È Û˘Ó¤‰ÚÈ·. Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2000 Ë ‚¿ÛË ‰È·Ù›ıÂÙ·È on-line ÛÙÔÓ ·ÁÎfiÛÌÈÔ ÈÛÙfi (WWW) ÙÔ˘ Internet, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ÚfiÛ‚·ÛË Û ·˘Ù‹Ó Û ÔÔÈÔÓ‰‹ÔÙ ¯Ú‹ÛÙË ¤¯ÂÈ ÚfiÛ‚·ÛË ÛÙÔ Internet. OÈ ¯Ú‹ÛÙ˜ ÌÔÚÔ‡Ó Ó· οÓÔ˘Ó online ·Ó·˙ËÙ‹ÛÂȘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·˜ ‰È¿ÊÔÚ· ÎÚÈÙ‹ÚÈ· Î·È ÂÚÈÔÚÈÛÌÔ‡˜ Î·È Ó· ‰Ô˘Ó ÙȘ ÂÚÈÏ‹„ÂȘ ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ Ô˘ ‚Ú¤ıËηÓ. ™ÙËÓ ÂÈÎfiÓ· 1 Ê·›ÓÂÙ·È Ë ÊfiÚÌ· ·Ó·˙‹ÙËÛ˘, ÛÙËÓ ÔÔ›· Ô ¯Ú‹ÛÙ˘ ÚÔÛ‰ÈÔÚ›˙ÂÈ Ù· ÎÚÈÙ‹ÚÈ· Î·È ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·Ó·˙‹ÙËÛ˘.
∂ÈÎfiÓ· 1.
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
OÈ fiÚÔÈ ·Ó·˙‹ÙËÛ˘ ÌÔÚ› Ó· Â›Ó·È ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ. EÎÙfi˜ ·fi ÙËÓ ·Ú¿ıÂÛË ÙˆÓ fiÚˆÓ, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Î·È ÔÚÈṲ̂ÓÔ˘˜ ηÓfiÓ˜ ÁÈ· ÙËÓ ÏÔÁÈ΋ Ù˘ ·Ó·˙‹ÙËÛ˘. OÈ Î·ÓfiÓ˜ ·˘ÙÔ› ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiÙ·Ó ÔÈ fiÚÔÈ ·Ó·˙‹ÙËÛ˘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ÙÔ˘ ÂÓfi˜. EÍ' ÔÚÈÛÌÔ‡ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔÈ fiÚÔÈ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙË ÏÔÁÈ΋ ‰È¿˙¢ÍË (OR). E¿Ó ÌÚÔÛÙ¿ ·fi ÙÔÓ fiÚÔ ÙÔÔıÂÙËı› ÙÔ Û‡Ì‚ÔÏÔ +, ÙfiÙÂ Ô fiÚÔ˜ Á›ÓÂÙ·È ˘Ô¯ÚˆÙÈÎfi˜. AÓÙ›ıÂÙ· Â¿Ó ÌÚÔÛÙ¿ ·fi ÙÔÓ fiÚÔ ÚÔÛÙÂı› ÙÔ Û‡Ì‚ÔÏÔ -, Ô fiÚÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· ÂÚȤ¯ÂÙ·È ÛÙȘ ÂÁÁڷʤ˜ Ô˘ ı· ‚ÚÂıÔ‡Ó. °È· Ó· ÚÔÛ‰ÈÔÚÈÛıÔ‡Ó Û‡ÓıÂÙÔÈ fiÚÔÈ, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ‰ÈÏ¿ ÂÈÛ·ÁˆÁÈο. ™ÙÔÓ ›Ó·Î· 1 ‰›ÓÔÓÙ·È ·Ú·‰Â›ÁÌ·Ù· Î·È ÂÂÍËÁ‹ÛÂȘ ÁÈ· ÙË ¯Ú‹ÛË ÙˆÓ Û˘Ì‚fiψÓ.
¶›Ó·Î·˜ 1. ŸÚÔÈ ·Ó·˙‹ÙËÛ˘
AÔÙ¤ÏÂÛÌ· ·Ó·˙‹ÙËÛ˘
ÈÏ·Ú¿ ÂÚ˘ıÚ¿
ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" Î·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÂÚ˘ıÚ¿" (ÏÔÁÈÎfi OR) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" (ÚÒÙ˜ ÛÙ· ·ÔÙÂϤÛÌ·Ù· fiÛ˜ ·fi ·˘Ù¤˜ ¤¯Ô˘Ó Î·È ÙÔÓ fiÚÔ ÂÚ˘ıÚ¿) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" Î·È ÙÔÓ fiÚÔ "ÂÚ˘ıÚ¿" (ÏÔÁÈÎfi AND) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÈÏ·Ú¿" ÂÎÙfi˜ ·fi ·˘Ù¤˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "ÂÚ˘ıÚ¿" (ÏÔÁÈÎfi NOT) ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "·ıÔÏÔÁÈ΋" Î·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "·Ó·ÙÔÌÈ΋" ŸÏ˜ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ fiÚÔ "·ıÔÏÔÁÈ΋ ·Ó·ÙÔÌÈ΋"
+ÈÏ·Ú¿ ÂÚ˘ıÚ¿ +ÈÏ·Ú¿ +ÂÚ˘ıÚ¿ ÈÏ·Ú¿ -ÂÚ˘ıÚ¿ ·ıÔÏÔÁÈ΋ ·Ó·ÙÔÌÈ΋ "·ıÔÏÔÁÈ΋ ·Ó·ÙÔÌÈ΋"
§fiÁˆ ÙˆÓ ÁÚ·ÌÌ·ÙÈÎÒÓ Î·ÓfiÓˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ· Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛıÔ‡Ó fiÚÔÈ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ¿ÏÏË ÙÒÛË ·fi ·˘Ù‹Ó Ô˘ ¯ÚËÛÈÌÔÔÈ› Ô ¯Ú‹ÛÙ˘ (Û˘Ó‹ıˆ˜ ÙËÓ ÔÓÔÌ·ÛÙÈ΋). °È· ÙÔ ÏfiÁÔ ·˘Ùfi Û˘Ó›ÛÙ·Ù·È Ë ¯Ú‹ÛË Ù˘ Ú›˙·˜ ÙÔ˘ ·Ó·˙ËÙÔ‡ÌÂÓÔ˘ fiÚÔ˘ ¤ÙÛÈ ÒÛÙ ӷ ÌÂÁÈÛÙÔÔÈËı› Ë ÂÈÙ˘¯›· Ù˘ ·Ó·˙‹ÙËÛ˘. ¶.¯. ·ÓÙ› ÙÔ˘ fiÚÔ˘ "ÂÌ‚ÔÏÈ·ÛÌfi˜" ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Ô fiÚÔ˜ "ÂÌ‚ÔÏÈ", fiÔÙ ÛÙ· ·ÔÙÂϤÛÌ·Ù· ı· Û˘ÌÂÚÈÏËÊıÔ‡Ó Î·È ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔ˘˜ fiÚÔ˘˜ ÂÌ‚fiÏÈÔ, ÂÌ‚ÔÏ›ˆÓ, Î.Ï. EÎÙfi˜ ·fi ÙÔ˘˜ fiÚÔ˘˜ ·Ó·˙‹ÙËÛ˘ Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÌÈ· ÛÂÈÚ¿ ·fi ÂÚÈÔÚÈÛÌÔ‡˜. ¶ÚÒÙÔ˜ ÂÚÈÔÚÈÛÌfi˜ Â›Ó·È Ë ÂÚÈÔ¯‹ ·Ó·˙‹ÙËÛ˘. EÍ' ÔÚÈÛÌÔ‡ Ë ·Ó·˙‹ÙËÛË ÙˆÓ fiÚˆÓ Á›ÓÂÙ·È ÛÙÔÓ Ù›ÙÏÔ Î·È ÙȘ ϤÍÂȘ-ÎÏÂȉȿ ÙˆÓ ÂÁÁÚ·ÊÒÓ. EÓ·ÏÏ·ÎÙÈο Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· οÓÂÈ ÙËÓ ·Ó·˙‹ÙËÛË ÙÔ˘ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‹/Î·È ÛÙËÓ ÂÚ›ÏË„Ë ÙˆÓ ÂÁÁÚ·ÊÒÓ. H ·Ó·˙‹ÙËÛË ÙˆÓ fiÚˆÓ ÛÙËÓ ÂÚ›ÏË„Ë Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ¯ÚÔÓÔ‚fiÚ·. EÈϤÔÓ Ë ·Ó·˙‹ÙËÛË ÌÔÚ› Ó· ÂÚÈÔÚÈÛı› Û ¤Ó· ÌfiÓÔ ·fi Ù· ÂÚÈÔ‰Èο Ô˘ ηٷÏÔÁÔÁÚ·ÊÔ‡ÓÙ·È ÛÙË ‚¿ÛË. A˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÂÈϤÁÔÓÙ·˜ ÙÔÓ Ù›ÙÏÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ·fi ÙÔÓ Î·Ù¿ÏÔÁÔ. TÚ›ÙÔ˜ ÂÚÈÔÚÈÛÌfi˜ Â›Ó·È ÙÔ ¤ÙÔ˜ ‰ËÌÔÛ›Â˘Û˘. O ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ ÂÚ›Ô‰Ô Ô˘ ÙÔÓ ÂӉȷʤÚÂÈ, ÂÈÛ¿ÁÔÓÙ·˜ Ù· ¤ÙË ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ı¤ÛÂȘ Ù˘ ÊfiÚÌ·˜. T¤ÏÔ˜, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ fiÛ˜ ÂÁÁڷʤ˜ ı· ÂÌÊ·Ó›˙ÔÓÙ·È ·Ó¿ ÛÂÏ›‰· ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ.
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
∂ÈÎfiÓ· 2.
™ÙËÓ ÂÈÎfiÓ· 2 Ê·›ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ·Ó·˙‹ÙËÛ˘. °È· οı ÂÁÁÚ·Ê‹ Ô˘ ÈηÓÔÔÈ› Ù· ÎÚÈÙ‹ÚÈ· ·Ó·˙‹ÙËÛ˘ ‰›ÓÂÙ·È Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÊÔÚ¿. O ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ‰ÂÈ ÌÈ· ÂÚ›ÏË„Ë Î¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÙÔÓ Ù›ÙÏÔ Ù˘ ÂÁÁÚ·Ê‹˜. EÓ·ÏÏ·ÎÙÈο ÌÔÚ› Ó· ÂÈϤÍÂÈ ÌÈ· ÛÂÈÚ¿ ·fi ÂÁÁڷʤ˜ οÓÔÓÙ·˜ ÎÏÈÎ ÌÚÔÛÙ¿ ·fi ÙÔÓ Ù›ÙÏÔ Î·È ·ÎÔÏÔ‡ıˆ˜ Ó· ·Ù‹ÛÂÈ ÙÔ ÎÔ˘Ì› "EÌÊ¿ÓÈÛË ÂÈÏÂÁ̤ӈÓ". TÔ ÎÔ˘Ì› "EfiÌÂÓ˜ 20" ÂÌÊ·Ó›˙ÂÈ ÙȘ ÂfiÌÂÓ˜ ÂÁÁڷʤ˜ Ô˘ ÈηÓÔÔÈÔ‡Ó ÙÔ˘˜ fiÚÔ˘˜ ·Ó·˙‹ÙËÛ˘. T¤ÏÔ˜, ÙÔ ÎÔ˘Ì› "N¤· ·Ó·˙‹ÙËÛË" ÂÌÊ·Ó›˙ÂÈ ÙË ÊfiÚÌ· ·Ó·˙‹ÙËÛ˘.
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
∂ÈÎfiÓ· 3.
™ÙËÓ ÂÈÎfiÓ· 3 Ê·›ÓÂÙ·È ÌÈ· Ï‹Ú˘ ÂÁÁÚ·Ê‹ Ô˘ ÚԤ΢„ ·fi ·Ó·˙‹ÙËÛË. K·Ù¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ Û‡Ó‰ÂÛÌÔÈ (links) Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È ÔÈ Ï¤ÍÂȘ-ÎÏÂȉȿ. K¿ÓÔÓÙ·˜ ÎÏÈÎ ÛÙÔ fiÓÔÌ· ÂÓfi˜ Û˘ÁÁڷʤ·, ÂÌÊ·Ó›˙ÔÓÙ·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔÓ Û˘ÁÁڷʤ· ·˘ÙfiÓ, ÂÓÒ Î¿ÓÔÓÙ·˜ ÎÏÈÎ Û ÌÈ· ϤÍË-ÎÏÂȉ›, ÂÌÊ·Ó›˙ÔÓÙ·È fiϘ ÔÈ ÂÁÁڷʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙË Ï¤ÍË-ÎÏÂȉ›. H ÂÎÙ‡ˆÛË ÙfiÛÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ fiÛÔ Î·È ÙˆÓ ÂÚÈÏ‹„ÂˆÓ Á›ÓÂÙ·È Ì¤Ûˆ ÙÔ˘ ÏÔÁÈÛÌÈÎÔ‡ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÚÔ‚ÔÏ‹ ÛÂÏ›‰ˆÓ (browser). TÔ ÂÚȯfiÌÂÓÔ Ù˘ ‚¿Û˘ IPI™-Online ÂÓËÌÂÚÒÓÂÙ·È Ù·ÎÙÈο ·fi ÙÔ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Î·È ÙË ‰È·Û‡Ó‰ÂÛË Ì ÙÔ ¯Ú‹ÛÙË, ı· Á›ÓÔÓÙ·È ‚ÂÏÙÈÒÛÂȘ ¤ÙÛÈ ÒÛÙ ӷ ·ÔÙÂϤÛÂÈ ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ÎfiÛÌÔ ÂÓÙfi˜ Î·È ÂÎÙfi˜ EÏÏ¿‰·˜.
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12:57
™ÂÏ›‰·75
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜
™Â ·˘Ùfi ÙÔ Ù‡¯Ô˜ 2000,63:(1) ‰ËÌÔÛȇÔÓÙ·È Û˘ÌÏËڈ̷ÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜. OÈ Ô‰ËÁ›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘Ú›ˆ˜ ÙȘ ÚԉȷÁڷʤ˜/ ··ÈÙ‹ÛÂȘ Ô˘ ¤¯Ô˘Ó ÔÚÈÛÙ› ·fi ÙÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Û‡ÓÙ·Í˘ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÍÂÓfiÁψÛÛˆÓ ‚ÈÔ˚·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ (Uniform Requirements for Manuscripts Submitted to Biomedical Journals 1997). EÈÛËÌ·›ÓÂÙ·È fiÙÈ Ë ¶AI¢IATPIKH ˙ËÙ¿ ÂÈϤÔÓ ·fi ÙÔ˘˜ ŒÏÏËÓ˜ Û˘ÁÁÚ·Ê›˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È ÂÏÏËÓÈΤ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜.
¶·ÚÔÚ¿Ì·Ù· 1- ™ÙÔ ¿ÚıÚÔ Û‡ÓÙ·Í˘ Ù˘ ™. N¿ÎÔ˘ "¶ÂÚÈ‚·ÏÏÔÓÙÈÎfi˜ ηÓfi˜ ÙÛÈÁ¿ÚˆÓ. ŒÓ· Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜" ¶AI¢IATPIKH 1999,62:415, Ë ÛÂÈÚ¿ 2 Ú¤ÂÈ Ó· ‰È·‚·ÛÙ›: (TÛfiÏ·˜ Î·È TÛ·ÁÚ‹˜, ÛÂÏ 437-446, TÛfiÏ·˜ Î·È TÛ·ÁÚ‹˜, ÛÂÏ 447-449, K·Ú·Ù˙¿, B·Ú‚·Ú‹ÁÔ˘, XÚÈÛÙÔÊ›‰Ô˘, B·ÛÈÏ¿ÎÔ˜, TÛ·¿ÓÔ˜, KÔ˘ÚÔ‡Ó˘ Î·È MÂÚ¿Ù˘ ÛÂÏ 457-463) 2- ™ÙËÓ ÂÚÁ·Û›· ÙˆÓ ¢. K·ÙÚÈÔ‡, º. Aı·Ó·ÛÈ¿‰Ô˘, X. AÁÁÔ˘Úȉ¿ÎË, £. ¶··ÁˆÚÁ›Ô˘, B. TÛ·‚‰·Ú›‰Ô˘, M. X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ "E›Â‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, sICAM-1 sVCAM-1 Û ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ" ¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85, ÂÎ ·Ú·‰ÚÔÌ‹˜ ‰ÂÓ ÂÚÈÏ‹ÊıËÎ·Ó Ù· Û¯‹Ì·Ù· Î·È Ô ›Ó·Î·˜ Ô˘ ÙË Û˘Ófi‰Â˘·Ó. ™ÙȘ ÛÂÏ›‰Â˜ 80-85 ‰ËÌÔÛȇÂÙ·È Ë Ï‹Ú˘ ÂÚÁ·Û›·. ∏ ÂÚÁ·Û›· ı· ηٷÏÔÁÔÁÚ·ÊËı› Ì ٷ ÛÙÔȯ›· ¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85. ∞˘Ù¿ Ù· ÛÙÔȯ›· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙȘ ·Ó·ÊÔÚ¤˜.
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JAN.-FEB.2000
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12:57
™ÂÏ›‰·76
¶∞π¢π∞∆ƒπ∫∏ 2000;63:66-77
¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
A¡∞∫O⁄ºπ™∏ ∆OÀ ¶O¡OÀ ™∆∞ ¶∞π¢πÕ ª∂ ∫∞ƒ∫ÿ¡O
ŸÏ· ۯ‰fiÓ Ù· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ηÚΛÓÔ ¤¯Ô˘Ó ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ fiÓÔ˘. ¶ÂÚÈÛÛfiÙÂÚ· ·fi 70% ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Û οÔÈ· Ê¿ÛË, ı· ˘ÔʤÚÔ˘Ó ·fi ÛÔ‚·Úfi fiÓÔ. H ÁÓÒÛË Î·È Ë Ù¯ÓÔÏÔÁ›· ˘¿Ú¯Ô˘Ó ÁÈ· Ó· ıÂÚ·Â‡Ô˘Ó ·˘ÙfiÓ ÙÔÓ fiÓÔ. K·Ó¤Ó· ·È‰› ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘ÔʤÚÂÈ ·fi ÛÔ‚·Úfi ‹ ·Ú·ÙÂÈÓfiÌÂÓÔ fiÓÔ. AÚ¯¤˜ Ù˘ ¶OY ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ 1. H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ·Ú¯›˙ÂÈ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ı· ‰È·ÁÓˆÛı› Ô Î·ÚΛÓÔ˜ Û ¤Ó· ·È‰› Î·È Û˘Ó¯›˙ÂÙ·È Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÚÚÒÛÙÈ·˜. 2. O ηÚΛÓÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Â›Ó·È ÔχÏÔÎÔ˜ Î·È ··ÈÙ› ‰ÈÂÈÛÙËÌÔÓÈ΋ ÚÔÛ¤ÁÁÈÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ ÙÔ Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÔÈ ÛÙ¿ÛÂȘ Î·È ÔÈ Û˘ÌÂÚÈÊÔÚ¤˜ ÌÔÚ› Ó· ·˘Í‹ÛÔ˘Ó ÛËÌ·ÓÙÈο ‹ Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ fiÓÔ ÙÔ˘ ·È‰ÈÔ‡. 3. H ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙË ¯Ú‹ÛË ·Ó·ÏÁËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙÈÏËÙÈΤ˜, Û˘ÌÂÚÈÊÔÚÈΤ˜, ۈ̷ÙÈΤ˜ Î·È ˘ÔÛÙËÚÈÎÙÈΤ˜ Ú·ÎÙÈΤ˜ ıÂڷ›˜. ¶ÔÏϤ˜ ·fi ·˘Ù¤˜ ÙȘ ıÂڷ›˜ ÌÔÚÔ‡Ó Ó· ·Ú¤¯ÔÓÙ·È ·fi ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜.
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¶·È‰È·ÙÚÈ΋ ÂÓË̤ڈÛË
4. ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ Ô˘ ÚÔÛʤÚÂÙ·È, ı· Ú¤ÂÈ Ó· ηıÔÚÈÛÙ› Î·È Ó· ıÂڷ¢Ù› Ë ˘ÔΛÌÂÓË ·ÈÙ›· ÙÔ˘ fiÙ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ. 5. °È· Ù· ·È‰È¿ Ô˘ ·›ÚÓÔ˘Ó ıÂڷ›·, Û˘¯Ó¿ Ô fiÓÔ˜ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Î·È ıÂڷ¢ÙÈÎÒÓ Ú¿ÍÂˆÓ Â›Ó·È ¯ÂÈÚfiÙÂÚÔ˜ ·fi ·˘ÙfiÓ Ù˘ ·ÚÚÒÛÙÈ·˜. O fiÓÔ˜ Ô˘ ÚÔηÏÂ›Ù·È ·fi ·˘Ù¤˜ ÙȘ Ú¿ÍÂȘ ı· Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Î·È Ó· ıÂڷ‡ÂÙ·È ‰Ú·ÛÙÈο. 6. H "Îϛ̷η ·Ó·ÏÁËÛ›·˜" Ù˘ ¶OY ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÂÈÏÔÁ‹ Ê·ÚÌ¿ÎˆÓ Ô˘ ·Ó·ÎÔ˘Ê›˙Ô˘Ó ÙÔÓ fiÓÔ. ™Â ·˘Ù‹ ÙËÓ ÎÏÈ̷Έً ÚÔÛ¤ÁÁÈÛË, ηıÔÚ›˙ÂÙ·È Ë ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ fiÓÔ˘ ÙÔ˘ ·È‰ÈÔ‡, Ô Ù‡Ô˜ Î·È Ë ‰fiÛË ÙÔ˘ ·Ó·ÏÁËÙÈÎÔ‡. 7. E·ÚΛ˜ ·Ó·ÏÁËÙÈΤ˜ ‰fiÛÂȘ ı· Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È Û ٷÎÙ¿ ‰È·ÛÙ‹Ì·Ù· - "Ì ÙÔ ÚÔÏfiÈ" Î·È fi¯È "fiÙ·Ó ¯ÚÂÈ·ÛÙ›". 8. T· ·Ó·ÏÁËÙÈο, fiÔ˘ Â›Ó·È ‰˘Ó·Ùfi, Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È ·fi ÙÔ ÛÙfiÌ·. 9. H ηٿÏÏËÏË ‰fiÛË ÂÓfi˜ ÔÔÈÔ‡¯Ô˘ Â›Ó·È ÂΛÓË Ô˘ ·Ó·ÎÔ˘Ê›˙ÂÈ ÙÔÓ fiÓÔ ·ÔÙÂÏÂÛÌ·ÙÈο. T· ·È‰È¿ ÌÔÚ› Ó· ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚ· ÌÂÁ¿Ï˜ ‰fiÛÂȘ ÁÈ· Ó· ·Ó·ÎÔ˘ÊÈÛÙÔ‡Ó. 10. ŒÓ·˜ ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÏfiÁÔ˘˜ Ô˘ Ù· ·È‰È¿ Ì ÛÔ‚·Úfi fiÓÔ ÏfiÁˆ ηÚΛÓÔ˘ ‰ÂÓ ·›ÚÓÔ˘Ó Â·Ú΋ ·Ó·ÏÁËÛ›·, Â›Ó·È Ô Êfi‚Ô˜ Ù˘ "ÂÍ¿ÚÙËÛ˘" ·fi Ù· ÔÔÈÔ‡¯·. A˘Ùfi˜ Ô Êfi‚Ô˜ Ô˘ ¤¯ÂÈ ˘ÂÚ‚ÔÏÈο ÌÂÁ·ÏÔÔÈËı›, ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› Î·È Ó· ̤ÓÂÈ Û ۈÛÙ¿ ̤ÙÚ·. 11. OÈ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ÔÈÔ‡¯ˆÓ ı· Ú¤ÂÈ Ó· ÚԂϤÔÓÙ·È, Ó· ıÂڷ‡ÔÓÙ·È ‰Ú·ÛÙÈο Î·È Ó· ÂÎÙÈÌÒÓÙ·È Ù·ÎÙÈο. 12. ŸÙ·Ó ÌÂÈÒÓÔÓÙ·È ‹ ‰È·ÎfiÙÔÓÙ·È Ù· ÔÔÈÔ‡¯·, ÔÈ ‰fiÛÂȘ Ú¤ÂÈ Ó· ÌÂÈÒÓÔÓÙ·È ‚·ıÌÈ·›· ÒÛÙ ӷ ·ÔÊ¢¯ı› ÛÔ‚·Ú‹ ·fiÙÔÌË ˘ÔÙÚÔ‹ ÙÔ˘ fiÓÔ˘ ‹ Û˘ÌÙÒÌ·Ù· ÛÙ¤ÚËÛ˘.
13. AÓ Î·È Ë Î·Ù·ÓfiËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ ·fi Ù· ·È‰È¿ ·ÏÏ¿˙ÂÈ ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó·Ù˘ÍÈ·Îfi ÙÔ˘˜ ÛÙ¿‰ÈÔ, Û˘¯Ó¿ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÚfiÎÂÈÙ·È Ó· Âı¿ÓÔ˘Ó. O Êfi‚Ô˜ Ù˘ ÂÁηٿÏÂȄ˘ Î·È Ô Êfi‚Ô˜ fiÙÈ ı· ˘ÔʤÚÔ˘Ó Â›Ó·È ÔÈ Î‡ÚȘ ·ÓËÛ˘¯›Â˜ ÙˆÓ ·È‰ÈÒÓ Î¿ı ËÏÈΛ·˜ Ì ·ÚÚÒÛÙÈ· Ô˘ Ô‰ËÁ› ÛÙÔÓ ı¿Ó·ÙÔ. °È' ·˘Ùfi ÙÔÓ ÏfiÁÔ, ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ı· Ú¤ÂÈ Ó· ÙÔÓ›˙Ô˘Ó Û ·˘Ù¿ Ù· ·È‰È¿ fiÙÈ ı· ÙÔ˘˜ ÚÔÛÊÂÚı› ·Ó·ÎÔ‡ÊÈÛË Î·È fiÙÈ Ù· ·Á·Ë̤ӷ ÙÔ˘˜ ÚfiÛˆ· ı· Â›Ó·È ‰È·ÚÎÒ˜ ‰›Ï· ÙÔ˘˜. 14. H ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ıÂڷ›· ı· Ú¤ÂÈ Ó· Â›Ó·È ÛÊ·ÈÚÈ΋ Î·È Ó· Ï·Ì‚¿ÓÂÈ ˘fi„Ë ÙȘ „˘¯ÔÏÔÁÈΤ˜, ÔÏÈÙÈÛÙÈΤ˜ Î·È ÓÂ˘Ì·ÙÈΤ˜ ·Ó¿ÁΘ. E¿Ó ÂΉËψı› Û¯ÂÙÈ΋ ÂÈı˘Ì›·, ı· Ú¤ÂÈ ·˘Ù‹ Ë ıÂڷ›· Ó· ÚÔÛʤÚÂÙ·È ÛÙÔ Û›ÙÈ. 15. E›Ó·È ¢ı‡ÓË Î¿ı ·ÁÁÂÏÌ·Ù›· ˘Á›·˜, οı ȉڇ̷ÙÔ˜ Î·È Î¿ı ΢‚ÂÚÓËÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ¤¯ÂÈ ÙË ÊÚÔÓÙ›‰· Ù¤ÙÔÈˆÓ ·È‰ÈÒÓ, Ó· ˘ÔÛÙËÚ›ÍÂÈ, Ó· Âηȉ‡ÛÂÈ Î·È Ó· Û˘ÓËÁÔÚ‹ÛÂÈ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ·Ú¯ÒÓ. EΉfiÛÂȘ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ YÁ›·˜ A˘Ù¤˜ ÔÈ ·Ú¯¤˜ ¤¯Ô˘Ó ÏËÊı› ·fi ÙÔ ‚È‚Ï›Ô "Cancer Pain Relief and Palliative Care in Children" Ô˘ ÂΉfiıËΠ·fi ÙËÓ ¶OY ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙË ¢ÈÂıÓ‹ EÙ·ÈÚ›· MÂϤÙ˘ ¶fiÓÔ˘. ¢È‡ı˘ÓÛË ÁÈ· ·Ú·ÁÁÂϛ˜: bookorders@who.ch
Afi‰ÔÛË ÛÙ· ÂÏÏËÓÈο ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·
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BÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË
ŒÎ‰ÔÛË ÛÙ· Ï·›ÛÈ· ŒÚÁÔ˘ Ì ٛÙÏÔ: "E˘·ÈÛıËÙÔÔ›ËÛË Î·È Î·Ù¿ÚÙÈÛË Â·ÁÁÂÏÌ·ÙÈÒÓ ·È‰Â›·˜ Î·È ˘Á›·˜, ÛÙËÓ ˘ÔÛÙ‹ÚÈÍË ·È‰ÈÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ·ÚÚÒÛÙÈ· Î·È ı¿Ó·ÙÔ ÛÙË ˙ˆ‹ ÙÔ˘˜" (E¶EAEK-EÓ¤ÚÁÂÈ· 1.1.Z.2)
Œ¯ÂÈ ÂÚ¿ÛÂÈ Î·ÈÚfi˜ Ô˘ Ë ÂÍ‹ÁËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ Û ¤Ó· ·È‰› ·ÔÙÂÏÔ‡Û ٷÌÔ‡ Î·È Ô˘ ıˆÚ›ÙÔ fiÙÈ Ô ı¿Ó·ÙÔ˜ ı· ÂÍ·Ê·ÓÈÛÙ› Ì·ÁÈο ·Ó ‰ÂÓ Û˘˙ËÙËı›. TÒÚ· fiÏÔÈ ·Ó·ÁÓˆÚ›˙Ô˘Ì fiÙÈ Ô ı¿Ó·ÙÔ˜ Â›Ó·È ÌÈ· ·ÁÎfiÛÌÈ· Î·È ·Ó·fiÊ¢ÎÙË ‰È·‰Èηۛ· Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó fiϘ ÔÈ ËÏÈ˘ Î·È fiÙÈ Ë Î·Ï‹ „˘¯È΋ ˘Á›· ÂÍ·ÚÙ¿Ù·È fi¯È ·fi ÙËÓ ¿ÚÓËÛË ÙÔ˘ ıÚ‹ÓÔ˘, ·ÏÏ¿ ·fi ÙËÓ ÂÈÏÈÎÚÈÓ‹ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÂÒ‰˘ÓÔ˘ ·Ô¯ˆÚÈÛÌÔ‡. ŒÓ· ·fi Ù· ÈÔ ‰‡ÛÎÔÏ· ¤ÚÁ· Î·È Î·ı‹ÎÔÓÙ· ÙˆÓ ÂÓËÏ›ÎˆÓ (ÁÔÓÈÒÓ, ‰·ÛÎ¿ÏˆÓ Î·È Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜) Â›Ó·È Ë Û˘˙‹ÙËÛË ÙÔ˘ ı·Ó¿ÙÔ˘ Ì ¤Ó· ·È‰› Ô˘ ¤¯·Û οÔÈÔ ·Á·Ë̤ÓÔ ÙÔ˘ ÚfiÛˆÔ. ™˘¯Ó¿ ·Ó·ÚˆÙÈÔ‡ÓÙ·È ÔÈ· Â›Ó·È Ë Î·Ù·ÓfiËÛË ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙÔÓ ı¿Ó·ÙÔ, Ò˜ ıÚËÓÔ‡Ó, ÔȘ Â›Ó·È ÔÈ ·Ó¿ÁΘ ÙÔ˘˜, Ò˜ ÌÔÚÔ‡Ó Ó· Ù· ÂÓËÌÂÚÒÛÔ˘Ó, Ò˜ ı· ÂÓı·ÚÚ‡ÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ÙÔ˘˜, Ò˜ ı· ÚÔˆı‹ÛÔ˘Ó ÙË ÛÙ·ıÂÚfiÙËÙ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜, fiÙ ı· Ú¤ÂÈ Ó· ·ÓËÛ˘¯‹ÛÔ˘Ó, M ÛÎÔfi Ó· ··ÓÙ‹ÛÂÈ Û fiÏ· ·˘Ù¿ Ù· ÂÚˆÙ‹Ì·Ù· Î·È Ó· ‚ÔËı‹ÛÂÈ ·˘ÙÔ‡˜ Ô˘ ı· ÛÙËÚ›ÍÔ˘Ó ÙÔ ·È‰›, ¤¯ÂÈ ÂΉÔı› ¤Ó· ηÏfiÁÔ˘ÛÙÔ Ê˘ÏÏ¿‰ÈÔ Ì ٛÙÏÔ "™ÙËÚ›˙ÔÓÙ·˜ ÙÔ ¶·È‰› Ô˘ £ÚËÓ› ÙÔ £¿Ó·ÙÔ AÁ·Ë̤ÓÔ˘ ÙÔ˘ ¶ÚÔÛÒÔ˘". Œ¯ÂÈ ÁÚ·ÊÙ› ·fi ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÙÔ˘ ™˘Ì‚Ô˘Ï¢ÙÈÎÔ‡ K¤ÓÙÚÔ˘ Ù˘ MEPIMNA™, ¢·Ó¿Ë ¶··‰¿ÙÔ˘, EÈÚ‹ÓË M·Ì·ÓÙ¿ÎË, EÈÚ‹ÓË ¶·¿˙ÔÁÏÔ˘, EÏ¢ıÂÚ›· P¿ÏÏË Î·È M˘ÚÙÒ N›ÏÛÂÓ. ¢È·Ó¤ÌÂÙ·È ‰ˆÚÂ¿Ó ·fi Ù· ÁÚ·Ê›· Ù˘ MEPIMNA™, TÈÌÔϤÔÓÙÔ˜ B¿ÛÛÔ˘ 16, ¶Ï·Ù›· M·‚›ÏË, 11521 Aı‹Ó·. TËÏ. 6452013 Î·È 6463367. ™Ù¤ÏÏ· TÛ›ÙÔ˘Ú·
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E›Â‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, sICAM-1 Î·È sVCAM-1 Û ·È‰È¿ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ¢ˆÚÔı¤· K·ÙÚÈÔ‡1, º·Ó‹ Aı·Ó·ÛÈ¿‰Ô˘1, XÚÈÛÙ›Ó· AÁÁÔ˘Úȉ¿ÎË2, £ÂÔ‰fiÙ˘ ¶··ÁˆÚÁ›Ô˘1, B·ÛÈÏÈ΋ TÛ·‚‰·Ú›‰Ô˘2, M·Ú›· X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1. ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂϤÙË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ (sICAM1 Î·È sVCAM-1) ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ, Û ۯ¤ÛË Ì ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘. H ÌÂϤÙË ÂÚÈÏ¿Ì‚·Ó 8 ·È‰È¿ Ì ™E§ ËÏÈΛ·˜ 18 ÌËÓÒÓ ¤ˆ˜ 14 ¯ÚfiÓˆÓ (ÔÌ¿‰· A) Î·È 16 ˘ÁÈ‹ ·È‰È¿ (ÔÌ¿‰· B) Ù˘ ›‰È·˜ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ì ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ A. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· ›‰· ÛÙÔÓ ÔÚfi: ÙˆÓ sIL2R, ÙˆÓ CIC, Ù˘ CRP, ÙˆÓ C3 Î·È C4 Î·È ÙˆÓ sICAM-1 Î·È sVCAM-1 ηıÒ˜ ›Û˘ Î·È Ë TKE. OÈ ·Ú¿ÌÂÙÚÔÈ ·˘ÙÔ› ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·Ó¿ Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Î·È ÛÙȘ ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘. H ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ ÙˆÓ ·ÛıÂÓÒÓ, Î˘Ì¿ÓıËΠ·fi 5 Ì‹Ó˜ ̤¯ÚÈ 4 ¯ÚfiÓÈ·. AÔÙÂϤÛÌ·Ù·: T· ›‰· ÙˆÓ sICAM-1 Î·È sVCAM-1 ÛÙËÓ ÔÌ¿‰· A, ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÚÔ˘Û›·Û·Ó ‰È·Î˘Ì¿ÓÛÂȘ 368,2-994,8 ng/mL (̤ÛË ÙÈÌ‹ 599,3±96,3 ng/mL), Î·È 2154,4-2972,2 ng/mL (̤ÛË ÙÈÌ‹ 2559,2±378,7 ng/mL), ·ÓÙ›ÛÙÔȯ·, ¤Ó·ÓÙÈ ÙˆÓ 104,7-328,9 ng/mL (̤ÛË ÙÈÌ‹ 228,2±49,4 ng/mL) Î·È 315-789 ng/mL (̤ÛË ÙÈÌ‹ 592±104 ng/mL) Ù˘ ÔÌ¿‰·˜ B. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‡ÊÂÛ˘ Ë Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ sICAM-1 Î·È sVCAM-1 ‹Ù·Ó 101±39 ng/mL Î·È 586±92 ng/mL ·ÓÙ›ÛÙÔȯ·, ‰ËÏ·‰‹ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. T· ›‰· ÙˆÓ sICAM-1 Î·È sVCAM-1 ÛÙËÓ ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ Ù˘ ‡ÊÂÛ˘ (p< 0,001). H ·‡ÍËÛË ·˘Ù‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ sICAM-1 Î·È sVCAM-1 Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ C3 Î·È ÙÔ˘ C4, ÙËÓ ·‡ÍËÛË ÙˆÓ CIC, ÙˆÓ sIL-2Rs, Ù˘ TKE Î·È Ù˘ CRP. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ›‰· ÙˆÓ sICAM-1 Î·È sVCAM-1, ·˘Í¿ÓÔ˘Ó Î·Ù¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË ÙˆÓ CIC, Ù˘ TKE, Ù˘ CRP Î·È Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙÔ˘ C3 Î·È ÙÔ˘ C4, ÂÓÈÛ¯‡ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ˘fiıÂÛË ÙÔ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ÙˆÓ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ, Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È fiÙÈ Ù· sICAM-1 Î·È sVCAM-1 ÌÔÚ› Ó· ıˆÚËıÔ‡Ó fiÙÈ ·ÔÙÂÏÔ‡Ó ‰‡Ô ÂÈϤÔÓ ‰Â›ÎÙ˜ ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:80-85. §¤ÍÂȘ ÎÏÂȉȿ: ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘, Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, sICAM-1, sVCAM, sIL-2R. D. CatriÔu, F. Athanasiadou, C. Aggouridaki, T. Papageorgiou, V. Tsabdaridou, M. Hatzistilianou. Levels of the soluble adhesion molecules sICAM-1 and sVCAM-1 in children with systemic lupus erythematosus. Paediatriki 2000;63:80-85. ● Abstract: The aim of this paper was to study the levels of soluble adhesion molecules (sICAM-1 and sVCAM-1) in the serum of children with systemic lupus erythematosus (SLE), in relation to the activity of the disease. The study included 8 children with SLE, aged 18 months to 14 years (group A) and 16 healthy children of the same age and sex (group B). The levels of sIL-2R, CIC, CRP, C3, C4, sICAM-1, sVCAM-1 and the ESR were determined at diagnosis, once a month after the beginning of therapy, and at relapse. Monitoring of the disease ranged from 5 months to 4 years. Results: The levels of sICAM-1 and sVCAM-1 in group A at diagnosis showed ranges of 368.2-994.8 ng/mL (MV±SD 599.3±96.3 ng/mL), and 2154.4-2972.2 ng/mL (MV±SD 2559.2±378.7 ng/mL), respectively compared with 104.7-328.9 ng/mL (MV±SD 228.2±49.4 ng/mL) and 315-789 ng/mL respectively in (MV±SD 592±104 ng/mL) group B. During remission the mean levels of sICAM-1 and sVCAM-1 were within normal limits 101±39 ng/mL and 586±92 ng/mL respectively in group A. The levels of sICAM-1 and sVCAM-1 at relapse were significantly higher than those during remission (p<0.001). These increases in the sICAM-1 and sVCAM-1 levels were correlated to decreases in levels of C3 and C4 and increases in levels of CIC, sIL-2R, ESR and CRP. In conclusion, sICAM-1 and sVCAM-1 levels increase during disease activity of SLE, in parallel with increases in CIC, SER and CRP and decreases in C3 and C4,
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B' ¶·Ó/΋ ¶·È‰/΋ KÏÈÓÈ΋, NÔÛÔÎÔÌÂ›Ô AXE¶A, A.¶.£. OÚÔÏÔÁÈÎfi EÚÁ·ÛÙ‹ÚÈÔ, NÔÛÔÎÔÌÂ›Ô AXE¶A, £ÂÛÛ·ÏÔÓ›ÎË
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¢È·Ï˘Ù¿ ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ ™∂§
reinforcing the hypothesis of immune complex formation and activation of complement, lymphocytes and endothelial cells. Thus, sICAM-1 and sVCAM-1 may be considered as two additional indicators of disease activation in SLE. Key words: soluble adhesion molecules, lupus erythematosus, sICAM-1, sVCAM-1, SEL, sIL-2R.
EÈÛ·ÁˆÁ‹ OÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (™E§) ¤¯Ô˘Ó ‰È·Ù·Ú·¯‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ Î·È Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜ (1). H ÛËÌ·Û›· Ù˘ ‰È·Ù·Ú·¯‹˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ Î·È Ë Û¯¤ÛË Ù˘ Ì ÙË ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ Û·ÊÒ˜ ηıÔÚÈÛı› (2). H ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÓ·Ôı¤ÛÂȘ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙ· ·ÁÁ›· ‰È·ÊfiÚˆÓ ÔÚÁ¿ÓˆÓ, Ì ·ÎfiÏÔ˘ıÔ ÙËÓ ÂΉ‹ÏˆÛË ·ÁÁÂÈ›Ùȉ·˜. ™ÙË Ê¿ÛË ·˘Ù‹ Ù˘ ÓfiÛÔ˘ ˘¿Ú¯ÂÈ ¤ÓÙÔÓË ÂÓÂÚÁÔÔ›ËÛË Î·È ÌÂÙ·Ó¿ÛÙ¢ÛË ÙfiÛÔ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰ÈˢڢṲ̂ÓÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁ›ˆÓ, ÛÙÔ˘˜ ÈÛÙÔ‡˜ (3). T· ·ÙÙ·Ú· ·˘Ù¿ ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· Ú·ÁÌ·ÙÔÔÈËı› Ë ÌÂÙ·Ó¿ÛÙÂ˘Û‹ ÙÔ˘˜. H ¤ÎÊÚ·ÛË ·˘Ù‹ ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ Î˘ÙÙ¿ÚˆÓ Û˘Ì›ÙÂÈ ¯ÚÔÓÈο Ì ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ·ÁÁ›ˆÓ Î·È Û˘Ì‚¿ÏÏÂÈ ¤ÙÛÈ ÛÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (4). T· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÌÔÚ› Ó· ·ÔÎfiÙÔÓÙ·È ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË Î·È Ó· ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔÓ ÔÚfi Ì ÙË ÌÔÚÊ‹ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ. H ̤ıÔ‰Ô˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÛÙÔÓ ÔÚfi ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, ÙfiÛÔ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ Ù˘ ÌÂıfi‰Ô˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Û ΢ÙÙ·ÚÈÎfi Â›Â‰Ô ÁÈ·Ù› Â›Ó·È ÈÔ ·Ï‹ Î·È ÁÚ‹ÁÔÚË (3,4). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂϤÙË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ (sICAM-1 Î·È sVCAM-1) ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ Ì ™E§ Î·È Ë ÂÎÙ›ÌËÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ÂȤ‰ˆÓ ·˘ÙÒÓ Û ۯ¤ÛË Ì ÙË ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘. YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ H ÌÂϤÙË ÂÚÈÏ¿Ì‚·Ó ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ A Î·È B. H ÔÌ¿‰· A ·ÔÙÂÏ›ÙÔ ·fi 8 ·È‰È¿, 2 ·ÁfiÚÈ· Î·È 6 ÎÔÚ›ÙÛÈ· Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ ÙÔ˘ ™E§ (1). H ̤ÛË ËÏÈΛ· ÙÔ˘˜ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 8,1 ¯ÚfiÓÈ· (‰È·Î‡Ì·ÓÛË 18 ÌËÓÒÓ - 14 ¯ÚÔÓÒÓ). O ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì¿ÓıËΠ·fi 5 Ì‹Ó˜ ¤ˆ˜ 4 ¯ÚfiÓÈ·. H ÔÌ¿‰· B ·ÔÙÂÏ›ÙÔ ·fi 16 ·È‰È¿ Ù˘ ȉ›·˜ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ì ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ A, ÒÛÙ ӷ ·ÓÙÈÛÙÔÈ¯Ô‡Ó 2 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ B Û 1 Ù˘ ÔÌ¿‰·˜ A.
™˘ÓÙÔÌÔÁڷʛ˜ ™E§ CIC sIL-2R sICAM-1 sVCAM-1
™˘ÛÙËÌ·ÙÈÎfi˜ EÚ˘ıËÌ·Ù҉˘ §‡ÎÔ˜ K˘ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· (circulating immunocomplex) ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ ÈÓÙÂÚÏ¢ΛÓ˘ 2 soluble intercellular adhesion molecule 1 soluble vascular cell adhesion molecule 1
H ÂÎÙ›ÌËÛË Ù˘ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ A ÁÈÓfiÙ·Ó Ì ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ· Ô˘ ηٷÁÚ¿ÊÔÓÙ·Ó Û ÂȉÈÎfi ÚˆÙfiÎÔÏÏÔ Î·Ù¿ ÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔÓ Ì‹Ó· ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›·, ÂÓÒ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È ÓÔÛËχÔÓÙ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì›· ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰·. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ·Ì‚¿ÓÔÓÙÔ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔÓ Ì‹Ó· ·fi οı ·ÛıÂÓ‹ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. O ·ÚÈıÌfi˜ ‰ÂÈÁÌ¿ÙˆÓ Ô˘ ·ÓÙÈÛÙÔȯԇÛ Û οı ·ÛıÂÓ‹ ηٿ ̤ÛÔ fiÚÔ ‹Ù·Ó 22 (·fi 14 ¤ˆ˜ 68 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜). K·Ù¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ ¯ÔÚËÁ›ÙÔ ÎÔÚÙÈ˙fiÓË Û ‰fiÛË 1 mg/Kg ËÌÂÚËÛ›ˆ˜ Ì ‹ ¯ˆÚ›˜ ·˙·ıÂÈÔÚ›ÌË. MÂÙ¿ ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ¿Ú¯È˙Â Ë ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ÎÔÚÙÈ˙fiÓ˘. OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÌÂÙÚ‹ıËÎ·Ó Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‹Ù·Ó Ë TKE, Ë C ·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP), Ù· ÎÏ¿ÛÌ·Ù· C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· (circulating immunocomplex, CIC), Ù· ›‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 2 (sIL-2R), Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ (soluble intercellular adhesion molecule 1, sICAM-1), Î·È soluble vascular cell adhesion molecule 1, sVCAM-1) H CRP Î·È Ù· ÎÏ¿ÛÌ·Ù· C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó Ì ÙËÓ Ì¤ıÔ‰Ô Ù˘ ÓÂÊÂÏÔÌÂÙÚ›·˜, ÂÓÒ Ù· CIC, Ô ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ sIL-2R Î·È Ù· ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ sICAM-1 Î·È sVCAM-1 Ì ÙËÓ Ì¤ıÔ‰Ô ELISA. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ÁÈ· ÙËÓ Û‡ÁÎÚÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·Ó¿Ï˘ÛË ÙÔ˘ x2, student's t test. H ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ ıˆڋıËΠÛËÌ·ÓÙÈ΋ fiÙ·Ó ÙÔ P<0,05. °È· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Î·Ù¿ Pearson Û˘Û¯¤ÙÈÛË.
81
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™ÂÏ›‰·82
¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85
AÔÙÂϤÛÌ·Ù· H ̤ÛË ÙÈÌ‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ sIL-2R, ÙˆÓ CIC, Ù˘ CRP, ÙˆÓ C3 Î·È C4 Î·È ÙˆÓ sICAM-1, sVCAM-1 ηıÒ˜ ›Û˘ Î·È Ë TKE ÛÙËÓ ÔÌ¿‰· A, ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Î·È ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ÂΛӷ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ B (¶›Ó·Î·˜ 1). H ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,001). MfiÓÔ Û 2 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ A Ë ÙÈÌ‹ Ù˘ CRP ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. K·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ηٷÁÚ¿ÊËÎ·Ó 7 ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ Ô˘ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ·ÚÔ˘Û›· Ïԛ̈͢. OÈ ÙÈ̤˜ Ù˘ TKE, Ù˘ CRP Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÛÙËÓ ‡ÊÂÛË, ÚÈÓ ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˘ÔÙÚÔ‹˜ Î·È ÛÙÔ˘˜ ÚÒÙÔ˘˜ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ˘ÔÙÚÔ‹, Ê·›ÓÔÓÙ·È ÛÙ· Û¯‹Ì·Ù· 1 Î·È 2, ÂÓÒ Ù· ›‰· ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÛÙÔ Û¯‹Ì· 3. ™Â 4 ·ÛıÂÓ›˜ ÔÈ ·Ú·¿Óˆ ·Ú¿ÌÂÙÚÔÈ TKE, CRP, sIL-2R, sICAM-1, sVCAM-1, C3 Î·È C4 ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó 2 ÊÔÚ¤˜ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ÚÈÓ ÙËÓ ˘ÔÙÚÔ‹ Î·È ÂΛ ‰È·ÁÓÒÛıËΠÂÚÁ·ÛÙËÚȷο Ë ÚÒÈÌË ‰È·Ù·Ú·¯‹ ÙˆÓ C3 Î·È C4. OÈ ÙÈ̤˜ ÙˆÓ C3 Î·È C4 Î˘Ì¿ÓıËÎ·Ó ·fi 0,12-0,95 Î·È ·fi 0,06-0,15 ·ÓÙ›ÛÙÔȯ· ÛÙÔ˘˜ 4 ·˘ÙÔ‡˜ ·ÛıÂÓ›˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ‰È·Ù·Ú¿¯ıË-
¢. K·ÙÚÈÔ‡ Î·È Û˘Ó.
¶›Ó·Î·˜ 1. ⁄ÊÂÛË 1Ì‹Ó· ÚÈÓ ÙËÓ ˘ÔÙÚÔ‹ ÀÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ 1 Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ 2 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜
CRP
CIC
15 22 105
0,7 0,9 4,4
1 1,3 4,6
65
1
3,1
32
0,8
2,2
18
0,6
1,2
Î·Ó ÚÈÓ ·fi ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜ ÚÒÙ· Ù· ›‰· ÙˆÓ C3 (ÛÙȘ 4/7 ˘ÔÙÚÔ¤˜) Î·È C4 (Û 2/7 ˘ÔÙÚÔ¤˜), ·ÎÔÏÔ˘ıÔ‡Û·Ó ·˘Ù¿ ÙˆÓ sIL-2R (Û 6/7 ˘ÔÙÚÔ¤˜), ÙˆÓ sICAM-1 (ÛÙȘ 6/7 ˘ÔÙÚÔ¤˜) Î·È ÙˆÓ sVCAM-1 (6/7 ˘ÔÙÚÔ¤˜) Î·È Ù¤ÏÔ˜ Ù˘ CRP (4/7 ˘ÔÙÚÔ¤˜) Î·È Ù˘ TKE (7/7 ˘ÔÙÚÔ¤˜). H ·ÔηٿÛÙ·ÛË ‰Â ÙˆÓ ÙÈÌÒÓ Î·Ù¿ ÙËÓ ‡ÊÂÛË Ù˘ ÓfiÛÔ˘ ·ÎÔÏÔ˘ıÔ‡Û ÙËÓ ›‰È· ÛÂÈÚ¿. ¶Ï¤ÔÓ Â˘·›ÛıËÙÔÈ ·Ú¿ÌÂÙÚÔÈ ‰È¿ÁÓˆÛ˘ ÙˆÓ ˘ÔÙÚÔÒÓ ıˆڋıËÎ·Ó ÔÈ ·Ú¿ÌÂÙÚÔÈ: TKE, sIL2R, sICAM-1 Î·È sVCAM-1. OÈ ·Ú¿ÌÂÙÚÔÈ ·˘Ù¤˜ ‰È·Ù·Ú¿¯ıËÎ·Ó Û ÔÛÔÛÙfi 85-100% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘. O ¯ÚfiÓÔ˜ fï˜ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘˜ ‹Ù·Ó ÔÈΛÏÔ˜ fiˆ˜ ·Ó·Ê¤Ú·-
™¯‹Ì· 1. ∏ ̤ÛË ÙÈÌ‹ Ù˘ ∆∫∂ ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘.
82
TKE
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12:57
™ÂÏ›‰·83
¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85
¢È·Ï˘Ù¿ ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ ™∂§
™¯‹Ì· 2. ∏ ̤ÛË ÙÈÌ‹ ÙˆÓ CRP, CIC, C3 Î·È C4 ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘.
™¯‹Ì· 3. ª¤ÛË ÙÈÌ‹ ÙˆÓ sIL-2R, sICAM Î·È sVCAM Û fiÏ· Ù· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘.
83
JAN.-FEB.2000
30-05-03
12:57
™ÂÏ›‰·84
¶∞π¢π∞∆ƒπ∫∏ 2000;63:80-85
Ì ÚÔËÁÔ˘Ì¤Óˆ˜. ¢È·ÈÛÙÒıËΠÈÛ¯˘Ú‹ ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ sIL-2R Î·È ÙˆÓ sICAM-1 (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Pearson, r=0,892) ηıÒ˜ ›Û˘ Î·È ÌÂٷ͇ ÙˆÓ sIL-2R Î·È ÙˆÓ sVCAM-1 (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Pearson r=0,914). ™˘˙‹ÙËÛË H ·˘ÍË̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Â›Ó·È ÙÔ Î‡ÚÈÔ ÛËÌÂ›Ô ÛÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘. ¶·ÚfiÏ· ·˘Ù¿ Û‹ÌÂÚ· ÈÛÙ‡ÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (1). OÈ sIL-2R ÂÎÊÚ¿˙ÔÓÙ·È ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ T-ÏÂÌÊÔ·ÙÙ·Ú· Î·È ·fi ·˘Ù¿ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È (5). H ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ·˘ÙÒÓ, Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ÚÈÓ ÙËÓ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ Û˘ÌʈÓ› Ì ÙËÓ ¿Ô„Ë ÙˆÓ ÂÚ¢ÓËÙÒÓ fiÙÈ ·˘Í¿ÓÔ˘Ó Û ·ÚÈıÌfi Ù· ÂÓÂÚÁÔÔÈË̤ӷ T-ÏÂÌÊÔ·ÙÙ·Ú· (5,6). ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·Û›·˜ ÔÈ ÛËÌ·ÓÙÈΤ˜ ·˘Í‹ÛÂȘ ÙˆÓ ÙÈÌÒÓ ÙˆÓ sIL-2R ÛÙÔÓ ÔÚfi 85% ÙˆÓ ·ÛıÂÓÒÓ, ÂΉËÏÒıËÎ·Ó Ï›ÁÔ ·ÚÁfiÙÂÚ· ¯ÚÔÓÈο, ·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ C3 /C4. TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ, ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ, ÌÔÚ› Ó· Â›Ó·È Â·ÎfiÏÔ˘ıÔ ÌÈ·˜ ÁÂÓÈÎfiÙÂÚ˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÏÔÈfiÓ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ sIL2R ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì ™E§, Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ ÚÈÓ ÙËÓ ÎÏÈÓÈ΋ Ù˘ ÂΉ‹ÏˆÛË Î·È ·ÔÙÂÏ› ¢·›ÛıËÙÔ ‰Â›ÎÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘. O ‰Â›ÎÙ˘ ·˘Ùfi˜ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· fiÙÈ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹ÁÔÚ·. T· ÂÓÂÚÁÔÔÈË̤ӷ ÏÂÌÊÔ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (ICAM1) Ô˘ Ì οÔÈÔ ¿ÁÓˆÛÙÔ Ì˯·ÓÈÛÌfi ·ÔÎfiÙÔÓÙ·È ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË Î·È Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙÔÓ ÔÚfi Ì ÙËÓ ÌÔÚÊ‹ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ (7,8). T·˘Ùfi¯ÚÔÓ· Ì ٷ ÂÓÂÚÁÔÔÈË̤ӷ ÏÂÌÊÔ·ÙÙ·Ú· ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ÙˆÓ ·ÁÁ›ˆÓ Î·È ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (VCAM-1) ‰È¢ÎÔχÓÔÓÙ·˜ ¤ÙÛÈ Ù· ÚÒÙ· Ó· Î˘Ï‹ÛÔ˘Ó ¿Óˆ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁ›ˆÓ. T· ·ÁÁ›· ‰È¢ڇÓÔÓÙ·È Î·È ÂÈÙÚ¤Ô˘Ó ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ ÏÂÌÊÔ·ÙÙ·Ú· Ó· ÌÂÙ·Ó·ÛÙ‡ÛÔ˘Ó ÛÙÔ˘˜ ÈÛÙÔ‡˜ fiÔ˘ Û˘Ó·ÓÙÔ‡Ó ÙÔÓ ÛÙfi¯Ô ÙÔ˘˜ (911). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‰È·ÈÛÙÒıËΠ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Û ÔÛÔÛÙfi 85%, ÁÂÁÔÓfi˜ Ô˘ ·ÓÙÈηÙÔÙÚ›˙ÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔ-
84
¢. K·ÙÚÈÔ‡ Î·È Û˘Ó.
΢ÙÙ¿ÚˆÓ Ôχ ÚÈÓ ÂΉËψı› Ë ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ ÎÏÈÓÈο Î·È ¤ÙÛÈ Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÔÈ ·Ú¿ÌÂÙÚÔÈ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. H ÈÛ¯˘Ú‹ ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË Ô˘ ‰È·ÈÛÙÒıËΠÌÂٷ͇ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ sIL-2R Î·È sICAM-1 Î·È ÙˆÓ sIL-2R Î·È sVCAM-1, ·Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ Û¯Â‰fiÓ Ù·˘Ùfi¯ÚÔÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ·˘Ù‹ ÙˆÓ T-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÚÈÓ ·ÎfiÌË ÂΉËψı› ÎÏÈÓÈο Ë ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ·›ÓÔ˘Ì ÏÔÈfiÓ fiÙÈ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ 3 Î·È 4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ Î·È Ë ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì ™E§ Û ÔÛÔÛÙfi 55% Î·È 85% ·ÓÙ›ÛÙÔȯ·, ÚÈÓ ·fi ÙËÓ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙ· Ï·›ÛÈ· ÁÂÓÈÎfiÙÂÚ˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. H Û˘ÛÙËÌ·ÙÈ΋ ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Ì ™E§, ÌÔÚ› Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘. T· ›‰· ÙˆÓ sIL-2R, sICAM-1 Î·È sVCAM-1 ÌÔÚÔ‡Ó Ó· ÚÔÛÙÂıÔ‡Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Â˘·›ÛıËÙˆÓ ‰ÂÈÎÙÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÓfiÛÔ˘ Î·È Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÂÊ·ÚÌÔ˙fiÌÂÓË ıÂڷ›·. BÈ‚ÏÈÔÁÚ·Ê›· 1. Kotzin BL, O'Dell JR. Systemic lupus erythematosus. In : Frank MM, Austen KF, Claman HN, Unanue ER eds. Immunologic diseases. 5th ed. Boston: Little Brown, 1995:667-697. 2. Feldmann M.: T-cell activation in health and disease. Immunology Today 1988; 9:121-124. 3. Gorski A. The role of cell adhesion molecules in immunopathology. Immunology Today 1994;15(6):251255. 4. Shimizu Y, Newman W, Tanaka Y, Shaw S. Lymphocyte interactions with endothelial cells. Immunology Today 1992;13(3):106-112. 5. Srivastava M, Rossi TM, Lebenthal E. Serum soluble interleukin-2 receptor, soluble CD8 and soluble intercellular adhesion molecule-1 levels in Crohn’s disease, celiac disease, and systemic lupus erythematosus. Res Commun Mol Pathol Pharmac 1995; 87(1):21-26. 6. Spronk PE, Ter Borg EJ, Huitema MG, Limburg PC, Kallenberg CG. Changes in levels of soluble T-cell activation markers, sIL-2R, sCD4, and sCD8 in relation to disease exacerbations in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis 1994;53:235-239
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7. Straub RH, Zeuner M, Antoniou E, Scholmerich J, Lang B. Dehydro-epiandroepiandrosterone sulfate is positively correlated with soluble interleukin 2 receptor and soluble intercellular adhesion molecule in systemic lupus erythematosus. J Rheumatol, 1996;23:5, 856-861. 8. Sfikakis PP, Charalambopoulos D, Vayiopoulos G, Oglesby R, Sfikakis P, Tsokos GC. Increased levels of intercellular adhesion molecule-1 in the serum of patients with systemic lupus erythematosus. Clin-Exp-Rheumatol 1994;12(1): 5-9. 9. Spronk PE, Bootsma H, Huitema MG, Limburg PC, Kallenberg CG. Levels of soluble VCAM-1, soluble ICAM1, and soluble E-selectin during disease exacerbations in patients with systemic lupus erythematosus (SLE); a long term prospective study. Clin-Exp-Immunol. 1994;97(3): 439-444.
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10. Sfikakis PP, Tsokos GC. Clinical use of the measurement of soluble cell adhesion molecules in patients with autoimmune rheumatic diseases. Clin Diagn Lab Immunol, 1997, 4(3): 241-246. 11. Nyberg F, Acevedo F, Stephansson E. Different patterns of soluble adhesion molecules in systemic and cutaneous lupus erythematosus. Exp Dermatol, 1997;6(5): 230-235.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-10-98 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-06-99 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ˆÚÔı¤· K·ÙÚÈÔ‡ ¶. AÓÙˆÓ›Ô˘ 9 54632 £ÂÛÛ·ÏÔÓ›ÎË
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∆ιαδικασία αξιολόγησης και αποδελτιωσης βιοϊατρικών περιοδικών στη Βάση του IATPOTEK
A. Προδιαγραφές i. Yποψήφια για αποδελτίωση είναι µόνο περιοδικά που εµπίπτουν στο χώρο των Eπιστηµών Yγείας και τα οποία συντάσσονται εξ ολοκλήρου ή παραθέτουν τα τεκµηριωτικά στοιχεία των άρθρων τους (τίτλος, περίληψη, λέξεις ευρετηρίου, ονόµατα συγγραφέων και κέντρων προέλευσης) στην Eλληνική γλώσσα.
A1. Συντακτικές-Eκδοτικές i. Tήρηση των οδηγιών της International Committee of Medical Editors: Uniform Requirements for Manuscripts Submitted to Biomedical Journals, 1997.(1) ii. Tακτική έκδοση. Tα τεύχη των περιοδικών οφείλουν να κυκλοφορούν και να φθάνουν στη Γραµµατεία, µε το συνήθη τρόπο διανοµής του περιοδικού, µέχρι 6 µήνες από το τέλος της εκδοτικής περιόδου, στην οποία αντιστοιχούν.
A2. Προδιαγραφές λειτουργίας i. O φορέας, στον οποίο ανήκει το περιοδικό, οφείλει να έχει συντάξει Kανονισµό Λειτουργίας, στον οποίο καταγράφονται τα µέσα και οι διαδικασίες, δια των οποίων επιδιώκει τη διασφάλιση της ποιότητας του περιοδικού. O Kανονισµός Λειτουργίας περιλαµβάνει κατ’ ελάχιστον: • τη διάρκεια ισχύος του • το σκοπό έκδοσης του περιοδικού • το γνωστικό πεδίο που καλύπτει η έκδοση του περιοδικού • τη βασική διαδικασία αξιολόγησης των υπό δηµοσίευση εργασιών (εξωτερικοί κριτές, εσωτερική αξιολόγηση από τη Συντακτική Eπιτροπή, άλλος) • τον αριθµό των µελών της Συντακτικής Eπιτροπής • τη διαδικασία επιλογής του ∆ιευθυντή Σύνταξης και των µελών της Συντακτικής Eπιτροπής • τη διάρκεια της θητείας του ∆ιευθυντή Σύνταξης και των µελών της Συντακτικής Eπιτροπής και τη διαδικασία παύσης τους, στις καταγεγραµµένες περιπτώσεις ανεπάρκειάς τους • τα καθήκοντα και τα δικαιώµατα του ∆ιευθυντή Σύνταξης • τους οικονοµικούς πόρους του περιοδικού και τον τρόπο διαχείρισής τους. ii. H Σύνταξη του περιοδικού οφείλει να τηρεί: • Πρακτικά των συνεδριάσεών της • Bιβλίο διακίνησης των υπό δηµοσίευση άρθρων, στο οποίο θα φαίνεται λεπτοµερώς η διαδικασία, την οποία ακολούθησε κάθε κείµενο που υποβλήθηκε στο περιοδικό, µέχρι τη στιγµή που λήφθηκε η τελική απόφαση για το δηµοσιεύσιµό του. • Aρχείο από την αλληλογραφία κάθε άρθρου.
B. ∆ιαδικασία αξιολόγησης i. O φορέας, στον οποίο ανήκει το περιοδικό και επιθυµεί την καταλογογράφηση και αποδελτίωση του στη βάση του IATPOTEK, υποβάλλει, δια του νοµίµου εκπροσώπου του, στη Γραµµατεία του IATPOTEK, Aίτηση Aξιολόγησης.(2)
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ii. H Aίτηση Aξιολόγησης συνοδεύεται από (α) τα τεύχη του περιοδικού των δύο τελευταίων ετών, (β) συµπληρωµένο το επισυναπτόµενο Στατιστικό ∆ελτίο Περιοδικού, και (γ) υποχρέωση τακτικής αποστολής των µελλοντικών τευχών του περιοδικού στη Γραµµατεία του IATPOTEK. iii. H Γραµµατεία ελέγχει την αντιστοιχία του περιοδικού µε τις προδιαγραφές. H αντιστοιχία µε τις συντακτικές και εκδοτικές προδιαγραφές ελέγχεται στα τεύχη του τρέχοντος έτους.
iv. Aν το περιοδικό δεν καλύπτει πλήρως τις προδιαγραφές, αλλά κρίνεται ότι έχει τη δυνατότητα να τις καλύψει µετά από κάποιο χρόνο, η Γραµµατεία προβαίνει σε συγκεκριµένες υποδείξεις προς το φορέα του περιοδικού και προτείνει επανυποβολή της Aίτησης Aξιολόγησης σε χρόνο όχι µικρότερο του ενός έτους, οπότε επαναλαµβάνεται η ίδια διαδικασία. v. Σε κάθε άλλη περίπτωση, η Γραµµατεία συντάσσει και υποβάλλει αιτιολογηµένη εισήγηση στο Συµβούλιο Kρίσεως, που αποτελείται από οµάδα Aκαδηµαϊκών και Oµοτίµων Kαθηγητών της Iατρικής µε Πρόεδρο τον κ. N. Mατσανιώτη και το οποίο αποφασίζει για την αποδοχή ή την απόρριψη της Aίτησης Aξιολόγησης του περιοδικού. vi. Mετά από την αποδοχή της Aίτησης Aξιολόγησης, η Γραµµατεία φροντίζει για την αποδελτίωση των τευχών του περιοδικού και παρακολουθεί διαρκώς τη συµµόρφωσή του µε τις προδιαγραφές. vii. Aν διαπιστωθεί ότι παραβαίνονται οι προδιαγραφές, η Γραµµατεία έχει το δικαίωµα (α) να προβεί σε συστάσεις συµµόρφωσης, (β) να διακόψει προσωρινά την αποδελτίωση, (γ) να εισηγηθεί στο Συµβούλιο Kρίσεως την οριστική διακοπή της αποδελτίωσης του περιοδικού.
Γ. Όροι αποδελτίωσης Προκειµένου να αρχίσει η αποδελτίωσή τους στη βάση του IATPOTEK, τα περιοδικά, των οποίων γίνεται αποδεκτή η Aίτηση Aξιολόγησης, έχουν υποχρέωση: i. Nα αποστέλλουν ανελλιπώς στη Γραµµατεία του IATPOTEK τα τεύχη που εκδίδονται ii. Nα αποστέλλουν στη Γραµµατεία του IATPOTEK, σε ηλεκτρονική µορφή, το σύνολο της ύλης των τευχών, όπως ακριβώς είναι σε έντυπη µορφή. iii. Nα καταβάλουν ως τέλος αποδελτίωσης 50.000 δρχ. ανά τεύχος.
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¶PO™EXH ™YNE¢PIA ª¿ÚÙÈÔ˜ 2000 26-30 March 2000 Taipei, Taiwan 10th Asian Congress of Pediatrics Secretariat: 6F, 400, Kee Lung Rd., Sec. 1 Taipei, 110, TAIWAN Tel: 886-2-2722-1227, Fax: 886-2-2723-4187 e-mail: pcogis@ms14.hinet.net website: http://www.pcogis.com.tw
∞Ú›ÏÈÔ˜ 2000 1-2 ∞ÚÈÏ›Ô˘ 2000 ∞ı‹Ó· 1Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›· C&C International A.E. TËÏ: 01 6889100, Fax: 01 6844777 e-mail: congress@cnc.gr
1o ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜
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ª¿ÈÔ˜ 2000 10-13 ª·˝Ô˘ Santander, Spain European Conference on Health Promotion and Health Education Organised by the International Union for Health Promotion and Education Andalusian School of Public Health - Campus Universitario de Cartuja Apdo. Correos 2070 18080 Granada (Spain) e-mail: iuhpe@easp.es Tel: (34) 958 161 044 Fax: (34) 958 161 142
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OÎÙÒ‚ÚÈÔ˜ 2000 4-6 OÎÙˆ‚Ú›Ô˘ Portoroz, Slovenia 26th Annual Congress of the Union of Middle-Eastern & Mediterranean Paediatric Societies Information: Dr Ivan Vidmar Division for Paediatric Surgery & Intensive Care 1525 Ljubljana - Slovenia Fax: 0038661-1301714
∏ÌÂÚ›‰Â˜ 3-4 πÔ˘Ó›Ô˘ 2000 9Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ £¤Ì·: ¶ÂÚÈ‚¿ÏÏÔÓ Î·È ·È‰ÈÎfi˜ Ó‡ÌÔÓ·˜ ¢ÈÔÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· ∞ÈÁ›‰·: ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ™˘ÌÌÂÙÔ¯‹: ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ∂Î·È‰Â˘ÙÈÎfi ∫¤ÓÙÚÔ ∞ÁÚÔÙÈ΋˜ ∆Ú¿Â˙·˜, ∫·ÛÙÚ› (∂Ï. µÂÓÈ˙¤ÏÔ˘ 154 & ∞ÓÙÈÁfiÓ˘, ¡. ∂Ú˘ıÚ·›·) ¶ÏËÚÔÊÔڛ˜: ∫ÒÛÙ·˜ ¡. ¶Ú›ÊÙ˘ ∆ËÏ.: 80 36 484, fax: 61 31 173
¶∞π¢OæÀÃπ∞∆ƒπ∫∏ ∂∆∞πƒπ∞ ∂§§∞¢O™ HELLENIC SOCIETY OF CHILD & ADOLESCENT PSYCHIATRY
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™YNTOMO°PAºIE™ - (Abbreviations) ™˘ÓÙÔÌÔÁڷʛ˜
EÏÏËÓÈÎÔ› fiÚÔÈ
AÁÁÏÈÎÔ› fiÚÔÈ
AIDS
Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜
AMP, ADP, ATP
ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË
ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA
ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ·ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜
Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º. L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p
·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·
acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability
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EÏÏËÓÈÎÔ› fiÚÔÈ
AÁÁÏÈÎÔ› fiÚÔÈ
p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE U
·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·
by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit
™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12
tera- (10 ) 9 giga- (10 ) 6 mega-(10 ) 3 kilo- (10 ) 2 hecto(10 ) 1 deca (10 ) -1 deci (10 ) -2 centi- (10 ) -3 milli(10 ) -5 micro (10 ) -9 nano (10 ) -12 pico (10 ) -15 femto (10 ) -18 atto (10 )
xix
Combining prefixes T G M k h da d c m Ì n p f a