Παιδιατρική | Τόμος 63 • Τεύχος 2 • Μάρτιος - Απρίλιος 2000

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

¶AI¢IATPIKH TfiÌÔ˜ 63, T‡¯Ô˜ 2Ô ª·ÚÙ.-∞Ú. 2000

HELLENIC PAEDIATRIC SOCIETY

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Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

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Publisher K. Griveas

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™‡Ì‚Ô˘ÏÔÈ ∂Ù·ÈÚÂÈÒÓ ¶·È‰È·ÙÚÈÎÒÓ ÀÔÂȉÈÎÔÙ‹ÙˆÓ ™. °Ú·Ê¿ÎÔ˜ ∞ÈÌ·ÙÔÏÔÁ›·-OÁÎÔÏÔÁ›· ∂. ƒÒÌ· °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· µ. ™ËÏÈÒÙË ∂Ó‰ÔÎÚÈÓÔÏÔÁ›· µ. £·ÓfiÔ˘ÏÔ˜ ∫·Ú‰ÈÔÏÔÁ›· ∂. ¶ÂÙÚ›‰Ô˘ ∫ÔÈÓˆÓÈ΋ ¶·È‰È·ÙÚÈ΋ ª. •¿ÓıÔ˘ ¡ÂÔÁÓÔÏÔÁ›· ∫. ™ÙÂÊ·Ó›‰Ë˜ ¡ÂÊÚÔÏÔÁ›· §. ¶··ÁÈ·ÓÓÔ‡ÏË ¶·È‰Ô‰ÔÓÙÈ·ÙÚÈ΋ ∞. ¶··‚·ÛÈÏ›Ԣ ¶·È‰ÔÓ¢ÚÔÏÔÁ›· π. ∆۷ӿη˜ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁ›·

Consultants, Paediatric Subspecialty Societies S. Grafacos Haematology-Oncology E. Roma Gastroenterology V. Spilioti Endocrinology V. Thanopoulos Cardiology E. Petridou Social Paediatrics M. Xanthou Neonatology K. Stefanidis Nephrology L. Papagianouli Paedodontics A. Papavassiliou Neurology J. Tsanakas Pneumonology

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

HELLENIC PAEDIATRIC SOCIETY

¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 2Ô ª·ÚÙ.-∞Ú. 2000

Volume 63, No. 2, Mar-Apr. 2000

¶EPIEÃOMENA

CONTENTS ™ÂÏ.

Aºπ∂ƒøª∞: ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡ 2000

Page

SPECIAL SERIES: Children’s Health 2000

¶ÚfiÏÔÁÔ˜

Forward

ª. ¶··ÁÚËÁÔÚ›Ô˘, ∂. µ·Ï¿ÛÛË - ∞‰¿Ì

87

M. Papagregoriou, E. Valassi - Adam

87

The management of thalassaemia - Present and future

ªÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· - ¶·ÚfiÓ Î·È Ì¤ÏÏÔÓ Ã. ∫·ÙÙ¿Ì˘

88

C. Kattamis

88

∏ ÈÛÙÔÚ›· Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜. ∂ÈÙ‡ÁÌ·Ù· Î·È ÛÎȤ˜ ÙÔ˘ ¯ı˜ - ÚÔÛ‰Ô˘ Ù˘ ·‡ÚÈÔÓ

The history of haemophilia. Achievements and shadows of the past - expectations for the future

™. ∞ÚÒÓË - µÔ˘ÚÓ¿

S. Aronis - Vournas

93

The paediatrician and the rights of children.

O ·È‰›·ÙÚÔ˜ Î·È Ù· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ ∂. ∞Á¿ıˆÓÔ˜ - °ÂˆÚÁÔÔ‡ÏÔ˘

97

∂. Agathonos - Georgopoulou

°ƒ∞¶∆O ™Àª¶O™πO

ROUND TABLE

§ÔÈÌÒÍÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹

Infections in childhood and chronic diseases later in life Coordination: ∫. ªalaka - ∑afiriou

™˘ÓÙÔÓÈÛÌfi˜: ∫. ª·Ï·Î¿ - ∑·ÊÂÈÚ›Ô˘ ∂È̤ÏÂÈ·: ª. ∞ı·Ó·Û›Ô˘ - ªÂÙ·Í¿

93

101

97

Editing: M. Athanasiou - Metaxa

101

Infections and immunosuppression

§ÔÈÌÒÍÂȘ Î·È ·ÓÔÛÔηٷÛÙÔÏ‹ ª. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ - ™È‰ËÚÔÔ‡ÏÔ˘

103

M. Hatzistylianou - Sidiropoulou

Infections and immune cytopenias

§ÔÈÌÒ‰ÂȘ Î·È ¿ÓÔÛ˜ ΢ÙÙ·ÚÔÂӛ˜ ª. ∞ı·Ó·Û›Ô˘ - ªÂÙ·Í¿

106

¡. °ÔÌ¿Î˘

M. Athanasiou - Metaxa

Viral infections and cancer

πÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È Î·ÚΛÓÔ˜ ÛÙÔÓ ¿ÓıÚˆÔ 107

N. Gombakis

Infections and atherosclerosis

§ÔÈÌÒÍÂȘ Î·È ·ıËÚÔÛÎÏ‹Ú˘ÓÛË ∫. ª·Ï·Î¿ - ∑·ÊÂÈÚ›Ô˘

110

™. µ·ÚÏ¿Ì˘

K. Malaka - Zafiriou

Viral infections and dilated cardiomyopathy

πÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· 112

S. Varlamis

Infections and chronic lung disease

§ÔÈÌÒÍÂȘ Î·È ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ª. ∂ÌÔÚÈ¿‰Ô˘

115

M. Emboriadou

∞ƒ£ƒO ∂π¢π∫OÀ ∂¡¢π∞º∂ƒO¡∆O™

SPECIAL ARTICLE

O ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÁÎÔÏfiÁÔ˘ ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡ Ì ηÚΛÓÔ

The role of the paediatric oncologist during the terminal phase of cancer in a child

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - ∞Ó‰ÚÔ˘Ï·Î¿ÎË

S. Polychronopoulou - Androulakaki

121

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ORIGINAL PAPERS

H ‚·ÛÈ΋ ÂÎÎÚÈÙÈ΋ Âʉڛ· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1

Pancreatic reserve in the identification of type 1 diabetes

§. KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M. E˘ÛÙ·ıÈ¿‰Ô˘, N. ¢ËÌËÙÛ›ÎÔÁÏÔ˘, A. ¶Ô‡ÏÔ˘, E. æˆÌ¿, I. ¢ËÌËÙÛ›ÎÔÁÏÔ˘

129

H ·¯˘Û·ÚΛ· Û ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ K‡ÚÔ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ· °. KÔ˘Ú›‰Ë˜, M. TÔÚÓ·Ú›Ù˘, X. KÔ˘Ú›‰Ë˜, ™. ™¿‚‚·, X. X·Ù˙ËÁˆÚÁ›Ô˘, M. ™È·ÌÔ‡ÓÎË

121

L. Konstantinidou, M. Eustathiadou, N. Dimitsikoglou, A. Pulu, E. Psoma, I. Dimitsicoglou

129

Obesity in children aged 11 to 12 years in Cyprus.

Significant increase during the last 8 years 137

™˘Ó¯›˙ÔÓÙ·È

Y. Kourides, M. Tornaritis, C. Kourides, S. Savva, H. Hadjigeorgiou, M Siamounki

137

Continued

iii

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E§§HNIKH ¶AI¢IATPIKH ETAIPEIA

HELLENIC PAEDIATRIC SOCIETY

¶AI¢IATPIKH

PAEDIATRIKI

TfiÌÔ˜ 63, T‡¯Ô˜ 2Ô ª·ÚÙ.-∞Ú. 2000

Volume 63, No. 2, Mar-Apr. 2000

™ÂÏ.

Page

H ¯ÚËÛÈÌfiÙËÙ· Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ ·È‰ÈÒÓ ÚÈÓ ·fi ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

The role of chloral hydrate in the sedation of children before computerized tomography.

M. Z·Ú›ÊË, N. E˘ÏÔÁÈ¿˜, M. X·ÛÈÒÙÔ˘-BÚ›ÙÛÈÔ˘, B. £ÂÔ‰ˆÚfiÔ˘ÏÔ˜

M. Zarifi, N. Evlogias, M. Hasiotou-Vritsiou, V. Theodoropoulos

145

AÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ ÈÏ·Ú¿˜ Î·È ÂÚ˘ıÚ¿˜ ÛÙÔ Î·ÙÒÊÏÈ ÙÔ˘ 2000 ¢. AÏÂ͛Ԣ, X. MfiÚ·, Õ. MÂÛÛ·ÚÈÙ¿ÎË, N. M¿ÚÁ·ÚË, £. K·Ú¿ıÈÔ˜

The efficacy of prevention programmes for measles and rubella at the dawn of 2000.

150

D. Alexiou, C. Bora, A. Messaritaki, N. Margari, T. Karpathios

∫§π¡π∫∏ ∂ª¶∂πƒπ∞

CLINICAL EXPERIENCE

¶ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙÔ˘ ™˘ÁÁÂÓÔ‡˜ EÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ IÛ¯›Ô˘ (™EI) Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁ¤ÓÓËÙ·

Early diagnosis and treatment of congenital dislocation of the hip (CDH) in newborn, full term babies

I. K. NÙÔ˘ÓÙÔ˘Ï¿Î˘

156

J.K. Doudoulakis

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

CASE REPORT

¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ¯˘ÏÔ˘Ú›·

Case report of a child with chyluria

¢. K·Ú·Î·˚‰fi˜, ¶. ZÒÛË, H. °ÂˆÚÁÈ¿‰Ë˜, E. KˆÛÙÔÔ‡ÏÔ˘, K. NÙ¤ÚÔ˜, X. K·Ú‹˜

145

163

D. Karakaidos, P. Zosi, H. Georgiadis, H. Kostopoulou, K. Nteros, C. Karis

150

156

163

A¶EIKONI™TIKH ¶EPI¶Tø™H

RADIOLOGICAL CASE OF THE ISSUE

EÛٛ˜ ÂÍˆÌ˘ÂÏÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘ Û ·È‰› Ì ÂӉȿÌÂÛË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·

Foci of extramedullary haemopoiesis in a patient with thalassaemia intermedia

M. Aı·Ó·Û›Ô˘-MÂÙ·Í¿, A. KÔ‡ÛË, I. TÛ¿ÙÚ·, M. M·ÓÙÔ˘Ú¿ÎË

167

M. Athanasiou-Metaxa, A. Koussi, J. Tsatra, M. Badouraki

™À¡∂Ãπ∑Oª∂¡∏ ∂∫¶∞π¢∂À™∏

CONTINUING MEDICAL EDUCATION

¶ÚÔʇϷÍË ·fi ÙȘ ˘ÔÙÚÔ¤˜ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ

Prophylaxis from recurrence of febrile convulsions

A. ™Î·Ú‰Ô‡ÙÛÔ˘

A. Skardoutsou

167

170

170

PAEDIATRICIANS’ PRACTICAL ADVICE TO PARENTS

¶PAKTIKE™ O¢H°IE™ TOY ¶AI¢IATPOY ™TOY™ °ONEI™ H ÛËÌ·Û›· ÙÔ˘ ·È¯ÓȉÈÔ‡ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË I. AÓÙˆÓÈ¿‰Ô˘ - KÔ˘Ì¿ÙÔ˘

177

I. Antoniadou - Koumatou

177

∂¶π™∆O§∂™

180

LETTERS

180

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

Forthcoming meetings

™˘ÓÙÔÌÔÁڷʛ˜

Abbreviations

iv

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™ÂÏ›‰·9

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ H ¶AI¢IATPIKH Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤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 ‰›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˘ ÂÈÛÙËÌÔÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ· °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ,Â›Î·ÈÚ· 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΋˜ ÂÎ·›‰Â˘Û˘ Î·È ˘Á›·˜, Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÔ‡ ÙÚ·Â˙ÈÔ‡, ÎÏÈÓÈÎÔ·ıÔÏÔÁÈΤ˜ Û˘˙ËÙ‹ÛÂȘ, ÛÂÌÈÓ¿ÚÈ·, Û˘ÌfiÛÈ·, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ¿ÚıÚ· Û˘Ó¯È˙fiÌÂÓ˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙËÌÔÓÈ΋ ÂȉËÛÂÔÁÚ·Ê›· fiˆ˜ ÂÓË̤ڈÛË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Û˘Ó‰ڛˆÓ, Û˘ÌÔÛ›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 ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 11528 Aı‹Ó· H ¶AI¢IATPIKH ·ÎÔÏÔ˘ı› ÙȘ KÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· XÂÈÚfiÁÚ·Ê· Ô˘ YÔ‚¿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 ÂÈÛÙÔÏ‹, Ô˘ Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›·: ·) 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 ÌÔÚÔ‡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 οÔÈ· 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 ÂËÚ¿˙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˘˜ ÂÈÙÚ¤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 fiˆ˜ ·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 ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο, ÛËÌÂ›Ô ÚÔ˜ ÛËÌ›Ô, ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·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.

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MART.-APR.2000 ÓÂÔ

30-05-03

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™‡ÓÙ·ÍË ÙˆÓ ÂÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·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 ‰ÈÏfi ‰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 ÂȉÔÙ‹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· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ 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 ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ 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 ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›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˘ÌÂÚ¿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˜ ÂÚÈÙÒÛÂȘ ¤¯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· ¯ÚËÛÈÌÔÔÈËıÔ‡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˘

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¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜.

H ÂÚÈÁÚ·Ê‹ ÙÔ˘ ˘ÏÈÎÔ‡ Î·È ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤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˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË.

OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ 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 ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›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·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, 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·ÔÌÒÓ 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·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ 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˘ ÔÈÛı›·˜ 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. ™˘ÌÏËڈ̷ÙÈÎfi 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˘-AÏÈÚ¿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. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: MÂÓ¤ÙÔ˘-M·Ú·ÓÙ›‰Ô˘ A. XÚËÛÈÌÔÔ›ËÛË ÔÏÏ·ÏÒÓ ÂȉÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÌÔÏ˘‚‰È¿Ûˆ˜ ÛÙÔ K.N.™. ·È‰ÈÒÓ (¢È‰·ÎÙ. ¢È·ÙÚ.). Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ 1988.

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 ¶›Ó·Î˜ Î·È ÂÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡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 ÂÂÍ‹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 ÔÔ›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: - ÂÈÛÙÔÏ‹ ˘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 ÂÈÛÙÔÏ‹ ¤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 ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

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AºIEPøMA: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

M·Ú›· ¶··ÁÚËÁÔÚ›Ô˘-£ÂÔ‰ˆÚ›‰Ô˘, EϤÓË B·Ï¿ÛÛË-A‰¿Ì

¶ÚfiÏÔÁÔ˜ H ÌÂÙ¿‚·ÛË ÛÙË Ó¤· ¯ÈÏÈÂÙ›· ÂÎÙfi˜ ·fi ÙËÓ ÁÂÓÈ΋ ·ÙÌfiÛÊ·ÈÚ· ÂÂÙÂÈ·ÎÒÓ ·ÓËÁ˘ÚÈÛÌÒÓ Ê˘ÛÈÎfi ‹Ù·Ó Ó· ηÏÏÈÂÚÁ‹ÛÂÈ ÛÙÔÓ È·ÙÚÈÎfi ÎfiÛÌÔ ÌÈ· ‰È¿ıÂÛË ·ÔÏÔÁÈÛÌÒÓ, ·Ó·ÛÎÔ‹ÛÂˆÓ Î·È ÚÔ‚ÔÏ‹˜ ÔÚ·Ì¿ÙˆÓ. OÈ ·È‰›·ÙÚÔÈ, fiÔÈ· ÎÈ ·Ó Â›Ó·È Ë ÂȉÈÎfiÙËÙ·, ÙÔ ·ÓÙÈΛÌÂÓÔ ‰Ô˘ÏÂÈ¿˜, Ë ËÏÈΛ·, Ë Â¤Ó‰˘ÛË ÛÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÂÓË̤ڈÛË ÙÔ˘ ηıÂÓfi˜, ¤¯Ô˘Ì Â›ÁÓˆÛË fiÙÈ ÔÈ ·ÏÏ·Á¤˜ ÛÙÔ ¯ÒÚÔ Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Ú·Á‰·›Â˜, ÔÈ ÁÓÒÛÂȘ ·ıÚÔ›˙ÔÓÙ·È Ù·¯‡ÙÂÚ· ·fi fiÛÔ ÌÔÚԇ̠ӷ ÙȘ ÚÔÛÏ¿‚Ô˘ÌÂ, Ë ÂÍÂȉ›Î¢ÛË Ì·˜ οÓÂÈ Ó· ÌÂÈÔÓÂÎÙԇ̠۠‚·ÛÈΤ˜ ÁÂÓÈΤ˜ ÁÓÒÛÂȘ Î·È fiÙÈ Â›Ó·È ·Ó¤ÊÈÎÙÔ Ó· ÂÂÍÂÚÁ·ÛÙԇ̠ÙȘ Ӥ˜ ÁÓÒÛÂȘ Û ı¤Ì·Ù· ÂÎÙfi˜ ÙˆÓ ÛÙÂÓÒÓ ÂÈÛÙËÌÔÓÈÎÒÓ Ì·˜ ÂӉȷÊÂÚfiÓÙˆÓ. ¢ÂÓ Â›Ó·È ·Ï·˙ÔÓ›·, Ô‡ÙÂ Ê˘ÁÔÔÓ›· Ó· ·Ó·˙ËÙ¿ ηÓ›˜ Ó· ·ÔÎÙ‹ÛÂÈ ÁÂÓÈ΋ ÂÔÙ›· Û ı¤Ì· ÁÂÓÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜ ·fi οÔÈÔÓ ·fiÏ˘Ù· ÂȉÈÎfi Û˘Ó¿‰ÂÏÊÔ ¯ˆÚ›˜ Ó· ÂÂÓ‰‡ÛÂÈ Ôχ ¯ÚfiÓÔ Î·È ÎfiÔ. OÈ ÂȉÈÎÔ› ¢¯·Ú›ÛÙˆ˜ Ì·˜ ‰›ÓÔ˘Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ fiÙ·Ó ÙȘ ˙ËÙԇ̠ÁÈ· Û˘ÁÎÂÎÚÈ̤ӷ ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÂÏ·ÙÒÓ Ì·˜, ·ÏÏ¿ Û ÚÔÛˆÈÎfi Â›Â‰Ô ‰ÂÓ ÙÔÏÌԇ̠‚¤‚·È· Ó· ÙÔ˘˜ ˙ËÙ‹ÛÔ˘Ì ӷ Ì·˜ ‰ÒÛÔ˘Ó Û˘ÌÂ˘Îӈ̤ÓË ÙËÓ ›ڷ Î·È ÙȘ ı¤ÛÂȘ ÙÔ˘˜ ÁÈ· ÙÔ ·ÓÙÈΛÌÂÓÔ ÛÙÔ ÔÔ›Ô ÂȉÈ·ÔÓÙ·È. A˘Ùfi ·ÎÚÈ‚Ò˜ ˙ËÙ‹Û·Ì Ì ·˘Ùfi ÙÔ ·ÊȤڈ̷ ÛÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡.

EÈϤͷÌ ı¤Ì·Ù· ÁÂÓÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜ ÛÙ· ÔÔ›· ÂÎÙÈÌԇ̠fiÙÈ Ë ÂÓË̤ڈۋ Ì·˜ ¤¯ÂÈ ÎÂÓ¿ ÁÈ· ÔÈΛÏÔ˘˜ ÏfiÁÔ˘˜: ¿ÏÏ· ÁÈ·Ù› ¤¯Ô˘Ó ηÈÚfi Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÛÙÔÓ ·È‰È·ÙÚÈÎfi Ù‡Ô, ¿ÏÏ· ÁÈ·Ù› ¤¯Ô˘Ó ·Ó·‰˘ı› Û¯ÂÙÈο ÚfiÛÊ·Ù·, ¿ÏÏ· ÁÈ·Ù› ÚfiÛÊ·Ù˜ ÂÍÂÏ›ÍÂȘ ÂÈ‚¿ÏÔ˘Ó ·Ó·ıÂÒÚËÛË ‹ Ó¤· ÚÔÛ¤Ï·ÛË, ¿ÏÏ· ÁÈ·Ù› ·fiÎÙËÛ·Ó Ó¤· ı¤ÛË ‹ Ӥ˜ ‰È·ÛÙ¿ÛÂȘ ÛÙÔ ¯ÒÚÔ Ù˘ ˘Á›·˜. Œ¯ÔÓÙ·˜ ÂÈϤÍÂÈ Ù· ı¤Ì·Ù· Ô˘ ÈÛÙ‡ԢÌ fiÙÈ ı· ηχ„Ô˘Ó ÙȘ ·Ó¿ÁΘ Î·È ÙȘ ÂÈı˘Ì›Â˜ ÔÏÏÒÓ ·Ó·ÁÓˆÛÙÒÓ ·Ó·˙ËÙ‹Û·Ì ηٷÍȈ̤ÓÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÁÈ· Ó· Ù· ·Ó·Ù‡ÍÔ˘Ó. TÔ˘˜ ˙ËÙ‹Û·Ì ӷ ÁÚ¿„Ô˘Ó Û ÌÔÚÊ‹ ¿ÚıÚÔ˘ Û‡ÓÙ·Í˘ ‹ Û‡ÓÙÔÌ˘ ÂÓË̤ڈÛ˘ Î·È Ó· ÌÔÈÚ·ÛÙÔ‡Ó Ì ÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜ ÙËÓ ›ڷ, ÙȘ ÂÈÊ˘Ï¿ÍÂȘ Î·È ÙȘ ÚÔÛ‰Ô˘ ÙÔ˘˜. ™Â οı Ù‡¯Ô˜ Ë ¶AI¢IATPIKH ı· ÊÈÏÔÍÂÓ› 3-4 ¿ÚıÚ·. ™Â ·˘Ùfi ÙÔ Ù‡¯Ô˜ ‰ËÌÔÛȇÔÓÙ·È ÙÚ›· ¿ÚıÚ· "MÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. ¶·ÚfiÓ Î·È Ì¤ÏÏÔÓ" "IÛÙÔÚ›· Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜. EÈÙ‡ÁÌ·Ù· Î·È ÛÎȤ˜ ÙÔ˘ ¯ı˜/ ÚÔÛ‰Ô˘ Ù˘ ·‡ÚÈÔÓ" Î·È "O ·È‰›·ÙÚÔ˜ Î·È Ù· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡". ™Â ÂfiÌÂÓ· Ù‡¯Ë ı· Î·Ï˘ÊıÔ‡Ó: ÂÚÈ‚¿ÏÏÔÓ Î·È ˘Á›·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ ·È‰Ô„˘¯È·ÙÚÈ΋, Ï¢¯·ÈÌ›·, ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·-ÌÂÙ·ÌÔۯ‡ÛÂȘ, ÙÔ ·È‰› Ì ÙÔ ¯ÚfiÓÈÔ ÓfiÛËÌ·, ÂÈ‚›ˆÛË ÓÂÔÁÓÒÓ, ÌÈÎÚԂȷ΋ ·ÓÙÔ¯‹, ·˘ÍËÙÈ΋ ÔÚÌfiÓË, ÁÔÓȉ›ˆÌ·, ÂÍÂÏ›ÍÂȘ ÛÙË ÁÂÓÂÙÈ΋, Ô ·È‰›·ÙÚÔ˜ ˆ˜ ÔÚÁ·ÓˆÙ‹˜ ˘ËÚÂÛÈÒÓ ˘Á›·˜, ¿ÛıÌ·, ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ‰Â›ÎÙ˜ ˘Á›·˜, ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰·, ÂÌ‚fiÏÈ·, Ë·Ù›Ùȉ˜, ÔÈfiÙËÙ· ˙ˆ‹˜, Û˘ÓÂÚÁ·Û›· Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, ·ÂÈÎÔÓÈÛÙÈΤ˜ Ù¯ÓÈΤ˜, ‰È·ÙÚÔÊ‹. A˘Ù¿ ÂÍ·Ûʷϛ۷Ì ÂÌ›˜ ˆ˜ ÂÈÌÂÏ‹ÙÚȘ ¤Î‰ÔÛ˘ ·˘ÙÔ‡ ÙÔ˘ ·ÊÈÂÚÒÌ·ÙÔ˜. AÓ Î¿ÔÈÔ˜ ·fi ÙÔ˘˜ ·Ó·ÁÓÒÛÙ˜ ¤¯ÂÈ Ó· ÚÔÙ›ÓÂÈ Î¿ÔÈÔ ·ÎfiÌË ı¤Ì· ·˜ ÁÚ¿„ÂÈ ÙËÓ ÚfiÙ·Û‹ ÙÔ˘. £· ÚÔÛ·ı‹ÛÔ˘Ì ӷ ‚Úԇ̠ÙÔÓ Î·Ù¿ÏÏËÏÔ Û˘ÁÁڷʤ· Î·È ÙÔÓ ··Ú·›ÙËÙÔ ¯ÒÚÔ ÛÙÔ ÂÚÈÔ‰ÈÎfi.

O Ù›ÙÏÔ˜ ÙÔ˘ ·ÊÈÂÚÒÌ·ÙÔ˜ "YÁ›· ÙÔ˘ ·È‰ÈÔ‡" ÈÛÙ‡ԢÌ fiÙÈ ÂÎÊÚ¿˙ÂÈ ÙÔ ·ÓÙÈΛÌÂÓÔ ÙˆÓ ·È‰È¿ÙÚˆÓ Ôχ ηχÙÂÚ· ·fi ÙÔÓ fiÚÔ "¶·È‰È·ÙÚÈ΋".

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:88-92

MÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. ¶·ÚfiÓ Î·È Ì¤ÏÏÔÓ XÚ‹ÛÙÔ˜ K·ÙÙ¿Ì˘ Christos Kattamis. The management of thalassaemia. Present and future. Paediatriki 2000;63:88-92 ● Abstract: Progress in the prevention and treatment of thalassaemia in the last three decades has been significant in industrialized countries. Well organized prevention programmes have proved that elimination of this disease will be feasible for the next generations. In contrast to the development in prevention, therapy although effective still poses unsolved problems such as high cost and difficulties of the patients in following therapeutic regimes appropriate for the disease and the side effects. Problems are even more serious in developing countries where there are many more patients. It is expected that the numbers will rise as mortality from infectious diseases and malnutrition diminish. In the new millennium the interest of WHO and other international organisations will need to expand to cover thalassaemia syndromes. A major issue would be the study of the epidemiology and types of thalassaemia syndromes in various populations. This should give an accurate estimate of the extent of the problem and could serve to initiate planning of more effective ways of handling the disease, adapted to the socioeconomic conditions in each country. ∫ey words: thalassaemia, therapy, prevention.

OÈ ÎÏÈÓÈΤ˜ ÌÔÚʤ˜ Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ (MA) ·Ó·ÁÓˆÚ›ÛıËÎ·Ó Ù·˘Ùfi¯ÚÔÓ· ÛÙËÓ IÙ·Ï›· Î·È ÛÙËÓ AÌÂÚÈ΋ ÙÔ 1925. T· ÂfiÌÂÓ· ¯ÚfiÓÈ· Ë ÓfiÛÔ˜ ‰È·ÈÛÙÒıËÎÂ Î·È Û ¿ÏÏÔ˘˜ ÏËı˘ÛÌÔ‡˜ ·ÏÏ¿ Ë Û˘ÛÙËÌ·ÙÈ΋ ÌÂϤÙË Ù˘ ÍÂΛÓËÛ ÌÂÙ¿ ÙÔ 1950. TË ‰ÂηÂÙ›· ·˘Ù‹ ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ÚˆÙÂ˚ÓÈÎfi ÎÏ¿ÛÌ· ÙˆÓ ·ÈÌÔÛÊ·ÈÚÈÓÒÓ ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ˙‡ÁË ‰È·ÊÔÚÂÙÈÎÒÓ ·Ï˘Û›‰ˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ·ÈÌÔÛÊ·ÈÚ›ÓË A ·fi ÙȘ ·Ï˘Û›‰Â˜ · Î·È ‚ (·2‚2), Ë ÂÌ‚Ú˘˚΋ ·ÈÌÔÛÊ·ÈÚ›ÓË F ·fi ÙȘ ·Ï˘Û›‰Â˜ · Î·È Á (·2Á2) Î·È Ë ·ÈÌÔÛÊ·ÈÚ›ÓË A2 ·fi ÙȘ · Î·È ‰ (·2‰2)(1,2). ™ÙË Û˘Ó¤¯ÂÈ· ·ÂηχÊıË fiÙÈ Ù· Û‡Ó‰ÚÔÌ· ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÔÊ›ÏÔÓÙ·È Û ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ Û‡ÓıÂÛ˘ ÙˆÓ ÔÏ˘ÂÙȉÈÎÒÓ ·Ï˘Û›‰ˆÓ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÈÌÔÛÊ·ÈÚÈÓÒÓ ÙÔ˘ ·ÓıÚÒÔ˘.

A‰ÚÔ› ˘ÔÏÔÁÈÛÌÔ› ·Ó‚¿˙Ô˘Ó ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ÊÔÚ¤ˆÓ Ù˘ · Î·È ‚ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û 100.000.000. ¶·Ú¿ÏÏËÏ·, ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ‰È·›ÛÙˆÛ·Ó ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ Ù˘ ÓfiÛÔ˘. H MA Â›Ó·È Û˘¯Ó‹ Û ¯ÒÚ˜ Ù˘ MÂÛÔÁ›Ԣ, Ù˘ M¤Û˘ AÓ·ÙÔÏ‹˜, Ù˘ KÂÓÙÚÈ΋˜ Î·È NÔÙÈÔ·Ó·ÙÔÏÈ΋˜ AÛ›·˜ Î·È Ù˘ BfiÚÂÈ·˜ Î·È KÂÓÙÚÈ΋˜ AÊÚÈ΋˜, ÂÓÒ Â›Ó·È ¿ÁÓˆÛÙË Û ¯ÒÚ˜ Î·È ÏËı˘ÛÌÔ‡˜ Ù˘ ¢˘ÙÈ΋˜, KÂÓÙÚÈ΋˜, BfiÚÂÈ·˜ Î·È AÓ·ÙÔÏÈ΋˜ E˘ÚÒ˘(3). E›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ MA ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ·ÎfiÌË Î·È Û ÔÌÔÈÔÁÂÓ›˜ ÏËı˘ÛÌÔ‡˜. H ÂÙÂÚÔÁ¤ÓÂÈ· ·˘Ù‹ ·Ô‰fiıËΠ۠ÈÛÔÚÚÔË̤ÓÔ˘˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ·fi ÙËÓ ÂÈÏÂÎÙÈ΋ ‹È· ‰Ú¿ÛË ‚Ï·ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È Î˘Ú›ˆ˜ ·Ú·ÛÈÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙÔ˘˜ ÊÔÚ›˜ MA Û ۯ¤ÛË ÌÂ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ·. AÓÙ›ıÂÙ·, ·fi ÚfiÛÊ·Ù˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¯·Ú·ÎÙËÚÈÛÌÔ‡ Î·È Û˘¯ÓfiÙËÙ·˜ ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰È·ÈÛÙÒıËΠÏËı˘ÛÌȷ΋ ÂÍÂȉ›Î¢ÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙfiÛÔ Ù˘ ·- fiÛÔ Î·È Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜(4). X·Ú·ÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÊÔÚ¤ˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ (5), fiˆ˜ Î·È ÛÙÔ Ê¿ÛÌ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ù˘ ‚-MA ÛÙË ¯ÒÚ· Ì·˜. M¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛı› ‰ÈÂıÓÒ˜ ÂÚ›Ô˘ 200 ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ‚ ÁfiÓÔ˘. ™ÙËÓ EÏÏ¿‰· ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛı› ¿Óˆ ·fi 25 ÌÂÙ·ÏÏ¿ÍÂȘ Ì ÈÔ Û˘¯Ó¤˜ ++ ÙËÓ ‚+ IVS-I-n110, ÙËÓ ‚Ô CD39 Î·È ÙËÓ ‚ IVS1-n6(6).

O ¯·Ú·ÎÙËÚÈÛÌfi˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ÂÈÎÚ·ÙÔ‡Ó ÛÙÔÓ ÏËı˘ÛÌfi Î·È Ù· ‰Â‰Ô̤ӷ ÏÂÙÔÌÂÚÒÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ ¤¯Ô˘Ó ȉȷ›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ È·ÙÚÈÎÒÓ, ÓÔÛËÏ¢ÙÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi MA Î·È ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘˜, H ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤¯ÂÈ ‰‡Ô ‚·ÛÈο ÛΤÏË. TËÓ ÚfiÏË„Ë Î·È ÙË ıÂÚ·›·. K·È ÛÙ· ‰‡Ô ·˘Ù¿ ÛΤÏË ÔÈ ÚfiÔ‰ÔÈ Ù˘ ÙÂÏÂ˘Ù·›·˜ ÙÚÈ·ÎÔÓÙ·ÂÙ›·˜ Â›Ó·È ÛËÌ·ÓÙÈΤ˜.

OÌfiÙÈÌÔ˜ K·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ AıËÓÒÓ

88

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

¶∞π¢π∞∆ƒπ∫∏ 2000;63:88-92

™ÂÏ›‰·89

∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

¶ÚfiÏË„Ë M ‰Â‰Ô̤ÓË ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, Á‡Úˆ ÛÙÔ 8%, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ 1 ÛÙ· 600 ÂÚ›Ô˘ ÓÂÔÁÓ¿ ı· ÁÂÓÓËı› Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. TÔ Úfi‚ÏËÌ· Â›Ó·È Ô͇ÙÂÚÔ Û ÂÚÈÔ¯¤˜ Ì ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ fiˆ˜ Â›Ó·È Ë Pfi‰Ô˜, Ë K·Ú‰›ÙÛ·, (Á‡Úˆ ÛÙÔ 20%), fiÔ˘ Ë ·Ó·ÌÂÓfiÌÂÓË Û˘¯ÓfiÙËÙ· ÁÂÓÓ‹ÛÂˆÓ ·ÚÚÒÛÙˆÓ ·È‰ÈÒÓ ı· ¤Êı·Ó ÛÙÔ 1 Û 100-120 ÁÂÓÓ‹ÛÂȘ Î·È ËÈfiÙÂÚÔ Û ÂÚÈÔ¯¤˜ Ì ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ· fiˆ˜ Û ÓÔÌÔ‡˜ ÙË BfiÚÂÈ·˜ EÏÏ¿‰·˜, (<5%), fiÔ˘ Ë Û˘¯ÓfiÙËÙ· Â›Ó·È Î¿Ùˆ ·fi 1 Û 2000 ÁÂÓÓ‹ÛÂȘ. °È· ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ ÚfiÏ˄˘ ÛÙË ¯ÒÚ· Ì·˜ ¤ÁÈÓ·Ó ÛËÌ·ÓÙÈΤ˜ ÚÔÛ¿ıÂȘ Ù· ÙÂÏÂ˘Ù·›· 25 ¯ÚfiÓÈ·. °È· ÙËÓ ÂÈÙ˘¯›· Ù˘ ÚfiÏ˄˘ ¯ÚÂÈ¿˙ÔÓÙ·È: 1. ™˘ÛÙËÌ·ÙÈ΋ Î·È Û˘Ó¯‹˜ ÂÓË̤ڈÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ Ì ÛÙfi¯Ô Ó· ¤¯Ô˘Ó ÂÏÂÁ¯ı› ÚÈÓ ·fi ÙËÓ ÙÂÎÓÔÔ›ËÛË fiÏ· Ù· ˙¢Á¿ÚÈ·. A˘Ùfi ÚÔ¸Ôı¤ÙÂÈ Î·È ÂÓÂÚÁËÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÏËı˘ÛÌÔ‡.

2. YÔ¯ÚˆÙÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘.

3. ¢˘Ó·ÙfiÙËÙ· ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ‰È·ÎÔ‹ ·ËÛ˘ Û ÂÚ›ÙˆÛË ¿ÚÚˆÛÙÔ˘ ÂÌ‚Ú‡Ô˘.

4. O ¤ÏÂÁ¯Ô˜ Ó· Á›ÓÂÙ·È ‹ Ó· ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙȘ ÂȉÈΤ˜ ÌÔÓ¿‰Â˜ ÚfiÏ˄˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‹ ·fi ÂÚÁ·ÛÙ‹ÚÈ· Ì ÂÌÂÈÚ›· ÛÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Î·È È‰È·›ÙÂÚ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ, H ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÚfiÏ˄˘ Û ·ÓÂÏÏ‹ÓÈ· Îϛ̷η ·fi ÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 70 ¤Ù˘¯Â Ó· ÌÂÈÒÛÂÈ ÛËÌ·ÓÙÈο, Û ÔÛÔÛÙfi ÂÚ›Ô˘ 80%, ÙȘ ÁÂÓÓ‹ÛÂȘ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ(7). MÈ· ÚfiÛÊ·ÙË ÌÂϤÙË Ì·˜ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Ó¤‚·Ï·Ó ÛÙȘ ÁÂÓÓ‹ÛÂȘ ·È‰ÈÒÓ Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ¤‰ÂÈÍ fiÙÈ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 40% ÔÈ ÁÔÓ›˜ ‹Ù·Ó ·ÏËÚÔÊfiÚËÙÔÈ ÁÈ· ÙËÓ ·ÚÚÒÛÙÈ· Î·È ÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÚfiÏ˄˘ Ù˘, ÂÓÒ Û ÔÛÔÛÙfi 30% Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÔÓÈÒÓ ‰ÂÓ ·ÂÎ¿Ï˘„ ÙÔ˘˜ ÊÔÚ›˜ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜. £· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ›¯Â Á›ÓÂÈ Û ȉȈÙÈο ÂÚÁ·ÛÙ‹ÚÈ· ‹ ÎÏÈÓÈΤ˜ Î·È fi¯È ÛÙȘ ÂȉÈΤ˜ ÌÔÓ¿‰Â˜ ÚfiÏ˄˘ Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó Û ÔÏfiÎÏËÚË ÙË ¯ÒÚ·. ◊‰Ë ·fi ÂÈÎÔÛ·ÂÙ›·˜, ÛÙ· ˙¢Á¿ÚÈ· Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ΛӉ˘ÓÔ ·Ú¤¯ÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ·, Ì ۈÛÙ‹ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Î·È ¤ÁηÈÚË ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, Ó· ·ÔÎÙ‹ÛÔ˘Ó ÌfiÓÔ ˘ÁÈ‹ ·È‰È¿. H ÚfiÔ‰Ô˜ Ô˘ ¤¯ÂÈ ÂÈÙ¢¯ı› ÛÙÔÓ ÙÔ̤· Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Â›Ó·È ·ÍÈÔÛËÌ›ˆÙË. OÈ Ù¯ÓÈΤ˜ Ô˘ Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Ó·È ·ÎÚȂ›˜ Î·È ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌÔÛıÔ‡Ó ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ·ËÛ˘ (Á‡Úˆ ÛÙË 10Ë-12Ë Â‚‰ÔÌ¿‰·) ¤ÙÛÈ ÒÛÙÂ Ë ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ Ó· Â›Ó·È ·ÛÊ·Ï‹˜, ·ÓÒ‰˘ÓË Î·È ¯ˆÚ›˜ ۈ̷ÙÈΤ˜ Î·È „˘¯ÈΤ˜ ÂÈÙÒÛÂȘ ÛÙË ÌËÙ¤Ú·. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÚÔËÁ̤Ó˜ Ù¯ÓÈΤ˜ ÌÂϤÙ˘ DNA. M ÙȘ Ù¯ÓÈΤ˜ ·˘Ù¤˜ ÔÏÔÎÏËÚÒÓÂÙ·È Ô ÁÔÓÔÙ˘ÈÎfi˜ ¯·Ú·ÎÙËÚÈÛÌfi˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ¤ÙÛÈ Î·ıÔÚ›˙ÂÙ·È Ì ·ÎÚ›‚ÂÈ· ÙÔ Â›‰Ô˜ Ù˘ ÌÔÚȷ΋˜ ‚Ï¿‚˘ ÙËÓ ÔÔ›· ·Ó·Ì¤ÓÂÙ·È Ó· ¤¯ÂÈ ÙÔ ¤Ì‚Ú˘Ô. ™‹ÌÂÚ· ˆ˜ ÂÌ‚Ú˘˚Îfi ˘ÏÈÎfi ÌÂϤÙ˘ DNA ÁÈ· ÚÒÈÌË ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ ÙÚÔÊÔ‚Ï¿ÛÙ˜. EÎÙfi˜ ÙˆÓ ÙÚÔÊÔ‚Ï·ÛÙÒÓ, Û ÚÔ¯ˆÚË̤ÓË ÂÁ΢ÌÔÛ‡ÓË, ˆ˜ ËÁ‹ ÂÌ‚Ú˘˚ÎÔ‡ DNA ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î‡ÙÙ·Ú· ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Î·È ÂÌ‚Ú˘˚Îfi ·›Ì·(8).

O ¯·Ú·ÎÙËÚÈÛÌfi˜ ÙˆÓ ÌÔÚÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙË ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Ô ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›ÓÔÓÙ·È Û ÂÈÏÂÁ̤ӷ ΤÓÙÚ· fiˆ˜ Ë MÔÓ¿‰· ¶ÚÔÁÂÓÓËÙÈ΋˜ ¢È¿ÁÓˆÛ˘ ÙÔ˘ §·˚ÎÔ‡ NÔÛÔÎÔÌ›Ԣ, Ô˘ Â›Ó·È Î·È ÙÔ EıÓÈÎfi K¤ÓÙÚÔ ·Ó·ÊÔÚ¿˜ Î·È Ë MÔÓ¿‰· MÂÛÔÁÂȷ΋˜ AÓ·ÈÌ›·˜ ÛÙÔ XˆÚ¤ÌÂÈÔ EÚ¢ÓËÙÈÎfi EÚÁ·ÛÙ‹ÚÈÔ Ù˘ A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·". T· K¤ÓÙÚ· ·˘Ù¿ ηχÙÔ˘Ó ÙȘ ·Ó¿ÁΘ Ù˘ ¯ÒÚ·˜. YÔÏÔÁ›˙ÂÙ·È fiÙÈ Î·Ù¿ ¤ÙÔ˜ Á›ÓÔÓÙ·È ÂÚ›Ô˘ 500 ÚÔÁÂÓÓËÙÈΤ˜ ‰È·ÁÓÒÛÂȘ ÁÈ· ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. OÈ ·Ï·ÈfiÙÂÚ˜ Ù¯ÓÈΤ˜ ‹Ù·Ó ¯ÚÔÓÔ‚fiÚ˜ Î·È ÂÈÛÊ·Ï›˜. TËÓ ÙÂÏÂ˘Ù·›· ÙÚÈÂÙ›· ÛÙËÓ ÌÔÓ¿‰· Ì·˜, ÛÙËÓ A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ¤¯Ô˘Ó ‹‰Ë Á›ÓÂÈ ¿Óˆ ·fi 300 ÚÔÁÂÓÓËÙÈΤ˜ ‰È·ÁÓÒÛÂȘ Ì ÌÔÚȷΤ˜ Ù¯ÓÈΤ˜ Ô˘ ‰›ÓÔ˘Ó ÁÚ‹ÁÔÚË Î·È ·ÛÊ·Ï‹ ‰È¿ÁÓˆÛË(9). ø˜ ÌÂÏÏÔÓÙÈΤ˜ ÚÔÔÙÈΤ˜ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ·Ó·Ê¤ÚÔÓÙ·È: 1. H ‰˘Ó·ÙfiÙËÙ· Ï‹„˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Î·È Î˘ÙÙ¿ÚˆÓ ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘.

2. H ·ÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙÔ ·›Ì· Ù· ÌËÙ¤Ú·˜ Ô˘ ‚Ú›ÛÎÂÙ·È ·ÎfiÌË Û ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ.

3. H ÚÔÂÌÊ˘Ù¢ÙÈ΋ ‰È¿ÁÓˆÛË Î·È ÂÈÏÔÁ‹ ÁÈ· ÂÌʇÙ¢ÛË ÌfiÓÔ ˘ÁÈÒÓ, ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ, Û ÂÚÈÙÒÛÂȘ Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘. H ̤ıÔ‰Ô˜ ÚÔ¸Ôı¤ÙÂÈ ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ DNA ÁÔÓÈÒÓ Î·È ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ.

H ÚÔÂÌÊ˘Ù¢ÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤¯ÂÈ ÚfiÛÊ·Ù· ÂÊ·ÚÌÔÛı› Ì ÂÈÙ˘¯›· Û ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ÂÚÈÙÒÛÂˆÓ ÙfiÛÔ ‰ÈÂıÓÒ˜ fiÛÔ Î·È ÛÙËÓ EÏÏ¿‰·. ™ÙË ÌÔÓ¿‰· ÌÔÚȷ΋˜ È·ÙÚÈ΋˜ Ù˘ A' ¶·È‰È·ÙÚÈ΋˜ KÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ ‹‰Ë, ÁÂÓÓ‹ıËÎ·Ó 5 ·È‰È¿ ÌÂÙ¿ ·fi ÂÈÙ˘¯‹ ÚÔÂÌÊ˘Ù¢ÙÈ΋ ‰È¿ÁÓˆÛË.

89

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·90

¶∞π¢π∞∆ƒπ∫∏ 2000;63:88-92

T· ‚ÈÔËıÈο ÚÔ‚Ï‹Ì·Ù· Î·È ‰ÈÏ‹ÌÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÛÙÔ ÁÔÓÈÌÔÔÈË̤ÓÔ ˆ¿ÚÈÔ, fiˆ˜ Î·È ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ Û ÂÚ›ÙˆÛË ¿ÚÚˆÛÙÔ˘ ÂÌ‚Ú‡Ô˘, ¤¯Ô˘Ó ÚÔηϤÛÂÈ Ô͇ٷÙ˜ Û˘˙ËÙ‹ÛÂȘ, ¯ˆÚ›˜ Ó· ¤¯Ô˘Ó Ï‹Úˆ˜ ÂÈÏ˘ı›. ∞ÓÙÈı¤Ùˆ˜, ÔÈ ÚfiÔ‰ÔÈ Ù˘ È·ÙÚÈ΋˜ Î·È ‚ÈÔÙ¯ÓÔÏÔÁ›·˜ Â·˘Í¿ÓÔ˘Ó Û˘Ó¯Ҙ ÙÔ˘˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ Î·È Ù· ‰ÈÏ‹ÌÌ·Ù·. ™ÙË ¯ÒÚ· Ì·˜ Ë ÂÊ·ÚÌÔÁ‹ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ‰È·ÎÔ‹ ·ËÛ˘, Û·Ó Ì¤ÛÔ ÚfiÏ˄˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, Â›Ó·È Û‹ÌÂÚ· ÎÔÈÓˆÓÈο Î·È ÓÔÌÈο ·Ô‰ÂÎÙ‹.

OÚÁ·ÓˆÌ¤Ó· ÚÔÁÚ¿ÌÌ·Ù· ÚfiÏ˄˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤¯Ô˘Ó ÂÊ·ÚÌÔÛı› ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›· ÛÙËÓ IÙ·Ï›· (΢ڛˆ˜ Û ÂÚÈÔ¯¤˜ Ì ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ, fiˆ˜ Ë ™·Ú‰ËÓ›·), ÛÙËÓ K‡ÚÔ, ÛÙËÓ EÏÏ¿‰·, ÛÙËÓ AÁÁÏ›· Î·È Û ¿ÏϘ ¯ÒÚ˜ (΢ڛˆ˜ Û ÌÂÈÔÓfiÙËÙ˜ Ì ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ). ™ÙËÓ K‡ÚÔ ÔÈ ÁÂÓÓ‹ÛÂȘ ·ÚÚÒÛÙˆÓ ¤¯Ô˘Ó ÌˉÂÓÈÛı›. ™ÙËÓ IÙ·Ï›· Î·È ÙËÓ EÏÏ¿‰· ¤¯Ô˘Ó ÌÂȈı› ÛËÌ·ÓÙÈο ¯ˆÚ›˜ Ó· ÌˉÂÓÈÛÙÔ‡Ó. ™ÙËÓ AÁÁÏ›· Î·È ÙȘ ¿ÏϘ ¯ÒÚ˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚfiÏ˄˘ ‹Ù·Ó Ôχ ÂÚÈÔÚÈṲ̂ÓË(10). £ÂÚ·›· H Û‡Á¯ÚÔÓË ıÂÚ·›· ¤Ù˘¯Â Ó· ·˘Í‹ÛÂÈ ÛËÌ·ÓÙÈο ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÚÚÒÛÙˆÓ, Ó· ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÔÈfiÙËÙ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ Î·È Ó· ÂÏ·¯ÈÛÙÔÔÈ‹ÛÂÈ Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘. ™ÙËÚ›˙ÂÙ·È: ·) ÛÙȘ Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂȘ, ‚) ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·ÔÛȉ‹ÚˆÛË Î·È Á) ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ ıÂÚ·›·˜ Î·È Ù˘ ÓfiÛÔ˘(2).

T· ‚·ÛÈο ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù˘ ıÂÚ·›·˜ Â›Ó·È Ë Û˘Ó¯‹˜ Ù·Ï·ÈˆÚ›· ÙˆÓ ·ÚÚÒÛÙˆÓ, ÙÔ ˘„ËÏfi ÎfiÛÙÔ˜ Î·È Ô ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÂȉÈÎÒÓ ÌÔÓ¿‰ˆÓ ÁÈ· ÙË Û˘ÓÔÏÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÔÈÎ›ÏˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·ÚÚÒÛÙˆÓ.

A¯›ÏÏÂÈÔ˜ Ù¤ÚÓ· ÙˆÓ Û˘¯ÓÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ ·Ú·Ì¤ÓÂÈ Ë ‰È·ÛÊ¿ÏÈÛË ·›Ì·ÙÔ˜ ÁÈ· ÛˆÛÙ‹ ıÂÚ·›·. ¶·Ú¿ ÙȘ ÚÔÛ¿ıÂȘ ÙˆÓ ·ÚÌfi‰ÈˆÓ ˘ËÚÂÛÈÒÓ, ÁÈ· ÚÔÒıËÛË Ù˘ ÂıÂÏÔÓÙÈ΋˜ ·ÈÌÔ‰ÔÛ›·˜, ÔÈ ·Ó¿ÁΘ Û ·›Ì· ‰ÂÓ ÌÔÚÔ‡Ó Ó· Î·Ï˘ÊıÔ‡Ó. ™˘Ó¯›˙ÂÙ·È Ë ÂÈÛ·ÁˆÁ‹ ·›Ì·ÙÔ˜ ·fi ÙÔÓ EÏ‚ÂÙÈÎfi EÚ˘ıÚfi ™Ù·˘Úfi. H ÂıÂÏÔÓÙÈ΋ ·ÈÌÔ‰ÔÛ›· ¯ÚÂÈ¿˙ÂÙ·È Î·Ï‡ÙÂÚË ÔÚÁ¿ÓˆÛË Î·È ÂÓ›Û¯˘ÛË. £· ÌÔÚÔ‡Û·Ì ӷ ·Ú·‰ÂÈÁÌ·ÙÈÛÙÔ‡ÌÂ Î·È ¿ÏÈ ·fi ÙËÓ K‡ÚÔ Ë ÔÔ›· Ì ηٿÏÏËÏË ÔÚÁ¿ÓˆÛË Î·È ·ÁˆÁ‹ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ ηÙfiÚıˆÛ ӷ Â›Ó·È ·˘Ù¿Ú΢ ·Ú¿ ÙȘ ·Ó·ÏÔÁÈο ·˘ÍË̤Ó˜ ·Ó¿ÁΘ.

M ÙȘ Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂȘ Î·È ÙË ‰È·Ù‹ÚËÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ ¿Óˆ ·fi 9-10g/dl, Ë Ô͢ÁfiÓˆÛË ÙˆÓ ÈÛÙÒÓ Â›Ó·È ÈηÓÔÔÈËÙÈ΋ Î·È ÂÈÙÚ¤ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Î·È ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ ÔÛÙÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Î·È Ù˘ ‰ÈfiÁΈÛ˘ ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ÛÏËÓfi˜.

H Ì›ˆÛË ÙˆÓ ÂÈÏÔÎÒÓ Î·È ·ÓÙȉڿÛÂˆÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙË Û¯ÔÏ·ÛÙÈ΋ Ù‹ÚËÛË ‚·ÛÈÎÒÓ Î·ÓfiÓˆÓ(2).

OÈ ÈÔ ÛËÌ·ÓÙÈÎÔ› ›ӷÈ: ·) H ·˘ÛÙËÚ‹ ÂÈÏÔÁ‹ Î·È Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÈÌÔ‰ÔÙÒÓ ÁÈ· ÛÂÈÚ¿ ÓfiÛˆÓ Ô˘ ÌÂÙ·‰›‰ÔÓÙ·È Ì ÙË ÌÂÙ¿ÁÁÈÛË ‚) O Û¯ÔÏ·ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·fiÏ˘Ù· Û˘Ì‚·Ùfi ·›Ì· Î·È ÚfiÏË„Ë ·ÏÏÔ·ÓÔÛÔÔ›ËÛ˘ Û ·ÚȘ Î·È Û¿ÓȘ ÔÌ¿‰Â˜ ·›Ì·ÙÔ˜. Á) H ¯Ú‹ÛË ·Ú·Û΢·ÛÌ¿ÙˆÓ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ (·ÈÌ·ÙÔÎÚ›Ù˘ 70-80%) ÂχıÂÚ· Ï¢ÎÔ΢ÙÙ¿ÚˆÓ.

H ·Ê·›ÚÂÛË ÙˆÓ Ï¢ÎÒÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Â›Ù Ì χÛË Â›Ù Ì ÙË ¯Ú‹ÛË ÂȉÈÎÒÓ Ê›ÏÙÚˆÓ. ‰) ™Â οıÂ Û˘Ó‰ڛ· ÙÔ ÔÏÈÎfi ÔÛfi ÙÔ˘ ÌÂÙ·ÁÁÈ˙fiÌÂÓÔ˘ ·›Ì·ÙÔ˜ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ Ù· 10-15ml/Kg. OÈ Î·ÓfiÓ˜ ·˘ÙÔ› ÙËÚÔ‡ÓÙ·È Ôχ ÈηÓÔÔÈËÙÈο ·fi fiϘ ÙȘ ÌÔÓ¿‰Â˜ Î·È ÙȘ ÙÚ¿Â˙˜ ·›Ì·ÙÔ˜. °È· ÙÔ˘˜ ·ÚÚÒÛÙÔ˘˜ ÙÔ ‚·Ú‡ Ù›ÌËÌ· ÙˆÓ Â˘ÂÚÁÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ Û˘¯ÓÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ Â›Ó·È Ë ÙÔÍÈ΋ ‰Ú¿ÛË ÙÔ˘ Ûȉ‹ÚÔ˘ Ô˘ ·ıÚÔ›˙ÂÙ·È Ì ÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ÛÙ· ‰È¿ÊÔÚ· fiÚÁ·Ó·. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ÔÈ ÚÒÙ˜ ÂÈÙÒÛÂȘ Ù˘ ·ÈÌÔÛȉ‹ÚˆÛ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ηٿ Î·È ÌÂÙ¿ ÙËÓ ÂÓ‹‚ˆÛË Î·È ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙÔ˘˜ ÂÓ‰ÔÎÚÈÓ›˜ ·‰¤Ó˜, ÙÔ ‹·Ú Î·È ÙËÓ Î·Ú‰È¿. °È· ÙËÓ ·ÔÛȉ‹ÚˆÛË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·fi ¯ÚfiÓÈ· Ë ¯ËÏÈ΋ Ô˘Û›· desferioxamine (Desferal) Û ËÌÂÚ‹ÛÈ· ˘Ô‰fiÚÈ· ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈ΋˜ ·ÓÙÏ›·˜. H ·Ú·ÙÂٷ̤ÓË ˘Ô‰fiÚÈ· ¤Á¯˘ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·ÔÙÂÏ› ÌÈ· ηıËÌÂÚÈÓ‹ Ù·Ï·ÈˆÚ›· Î·È ÔÏÏÔ› ·ÛıÂÓ›˜ ‰˘ÛÎÔχÔÓÙ·È Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÈÛÙ¿ ÙÔ ¯ÚÔÓԉȿÁÚ·ÌÌ· Ù˘ ·ÔÛȉ‹ÚˆÛ˘. ™ÙÔÓ ‚·ÛÈÎfi ·˘Ùfi ÏfiÁÔ, ÚÔÛÙ›ıÂÙ·È ÙÔ ˘„ËÏfi ÎfiÛÙÔ˜ Î·È ÔÈ Èı·Ó¤˜ ·ÚÂÓ¤ÚÁÂȘ. ™Ô‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂȘ Â›Ó·È Û¿ÓȘ Î·È Û˘Ó‰¤ÔÓÙ·È Î·Ù¿ ηÓfiÓ· Ì ÌÂÁ¿Ï˜ Î·È ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ‰fiÛÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Û ·ÚÚÒÛÙÔ˘˜ Ì ۯÂÙÈο ¯·ÌËÏ¿ ·Ôı¤Ì·Ù· Ûȉ‹ÚÔ˘.

H ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ Û˘ÌÏËÚÒÓÂÙ·È Ì ÛÂÈÚ¿ ̤ÙÚˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÚfiÏË„Ë Î·È ıÂÚ·›· ÙˆÓ ÂÈÏÔÎÒÓ ÙˆÓ ÌÂÙ·ÁÁ›ÛÂˆÓ Î·È Ù˘ ÓfiÛÔ˘ fiˆ˜ Ë ÂÓ‰ÔÎÚÈÓÔ¿ıÂȘ, Ë Ì˘ÔηډÈÔ¿ıÂÈ·, Ë Ë·ÙÔ¿ıÂÈ· Î·È Ù· „˘¯Èο Î·È ÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ·ÚÚÒÛÙˆÓ(2).

H ÂÊ·ÚÌÔ˙fiÌÂÓË Û‹ÌÂÚ· ıÂÚ·›· ¤Ù˘¯Â Ó· ·˘Í‹ÛÂÈ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, Ó· ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È Ó· ÂÏ·¯ÈÛÙÔÔÈ‹ÛÂÈ Ù· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ (·Ó·ÈÌ›·, ÔÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ, η-

90

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

¶∞π¢π∞∆ƒπ∫∏ 2000;63:88-92

™ÂÏ›‰·91

∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ Î·È ÛÏËÓÔË·ÙÔÌÂÁ·Ï›·). EÓ‰ÂÈÎÙÈο Â›Ó·È Ù· ÛÙÔȯ›· ·fi ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÚÚÒÛÙˆÓ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙË ÌÔÓ¿‰· Ì·˜: ¶ÚÈÓ ·fi ÙË ıÂÚ·›· ÌÂ Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂȘ, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÚÚÒÛÙˆÓ Ô˘ ÍÂÂÚÓÔ‡Û·Ó ÙËÓ ÚÒÙË ‰ÂηÂÙ›· ‹Ù·Ó ÌfiÏȘ 10%. ™‹ÌÂÚ· Ë Èı·ÓfiÙËÙ· ÂÈ‚›ˆÛ˘ ¿Óˆ ·fi 35 ¯ÚfiÓÈ· ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÚÚÒÛÙˆÓ Ô˘ ·Ú·ÎÔÏÔ˘ıԇ̠ÂÌ›˜ Êı¿ÓÂÈ ÙÔ 60%. °È· ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÚÚÒÛÙˆÓ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ·ÔÛȉ‹ÚˆÛË (ÊÂÚÚÈÙ›ÓË <2.500 ng/ml), Ë ÂÈ‚›ˆÛË ÏËÛÈ¿˙ÂÈ ÙÔ 90%. ¶·Ú¿ Ù· ·ÍÈfiÏÔÁ· ÂÈÙ‡ÁÌ·Ù·, Ë Û‡Á¯ÚÔÓË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ ‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ÈηÓÔÔÈËÙÈ΋ ÌÈ· Î·È Ô ÙÂÏÈÎfi˜ ÛÙfi¯Ô˜ Â›Ó·È Ë ÚÈ˙È΋ ıÂÚ·›·. ¶ÚÔ˜ ÙÔ ·ÚfiÓ Ô ÌfiÓÔ˜ ÙÚfiÔ˜ ÚÈ˙È΋˜ ıÂÚ·›·˜ Â›Ó·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ŸÌˆ˜, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ¤¯ÂÈ ÂÚÈÔÚÈÛÌÔ‡˜ Î·È ‰ÂÓ ÌÔÚ› Ó· ÂÊ·ÚÌÔÛı› Û fiÏÔ˘˜ ÙÔ˘˜ ·ÚÚÒÛÙÔ˘˜. OÈ ··Ú·›ÙËÙ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È: ·) H ‡·ÚÍË ·fiÏ˘Ù· ÈÛÙÔÛ˘Ì‚·ÙÔ‡ ‰fiÙË (Û˘Ó‹ıˆ˜ ·‰ÂÏÊÔ‡, Û·ÓÈfiÙÂÚ· ÁÔÓÈÒÓ). ‚) H ·Ô˘Û›· ÂÈ‚·Ú˘ÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÂÈÏÔÎÒÓ Ô˘ ÌÂÈÒÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÈÙ˘¯›·˜ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ (ÌÂÁ¿ÏË ËÏÈΛ·, ›ÓˆÛË ‹·ÙÔ˜, ηډÈÔ¿ıÂÈ· ÎÏ).

H ÂÌÂÈÚ›· Ô˘ ˘¿Ú¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÊÔÚ¿ Û ÌÂÙ·ÌÔۯ‡ÛÂȘ ·fi ·fiÏ˘Ù· Û˘Ì‚·ÙÔ‡˜ Û˘ÁÁÂÓ›˜ ‰fiÙ˜. ™Â ·ÚÚÒÛÙÔ˘˜ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÂÈÏÔΤ˜ ·fi ÙË ÓfiÛÔ, ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ Êı¿ÓÂÈ Ì¤¯ÚÈ Î·È 90%, ÂÓÒ Û ¿ÙÔÌ· Ì ÂÈÏÔΤ˜ ÌÂÈÒÓÂÙ·È ÛÙÔ 65%(11).

H ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ¤¯ÂÈ ÂÊ·ÚÌÔÛı› ‰ÈÂıÓÒ˜ Û ÂηÙÔÓÙ¿‰Â˜ ·ÚÚÒÛÙÔ˘˜. OÈ ‚·ÛÈÎÔ› fï˜ ηÓfiÓ˜ ÌÂÙ·ÌÔۯ‡Ûˆ˜ Û ·ÚÚÒÛÙÔ˘˜ Ì MA ηıÔÚ›ÛıËÎ·Ó ·fi ÙËÓ ÔÌ¿‰· Lucarelli, Ì ÂÍÂȉ›Î¢ÛË Î·È ÂÌÂÈÚ›· Û ÌÂÙ·ÌÔۯ‡ÛÂȘ Ì˘ÂÏÔ‡ Û ·ÚÚÒÛÙÔ˘˜ Ì MA(11). M¤¯ÚÈ Û‹ÌÂÚ· ¤¯ÂÈ ÌÂÙ·ÌÔÛ¯Â˘ı› ¤Ó·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ EÏÏ‹ÓˆÓ ·ÚÚÒÛÙˆÓ Û ΤÓÙÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ (΢ڛˆ˜ ÛÙËÓ IÙ·Ï›·) Î·È Ù· ÙÂÏÂ˘Ù·›· ÙÚ›· ¯ÚfiÓÈ· Î·È ÛÙËÓ EÏÏ¿‰·.

K¤ÓÙÚ· ÌÂÙ·ÌfiÛ¯Â˘Û˘ Ì˘ÂÏÔ‡ ÁÈ· ÂÓ‹ÏÈΘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ‹‰Ë ÛÙË £ÂÛÛ·ÏÔÓ›ÎË Î·È ÛÙËÓ Aı‹Ó· Î·È ÁÈ· ·È‰È¿ ÛÙÔ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·". ™ÙË MÔÓ¿‰· MÂÙ·ÌfiÛ¯Â˘Û˘ M˘ÂÏÔ‡ ÙˆÓ OÛÙÒÓ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" ¤¯Ô˘Ó Á›ÓÂÈ Ì ÂÈÙ˘¯›· 35 ÌÂÙ·ÌÔۯ‡ÛÂȘ Û 39 ·ÚÚÒÛÙÔ˘˜ Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. E› ·ÔÙ˘¯›·˜ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÔÚ› Ó· Â·Ó·ÏËÊı›.

EÎÙfi˜ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ Ì˘ÂÏÔ‡ Ô˘ ÚÔÔÚ›˙ÂÙ·È ÁÈ· ÂÈÏÂÁ̤ÓÔ˘˜ ·ÚÚÒÛÙÔ˘˜, ÁÈ· ÙË ÌÂÏÏÔÓÙÈ΋ ıÂÚ·›· ‰ÈÂÚ¢ÓÒÓÙ·È Î·È ¿ÏϘ ÚÔÛÂÏ¿ÛÂȘ. OÈ ÈÔ ÛËÌ·ÓÙÈΤ˜ ·fi ·˘Ù¤˜ ›ӷÈ: 1. H ÂÓÂÚÁÔÔ›ËÛË ·Ú·ÁˆÁ‹˜ ÂÌ‚Ú˘˚΋˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Ì ‰È¿ÊÔÚ· Ê¿Ú̷η. ◊‰Ë ÂÊ·ÚÌfi˙ÂÙ·È ıÂÚ·›· Ì ˘‰ÚÔ͢Ԣڛ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÒ‰˘ÓˆÓ ÎÚ›ÛÂˆÓ Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ‰ÔÎÈÌ¿˙ÂÙ·È Ë ‰Ú¿ÛË ÙÔ˘ ‚Ô˘Ù˘ÚÈÎÔ‡ ÔͤԘ Î·È Ù˘ ÂÚ˘ıÚÔÔÈËÙ›Ó˘. H ıÂÚ·›· ·˘Ù‹ ‰ÂÓ Ê·›ÓÂÙ·È Èı·Ófi Ó· ·Ô‰ÒÛÂÈ Û ·ÚÚÒÛÙÔ˘˜ Ì ‚·ÚÈ¿ ·Ó·ÈÌ›· Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÌÂÙ·ÁÁ›ÛÂȘ. ™Â ÔÚÈṲ̂Ó˜ fï˜ ÂÚÈÙÒÛÂȘ ÂӉȿÌÂÛ˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, Ë ˘‰ÚÔ͢Ԣڛ· ÌÔÚ› Ó· ·Ô‰ÒÛÂÈ ÁÈ·Ù› ·˘Í¿ÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÂÌ‚Ú˘˚΋˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘(12).

2. °ÔÓȉȷ΋ £ÂÚ·›·. A˘Ù‹ ÛÙԯ‡ÂÈ ÛÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁfiÓÔ˘ Ì ÂÈÛ·ÁˆÁ‹ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÁfiÓÔ˘ ÛÙ· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú· ÙÔ˘ ·ÚÚÒÛÙÔ˘ ‹ Ì ‰ÈfiÚıˆÛË Ì ¯ÂÈÚÈÛÌÔ‡˜ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁfiÓÔ˘.

H ÚÔÛ¤Ï·ÛË ·˘Ù‹ Î·È Î˘Ú›ˆ˜ Ë ÂÈÛ·ÁˆÁ‹ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÁfiÓÔ˘ ÛÙ· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú· Ê·›ÓÂÙ·È Ó· Â›Ó·È Î·È Ë ÈÔ Ú·ÏÈÛÙÈ΋ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË fiÏˆÓ ÙˆÓ ·ÚÚÒÛÙˆÓ. °È· ÙËÓ ˘ÏÔÔ›ËÛË Ù˘ ¯ÚÂÈ¿˙ÂÙ·È ·ÎfiÌ· ·ÚÎÂÙ‹ Î·È ÛÔ‚·Ú‹ ‰Ô˘ÏÂÈ¿ Û ÂÈÚ·Ì·ÙÈÎfi Â›Â‰Ô ÁÈ·Ù› ı· Ú¤ÂÈ Ó· ˘ÂÚÓÈÎËıÔ‡Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· fiˆ˜ Ë ·ÔÌfiÓˆÛË ÈηÓÔ‡ ·ÚÈıÌÔ‡ ·Ú¯ÂÁfiÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ë ·Ó‡ÚÂÛË ÙÔ˘ ηٿÏÏËÏÔ˘ Ô¯‹Ì·ÙÔ˜ ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁfiÓÔ˘ ÛÙÔ Î‡ÙÙ·ÚÔ ÛÙfi¯Ô, Î·È Ë ÌÂϤÙË ÙˆÓ ÚÔ¸Ôı¤ÛÂˆÓ ÁÈ· ÙËÓ ·Ô‰ÔÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÁfiÓÔ˘(13). EÈϤÔÓ, Ì ٷ ÛËÌÂÚÈÓ¿ ‰Â‰Ô̤ӷ Ë ÁÔÓȉȷ΋ ıÂÚ·›· Ê·›ÓÂÙ·È È‰È·›ÙÂÚ· ‰··ÓËÚ‹ ÒÛÙ ӷ ÌÔÚ¤ÛÂÈ Ó· ¯ÚËÛÈÌÔÔÈËı› Û ¢Ú›· Îϛ̷η ΢ڛˆ˜ ÛÙȘ ˘fi ·Ó¿Ù˘ÍË ¯ÒÚ˜.

MÈ· Î·È Ë ÚÈ˙È΋ ıÂÚ·›· Ê·›ÓÂÙ·È ·ÔÌ·ÎÚ˘Ṳ̂ÓË Û˘Ó¯›˙ÔÓÙ·È ÔÈ ÚÔÛ¿ıÂȘ ÁÈ· Â·‡ÍËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ÛËÌÂÚÈÓÒÓ ÌÂıfi‰ˆÓ ıÂÚ·›·˜. ™ÙȘ ÚÔÛ¿ıÂȘ ·˘Ù¤˜ ÚˆÙ·Ú¯È΋ ı¤ÛË ¤¯ÂÈ Ë ÂÚ¢ÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ Î·È ·ÙÔÍÈÎÔ‡ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Ê·ÚÌ¿ÎÔ˘ ÁÈ· ÙËÓ ·Ô‚ÔÏ‹ Ûȉ‹ÚÔ˘ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÈÌÔÛȉËÚÒÛˆ˜ ÙˆÓ ·ÛıÂÓÒÓ. ™ÙȘ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Ô˘Û›Â˜ ȉȷ›ÙÂÚË ı¤ÛË Î·Ù¤¯ÂÈ Ë deferiprone ‹ L1. KÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ˘ÛÙÂÚ› ÛÙËÓ ·¤ÎÎÚÈÛË Ûȉ‹ÚÔ˘ Û ۯ¤ÛË Ì ÙÔ Desferal Î·È ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÓÙȉڿÛÂȘ Ì ÈÔ ÛÔ‚·Ú‹ ÙËÓ Ô˘‰ÂÙÂÚÔÂÓ›·(14). ™Â ·ÛıÂÓ›˜ Ì ¤ÓÙÔÓ˜ ·ÓÙȉڿÛÂȘ ÛÙÔ Desferal ¤¯ÂÈ ÂÁÎÚÈı› Ë ¯ÔÚ‹ÁËÛË Ù˘ ˘fi Û˘Ó¯‹ ÂÚÁ·ÛÙËÚȷ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ¶·Ú¿ÏÏËÏ· ‚Ú›ÛÎÂÙ·È ÛÙÔ ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ Ë ·Ú·Û΢‹ Î·È ¿ÏÏˆÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ËÏÈÎÒÓ Ô˘ÛÈÒÓ.

H ·ÓÙÈÌÂÙÒÈÛË Û˘ÌÏËÚÒÓÂÙ·È Ì ÙËÓ Î·Ù¿ÏÏËÏË ÔÚÁ¿ÓˆÛË „˘¯È΋˜ Î·È ÎÔÈÓˆÓÈ΋˜ ÛÙ‹ÚÈ͢ ÙˆÓ ·ÚÚÒÛÙˆÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ Ô˘ ÙÔ˘˜ ÂÈÙÚ¤ÂÈ ÙËÓ ÔÌ·Ï‹ Î·È ·Ú·ÁˆÁÈ΋ ¤ÓÙ·ÍË ÙÔ˘˜ ÛÙÔ ÎÔÈÓˆÓÈÎfi Û‡-

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ÓÔÏÔ(15). ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi Ë ÔÏÈÙ›· ¤¯ÂÈ ‰Â›ÍÂÈ Â˘·ÈÛıËÛ›· Î·È Ì ÛÂÈÚ¿ ÓÔÌÔıÂÙÈÎÒÓ Ì¤ÙÚˆÓ ÛÙËÚ›˙ÂÈ ÙËÓ ÎÔÈÓˆÓÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ÙÔ˘˜ ·ÔηٿÛÙ·ÛË.

E›ÏÔÁÔ˜ TËÓ ÙÂÏÂ˘Ù·›· ÙÚÈ·ÎÔÓÙ·ÂÙ›· ÛÙȘ ÚÔËÁ̤Ó˜ ˘ÁÂÈÔÓÔÌÈο ¯ÒÚ˜ ¤¯Ô˘Ó Á›ÓÂÈ ÛËÌ·ÓÙÈΤ˜ ÚfiÔ‰ÔÈ ÛÙËÓ ÚfiÏË„Ë Î·È ÛÙË ıÂÚ·›· Ù˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜. ™˘ÛÙËÌ·ÙÈο ÚÔÁÚ¿ÌÌ·Ù· ÚfiÏ˄˘ ·¤‰ÂÈÍ·Ó ÙË ‰˘Ó·ÙfiÙËÙ· ÂÍ·Ê¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙȘ ÌÂÏÏÔÓÙÈΤ˜ ÁÂÓȤ˜. AÓÙ›ıÂÙ·, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÚÒÛÙˆÓ, ·Ú¿ Ù· ·ÍÈÔÛËÌ›ˆÙ· ·ÔÙÂϤÛÌ·Ù· Ù˘, ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÎfiÌ· ‰˘ÛÂ›Ï˘Ù· ÚÔ‚Ï‹Ì·Ù· fiˆ˜ ÙÔ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ ÎfiÛÙÔ˜ Î·È Ë ‰˘ÛÎÔÏ›· ÙˆÓ ·ÛıÂÓÒÓ Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó Û˘ÛÙËÌ·ÙÈο ÙË ıÂÚ·›· Ù˘ ÓfiÛÔ˘ Î·È ÙˆÓ ÂÈÏÔÎÒÓ Ù˘. T· ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ·ÎfiÌ· ÈÔ ‰‡ÛÎÔÏ· ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ fiÔ˘ ··ÓÙ¿Ù·È Î·È Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ. O ·ÚÈıÌfi˜ ·˘Ùfi˜ ·Ó·Ì¤ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ Û˘Ó¯Ҙ fiÛÔ ÌÂÈÒÓÂÙ·È Ë ıÓËÛÈÌfiÙËÙ· ·fi Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· Î·È Ù· ÓÔÛ‹Ì·Ù· ıÚ¤„ˆ˜. ŒÙÛÈ, ÛÙË Ó¤· ¯ÈÏÈÂÙ›· ÙÔ ÂӉȷʤÚÔÓ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ YÁ›·˜ Î·È ¿ÏÏˆÓ ‰ÈÂıÓÒÓ ÔÚÁ·ÓÈÛÌÒÓ, ı· ¯ÚÂÈ·Ûı› Ó· ÂÂÎÙ·ı› Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘Ó‰ÚfiÌˆÓ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜. B·ÛÈÎfi ÛΤÏÔ˜ Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ Â›Ó·È Ë ÌÂϤÙË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Î·È ÙˆÓ Ù‡ˆÓ ÙˆÓ ÌÂÛÔÁÂÈ·ÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙÔ˘˜ ηı¤Î·ÛÙ· ÏËı˘ÛÌÔ‡˜, ÒÛÙ ӷ ÂÎÙÈÌËı› Ì ·ÎÚ›‚ÂÈ· ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È Ó· ·Ó·˙ËÙËıÔ‡Ó ÔÈ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎÔ› ÙÚfiÔÈ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘ ·Ó¿ÏÔÁ· Ì ÙȘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ οı ¯ÒÚ·˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1.

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Weatherall DJ, Clegg JB. The thalassemia syndromes. 3rd ed. Oxford, Blackwell Scientific Publications: 1981.

K·ÙÙ¿Ì˘ X. £ÂÚ·¢ÙÈ΋ AÓÙÈÌÂÙÒÈÛË MÂÛÔÁÂȷ΋˜ AÓ·ÈÌ›·˜. Aı‹Ó·, ∂Ή. "T¿Áη˜": 1989.

WHO. Report on the community control of hereditary anemias. Memorandum from WHO Meeting. Bull. WHO. 1983;61:63-80.

Weatherall DJ, Clegg JB. Thalassemia, a global health problem. Nature Medicine 1996;2:847-849.

Kattamis C. Mass Screening for ‚ and ‰‚ thalassemias. In: Thalassemia Today, Eds. Sirchia G, Zanella A, ªilano: Centro Transfusionale Ospedale Maggiore Policlinico di Milano Editore, 1987:203-213.

Kattamis C, Kattamis A (Editorial). Genotypes and phenotypes of ‚-thalassemia in Mediterranean population. Pediatric Hematology Oncology 1997;14(3):VII-IX. Loukopoulos D. Prenatal diagnosis of thalassemia and of the hemoglobinopathies; a review. In: Thalassemia Today. The Mediterranean Experience. Eds. Sirchis G, Zanella A. Milano: Centro Transfusionale Ospedale Maggiore Policlinico di Milano, 1987;177-182.

K·ÙÙ¿Ì˘ X. ¢ÂÔÓÙÔÏÔÁÈÎÔ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÔÚÈ·ÎÒÓ Ù¯ÓÈÎÒÓ ÛÙËÓ ÚfiÏË„Ë Î·È ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ÌÔÓÔÁÔÓȉȷÎÒÓ ÓfiÛˆÓ. ¢ÂÏÙ›Ô A' ¶·È‰. KÏÈÓ. ¶·Ó. AıËÓÒÓ 1995;42:46-55.

K·ÙÙ¿Ì˘ X. ™‡Ó‰ÚÔÌ· MÂÛÔÁÂȷ΋˜ AÓ·ÈÌ›·˜. ™Â: "EÊ·ÚÌÔÁ‹ ÌÔÚÈ·ÎÒÓ Ù¯ÓÈÎÒÓ ÛÙË ÌÂϤÙË ÁÂÓÂÙÈÎÒÓ ÓfiÛˆÓ". K·ÙÙ¿Ì˘ X, K·Ó·‚¿Î˘ E. EȉÈο MÂÙÂÎ·È‰Â˘ÙÈο ™ÂÌÈÓ¿ÚÈ· A' ¶·È‰ KÏÈÓ ¶·Ó AıËÓÒÓ. Aı‹Ó·: I·ÙÚÈΤ˜ EΉfiÛÂȘ "Z‹Ù·" 1995;24-44.

Cao A, Rosatelli MC. Screening and prenatal diagnosis of the haemoglobinopathies. Semin Hematol, 1995;33:263-286.

Lucarelli G, Galiberti M, Giardini G, Polchi P, Anelucci E, Baronciani D et al. Bone Marrow Transplantation in Thalassemia. In "Cooleys Anemia. Seventh Symposium", Ed. Cohen A. New York: The New York Academy of Sciences 1998:270-275.

Olivieri NF. Clinical Experience with reactivation of fetal hemoglobin in data haemoglobinopathies. Semin Hematol 1995;33:24-42.

Smith AE. Gene therapy where we are? Molecular Medicine. Lancet 1999; 354: SI1-SI3.

Olivieri NF, Brittenham GM, Matsui D, Merkovitch M, Blendis L, Cameron R, McClelland R, Lin P, Templeton D, Koren G et al.

Iron chelation therapy with oral deferiprone in patients with thalassemia major. N Engl J Med 1995;332:918-922.

Kattamis C. Psychological development, education, employment and social integration of thalassemic patients. In: Desferrioxamine History, Clinical Value and Perspectives. Eds. Gross K, Aumiller J, Gelzer J. Munich: MMV Medizin Verlag 1992;53-68.

¢È‡ı˘ÓÛË AÏÏËÏÔÁÚ·Ê›·˜: XÚ‹ÛÙÔ˜ K·ÙÙ¿Ì˘ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·", 11527, °Ô˘‰›, Aı‹Ó·

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:93-96

H IÛÙÔÚ›· Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ EÈÙ‡ÁÌ·Ù· Î·È ÛÎȤ˜ ÙÔ˘ ¯ı˜ - ÚÔÛ‰Ô˘ Ù˘ ·‡ÚÈÔÓ ™ÔÊ›· AÚÒÓË - BÔ˘ÚÓ¿

S. Aronis - Vournas. The history of haemophilia. Achievements and shadows of the past - expectations for the future. Paediatriki 2000;63:93-96 ● Abstract: The picture of haemophilia was gloomy only a few years ago. Crippling was the rule and the life expectancy of a haemophiliac was less than twenty years. The first breakthrough in the early 1970s was the introduction of factor concentrates in haemophiliac therapy which allowed "home treatment" programmes. Factor concentrates offered haemophiliacs "a better quality" of life, however they were associated with certain risks of transmitting viral infections such as hepatitis B and C, and AIDS. The tragedies of the past stimulated research for the production of "safer products". Moreover, in the mid 1990s, recombinant products became available and prophylactic treatment was accepted as the treatment of choice for children, to prevent haemophilic arthropathy.

However 80% of haemophiliacs worldwide have no access to diagnosis and treatment, and carrier detection and prenatal diagnosis of haemophilia with DNA techniques are even less available. What are the expectations for the future? Several steps are necessary to increase the availability of treatment for haemophiliacs on a global basis.

The production of concentrates using transgenic technology is regarded as an intriguing possibility, while gene therapy is considered an exciting challenge, with hopes of partial or complete cure for haemophiliacs, if it eventually works in humans. The availability or cost of either therapy are unsure, but whatever the treatment for the next millennium, it needs to be 100% safe and to offer haemophiliac boys a life as near normal as possible. ∫ey words: haemophilia, therapy, concentrates, recombinants, gene therapy.

TÔ ÎÂÊ¿Ï·ÈÔ Ù˘ ·ÈÌfiÛÙ·Û˘ ·Ó·Ù‡¯ıËΠÂÓÙ˘ˆÛȷο ÙȘ ‰˘Ô ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ Ù˘ ÂÚ·Ṳ̂Ó˘ ¯ÈÏÈÂÙ›·˜. N¤ÔÈ ·Ú¿ÁÔÓÙ˜ ‹Í˘ ÂÚÈÁÚ¿ÊËηÓ, ÙÔ Û‡ÛÙËÌ· Ù˘ ·ÈÌfiÛÙ·Û˘ ¤ÁÈÓ ÂÚÈÛÛfiÙÂÚÔ ÔχÏÔÎÔ, Ù¯ÓÈΤ˜ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ ˘Ôη٤ÛÙËÛ·Ó Î¿ÔȘ ·fi ÙȘ ËÎÙÈÎÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜, Ó¤· ·ÓÙÈËÎÙÈο Ê¿Ú̷η ΢ÎÏÔÊfiÚËÛ·Ó, ÂÓÒ Î·ı·ÚfiÙÂÚÔÈ ·Ú¿ÁÔÓÙ˜ VIII ‹ IX ηıÒ˜ Î·È ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜ ‰È·Ù¤ıËÎ·Ó ÛÙÔ ÂÌfiÚÈÔ Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Ù˘ ¯ÈÏÈÂÙ›·˜. B¤‚·È·, fiÏ· ·˘Ù¿ Ù· ÂÈÙ‡ÁÌ·Ù· ‰ÂÓ ¯ˆÚ¿Ó Û ¤Ó· ¿ÚıÚÔ Û‡ÓÙ·Í˘, ÁÈ' ·˘Ùfi Î·È ˆ˜ ı¤Ì· ÂÂϤÁË "Ë ·ÈÌÔÚÚÔÊÈÏ›·" ÁÈ· Ó· ·Ó·‰ÂȯıÔ‡Ó Ù· ¿ÏÌ·Ù· Ô˘ ¤Î·ÓÂ Ë I·ÙÚÈ΋ EÈÛÙ‹ÌË ÛÙË ‰‡ÛË Ù˘ ÂÚ·Ṳ̂Ó˘ ¯ÈÏÈÂÙ›·˜, "¿ÏÌ·Ù·" Ô˘ οÔÈ· ˘‹ÚÍ·Ó "ÛˆÙ‹ÚÈ·", ÂÓÒ ¿ÏÏ· ·¤‚ËÛ·Ó "ı·Ó·ÙËÊfiÚ·", Â˘Ù˘¯Ò˜ ÁÈ· Ï›ÁÔ˘˜.

TÔ "¯ÚÔÓÈÎfi" Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ ÂÌÂÚȤ¯ÂÈ ÂÚÈfi‰Ô˘˜ ˙ÔÊÂÚ¤˜ Ô˘ ÂÓ·ÏÏ¿ÛÛÔÓÙ·È Ì ÂÚÈfi‰Ô˘˜ ʈÙÂÈÓ¤˜. A˜ ·Ú·ÎÔÏÔ˘ı‹ÛÔÌ fï˜ ÙËÓ ÂͤÏÈÍË ÙˆÓ ÁÂÁÔÓfiÙˆÓ ‰È·¯ÚÔÓÈο.

H ·ÈÌÔÚÚÔÊÈÏ›· Â›Ó·È ¤Ó· ¯ÚfiÓÈÔ ÓfiÛËÌ· ÎÏËÚÔÓÔÌÈο ÌÂÙ·‚È‚·˙fiÌÂÓÔ ·fi ÙË Ì¿Ó· ÊÔÚ¤· ÛÙÔ ·ÁfiÚÈ Ù˘, Ô˘ ¿Û¯ÂÈ. OÈ ÚÒÙ˜ ÁÚ·Ù¤˜ ·Ó·ÊÔÚ¤˜ ÛÙËÓ Î·Ù¿ÛÙ·ÛË Ô˘ Û‹ÌÂÚ· ÁÓˆÚ›˙ÔÌ ˆ˜ ·ÈÌÔÚÚÔÊÈÏ›· ·Ó¿ÁÔÓÙ·È ÛÙȘ E‚Ú·˚Τ˜ Áڷʤ˜ ÙÔ˘ ‰Â˘Ù¤ÚÔ˘ ·ÈÒÓ· A.D (Apres David) (1,2). ™‡Ìʈӷ Ì ·˘Ù¤˜, Ô ÙÚ›ÙÔ˜ ÁÈÔ˜ ÌÈ·˜ Á˘Ó·›Î·˜ ÂÍ·ÈÚ›ÙÔ Ù˘ ÂÚÈÙÔÌ‹˜, ·Ó Ù· ‰˘Ô ÚÒÙ· ·ÁfiÚÈ· Ù˘ ›¯·Ó Âı¿ÓÂÈ ·fi ·ÈÌÔÚÚ·Á›· ÌÂÙ¿ ·fi ÂÚÈÙÔÌ‹. ¶ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 18Ô˘ ·ÈÒÓ·, ÂÌÊ·Ó›˙ÔÓÙ·È ÔÈ ÚÒÙ˜ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÈÁڷʤ˜ Ù˘ ÓfiÛÔ˘, ÂÓÒ ÙÔ fiÓÔÌ· ·ÈÌÔÊÈÏ›· (haemophilia, ·Á¿Ë ÁÈ· ÙÔ ·›Ì·) ηıÈÂÚÒÓÂÙ·È ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ· (1). H B·Û›ÏÈÛÛ· BÈÎÙÒÚÈ·, Ë ÈÔ ‰È¿ÛËÌË ÊÔÚ¤·˜ Ù˘ ÓfiÛÔ˘, ‰È¤ÛÂÈÚ ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ ·Ó¿ Ù· ‚·Û›ÏÂÈ· Ù˘ E˘ÚÒ˘ ̤ۈ ÙˆÓ ı˘Á·Ù¤ÚˆÓ Ù˘. O ·ÈÌÔÚÚÔÊÈÏÈÎfi˜ ÁÈÔ˜ Ù˘, §ÂÔfiωԘ, ¤ı·Ó ·fi ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· Û ËÏÈΛ· 31 ¯ÚfiÓˆÓ. ŸÙ·Ó Ô §ÂÔfiωԘ ‹Ù·Ó 26 ¯ÚfiÓˆÓ, Ë B·Û›ÏÈÛÛ· ¤ÁÚ·Ê ÛÙÔÓ ¶Úˆı˘Ô˘ÚÁfi Ù˘: "¤ÊÙ·Û ÛÙ· Úfiı˘Ú· ÙÔ˘ ı·Ó¿ÙÔ˘ 4 ¤ˆ˜ 5 ÊÔÚ¤˜ Î·È ‰ÂÓ ÛÙ¿ıËΠfiÚıÈÔ˜, ÛÙ· fi‰È· ÙÔ˘, ÔÙ¤ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi ÌÂÚÈÎÔ‡˜ Ì‹Ó˜" (1). XˆÚ›˜ ηӤӷ ›‰Ô˜ ıÂÚ·¢ÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘, Ë ÂÈÎfiÓ· ÙÔ˘ ·ÈÌÔÚÚÔÊÈÏÈÎÔ‡ ÂΛӢ Ù˘ ÂÔ¯‹˜ ‹Ù·Ó ÙÚ·ÁÈ΋. H ·Ó·ËÚ›· ·fi Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ·ÈÌÔÚÚ·Á›Â˜ ÛÙȘ ·ÚıÚÒÛÂȘ ‹Ù·Ó

93

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·94

¶∞π¢π∞∆ƒπ∫∏ 2000;63:93-96

Ô Î·ÓfiÓ·˜. EÓÒ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ‰ÂÓ ÍÂÂÚÓÔ‡Û ٷ 20 ¯ÚfiÓÈ· (2).

H ·Ó¿Ù˘ÍË Ù˘ ·ÈÌÔ‰ÔÛ›·˜ ¿ÓÔÈÍ ÙÔ ‰ÚfiÌÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ Ì ıÂÚ·›· ˘ÔηٿÛÙ·Û˘. H ÚÒÙË ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÊÔÚ¿ Û ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Û ·ÈÌÔÚÚÔÊÈÏÈÎfi ·ÁfiÚÈ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ 1840 (3). TÔ 1938, Ô Î·ıËÁËÙ‹˜ McFarlane ·Ó·ÁÓÒÚÈ˙ fiÙÈ Ë ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ ÚÔÛ¤ÊÂÚ ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÏËÓ fï˜ ÚÔÛˆÚÈÓ‹ ıÂÚ·›· ÂÓfi˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ˘ÔηıÈÛÙÒÓÙ·˜ οÔÈÔ ÛËÌ·ÓÙÈÎfi, ˆÛÙfiÛÔ ¿ÁÓˆÛÙÔ ·ÎfiÌË ·Ú¿ÁÔÓÙ·, Ô˘ ¤ÏÂÈ ·fi ÙÔ ·›Ì· ÙÔ˘ ·ÛıÂÓ‹ (1). AÚÁfiÙÂÚ·, ¤ÁÈÓ ·ÓÙÈÏËÙfi ˆ˜ Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó ÌÂÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÈÌ¿ÚıÚˆÓ ‹ ·È̷و̿وÓ, fiÙ·Ó ‰ÈÓfiÙ·Ó ÛÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔÚÚ·Á›·˜, ÏËÓ fï˜, ·ÔÙ‡Á¯·Ó ӷ ÂϤÁÍÂÈ ÌÂÁ¿Ï˜ ÌÂÙ·ÙÚ·˘Ì·ÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ Î·È ÂÈϤÔÓ ˘ÂÚÊfiÚÙˆÓ ÙËÓ Î˘ÎÏÔÊÔÚ›·. TÔ Úfi‚ÏËÌ· Ù˘ ˘ÂÚÊfiÚÙˆÛ˘ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ·Ú·Î¿ÌÊıËΠÚÔÛˆÚÈÓ¿ Ì ÙÔ ÎÚ˘˚Ôηı›˙ËÌ·, ÙÔ ÔÔ›Ô ÂÈÛ‹Á·ÁÂ Ë Pool, Ùo 1965 (4). ◊‰Ë ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '50, ÔÈ ·ÈÌÔÚÚÔÊÈÏÈÎÔ› Û˘ÁÎÂÓÙÚÒıËÎ·Ó Û ÔÚÁ·ÓˆÌ¤Ó· K¤ÓÙÚ· AÈÌÔÚÚÔÊÈÏ›·˜ (1,4), Ù· ÔÔ›· ·Ú¯Èο ÚÔÛ¤ÊÂÚ·Ó ‰È¿ÁÓˆÛË Î·È ˘ÔÙ˘Ò‰Ë ıÂÚ·›· ÁÈ· Ó· ÂÍÂÏȯıÔ‡Ó Û "¯ÒÚÔ" ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ÛÙÔÓ ÔÔ›Ô ÔÈ ·ÛıÂÓ›˜ ¤‚ÚÈÛÎ·Ó Î·È ‚Ú›ÛÎÔ˘Ó Ï‡ÛË ÁÈ· οı Úfi‚ÏËÌ· Ô˘ ÙÔ˘˜ ·ÊÔÚ¿, Û˘Ó·Ê¤˜ Ì ÙË ÓfiÛÔ, ÙȘ ÂÈÏÔΤ˜ ·fi ÙË ıÂÚ·›· ‹ ÙËÓ „˘¯È΋ ÙÔ˘˜ ˘Á›·.

H Â·Ó¿ÛÙ·ÛË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ¤ÁÈÓ ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '70 Ì ÙË ‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ (4). OÈ Û˘Ì˘Îӈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜ ¤Î·Ó·Ó ÂÊÈÎÙ‹ ÙË ıÂÚ·›· ÛÙÔ Û›ÙÈ (home therapy) Ô˘ ›¯Â ˆ˜ Û˘ÓÂ·ÎfiÏÔ˘ıÔ ÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ ÂÈÛΤ„ÂˆÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÙË Ì›ˆÛË ÙˆÓ ·Ô˘ÛÈÒÓ ·fi ÙÔ Û¯ÔÏÂ›Ô ‹ ÙËÓ ÂÚÁ·Û›· (5). O ·ÛıÂÓ‹˜ Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ¿Ú¯ÈÛ·Ó Ó· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÂÓÂÚÁfi Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ Î·È Ë ˙ˆ‹ ÙÔ˘ ·ÈÌÔÚÚÔÊÈÏÈÎÔ‡ ¤ÁÈÓ ÈÔ ·ÓıÚÒÈÓË. ¶Ôχ ÁÚ‹ÁÔÚ· fï˜, ÚÔ˜ ÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '70, ¿Ú¯ÈÛ·Ó Ó· ‰È·Ê·›ÓÔÓÙ·È ÔÈ ÚÒÙ˜ ÛÎȤ˜. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó "ÙÚ·ÓÛ·ÌÈÓ·ÈÌ›·" Ô˘ ·Ú¯Èο ·Ô‰fiıËΠ۠ÌfiÏ˘ÓÛË Ì ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ (6). H ηıȤڈÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÚÔÛٿ٢۠ÙÔ˘˜ ·ÛıÂÓ›˜ ·fi ÙË ÌfiÏ˘ÓÛË Ì ÙÔÓ HBV, ·Ú¤ÌÂÈÓ fï˜ Úfi‚ÏËÌ· Ë Ë·Ù›Ùȉ· C (HCV) (7). TÔ 1982 ÂÚÈÁÚ¿ÊËÎ·Ó ÔÈ ‰˘Ô ÚÒÙ˜ ÂÚÈÙÒÛÂȘ AIDS Û ·ÈÌÔÚÚÔÊÈÏÈÎÔ‡˜. TÔ 1984, fiÙ·Ó ¤ÁÈÓ ‰˘Ó·Ù‹ Ë ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ HIV (human immunodeficiency virus), ·ԉ›¯ıËΠˆ˜ 40-94% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ Û ‰È¿ÊÔÚ· K¤ÓÙÚ· ·Ó¿ ÙÔÓ ÎfiÛÌÔ Â›¯·Ó ÌÔÏ˘Óı› Ì ÙÔÓ Èfi (8). KÈ ÂÓÒ Ë ÂÈÛ·ÁˆÁ‹ ÙˆÓ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙË ıÂÚ·›· ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ˘ÔÛ¯fiÙ·Ó ·‡ÍËÛË ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ (~60 ¯ÚfiÓÈ·) (4), ÙÔ 1994 Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛ˘ ¤ÂÛ ÛÙ· 40 ¯ÚfiÓÈ·. H ·ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ‹Ù·Ó ÙÔ AIDS Î·È Ë ‰Â‡ÙÂÚË ÙÔ Ë·ÙÈÎfi ÓfiÛËÌ·. øÛÙfiÛÔ, Ô Û˘Ó‰˘·ÛÌfi˜ ·ÓÙÈ-ÈÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÂÙ¤ÙÚ„ ϤÔÓ ÙÔ AIDS Û ¤Ó· ¯ÚfiÓÈÔ ÓfiÛËÌ· (9), ÂÓÒ ‰È·Ê·›ÓÂÙ·È ˆ˜ Ù· ÚÔÛ¯‹ ¯ÚfiÓÈ·, ÙÔ Ë·ÙÈÎfi ÓfiÛËÌ· ı· ¿ÚÂÈ ÙË ı¤ÛË ÙÔ˘ AIDS, ˆ˜ ÚÒÙË ·ÈÙ›· ı·Ó¿ÙÔ˘, ·Ó ÂÓ Ùˆ ÌÂٷ͇ ‰ÂÓ ·ÏÏ¿ÍÂÈ Î¿ÙÈ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘.

OÈ Û˘ÛÛˆÚÂ˘Ì¤Ó˜ ·ÓÂÈı‡ÌËÙ˜ ÂÈÏÔΤ˜ ÌÈ·˜ "ıÂÚ·›·˜ ˙ˆ‹˜", Ô˘ ÚԤ΢„ "ıÂÚ·›· ı·Ó¿ÙÔ˘", ÂÓÂÚÁÔÔ›ËÛ·Ó ÙËÓ ¤Ú¢ӷ Î·È ÂÓÙ·ÙÈÎÔÔ›ËÛ·Ó ÙËÓ ÚÔÛ¿ıÂÈ· ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ÂÙ·ÈÚÂÈÒÓ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ηı·ÚfiÙÂÚˆÓ ÚÔ˚fiÓÙˆÓ ÂÈ‚¿ÏÏÔÓÙ·˜ ÙÔÓ ¤ÏÂÁ¯Ô (screening) ÙˆÓ ·ÈÌÔ‰ÔÙÒÓ ÁÈ· ÙÔ˘˜ ÁÓˆÛÙÔ‡˜ ÈÔ‡˜ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù¯ÓÈÎÒÓ ·‰Ú·ÓÔÔ›ËÛ˘ ÙÔ˘ ÙÂÏÈÎÔ‡ ÚÔ˚fiÓÙÔ˜ (ÚÔı¤ÚÌ·ÓÛË, ¯ËÌÈ΋ ÂÂÍÂÚÁ·Û›·, ¯ÚˆÌ·ÙÔÁÚ·Ê›· ÎÏ) (10). OÈ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜ ·ÎÔÏÔ‡ıËÛ·Ó ˆ˜ Ê˘ÛÈ΋ Û˘Ó¤ÂÈ· Ù˘ ÚÔfi‰Ô˘ Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ (11). øÛÙfiÛÔ, ÔÈ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜ ÚÒÙ˘ ÁÂÓÈ¿˜ ÂÚÈ›¯·Ó ·ÎfiÌË ›¯ÓË ·Ï‚Ô˘Ì›Ó˘, ˆ˜ ÛÙ·ıÂÚÔÔÈËÙÈÎfi ÙÔ˘ ·Ú¿ÁÔÓÙ· VIII Î·È ¿Ú·, fiˆ˜ Î·È ÔÈ ÚÔÂÚ¯fiÌÂÓÔÈ ·fi ÙÔ Ï¿ÛÌ· ·Ú¿ÁÔÓÙ˜ ˘„ËÏ‹˜ ηı·ÚfiÙËÙ·˜, ÂÓ›¯·Ó ·ÎfiÌË ÙÔÓ Î›Ó‰˘ÓÔ ÌÂÙ·‚›‚·Û˘ ÙÔ˘ ÈÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ A (HAV), ÙÔ˘ parvo-virus B19 ‹/ Î·È ÙÔ˘ prion Ù˘ Ó¤·˜ ÔÈÎÈÏÔÌÔÚÊ›·˜ Ù˘ Creutzfeldt-Jacob - nv CJD - ÚÔ˜ ÙÔ ·ÚfiÓ ·Ó·fi‰ÂÈÎÙÔ˜ ΛӉ˘ÓÔ˜ (12). ŒÓ· ‰È·¯ÚÔÓÈÎfi Úfi‚ÏËÌ· Ù˘ ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘ Ì ·Ú¿ÁÔÓÙ˜ (›Ù ·˘ÙÔ› ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ·›Ì· ›ÙÂ Â›Ó·È ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔÈ) ·Ú·Ì¤ÓÂÈ Ë ·Ó¿Ù˘ÍË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ·Ú¿ÁÔÓÙ· VIII ‹ IX (inhibitors), Ë ÔÔ›· ηıÈÛÙ¿ ÙËÓ ÂÚ·ÈÙ¤Úˆ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÚÔ‚ÏËÌ·ÙÈ΋ Î·È È‰È·›ÙÂÚ· ‰··ÓËÚ‹. H Â›ÙˆÛË ÙˆÓ ·Ó·ÛÙ·ÏÙÒÓ Û ‰È¿ÊÔÚÔ˘˜ ÏËı˘ÛÌÔ‡˜ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Â˘Ú›· ‰È·Î‡Ì·ÓÛË (6%-52%). °È·Ù› ÔÚÈṲ̂ÓÔÈ ·ÈÌÔÚÚÔÊÈÏÈÎÔ› Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›· ·Ó·Ù‡ÛÛÔ˘Ó ·Ó·ÛÙ·ÏÙ¤˜ Î·È ¿ÏÏÔÈ OXI, ·Ú·Ì¤ÓÂÈ ·Ó·¿ÓÙËÙÔ ÂÚÒÙËÌ·, ·Ú¿ ÙȘ Û˘Ó¯È˙fiÌÂÓ˜ ÌÂϤÙ˜ (13). ¶¿ÓÙˆ˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·Û·Ê‹ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ·Ó·ÛÙ·ÏÙÒÓ, ÂÓı·ÚÚ˘ÓÙÈο ‚‹Ì·Ù· ¤¯Ô˘Ó Á›ÓÂÈ ÙÂÏÂ˘Ù·›ˆ˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. H ·ÓÔÛÔ·ÓÔ¯‹ (immune tolerance) Û˘Ó›ÛÙ·Ù·È Û ηıËÌÂÚÈÓ‹ ¤Á¯˘ÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ ·Ú¿ÁÔÓÙ· VIII (25-200 ÌÔÓ/kg x 2/d Â› 6 Ì‹Ó˜ ¤ˆ˜ Î·È ¯ÚfiÓÔ) Ì ÛÙfi¯Ô ÙËÓ Î·Ù·ÛÙÔÏ‹ Î·È ÚÔԉ¢ÙÈ΋ ÂÍ·Ê¿ÓÈÛË ÙÔ˘ ·Ó·ÛÙ·ÏÙ‹ (14). TÔ ÎfiÛÙÔ˜ ÌÈ·˜ Ù¤ÙÔÈ·˜ ıÂÚ·›·˜ Â›Ó·È ‰˘Û‚¿ÛÙ·¯ÙÔ Î·È ÔÈ Û˘¯Ó¤˜ ÊÏ‚ÔÎÂÓÙ‹ÛÂȘ ÚÔ‚ÏËÌ·ÙÈΤ˜ ÁÈ· ÌÈÎÚ¿ ·È‰È¿ (Û˘ÓÈÛÙ¿Ù·È ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜-Port-A-Cath). E› ·È-

94

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

¶∞π¢π∞∆ƒπ∫∏ 2000;63:93-96

™ÂÏ›‰·95

∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

ÌÔÚÚ·Á›·˜, ÁÂÓÈÎÒ˜, ÚÔÙÈÌ¿Ù·È Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË rFVII·, Ë ÔÔ›· Â·Ó·Ï·Ì‚¿ÓÂÙ·È ·Ó¿ 2 ¤ˆ˜ 3 ÒÚ˜, ·Ó¿ÏÔÁ· Ì ÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· (15). O rFVII· ‰È·ÛÊ·Ï›˙ÂÈ ·ÈÌfiÛÙ·ÛË ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÙËÓ Â͈ÁÂÓ‹ Ô‰fi ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Ù˘ ‹Í˘. ™ÙÔÓ ·fiË¯Ô ÙÔ˘ AIDS Î·È Ù˘ Ë·Ù›Ùȉ·˜ A, B ‹ C, ÔÈ Ó¤Â˜ ÁÂÓȤ˜ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÌÂÁ·ÏÒÓÔ˘Ó Ì ÙË ‰·ÌfiÎÏÂÈÔ Û¿ıË Ù˘ ·ÈÌÔÚÚÔÊÈÏÈ΋˜ ·ÚıÚÔ¿ıÂÈ·˜ Ô˘ Â›Ó·È ·fiÚÚÔÈ· ÙˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·ÈÌÔÚÚ·ÁÈÒÓ ÛÙËÓ ›‰È· ¿ÚıÚˆÛË ‹ ·ÙÂÏÔ‡˜ Î·È ÌË ¤ÁηÈÚ˘ ıÂÚ·›·˜ ·ÎfiÌË Î·È ÌÈ·˜ ·ÈÌÔÚÚ·Á›·˜.

H ·Ú·ÌÔÓ‹ ÙÔ˘ ·›Ì·ÙÔ˜ ̤۷ ÛÙÔÓ ·ÚıÚÈÎfi ı‡Ï·ÎÔ, ¤ÛÙˆ Î·È ÁÈ· 48 ÒÚ˜, ¤¯ÂÈ ·Ô‰Âȯı› ˆ˜ ÚÔηÏ› ÛÔ‚·Ú‹ ‚Ï¿‚Ë ÛÙËÓ ¿ÚıÚˆÛË, ÁÈ ·˘Ùfi Ë IÔÎÚ¿ÙÂÈÔ˜ ·Ú¯‹ "ÚÔÏ·Ì‚¿ÓÂÈÓ Î·È Ô˘¯› ıÂÚ·‡ÂÈÓ" ÎÂÚ‰›˙ÂÈ ÔÏÔÓ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ ¤‰·ÊÔ˜ ÛÙ· K¤ÓÙÚ· AÈÌÔÚÚÔÊÈÏ›·˜ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ÎÚ·ÙÒÓ. OÈ ™Ô˘Ë‰Ô› Â›Ó·È ÔÈ ÚÒÙÔÈ Ô˘ ÂÊ¿ÚÌÔÛ·Ó ÙËÓ "ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›·" (prophylactic therapy), Û ·È‰È¿ Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›·, ÚÈÓ ÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ ·ÈÌ¿ÚıÚˆÓ, ·fi ÙËÓ ËÏÈΛ· 1 ¤ˆ˜ 1,5 ¯ÚfiÓÔ˘ (16). O ·Ú¿ÁÔÓÙ·˜ VIII ¯ÔÚËÁÂ›Ù·È ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ‹ οı ‰Â‡ÙÂÚË Ì¤Ú· Û ‰fiÛË 20-40 IU/Kg*, ÂÓÒ Ô ·Ú¿ÁÔÓÙ·˜ IX ¯ÔÚËÁÂ›Ù·È ÛÙËÓ ›‰È· ‰fiÛË, ‰˘Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ‹ οı ÙÚ›ÙË Ì¤Ú·. ™Ùfi¯Ô˜ Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ıÂÚ·›·˜ Â›Ó·È Ë ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ ·ÈÌ¿ÚıÚˆÓ, Ô ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ·ÚıÚÈÙÈÎÒÓ ·ÏÏÔÈÒÛˆÓ, Ë Ê˘ÛÈÔÏÔÁÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Ë Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙÔ˘ ·ÈÌÔÚÚÔÊÈÏÈÎÔ‡ ·ÁÔÚÈÔ‡. ¶·Ú¿ Ù· ÛËÌ·ÓÙÈο ÂÈÙ‡ÁÌ·Ù· ÙˆÓ ‰˘Ô ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ, ÔÈ Ù¯ÓÈΤ˜ ÎψÓÔÔ›ËÛ˘ ‰È¤„Â˘Û·Ó ÙȘ ÚԂϤ„ÂȘ ÂÚ› ·¤Ó·Ë˜ ·Ú·ÁˆÁ‹˜ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·Ú¿ÁÔÓÙ· VIII ‹ IX Û ¯·ÌËÏfi ÎfiÛÙÔ˜. TÂÏÈο, Ë ·Ú·ÁˆÁ‹ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È ÙÔ ÎfiÛÙÔ˜ ȉȷ›ÙÂÚ· ˘„ËÏfi, ·Ó fi¯È ··ÁÔÚ¢ÙÈÎfi ÁÈ· ÌË ·ÓıËÚ¤˜ ÔÈÎÔÓƠ̂˜ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ ÎÚ·ÙÒÓ. ™‡Ìʈӷ Ì ÛÙÔȯ›· Ù˘ WFH (World Federation of Haemophilia), 75%-80% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ, ·Ó¿ ÙÔÓ ÎfiÛÌÔ, ‰ÂÓ ¤¯Ô˘Ó ÚfiÛ‚·ÛË ÛÙË ıÂÚ·›· Ì ·Ú¿ÁÔÓÙ˜, ÔÔÈ·Û‰‹ÔÙ ÚÔ¤Ï¢Û˘ (17). EÍ¿ÏÏÔ˘, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÔÏ·Ì‚¿ÓÔ˘Ó ÙÔ ÚÔÓfiÌÈÔ Ù˘ "ÚÔÊ˘Ï·ÎÙÈ΋˜ ıÂÚ·›·˜" ‰ÂÓ ÍÂÂÚÓ¿ ÙÔ 1%. ™ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, Ù· ¿ÙÔÌ· Ì ·ÈÌÔÚÚÔÊÈÏ›· ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¤¯Ô˘Ó ÌÈ· ÙÚ·ÁÈο ‰‡ÛÎÔÏË ˙ˆ‹, ÛÙÂÚË̤ÓË ·ÎfiÌË Î·È ·fi ÙË ¯·Ú¿ Ù˘ ΛÓËÛ˘ ‹ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. E›ϤÔÓ, Û ·˘Ù¤˜ ÙȘ ¯ÒÚ˜, ‰ÂÓ ÚÔÛʤÚÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ÙˆÓ Á˘Ó·ÈÎÒÓ-ÊÔÚ¤ˆÓ Ù˘ ‰È·Ù·Ú·¯‹˜ Î·È Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜ Ì Ù¯ÓÈΤ˜ DNA, ÂÈÙ‡ÁÌ·Ù· Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÙ›·˜, Ô˘ ·ÔÏ·Ì‚¿ÓÔ˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ, ۯ‰fiÓ Î·Ù¿ ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· ÔÈ ÎÔÈӈӛ˜ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (18). ¶ÔȘ Â›Ó·È ÔÈ ÚÔÛ‰Ô˘ ÁÈ· ÙË Ó¤· ¯ÈÏÈÂÙ›·; H ·ÁÎÔÛÌÈÔÔ›ËÛË Ù˘ ÔÌÔÂȉԇ˜ Î·È ·ÛÊ·ÏÔ‡˜ ıÂÚ·›·˜. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, Ë World Federation of Haemophilia ¤¯ÂÈ ˆ˜ ¿ÌÂÛÔ ÛÙfi¯Ô ÙË ‰È¿ıÂÛË ˘„ËÏ‹˜ ηı·ÚfiÙËÙ·˜ ·Ú·ÁfiÓÙˆÓ, ÚÔÂÚ¯ÔÌ¤ÓˆÓ ·fi ·›Ì· ‹ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓˆÓ ‰Â‡ÙÂÚ˘ ÁÂÓÈ¿˜ (ÛÙÂÚÔ‡ÓÙ·È ·Ï‚Ô˘Ì›Ó˘) ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ÙÔ˘ ÎfiÛÌÔ˘ Ô˘ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Êı¿ÓÂÈ ÙȘ 340.000 (17). H ·Ú·ÁˆÁ‹ ‰È·ÁÔÓȉȷÎÒÓ ·Ú·ÁfiÓÙˆÓ ·fi ÎψÓÔÔÈË̤ӷ ˙Ò· Î·È Ë ÁÔÓȉȷ΋ ıÂÚ·›· ·ÔÙÂÏÔ‡Ó ÌÂÏÏÔÓÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜ (19), ·ÚfiÙÈ Ù· ÂÚ¢ÓËÙÈο ÚÔÁÚ¿ÌÌ·Ù· ¤¯Ô˘Ó ÍÂÎÈÓ‹ÛÂÈ ·fi ÂÙÒÓ. T· ‰È·ÁÔÓȉȷο ÚÔ˚fiÓÙ·, ·Ó ÙÂÏÈÎÒ˜ Ú·ÁÌ·ÙÔÔÈËıÔ‡Ó, ıˆÚËÙÈÎÒ˜ ı· Â›Ó·È ÂχıÂÚ· ·fi ·ÓıÚÒÈÓÔ˘˜ ÈÔ‡˜, Ë Î¿ı·ÚÛ‹ ÙÔ˘˜ ı· Â›Ó·È ·Ï‹ Î·È ·Ó¤ÍÔ‰Ë Î·È ı· ‰È·Ù›ıÂÓÙ·È Û ÈηӤ˜ ÔÛfiÙËÙ˜ ÁÈ· Ó· ηχ„Ô˘Ó ÙȘ ·Ó¿ÁΘ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ, ·ÁÎÔÛÌ›ˆ˜. ŸÏ· ·˘Ù¿ ̤ÏÏÂÈ Ó· ·Ô‰ÂȯıÔ‡Ó, fiˆ˜ ̤ÏÏÂÈ Ó· ·Ô‰Âȯı› Ë ·ÛÊ¿ÏÂÈ·, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Èı·ÓfiÙËÙ· ÌÂÙ¿‰ÔÛ˘ ÈÒÓ ·fi Ù· ÎψÓÔÔÈË̤ӷ ˙Ò·.

H ÁÔÓȉȷ΋ ıÂÚ·›·, ÂӉ¯Ô̤ӈ˜, ı· Ú·ÁÌ·Ùˆı› ̤۷ ÛÙËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘ Ó¤·˜ ¯ÈÏÈÂÙ›·˜ Î·È Èı·ÓÔÏÔÁÂ›Ù·È ˆ˜ ı· ÚÔÛʤÚÂÈ ÌÂÚÈ΋ ‹ Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ‰È·Ù·Ú·¯‹˜. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, ˘¿Ú¯Ô˘Ó ÔÏÏ¿ Î·È ÔÈΛϷ Ù¯ÓÈο ÚÔ‚Ï‹Ì·Ù·, ÂÓÙÔ‡ÙÔȘ ÔÈ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ ÛÙÔÓ ¿ÓıÚˆÔ (ÙfiÛÔ ÁÈ· ÙËÓ ·ÈÌÔÚÚÔÊÈÏ›· B fiÛÔ Î·È ÙËÓ A) ¤¯Ô˘Ó ‰ÚÔÌÔÏÔÁËı›, ÏËÓ fï˜ Ù· ÚÒÙ· ıÂÙÈο ‹ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· Â›Ó·È ¿ÁÓˆÛÙÔ fiÙ ı· ·Ó·ÎÔÈÓˆıÔ‡Ó, fiˆ˜ ¿ÁÓˆÛÙÔ ·Ú·Ì¤ÓÂÈ ÙÔ ÎfiÛÙÔ˜ ıÂÚ·›·˜ ηıÒ˜ Î·È ÌË ÚԂϤ„È̘ ÔÈ ·ÚÂÓ¤ÚÁÂȘ ‹ Ë ‰˘Ó·ÙfiÙËÙ· ‰È¿ıÂÛ˘ Ù˘ ÁÔÓȉȷ΋˜ ıÂÚ·›·˜ Û ·ÁÎfiÛÌÈÔ Â›‰Ô. ™ÙËÓ EÏÏ¿‰· ÏÂÈÙÔ˘ÚÁÔ‡Ó Ù¤ÛÛÂÚ· K¤ÓÙÚ· AÈÌÔÚÚÔÊÈÏ›·˜, ·Ó·ÁÓˆÚÈṲ̂ӷ ·fi ÙÔ YÔ˘ÚÁÂ›Ô YÁ›·˜, ÙÚ›· ÛÙËÓ Aı‹Ó· (IÔÎÚ¿ÙÂÈÔ, §·˚Îfi NÔÛÔÎÔÌ›Ô, ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·") Î·È ¤Ó· ÛÙË £ÂÛÛ·ÏÔÓ›ÎË (IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌ›Ô). OÈ Û˘Ì˘Îӈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜ ¿Ú¯ÈÛ·Ó Ó· ÂÈÛ¿ÁÔÓÙ·È ÛÙË ¯ÒÚ· Ì·˜, ÙÔ 1980 Î·È ¤ÎÙÔÙ ·ÔÙÂÏÔ‡Ó ÙË ıÂÚ·›· ÂÎÏÔÁ‹˜ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ. M¤¯ÚÈ Û‹ÌÂÚ·, ·ÎÔÏÔ˘ıÒÓÙ·˜ ÙȘ ‰ÈÂıÓ›˜ ÂÈÙ·Á¤˜, ÂÓ·ÏÏ¿ÛÛÔ˘Ì ٷ ÚÔ˚fiÓÙ·, ‰È·ÛÊ·Ï›˙ÔÓÙ·˜ ¿ÓÙ· ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜, fi,ÙÈ ıˆÚÂ›Ù·È "·ÛʷϤÛÙÂÚÔ Î·È Î·ı·ÚfiÙÂÚÔ ÚÔ˚fiÓ" ·Ó¿ ÂÔ¯‹, Ì ‚¿ÛË ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜. ™ÙÔ K¤ÓÙÚÔ ÙÔ˘ "AÁ›· ™ÔÊ›·" Ë ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›· ÂÊ·ÚÌfi˙ÂÙ·È Â‰Ò Î·È ÂÙ¿ ¯ÚfiÓÈ· Û ·È‰È¿ Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ·ÈÌÔÚÚ·Á›Â˜ Û ÌÈ· ‹ ÂÚÈÛÛfiÙÂÚ˜ ·ÚıÚÒÛÂȘ. Afi ÙȘ ·Ú¯¤˜ ÙÔ˘ 1998, fiÏ· Ù· ·È‰È¿ Ì ·ÈÌÔÚÚÔÊÈÏ›· A Î·È B ıÂÚ·‡ÔÓÙ·È Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, Û‡Ìʈӷ Ì ÙȘ Û˘ÛÙ¿ÛÂȘ ÙÔ˘ ™˘Ì‚Ô˘Ï›Ô˘ Ù˘ E˘ÚÒ˘, ÁÈ· ÙÔ ıˆÚËÙÈÎfi ΛӉ˘ÓÔ Ù˘ nvCJD. Afi Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980 ÚÔÛʤÚÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ÊÔÚ¤ˆÓ Î·È ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Ù˘ ·ÈÌÔÚÚÔÊÈÏ›·˜, ·Ú¯Èο ÌÂ Û˘Ì‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜ Î·È ·fi ÂÓÙ·ÂÙ›·˜ Ì Ù¯ÓÈΤ˜ DNA.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:93-96

E›ÏÔÁÔ˜ H ·Ó·‰ÚÔÌ‹ ÛÙÔ ¯ÚfiÓÔ ·¤‰ÂÈÍ ˆ˜ Ë ·Ú¤Ì‚·ÛË ÛÙË Ê‡ÛË ÚÔηÏ› ·ÚfiÛÌÂÓ˜ Î·È ÂÓ ÔÏÏÔ›˜, ‰˘Û¿ÚÂÛÙ˜ ·ÓÙȉڿÛÂȘ. EΛÓÔ fï˜, Ô˘ ÌÂÙÚ¿ÂÈ Â›Ó·È ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·. ¢˘ÛÙ˘¯Ò˜, ¤Ó·˜ ·ÚÈıÌfi˜ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ Ï‹ÚˆÛ ·ÎÚÈ‚¿ ÙÔ Ù›ÌËÌ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· "ηχÙÂÚË ÔÈfiÙËÙ·" ˙ˆ‹˜, ·Ó·ÌÊÈÛ‚‹ÙËÙ· fï˜ Ô ‰ÚfiÌÔ˜ ¿ÓÔÈÍ ÁÈ· ÙȘ ÂfiÌÂÓ˜ ÁÂÓȤ˜, ¤Ó·˜ ‰ÚfiÌÔ˜ Ô˘ ÌÔÚ› ·ÎfiÌË Ó· ÌËÓ Â›Ó·È ‹ Ó· ÌË Á›ÓÂÈ ÔÙ¤ ·ÓıfiÛ·ÚÙÔ˜, ÏËÓ fï˜, Â›Ó·È ‚·Ùfi˜. E˘¯‹ Î·È ÂÏ›‰· fiÏˆÓ Ì·˜ ÁÈ· ÙË Ó¤· ¯ÈÏÈÂÙ›· Â›Ó·È Ë ÂÈÙ˘¯›· Ù˘ ÁÔÓȉȷ΋˜ ıÂÚ·›·˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù˘ ·Ú·ÁˆÁ‹˜ ‰È·ÁÔÓȉȷÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ë ‰È¿ıÂÛË Ù˘ fiÔÈ·˜ ıÂÚ·›·˜ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô ÚÔ˜ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (Î·È ·ÛÊ·ÏÒ˜ Î·È ÙˆÓ ÁÈ·ÙÚÒÓ).

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Ljung R. Prenatal diagnosis of haemophilia. Haemophilia 1999;5:84-87.

O' Mahony B. Plasma- derived and Biotech Products: What is the future of haemophilia therapy ? WFH 1999;1:1-9.

¢È‡ı˘ÓÛË AÏÏËÏÔÁÚ·Ê›·˜: ™. AÚÒÓË BÔ˘ÚÓ¿ MÔÓ¿‰· AÈÌfiÛÙ·Û˘ - AÈÌÔÚÚÔÊÈÏ›·˜ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

96

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13:04

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:97-100

O ·È‰›·ÙÚÔ˜ Î·È Ù· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ EϤÓË AÁ¿ıˆÓÔ˜-°ÂˆÚÁÔÔ‡ÏÔ˘

H. Agathonos-Georgopoulou. The paediatrician and the rights of children. Paediatriki 2000;63:97-100 ● Abstract: The UN Convention on the Rights of the Child in its 40 main articles, changes the perception of the child from the object of protection to the subject of rights. The three major domains of the Convention refer to the rights of children for provision, protection and participation. The three clusters of articles interrelate and interact in favour of children, not only when rights are violated in various contexts, but also in the framework of everyday paediatric practice. The aims of the Convention are being achieved fairly well as regards to children's rights to protection and provision. However major limitations are observed in the rights to participation. Contemporary paediatrics, having conquered technology needs to develop better skills in communicating with children on the basis of the UN Convention on the Rights of the Child. ∫ey words: UN Convention, rights.

T· ÙÂÏÂ˘Ù·›· 50 ÌÂÙ·ÔÏÂÌÈο ¯ÚfiÓÈ·, ÛÙË ¢˘ÙÈ΋ E˘ÚÒË, Ú·Á‰·›Â˜ ‰ËÌÔÁÚ·ÊÈΤ˜ ·ÏÏ·Á¤˜ ¤¯Ô˘Ó ÂȉڿÛÂÈ ÛÙÔ ıÂÛÌfi Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÛÙÔ ÚfiÏÔ Ù˘ Á˘Ó·›Î·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÛÙËÓ ÎÔÈÓˆÓ›·, ÂÓÒ Ô ·˘Í·ÓfiÌÂÓÔ˜ ·ÙÔÌÈÎÈÛÌfi˜ ˆ˜ ·Í›· ˙ˆ‹˜ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ Û ÂÚÈÛÛfiÙÂÚ˜ Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ÂÂÓ‰‡ÛÂȘ, ÚÔÛ‰Ô˘ Î·È ··ÈÙ‹ÛÂȘ ÙˆÓ ÁÔÓÈÒÓ ·fi Ù· ·È‰È¿ Ô˘ ÂÈı˘ÌÔ‡Ó Ó· ·ÔÎÙ‹ÛÔ˘Ó. H Ó¤· ·˘Ù‹ ‰ËÌÔÁÚ·ÊÈ΋ ÂÈÎfiÓ·, Ë ÔÔ›· Û˘Ó¯Ҙ ÂÍÂÏ›ÛÛÂÙ·È Î·È ÌÂÙ·‚¿ÏÏÂÙ·È, ÛÂ Û˘Ó‰˘·ÛÌfi Ì Ӥ· ÎÔÈÓˆÓÈο Î·È ÔÈÎÔÓÔÌÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ "ÂÓ ÂÍÂÏ›ÍÂÈ" E˘ÚÒË, ¤¯Ô˘Ó ı¤ÛÂÈ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÛÙÔ Ì¿ÙÈ ÙÔ˘ ΢ÎÏÒÓ·. H ÔÈÎÔÁ¤ÓÂÈ· ‰ÂÓ ÌÔÚ› ϤÔÓ ÌfiÓË Ù˘ Ó· ηٷʤÚÂÈ ·˘Ù¿ Ô˘ ·Ï·ÈfiÙÂÚ· ‹Ù·Ó ¢ı‡ÓË Ù˘ Û˘ÁÁÂÓÈ΋˜ ÔÌ¿‰·˜, Ù˘ ÁÂÈÙÔÓÈ¿˜, Ù˘ ÎÔÈÓfiÙËÙ·˜. ™˘Á¯ÚfiÓˆ˜ fï˜, ÛÙË ÌÂÙ·‚·ÙÈ΋ ·˘Ù‹ ÂÚ›Ô‰Ô Ô˘ ‰È·Ó‡Ô˘ÌÂ, ·Ú·ÙËÚÂ›Ù·È Ì›· ÂÈÛÙÚÔÊ‹ ÛÙÔ ıÂÛÌfi Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ì ÔÔÈ·‰‹ÔÙ Ӥ· ÌÔÚÊ‹, ÂÊfiÛÔÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È ˆ˜ Ë ÎÈÓËÙ‹ÚÈ· ‰‡Ó·ÌË ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ Î·È ÙÔ Î·Ï‡ÙÂÚÔ Ï·›ÛÈÔ ˙ˆ‹˜ ÁÈ· ÙÔ ·È‰›.

OÈ ·ÏÏ·Á¤˜ ·˘Ù¤˜ ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ Û Ӥ˜ ·Ó¿ÁΘ Î·È Û ӤԢ Ù‡Ô˘ ÓÔÛËÚfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ, Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÔÔ›ˆÓ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë ÛÙÔÓ ÙÔ̤· ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÂÈÛÙËÌÒÓ ‹ ÁÈ· ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰· ÛÙÔÓ ÙÔ̤· Ù˘ ˘Á›·˜. H ·‡ÍËÛË ÙˆÓ „˘¯ÔÎÔÈÓˆÓÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙ· ·È‰È¿ Â›Ó·È ¤Ó· Úfi‚ÏËÌ· Ô˘, ·Ó ‰ÂÓ ÚÔÏËÊı› ηٿ ÙËÓ ·ÊÂÙËÚ›· Ù˘ ÔÈÎÔÁÂÓÂȷ΋˜ ˙ˆ‹˜ ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ Î·È ·ÓÙ›ÛÙÔȯ·, ηٿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡, ÏÂÈÙÔ˘ÚÁ› ˆ˜ ÚÔı¿Ï·ÌÔ˜ ÁÈ· ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ Î·È Û˘ÓËıÂÈÒÓ fiˆ˜ Ë ¯Ú‹ÛË ÓfiÌÈÌˆÓ Î·È ·Ú¿ÓÔÌˆÓ Ô˘ÛÈÒÓ, ÔÈ ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ Ë Î·Ù¿ıÏÈ„Ë, Ë ·Ú·‚·ÙÈÎfiÙËÙ·, Ë Û¯ÔÏÈ΋ ·ÔÙ˘¯›· Î.¿. ™ÙË ÛËÌÂÚÈÓ‹ E˘ÚÒË, ¤Ó· ÛÙ· ÂÙ¿ ·È‰È¿ ˘ÔʤÚÔ˘Ó ·fi Úfi‚ÏËÌ· „˘¯È΋˜ ˘Á›·˜ ÙÔ ÔÔ›Ô ¤¯ÂÈ ·Ó¿ÁÎË ·fi ˘ÔÛÙ‹ÚÈÍË ‹ ıÂÚ·›·. E›ÎÔÛÈ ÂηÙÔÌ̇ÚÈ· ·È‰È¿ ÙÚ·˘Ì·Ù›˙ÔÓÙ·È Û ·Ù˘¯‹Ì·Ù· οı ¯ÚfiÓÔ ÂÓÒ ÁÈ· ÙȘ ËÏÈ˘ 0-5 ÂÙÒÓ, Ù· ÂÚÈÛÛfiÙÂÚ· Û˘Ì‚·›ÓÔ˘Ó Ì¤Û· ÛÙÔ Û›ÙÈ, fiÙ·Ó Ù· ·È‰È¿ ‚Ú›ÛÎÔÓÙ·È ˘fi ÙË ÊÚÔÓÙ›‰· ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘˜ ‹ ¿ÏÏˆÓ Ô˘ ÙÔ˘˜ ˘ÔηıÈÛÙÔ‡Ó. H Û˘¯ÓfiÙËÙ· Ù˘ ηÎÔÔ›ËÛ˘ Î·È ·Ú·Ì¤ÏËÛ˘ ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÂÎÙÈÌËı› ˆ˜ 1-2% ÁÈ· οı ¤ÙÔ˜ ËÏÈΛ·˜, ηٿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ ÂÚ›Ô‰Ô, Ì ·ÔÙ¤ÏÂÛÌ· Ë ¶OY Ó· ÙËÓ ÔÚ›ÛÂÈ Î·È Î·Ù·Ù¿ÍÂÈ ÛÙ· ÚÔ‚Ï‹Ì·Ù· ‰ËÌfiÛÈ·˜ ˘Á›·˜.

T· ·Ú·¿Óˆ ·Ú·‰Â›ÁÌ·Ù· ·Ó·‰ÂÈÎÓ‡Ô˘Ó - ÌÂٷ͇ ¿ÏÏˆÓ - ÙËÓ ·Ó¿ÁÎË ÁÈ· Â·Ó·ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ ·È‰È¿ÙÚÔ˘, Û fiÏ· Ù· Â›‰· ÊÚÔÓÙ›‰·˜ ˘Á›·˜. ¶·Ú¿ÏÏËÏ· Ì ÙȘ ‰ËÌÔÁÚ·ÊÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ÂÍÂÏ›ÍÂȘ Ì Â›ÎÂÓÙÚÔ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Ù· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·, ÈÛÙÔÚÈÎÔ› ÌÂÏÂÙËÙ¤˜ ¤¯Ô˘Ó ÂÚÈÁÚ¿„ÂÈ ÙË Û‡Á¯ÚÔÓË ·È‰È΋ ËÏÈΛ· ˆ˜ Ì›· ÂÚ›Ô‰Ô Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤ÓÙÔÓ˜, ‚ÈÔÏÔÁÈÎÔ‡ Ù‡Ô˘ ·Ó·ÊÔÚ¤˜ Î·È ÂÍ·ÚÙ‹ÛÂȘ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ú·ÁÓˆÚ›˙ÂÙ·È Û˘¯Ó¿ Ë ÎÔÈÓˆÓÈ΋ Ù˘ ‰È¿ÛÙ·ÛË. H ·È‰È΋ ËÏÈΛ·, ‰ËÏ·‰‹, ÂÍÂÙ¿˙ÂÙ·È ˆ˜ ¤Ó· ‚ÈÔÏÔÁÈÎfi ÌÂÙ·‚·ÙÈÎfi ÛÙ¿‰ÈÔ Ô˘ ı· Ô‰ËÁ‹ÛÂÈ ÙÔ "·ÓÒÚÈÌÔ" ·È‰› ÛÙËÓ "ˆÚÈÌfiÙËÙ·" Ù˘ ÂÓËÏÈΛˆÛ˘. ™ÙËÓ E˘ÚÒË Ë ıÂÒÚËÛË Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

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ˆ˜ ͯˆÚÈÛÙ‹˜ ÎÔÈÓˆÓÈ΋˜ ηÙËÁÔÚ›·˜, ÂÚÈÔÚ›˙ÂÙ·È ·fi ÙË ‰È·Ú΋ Ì›ˆÛË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ ÙÚ›Ù˘ ËÏÈΛ·˜, ÁÂÁÔÓfi˜ Ô˘ Âȉڿ ÛÙË ‰È¿ıÂÛË ÙˆÓ ÔÈÎÔÓÔÌÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ fiÚˆÓ. H ¿ÓÈÛË ·˘Ù‹ ηٷÓÔÌ‹ Ù˘ "‰‡Ó·Ì˘", ¿Ú· Î·È Ë ·ÔÓÔÌ‹ ÙˆÓ ‰ÈηȈ̿وÓ, "‰ÈηÈÔÏÔÁÔ‡Ó" Î·È ‰È·ÈˆÓ›˙Ô˘Ó ÙȘ ÎÔÈÓˆÓÈΤ˜ ·ÓÈÛfiÙËÙ˜ Î·È ÙÔÓ ÎÔÈÓˆÓÈÎfi ·ÔÎÏÂÈÛÌfi Ì ¿ÍÔÓ· ¯·Ú·ÎÙËÚÈÛÙÈο fiˆ˜ Ë ÎÔÈÓˆÓÈ΋ Ù¿ÍË, Ë Î·Ù·ÁˆÁ‹, ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈΛ·. H ÌÂȈ̤ÓË ÎÔÈÓˆÓÈ΋ ıÂÒÚËÛË ÙÔ˘ ·È‰ÈÔ‡ ˆ˜ "·˘ÙfiÓÔÌÔ˘" ·ÙfiÌÔ˘ ·ÏÏ¿ Î·È Ë ·ÓÙ›ÛÙÔȯ· ÌÂȈ̤ÓË ıÂÒÚËÛ‹ ÙÔ˘ ̤ۈ Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ "Û ÂͤÏÈÍË" ʇÛË ÙÔ˘ Î·È ÙË ÛˆÌ·ÙÈ΋ ÙÔ˘ ·‰˘Ó·Ì›·, Û˘ÓÂÙ¤ÏÂÛ·Ó ÛÙËÓ Ù·‡ÙÈÛË Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Ì ÙËÓ ·ÂÈÚ›·, ÙËÓ ·ÓˆÚÈÌfiÙËÙ·, ÙËÓ ¤ÏÏÂÈ„Ë Â˘ı‡Ó˘, ÙËÓ ·‰˘Ó·Ì›· ÂÈÏÔÁÒÓ, ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ ·˘ÙfiÌ·Ù· ÂÎÏ›Ô˘Ó ÙË ÛÙÈÁÌ‹ Ô˘ ÙÔ ·È‰› Û˘ÌÏËÚÒÛÂÈ ÙÔ 18Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ ÙÔ˘. ø˜ ‰È· Ì·Á›·˜, Ô Ó¤Ô˜ ÔÏ›Ù˘ Î·È Î·Ù¿ Ì›· Ë̤ڷ "ÚÒËÓ ·È‰›", ·Ó·Ì¤ÓÂÙ·È Ó· ¤¯ÂÈ ÍÂÂÚ¿ÛÂÈ ÙË ÌÂÙ¿‚·ÛË ·˘Ù‹, ¤¯ÔÓÙ·˜ ÂÓÙ·¯ı› ÛÙËÓ ÎÔÈÓˆÓÈ΋ ηÙËÁÔÚ›· ÙˆÓ ÂÓËÏ›ÎˆÓ ÔÏÈÙÒÓ ÔÈ ÔÔ›ÔÈ ÌÔÚÔ‡Ó Ó· ‰È·Ú·ÁÌ·Ù¢ıÔ‡Ó Î·È Ó· ‰ÈÂΉÈ΋ÛÔ˘Ó Ù· ‰ÈηÈÒÌ·Ù¿ ÙÔ˘˜.

K·Ù¿ ÙË ‰È¿ÚÎÂÈ·, fï˜ ÙˆÓ 18 ÂÙÒÓ Ù˘ ÌÂȈ̤Ó˘ ÎÔÈÓˆÓÈ΋˜ ÔÚ·ÙfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ, Ô Ù·¯‡˜ Ú˘ıÌfi˜ Ù˘ ۈ̷ÙÈ΋˜, ÓÔËÙÈ΋˜, Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ Î·È ÎÔÈÓˆÓÈ΋˜ ·Ó¿Ù˘Í˘, Ù· ηıÈÛÙ¿ ÈÔ Â˘¿ÏˆÙ· ÛÙȘ ÂȉڿÛÂȘ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ ‰È·ÎÚ›ÛÂˆÓ Î·È ÎÔÈÓˆÓÈÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡, ¿Ú· Î·È ·Ú·‚›·Û˘ ÙˆÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ ÙÔ˘˜.

A˘Ù‹ Â›Ó·È fï˜, Ë ËÏÈÎȷ΋ ÂÚ›Ô‰Ô˜ Ô˘ ηχÙÂÙ·È ·fi ÙËÓ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· Î·È Î·Ù' Â¤ÎÙ·ÛË, Ô Û‡Á¯ÚÔÓÔ˜ ·È‰›·ÙÚÔ˜ ηÏÂ›Ù·È Ó· ·Ó·‰Â›ÍÂÈ Î·È Ó· ÂÓÈÛ¯‡ÛÂÈ ÙË ÔÚ·ÙfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ ̤۷ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·ÏÏ¿ Î·È ÛÙ· Ï·›ÛÈ· ˙ˆ‹˜ Î·È ‰Ú¿Û˘ ¤Íˆ ·fi ·˘Ù‹Ó, ¿Ú· Î·È Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ Î·È ÚÔ·Á¿ÁÂÈ Ù· ·ÚÈ· ‰ÈηÈÒÌ·Ù¿ ÙÔ˘ ÛÙËÓ ˘Á›·, ÙËÓ ÚÔÛÙ·Û›·, ÙËÓ ÎÔÈÓˆÓÈ΋ ·ÛÊ¿ÏÈÛË Î·È ÙË Û˘ÌÌÂÙÔ¯‹.

T· ÌÂÙ·ÔÏÂÌÈο ¯ÚfiÓÈ·, ÛÙËÓ E˘ÚÒË, Ì›· ·Ú¿ÏÏËÏË ÔÚ›· ·ÏÏ·ÁÒÓ Û˘ÓÙÂÏÂ›Ù·È ÛÙËÓ È·ÙÚÈ΋ ÂÈÛÙ‹ÌË, ·ÏÏ¿ ÚÔ˜ ÙËÓ ·ÓÙ›ıÂÙË Î·Ù‡ı˘ÓÛË. ™ÙË ÌÂÙ·‚ÈÔÌ˯·ÓÈ΋ M. BÚÂÙ·Ó›· ÙÔ˘ 19Ô˘ ·ÈÒÓ· Û˘Ó‰˘·˙fiÙ·Ó Ë ‰ËÌfiÛÈ· ˘Á›· Ì ÙËÓ ·È‰È΋ ÚÔÛÙ·Û›· ÛÙ· Ï·›ÛÈ· ÙˆÓ K¤ÓÙÚˆÓ ¶ÚfiÓÔÈ·˜ ¶·È‰ÈÔ‡, Ì ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡˜ ÂÎÚÔÛÒÔ˘˜ ÙȘ ÂÈÛΤÙÚȘ ˘Á›·˜ Ô˘ ›¯·Ó Ï‹ÚË ÁÓÒÛË Ù˘ ÎÔÈÓfiÙËÙ·˜ Î·È Î¿ı ÔÈÎÔÁ¤ÓÂÈ·˜ ̤۷ Û ·˘Ù‹. ™Ù·‰È·Î¿, οو ·fi ÙËÓ ›ÂÛË Ù˘ ÚÔfi‰Ô˘ Ù˘ È·ÙÚÈ΋˜, ‰fiıËΠ¤ÌÊ·ÛË ÛÙËÓ "¤ÁηÈÚË ‰È¿ÁÓˆÛË" Ì ÌÂÙÂͤÏÈÍË ÙˆÓ ·Ú·¿Óˆ ΤÓÙÚˆÓ Û K¤ÓÙÚ· YÁ›·˜ ¶·È‰ÈÔ‡, ηٿ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1970. H EÏÏ¿‰· ‰ÂÓ Â›¯Â ÙËÓ ÂÌÂÈÚ›· Ì›·˜ Ù¤ÙÔÈ·˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÂÊfiÛÔÓ ¿ÓÙ· ÛÙËÚ›˙ÔÓÙ·Ó Û ¤Ó· ÌÔÓÙ¤ÏÔ È·ÙÚÈÎÔ‡ ·ÙÂÚÓ·ÏÈÛÌÔ‡ Ô˘ ·ÔÎÏ›ÂÈ ÙȘ ÔÚÈ˙fiÓÙȘ Û¯¤ÛÂȘ, ›Ù ÛÙ· Ï·›ÛÈ· Ù˘ È·ÙÚÈ΋˜ ÔÌ¿‰·˜ ›Ù ÛÙÔ ÙÚ›Ù˘¯Ô ·È‰›·ÙÚÔ˜ - ·È‰› ÔÈÎÔÁ¤ÓÂÈ·. ¶·Ú·‰ÔÛȷο Ë Û¯¤ÛË Ì ÙÔ ·È‰› ‹Ù·Ó ̤ۈ ÙˆÓ ÁÔÓÈÒÓ. TÔ ·È‰› ‹Ù·Ó Û˘¯Ó¿ ·Ì¤ÙÔ¯Ô˜ ı·ً˜. ŸÔ˘ ÎÈ ·Ó ÂÓÙ¿ÛÛÂÙ·È Ô Û‡Á¯ÚÔÓÔ˜ ·È‰›·ÙÚÔ˜, ‚Ú›ÛÎÂÙ·È ·ÓÙÈ̤وÔ˜ Ì ÙȘ ‰È·ÚÎÒ˜ ·Ó·Ê˘fiÌÂÓ˜ Ӥ˜ ·Ó¿ÁΘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙȘ Ôԛ˜ Ú¤ÂÈ Ó· ÚÔÂÙÔÈÌ·Ûı› Î·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ. N¤· "·ÎÔ‡ÛÌ·Ù·" fiˆ˜ "ÎÔÈÓˆÓÈÎfi˜ ·ÔÎÏÂÈÛÌfi˜", "‰ÈηÈÒÌ·Ù· ·È‰ÈÒÓ", "ÌË ‰È·ÎÚ›ÛÂȘ", "ÛÂÍÔ˘·ÏÈ΋ ÂÎÌÂÙ¿ÏÏ¢ÛË", "ı˘Ì·ÙÔÔ›ËÛË" Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÛÙÔÓ ·È‰›·ÙÚÔ ·ÈÛı‹Ì·Ù· ·Ó·ÛÊ¿ÏÂÈ·˜ ÌÚÔÛÙ¿ ÛÙÔ Î·ÈÓÔ‡ÚÁÈÔ Ô˘ ¯Ù˘¿ ÂÈÙ·ÎÙÈο ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÙÔ˘ fiÚÙ·. ™ÙÔ ‰›ÏËÌÌ· ·˘Ùfi, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÓÙȉڿÛÂÈ Ì ÔÈΛÏÔ˘˜ ÙÚfiÔ˘˜. N· ·ÈÛı·Óı› ·Ì˯·Ó›· ˘fi ÙËÓ ·ÂÈÏ‹ ÙÔ˘ "ηÈÓÔ‡ÚÁÈÔ˘" ÁÈ· ÙÔ ÔÔ›Ô ‰ÂÓ Â›Ó·È ÚÔÂÙÔÈÌ·Ṳ̂ÓÔ˜ Î·È Ó· ÂÚÈÔÚÈÛı› Û ·˘Ùfi Ô˘ ̤¯ÚÈ Û‹ÌÂÚ· ˙ËÙÂ›Ù·È ·fi ·˘ÙfiÓ. N· ·ÓÙÈÌÂÙˆ›ÛÂÈ, ‰ËÏ·‰‹, ÙËÓ ·fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜ ÂÓfi˜ ·È‰ÈÔ‡ ‹ ÙËÓ Î·ÎÔÔ›ËÛ‹ ÙÔ˘ Û ÛÙÂÓ¿ ÎÏÈÓÈο fiÚÈ· ¯ˆÚ›˜ Ó· ÂӉȷÊÂÚı› ÁÈ· ÙÔ ÚÈÓ Î·È ÙÔ ÌÂÙ¿, ·ÏÏ¿ ΢ڛˆ˜, ¯ˆÚ›˜ Ó· ·ÎÔ‡ÛÂÈ ÙÔ ›‰ÈÔ ÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ͯˆÚÈÛÙ¿. MÔÚ›, fï˜, Ó· ·Ó·Î·Ï‡„ÂÈ ÛÙȘ ÈÂÛÙÈΤ˜ Ӥ˜ ·Ó¿ÁΘ, ÙËÓ ÂÈÛÙËÌÔÓÈ΋ Î·È ·ÓıÚÒÈÓË ÚfiÎÏËÛË Ô˘ ı· ÙÔÓ Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó·˙‹ÙËÛË ÙÚfiˆÓ ÁÈ· ÙÔÓ Â·Ó·ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘.

T· ÙÚ›· ·˘Ù¿ ‰›·, ‰ËÏ·‰‹, ÔÈ ÎÔÈÓˆÓÈΤ˜ ·ÏÏ·Á¤˜ Ô˘ ÂȉÚÔ‡Ó ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙÔ ·È‰›, Ë Ó¤· ı¤ÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ·Ó·‰ÂÈÎÓ‡ÂÙ·È Î·È ÔÈ Ó¤Â˜ ·Ó¿ÁΘ Ù˘ ·È‰È·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘, ̤۷ ·fi ·ÏÏËÏÔÂÈηχ„ÂȘ Î·È ·ÏÏËÏÔÛ˘ÁÎÚÔ‡ÛÂȘ, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙËÓ ·Ó¿ÁÎË Û˘Ó¿ÓÙËÛ‹˜ ÙÔ˘˜ Û ¤Ó· ÎÔÈÓfi ÛËÌ›Ô, ¤Ó· ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ Ô˘ ı· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ ˆ˜ ÎÒ‰Èη˜ ·ÍÈÒÓ ·ÏÏ¿ Î·È ˆ˜ Ô‰ËÁfi˜ ÂÊ·ÚÌÔÁÒÓ Ì Â›ÎÂÓÙÚÔ ÙÔ ·È‰›.

TÔ ÎÂÓfi ·˘Ùfi ηχÙÂÙ·È ·fi ÙËÓ Û˘Ó¿ÓÙËÛË ‰‡Ô ·ÁÎfiÛÌÈˆÓ ÎÈÓËÌ¿ÙˆÓ. AÊÂÓfi˜, ÙËÓ ÂÈÚËÓÈ΋ Â·Ó¿ÛÙ·ÛË Ô˘ Û˘ÓÙÂÏÂ›Ù·È ·fi ÙÔ 1989, ÛÙ· Ï·›ÛÈ· Ù˘ ‰È¿‰ÔÛ˘ Î·È Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ™‡Ì‚·Û˘ ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡ ÙÔ˘ OHE, Ô˘ ·ÔÙÂÏ› ÓfiÌÔ Î·È ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÎÚ¿ÙÔ˘˜ ·fi ÙÔ 1992. AÊÂÙ¤ÚÔ˘, ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ¤ÓÓÔÈ·˜ Ù˘ ˘Á›·˜ ·fi ÙËÓ ¶OY ˆ˜ "¢ÂÍ›·" (well being), fiÚÔ˜ Ô˘ Û˘Ó‰˘¿˙ÂÈ ÙË ÛˆÌ·ÙÈ΋ ˘Á›·, ÙËÓ „˘¯È΋ ˘Á›· Î·È ÙËÓ ÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ·ÙfiÌÔ˘. ŒÙÛÈ, Ë "ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ ÛÙÔÓ ¿ÍÔÓ· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡", ·ÔÙÂÏ› ÙÔ ÛËÌÂ›Ô Û˘Ó¿ÓÙËÛ˘ ÙˆÓ ‰‡Ô ÎÈÓËÌ¿ÙˆÓ Î·È ¤Ó· Ó¤Ô ‰›Ô Ù˘ ·È‰È·ÙÚÈ΋˜ ˆ˜ ÂÈÛÙ‹Ì˘ Î·È ˆ˜ Ù¤¯Ó˘.

H ™‡Ì‚·ÛË ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡ (™¢¶), ̤۷ ·fi Ù· 40 ·ÚÈ· ¿ÚıÚ· Ù˘, ÌÂÙ·‚¿ÏÏÂÈ ÙË Ì¤¯ÚÈ Û‹ÌÂÚ· ıÂÒÚËÛË ÙÔ˘ ·È‰ÈÔ‡ ·fi ·ÓÙÈΛÌÂÓÔ ÚÔÛÙ·Û›·˜ Û ˘ÔΛÌÂÓÔ ‰ÈηȈ̿وÓ. OÈ ÙÚÂȘ ·ÚȘ ÂÓfiÙËÙ¤˜ Ù˘ ·ÊÔÚÔ‡Ó ÛÙ· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ Û ·ÚÔ¯¤˜, Û ÚÔÛÙ·Û›· Î·È ÛÂ Û˘ÌÌÂÙÔ¯‹. E‡ÏÔÁÔ Â›Ó·È, fiÙÈ Î·È Ù· ÙÚ›· ‰›· ·ÏÏËÏÔ-ÂÌϤÎÔÓÙ·È Î·È Û˘Ó-ÏÂÈÙÔ˘ÚÁÔ‡Ó ˘¤Ú ÙˆÓ ·È‰ÈÒÓ fi¯È ÌfiÓÔ fiÙ·Ó ·˘Ù¿ ·Ú·-

98

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

¶∞π¢π∞∆ƒπ∫∏ 2000;63:97-100

™ÂÏ›‰·99

∞ÊȤڈ̷: ÀÁ›· ÙÔ˘ ·È‰ÈÔ‡ 2000

‚È¿˙ÔÓÙ·È ·ÏÏ¿ ÛÙ· Ï·›ÛÈ· Ù˘ ηıËÌÂÚÈÓ‹˜ ·È‰È·ÙÚÈ΋˜ Ú¿Í˘. ™Â ˘„ËÏfi ÔÛÔÛÙfi ·˘Ùfi Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Î˘Ú›ˆ˜, ˆ˜ ÚÔ˜ ÙÔ ‰Èη›ˆÌ· ÛÙȘ ·ÚÔ¯¤˜ ˘Á›·˜ Î·È Ôχ ÏÈÁfiÙÂÚÔ ˆ˜ ÚÔ˜ ÙÔ ‰Èη›ˆÌ· ÛÙËÓ ÚÔÛÙ·Û›·. ™ËÌ·ÓÙÈÎfi ÎÂÓfi fï˜, ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÚÔ·ÁˆÁ‹ ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜ Ù˘ Û˘ÌÌÂÙÔ¯‹˜.

EÈÙÚÔ‹ Ù˘ BÚÂÙ·ÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ‰ËÌÔÛ›Â˘Û ÙÔ 1995 ¤Ó·Ó Ôχ ¯Ú‹ÛÈÌÔ Ô‰ËÁfi ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ¿ÚıÚÔ˘ 24 Ù˘ ™‡Ì‚·Û˘ ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡ ÁÈ· ÙËÓ ˘Á›·, Î·È Û˘ÓÔ‰ÒÓ ¿ÚıÚˆÓ, ÛÙ· Ï·›ÛÈ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜. TÔ ¿ÚıÚÔ 24 ˘·ÁÔÚ‡ÂÈ ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÂÓfi˜ ÈηÓÔÔÈËÙÈÎÔ‡ ÂÈ¤‰Ô˘ ˘Á›·˜ ÁÈ· οı ·È‰›, ÙËÓ ÚfiÛ‚·ÛË Î·È ·ÍÈÔÔ›ËÛË ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Î·È ·ÔηٿÛÙ·Û˘, ÙË ÁÓÒÛË ÁÈ· ·˘ÙÔÊÚÔÓÙ›‰· Î·È ÚfiÏË„Ë Î·È ÙË ‰ÈÂıÓ‹ Û˘ÓÂÚÁ·Û›· ÁÈ· ÙËÓ ·ÓÙ·ÏÏ·Á‹ Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÁÓÒÛ˘. H ÌÂϤÙË ·˘Ù‹ ‰›ÓÂÈ ÙËÓ Â˘Î·ÈÚ›· ÛÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÔ‡˜ ˘Á›·˜ Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙȘ ̤¯ÚÈ ÙÒÚ· Ú·ÎÙÈΤ˜ ÙÔ˘˜ Î·È Ó· ÙȘ ‚ÂÏÙÈÒÛÔ˘Ó Ì ¿ÍÔÓ· ÙÔ Û˘ÌʤÚÔÓ ÙÔ˘ ·È‰ÈÔ‡. T· ‰›· ·ÍÈÔÏfiÁËÛ˘ Â›Ó·È Ù· ÂÍ‹˜: 1) ¶ÂÚÈ‚¿ÏÏÔÓ: Â›Ó·È ÙÔ È·ÙÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÊÈÏÈÎfi ÚÔ˜ ÙÔ ·È‰› ˆ˜ ˘ÔÎÂÈ̤ÓÔ˘ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘Á›·˜; .¯. Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÙÔ ‰Èη›ˆÌ¿ ÙÔ˘ ÛÙËÓ Â¯Â̇ıÂÈ· ÛÙÔ Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ‹ ‚Ú›ÛÎÔÓÙ·È Î·È ¿ÏÏ· ¿ÙÔÌ· ÂΛ ‹ ·ÓÔÈÁÔÎÏ›ÓÂÈ Ë fiÚÙ·; §ÂÈÙÔ˘ÚÁÔ‡Ó È·ÙÚ›· Û ·ÔÁÂ˘Ì·ÙÈÓ¤˜ ÒÚ˜ ‹ Ú¤ÂÈ Ó· Ï›„ÂÈ ÙÔ ·È‰› ·fi ÙÔ Û¯ÔÏÂ›Ô Î·È Ô ÁÔÓÈfi˜ ·fi ÙË ‰Ô˘ÏÂÈ¿ ÙÔ˘; 2) ™ÙÂϤ¯Ë ÊÚÔÓÙ›‰·˜ ˘Á›·˜: ¤¯Ô˘Ó ÂÎ·È‰Â˘Ù› ÛÙËÓ ÂÈÎÔÈÓˆÓ›· È·ÙÚÔ‡ -·ÛıÂÓÔ‡˜, ȉȷ›ÙÂÚ· ˆ˜ ÚÔ˜ Ù· ‰È¿ÊÔÚ· ÛÙ¿‰È· ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡; §ÂÈÙÔ˘ÚÁ› ÔÌ¿‰· ˘Á›·˜ ÒÛÙ ӷ ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó ÔÈ ÔχÏ¢Ú˜ ·Ó¿ÁΘ ·È‰ÈÔ‡ Î·È ÔÈÎÔÁ¤ÓÂÈ·˜; Œ¯ÂÈ ·Ó·Ù‡ÍÂÈ ÙÔ Ï·›ÛÈÔ Û‡Ó‰ÂÛË Ì ÙËÓ ÎÔÈÓfiÙËÙ· ‹ ÁÓˆÚ›˙ÂÈ Ô È‰ÈÒÙ˘ ·È‰›·ÙÚÔ˜ Ô‡ ı· ·Ú·¤Ì„ÂÈ Î·È ÁÈ·Ù›; 3) YËÚÂۛ˜ ˘Á›·˜: °ÓˆÚ›˙Ô˘Ó ÙË ‰ËÌÔÁÚ·ÊÈ΋ Î·È ÎÔÈÓˆÓÈ΋ Ù·˘ÙfiÙËÙ· Ù˘ ÎÔÈÓfiÙËÙ·˜; Œ¯ÂÈ ÏËÊı› ˘fi„Ë Ë ÁÓÒÌË ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ Ó¤ˆÓ ÛÙÔ Û¯Â‰È·ÛÌfi ÙˆÓ ˘ËÚÂÛÈÒÓ Ô˘ ·¢ı‡ÓÔÓÙ·È Û ·˘ÙÔ‡˜; ¢È·¯ˆÚ›˙ÔÓÙ·È ÔÈ ˘ËÚÂۛ˜ ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ÙˆÓ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ ‹ ÙȘ ËÏÈÎȷΤ˜ ·Ó¿ÁΘ .¯. ¤ÊË‚ÔÈ; Y¿Ú¯ÂÈ Û‚·ÛÌfi˜ ÁÈ· ÙȘ ÔÏÈÙÈÛÌÈΤ˜ ȉȷÈÙÂÚfiÙËÙ˜; AÍÈÔÏÔÁÔ‡ÓÙ·È Û ÛÙ·ıÂÚ‹ ‚¿ÛË ÔÈ ÂÌÂÈڛ˜ ηϋ˜ Ú·ÎÙÈ΋˜ Ì ÁÓÒÌÔÓ· Ù· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡; ¶ÚÔÛʤÚÂÙ·È ÏËÚÔÊfiÚËÛË ÛÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ÁÈ· ÙËÓ ™‡Ì‚·ÛË ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ÛÙ· ›‰È· Ù· ·È‰È¿ - ·ÛıÂÓ›˜; ™˘ÌÌÂÙ¤¯Ô˘Ó Ù· ›‰È· Ù· ·È‰È¿ ÛÙËÓ ·Ó¿Ù˘ÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜; 4) £ÂÚ·›· Î·È ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ: TÈ ÁÓˆÚ›˙ÂÈ ÙÔ ›‰ÈÔ ÙÔ ·È‰› ˆ˜ ˘ÔΛÌÂÓÔ ‰ÈηȈ̿وÓ, ÁÈ· ÙËÓ Â¤Ì‚·ÛË Î·È ÙË ıÂÚ·›· ÙÔ˘; Œ¯Ô˘Ó ÂÎ·È‰Â˘ı› Ù· ÛÙÂϤ¯Ë ˘Á›·˜ ÛÙËÓ ÂÈÎÔÈÓˆÓ›· Ì ·È‰È¿ ‰È·ÊfiÚˆÓ ËÏÈÎÈÒÓ Î·È Ì ‰È·ÊÔÚÂÙÈο ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜; EÍËÁÔ‡ÓÙ·È ÛÙÔ ·È‰› ÔÈ ·ÚÂÓ¤ÚÁÂȘ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ‹ Ë ¯ÚÔÓÈfiÙËÙ· Ù˘ ·ÔηٿÛÙ·Û˘; 5) ¶ÚÔ·ÁˆÁ‹ Ù˘ ÚÔÛˆÈ΋˜ ˘Á›·˜: ™˘ÌÌÂÙ¤¯Ô˘Ó Ù· ·È‰È¿ ÛÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ ÙÔ˘˜; EÓÈÛ¯‡ÂÙ·È Ë ·˘ÙÂÓ¤ÚÁÂÈ· Î·È Ë ·˘ÙÔÊÚÔÓÙ›‰·; 6) ¶ÚÔÛÙ·Û›·: ™˘ÌÌÂÙ¤¯Ô˘Ó Ù· ·È‰È¿ ÛÙÔ ‰Èη›ˆÌ¿ ÙÔ˘˜ ÁÈ· ÚÔÛÙ·Û›·, fiÙ·Ó ·Ú·‚È¿˙ÂÙ·È ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜ ‹ ·fi ÙÚ›ÙÔ˘˜; °ÓˆÚ›˙Ô˘Ó ÙȘ ‰È·‰Èηۛ˜ Û ÂÚÈÙÒÛÂȘ ηÎÔÔ›ËÛ˘ Ô˘ Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÛÙȘ ·Ú¯¤˜; ¶Ò˜ ηÙÔ¯˘ÚÒÓÂÙ·È ÙÔ ‰Èη›ˆÌ¿ ÙÔ˘˜ ÛÙËÓ ¤ÎÊÚ·ÛË ·ÏÏ¿ Û˘Á¯ÚfiÓˆ˜ Î·È Û ¯Â̇ıÂÈ· Î·È ÚÔÛÙ·Û›· ·fi ‰Â˘ÙÂÚÔÁÂÓ‹ ηÎÔÔ›ËÛË; ™˘ÌÌÂÙ¤¯Ô˘Ó Ù· ·È‰È¿ ÛÙÔ Û¯Â‰È·ÛÌfi Ù˘ ‰È΋˜ ÙÔ˘˜ ˙ˆ‹˜ fiÙ·Ó ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·; ¶ÚÔÛʤÚÂÈ ÙÔ ÓÔÛÔÎÔÌÂ›Ô ‰˘Ó·ÙfiÙËÙ· ÂÎÚÔÛÒËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ‰ÈηÛÙ‹ÚÈÔ ·fi ¤ÌÂÈÚÔ ·È‰›·ÙÚÔ - Ú·ÁÌ·ÙÔÁÓÒÌÔÓ·; °ÓˆÚ›˙ÂÈ ÙÔ ·È‰› οو ·fi ÔȘ Û˘Óı‹Î˜ Ú¤ÂÈ Ó· ·Ú·‚È¿ÛÂÈ ÙÔ ·fiÚÚËÙÔ ÒÛÙ ӷ ÚÔÛٷ٢ı›; 7) ¶ÚÔ·ÁˆÁ‹ ıÂÙÈ΋˜ ÂÈı·Ú¯›·˜: Œ¯Ô˘Ó ÂÎÙÈÌËı› ÔÈ ÛÙ¿ÛÂȘ ÙˆÓ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜ Û ı¤Ì·Ù· ÚÔÒıËÛ˘ Ù˘ ÌË- ‚›·È˘ ÂÈı·Ú¯›·˜ ÛÙ· Ï·›ÛÈ· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜; Œ¯Ô˘Ó ÚfiÛ‚·ÛË ÔÈ ÁÔÓ›˜ ÛÙË ÁÓÒÛË ·˘Ù‹ Î·È Û ¤ÓÙ˘Ë ÏËÚÔÊfiÚËÛË; 8) EÍ·ÛÊ¿ÏÈÛË ÙÔ˘ ·ÔÚÚ‹ÙÔ˘ ÛÙËÓ ÎÔÈÓfiÙËÙ·: Œ¯ÂÈ ÙÔ Ï·›ÛÈÔ ˘Á›·˜ ·Ó·Ù‡ÍÂÈ ÌÈ· ÔÏÈÙÈ΋ ‰È·ÛÊ¿ÏÈÛ˘ ÙÔ˘ ·ÔÚÚ‹ÙÔ˘, ȉȷ›ÙÂÚ· ˘fi ÙËÓ ›ÂÛË ÙˆÓ MME; M›· ·Ï‹ ·Ó¿ÁÓˆÛË ÙˆÓ ÚÔ¸Ôı¤ÛÂˆÓ ·˘ÙÒÓ Ô‰ËÁ› Û ‰È·ÊÔÚÂÙÈÎÔ‡ Ù‡Ô˘ ·ÓÙȉڿÛÂȘ: "M· ·˘Ù¿ Â›Ó·È ·˘ÙÔÓfiËÙ·, ¤ÙÛÈ ÎÈ ·ÏÏÈÒ˜ Á›ÓÔÓÙ·È", ‹ "·˘Ù¿ ‰ÂÓ Â›Ó·È ÁÈ· ÂÌ¿˜, ÛÙËÓ EÏÏ¿‰· Ë ÔÈÎÔÁ¤ÓÂÈ· ¤Ú¯ÂÙ·È ÚÒÙË" ‹ ·ÎfiÌ· "ÂÌ›˜ ‰ÂÓ ¤¯Ô˘Ì ٤ÙÔÈ· Û˘ÛÙ‹Ì·Ù·". MÈ· ‰Â‡ÙÂÚË fï˜ ·Ó¿ÁÓˆÛË ı· ·Ó·‰Â›ÍÂÈ ÙË Ó¤· ÂÈÎfiÓ· ÙˆÓ Ú·ÁÌ¿ÙˆÓ, fiÔ˘ ÙÔ ¶AI¢I, ˆ˜ ˘ÔΛÌÂÓÔ ‰ÈηȈ̿وÓ, ÚˆÙ·ÁˆÓÈÛÙ› ÛÙË ‰È΋ ÙÔ˘ ˙ˆ‹. H Ó¤· ·˘Ù‹ ı¤ÛË Ô˘ ÔÊ›ÏÂÈ Ó· ÚÔ·Û›ÛÂÈ Ô ¯ÒÚÔ˜ Ù˘ ˘Á›·˜, ı· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ ˆ˜ Ó¤Ô˘ ÔÏ›ÙË. ™ÙËÓ E˘Úˆ·˚΋ ŒÓˆÛË, Ë ı¤ÛË ·˘Ù‹ ηٷÎÙ‹ıËΠÚfiÛÊ·Ù·, ÌÂÙ¿ ·fi ÔÏÏÔ‡˜ ·ÁÒÓ˜ ÌË Î˘‚ÂÚÓËÙÈÎÒÓ ÔÚÁ·ÓÒÛˆÓ, Ì ÙËÓ Í¯ˆÚÈÛÙ‹ ·Ó·ÊÔÚ¿ ÛÙÔ ¶AI¢I - ¶O§ITH Ù˘ E˘ÚÒ˘, ÛÙË ™˘Óı‹ÎË ÙÔ˘ Amsterdam ÁÈ· ÙËÓ EE (1996). A˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ë EE ·Ó·Ù‡ÛÛÂÈ Ì›· ·ÓÂÍ¿ÚÙËÙË ÔÏÈÙÈ΋ ÁÈ· Ù· ·È‰È¿ ̤ۈ ÚÔÁÚ·ÌÌ¿ÙˆÓ .¯. ÂÓ¿ÓÙÈ· ÛÙË ‚›·, Î·È ÛÙȘ ÌË ‰È·ÎÚ›ÛÂȘ Î·È ˘¤Ú Ù˘ Û˘ÌÌÂÙÔ¯‹˜, ÙˆÓ ›ÛˆÓ ¢ηÈÚÈÒÓ, Ù˘ ÚÔÛÙ·Û›·˜ ·fi ÙÔÓ Î·Ù·Ó·ÏˆÙÈÛÌfi, fiˆ˜ Î·È ¿ÏÏˆÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ Ô˘ ı· Ú¤ÂÈ Ó· ·ÔÏ·Ì‚¿ÓÂÈ ÙÔ ·È‰› ̤ۈ Ù˘

99

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·100

¶∞π¢π∞∆ƒπ∫∏ 2000;63:97-100

Ó¤·˜ ÙÔ˘ ıÂÒÚËÛ˘.

T· ‰ÈηÈÒÌ·Ù· ÙÔ˘ ·È‰ÈÔ‡ ı· ηٷÎÙËıÔ‡Ó Ì ÙË Û˘ÛÙÚ¿Ù¢ÛË fiψÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘˜, ̤۷ ·fi ÙËÓ ·Ó¿Ù˘ÍË ÌÈ·˜ Û˘ÓÂÚÁÂȷ΋˜ Û˘ÌÌÂÙÔ¯‹˜, Ì ̷ÎÚ¿ ÔÚ›· ̤۷ ÛÙÔ ¯ÚfiÓÔ.

O ÔÈÎÔÁÂÓÂÈ·Îfi˜ ·È‰›·ÙÚÔ˜, ˆ˜ Ô ÚÒÙÔ˜ Û‡Ì‚Ô˘ÏÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ·Ó·‰ÂÈÎÓ‡ÂÙ·È Ù·˘Ùfi¯ÚÔÓ· Î·È ˆ˜ "Û˘Ó‹ÁÔÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡". EÓÈÛ¯‡ÂÈ Î·È ÚÔ¿ÁÂÈ ÙÔ ‰Èη›ˆÌ· Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÚˆÙÔÁÂÓ¤˜ ÔÈÎÔÁÂÓÂÈ·Îfi ·ÙÙ·ÚÔ, ·fi ÙË ÛÙÈÁÌ‹ Ù˘ Á¤ÓÓËÛ˘, fiÙ·Ó ÔÈ ÁÔÓ›˜ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙȘ ÚÒÙ˜ ·Ó¿ÁΘ, Ù· ÚÒÙ· „ÂÏÏ›ÛÌ·Ù·, ÙÔ ÎÏ¿Ì·, ÙÔ ‚ϤÌÌ· ÂÈÎÔÈÓˆÓ›·˜. Afi ÙË ÛÙÈÁÌ‹ ·˘Ù‹ ¤ˆ˜ ÙËÓ ÂÊ˂›·, Ê¿ÛË ˙ˆ‹˜ Ô˘ Ô ¤ÊË‚Ô˜ Í·Ó·˙› Ù· ÚÒÙ· ·È‰Èο ÙÔ˘ ¯ÚfiÓÈ·, Ô ·È‰›·ÙÚÔ˜ ‚Ú›ÛÎÂÙ·È ÎÔÓÙ¿ ÛÙÔ ·È‰› ˆ˜ ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ Î·È ÛÙ·ıÂÚfiÙËÙ·˜, ‚·ÛÈṲ̂Ó˘ ÛÙË Û¯¤ÛË Ô˘ ¤¯ÂÈ ÔÈÎÔ‰ÔÌ‹ÛÂÈ. ŒÓ· ‡ÏÔÁÔ ÂÚÒÙËÌ· Ô˘ ÚÔ·ÙÂÈ Â›Ó·È: "Ì‹ˆ˜ ·Ó·ı¤ÙÔ˘Ì ˘ÂÚ‚ÔÏÈΤ˜ ¢ı‡Ó˜ ÛÙÔÓ ·È‰›·ÙÚÔ, Ô˘ ‰ÂÓ ÌÔÚ› Ó· ÙȘ ÛËÎÒÛÂÈ"; H ·¿ÓÙËÛË: "B‚·›ˆ˜ Î·È ÙÔ˘ ·Ó·ı¤ÙÔ˘ÌÂ, ÂÍ·ÈÙ›·˜ Ù˘ ÚÔÓÔÌȷ΋˜ ÙÔ˘ ı¤Û˘ Î·È Û¯¤Û˘ Ì ٷ ·È‰È¿ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·". M ÙË ‰È·ÊÔÚ¿ fiÙÈ, Ô Û‡Á¯ÚÔÓÔ˜ ·È‰›·ÙÚÔ˜ ÔÊ›ÏÂÈ Ó· ·ÔÙÂÏ› ̤ÏÔ˜ Ù˘ ÔÌ¿‰·˜ ˘Á›·˜ Ô˘ ÏÂÈÙÔ˘ÚÁ› ÈÛfiÙÈÌ· ÌÂٷ͇ ÙˆÓ ÌÂÏÒÓ Ù˘ ÂÓÒ ·Ó·Ù‡ÛÛÂÈ ÔÚÈ˙fiÓÙȘ Û¯¤ÛÂȘ Û˘ÓÂÚÁ·Û›·˜ Ì ÙÔ ›‰ÈÔ ÙÔ ·È‰› Î·È Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘.

E›ÏÔÁÔ˜ H Û‡Á¯ÚÔÓË ·È‰È·ÙÚÈ΋ ÂÈÛÙ‹ÌË, ¤¯ÔÓÙ·˜ ηٷÎÙ‹ÛÂÈ ÙËÓ Ù¯ÓÔÏÔÁ›·, ·Ó·Ù‡ÛÛÂÙ·È ÚÔ˜ ÙËÓ Î·Ù¿ÎÙËÛË Ù˘ Ù¯ÓÔ-ÏÔÁ›·˜, ‰ËÏ·‰‹ Ù˘ Ù¤¯Ó˘ ÙÔ˘ ÏfiÁÔ˘, ¤ÙÛÈ ÒÛÙ ӷ ηÏÏÈÂÚÁÂ›Ù·È Ë ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ·È‰› ˆ˜ ˘ÔÎÂÈ̤ÓÔ˘ ‰ÈÎ·ÈˆÌ¿ÙˆÓ ÛÙËÓ ˘Á›· ÙÔ˘ Î·È ·Ú¿ÏÏËÏ·, Ë ·È‰È·ÙÚÈ΋ ˆ˜ ÂÈÛÙ‹ÌË Î·È ˆ˜ Ù¤¯ÓË ˙ˆ‹˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. AÁ¿ıˆÓÔ˜ - °ÂˆÚÁÔÔ‡ÏÔ˘ E. (EÈÌ.) OÈÎÔÁ¤ÓÂÈ· - ¶·È‰È΋ ¶ÚÔÛÙ·Û›· -KÔÈÓˆÓÈ΋ ¶ÔÏÈÙÈ΋, ÕÚıÚ· ÙˆÓ: AÁ¿ıˆÓÔ˜-°ÂˆÚÁÔÔ‡ÏÔ˘ E: "TÔ ÎÚ¿ÙÔ˜ ˆ˜ ÁÔÓÈfi˜: Û‡ÌÌ·¯Ô˜ ‹ ·ÓÙ›·ÏÔ˜;" M·ÎÚ˘ÓÈÒÙË ¢: "H ·È‰È΋ ËÏÈΛ· ˆ˜ ÎÔÈÓˆÓÈÎfi Ê·ÈÓfiÌÂÓÔ" ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T: "KÔÈÓÔÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ". Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, 1993.

2. AÁ¿ıˆÓÔ˜-°ÂˆÚÁÔÔ‡ÏÔ˘ E. (EÈÌ.) O‰ËÁfi˜ ÁÈ· ÙËÓ AÓ·ÁÓÒÚÈÛË Î·È AÓÙÈÌÂÙÒÈÛË Ù˘ K·ÎÔÔ›ËÛ˘ Î·È ¶·Ú·Ì¤ÏËÛ˘ ÙÔ˘ ¶·È‰ÈÔ‡. Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, 1998.

3. A Children's Policy for 21st. Century Europe: First steps, Report by Sandy Ruxton EURONET, 1999.

4. ™‡Ì‚·ÛË ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡, NfiÌÔ˜ 2101 - º‡ÏÏÔ EÊËÌÂÚ›‰·˜ K˘‚ÂÚÓ‹Ûˆ˜ 192, EıÓÈÎfi T˘ÔÁÚ·ÊÂ›Ô Ù˘ EÏÏ¿‰Ô˜ 2.12.1992.

5. AÁ¿ıˆÓÔ˜-°ÂˆÚÁÔÔ‡ÏÔ˘ E, TÛ¿ÁηÚË M: EÁ¯ÂÈÚ›‰ÈÔ ÁÈ· Ù· ¢ÈηÈÒÌ·Ù· ÙÔ˘ ¶·È‰ÈÔ‡. Aı‹Ó·: IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, 1999.

¢È‡ı˘ÓÛË AÏÏËÏÔÁÚ·Ê›·˜: EϤÓË AÁ¿ıˆÓÔ˜-°ÂˆÚÁÔÔ‡ÏÔ˘ Ph D. æ˘¯ÔÏfiÁÔ˜, ¢È¢ı‡ÓÙÚÈ·, ¢È‡ı˘ÓÛË OÈÎÔÁÂÓÂÈ·ÎÒÓ ™¯¤ÛˆÓ, IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ºˆÎ›‰Ô˜ 7, 115 27

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

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§ÔÈÌÒÍÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹ ∫·›ÙË ª·Ï·Î¿-Z·ÊÂÈÚ›Ô˘1, M·Ú›· X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡-™È‰ËÚÔÔ‡ÏÔ˘2, MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘-MÂÙ·Í¿1, NÈÎfiÏ·Ô˜ °ÔÌ¿Î˘1, °ÂÒÚÁÈÔ˜ B·ÚÏ¿Ì˘2, M·Ú›· EÌÔÚÈ¿‰Ô˘2 ● ¶ÂÚ›ÏË„Ë: OÚÈṲ̂ÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ηٷÛÙ¤ÏÔ˘Ó ·Ú¿ Ó· ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂΉ‹ÏˆÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, Ô˘ Û˘Ó‹ıˆ˜ Â›Ó·È ·ÚÔ‰È΋. OÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Û˘Ó‹ıˆ˜ ÚÔηÏÔ‡Ó Î·Ù·ÛÙÔÏ‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ‹ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜, ÂÓÒ ÂÏ¿¯ÈÛÙÔÈ Î·Ù·ÛÙ¤ÏÏÔ˘Ó Î·È ÙȘ ‰‡Ô. OÈ Ì˯·ÓÈÛÌÔ› ηٷÛÙÔÏ‹˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÔÏÏÔ› Î·È ‰ÂÓ Â›Ó·È ·ÎfiÌË fiÏÔÈ ÁÓˆÛÙÔ›, ÏfiÁˆ Ù˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ Î·È ÙˆÓ ÔÏÏ·ÏÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË. ™‹ÌÂÚ·, ÔÈ ÁÓˆÛÙfiÙÂÚÔÈ Ì˯·ÓÈÛÌÔ› ·ÊÔÚÔ‡Ó ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ‹ ı·Ó¿ÙˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ. °ÂÓÈο ÔÈ ÏÔÈÌÒÍÂȘ, ÌÈÎÚԂȷΤ˜ ‹ ÈÔÁÂÓ›˜, ·Ú·ÛÈÙÈΤ˜ ‹ Ì˘ÎËÙÈ·ÛÈΤ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË Î˘ÙÙ·ÚÔÂÓÈÒÓ Ì ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. A˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ì ÙËÓ ·ÚÔ˘Û›· IgG (ıÂÚÌÔ‡ Ù‡Ô˘) ‹ IgM („˘¯ÚÔ‡ Ù‡Ô˘) ·ÓÙÈۈ̿وÓ, ÚÔηÏÔ‡Ó ÔÈ ÈÔ› Ù˘ ÈÏ·Ú¿˜, EB, CMV, Coxsackie, ·ÓÂÌ¢ÏÔÁÈ¿˜, ·ÏÔ‡ ¤ÚËÙ·, Ë·Ù›Ùȉ·˜, HIV Î·È ÈÓÊÏÔ˘¤ÓÙ˙·˜. TÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÌÈÎÚÔ‚È·Îfi ·›ÙÈÔ ÚfiÎÏËÛ˘ ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ „˘¯ÚÔ‡ Ù‡Ô˘. ¢Â˘ÙÂÚÔ·ı‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· ¿ÓÔÛÔ˘ Ù‡Ô˘ ÂÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ÏÔÈÌÒÍÂˆÓ Î˘Ú›ˆ˜ ·fi ÙÔÓ Èfi EB Î·È Parvo B19, fiˆ˜ Î·È ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. H Ô˘‰ÂÙÂÚÔÂÓ›· ·˘Ù‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÓ·ÓÙ›ÔÓ ÙˆÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ. °È· ÙËÓ ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ ıÚÔÌ‚ÔÂÓ›·˜ ¿ÓÔÛÔ˘ Ù‡Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Â›Û˘, ÈÔÁÂÓ›˜ (ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË, CMV, ·ÓÂÌ¢ÏÔÁÈ¿, ÈÏ·Ú¿, ÂÚ˘ıÚ¿, ÎÙÏ.), ‚·ÎÙËÚȷΤ˜ (BÚԢΤÏψÛË), ÚˆÙÔ˙ˆÈΤ˜ (ÂÏÔÓÔÛ›·) ÏÔÈÌÒÍÂȘ Î·È Ì‡ÎËÙ˜. E›Û˘, ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Î·ÎÔËıÂÈÒÓ ÛÙÔÓ ¿ÓıÚˆÔ, Û ÔÛÔÛÙfi 15% ÂÚ›Ô˘. O ηÚΛÓÔ˜ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜, Ô ÚˆÙÔ·ı‹˜ ηÚΛÓÔ˜ ÙÔ˘ ‹·ÙÔ˜, ÙÔ Ï¤Ìʈ̷ Burkitt, Ë ÓfiÛÔ˜ ÙÔ˘ Hodgkin, ÙÔ Û¿ÚΈ̷ Kaposi Î·È ÌÈ· ÏÂÈ¿‰· ¿ÏÏˆÓ Î·ÎÔËıÂÈÒÓ Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜ ‹ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜, Û¯ÂÙ›˙ÔÓÙ·È ·ÈÙÈÔÏÔÁÈο ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÈÔ‡˜. MfiÓË Ë ·ÚÔ˘Û›· ÙÔ˘ ÈÔ‡ ‰ÂÓ Â›Ó·È ÈηӋ Ó· ÚÔηϤÛÂÈ Î·ÎÔ‹ıÂÈ·. A·ÈÙÔ‡ÓÙ·È ÎÈ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ - ÁÂÓÂÙÈÎÔ›, Â›ÎÙËÙÔÈ, ÔÚÌÔÓÈÎÔ›, ·ÓÔÛÔÏÔÁÈÎÔ› Î.¿. - ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘. H ·Ú·Û΢‹ ÂÌ‚ÔÏ›ˆÓ ÂÓ·ÓÙ›ÔÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÁÎÔÁfiÓˆÓ ÈÒÓ, ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÏ¿ÙÙˆÛ˘ ‹ ÂÍ¿ÏÂȄ˘ ·˘Ù‹˜ Ù˘ ·ÈÙ›·˜ ηÚΛÓÔ˘ ÛÙÔÓ ¿ÓıÚˆÔ. T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÈ ÏÔÈÌÒÍÂȘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Î·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘. EÓÔ¯ÔÔÈÔ‡ÓÙ·È Ù· ¯Ï·Ì‡‰È· Ù˘ Ó¢ÌÔÓ›·˜, ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ Î·È Ô ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi˜, fiˆ˜ Î·È ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ÚÔηÏÔ‡Ó ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ÓfiÛÔ. K·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ·˘ÙÒÓ ÙˆÓ ¯ÚfiÓȈÓ, ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ, ÏÔÈÌÒÍÂˆÓ ÚÔηÏÔ‡ÓÙ·È ‚Ï¿‚˜ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁ›ˆÓ, ÔÈ Ôԛ˜ ˆ˜ ÁÓˆÛÙfiÓ, ·ÔÙÂÏÔ‡Ó ÙË ‚·ÛÈ΋ ‰ÈÂÚÁ·Û›· Ô˘ ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÚfiÎÏËÛË Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘. E›Û˘, Ë ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ‰ÈÂÚÁ·Û›· Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Î·È ÙËÓ ˘ÂÚ·Ú·ÁˆÁ‹ ÙˆÓ Î˘ÙÔÎÈÓÒÓ, ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÙË ‰ÈÂÚÁ·Û›· Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘. EÓÙ·ÙÈΤ˜ ÌÂϤÙ˜ ÛÙÚ¤ÊÔÓÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ‰ÂÈÎÙÒÓ ÁÈ· ÙËÓ ˘fi‰ÂÈÍË ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ïԛ̈ÍË Ô˘ ı· ÂˆÊÂÏËıÔ‡Ó ·fi ÙË ¯Ú‹ÛË ÂÌ‚ÔÏ›Ô˘ ‹ ıÂÚ·›·˜ ÚÈÓ ÂÌÊ·Ó›ÛÔ˘Ó Î·Ú‰È·Î‹ ÓfiÛÔ. H Û˘Û¯¤ÙÈÛË ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ηډȷΤ˜ ·ı‹ÛÂȘ ‹ ÂÈÏÔΤ˜, fiˆ˜ Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë ÂÓ‰Ôηډȷ΋ ÈÓÔÂÏ¿ÛÙˆÛË, ÔÈ ¯ÚfiÓȘ ·ÚÚ˘ı̛˜ Î·È Ë ·ıËÚÔÛÎÏ‹Ú˘ÓÛË ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ÂȂ‚·ÈˆıÔ‡Ó ·Ú¿ ÌfiÓÔ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ù˘ ·ÓÔÛÔ‚ÈÔÏÔÁ›·˜, ηıÒ˜ Î·È Ì ÙË ‚ÂÏÙ›ˆÛË Ù˘ Ù¯ÓÈ΋˜ Ù˘ ÂÓ‰ÔÌ˘Ôηډȷ΋˜ ‚ÈÔ„›·˜, Ì ÙËÓ ÔÔ›· ·ÔηχÙÂÙ·È fiÙÈ Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙȘ ÈÒÛÂȘ Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚË ·fi fiÙÈ ÈÛÙ‡ÂÙÔ ÛÙÔ ·ÚÂÏıfiÓ. ¶ÔÏÏÔ› ÈÔ›, ȉȷ›ÙÂÚ· ÔÈ ÂÓÙÂÚÔ˚Ô› Î·È ÂȉÈÎfiÙÂÚ· ÔÈ ÈÔ› Coxsackie B, ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÂÚÈÙÒÛÂȘ Ì˘Ôηډ›Ùȉ·˜ Ô˘ ÂÍÂÏ›ÛÛÔÓÙ·È Û ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ÁÈ· ÙËÓ ÔÔ›· Â›Ó·È ·Ô‰ÂÎÙfi Û‹ÌÂÚ· fiÙÈ Â›Ó·È ¿ıËÛË ·ÓÔÛÔÏÔÁÈ΋˜, ÁÂÓÂÙÈ΋˜, ÏÔÈÌÒ‰Ô˘˜ ‹ ÌÈÎÙ‹˜ ·ÈÙÈÔÏÔÁ›·˜. T¤ÏÔ˜, ÔÏϤ˜ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ÈÛÙ‡ÂÙ·È fiÙÈ ÔÊ›ÏÔÓÙ·È Û ÚÔËÁËı›۷ Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·fi ·›ÙÈ· fiˆ˜ ÈÔ› (·‰ÂÓÔ˚fi˜, ÈÏ·Ú¿˜ Î.¿.), ¿Ù˘ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› (Ì˘ÎfiÏ·ÛÌ· Î.¿.), ÌÈÎÚfi‚È· (ÎÔÎ·Ù˘, Ê˘Ì·Ù›ˆÛË Î.¿.), ̇ÎËÙ˜ (·Û¤ÚÁÈÏÏÔ˜), Î·È ·Ú¿ÛÈÙ· (Ó¢ÌÔÓÔ·ÛÙË). MÂϤÙ˜ ÂÈÛËÁÔ‡ÓÙ·È ÎÔÈÓÔ‡˜ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ·Ó¿Ù˘Í˘ ·ÔÊÚ·ÎÙÈ΋˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜, ȉÈÔ·ıÔ‡˜ ‰È¿ÌÂÛ˘ ›ÓˆÛ˘, ‰È·Ì¤ÛˆÓ Ó¢ÌÔÓÈÒÓ Î·È ¿ÏÏˆÓ ¯ÚfiÓÈˆÓ Ó¢ÌÔÓÔ·ıÂÈÒÓ, ΢ڛˆ˜ ·fi ÈÔ‡˜. H ηٷÛÙÚÔÊ‹ ÈÛÙÔ‡ ÛÙ· ‚·ı‡ÙÂÚ· ˘Ô‚ÏÂÓÓÔÁfiÓÈ· ÛÙÚÒÌ·Ù· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (ÓÂÎÚˆÙÈ΋ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ‹ Ó¢ÌÔÓ›·) Ô‰ËÁ› Û ÊÏÂÁÌÔÓÒ‰Ë ‰È‹ıËÛË Î·È ÂÓ·fiıÂÛË ˘·Ï›Ó˘ ÌÂÌ‚Ú¿Ó˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ¯ÚfiÓÈ· ÈÓÒ‰Ë ÂÍÂÚÁ·Û›· ÙˆÓ Ó¢ÌfiÓˆÓ. OÈ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó Û˘¯Ó‹ ·ÈÙ›· ·Ó·ËÚ›·˜ ‹ ı·Ó¿ÙÔ˘, ÁÈ' ·˘Ùfi Ë ÚfiÏË„Ë (ÂÌ‚fiÏÈ· Î.¿.) ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÛÙ· ·È‰È¿, ·ÔÙÂÏ› ÙËÓ Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ·È‰È·ÙÚÈ΋ ·Ú¤Ì‚·ÛË. ¶·È‰È·ÙÚÈ΋ 2000;63:101-120.

101

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·102

¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

°Ú·Ùfi ™˘ÌfiÛÈÔ

§¤ÍÂȘ ÎÏÂȉȿ: §ÔÈÌÒÍÂȘ, ·ÓÔÛÔηٷÛÙÔÏ‹, ΢ÙÙ·ÚÔÂӛ˜, ηÚΛÓÔ˜, ·ıËÚÔÛÎÏ‹Ú˘ÓÛË, Ì˘ÔηډÈÔ¿ıÂÈ·, Ó¢ÌÔÓÔ¿ıÂÈ·.

K. Malaka - Zafiriou, M. Hatzistylianou - Sidiropoulou, M. Athanasiou - Metaxa, N. Gombakis, G. Varlamis, M. Emboriadou.

Round table: Infections in childhood and chronic diseases later in life.

Paediatriki 2000;63:101-120. ● Abstract: Certain infectious microorganisms have the ability to suppress rather than stimulate the immune response, resulting in the manifestation of a secondary immunodeficiency, which is usually temporary. Most microorganisms cause suppression of either cellular or humoral immunity, while a very few suppress both. Not all of the immunosuppression mechanisms are known, because of their heterogeneity and the multiple functions of the cells participating in the immune response. The mechanisms which are already well known are the modification of cell function and the killing or destruction of cells. Infections, bacterial, viral, fungal or parasitic may be responsible for cytopenias due to activation of the immune system. Autoimmune haemolytic anaemia, with the production of IgG (warm type) or IgM (cold type) antibodies, can be induced by several viruses, such as measles, Epstein Barr (EB), cytomegalovirus (CMV), Coxsackie, chickenpox, herpes simplex, hepatitis, HIV and influenza. Mycoplasma pneumoniae constitutes a typical causal agent of cold type autoimmune haemolytic anaemia. Secondary autoimmune neutropenia presents during infections from EB and Parvo B19 viruses and also from Mycoplasma pneumoniae. This neutropenia is characterized by the production of specific antibodies against polymorphonuclear leucocytes. Secondary thrombocytopenia may follow various infections, viral (infectious mononucleosis, CMV, chickenpox, measles, rubella, etc), bacterial (brucellosis), and protozoal (malaria) as well as fungal.

It is generally believed that viral infections contribute a significant share (about 15%) in the pathogenesis of several human cancers. The development of uterine cervical cancer, primary liver cancer, Burkitt's lymphoma, Hodgkin's disease, Kaposi sarcoma and other malignancies in immunocompromized and transplanted patients has been related to specific viruses.

Apart from viruses, a variety of other factors, genetic, acquired, hormonal, immunological, are necessary for the creation of a tumour. Prevention against specific tumour-inducing viruses though the production of new vaccines may offer the possibility of reducing the risk of several cancers. In recent years, infectious diseases have been implicated in the pathogenesis of atherosclerosis. Chlamydia pneumoniae, Helicobacter pylorum and CMV, as well as bacteria which cause periodontal diseases are thought to be responsible. Damage of the vascular endothelium during these chronic infections is thought to be the mechanism leading to the development of atherosclerosis. In addition, the chronic inflammatory process caused by activation of macrophages and overproduction of cytokines, resembles the atherosclerotic process.

Many studies have a aimed at the identification of specific markers in order to determine which patients with chronic infection could benefit from vaccination or treatment before heart disease develops. The association of viral infections with cardiac diseases or their sequelae, such as dilated cardiomyopathy, endocardial fibroelastosis, chronic arrhythmias and atherosclerosis can now be confirmed, due to the progress of molecular biology and immunobiology, as well as the improvement in myocardial biopsy technique. These modern techniques have revealed that myocardial involvement in viral infections is much more frequent than was previously thought. Enteroviruses, especially Coxsackie B virus, have been related with the progression of myocarditis to dilated cardiomyopathy, which is generally accepted as a disease of genetic, immunological, infectious or of multiple aetiology. Finally, there is increasing evidence that most chronic lung disease is caused by prior lower respiratory illness in childhood, including viral (adenovirus, measles, etc), atypical (mycoplasma, etc), bacterial (pertussis, tuberculosis, etc), fungal (aspergillus) and parasitic (Pneumocystis carinii) infections. Studies suggest common pathogenetic mechanisms in the development of chronic lung disease (bronchiolitis obliterans, idiopathic interstitial fibrosis, other interstitial pneumonias, etc) mainly by viruses. Chronic lung disease is a major cause of death and disability and consequently the prevention by vaccination of infectious diseases in children is essential.

Key words: Infections, immunosuppression, cytopenias, cancer, atherosclerosis, cardiomyopathy, pneumonopathy.

TÔ °Ú·Ùfi ™˘ÌfiÛÈÔ ·ÚÔ˘ÛÈ¿ÛÙËΠˆ˜ ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙· ÛÙÔ 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, £ÂÛÛ·ÏÔÓ›ÎË, 28-30 ª·˝Ô˘ 1999.

™˘ÓÙÔÓ›ÛÙÚÈ· ™ÙÚÔÁÁ˘Ï‹˜ ∆Ú¿Â˙·˜: ∫·›ÙË ª·Ï·Î¿ - ∑·ÊÂÈÚ›Ô˘, ∫·ıËÁ‹ÙÚÈ· ¢È¢ı‡ÓÙÚÈ· ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ∞¶£. ∂È̤ÏÂÈ· °Ú·ÙÔ‡ ™˘ÌÔÛ›Ô˘: ªÈÚ¿ÓÙ· ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿, ∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈ΋˜ ∞¶£.

1 ¡ÔÛÔÎÔÌÂ›Ô “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔÓ›ÎË 2 ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞ £ÂÛÛ·ÏÔÓ›ÎË

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§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

§ÔÈÌÒÍÂȘ Î·È ·ÓÔÛÔηٷÛÙÔÏ‹ M·Ú›· X·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡-™È‰ËÚÔÔ‡ÏÔ˘

H ›ÛÔ‰Ô˜ ÏÔÈÌÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙÔÓ ÌÂÁ·ÏÔÔÚÁ·ÓÈÛÌfi Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ÙËÓ ÂΉ‹ÏˆÛË ‹ ÌË Ïԛ̈͢, Ë ÔÚ›· Ù˘ ÔÔ›·˜, ηıÒ˜ Î·È Ë ·ÓÔÛȷ΋ ·¿ÓÙËÛË ÂÍ·ÚÙÒÓÙ·È: 1. Afi ÙÔÓ ÏÔÈÌÔÁfiÓÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi Î·È ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ‰È·ı¤ÙÂÈ ÁÈ· Ó· ÂÈÛ¤ÏıÂÈ, Ó· ÂÈ˙‹ÛÂÈ, Ó· ÔÏÏ·Ï·ÛÈ·Ûı› ÂÓÙfi˜ ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È Ó· ·ÔʇÁÂÈ ÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË ·˘ÙÔ‡ Î·È 2. Afi ÙÔÓ ÍÂÓÈÛÙ‹ Î·È Ì¿ÏÈÛÙ· (·) ·fi ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ê˘ÛÈ΋˜ ¿Ì˘Ó·˜ Ô˘ ·˘Ùfi˜ ‰È·ı¤ÙÂÈ ÁÈ· Ó· ·ÔʇÁÂÈ ÙË Ïԛ̈ÍË (¤ÌÊ˘ÙË ‹ ÌË ÂȉÈ΋ ·ÓÔÛ›·) Î·È (‚) ·fi ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ÂȉÈ΋˜ ·ÓÔÛ›·˜.

AÓÙÈÙ¿ÛÛÔÓÙ·È ‰‡Ô ‰˘Ó¿ÌÂȘ. H Ì›· Â›Ó·È Ô ÏÔÈÌÔÁfiÓÔ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ Î·È Ë ¿ÏÏË ÙÔ ·Ì˘ÓÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÌÂÁ·ÏÔÔÚÁ·ÓÈÛÌÔ‡. K¿ı ̛· ·fi ÙȘ ‰˘Ó¿ÌÂȘ ·˘Ù¤˜ ÚÔÛ·ı› Ó· ÂÈ‚ÈÒÛÂÈ ÚÔηÏÒÓÙ·˜ ÛËÌ·ÓÙÈ΋ ‚Ï¿‚Ë ÛÙËÓ ¿ÏÏË.

O Von Pirquet (1908) ÚÒÙÔ˜ ·Ú·Ù‹ÚËÛ fiÙÈ ÙfiÛÔ Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ïԛ̈͢ Ì ÙÔÓ Èfi Ù˘ ÈÏ·Ú¿˜, fiÛÔ Î·È 6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿, Ë ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ηı›ÛÙ·ÙÔ ·ÚÔ‰Èο ·ÚÓËÙÈ΋, Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÚÔËÁÔ˘Ì¤Óˆ˜ ‹Ù·Ó ıÂÙÈ΋.

Afi ÙfiÙ ¤Ú·Û ۯ‰fiÓ ÌÈÛfi˜ ·ÈÒÓ·˜ ÁÈ· Ó· ‰ÈÂÚ¢ÓËı› Ë ·Ú·Ù‹ÚËÛË ·˘Ù‹ ÙÔ˘ Von Pirquet ·fi ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜. ŒÙÛÈ, Û‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÚÈṲ̂ÓÔÈ ÏÔÈÌÔÁfiÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ηٷÛÙ¤ÏÏÔ˘Ó, ·Ú¿ Ó· ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂΉ‹ÏˆÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ Ô˘ Û˘Ó‹ıˆ˜ Â›Ó·È ·ÚÔ‰È΋. ø˜ ‰Â˘ÙÂÚÔ·ı›˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ÔÈ ÔÈÔÙÈΤ˜ ‹ ÔÛÔÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û ÔÔÈÔ‰‹ÔÙ ÛΤÏÔ˜ Ù˘ ¿Ì˘Ó·˜, Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û ÚÔËÁÔ˘Ì¤Óˆ˜ ˘ÁÈ‹ ¿ÙÔÌ· Î·È ÔÈ Ôԛ˜ ÔÊ›ÏÔÓÙ·È Û ‰È¿ÊÔÚ· ·›ÙÈ· fiˆ˜ Â›Ó·È ÔÈ ÏÔÈÌÒÍÂȘ, Ù· ηÎÔ‹ıË Î·È Ù· ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, Ë ·ÎÙÈÓÔ‚ÔÏ›· Î·È ¿ÏÏ·.

O ÓÔÛÒÓ ÍÂÓÈÛÙ‹˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ·Ô‰˘Ó·ÌˆÌ¤ÓË ·ÓÔÛȷ΋ ·¿ÓÙËÛË Û ·ÓÙÈÁfiÓÔ Ô˘ ‰ÂÓ Û˘Ó‰¤ÂÙ·È Ì ÂΛÓÔ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· Ì ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ÂÈÚÚÂ‹˜ Û ÂÈÁÂÓ›˜ ‰Â˘ÙÂÚ‡ԢÛ˜ ÏÔÈÌÒÍÂȘ. T¤ÙÔÈÔÈ ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜, Ô˘ ÚÔηÏÔ‡Ó ‰Â˘ÙÂÚÔ·ı‹ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Â›Ó·È ‚·ÎÙËÚ›‰È·, ÈÔ›, ̇ÎËÙ˜ Î·È ÚˆÙfi˙ˆ·. ™ÙËÓ ·-

ÚÔ‡Û· ·Ó·ÛÎfiËÛË ı· ·Ó·ÊÂÚıԇ̠ÌfiÓÔ ÛÙËÓ ·ÓÔÛÔηٷÛÙÔÏ‹ Ô˘ ÚÔηÏÔ‡Ó Ù· ‚·ÎÙËÚ›‰È· Î·È ÔÈ ÈÔ›. ™ÙÔÓ ›Ó·Î· 1 Ê·›ÓÔÓÙ·È ÔÈ ÏÔÈÌÔÁfiÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›, ‚·ÎÙËÚ›‰È· Î·È ÈÔ›, Ô˘ ÚÔηÏÔ‡Ó ÙȘ ÈÔ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ÛÙÔÓ ¿ÓıÚˆÔ Î·È ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ·Ô‰˘Ó·ÌÒÓÔ˘Ó ÙÔ ·Ì˘ÓÙÈÎfi Û‡ÛÙËÌ¿ ÙÔ˘ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜.

OÚÈṲ̂ÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ÚÔηÏÔ‡Ó Î·Ù·ÛÙÔÏ‹ ÌfiÓÔ Ù˘ ΢ÙÙ·ÚÈ΋˜ ‹ ÌfiÓÔ Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜, ÂÓÒ ¿ÏÏÔÈ Î·Ù·ÛÙ¤ÏÏÔ˘Ó Î·È ÙËÓ Î˘ÙÙ·ÚÈ΋ Î·È ÙËÓ ¯ËÌÈ΋ ·ÓÔÛ›·.

OÈ Ì˯·ÓÈÛÌÔ› ηٷÛÙÔÏ‹˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÔÏÏÔ› Î·È ‰ÂÓ Â›Ó·È ·ÎfiÌË fiÏÔÈ ÁÓˆÛÙÔ›. A˘Ùfi Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ ÏfiÁˆ Ù˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ Î·È ÙˆÓ ÔÏÏ·ÏÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË.

¶›Ó·Î·˜ 1. MÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ÚÔηÏÔ‡Ó ‰Â˘ÙÂÚÔ·ı‹ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·.

MÈÎÚÔÔÚÁ·ÓÈÛÌÔ› K˘ÙÙ·ÚÈ΋ X˘ÌÈ΋ ·ÓÔÛ›· ·ÓÔÛ›· M. º˘Ì·Ù›ˆÛ˘ M. §¤Ú·˜ ™ÙÚÂÙfiÎÔÎÎÔÈ TÚÂfiÓËÌ· ÙÔ ˆ¯ÚfiÓ BÚԢΤÏϘ Ifi˜ IÏ·Ú¿˜ Ifi˜ EÚ˘ıÚ¿˜ Ifi˜ ·ÚˆÙ›Ùȉ·˜ Ifi˜ EBV Ifi˜ CMV Ifi˜ ŒÚËÙ· Ifi˜ RSV Ifi˜ HIV Ifi˜ AÓÂÌ¢ÏÔÁÈ¿˜ Ifi˜ H·Ù›Ùȉ·˜ Ifi˜ ¶ÔÏ˘ÔÌ˘ÂÏ›Ùȉ·˜ Ifi˜ A‰ÂÓÔ˚fi˜ Ifi˜ °Ú›˘

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OÈ ÈÔ ÁÓˆÛÙÔ› Ì˯·ÓÈÛÌÔ› ›ӷÈ: 1) Ë ÙÚÔÔÔ›ËÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·, Î·È (2) Ë Î·Ù·ÛÙÚÔÊ‹ ‹ ı·Ó¿ÙˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

H ηٷÛÙÚÔÊ‹ ‹ ı·Ó¿ÙˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÂÈÙ˘Á¯¿ÓÂÙ·È: (·) Ì ÙËÓ ¿ÌÂÛË Ïԛ̈ÍË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‹ ÙˆÓ ÌÔÓÔ˘Ú‹ÓˆÓ Ê·ÁÔ΢ÙÙ¿ÚˆÓ (Èfi˜ ÈÏ·Ú¿˜, ΢ÙÙ·ÚÔÌÂÁ·ÏÔÈfi˜ (CMV), Èfi˜ Epstein Barr (EBV), Èfi˜ ÈÓÊÏÔ˘¤ÓÙ˙·˜ Î·È Ô ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜). (‚) Ì ÙËÓ ·Ú·ÁˆÁ‹ ·ıÔÏÔÁÈÎÒÓ ÚˆÙÂ˚ÓÒÓ ‹ ‰È·Ï˘ÙÒÓ Ô˘ÛÈÒÓ, (Á) Ì ÙËÓ ·ÚÂÌfi‰ÈÛË ·Ú·ÁˆÁ‹˜ ‹ ‰Ú¿Û˘ ÂÓ˙‡ÌˆÓ Ô˘ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘ (Èfi˜ ÔÏ˘ÔÌ˘ÂÏ›Ùȉ·˜, ·‰ÂÓÔ˚fi˜), Î·È (‰) Ì ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÂÓ‰Ô΢ÙÙ¿ÚÈˆÓ Û¯ËÌ·ÙÈÛÌÒÓ (Ï˘ÛÔۈ̿وÓ) Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ı·Ó·ÙËÊfiÚˆÓ ÂÓ˙‡ÌˆÓ.

B·ÎÙËÚ›‰È· OÚÈṲ̂ӷ ‚·ÎÙËÚ›‰È· fiˆ˜ Ô ™ÙÚÂÙfiÎÔÎÎÔ˜, Ù· M˘ÎÔ‚·ÎÙËÚ›‰È· º˘Ì·Ù›ˆÛ˘ Î·È §¤Ú·˜, Ë BÚԢΤÏÏ·, Ë ÛÂÈÚÔ¯·›ÙË, ηٷÛÙ¤ÏÏÔ˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›· Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂΉ‹ÏˆÛË ‰Â˘ÙÂÚÔ·ıÒÓ ÏÔÈÌÒÍÂˆÓ ‹ ÙËÓ ·Ó·˙ˆ‡ÚˆÛË Ï·Óı¿ÓÔ˘Û·˜ Ïԛ̈͢. X·Ú·ÎÙËÚÈÛÙÈο ·Ú·‰Â›ÁÌ·Ù· Â›Ó·È Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ·ÓÙ›‰Ú·Û˘ ÂÈ‚Ú·‰˘ÓÔ̤Ó˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ Û ¿ÙÔÌ· Ì ‚·ÚÈ¿ Ê˘Ì·Ù›ˆÛË ‹ ϤÚ·, Ë ·Ó¿Ù˘ÍË Ó¢ÌÔÓÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ Â› ‰¿ÊÔ˘˜ Ê˘Ì·Ù›ˆÛ˘ Î·È Ë ·Ó·˙ˆ‡ÚˆÛË Ï·Óı¿ÓÔ˘Û·˜ Ê˘Ì·Ù›ˆÛ˘ ÌÂÙ¿ ·fi ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË.

H ηٷÛÙÔÏ‹ ·˘Ù‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ ÔÊ›ÏÂÙ·È ÛÙË ‰È·Ù·Ú·¯‹ ΢ÎÏÔÊÔÚ›·˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ Ô‰Ô‡˜, ÛÙË ÌË Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ (M. §¤Ú·˜), Î·È ÛÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ê·ÁÔ΢ÙÙ¿ÚˆÓ (Â͈ÙÔ͛Ә ÛÙÚÂÙÔÎfiÎΈÓ).

EÎÙfi˜ fï˜ ·fi ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤¯Ô˘Ì ‰È·Ù·Ú·¯‹ Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜. ŒÙÛÈ, ‰È¿ÊÔÚ· ÌÈÎÚfi‚È· Â›Ó·È ‰˘Ó·ÙfiÓ Â›Ù ӷ ηٷÛÙ›ÏÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ B ΢ÙÙ¿ÚˆÓ Â›Ù ӷ ÚÔηϤÛÔ˘Ó ÔÏ˘ÎψÓÈ΋ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ B ΢ÙÙ¿ÚˆÓ ¯ˆÚ›˜ fï˜ ÙËÓ ·Ú·ÁˆÁ‹ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (.¯ M. §¤Ú·˜) Ì ·ÔÙ¤ÏÂÛÌ· Î·È ¿ÏÈ ÙËÓ ÂΉ‹ÏˆÛË ‰Â˘ÙÂÚÔ·ıÒÓ ÏÔÈÌÒ͈Ó.

IÔ› OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÈÔ› Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÚÔηÏÔ‡Ó ·ÓÔÛÔηٷÛÙÔÏ‹ Ì ‰È¿ÊÔÚÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜.

TÔ ÎÏÈÓÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÌÔχÓÔÓÙ·È Î·È Î·Ù·ÛÙÚ¤ÊÔÓÙ·È, ΢ڛˆ˜ fï˜ ·fi ÙË ÏÂÈÙÔ˘ÚÁ›· ·˘ÙÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ. K·Ù·ÛÙÚÔÊ‹ Û¯Â-

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°Ú·Ùfi ™˘ÌfiÛÈÔ

ÙÈο Ï›ÁˆÓ ΢ÙÙ¿ÚˆÓ Ô˘ fï˜ ¤¯Ô˘Ó ÂÍÂȉÈÎÂ˘Ì¤ÓË ÏÂÈÙÔ˘ÚÁ›·, ÌÔÚ› Ó· ·ÂÈÏ‹ÛÂÈ ÙËÓ ›‰È· ÙË ˙ˆ‹.

O ÙÚÔÈÛÌfi˜ ÙÔ˘ ÈÔ‡ Î·È Ô ˘Ô‰Ô¯¤·˜ ÙÔ˘ ΢ÙÙ¿ÚÔ˘, Ì ÙÔÓ ÔÔ›Ô Û˘Ó‰¤ÂÙ·È Ô Èfi˜ Â›Ó·È ÔÈ Î·ıÔÚÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂͤÏÈÍË Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ›ˆÛ˘. O Èfi˜ Epstein-Barr ¯ÚËÛÈÌÔÔÈ› ÙÔÓ C3b ˘Ô‰Ô¯¤· (CR2) Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÌË ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ·fi ÙÔ ·ÓÔÛÔ·ÙÙ·ÚÔ Î·È ÙËÓ ÌË ÂͤÏÈÍË Ù˘ ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘. O Èfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV) ¯ÚËÛÈÌÔÔÈ› ÙÔÓ CD4 ˘Ô‰Ô¯¤· ÁÈ· Ó· ÂÈÛ¤ÏıÂÈ ÛÙ· ÌÔÏ˘Ṳ̂ӷ ·ÙÙ·Ú·ÛÙfi¯Ô˘˜ ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. AÊÔ‡ ÂÈÛ¤ÏıÂÈ ÛÙÔ Î‡ÙÙ·ÚÔ, Ô Èfi˜ ÌÔÚ› Ó· ÙÔ ÛÎÔÙÒÛÂÈ Ì ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜.

OÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÚÔηÏÔ‡Ó ÔÈ ‰È¿ÊÔÚÔÈ ÈÔ› ›ӷÈ: - O˘‰ÂÙÂÚÔÂÓ›· Ô˘ ÙËÓ ÚÔηÏÔ‡Ó Ô Èfi˜ Ù˘ ÁÚ›˘, Ù˘ Ë·Ù›Ùȉ·˜ A, B Î·È C, Ù˘ ÈÏ·Ú¿˜, ÂÚ˘ıÚ¿˜, ·ÚˆÙ›Ùȉ·˜, Ô ·‰ÂÓÔ˚fi˜, Ô CMV, EBV, Coxsackie A21, Î·È Ô Èfi˜ HIV. OÈ ÈÔ› ·˘ÙÔ› ÚÔÛ‚¿ÏÏÔ˘Ó Î·È Î·Ù·ÛÙÚ¤ÊÔ˘Ó Ù· ÒÚÈÌ· ·ÙÙ·Ú· ›Ù ¿ÌÂÛ· (΢ÙÙ·ÚÔÙÔÍÈ΋ ‰Ú¿ÛË ÙˆÓ ÈÒÓ) ‹ ̤ۈ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ‹ Ù¤ÏÔ˜ ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™˘Ó‹ıˆ˜ Ë Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È ÂÏ·ÊÚ¿ Î·È ·ÚÔ‰È΋, Û¿ÓÈ· Â›Ó·È ‚·ÚÈ¿, Ì ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ‰Â˘ÙÂÚÔ·ıÒÓ ÌÈÎÚÔ‚È·ÎÒÓ ÏÔÈÌÒ͈Ó, ÏfiÁˆ ·ÊÂÓfi˜ ÌÂÓ ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ÙˆÓ ·Ó·ÙÔÌÈÎÒÓ ÊÚ·ÁÌÒÓ ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ Î·È ·ÊÂÙ¤ÚÔ˘ Ù˘ ηٷÛÙÔÏ‹˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜, Ô˘ ÚÔηÏÔ‡Ó ÔÈ ÈÔ›.

- EÏ¿ÙÙˆÛË Ù˘ ·ÓÙ›‰Ú·Û˘ ÂÈ‚Ú·‰˘ÓfiÌÂÓ˘ ¢·ÈÛıËÛ›·˜, ÙËÓ ÔÔ›· ÚÔηÏÔ‡Ó ÔÈ ‚ÏÂÓÔ˚Ô› (Èfi˜ Ù˘ ÈÏ·Ú¿˜, ÂÚ˘ıÚ¿˜, ·ÚˆÙ›Ùȉ·˜, ÁÚ›˘ Î·È ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜) Ô CMV Î·È Ô EBV. O οı Èfi˜ fï˜, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ Û˘Ó¤¯ÂÈ· ¤¯ÂÈ ÙËÓ ‰È΋ ÙÔ˘ ÛÙÚ·ÙËÁÈ΋ ̤ۈ Ù˘ ÔÔ›·˜ ÚÔηÏ› ÙËÓ ·ÓÔÛÔηٷÛÙÔÏ‹ ÛÙÔÓ ÍÂÓÈÛÙ‹. ™˘ÁÎÂÎÚÈ̤ӷ: (·) O Èfi˜ CMV ÌÔχÓÂÈ Ù· ÌÔÓÔ·ÙÙ·Ú·, ηٷÛÙ¤ÏÏÂÈ ÙË ‰È·‰Èηۛ· Ù˘ ·ÚÔ˘Û›·Û˘ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ (Ag), ηٷÛÙ¤ÏÏÂÈ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ÈÓÙÂÚÏ¢ΛÓ˘ (IL-1), ηٷÛÙ¤ÏÏÂÈ ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ê˘ÛÈÎÒÓ ÊÔÓ¤ˆÓ (Natural Killer cells, NK) Î·È ÚÔηÏ› ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ÈÓÙÂÚÊÂÚfiÓ˘-Á (INFÁ) ·fi Ù· ÌÔÏ˘Ṳ̂ӷ ·ÙÙ·Ú·. H ·ÎÚÈ‚‹˜ Â›‰Ú·ÛË ÙÔ˘ ÈÔ‡ ÛÙ· T ÏÂÌÊÔ·ÙÙ·Ú· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, ·Ó Î·È ¤¯ÂÈ ·Ô‰Âȯı› Ë ·ÚÔ˘Û›· ÙÔ˘ ÛÙ· CD4+. (‚) O Èfi˜ EBV ηٷÛÙ¤ÏÏÂÈ ÙfiÛÔ ÙËÓ Î˘ÙÙ·ÚÈ΋ fiÛÔ Î·È ÙËÓ ¯˘ÌÈ΋ ·ÓÔÛ›·. H Â›‰Ú·ÛË ÙÔ˘ ÈÔ‡ ÛÙ· T ÏÂÌÊÔ·ÙÙ·Ú· Î·È Â‰Ò ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ ·Ó Î·È ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4+ Î·È ·‡ÍËÛË ÙˆÓ CD8+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ

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ÌË ÈηÓÔÔÈËÙÈ΋ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ·fi Ù· B ÏÂÌÊÔ·ÙÙ·Ú·. ¶ÚÔηÏ› ÙÔÓ ÌÂÙ·Û¯ËÌ·ÙÈÛÌfi ÙˆÓ B ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ù· ÔÔ›· Î·È ·˘ÙÔ-‰È·ÈˆÓ›˙ÔÓÙ·È.

EӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ¿ÙÔÌ· Ô˘ ¿Û¯Ô˘Ó ·fi ÙÔ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ. T· ¿ÚÚÂÓ· ¿ÙÔÌ· Ô˘ ʤÚÔ˘Ó ÙÔ ·ıÔÏÔÁÈÎfi ÁÔÓ›‰ÈÔ, Â›Ó·È Â˘·›ÛıËÙ· ÛÙËÓ Ïԛ̈ÍË ·fi ÙÔÓ Èfi EBV Î·È fiÙ·Ó ÚÔÛ‚ÏËıÔ‡Ó ·fi ÙÔÓ Èfi, ·Ó·Ù‡ÛÛÔ˘Ó ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Î·È Ì¿ÏÈÛÙ· ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·. ŒÓ· ÌÈÎÚfi ÔÛÔÛÙfi ÂΉËÏÒÓÂÈ Ï¤Ìʈ̷ Ù‡Ô˘ Burkitt. (Á) O Èfi˜ HIV ÚÔηÏ› ‰È·Ù·Ú·¯¤˜ Û ÌÈ· ÛÂÈÚ¿ ·ÓÔÛÔ΢ÙÙ¿ÚˆÓ fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 2. (‰) O Èfi˜ Ù˘ ÈÏ·Ú¿˜ ÚÔηÏ› ‰È·Ù·Ú·¯‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜. H ‰È·Ù·Ú·¯‹ ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙË Û‡Ó‰ÂÛË ÙÔ˘ ÈÔ‡ Ì ٷ T ÏÂÌÊÔ·ÙÙ·Ú· Ì ·ÔÙ¤ÏÂÛÌ· ·˘Ù¿ Ó· ÌËÓ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È. (Â) O Èfi˜ Ù˘ ÂÚ˘ıÚ¿˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂȈ̤ÓË ·¿ÓÙËÛË ÛÙ· ÌÈÙÔÁfiÓ·, Î·È ‰˘ÛÁ·ÌÌ·-ÚˆÙÂ˚Ó·ÈÌ›· (·˘ÍË̤ӷ Â›‰· IgM, ¯·ÌËÏ¿ Â›‰· IgA, Î·È Î·ı˘ÛÙ¤ÚËÛË ÂÌÊ¿ÓÈÛ˘ Ù˘ IgG). (ÛÙ) O ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ ÚÔηÏ› ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ ·ÓÙ·ÁˆÓÈÛÙ‹ Ù˘ IL-1 ·fi Ù· ÌÔÓÔ·ÙÙ·Ú· Ôχ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ IL-1 Î·È ·˘Ùfi ·ÎÔÏÔ‡ıˆ˜ ÚÔηÏ› ÙËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ.

§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

OÈ ·ÛıÂÓ›˜ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÙÔ˘˜ ·Ú·¿Óˆ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, Ô˘ ÚÔηÏÔ‡Ó ·ÓÔÛÔηٷÛÙÔÏ‹, ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ Ïԛ̈͢ Î·È Ì¤¯ÚÈ Ó· ·ÔηٷÛÙ·ı› Ï‹Úˆ˜ Ë Î˘ÙÙ·ÚÈ΋ Î·È ¯˘ÌÈ΋ ÙÔ˘˜ ·ÓÔÛ›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› οÔÈ· ‰Â˘ÙÂÚÔ·ı‹˜ Ïԛ̈ÍË (Ó¢ÌÔÓÈ΋ ·ÛÂÚÁ›ÏψÛË Â› ‰¿ÊÔ˘˜ Ê˘Ì·Ù›ˆÛ˘), ‹ ·Ó·˙ˆ‡ÚˆÛË ÚÔ¸¿Ú¯Ô˘Û·˜ Ïԛ̈͢ (·Ó·˙ˆ‡ÚˆÛË Ï·Óı¿ÓÔ˘Û·˜ Ê˘Ì·Ù›ˆÛ˘ ÌÂÙ¿ ·fi ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË). H ·ÓÙÈÌÂÙÒÈÛË Á›ÓÂÙ·È Ì ·ÓÙÈÌÈÎÚԂȷο, ·ÓÙÈÈο Ê¿Ú̷η Î·È ¯ÔÚ‹ÁËÛË ÎÔÈÓ‹˜ ‹ ÂȉÈ΋˜ ˘ÂÚ·ÓfiÛÔ˘ Á-ÛÊ·ÈÚ›Ó˘, fiÔ˘ Â›Ó·È ··Ú·›ÙËÙ·.

E›Û˘, ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ïԛ̈͢ Î·È ÁÈ· ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¿ÚÛË Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ ‰ÂÓ ¯ÔÚËÁԇ̠ÂÌ‚fiÏÈ· Ô˘ ÂÚȤ¯Ô˘Ó ˙ˆÓÙ·ÓÔ‡˜ ÂÍ·ÛıÂÓË̤ÓÔ˘˜ ÈÔ‡˜. ŸÙ·Ó ·Ú·ÛÙ› ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛ˘ ¿ÏÏˆÓ ÂÌ‚ÔÏ›ˆÓ, ÂÎÙfi˜ ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ, ı· Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ì fiÙÈ Ë ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ‰ÂÓ Â›Ó·È Ôχ ηϋ Î·È ÁÈ' ·˘Ùfi ›Ûˆ˜ ¯ÚÂÈ·Ûı› Ó· Â·Ó·Ï¿‚Ô˘Ì ̛· Â› ϤÔÓ ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ·ÚÁfiÙÂÚ·, ·ÊÔ‡ ÚÔËÁÔ˘Ì¤Óˆ˜ ÚÔÛ‰ÈÔÚ›ÛÔ˘Ì ÙÔÓ Ù›ÙÏÔ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ÂÚÈ›¯Â ÙÔ ÂÌ‚fiÏÈÔ.

¶›Ó·Î·˜ 2. ∞ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÚÔηÏ› Ô Èfi˜ HIV.

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§ÔÈÌÒÍÂȘ Î·È ¿ÓÔÛ˜ ΢ÙÙ·ÚÔÂӛ˜ MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘-MÂÙ·Í¿ OÈ ÏÔÈÌÒÍÂȘ, ‚·ÎÙËÚȷΤ˜ ‹ ÈÔÁÂÓ›˜, Ì˘ÎËÙÈ·ÛÈΤ˜ ‹ ÚˆÙÔ˙ˆÈΤ˜ ÚÔηÏÔ‡Ó Ì ‰È¿ÊÔÚÔ˘˜ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, ÔÈΛϘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi.

MÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·ıÔÁÂÓÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Âͤ¯Ô˘Û· ı¤ÛË Î·Ù¤¯ÂÈ Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·fi ÙË Ïԛ̈ÍË Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚfiÎÏËÛË ·Ó·ÈÌ›·˜, Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‹ ıÚÔÌ‚ÔÂÓ›·˜ ·ÓfiÛÔ˘ Ù‡Ô˘. §ÔÈÌÒÍÂȘ Î·È ·Ó·ÈÌ›· ¿ÓÔÛÔ˘ Ù‡Ô˘ OÈ ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ì ÙËÓ ÎÈÓËÙÔÔ›ËÛË ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·È ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ ıÂÚÌÔ‡ ‹ „˘¯ÚÔ‡ Ù‡Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. T· IgG ·ÓÙÈÛÒÌ·Ù· (ıÂÚÌÔ‡ Ù‡Ô˘) ÛÙÚ¤ÊÔÓÙ·È Û˘Ó‹ıˆ˜ (70%) ÂÓ·ÓÙ›ÔÓ ÂÓfi˜ ·fi Ù· ·ÓÙÈÁfiÓ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ RH ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È Â›Ó·È ÂΛӷ Ô˘ ··ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙȘ ·ÈÌÔÏ˘ÙÈΤ˜ ·Ó·È̛˜ ÏÔÈÌÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜.

OÈ ÈÔ› EB, ÈÏ·Ú¿˜, ÈÓÊÏÔ˘¤ÓÙ˙·˜ ÚÔηÏÔ‡Ó ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ì ÙËÓ ·Ú·ÁˆÁ‹ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ („˘¯ÚÔ‡ Ù‡Ô˘). EȉÈο Ô Èfi˜ EB, ÚÔηÏ› ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· ¿ÓÔÛÔ˘ Ù‡Ô˘ Û ÔÛÔÛÙfi 3% ÙˆÓ ÚÔÛ‚ÏËı¤ÓÙˆÓ ·ÛıÂÓÒÓ Î·È Ù· IgM ·ÓÙÈÛÒÌ·Ù· ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ i ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ. O Èfi˜ ÈÓÊÏÔ˘¤ÓÙ˙·˜ fiˆ˜ Î·È ÔÍ›˜ ‚·¶›Ó·Î·˜ 1. §ÔÈÌÒÍÂȘ Î·È ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·.

IÔ› IÏ·Ú¿˜ E.B. CMV Coxsackie AÓÂÌ¢ÏÔÁÈ¿˜ ŒÚËÙ· ˙ˆÛÙ‹Ú· AÏÔ‡ ¤ÚËÙ· H·Ù›Ùȉ·˜ HIV Influenza M˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ EÏÔÓÔÛ›·

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ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÛÙ· ·È‰È¿ ÚÔηÏÔ‡Ó ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ì ÙËÓ ·Ú·ÁˆÁ‹ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ T ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ. TÔ ·ÓÙÈÁfiÓÔ T ‚Ú›ÛÎÂÙ·È Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓ ÂÚ˘ıÚÒÓ Î·È ÂÓÂÚÁÔÔÈÂ›Ù·È ·fi ÙËÓ Ó¢ڷÌÈÓȉ¿ÛË Ô˘ ÂÎÎÚ›ÓÂÙ·È ·fi ÔÚÈṲ̂ÓÔ˘˜ ÈÔ‡˜ fiˆ˜ Ë ÈÓÊÏÔ˘¤ÓÙ˙· Î·È ‚·ÎÙËÚ›‰È· fiˆ˜ ÙÔ ÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ.

TÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ÚÔηÏ› Û ÔÛÔÛÙfi 30%-70%, ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ì ÙËÓ ·Ú·ÁˆÁ‹ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ I ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ. TÔ ·ÓÙÈÁfiÓÔ I Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÛÈ·ÏÈÎÔ‡ ÔͤԘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ˘Ô‰Ô¯¤·˜ ÁÈ· ÙÔ Ì˘ÎfiÏ·ÛÌ· Î·È Ù· IgM ·ÓÙÈÛÒÌ·Ù· ηÙ¢ı‡ÓÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ·˘ÙÔ‡ ˘Ô‰Ô¯¤· ÙÔ˘ ÂÚ˘ıÚÔ‡ ·ÈÌÔÛÊ·ÈÚ›Ô˘ ηıÈÛÙÒÓÙ·˜ ÙÔ ·ÓÔÛÔÁfiÓÔ. H ·Ó·ÈÌ›· ÂÌÊ·Ó›˙ÂÙ·È 2-3 ‚‰ÔÌ¿‰Â˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Î·È ‰È·ÚΛ 3-4 Ì‹Ó˜ ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ. ¢Â˘ÙÂÚÔ·ı‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· ¿ÓÔÛÔ˘ Ù‡Ô˘ ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ÏÔÈÌÒÍÂˆÓ ·fi ÙÔÓ Èfi Parvo B19, ÙÔÓ EB, fiˆ˜ Î·È ·fi ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ¶ÚÔηÏÂ›Ù·È ÏfiÁˆ ·Ó¿Ù˘Í˘ Î·È ÂÌÊ¿ÓÈÛ˘ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙˆÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ. T· ·ÓÙÈÁfiÓ· ÙˆÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ ηٷٿÛÛÔÓÙ·È Û 6 ·ÚȘ

AÓÙÈÛÒÌ·Ù· IgG IgM + + + + + + + + ?

+

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AÓÙÈÁfiÓ· EÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ i RH RH RH RH RH RH I, I, Lu, E, K...

T I RH

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§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

ÔÌ¿‰Â˜ ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·ÓÙÈÁfiÓ· NA Î·È NB (™‡ÛÙËÌ· "N").

AӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ Ô Èfi˜ Parvo B19 ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Ì ÙËÓ ·Ú·ÁˆÁ‹ IgM ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Û ÓÂÔÁÓ¿ Î·È ˘ÁÈ‹ ¿ÙÔÌ·.

H Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È ÂÚÈÊÂÚÈÎÔ‡ Ù‡Ô˘, ‰È¿ÚÎÂÈ·˜ ÂÚ›Ô˘ 12 ÌËÓÒÓ, Û˘Ó‹ıˆ˜ ηϋ˜ ÚfiÁÓˆÛ˘. ™ÙÔÓ ÔÚfi ÙÔ˘ ·ÛıÂÓ‹ ·Ó¢ڛÛÎÔÓÙ·È Ì ‰È¿ÊÔÚ˜ Ù¯ÓÈΤ˜ ·ÓÙÈÏ¢ÎÔ΢ÙÙ·ÚÈο ·ÓÙÈÛÒÌ·Ù· Ù· ÔÔ›· ÂȂ‚·ÈÒÓÔ˘Ó ÙË ‰È¿ÁÓˆÛË. ¢Â˘ÙÂÚÔ·ı‹˜ ıÚÔÌ‚ÔÂÓ›· ·ÓfiÛÔ˘ Ù‡Ô˘ ¶ÏËıÒÚ· ·ıÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Î·È ÔÈ ÏÔÈÌÒÍÂȘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ‰Â˘ÙÂÚÔ·ı‹ ıÚÔÌ‚ÔÂÓ›· ·ÓfiÛÔ˘ Ù‡Ô˘.

EÓÔ¯ÔÔÈÔ‡ÓÙ·È ÈÔÁÂÓ›˜, ‚·ÎÙËÚȷΤ˜, ÚˆÙÔ˙ˆÈΤ˜ Î·È Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ (¶›Ó·Î·˜ 2).

OÈ ÙÔ͛Ә ‹ ÔÈ ÈÔ› ÂȉÚÔ‡Ó ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÙÚÔÔÔÈÒÓÙ·˜ ÙȘ ÚˆÙÂ˚ÓÈΤ˜ Ô˘Û›Â˜ Ù˘ ÌÂÌ‚Ú¿Ó˘ II‚ Î·È III· Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ͤÓ˜ ÚÔ˜ ÙÔÓ ÔÚÁ·ÓÈÛÌfi Ô˘Û›Â˜ Î·È Ó· ·Ú¿ÁÔÓÙ·È ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·˘ÙÒÓ ·ÈÌÔÂÙ·-

¶›Ó·Î·˜ 2. ¢Â˘ÙÂÚÔ·ı‹˜ A˘ÙÔ¿ÓÔÛË £ÚÔÌ‚ÔÂÓ›·.

A›ÙÈ· ñ IÔ›: E.B, CMV, AÓÂÌ¢ÏÔÁÈ¿˜, ŒÚËÙ· ˙ˆÛÙ‹Ú·, ¶·ÚˆÙ›Ùȉ·˜, IÏ·Ú¿˜, EÚ˘ıÚ¿˜, HIV, ParvoB19 ñ TÔÍÔÏ¿Û̈ÛË ñ B·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ (BÚԢΤÏψÛË) ñ ¶ÚˆÙÔ˙ˆÈΤ˜ ÏÔÈÌÒÍÂȘ (EÏÔÓÔÛ›·) ñ M‡ÎËÙ˜ Ï›ˆÓ ·ÏÏ¿ Î·È ÂÓ·ÓÙ›ÔÓ ¿ÏÏˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÈÌÔÂÙ·Ï›ˆÓ (™Ù·˘ÚÔÂȉ‹˜ ·ÓÙ›‰Ú·ÛË). ŸÌˆ˜, Â›Ó·È ‰˘Ó·ÙfiÓ Ô ›‰ÈÔ˜ ÏÔÈÌÔÁfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜ Ó· ‰Ú· Û·Ó ·ÓÙÈÁfiÓÔ Î·È Ó· ‰ÂÛ̇ÂÙ·È ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. T· ·Ú·ÁfiÌÂÓ· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ ÙÔ˘ Û˘ÌÏfiÎÔ˘ "ÏÔÈÌÔÁfiÓÔ˜ ·Ú¿ÁˆÓ- ·ÈÌÔÂÙ¿ÏÈÔ", ÚÔηÏÒÓÙ·˜ ‚Ï¿‚Ë ÙÔ˘ ·ÈÌÔÂÙ·Ï›Ô˘, ·ÔÌ¿ÎÚ˘ÓÛË Î·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘. ¢ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, ·Ó Î·È ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÁÈ·Ù› ÔÚÈṲ̂ÓÔÈ ·ÛıÂÓ›˜ ·Ú¿ÁÔ˘Ó ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο ·ÓÙÈÛÒÌ·Ù· ÌÂÙ¿ ·fi Ïԛ̈ÍË.

H ‰Â˘ÙÂÚÔ·ı‹˜ ıÚÔÌ‚ÔÂÓ›· Â›Ó·È Û˘Ó‹ıˆ˜ ·ÚÔ‰È΋ Î·È ÂϤÁ¯ÂÙ·È fiÙ·Ó ÂÏÂÁ¯ı› Î·È Ë Ïԛ̈ÍË Ô˘ ÙËÓ ÚÔοÏÂÛÂ.

IÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È Î·ÚΛÓÔ˜ ÛÙÔÓ ¿ÓıÚˆÔ NÈÎfiÏ·Ô˜ °ÔÌ¿Î˘ H Û¯¤ÛË ÙˆÓ ÈÒÓ Ì ÙÔÓ Î·ÚΛÓÔ ¤¯ÂÈ ¤Ó· Ôχ Ì·ÎÚ‡ ÈÛÙÔÚÈÎfi. H ¤Ú¢ӷ ÁÈ· ÙËÓ ÔÁÎÔÁfiÓÔ ‰Ú¿ÛË ÙˆÓ ÈÒÓ ÍÂΛÓËÛ ÛÙËÓ ·Ú¯‹ ÙÔ˘ ·ÈÒÓ· Ì·˜ Ì ÌÂϤÙ˜ ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ·. H ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ÁÈ· ‰È·ÊfiÚÔ˘˜ ÏfiÁÔ˘˜ ‰ÂÓ ·ÍÈÔÏfiÁËÛ ٷ ·Ú¯Èο Â˘Ú‹Ì·Ù· Î·È ¯¿ıËΠÔχÙÈÌÔ˜ ¯ÚfiÓÔ˜ ÁÈ· ·ÚÎÂÙ¤˜ ‰ÂηÂٛ˜. O Èfi˜ Epstein-Barr (E-B) Â›Ó·È Ô ÚÒÙÔ˜ Èfi˜ Ô˘ Û˘Ó‰¤ıËΠÙÔ 1964 Ì ÙÔ Ï¤Ìʈ̷ Burkitt ÛÙÔÓ ¿ÓıÚˆÔ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì ÙÔÓ ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ηÚΛÓÔ Î·È ÌÈ· ÏÂÈ¿‰· ¿ÏÏˆÓ Î·ÎÔËıÂÈÒÓ ÂȉÈο Û ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜. °È· ÙËÓ Ë·Ù›Ùȉ· B ˘‹Ú¯·Ó ˘Ô„›Â˜ fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ ‹·ÙÔ˜ ·fi ÙÔ 1940 ·ÏÏ¿ ÌfiÓÔ ÌÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë ÙˆÓ ÂȉÈÎÒÓ ‰ÂÈÎÙÒÓ Ù˘ ÌfiÚÂÛ ӷ ·Ô‰Âȯı› Ô Û˘Û¯ÂÙÈÛÌfi˜ ·˘Ùfi˜. °È· ÙËÓ Ë·Ù›Ùȉ· C Î·È ÙÔÓ Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ, ÚÔ˜ ÙÔ ·ÚfiÓ, ˘¿Ú¯Ô˘Ó ÌfiÓÔ ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›·.

TÔ 1980 ·Ó·Î·Ï‡ÊıËÎÂ Ô ÚÂÙÚÔ˚fi˜ Ù‡Ô˜ I Î·È Û Ôχ ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Û˘Û¯ÂÙ›ÛıËΠ̠ÙËÓ T-Ï¢¯·ÈÌ›· ÙˆÓ ÂÓËÏ›ÎˆÓ ÂÓÒ ÔÈ ÈÔ› ÙÔ˘ ·ÓıÚˆ›ÓˆÓ ıËψ̿وÓ, ÂȉÈο ÔÈ "˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘" Ù‡ÔÈ

16 Î·È 18, Û˘Ó‰¤ıËÎ·Ó Ì ÙÔÓ Î·ÚΛÓÔ Ù˘ Ì‹ÙÚ·˜ ÙÔ 1983 Î·È Ù¤ÏÔ˜, ÌfiÏȘ ÙÔ 1994, Ô ·ÓıÚÒÈÓÔ˜ ÂÚËÙÔ˚fi˜ 8 Û˘Ó‰¤ıËΠ̠ÙÔ Û¿ÚΈ̷ Kaposi. OÚÈṲ̂ÓÔÈ ÈÔ› Ô˘ Â›Ó·È ¤ÓÙÔÓ· ηÚÎÈÓÔÁfiÓÔÈ ÁÈ· Ù· ÂÈÚ·Ì·Ùfi˙ˆ·, ÚÔ˜ ÙÔ ·ÚfiÓ ‰ÂÓ Û˘Ó‰¤ÔÓÙ·È ÂȉËÌÈÔÏÔÁÈο Ì ηÚΛÓÔ ÛÙÔÓ ¿ÓıÚˆÔ. T¤ÙÔÈÔÈ ÈÔ› Â›Ó·È ÔÚÈṲ̂ÓÔÈ ·‰ÂÓÔ˚Ô› Î·È ·fi ÙÔ˘˜ ÈÔ‡˜ ÔÏ˘ÒÌ·, ÔÈ BK Î·È JC. H ÏÔÈÌ҉˘ ·ÈÙÈÔÏÔÁ›· Ù˘ ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ ÙˆÓ ·È‰ÈÒÓ ÂÈο˙ÂÙ·È ¯ˆÚ›˜ fï˜ Ó· ÌÔÚ› Ó· Û˘Ó‰Âı› ÚÔ˜ ÙÔ ·ÚfiÓ, Ì οÔÈÔÓ ÔÁÎÔÁfiÓÔ Èfi.

H Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Î·Ù¿ Ôχ „ËÏfiÙÂÚË ·fi ÙÔÓ Î·ÚΛÓÔ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·˘Ù¤˜, Èı·ÓfiÓ ÁÈ·Ù› ÔÈ ÈÔ› ·Ê' ·˘ÙÒÓ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Ï‹ÚË Î·ÎÔ‹ıÂÈ·. OÈ ÂȉËÌÈÔÏfiÁÔÈ ÂÎÙÈÌÔ‡Ó fiÙÈ ÁÈ· Ó· ·Ó·Ù˘¯ı› ÌÈ· ηÎÔ‹ıÂÈ· ÛÙÔÓ ¿ÓıÚˆÔ ··ÈÙÔ‡ÓÙ·È 4-6 ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ΢ڛˆ˜ Â›Ó·È ÌÂÙ·ÏÏ¿ÍÂȘ. H Ïԛ̈ÍË ·fi ÙÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜ ÌÔÚ› Ó· Â›Ó·È ÙÔ ÚÒÙÔ ‹ ÙÔ Ôχ ÙÔ ‰Â‡ÙÂÚÔ ‚‹Ì· ·˘Ù‹˜ Ù˘ ‰È·‰Èηۛ·˜ Î·È Á›ÓÂÙ·È ¿ÏÈ Ì ÌÂÙ¿ÏÏ·ÍË. H ıˆڛ· fiÙÈ Ô

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°Ú·Ùfi ™˘ÌfiÛÈÔ

ηÚΛÓÔ˜ Â›Ó·È ÈÔ Û˘¯Ófi˜ Û ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÓÔÛ›·˜, ÂȉÈο Ù˘ ΢ÙÙ·ÚÈ΋˜, ÏËÓ ÂÏ·¯›ÛÙˆÓ ÂÍ·ÈÚ¤ÛˆÓ, ‚Ú›ÛÎÂÈ ÂÊ·ÚÌÔÁ‹ ÛÙÔÓ Î·ÚΛÓÔ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. E˘Ú‹Ì·Ù· fiˆ˜ Ë ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ηÚΛÓÔ˘ ·fi ÚÂÙÚÔ˚Ô‡˜ Î·È ¿ÏÏÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜ (ÔÈ ÈÔ› ÔÏ˘ÒÌ·) Î·È Ë ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ‰È·Ù·Ú·¯‹˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ (AIDS, ÌÂÙ·ÌfiÛ¯Â˘ÛË ÔÚÁ¿ÓˆÓ) Û ÌÈ· ÔÈÎÈÏ›· ηÚΛӈÓ, ÂÓÈÛ¯‡Ô˘Ó ·˘Ù‹ ÙËÓ ¿Ô„Ë.

T· ηÚÎÈÓÈο ·ÙÙ·Ú· Â›Ó·È ÁÂÓÂÙÈο ÌÂÙ·ÏÏ·Á̤ӷ Î·È ·˘Ùfi ÌÔÚ› Ó· Á›ÓÂÈ Â›Ù ¿ÌÂÛ· ›Ù ¤ÌÌÂÛ· Ì ÙËÓ ·ÚÂÌ‚ÔÏ‹ ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó. A¢ı›·˜, ÔÈ ÔÁÎÔÁfiÓÔÈ ÈÔ› ÚÔÛ‚¿ÏÔ˘Ó ÙȘ Úfi‰ÚÔ̘ ÌÔÚʤ˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÚÔÔÚ›˙ÔÓÙ·È Ó· Á›ÓÔ˘Ó Î·ÚÎÈÓÈο Î·È ÙÔ ÁÔÓȉ›ˆÌ¿ ÙÔ˘˜ (‹ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÌ‹Ì· ÙÔ˘) ·Ú·Ì¤ÓÂÈ Â›ÌÔÓ· ̤۷ Û ·˘Ù¿. TÔ DNA ÙÔ˘ ÈÔ‡ ‹ Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘, ÔÈ ÈÔ˚Τ˜ ÚˆÙ½Ó˜ ÌÔÚ› Ó· ÂÓÂÚÁÔÔÈ‹ÛÔ˘Ó Ù· ÔÁÎÔÁÔÓ›‰È·, Ó· ‰È·Ù·Ú¿ÍÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÔÁÎÔηٷÛÙ·ÏÙÈÎÒÓ ÁÔÓȉ›ˆÓ ‹ Ó· ·Ó·ÛÙ›ÏÔ˘Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ ı¿Ó·ÙÔ ÙˆÓ Î˘ÙÙ¿ÚˆÓ (ÙËÓ ·fiÙˆÛË) ÎÈ ¤ÙÛÈ Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ·Ó¿Ù˘ÍË Î·ÚΛÓÔ˘. ™ÙÔÓ Ì˯·ÓÈÛÌfi ¤ÌÌÂÛ˘ ηÚÎÈÓÔÁ¤ÓÂÛ˘ ÔÈ ›‰ÈÔÈ ÔÈ ÈÔ› ‰ÂÓ ÚÔÛ‚¿ÏÔ˘Ó Ù· ·ÙÙ·Ú· ·ÏÏ¿ ¤ÌÌÂÛ· Ì Ì˯·ÓÈÛÌÔ‡˜ fiˆ˜ Ë ‰È·Ù·Ú·¯‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ (AIDS), ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ηÎÔ‹ıÂȘ. K·È Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Ù· ÛÙÔȯ›· Â›Ó·È Î˘Ú›ˆ˜ ÂȉËÌÈÔÏÔÁÈο.

K¿ı Èfi˜ ‰È·Ê¤ÚÂÈ ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÌÔÚ› Ó· ÚÔηϤÛÂÈ Î·ÚÎÈÓÔÁ¤ÓÂÛË, ÎÔÈÓfi˜ fï˜ ‰ÚfiÌÔ˜ ÁÈ· ÙÔ˘˜ ÌÈÎÚÔ‡˜ ÔÁÎÔÁfiÓÔ˘˜ DNA ÈÔ‡˜ fiˆ˜ ·‰ÂÓÔ˚Ô‡˜, ÈÔ‡˜ ÔÏ˘ÒÌ· Î·È ÈÔ‡˜ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ Â›Ó·È Ë ·‰Ú·ÓÔÔ›ËÛË ÙˆÓ ÔÁÎÔηٷÛÙ·ÏÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ p53 Î·È ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ (RB). H ÔÁÎÔÁ¤ÓÂÛË ·fi ÚÂÙÚÔ˚Ô‡˜ Á›ÓÂÙ·È Â›Ù Ì ÂÓÂÚÁÔÔ›ËÛË Î˘ÙÙ·ÚÈÎÒÓ ÔÁÎÔÁÔÓȉ›ˆÓ ›Ù ÈÔ Û¿ÓÈ· Ì ·Ê·›ÚÂÛË Î·È ÂÓۈ̿وÛË ÛÙÔ ÁÔÓȉ›ˆÌ¿ ÙÔ˘˜ ΢ÙÙ·ÚÈÎÒÓ ÔÁÎÔÁÔÓȉ›ˆÓ. OÈ ÔÁÎÔÁfiÓÔÈ ÂÚËÙÔ˚Ô›, ·Ó Î·È ÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘˜ Â›Ó·È Ôχ ÈÔ ÌÂÁ¿ÏÔ (150 ÁÔÓ›‰È·) Û ۯ¤ÛË Ì ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ (3-10 ÁÔÓ›‰È·), ÏÂÈÙÔ˘ÚÁÔ‡Ó Ì ·ÚfiÌÔÈÔ ÙÚfiÔ ‰ÈÂÁ›ÚÔÓÙ·˜ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ·fiÙˆÛË. £· ·Ó·ÊÂÚıԇ̠ÂÓ Û˘ÓÙÔÌ›· ÛÙÔ˘˜ ÈÔ ÛËÌ·ÓÙÈÎÔ‡˜ ÁÓˆÛÙÔ‡˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜ ÙÔ˘ ·ÓıÚÒÔ˘.

ÛÌfi˜ Î·È ‚) Ë ÂÈÛ¯ÒÚËÛË ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÙÔ˘ ÈÔ‡ ÛÙÔ ÁÔÓȉ›ˆÌ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÍÂÓÈÛÙ‹.

O Èfi˜ ÂÚȤ¯ÂÈ ¤ÍÙÚ· ÔÁÎÔÁÔÓ›‰È· fiˆ˜ ÙÔ Tax ÙÔ ÔÔ›Ô ÚÔηÏ› ·ÔÚ‡ıÌÈÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ̤ۈ ·˘ÍËÙÈÎÒÓ ÁÔÓȉ›ˆÓ fiˆ˜ ÙÔ fos, Î·È Î˘ÙÙ·ÚÔÎÈÓÒÓ fiˆ˜ Ë IÓÙÂÚÏ¢ΛÓË 2 (IL-2) Î·È Ô ˘Ô‰Ô¯¤·˜ Ù˘. T· Ê˘ÛÈÔÏÔÁÈο T-ÏÂÌÊÔ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ IL-2 ÌfiÓÔ Î·Ù¿ ÙË Ì›ÙˆÛË ÂÓÒ Ù· ÌÔÏ˘Ṳ̂ӷ ·fi ÙÔÓ ÚÂÙÚÔ˚fi Ù‡Ô˘ I ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó Û˘Ó¯Ҙ ˘Ô‰Ô¯¤· Ù˘ IL-2. ™˘Ó¤ÓˆÛË ·˘Ù‹˜ Ì ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ ˘ÚÔ‰ÔÙ› Û˘Ó¯Ҙ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ÔÏÏ·Ï·ÛÈ·ÛÌfi. O ÚÂÙÚÔ˚fi˜ Ù‡Ô˘ III, Ô ÁÓˆÛÙfi˜ HIV ÚÔηÏ› ¤ÌÌÂÛ· ηÚÎÈÓÔÁ¤ÓÂÛË Èı·ÓfiÓ Ì¤Ûˆ Ù˘ ¯ÚfiÓÈ·˜ ·ÓÔÛÔηٷÛÙÔÏ‹˜ Ô˘ ÙÔÓ Û˘Óԉ‡ÂÈ. ŒÙÛÈ, ·Ó·Ê¤ÚÔÓÙ·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Û ·ÓÔÛÔ‚Ï·ÛÙÈÎfi ϤÌʈ̷, Û Hodgkin Î·È ÌË Hodgkin ÏÂÌÊÒÌ·Ù·, Û ۿÚΈ̷ Kaposi Î·È Û ηÚΛÓÔ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜ Î·È ÙÔ˘ ÚˆÎÙÔ‡ Û ·ÛıÂÓ›˜ Ì AIDS.

PÂÙÚÔ˚Ô› O ÚÂÙÚÔ˚fi˜ Ù‡Ô˘ I ÚÔηÏ› ÙËÓ T-Ï¢¯·ÈÌ›· ÙˆÓ ÂÓËÏ›ÎˆÓ Ô˘ ÂÓ‰ËÌ› Û ÂÚÈÔ¯¤˜ fiˆ˜ Ë K·Ú·˚‚È΋ Î·È Ë Õˆ AÓ·ÙÔÏ‹. MfiÓÔ ÙÔ 1-4% ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·ÙfiÌˆÓ ı· ·Ó·Ù‡ÍÂÈ ÓfiÛÔ ÌÂÙ¿ Ì·ÎÚ¿ Ï·Óı¿ÓÔ˘Û· ÂÚ›Ô‰Ô (40 ¯ÚfiÓÈ·) ·fi ÙËÓ Ïԛ̈ÍË.

O Èfi˜ Â›Û˘ ÚÔηÏ› ·ÓÔÛÔηٷÛÙÔÏ‹ Î·È ÙËÓ ÙÚÔÈ΋ Û·ÛÙÈ΋ ·Ú·¿ÚÂÛË. ™ÙÔÓ ÙÚfiÔ Ô˘ ÚÔηÏ› ηÚÎÈÓÔÁ¤ÓÂÛË Ô Èfi˜ Ê·›ÓÂÙ·È fiÙÈ ·) ÂÌϤÎÂÙ·È ÙÔ ¤Ï˘ÙÚÔ ÙÔ˘ ÈÔ‡ ¯ˆÚ›˜ Ó· Â›Ó·È ÁÓˆÛÙfi˜ Ô Ì˯·ÓÈ-

EÚËÙÔ˚Ô› - Ifi˜ Epstein - Barr (EB) O Èfi˜ Epstein-Barr ÚÔÛ‚¿ÏÏÂÈ fiÏÔ˘˜ ۯ‰fiÓ ÙÔ˘˜ ·ÓıÚÒÔ˘˜ Û Ó·ڿ ΢ڛˆ˜ ËÏÈΛ· Î·È ÚÔηÏ› ÙË ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ̤ÓÂÈ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË ÛÙÔ ÏÂÌÊÈÎfi ÈÛÙfi ¯ˆÚ›˜ ·˘Ùfi Ó· Û˘Ó‰¤ÂÙ·È Ì οÔÈÔÓ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ηÎÔ‹ıÂÈ·˜. ™Â ¤Ó· ÌÈÎÚfi fï˜ ·ÚÈıÌfi ·ÛıÂÓÒÓ, Ô Èfi˜ Á›ÓÂÙ·È ÔÁÎÔÁfiÓÔ˜ ÂÍ·ÈÙ›·˜ οÔÈˆÓ ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙË Ï·Óı¿ÓÔ˘Û· Ê¿ÛË ÙÔ˘ ÈÔ‡ Î·È ÔÈ

108

IÔ› ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ ™ÙÔ˘˜ ÈÔ‡˜ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È >70 Ù‡ÔÈ Ô˘ ÚÔÛ‚¿ÏÔ˘Ó ÂÈıËÏȷο ·ÙÙ·Ú· Î·È ÚÔηÏÔ‡Ó ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ Î·È Î·ÏÔ‹ıÂȘ fiÁÎÔ˘˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ fiˆ˜ ÔÈ Ì˘ÚÌËÁ˘ Î.Ï. Y„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È Î˘Ú›ˆ˜ ÔÈ Ù‡ÔÈ 16 Î·È 18 Ô˘ ÚÔηÏÔ‡Ó ÚÔηÚÎÈÓÈΤ˜ ηٷÛÙ¿ÛÂȘ Î·È Î·ÚΛÓÔ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜ Î·È Û·ÓÈfiÙÂÚ· ηÚΛÓÔ ÙÔ˘ ÚˆÎÙÔ‡ Î·È ÙÔ˘ ·È‰Ô›Ô˘. H Â›ÙˆÛË Ù˘ Ïԛ̈͢ ·fi ÙÔ˘˜ "˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÈÔ‡˜" Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 10% ÂÓÒ Î·ÚΛÓÔ ı· ·Ó·Ù‡ÍÂÈ ÏÈÁfiÙÂÚÔ ·fi 1% Û ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 20-50 ¯ÚfiÓˆÓ. AÓ Î·È ÔÈ ‰‡Ô Ù‡ÔÈ ·˘ÙÔ› ÙˆÓ ÈÒÓ, Â›Ó·È Ô ÈÔ ÁÓˆÛÙfi˜ ÂÈ‚·Ú˘ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÚfiÎÏËÛË Î·ÚΛÓÔ˘ Ù˘ Ì‹ÙÚ·˜, ··ÈÙÔ‡ÓÙ·È Î·È ¿ÏÏÔÈ ÌË Ï‹Úˆ˜ ÚÔÛ‰ÈÔÚÈṲ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜ (Â͈ÁÂÓ›˜, ÔÈÛÙÚÔÁfiÓ·, ¤ÚËÙ·˜ Î.¿.) ÁÈ· ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘. TÔ DNA ÙÔ˘ ÈÔ‡ ‚Ú›ÛÎÂÙ·È ÛÙ· ·ÙÙ·Ú· ÙˆÓ fiÁÎˆÓ ·˘ÙÒÓ. O Èfi˜ Έ‰ÈÎÔÔÈ› ‰‡Ô ÚˆÙ½Ó˜ ÙËÓ E6 Î·È E7 Ô˘ ¯ÚËÛÈÌÂ‡Ô˘Ó ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È·Ù‹ÚËÛË ÙÔ˘ ·ı·Ó·ÙÔÔÈË̤ÓÔ˘ Ê·ÈÓÔÙ‡Ô˘ ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ·Ó·ÛÙÔÏ‹ Ú‡ıÌÈÛ˘ ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘ (E6) Ì ÚˆÙÂfiÏ˘ÛË Ù˘ ÔÁÎÔηٷÛÙ·ÏÙÈ΋˜ ÚˆÙ½Ó˘ p53 Î·È ·‰Ú·ÓÔÔ›ËÛË (E7) Ù˘ Â›Û˘ ÔÁÎÔηٷÛÙ·ÏÙÈ΋˜ ÚˆÙ½Ó˘ RB.

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·109

¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

Ôԛ˜ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ÛÙË Ê¿ÛË ·˘Ù‹. OÈ ÚˆÙ½Ó˜ ·˘Ù¤˜ ˘fi ÔÚÈṲ̂Ó˜ Û˘Óı‹Î˜ fiˆ˜ Û ·ÓÔÛÔηٷÛÙÔÏ‹, ÌÔÚ› Ó· ·ÔÚ˘ıÌ›ÛÔ˘Ó ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ΢ÙÙ·ÚÈ΋˜ ·Ó¿Ù˘Í˘ Î·È Ó· ÚÔηϤÛÔ˘Ó Î·ÚΛÓÔ. O Èfi˜ Û˘Ó‰¤ıËΠÚÒÙ· Ì ÙÔ Ï¤Ìʈ̷ Burkitt Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì Ca ÚÈÓÔÊ¿Ú˘ÁÁ· Î·È ÌÈ· ÏÂÈ¿‰· ηÚÎ›ÓˆÓ Û ·ÛıÂÓ›˜ Ì AIDS ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÔÚÁ¿ÓˆÓ.

O Èfi˜ EB Â›Ó·È Ô ÌÔÓ·‰ÈÎfi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙÔ ·ÓÔÛÔ‚Ï·ÛÙÈÎfi ϤÌʈ̷ Ô˘ ·Ó·Ù‡ÛÛÂÙ·È Û ·ÛıÂÓ›˜ Ì ·Ú·ÙÂٷ̤ÓË ·ÓÔÛÔηٷÛÙÔÏ‹ (ÌÂÙ·ÌfiÛ¯Â˘ÛË ÔÚÁ¿ÓˆÓ, AIDS). O Èfi˜ ‚Ú›ÛÎÂÙ·È ÛÙ·ıÂÚ¿ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ fiÁÎÔ˘, ‰ÂÓ ˘¿Ú¯Ô˘Ó ¯ÚˆÌ·ÙÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ˘¿Ú¯ÂÈ ÛÙ·ıÂÚ¿ ηٷÛÙÔÏ‹ Ù˘ T-·ÓÔÛ›·˜. H ¯·Ú·ÎÙËÚÈÛÙÈ΋ ·Ô˘Û›· ηڢÔÙ˘ÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÂÈÙÚ¤ÂÈ Ó· ˘Ôı¤ÛÔ˘Ì fiÙÈ Èı·ÓfiÓ ÌÈ· ‹ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÈÔÁÂÓ›˜ ÚˆÙ½Ó˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÔÁÎÔÁ¤ÓÂÛË. ™ÙÔ ÂÓ‰ËÌÈÎfi ϤÌʈ̷ Burkitt (§B) Ô Èfi˜ EB ‚Ú›ÛÎÂÙ·È Û >95% ÛÙ· ·ÙÙ·Ú· ÙÔ˘ fiÁÎÔ˘ ÂÓÒ ÛÙÔ ÛÔÚ·‰ÈÎfi ÌfiÓÔ ÛÙÔ 10-15% (˘¿Ú¯Ô˘Ó ‚¤‚·È· Î·È ÎÏÈÓÈΤ˜, ÂȉËÌÈÔÏÔÁÈΤ˜ Î·È ¿ÏϘ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙÔ˘˜) Î·È ÛÙÔ Û¯ÂÙÈ˙fiÌÂÓÔ §B Ì AIDS ÛÙÔ 3050% ÙˆÓ fiÁΈÓ. ™ÙÔ §B ‚Ú›ÛÎÂÙ·È ÛÙ·ıÂÚ¿ Ë ¯ÚˆÌ·ÙÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· t (8;14) Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Ë t (2;8) Î·È t (8;22). ™Â ·˘Ù‹ Á›ÓÂÙ·È ÌÂÙ¿ıÂÛË ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ 8 ¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ Ô˘ ÂÚȤ¯ÂÈ ÙÔ C-myc ÔÁÎÔÁÔÓ›‰ÈÔ ÛÙË ı¤ÛË ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ‹ ÛÙÔ ¯ÚˆÌ·Ùfiۈ̷ 14, ‹ ÛÙÔ 2 ‹ ÛÙÔ 22 Î·È ·˘Ùfi ‰ËÌÈÔ‡ÚÁËÛ ÂӉȷʤÚÔÓÙ· ÛÂÓ¿ÚÈ· ÁÈ· ÙËÓ Î·ÚÎÈÓÔÁ¤ÓÂÛË ·fi ÙÔÓ Èfi EB ÛÙÔ §B. ™Â ·ÓÙ›ıÂÛË Ì ÙÔ §B, ÙÔ DNA ÙÔ˘ ÈÔ‡ ‚Ú›ÛÎÂÙ·È ÛÙ·ıÂÚ¿ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ÚÈÓÔÊ·Ú˘ÁÁÈÎÔ‡ ηÚΛÓÔ˘. O Ì˯·ÓÈÛÌfi˜ ηÚÎÈÓÔÁ¤ÓÂÛ˘ ÛÙÔÓ fiÁÎÔ ·˘ÙfiÓ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÍÂηı·ÚÈṲ̂ÓÔ˜. H ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ ÙÔ˘ fiÁÎÔ˘ Â›Ó·È Â˘Ú›· Î·È ·˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙË ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÙˆÓ Ê˘ÏÒÓ (΢ڛˆ˜ ΛÙÚÈÓË Ê˘Ï‹) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ‰È·ÙÚÔÊ‹ (ÈοÓÙÈη Ê·ÁËÙ¿). ™ÙÔÓ ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ηÚΛÓÔ Ô EB ÁfiÓÔ˜ ÂÎÊÚ¿˙ÂÙ·È Ì ‰‡Ô Ï·Óı¿ÓÔ˘Û˜ ÚˆÙ½Ó˜ ÌÂÌ‚Ú¿Ó˘ 1,2 (LMP1,2) Ô˘ Èı·ÓfiÓ Û˘Ó‰¤ÔÓÙ·È Ì ÙËÓ Î·ÚÎÈÓÔÁ¤ÓÂÛË. ™ÙË ÓfiÛÔ ÙÔ˘ Hodgkin o Èfi˜ EB ‚Ú›ÛÎÂÙ·È ÛÙ· ·ÙÙ·Ú· Reed-Sternberg Û 14% ÛÙÔ ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi Ù‡Ô Û 40% ÛÙÔÓ Ù‡Ô Ù˘ Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛ˘ ÂÓÒ ÛÙÔÓ ¯ÂÈÚfiÙÂÚ˘ ÚfiÁÓˆÛ˘ Ù‡Ô Ù˘ ÌÈÎÙ‹˜ ΢ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ Û 70% ÙˆÓ ÂÚÈÙÒÛˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È ÏÔÈfiÓ, Ô Èfi˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÓ ÓfiÛÔ ÙÔ˘ Hodgkin.

AÓıÚÒÈÓÔ˜ ÂÚËÙÔ˚fi˜-8 O ·ÓıÚÒÈÓÔ˜ ÂÚËÙÔ˚fi˜-8 ÌfiÏȘ ÙÔ 1994 Û˘Ó‰¤-

§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

ıËΠ̠ÙÔ Û¿ÚΈ̷ Kaposi (™K). E›Û˘, ÚÔηÏ› ‰È¿¯˘ÙÔ Ï¤Ìʈ̷ Î·È Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ ÙÔ˘ Castelman. Y¿Ú¯ÂÈ ÌÈ· ¤ÎÚËÍË ÂÚÈÙÒÛÂˆÓ ™K Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™ÙÔ AIDS Â›Ó·È 20.000 ÊÔÚ¤˜ ÈÔ Û˘¯Ófi ·fi fiÙÈ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. OÚÈṲ̂Ó˜ ·fi ÙȘ ÚˆÙ½Ó˜ Ô˘ Έ‰ÈÎÔÔÈÔ‡ÓÙ·È ·fi ÙÔÓ Èfi ÌÔÚ› Ó· ·ÔÚ˘ıÌ›ÛÔ˘Ó ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ·ÎÏÔ˘, Ó· ·Ó·ÛÙ›ÏÔ˘Ó ÙËÓ ·fiÙˆÛË Î·È Ó· ‰È·Ù·Ú¿ÍÔ˘Ó ÙËÓ ·˘ÍËÙÈ΋ ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Î·È ¤ÙÛÈ Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ηÚÎÈÓÔÁ¤ÓÂÛË.

IÔ› Ù˘ H·Ù›Ùȉ·˜ H ¯ÚfiÓÈ· Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ B ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ Ë·ÙÈ΋ ‚Ï¿‚Ë, ΛÚÚˆÛË Î·È Î·ÚΛÓÔ ÙÔ˘ ‹·ÙÔ˜. O ΛӉ˘ÓÔ˜ ·Ó¿Ù˘Í˘ Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ Û ¯ÚfiÓÈÔ˘˜ ÊÔÚ›˜ Ë·Ù›Ùȉ·˜ B Â›Ó·È 30-100 ÊÔÚ¤˜ ÈÔ Û˘¯Ófi˜ Î·È ·Ó·Ù‡ÛÛÂÙ·È ÌÂÙ¿ 20-40 ¯ÚfiÓÈ· Â›ÌÔÓ˘ Ïԛ̈͢, ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ·ÊÏ·ÙÔÍ›ÓË, ÌÔÚ› Ó· Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘. H ΛÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜ Ô˘ ·ÎÔÏÔ˘ı› ÙËÓ ¯ÚfiÓÈ· Ïԛ̈ÍË ·fi Èfi Ë·Ù›ÙȉԘ B Â›Ó·È ÈÛ¯˘Úfi˜ ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ·Ó¿Ù˘ÍË Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ Ô ÔÔ›Ô˜ fï˜, ·Ó·Ù‡ÛÛÂÙ·È Î·È Û ¯ÚfiÓÈÔ˘˜ ÊÔÚ›˜ ÌË ÎÈÚÚˆÙÈÎÔ‡˜ Î·È Â›Û˘, Â›Ó·È Û¿ÓÈÔ˜ Û ¿ÏϘ ÌÔÚʤ˜ ΛÚÚˆÛ˘ fiˆ˜ Ë ÓfiÛÔ˜ Wilson Î.Ï. TÚÂȘ Ì˯·ÓÈÛÌÔ› ÌÂÏÂÙÒÓÙ·È ÛÙËÓ Î·ÚÎÈÓÔÁ¤ÓÂÛË ·fi ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ B: 1) ÕÌÂÛ·, Ì ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ DNA ÙÔ˘ ÈÔ‡ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ÍÂÓÈÛÙ‹ (‚Ú›ÛÎÂÙ·È Û >90% ÛÙÔÓ Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ Ì HBSAg(+)) Û ı¤ÛÂȘ Ô˘ Èı·ÓfiÓ Ó· Â›Ó·È ÎÚ›ÛÈ̘ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ΢ÙÙ·ÚÈ΋˜ Ú‡ıÌÈÛ˘ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÔÁÎÔÁÔÓ›‰È· ‹ ·ÂÓÂÚÁÔÔÈ› Ù· ηٷÛÙ·ÏÙÈο ÁÔÓ›‰È·, ·ÔÚ˘ıÌ›˙ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ Î˘ÙÙ·ÚÈ΋ ÈÛÔÚÚÔ›·. 2) ŒÌÌÂÛ·, Ô Èfi˜ Έ‰ÈÎÔÔÈ› ÌÈ· ÌÂÙ·ÏÏ·Á̤ÓË ÚˆÙ½ÓË (HBX) Ô˘ ·‰Ú·ÓÔÔÈ› ÙËÓ ÔÁÎÔηٷÛÙ·ÏÙÈ΋ ÚˆÙ½ÓË p53, Î·È 3) Ì ÌË ÂȉÈÎfi ÙÚfiÔ, ̤ۈ Ù˘ Â·ÎÔÏÔ˘ıÔ‡Û·˜ ÙËÓ ¯ÚfiÓÈ· ‚Ï¿‚Ë Î˘ÙÙ·ÚÈ΋˜ ·Ó·Á¤ÓÓËÛ˘ Î·È Î›ÚÚˆÛ˘, Ô‰ËÁ› Û ηÚΛÓÔ.

H Ë·Ù›Ùȉ· C ·ÔÙÂÏ› ¤Ó· ·ÁÎfiÛÌÈÔ Úfi‚ÏËÌ·, Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ÔÈΛÏÏÂÈ Î·È Î˘Ì·›ÓÂÙ·È ·fi 0,5-10%. TÔ 80% ÙˆÓ ·ÛıÂÓÒÓ Ì ÔÍ›· Ïԛ̈ÍË ı· ÌÂÙ·¤ÛÔ˘Ó Û ¯ÚfiÓÈ· Î·È ·fi ·˘ÙÔ‡˜ ÙÔ 20% ı· ·Ó·Ù‡ÍÂÈ Î›ÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜. Afi ÙÔ˘˜ ÎÈÚÚˆÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ¤Ó· ÔÛÔÛÙfi 1-5% ı· ·Ó·Ù‡ÍÂÈ Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Û˘Ó‹ıˆ˜ 20-30 ¯ÚfiÓÈ·. O Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Ô Èfi˜ ÚÔηÏ› ηÚΛÓÔ Â›Ó·È ¿ÁÓˆÛÙÔ˜. ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Á›ÓÂÙ·È Ì¤Ûˆ Ù˘ ΛÚÚˆÛ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο: 1. OÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· >15% ÙˆÓ Î·ÚÎ›ÓˆÓ ÛÙÔÓ ¿ÓıÚˆÔ Î·È ·fi ·˘ÙÔ‡˜ ÙÔ 80% ·ÊÔÚ¿ ÙÔÓ Î·ÚΛÓÔ Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔ˘˜ ÈÔ‡˜ Ù˘ Ë·Ù›Ùȉ·˜. ™ÙÔ Ì¤ÏÏÔÓ, ÙÔ ÔÛÔÛÙfi

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

°Ú·Ùfi ™˘ÌfiÛÈÔ

·˘Ùfi Èı·ÓfiÓ Ó· ·˘ÍËı› Ì ÙÔ Û˘Û¯ÂÙÈÛÌfi Î·È ¿ÏÏˆÓ Ù‡ˆÓ ηÚΛÓÔ˘ Ì ¿ÏÏÔ˘˜ ÈÔ‡˜.

2. H Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Î·Ù¿ Ôχ ˘„ËÏfiÙÂÚË ·fi ÙË Û˘¯ÓfiÙËÙ· Ô˘ ÚÔηÏÔ‡Ó Î·ÚΛÓÔ Î·È ·˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÁÂÓÂÙÈÎÔ›, Â›ÎÙËÙÔÈ, ÔÚÌÔÓÈÎÔ›, ·ÓÔÛÔÏÔÁÈÎÔ› Î.¿. Â›Ó·È ··Ú·›ÙËÙÔÈ ÁÈ· ÙËÓ ÚfiÎÏËÛ‹ ÙÔ˘.

3. H ÌÂϤÙË ÙÔ˘ ηÚΛÓÔ˘ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÈÔ‡˜ ‚Ô‹ıËÛ ӷ Á›ÓÂÈ ϤÔÓ ÁÂÓÈÎfiÙÂÚ· ηٷÓÔËÙfi ÙÔ Ê·ÈÓfiÌÂÓÔ Î·ÚΛÓÔ˜. ¶.¯. Ù· ÔÁÎÔÁÔÓ›‰È· Î·È Ù· ÔÁÎÔηٷÛÙ·ÏÙÈο ÁÔÓ›‰È·, ÚÒÙ· ÂÚÈÁÚ¿ÊËÎ·Ó Û ηÎÔ‹ıÂȘ fiÁÎÔ˘˜ ·fi ÈÔ‡˜ Û ÂÈÚ·Ì·Ùfi˙ˆ·.

4. H ·Ó¿Ù˘ÍË ÙÔ˘ ηÚΛÓÔ˘ Û˘¯Ó¿ (fi¯È fï˜ ··-

Ú·›ÙËÙ·), Á›ÓÂÙ·È ÔÏÏ¿ ¯ÚfiÓÈ· ÌÂÙ¿ ·fi ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ Î·È ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi Ô Èfi˜ ·Ú·Ì¤ÓÂÈ Â›ÌÔÓ· ̤۷ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ÍÂÓÈÛÙ‹.

5. T¤ÏÔ˜, ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ì ÂÌ‚ÔÏÈ·ÛÌÔ‡˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ‹ ÂÍ·Ê¿ÓÈÛË Ù˘ ÈÔÁÂÓÔ‡˜ ·ÈÙ›·˜ ηÚΛÓÔ˘ ÛÙÔÓ ¿ÓıÚˆÔ. MÈ· Ù¤ÙÔÈ· ·Ú¤Ì‚·ÛË Â›Ó·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÁÈ· ÙËÓ Ë·Ù›Ùȉ· B Ô˘ Û‹ÌÂÚ· Á›ÓÂÙ·È ·ÁÎÔÛÌ›ˆ˜.

H Â›ÙˆÛ‹ ÙÔ˘ fï˜, ÛÙÔÓ Î·ÚΛÓÔ ÙÔ˘ ‹·ÙÔ˜ ı· Ê·Ó› ›Ûˆ˜ ÌÂÙ¿ ·fi 30-40 ¯ÚfiÓÈ·. °È· ÙÔ˘˜ ¿ÏÏÔ˘˜ ÈÔ‡˜ Ô˘ ·Ó·Ê¤ÚıËηÓ, Ù· ÂÌ‚fiÏÈ· ›Ù ‚Ú›ÛÎÔÓÙ·È Û Ôχ ÚÒÈÌ· ÛÙ¿‰È· ›Ù ‰ÂÓ ÌÔÚÔ‡Ó ÚÔ˜ ÙÔ ·ÚfiÓ Ó· ·Ú·Û΢·ÛıÔ‡Ó ÁÈ· ÔÈΛÏÔ˘˜ ÏfiÁÔ˘˜.

§ÔÈÌÒÍÂȘ Î·È ·ıËÚÔÛÎÏ‹Ú˘ÓÛË K·›ÙË M·Ï·Î¿ - Z·ÊÂÈÚ›Ô˘ Afi ÔÏÏ¿ ¯ÚfiÓÈ· ÂÎÙÂٷ̤Ó˜ ÌÂϤÙ˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘ Û Ӥ· ¿ÙÔÌ· ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ·˘ÙÒÓ Î·È Ù˘ ÓfiÛÔ˘.

K·Ù·Ù¿ÛÛÔÓÙ·˜ ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ÌÂÁ¿Ï˜ ηÙËÁÔڛ˜ ıˆÚÂ›Ù·È fiÙÈ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘ Û˘ÌÌÂÙ¤¯Ô˘Ó: ·ÈÌÔ‰˘Ó·ÌÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ¢ÓÔÔ‡Ó ÙË ıÚfiÌ‚ˆÛË, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÏÈȉ›ˆÓ Î·È ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ·ÁÁ›ˆÓ.

EÎÙÂٷ̤Ó˜ ÌÂϤÙ˜ ÏËı˘ÛÌÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ¤‰ÂÈÍ·Ó ÛÔ‚·Ú¤˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ·ÚÙËÚÈÒÓ ‹‰Ë ·fi ÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·. ™ÙÔ˘˜ ·ÓˆÙ¤Úˆ ·Ú¿ÁÔÓÙ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› fiˆ˜ ÙÔ Î¿ÓÈÛÌ·, Ë Ï‹„Ë ÎÔη˝Ó˘ Î·È Ô ÙÚfiÔ˜ ˙ˆ‹˜ (¶›Ó·Î·˜ 1). OÈ ÙÚÂȘ ‚·ÛÈΤ˜ ·ıÔÁÂÓÂÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜ ‰ËÏ·‰‹, Ë ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜, Ë ·˘ÍË̤ÓË Ù¿ÛË ÁÈ· Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚ˆÓ ÏfiÁˆ ·˘Í‹Ûˆ˜ ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ Î·È ÂÓÂÚÁÔÔÈ‹Ûˆ˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Î·È ÔÈ ·ÏÏÔÈÒÛÂȘ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ·ÁÁ›ˆÓ ÏfiÁˆ ‚Ï¿‚˘ ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁ›ˆÓ ÚÔηÏÔ‡ÓÙ·È Ôχ Û˘¯Ó¿ ηٿ ÙË ‰È·‰ÚÔÌ‹ ÔÚÈÛÌ¤ÓˆÓ ¯ÚfiÓÈˆÓ ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ ÏÔÈÌÒ͈Ó. EÍ¿ÏÏÔ˘, Ë ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ‰ÈÂÚÁ·Û›· Ô˘ ÚÔηÏÂ›Ù·È ÏfiÁˆ ÂÓÂÚÁÔÔÈ‹Ûˆ˜ ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Î·È ˘ÂÚ·Ú·ÁˆÁ‹˜ ΢ÙÔÎÈÓÒÓ ÚÔÛÔÌÔÈ¿˙ÂÈ ÚÔ˜ ÙË ‰ÈÂÚÁ·Û›· Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘.

Afi ÙÔ 1970, ·Ú·ÙËÚ‹ÛÂȘ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ·Ó fiÙÈ Ïԛ̈ÍË Ì ÔÚÈṲ̂ÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ÚÔηÏ› ·ÚÙËÚȷ΋ ÓfiÛÔ Ô˘ ÚÔÛÔÌÔÈ¿˙ÂÈ ÚÔ˜ ÙËÓ ·ıËÚÔÛÎÏËÚˆÙÈ΋ ·ÁÁÂȷ΋ ÓfiÛÔ ÙÔ˘ ·Ó-

110

ıÚÒÔ˘. ŒÎÙÔÙ ˘¿Ú¯Ô˘Ó ÛÔÚ·‰ÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ Ô˘ Û˘Û¯ÂÙ›˙Ô˘Ó ÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÚÔ˜ ÙË Ïԛ̈ÍË Ì ÔÚÈṲ̂ӷ Gram ·ÚÓËÙÈο ‚·ÎÙËÚ›‰È· Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÚÔ˜ ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ Î·È Ù· ¯Ï·Ì‡‰È· Ù˘ Ó¢ÌÔÓ›·˜, ÚÔ˜ ÔÚÈṲ̂ÓÔ˘˜ ÂÚËÙÔ˚Ô‡˜ Î·È Î˘Ú›ˆ˜ ÙÔÓ ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi (CMV). (¶›Ó·Î˜ 1 Î·È 2). E›Û˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› Ô Èfi˜ ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ (¢¿ÁÁÂÈÔ˘) ˘ÚÂÙÔ‡, ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ·Ó¢ڛÛÎÔÓÙ·È ÛÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ÓfiÛÔ (Streptococcus sanguis Î·È Porphyromonas gingivalis), ÔÈ ÈÔ› Ù˘ ÁÚ›˘, HIV-1 Î·È ·‰ÂÓÔ˚Ô› ηıÒ˜ Î·È Ô Èfi˜ Coxsackie B4.

TÔ ÔÛÔÛÙfi ÙˆÓ ÂÓËÏ›ÎˆÓ Ô˘ ¤¯ÂÈ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ 3 ·˘ÙÒÓ Î‡ÚÈˆÓ ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› ÂÚÈÛÛfiÙÂÚÔ Êı¿ÓÂÈ ÙÔ 50% ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. AÏÏ¿ Ë ·Ó‡ÚÂÛË ˘„ËÏÔ‡ Ù›ÙÏÔ˘ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ÛËÌ·›ÓÂÈ ··Ú·›ÙËÙ· ¯ÚfiÓÈ· ÂÓÂÚÁfi ÓfiÛÔ ‰ÈfiÙÈ ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ·˘ÙÔ› ‚Ú›ÛÎÔÓÙ·È Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË Â› ÛÂÈÚ¿ ÂÙÒÓ ‹ ηı' fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜. O Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘Í¿ÓÂÈ fiÙ·Ó Û˘Ì‚Â› ÂÓÂÚÁÔÔ›ËÛË Ù˘ Ï·Óı¿ÓÔ˘Û·˜ Ïԛ̈͢ ‹ Â·Ó·ÌfiÏ˘ÓÛË. ŒÙÛÈ, ÁÈ· Ó· Â›Ó·È ·ÍÈfiÈÛÙË Ë Û˘Û¯¤ÙÈÛË Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÔÏϤ˜ ÌÂÙÚ‹ÛÂȘ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‹ Ó· ·Ó‚ÚÂıÔ‡Ó ÛÙ·ıÂÚ¿ ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ÛÙËÓ ·Ó·ÙÔÌÈ΋ ı¤ÛË Ù˘ ‚Ï¿‚˘.

OÈ Ì˯·ÓÈÛÌÔ› Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ıËÚÔÁ¤ÓÂÛË ¤¯Ô˘Ó Û¯¤ÛË Ì ¿ÌÂÛË Â›‰Ú·ÛË ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ·˘ÙÒÓ ÛÙË ı¤ÛË Û¯ËÌ·ÙÈÛÌÔ‡ Ù˘ ·ıËÚÔÌ·ÙÈ΋˜ Ͽη˜, ÛÙË Ú‹ÍË ·˘Ù‹˜ Î·È ÙÂÏÈο ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚Ô˘. H ¿ÌÂÛË Â›‰Ú·ÛË Û˘Ó›ÛÙ·Ù·È Û Ïԛ̈ÍË ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, ÌÂ

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·111

¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ıËÚÔÛÎÏËÚˆÙÈ΋˜ ·ÁÁÂȷ΋˜ ÓfiÛÔ˘. ¶·¯˘Û·ÚΛ·* K¿ÓÈÛÌ· ¢˘ÛÏÈȉ·ÈÌ›·* TÚfiÔ˜ ˙ˆ‹˜ Y¤ÚÙ·ÛË* §‹„Ë ÎÔη˝Ó˘ Î.¿. ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘* §ÔÈÌÒÍÂȘ *OÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› ·Ó·Ê¤ÚÔÓÙ·È Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ X, ı·Ó·ÙËÊfiÚÔ ÎÔ˘·ÚÙ¤ÙÔ, Û‡Ó‰ÚÔÌÔ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ·ÔÙ¤ÏÂÛÌ· ÚfiÎÏËÛË ‚Ï¿‚˘ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·˘ÙÔ‡, ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ Î·È ÙÔÈ΋ ÊÏÂÁÌÔÓ‹. T· ¤ÌÌÂÛ· ·ÔÙÂϤÛÌ·Ù· Ô˘ Â›Ó·È Î·È Û˘¯ÓfiÙÂÚ·, Û˘Ó›ÛÙ·ÓÙ·È Û ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜, ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ·ÓÙÈۈ̷ÙÈ΋ ·ÓÙ›‰Ú·ÛË, ‹ ÚfiÎÏËÛË ‰È·Ù·Ú·¯ÒÓ ÛÙÔ˘˜ ÁÓˆÛÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Ù· ÏÈ›‰È·, oÈ ÚˆÙ½Ó˜ Ù˘ ‹Íˆ˜, ÔÈ ÌÂÙ·‚Ôϛ٘ Ù˘ ÔÍ›‰ˆÛ˘ Î·È Ë ÔÌÔ΢ÛÙ½ÓË.

TÔ ÂÚÒÙËÌ· Â›Ó·È ·Ó Ú¿ÁÌ·ÙÈ ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ·˘ÙÔ› Â›Ó·È Ù· Ú·ÁÌ·ÙÈο ·›ÙÈ· ‹ ·ÔÙÂÏÔ‡Ó Û˘ÓÔ‰¿ ̤ÏË Ù· ÔÔ›· ·ÏÒ˜ ·Ú¢ڛÛÎÔÓÙ·È ÛÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙ˜ ·ÁÁÂÈ·ÎÔ‡˜ ÈÛÙÔ‡˜. AÓÂÍ¿ÚÙËÙ· fï˜ Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ê·›ÓÂÙ·È fiÙÈ Ë ÊÏÂÁÌÔÓ҉˘ ÂÂÍÂÚÁ·Û›· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÂÈÙ·¯‡ÓÂÈ ÙË ‰È·‰Èηۛ· Ù˘ ·ıËÚÔÁ¤ÓÂÛ˘ Ë ÔÔ›· ÔÊ›ÏÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÏÈȉ›ˆÓ Î·È Û ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. OÈ ÈÔ› .¯. ÚÔηÏÔ‡Ó ·ÚÙËÚÈ›Ùȉ·, fï˜ Ë ·ıËÚÔÛÎÏ‹Ú˘ÓÛË ı· Û˘Ì‚Â› ÌfiÓÔ ·Ó ηٿ ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ Â›Ó·È ·˘ÍË̤ӷ Ù· ÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜. ¶·Ú¿ Ù·‡Ù· fï˜, ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ·Ó·ÌÊÈÛ‚‹ÙËÙ· Ù· ¯Ï·Ì‡‰È· Ù˘ Ó¢ÌÔÓ›·˜ fiÙ·Ó ÚÔηÏÔ‡Ó ÂÈ̤ÓÔ˘Û· Ïԛ̈ÍË ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘. H ıˆڛ· ·˘Ù‹ ÛÙËÚ›˙ÂÙ·È ÛÙ· ·Ú·Î¿Ùˆ ÁÂÁÔÓfiÙ·: 1. £ÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·ıËÚÔÛÎÏËÚˆÙÈ΋˜ ÓfiÛÔ˘ Î·È ÂÈ¤‰Ô˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ÔÚÔ‡ ¤Ó·ÓÙÈ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡. ™Â 20 ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ‚Ú¤ıËΠ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Û 2.

2. O ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ·˘Ùfi˜ ¤¯ÂÈ ·Ó¢ÚÂı› Ì ‰È¿ÊÔÚ˜ Ù¯ÓÈΤ˜ Û ˘„ËÏfi ÔÛÔÛÙfi ÙˆÓ ·ıËÚÔÌ·ÙÈÎÒÓ Ï·ÎÒÓ Û ‰È¿ÊÔÚ· ·Ó·ÙÔÌÈο ÛËÌ›·.

3. TÚÂȘ ‰ÈÂıÓ›˜ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ıÂÚ·¢ÙÈο Ì·ÎÚÔÏ›‰Â˜ Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÎÚ›ıËÎ·Ó ÂÈÙ˘¯Â›˜.

4. T· ·ÙÙ·Ú· ÛÙfi¯ÔÈ ÛÙËÓ ·ıËÚÔÛÎÏ‹Ú˘ÓÛË, ‰ËÏ·‰‹ Ù· ÂÓ‰ÔıËÏȷο, Ù· Ì·ÎÚÔÊ¿Á· Î·È Ù· Ì˘˚ο, ÌÔχÓÔÓÙ·È Ì ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi in vitro. ™Â Ì·ÎÚÔÊ¿Á· Ô˘ ÌÔχÓıËÎ·Ó ·fi ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi in vitro ÂÓÂÚÁÔÔÈ‹ıËÎÂ Ë ÚfiÛÏË„Ë ·fi ·˘Ù¿ LDL Î·È Ù·¯¤ˆ˜ ÌÂÙ·ÙÚ¿ËÎ·Ó ÛÙ· ·ÊÚÒ‰Ë Î‡ÙÙ·Ú· Ô˘

§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

·Ó¢ڛÛÎÔÓÙ·È ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË.

5. T· ÂÈÚ¿Ì·Ù· Â› ˙ÒˆÓ Â›Ó·È ıÂÙÈο.

6. ™ÙË ÌÂϤÙË ÙÔ˘ Helsinki ÔÈ ‰Â›ÎÙ˜ Ù˘ ¯ÚfiÓÈ·˜ ÌfiÏ˘ÓÛ˘ ·fi Ù· ¯Ï·Ì‡‰È· Ù˘ Ó¢ÌÔÓ›·˜ ‹Ù·Ó ÔÈ ÂÚÈÛÛfiÙÂÚÔ ÛÙ·ıÂÚÔ› ÁÈ· ÙËÓ ÚfiÎÏËÛË ÙÔ˘ ηÏÔ‡ÌÂÓÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ¢‡ÛÎÔÏ· fï˜, ÌÔÚ› Ó· ÂÍËÁËı› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÙÚÔÈΤ˜ ¯ÒÚ˜, ·Ú¿ ÙË Û˘¯Ó‹ Ïԛ̈ÍË Ì ¯Ï·Ì‡‰È· Ë ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Â›Ó·È Û¿ÓÈ·. M›· ÂÍ‹ÁËÛË Â›Ó·È fiÙÈ ÛÙȘ ¯ÒÚ˜ ·˘Ù¤˜ Ë ÚˆÙÔ·ı‹˜ Ïԛ̈ÍË Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙËÓ ·È‰È΋ ËÏÈΛ· ηٿ ÙËÓ ÔÔ›· ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘.

K·Ù¿ ÙËÓ ·È‰È΋ ËÏÈΛ· Ù· ¯Ï·Ì‡‰È· Ù˘ Ó¢ÌÔÓ›·˜ ÚÔηÏÔ‡Ó ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ˆÙ›Ùȉ·˜ Î·È ·Ú·ÚÈÓÔÎÔÏ›Ùȉ·˜, ‚ÚÔÁ¯ÔÓ¢ÌÔÓ›· Î·È Ó¢ÌÔÓ›Ùȉ·. OÈ ÏÔÈÌÒÍÂȘ ·˘Ù¤˜ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ˘ÔÙÚÔÈ¿˙Ô˘Ó ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËı› ·Ú·ÌÔÓ‹ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Â› Ì‹Ó˜ ¤ˆ˜ Î·È ¤ÙÔ˜ ÌÂÙ¿ ÙË ÓfiÛËÛË. ¶ÔÛÔÛÙfi 30-40% ÙˆÓ ÂÊ‹‚ˆÓ ¤¯ÂÈ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Î·È ·fi ·˘Ùfi Û˘Ó¿ÁÂÙ·È fiÙÈ Ë ‰È·ÛÔÚ¿ Î·È ÌfiÏ˘ÓÛË Û˘Ì‚·›ÓÂÈ ‹‰Ë ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·. AÛ˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜ ·Ó¢ڛÛÎÔÓÙ·È Û ÔÛÔÛÙfi 2-5% ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ·È‰ÈÒÓ. ¶Èı·ÓfiÓ ÔÈ ÊÔÚ›˜ Ó· ·ÔÙÂÏÔ‡Ó ÙË ‰ÂÍ·ÌÂÓ‹ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Î·È Ó· Û˘Ì‚¿ÏÔ˘Ó ÛÙË ‰È·ÛÔÚ¿. ¶ÚÔ˜ ÙÔ ·ÚfiÓ ‰ÂÓ ˘¿Ú¯ÂÈ ÂÌ‚fiÏÈÔ. °›ÓÔÓÙ·È fï˜, ÂÓÙ·ÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ‰Â›ÎÙË Ô˘ ı· ˘Ô‰ÂÈÎÓ‡ÂÈ ÔÈÔÈ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ïԛ̈ÍË ·fi ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi ı· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂˆÊÂÏËıÔ‡Ó ·fi ÙË ıÂÚ·›· ÚÈÓ ÂÌÊ·Ó›ÛÔ˘Ó ÙÔ ÚÒÙÔ Î·Ú‰È·Îfi ÂÂÈÛfi‰ÈÔ, ηıÒ˜ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ϤÔÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ıÂÚ·›·˜. ™ÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ÂÓÙfiÈÛË Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ›Ûˆ˜, ÁÈ·Ù› Ù· ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· ÌÂÏÂÙÒÓÙ·È Û˘¯Ófi¶›Ó·Î·˜ 2. §ÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÚÔ˜ ÙËÓ ·ıËÚÔÛÎÏ‹Ú˘ÓÛË. ñ XϷ̇‰È· Ù˘ Ó¢ÌÔÓ›·˜ ñ EÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡ ñ MÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi˜ (ÂÚËÙÔ˚Ô›;) AÛıÂÓ›˜ ˘Ô„›Â˜: ñ MÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ù˘ ÂÚÈÔ‰ÔÓÙÈ΋˜ ÓfiÛÔ˘ (straptococcus sanguis Î·È Porphyromas gingivalis) ñ Ifi˜ ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ (¢¿ÁÁÂÈÔ˘) ˘ÚÂÙÔ‡ ñ IÔ› Ù˘ ÁÚ›˘ ñ HIV-1 ñ A‰ÂÓÔ˚Ô› ñ Coxsackie B4

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MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·112

¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

°Ú·Ùfi ™˘ÌfiÛÈÔ

ÙÂÚ·. ÕÏϘ ·Ó·ÙÔÌÈΤ˜ ÂÓÙÔ›ÛÂȘ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› Û·ÓÈfiÙÂÚ·, Â›Ó·È Ù· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÌÂÙ¿ ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·, ÂÛÙÂӈ̤ӷ ÙÌ‹Ì·Ù· ÙˆÓ

ηڈٛ‰ˆÓ, ηıÒ˜ Î·È ·Ó¢ڇÛÌ·Ù· Ù˘ ·ÔÚÙ‹˜ Î·È ¿ÏÏˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ Ù· ÔÔ›· ¯ÂÈÚÔ˘ÚÁ‹ıËηÓ.

IÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· °ÂÒÚÁÈÔ˜ ™. B·ÚÏ¿Ì˘ H ÌÂϤÙË Ù˘ Û¯¤Û˘ ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Ì ÙȘ ¯ÚfiÓȘ ·ı‹ÛÂȘ Î·È È‰È·›ÙÂÚ· Ì ÙȘ ¯ÚfiÓȘ ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ, Â›Ó·È ¤ÚÁÔ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰‡Ô ‰ÂηÂÙÈÒÓ. OÈ ÎÏÈÓÈΤ˜ Î·È ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ Ù˘ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÈÔÁÂÓÒÓ ÂȉËÌÈÒÓ ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ηډȷΤ˜ ·ı‹ÛÂȘ ‹ ÂÈÏÔΤ˜, fiˆ˜ Â›Ó·È Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë ÂÓ‰Ôηډȷ΋ ÈÓÔÂÏ¿ÛÙˆÛË, ÔÈ ¯ÚfiÓȘ ·ÚÚ˘ı̛˜, Ë ·ıËÚÔÛÎÏ‹Ú˘ÓÛË, ηıÒ˜ Î·È Ë Èı·ÓfiÙËÙ· Ù˘ Û¯¤Û˘ ÙˆÓ Û˘¯ÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Ì ηډȷΤ˜ ·ı‹ÛÂȘ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ÂȂ‚·ÈˆıÔ‡Ó ·Ú¿ ÌfiÓÔ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ù˘ ·ÓÔÛÔ‚ÈÔÏÔÁ›·˜ Î·È Ì ÙË ‚ÂÏÙ›ˆÛË Ù˘ Ù¯ÓÈ΋˜ Ù˘ ÂÓ‰ÔÌ˘Ôηډȷ΋˜ ‚ÈÔ„›·˜.

OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ·ÓÙÈΛÌÂÓÔ ÂÓÙ·ÙÈÎÒÓ ÂÚ¢ÓÒÓ ÛÙȘ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜.

M ÛÙ·ıÂÚfi Ú˘ıÌfi ‰È¢ÎÚÈÓ›˙ÂÙ·È Ë ·ÈÙÈÔÏÔÁ›· ÙÔ˘˜ Î·È ‰È·Ê·›ÓÂÙ·È Ë ÂÏ›‰· ÚfiÏË„‹˜ ÙÔ˘˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·. I‰È·›ÙÂÚ· ¤¯ÂÈ ÌÂÏÂÙËı› Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (¢MK£), ÁÈ· ÙËÓ ÔÔ›· Â›Ó·È ·Ô‰ÂÎÙfi fiÙÈ "Â›Ó·È ¿ıËÛË ·ÓÔÛÔÏÔÁÈ΋˜, ÁÂÓÂÙÈ΋˜, ÏÔÈÌÒ‰Ô˘˜, ‹ ÌÈÎÙ‹˜ ·ÈÙÈÔÏÔÁ›·˜".

IÔ› Î·È Ì˘Ôηډ›Ùȉ· - ™¯¤ÛË ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ Î·È ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ H Èı·ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙË ‰È¿ÚÎÂÈ· ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹. H ÎÔÈÓÒ˜ ·Ô‰ÂÎÙ‹ Û˘¯ÓfiÙËÙ· Ù˘ Ì˘Ôηډ›Ùȉ·˜ Û ¶·È‰È·ÙÚÈΤ˜ KÏÈÓÈΤ˜, Î˘Ì·›ÓÂÙ·È ·fi 0,15 ˆ˜ 1%, Î·È Ù˘ ÂÚÈηډ›Ùȉ·˜ Â›Ó·È ÂÚ›Ô˘ 0,3%. ™Â ÓÂÎÚÔÙÔÌÈΤ˜ ÌÂϤÙ˜ fï˜, Ë Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ Ì˘Ôηډ›Ùȉ·˜ Û ·ÛıÂÓ›˜ Ô˘ η٤ÏËÍ·Ó ÛÙË ‰È¿ÚÎÂÈ· ÂÌ‡ÚÂÙÔ˘ ÏÔÈÌÒ‰Ô˘˜ ÓÔÛ‹Ì·ÙÔ˜ ÊÙ¿ÓÂÈ ÙÔ 6-10%. M ‚¿ÛË ÌÂϤÙ˜ ÛÙË ‰È¿ÚÎÂÈ· ÂȉËÌÈÒÓ Ì ÂÓÙÂÚÔ˚Ô‡˜ ÛÙËÓ E˘ÚÒË, Ë Û˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ˘ÔÏÔÁ›ÛÙËΠ۠5%, ÂÓÒ Û ¿ÏÏË ÈÔÁÂÓ‹ ÂȉËÌ›·, Ë Î·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹, Ô˘ Û˘Ó›ÛÙ·ÙÔ Û "ηډȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·", ˘‹Ú¯Â ÛÙÔ 12% ÙˆÓ ·ÙfïÓ. ™‡Ìʈӷ Ì ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È Ì ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË YÁ›·˜, Ë "ηډȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·" Ù·˘Ù›˙ÂÙ·È ÎÏÈÓÈο Î·È ÈÛÙÔÏÔÁÈο Ì ÙË ¢MK£ ÌÂÙ¿ ·fi Ì˘Ôηډ›Ùȉ·. E›Ó·È Â›Û˘ ÛËÌ·ÓÙÈÎfi Ó· ·Ó·ÊÂÚı›, fiÙÈ

112

ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì˘Ôηډ›Ùȉ·˜ ·fi Èfi Coxsackie B, Ë ÎÏÈÓÈ΋ ‰È·‰ÚÔÌ‹ ‹Ù·Ó ÛȈËÚ‹. ™Â ·‰ËÌÔÛ›Â˘ÙË ‰È΋ Ì·˜ ÌÂϤÙË, Ë Û˘¯ÓfiÙËÙ· Ì˘Ôηډ›Ùȉ·˜ ηÈ/‹ ÂÚÈηډ›Ùȉ·˜ ÛÙË ‰È¿ÚÎÂÈ· ÓfiÛËÛ˘ ·fi ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ΢ڛˆ˜ ·fi ÙÔÓ Èfi ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ (Ì ·Ô˘Û›· ÈÒÓ Coxsackie), ‚Ú¤ıËΠ9%. Afi Ù· ÈÔ ¿Óˆ, ÂÍ¿ÁÂÙ·È ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙfiÛÔ ÛÙËÓ ÈÔÁÂÓ‹ Ì˘Ôηډ›Ùȉ·, fiÛÔ Î·È ÛÙË ¢MK£, Á›ÓÂÙ·È ˘ԉȿÁÓˆÛË Ì ٷ Û˘Ó‹ıË ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·, ÂÓÒ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fi¯È ÌfiÓÔ ÁÈ· ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Ù˘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜, ·ÏÏ¿ Î·È ÁÈ· ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÌÂÙ¿ÙˆÛ‹˜ Ù˘ Û ¢MK£.

OÈ ÈÔ› Ô˘ ·ԉ›¯ÙËΠ̠ÔÈΛϘ ‰È·ÁÓˆÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ fiÙÈ ÚÔηÏÔ‡Ó Ì˘Ôηډ›Ùȉ· ÛÙÔÓ ¿ÓıÚˆÔ, Û fiϘ ÙȘ ËÏÈ˘, Â›Ó·È ÔÏÏÔ› (›Ó·Î·˜ 1). MÂÚÈÎÔ› ·fi ·˘ÙÔ‡˜ Â›Ó·È ÁÓˆÛÙÔ› ·fi ÙÔ ·ÚÂÏıfiÓ, ÂÓÒ ¿ÏÏÔÈ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó ÈÔ ÚfiÛÊ·Ù·. K¿ÔÈÔÈ ıˆÚÔ‡ÓÙ·È ˘‡ı˘ÓÔÈ Î·È ÁÈ· ¿ÏϘ ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ. OÈ ÂÓÙÂÚÔ˚Ô›, ÔÈ ÈÔ› Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜, Ô Èfi˜ Epstein-Barr, Ô Èfi˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘, Ô ÌÂÁ·ÏÔ΢ÙÙ·ÚÈÎfi˜ Èfi˜, ÔÈ ÂÚËÙÈÎÔ› ÈÔ› Î·È Ô Èfi˜ ÙÔ˘ AIDS ¤¯Ô˘Ó ‚‚·Èˆı› ˆ˜ ·ÈÙ›· "ÔÍ›·˜ ηډȷ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜", ÂÌÊÚ¿ÁÌ·ÙÔ˜, ÔÍ›·˜ ÂÚÈηډ›Ùȉ·˜, ·ÚÚ˘ıÌ›·˜ Î·È ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Û ‰È¿ÊÔÚ˜ ËÏÈ˘.

H Û¯ÂÙÈο ÌÈÎÚ‹ ·Ó·ÏÔÁ›· (14/87) ÚˆÙÔ·ıÔ‡˜ "ηډȷ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜" Ô˘ ‚Ú‹Î·Ó ÛÙËÓ ÚˆÙÔÔÚȷ΋ ÙÔ˘˜ ¤Ú¢ӷ ÔÈ Montague et al., ÂÚÌËÓ‡ÂÙ·È ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ Û·Ó ¤Ó‰ÂÈÍË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ Ô˘ ˘¿Ú¯Ô˘Ó ˆ˜ ÚÔ˜ ÙËÓ Ù·‡ÙÈÛË ÌÈ·˜ ÛÔ‚·Ú‹˜ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ¢MK£. ™‡Ìʈӷ Ì ÙÔ˘˜ ›‰ÈÔ˘˜, ·ÏÏ¿ Î·È ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ ‚‚·ÈÒÓÂÙ·È Ë ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË ÙˆÓ ÂÓÙÂÚÔ˚ÒÓ, ÔÈ ÔÔ›ÔÈ ·Ó¢ڛÛÎÔÓÙ·È ˆ˜ ˘‡ı˘ÓÔÈ Ì¤¯ÚÈ Î·È ÛÙÔ 69% ÙˆÓ ÙÂÎÌËÚÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ ÈÔÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È ··Û¯ÔÏÔ‡Ó ¤ÓÙÔÓ· ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ÏfiÁˆ ÙÔ˘ ÁÓˆÛÙÔ‡ ηډÈÔÙÚÔÈÛÌÔ‡ ÙÔ˘˜.

OÈ Kereiakes and Parmley ‰ËÌÔÛ›Â˘Û·Ó ÙÔ 1984 ÌÈ· ÂÍ·ÈÚÂÙÈ΋ Î·È ÂÎÙÂٷ̤ÓË ·Ó·ÛÎfiËÛË Ì ı¤Ì· ÙË Û¯¤ÛË Ù˘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ Ì ÙË ¢MK£, Ô˘ ˘‹ÚÍ ÚfiÙ˘Ô ·Ó·ÊÔÚ¿˜ ÌÂÙ·ÁÂÓ¤ÛÙÂÚˆÓ ÌÂÏÂÙÒÓ. OÈ ÈÔ ¿Óˆ Û˘ÁÁÚ·Ê›˜ ‰È·Ù‡ˆÛ·Ó "˘fiıÂÛË" ÁÈ· Ó· ÂÍËÁ‹ÛÔ˘Ó ÙË ‰Ú¿ÛË ÙˆÓ ÈÒÓ ÛÙÔ Ì˘ÔοډÈÔ Î·È ÙËÓ Î·Ù¿ÏËÍË Ù˘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ Û ¢MK£. ™‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË ·˘Ù‹, Ë

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‰Ú¿ÛË ÙˆÓ ÈÒÓ Â›Ó·È ‰ÈÙÙ‹: ·) ÚÔηÏÂ›Ù·È ¿ÌÂÛË Î·Ù·ÛÙÚÔÊ‹ Ù˘ ηډȷ΋˜ Ì˘˚΋˜ ›Ó·˜ (΢ÙÙ·ÚfiÏ˘ÛË), Î·È ‚) ÚÔηÏÂ›Ù·È ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË (·‡ÍËÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ IgM ·ÓÙÈۈ̿وÓ), ηıÒ˜ Î·È Î˘ÙÙ·ÚÈ΋ ·¿ÓÙËÛË. H ÙÂÏÂ˘Ù·›· Û˘Ó›ÛÙ·Ù·È Û ÎÈÓËÙÔÔ›ËÛË ÙˆÓ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ NK (·ÙÙ·Ú·-ÊÔÓ›˜) ΢ÙÙ¿ÚˆÓ, Ô˘ Ì·˙› Ì ٷ Ì·ÎÚÔÊ¿Á·, ηٷÛÙÚ¤ÊÔ˘Ó Ù· ÂÈ˙ÒÓÙ· ηډȷο Ì˘˚ο ·ÙÙ·Ú·. ŒÙÛÈ, Â¤Ú¯ÂÙ·È ÂӉȿÌÂÛË ÊÏÂÁÌÔÓ҉˘ ˘ÔÍ›· ‚Ï¿‚Ë ÙÔ˘ Ì˘Ôηډ›Ô˘, ·˘ÙÔ·ÓÔÛÔÔÈËÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·. H ÙÂÏÂ˘Ù·›· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÌfiÓÈ̘ ‚Ï¿‚˜. ™ÙË ıˆڛ· ·˘Ù‹ ÚÔÛÙ¤ıËÎÂ Î·È ¿ÏÏÔ˜ ‚·ÛÈÎfi˜ Ì˯·ÓÈÛÌfi˜, ·˘Ùfi˜ Ù˘ ‚Ï¿‚˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ô˘ ÚÔηÏ› ·fiÊÚ·ÍË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÌÈÎÚÔ΢ÎÏÔÊÔÚ›·˜ Î·È Û˘Ì‚¿ÏÏÂÈ ÙÂÏÈο Î·È ·˘Ùfi˜ ÛÙË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. H ıˆڛ· ·˘Ù‹, ÛÙÔ Û‡ÓÔÏfi Ù˘, ÂȂ‚·ÈÒÓÂÈ ÙËÓ "˘fiıÂÛË ÂÚÁ·Û›·˜" ÙÔ˘ Goodwin Ô˘ ›¯Â ‰È·Ù˘ˆı› ‹‰Ë ·fi ÙÔ 1982, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· "ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÂÚÈÙÒÛÂˆÓ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ ÌÂÙ·›ÙÂÈ Û ¢MK£, ÌÂÙ¿ ·fi ¿ÏÏÔÙ ‰È·ÊÔÚÂÙÈ΋˜ ‰È¿ÚÎÂÈ·˜ ÛȈËÚ‹ ÂÚ›Ô‰Ô".

T· ‰Â‰Ô̤ӷ ÙˆÓ ÈÔ ¿Óˆ, ·ÏÏ¿ Î·È ÌÂÙ·ÁÂÓ¤ÛÙÂÚˆÓ Û˘ÁÁڷʤˆÓ, ÛÙËÚ›˙ÔÓÙ·È Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, ÓÂÎÚÔÙÔÌÈο Â˘Ú‹Ì·Ù· Î·È ·Ó‡ÚÂÛË ˘„ËÏÒÓ ÙÈÌÒÓ Ù›ÙÏˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ, Ù· ÔÔ›· fï˜ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· Â·Ú΋ ÁÈ· Ó· ÂȂ‚·ÈÒÛÔ˘Ó ÙËÓ ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË ÙˆÓ ÈÒÓ Ì ÙË ¢MK£. ◊Ù·Ó ··Ú·›ÙËÙÔ Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó Â·ÎÚÈ‚Ò˜ Ë Û˘ÁÎÂÎÚÈ̤ÓË ‰Ú¿ÛË ÙˆÓ ÈÒÓ Î·È Ô ÙÚfiÔ˜ Ù˘ ·¿ÓÙËÛ˘ ÙÔ˘ ·ÓÔÛÔ‚ÈÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ Î·È Ó· ·Ú·ÎÔÏÔ˘ıËı› Ë ÂͤÏÈÍË ÙˆÓ ‚Ï·‚ÒÓ. T· ÈÔ ¿Óˆ ÂÈÙ‡¯ıËÎ·Ó ¯¿ÚË: ·) ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ Ù¯ÓÈ΋˜ Ù˘ ÂÓ‰ÔÌ˘Ôηډȷ΋˜ ‚ÈÔ„›·˜, ‚) ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ú·‰ÈÔ˚ÛÔÙÔÈÎÒÓ ÌÂıfi‰ˆÓ ÌÂÁ¿Ï˘ ¢·ÈÛıËÛ›·˜, Á) ÛÙËÓ Ù¯ÓÈ΋ ÙÔ˘ ˘‚ÚȉÈÛÌÔ‡ Î·È ‰) ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ¿ÏÏˆÓ Ù¯ÓÈÎÒÓ Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È ÙˆÓ ÌÂıfi‰ˆÓ ÈÔÏÔÁÈ΋˜, ÁÂÓÈο, ¤Ú¢ӷ˜ Û fiϘ ÙȘ Ê¿ÛÂȘ Ù˘ ÂͤÏÈ͢ Ù˘ Ïԛ̈͢ ÙÔ˘ Ì˘Ôηډ›Ô˘.

H ÏÔÈÌ҉˘ ·ÈÙÈÔÏÔÁ›· ·Ô‰ÂÈÎÓ‡ÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ‰È‹ıËÛ˘ Û ‰Â›ÁÌ·Ù· ÂÓ‰ÔÌ˘Ôηډȷ΋˜ ‚ÈÔ„›·˜, ÛÙË ‰È¿ÚÎÂÈ· ΢ڛˆ˜

§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ ·ÏÏ¿ Î·È ÛÙȘ ˘fiÏÔÈ˜ Ê¿ÛÂȘ Ù˘ ÂͤÏÈÍ‹˜ Ù˘. ™ÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Â˘Ú‹Ì·ÙÔ˜ ·˘ÙÔ‡ ÛÂ Ì˘Ôηډ›Ùȉ· Î·È Û ¢MK£ ÌÂÙ¿ ·fi ÈÔÁÂÓ›˜ ÂȉË̛˜, Î˘Ì·›ÓÂÙ·È ·fi 0 ˆ˜ 65%. OÈ ÌÂÁ¿Ï˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÂÚ¢ÓËÙÒÓ ·Ô‰fiıËÎ·Ó ÛÙË ¯Ú‹ÛË ‰È·ÊÔÚÂÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÂÈÏÔÁ‹˜ ÙˆÓ ·ÚÚÒÛÙˆÓ Î·È ÛÙËÓ ·ÓÔÌÔÈÔÌÔÚÊ›· ÙˆÓ ÎÚÈÙËÚ›ˆÓ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ù˘ ‚ÈÔ„›·˜. ⁄ÛÙÂÚ· fï˜ ·fi ÙËÓ Î·ıȤڈÛË ÙˆÓ "ÎÚÈÙËÚ›ˆÓ ÙÔ˘ Dallas" ÁÈ· ÙË Ì˘Ôηډ›Ùȉ·, Ì ‚¿ÛË Ù· Â˘Ú‹Ì·Ù· Ù˘ ‚ÈÔ„›·˜, Ô˘ ıˆÚÔ‡ÓÙ·È Ù· ÈÔ ·ÓÙÈÎÂÈÌÂÓÈο, Ë Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ‰È‹ıËÛ˘ Î·È ¿ÏÏˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÂӉ›ÍÂˆÓ ÛÂ Ì˘Ôηډ›Ùȉ· Î·È ¢MK£ ÂÚÈÔÚ›ÛÙËΠÛÙÔ 8-9% Ì ·ÎÚ·›Â˜ ÙÈ̤˜ 0-38%. ø˜ ÚÔ˜ ÙË ‰Ú¿ÛË ÙˆÓ ÈÒÓ, ¯¿ÚȘ ÛÙË ÌÔÚȷ΋ ‚ÈÔÏÔÁ›· Û‹ÌÂÚ· Â›Ó·È ·Ô‰ÂÎÙfi: 1) ŸÙÈ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ Ì˘Ôηډ›Ùȉ·˜, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È Î·È ·fi ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÚÔ˘Û›·˜ ÙˆÓ ÈÒÓ ÛÙ· ·ÙÙ·Ú· Î·È ·fi ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ÈÒÓ, Ô˘ ‰ÂÓ ÍÂÂÚÓ¿ ÙȘ 15 Ë̤Ú˜, Â¤Ú¯ÔÓÙ·È ÙfiÛÔ Ë ¿ÌÂÛË Ú‹ÍË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ·fi ÙÔÓ ·ıÔÁfiÓÔ Èfi, fiÛÔ Î·È Ë ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Î·È Ë Û˘Ó¤¯ÈÛË Ù˘ ηٷÛÙÚÔÊ‹˜ ÙˆÓ Î·Ú‰È·ÎÒÓ Ì˘˚ÎÒÓ ÈÓÒÓ, fiˆ˜ ·Ú¯Èο ›¯Â ˘ÔÙÂı›. TÔ DNA ÙÔ˘ ÈÔ‡ ηıÔ‰ËÁ› Ù· ·Ó·Áη›· ÁÈ· ·Ó·Ù‡ˆÛË ÙÔ˘ ÈÔ‡ ÚˆÙÂ˚ÓÈο ÛÙÔȯ›· ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÙÔ˘ ÍÂÓÈÛÙ‹. A˘Ù¿ ηٷÛÙÚ¤ÊÔÓÙ·È Î·È ÔÈ ÚˆÙ½Ó˜ ÙÔ˘ ÈÔ‡ Ô˘ ¤¯Ô˘Ó Û˘ÓÙÂı› ·ÂÏ¢ıÂÚÒÓÔÓÙ·È. ŒÙÛÈ, Í·Ó·Ú¯›˙ÂÈ Ô ÚˆÙÂ˚ÓÈÎfi˜ ·ÎÏÔ˜.

2) ŸÙÈ Î·Ù¿ ÙȘ ÌÂÙ¤ÂÈÙ· Ê¿ÛÂȘ Ù˘ Ïԛ̈͢, Û˘Ó¯›˙ÂÙ·È Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Î·Ú‰È·ÎÒÓ Ì˘˚ÎÒÓ ÈÓÒÓ, ˆ˜ ·˘ÙÔ·ÓÔÛÔÔÈËÙÈ΋ ·¿ÓÙËÛË ϤÔÓ, Ô‰ËÁÒÓÙ·˜ Û ¯ÚÔÓÔÏÔÁÈο ÂӉȿÌÂÛË ˘ÔÍ›· Ì˘Ôηډ›Ùȉ· ·˘ÙÔ·ÓÔÛÔÔÈËÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, Ë ÔÔ›· ÌÂÙ·›ÙÂÈ Û ¢MK£. X¿ÚȘ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ù¯ÓÈÎÒÓ Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ ÛÙËÓ ÈÔÏÔÁ›·, ÌÔÚԇ̠ӷ ·ÓȯÓ‡ÛÔ˘Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÂÈÙÒÛÂˆÓ ÙˆÓ ÁÂÓˆÌ¿ÙˆÓ ÙˆÓ ÂÓÙÂÚÔ˚ÒÓ Î·È ÂȉÈÎfiÙÂÚ· ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ Coxsackie B ÛÙ· ‰Â›ÁÌ·Ù· ÈÛÙÔ‡ Ô˘ ·›ÚÓÔ˘Ì Ì ÂÓ‰Ôηډȷ΋ ‚ÈÔ„›·, ÙfiÛÔ ÛÂ Ì˘Ôηډ›Ùȉ·, fiÛÔ Î·È Û ¢MK£. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ Ù¯ÓÈ΋ ÙÔ˘ ˘‚ÚȉÈÛÌÔ‡. M ÙËÓ Ù¯ÓÈ΋

¶›Ó·Î·˜ 1. IÔ› Ô˘ ·ԉ‰ÂÈÁ̤ӷ ÚÔηÏÔ‡Ó Ì˘Ôηډ›Ùȉ· ÛÙÔÓ ¿ÓıÚˆÔ ·ÏÏ¿ Î·È ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ·.

IÔ› RNA OÚıÔ‚ÏÂÓÓÔ˚fi˜, ¶·Ú·‚ÏÂÓÓÔ˚fi˜, P·‚‰Ô˚fi˜, IÔ›: Picirba, Toya, Arena, Corona Cocsackie A Î·È B ÈÔ›, Echo Èfi˜, IÔ›: ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, H·Ù›Ùȉ·˜ A, IÓÊÏÔ˘¤ÓÙ˙·˜ A Î·È B, IÏ·Ú¿˜, EÚ˘ıÚ¿˜, ¶·ÚˆÙ›Ùȉ·˜, K›ÙÚÈÓÔ˘ ˘ÚÂÙÔ‡, §‡ÛÛ·˜ IÔ› DNA Ifi˜ ·ÏÔ‡ ¤ÚËÙ·, A‰ÂÓÔ˚fi˜, Ifi˜ H·Ù›Ùȉ·˜ B, Ifi˜ §ÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ¯ÔÚÈÔÌËÓÈÁÁ›Ùȉ·˜, IÔ›: E˘ÏÔÁÈ¿˜, AÓÂÌ¢ÏÔÁÈ¿˜, ŒÚËÙ·-˙ˆÛÙ‹Ú·, Pox, Parvo

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·˘Ù‹, fiˆ˜ ı· ‰Ô‡Ì ÈÔ Î¿Ùˆ, ÚÔ˜ ÙÔ ·ÚfiÓ ·ÏÒ˜ ÂȂ‚·ÈÒÓÂÙ·È Ë Û¯¤ÛË Ì˘Ôηډ›Ùȉ·˜ Î·È ¢MK£.

H ÌÂÙ¿ÙˆÛË Ù˘ Ì˘Ôηډ›Ùȉ·˜ Û ¢MK£ ¤¯ÂÈ ‰È·ÈÛÙˆı› ÛÙÔÓ ¿ÓıÚˆÔ Ì ÎÏÈÓÈΤ˜ Î·È ÂÓ‰ÂÈÎÙÈΤ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÌÂıfi‰Ô˘˜ Î·È ·ԉ›¯ÙËΠ۠ÂÈÚ·Ì·Ùfi˙ˆ·, Ì ÚfiÎÏËÛË Ì˘Ôηډ›Ùȉ·˜ Î·È ÂÓ Û˘Ó¯›· ·Ó·ÙÔÌÈ΋ ‰È·›ÛÙˆÛË ¢MK£. ™˘ÁÎÂÎÚÈ̤ӷ, ˘¿Ú¯Ô˘Ó ÂÈÚ·Ì·ÙÈΤ˜ ·ԉ›ÍÂȘ, fiÙÈ Ë ÚÔÎÏËÙ‹ ÈÔÁÂÓ‹˜ Ì˘Ôηډ›Ùȉ· ÌÔÚ› Ó· ÌÂÙ·¤ÛÂÈ Û ¢MK£ ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ· Î·È fiÙÈ ·˘Ùfi ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ÈÔ‡ Î·È ·fi ÙË Ê˘Ï‹ ÙÔ˘ ÂÈÚ·Ì·Ùfi˙ˆÔ˘, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ Î·È ÙË ÁÂÓÂÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ¢MK£.

H ¢MK£ Î·È Ô ¿ÌÂÛÔ˜ ÚfiÏÔ˜ ÙˆÓ ÈÒÓ Coxsackie H ·Ó¿Ù˘ÍË ¢MK£ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (Û˘Ó‹ıˆ˜ - Î·È Î˘Ú›ˆ˜ - Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜) Î·È ·fi ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· ÛÔ‚·Ú‹˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Â›Ó·È ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ·fi ÔÈΛϷ ·›ÙÈ·. ™ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ·Ó¢ڛÛÎÔÓÙ·È ÂÎÙÂٷ̤Ó˜ ÂÚÈÔ¯¤˜ ‰È¿ÌÂÛ˘ Î·È ÂÚÈ·ÁÁÂȷ΋˜ ›ÓˆÛ˘ Î·È ÌÈÎÚ¤˜ ÂÚÈÔ¯¤˜ Ó¤ÎÚˆÛ˘ Ì ÊÏÂÁÌÔÓÒ‰Ë Î˘ÙÙ·ÚÈ΋ ‰È‹ıËÛË. ™ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ·Ó¢ڛÛÎÔÓÙ·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Ì ÂÍÔ›‰ËÛË Î·È ·ÒÏÂÈ· ÙˆÓ ·ÎÚÔÏÔÊÈÒÓ (cristae) Ù˘ ¤Ûˆ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘˜ ηıÒ˜ Î·È Ì ÂÏ·Ùو̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ÂÓ˙‡ÌˆÓ ÙÔ˘˜. OÈ ‚Ï¿‚˜ ·˘Ù¤˜ Â›Ó·È ÌË ÂȉÈΤ˜ Î·È ÌfiÓÔÓ ·Ó ·Ó¢ڛÛÎÔÓÙ·È ÛÙ·ıÂÚ¿, ÌÔÚÔ‡Ó Ó· ¯·Ú·ÎÙËÚÈÛÙÔ‡Ó ˆ˜ "ÌÈÙÔ¯ÔÓ‰Úȷ΋ ¢MK£". ¶·ÚfiÌÔȘ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ ·Ó¢ڛÛÎÔÓÙ·È Î·È ÛÙËÓ ÈÔÁÂÓ‹ Ì˘Ôηډ›Ùȉ·, Ì ‰È·ÊÔÚ¤˜ Ì¿ÏÏÔÓ ÔÛÔÙÈΤ˜. OÈ ÈÛÙÔÏÔÁÈΤ˜ ÔÌÔÈfiÙËÙ˜ Î·È ‰È·ÊÔÚ¤˜ Ì˘Ôηډ›Ùȉ·˜ Î·È ¢MK£, Ô˘ ·Ó¢ڛÛÎÔÓÙ·È, ÂÍ·ÚÙÒÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Ù˘ ‚ÈÔ„›·˜ Ô ÔÔ›Ô˜, ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈÛÙ¿Ù·È Ó· Â›Ó·È fiÛÔ Á›ÓÂÙ·È ÌÂÁ·Ï‡ÙÂÚÔ˜. OÈ ÔÌÔÈfiÙËÙ˜ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÌÂÙ¿ÙˆÛ˘ Î·È ÂÚÌËÓÂ‡Ô˘Ó ÙȘ Û˘¯Ó¿ ·Ó·ÊÂÚfiÌÂÓ˜ ÛÔ‚·Ú¤˜ ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ÚÔËÁËı›۷˜ Ì˘Ôηډ›Ùȉ·˜ Û ·ÛıÂÓ›˜ Ì ¢MK£.

M ÙÔ Ú›ÛÌ· ·˘Ùfi, ı· ‹Ù·Ó Â·Ú΋˜ ·fi‰ÂÈÍË Ë ¿ÌÂÛË ·Ó‡ÚÂÛË ÈÒÓ Coxsackie ‹ Ë ·Ó‡ÚÂÛË ÂȉÈÎÒÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ÈÔ‡ ÛÙÔ Ì˘ÔοډÈÔ Ô˘ fï˜ ·ÔÙÂÏÔ‡Ó Û¿ÓÈÔ Â‡ÚËÌ·. AÓÙ›ıÂÙ·, Ôχ Û˘¯ÓfiÙÂÚ· Î·È Â˘ÎÔÏfiÙÂÚ· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ˘„ËϤ˜ ÙÈ̤˜ ÂÍÔ˘‰ÂÙÂÚˆÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ Coxsackie B Ì ÙË ÌÈÎÚÔ̤ıÔ‰Ô Û‡Ó‰ÂÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜. OÈ Ù›ÙÏÔÈ ·˘ÙÔ› ‚Ú¤ıËÎ·Ó Ôχ ˘„ËÏfiÙÂÚÔÈ Û ¿Û¯ÔÓÙ˜ ·fi ¢MK£ Û˘ÁÎÚÈÙÈο Ì ̿ÚÙ˘Ú˜ Î·È Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. H ·Í›· fï˜, Ù˘ ¤Ó‰ÂÈ͢ ·˘Ù‹˜ ÌÂÈÒÓÂÙ·È ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ‰È¿‰ÔÛ˘ ÙˆÓ ÂÓÙÂÚÔ˚ÒÓ.

M ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ÙÔ˘ ˘‚ÚȉÈÛÌÔ‡ Ô˘ ¿Ú¯ÈÛ ÙÔ 1986 Î·È Ô˘ ÂÍÂÏ›ÛÛÂÙ·È, ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·, ÂÓ‰ÂÈÎÙÈο ‚Ï¿‚˘ ÙÔ˘ Ì˘Ôηډ›Ô˘ ·fi

114

°Ú·Ùfi ™˘ÌfiÛÈÔ

ÂÓÙÂÚÔ˚fi, ·Ó¢ڛÛÎÔÓÙ·È Û ÔÛÔÛÙfi ̤¯ÚÈ 66% ÁÈ· ÙË ¢MK£ Î·È Ì¤¯ÚÈ 30% ÁÈ· ÙË Ì˘Ôηډ›Ùȉ·. TÔ ÌÂÈÔÓ¤ÎÙËÌ· ·˘Ù‹˜ Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È Ë ·Ó¿ÁÎË ÛËÌ·ÓÙÈÎÒÓ ÔÛÔÙ‹ÙˆÓ Ì˘ÔηډȷÎÔ‡ ÈÛÙÔ‡. H ‰˘ÛÎÔÏ›· ·˘Ù‹ ÌÔÚ› Ó· ÍÂÂÚ·ÛÙ› Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÂÓ˙˘Ì·ÙÈ΋˜ Ù¯ÓÈ΋˜ (PCR), Ì ÙËÓ ÔÔ›· Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÔÈΛÏÔ˘Ó ÛÂ Ì˘Ôηډ›Ùȉ· ·fi 20100%, ÂÓÒ Û ¢MK£ ·fi 0-66%. MÔÚ› Î·È ·˘Ù‹ Ë Ì¤ıÔ‰Ô˜ Ó· ÌËÓ Â›Ó·È Û ı¤ÛË ·ÎfiÌË Ó· ‰ÒÛÂÈ Ï‹ÚË ·¿ÓÙËÛË, ·ÏÏ¿ ˘fiÛ¯ÂÙ·È Î·Ï‡ÙÂÚË ÌÂϤÙË Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ ÈÔÁÂÓÔ‡˜ ¢MK£. A·ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ÚfiÔ‰Ô˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÚÔ˜ ÌÂϤÙË ·ÙfïÓ, ÒÛÙ ӷ ·ÔÎÏ›ÔÓÙ·È ÔÈ ÔÈÎÔÁÂÓ›˜ ‹ ÔÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜.

M›· ̤ıÔ‰Ô˜ Ì ÌÂÁ¿ÏË Â˘·ÈÛıËÛ›·, Ô˘ ‚ÔËı¿ ÛËÌ·ÓÙÈο ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÔÍ›·˜ Ì˘Ôηډ›Ùȉ·˜ Î·È ÛÙËÓ ÈÔ ¿Óˆ ˙ËÙÔ‡ÌÂÓË ÂÈÏÔÁ‹ ÙˆÓ ·ÙfïÓ, Â›Ó·È Ô Ú·‰ÈÔ˚ÛÔÙÔÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ڷ‰ÈÔÛÂÛËÌ·Ṳ̂ӷ ·ÓÙÈÌ˘ÔÛÈÓÈο ·ÓÙÈÛÒÌ·Ù· Ì indium-111, Ô˘ ¤¯ÂÈ ‹‰Ë ·ÓÙÈηٷÛÙ‹ÛÂÈ ÙË Ú·‰ÈÔÛ‹Ì·ÓÛË ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Ì gallium-67, ÂÍ·ÈÙ›·˜ Ù˘ ¯·ÌËÏ‹˜ Ù˘ ¢·ÈÛıËÛ›·˜. H ¢·ÈÛıËÛ›· Ù˘ Ó¤·˜ ÌÂıfi‰Ô˘ Â›Ó·È 83-100% Î·È Ë ÂÍÂȉ›ÎÂ˘Û‹ Ù˘ 35-66% Î·È ÁÈ' ·˘Ùfi Â›Ó·È Ôχ ¯Ú‹ÛÈÌË ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì˘Ôηډ›Ùȉ·˜ ÚÈÓ ·fi ÙË ‚ÈÔ„›· Î·È ¯ÚËÛÈÌÔÔÈÂ›Ù·È ‹‰Ë Û ÔÚÈṲ̂ӷ Â˘Úˆ·˚ο ΤÓÙÚ·, ηıÒ˜ Î·È ÛÙË ¯ÒÚ· Ì·˜. ¶ÚÈÓ ÚԂԇ̠ÛÙË ‚ÈÔ„›·, Û˘ÓÈÛÙ¿Ù·È Ó· ·Ó·Ì¤ÓÔ˘Ì ÙËÓ ÂͤÏÈÍË Ù˘ Ì˘Ôηډ›Ùȉ·˜ Â› 2-3 ‚‰ÔÌ¿‰Â˜, ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜, ¤Ó·˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Â›Ó·È fiÙÈ ‰ÂÓ ·ÔÎÏ›ÂÙ·È Ë Ï‹Ú˘ ›·ÛË ÌÂÙ¿ ÙË 15Ë Ë̤ڷ ÓfiÛÔ˘. ¶·ÚfiÏ· ·˘Ù¿, ÙÔ ÌÂÁ¿ÏÔ ÂÚÒÙËÌ· "fiÙ ·ÎÚÈ‚Ò˜ ·Ú¯›˙ÂÈ Ë ÌÂÙ¿ÙˆÛË Û ¢MK£ ÌÂÙ¿ ·fi Ïԛ̈ÍË Ì Èfi Coxsackie" ‰ÂÓ ¤¯ÂÈ ··ÓÙËı› ·ÎfiÌË. ™Â ÌÂÚÈΤ˜ Ì¿ÏÈÛÙ· ÂÚÈÙÒÛÂȘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜, Ë ÂÈÎfiÓ· "ηډȷ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜" Â›Ó·È Ôχ ÚÒÈÌË. ¶Èı·ÓfiÙËÙ˜ ÂͤÏÈ͢ Ù˘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ Î·È Ù˘ ¢MK£ E›Ó·È ÁÓˆÛÙfi ·fi ÙÔ 1964, fiÙÈ Ë ÂͤÏÈÍË Ù˘ Ì˘Ôηډ›Ùȉ·˜ Â›Ó·È Ë Ï‹Ú˘ ›·ÛË, ̤¯ÚÈ 25-50%, ‹ Ô ı¿Ó·ÙÔ˜, ÛÙÔ 10-25% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ ÚfiÎÂÈÙ·È ÁÈ· ·ÛıÂÓ›˜ Ô˘ Â›Ó·È Ê·ÈÓÔÌÂÓÈο ˘ÁÈ›˜. Afi ·˘ÙÔ‡˜, Ô˘ÛÈ·ÛÙÈο Û ¿ÁÓˆÛÙË ·Ó·ÏÔÁ›·, ‹ ÔÚÈÛÙÈÎÔÔÈÂ›Ù·È ‹ ›·ÛË ‹, ¿ÏÏÔÙÂ, ÂΉËÏÒÓÂÙ·È ¢MK£.

Afi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ Ì ¢MK£, Ô˘ ÂΉËÏÒÓÂÙ·È Û ·È‰È΋ ËÏÈΛ·, Î·È ÔÈ ÔÔ›ÔÈ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ù·ÎÙÈο, ηډÈÔÏÔÁÈο, Î·È Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÛÙ·ıÂÚ¿ ÙËÓ ˘ÔÛÙËÚÈÎÙÈ΋ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Ì ‰·ÎÙ˘Ï›Ùȉ· Î·È ‰ÈÔ˘ÚËÙÈο, ·Ú·ÙËÚÂ›Ù·È ·ÔηٿÛÙ·ÛË ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi Û ÔÛÔÛÙfi 35-50 %, ÌÂÙ¿ ·fi 20-30 ¯ÚfiÓÈ·. OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ Â˘ÓÔ˚΋ ‹ ‰˘ÛÌÂÓ‹ ÂͤÏÈÍË ‰ÂÓ Â›Ó·È Â·ÎÚÈ‚Ò˜ ÁÓˆÛÙÔ›. ™˘ÌÂÚ·ÛÌ·ÙÈο, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ÔÏÏÔ› ÈÔ›, ȉȷ›ÙÂÚ· ÔÈ ÂÓÙÂÚÔ˚Ô› Î·È ÂȉÈÎfiÙÂÚ· ÔÈ ÈÔ›

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·115

¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

Coxsackie B, ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÂÚÈÙÒÛÂȘ Ì˘Ôηډ›Ùȉ·˜ Ô˘ ÂÍÂÏ›ÛÛÔÓÙ·È Û ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. OÈ ÎÏÈÓÈΤ˜ Î·È ÔÈ ÔÚÔÏÔÁÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ÌÂÙ¿ÙˆÛË ·˘Ù‹ Â›Ó·È ·ÚÎÂÙ¿ ÁÓˆÛÙ¤˜. H ‚ÂÏÙ›ˆÛË Ù˘ Ù¯ÓÈ΋˜ Ù˘ ÂÓ‰ÔÌ˘Ôηډȷ΋˜ ‚ÈÔ„›·˜ Û˘Ó¤‚·Ï ÛÙËÓ ÙÂÎÌËÚ›ˆÛË ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ô˘ ›ıÔ˘Ó ·ÚÎÂÙ¿ ÈηÓÔÔÈËÙÈο ÁÈ· ÙË Û¯¤ÛË ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·È Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. ™˘Ó¤‚·Ï Â›Û˘, Î·È ÛÙË ÌÂϤÙË ÙˆÓ ÂÈÙÒÛÂˆÓ ÙˆÓ ÈÒÓ Coxsackie ÛÙȘ ηډȷΤ˜ Ì˘˚Τ˜ ›Ó˜ Û ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ì ÙË ‚Ô‹ıÂÈ· Ù˘ Ù¯ÓÈ΋˜ ÙÔ˘ ˘‚ÚȉÈÛÌÔ‡ Î·È Ù˘ PCR. º·›ÓÂÙ·È fiÙÈ ·˘Ù‹ ı· Â›Ó·È Ë Ù¯ÓÈ΋ Ô˘ ÛÙÔ ÂÁÁ‡˜ ̤ÏÏÔÓ ı· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙ· ·Ó·¿ÓÙËÙ· ·ÎfiÌË

ÂÚˆÙ‹Ì·Ù· Ù˘ Ú·ÁÌ·ÙÈ΋˜ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ Î·È Ù˘ Ú·ÁÌ·ÙÈ΋˜ Èı·ÓfiÙËÙ·˜ ÌÂÙ¿ÙˆÛ‹˜ Ù˘ Û ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·.

H ÛËÌ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ·˘ÙÒÓ ÁÈ· ÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Ôχ ÌÂÁ·Ï‡ÙÂÚË ·' fiÙÈ Ê·›ÓÂÙ·È, ÁÈ·Ù› Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙȘ ÈÒÛÂȘ Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚË ·' fiÛÔ ÈÛÙ‡ԢÌÂ Î·È ÁÈ·Ù› fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ·Ú¯›˙ÂÈ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 2 ¯ÚfiÓˆÓ.

§ÔÈÌÒÍÂȘ Î·È ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ M·Ú›· EÌÔÚÈ¿‰Ô˘ ¶ÔÏϤ˜ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ÈÛÙ‡ÂÙ·È fiÙÈ ÔÊ›ÏÔÓÙ·È Û ÚÔËÁËı›۷ Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. OÈ Colley Î·È Û˘Ó. ·Ú·ÎÔÏÔ‡ıËÛ·Ó ÌÈ· ÔÌ¿‰· ·È‰ÈÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙË MÂÁ¿ÏË BÚÂÙ·Ó›· ÙÔ 1946 Î·È ‚Ú‹Î·Ó fiÙÈ ·˘Ù¿ Ô˘ ›¯·Ó ‚ÚÔÁ¯›Ùȉ· ‹ Ó¢ÌÔÓ›· Ù· 2 ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜, ·ÚÔ˘Û›·˙·Ó ¯ÚfiÓÈÔ ‚‹¯· ÛÙËÓ ËÏÈΛ· ÙˆÓ 20 Î·È 25 ¯ÚfiÓˆÓ. OÈ Burrows Î·È Û˘Ó., ÛÙÔ Tuscon Ù˘ Arizona, ‚Ú‹Î·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÈÛÙÔÚÈÎÔ‡ ·Ó·Ó¢ÛÙÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Û ÂÓ‹ÏÈΘ Ì ¯ÚfiÓÈ· ‚ÚÔÁ¯›Ùȉ·. OÈ Leeder Î·È Û˘Ó. ·Ú·ÎÔÏÔ‡ıËÛ·Ó ·Ó·‰ÚÔÌÈο, ·fi ÙË Á¤ÓÓËÛË Ì¤¯ÚÈ Ù· 5 ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜, ÌÈ· ÔÌ¿‰· ·È‰ÈÒÓ ÛÙÔ §ÔÓ‰›ÓÔ Î·È ‚Ú‹Î·Ó fiÙÈ ÂΛӷ Ì ‚ÚÔÁ¯›Ùȉ· Î·È Ó¢ÌÔÓ›· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, Û˘Ó¤¯È˙·Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù· Î·È ÂÏ¿ÙÙˆÛË Ù˘ ̤ÁÈÛÙ˘ ÂÎÓ¢ÛÙÈ΋˜ ÚÔ‹˜ ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹. ¶ÔÏÏÔ› ÂÓ‹ÏÈΘ Ì ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈ΋ ÓfiÛÔ, Â›Ó·È ÍÂοı·ÚÔ fiÙÈ ¤¯Ô˘Ó ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ·Ó·Ó¢ÛÙÈ΋˜ Ïԛ̈͢ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ù·¯‡ÙÂÚË Âȉ›ӈÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜, Î·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ Ì ÙÔ Î¿ÓÈÛÌ· ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. °ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰È·ÊÔÚÔÔÈÔ‡Ó ÙËÓ ·Ó¿Ù˘ÍË Ó¢ÌÔÓÔ¿ıÂÈ·˜ ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ. T· ·ÁfiÚÈ· Â›Ó·È ÈÔ ÂÈÚÚÂ‹ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¢ÌÔÓÔ¿ıÂÈ·˜ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜. ¶Ó¢ÌÔÓÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ù· ·ÁfiÚÈ· ¤¯Ô˘Ó Û¯ÂÙÈο ÌÈÎÚfiÙÂÚÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ·' fiÙÈ Ù· ÎÔÚ›-

ÙÛÈ· Î·È ·˘Ùfi ÌÔÚ› Ó· Úԉȷı¤ÙÂÈ Û ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÏÔÈÌÒÍÂˆÓ Î·ÙˆÙ¤ÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ŸÌˆ˜, Ô ÎÔÎ·Ù˘ Â›Ó·È ÌÈ· ηٿÛÙ·ÛË Î·Ù¿ ÙËÓ ÔÔ›· Ù· ÎÔÚ›ÙÛÈ· Â›Ó·È ÈÔ ÂÈÚÚÂ‹ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¢ÌÔÓÔ¿ıÂÈ·˜ ·' fiÙÈ Ù· ·ÁfiÚÈ·. O ÏfiÁÔ˜ ÁÈ' ·˘Ù‹ ÙË ‰È·ÊÔÚ¿ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ›. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ¿ÛıÌ· ˆ˜ ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·, ıˆÚÂ›Ù·È fiÙÈ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÍÂÎÈÓÔ‡Ó ÙË ÓfiÛÔ Û ÁÂÓÂÙÈο ÚԉȷÙÂıÂÈ̤ӷ ¿ÙÔÌ·, Î·È ¿ÏÏÔÈ ÚÔηÏÔ‡Ó ÙȘ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. OÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, Ù· ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ÔÈ ÂÚÂıÈÛÙÈΤ˜ Ô˘Û›Â˜ Â›Ó·È ·Ú¿ÁÔÓÙ˜ Ô˘ ÍÂÎÈÓÔ‡Ó ÙË ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹ Î·È ÙȘ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ.

O Û˘ÚÈÁÌfi˜ ÛÙ· ‚Ú¤ÊË Î·È ÛÙ· Ó‹È· Â›Ó·È ¤Ó· Û˘¯Ófi "¯ÚfiÓÈÔ" Úfi‚ÏËÌ· ÛÙËÓ Î·ı' Ë̤ڷ Ú¿ÍË.

T· ·È‰È¿ ·˘Ù¿ ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó¯‹ ‚‹¯· Î·È Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹. AӷʤÚÂÙ·È fiÙÈ ÛÙ· 3 ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ‰Ú· οÔÈÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ηıÔÚ›˙ÂÈ ÙËÓ ÚfiÁÓˆÛË ÙÔ˘ Û˘ÚÈÁÌÔ‡. O ·Ú¿ÁÔÓÙ·˜ ·˘Ùfi˜ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ηٿ ÙË Á¤ÓÓËÛË, ·ÏÏ¿ ÂӉ¯Ô̤ӈ˜ Ì ÙÔ Â›‰Ô˜ Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÛÙËÓ ÚÒÙË ÈÔÁÂÓ‹ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. BÚ¤ÊË Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi RSV Î·È ÂȉÈο ·˘Ù¿ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ‚Ú¤ıËΠfiÙÈ ÂÌÊ·Ó›˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ˘ÔÙÚÔ¤˜ Û˘Ú›ÙÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ ‹ ¿ÏÏË ¯ÚfiÓÈ· ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ. OÈ ·Èٛ˜ ÁÈ' ·˘Ùfi Ê·›ÓÂÙ·È Ó· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈΤ˜. MÂÚÈΤ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ê˘ÛÈÔÏÔÁÈο ÌÈÎÚ¿ ‚Ú¤ÊË ¤¯Ô˘Ó ÌÈ· ÂȉÈ΋ ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· ‚ÚfiÁ¯ˆÓ, Ô˘ ÌÔÚ› Ó·

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MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·116

¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

Úԉȷı¤ÙÂÈ Û ÔÔÈ·‰‹ÔÙ ‚Ï¿‚Ë ÛÙÔÓ Ó‡ÌÔÓ· Î·È Ô˘ Ê˘ÛÈÔÏÔÁÈο ÌÂÈÒÓÂÙ·È Ì ÙËÓ ËÏÈΛ·.

H ·ÔÊÚ·ÎÙÈ΋ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Â›Ó·È ¤Ó·˜ ¯ÚfiÓÈÔ˜ Ù‡Ô˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜. ™˘Ó‰¤ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Ì Ïԛ̈ÍË ·fi ·‰ÂÓÔ˚Ô‡˜ 7 Î·È 21 Û ‚Ú¤ÊË Ì ˘ÔΛÌÂÓË ÌË Î·ıÔÚÈṲ̂ÓË ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË. T¤ÙÔÈ· ‚Ú¤ÊË ¤¯Ô˘Ó Û˘¯Ó¿ ‚ÚÔÁ¯ÔÓ¢ÌÔÓ›· ·Ú¿ÏÏËÏ· Ì ٷ ÛËÌ›· Ù˘ ‚ÔÁ¯ÈÔÏ›Ùȉ·˜ Ô˘ Û˘Ó¯›˙ÂÈ ÁÈ· ‚‰ÔÌ¿‰Â˜ Î·È Ì‹Ó˜ Ì ÔÈΛÏË ‚·Ú‡ÙËÙ·. ¶ÂÚ›Ô˘ 60% ·˘ÙÒÓ ·Ó·Ù‡ÛÛÔ˘Ó ¯ÚfiÓÈ· ÓfiÛÔ ÌÂ Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹, ·ÙÂÏÂÎÙ·Û›·, ‚ÚÔÁ¯ÂÎٷۛ˜, ˘ÔÙÚÔÈ¿˙Ô˘Û· Ó¢ÌÔÓ›·, ˘ÂÚ·ÂÚÈÛÌfi ηÈ/‹ ÂÙÂÚfiÏ¢ÚÔ Û‡Ó‰ÚÔÌÔ ˘ÂډȷʷÓÔ‡˜ Ó‡ÌÔÓ·, ÏfiÁˆ ·fiÊڷ͢ Î·È Î·Ù·ÛÙÚÔÊ‹˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ Î·È ‚ÚÔÁ¯ÈÔÏ›ˆÓ. TÔ Û‡Ó‰ÚÔÌÔ ˘ÂډȷʷÓÔ‡˜ Ó‡ÌÔÓ· Â›Ó·È ·ÎÙÈÓÔÏÔÁÈÎfi ‡ÚËÌ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ÓË ˘ÂډȷʿÓÂÈ· fiÏÔ˘ ‹ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓfi˜ Ó‡ÌÔÓ· Ì Ì›ˆÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ Ó‡ÌÔÓ· ÏfiÁˆ Ì›ˆÛ˘ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ. °È· ÙÔ Û‡Ó‰ÚÔÌÔ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÏÔÈÌÒÍÂȘ ·fi ·‰ÂÓÔ˚fi, ÁÚ›Ë, ÈÏ·Ú¿, Î·È Ì˘ÎfiÏ·ÛÌ·.

TÔ ÎÔÎ΢ÙÔÂȉ¤˜ Û‡Ó‰ÚÔÌÔ Û˘Ó‰¤ÂÙ·È Ì ‚·ÚÈ¿ Ïԛ̈ÍË ·fi ·‰ÂÓÔ˚fi Ù‡Ô˘ 1,2,3,5,12 Î·È 19. H ÓfiÛÔ˜ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ‚Ú¤ÊË Î·È Û ÌÈÎÚ¿ ·È‰È¿ οو ÙˆÓ 36 ÌËÓÒÓ Î·È ‰È·ÚΛ 4-19 ‚‰ÔÌ¿‰Â˜. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ÙÔ ÎÔÎ΢ÙÔÂȉ¤˜ Û‡Ó‰ÚÔÌÔ ÔÊ›ÏÂÙ·È ÛÙËÓ MÔÚÙÂÙ¤ÏÏ· ÙÔ˘ ÎÔηÙË Î·È fiÙÈ Û˘Ó˘¿Ú¯ÂÈ Ïԛ̈ÍË Ì ·‰ÂÓÔ˚fi.

BÚ¤ÊË Ì ΢ÛÙÈ΋ ›ÓˆÛË ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ó‡ÌÔÓ˜ ÛÙË Á¤ÓÓËÛË. ŸÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ ÚÔÛ‚ÏËı› ·fi ÔÍ›· ÈÔÁÂÓ‹ Ïԛ̈ÍË ·Ú¿ÁÂÙ·È ·ıÔÏÔÁÈ΋ ‚ϤÓÓË Ô˘ Úԉȷı¤ÙÂÈ Û ·fiÊÚ·ÍË ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, ‰Â˘ÙÂÚÔ·ı‹ ÌÈÎÚԂȷ΋ Ïԛ̈ÍË, ηٷÛÙÚÔÊ‹ ‚ÚfiÁ¯ˆÓ Î·È ÂÚ·ÈÙ¤Úˆ Ïԛ̈ÍË. EÊfiÛÔÓ ¤¯ÂÈ Û˘Ì‚Â› Ë ·Ú¯È΋ ηٷÛÙÚÔÊ‹ ÙÔ˘ Ó‡ÌÔÓ·, ÙfiÙ ÙÔ ‚Ú¤ÊÔ˜ ·Ó·Ù‡ÛÛÂÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ Î·È ÚÔԉ¢ÙÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜.

H ˈÛÈÓÔÊÈÏÈ΋ Ó¢ÌÔÓ›· ıˆÚÂ›Ù·È ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ· Ì ‰È‹ıËÛË ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔÓ Ó‡ÌÔÓ·, Ì ‹ ¯ˆÚ›˜ ˈÛÈÓÔÊÈÏ›· ·›Ì·ÙÔ˜ Ô˘ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ¤ÏÌÈÓı˜, OÈ Ó¢ÌÔÓÈΤ˜ ‚Ï¿‚˜ ·ÊÔÚÔ‡Ó ‚Ï¿‚Ë ÙˆÓ ÌÈÎÚÒÓ ‚ÚfiÁ¯ˆÓ ‹ ‚ÚÔÁ¯ÈÔÏ›ˆÓ fiÙ·Ó Ù· Û˘ÌÙÒÌ·Ù· ‰È·ÚÎÔ‡Ó ¿Óˆ ·fi 2 ¯ÚfiÓÈ·.

H ȉÈÔ·ı‹˜ ‹ ÎÚ˘ÙÔÁÂÓ‹˜ Ó¢ÌÔÓÈ΋ ›ÓˆÛË Â›Ó·È ÌÈ· ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ· Ô˘ ·Ó·ÁÓˆÚ›˙ÂÙ·È fiÏÔ Î·È Û˘¯ÓfiÙÂÚ· Ì η΋ ÚfiÁÓˆÛË. ™ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Ô Èfi˜ Ù˘ Ë·Ù›Ùȉ·˜, Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ (EBV) Î·È Ô ·‰ÂÓÔ˚fi˜ ÂÓÒ ·ÔÙÂÏ› ·Ú¿‰ÂÈÁÌ· ÌÂٷ͇ ÔÏÏÒÓ ¯ÚfiÓÈˆÓ Ó¢ÌÔÓÔ·ıÂÈÒÓ ÁÓˆÛÙ¤˜ Û·Ó "‰È¿ÌÂÛ˜ Ó¢ÌÔӛ˜". ¶·ıÔÁ¤ÓÂÈ· O ·ÎÚÈ‚‹˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜ ·fi ÏÔÈÌÒÍÂȘ ‰ÂÓ ¤¯ÂÈ ·ÔÛ·ÊËÓÈÛÙ›. OÈ ÈÔ› Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Â›Ó·È Ù˘ Ë·Ù›Ùȉ·˜ C, o EBV Î·È Ô ·‰ÂÓÔ˚fi˜. OÈ ÈÔ› ·˘ÙÔ› ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È ÂÓÂÚÁ¿ Î·È Ó· ‰È·‰Ú¿ÌÔ˘Ó ¤Ó· ÂÓ‰ÔÁÂÓ¤˜ Ï·Óı¿ÓÔÓ ÛÙ¿‰ÈÔ ÌÂÙ¿ ÙËÓ

116

°Ú·Ùfi ™˘ÌfiÛÈÔ

ÔÍ›· Ïԛ̈ÍË (·‰ÂÓÔ˚fi˜, EBV) ‹ ÛÙ¿‰ÈÔ ¯ÚfiÓÈ·˜ Ïԛ̈͢ (Ë·Ù›Ùȉ· C). M ۇÁ¯ÚÔÓ˜ Ù¯ÓÈΤ˜ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜, ·˘Í¿ÓÂÈ Ë ‰˘Ó·ÙfiÙËÙ· Û˘Û¯¤ÙÈÛ‹˜ ÙÔ˘˜ Ì ÙȘ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ. H ÌÂϤÙË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙˆÓ ÈÒÓ ·˘ÙÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ȉÈÔ·ıÔ‡˜ Ó¢ÌÔÓÈ΋˜ ›ÓˆÛ˘, ·ÔÙÂÏ› ÙÔ ÌÔÓÙ¤ÏÔ Ô˘ ÂȯÂÈÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙÔÓ ÎÔÈÓfi ·ıÔÁÂÓÂÙÈÎfi Ì˯·ÓÈÛÌfi ÙˆÓ ¯ÚfiÓÈˆÓ Ó¢ÌÔÓÔ·ıÂÈÒÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙȘ ÈÔÁÂÓ›˜ ΢ڛˆ˜ ÏÔÈÌÒÍÂȘ.

TÔ 1997, ÔÈ Kuwano Î·È Û˘Ó. ÌÂϤÙËÛ·Ó ÙËÓ ÂÈÎÚ¿ÙËÛË ÙÔ˘ DNA ·‰ÂÓÔ˚Ô‡ ÛÙÔÓ Ó¢ÌÔÓÈÎfi ÈÛÙfi ·ÛıÂÓÒÓ Ì ȉÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÚÔÙ‡Ô˘˜ ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÚˆÙ½Ó˘ EIA ÙÔ˘ ·‰ÂÓÔ˚Ô‡, ÁÔÓ›‰ÈÔ Ô˘ ‰È¢ÎÔχÓÂÈ ÙË ÌÂÙ¿ÏÏ·ÍË ÙˆÓ Î˘ÙÙ¿ÚˆÓ. ™ÙË ÌÂϤÙË ·˘Ù‹, ÛÙÔ 16% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‚Ú¤ıËΠDNA ·‰ÂÓÔ˚Ô‡, ÛÙ· ‚ÚÔÁ¯Èο ÂÈıËÏȷο ·ÙÙ·Ú·. OÈ ›‰ÈÔÈ Û˘ÁÁÚ·Ê›˜ ‚Ú‹Î·Ó fiÙÈ ÙÔ DNA ·‰ÂÓÔ˚Ô‡ ‹Ù·Ó Û˘¯ÓfiÙÂÚÔ ÛÙÔ˘˜ ·ÚÚÒÛÙÔ˘˜ Ô˘ ¤·ÈÚÓ·Ó ıÂÚ·›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (67%), Û ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó (10%), ÁÂÁÔÓfi˜ Ô˘ ÚÔηÏ› ¤ÓÙÔÓÔ ÂӉȷʤÚÔÓ. H ÚˆÙ½ÓË EIA ÙÔ˘ ·‰ÂÓÔ˚Ô‡ ‰˘ÓËÙÈο ÌÔÚ› Ó· Û˘Ó‰Âı› Ì ÙÔ RB ÔÁÎÔÁÔÓ›‰ÈÔ. TÔ RB ÁÔÓ›‰ÈÔ ÂϤÁ¯ÂÈ ÙË Á¤ÓÂÛË Ù˘ Ê¿Û˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ ΢ÙÙ¿ÚÔ˘. H EIA ÚÔˆı› ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ RB Î·È ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ô ·‰ÂÓÔ˚fi˜ ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ·. ™ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ȉÈÔ·ıÔ‡˜ Ó¢ÌÔÓÈ΋˜ ›ÓˆÛ˘ Ô EBV ÂÓÔ¯ÔÔÈ‹ıËΠ·Ú¯Èο ÙÔ 1984 ·fi ÙÔÓ French, ÛÙËÚÈ˙fiÌÂÓ˜ Û ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô. ¶·Ú·ÙËÚ‹ıËÎ·Ó ·˘ÍË̤ӷ Â›‰· IgG Î·È IgA ¤Ó·ÓÙÈ ÙÔ˘ η„ÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘ (VCA) ÙÔ˘ ÈÔ‡ Û 11 ·ÚÚÒÛÙÔ˘˜ Ì ȉÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË. AÓ Î·È, ÁÂÓÈο, Ô ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ EBV ¤¯ÂÈ ¯·ÌËÏ‹ ¢·ÈÛıËÛ›· Î·È ÂÍÂȉ›Î¢ÛË, Ë ÂÍÂȉ›Î¢ÛË Ù˘ IgA ¤Ó·ÓÙÈ ÙÔ˘ η„ÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘ (VCA) Â›Ó·È ˘„ËÏ‹ Î·È ÂÈÛËÁÂ›Ù·È ÙËÓ ·ÚÔ˘Û›· ÂÓÂÚÁÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ EBV ÛÙ· ÂÈıËÏȷο ·ÙÙ·Ú·. Afi 20 ‚ÈÔ„›Â˜ ·ÓÔȯÙÔ‡ Ó‡ÌÔÓ·, Û ·ÚÚÒÛÙÔ˘˜ Ì ȉÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË, ÔÈ 14 ›¯·Ó ıÂÙÈ΋ ¯ÚÒÛË ÁÈ· ÙÔ ›‰ÈÔ ·ÓÙÈÁfiÓÔ, η„ÈÎfi VCA Î·È Ù˘ ÌÂÌ‚Ú¿Ó˘ gp340/220, Û ʿÛË ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ ÈÔ‡. ™ÙÔ˘˜ 21 Ì¿ÚÙ˘Ú˜, ‰‡Ô ‹Ù·Ó ıÂÙÈÎo› ÁÈ· EBV, VCA Î·È gp340/220.

EȉÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ÚˆÙ½Ó˘ BZLFI, Û˘ÛÙ·ÙÈÎfi ÙÔ˘ η„ÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘ (VCA) ‹ ·ÓÙÈÁfiÓÔ˘ Ù˘ ÌÂÌ‚Ú¿Ó˘ gp340/220 (37), ¤¯Ô˘Ó ÌÂÏÂÙËı› ÛÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ·Ó··Ú·ÁfiÌÂÓÔ˘ ÈÔ‡ ÛÙËÓ È‰ÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË. T· ÊÏÂÁÌÔÓÒ‰Ë Î‡ÙÙ·Ú· ·fi ÙÔÓ Èfi, ÂËÚ¿˙Ô˘Ó ÙË Ê¿ÛË ÙˆÓ ÁÔÓȉ›ˆÓ ÙÔ˘ EBV. ŒÙÛÈ, Ë ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙˆÓ ÈÒÓ Ì ٷ ÁÔÓ›‰È· Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ Ú‡ıÌÈÛË Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ÌÔÚ› Ó· ÂÚÌËÓ‡ÛÂÈ Ì ÎÔÈÓfi Ì˯·ÓÈÛÌfi ÙÔÓ ÚfiÏÔ ÙˆÓ ÈÒÓ Û ÌÈ· ÈÓÒ‰Ë ÂÂÍÂÚÁ·Û›·, fiˆ˜ Â›Ó·È Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ›ÓˆÛË. ŸÌˆ˜, ··ÈÙÔ‡ÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ¿Óˆ Û ·˘Ùfi ÙÔ ı¤Ì·.

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§ÔÈÌÒÍÂȘ Î·È ÌÂÙ¤ÂÈÙ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·

‚Ï¿‚˜ Ô˘ ÂÂÎÙ›ÓÔÓÙ·È ‚·ı‡ÙÂÚ· ÛÙÔÓ ˘Ô‚ÏÂÓÓÔÁfiÓÈÔ ¯ÈÙÒÓ· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÔÚ› Ó· ÌËÓ ·Ó·ÛÙÚ·ÊÔ‡Ó Î·È Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ·.

H ȉÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ›ÓˆÛË (I¶I) ÌÔÚ› Ó· ÌË Û¯ÂÙ›˙ÂÙ·È ·Ó·ÁηÛÙÈο Ì ¤Ó·Ó ÌfiÓÔ Èfi, ·ÏÏ¿ Ì¿ÏÏÔÓ ‰È·ÊÔÚÂÙÈÎÔ› ·ÓÙ·¯Ô‡ ·ÚfiÓÙ˜ ÈÔ› ÌÔÚ› Ó· ÚÔηÏÔ‡Ó ÙË ÓfiÛÔ Ì¤Ûˆ ÎÔÈÓÔ‡ ·ıÔÁÂÓÂÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡. K·ıfiÛÔÓ ·ÛıÂÓ›˜ ÂȉÂÈÓÒÓÔÓÙ·È ÛÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ì ·ÓÔÛÔηٷÛÙÔÏ‹, Â›Ó·È ˘fi Û˘˙‹ÙËÛË Â¿Ó ¤Ó· ·˘ÍË̤ÓÔ ÈÔÁÂÓ¤˜ ÊÔÚÙ›Ô ÌÔÚ› Ó· Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘. ™ÙËÓ È‰ÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË ·fi ÈÔ‡˜, Ô ÚfiÏÔ˜ ÙÔ˘˜ Á›ÓÂÙ·È ‰ÂÎÙfi˜, Â¿Ó ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ·¿ÓÙËÛË ÛÙËÓ ·ÓÙÈ˚΋ ıÂÚ·›·. H Ïԛ̈ÍË ·fi ·‰ÂÓÔ˚fi (ÛÙÂϤ¯Ë 3,7,11,21) ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÓÂÎÚˆÙÈ΋ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ÔÈ ¶›Ó·Î·˜ 1. XÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ Î·È ÏÔÈÌÒÍÂȘ.

XÚfiÓȘ ¶Ó¢ÌÔÓÔ¿ıÂȘ

IÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ OÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Ó‡ÌÔÓ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹. O ·‰ÂÓÔ˚fi˜ Î·È Ô Èfi˜ Ù˘ ÈÏ·Ú¿˜ ·ÔÙÂÏÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Î·È ·ÎÔÏÔ˘ıÔ‡Ó Ô Èfi˜ Ù˘ ÁÚ›˘, ÔÈ RSV Î.¿. (›Ó·Î·˜ 1). Afi ÙÔ˘˜ ·‰ÂÓÔ˚Ô‡˜, ÂȉÈο ÔÈ Ù‡ÔÈ 3,7 Î·È 21 ÌÔÚ› Ó· Â›Ó·È ·ÈÙ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Î·È Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ‚·ÚȤ˜ ˘ÔÏÂÈÌÌ·-

A›ÙÈÔ

AÔÊÚ·ÎÙÈ΋ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ™‡Ó‰ÚÔÌÔ ÂÙÂÚfiÏ¢ÚÔ˘ ˘ÂډȷʷÓÔ‡˜ Ó‡ÌÔÓ· (Swyer James Î·È McLeod Û‡Ó‰ÚÔÌÔ)

IÔ›: ·‰ÂÓÔ˚fi˜ 7,21, RSV1H, ÈÏ·Ú¿˜, ÁÚ›˘, ·Ú·ÁÚ›˘, ÚÈÓÔ˚Ô› MÈÎÚfi‚È·: Ì˘ÎfiÏ·ÛÌ· (Ó¢ÌÔÓ›·˜, „ÈÙٿΈÛ˘, ÙÚ·¯ÒÌ·ÙÔ˜)

EÈ̤ÓÔ˘Û· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·

IÏ·Ú¿, M˘ÎfiÏ·ÛÌ·, KÔÎ·Ù˘

I‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ›ÓˆÛË Î·È ¿ÏϘ ‰È¿ÌÂÛ˜ Ó¢ÌÔӛ˜

IÔ›: ·‰ÂÓÔ˚fi˜ 7,21, ÈÏ·Ú¿˜, RSV, EBV2, CMV3, HSV4, ÂÚ˘ıÚ¿˜, ·ÓÂÌ¢ÏÔÁÈ¿˜ ÕÙ˘·: ¯Ï·Ì‡‰È·, ÚÈΤÙÛȘ, Ì˘ÎfiÏ·ÛÌ· M‡ÎËÙ˜: ·Û¤ÚÁÈÏÏÔ˜ MÈÎÚfi‚È·: ÙÔ˘Ï·Ú·ÈÌ›·˜, Û·ÏÌÔÓ¤ÏÏ·

§ÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È¿ÌÂÛË Ó¢ÌÔÓ›·

IÔ›: EBV, HIV5 ÕÙ˘·: Ì˘ÎfiÏ·ÛÌ·

™˘ÁÁÂÓ‹˜ ‰È¿ÌÂÛË Ó¢ÌÔÓ›·

IÔ›: ÂÚ˘ıÚ¿˜, CMV, HSV

KÔÎ΢ÙÔÂȉ¤˜ Û‡Ó‰ÚÔÌÔ

A‰ÂÓÔ˚fi˜ 1,2,3,5,12,19.

BÚÔÁ¯ÈÂÎÙ·Û›·

IÔ›: ·‰ÂÓÔ˚fi˜ 1,2,3,5,12,19, ÈÏ·Ú¿˜, ÎÔηÙË, HSV ÕÙ˘·: Ì˘ÎfiÏ·ÛÌ· MÈÎÚfi‚È·: TBC, ÎÔÎ·Ù˘

YÔ͇ ÂÌʇÛËÌ·

IÏ·Ú¿

Eȉ›ӈÛË TBC

IÏ·Ú¿

MÂȈ̤Ó˜ Ó¢ÌÔÓÈΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ, MÂȈ̤ÓË Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›·

IÔ›: RSV ÕÙ˘·: Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È· MÈÎÚfi‚È·: ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜

MÂÙ·ÏÔÈÌ҉˘ Û˘ÚÚ›ÙÔ˘Û· ·Ó·ÓÔ‹

AÓ·Ó¢ÛÙÈÎÔ› ÈÔ›: RSV, °Ú›˘

A‡ÚÂÙÔ Û‡Ó‰ÚÔÌÔ Ó¢ÌÔÓ›Ùȉ·˜ ‚ÚÂÊÒÓ

IÔ›: CMV ÕÙ˘·: Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È· (ÙÚ·¯ÒÌ·ÙÔ˜, Ó¢ÌÔÓ›·˜, ÁÂÓ. ÔÚÁ¿ÓˆÓ).

M‡ÎËÙ˜: Ó¢ÌÔÓÔ·ÛÙË

HˆÛÈÓÔÊÈÏÈ΋ Ó¢ÌÔÓ›·

ŒÏÌÈÓı˜ 1 2 3 4 5

·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ Èfi˜ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Èfi˜ ·ÏÔ‡ ¤ÚËÙ· Èfi˜ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (AIDS)

117

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:101-120

ÙÈΤ˜ ‚Ï¿‚˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Ô˘ Ô‰ËÁÔ‡Ó Û ·ÔÊÚ·ÎÙÈ΋ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ηÈ/‹ ÛÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘ÂډȷʷÓÔ‡˜ Ó‡ÌÔÓ· (Swyer James). H ÈÏ·Ú¿ ÌÔÚ› Ó· ÂÈϤÎÂÙ·È Ì ‚·ÚÈ¿ Ó¢ÌÔÓ›·, Ì ·ÔÙ¤ÏÂÛÌ· ·ÔÊÚ·ÎÙÈ΋ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ˘Ô͇ ÂÌʇÛËÌ·, ‚ÚÔÁ¯ÈÂÎٷۛ˜. H ÈÏ·Ú¿ Ì·˙› Ì ÙÔÓ ·‰ÂÓÔ˚fi Î·È ÙË Ê˘Ì·Ù›ˆÛË ·Ú·Ì¤ÓÔ˘Ó Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜.

O Û˘Á΢ÙÈ·Îfi˜ Èfi˜ (RSV) Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙ· ‚Ú¤ÊË Î·È Û˘¯Ó¿ ÚÔηÏ› ÂÂÈÛfi‰È· Û˘Ú›ÙÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ Î·È ÂÈ̤ÓÔ˘Û˜ ‰È·Ù·Ú·¯¤˜ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. A˘ÍË̤Ó˜ Ó¢ÌÔÓÈΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ Î·È ˘ÂÚ·ÂÚÈÛÌfi˜ Ó¢ÌfiÓˆÓ ÌÂÙ¿ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÂÈ̤ÓÔ˘Ó ÁÈ· ¿Óˆ ·fi 12 Ì‹Ó˜. ™ÙË Ì¤ÛË ·È‰È΋ ËÏÈΛ· ̤¯ÚÈ Ù· ‰‡Ô ÙÚ›Ù· ÙˆÓ ‚ÚÂÊÒÓ ·˘ÙÒÓ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÙÚÔ¤˜ Û˘Ú›ÙÙÔ˘Û·˜ ·Ó·ÓÔ‹˜, ÌÂȈ̤Ó˜ ÂÎÓ¢ÛÙÈΤ˜ ÚÔ¤˜ Î·È ·˘ÍË̤ÓË ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· ÛÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜. ¢ÂÓ Â›Ó·È ÍÂοı·ÚÔ Â¿Ó Ô RSV ÚÔηÏ› Û˘Ú›ÙÔ˘Û· ·Ó·ÓÔ‹ ‹ Â¿Ó Ë Ïԛ̈ÍË ·fi RSV ÂÓÙÔ›˙ÂÈ Ù· ÁÂÓÂÙÈο ÚԉȷÙÂıÂÈ̤ӷ ¿ÙÔÌ· ÁÈ· ¿ÛıÌ· Î·È ¿ÏÏ· ÓÔÛ‹Ì·Ù· ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. T· ÎÏÈÓÈο Û‡Ó‰ÚÔÌ· Ô˘ ‚ϤÔ˘Ì ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹ ÌÔÚ› Ó· Â›Ó·È Û˘Ó‰˘·ÛÌfi˜ ÂÎÂ›ÓˆÓ Ì ¿ÛıÌ· Ô˘ ÚÔËÁ‹ıËΠÏԛ̈͢ ·fi RSV ‹ ÂÎÂ›ÓˆÓ Ì ÌÈÎÚfiÙÂÚ˘ ‰È·Ì¤ÙÚÔ˘ ‚ÚfiÁ¯Ô˘˜ ÛÙË Á¤ÓÓËÛË Î·È Â›Ó·È ÚԉȷÙÂıÂÈ̤ӷ Û ˘ÔÙÚÔ¤˜ Û˘Ú›ÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ ÛÙËÓ ÚÒÈÌË ·È‰È΋ ËÏÈΛ·, Î·È ÂÎÂ›ÓˆÓ Ô˘ ¤¯Ô˘Ó Û˘ÌÙÒÌ·Ù· ÏfiÁˆ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‚Ï¿‚˘ ·fi RSV. ÕÏϘ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, fiˆ˜ ÚÈÓÔ˚Ô›, ÁÚ›˘ (ÈÓÊÏÔ˘¤ÓÙ˙·˜) Î·È ·Ú·ÁÚ›˘ (·Ú·˚ÓÊÏÔ˘¤ÓÙ˙·˜) ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›Ùȉ· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿Ó ÔÈ Û˘ÁÎÂÎÚÈ̤ÓÔÈ ·˘ÙÔ› ÈÔ› ÚÔηÏÔ‡Ó ¯ÚfiÓȘ ‚Ï¿‚˜ ÛÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ Î·È ÂÔ̤ӈ˜ ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ·. IÔ› Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ˘˜ Ó‡ÌÔÓ˜ Ì ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔÚ¿, fiˆ˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú·, ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ Epstein-Barr (EBV), ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ (CMV), ·ÏÔ‡ ¤ÚËÙ· (HSV) Î·È ÂÚ˘ıÚ¿˜, ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ‰È¿ÌÂÛË Ó¢ÌÔÓ›· Û ¤‰·ÊÔ˜ Û˘ÁÁÂÓÔ‡˜ ‹ Â›ÎÙËÙ˘ Ïԛ̈͢. O Èfi˜ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ ıˆÚÂ›Ù·È fiÙÈ Â˘ı‡ÓÂÙ·È ÁÈ· ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ, fiˆ˜ ȉÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË Î·È ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È¿ÌÂÛË Ó¢ÌÔÓ›·. O ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ ·Ó·Ê¤ÚÂÙ·È Û·Ó ·ÈÙ›· ¯ÚfiÓÈ·˜ ‰È¿¯˘Ù˘ ‰È¿ÌÂÛ˘ Ó¢ÌÔÓ›Ùȉ·˜ Î·È È‰È·›ÙÂÚ· Û ¿ÙÔÌ· ÌÂÙ¿ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ô˘ Ô‰ËÁ› Û ·fiÚÚÈ„Ë ÌÔۯ‡̷ÙÔ˜. E›Û˘, ÚÔηÏ› ‰È¿ÌÂÛË Û˘ÁÁÂÓ‹ Ó¢ÌÔÓ›· Î·È ÙÔ ·‡ÚÂÙÔ Û‡Ó‰ÚÔÌÔ Ó¢ÌÔÓ›Ùȉ·˜ ÛÙ· ‚Ú¤ÊË. ™ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi Ë Ó¢ÌÔÓ›Ùȉ· Â›Ó·È ˘ÔÍ›· ‹ ¯ÚfiÓÈ· Î·È ÌË Âԯȷ΋, ¯ˆÚ›˜ ˘ÚÂÙfi, Ì ·ÚÔ͢ÓÙÈÎfi ‚‹¯·, ‰È¿¯˘ÙÔ˘˜ ÚfiÁ¯Ô˘˜ ÛÙËÓ ·ÎÚfi·ÛË Î·È ·/· ıÒڷη Ì ‰È¿ÌÂÛ˜ ‰ÈËı‹ÛÂȘ Î·È ˘ÔÙÌËÌ·ÙÈ΋ ·ÙÂÏÂÎÙ·Û›·. ÕÏÏ· ·›ÙÈ· ·˘ÙÔ‡ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë Ó¢ÌÔÓÔ·ÛÙË Carini, o CMV, ÙÔ Ì˘ÎfiÏ·ÛÌ· ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Î·È Ù· ¯Ï·Ì‡‰È· ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜. O ÂÚËÙÔ˚fi˜ Ì·˙› Ì ÙÔÓ ·‰ÂÓÔ˚fi, Â›Û˘ ÌÂÙ¿

118

°Ú·Ùfi ™˘ÌfiÛÈÔ

Ó¢ÌÔÓ›·, ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ‚ÚÔÁ¯ÈÂÎٷۛ˜ Î·È È‰ÈÔ·ı‹ ‰È¿ÌÂÛË Ó¢ÌÔÓ›·. O Èfi˜ Ù˘ Ë·Ù›Ùȉ·˜ C (HCV), ¤Ó·˜ RNA Èfi˜, Û‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi ·›ÙÈÔ Ù˘ non-A, non-B Ë·Ù›Ùȉ·˜ ·fi ÌÂÙ¿ÁÁÈÛË. M ÙȘ ‚ÂÏÙȈ̤Ó˜ ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜, Ë Ïԛ̈ÍË ·fi HCV ·Ó¢ڛÛÎÂÙ·È Û˘¯ÓfiÙÂÚ· Î·È ·Ó·ÁÓˆÚ›˙ÂÙ·È Û·Ó ·›ÙÈÔ, ¿ÏÏˆÓ Â͈Ë·ÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, fiˆ˜ Â›Ó·È ÔÈ Ó¢ÌÔӛ˜. Y¿Ú¯Ô˘Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ ÁÈ· ÙË Û¯¤ÛË Ù˘ HCV Ïԛ̈͢ Ì ÙËÓ È‰ÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ›ÓˆÛË.

OÈ Keda Î·È Û˘Ó. ÚÒÙÔÈ ÂÓÙfiÈÛ·Ó ÙË Û¯¤ÛË ÌÂٷ͇ I¶I Î·È HCV Ïԛ̈͢ Û I¿ˆÓ˜ ·ÚÚÒÛÙÔ˘˜ Ì ÙËÓ Ì¤ıÔ‰Ô ELISA. AÎÔÏÔ‡ıËÛ·Ó ÎÈ ¿ÏϘ ÌÂϤÙ˜ Ô˘ ÂÈÛËÁ‹ıËÎ·Ó ÙË Û¯¤ÛË Ù˘ I¶I Ì ÙËÓ HCV Ïԛ̈ÍË. ÕÏÏ· ÏÔÈÌÒ‰Ë ·›ÙÈ· TÔ M˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ÌÔÚ› Ó· Â›Ó·È ·ÈÙ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙ· ‚Ú¤ÊË Î·È ‚ÚÔÁ¯›Ùȉ·˜ ‹ Ó¢ÌÔÓ›·˜ ÛÙ· Ó‹È· Î·È ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿. T· ¯Ï·Ì‡‰È· ¤¯Ô˘Ó Â›Û˘ ·Ó·ÊÂÚı› Û·Ó ·ÈÙ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙ· ‚Ú¤ÊË. OÈ ‰‡Ô ·˘ÙÔ› ·Ú¿ÁÔÓÙ˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ·Ó¿Ù˘ÍË ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜. Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ·ÔÊÚ·ÎÙÈ΋˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ·fi Ì˘ÎfiÏ·ÛÌ· Ô˘ Ô‰ËÁ› ÛÙÔ Û‡Ó‰ÚÔÌÔ Mcleod ‹ Swyer-James (ÂÙÂÚfiÏ¢ÚÔ˜ ˘ÂډȷʷӋ˜ Ó‡ÌÔÓ·˜). ™ÙÔ ÛÙ¿‰ÈÔ ·Ó¿ÚÚˆÛ˘ ·fi Ïԛ̈ÍË ÌÂ Ì˘ÎfiÏ·ÛÌ· ÌÔÚ› Ó· Û˘Ì‚Â› "ÌÂÙ·ÏÔÈÌ҉˘ ‚ÚÔÁ¯›Ùȉ·" Ô˘ ‰È·ÚΛ ‚‰ÔÌ¿‰Â˜. T· ¯Ï·Ì‡‰È· ÙÚ·¯ÒÌ·ÙÔ˜ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÙÔ "·‡ÚÂÙÔ Û‡Ó‰ÚÔÌÔ Ó¢ÌÔÓ›Ùȉ·˜ ‚ÚÂÊÒÓ" ‰È¿ÚÎÂÈ·˜ 4-14 ‚‰ÔÌ¿‰ˆÓ. Afi ÙÔ˘˜ ¿Ù˘Ô˘˜ ÌÈÎÚÔÔÚÁ·ÓÔÛÌÔ‡˜ Ë ÏÂÁȈӤÏÏ· Î·È ·fi ÙȘ ÚÈΤÙÛȘ Ë Coxiella Burnetti, Û¿ÓÈ· ·Ó·Ê¤ÚÔÓÙ·È Û·Ó ·ÈÙ›· ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜.

H MÔÚÙÂÙ¤ÏÏ· ÙÔ˘ ÎÔηÙË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‚ÚÔÁ¯ÈÂÎٷۛ˜, ηıÒ˜ ÔÏÏÔ› ÂÓ‹ÏÈΘ Ì ‚ÚÔÁ¯ÈÂÎÙ·Û›· ›¯·Ó ÈÛÙÔÚÈÎfi ÎÔÎ΢ÙÔÂȉԇ˜ ‚‹¯· ÛÙËÓ ÌÈÎÚ‹ ·È‰È΋ ËÏÈΛ·. EÓÙÔ‡ÙÔȘ, ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÂÈÛËÁÔ‡ÓÙ·È fiÙÈ ·˘Ùfi Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Î·È fiÙÈ ·˘Ùfi˜ ηı·˘Ùfi˜ Ô ÎÔÎ·Ù˘ ‰ÂÓ Úԉȷı¤ÙÂÈ Û ‚ÚÔÁ¯ÈÂÎÙ·Û›·. O ·ÈÌfiÊÈÏÔ˜ Ù˘ ÁÚ›˘ Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Ì ÔÍ›˜ Î·È ¯ÚfiÓȘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (‚ÚÔÁ¯›Ùȉ·, Ó¢ÌÔÓ›·) Û ‚Ú¤ÊË ÛÙȘ ˘Ô·Ó¿Ù˘ÎÙ˜ ¯ÒÚ˜. O ¯ÚfiÓÈÔ˜ ·ÔÈÎÈÛÌfi˜ Ê·›ÓÂÙ·È fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÙȘ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ Î·È ·fiÊÚ·ÍË ·ÂÚ·ÁˆÁÒÓ Û ·˘Ù¿ Ù· ·È‰È¿. O ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ Â›Ó·È ·ÈÙ›· ‚·ÚÈ¿˜ Ó¢ÌÔÓ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. MÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ¯ÚfiÓȘ ‰È·Ù·Ú·¯¤˜ Ù˘ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. §Ô›ÌˆÍË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ·fi ÛÙ·Ê˘ÏfiÎÔÎÎÔ Ô‰ËÁ› ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ· ·' fiÙÈ ·˘Ù‹ Ì ·‰ÂÓÔ˚fi, Ô˘ ‰Ú· ηÙÂÍÔ¯‹Ó ÛÙÔ ‚ÚÔÁ¯ÈÎfi ‰¤Ó‰ÚÔ.

OÈ ÓÂ˘Ì·ÙÔ΋Ϙ ÌÔÚ› Ó· ÂÈ̤ÓÔ˘Ó ÁÈ· Ì‹Ó˜ ·ÏÏ¿ Û˘Ó‹ıˆ˜ ‰ÂÓ ··ÈÙÔ‡Ó ÂȉÈ΋ ıÂÚ·›·. ¢È¿ÊÔÚ· ¿ÏÏ· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· fiˆ˜ Ë Û·ÏÌÔÓ¤ÏψÛË Î·È Ë ÙÔ˘Ï·Ú·ÈÌ›·, ÈÛÙ‡ÂÙ·È fiÙÈ Û¿ÓÈ· Ô‰ËÁÔ‡Ó ÛÂ

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·119

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¯ÚfiÓÈ· ‰È¿ÌÂÛË ›ÓˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ.

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Y¿Ú¯Ô˘Ó ÔÏÏ¿ ÂÚˆÙ‹Ì·Ù· Ô˘ Ú¤ÂÈ Ó· ··ÓÙËıÔ‡Ó ÒÛÙ ӷ ‚ÔËı‹ÛÔ˘Ó ÛÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Ù˘ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜ ÌÂÙ¿ Ïԛ̈ÍË. ™Ù·ıÂÚ¤˜ ̤ıÔ‰ÔÈ, ·Ô‰ÂÎÙÔ› ÔÚÈÛÌÔ› Ù˘ ÓfiÛÔ˘, ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ‰ÂÈÁÌ¿ÙˆÓ Î·È Ôχ Ì·ÎÚÔ¯ÚfiÓȘ ÌÂϤÙ˜ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· Ó· ··ÓÙËıÔ‡Ó Ù· ÂÚˆÙ‹Ì·Ù· Ô˘ ˘¿Ú¯Ô˘Ó. AÓ·‰ÚÔÌÈΤ˜ ÌÂϤÙ˜ Ô˘ ÂÎÔÓÔ‡ÓÙ·È ÌÔÚ› Ó· ‰ÒÛÔ˘Ó ÂÈÚfiÛıÂÙ˜ ÏËÚÔÊÔڛ˜ Ô˘ ı· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ ÁÓÒÛË Ì·˜ ¿Óˆ ÛÙËÓ ÚfiÎÏËÛË Ù˘ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜.

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● ¶ÂÚ›ÏË„Ë: ¶·Ú¿ ÙË ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÂÈÙ¢¯ı› ÛÙË Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ÙÔ 1/3 ÂÚ›Ô˘ ·fi ·˘Ù¿ ÙÂÏÈο ηٷϋÁÂÈ. H ÔÚ›· ÚÔ˜ ÙÔÓ ı¿Ó·ÙÔ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂϤÛÂÈ Ì›· ‰‡ÛÎÔÏË Î·È ÂÒ‰˘ÓË ‰È·‰Èηۛ· ÁÈ· ÙÔ ›‰ÈÔ ÙÔ ·È‰› ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘. TÔ ¤ÚÁÔ Ù˘ Û˘ÓÔÏÈ΋˜ ˘ÔÛÙ‹ÚÈ͢, È·ÙÚÈ΋˜, Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ Î·È „˘¯ÔÏÔÁÈ΋˜, ÙÔ˘ ηÚÎÈÓÔ·ıÔ‡˜ ·È‰ÈÔ‡ Î·È fiÏˆÓ ÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÏÁÂÈÓ‹ ·˘Ù‹ ‰È·‰Èηۛ·, ÔÊ›ÏÂÈ Ó· ÂˆÌ›˙ÂÙ·È Ë ÔÌ¿‰· Ô˘ ›¯Â ÙË ıÂÚ·¢ÙÈ΋ ¢ı‡ÓË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ·È‰ÈÔ‡. O ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÁÎÔÏfiÁÔ˘, ÛÙË ÂÚ›ÙˆÛË ·˘Ù‹, Â›Ó·È ÎÚÈÙÈ΋˜ ÛËÌ·Û›·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ú¤ÂÈ Ó· ·ÔÊ·Û›˙ÂÈ Ó· Û˘ÓÙÔÓ›˙ÂÈ Î·È Ó· ‰È¢ÎÔχÓÂÈ fiϘ ÙȘ ÚÔÛ¿ıÂȘ Î·È ÙȘ ·ÚÂÌ‚¿ÛÂȘ, È·ÙÚÈΤ˜, ÓÔÛËÏ¢ÙÈΤ˜ ‹ Î·È „˘¯ÔÎÔÈÓˆÓÈΤ˜, Ì ÛÙfi¯Ô ¿ÓÙÔÙ ÙËÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ·ÓÒ‰˘ÓË Î·È ·ÍÈÔÚÂ‹ ‰È¤Ï¢ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙË ˙ˆ‹ ÛÙÔ ı¿Ó·ÙÔ. ¶·Ú¿ÏÏËÏ· Ú¤ÂÈ Ó· ·Ó·Ï·Ì‚¿ÓÂÈ ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ¿ÌÂÛÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÚÔÂÙÔÈÌ¿˙ÔÓÙ·˜ Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÁÈ· ÙËÓ ·Ô‰Ô¯‹ ÙÔ˘ ÂÂÚ¯fiÌÂÓÔ˘ ÁÂÁÔÓfiÙÔ˜. °È· ÙËÓ ÔÌ·Ï‹ fï˜ ‰ÈÂÎÂÚ·›ˆÛË ÙÔ˘ ¤ÚÁÔ˘ Ù˘ ÊÚÔÓÙ›‰·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÙÔ˘ ·ÛıÂÓÔ‡˜, Ô ·È‰›·ÙÚÔ˜ ÔÁÎÔÏfiÁÔ˜ ¤¯ÂÈ ·Ó¿ÁÎË Ù˘ ÂÓÂÚÁÔ‡ Û˘ÌÌÂÙÔ¯‹˜, ·ÊÂÓfi˜ Î·È ¿ÏÏˆÓ È·ÙÚÈÎÒÓ ÂȉÈÎÔÙ‹ÙˆÓ ·ÊÂÙ¤ÚÔ˘ Î·È ÂÍ›ÛÔ˘ ÛËÌ·ÓÙÈο, Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡ Î·È Ù˘ ÔÌ¿‰·˜ „˘¯oÏÔÁÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ˘‡ı˘ÓÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ΤÓÙÚÔ˘. M ÙÔÓ ÙÚfiÔ ·˘Ùfi ÌÔÚ› ÙÂÏÈο Ó· ˘ÏÔÔÈËı› Ô ‚·ÛÈÎfi˜ ÛÙfi¯Ô˜ fiÏˆÓ ÙˆÓ ÚÔÛ·ıÂÈÒÓ Ô˘ Â›Ó·È Ë ϤÔÓ ·ÓÒ‰˘ÓË Î·È ÔÌ·Ï‹ ηٿÏËÍË ÙÔ˘ ·È‰ÈÔ‡. OÈ È·ÙÚÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ÂÈ‚¿ÏÏÂÙ·È Ó· ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘, ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·ÈÛı‹Ì·ÙÔ˜ Ù˘ ‰›„·˜, ÙˆÓ ÛÔ‚·ÚÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ·fi Ù· ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· (‰‡ÛÓÔÈ·˜, ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢, Û·ÛÌÒÓ ÎÏ.) Î·È Ù¤ÏÔ˜ ÛÙË Û˘Ìو̷ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ Î·È ÙˆÓ ·ÈÌÔÚÚ·ÁÈÒÓ Ô˘ ÂӉ¯fiÌÂÓ· ÛÙËÓ ÔÚ›· ı· ÂÌÊ·Ó›ÛÂÈ Ô/Ë ·ÛıÂÓ‹˜. OÈ Ì›˙ÔÓ˜ ıÂÚ·¢ÙÈΤ˜ ÂÓ¤ÚÁÂȘ (˘fi ÙËÓ ¤ÓÓÔÈ· .¯. ÂÓÙ·ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ¯ËÌÂÈÔıÂÚ·›·˜) ÁÈ· ·Ó·ÛÙÚÔÊ‹ Ù˘ ÙÂÎÌËÚȈ̤ӷ ÙÂÏÂÛ›‰È΢ ÔÚ›·˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ηÎÔ‹ıÔ˘˜ ÓÔÛ‹Ì·ÙÔ˜, ‰ÂÓ ˆÊÂÏÔ‡Ó ‰ÈfiÙÈ ¤ÙÛÈ ÂÈÙ˘Á¯¿ÓÂÙ·È ÌfiÓÔ ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚÔÓÈÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ Ù˘ Ù·Ï·ÈˆÚ›·˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÂÓÒ ·Ú¿ÏÏËÏ· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ „¢‰·ÈÛı‹ÛÂȘ ÁÈ· Ù˘¯fiÓ Â·Ó¤ÏÂÁ¯Ô Ù˘ ÓfiÛÔ˘. H ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ·Ó·Î‡ÙÔ˘Ó Î·Ù¿ ÙÔ ÙÂÏÈÎfi ·˘Ùfi ÛÙ¿‰ÈÔ, ηÏfiÓ Â›Ó·È Ó· ·Ú¤¯ÂÙ·È, Â¿Ó ÙÔ‡ÙÔ Â›Ó·È ÂÊÈÎÙfi, ÛÙÔ Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡, ÙÔ Û›ÙÈ ÙÔ˘, ÂÊfiÛÔÓ ÙÔ ÂÈı˘ÌÔ‡Ó ÔÈ ÁÔÓ›˜ Î·È ÙÔ ›‰ÈÔ ÙÔ ·È‰›. A·Ú·›ÙËÙË ÚÔ¸fiıÂÛË ‚¤‚·È· ·ÔÙÂÏ› Ë ÂÍ·ÛÊ¿ÏÈÛË Ù˘ ·Ó·Áη›·˜ È·ÙÚÈ΋˜, ÓÔÛËÏ¢ÙÈ΋˜ Î·È „˘¯ÔÏÔÁÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ ηٿ ÙË Û‡ÓÙÔÌË ‹ Î·È Ì·ÎÚ¿ ·˘Ù‹ ‰È·‰Èηۛ· Î·È Ë ‰È·‚‚·›ˆÛË fiÙÈ ÔÔÈ·‰‹ÔÙ ÛÙÈÁÌ‹ ·ÈÛı·ÓıÔ‡Ó ÙËÓ ·Ó¿ÁÎË, Ë ÚfiÛ‚·Û‹ ÙÔ˘˜ ÛÙÔ NÔÛÔÎÔÌÂ›Ô ı· Â›Ó·È ÂχıÂÚË, ¯ˆÚ›˜ Ó· ηٷÎχ˙ÔÓÙ·È ·fi ¿Á¯Ô˜ ‹ ·ÈÛı‹Ì·Ù· ÂÓÔ¯‹˜ ÁÈ· Ô,Ùȉ‹ÔÙ ÚÔ·„ÂÈ ÛÙËÓ ÔÚ›·. ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Û˘Ó‹ıÂȘ ηٷÛÙ¿ÛÂȘ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ Ô ·È‰›·ÙÚÔ˜ ÔÁÎÔÏfiÁÔ˜ ÛÙ· ÙÂÏÈο ÛÙ¿‰È· ÙÔ˘ ·È‰ÈÔ‡ Ì ηÚΛÓÔ Î·È ÚÔÙ›ÓÔÓÙ·È oÚÈṲ̂Ó˜, ¢ڇÙÂÚ· ·Ô‰ÂÎÙ¤˜, ıÂÚ·¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ÁÈ· ÙËÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ ÔÏÔÎÏËڈ̤ÓË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÂÚ¯fiÌÂÓÔ˘ ı·Ó¿ÙÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:121-128. §¤ÍÂȘ ÎÏÂȉȿ: ·È‰È΋ ËÏÈΛ·, ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·.

S. Polychronopoulou - Androulakaki. The role of the paediatric oncologist during the terminal phase of cancer in a child. Paediatriki 2000;63:121-128. ● Abstract: In spite of the increase in overall survival of paediatric patients with malignant diseases during the last years, about one third of them will finally die of the disease. The death process is laborious and painful, affecting

NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:121-128

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - AÓ‰ÚÔ˘Ï·Î¿ÎË

both the patient and the family. Under these uncomfortable circumstances, the therapeutic team responsible for the treatment and follow-up, assume the major supporting role for the patient and family. The paediatric oncologist plays a unique and important role, which is psychologically very demanding, deciding about and co-ordinating all the interventions for the child’s pain-free and dignified transition from life to death. Moreover, the oncologist must advise and provide emotional support to the family members, preparing them, as far as possible, for the upcoming fatal event. Paediatric oncologists undertake a heavy burden and they need active support from the other medical specialists involved, as well as from the nursing staff, psychologists and social workers. This is necessary in order for the fundamental goal to be fulfilled, namely a painless, quiet, and peaceful end for the patient. Ineffective "heroic" attempts against the underlying malignant disease which generate false illusions for potential remission of the cancer and prolong the patient’s suffering should be avoided. All interventions must concentrate on the alleviation of distressing symptoms, (e.g. thirst, pain, dyspnoea) and the management of febrile episodes, blood loss and anaemia. Palliative care should preferably be given in the child’s own physical environment, the home.

Discussions with the parents aim at assuring them that the child's own room is the most familiar place for their child to die, provided they are capable of undergoing this difficult process at home. They must also be assured that they can bring their child to the hospital any time they need to for reasons of security or support. The management of some of the most common medical problems arising during the terminal phase of cancer in children, is discussed.

Key words: childhood, cancer, terminal phase, terminal care, palliative care.

H ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ Ô˘ ¤¯ÂÈ Û˘ÓÙÂÏÂÛı› ÛÙËÓ Î·Ù·ÓfiËÛË Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Î·È ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ ÙˆÓ Î·ÎÔ‹ıˆÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ô‰ËÁ› Û‹ÌÂÚ· Û ›·ÛË ÙÔ 60% ÂÚ›Ô˘ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ηÚΛÓÔ (1,2). ¶·Ú¿ Ù· ¿ÚÈÛÙ· fï˜ ·˘Ù¿ ·ÔÙÂϤÛÌ·Ù·, Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ Ô Î·ÚΛÓÔ˜ ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÂÈÏ› ÙËÓ ˙ˆ‹ ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ·È‰ÈÔ‡, Ô‰ËÁÒÓÙ·˜ ÙÂÏÈο ÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔÓ ı¿Ó·ÙÔ. H ÔÚ›· ·˘Ù‹ ‰˘Ó·ÙfiÓ Ó· Â›Ó·È ÂÚÁ҉˘ Î·È ÂÒ‰˘ÓË ÂÓÒ Û¯Â‰fiÓ ¿ÓÙÔÙ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ÓË ·ÚÔ˘Û›· ÂÓfi˜ ÌÂÁ¿ÏÔ˘ Ê¿ÛÌ·ÙÔ˜ Ê˘ÛÈÎÒÓ, ÔÚÁ·ÓÈÎÒÓ, Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ, „˘¯ÔÏÔÁÈÎÒÓ, ˘·ÚÍÈ·ÎÒÓ, ÓÂ˘Ì·ÙÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ™ÙÔ Ï·›ÛÈÔ ÙÔ˘ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Ù˘ ÓfiÛÔ˘, ¤Ó· ·fi Ù· ÈÔ ‰‡ÛÎÔÏ· ηı‹ÎÔÓÙ· Ô˘ Ú¤ÂÈ Ó· ÂˆÌÈÛı› Ô ·È‰›·ÙÚÔ˜-ÔÁÎÔÏfiÁÔ˜ Â›Ó·È Î·È ÙÔ Î·ı‹ÎÔÓ, ·ÊÔ‡ ÚÒÙ· Ô ›‰ÈÔ˜ ÙÔ ·Ó·ÁÓˆÚ›ÛÂÈ Î·È ÙÔ ·ԉ¯ı› ˆ˜ ÁÂÁÔÓfi˜, Ó· ·Ó·ÎÔÈÓÒÛÂÈ fiÙÈ ÁÈ· ÙÔ ·È‰› ·˘Ùfi Ì ηÚΛÓÔ ‰ÂÓ ˘¿Ú¯ÂÈ È· ¿ÏÏË ıÂÚ·›·, ‰ÂÓ ˘¿Ú¯ÂÈ È· ÚÔÔÙÈ΋ ›·Û˘ Î·È fiÙÈ ÙÔ Ù¤ÏÔ˜ ¢ڛÛÎÂÙ·È "Â› ı‡Ú·È˜". ŒÙÛÈ, ÂÓÒ Ë Ô‰‡ÓË Î·È Ë Ù·Ú·¯‹ Ù˘ ·Ú¯È΋˜ ‰È¿ÁÓˆÛ˘ ÍÂÂÚÓÈÔ‡ÓÙ·È Ì ÙËÓ ·ÔÊ·ÛÈÛÙÈÎfiÙËÙ· ÁÈ· ·ÁÒÓ· Î·È ÙËÓ ·ÈÛÈÔ‰ÔÍ›· ÁÈ· ÙËÓ ÙÂÏÈ΋ Ó›ÎË, Ì ÙËÓ ·Ó·ÁÓÒÚÈÛË Ù˘ ·ÔÙ˘¯›·˜ Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Î·È ÙËÓ ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ fiÏ· ηٷÚÚ¤Ô˘Ó Î·È ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi ·ÈÛı‹Ì·Ù· ·ÔÙ˘¯›·˜ Î·È ‹ÙÙ·˜.

TfiÙ ¤Ú¯ÂÙ·È Ë ÛÙÈÁÌ‹ Ô˘ Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· Û˘ÓÂȉËÙÔÔÈ‹ÛÂÈ fiÙÈ ÂÈ‚¿ÏÏÂÙ·È Ó· ÚÔÛ·ÚÌfiÛÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ Î·È Ó· ÌÂÙ·ÙÚ¤„ÂÈ ÙËÓ ·Ú¯È΋ ÂÈıÂÙÈ΋, ÂÏȉÔÊfiÚ· Î·È ÓÈÎËÊfiÚ· È·ÙÚÈ΋ ÙÔ˘

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Ú·ÎÙÈ΋, Û ̛· ¿ÏÏË, ÂÍ›ÛÔ˘ ÔχÙÈÌË È·ÙÚÈ΋ Ú·ÎÙÈ΋. EΛÓË Ô˘ ı· ÚÔÛʤÚÂÈ ·ÓıÚÒÈÓË ÊÚÔÓÙ›‰· ÛÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, Ô˘ ı· ‚ÔËı‹ÛÂÈ ÙËÓ ·Ù۷ϤÓÈ· ÙÔ˘˜ ηډȿ Ó· Á›ÓÂÈ "ηډȿ ·fi ¤ÙÚ·", Ô˘ Ì ˙ÂÛÙ·ÛÈ¿ Î·È ÙÚ˘ÊÂÚfiÙËÙ· ı· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ÙËÓ ·ÓıÚˆÈ¿, ÙȘ ÁÓÒÛÂȘ Î·È ÙÔÓ ÂÈÛÙËÌÔÓÈÎfi ÂÍÔÏÈÛÌfi ÙÔ˘, ¤ÙÛÈ ÒÛÙÂ Ô ı¿Ó·ÙÔ˜ Ó· Â›Ó·È ·ÓÒ‰˘ÓÔ˜ Î·È ÂÈÚËÓÈÎfi˜. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi ·ÎÚÈ‚Ò˜ ·Ú¤¯ÂÙ·È Ë ÊÚÔÓÙ›‰· Ë ÔÔ›· ·ԂϤÂÈ ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË Î·È ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ˆÚÒÓ Ù˘ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ Ì ηÚΛÓÔ. H ·Ó¿ÁÎË ‡·Ú͢ Î·È ·ÚÔ¯‹˜ ÌÈ·˜ Ù¤ÙÔÈ·˜ ÔÏÔÎÏËڈ̤Ó˘ Î·È ÔÚÁ·ÓˆÌ¤Ó˘ ÊÚÔÓÙ›‰·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÚÔ‚¿ÏÏÂÈ ÂÈÙ·ÎÙÈο.

H ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ·ÊÔÚ¿ ÛÙËÓ ÂȉÈ΋ ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ÔÈ Ôԛ˜ ¤¯Ô˘Ó ¯·Ú·ÎÙ‹Ú· ηٿ ‚¿ÛË ˘ÔÛÙËÚÈÎÙÈÎfi Î·È ·Ú¤¯ÔÓÙ·È Û ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Ï›ÁÔ ÚÈÓ ·fi ÙÔ ı¿Ó·ÙÔ. °È· ÙËÓ ¿ÚÙÈ· ·ÚÔ¯‹ ÌÈ·˜ Ù¤ÙÔÈ·˜ ÊÚÔÓÙ›‰·˜ ··ÈÙÂ›Ù·È ÌÈ· ÔÏÈÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ù˘ ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙÔ˘ ¿ÌÂÛÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, Û Â›Â‰Ô ÔÚÁ·ÓÈÎÒÓ, „˘¯ÔÎÔÈÓˆÓÈÎÒÓ Î·È ÓÂ˘Ì·ÙÈÎÒÓ ·Ó·ÁÎÒÓ, Ì ÛÙfi¯Ô ÙËÓ Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· Ù˘ ˙ˆ‹˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ·È‰ÈÔ‡ (3). ™ÙËÓ ÚÔÛ¿ıÂÈ· ·˘Ù‹ Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Î·È Ó· ˘ÔÛÙËÚ›˙ÔÓÙ·È, ÒÛÙ ӷ Û˘ÌÌÂÙ¤¯Ô˘Ó ÂÓÂÚÁ¿ Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÁÔÓ›˜ Î·È ·‰¤ÏÊÈ·, ÚÔÛʤÚÔÓÙ·˜ ¿ÌÂÛ· Î·È Û˘Ó¯Ҙ ÙË ÊÚÔÓÙ›‰· ÛÙÔ ¿ÚÚˆÛÙÔ ·È‰› ÙÔ˘˜ (3,4). ¶·Ú¿ÏÏËÏ· ÎÚÈÙÈ΋˜ ÛËÌ·Û›·˜ ÚfiÏÔ, ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÙÔ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÈ· ÙÔÓ Î¿ı ·ÛıÂÓ‹ ıÂÚ·¢ÙÈÎÔ‡ ΤÓÙÚÔ˘, ÔÈ „˘-

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·123

¶∞π¢π∞∆ƒπ∫∏ 2000;63:121-128

¯ÔÏfiÁÔÈ, ÔÈ ÎÔÈÓˆÓÈÎÔ› ÏÂÈÙÔ˘ÚÁÔ›, ÔÈ ÂÚÁÔıÂÚ·Â˘Ù¤˜ Î·È ¿ÏÏÔÈ ÏÂÈÙÔ˘ÚÁÔ› "ÚÔÛÊÔÚ¿˜ ÊÚÔÓÙ›‰·˜" Î·È Ê˘ÛÈο Ô ·È‰›·ÙÚÔ˜ - ÔÁÎÔÏfiÁÔ˜ Ô˘ ·ÛΛ ¤Ú·Ó ÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÙÔ Î·Ù' ÂÍÔ¯‹Ó Û˘ÓÙÔÓÈÛÙÈÎfi ¤ÚÁÔ ÛÙËÓ ÔÌ¿‰·.

M¤Ûˆ Ù˘ ˘ÔÛÙËÚÈÎÙÈ΋˜ ·˘Ù‹˜ ÔÌ¿‰·˜ ÌÔÚÔ‡Ó Ì ÂÈÙ˘¯›· Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Ù· ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ·ÚÚÒÛÙÈ·˜ ÙÔ˘ ·È‰ÈÔ‡ Ì ηÚΛÓÔ. H Û˘Ì·Ú¿ÛÙ·ÛË, Ë ÂÓË̤ڈÛË Î·È Î˘Ú›ˆ˜ Ë ÛˆÛÙ‹ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ ¿ÚÚˆÛÙÔ ·È‰›, ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ‰È¤ÍÔ‰Ô Û ‰ÈÏ‹ÌÌ·Ù·, Ó· ÁÎÚÂÌ›ÛÔ˘Ó Ù›¯Ë ·ÔÌfiÓˆÛ˘, ıÏ›„˘, ı˘ÌÔ‡ Î·È ·ÂÏÈÛ›·˜ Ô˘ ·˘ÙfiÌ·Ù· ÔÚıÒÓÔÓÙ·È, ÚÔÛʤÚÔÓÙ·˜ ηٷʇÁÈÔ Î·È ·Ó·ÎÔ‡ÊÈÛË ÛÙ· ·È‰È¿ Ô˘ Âı·›ÓÔ˘Ó, ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜ ·ÏÏ¿ Î·È Û ·˘ÙÔ‡˜ ÙÔ˘˜ ›‰ÈÔ˘˜ Ô˘ ·Ú¤¯Ô˘Ó ÙȘ ˘ËÚÂۛ˜ (5-7).

H Û˘ÌfiÚ¢ÛË Ì ÙÔ ·È‰› Ì ηÚΛÓÔ Ô˘ Âı·›ÓÂÈ Â›Ù ¿ÌÂÛ· ›Ù Û οÔÈÔ ÙÂÏÂÛ›‰Èη ÂÂÚ¯fiÌÂÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÚÔÛ‰›‰ÂÈ Ì›· Ú·ÁÌ·ÙÈο ÙÂÚ¿ÛÙÈ· „˘¯È΋, ËıÈ΋ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË fi¯È ÌfiÓÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ·ÏÏ¿ Î·È Û fiÏÔ˘˜ fiÛÔ˘˜ ‚Ú›ÛÎÔÓÙ·È ÎÔÓÙ¿ ÙÔ˘ ÁÈ· Ó· ÙÔ ÊÚÔÓÙ›ÛÔ˘Ó.

MÂٷ͇ ·˘ÙÒÓ, Ô ·È‰›·ÙÚÔ˜-ÔÁÎÔÏfiÁÔ˜ ·ÔÙÂÏ› ¿ÌÂÛÔ ·Ô‰¤ÎÙË ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ÙˆÓ ÁÂÁÔÓfiÙˆÓ Î·È ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ, Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó fi¯È ÌfiÓÔ ÙËÓ ·ÓıÚÒÈÓË ·ÒÏÂÈ· ÁÂÓÈο, ·ÏÏ¿ ÂȉÈÎfiÙÂÚ· ÙËÓ ·ÒÏÂÈ· ÌÈ·˜ ·È‰È΋˜ ‡·Ú͢. ø˜ ÂÎ ÙÔ‡ÙÔ˘ ·ÔÙÂÏ› Î·È ÈÛ¯˘Úfi ˘Ô„‹ÊÈÔ ÂÌÊ¿ÓÈÛ˘ Û˘ÌÙˆÌ¿ÙˆÓ Â·ÁÁÂÏÌ·ÙÈ΋˜ ÂÍÔ˘ı¤ÓˆÛ˘ ÌÂ Û˘Ó¯‹ ÙÚÈ‚‹ Î·È ÊıÔÚ¿ Û ·Ó¿ÏÔÁ˜ ηٷÛÙ¿ÛÂȘ, ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ÔÔ›·˜ ··ÈÙÂ›Ù·È Ë ÛÙ·ıÂÚ‹ Î·È ÈÛ¯˘Ú‹ ‰È΋ ÙÔ˘, ·Ú¿ÏÏËÏË, „˘¯È΋, ÓÂ˘Ì·ÙÈ΋ Î·È ÛˆÌ·ÙÈ΋ ˘ÔÛÙ‹ÚÈÍË (8).

MÂϤÙ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ Û˘Ó·ÈÛıËÌ·ÙÈ΋ Â¤Ó‰˘ÛË ÙˆÓ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ÛÙÔÓ ¯ÒÚÔ ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ıˆÚÔ‡Ó ˆ˜ ȉȷ›ÙÂÚ· ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ¿Á¯Ô˘˜ Î·È Â·ÁÁÂÏÌ·ÙÈ΋˜ ÂÍÔ˘ı¤ÓˆÛ˘: ·) ÙËÓ ¯ÚÔÓÈfiÙËÙ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Î·È ÙËÓ ·‚‚·ÈfiÙËÙ· Ù˘ ÂͤÏÈÍ‹˜ ÙÔ˘, ‚) ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ Â›‰Ú·ÛË Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë Ì·ÎÚfi¯ÚÔÓË ÂÓ·Û¯fiÏËÛË Ì ÙÔ ·È‰› ‹ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, Á) ÙËÓ ·ÚÔ˘Û›· Î·È ˙ˆÓÙ·Ó‹ ÙÔ˘˜ Ì·ÚÙ˘Ú›· ÂÓÒÈÔÓ ÂÓfi˜ ·È‰ÈÔ‡ Ô˘ ˘ÔʤÚÂÈ Î·È ·ÁˆÓ›˙ÂÙ·È Ó· ‰È·ÙËÚ‹ÛÂÈ ÙÔÓ ¤ÏÂÁ¯Ô Â¿Óˆ Û ¤Ó· ÚÒÈÌ· ÂÂÚ¯fiÌÂÓÔ ı¿Ó·ÙÔ, ‰) ÙËÓ Â›ÙˆÛË ÔÏÏÒÓ Û˘Ì‚·Ì¿ÙˆÓ ı·Ó¿ÙÔ˘ Û ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÒÛÙ ӷ ÌËÓ ·Ú·Ì¤ÓÂÈ ÂÚÈıÒÚÈÔ ÁÈ· Ê˘ÛÈÔÏÔÁÈÎfi ıÚ‹ÓÔ, Â) ÙËÓ ıÏ›„Ë ÁÈ· ÙÔÓ ı¿Ó·ÙÔ Î¿ÔÈÔ˘ ‹ οÔÈˆÓ ·È‰ÈÒÓ Ë ÔÔ›· Û˘ÛÛˆÚ‡ÂÙ·È Î·È Ô‰ËÁ› Û ¯ÚfiÓÈÔ ¿Á¯Ô˜ fiÙ·Ó ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È Î·È ‰ÂÓ ÂÎÊÚ¿˙ÂÙ·È, Î·È Ù¤ÏÔ˜, ÛÙ) Ù· ·ÈÛı‹Ì·Ù· ·ÌÊÈ‚ÔÏ›·˜ Î·È ·ÌÊÈÛ‚‹ÙËÛ˘ Ù· ÔÔ›· ÚÔ·ÙÔ˘Ó fiÙ·Ó Ô ÛÙfi¯Ô˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁÔ‡ ˘Á›·˜

TÂÏÈÎfi ÛÙ¿‰ÈÔ Î·ÚΛÓÔ˘

Î·È ÂȉÈÎfiÙÂÚ· ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÁÎÔÏfiÁÔ˘, ÌÂÙ·ÙÚ¤ÂÙ·È ·fi ıÂÚ·¢ÙÈÎfi Û ·Ï¿ ·Ó·ÎÔ˘ÊÈÛÙÈÎfi Î·È ·ÚËÁÔÚËÙÈÎfi (3,9,10).

EÈÚfiÛıÂÙ·, Û ÌÂϤÙË Ô˘ ·Ó·Ê¤ÚÂÙ·È Û ÂÓ‹ÏÈΘ Ì ηÎÔ‹ıÂȘ (5), ÚÔ·ÙÂÈ fiÙÈ È‰È·›ÙÂÚ· ÛÙÔȯ›· Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ „˘¯È΋, ÓÂ˘Ì·ÙÈ΋ Î·È ÛˆÌ·ÙÈ΋ ηٷfiÓËÛË ÙÔ˘ ÁÈ·ÙÚÔ‡, ηٿ ÙË ‰È·‰Èηۛ· ÙÔ˘ ı·Ó¿ÙÔ˘, ›ӷÈ: ñ Ë ÌfiÓÈÌË ‰È·ÎÔ‹ Ù˘ Û¯¤Û˘ ÁÈ·ÙÚÔ‡-·ÛıÂÓÔ‡˜ ñ Ù· ·ÈÛı‹Ì·Ù· ·ÔÙ˘¯›·˜ ÛÙÔ ¤ÚÁÔ ÙÔ˘ ñ Ë ·ıËÙÈ΋ ÛÙ¿ÛË, ¯ˆÚ›˜ ÙË ‰˘Ó·ÙfiÙËÙ· ÚÔÛÊÔÚ¿˜ οÔÈ·˜ ‚Ô‹ıÂÈ·˜ ñ Ë ·˘ÍË̤ÓË Û˘ÓÂȉËÙÔÔ›ËÛË Ù˘ ‰È΋˜ ÙÔ˘ ıˆÚËÙÈ΋˜ ıÓËÙfiÙËÙ·˜, ÙÔ˘ ·ÓıÚÒÈÓÔ˘ Êı·ÚÙÔ‡ ñ Ë ·ÚÔ˘Û›· ·Ó·¿ÓÙËÙˆÓ ÂÚˆÙËÌ¿ÙˆÓ.

T· ÈÔ Û˘¯Ó¿ ‰Â, ·Ó·ÊÂÚfiÌÂÓ· ·ÈÛı‹Ì·Ù· Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ›‰È· ÌÂϤÙË ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ‰›Ï· ÛÙÔ ÎÚ‚¿ÙÈ ÙÔ˘ ÂÙÔÈÌÔı¿Ó·ÙÔ˘ ·ÚÚÒÛÙÔ˘ Â›Ó·È Ë ıÏ›„Ë, Ë Û˘ÓÂȉËÙÔÔ›ËÛË Ù˘ ·‰˘Ó·Ì›·˜ ÁÈ· ¯ÔÚ‹ÁËÛË ‚Ô‹ıÂÈ·˜, Ë ·›ÛıËÛË Ù˘ ·ÔÙ˘¯›·˜, Ë ·ÔÁÔ‹Ù¢ÛË Î·È Ë ÌÔÓ·ÍÈ¿, ÁÈ·Ù› ·˘Ù‹ ÙËÓ ÒÚ· Î·È Ô ıÂÚ¿ˆÓ È·ÙÚfi˜ ·ÈÛı¿ÓÂÙ·È ÌfiÓÔ˜.

E›Ó·È ÁÓˆÛÙfi fiÙÈ Ì ÙË ‰È¿ÁÓˆÛË ÂÓfi˜ ηÎÔ‹ıÔ˘˜ ÓÔÛ‹Ì·ÙÔ˜ ·ÎÔÏÔ˘ı› Ì›· ÂÓÙ·ÙÈ΋, Â›ÔÓË Î·È Ì·ÎÚfi¯ÚÔÓË ıÂÚ·¢ÙÈ΋ ÚÔÛ¿ıÂÈ· Ô˘ ÛÎÔfi ¤¯ÂÈ ·Ú¯Èο ÙÔÓ ÂÚÈÔÚÈÛÌfi Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙËÓ ÂÍ·Ê¿ÓÈÛË ÙˆÓ Î·ÎÔ‹ıˆÓ ΢ÙÙ¿ÚˆÓ ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi ÙÔ˘ ¿Û¯ÔÓÙÔ˜. M ÙÔÓ ÙÚfiÔ ·˘Ùfi ÚÔÛ·ıԇ̠ӷ ÂÌÔ‰›ÛÔ˘Ì ÙËÓ Â·ÓÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Î·È Ó· ÚÔÛʤÚÔ˘Ì ÛÙÔÓ ·ÛıÂÓ‹ ÙËÓ ‰˘Ó·ÙfiÙËÙ· Ì·ÎÚfi¯ÚÔÓ˘ ›·Û˘. ™ÙËÓ ÂÚ›ÙˆÛË fï˜, Ô˘ ÙÔ ÔıËÙfi ·ÔÙ¤ÏÂÛÌ· ‰ÂÓ Ú·ÁÌ·ÙÔÔÈËı›, ·Ú¯›˙ÂÈ Ì›· ‰Â‡ÙÂÚË ÚÔÛ¿ıÂÈ·, Ë ÔÔ›· ··ÈÙ› Ì›· Ó¤· Û˘ÓÔÏÈ΋ ÂÈÛÙËÌÔÓÈ΋ ÙÔÔı¤ÙËÛË ÙfiÛÔ ÛÙÔ ·È‰› fiÛÔ Î·È ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, ¿Óˆ ÛÙËÓ ‚·ÛÈ΋ ÓfiÛÔ Î·È ÛÙËÓ ‰È·ÁÚ·ÊfiÌÂÓË ‰˘Û¿ÚÂÛÙË ÔÚ›·. AÚ¯›˙ÂÈ Ì›· ÚÔÛ¿ıÂÈ·, ÈÔ ÎÔ˘Ú·ÛÙÈ΋ Î·È Ôχ ÏÈÁfiÙÂÚÔ ·ÈÛÈfi‰ÔÍË.

AÚ¯›˙ÂÈ Ì›· ÊÚÔÓÙ›‰· Ì ‰ÈÛ˘fiÛÙ·ÙÔ ÛÙfi¯Ô: ‚ÂÏÙ›ˆÛË Î·È ·Ó·ÎÔ‡ÊÈÛË Ù˘ ˘fiÏÔÈ˘ ˙ˆ‹˜ ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜ ·Ú¿ÏÏËÏ· Ì ÙËÓ ÂÓı¿ÚÚ˘ÓÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ, ·ÊÔ‡ ÂÓËÌÂÚˆıÔ‡Ó Ï‹Úˆ˜, Ó· ¿ÚÔ˘Ó ÙȘ ‰ÈΤ˜ ÙÔ˘˜ ·ÔÊ¿ÛÂȘ Î·È Ó· ·Ó·Ï¿‚Ô˘Ó Î˘Ú›·Ú¯Ô ÚfiÏÔ ÛÙËÓ ÊÚÔÓÙ›‰· ÙÔ˘ ·È‰ÈÔ‡ ÙȘ ÛËÌ·ÓÙÈΤ˜ ·˘Ù¤˜ ÛÙÈÁ̤˜ Ù˘ ˙ˆ‹˜ ÙÔ˘. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ı· ‰Ôı› Ë ‰˘Ó·ÙfiÙËÙ·, ÛÙÔ˘˜ ÁÔÓ›˜ Î·È ÛÙ· ·‰¤ÏÊÈ·, Ó· ÚÔÂÙÔÈÌ·ÛıÔ‡Ó Î·È „˘¯Èο ÁÈ· ÙÔÓ ÂÂÚ¯fiÌÂÓÔ ÌfiÓÈÌÔ ·Ô¯ˆÚÈÛÌfi ·fi ÙÔ ·Á·Ë̤ÓÔ ÙÔ˘˜ ÚfiÛˆÔ.

O ÚfiÏÔ˜ ÙÔ˘ ÁÈ·ÙÚÔ‡ Â‰Ò Â›Ó·È ıÂÌÂÏÈ҉˘. Afi ÙȘ ÈÔ ‰‡ÛÎÔϘ ÛÙÈÁ̤˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó Â›Ó·È Ë ÛÙÈÁÌ‹ Ô˘ ı· Ú¤ÂÈ Ì ·Ï¿ Î·È Î·Ù·ÓÔËÙ¿ ÏfiÁÈ· Ó· ÂÍËÁ‹ÛÂÈ ÛÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ ¿ÚÚˆÛÙÔ ·È‰› fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ È· ηÌÈ¿ ÚfiÛÊÔÚË ıÂÚ·›· ÁÈ· ÙÔ Úfi‚ÏËÌ¿ ÙÔ˘. H ÚÔÛ¤ÁÁÈÛË ·˘Ù‹ ÂÍ·ÙÔÌÈ·ÂÙ·È Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÌÔÚʈÙÈÎfi Â›‰Ô, ÙËÓ

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13:04

™ÂÏ›‰·124

¶∞π¢π∞∆ƒπ∫∏ 2000;63:121-128

„˘¯ÔÛ‡ÓıÂÛË Î·È ÙË ÓÔËÙÈ΋ ηٿÛÙ·ÛË ·È‰ÈÔ‡ÁÔÓÈÒÓ (6).

O ¯ÒÚÔ˜ Ù˘ ÂÓË̤ڈÛ˘ Ú¤ÂÈ Ó· Â›Ó·È ‹Û˘¯Ô˜, ·˘ÛÙËÚ¿ ÚÔÛˆÈÎfi˜, ¯ˆÚ›˜ ÂÓÔ¯ÏËÙÈΤ˜ Î·È ¿ÛÎÔ˜ ·ÚÂÌ‚¿ÛÂȘ ÙÚ›ÙˆÓ. H ÂÓË̤ڈÛË Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ fiÏ· fiÛ· ̤¯ÚÈ ÂΛÓË ÙË ÛÙÈÁÌ‹ ¤¯Ô˘Ó ÚÔËÁËı› Û ۯ¤ÛË Ì ÙË ‚·ÛÈ΋ ÓfiÛÔ Î·È Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Ù· ηÈÓÔ‡ÚÁÈ· ‰Â‰Ô̤ӷ. AÎÔÏÔ˘ıÔ‡Ó ÔÈ ı¤ÛÂȘ ¿Óˆ Û fiÙÈ ÌÔÚ› ·ÎfiÌË Ó· Á›ÓÂÈ ıÂÚ·¢ÙÈο, ›Ûˆ˜ Î·È ÛÙ· Ï·›ÛÈ· ÂÚ¢ÓËÙÈÎÒÓ ıÂÚ·¢ÙÈÎÒÓ ÂÈÏÔÁÒÓ, ÁÈ· ÙȘ Ôԛ˜ ¿ÓÙ· Ú¤ÂÈ Ó· ˙ËÙÂ›Ù·È Ë Û‡ÌʈÓË ÁÓÒÌË ÙˆÓ ÁÔÓÈÒÓ ‹ Î·È ÙÔ˘ ·È‰ÈÔ‡, Â¿Ó Ë ËÏÈΛ· ÙÔ˘ ÙÔ ÂÈÙÚ¤ÂÈ (7). ™Â ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË, Ô ÁÈ·ÙÚfi˜ ˘Ô¯ÚÂÔ‡Ù·È Ó· ÛÎÈ·ÁÚ·Ê‹ÛÂÈ ÙËÓ ÂÚ·ÈÙ¤Úˆ ÔÚ›· Ì ÙȘ ÂӉ¯fiÌÂÓ˜ ÂÈÏÔΤ˜, Ù· ÚÔ‚Ï‹Ì·Ù· Î·È ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Ô˘ ¤¯Ô˘Ì ۋÌÂÚ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘˜ (6,7).

OÚÈṲ̂ÓÔÈ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÛÙËÓ ÂÓË̤ڈÛË Ú¤ÂÈ Ó· Û˘ÌÌÂÙ¤¯ÂÈ Î·È ÙÔ ¿ÚÚˆÛÙÔ ·È‰›, ÂȉÈÎfiÙÂÚ· ·Ó Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ·fi 5 ¯ÚfiÓˆÓ, ÁÈ·Ù› ¤ÙÛÈ ÛÙËÓ ‰È·‰Èηۛ· Ô˘ ı· ·ÎÔÏÔ˘ı‹ÛÂÈ ı· ‰È¤ÂÙ·È ·fi ÏÈÁfiÙÂÚË ·Ó·ÛÊ¿ÏÂÈ· Î·È ÏÈÁfiÙÂÚÔ˘˜ Êfi‚Ô˘˜ (6). H ı¤ÛË ·˘Ù‹ ‚¤‚·È· ı· Ú¤ÂÈ ¿ÓÙÔÙ ӷ ÎÚ›ÓÂÙ·È ˘fi ÙÔ Êˆ˜ Ù˘ ˘¿Ú¯Ô˘Û·˜ ÎÔÈÓˆÓÈ΋˜ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜ Î·È Ù˘ ·Ó¿ÏÔÁ˘ "ÚÔÂÙÔÈÌ·Û›·˜" ÛÙËÓ ÔÔ›· ¤¯ÂÈ ˘Ô‚ÏËı› Ô ÂοÛÙÔÙ ·ÛıÂÓ‹˜ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓ, ‹‰Ë ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ηÎÔ‹ıÂÈ·˜. ŒÓ· ¿ÏÏÔ ÛÙÔÈ¯Â›Ô ÙÔ ÔÔ›Ô ı· Ú¤ÂÈ Ó· Ï¿‚Ô˘Ì ÛÔ‚·Ú¿ ˘fi„Ë Ì·˜, ηٿ ÙË ‰È·‰Èηۛ· ÂÓË̤ڈÛ˘ Û ·˘Ù‹ ÙËÓ ÙÂÏÈ΋ Ê¿ÛË, Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·È‰› Ì ηÚΛÓÔ ‰ÂÓ ·ÔÙÂÏ› ÌÈÎÚÔÁÚ·Ê›· ÂÓfi˜ ·ÓÙ›ÛÙÔÈ¯Ô˘ ÂÓËÏ›ÎÔ˘ ·ÛıÂÓÔ‡˜. T˘¯fiÓ ˘ÔÙ›ÌËÛË Ù˘ ·ÓÙ›ÏË„‹˜ ÙÔ˘, Ù˘ ‰È·›ÛıËÛ‹˜ ÙÔ˘, ÙˆÓ ÁÓÒÛÂˆÓ ‹ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘ ·ÔÙÂÏ› Ï¿ıÔ˜ (7). TÔ ·È‰›, ¿ÓÙ· ÁÓˆÚ›˙ÂÈ ÙÈ ÙÔ˘ Û˘Ì‚·›ÓÂÈ, ·ÎfiÌË Î·È fiÙ·Ó ‰ÂÓ ÙÔ ‰ËÏÒÓÂÈ ÊÔ‚Ô‡ÌÂÓÔ Ì‹ˆ˜ ÏËÁÒÛÂÈ ‹ ‰È·Ù·Ú¿ÍÂÈ ÙËÓ ÈÛÔÚÚÔ›· ÙˆÓ ·Á·ËÌ¤ÓˆÓ ÙÔ˘ ÚÔÛÒˆÓ. ŸÌˆ˜, ÊÔ‚¿Ù·È ÙÔ ¿ÁÓˆÛÙÔ, ¤¯ÂÈ ÙȘ ‰ÈΤ˜ ÙÔ˘ Ê·ÓÙ·ÛÈÒÛÂȘ, ¤¯ÂÈ Ù¿ÛÂȘ ·ÔÌfiÓˆÛ˘. °È· fiÏ· ·˘Ù¿ ÂÚÈ̤ÓÂÈ ·fi ÙÔÓ ÁÈ·ÙÚfi ÙÔ˘ Ì›· ·Ï‹ Î·È ÂÈÏÈÎÚÈÓ‹ ÚÔÛ¤ÁÁÈÛË, Ô˘ ı· ··ÓÙ¿ Û fiÏ· Ù· ÂӉ¯fiÌÂÓ· ÂÚˆÙ‹Ì·Ù· ‹ ·Ôڛ˜ ÙÔ˘ (6,7).

Afi Ù· ÚÔËÁÔ‡ÌÂÓ· Â›Ó·È Ê·ÓÂÚfi, fiÙÈ Ô ÚfiÏÔ˜ ÙÔ˘ È·ÙÚÔ‡ Î·È ·Ú¿ÏÏËÏ· ÙÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡, Û˘¯Ó¿ ÂÂÎÙ›ÓÂÙ·È ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÊ·›Ú·. H ‚Ô‹ıÂÈ· Ô˘ ·Ú¤¯Ô˘Ó Ù· ̤ÏË Ù˘ ¢ڇÙÂÚ˘ ıÂÚ·¢ÙÈ΋˜ ÔÌ¿‰·˜ Â›Ó·È ÛËÌ·ÓÙÈ΋ Î·È Î·ıÔÚÈÛÙÈ΋ ˆ˜ ÚÔ˜ ÙËÓ ÔÌ·ÏfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ Êfi‚Ô˘, ÔÚÁ‹˜, ı˘ÌÔ‡ Î·È Î·Ù¿ıÏȄ˘ Ô˘ ÔÈ ·ÛıÂÓ›˜ ÂΉËÏÒÓÔ˘Ó Û ·˘Ù‹ ÙËÓ ÙfiÛÔ ÎÚ›ÛÈÌË ÂÚ›Ô‰Ô. M¤Ûˆ Ù˘ Û˘Ó¯ԇ˜ ÚÔÛ¿ıÂÈ·˜ Ë ·fiÛÙ·ÛË ·fi ÙÔÓ ÂÈı˘ÌËÙfi ÛÙfi¯Ô ÛÌÈÎÚ‡ÓÂÙ·È Î·È ÙÂÏÈο ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÛÔ‚·Ú¤˜ Èı·ÓfiÙËÙ˜ Ô

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™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - AÓ‰ÚÔ˘Ï·Î¿ÎË

·ÛıÂÓ‹˜ Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· Û˘ÌÊÈÏȈı› Ì fiÏ· ·˘Ù¿ Ù· Û˘Ó·ÈÛı‹Ì·Ù·. H Û˘ÌÊÈÏ›ˆÛË ·˘Ù‹ Â›Ó·È ›Ûˆ˜ Ë ÌÔÓ·‰È΋ ·Ó·ÎÔ‡ÊÈÛË ÛÙÔÓ ¿ÚÚˆÛÙÔ Ô˘ Âı·›ÓÂÈ Î·È ÙÔ‡ÙÔ ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÙËÓ Ú¿ÍË Ì ÙËÓ ·Ú·ÌÔÓ‹ Ì·˜ ‰›Ï· ÛÙÔ ÎÚ‚¿ÙÈ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ì ÙËÓ ÚÔı˘Ì›· Ì·˜ Ó· Û˘˙ËÙ‹ÛÔ˘ÌÂ Î·È Ó· ·ÎÔ‡ÛÔ˘ÌÂ, Ó· ÂӉȷÊÂÚıԇ̠ÁÈ· fiÏ· ÂΛӷ Ô˘ ı¤ÏÂÈ Ó· ÂÎÊÚ¿ÛÂÈ. ŒÙÛÈ, ̤۷ ·fi Û˘Ó¯‹ ÂÈÎÔÈÓˆÓ›· ‰È· ÙÔ˘ ÏfiÁÔ˘ ‹ Ù˘ ·Ï‹˜ ·ÚÔ˘Û›·˜ Ì·˜, ÂÈÙ˘Á¯¿ÓÂÙ·È Ë Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ·fi ̤ÚÔ˘˜ ÙÔ˘ ·È‰ÈÔ‡ ·ÔÎ¿Ï˘„Ë ÙˆÓ Êfi‚ˆÓ ÙÔ˘ Û˘Ó·ÎfiÏÔ˘ı· ‰Â, Ë ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ (6,7,9,10).

OÈ Î·Ù¿ÏÏËÏÔÈ ¯ÂÈÚÈÛÌÔ› ·fi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ·È‰È¿ÙÚÔ˘-ÔÁÎÔÏfiÁÔ˘ ÌÔÚÔ‡Ó Â›Û˘ Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙË ÛˆÛÙ‹, Û‡Ìʈӷ Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ÂÈÏÔÁ‹ ÙÔ˘ ÙfiÔ˘ Ô˘ ı· ÂÈÛ˘Ì‚Â› Ô ı¿Ó·ÙÔ˜ (6,7). H Ù¿ÛË Ô˘ ˘‹Ú¯Â ·Ï·ÈfiÙÂÚ· ˆ˜ ÚÔ˜ ÙÔÓ ÙfiÔ Ù˘ ÙÂÏÈ΋˜ ηٿÏË͢ ¤ÎÏÈÓ ηٿ ·ÔÎÏÂÈÛÙÈÎfi Ì¿ÏÏÔÓ ÙÚfiÔ, ˘¤Ú ÙˆÓ Î¤ÓÙÚˆÓ ÙÚÈÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘, fiÔ˘ ·Ú¯Èο ›¯Â ·ÓÙÈÌÂÙˆÈÛı› Ë Î·ÎÔ‹ıÂÈ· ÙÔ˘ ·ÛıÂÓÔ‡˜ (7,11). ŸÌˆ˜, ·fi ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '80, ˘‹ÚÍ ̛· ÛËÌ·ÓÙÈ΋ ÌÂÙ·ÛÙÚÔÊ‹. ŒÙÛÈ Û‹ÌÂÚ·, Ë Ù¿ÛË Ô˘ ÂÈÎÚ·Ù› ‰ÈÂıÓÒ˜, Â›Ó·È Ó· ·Ú¤¯ÔÓÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓfiÛÔ˘, ÔÈ ıÂÚ·¢ÙÈΤ˜ ‹ ÔÈ ·Ó·ÎÔ˘ÊÈÛÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÛÙÔ Û›ÙÈ (ηÙ' Ô›ÎÔÓ ÓÔÛËÏ›·) ̤¯ÚÈ ÙÔ˘ Ù¤ÏÔ˘˜ (1113). H ¿Ô„Ë ·˘Ù‹ ÛÙËÚ›˙ÂÙ·È ÛÙ· ÌÂÁ¿Ï· ÏÂÔÓÂÎÙ‹Ì·Ù· Ô˘ Ë ÓÔÛËÏ›· ÛÙÔ Û›ÙÈ ÚÔÛʤÚÂÈ Î·È Ù· ÔÔ›· ÂÓ Û˘ÓÙÔÌ›· ·ÊÔÚÔ‡Ó: ñ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ ·È‰ÈÔ‡ Û ¤Ó· ÁÓÒÚÈÌo Î·È ÊÈÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ ·fi ÙÔ ÔÔ›Ô ÂӉ¯Ô̤ӈ˜ ÏfiÁˆ Ù˘ ÓfiÛÔ˘ ÙÔ˘ ›¯Â ·ÔÌ·ÎÚ˘Óı› ÁÈ· ÌÂÁ¿Ï· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ñ ÙË ‰˘Ó·ÙfiÙËÙ· ÙˆÓ ÁÔÓÈÒÓ Î·È ÙÔ˘ ¿ÌÂÛÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ó· ·Û¯ÔÏËıÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ Ì ÙÔ ·È‰› ÙÔ˘˜, Ó· ‚ÚÂıÔ‡Ó ÈÔ ÎÔÓÙ¿ ÙÔ˘, Ó· ‚ÈÒÛÔ˘Ó Î·È Ó· ÌÔÈÚ·ÛÙÔ‡Ó ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÙÔ˘ ÛÙÈÁ̤˜. ¶·ÚfiÙÈ ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi Ê·ÓÙ¿˙ÂÈ Ôχ Ô‰˘ÓËÚfi, Ë Ú·ÁÌ·ÙÈÎfiÙËÙ· Â›Ó·È ÙÂÏ›ˆ˜ ·ÓÙ›ıÂÙË Î·È ÔÈ ÛÙÈÁ̤˜ ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó, ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡, ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· "ʈÙÂÈÓ¿ ÛËÌ›·" (6,7,13).

B¤‚·È·, ÂÊfiÛÔÓ ·ÔÙÂÏ› ·fiÊ·ÛË Î·È ÂÈı˘Ì›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙˆÓ ÁÔÓÈÒÓ Ó· ÓÔÛËÏ¢ı› Ô ·ÛıÂÓ‹˜ ÛÙÔ Û›ÙÈ, ı· Ú¤ÂÈ ÔˆÛ‰‹ÔÙ ӷ ÏËÚÔ‡ÓÙ·È ÔÚÈṲ̂Ó˜ ‚·ÛÈΤ˜ ÚÔ¸Ôı¤ÛÂȘ, ÚÔÎÂÈ̤ÓÔ˘ ÙÔ‡ÙÔ Ó· ¢ԉˆı›, fiˆ˜ (6,7,13): ñ Ù·ÎÙÈ΋, ÂÚ›Ô˘ ·Ó¿ ‚‰ÔÌ¿‰·, Â›ÛÎÂ„Ë ÛÙÔ Û›ÙÈ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡ Ô ÔÔ›Ô˜ ηٿ ÚÔÙ›ÌËÛË Ú¤ÂÈ Ó· ·Ó‹ÎÂÈ ÛÙËÓ ıÂÚ·¢ÙÈ΋ ÔÌ¿‰· Ô˘ ÂÍ·Ú¯‹˜ ·Ú·ÎÔÏÔ˘ıÔ‡Û ÙÔ ·È‰› ñ ηıËÌÂÚÈÓ‹ Â›ÛÎÂ„Ë Ù˘ ÂÍÂȉÈÎÂ˘Ì¤Ó˘ ÓÔÛËχÙÚÈ·˜ ÁÈ· ÙËÓ ··Ú·›ÙËÙË ÓÔÛËÏ›· Î·È ÙËÓ

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·125

¶∞π¢π∞∆ƒπ∫∏ 2000;63:121-128

ÂÎÙ›ÌËÛË Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜ ñ ‰˘Ó·ÙfiÙËÙ· ‰ËÌÈÔ˘ÚÁ›·˜ ‹ÚÂÌÔ˘, ¢¯¿ÚÈÛÙÔ˘ ·ÎfiÌ· Î·È ¯·ÚÔ‡ÌÂÓÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ·fi fiÏÔ ÙÔ ¿ÌÂÛÔ ·ÏÏ¿ Î·È ¤ÌÌÂÛÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡ ñ ÛˆÛÙ‹ ÂÓË̤ڈÛË Î·È ÂÎ·›‰Â˘ÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Î·ıËÌÂÚÈÓÒÓ ·Ó·ÁÎÒÓ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ‹ ÂÎÙ¿ÎÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ fiˆ˜ .¯. ÂÓfi˜ ÂÂÈÛÔ‰›Ô˘ Û·ÛÌÒÓ, Î.¿. ñ ¢¯ÂÚ‹˜ ÚfiÛ‚·ÛË ÛÙÔ ˘‡ı˘ÓÔ ıÂÚ·¢ÙÈÎfi ΤÓÙÚÔ ÔÔÈ·‰‹ÔÙ ÛÙÈÁÌ‹ ÔÈ ÁÔÓ›˜ ·ÈÛı·ÓıÔ‡Ó ÙËÓ ·Ó¿ÁÎË Ó· ÌÂٷʤÚÔ˘Ó ÙÔ ·È‰› ÙÔ˘˜, ¯ˆÚ›˜ Ó· ·ÈÛı¿ÓÔÓÙ·È ·ÈÛı‹Ì·Ù· ÂÓÔ¯‹˜ ÁÈ· Ù˘¯fiÓ ¯ÚÔÓÈΤ˜ ηı˘ÛÙÂÚ‹ÛÂȘ H È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓfiÛÔ˘, ·Ú¤¯ÂÙ·È ÛÙÔ ÌÂÙ·›¯ÌÈÔ ˙ˆ‹˜ Î·È ı·Ó¿ÙÔ˘, ÛÙËÓ ÎÚÈÛÈÌfiÙÂÚË ›Ûˆ˜ ηÌ‹ Ù˘ ˙ˆ‹˜ οı ·ÓıÚÒÈÓ˘ ‡·Ú͢. EȉÈÎfiÙÂÚ· ÁÈ· ÙÔ Â˘·›ÛıËÙÔ Î·È Â˘¿ÏˆÙÔ ·È‰›, Ë È‰È·›ÙÂÚË ÛËÌ·Û›· Ù˘ ÚÒÈÌ˘, ¿‰È΢ Î·È ‚›·È˘ ‰È·ÎÔ‹˜ Ù˘ ÔÌ·Ï‹˜ Û˘Ó¤¯ÈÛ˘ ÙÔ˘ Ó‹Ì·ÙÔ˜ Ù˘ ˙ˆ‹˜ ÙÔ˘, Â›Ó·È Â˘ÓfiËÙË. ¶Ú¤ÂÈ ÏÔÈfiÓ ¤Ú· ·fi ÙËÓ ÂÎÏ‹ÚˆÛË ÙˆÓ È·ÙÚÈÎÒÓ, ÓÔÛËÏ¢ÙÈÎÒÓ ‹ ¿ÏÏˆÓ Ú·ÎÙÈÎÒÓ ·Ó·ÁÎÒÓ, Ó· ‰È¤ÂÙ·È ·fi ÔÚÈṲ̂Ó˜ ıÂÌÂÏÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ·Ú¯¤˜. OÈ ·Ú¯¤˜ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ηıÔÚ›˙Ô˘Ó ÙËÓ Û˘ÓÔÏÈ΋ ÛÙ¿ÛË, ÙȘ ı¤ÛÂȘ Î·È ÙȘ ·ÚÂÌ‚¿ÛÂȘ Ì·˜ ˆ˜ ·Ú¯fiÓÙˆÓ ˘ËÚÂۛ˜ ˘Á›·˜. T¤ÙÔȘ ·Ú¯¤˜ Ô˘ ÈÛ¯‡Ô˘Ó Û ÌÂÁ¿ÏÔ˘˜ Î·È Û ·È‰È¿, Ú¤ÂÈ Ó· Â›Ó·È ÔÈ ÂÍ‹˜ (5): ñ ÔÈ ·ÛıÂÓ›˜ Ô˘ Âı·›ÓÔ˘Ó Â›Ó·È ˙ˆÓÙ·Ó¤˜ ·ÓıÚÒÈÓ˜ ˘¿ÚÍÂȘ Î·È ËıÈο ÂÈÙ¿ÛÛÂÙ·È Ë ÚÔÛÊÔÚ¿ Û ·˘ÙÔ‡˜ Ù˘ Ú¤Ô˘Û·˜ ÊÚÔÓÙ›‰·˜ Î·È ·Ó·ÎÔ‡ÊÈÛ˘ ñ ÔÈ ·ÛıÂÓ›˜ Ô˘ Âı·›ÓÔ˘Ó ‰ÂÓ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÔÓÙ·È Û ÌË ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ Î·È ¿ÛÎÔ˜ ·ÓÙÈηÚÎÈÓÈΤ˜ ıÂÚ·›˜ ñ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ·ÏÏ¿ ÂȉÈÎfiÙÂÚ· ÔÈ ·ÛıÂÓ›˜ Ô˘ Âı·›ÓÔ˘Ó, ¤¯Ô˘Ó ÙÔ ‰Èη›ˆÌ· Ù˘ ÈηÓÔÔÈËÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ì ÛÎÔfi ÙËÓ Ì›ˆÛË ÙˆÓ ÔÚÁ·ÓÈÎÒÓ Î·È „˘¯ÔÏÔÁÈÎÒÓ ÙÔ˘˜ ÚÔ‚ÏËÌ¿ÙˆÓ Î·ıÒ˜ Î·È ÙÔ ‰Èη›ˆÌ· Ù˘ ÎÔÈÓˆÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢. TÔ‡ÙÔ Ë ·Ú¯·›· ÂÏÏËÓÈ΋ ÁÚ·ÌÌ·Ù›· ("ZËÓ Î·È ÙÂıÓ¿Ó·È Î·ÏÒ˜") Î·È ÙÔ E˘·ÁÁ¤ÏÈÔ, ·ÔÙ˘ÒÓÔ˘Ó Ì ȉ·ÓÈÎfi ÙÚfiÔ, ‰È·ÎËÚ‡ÛÛÔÓÙ·˜ fiÙÈ ÔÈ ¿ÓıÚˆÔÈ ÔÊ›ÏÔ˘Ó Ó· ÚÔۂϤÔ˘Ó Û "Ù¤ÏË ·ÓÒ‰˘Ó·, ·ÓÂ·›Û¯˘ÓÙ· Î·È ÂÈÚËÓÈο" ñ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÙÔ ‰Èη›ˆÌ· Ù˘ ·ÚÔ¯‹˜, ÙËÚÔ˘Ì¤ÓˆÓ ÙˆÓ ·Ó·ÏÔÁÈÒÓ Î·È ÙˆÓ ÂȉÈÎÒÓ ÂÚÈÛÙ¿ÛˆÓ, Ù˘ ηχÙÂÚ˘ ‰˘Ó·Ù‹˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜. ø˜ ÂÎ ÙÔ‡ÙˆÓ Ë ·˘ÙÔÓÔÌ›· ÙÔ˘˜, Ë ·ÍÈÔÚ¤ÂÈ¿ ÙÔ˘˜, Ë Ï‹Ú˘ ·ÔÙ‡ˆÛË Ù˘ ηٷÛÙ¿ÛÂÒ˜ ÙÔ˘˜, Ë ‰›Î·ÈË Î·È ÂÈÏÈÎÚÈÓ‹˜ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜, ·ÔÙÂÏÔ‡Ó ËıÈο ·ÍÈÒÌ·Ù· Ô˘ Ú¤ÂÈ Ó· ÏËÚÔ› Ë ÊÚÔÓÙ›‰· ÙÔ˘˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È¤ÏıÔ˘Ó fiÛÔ Á›ÓÂ-

TÂÏÈÎfi ÛÙ¿‰ÈÔ Î·ÚΛÓÔ˘

Ù·È ÈÔ ÔÌ·Ï¿ Î·È ·ÓÒ‰˘Ó· Ù· ÛÙ¿‰È· ÂÓfi˜ ·ÍÈÔÚÂÔ‡˜ ı·Ó¿ÙÔ˘.

Afi ηı·Ú¿ Ú·ÎÙÈ΋ È·ÙÚÈ΋ ¿Ô„Ë, ÔÈ Î·Ù·ÛÙ¿ÛÂȘ ÛÙȘ Ôԛ˜ ÂÛÙÈ¿˙ÂÙ·È Ë È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ¯ÔÚËÁÔ‡ÌÂÓË ÛÙÔ NÔÛÔÎÔÌÂ›Ô ‹ ÛÙÔ Û›ÙÈ, Â›Ó·È Î˘Ú›ˆ˜ Ô fiÓÔ˜, Ë Ó·˘Ù›·, ÔÈ ¤ÌÂÙÔÈ, Ë ‰˘ÛÎÔÈÏÈfiÙËÙ·, Ë ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË, Ë ‰‡ÛÓÔÈ·, ÔÈ Û·ÛÌÔ›, Ë ·ÓÔÚÂÍ›·, Ë ·Ê˘‰¿ÙˆÛË, ÔÈ ÏÔÈÌÒÍÂȘ Î·È ÔÈ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ. OÈ Î·Ù·ÛÙ¿ÛÂȘ ·˘Ù¤˜ Î·È Ë ‚·ÛÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Û˘ÓÔÙÈο ·Ó·Ê¤ÚÔÓÙ·È Î·ÙˆÙ¤Úˆ.

1) EÒ‰˘Ó˜ ηٷÛÙ¿ÛÂȘ O fiÓÔ˜ ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ Î·È ÙÔ ÈÔ ‰˘Û¿ÚÂÛÙÔ Û‡Ìو̷ ÁÈ· ÙÔÓ ·ÛıÂÓ‹ ·ÏÏ¿ Î·È ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘. ŸÏ· Ù· ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ·ÈÌ·ÙÔÏÔÁÈο ‹ Û˘Ì·Á›˜ fiÁÎÔÈ, ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ¿ÏÁË ‰È¿¯˘Ù· ‹ ÂÓÙÔÈṲ̂ӷ. ™Â ÌÂϤÙË 199 ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ì ·›ÛıËÌ· fiÓÔ˘ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ·ÊÔÚÔ‡Û ·ÛıÂÓ›˜ ̠Ϣ¯·ÈÌ›· ‹ ϤÌʈ̷ (44%) ÂÓÒ Ù· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÁÈ· ÔÈΛÏÔ˘˜ Û˘Ì·Á›˜ fiÁÎÔ˘˜ Î·È ÂȉÈÎfiÙÂÚ· ÁÈ· fiÁÎÔ˘˜ ÙÔ˘ KN™ ‹Û·Ó 33% Î·È 23% ·ÓÙ›ÛÙÔȯ· (14).

H ·Ó¿ÁÎË ÁÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÒ‰˘ÓˆÓ ηٷÛÙ¿ÛÂˆÓ Ô‰‹ÁËÛ ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '80, ÛÙË ‰ËÌÈÔ˘ÚÁ›· È·ÙÚÈ΋˜ ÂÍÂȉ›Î¢Û˘ Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘. ™‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂÊfiÛÔÓ ¯ÔÚËÁËı› Ë Î·Ù¿ÏÏËÏË ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹ ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· Ó· ÂÏÂÁ¯ı› Ô fiÓÔ˜ ÛÙÔ 80-90% ÙˆÓ ·ÛıÂÓÒÓ (5,1417). ¢˘ÛÙ˘¯Ò˜ fï˜ Ë Ú·ÁÌ·ÙÈÎfiÙËÙ· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ôχ ‰È·ÊÔÚÂÙÈ΋ Î·È ÌfiÏȘ ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ·ÔÏ·Ì‚¿ÓÂÈ ÂÈÙ˘¯Ô‡˜ ·Ó·ÏÁËÙÈ΋˜ ·ÁˆÁ‹˜, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ ÁÈ· ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Â›Ó·È ·ÎfiÌË ¯·ÌËÏfiÙÂÚÔ (<10%) (7,18).

H ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ fiÓÔ˘ Î·È ·ÎÔÏÔ˘ı› Û˘Ó‹ıˆ˜ Ì›· ÛÙ·‰È·Î¿ ÂÓÙ·ÙÈÎÔÔÈË̤ÓË ÔÚ›·. TÔ Ê¿ÛÌ· ÙˆÓ ¯ÔÚËÁÔ˘Ì¤ÓˆÓ Ê·ÚÌ¿ÎˆÓ Î˘Ì·›ÓÂÙ·È ·fi ÙËÓ ·ÎÂÙ·ÌÈÓÔÊ·›ÓË Î·È Ù· ÌË ÛÙÂÚÔÂȉ‹ ·Ó·ÏÁËÙÈο ÁÈ· ÙȘ ÈÔ ÂÏ·ÊÚ¤˜ ÂÚÈÙÒÛÂȘ, ̤¯ÚÈ Ù· ÈÛ¯˘Ú¿ ÔÈÔÂȉ‹ ÁÈ· ÙȘ Ôχ ÂÒ‰˘Ó˜ ηٷÛÙ¿ÛÂȘ (14,17). H ‰ÔÛÔÏÔÁ›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Û΢·ÛÌ¿ÙˆÓ ‰È·ÌÔÚÊÒÓÂÙ·È ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙȘ Ù˘¯fiÓ Û˘Ó˘¿Ú¯Ô˘Û˜ ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ‹ ÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ›‰ÈˆÓ ÙˆÓ Ê·Ú̿ΈÓ. ŒÙÛÈ ÏÔÈfiÓ, Û ÂÚ›ÙˆÛË Ô˘ ÌÂ Û˘Ì‚·ÙÈο ·Ó·ÏÁËÙÈο Û¯‹Ì·Ù· ‰ÂÓ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÙÔ Úfi‚ÏËÌ·, ·ÎÔÏÔ˘ı› Ë ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË ÔÈÔ‡¯ˆÓ Û΢·ÛÌ¿ÙˆÓ Û ÛÙ·‰È·Î‹ ·‡ÍËÛË. E› ·ÔÙ˘¯›·˜ ‹ ‰˘Û·ÓÂÍ›·˜ Ù˘ Ï‹„˘ ·fi ÙÔ ÛÙfiÌ· ·ÎÔÏÔ˘ı› Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÙÔ˘ ÔÈÔÂȉԇ˜

125

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30-05-03

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™ÂÏ›‰·126

¶∞π¢π∞∆ƒπ∫∏ 2000;63:121-128

Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ‹ ÛÂ Û˘Ó¯‹ ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË. OÈ ‰fiÛÂȘ ·˘Í¿ÓÔÓÙ·È ÛÙ·‰È·Î¿ Î·È Î˘Ì·›ÓÔÓÙ·È Â˘Ú¤ˆ˜ (·Ó·Ê¤ÚÔÓÙ·È ÈÛÔ‰‡Ó·Ì˜ ÁÈ· ÌÔÚÊ›ÓË ‰fiÛÂȘ Ù˘ ٿ͈˜ ÙˆÓ 518mg/kg/ÒÚ·) (14). º¿Ú̷η Ô˘ Û˘ÓÂÈÎÔ˘ÚÔ‡Ó ÙËÓ ·Ó·ÏÁËÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÔÈÔ‡¯ˆÓ Û΢·ÛÌ¿ÙˆÓ, Â›Ó·È Ù· ÛÙÂÚÔÂȉ‹ Î·È Ù· ÌË ÛÙÂÚÔÂȉ‹ ·Ó·ÏÁËÙÈο.

EÈÚfiÛıÂÙ·, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÚÔηÏÔ‡ÌÂÓ˘ ·fi ÙËÓ ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹ ˘ÓËÏ›·˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÙËÚËı› Ô ·ÛıÂÓ‹˜ Û ÂÁÚ‹ÁÔÚÛË Î·È Û ηϋ ‰È¿ıÂÛË ÌÔÚ› Ó· ¯ÔÚËÁËıÔ‡Ó ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο ‹ „˘¯Ô‰ÈÂÁÂÚÙÈο Û΢¿ÛÌ·Ù· (5). °È· ÙȘ ϤÔÓ ·ÓıÂÎÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂȯÂÈÚÂ›Ù·È ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›·, Ë ÔÔ›· ‚‚·›ˆ˜ ηٿ ÙÔ ‰˘Ó·ÙfiÓ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È, fiˆ˜ Â›Û˘ ÂÈÛÎÏËÚ›‰È· ‹ ÂÓ‰ÔÌ˘ÂÏÈ΋ ¤Á¯˘ÛË ·Ó·ÏÁËÙÈÎÒÓ (5-7,14).

OÏÔÎÏËÚÒÓÔÓÙ·˜ ÙË Û‡ÓÙÔÌË ·˘Ù‹ ·Ó·ÊÔÚ¿ ÛÙËÓ ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹, ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ÛÙÔÓ ÙÔ̤· ·˘ÙfiÓ ·ÈˆÚÔ‡ÓÙ·È Î¿ÔÈÔÈ "È·ÙÚÈÎÔ› ̇ıÔÈ Î·È ‰Ôͷۛ˜" Ô˘ Û˘¯Ó¿ ı¤ÙÔ˘Ó ÊÚ·ÁÌÔ‡˜ ÛÙËÓ ÛˆÛÙ‹ ÂÊ·ÚÌÔÁ‹ Ù˘. AÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙËÓ Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ Ù· Ó·ÚΈÙÈο ıˆÚËÙÈÎÒ˜ ÚÔηÏÔ‡Ó, ÙËÓ Èı·Ó‹ ÂÍ¿ÚÙËÛË, ÙÔÓ ÂıÈÛÌfi ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙȘ Ó·ÚΈÙÈΤ˜ ·Ó·ÏÁËÙÈΤ˜ Ô˘Û›Â˜ ÎÏ. T¤ÙÔȘ ·fi„ÂȘ Â›Ó·È ·˘ÙÔÓfiËÙÔ fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ı¤ÛË ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ‰ÂÓ ÂȂ‚·ÈÒÓÔÓÙ·È ¿ÓÙÔÙ ‚È‚ÏÈÔÁÚ·ÊÈο (6,7,18-20) Î·È ÙÔ Ô˘ÛÈ·ÛÙÈÎfiÙÂÚÔ, ‰ÂÓ Ú¤ÂÈ Ó· ·ÔÙÂÏÔ‡Ó ÙÚÔ¯Ô¤‰Ë ÁÈ· ÙËÓ ¯ÔÚ‹ÁËÛË ÌÈ·˜ ÈηÓÔÔÈËÙÈ΋˜, ¤ÓÙÔÓ˘ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ·Ó·ÏÁËÙÈ΋˜ ·ÁˆÁ‹˜, fiÙ·Ó ·˘Ù‹ ÂÈ‚¿ÏÂÙ·È.

2) N·˘Ù›· Î·È ¤ÌÂÙÔÈ ¶ÔÏÏ¿ ÛËÌ›· ÙˆÓ ·ıÔÁÂÓÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Ô˘ ÂÌϤÎÔÓÙ·È ÛÙËÓ Ó·˘Ù›· Î·È ÛÙÔÓ ¤ÌÂÙÔ ¤¯Ô˘Ó ÚfiÛÊ·Ù· ‰È·Û·ÊËÓÈÛı› Î·È ‰Ú·ÛÙÈΤ˜ Ê·Ú̷΢ÙÈΤ˜ Ô˘Û›Â˜ ¤¯Ô˘Ó ·Ó·Ù˘¯ı›, Ì ·ÔÙ¤ÏÂÛÌ· Û‹ÌÂÚ· Ë ·Ú¤Ì‚·Û‹ Ì·˜ ÛÙÔÓ ÙÔ̤· ·˘Ùfi Ó· Â›Ó·È ÂÈÙ˘¯‹˜ (5,15,21,22). ¢˘ÛÙ˘¯Ò˜ fï˜, Ë ÂȉÈ΋ ·ÓÙÈÂÌÂÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ ·Ô‰›‰ÂÈ ¿ÓÙÔÙ ٷ ·Ó·ÌÂÓfiÌÂÓ·. TÔ‡ÙÔ ÔÊ›ÏÂÙ·È ÛÙËÓ ÏÂÈ¿‰· ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÚfiÎÏËÛ˘ Ù˘ Ó·˘Ù›·˜ Î·È ÙˆÓ Â̤وÓ, Ì ¯·Ú·ÎÙËÚÈÛÙÈο ·Ú·‰Â›ÁÌ·Ù· ÙËÓ Á·ÛÙÚ›Ùȉ· ‹ ÙÔ Á·ÛÙÚÈÎfi ¤ÏÎÔ˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ¯ÔÚ‹ÁËÛË H2 ·Ó·ÛÙÔϤˆÓ Î·È ÙȘ ‰È¿ÊÔÚ˜ ÂÒ‰˘Ó˜ ηٷÛÙ¿ÛÂȘ Ë ÂÈÙ˘¯‹˜ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÔÔ›ˆÓ, ÂÍ·Ê·Ó›˙ÂÈ Ù· ÂÓԯϋ̷ٷ ·˘Ù¿ (5,15,22).

A·Ú·›ÙËÙ· ÎÚ›ÓÔÓÙ·È Ù· ÛÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Ô˘ ı· ‰È¢ÎÚÈÓ›ÛÔ˘Ó ‰È·ÁÓˆÛÙÈο ÙÔ Úfi‚ÏËÌ· ÙÔ˘ Â̤ÙÔ˘ Î·È ı· ˘ԉ›ÍÔ˘Ó ÙËÓ ϤÔÓ ·ÈÙÈÔÏÔÁÈ΋ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘.

3) ¢˘ÛÎÔÈÏÈfiÙËÙ· Î·È ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË TÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ·ÛıÂÓÔ‡˜, ÔÈ ÚÔËÁÔ‡ÌÂÓ˜ ÂÓÙÂÚÈΤ˜ Û˘Ó‹ıÂȤ˜ ÙÔ˘, Ë Î·Ï‹ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË

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™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - AÓ‰ÚÔ˘Ï·Î¿ÎË

Ù˘ ÎÔÈÏȷ΋˜ ¯ÒÚ·˜ Î·È Ë Â› ÂӉ›ÍÂˆÓ ‰·ÎÙ˘ÏÈ΋ ÂͤٷÛË ÙÔ˘ ÔÚıÔ‡, ‚ÔËıÔ‡Ó ÛÙËÓ ·ÈÙÈÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰˘ÛÎÔÈÏÈfiÙËÙ·˜ ‹ Ù˘ ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢ Î·È ÙË ÈÔ ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ (15).

E›Ó·È ÁÓˆÛÙ‹ Ë ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Ô˘ ·ÛÎÔ‡Ó Ù· ÔÈÔ‡¯· Û΢¿ÛÌ·Ù· ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÂȉÈÎfiÙÂÚ· ·Ó Û˘Ó‰˘¿˙ÔÓÙ·È Ì ˘ÔıÚ„›·, Ì ·ÔÙ¤ÏÂÛÌ· ÔÏÏÔ› ·ÛıÂÓ›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Ó· ÂÌÊ·Ó›˙Ô˘Ó ‰˘ÛÎÔÈÏÈfiÙËÙ· (14). H ıÂÚ·›· Ù˘ ·Ú¯Èο Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ˘‰ÚÈ΋˜ ‹ ÌÂ Ê˘ÙÈΤ˜ ›Ó˜ ‰›·ÈÙ·˜ Î·È ÙÔÔı¤ÙËÛË ıÂÚÌÒÓ ÂÈıÂÌ¿ÙˆÓ ÛÙËÓ ÎÔÈÏȷ΋ ¯ÒÚ·. E› ·ÔÙ˘¯›·˜ ÚÔÛÙ›ıÂÓÙ·È ‰ÈÂÁÂÚÙÈο ÙÔ˘ ÂÓÙ¤ÚÔ˘ (senna-bisacodyl), ÔÛ̈ÙÈο ‰ÚÒÓÙ˜ ·Ú¿ÁÔÓÙ˜ (ÛÔÚ‚ÈÙfiÏË-Ï·ÎÙÔ˘Ïfi˙Ë) Î·È Lomotil (5). K·ÏfiÓ Â›Ó·È, ηٷگ‹Ó Ó· ·ÔʇÁÔÓÙ·È ÔÈ ˘ÔÎÏ˘ÛÌÔ› Î·È Ù· ˘fiıÂÙ·. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ fiÙ·Ó ÔÈ ÂÒ‰˘Ó˜ Û˘Û¿ÛÂȘ ÙˆÓ ÎÔ›ÏˆÓ ÛÏ¿¯ÓˆÓ Î·È Ë ÛÙ¿ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ‰ÂÓ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘ÓÙËÚËÙÈο, ‰˘Ó·ÙfiÓ Ó· ÂȯÂÈÚËı› ·ÎfiÌË Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (5,14).

4) ¢‡ÛÓÔÈ· H ‰‡ÛÓÔÈ· Â›Ó·È Û‡ÓıÂÙÔ ˘ÔÎÂÈÌÂÓÈÎfi ÂÓfi¯ÏËÌ· Âȉ¯fiÌÂÓÔ ÔÈÎ›ÏˆÓ Ê˘ÛÈÎÒÓ, „˘¯ÔÏÔÁÈÎÒÓ, ÎÔÈÓˆÓÈÎÒÓ Î·È ÓÔËÙÈÎÒÓ ÂÈÚÚÔÒÓ.

TÔ Î¤ÓÙÚÔ Ù˘ ·Ó·ÓÔ‹˜ Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi Û٤ϯԘ ‰¤¯ÂÙ·È ÂÚÂı›ÛÌ·Ù· ·fi: ñ ÂȉÈÎÔ‡˜ ˘ԉԯ›˜ ÙˆÓ ÔÔ›ˆÓ ÙÔ ÔÌfiÏÔÁÔ ÂÚ¤ıÈÛÌ· Â›Ó·È Ù· Â›‰· ÙÔ˘ O2 Î·È ÙÔ˘ CO2 ÙÔ˘ ·›Ì·ÙÔ˜ ñ Ù·ÛÂÔ¸ԉԯ›˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÙˆÓ Ó¢ÌfiÓˆÓ ñ ˘ԉԯ›˜ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ñ ÙÔÓ ÊÏÔÈfi ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (15) H ‰Ú¿ÛË ÔÏÏ·ÏÒÓ ·Ú·ÁfiÓÙˆÓ Â› ÙˆÓ ·ÓˆÙ¤Úˆ ÂÚÈÔ¯ÒÓ, Ô˘ ÂÓ Û˘Ó¯›· ÂËÚ¿˙Ô˘Ó ÙÔ Î¤ÓÙÚÔ Ù˘ ·Ó·ÓÔ‹˜ Û˘Óı¤ÙÂÈ ÙËÓ ÔÈΛÏË ·ÈÙÈÔÏÔÁ›· Ù˘ ‰‡ÛÓÔÈ·˜ (6,15). ™˘Ó‹ıˆ˜ Â› ‰‡ÛÓÔÈ·˜ ‰È·ÁÓˆÛÙÈο ‰ÈÂÓÂÚÁÔ‡ÓÙ·È ·/· ıÒÚ·ÎÔ˜ Î·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜ ÂÓÒ Ô ˘fiÏÔÈÔ˜ ¤ÏÂÁ¯Ô˜ ÂÍ·ÙÔÌÈ·ÂÙ·È ·Ó¿ÏÔÁ· Ì ٷ ÂοÛÙÔÙ ÎÏÈÓÈο ÛÙÔȯ›· ÙÔ˘ ·ÛıÂÓÔ‡˜.

H ıÂÚ·›· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ fiˆ˜ ·ÚÔ˘Û›· ˘‰ÚÔıÒÚ·ÎÔ˜, ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ·Ó·ÈÌ›·˜, ÎÏ. °ÂÓÈο, Ù· ÔÈÔÂȉ‹ Î·È Ù· ÛÙÂÚÔÂȉ‹ Ê·›ÓÂÙ·È fiÙÈ ‚ÔËıÔ‡Ó ÛËÌ·ÓÙÈο ÛÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ‰‡ÛÓÔÈ·˜. H ıÂÚ·›· Û˘Ó‹ıˆ˜ ÍÂÎÈÓ¿ Ì ¯ÔÚËÁÔ‡ÌÂÓ· ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Û΢¿ÛÌ·Ù· Έ‰Â˝Ó˘ ‹ ˘‰ÚÔΈ‰Â˝Ó˘. ™ÙË Û˘Ó¤¯ÂÈ·, Â› ÌË ÈηÓÔÔÈËÙÈ΋˜ ·ÓÙ·fiÎÚÈÛ˘ ‰ÔÎÈÌ¿˙ÂÙ·È Ë ÔÍ˘Îˆ‰Â˝ÓË ‹ Ù· Û΢¿ÛÌ·Ù· ÌÔÚÊ›Ó˘. ¶¿ÓÙˆ˜ ·ÓÂÍ¿ÚÙËÙ· ÙÔ˘ ¯ÔÚËÁÔ˘Ì¤ÓÔ˘ Û΢¿ÛÌ·ÙÔ˜ Ë ‰fiÛË ÌÔÚ› Ó· ·˘Í¿ÓÂÙ·È

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·127

¶∞π¢π∞∆ƒπ∫∏ 2000;63:121-128

ηıËÌÂÚÈÓ¿ ηٿ ÙÔ 30 ¤ˆ˜ 50% Ù˘ ÚÔËÁÔ‡ÌÂÓ˘, ̤¯ÚȘ fiÙÔ˘ ÂÙ‡¯Ô˘Ì ÙÂÙÚ¿ˆÚË ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (15). ™Â ·ÛıÂÓ›˜ Ì ¤ÓÙÔÓÔ ¿Á¯Ô˜ ÌÔÚ› Ó· ¯ÔÚËÁËı› ·Ú¿ÏÏËÏ· Î·È Î¿ÔÈÔ Û··ÛÌ· Ù˘ ÔÌ¿‰·˜ ÙˆÓ ‚ÂÓ˙ԉȷ˙ÂÈÓÒÓ (15).

5) ™·ÛÌÔ› OÈ Û·ÛÌÔ› ·ÔÙÂÏÔ‡Ó Ôχ ‰˘Û¿ÚÂÛÙÔ Û˘Ì‚¿Ó ÁÈ· ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Û ÔÈΛÏÔ˘˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (.¯. ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜ ‹ ÌÂÙ·ÛÙ¿ÛÂȘ, ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î.¿). H ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Â›Ó·È Î·Ù·Ú¯‹Ó ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋, Á›ÓÂÙ·È Ì ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·ÏÏ¿ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Î·È Ì ˘ÔÎÏ˘ÛÌÔ‡˜ ηٷÛÙ·ÏÙÈÎÒÓ ÙÔ˘ KN™ ÛÙÔ Û›ÙÈ, ÂÊfiÛÔÓ ÙÔ‡ÙÔ ¯ÚÂÈ·Ûı› (7).

6) AÓÔÚÂÍ›· - ·Ê˘‰¿ÙˆÛË H ·ÓÔÚÂÍ›· ‹ Ë ÂӉ¯fiÌÂÓË ·Ê˘‰¿ÙˆÛË Û˘ÓÈÛÙÔ‡Ó Û¯Â‰fiÓ ÌfiÓÈÌÔ ¿Á¯Ô˜ ÙˆÓ ÁÔÓÈÒÓ, ÔÈ ÔÔ›ÔÈ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ì ÙË Û›ÙÈÛË ÚÔÛʤÚÔ˘Ó ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙÔ ·È‰› ÙÔ˘˜. ¢È΋ Ì·˜ ˘Ô¯Ú¤ˆÛË Â›Ó·È Ë ‰È·‚‚·›ˆÛË ÂÚ› ÙÔ˘ ·ÓÙÈı¤ÙÔ˘ Î·È ÂÚ› ÙÔ˘ fiÙÈ ÙÔ ·È‰› Ú¤ÂÈ Ó· ÛÈÙ›˙ÂÙ·È ÌfiÓÔ fiÙ·Ó ÙÔ ÂÈı˘Ì› (6,7). ŒÙÛÈ, Ë ¯Ú‹ÛË ÚÈÓÔÁ·ÛÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Û›ÙÈÛ˘, Ë ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊÏ‚›ˆÓ ˘ÁÚÒÓ ‹ ·ÚÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ¿ÏÏˆÓ ·ÚfiÌÔÈˆÓ ·ÚÂÌ‚¿ÛÂˆÓ ÁÂÓÈο Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È. AÓÙ›ıÂÙ· fï˜ ı· Ú¤ÂÈ ¿ÓÙ· Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÙÔ ·›ÛıËÌ· Ù˘ ‰›„·˜, ȉȷ›ÙÂÚ· ÂÊfiÛÔÓ ÙÔ‡ÙÔ ÂÎÊÚ¿˙ÂÙ·È ·fi ÙÔÓ ·ÛıÂÓ‹, ‰È· Ù˘ ÂÓÙÂÚÈ΋˜ ‹ Ù˘ ·ÚÂÓÙÂÚÈ΋˜ Ô‰Ô‡ (6,7,23).

7) AÈÌÔÚÚ·Á›· H ÂΉ‹ÏˆÛË ·ÈÌÔÚÚ·Á›·˜ ÚÔηÏ› ÌÂÁ¿ÏË ·Ó·ÛٿوÛË ÛÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ Î·È Î·Ù' Â¤ÎÙ·ÛË ÛÙÔÓ ¿Û¯ÔÓÙ·. H ÌÂÙ¿ÁÁÈÛË Ì ·ÈÌÔÂÙ¿ÏÈ· ‹ Û˘Ì˘Îӈ̤ӷ ÂÚ˘ıÚ¿ ·Ó ¯ÚÂÈ·ÛÙ›, ΢ڛˆ˜ ·Ó·ÎÔ˘Ê›˙ÂÈ ·fi ÙÔÓ „˘¯ÈÎfi ÊfiÚÙÔ ·ÏÏ¿ ·ÓÙÈÌÂÙˆ›˙ÂÈ ÚÔÛˆÚÈÓ¿ Î·È ÌfiÓÔÓ ÙË Û˘ÁÎÂÎÚÈ̤ÓË Î·Ù¿ÛÙ·ÛË (4). ¶¿ÓÙˆ˜ ηÏfiÓ Â›Ó·È Ó· ÙÔÓ›˙ÂÙ·È ÛÙÔ˘˜ ÁÔÓ›˜ fiÙÈ Ë ·ÈÌÔÚÚ·Á›· ‰ÂÓ ·ÔÙÂÏ› ÂÒ‰˘ÓÔ Û‡Ìو̷ fiˆ˜ Â›Û˘ fiÙÈ ˘¿Ú¯ÂÈ ¿ÓÙ· ÙÔ ÂӉ¯fiÌÂÓÔ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙÔÓ ·ÛıÂÓ‹ Ì ÓfiÛÔ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÁÈ· ÙÔÓ ÔÔ›Ô ›Ûˆ˜ ·ÔÙÂÏ› Î·È ÌÈ· ·ÓÒ‰˘ÓË ‰È¤ÍÔ‰Ô ÚÔ˜ ÙÔÓ ı¿Ó·ÙÔ (4,6,7).

8) §ÔÈÌÒÍÂȘ H ÛË„·ÈÌ›·, ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, Û˘Ó‹ıˆ˜ ÚÔ‰Èο˙ÂÈ ÙË ÌÔÈÚ·›· ηٿÏËÍË Ô˘ ηٿ ηÓfiÓ· ·ÎÔÏÔ˘ı› Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (24-26). ™ÙÔ˘˜ ÁÔÓ›˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê¤˜, fiÙÈ Ë ÛË„·ÈÌ›· ‰ÂÓ Â›Ó·È ÂÒ‰˘ÓË Î·Ù¿ÛÙ·ÛË Î·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ Ê·ÚÌ¿ÎˆÓ ‰ÂÓ ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· (5). AÓÙ›ıÂÙ· Ë ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ Û˘¯Ó¿ ‚ÔËı¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÙÔÈ΋˜ Î·È ÂÒ‰˘Ó˘ ÊÏÂÁÌÔÓ‹˜ (5-7).

TÂÏÈÎfi ÛÙ¿‰ÈÔ Î·ÚΛÓÔ˘

E›ÏÔÁÔ˜ ™Ù· Ï·›ÛÈ· Ù˘ ÊÚÔÓÙ›‰·˜ ÙˆÓ ·È‰ÈÒÓ Ì ηÚΛÓÔ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÛËÌ·ÓÙÈ΋ Û˘ÓÈÛÙÒÛ· ·ÔÙÂÏ› Ë ·ÓıÚÒÈÓË ÛÙ¿ÛË Î·È Ë ÙÔÔı¤ÙËÛË ÙÔ˘ ÁÈ·ÙÚÔ‡ ·¤Ó·ÓÙÈ ÛÙÔÓ ÂÈΛÌÂÓÔ ı¿Ó·ÙÔ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÔ˘.

H ÎÈÓËÙÔÔ›ËÛË Ù˘ ÂÓÂÚÁËÙÈÎfiÙËÙ¿˜ ÙÔ˘, Ë ¯Ú‹ÛË Ù˘ ÂÌÂÈÚ›·˜ ÙÔ˘ Î·È ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙÔ˘ ÔÊ›ÏÔ˘Ó Ó· ÛÙÔ¯Â‡Ô˘Ó ÛÙÔ ÈÔ ·ÓÒ‰˘ÓÔ Î·È ÔÌ·Ïfi ¤Ú·ÛÌ· ·fi ÙË ˙ˆ‹ ÛÙÔ ı¿Ó·ÙÔ. ¶ÚÔ˜ ÙÔ‡ÙÔ ··ÈÙÂ›Ù·È ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÎÏÈÓÈ΋ ÂÓ¿ÚÁÂÈ·, ‰Ú·ÛÙËÚÈfiÙËÙ·, ΢ڛˆ˜ ‰Â ÚÔÛ·ÚÌÔÛÙÈÎfiÙËÙ· ÛÙȘ ÂοÛÙÔÙ ·Ó·Ê˘fiÌÂÓ˜ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡ Û ·˘Ùfi ÙÔ ÛÙ¿‰ÈÔ. ¶ÔÏϤ˜ ‰˘Û¿ÚÂÛÙ˜ ηٷÛÙ¿ÛÂȘ fiˆ˜ Ë ‰‡ÛÓÔÈ·, Ë Ó·˘Ù›· Î·È ¿ÏϘ Ô˘ ‹‰Ë ·Ó·Ê¤ÚıËÎ·Ó Ì ÙȘ Û‡Á¯ÚÔÓ˜ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ۯ‰fiÓ, ÌÔÚÔ‡Ó Û‹ÌÂÚ· Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó ÔÏÔÎÏËÚˆÙÈο (27). ¢ÂÓ ·ÚΛ fï˜ ÌfiÓÔ Ë ·ÓÙÈÌÂÙÒÈÛË ·˘ÙÒÓ. ™ÙËÓ ÚÔÛ¿ıÂÈ· Â›Ù¢Í˘ ÂÓfi˜ "ηÏÔ‡ ı·Ó¿ÙÔ˘", ÙÔ˘ Ú¤ÔÓÙÔ˜ ı·Ó¿ÙÔ˘, ··ÈÙÂ›Ù·È Ë ‚Ô‹ıÂÈ· fi¯È ÌfiÓÔ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÁÎÔÏfiÁÔ˘ ·ÏÏ¿ Î·È ÔÏfiÎÏËÚ˘ Ù˘ ÔÏ˘‰‡Ó·Ì˘ ÔÌ¿‰·˜ - fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËΠ- Ù· ̤ÏË Ù˘ ÔÔ›·˜ ı· ÎÈÓËÙÔÔÈ‹ÛÔ˘Ó fiÏ· Ù· Ê˘ÛÈο Î·È „˘¯Èο ÙÔ˘˜ ·Ôı¤Ì·Ù· Ô‡Ùˆ˜ ÒÛÙÂ: - ÙÔ ·È‰› Ô˘ Âı·›ÓÂÈ Ó· ÌË ¯¿ÓÂÙ·È ·ÏÏ¿ Ó· ·ÂÏ¢ıÂÚÒÓÂÙ·È ¤¯ÔÓÙ·˜ ÈηÓÔÔÈ‹ÛÂÈ ÙȘ ÛËÌ·ÓÙÈΤ˜, „˘¯ÈΤ˜ Î·È ÓÂ˘Ì·ÙÈΤ˜ ÙÔ˘ ·Ó¿ÁΘ.

- Ë ÔÈÎÔÁ¤ÓÂÈ·, ÔχÙÈÌÔ˜ ÊÔÚ¤·˜ ˙ˆ‹˜, ¿ÚÚËÎÙÔ Û‡ÓÔÏÔ Î·È Û‡Ì‚ÔÏÔ ÂÓfiÙËÙ·˜ Î·È ·ÛÊ¿ÏÂÈ·˜, Ó· Û˘Ó¯›˙ÂÈ Ó· ÏÂÈÙÔ˘ÚÁ› Î·È Ó· ÌËÓ ·ÔÎfiÙÂÙ·È ·fi ÙËÓ ·ÓıÚÒÈÓË ·Ï˘Û›‰·, Ì ÙËÓ ·ÒÏÂÈ· ÂÓfi˜ ÔχÙÈÌÔ˘ ÎÚ›ÎÔ˘, ÙÔ˘ ·È‰ÈÔ‡ Ù˘ Ô˘ Âı·›ÓÂÈ.

- Ô ÁÈ·ÙÚfi˜, Ô ÓÔÛËÏÂ˘Ù‹˜ ‹ Ô Î¿ı ÏÂÈÙÔ˘ÚÁfi˜ ÚÔÛÊÔÚ¿˜ ÊÚÔÓÙ›‰·˜, ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ‹ ÛÙËÓ ÙÂÏÈ΋ ·˘Ù‹ Ê¿ÛË ÙÔ˘ ·È‰ÈÔ‡, Ó· ÌÔÚ› Ó· ·ÔÎÔÌ›˙ÂÈ ·ÈÛı‹Ì·Ù· ıÂÙÈο. ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ ÁÈ·ÙÚfi ÂȉÈÎfiÙÂÚ·, Â›Ó·È Ôχ ÛÔ˘‰·›Ô ÛÙÔ Ù¤ÏÔ˜ ·˘Ù‹˜ Ù˘ ‰È·‰Èηۛ·˜ Ó· ÌÔÚ› Ó· ·ÈÛı¿ÓÂÙ·È fiÙÈ ÚÔÛ¤ÊÂÚ ·˘Ùfi Ô˘ Â›Ó·È Ë ÂÌÙÔ˘Û›· Ù˘ È·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘, ‰ËÏ·‰‹ Ë ·Ó·ÎÔ‡ÊÈÛË ·fi οı ›‰Ô˘˜ fiÓÔ. E›Û˘, Ó· ·ÈÛı¿ÓÂÙ·È fiÙÈ Û˘ÓÂÙ¤ÏÂÛ Â·ÁˆÁÈο Î·È Ì fiϘ ÙÔ˘ ÙȘ ‰˘Ó¿ÌÂȘ ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÂÓfi˜ ·ÎÏÔ˘ ˙ˆ‹˜ ÂÓfi˜ ·ÎÏÔ˘, Ô ÔÔ›Ô˜ ·Ú¿ÏÏËÏ· Ì ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙÔ˘ ı· ÂÌÓ¤ÂÈ Î·È ı· ÂÓ‰˘Ó·ÌÒÓÂÈ ÙÔÓ ·ÁÒÓ· Ù˘ ˙ˆ‹˜ Û ·˘ÙÔ‡˜ Ô˘ ̤ÓÔ˘Ó ›Ûˆ.

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21. Mantovanni G, Maccio A, Bianchi A, Curreli L, Ghiani M, Proto E. Comparison of granisetron, ondansetron and tropisetron in the prophylaxis of acute nausea and vomiting induced by cisplatin for the treatment of head and neck cancer. A randomized control trial. Cancer 1996; 77: 941-948.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-04-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-01-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - AÓ‰ÚÔ˘Ï·Î¿ÎË, EÈÌÂÏ‹ÙÚÈ· A' TÌ‹Ì·ÙÔ˜ ¶·È‰È·ÙÚÈ΋˜ AÈÌ·ÙÔÏÔÁ›·˜ - OÁÎÔÏÔÁ›·˜ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

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H ‚·ÛÈ΋ ÂÎÎÚÈÙÈ΋ Âʉڛ· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1 §Ô˘Î›· KˆÓÛÙ·ÓÙÈÓ›‰Ô˘, M·Ú›· E˘ÛÙ·ıÈ¿‰Ô˘, NÈÎfiÏ·Ô˜ ¢ËÌËÙÛ›ÎÔÁÏÔ˘, AÁÁÂÏÈ΋ ¶Ô‡ÏÔ˘, EϤÓË æˆÌ¿, IÔÚ‰¿Ó˘ ¢ËÌËÙÛ›ÎÔÁÏÔ˘

● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1 Ì ‚¿ÛË ÙÔ C-ÂÙ›‰ÈÔ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, ÒÛÙ ӷ ˘Ô‚ÔËıÂ›Ù·È Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘ ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜ Ù‡Ô˘˜ Î·È ˘fiÙ˘Ô˘˜ Î·È Ë Ù·ÍÈÓfiÌËÛË ÙÔ˘ ‰È·‚‹ÙË ÁÂÓÈÎfiÙÂÚ·. H ·ÚÔ‡Û· ÌÂϤÙË Û˘ÌÏËÚÒÓÂÈ ÌÈ· ÛÂÈÚ¿ ÌÂÏÂÙÒÓ ÛÙȘ Ôԛ˜ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÙÔ C-ÂÙ›‰ÈÔ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙfi Ù‡Ô ‰È·‚‹ÙË. EÊ·ÚÌfi˙ÔÓÙ·˜ ̤ıÔ‰Ô ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ ÌÂÙÚ‹Û·Ì ÙÔ ‚·ÛÈÎfi (ÓËÛÙ›·˜) C-ÂÙ›‰ÈÔ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Û 50 ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1, Ì ¤Ó·ÚÍË ÙÔ˘ ‰È·‚‹ÙË ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 30 ÂÙÒÓ ("Ó·ÓÈÎfi˜" ÈÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜ -Ù‡Ô˘ 1- ۷ί·Ú҉˘ ‰È·‚‹Ù˘, NIE™¢), Û 50 ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1 Ì ¤Ó·ÚÍË ÙÔ˘ ‰È·‚‹ÙË Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· (ÈÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜ -Ù‡Ô˘ 1- ۷ί·Ú҉˘ ‰È·‚‹Ù˘ ÙˆÓ ÂÓËϛΈÓ, IE™¢E), Û 50 ‰È·‚ËÙÈÎÔ‡˜ "Ù‡Ô˘ 1,5" (§·Óı¿ÓˆÓ A˘ÙÔ¿ÓÔÛÔ˜ ‰È·‚‹Ù˘ ÛÙÔ˘˜ EÓ‹ÏÈΘ, Latent Autoimmune Diabetes in Adults, LADA), ηıÒ˜ Î·È Û 50 ÈÓÛÔ˘ÏÈÓÔÂÓÈÎÔ‡˜ ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 (I¶™¢2). OÈ ÙÈ̤˜ ÙÔ˘ C-ÂÙȉ›Ô˘ ÛÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 1 ‚Ú¤ıËÎ·Ó ÙfiÛÔ Ôχ ¯·ÌËÏfiÙÂÚ˜, ÒÛÙ ӷ ÂÈÙÚ¤Ô˘Ó ÙË ‰È¿ÎÚÈÛ‹ ÙÔ˘ ·fi ÙÔÓ "Ù‡Ô 1,5" Î·È ÙÔÓ ÈÓÛÔ˘ÏÈÓÔÂÓÈÎfi Ù‡Ô 2, ·ÎfiÌË ÎÈ ·Ó ‰ÂÓ Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Î·Ó¤Ó· ¿ÏÏÔ ÎÚÈÙ‹ÚÈÔ ÂÎÙfi˜ ·fi ·˘Ù¤˜ (0,575±0,35, ¤Ó·ÓÙÈ 1,21±0,35 Î·È 1,80±0,31 ng/ml, ·ÓÙ›ÛÙÔȯ·). AÓ¿ÌÂÛ· ÛÙȘ ‰˘Ô ˘ÔÔÌ¿‰Â˜ ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1, ·ÓÙ›ıÂÙ·, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ C-ÂÙ›‰ÈÔ. H ‰È¿ÚÎÂÈ· ÙÔ˘ ‰È·‚‹ÙË ·ԉ›¯ıËΠfiÙÈ ·›˙ÂÈ Î‡ÚÈÔ ÚfiÏÔ ÛÙË Ì›ˆÛË ÙˆÓ ·Ú¯ÈÎÒÓ ÙÈÌÒÓ ÙÔ˘ C-p Û Â›‰· οو ·fi Ù· ·ÓȯÓ‡ÛÈÌ· fiÚÈ·. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ô ‰È·‚‹Ù˘ Ù‡Ô˘ 1 ÌÔÚ› Ó· Ù·˘ÙÔÔÈËı› ·fi ÙȘ Ôχ ¯·ÌËϤ˜ ÙÈ̤˜ ÙÔ˘ C-ÂÙȉ›Ô˘ (ηٿ ηÓfiÓ· <1,50 ng/ml), ‹‰Ë ηٿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÙÔ˘, ÔÈ Ôԛ˜ Û¯ÂÙÈο ÁÚ‹ÁÔÚ· ÌÂÈÒÓÔÓÙ·È Û Â›‰· Ô˘ ÂÁÁ›˙Ô˘Ó Ú·ÎÙÈο ÙËÓ ·fiÏ˘ÙË ÈÓÛÔ˘ÏÈÓÔÂÓ›·, ·Ó Î·È fi¯È Ì ÙÔÓ ›‰ÈÔ Ú˘ıÌfi Û fiÏÔ˘˜. ™Â ÔÚȷΤ˜ ‹ ·ÌÊÈÏÂÁfiÌÂÓ˜ ÂÚÈÙÒÛÂȘ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ C-ÂÙȉ›Ô˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙË ‰È¿ÎÚÈÛË ÙˆÓ Ù‡ˆÓ ÙÔ˘ ‰È·‚‹ÙË Î·È Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÈÔ ÔÚıÔÏÔÁÈο ÙȘ ·Ó¿ÁΘ Û ÈÓÛÔ˘Ï›ÓË. ¶·È‰È·ÙÚÈ΋ 2000;63:129-136. §¤ÍÂȘ ÎÏÂȉȿ: C-ÂÙ›‰ÈÔ, ‰È·‚‹Ù˘ Ù‡Ô˘ 1.

L. Konstantinidou, M. Eustathiadou, N. Dimitsikoglou, A. Pulu, E. Psoma, I. Dimitsikoglou. Pancreatic reserve in the identification of type 1 diabetes. Paediatriki 2000;63:129-136. ● Abstract: This study was designed to test the efficacy of the determination of fasting plasma C-peptide concentration for discrimination between type 1 diabetes mellitus and insulinopenic type 2 diabetes and "type 1.5" (Latent Autoimmune Diabetes in Adults, LADA) diabetes. In 100 patients with clinical type 1 diabetes 50 with onset before the age of 30 years, and 50 with onset at 30 years of age or later, and in 50 "type 1.5" (LADA) and 50 type 2 diabetic patients, basal (fasting) plasma C-peptide concentration was measured by solid-phase, chemiluminescent enzyme immunoassay. The C-peptide concentration was found to be so much lower in type 1 diabetes than in LADA and type 2 diabetes (0.575±0.35 ng/ml, versus 1.21±0.35 and 1.80±0.31 ng/ml, respectively), that classification and discrimination can be made by C-peptide criteria only.

For most cases with diabetes of up to 5 years’ duration, a 1.5 ng/ml cutoff point serves discriminate type 1 diabetes from the other types. The duration of diabetes has a marked influence on the residual beta-cell

¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋, ¢È·‚ËÙÔÏÔÁÈÎfi I·ÙÚÂ›Ô Î·È BÈÔ¯ËÌÈÎfi EÚÁ·ÛÙ‹ÚÈÔ NÔÛÔÎÔÌ›Ԣ ™ÂÚÚÒÓ

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§. KˆÓÛÙ·ÓÙÈÓ›‰Ô˘ Î·È Û˘Ó.

function in type 1 diabetes. Estimation of C-peptide concentration can be of value in discriminating between borderline cases and helps in making a rational estimation of insulin needs of the individual patients.

Key words: C-peptide, type 1 diabetes.

EÈÛ·ÁˆÁ‹ ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Â›Ó·È ÁÓˆÛÙfi˜ ÁÈ· ÂÚÈÛÛfiÙÂÚ· ·fi 2000 ¯ÚfiÓÈ·(1), Î·È Ë ‰È¿ÎÚÈÛË ‰˘Ô Ù‡ˆÓ ÙÔ˘ ηıÈÂڈ̤ÓË Â‰Ò Î·È 65 ÂÚ›Ô˘ ¯ÚfiÓÈ·(2), Ô‡ÙÂ Ë Ù·ÍÈÓfiÌËÛË ÙÔ˘, Ô‡ÙÂ Ë ÔÓÔÌ·ÙÔÏÔÁ›· ÙˆÓ Ù‡ˆÓ ÙÔ˘ - ·ÏÏ¿ Ô‡ÙÂ Î·È ·˘Ù¿ ·ÎfiÌË Ù· ‰È·ÁÓˆÛÙÈο ÙÔ˘ ÎÚÈÙ‹ÚÈ· - ‰ÂÓ ¤¯Ô˘Ó ÔÚÈÛÙÈÎÔÔÈËı› ·ÌÂÙ¿ÎÏËÙ· ̤¯ÚÈ Û‹ÌÂÚ·. H Ù·ÍÈÓfiÌËÛË ÙÔ˘ 1979(3), ¤Ù˘¯Â ¢Ú›·˜ ·Ô‰Ô¯‹˜ ÙÔ 1980(4), ·ÏÏ¿ Û‹ÌÂÚ· ÙÂÏ› ˘fi ·Ó·ıÂÒÚËÛË(5). H ÔÓÔÌ·ÙÔÏÔÁ›· ÙˆÓ ıÂÌÂÏȈ‰ÒÓ Ù‡ˆÓ ÙÔ˘ ‰È·‚‹ÙË ¿ÏÏ·Í ·fi "Ó·ÓÈÎfi˜" Î·È "ÙˆÓ ÂÓËϛΈÓ" Û "ÈÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜" Î·È "ÌË ÈÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜" Î·È ·ÚÁfiÙÂÚ· Û "Ù‡Ô˜ 1" Î·È "Ù‡Ô˜ 2", ÂÓÒ ÚfiÛÊ·Ù· ÚÔÙ›ÓÂÙ·È Î·È Ë ‰È¢ÎÚ›ÓÈÛË "·˘ÙÔ¿ÓÔÛÔ˜" Ë "¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜"(5), Î·È ¿ÏÈ fï˜ ÙÔ ·˘ÙÔ·ÓÔÛÈ·Îfi ÛÙÔÈ¯Â›Ô ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙË Ó·ÓÈ΋ ÌfiÓÔ ËÏÈΛ·, ·ÊÔ‡ ‰È·ÈÛÙÒÓÂÙ·È Î·È ÛÙÔ˘˜ EÓ‹ÏÈΘ (LADA, Latent Autoimmune Diabetes in Adults, §·Óı¿ÓˆÓ A˘ÙÔ¿ÓÔÛÔ˜ ‰È·‚‹Ù˘ ÛÙÔ˘˜ EÓ‹ÏÈΘ, "Ù‡Ô˜ 1,5")(6,7). O ̤¯ÚÈ ÚfiÛÊ·Ù· ·ÔηÏÔ‡ÌÂÓÔ˜ "‰È·‚‹Ù˘ Ù˘ ÒÚÈÌ˘ ËÏÈΛ·˜ ÛÙÔ˘˜ Ó¤Ô˘˜" (Maturity-Onset Diabetes of the Young, MODY) ·ԉ›¯ıËΠӷ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ù˘ ÁÏ˘ÎÔÎÈÓ¿Û˘(8) Î·È ÙˆÓ ÁÔÓȉ›ˆÓ ÙÔ˘ ˘ÚËÓÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ Ë·ÙÔ΢ÙÙ¿ÚÔ˘ 1·(9) Î·È 4·(10). E›Û˘, ÚfiÛÊ·Ù· ‰È·ÈÛÙÒÓÂÙ·È - Î·È ·Ó·ÁÓˆÚ›˙ÂÙ·È ˆ˜ ȉȷ›ÙÂÚË ÔÓÙfiÙËÙ· fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ- fiÙÈ ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ÛÙÔ˘˜ EÓ‹ÏÈΘ Ô˘ ηٿ Ù· ÚÒÙ· Ï›Á· ¯ÚfiÓÈ· Ù˘ ÎÏÈÓÈ΋˜ ÙÔ˘˜ ÔÚ›·˜ ÌÈÌÔ‡ÓÙ·È ÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 2, ·ÔÙÂÏÔ‡Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰È·‚‹ÙË Ù‡Ô˘ 1 ‚Ú·‰Â›·˜ ÂÈÛ‚ÔÏ‹˜ (slow-onset type 1 diabetes) (11,12). OÍ›· ÂÈÛ‚ÔÏ‹ Ì ‰È·‚ËÙÈ΋ ÎÂÙÔ-ÔͤˆÛË (Ù˘È΋ ÁÈ· ÙÔÓ Ù‡Ô 1) Û EÓ‹ÏÈΘ AÊÚÈηÓÔ-AÌÂÚÈηÓÔ‡˜ ÙÔ˘ Flatbush (New York), ·ÓÙ›ÛÙÚÔÊ·, ·ÎÔÏÔ˘ıÂ›Ù·È ÛÙË Û˘Ó¤¯ÂÈ· ·fi ÎÏÈÓÈ΋ ‰È·‰ÚÔÌ‹ Ô˘ Â›Ó·È Û˘Ì‚·Ù‹ Ì ÙË ‰È¿ÁÓˆÛË ‹ÈÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 2 (‰È·‚‹Ù˘ Flatbush) (13), ÂÓÒ ·Ú¿ÏÏËÏ· ÁÓ‹ÛÈÔ˜ ‰È·‚‹Ù˘ Ù‡Ô˘ 2 ‰È·ÈÛÙÒÓÂÙ·È Û MÂÍÈηÓÈ΋˜ ηٷÁˆÁ‹˜ AÌÂÚÈηÓÔ‡˜ ¤ÊË‚Ô˘˜(14). ¶ÚÔÊ·ÓÒ˜, ÔÈ ·Ú·¿Óˆ ·Ó·ıˆڋÛÂȘ Ù˘ Ù·ÍÈÓfiÌËÛ˘, ηıÒ˜ Î·È ÔÈ ‰È·ÚΛ˜ ·Ó·ÁÓˆÚ›ÛÂȘ "ÌË ‰˘Ó¿ÌÂÓˆÓ" Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Î·È ·ÌÊÈÏÂÁfiÌÂÓˆÓ ÂÚÈÙÒÛÂˆÓ ·ÓÙ·Ó·ÎÏÔ‡Ó ÂÏÏ›„ÂȘ Î·È ·ÓÂ¿ÚÎÂȘ ÛÙËÓ Î·Ù·ÓfiËÛË Ù˘ Ï‹ÚÔ˘˜ ·ÈÙÈÔÏÔÁ›·˜ ÙÔ˘ ‰È·‚‹ÙË, ÙËÓ ÛÙ‹ÚÈÍË

130

™˘ÓÙÔÌÔÁڷʛ˜: NIE™¢ = "N·ÓÈÎfi˜" IÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜ -Ù‡Ô˘ 1™·Î¯·Ú҉˘ ¢È·‚‹Ù˘ IE™¢E = IÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ -Ù‡Ô˘ 1™·Î¯·Ú҉˘ ¢È·‚‹Ù˘ ÙˆÓ EÓËÏ›ÎˆÓ LADA = Latent Autoimmune Diabetes in Adults C-p = C-peptide BMI = Body Mass Index = ¢Â›ÎÙ˘ M¿˙·˜ ™ÒÌ·ÙÔ˜

ÁÈ· ÙËÓ Ù·ÍÈÓfiÌËÛË ÛÙËÓ ·Ú·Ù‹ÚËÛË ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÌfiÓÔ, ηıÒ˜ Î·È ÙË ÌÂÛÔÏ·‚‹Û·Û· ÂÓ Ùˆ ÌÂٷ͇ ÚfiÔ‰Ô. ◊‰Ë Á›ÓÂÙ·È ‰ÂÎÙ‹ ÌÈ· Ó¤· ÚÔÙ·ı›۷ ·ÈÙÈÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË(5) Î·È Ê·›ÓÂÙ·È Ôχ Èı·Ófi fiÙÈ ı· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó Î·È ¿ÏϘ Û ÌÂÚÈο ¯ÚfiÓÈ·.

O ۷ί·Ú҉˘ ‰È·‚‹Ù˘ ÂÌÊ·Ó›˙ÂÈ ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ·, ÔÈ Ù‡ÔÈ Î·È ÔÈ ˘fiÙ˘ÔÈ ÙÔ˘ ‰È·‚‹ÙË Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ÙÔ˘ ÂÓfi˜, ÔÈ ‰È·‚·ıÌ›ÛÂȘ ÛÙÔÓ Î·ı¤Ó· ·fi ·˘ÙÔ‡˜ Ôχ ÂÚÈÛÛfiÙÂÚ˜, Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Ù·˘ÙÔÔ›ËÛ˘ Î·È Ù·ÍÈÓfiÌËÛ‹˜ ÙÔ˘ ÛÙËÓ Î·ı' Ë̤ڷ Ú¿ÍË Û˘¯Ó¿ Î·È ‰˘ÛÂ›Ï˘Ù·, ÂȉÈο fiÛÔ ·˘Í¿ÓÂÙ·È Ë ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ‰È·‚‹ÙË ¤Ú· ·fi Ù· 30 ¤ÙË, fiÛÔ ÌÈÎÚfiÙÂÚÔ˜ Â›Ó·È Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (Body Mass Index, BMI) ηÈ, ‚¤‚·È·, ÛÙȘ ÔÚȷΤ˜ Î·È ·ÌÊÈÏÂÁfiÌÂÓ˜ ÂÚÈÙÒÛÂȘ. TÔ Úfi‚ÏËÌ· ÂÚÈϤÎÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ì ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·‚‹ÙË Ù‡Ô˘ 2 Û fiÏÔ Î·È ÌÈÎÚfiÙÂÚË ËÏÈΛ· (6), ·ÎfiÌË Î·È Û ¤ÊË‚Ô˘˜. H ·Ó¿ÁÎË Ù·˘ÙÔÔ›ËÛ˘ ÙÔ˘ Ù‡Ô˘ Î·È Ù˘ ‰È·‚¿ıÌÈÛ˘ ÙÔ˘ ‰È·‚‹ÙË ÂÓfi˜ ÂοÛÙÔ˘ ‰È·‚ËÙÈÎÔ‡, ÂÔ̤ӈ˜, ÚÔ‚¿ÏÏÂÈ ÂÈÙ·ÎÙÈ΋ Î·È ÙÔ ÎÚÈÙ‹ÚÈÔ Ù˘ ‰È·ı¤ÛÈÌ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ÈÓÛÔ˘Ï›Ó˘ Û οı ÌÈ· ÂÚ›ÙˆÛË ÂÓ‰¤¯ÂÙ·È Ó· ·Ô‰Âȯı› ÈÔ ÛËÌ·ÓÙÈÎfi ÁÈ· ÙË ‰È¿ÎÚÈÛË Î·È ‰È·‚¿ıÌÈÛË ÙˆÓ ÂÚÈÙÒÛˆÓ, ·fi fi,ÙÈ ·Ú¯Èο ıˆڋıËÎÂ.

H ÂÎÙ›ÌËÛË Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÂÔ̤ӈ˜, ÌÔÚ› Ó· Â›Ó·È ÁÂÓÈο ¯Ú‹ÛÈÌË, ÙfiÛÔ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Ù‡Ô˘ Î·È Ù˘ ‰È·‚¿ıÌÈÛ˘ ÙÔ˘ ‰È·‚‹ÙË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ‰È·‚ËÙÈÎÔ‡, fiÛÔ Î·È ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÔÈÎ›ÏˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÌÔÚÔ‡Ó Ó· ÂËÚ¿˙Ô˘Ó ÙË ÁÏ˘¯·ÈÌÈ΋ Ú‡ıÌÈÛË Û οı ¤Ó· ÌÂÌÔӈ̤ÓÔ ‰È·‚ËÙÈÎfi Î·È Ó· ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÙÔ˘˜ ··ÈÙÔ‡ÌÂÓÔ˘˜ Û οı ÂÚ›ÙˆÛË ıÂÚ·¢ÙÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜, ·Ó Î·È ÙÔ ÙÂÏÂ˘Ù·›Ô ·˘Ùfi ‚Ú›ÛÎÂÈ Ï‹ÚË ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÛÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 2 Î·È "Ù‡Ô˘ 1,5" (LADA) ÌfiÓÔ.

TÔ ·‰Ú·Ó¤˜ C-ÂÙ›‰ÈÔ (Connecting peptide) ·Ú¿ÁÂÙ·È Î·Ù¿ ÙÔÓ ÂÓ˙˘Ì·ÙÈÎfi ‰È·¯ˆÚÈÛÌfi Ù˘ ÈÓÛÔ˘-

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·131

¶∞π¢π∞∆ƒπ∫∏ 2000;63:129-136

Ï›Ó˘ ·fi ÙËÓ ÚÔ˚ÓÛÔ˘Ï›ÓË (15-17) Î·È ÂÎÎÚ›ÓÂÙ·È ·fi ÙÔ ‚-·ÙÙ·ÚÔ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÛÙËÓ ˘Ï·›· ΢ÎÏÔÊÔÚ›· ·Ú¿ÏÏËÏ· Î·È ÈÛÔÌÔÚȷο Ì ÙËÓ ÈÓÛÔ˘Ï›ÓË (17-19). OÈ ÙÈ̤˜ ÙÔ˘ ÛÙÔ Ï¿ÛÌ· Û˘Ì‚·‰›˙Ô˘Ó Ì ÂΛӘ Ù˘ ÙÂÏÂ˘Ù·›·˜, ÙfiÛÔ ÛÙË ‚·ÛÈ΋ (ÓËÛÙ›·˜), fiÛÔ Î·È Û ηٷÛÙ¿ÛÂȘ ‰È¤ÁÂÚÛ˘ (17). °È· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ C-ÂÙȉ›Ô˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÚÔÛʤÚÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÂΛÓÔ Ù˘ ÈÓÛÔ˘Ï›Ó˘ ‰ÈfiÙÈ ÙÔ C-ÂÙ›‰ÈÔ ÂÏ¿¯ÈÛÙ· ÌfiÓÔ ·ÔÌ·ÎÚ‡ÓÂÙ·È ·fi ÙÔ ‹·Ú Î·È Ë Ù˘¯fiÓ Â͈ÁÂÓÒ˜ ¯ÔÚËÁÔ‡ÌÂÓË ÈÓÛÔ˘Ï›ÓË ‰ÂÓ ÂÌϤÎÂÙ·È ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ (19-22). EÈϤÔÓ ÔÈ Ì¤ıÔ‰ÔÈ ·ÓÔÛÔÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ÈÓÛÔ˘Ï›Ó˘ Â›Ó·È ·Î·Ù¿ÏÏËÏÔÈ ÁÈ· fiÛÔ˘˜ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Â͈ÁÂÓÒ˜ ¯ÔÚËÁËı›۷˜ ÈÓÛÔ˘Ï›Ó˘, ÂÓÒ ·˘Ù¤˜ ÁÈ· ÙÔ C-ÂÙ›‰ÈÔ ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È(19-22).

T· Â›‰· ÙÔ˘ ‰ÈÂÁÂÚı¤ÓÙÔ˜ C-ÂÙȉ›Ô˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (ÌÂÙ¿ ·fi ¤Ó· standard Á‡̷ Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË glucagon) ·ÔÙÂÏÔ‡Ó ¿ÚÈÛÙÔ ·ÓÙÈÎÂÈÌÂÓÈÎfi ̤ÙÚÔ ÙÔ˘ ÂÈ¤‰Ô˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‚΢ÙÙ¿ÚˆÓ, ·ÏÏ¿ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘˜ ÛÙËÓ Î·ı' Ë̤ڷ Ú¿ÍË Î·È ÁÈ· ÙÔ˘˜ ÔÏÏÔ‡˜ ‰È·‚ËÙÈÎÔ‡˜ ÚÔÛÎÚÔ‡ÂÈ ÛÙȘ Ù¯ÓÈΤ˜ ‰˘ÛÎÔϛ˜ Ù˘ ‰È¤ÁÂÚÛ˘. TÔ ‚·ÛÈÎfi (ÓËÛÙ›·˜) C-ÂÙ›‰ÈÔ, ·ÓÙ›ıÂÙ·, ‰ÂÓ ··ÈÙ› ÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ Ù˘ ‰È¤ÁÂÚÛ˘ Î·È ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Â‡ÎÔÏ·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Á›ÓÂÙ·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ C-ÂÙȉ›Ô˘ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (C-p) Û ‰È·‚ËÙÈÎÔ‡˜ ÔÈ ÔÔ›ÔÈ Ì ‚¿ÛË ÙË Ì¤¯ÚÈ ÙÔ ¯ÚfiÓÔ Ù˘ ÌÂϤÙ˘ ÁÓˆÛÙ‹ ÔÚ›· ÙÔ˘˜, ÎÚ›ıËÎ·Ó Ì ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·, ¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›·, ˆ˜ Ù‡Ô˘ 1. E›Û˘, ÂȯÂÈÚÂ›Ù·È ·Ó·‰ÚÔÌÈο Ë Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1 Ì ‚¿ÛË ÙÔ C-ÂÙ›‰ÈÔ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ÔÚ›ˆÓ Ù˘ ÙÈÌ‹˜ ÙÔ˘ C-ÂÙȉ›Ô˘ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1, ÒÛÙ ӷ ˘Ô‚ÔËıÂ›Ù·È Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘ ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜ Ù‡Ô˘˜, Î·È Ë Ù·ÍÈÓfiÌËÛË ÙÔ˘ ‰È·‚‹ÙË ÁÂÓÈÎfiÙÂÚ·, ·Ó Î·È Û ÔÏÏÔ‡˜ Ù‡Ô˘ 1 ‰È·‚ËÙÈÎÔ‡˜ (fi¯È fï˜ fiÏÔ˘˜) Ë ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘, Ô ÙÚfiÔ˜ ÂÈÛ‚ÔÏ‹˜ Î·È Ë ÎÏÈÓÈ΋ ÔÚ›· Â›Ó·È ÙfiÛÔ ¯·Ú·ÎÙËÚÈÛÙÈο, ÒÛÙ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Î·Ì›· ¿ÏÏË È‰È·›ÙÂÚË ÂȂ‚·›ˆÛË. H ÌÂϤÙË fï˜, ·Ú¿ÏÏËÏ·, Û˘ÌÏËÚÒÓÂÈ ÌÈ· ÛÂÈÚ¿ ÌÂÏÂÙÒÓ ÛÙȘ Ôԛ˜ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÙÔ C-ÂÙ›‰ÈÔ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙfi Ù‡Ô ‰È·‚‹ÙË -Ù‡Ô˘ 2, Ù‡Ô˘ 1 Î·È "Ù‡Ô˘ 1,5" (LADA)- Î·È Ë ÏËÚfiÙËÙ· Ù˘ ‰È·ÎÚÈÙ‹˜ Ù·˘ÙÔÔ›ËÛ˘ ÂÈ‚¿ÏÏÂÈ ÙË ÌÂϤÙË ÔÏfiÎÏËÚÔ˘ ÙÔ˘ Ê¿ÛÌ·ÙÔ˜. EÎÙfi˜ ·fi ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ‰È·‚‹ÙË Î·È ÙËÓ ·ÛʷϤÛÙÂÚË Ù·ÍÈÓfiÌËÛË ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ì ‚¿ÛË Î·È ÙȘ ÙÈ̤˜ ÙÔ˘ C-ÂÙȉ›Ô˘, ¤Ó·˜ ‰Â‡ÙÂÚÔ˜ ÛÙfi¯Ô˜ ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ Â›Ó·È Ô Î·ıÔÚÈÛÌfi˜ Ù˘ ·ÁÎÚ·ÙÈ΋˜ Âʉڛ·˜ - Î·È ÂÔ̤ӈ˜ Î·È ÙˆÓ ıÂÚ·¢ÙÈ-

TÔ C-ÂÙ›‰ÈÔ ÛÙÔÓ ‰È·‚‹ÙË Ù‡Ô˘ 1

ÎÒÓ ··ÈÙ‹ÛÂˆÓ Û ÈÓÛÔ˘Ï›ÓË - Û ¤Ó· ¤Î·ÛÙÔ ‰È·‚ËÙÈÎfi, ÒÛÙ ӷ ˘Ô‰ÂÈÎÓ‡ÂÙ·È ·ÛʷϤÛÙÂÚ· Ë ·ÎÔÏÔ˘ıËÙ¤· ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹, ·Ó Î·È ÙÔ ÙÂÏÂ˘Ù·›Ô ·˘Ùfi ‚Ú›ÛÎÂÈ Î‡ÚÈ· ÂÊ·ÚÌÔÁ‹ ÛÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 2 Î·È 1,5 (LADA).

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ OÈ ‰È·‚ËÙÈÎÔ› Ù‡Ô˘ 1. T· ‚·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ù˘ ÌÂϤÙ˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1 (·ÚÈÛÙÂÚ¿). AÓ·˙ËÙÒÓÙ·˜ Ù˘¯fiÓ ‰È·ÊÔÚ¤˜, Ù·ÍÈÓÔÌ‹Û·Ì ÙÔ˘˜ 100 Ù‡Ô˘ 1 ‰È·‚ËÙÈÎÔ‡˜ Ù˘ ÌÂϤÙ˘ Û ‰‡Ô ÈÛ¿ÚÈı̘ ÔÌ¿‰Â˜: ™Â ·˘ÙÔ‡˜ Ì ¤Ó·ÚÍË ÙÔ˘ ‰È·‚‹ÙË ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 30 ÂÙÒÓ ("Ó·ÓÈÎfi˜" ÈÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜ -Ù‡Ô˘ 1- ۷ί·Ú҉˘ ‰È·‚‹Ù˘, NIE™¢) Î·È Û ·˘ÙÔ‡˜ Ì ¤Ó·ÚÍË ÙÔ˘ ‰È·‚‹ÙË ÛÙËÓ ËÏÈΛ· ÙˆÓ 30 ÂÙÒÓ ‹ ·ÚÁfiÙÂÚ· (ÈÓÛÔ˘ÏÈÓÂÍ·ÚÙÒÌÂÓÔ˜ -Ù‡Ô˘ 1- ۷ί·Ú҉˘ ‰È·‚‹Ù˘ ÙˆÓ ÂÓËϛΈÓ, IE™¢E).

KÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ù‡Ô˘ 1. OÈ 100 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ÂÈϤ¯ıËÎ·Ó ¤ÙÛÈ ÒÛÙ ӷ ÌË ˘¿Ú¯ÂÈ, ηٿ ÙÔ ‰˘Ó·ÙfiÓ, η̛· ·ÌÊÈ‚ÔÏ›· fiÙÈ Â›Ó·È Ú¿ÁÌ·ÙÈ ‰È·‚ËÙÈÎÔ› Ù‡Ô˘ 1. ŸÏÔÈ ÔÈ ‰È·‚ËÙÈÎÔ› Ù˘ ÌÂϤÙ˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ù·ÎÙÈο ÛÙÔ ‰È·‚ËÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ™ÂÚÚÒÓ ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ÚÒÙ˘ ·ÔÎ¿Ï˘„˘ ÙÔ˘ ‰È·‚‹ÙË ÙÔ˘˜ ‹ ·fi ÙÔ 1985 Î·È ÌÂÙ¿. ŸÏÔÈ ¯ÚÂÈ¿ÛÙËÎ·Ó Î·È ‹Ú·Ó ÈÓÛÔ˘Ï›ÓË ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‰È·‚‹ÙË ÙÔ˘˜, ›Ù ϛÁÔ ·ÚÁfiÙÂÚ· Î·È ¿ÓÙˆ˜ ̤۷ Û 12 Ì‹Ó˜ (›Ó. 2, ·ÚÈÛÙÂÚ¿), Î·È Û˘Ó¯›˙Ô˘Ó Ó· ÙË ¯ÚÂÈ¿˙ÔÓÙ·È Î·È Ó· ÙËÓ ·›ÚÓÔ˘Ó Ì¤¯ÚÈ Î·È Û‹ÌÂÚ·. H ÂÈÛ‚ÔÏ‹ ÙÔ˘ ‰È·‚‹ÙË Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ›Ù Ì ÎÂÙÔÔͤˆÛË, ›Ù ÔÍ›· ·ÏÏ¿ ¯ˆÚ›˜ ÛËÌ·ÓÙÈ΋ ÔͤˆÛË, ›Ù ¤ÛÙˆ ˘ÔÍ›· ·ÏÏ¿ Ì ·ÎÚ·›· ˘ÂÚÁÏ˘¯·ÈÌ›· (> 280 mg/dl), ÛËÌ·ÓÙÈ΋ ÎÂÙÔÓÔ˘Ú›· Î·È Ì¤ÙÚÈ· ·Ê˘‰¿ÙˆÛË (¯ˆÚ›˜ ÔͤˆÛË). K·Ó¤Ó·˜ ‰È·‚ËÙÈÎfi˜ Ù˘ ÌÂϤÙ˘ ‰ÂÓ Â›¯Â ‡Ô˘ÏË ÂÈÛ‚ÔÏ‹, Ì ·‚Ï˯ڿ ‹ ηıfiÏÔ˘ Û˘ÌÙÒÌ·Ù· (›Ó. 3, ·ÚÈÛÙÂÚ¿) Î·È Ô B.M.I. ‹Ù·Ó ηٿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÌÈÎÚfiÙÂÚÔ˜ ·fi 27 Kg/m Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ¢È·‚ËÙÈÎÔ› ¿ÏÏˆÓ Ù‡ˆÓ ÁÈ· Û‡ÁÎÚÈÛË. °È· ÙË ‰È·ÎÚÈÙ‹ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1, ÙfiÛÔ Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙË Ì¤ÙÚËÛË ÙÔ˘ C-p, fiÛÔ Î·È ¿ÏÏˆÓ ÂÎÙÈÌ‹ÛÂˆÓ ·ÓÙÈ·Ú·‚¿ÏÏÔÓÙ·È ÚÔ˜ Ù· ·ÓÙ›ÛÙÔȯ·, Û˘ÁÎÚ›ÛÈÌˆÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ˆ˜ ÚÔ˜ ÙȘ ¿ÏϘ ·Ú·Ì¤ÙÚÔ˘˜, 50 ‰È·‚ËÙÈÎÒÓ "Ù‡Ô˘ 1,5" (LADA) Î·È 50 ‰È·‚ËÙÈÎÒÓ Ù‡Ô˘ 2, Ù·˘ÙÔÔÈËı¤ÓÙˆÓ ˆ˜ Ù¤ÙÔÈˆÓ Û ¿ÏϘ ÌÂϤÙ˜ Ì·˜. TfiÛÔ ÔÈ ‰È·‚ËÙÈÎÔ› "Ù‡Ô˘ 1,5" (LADA) fiÛÔ Î·È ÔÈ ‰È·‚ËÙÈÎÔ› Ù‡Ô˘ 2 ÂÈϤ¯ıËÎ·Ó ÌÂٷ͇ 125 Î·È 600 ·ÓÙ›ÛÙÔȯ·, ¤ÙÛÈ ÒÛÙÂ Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (BMI), Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ‰È·‚‹ÙË Î·È Ô ‚·ıÌfi˜ ÁÏ˘¯·ÈÌÈ΋˜ Ú‡ıÌÈÛ˘ (ÁÏ˘¯·ÈÌ›· ÓËÛÙ›·˜ Î·È HbA1c) Ó· ÚÔÛÔÌÔÈ¿˙Ô˘Ó Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ Ì ÂΛӷ ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ù‡Ô˘ 1 Ù˘ ÌÂϤÙ˘ (›Ó. 1, ‰ÂÍÈ¿).

131

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§. KˆÓÛÙ·ÓÙÈÓ›‰Ô˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. B·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ù˘ ÌÂϤÙ˘ TY¶OY 1 X NIE™¢ IE™¢E +SD (‡ÚÔ˜) p

‰È¿ÚÎÂÈ· ‰È·‚‹ÙË (¤ÙË)

p

p

50

50

50

26,0 10,5 (2,5-49)

51,2 11,5 (30-77)

54,4 9,3 (39-78)

61,4 10,2 (55-70)

10,7 6,9 (0-24)

ËÏÈΛ· ηٿ ÙËÓ ¤Ó·ÚÍË (¤ÙË)

TY¶OY 2

50

n ËÏÈΛ· (¤ÙË)

"TY¶OY 1,5" (LADA)

*

11,8 8,1 (0,5-28)

15,3 7,3 (1,1-29)

BMI (Kg/m)

22,9 3,5 (14,9-30,4)

FBG (mg/dl)

173,8 65,2 (55-300)

HbA1c (%)

7,71 1,64 (4,60-10,90)

*

10,7 6,1 (0,2-38)

39,4 9,5 (30-60) *

43,6 10,8 (28-75)

23,7 3,6 (18,7-30,7)

*

24,2 3,8 (19-32)

178,4 72,9 (50-340) *

*

49,7 8,7 (40-64) *

181,3 53,8 (50-340)

7,76 1,54 (5,00-10,90)

*

8,01 1,59 (4,70-12,70)

11,7 6,0 (4-30)

24,0 2,7 (20,1-26,9) 186,3 62,4 (66-231)

*

7,88 1,51 (6,21-10,54)

* = NS

¶›Ó·Î·˜ 2. XÚÔÓÈÎfi ‰È¿ÛÙËÌ· ̤¯ÚÈ ÙËÓ ¤Ó·ÚÍË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ‰È·‚ËÙÈÎÒÓ NIE™¢ IE™¢E LADA I¶™¢2 (n = 50) (n = 50) (n = 50) (n = 50) < 1 Ì‹Ó·

49 (98,0 %) 1 0

30 (60,0 %) 12 8

1-3 ¤ÙË 3-8 ¤ÙË

0 0

0 0

> 8 ¤ÙË

0

0

1-3 Ì‹Ó˜ 3-12 Ì‹Ó˜

0

0

0 0

0 0

14 36 (72,0 %)

0 0

0

23

¶›Ó·Î·˜ 3. B·Ú‡ÙËÙ· ηٿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ‰È·‚‹ÙË NIE™¢ IE™¢E LADA I¶™¢2 (n = 50) (n = 50) (n = 50) (n = 50) ¢È·‚ËÙÈ΋ ÎÂÙÔ-ÔͤˆÛË

26 (52 %)

OÍ›· ÂÈÛ‚ÔÏ‹ ¯ˆÚ›˜ ÔͤˆÛË

19 (38 %)

YÔÍ›· ÂÈÛ‚ÔÏ‹ Ì ÎÂÙÔÓÔ˘Ú›· Î·È Ì¤ÙÚÈ· ·Ê˘‰¿ÙˆÛË

5 (10 %)

⁄Ô˘ÏË ÂÈÛ‚ÔÏ‹ Ì ·‚Ï˯ڿ ‹ ηıfiÏÔ˘ Û˘ÌÙÒÌ·Ù·

132

0

17 (34 %) 14 (28 %) 18 (36 %) 1 (2 %)

0

0

1 (2 %)

0

11 (22 %) 38 (76 %)

3 (6 %) 47 (94 %)

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M¿ÏÈÛÙ·, ÔÈ ‰È·‚ËÙÈÎÔ› Ù‡Ô˘ 2 Ô˘ ÂÈϤ¯ıËÎ·Ó ÁÈ· ÙË Û‡ÁÎÚÈÛË ‹Ù·Ó ÌÂٷ͇ ÙˆÓ ÈÔ ÈÓÛÔ˘ÏÈÓÔÂÓÈÎÒÓ (I¶™¢2) ·fi ÙÔ˘˜ 600 (Ì C-p < 2,40 ng/ml).

M¤ÙÚËÛË ÙÔ˘ C-ÂÙȉ›Ô˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜. ™Â οı ¤Ó·Ó ·fi ÙÔ˘˜ 200 ‰È·‚ËÙÈÎÔ‡˜ ÙÔ˘ ›Ó·Î· 1, ÌÂÙÚ‹ıËΠÙÔ ‚·ÛÈÎfi (ÓËÛÙ›·˜) C-ÂÙ›‰ÈÔ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È "‰ÈÔÚıÒıËÎÂ" ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (C-p/Kg)(X 100). H ̤ÙÚËÛË ¤ÁÈÓ Ì ̤ıÔ‰Ô ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (Immulite).

AÔÙÂϤÛÌ·Ù· H ηÌ‡ÏË Î·Ù·ÓÔÌ‹˜ ÙˆÓ Û˘¯ÓÔÙ‹ÙˆÓ (frequency distribution) ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˆ˜ ÌÔÓÔÎfiÚ˘ÊÔ˜ (unimodal) ÌË Îˆ‰ˆÓÔÂȉ‹˜ (ÂÈÎfiÓ· 1), ·ÏÏ¿ Â›Ó·È Ê·ÓÂÚfi fiÙÈ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÚfiÎÂÈÙ·È ÁÈ· ıÂÙÈÎÒ˜ ÏÔÍ‹, ÂÏ·ÊÚÒ˜ ·Û‡ÌÌÂÙÚË Îˆ‰ˆÓÔÂȉ‹ ηٷÓÔÌ‹, Ë ÔÔ›· ·Ú·ÌÔÚÊÒÓÂÙ·È ÂÂȉ‹ ÔÈ ÌÈÎÚfiÙÂÚ˜ ·fi 0,50 ng/ml ÙÈ̤˜ ÙÔ˘ C-ÂÙȉ›Ô˘, ·ÓÙ› Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ì›·-Ì›·, Û˘Ó·ıÚÔ›˙ÔÓÙ·È fiϘ Ì·˙› Û ÌÈ· ÛÙ‹ÏË (0,50 ng/ml= ÙÔ Î·ÙÒÙÂÚÔ ÚÔÛ‰ÈÔÚ›ÛÈÌÔ fiÚÈÔ). O ‚·ıÌfi˜ ‰È·ÛÔÚ¿˜ (dispersion) ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ Â›Ó·È Ì¿ÏÏÔÓ ÌÈÎÚfi˜, ÙfiÛÔ Û ·˘ÙÔ‡˜ Ì NIE™¢, fiÛÔ Î·È Û ·˘ÙÔ‡˜ Ì IE™¢E. H ·Û‡ÌÌÂÙÚË Î·Ù·ÓÔÌ‹ ¢ÓÔ› Ù· ÂηÙÔÛÙËÌfiÚÈ· Ì¿ÏÏÔÓ (·ıÚÔÈÛÙÈÎfi ‰È¿ÁÚ·ÌÌ·, ÂÈÎfiÓ· 2), ·Ú¿ ÙË ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË (SD), ÁÈ· ÙËÓ ÂÚÈÁÚ·Ê‹ Ù˘ ‰È·ÛÔÚ¿˜ ÙˆÓ ·Ú·ÙËÚ‹ÛˆÓ. OÈ ÙÈ̤˜ ÙÔ˘ C-p Ô˘ ‚Ú¤ıËÎ·Ó Ê·›ÓÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ ›Ó·Î· 4 (·ÚÈÛÙÂÚ¿). ™Â 30 ·fi ÙȘ 50 ÂÚÈÙÒÛÂȘ NIE™¢ ÙÔ C-p ‚Ú¤ıËΠ<0,50 ng/ml, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 20 Î˘Ì¿ÓıËÎÂ

TÔ C-ÂÙ›‰ÈÔ ÛÙÔÓ ‰È·‚‹ÙË Ù‡Ô˘ 1

·fi 0,50-1,90 ng/ml Ì ̤ÛË ÙÈÌ‹ X+SD= 0,89+0,39 ng/ml. OÈ ‰È·‚ËÙÈÎÔ› Ì ÙÔ ¯·ÌËÏfiÙÂÚÔ C-p ›¯·Ó ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ‰È·‚‹ÙË, Û ۇÁÎÚÈÛË ÚÔ˜ ·˘ÙÔ‡˜ Ì ˘„ËÏfiÙÂÚÔ (›Ó. 6). MÂÙ¿ ·fi 5-10 ¤ÙË ÎÏÈÓÈÎÔ‡ ‰È·‚‹ÙË, Ë ÌÂÁ¿ÏË ·Ó·ÏÔÁ›· ÙˆÓ ·ÛıÂÓÒÓ Ì NIE™¢ ¤¯Ô˘Ó ÙÈ̤˜ C-p < 0,5 ng/ml, ÌÂÚÈÎÔ› fï˜ Û˘Ó¯›˙Ô˘Ó Ó· ¤¯Ô˘Ó ·ÓȯÓ‡ÛÈÌÔ C-ÂÙ›‰ÈÔ Î·È ÌÂÙ¿ ÂÚÈÛÛfiÙÂÚ· ¤ÙË (̤¯ÚÈ Î·È ÌÂÙ¿ 24 ¤ÙË, Û ̛· ÂÚ›ÙˆÛË). ¶ÚÔÊ·ÓÒ˜, Ë Î·Ù·ÛÙÚÔÊÈ΋ ÂÍÂÚÁ·Û›· ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ Û˘Ó¯›˙ÂÙ·È Ì ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ú˘ıÌÔ‡˜ ÛÙ· ‰È¿ÊÔÚ· ¿ÙÔÌ· Ì NIE™¢. E¿Ó fiϘ ÔÈ <0,50 ng/ml ÙÈ̤˜ ıˆÚËıÔ‡Ó ›Û˜ Ì 0,40, ÙfiÙÂ Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ C-p (+SD) ÁÈ· ÙÔÓ NIE™¢ Â›Ó·È ›ÛË Ì 0,59 (+0,39) ng/ml. ¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· Â˘Ú‹Ì·Ù· Î·È ÁÈ· ÙÔÓ IE™¢E. ™Â 21 ·fi ÙȘ 50 ÂÚÈÙÒÛÂȘ ÙÔ C-p ‚Ú¤ıËΠ<0,50 ng/ml, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 29 Î˘Ì¿ÓıËΠ·fi 0,501,60 ng/ml Ì ̤ÛË ÙÈÌ‹ X (+SD) = 0,78 (+0,32) ng/ml. OÈ ‰È·‚ËÙÈÎÔ› Ì ÙÔ ¯·ÌËÏfiÙÂÚÔ C-p ›¯·Ó ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ‰È·‚‹ÙË, Û ۇÁÎÚÈÛË ÚÔ˜ ·˘ÙÔ‡˜ Ì ˘„ËÏfiÙÂÚÔ (›Ó. 6). MÂÙ¿ ·fi 5-10 ¤ÙË ÎÏÈÓÈÎÔ‡ ‰È·‚‹ÙË, Ë ÌÂÁ¿ÏË ·Ó·ÏÔÁ›· ÙˆÓ ·ÛıÂÓÒÓ Ì IE™¢E ¤¯Ô˘Ó ÙÈ̤˜ C-p <0,50 ng/ml, ÌÂÚÈÎÔ› fï˜ Û˘Ó¯›˙Ô˘Ó Ó· ¤¯Ô˘Ó ·ÓȯÓ‡ÛÈÌÔ C-ÂÙ›‰ÈÔ Î·È ÌÂÙ¿ ÂÚÈÛÛfiÙÂÚ· ¤ÙË (̤¯ÚÈ Î·È ÌÂÙ¿ 21 ¤ÙË Û ̛· ÂÚ›ÙˆÛË). ¶ÚÔÊ·ÓÒ˜ Ë Î·Ù·ÛÙÚÔÊÈ΋ ÂÍÂÚÁ·Û›· ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ Û˘Ó¯›˙ÂÙ·È Ì ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ú˘ıÌÔ‡˜ ÛÙ· ‰È¿ÊÔÚ· ¿ÙÔÌ· Ì IE™¢E. E¿Ó fiϘ ÔÈ <0,50 ng/ml ÙÈ̤˜ ıˆÚËıÔ‡Ó ›Û˜ Ì 0,40, ÙfiÙÂ Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ C-p (+SD) ÁÈ· ÙÔÓ IE™¢E Â›Ó·È ›ÛË Ì 0,56 (+0,32) ng/ml.

·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ (Û‡ÓÔÏÔ Ë=100)

EÈÎfiÓ· 1. OÈ ÙÈ̤˜ ÙÔ˘ C-ÂÙȉ›Ô˘ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1. K·Ì‡ÏË Î·Ù·ÓÔÌ‹˜ Û˘¯ÓÔًوÓ.

EÈÎfiÓ· 2. AıÚÔÈÛÙÈÎfi ‰È¿ÁÚ·ÌÌ· ÙÔ˘ C-ÂÙȉ›Ô˘ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜ Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 1. O οıÂÙÔ˜ ¿ÍÔÓ·˜ (ÙÂÙ·Á̤ÓË) ÂÎÚÔÛˆ› ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ Ô˘ ÛËÌÂÈÒıËÎ·Ó fi¯È Û οı ÔÌ¿‰· ÙÈÌÒÓ, ·ÏÏ¿ ·ıÚÔÈÛÙÈο ̤¯ÚÈ Î¿ı ÌÈ· ÙÈÌ‹.

H ‰È¿ÌÂÛË ÙÈÌ‹ Î·È Ù· ÙÂÙ·ÚÙËÌfiÚÈ· ‚Ú›ÛÎÔÓÙ·È Ì ÙË ÁÚ·ÊÈ΋ ̤ıÔ‰Ô.

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§. KˆÓÛÙ·ÓÙÈÓ›‰Ô˘ Î·È Û˘Ó.

ŸÛÔÓ ·ÊÔÚ¿ ÙÔ C-p ÂÔ̤ӈ˜, Ô NIE™¢ ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ÙÔÓ IE™¢E Î·È ·ıÚÔÈÛÙÈο ÁÈ· ÙȘ ‰˘Ô ˘ÔÔÌ¿‰Â˜ ÙÔ˘ Ù‡Ô˘ 1 (n =100), Ë ÙÈÌ‹ ÙÔ˘ C-ÂÙȉ›Ô˘ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ·Ó¤Ú¯ÂÙ·È Û 0,575 (+0,35) ng/ml. K·È ÔÈ ‰˘Ô ·˘Ù¤˜ ˘ÔÔÌ¿‰Â˜ ÙÔ˘ Ù‡Ô˘ 1 fï˜, Â›Ó·È Û·ÊÒ˜ ‰È·ÎÚÈÙ¤˜ ·fi ÙÔÓ Ù‡Ô "1,5" (LADA) Î·È ÙÔÓ I¶™¢2, Î·È ÌfiÓÔ ·fi ÙËÓ ÙÈÌ‹ ÙÔ˘ C-ÂÙȉ›Ô˘ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ (›Ó. 4, ‰ÂÍÈ¿). ¶·Ú¿ ÙËÓ ·ÚfiÌÔÈ· ÙÈÌ‹ ÙÔ˘ C-p, fï˜, Ë ‰È·‚ËÙÈ΋ ÎÂÙÔÔͤˆÛË Î·Ù¿ ÙËÓ ÂÈÛ‚ÔÏ‹ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙÔÓ NIE™¢, ·fi fiÙÈ ÛÙÔÓ IE™¢E (›Ó. 3, ·ÚÈÛÙÂÚ¿). H ¿ÌÂÛË ¤Ó·ÚÍË Ù˘ ÈÓÛÔ˘Ï›Ó˘, ÂÍ¿ÏÏÔ˘, ıˆڋıËΠ··Ú·›ÙËÙË ÛÙÔ 98% ÙˆÓ ÂÚÈÙÒÛÂˆÓ NIE™¢, ·ÏÏ¿ ÌfiÓÔ ÛÙÔ 60% ÙˆÓ ÂÚÈÙÒÛÂˆÓ IE™¢E (›Ó. 2). H ÛÊÔ‰Ú‹ ÂÈÛ‚ÔÏ‹ Î·È Ë ·Ó¿ÁÎË ÁÈ· ¿ÌÂÛË ¤Ó·ÚÍË Ù˘ ÈÓÛÔ˘Ï›Ó˘, ÂÔ̤ӈ˜, Â›Ó·È Û˘¯ÓfiÙÂÚ˜ ÛÙÔ NIE™¢ Û ۇÁÎÚÈÛË Ì ÙÔÓ IE™¢E, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·È ÔÈ ‰‡Ô ÔÌ¿‰Â˜, ·Û¯¤Ùˆ˜ ËÏÈΛ·˜ ¤Ó·Ú͢, ¤¯Ô˘Ó ›‰ÈÔ C-p ÓËÛÙ›·˜ Î·È ·Ó‹ÎÔ˘Ó ÛÙÔÓ ›‰ÈÔ Ù‡Ô ÙÔ˘ ‰È·‚‹ÙË, ÙÔÓ Ù‡Ô 1.

H ‰È¿ÚÎÂÈ· ÙÔ˘ ‰È·‚‹ÙË ·Ô‰ÂÈÎÓ‡ÂÙ·È Ó· ·›˙ÂÈ ÙÔÓ Î‡ÚÈÔ ÚfiÏÔ ÁÈ· ÙËÓ Ì›ˆÛË ÙˆÓ ·Ú¯ÈÎÒÓ ÂÈ¤‰ˆÓ ÙÔ˘ C-p Û fiÚÈ· οو ·fi Ù· ÚÔÛ‰ÈÔÚ›ÛÈÌ·. K·Ù¿ Ù· ÚÒÙ· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1 ÔÈ ·ÛıÂÓ›˜ ‰È·ı¤ÙÔ˘Ó ·ÎfiÌË ÌÂÙÚËÙ‹, ·Ó Î·È Ôχ ¯·ÌËÏ‹, ÂÓ‰ÔÁÂÓ‹ ·Ú·ÁˆÁ‹ ÈÓÛÔ˘Ï›Ó˘, Ë ÔÔ›· fï˜ ÌÂÈÒÓÂÙ·È Û‡ÓÙÔÌ· Û ÌË ˘ÔÏÔÁ›ÛÈÌ· Â›‰·.

O Ú˘ıÌfi˜ Ì¿ÏÈÛÙ· Ù˘ Ì›ˆÛ˘ ·˘Ù‹˜ Â›Ó·È Ù·¯‡ÙÂÚÔ˜ ·fi fiÙÈ ÛÙÔÓ "Ù‡Ô 1,5" Î·È 2, ·ÊÔ‡ ÁÈ· ÙÔÓ ˘Ô‰ÈÏ·ÛÈ·ÛÌfi ÙˆÓ ·Ú¯ÈÎÒÓ ÂÈ¤‰ˆÓ ÙÔ˘ C-p ÛÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 1 ·ÚÎÔ‡Ó Ù· 10+ ¤ÙË, ÂÓÒ ÛÙÔÓ "Ù‡Ô 1,5" Î·È 2 ··ÈÙÔ‡ÓÙ·È 20+ ¤ÙË (›Ó·Î·˜ 5 Î·È ÂÈÎfiÓ· 3). ™ÙÔÓ "Ù‡Ô 1,5" (LADA) ÙÔ C-p Î˘Ì¿ÓıËΠ·fi <0,50 ̤¯ÚÈ 2,40 ng/ml, ·ÏÏ¿ ÛÙȘ 3 ÂÚÈÙÒÛÂȘ Ô˘ ‚Ú¤ıËΠ<0,50 ng/ml ÂÚfiÎÂÈÙÔ ÁÈ· ‰È·‚ËÙÈÎÔ‡˜ Ì Ôχ ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ· ‰È·‚‹ÙË (18,3+7,1 ¤ÙË, ¤Ó·ÓÙÈ 10,2+6,1 ¤ÙË ·˘ÙÒÓ Ì C-p ›ÛÔ Ì 0,50-2,40 ng/ml). E¿Ó Î·È ÔÈ ÙÚÂȘ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 0,50 ng/ml ÙÈ̤˜ ıˆÚËıÔ‡Ó ›Û˜ Ì 0,40, ÙfiÙÂ Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ C-p (+SD) ÁÈ· ÙÔ ‰È·‚‹ÙË Ù‡Ô˘ LADA Â›Ó·È ›ÛË ÌÂ

∞ÚÈıÌfi˜ ÂÚÈÙÒÛˆÓ

MART.-APR.2000 ÓÂÔ

EÈÎfiÓ· 3. H Ì›ˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ C-ÂÙȉ›Ô˘ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜ ·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ‰È·‚‹ÙË ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ÙÔ˘.

1,21 (+ 0,35) ng/ml (›Ó. 4). ™ÙÔÓ Ù‡Ô ·˘Ùfi ÙÔ˘ ‰È·‚‹ÙË - ηıÒ˜ Î·È Û ·˘ÙÔ‡˜ Ì I¶™¢2, ·Ú¿ ÙÔ fiÙÈ Î·Ù·ÁÚ¿ÊËÎ·Ó (ηٿ ÙËÓ ÂÈÛ‚ÔÏ‹ ‹ ·ÚÁfiÙÂÚ·) ÂÂÈÛfi‰È· Ì ·ÎÚ·›Â˜ ˘ÂÚÁÏ˘¯·È̛˜, ‹È· ·Ê˘‰¿ÙˆÛË Î·È ÎÂÙÔÓÔ˘Ú›·, ·ÏËıÈÓ‹ (ÎÂÙÔ)ÔͤˆÛË ‰ÂÓ ÂÌÊ·Ó›ÛÙËΠ۠ηӤӷ ¿ÙÔÌÔ. H ÂÈÛ‚ÔÏ‹, ÂÍ¿ÏÏÔ˘, ‰ÂÓ ‹Ù·Ó ÔÍ›· Û η̛· ÂÚ›ÙˆÛË (›Ó. 3).

OÈ ÙÈ̤˜ ÙÔ˘ C-p ÛÙÔ˘˜ 50 ÈÓÛÔ˘ÏÈÓÔÂÓÈÎÔ‡˜ ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 Î˘Ì¿ÓıËÎ·Ó ·fi 1,31 ̤¯ÚÈ 2,40 ng/ml), Ì ̤ÛË ÙÈÌ‹ ›ÛË Ì 1,80 (+0,31) ng/ml (›Ó. 4), Î·È ¿ÏÈ ‰ËÏ·‰‹, Ôχ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ù‡Ô˘ 1 Î·È "Ù‡Ô˘ 1,5"(LADA). MÂÚÈÎÔ› ·fi ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 Ì ÙÈ̤˜ C-p <2,4 ng/ml ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Î·È Ì ÈÓÛÔ˘Ï›ÓË (Û˘Ó‹ıˆ˜ 0,2 i.u./kg ÈÓÛÔ˘Ï›Ó˘ ̤Û˘ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘, Û ̛· ¤ÓÂÛË, ÚÈÓ ·fi ÙËÓ Î·Ù¿ÎÏÈÛË), ÂÈϤÔÓ ÙˆÓ ˘ÔÁÏ˘¯·ÈÌÈÎÒÓ ·fi ÙÔ ÛÙfiÌ·. ¶ÔÏÏÔ› -·ÏÏ¿ fi¯È fiÏÔÈ- ‰È·‚ËÙÈÎÔ› Ù‡Ô˘ 2 Ì ÙÈ̤˜ C-p <2,00 ng/ml ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Ì ÈÓÛÔ˘Ï›ÓË ‹ Î·È ÈÓÛÔ˘Ï›ÓË, fiÏÔÈ fï˜ ÔÈ ‰È·‚ËÙÈÎÔ› Ì ÙÈ̤˜ C-

¶›Ó·Î·˜ 4. To C-ÂÙ›‰ÈÔ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Û ‰È·ÊÔÚÔ˘˜ Ù‡Ô˘˜ ÙÔ˘ ‰È·‚‹ÙË.

NIE™¢

TY¶O™ 1 IE™¢E p

"TY¶O™ 1,5" (LADA) p

p

C-p(ng/ml) X SD

0,59 0,39

NS

0,56 0,32

<<0,001

1,21 0,35

C-p/kg (X100) X SD

1,06 0,74

NS

0,86 0,39

<<0,001

1,86 0,87

134

IN™OY§INO¶ENIKO™ TY¶O™ 2

<<0,001

<<0,001

1,80 0,31 3,18 1,21

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TÔ C-ÂÙ›‰ÈÔ ÛÙÔÓ ‰È·‚‹ÙË Ù‡Ô˘ 1

p <1,5 ng/ml ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Ì ÈÓÛÔ˘Ï›ÓË. ™˘ÓÔÏÈο 23 ·fi ÙÔ˘˜ 50 ‰È·‚ËÙÈÎÔ‡˜ Ì I¶™¢2 Ù˘ ÌÂϤÙ˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Ì ‹ Î·È Ì ÈÓÛÔ˘Ï›ÓË.

H ·Ó·ÏÔÁ›· ÙˆÓ ‰È·‚ËÙÈÎÒÓ Ì NIE™¢ Ô˘ ›¯·Ó ‰È·‚ËÙÈÎÔ‡˜ ÁÔÓ›˜ (¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔ) ·Ó¤Ú¯ÂÙ·È Û 7/50=14% Î·È ‰È·‚ËÙÈο ·‰¤ÏÊÈ· (¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔ) Û 1/50=2%. OÈ ›‰È˜ ·Ó·ÏÔÁ›Â˜ ÁÈ· ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ì IE™¢E ·Ó¤Ú¯ÔÓÙ·È Û 7/50=14% Î·È 8/50=16%, ÂÓÒ ÁÈ· ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ LADA Û 24/50=48% Î·È 16/50=32%, Î·È ÁÈ· ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 2 Û 36/50=72% Î·È 28/50=56%, ·ÓÙ›ÛÙÔȯ·. ™˘˙‹ÙËÛË H ·Í›· ÙÔ˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘ C-p ÛÙË ‰È·ÎÚÈÙ‹ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ‰È·‚‹ÙË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ‰È·‚ËÙÈÎÒÓ, ηıÒ˜ Î·È ÛÙËÓ ÔÚıÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ··ÈÙ‹ÛÂˆÓ Û ÈÓÛÔ˘Ï›ÓË ¤¯ÂÈ ÙÔÓÈÛı› Î·È Û ¿ÏϘ ÌÂϤÙ˜ (23,24), ·Ó Î·È fi¯È ÔÏϤ˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Î·Ù·‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ô ‰È·‚‹Ù˘ Ù‡Ô˘ 1, ¿Û¯ÂÙ· Ì ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘, ÌÔÚ› Ó· Ù·˘ÙÔÔÈËı› ·fi ÙȘ Ôχ ¯·ÌËϤ˜ ÙÈ̤˜ ÙÔ˘ C-p (Û˘Ó‹ıˆ˜ <1,50 ng/ml), ‹‰Ë ηٿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÙÔ˘, ÔÈ Ôԛ˜ ÁÚ‹ÁÔÚ· Û¯ÂÙÈο ÌÂÈÒÓÔÓÙ·È Û ÌË ˘ÔÏÔÁ›ÛÈ̘ ‹ Û Â›‰· Ô˘ ÂÁÁ›˙Ô˘Ó Ú·ÎÙÈο ÙËÓ ·fiÏ˘ÙË ÈÓÛÔ˘ÏÈÓÔÂÓ›·, ·Ó Î·È fi¯È Ì ÙÔÓ ›‰ÈÔ Ú˘ıÌfi Û fiÏÔ˘˜. ¢È·‚‹Ù˘ Ô˘ ηٿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÙÔ˘ ‹ Î·È Ì¤¯ÚÈ 5 ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ· Û˘Óԉ‡ÂÙ·È ·fi ÙÈ̤˜ C-p<1,5 ng/ml Â›Ó·È ‰È·‚‹Ù˘ Ù‡Ô˘ 1.

EÊfiÛÔÓ ÌÂÏÂÙÒÓÙ·È ‰È·‚ËÙÈÎÔ› Ì ›‰È· ÂÚ›Ô˘ ‰È¿ÚÎÂÈ· ‰È·‚‹ÙË, ÔÈ ÙÈ̤˜ ÙÔ˘ C-p ÛÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 1 Â›Ó·È ÙfiÛÔ Ôχ ¯·ÌËÏfiÙÂÚ˜, ÒÛÙ ÂÈÙÚ¤Ô˘Ó ÙË ‰È¿ÎÚÈÛ‹ ÙÔ˘ ·fi ÙÔÓ "Ù‡Ô 1,5" (LADA) Î·È ÙÔÓ ÈÓÛÔ˘ÏÈÓÔÂÓÈÎfi ·ÎfiÌË Ù‡Ô 2, ¤ÛÙˆ ÎÈ ·Ó ‰ÂÓ Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Î·Ó¤Ó· ¿ÏÏÔ ÎÚÈÙ‹ÚÈÔ ÂÎÙfi˜ ·fi ·˘Ù¤˜. ŒÙÛÈ, Û ÂÚÈÙÒÛÂȘ ÔÚȷΤ˜ ‹ ·ÌÊÈÏÂÁfi̶›Ó·Î·˜ 5. To C-ÂÙ›‰ÈÔ ÓËÛÙ›·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Û ‰È·ÊÔÚÔ˘˜ Ù‡Ô˘˜ ÙÔ˘ ‰È·‚‹ÙË. ¢È¿ÚÎÂÈ· ‰È·‚‹ÙË (¤ÙË)

C-Peptide (ng/ml) [Ã+(SD)] p

(n=26) [ 0-5 6-10 (n=22)

0,847 (0,36) 0,604 (0,39)

]

BÈ‚ÏÈÔÁÚ·Ê›· <0,001

11-15 (n=25) 16-20 (n=16) 21-25+(n=11)

0,457 (0,31) <0,400 <0,400

™‡ÓÔÏÔ (n=100)

0,575 (0,35)

[

]

Ó˜ ‹ ‰‡ÛÎÔϘ Ó· Ù·ÍÈÓÔÌËıÔ‡Ó, Ë ÙÈÌ‹ ÙÔ˘ C-p ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙË ‰È¿ÎÚÈÛË ÙˆÓ Ù‡ˆÓ ÙÔ˘ ‰È·‚‹ÙË. O ηıÔÚÈÛÙÈÎfi˜ ÚfiÏÔ˜ Ù˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ‰È·‚‹ÙË ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È Û ¿ÏϘ ÌÂϤÙ˜ (23,25).

E¿Ó, ·ÓÙ›ıÂÙ·, ‰ÂÓ Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ‰È·‚‹ÙË, ÙfiÙ ÔÈ ÙÈ̤˜ ÙÔ˘ C-p ÛÙÔ ‰È·‚‹ÙË Ù‡Ô˘ 2 Ì Ôχ ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ·, ÛÙÔÓ ‰È·‚‹ÙË "Ù‡Ô˘ 1,5" (LADA) Ì ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ· Î·È ÛÙÔÓ ‰È·‚‹ÙË Ù‡Ô˘ 1 Ì ÌÈÎÚ‹ ‰È¿ÚÎÂÈ· ‹ ÚfiÛÊ·ÙË ¤Ó·ÚÍË ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ·ÚfiÌÔȘ ‹ ¤ÛÙˆ Ó· ÂÌÊ·Ó›˙Ô˘Ó ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë.

EÎÙfi˜ ·fi ÙË Û˘Ì‚ÔÏ‹ ÛÙË ‰È¿ÎÚÈÛË Î·È ÙË ‰È·‚¿ıÌÈÛË ÙˆÓ Ù‡ˆÓ ÙÔ˘ ‰È·‚‹ÙË, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ C-p ÌÔÚ› Ó· Û˘ÓÂÈÛʤÚÂÈ Î·È Û ¤Ó·Ó ÔÚıÔÏÔÁÈÎfi ˘ÔÏÔÁÈÛÌfi ÙˆÓ ··ÈÙ‹ÛÂˆÓ Û ÈÓÛÔ˘Ï›ÓË Û οı ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ‰È·‚ËÙÈÎfi. AÎfiÌË Î·È ÌÈ· ÌÈÎÚ‹ ˘ÔÏÂÈÌÌ·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ ÛÙÔ ‰È·‚ËÙÈÎfi Ù‡Ô˘ 1 Â›Ó·È Ôχ ˆÊ¤ÏÈÌË ‰ÈfiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÌÈÎÚfiÙÂÚ˜ ‰fiÛÂȘ ÈÓÛÔ˘Ï›Ó˘, ηχÙÂÚÔ Î·È ÛÙ·ıÂÚfiÙÂÚÔ ÁÏ˘¯·ÈÌÈÎfi ¤ÏÂÁ¯Ô Î·È ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘, ηıÒ˜ Â›Û˘ Î·È Ì ÌÈÎÚfiÙÂÚË ·ÔÚ‡ıÌÈÛË Û ÂÚ›ÙˆÛË ‰È·ÎÔ‹˜ Ù˘ ÈÓÛÔ˘Ï›Ó˘. ŒÙÛÈ, Ô ‰È·‚ËÙÈÎfi˜ Ù‡Ô˘ 1, Ì ÌÈÎÚ‹ ÌÂÓ ·ÏÏ¿ ˘ÔÏÔÁ›ÛÈÌË ·ÁÎÚ·ÙÈ΋ Âʉڛ·, ·Ó·Ì¤ÓÂÙ·È Ó· ¤¯ÂÈ Î·Ï‡ÙÂÚË ÁÏ˘¯·ÈÌÈ΋ Ú‡ıÌÈÛË ·fi ¤Ó·Ó ¿ÏÏÔ ¯ˆÚ›˜ ηıfiÏÔ˘ Ú·ÎÙÈο ÂÓ‰ÔÁÂÓ‹ ·Ú·ÁˆÁ‹ ÈÓÛÔ˘Ï›Ó˘, ÂÍ ÔÏfiÎÏËÚÔ˘ ÂÍ·ÚÙÒÌÂÓÔ ·fi ÙËÓ Â͈ÁÂÓ‹ ¯ÔÚ‹ÁËÛ‹ Ù˘. O ·¯‡Û·ÚÎÔ˜ ‰È·‚ËÙÈÎfi˜ Ù‡Ô˘ 2 ÂÍ¿ÏÏÔ˘, Ì Ùˆ¯‹ ÌÂÓ Ú‡ıÌÈÛË, ·ÏÏ¿ Ì ¿ÊıÔÓË ÂÓ‰ÔÁÂÓ‹ ·Ú·ÁˆÁ‹ ÈÓÛÔ˘Ï›Ó˘ ‰ÂÓ ·Ó·Ì¤ÓÂÙ·È Ó· ˆÊÂÏËı› ·ÏËıÈÓ¿ ·fi ÙËÓ ÚÔÛı‹ÎË ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ ıÂÚ·¢ÙÈÎfi ÚfiÁÚ·ÌÌ·. AÓÙ›ıÂÙ·, Ô ‰È·‚ËÙÈÎfi˜ Ù‡Ô˘ 2 Ì ÛËÌ·ÓÙÈο ÌÂȈ̤ÓË ÙËÓ ÂÓ‰ÔÁÂÓ‹ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ ¯ÚÂÈ¿˙ÂÙ·È ÙËÓ ÚÔÛı‹ÎË ÈÓÛÔ˘Ï›Ó˘ ÛÙË ıÂÚ·›· ÙÔ˘. AÓ·ÁÓˆÚ›˙ÂÙ·È ‚¤‚·È·, fiÙÈ Ë ÔÛfiÙËÙ· Ù˘ ‰È·ı¤ÛÈÌ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ÈÓÛÔ˘Ï›Ó˘ ‰ÂÓ Â›Ó·È Ô ÌfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ηıÔÚ›˙ÂÈ ÙÔÓ ‚·ıÌfi Ù˘ ÂÈÙ˘Á¯·ÓfiÌÂÓ˘ ÁÏ˘¯·ÈÌÈ΋˜ Ú‡ıÌÈÛ˘.

H ÛÊÔ‰Ú‹ ‹ Ë ÔÍ›· ÂÈÛ‚ÔÏ‹, Ë ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘ ÙÔ Ôχ ̤۷ Û 12 Ì‹Ó˜ Î·È Ë Û·ÓÈfiÙËÙ· ÈÛÙÔÚÈÎÔ‡ ‰È·‚‹ÙË ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‚·ıÌÔ‡, Â›Ó·È ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 1.

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H ·¯˘Û·ÚΛ· Û ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ K‡ÚÔ ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ· °È¿ÓÓ˘ KÔ˘Ú›‰Ë˜, Mȯ¿Ï˘ TÔÚÓ·Ú›Ù˘, XÚ‹ÛÙÔ˜ KÔ˘Ú›‰Ë˜, ™¿‚‚·˜ ™¿‚‚·, X·Ú¿Ï·ÌÔ˜ X·Ù˙ËÁˆÚÁ›Ô˘, M·Ú›· ™È·ÌÔ‡ÓÎË

● ¶ÂÚ›ÏË„Ë: M ÛÎÔfi ÙË ÌÂϤÙË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ K‡ÚÔ, ÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ Â·Ú¯ÈÒÓ, ÌÂٷ͇ ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Î·È Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÛÙËÓ ¶¿ÊÔ, ÌÂÏÂÙ‹ıËÎ·Ó 8614 ·È‰È¿ Ù˘ ™T' Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Ù˘ ÂχıÂÚ˘ K‡ÚÔ˘ Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÙË Û¯ÔÏÈ΋ ¯ÚÔÓÈ¿ 1997-98. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÛ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ t-test, One way ANOVA Î·È Pearson Correlation. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢M™) ‹Ù·Ó ›‰ÈÔ˜ Û fiϘ ÙȘ ÂÚÈÔ¯¤˜ ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (18,9 kg/m2 ̤¯ÚÈ 19,6 kg/m2) ·ÏÏ¿ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ (¢¶T). ™Ù· ·ÁfiÚÈ· ‹Ù·Ó ¯·ÌËÏ‹ ÛÙȘ Â·Ú¯›Â˜ §Â˘ÎˆÛ›·˜ (17,2 mm), §¿Úӷη˜ (17,6 mm) Î·È ¶¿ÊÔ˘ (18,5 mm) Î·È ·˘ÍË̤ÓË ÛÙË §ÂÌÂÛfi (19,6 mm), [p<0,001], Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ¯·ÌËÏ‹ Û §Â˘ÎˆÛ›· (18,1 mm) Î·È §¿Úӷη (18,6 mm) Î·È ·˘ÍË̤ÓË Û ¶¿ÊÔ (20,1 mm) Î·È §ÂÌÂÛfi (20,5 mm), [p<0,001]. ™ÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó ¯·ÌËÏ‹ Û fiϘ ÙȘ Â·Ú¯›Â˜ Ì ÂÍ·›ÚÂÛË ÙËÓ ¶¿ÊÔ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Î·È ÙË §ÂÌÂÛfi Û ÎÔÚ›ÙÛÈ·. ¶·Á·ÚÈ· ÛÙ· ·ÁfiÚÈ·, Ë ¢¶T ÛÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó 16,9 mm Î·È ÛÙȘ ·ÛÙÈΤ˜ 19 mm (p<0,001) Î·È ÛÙ· ÎÔÚ›ÙÛÈ· 18 mm Î·È 19,9 mm ·ÓÙ›ÛÙÔȯ· (p<0,001). OÈ ¯·ÌËϤ˜ ÙÈ̤˜ ¢¶T ÛÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Û˘Ó‰È¿ÛÙËÎ·Ó Ì ηχÙÂÚË Â›‰ÔÛË ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (·ÁfiÚÈ· 4,8 v 4,4 ÛÙ¿‰È·, ÎÔÚ›ÙÛÈ· 3,5 v 3,3 ÛÙ¿‰È·), [p<0,001], Î·È ÂÏ·Ùو̤ÓË LDL-C (·ÁfiÚÈ· 102,4 v 106,6 mg/dl, ÎÔÚ›ÙÛÈ· 99,2 v 103,6 mg/dl), [p<0,001]. ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙË ¢¶T Û ·È‰È¿ ËÏÈΛ·˜ 11 ÂÙÒÓ ÛÙËÓ ¶¿ÊÔ, Ì ÌÂÙÚ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó ÚÈÓ ·fi 7,5 ¯ÚfiÓÈ· (1990-91), ‰È·ÈÛÙÒÓÂÙ·È ÌÂÁ¿ÏË ·‡ÍËÛË. ™˘ÁÎÂÎÚÈ̤ӷ Ù· ·ÁfiÚÈ· ›¯·Ó ·˘ÍË̤ÓË ÙË ¢¶T ηٿ 26,4% (·fi 14,4 mm Û 18,2 mm) Î·È Ù· ÎÔÚ›ÙÛÈ· ηٿ 23,7% (·fi 16 mm Û 19,8 mm) [p<0,001]. ™˘ÌÂÚ·ÛÌ·ÙÈο, ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙËÓ K‡ÚÔ. TÔ Úfi‚ÏËÌ· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ·ÛÙÈο ΤÓÙÚ· Î·È Û˘Ó‰È¿˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. H ¢¶T ÎÚ›ÓÂÙ·È Î·Ï‡ÙÂÚË ÂͤٷÛË ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·¯˘Û·ÚΛ·˜ ·fi fiÙÈ Ô ¢M™. ¶·È‰È·ÙÚÈ΋ 2000;63:137-144. §¤ÍÂȘ ÎÏÂȉȿ: ·¯˘Û·ÚΛ·, ·È‰È¿, K‡ÚÔ˜.

Y. Kourides, M. Tornaritis, C. Kourides, S. Savva, H. Hadjigeorgiou, M. Siamounki. Obesity in children aged 11 to 12 years in Cyprus. Significant increase during the last 8 years. Paediatriki 2000;63:137-144. ● Abstract: The aim of this study was to estimate the prevalence of obesity in children aged 11 to12 years in Cyprus and to make comparisons between districts, between urban and rural areas, and with previous studies.

We studied 8,614 children (4,446 boys, 4,168 girls), aged 11-12 years, examined at their schools as part of the "Child Health Programme", between October 1997 and June 1998. The data from the examination of the children included measurement of body mass index (BMI), triceps skinfold thickness (TST), physical fitness: EUROFIT Test, 20m shuttle run test (SRT), and serum LDL-Cholesterol (LDL-C). Statistical analyses were made applying Student’s t-test, one way ANOVA and the Pearson correlation using SPSS 8.0. The means of BMI and TST were compared between districts and between urban and rural areas, and the TST with previous studies in Paphos. The mean BMI was similar in all areas, for boys and for girls (18.9 kg/m2 to 19.6 kg/m2), but significant differences in the mean TST were observed between areas: It was lower in Nicosia (17.2 mm),

EÎ·È‰Â˘ÙÈÎfi Î·È EÚ¢ÓËÙÈÎfi ¶ÚfiÁÚ·ÌÌ· YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡, K‡ÚÔ˜

137

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°. KÔ˘Ú›‰Ë˜ Î·È Û˘Ó.

Larnaca (17.6 mm) and Paphos (18.5 mm) and higher in Limassol (19.6 mm) in boys [p<.001], and lower in Nicosia (18.1 mm) and Larnaca (18.6 mm) and higher in Paphos (20.1 mm) and Limassol (20.5 mm) in girls [p<.001]. The mean TST was lower in all the rural areas except for that of Paphos in boys and girls, and Limassol in girls. For the total population, the mean TST was 16.9 mm in the rural and 19 mm in the urban areas in boys (p<.001), and 18 mm and 19.9 mm respectively in girls (p<.001). The lower TST in the rural areas was associated with better performance in the SRT (4.8 v 4.4 stages in boys, 3.5 v 3.3 stages in girls), [p<.001], and lower LDL-C (102.4 v 106.6 mg/dl in boys, 99.2 v 103.6 mg/dl in girls), [p<.001]. Comparing the TST of the children aged 11 years in Paphos with measurements performed 7.5 years earlier (1990-91), a large increase was observed. The mean TST had increased in boys by 26.4% (from 14.4 mm to 18.2 mm) and in girls by 23.7% (from 16 mm to 19.8 mm) [p<.001]. In conclusion, there was a significant increase between 1990-91 and 1997-98 in the prevalence of obesity in children of Cyprus which was more pronounced in the urban areas and is related with increased risk of atherosclerosis. The TST is more sensitive than the BMI for monitoring obesity in children.

Key words: obesity, children, Cyprus.

EÈÛ·ÁˆÁ‹ H ·¯˘Û·ÚΛ· ÛÙ· ·È‰È¿ ¤¯ÂÈ Û˘Ó‰Âı› Ì ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, „˘¯ÔÏÔÁÈο Î·È ÛˆÌ·ÙÈο Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·¯˘Û·ÚΛ· ÙˆÓ ÂÓËÏ›ÎˆÓ (1-3). T· „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· fiˆ˜ Ë ÌÂȈ̤ÓË ·˘ÙÔÂÎÙ›ÌËÛË, Ë ÎÔÈÓˆÓÈ΋ ·ÔÌfiÓˆÛË Î·È Ë ‰˘ÛÎÔÏ›· ÔÈÎÔÁÂÓÂȷ΋˜ ·ÔηٿÛÙ·Û˘ ÙˆÓ Ó·ÚÒÓ Á˘Ó·ÈÎÒÓ Â›Ó·È Û˘¯Ó‹. ¶ÚÔηÏ› ÚÒÈÌË ˆÚ›Ì·ÓÛË Ì ÂÈÙ¿¯˘ÓÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜, ÙÔ˘ ‡„Ô˘˜ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÂÌÌ‹ÓÔ˘ Ú‡Û˘ Ì ¿ÁÓˆÛÙ˜ ̤¯ÚÈ Û‹ÌÂÚ· Û˘Ó¤ÂȘ. OÈ ÏÈÔÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ·ıËÚÔÛÎÏ‹ÚˆÛË [¯ÔÏËÛÙÂÚfiÏË ¯·ÌËÏ‹˜ (LDLC), ÂӉȿÌÂÛ˘ Î·È Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜] Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG) ·˘Í¿ÓÔÓÙ·È, ÂÓÒ Ë ÚÔÛٷ٢ÙÈ΋ ¯ÔÏËÛÙÂÚfiÏË ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (HDL-C) ÌÂÈÒÓÂÙ·È. Y¿Ú¯ÂÈ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ì ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. E›Û˘ Ë ¯ÔÏÔÏÈı›·ÛË, Ë ÏÈ҉˘ ‰È‹ıËÛË ÙÔ˘ ‹·ÙÔ˜, ÔÈ ÔÏ˘Î˘ÛÙÈΤ˜ ˆÔı‹Î˜, Ë ˘¤ÚÙ·ÛË, Ë Ó˘¯ÙÂÚÈÓ‹ ¿ÓÔÈ· Î·È ÔÈ ÔÚıÔ‰ÈΤ˜ ÂÈÏÔΤ˜ ‰ÂÓ Â›Ó·È Û¿ÓȘ. ŸÛÔ ÈÔ ÌÂÁ¿ÏË Â›Ó·È Ë ËÏÈΛ· ÙÔ˘ ·¯‡Û·ÚÎÔ˘ ·È‰ÈÔ‡, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë Èı·ÓfiÙËÙ· Ó· ·Ú·Ì›ÓÂÈ ·¯‡Û·ÚÎÔ˜ Û·Ó ÂÓ‹ÏÈη˜ Ì fiϘ ÙȘ ÛÔ‚·Ú¤˜ Û˘Ó¤ÂȘ. ™Ù· ·ÁfiÚÈ· ËÏÈΛ·˜ 9-11 ¯ÚfiÓˆÓ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È 32% Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ›‰È·˜ ËÏÈΛ·˜ 41% (4). ¶·Ú¿ Ù· ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ÚÔηÏ› Ë ·¯˘Û·ÚΛ·, Û ÔÏϤ˜ ¯ÒÚ˜ ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ Î·È Ù˘ ÌÂȈ̤Ó˘ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Ô˘ Û˘Ì‚·›ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (4-10) . ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË Ì·˜ ÛÙËÓ E·Ú¯›· ¶¿ÊÔ˘ ÚÈÓ ·fi 7,5 ¯ÚfiÓÈ· (1990-91), ›¯·Ì ˘ÔÏÔÁ›ÛÂÈ ÙËÓ ·¯˘Û·ÚΛ· Û ·È‰È¿ ËÏÈΛ·˜ 6-11 ¯ÚfiÓˆÓ Ì ÙȘ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ÙÚÈÎÂÊ¿ÏÔ˘ (¢¶T) Î·È ˆÌÔ-

138

™˘ÓÙÔÌÔÁڷʛ˜: B™ ¢M™ ¢¶ ¢¶T E£ HDL-C IK LDL- C M™ MT ¶TA ™A TC TG

B¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¢ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ EηÙÔÛÙÈ·›· ı¤ÛË XÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ IÛ¯·ÈÌÈ΋ ηډÈÔ¿ıÂÈ· XÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ M‹ÎÔ˜ ÛÒÌ·ÙÔ˜ M¤ÛË ÙÈÌ‹ ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ™Ù·ıÂÚ‹ ·fiÎÏÈÛË OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË TÚÈÁÏ˘ÎÂÚ›‰È·

Ï¿Ù˘ (11). Afi ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÛÙËÓ K‡ÚÔ (1995-1998) Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜ (12-14). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ÌÂϤÙË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ 11-12 ÂÙÒÓ ÛÙËÓ K‡ÚÔ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ¢M™ Î·È ÙË ¢¶T, Ë Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ Â·Ú¯ÈÒÓ, ÌÂٷ͇ ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Î·È Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ¢¶T ÛÙËÓ ¶¿ÊÔ.

YÏÈÎfi-M¤ıÔ‰ÔÈ MÂÏÂÙ‹ıËÎ·Ó 8.614 ·È‰È¿ (4.446 ·ÁfiÚÈ·, 4.168 ÎÔÚ›ÙÛÈ·), ·ÛÙÈÎÒÓ (4.533) Î·È ·ÁÚÔÙÈÎÒÓ (4.081) ÂÚÈÔ¯ÒÓ Ù˘ ÂχıÂÚ˘ K‡ÚÔ˘, ËÏÈΛ·˜ 11-12 ÂÙÒÓ Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· ¢ËÌÔÙÈο ™¯ÔÏ›· ·fi OÎÙÒ‚ÚÈÔ 1997 ̤¯ÚÈ IÔ‡ÓÈÔ 1998, ÛÙ· Ï·›ÛÈ· ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡" (¶›Ó·Î·˜ 1). TÔ ¶ÚfiÁÚ·ÌÌ· "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡" Á›ÓÂÙ·È ·fi ÔÌ¿‰·

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¶·¯˘Û·ÚΛ· ÛÙ· ·È‰È¿ ÛÙËÓ ∫‡ÚÔ

¶›Ó·Î·˜ 1. ¶ÂÚÈÁÚ·Ê‹ ‰Â›ÁÌ·ÙÔ˜.

AÁfiÚÈ·

AÛÙÈΤ˜

AÁÚÔÙÈΤ˜

KÔÚ›ÙÛÈ·

AÛÙÈΤ˜

AÁÚÔÙÈΤ˜

™‡ÓÔÏÔ

§Â˘ÎˆÛ›· §ÂÌÂÛfi˜ §¿Úӷη ¶¿ÊÔ˜ AÌÌfi¯ˆÛÙÔ˜

1439 1264 939 517 287

762 823 445 282 -

677 441 494 235 287

1330 1282 873 463 220

705 832 412 272 -

625 450 461 191 220

2769 2546 1812 980 507

™‡ÓÔÏÔ

4446

2312

2134

4168

2221

1947

8614

ÂÈÛÙËÌfiÓˆÓ, ˘fi ÙËÓ ·ÈÁ›‰· ÙˆÓ YÔ˘ÚÁ›ˆÓ YÁ›·˜ Î·È ¶·È‰Â›·˜ Ù˘ K‡ÚÔ˘, Ì ¯ÚËÌ·ÙÔ‰fiÙËÛË ·fi ÙË §·˚΋ TÚ¿Â˙· K‡ÚÔ˘ Î·È Î·ıÔ‰‹ÁËÛË ·fi ÙËÓ KÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ I·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ KÚ‹Ù˘. TÔ ¶ÚfiÁÚ·ÌÌ· ·ÓȯÓ‡ÂÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· Î·È ÌÂÚÈΤ˜ ÌÔÚʤ˜ ηÚΛÓÔ˘ Û fiÏ· Ù· ·È‰È¿ Ù˘ ™T' Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Ù˘ ÂχıÂÚ˘ K‡ÚÔ˘ Î·È Û ‰Â›ÁÌ· Ì·ıËÙÒÓ Û °˘ÌÓ¿ÛÈ· Î·È §‡ÎÂÈ·. °›ÓÂÙ·È ÌÂÙ¿ ·fi ÁÚ·Ù‹ ÂÓË̤ڈÛË Î·È Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ·ÚÂÌ‚·›ÓÂÈ Ì ·ÙÔÌÈΤ˜ Î·È ÁÂÓÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÚfiÏË„Ë ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ. ™Â fiÏË ÙË Û¯ÔÏÈ΋ ¯ÚÔÓÈ¿ 1997-98 ›¯·Ó ÂÍÂÙ·ÛÙ› 8.950 ·È‰È¿ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 10.550 Ì·ıËÙÒÓ Ù˘ ™T' Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Ù˘ K‡ÚÔ˘ (84,8%). H ÂÚÈÔ¯‹ ™ÙÚÔ‚fiÏÔ˘ §Â˘ÎˆÛ›·˜ (850 ·È‰È¿) ‰ÂÓ ÂÍÂÙ¿ÛÙËÎÂ, ÂÔ̤ӈ˜ Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó 92,2%. ™˘ÌÂÚÈÏ‹ÊıËÎ·Ó 8.614 ·È‰È¿ (81,6%) Ù· ÔÔ›· ›¯·Ó ÂÍÂÙ·ÛÙ› Î·È ‹Ù·Ó ËÏÈΛ·˜ 11-12 ÂÙÒÓ.

AÓıÚˆÔÌÂÙÚÈο ‰Â‰Ô̤ӷ TÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËΠ̠ÊÔÚËÙ‹ ˙˘Á·ÚÈ¿ Seca ·ÎÚȂ›·˜ ±0,5 Kg Ì ٷ ·È‰È¿ ÓÙ˘Ì¤Ó· ÂÏ·ÊÚ¿. TÔ ‡„Ô˜ ÌÂÙÚ‹ıËΠ۠fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ· Ì ·Ó·ÛÙËÌfiÌÂÙÚÔ ÙÔ›¯Ô˘. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢M™) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ‡„Ô˜ (B™/M™2) Û kg/m2. H ¢¶T ¿ÚıËΠ̠Ù˘¯fiÌÂÙÚÔ Ù‡Ô˘ Jamar ·ÎÚȂ›·˜ ±0,5 mm ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÙÔ˘ ·ÎÚˆÌ›Ô˘ Î·È ÙÔ˘ ˆÏÂÎÚ¿ÓÔ˘ ÛÙËÓ Ô›ÛıÈ· ÂÈÊ¿ÓÂÈ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ· (15). ŒÏÂÁ¯Ô˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ O ¤ÏÂÁ¯Ô˜ Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÁÈÓfiÙ·Ó ·fi ηıËÁËÙ‹ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ Ì 4 ·fi ÙȘ 5 ‰ÔÎÈ̷ۛ˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÚˆÙfiÎÔÏÏÔ EUROFIT (16,17): ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÌÂÙÚ‹ÛÂȘ ·fi ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶TA), ÙÔ ÔÔ›Ô ıˆÚÂ›Ù·È Î·Ïfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ¤ÌÌÂÛË Ì¤ÙÚËÛË Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜.

OÈ Ì·ıËÙ¤˜ ¯ˆÚ›˙ÔÓÙ·È Û ÌÈÎÚ¤˜ ÔÌ¿‰Â˜ 4-5 ·ÙfïÓ, Î·È Î·ÏÔ‡ÓÙ·È Ó· ‰È·Ó‡ÛÔ˘Ó, fiÛ˜ ÈÔ ÔÏϤ˜

ÊÔÚ¤˜ ÌÔÚÔ‡Ó, ÌÈ· ·fiÛÙ·ÛË 20 ̤ÙÚˆÓ ÌÂٷ͇ ‰‡Ô ÁÚ·ÌÌÒÓ. H Ù·¯‡ÙËÙ· Ì ÙËÓ ÔÔ›· ÎÈÓÔ‡ÓÙ·È ÌÂٷ͇ ÙˆÓ ‰‡Ô ÁÚ·ÌÌÒÓ Î·ıÔÚ›˙ÂÙ·È ·fi ¤Ó· Ì·ÁÓËÙÔʈÓË̤ÓÔ Ë¯ËÙÈÎfi Û‹Ì· Ô˘ Á›ÓÂÙ·È ÛÙ·‰È·Î¿ fiÏÔ Î·È ÈÔ ÁÚ‹ÁÔÚÔ Î·È ÙÔ ÔÔ›Ô Â›Û˘ ηıÔÚ›˙ÂÈ ÙÔ ÛÙ¿‰ÈÔ ÛÙÔ ÔÔ›Ô Î·Ù·Ê¤ÚÓÂÈ Ó· ÊÙ¿ÛÂÈ Ô Î¿ı ̷ıËÙ‹˜.

EÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ OÈ ·ÈÌÔÏË„›Â˜ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÓËÛÙ›· 12 ˆÚÒÓ.

Afi οı ̷ıËÙ‹ ÂÏ‹ÊıËÛ·Ó 5 ml ·›Ì·ÙÔ˜ ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È 3-5 ml Ì EDTA ÁÈ· ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ. T· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÁÈ· ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÙÔÔıÂÙÔ‡ÓÙ·Ó Û ÊÔÚËÙfi „˘ÁÂ›Ô Ì ·ÁÔ·ÛÙ˜ Î·È ÌÂٷʤÚÔÓÙ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ °ÂÓÈÎÔ‡ NÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ̤۷ Û 2-3 ÒÚ˜. OÈ ÂÍÂÙ¿ÛÂȘ Á›ÓÔÓÙ·Ó Ì ·Ó·Ï˘Ù‹ HITACHI 717 Ù˘ Boehringer Mannheim ›Ù ÙËÓ ›‰È· Ë̤ڷ, ›Ù ÙËÓ ÂÔ̤ÓË ÔfiÙÂ Ô ÔÚfi˜ Ê˘Ï·ÁfiÙ·Ó ÛÙËÓ Î·Ù¿„˘ÍË (-20ÆC). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ TC Î·È ÙˆÓ TG Á›ÓÔÓÙ·Ó Ì ÂÓ˙˘ÌÈ΋ ¯ÚˆÌ·ÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô (18,19) Î·È Ù˘ HDL-C Ì ¿ÌÂÛË Ì¤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÏ˘ÌÂÚ‹ (20). H LDLC ˘ÔÏÔÁÈ˙fiÙ·Ó ·fi ÙÔ Ù‡Ô: LDL-C=TC+(HDL-CTG/5) (21).

TÔ ÂÚÁ·ÛÙ‹ÚÈÔ ¤¯ÂÈ ÙfiÛÔ ÂÛˆÙÂÚÈÎfi (beringer, local), fiÛÔ Î·È Â͈ÙÂÚÈÎfi ¤ÏÂÁ¯Ô ÔÈfiÙËÙ·˜ Ì ÚÔÙ˘ÔÔ›ËÛË Ù˘ Murex, ÙÔ˘ International EQAS, WHO Î·È ÙÔ˘ E™EA¶ (EıÓÈÎfi ™‡ÛÙËÌ· E͈ÙÂÚÈ΋˜ AÍÈÔÏfiÁËÛ˘ ¶ÔÈfiÙËÙ·˜ ∞ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙËÓ ÎÏÈÓÈ΋ ¯ËÌ›·, E˘·ÁÁÂÏÈÛÌfi˜, Aı‹Ó·). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ŸÏ· Ù· ÛÙÔȯ›· ÙˆÓ ·È‰ÈÒÓ Ì˯·ÓÔÁÚ·Ê‹ıËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· Epi Info 6 (CDC USA, WHO) Î·È ÌÂٷʤÚıËÎ·Ó ÁÈ· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÛÙ· ÚÔÁÚ¿ÌÌ·Ù· Excel Î·È SPSS. YÔÏÔÁ›ÛÙËÎ·Ó ÔÈ Ì¤Û˜ ÙÈ̤˜ (MT) Î·È Ë Û˘¯ÓfiÙËÙ· ·¯˘Û·ÚΛ·˜ (>95Ë E£) Î·È ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·¯˘Û·ÚΛ· (>85Ë E£) Ì ÙÔ ¢M™ Î·È Ì ÙË ¢¶T ÛÙȘ Â·Ú¯›Â˜ Î·È ·ÛÙÈΤ˜-·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜, ͯˆÚÈÛÙ¿ ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Î·È ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ MT Ì ÙË ‰ÔÎÈÌ·Û›· One way ANOVA.

139

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°. KÔ˘Ú›‰Ë˜ Î·È Û˘Ó.

EÂȉ‹ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ¢M™ Î·È ¢¶T ÛÙȘ ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜, ÚÔ¯ˆÚ‹Û·Ì Û ۇÁÎÚÈÛË ·˘ÙÒÓ Ì ÙÔ ¶TA Î·È ÙËÓ LDL-C Î·È ˘ÔÏÔÁÈÛÌfi ÙˆÓ ÌÂٷ͇ ÙÔ˘˜ Û˘ÓÙÂÏÂÛÙÒÓ Û˘Û¯¤ÙÈÛ˘ (Pearson Correlation). °È· Ù· ·È‰È¿ ËÏÈΛ·˜ 11 ¯ÚfiÓˆÓ ÛÙ· ÔÔ›· ˘¿Ú¯Ô˘Ó ÌÂÙÚ‹ÛÂȘ Ù˘ ¢¶T, ÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û· fiÛÔ Î·È Û ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË (11), Á›ÓÂÙ·È Û‡ÁÎÚÈÛË ÙˆÓ MT Ì ÙË ‰ÔÎÈÌ·Û›· Student's t-test.

AÔÙÂϤÛÌ·Ù· H ̤ÛË ÙÈÌ‹ (MT) ÙÔ˘ ¢M™ ‹Ù·Ó ›‰È· Û fiϘ ÙȘ ÂÚÈÔ¯¤˜ ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (18,9 kg/m2 ̤¯ÚÈ 19,6 kg/m2) (¶›Ó·Î·˜ 2), ·ÏÏ¿ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙË MT Ù˘ ¢¶T (¶›Ó·Î·˜ 3). ™Ù· ·ÁfiÚÈ· ‹Ù·Ó ¯·ÌËÏ‹ ÛÙȘ Â·Ú¯›Â˜ §Â˘ÎˆÛ›·˜

(17,2 mm), §¿Úӷη˜ (17,6 mm) Î·È ¶¿ÊÔ˘ (18,5 mm) Î·È ·˘ÍË̤ÓË ÛÙË §ÂÌÂÛfi (19,6 mm), [p<0,001], Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ¯·ÌËÏ‹ Û §Â˘ÎˆÛ›· (18,1 mm) Î·È §¿Úӷη (18,6 mm) Î·È ·˘ÍË̤ÓË Û ¶¿ÊÔ (20,1mm) Î·È §ÂÌÂÛfi (20,5mm), [p<0,001]. ™ÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó ¯·ÌËÏ‹ Û fiϘ ÙȘ Â·Ú¯›Â˜ Ì ÂÍ·›ÚÂÛË ÙËÓ ¶¿ÊÔ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Î·È ÙË §ÂÌÂÛfi ÛÙ· ÎÔÚ›ÙÛÈ·. ™ÙȘ ÂχıÂÚ˜ ÂÚÈÔ¯¤˜ AÌÌÔ¯ÒÛÙÔ˘ ‚Ú¤ıËÎ·Ó ÔÈ ÈÔ ¯·ÌËϤ˜ ÙÈ̤˜ (15,2 mm Û ·ÁfiÚÈ· Î·È 15,5 mm Û ÎÔÚ›ÙÛÈ·). ¶·Á·ÚÈ· ÛÙ· ·ÁfiÚÈ·, Ë ¢¶T ÛÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó 16,9 mm Î·È ÛÙȘ ·ÛÙÈΤ˜ 19 mm (p<0,001) Î·È ÛÙ· ÎÔÚ›ÙÛÈ· 18 mm Î·È 19,9 mm ·ÓÙ›ÛÙÔȯ· (p<0,001) OÈ ¯·ÌËϤ˜ ÙÈ̤˜ ¢¶T ÛÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Û˘Ó‰˘¿ÛÙËÎ·Ó Ì ηχÙÂÚË

¶›Ó·Î·˜ 2. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ ÛÙ· ·ÁfiÚÈ·. ¢M™ (MT±™A) (kg/m2) §Â˘ÎˆÛ›· §ÂÌÂÛfi˜ §¿Úӷη ¶¿ÊÔ˜ AÌÌfi¯ˆÛÙÔ˜

AÛÙÈΤ˜ 19,4±3,6 19,2±3,7 19,1±3,7 19,0±3,6 -

AÁÚÔÙÈΤ˜ 18,9±3,5 19,1±3,6 19,6±3,6 18,9±3,8 19,4±3,7

¢¶T (MT±™A) (mm) ™‡ÓÔÏÔ* 19,2±3,6 19,2±3,6 19,4±3,7 19,0±3,6 19,4±3,7

AÛÙÈΤ˜ 18,4±7,7 20,1±7,6 18,9±7,7 18,2±8,0 -

AÁÚÔÙÈΤ˜ 16,0±7,0 18,6±7,3 16,5±6,5 18,8±8,0 15,2±6,3

™‡ÓÔÏÔ** 17,2±7,3 19,6±7,5 17,6±7,1 18,5±8,0 15,2±6,3

* p =0,245, ** p <0,001

¶›Ó·Î·˜ 3. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ ÛÙ· ÎÔÚ›ÙÛÈ·. ¢M™ (MT±™A) (kg/m2) §Â˘ÎˆÛ›· §ÂÌÂÛfi˜ §¿Úӷη ¶¿ÊÔ˜ AÌÌfi¯ˆÛÙÔ˜

AÛÙÈΤ˜ 19,2±3,6 19,2±3,6 19,1±3,4 19,0±3,5 -

AÁÚÔÙÈΤ˜ 19,1±3,5 19,2±3,3 19,5±3,6 18,9±3,7 19,0±3,5

¢¶T (MT±™A) (mm) ™‡ÓÔÏÔ* 19,2±3,6 19,2±3,5 19,3±3,5 19,0±3,6 19,0±3,5

AÛÙÈΤ˜ 18,8±6,6 20,8±6,9 20,0±6,7 20,3±7,0 -

AÁÚÔÙÈΤ˜ 17,3±6,5 20,1±6,3 17,4±5,5 19,9±7,6 15,5±5,0

™‡ÓÔÏÔ** 18,1±6,5 20,5±6,7 18,6±6,2 20,1±7,2 15,5±5,0

* p =0,469, ** p <0,001

¶›Ó·Î·˜ 4. ™‡ÁÎÚÈÛË ÌÂٷ͇ ·ÛÙÈÎÒÓ-·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ (MT±™A).

AÁfiÚÈ·

KÔÚ›ÙÛÈ·

140

AÛÙÈΤ˜ AÁÚÔÙÈΤ˜ p AÛÙÈΤ˜ AÁÚÔÙÈΤ˜ p

¢M™

¢¶T

¶TA

LDL-C

(kg/m2) 19,2±3,6 19,2±3,6 0,644 19,2±3,6 19,2±3,5 0,885

(mm) 19,0±7,6 16,9±7,1 <0,001 19,9±6,8 18,0±6,2 <0,001

(ÛÙ¿‰È·) 4,4±1,7 4,8±1,7 <0,001 3,3±1,3 3,5±1,3 <0,001

(mg/dl) 106,6±28,0 102,4±27,2 <0,001 103,6±25,9 99,2±25,2 <0,001

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¶·¯˘Û·ÚΛ· ÛÙ· ·È‰È¿ ÛÙËÓ ∫‡ÚÔ

¢ª™: ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¢¶∆: ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘, ¶∆∞: ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, LDL-C: ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ

¢ª™: ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¢¶∆: ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘, ¶∆∞: ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, LDL-C: ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ

™¯‹Ì· 1. ™‡ÁÎÚÈÛË ÌÂٷ͇ ·ÛÙÈÎÒÓ-·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÛÙ· ·ÁfiÚÈ·.

™¯‹Ì· 2. ™‡ÁÎÚÈÛË ÌÂٷ͇ ·ÛÙÈÎÒÓ-·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÛÙ· ÎÔÚ›ÙÛÈ·.

Â›‰ÔÛË ÛÙÔ ¶TA (·ÁfiÚÈ· 4,8 v 4,4 ÛÙ¿‰È·, ÎÔÚ›ÙÛÈ· 3,5 v 3,3 ÛÙ¿‰È·), [p<0,001], Î·È ÂÏ·Ùو̤ÓË LDL-C (·ÁfiÚÈ· 102,4 v 106,6 mg/dl, ÎÔÚ›ÙÛÈ· 99,2 v 103,6 mg/dl), [p<.001] (¶›Ó·Î·˜ 4, ™¯‹Ì·Ù· 1 Î·È 2). °ÂÓÈο, Ë Û˘Û¯¤ÙÈÛË Ù˘ ¢¶T Ì ¶TA Î·È LDL-C ‹Ù·Ó ηχÙÂÚË ·Ú¿ ÙÔ˘ ¢M™ (¶›Ó·Î·˜ 5). O Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ¢M™ Î·È ¢¶T ‹Ù·Ó 0,854 ÁÈ· Ù· ·ÁfiÚÈ· Î·È 0,825 ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ™ÙÔÓ ›Ó·Î· 6 ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÙÔ˘ ¢M™ Î·È Ù˘ ¢¶T Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 11-12 ¯ÚfiÓˆÓ fiˆ˜ ÚÔ·ÙÔ˘Ó ·fi ÙÔ ‰Â›ÁÌ· Ì·˜. T· ÔÛÔÛÙ¿ ÙˆÓ ·È‰ÈÒÓ Ì ·˘ÍË̤ÓÔ

¢M™ ‹ ·˘ÍË̤ÓË ¢¶T Ì ‚¿ÛË ÙËÓ 85Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (E£) ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 7. Y¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ Î·È ·Ó¿ÏÔÁ· Ì ÙË Ì¤ıÔ‰Ô Ì¤ÙÚËÛ˘. ™Ù· ·ÁfiÚÈ· ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Ì ÙÔ ¢M™ Â›Ó·È 12,4%-16,6% Î·È Ì ÙË ¢¶T 15,3%-21,7%, Î·È ÛÙȘ ·ÁÚÔÙÈΤ˜ 11,9%18,2% Î·È 6,3%-17,1% ·ÓÙ›ÛÙÔȯ·. ™Ù· ÎÔÚ›ÙÛÈ· ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Ì ÙÔ ¢M™ Â›Ó·È 13,3%-16,7% Î·È Ì ÙË ¢¶T 14,4%-20,2%, Î·È ÛÙȘ ·ÁÚÔÙÈΤ˜ 10,9%17,1% Î·È 6,3%-20,1% ·ÓÙ›ÛÙÔȯ·.

M ‚¿ÛË ÙËÓ 95Ë E£ ·fi Ù· ÛÙÔȯ›· ÙÔ˘ AÈ‚¿˙Ë ÛÙË £ÂÛÛ·ÏÔÓ›ÎË (22), ÚÔ·ÙÔ˘Ó ÔÛÔÛÙ¿

¶›Ó·Î·˜ 5. ™˘Û¯¤ÙÈÛË (Pearson Correlation) ¢Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ¢ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÙÚÈÎÂÊ¿ÏÔ˘ Ì ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ Î·È XÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ. ¢M™ AÁfiÚÈ· KÔÚ›ÙÛÈ·

¶TA LDL-C ¶TA LDL-C

¢¶T

-0,536* 0,172* -0,390* 0,017

P**

-0,571* 0,205* -0,424* 0,077*

0,023 0,117 0,073 0,008

* ™˘Û¯¤ÙÈÛË ÛËÌ·ÓÙÈ΋ ÛÙÔ Â›Â‰Ô p<0,001 ** ™‡ÁÎÚÈÛË Û˘ÓÙÂÏÂÛÙÒÓ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ¢M™ Î·È ¶TA

¶›Ó·Î·˜ 6. EηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ¢Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ¢ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÙÚÈÎÂÊ¿ÏÔ˘.

AÁfiÚÈ· KÔÚ›ÙÛÈ·

2

¢M™ (kg/m ) ¢¶T (mm) ¢M™ (kg/m2) ¢¶T (mm)

5Ë

15Ë

25Ë

50Ë

75Ë

85Ë

95Ë

14,8 8 14,7 10

15,9 10 15,8 12

16,6 12 16,6 14

18,3 17 18,5 18

21,1 22 21,2 23

23,1 26 22,9 26

26,4 32 26,1 32

141

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°. KÔ˘Ú›‰Ë˜ Î·È Û˘Ó.

¶›Ó·Î·˜ 7. ¶ÔÛÔÛÙ¿ ·È‰ÈÒÓ Ì ·˘ÍË̤ÓÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ‹ ·˘ÍË̤ÓË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ (¢M™ ‹ ¢¶T>85Ë E£).

AÁfiÚÈ·

§Â˘ÎˆÛ›· §ÂÌÂÛfi˜ §¿Úӷη ¶¿ÊÔ˜ AÌÌfi¯ˆÛÙÔ˜

KÔÚ›ÙÛÈ·

¢M™ >85Ë E£

¢¶T >85Ë E£

¢M™ >85Ë E£

¢¶T >85Ë E£

AÛÙÈΤ˜ 15,5% 16,6% 16,4% 12,4% -

AÛÙÈΤ˜ 15,3% 21,7% 15,3% 16,7% -

AÛÙÈΤ˜ 16,7% 14,7% 13,3% 13,6% -

AÛÙÈΤ˜ 14,4% 20,2% 14,4% 17,6% -

AÁÚÔÙÈΤ˜ 12,4% 13,1% 18,2% 11,9% 16,0%

AÁÚÔÙÈΤ˜ 8,0% 16,8% 8,9% 17,1% 6,3%

AÁÚÔÙÈΤ˜ 13,9% 14,2% 17,1% 13,6% 10,9%

AÁÚÔÙÈΤ˜ 8,8% 15,1% 7,2% 20,1% 6,3%

¶›Ó·Î·˜ 8. ¶ÔÛÔÛÙ¿ ·¯˘Û·ÚΛ·˜ (¢M™ ‹ ¢¶T>95Ë E£, AÈ‚¿˙˘ 1990).

AÁfiÚÈ·

11 ¯ÚfiÓˆÓ 12 ¯ÚfiÓˆÓ

KÔÚ›ÙÛÈ·

¢M™ >95Ë E£

¢¶T >95Ë E£

¢M™ >95Ë E£

¢¶T >95Ë E£

15,6% 12,1%

16,2% 18,0%

11,9% 8,2%

13,2% 15,5%

¶›Ó·Î·˜ 9. ™‡ÁÎÚÈÛË ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÙÚÈÎÂÊ¿ÏÔ˘ Û ·È‰È¿ ËÏÈΛ·˜ 11 ÂÙÒÓ, Ì ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ ÛÙËÓ ¶¿ÊÔ ÚÈÓ 7,5 ¯ÚfiÓÈ·.

1990-91 AÁfiÚÈ· KÔÚ›ÙÛÈ·

N 219 175

1998 MT±™A (mm) 14,4±6,3 16,0±5,8

·¯˘Û·ÚΛ·˜ 12,1%-18% ÛÙ· ·ÁfiÚÈ· Î·È 8,2%-15,5% ÛÙ· ÎÔÚ›ÙÛÈ· (¶›Ó·Î·˜ 8). ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙË ¢¶T Û ·È‰È¿ ËÏÈΛ·˜ 11 ÂÙÒÓ ÛÙËÓ ¶¿ÊÔ, Ì ÌÂÙÚ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó ÚÈÓ ·fi 7,5 ¯ÚfiÓÈ· (1990-91), ÚÔ·ÙÂÈ ÙÂÚ¿ÛÙÈ· ·‡ÍËÛË. ™˘ÁÎÂÎÚÈ̤ӷ Ù· ·ÁfiÚÈ· ›¯·Ó ·˘ÍË̤ÓË ÙË ¢¶T ηٿ 26,4% (·fi 14,4 mm Û 18,2 mm) Î·È Ù· ÎÔÚ›ÙÛÈ· ηٿ 23,7% (·fi 16 mm Û 19,8 mm) [p<0,001] (¶›Ó·Î·˜ 9). ™˘˙‹ÙËÛË H ·¯˘Û·ÚΛ· ÛÙËÓ K‡ÚÔ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi È·ÙÚÈÎfi Î·È ÎÔÈÓˆÓÈÎfi Úfi‚ÏËÌ· ·ÊÔ‡ ÚÔÛ‚¿ÏÏÂÈ 10%-20% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 11-12 ÂÙÒÓ, ÔÏÏ¿ ·fi Ù· ÔÔ›· ı· Û˘Ó¯›ÛÔ˘Ó Û·Ó ÂÓ‹ÏÈΘ ·¯‡Û·ÚÎÔÈ Ì fiϘ ÙȘ ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ. AÎfiÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Â›Ó·È ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ˘¤Ú‚·ÚˆÓ (>85Ë E£) Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÍÂÏȯıÔ‡Ó Û ·¯‡Û·ÚÎÔ˘˜. Ÿˆ˜ ·ԉ›ͷÌÂ Ë ·¯˘Û·ÚΛ· ¤¯ÂÈ ·˘ÍËı› Ôχ Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ·, Èı·ÓfiÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ (14), ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙË ‚Ï·ÙÈ΋ Â›‰Ú·ÛË ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÔÚÁ·ÓÈÛÌfi

142

N 253 236

MT±™A (mm) 18,2±3,6 19,8±3,6

A‡ÍËÛË

p

26,4% 23,7%

<0,001 <0,001

ÙˆÓ ·È‰ÈÒÓ. TÔ Úfi‚ÏËÌ· ·˘Ùfi Ê˘ÛÈο ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÙËÓ K‡ÚÔ ·ÏÏ¿ fiϘ ۯ‰fiÓ ÙȘ ·Ó·Ù˘Á̤Ó˜ Î·È ÔÏϤ˜ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ (4-10).

T· ·›ÙÈ· Ù˘ ·‡ÍËÛ˘ ·˘Ù‹˜ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó ÛÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÏÔ‡ÛÈ· ‰È·ÙÚÔÊ‹ Î·È ÂÏ¿¯ÈÛÙË ¿ÛÎËÛË. T· ·È‰È¿ ηٷӷÏÒÓÔ˘Ó ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·fi ¤ÙÔÈ̘ ÙÚÔʤ˜ ÏÔ‡ÛȘ Û ϛË Î·È ıÂÚÌ›‰Â˜ fiˆ˜ ÛÔÎÔÏ¿Ù˜, ·ÁˆÙ¿, Á·Úȉ¿ÎÈ·, ÙÛÈ˜, ›ÙÛ˜ Î·È ÎÚ·ÙÈο Î·È ·ÛÎÔ‡ÓÙ·È Ôχ Ï›ÁÔ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ¢Ú›·˜ ¯Ú‹Û˘ ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘ ÛÙȘ ÌÂÙ·ÎÈÓ‹ÛÂȘ Î·È Ù˘ ηı‹ÏˆÛ˘ ÌÚÔÛÙ¿ ·fi ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· ÔÏϤ˜ ÒÚ˜. ™ÙËÓ K‡ÚÔ ÚÈÓ ·fi 10 ¯ÚfiÓÈ· ˘‹Ú¯Â ÌfiÓÔ ¤Ó· ηӿÏÈ ÙËÏÂfiÚ·Û˘ Ì ÂÚÈÔÚÈṲ̂Ó˜ ÒÚ˜ ÂÎÔÌ‹˜. ™‹ÌÂÚ· ˘¿Ú¯Ô˘Ó 10 ‹ ÂÚÈÛÛfiÙÂÚ· ηӿÏÈ· Ì ÔÏÔ‹ÌÂÚË ÂÎÔÌ‹. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË Ì·˜ Ì ·È‰È¿ ÙÔ˘ ·ÚfiÓÙÔ˜ ‰Â›ÁÌ·ÙÔ˜ ·fi ÙËÓ ¶¿ÊÔ, ›¯·Ì ‚ÚÂÈ fiÙÈ ÙÔ 32% ·Ú·ÎÔÏÔ˘ıÔ‡Û ÙËÏÂfiÚ·ÛË >28 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰· Î·È ·ԉ›ͷÌ fiÙÈ Ë ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ·¯˘Û·ÚΛ· Î·È ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (23).

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:137-144

™ÙË ÌÂϤÙË Ì·˜ ¯ÚËÛÈÌÔÔÈ‹Û·Ì ‰‡Ô ·ÓÂÍ¿ÚÙËÙ˜ ÌÂıfi‰Ô˘˜ ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ·¯˘Û·ÚΛ·˜, ÙÔ ¢M™ Î·È ÙË ¢¶T. ™˘ÁÎÚ›ÛÂȘ Î·È ÙˆÓ ‰‡Ô Ì ÙË Ì¤ıÔ‰Ô Dual energy x-ray absorptiometry (DXA) ¤‰ÂÈÍ·Ó Ôχ ηϤ˜ Û˘Û¯ÂÙ›ÛÂȘ (>0,77) ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ ÔÛÔÛÙÔ‡ Ï›Ô˘˜ ÛÙ· ·È‰È¿ (24-26).

Y¿Ú¯ÂÈ ˆÛÙfiÛÔ ‰È·ÊˆÓ›· ÁÈ· ÙÔ ÔÈ· Â›Ó·È Ë Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô˜. O ¢M™ ‰ÂÓ ÌÔÚ› Ó· ͯˆÚ›ÛÂÈ ÙÔ˘˜ ˘¤Ú‚·ÚÔ˘˜ ÏfiÁˆ ÛÎÂÏÂÙÔ‡ ‹ ·˘ÍË̤Ó˘ Ì˘˚΋˜ Ì¿˙·˜ (·ıÏËÙ¤˜), Ô‡Ù ÌÔÚ› Ó· ηıÔÚ›ÛÂÈ ÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË Ì ÙÔ ·ÚfiÓ ˘ÏÈÎfi ›¯·Ì ‚ÚÂÈ fiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ (¢M™ ≥22 kg/m2) Ù· ÔÔ›· ›¯·Ó ¯·ÌËÏ‹ ¢¶T (·ÁfiÚÈ· ≤17 mm, ÎÔÚ›ÙÛÈ· ≤18 mm) ›¯·Ó ‰˘ÛÌÂÓ¤ÛÙÂÚÔ˘˜ ‰Â›ÎÙ˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ (27). A˘Ùfi ÂÍËÁÂ›Ù·È ÁÈ·Ù› ÚÔÊ·ÓÒ˜ Ù· ·È‰È¿ ·˘Ù¿ ›¯·Ó ÎÂÓÙÚÈ΋ ηٷÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (28,29). ¢È·ÊÔÚ¤˜ ÌÂٷ͇ ¢M™ Î·È ¢¶T ‰È·ÈÛÙÒÛ·ÌÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ì ÙË ¢¶T Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Î·Ï‡ÙÂÚ· Ì ¶TA Î·È LDL-C, ·Ó Î·È ÌÂٷ͇ ÙÔ˘˜ ˘¿Ú¯ÂÈ Ôχ ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË (r=0,825-0,854). TÔ ¶TA Â›Ó·È Î·Ïfi˜ ‰Â›ÎÙ˘ Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, Ë ÔÔ›· Â›Ó·È ÂÏ·Ùو̤ÓË ÛÙËÓ ·¯˘Û·ÚΛ· Î·È Ë LDL-C Â›Ó·È ·fi ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. ¢ÂÓ Û˘ÌÂÚÈÏ¿‚·Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ·Ù› ‚·ÛÈÎfi˜ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‰ÂÓ ‹Ù·Ó ·˘Ùfi˜. OˆÛ‰‹ÔÙ fï˜, ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ı¤Ì·ÙÔ˜ ÌÂ Û˘ÌÌÂÙÔ¯‹ ·È‰ÈÒÓ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ. °È· ÙÔÓ ·ÎÚÈ‚‹ ηıÔÚÈÛÌfi Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙÔ˘ Ù‡Ô˘ Ù˘, ›Ûˆ˜ ¯ÚÂÈ¿˙ÂÙ·È Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ¢M™ Ì ÙË Ì¤ÙÚËÛË ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (¢¶) ‹ Î·È ÂÚÈ̤ÙÚˆÓ Û ‰È¿ÊÔÚ˜ ·Ó·ÙÔÌÈΤ˜ ı¤ÛÂȘ. ¶Úfi‚ÏËÌ· ˘¿Ú¯ÂÈ Î·È ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ÙÈÌÒÓ (cutoff) ÙˆÓ ¢M™ Î·È ¢¶ ÁÈ· ÙË ‰È¿ÎÚÈÛË Ù˘ ·¯˘Û·ÚΛ·˜. EÓÒ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ ¤¯Ô˘Ó ηıÔÚÈÛÙ› Û·Ê›˜ ÙÈ̤˜ ¢M™ ÁÈ· ‰È·¯ˆÚÈÛÌfi ÙˆÓ ‚·ıÌ›‰ˆÓ ·¯˘Û·ÚΛ·˜ Î·È ¤¯Ô˘Ó ÚÔÙ·ı› ·ÓÙ›ÛÙÔȯ˜ ÁÈ· ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (30), ÛÙ· ·È‰È¿ ˘¿Ú¯ÂÈ ·Û¿ÊÂÈ·. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ¯ÚËÛÈÌÔÔÈÔ‡Ó Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙÔ˘˜ ÂÊ‹‚Ô˘˜: Y¤Ú‚·Ú·, ¢M™ ≥95Ë E£ Î·È ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Ó· Á›ÓÔ˘Ó ˘¤Ú‚·Ú· ≥85Ë-95Ë E£ (8). £· Ú¤ÂÈ fï˜ Ó· ηıÔÚÈÛÙÔ‡Ó E£ ·Ó·ÊÔÚ¿˜ ·ÊÔ‡ ÔÈ E£ ÂÓfi˜ Ôχ ·¯‡Û·ÚÎÔ˘ ÏËı˘ÛÌÔ‡ ı· Â›Ó·È „ËϤ˜ Î·È ı· ˘ÔÂÎÙÈÌ‹ÛÔ˘Ó ÙÔ Úfi‚ÏËÌ·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙȘ E£ ÙˆÓ ·È‰ÈÒÓ Ù˘ £ÂÛÛ·ÏÔӛ΢, ÙˆÓ ÔÔ›ˆÓ Ë 95Ë E£ Û˘Ì›ÙÂÈ ÂÚ›Ô˘ Ì ÙË ‰È΋ Ì·˜ 85Ë E£ (22).

H ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ Ù˘ K‡ÚÔ˘ ı· Ú¤ÂÈ Ó· ¢·ÈÛıËÙÔÔÈ‹ÛÂÈ fiÏÔ˘˜ ÙÔ˘˜ ÊÔÚ›˜ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜, ΢‚ÂÚÓËÙÈÎÔ‡˜ Î·È È‰ÈˆÙÈÎÔ‡˜, ÒÛÙ ӷ ÂÈÙ·ı› Ô ·ÁÒÓ·˜ ÁÈ· ·ÏÏ·Á‹ Ù˘ ηٿÛÙ·Û˘. XÚÂÈ¿˙ÂÙ·È

¶·¯˘Û·ÚΛ· ÛÙ· ·È‰È¿ ÛÙËÓ ∫‡ÚÔ

·ÏÏ·Á‹ ÛÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ·È‰ÈÒÓ Î·È Î·Ù' Â¤ÎÙ·ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Î˘Ú›ˆ˜ Ë ·Ó‡ÚÂÛË ÙÚfiˆÓ ÂÈÛÙÚÔÊ‹˜ ÙˆÓ ·È‰ÈÒÓ ÛÙË Ê‡ÛË ÙÔ˘˜, Ô˘ Â›Ó·È Ë Î›ÓËÛË Î·È Ë ¿ÛÎËÛË. T· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ KÚ‹Ù˘ (31), ÂÓÈÛ¯‡Ô˘Ó ÙÔ ¶ÚfiÁÚ·ÌÌ· "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡" Ù˘ K‡ÚÔ˘ ÁÈ· Ó· Û˘Ó¯›ÛÂÈ ÈÔ ÂÓÙ·ÙÈο ÙËÓ ÚÔÛ¿ıÂÈ·. ™˘ÌÂÚ¿ÛÌ·Ù· Y¿Ú¯ÂÈ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙËÓ K‡ÚÔ. TÔ Úfi‚ÏËÌ· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ·ÛÙÈο ΤÓÙÚ· Î·È Û˘Ó‰˘¿˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. H ¢¶T Û˘Û¯ÂÙ›˙ÂÙ·È Î·Ï‡ÙÂÚ· Ì ¿ÏÏÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È Â›Ó·È ›Ûˆ˜ ÈÔ Â˘·›ÛıËÙË Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ ·fi fiÙÈ Ô ¢M™.

E˘¯·ÚÈÛÙÔ‡ÌÂ: TÔ YÔ˘ÚÁÂ›Ô YÁ›·˜ Î·È ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ‚ÈÔ¯ËÌÈÎÔ‡ ÂÚÁ·ÛÙËÚ›Ô˘ ÙÔ˘ °ÂÓÈÎÔ‡ NÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ÁÈ· ÙË ‰ÈÂÎÂÚ·›ˆÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ.

TÔ YÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜, ÙÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Î·È ÙÔ˘˜ ‰·ÛοÏÔ˘˜ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ ÁÈ· ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘˜.

TË §·˚΋ TÚ¿Â˙· ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡".

TÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ "YÁ›· ÙÔ˘ ¶·È‰ÈÔ‡".

T· ·È‰È¿ Ù˘ ™T' Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, Î·È fiÏÔ˘˜ fiÛÔÈ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜.

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Caprio S, Hyman LD, McCarthy S, Lange R, Bronson M, Tamborlane WV. Fat distribution and cardiovascular risk factors in obese adolescent girls: importance of the intraabdominal fat depot. Am J Clin Nutr 1996;64:12-17.

Himes JH, Dietz WH. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Am J Clin Nutr 1994;59:307-316.

K·Ê¿ÙÔ˜ A, M·ÓÈfi˜ °, X·Ù˙‹˜ X, MÔÛ¯·Ó‰Ú¤· I, M·ÏˆÌÂÓ¿ÎË E, Aı·Ó·ÛfiÔ˘ÏÔ˜ ¢, Î·È Û˘Ó. AÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ "AÁˆÁ‹ YÁ›·˜" ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ KÚ‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1998,61:483-497.

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H ¯ÚËÛÈÌfiÙËÙ· Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ ·È‰ÈÒÓ ÚÈÓ ·fi ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· M·Ú›· Z·Ú›ÊË, N›ÎÔ˜ E˘ÏÔÁÈ¿˜, M·Ú›· X·ÛÈÒÙÔ˘-BÚ›ÙÛÈÔ˘, B·Û›Ï˘ £ÂÔ‰ˆÚfiÔ˘ÏÔ˜ ● ¶ÂÚ›ÏË„Ë: H ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË, Û ÌÈÎÚ¤˜ ‰fiÛÂȘ, ˆ˜ ‹ÈÔ Î·Ù·ÛÙ·ÏÙÈÎfi ̤ÛÔ. H ¯Ú‹ÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ ·È‰ÈÒÓ ÚÈÓ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¤¯ÂÈ ÌÂÏÂÙËı› ‰ÈÂıÓÒ˜, Û ÂÚÈÔÚÈṲ̂ÓË Îϛ̷η Î·È Î˘Ú›ˆ˜ ·Ó·‰ÚÔÌÈο. XÔÚËÁ‹Û·Ì ·fi ÙÔ ÛÙfiÌ· ‹ ·fi ÙÔ ÔÚıfi ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË Û ·˘ÍË̤ÓË ‰fiÛË 50-75mg/kg (ÌÂÁ›ÛÙË ÂÊ¿·Í ‰fiÛË 2g), Û 400 ·È‰È¿ ÚÈÓ ÙËÓ ‰ÈÂÍ·ÁˆÁ‹ 400 ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ. §‹ÊıËÎ·Ó ˘fi„Ë fiϘ ÔÈ ·fiÏ˘Ù˜ Î·È ÔÈ Û¯ÂÙÈΤ˜ ·ÓÙÂӉ›ÍÂȘ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ¯ÏˆÚ¿Ï˘ Û ·˘ÍË̤ÓË ‰fiÛË. ™Â 360 ÂÚÈÙÒÛÂȘ (90,0%) Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‹Ù·Ó ¿ÚÙÈ· Î·È Û 28 (7,0%) Ù¯ÓÈο ˘Ô‚·ıÌÈṲ̂ÓË, ·ÏÏ¿ ·Ô‰ÂÎÙ‹. MfiÓÔ Û 12 ÂÚÈÙÒÛÂȘ (3,0%) ¯ÚÂÈ¿ÛıËΠÂ·Ó¿ÏË„Ë Ù˘ ÂͤٷÛ˘ ÌÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ·Ó·ÈÛıËÛ›·.

OÈ ·ÚÂÓ¤ÚÁÂȘ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ‹Ù·Ó: ¤ÌÂÙÔ˜ Û 30 ÂÚÈÙÒÛÂȘ (7,5%), ‰È¿ÚÚÔÈ· Û 4 (1,0%), ·Ú¿‰ÔÍË ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Û 2 (0,5%), ¿ÓÔÈ· Û 1 (0,3%). ¶·Ú·ÙÂٷ̤ÓË Ó¿ÚΈÛË (¤Ú·Ó ÙˆÓ 2 ˆÚÒÓ) ·Ú·ÙËÚ‹ıËΠ۠71 Â› Û˘ÓfiÏÔ˘ 245 ÂÍÂÙ¿ÛÂˆÓ (29,0%). ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÚÂÓ¤ÚÁÂȘ Ì ÙËÓ Ù·˘Ùfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ·fi ÙÔ ÛÙfiÌ· ‹ ÂÓ‰ÔÊÏ‚›ˆ˜. H ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË Û ·˘ÍË̤ÓË ‰fiÛË ÚÔηÏ› ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ηٷÛÙÔÏ‹ ÛÙ· ·È‰È¿ ÚÈÓ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·. ¶·È‰È·ÙÚÈ΋ 2000;63:145-149. §¤ÍÂȘ ÎÏÂȉȿ: ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË, ·È‰È¿, ηٷÛÙÔÏ‹, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·.

M. Zarifi, N. Evlogias, M. Hasiotou-Vritsiou, V. Theodoropoulos. The role of chloral hydrate in the sedation of children before computerized tomography. Paediatriki 2000;63:145-149. ● Abstract: The use of chloral hydrate for sedation of children before computerized tomography (CT) has been studied systematically on a limited scale and mainly retrospectively. A prospective study was conducted on the safety and efficacy of chloral hydrate administered to children at medium dose levels for sedation. Chloral hydrate in a dose of 50-75 mg/kg (max dose: 2g) was administered p.o. or per rectum to 400 children for 400 CT examinations. All absolute and relative contraindications had been taken into account. Of the CT examinations 360 (90%) were free of motion artifacts, following successful sedation and 28 examinations (7%) were less Ôptimal, but still diagnostic, so repetition was unnecessary. Only 12 examinations (3%) had to be repeated using i.v. anesthesia. Adverse reactions to the chloral hydrate were: vomiting in 30 cases (7.5%), diarrhoea in 4 (1%), hyperactivity in 2 (0.5%), and apnoea in one case (0.3%). Prolonged sedation (>2h) was observed in 71 of 245 children (29%). No side-effects were observed from the concurrent oral or i.v. administration of contrast medium. It is concluded that chloral hydrate in medium doses produces safe and effective sedation in children before CT. Key words: chloral hydrate, children, sedation, CT.

EÈÛ·ÁˆÁ‹ OÈ ÓÂfiÙÂÚ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ÚÔ¸Ôı¤ÙÔ˘Ó Ï‹ÚË ·ÎÈÓËÙÔÔ›ËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· Â›Ó·È ‰È·ÁÓˆÛÙÈΤ˜. H ÚÔ¸fiıÂÛË ·˘Ù‹ ‰‡ÛÎÔÏ· ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÛÙ· ÌÈÎÚ¿ ·È‰È¿ ¯ˆÚ›˜ ηٷ-

ÛÙÔÏ‹ ‹ Ï‹ÚË Ó¿ÚΈÛË. H ηٷÛÙÔÏ‹ ·È‰ÈÒÓ ÚÈÓ ·fi ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ·ÚfiÏË ÙË ÛËÌ·Û›· Ù˘, ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Û ¢Ú›· Îϛ̷η (1).

H ¤Ó‰ÂÈ· Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È Ë ÏËıÒÚ· ÙˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔ-

TÌ‹Ì· AÍÔÓÈÎÔ‡ Î·È M·ÁÓËÙÈÎÔ‡ TÔÌÔÁÚ¿ÊÔ˘, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ AÁ›· ™ÔÊ›·, Aı‹Ó·

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M. Z·Ú›ÊË Î·È Û˘Ó.

ÔÈÔ‡ÓÙ·È ÛÙ· ·È‰È·ÙÚÈο ÙÌ‹Ì·Ù· ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ‰ÈÂıÓÒ˜, ·ÔηχÙÔ˘Ó fiÙÈ Ë ÂÈÏÔÁ‹ ÙÔ˘ ηٷÛÙ·ÏÙÈÎÔ‡ ̤ÛÔ˘ ·ÎfiÌ· Î·È Û‹ÌÂÚ· ÛÙËÚ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÚÔÛˆÈ΋ ÂÌÂÈÚ›· Î·È ÚÔÙ›ÌËÛË, ηıÒ˜ Î·È ÛÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÙÔ˘ ÂοÛÙÔÙ ÙÌ‹Ì·ÙÔ˜ ·ÍÔÓÈÎÔ‡ ÙÔÌÔÁÚ¿ÊÔ˘, ·Ú¿ Û ÙÂÎÌËÚȈ̤ӷ ·ÔÙÂϤÛÌ·Ù· (2). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÏÂÁ¯ı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ ÛÙËÓ ·˘ÍË̤ÓË ‰fiÛË ÙˆÓ 5075mg/kg ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ ·È‰ÈÒÓ Ô˘ ÚfiÎÂÈÙ·È Ó· ˘Ô‚ÏËıÔ‡Ó Û ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·.

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË ·˘Ù‹ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó 400 ·È‰È¿, 197 ·ÁfiÚÈ· Î·È 203 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ ÂÓfi˜ ÌËÓfi˜ ˆ˜ ‰Âη¤ÓÙ ÂÙÒÓ Ô˘ ¤Ï·‚·Ó ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ÛÙÔ ÙÌ‹Ì· Ì·˜ Û ‰È¿ÛÙËÌ· ÂÓfi˜ ÂÍ·Ì‹ÓÔ˘. H ηٷÓÔÌ‹ ËÏÈÎÈÒÓ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (N=1.592) Î·È ·˘ÙÒÓ Ô˘ ‹Ú·Ó ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË (N=400) ÛÙÔ ‰È¿ÛÙËÌ· ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÂÍ·Ì‹ÓÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ Û¯‹Ì· 1.

H ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ¯ÔÚËÁ‹ıËΠ˘fi ÌÔÚÊ‹ ‰È·Ï‡Ì·ÙÔ˜ 5% Û ‰fiÛË 50-75 mg/kg (̤ÁÈÛÙË ÂÊ¿·Í ‰fiÛË 2 g), ·fi ÙÔ ÛÙfiÌ· (388 ·È‰È¿) ‹ ·fi ÙÔ ÔÚıfi (12 ·È‰È¿). ¢ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠ¿ÏÏÔ Ì¤ÛÔ Î·Ù·ÛÙÔÏ‹˜ Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË.

E›ÎÔÛÈ ÏÂÙ¿ ÚÈÓ ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÒÚ· ÂͤٷÛ˘ ÔÈ ÌÈÎÚÔ› ·ÛıÂÓ›˜ ÂÏ¿Ì‚·Ó·Ó ÌÈ· ·Ú¯È΋ ‰fiÛË (50 mg/Kg) ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘. E› ·Ô˘Û›·˜ ÛËÌ›ˆÓ ηٷÛÙÔÏ‹˜ ̤۷ ÛÙ· ÂfiÌÂÓ· ÙÚÈ¿ÓÙ· ÏÂÙ¿ ¯ÔÚËÁ›ÙÔ Û˘ÌÏËڈ̷ÙÈ΋ ‰fiÛË Ì¤¯ÚÈ Î·È 75

mg/Kg. E¿Ó ÙÔ ·È‰› ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ Â›Ó·È ˙ˆËÚfi Î·È ÌË Û˘ÓÂÚÁ¿ÛÈÌÔ ÌÂÙ¿ ·fi ÌÈ· ÒÚ· ÂÏ¿Ì‚·Ó ÙËÓ ˘fiÏÔÈË ÔÛfiÙËÙ· ̤¯ÚÈ Ó· Û˘ÌÏËÚˆı› Ë ‰fiÛË ÙˆÓ 75 mg/kg. E¿Ó ÙÔ ·È‰› ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ Â›Ó·È ˙ˆËÚfi Î·È ÌË Û˘ÓÂÚÁ¿ÛÈÌÔ ÌÂÙ¿ ·fi ÌÈ· ÒÚ·, ÂÏ¿Ì‚·Ó ÙËÓ ˘fiÏÔÈË ÔÛfiÙËÙ· ̤¯ÚÈ Ó· Û˘ÌÏËÚˆı› Ë ‰fiÛË ÙˆÓ 75 mg/Kg, ·Ó ‰ÂÓ ÙËÓ Â›¯Â ‹‰Ë Ï¿‚ÂÈ Î·È ¯ˆÚ›˜ ÔÙ¤ Ó· ˘Âڂ› ÙËÓ Ì¤ÁÈÛÙË ‰fiÛË ÙˆÓ 2 g.

T· ·È‰È¿ ·Ú¤ÌÂÓ·Ó ÓËÛÙÈο Â› ÙÚ›ˆÚÔ ÚÈÓ ÙËÓ ÂͤٷÛË, ÂÓÒ Ë Û˘ÛÙËÌ·ÙÈ΋ ÛÙ¤ÚËÛË ÙÔ˘ ‡ÓÔ˘ ‰ÂÓ ÎÚ›ıËΠ··Ú·›ÙËÙË. EÈÎÔÛȤӷ ·È‰È¿ ¤Ï·‚·Ó ÛÎÈ·ÁÚ·ÊÈ΋ Ô˘Û›· ·fi ÙÔ ÛÙfiÌ· ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ ÎÔÈÏ›·˜, ÂÓÓ¤· ·fi ·˘Ù¿ ›ÎÔÛÈ ÏÂÙ¿ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘.

EÓ‰ÔÊϤ‚È· ÛÎÈ·ÁÚ·ÊÈ΋ Ô˘Û›· ¯ÔÚËÁ‹ıËΠ۠۷ڿÓÙ· ÔÎÙÒ ·È‰È¿ ÚÈÓ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘. ™Â ÂÚ›ÙˆÛË Ï‹ÚÔ˘˜ ·ÔÙ˘¯›·˜ Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ Ë ÂͤٷÛË ÚÔÁÚ·ÌÌ·ÙÈ˙fiÙ·Ó ÂÎ Ó¤Ô˘ Ì ÂÓ‰ÔÊϤ‚È· ·Ó·ÈÛıËÛ›·.

AfiÏ˘Ù˜ ·ÓÙÂӉ›ÍÂȘ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ ‹Ù·Ó Ë ·ÚÔ˘Û›· ÛÔ‚·Ú‹˜ Ë·ÙÈ΋˜, ÓÂÊÚÈ΋˜, ηډȷ΋˜ Î·È ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Ë ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË, Ë ÔÚÊ˘Ú›· Î·È Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÊÔ˘ÚÔÛÂÌ›‰Ë˜ ÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÂÈÎÔÛÈÙ¤ÛÛÂÚȘ ÒÚ˜. K·Ó¤Ó· ·È‰› Ì ·fiÏ˘ÙË ·ÓÙ¤Ó‰ÂÈÍË ‰ÂÓ ¤Ù˘¯Â Ó· ¯ÚÂÈ·Ûı› ηٷÛÙÔÏ‹ ÚÈÓ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜.

H Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÔÈ ‰˘ÛϷۛ˜ ÚÔÛÒÔ˘ Î·È ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë ÚÔˆÚfiÙËÙ·, Ë ÌÈÎÚ‹ ËÏÈΛ· (οو ÙÔ˘ ÂÓfi˜ ÌËÓfi˜) Î·È ÙÔ ÌÈÎÚfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (<4 Kg)

AÚÈıÌfi˜ ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ

MART.-APR.2000 ÓÂÔ

1. ™‡ÓÔÏÔ ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ (¡=1592) 2. ∞ÍÔÓÈΤ˜ ÙÔÌÔÁڷʛ˜ Ì ˘‰ÚÈ΋ ¯ÏˆÚ¿ÏË (n= 400)

1-12

13-24

25-36 37-48 ∏ÏÈΛ· (Ì‹Ó˜)

49-60

60-

™¯‹Ì· 1. HÏÈÎȷ΋ ηٷÓÔÌ‹ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (¡=1592) Î·È ·˘ÙÒÓ Ô˘ ‹Ú·Ó ¯ÏˆÚ¿ÏË (n=400)

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ŒÓ˘‰ÚË ¯ÏˆÚ¿ÏË ÚÈÓ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

·ÂÙ¤ÏÂÛ·Ó Û¯ÂÙÈΤ˜ ·ÓÙÂӉ›ÍÂȘ (3,4). NÂÔÁÓ¿ ÌÈÎÚfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ÌËÓfi˜ Î·È ‚Ú¤ÊË Ì ‚¿ÚÔ˜ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 4 Kg ‰ÂÓ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË ·˘Ù‹. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ï‹Ú˘ ·ÎÈÓËÙÔÔ›ËÛË ÂÈÙ‡¯ıËΠ̠ÙË ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ÂÚÈÔÚÈÛÙÈÎÒÓ ‚ÔËıËÌ¿ÙˆÓ ‹ Ì ÙË ¯ÔÚ‹ÁËÛË ÌÈÎÚfiÙÂÚ˘ ‰fiÛ˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ (20 mg/Kg).

I·ÙÚfi˜ ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ·Ú·ÎÔÏÔ˘ıÔ‡Û ÚÔÛÂÎÙÈο Ù· ·È‰È¿ ÁÈ· ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÙfiÛÔ Î·Ù¿ ÙËÓ ÚÔÂÙÔÈÌ·Û›· (¤ÏÂÁ¯Ô˜ ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ), fiÛÔ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘ ·fi ÙÔÓ ¯ÒÚÔ ÙÔ˘ ¯ÂÈÚÈÛÙËÚ›Ô˘ (Û˘¯ÓfiÙËÙ· Î·È ‚¿ıÔ˜ ·Ó·ÓÔÒÓ, ¯ÚÒÌ· ÚÔÛÒÔ˘). ¢ÂÓ ¤ÁÈÓÂ Û˘ÛÙËÌ·ÙÈ΋ ¯Ú‹ÛË Û˘Û΢ÒÓ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈÎÔ‡ ÂϤÁ¯Ô˘. OÈ Â͈ÙÂÚÈÎÔ› ·ÛıÂÓ›˜ ·Ú¤ÌÂÓ·Ó ÛÙÔ ÙÌ‹Ì· ̤¯ÚÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÚÒÙˆÓ ÛËÌ›ˆÓ ÂÁÚ‹ÁÔÚÛ˘. A˘ÛÙËÚ‹ ··ÁfiÚ¢ÛË ¯ÔÚ‹ÁËÛ˘ ÔÔÈ·Û‰‹ÔÙ ÙÚÔÊ‹˜ ̤¯ÚÈ ÙËÓ Ï‹ÚË ·Ó¿ÎÙËÛË ÙˆÓ ·ÈÛı‹ÛÂˆÓ ‹Ù·Ó Ë Î˘ÚÈfiÙÂÚË Ô‰ËÁ›· ÂÍfi‰Ô˘. ™Â ÂȉÈÎfi ¤ÓÙ˘Ô ÁÈ· οı ·È‰› ηٷÁÚ·ÊfiÙ·Ó Ë ËÏÈΛ·, ÙÔ ‚¿ÚÔ˜, ÔÈ Ù˘¯fiÓ ·ÓÙÂӉ›ÍÂȘ, Ë ËÌÂÚÔÌËÓ›· Î·È ÙÔ Â›‰Ô˜ Ù˘ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜, Ë ÔÏÈ΋ ‰fiÛË ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘, Ô ¯ÚfiÓÔ˜ Î·È Ë Ô‰fi˜ ¯ÔÚ‹ÁËÛ˘, Ô ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Î·È Ë ‰È¿ÚÎÂÈ· Ù˘ ηٷÛÙÔÏ‹˜-Ó¿ÚΈÛ˘, Ë ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ·fi ÙÔ ÛÙfiÌ· ‹ ÂÓ‰ÔÊÏ‚›ˆ˜, Ë ‰È·ÁÓˆÛÙÈ΋ ·Í›· Ù˘ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Î·È Ù¤ÏÔ˜ ÔÈ ·ÚÂÓ¤ÚÁÂȘ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ŒÁÈÓ ÚÔÛ¿ıÂÈ· Û˘Û¯¤ÙÈÛ˘ ÙÔ˘ ¯ÚfiÓÔ˘ ¤Ó·Ú͢ Ù˘ ηٷÛÙÔÏ‹˜, Ù˘ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ Ì ÙË ‰fiÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘.

H ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂıˆÚ›ÙÔ Ù¯ÓÈο ¿ÚÙÈ· fiÙ·Ó ‰ÂÓ ˘‹Ú¯Â Ù¯ÓÈÎfi ÛÊ¿ÏÌ· ΛÓËÛ˘. H ÂͤٷÛË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó Ù¯ÓÈο ˘Ô‚·ıÌÈṲ̂ÓË, ·ÏÏ¿ ·Ô‰ÂÎÙ‹, Û ÂÚ›ÙˆÛË ··Ú·›ÙËÙ˘ Â·Ó¿Ï˄˘ 1-3 ÙÔÌÒÓ ÏfiÁˆ ‡·Ú͢ Ù¯ÓÈÎÒÓ ÛÊ·ÏÌ¿ÙˆÓ Î›ÓËÛ˘.

H Ó¿ÚΈÛË ÂıˆÚ›ÙÔ ·Ú·ÙÂٷ̤ÓË ·Ó ‰È·ÚÎÔ‡Û ¤Ú·Ó ÙˆÓ ‰‡Ô ˆÚÒÓ.

ŸÏ˜ ÔÈ ·ÍÔÓÈΤ˜ ÙÔÌÔÁڷʛ˜ ¤ÁÈÓ·Ó Û ·ÍÔÓÈÎfi ÙÔÌÔÁÚ¿ÊÔ Philips Tomoscan LX Ì ¯ÚfiÓÔ ÙÔÌ‹˜ 2,9 sec.

AÔÙÂϤÛÌ·Ù· H ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ̤¯ÚÈ Î·È 36 ÌËÓÒÓ ¯ÚÂÈ¿ÛıËΠӷ ¿ÚÂÈ ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ÚÈÓ ÙË ‰ÈÂÍ·ÁˆÁ‹ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ (Û¯‹Ì· 1). ™Â 306 ·È‰È¿ (76,5%) ¯ÔÚËÁ‹ıËΠÌfiÓÔ Ë ·Ú¯È΋ ‰fiÛË ÙˆÓ 50 mg/Kg (·' ÔÌ¿‰·). ™˘ÌÏËڈ̷ÙÈ΋ ‰fiÛË ¯ÏˆÚ¿Ï˘ ¤Ï·‚·Ó 74 ·È‰È¿ (18,5%) ÙÚÈ¿ÓÙ· ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ¯ÔÚ‹ÁËÛË (‚’ ÔÌ¿‰·) Î·È 20 ·È‰È¿ (5,0%) ÛÙ· ÂÍ‹ÓÙ· ÏÂÙ¿ (Á’ ÔÌ¿‰·).

Afi ÙËÓ ·’ ÔÌ¿‰· ·È‰ÈÒÓ Â‹Ïı Ï‹Ú˘ ηٷÛÙÔÏ‹ Û 167 ·È‰È¿ ÛÙ· ÚÒÙ· ‰Âη¤ÓÙ ÏÂÙ¿, Û 118 ·È‰È¿ Û ‰Âη¤ÓÙ Ì ÙÚÈ¿ÓÙ· ÏÂÙ¿ Î·È Û 14 ·È‰È¿ Û ÙÚÈ¿ÓÙ· Ì ÂÍ‹ÓÙ· ÏÂÙ¿. ™Â 7 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ·˘Ù‹˜ ‰ÂÓ Â‹Ïı ηٷÛÙÔÏ‹. Afi ÙË ‚’ Î·È Á’ ÔÌ¿‰· ̤۷ Û ÂÍ‹ÓÙ· Î·È ÌÂÙ¿ ·fi ÂÍ‹ÓÙ· ÏÂÙ¿ ·fi ÙËÓ ·Ú¯È΋ ¯ÔÚ‹ÁËÛË, ηÙÂÛÙ¿ÏËÛ·Ó 59 Î·È 15 ·È‰È¿ ·ÓÙÈÛÙÔ›¯ˆ˜. ™Â 15 ·È‰È¿ Ù˘ ‚’ ÔÌ¿‰·˜ Î·È Û ¤ÓÙ Ù˘ Á’ ÔÌ¿‰·˜ ‰ÂÓ Â‹Ïı η̛· ηٷÛÙÔÏ‹. ŒÙÛÈ, Û˘ÓÔÏÈο Û 27 ·È‰È¿ (6,8%) Ë ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË Â›Ù ·¤Ù˘¯Â Ó· ÂÈʤÚÂÈ Î·Ù·ÛÙÔÏ‹ (12 ÂÚÈÙÒÛÂȘ) ›Ù ηı˘ÛÙ¤ÚËÛ ӷ ÙËÓ ÚÔηϤÛÂÈ ¿Óˆ ·fi ÂÍ‹ÓÙ· ÏÂÙ¿ ·fi ÙËÓ ·Ú¯È΋ ¯ÔÚ‹ÁËÛ‹ Ù˘ (15 ÂÚÈÙÒÛÂȘ). T· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2. ¶›Ó·Î·˜ 1. ¶·ÚÂÓ¤ÚÁÂȘ Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘. ¶·ÚÂÓ¤ÚÁÂÈ·

AÚÈıÌfi˜ ·ÛıÂÓÒÓ

%

30 4 2 1

7,5 1,0 0,5 0,3

EÌÂÙfi˜ ¢È¿ÚÚÔÈ· YÂÚÎÈÓËÙÈÎfiÙËÙ· ÕÓÔÈ·

¶›Ó·Î·˜ 2. XÚfiÓÔ˜ ¤Ó·Ú͢ Ù˘ ‰Ú¿Û˘ Ù˘ ¯ÏˆÚ¿Ï˘ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ Î·È ÙËÓ Û˘ÌÏËڈ̷ÙÈ΋ ‰fiÛË ÚÈÓ ·fi 400 ·ÍÔÓÈΤ˜ ÙÔÌÔÁڷʛ˜.

XÚfiÓÔ˜ ¤Ó·Ú͢ Ù˘ ‰Ú¿Û˘

AÚÈıÌfi˜ Î·È % ÙˆÓ ÂÍÂÙ¿ÛˆÓ* Û‡ÓÔÏÔ Ó¿ÚΈÛ˘ ÂÓÙfi˜ 60 min

N¿ÚΈÛË Ì¤Û· Û 15min N¿ÚΈÛË ÌÂٷ͇ 15-30min ŒÏ·‚·Ó Û˘ÌÏËڈ̷ÙÈ΋ ‰fiÛË ÛÙ· 30min XˆÚ›˜ Û˘ÌÏËڈ̷ÙÈ΋ ‰fiÛË ÛÙ· 30min

167 (41,8) 118 (29,5) 94 (23,5)

167 (41,8) 118 (29,5) 74 (18,5)

21 ( 5,3)

14 ( 3,5)

™‡ÓÔÏÔ

400 (100)

373 (93,3)

¯ˆÚ›˜ Ó¿ÚΈÛË ÂÓÙfi˜ 60 min

¯ˆÚ›˜ Ó¿ÚΈÛË

15 (3,8)

5(1,3) 7 (1,8)

15 (3,8)

12 (3,0)

*% ÂÓÙfi˜ ÙˆÓ ·ÚÂÓı¤ÛˆÓ

147

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·148

¶∞π¢π∞∆ƒπ∫∏ 2000;63:145-149

H ‰È¿ÚÎÂÈ· Ù˘ Ó¿ÚΈÛ˘ ηٷÁÚ¿ÊËΠ۠245 ÂÚÈÙÒÛÂȘ. 30 ·È‰È¿ (12,2%) ͇ÓËÛ·Ó Ì¤Û· Û 15 min, 53 (21,6%) ̤۷ Û 30 min, 40 (16,3%) ̤۷ Û 60 min, ÂÓÒ 51 (20,8%) ÎÔÈÌ‹ıËÎ·Ó ÁÈ· 2 ÒÚ˜ ÂÚ›Ô˘. 71 ·È‰È¿ (29,0%) ·ÚÔ˘Û›·Û·Ó ·Ú·ÙÂٷ̤ÓË Ó¿ÚΈÛË (¿Óˆ ÙˆÓ 2 ˆÚÒÓ). EÏ¿¯ÈÛÙÔÈ ·ÛıÂÓ›˜ ͇ÓËÛ·Ó Î·Ù¿ ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘˜ ÛÙÔÓ ÂÍÂÙ·ÛÙÈÎfi ¯ÒÚÔ. AÎfiÌ· Î·È ÙfiÙÂ Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‰ÈÂÍ‹¯ıË ·ÚfiÛÎÔÙ· ›Ù ÌÂÙ¿ ·fi Û‡ÓÙÔÌË ·Ó·ÌÔÓ‹ ›Ù Ì ÌÈÎÚ‹ Â·Ó·ÏËÙÈ΋ ‰fiÛË ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘.

H ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ÚÔοÏÂÛ ηٷÛÙÔÏ‹- Ó¿ÚΈÛË Â·Ú΋ ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Ù¯ÓÈο ¿ÚÙÈ·˜ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Û 360 ÂÚÈÙÒÛÂȘ (90%). H ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‹Ù·Ó Ù¯ÓÈο ˘Ô‚·ıÌÈṲ̂ÓË, ·ÏÏ¿ ·Ô‰ÂÎÙ‹ Û 28 ÂÚÈÙÒÛÂȘ (7%). ™Â 12 ÂÚÈÙÒÛÂȘ (3%) Ë ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ‰ÂÓ Â¤ÊÂÚ ηٷÛÙÔÏ‹ Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¤ÁÈÓ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊϤ‚È·˜ ·Ó·ÈÛıËÛ›·˜ (Midazolam) (5) ·fi ·Ó·ÈÛıËÛÈÔÏfiÁÔ.

OÈ ·ÚÂÓ¤ÚÁÂȘ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ‹Û·Ó: ÂÌÂÙfi˜ Û 30 ·È‰È¿ (7,5%), ¿ÓÔÈ· Û ¤Ó· (0,3%), ·Ú¿‰ÔÍË ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Û 2 (0,5%) Î·È ‰È¿ÚÚÔÈ· Û 4 ·È‰È¿ (1,0%), ÙÚ›· ·fi Ù· ÔÔ›· ›¯·Ó ¿ÚÂÈ ÙËÓ ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ·fi ÙÔ ÔÚıfi (›Ó·Î·˜ 1). ŸÏ˜ ÔÈ ·ÚÂÓ¤ÚÁÂȘ ·ÚÔ˘ÛÈ¿ÛıËÎ·Ó Ì¤Û· ÛÙ· ÚÒÙ· 10 min ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ Î·È ˘Ô¯ÒÚËÛ·Ó ·˘ÙfiÌ·Ù·. AÒÙÂÚ˜ ÂÈÏÔΤ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ. K·È Ù· ‰‡Ô ·È‰È¿ (ËÏÈΛ·˜ 14 Î·È 13 ÂÙÒÓ) Ô˘ ·ÚÔ˘Û›·Û·Ó ·Ú¿‰ÔÍË ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ‰È¿ÚÎÂÈ·˜ 15 min ÂÚ›Ô˘, ¤·Û¯·Ó ·fi ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È Â›¯·Ó Ï¿‚ÂÈ ÙËÓ ÌÂÁ›ÛÙË ÂÊ¿·Í ‰fiÛË. ™ÙÔ ÚÒÙÔ ·È‰› Â‹Ïı Ï‹Ú˘ ηٷÛÙÔÏ‹ ÌÂÙ¿ 45 min Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‹Ù·Ó Ù¯ÓÈο ¿ÚÙÈ·, ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ ·È‰› ·Ú¤ÌÂÈÓ Û ηٿÛÙ·ÛË ÌÂÚÈ΋˜ ÂÁÚ‹ÁÔÚÛ˘ Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‹Ù·Ó Ù¯ÓÈο ˘Ô‚·ıÌÈṲ̂ÓË, ·ÏÏ¿ ·Ô‰ÂÎÙ‹. K·È ÛÙ· ‰‡Ô ·È‰È¿ Ë ·Ú¿‰ÔÍË ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ‰È‹ÚÎÂÛ ÂÚ›Ô˘ 15 min. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÚÂÓ¤ÚÁÂȘ ÛÙ· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ÛÎÈ·ÁÚ·ÊÈ΋ Ô˘Û›· ›Ù ·fi ÙÔ ÛÙfiÌ· ›Ù ÂÓ‰ÔÊÏ‚›ˆ˜. ™˘˙‹ÙËÛË H ¯ÏˆÚ¿ÏË Â›Ó·È Ì›· ÎÚ˘ÛÙ·ÏÏÈ΋ Ô˘Û›·, Ë ÔÔ›· ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ ‹·Ú ÛÙÔÓ ÂÓÂÚÁfi ÌÂÙ·‚ÔÏ›ÙË ÙÚȯψÚÔ·Èı·ÓfiÏË, Ô˘ ¤¯ÂÈ ¯ÚfiÓÔ ËÌÈÛ›·˜ ˙ˆ‹˜ 412 ÒÚ˜ Î·È ·Ô‚¿ÏÏÂÙ·È ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ (6). H ¤Ó˘‰ÚË ÌÔÚÊ‹ Ù˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Û ÌÈÎÚ‹ ‰fiÛË ˆ˜ ̤ÛÔ Î·Ù·ÛÙÔÏ‹˜ ÛÙËÓ ·È‰È·ÙÚÈ΋, ÛÙËÓ ·È‰È·ÙÚÈ΋ ÔÊı·ÏÌÔÏÔÁ›·, ηıÒ˜ Î·È Î·Ù¿ ÙËÓ ‰ÈÂÍ·ÁˆÁ‹ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊËÌ¿ÙˆÓ Î·È ‰ÔÎÈÌ·ÛÈÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ. ™ÙËÓ ·È‰Ô·ÎÙÈÓÔÏÔÁ›· Ë ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÌfiÓË Ù˘ ‹ Û ÔÏ˘Ê·Ú̷΢ÙÈο

148

M. Z·Ú›ÊË Î·È Û˘Ó.

Û¯‹Ì·Ù· Û ‰ÔÛÔÏÔÁ›· Ô˘ ÔÈΛÏÏÂÈ Â˘Ú¤ˆ˜ (25100 mg/kg) ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹- Ó¿ÚΈÛË ·È‰ÈÒÓ ÚÈÓ ·fi ·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. EÓÙÔ‡ÙÔȘ Ë È‰·ÓÈ΋ ‰fiÛË Ô˘ Û˘Ó‰˘¿˙ÂÈ ˘„ËÏ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· ηıÔÚÈÛı› (7,8).

K·Ù¿ ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ë ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË ÛÙËÓ ‰fiÛË ÙˆÓ 50-75 mg/kg Â¤‰ÂÈÍ ˘„ËÏ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·. ™Â 97% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â¤Ù˘¯Â ηٷÛÙÔÏ‹- Ó¿ÚΈÛË Â·Ú΋ ÁÈ· ÙËÓ ‰ÈÂÍ·ÁˆÁ‹ ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ Ï‹ÚÔ˘˜ ‹ ۯ‰fiÓ Ï‹ÚÔ˘˜ ‰È·ÁÓˆÛÙÈ΋˜ ·Í›·˜, ¯ˆÚ›˜ Ó· ¯ÚÂÈ·Ûı› ¿ÏÏÔ Û˘ÌÏËڈ̷ÙÈÎfi ηٷÛÙ·ÏÙÈÎfi ̤ÛÔ. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÔÈ Greenberg et al. ¤¯Ô˘Ó ·ÚÔ˘ÛÈ¿ÛÂÈ Û˘ÁÎÚ›ÛÈÌ· ·ÔÙÂϤÛÌ·Ù· Ì ˘„ËÏfiÙÂÚË ‰fiÛË ¯ÏˆÚ¿Ï˘ (80-100 mg/kg) (3) ÂÓÒ ÔÈ Thompson et al., Ì ÂÍ›ÛÔ˘ ˘„ËÏ‹ ‰fiÛË ¯ÏˆÚ¿Ï˘ (80 mg/kg) ·Ó¤ÊÂÚ·Ó ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ·ÔÙ˘¯›·˜ Ô˘ ·¤‰ˆÛ·Ó fï˜ Î·È Û ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, fi¯È ÌfiÓÔ ÛÙË ¯ÏˆÚ¿ÏË (9).

H ¿ÓÔÈ· ·ÔÙ¤ÏÂÛ ÙËÓ ÛÔ‚·ÚfiÙÂÚË ÂÈÏÔ΋ (Ì›· ÂÚ›ÙˆÛË). AÏÏ·Á‹ ı¤Û˘ Î·È ÂÏ·ÊÚ¿ ÂÒ‰˘Ó· ÂÚÂı›ÛÌ·Ù· ‚Ô‹ıËÛ·Ó ÙÔ ·È‰› Ó· Û˘Ó¤ÏıÂÈ. AÓ·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ·Ó·ÊÂÚı› Î·È Ì ÙËÓ ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË, ·Ó Î·È Ôχ Û·ÓÈfiÙÂÚ· ·fi fiÙÈ Ì ٷ ‚·Ú‚ÈÙÔ˘ÚÈο (10).

K·Ù¿ ÙËÓ ÌÂϤÙË ·˘Ù‹ ‰ÂÓ ·Ó·‰Â›¯ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰fiÛ˘ Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ Â̤وÓ, ¿ÓÔÈ·˜ Î·È ‰È¿ÚÚÔÈ·˜. H ÂÌÊ¿ÓÈÛË ÂÌ¤ÙˆÓ Î·È ‰È¿ÚÚÔÈ·˜ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Ì ÙÔÈ΋ ÂÚÂıÈÛÙÈ΋ ‰Ú¿ÛË Ù˘ ¯ÏˆÚ¿Ï˘ Â› ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ÔÚıÔ‡ ·ÓÙ›ÛÙÔȯ·. AÓÙ›ıÂÙ· Ë ÂÌÊ¿ÓÈÛË ·Ú¿‰Ô͢ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ı· ÌÔÚÔ‡Û ›Ûˆ˜ Ó· Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ‰fiÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘, ηıÒ˜ Î·È Ù· ‰˘Ô ·È‰È¿ Ô˘ ÙË ·ÚÔ˘Û›·Û·Ó ›¯·Ó Ï¿‚ÂÈ ÙËÓ ÌÂÁ›ÛÙË ‰fiÛË. AÍÈÔÛËÌ›ˆÙÔ Â›Û˘ Â›Ó·È Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·È Ù· ‰‡Ô ·È‰È¿ ·˘Ù¿ ¤·Û¯·Ó ·fi ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ‹Û·Ó ¿Óˆ ÙˆÓ 5 ÂÙÒÓ.

EÎÙfi˜ ·fi ÙËÓ ¿ÓÔÈ·, Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ ÌÔÈÚ·›· ·ÔÙÂϤÛÌ·Ù· ·Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛı› ÂÁη›Úˆ˜, fiϘ ÔÈ ¿ÏϘ ÂÈÏÔΤ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ÌÂϤÙË ·˘Ù‹ ‹Û·Ó ·Î›Ó‰˘Ó˜, ˘Ô¯ÒÚËÛ·Ó ·˘ÙfiÌ·Ù· Î·È ‰ÂÓ ·ÚÂÌfi‰ÈÛ·Ó ÙË ‰ÈÂÍ·ÁˆÁ‹ Ù˘ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜. EÈΛӉ˘Ó˜ ÂÈÏÔΤ˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Û˘¯ÓfiÙÂÚ· ÙfiÛÔ Ì ٷ ‚·Ú‚ÈÙÔ˘ÚÈο fiÛÔ Î·È Ì ٷ ÔÏ˘Ê·Ú̷΢ÙÈο Û¯‹Ì·Ù· (11). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· Ë ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË, ΢ڛˆ˜ Û ˘„ËϤ˜ ‰fiÛÂȘ ¤¯ÂÈ Û˘Ó‰˘·Ûı› Ì ӷ˘Ù›·, Ì ˘ÔÍ›·, ·ÚÚ˘ı̛˜, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘, ÔÚÊ˘Ú›·, ÛÙ¤ÓˆÛË ÔÈÛÔÊ¿ÁÔ˘, ÂÍ¿ÓıËÌ· Î·È ·‡ÍËÛË Ù˘ ›ÂÛ˘ ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ (12-16).

AÏÏËÏÂ›‰Ú·ÛË ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ Î·È ÂÓ‰ÔÊϤ‚È·˜ ÊÔ˘ÚÔÛÂÌ›‰Ë˜, ·ÎfiÌ· Î·È Û ̛· ÌfiÓÔ ‰fiÛË ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·fiÙÔÌË ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú¿

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:145-149

˘fi„Ë fiÙ·Ó ÔÈ ‰‡Ô Ô˘Û›Â˜ ¯ÔÚËÁÔ‡ÓÙ·È Û ÌÂÛԉȿÛÙËÌ· 24 ˆÚÒÓ (17).

H ¤Ó·ÚÍË Î·È Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ˘¿ÁÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ Î·ÓfiÓ·. ¶·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÔÏÏ·Ϥ˜ ·ÍÔÓÈΤ˜ ÙÔÌÔÁڷʛ˜ ÛÙ· Ï·›ÛÈ· Â·ÓÂϤÁ¯ˆÓ ‰ÂÓ ·ÓÙ¤‰Ú·Û·Ó ÛÙËÓ ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË Ì ÙÔÓ ›‰ÈÔ ÙÚfiÔ Î¿ı ÊÔÚ¿. A˘Ù‹ Ë ·‰˘Ó·Ì›· Úfi‚Ï„˘ Ù˘ ‰Ú¿Û˘ Ù˘ ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛı› Û·Ó ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘, ȉ›ˆ˜ Û ۇÁÎÚÈÛË Ì ٷ ‚·Ú‚ÈÙÔ˘ÚÈο, Ô˘ ¯ÔÚËÁÔ‡ÌÂÓ· ÂÓ‰ÔÊÏ‚›ˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡ÓÙÔÌÔ Î·È ÚԂϤ„ÈÌÔ ¯ÚfiÓÔ ¤Ó·Ú͢ Î·È ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ (18). ™ÙË ÌÂϤÙË ·˘Ù‹ 71% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·Û·Ó ηٷÛÙÔÏ‹ ̤۷ Û 30 min Î·È Û 93% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ‰È·‰Èηۛ· (ÚÔÂÙÔÈÌ·Û›· Î·È ‰ÈÂÍ·ÁˆÁ‹ ÂͤٷÛ˘) ÔÏÔÎÏËÚÒıËΠ̤۠ÛÔ ¯ÚfiÓÔ 3040 min (ÂÏ¿¯ÈÛÙË ‰È¿ÚÎÂÈ·: 15 min, ̤ÁÈÛÙË ‰È¿ÚÎÂÈ·: 75 min). ¶·Ú·ÙÂٷ̤ÓË Ó¿ÚΈÛË ·ÚÔ˘ÛÈ¿ÛıËΠ۠29% ÙˆÓ ·È‰ÈÒÓ.

H Ù·˘Ùfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ·fi ÙÔ ÛÙfiÌ· ‹ ÂÓ‰ÔÊÏ‚›ˆ˜ ‰ÂÓ ÚÔοÏÂÛ ·ÚÂÓ¤ÚÁÂȘ. K˘Ú›ˆ˜ Ú¤ÂÈ Ó· ÙÔÓÈÛı› Ë ·Ô˘Û›· ÂÈÏÔÎÒÓ ÛÙ· 9 ·È‰È¿ Ô˘ ›¯·Ó Ï¿‚ÂÈ ÙËÓ ÙÂÏÂ˘Ù·›· ÔÛfiÙËÙ· Ù˘ ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ·fi ÙÔ ÛÙfiÌ· 20 min ÚÈÓ ÙËÓ ¯ÔÚ‹ÁËÛË Ù˘ ¤Ó˘‰Ú˘ ¯ÏˆÚ¿Ï˘. H ·ÚÔ˘Û›· ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ÛÙÔÓ ÂÙÈÎfi ۈϋӷ ·ÔÙÂÏ› ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ ‰È·ÁÓˆÛÙÈÎÒÓ ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ ÎÔÈÏ›·˜ ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿ fiÔ˘ ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜ (¤ÏÏÂÈ„Ë ÂÚÈÛÏ¿Á¯ÓÈÔ˘ Ï›Ô˘˜ ÎÏ.) ÌÂÈÒÓÔ˘Ó ÙË ‰È·ÁÓˆÛÙÈ΋ ·Í›· Ù˘ ÂͤٷÛ˘. Afi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÔÔÈÔ˘‰‹ÔÙ ̤ÛÔ˘ ÚÔ˜ ηٷÛÙÔÏ‹-Ó¿ÚΈÛË ÂÈ‚¿ÏÏÂÙ·È ÛÙ¤ÚËÛË Î¿ı ˘ÁÚ¿˜ ‹ ÛÙÂÚ¿˜ ÙÚÔÊ‹˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ Â› 3 ÒÚ˜. OÈ Ù¿ÛÂȘ Ù˘ Û‡Á¯ÚÔÓ˘ ·Ó·ÈÛıËÛÈÔÏÔÁ›·˜ Â›Ó·È Ó· ÂÚÈÔÚÈÛı› Ô ¯ÚfiÓÔ˜ ·˘Ùfi˜ οو ÙˆÓ 2 ˆÚÒÓ, ÂÓÙÔ‡ÙÔȘ ·˘Ùfi ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· ÂÊ·ÚÌÔÛı› Ï‹Úˆ˜ ÛÙËÓ Î·ı' Ë̤ڷ Ú¿ÍË (4). ™ÙÔ ÙÌ‹Ì· Ì·˜ ·fi ÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ̤¯ÚÈ Î·È Û‹ÌÂÚ· ¤¯ÂÈ ·ÎÔÏÔ˘ıËı› Ë ›‰È· ÌÂıÔ‰ÔÏÔÁ›· ¯ˆÚ›˜ Ó· ÛËÌÂȈı› ÔÔÈ·‰‹ÔÙ ÂÈÏÔ΋. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¤Ó˘‰ÚË ¯ÏˆÚ¿ÏË Â›Ó·È ¤Ó· ·Ïfi, ‡ÏËÙÔ Î·Ù·ÛÙ·ÏÙÈÎfi-˘ÓˆÙÈÎfi ̤ÛÔ, Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ‡ÎÔÏ· ·fi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÍÔÓÈÎÔ‡ ÙÔÌÔÁÚ¿ÊÔ˘ ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ· ·Î›Ó‰˘ÓˆÓ ÂÈÏÔÎÒÓ (Ì ÂÍ·›ÚÂÛË ÙËÓ ¿ÓÔÈ·). T¤ÏÔ˜, ÌÔÚ› Ó· Û˘Ó‰˘·Ûı› Ì ·ÛÊ¿ÏÂÈ· Ì ٷ˘Ùfi¯ÚÔÓË

ŒÓ˘‰ÚË ¯ÏˆÚ¿ÏË ÚÈÓ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ÂÓ‰ÔÊÏ‚›ˆ˜ ‹ ·fi ÙÔ ÛÙfiÌ·, ·Ó ÙÔ‡ÙÔ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Cohen MD. Pediatric sedation. Radiology 1990;175:611612.

2. Keeter S, Benator RM, Weinberg SM, Hartenberg MA. Sedation in pediatric CT: national survey of current practice. Radiology 1990;175:745-752.

3. Greenberg SB, Faerber EN, Aspinall CL. High dose chloral hydrate sedation for children undergoing CT. J Comput Assist Tomogr 1991;15:467-469.

4. Fisher DM. Sedation of pediatric patients: an anesthesiologist's perspective. Radiology 1990;175:613615.

5. Diament MJ, Stanley P. The use of midazolam for sedation of infants and children. AJR 1988;150:377-378.

6. Marshall EK, Owens AH. Absorption, excretion and metabolic fate of chloral hydrate and trichloroethanol. Bull Johns Hopkins Hosp 1954;95:1-9.

7. Bisset GS III, Ball WS Jr. Preparation, sedation and monitoring of the pediatric patient in the magnetic resonance suite. Semin in Ultrasound CT MR 1991;12:376-378.

8. Greenberg SB, Faerber EN, Radke JL, Aspinall CL, Adams RC, Mercer-Wilson DD. Sedation of difficult-to-sedate children undergoing MR imaging: value of thiridazine as an adjunct to chloral hydrate. AJR 1994;163:165-168.

9. Thompson JR, Schneider S, Ashwal S, Holden BS, Hinshaw DB Jr, Hasso AN. The choice of sedation for computed tomography in children: a prospective evaluation. Radiology 1982;143:475-479.

10. Mallol J, Sly PD. Effect of chloral hydrate on the arterial oxygen saturation in wheezy infants. Pediatr Pulmonol 1988;5:96-99.

11. Mitchell AA, Louik C, Lacouture P, Slone D, Goldman P, Shapiro S. Risks to children from computed tomographic scan premedication. JAMA 1982;247:2385-2388.

12. Abdul-Baqi KJ. Chloral hydrate and middle ear pressure. J Laryngol Otol 1991;105:421-423.

13. Bowyer K, Glasser Sp. Chloral hydrate overdose and carrier arrhythmias. Chest 1980;77:232-235.

14. Gleich GJ, Mongan ES, Vaules DW. Esophageal stricture following chloral hydrate poisoning. JAMA 1967;201:266.

15. Granoff DN, Mc Daniel DB, Borkowf SP. Cardiorespiratory arrest following aspiration of chloral hydrate. Am J Dis Child 1971;122:170.

16. Vade A, Sukhani R, Dolenga M, Habisohn-Schuck C. Chloral hydrate sedation of children undergoing CT and MR imaging: safety as judged by American Academy of Pediatrics guidelines. AJR 1995;165:905-909.

17. Dean RP, Rudinsky BF, Kelleher MD. Interaction of chloral hydrate and intravenous furosemide in a child. Clin Pharm 1991;10:385-387.

18. Strain JD, Harvey LA, Foley LC, Campbell JB. Intravenously administered pentobarbital sodium for sedation in pediatric CT. Radiology 1986;161:105-108.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-06-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-02-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M. Z·Ú›ÊË TÚÈÎ¿ÏˆÓ 26, 11526 Aı‹Ó·

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:150-155

AÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ ÈÏ·Ú¿˜ Î·È ÂÚ˘ıÚ¿˜ ÛÙÔ Î·ÙÒÊÏÈ ÙÔ˘ 2000 ¢ËÌÔÛı¤Ó˘ AÏÂ͛Ԣ, XÚÈÛÙ›Ó· MfiÚ·, ÕÓÓ· MÂÛÛ·ÚÈÙ¿ÎË, NÈÎÔϤÙÙ· M¿ÚÁ·ÚË, £ÂÌÈÛÙÔÎÏ‹˜ K·Ú¿ıÈÔ˜ ● ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ Ù˘ ÈÏ·Ú¿˜ Î·È Ù˘ ÂÚ˘ıÚ¿˜ ÛÙË ¯ÒÚ· Ì·˜ Î·È Ë Úfi‚ÏÂ„Ë ÁÈ· Ù· ·fiÌÂÓ· 10-15 ¯ÚfiÓÈ·. XÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â‰Ô̤ӷ Ù˘ ™Ù·ÙÈÛÙÈ΋˜ YËÚÂÛ›·˜ ÙÔ˘ ÎÚ¿ÙÔ˘˜ ÁÈ· ÙËÓ ÈÏ·Ú¿ Î·È ÙËÓ ÂÚ˘ıÚ¿ Ô‡ ·ÊÔÚÔ‡Ó ÙȘ ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Ù˘ ¯ÒÚ·˜ ÁÈ· ÙÔ ‰È¿ÛÙËÌ· ·fi ÙÔ 1980 ̤¯ÚÈ ÙÔ 1994. M ηٿÏÏËÏË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ÛÙÔȯ›ˆÓ (time series model, trend analysis Î·È decomposition forecasting model with trend) Á›ÓÂÙ·È Úfi‚ÏÂ„Ë ÁÈ· ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ÂΉËψıÔ‡Ó ÌÂÙ¿ ÙÔ 2000. TÔ ÚfiÁÚ·ÌÌ· ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ Ù˘ ÈÏ·Ú¿˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ‚Ú·‰¤ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfi Ì Ì›ˆÛË ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ·fi ÙË ÓfiÛÔ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜. MÂÙ¿ ÙÔ 2005 ÚԂϤÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ¯ÚÔÓÈΤ˜ ÂÚ›Ô‰ÔÈ Ì ÌˉÂÓÈΤ˜ ÂÈÛ·ÁˆÁ¤˜ ·ÛıÂÓÒÓ Ì ÈÏ·Ú¿. AÓÙ›ıÂÙ·, Ë ÚfiÏË„Ë Ù˘ ÂÚ˘ıÚ¿˜ Ê·›ÓÂÙ·È fiÙÈ ·¤Ù˘¯Â. OÈ ÂÈÛ·ÁˆÁ¤˜ ·ÛıÂÓÒÓ Ì ÂÚ˘ıÚ¿ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ ·˘Í¿ÓÔ˘Ó Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. H ηÌ‡ÏË ÓfiÛËÛ˘ ÌÂÙ·ÎÈÓ‹ıËΠÛÙȘ ·Ó··Ú·ÁˆÁÈΤ˜ ËÏÈ˘, Ì ·‡ÍËÛË Û˘ÓÂÒ˜ ÙÔ˘ ΛӉ˘ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÂÚÈÙÒÛÂˆÓ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜. EȉË̛˜ Ù˘ ÓfiÛÔ˘ ·Ó·Ì¤ÓÔÓÙ·È ÌÂÙ¿ ÙÔ 2000 Ì ÎÚÔ‡ÛÌ·Ù· ΢ڛˆ˜ ÌÂٷ͇ ÙˆÓ ·ÚÚ¤ÓˆÓ ËÏÈΛ·˜ 15-29 ¯ÚfiÓˆÓ. H ·Ó¿ÁÎË ·Ó·ıÂÒÚËÛ˘ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ ηٿ Ù˘ ÂÚ˘ıÚ¿˜ Â›Ó·È Â›ÁÔ˘Û· Ì ÂÈΤÓÙÚˆÛË ÛÙËÓ ¯ÔÚ‹ÁËÛË Ù˘ 2˘ ‰fiÛ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙ· Ó·ڿ ¿ÙÔÌ· ËÏÈΛ·˜ 15-29 ¯ÚfiÓˆÓ. ¶·È‰È·ÙÚÈ΋ 2000;63:150-155. §¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚ÔÏÈ·ÛÌfi˜, ÂÚ˘ıÚ¿, ÈÏ·Ú¿, ÚÔÁÚ¿ÌÌ·Ù· ÂÌ‚ÔÏÈ·ÛÌÒÓ.

D. Alexiou, C. Bora, A. Messaritaki, N. Margari, T. Karpathios. Efficacy of prevention programmes for measles and rubella at the dawn of 2000. Paediatriki 2000;63:150-155. ● Abstract: Objective: Projection of the efficacy of the prevention programmes for measles and rubella in Greece for the next 10 to 15 years. Material and methods: The data of the National Statistical Service concerning the cases of patients with measles and rubella admitted to all the hospitals in Greece from 1980 to 1994 were used. Using appropriate statistical analysis (time series model, trend analysis and decomposition forecasting model with trend), computation of the cases expected to be registered after the year 2000 was made. Results: The prevention programme for measles seems to be progressively efficacious with an apparent decrease in the cases of measles admitted to hospital. After the year 2005 it is projected that there will be periods of time with no cases of measles in the hospitals. Conversely, the prevention programme for rubella seems to be failing. The cases of rubella are increasing with time and the age curve of patients has shifted to the reproductive age-group so that the risk of congenital rubella is increased. Rubella epidemics are predicted to appear after the year 2000 and males aged 15-29 years will be principally affected. The prevention programme for rubella should be revised, with particular attention to giving a second dose of anti-rubella vaccine to males aged 15-29 years.

Key words: immunization, rubella, measles, immunization programmes.

EÈÛ·ÁˆÁ‹ ™ÙÔÓ ·fiË¯Ô ÙÔ˘ 1999 Î·È ÙËÓ ·Ú¯‹ ÙÔ˘ 21Ô˘ ·ÈÒÓ· Ê¿ÓËΠ¯Ú‹ÛÈÌÔ Ó· ‰ÈÂÚ¢ÓËı› ÙÈ ¤¯Ô˘Ì ÂÈ-

B’ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

150

Ù‡¯ÂÈ Î·È ÙÈ fi¯È ÛÙËÓ ÚfiÏË„Ë Ù˘ ÈÏ·Ú¿˜ Î·È Ù˘ ÂÚ˘ıÚ¿˜. ™ÙËÓ ·È‰È·ÙÚÈ΋ Ë ÈÏ·Ú¿ Î·È Ë ÂÚ˘ıÚ¿ Â›Ó·È ·fi Ù· ÎÔÚ˘Ê·›· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·, ÏfiÁˆ Ù˘

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¶ÚÔÔÙÈΤ˜ ÚfiÏ˄˘ ÈÏ·Ú¿˜ - ÂÚ˘ıÚ¿˜

Û˘¯ÓfiÙËÙ·˜ ·ÏÏ¿ Î·È ÙˆÓ ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó.

O ·ÚÈıÌfi˜ ÙˆÓ ÂÙËÛ›ˆ˜ ÓÔÛËÏ¢ı¤ÓÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ Î·È ÂÚ˘ıÚ¿˜ ÛÙË ¯ÒÚ· Ì·˜ ηٷÁÚ¿ÊÔÓÙ·È Î·È ‰ËÌÔÛȇÔÓÙ·È Û ›Ó·Î˜ ·fi ÙË ™Ù·ÙÈÛÙÈ΋ YËÚÂÛ›· ÙÔ˘ KÚ¿ÙÔ˘˜ (™YK) Ì ‚¿ÛË ÙȘ ‰È·ÁÓÒÛÂȘ ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Ù˘ ¯ÒÚ·˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÛÙÔȯ›·, Ô˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ Â›Ó·È ·ÎÚÈ‚‹ ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÓÔÛËÏ¢ÔÌ¤ÓˆÓ ·ÛıÂÓÒÓ. º˘ÛÈο ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ó¿ÏÔÁ· ÛÙÔȯ›· ÁÈ· ÙÔ˘˜ ÌË ÓÔÛËÏ¢ı¤ÓÙ˜, ÒÛÙ Û ·fiÏ˘ÙÔ˘˜ ·ÚÈıÌÔ‡˜ Ù· ÛÙÔȯ›· ‰ÂÓ Â›Ó·È ·ÍÈÔÔÈ‹ÛÈÌ·.

OÈ ÂÙ‹ÛÈÔÈ ·ÚÈıÌÔ› ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Ù˘ ¯ÒÚ·˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËı› Ë ‰È·Î‡Ì·ÓÛË, ‰È·¯ÚÔÓÈο, ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙˆÓ ÏÔÈ̈‰ÒÓ ·˘ÙÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙÔ ·ÚÂÏıfiÓ, ·ÏÏ¿ ÌÂÙ¿ ·fi ηٿÏÏËÏË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· Î·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÛ‹ Ù˘ ÔÚ›·˜ ÙÔ˘˜ ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ.

TÂÏÂ˘Ù·›· ˙‹Û·Ì ÙËÓ Î·Ù¿ ÙÔ 1993 ¤Í·ÚÛË Ù˘ EÚ˘ıÚ¿˜, Ì ÂÌÊ¿ÓÈÛË Î·È 25 ÂÚÈÙÒÛÂˆÓ Û˘ÁÁÂÓÔ‡˜ ÚÔÛ‚ÔÏ‹˜ (1) Î·È ÙËÓ Î·Ù¿ ÙÔ 1996 ¤Í·ÚÛË ÈÏ·Ú¿˜ (2), ·Ú¿ Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘, Ô˘ ¿Ú¯ÈÛ·Ó Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙË ¯ÒÚ· Ì·˜ ÚÔ˜ ÙÔ Ù¤ÏÔ˜ Ù˘ 10ÂÙ›·˜ ÙÔ˘ 1970 (3,4) Î·È ·Ú¿ ÙËÓ Î·ıȤڈÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙÔ˘ MMR Û·Ó ˘Ô¯ÚˆÙÈÎÔ‡ ·fi ÙÔ 1985 (5). ™Ùfi¯Ô˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘ ÂȉËÌÈÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ·Ó·ÊÔÚÈο Ì ÙËÓ ÈÏ·Ú¿ Î·È ÙËÓ ÂÚ˘ıÚ¿, ηٿ ÙËÓ ÚÔËÁÔ‡ÌÂÓË 15ÂÙ›·, ηıÒ˜ Î·È Ù˘ ÌÂÏÏÔÓÙÈ΋˜, ¤Ú·Ó ÙÔ˘ 2000 ÔÚ›·˜ Ù˘, Ì ‚¿ÛË Ù· ̤¯ÚÈ Û‹ÌÂÚ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÊ·Ú-

ÌÔÁ‹˜ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘.

YÏÈÎfi -M¤ıÔ‰Ô˜ K·Ù·ÁÚ¿„·Ì ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÂÚÈÙÒÛÂˆÓ ÈÏ·Ú¿˜ Î·È ÂÚ˘ıÚ¿˜ ·Ó¿ ¤ÙÔ˜, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜, ηٿ ÙË 15ÂÙ›· ·fi ÙÔ ¤ÙÔ˜ 1980 ̤¯ÚÈ ÙÔ ¤ÙÔ˜ 1994. MÂÙ·ÁÂÓ¤ÛÙÂÚ· ÛÙÔȯ›· ‰ÂÓ ¤¯Ô˘Ó ÂÈÛ¤ÙÈ ‰ËÌÔÛÈ¢Ù› ·fi ÙËÓ E™Y. H ηٷÁÚ·Ê‹ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 1. ™ÙÔÓ ›Ó·Î· 2 Ê·›ÓÔÓÙ·È Ù· ·ÓÙ›ÛÙÔȯ· ‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ̤¯ÚÈ Î·È 14 ¯ÚfiÓˆÓ, fiˆ˜ Î·È ÛÙ· Ó·ڿ ¿ÙÔÌ· ËÏÈΛ·˜ ·fi 15-29 ¯ÚfiÓˆÓ ¯ˆÚÈÛÙ¿ ÛÙ· ¿ÚÚÂÓ· Î·È Ù· ı‹Ï·. °È· ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ÛÙÔȯ›ˆÓ ÂÊ·ÚÌfiÛÙËÎ·Ó Ì¤ıÔ‰ÔÈ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ‰Â‰Ô̤ӷ Ù· ÔÔ›· Û˘ÏϤ¯ÙËÎ·Ó Î·Ù¿ Ù·ÎÙ¿ ¯ÚÔÓÔÏÔÁÈο ‰È·ÛÙ‹Ì·Ù·, fiˆ˜ Â›Ó·È Ô Î·Ù¿ ¯ÚfiÓÔ ·ÚÈıÌfi˜ ÙˆÓ ÓÔÛËÏ¢ı¤ÓÙˆÓ ·ÛıÂÓÒÓ. H Û˘ÁÎÂÎÚÈ̤ÓË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· Á›ÓÂÙ·È Ì ηٷÁÚ·Ê‹ ÙÔ˘ ˘ÏÈÎÔ‡ Û ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹ Î·È Ì ÂÊ·ÚÌÔÁ‹ ÛÙ·ÙÈÛÙÈÎÒÓ ‰È·‰ÈηÛÈÒÓ Ì Â›Ï˘ÛË ÂÎıÂÙÈÎÒÓ ÂÍÈÛÒÛÂˆÓ Î·È ÔÏÔÎÏËڈ̿وÓ. ™˘ÁÎÂÎÚÈ̤ӷ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ "time series model", Ë Ì¤ıÔ‰Ô˜ "trend analysis" Î·È ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙËÓ Úfi‚ÏÂ„Ë ÙˆÓ ÌÂÏÏÔÓÙÈÎÒÓ ÂÍÂÏ›ÍÂˆÓ Ë Ì¤ıÔ‰Ô˜ "decomposition forecasting model with trend" (6). XÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÚÔ·Ó·ÊÂÚfiÌÂÓË ÛÙ·ÙÈÛÙÈ΋ ÌÂıÔ‰ÔÏÔÁ›· Ì ¯Ú‹ÛË ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ ·Î¤ÙÔ˘ "MiniTab", ¤Î‰ÔÛË 1998. ¶ÚfiÎÂÈÙ·È ÁÈ· ÛÙ·ÙÈÛÙÈ΋ ̤ıÔ‰Ô Ô˘ ¯ÚËÛÈÌÔÔÈ› ‰ÈÏ‹ ÂÎıÂÙÈ΋ ÔÌ·ÏÔÔ›ËÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ì ˘ÔÏÔÁÈÛÌfi ÙËÓ Ù¿ÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ, ÙÔÓ ‚·ıÌfi

¶›Ó·Î·˜ 1. AÚÈıÌfi˜ ·ÙfiÌˆÓ (ËÏÈΛ·˜ <30 ¯ÚfiÓˆÓ) Ô˘ ÓfiÛËÛ·Ó ·fi ÈÏ·Ú¿ Î·È ÂÚ˘ıÚ¿ Î·È ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ ηٿ ÙË 15ÂÙ›·, ·fi ÙÔ 1980 ̤¯ÚÈ Î·È ÙÔ 1994.

I§APA EPY£PA ŒÙÔ˜ ÕÚÚÂÓ· £‹Ï· ™‡ÓÔÏÔ ÕÚÚÂÓ· £‹Ï· ™‡ÓÔÏÔ 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

987 37 221 1250 47 23 22 186 506 53 13 546 1190 154 34

727 25 154 770 18 4 7 108 305 19 8 159 389 56 25

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29 8 31 515 66 148 268 410 221 386 45 43 233 1186 38

9 6 8 50 18 19 32 24 16 18 8 16 21 72 17

38 14 39 565 84 167 300 434 237 404 53 59 254 1258 55

™‡ÓÔÏÔ

5269

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8043

3627

334

3961

151

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¢. AÏÂ͛Ԣ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. AÚÈıÌfi˜ ·ÓËÏ›ÎˆÓ (ËÏÈΛ·˜ <15 ¯ÚfiÓˆÓ ) Î·È Ó·ÚÒÓ ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ ËÏÈΛ·˜ 15-29 ¯ÚfiÓˆÓ Ô˘ ÓfiÛËÛ·Ó ·fi ÂÚ˘ıÚ¿ Î·È ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ ηٿ ÙË 15ÂÙ›· ·fi ÙÔ 1980 ̤¯ÚÈ Î·È ÙÔ ¤ÙÔ˜ 1994 ·Ó¿ ʇÏÔ.

AÛıÂÓ›˜ AÛıÂÓ›˜ ™¯¤ÛË <15 ¯ÚfiÓˆÓ 15-29 ¯ÚfiÓˆÓ ÂÓËϛΈÓ/ ŒÙÔ˜ ÕÚÚÂÓ· £‹Ï· ™‡ÓÔÏÔ ÕÚÚÂÓ· £‹Ï· ™‡ÓÔÏÔ ·È‰ÈÒÓ 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

9 5 7 65 9 13 26 30 17 32 15 13 21 64 15

7 3 6 25 15 12 20 15 13 9 7 13 14 48 16

16 8 13 90 24 25 46 45 30 41 22 26 35 112 31

ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘ ÂÓfi˜ Ê·ÈÓÔ̤ÓÔ˘, fiˆ˜ Î·È ÙË ‰È·‰Ô¯‹ ÙˆÓ ÁÂÁÔÓfiÙˆÓ Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ÂȉÈÎfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÔ ˘ÔÏÔÁÈÛÙÈÎfi ÌÔÓÙ¤ÏÔ Winter's, Ô˘ ‰›ÓÂÈ ¯Ú‹ÛÈ̘ ÚÔÔÙÈΤ˜ ÌÂÏÏÔÓÙÈΤ˜ ÚԂϤ„ÂȘ. XÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÂÂÍÂÚÁ·Û›· ‰Â‰ÔÌ¤ÓˆÓ Ô˘ ÌÂÙ·‚¿ÏÏÔÓÙ·È ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙÔ ¯ÚfiÓÔ. H ̤ıÔ‰Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ ÂÈ¤‰Ô˘ ÁÚ·ÌÌÈ΋˜ ÌÂÙ·‚ÔÏ‹˜, ÙÔÓ ‚·ıÌfi Ù˘ ÌÂÙ·‚ÔÏ‹˜ Î·È ÙËÓ ÂÚÈÔ‰ÈÎfiÙËÙ· ÙˆÓ ÌÂÙ·‚ÔÏÒÓ (7).

AÔÙÂϤÛÌ·Ù· H ÂͤÏÈÍË ÙˆÓ ·ÓˆÙ¤Úˆ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ Ê·›ÓÂÙ·È ÛÙ· Û¯‹Ì·Ù· 1 Î·È 2, Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ·fi ÙÔ Û‡ÛÙËÌ· Î·È ‰Â›¯ÓÔ˘Ó ÙËÓ Ù¿ÛË ÂͤÏÈÍ‹˜ ÙÔ˘˜ Î·È ÌÂÙ¿ ÙÔ ¤ÙÔ˜ 2000. EȉÈÎfiÙÂÚ· ÛÙÔ Û¯‹Ì· 1 Ê·›ÓÔÓÙ·È ÔÈ Î·Ì‡Ï˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ì ÈÏ·Ú¿ ËÏÈΛ·˜ <30 ¯ÚfiÓˆÓ, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Ù˘ ¯ÒÚ·˜, ·Ó¿ ¤ÙÔ˜ ηٿ ÙË 15ÂÙ›· ·fi ÙÔ 1980-1994. ™ÙÔ ·ÚÈÛÙÂÚfi ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜ ÌÂ Û˘Ó¯‹ ÁÚ·ÌÌ‹ ‰Â›¯ÓÔÓÙ·È ÔÈ ·ÛıÂÓ›˜ ÙÔ˘ ›Ó·Î· 1. ¶·Ú·ÙËÚÔ‡ÌÂ, fiÙÈ ÛÙËÓ ÈÏ·Ú¿ ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÂÌÊ·Ó›˙ÂÙ·È ·Ó¿ 4-5ÂÙ›· ÂÚ›Ô˘. M ÁÚ·ÌÌ‹ ·fi ·‡Ï˜ Ê·›ÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û‡Ìʈӷ Ì ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜ ÙÔ˘ Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ. E›Ó·È ÚÔÊ·Ó¤˜, fiÙÈ Ë Î·Ì‡ÏË ‰È·Î‡Ì·ÓÛ˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÏ¿¯ÈÛÙ· ‰È·Ê¤ÚÂÈ, ¯ÚÔÓÔÏÔÁÈο ‹ ·ÚÈıÌËÙÈο, ÂΛӢ Ô˘ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛËÌÂÈÒıËÎÂ. H ηٿ ÙÔ 1996 ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ÚԂϤÊıËΠ·fi ÙÔ Û‡ÛÙËÌ· Ì ٷ ÛÙÔȯ›· Ô˘ ›¯·Ó ηٷ¯ˆÚËı› ̤¯ÚÈ ÙÔ 1994, ‰ËÏ·‰‹ ÚÈÓ ·fi Ì›· ‰ÈÂÙ›·.

152

20 3 24 450 57 130 242 380 204 354 30 30 219 1122 23

2 3 2 25 5 7 12 9 3 9 1 3 7 24 1

22 6 26 475 62 137 254 389 207 363 31 33 226 1146 24

1,4 0,8 2,0 5,3 2,6 5,5 5,5 8,6 6,9 8,9 1,4 1,3 6,5 10,2 0,8

H ¢ı›· Û˘Ó¯‹˜ ÁÚ·ÌÌ‹ ‰Â›¯ÓÂÈ ÙËÓ Ù¿ÛË ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ. H ÔÚ›· Â›Ó·È Î·ıÔ‰È΋. ™ÙÔ ‰ÂÍÈfi ÙÌ‹Ì· Ù˘ ÂÈÎfiÓ·˜ ÛËÌÂÈÒÓÂÙ·È Ì ÛÙÈÎÙ‹ ÁÚ·ÌÌ‹ Ë Î·ı' ˘ÔÏÔÁÈÛÌfi ÌÂÏÏÔÓÙÈ΋ ηÌ‡ÏË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ, ÂÊfiÛÔÓ ‰ÂÓ ·ÏÏ¿ÍÂÈ ÙÔ ÚfiÁÚ·ÌÌ· ÚfiÏ˄˘ Ù˘ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ ηٿ Ù˘ ÓfiÛÔ˘, Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ·. ¶·Ú·ÙËÚԇ̠fiÙÈ Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÓÔÛËÏ¢ÔÌ¤ÓˆÓ Ì ÈÏ·Ú¿ Ù›ÓÂÈ Ó· ÌÂÈÒÓÂÙ·È ‚Ú·‰¤ˆ˜ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, ÒÛÙ ·fi ÙÔ ¤ÙÔ˜ 2005 ÂÚ›Ô˘ Î·È ÌÂÙ¿ Ô ·ÚÈıÌfi˜ ÙˆÓ ÓÔÛËÏ¢ÔÌ¤ÓˆÓ Ì ÈÏ·Ú¿, ηٿ ÂÚÈfi‰Ô˘˜ ı· ÌˉÂÓ›˙ÂÙ·È. H ÂηÙÔÛÙÈ·›· ·Ó·ÏÔÁ›· ·Ó¿ ʇÏÔ (¿ÚÚÂÓ·/ı‹Ï·) Â›Ó·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ Ì ÈÏ·Ú¿ 65,5% ÚÔ˜ 34,5% (5269/2774), ‰ËÏ·‰‹ ¤¯Ô˘Ì ÂÏ·ÊÚ¿ ˘ÂÚÔ¯‹ ÙˆÓ ·ÚÚ¤ÓˆÓ.

AÓ·ÊÔÚÈο Ì ÙËÓ ÂÚ˘ıÚ¿ (Û¯‹Ì· 2), ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·Ú·ÙËÚÂ›Ù·È ·Ó¿ ÂÓÙ·ÂÙ›· ÂÚ›Ô˘ Ì ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÔÛËÏ¢ÔÌ¤ÓˆÓ (¤Í·ÚÛË Ù˘ ÓfiÛÔ˘), ·Ó¿ ‰ÂηÂÙ›· ÂÚ›Ô˘. ™ÙÔ Û¯‹Ì·, Ë ÁÚ·ÌÌ‹ ·fi ·‡Ï˜ ‰Â›¯ÓÂÈ ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û‡Ìʈӷ Ì ˘ÔÏÔÁÈÛÌÔ‡˜ ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘. Ÿˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ÈÏ·Ú¿˜ ÂÏ¿¯ÈÛÙË Â›Ó·È Ë ‰È·ÊÔÚ¿, ¯ÚÔÓÔÏÔÁÈο Î·È ·ÚÈıÌËÙÈο, ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂٷ͇ ÙˆÓ Î·Ù·¯ˆÚËÌ¤ÓˆÓ ÂÈÛ·ÁˆÁÒÓ (Û˘Ó¯‹˜ ÁÚ·ÌÌ‹) Î·È ÂÎÂ›ÓˆÓ Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó ·fi ÙÔ Ì·ıËÌ·ÙÈÎfi ÛÙ·ÙÈÛÙÈÎfi ÌÔÓÙ¤ÏÔ (ÁÚ·ÌÌ‹ Ì ·‡Ï˜). M ¢ı›· Û˘Ó¯‹ ÁÚ·ÌÌ‹ ·Ú›ÛÙ·Ù·È Ë Ù¿ÛË ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ Ô˘ Â›Ó·È ·ÓÔ‰È΋. ™ÙÔ ‰ÂÍÈfi ÙÌ‹Ì· ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÛËÌÂÈÒÓÂÙ·È Ì ÛÙÈÎÙ‹ ÁÚ·ÌÌ‹ Ë Î·ı’ ˘ÔÏÔÁÈÛÌfi ÌÂÏÏÔÓÙÈ΋ ηÌ‡ÏË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÂÚ˘ıÚ¿˜, ÂÊfiÛÔÓ

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·153

¶∞π¢π∞∆ƒπ∫∏ 2000;63:150-155

¶ÚÔÔÙÈΤ˜ ÚfiÏ˄˘ ÈÏ·Ú¿˜ - ÂÚ˘ıÚ¿˜

‰ÂÓ ·ÏÏ¿ÍÂÈ ÙÔ ÚfiÁÚ·ÌÌ· ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘. ™Â ·ÓÙ›ıÂÛË Ì fiÙÈ Û˘Ì‚·›ÓÂÈ ÛÙËÓ ÈÏ·Ú¿, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÛÙËÓ ÂÚ˘ıÚ¿, Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Ù›ÓÂÈ Ó· ·˘Í¿ÓÂÙ·È ‚Ú·‰¤ˆ˜ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÚ¢ÓËı› ÙÔ ·›ÙÈÔ ‹ Ù· ·›ÙÈ· Ù˘ ·ÔÙ˘¯›·˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÚfiÏ˄˘ Ù˘ ÂÚ˘ıÚ¿˜ ·Ó·Ï‡ıËÎÂ Ë Î·Ù¿ ʇÏÔ ÓfiÛËÛË ·fi ÂÚ˘ıÚ¿ ¯ˆÚÈÛÙ¿ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ <15 ¯ÚfiÓˆÓ Î·È ¯ˆÚÈÛÙ¿ ÛÙ· ÓÂÚ¿ ¿ÙÔÌ· ËÏÈΛ·˜ 15-29 ¯ÚfiÓˆÓ. H ÂηÙÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ·ÚÚ¤ÓˆÓ ÚÔ˜ Ù· ı‹Ï· ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ ËÏÈΛ·˜ <30 ¯ÚfiÓˆÓ Â›Ó·È Ôχ ˘„ËÏfiÙÂÚË Ù˘ ·ÓÙ›ÛÙÔȯ˘ Ù˘ ÈÏ·Ú¿˜ Ì ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ˘ÏÈÎÔ‡ 91,6% ÚÔ˜ 8,4% (3627/334). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ 15-29 ¯ÚfiÓˆÓ Ë ÂηÙÔÛÙÈ·›· ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· Â›Ó·È ·ÎfiÌË ˘„ËÏfiÙÂÚË ·ÓÂÚ¯fiÌÂÓË Û 96,7% ÚÔ˜ 3,3% (3288/11), ÂÓÒ ÛÙ· ·È‰È¿, Ë Û¯¤ÛË ·ÚÚ¤ÓˆÓ ÚÔ˜ ı‹Ï· Â›Ó·È Û˘ÁÎÚÈÙÈο ÌÈÎÚfiÙÂÚË, fï˜ Â›Û˘ ˘¤Ú ÙˆÓ ·ÚÚ¤ÓˆÓ 60,5% ÚÔ˜ 39,5% (341/223). ¶·Ú·ÙËÚÂ›Ù·È Û˘ÓÂÒ˜ Û·Ê‹˜ ˘ÂÚÔ¯‹ ÓfiÛËÛ˘ ÙˆÓ ·ÚÚ¤ÓˆÓ, Û˘ÁÎÚÈÙÈο ÚÔ˜ Ù· ı‹Ï· Î·È ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ ÙȘ ÂÍ¿ÚÛÂȘ Ù˘ ÓfiÛÔ˘, ȉȷ›ÙÂÚ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ó·ÚÒÓ ·ÙfïÓ, ËÏÈΛ·˜ 15-29 ¯ÚfiÓˆÓ. H ‰È·›ÛÙˆÛË Ê·ÓÂÚÒÓÂÈ fiÙÈ ˘¿Ú¯ÂÈ Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Â›ÓÔÛˆÓ ·ÚÚ¤ÓˆÓ È‰È·›ÙÂÚ· ÛÙȘ ËÏÈ-

˘ ·fi 15 ̤¯ÚÈ 30 ¯ÚfiÓˆÓ.

EÍÂÙ¿ÛÙËÎÂ Î·È Ë Û¯¤ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÔÛËÏ¢ı¤ÓÙˆÓ Ó·ÚÒÓ ÂÓËÏ›ÎˆÓ ÚÔ˜ ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô ·ÚÈıÌfi ÙˆÓ ÓÔÛËÏ¢ı¤ÓÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 0-14 ¯ÚfiÓˆÓ, ‰ËÏ·‰‹ ÓÔÛËÏ¢ı¤ÓÙ˜ ÂÓ‹ÏÈΘ /ÓÔÛËÏ¢ı¤ÓÙ· ·È‰È¿ ÛÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ (Û¯‹Ì· 3). E›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ë Û¯¤ÛË ·˘Í¿ÓÂÙ·È ÚÔԉ¢ÙÈο ·fi ÙÔ 1980 ̤¯ÚÈ ÙÔ 1994, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ, fiÙÈ Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿ ÔÈ Ó·ÚÔ› ÂÓ‹ÏÈΘ Û˘ÓÈÛÙÔ‡Ó ÔÌ¿‰· ·ÙfiÌˆÓ ÙÔ˘ ÔÔ›Ô˘˜ ÂÈÏÂÎÙÈο ÚÔÛ‚¿ÏÏÂÈ Ë ÂÚ˘ıÚ¿. H Û¯¤ÛË Ï·Ì‚¿ÓÂÈ ÙȘ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ηٿ ÙȘ Ê¿ÛÂȘ ÂÍ¿ÚÛÂȘ Ù˘ ÓfiÛÔ˘. H Â͛ۈÛË Ù˘ ÁÚ·ÌÌ‹˜ Ù¿Û˘ Ù˘ Û¯¤Û˘ ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙÔ ¯ÚfiÓÔ ¤¯ÂÈ ˆ˜ ·ÎÔÏÔ‡ıˆ˜:

™¯‹Ì· 1. AÛıÂÓ›˜ Ì ÈÏ·Ú¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔ-

™¯‹Ì· 2. AÛıÂÓ›˜ Ì ÂÚ˘ıÚ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔ-

ÎÔÌ›· Ù˘ ¯ÒÚ·˜ (Û˘Ó¯‹˜ ÁÚ·ÌÌ‹, ÛÙÔȯ›· Ù˘ E™Y) Î·È ÎÚÔ‡ÛÌ·Ù· Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó (‰È·ÎÂÎÔÌ̤ÓË ÁÚ·ÌÌ‹, ‚¿ÛË ÙÔ˘ Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘). K·Ù¿ ÙË 15ÂÙ›· 1980-1994 Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ÂÏ¿¯ÈÛÙ· ‰È·Ê¤ÚÂÈ ÙˆÓ Ú·ÁÌ·ÙÈÎÒÓ ¯ÚÔÓÔÏÔÁÈο Î·È ·ÚÈıÌËÙÈο. OÈ ÂÍ¿ÚÛÂȘ Û˘Ì›ÙÔ˘Ó ·fiÏ˘Ù· Ì ·˘Ù¤˜ Ô˘ ÛËÌÂÈÒıËÎ·Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, H ·ÎÚ›‚ÂÈ· Ù˘ Úfi‚Ï„˘ Â›Ó·È ÌÂÁ¿ÏË ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙȘ ÂÍ¿ÚÛÂȘ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ‹ ÙË ¯ÚÔÓÔÏÔÁÈ΋ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. ™ÙÔ ‰ÂÍÈfi ÙÌ‹Ì· (ÛÙÈÎÙ‹ ÁÚ·ÌÌ‹) Ê·›ÓÂÙ·È Ë Û‡Ìʈӷ Ì ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜ Úfi‚ÏÂ„Ë ÙˆÓ ÁÂÁÔÓfiÙˆÓ Î·Ù¿ ÙËÓ 15ÂÙ›· ·fi 2000 ̤¯ÚÈ ÙÔ 2015. H ÁÚ·ÌÌ‹ Ù¿Û˘ ‰Â›¯ÓÂÈ ÙËÓ ‚Ú·‰Â›· ÚÔԉ¢ÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÈÏ·Ú¿˜.

ÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ (Û˘Ó¯‹˜ ÁÚ·ÌÌ‹, ÛÙÔȯ›· Ù˘ E™Y) Î·È ÎÚÔ‡ÛÌ·Ù· Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó (‰È·ÎÂÎÔÌ̤ÓË ÁÚ·ÌÌ‹, ‚¿ÛË ÙÔ˘ Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘. K·Ù¿ ÙË 15ÂÙ›· 1980-1994 Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÂÚ˘ıÚ¿˜ ÂÏ¿¯ÈÛÙ· ‰È·Ê¤ÚÂÈ ÙˆÓ Ú·ÁÌ·ÙÈÎÒÓ ¯ÚÔÓÔÏÔÁÈο Î·È ·ÚÈıÌËÙÈο. OÈ ÂÍ¿ÚÛÂȘ Û˘Ì›ÙÔ˘Ó ·fiÏ˘Ù· Ì ·˘Ù¤˜ Ô˘ ÛËÌÂÈÒıËÎ·Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, H ·ÎÚ›‚ÂÈ· Ù˘ Úfi‚Ï„˘ Â›Ó·È ÌÂÁ¿ÏË ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙȘ ÂÍ¿ÚÛÂȘ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ‹ ÙË ¯ÚÔÓÔÏÔÁÈ΋ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. ™ÙÔ ‰ÂÍÈfi ÙÌ‹Ì· (ÛÙÈÎÙ‹ ÁÚ·ÌÌ‹) Ê·›ÓÂÙ·È Ë Û‡Ìʈӷ Ì ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜ Úfi‚ÏÂ„Ë ÙˆÓ ÁÂÁÔÓfiÙˆÓ Î·Ù¿ ÙËÓ 10ÂÙ›· ·fi 2000 ̤¯ÚÈ ÙÔ 2010. H ÁÚ·ÌÌ‹ Ù¿Û˘ ‰Â›¯ÓÂÈ ÙËÓ ‚Ú·‰Â›· ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÚ˘ıÚ¿˜.

Yt=2,55848+0,276436t ™Â Â›ÚÚˆÛË ÙˆÓ ·ÓˆÙ¤Úˆ, Ë Úfi‚ÏÂ„Ë ÙÔ˘ Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ Ô˘ ÂÊ·ÚÌfiÛÙËÎÂ Â›Ó·È fiÙÈ, ÂÊfiÛÔÓ Ù· Ú¿ÁÌ·Ù· ·Ú·Ì›ÓÔ˘Ó ˆ˜ ¤¯Ô˘Ó Î·È ‰ÂÓ ÏËÊıÔ‡Ó ÚfiÛıÂÙ· ̤ÙÚ· ÂÓ›Û¯˘Û˘ Ù˘ ÚfiÏ˄˘ Ù˘ ÂÚ˘ıÚ¿˜, ÌÂÙ¿ ÙÔ ¤ÙÔ˜ 2000 ·Ó·Ì¤ÓÔÓÙ·È 2 ÂȉËÌÈΤ˜ ÂÍ¿ÚÛÂȘ Ù˘ ÓfiÛÔ˘ Ì ·ÚÈıÌfi ÂÈÛ·ÁˆÁÒÓ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ Ô˘ ı· Î˘Ì·›ÓÂÙ·È ·fi 1500 Ì 1700 ¿ÙÔÌ·, ËÏÈΛ·˜ 15-29 ¯ÚfiÓˆÓ (Û¯‹Ì· 5). Afi ·˘Ù¿, Ù· 1500 ÂÚ›Ô˘ ı· Â›Ó·È ¿Ó‰Ú˜ Î·È Ù· 100 ÂÚ›Ô˘ Á˘Ó·›Î˜.

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™¯‹Ì· 3. ™¯¤ÛË ÂÓ‹ÏÈΘ/ ·È‰È¿ (ËÏÈΛ·˜ <15 ¯ÚfiÓˆÓ) Ì ÂÚ˘ıÚ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ (Û˘Ó¯‹˜ ÁÚ·ÌÌ‹, ÛÙÔȯ›· Ù˘ E™Y) Î·È Ù¿ÛË ÂͤÏÈ͢ Ù˘ Û¯¤Û˘ Ô˘ ˘ÔÏÔÁ›ÛÙËΠ(‚¿ÛË Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘) ̤¯ÚÈ ÙÔ 2010. H ÁÚ·ÌÌ‹ Ù¿Û˘ ‰Â›¯ÓÂÈ ÙË ‚Ú·‰Â›· ÚÔԉ¢ÙÈ΋ ·‡ÍËÛ‹ Ù˘. ™˘˙‹ÙËÛË H ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÛÙÔȯ›ˆÓ Ù˘ E™Y Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÓÔÛËÏ¢ı¤ÓÙ˜ ·ÛıÂÓ›˜ Ì ÈÏ·Ú¿ Î·È ÂÚ˘ıÚ¿ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ ηٿ ÙË 15ÂÙ›· ·fi ÙÔ 1980 ̤¯ÚÈ ÙÔ 1994 ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·) Ó· ¤¯Ô˘Ì ÂÓ·ÚÁ‹ ÂÈÎfiÓ· ÙÔ˘ ÂȉËÌÈÔÏÔÁÈÎÔ‡ ·ÚfiÓÙÔ˜ Î·È ‚) Ó· ÚԂϤ„Ô˘Ì ÙË ÌÂÏÏÔÓÙÈ΋ ÂͤÏÈÍË ÛÙȘ ‰‡Ô ·˘Ù¤˜ ÏÔÈÌÒ‰ÂȘ ÓfiÛÔ˘˜ ¤Ú· ·fi ÙÔ ¤ÙÔ˜-ÔÚfiÛËÌÔ 2000. °ÂÓÈο, ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙËÓ ÈÏ·Ú¿, Ù· ÎÚÔ‡ÛÌ·Ù· ·ÎÔÏÔ˘ıÔ‡Ó Êı›ÓÔ˘Û· ÔÚ›·, ·Ú¿ ÙËÓ ÚfiÛÊ·ÙË ÂȉËÌ›· Ù˘ ÓfiÛÔ˘ ηٿ ÙÔ ¤ÙÔ˜ 1996, Î·È Û˘ÓÂÒ˜ ÌÔÚ› Ó· ıˆÚËı› fiÙÈ ÙÔ Ì¤¯ÚÈ Û‹ÌÂÚ· ÚfiÁÚ·ÌÌ· ÚfiÏ˄˘ Â›Ó·È ‚Ú·‰¤ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfi. Aӷ̤ÓÂÙ·È Ì¿ÏÈÛÙ· fiÙÈ ÌÂÙ¿ ÙÔ 2010 ÂÚ›Ô˘ Ó· ˘¿ÚÍÔ˘Ó ÂÚ›Ô‰ÔÈ Ì ÌˉÂÓÈΤ˜ ÂÈÛ·ÁˆÁ¤˜ ·ÛıÂÓÒÓ Ì ÈÏ·Ú¿, fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È Û ¿ÏϘ ¯ÒÚ˜.

AÓÙ›ıÂÙ·, ÛÙËÓ ÂÚ˘ıÚ¿ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ‚Ú·‰Â›·˜ ÚÔԉ¢ÙÈ΋˜ ·ÓÔ‰È΋˜ ÔÚ›·˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ ÙˆÓ ·Û¯fiÓÙˆÓ ·fi ÙË ÓfiÛÔ, ÙfiÛÔ ÛÙȘ ηٷÁÚ·Ì̤Ó˜ ̤¯ÚÈ ÙÔ 1994 ÂÈÛ·ÁˆÁ¤˜, fiÛÔ Î·È ÛÙȘ ÚÔ‚ÏÂfiÌÂÓ˜ ÁÈ· Ù· ÚÔÛ¯‹ ¤ÙË. E›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ì·ÎÚÔÚfiıÂÛÌ·, ÙÔ ÚfiÁÚ·ÌÌ· ÚfiÏ˄˘ Ù˘ ÂÚ˘ıÚ¿˜ Â›Ó·È ‚Ú·‰¤ˆ˜ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎfi. Y¤Ú Ù˘ ¿Ԅ˘ ·˘Ù‹˜ Â›Ó·È Ô ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜, fiˆ˜ Î·È Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘ Î·È Û˘Ó. (8), Û‡Ìʈӷ Ì ٷ ÔÔ›· ¯ÚÂÈ¿˙ÂÙ·È ¿ÌÂÛË ÂÓ›Û¯˘ÛË ÙˆÓ Ì¤ÙÚˆÓ ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘ (9). OÈ ÓÔÛËÏ¢fiÌÂÓÔÈ ÛÙ· ÓÔÛÔÎÔÌ›· ·ÛıÂÓ›˜ Â›Ó·È ÚÔÊ·ÓÒ˜ ÂΛÓÔÈ Ì ÙȘ ÂÓÙÔÓfiÙÂÚ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, fi¯È ηÙ' ·Ó¿ÁÎË ÂΛÓÔÈ Ô˘ ÓÔÛÔ‡Ó ‚·Ú‡ÙÂÚ·, ÁÂÁÔÓfi˜ Ô˘ Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, fiˆ˜ Û˘Ì‚·›ÓÂÈ Û fiÏ· Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·.

154

¢. AÏÂ͛Ԣ Î·È Û˘Ó.

H ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ·ÔÙ˘¯›·˜ ÛÙËÓ ·ÚÔ‡Û· ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ·) Ë ËÏÈΛ· ÚÔÛ‚ÔÏ‹˜ ÌÂÙ·ÎÈÓ‹ıËÎÂ Î·È ı· Û˘Ó¯›ÛÂÈ Ó· ÌÂÙ·ÎÈÓÂ›Ù·È ÚÔ˜ ÙÔ˘˜ Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ̤¯ÚÈ 30 ¯ÚfiÓˆÓ Î·È ‚) Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÚÚ¤ÓˆÓ Ô˘ ÓÔÛÔ‡Ó ·˘Í¿ÓÂÈ Û˘ÁÎÚÈÙÈο Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ıËϤˆÓ. TÔ Â‡ÚËÌ· ·˘Ùfi ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ ¶··ÁȈÙfiÔ˘ÏÔ˘ Î·È Û˘Ó. (8), ÔÈ ÔÔ›ÔÈ Ó·È ÌÂÓ ‰È·ÈÛÙÒÓÔ˘Ó ÌÂٷΛÓËÛË Ù˘ ηÌ‡Ï˘ ÚÔÛ‚ÔÏ‹˜ ÚÔ˜ ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, fi¯È fï˜ Î·È ÙËÓ ÚÔÛ‚ÔÏ‹ ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ·ÚÚ¤ÓˆÓ (10). ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ô Èfi˜ Ù˘ ÂÚ˘ıÚ¿˜ ‰ÂÓ ¤¯ÂÈ ÚÔÙ›ÌËÛË ÛÙÔ ¿ÚÚÂÓ Ê‡ÏÔ, Ë ÚÔÛ‚ÔÏ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·ÚÚ¤ÓˆÓ ÚÔÊ·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙÔ Û¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ÂÊ·ÚÌfiÛÙËΠ̤¯ÚÈ ÙÔ 1989. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ̤¯ÚÈ ÙfiÙ ٷ ·È‰È¿ ÂÌ‚ÔÏÈ·˙fiÙ·Ó Ì ÙÔ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÂÚ˘ıÚ¿˜ Î·È Î·Ù¿ ÚÔÙ›ÌËÛË Ù· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 11-12 ¯ÚfiÓˆÓ. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰È¿ÙÚˆÓ ¯ÚËÛÈÌÔÔÈ› ÙÔ ÔÏ˘‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ (MMR). TÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÚÔÔÙÈ΋ Ù˘ ÂͤÏÈ͢ Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘ ‚·Û›˙ÂÙ·È Û ۯ‹Ì· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙÔ ÔÔ›Ô ‰ÂÓ ÂÊ·ÚÌfi˙ÂÙ·È ϤÔÓ ÂÎÙÂٷ̤ӷ Èı·ÓfiÓ Ó· ÌÂÙ·‚¿ÏÂÈ ÌÂÚÈΤ˜ ·fi ÙȘ ·ÒÙÂÚ˜ ÚԂϤ„ÂȘ Ù˘ ·ÚÔ‡Û˘ ÂÚÁ·Û›·˜, fi¯È fï˜ Î·È ÙËÓ Úfi‚ÏÂ„Ë ÁÈ· Ù· ¿ÌÂÛ· ÚÔÛ¯‹ ¯ÚfiÓÈ·. ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û˘ ÂÚÁ·Û›·˜ Ë ·ÔÙ˘¯›· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ ÂÚ˘ıÚ¿˜ Èı·ÓfiÓ, ÂÊfiÛÔÓ Ù· ÛÙÔȯ›· Ù˘ E™Y ›ӷÈ

™¯‹Ì· 4. ÕÓ‰Ú˜ Ì ÂÚ˘ıÚ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ (Û˘Ó¯‹˜ ÁÚ·ÌÌ‹, ÛÙÔȯ›· Ù˘ E™Y) Î·È ÎÚÔ‡ÛÌ·Ù· Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó (‰È·ÎÂÎÔÌ̤ÓË ÁÚ·ÌÌ‹, ‚¿ÛË ÙÔ˘ Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘). K·Ù¿ ÙË 15ÂÙ›· 1980-1994 Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ·Ó‰ÚÒÓ Ì ÂÚ˘ıÚ¿ ÂÏ¿¯ÈÛÙ· ‰È·Ê¤ÚÂÈ ÙˆÓ Ú·ÁÌ·ÙÈÎÒÓ ¯ÚÔÓÔÏÔÁÈο Î·È ·ÚÈıÌËÙÈο. OÈ ÂÍ¿ÚÛÂȘ Û˘Ì›ÙÔ˘Ó ·fiÏ˘Ù· Ì ·˘Ù¤˜ Ô˘ ÛËÌÂÈÒıËÎ·Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. H ·ÎÚ›‚ÂÈ· Ù˘ Úfi‚Ï„˘ Â›Ó·È ÌÂÁ¿ÏË ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙȘ ÂÍ¿ÚÛÂȘ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ‹ ÙË ¯ÚÔÓÔÏÔÁÈ΋ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. ™ÙÔ ‰ÂÍÈfi ÙÌ‹Ì· (ÛÙÈÎÙ‹ ÁÚ·ÌÌ‹) Ê·›ÓÂÙ·È Ë Û‡Ìʈӷ Ì ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜ Úfi‚ÏÂ„Ë ÙˆÓ ÁÂÁÔÓfiÙˆÓ Î·Ù¿ ÙËÓ 10ÂÙ›· ·fi 2000 ̤¯ÚÈ ÙÔ 2010. H ÁÚ·ÌÌ‹ Ù¿Û˘ ‰Â›¯ÓÂÈ ÙËÓ ‚Ú·‰Â›· ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÚ˘ıÚ¿˜.

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¶ÚÔÔÙÈΤ˜ ÚfiÏ˄˘ ÈÏ·Ú¿˜ - ÂÚ˘ıÚ¿˜

ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜, ÒÛÙ ӷ ÚԂϤÂÙ·È fiÙÈ ÌÂÙ¿ ÙÔ ¤ÙÔ˜ 2005 ÔÈ ÂÈÛ·ÁˆÁ¤˜ ·Û¯fiÓÙˆÓ ·fi ÈÏ·Ú¿ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ ηٿ ÂÚÈfi‰Ô˘˜ ı· ÌˉÂÓ›˙ÔÓÙ·È, ÂÓÒ ·ÓÙ›ıÂÙ· Ë ÚfiÏË„Ë Ù˘ ÂÚ˘ıÚ¿˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ‚Ú·‰¤ˆ˜ ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ¯ÚÂÈ¿˙ÂÙ·È ¿ÌÂÛË ÂÓ›Û¯˘ÛË, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌËÓ ¤¯Ô˘Ì Â·Ó¿ÏË„Ë Ù˘ ÚfiÛÊ·Ù˘, ηٿ ÙÔ 1993, η΋˜ ÂÌÂÈÚ›·˜. H ·Ó¿ÁÎË ¿ÌÂÛ˘ ·Ó·ıÂÒÚËÛ˘ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ ÂÓ·ÓÙ›ÔÓ Ù˘ ÂÚ˘ıÚ¿˜ ¤¯ÂÈ ÙÔÓÈÛÙ› Â·ÓÂÈÏËÌ̤ӷ Î·È ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ (11-14).

BÈ‚ÏÈÔÁÚ·Ê›·

™¯‹Ì· 5. °˘Ó·›Î˜ Ì ÂÚ˘ıÚ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ (Û˘Ó¯‹˜ ÁÚ·ÌÌ‹, ÛÙÔȯ›· Ù˘ E™Y) Î·È ÎÚÔ‡ÛÌ·Ù· Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó (‰È·ÎÂÎÔÌ̤ÓË ÁÚ·ÌÌ‹, ‚¿ÛË ÙÔ˘ Ì·ıËÌ·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘). K·Ù¿ ÙË 15ÂÙ›· 19801994 Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ Á˘Ó·ÈÎÒÓ Ì ÂÚ˘ıÚ¿ ÂÏ¿¯ÈÛÙ· ‰È·Ê¤ÚÂÈ ÙˆÓ Ú·ÁÌ·ÙÈÎÒÓ ¯ÚÔÓÔÏÔÁÈο Î·È ·ÚÈıÌËÙÈο. OÈ ÂÍ¿ÚÛÂȘ Û˘Ì›ÙÔ˘Ó ·fiÏ˘Ù· Ì ·˘Ù¤˜ Ô˘ ÛËÌÂÈÒıËÎ·Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. H ·ÎÚ›‚ÂÈ· Ù˘ Úfi‚Ï„˘ Â›Ó·È ÌÂÁ¿ÏË ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙȘ ÂÍ¿ÚÛÂȘ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ‹ ÙË ¯ÚÔÓÔÏÔÁÈ΋ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. ™ÙÔ ‰ÂÍÈfi ÙÌ‹Ì· (ÛÙÈÎÙ‹ ÁÚ·ÌÌ‹) Ê·›ÓÂÙ·È Ë Û‡Ìʈӷ Ì ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜ Úfi‚ÏÂ„Ë ÙˆÓ ÁÂÁÔÓfiÙˆÓ Î·Ù¿ ÙËÓ 10ÂÙ›· ·fi 2000 ̤¯ÚÈ ÙÔ 2010. H ÁÚ·ÌÌ‹ Ù¿Û˘ ‰Â›¯ÓÂÈ ÙËÓ ‚Ú·‰Â›· ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÚ˘ıÚ¿˜.

Ú·ÁÌ·ÙÈο, ÔÊ›ÏÂÙ·È ÛÙË ÌË Ú·ÁÌ·ÙÔÔ›ËÛË Â·Ó·ÏËÙÈÎÔ‡ ‹ ÙÔÓ ÌË ÂÌ‚ÔÏÈ·ÛÌfi ÂÓ·ÓÙ›ÔÓ Ù˘ ÂÚ˘ıÚ¿˜ ÙˆÓ ·ÚÚ¤ÓˆÓ Ù¤ÎÓˆÓ. EÎÙÂٷ̤ÓË ·Ó·ÊÔÚ¿ ÙˆÓ ÌÂıfi‰ˆÓ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ ηٿ Ù˘ ÓfiÛÔ˘ ˘¿Ú¯ÂÈ ÛÙËÓ ¤ÎıÂÛË ÙÔ˘ IÓÛÙÈÙÔ‡ÙÔ˘ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÁÈ· ÙËÓ ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÛÙË ¯ÒÚ· Ì·˜ (10).

AÓ·ÊÔÚÈο Ì ÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ - fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙËÓ ¤ÎıÂÛË ÙÔ˘ IÓÛÙÈÙÔ‡ÙÔ˘ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ - Ë ÌÂÙ·ÙfiÈÛË Ù˘ ËÏÈΛ·˜ ÓfiÛËÛ˘ ·fi ÙËÓ ·È‰È΋ ÚÔ˜ ÙȘ ·Ó··Ú·ÁˆÁÈΤ˜ Û˘ÓÈÛÙ¿ ΛӉ˘ÓÔ ·‡ÍËÛ˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜, ·Ú¿ ÙÔÓ ÌÈÎÚfi ·ÚÈıÌfi ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛ‚ÏËıÔ‡Ó, ÒÛÙ ÙÂÏÈο Â›Ó·È Èı·Ófi, fiˆ˜ Û˘Ó¤‚Ë ÙÔ 1993, Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ Ô˘ ı· ÚÔÛ‚ÏËıÔ‡Ó ·fi ÙÔÓ Èfi Ó· Â›Ó·È fi¯È ÌÂȈ̤ÓÔ˜ ·ÏÏ¿ ·˘ÍË̤ÓÔ˜ Û¯ÂÙÈο Ì ÙÔ ·ÚÂÏıfiÓ, ÂÓÒ ÙÔ fiÏÔ Û‡ÛÙËÌ· ÚfiÏ˄˘ Ù˘ ÂÚ˘ıÚ¿˜ ı· ¤¯ÂÈ Î·Ù·Ï‹ÍÂÈ Û ·Ù·ÁÒ‰Ë Î·È Ù·˘Ùfi¯ÚÔÓ· ÙÚ·ÁÈ΋ ·ÔÙ˘¯›·. ™˘ÌÂÚ·ÛÌ·ÙÈο, ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û˘ ·Ó¿Ï˘Û˘ ÚÔ·ÙÂÈ fiÙÈ Ë ÚfiÏË„Ë Ù˘ ÈÏ·Ú¿˜ ‚Ú›ÛÎÂÙ·È Û ηÏfi ‰ÚfiÌÔ, Ì ‚Ú·‰‡ Ú˘ıÌfi ıÂÙÈ΋˜ ·Ô-

1. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T, AÓÙˆÓÈ¿‰Ô˘ I., B·Ï¿ÛÛË-A‰¿Ì E. EȉËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993 ÛÙËÓ EÏÏ¿‰·. K·Ù·ÁÚ·Ê‹ 25 ÂȂ‚·ÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛˆÓ. ¶·È‰È·ÙÚÈ΋ 1997;60:502-591.

2. TÛ·ÓٛϷ K, MfiÚ· X, £ÂÔ‰ˆÚ›‰Ô˘ M, MÔÛÙÚÔ‡ °, AÏÂ͛Ԣ ¢, K·ÙÙ¿Ì˘ X. ™ÙÔȯ›· ·fi ÙË ÓÔÛËÏ›· ·È‰ÈÒÓ Ì ÈÏ·Ú¿ ηٿ ÙËÓ ÂȉËÌÈ΋ ¤Í·ÚÛË ÙÔ˘ 1996. ¶·È‰È·ÙÚÈ΋ 1999;62:305-309.

3. ¢·Ì·ÏÈÛÌfi˜, ÂÌ‚fiÏÈ·: ·ÓÙÈÌËÓÈÁÁÈÙȉÈÎfi, ÈÏ·Ú¿˜, ÂÚ˘ıÚ¿˜ Î·È ·ÚˆÙ›Ùȉ·˜, MMR. 10Ë ÂÙ‹ÛÈ· ıÂÚ·¢ÙÈ΋ ÂÓË̤ڈÛË, AÚ›ÏÈÔ˜ 1977. ¢ÂÏÙ›Ô A' ¶·È‰. KÏÈÓ. ¶·Ó/Ì›Ô˘ AıËÓÒÓ 1981;28 (·Ú¿ÚÙËÌ·):104-135.

4. EÌ‚fiÏÈ· 1980. 13Ë ÂÙ‹ÛÈ· ıÂÚ·¢ÙÈ΋ ÂÓË̤ڈÛË ,AÚ›ÏÈÔ˜ 1980. ¢ÂÏÙ›ÈÔ A' ¶·È‰. KÏÈÓ. ¶·Ó/Ì›Ô˘ AıËÓÒÓ 1981;28 (·Ú¿ÚÙËÌ·): 116-143.

5. YÔ˘ÚÁÂ›Ô Y¶KA. EıÓÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ÙËÓ EÏÏ¿‰·, Aı‹Ó· 1991.

6. Moore DS, McCabe GP. Introduction to the practice of statistics. 3rd ed. New York: WH Freeman and Co,1999;21-23.

7. Meyer R, Krueger D. A minitab guide to statistics. London: Simon and Schuster 1998;349-356.

8. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T, AÓÙˆÓÈ¿‰Ô˘ I, AÓÙˆÓÔÔ‡ÏÔ˘ E, °ÎfiÁÎÔÁÏÔ˘ B, T·Ô˘Û¿ÓË ™ Î·È Û˘Ó. EȉËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ 1993. A‡ÍËÛË Ù˘ ËÏÈΛ·˜ ÓfiÛËÛ˘ ÛÙËÓ AÙÙÈ΋. AÚ¯ EÏÏ I·ÙÚ 1996;13:211-219.

9. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T, AÓÙˆÓÈ¿‰Ô˘ I, B·Ï¿ÛÛË-A‰¿Ì E. EȉËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993 ÛÙËÓ EÏÏ¿‰·. K·Ù·ÁÚ·Ê‹ 25 ÂȂ‚·ÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛˆÓ. ¶·È‰È·ÙÚÈ΋ 1997;60:582-591.

10. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T, AÓÙˆÓÈ¿‰Ô˘ I, B·Ï¿ÛÛË-A‰¿Ì E. MÂÁ¿ÏË ÂȉËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993 ÛÙËÓ EÏÏ¿‰·.

E›ÁÔÓ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜. ŒÎıÂÛË ÌÂϤÙ˘ ÙÔ˘ IÓÛÙÈÙÔ‡ÙÔ˘ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, Aı‹Ó·, ¢ÂΤ̂ÚÈÔ˜ 1995.

11. A‰¿Ì E. EÌ‚fiÏÈ· 1980. ¢ÂÏÙ›Ô A' ¶·È‰ KÏÈÓ. ¶·Ó/Ì›Ô˘ AıËÓÒÓ 1981;28 (·Ú¿ÚÙËÌ·):116-120.

12. ™ÙÂÊ¿ÓÔ˘ £. ¢ÈÂÓ¤ÚÁÂÈ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·ÚˆÙ›Ùȉ·˜ Î·È ÂÚ˘ıÚ¿˜ ÛÙË ÓËȷ΋ ËÏÈΛ·. YY¶KA. ¢È¢ı/ÛË ¢ËÌfiÛÈ·˜ YÁÈÂÈÓ‹˜ A4/8746/22.9.86.

13. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T. EÎÙ›ÌËÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡. Materia Medica Greca 1990;18:28-33.

14. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T. YÁ›· ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·. EÈÎfiÓ· ÓÔÛËÚfiÙËÙ·˜ Î·È ·Ó¿ÁΘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜. Aı‹Ó·: ÿ‰Ú˘Ì· EÚ¢ÓÒÓ ÁÈ· ÙÔ ·È‰›.

1991;124-136.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-06-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-11-1999 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢. AÏÂ͛Ԣ KÏÂÈÔ‡˜ 13, 155 61 XÔÏ·ÚÁfi˜

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K§INIKH EM¶EIPIA

¶ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙÔ˘ ™˘ÁÁÂÓÔ‡˜ EÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ IÛ¯›Ô˘ (™EI) Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁ¤ÓÓËÙ· I¿ÛˆÓ K. NÙÔ˘ÓÙÔ˘Ï¿Î˘

● ¶ÂÚ›ÏË„Ë: EÍÂÙ¿ÛÙËÎ·Ó ·fi ÙÔÓ Û˘ÁÁڷʤ·, ÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙÔÓ ÙÔÎÂÙfi, 61.427 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁ¤ÓÓËÙ· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ MHTEPA ÛÙÔ ‰È¿ÛÙËÌ· 1990-1994. ™Â 462 ÓÂÔÁ¤ÓÓËÙ· (7,5ò) 584 ÈÛ¯›·, ‚Ú¤ıËΠıÂÙÈÎfi ÙÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani ‹ ÙÔ ÛËÌÂ›Ô ÙÔ˘ Barlow. Afi ·˘Ù¿ 146 (31,6%) ›¯·Ó ÁÂÓÓËı› Ì Èۯȷ΋ ÚÔ‚ÔÏ‹. YÂÚ˯ÔÁÚ¿ÊËÌ· ¤ÁÈÓ ÌfiÓÔ Û ÓÂÔÁÓ¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Û˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ· ÈÛ¯›Ô˘ ™EI. ™Â 36 ÈÛ¯›· Ë ‰È¿ÁÓˆÛË ™EI ¤ÁÈÓ ηٿ ÙË ‰Â‡ÙÂÚË ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ 5Ô 24ˆÚÔ ˙ˆ‹˜ ÂÓÒ Â›¯Â ‰È·Ê‡ÁÂÈ ÛÙËÓ ÚÒÙË ÂͤٷÛË. TÔ ™EI ‚Ú¤ıËÎÂ Û˘¯ÓfiÙÂÚ· Û ÎÔÚ›ÙÛÈ·, Û ÓÂÔÁ¤ÓÓËÙ· Ì Èۯȷ΋ ÚÔ‚ÔÏ‹, Î·È Ì ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË. ŒÓ· ÛÔ˘‰·›Ô ÎÏÈÓÈÎfi ÛËÌÂ›Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ™EI ‹Ù·Ó ÙÔ ‚¿ıÔ˜ Ù˘ ÌËÚÔ‚Ô˘‚ˆÓÈ΋˜ Ù˘¯‹˜. ¢ÂÓ ‚Ú¤ıËΠηӤӷ ÂÍ·Úıڈ̤ÓÔ ÈÛ¯›Ô ÌË ·Ó·Ù¿ÍÈÌÔ. H ıÂÚ·›· ÁÈÓfiÙ·Ó Ì ˘Ê·ÛÌ¿ÙÈÓ˜ ¿Ó˜ Û fiÏ· Ù· ÂÍ·Úıڈ̤ӷ Î·È ·ÛÙ·ı‹ ÈÛ¯›·. TÔ 95,5% ÙˆÓ ÈÛ¯›ˆÓ Ì ™EI Ô˘ ¿Ú¯ÈÛ·Ó Î·ÓÔÓÈο ıÂÚ·›· ÙÔ ÚÒÙÔ 24ˆÚÔ ‚Ú¤ıËÎ·Ó ÛÙ·ıÂÚ¿ ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙËÓ ÎÏÈÓÈ΋. ŸÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· Ì ÛÙ·ıÂÚ¿ ÈÛ¯›· ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙËÓ ÎÏÈÓÈ΋ Î·È ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ Û˘Ó¤¯ÈÛ·Ó Î·ÓÔÓÈο ÙË ıÂÚ·›· ÛÙÔ Û›ÙÈ, ›¯·Ó ÛÙ·ıÂÚ¿ Ù· ÈÛ¯›· ÙÔ˘˜ ÛÙËÓ Â·ÓÂͤٷÛË. EÈÏÔΤ˜ fiˆ˜ ÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË Ù˘ ÌËÚÈ·›·˜ ÎÂÊ·Ï‹˜, Ô˘ Ó· ÔÊ›ÏÂÙ·È ÛÙË ıÂÚ·›·, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó Û ηӤӷ ·fi Ù· ÓÂÔÁÓ¿ Ô˘ Â·ÓÂÍÂÙ¿ÛÙËηÓ. ™Â 10 ÓÂÔÁ¤ÓÓËÙ· ÔÈ ÌËÙ¤Ú˜ ‰È¤ÎÔ„·Ó ÙË ıÂÚ·›· ÌfiÏȘ ‹Á·Ó ÛÙÔ Û›ÙÈ Î·È Ù· ÈÛ¯›· Â·ÓÂÍ·ÚıÚÒıËηÓ. Afi ·˘Ù¿ Ù· ÙÚ›· ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ÁÈ· ·ÔηٿÛÙ·ÛË ÙÔ˘ ÂÍ·ÚıÚ‹Ì·ÙÔ˜. ¶·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó 296 ‚Ú¤ÊË (64%) ̤¯ÚÈ ÙËÓ ËÏÈΛ· Ù˘ ‚¿‰ÈÛ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:156-162. §¤ÍÂȘ ÎÏÂȉȿ: ™˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ·, ÓÂÔÁÓ¿, ‰È¿ÁÓˆÛË.

J.K. Doudoulakis. Early diagnosis and treatment of congenital dislocation of the hip (CDH) in newborn, full term babies. Paediatriki 2000;63:156-162. ● Abstract: Over a period of five years (1990-1994), the author examined 61,427 newborn full term babies at MITERA Hospital within 24 hours of birth. In 462 babies (7.5ò), 584 hips were found to have positive Ortolani or Barlow test. None of the dislocated hips were irreducible within 24 hours of birth. One third of the dislocated hips were diagnosed in babies born with breech presentation. Ultrasonography was not performed routinely, but only in babies with a high risk of congenital dislocation of the hip (CDH). In 36 hips (6%) the dislocation was not elicited clinically at the first examination but it was found 5 days later at the second examination before discharge. An important clinical sign for the diagnosis is the deep femoral groin crease. Predisposing factors for CDH, apart from breech presentation, were the female sex of the baby and the family history. Treatment was initiated immediately,using towelling nappies in all babies with dislocated or unstable hips and 95.5% of the hips with CDH were found to be stable within five days of the start of treatment. Complications such as avascular necrosis due to treatment were not found. All re-examined babies with stable hips on discharge from the clinic, whose treatment was continued at home, were found to have stable hips on re-examination 40 days later. In 10 babies the treatment was stopped at home and the hips re-dislocated, of which three required open reduction for treatment. It was possible to follow up 296 (64% of those with CDH) babies until walking age.

Key words: congenital dislocation, newborn, diagnosis.

M·È¢ÙÈÎfi Î·È XÂÈÚÔ˘ÚÁÈÎfi K¤ÓÙÚÔ MHTEPA

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EÈÛ·ÁˆÁ‹ H ÚÔÏËÙÈ΋ ÓÂÔÁÓÈ΋ ÂͤٷÛË Ô˘ Á›ÓÂÙ·È Û˘ÛÙËÌ·ÙÈο Û‹ÌÂÚ·, Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ, ·ÏÏ¿ Î·È Ë ‚Ô‹ıÂÈ· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÙˆÓ ÈÛ¯›ˆÓ, ¤¯Ô˘Ó Û·Ó Û˘Ó¤ÂÈ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ·Ú·ÌÂÏËÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ (™EI) Ô˘ ‚Ϥ·Ì ·Ï·ÈfiÙÂÚ·. H ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙˆÓ ·ÛÙ·ıÒÓ ÈÛ¯›ˆÓ Â›Ó·È ·˘Ù‹ Ô˘ ÌÂÈÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ™EI(1-3).

H ÛÔ˘‰·ÈfiÙÂÚË ÚfiÔ‰Ô˜ ÛÙËÓ ÈÛÙÔÚ›· ÙÔ˘ ™EI ‹Ù·Ó Ë ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· fiˆ˜ ÚÔÙ¿ıËΠ·fi ÙÔ˘˜ Ortolani (1937), Von Rosen (1956) Î·È Palmen (1961).(1,4,5) ŸÌˆ˜, ·Ú¿ ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙÔ˘ ™EI ‰ÂÓ Ï‡ıËÎ·Ó fiÏ· Ù· ÚÔ‚Ï‹Ì·Ù· Ù˘ ¿ıËÛ˘ ·˘Ù‹˜. E›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÚÈṲ̂ӷ ÈÛ¯›· ·Ú¿ ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›·, ‰ÂÓ ÛÙ·ıÂÚÔÔÈÔ‡ÓÙ·È Î·È ¯ÚÂÈ¿˙ÔÓÙ·È ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›·.(6,8) T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÈÂıÓÒ˜ Ô fiÚÔ˜ Congenital Dislocation of the Hip (CDH) ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› ·fi ÙÔÓ fiÚÔ Developmental Dyspasia of the Hip (DDH).(9,10) E›Ó·È ¤Ó·˜ fiÚÔ˜ Ô ÔÔ›Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÂÍ¿ÚıÚËÌ·, ÙÔ ˘ÂÚ¿ÚıÚËÌ· ·ÏÏ¿ Î·È ÙË ‰˘ÛÏ·Û›· Ù˘ ÎÔÙ‡Ï˘. ¶ÔÏÏÔ› Û˘ÁÁÚ·Ê›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ÂÍ¿ÚıÚËÌ· ‰ÂÓ Â›Ó·È ¿ÓÙ· Û˘ÁÁÂÓ¤˜ ·ÏÏ¿ ÔÏϤ˜ ÊÔÚ¤˜ ·Ó·Ù‡ÛÛÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi.(9,10) H ‰È¿ÁÓˆÛË ÙÔ˘ ™EI ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Â›Ó·È Î˘Ú›ˆ˜ ÎÏÈÓÈ΋.(3,11-14) H ÎÏÈÓÈ΋ ÂͤٷÛË ÙˆÓ ÓÂÔÁÓÈÎÒÓ ÈÛ¯›ˆÓ ·Ó·Î·Ï‡ÙÂÈ 4 ˆ˜ 20 ·ÛÙ·ı‹ ÈÛ¯›· ÛÙ· 1000 ˙ÒÓÙ· ÓÂÔÁ¤ÓÓËÙ·.(15) Afi ·˘Ù¿ ı· ÛÙ·ıÂÚÔÔÈËıÔ‡Ó ÙÔ 50-60% ̤۷ ÛÙËÓ 1Ë Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜ ¯ˆÚ›˜ η̛· ıÂÚ·›·.(2,16,17) K·Ù¿ ÙÔÓ Andren(16) Â¿Ó Ë ÎÏÈÓÈ΋ ÂͤٷÛË ÙˆÓ ÈÛ¯›ˆÓ Á›ÓÂÈ ÌÂÙ¿ ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜, Ë ‰È¿ÁÓˆÛË Â›Ó·È ·Ó·ÍÈfiÈÛÙË Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·‚‚·›ˆÛË fiÙÈ Ù· ÈÛ¯›· Ô˘ ÛÙ·ıÂÚÔÔÈ‹ıËÎ·Ó ·fi ÌfiÓ· ÙÔ˘˜, ‰ÂÓ ı· ÂÍ·ÚıÚˆıÔ‡Ó ¿ÏÈ ·Ó ·ÊÂıÔ‡Ó ¯ˆÚ›˜ ıÂÚ·›·. °È· ·˘Ùfi ÔÏÏÔ› ÚÔÙ›ÓÔ˘Ó Ó· ÂÍÂÙ¿˙ÔÓÙ·È fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· ÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Î·È Ó· ıÂÚ·‡ÔÓÙ·È fiÏ· Ù· ÈÛ¯›· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÛÙ¿ıÂÈ·.(16,18,19) K·Ù¿ ÙÔÓ Barlow, Â¿Ó Ë ÂͤٷÛË ÙˆÓ ÈÛ¯›ˆÓ Á›ÓÂÈ Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Û ¤Ó· ·ÚÈıÌfi ÓÂÔÁÓÒÓ Ì ÂÍ·Úıڈ̤ӷ ÈÛ¯›·, Ë ·ÛÙ¿ıÂÈ· ϤÔÓ ‰ÂÓ Ê·›ÓÂÙ·È, ÏfiÁˆ Û˘ÚÚ›ÎÓˆÛ˘ ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ·ÏÏ¿ ÂΉËÏÒÓÂÙ·È Û·Ó ÌÂȈ̤ÓË ··ÁˆÁ‹ ÙˆÓ ÈÛ¯›ˆÓ.(2) ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÌÂÈÚ›· ÙÔ˘ Û˘ÁÁڷʤ· ·fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË 61.427 ÓÂÔÁ¤ÓÓËÙˆÓ Ô˘ ¤¯ÂÈ ÂӉȷʤÚÔÓ fi¯È ÌfiÓÔ ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·ÏÏ¿ Î·È ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 1Ô Î·È ÙÔ 5Ô 24ˆÚÔ Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ·fi ÙÔ ›‰ÈÔ ¿ÙÔÌÔ. O ·ÚÈıÌfi˜ ·˘Ùfi˜ ·ÓÙÈÚÔÛˆ‡ÂÈ ¿Óˆ ·fi 12% ÙˆÓ ÙÔÎÂÙÒÓ

¶ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ™EI

Ù˘ ÂÓÙ·ÂÙ›·˜ Û fiÏË ÙËÓ EÏÏ¿‰·.

YÏÈÎfi - ̤ıÔ‰ÔÈ ¶ÏËı˘ÛÌfi˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ÌÂϤÙË: EÍÂÙ¿ÛÙËÎ·Ó ÚÔÁÚ·ÌÌ·ÙÈṲ̂ӷ ·fi ÙÔÓ Û˘ÁÁڷʤ·, fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ MHTEPA, ÙËÓ ÂÓÙ·ÂÙ›· 1990-1994, ÂÎÙfi˜ ·fi ·˘Ù¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË MÔÓ¿‰· ¶ÚÔÒÚˆÓ. ™ÙÔȯ›· ÈÛÙÔÚÈÎÔ‡: ™Â fiÏ· Û˘ÌÏËÚÒÓÔÓÙ·Ó ÛÙÔȯ›· ÁÈ· ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÚÔ‚ÔÏ‹ ÙÔÎÂÙÔ‡, ˘‰Ú¿ÌÓÈÔ, ÔÏÈÁÔ¿ÌÓÈÔ, ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ™EI, ηÓÈÛÙÈΤ˜ Û˘Ó‹ıÂȘ ÌËÙ¤Ú·˜, ËÏÈΛ· ÌËÙ¤Ú·˜.

KÏÈÓÈ΋ ÂͤٷÛË: H ÂͤٷÛË ÁÈÓfiÙ·Ó Û fiÏ· Ù· ·È‰È¿ ÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙË Á¤ÓÓËÛË Î·È Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ M·ÈÂ˘Ù‹ÚÈÔ, Û˘Ó‹ıˆ˜ ÙÔ ¤ÌÙÔ 24ˆÚÔ ˙ˆ‹˜.

MÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó 64% fiÛˆÓ Â›¯·Ó ™EI, ÛÙȘ 30-40 ̤Ú˜, ÛÙÔ˘˜ 3 Ì‹Ó˜, ÛÙÔ˘˜ 6 Ì‹Ó˜ Î·È ÛÙËÓ ËÏÈΛ· ‚¿‰ÈÛ˘.

H ÎÏÈÓÈ΋ ÂͤٷÛË ÂÚÈÏ¿Ì‚·Ó ·Ó·˙‹ÙËÛË ÙÔ˘ ÛËÌ›Ԣ Ortolani, ÙÔ˘ ÛËÌ›Ԣ Barlow, Ù˘ ÌÂÁ¿Ï˘ Ì›ˆÛ˘ Ù˘ ··ÁˆÁ‹˜ ÙˆÓ ÈÛ¯›ˆÓ, ‚·ıÈ¿˜ ÌËÚÔ‚Ô˘‚ˆÓÈ΋˜ Ù˘¯‹˜, Î·È ‚Ú¿¯˘ÓÛ˘ ÙÔ˘ ÛΤÏÔ˘˜.

TÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani, ·Ó·Î·Ï‡ÙÂÈ Ù· ÂÍ·Úıڈ̤ӷ ÈÛ¯›· ÂÓÒ ÙÔ˘ Barlow Ù· ·ÛÙ·ı‹ ‹ ÂÍ·ÚıÚÒÛÈÌ· ÈÛ¯›·. TÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani Â›Ó·È Ë ·›ÛıËÛË Ù˘ ·Ó·‹‰ËÛ˘ ÙÔ˘ ÈÛ¯›Ô˘ fiÙ·Ó ·˘Ùfi ·Ó·Ù¿ÛÛÂÙ·È ·fi ÙËÓ ÂÍ·Úıڈ̤ÓË ı¤ÛË. TÔ ÛËÌÂ›Ô ÙÔ˘ Barlow Â›Ó·È ·ÓÙ›ıÂÙÔ ÛÙËÓ ÂÎÙ¤ÏÂÛ‹ ÙÔ˘ ·fi ÙÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani. E‰Ò Ȥ˙Ô˘Ì ٷ ÈÛ¯›· Ô˘ Â›Ó·È ÛÂ Î¿Ì„Ë Î·È ··ÁˆÁ‹ ÚÔ˜ Ù· Ô›Ûˆ, ÙËÓ ÒÚ· Ô˘ Ù· ʤÚÓÔ˘Ì Û ÚÔÛ·ÁˆÁ‹, ÒÛÙ ӷ ÂÍ·ÚıÚˆıÔ‡Ó. ŒÙÛÈ ¤¯Ô˘Ì ̛· ·›ÛıËÛË ·ÛÙ¿ıÂÈ·˜ ÙÔ˘ ÈÛ¯›Ô˘ ÙËÓ ÒÚ· Ô˘ Ë ÌËÚÈ·›· ÎÂÊ·Ï‹ ‚Á·›ÓÂÈ ¤Íˆ ·fi ÙËÓ ÎÔÙ‡ÏË. K·È Ù· ‰‡Ô ·˘Ù¿ ÛËÌ›· fiÙ·Ó ‚ÚÂıÔ‡Ó ˘Ô‰ËÏÒÓÔ˘Ó ÂÍ¿ÚıÚËÌ· ÙÔ˘ ÈÛ¯›Ô˘. ™ÙË ÌÂϤÙË ·˘Ù‹ ÂÚÈÏ‹ÊıËÎ·Ó ÌfiÓÔ ÓÂÔÁÓ¿, Ô˘ ›¯·Ó ıÂÙÈÎfi ÙÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani ‹ ÙÔ ÛËÌÂ›Ô ÙÔ˘ Barlow.

YÂÚ˯ÔÁÚ¿ÊËÌ· ÈÛ¯›ˆÓ ÁÈÓfiÙ·Ó ÌfiÓÔ Û ÓÂÔÁ¤ÓÓËÙ· Î·È ‚Ú¤ÊË Ì ·Û·Ê‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Ì ‚·ıÈ¿ ÌËÚÔ‚Ô˘‚ˆÓÈ΋ Ù˘¯‹, Î·È ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Ì ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË. E›Û˘ ¤ÁÈÓ Û ÔÚÈṲ̂ӷ ÈÛ¯›· Ì ıÂÙÈÎfi ÙÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani ‹ ÙÔ˘ Barlow ÁÈ· ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ‰‡Ô ÌÂıfi‰ˆÓ.

AÎÙÈÓÔÁÚ·Ê›· ÈÛ¯›ˆÓ ÁÈÓfiÙ·Ó ÛÙËÓ ÂͤٷÛË ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÙÔ˘˜ 3 Ì‹Ó˜ Î·È Â¿Ó ‰ÂÓ Â›¯·Ó ÂÌÊ·ÓÈÛÙ› ˘Ú‹Ó˜ ÔÛÙÂÒÛˆ˜ ‹ ˘‹Ú¯Â ‰˘ÛÏ·Û›· Ù˘ ÎÔÙ‡Ï˘ Â·Ó·Ï·Ì‚·ÓfiÙ·Ó ÛÙÔ˘˜ 6 Ì‹Ó˜.

H ıÂÚ·›· ¿Ú¯È˙ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË Ì ˘Ê·ÛÌ¿ÙÈÓ˜ ¿Ó˜ ·ÚÎÂÙ¤˜ ÒÛÙ ӷ ÎÚ·ÙÔ‡Ó Ù· ÈÛ¯›·

157

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™ÂÏ›‰·158

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I. K. NÙÔ˘ÓÙÔ˘Ï¿Î˘

EÈÎfiÓ· 1Á. Ro Ì ÙȘ ¿Ó˜ Î·È Ù· ÈÛ¯›· Û ı¤ÛË ·Ó¿Ù·Í˘.

EÈÎfiÓ· 1·. Ro ÈÛ¯›ˆÓ Û ÓÂÔÁ¤ÓÓËÙÔ ‰Â›¯ÓÔÓÙ·˜ ·ÌÊÔÙÂÚfiÏ¢ÚÔ ÂÍ¿ÚıÚËÌ·.

EÈÎfiÓ· 1‚. ¶¿Ó˜ Ì ٷ ÈÛ¯›· Û ··ÁˆÁ‹.

Û ··ÁˆÁ‹ Î·È Î¿Ì„Ë (EÈÎfiÓ˜ 1·, 1‚, 1Á) Î·È ‰È·ÚÎÔ‡Û 2-3 Ì‹Ó˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È Ù· ˘ÂÚ˯ÔÁÚ·ÊÈο ‹ ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ™ÙËÓ Â·ÓÂͤٷÛË ÙˆÓ 3 ÌËÓÒÓ ÁÈÓfiÙ·Ó ·ÎÙÈÓÔÁÚ·Ê›· ÈÛ¯›ˆÓ Î·È ·Ó Â¤ÌÂÓÂ Ë ÂÈÎfiÓ· ‰˘ÛÏ·Û›·˜ Ù˘ ÎÔÙ‡Ï˘ ·Ú·ÙÂÈÓfiÙ·Ó Ë ıÂÚ·›· Ì ¿Ó˜ ̤¯ÚÈ Ó· ‰ÈÔÚıˆı› ·˘Ù‹. ¢ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î·ÓÂÓfi˜ ›‰Ô˘˜ ÎˉÂÌfiÓ˜.

AÔÙÂϤÛÌ·Ù· 1. E˘Ú‹Ì·Ù· EÍÂÙ¿ÛÙËÎ·Ó 61.427 ÓÂÔÁ¤ÓÓËÙ·, 31.502 (51,2%) ·ÁfiÚÈ·, 29.925 (48,7%) ÎÔÚ›ÙÛÈ·. M Èۯȷ΋ ÚÔ‚ÔÏ‹ ›¯·Ó ÁÂÓÓËı› 2.095 (3,4%), (·ÁfiÚÈ· 47,6%, ÎÔÚ›ÙÛÈ· 53,4%). £ÂÙÈο ÛÙÔȯ›· ™EI ›¯·Ó Û˘ÓÔÏÈο 462 ÓÂÔÁ¤ÓÓËÙ· (584 ÈÛ¯›·), ÎÔÚ›ÙÛÈ· 405, ·ÁfiÚÈ· 57 (¶›Ó·Î·˜ 1, ¶›Ó·Î·˜ 2). ™Â 36 ÈÛ¯›· (6%) ‰È·ÈÛÙÒıËΠÛËÌÂ›Ô Ortolani ‹ Barlow ÛÙËÓ ÂͤٷÛË ÙÔ˘ 5Ô˘ 24ˆÚÔ˘ ÂÓÒ Â›¯Â ‰È·Ê‡ÁÂÈ ÛÙËÓ ÚÒÙË ÂͤٷÛË. ŸÏ· Ù· ÂÍ·Úıڈ̤ӷ ÈÛ¯›· ‹Ù·Ó ·Ó·Ù¿ÍÈÌ· ÙËÓ Ë̤ڷ Ô˘ ÂÍÂÙ¿ÛÙËηÓ.

M Èۯȷ΋ ÚÔ‚ÔÏ‹ ÁÂÓÓ‹ıËÎ·Ó 146 (31,6%), 124 (30,6%) ÙˆÓ ÎÔÚÈÙÛÈÒÓ Î·È 22 (38,5%) ÙˆÓ ·ÁÔÚÈÒÓ Ì ™EI. ∏ ηٷÓÔÌ‹ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ Î·Ù¿ Ì‹Ó· Á¤ÓÓËÛ˘ Ê·›ÓÂÙ·È ÛÙËÓ ÂÈÎfiÓ· 2 Î·È ÔÈ Â› ÙÔȘ ¯ÈÏ›ÔȘ ÁÂÓÓ‹ÛÂȘ ÓÂÔÁÓÒÓ Ì ™EI ηٿ Ì‹Ó· ÛÙËÓ ÂÈÎfiÓ· 2·. ¶ÚˆÙfiÙÔη ‹Ù·Ó 320 (69%) ÂÓÒ Û 15.000 Û˘Ó¯›˜ ÁÂÓÓ‹ÛÂȘ ÙÔ˘ ›‰ÈÔ˘ Ì·È¢ÙËÚ›Ô˘ ÙÔ ÔÛÔÛÙfi ‚Ú¤ıËΠ40%.

TÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ Ì ™EI ‰ÂÓ ‰È¤ÊÂÚ ·fi ·˘Ùfi ÙˆÓ ˘ÔÏÔ›ˆÓ ÓÂÔÁÓÒÓ (M¤ÛÔ ‚¿ÚÔ˜ ÓÂÔÁÓÒÓ Ì ™EI: 3.300 gr, ̤ÛÔ ‚¿ÚÔ˜ ˘ÔÏÔ›ˆÓ: 3.350 gr). OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ™EI ·Ó·Ê¤ÚıËΠ۠92 ÂÚÈÙÒÛÂȘ. ™Â 10 ÓÂÔÁÓ¿ ˘‹Ú¯Â

¶›Ó·Î·˜ 1. K·Ù·ÓÔÌ‹ ÙˆÓ ıÂÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·Ù¿ ʇÏÔ. ¶ÂÚÈÙÒÛÂȘ

IÛ¯›·

Barlow +

Ortolani +

KÔÚ›ÙÛÈ· AÁfiÚÈ·

405 57

509 75

174 (34%) 17 (22,6%)

335 (66%) 58 (77,3%)

™‡ÓÔÏÔ

462

584

191

393

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¶ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ™EI

¶›Ó·Î·˜ 2. K·Ù·ÓÔÌ‹ ÙˆÓ ıÂÙÈÎÒÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·Ù¿ ÈÛ¯›Ô. ™‡ÓÔÏÔ

Barlow +

Ortolani +

AÚÈÛÙÂÚfi ÈÛ¯›Ô

307

104 (10 ¿Ìʈ)

203 (75 ¿Ìʈ)

¢ÂÍÈfi ÈÛ¯›Ô

277

87 (10 ¿Ìʈ)

190 (75 ¿Ìʈ)

Û˘ÁÁÂÓ¤˜ ·Ó¿Î˘ÚÙÔ ÁfiÓ·ÙÔ Ì ۇÛÙÔÈ¯Ô ™EI Û 7. ¶Ï·ÁÈÔÎÂÊ·Ï›· ‹ Û˘ÁÁÂÓ‹˜ ÛÎÔÏ›ˆÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ.

2. ŒÎ‚·ÛË ™ÙËÓ ÂͤٷÛË ÂÍfi‰Ô˘ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÛÙ· 535 ÈÛ¯›· Ô˘ ¿Ú¯ÈÛ·Ó Î·ÓÔÓÈο ıÂÚ·›·, Ù· 511 (95,5%) ‚Ú¤ıËÎ·Ó ÛÙ·ıÂÚ¿ Î·È 24 (4,5%) ‰ÂÓ Â›¯·Ó ÛÙ·ıÂÚÔÔÈËı›. ™Â 49 ÈÛ¯›· Ì ıÂÙÈÎfi ÛËÌÂ›Ô Ortolani ‹ Barlow ‰ÂÓ ÙÔÔıÂÙ‹ıËÎ·Ó ¿Ó˜ ‹ ηı˘ÛÙ¤ÚËÛÂ Ë ÙÔÔı¤ÙËÛ‹ ÙÔ˘˜ ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜, fiˆ˜ ˘„ËÏfi˜ ›ÎÙÂÚÔ˜, Â›ÁÔ˘Û˜ ÂÂÌ‚¿ÛÂȘ, ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù· ‹ ¿ÚÓËÛË ÙˆÓ Á˘Ó·ÈÎÔÏfiÁˆÓ Ó· ÂÓËÌÂÚˆıÔ‡Ó ÔÈ ÌËÙ¤Ú˜ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ. T· ÌÈÛ¿ Î·È Ï›ÁÔ ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ ÛÙ·ıÂÚÔÔÈ‹ıËÎ·Ó ¯ˆÚ›˜ η̛· ıÂÚ·›·, ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ¤ÌÂÈÓ·Ó ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ŸÛ· ÈÛ¯›· ‰ÂÓ ÛÙ·ıÂÚÔÔÈ‹ıËÎ·Ó ‹Ù·Ó ÈÛ¯›· Ì ıÂÙÈÎfi ÛËÌÂ›Ô Ortolani.

OÌ¿‰· Ì Ï‹ÚË ·Ú·ÎÔÏÔ‡ıËÛË MÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó 296 ·È‰È¿ (369 ÈÛ¯›·), 266 ÎÔÚ›ÙÛÈ· Î·È 30 ·ÁfiÚÈ·, 64% ÙˆÓ ·È‰ÈÒÓ Ì ™EI ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ™ÙËÓ ÔÌ¿‰· ·˘Ù‹, ıÂÙÈÎfi ÛËÌÂ›Ô Ortolani ›¯·Ó 236 ÈÛ¯›· Î·È ıÂÙÈÎfi Barlow 133 ÈÛ¯›·. H ÂÓÙfiÈÛË ÙÔ˘ ™EI

π·Ó

‹Ù·Ó ‰ÂÍÈ¿ Û 127, ·ÚÈÛÙÂÚ¿ Û 165 Î·È ¿Ìʈ Û 73.

Afi 12 ÈÛ¯›· Ô˘ ›¯·Ó ÂÏÂÁ¯ı› ·ÛÙ·ı‹ ÙËÓ ¤ÌÙË Ë̤ڷ ˙ˆ‹˜ Ù· 8 ›¯·Ó ÛÙ·ıÂÚÔÔÈËı› ÛÙÔÓ ¤Ó· Ì‹Ó·, Ù· 2 ÌÂÙ¿ ‰‡Ô Ì‹Ó˜ Î·È 2 ¯ÚÂÈ¿ÛÙËÎ·Ó ÂÁ¯Â›ÚËÛË Û ËÏÈΛ· ÙÚÈÒÓ ÌËÓÒÓ, ÏfiÁˆ ÌË ·Ó·Ù¿Íˆ˜ ÙÔ˘ ÈÛ¯›Ô˘. ™Â 10 ÂÚÈÙÒÛÂȘ (10 ·È‰È¿, 10 ÈÛ¯›·) ηٿ ÙËÓ Â·ÓÂͤٷÛË Û ËÏÈΛ· 30-40 ËÌÂÚÒÓ Ù· ÈÛ¯›· ‚Ú¤ıËÎ·Ó ÂÍ·Úıڈ̤ӷ ·ÚfiÏÔ Ô˘ fiÙ·Ó ¤Ê˘Á·Ó ·fi ÙËÓ ÎÏÈÓÈ΋ ‹Ù·Ó ÛÙ·ıÂÚ¿. K·È ÛÙ· 10 ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ‰È·Îfi„ÂÈ fiˆ˜ ·Ú·‰¤¯ÙËηÓ, ÙË ıÂÚ·›· fiÙ·Ó ‹Á·Ó ÛÙÔ Û›ÙÈ ÁÈ· Ó· ÌËÓ ÂÓÔ¯ÏÔ‡Ó Ù· ÌÈÎÚ¿ ÙÔ˘˜. E›Û˘, οÔȘ, ·ÓÙ› ÁÈ· ÙȘ ˘ÊÈÛÙ¿ÌÂÓ˜ ¿Ó˜ ¤‚·˙·Ó 2 ‚ÈÔÌ˯·ÓÔÔÈË̤Ó˜ ¿Ó˜ ÌÈ·˜ ¯Ú‹Ûˆ˜ Ì ÙË Û‡ÛÙ·ÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÙÔ˘˜. Afi ·˘Ù¿ Ù· ·È‰È¿, 3 ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, 5 ¯ÚÂÈ¿ÛÙËÎ·Ó Á‡„Ô Î·È ÌfiÓÔ 2 ıÂÚ·‡ÙËÎ·Ó Ì ¿Ó˜. ŸÏ· Ù· ·È‰È¿ ÂÚ·ÙÔ‡Û·Ó Î·ÓÔÓÈο ÛÙËÓ ÙÂÏÂ˘Ù·›· ÂͤٷÛË. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË Ù˘ ÌËÚÈ·›·˜ ÎÂÊ·Ï‹˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÂÚ·›·˜. ™˘˙‹ÙËÛË E›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ™EI Â›Ó·È Ë ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙÔ˘, Ë

ºÂ‚ ª·Ú ∞Ú ª·˚ πÔ˘Ó πÔ˘Ï ∞˘Á

™Â OÎÙ ¡Ô ¢ÂÎ

EÈÎfiÓ· 2. AÚÈıÌfi˜ ÁÂÓÓ‹ÛÂˆÓ Î·Ù¿ Ì‹Ó· ÙËÓ ÂÓÙ·ÂÙ›· 1990-1994. Afi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÔÎÂÙÒÓ ÛÙÔÓ ›Ó·Î·, 10.578 ÓÂÔÁ¤ÓÓËÙ· ÓÔÛËχÙËÎ·Ó ÛÙÔ ÙÌ‹Ì· ÚÔÒÚˆÓ.

159

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π·Ó

I. K. NÙÔ˘ÓÙÔ˘Ï¿Î˘

ºÂ‚ ª·Ú ∞Ú ª·˚ πÔ˘Ó πÔ˘Ï ∞˘Á

™Â OÎÙ ¡Ô ¢ÂÎ

EÈÎfiÓ· 2·. AÚÈıÌfi˜ ÓÂÔÁ¤ÓÓËÙˆÓ Ì ™EI ηٿ Ì‹Ó· ÙËÓ ÂÓÙ·ÂÙ›· 1990-1994. ¶ÔÛÔÛÙfi ò. ÔÔ›· Â›Ó·È Î·Ïfi Ó· Á›ÓÂÙ·È Ì¤Û· ÛÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙË Á¤ÓÓËÛË.(16,18) H ·Ó›¯Ó¢ÛË Ô˘ Á›ÓÂÙ·È Û‹ÌÂÚ·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙˆÓ ÈÛ¯›ˆÓ ¤¯Ô˘Ó ηٿ Ôχ ÂÏ·ÙÙÒÛÂÈ ÙȘ ·Ú·ÌÂÏË̤Ó˜ ÂÚÈÙÒÛÂȘ ÙÔ˘ ™EI. H ¯Ú‹ÛË ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ Â›Ó·È ÔχÙÈÌË, (20-22) ·ÏÏ¿ ÔÏϤ˜ ÊÔÚ¤˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· Á›ÓÂÈ Û fiÏ· Ù· ÓÂÔÁÓ¿ ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜ (¯ÚfiÓÔ˜, ÎfiÛÙÔ˜, ̤۷, ÂÌÂÈÚ›· ÎÏ.), (23), Î·È ¿ÓÙ· Ú¤ÂÈ Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË.(24,25) H ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙ· ÛËÌ›· Ortolani Î·È Barlow. TÔ ‚¿ıÔ˜ Ù˘ ÌËÚÔ‚Ô˘‚ˆÓÈ΋˜ Ù˘¯‹˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ˆ˜ ÎÏÈÓÈÎfi ÛËÌÂ›Ô ‰È¿ÁÓˆÛ˘ ÙÔ˘ ™EI ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ·ÍÈÔÏÔÁËı› Ë ÛËÌ·Û›· ÙÔ˘.(3,26) H ÚÔÛˆÈ΋ ›ڷ ·fi ·˘Ù‹ ÙË ÌÂϤÙË ‰Â›¯ÓÂÈ fiÙÈ Â›Ó·È ¤Ó· ÎÏÈÓÈÎfi ÛËÌÂ›Ô fi¯È Ôχ Û˘¯Ófi, ÙÔ ÔÔ›Ô fiÙ·Ó ‚Ú›ÛÎÂÙ·È Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁ›ٷÈ.

MÈ· ‚·ıÈ¿ ÌËÚÔ‚Ô˘‚ˆÓÈ΋ Ù˘¯‹, fiÙ·Ó Ù· ÈÛ¯›· ‚Ú›ÛÎÔÓÙ·È ÛÂ Î¿Ì„Ë Î·È Ï‹ÚË ··ÁˆÁ‹, Èı·ÓÒ˜ Ó· ÛËÌ·›ÓÂÈ fiÙÈ Ë ÌËÚÈ·›· ÎÂÊ·Ï‹ Â›Ó·È ÂÍ·Úıڈ̤ÓË ÚÔ˜ Ù· ›Ûˆ, ˘ÂÚ¿ÚıÚËÌ·, ‹ ·ÏÒ˜ Ì›· ·‚·ı‹˜ ÎÔÙ‡ÏË. A˘Ù¿ Ù· ÈÛ¯›· ¯ÚÂÈ¿˙ÔÓÙ·È Â·ÓÂͤٷÛË, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ·Ú·ÎÔÏÔ‡ıËÛË. E›Ó·È ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÍÂʇÁÔ˘Ó ÙËÓ ÚÒÈÌË ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È ·Ó·Î·Ï‡ÙÔÓÙ·È ·ÚÁfiÙÂÚ· ›ÙÂ Û·Ó ·ÛÙ·ı‹ ÈÛ¯›·, ›ÙÂ Û·Ó ÌÂȈ̤ÓË ··ÁˆÁ‹ ÌfiÓÔ (EÈÎfiÓ· 3).

M›· ·Á›‰· ·ÔÙÂÏÔ‡Ó Ù· ÈÛ¯›· Ô˘ ¤¯Ô˘Ó Ï‹ÚË ··ÁˆÁ‹, ¯ˆÚ›˜ η̛· ¤Ó‰ÂÈÍË ÁÈ· ™EI. AÓ Ù· ÂÍÂÙ¿ÛÂÈ Î·Ó›˜ ÚÔÛÂÎÙÈο, ·Ú·ÙËÚÂ›Ù·È fiÙÈ ¤¯Ô˘Ó ıÂÙÈÎfi ÙÔ ÛËÌÂ›Ô ÙÔ˘ Ortolani ‹ Barlow. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi Ú¤ÂÈ Ó· „¿¯ÓÂÈ Î·Ó›˜ Î·È ÁÈ· Ù· ‰‡Ô ·˘Ù¿ ‚·ÛÈο ÎÏÈÓÈο ÛËÌ›·. EÂȉ‹ Ë ÌÂϤÙË ·˘Ù‹ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Û ‰˘ÛϷۛ˜ Ù˘ ÎÔÙ‡Ï˘ ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ¿ÏÏ· ÎÏÈÓÈο ÛËÌ›· fiˆ˜ Ì›ˆÛË Ù˘ ··ÁˆÁ‹˜ ÎÏ,

160

ÛËÌ›· Ù· ÔÔ›· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ˘Ô‰ËÏÒÓÔ˘Ó Ì›· ‰˘ÛÏ·Û›· Ù˘ ÎÔÙ‡Ï˘. MÂÁ¿ÏË Ì›ˆÛË Ù˘ ··ÁˆÁ‹˜, ÂÚÈÛÛfiÙÂÚÔ ·fi 60Æ, Èı·ÓÒ˜ Ó· ÛËÌ·›ÓÂÈ ÂÍ¿ÚıÚËÌ· ÙÔ˘ ÈÛ¯›Ô˘, ‰ËÏ·‰‹ fiÙÈ Ù· ÈÛ¯›· ‰ÂÓ ·Ó·Ù¿ÛÛÔÓÙ·È. H ÌÂϤÙË ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Û ÌÂȈ̤ÓË ··ÁˆÁ‹ ÛÙ· ÛÙ·ıÂÚ¿ ÎÏÈÓÈο ÛËÌ›· ÂÂȉ‹ ‰ÂÓ ‚Ú¤ıËΠηӤӷ ÈÛ¯›Ô ÙÔ ÔÔ›Ô ‰ÂÓ ·Ó·Ù·ÛÛfiÙ·Ó. ™Â ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ‹ ÌÂȈ̤ÓË ··ÁˆÁ‹ ηıÒ˜ Î·È Ë ‚Ú¿¯˘ÓÛË ÙÔ˘ ÛΤÏÔ˘˜ ·ÔÙÂÏÔ‡Ó ‚·ÛÈο ÎÏÈÓÈο ÛËÌ›· Ô˘ Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È.

MÂÁ¿ÏË Û˘˙‹ÙËÛË Á›ÓÂÙ·È ÁÈ· ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙˆÓ ÈÛ¯›ˆÓ ÛÙ· ÓÂÔÁ¤ÓÓËÙ·. O Û˘ÁÁڷʤ·˜ Û˘ÌʈÓ› Ì ¿ÏϘ ÂÚÁ·Û›Â˜ fiÙÈ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙˆÓ ÈÛ¯›ˆÓ ¯ˆÚ›˜ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ Î·ÙÔ¯˘ÚÒÓÂÈ ÙË ‰È¿ÁÓˆÛË.(12,13,25) T· ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó „¢‰Ò˜ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· Î·È ÔÏÏ¿ ‰›ÓÔ˘Ó „¢‰Ò˜ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ˘ÂÚıÂÚ·›· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÈÛ¯›ˆÓ Î·È Î›Ó‰˘ÓÔ ¿ÛËÙ˘ Ó¤ÎÚˆÛ˘ Ù˘

EÈÎfiÓ· 3. B·ıÈ¿ ÌËÚÔ‚Ô˘‚ˆÓÈ΋ Ù˘¯‹.

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ÌËÚÈ·›·˜ ÎÂÊ·Ï‹˜.(23,25,27) TÔ fiÙ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, Î·È ·Ó Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û·Ó ÚÔ˘Ù›Ó· Û fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ·, Â›Ó·È ¤Ó· ÂÚÒÙËÌ· Ô˘ Âȉ¤¯ÂÙ·È ÔÈÎÈÏ›· ··ÓÙ‹ÛˆÓ. H ÚÔÛˆÈ΋ ·ÚÔı˘Ì›· ÙÔ˘ Û˘ÁÁڷʤ· Ó· ˘ÔÛÙËÚ›ÍÂÈ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÚÔ˘Ù›Ó·˜ ‚·Û›˙ÂÙ·È ÛÙÔ ÎfiÛÙÔ˜, ÛÙÔÓ ¯ÚfiÓÔ Î·È ÛÙÔÓ Î›Ó‰˘ÓÔ Ó· ·ÌÂÏËı› Ë ÎÏÈÓÈ΋ ÂͤٷÛË. OÈ Û˘˙ËÙ‹ÛÂȘ Û ÚfiÛÊ·Ù· ‰ÈÂıÓ‹ ÔÚıÔ‰Èο Û˘Ó¤‰ÚÈ· ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÏÏÔ› ¤ÁÎÚÈÙÔÈ ÔÚıÔ‰ÈÎÔ› (.¯., Vialik ÛÙÔ IÛÚ·‹Ï, Terjensen ÛÙË NÔÚ‚ËÁ›·) ¿ÏÏÔÙ ˘¤ÚÌ·¯ÔÈ ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÚÔ˘Ù›Ó·˜ Û˘ÌÌÂÚ›˙ÔÓÙ·È ϤÔÓ ÙËÓ ¿Ô„Ë Ó· Á›ÓÂÈ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Û ÂÈÏÂÁ̤Ó˜ ÌfiÓÔ ÂÚÈÙÒÛÂȘ Î·È Û˘Ó‹ıˆ˜ ÛÙËÓ ËÏÈΛ· 30 ËÌÂÚÒÓ.(20,28) EÓÙÔ›˙ÔÓÙ·È, fi¯È Û¿ÓÈ·, ÂÚÈÙÒÛÂȘ ÓÂÔÁ¤ÓÓËÙˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ Ô˘ ÛÙËÓ Â·ÓÂͤٷÛË ÙÔ˘ ÙÚ›ÙÔ˘ Ì‹Ó· ‰È·ÈÛÙÒÓÂÙ·È ÌÂȈ̤ÓË ··ÁˆÁ‹ ÈÛ¯›ˆÓ (Û˘Ó‹ıˆ˜ ÙÔ˘ ÂÓfi˜) Î·È ·ÎÙÈÓÔÁÚ·ÊÈÎÒ˜ ‰˘ÛÏ·Û›· Ù˘ ÎÔÙ‡Ï˘. O Û˘ÁÁڷʤ·˜ ÈÛÙ‡ÂÈ fiÙÈ ÌÈ· ·fi ÙȘ ·Èٛ˜ Ù˘ ÌÂȈ̤Ó˘ ··ÁˆÁ‹˜ Â›Ó·È Ô ÙÚfiÔ˜ Ô˘ ÎÔÈÌÔ‡ÓÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ù· ̈ڿ ‰ËÏ·‰‹ ÛÙÔ Ï¿È ÁÈ· ÙÔ˘˜ ÁÓˆÛÙÔ‡˜ ÏfiÁÔ˘˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘.

H ÚËÓ‹˜ ı¤ÛË Èı·ÓÒ˜ ‚ÔËıÔ‡Û ÙËÓ ·˘ÙÔ›·ÛË.

T· ÓÂÔÁ¤ÓÓËÙ· Ì ÌÂȈ̤ÓË ··ÁˆÁ‹ ÙˆÓ ÈÛ¯›ˆÓ Î·È ·È‰È¿ Ô˘ ÊÔÚÔ‡Ó ¿Ó˜ ÁÈ· ıÂÚ·›· ™EI ‹ ‰ÈÛÏ·Û›· Ù˘ ÎÔÙ‡Ï˘, ‰ÂÓ Ú¤ÂÈ Ó· ÎÔÈÌÔ‡ÓÙ·È ÛÙÔ Ï¿È.

H ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ™EI Â›Ó·È ¿ÁÓˆÛÙË(29) Î·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÛÙ· ÎÔÚ›ÙÛÈ· ˘Ô‰ËÏÒÓÂÈ Î·Ù¿ ÙÔÓ Wilkinson fiÙÈ ›Ûˆ˜ Ù· ÔÈÛÙÚÔÁfiÓ· ηıÒ˜ Î·È Ë ÁÂÓÈÎÂ˘Ì¤ÓË ¯·Ï·ÚfiÙ˘ ÙˆÓ ·ÚıÚÒÛÂˆÓ (Joint laxity), ·›˙Ô˘Ó Î¿ÔÈÔ ÚfiÏÔ ÛÙÔ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ™EI ÛÙ· ıËÏ˘Î¿ ÈÛ¯›·(26). H ı¤ÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙË Ì‹ÙÚ· ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› Â›Û˘ ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÔÛÔÛÙÔ‡ ÂÍ·ÚıÚˆÌ¤ÓˆÓ ÈÛ¯›ˆÓ Û ÓÂÔÁÓ¿ Ì Èۯȷ΋ ÚÔ‚ÔÏ‹.(26,30) ™ÙË ‰È΋ Ì·˜ ÂÚÁ·Û›· ‚Ú¤ıËΠfiÙÈ ÂÚ›Ô˘ ÙÔ 1/3 ÙˆÓ ÈÛ¯›ˆÓ Ì ™EI ·Ó‹Î·Ó Û ÓÂÔÁ¤ÓÓËÙ· Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì Èۯȷ΋ ÚÔ‚ÔÏ‹ ÂÓÒ Ë Û˘¯ÓfiÙËÙ· Èۯȷ΋˜ ÚÔ‚ÔÏ‹˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÙÔ˘ Ì·È¢ÙËÚ›Ô˘ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 35ò.

E›Û˘, ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ™EI ÙÔ ÔÛÔÛÙfi ÙˆÓ ÚˆÙfiÙÔÎˆÓ ‹Ù·Ó Ôχ ÌÂÁ·Ï‡ÙÂÚÔ (69%) ·fi fiÙÈ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ (40%). KÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ·Ó·Ê¤ÚıËΠ۠20% ÙˆÓ ·È‰ÈÒÓ Ì ™EI ·ÏÏ¿ ˘ÔÏÔÁ›˙Ô˘Ì fiÙÈ ÙÔ ÔÛÔÛÙfi Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ Î·È ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜ ÔÈ ÌËÙ¤Ú˜ ¤ÎÚ˘‚·Ó ÙËÓ ·Ï‹ıÂÈ·.(6,26,31) E›¯·Ì ‰È·ÈÛÙÒÛÂÈ Û ·Ï·ÈfiÙÂÚË ÌÂϤÙË ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ™EI Û ÔÚÈṲ̂ӷ ̤ÚË Ù˘ EÏÏ¿‰·˜ (◊ÂÈÚÔ˜, ¢. ¶ÂÏÔfiÓÓËÛÔ˜, ¢. ™ÙÂÚ¿, KÚ‹ÙË, E‡‚ÔÈ· (32). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·Ï˘ı› ·˘Ùfi ÏfiÁˆ Ù˘ ÂÈÏÂÁ̤Ó˘ ÁˆÁÚ·ÊÈ΋˜ ÚÔ¤Ï¢Û˘ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙÔ˘ Ì·È¢ÙËÚ›Ô˘ ΢ڛˆ˜ ·fi ÙÔÓ NÔÌfi AÙÙÈ΋˜. ™Ùfi¯Ô˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ

¶ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ™EI

ÎÏÈÓÈÎÒÓ ÛÙÔȯ›ˆÓ Î·È Ù˘ ıÂÚ·›·˜. ¶·Ú¿ÁÔÓÙ˜ ÔÈ ÔÔ›ÔÈ ‰˘Ó·ÙfiÓ Ó· ›¯·Ó οÔÈ· Û¯¤ÛË Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· ‹ Û˘¯ÓfiÙËÙ· ÙÔ˘ ™EI fiˆ˜ ÙÔ ‚¿ÚÔ˜, ÔÏÈÁÔ·Ì›ÓÈÔ, ËÏÈΛ· Á¤ÓÓËÛ˘ Î·È Î¿ÓÈÛÌ· Ù˘ ÌËÙ¤Ú·˜, ηٷÁÚ¿ÊËÎ·Ó ·ÏÏ¿ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛÂ Û˘¯ÓfiÙËÙ· Ù¤ÙÔÈ· Ô˘ Ó· ‰ÈηÈÔÏÔÁ› ·Ó¿Ï˘ÛË. ¢ÂÓ ‚Ú¤ıËΠηӤӷ ÌË ·Ó·Ù·ÛÛfiÌÂÓÔ ÈÛ¯›Ô, Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ fiÏ· Ù· ÂÍ·Úıڈ̤ӷ ÈÛ¯›· ·Ó·Ù¿ÛÛÔÓÙ·È ·Ú¯ÈÎÒ˜ ·Ó ÂÍÂÙ·ÛÙÔ‡Ó Ì¤Û· ÛÙ· ÚÒÙ· 24ˆÚ· ·fi ÙË Á¤ÓÓËÛË, ÂÎÙfi˜ ‚¤‚·È· ÂÍ·Úıڈ̤ӷ ÈÛ¯›· Ô˘ ·Ó‹ÎÔ˘Ó Û ÓÂÔÁ¤ÓÓËÙ· Ì ·ÚıÚÔÁÚ‡ˆÛË ‹ ¿ÏÏ· Û‡Ó‰ÚÔÌ·, Ù· ÔÔ›· ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Û ·˘Ù‹Ó ÙË ÌÂϤÙË. AÓ fï˜, Ù· ÈÛ¯›· Ì ÂÍ¿ÚıÚËÌ· ·ÊÂıÔ‡Ó ¯ˆÚ›˜ ıÂÚ·›·, Ù· ̷Ϸο ÌfiÚÈ· Á‡Úˆ ·fi ÙËÓ ¿ÚıÚˆÛË ÙÔ˘ ÈÛ¯›Ô˘ Û˘ÚÚÈÎÓÒÓÔÓÙ·È Î·È ¤ÙÛÈ Ù· ÈÛ¯›· ‰ÂÓ ·Ó·Ù¿ÛÛÔÓÙ·È ϤÔÓ ·Ó ÂÍÂÙ·ÛÙÔ‡Ó ÌÂÚÈΤ˜ Ë̤Ú˜ ‹ ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·. MÂÚÈο ÈÛ¯›· Ê·›ÓÔÓÙ·È Ó· ¤¯Ô˘Ó ÌÂÁ¿ÏË Ì›ˆÛË Ù˘ ··ÁˆÁ‹˜ ÌfiÓÔ. ™ÙËÓ ÔÌ¿‰· Ù˘ ÌÂϤÙ˘ ·˘Ùfi ·Ú·ÙËÚ‹ıËΠ۠8 ·fi ÙȘ 10 ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ÌËÙ¤Ú˜ ‰ÂÓ Û˘ÌÌÔÚÊÒıËÎ·Ó Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔÔı¤ÙËÛ˘ ‰ÈÏ‹˜ ¿Ó·˜. T· ÙÚ›· ·fi ·˘Ù¿ ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ÁÈ· Ó· ·Ó·Ù·¯ı› ÙÔ ÈÛ¯›Ô. ™Â ‰¤Î· ·È‰È¿ Ô˘ ›¯·Ó Û˘ÁÁÂÓ›˜ ·Ó¿Î˘ÚÙÔ ÁfiÓ·ÙÔ, Ù· ÂÙ¿ ›¯·Ó Î·È ™EI ·ÓÙÈÛÙÔ›¯ˆ˜ Î·È ·˘Ùfi Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙË ı¤ÛË ÙÔ˘ ÛΤÏÔ˘˜ ̤۷ ÛÙË Ì‹ÙÚ·. ¢ÂÓ ‚Ú¤ıËΠۯÂÙÈ΋ ·Ó·ÊÔÚ¿ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ™‡Ìʈӷ Ì ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ Û˘ÁÁڷʤ·, Ë ÎÏÈÓÈ΋ ÂͤٷÛË ÙˆÓ ÈÛ¯›ˆÓ Ú¤ÂÈ Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È 5-7 Ë̤Ú˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ηıÒ˜ Î·È ¤Ó· Î·È ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ™’ ·˘Ù‹ ÙË ÌÂϤÙË, ·Ú¿ ÙË Û¯ÔÏ·ÛÙÈ΋ ÂͤٷÛË fiÏˆÓ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ÙÔ ÚÒÙÔ 24ˆÚÔ Ù˘ ˙ˆ‹˜, 36 ÈÛ¯›· Ì ™EI (6%) ‰È·ÁÓÒÛÙËÎ·Ó ÛÙËÓ 2Ë ÎÏÈÓÈ΋ ÂͤٷÛË.

T¤ÏÔ˜, ·ÎÙÈÓÔÁڷʛ˜ Û·Ó ÚÔ˘Ù›Ó· ÛÙ· ÓÂÔÁ¤ÓÓËÙ· ‰ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰ÈfiÙÈ ‰ÂÓ ‚ÔËıÔ‡Ó. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ‰ÂÓ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÁÈ·Ù› ÌfiÓÔ Û‡Á¯˘ÛË ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó.(22) ™˘ÌÂÚ¿ÛÌ·Ù· 1) H ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙˆÓ ·ÛÙ·ıÒÓ ÈÛ¯›ˆÓ ̤۷ ÛÙÔ ÚÒÙÔ 24ˆÚÔ Ù˘ ˙ˆ‹˜, ÛÙ·ıÂÚÔÔÈ› Ù· ÈÛ¯›· Û ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi, ÂÚ›Ô˘ 95,5% fiˆ˜ ‚Ú¤ıËΠ۠·˘Ù‹ ÙË ÌÂϤÙË, ̤۷ ÛÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜. IÛ¯›· Ù· ÔÔ›· ·Ê¤ıËÛ·Ó ¯ˆÚ›˜ ıÂÚ·›· ÛÙ·ıÂÚÔÔÈ‹ıËÎ·Ó Û ÔÛÔÛÙfi 50% ÛÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

2) H ‰È¿ÁÓˆÛË ÙÔ˘ ™EI ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Â›Ó·È Û˘Ó‹ıˆ˜ ÎÏÈÓÈ΋. K·ÏfiÓ Â›Ó·È Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ÛÙ· ÓÂÔÁ¤ÓÓËÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™EI ‹ ÓÂÔÁ¤ÓÓËÙ· Ì ·Û·Ê‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ·. H ÎÏÈÓÈ΋ ÂͤٷÛË Ú¤ÂÈ Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È ÚÈÓ ·fi ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÁÈ· ÙËÓ ·ÛÊ·Ï‹ ‰È¿ÁÓˆÛË.

3) ¢ÂÓ ‚Ú¤ıËΠηӤӷ ÈÛ¯›Ô ·fi ·˘Ù¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Ô˘

161

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Ó· ÌËÓ ·Ó·Ù¿ÛÛÂÙ·È, Ú¿ÁÌ· Ô˘ ‰Â›¯ÓÂÈ fiÙÈ fiÏ· Ù· ÂÍ·Úıڈ̤ӷ ÈÛ¯›· ·Ó·Ù¿ÛÛÔÓÙ·È ·Ú¯ÈÎÒ˜ fiÙ·Ó ÂÍÂÙ·ÛÙÔ‡Ó Ì¤Û· ÛÙ· ÚÒÙ· 24ˆÚ· ·fi ÙË Á¤ÓÓËÛË, ÂÎÙfi˜ ·fi Ù· ÈÛ¯›· Û ·È‰È¿ Ì ·ÚıÚÔÁÚ‡ˆÛË ‹ ¿ÏÏ· Û‡Ó‰ÚÔÌ·.

4) TÔ ‚¿ıÔ˜ Ù˘ ÌËÚÔ‚Ô˘‚ˆÓÈ΋˜ Ù˘¯‹˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ¤Ó· ·ÍÈfiÏÔÁÔ ÎÏÈÓÈÎfi ÛËÌÂ›Ô Î·È Ú¤ÂÈ fiÙ·Ó ‚ÚÂı› ¤ÓÙÔÓÔ, Ó· ·ÍÈÔÏÔÁ›ٷÈ.

5) OÈ ˘Ê·ÛÌ¿ÙÈÓ˜ ¿Ó˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛÙ·ıÒÓ ‹ ÂÍ·ÚıÚˆÌ¤ÓˆÓ ÈÛ¯›ˆÓ, ·ԉ›¯ıËÎ·Ó Â·ÚΛ˜ ÁÈ· ÙË ıÂÚ·›· Î·È ‰ÂÓ Ì·˜ ‰ËÌÈÔ‡ÚÁËÛ·Ó Î·Ì›· ·Ôχو˜ ÂÈÏÔ΋, fiˆ˜ ÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË Ù˘ ÌËÚÈ·›·˜ ÎÂÊ·Ï‹˜, Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Ì‚Â› Ì ¿ÏÏÔ˘˜ ÙÚfiÔ˘˜ ıÂÚ·›·˜.(1,6-8) OÈ ¿Ó˜ Ú¤ÂÈ Ó· Â›Ó·È ·ÚÎÂÙ¤˜ ÁÈ· Ó· ÎÚ·ÙÔ‡Ó Ù· ÈÛ¯›· Û ··ÁˆÁ‹ Î·È Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· 2-3 Ì‹Ó˜ ÂÚ›Ô˘. OÈ ‰ÈϤ˜ ¿Ó˜ ÌÈ·˜ ¯Ú‹Ûˆ˜ Ô˘‰ÂÌ›· ı¤ÛË ¤¯Ô˘Ó ÛÙË ıÂÚ·›· ÙˆÓ ÂÍ·ÚıÚˆÌ¤ÓˆÓ Î·È ·ÛÙ·ıÒÓ ÈÛ¯›ˆÓ Î·È ‰ÂÓ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È.

E˘¯·ÚÈÛٛ˜ E˘¯·ÚÈÛÙÒ ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ Ù˘ ¶AI¢IATPIKH™ ÁÈ· ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘˜ Î·È ÙËÓ Î· B·Ï¿ÛÛË-A‰¿Ì ÁÈ· ÙȘ Ô‰ËÁ›Â˜ Î·È ÙËÓ ÔχÙÈÌË ‚Ô‹ıÂÈ¿ Ù˘ ÁÈ· ÙËÓ Û‡ÓÙ·ÍË Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Û‡Ìʈӷ Ì ÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Palmen K. Preluxation of the hip joint. Acta paediatrica 1961;129(suppl):.

2. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg 1962;44µ:292-301.

3. McNicol FM. The early management of congenital dislocation of the hip. Current Orthop 1992;6:245-251.

4. Ortolani M. Un segno poco noto e sua importanza per la dioagnosi pre coce di prelussazione congenita dell' anca.

Pediatria 1937;45:129.

5. Von Rosen S. Early diagnosis and treatment of congenital dislocation of the hip joint. Acta Orthop Scand 1956;26:136-155.

6. Hänsson G. Congenital dislocation of the hip joint problems in diagnosis and treatment. Current Orthop 1998;2:104-111.

7. Suzuki S, Yamamuro T. Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip. J Bone Joint Surg 1990;72-A:1048-1055.

8. Rombouts J, Kaelin A. Inferior (obdurator) dislocation of the hip in neonates. J Bone Joint Surg 1992;74-B:708-710.

9. Klisic P. Congenital dislocation of the hip-a misleading term. J Bone Joint Surg 1989;71-B:136.

10. Hotchkiss BL. New terminology to replace C.D.H. Bullet paediat Orthop Soc N America 1991;4: 11. Krikler SS, Dwyer N. Comparison of results of two approaches to hip screening in infants. J Bone Joint Surg HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 07-12-1998 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-01-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: I. K. NÙÔ˘ÓÙÔ˘Ï¿Î˘ TÚÂÌÂÛ›Ó·˜ 16, ¶. æ˘¯ÈÎfi 154 52

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1992;74-B:701-703.

12 Catterall A. The early deagnosis of congenital dislocation of the hip. J Bone Joint Surg 1994;76-B:517-519.

13. Boeree RN, Clarke PMN. Ultrasound imaging and secondary screening for congenital dislocation of the hip.

J Bone Joint Surg 1994;76-B:525-533.

14. Poul J, Bajerova J, Sommernitz M, Straka M, Pokorny M, Wong FYH. Early diagnosis of congenital dislocation of the hip. J Bone Joint Surg 1992;74:695-700.

15. Dunn PN. Screening for detection of congenital dislocation of the hip. Arch Dis Child 1986;61:921-926.

16. Andren. Pelvic instability in newborns with special reference to congenital dislocation of the hip and hormonal factors. Acta Radiologica 1992;212 (Suppl): 17. Hadlow W. Neonatal screening for congenital dislocation of the hip. A prospective 21 year survey. J Bone Joint Surg 1988;70-B:740-743.

18. Somerville WE. The clinical diagnosis of congenital dislocation of the hip. Current orhop 1987;1:255-257.

19. Gröss HR. The conservative management on congenital dislocation of the hip. Current Orthopaedics 1987;1:267274.

20. Terjensen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg 1989;71-B: 767-769.

21. Salter RB. The hip in childhood. Current Orthop 1991;5:149-150.

22. Bennet CG. Screening for congenital dislocation of the hip. J Bone Joint Surg 1992;74B: 643-644.

23. Bar-on E, Meyer S, Harari G, Porat S. Ultrasonography of the hip in developmental hip dysplasia. J Bone Joint Surg 1998;80-B:321-324.

24. Hernandez VR, Cornell GR, Hensinger NR. Ultrasound diagnosis of neonatal congenital dislocation of the hip. A Decision Analysis Assessment. J Bone Joint Surg 1994;76-B:539-543.

25. Castelein MR. Ultrasonography in developmental dysplasia of the hip. Current Orthop 1997;11:271-274.

26. Wilkinson AJ. The epidemiology of congenital dislocation of the hip. Current Orthop 1987;1:249-254.

27. Kalamchi A, McEwen GD. Avascular necrosis folowing treatment of congenital dislocation of the hip. J Bone Joint Surg 1980;62-A:876-888.

28. Vialik V., Bialik GM, Wiener F. Prevention of overtreatment of neonatal hip dysplasia by the use of ultrasonography. J Pediatr Orth 1998;7:39-42.

29. Leck I. An epidemiological assessment of neonatal screening for dislocation of the hip. J R Coll Physicians 1986;20:56-62.

30. McEwen DG. Congenital dislocation of the hip. Current Orthop 1988;2:104-111.

31. Davies RW. Heritable disorders in orthopaedic practice.

Oxford, London, Edinburgh, Melbourne: Blackwell Scientific Publications 1973.

32. NÙÔ˘ÓÙÔ˘Ï¿Î˘ I. H XÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ·È‰È¿ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹], ¶·ÓÂÈÛÙ‹ÌÈÔ AıËÓÒÓ,1979.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:163-166

E¡¢π∞º∂ƒOÀ™A ¶∂ƒπ¶∆ø™H

¶ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ¯˘ÏÔ˘Ú›· ¢ÈÔÓ‡ÛÈÔ˜ K·Ú·Î·˚‰fi˜1, ¶·Ú·Û΢‹ ZÒÛË1, HÚ·ÎÏ‹˜ °ÂˆÚÁÈ¿‰Ë˜1, EϤÓË KˆÛÙÔÔ‡ÏÔ˘1, KˆÛÙ·ÓÙ›ÓÔ˜ NÙ¤ÚÔ˜2, XÚ›ÛÙÔ˜ K·Ú‹˜1

● ¶ÂÚ›ÏË„Ë: H ·ÚÔ˘Û›· ϤÌÊÔ˘ ÛÙ· Ô‡Ú·, Ô˘ ·ÔÎÙÔ‡Ó Á·Ï·ÎÙÒ‰Ë ¯ÚÔÈ¿, ÔÓÔÌ¿˙ÂÙ·È ¯˘ÏÔ˘Ú›·. ™˘Ó‹ıˆ˜ ÔÊ›ÏÂÙ·È Û ·ıÔÏÔÁÈ΋ ÂÈÎÔÈÓˆÓ›· ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÏÂÌÊ·ÁÁ›ˆÓ Ì ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·È‰ÈÔ‡ 13,5 ÂÙÒÓ Ì ÌË ·Ú·ÛÈÙÈ΋ ¯˘ÏÔ˘Ú›·, Ô˘ ·ÔÙÂÏ› Î·È ÙËÓ ÚÒÙË ÂÚÈÁÚ·Ê‹ ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·. AÓ·ÛÎÔÂ›Ù·È Ë ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·, Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹, Ë ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Î·È Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘. ¶·È‰È·ÙÚÈ΋ 2000;63:163-166. §¤ÍÂȘ ÎÏÂȉȿ: ¯˘ÏÔ˘Ú›·, Á·Ï·ÎÙÒ‰Ë Ô‡Ú·.

D. Karakaidos, P. Zosi, H. Georgiadis, H. Kostopoulou, K. Nteros, C. Karis. Case report of a child with chyluria. Paediatriki 2000;63:163-166. ● Abstract: Chyluria is the appearance of chyle in the urine. The most frequent cause of chyluria is a fistula between the intestinal lymphatic system and the urinary tract, which is frequently due to complications of parasitosis. A case is reported of a 13.5 year old boy with non-parasitic chyluria, which is the first such report in the Greek literature. The aetiology, pathogenesis, symptoms and therapeutic procedures are discussed.

Key words: chyluria, milky urine.

EÈÛ·ÁˆÁ‹ X˘ÏÔ˘Ú›· ÔÓÔÌ¿˙Ô˘Ì ÙËÓ ·ÚÔ˘Û›· ϤÌÊÔ˘ ÛÙ· Ô‡Ú· Ô˘ ·ÔÎÙÔ‡Ó "Á·Ï·ÎÙÒ‰Ë" ¯ÚÔÈ¿. ¢È·ÎÚ›ÓÔ˘Ì 2 ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘: 1) ÙËÓ ·Ú·ÛÈÙÈ΋ (‹ ÙÚÔÈ΋ ‹ ÂÓ‰ËÌÈ΋), 2) ÙË ÌË ·Ú·ÛÈÙÈ΋. H ÂÌÊ¿ÓÈÛË Ù˘ ¯˘ÏÔ˘Ú›·˜ ÌÔÚ› Ó· Â›Ó·È ·ÈÊÓ›‰È·, Û˘¯Ó¿ ‰È·Ï›Ô˘Û· Î·È Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È ·fi ÙËÓ ‰Â‡ÙÂÚË ¤ˆ˜ ÙËÓ ¤ÌÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. °È· ¯ÚfiÓÈ· ÌÔÚ› Ó· ÌËÓ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ˘Á›· ÙˆÓ ·ÛıÂÓÒÓ (1,2). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ AÁfiÚÈ, ËÏÈΛ·˜ 13,5 ÂÙÒÓ ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ Ì·˜ ÏfiÁˆ Ô‡ÚˆÓ Ì "Á·Ï·ÎÙÒ‰Ë" fi„Ë. E›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·fi Ù· ÙÚ›· ·È‰È¿ Ê·ÈÓÔÙ˘ÈÎÒ˜ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. T· ·‰¤ÚÊÈ· ÙÔ˘, ·ÁfiÚÈ· ËÏÈΛ·˜ 16 Î·È 11 ÂÙÒÓ Â›Ó·È Â›Û˘ ˘ÁÈ‹. ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋

ÂÚ›Ô‰Ô Î·È Î·Ù¿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘. ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È Ù·Í›‰È· Û ÙÚÔÈΤ˜ ¯ÒÚ˜. ™Â ËÏÈΛ· 9 ÂÙÒÓ ÌÂÙ¿ ·fi οΈÛË ÔÛ¯¤Ô˘ ·ÚÔ˘Û›·ÛÂ Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ‰ÂÍÈ¿ (ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ˘‰ÚÔ΋ÏË) ÁÈ· ÙËÓ ÔÔ›· ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ. TÔ ·È‰› ‹Ù·Ó ÂχıÂÚÔ Û˘ÌÙˆÌ¿ÙˆÓ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ fiÔ˘ ·ÈÊÓ›‰È· ·ÚÔ˘Û›·Û ԇڷ Ì Á·Ï·ÎÙÒ‰Ë ¯ÚÔÈ¿ ÁÂÁÔÓfi˜ Ô˘ ·¤ÎÚ˘„ ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ÁÈ· 15 Ë̤Ú˜. ™ÙË Û˘Ó¤¯ÂÈ·, Â·ÓÂÈÏËÌ̤Ó˜ ÂÍÂÙ¿ÛÂȘ Ô‡ÚˆÓ ¤‰ÂÈÍ·Ó ÏÂÌÊÔÌ·ÙÔ˘Ú›· Î·È ÙÔ ·È‰› ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô. AÍ›˙ÂÈ Ó· ÛËÌÂȈı› Ë ·Ô˘Û›· ¿ÏÏˆÓ Û˘ÓÔ‰ÒÓ Û˘Ìو̿وÓ.

H ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ·ÂÎ¿Ï˘„ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. T· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›· ‚¿ÚÔ˜, ‡„Ô˜, ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ηıÒ˜ Â›Û˘ Î·È Ë ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ.

1

¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ - ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi NÔÛÔÎÔÌÂ›Ô N›Î·È·˜ - ¶ÂÈÚ·È¿ "ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ó" 2 O˘ÚÔÏÔÁÈÎfi TÌ‹Ì· - ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi NÔÛÔÎÔÌÂ›Ô N›Î·È·˜ - ¶ÂÈÚ·È¿ "ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ó"

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MART.-APR.2000 ÓÂÔ

30-05-03

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™ÂÏ›‰·164

¶∞π¢π∞∆ƒπ∫∏ 2000;63:163-166

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: Hb:12,7 g/dl, Ht: 36%, §Â˘Î¿: 7500/mmÑ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi Ù‡Ô Î·È ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ. TKE: 9 mm/1h, CRP: 10 mg/L, Ca: 9,6mg/dl, P: 4,9 mg/dl, ÔÏÈο Ï¢ÎÒÌ·Ù·: 7,4 g/dl, ÏÂ˘ÎˆÌ·Ù›Ó˜: 3,2 g/dl, ÛÊ·ÈÚ›Ó˜: 3,2 g/dl.

O ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹·ÙÔ˜ Î·È ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. °ÂÓÈ΋ ÂͤٷÛË Ô‡ÚˆÓ: fi„Ë Á·Ï·ÎÙ҉˘, Ï¢ÎÔ·ÙÙ·Ú· 50-60/mmÑ, ÂÚ˘ıÚ¿ 10-20/mmÑ, χΈ̷ 300 mg/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È· 68 mg/dl, ¯ÔÏËÛÙÂÚfiÏË 9,2mg/dl. ™Â Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ 24ÒÚÔ˘ ÔÈ ÙÈ̤˜ Ï¢ÎÒÌ·ÙÔ˜ ‹Ù·Ó ·fi 3-5 gr/24ˆÚÔ.

AÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜-ÓÂÊÚÒÓ, ·ÓÈÔ‡Û· ΢ÛÙÂÔ˘ÚËıÚÔÁÚ·Ê›·, ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›·, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜-ÎÔÈÏ›·˜ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·.

YÂÚ˯ÔÁÚ¿ÊËÌ· ÔÛ¯¤Ô˘-·ÛÙÂÔ˜-fiگˆÓ: fiÚ¯ÂȘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÌÂÁ¤ıÔ˘˜, ÂÓÙfi˜ ÙÔ˘ ÔÛ¯¤Ô˘ Î·È ÔÈ ‰‡Ô, ·ÚÈÛÙÂÚ¿ Âȉȉ˘Ì›‰· ÎÊ,. ™ÙË ‰ÂÍÈ¿ Âȉȉ˘Ì›‰· ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰‡Ô ˘fi˯· ÌÔÚÊÒÌ·Ù·, Û·ÊÒÓ-ÔÌ·ÏÒÓ ÔÚ›ˆÓ, ‰È·ÛÙ¿ÛÂˆÓ 1,82 x 1,26cm Î·È 1,41x1,18cm ·ÓÙÈÛÙÔ›¯ˆ˜, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ·Ϥ˜ ·ÛÙÂȘ. (EÈÎfiÓ· 1) TÔ ·È‰› 6 Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, Â›Ó·È ÂχıÂÚÔ Û˘Ìو̿وÓ, Ë ¯ÚÔÈ¿ ÙˆÓ Ô‡ÚˆÓ ¤¯ÂÈ Ï‹Úˆ˜ ·ÔηٷÛÙ·ı› Î·È Ë ÁÂÓÈ΋ Ô‡ÚˆÓ Â›Ó·È ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ™˘˙‹ÙËÛË X˘ÏÔ˘Ú›· ÔÓÔÌ¿˙Ô˘Ì ÙËÓ ·ÚÔ˘Û›· ϤÌÊÔ˘ ÛÙ· Ô‡Ú·, Ô˘ ·ÔÎÙÔ‡Ó "Á·Ï·ÎÙÒ‰Ë" fi„Ë. °È· ÚÒÙË ÊÔÚ¿ Ô IÔÎÚ¿Ù˘ ·Ó·ÁÓÒÚÈÛÂ Î·È ÂÚȤÁÚ·„ ÙË ÓfiÛÔ (3,4). ™ÙËÚÈ˙fiÌÂÓÔ˜ ÛÙËÓ ·Ó·Î¿Ï˘„Ë Ù˘ ΢ÎÏÔÊÔÚ›·˜ Ù˘ ϤÌÊÔ˘ ·fi ÙÔÓ Jean Pecquet ÙÔ 1651, Ô Moellenbrogii ·¤‰ˆÛ ٷ ¯˘ÏÒ‰Ë Ô‡Ú· Û ÌÈ· ·ÓÒÌ·ÏË ¤ÓˆÛË ÙÔ˘ ÏÂÌÊÈÎÔ‡ Î·È ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™¯Â‰fiÓ 100 ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ· Ô Morgani ÂÍ‹ÁËÛ ÙË ¯˘ÏÔ˘Ú›· ÛÙË ‚¿ÛË Ù˘ ‰È·Ù·Ú·¯‹˜ Ù˘ ÏÂÌÊÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ (3,4). TÔ 1866 Ô Otto Wucherer ‰Ô˘Ï‡ÔÓÙ·˜ ÛÙË BÚ·˙ÈÏ›· ‚ڋΠÌÈÎÚÔÊÈÏ¿ÚȘ ÛÙ· Ô‡Ú· ·ÛıÂÓÔ‡˜ Ì ·ÈÌ·ÙÔ˘Ú›·. O Wood to 1929 ÚÒÙÔ˜ ¤‰ÂÈÍ ˘ÂÏÔÏÂÌÊÈ΋ ÂÈÎÔÈÓˆÓ›· Ì ·Ï›Ó‰ÚÔÌË ˘ÂÏÔÁÚ·Ê›·. ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '60 Ô Kittrege Î·È Û˘ÓÂÚÁ¿Ù˜ (5), Ô Callahan Î·È Û˘ÓÂÚÁ¿Ù˜ (6) Î·È ¿ÏÏÔÈ ¤‰ÂÈÍ·Ó Ì ÙË xÚËÛÈÌÔÔ›ËÛË Ù˘ ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›·˜ ÙÔ ÛËÌÂ›Ô Ù˘ ·Ó·ÙÔÌÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÙÔ˘ ÏÂÌÊÈÎÔ‡ Ì ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. H ÂÈÎÔÈÓˆÓ›· ÌÔÚ› Ó· ‚Ú›ÛÎÂÙ·È Û ÔÔÈÔ‰‹ÔÙ ‡„Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (ÓÂÊÚÔ›, ‡ÂÏÔ˜, Ô˘ÚËÙ‹Ú˜, ·ÛÙË) Ó· Â›Ó·È ÂÙÂÚfiÏ¢ÚË Ë Û·ÓÈfiÙÂÚ· ·ÌÊÔÙÂÚfiÏ¢ÚË (1,2).

164

EӉȷʤÚÔ˘Û· ÂÚ›ÙˆÛË

O Carter ÙÔ 1862, Ô Ackerman ÙÔ 1863 (3) ÚfiÙÂÈÓ·Ó ÙËÓ "·ÔÊÚ·ÎÙÈ΋" ıˆڛ· ÁÈ· Ó· ÂÍËÁ‹ÛÔ˘Ó ÙËÓ ¯˘ÏÔ˘Ú›· Ë ÔÔ›· ÁÈ· ¯ÚfiÓÈ· ‹Ù·Ó ÁÂÓÈο ·Ô‰ÂÎÙ‹ (4): ÔÚÁ·ÓÈ΋ ·fiÊÚ·ÍË ÌÂٷ͇ ÙˆÓ Á·Ï·ÎÙÔÊfiÚˆÓ ÏÂÌÊ·ÁÁ›ˆÓ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Î·È Ù˘ ·fiÏË͢ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ fiÚÔ˘ ÛÙÔ ÊÏ‚ÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ô‰ËÁ› Û ¿˘ÍËÛË Ù˘ ›ÂÛ˘ ÂÓÙfi˜ ÙˆÓ ÏÂÌÊ·ÁÁ›ˆÓ, ÏÂÌÊÈ΋ ÛÙ¿ÛË, ·Ó¿Ù˘ÍË ‚·Ï‚ȉÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ‰ËÌÈÔ˘ÚÁ›· ÏÂÌÊÈÎÒÓ ÎÈÚÛÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ú‹ÍË ·˘ÙÒÓ ÂÓÙfi˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ Û οÔÈ· ÎÔÈÏfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ (˘Â˙ˆÎfiÙ·˜-ÂÚÈÙfiÓ·ÈÔ). MÂÙ¿ Ù· ÂÈÚ¿Ì·Ù· ÙˆÓ Blalock Î·È Û˘ÓÂÚÁ·ÙÒÓ ÙÔ 1937, Ë "·ÔÊÚ·ÎÙÈ΋" ıˆڛ· ¿Ú¯ÈÛ ӷ ·ÌÊÈÛ‚ËÙÂ›Ù·È (7,8).

O Koehler Î·È Û˘ÓÂÚÁ¿Ù˜ ÙÔ 1968 (9) ˘ÔÛÙ‹ÚÈÍ·Ó fiÙÈ Ë ¯˘ÏÔ˘Ú›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÔÈ΋˜ ÏÂÌÊÈ΋˜ ·fiÊڷ͢ Ô˘ Â›Ó·È Û˘Ó¤ÂÈ· ÂÎÙÂٷ̤Ó˘ ›ÓˆÛ˘ ÙˆÓ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ. ¶·ÏÈÓ‰ÚfiÌËÛË Ï¤ÌÊÔ˘ ÌÔÚ› Ó· ¤¯Ô˘ÌÂ Î·È Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ÓfiÛÔ ÙÔ˘ ÏÂÌÊÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (.¯. ÚˆÙÔ·ı¤˜ ÏÂÌÊÔ›‰ËÌ·).

H ¯˘ÏÔ˘Ú›· Ù·ÍÈÓÔÌÂ›Ù·È Û ‰‡Ô ÔÌ¿‰Â˜, ÙËÓ ·Ú·ÛÈÙÈ΋ (‹ ÙÚÔÈ΋) Î·È ÙËÓ ÌË ·Ú·ÛÈÙÈ΋. H ·Ú·ÛÈÙÈ΋ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ Wuchereria bancrofti ÙÔ ·Ú¿ÛÈÙÔ Ô˘ ÚÔηÏ› ÙËÓ ÊÈÏ·Ú›·ÛË. TË Û˘Ó·ÓÙ¿Ì ÛÙËÓ ÙÚÔÈ΋ AÛ›·, AÊÚÈ΋ Î·È AÌÂÚÈ΋, ÂÚÈÔ¯¤˜ Ô˘ ÂÓ‰ËÌ› Î·È Ë ÊÈÏ·Ú›·ÛË. Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Î·È ¿ÏÏ· ·Ú¿ÛÈÙ· fiˆ˜ Ô Â¯ÈÓfiÎÔÎÎÔ˜, Ë ·Ûηڛ‰·, Ô Î˘ÛÙ›ÎÂÚÎÔ˜ ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛı› ηٿ fiÛÔ ¤¯Ô˘Ó ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ¯˘ÏÔ˘Ú›·˜ ‹ ·ÔÙÂÏÔ‡Ó Û˘Ó˘¿Ú¯Ô˘Û· Ïԛ̈ÍË (10). H ÌË ·Ú·ÛÈÙÈ΋ ¯˘ÏÔ˘Ú›· Â›Ó·È Û·ÓÈfiÙÂÚË, ÙËÓ Û˘Ó·ÓÙԇ̠΢ڛˆ˜ ÛÙËÓ E˘ÚÒË Î·È ¤¯ÂÈ ÔÈΛÏË ·ÈÙÈÔÏÔÁ›·: ηÎÔ‹ıÂȘ ÓfiÛÔÈ ÔÈÛıÔÂÚÈÙÔÓ·›Ô˘ (9,11), ¯ÚfiÓȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ı‹ÛÂȘ, Ê˘Ì·Ù›ˆÛË (12), ÙÚ·˘Ì·ÙÈÛÌfi˜ (3), ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ-

EÈÎfiÓ· 1. ™ÙËÓ ‰ÂÍÈ¿ Âȉȉ˘Ì›‰· ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰‡Ô ˘fi˯· ÌÔÚÊÒÌ·Ù·, Û·ÊÒÓ-ÔÌ·ÏÒÓ ÔÚ›ˆÓ, ‰È·ÛÙ¿ÛÂˆÓ 1,82x1,26 cm Î·È 1,41x1,18 cm ·ÓÙÈÛÙÔ›¯ˆ˜, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ·Ϥ˜ ·ÛÙÂȘ.

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‚¿ÛÂȘ, Ì˯·ÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ (.¯ ÂÁ΢ÌÔÛ‡ÓË) (3,9,11) Û˘ÁÁÂÓ‹˜ ÌÔÚÊ‹ (13,14) (¶›Ó·Î·˜ 1).

H ¯˘ÏÔ˘Ú›· ÌÔÚ› Ó· ¤¯ÂÈ ·ÈÊÓ›‰È· ¤Ó·ÚÍË, Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈο ‰È·Ï›Ô˘Û· Ì ‰È·Î˘Ì¿ÓÛÂȘ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. ¶·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ·Ó¿ÌÂÛ· ÛÙË ‰Â‡ÙÂÚË Î·È ÛÙË ¤ÌÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜, ÌÔÚ› Ó· ·Ú·Ì›ÓÂÈ ÁÈ· ¯ÚfiÓÈ· ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ˘Á›· ÙÔ˘ ·ÛıÂÓÔ‡˜. ¢ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ Â›ÙˆÛ˘ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ (1). H ‰ËÌÈÔ˘ÚÁ›· ¯˘ÏÒ‰Ô˘˜ ıÚfiÌ‚Ô˘ ÂÓÙfi˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ÎÔÏÈÎfi, ·ÈÌ·ÙÔ˘Ú›·, ‰˘ÛÔ˘ÚÈο ÂÓԯϋ̷ٷ. AӷʤÚÂÙ·È Â›Û˘ Û¯ÂÙÈο ·˘ÍË̤ÓË Â›ÙˆÛË ÏÔÈÌÒÍÂˆÓ Ô˘ÚÔÔÈËÙÈÎÔ‡ (2). H ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· ÌÔÚ› Ó· ÚÔηϤÛÂÈ ˘ÔÚˆÙÂ˚Ó·ÈÌ›·, Ë ·ÒÏÂÈ· Ï›Ô˘˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÒÏÂÈ· ‚¿ÚÔ˘˜ fiˆ˜ Î·È Ë ·ÒÏÂÈ· ·›Ì·ÙÔ˜ Û ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·. H ·ÒÏÂÈ· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û˘Ó‹ıˆ˜ ‰ÂÓ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓË Â›ÙˆÛË Û ÏÔÈÌÒÍÂȘ Èı·ÓfiÓ ÏfiÁˆ Ù˘ Â·ÚÎÔ‡˜ ·Ó·Ï‹ÚˆÛ˘ (13).

YÔÙÚÔ¤˜ ‹ Âȉ›ӈÛË Ù˘ ¯˘ÏÔ˘Ú›·˜ ¤¯Ô˘Ó ·Ô‰Ôı› Û ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ¿ÛÎËÛË, Ë ¤ÌÌËÓÔ˜ Ú‡ÛË, Ë ‰›·ÈÙ·, Ë ÂÁ΢ÌÔÛ‡ÓË (15).

H "Á·Ï·ÎÙ҉˘" fi„Ë ÙˆÓ Ô‡ÚˆÓ ·ÔÙÂÏ› Û·Ê‹ ¤Ó‰ÂÈÍË ¯˘ÏÔ˘Ú›·˜ Ë ÔÔ›· ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ÛÙ· Ô‡Ú· ÚˆÙÂ˚ÓÒÓ, ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ¯˘ÏÔÌÈÎÚÒÓ, ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ¯ÔÏËÛÙÂÚfiÏ˘ Û ÔÈΛÏË ·Ó·ÏÔÁ›·. H ·Ó¿ÌÂÈÍË ÙˆÓ Ô‡ÚˆÓ Ì Sudan III ‰›ÓÂÈ Û ·˘Ù¿ ÂÚ˘ıÚ¿ ¯ÚÔÈ¿ (1,2). H ·ÓÈÔ‡Û· ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›· Â›Ó·È Ë ÂͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË ÙˆÓ ‰È·ÙÂÙ·ÁÌ¤ÓˆÓ ÏÂÌÊ·ÁÁ›ˆÓ, ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ Î·È Ù˘ ı¤Û˘ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÙÔ˘˜ Ì ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· (16). TÔ ÛÈÓıËÚÔÁÚ·ÊÈÎfi ÏÂÌÊ·ÁÁÂÈÔÁÚ¿ÊËÌ· Ì Tc-99 Î·È ÎÔÏÔÂȉ¤˜ ·ÓÙÈÌfiÓÈÔ Â›Ó·È ·ÏÔ‡ÛÙÂÚË Î·È ÏÈÁfiÙÂÚÔ ÂÂÌ‚·ÙÈ΋ ÂͤٷÛË, ÌÂÈÔÓÂÎÙ› fï˜ Û ·ÎÚ›‚ÂÈ· ˆ˜ ÚÔ˜ ÙËÓ ·Ó·ÙÔÌÈ΋ ·ÂÈÎfiÓÈÛË ¤Ó·ÓÙÈ Ù˘ ·Ï‹˜ ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›·˜ ¶›Ó·Î·˜ 1. A›ÙÈ· ¯˘ÏÔ˘Ú›·˜.

1. ¶·Ú·ÛÈÙÈ΋ (‹ ÙÚÔÈ΋) - Wuchereria bancrofti - Echinococcus, Cysticercus cell, Ascaris, Tinea, ÂÏÔÓÔÛ›· 2. MË ·Ú·ÛÈÙÈ΋ (ÌË ÙÚÔÈ΋, Â˘Úˆ·˚΋) - K·ÎÔ‹ıÂȘ ÓfiÛÔÈ ÔÈÛıÔÂÚÈÙÔÓ·›Ô˘ - XÚfiÓȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ - º˘Ì·Ù›ˆÛË - AfiÛÙËÌ· - ™·Î¯·Ú҉˘ ¢È·‚‹Ù˘ - M˯·ÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ (.¯ ÂÁ΢ÌÔÛ‡ÓË) - TÚ·‡Ì· - ™˘ÁÁÂÓ‹˜

EӉȷʤÚÔ˘Û· ÂÚ›ÙˆÛË

(17). TÔ ÁÂÁÔÓfi˜ ·˘Ùfi ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ë ·Ï‹ ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›· Ó· ·Ú·Ì¤ÓÂÈ Ë ÂͤٷÛË ÂÎÏÔÁ‹˜ ÛÙÔÓ ÚÔÂÁ¯ÂÈÚËÙÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ (1). AÎÙÈÓÔÁÚ·Ê›· ıÒڷη, U/S ÓÂÊÚÒÓ, CT ıÒڷη-ÎÔÈÏ›·˜ ·ÔÙÂÏÔ‡Ó ··Ú·›ÙËÙ˜ ÂÍÂÙ¿ÛÂȘ ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ¯˘ÏÔ˘Ú›·˜.

H ÓfiÛÔ˜ ÌÔÚ› Ó· ·Ú·Ì¤ÓÂÈ ÁÈ· ¯ÚfiÓÈ· ¯ˆÚ›˜ ÛÔ‚·Ú‹ ÂÈ‚¿Ú˘ÓÛË Ù˘ ˘Á›·˜ ÙˆÓ ·ÛıÂÓÒÓ. ™Â ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Î·ÌÌ›· ·Ú¤Ì‚·ÛË. ™Â ‹È· Û˘ÌÙÒÌ·Ù· ‰›·ÈÙ· ¯·ÌËÏ‹ Û ÏÈ·Ú¿ (΢ڛˆ˜ ÌÈÎÚ‹˜ Î·È Ì¤Û˘ ·Ï‡ÛÔ˘) (18), ˘„ËÏ‹ Û ÚˆÙ›Ó˜ ¤¯ÂÈ Ôχ ηϿ ·ÔÙÂϤÛÌ·Ù·. T¤ÏÔ˜, ÛÙȘ Â˘Ù˘¯Ò˜, Ï›Á˜ ÂÚÈÙÒÛÂȘ ‚·Ú›·˜ ¯˘ÏÔ˘Ú›·˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË (1,19). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ Ë ¤Ó·ÚÍË Ù˘ ¯˘ÏÔ˘Ú›·˜ ‹Ù·Ó ·ÈÊÓ›‰È·, Ë ‰È·‰ÚÔÌ‹ Ù˘ ‹Ù·Ó ·Û˘Ìو̷ÙÈ΋ (ÂÎÙfi˜ Ù˘ Á·Ï·ÎÙÒ‰Ô˘˜ ¯ÚÔÈ¿˜ ÙˆÓ Ô‡ÚˆÓ) Ë ‰Â ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ë ıÚ¤„Ë Î·È Ë ·Ó¿Ù˘ÍË ‰ÂÓ ÂËÚ¿ÛÙËηÓ, ÁÂÁÔÓfi˜ Ô˘ ÂÚÈfiÚÈÛ ÙËÓ ·Ú¤Ì‚·Û‹ Ì·˜ Û ·Ï‹ ·Ú·ÎÔÏÔ‡ıËÛË. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÈÙÈÔÏÔÁ›·, Ë ÌË ‰È·‚›ˆÛË Û ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜ ·ÔÎÏ›ÂÈ ÙËÓ ·Ú·ÛÈÙÈ΋ ÌÔÚÊ‹. O ÏÂÙÔÌÂÚ‹˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜-·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·¤ÎÏÂÈÛ ٷ ÂÚÈÛÛfiÙÂÚ· ·›ÙÈ· ÌË ·Ú·ÛÈÙÈ΋˜ ¯˘ÏÔ˘Ú›·˜. TÔ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ‡ÚËÌ· ÙˆÓ Î˘ÛÙÈÎÒÓ ÌÔÚÊˆÌ¿ÙˆÓ ÛÙË ‰ÂÍÈ¿ Âȉȉ˘Ì›‰· Û·ÊÒ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÚÔ 4ÂÙ›·˜ οΈÛË ÙÔ˘ fiÛ¯ÂÔ˘ ÛÙËÓ ÔÔ›· Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È Î·È Ë ·ıÔÏÔÁÈ΋ ÂÈÎÔÈÓˆÓ›· ÙÔ˘ ÏÂÌÊÈÎÔ‡ Ì ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. H ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›· ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ‰Â›ÍÂÈ ÙËÓ ÂÈÎÔÈÓˆÓ›· ÂÓÒ Ë Ú·‰ÈÔ˚ÛÔÙÔÈ΋ ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›· - Ë ÔÔ›·, Ú¤ÂÈ Ó· ÛËÌÂÈÒÛÔ˘ÌÂ, ˘ÛÙÂÚ› Û ·ÎÚ›‚ÂÈ· ÛÙËÓ ·Ó·ÙÔÌÈ΋ ·ÂÈÎfiÓÈÛË - ‰ÂÓ ¤ÁÈÓ ·Ú¯Èο, ÏfiÁˆ Ù¯ÓÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÏfiÁˆ Ù˘ ·Û˘Ìو̷ÙÈ΋˜ ÔÚ›·˜ Î·È Ù˘ ·ÚÔı˘Ì›·˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ó· Û˘Ó¯ÈÛÙ› Ô ¤ÏÂÁ¯Ô˜.

AÍ›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÂÚ›ÙˆÛË ÌË ·Ú·ÛÈÙÈ΋˜ ¯˘ÏÔ˘Ú›·˜ Û ·È‰› ‰ÂÓ ¤¯ÂÈ Í·Ó¿ ÂÚÈÁÚ·Ê› ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, ÂÓÒ ÂÏ¿¯ÈÛÙ˜ Â›Ó·È Î·È ÔÈ ‰ËÌÔÛȇÛÂȘ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Stalens JP, Falk M, Howmann-Giles R, Roy LP. "Milky" urine- a child with chyluria. Eur J Pediatr 1992; 151:61-62.

2. Schneider J, Schacht RG. Chyluria in an adolescent hemophiliac. A discussion of diagnosis and management.

Clin Pediatr 1977; 16:959-960.

3. Lazarus JA, Marks MS. Non paracitic chyluria with special reference to traumatic chyluria. J Urol 1946; 56:246-258.

4. Kinmonth JB,Taylor GW. Chylous Reflux. BMJ 1964;1:529-533.

5. Kittredge RD, Hashim S, Roholt HB, Van Itallie TB, Finby N. Demonstration of Lymphatic abnormalities in a patient with chyluria. Am J Roentgenol 1963;90:159-165.

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6. Callahan DH, Graf EC, Gersack J, Turbow AM. Lymphangiography and simultaneous excretory urography as a diagnostic aid in chyluria. J Urol 1965;93:417-419.

7. Blalock A, Robinson CS, Cunningham RS, Gray ME. Experimental studies on lymphatic blockage. Arch Surg 1937;34:1049-1071.

8. Neyazaki T, Kupic EA, Marshall WH and Abrams HL. Collateral lymphatico-venous communications after experimental obstruction of the thoracic duct. Radiology 1965;85:423-432.

9. Koehler PR, Chiang TC, Lin CT, Chen KC, Chen KY. Lymphagiography in chyluria. Am J Roentgenol 1968; 102:455-465.

10. Johnson DW. Chyluria: Case report and review of literature. Ann Int Med 1955;42:931-937.

11. Kutzmann AA. Non-parasitic chyluria. Ann Surg 1925;82:765-780.

12. Curtis GM. The lymphatic system. In: Christopher F, ed.

Textbook of Surgery Ed 5, Philadelphia: WB Saunders Company 1949:672.

13. Arnold WC, Steele RW. Immunodeficiency in congenital chyluria. Pediatrics 1980;66:792-794.

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14. Mogg RA, Joner JH. Non parasitic chyluria. Br J Urol 1971;42:28-34.

15. Yamauchi S. Chyluria, clinical, laboratory and statistical study of 45 personal cases observed in Hawaii. J Urol 1945; 54:318-347.

16. Greig JD, Mackenzie JR, Azmy AA. Congenital pyelolymphatic fistula in a child with chyluria. Br J Urol 1989; 63: 550-551.

17. Petit J, Sawczuk IS. Use of lymphoscintigraphy in chyluria.

Urology 1988; 32:427-431.

18. Hashim SA, Roholt HB, Babayan VK, Van Hallie.

Treatment of chyluria and chylothorax with medium chain triglyceride. N Engl J Med 1964; 270: 756-761.

19. Chang CY, Luc YB, Lapides J. Surgical treatment for chyluria. J Urol 1973;109:299.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-09-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-12-1999 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: XÚ›ÛÙÔ˜ K·Ú‹˜ Z·Î‡ÓıÔ˘ 2 - X·Ï¿Ó‰ÚÈ

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EÛٛ˜ ÂÍˆÌ˘ÂÏÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘ Û ·È‰› Ì ÂӉȿÌÂÛË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· MÈÚ¿ÓÙ· Aı·Ó·Û›Ô˘-MÂÙ·Í¿1, AÊÚÔ‰›ÙË KÔ‡ÛË1, Iˆ¿ÓÓ· TÛ¿ÙÚ·1, M·Ú›· M·ÓÙÔ˘Ú¿ÎË2

M. Athanasiou - Metaxa, A. Koussi, J. Tsatra, M. Badouraki. Foci of extramedullary haemopoiesis in a patient with thalassaemia intermedia. Paediatriki 2000;63:167-169. ● Abstract: This is a case of an 8 year old boy with thalassaemia intermedia, who presented with a respiratory infection. His chest X-ray demonstrated expanded rarefied ribs and enlargement of the posterior mediastinum suggesting lesions of extramedullary haemopoiesis. CT scan demonstrated distended osteoporotic ribs with a coarse trabeculated spongiform pattern and thin cortex, and nodular masses in the posterior mediastinum contiguous to the ribs and the spine consistent with extramedullary haemopoiesis.

Key words: thalassaemia intermedia, extramedullary haemopoiesis.

H ÂӉȿÌÂÛË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· (EMA) ·ÓÙÈÚÔÛˆ‡ÂÈ ÌÈ· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ Û˘Ó‰˘·ÛÌfi ‹ÈˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ‚ ÁÔÓ›‰ÈÔ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (H‚), Û˘Ó‡·ÚÍË · Î·È ‚- ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‹ ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ Á-·Ï‡ÛˆÓ (1). H EMA ÂÌÊ·Ó›˙ÂÙ·È Ì ÔÈΛÏË ÎÏÈÓÈ΋ ÂÈÎfiÓ·: ‹È· ¤ˆ˜ ‚·ÚÈ¿ ·Ó·ÈÌ›·, ηϋ ‹ ηı˘ÛÙÂÚË̤ÓË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË, ÛÎÂÏÂÙÈΤ˜ ·Ú·ÌÔÚÊÒÛÂȘ, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ˘›ÎÙÂÚÔ (2). ™ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÔÚ›· Ù˘ ÓfiÛÔ˘ ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ¿ Ù˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÂÈÏÔΤ˜, fiˆ˜ ˘ÂÚÛÏËÓÈÛÌfi˜, ¯ÔÏÔÏÈı›·ÛË, ÂÛٛ˜ ÂÍˆÌ˘ÂÏÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘, ¤ÏÎË ÎÓËÌÒÓ Î.¿. (3). A·ÈÙÂ›Ù·È Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·Û¯fiÓÙˆÓ Î·È ·Ó¿ÏÔÁ· Ì ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ Ô ·ÛıÂÓ‹˜ ˘Ô‚¿ÏÏÂÙ·È Û ÂÚÈÛÙ·ÛȷΤ˜ ÌÂÙ·ÁÁ›ÛÂȘ ‹ ·ÎÔÏÔ˘ı› Ù·ÎÙÈÎfi ÚfiÁÚ·ÌÌ· ÌÂÙ¿ÁÁÈÛ˘ - ·ÔÛȉ‹ÚˆÛ˘ (3). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ AÁfiÚÈ ËÏÈΛ·˜ 8 ¯ÚfiÓˆÓ Ì ÁÓˆÛÙ‹ EMA ÚÔÛ‹Ïı ÛÙÔ E͈ÙÂÚÈÎfi ¶·È‰È·ÙÚÈÎfi AÈÌ·ÙÔÏÔÁÈÎfi I·ÙÚÂ›Ô ÁÈ· ‚‹¯·, ˘ÚÂÙfi Î·È ¤ÓÙÔÓË ˆ¯ÚfiÙËÙ·. H ‰È¿ÁÓˆÛË Ù˘ EMA Ù¤ıËΠ۠ËÏÈΛ· 3 ¯ÚfiÓˆÓ ÛÙ·

1 2

Ï·›ÛÈ· ÂϤÁ¯Ô˘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÂÂȉ‹ ÛÙË ÌÂÁ·Ï‡ÙÂÚË ·‰ÂÏÊ‹ ÙÔ˘ ‰È·ÁÓÒÛıËΠEMA. ™ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ ‚Ú¤ıËÎÂ: H‚= 8 g/dl, Ht= 28%, MCV= 62,7 fl, H‚A2= 3%, H‚F= 78%, H‚A = 15%. H ÌÂϤÙË ÙÔ˘ Ù‡Ô˘ Ù˘ ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ ‚ ÁÔÓȉ›Ô˘ ¤‰ÂÈÍ ‚+ - 87/ ‚Ô Codon 39. ŒÎÙÔÙÂ, Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ηϋ, ‰È·ÙËÚÔ‡Û Â›‰· H‚= 7-8 g/dl ¯ˆÚ›˜ ÌÂÙ·ÁÁ›ÛÂȘ. H È·ÙÚÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘ ‹Ù·Ó ÂÏÏÈ‹˜. ™ÙËÓ ·ÚÔ‡Û· ÓfiÛÔ ÙÔ ·È‰› ÂÌÊ¿ÓÈ˙ ¤ÓÙÔÓË ˆ¯ÚfiÙËÙ· Ì ˘ÈÎÙÂÚÈ΋ ¯ÚÔÈ¿ ÂÈÂÊ˘ÎfiÙˆÓ, „ËÏ·ÊËÙfi ‹·Ú Î·È ÛÏ‹Ó· 2 cm. K·Ù¿ ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ˘‹Ú¯·Ó ÍËÚÔ› ÚfiÁ¯ÔÈ ¿Ìʈ Î·È ·fi ÙÔ Î˘ÎÏÔÊÔÚÈÎfi, Ù·¯˘Î·Ú‰›· 130 ÛʇÍÂȘ/ 1’, ÙÚ·¯‡ Û˘ÛÙÔÏÈÎfi ʇÛËÌ· ÂÓÙ¿Ûˆ˜ 2/6 ÛÙÔ 3-4Ô ·ÚÈÛÙÂÚfi ÌÂÛÔχÚÈÔ ‰È¿ÛÙËÌ·, A¶ 95/ 65.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: H‚= 5,2 g/dl, Ht= 16%, §Â˘Î¿ = 12.000 mm3, ¶= 65%, TKE= 25 mm, CRP= 20 mg/l. H ·/· ıÒڷη ¤‰ÂÈÍ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ηډȿ˜ (K£¢= 0,63) Î·È ‰È·Ï¿Ù˘ÓÛË ÙÔ˘ ¿Óˆ ÌÂÛÔıˆÚ·Î›Ô˘ ¿Ìʈ, ÂÓÙÔÓfiÙÂÚË ‰ÂÍÈ¿, ÔÊÂÈÏfiÌÂÓË Û ‰È·Ï¿Ù˘ÓÛË ÙˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ¿ÎÚˆÓ ÙˆÓ Ï¢ÚÒÓ (4Ë - 7Ë) (EÈÎfiÓ· 1).

MÔÓ¿‰· MÂÛÔÁÂȷ΋˜ AÓ·ÈÌ›·˜, A' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ A¶£, AÎÙÈÓÔÏÔÁÈÎfi EÚÁ·ÛÙ‹ÚÈÔ °ÂÓÈÎÔ‡ ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ NÔÛÔÎÔÌ›Ԣ "IÔÎÚ¿ÙÂÈÔ" £ÂÛÛ·ÏÔӛ΢

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M. Aı·Ó·Û›Ô˘ - MÂÙ·Í¿ Î·È Û˘Ó.

EÈÎfiÓ· 1. A‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ηډȿ˜. ¢È·Ï¿Ù˘ÓÛË ÙÔ˘ ¿Óˆ ÌÂÛÔıˆÚ¿ÎÈÔ˘ ÏfiÁˆ ‰È·Ï¿Ù˘ÓÛ˘ ÙˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ¿ÎÚˆÓ ÙˆÓ Ï¢ÚÒÓ.

EÈÎfiÓ· 2. ŒÓÙÔÓË ‰ÈfiÁΈÛË Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ¿ÎÚÔ˘ ÙˆÓ ·ÂÈÎÔÓÈ˙ÔÌ¤ÓˆÓ Ï¢ÚÒÓ, Ô˙Ò‰ÂȘ ÛÎÈ¿ÛÂȘ ÂÎÙfi˜ Ï¢ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜: ÂÛٛ˜ ÂÓ‰Ô Î·È Â͈- Ì˘ÂÏÈ΋˜ ·ÈÌÔÔ›ËÛ˘.

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M ÙËÓ ˘Ô„›· Ù˘ ÂÍˆÌ˘ÂÏÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘ ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT) ıÒڷη Ô˘ ¤‰ÂÈÍ ¤ÓÙÔÓË ‰ÈfiÁΈÛË Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ¿ÎÚÔ˘ ÙˆÓ ·ÂÈÎÔÓÈ˙fiÌÂÓˆÓ Ï¢ÚÒÓ ·ÏÏ¿ Î·È Ô˙Ò‰ÂȘ ÛÎÈ¿ÛÂȘ ÂÎÙfi˜ Ï¢ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ÂÛٛ˜ ¤Ó‰Ô Î·È ÂÍˆÌ˘ÂÏÈ΋˜ ·ÈÌÔÔ›ËÛ˘ (EÈÎfiÓ· 2). ™˘˙‹ÙËÛË OÈ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ÔÛÙÒÓ Ù˘ MA ¤ÁÈÓ·Ó ·ÊÔÚÌ‹ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ Cooley ÙÔ 1927 (4) Î·È Ë ÏÂÙÔÌÂÚ‹˜ ÂÚÈÁÚ·Ê‹ ·˘ÙÒÓ ¤ÁÈÓ ·fi ÙÔ˘˜ Cooley Î·È Û˘Ó. Ï›ÁÔ ·ÚÁfiÙÂÚ· (5). ™‹ÌÂÚ·, Ì ÙË ÛˆÛÙ‹ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÔÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ. ™Ù· ˘ÔÌÂÙ·ÁÁÈ˙fiÌÂÓ· ¿ÙÔÌ· (fiˆ˜ ÔÈ ·ÛıÂÓ›˜ Ì EMA) Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ÌÔÚ› Ó· ·˘ÍËı› ηٿ 15-30 ÊÔÚ¤˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (2,3). H ˘ÂÚÏ·Û›· ·˘Ù‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÚÔηÏ› ‰È‡ڢÓÛË Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜, ϤÙ˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÔÛÙÒÓ, Ú‹ÍË ÙÔ˘ ÂÚÈÔÛÙ¤Ô˘ Î·È ·Ó¿Ù˘ÍË ÙÔ˘ ÂÚ˘ıÚÔÔÈËÙÈÎÔ‡ Ì˘ÂÏÔ‡ ÂÎÙfi˜ Ù˘ Ì˘ÂÏÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Û ‰È¿ÊÔÚ˜ ı¤ÛÂȘ ·Ú·ÛÔÓ‰˘ÏÈο, ΢ڛˆ˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ, ·ÏÏ¿ Î·È Û ‰È¿ÊÔÚ· fiÚÁ·Ó· fiˆ˜ ‹·Ú, ÛÏ‹Ó· (6). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ Ô ·ÛıÂÓ‹˜ ÏfiÁˆ ÙˆÓ Û¯ÂÙÈο ˘„ËÏÒÓ ÙÈÌÒÓ H‚ Ô˘ ‰È·ÙËÚÔ‡Û ‰ÂÓ ÌÂÙ·ÁÁ›ÛıËΠÔÙ¤ Î·È ÌfiÓÔ Ì ÙËÓ Â˘Î·ÈÚ›· Ù˘ Ïԛ̈͢ Î·È Ù˘ ¤ÓÙÔÓ˘ ˆ¯ÚfiÙËÙ·˜ ÂÈÛΤÊıËΠÙÔ Â͈ÙÂÚÈÎfi AÈÌ·ÙÔÏÔÁÈÎfi I·ÙÚ›Ô. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·ÂÎ¿Ï˘„·Ó ¤ÓÙÔÓË ‰ÈfiÁΈÛË Ù˘ Ì˘ÂÏÈ΋˜ ÌÔ›Ú·˜ ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ¿ÎÚÔ˘ ÙˆÓ ·ÂÈÎÔÓÈ˙fiÌÂÓˆÓ Ï¢ÚÒÓ Ì ÛÎÈ¿ÛÂȘ Î·È ÂÎÙfi˜ ÙÔ˘ Ï¢ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, ÔÈ Ôԛ˜ ÏfiÁˆ Ù˘ ÔÏÏ·ÏfiÙËÙ·˜ Î·È ÙÔ˘ ·ÌÊÔÙÂÚfiÏ¢ÚÔ˘ ÙˆÓ ‚Ï·‚ÒÓ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÛٛ˜ ÂÓ‰Ô Î·È ÂÍˆÌ˘ÂÏÈ΋˜ ·ÈÌÔÔ›ËÛ˘. AÎÔÏÔ˘ıÒÓÙ·˜ Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ÙÔ ·È‰› Ù¤ıËΠ۠ÚfiÁÚ·ÌÌ· Û˘ÛÙËÌ·ÙÈÎÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ ÁÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ ÂÍˆÌ˘ÂÏÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘ (2,3).

∞ÂÈÎÔÓÈÛÙÈ΋ ÂÚ›ÙˆÛË

BÈ‚ÏÈÔÁÚ·Ê›· 1. K·Ó·‚¿Î˘ E. ¶·ıÔÁ¤ÓÂÈ· Î·È ÌÔÚȷ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÂӉȿÌÂÛ˘ ‚-MÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜. Haem 1999;2 (4 suppl):88-91.

2. Weatherall DJ, Clegg GB. The Thalassemia Syndromes (3rd ed) Oxford: Blackwell Scientific Publications, 1981.

3. Mc Donach KT, Nienhuis AW. The Thalassemias. In: Nathan and Oski Hematology of infancy and childhood.

4th ed, Philadelphia: WB Saunders Company, 1993:847849.

4. Cooley TB, Witner E, Lee P. Anemia in children with splenomegaly and peculiar changes in the bones. Amer J Dis Child 1927;34:347-350.

5. Caffey J. Cooley's anemia a review of the roentgenographic findings in the skeleton. Amer J Roentgen 1957;78:361-381.

6. Spinal cord compression in Thalassemia (editorial).

Lancet 1982;1:664-669.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-02-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-02-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: M. ∞ı·Ó·Û›Ô˘ - ªÂÙ·Í¿ ∞Á›·˜ ™ÔÊ›·˜ 30 - 546 22 £ÂÛÛ·ÏÔÓ›ÎË

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™YNEXIZOMENH EK¶AI¢EY™∏

¶ÚÔʇϷÍË ·fi ÙȘ ˘ÔÙÚÔ¤˜ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ AÁÁÂÏÈ΋ ™Î·Ú‰Ô‡ÙÛÔ˘

● ¶ÂÚ›ÏË„Ë: T· ·ÚÈ· ̤۷ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ fiˆ˜ Â›Ó·È Ù· ·ÓÙÈ˘ÚÂÙÈο Î·È Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ‰ÂÓ ÚÔÛÙ·ÙÂ‡Ô˘Ó Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ·fi ÙȘ ˘ÔÙÚÔ¤˜. T· ·ÓÙÈÂÈÏËÙÈο ΢ڛˆ˜ Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È ·fi ÙÔ ÛÙfiÌ· ÚÔηÏÔ‡Ó ÓˆıÚfiÙËÙ·, ·Ù·Í›·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·ÓÙ›ÏË„Ë ÛÙÔ 40% ÙˆÓ ·È‰ÈÒÓ. EÈϤÔÓ, ‰ÂÓ ˘¿Ú¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·fi‰ÂÈÍË fiÙÈ ÙÚÔÔÔÈÔ‡Ó ÙÔ ÌÈÎÚfi ΛӉ˘ÓÔ Ô˘ ¤¯Ô˘Ó ÔÚÈṲ̂ӷ ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Ó· ÂΉËÏÒÛÔ˘Ó ÂÈÏË„›·. O ηχÙÂÚÔ˜ ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Û‹ÌÂÚ· Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ˘ÚÂÙÈÎÒÓ Ì ÛÙfi¯Ô ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi ¤ÓÙÂÚÔ ÁÈ· ÙË ‰È·ÎÔ‹ ÂÓfi˜ ·Ú·ÙÂٷ̤ÓÔ˘ Û·ÛÌÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË ·Ú·ÙÂٷ̤ÓÔ˘ ·Ú¯ÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Ë ‰È·˙Â¿ÌË ÌÔÚ› Ó· ¯ÔÚËÁÂ›Ù·È Î·È ÚÔÊ˘Ï·ÎÙÈο ·fi ÙÔ ÛÙfiÌ· ÛÙËÓ ·Ú¯‹ ÙÔ˘ ˘ÚÂÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. A·Ú·›ÙËÙË Â›Ó·È Ë ÏÂÙÔÌÂÚ‹˜ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ Û¯ÂÙÈο Ì ÙËÓ ÂÍ·ÈÚÂÙÈο ηÏÔ‹ıË ÚfiÁÓˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÒÛÙ ӷ ÌÂȈı› ÙÔ ¿Á¯Ô˜ Î·È Ë ÊÔ‚›· ÙÔ˘ ˘ÚÂÙÔ‡ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙËÓ Î·ÏÔ‹ıË ·˘Ù‹ ηٿÛÙ·ÛË. ¶·È‰È·ÙÚÈ΋ 2000;63:170-176. §¤ÍÂȘ ÎÏÂȉȿ: ˘ÚÂÙÈÎÔ› Û·ÛÌÔ›, ˘ÔÙÚÔ¤˜, ÚÔʇϷÍË, ·ÓÙÈ˘ÚÂÙÈο, ·ÓÙÈÂÈÏËÙÈο.

A. Skardoutsou. Prophylaxis from recurrence of febrile convulsions. Paediatriki 2000;63:170-176. ● Abstract: The generally available oral medication regimens (i.e. antipyretics, diazepam or both) will not prevent recurrent febrile convulsions in most children. There is no evidence that oral anticonvulsant medication can modify the small risk of epilepsy carried by some children with febrile convulsions. Antiepileptic drugs, and especially phenobartitone, may cause somnolence, ataxia, hyperactivity and impairment in cognitive abilities in 40% of treated children. The best policy today as regards the management of recurrences is the prophylactic administration of oral antipyretics for the comfort of the child and the use of rectal diazepam to shorten a prolonged seizure. Diazepam may be given prophylactically by mouth at the onset of fever in selected cases such as those with a prolonged first episode. Parents should be reassured about the generally excellent prognosis of febrile convulsions.

Key words: febrile convulsions, recurrences, prevention, antipyretics, antiepileptics.

EÈÛ·ÁˆÁ‹ OÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› Â›Ó·È ÂÈÏËÙÈο ÂÂÈÛfi‰È· ÚÔηÏÔ‡ÌÂÓ· ·fi ˘„ËÏfi ˘ÚÂÙfi Ô ÔÔ›Ô˜ ‰ÂÓ Ú¤ÂÈ Ó· ÔÊ›ÏÂÙ·È Û ÂÓ‰ÔÎÚ¿ÓÈ· Ïԛ̈ÍË. ¶·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ 2-4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ. M ‚¿ÛË ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‰È·ÎÚ›ÓÔÓÙ·È Û ·ÏÔ‡˜ Î·È Û‡ÓıÂÙÔ˘˜. ø˜ Û‡ÓıÂÙÔÈ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È fiÛÔÈ ¤¯Ô˘Ó ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· οوıÈ ¯·Ú·ÎÙËÚÈÛÙÈο: Â›Ó·È ÂÛÙÈ·ÎÔ›, ¤¯Ô˘Ó ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ·fi 15 ÏÂÙ¿ ‹ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ·fi

¤Ó·˜ ÛÙÔ ›‰ÈÔ 24ˆÚÔ. AÏÔ› Â›Ó·È fiÛÔÈ ‰ÂÓ ¤¯Ô˘Ó ηӤӷ ·fi Ù· ·ÓˆÙ¤Úˆ ¯·Ú·ÎÙËÚÈÛÙÈο. TÔ ¤Ó· ÙÚ›ÙÔ Û¯Â‰fiÓ ·fi Ù· ·È‰È¿ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (34%) ı· ·ÚÔ˘ÛÈ¿ÛÂÈ ÌÈ· ˘ÔÙÚÔ‹ Î·È ÌfiÓÔ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi (4-7%) ı· ÂΉËÏÒÛÂÈ ·ÚÁfiÙÂÚ· ÂÈÏË„›· (‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ·‡ÚÂÙˆÓ Û·ÛÌÒÓ) (1-2).

EÂȉ‹ Ë Û˘¯ÓfiÙËÙ· Ù˘ ÂÈÏË„›·˜ (·‡ÚÂÙÔÈ Û·ÛÌÔ›) ÛÙ· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Â›Ó·È ·˘ÍË̤ÓË Û ۯ¤ÛË Ì ÂΛÓË

B' ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡"

170

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·171

¶∞π¢π∞∆ƒπ∫∏ 2000;63:170-176

ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (0,5%) ›¯·Ó ÛÙÔ ·ÚÂÏıfiÓ ÂÎÊÚ·ÛÙ› Êfi‚ÔÈ fiÙÈ ÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ‹ Ó· Úԉȷı¤ÛÔ˘Ó ÔÚÈṲ̂ÓÔ˘˜ ¿Û¯ÔÓÙ˜ Û ÂÈÏË„›·. E›Û˘, ›¯Â ‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ ÔÈ ·Ú·ÙÂٷ̤ÓÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÂÈÏË„›· ·fi ÂÎÏÂÎÙÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ Î·È È‰È·›ÙÂÚ· ÙÔ˘ ·Ì̈Ó›Ԣ ΤڷÙÔ˜ ÙˆÓ ÈÔοÌˆÓ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË fiÙÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÂÓËÏ›ÎˆÓ ¯ÂÈÚÔ˘ÚÁËı¤ÓÙˆÓ ÁÈ· ÂÈÏË„›· ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ ·Ó¤ÊÂÚ·Ó ÈÛÙÔÚÈÎfi ·Ú·ÙÂÙ·Ì¤ÓˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÛÙËÓ ·È‰È΋ ÙÔ˘˜ ËÏÈΛ· (3). ™ÙË ‰ÂηÂÙ›· ÙÔ˘ ’80 ›¯Â ÂÔ̤ӈ˜ ıˆÚËı› ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ Ë ÚfiÏË„Ë ÙˆÓ ·Ú·ÙÂÙ·Ì¤ÓˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Ì ÙË ¯ÔÚ‹ÁËÛË Û ÂÈÏÂÁ̤ÓÔ ·ÚÈıÌfi ·È‰ÈÒÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È Ì ÙÔ ÛÎÂÙÈÎfi fiÙÈ Ë ÚÔʇϷÍË ·fi ÙÔ˘˜ ·Ú·ÙÂٷ̤ÓÔ˘˜ Û·ÛÌÔ‡˜ ›Ûˆ˜ Ó· ÚÔʇϷÛÛÂ Î·È ·fi ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÂÈÏË„›·˜ (4).

O ΛӉ˘ÓÔ˜ fï˜ Ù˘ ÂÈÏË„›·˜ ÛÙ· ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ›¯Â ÛÙÔ ·ÚÂÏıfiÓ ˘ÂÚÂÎÙÈÌËı› ÂÂȉ‹ ›¯Â ˘ÔÏÔÁÈÛÙ› Ì ‚¿ÛË ÌÂϤÙ˜ Ôχ ÂÈÏÂÁÌ¤ÓˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ô˘ ÓÔÛËχıËÎ·Ó Û ÓÔÛÔÎÔÌ›·. TÔ Úfi‚ÏËÌ· Ù˘ ÂÈÏÔÁ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËΠÈÔ ÚfiÛÊ·Ù· Ì ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÔÏÏÒÓ ÂηÙÔÓÙ¿‰ˆÓ ·È‰ÈÒÓ ·fi ÙË ÛÙÈÁÌ‹ Ù˘ Á¤ÓÓËÛ‹˜ ÙÔ˘˜ Î·È ÚÈÓ ·fi ÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Î·È ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂıfi‰Ô˘ Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó¿Ï˘Û˘. ¢‡Ô Ù¤ÙÔȘ ÂıÓÈΤ˜ ÌÂϤÙ˜, ÌÈ· ·fi ÙȘ H¶A Î·È ÌÈ· ·fi ÙË BÚÂÙ·Ó›·, ÔÈ Ôԛ˜ η٤ÏËÍ·Ó Û ÂÓÙ˘ˆÛȷο ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Ù˘ ÂÈÏË„›·˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Â›Ó·È ÁÂÓÈο ÌÈÎÚfi˜ Î·È ˘ÔÏÔÁ›˙ÂÙ·È Û 4,5% ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ Î·È 7% ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 25 ÂÙÒÓ (1,2,6).

M ‚¿ÛË Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ê·›ÓÂÙ·È fiÙÈ Ù· ·È‰È¿ Ô˘ οÓÔ˘Ó ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ·ÔÙÂÏÔ‡Ó ÌÈ· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· Ë ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ˘ÔÔÌ¿‰Â˜ (7). H ÚÒÙË Ë ÔÔ›· Â›Ó·È Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÏ·Ì‚¿ÓÂÈ fiÛ· ·È‰È¿ οÓÔ˘Ó ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ (·ÏÔ‡˜ ·ÏÏ¿ Î·È Û‡ÓıÂÙÔ˘˜) Û·Ó ·ÔÙ¤ÏÂÛÌ· ÌÈ·˜ ¿ÁÓˆÛÙ˘ ÚԉȿıÂÛ˘ Ô˘ ηıÔÚ›˙ÂÙ·È ÁÂÓÂÙÈο (ÁÓ‹ÛÈÔÈ ‹ ηÏÔ‹ıÂȘ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ›). ™ÙËÓ ÔÌ¿‰· ·˘Ù‹ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÚÁfiÙÂÚ· ÂÈÏË„›·. H ‰Â‡ÙÂÚË, Ôχ ÌÈÎÚ‹, ÔÌ¿‰· ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰È¿ ÛÙ· ÔÔ›· Ô ˘ÚÂÙfi˜ ‰Ú· Û·Ó ÂÎÏ˘ÙÈÎfi ÂÚ¤ıÈÛÌ· ÙÔ ÔÔ›Ô ·ÔηχÙÂÈ ÙËÓ ÚԉȿıÂÛË Ô˘ ¤¯Ô˘Ó ÁÈ· Û·ÛÌÔ‡˜ Î·È ÂÈÏË„›· Ë ÔÔ›· ÙÂÏÈο ı· ÂΉËψı› Î·È ¯ˆÚ›˜ ÙË ÌÂÛÔÏ¿‚ËÛË ÙÔ˘ ˘ÚÂÙÔ‡ (ÂÈÏË„›· Ù˘ ÔÔ›·˜ ÚÔËÁÔ‡ÓÙ·È ˘ÚÂÙÈÎÔ› Û·ÛÌÔ›) (7). ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ÎÏËÚÔÓÔÌÂ›Ù·È ¤Ó·˜ ÎÔÈÓfi˜ ·Ú¿ÁˆÓ ÁÈ· ·ÌÊfiÙÂÚ· ÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È ÙËÓ ÂÈÏË„›·. K·È

ÛÙËÓ ÔÌ¿‰· ·˘Ù‹ Ù· ·È‰È¿ ÂΉËÏÒÓÔ˘Ó ÙfiÛÔ ·ÏÔ‡˜ fiÛÔ Î·È Û‡ÓıÂÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜.

AÓ Î·È ı· ‹Ù·Ó ÂÈı˘ÌËÙ‹ ÁÈ· ÚÔÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Ë ‰È¿ÎÚÈÛË ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ˘˜ ÁÓ‹ÛÈÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ·fi Ù· ¿ÏÏ· Ì ÙË ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÁÈ· ÂÈÏË„›· ·fi ÙËÓ ·Ú¯‹, ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÈ ÂÊfiÛÔÓ Î·È ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ÂΉËÏÒÓÔ˘Ó ·ÏÔ‡˜ Î·È Û‡ÓıÂÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ÎÏÈÓÈο ·‰È·¯ÒÚÈÛÙÔ˘˜. H ÔÌ¿‰· Ù˘ ÂÈÏË„›·˜ Ù˘ ÔÔ›·˜ ÚÔËÁÔ‡ÓÙ·È ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› Â›Ó·È Â›Û˘ ÂÙÂÚÔÁÂÓ‹˜. ™Â ·˘Ù‹Ó ¤¯ÂÈ Ù·˘ÙÔÔÈËı› ÌÈ· ηÙËÁÔÚ›· ·È‰ÈÒÓ Ù· ÔÔ›· ÙÔ˘˜ ÚÒÙÔ˘˜ 10 Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ÂΉËÏÒÓÔ˘Ó ·Ú·ÙÂٷ̤ÓÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ÔÈ ÔÔ›ÔÈ ÂÎχÔÓÙ·È Ì ¯·ÌËÏfi ˘ÚÂÙfi ˘ÔÙÚÔÈ¿˙Ô˘Ó Î¿ı ϛÁÔ˘˜ Ì‹Ó˜ Î·È ·ÎÔÏÔ˘ıÔ‡ÓÙ·È, ̤۷ ÛÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜, ·fi ¤Ó· Û·ÊÒ˜ ηıÔÚÈṲ̂ÓÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂ Ì˘ÔÎÏÔÓÈÎÔ‡˜ Î·È ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ÙË ‚·ÚÈ¿ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (7). ™ÙËÓ ÔÌ¿‰· Ù˘ ÂÈÏË„›·˜ Ù˘ ÔÔ›·˜ ÚÔËÁÔ‡ÓÙ·È ÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ¤¯Ô˘Ó Â›Û˘ ÂÚÈÁÚ·Ê› ÌÈ· ηÙËÁÔÚ›· ·È‰ÈÒÓ Ì ÔÏÏ¿ (¿Óˆ ·fi 3) ÂÂÈÛfi‰È· ·ÏÒÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜, Ù· ÔÔ›· ·ÚÁfiÙÂÚ· ÂΉËÏÒÓÔ˘Ó ÂÈÏË„›· Ì ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜ (6), ηıÒ˜ Î·È ÌÈ· ¿ÏÏË Î·ÙËÁÔÚ›· ·È‰ÈÒÓ Ù· ÔÔ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡ÓıÂÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È ·ÚÁfiÙÂÚ· ÂÈÏË„›· ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ (6). ™˘Û¯¤ÙÈÛË ¤¯ÂÈ ‰È·ÈÛÙˆı› Â›Û˘ ÌÂٷ͇ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Î·È Î·ÏÔ‹ıÔ˘˜ ÂÛÙȷ΋˜ ÂÈÏË„›·˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (ÚÔÏ¿Ó‰ÂÈÔ˜) (9).

H ‰È¿ÎÚÈÛË ÂÔ̤ӈ˜ Û‹ÌÂÚ· ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Û ·ÏÔ‡˜ Î·È Û‡ÓıÂÙÔ˘˜ ‰ÂÓ ˘Ô‰ËÏÔ› οÔÈ· ‰È·ÊÔÚ¿ ÛÙË Ê‡ÛË ÙÔ˘ ˘ÚÂÙÈÎÔ‡ Û·ÛÌÔ‡ ‹ ÙÔ Ì˯·ÓÈÛÌfi Ù˘ ·Ú·ÁˆÁ‹˜ ÙÔ˘. EÓÙÔ‡ÙÔȘ, Ë ‰È¿ÎÚÈÛË ·˘Ù‹ Â›Ó·È ¯Ú‹ÛÈÌË ÂÂȉ‹ Ô Û‡ÓıÂÙÔ˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ˘ÚÂÙÈÎÔ‡ Û·ÛÌÔ‡ Â›Ó·È ÙÔ Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ ÔÔ›Ô ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Èı·ÓfiÙËÙ· ÂÈÏË„›·˜ (6).

H Û˘¯ÓfiÙËÙ· Ù˘ ÂÈÏË„›·˜ ÛÙ· ·È‰È¿ Ì ۇÓıÂÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 217%, ÂÓÒ Û ÂΛӷ Ì ·ÏÔ‡˜ ÌÂٷ͇ 0,9-2,4% [·Ó¿ÏÔÁ· Ì ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘] (1,6,14). ™Â ÌÈ· ÏËı˘ÛÌȷ΋ ÌÂϤÙË ·fi ÙȘ H¶A Ë ÔÔ›· ÂÚȤϷ‚ 687 ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ‰È·ÈÛÙÒıËΠfiÙÈ Î¿ı ¤Ó· ·fi Ù· ÙÚ›· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Û‡ÓıÂÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (ÂÛÙÈ·ÎÔ›, ·Ú·ÙÂٷ̤ÓÔÈ, ÂÚÈÛÛfiÙÂÚÔÈ ·fi ¤Ó·˜ Û ¤Ó· 24ˆÚÔ) ·ÔÙÂÏ› ͯˆÚÈÛÙfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÈÏË„›·. ™˘ÁÎÂÎÚÈ̤ӷ fiÙ·Ó ˘‹Ú¯Â ¤Ó· ÔÔÈÔ‰‹ÔÙ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ô Î›Ó‰˘ÓÔ˜ ‹Ù·Ó ÂÚ›Ô˘ 8%, fiÙ·Ó ˘‹Ú¯·Ó ‰‡Ô 20% Î·È fiÙ·Ó Û˘Ó˘‹Ú¯·Ó Î·È Ù· ÙÚÈ· 50% (6). MfiÓÔ ÙÔ 1% ÙˆÓ ·È‰ÈÒÓ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Û˘Ó‰‡·˙·Ó Î·È Ù· ÙÚ›· ¯·Ú·ÎÙËÚÈÛÙÈο.

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¶∞π¢π∞∆ƒπ∫∏ 2000;63:170-176

™ÙËÓ ›‰È· ÌÂϤÙË Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÂÈÏË„›· ‹Ù·Ó Ï›ÁÔ ·˘ÍË̤ÓÔ˜ ÛÙ· ‚Ú¤ÊË, Û fiÛ· ›¯·Ó ¿Óˆ ·fi ‰‡Ô ˘ÔÙÚÔ¤˜ ‹ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜, fiÙ·Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù¿ ÂÍÂÙ¿˙ÔÓÙ·È ÌÂÌÔӈ̤ӷ. O ΛӉ˘ÓÔ˜ ÛÙȘ ‰‡Ô ÚÒÙ˜ ηÙËÁÔڛ˜ ¤·˘Â Ó· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó¿Ï˘Û˘. ™‡Ìʈӷ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ë ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ‚Ú¤ÊË Â›Ó·È Èı·ÓfiÓ Ó· ÌË Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÌÈÎÚ‹ ËÏÈΛ· ·ÏÏ¿ Ì ÙÔ˘˜ Û‡ÓıÂÙÔ˘˜ Û·ÛÌÔ‡˜ ÔÈ ÔÔ›ÔÈ ÂΉËÏÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ· (6). ™ÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÔÏÏ·ÏÒÓ ˘ÔÙÚÔÒÓ Ô Î›Ó‰˘ÓÔ˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, Ê·›ÓÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Û ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ÂÈÏË„›· fiˆ˜ Û˘ÌÂÚ·›ÓÂÙ·È ·fi ÙË ‰È·›ÛÙˆÛË ıÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ·ÚÈıÌÔ‡ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÂÈÏË„›·˜ (6).

O ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· ÂÈÏË„›· ÛÙ· ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ Â›Ó·È ÔÛÔÙÈο ·˘Ùfi˜ Ô˘ ·Ó·Ì¤ÓÂÙ·È ‚¿ÛÂÈ Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ÚԉȿıÂÛ˘ ÁÈ· ÂÈÏË„›· Î·È ÂӉ¯Ô̤ӈ˜ Ó· ÌË Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ (6). X·Ú·ÎÙËÚÈÛÙÈο fiˆ˜ Â›Ó·È ÚÒÙË ÂΉ‹ÏˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÌÂÙ¿ ÙÔ ÙÚ›ÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ, Î·È ÙÔ ·ıÔÏÔÁÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·, ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÈÏË„›· (1,2,6). ™˘ÌÂÚ·ÛÌ·ÙÈο, Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ÈÛ¯˘ÚÔ› ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÈÏË„›· Û ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜. ™ÙËÓ EıÓÈ΋ AÌÂÚÈηÓÈ΋ MÂϤÙË, Ë ÔÔ›· ÂÚȤϷ‚Â Î·È ·È‰È¿ Ì ‰È·Ù·Ú·¯¤˜ ÛÙË Ó¢ÚÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Û·Ó ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÈÏË„›·, Ù·˘ÙÔÔÈ‹ıËÎ·Ó ÔÈ Û‡ÓıÂÙÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ›, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ Î·È Ë ·ÓÒÌ·ÏË Ó¢ÚÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË. H Û˘¯ÓfiÙËÙ· Ù˘ ÂÈÏË„›·˜ Û fiÛ· ·È‰È¿ ‰ÂÓ Â›¯·Ó ηӤӷ ·fi ÙÔ˘˜ ·ÓˆÙ¤Úˆ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ‹Ù·Ó 0,9%, Û fiÛ· ›¯·Ó ¤Ó· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ‹Ù·Ó 2%, Î·È ÁÈ· ÂΛӷ Ì ‰‡Ô ·Ú¿ÁÔÓÙ˜, ÂÚ›Ô˘ 10%. ™˘ÓÂÒ˜, ·ÎfiÌË Î·È Ù· ·È‰È¿ Ì ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Â›¯·Ó 90% Èı·ÓfiÙËÙ· Ó· ÌËÓ ÂΉËÏÒÛÔ˘Ó ÂÈÏË„›·. TÔ 75% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂΉ‹ÏˆÛ·Ó ÂÈÏË„›· ›¯·Ó ¤Ó· ·Ïfi ÂÂÈÛfi‰ÈÔ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ‹ ÌfiÓÔ ¤Ó· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘.

H ÚÔÛ¿ıÂÈ· ÂÔ̤ӈ˜ Ó· ÚÔ‚ÏÂÊı› Ë ÂÈÏË„›· ÌÂÙ¿ ¤Ó· ÂÂÈÛfi‰ÈÔ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ, ÌÔÈ¿˙ÂÈ Ì ÂΛÓË Ù˘ ·Ó·˙‹ÙËÛ˘: "‚ÂÏfiÓ·˜ ÛÙ· ¿¯˘Ú·" ηٿ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ Camfield (27).

EÊfiÛÔÓ ÔÈ ÔÏÏ·Ϥ˜ ˘ÔÙÚÔ¤˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ·

172

A. ™Î·Ú‰Ô‡ÙÛÔ˘

ÂÈÏË„›·, Ë ÚÔÛ¿ıÂÈ· Ó· ÚÔÏËÊıÔ‡Ó ÔÈ ˘ÔÙÚÔ¤˜ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Ì ÙÔ ÛÎÂÙÈÎfi Ó· ÚÔÏËÊı› Ë ÂÈÏË„›· ‰ÂÓ Â›Ó·È ‰ÈηÈÔÏÔÁË̤ÓË. ¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ› Î·È ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë ¢ÂÓ ˘¿Ú¯ÂÈ ÛÔ‚·Ú‹ ¤Ó‰ÂÈÍË fiÙÈ ÔÈ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÚÔηÏÔ‡Ó ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, ÁÈ· ÙÔ˘˜ ·Ú·ÙÂٷ̤ÓÔ˘˜ fï˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ÂÍ·ÎÔÏÔ˘ı› Ó· ˘¿Ú¯ÂÈ Û¯ÂÙÈ΋ ·ÌÊÈ‚ÔÏ›·. ™Â ·ÚÎÂÙ¤˜ ·Ó·‰ÚÔÌÈΤ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ¤Ó· ÔÛÔÛÙfi 25-35% ÙˆÓ ·ÙfiÌˆÓ Ù· ÔÔ›· ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ÁÈ· ·ÓıÂÎÙÈ΋ ÂÈÏË„›· ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ fiÔ˘ ÙÔ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ‡ÚËÌ· ‹Ù·Ó ÁÏÔ›ˆÛË (ÛÎÏ‹Ú˘ÓÛË) Ù˘ ¤Ûˆ ÌÔ›Ú·˜ ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡, ÛÙË ÂÚÈÔ¯‹ ÙˆÓ ÈÔοÌˆÓ ·Ó¤ÊÂÚ·Ó ÈÛÙÔÚÈÎfi ·Ú·ÙÂÙ·Ì¤ÓˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÛÙËÓ ·È‰È΋ ÙÔ˘˜ ËÏÈΛ· (3,10). ŸÌˆ˜, Ë ˘fiıÂÛË fiÙÈ ÔÈ ·Ú·ÙÂٷ̤ÓÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÛÎÏ‹Ú˘ÓÛË Î·È ·ÙÚÔÊ›· ÙˆÓ ÈÔοÌˆÓ Û˘ÓÂ›· ·ÓÔÍ›·˜, ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ˘ÔÛÙËÚȯı› Â¿Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ‰ÂÓ ÂÍ·ÎÚÈ‚ˆı› fiÙÈ Ë ÂÚÈÔ¯‹ ·˘Ù‹ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÚÈÓ ·fi ÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ. ™ÎÏ‹Ú˘ÓÛË ÙˆÓ ÈÔοÌˆÓ ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È Û ¿ÙÔÌ· Ì ÂÈÏË„›· ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ ¯ˆÚ›˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜, Ú¿ÁÌ· Ô˘ ‰ËÌÈÔ˘ÚÁ› ÙËÓ ·ÓÙ›ÛÙÚÔÊË ˘fiıÂÛË fiÙÈ Ë ÛÎÏ‹Ú˘ÓÛË ›Ûˆ˜ Ó· ÚÔ¸¿Ú¯ÂÈ Î·È Ó· Úԉȷı¤ÙÂÈ Û ·ÌÊfiÙÂÚ· ÙÔ˘˜ ·Ú·ÙÂٷ̤ÓÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È ÙËÓ ÂÈÏË„›·. TÔ ›‰ÈÔ ÌÔÚ› Ó· ÈÛ¯‡ÂÈ Î·È ÁÈ· ‰È¿ÊÔÚ˜ ‰˘ÛϷۛ˜ ÛÙËÓ ›‰È· ÂÚÈÔ¯‹. °È· Ó· ··ÓÙËı› ÙÔ ÂÚÒÙËÌ· Â¿Ó ÔÈ ·Ú·ÙÂٷ̤ÓÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÚÔηÏÔ‡Ó ‹ fi¯È ÛÎÏ‹Ú˘ÓÛË ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ ¤ÏÂÁ¯Ô˜ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÚÈÓ ·fi ÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ, Ú¿ÁÌ· Ôχ ‰‡ÛÎÔÏÔ. ™‹ÌÂÚ· Ê·›ÓÂÙ·È fiÙÈ Â¿Ó Ú·ÁÌ·ÙÈο ˘¿Ú¯ÂÈ ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·Ú·ÙÂÙ·Ì¤ÓˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Î·È ‚Ï¿‚˘ ÙÔ˘ ÈÔοÌÔ˘ ·fi ·ÓÔÍ›·, ·˘Ùfi Ú¤ÂÈ Ó· Â›Ó·È Ôχ Û¿ÓÈÔ. ™Â ÌÈ· ÌÂϤÙË ·fi ÙÔÓ K·Ó·‰¿ (9) Ô Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÙÂٷ̤ÓÔ˜ ˘ÚÂÙÈÎfi˜ Û·ÛÌfi˜ Î·È ·ÓıÂÎÙÈ΋ ÂÈÏË„›· ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ Ì ÛÎÏ‹Ú˘ÓÛË ÙÔ˘ ·Ì̈Ó›Ԣ ΤڷÙÔ˜ ˘ÔÏÔÁ›ÛıËΠ۠1/75.000 Ê˘ÛÈÔÏÔÁÈο ·È‰È¿.

H ˘fiıÂÛË fiÙÈ ÔÈ ˘ÔÙÚÔÈ¿˙ÔÓÙ˜ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÚÔηÏÔ‡Ó ÚÔԉ¢ÙÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Ô‰ËÁ› Û ˘ÔÙÚÔ¤˜ ÌÂÁ·Ï‡ÙÂÚ˘ ‰È·ÚΛ·˜ Î·È ÂÈÏË„›·, ·ԉ›¯ıËΠ·fi ÙȘ ÓÂfiÙÂÚ˜ ÌÂϤÙ˜ ·‚¿ÛÈÌË fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙË ‰È·›ÛÙˆÛË fiÙÈ Ë ·ÏÏËÏÔ˘¯›· ·Ïfi ÚÒÙÔ ÂÂÈÛfi‰ÈÔ, ·Ú·ÙÂٷ̤ÓË ˘ÔÙÚÔ‹, ÂÈÏË„›· ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ۠ηӤӷ ·È‰› ÛÙËÓ EıÓÈ΋ AÌÂÚÈηÓÈ΋ ÌÂϤÙË (8).

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·173

¶∞π¢π∞∆ƒπ∫∏ 2000;63:170-176

¶ÚÔʇϷÍË ·fi ÙȘ ˘ÔÙÚÔ¤˜ TÔ ÚÒÙÔ ı¤Ì· Û¯ÂÙÈο Ì ÙËÓ ÚÔʇϷÍË ·fi ÙȘ ˘ÔÙÚÔ¤˜ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Â›Ó·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘ÚÂÙÔ‡. Y¿Ú¯Ô˘Ó Û‹ÌÂÚ· ÔÏÏ¿ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Ù· ÔÔ›· Û˘ÓËÁÔÚÔ‡Ó fiÙÈ ÔÈ Û˘Ó‹ıÂȘ ̤ıÔ‰ÔÈ ÂϤÁ¯Ô˘ ÙÔ˘ ˘ÚÂÙÔ‡ (·ÓÙÈ˘ÚÂÙÈο, ¯ÏÈ·Ú¿ Ì¿ÓÈ·) ‰ÂÓ ¤¯Ô˘Ó ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË ÛÙȘ ˘ÔÙÚÔ¤˜ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (13-15). H Û˘Ì‚Ô˘Ï‹ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÏÂÙÔÌÂÚÒ˜ ÙÔÓ ˘ÚÂÙfi Î·È Ó· ¯ÔÚËÁÔ‡Ó ¿ÊıÔÓ· ·ÓÙÈ˘ÚÂÙÈο ÚÔÔÚ›˙ÂÙ·È ÌfiÓÔ Ó· ·˘Í‹ÛÂÈ ÙÔ ¿Á¯Ô˜ Î·È ÙË ÊÔ‚›· ÙÔ˘ ˘ÚÂÙÔ‡ (16). K·Ï‡ÙÂÚË Ú·ÎÙÈ΋ Â›Ó·È Ë ıÂÚÌÔ̤ÙÚËÛË ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· Î·È Ë ¯ÔÚ‹ÁËÛË ·Ú·ÎÂÙ·ÌfiÏ˘ fiÙ·Ó Ô ˘ÚÂÙfi˜ ÍÂÂÚÓ¿ ÙÔ˘˜ 38oC ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙËÓ ÚfiÏË„Ë Ù˘ ·Ê˘‰¿ÙˆÛ˘. °È· ÙËÓ ÙÂÏÂ˘Ù·›· Û˘ÓÈÛÙ¿Ù·È Â·Ú΋˜ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ (17).

M¤ıÔ‰ÔÈ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ˘ÚÂÙÔ‡ fiˆ˜ ·ÓÂÌÈÛÙ‹Ú˜ Î·È Ì¿ÓÈ· Ì ¯ÏÈ·Úfi ÓÂÚfi ÚÔηÏÔ‡Ó ‰˘ÛÊÔÚ›· ÛÙÔ ·È‰› Î·È ‰ÂÓ Û˘ÓÈÛÙÒÓÙ·È (16,17).

TÔ ‰Â‡ÙÂÚÔ ı¤Ì· Û¯ÂÙÈο Ì ÙËÓ ÚÔʇϷÍË Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈÎÒÓ. ™ÙË ‰ÂηÂÙ›· ÙÔ˘ ’80 ıˆÚ›ÙÔ ÛÎfiÈÌÔ ÔÚÈṲ̂ӷ ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Ó· ÚÔÊ˘Ï¿ÛÛÔÓÙ·È ·fi ÙȘ ˘ÔÙÚÔ¤˜ ÁÈ· ¤Ó· Ì ‰‡Ô ¯ÚfiÓÈ· Ì ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ȉȷ›ÙÂÚ· Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ. T· Ê¿Ú̷η ·˘Ù¿ ›¯Â ‚ÚÂı› fiÙÈ Û ηıËÌÂÚÈÓ‹ ¯ÔÚ‹ÁËÛË ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÂÊfiÛÔÓ Ë Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÛÙÔ ·›Ì· ‹Ù·Ó ̤۷ Û ıÂÚ·¢ÙÈο Â›‰·. YÔ„‹ÊÈ· ÁÈ· ÚÔʇϷÍË ‹Ù·Ó Ù· ·È‰È¿ Ì ۇÓıÂÙÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È fiÛ· ›¯·Ó ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ˘ÔÙÚÔÒÓ fiˆ˜ Â›Ó·È Ù· ‚Ú¤ÊË (Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ 48%) Ù· ·È‰È¿ Ì ‰‡Ô ÂÂÈÛfi‰È· (48%) Î·È fiÛ· ›¯·Ó ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (55%) (4,12,18).

TÔ ÛÎÂÙÈÎfi ÁÈ· ÙË ¯ÚfiÓÈ· ·˘Ù‹ Ê·Ú̷΢ÙÈ΋ ¯ÔÚ‹ÁËÛË ‹Ù·Ó Ó· ÚÔÊ˘Ï·¯ÙÔ‡Ó ·fi ÙȘ Û‡ÓıÂÙ˜ ˘ÔÙÚÔ¤˜ Î·È ÙȘ ÔÏϤ˜ ˘ÔÙÚÔ¤˜ (ÌÂÚÈΤ˜ ·fi ÙȘ Ôԛ˜ ı· ‹Ù·Ó Û‡ÓıÂÙ˜) ‰Â‰Ô̤Ó˘ Ù˘ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ Û‡ÓıÂÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Î·È ÂÈÏË„›·˜ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡. OÚÈṲ̂ÓÔÈ ıˆÚÔ‡Û·Ó ÛÎfiÈÌÔ Ó· ÚÔÊ˘Ï¿ÛÛÔÓÙ·È Â›Û˘ Ù· ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ Î·È ÂΛӷ Ì ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Ì ÙÔ ÛÎÂÙÈÎfi fiÙÈ ÔÈ Û‡ÓıÂÙ˜ ˘ÔÙÚÔ¤˜ ÌÔÚ› Ó· ÂÓÂÚÁÔÔÈ‹ÛÔ˘Ó ÙË ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË Ô˘ ¤¯Ô˘Ó Ù· ·È‰È¿ ·˘Ù¿ ÁÈ· ÂÈÏË„›· (4). H ÚfiÏË„Ë fï˜ ÙˆÓ Û‡ÓıÂÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Â›Ó·È Ôχ ‰‡ÛÎÔÏË ÂÂȉ‹ ÂΉËÏÒÓÔÓÙ·È Û ÔÛÔÛÙfi 80% Û·Ó ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Û˘Ó‹ıˆ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (fiÙ·Ó Ë Úfi‚Ï„‹ ÙÔ˘˜ Â›Ó·È ·‰‡Ó·ÙË) Î·È ÌfiÓÔ Û ÔÛÔÛÙfi 20% Û·Ó ˘ÔÙÚÔ¤˜ (2,8).

H Úfi‚ÏÂ„Ë Û‡ÓıÂÙ˘ ˘ÔÙÚÔ‹˜ Â›Ó·È Â›Û˘ ‰‡ÛÎÔÏË ÂÂȉ‹ ·fi Ù· 100 ·È‰È¿ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÌfiÓÔ Ù· 13 ı· οÓÔ˘Ó Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ Û‡ÓıÂÙ˜ ˘ÔÙÚÔ¤˜ (Î·È Ù· 22 ·Ϥ˜) (28). H Èı·ÓfiÙËÙ· ˘ÔÙÚÔ¤˜ Ó· Â›Ó·È status epilepticus Â›Ó·È 2%.

H Èı·ÓfiÙËÙ· Û‡ÓıÂÙ˘ ˘ÔÙÚÔ‹˜ ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈο, fiÛÔ ·˘Í¿ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ˘ÔÙÚÔÒÓ Î·ıÒ˜ Â›Û˘ Î·È fiÙ·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ‹Ù·Ó ·Ú·ÙÂٷ̤ÓÔ (>10 ÏÂÙ¿)(28). ™ÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË fï˜, Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù¿ ‰ÂÓ ¤¯Ô˘Ó ÛËÌ·ÓÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· ÁÈ· Û‡ÓıÂÙ˜ ˘ÔÙÚÔ¤˜ ÂÂȉ‹ ¤Ó·˜ ÌÈÎÚfi˜ ÌfiÓÔ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ (5%-10%) οÓÔ˘Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi 2 ˘ÔÙÚÔ¤˜ Î·È ÌÂÙ¿ ·fi ¤Ó· Û‡ÓıÂÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ, Û˘Ó‹ıˆ˜ ·ÎÔÏÔ˘ıÔ‡Ó ¤Ó· Ì ‰‡Ô ·Ï¿.

MÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ Ô Î›Ó‰˘ÓÔ˜ ˘ÔÙÚÔ‹˜ ÂÎÙÈÌ¿Ù·È Û 6-11% ÁÈ· οı ÂÌ‡ÚÂÙË Ïԛ̈ÍË (15).

TËÓ Î˘ÚÈfiÙÂÚË ıˆÚËÙÈο ¤Ó‰ÂÈÍË ÁÈ· ÚÔʇϷÍË ¤¯Ô˘Ó Ù· ‚Ú¤ÊË ÏfiÁˆ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ˘ÚÂÙÈÎfi status epilepticus Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ŸÌˆ˜, Ë ·Í›· Ù˘ ÚÔʇϷ͢ ÛÙ· ‚Ú¤ÊË ·ÌÊÈÛ‚ËÙ‹ıËΠÛÔ‚·Ú¿ ÌÂÙ¿ ÙË ‰ËÌÔÛ›Â˘ÛË ÌÈ·˜ ÌÂϤÙ˘ ·fi ÙÔ ™Ë¿ÙÏ ÙˆÓ H¶A ÛÙËÓ ÔÔ›· ‚Ú¤ÊË Î·È Ó‹È· Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Û‡ÓıÂÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠʷÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÁÈ· ‰˘Ô ¯ÚfiÓÈ· ·ÚÔ˘Û›·Û·Ó ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·ÓÙ›ÏË„Ë Î·È Ì›ˆÛË ÙÔ˘ ‰Â›ÎÙË Ù˘ ÓÔËÌÔÛ‡Ó˘ ηٿ 8 ÌÔÓ¿‰Â˜, Ù· ÔÔ›· ‰È·ÙËÚ‹ıËÎ·Ó Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (19). EÈϤÔÓ, ÛÙ· ·È‰È¿ ·˘Ù¿ ‰ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ˘ÔÙÚÔÒÓ Û ۯ¤ÛË Ì ÂΛӷ ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÌfiÓÔ placebo (19).

H ·ÌÊÈÛ‚‹ÙËÛË Ù˘ ¯ÚfiÓÈ·˜ ÚÔʇϷ͢ ·˘Í‹ıËΠηٷÎfiÚ˘Ê· ÌÂÙ¿ ÙË ‰ËÌÔÛ›Â˘ÛË ÌÈ·˜ ‚ÚÂÙ·ÓÈ΋˜ ÌÂϤÙ˘ ÛÙËÓ ÔÔ›· Î·È Û ÌÈ· ÌÂÙ¿-·Ó¿Ï˘ÛË fiÏˆÓ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ¤ÁÈÓ·Ó ÛÙË µÚÂÙ·Ó›· Ë ÔÔ›· ÂÚȤϷ‚Â Î·È ÌÂϤÙ˜ Ô˘ ‰ÂÓ ‰ËÌÔÛȇıËÎ·Ó (ÂÂȉ‹ Ù· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈο) ‰ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ˘ÔÙÚÔÒÓ ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ú·Ó Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Û ۯ¤ÛË Ì fiÛ· ‰ÂÓ ‹Ú·Ó ηӤӷ Ê¿ÚÌ·ÎÔ (20). M ‚¿ÛË ÙËÓ ÌÂϤÙË ·˘Ù‹ ˘ÔÏÔÁ›ÛÙËΠfiÙÈ ÁÈ· οı ÂηÙfi ·È‰È¿ Ô˘ ·›ÚÓÔ˘Ó Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÚÔÊ˘Ï¿ÛÛÔÓÙ·È ·fi ˘ÔÙÚÔ‹ ÌfiÓÔ Ù· ¤ÍÈ.

M ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ fiˆ˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 40% ÙˆÓ ·È‰ÈÒÓ Ô˘ ·›ÚÓÔ˘Ó Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È Ì ÙË ÁÓˆÛÙ‹ Èı·ÓfiÙËÙ· Ù˘ Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜ Û ‚Ú¤ÊË Ô˘ ·›ÚÓÔ˘Ó ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‹ ηıËÌÂÚÈÓ‹ ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓˆÙ¤Úˆ Ê·ÚÌ¿ÎˆÓ ‰ÂÓ ‰ÈηÈÔÏÔÁÂ›Ù·È ÁÈ· ÚÔʇϷÍË ·fi ÌÈ· ηÏÔ‹ıË Î·Ù¿ÛÙ·ÛË fiˆ˜ Â›Ó·È ÔÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› (5,17).

173

MART.-APR.2000 ÓÂÔ

30-05-03

13:04

™ÂÏ›‰·174

¶∞π¢π∞∆ƒπ∫∏ 2000;63:170-176

™‹ÌÂÚ· Ô ·Ú¯ÈÎfi˜ ÂÓıÔ˘ÛÈ·ÛÌfi˜ Û¯ÂÙÈο Ì ÙËÓ ·Í›· Ù˘ ¯ÚfiÓÈ·˜ ÚÔʇϷ͢ ¤¯ÂÈ ÂÍ·Ê·ÓÈÛÙ›.

TÚÂȘ ÏfiÁÔÈ ¤¯Ô˘Ó Û˘ÓÙÂϤÛÂÈ Û ·˘Ùfi: ¶ÚÒÙÔÓ, ÙÔ ÌÈÎÚfi ̤ÁÂıÔ˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÈÏË„›· ÛÙ· ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ÁÂÓÈο. ¢Â‡ÙÂÚÔÓ, Ë ·ÌÊÈÛ‚‹ÙËÛË ÛÔ‚·Ú‹˜ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·Í›·˜ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ˘ÔÙÚÔ¤˜, Î·È ÙÚ›ÙÔÓ Ë ‰È·›ÛÙˆÛË fiÙÈ Î·È Â¿Ó ·ÎfiÌË ıˆÚËı› fiÙÈ Ù· Ê¿Ú̷η ·˘Ù¿ ¯ÔÚËÁÔ‡ÌÂÓ· ·fi ÙÔ ÛÙfiÌ· ÚÔÊ˘Ï¿ÛÛÔ˘Ó ÌÂÚÈο ·È‰È¿ ·fi ÙȘ ˘ÔÙÚÔ¤˜ ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÔ˘Ó Î·È ÙÔÓ Ôχ ÌÈÎÚfi ΛӉ˘ÓÔ Ô˘ ¤¯Ô˘Ó ÔÚÈṲ̂ӷ ·fi ·˘Ù¿ ÁÈ· ÂÈÏË„›· (17,24).

H ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË Î¿ÔÈˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÌ‡ÚÂÙÔ˘ ‹ ÙÔ˘ Û·ÛÌÔ‡ Â›Ó·È ÈÔ ·Ô‰ÂÎÙ‹. H ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ·fi ÙÔ ÛÙfiÌ· ηٿ ÙȘ Ë̤Ú˜ ÙÔ˘ ˘ÚÂÙÔ‡ Â›Ó·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÂȉ‹ ÙÔ ·ÓÙÈÂÈÏËÙÈÎfi Â›Â‰Ô ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·˘ÙÔ‡ ÛÙÔ ·›Ì· Ì ÙȘ Û˘Ó‹ıÂȘ ‰fiÛÂȘ ÂÈÙ˘Á¯¿ÓÂÙ·È ·ÚÁ¿.

H ‰È·˙Â¿ÌË fiÙ·Ó ¯ÔÚËÁËı› ·fi ÙÔ ÛÙfiÌ· Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ 0,3 mg/kg/8ˆÚÔ ÁÈ· fiÛ˜ Ë̤Ú˜ ÙÔ ·È‰› ¤¯ÂÈ ˘ÚÂÙfi ¿Óˆ ·fi 38oC ÚÔηÏ› ÌÂÙÚ›ˆ˜ ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜ (21). ŸÌˆ˜, ÚÔηÏ› ÌÂÁ¿ÏË ÓˆıÚfiÙËÙ· Î·È ·Ù·Í›· ÛÙÔ 40% ÙˆÓ ·È‰ÈÒÓ. OÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÂÍ·Ê·Ó›˙ÔÓÙ·È fiÙ·Ó Ë ‰fiÛË ÌÂȈı› Û 0,2 mg/kg/8ˆÚÔ Ë ‰fiÛË fï˜ ·˘Ù‹ ‰ÂÓ Â›Ó·È ¿ÓÙ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ (15,22). M ‚¿ÛË Ù· ÛÙÔȯ›· Ù˘ ·ÓˆÙ¤Úˆ ÌÂϤÙ˘ ˘ÔÏÔÁ›ÛÙËΠfiÙÈ 14 ·È‰È¿ ı· ¤ÚÂ ӷ ¿ÚÔ˘Ó ‰È·˙Â¿ÌË ·fi ÙÔ ÛÙfiÌ· ÁÈ· Ó· ÚÔÏËÊı› ÌÈ· ˘ÔÙÚÔ‹ Û ¤Ó· ·fi ·˘Ù¿ (16). ¶ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Û¯ÂÙÈο Ì ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋ ·Í›· Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÛÙfiÌ· ·ÊÔ‡ ÂÍ·ÛÊ·ÏÈÛÙ› ηχÙÂÚË Û˘ÌÌfiÚʈÛË Â›Ó·È ··Ú·›ÙËÙ˜ (16).

M ‚¿ÛË Ù· ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ ‰ÂÓ ‰ÈηÈÔÏÔÁÂ›Ù·È Ë Â˘Ú›· ¯Ú‹ÛË Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÛÙfiÌ· ÁÈ· ÙË ÚÔʇϷÍË ·fi ÙȘ ˘ÔÙÚÔ¤˜ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ.

H ‰È·˙Â¿ÌË fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÔÚıfi ÛÙËÓ ·Ú¯‹ ÙÔ˘ Û·ÛÌÔ‡ Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ÂÊ’ fiÛÔÓ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÂÈÙ˘Á¯¿ÓÂÙ·È ·ÓÙÈÂÈÏËÙÈÎfi Â›Â‰Ô ÛÙÔ ·›Ì· Û 2-5 ÏÂÙ¿. O ¯ÚfiÓÔ˜ Ù˘ ̤ÁÈÛÙ˘ ‰Ú¿Û˘ Ù˘ Â›Ó·È Ù· 15 ÏÂÙ¿. XÔÚËÁÂ›Ù·È ÙÔ Û‡ÓËı˜ ‰È¿Ï˘Ì· ÁÈ· ÂÓ‰ÔÌ˘˚΋ ¯ÔÚ‹ÁËÛË, ·‰È¿Ï˘ÙÔ Ì ۇÚÈÁÁ· ÈÓÛÔ˘Ï›Ó˘ Û ‰fiÛË 0,5 mg/kg. H ›‰È· ‰fiÛË ÌÔÚ› Ó· Â·Ó·ÏËÊı›, Â¿Ó ¯ÚÂÈ·Ûı›, ÌÂÙ¿ 10 ÏÂÙ¿. E›Û˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Î·È Û·Ó ¤ÙÔÈÌÔ ‰È¿Ï˘Ì· ̤۷ Û Ï·ÛÙÈο ÌÈÎÚÔÎχÛÌ·Ù· Ù· ÔÔ›· ΢ÎÏÔÊÔÚÔ‡Ó Ì ÙËÓ ÔÓÔÌ·Û›· Stesolid Ô˘ ÂÚȤ¯Ô˘Ó 5 Î·È 10 mg ‰È·˙Â¿Ì˘. ŸÙ·Ó Ë ‰È·˙Â¿ÌË ¯ÔÚËÁËı› ·fi ÙÔ ÔÚıfi οı ÊÔÚ¿ Ô˘ Ô ˘ÚÂÙfi˜ ˘Âڂ› ÙÔ˘˜ 38oC ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘

174

A. ™Î·Ú‰Ô‡ÙÛÔ˘

Û·ÛÌÔ‡. M ‚¿ÛË ÙË ‰È·Ï›Ô˘Û· ·˘Ù‹ ¯ÔÚ‹ÁËÛË ÌÂÈÒÓÔÓÙ·È ÔÈ ˘ÔÙÚÔ¤˜ ÛÙÔ 1/3 (24), fï˜ ÙÔ ·È‰› ·›ÚÓÂÈ ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ ‰È·˙Â¿Ì˘ ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ÌÂÁ¿ÏË ÓˆıÚfiÙËÙ· Î·È ·Ù·Í›·. H ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi ‰ÂÓ ÌÂÈÒÓÂÈ Î·È ÙÔÓ Ôχ ÌÈÎÚfi ΛӉ˘ÓÔ Ô˘ ¤¯Ô˘Ó ÔÚÈṲ̂ӷ ·È‰È¿ ÁÈ· ÂÈÏË„›· (24).

TÔÓ IÔ‡ÓÈÔ ÙÔ˘ 1991 Û˘ÁÎÚÔÙ‹ıËΠÛÙË BÚÂÙ·Ó›· ÌÈ· ÂÈÙÚÔ‹ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ Ì ÛÎÔfi Ó· ·ÔÊ·Û›ÛÔ˘Ó ¿Óˆ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Ì ‚¿ÛË Ù· ‰Â‰Ô̤ӷ ·fi ÙËÓ EıÓÈ΋ BÚÂÙ·ÓÈ΋ ÌÂϤÙË (17). H ÂÈÙÚÔ‹ ·ÔÊ¿ÛÈÛ fiÙÈ Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ‰ÂÓ ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Î·ıfiÏÔ˘ ‹ ÂӉ¯Ô̤ӈ˜ Ôχ Û¿ÓÈ· Û·Ó ÚÔʇϷÍË, ÂÂȉ‹ Â›Ó·È Ì¿ÏÏÔÓ ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·ÓÙ›ÏË„Ë ·ÚÔÛ‰ÈfiÚÈÛÙ˘ ‰È¿ÚÎÂÈ·˜. ™‡Ìʈӷ Ì ÙËÓ ÂÈÙÚÔ‹, ÚÔʇϷÍË Ì ʷÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÔÚ› Ó· ‰›‰ÂÙ·È Û ¤Ó· Ôχ ÌÈÎÚfi ·ÚÈıÌfi ·È‰ÈÒÓ Ì Ôχ Û˘¯Ó¤˜ ˘ÔÙÚÔ¤˜ Ì ÙÔ ÛÎÂÙÈÎfi fiÙÈ ÌÔÚ› Ó· ÚÔÏËÊıÔ‡Ó ÌÂÚÈΤ˜ ·fi ·˘Ù¤˜. ¢ÂÓ Î·ıÔÚ›ÛÙËΠÙÈ Â›Ó·È Û˘¯Ó¤˜ ˘ÔÙÚÔ¤˜. °È· Ù· ˘fiÏÔÈ· ·È‰È¿ ·ÔÊ·Û›ÛÙËΠfiÙÈ Î·ÏfiÓ Â›Ó·È Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi Ì ÛÎÔfi Ó· ÂÚÈÔÚÈÛÙÔ‡Ó ÔÈ ˘ÔÙÚÔ¤˜ ÌÂÁ¿Ï˘ ‰È¿ÚÎÂÈ·˜. ¶·Ú¿ ÙË ˙ˆËÚ‹ Û˘˙‹ÙËÛË ‰ÂÓ ˘‹ÚÍ ÔÌÔʈӛ· Â¿Ó Ë ‰È·˙Â¿ÌË ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Ì ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û·ÛÌÒÓ ‹ fiÙ·Ó ÔÈ Û·ÛÌÔ› Û˘Ó¯›˙ÔÓÙ·È ÌÂÙ¿ Ï›Á· ÏÂÙ¿, ‰È¿ÛÙËÌ· ÛÙÔ ÔÔ›Ô ÛÙȘ Ï›ÛÙ˜ ÂÚÈÙÒÛÂȘ ÛÙ·Ì·ÙÔ‡Ó ¯ˆÚ›˜ Ê·Ú̷΢ÙÈ΋ ·Ú¤Ì‚·ÛË. H ¯ÔÚ‹ÁËÛË Ù˘ ‰È·˙Â¿Ì˘ ‰È·Ï›ÔÓÙÔ˜ ·fi ÙÔ ÔÚıfi οı ÊÔÚ¿ Ô˘ Ô ˘ÚÂÙfi˜ ÍÂÂÚÓ¿ ÙÔ˘˜ 38oC, ·Ó Î·È ıˆڋıËΠ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ ‰ÂÓ ÎÚ›ıËΠÛÎfiÈÌË ÁÈ· fiÏ· Ù· ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ÂÂȉ‹ Û˘Ó‹ıˆ˜ ÚÔηÏ› ÓˆıÚfiÙËÙ· Î·È ·Ù·Í›·. ¢ÂÓ Î·ıÔÚ›ÛÙËΠÔȘ Â›Ó·È ÔÈ ÂӉ›ÍÂȘ ÁÈ· ÙË ¯ÔÚ‹ÁËÛ‹ Ù˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ ‰ÈÂıÓ‹˜ Û˘Ó·Ô‰Ô¯‹ Û¯ÂÙÈο Ì ÙË Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ. H ·Ï·ÈfiÙÂÚË Û¯ÂÙÈ΋ ·fiÊ·ÛË ÙÔ˘ AÌÂÚÈηÓÈÎÔ‡ EıÓÈÎÔ‡ IÓÛÙÈÙÔ‡ÙÔ˘ YÁ›·˜ (4) ¯ÚÂÈ¿˙ÂÙ·È ·Ó·ıÂÒÚËÛË (1,5,16,25,26). H ‰È΋ Ì·˜ ÛËÌÂÚÈÓ‹ Ú·ÎÙÈ΋ Ë ÔÔ›· Û˘ÌʈÓ› Ì ÙȘ ·fi„ÂȘ Î·È ¿ÏÏˆÓ (5,16,27,28) Â›Ó·È Ë ÂÍ‹˜: ™Â οı ·È‰› Ô˘ ¤¯ÂÈ Î¿ÓÂÈ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Û˘ÓÈÛÙ¿Ù·È ÔÈ ˘ÔÙÚÔ¤˜ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi ÛÙËÓ ·Ú¯‹ ÙÔ˘ Û·ÛÌÔ‡. H Û˘ÓÈÛÙÒÌÂÓË ‰fiÛË Â›Ó·È 0,5 mg/kg Ì ̤ÁÈÛÙË ‰fiÛË 10 mg. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ fiÙ·Ó ÙÔ

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ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ‹Ù·Ó Ôχ ·Ú·ÙÂٷ̤ÓÔ status epilepticus Î·È ÔÈ ÁÔÓ›˜ Â›Ó·È Ï›·Ó ·ÍÈfiÈÛÙÔÈ, ÌÔÚ› Ó· ·ÔÊ·ÛÈÛı› Ë ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ ·fi ÙÔ ÛÙfiÌ· Ì ‰fiÛË 0,3 mg/kg/8ˆÚÔ fiÙ·Ó Ô ˘ÚÂÙfi˜ ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ 38oC ÁÈ· ‰‡Ô Ë̤Ú˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË ÛÙ·Ì·Ù¿ 12 Ì 18 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÙÂÏÂ˘Ù·›· ˘ÔÙÚÔ‹, ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÌÂÙ¿ ÙÔ ÔÔ›Ô, Ë Èı·ÓfiÙËÙ· Ó¤·˜ ˘ÔÙÚÔ‹˜ Â›Ó·È ÌfiÓÔ 5-10%. ¶ÚÔʇϷÍË Ì ʷÈÓÔ‚·Ú‚ÈÙ¿ÏË ·fi ÙÔ ÛÙfiÌ· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÛÙȘ Û˘Ó‹ıÂȘ ÂÚÈÙÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜. MÔÚ› Ó· ÛÎÂÊıԇ̠ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ Û ȉȷ›ÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ÔÈ Ôԛ˜ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηıÔÚÈÛÙÔ‡Ó fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ‚Ú¤ÊË ÌÂ Û˘¯Ó¤˜ (οı ϛÁ˜ ‚‰ÔÌ¿‰Â˜) ‹ ·Ú·ÙÂٷ̤Ó˜ ˘ÔÙÚÔ¤˜.

TÔ ·È‰› Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÂÈÛ¿ÁÂÙ·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÁÈ· Ó· ‰È‰·¯ÙÔ‡Ó ÔÈ ÁÔÓ›˜ ÏÂÙÔÌÂÚÒ˜ ÙËÓ Ù¯ÓÈ΋ Ù˘ ¯ÔÚ‹ÁËÛ˘ Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi. °›ÓÂÙ·È ÁÂÓÈ΋ ÂͤٷÛË ÙÔ˘ ·›Ì·ÙÔ˜ ηıÒ˜ Î·È ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Û fiÏ· Ù· ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ 12 ÌËÓÒÓ, Û fiÛ· ·È‰È¿ ¤¯Ô˘Ó Û‡ÓıÂÙÔ˘˜, ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È Û ÂΛӷ Ì ˘Ô„›· ÌËÓÈÁÁ›Ùȉ·˜. ÕÏÏÔ˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ˜.

MÂÁ¿ÏË ÛËÌ·Û›· ¤¯ÂÈ Ë ÏÂÙÔÌÂÚ‹˜ Î·È ÚÔÛÂÎÙÈ΋ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ¿Óˆ ÛÙËÓ ÂÍ·ÈÚÂÙÈο ηÏÔ‹ıË ÚfiÁÓˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ, ηıÒ˜ Î·È ÙËÓ ·‰˘Ó·Ì›· ÙˆÓ Ê·ÚÌ¿ÎˆÓ fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È ·fi ÙÔ ÛÙfiÌ· Ó· ÚÔÊ˘Ï¿ÍÔ˘Ó Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ·fi ÙȘ ˘ÔÙÚÔ¤˜. H ηıËÛ‡¯·ÛË ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ ÎˉÂÌfiÓˆÓ Ì·˙› Ì ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË fiÙ·Ó ¯ÚÂÈ·Ûı›, Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ· ÙË ‚¿ÛË Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976;295:1029-1033.

2. Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. BMJ 1991;303:13731376.

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Microdysgenesis in resected temporal neocortex.

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18. Offringa M, Bossuyt PM, Lubsen J. et al. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies: J Pediatr 1994; 124:574-584.

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23. Knudsen FU. Rectal administration of diazepam in

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solution in the acute treatment of convulsions in infants and children. Arch Dis Child 1979;54:855-857.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-08-1999 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-01-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: AÁÁÂÏÈ΋ ™Î·Ú‰Ô‡ÙÛÔ˘ B’ ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "¶. & A. K˘ÚÈ·ÎÔ‡"

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26. Fukuyama Y, Seki T, Outsuka Ch, Miura H, Hara K. Practical guidelines for physicians in the management of febrile seizures. Brain and Devel 1996;18:479-484.

27. Camfield P, Camfield C. Management and treatment of febrile seizures. Cur Probl Pediatr 1997;27:6-12.

28. Berg A, Shinnar S. Complex febrile seizures. Epilepsia 1996;37(2):126-133.

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¶ƒ∞∫∆π∫∂™ O¢∏°π∂™ ∆OÀ ¶∞π¢π∞∆ƒOÀ ™∆OÀ™ °O¡∂π™

H ÛËÌ·Û›· ÙÔ˘ ·È¯ÓȉÈÔ‡ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Iˆ¿ÓÓ· AÓÙˆÓÈ¿‰Ô˘-KÔ˘Ì¿ÙÔ˘

H Ì¿ıËÛË ·Ú¯›˙ÂÈ Ôχ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Ù˘È΋˜ ÂÎ·›‰Â˘Û˘. H ·ÏÏËÏÂ›‰Ú·ÛË ·Ó¿ÌÂÛ· ÛÙÔ ‚Ú¤ÊÔ˜ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ‹ ÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ ÙÔ ÊÚÔÓÙ›˙Ô˘Ó, ηıÒ˜ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ, Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ÚÒÈÌË Ì¿ıËÛË.

TÔ ·È¯Ó›‰È ·›˙ÂÈ ¤Ó· Ôχ ÛËÌ·ÓÙÈÎfi ˘ÔÛÙËÚÈÎÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡. ¢›ÓÂÈ ¯·Ú¿ Î·È ÁÓÒÛË˙Â›Ó·È Ë ÈÔ ÚÔÓÔÌÈÔ‡¯Ô˜ ‰È·‰Èηۛ· Ì¿ıËÛ˘ Î·È Ô‰ËÁ› ÙÔ ·È‰› ÛÙËÓ ÔÏfiÏ¢ÚË ·Ó¿Ù˘Í‹ ÙÔ˘. M¤Û· ·fi ÙÔ ·È¯Ó›‰È ÁÓˆÚ›˙ÂÈ ÙÔÓ Â·˘Ùfi ÙÔ˘, ÂÈÎÔÈÓˆÓ› Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ Î·È ·Ó·Ù‡ÛÛÂÈ ÌÈ· ·ÌÊ›‰ÚÔÌË Û¯¤ÛË Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ì¤Û· ÛÙÔ ÔÔ›Ô ˙ÂÈ. ™˘ÁÎÂÎÚÈ̤ӷ: - ÂÍÂÚÂ˘Ó¿ ÙÔÓ Â·˘Ùfi ÙÔ˘ Î·È ·ÔÎÙ¿ ÂÈÎfiÓ· ÁÈ· ÙÔ ›‰ÈÔ ·ÏÏ¿ Î·È ÁÈ· ÙÔ˘˜ ¿ÏÏÔ˘˜, ·ÔÎÙ¿ ‰ËÏ·‰‹ ÁÓˆÛÙÈÎfi Û¯‹Ì· ÙÔ˘ ÛÒÌ·ÙÔ˜ - ‰ËÌÈÔ˘ÚÁ› ÔÈΛϘ Û¯¤ÛÂȘ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÙ· Ï·›ÛÈ· Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘ - ÚÔ¿ÁÂÈ ÙË ‰ËÌÈÔ˘ÚÁÈ΋ ¤ÎÊÚ·ÛË - ÔÈÎÔ‰ÔÌ› ÙȘ ‚·ÛÈΤ˜ ¤ÓÓÔȘ ÙÔ˘ ¯ÒÚÔ˘ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ - ‰ËÌÈÔ˘ÚÁ› Û¯¤ÛÂȘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ó·Î·Ï‡ÙÂÈ ÙË ¯·Ú¿ Ù˘ ·ÌÊ›‰ÚÔÌ˘ Û¯¤Û˘ - ÂÓÙ¿ÛÛÂÙ·È ÛÙÔ Û¯‹Ì· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ·ÚÁfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ Û˘ÓÔÌ‹ÏÈÎˆÓ ˆ˜ ‰ËÌÈÔ˘ÚÁÈÎfi ̤ÏÔ˜ - ·Ó·Î·Ï‡ÙÂÈ ÙË ‰‡Ó·ÌË Ù˘ Û˘ÏÏÔÁÈ΋˜ ÚÔÛ¿ıÂÈ·˜ - ÚÔÛÂÁÁ›˙ÂÈ ÙË Ê‡ÛË - ·Ó·Ù‡ÛÛÂÈ ·ÈÛıËÙÈÎfi ÎÚÈÙ‹ÚÈÔ - ‰ÈÂÚÂ˘Ó¿ ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· - ÂÌÏÔ˘Ù›˙ÂÈ ÙȘ ÂÌÂÈڛ˜ ÙÔ˘ - ÔÚÁ·ÓÒÓÂÈ ÙËÓ ÂÌÂÈÚ›· Û ÁÓÒÛË Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ Û˘Ì‚ÔÏÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ - ÔÈÎÔ‰ÔÌ› ·Í›Â˜ Ù˘ ÎÔÈÓˆÓÈ΋˜ ˙ˆ‹˜ - ·Ó·Ù‡ÛÛÂÈ ‰ÂÍÈfiÙËÙ˜ ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ Î·Ù¿ÎÙËÛË ÙÔ˘ ÁÚ·ÙÔ‡ ÏfiÁÔ˘ Î·È ÙˆÓ Ì·ıËÌ·ÙÈÎÒÓ ÂÓÓÔÈÒÓ - ·Ó·Ù‡ÛÛÂÈ ıÂÙÈ΋ Û¯¤ÛË Ì ÙË Ì¿ıËÛË Î·È ÙË ˙ˆ‹.

H ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó· ·›˙ÂÈ ÁÂÓÓÈ¤Ù·È ¤ÌÊ˘Ù· Î·È ·Ú¿ÏÏËÏ· Ì ÙËÓ ÈηÓfiÙËÙ· Ó· ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È, Ó· ÁÓˆÚ›˙ÂÈ, Ó· Ì·ı·›ÓÂÈ. H ˆÚ›Ì·ÓÛË Âȉڿ ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÙÔ ·È‰› ·›˙ÂÈ, Î·È ÙÔ ·È¯Ó›‰È Âȉڿ ÛÙË ‰È·‰Èηۛ· Ù˘ ˆÚ›Ì·ÓÛ˘. E›Ó·È ‰ËÏ·‰‹ ÙÔ ·È¯Ó›‰È ÙÚÔÊ‹ ÁÈ· ÙËÓ ˆÚ›Ì·ÓÛË, ÂÓÒ ·Ú¿ÏÏËÏ· ‰›ÓÂÈ ÙÔ ‚·ı‡ÙÂÚÔ ÓfiËÌ· ÛÙË ˙ˆ‹ ÁÈ·Ù› οÓÂÈ ÙÔ ¿ÙÔÌÔ ÈηÓfi Ó· ÊÙÈ¿ÍÂÈ Ù· fiÚÈ· Ù˘ ‡·ÚÍ‹˜ ÙÔ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ó· Ù· ˘ÂÚˉ‹ÛÂÈ. M¤Û· ·fi ÙÔ ·È¯Ó›‰È, ÙÔ ·È‰› ÍÂÂÚÓ¿ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ Ê˘ÛÈÎÒÓ, „˘¯ÈÎÒÓ, ÓÂ˘Ì·ÙÈÎÒÓ, Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÙÔ ··ÚÙ›˙Ô˘Ó.

A·Ú·›ÙËÙ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙÔ ·È¯Ó›‰È ›ӷÈ: ÙÔ ˘ÏÈÎfi, Ô ¯ÒÚÔ˜, Ô ¯ÚfiÓÔ˜, Ë ·Ú¤·. ¶·È‰›·ÙÚÔ˜-AÓ·Ù˘Íȷ΋ ¶·È‰›·ÙÚÔ˜ ¢È¢ı‡ÓÙÚÈ· TÔ̤· AÓ·Ù˘Íȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ IÓÛÙÈÙÔ‡ÙÔ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

177

MART.-APR.2000 ÓÂÔ

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13:04

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¶∞π¢π∞∆ƒπ∫∏ 2000;177-179

TÔ ˘ÏÈÎfi ¤¯ÂÈ Ôχ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ÙÔ˘ ·È¯ÓȉÈÔ‡ ¯ˆÚ›˜ Ó· Â›Ó·È ·Ó¿ÎÂÈ·. T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÍ·ÈÙ›·˜ Ù˘ ÙÂÚ¿ÛÙÈ·˜ ÂÌÔÚÂ˘Ì·ÙÔÔ›ËÛ˘ ÙÔ˘ ·È¯ÓȉÈÔ‡ Î·È Ù˘ ·Ó¿Ù˘Í˘ Ù˘ ‰È·Ê‹ÌÈÛ˘ Ì ÛÙfi¯Ô ÙËÓ ÚÔ‚ÔÏ‹ ÙÔ˘ fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ··ÈÙÔ‡ÌÂ Î·È ÚÔÙ›ÓÔ˘Ì "ÂÎ·È‰Â˘ÙÈο ·È¯Ó›‰È·". A˘Ùfi οÓÂÈ ÙÔ˘˜ ÁÔÓ›˜ ·ÏÏ¿ Î·È ÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ¤ÚÌ·È· ·˘Ù‹˜ Ù˘ ȉ¤·˜. ¶Ú¤ÂÈ Ó· ηٷÓÔ‹ÛÔ˘Ì fiÙÈ ·˘Ùfi Ô˘ ÚÔ‚¿ÏÏÂÙ·È ˆ˜ ÂÎ·È‰Â˘ÙÈÎfi ·È¯Ó›‰È Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ. TÔ ·È¯Ó›‰È Â›Ó·È ¤ÌÊ˘ÙÔ ÁÈ· ÙÔ ·È‰› Î·È ¤Ó· ÔÈÎÔÁÂÓÂÈ·Îfi Ï·›ÛÈÔ ‰›ÓÂÈ ¿ÊıÔÓ· "ÂÎ·È‰Â˘ÙÈο ˘ÏÈο". T· ·Ï¿, ·ÛÊ·Ï‹ ·ÓÙÈΛÌÂÓ· ÙÔ˘ ÛÈÙÈÔ‡ fiˆ˜ ÎÔ˘˙ÈÓÈο, Ï·ÛÙÈο ÎÔ˘ÙÈ¿, ¯·ÚÙÈ¿ Û˘Û΢·Û›·˜, ÂÊËÌÂÚ›‰Â˜ Î·È ÂÚÈÔ‰Èο, ·ÏÈ¿ ÚÔ‡¯·, ˙˘Ì¿ÚÈ... ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·È Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ¿ÊıÔÓ˜ ÒÚ˜ ¯·Ú¿˜, ‰ËÌÈÔ˘ÚÁ›·˜, ÂÍÂÚ‡ÓËÛ˘, Û˘Ì‚ÔÏÈÎÔ‡ ·È¯ÓȉÈÔ‡. ¶·Ú·‰ÔÛȷο ̤۷ fiˆ˜ ÌÔÁȤ˜, Ï·ÛÙÂÏ›ÓË, ÎÔ˘‚¿ÚÈ· Î·È ÎψÛÙ¤˜, ˘Ê¿ÛÌ·Ù·, ͇ÏÈÓÔÈ Î‡‚ÔÈ ‚ÔËıÔ‡Ó ÙÔ Û˘Ì‚ÔÏÈÛÌfi Î·È ÙËÓ ÈηÓfiÙËÙ· Î·È Ï‡ÓÔ˘Ó ÚÔ‚Ï‹Ì·Ù·. ŒÙÛÈ, Â›Ó·È ÛÎfiÈÌÔ Ó· ·ÂÓÔ¯ÔÔÈ‹ÛÔ˘Ì ÙÔ˘˜ ÁÔÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·ÁÔÚ¿ÛÔ˘Ó ÂȉÈο ÂÎ·È‰Â˘ÙÈο ·È¯Ó›‰È· fiˆ˜ Î·È Ó· ‚ÔËı‹ÛÔ˘Ì ӷ ÂÍÈÛÔÚÚÔ‹ÛÔ˘Ó ÙË ÛÙ¿ÛË ÙÔ˘˜ fiÛÔÈ ÁÔÓ›˜ Â›Ó·È ı‡Ì·Ù· Ù˘ ‰È·Ê‹ÌÈÛ˘ Î·È ‚ÔÌ‚·Ú‰›˙Ô˘Ó Ù· ·È‰È¿ ÙÔ˘˜ Ì ÔÏÏ¿ ·È¯Ó›‰È· Î·È ÂÚÈÛÛ¤˜ ÚÔÛ‰Ô˘.

O ·È‰›·ÙÚÔ˜ Ú¤ÂÈ Ó· ·Ú¤¯ÂÈ ÙË ÁÓÒÛË ÛÙÔ˘˜ ÁÔÓ›˜ ÒÛÙ ӷ ÂÈϤÁÔ˘Ó ·È¯Ó›‰È· Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. K¿ı ˘ÏÈÎfi ÁÈ· ·È¯Ó›‰È ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Û ÔÏÏ¿ ÛÙ¿‰È· ·Ó¿Ù˘Í˘ Ì ‰È·ÊÔÚÂÙÈÎfi ÙÚfiÔ, .¯. Ì ÙÔ˘˜ ͇ÏÈÓÔ˘˜ ·‚Ô˘˜ ¤Ó· ·È‰› Ï›ÁˆÓ ÌËÓÒÓ ·›˙ÂÈ ÎÔÈÙÒÓÙ·˜ ÙÔ˘˜, „ËÏ·ÊÒÓÙ·˜ ÙÔ˘˜, ÎÙ˘ÒÓÙ·˜ ÙÔ˘˜, ·ÚÁfiÙÂÚ· ÎÚ‡‚ÔÓÙ·˜-„¿¯ÓÔÓÙ¿˜ ÙÔ˘˜ ‹ ‚¿˙ÔÓÙ·˜-‚Á¿˙ÔÓÙ·˜, ·ÚÁfiÙÂÚ· ‚¿˙ÔÓÙ·˜ ÙÔÓ ¤Ó· ¿Óˆ ÛÙÔÓ ¿ÏÏÔ ‹ ¯Ù›˙ÔÓÙ·˜ ‹ Û˘Ì‚ÔÏ›˙ÔÓÙ·˜.

H ·ÛÊ¿ÏÂÈ· ÙˆÓ ·È¯ÓȉÈÒÓ Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘˜. ™ÙË ¯ÒÚ· Ì·˜ ÔÈ ÚԉȷÁڷʤ˜ ·ÛÊ¿ÏÂÈ·˜ ‰ÂÓ ¤¯Ô˘Ó ÙfiÛÔ ·˘ÛÙËÚ‹ Î·È Û·Ê‹ Ù˘ÔÔ›ËÛË. ŒÙÛÈ, ·ÓÙÈÛÙÔȯ› ÌÂÁ·Ï‡ÙÂÚË Â˘ı‡ÓË ÛÙÔÓ ·È‰›·ÙÚÔ ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ. AÔÛÒÌÂÓ· ÌÈÎÚ¿ ÎÔÌÌ¿ÙÈ·, ‚·ÚÈ¿ ·ÓÙÈΛÌÂÓ·, Ôχ ÌÈÎÚ¿ ·È¯Ó›‰È· ‹ ̤ÚË ·È¯ÓȉÈÒÓ ÛÙ· ¯¤ÚÈ· ‚ÚÂÊÒÓ, ÎÔÊÙÂÚ¤˜ ÂÈÊ¿ÓÂȘ, ÙÔÍÈο ¯ÚÒÌ·Ù·, ÚÔÛÂÏ¿ÛÈÌË ËÏÂÎÙÚÈ΋ ËÁ‹ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È. ŸÌˆ˜, Ù· ·È¯Ó›‰È· Ú¤ÂÈ Ó· ÂÍ·ÛÊ·Ï›˙Ô˘Ó Î·È ÙËÓ „˘¯È΋ ·ÛÊ¿ÏÂÈ·. E›Ó·È ÛÙÔ ÚfiÏÔ ÙÔ˘ ·È‰›·ÙÚÔ˘ Ó· ÚÔÛٷهÛÂÈ Ù· ·È‰È¿ ·fi ·È¯Ó›‰È· ‚›·˜ ‹ ·È¯Ó›‰È· ·ÚÓËÙÈÎÒÓ ÛÙÂÚÂÔÙ‡ˆÓ .¯. ʇÏÔ˘ ‹ Ê˘Ï‹˜. ™˘¯Ó¿ Ù· video games ¤¯Ô˘Ó Ôχ ‚›·ÈÔ˘˜ ‹ÚˆÂ˜ ‹ ‚›·È· ÁÚ·ÊÈο Î·È Ú¤ÂÈ Ó· ÂÈϤÁÔÓÙ·È Ì ÚÔÛÔ¯‹.

O ¯ÒÚÔ˜ Ô˘ ÙÔ ·È‰› ·›˙ÂÈ Ú¤ÂÈ Ó· ¤¯ÂÈ ‚·ÛÈ΋ ÔÚÁ¿ÓˆÛË ·Ó¿ÏÔÁË Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ηıÒ˜ Î·È ÛÙ·ıÂÚfiÙËÙ·. ŒÓ·˜ ¯ÒÚÔ˜ ·È¯ÓȉÈÔ‡ Ì ÌÈ· ÌÔΤٷ ‹ Ì·ÍÈÏ¿ÚÈ· ÁÈ· Ù· ÌÈÎÚ¿ ·È‰È¿ ‹ ¤Ó· ÙÚ·Â˙¿ÎÈ Î·È Î·ÚÂÎÏ¿ÎÈ ÛÙ· ÌÂÁ¤ıË ÂÓfi˜ ÓË›Ô˘, ÔÚÁ·ÓÒÓÔ˘Ó Î·È ÂÚÈÁÚ¿ÊÔ˘Ó ÙÔ ·È¯Ó›‰È. T· ·È¯Ó›‰È· Ú¤ÂÈ Ó· Â›Ó·È Ù·ÎÙÔÔÈË̤ӷ Î·È Ó· ÌË Ï›Ô˘Ó ÎÔÌÌ¿ÙÈ·. H Û˘ÓËıÈṲ̂ÓË Ï‡ÛË Ì ÙÔ ÌÂÁ¿ÏÔ ÎÔ˘Ù› Ô˘ Ô˘ÛÈ·ÛÙÈο ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ηı·Ú›˙ÂÙ·È ÙÔ ‰ˆÌ¿ÙÈÔ ‰ÂÓ ‚ÔËı¿ÂÈ Ù· ·È‰È¿. AÓÙ›ıÂÙ·, Û˘Ó‹ıˆ˜ Ù· ·Ó·ÛÙ·ÙÒÓÂÈ Î·È Ù· οÓÂÈ Ó· ÌËÓ ·›ÚÓÔ˘Ó ¯·Ú¿ Î·È ÁÓÒÛË ·fi ¤Ó· ·È¯Ó›‰È ¯ˆÚ›˜ fiÚÈ·. ™˘Óı‹Î˜ ·ÛÊ¿ÏÂÈ·˜ Ú¤ÂÈ Ó· ¤¯ÂÈ Î·È Ô ¯ÒÚÔ˜ ̤۷ ÛÙÔÓ ÔÔ›Ô ÙÔ ·È‰› ·›˙ÂÈ. ŒÙÛÈ, Ú›˙˜, ηÏ҉ȷ, οÁÎÂÏ·, ËÁ¤˜ ıÂÚÌfiÙËÙ·˜, Ù˙¿ÌÈ· Ú¤ÂÈ Ó· ÊÚÔÓÙ›˙Ô˘Ì ÒÛÙ ӷ ÌËÓ Â›Ó·È ÛÙËÓ ¿ÌÂÛË ÚÔÛ¤Ï·ÛË ÙˆÓ ·È‰ÈÒÓ.

O ¯ÚfiÓÔ˜ ÙÔ˘ ·È¯ÓȉÈÔ‡ Ú¤ÂÈ Ó· Â›Ó·È Û·Ê‹˜. TÔ ·È¯Ó›‰È Û οı ËÏÈΛ· Â›Ó·È Î·Ïfi Ó· ¤¯ÂÈ ·Ú¯‹ Î·È Ù¤ÏÔ˜ ‰Ëψ̤ӷ. H ‰È¿ÚÎÂÈ· Ú¤ÂÈ Ó· Â›Ó·È ·Ó¿ÏÔÁË Ì ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÚÔÛÔ¯‹ Î·È Û˘ÁΤÓÙÚˆÛË. ŒÙÛÈ ¤Ó· ·È‰› 4 ¯ÚfiÓˆÓ ‰ÂÓ Â›Ó·È ÛÎfiÈÌÔ Ó· ˙ˆÁÚ·Ê›˙ÂÈ Î·ıÈṲ̂ÓÔ ÂÚÈÛÛfiÙÂÚÔ ·fi 20 ÏÂÙ¿. ŸÙ·Ó Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Â›Ó·È Â˘¯¿ÚÈÛÙË Î·È ‰ÈÂÁÂÚÙÈ΋ ÁÈ· ÙÔ ·È‰›, ‰ÂÓ Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È ·fiÙÔÌ·, ȉ›ˆ˜ Ì ÎÚÈÙ‹ÚÈ· Ù· ÔÔ›· ÙÔ ·È‰› ‰ÂÓ ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È. E›Ó·È ÛˆÛÙfi ÙÔ ·È‰› Ó· ÚÔÂȉÔÔÈÂ›Ù·È ÁÈ· ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ·È¯ÓȉÈÔ‡. °È· ÙËÓ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ·ÚÓÂ›Ù·È Ó· ʇÁÂÈ ·fi ÙËÓ ·È‰È΋ ¯·Ú¿ Ô˘ÚÏÈ¿˙ÔÓÙ·˜, ‰ÂÓ Â˘ı‡ÓÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÙÔ ·È‰›.

H Û˘ÓÙÚÔÊÈ¿ Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ÙÔ˘ ·È¯ÓȉÈÔ‡. ™ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Â›Ó·È ·˘ÙÔÓfiËÙÔ fiÙÈ Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ ¤Ó·˜ ÂÓ‹ÏÈη˜ ÎÔÓÙ¿ ÛÙÔ ·È‰› Î·È Ó· ˘ÔÛÙËÚ›˙ÂÈ ÙÔ ·È¯Ó›‰È. AÚÁfiÙÂÚ· Î·È fiÙ·Ó ÙÔ ·È‰› - Á‡Úˆ ÛÙÔÓ 8Ô Ì‹Ó· - ·Ó·Ù‡ÛÛÂÈ ÙË ‰È·‰Èηۛ· ÙÔ˘ ·Ô¯ˆÚÈÛÌÔ‡ ·fi ÙË ÌËÙ¤Ú· ÌÔÚ› Ó· ̤ÓÂÈ ÁÈ· Ôχ Ï›ÁÔ ¯ÚfiÓÔ ÌfiÓÔ ÙÔ˘. M¤¯ÚÈ Ù· 2,5 ¯ÚfiÓÈ· ÙÔ ·È¯Ó›‰È Â›Ó·È ÌÔÓ·¯ÈÎfi Î·È ·Ú¿ÏÏËÏÔ, ‰ËÏ·‰‹ ·›˙ÂÈ Ì ¿ÏÏ· ·È‰È¿ ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈ΋ Û˘Ó·ÏÏ·Á‹ Î·È Î·Ù¿ ÚÔÙ›ÌËÛË Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ¢ÂÓ ¤¯ÂÈ ·Ó·Ù‡ÍÂÈ ÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ¿ ÙÔ˘ ÙfiÛÔ ÒÛÙ ӷ ̤ÓÂÈ Â˘¯¿ÚÈÛÙ· ÌfiÓÔ ÙÔ˘, Ó· ·›˙ÂÈ ÔÌ·‰Èο ‹ Ó· Û¤‚ÂÙ·È Î·ÓfiÓ˜ ·È¯ÓȉÈÔ‡. A˘Ù¿ ·Ó·Ù‡ÛÛÔÓÙ·È ·ÚÁfiÙÂÚ· Î·È Á‡Úˆ ÛÙÔÓ 4Ô ¯ÚfiÓÔ Ù· ·È‰È¿ ÌÔÚÔ‡Ó Ó· ¯·›ÚÔÓÙ·È ÙËÓ ·Ú¤· ¿ÏÏˆÓ ·È‰ÈÒÓ, Ó· ·›˙Ô˘Ó ‰ËÌÈÔ˘ÚÁÈο Î·È Û˘ÓÙÚÔÊÈο Û ·Ú¤Â˜ ÔÌËϛΈÓ.

O ÚfiÏÔ˜ ÙÔ˘ ÁÔÓÈÔ‡ Û' ·˘Ùfi ÙÔ ‰ÚfiÌÔ Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi˜ Î·È Ë ÛÙÂÓ‹ ‹ ·ÚÁfiÙÂÚ· ·fi ·fiÛÙ·ÛË ·ÚÔ˘Û›· ÙÔ˘, Ë Î·Ï‡ÙÂÚË ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË, Û˘ÁÎÚfiÙËÛË Î·È ÂÌ„‡¯ˆÛË ÙÔ˘ ·È¯ÓȉÈÔ‡. K·Ó¤Ó· "ÂÎ·È‰Â˘ÙÈÎfi ˘ÏÈÎfi" ‰ÂÓ ÌÔÚ› Ó· ˘ÔηٷÛÙ‹ÛÂÈ ·˘Ùfi.

O Û‚·ÛÌfi˜ ÛÙË ÌÔÓ·‰ÈÎfiÙËÙ· Î·È ÙȘ ÚÔÛˆÈΤ˜ ·Ó¿ÁΘ Î·È Ú˘ıÌÔ‡˜ ηıÒ˜ Î·È Ô Û‚·ÛÌfi˜ Î·È Ë Î·ÏÏȤÚÁÂÈ· Ù˘ Û˘ÏÏÔÁÈÎfiÙËÙ·˜ Ú¤ÂÈ Ó· ‰È·ÂÚÓÔ‡Ó ÙË ‰È·‰Èηۛ· ÙÔ˘ ·È¯ÓȉÈÔ‡ Û fiϘ ÙȘ ËÏÈ˘.

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K·Ù¿ÏÏËÏ· ·È¯Ó›‰È· ·Ó¿ ËÏÈΛ·

MˆÚfi

¶ÚˆÙÔÌ›ÏËÌ·, ÙÚ·ÁÔ‡‰È KÔ›Ù·ÁÌ·, ¯¿È‰ÂÌ·, ¿ÁÁÈÁÌ· ¶·È¯Ó›‰È· Ô˘ ‚Á¿˙Ô˘Ó ‹ÈÔ˘˜ ‹¯Ô˘˜ KÚÂÌ·ÛÙ¿ ·ÓÙÈΛÌÂÓ· Ó· ‚ϤÂÈ Î·È Ó· È¿ÓÂÈ

8-12 ÌËÓÒÓ

¶·È¯Ó›‰È· Ì ÎÚ‡‚ˆ-‚Ú›ÛΈ (ÎÔ‡ÎÔ˘-ÙÛ·, ÎÚ‡‚ÔÌ·È ›Ûˆ ·fi ÙÔ ÛÂÓÙfiÓÈ...) ¶·È¯Ó›‰È· Ì ٷ ¯¤ÚÈ· (ÎÔ˘-Â-¤, ÁÂÈ·, ˙‹ÏÈ·...)

K·ıÚ¤ÊÙ˜ ¶¿ÓÈÓ· ˙Ò· KÚ›ÎÔÈ, ·‚ÔÈ, Ì¿Ï˜ BÈ‚Ï›· Ì ÂÈÎfiÓ˜ MÔ˘ÛÈο ·È¯Ó›‰È·

2Ô˜ ¯ÚfiÓÔ˜

K‡‚ÔÈ, ÎÔ˘˙ÈÓÈο, ÎÔ˘ÙÈ¿ M¿Ï˜ A˘ÙÔÎÈÓËÙ¿ÎÈ· ·ÛÊ·Ï‹ ¶·È¯Ó›‰È· ÁÈ· ÛÚÒÍÈÌÔ, ÙÚ¿‚ËÁÌ· BÈ‚Ï›· ·fi ‡Ê·ÛÌ·, ¯·ÚÙfiÓÈ Ì ÌÂÁ¿Ï˜ ÂÈÎfiÓ˜ ‹ Ôχ ·Ϥ˜ ÈÛÙÔڛ˜ MÔ˘ÛÈο ·È¯Ó›‰È· ™¯‹Ì·Ù· (·Ï¿)

3Ô˜ ¯ÚfiÓÔ˜

K‡‚ÔÈ, ÂÓÛÊËÓÒÛÂȘ, ·˙Ï Ì ϛÁ· ÎÔÌÌ¿ÙÈ·, Û¯‹Ì·Ù· KÔ‡ÎϘ, ·˘ÙÔÎÈÓËÙ¿ÎÈ·, Ì¿Ï˜ ¶Ô‰‹Ï·ÙÔ Ì 3 Úfi‰Â˜ BÈ‚Ï›·, ·Ú·Ì‡ıÈ MÔ˘ÛÈ΋, ÙÚ·ÁÔ‡‰È ¶Ï¿ÛÈÌÔ, ˙ˆÁÚ¿ÊÈÛÌ· ¶·È¯Ó›‰È· Ì›ÌËÛ˘ Î·È ÚfiÏˆÓ (ÎÔ˘˙ÈÓÈο, ÌÂÙ·ÌÊȤÛÂȘ) KÔ‡ÓȘ, ÙÛÔ˘Ï‹ıÚ˜...

4Ô˜ ¯ÚfiÓÔ˜

MÔχ‚È·, „·Ï›‰È·, ¯ÚÒÌ·Ù·, Ï·ÛÙÂϛӘ, ËÏfi˜ ZˆÁÚ¿ÊÈÛÌ·, ÎfiÏÏËÌ·, Ù·›ÚÈ·ÛÌ· ¶·˙Ï Ì ÂÚÈÛÛfiÙÂÚ· ÎÔÌÌ¿ÙÈ· KÔ˘˙ÈÓÈο, ÎÔ˘ÙÈ¿, ·ÏÈfi ˘ÏÈÎfi ÛÈÙÈÔ‡ MÂÙ·ÌÊȤÛÂȘ, ÚfiÏÔÈ BÈ‚Ï›· ¶·Ú·Ì‡ıÈ, ·ÚÔÈ̛˜ ¶·Ú·‰ÔÛȷο ·È¯Ó›‰È· £¤·ÙÚÔ KÔ‡ÎϘ, ÎÔ˘ÎÏfiÛÈÙ· MÔ˘ÛÈο fiÚÁ·Ó· (͢ÏfiʈÓÔ, È·Ó¿ÎÈ, Ù‡Ì·ÓÔ...), ÙÚ·ÁÔ‡‰È M¿Ï·, Ô‰‹Ï·ÙÔ EÌÂÈڛ˜ ¤Íˆ ·fi ÙÔ Û›ÙÈ.

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E¶π™∆O§∂™ ™¯ÔÏÈ·ÛÌfi˜ ¢ËÌÔÛ›Â˘Û˘

£· ‹ıÂÏ· Ó· οӈ ÙȘ ·ÎfiÏÔ˘ı˜ ·Ú·ÙËÚ‹ÛÂȘ ¿Óˆ ÛÙËÓ Ôχ ÂӉȷʤÚÔ˘Û· ÌÂϤÙË Ì ٛÙÏÔ "XÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘, ‚ÈÙ·ÌÈÓÒÓ Î·È Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜ Û ‰Â›ÁÌ· ·È‰ÈÒÓ", Ô˘ ‰ËÌÔÛȇÂÙ·È ÛÙÔ ÂÚÈÔ‰ÈÎfi ¶·È‰È·ÙÚÈ΋ 1999;62:390-393.

1. OÈ ·Ó·ÊÂÚfiÌÂÓ˜ ÛÙÔÓ ›Ó·Î· 3 (ÛÂÏ. 392) ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ ‚ÈÙ·ÌÈÓÒÓ B2, B6, B12, C Î·È E ÁÈ· ÌË ·ıÏÔ‡ÌÂÓÔ˘˜ ÂÊ‹‚Ô˘˜ Â›Ó·È „ËÏfiÙÂÚ˜ ·fi ÙȘ Û˘ÓÈÛÙÒÌÂÓ˜ (Food and Nutrition Board, Institute of Medicine, 1997) ÙÈ̤˜ ·Ó·Áη›·˜ ËÌÂÚ‹ÛÈ·˜ ÚfiÛÏ˄˘ ÁÈ· ÙȘ ‚Èٷ̛Ә ·˘Ù¤˜, Ô˘ Â›Ó·È ÁÈ· ·ÁfiÚÈ· 11-14 ¯ÚfiÓˆÓ: B2,:1,5, B6:1,7, B12:2, C:50 Î·È E: 10 (mg) (1).

2. H Û‡ÛÙ·ÛË ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ù˘ ÌÂϤÙ˘ ¯ÔÚ‹ÁËÛ˘ ÛÙÔ˘˜ ·ıÏËÙ¤˜ ‚ÈÙ·ÌÈÓÔ‡¯ˆÓ Û΢·ÛÌ¿ÙˆÓ (¤ÛÙˆ Î·È ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ‚Èٷ̛Ә), ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙȘ Û˘ÛÙ¿ÛÂȘ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ÙÔ˘˜ ·Û¯ÔÏÔ‡ÌÂÓÔ˘˜ Ì ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·ıÏËÙÒÓ ÂÚ¢ÓËÙ¤˜ (2). B¤‚·È·, Ë ‰È·ÙÚÔÊ‹ ÙˆÓ ·ıÏËÙÒÓ ··Û¯ÔÏ› ¤ÓÙÔÓ· ÙË ‰ÈÂıÓ‹ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ, ·fi Ù· ̤¯ÚÈ ÙÒÚ· fï˜ ‰Â‰Ô̤ӷ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ‰ÂÓ ˘ÔÛÙËÚ›˙ÂÙ·È Ë ·Ó¿ÁÎË Û˘ÌÏËڈ̷ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÔÔÈÔ˘‰‹ÔÙ ıÚÂÙÈÎÔ‡ Û˘ÛÙ·ÙÈÎÔ‡ ÛÙÔ˘˜ ·ıÏÔ‡ÌÂÓÔ˘˜. AÓÙ›ıÂÙ·, ÙÔÓ›˙ÂÙ·È Ë ·Ó¿ÁÎË Ù˘ ÚfiÛÏ˄˘ ·fi ÙÔ˘˜ ·ıÏËÙ¤˜ fiÏˆÓ ÙˆÓ ·Ó·Áη›ˆÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ·fi Ê˘ÛÈΤ˜ ËÁ¤˜, ̤۷ ·fi ¤Ó· ÔÈΛÏÔ Î·È ÈÛÔÚÚÔË̤ÓÔ ‰È·ÈÙÔÏfiÁÈÔ (2,3,4). ¢Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÈÂıÓÒ˜, ÔÈ ·ıÏËÙ¤˜ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ηٷʇÁÔ˘Ó ÛÂ Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ ·fi ¿¯ÚËÛÙ· ¤ˆ˜ Î·È ÂÈΛӉ˘Ó· ÔÏϤ˜ ÊÔÚ¤˜, ı· Ú¤ÂÈ Ó· ›̷ÛÙ ȉȷ›ÙÂÚ· ÚÔÛÂÎÙÈÎÔ› ÛÙ· ÌËӇ̷ٷ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ Â˘·›ÛıËÙÔ ·˘Ùfi ı¤Ì·.

M ÂÎÙ›ÌËÛË EÈÚ‹ÓË KÔÓÙÔfi‰Ë - KˆÛÙÔ‡ÎË E. A' ¶·È‰È·ÙÚÈÎÔ‡ TÌ‹Ì·ÙÔ˜, B' ¶·ı. TÔ̤· NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·"

BÈ‚ÏÈÔÁÚ·Ê›· 1. Curran SJ, Barness AL. Nutritional Requirements. In: Nelson WE. Textbook of Pediatrics, 16th edition (copyright 2000).

Philadelphia, USA: Saunders Company.

2. Manore MM. The effect of physical activity on Theamin, Rivoflavin, and Vitamin B6 requirements. In: Workshop on the role of dietary supplements for physically active people. NIH, Bethesda, Maryland, June 3-4, 1996:72-82.

3. Wahl R. Nutrition in the adolescent. Pediatric Annals 1999;28:107-111.

4. Probart KC, Bird JP, Parker AK. Diet and athletic performance. Med Clin North Am 1993;77(4):757-772.

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∞¿ÓÙËÛË Û˘ÁÁڷʤˆÓ

™¯ÂÙÈο Ì ÙËÓ ÂÈÛÙÔÏ‹ Ù˘ ·È‰È¿ÙÚÔ˘ Î. EÈÚ‹Ó˘ KÔÓÙÔfi‰Ë - KˆÛÙÔ‡ÎË, Ë ÔÔ›· ·ÊÔÚ¿ ÙËÓ ÂÚÁ·Û›· Ì·˜ "XÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘, ‚ÈÙ·ÌÈÓÒÓ Î·È Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜" ¶·È‰È·ÙÚÈ΋ 1999,62:390-393, ı· ‹ıÂÏ· Ó· ¢¯·ÚÈÛÙ‹Ûˆ ÙË Û˘Ó¿‰ÂÏÊÔ ÁÈ· ÙȘ ·Ú·ÙËÚ‹ÛÂȘ Ù˘ Î·È Ó· ÛËÌÂÈÒÛˆ fiÙÈ: 1. H ‰È·ÊÔÚ¿ ÛÙȘ ÙÈ̤˜ ÙˆÓ ËÌÂÚËÛ›ˆÓ ·Ó·ÁÎÒÓ Û ‚Èٷ̛Ә ÙˆÓ ÌË ·ıÏÔ‡ÌÂÓˆÓ ÂÊ‹‚ˆÓ ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ Ë ÌÂϤÙË Ì·˜ ˘Ô‚Ï‹ıËΠÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 1997 ÛÙÔ ÂÚÈÔ‰ÈÎfi, Î·È ÔÈ ·Ó·ÊÂÚfiÌÂÓ˜ ÙÈ̤˜ Â›Ó·È ·fi ÙÔ Sports Med 1994;17:152-162.

2. ¢ÂÓ ¤¯Ô˘Ì ԢÛÈ·ÛÙÈ΋ ‰È·ÊˆÓ›· Ì ÙË Û˘Ó¿‰ÂÏÊÔ ÛÙÔ - fi¯È Ï˘Ì¤ÓÔ - ı¤Ì· Ù˘ ¯ÔÚ‹ÁËÛ˘ Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜ ÛÙÔ˘˜ ·ıÏÔ‡ÌÂÓÔ˘˜ ÂÊ‹‚Ô˘˜. TÔÓ›˙Ô˘Ì ÛÙËÓ ÂÚÁ·Û›· Ì·˜ ΢ڛˆ˜ ÙËÓ ÂÓ›Û¯˘ÛË ÛˆÛÙÒÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È fi¯È ÙË ¯ÔÚ‹ÁËÛË Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜. EÍ¿ÏÏÔ˘, ÛÙË Û˘˙‹ÙËÛË Ù˘ ÂÚÁ·Û›·˜ ‰›‰ÂÙ·È ¤ÌÊ·ÛË ÁÂÓÈÎÒ˜, ÛÙËÓ ·ÔÊ˘Á‹ ¿ÛÎÔ˘ ¯ÔÚ‹ÁËÛ˘ Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜.

M ÂÎÙ›ÌËÛË M·Ú›· - A‰·Ì·ÓÙ›· M·ÏÏÈ·ÚÔ‡ EÈÌÂÏ‹ÙÚÈ· NÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "AÁ›· ™ÔÊ›·" B·ÏÙÂÙÛ›Ô˘ 9 151 25 M·ÚÔ‡ÛÈ

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¶·ÚÔÚ¿Ì·Ù· 1. ™ÙÔ 5Ô Ù‡¯Ô˜ Ù˘ ¶AI¢IATPIKH™, ÛÙË ‰ËÌÔÛ›Â˘ÛË Ù˘ EӉȷʤÚÔ˘Û·˜ ¶ÂÚ›ÙˆÛ˘ "OÈÎÔÁÂÓ‹˜ ÓfiÛÔ˜ Hodgkin - ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛˆÓ", EÈÚ‹ÓË MÔψӿÎË, E˘Ù˘¯›· ™ÙÂȷοÎË, E˘·ÁÁÂÏ›· §˘‰¿ÎË, K·ÏÏÈfiË ™ÙÂÊ·Ó¿ÎË, °ÈÒÚÁÔ˜ ¢ÂÏ›‰Ë˜, M·Ú›· K·ÏÌ·ÓÙ‹ (¶·È‰È·ÙÚÈ΋ 1999;62:394-396), ‰ËÌÔÛȇÙËΠÂÎ ·Ú·‰ÚÔÌ‹˜ Ï¿ıÔ˜ ÂÈÎfiÓ·. ¢ËÌÔÛȇԢÌ ÙȘ ÛˆÛÙ¤˜ ÂÈÎfiÓ˜.

EÈÎfiÓ· 1. In situ ˘‚ÚȉÈÛÌfi˜ Ì EBER-1 Û ·ÙÙ·Ú· ‚ÈÔ„›·˜ ÏÂÌÊ·‰¤Ó· ÓfiÛÔ˘ Hodgkin.

EÈÎfiÓ· 2. ∞ÓÔÛÔ˚ÛÙÔ¯ËÌ›· ÁÈ· LMP-1 ÙÔ˘ ÈÔ‡ Epstein Barr Û ·ÙÙ·Ú· ‚ÈÔ„›·˜ ÏÂÌÊ·‰¤Ó· ÓfiÛÔ˘ Hodgkin.

2. ™ÙËÓ ›‰È· ‰ËÌÔÛ›Â˘ÛË, Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ¤¯Ô˘Ó ˆ˜ ÂÍ‹˜: I. Bolonaki, E. Stiakaki, E. Lydaki, K. Stefanaki, G. Delides, M. Kalmanti.

3. ™ÙËÓ ÂÚÁ·Û›· "™‡Ó‰ÚÔÌÔ Gilbert: °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Û˘Û¯¤ÙÈÛË Ì ÙÔ Ê·ÈÓfiÙ˘Ô Û ·È‰ÈÎfi Ï˘ı˘ÛÌfi" AÛ·Û›· TÛ¤˙Ô˘, M·Ú›· T˙¤ÙË, ™ÔÊ›· K›ÙÛÈÔ˘, AÁÁÂÏÈ΋ °·ÏÏ¿, EÌÌ·ÓÔ˘‹Ï K·‚·˙·Ú¿Î˘, AÓ‰ÚÔÓ›ÎË X·Ù˙ˉËÌԇϷ, EÏ¢ıÂÚ›· ¶·ÙÂÚ¿ÎË, AÓÙÒÓÈÔ˜ ¢Ú·Î¿ÙÔ˜, EÌÌ·ÓÔ˘‹Ï K·Ó·‚¿Î˘, £ÂÌÈÛÙÔÎÏ‹˜ K·Ú¿ıÈÔ˜. ¶AI¢IATPIKH 2000;63:21-26, ‰ÂÓ ÂÚÈÂÏ‹ÊıËÛ·Ó ÔÈ ·Ú·Î¿Ùˆ ‚È‚ÏÈÔÁڷʛ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ.

16. De Morais SMF, Utrecht JP, Well PG (1992). Decreased glucuronidation and increased acetaminophen bioactivation in Gilbert's syndrome. Gastroenterology 102:577-586.

17. Chowdhury RJ, Jansen PLM (1996). Bilirubin metabolism and its disorders. In: Zakim D, Boyer TD eds. Hepatology: a textbook of liver disease. Volume 1, 3rd ed. Philadelphia Saunders: 323-361.

18. Berk ED, Noyer C (1994). The familial unconjugated hyperbilirubinemias. Semin. Liver Dis. 356:385.

19. Iolascon A, Faienza MF, Centra M, Storelli S, Zelante L, Savoia A (1999). (TA)8 allele in the UGT1A1 gene promoter of a Caucasian with Gilbert's syndrome. Haematologica 84:106-109.

20. Bancroft JD, Kreamer B, Gourley GR (1998). Gilbert syndrome accelerates development of neonatal jauntice. J. Paediatr.

132(4):656-660.

21. Galanello R, Perseu L, Melis MA, Cipollina L, Barella S, Giagu N, Turco MP (1997). Hyperbilirubineamia in heterozygous ‚thalassemia is related to co-inherited Gilbert's syndrome. Br J Haematol 99:433-436.

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∞Ú›ÏÈÔ˜ 2000 1-2 ∞ÚÈÏ›Ô˘ 2000 ∞ı‹Ó· 1Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel OÚÁ¿ÓˆÛË-°Ú·ÌÌ·Ù›· C&C International A.E. TËÏ: 01 68 89 100, Fax: 01 68 44 777 e-mail: congress@cnc.gr

1o ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜

Aı‹Ó· 1-2 AÚÈÏ›Ô˘ 2000 •ÂÓÔ‰Ô¯Â›Ô Divani Caravel

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 25-27 ª·˝Ô˘ ª˘ÙÈÏ‹ÓË, §¤Û‚Ô˜ 12Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ “∂Êԉȿ˙ÔÓÙ·˜ Ù· ·È‰È¿ Ì·˜ Ì ‰ÂÍÈfiÙËÙ˜ ˙ˆ‹˜”

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∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ °Ú·ÌÌ·Ù›·: µ. ºÚ·ÁοÎË ∆ËÏ./Fax: 777 38 40 πÔ‡ÓÈÔ˜ 2000 16-18 πÔ˘Ó›Ô˘ 2000 ∫ˆ˜ 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∫ipriotis Village Hotel OÚÁ¿ÓˆÛË - °Ú·ÌÌ·Ù›· C & C International A.∂. ¶·Ú·‰Â›ÛÔ˘ 16, 15125 Aı‹Ó· TËÏ.: 01 68 89 100 Fax: 01 68 44 777 e-mail:congress@cnc.gr ¶

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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›‰· 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‰ÔÓ¢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

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™YNTOMO°PAºIE™ - (Abbreviations) ™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿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˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ 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΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚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 ÏÂÙfi ·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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™˘ÓÙÔÌÔÁڷʛ˜

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˘ÙÂÚfiÏÂÙÔ ˘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 )

xii

Combining prefixes T G M k h da d c m Ì n p f a