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TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 4 ñ IÔ‡ÏÈÔ˜-∞‡ÁÔ˘ÛÙÔ˜ 2005 ¶·È‰È·ÙÚÈ΋ ñ TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 4 ñ πÔ‡ÏÈÔ˜-∞‡ÁÔ˘ÛÙÔ˜ 2005
www.paediatriki.edu.gr
Volume 68 ñ Number 4 ñ July-August 2005 ISSN 0377-2551
Pediatr July-Aug 05 new
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¶·È‰È·ÙÚÈ΋ ∆fiÌÔ˜ 68 ñ ∆‡¯Ô˜ 4 ñ πÔ‡ÏÈÔ˜-∞‡ÁÔ˘ÛÙÔ˜ 2005 ¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ ª. ∫·Ó¿ÚÈÔ˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë A. K·ÙÙ¿Ì˘ Ã. ∫ÒÛÙ·ÏÔ˜ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ¶··‰ÔÔ‡ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË
¶ÂÚȯfiÌÂÓ· µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞
∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™
245 ∂ÏÏ›ÌÌ·Ù· ÙÔ˘ À ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Û ·È‰È¿ ÌÂ Ê˘ÏÂÙÈÎfi ̈۷˚ÎÈÛÌfi: Èı·Ófi˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡ Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘, ¡. ™ÎÔÚ‰‹˜, ∫. ™ÈÛÌ¿ÓË, §. ∫Ô˘ÛÔ˘Ï›‰Ô˘, °. ∫Ô˘Ì·Ú‹˜, Ã. ∂˘Ù‡¯Ë, °. ™Ù·˘Ú›‰Ë˜, ∞. πÔ˘ÏÈ·Ófi˜, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞. °·ÏÏ¿-µÔ˘Ì‚Ô˘Ú¿ÎË, ∑. ∫ÔÛÌ·˝‰Ô˘, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜, º. ∫. ¶·ÙÛ·Ï‹˜
289 ¶ÔÏÏ·Ï¿ ÂÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù· ·fi Listeria monocytogenes Û ·È‰› Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ™. ¡ÙÂÏ›ÎÔ˘, º. ÷ÏÈÒÙ˘, ∫. ∫·Ú·‚·Ó¿ÎË, º. ¶ÚÔ‰ÚfiÌÔ˘, ™. ∞˘ÏˆÓ›Ù˘ 296 ™˘ÁÁÂÓ¤˜ ÎÔÏfi‚ˆÌ· ›Úȉ·˜-¯ÔÚÈÔÂȉԇ˜: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ∫. ªfiÓÙË, ¡. ª·ÓÈfi˜
∞¡∞™∫√¶∏™∂π™ ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘
¶ƒ∞∫∆π∫√ £∂ª∞ 257 ºˆÙÔ¢·ÈÛıËÛ›·, ÙËÏÂfiÚ·ÛË Î·È ÂÈÏË„›· ¡. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜ 268 √È ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∞. ™ÈÒÌÔ˘, Õ. ÿÏÏ·
301 ∫·Ú‰ÈÔÏÔÁÈÎÔ› ΛӉ˘ÓÔÈ ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË ™. ∞ÓÙˆÓÈ¿‰Ë˜
°ƒ∞¶∆√ ™Àª¶√™π√
K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ∞ÚÙ¤ÌȉԘ 3 151 25 M·ÚÔ‡ÛÈ TËÏ.: 210 87 78 810 Fax: 210 87 78 822
279 ∞ÍÈÔÏfiÁËÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ Û ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Õ. ÿÏÏ·, ∞. ™ÈÒÌÔ˘, ª. ∆˙Ô‡ÊË, ¢. §··ÙÛ¿Ó˘, µ. ÃÔϤ‚·˜, ∞. ªÔ˘Ï¿˜, ¡. ÷ÏÈ¿ÛÔ˜, ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘
308 √ ¤ÊË‚Ô˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ª. §È·ÎÔÔ‡ÏÔ˘, ∂. ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘, Ã. ∫·Ó·Î¿-Gantenbein, ∆. ∞ÏÈÊÈÂÚ¿ÎË, ª. ∫Ô˘ÙÛ·Ó¤ÏÏÔ˘-Meyer, £. ∫Ô‚¿Ó˘
321 ∫§π¡π∫√ ∫√Àπ∑
I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889
ISSN 0377-2551
322 NEA ∞¶√ ∆√ ¢π∞¢π∫∆À√
Pediatr July-Aug 05 new
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Paediatriki Volume 68 ñ Number 4 ñ July-August 2005 Bimonthly Publication of the Greek Paediatric Society President A. Constantopoulos Editorial Board Editor C. Stefanidis Members P. Avgoustidou-Savvopoulou H. Antonopoulou A. Vazeou-Gerasimidi G. Varlamis M. Kanariou ∂. Katsarou-Pectasides A. Kattamis Ch. Costalos N. Papadopoulos ∞. Papadopoulou A. Siamopoulou-Mavridou M. Tsolia-Pasparaki
Contents AWARD-WINNING ARTICLE
CASE REPORTS
256 High frequency of Y chromosome deletions in patients with sex chromosome mosaicism: a putative mechanism of sex chromosome aneuploides C. G. Hadjiathanasiou, N. Skordis, C. Sismani, L. Kousoulidou, G. Koumbaris, C. Eftychi, G. Stavrides, A. Ioulianos, S. Kitsiou-Tzeli, A. Gala-Voumvouraki, Z. Kosmaidou, A. Konstantopoulos, P. C. Patsalis
295 Multiple brain abscesses caused by Listeria monocytogenes in a 12 year-old boy suffering from nephrotic syndrome. A case report S. Delicou, F. Haliotis, K. Karavanaki, P. Prodromou, S. Avlonitis
REVIEW ARTICLES
PRACTICAL ISSUE
267 Photosensitivity, television and epilepsy N. Diamantopoulos
307 Cardiac dangers in paediatric practice S. Antoniadis
278 Biochemical markers of bone metabolism in childhood E. Siomou, A. Challa
ROUND TABLE
300 Congenital coloboma of the iris-choroid: case report and literature review K. Monti, N. Manios
Manuscript Editing Greek Editing I. Karavranou English Editing S. Nakou Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 3 Artemidos str. GR - 151 25, Maroussi Tel.: +30 210 87 78 810 Fax: +30 210 87 78 822 Owner Greek Paediatric Society© 92 Michalakopoulou str. GR - 115 28, Athens Tel.: +30 210 7771 140 +30 210 7771 663 Fax: +30 210 7758 354 e-mail: hps@ath.forthnet.gr Annual Subscription All foreign countries: US $ 50
288 Evaluation of biochemical markers of bone metabolism in various disorders of childhood A. Challa, E. Siomou, M. Tzoufi, D. Lapatsanis, V. Cholevas, A. Moulas, N. Chaliasos, A. Siamopoulou-Mavridou
320 The adolescent with a chronic medical problem and his family M. Liakopoulou, E. Platokouki-Komitopoulou, C. Kanaka-Gantenbein, T. Alifieraki, M. Koutsanelou-Meyer, T. Kovanis
321 CLINICAL QUIZ
322 NEWS FROM THE INTERNET
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√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜). 2. ∞Ó·ÛÎÔ‹ÛÂȘ. 3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜. 4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜. 5. ∫ÏÈÓÈο ∫Ô˘›˙. 6. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ. 7. ∂›Î·ÈÚ· ı¤Ì·Ù·. 8. £¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜. 9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. 10. ™‡ÓÙÔÌ· Ó¤·. 11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. 12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË. 13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. 14. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋
xi
·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.
µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È Ù˘ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (21x29,7 cm), Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ. 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·: ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.
™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ. ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋. ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤ·/ˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙÔ˘˜. ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.
¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ñ ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™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˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.
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K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.
K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË, 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˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜.
Editors/ Uniform Requirements for Manuscripts Sub-mitted to Biomedical Journals, (http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)]. ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.
T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279. Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679.
™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.
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 ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf
™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜, ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó:
¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562. Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701. Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [Letter]. Arch Dis Child 1996;75:355-356. II. µπµ§π∞ ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742.
™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.
ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. ñ ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.
¢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 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.
H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal
¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.
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Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002. IV. ™∆O ¢π∞¢π∫∆ÀO ÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi: Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm
ªÔÓÔÁÚ·Ê›·: Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html
¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô Î·È ‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (15,5 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜ Î·È ı· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.
πÛÙÔÛÂÏ›‰Â˜: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/
°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰ÈÛΤٷ ‹ CD, ηıÒ˜ Î·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ 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. T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó·
¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó· Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜. 2. ¢ÈÛΤٷ ‹ CD Ì fiÏÔ ÙÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ (ΛÌÂÓÔ, ›Ó·Î˜, ÂÈÎfiÓ˜). 3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜. 4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·.Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚.fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰.fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢). 9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó. 11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó. 12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
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A cal cm cm2 cm3 o C g h IU kg l m mg min mm mol n NS ‹ ª™ osm p SD SE sec U
angstrom ıÂÚÌ›‰· ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢‚ÈÎfi ÂηÙÔÛÙfi ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ ÁÚ·ÌÌ¿ÚÈÔ ÒÚ· ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ¯ÈÏÈfiÁÚ·ÌÌÔ Ï›ÙÚÔ Ì¤ÙÚÔ ¯ÈÏÈfiÁÚ·ÌÌÔ ÏÂÙfi ¯ÈÏÈÔÛÙfiÌÂÙÚÔ ÁÚ·ÌÌÔÌfiÚÈÔ ·ÚÈıÌfi˜ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Èı·ÓfiÙËÙ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ‰Â˘ÙÂÚfiÏÂÙÔ ÌÔÓ¿‰·
™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12
tera- (10 ) giga- (109) mega- (106) kilo- (103) hector- (102) deca- (101) deci- (10-1) centi- (10-2) milli- (10-3) micro- (10-6) nano- (10-9) pico- (10-12) femto- (10-15) atto- (10-18)
ABBREVIATIONS
Combining prefixes T G M k h da d c m Ì n p f a
angstrom calorie centimeter square centimeter cubic centimeter degree Celsius gram hour international unit kilogram liter meter milligram minute millimeter mole number not significant osmole probability standard deviation standard error second unit
r
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INSTRUCTIONS TO AUTHORS A. General Information The Greek Paediatric Society is the owner of “Paediatriki”, its official scientific journal, which is distributed to its members. Its objectives are the publication of paediatric scientific work and the continuing education of paediatricians. For this purpose, it publishes a variety of articles, and in particular: 1. Editorials (upon invitation by the Editorial Board). 2. Review articles. 3. Award-winning articles. 4. Original articles. 5. Clinical Quiz. 6. Round tables. 7. Current issues. 8. Issues of healthcare management and education. 9. Case reports. 10. News. 11. Brief reports. 12. Letters to the editor. 13. Abstracts. 14. Future congresses and events. 15. Book reviews. The Editorial Board reserves the right to publish articles of special scientific interest and articles on current issues without observing submission order. In addition it publishes upon decision original papers presented at the Annual Paediatric Conference, presentations of special interest - in whole or in part, and letters - in whole or in part - referring to scientific articles published in the journal. Regarding papers on current issues, the author’s request for immediate publication should be quoted on the first page. The Editorial Board reserves the right to accept such papers for immediate publication. All manuscripts should not have been published previously, in whole or in part, and not be under consideration by another publication. Manuscripts should acknowledge any funding, sponsorship or other financial support. All clinical research should have been conducted following informed consent of participants or of their legal representatives according to the Declarations of Helsinki and Tokyo. In addition, the US National Institute of Health guide for the care and use of laboratory animals (DHEW Publication, NIH, 80-23) should have been observed. Clinical trials should have been approved by the Ethics Committee of the Hospital. Authors’ opinions and conclusions expressed in the published papers do not necessarily reflect those of the journal. The Greek Paediatric Society, the Editorial Board and the Publisher of the journal do not necessarily approve the content of the advertisements appearing in the journal. The copyright of all published papers is held by “Paediatriki” and their reproduction in whole or in part is authorized only following written consent of the journal.
B. Manuscript Preparation “Paediatriki” suggests compliance with the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”, recently modified and published on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf The entire paper (including figure legends and tables)
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should be typed on one side of blank paper format A4 (21x29.7 cm), double line spacing and minimum indent 2.5 cm on both sides. The paper should have the following structure: title page, short title, abstract in Greek and English, list of abbreviations, text, acknowledgements and quoting of grants, sponsorships or other financial support sources, references, tables, figures, figure legends. Each of these sections should be started on a new page. Pages should be numbered consecutively, beginning with the title page. Text length shall be: ñ review articles 2000-3000 words; ñ original articles and case reports 1500-2500 words; ñ brief reports1000-1500 words; ñ letters 250-500 words. The title page should include: ñ the title (<14 words) and the short title (<5 words) of the article. No abbreviations are permitted in the title; ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of the paper. If there is no affiliation with a specific centre, the status of the author(s) should be cited (e.g., private paediatrician) and home address; ñ the complete address, e-mail and telephone number of the author to whom correspondence should be addressed. Abstracts The abstract should summarize the objectives, methodology, main results and conclusions of the study. ñ It should contain at least 200 words, and not exceed 250 words. ñ It should consist of the following paragraphs: background, methods, results and conclusions. The English abstract should cite at the beginning the title of the paper and the authors’ names in English. The content of the text should consist of the following paragraphs: background, methods, results and conclusions. The abstract in English should not differ in content from the corresponding Greek abstract. Beneath the Greek and English abstracts, three to five key words in the respective language should be supplied, to be used in the thematic index. Text Original articles include: introduction, methods, results and discussion. The introduction includes the latest research data on the subject and the main references and the objectives of the paper. The description of the methods should be precise and detailed so as to enable reproduction by other researchers. In addition, the statistical methods of analysis and evaluation of the results should be described. Results should be presented clearly, together with the appropriate statistical analysis. Discussion should cover the results ensuing from the research, their significance and possible associations with the observations of other researchers. Case reports comprise a short introduction, case description and brief discussion, with emphasis on differential diagnosis. The structure of all other articles is free, according to the judgment of the authors. Thanks or acknowledgements (reference to grants, sponsorships or other sources of financial support) should be quoted at the end of the text, before references.
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Units of measures of laboratory analyses Laboratory analyses should be expressed in the Système International (SI) units and in the metric (Conventional) system in parentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf
II. BOOKS Chapter in book: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742.
Abbreviations All issues of the journal contain internationally established abbreviations. Complex or long terms often repeated in the text may be replaced by abbreviations explained by the authors in a list submitted with the paper. Abbreviations are reported in parentheses only in abstracts.
Book or monograph: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.
References The reference section contains all references numbered in the order in which they appear in the text. In the text, references are to be indicated by Arabic numerals in parentheses. References should be no more than: ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters. In listing references follow the recently modified standards of the International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Abbreviated names of journals should conform to the Cumulated Index Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)]. Examples of reference style I. JOURNALS All authors are cited if they are six or less; if they are 7 or more, the first six are cited, followed by “et al”.
Regular edition: Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. Supplement issue: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. No author: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. Article type specification: Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562. Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701. Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [Letter]. Arch Dis Child 1996;75:355-356.
Publication in a volume of proceedings: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500. Doctoral dissertation: Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002. IV. ON THE INTERNET Article in journal Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm
Monograph Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html Websites Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/ Tables and Figures Three copies should be submitted (original plus 2 copies). Their width should either be equal to the width of one column (7.5 cm) or to the width of the page (15.5 cm). Their maximum length, titles included, should not exceed 22 cm. Tables are numbered with Arabic numerals in the order in which they appear in the text. They should have a short title and abbreviations should be listed at the bottom. Vertical lines in tables should be avoided. All illustration material is considered as figures (graphs, pictures, etc.). They should be of excellent quality. Also, at the back of every picture, the number of the picture and the name of the first author should be noted in pencil, with an arrow showing the top of the picture. The identity of patients should not be recognizable from their pictures nor should their names be stated.
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C. Manuscript Submission and Publication All manuscripts should be accompanied by a floppy disk or CD, as well as by a letter, signed by all the authors, in which it is stated that the paper has not been published in part or in whole, or is not under consideration by another journal and that the authors accept its publication in “Paediatriki”. Any funding, sponsorship or other financial support should be acknowledged. Once the manuscript has been accepted, the corrected version, rewritten according to the reviewers’ recommendations should be submitted to the Editorial Board accompanied by a floppy disk or CD, containing the paper in Word format, along with a covering letter specifying in detail the modifications or objections to the reviewers’ suggestions. Delay in submission of the modified paper exceeding 30 days entails new submission. Authors will be charged film and reprint expenses, paid upon dispatch of the first proof directly to the printer. Manuscripts of papers which have not been approved for publication are not returned to the author. The accompanying figures and photographs can be returned upon request within six months. Manuscripts submitted for review and publication in “Paediatriki” should be sent in three copies to the following address: Editorial Board Greek Paediatric Society 92, Michalakopoulou Street 115 28 Athens, Greece
Before submitting your paper, make sure it contains: 1. 3 copies of the text of the paper, printed according to instructions. 2. A floppy disk or CD with the entire material of the paper (text, tables, pictures). 3. A covering letter and a statement that the paper has not been previously published. 4. The title page (on a separate page), which includes: a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and telephone number; 5. English and Greek abstracts, with the following structure: background, methods, results and conclusions (double space, separate page) and keywords. 6. List of abbreviations (double space, separate page). 7. Text (double space, separate page). 8. Acknowledgements and reference to funding, sponsorships or other financial sources. 9. References (double space, separate page). 10. Tables (one per page) in three copies. 11. Figures with an arrow at the back showing the top, numbered, in two copies. 12. Figure titles (double space - on separate pages) in three copies.
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µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞
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∂ÏÏ›ÌÌ·Ù· ÙÔ˘ À ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Û ·È‰È¿ ÌÂ Ê˘ÏÂÙÈÎfi ̈۷˚ÎÈÛÌfi: Èı·Ófi˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡ Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘1, ¡. ™ÎÔÚ‰‹˜2, ∫. ™ÈÛÌ¿ÓË3, §. ∫Ô˘ÛÔ˘Ï›‰Ô˘3, °. ∫Ô˘Ì·Ú‹˜3, Ã. ∂˘Ù‡¯Ë3, °. ™Ù·˘Ú›‰Ë˜3, ∞. πÔ˘ÏÈ·Ófi˜3, ™. ∫›ÙÛÈÔ˘ - ∆˙¤ÏË4, ∞. °·ÏÏ¿ - µÔ˘Ì‚Ô˘Ú¿ÎË5, ∑. ∫ÔÛÌ·˝‰Ô˘6, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜5, º. ∫. ¶·ÙÛ·Ï‹˜3
¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: OÈ ‰È¿ÊÔÚ˜ ·Ó·Î·Ù·Ù¿ÍÂȘ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Û˘Óԉ‡ÔÓÙ·È Û˘¯Ó¿ ·fi ÙËÓ ·ÚÔ˘Û›· Ì›·˜ ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ 45,Ã. ™˘¯Ófi Ê·ÈÓfiÌÂÓÔ ·ÔÙÂÏ› Ô ÌˆÛ·˚ÎÈÛÌfi˜, Ì ̛· ÚfiÛıÂÙË Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÌ·ÏÔ ¯ÚˆÌfiۈ̷ À, Ô ÔÔ›Ô˜ Û˘Óԉ‡ÂÙ·È ·fi ¤Ó· ¢ڇ Ê¿ÛÌ· Ê·ÈÓÔÙ‡ˆÓ, Ô˘ ÔÈΛÏÏÔ˘Ó ·fi Ê·ÈÓfiÙ˘Ô ı‹ÏÂÔ˜ Ì ۇӉÚÔÌÔ Turner Û ·ÙÂÏÒ˜ ·ÚÚÂÓÔÔÈË̤ӷ ¿ÚÚÂÓ· Ì ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÚÚÂÓ· ¿ÙÔÌ· Ì ·˙ˆÔÛÂÚÌ›·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÌÂÏÂÙËı› Ë ‡·ÚÍË ÌÈÎÚÔÂÏÏÂÈÌÌ¿ÙˆÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Û ·È‰È¿ Ì 45,à ̈۷˚ÎÈÛÌfi Î·È Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙËÓ ·ÛÙ¿ıÂÈ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Î·È ÙÔÓ Ê·ÈÓfiÙ˘Ô. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 17 ·ÛıÂÓ›˜ Ì ̈۷˚ÎÈÛÌfi, Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ̛· ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ 45,Ã Î·È Ì›· ‰Â‡ÙÂÚË ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ıÔÏÔÁÈÎfi ¯ÚˆÌfiۈ̷ À. ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ STS ‰Â›ÎÙ˜ ÁÈ· ÙÔ ¯ÚˆÌfiۈ̷ À Î·È Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ÊıÔÚ›˙ÔÓÙÔ˜ › ÙfiÔ˘ ˘‚ÚȉÈÛÌÔ‡ (FISH). ∞ÔÙÂϤÛÌ·Ù·: ∂› Û˘ÓfiÏÔ˘ 17 ·ÛıÂÓÒÓ, ÔÈ 8 (47%) ·ÚÔ˘Û›·˙·Ó ÂӉȿÌÂÛ· ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, Ô˘ ÂÎÙ›ÓÔÓÙ·Ó ·fi ÙÔ ‰È¿ÎÂÓÔ 5C ̤¯ÚÈ ÙÔ ‰È¿ÎÂÓÔ 7, ÌÂ Û˘¯ÓfiÙÂÚË ·¿ÏÂÈ„Ë Ù˘ ÂÚÈÔ¯‹˜ 6F, Ë ÔÔ›· ÂÈηχÙÂÈ ÙË ˙ÒÓË AZF (AZoospermic Factor region). ∏ „¢‰Ô-·˘ÙÔۈ̷ÙÈ΋ ÂÚÈÔ¯‹ 2 (PAR2) ‰ÂÓ Â›¯Â ··ÏÂÈÊı› ÛÂ Î·Ó¤Ó·Ó ·ÛıÂÓ‹. ∆Ô Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ Î·È Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ‹ ¯ˆÚ›˜ ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À.
* ∞’ ÈڤÌÂÈÔ Œ·ıÏÔ 42Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2004 1 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁÈ΋ ªÔÓ¿‰·, ª·Î¿ÚÈÔ ¡ÔÛÔÎÔÌ›Ô, §Â˘ÎˆÛ›·, ∫‡ÚÔ˜ 3 ∆Ì‹Ì· ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ¡Â˘ÚÔÏÔÁ›·˜ Î·È °ÂÓÂÙÈ΋˜, §Â˘ÎˆÛ›·, ∫‡ÚÔ˜ 4 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 5 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 6 ∆Ì‹Ì· °ÂÓÂÙÈ΋˜, ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: º›ÏÈÔ˜ ∫. ¶·ÙÛ·Ï‹˜ ∆Ì‹Ì· ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ¡Â˘ÚÔÏÔÁ›·˜ Î·È °ÂÓÂÙÈ΋˜ ∫‡ÚÔ˘ ∆.∫. 234 62, 1683 §Â˘ÎˆÛ›·, ∫‡ÚÔ˜ E-mail: patsalis@cing.ac.cy
™˘ÌÂÚ¿ÛÌ·Ù·: ¢È·ÈÛÙÒıËΠÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂȉÈÎÒÓ Àq ÂӉȿÌÂÛˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ Î·È Ù˘ ·ÛÙ¿ıÂÈ·˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ˘Ô‰ËÏÒÓÔÓÙ·˜ ÙËÓ Èı·Ó‹ ·ıÔÁÂÓÂÙÈ΋ Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙËÓ ·Ó¿Ù˘ÍË Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡. ∂ÓÙÔ‡ÙÔȘ, Ë ·ÚÔ˘Û›· ÙˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ ·˘ÙÒÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ, ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ‹ Ù· ȉȷ›ÙÂÚ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ì 45,à ̈۷˚ÎÈÛÌfi.
§¤ÍÂȘ ÎÏÂȉȿ º˘ÏÂÙÈÎfi˜ ̈۷˚ÎÈÛÌfi˜, À ¯ÚˆÌfiۈ̷, AZF, PAR2.
∂ÈÛ·ÁˆÁ‹ ∆Ô ¯ÚˆÌfiۈ̷ À ÂÚȤ¯ÂÈ ÁÔÓ›‰È· ··Ú·›ÙËÙ· ÁÈ· ÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÔÓ¿‰ˆÓ ÙÔ˘ ¿ÚÚÂÓÔ˜ (1-3). ∞ӈ̷ϛ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Û ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi ‹ ÌÔÚÈ·Îfi Â›Â‰Ô Û˘Óԉ‡ÔÓÙ·È Î·Ù¿ ηÓfiÓ·
·fi Û˘ÁÎÂÎÚÈ̤ÓÔ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô. ∂› ·Ú·‰Â›ÁÌ·ÙÈ, Ë ·ÒÏÂÈ· ·ÏÏËÏÔ˘¯ÈÒÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ¿ÚÚÂÓ· ¿ÙÔÌ· Ì ·˙ˆÔÛÂÚÌ›· ‹ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÔÏÈÁÔÛÂÚÌ›· Î·È ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÙÔÓ Î·ıÔÚÈÛÌfi Ì›·˜ ÂÚÈÔ¯‹˜ ·˙ˆÔÛÂÚÌÈÎÔ‡ ·Ú¿ÁÔÓÙ· (AZoospermic Factor region - ∞ZF) (4,5). ∏ ¶·È‰È·ÙÚÈ΋ 2005;68:245-255
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Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.
ÂÚÈÔ¯‹ ·˘Ù‹ ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÛÙÔ Àq11.22-23 (6) Î·È ··ÚÙ›˙ÂÙ·È ·fi ÙÚÂȘ ˘ÔÂÚÈÔ¯¤˜: AZFa, AZFb Î·È AZFc. (5,7). ∂ÈϤÔÓ, ÂÚ›Ô˘ 10-12% ÙˆÓ Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ·Ó‰ÚÒÓ Ì ȉÈÔ·ı‹ ÛÙÂÈÚfiÙËÙ· Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈο ·Ô‰Â‰ÂÈÁ̤ÓÔ Ê˘ÛÈÔÏÔÁÈÎfi ¯ÚˆÌfiۈ̷ À Â›Ó·È ÊÔÚ›˜ ÌÈÎÚÔÂÏÏÂÈÌÌ¿ÙˆÓ Ù˘ ÂÚÈÔ¯‹˜ AZF (8). ªÂÁ·Ï‡ÙÂÚ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ÂÌÊ·Ó›˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈο, ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÂÏÏ›ÌÌ·Ù·, ÌÂÙ·ÙÔ›ÛÂȘ, ‰·ÎÙ˘ÏÈÔÂȉ‹ ¯ÚˆÌÔÛÒÌ·Ù·, ÈÛÔ¯ÚˆÌÔÛÒÌ·Ù· Î·È ÈÛÔ‰ÈÎÂÓÙÚÈο À ¯ÚˆÌÔÛÒÌ·Ù·. ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ˘fi ÌÔÚÊ‹Ó ÌˆÛ·˚ÎÔ‡, Ì ̛· ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ 45,à (9-12). ∞˘Ù¤˜ ÔÈ ÌÔÚʤ˜ Ê˘ÏÂÙÈÎÔ‡ ̈۷˚ÎÈÛÌÔ‡ Â›Ó·È Û¯ÂÙÈο Û˘¯Ó¤˜ Î·È Û˘Ó‰˘¿˙ÔÓÙ·È Ì ¢ڇ Ê¿ÛÌ· Ê·ÈÓÔÙ‡ˆÓ. ∆Ô Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ Î·È Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ·ÙfiÌˆÓ ·˘ÙÒÓ ÂÎÙ›ÓÔÓÙ·È ·fi ı‹Ï· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Turner Û ˘ÔÁfiÓÈÌ· ¿ÚÚÂÓ· ¿ÙÔÌ· Ì ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÚÚÂÓ· ¿ÙÔÌ· Ì ·˙ˆÔÛÂÚÌ›·. OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ÁÔÓ·‰ÈΤ˜ ·ÓˆÌ·Ï›Â˜ (ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘-
ÛÁÂÓÂÛ›·, Ù·ÈÓÈÔÂȉ›˜ ÁÔÓ¿‰Â˜), ·ÙÂÏ‹ ·ÚÚÂÓÔÔ›ËÛË (˘ÔÛ·‰›·˜, ÎÚ˘„ÔÚ¯›·) ‹/Î·È ÂÌÊ·Ó›˙Ô˘Ó Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Turner (¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ηډÈÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î.¿.) (13,14). ∫·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÁÈ· ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ Î·È ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Û ·˘ÙÔ‡˜ ÙÔ˘˜ ηڢÔÙ‡Ô˘˜ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÙÔ ÔÛÔÛÙfi Î·È Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÛÙ· ·ÙÙ·Ú· ΢ڛˆ˜ ÙˆÓ ÁÔÓ¿‰ˆÓ Î·È fi¯È ÛÙ· ÂÚÈÊÂÚÈο ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· (15,16). ∂¿Ó Ë Î˘Ú›·Ú¯Ë ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Â›Ó·È 45,Ã, Ô Ê·ÈÓfiÙ˘Ô˜ Â›Ó·È ·˘Ùfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Turner, ÂÓÒ fiÙ·Ó Ë Î˘Ú›·Ú¯Ë ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Â›Ó·È 46,ÃÀ, Ô Ê·ÈÓfiÙ˘Ô˜ Â›Ó·È ¿ÚÚÂÓÔ˜, ÛÙËÓ ÂÚ›ÙˆÛË ‰Â fiÔ˘ Î·È ÔÈ ‰‡Ô ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ·ÓÙÈÚÔۈ‡ÔÓÙ·È ÛÙȘ ÁÔÓ¿‰Â˜, ÙÔ ·ÔÙ¤ÏÂÛÌ· Â›Ó·È ·˘Ùfi Ù˘ ÌÈÎÙ‹˜ ÁÔÓ·‰È΋˜ ‰˘ÛÁÂÓÂÛ›·˜ (15,17-19). ∂›Ó·È ÁÂÓÈο ·Ú·‰ÂÎÙfi fiÙÈ Û ÂÚÈÙÒÛÂȘ ¯ÚˆÌÔÛˆÌÈ΋˜ ‰ÔÌ‹˜ 45,Ã Î·È ÌˆÛ·˚ÎÈÛÌÔ‡ Ì ¤Ó· ‰ÔÌÈο ·ÓÒÌ·ÏÔ ¯ÚˆÌfiۈ̷ À, ÙfiÛÔ Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË fiÛÔ Î·È ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ Î·ıÔÚ›˙ÔÓÙ·È ·fi ÙËÓ ··ÏÔÈÊ‹ ‹ fi¯È ÙÔ˘ ÁÔÓȉ›Ô˘ SRY ‹ ¿ÏÏˆÓ ÁÔÓȉ›ˆÓ ÛÙÔ ¯ÚˆÌfiۈ̷ À. º·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ¤Ó· ÎÚ›ÛÈÌÔ fiÚÈÔ
¶›Ó·Î·˜ 1. ∫·Ú˘fiÙ˘Ô˜*, ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È È‰È·›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Ì 45,à ̈۷˚ÎÈÛÌfi Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ∞ÛıÂÓ‹˜
∫·Ú˘fiÙ˘Ô˜
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13
45,Ã[50]/46,ÃÀ[50] 45,Ã[70]/46,X,idic(Y)[20]/ 47,X,idic(Y),+idic(Y)[10] 45,Ã[93]/46,X,der(Y)[7] 45,Ã[1]/46,X,idic(Y)[99] 45,Ã[15]/46,X,idic(Y)[85] 45,Ã[91]/46,X,idic(Y)[6]/ 47,X,idic(Y),+idic(Y)[3] 45,Ã[45]/46,X,der(Y)[55] 45,Ã[10]/46,X,idic(Y)[90] 45,Ã[85]/46,X,der(Y)[15] 45,Ã[60]/46,X,idic(Y)[40] 45,Ã[50]/46,XY[50] 45,Ã[70]/46,X,idic(Y)[15]/ 46,X,del(Yq)[15] 45,Ã[45]/46,XY,[55]
14 15
÷ÌËÏfi ¶ÙÂÚ‡ÁÈÔ Ã·ÌËÏ‹ ·Ó¿ÛÙËÌ· ·˘¯¤Ó· ÚfiÛÊ˘ÛË ÎÒÌ˘
µÚ·¯‡˜ ∞ӈ̷ϛ˜ ¢˘ÛϷۛ˜ ·˘¯¤Ó·˜ ÒÙˆÓ ÔÓ‡¯ˆÓ
+ +
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+ +
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-
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+ + +/-
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+ ++ ++ + +
+/+ +/+/-
+ + + +
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+ -
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45,Ã[20]/46,XY[80]
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45,Ã[40]/46,X,der(47)[3]/ 46,X,r(Y)[13] 45,Ã[20]/46,XY[80]
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45,Ã[80]/46,XY[20]
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* Ÿˆ˜ ÔÚÈÛÙÈÎÔÔÈ‹ıËΠ̠ÙË Ì¤ıÔ‰Ô FISH OÈ ‰‡Ô ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ‰È·¯ˆÚ›˙ÔÓÙ·È Ì ̛· οıÂÙË ÁÚ·ÌÌ‹ [ ]: µ·ıÌfi˜ ̈۷˚ÎÈÛÌÔ‡ SO: Ù·ÈÓÈÔÂȉ›˜ ÁÔÓ¿‰Â˜, LT-T: (·Ú.) fiگȘ, RT-T: (‰.) fiگȘ, TS: Û‡Ó‰ÚÔÌÔTurner, MGD: ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›·, A: ·˙ˆÔÛÂÚÌ›·; F: ı‹Ï˘, M1: ¿ÚÚÂÓ Ì ÎÚ˘„ÔÚ¯›·, ˘ÔÛ·‰›·, M2: Ê˘ÛÈÔÏÔÁÈÎfi ¤Ô˜
¶·È‰È·ÙÚÈ΋ 2005;68:245-255
O›‰ËÌ· ¿ÎÚˆÓ
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¶·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡
ÛÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ SRY ÛÙȘ ÁÂÓÓËÙÈΤ˜ Ù·Èӛ˜, οو ·fi ÙÔ ÔÔ›Ô ‰ÂÓ Î·ı›ÛÙ·Ù·È ‰˘Ó·Ù‹ Ë ·Ó¿Ù˘ÍË ÙÔ˘ ¿ÚÚÂÓÔ˜ Ê·ÈÓÔÙ‡Ô˘. ∂ÎÙfi˜ ÙÔ˘ ÁÔÓȉ›Ô˘ SRY, fï˜, ÂÏ¿¯ÈÛÙ· Â›Ó·È ÁÓˆÛÙ¿ ÁÈ· ÙË ÛËÌ·Û›· Ù˘ ·ÚÔ˘Û›·˜ ¿ÏÏˆÓ ÁÔÓȉ›ˆÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ¿ÚÚÂÓÔ˜ Ê·ÈÓÔÙ‡Ô˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Î·Ú˘fiÙ˘ÔÈ Ô˘ ÂÌÂÚȤ¯Ô˘Ó ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ·ÊÔÚÔ‡Ó Û ̈۷˚ÎÈÛÌfi Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ 45,à (9,11). ¶ÚfiÛÊ·Ù·, Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ 45,à ̈۷˚ÎÈÛÌÔ‡ ¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À (20-24). ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂȯÂÈÚ› Ó· Ù·˘ÙÔÔÈ‹ÛÂÈ Ù· ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Û ·ÛıÂÓ›˜ Ì 45,à ̈۷˚ÎÈÛÌfi Î·È Ó· ‰ÈÂÚ¢ӋÛÂÈ ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙË Ê·ÈÓÔÙ˘È΋ ÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·˘ÙÒÓ. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ÌÂÏÂÙ‹ıËÎÂ, Ì ÙË Ì¤ıÔ‰Ô STS (Sequence tagged sites) ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜, ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ηÏÒ˜ ÂÏÂÁÌ¤ÓˆÓ ÎÏÈÓÈο ·ÛıÂÓÒÓ Ì 45,à ̈۷˚ÎÈÛÌfi Î·È Ì›· ‰Â‡ÙÂÚË Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Ì ¤Ó· ¯ÚˆÌfiۈ̷ À.
ªÂ ÙËÓ ÂÎÙÂٷ̤ÓË ·˘Ù‹ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ‰ÈÂÚÂ˘Ó¿Ù·È ·ÊÂÓfi˜ Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÚÈÔ¯ÒÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Ô˘ ··Ï›ÊıËÎ·Ó Ì ÙÔÓ Ê˘ÏÂÙÈÎfi ̈۷˚ÎÈÛÌfi ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘, ·ÊÂÙ¤ÚÔ˘ Ë ÛËÌ·Û›· ÙÔ˘˜ ÛÙËÓ ·ÛÙ¿ıÂÈ· ÙÔ˘ ¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ À.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÀÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 17 ·ÛıÂÓ›˜ ·fi ÙËÓ ∂ÏÏ¿‰· Î·È ÙËÓ ∫‡ÚÔ, Ô˘ Û˘Ï¤¯ıËÎ·Ó ·fi ÙÔ 1995-2000. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÌÂÏÂÙ‹ıËÎ·Ó 13 ·È‰È¿ Ì ‰È·ÁÓˆṲ̂ÓÔ Û. Turner Î·È Ê·ÈÓfiÙ˘Ô ı‹ÏÂÔ˜, 2 ·È‰È¿ Ì ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· Î·È ÁÂÓÓËÙÈο fiÚÁ·Ó· ·ÌÊÈ‚fiÏÔ˘ ʇÏÔ˘ Î·È 2 ÂÓ‹ÏÈΘ Ì ÛÙÂÈÚfiÙËÙ· (ÏfiÁˆ ·˙ˆÔÛÂÚÌ›·˜) Î·È Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÙ˘Ô ¿ÚÚÂÓÔ˜. ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ø˜ ÔÌ¿‰· Ê˘ÛÈÔÏÔÁÈÎÒÓ Ì·ÚÙ‡ÚˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 50 ¿Ó‰Ú˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô 46,ÃÀ.
∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË Î·È ·Ó¿Ï˘ÛË ÊıÔÚ›˙ÔÓÙÔ˜ › ÙfiÔ˘ ˘‚ÚȉÈÛÌÔ‡ (Fluorescent in situ hybridization - FISH) ™ÙÔ˘˜ 17 ·ÛıÂÓ›˜, ηıÒ˜ Î·È ÛÙÔ˘˜ 50 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜, Ë Û˘Ì‚·ÙÈ΋ ηڢÔÙ˘È΋ ·Ó¿Ï˘ÛË ˘„ËÏ‹˜
µÏ·ÈÛÔ› ™ÎÔÏ›ˆÛË ∫·Ú‰È·ÁÁÂȷΤ˜ ¡ÂÊÚÈΤ˜ ªÂÏ·Á¯ÚˆÌ·ÙÈÎÔ› ¡ÔËÙÈ΋ ·ÁÎÒÓ˜ ·ÓˆÌ·Ï›Â˜ ·ÓˆÌ·Ï›Â˜ Û›ÏÔÈ ˘ÛÙ¤ÚËÛË
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∫ÏÈÓÈ΋ ‰È¿ÁÓˆÛË
ŒÍˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·
+ +
+
-
+ -
+
+
SO SO
TS TS
F F
+ -
+ -
+ -
+ -
-
+ -
SO SO SO SO
TS TS TS TS
F F F F
+ +/+ +
+/-
-
+ -
+ + + +
-
SO SO SO SO SO SO
TS TS TS TS TS TS
F F F F F F
-
-
-
-
-
-
MGD
M1
-
-
-
-
-
-
MGD
M1
-
-
-
-
-
-
A
M2
-
-
-
-
-
-
A
M2
?
-
-
-
-
-
RT-T (12 ml) LT-SO RT-T LT-SO RT-T (13 ml) LT-T (15 ml) RT-T (13 ml) LT-T (15 ml) SO
TS
F
¶·È‰È·ÙÚÈ΋ 2005;68:245-255
Pediatr July-Aug 05 new
22-07-05
12:16
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Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.
¢ÎÚ›ÓÂÈ·˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠ÂÚÈÊÂÚÈÎfi ·›Ì·, Ì ÙË ¯Ú‹ÛË Î·ıÈÂÚˆÌ¤ÓˆÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ Ù¯ÓÈÎÒÓ. °È· οı ¿ÙÔÌÔ ·Ó·Ï‡ıËÎ·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi 50 ΢ÙÙ·ÚÈΤ˜ ÌÈÙÒÛÂȘ (¶›Ó·Î·˜ 1). ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂȂ‚·Èˆı› Ë ·ÚÔ˘Û›· Î·È Ó· ¯·Ú·ÎÙËÚÈÛÙ› Ë ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ÌÂÏÂÙ‹ıËÎ·Ó ÂÚ·ÈÙ¤Úˆ Î·È ÔÈ 17 ÂÚÈÙÒÛÂȘ Ì ÙË ¯Ú‹ÛË FISH. ∂ȉÈÎÔ› ·ÓȯÓÂ˘Ù¤˜ (probes) ‰ÈÏÔ‡ ¯ÚÒÌ·ÙÔ˜ DXZ1 Î·È DYZ3 ÂȂ‚·›ˆÛ·Ó ÙËÓ ·ÚÔ˘Û›· ÎÂÓÙÚÔÌÂÚȉ›ˆÓ Ã Î·È À, ·ÓÙ›ÛÙÔȯ· (25). °È· ÙË ÌÂÙ·Ê·ÛÈ΋ ·Ó¿Ï˘ÛË ÌÂÏÂÙ‹ıËÎ·Ó Î·Ù’ ÂÏ¿¯ÈÛÙÔ ¤ÓÙ ÌÂÙ·Ê¿ÛÂȘ, Ô˘ ÂÚÈ›¯·Ó ÙÔ ‰ÔÌÈο ·ÓÒÌ·ÏÔ ¯ÚˆÌfiۈ̷. °È· ÙËÓ ·Ó¿Ï˘ÛË FISH ÂӉȿÌÂÛ˘ Ê¿Û˘ Î·È ÛÙ· ÂÚÈÊÂÚÈο ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÛÙÔÓ ÁÔÓ·‰ÈÎfi ÈÛÙfi, ¤ÁÈÓ·Ó 200 ˘ÔÏÔÁÈÛÌÔ› Ì ηϋ˜ ÔÈfiÙËÙ·˜ ÌË ÂÈÎ·Ï˘ÙfiÌÂÓ· ·ÙÙ·Ú·. µ·ÛÈ˙fiÌÂÓÔÈ ÛÙ· Â˘Ú‹Ì·Ù· Ù˘ ·Ó¿Ï˘Û˘ FISH (ÂȂ‚·›ˆÛË Ù˘ ·ÚÔ˘Û›·˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ÈÛÔ‰ÈÎÂÓÙÚÈÎÔ‡ À ‹ ¿ÏÏ˘ ‰ÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À), ÔÈ Î·Ú˘fiÙ˘ÔÈ ÔÚÈÛÙÈÎÔÔÈ‹ıËÎ·Ó Î·È ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.
∞Ó¿Ï˘ÛË DNA °ÂÓÔÌÈÎfi DNA ÂÏ‹ÊıË ·fi 5-10 ml ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ·fi fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÙÔ˘˜ ‰È·ı¤ÛÈÌÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Î·È ÙÔ˘˜ 50 Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ 46,ÃÀ ¿ÚÚÂÓ˜, Ô˘ ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (OπAamp Midi, DNA ∫it QIAGEN). ŸÏ· Ù· ‰Â›ÁÌ·Ù· DNA ·Ó·Ï‡ıËÎ·Ó ÁÈ· ÙËÓ ·ÚÔ˘Û›· ÂȉÈÎÒÓ ·ÏÏËÏÔ˘¯ÈÒÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À (STS) Ì ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (PCR). ŸÏ· Ù· ‰Â›ÁÌ·Ù· ÂϤÁ¯ıËÎ·Ó ÁÈ· 44 Û˘ÓÔÏÈο ÛËÌ›· STS, ηχÙÔÓÙ·˜ fiÏÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À. OÈ Û˘Óı‹Î˜ Ù˘ PCR Î·È ÔÈ ÂÚÈÔ¯¤˜ STS Ô˘ ·Ó·ÁÓˆÚ›ÛÙËηÓ, ÚÔ‹Ïı·Ó ·fi ÙÔ˘˜ ¯¿ÚÙ˜ Vollrath Î·È Û˘Ó Î·È Affara Î·È Û˘Ó (26,27). ∂ÈϤÔÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î·È ÂȉÈÎÔ› ÂÎÎÈÓËÙ¤˜ (primers) ÁÈ· Ó· ÂÏÂÁ¯ı› Ë „¢‰Ô-·˘ÙÔۈ̷ÙÈ΋ ÂÚÈÔ¯‹ ÙÔ˘ ÂÁÁ‡˜ ÔÚ›Ô˘ ÙÔ˘ Ì·ÎÚÔ‡ ÛΤÏÔ˘˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À (PAR2) (28). O ¤Ó·˜ ÂÎÎÈÓËÙ‹˜ ·Ó·ÁÓˆÚ›˙ÂÈ ÂȉÈ΋ ·ÏÏËÏÔ˘¯›· ÂÁÁ‡˜ ÙÔ˘ PAR2, ÂÓÒ Ô ‰Â‡ÙÂÚÔ˜ ·Ó·ÁÓˆÚ›˙ÂÈ ·ÎÔÏÔ˘ı›· ÂÓÙfi˜ ÙÔ˘ PAR2, Ô˘ Â›Ó·È ÎÔÈÓ‹ ÁÈ· Ù· ¯ÚˆÌÔÛÒÌ·Ù· Ã Î·È À. ∞˘ÙÔ› ÔÈ ÂÎÎÈÓËÙ¤˜ ›ӷÈ: YF1: Forward TTCCCCTGCCTCAGCCTCAGCG (ÂȉÈÎfi˜ ÁÈ· Y) ÃYR: Reverse CATCACTCTGGGGACTGTGGTG (ÎÔÈÓfi˜ ÁÈ· X/Y). ∂Âȉ‹ Ô ÂÎÎÈÓËÙ‹˜ YF1 ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ À ÂÙÂÚԯڈ̷ÙÈ΋ ÂÚÈÔ¯‹ Î·È Ô ÂÎÎÈÓËÙ‹˜ XYR ÛÙËÓ ÂÚÈÔ¯‹ À-PAR2, ¤Ó· ÙÌ‹Ì· 419bp ÂÓÈÛ¯‡ÂÙ·È ÌfiÓÔ Û ¿ÚÚÂÓ˜ Ì ÌË ·¿ÏÂÈ„Ë Ù˘ ˙ÒÓ˘ PAR2. °È· οı ·ÓÙ›‰Ú·ÛË PCR, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 100 ng ÁÂÓÔÌÈÎÔ‡ DNA, 20 pmol ÙÔ˘ οı ÂÎÎÈÓËÙ‹ Î·È 1U Taq ÔÏ˘ÌÂÚ¿Û˘ (Qiagen) Û ¤Ó·Ó ÙÂÏÈÎfi fiÁÎÔ 20 Ìl, ÛÙȘ ·ÎfiÏÔ˘ı˜ Û˘Óı‹Î˜: ·) ·ÔÛ‡˙¢ÍË (denaturation) ÛÙÔ˘˜ 94ÔC (2 ÏÂÙ¿) Î·È ‚) 25 ·ÎÏÔÈ ÛÙÔ˘˜ 94ÔC (1 ÏÂÙfi), ÛÙÔ˘˜ 66ÔC (1 ÏÂÙfi) Î·È ÛÙÔ˘˜ 72ÔC (1 ÏÂÙfi). O ¶›Ó·Î·˜ 2 ‰Â›¯ÓÂÈ ÙÔ˘˜ STS Î·È ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ‰ÂÈÎÙÒÓ. ªÂÙ¿ ÙËÓ Ù·˘ÙÔÔ›ËÛË ÂÓfi˜ ¯ÚˆÌÔÛˆÌÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜, Ù· ··ÏÂÈÊı¤ÓÙ· ÛËÌ›· STS ·ÏËı‡ÙËÎ·Ó 3 ÊÔÚ¤˜ ÁÈ· Ó· ÂȂ‚·Èˆı› ÙÔ ·ÔÙ¤ÏÂÛÌ·. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, fiÔ˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ¶·È‰È·ÙÚÈ΋ 2005;68:245-255
ÛÙËÓ ·Ó¿Ï˘ÛË ÂÍ·ÛıÂÓË̤Ó˜ ˙ÒÓ˜, Û¿ÓÈ· ‹ ·Û˘Ó‹ıÈÛÙ· ÂÏÏ›ÌÌ·Ù· ‹ ¿ÏϘ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ, ¤ÁÈÓ Âί‡ÏÈÛË DNA ·fi Ó¤Ô ‰Â›ÁÌ· ·›Ì·ÙÔ˜ Î·È Â·Ó·Ï‹ÊıËÎÂ Ë ·Ó¿Ï˘ÛË PCR ·ÚÎÂÙ¤˜ ÊÔÚ¤˜, ÚÔÛ·ÚÌfi˙ÔÓÙ·˜ ηٿÏÏËÏ· ÙȘ Û˘Óı‹Î˜ ·ÓÙ›‰Ú·Û˘ (.¯. ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙË ıÂÚÌÔÎÚ·Û›·). ŸÏ˜ ÔÈ ·Ó·Ï‡ÛÂȘ PCR ¤ÁÈÓ·Ó ¯ˆÚ›˜ ÚÔÁÂÓ¤ÛÙÂÚË ÁÓÒÛË Ù˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙÔ˘ ·ÛıÂÓ‹. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠıÂÙÈÎfi˜ Î·È ·ÚÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ DNA ·fi Ê˘ÛÈÔÏÔÁÈο ¿ÚÚÂÓ· Î·È ı‹Ï· ¿ÙÔÌ· ·ÓÙ›ÛÙÔȯ·, fiˆ˜ ›Û˘ Î·È ·Ô˘Û›· DNA.
∞ÔÙÂϤÛÌ·Ù· ∫ÏÈÓÈο Â˘Ú‹Ì·Ù· ∏ ÙÂÏÈ΋ ‰È¿ÁÓˆÛË, Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ë Ê‡ÛË ÙˆÓ ÁÔÓ¿‰ˆÓ ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. O Ê·ÈÓfiÙ˘Ô˜ ·ÚÔ˘Û›·˙ ÌÂÁ¿ÏÔ Â‡ÚÔ˜, ·fi ı‹Ï· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Turner, Û ¿ÚÚÂÓ· Ì ·ÙÂÏ‹ ·ÚÚÂÓÔÔ›ËÛË Î·È ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÚÚÂÓ· Ì ·˙ˆÔÛÂÚÌ›·. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Turner, ÂÎÙfi˜ ·fi ¤Ó·Ó, ›¯·Ó ¯·ÌËÏfi ·Ó¿ÛÙËÌ·. ∏ ÏÂÈÔ„ËÊ›· ·ÚÔ˘Û›·˙ ‚Ú·¯‡ ·˘¯¤Ó· ‹ ÙÂÚ‡ÁÈÔ, Ì ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÎÒÌ˘. ∞ӈ̷ϛ˜ ÙˆÓ ÒÙˆÓ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÔÛÔÛÙfi 46% ÙˆÓ ·ÛıÂÓÒÓ, ‚Ï·ÈÛÔ› ·ÁÎÒÓ˜ ÛÙÔ 53% Î·È ÌÂÏ·Á¯ÚˆÌ·ÙÈÎÔ› Û›ÏÔÈ ÛÙÔ 38%. ∆ÚÂȘ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó ÓÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ÂÙ·ÏÔÂȉ‹ ÓÂÊÚfi, ÂÙÂÚfiÏ¢ÚÔ ÏÂÈÔ΢ÛÙÈÎfi ÓÂÊÚfi Î·È ÂÙÂÚfiÏ¢ÚÔ ‰ÈÏfi ÓÂÊÚfi. ªfiÓÔ ¤Ó·˜ ·ÛıÂÓ‹˜ (¡Ô 3, ¶›Ó·Î·˜ 1) ·ÚÔ˘Û›·˙ ηډȷÁÁÂȷ΋ Û˘ÁÁÂÓ‹ ·ÓˆÌ·Ï›· (ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·). ŸÏ· Ù· ·È‰È¿ Ì ۇӉÚÔÌÔ Turner ›¯·Ó Ù·ÈÓÈÔÂȉ›˜ ÁÔÓ¿‰Â˜. ∆· ‰‡Ô ·È‰È¿ Ì ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· ÂÌÊ¿ÓÈ˙·Ó ÁÂÓÓËÙÈο fiÚÁ·Ó· ·ÌÊÈ‚fiÏÔ˘ ʇÏÔ˘, Ì ÌÈÎÚfi ¤Ô˜, ÔÛ¯ÂÔÂ˚Îfi ˘ÔÛ·‰›·, ‰Èۯȉ¤˜ fiÛ¯ÂÔ, ÂÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘. ™Â ·˘Ù¿ Ù· ‰‡Ô ·È‰È¿ Ë ÁÔÓ·‰È΋ ‚ÈÔ„›· ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· Ê˘ÛÈÔÏÔÁÈÎÒÓ fiÚ¯ÂˆÓ ÛÙË Ì›· ÏÂ˘Ú¿ Î·È Ù·ÈÓÈÔÂȉԇ˜ ÁÔÓ¿‰·˜ ÛÙËÓ ¿ÏÏË. O ·ÛıÂÓ‹˜ ¡Ô 13 Â›Ó·È ÙÒÚ· ÂÓ‹ÏÈÎÔ˜ Ì ηϋ ·ÚÚÂÓÔÔ›ËÛË Î·È fiÁÎÔ fiگˆ˜ 12 ml, ÂÓÒ Ô ·ÛıÂÓ‹˜ ¡Ô 14 Â›Ó·È ·ÎfiÌË ÛÙËÓ ÚÔÂÊË‚È΋ ËÏÈΛ·. OÈ ·ÛıÂÓ›˜ ¡Ô 15 Î·È ¡Ô 16 ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ› ÂÓ‹ÏÈÎÔÈ ¿ÚÚÂÓ˜, Ì ÌÂÌÔӈ̤ÓË ·˙ˆÔÛÂÚÌ›·. §ÂÙÔÌÂÚ‹˜ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ¤‰ÂÈÍ ·ıÔÏÔÁÈο ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, Ë ‰Â ·ÚÚÂÓÔÔ›ËÛË ‹Ù·Ó ηϋ, Ì fiÁÎÔ fiÚ¯ÂˆÓ 13-15 ml.
Pediatr July-Aug 05 new
22-07-05
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¶·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡
∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË Î·È ·Ó¿Ï˘ÛË FISH ∏ ·ÚÔ˘Û›· ÂÓfi˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‹ ·ÓÒÌ·ÏÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÛÙÔÓ Î·Ú˘fiÙ˘Ô ‚·Û›˙ÂÙ·È ÛÙËÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ (High resolution cytogenetic analysis) Î·È ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ·Ó¿Ï˘ÛË ‰ÈÏÔ‡ ¯ÚˆÌ·ÙÈÛÌÔ‡ FISH, Ì ÙË ¯Ú‹ÛË ÙˆÓ ÂȉÈÎÒÓ ÎÂÓÙÚÔÌÂÚÈÎÒÓ ·ÓȯÓ¢ÙÒÓ, ÙfiÛÔ ÁÈ· ÙÔ ¯ÚˆÌfiۈ̷ à (DXZ1) fiÛÔ Î·È ÁÈ· ÙÔ ¯ÚˆÌfiۈ̷ À (DYZ3). ∏ ÙÂÏÈ΋ ·Ó·ıˆÚË̤ÓË Î·Ú˘ÔÙ˘È΋ ·Ó¿Ï˘ÛË Î·È Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. OÈ ‰‡Ô ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ‰È·¯ˆÚ›˙ÔÓÙ·È Ì ̛· οıÂÙË ÁÚ·ÌÌ‹ Î·È Ô ‚·ıÌfi˜ ̈۷˚ÎÈÛÌÔ‡ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙȘ ·ÚÂÓı¤ÛÂȘ. ∫·È ÔÈ ‰ÂηÂÙ¿ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ¤Ó·Ó ̈۷˚Îfi ηڢfiÙ˘Ô, Ì ·ÚÔ˘Û›· ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ 45,Ã Î·È Ì›·˜ ¿ÏÏ˘ Ì 46 ¯ÚˆÌÔÛÒÌ·Ù· Ì ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ¯ÚˆÌfiۈ̷ Ã Î·È ¤Ó· ΢ÙÙ·ÚÔÁÂÓÂÙÈο Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÌ·ÏÔ ¯ÚˆÌfiۈ̷ À. ∆Ô ÔÛÔÛÙfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì ¯ÚˆÌfiۈ̷ À Î˘Ì·ÈÓfiÙ·Ó ·fi 7% ¤ˆ˜ 95%. ∏ ·Ó¿Ï˘ÛË FISH ÂȂ‚·›ˆÛ ÙËÓ ·ÚÔ˘Û›· ÎÂÓÙÚÔÌÂÚȉ›Ô˘ À Î·È Î·ıfiÚÈÛÂ Â¿Ó ÙÔ ¯ÚˆÌfiۈ̷ À Â›Ó·È ÌÔÓÔÎÂÓÙÚÈÎfi ‹ ÈÛÔ‰ÈÎÂÓÙÚÈÎfi. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ¡Ô 2, 4, 5, 6, 7, 10 Î·È 12, ÙÔ ¯ÚˆÌfiۈ̷ À ÂΉ‹ÏˆÛ ‰‡Ô ÊıÔÚ›˙ÔÓÙ· Û‹Ì·Ù· fiÙ·Ó ˘‚ÚȉÔÔÈ‹ıËΠ̠ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÎÂÓÙÚÔÌÂÚÈÎÔ‡˜ ·ÓȯÓÂ˘Ù¤˜ DYZ3 ηÈ, ηٿ Û˘Ó¤ÂÈ·, ·ӷٷÍÈÓÔÌ‹ıËΠˆ˜ ÈÛÔ‰ÈÎÂÓÙÚÈÎfi, 45,Ã/46,Ã, idic (Y). ∫·È ÛÙÔ˘˜ ‰¤Î· ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜, ÙÔ ¯ÚˆÌfiۈ̷ À ‹Ù·Ó ÌÔÓÔÎÂÓÙÚÈÎfi. ™Â ¤ÍÈ ·fi ·˘ÙÔ‡˜ (¡Ô 1, 11, 13, 14, 16 Î·È 17), ÙÔ ¯ÚˆÌfiۈ̷ À ‹Ù·Ó ÂÌÊ·ÓÒ˜ Ê˘ÛÈÔÏÔÁÈÎfi, ÂÓÒ Û ٤ÛÛÂÚȘ ¤Î‰ËÏ· ·ıÔÏÔÁÈÎfi Î·È ÂÚÈÁÚ¿ÊËΠˆ˜ ·Ú¿ÁˆÁÔ (derivative) ‹ ‰·ÎÙ˘ÏÈÔÂȉ¤˜ ¯ÚˆÌfiۈ̷. ∞Ó¿Ï˘ÛË DNA OÈ ÌÔÚȷΤ˜ ÌÂϤÙ˜ Î·È Ô ‚·ıÌfi˜ ÂÏÏÂÈÌÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ıËΠÛÙÔ Yq ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙË ÌÂϤÙË ·˘Ù‹, Ë PCR Ì ¤Ó·Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi (Û·Ú¿ÓÙ· Ù¤ÛÛÂÚȘ) STS Ô˘ Î¿Ï˘ÙÂ Î·È Ù· ÂÙ¿ ‰È¿ÎÂÓ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ÚÔÛ‰ÈfiÚÈÛ ٷ ·ÎÚÈ‚‹ ÛËÌ›· ‰È·ÎÔ‹˜ (breakpoints) ÁÈ· Ù· ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À. ÃÚˆÌÔÛˆÌÈο ÂÏÏ›ÌÌ·Ù· ·ÓȯÓ‡ıËÎ·Ó Û 8 ·ÛıÂÓ›˜ (47%). ™Â Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ Â›¯Â ··ÏÂÈÊı› Ë ÂÚÈÔ¯‹ PAR2, ÂȂ‚·ÈÒÓÔÓÙ·˜ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ fiÏ· Ù· ÂÏÏ›ÌÌ·Ù· Ô˘ ‚Ú¤ıËÎ·Ó Â›Ó·È ÂӉȿÌÂÛ·. ∆· ÂӉȿÌÂÛ· ·˘Ù¿ ÂÏÏ›ÌÌ·Ù· Î˘Ì·›ÓÔ-
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ÓÙ·Ó Û ̋ÎÔ˜ ·fi ÙÔÓ ÂÚÈÊÂÚÈÎfi ‰Â›ÎÙË sY160 (‰È¿ÎÂÓÔ 7) ̤¯ÚÈ ÙÔÓ ÂÁÁ‡˜ ‰Â›ÎÙË sY85 (‰È¿ÎÂÓÔ 5c). ŒÓ·˜ ·ÛıÂÓ‹˜ (¡Ô 17) ·ÚÔ˘Û›·˙ ¤Ó· ÌÂÁ¿ÏÔ ¤ÏÏÂÈÌÌ· ·fi ÙÔ sY85 ¤ˆ˜ ÙÔ sY160, 2 ·ÛıÂÓ›˜ (¡Ô 8 Î·È ¡Ô 16) ÂÌÊ¿ÓÈ˙·Ó ÌÂÛ·›Ô˘ ÌÂÁ¤ıÔ˘˜ ¯ÚˆÌÔÛˆÌÈο ÂÏÏ›ÌÌ·Ù· ·fi ÙÔ ÛËÌÂ›Ô sY103 ¤ˆ˜ ÙÔ sY158, ÂÓÒ 4 ·ÛıÂÓ›˜ ›¯·Ó ÌÈÎÚfiÙÂÚ· ÂÏÏ›ÌÌ·Ù· ·fi ÙÔ sY152 ¤ˆ˜ ÙÔ sY160. ŸÏ· Ù· ·Ú·¿Óˆ ¯ÚˆÌÔÛˆÌÈο ÂÏÏ›ÌÌ·Ù· ÂÌ›ÙÔ˘Ó ÛÙË ˙ÒÓË AZF, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™Â 8 Û˘ÓÔÏÈο ÂÚÈÙÒÛÂȘ, ÙÔ DNA ÙÔ˘ ·Ù¤Ú· ‹Ù·Ó ‰È·ı¤ÛÈÌÔ ÁÈ· ¤ÏÂÁ¯Ô, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ·Ó¿Ï˘ÛË PCR ‹Ù·Ó ıÂÙÈο ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ˘Ô‰ËÏÒÓÔÓÙ·˜ fiÙÈ Ù· ¯ÚˆÌÔÛˆÌÈο ÂÏÏ›ÌÌ·Ù· Â›Ó·È de novo ‹ ·Ó¢ڛÛÎÔÓÙ·È Ì ‹ÈÔ ÌˆÛ·˚ÎÈÛÌfi ÛÙÔÓ ·Ù¤Ú·.
™˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘-Ê·ÈÓÔÙ‡Ô˘ ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘, Ù· ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1, ‰Â›¯ÓÔ˘Ó ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ, ÙË ‰È¿ÁÓˆÛË Î·È Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÙÂÏÈ΋ ¯ÚˆÌÔÛˆÌÈ΋ Û‡ÛÙ·ÛË, fiˆ˜ ·˘Ù‹ Ù·˘ÙÔÔÈÂ›Ù·È ·fi ÙÔÓ Î·Ú˘fiÙ˘Ô Î·È ÙËÓ ·Ó¿Ï˘ÛË FISH. ∏ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›¯·Ó η̛· Û˘Û¯¤ÙÈÛË Ì ÙÔ ÔÛÔÛÙfi ̈۷˚ÎÈÛÌÔ‡ 45,à ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ·›Ì·ÙÔ˜. ∂›Û˘, ÔÈ ··ÏÂÈÊı›Û˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÛÙ· ‰È¿ÎÂÓ· ·fi 5C ¤ˆ˜ 7 ‰ÂÓ ·ÚÔ˘Û›·˙·Ó Û˘Û¯¤ÙÈÛË Ì ٷ ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ. ∆· ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙ· ›‰È· ÔÛÔÛÙ¿ (ÂÚ›Ô˘ 50%) ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ‰È·ÁÓÒÛÂˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Û 6 ·fi Ù· 13 ·È‰È¿ Ì ۇӉÚÔÌÔ Turner, Û 1 ·fi Ù· 2 ·È‰È¿ Ì ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· Î·È Û 1 ·fi ÙÔ˘˜ 2 ·ÛıÂÓ›˜ Ì ·˙ˆÔÛÂÚÌ›·.
™˘˙‹ÙËÛË OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÓfi˜ ¯ÚˆÌÔÛˆÌÈÎÔ‡ ̈۷˚ÎÈÛÌÔ‡ Ì ·ÚÔ˘Û›· Ì›·˜ ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ 45,Ã Î·È Ì›·˜ ‰Â‡ÙÂÚ˘ Ì ΢ÙÙ·ÚÔÁÂÓÂÙÈο Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÌ·ÏÔ ¯ÚˆÌfiۈ̷ À ÔÈΛÏÏÔ˘Ó Â˘Ú¤ˆ˜. ∏ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ ÂÎÙ›ÓÔÓÙ·È ·fi Ê·ÈÓÔÙ˘Èο Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·˙ˆÔÛÂÚÌÈÎÔ‡˜ ¿ÚÚÂÓ˜, Û ¿ÚÚÂÓ· ¿ÙÔÌ· Ì ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· Î·È ·ÌÊ›‚ÔÏ· ÁÂÓÓËÙÈο fiÚÁ·Ó· Î·È ¶·È‰È·ÙÚÈ΋ 2005;68:245-255
¶·È‰È·ÙÚÈ΋ 2005;68:245-255
sY14 sY16 sY18 sY59 RBM
SRY DYS242 DYS251 DYF59S1 YRRM TSPY DYS261 DYS262 DYS263 DYS264 AMGL DYZ3 DYS271 DYS272 DYS148 DYS274 DYS273 DYS275 DYS276 DYS278 KAL-Y182 KAL-Y151 DYS280 DYS282 DYS199 DYS202 DYS206 DYS208 DYS212 DYS214 DYS216 DYS218 DYS225 DYS224 DYS231 DYS236
1A1A 1A1B 1A2 3C 7/3 3C/4A 3D 3E 3F 3G 4A 4B 5A 5B 5C 5C 5C 5C 5D 5E 5E 5F 5H 5I 5J 5K 5M 5M 5N 5O 5P 5Q 6A 6A 6C 6E
-
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
¢È¿ÎÂÓÔ No DNA M -
F + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + -
1 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + -
2 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
3 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
4 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
5 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + -
6 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
7 + + + + + + + + + + + + + + + + + + + + + + + + -
8 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
9 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
10 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + -
11 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
12 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
13 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
14
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
15
+ + + + + + + + + + + + + + + + + + + + + + + + + + + -
16
+ + + + + + + + + + + + -
17
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sY66 sY67 sY68 sY69 sY70 sY78 sY81 sY82 sY86 sY85 sY84 sY87 sY88 sY90 sY182 sY151 sY95 sY98 sY103 sY106 sY114 sY116 sY121 sY123 sY125 sY127 sY135 sY134 sY143 sY152
STS
∞ÓȯÓÂ˘Ù‹˜/°ÔÓ›‰ÈÔ
¶›Ó·Î·˜ 2. ªÔÚȷ΋ ·Ó¿Ï˘ÛË Î·È ·Ú¿ıÂÛË ÙˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ıËÎ·Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘
Pediatr July-Aug 05 new ™ÂÏ›‰·250
Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.
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DYS1 DAZ DAZ DYS240 DYS241 DYZ2 DYZ1 PAR-2
sY149 sY254 sY255 sY157 sY158 sY159 sY160
6E 6 6 6F 6F 7 7
-
+ + + + + + + +
-
+
+ + +
+ + + + + + + +
+ + + + + + + +
+ + + + + + + +
+
+ + + + + + + +
+ + +
+ + + + + + + +
+ + + + + + + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + +
+ + + + + + + +
+
+
¶·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡
251
Û ı‹Ï· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Turner (13,14). O Ì˯·ÓÈÛÌfi˜ Ù˘ Ê·ÈÓÔÙ˘È΋˜ ÔÈÎÈÏÔÌÔÚÊ›·˜ Â›Ó·È ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙÔ˜. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ Î·È Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ÂËÚ¿˙ÔÓÙ·È È‰È·›ÙÂÚ· ·fi ÙÔ ÔÛÔÛÙfi Î·È ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ÁÔÓ¿‰ˆÓ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔ ¯ÚˆÌfiۈ̷ À (15,16). ∂›Ó·È ۷ʤ˜ fiÙÈ Ô Î·ıÔÚÈÛÌfi˜ ÙÔ˘ ʇÏÔ˘ Û ¿ÙÔÌ· Ì ̈۷˚ÎÈÛÌfi ÂÍ·ÚÙ¿Ù·È ÚˆÙ·Ú¯Èο ·fi ÙÔÓ ÂÈÎÚ·ÙÔ‡ÓÙ· ΢ÙÙ·ÚÈÎfi Ù‡Ô ÛÙËÓ ·‰È·ÊÔÚÔÔ›ËÙË ÁÔÓ¿‰·, Ô ÔÔ›Ô˜ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙË ¯ÚˆÌÔÛˆÌÈ΋ ‰ÔÌ‹ 45,à ԉËÁ› ÛÙÔ Û‡Ó‰ÚÔÌÔ Turner, ÁÈ· ÙË 46,ÃÀ Û ¿ÚÚÂÓ· Ê·ÈÓfiÙ˘Ô, ÂÓÒ Ë Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· Î·È ÙˆÓ ‰‡Ô ΢ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ Ô‰ËÁ› Û ÌÈÎÙ‹ ÁÔÓ·‰È΋ ‰˘ÛÁÂÓÂÛ›· (15,17,18). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ SRY, ¤Ú·Ó ÂÓfi˜ ÎÚ›ÛÈÌÔ˘ ÔÚ›Ô˘ ÛÙË ÁÂÓÓËÙÈ΋ Ù·ÈÓ›·, ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ê˘ÏÂÙÈ΋ ‰È·ÊÔÚÔÔ›ËÛË. ∂ÓÙÔ‡ÙÔȘ, Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË ÙˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ì ÙËÓ ·ÚÔ˘Û›· ‹ ÙËÓ ·Ô˘Û›· À ¯ÚˆÌÔÛˆÌÈÎÒÓ ÂÚÈÔ¯ÒÓ Ô˘ ÂÚȤ¯Ô˘Ó ÁÔÓ›‰È· ÂÎÙfi˜ ·fi ÙÔ SRY, ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰ÈÂÚ¢ÓËı›. ªÂ ÙËÓ ·Ó¿Ï˘ÛË ˘„ËÏ‹˜ ¢·ÈÛıËÛ›·˜ Ì ÙË Ì¤ıÔ‰Ô STS Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ, Ê¿ÓËΠfiÙÈ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÂӉȿÌÂÛˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ ÂÎÙ›ÓÂÙ·È ·fi ÙÔ ‰È¿ÎÂÓÔ 5C ¤ˆ˜ ÙÔ 7, Ì ÎÔÈÓfi ··ÏÂÈÊı¤Ó ÙÔ ‰È¿ÎÂÓÔ 6F. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÚÈÔ¯ÒÓ Ô˘ ··Ï›ÊıËÎ·Ó Î·È ÙˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÁÂÁÔÓfi˜ Ô˘ Èı·ÓfiÓ ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ô˘Û›· ÛËÌ·ÓÙÈ΋˜ ›‰Ú·Û˘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· ··ÏÂÈÊı¤ÓÙ· ‰È¿ÎÂÓ· 5C - 7, ÛÙË Ê˘ÏÂÙÈ΋ ‰È·ÊÔÚÔÔ›ËÛË. ∂ÓÈÛ¯˘ÙÈÎfi ÛÙÔÈ¯Â›Ô ÛÙË ‰È·›ÛÙˆÛË ·˘Ù‹ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ··ÏÂÈÊı›Û˜ ÂÚÈÔ¯¤˜ ‚Ú›ÛÎÔÓÙ·È Ì¤Û· ÛÙË ˙ÒÓË AZF, Ë ÔÔ›· ÚÔηÏ› ÌfiÓÔ ÛÂÚÌ·ÙÔÁÔÓÈ΋ ·Ó¿ÚÎÂÈ· Î·È fi¯È ¿ÏϘ ÎÏÈÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ (5,29). ∂›Ó·È Èı·Ófi fiÙÈ Ë ÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÂËÚ¿˙ÂÙ·È ·ÔÊ·ÛÈÛÙÈο ·fi ÙÔ ÔÛÔÛÙfi Î·È ÙËÓ Î·Ù·ÓÔÌ‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ 45,à ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜, fiˆ˜ ›Û˘ Î·È ·fi ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ ‰ڿ˙ÔÓÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ Ã. ª›· ¿ÏÏË ÛËÌ·ÓÙÈ΋ ‰È·›ÛÙˆÛË Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÔÙÂÏ› Ë Ù·˘ÙÔÔ›ËÛË ÂӉȿÌÂÛˆÓ ¯ÚˆÌÔÛˆÌÈÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ Û ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ (47%), fiˆ˜ ›Û˘ Î·È Ë ÛÙ·ıÂÚ‹ ÂÓÙfiÈÛ‹ ÙÔ˘˜ ÛÙÔ ¿ÎÚÔ ÙÔ˘ Ì·ÎÚÔ‡ ÛΤÏÔ˘˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À. ∆Ô ¶·È‰È·ÙÚÈ΋ 2005;68:245-255
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Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Î·È Û˘Ó.
‡ÚËÌ· ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ù· Àq ÂÏÏ›ÌÌ·Ù· Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· Ì ÙÔÓ Ê˘ÏÂÙÈÎfi ̈۷˚ÎÈÛÌfi Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ 45,Ã. ™˘ÁÎÂÎÚÈ̤ӷ, Ô ·ÛıÂÓ‹˜ ¡Ô 17 ·ÚÔ˘ÛÈ¿˙ÂÈ ¤Ó· ÂÎÙÂٷ̤ÓÔ ¤ÏÏÂÈÌÌ· ÂÚÈÊÂÚÈο ·fi ÙÔ ‰È¿ÎÂÓÔ 5C, ÔÈ ·ÛıÂÓ›˜ ¡Ô 8 Î·È ¡Ô 16 ÂÏÏ›ÌÌ·Ù· ÂÚÈÊÂÚÈο ·fi ÙÔ ‰È¿ÎÂÓÔ 5J, ÔÈ ·ÛıÂÓ›˜ ¡Ô 1, 2, 6 Î·È 11 ÂÚÈÊÂÚÈο ·fi ÙÔ ‰È¿ÎÂÓÔ 6∂, ÂÓÒ Ô ·ÛıÂÓ‹˜ ¡Ô 12 ÂÚÈÊÂÚÈο ·fi ÙÔ 6F. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ù· ¯ÚˆÌÔÛˆÌÈο ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ÔÚÈÔıÂÙÔ‡ÓÙ·È ÂÚÈÊÂÚÈο ÙÔ˘ ÛËÌ›Ԣ sÀ85 (‰È¿ÎÂÓÔ 5C) Î·È ÂÁÁ‡˜ ÙÔ˘ sY160 (‰È¿ÎÂÓÔ 7), ¤¯Ô˘Ó ¤Ó· ÎÔÈÓfi ··ÏÂÈÊı¤Ó ‰È¿ÎÂÓÔ 6F, ÂÓÒ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ë ˙ÒÓË PAR2 ·Ú·Ì¤ÓÂÈ ·Ó·ÏÏÔ›ˆÙË. ø˜ ÂÎ ÙÔ‡ÙÔ˘, fiÏ· Ù· ÂÏÏ›ÌÌ·Ù· Â›Ó·È ÂӉȿÌÂÛÔ˘ Ù‡Ô˘. ∂ÈϤÔÓ, fiÏ· Ù· ÂÏÏ›ÌÌ·Ù· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ÂÚÈÔ¯¤˜ AZFa, AZFb Î·È ∞∑Fc. ¢È·ÈÛÙÒÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ÂÚÈÔ¯‹ ·Ó¿ÌÂÛ· ÛÙ· ‰È¿ÎÂÓ· 5C Î·È 7, Ë ÔÔ›· ˘ÂÚηχÙÂÈ ÙË ˙ÒÓË ∞∑F, Â›Ó·È Î·ıÔÚÈÛÙÈ΋ ÂÚÈÔ¯‹, Ë ¤ÏÏÂÈ„Ë Ù˘ ÔÔ›·˜ ÚÔηÏ› ·ÛÙ¿ıÂÈ· ÛÙÔ ¯ÚˆÌfiۈ̷ À, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ·ÒÏÂÈ¿ ÙÔ˘ Î·È ÙËÓ ·Ó¿Ù˘ÍË Ì›·˜ ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ 45,Ã. ª›· ÈÔ ÂÌÂÚÈÛٷو̤ÓË ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ÙˆÓ ·Ó·ÊÔÚÒÓ ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÍ·ÁˆÁ‹ ÙˆÓ ·ÎfiÏÔ˘ıˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ: ·) ¶ÔÏÏÔ› ‰È·ÊÔÚÂÙÈÎÔ› Ù‡ÔÈ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙÔ˘˜ ̈۷˚ÎÈÛÌÔ‡˜ 45,Ã. ∞˘Ù‹ Ë ÎÔÈÓ‹ ·Ú·Ù‹ÚËÛË (9-11,20) Â›Ó·È Èı·ÓÒ˜ ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÛÙ¿ıÂÈ·˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ηٿ ÙË ‰È·›ÚÂÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ‚Ï¿‚Ë ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À (30,31). ‚) ™Â ÔÛÔÛÙfi ÂÚ›Ô˘ 10% ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Turner ‰È·ÈÛÙÒıËÎÂ Ê˘ÏÂÙÈÎfi˜ ¯ÚˆÌÔÛˆÌÈÎfi˜ ̈۷˚ÎÈÛÌfi˜ Ô˘ ÂÚȤ¯ÂÈ ÙËÓ Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ 45,Ã Î·È Ì›· ‰Â‡ÙÂÚË Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Ì ΢ÙÙ·ÚÔÁÂÓÂÙÈο Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÌ·ÏÔ ¯ÚˆÌfiۈ̷ À (32). ∂ÈϤÔÓ, ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·Ó¤ÊÂÚ·Ó fiÙÈ ÂÚ›Ô˘ 40% ÙˆÓ ·ÙfiÌˆÓ Ì ΢ÙÙ·ÚÔÁÂÓÂÙÈο ÌË ÌˆÛ·˚Îfi 45,à ¤¯Ô˘Ó Ì›· ‰Â‡ÙÂÚË ÎÚ˘ÙÈ΋ ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Ô˘ ÂÚȤ¯ÂÈ ¤Ó· ¯ÚˆÌfiۈ̷ À (33-35). ∆o ÁÂÁÔÓfi˜ ·˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ Ì›· ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ 45,à ‰ËÌÈÔ˘ÚÁÂ›Ù·È Èı·ÓfiÓ ·fi ·ÛÙ¿ıÂÈ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À Î·È ÙËÓ Â·ÎÔÏÔ˘ıÔ‡Û· ·ÒÏÂÈ· ÔÏfiÎÏËÚÔ˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜. ∏ ıˆڛ· ·˘Ù‹ Û˘ÌʈÓ› Ì ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ Û ۯ‰fiÓ 3/4 ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Turner, ÙÔ ¯ÚˆÌfiۈ̷ Ã Â›Ó·È ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ (36). ¶·È‰È·ÙÚÈ΋ 2005;68:245-255
Á) OÈ ·Ù¤Ú˜ ÙˆÓ ·È‰ÈÒÓ Ì ۇӉÚÔÌÔ Turner ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì›· ÌÈÎÚ‹, ·ÏÏ¿ ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ÌË ‰È·˙¢ÎÙÈÎÒÓ (non-disjunctional) ÛÊ·ÏÌ¿ÙˆÓ ÁÈ· Ù· Ê˘ÏÂÙÈο ¯ÚˆÌÔÛÒÌ·Ù·, ΢ڛˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂȈÙÈ΋˜ Ê¿Û˘ π (37). ‰) ∏ ·ÒÏÂÈ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ηÈ, ηٿ Û˘Ó¤ÂÈ·, Ë ·Ó¿Ù˘ÍË Î˘ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ 45,Ã Â›Ó·È Â›Û˘ ÎÔÈÓfi ÁÂÁÔÓfi˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÂÚÈÊÂÚÈο ÏÂÌÊÔ·ÙÙ·Ú· ‹ Ù· ·ÙÙ·Ú· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ ·ÓıÚÒˆÓ (38,39). Â) TÔ ¯ÚˆÌfiۈ̷ À Â›Ó·È Û˘¯Ó¿ ÙÔ ÚÒÙÔ ¯ÚˆÌfiۈ̷ Ô˘ ¯¿ÓÂÙ·È Û ÔÈΛÏÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ù‡Ô˘˜ ΢ÙÙ¿ÚˆÓ Û ηÎÔ‹ıÂȘ, fiˆ˜ Ë ÔÍ›· ÌË ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·, Ô Î·ÚΛÓÔ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘, ÔÈ fiÁÎÔÈ ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ Ù˘ ÁÂÓÓËÙÈ΋˜ Ù·ÈÓ›·˜, Ô Î·ÚΛÓÔ˜ ÙˆÓ Ó¢ÌfiÓˆÓ Î·È Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ (40-44). ÛÙ) ¶ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ì›· ˘ÔÔÌ¿‰· ÛÙÂ›ÚˆÓ ·Ó‰ÚÒÓ, Ì ÂÏÏ›ÌÌ·Ù· ∞ZFc, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÔÛÔÛÙ¿ 45,Ã Î˘ÙÙ¿ÚˆÓ ÛÙ· ÏÂÌÊÔ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È Û ÛÂÚÌ·ÙÔ·ÙÙ·Ú· (45), ˘Ô‰ËÏÒÓÔÓÙ·˜ ÂÎÙÂٷ̤ÓË ·ÒÏÂÈ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÛÂÚÌ·ÙÔÁ¤ÓÂÛ˘. ∂ÈϤÔÓ, ÙÔ˘Ï¿¯ÈÛÙÔÓ 15% ÙˆÓ ·ÛıÂÓÒÓ Ì AZFc ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ʤÚÂÈ ¤Ó· ̈۷˚Îfi Ì ̛· 45,Ã Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ (21,23). ˙) ª›· ¿ÏÏË ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ô Ê˘ÏÂÙÈÎfi˜ ̈۷˚ÎÈÛÌfi˜ ÌÔÚ› Ó· ÚÔ·ÙÂÈ fiÙ·Ó ¯ÚˆÌÔÛÒÌ·Ù· À Ì AZFc-ÂÏÏ›ÌÌ·Ù· ÌÂٷʤÚÔÓÙ·È ·fi ÙË Ì›· ÁÂÓÈ¿ ÛÙËÓ ¿ÏÏË Ì ˘Ô‚ÔËıÔ‡ÌÂÓË ·Ó··Ú·ÁˆÁ‹ (24). °È· ÙËÓ ·Ó¿Ù˘ÍË ·˘ÙÔ‡ ÙÔ˘ Ê˘ÏÂÙÈÎÔ‡ ̈۷˚ÎÈÛÌÔ‡ ÚÔÙ›ÓÂÙ·È Ô ·ÎfiÏÔ˘ıÔ˜ Ì˯·ÓÈÛÌfi˜: ∏ ·ÒÏÂÈ· ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ Û ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÂÌÊ·Ó›ÛÙËΠ·˘ÙfiÌ·Ù· Û ˘„ËÏ‹ Û˘¯ÓfiÙËÙ·, ÏfiÁˆ ÙÔ˘ fiÙÈ ÙÔ ¯ÚˆÌfiۈ̷ À ÂÌÊ·Ó›˙ÂÙ·È È‰È·›ÙÂÚ· ÂÈÚÚ¤˜ Û ·˘ÙfiÌ·ÙË ·ÒÏÂÈ· ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡. ∞˘Ù‹ Ë ÂÈÚÚ¤ÂÈ· ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÂ: ·) ·ÓÒÌ·ÏÔ ·Ó·Û˘Ó‰˘·ÛÌfi ÌÂٷ͇ ÂÚÈÔ¯ÒÓ ÔÌfiÏÔÁˆÓ ‹ ·ÚfiÌÔÈˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ÌÂٷ͇ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ã Î·È À, ‚) ·ÓÒÌ·ÏÔ ÂÓ‰Ô¯ÚˆÌÔÛˆÌÈÎfi Û˘Ó‰˘·ÛÌfi Ì ÌË ÈÛfiÚÚÔË ·ÓÙ·ÏÏ·Á‹ ·‰ÂÏÊÒÓ ¯ÚˆÌ·Ù›‰ˆÓ ‹ Á) ‰ÈÔÏ›ÛıËÛË (slippage) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÓÙÈÁÚ·Ê‹˜ (replication) ÙÔ˘ DNA (46). ¶Ú¿ÁÌ·ÙÈ, ÔÈ Kirsch Î·È Û˘Ó ÂÚȤÁÚ·„·Ó ·ӷÏËÙÈΤ˜ ·ÏÏËÏÔ˘¯›Â˜ ÛÙÔ Yq11, fiÔ˘ Ë Û¯¿ÛË ·‰ÂÏÊÒÓ ¯ÚˆÌ·Ù›‰ˆÓ ηÈ
Pediatr July-Aug 05 new
22-07-05
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¶·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ê˘ÏÂÙÈÎÔ‡ ·Ó¢ÏÔÂȉÈÛÌÔ‡
·ÓÒÌ·Ï˘ ·ӤӈÛ˘ ÎÂÚÌ·ÙÈÛÌ¤ÓˆÓ ¿ÎÚˆÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÈÛÔ‰ÈÎÂÓÙÚÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ (47). ∆Ô ÈÛÔ‰ÈÎÂÓÙÚÈÎfi À ¯ÚˆÌfiۈ̷ Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ·ÓˆÌ·Ï›· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Turner Î·È ÌˆÛ·˚ÎÈÛÌfi. ∂›Ó·È Èı·Ófi Ù· ÈÛÔ‰ÈÎÂÓÙÚÈο ¯ÚˆÌÔÛÒÌ·Ù· À Ó· Û¯ËÌ·Ù›˙ÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Á·ÌÂÙÔÁ¤ÓÂÛ˘, ÚÈÓ ·fi ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ÛÂÚÌ·Ù›‰ˆÓ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÙ˘ ‰È·›ÚÂÛ˘ ÌÂÙ¿ ÙË ÁÔÓÈÌÔÔ›ËÛË (48). ™ÙËÓ ›‰È· ÂÓÙfiÈÛË ÙˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, ÔÈ ÂÚÈÔ¯¤˜ AZFa, AZFb Î·È AZFc Ï·ÈÛÈÒÓÔÓÙ·È Î·È Â›Ó·È ÁÂÌ¿Ù˜ ·fi Û‡ÌÏÔη ÔÌfiÏÔÁˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ, ¿ÌÂÛ˜ ·ӷϋ„ÂȘ (direct repeats), ÔÏÏ·Ï¿ ·ÓÙ›ÁÚ·Ê· ÁÔÓȉ›ˆÓ Î·È ·Ï›Ó‰ÚÔ̘ ·ÏÏËÏÔ˘¯›Â˜ (49-51). OÌfiÏÔÁÔ˜ ·Ó·Û˘Ó‰˘·ÛÌfi˜ ÌÂٷ͇ ÙˆÓ Û˘ÌÏfiÎˆÓ ·˘ÙÒÓ Â˘ı‡ÓÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÁÈ· Ù· ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ (49,5254). OÈ ·ÏÏËÏÔ˘¯›Â˜ ηٿ Ì‹ÎÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ÂӉ¯Ô̤ӈ˜ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ À, Ì ÙË ‰È·Ù‹ÚËÛË Ì›·˜ ÛÙÂÓ‹˜ Û˘Û¯¤ÙÈÛ˘ Ì ÙÔ Ã ‹ ¿ÏÏ· ¯ÚˆÌÔÛÒÌ·Ù· (55). ∞Ó Î·È ·˘Ù¤˜ ÔÈ ÂÚÈÔ¯¤˜ ‰ÂÓ ˘fiÎÂÈÓÙ·È Û ·Ó·Û˘Ó‰˘·ÛÌfi Ì ÙÔ ¯ÚˆÌfiۈ̷ à ‹ ·˘ÙÔۈ̷ÙÈο ¯ÚˆÌÔÛÒÌ·Ù·, ¯ˆÚ›˜ ÙË ÛÙ·ıÂÚÔÔÈËÙÈ΋ ›‰Ú·ÛË ·˘ÙÒÓ ÙˆÓ ÂÚÈÔ¯ÒÓ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ÂÈϤÔÓ ·ÛÙ¿ıÂÈ· Î·È ‚Ï¿‚Ë ÛÙȘ ˘fiÏÔȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ·ÏÏËÏÔ˘¯›Â˜ Àq (12). ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ·ÓȯÓ‡ıËÎÂ Ë ·ÚÔ˘Û›· PAR2, Ì ÙË Ì¤ıÔ‰Ô Ù˘ PCR. H ÂÚÈÔ¯‹ ·˘Ù‹ ÙˆÓ 330 Kb ÂÚȤ¯ÂÈ 4 ÁÔÓ›‰È· Ì ÔÌfiÏÔÁ· ÛÙÔ ¯ÚˆÌfiۈ̷ à (56). ∞ÓıÚÒÈÓ· Ê˘ÏÂÙÈο ¯ÚˆÌÔÛÒÌ·Ù·, Ô˘ ÌÔÚ› Ó· Â›Ó·È ÌÔÚÊÔÏÔÁÈο ‹/Î·È ÁÂÓÂÙÈο ‰È·ÊÔÚÂÙÈο ÌÂٷ͇ ÙÔ˘˜, ÌÔÈÚ¿˙ÔÓÙ·È ÌÂÚÈΤ˜ ÂÚÈÔ¯¤˜ ÔÌÔÏÔÁ›·˜. ∆Ô ÂÁÁ‡˜ PAR2 ÂÚȤ¯ÂÈ ‰‡Ô ÁÔÓ›‰È· Ô˘ ·‰Ú·ÓÔÔÈÔ‡ÓÙ·È Î·È ÛÙ· ‰‡Ô ·ÓÂÓÂÚÁ¿ Ã Î·È À ¯ÚˆÌÔÛÒÌ·Ù·, ÙË Û˘Ó·ÙÔÌ‚›ÓË (synaptobevin) Î·È ¤Ó· Ó¤Ô ÔÌfiÏÔÁÔ Ù˘ Drosophila sprouty. ∏ ÂÚÈÊÂÚÈ΋ ÂÚÈÔ¯‹ PAR2 ÂÚȤ¯ÂÈ ÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 9 Î·È ¤Ó· novel ÁÔÓ›‰ÈÔ, ÙÔ CXYorfl (56). ∏ ·ÚÔ˘Û›· ÙÔ˘ PAR2 ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ì ··ÏÂÈÊı¤ÓÙ· ¯ÚˆÌÔÛÒÌ·Ù· À, ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·Ô˘Û›· PAR2 Û 4 ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ ‰ÔÚ˘ÊÔÚÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ À (57). À¿Ú¯Ô˘Ó ÚfiÛÊ·Ù˜ ÂӉ›ÍÂȘ fiÙÈ Ù· ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ÛÙË ˙ÒÓË AZF Èı·ÓfiÓ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË Û˘Ó‰ÚfiÌÔ˘ Turner ‹
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¿ÏÏ˘ ÌÔÚÊ‹˜ ¯ÚˆÌÔÛˆÌÈÎÔ‡ ̈۷˚ÎÈÛÌÔ‡ ÛÙ· Ù¤ÎÓ· ·Ó‰ÚÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ıÂڷ›· Ì ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÛÂÚÌ·Ù¤Á¯˘ÛË (24). ∞˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ·Ó¿Ù˘Í˘ Û˘Ó‰ÚfiÌÔ˘ Turner Î·È ÁÔÓÔÙ˘ÈÎÔ‡ ̈۷˚ÎÈÛÌÔ‡ 45,Ã/46,ÃÀ ¤¯ÂÈ ‹‰Ë ·Ó·ÊÂÚı› Û ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ·˘Ù‹ ÙË Ì¤ıÔ‰Ô ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ (58,59). ∂Ô̤ӈ˜, ÚÔÙ›ÓÂÙ·È Û οı ·ÛıÂÓ‹ ÊÔÚ¤· ÂÓfi˜ ÌÈÎÚÔÂÏÏ›ÌÌ·ÙÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À, Ô ÔÔ›Ô˜ ÂÈ˙ËÙ¿ ÙË ‚Ô‹ıÂÈ· Ù˘ ÌÂıfi‰Ô˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ÛÂÚÌ·Ù¤Á¯˘Û˘, Ó· Á›ÓÂÙ·È ÚÔÁÂÓÓËÙÈÎfi˜ Û˘Ì‚Ô˘Ï¢ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÁÔÓ·‰ÈÎÔ‡ ̈۷˚ÎÈÛÌÔ‡ Ì ÔÏ˘¯ÚˆÌ·ÙÈ΋ ̤ıÔ‰Ô FISH ÛÙ· ۈ̷ÙÈο Î·È ÁÂÓÓËÙÈο ·ÙÙ·Ú·, ηıÒ˜ Î·È ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· Â˘Ú‹Ì·Ù· Ô˘ ÂÓÙÔ›ÛÙËÎ·Ó Û ·ÛıÂÓ›˜ Ì ̈۷˚Îfi ηڢfiÙ˘Ô 45,Ã, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Ì ¯ÚˆÌfiۈ̷ À, ‰Â›¯ÓÔ˘Ó ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Àq ÂӉȿÌÂÛˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ, Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙ· ‰È¿ÎÂÓ· ÌÂٷ͇ 5C ¤ˆ˜ Î·È 7, ‰ËÏ·‰‹ Ì›· ÂÚÈÔ¯‹ Ô˘ ÂÈηχÙÂÈ ÙË ˙ÒÓË AZF. ∞˘Ù¿ Ù· ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Ê·ÈÓÔÙ˘ÈÎfi ʇÏÔ, ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ‹ ¿ÏÏ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ∂ÓÙÔ‡ÙÔȘ, Ù· ÂӉȿÌÂÛ· ÂÏÏ›ÌÌ·Ù· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÛÙ¿ıÂÈ· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À.
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* 1st Choremio Award 42th Panhellenic Paediatric Meeting, 2004 1 Department of Endocrinology, “P. & A. Kyriakou” Children’s Hospital, Athens 2 Unit of Paediatric Endocrinology, Makario Hospital, Nicosia, Cyprus 3 Department of Cytogenetics, Institute of Neurology and Genetics, Nicosia, Cyprus 4 Laboratory of Medical Genetics, Medical School of the University of Athens, “Aghia Sophia” Children’s Hospital, Athens 5 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens 6 Department of Genetics, “Alexandra” Hospital, Athens Correspondence: Philippos C. Patsalis Department of Cytogenetics, Institute of Neurology and Genetics 234 62, Nicosia, 1683, Cyprus E-mail: patsalis@cing.ac.cy
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AWARD-WINNING ARTICLE
High frequency of Y chromosome deletions in patients with sex chromosome mosaicism: a putative mechanism of sex chromosome aneuploides C. G. Hadjiathanasiou1, N. Skordis2, C. Sismani3, L. Kousoulidou3, G. Koumbaris3, C. Eftychi3, G. Stavrides3, A. Ioulianos3, S. Kitsiou - Tzeli4, A. Gala - Voumvouraki5, Z. Kosmaidou6, A. Konstantopoulos5, P. C. Patsalis3
Abstract Background: Rearrangements of the human Y chromosome are often associated with the presence of a 45,X cell line. A mosaic karyotype consisting of a 45,X cell line and an additional cell line with a cytogenetically normal or abnormal Y chromosome is relatively common and is associated with a wide spectrum of phenotypes, ranging from female with Turner’s syndrome (TS) to undervilirized male with mixed gonadal dysgenesis (MGD) and to normally virilized male with azoospermia. The aim of this study was to define the presence of Y chromosome deletions and examine their potential association with Y chromosome instability, as well as with the phenotype. Methods: Seventeen clinically well-characterized patients were studied who had 45,X mosaicism and a second cell line including a cytogenetically normal or abnormal Y chromosome. The Y chromosome was investigated using high-density Y-chromosome-specific STS markers and fluorescent in situ hybridization (FISH). Results: Forty seven percent (8/17) of all patients were found to have Y chromosome deletions. The deletions were found to be interstitial, and extended from 5C up to interval 7. The commonest deleted interval was 6F, which overlaps with the AZF region. The pseudo-autosomal region 2 (PAR 2) was not deleted in any of the patients. Conclusions: A strong association was demonstrated between specific Yq chromosome interstitial deletions and Y chromosome instability, leading to sex chromosome aneuploides. There was no apparent association between deletions of the Y chromosome with the phenotypic sex, the diagnosis or, more importantly, with the stigmata of Turner’s syndrome.
Key words Sex mosaicism, Y chromosome, AZF, PAR2.
Paediatriki 2005;68:256
Pediatr July-Aug 05 new
22-07-05
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ºˆÙÔ¢·ÈÛıËÛ›·, ÙËÏÂfiÚ·ÛË Î·È ÂÈÏË„›· ¡. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜
¶ÂÚ›ÏË„Ë OÈ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÂȉÈÎÔ‡ Ù‡Ô˘ ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó fi¯È Û¿ÓÈÔ Úfi‚ÏËÌ·, Ô˘ ·ÊÔÚ¿ ΢ڛˆ˜ Û ·È‰È¿, ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ, ÂÓÒ ÂÚÁ·ÛÙËÚȷο ‰È·ÈÛو̤ÓË ÊˆÙÔ¢·ÈÛıËÛ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙÔ˘ ˘ÁÈÔ‡˜ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ∏ ʈÙÔ¢·ÈÛıËÛ›· ·ÔÙÂÏ› ÁÂÓÂÙÈο ÂÏÂÁ¯fiÌÂÓË ÂÈÏËÙÔÁfiÓÔ ÚԉȿıÂÛË. OÈ ÎÚ›ÛÂȘ ÌÔÚ› Ó· Â›Ó·È ·ÌÈÁÒ˜ ʈÙÔ¢·›ÛıËÙÔ˘ ¯·Ú·ÎÙ‹Ú· ‹ Ó· Û˘Ó‰˘¿˙ÔÓÙ·È Î·È Ì ·˘ıfiÚÌËÙ˜ ÎÚ›ÛÂȘ. ∂ÎÙfi˜ Ù˘ ·ÌÈÁÒ˜ ʈÙÔ¢·›ÛıËÙ˘ ÂÈÏË„›·˜, ʈÙÔ¢·ÈÛıËÛ›· ¯·Ú·ÎÙËÚ›˙ÂÈ ·ÚÎÂÙ¿ ·fi Ù· ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ™˘ÓËı¤ÛÙÂÚÔÈ ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Â›Ó·È ÙÔ ËÏÈ·Îfi ʈ˜, Ë ÙËÏÂfiÚ·ÛË Î·È Ù· ‚ÈÓÙÂԷȯӛ‰È·. §fiÁˆ ÙÔ˘ ΢ڛ·Ú¯Ô˘ ÚfiÏÔ˘ Ù˘ ÙËÏÂfiÚ·Û˘ ÛÙË Û‡Á¯ÚÔÓË ˙ˆ‹, Ë Û¯¤ÛË Ù˘ Ì ÙËÓ ÂÈÏË„›· ÚÔ‚ÏËÌ·Ù›˙ÂÈ Â‡ÏÔÁ· ÙËÓ ÎÔÈÓ‹ ÁÓÒÌË. ∏ ʈÙÔÂÚÂıÈÛÙÈ΋ ‰Ú¿ÛË Ù˘ ÙËÏÂfiÚ·Û˘ ÂÍ·ÚٿٷÈ, ÌÂٷ͇ ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ, ·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ Û˘Û΢‹˜, ÙËÓ ·fiÛÙ·ÛË ÔıfiÓ˘-ı·ً, ·ÏÏ¿ Î·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ÙËÏÂÔÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜. °›ÓÂÙ·È ·Ó·ÛÎfiËÛË ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ, ÁÂÓÂÙÈÎÒÓ, ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ÊˆÙÔ¢·›ÛıËÙˆÓ ÂÈÏË„ÈÒÓ, Ì ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙÔÓ ÚfiÏÔ Ù˘ ÙËÏÂfiÚ·Û˘ Î·È ÙˆÓ ‚ÈÓÙÂԷȯÓȉÈÒÓ, ÂÓÒ ÚÔÙ›ÓÔÓÙ·È Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÚÔÏËÙÈο ̤ÙÚ·.
¶·È‰ÔÓ¢ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ∫·Ú·Ì·Ó‰¿ÓÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ, ¶¿ÙÚ· AÏÏËÏÔÁÚ·Ê›·: ¡ÈÎfiÏ·Ô˜ ¢È·Ì·ÓÙfiÔ˘ÏÔ˜ ¶·È‰ÔÓ¢ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ∫·Ú·Ì·Ó‰¿ÓÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∂Ú˘ıÚÔ‡ ™Ù·˘ÚÔ‡ 40 ∆.∫. 263 31, ¶¿ÙÚ· ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 23-01-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 27-04-2005
§¤ÍÂȘ ÎÏÂȉȿ ºˆÙÔ¢·ÈÛıËÛ›·, ÂÈÏË„›·, ÙËÏÂfiÚ·ÛË.
™˘ÓÙÔÌÔÁڷʛ˜ ¢º∂ ∏∂° º¶∞ º/∂ º/∂ ÂÈÏË„›· ™/∂
¢È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· ∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ºˆÙÔ·ÚÔ͢ÛÌÈ΋ ·ÓÙ›‰Ú·ÛË ºˆÙÔ¢·ÈÛıËÛ›· ºˆÙÔ¢·›ÛıËÙË ÂÈÏË„›· ™¯Â‰ÈÔ¢·ÈÛıËÛ›·
∂ÈÛ·ÁˆÁ‹ ∏ ÁÓÒÛË fiÙÈ ÙÔ Êˆ˜, ËÏÈ·Îfi ‹ Ù¯ÓËÙfi, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÎÚ›ÛÂȘ ÂÈÏË„›·˜ ‰ÂÓ Â›Ó·È ÚfiÛÊ·ÙË. ∏ ·Ï·ÈfiÙÂÚË ·Ó·ÊÔÚ¿ Û ʈÙÔ¢·›ÛıËÙË ÂÈÏËÙÈ΋ ÎÚ›ÛË Èı·ÓfiÓ ÂÚȤ¯ÂÙ·È ÛÙÔ ¤ÚÁÔ “∞ÔÏÔÁ›·” ÙÔ˘ ∞Ô‡ÏÈÔ˘, ÁÚ·Ì̤ÓÔ ÂÚ› ÙÔ 125 Ì.Ã. (1). O Û˘ÁÁڷʤ·˜, ˘ÂÚ·ÛÈ˙fiÌÂÓÔ˜ ÙÔÓ Â·˘Ùfi ÙÔ˘ ¤Ó·ÓÙÈ Ù˘ ηÙËÁÔÚ›·˜ fiÙÈ ·ÛÎÒÓÙ·˜ Ì·Á›· ÚÔηÏÔ‡Û ÎÚ›ÛÂȘ ÛÙÔÓ £·ÏÏfi, ¤Ó·Ó Ó·Úfi ÛÎÏ¿‚Ô, ÈÛ¯˘Ú›˙ÂÙ·È fiÙÈ “….ÙÔ ÛÙÚÈÊÔÁ‡ÚÈÛÌ· ÙÔ˘ ÙÚÔ¯Ô‡ Ù˘ ÎÂÚ·ÌÈ΋˜ ‡ÎÔÏ· ÚÔηÏ› Û ¤Ó·Ó ¿ÓıÚˆÔ Ô˘ ˘ÔʤÚÂÈ ·fi ·˘Ù‹ ÙËÓ ·Ûı¤ÓÂÈ· ÙË ˙·Ï¿‰· ÙÔ˘... Ë ı¤· ÙˆÓ ÂÚÈÛÙÚÔÊÒÓ ÂÍ·ÛıÂÓ›˙ÂÈ ÙÔ ‹‰Ë ·‰‡Ó·ÌÔ Ì˘·Ïfi ÙÔ˘ Î·È Ô ÙÚÔ¯fi˜ Ù˘ ÎÂÚ·ÌÈ΋˜ Â›Ó·È Ôχ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ·fi ÙË Ì·Á›· ÛÙÔ Ó· ÚÔηÏ› Û·ÛÌÔ‡˜ Û ¤Ó·Ó ÂÈÏËÙÈÎfi”. ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜,
ˆÛÙfiÛÔ, ·ÌÊÈÛ‚ËÙÔ‡Ó ÙË ÛËÌ·Û›· ·˘Ù‹˜ Ù˘ ÂÚÈÁÚ·Ê‹˜ (2). ™Â οı ÂÚ›ÙˆÛË, Ë ÚÒÙË ÙÂÎÌËÚȈ̤ÓË ·Ó·ÊÔÚ¿ Û ʈÙÔ¢·›ÛıËÙË ÂÈÏË„›· Á›ÓÂÙ·È ·fi ÙÔÓ ÌÂÁ¿ÏÔ ÂÈÏËÙÔÏfiÁÔ Gowers, ÙÔ 1885 (3). ™Ù· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’40 ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ·Ó·Ï˘ÙÈ΋ ÂÚÈÁÚ·Ê‹ ÛÂÈÚ¿˜ ʈÙÔ¢·›ÛıËÙˆÓ ·ÛıÂÓÒÓ (4), ÔÈ ÔÔ›ÔÈ ÌÂÏÂÙ‹ıËÎ·Ó Ì ÙËÓ ÚˆÙÔÔÚȷ΋ Ùfi٠ٯÓÈ΋ ÙÔ˘ ÛÙÚÔ‚ÔÛÎÔ›Ô˘ Ì ‰È·Ï›ԢÛ˜ Ï¿Ì„ÂȘ ʈÙfi˜. ∆Ë ‰ÂηÂÙ›· ÙÔ˘ ’60 ÂÈÛ‚¿ÏÏÂÈ ÛÙË ˙ˆ‹ Ì·˜ Ë ÙËÏÂfiÚ·ÛË Î·È ·Ú¯›˙Ô˘Ó ÔÈ ÚÒÙ˜ ·Ó·ÊÔÚ¤˜ Û ÎÚ›ÛÂȘ “ÚÔηÏÔ‡ÌÂÓ˜” ·fi ·˘Ù‹. ∂ȉÈο ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ÌÂÁ¿ÏË ‰ËÌÔÛÈfiÙËÙ· ¤Ï·‚Â Ë Û¯¤ÛË ÙˆÓ Û‡Á¯ÚÔÓˆÓ ·È‰ÈÎÒÓ ÙËÏÂÔÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È ÙˆÓ ‚ÈÓÙÂԷȯÓȉÈÒÓ Ì ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. ∆Ô 1993 ·ÚÔ˘ÛÈ¿ÛÙËΠÛÙËÓ ∂˘ÚÒË ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏËÙÈ΋ ÎÚ›ÛË, ÂÓÒ ¤·È˙·Ó ÙÔ ÂÈÙ˘¯Ë̤ÓÔ ‚ÈÓÙÂԷȯӛ‰È “Super Mario World”. ∆Ô ı¤Ì·, fï˜, ¤Ï·‚ ÂÎÚËÎÙÈΤ˜ ‰È·ÛÙ¿ÛÂȘ, fiÙ·Ó ÛÙËÓ π·ˆÓ›· ̤۷ Û ̛· ÌfiÓÔÓ Ë̤ڷ, ÙËÓ 16Ë ¢ÂÎÂÌ‚Ú›Ô˘ 1998, 685 ¿ÙÔÌ· (Ù· ÂÚÈÛÛfiÙÂÚ· ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜) ·ÚÔ˘Û›·Û·Ó ÂÈÏËÙÈ΋ ÎÚ›ÛË ·Ú·ÎÔÏÔ˘ıÒÓÙ·˜ ÙÔ ‰ËÌÔÊÈϤ˜ ·È‰ÈÎfi ÙËÏÂÔÙÈÎfi ÚfiÁÚ·ÌÌ· ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
Pediatr July-Aug 05 new
22-07-05
12:16
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¡. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜
“The Pockemon monster”. ∂›Û˘, ÔÏϤ˜ ÂηÙÔÓÙ¿‰Â˜ ·ÙfiÌˆÓ ÂÈÛΤÊıËÎ·Ó Ù· ÓÔÛÔÎÔÌ›· Ì ¿Ù˘· ÂÓԯϋ̷ٷ, fiˆ˜ ˙¿ÏË, ÎÂÊ·Ï·ÏÁ›·, ÔÙÈ΋ ıfiψÛË Î.Ï., Û ۯ¤ÛË Ì ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÚfiÁÚ·ÌÌ· (5-7). O ∆‡Ô˜ ¤Êı·Û ÛÙÔ ÛËÌÂ›Ô Ó· οÓÂÈ ·Ó·ÊÔÚ¿ - fi¯È ·‰›Îˆ˜ - ·ÎfiÌË Î·È ÁÈ· “ÂȉËÌ›·” ÂÈÏË„›·˜, ÌÂ Û˘Ó¤ÂÈ· ·ÓÈÎfi Î·È Û‡Á¯˘ÛË. ∫ÈÓ‰˘Ó‡ÂÈ, ¿Ú·ÁÂ, Ô Î¿ı ÙËÏÂı·ً˜ Ó· ¿ıÂÈ ÂÈÏË„›·; ∞ÔÙÂÏÔ‡Ó Ù· ÙfiÛÔ ‰ËÌÔÊÈÏ‹ ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ - ‚ÈÓÙÂԷȯӛ‰È· Ú·ÁÌ·ÙÈο ÂÈΛӉ˘Ó· ·È¯Ó›‰È·; ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÎÏÈÓÈο, ÂȉËÌÈÔÏÔÁÈο, ÁÂÓÂÙÈο, ÂÚÁ·ÛÙËÚȷο Î·È ıÂڷ¢ÙÈο ‰Â‰Ô̤ӷ ÙˆÓ ÊˆÙÔ¢·›ÛıËÙˆÓ (Ê/Â) ÂÈÏË„ÈÒÓ. π‰È·›ÙÂÚË ¤ÌÊ·ÛË ‰›‰ÂÙ·È ÛÙÔÓ ÚfiÏÔ Ù˘ ÙËÏÂfiÚ·Û˘, ÙˆÓ ‚ÈÓÙÂԷȯÓȉÈÒÓ Î·È ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ, ÏfiÁˆ Ù˘ ÙÂÚ¿ÛÙÈ·˜ ‰È¿‰ÔÛ‹˜ ÙÔ˘˜ ÛÙË Û‡Á¯ÚÔÓË ÎÔÈÓˆÓ›·.
µ·ÛÈΤ˜ ¤ÓÓÔȘ ŸÙ·Ó ÈÛ¯˘Ú‹˜ ¤ÓÙ·Û˘ Ú˘ıÌÈο ‰È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· (¢º∂) ÚÔÛ›ÙÔ˘Ó ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÙÔ ÂÚ¤ıÈÛÌ· ÊÙ¿ÓÂÈ ÛÙÔÓ ÔÙÈÎfi ÊÏÔÈfi Î·È ÚÔηÏ› ¯·ÌËÏÔ‡ ‰˘Ó·ÌÈÎÔ‡ ËÏÂÎÙÚÈ΋ ·¿ÓÙËÛË, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ ∏∂° ˆ˜ Ú˘ıÌÈο ·̷ٷ ÛÙȘ ÈÓȷΤ˜ ÂÚÈÔ¯¤˜ Ì ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ· ‹ ›ÛË Ì ̛· ·ÚÌÔÓÈ΋ ‹ ˘Ô·ÚÌÔÓÈ΋ Û˘¯ÓfiÙËÙ· (.¯. ÙÔ ‹ÌÈÛ˘) ÙˆÓ ¢º∂. ∏ Ê˘ÛÈÔÏÔÁÈ΋ ·˘Ù‹ ·¿ÓÙËÛË ÔÓÔÌ¿˙ÂÙ·È ·ÓÙ›‰Ú·ÛË ·Ú¿Û˘ÚÛ˘ Î·È ‰È·ÚΛ fiÛÔ Î·È ÙÔ ÂÚ¤ıÈÛÌ·. øÛÙfiÛÔ, Ô ÂÚÂıÈÛÌfi˜ Ì ¢º∂ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ·ÚÔ͢ÛÌÈÎÔ‡ Ù‡Ô˘ ·ÓÙ›‰Ú·ÛË Ì ÂÈÏËÙfiÌÔÚʘ ·ÓˆÌ·Ï›Â˜, ‰ËÏ·‰‹ ·È¯Ì¤˜ ‹ ÔÏ˘·È¯Ì¤˜ Û ηÓÔÓÈ΋ ‹ ·Î·ÓfiÓÈÛÙË ÚfiÛÌÈÍË Ì ‚Ú·‰¤· ·̷ٷ, Ë ÔÔ›· ÔÓÔÌ¿˙ÂÙ·È ÊˆÙÔ·ÚÔ͢ÛÌÈ΋ ·ÓÙ›‰Ú·ÛË (º¶∞). ∏ ÂÌÊ¿ÓÈÛË Ù¤ÙÔÈÔ˘ Ù‡Ô˘ ·ÓÙ›‰Ú·Û˘ ÛÙ· ¢º∂ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔ ¿ÙÔÌÔ ˆ˜ ʈÙÔ¢·›ÛıËÙÔ (Ê/Â). ºˆÙÔ·ÚÔ͢ÛÌÈ΋ ·ÓÙ›‰Ú·ÛË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛÙ› Î·È Ì ¿ÏÏÔ˘ Ù‡Ô˘ ÔÙÈο ÂÚÂı›ÛÌ·Ù·, fiˆ˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ¯·Ú·ÎÙ‹Ú· ÁˆÌÂÙÚÈο Û¯¤‰È·, ÎÈÓÔ‡ÌÂÓ· ‹ fi¯È (patterns). ∆· ¿ÙÔÌ· ·˘Ù¿ ÔÓÔÌ¿˙ÔÓÙ·È Û¯Â‰ÈÔ¢·›ÛıËÙ· (Û/Â) (ÂÏÏËÓÈ΋ ·fi‰ÔÛË ÙÔ˘ ·ÁÁÏÈÎÔ‡ fiÚÔ˘ pattern sensitive). ∆· Ê/ ¿ÙÔÌ· ÌÔÚ› Ó· ¿Û¯Ô˘Ó ·fi ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ (·˘ıfiÚÌËÙ˜ ‹ ÚÔηÏÔ‡ÌÂÓ˜ ·fi ‰È¿ÊÔÚ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·) ‹ Ó· ÌËÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ó¤Ó· ÎÏÈÓÈÎfi Úfi‚ÏËÌ·. ™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ÚfiÎÂÈÙ·È ÂÚ› ÎÏÈÓÈ΋˜ Ê/Â, ÂÓÒ ÛÙË ‰Â‡ÙÂÚË ÁÈ· ÂÚÁ·ÛÙËÚȷ΋ ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
Ê/ ‹ ·ÏÒ˜ Ê/Â. ∞Ó¿ÏÔÁ· Ì ÙÔÓ ‚·ıÌfi ¢·ÈÛıËÛ›·˜ ÙÔ˘˜, Ù· Ê/ ¿ÙÔÌ· Ù·ÍÈÓÔÌÔ‡ÓÙ·È (8) Û ÙÚÂȘ ÔÌ¿‰Â˜ (∂ÈÎfiÓ· 1): OÌ¿‰· ∞: ˘ÁÈ‹ (ÌË ÂÈÏËÙÈο) ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó º¶∞. OÌ¿‰· µ: ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÎÚ›ÛÂȘ ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰ÔÎÈÌ·Û›· ÙˆÓ ¢º∂. OÌ¿‰· °: ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜ (ËÏÈ·Îfi ʈ˜, ÙËÏÂfiÚ·ÛË Î.Ï.). OÈ ÎÚ›ÛÂȘ ÙÔ˘˜ ÌÔÚ› Ó· Â›Ó·È ·ÔÎÏÂÈÛÙÈο ʈÙÔ¢·›ÛıËÙ˜ ‹ Ó· Û˘Ó‰˘¿˙ÔÓÙ·È Î·È Ì ·˘ıfiÚÌËÙ˜ ÎÚ›ÛÂȘ. ªfiÓÔ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ° Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÌÈÁÒ˜ Ê/ ÎÚ›ÛÂȘ ÂÈÙÚ¤ÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ fiÚÔ˘ Ê/ ÂÈÏË„›·. O fiÚÔ˜ ·˘Ùfi˜ ¤¯ÂÈ ÂÚÈÁÚ·ÊÈÎfi ¯·Ú·ÎÙ‹Ú· Î·È ‰ÂÓ ·ÔÙÂÏ› ȉȷ›ÙÂÚÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ, ηıÒ˜ ÔÈ ·ÛıÂÓ›˜ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏ· ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë Ê/ ÂÈÏË„›· ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚË ı¤ÛË ˆ˜ ·˘ÙfiÓÔÌË ÔÓÙfiÙËÙ· ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· ∆·ÍÈÓfiÌËÛ˘ ÙˆÓ ∂ÈÏËÙÈÎÒÓ ™˘Ó‰ÚfiÌˆÓ (9), ·ÏÏ¿ ÂÓÙ¿ÛÛÂÙ·È ÛÙË ÁÂÓÈÎfiÙÂÚË ÔÌ¿‰· ÙˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ ÂÈÏË„ÈÒÓ. ™Â fiϘ ÙȘ ¿ÏϘ ÂÚÈÙÒÛÂȘ (ÌÈÎÙÔ‡ Ù‡Ô˘ ÎÚ›ÛÂȘ), Ë ‡·ÚÍË Ê/Â Â›Ó·È ·Ï¿ ¤Ó· ȉȷ›ÙÂÚÔ Û˘ÓÔ‰fi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÂÈÏË„›·˜ ·fi ÙËÓ ÔÔ›· ¿Û¯ÂÈ Ô ·ÛıÂÓ‹˜.
∂ȉËÌÈÔÏÔÁÈο Î·È ÁÂÓÂÙÈο ‰Â‰Ô̤ӷ ∆Ô Ê·ÈÓfiÌÂÓÔ Ù˘ Ê/ ¯·Ú·ÎÙËÚ›˙ÂÈ Î·Ù¿ ·ÚÈÔ ÏfiÁÔ Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ηıÒ˜ ºˆÙÔ¢·›ÛıËÙ· ¿ÙÔÌ· (º¶∞ ηٿ ÙË ‰ÔÎÈÌ·Û›· ¢º∂)
∞: Ÿ¯È ÎÚ›ÛÂȘ
∂ÚÁ·ÛÙËÚȷ΋ ʈÙÔ¢·ÈÛıËÛ›·
µ: ∫Ú›ÛÂȘ ÌfiÓÔ Ì ‰ÔÎÈÌ·Û›· ¢º∂
∞ÌÈÁÒ˜ Ê/ ÎÚ›ÛÂȘ
ºˆÙÔ¢·›ÛıËÙË ÂÈÏË„›·
°: ∫Ú›ÛÂȘ ÌÂ Û˘Ó‹ıË ÊˆÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·
º/Â Î·È ·˘ıfiÚÌËÙ˜ ÎÚ›ÛÂȘ
∂ÈÏË„›· Ì ʈÙÔ¢·ÈÛıËÛ›·
∂ÈÎfiÓ· 1. ∆·ÍÈÓfiÌËÛË ÊˆÙÔ¢·ÈÛıËÛ›·˜.
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·259
259
ºˆÙÔ¢·›ÛıËÙË ÂÈÏË„›·
ÂÌÊ·Ó›˙ÂÙ·È ‹‰Ë ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ÎÔÚ˘ÊÒÓÂÙ·È ÛÙËÓ ÂÊË‚È΋ Î·È ·Ú¯›˙ÂÈ Ó· ÌÂÈÒÓÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 25 ÂÙÒÓ (10). ∏ Ê/Â, ÎÏÈÓÈ΋ ‹ ÂÚÁ·ÛÙËÚȷ΋, ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙ· ı‹Ï· ¿ÙÔÌ· (∞/£ = 40/60) (11-13). ∂ÚÁ·ÛÙËÚȷ΋ Ê/ ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ 10-20% ÙˆÓ ÂÈÏËÙÈÎÒÓ ·È‰ÈÒÓ Î·È ÛÙÔ 5-10% ÙˆÓ ÂÓËÏ›ÎˆÓ ÂÈÏËÙÈÎÒÓ (18). ∏ Ê/Â Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙÔ Ï·›ÛÈÔ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfïÓ, ı¤Ì· Ô˘ Û˘˙ËÙÂ›Ù·È ·Ó·Ï˘ÙÈÎfiÙÂÚ· ÛÙË Û˘Ó¤¯ÂÈ·. ºˆÙÔ¢·ÈÛıËÛ›·, fï˜, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ú·ÙËÚËı› Î·È ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfïÓ, ȉȷ›ÙÂÚ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ (14-16) ÛÂ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙËÓ ÂÎÙ›ÌËÛË fiÙÈ ÂÚÁ·ÛÙËÚȷ΋ Ê/ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 0,5-2% ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ Ó·ÚÒÓ ÂÓËϛΈÓ, ·Ó Î·È ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ (¤ˆ˜ Î·È 9%) (17). ∞˘Ù¤˜ ÔÈ ÌÂÁ¿Ï˜ ·ÔÎÏ›ÛÂȘ ÔÊ›ÏÔÓÙ·È Û ÌÂıÔ‰ÔÏÔÁÈΤ˜ ‰È·ÊÔÚ¤˜ (18). ∏ Ê/ ·ÔÙÂÏ› ÁÂÓÂÙÈο ηıÔÚÈ˙fiÌÂÓË ‰È·Ù·Ú·¯‹, fiˆ˜ ¤¯ÂÈ ‰È·ÈÛÙˆı› ·fi ÔÏϤ˜ ÔÈÎÔÁÂÓÂȷΤ˜ ÌÂϤÙ˜ (19-23). OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÍ ·˘ÙÒÓ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙËÓ ¿Ô„Ë Ù˘ ÁÂÓÂÙÈ΋˜ ÌÂÙ·‚›‚·Û˘ Ì ·˘ÙfiÛˆÌË ÛˆÌ·ÙÈ΋ ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ, ˘¿Ú¯Ô˘Ó fï˜ Î·È ÌÂϤÙ˜ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ÔÏ˘ÁÔÓȉȷ΋ ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ (24). ∏ Ê/ ıˆÚÂ›Ù·È ˆ˜ Ì›· ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÚԉȿıÂÛË ÚÔ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, Ë ÔÔ›· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂΉËψı› ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙË Û˘Ó‡·ÚÍË ¿ÏÏˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È, Ù¤ÏÔ˜, ÙËÓ ·ÚÔ˘Û›· ÂȉÈÎÔ‡ Ù‡Ô˘ ʈÙÂÈÓÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·ÙfiÌÔ˘. À‡ı˘Ó· ÁÔÓ›‰È· ‰ÂÓ ¤¯Ô˘Ó ÂÓÙÔÈÛÙ›.
∫ÏÈÓÈο ‰Â‰Ô̤ӷ O ·Ï·ÈfiÙÂÚÔ˜ ÁÓˆÛÙfi˜ ʈÙÔÂÚÂıÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Â›Ó·È ÙÔ ËÏÈ·Îfi ʈ˜, ›Ù ÛÙË Û˘ÓËıÈṲ̂ÓË Û˘Ó¯‹ ÌÔÚÊ‹ ÙÔ˘ ›Ù fiÙ·Ó ·ÔÎÙ¿ ‰È·ÎÔÙfiÌÂÓË ‹ ·ÏÏfiÌÂÓË ÌÔÚÊ‹ (.¯. ÎÈÓÔ‡ÌÂÓÔÈ Ì¤Û· Û ̛· ‰ÂÓ‰ÚÔÛÙÔȯ›·, fiÙ·Ó ·ÓÙ·Ó·ÎÏ¿Ù·È Û ÂÈÊ¿ÓÂÈ· ÓÂÚÔ‡ ‹ ¯ÈÔÓÈÔ‡ Î.Ï.). ™ÙË Û‡Á¯ÚÔÓË ÂÔ¯‹, Ù· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· Ô˘ Û˘ÓËı¤ÛÙÂÚ· Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Â›Ó·È ÙÔ ËÏÈ·Îfi ʈ˜, Ë ÙËÏÂfiÚ·ÛË Î·È Ù· ‚ÈÓÙÂԷȯӛ‰È·, Ù· ʈÙÔÚ˘ıÌÈο Û ¯ÒÚÔ˘˜ ‰È·ÛΤ‰·Û˘ ηÈ, Û·ÓÈfiÙÂÚ·, ÔÈ ËÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜. ŒÓ· ¿ÏÏÔ Â›‰Ô˜ ÔÙÈÎÔ‡ ÂÚÂıÈÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·ÔÙÂÏÔ‡Ó Û¯¤‰È·, ÁˆÌÂÙÚÈÎÔ‡ Û˘Ó‹-
ıˆ˜ ¯·Ú·ÎÙ‹Ú·, ÙÔ˘ Ù‡Ô˘ ÙˆÓ Î¿ıÂÙˆÓ, ·Ú¿ÏÏËÏˆÓ ‹ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ (Û·Ó ÛηÎȤڷ) ÁÚ·ÌÌÒÓ ‹ ψڛ‰ˆÓ. ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ÔÓÔÌ¿˙ÂÙ·È pattern sensitivity, fiÚÔ˜ Ô˘ ÛÙËÓ ÂÏÏËÓÈ΋ ÁÏÒÛÛ· ÌÔÚ› Ó· ·Ô‰Ôı› ˆ˜ ۯ‰ÈÔ¢·ÈÛıËÛ›· (Û/Â). ∏ ·ÚÔ˘Û›· Û/ ÂϤÁ¯ÂÙ·È ÂÚÁ·ÛÙËÚȷο Ì ÙËÓ ·ÚÔ˘Û›·ÛË ÛÙÔÓ ·ÛıÂÓ‹, ̤ۈ ÂȉÈÎÔ‡ ÏÔÁÈÛÌÈÎÔ‡ Î·È ÔıfiÓ˘, ‰È·ÊfiÚˆÓ Û¯Â‰›ˆÓ (.¯. ÛηÎȤڷ, ·Ú¿ÏÏËϘ Ù·Èӛ˜ Î.Ï.). ∏ Û/ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Î·È Ì ·Î›ÓËÙ· Û¯¤‰È·, ·ÏÏ¿ Ôχ ÂÚÈÛÛfiÙÂÚÔ Â¿Ó Ù· Û¯¤‰È· ÎÈÓÔ‡ÓÙ·È ‹ ¿ÏÏÔÓÙ·È. ∞Ó Î·È ÂÚÁ·ÛÙËÚȷο ‰È·ÈÛو̤ÓË Û/ ·Ú·ÙËÚÂ›Ù·È Û ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÙfïÓ, Ë ÚfiÎÏËÛË ÎÚ›ÛÂˆÓ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ ·fi ·ÓÙ›ÛÙÔȯ· ÂÚÂı›ÛÌ·Ù· Â›Ó·È ·ÚÎÂÙ¿ ·Û˘Ó‹ıÈÛÙÔ Ê·ÈÓfiÌÂÓÔ. ¶·Ú·‰Â›ÁÌ·Ù· ·fi ÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ ·ÔÙÂÏÔ‡Ó ÔÈ Î˘ÏÈfiÌÂÓ˜ ÛοϘ, Ù· ÚÔ‡¯· Ì ·ÚfiÌÔÈ· Û¯¤‰È·, ÔÈ Ù·ÂÙ۷ڛ˜ Ì ÁÚ·ÌÌÈο Û¯¤‰È· Î.Ï. (25). ™¯Â‰ÈÔ¢·›ÛıËÙ˜ ÎÚ›ÛÂȘ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ÔÛÔÛÙfi 2-6% › ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ê/ ·ÛıÂÓÒÓ (10). ∏ Û/ ·ÔÙÂÏ› ˘ÔηÙËÁÔÚ›· ÙÔ˘ ÁÂÓÈÎfiÙÂÚÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ Ê/Â, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ ÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ ÙˆÓ Û¯Â‰ÈÔ¢·›ÛıËÙˆÓ ·ÙfiÌˆÓ Â›Ó·È Ê/ Ì ÙËÓ ÎÏ·ÛÈ΋ ‰ÔÎÈÌ·Û›· ÙˆÓ ¢º∂ ηÈ, ·ÓÙÈÛÙÚfiʈ˜, 1/3 ÙˆÓ Ê/ ·ÙfiÌˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Û/ (26). ªÂÚÈÎÔ› Ê/ ·ÛıÂÓ›˜ Â›Ó·È Â˘·›ÛıËÙÔÈ ÛÙËÓ ·Ï‹ ‰È·‰Èηۛ· ÎÏÂÈ̷ۛÙÔ˜ ÙˆÓ ÔÊı·ÏÌÒÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÚÔ˘Û›· ʈÙÂÈÓÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È ÂÌÊ·Ó›˙Ô˘Ó ·Ê·ÈÚ¤ÛÂȘ ‹ Ì˘ÔÎÏÔӛ˜ ÌfiÏȘ ÎÏ›ÓÔ˘Ó Ù· Ì¿ÙÈ· ÙÔ˘˜ (27). ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi, Ô˘ ¤¯ÂÈ ÌÂÏÂÙËı› ‰ÈÂÍÔ‰Èο ·fi ÙÔÓ ŒÏÏËÓ· ∫·ıËÁËÙ‹ ¶·Ó·ÁȈÙfiÔ˘ÏÔ (28), Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ù¿ÚÁËÛË Ù˘ ÎÂÓÙÚÈ΋˜ fiÚ·Û˘ Î·È Ù˘ ÂÛÙ›·Û˘ (fixation off sensitivity) Ô˘ Ê˘ÛÈÔÏÔÁÈο Û˘Óԉ‡ÂÈ ÙÔ ÎÏ›ÛÈÌÔ ÙˆÓ ÔÊı·ÏÌÒÓ. OÈ Ê/ ÎÚ›ÛÂȘ, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜, ¤¯Ô˘Ó ÙÔÓ ¯·Ú·ÎÙ‹Ú· ÂÓfi˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÌÔÚ› fï˜ Ó· Â›Ó·È Î·È ·Ê·ÈÚÂÙÈÎÔ‡ ‹ Ì˘ÔÎÏÔÓÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·. ™ÙËÓ ÎÏ·ÛÈ΋ ÛÂÈÚ¿ ·ÛıÂÓÒÓ ÙˆÓ Jeavons Î·È Harding (29), ÙÔ 84% ›¯Â ÙÔÓÈÎÔÎÏÔÓÈο ÂÂÈÛfi‰È·, ÙÔ 6% ·Ê·ÈÚ¤ÛÂȘ, ÙÔ 2,5% ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ Î·È ÌfiÓÔ 1,5% ›¯Â Ì˘ÔÎÏÔÓÈΤ˜ Û˘Û¿ÛÂȘ. ¢Â‰Ô̤ÓÔ˘, fï˜, fiÙÈ ÔÈ ·Ê·ÈÚÂÙÈΤ˜ Î·È ÔÈ Ì˘ÔÎÏÔÓÈΤ˜ ÎÚ›ÛÂȘ Û˘¯Ó¿ ‰ÂÓ Á›ÓÔÓÙ·È ·ÓÙÈÏËÙ¤˜ ·fi ÙÔÓ ›‰ÈÔ ÙÔÓ ·ÛıÂÓ‹ ‹ ˘ÔÂÎÙÈÌ¿Ù·È Ë ÛËÌ·Û›· ÙÔ˘˜ Î·È ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ·˘ıfiÚÌËÙ· ηٿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, Â›Ó·È Ôχ Èı·Ófi Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ Ó· Â›Ó·È ÛËÌ·ÓÙÈο ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
Pediatr July-Aug 05 new
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ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì fi,ÙÈ ıˆÚÂ›Ù·È (30). OÈ Ê/ ÎÚ›ÛÂȘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ˘ÔÎÂÈÌÂÓÈÎfi ·›ÛıËÌ· ¢¯·Ú›ÛÙËÛ˘ ‹ ˉÔÓ‹˜, ÂÓÒ Â›Ó·È ÁÓˆÛÙfi ÙÔ Ê·ÈÓfiÌÂÓÔ ÙˆÓ ·˘ÙÔÚÔηÏÔ‡ÌÂÓˆÓ ÎÚ›ÛˆÓ. ∞ÚÎÂÙÔ› Ê/ ·ÛıÂÓ›˜ ÚÔηÏÔ‡Ó ÔÈ ›‰ÈÔÈ ÙȘ ÎÚ›ÛÂȘ Ì ‰È¿ÊÔÚÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜, fiˆ˜ Ë ÁÚ‹ÁÔÚË Î›ÓËÛË ÙÔ˘ ¯ÂÚÈÔ‡ ÌÚÔÛÙ¿ ·fi Ù· Ì¿ÙÈ·, ÙÔ ÂÎÔ‡ÛÈÔ ÎÏ›ÛÈÌÔ ÙˆÓ ÔÊı·ÏÌÒÓ Ì ‚ÔÏ‚ÔÛÙÚÔÊ‹ ‹ ÙÔ ÎÔ›Ù·ÁÌ· ÚÔ˜ ÙÔÓ ‹ÏÈÔ (31). ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ, fiÙ·Ó Ë ÙËÏÂfiÚ·ÛË ·ÔÙÂÏ› ÙÔÓ ÂÎÏ˘ÙÈÎfi ·Ú¿ÁÔÓÙ·, Ô ·ÛıÂÓ‹˜ ·ÈÛı¿ÓÂÙ·È ·Î·Ù·Ó›ÎËÙË ¤ÏÍË Ó· ÏËÛÈ¿ÛÂÈ ÚÔ˜ ÙËÓ ÔıfiÓË - Ë ÔÔ›· ÙÔ˘ ÚÔηÏ› ÙȘ ÎÚ›ÛÂȘ - Î·È ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÛÈÁ¿-ÛÈÁ¿ ÏËÛÈ¿˙ÂÈ ÚÔ˜ ·˘Ù‹ Û·Ó Ì·ÁÓËÙÈṲ̂ÓÔ˜. ∂›Ó·È Ê·ÓÂÚfi fiÙÈ Ë ·Ó›¯Ó¢ÛË ÙÔ˘ ÚÔÎÏËÙÔ‡ ¯·Ú·ÎÙ‹Ú· ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È ‰‡ÛÎÔÏË Î·È Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ÂÍ·ÚÙ¿Ù·È ·ÔÎÏÂÈÛÙÈο ·fi ÙËÓ “ÔÌÔÏÔÁ›·” ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜.
™¯¤ÛË Ê/ Ì ÂȉÈο ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ· Ÿˆ˜ ¤¯ÂÈ ‹‰Ë ·Ó·ÊÂÚı›, Ê/ ÌÔÚ› Ó· ¯·Ú·ÎÙËÚ›˙ÂÈ ÔÔÈ·‰‹ÔÙ ÌÔÚÊ‹ ÂÈÏË„›·˜ ¤Ú·Ó ·fi ÙËÓ ·ÌÈÁÒ˜ Ê/ ÌÔÚÊ‹ Ù˘. øÛÙfiÛÔ, ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ Û¯¤ÛË Ì ÔÚÈṲ̂ӷ - Û˘Ó‹ıˆ˜ ȉÈÔ·ıÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ¯·Ú·ÎÙ‹Ú· - ÂȉÈο Û‡Ó‰ÚÔÌ·, Ù· ÔÔ›· ηٿ ÛÂÈÚ¿ ËÏÈÎȷ΋˜ ÂÌÊ¿ÓÈÛ˘ Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: ∫·ÏÔ‹ı˘ Ì˘ÔÎÏÔÓÈ΋ ‚ÚÂÊÈ΋ ÂÈÏË„›·: ™Â ·˘Ùfi ÙÔ Û¿ÓÈÔ Û‡Ó‰ÚÔÌÔ, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ì·˙ÈΤ˜ Ì˘ÔÎÏÔÓÈΤ˜ Û˘Û¿ÛÂȘ Û ËÏÈΛ· ÌÂٷ͇ 4 ÌËÓÒÓ Î·È 3 ÂÙÒÓ Î·È ¤¯ÂÈ ¿ÚÈÛÙË Ì·ÎÚÔÚfiıÂÛÌË ÚfiÁÓˆÛË, Ê/ ˘¿Ú¯ÂÈ Û ÔÛÔÛÙfi 10%. ¶·È‰È΋ ·Ê·ÈÚÂÙÈ΋ ÂÈÏË„›·: ¶ÂÚ›Ô˘ 15% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ º¶∞ ÛÙÔ ∏∂°. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi (32) Â¿Ó ÙÔ Â‡ÚËÌ· ·˘Ùfi ÂÈ‚·Ú‡ÓÂÈ ÙË Ì·ÎÚÔÚfiıÂÛÌË ÚfiÁÓˆÛË, ‰ËÏ·‰‹ ÙÔ ÂӉ¯fiÌÂÓÔ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› Ó· ÌÂÙ·¤ÛÔ˘Ó ÛÙËÓ ÂÊË‚È΋ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›·. ¡Â·ÓÈ΋ ·Ê·ÈÚÂÙÈ΋ ÂÈÏË„›·: ¶ÔÛÔÛÙfi 8% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÊˆÙÔ¢·ÈÛıËÛ›·. ¶ÂÚ›Ô˘ 15% ÙˆÓ ·ÛıÂÓÒÓ ı· ÌÂÙ·¤ÛÂÈ ÛÙËÓ ÂÊË‚È΋ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· (33), ·ÏÏ¿ Î·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ô ÚÔÁÓˆÛÙÈÎfi˜ ÚfiÏÔ˜ Ù˘ ·ÚÔ˘Û›·˜ º¶∞ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. ∂ÊË‚È΋ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›·: ∂›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ Ì ÙËÓ ˘„ËÏfiÙÂÚË Û˘Û¯¤ÙÈÛË Ì ÙË ÊˆÙÔ¢·ÈÛıËÛ›·. ¶ÔÛÔÛÙfi 30-55% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÊˆÙÔ¢·ÈÛıËÛ›· (13,35), ›Ù Ì ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ›Ù ·ÏÒ˜ Ì º¶∞. ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÛÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi Ë Ê/ ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
Èı·ÓÒ˜ Ó· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ‰È·ÊÔÚÂÙÈÎfi ÙÚfiÔ ·fi fi,ÙÈ Ë ÎÏÈÓÈ΋ ÙÔ˘ ¤ÎÊÚ·ÛË. ∂ÈÏË„›· Ì ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÎÚ›ÛÂȘ ηٿ ÙËÓ ÚˆÈÓ‹ ·Ê‡ÓÈÛË: ™ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi Ê/ ˘¿Ú¯ÂÈ ÛÙÔ 13%. ∂ÈÏË„›· ÂÍ ·Ó·ÁÓÒÛˆ˜: ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÔÚÊ‹ ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋˜ ÂÈÏË„›·˜, ÛÙËÓ ÔÔ›· ÔÈ ÎÚ›ÛÂȘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙË ‰È·‰Èηۛ· ·Ó¿ÁÓˆÛ˘ ÂÓfi˜ ÎÂÈ̤ÓÔ˘. ∞Ó Î·È ÎÏÈÓÈο ÔÈ ·ÛıÂÓ›˜ ‰ÂÓ Â›Ó·È Ê/Â, ˆÛÙfiÛÔ ÔÛÔÛÙfi 9% ·ÚÔ˘ÛÈ¿˙ÂÈ º¶∞ ÛÙÔ ∏∂° (34). ª¤¯ÚÈ ÚfiÛÊ·Ù· ıˆÚÔ‡ÓÙ·Ó fiÙÈ ÔÈ Ê/ ÎÚ›ÛÂȘ Â›Ó·È ¿ÓÙ· ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ¯·Ú·ÎÙ‹Ú· Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Ï·›ÛÈÔ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÌfiÓÔ ÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfïÓ. ™ÂÈÚ¿, fï˜, ·Ú·ÙËÚ‹ÛÂˆÓ ÙÂÎÌËÚÈÒÓÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ Ê/ ÎÚ›ÛÂȘ ÌÔÚ› Ó· ¤¯Ô˘Ó ÂÛÙÈ·Îfi ¯·Ú·ÎÙ‹Ú· (11,36-38). ™ÙÔ ∏∂° ·Ú·ÙËÚÔ‡ÓÙ·È ÂÛÙȷΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÂوȷ›· ‹ ÙËÓ ÎÚÔÙ·ÊÈ΋ ÂÚÈÔ¯‹ Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ÙȘ ¿ÏϘ ÂÚÈÙÒÛÂȘ Ì ·ÓÙ›ÛÙÔÈ¯Ë ÚԤϢÛË. π‰È·›ÙÂÚ˘ ÛËÌ·Û›·˜ Â›Ó·È Ë ÂÚ›ÙˆÛË fiÔ˘ ËÁ‹ ÚÔ¤Ï¢Û˘ Â›Ó·È Ô ÈÓÈ·Îfi˜ ÏÔ‚fi˜, ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È¿ÊÔÚ˜ ÔÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ·Ì·‡ÚˆÛË Ù˘ fiÚ·Û˘, Ï¿Ì„ÂȘ, ¯ÚÒÌ·Ù·, ·ÏÏfiÌÂÓ· Û¯‹Ì·Ù· Î.Ï. OÈ ÈÓȷΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ÌÔÚ› Ó· Â›Ó·È È‰È·›ÙÂÚ· ·Ú·ÙÂٷ̤Ó˜ Î·È Ó· ÂÈ̤ÓÔ˘Ó ·ÎfiÌË Î·È ÌÂÙ¿ ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙË ÊˆÙÂÈÓ‹ ËÁ‹ Ô˘ ÙȘ ÚÔοÏÂÛ (31). °È· ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ - Î·È ÂÊfiÛÔÓ ‰ÂÓ ÔÊ›ÏÔÓÙ·È Û ‰ÔÌÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÈÓÈ·ÎÔ‡ ÏÔ‚Ô‡ - ¤¯ÂÈ ÚÔÙ·ı› Ô fiÚÔ˜ ȉÈÔ·ı‹˜ ʈÙÔ¢·›ÛıËÙË ÂÛÙȷ΋ ÂÈÏË„›· ÙÔ˘ ÈÓÈ·ÎÔ‡ ÏÔ‚Ô‡ (39,40). ∂¿Ó, fï˜, Ù· Ê·ÈÓfiÌÂÓ· ·˘Ù¿ ¤¯Ô˘Ó ÌÈÎÚ‹ ‰È¿ÚÎÂÈ· Î·È ÙÔ ÂÂÈÛfi‰ÈÔ ÂÓ Û˘Ó¯›· ÁÂÓÈ΢ı›, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ë ·Ú¯È΋ ÙÔ˘ Ê¿ÛË Î·È, ¿Ú·, Ô ÂÛÙÈ·Îfi˜ ÙÔ˘ ¯·Ú·ÎÙ‹Ú·˜, ‰ÂÓ Á›ÓÔÓÙ·È Â‡ÎÔÏ· ·ÓÙÈÏËÙ¿, ÂÈÎ·Ï˘ÙfiÌÂÓ· ·fi ÙÔ Ì›˙ÔÓ ÁÂÁÔÓfi˜ Ù˘ ÙÔÓÈÎÔÎÏÔÓÈ΋˜ ÎÚ›Û˘. ∆¤ÏÔ˜, Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÂÎÙfi˜ ·fi ÙȘ ȉÈÔ·ı›˜ ÌÔÚʤ˜ ÂÈÏË„›·˜, ÛÙȘ Ôԛ˜ ‹‰Ë ¤ÁÈÓ ·Ó·ÊÔÚ¿, Ê/ ÌÔÚ› Ó· ·Ú·ÙËÚËı› Î·È ÛÂ Û˘Ìو̷ÙÈΤ˜ ‹ ÎÚ˘ÙÔÁÂÓ›˜ ÌÔÚʤ˜ ÂÈÏË„›·˜. ºˆÙÔ¢·ÈÛıËÛ›· Û ·ÚÎÂÙ¿ ˘„ËÏ¿ ÔÛÔÛÙ¿ ·Ú·ÙËÚÂ›Ù·È ÛÙË Ì˘ÔÎÏÔÓÈ΋-·ÛÙ·ÙÈ΋ ÂÈÏË„›· (ÙÔ˘ Doose), ÛÙËÓ Î·ÎÔ‹ıË ‚ÚÂÊÈ΋ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· (Û‡Ó‰ÚÔÌÔ Dravet) Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Lennox-Gastaut. ªÂٷ͇ ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ (‰Â˘ÙÂÚÔ·ıÒÓ) ÂÈÏË„ÈÒÓ, Ë Ê/Â Â›Ó·È Û˘¯Ó‹ ÛÙȘ ÚÔԉ¢ÙÈΤ˜ Ì˘ÔÎÏÔÓÈΤ˜ ÂÈÏË„›Â˜ (‚ÚÂÊÈ΋ Î·È ÂÓ‹ÏÈÎË ÌÔÚÊ‹ Ó¢ÚÔÏÈÔÊÔ˘ÛΛӈÛ˘, Û‡Ó‰ÚÔÌÔ
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·261
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ºˆÙÔ¢·›ÛıËÙË ÂÈÏË„›·
Unverricht-Lundborg, Û‡Ó‰ÚÔÌÔ ÛˆÌ·Ù›ˆÓ Lafora) Î·È ÛÙËÓ ÂÈÏË„›· Ì ηٷÎÂÚÌ·ÙÈṲ̂Ó˜ Ì˘˚Τ˜ ›Ó˜. ™ÙȘ ÚÔԉ¢ÙÈΤ˜ Ì˘ÔÎÏÔÓÈΤ˜ ÂÈÏË„›Â˜, Ë º¶∞ ÂÌÊ·Ó›˙ÂÙ·È ¯·Ú·ÎÙËÚÈÛÙÈο ÛÙȘ Ôχ ¯·ÌËϤ˜ Û˘¯ÓfiÙËÙ˜ ÙˆÓ ¢º∂, ‰ËÏ·‰‹ ÛÙ· 1, 2, 3 Hz.
∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ∏ ‡·ÚÍË Ê/ ÂϤÁ¯ÂÙ·È ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, ηٿ ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛË ÙÔ˘ ∏∂°, Ì ÙË ‰ÔÎÈÌ·Û›· ÙˆÓ ¢º∂. OÈ Ù¯ÓÈΤ˜ ÏÂÙÔ̤ÚÂȘ ¤¯Ô˘Ó ÌÂÁ¿ÏË ÛËÌ·Û›· Î·È Ë ÌË Û˘ÌÌfiÚʈÛË Ì ÙȘ Û¯ÂÙÈΤ˜ Ô‰ËÁ›Â˜ (41) ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ˘„ËÏfi ÔÛÔÛÙfi „¢‰Ò˜ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. OÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·fi ·˘Ù¤˜ ÙȘ Ô‰ËÁ›Â˜ Â›Ó·È ÔÈ ÂÍ‹˜: ·) O Ï·ÌÙ‹Ú·˜ ·Ú·ÁˆÁ‹˜ ÙˆÓ Ï¿Ì„ÂˆÓ Ú¤ÂÈ Ó· ·Ú¿ÁÂÈ ÈÛ¯˘Ú‹˜ ¤ÓÙ·Û˘ Ï¿Ì„ÂȘ Ï¢ÎÔ‡ ʈÙfi˜ Î·È Ó· ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ú·ÁˆÁ‹˜ Ï¿Ì„ÂˆÓ ·fi 1 Hz ¤ˆ˜ 60 Hz. ‚) O Ï·ÌÙ‹Ú·˜ ÙÔÔıÂÙÂ›Ù·È Û ·fiÛÙ·ÛË 30 cm ·fi ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ ÙÔ˘ ·ÛıÂÓ‹, Ô ÔÔ›Ô˜ Ú¤ÂÈ Ó· ÎÔÈÙ¿˙ÂÈ Î·Ù¢ı›·Ó ÚÔ˜ ÙÔ Î¤ÓÙÚÔ ÙÔ˘. Á) ™ÙÔÓ ÂÍÂÙ·˙fiÌÂÓÔ ·ÚÔ˘ÛÈ¿˙ÂÙ·È fiÏÔ ÙÔ Ê¿ÛÌ· Û˘¯ÓÔÙ‹ÙˆÓ ·fi Ù· 3 Hz ¤ˆ˜ Ù· 60 Hz Û ‚·ıÌ›‰Â˜ 2 ‹ 3 Hz, .¯. 1, 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 50, 60 Hz. ‰) ∆Ô Î¿ı ÂÚ¤ıÈÛÌ· Ú¤ÂÈ Ó· ‰È·ÚΛ ÙÔ˘Ï¿¯ÈÛÙÔÓ 10 sec, Ì ·ÚÂÌ‚ÔÏ‹ ‰È·Ï›ÌÌ·ÙÔ˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 7 sec. Â) ∏ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ º¶∞ ÂËÚ¿˙ÂÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË ÙˆÓ ÔÊı·ÏÌÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘. ªÂٷ͇ ÙˆÓ ÙÚÈÒÓ Èı·ÓÒÓ Î·Ù·ÛÙ¿ÛˆÓ: i) ÔÊı·ÏÌÔ› Û˘Ó¯Ҙ ·ÓÔÈÎÙÔ›, ii) ÔÊı·ÏÌÔ› Û˘Ó¯Ҙ ÎÏÂÈÛÙÔ› Î·È iii) ÔÊı·ÏÌÔ› ·Ú¯Èο ·ÓÔÈÎÙÔ› Ô˘ ÎÏ›ÓÔ˘Ó ÛÙÔ Ì¤ÛÔÓ Ù˘ ÚÈ‹˜ ÙˆÓ ¢º∂, ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ô ÙÚ›ÙÔ˜ ÙÚfiÔ˜ ¤¯ÂÈ Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· Û˘Óԉ¢Ù› ·fi º¶∞. ∂›Ó·È, Û˘ÓÂÒ˜, Ô ÔÚıfi˜ ÙÚfiÔ˜ Ú·ÁÌ·ÙÔÔ›ËÛ˘ Ù˘ ÂͤٷÛ˘. ∂¿Ó ÎÚÈı› ··Ú·›ÙËÙÔ, ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·È ÔÈ ÙÚÂȘ ̤ıÔ‰ÔÈ. ø˜ ʈÙÔ·ÚÔ͢ÛÌÈ΋ ·ÓÙ›‰Ú·ÛË (º¶∞) ¯·Ú·ÎÙËÚ›˙ÂÙ·È Ë ÂÌÊ¿ÓÈÛË Ù˘È΋˜ ÂÈÏËÙfiÌÔÚÊ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (·È¯Ì¤˜ ‹ ÔÏ˘·È¯Ì¤˜ ‹ ·È¯ÌËÚ¿ ·̷ٷ ·ÎÔÏÔ˘ıÔ‡ÌÂÓ· ‹ fi¯È ·fi ‚Ú·‰¤· ·̷ٷ) ηٿ ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛË ÙˆÓ ¢º∂. ∫¿ı ¿ÏÏÔ˘ Ù‡Ô˘ Â˘Ú‹Ì·Ù·, fiˆ˜ ·ÚÔ͢ÛÌÈο ·̷ٷ ı ‹ ‰, ‰ÂÓ ıˆÚÔ‡ÓÙ·È ˆ˜ ·ıÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË. ∏ º¶∞ ÂÌÊ·Ó›˙ÂÙ·È
Û˘ÓËı¤ÛÙÂÚ· Ì ÂÚÂı›ÛÌ·Ù· Û˘¯ÓfiÙËÙ·˜ 10-20 Hz, ÂÓÒ Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ Ù˘ ÌÂÈÒÓÂÙ·È fiÛÔ ·˘Í¿ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÚÂıÈÛÌÔ‡. ªÔÚ› fï˜ Ó· ÂÌÊ·ÓÈÛÙ› Î·È Ì οı ¿ÏÏË Û˘¯ÓfiÙËÙ·. ∆Ô ¿ÙÔÌÔ Ô˘ ÂÌÊ·Ó›˙ÂÈ º¶∞ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ʈÙÔ¢·›ÛıËÙÔ. ∏ º¶∞ ÌÔÚ› Ó· ‰È·ÚΛ fiÛÔ ÙÔ ÊˆÙÂÈÓfi ÂÚ¤ıÈÛÌ· ‹ ÏÈÁfiÙÂÚÔ ‹ Ó· ÂÈ̤ÓÂÈ ÁÈ· ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Î·È ÌÂÙ¿ ÙË Ï‹ÍË ÙÔ˘. Œ¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë º¶∞ ˘ÂÚ‚·›ÓÂÈ ÙË Ï‹ÍË ÙÔ˘ ʈÙÂÈÓÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜, Ë Èı·ÓfiÙËÙ· ÙÔ ¿ÙÔÌÔ Ó· ¿Û¯ÂÈ ·fi ÂÈÏË„›· Â›Ó·È ·˘ÍË̤ÓË (42), ÁÂÁÔÓfi˜, fï˜, Ô˘ ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È ·fi ¿ÏϘ ÌÂϤÙ˜. ∏ ÚÔ·Ó·ÊÂÚfiÌÂÓË Ì¤ıÔ‰Ô˜ ÌÂϤÙ˘ Ù˘ Ê/ Ì ¯Ú‹ÛË ¢º∂ Ï¢ÎÔ‡ ʈÙfi˜ Â›Ó·È Î·ıÈÂڈ̤ÓË ˆ˜ ÂͤٷÛË ÚÔ˘Ù›Ó·˜, ηıÒ˜ Â›Ó·È Ë Ï¤ÔÓ ·Ï‹ ·ÏÏ¿ Î·È Ë Ï¤ÔÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÌÂٷ͇ fiÏˆÓ ÙˆÓ ¿ÏÏˆÓ ÙÚfiˆÓ ÂϤÁ¯Ô˘ Ù˘ Ê/ (10,43). ∂›Ó·È, ˆÛÙfiÛÔ, ‰˘Ó·ÙfiÓ Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·È ¿ÏϘ ËÁ¤˜ ʈÙÂÈÓÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ, ›Ù ÁÈ· ÂÚ¢ÓËÙÈÎÔ‡˜ ›Ù ÁÈ· ȉȷ›ÙÂÚÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ÏfiÁÔ˘˜. ¶·Ú·‰Â›ÁÌ·Ù· Ù¤ÙÔÈˆÓ ÊˆÙÂÈÓÒÓ ËÁÒÓ Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: ·) ¢È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· (¢º∂) ‰È¿¯˘ÙÔ˘ ¤Á¯ÚˆÌÔ˘ ʈÙfi˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂÏÂÙËı› Ë Ê/ Û ۯ¤ÛË Ì ٷ ‰È¿ÊÔÚ· Û˘ÛÙ·ÙÈο ÙÔ˘ Ï¢ÎÔ‡ ʈÙfi˜. ø˜ ÂÚÂıÈÛÙÈÎfiÙÂÚÔ ıˆÚÂ›Ù·È ÙÔ ‚·ı‡ ÂÚ˘ıÚfi ¯ÚÒÌ·. ‚) ∏ ·ÚÔ˘Û›· Û/ ÂϤÁ¯ÂÙ·È Ì ÂȉÈ΋ ÔıfiÓË Î·È software, ̤ۈ ÙˆÓ ÔÔ›ˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙ·ıÂÚ¿ ‹ ·ÏÏfiÌÂÓ· ÁˆÌÂÙÚÈο Û¯¤‰È·, fiˆ˜ ¢ı›˜ ‹ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ˜ ψڛ‰Â˜ ʈÙfi˜, ÎԢΛ‰Â˜ Î.Ï. Á) ∂¿Ó ÂÛÙÈ¿˙ÂÙ·È ÙÔ ÂӉȷʤÚÔÓ ÛÙÔÓ ÚfiÏÔ Ù˘ ÙËÏÂfiÚ·Û˘ ‹ ÙˆÓ ‚ÈÓÙÂԷȯÓȉÈÒÓ, ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÔÈ ·ÓÙ›ÛÙÔȯ˜ Û˘Û΢¤˜, ·ÛÚfiÌ·˘Ú˜ ‹ ¤Á¯ÚˆÌ˜, Ì ÔÈΛÏÔ ÔÙÈÎfi ÂÚȯfiÌÂÓÔ (Û˘ÓËıÈṲ̂ÓÔ ÙËÏÂÔÙÈÎfi ÚfiÁÚ·ÌÌ·, ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ‚ÈÓÙÂԷȯӛ‰È· Î.Ï.).
¶·ıÔÏÔÁÈ΋ Ê˘ÛÈÔÏÔÁ›· ∏ Ê/ ÂÈÏË„›· ¤¯ÂÈ ÌÂÏÂÙËı› ÂÎÙÂٷ̤ӷ ÛÙÔÓ ÁÂÓÂÙÈο Ê/ ›ıËÎÔ Papio papio (44). ∆Ô ÌÂÛÔÏfi‚ÈÔ ·ÔÙÂÏ› Ô˘ÛÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ - ÁÈ· ÙËÓ ÚfiÎÏËÛË Ê/ ÎÚ›ÛÂˆÓ - ÂÁÎÂÊ·ÏÈ΋ ‰ÔÌ‹ Û ·˘ÙfiÓ ÙÔÓ ›ıËÎÔ Î·È Èı·ÓÒ˜ Î·È ÛÙÔÓ ¿ÓıÚˆÔ (45). ™Â ·ÌÊfiÙÂÚ˜ ÙȘ ÂÚÈÙÒÛÂȘ, Ô ÚˆÙÔÁÂÓ‹˜ ÔÙÈÎfi˜ ÊÏÔÈfi˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙË Û˘Á¯ÚÔÓÈṲ̂ÓË ‰È¤ÁÂÚÛË ÙˆÓ ÓÂ˘ÚˆÓÈÎÒÓ ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
Pediatr July-Aug 05 new
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΢Îψ̿وÓ, Ë ÔÔ›· Û¯ÂÙ›˙ÂÙ·È Ì ٷ ÎÏÈÓÈο Ê·ÈÓfiÌÂÓ·. Œ¯ÂÈ, ›Û˘, ·Ú·ÙËÚËı› fiÙÈ ÛÙȘ ÈÓȷΤ˜ ÂÚÈÔ¯¤˜ ηٷÁÚ¿ÊÔÓÙ·È ·È¯Ì¤˜ ‹ Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ 100-300 ms ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÁÂÓÈÎÂ˘Ì¤Ó˘ º¶∞, ÛÙÔ ∏∂° ÎÏÈÓÈο Ê/ ·ÛıÂÓÒÓ (38). ªÂϤÙ˜ Û Û/ ¿ÙÔÌ· ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÁÂÓÈÎÂ˘Ì¤ÓË ÂÈÏËÙÈ΋ ÎÚ›ÛË ÌÔÚ› Ó· ÚÔÎÏËı› ÌÂ Ê˘ÛÈÔÏÔÁÈο ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·, ·ÚΛ ·˘Ù¿ Ó· Â›Ó·È Â·Ú΋ ÛÙÔ Ó· ‰ÈÂÁ›ÚÔ˘Ó Ì›· “ÎÚ›ÛÈÌË” Ì¿˙· Ó¢ÚÒÓˆÓ ÛÂ Û˘Á¯ÚÔÓÈṲ̂ÓË ‰È¤ÁÂÚÛË, Ë ÔÔ›· ¤¯ÂÈ ·ÊÂÙËÚ›· ÙÔÓ ÈÓÈ·Îfi ÏÔ‚fi ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, ÂÂÎÙ›ÓÂÙ·È ÛÙÔÓ ˘fiÏÔÈÔ ÂÁΤʷÏÔ (46). ∂›Ó·È, ÂÔ̤ӈ˜, Èı·Ófi fiÙÈ ÛÙÔ ÁÂÓÂÙÈο ÚԉȷÙÂıÂÈ̤ÓÔ ¿ÙÔÌÔ Ù· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· Ô˘ ‰È·ı¤ÙÔ˘Ó ÎÚ›ÛÈÌ· Ê˘ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ô‰ËÁÔ‡Ó Û ̷˙È΋ Î·È Û˘Á¯ÚÔÓÈṲ̂ÓË ÂÎÊfiÚÙÈÛË ÓÂ˘ÚˆÓÈÎÒÓ Î˘ÎÏˆÌ¿ÙˆÓ ÙÔ˘ ÈÓÈ·ÎÔ‡ ÏÔ‚Ô‡. ∂¿Ó Ë ÂÎÊfiÚÙÈÛË ·˘ÙÔÂÚÈÔÚ›˙ÂÙ·È, ÚÔηÏ› ·ÏÒ˜ ÂÌÊ¿ÓÈÛË º¶∞. ∞ÓÙÈı¤Ùˆ˜, Â¿Ó Ë Ì·˙È΋ ÂÎÊfiÚÙÈÛË ÂÂÎÙ·ı› ÛÙÔÓ ˘fiÏÔÈÔ ÂÁΤʷÏÔ, ı· ÚÔÎÏËıÔ‡Ó ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. Œ¯ÂÈ, Û˘ÓÂÒ˜, ˘ÔÛÙËÚȯı› fiÙÈ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ‡·ÚÍË ‹ fi¯È ÎÏÈÓÈο ·ÓÙÈÏËÙÒÓ ÂÛÙÈ·ÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙËÓ ¤Ó·ÚÍË Ì›·˜ Ê/ ÎÚ›Û˘, ÔÈ ÎÚ›ÛÂȘ ·˘Ù¤˜ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ·ÔÙÂÏÔ‡Ó ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ Ì ·ÛÙÚ·È·›· ‰Â˘ÙÂÚÔÁÂÓ‹ ÁÂӛ΢ÛË (38). ∏ ·Ú·‰Ô¯‹ ·˘Ù‹ ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÂΛÓË Î·Ù¿ ÙËÓ ÔÔ›· Ë Ê/ ÂÈÏË„›· ·ÔÙÂÏ› ÁÂÓÈÎÂ˘Ì¤ÓË ÌÔÚÊ‹ ÂÈÏË„›·˜. ¶ÚfiÎÂÈÙ·È, fï˜, ÁÈ· ¤Ó· ·ÎfiÌË ·Ú¿‰ÂÈÁÌ· fiÙÈ ÔÈ ¤ÓÓÔȘ ÁÂÓÈÎÂ˘Ì¤ÓË Î·È ÂÛÙȷ΋ ÌÔÚÊ‹ ÂÈÏË„›·˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ‰ÔÁÌ·ÙÈο ‰È·¯ˆÚÈṲ̂Ó˜ ¤ÓÓÔȘ, ·ÏÏ¿ Ì¿ÏÏÔÓ ÙȘ ‰‡Ô ¿ÎÚ˜ ÂÓfi˜ Û˘Ó¯fiÌÂÓÔ˘ Ê¿ÛÌ·ÙÔ˜ ÂÈÏËÙÈÎÒÓ ÂΉËÏÒÛˆÓ, οÙÈ ÙÔ ÔÔ›Ô Á›ÓÂÙ·È ·Ô‰ÂÎÙfi Î·È ·fi ÙËÓ ÈÔ ÚfiÛÊ·ÙË ÚfiÙ·ÛË ∆·ÍÈÓfiÌËÛ˘ ÙˆÓ ∂ÈÏË„ÈÒÓ (9). ∆Ô ÌÔÓÙ¤ÏÔ ·˘Ùfi ·ÔÙÂÏ›, ›Û˘, Ù˘ÈÎfi ·Ú¿‰ÂÈÁÌ· ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È ÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ì ÙÔÈ΋ ËÁ‹ ÚÔ¤Ï¢Û˘ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÏÂÈÙÔ˘ÚÁÈ΋˜ ‰È¤ÁÂÚÛ˘ Ù˘ ÂÚÈÔ¯‹˜ ·˘Ù‹˜ Î·È ›Ûˆ˜ Ó· ¤¯ÂÈ ÂÊ·ÚÌÔÁ‹ Î·È Û ¿ÏϘ ·ÓÙ·Ó·ÎÏ·ÛÙÈΤ˜ ÂÈÏË„›Â˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÂÚÂı›ÛÌ·Ù· fiˆ˜ Ë ÌÔ˘ÛÈ΋, Ë ·Ó¿ÁÓˆÛË, Ë ÛΤ„Ë, Ë Ú¿ÍË Î.Ï.
∆ËÏÂfiÚ·ÛË, ‚ÈÓÙÂԷȯӛ‰È· Î·È ÊˆÙÔ¢·ÈÛıËÛ›· O Û‡Á¯ÚÔÓÔ˜ ¿ÓıÚˆÔ˜, ÂȉÈο ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ÎÔÈӈӛ˜, ‰··Ó¿ ÔÏϤ˜ ÒÚ˜ ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
ÌÚÔÛÙ¿ ÛÙËÓ ÔıfiÓË Ù˘ ÙËÏÂfiÚ·Û˘ ‹ ÂÓfi˜ ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹, ›Ù ÁÈ· „˘¯·ÁˆÁ›· ›Ù ÁÈ· ·ÁÁÂÏÌ·ÙÈÎÔ‡˜ ÏfiÁÔ˘˜. ∆· ·È‰È¿ ‰È·ÛΉ¿˙Ô˘Ó Ì ٷ ‰È¿ÊÔÚ· ‚ÈÓÙÂԷȯӛ‰È·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ÔıfiÓ˜ ÚÔ‚ÔÏ‹˜ ›Ù ÙËÓ ÙËÏÂfiÚ·ÛË Â›Ù ÙÔÓ ∏/À ›Ù ÙË ÌÈÎÚ‹ ¯ÂÈÚÔΛÓËÙË ÔıfiÓË Ô˘ Û˘Óԉ‡ÂÈ ÙÔ ·È¯Ó›‰È. ™Â fiϘ ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, ÙÔ Â›‰ˆÏÔ Û¯ËÌ·Ù›˙ÂÙ·È ÛÙËÓ ÔıfiÓË ·fi Ù·¯¤ˆ˜ ·ӷϷ̂·ÓfiÌÂÓ˜ ÂÈÎfiÓ˜ ηÈ, Û˘ÓÂÒ˜, ‰ÂÓ ·ÔÙÂÏ› ¤ÎÏËÍË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ Û˘Û΢¤˜ ·˘Ù¤˜ ÌÔÚ› Ó· ÂÌϤÎÔÓÙ·È Ì ÙËÓ ÂÈÏË„›·. ¢Â‰Ô̤Ó˘, ÏÔÈfiÓ, Ù˘ Â˘Ú‡Ù·Ù˘ ¯Ú‹Û˘ ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Â‡ÏÔÁ· ÌÂÁ¿ÏË ·ÓËÛ˘¯›· ÛÙÔ Â˘Ú‡ ÎÔÈÓfi. ∞Ú¯Èο ıˆڋıËΠfiÙÈ ÔÈ ÚÔηÏÔ‡ÌÂÓ˜ ·fi ÙËÓ ÙËÏÂfiÚ·ÛË ÎÚ›ÛÂȘ ÔÊ›ÏÔÓÙ·Ó Û ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ Û˘Û΢‹˜ Î·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÎÈÓÔ‡ÌÂÓˆÓ ÁÚ·ÌÌÒÛˆÓ. ™‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·˘Ùfi ‰ÂÓ ÈÛ¯‡ÂÈ Î·È ¤¯ÂÈ ‚ÚÂı› fiÙÈ Ô ÊˆÙÔÂÚÂıÈÛÙÈÎfi˜ ÚfiÏÔ˜ ÂÓfi˜ ÙËÏÂÔÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙÚÂȘ ·Ú·Ì¤ÙÚÔ˘˜.
∞. ¶·Ú¿ÁÔÓÙ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ÙËÓ ›‰È· ÙË Û˘Û΢‹ ∏ ‚·ÛÈ΋ ·Ú¿ÌÂÙÚÔ˜ Â›Ó·È Ô Ú˘ıÌfi˜ ·Ó·Ó¤ˆÛ˘ (refresh rate) Ù˘ ÔıfiÓ˘, ‰ËÏ·‰‹ Ë Ù·¯‡ÙËÙ· Ì ÙËÓ ÔÔ›· ·ӷϷ̂¿ÓÔÓÙ·È ÔÈ ÂÈÎfiÓ˜, ¤ÙÛÈ ÒÛÙÂ Ô ÂÁΤʷÏÔ˜ Ó· ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙËÓ ÂÈÎfiÓ· ˆ˜ ·Î›ÓËÙË. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË, Ô Ú˘ıÌfi˜ ·Ó·Ó¤ˆÛ˘ ÈÛÔ‡Ù·È Ì ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ÔÈÎÈ·ÎÔ‡ Ú‡̷ÙÔ˜ Ô˘ Â›Ó·È 50 Hz ÁÈ· ÙËÓ ∂˘ÚÒË (Î·È ÙÌ‹Ì· Ù˘ π·ˆÓ›·˜) Î·È 60 Hz ÁÈ· ÙȘ ∏¶∞, ÂÓÒ ÁÈ· ÙȘ ÔıfiÓ˜ ∏/À Ô Ú˘ıÌfi˜ ·Ó·Ó¤ˆÛ˘ Â›Ó·È Ú˘ıÌÈ˙fiÌÂÓÔ˜ ÌÂٷ͇ 60 Hz Î·È 120 Hz. Ÿˆ˜ ¤¯ÂÈ ÚÔ·Ó·ÊÂÚı›, Ë º¶∞ Â›Ó·È Ï¤ÔÓ ¤Î‰ËÏË ÛÙȘ ÌÂÛ·›Â˜ Û˘¯ÓfiÙËÙ˜ ÂÚÂıÈÛÌÔ‡, ÌÂٷ͇ 10 Hz Î·È 20 Hz, ˘Ê›ÛÙ·Ù·È fï˜ Î·È ÛÙȘ ˘„ËÏfiÙÂÚ˜ Û˘¯ÓfiÙËÙ˜, ηıÒ˜ 50% ÙˆÓ Ê/ ·ÛıÂÓÒÓ ·ÓÙȉڿ Ì º¶∞ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ 50 Hz, ÂÓÒ ¤Ó· Ôχ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·ÓÙȉڿ ·ıÔÏÔÁÈο ÛÙ· 60 Hz. ∞˘Ùfi ÂӉ¯Ô̤ӈ˜ ÂÍËÁ› ÁÈ·Ù› ÔÈ ÂÎ ÙËÏÂÔÚ¿Ûˆ˜ Ê/ ÎÚ›ÛÂȘ ·ÔÙÂÏÔ‡Ó ÌÂÁ·Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ÛÙËÓ ∂˘ÚÒË Û˘ÁÎÚÈÙÈο Ì ÙȘ ∏¶∞. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ∂˘ÚÒË Î˘ÎÏÔÊÔÚÔ‡Ó ÔıfiÓ˜ ÙËÏÂfiÚ·Û˘ Ì ڢıÌfi ·Ó·Ó¤ˆÛ˘ 100 Hz. ∞˘Ù¤˜ ÔÈ ÓÂfiÙÂÚÔ˘ Ù‡Ô˘ ÔıfiÓ˜ ÙËÏÂfiÚ·Û˘ ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ Ê/ ÎÚ›Û˘ (40). ÷ڷÎÙËÚÈÛÙÈο Â›Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· ÔÏ˘ÎÂÓÙÚÈ΋˜ Â˘Úˆ·˚΋˜ ¤Ú¢ӷ˜ (10), fiÔ˘ Û˘ÁÎÚ›ıËÎ·Ó ÙËÏÂÔÚ¿ÛÂȘ ÙˆÓ 50 Hz Î·È 100 Hz Ì ‰È¿ÊÔÚ· ÙËÏÂÔÙÈο
Pediatr July-Aug 05 new
22-07-05
12:16
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ºˆÙÔ¢·›ÛıËÙË ÂÈÏË„›·
ÚÔÁÚ¿ÌÌ·Ù·: Û‡ÓËı˜, ÂÚÂıÈÛÙÈÎfi (ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·) Î·È ÙÔ ‚ÈÓÙÂԷȯӛ‰È “Super Mario World” (¶›Ó·Î·˜ 1). ¶ÚԤ΢„Â Î·È Ì ٷ ÙÚ›· ›‰Ë ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ º¶∞, ÂÓÒ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË Ì ÙË ¯Ú‹ÛË ÔıfiÓ˘ 100 Hz.
µ. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙÔ ÔÙÈÎfi ÂÚȯfiÌÂÓÔ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ª›· ÙËÏÂÔÙÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ù· ¯ÚÒÌ·Ù· Ô˘ ÂÚȤ¯ÂÈ, ÙË ÁÂÓÈ΋ ʈÙÂÈÓfiÙËÙ¿ Ù˘, ÙÔ contrast, ‰ËÏ·‰‹ ÙË ‰È·ÊÔÚ¿ ʈÙÂÈÓfiÙËÙ·˜ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÙÌËÌ¿ÙˆÓ Ù˘ (ÛÎÔ‡Ú· Î·È ÊˆÙÂÈÓ¿ ÛËÌ›·), ÙËÓ Ù·¯‡ÙËÙ· Ô˘ ÂÓ·ÏÏ¿ÛÛÔÓÙ·È ·˘Ù¿ Ù· ÛÙÔȯ›· Î·È ÙËÓ Ù˘¯fiÓ ·ÚÔ˘Û›· Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ¯·Ú·ÎÙ‹Ú· ۯ‰›ˆÓ Î·È Ï¿Ì„ÂˆÓ ÂÓÙfi˜ Ù˘ ÂÈÎfiÓ·˜. ŸÏ· ·˘Ù¿ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÂËÚ¿˙Ô˘Ó ÙÔÓ ÂÚÂıÈÛÙÈÎfi ¯·Ú·ÎÙ‹Ú· ÂÓfi˜ ÙËÏÂÔÙÈÎÔ‡ ı¿̷ÙÔ˜. Œ¯ÂÈ, ›Û˘, ‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ Ë ÂÓÂÚÁfi˜ Û˘ÌÌÂÙÔ¯‹ Û ¤Ó· ‚ÈÓÙÂԷȯӛ‰È (Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·Ï‹ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘) ·ÛΛ ¤Ó·Ó ÂÈϤÔÓ ÂÈ‚·Ú˘ÓÙÈÎfi ÚfiÏÔ, ¯ˆÚ›˜ fï˜ ·˘Ùfi Ó· ¤¯ÂÈ ·Ô‰Âȯı› (10). ∆· ΢ÚÈfiÙÂÚ· ÔÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ì ·˘ÍË̤ÓË ÊˆÙÔÂÚÂıÈÛÙÈÎfiÙËÙ· ›ӷÈ: ·) ∆Ô Â›‰Ô˜ ÙÔ˘ ¯ÚÒÌ·ÙÔ˜ Â›Ó·È Î·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ù˘ Ê/ (26). ∆Ô ‚·ı‡ ÂÚ˘ıÚfi ¯ÚÒÌ· Ì ̋ÎÔ˜ ·̷ÙÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 700 nm (2,26) Â›Ó·È È‰È·›ÙÂÚ· ÂÚÂıÈÛÙÈÎfi, fiˆ˜ Î·È Ë ÂÓ·ÏÏ·Á‹ ÙÔ˘ Ì ÙÔ ‚·ı‡ ÌÏ ¯ÚÒÌ· (26,47). ∏ Û˘ÁÎÂÎÚÈ̤ÓË ·˘Ù‹ ¯ÚˆÌ·ÙÈ΋ ÂÓ·ÏÏ·Á‹ ¯·Ú·ÎÙ‹ÚÈ˙ ÙÔ ÙÌ‹Ì· Ù˘ ÛÂÈÚ¿˜ ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ “Pockemon monster” Ô˘ ÚÔοÏÂÛ ÙË ÁÓˆÛÙ‹ “ÂȉËÌ›·” ÂÈÏË„›·˜ ÛÙËÓ π·ˆÓ›·. ‚) ∆Ô ¤ÓÙÔÓÔ contrast Ù˘ ÂÈÎfiÓ·˜. Á) ∏ ȉȷ›ÙÂÚ· Ù·¯Â›· ÂÓ·ÏÏ·Á‹ ÙˆÓ ÂÈÎfiÓˆÓ Î·È Ë ·ÚÔ˘Û›· ʈÙÂÈÓÒÓ Ï¿Ì„ÂˆÓ ÂÓÙfi˜ Ù˘ ÂÈÎfiÓ·˜. ‰) ∂ÈÎfiÓ˜ Ì ·Ú¿ÏÏËϘ, οıÂÙ˜, ·ÎÙÈÓÔÂȉ›˜ ‹ ΢ÎÏÈΤ˜ ψڛ‰Â˜ ·˘ÍË̤Ó˘-ÌÂȈ̤Ó˘ ʈÙÂÈÓfiÙËÙ·˜ (ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 Ù¤ÙÔÈ· ˙‡ÁË), ÂȉÈο Â¿Ó Ù· Û¯¤‰È· ·˘Ù¿ ÎÈÓÔ‡ÓÙ·È, ¿ÏÏÔÓÙ·È ‹ ÂÚÈÛÙÚ¤ÊÔÓÙ·È. ∆¤ÙÔÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ·ÊıÔÓÔ‡Ó Û ÙËÏÂÔÙÈΤ˜ ‰È·ÊËÌ›ÛÂȘ, ·È‰Èο ÚÔÁÚ¿ÌÌ·Ù· Ì ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ·ÏÏ¿ Î·È ÛÙ· ÂÚÈÛÛfiÙÂÚ· ‚ÈÓÙÂԷȯӛ‰È·. ∏ ÚÔ·Ó·ÊÂÚı›۷ Â˘Úˆ·˚΋ ÌÂϤÙË (10) ÂÚ‡ÓËÛ ÙÔÓ ÊˆÙÔÂÚÂıÈÛÙÈÎfi ÚfiÏÔ ÙˆÓ ‰È·ÊfiÚˆÓ ÙËÏÂÔÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ Â›‰Ô˜ Ù˘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˘ ÙËÏÂfiÚ·Û˘ Î·È Ù· η٤ٷÍ - ηٿ Êı›ÓÔ˘Û· ÛÂÈÚ¿ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ - ˆ˜ ÂÍ‹˜:
¶›Ó·Î·˜ 1. ºˆÙÔ¢·ÈÛıËÛ›·, ›‰Ô˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È Û˘Û΢¤˜ ÙËÏÂfiÚ·Û˘ ¶ÔÛÔÛÙfi % Ê/ ·ÛıÂÓÒÓ ∆ËÏÂfiÚ·ÛË ∆ËÏÂfiÚ·ÛË 50 Hz 100 Hz ∂ÚÂıÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· µÈÓÙÂԷȯӛ‰È ™‡ÓËı˜ ÚfiÁÚ·ÌÌ·
37% 22% 20%
21% 9% 6%
¶ÔÛÔÛÙ¿ ÂÌÊ¿ÓÈÛ˘ º¶∞ ÛÙÔ ∏∂° ÁÓˆÛÙÒÓ Ê/ ·ÛıÂÓÒÓ, ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ ÙÔ˘ ÙËÏÂÔÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙÔÓ Ù‡Ô Ù˘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˘ ÔıfiÓ˘ ÙËÏÂfiÚ·Û˘. ™˘ÁÎÚ›ÓÔÓÙ·È ¤Ó· Û‡ÓËı˜ ÚfiÁÚ·ÌÌ·, ¤Ó· ÂÚÂıÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· (ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È· Ì ¤ÓÙÔÓ˜ ÂÓ·ÏÏ·Á¤˜ ʈÙÂÈÓfiÙËÙ·˜, ¯ÚˆÌ¿ÙˆÓ Î·È Ï¿Ì„ÂˆÓ) Î·È ¤Ó· ‚ÈÓÙÂԷȯӛ‰È. ∂›Ó·È Û·Ê‹˜ Ë ‰È·ÊÔÚÂÙÈ΋ ÂÈÎÈÓ‰˘ÓfiÙËÙ· ÙˆÓ ‰È·ÊfiÚˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, ·ÏÏ¿ Î·È Ô “ÚÔÛٷ٢ÙÈÎfi˜” ÚfiÏÔ˜ Ù˘ ÔıfiÓ˘ ÙˆÓ 100 Hz (·fi ‚È‚Ï. ·Ó·ÊÔÚ¿ 43).
1) µÈÓÙÂԷȯӛ‰È (·›ÍÈÌÔ) Û ÙËÏÂfiÚ·ÛË 50 Hz 2) µÈÓÙÂԷȯӛ‰È (·Ú·ÎÔÏÔ‡ıËÛË) Û ÙËÏÂfiÚ·ÛË 50 Hz 3) ∂ÚÂıÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· Û ÙËÏÂfiÚ·ÛË 50 Hz 4) ∂ÚÂıÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· Û ÙËÏÂfiÚ·ÛË 100 Hz 5) ∫·ÓÔÓÈÎfi ÚfiÁÚ·ÌÌ· Û ÙËÏÂfiÚ·ÛË 50 Hz 6) µÈÓÙÂԷȯӛ‰È (·Ú·ÎÔÏÔ‡ıËÛË) Û ÙËÏÂfiÚ·ÛË 100 Hz 7) µÈÓÙÂԷȯӛ‰È (·›ÍÈÌÔ) Û ÙËÏÂfiÚ·ÛË 100 Hz 8) ∫·ÓÔÓÈÎfi ÚfiÁÚ·ÌÌ· Û ÙËÏÂfiÚ·ÛË 100 Hz. ∂›Ó·È ·fiÏ˘Ù· ۷ʤ˜ fiÙÈ Ï¤ÔÓ “ÂÈΛӉ˘Ó·” Â›Ó·È Ù· ÚÔÁÚ¿ÌÌ·Ù· ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ Ì ¤ÓÙÔÓ· ¯ÚÒÌ·Ù· Î·È Ï¿Ì„ÂȘ, ÔÈ ‰È·ÊËÌ›ÛÂȘ Ì ·ÓÙ›ÛÙÔÈ¯Ô ÔÙÈÎfi ÂÚȯfiÌÂÓÔ, Ù· ‰È¿ÊÔÚ· ‚ÈÓÙÂԷȯӛ‰È· ηÈ, Ôχ ÏÈÁfiÙÂÚÔ, Ù· Û˘ÓËıÈṲ̂ӷ ÙËÏÂÔÙÈο ÚÔÁÚ¿ÌÌ·Ù·. O ΛӉ˘ÓÔ˜ ÌÂÈÒÓÂÙ·È Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Â¿Ó ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÔıfiÓË 100 Hz. O ΛӉ˘ÓÔ˜, ›Û˘, ÌÂÈÒÓÂÙ·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ·fiÛÙ·ÛË ı·ً-ÔıfiÓ˘ Î·È Â¿Ó ·ÓÙ› ¤Á¯ÚˆÌË - Ë ÔıfiÓË Â›Ó·È ·ÛÚfiÌ·˘ÚË. °È· Ó· ÌÂȈı› Ô Èı·Ófi˜ ΛӉ˘ÓÔ˜ ·fi Ù· ÙËÏÂÔÙÈο ÚÔÁÚ¿ÌÌ·Ù·, Ë ª. µÚÂÙ·Ó›· ¤¯ÂÈ ÂΉÒÛÂÈ Û˘ÁÎÂÎÚÈ̤Ó˜ Ô‰ËÁ›Â˜ ÛÙÔ˘˜ ·Ú·ÁˆÁÔ‡˜ ÙËÏÂÔÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, οÙÈ Ô˘ - ÚÔ˜ ÙÔ ·ÚfiÓ - ‰ÂÓ ÈÛ¯‡ÂÈ ÁÈ· ÙËÓ ˘fiÏÔÈË ∂˘ÚÒË ‹ ÙȘ ∏¶∞.
°. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙÔÓ ÙÚfiÔ ÙËÏÂı¤·Û˘ ◊‰Ë ·Ó·Ê¤ÚıËΠfiÙÈ Ë ·fiÛÙ·ÛË ÌÂٷ͇ ÙÔ˘ ÙËÏÂı·ً Î·È Ù˘ ÔıfiÓ˘ Â›Ó·È ÎÚ›ÛÈÌ˘ ÛËÌ·Û›·˜, ηıÒ˜ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÎÚ›ÛÂȘ ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
Pediatr July-Aug 05 new
22-07-05
12:16
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¡. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜
Û˘Ì‚·›ÓÔ˘Ó fiÙ·Ó ÙÔ ¿ÙÔÌÔ ‚Ú›ÛÎÂÙ·È Ôχ ÎÔÓÙ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË. ∆Ô ÁÂÁÔÓfi˜ ¤¯ÂÈ ‰ÈÏ‹ ÂÍ‹ÁËÛË. ∏ ÚÒÙË Â›Ó·È fiÙÈ fiÛÔ ÌÈÎÚfiÙÂÚË Â›Ó·È Ë ·fiÛÙ·ÛË ·ÓÙÈÎÂÈ̤ÓÔ˘-ÔÊı·ÏÌÔ‡ ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ Â›Ó·È ÙÔ Û¯ËÌ·ÙÈ˙fiÌÂÓÔ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹ ¯ÈÙÒÓ· ›‰ˆÏÔ, Û˘ÓÂÒ˜ ÙfiÛÔ ÈÔ ÂÎÙÂٷ̤ÓË Ë ÂÚÂıÈ˙fiÌÂÓË ÂÚÈÔ¯‹ ÙÔ˘ ÔÙÈÎÔ‡ ÊÏÔÈÔ‡ ηÈ, ¿Ú·, Ôχ ÈÔ Èı·Ó‹ Ì›· Û˘Á¯ÚÔÓÈṲ̂ÓË ËÏÂÎÙÚÈ΋ ÂÎÊfiÚÙÈÛË Ù˘ ÂÚÈÔ¯‹˜ ·˘Ù‹˜. ∏ ‰Â‡ÙÂÚË Èı·Ó‹ ÂÍ‹ÁËÛË Â›Ó·È fiÙÈ ·fi Ôχ ÎÔÓÙÈÓ‹ ·fiÛÙ·ÛË Ô ÙËÏÂı·ً˜ ÌÔÚ› Ó· ‰È·ÎÚ›ÓÂÈ - ÂÎÙfi˜ ·fi ÙËÓ ·Ó·Ó¤ˆÛË Ù˘ ÂÈÎfiÓ·˜ Ì 50 Hz - Î·È Ì›· ‰È·ÏÂÎfiÌÂÓË Û¿ÚˆÛË Ù˘ ÂÈÎfiÓ·˜ ›ÛË Ì ÙÔ ‹ÌÈÛ˘ ÙÔ˘ ÔÈÎÈ·ÎÔ‡ Ú‡̷ÙÔ˜, ‰ËÏ·‰‹ ÛÙ· 25 Hz (48). ∏ Û˘¯ÓfiÙËÙ· ·˘Ù‹ Â›Ó·È ¤ÓÙÔÓ· ʈÙÔÂÚÂıÈÛÙÈ΋ Î·È Èı·ÓfiÓ ·˘Í¿ÓÂÈ ÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ· Ù˘ ÙËÏÂı¤·Û˘. O ¿ÏÏÔ˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Â›Ó·È Â¿Ó Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÙËÏÂfiÚ·Û˘ Á›ÓÂÙ·È ‰ÈfiÊı·ÏÌ· (Ë Û˘Ó‹ı˘ ηٿÛÙ·ÛË) ‹ ÌÔÓfiÊı·ÏÌ· (Ì ÙÔ ¤Ó· Ì¿ÙÈ ÎÏÂÈÛÙfi). ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ º¶∞ Î·È Â›Ó·È Â‡ÏÔÁÔ, ·ÏÏ¿ fi¯È ·Ô‰Â‰ÂÈÁ̤ÓÔ, fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Ì›·˜ ÎÚ›Ûˆ˜ Â›Ó·È Â›Û˘ ÌÂȈ̤ÓÔ˜.
∞ÓÙÈÌÂÙÒÈÛË OÈ ÂÈÏÔÁ¤˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÊˆÙÔ¢·›ÛıËÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ÊÂÓfi˜ ÙËÓ ·ÔÊ˘Á‹ ‹ ÙË Ì›ˆÛË Ù˘ ¤ÎıÂÛ˘ ÛÙ· Û˘ÁÎÂÎÚÈ̤ӷ ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· Ô˘ ÂÎÏ‡Ô˘Ó ÙȘ ÎÚ›ÛÂȘ, ·ÊÂÙ¤ÚÔ˘ ÙË ¯Ú‹ÛË ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ. O ·ÛıÂÓ‹˜ Ô˘ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÌfiÓÔ Ì›· ‹ ÌÈÎÚfi ·ÚÈıÌfi Î·È ‹ÈÔ˘ ¯·Ú·ÎÙ‹Ú· ÎÚ›ÛÂȘ Û ۷ʤÛÙ·ÙË Û˘Û¯¤ÙÈÛË ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· (.¯. ÙËÏÂfiÚ·ÛË, ‚ÈÓÙÂԷȯӛ‰È·, ʈÙÔÚ˘ıÌÈο Î.Ï.) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈϤÍÂÈ ˆ˜ ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ˘ ÙËÓ ·˘ÛÙËÚ‹ ·ÔÊ˘Á‹ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ ‹ ÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÙÚfiÔ˘ ·ʋ˜ ÙÔ˘ Ì ٷ ÂÚÂı›ÛÌ·Ù· ·˘Ù¿. µÂ‚·›ˆ˜, ÏfiÁˆ ÙÔ˘ ΢ڛ·Ú¯Ô˘ ÚfiÏÔ˘ Ù˘ ÙËÏÂfiÚ·Û˘ ÛÙË ˙ˆ‹ Ì·˜, Ë Ï‹Ú˘ ·ÔÊ˘Á‹ Ù˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË - ·Ó fi¯È Ô˘ÙÔÈ΋ - χÛË. ∂ȉÈο ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ, Ë ÂÓÙÔÏ‹ ·ÔÊ˘Á‹˜ Ù˘ ÙËÏÂfiÚ·Û˘ ı· ÌÔÚÔ‡Û ӷ ÂÎÏËÊı› Î·È ˆ˜ “·Ú·‚›·ÛË” ÙˆÓ ·ÓıÚˆ›ÓˆÓ ‰ÈηȈ̿وÓ! ∂›Ó·È, ˆÛÙfiÛÔ, ·fiÏ˘Ù· ÂÊÈÎÙfi Ó· ÏËÊıÔ‡Ó ÔÚÈṲ̂ӷ ̤ÙÚ· Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ. ∫·Ù’ ·Ú¯¿˜, Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓÈÛÙ› fiÙÈ Ë ¶·È‰È·ÙÚÈ΋ 2005;68:257-266
·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘ ‰ÂÓ Â›Ó·È ÁÂÓÈο “ÂÈÏËÙÔÁfiÓÔ˜” Î·È ‰ÂÓ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÎÚ›ÛÂȘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ·Ú¿ ÌfiÓÔ Û ÂΛӷ Ù· ¿ÙÔÌ· Ô˘ fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙÔÓ ¤ÏÂÁ¯Ô Ì ∏∂° Â›Ó·È ÊˆÙÔ¢·›ÛıËÙ·. °È· ·˘Ù¿ Î·È ÌfiÓÔÓ Ù· ¿ÙÔÌ· Î·È ÂÊfiÛÔÓ Ë ·ÓÙÂÏ‹˜ ·ÔÊ˘Á‹ Ù˘ ÙËÏÂfiÚ·Û˘ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹, ÚÔÙ›ÓÔÓÙ·È Ù· ·ÎfiÏÔ˘ı· ÚÔÏËÙÈο ̤ÙÚ·: ·) O ¯ÚfiÓÔ˜ ¤ÎıÂÛ˘ ÛÙËÓ ÙËÏÂfiÚ·ÛË ÌÂÈÒÓÂÙ·È ÛÙÔ ÂÏ¿¯ÈÛÙÔ ‰˘Ó·Ùfi. ‚) ∂Ï¿¯ÈÛÙË ÂÈı˘ÌËÙ‹ ·fiÛÙ·ÛË ·Ú·ÎÔÏÔ‡ıËÛ˘ Â›Ó·È Ù· 2 m, ÂÓÒ Ë ·fiÛÙ·ÛË ÙˆÓ 34 m Â›Ó·È ÚÔÙÈÌfiÙÂÚË. ™Â η̛· ÂÚ›ÙˆÛË ‰ÂÓ ÏËÛÈ¿˙Ô˘Ì Ôχ ÎÔÓÙ¿ ÛÙËÓ ÔıfiÓË. Á) Œ¯ÂÈ ‹‰Ë ·Ó·ÊÂÚı› Ô “ÚÔÛٷ٢ÙÈÎfi˜” ÚfiÏÔ˜ ÙˆÓ Û‡Á¯ÚÔÓˆÓ ÙËÏÂÔÚ¿ÛÂˆÓ 100 Hz. ™˘ÓÂÒ˜, Ù· Ê/ ¿ÙÔÌ· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó Û˘Û΢‹ ÙËÏÂfiÚ·Û˘ 100 Hz. ¶ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÔıfiÓË ˘ÔÏÔÁÈÛÙ‹, Ë Û˘¯ÓfiÙËÙ· ·Ó·Ó¤ˆÛ˘ Ú¤ÂÈ Ó· Ú˘ıÌ›˙ÂÙ·È ÛÙ· 100 Hz ‹ ÂÚÈÛÛfiÙÂÚÔ. ‰) ™ÙÔ Ì¤ÙÚÔ ÙÔ˘ ÂÊÈÎÙÔ‡, Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÂÙ·È Ë ·Ú·ÎÔÏÔ‡ıËÛË ¤ÓÙÔÓ· ÂÚÂıÈÛÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ (ÂÚȯfiÌÂÓÔ Ì ٷ¯¤ˆ˜ ÂÓ·ÏÏ·ÛÛfiÌÂÓ˜ ÂÈÎfiÓ˜, Ôχ ¤ÓÙÔÓ· ¯ÚÒÌ·Ù· Î·È ¤ÓÙÔÓË ¯ÚˆÌ·ÙÈ΋ ·ÓÙ›ıÂÛË). ∏ ·Ú·ÎÔÏÔ‡ıËÛË ·ÚfiÌÔÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Û ¿ÛÚÔ-Ì·‡ÚÔ ¯ÚÒÌ· Èı·ÓÒ˜ ÌÂÈÒÓÂÈ ÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ¿ ÙÔ˘˜. O ΛӉ˘ÓÔ˜, ›Û˘, ÂÓ‰¤¯ÂÙ·È Ó· ÌÂÈÒÓÂÙ·È Â¿Ó Ë ·Ú·ÎÔÏÔ‡ıËÛË Á›ÓÂÙ·È Ì ÙÔÓ ¤Ó· ÌfiÓÔÓ ÔÊı·ÏÌfi (ηχÙÔÓÙ·˜ Ì ÙÔ ¯¤ÚÈ ÙÔÓ ¿ÏÏÔ ÔÊı·ÏÌfi). Â) O ηÏfi˜ ʈÙÈÛÌfi˜ ÙÔ˘ ‰ˆÌ·Ù›Ô˘ fiÔ˘ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÙËÏÂfiÚ·ÛË (Ú·ÎÙÈο Ó· Â›Ó·È ·Ó·Ì̤ÓÔ ÙÔ Êˆ˜ ÙÔ˘ ‰ˆÌ·Ù›Ô˘ ÙȘ ‚Ú·‰ÈÓ¤˜ ÒÚ˜) Èı·ÓÒ˜ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ. ÛÙ) ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Û ÂÚÈfi‰Ô˘˜ ·Ûı¤ÓÂÈ·˜ ‹ ÛÙ¤ÚËÛ˘ ‡ÓÔ˘ (¯ˆÚ›˜ Ó· Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› Ú¿ÁÌ·ÙÈ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ). ˙) ∏ ¯Ú‹ÛË ÂȉÈÎÔ‡ Ù‡Ô˘ Á˘·ÏÈÒÓ, Ô˘ ›Ù ·ÔÚÚÔÊÔ‡Ó Û˘ÁÎÂÎÚÈ̤ӷ ¯ÚÒÌ·Ù· ‹ ·ÔÚÚÔÊÔ‡Ó ÌfiÓÔ Ôψ̤ÓÔ Êˆ˜, ıˆÚËÙÈο ı· ÌÔÚÔ‡Û ӷ ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Û ÂΛÓÔ˘˜ ÌfiÓÔ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ì ÂȉÈ΋ ÂÚÁ·ÛÙËÚȷ΋ ÌÂϤÙË ı· ›¯Â ÂÓÙÔÈÛÙ› Ô È‰È·›ÙÂÚÔ˜ ÚfiÏÔ˜ ·˘ÙÒÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ. ™Â Ú·ÎÙÈÎfi ›‰Ô, ÁÂÓÈÎÔ‡ Ù‡Ô˘ Û‡ÛÙ·ÛË ÁÈ· ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ÁÈ·ÏÒÓ ‰ÂÓ ÚÔÙ›ÓÂÙ·È. OÈ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌfiÛÔ˘Ó ·˘Ù¤˜ ÙȘ Ù·ÎÙÈΤ˜ ‹ ·˘Ù¤˜ ¤¯Ô˘Ó ·Ô‰Âȯı› ·Ó·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ‹ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È
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·˘ıfiÚÌËÙ˜ (ÌË ÊˆÙÔ¢·›ÛıËÙ˜) ÎÚ›ÛÂȘ, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ú¤ÂÈ Ó· ÙÂıÔ‡Ó Û ¯ÚfiÓÈ· ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹. ªÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, ÙÔ Ï¤ÔÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ˆ˜ ÚÔ˜ ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ʈÙÔ¢·ÈÛıËÛ›·˜ Â›Ó·È ÙÔ ‚·ÏÚÔ˚Îfi Ô͇ (29,49,50). ∏ Ï·ÌÔÙÚÈÁ›ÓË (51) Î·È ÔÈ ‚ÂÓ˙ԉȷ˙›Ó˜ ıˆÚÔ‡ÓÙ·È ˆ˜ Ê¿Ú̷η ‰Â‡ÙÂÚ˘ ÂÈÏÔÁ‹˜, ÂÓÒ Ù· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌ· ÌÂÏÂÙËı› ·ÚÎÒ˜. ∏ ‰Ú¿ÛË ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ ÔͤԘ Â›Ó·È ÂӉȷʤÚÔ˘Û·, ηıÒ˜ fi¯È ÌfiÓÔ ÂϤÁ¯ÂÈ ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, ·ÏÏ¿ Î·È ÌÂÈÒÓÂÈ ‹ ÂÍ·Ê·Ó›˙ÂÈ ÙÂÏ›ˆ˜ ÙËÓ ÂÚÁ·ÛÙËÚȷο ÂÏÂÁ¯fiÌÂÓË º¶∞. ∂›Ó·È, Û˘ÓÂÒ˜, ‰˘Ó·ÙfiÓ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂڷ›·˜ Î·È ÂӉ¯Ô̤ӈ˜ Ó· ·Ó·ÚÔÛ·ÚÌfi˙ÂÙ·È Ë ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, › ÙË ‚¿ÛÂÈ Ù˘ ÌÂϤÙ˘ Ì ¢º∂. ∏ ÚfiÁÓˆÛË Ù˘ ·ÌÈÁÒ˜ Ê/ ÂÈÏË„›·˜ Â›Ó·È Û¯ÂÙÈο ηϋ, ηıÒ˜ ÔÈ ÎÚ›ÛÂȘ ÂϤÁ¯ÔÓÙ·È Û˘Ó‹ıˆ˜ ‡ÎÔÏ·, ÂÓÒ Û ̷ÎÚÔÚfiıÂÛÌË ‚¿ÛË Ë Ê/ Ù›ÓÂÈ Ó· ÌÂÈÒÓÂÙ·È ÌÂÙ¿ Ù· 30 ¤ÙË (11,52). ŸÙ·Ó Ë Ê/ ˘Ê›ÛÙ·Ù·È ÛÙÔ Ï·›ÛÈÔ Î¿ÔÈÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ Û˘Ó‰ÚfiÌÔ˘, Ë ÚfiÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fiÏ˘Ù· ·fi ÙË Ê‡ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘ÙÔ‡.
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40. Ricci S, Vigevano F, Manfredi M, Kasteleijn-Nolst Trenite DG. Epilepsy provoked by television and video games: safety of 100-Hz screens. Neurology 1998;50:790-793. 41. Kasteleijn-Nolst Trenite DG, Binnie CD, Harding GF, Wilkins A. Photic stimulation: standardization of screening methods. Epilepsia 1999;40 (Suppl 4): S75-S79. 42. Reilly EL, Peters JF. Relationship of some varieties of electroencephalographic photosensitivity to clinical convulsive disorders. Neurology 1973;23:1050-1057. 43. Kasteleijn-Nolst Trenite DG, Martins da Silva A, Ricci S, Rubboli G, Tassinari CA, Lopes J et al. Video games are exciting: a European study of video gameinduced seizures and epilepsy. Epileptic Disord 2002;4:121-128. 44. Menini C, Silva-Barrat C. The photosensitive epilepsy of the baboon. A model of generalized reflex epilepsy. In: Zifkin BG, Andermann F, Beaumanoir A, Rowan AJ, editors. Reflex epilepsies and reflex seizures. Advances in neurology. Vol 75. Philadelphia: Lippincott-Raven Press; 1998. p. 29-47. 45. Brinciotti M, Matricardi M, Pelliccia A, Trasatti G. Pattern sensitivity and photosensitivity in epileptic children with visually induced seizures. Epilepsia 1994;35:842-849. 46. Binnie CD, Findlay J, Wilkins AJ. Mechanisms of epileptogenesis in photosensitive epilepsy implied by the effects of moving patterns. Electroencephalogr Clin Neurophysiol 1985;61:1-6. 47. Shirakawa S, Funatsuka M, Osawa M, Fujita M, Oguni H. A study of the effect of color photostimulation from a cathode-ray tube (CRT) display on photosensitive patients: the effect of alternating redcyan flicker stimulation. Epilepsia 2001;42:922-929. 48. Wilkins AJ, Darby CE, Binnie CD. Neurophysiological aspects of pattern-sensitive epilepsy. Brain 1979;102:1-25. 49. Harding GF, Herrick CE, Jeavons PM. A controlled study of the effect of sodium valproate on photosensitive epilepsy and its prognosis. Epilepsia 1978;19:555-565. 50. Myslobodsky MS, Mintz M, Douglas R. Electroencephalographic and behavioural effects of sodium valproate in patients with photosensitive epilepsy. A single dose trial. J Neurol 1980;224:111-123. 51. Burrow CE, Harding GF, Betts T, Fylan F, Lai M. Preliminary findings of a trial to determine the effects of lamotrigine on photoparoxysmal responses in photosensitive and pattern sensitive patients. Clin Neurophysiol 2001;112 (Suppl 1):S23. 52. Harding GF, Edson A, Jeavons PM. Persistence of photosensitivity. Epilepsia 1997;38:663-669.
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Photosensitivity, television and epilepsy N. Diamantopoulos
Abstract Epileptic seizures related to specific photic stimuli are not uncommon, especially among children, adolescents and young adults, while laboratory documented photosensitivity is also detected in a significant proportion of healthy people. Photosensitivity is a genetically determined epileptogenic factor. The seizures may be purely photo-induced or be combined with unprovoked seizures. Apart from its role in pure photosensitive epilepsy, photosensitivity characterizes many of the childhood epileptic syndromes. Common provoking factors include sunlight, television and videogames. Due to the ever-increasing role of television in modern society, its association with epilepsy gives rise to understandable public apprehension. The provoking role of television depends, among other factors, on certain monitor characteristics, the monitor-viewer distance and the programme content. The epidemiological, genetic, clinical and laboratory features of the photosensitive epilepsies are discussed. Special emphasis is given to the provoking role of television and videogames, and specific protective measures are suggested.
Department of Paediatric Neurology, Karamandaneio Children’s Hospital, Patras Correspondence: Nikolaos Diamantopoulos Department of Paediatric Neurology, Karamandaneio Children’s Hospital 40 Erythrou Stavrou Str. 263 31, Patras Date of submission: 23-01-2004 Date of approval: 27-04-2005
Key words Photosensitivity, epilepsy, television.
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˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÛÙ· ·È‰È¿ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, ·ÎÔÏÔ˘ıÒÓÙ·˜ ·Ú¿ÏÏËÏ· ÙȘ η̇Ϙ Î·È ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘, ‰ÈfiÙÈ ÛÙË ‰È¿ÚÎÂÈ¿ Ù˘ Ù· ÔÛÙ¿ ˘Ê›ÛÙ·ÓÙ·È ¤ÓÙÔÓË ·Ó·Ù˘Íȷ΋ ·Ó·Î·Ù·Û΢‹ (2,4,8-10). ∂›Û˘, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Ë Èı·Ó‹ ‡·ÚÍË ËÌÂÚ‹ÛÈ·˜ ‰È·Î‡Ì·ÓÛ˘ (ÎÈοډÈÔ˘ Ú˘ıÌÔ‡), Ë ÂȉÈÎfiÙËÙ· Î·È Ë Â˘·ÈÛıËÛ›· ÙÔ˘ οı ‰Â›ÎÙË, ·ÏÏ¿ Î·È Ë ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË Ì¤ıÔ‰Ô˜ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ (10). °È· Ó· ÌÂȈıÔ‡Ó ÔÈ ÂȉڿÛÂȘ ÙÔ˘ ÎÈοډÈÔ˘ Ú˘ıÌÔ‡ ÛÙȘ ÙÈ̤˜ ÙˆÓ ˘fi ÌÂϤÙË ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ, ΢ڛˆ˜ Û ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ì·ÎÚÔ¯ÚfiÓÈ·, ı· Ú¤ÂÈ Ë Ï‹„Ë ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÙËÓ ›‰È· ÂÚ›Ô˘ ÒÚ· Ù˘ Ë̤ڷ˜ (2). ∆¤ÏÔ˜, ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ fiÙÈ ÔÈ ‰Â›ÎÙ˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÛÙ· Ô‡Ú· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈ΋ ‰È·Î‡Ì·ÓÛË ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ ·fi ̤ڷ Û ̤ڷ
™‡ÓıÂÛ˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ πππ ÛÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜
(11,12). ∞Ó¿ÏÔÁ· ‰Â‰Ô̤ӷ ÁÈ· ÙÔ˘˜ ‰Â›ÎÙ˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÛÙÔÓ ÔÚfi ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ· ·È‰È¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ Û˘¯Ó¤˜ ·ÈÌÔÏË„›Â˜ ÁÈ· ηı·Ú¿ ÂÚ¢ÓËÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ‰ÂÓ ıˆÚÔ‡ÓÙ·È ËıÈο ·Ô‰ÂÎÙ¤˜.
µÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ OÈ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÚÔ˚fiÓÙ· ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ, Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È ·fi ‰È·ÊÔÚÂÙÈο ÛÙ¿‰È· Ù˘ ‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜. ∞˘ÙÔ› Â›Ó·È Ë ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (∞LP), Ë ÔÛÙÂÔηÏÛ›ÓË (OC) Î·È ÙÔ C-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π (PICP) (∂ÈÎfiÓ· 1). ∆· ÚÔ˚fiÓÙ· ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ÓˆÚ›˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ Úfi‰ÚÔÌˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ. ∏ ¤ÎÊÚ·ÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ù˘ ∞LP ·Ú¯›˙ÂÈ ¶·È‰È·ÙÚÈ΋ 2005;68:268-277
Pediatr July-Aug 05 new
22-07-05
12:16
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√ÛÙÂÔÂȉ¤˜
∞. ™ÈÒÌÔ˘ Î·È Û˘Ó.
∫ÔÏÏ·ÁfiÓÔ √ÛÙÂÔηÏÛ›ÓË
√ÛÙÂÔηÏÛ›ÓË ∞ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË
¶ÚÔÎÔÏÏ·ÁfiÓÔ PICP √ÛÙÂÔ‚Ï¿ÛÙË
∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘. ∏ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ Â›Ó·È Ë Û‡ÓıÂÛË ÙÔ˘ ÔÛÙÂÔÂȉԇ˜, ‰ËÏ·‰‹ Ù˘ ÔÚÁ·ÓÈ΋˜ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ ÙÔ˘ ÔÛÙÔ‡. ∆Ô ÎÔÏÏ·ÁfiÓÔ ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË ÚˆÙ½ÓË Ù˘ ÔÚÁ·ÓÈ΋˜ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ ÙÔ˘ ÔÛÙÔ‡. ∏ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Â›Ó·È ¤Ó˙˘ÌÔ ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ, ÙÔ ÔÔ›Ô ·ÔÛ¿Ù·È ·fi ÙËÓ Â͈ÙÂÚÈ΋ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Ì ڢıÌfi ·Ó¿ÏÔÁÔ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘. ∏ ÔÛÙÂÔηÏÛ›ÓË Û˘ÓÙ›ıÂÙ·È ·ÔÎÏÂÈÛÙÈο ·fi ÙÔ˘˜ ÔÛÙÂÔ‚Ï¿ÛÙ˜, fiÔ˘ ηٿ 50% ÂÓ·ÔÙ›ıÂÙ·È ÛÙÔ ÔÛÙfi Î·È Î·Ù¿ 50% ·ÂÏ¢ıÂÚÒÓÂÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›·. ∆· ÂÙ›‰È· ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π (PICP) ·ÔÛÒÓÙ·È ·fi ÙÔ Î·Ú‚Ô͢ÏÈÎfi ÙÔ˘ ¿ÎÚÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ Úfi‰ÚÔÌˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ Î·È, ÛÙË Û˘Ó¤¯ÂÈ·, ·ÂÎÎÚ›ÓÔÓÙ·È Ì ڢıÌfi ·Ó¿ÏÔÁÔ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘.
·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÌÂÈÒÓÂÙ·È Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÓ·fiıÂÛ˘ ·Ï¿ÙˆÓ ÛÙË ıÂ̤ÏÈ· Ô˘Û›· ÙÔ˘ ÔÛÙÂÔÂȉԇ˜. ∏ Û‡ÓıÂÛË Ù˘ OC ·fi ÙÔ˘˜ oÛÙÂÔ‚Ï¿ÛÙ˜ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÓ·fiıÂÛ˘ ÙˆÓ ·Ï¿ÙˆÓ ÛÙË ıÂ̤ÏÈ· Ô˘Û›· ÙˆÓ ÔÛÙÒÓ (11). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ fiÏˆÓ ÙˆÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÛÙÔÓ ÔÚfi ‹ ÛÙÔ Ï¿ÛÌ· Î·È Ë ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ ˆ˜ ‰Â›ÎÙ˜ ·‡ÍËÛ˘ Î·È ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ÛÙ· ·È‰È¿ Â›Ó·È Ï¤ÔÓ Î·Ï¿ ÙÂÎÌËÚȈ̤ÓË (2,4).
∞ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (ALP) Î·È ÔÛÙÈÎfi ÎÏ¿ÛÌ· ·˘Ù‹˜ (BAP) ∏ ÔÏÈ΋ ALP ·ÔÙÂÏÂ›Ù·È ·fi Ì›· ÔÌ¿‰· ÈÛÔÂÓ˙‡ÌˆÓ, Ô˘ ÚÔ¤Ú¯ÔÓÙ·È Î˘Ú›ˆ˜ ·fi Ù· ÔÛÙ¿, ÙÔ ‹·Ú Î·È ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ ·fi ÙÔ ¤ÓÙÂÚÔ Î·È ÙÔÓ Ï·ÎÔ‡ÓÙ· (13). ∆· ‰‡Ô ·ÚÈ· ÈÛÔ¤Ó˙˘Ì· Ô˘ ··ÓÙÒÓÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· ÔÛÙ¿ Î·È ÙÔ ‹·Ú. °È· ÙË Ì¤ÙÚËÛË ÙÔ˘ ÈÛÔÂÓ˙‡ÌÔ˘ ÙˆÓ ÔÛÙÒÓ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÂȉÈΤ˜ Ù¯ÓÈΤ˜ Ì ÙË ¯Ú‹ÛË ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙÔ ÔÛÙÈÎfi ÈÛÔ¤Ó˙˘ÌÔ (14,15). ∆· ›‰· Ù˘ ÔÏÈ΋˜ ALP Â›Ó·È ˘„ËÏfiÙÂÚ· ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÂÈÒÓÔÓÙ·È ÛÙ·‰È·Î¿, ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ (16). ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛËÌÂÈÒÓ¶·È‰È·ÙÚÈ΋ 2005;68:268-277
Ù·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 8-12 ÂÙÒÓ Î·È ÛÙ· ·ÁfiÚÈ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 10-14 ÂÙÒÓ (9,17). ∆· ›‰· ÙˆÓ ÂÓËÏ›ÎˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 17-18 ÂÙÒÓ, ÂÓÒ ÛÙ· ·ÁfiÚÈ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ (18). OÈ ÌÂÙ·‚ÔϤ˜ ÛÙ· ›‰· Ù˘ ÔÏÈ΋˜ ALP ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó Î˘Ú›ˆ˜ ÙȘ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ÔÛÙÈÎÔ‡ ÈÛÔÂÓ˙‡ÌÔ˘, ÂÊfiÛÔÓ Ë Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∆Ô ÔÛÙÈÎfi ÎÏ¿ÛÌ· Ù˘ ALP (BAP) ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ·. ŒÙÛÈ, ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 4 ÂÙÒÓ ·ÔÙÂÏ› ÙÔ 75-90% Ù˘ ÔÏÈ΋˜ ALP, ÂÓÒ ÌÂÙ¿ ÙËÓ ÂÊ˂›· ÙÔ ÔÛÔÛÙfi ÌÂÈÒÓÂÙ·È ÛÙÔ 50% (17,18). ∂Âȉ‹, ÏÔÈfiÓ, Ë ÔÏÈ΋ ALP ÛÙ· ·È‰È¿ ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi Ù· ÔÛÙ¿, ÔÈ ‰È·Ù·Ú·¯¤˜ ÛÙË Û˘ÁΤÓÙÚˆÛ‹ Ù˘ ·ÓÙ·Ó·ÎÏÔ‡Ó Û˘Ó‹ıˆ˜ ˘ÔΛÌÂÓË ÔÛÙÈ΋ ‚Ï¿‚Ë (17). ∆Ô ÔÛÙÈÎfi ÈÛÔ¤Ó˙˘ÌÔ Ù˘ ALP ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ ‹·Ú Î·È Ô ¯ÚfiÓÔ˜ ËÌÈ˙ˆ‹˜ ÙÔ˘ Î˘Ì·›ÓÂÙ·È ·fi 24 ¤ˆ˜ 48 ÒÚ˜ (19). µÚ›ÛÎÂÙ·È ÛÙËÓ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ oÛÙÂÔ‚Ï·ÛÙÒÓ, ·fi fiÔ˘ ·Ô‰ÂÛ̇ÂÙ·È Î·È ·Ô‰›‰ÂÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›·. ∏ ‰Ú¿ÛË ÙÔ˘ Â›Ó·È Ó· ηٷχÂÈ ÙËÓ ˘‰ÚfiÏ˘ÛË ÙˆÓ ÊˆÛÊÔÚÈÎÒÓ ÂÛÙ¤ÚˆÓ Û ·ÏηÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÚÔ¿ÁÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÂÓ·fiıÂÛË ·Ï¿ÙˆÓ ÛÙË ıÂ̤ÏÈ· Ô˘Û›· ÙˆÓ ÔÛÙÒÓ (20). ∞‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ÔÛÙÈÎÔ‡ ÈÛÔÂÓ˙‡ÌÔ˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÂÊ˂›· (17), ·ÏÏ¿ Î·È ÛÙËÓ ˆ¯ÚÈÓÈ΋ Ê¿ÛË ÙÔ˘ ηٷ̋ÓÈÔ˘ ·ÎÏÔ˘ ÛÙ· ÎÔÚ›ÙÛÈ· (21). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÔÏÈ΋˜ ALP ·ÔÙÂÏ› ÙÔÓ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ ‰Â›ÎÙË Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ Â›Ó·È Ô ÈÔ ÂȉÈÎfi˜ (1,3,13,22-24). ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· (19,25-27) Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· (15,19,28) ·fi ÙË ¯Ú‹ÛË Ù˘ ALP ˆ˜ ‰Â›ÎÙË ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.
OÛÙÂÔηÏÛ›ÓË (OC) ∏ OC Â›Ó·È Ë Î˘ÚÈfiÙÂÚË ÌË ÎÔÏÏ·ÁÔÓÔ‡¯· ÚˆÙ½ÓË Ù˘ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ ÙÔ˘ ÔÛÙÔ‡. ∞ÔÙÂÏ› ÙÔ 10-20% ÙˆÓ ÌË ÎÔÏÏ·ÁÔÓÔ‡¯ˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÛÙÔ‡ Î·È ÙÔ 1-2% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ (29). ¶·Ú¿ÁÂÙ·È ·ÔÎÏÂÈÛÙÈο ·fi ÙÔ˘˜ ÔÛÙÂÔ‚Ï¿ÛÙ˜ (20,30) ηٿ ÙË ‰È·‰Èηۛ· Ù˘ ÂÓ·fiıÂÛ˘ ·Ï¿ÙˆÓ ÛÙË ıÂ̤ÏÈ· Ô˘Û›·, ˘fi ÙËÓ Â›‰Ú·ÛË Ù˘ 1,25(OH)2D (31,32), ·ÏÏ¿ Èı·ÓfiÓ Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ (33). ∂›Ó·È ÂȉÈÎfi˜ Î·È Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ ÔÛÙÂÔ‚Ï·ÛÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (30) Î·È ·ÔÙÂÏ› ÙÔÓ ÌÔÓ·‰ÈÎfi ‰Â›ÎÙË ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘
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OÛÙÈÎÔ› ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÛÙ· ·È‰È¿
¶›Ó·Î·˜ 2. ªÂÈÔÓÂÎÙ‹Ì·Ù· Î·È ÏÂÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ¢Â›ÎÙ˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘
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OÏÈ΋ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË 1. ŒÏÏÂÈ„Ë ÂȉÈÎfiÙËÙ·˜ ‰ÈfiÙÈ (ALP) ·ÔÙÂÏÂ›Ù·È ·fi 4 ÈÛÔ¤Ó˙˘Ì· 2. ŒÏÏÂÈ„Ë Â˘·ÈÛıËÛ›·˜ ÏfiÁˆ ÌÂÁ¿ÏÔ˘ ¯ÚfiÓÔ˘ ËÌÈ˙ˆ‹˜ 3. ∞‡ÍËÛË ÂȤ‰ˆÓ ÛÙË Ú·¯›Ùȉ· Î·È ÛÙË Ï‹„Ë 1,25(O∏)2D, ¯ˆÚ›˜ ‡·ÚÍË Ú·ÁÌ·ÙÈ΋˜ ·‡ÍËÛ˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ OÛÙÈÎfi ÈÛÔ¤Ó˙˘ÌÔ ALP (BAP) ŒÏÏÂÈ„Ë Â˘·ÈÛıËÛ›·˜ ÏfiÁˆ ‚Ú·‰Â›·˜ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ›· OÛÙÂÔηÏÛ›ÓË (OC) 1. ⁄·ÚÍË ËÌÂÚ‹ÛÈ·˜ ‰È·Î‡Ì·ÓÛ˘ 2. ∞‡ÍËÛË ÂȤ‰ˆÓ Ì ÙË Ï‹„Ë 1,25(O∏)2D 3. ∞‡ÍËÛË ÂȤ‰ˆÓ ÛÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÏfiÁˆ ·Ô‚ÔÏ‹˜ ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ 4. ∞‡ÍËÛË ÂȤ‰ˆÓ ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓÔ ÎÏÈÓÔÛÙ·ÙÈÛÌfi C-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ªÈÎÚfiÙÂÚË ÂȉÈÎfiÙËÙ· Û ۯ¤ÛË ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π Ì ÙËÓ µAP Î·È ÙËÓ OC, ÏfiÁˆ (PICP) ·ÚÔ˘Û›·˜ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π ÂÎÙfi˜ ·fi ÙÔ ÔÛÙfi, ÛÙÔ ‰¤ÚÌ· Î·È ÙÔ ‹·Ú
Ô˘ ‚Ú›ÛÎÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙÔ ÂÈÌÂÙ·Ïψ̤ÓÔ ÔÛÙfi (1,3,22-24). ŒÓ· ̤ÚÔ˜ Ù˘ ÓÂÔÛ˘ÓÙÈı¤ÌÂÓ˘ OC (ÂÚ›Ô˘ 50%) ·ÂÏ¢ıÂÚÒÓÂÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›·, ÂÓÒ ÙÔ ˘fiÏÔÈÔ ÂÓۈ̷ÙÒÓÂÙ·È ÛÙË ıÂ̤ÏÈ· Ô˘Û›·, fiÔ˘ ‰ÂÛ̇ÂÈ ÙÔ ·Û‚¤ÛÙÈÔ Ì¤Ûˆ ÙÔ˘ Á-ηڂÔ͢ÁÏÔ˘Ù·ÌÈÎÔ‡ ÔͤԘ Ô˘ ÂÚȤ¯ÂÈ ÛÙÔ ÌfiÚÈfi Ù˘. ∂Âȉ‹ Ë Û‡ÓıÂÛË ÙÔ˘ Á-ηڂÔ͢ÁÏÔ˘Ù·ÌÈÎÔ‡ ÔͤԘ ·fi ÙÔ ÁÏÔ˘Ù·ÌÈÎfi Ô͇ ··ÈÙ› Ì›· ηڂÔÍ˘Ï›ˆÛË Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‚ÈÙ·Ì›ÓË K, Ë ‚ÈÙ·Ì›ÓË ·˘Ù‹ ıˆÚÂ›Ù·È ··Ú·›ÙËÙË ÁÈ· ÙË Û‡ÓıÂÛË Ù˘ OC (33). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÙÔ 1/3 Ù˘ ΢ÎÏÔÊÔÚÔ‡Û·˜ OC ·ÓÙÈÚÔۈ‡ÂÙ·È ·fi ÙÔ ÔÏÈÎfi ÌfiÚÈÔ, ÂÓÒ Ù· ˘fiÏÔÈ· 2/3 ·fi Ù· C Î·È N-ÙÂÏÈο ÂÙ›‰È· (34). OÈ Ì¤ıÔ‰ÔÈ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ì ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓÂ‡Ô˘Ó ÙÔ ÔÏÈÎfi ÌfiÚÈfi Ù˘. ∏ ·¤ÎÎÚÈÛ‹ Ù˘ Á›ÓÂÙ·È ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ (35) Î·È Ô ¯ÚfiÓÔ˜ ËÌÈ˙ˆ‹˜ Ù˘ ÛÙÔÓ ¿ÓıÚˆÔ Ê·›ÓÂÙ·È Ó· Î˘Ì·›ÓÂÙ·È ÛÙÔ Â›Â‰Ô ÏÂÙÒÓ (10-70 ÏÂÙ¿) (36) ‹ ˆÚÒÓ (9-16 ÒÚ˜) (37). OÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜ (38-40), ÂÓÒ Î·Ù¿ ÙË ‰È¿Ú-
1. ⁄·ÚÍË ÌÈÎÚ‹˜ ËÌÂÚ‹ÛÈ·˜ ‰È·Î‡Ì·ÓÛ˘ ÏfiÁˆ ÌÂÁ¿ÏÔ˘ ¯ÚfiÓÔ˘ ËÌÈ˙ˆ‹˜ 2. ÃÚ‹ÛË Û ·È‰È¿ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÏfiÁˆ ÌË ·Ô‚ÔÏ‹˜ ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ 3. ÃÚ‹ÛË Û ·È‰È¿ Ì ˷ÙÈΤ˜ ·ı‹ÛÂȘ ÏfiÁˆ ‰˘Ó·ÙfiÙËÙ·˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘ ÔÛÙÈÎÔ‡ ÈÛÔÂÓ˙‡ÌÔ˘ ∞˘ÍË̤ÓË ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔÓ ÔÛÙ›ÙË ÈÛÙfi
1. ∞˘ÍË̤ÓË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· 2. ¢Â›ÎÙ˘ ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘
1. ∞˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÏfiÁˆ Ù·¯‡ÙÂÚ˘ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›· ·fi ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜ 2. ⁄·ÚÍË ÌÈÎÚ‹˜ ËÌÂÚ‹ÛÈ·˜ ‰È·Î‡Ì·ÓÛ˘ 3. ∞Ô˘Û›· ›‰Ú·Û˘ Ù˘ 1,25(O∏)2D ÛÙË Û‡ÓıÂÛ‹ Ù˘ 4. ÃÚ‹ÛË Û ·È‰È¿ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÏfiÁˆ ·Ô˘Û›·˜ ·Ô‚ÔÏ‹˜ ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜
ÎÂÈ· Ù˘ Ë̤ڷ˜ (10:00-16:00) ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ 30-60% ¯·ÌËÏfiÙÂÚ˜ (39-41). ™Â fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÔÈ ÙÈ̤˜ Â›Ó·È ˘„ËÏfiÙÂÚ˜ Û ۇÁÎÚÈÛË Ì ÂΛӘ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÌÂÙ·‚¿ÏÏÔÓÙ·È ·Ú¿ÏÏËÏ· Ì ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘. ∞fi ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÙˆÓ 12 ÛÙ· ·ÁfiÚÈ· ·˘Í¿ÓÔÓÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ Î·È Êı¿ÓÔ˘Ó Ù· ̤ÁÈÛÙ· ÛÙȘ ËÏÈ˘ ÙˆÓ 12 Î·È 14 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·. ∫·ÙfiÈÓ, ·Ú¯›˙Ô˘Ó Ó· ÌÂÈÒÓÔÓÙ·È Î·È Êı¿ÓÔ˘Ó Ù· ›‰· ÙˆÓ ÂÓËÏ›ÎˆÓ ÛÙȘ ËÏÈ˘ ÙˆÓ 17-19 ÂÙÒÓ ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 18-20 ÛÙ· ·ÁfiÚÈ· (9,42,43). ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· (31,32,38-40,42-45) Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· (1,3,23,24) ·fi ÙË ¯Ú‹ÛË Ù˘ OC ˆ˜ ‰Â›ÎÙË ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.
C-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I (PICP) ∆Ô ÎÔÏÏ·ÁfiÓÔ ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË ÚˆÙ½ÓË Ù˘ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ ÙÔ˘ ÔÛÙÔ‡, Û ÔÛÔÛÙfi Ô˘ Êı¿ÓÂÈ ÙÔ 90-95%. ∆Ô 97% ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÙÔ˘ ÔÛÙÔ‡ Â›Ó·È Ù‡Ô˘ I Î·È Û˘ÓÙ›ıÂÙ·È ¶·È‰È·ÙÚÈ΋ 2005;68:268-277
Pediatr July-Aug 05 new
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∞. ™ÈÒÌÔ˘ Î·È Û˘Ó.
µÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ OÈ ‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙË ‰Ú¿ÛË ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ Î·È Â›Ó·È Â›Ù ÚÔ˚fiÓÙ· ·ÔÈÎÔ‰fiÌËÛ˘ Ù˘ ıÂ̤ÏÈ·˜ Ô˘Û›·˜, fiˆ˜ Ë ˘‰ÚÔ͢ÚÔÏ›ÓË, Ù· ·Ú¿ÁˆÁ· ÙÔ˘ ˘ÚȉÈÓ›Ô˘ Î·È Ù· ÙÂÏÔÂÙ›‰È· ·ÔÈÎÔ‰fiÌËÛ˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I, ›Ù ÚÔ˚fiÓÙ· ‰È¿Û·Û˘ ÙÔ˘ ˘‰ÚÔ͢··Ù›ÙË, fiˆ˜ Ë ·¤ÎÎÚÈÛË ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Û ‰Â›ÁÌ· Ô‡ÚˆÓ (23) (∂ÈÎfiÓ· 2). OÈ ÂÚÈÛÛfiÙÂÚÔÈ ‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÛÙ· Ô‡Ú·. ∆Ô Î‡ÚÈÔ Úfi‚ÏËÌ· Ì ÙÔ˘˜ ‰Â›ÎÙ˜ ÛÙ· Ô‡Ú· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ Ú¿ÍË Â›Ó·È Ë ÌÂÁ¿ÏË ‚ÈÔÏÔÁÈ΋ ‰È·Î‡Ì·ÓÛË Ô˘ ˘¿Ú¯ÂÈ ÌÂٷ͇ ÙˆÓ ·ÙfïÓ. ∂›Û˘, ÏfiÁˆ ÙÔ˘ fiÙÈ Ë Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ 24ÒÚÔ˘ ‰ÂÓ Â›Ó·È Â‡ÎÔÏ· ÂÊÈÎÙ‹ ÛÙ· ·È‰È¿, Û˘¯Ó¿ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Á›ÓÂÙ·È ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· Ô‡ÚˆÓ. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, ÙÔ ·ÔÙ¤ÏÂÛÌ· ÂÎÊÚ¿˙ÂÙ·È ˆ˜ Ô ÏfiÁÔ˜ ÚÔ˜ ÙËÓ ÎÚ·ÙÈÓ›ÓË ÙˆÓ Ô‡ÚˆÓ, Ô˘ Î·È ·˘Ù‹ fï˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ‚ÈÔÏÔÁÈ΋ ‰È·Î‡Ì·ÓÛË Î·È Â›Û˘ ÂËÚ¿˙ÂÙ·È ·fi ÙË Ì˘˚΋ Ì¿˙· (2). §fiÁˆ ÙˆÓ ·Ú·¿Óˆ ¶·È‰È·ÙÚÈ΋ 2005;68:268-277
°·Ï·ÎÙÔÛ˘Ï˘‰ÚÔÍ˘Ï˘Û›ÓË À‰ÚÔ͢ÚÔÏ›ÓË √ÛÙfi
·fi Úfi‰ÚÔÌ· ÌfiÚÈ· ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÈÌ˘ Ê¿Û˘ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ (46-48). ªÂÙ¿ ÙËÓ ¤ÎÎÚÈÛË ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ ÛÙÔÓ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ, ÙÔ C-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ·ÔÛ¿Ù·È Ì ÙË ‰Ú¿ÛË ÂÓ‰ÔÂÙȉ·ÛÒÓ Î·È ÂÈÛ¤Ú¯ÂÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›· (49), fiÔ˘ ·ÔÙÂÏ› ¯Ú‹ÛÈÌÔ ‰Â›ÎÙË Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I ·fi ÙÔ˘˜ ÔÛÙÂÔ‚Ï¿ÛÙ˜ Î·È ÁÂÓÈÎfiÙÂÚ· Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ (1,13,22). §fiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÌÔÚÈ·ÎÔ‡ ÙÔ˘ ‚¿ÚÔ˘˜, ÙÔ PICP ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ ‹·Ú Î·È ‰ÂÓ ‰ÈËıÂ›Ù·È ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ (50). ∂ÌÊ·Ó›˙ÂÈ ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË Î·Ù¿ 10-20% (51), Ì ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜ Î·È ÙȘ ÌÈÎÚfiÙÂÚ˜ ·ÚÁ¿ ÙÔ Úˆ› Î·È ÓˆÚ›˜ ÙÔ ·fiÁÂ˘Ì· (41). OÈ ÙÈ̤˜ ÙÔ˘ ‰Â›ÎÙË ·˘ÙÔ‡ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Î·Ù¿ ÙË ÌÂÙ¿‚·ÛË ·fi ÙËÓ ·È‰È΋ ÚÔ˜ ÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î·È ÛÙ· ‰‡Ô ʇϷ, ÂÏ·ÙÙÒÓÔÓÙ·È fï˜ ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ ÌÂÙ¿ ÙËÓ ÂÊ˂›·, Ë ‰Â Ì›ˆÛË ·˘Ù‹ ÂÌÊ·Ó›˙ÂÙ·È ÓˆÚ›ÙÂÚ· ÛÙ· ÎÔÚ›ÙÛÈ· (52). ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· (1,2,5,10,13,22) Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· (2,5,31,50) ·fi ÙË ¯Ú‹ÛË ÙÔ˘ PICP ˆ˜ ‰Â›ÎÙË ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.
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§˘ÛÔÛˆÌÈ΋ fiÍÈÓË ÊˆÛÊ·Ù¿ÛË
∫ÔÏÏ·ÁfiÓÔ
√ÛÙÂÔÎÏ¿ÛÙË
∂ÈÎfiÓ· 2. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘. ∏ Ï˘ÛÔÛˆÌÈ΋ fiÍÈÓË ÊˆÛÊ·Ù¿ÛË Â›Ó·È ›Ûˆ˜ ÙÔ Î˘ÚÈfiÙÂÚÔ ¤Ó˙˘ÌÔ ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ Î·È Ë Û˘ÁΤÓÙÚˆÛ‹ Ù˘ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ·Ô‰ÔÌÔ‡ÌÂÓÔ˘ ÔÛÙÔ‡. ∏ ˘‰ÚÔ͢ÚÔÏ›ÓË ‚Ú›ÛÎÂÙ·È Û ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË ÛÙÔ ÎÔÏÏ·ÁfiÓÔ Î·È ¤ÙÛÈ Ë ·¤ÎÎÚÈÛ‹ Ù˘ ÛÙ· Ô‡Ú· ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÔÛÙÈ΋ ·Ô‰fiÌËÛË. ∏ Á·Ï·ÎÙÔÛ˘Ï˘‰ÚÔÍ˘Ï˘Û›ÓË ··ÓÙ¿Ù·È Û ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· ÛÙÔ ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ π ÙˆÓ ÔÛÙÒÓ Û˘ÁÎÚÈÙÈο Ì ÙÔ ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ π ¿ÏÏˆÓ ÈÛÙÒÓ. ŒÙÛÈ, Ë ·¤ÎÎÚÈÛ‹ Ù˘ ·ÔÙÂÏ› ‰Â›ÎÙË ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘. ∏ ˘ÚȉÈÓÔÏ›ÓË Î·È Ë ‰ÂÔ͢˘ÚȉÈÓÔÏ›ÓË Â›Ó·È ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÔÈ ‰ÂÛÌÔ› ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È ·ÂÎÎÚ›ÓÔÓÙ·È Ì ڢıÌfi ·Ó¿ÏÔÁÔ Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘.
ÂÚÈÔÚÈÛÌÒÓ ÚÔ·ÙÂÈ Ë ·Ó¿ÁÎË ÁÈ· ¤Ó·Ó ÂȉÈÎfi Î·È Â˘·›ÛıËÙÔ ‰Â›ÎÙË Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘, Ô˘ Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÛÙÔÓ ÔÚfi Î·È Ó· ÌÔÚ› Ó· Û˘ÁÎÚÈı› ¿ÌÂÛ· Ì ÙÔ˘˜ ‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ÛÙÔ ›‰ÈÔ ‰Â›ÁÌ· (53). ª¤¯ÚÈ ÚfiÛÊ·Ù· ÌfiÓÔ ¤Ó·˜ ‰Â›ÎÙ˘ ÌÔÚÔ‡Û ӷ ÌÂÙÚËı› ÛÙÔÓ ÔÚfi, ÙÔ C-ÙÂÏÔÂÙ›‰ÈÔ-1 ÙÔ˘ ¤ÏÈη (ICTP) (54). ∆ÂÏÂ˘Ù·›·, ˆÛÙfiÛÔ, ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ Û ·È‰ÈÎfi ÏËı˘ÛÌfi Î·È ÂÓfi˜ ¿ÏÏÔ˘ ‰Â›ÎÙË Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ Ô˘ ÌÂÙÚ¿Ù·È ÛÙÔÓ ÔÚfi ‹ ÙÔ Ï¿ÛÌ·, ÙÔ˘ C-ÙÂÏÔÂÙȉ›Ô˘-2 (CTX ‹ CrossLaps). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·˘ÙÔ‡ ÙÔ˘ ‰Â›ÎÙË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó›¯Ó¢ÛË ÚÔ˚fiÓÙˆÓ ·ÔÈÎÔ‰fiÌËÛ˘ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ ‰ÂÛÌÒÓ ÙˆÓ C-ηڂÔ͢ÙÂÏÈÎÒÓ ¿ÎÚˆÓ ÙˆÓ ÙÂÏÔÂÙȉ›ˆÓ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π (53). ∂›Û˘, Á›ÓÔÓÙ·È ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÛÙ· Ô‡Ú· Î·È ¿ÏÏˆÓ ‰ÂÈÎÙÒÓ Ô˘ Â›Ó·È ·Ú¿ÁˆÁ· ÙˆÓ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ ‰ÂÛÌÒÓ ÙˆÓ ˘ÚȉÈÓÔÏÈÓÒÓ Î·È ı· ‚ÔËı‹ÛÔ˘Ó ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ Î·Ù·‚ÔÏÈÛÌfi ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÙˆÓ ÔÛÙÒÓ, ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ (55,56).
∞¤ÎÎÚÈÛË ·Û‚ÂÛÙ›Ô˘ ÛÙ· Ô‡Ú· (UCa/UCr) ∏ ·¤ÎÎÚÈÛË ÙÔ˘ Ca Û ‰Â›ÁÌ· Ô‡ÚˆÓ Ó‹ÛÙˆ˜ ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÎÈÓËÙÔÔ›ËÛ‹ ÙÔ˘ ·fi
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OÛÙÈÎÔ› ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÛÙ· ·È‰È¿
Ù· ÔÛÙ¿ (57,58) Î·È ·ÔÙÂÏ› Û˘ÓËıÈṲ̂ÓÔ ‰Â›ÎÙË ÂÎÙ›ÌËÛ˘ ÙÔ˘ Ú˘ıÌÔ‡ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘. ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Ù˘ ¯Ú‹Û˘ ÙÔ˘ (1) ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.
∞¤ÎÎÚÈÛË ˘‰ÚÔ͢ÚÔÏ›Ó˘ ÛÙ· Ô‡Ú· (UOHPr/UCr) ∏ ˘‰ÚÔ͢ÚÔÏ›ÓË ·ÂÏ¢ıÂÚÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰È¿Û·Û˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘. ∆Ô 90% Ù˘ ˘‰ÚÔ͢ÚÔÏ›Ó˘ ‰È·Û¿Ù·È Û ·ÌÈÓÔͤ·, Ù· ÔÔ›· ‰ÈËıÔ‡ÓÙ·È Î·È Â·Ó·ÚÚÔÊÔ‡ÓÙ·È ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ηٷ‚ÔÏ›˙ÔÓÙ·È ÛÙÔ ‹·Ú Û Ԣڛ· Î·È CO2, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 10% ‰È·Û¿Ù·È Û ÌÈÎÚ¿ ÂÙ›‰È· Ô˘ ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙ· Ô‡Ú· (1) Î·È ·ÔÙÂÏÔ‡Ó ‰Â›ÎÙË ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ (46,47,59). ™ÙË ‚ÚÂÊÈ΋ Î·È ÂÊË‚È΋ ËÏÈΛ·, ÔÈ ÙÈ̤˜ ÙÔ˘ ÏfiÁÔ˘ UOHPr/UCr ¤¯Ô˘Ó ‚ÚÂı› ̤¯ÚÈ Î·È 20-30 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚ˜ ·fi ÂΛӘ ÙˆÓ ÂÓËÏ›ÎˆÓ (59). ∏ ·¤ÎÎÚÈÛË Ù˘ OHPr Û ‰Â›ÁÌ· Ô‡ÚˆÓ ·Ú·Ì¤ÓÂÈ - ÁÈ· ÂÚÈÛÛfiÙÂÚ· ·fi 30 ¯ÚfiÓÈ· - ¤Ó·˜ ¢ڤˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˜ ‰Â›ÎÙ˘ ÂÎÙ›ÌËÛ˘ Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ (60), ÛÙÂÚÂ›Ù·È fï˜ ÂȉÈÎfiÙËÙ·˜ Î·È Â˘·ÈÛıËÛ›·˜ (1,10,13,23). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› ÚÔ¤Ú¯ÂÙ·È Î·È ·fi ¿ÏϘ ËÁ¤˜, fiˆ˜ ÙÔ C1q ÎÏ¿ÛÌ· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ (ÔfiÙ ÌÔÚ› Ó· ‚ÚÂı› ·˘ÍË̤ÓË Û ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ) Î·È ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ Ù˘ ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘ (46,47). ∂›Û˘, ÂÚȤ¯ÂÙ·È Û ÚÔ˚fiÓÙ· ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È ÁÈ’ ·˘Ùfi Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÌÂÙ¿ ·fi ‰›·ÈÙ· ÂχıÂÚË Ù¤ÙÔÈˆÓ ÚÔ˚fiÓÙˆÓ Û ԇڷ 24ÒÚÔ˘ ‹ ηχÙÂÚ· Û ‰Â›ÁÌ· Ô‡ÚˆÓ Ó‹ÛÙˆ˜ (61,62). ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· (1,10,13,23,46,47,61,62) Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· (60) Ù˘ ¯Ú‹Û˘ Ù˘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∞¤ÎÎÚÈÛË ‰ÂÛÌÒÓ ˘ÚȉÈÓ›Ô˘ ÛÙ· Ô‡Ú· (UPYD/UCr Î·È UDPD/UCr) ∏ ˘ÚȉÈÓÔÏ›ÓË (PYD) Î·È Ë ‰ÂÔ͢˘ÚȉÈÓÔÏ›ÓË (DPD) Â›Ó·È ‰‡Ô ·ÌÈÓÔͤ· Ô˘ Û¯ËÌ·Ù›˙Ô˘Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÔ˘˜ ‰ÂÛÌÔ‡˜ ÛÙËÓ ÒÚÈÌË ÌÔÚÊ‹ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È Ì ÙÔÓ ÙÚfiÔ ·˘Ùfi ÛÙ·ıÂÚÔÔÈÔ‡Ó ÙÔ ÌfiÚÈfi ÙÔ˘ (63,64). ∏ PYD ··ÓÙ¿Ù·È Â˘Ú¤ˆ˜ ÛÙÔ ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ I ÙÔ˘ ÔÛÙÔ‡, ÛÙÔ ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ II ÙˆÓ ¯fiÓ‰ÚˆÓ Î·È ÏÈÁfiÙÂÚÔ Û ¿ÏÏÔ˘˜ Û˘Ó‰ÂÙÈÎÔ‡˜ ÈÛÙÔ‡˜ (65). ∏ DPD ‚Ú›ÛÎÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ I ÙÔ˘ ÔÛÙÔ‡ Î·È ÁÈ’ ·˘Ùfi ıˆÚÂ›Ù·È ÈÔ ÂȉÈÎfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙÔÓ ÔÛÙ›ÙË ÈÛÙfi. ∏ Û˘ÁΤÓÙÚˆÛË Ù˘ PYD ÛÙÔÓ ·ÓıÚÒÈÓÔ ÛÎÂÏÂÙfi ›-
Ó·È Î·Ù¿ 3-5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË Ù˘ DPD (64). ∫·È ÔÈ ‰‡Ô ·˘ÙÔ› ‰Â›ÎÙ˜ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ηٿ ÙËÓ ·ÔÈÎÔ‰fiÌËÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ·fi ÙÔ˘˜ ÔÛÙÂÔÎÏ¿ÛÙ˜, ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙ· Ô‡Ú· ¯ˆÚ›˜ ÚÔËÁÔ˘Ì¤Óˆ˜ Ó· ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È Î·È ‰ÂÓ Â·Ó·¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË Û‡ÓıÂÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ (63,64,66). T· ̤ÁÈÛÙ· ›‰· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 10-15 ÂÙÒÓ Î·È Î·ÙfiÈÓ ÌÂÈÒÓÔÓÙ·È ÛÙ·‰È·Î¿ ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛË, fiÔ˘ Î·È ·Ú·Ì¤ÓÔ˘Ó ÛÙ·ıÂÚ¿ ÛÙËÓ ˘fiÏÔÈË ÂÓ‹ÏÈÎË ˙ˆ‹ (64). ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· (10,12,67) Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· (1,3,13,22,23) Ù˘ ¯Ú‹Û˘ ÙÔ˘˜ ˆ˜ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.
∆ÂÏÔÂÙ›‰È· ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ ‰ÂÛÌÒÓ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I (NTX, ICTP, CTX ‹ CrossLaps) ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·Ó·Ó¤ˆÛ˘ Ù˘ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ ÙÔ˘ ÔÛÙÔ‡ Ô˘ ·ÔÙÂÏÂ›Ù·È Î˘Ú›ˆ˜ ·fi ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ π (>90%), ÙÔ ÌfiÚÈÔ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ·ÔÈÎÔ‰ÔÌÂ›Ù·È Û ÌÈÎÚ¿ ÂÙ›‰È· Ô˘ ÛÙË Û˘Ó¤¯ÂÈ· ·Ô‰›‰ÔÓÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›·. ¶ÚÔ˚fiÓÙ· ·˘Ù‹˜ Ù˘ ·ÔÈÎÔ‰fiÌËÛ˘, ÂÎÙfi˜ ·fi ÙÔ˘˜ ‰ÂÛÌÔ‡˜ ˘ÚȉÈÓ›Ô˘, Â›Ó·È Î·È ‰È¿ÊÔÚ· ÙÂÏÔÂÙ›‰È· ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ ‰ÂÛÌÒÓ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘. ∂ȉÈΤ˜ Ù¯ÓÈΤ˜ Ì ·ÓÙÈÛÒÌ·Ù· ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·˘ÙÒÓ ÙˆÓ ÙÂÏÔÂÙȉ›ˆÓ, fiˆ˜ ÙÔ˘ N-ÙÂÏÔÂÙȉ›Ô˘ ÙÔ˘ ¤ÏÈη (NTX) Ô˘ ·ÓȯÓ‡ÂÙ·È ÛÙ· Ô‡Ú·, ÙÔ˘ C-ÙÂÏÔÂÙȉ›Ô˘-1 ÙÔ˘ ¤ÏÈη (ICTP) Ô˘ ·ÓȯÓ‡ÂÙ·È ÛÙÔÓ ÔÚfi Î·È ÙÔ˘ C-ÙÂÏÔÂÙȉ›Ô˘-2 (CTX ‹ CrossLaps) Ô˘ ·ÓȯÓ‡ÂÙ·È ÛÙÔÓ ÔÚfi Î·È Ù· Ô‡Ú· (10,24,34,48,68). ™Ù· ·È‰È¿ ˘¿Ú¯Ô˘Ó Ï›Á· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ·˘Ù¿ Ù· ÙÂÏÔÂÙ›‰È· (51,69). À„ËÏfiÙÂÚ˜ ÙÈ̤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ÓÂÔÁ¤ÓÓËÙ·, Ì ÙȘ ̤ÁÈÛÙ˜ Ó· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ 2Ô Ì‹Ó· ˙ˆ‹˜ Î·È Î·ÙfiÈÓ Ó· ÂÏ·ÙÙÒÓÔÓÙ·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ (70). ™ÙË Û˘Ó¤¯ÂÈ·, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‰È·ÙËÚÔ‡ÓÙ·È ÛÙ·ıÂÚ¤˜, ·ÏÏ¿ ˘„ËÏfiÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ (51,70,71). ªÂÙ¿ ÙËÓ ÂÊ˂›·, Ù· ›‰· ·˘ÙÒÓ ÙˆÓ ÙÂÏÔÂÙȉ›ˆÓ ÂÏ·ÙÙÒÓÔÓÙ·È ÛÙ· ·ÓÙ›ÛÙÔȯ· ÙˆÓ ÂÓËÏ›ÎˆÓ (10,52). ∞˘Ù‹ Ë ‰È·Î‡Ì·ÓÛË ·ÓÙÈηÙÔÙÚ›˙ÂÈ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Î·Ì‡ÏË ·‡ÍËÛ˘ Î·È Â›Ó·È ·ÚfiÌÔÈ· Ì ÙȘ ‰È·Î˘Ì¿ÓÛÂȘ ÙˆÓ ˘fiÏÔÈˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘ ÛÙ· ·È‰È¿ (2,53). ¶·È‰È·ÙÚÈ΋ 2005;68:268-277
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∞. ™ÈÒÌÔ˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 3. ªÂÈÔÓÂÎÙ‹Ì·Ù· Î·È ÏÂÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ¢Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ªÂÈÔÓÂÎÙ‹Ì·Ù· ∞Û‚¤ÛÙÈÔ/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (UCa/UCr) À‰ÚÔ͢ÚÔÏ›ÓË/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (UOHPr/UCr)
¶˘ÚȉÈÓÔÏ›ÓË/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (UPYD/UCr) Î·È ¢ÂÔ͢˘ÚȉÈÓÔÏ›ÓË/ ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (UDPD/UCr) ∆ÂÏÔÂÙ›‰È· ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ ‰ÂÛÌÒÓ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π (NTX, ICTP, CTX ‹ CrossLaps) °·Ï·ÎÙÔÛ˘Ï˘‰ÚÔÍ˘Ï˘Û›ÓË (GHLy) ¡-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ πππ (PIIINP)
ŒÏÏÂÈ„Ë ÂȉÈÎfiÙËÙ·˜ Î·È Â˘·ÈÛıËÛ›·˜
∂˘Ú¤ˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˜ ‰Â›ÎÙ˘
1. ŒÏÏÂÈ„Ë ÂȉÈÎfiÙËÙ·˜ Î·È Â˘·ÈÛıËÛ›·˜ 2. °È· ÙËÓ ·ÍÈÔÏfiÁËÛ‹ Ù˘ ··ÈÙÂ›Ù·È ‰›·ÈÙ· ÂχıÂÚË ·fi ÚÔ˚fiÓÙ· ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘ 1. ªÂÁ¿ÏË ‚ÈÔÏÔÁÈ΋ ‰È·Î‡Ì·ÓÛË ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ 2. ªÈÎÚ‹ ÁÂÓÈο ¢·ÈÛıËÛ›· ÏfiÁˆ ÌÂÁ¿ÏÔ˘ ‡ÚÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ
∂˘Ú¤ˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˜ ‰Â›ÎÙ˘
¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ‰Â‰Ô̤ӷ Û ·È‰È¿
1. ∂ÌÊ·Ó›˙ÂÈ ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË 2. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ‰Â‰Ô̤ӷ ÛÙ· ·È‰È¿ ∞ÓÙ·Ó·ÎÏ¿ ΢ڛˆ˜ ÙÔÓ ·Ó·Û¯ËÌ·ÙÈÛÌfi ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Î·È ÂÏ¿¯ÈÛÙ· ÙˆÓ ÔÛÙÒÓ
™¯ÂÙÈο Ì ÙËÓ ‡·ÚÍË ËÌÂÚ‹ÛÈ·˜ ‰È·Î‡Ì·ÓÛ˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ‰Â‰Ô̤ӷ ÛÙ· ·È‰È¿ (53). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, fï˜, ÔÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜, fiˆ˜ Î·È Ì ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ (Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘), ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ÂÏ·ÙÙÒÓÔÓÙ·È Û ۯÂÙÈο ÛÙ·ıÂÚ¿ ›‰· ÌÂٷ͇ ÙˆÓ ˆÚÒÓ 11:0015:00 (72). ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· (51,53,72) Î·È Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· (68,73) ·fi ÙË ¯Ú‹ÛË ÙÔ˘˜ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.
°·Ï·ÎÙÔÛ˘Ï˘‰ÚÔÍ˘Ï˘Û›ÓË (GHLy) ∏ GHLy ·ÂÏ¢ıÂÚÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‰È¿Û·Û˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È ·ÂÎÎÚ›ÓÂÙ·È ÛÙ· Ô‡Ú·. ¶·Ú’ fiÙÈ ··ÓÙ¿Ù·È Î·È ÛÙÔ ÎÔÏÏ·ÁfiÓÔ ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ, ÙÔ ÌfiÚÈÔ Ô˘ ˘ÂÚ¤¯ÂÈ Î·Ù¿ Ôχ Û ÔÛfiÙËÙ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔÓ ÔÛÙ›ÙË ÈÛÙfi. ¢ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÙ·È ·fi ÙË ‰È·ÙÚÔÊ‹ Î·È Ú·ÎÙÈο ‰ÂÓ ÌÂÙ·‚ÔÏ›˙ÂÙ·È (74). ¶·ÚÔ˘ÛÈ¿˙ÂÈ fï˜ ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË Ì¤¯ÚÈ Î·È 30% (75). ∆· ›‰· ÛÙ· ·È‰È¿ Â›Ó·È ˘„ËÏfiÙÂÚ· ·fi ÂΛӷ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· Î·È ÙÔ ÛÙ¿‰ÈÔ ÂÊ˂›·˜. øÛÙfiÛÔ, Ù· ̤¯ÚÈ Û‹ÌÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ·˘ÙfiÓ ÙÔÓ ‰Â›ÎÙË Â›Ó·È ÂÚÈÔÚÈṲ̂ӷ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (75) (¶›Ó·Î·˜ 3). ¶·È‰È·ÙÚÈ΋ 2005;68:268-277
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1. ¶ÈÔ ÂȉÈÎÔ› Î·È Â˘·›ÛıËÙÔÈ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ Û ۯ¤ÛË Ì ÙËÓ ·¤ÎÎÚÈÛË ÛÙ· Ô‡Ú· Ca η O∏Pr 2. O ÏfiÁÔ˜ UDPD/UCr Â›Ó·È Ô ÈÔ ÂȉÈÎfi˜ ‰Â›ÎÙ˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ OÈ ‰Â›ÎÙ˜ ICTP Î·È CTX ÌÔÚÔ‡Ó Ó· ·ÓȯÓ¢ıÔ‡Ó ÛÙÔÓ ÔÚfi
1. ¢ÂÓ ÂËÚ¿˙ÂÙ·È ·fi ÙË ‰È·ÙÚÔÊ‹ 2. ¶Ú·ÎÙÈο ‰ÂÓ ÌÂÙ·‚ÔÏ›˙ÂÙ·È ™˘Û¯ÂÙ›˙ÂÙ·È Â·ÚÎÒ˜ Ì ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘
N-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ III (PπππNP) ∆Ô ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ III ··ÓÙ¿Ù·È Û fiÏÔ˘˜ ÙÔ˘˜ Û˘Ó‰ÂÙÈÎÔ‡˜ ÈÛÙÔ‡˜ ÙÔ˘ ÛÒÌ·ÙÔ˜. §fiÁˆ ÙÔ˘ fiÙÈ Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÔÛÙ›ÙË ÈÛÙÔ‡ Û ÎÔÏÏ·ÁfiÓÔ Ù‡Ô˘ III Â›Ó·È ÂÏ¿¯ÈÛÙË, Ô ‰Â›ÎÙ˘ ·˘Ùfi˜ ·ÓÙ·Ó·ÎÏ¿ ΢ڛˆ˜ ÙÔÓ ·Ó·Û¯ËÌ·ÙÈÛÌfi ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ (76). ¶·Ú’ fiÙÈ ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÛÙȘ ÙÈ̤˜ ÙÔ˘ PπππNP Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, ‚Ú¤ıËΠӷ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ Ì ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (77) (¶›Ó·Î·˜ 3).
™˘ÌÂÚ¿ÛÌ·Ù· OÈ ÚfiÔ‰ÔÈ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ÛÙȘ Ù¯ÓÈΤ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ÔÛÙÈÎÒÓ ‰ÂÈÎÙÒÓ ¤¯Ô˘Ó ‚ÂÏÙÈÒÛÂÈ Î·Ù¿ Ôχ ÙËÓ ÂȉÈÎfiÙËÙ· Î·È ÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘˜. ¶·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ‰Â›ÎÙ˘ Ô˘ Ó· ÏËÚÔ› fiÏ· Ù· ÎÚÈÙ‹ÚÈ· Î·È Ó· Â›Ó·È Ô È‰·ÓÈÎfi˜. OÈ ‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ‰È·Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ ÂȉÈÎfiÙËÙ¿ ÙÔ˘˜ Î·È ‰›ÓÔ˘Ó Û˘ÌÏËڈ̷ÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ÔÛÙÂÔ‚Ï·ÛÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ŒÙÛÈ, Ë ÂÈÏÔÁ‹ ÙÔ˘ ‰Â›ÎÙË ‹ ÙˆÓ ‰ÂÈÎÙÒÓ Ô˘ ı· ‚ÔËı‹ÛÔ˘Ó ÛÙË ‰È¿ÁÓˆÛË ÂÍ·ÚٿٷÈ
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·fi ÙËÓ ÎÏÈÓÈ΋ ‰È·Ù·Ú·¯‹. ∆Ô ÔÛÙÈÎfi ÎÏ¿ÛÌ· Ù˘ ALP Â›Ó·È ÂȉÈÎfi ÁÈ· ÙÔÓ ÔÛÙ›ÙË ÈÛÙfi Î·È ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÔÛÙÈ΋ Û‡ÓıÂÛË Î·È ÙËÓ ·‡ÍËÛË ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÎÏÈÓÈΤ˜ ηٷÛÙ¿ÛÂȘ, ¤¯ÂÈ fï˜ ‚Ú·‰Â›· ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. Ÿˆ˜ Ë BAP, ¤ÙÛÈ Î·È Ë OC Â›Ó·È ÂȉÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ÔÛÙÂÔ‚Ï·ÛÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ·ÏÏ¿ ÂÌÊ·Ó›˙ÂÈ ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË. ∂›Û˘, ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ÚÔ‚Ï‹Ì·Ù· Û¯ÂÙÈο Ì ÙȘ ÌÂıfi‰Ô˘˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ Î·È ÙË ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ ÌÔÚ›Ô˘ Ù˘. ∆Ô PICP ·ÓÙ·ÔÎÚ›ÓÂÙ·È ¿ÌÂÛ· ÛÙȘ ıÂڷ¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚfiÙÂÚË ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔÓ ÔÛÙ›ÙË ÈÛÙfi (¶›Ó·Î·˜ 2). ∞fi ÙÔ˘˜ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·ÔÚÚfiÊËÛ˘, Ô UDPD/UCr Â›Ó·È Ô ÈÔ ÂȉÈÎfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙÔ ÔÛÙfi, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ‚ÈÔÏÔÁÈ΋ ‰È·Î‡Ì·ÓÛË ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ, ÂÓÒ Ë ¤ÎÊÚ·ÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÚÔ˜ ÙËÓ ÎÚ·ÙÈÓ›ÓË ·˘Í¿ÓÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÙË ‰È·Î‡Ì·ÓÛË ·˘Ù‹. ∂›Û˘, ÙÔ Â‡ÚÔ˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÙÔ˘ ÛÙ· ·È‰È¿ Â›Ó·È ÌÂÁ¿ÏÔ Î·È ¤ÙÛÈ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ¢·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂڷ¢ÙÈÎÒÓ ·ÚÂÌ‚¿ÛˆÓ. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ‰ÂÈÎÙÒÓ ICTP Î·È CTX ÌÔÚ› Ó· Á›ÓÂÈ ÛÙÔÓ ÔÚfi Î·È Ù· Ô‡Ú· Î·È Ê·›ÓÂÙ·È Ó· ·Ú¤¯ÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÔÛÙÈ΋ ·Ô‰fiÌËÛË, ¯ÚÂÈ¿˙ÂÙ·È fï˜ ÂÚÈÛÛfiÙÂÚË ÌÂϤÙË ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi (¶›Ó·Î·˜ 3).
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67. Spagnoli A, Branca F, Spadoni GL, Cianfarani S, Pasquino AM, Argiro G et al. Urinary pyridinium collagen cross-links predict growth performance in children with idiopathic short stature and with growth hormone (GH) deficiency treated with GH. Skeletal metabolism during GH treatment. J Clin Endocrinol Metab 1996;81:3589-3593. 68. Rosenquist C, Fledelius C, Christgau S, Pedersen BJ, Bonde M, Qvist P et al. Serum CrossLaps One Step ELISA. First application of monoclonal antibodies for measurement in serum of bone-related degradation products from C-terminal telopeptides of type I collagen. Clin Chem 1998;44:2281-2289. 69. Lieuw-A-Fa M, Sierra RI, Specker BL. Carboxy-terminal propeptide of human type I collagen and pyridinium cross-links as markers of bone growth in infants 1 to 18 months of age. J Bone Miner Res 1995;10:849-853. 70. Bollen AM, Eyre DR. Bone resorption rates in children monitored by the urinary assay of collagen type I cross-linked peptides. Bone 1994;15:31-34. 71. Marowska J, Kobylinska M, Lukaszkiewicz J, Talajko A, Rymkiewicz-Kluczynska B, Lorenc RS. Pyridinium crosslinks of collagen as a marker of bone resorption rates in children and adolescents: normal values and clinical application. Bone 1996;19:669-677. 72. Christgau S, Bitsch-Jensen O, Hanover Bjarnason N, Gamwell Henriksen E, Qvist P, Alexandersen P et al. Serum CrossLaps for monitoring the response in individuals undergoing antiresorptive therapy. Bone 2000;26:505-511. 73. Crofton PM, Evans N, Stephen R. Serum CrossLaps compared with other markers of bone turnover in severely malnourished children before and after refeeding. Clin Chem 2003;49:192-195. 74. Bettica P, Baylink DJ, Moro L. Galactosyl hydroxylysine and deoxypyridinoline: a methodological comparison. Eur J Clin Chem Clin Biochem 1993;31:459-465. 75. Rauch F, Schnabel D, Seibel MJ, Remer T, Stabrey A, Michalk D et al. Urinary excretion of galactosyl-hydroxylysine is a marker of growth in children. J Clin Endocrinol Metab 1995;80:1295-1300. 76. Risteli J, Niemi S, Trivedi P, Maentausta O, Mowat AP, Risteli L. Rapid equilibrium radioimmunoassay for the amino-terminal propeptide of human type III procollagen. Clin Chem 1988;34:715-718. 77. Hertel NT, Stoltenberg M, Juul A, Main KM, Muller J, Nielsen CT et al. Serum concentrations of type I and III procollagen propeptides in healthy children and girls with central precocious puberty during treatment with gonadotropin-releasing hormone analog and cyproterone acetate. J Clin Endocrinol Metab 1993;76:924-927.
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Biochemical markers of bone metabolism in childhood E. Siomou1, A. Challa2 1 Department of Paediatrics, University Hospital of Ioannina 2 Laboratory of Paediatrics, Medical School, University of Ioannina Correspondence: Anna Challa Department of Paediatrics, Medical School, University of Ioannina P.O. Box 1186, 451 10, Ioannina E-mail: achalla@cc.uoi.gr Date of submission: 28-04-2004 Date of approval: 17-05-2005
Paediatriki 2005;68:278
Abstract The biochemical markers of bone metabolism are either enzymes or components of the bone matrix liberated into the circulation during the process of bone synthesis and resorption. They can be measured in serum or urine. Measurement of these markers is essential for the evaluation of bone turnover in adults and children and for assessment of growth disturbances in childhood. Biochemical bone markers provide information about bone response to treatment long before changes in growth velocity or bone density can be detected. Children have higher bone turnover than adults, because of their continuous growth, and for this reason their normal values of biochemical bone markers are comparatively elevated, especially during the periods of accelerated growth (infancy and adolescence). In this review, the clinical and research uses of the available biochemical bone markers are summarized and their limitations are emphasized. Key words Bone turnover, biochemical bone markers, growth, children.
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∞ÍÈÔÏfiÁËÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ Û ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Õ. ÿÏÏ·1, ∞. ™ÈÒÌÔ˘2, ª. ∆˙Ô‡ÊË2, ¢. §··ÙÛ¿Ó˘2, µ. ÃÔϤ‚·˜1, ∞. ªÔ˘Ï¿˜1, ¡. ÷ÏÈ¿ÛÔ˜2, ∞. ™È·ÌÔÔ‡ÏÔ˘ - ª·˘Ú›‰Ô˘2
¶ÂÚ›ÏË„Ë O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ ·Ú¤¯ÂÈ Ì›· ‰˘Ó·ÌÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘ÓfiÏÔ˘ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ Î·È Ù˘ ·‡ÍËÛ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. øÛÙfiÛÔ, Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜ ÛÙ· ·È‰È¿ Â›Ó·È ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‡ÚÔ˘˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ Û˘Ó¯fiÌÂÓ˘ ·‡ÍËÛ˘ Ô˘ ÛËÌÂÈÒÓÂÙ·È Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ∂ÈϤÔÓ, Ë ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ Û ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÛÙÒÓ ‰ÂÓ ¤¯ÂÈ ÂÎÙÂÓÒ˜ ÌÂÏÂÙËı› ÛÙ· ·È‰È¿, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∏ ·ÚÈ· ¯Ú‹ÛË ÙÔ˘˜ ¤ÁÎÂÈÙ·È ÛÙÔ Ó· ·Ú¤¯Ô˘Ó Ì ÈηÓÔÔÈËÙÈ΋ ¢·ÈÛıËÛ›· ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹, Ôχ ÚÈÓ ÛËÌÂȈıÔ‡Ó ÌÂÙ·‚ÔϤ˜ ÛÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ Î·È ÛÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·. ∞Ó Î·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó Á›ÓÂÈ ÛËÌ·ÓÙÈΤ˜ ÚfiÔ‰ÔÈ ˆ˜ ÚÔ˜ ÙȘ Ù¯ÓÈΤ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘˜, Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂȉÈÎfiÙËÙ·˜ Î·È Â˘·ÈÛıËÛ›·˜ ÙÔ˘˜, Ë ¯Ú‹ÛË ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ‰ÂÈÎÙÒÓ ‰ÂÓ Â›Ó·È Â˘Ú¤ˆ˜ ‰È·ı¤ÛÈÌË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·Ó·Ê¤ÚÔÓÙ·È ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙË ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·ÔÚÚfiÊËÛ˘ Û ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÛÙÒÓ Û ‚Ú¤ÊË, ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∂›Û˘, Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ‰ËÌÔÛȇÛÂȘ Ì ‰Â‰Ô̤ӷ ·fi ÙËÓ ÂÌÂÈÚ›· Ì·˜ Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ Û ‚Ú¤ÊË Î·È ·È‰È¿.
1 ∂ÚÁ·ÛÙ‹ÚÈÔ ¶·È‰È·ÙÚÈ΋˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ AÏÏËÏÔÁÚ·Ê›·: ÕÓÓ· ÿÏÏ· ∆Ô̤·˜ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, π·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ ∆.£. 1186, ∆.∫. 451 10, πˆ¿ÓÓÈÓ· E-mail: achalla@cc.uoi.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-04-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-05-2005
§¤ÍÂȘ ÎÏÂȉȿ µÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜, ÓÔÛ‹Ì·Ù· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ, ·È‰È¿, ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹.
™˘ÓÙÔÌÔÁڷʛ˜ ∞LP BAP
∞ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË OÛÙÈÎfi ÎÏ¿ÛÌ· ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ PICP C-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π OC OÛÙÂÔηÏÛ›ÓË UCa/UCr ∞¤ÎÎÚÈÛË ·Û‚ÂÛÙ›Ô˘ ÛÙ· Ô‡Ú· ICTP C-ÙÂÏÔÂÙ›‰ÈÔ-1 ÙÔ˘ ¤ÏÈη NTX ¡-ÙÂÏÔÂÙ›‰ÈÔ ÙÔ˘ ¤ÏÈη UPYD/UCr ∞¤ÎÎÚÈÛË ˘ÚȉÈÓÔÏ›Ó˘ ÛÙ· Ô‡Ú· UDPD/UCr ∞¤ÎÎÚÈÛË ‰ÂÔ͢˘ÚȉÈÓÔÏ›Ó˘ ÛÙ· Ô‡Ú· PIIINP ¡-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ πππ UOHPr/UCr ∞¤ÎÎÚÈÛË ˘‰ÚÔ͢ÚÔÏ›Ó˘ ÛÙ· Ô‡Ú· BMC ¶˘ÎÓfiÙËÙ· ÔÛÙÈÎÒÓ ·Ï¿ÙˆÓ
∂ÈÛ·ÁˆÁ‹ O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ ‰›ÓÂÈ Ì›· ‰˘Ó·ÌÈ-
΋ ÂÈÎfiÓ· ÙÔ˘ Û˘ÓfiÏÔ˘ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ Î·È Ù˘ ·‡ÍËÛ˘ ÛÙË ‚ÚÂÊÈ΋, ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· (1,2). ∏ ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ Û ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÛÙÒÓ Û ·˘Ù¤˜ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ‰ÂÓ ¤¯ÂÈ ÂÎÙÂÓÒ˜ ÌÂÏÂÙËı›, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. ¶·Ú’ fiÏ· ·˘Ù¿, ·Ú¤¯Ô˘Ó Ì ÈηÓÔÔÈËÙÈ΋ ¢·ÈÛıËÛ›· ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹, Ôχ ÚÈÓ ÛËÌÂȈıÔ‡Ó ·ÓȯÓ‡ÛÈ̘ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ‹ ÛÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· (1,2). OÈ ¤ˆ˜ Û‹ÌÂÚ· ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Â›Ó·È ÌÈÎÚfiÙÂÚË Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÁÈ·Ù› ÙÔ Â‡ÚÔ˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ Â›Ó·È ÌÂÁ¿ÏÔ ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ Ô˘ ÛËÌÂÈÒÓÂÙ·È Û ·˘Ù¤˜ ÙȘ ËÏÈ˘. ∂›Û˘, Ë ¯Ú‹ÛË ÙÔ˘˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË ‰ÂÓ Â›Ó·È Â˘Ú¤ˆ˜ ‰È·ı¤ÛÈÌË ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ Î·È, Û˘ÓÂÒ˜, ÁÈ· οÔÈÔ˘˜ ·fi ·˘ÙÔ‡˜ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ Û ÂÚ¢ÓËÙÈÎfi ›‰Ô. ¶·È‰È·ÙÚÈ΋ 2005;68:279-287
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Õ. ÿÏÏ· Î·È Û˘Ó.
·È‰ÈÎfi ÏËı˘ÛÌfi, ·Ó·Ê¤ÚÔÓÙ·È ·˘ÍË̤Ó˜ ÙÈ̤˜ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘, fiˆ˜ ÙˆÓ ÙÂÏÔÂÙȉ›ˆÓ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓˆÓ ‰ÂÛÌÒÓ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π (ICTP Î·È NTX) Î·È Ù˘ ·¤ÎÎÚÈÛ˘ Ù˘ ‰ÂÔ͢˘ÚȉÈÓÔÏ›Ó˘ (UDPD/UCr) ÛÙ· Ô‡Ú·, Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Û ۇÁÎÚÈÛË ÌÂ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ Ì·ÚÙ‡ÚˆÓ. OÈ ‰È·ÊÔÚ¤˜ Á›ÓÔÓÙ·È ÌÂÁ·Ï‡ÙÂÚ˜ ÛÙËÓ ÂÊ˂›· Î·È ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (9,10). OÈ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ (BAP, OC Î·È PICP) ‚Ú¤ıËÎ·Ó ÌÂȈ̤Ó˜ ÛÙËÓ ÂÊË‚È΋, ·ÏÏ¿ fi¯È ÛÙËÓ ·È‰È΋ ËÏÈΛ· (9,11). ∞˘Ùfi Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È ÂÓ Ì¤ÚÂÈ ÛÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÂÌÊ¿ÓÈÛ˘ Ù˘ ÏÂÁfiÌÂÓ˘ ·Ó·Ù˘Íȷ΋˜ “¤ÎÚË͢” Ù˘ ÂÊ˂›·˜. øÛÙfiÛÔ, Ë OC ·Ú¤ÌÂÓ Û ϛÁÔ ¯·ÌËÏfiÙÂÚ· ›‰· ·ÎfiÌË Î·È ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÊ˂›·˜ Û ۇÁÎÚÈÛË Ì ÂΛӷ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ Ì·ÚÙ‡ÚˆÓ, ÁÂÁÔÓfi˜ Ô˘ Èı·ÓfiÓ ÛËÌ·›ÓÂÈ fiÙÈ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ·Ú·Ì¤ÓÂÈ ¤Ó· Û¯ÂÙÈο ÌÈÎÚfi ¤ÏÏÂÈÌÌ· ÛÙËÓ ÔÛÙÈ΋ Û‡ÓıÂÛË (¶›Ó·Î·˜ 1). ∞ÓÙ›ıÂÙ·, ÔÈ ÙÈ̤˜ ÙÔ˘ ‰Â›ÎÙË ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ III (PIIINP) ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È ˘„ËÏfiÙÂÚ˜ ÛÙ· Ó·ڿ ÂÓ‹ÏÈη ¿ÙÔÌ· Ì ÙË ÓfiÛÔ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Î·È ·Ô‰fiıËÎ·Ó Ì¿ÏÏÔÓ ÛÙËÓ ›ÓˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ ·Ú¿ ÛÙËÓ ·˘ÍË̤ÓË Û‡ÓıÂÛË Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ (9). ŸÏ· Ù· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·Ê·Ï¿ÙˆÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ Î˘ÛÙÈ΋ ›ÓˆÛË ÔÊ›ÏÂÙ·È ÛÙË ‰È·Ù·Ú·¯‹ Ù˘ ÈÛÔÚÚÔ›·˜ ÌÂٷ͇ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘ Î·È Î˘Ú›ˆ˜ ÛÙËÓ ·˘ÍË̤ÓË ÔÛÙÈ΋ ·Ô‰fiÌËÛË. OÈ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ (Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘) ı· ÌÔÚÔ‡Û·Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ıÂڷ¢ÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ Û ·˘Ù¿ Ù· ·È‰È¿, fiˆ˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ ‹ ÙˆÓ Ê˘ÛÈÎÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÙÔ˘˜ (2,9).
Ÿˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ¤ÙÛÈ Î·È ÛÙ· ·È‰È¿ Â›Ó·È ‰˘Ó·Ùfi Ó· ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ‹ ·Ô‰fiÌËÛ˘, ·ÓÙÈηÙÔÙÚ›˙ÔÓÙ·˜ ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ÚˆÙÔ·ıÔ‡˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ (2). °È· ·Ú¿‰ÂÈÁÌ·, ÛÙË Ú·¯›Ùȉ· ›Ù ·fi ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ D ‹ ÛÙËÓ ÎÏËÚÔÓÔÌÈ΋, Ë ÔÏÈ΋ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (ALP) Î·È ÙÔ ÔÛÙÈÎfi ÎÏ¿ÛÌ· Ù˘ (BAP) Â›Ó·È ·˘ÍË̤ӷ Î·È ·ÔÙÂÏÔ‡Ó ÈÔ Â˘·›ÛıËÙÔ˘˜ ‰Â›ÎÙ˜ ·fi ÙÔ C-ÙÂÏÈÎfi ÚÔÂÙ›‰ÈÔ ÙÔ˘ ÚÔÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π (PICP), ÂÓÒ Ë ÔÛÙÂÔηÏÛ›ÓË (OC) ¤¯ÂÈ ‚ÚÂı› Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÂÏ·Ùو̤ÓË (3-5). ∂ÈÚfiÛıÂÙ·, ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ ALP Ê·›ÓÂÙ·È Ó· ·ÓÙ·Ó·ÎÏÔ‡Ó Ì ·ÍÈÔÈÛÙ›· ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘ ·ÎÙÈÓÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜ (6,7). ∏ ·¤ÎÎÚÈÛË ÙÔ˘ Ca ÛÙ· Ô‡Ú· (UCa/UCr) ·˘Í¿ÓÂÙ·È ÛÙËÓ ˘ÔʈÛÊ·Ù·ÈÌÈ΋ Ú·¯›Ùȉ·, ÂÓÒ ÛÙË ÛÈÙÈÔÁÂÓ‹ Î·È ‚ÈÙ·ÌÈÓÔÂÍ·ÚÙÒÌÂÓË Â›Ó·È ÌÂȈ̤ÓË (8). ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·Ó·Ê¤ÚÔÓÙ·È ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙË ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·ÔÚÚfiÊËÛ˘ Û ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÔÛÙÒÓ Û ‚Ú¤ÊË, ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∂›Û˘, Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ‰ËÌÔÛȇÛÂȘ Ì ‰Â‰Ô̤ӷ ·fi ÙËÓ ÂÌÂÈÚ›· Ì·˜ Û ÓÔÛ‹Ì·Ù· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ Û ·È‰È¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ, fiÔ˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÚÈÎÔ› ‚ÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡.
∫˘ÛÙÈ΋ ›ÓˆÛË ™ÙËÓ Î˘ÛÙÈ΋ ›ÓˆÛË ·Ú·ÙËÚÂ›Ù·È ˘„ËÏ‹ ›وÛË ÔÛÙÂÔfiÚˆÛ˘ Î·È ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ηٷÁÌ¿ÙˆÓ, ΢ڛˆ˜ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ¶·Ú¿ ÙÔÓ ÌÈÎÚfi ·ÚÈıÌfi ÌÂÏÂÙÒÓ ÛÙÔÓ
¶›Ó·Î·˜ 1. ªÂÙ·‚ÔϤ˜ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ Û ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¢È·Ù·Ú·¯‹ ∫˘ÛÙÈ΋ ›ÓˆÛË ¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ·ÚıÚ›Ùȉ· (ÂÓÂÚÁ‹ ÓfiÛÔ˜) ¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ÔÛÙÂÔfiÚˆÛË (ÂÓÂÚÁ‹ ÓfiÛÔ˜) ∞ÙÂÏ‹˜ ÔÛÙÂÔÁ¤ÓÂÛË ƒ·¯›Ùȉ· (·ÓÂÍ·Úًو˜ ·ÈÙÈÔÏÔÁ›·˜)
PICP
BAP
OC
PYD/DPD
ICTP
NTX
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º: Ê˘ÛÈÔÏÔÁÈ΋, : ÌÂȈ̤ÓË, : ·˘ÍË̤ÓË, -: ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰Â‰Ô̤ӷ ÛÙ· ·È‰È¿ ¶·È‰È·ÙÚÈ΋ 2005;68:279-287
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Pediatr July-Aug 05 new
22-07-05
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µÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ Î·È ·È‰È·ÙÚÈο ÓÔÛ‹Ì·Ù·
¢È·Ù·Ú·¯¤˜ ·‡ÍËÛ˘ ∞Ó Î·È ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ ÙÈ̤˜ ÙˆÓ ÔÛÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ÛÙ· ·È‰È¿ Ì ¤ÏÏÂÈ„Ë ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Û ۇÁÎÚÈÛË Ì ٷ ˘ÁÈ‹, ·Ú·ÙËÚÂ›Ù·È ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÂÈÎ¿Ï˘„˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ú·ÎÙÈÎÒ˜ ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ ‰ÂÓ ‚ÔËıÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË (12-17), ·ÏÏ¿ ·Ô‰ÂÈÎÓ‡ÔÓÙ·È Ôχ ¯Ú‹ÛÈÌÔÈ ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ (15,18-20). OÈ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ÛÙ· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ¤ÏÏÂÈ„Ë ‹ ÛÙ· ·È‰È¿ Ì ȉÈÔ·ı¤˜ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ·Ú¤¯Ô˘Ó ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÚÔÛ‰fiÎÈÌË Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ÙÔ˘ ‡„Ô˘˜ ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ. H ÔÏÈ΋ ALP ‹ ÙÔ ÔÛÙÈÎfi ÎÏ¿ÛÌ· Ù˘ Ê·›ÓÂÙ·È Ó· ‰›ÓÂÈ ÈÔ ·ÍÈfiÈÛÙ˜ ÏËÚÔÊÔڛ˜ fiÙ·Ó ÔÈ ÌÂÙÚ‹ÛÂȘ Á›ÓÔÓÙ·È 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜. ∞ÎÔÏÔ˘ıÔ‡Ó Ì Ôχ ÏÈÁfiÙÂÚË ·ÍÈÔÈÛÙ›· ÔÈ ‰Â›ÎÙ˜ PIIINP, PICP Î·È ICTP (21). ªÂ Ù· ̤¯ÚÈ ÙÒÚ· ‰Â‰Ô̤ӷ, Ë ÚfiÁÓˆÛË Ù˘ Ù·¯‡ÙËÙ·˜ ·‡ÍËÛ˘ ÙÔ˘ ‡„Ô˘˜ Ì ÙË ¯Ú‹ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ‰ÂÓ ¤¯ÂÈ ÈηÓÔÔÈËÙÈ΋ ·ÍÈÔÈÛÙ›·. øÛÙfiÛÔ, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘˜ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÌË Î·Ï‹˜ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹, ÒÛÙ ·˘Ù‹ Ó· ÌË Û˘Ó¯›˙ÂÙ·È ¿ÛÎÔ· (21).
OÛÙÂÔÂÓ›· Ù˘ ÚÔˆÚfiÙËÙ·˜ ŸÏÔÈ ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ÛÙ· ‚Ú¤ÊË ··ÓÙÒÓÙ·È Û Ôχ ˘„ËÏfiÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Û ۯ¤ÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, ·ÓÙÈηÙÔÙÚ›˙ÔÓÙ·˜ ÙÔ˘˜ ˘„ËÏÔ‡˜ Ú˘ıÌÔ‡˜ ·‡ÍËÛ˘ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (21,22). Ÿˆ˜ Î·È ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, ÙÔ PICP, Ë OC Î·È Ë ·¤ÎÎÚÈÛË Ù˘ ˘‰ÚÔ͢ÚÔÏ›Ó˘ (UOHPr/UCr) Î·È Ù˘ PYD ÛÙ· Ô‡Ú· Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ Î·È ÙËÓ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (22-24). ∂ÈϤÔÓ, ÔÈ ÙÈ̤˜ ÙÔ˘ PICP ‰Â›¯ÓÔ˘Ó ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Î·È Ì ÙËÓ ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ Ì¿˙·˜ (22). ∏ ALP Ê·›ÓÂÙ·È Ó· Â›Ó·È ¯Ú‹ÛÈÌÔ˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ÔÛÙÂÔÂÓ›· Ù˘ ÚÔˆÚfiÙËÙ·˜. ∞ÓÙ›ıÂÙ· Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜, Ë ÔÏÈ΋ ALP ¤¯ÂÈ ·ÚÓË-
ÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ˘ÎÓfiÙËÙ· ÔÛÙÈÎÒÓ ·Ï¿ÙˆÓ (BMC) Ù˘ ÎÂÚΛ‰·˜ Î·È ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ Û ÚfiˆÚ· ÓÂÔÁÓ¿ (25,26). ¶ÔÏϤ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ÛËÌ·Û›· ÙˆÓ ‰È·‰Ô¯ÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ALP, ÁÈ·Ù› ÔÈ Ì¤ÁÈÛÙ˜ ÙÈ̤˜ Ù˘ ‰ÂÓ Û˘Ì›ÙÔ˘Ó Ì ÙoÓ Ì¤ÁÈÛÙÔ ‚·ıÌfi ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ‹ Ù· ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÔÛÙÂÔÂÓ›·˜. ™˘Ó‹ıˆ˜, Ë Ì¤ÁÈÛÙË ÙÈÌ‹ Ù˘ ALP ÚÔËÁÂ›Ù·È 2-4 ‚‰ÔÌ¿‰Â˜ Ù˘ ·Ó›¯Ó¢Û˘ Ì ·ÎÙÈÓÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜ Ù˘ ̤ÁÈÛÙ˘ ÌÂÙ·‚ÔÏ‹˜ ÛÙÔÓ ÔÛÙ›ÙË ÈÛÙfi. ∞ÎÙÈÓÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË Û˘ÓÈÛÙ¿Ù·È ÛÙÔ ÓÂÔÁÓfi ÙÔ˘ ÔÔ›Ô˘ Ë ÙÈÌ‹ Ù˘ ALP ˘ÂÚ‚·›ÓÂÈ Î·Ù¿ 5 ÊÔÚ¤˜ ÙÔ ·ÓÒÙ·ÙÔ fiÚÈÔ Ù˘ ALP ÙˆÓ ÂÓËÏ›ÎˆÓ (27). ∆ÔÓ›˙ÂÙ·È fiÙÈ Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÒÓ Î·È ‚ÚÂÊÒÓ Ì ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ‹ ÏÔÈÌÒÍÂȘ ·fi Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÈÔ‡˜ (ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi, Epstein-Barr, ÈÏ·Ú¿˜, ÂÚ˘ıÚ¿˜ Î·È ¤ÚËÙ·) ηıÒ˜ Î·È ·fi ÚˆÙfi˙ˆ· (ÙÔÍfiÏ·ÛÌ·), Ë ALP ÌÔÚ› Ó· ·˘ÍËı› ¤ˆ˜ Î·È 20 ÊÔÚ¤˜ ¿Óˆ ·fi ÙÔ ·ÓÒÙ·ÙÔ fiÚÈÔ Ù˘ ALP ÙˆÓ ÂÓËϛΈÓ, ¯ˆÚ›˜ ·˘Ù‹ Ë ·‡ÍËÛË Ó· ˘Ô‰ËÏÒÓÂÈ ‰È·Ù·Ú·¯‹ ÛÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi. OÈ ÙÈ̤˜ ÂÈÛÙÚ¤ÊÔ˘Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi 1-3 Ì‹Ó˜ (28-30).
¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ·ÚıÚ›Ùȉ· ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ì Ó·ÓÈ΋ ȉÈÔ·ı‹ ·ÚıÚ›Ùȉ· ·ÓÙÈÌÂÙˆ›˙ÂÈ ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·‡ÍËÛË, ÔÛÙÂÔÂÓ›· Î·È Î·Ù¿ÁÌ·Ù· (31-33). ∆· ·È‰È¿ Ì ÂÓÂÚÁ‹ ÓfiÛÔ ¤¯Ô˘Ó ‚ÚÂı› Ó· ¤¯Ô˘Ó ¯·ÌËϤ˜ ÙÈ̤˜ ÛÙËÓ BMC, ·ÏÏ¿ Î·È ÛÙÔ ÔÛÙÈÎfi ÎÏ¿ÛÌ· Ù˘ ∞LP Î·È Ù˘ OC, Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ì ÓfiÛÔ Û ‡ÊÂÛË ‹ ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (¶›Ó·Î·˜ 1) (34-36). ∏ ‡ÊÂÛË Ù˘ ÓfiÛÔ˘ ‹ Ë ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ Ì ηÏÛÈÙÔÓ›ÓË ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÙÈÌÒÓ Ù˘ BMC, Ù˘ OC Î·È ÙË Ì›ˆÛË Ù˘ ·¤ÎÎÚÈÛ˘ Ù˘ OHPr Î·È ÙˆÓ ˘ÚȉÈÓÔÏÈÓÒÓ ÛÙ· Ô‡Ú· (37,38).
¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ÔÛÙÂÔfiÚˆÛË ª›· ·fi ÙȘ ·ÚȘ ¯ÚËÛÈÌfiÙËÙ˜ ÙˆÓ ÔÛÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â›Ó·È Ë Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ‰ÈÂÚÁ·ÛÈÒÓ Ô˘ Â›Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ÚfiÎÏËÛË Ù˘ Ó·ÓÈ΋˜ ȉÈÔ·ıÔ‡˜ ÔÛÙÂÔfiÚˆÛ˘. OÈ ÙÈ̤˜ ÙÔ˘ PICP Î·È Ù˘ OC ¤¯Ô˘Ó ‚ÚÂı› ¯·ÌËϤ˜, Ê˘ÛÈÔÏÔÁÈΤ˜ ‹ Î·È ˘„ËϤ˜ ¶·È‰È·ÙÚÈ΋ 2005;68:279-287
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Õ. ÿÏÏ· Î·È Û˘Ó.
·Ó¿ÏÔÁ· Ì ÙÔ ÛÙ¿‰ÈÔ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘ (39,40). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¤Í·ÚÛ˘ Ù˘ ÓfiÛÔ˘, Ë ·¤ÎÎÚÈÛË ÙˆÓ ˘ÚȉÈÓÔÏÈÓÒÓ Î·È ÙÔ˘ ICTP ÛÙ· Ô‡Ú· ‚Ú¤ıËΠ·˘ÍË̤ÓË, ÂÓÒ ÔÈ ÙÈ̤˜ Ù˘ µ∞P ‹Ù·Ó Û ¯·ÌËÏ¿ ›‰· ‹ ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο (39-41) (¶›Ó·Î·˜ 1). ∆· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·Ù¿ Ì ÙËÓ ·˘ÍË̤ÓË ÔÛÙÈ΋ ·Ô‰fiÌËÛË, Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÛÙÈ΋ Û‡ÓıÂÛË. ∏ ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Û˘Ó‰˘¿ÛÙËΠ̠ÙËÓ ÔÌ·ÏÔÔ›ËÛË fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ ‰ÂÈÎÙÒÓ (42).
∞ÙÂÏ‹˜ ÔÛÙÂÔÁ¤ÓÂÛË ™ÙËÓ ·ÙÂÏ‹ ÔÛÙÂÔÁ¤ÓÂÛË, Ë ÔÔ›· ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÁÈ· ÙȘ ·Ï‡ÛÔ˘˜ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I, Ô ‰Â›ÎÙ˘ PICP ¤¯ÂÈ ‚ÚÂı› Ó· Â›Ó·È ÂÏ·Ùو̤ÓÔ˜ ÛÙȘ ÌË ı·Ó·ÙËÊfiÚ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘, Û ۇÁÎÚÈÛË ÌÂ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ Ì·ÚÙ‡ÚˆÓ ‹ ˘ÁÈÒÓ Û˘ÁÁÂÓÒÓ (¶›Ó·Î·˜ 1) (43-45). ™ÙËÓ ·ÙÂÏ‹ ÔÛÙÂÔÁ¤ÓÂÛË Ù‡Ô˘ I ··ÓÙÒÓÙ·È Ù· ¯·ÌËÏfiÙÂÚ· ›‰· ÙÔ˘ ‰Â›ÎÙË PICP Î·È ·ÎÔÏÔ˘ıÔ‡Ó Ë Ù‡Ô˘ III Î·È IV (43,45,46). ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Î·È ÁÈ· ÙÔÓ ‰Â›ÎÙË ICTP, ÙÔ˘ ÔÔ›Ô˘ Ù· ›‰· ‚Ú¤ıËÎ·Ó ¯·ÌËÏfiÙÂÚ· ÛÙËÓ Ù‡Ô˘ I Û ۇÁÎÚÈÛË Ì ÙËÓ Ù‡Ô˘ III Î·È IV ·ÙÂÏ‹ ÔÛÙÂÔÁ¤ÓÂÛË (46). O ‰Â›ÎÙ˘ PπππNP ‚Ú¤ıËΠӷ Â›Ó·È ¯·ÌËÏfiÙÂÚÔ˜ ÛÙ· ·È‰È¿ ÌÂ Ù‡Ô˘ III ·ÙÂÏ‹ ÔÛÙÂÔÁ¤ÓÂÛË Û ۇÁÎÚÈÛË Ì ÂΛӷ ÌÂ Ù‡Ô˘ π (46). ∞ÓÙ›ıÂÙ·, Ù· ›‰· Ù˘ OC, Ù˘ ALP Î·È Ë ·¤ÎÎÚÈÛË ÙˆÓ ˘ÚȉÈÓÔÏÈÓÒÓ (PYD Î·È DPD) Î˘Ì·›ÓÔÓÙ·Ó Ì¤Û· ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Î·È ÛÙÔ˘˜ ÙÚÂȘ Ù‡Ô˘˜ ·ÙÂÏÔ‡˜ ÔÛÙÂÔÁ¤ÓÂÛ˘ (46). ∏ ÌÂϤÙË ÙˆÓ ·Ú·¿Óˆ ‰ÂÈÎÙÒÓ ‰Â›¯ÓÂÈ fiÙÈ ÛÙËÓ Ù‡Ô˘ I ·ÙÂÏ‹ ÔÛÙÂÔÁ¤ÓÂÛË Ë ÔÛÙÈ΋ ·Ô‰fiÌËÛË Â›Ó·È ÌÂȈ̤ÓË, fiˆ˜ Î·È Ë ÔÛÙÈ΋ Û‡ÓıÂÛË, Ì ·ÔÙ¤ÏÂÛÌ· Ô Ú˘ıÌfi˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ Ó· Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹, ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ˆ˜ ÚÔ˜ ÙÔÓ Ù‡Ô ıÂڷ›·˜ Î·È ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÔÈ ·ÛıÂÓ›˜ Ì ¯·ÌËÏ¿ ›‰· PICP Î·È ÌÂȈ̤ÓÔ˘˜ ‹ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ÌÔÚ› Ó· ‚ÔËıËıÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ·ÁˆÁ‹ Ô˘ ·˘Í¿ÓÂÈ ÙË Û‡ÓıÂÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ π fiˆ˜ Â›Ó·È Ë ·˘ÍËÙÈ΋ ÔÚÌfiÓË Î·È Ó· ·Ú·ÎÔÏÔ˘ıËıÔ‡Ó Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȤ‰ˆÓ PICP Î·È PINP (47). ∞ÓÙ›ıÂÙ·, ÔÈ ¶·È‰È·ÙÚÈ΋ 2005;68:279-287
·ÛıÂÓ›˜ Ì ·˘ÍË̤ÓÔ˘˜ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ ÌÔÚ› Ó· ‚ÔËıËıÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ·ÁˆÁ‹ Ì ‰ÈʈÛÊÔÓÈο ‹ Û˘Ó‰˘·ÛÌfi ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È ‰ÈʈÛÊÔÓÈÎÒÓ Î·È Ó· ·Ú·ÎÔÏÔ˘ıËıÔ‡Ó Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘ (48).
¢È·Ù·Ú·¯¤˜ ıÚ¤„˘ ™Â ‰È·Ù·Ú·¯¤˜ Ù˘ ıÚ¤„˘ ÛÙ· ·È‰È¿, ÔÈ ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ Ì ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ Â›Ó·È È‰È·›ÙÂÚ· ÂÚÈÔÚÈṲ̂Ó˜. ™ÙË Ó¢ÚÔÁÂÓ‹ ·ÓÔÚÂÍ›·, Ô˘ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ÂÊË‚È΋ Î·È Ó·ڋ ËÏÈΛ·, ·Ó·Ê¤ÚÂÙ·È ÔÛÙÂÔÂÓ›· (49-51). OÈ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ‰Â›¯ÓÔ˘Ó fiÙÈ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÂ›Ù·È ‰È·Ù·Ú·¯‹ ÙˆÓ Ú˘ıÌÒÓ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘. ŒÙÛÈ, Ô Ú˘ıÌfi˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÛÙ·ıÂÚfi˜ ‹ Ó· ÌÂÈÒÓÂÙ·È ·Ó¿ÏÔÁ· Ì ÙÔÓ ‚·ıÌfi ˘ÔÛÈÙÈÛÌÔ‡, fiˆ˜ ‰Â›¯ÓÔ˘Ó ÔÈ ·ÓÙ›ÛÙÔȯÔÈ ‰Â›ÎÙ˜ (BAP, OC, PICP) (49-51). ∞ÓÙ›ıÂÙ·, ÔÈ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ (NTÃ, ICTP, UCa/UCr) Â›Ó·È ·˘ÍË̤ÓÔÈ ‹ ÛÙ· ·ÓÒÙÂÚ· fiÚÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (49,50). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó¤ÊÂÚ·Ó Â›Â‰· ÙÔ˘ ‰Â›ÎÙË ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ CTX Û˘ÁÎÚ›ÛÈÌ· ÌÂ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, Ù· ÔÔ›· fï˜ ÌÂÈÒıËÎ·Ó ÌÂÙ¿ ÙË Û›ÙÈÛË (51), ÂÓÒ ÙÔ˘ ‰Â›ÎÙË ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ PICP ·˘Í‹ıËÎ·Ó (52). ™Â ·È‰È¿ Ì ÎÔÈÏÈÔοÎË, ÔÈ ÙÈ̤˜ ÙÔ˘ ‰Â›ÎÙË PICP Î·È Ù˘ OC ‚Ú¤ıËÎ·Ó ÌÂȈ̤Ó˜ Î·È ·˘Í‹ıËÎ·Ó ÌÂÙ¿ ·fi ÙÚ›ÌËÓË ‰›·ÈÙ·, ÂχıÂÚË ÁÏÔ˘Ù¤Ó˘ (53). ªÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· (4,3 ÂÙÒÓ) ‰›·ÈÙ· ÂχıÂÚË ÁÏÔ˘Ù¤Ó˘, ÔÈ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ BAP Î·È NTà ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È ˘„ËÏfiÙÂÚ˜ ·fi ÂΛӘ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ Ì·ÚÙ‡ÚˆÓ, Èı·ÓÒ˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ηٿ ÙË ‰È·‰Èηۛ· Ù·¯Â›·˜ ·‡ÍËÛ˘ ÁÈ· ÙËÓ Â›Ù¢ÍË Ù˘ ÚÔ‚ÏÂfiÌÂÓ˘ ÁÈ· ÙËÓ ËÏÈΛ· ÔÛÙÈ΋˜ Ì¿˙·˜ (54). ∞ÓÙ›ıÂÙ·, ηٿ ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ÂχıÂÚË ‰›·ÈÙ· ÁÈ· 4 ‚‰ÔÌ¿‰Â˜, ÔÈ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ ·˘ÙÒÓ, fiˆ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ÌÂÈÒıËÎ·Ó (55). ™ÙË ÛÈÙÈÔÁÂÓ‹ Ú·¯›Ùȉ·, ÔÈ ÙÈ̤˜ Ù˘ OC ‚Ú¤ıËÎ·Ó ¯·ÌËϤ˜ ‹ Ê˘ÛÈÔÏÔÁÈΤ˜, ÂÓÒ Ù˘ ÔÏÈ΋˜ ALP ˘„ËϤ˜. ªÂÙ¿ ÙË ıÂڷ¢ÙÈ΋ ·Ú¤Ì‚·ÛË, ÔÈ ÙÈ̤˜ Ù˘ OC ·˘Í‹ıËÎ·Ó Î·È Ù˘ ∞LP ÌÂÈÒıËÎ·Ó Î·È Â·Ó‹Ïı·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο ›‰· Û ‰È¿ÛÙËÌ· 2-3 ÌËÓÒÓ (56). ¶·Ú’ fiÏÔ Ô˘ Ë
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µÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ Î·È ·È‰È·ÙÚÈο ÓÔÛ‹Ì·Ù·
∞LP Â›Ó·È ÈÔ ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙ˘ ÛÙË ‰È¿ÁÓˆÛË Ù˘ Ú·¯›Ùȉ·˜ ·fi ÙËÓ OC, ÌÂÙ¿ ÙË ıÂڷ›· Ù· ›‰· Ù˘ OC ·˘Í¿ÓÔÓÙ·È ÈÔ ÁÚ‹ÁÔÚ· Û ۇÁÎÚÈÛË Ì ÙËÓ ÙÒÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ∞LP (57). ™Â ¿ÏϘ ÌÂϤÙ˜, ÔÈ ‰Â›ÎÙ˜ ÙfiÛÔ Ù˘ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ (ICTP) fiÛÔ Î·È Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ (ALP, OC, PICP) Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› Û ‚·ÚȤ˜ ηٷÛÙ¿ÛÂȘ Ú·¯›Ùȉ·˜ ÏfiÁˆ ˘ÔÛÈÙÈÛÌÔ‡, ¤¯Ô˘Ó ‚ÚÂı› Ó· Â›Ó·È ·˘ÍË̤ÓÔÈ ÏfiÁˆ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ Ù˘ ıÂ̤ÏÈ·˜ Ô˘Û›·˜ (58-60).
∂›‰Ú·ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÛÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ ·‡ÍËÛË OÈ ÂȉڿÛÂȘ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÛÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ ·‡ÍËÛË ¤¯Ô˘Ó ÌÂÏÂÙËı› ÂÎÙÂÓÒ˜, ÙfiÛÔ Û ÂÓ‹ÏÈΘ fiÛÔ Î·È Û ·È‰È¿.
™˘ÛÙËÌ·ÙÈο ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ∏ ıÂڷ›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÛÙ· ·È‰È¿ Ô‰ËÁ› Û ÌÂȈ̤ÓÔ Ú˘ıÌfi ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ Î·È ·‡ÍËÛ˘, fiˆ˜ Î·È Û ¯·ÌËÏ‹ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·. ∏ ¯Ú‹ÛË ÙˆÓ ÔÛÙÈÎÒÓ ‰ÂÈÎÙÒÓ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, Û‡Ìʈӷ Ì ٷ ˘¿Ú¯ÔÓÙ· ‰Â‰Ô̤ӷ, ÂÚÈϤÎÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi. ∞˘ÙÔ› ÌÔÚ› Ó· Â›Ó·È Ë ·Ûı¤ÓÂÈ· ·˘Ù‹ ηı·˘Ù‹ Î·È Ë ‚·Ú‡ÙËÙ¿ Ù˘, Ô ÙÚfiÔ˜ Î·È Ë ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ηıÒ˜ Î·È Ë Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ÙˆÓ ·È‰ÈÒÓ. ¶ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎ·Ó ˘„ËϤ˜ ‰fiÛÂȘ ‰ÂÍ·ÌÂı·˙fiÓ˘ (500 Ìg/kg/Ë̤ڷ), ·ÚÔ˘Û›·Û·Ó ÌÂÁ¿ÏË Ì›ˆÛË ÛÙȘ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ PICP, PIIINP Î·È ICTP ÌÂÙ¿ ·fi 3 Ë̤Ú˜ ıÂڷ›·˜. ªÂ ÙË Ì›ˆÛË Ù˘ ‰fiÛ˘ Û 200 Ìg/kg/Ë̤ڷ, ÔÈ ÙÈ̤˜ ¿Ú¯ÈÛ·Ó Ó· ·˘Í¿ÓÔÓÙ·È Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·ÙËÚ‹ıËΠۯ‰fiÓ ÔÌ·ÏÔÔ›ËÛË (21). ™Â ·È‰È¿ Ì ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· Ô˘ ¤Ï·‚·Ó ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË ÂÓ‰ÔÊÏ‚›ˆ˜ ·Ú·ÙËÚ‹ıËΠ¿ÌÂÛË Ì›ˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ PICP Û 24-48 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ (61). ™Â ‚Ú¤ÊË Î·È ·È‰È¿ Ì ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù· (‚ÚÔÁ¯ÈÔÏ›Ùȉ·, Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ ÌÂÙ¿ ·fi ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, Ï·Ú˘ÁÁ›Ùȉ·) Ô˘ ¤Ï·‚·Ó ÂÓ‰ÔÊÏ‚›ˆ˜ ˘‰ÚÔÎÔÚÙÈ˙fiÓË ‹ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË (10 Î·È 2 mg/kg/24ˆÚÔ, ·ÓÙ›ÛÙÔȯ·) ÁÈ· 48-72 ÒÚ˜, ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘, ÔÏÈ΋ ALP ηÈ
OC, ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο ÌÂÙ¿ ÙÔ 2Ô 24ˆÚÔ Î·È Ë Ì›ˆÛË ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ·È‰È¿ ËÏÈΛ·˜ >12 ÌËÓÒÓ Û ۇÁÎÚÈÛË Ì ٷ ‚Ú¤ÊË. øÛÙfiÛÔ, Û 2 ‚‰ÔÌ¿‰Â˜ ÔÈ ·Ú·¿Óˆ ·Ú¿ÌÂÙÚÔÈ Â›¯·Ó ·ӤÏıÂÈ ÛÙ· ÚÔ ıÂڷ›·˜ ‹ Î·È Û ˘„ËÏfiÙÂÚ· ›‰·. OÈ ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ô‰fiÌËÛ˘ (UCa/UCr, UOHPr/UCr, UPYD/UCr, UDPD/UCr) ÛÙÔÓ ›‰ÈÔ ÏËı˘ÛÌfi ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ ‹ ÌÂÙ¿ ·fi ·˘Ù‹ (62). ¶·È‰È¿ Ì ÊÏÂÁÌÔÓÒ‰ÂȘ ·ı‹ÛÂȘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó Û ıÂڷ›· Ì Ú‰ÓÈ˙ÔÏfiÓË Î·ıËÌÂÚÈÓ¿, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ÙÔ˘ ‰Â›ÎÙË PICP Î·È ÌÂȈ̤ÓË Ù·¯‡ÙËÙ· ·‡ÍËÛ˘, Û ۇÁÎÚÈÛË Ì ·˘Ù¿ Ô˘ Ï¿Ì‚·Ó·Ó ÙËÓ ·ÁˆÁ‹ οı ‰Â‡ÙÂÚË Ë̤ڷ ‹ ‹Ù·Ó ¯ˆÚ›˜ ·ÁˆÁ‹, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘. ªÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ, ÔÈ ÙÈ̤˜ ÙÔ˘ PICP Î·È Ë Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ ¿ÓÔ‰Ô (63). ¶·È‰È¿ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·, ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ Ú‰ÓÈ˙ÔÏfiÓ˘ ·fi ÙÔ ÛÙfiÌ· (·Ú¿ÏÏËÏ· Ì ÙË ¯ËÌÂÈÔıÂڷ›·), ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÔÏÏÒÓ ‰ÂÈÎÙÒÓ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È ÙˆÓ ÔÛÙÒÓ, Ô˘ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ Ú‰ÓÈ˙ÔÏfiÓ˘ ·ӋÏı·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο ›‰· (64). OÈ ·Ú·¿Óˆ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ÙË Ì›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ. ∂›Û˘, ‰Â›¯ÓÔ˘Ó fiÙÈ ·˘Ù¤˜ ÔÈ ÌÂÙ·‚ÔϤ˜ Â›Ó·È Ï‹Úˆ˜ ·Ó·ÛÙÚ¤„È̘ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜, ȉȷ›ÙÂÚ· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÁÈ· ‚Ú·¯‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. øÛÙfiÛÔ, οı ·ÚÓËÙÈ΋ ›وÛË Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ‹ ·ÓÂÈÏËÌ̤Ó˘ Û˘ÛÙËÌ·ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÛÙÔÓ ÔÛÙÈÎfi ·Ó·Û¯ËÌ·ÙÈÛÌfi Î·È ÛÙËÓ ·‡ÍËÛË ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú¿ ˘’ fi„ÈÓ.
∂ÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ∆· ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÛÙË ıÂڷ›· ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ Î·È Ë ¯Ú‹ÛË ÙÔ˘˜ ¤¯ÂÈ ÌÂÈÒÛÂÈ ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ. ¶·Ú’ fiÏ· ·˘Ù¿, Ê·›ÓÂÙ·È fiÙÈ Î·È Ù· ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ̤ۈ Ù˘ ·ÔÚÚfiÊËÛ‹˜ ÙÔ˘˜ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi ÂÈı‹ÏÈÔ, ÌÔÚ› Ó· ¤¯Ô˘Ó Û˘ÛÙËÌ·ÙÈΤ˜ ‰Ú¿ÛÂȘ ÛÙ· ÔÛÙ¿ Î·È ÙËÓ ·‡ÍËÛË. ¶·È‰È·ÙÚÈ΋ 2005;68:279-287
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™Â ÌÂϤÙË Ì ·ÛıÌ·ÙÈο ·È‰È¿ Ô˘ Ï¿Ì‚·Ó·Ó ÌÂÎÏÔÌÂı·˙fiÓË Û ÂÈÛÓÔ¤˜ Ì·ÎÚÔ¯ÚfiÓÈ·, ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ (µ∞ƒ Î·È OC) Î·È ·Ô‰fiÌËÛ˘ (·¤ÎÎÚÈÛË DPD), Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (65,66). ∞ÓÙ›ıÂÙ·, Û ¿ÏÏË ÚÔÔÙÈ΋ ÌÂϤÙË Û ·È‰È¿ Ô˘ ıÂڷ‡ÔÓÙ·Ó Ì ‚Ô˘‰ÂÛÔÓ›‰Ë Û ÂÈÛÓÔ¤˜, ÔÈ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ PICP Î·È OC ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο ¤Ó·Ó Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ¯ÔÚ‹ÁËÛ˘, ¯ˆÚ›˜ fï˜ ÙÔ ÔÛÙÈÎfi ÎÏ¿ÛÌ· Ù˘ ALP Ó· ÂËÚ¿˙ÂÙ·È (67). OÈ Birkebaek Î·È Û˘Ó (68) ÌÂϤÙËÛ·Ó ÙȘ ÂȉڿÛÂȘ Ù˘ ‚Ú·¯‡¯ÚÔÓ˘ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ, ‚Ô˘‰ÂÛÔÓ›‰Ë˜ Î·È ÌÂÎÏÔÌÂı·˙fiÓ˘, ÛÙË ‰fiÛË ÙˆÓ 800 Ìg/Ë̤ڷ ÁÈ· ‰‡Ô ‚‰ÔÌ¿‰Â˜. ∫·È Ù· ‰‡Ô ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÚÔοÏÂÛ·Ó ·ÚfiÌÔÈ· ÙÒÛË (13-20%) ÙÔ˘ PICP Î·È Ù˘ ·¤ÎÎÚÈÛ˘ ˘ÚȉÈÓÔÏÈÓÒÓ, ·ÏÏ¿ η̛· ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÔÛÙÂÔηÏÛ›Ó˘. ™Â ¿ÏÏË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË Ù˘ ÌÂÎÏÔÌÂı·˙fiÓ˘ Î·È ÊÏÔ˘ÙÈη˙fiÓ˘ Û ÂÈÛÓÔ¤˜ ÁÈ· 20 Ì‹Ó˜, Û ‰fiÛË 400 Ìg/Ë̤ڷ Î·È 200 Ìg/Ë̤ڷ, ·ÓÙ›ÛÙÔȯ·, Û ·È‰È¿ ËÏÈΛ·˜ 5-10 ÂÙÒÓ Ì ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·, Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ICTP, OC Î·È DPD ‰ÂÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ (69). ™Â Ù˘¯·ÈÔÔÈË̤ÓË, fï˜, ÌÂϤÙË Ì ÙË ¯Ú‹ÛË placebo Î·È ‚Ô˘‰ÂÛÔÓ›‰Ë˜ Û ÂÈÛÓÔ¤˜, Û ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÔ Û¯‹Ì·, ÔÈ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ PIIINP, ICTP Î·È ·¤ÎÎÚÈÛ˘ ˘ÚȉÈÓÔÏÈÓÒÓ Â›¯·Ó ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, fiˆ˜ ·˘Ù‹ ÌÂÙÚ‹ıËΠ̠ÙË Ì¤ıÔ‰Ô Ù˘ ÎÓËÌÔÌÂÙÚ›·˜. ∞ÓÙ›ıÂÙ·, ÔÈ ÙÈ̤˜ ÙÔ˘ PICP ‰ÂÓ ¤‰ÂÈÍ·Ó Ù¤ÙÔÈ· Û˘Û¯¤ÙÈÛË (70). ™Â ÌÂϤÙË ·È‰ÈÒÓ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ fiÔ˘ ÌÂÙÚ‹ıËÎ·Ó ‰Â›ÎÙ˜ Û‡ÓıÂÛ˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡Ô˘ I Î·È III (PINP, PICP, PIIINP) Î·È Î·Ù·‚ÔÏÈÛÌÔ‡ ÙÔ˘ (ICTP) ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚Ô˘‰ÂÛÔÓ›‰Ë˜ ‹ ÌÂÎÏÔÌÂı·˙fiÓ˘ Û ÂÈÛÓÔ¤˜ ÁÈ· 12 Ì‹Ó˜, ·˘ÙÔ› ‚Ú¤ıËÎ·Ó Ó· ÌÂÈÒÓÔÓÙ·È, Èı·ÓÒ˜ ÏfiÁˆ ÙÔ˘ ÌÂȈ̤ÓÔ˘ Ú˘ıÌÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ (71). ™ÙËÓ ›‰È· ÌÂϤÙË, Ë Ì¤ÙÚËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ¤‰ÂÈÍ Ì›ˆÛË ÌfiÓÔ ÛÙ· ›‰· OC Î·È fi¯È Ù˘ BAP. ªÂ ‚¿ÛË ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù· Ê·›ÓÂÙ·È fiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Â›Ó·È Èı·Ófi Ó· ·Ú¤¯ÂÈ ·ÎÚÈ‚¤ÛÙÂÚ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ Â›‰Ú·ÛË ÙˆÓ Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚËÁÔ‡ÌÂÓˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Û ۇÁÎÚÈÛË Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ‰ÂÈÎÙÒÓ OC Î·È BAP. ¶·È‰È·ÙÚÈ΋ 2005;68:279-287
∆· Â˘Ú‹Ì·Ù· fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ ÌÂÏÂÙÒÓ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÌÔÚ› Ó· ¤¯Ô˘Ó Û˘ÛÙËÌ·ÙÈΤ˜ ÂȉڿÛÂȘ ÛÙËÓ ·‡ÍËÛË Î·È ÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi, ·ÏÏ¿ ··ÈÙÔ‡ÓÙ·È Ì·ÎÚÔ¯ÚfiÓȘ ÌÂϤÙ˜ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜ Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· ·˘ÙÒÓ ÙˆÓ ÂȉڿÛˆÓ.
™˘ÌÂÚ¿ÛÌ·Ù· ¶·Ú¿ ÙËÓ ‡·ÚÍË ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È ÙˆÓ ÔÛÙÒÓ, Ë ÂÈÏÔÁ‹ ÙÔ˘/ÙˆÓ ‰Â›ÎÙË/‰ÂÈÎÙÒÓ Ô˘ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ/Ô˘Ó ÛÙË ‰È¿ÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÎÏÈÓÈ΋ ‰È·Ù·Ú·¯‹. øÛÙfiÛÔ, ‰ÂÓ ˘¿Ú¯ÂÈ ÈηÓÔÔÈËÙÈÎfi˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ ‰ÂÈÎÙÒÓ Î·È ÔÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÁÓÒÛÂȘ Ô˘ ¤¯Ô˘Ó ·ÔÎÙËı› fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ÂÏÏÈ›˜. ∞Ó·ÊÔÚÈο Ì ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÔÛÙÂÔÂÓ›· ˘¿Ú¯Ô˘Ó ÔÏÏÔ› ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È ·Ô‰fiÌËÛ˘ Ô˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó, fiˆ˜ ÙÔ PICP, Ë BAP, Ë OC, Ë ·¤ÎÎÚÈÛË ÛÙ· Ô‡Ú· Ù˘ DPD Î·È ÙÔ ICTP. ¶Ú¤ÂÈ, fï˜, Ó· ÙÔÓÈÛÙ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÏϤ˜ ·fi ÙȘ ÙÈ̤˜ ·˘ÙÒÓ ÙˆÓ ‰ÂÈÎÙÒÓ ÂÈηχÙÔ˘Ó ÂΛӘ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ, ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‡ÚÔ˘˜ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ. ∞fi Ù· ̤¯ÚÈ Û‹ÌÂÚ· ‰Â‰Ô̤ӷ Ê·›ÓÂÙ·È fiÙÈ Ë Î˘ÚÈfiÙÂÚË ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ οı ·È‰ÈÔ‡, ‰ÈfiÙÈ ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ ÌÂÙ·‚¿ÏÏÔÓÙ·È ÚÈÓ ·fi ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ Ù·¯‡ÙËÙ·˜ ·‡ÍËÛ˘ Î·È Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜. ªÂÏÏÔÓÙÈο, ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ Â›Ó·È Èı·Ófi Ó· ·Ô‚Ô‡Ó ¯Ú‹ÛÈÌÔÈ Î·È ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÂȉڿÛÂˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ıÂڷ¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ÛÙÔÓ ÔÛÙÈÎfi ·Ó·Û¯ËÌ·ÙÈÛÌfi Î·È ÙËÓ ·‡ÍËÛË.
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µÈÔ¯ËÌÈÎÔ› ÔÛÙÈÎÔ› ‰Â›ÎÙ˜ Î·È ·È‰È·ÙÚÈο ÓÔÛ‹Ì·Ù·
60. Sharp CA, Oginni LM, Worsfold M, Oyelami OA, Risteli L, Risteli J et al. Elevated collagen turnover in Nigerian children with calcium-deficiency rickets. Calcif Tissue Int 1997;61:87-94. 61. Hyams JS, Moore RE, Leichtner AM, Carey DE, Goldberg BD. Relationship of type I procollagen to corticosteroid therapy in children with inflammatory bowel disease. J Pediatr 1988;112:893-898. 62. Siomou E, Challa A, Tzoufi M, Papadopoulou ZL, Lapatsanis PD, Siamopoulou A. Biochemical markers of bone metabolism in infants and children under intravenous corticosteroid therapy. Calcif Tissue Int 2003;73:319-325. 63. Hyams JS, Moore RE, Leichtner AM, Carey DE, Goldberg BD. Longitudinal assessment of type I procollagen in children with inflammatory bowel disease subjected to surgery. J Pediatr Gastroenterol Nutr 1989;8:68-74. 64. Crofton PM, Ahmed SF, Wade JC, Stephen R, Elmlinger MW, Ranke MB et al. Effects of intensive chemotherapy on bone and collagen turnover and the growth hormone axis in children with acute lymphoblastic leukemia. J Clin Endocrinol Metab 1998;83:3121-3129. 65. Konig P, Hillman L, Cervantes C, Levine C, Maloney C, Douglass B et al. Bone metabolism in children with asthma treated with inhaled beclomethasone
dipropionate. J Pediatr 1993;122:219-226. 66. Chay OM, Goh A, Lim WH, Leong KH, Lou J. Effects of inhaled corticosteroid on bone turnover in children with bronchial asthma. Respirology 1999;4: 63-67. 67. Sorva R, Turpeinen M, Juntunen-Backman K, Karonen SL, Sorva A. Effects of inhaled budesonide on serum markers of bone metabolism in children with asthma. J Allergy Clin Immunol 1992;90:808-815. 68. Birkebaek NH, Esberg G, Andersen K, Wolthers O, Hassager C. Bone and collagen turnover during treatment with inhaled dry powder budesonide and beclomethasone dipropionate. Arch Dis Child 1995;73:524-527. 69. Rao R, Gregson RK, Jones AC, Miles EA, Campbell MJ, Warner JO. Systemic effects of inhaled corticosteroids on growth and bone turnover in childhood asthma: a comparison of fluticasone with beclomethasone. Eur Respir J 1999;13:87-94. 70. Heuck C, Wolthers OD, Kollerup G. Correlation between short term lower leg growth and markers of bone and collagen turnover. Horm Res 1996;46 (Suppl 2):S29-S30. 71. Crowley S, Trivedi P, Risteli L, Risteli J, Hindmarsh PC, Brook CG. Collagen metabolism and growth in prepubertal children with asthma treated with inhaled steroids. J Pediatr 1998;132:409-413.
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Evaluation of biochemical markers of bone metabolism in various disorders of childhood A. Challa1, E. Siomou2, M. Tzoufi2, D. Lapatsanis2, V. Cholevas1, A. Moulas1, N. Chaliasos2, A. Siamopoulou - Mavridou2 1 Department of Paediatrics, University Hospital of Ioannina 2 Laboratory of Paediatrics, Medical School, University of Ioannina Correspondence: Anna Challa Department of Paediatrics, Medical School, University of Ioannina P.O. Box 1186, 451 10, Ioannina E-mail: achalla@cc.uoi.gr Date of submission: 28-04-2004 Date of approval: 17-05-2005
Abstract The determination of biochemical markers of bone metabolism provides a dynamic picture on the whole, of bone turnover and growth in childhood. However, the sensitivity of biochemical markers is lower in children than in adults, because of the large variation in their normal range, due to the continuous growth in childhood. In addition, their usefulness in metabolic bone disorders has not been as extensively studied in children as it has in adults. Their main use seems to be in providing information, with satisfactory precision, about response to therapeutic treatment much earlier than any changes can be detected by growth velocity and bone density measurements. Despite significant improvements in the methodologies in recent years, which have improved the specificity and sensitivity of these markers, their use is not easily applicable in the everyday practice. Experimental findings for infants, children and adolescents, as reported in the literature, concerning the use of biochemical markers of bone synthesis and resorption in various bone disorders, are discussed in this review. Data included come also from publications on disorders of bone metabolism in infants and children, who were treated in our University Hospital. Key words Biochemical bone markers, disorders of bone metabolism, children, corticosteroids.
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¶ÂÚ›ÏË„Ë ∆· ÂÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù· ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Â›Ó·È Û¿ÓÈ· ÏfiÁˆ Ù˘ ¤ÁηÈÚ˘ ¯Ú‹Û˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂڷ›·˜ ÛÙȘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. O ·ÈÙÈÔ·ıÔÁfiÓÔ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ Î·È Ë ÚfiÁÓˆÛË ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔÓ ÏËı˘ÛÌfi Ô˘ ÌÂÏÂٿٷÈ. ∂ÓÙÔ‡ÙÔȘ, ÔÈ ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË ÛÙËÓ ÚÔÛ‚ÔÏ‹ ·fi ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· Ô˘ ÚÔηÏÂ›Ù·È ·fi ‚·ÎÙ‹ÚÈ· (·ÂÚfi‚È· Î·È ·Ó·ÂÚfi‚È·), ̇ÎËÙ˜ Î·È ÚˆÙfi˙ˆ·. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (ÌÂ Î·È ¯ˆÚ›˜ ¯Ú‹ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡) Â›Ó·È Ë Â˘ÎÔÏfiÙÂÚ· ‰È·ı¤ÛÈÌË ÂÚÁ·ÛÙËÚȷ΋ ÌÂϤÙË ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜. ∏ ¯Ú‹ÛË ÂÌÂÈÚÈ΋˜ ·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂڷ›·˜ Â›Ó·È ÛÙËÓ ÚÒÙË ÁÚ·ÌÌ‹ ·ÓÙÈÌÂÙÒÈÛ˘ ÁÈ· ÙÔ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·. ∏ ¿ÌÂÛË Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Â›Ó·È ˘Ô¯ÚˆÙÈ΋. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡, ËÏÈΛ·˜ 12 ÂÙÒÓ, Ì ÔÏÏ·Ï¿ ÂÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù· Û ·ÁˆÁ‹ Ì ΢ÎÏÔÛÔÚ›ÓË Î·È ÎÔÚÙÈ˙fiÓË ÏfiÁˆ ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘.
1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ¡Â˘ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ™ÔÊ›· ¡ÙÂÏ›ÎÔ˘ µ·ÚÓ¿‚· 7, ¶·ÁÎÚ¿ÙÈ ∆.∫. 116 36, ∞ı‹Ó· E-mail: sophiadelicou@in.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 13-07-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-05-2005
§¤ÍÂȘ ÎÏÂȉȿ §Ô›ÌˆÍË ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·, ·ÓÔÛÔηٷÛÙÔÏ‹, ΢ÎÏÔÛÔÚ›ÓË, Ú‰ÓÈ˙ÔÏfiÓË, Listeria monocytogenes.
∂ÈÛ·ÁˆÁ‹ OÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ˘ÚÂÙÔ‡ Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· ÎÂÓÙÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿. ∏ Ïԛ̈ÍË ÌÔÚ› Ó· ÚÔÎÏËı› ·fi ÔÔÈÔ‰‹ÔÙ ·ıÔÁfiÓÔ, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡. OÈ Û˘¯ÓfiÙÂÚ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÈÔÁÂÓ›˜. ∞ÎÔÏÔ˘ıÔ‡Ó ÔÈ ‚·ÎÙËÚȉȷΤ˜, ÂÓÒ ÔÈ Ì˘ÎËÙÈ·ÛÈΤ˜ Î·È ÔÈ ·Ú·ÛÈÙÈΤ˜ Â›Ó·È ÈÔ Û¿ÓȘ. π‰È·›ÙÂÚË Î·ÙËÁÔÚ›· ·ÔÙÂÏÔ‡Ó Ù· ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿, Ù· ÔÔ›· ηٿ ÙÔÓ ¯ÚfiÓÔ Ù˘ ¤ÎıÂÛ‹˜ ÙÔ˘˜ Û ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ· ‚Ú›ÛÎÔÓÙ·È Û ̛· ηٿÛÙ·ÛË Ô˘ ÌÂÈÒÓÂÈ ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÂÓ¿ÓÙÈ· ÛÙË Ïԛ̈ÍË, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ó· ÌËÓ Â›Ó·È Ù˘Èο Ù˘ ÓfiÛÔ˘ Î·È Ë ‰È¿ÁÓˆÛË Ó· ηı˘ÛÙÂÚ›. ™ÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÔÛÙËÌ¿ÙˆÓ, Ë ‚Ú·‰Â›· Î·È ÛÙ·‰È·Î‹ ·Ó¿Ù˘ÍË Ù˘
Û˘Ìو̷ÙÔÏÔÁ›·˜ ηıÈÛÙ¿ ÚfiÎÏËÛË ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ·fi ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ È·ÙÚÔ‡˜.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 12 ÂÙÒÓ, Ì ÈÛÙÔÚÈÎfi ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ¤‰·ÊÔ˜ ÂÛÙȷ΋˜ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛ˘. ∫·Ù¿ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 8 Ì‹Ó˜ ›¯Â ¯ÔÚËÁËı› Ú‰ÓÈ˙ÔÏfiÓË Î·È Î˘ÎÏÔÛÔÚ›ÓË Û ‰fiÛË ÚÔÛ·ÚÌÔ˙fiÌÂÓË, ÒÛÙ ӷ ‰È·ÙËÚÔ‡ÓÙ·È ÌË ÙÔÍÈο ›‰·. ∏ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ‹Ù·Ó Â̇ÚÂÙÔ ·fi 48ÒÚÔ˘ ¤ˆ˜ 40ÔC, ÂÓ·ÏÏ·Á‹ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È ÚÔ˘ÎÂÙÔÂȉ›˜ ¤ÌÂÙÔÈ. ∫·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó·, ÙÔ ·È‰› ·Ú·ÔÓÈfiÙ·Ó ÁÈ· ÌÂوȷ›· ÎÂÊ·Ï·ÏÁ›· Î·È ˙¿ÏË, ÂÓÒ Â›¯Â ·Ú·ÙËÚËı› ·ÏÏ·Á‹ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘, Ì ¤ÓÙÔÓË ˘ÓËÏ›· Î·È ÓˆıÚfiÙËÙ·. ∆· ·Ú·¿Óˆ Û˘ÌÙÒÌ·Ù· ›¯·Ó ·Ô‰Ôı› ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ Û Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ Î·È Ù˘ ÎÔÚÙÈ˙fiÓ˘. ¶·È‰È·ÙÚÈ΋ 2005;68:289-294
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™. ¡ÙÂÏ›ÎÔ˘ Î·È Û˘Ó.
∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ·È‰› ·ÚÔ˘Û›·˙ ˘ÚÂÙfi 39ÔC, ∞¶ 155/78 mm Hg, ™º 95/min, ·Ê˘‰¿ÙˆÛË 10%, Û‡Á¯˘ÛË Î·È ÂÎÏ˘fiÌÂÓ· ÛËÌ›· ÌËÓÈÁÁÈÎÔ‡ ÂÚÂıÈÛÌÔ‡ Kerning Î·È Brudzinski. ∏ ÂÎÙ›ÌËÛË Ì ‚¿ÛË ÙËÓ Îϛ̷η °Ï·ÛÎ҂˘ (Glascow score) ‹Ù·Ó 10/15. ∏ ‚˘ıÔÛÎfiËÛË ¤‰ÂÈÍ ÔÙÈΤ˜ ıËϤ˜ Ì ۷ʋ fiÚÈ· ¿Ìʈ. ∞fi Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ‰È·ÈÛÙÒıËÎÂ: §Â˘ÎÔ΢ÙÙ¿ÚˆÛË (WBC: 18.000/mm3, ¶/40%, §/60%), CRP: 160, TKE: 80 mm/1 h. ∏ ÁÂÓÈ΋ ∂¡À ·Ó¤‰ÂÈÍÂ: WBC: 600/mm3, ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·: <25%, ÚˆÙ½ÓË: 128 mg/dl, ÁÏ˘Îfi˙Ë: 60 mg/dl. ∏ ¿ÌÂÛË Î·Ù¿ Gram ¯ÚÒÛË ‹Ù·Ó ·ÚÓËÙÈ΋. ªÂ ÙËÓ Èı·Ó‹ ‰È¿ÁÓˆÛË Ù˘ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ·˜, ¤ÁÈÓ ¤Ó·ÚÍË ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ Ì ÎÂÊÙÚÈ·ÍfiÓË (100 mg/kg/24 h) Î·È ·Î˘ÎÏÔ‚›ÚË (30 mg/kg/24 h). ¶·Ú¿ÏÏËÏ·, ¤ÁÈÓ·Ó ÔÈ ··Ú·›ÙËÙ˜ ‰ÈÔÚıÒÛÂȘ ˘ÁÚÒÓ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ. ∏ Ú‰ÓÈ˙ÔÏfiÓË Î·È Ë Î˘ÎÏÔÛÔÚ›ÓË Û˘Ó¯›ÛÙËÎ·Ó ÛÙȘ ›‰È˜ ‰fiÛÂȘ. ∆Ô ·È‰› ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ Â›Ó·È Û˘Á¯˘ÙÈÎfi ηٿ ÙËÓ 3Ë Ë̤ڷ ÓÔÛËÏ›·˜ ÙÔ˘, Ì ·Ó·ÊÂÚfiÌÂÓË ÌÂوȷ›· ÎÂÊ·Ï·ÏÁ›·, ÂÓÒ ·ÚÔ˘Û›·Û ·˘ÙfiÌ·ÙÔ ÎÏfiÓÔ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ˘. ŒÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ·Ó¤‰ÂÈÍ “Ô›‰ËÌ· Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÎÚÔÙ·ÊÔ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ· Ì ·Ó¿‰ÂÈÍË ÔÏÏ·ÏÒÓ ˘fi˘ÎÓˆÓ ÂÛÙÈÒÓ, ÂÓÙfi˜ ÙˆÓ ÔÔ›ˆÓ ·Ú·ÙËÚ‹ıËΠ‰·ÎÙ˘ÏÈÔÂȉ‹˜ ÚfiÛÏË„Ë ÛÎÈ·ÁÚ·ÊÈÎÔ‡, ˆ˜ › ÂÁÎÂÊ·ÏÈÎÒÓ ·Ô-
ÛÙËÌ¿ÙˆÓ. ∂›Û˘, ÛËÌÂÈÒıËΠ·ÚÔ˘Û›· ‰ÔÚ˘ÊfiÚÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÌÂوȷ›Ô ÏÔ‚fi Î·È ›ÂÛË ÛÙËÓ ·ÚÈÛÙÂÚ‹ Ï¿ÁÈ· ÎÔÈÏ›· ¯ˆÚ›˜ ÌÂÙ·ÙfiÈÛË Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜” (∂ÈÎfiÓ· 1). ™ÙÔ ∏∂° ÙÔ ‰È¿ÁÚ·ÌÌ· ÂÁÚ‹ÁÔÚÛ˘ Î·È ‡ÓÔ˘ ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ·fi ‰È¿¯˘Ù˜ ‚Ú·‰˘·ÚÚ˘ı̛˜ ı Î·È ‰, ¯ˆÚ›˜ ·ıÔÏÔÁÈΤ˜ ‹ ÂȉÈΤ˜ ÂÈÎfiÓ˜. ŒÁÈÓ ¤Ó·ÚÍË ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ Ì ‚·ÏÚÔ˚Îfi Ô͇ (15 mg/kg/24 h), ‰È·ÎÔ‹ Ù˘ ·Î˘ÎÏÔ‚›Ú˘ Î·È ¤Ó·ÚÍË ÈÌÈÂÓ¤Ì˘/ÛÈÏ·ÛÙ·Ù›Ó˘ (100 mg/kg/24 h) Î·È ÙÂ˚ÎÔÏ·Ó›Ó˘ (15 mg/kg/24 h) Ì ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ·Ó·ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ‰fiÛÂˆÓ Û‡Ìʈӷ Ì ÙËÓ Î¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜, ‹·ÙÔ˜, ÛÏËÓfi˜ Î·È ÓÂÊÚÒÓ ‰ÂÓ ·Ó¤‰ÂÈÍ ‡·ÚÍË ¿ÏÏÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ ‹ ˘Ò‰Ô˘˜ Û˘ÏÏÔÁ‹˜. ∞ÚÓËÙÈÎfi˜ ‹Ù·Ó Î·È Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È ·Ú·ÚÚÈÓ›ˆÓ. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, Ô‡ÚˆÓ Î·È ∂¡À ‹Ù·Ó ÛÙ›Ú˜. ∫·Ù¿ ÙË 10Ë Ë̤ڷ ÓÔÛËÏ›·˜ ¤ÁÈÓ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ó·ÚÚfiÊËÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ¤Á¯˘ÛË ÁÂÓÙ·Ì˘Î›Ó˘ ÂÓ‰ÔÎÚ·Óȷο. ∏ ηÏÏȤÚÁÂÈ· ‡Ô˘ ·Ó¤Ù˘Í Listeria monocytogenes, ¢·›ÛıËÙË Û ‚·ÓÎÔÌ˘Î›ÓË, ÙÂ˚ÎÔÏ·Ó›ÓË, ÂÓÈÎÈÏ›ÓË, ·ÌÈÎÈÏ›ÓË Î·È ÂÚ˘ıÚÔÌ˘Î›ÓË. ŒÁÈÓ ‰È·ÎÔ‹ Ù˘ ÈÌÈÂÓ¤Ì˘/ÛÈÛÏ·Ù›Ó˘ Î·È ¤Ó·ÚÍË ·ÌÈÎÈÏ›Ó˘ (200 mg/kg/24 h), ÙËÓ ÔÔ›· ¤Ï·‚ ÁÈ· 8 ‚‰ÔÌ¿‰Â˜ ÌÂÙÂÁ¯ÂÈÚËÙÈο. O ¤ÏÂÁ¯Ô˜ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ ¤‰ÂÈÍ ·˘ÍË̤ÓÔ ·ÚÈıÌfi ·ÓÒÚÈÌˆÓ T ΢ÙÙ¿ÚˆÓ CD3+, CD4-, CD8- (40%), CD 3TRÁ‰ (34%) Î·È ·˘ÍË̤ÓÔ ·ÚÈıÌfi ÌÓ‹ÌÔÓˆÓ CD4, CD45R Û ۯ¤ÛË Ì ٷ ·Úı¤Ó· CD4. ∫·Ù¿ ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÛÙ·ıÂÚ‹ ‚ÂÏÙ›ˆÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ Î·È Â·Ó‹Ïı ÛÙȘ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ ÙÔ˘. O ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ¤‰ÂÈÍ ÂÍ·Ê¿ÓÈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ÛÌ›ÎÚ˘ÓÛË ÙˆÓ ‰‡Ô ‰ÔÚ˘ÊÔÚÈÎÒÓ (∂ÈÎfiÓ· 2). ∆Ô ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÂÏÂÁ¯fiÙ·Ó ÈηÓÔÔÈËÙÈο Ì ÙË ¯ÔÚ‹ÁËÛË Î˘ÎÏÔÛÔÚ›Ó˘ Î·È Ú‰ÓÈ˙ÔÏfiÓ˘.
™˘˙‹ÙËÛË
∂ÈÎfiÓ· 1. ¶·ÚÔ˘Û›· ‰ÔÚ˘ÊfiÚÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÌÂوȷ›Ô ÏÔ‚fi Î·È ›ÂÛË ÛÙËÓ ·ÚÈÛÙÂÚ‹ Ï¿ÁÈ· ÎÔÈÏ›· ¯ˆÚ›˜ ÌÂÙ·ÙfiÈÛË Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜. ¶·È‰È·ÙÚÈ΋ 2005;68:289-294
ø˜ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· ÔÚ›˙ÂÙ·È Ì›· ˘ÔÍ›· ÊÏÂÁÌÔÓ҉˘ ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Ô‰ËÁ› ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ı˘Ï¿ÎÔ˘ Ì ˘Ò‰Ë Û˘ÏÏÔÁ‹ Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi
Pediatr July-Aug 05 new
22-07-05
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∂ÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù· Û ·È‰› Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ
·Ú¤Á¯˘Ì· (1). ™Â ÔÛÔÛÙfi 40-60% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û¯ÂÙ›˙ÂÙ·È Ì ¤ÎÙ·ÛË Ïԛ̈͢ ·fi ÁÂÈÙÔÓÈ΋ ÂÚÈÔ¯‹ ÙÔ˘ ∫¡™ (3-6) ‹ ‰Â˘ÙÂÚÔÁÂÓ‹ ¤ÎÙ·ÛË ·fi ¿ÏÏË ÂÛÙ›· Ïԛ̈͢ (46). ∂ȉÈ΋ ηÙËÁÔÚ›· ·ÔÙÂÏÔ‡Ó ÔÈ ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔÈ (7-9) ·ÛıÂÓ›˜, Ô˘ ·ÔÙÂÏÔ‡Ó Â‡Î·ÈÚÔ ÍÂÓÈÛÙ‹ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÔÛÙËÌ¿ÙˆÓ. ∏ ·ıÔÁ¤ÓÂÛË (1,4) ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ÈÛ¯·ÈÌÈ΋˜ ‚Ï¿‚˘ ÛÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi, Ô˘ ·Ú¤¯ÂÈ ÙËÓ ·Ú¯È΋ ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜. ªÂ ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ·Ú¤Á¯˘Ì· ·Ó·Ù‡ÛÛÂÙ·È ÊÏÂÁÌÔÓ҉˘ ·ÓÙ›‰Ú·ÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÛÙȷ΋ ÂÁÎÂÊ·Ï›Ùȉ·, Ë ÔÔ›· ÛÙË Û˘Ó¤¯ÂÈ· ÂÌÊ·Ó›˙ÂÈ ÎÂÓÙÚÈ΋ Ó¤ÎÚˆÛË Î·È Û˘ÏÏÔÁ‹ ‡Ô˘ Ô˘ ÔÚÁ·ÓÒÓÂÙ·È Ì ο„· Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÙÔ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·. ∆· ÂÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù· ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙË Ï¢΋ Ô˘Û›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÛÙ· fiÚÈ· Ù˘ Ï¢΋˜ Ì ÙË Ê·È¿ Ô˘Û›·, fiÔ˘ Ë ·ÁÁ›ˆÛË Â›Ó·È Ùˆ¯fiÙÂÚË. ∂ȉÈ΋ ηÙËÁÔÚ›· ·ÔÙÂÏÔ‡Ó ÔÈ ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔÈ ·ÛıÂÓ›˜, Ô˘ ·ÔÙÂÏÔ‡Ó Â‡Î·ÈÚÔ ÍÂÓÈÛÙ‹ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÔÛÙËÌ¿ÙˆÓ (7-9). ∏ ·ÈÙÈÔÏÔÁ›· ÛÙÔÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ‰ÂÓ ‹Ù·Ó Û·Ê‹˜, ·ÏÏ¿ Èı·ÓfiÓ Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË Ú‰ÓÈ˙ÔÏfiÓ˘ Î·È Î˘ÎÏÔÛÔÚ›Ó˘ Ô˘ ÚÔοÏÂÛ·Ó ‚·ÚÈ¿ ·ÓÔÛÔηٷÛÙÔÏ‹. ∏ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙÔ˘˜ ·Ú¿ÁÔ-
∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. ∂Í·Ê¿ÓÈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ÛÌ›ÎÚ˘ÓÛË ÙˆÓ ‰‡Ô ‰ÔÚ˘ÊÔÚÈÎÒÓ.
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ÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÚԷӷʤÚıËÎ·Ó ÛÙËÓ ·ıÔÁ¤ÓÂÛË Î·È ÙËÓ ÂÓÙfiÈÛ‹ ÙÔ˘˜ ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ·Ú¤Á¯˘Ì· (10). ∆Ô Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ÂÓÙfiÈÛË, Â›Ó·È ÔÈ ·ÂÚfi‚ÈÔÈ Î·È ·Ó·ÂÚfi‚ÈÔÈ ÛÙÚÂÙfiÎÔÎÎÔÈ (5) Î·È ·ÎÔÏÔ˘ıÔ‡Ó Ù· ‚·ÎÙËÚÈÔÂȉ‹, Ù· ÂÓÙÂÚÔ‚·ÎÙËÚȉȷο, ÔÈ ÛÙ·Ê˘ÏfiÎÔÎÎÔÈ (6), Ô ·ÈÌfiÊÈÏÔ˜ Ù˘ ÈÓÊÔ˘¤ÓÙ˙·˜, ÂÓÒ ÈÔ Û¿ÓÈ· Î·È Û ÂȉÈΤ˜ ÂÚÈÙÒÛÂȘ ·ÓÔÛÔηÙÂÛÙ·ÏÌ¤ÓˆÓ (8,10,11) Ù· fusobacterium, actinomyces, nocardia asteroides, cryptococcus, Listeria monocytogenes, ̇ÎËÙ˜, Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘, ÙÔÍfiÏ·ÛÌ· Î·È CMV. ™ÙÔÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ‹Ù·Ó Ë Listeria monocytogenes. ∏ Listeria monocytogenes (12,13) Â›Ó·È Gram ıÂÙÈÎfi˜, ÌÈÎÚÔ·ÂÚfiÊÈÏÔ˜ ‚¿ÎÈÏÔ˜ Ô˘ ·Ú¿ÁÂÈ Ï›˜ ·ÔÈ˘ Î·È ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ÙÚÔÈÛÌfi. ªÂ ‚¿ÛË ÙÔ ÛˆÌ·ÙÈÎfi O Î·È ‚ÏÂÊ·ÚȉÈÎfi ∏ ·ÓÙÈÁfiÓÔ ÔÚ›˙ÔÓÙ·È ÔÚfiÙ˘ÔÈ. ∞fi ·˘ÙÔ‡˜ ÔÈ 1/2a, 1/2b Î·È 4b ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÌÔχÓÛˆÓ. ∏ Listeria monocytogenes (12) ÚÔηÏ› ÓfiÛËÛË Û ¿ÙÔÌ· Ì ÌÂȈ̤ÓÔ˘˜ ·Ì˘ÓÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ - fiˆ˜ Â›Ó·È Ù· ÓÂÔÁ¤ÓÓËÙ·, Ù· ÚfiˆÚ·, ÔÈ ËÏÈÎȈ̤ÓÔÈ Î·È Ù· ¿ÙÔÌ· Ì ˷ÙÈ΋ ‹ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· - Î·È Î˘Ú›ˆ˜ › ·Ó¿ÚÎÂÈ·˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜. ∞ÏηÏÈÎfi pH ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡, ÚˆÙÔ·ı¤˜ ‹ ‰Â˘ÙÂÚÔ·ı¤˜, ·fi Ê¿Ú̷η Úԉȷı¤ÙÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÂÓÙÂÚ›Ùȉ·˜, ‰È¢ÎÔχÓÔÓÙ·˜ ÙËÓ Â›ÛÔ‰Ô Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ Listeria monocytogenes ¤¯ÂÈ ·ÁÎfiÛÌÈ· ηٷÓÔÌ‹ Î·È ·Ó¢ڛÛÎÂÙ·È ÛÙÔ ¯ÒÌ·, ÙÔ ÓÂÚfi ‹ ÙË ÛÎfiÓË, ·’ fiÔ˘ Ô ¿ÓıÚˆÔ˜ Î·È Ù· ˙Ò· ÌÔχÓÔÓÙ·È ·ÓÂÍ¿ÚÙËÙ·. ∏ ¿ÌÂÛË Ïԛ̈ÍË ÌÂÙ·‰›‰ÂÙ·È Ì ·Â˘ı›·˜ ÌÂÙ¿‰ÔÛË Î·Ù¿ ÙËÓ ¿ÛÎËÛË Â·ÁÁ¤ÏÌ·ÙÔ˜ (ÎÙËÓ›·ÙÚÔÈ, ÎÚÂÔÒϘ, ÎÙËÓÔÙÚfiÊÔÈ Î.Ï.) ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÂÁ΢ÌÔÛ‡Ó˘ Î·È ÙÔÎÂÙÔ‡, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌfiÏ˘ÓÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘. ŒÌÌÂÛ· ÌÂÙ·‰›‰ÂÙ·È ·fi ÙË ‚ÚÒÛË ÌË Â·ÚÎÒ˜ ·ÛÙÂÚȈ̤ÓÔ˘ Á¿Ï·ÎÙÔ˜, Ù˘ÚÈÔ‡ Î·È ÌÔÏ˘ÛÌ¤ÓˆÓ Ï·¯·ÓÈÎÒÓ ‹ ·ÏÏ·ÓÙÈÎÒÓ. Œ¯Ô˘Ó ·Ú·ÙËÚËı› ÂȉË̛˜ ΢ڛˆ˜ ·fi ÌÔÏ˘Ṳ̂ӷ Ï·¯·ÓÈο, ̷Ϸο Ù˘ÚÈ¿ Camembert, ·ÁˆÙ¿ Î·È ·ÏÏ·ÓÙÈο, ÂÓÒ ı¿Ó·ÙÔÈ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ΢ڛˆ˜ Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜. ™ÙȘ ∏¶∞ ‰ËÏÒÓÔÓÙ·È ÂÙËÛ›ˆ˜ ÂÚ›Ô˘ 1800 ÏÔÈÌÒÍÂȘ, ÂÓÒ ÔÈ ÂÚÈÁÂÓÓËÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È ÌÂ Û˘¯ÓfiÙËÙ· 16 ·Ó¿ 100.000 ÁÂÓÓ‹ÛÂȘ. ∏ ÏÈÛÙÂÚ›ˆÛË ÛÙ· ÓÂÔÁ¤ÓÓËÙ· ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ¶·È‰È·ÙÚÈ΋ 2005;68:289-294
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·292
292
™. ¡ÙÂÏ›ÎÔ˘ Î·È Û˘Ó.
ÛË„·ÈÌ›· ÌÂ Û˘ÓÔ‰fi ÎÂÚ·ÙÔÂÈÂÊ˘Î›Ùȉ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Ó¢ÌÔÓ›· Î·È ‚·ÚÈ¿ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ· (13). ∏ Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ Ïԛ̈͢ ·fi ÏÈÛÙ¤ÚÈ· Â›Ó·È ÌË ÂȉÈ΋ Î·È Û˘¯Ó¿ ÂÈϤÎÂÙ·È ·fi Ó¢ÌÔÓ›·, Ï¢ڛÙȉ·, ÂÓ‰Ôηډ›Ùȉ·, Ë·Ù›Ùȉ· ‹ ÂÛÙȷ΋ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ ÔÊı·ÏÌÒÓ. ∏ ÌËÓÈÁÁ›Ùȉ· ·fi ÏÈÛÙ¤ÚÈ· ÌÔÚ› Ó· ÂΉËψı› ˆ˜ ÌÈÎÚԂȷ΋ ‹ ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ÌÈÌÔ‡ÌÂÓË ÈÔÁÂÓ‹ Ïԛ̈ÍË ‹ ˘ÔÍ›· Ì ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi Ù‡Ô Î·È ¯·ÌËÏfi ۿί·ÚÔ ÛÙÔ ∂¡À, ÔÌÔÈ¿˙Ô˘Û· ÌÂ Ê˘Ì·ÙÈÒ‰Ë. ∞ÓÂÍ¿ÚÙËÙ· ·fi ÙË ÌÔÚÊ‹ Ì ÙËÓ ÔÔ›· ÂΉËÏÒÓÂÙ·È Ë ÌËÓÈÁÁ›Ùȉ· ·fi ÏÈÛÙ¤ÚÈ·, ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó ‰È·Ù·Ú·¯‹ Û˘Ó›‰ËÛ˘, ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ηıÒ˜ Î·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÚÔÌ‹ÎÔ˘˜ Î·È ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ Ó‡ڈÓ. ∞˘Ù¤˜ ÔÈ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó ¿ÌÂÛË Û¯¤ÛË Ì ÙËÓ ‡·ÚÍË ÂÁÎÂÊ·Ï›Ùȉ·˜ ‹ ·ÔÛÙËÌ¿ÙˆÓ (15) Ô˘ ·ÔηχÙÔÓÙ·È ·ÂÈÎÔÓÈÛÙÈο ‹ ÓÂÎÚÔÙÔÌÈο. ∏ ‰È¿ÁÓˆÛË Â›Ó·È ÌÈÎÚÔ‚ÈÔÏÔÁÈ΋, Ì ·ÔÌfiÓˆÛË ÙÔ˘ ‚·ÎÙËÚȉ›Ô˘ ·fi ‚ÈÔÏÔÁÈο ˘ÏÈο (·›Ì·, ∂¡À, Ê·Ú˘ÁÁÈÎfi ›¯ÚÈÛÌ·, Ô‡Ú· Î.Ï.) Û ÂȉÈÎfi ηÏÏÈÂÚÁËÙÈÎfi ˘ÏÈÎfi. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ·ÍÈfiÈÛÙÔ˜ (14,15). ∏ ıÂڷ›· Ù˘ ÏÈÛÙ¤ÚÈ·˜ Ì ÂÓÈÎÈÏ›ÓË G ÚÔÛʤÚÂÈ ÌfiÓÔ ‚·ÎÙËÚÈÔÛÙ·ÙÈ΋ ‰Ú¿ÛË, ÂÓÒ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë ¤¯ÂÈ ‚·ÎÙËÚÈÔÎÙfiÓÔ ‰Ú¿ÛË. ∏ ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ Â›Ó·È 4 ‚‰ÔÌ¿‰Â˜ (12,13). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· ·ÔÙÂÏ› Û˘Ó‰˘·ÛÌfi ÂΉËÏÒÛÂˆÓ Ïԛ̈͢ Î·È ¯ˆÚÔηٷÎÙËÙÈ΋˜ ‚Ï¿‚˘ (16). O ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ›¯Â ÎÂÊ·Ï·ÏÁ›· Î·È ·ÏÏ·Á‹ Û˘ÌÂÚÈÊÔÚ¿˜. ∏ ÛˆÛÙ‹ ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Û˘¯Ó¿ ηı˘ÛÙÂÚ›, ‰ÈfiÙÈ ·˘ÙÔ› ÔÈ ·ÛıÂÓ›˜ Û ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ·fi 50% ÂÌÊ·Ó›˙Ô˘Ó ÙËÓ ÎÏ·ÛÈ΋ ÙÚÈ¿‰· ˘ÚÂÙÔ‡ - ÎÂÊ·Ï·ÏÁ›·˜ Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜. ∆Ô ÈÔ Û‡ÓËı˜ ‡ÚËÌ· Â›Ó·È Ë ÛÙ·‰È·Î¿ ÂȉÂÈÓÔ‡ÌÂÓË ÎÂÊ·Ï·ÏÁ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 65-70% ÙˆÓ ·ÛıÂÓÒÓ. O ˘ÚÂÙfi˜ ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 50-60% ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÛÙ· ·È‰È¿. ™Â ÔÛÔÛÙfi 30% ÂÌÊ·Ó›˙ÔÓÙ·È Û·ÛÌÔ›. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Î˘Ú›ˆ˜ ÙÔ˘˜ ÚˆÙÔ·ı›˜ Î·È ‰Â˘ÙÂÚÔ·ı›˜ fiÁÎÔ˘˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÙȘ ÂÁÎÂÊ·Ï›Ùȉ˜, ÙȘ ÌËÓÈÁÁ›Ùȉ˜, Ù· Ì˘ÎˆÙÈο ·Ó¢ڇÛÌ·Ù·, ÙȘ ·Ú·ÛÈÙÒÛÂȘ, ÙËÓ ÔÏÏ·Ï‹ ÛÎÏ‹Ú˘ÓÛË, ÙËÓ ÔÍ›· Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Ù· ÈÛ¯·ÈÌÈο Î·È ·ÈÌÔÚÚ·ÁÈο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· Î.¿. ¶·È‰È·ÙÚÈ΋ 2005;68:289-294
∏ ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ÛÙËÚ›˙ÂÙ·È ‚·ÛÈο ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÛÙȘ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜ Ì ·ÍÔÓÈ΋ (CT) (17,18) Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) Ô˘ ı· Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÚÈÓ ·fi ÙËÓ ÂÎÙ¤ÏÂÛË ÔÛÊ˘ÔÓˆÙÈ·›·˜ ·Ú·Î¤ÓÙËÛ˘ (O¡¶). ∏ O¡¶ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÎÙÂÏÂ›Ù·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Èı·ÓÔÏÔÁÔ‡ÌÂÓÔ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·, ‰ÈfiÙÈ ÌÔÚ› Ó· ÚÔÎÏËı› ÂÁÎÔÏ·ÛÌfi˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (ÂÁÎÂÊ·ÏÈ΋ ΋ÏË). ∏ ÌË ÛÎÈ·ÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË Û˘Ó‹ıˆ˜ ‰Â›¯ÓÂÈ Ô›‰ËÌ· Ï¢΋˜ Ô˘Û›·˜ Î·È ÂÈÎfiÓ· fiÁÎÔ˘, ÂÓÒ Ë ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ·Ó·‰ÂÈÎÓ‡ÂÈ ‰·ÎÙ˘ÏÈÔÂȉ‹ ÂÓ›Û¯˘ÛË ÛÙÔ Ï‹Úˆ˜ ·ÓÂÙ˘Á̤ÓÔ ·fiÛÙËÌ·. ∞ÌÊfiÙÂÚ˜ Ë ·ÍÔÓÈ΋ Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÛÙÂÚÂÔÙ·ÎÙÈΤ˜ ‚ÈÔ„›Â˜ ‹ ·Ó·ÚÚÔÊ‹ÛÂȘ ÙˆÓ ‡ÔÙˆÓ ‚Ï·‚ÒÓ, ÁÈ· ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ··Ú·Èًو˜ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌfiÓÔ Ì ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›·. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ··ÈÙ› Û˘Ó‰˘·ÛÌfi ¯ÂÈÚÔ˘ÚÁÈ΋˜ Î·È ·ÓÙÈÌÈÎÚԂȷ΋˜ ıÂڷ›·˜ (10,19,20). ¶·Ú¿ ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹, Ë ıÓËÙfiÙËÙ· ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· ÌÔÚ› Ó· ÊÙ¿ÛÂÈ ÙÔ 23-30%, ÂÓÒ ÌfiÓÈÌ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÛÔÛÙfi 30%. ∏ ·Ú¯È΋ ÂÈÏÔÁ‹ Ù˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ ‚·Û›˙ÂÙ·È ÛÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ÛÙËÓ ÚˆÙÔ·ı‹ ÂÛÙ›· Ïԛ̈͢ Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· Ó· ÚÔ‚ÏÂÊıÔ‡Ó Ù· Èı·Ó¿ ‚·ÎÙËÚȷο ·›ÙÈ·. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· ÙÚÔÔÔÈÂ›Ù·È ‚¿ÛÂÈ Ù˘ ηÏÏȤÚÁÂÈ·˜ ·fi ÙËÓ ˘Ò‰Ë Û˘ÏÏÔÁ‹. ¶ÚÈÓ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÚÔ¯¤Ù¢ÛË, Ë ıÂڷ›· ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÌÂ Û˘Ó‰˘·ÛÌfi ÂÓÈÎÈÏ›Ó˘ G Î·È ÌÂÙÚÔÓȉ·˙fiÏ˘ (19,20). ∏ ÌÂÙÚÔÓȉ·˙fiÏË ı· Ú¤ÂÈ Ó· ÚÔÙÈÌ¿Ù·È ·fi ÙË ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË, ‰ÈfiÙÈ ÂÈÙ˘Á¯¿ÓÂÈ ˘„ËÏfiÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÂÓÙfi˜ Ù˘ ·ÔÛÙËÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¤Ó·ÓÙÈ ÙÔ˘ Bacteroides. ∞˘Ù‹ Ë Û˘Ó‰˘·ÛÙÈ΋ ıÂڷ›· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¤Ó·ÓÙÈ ÛÙÚÂÙfiÎÔÎΈÓ, bacteroides, ÂȉÒÓ fusobacterium Î·È ÔÏÏÒÓ ÂÓÙÂÚÔ‚·ÎÙËÚȉȷÎÒÓ, ÌÔÏÔÓfiÙÈ Ë Èı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ·ÓÙÔ¯‹˜ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ÌÔÚ› Ó· ˘Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó¿ÁÎË ÈÛ¯˘ÚfiÙÂÚ˘ Î¿Ï˘„˘ Ì ̛· ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë ‹ Ì 3˘ ÁÂÓÈ¿˜ ÎÂÊ·ÏÔÛÔÚ›ÓË fiˆ˜ Â›Ó·È Ë ÎÂÊÙÚÈ·ÍfiÓË ‹ Ë ÎÂÊÙ·˙ȉ›ÌË. ∏ ÌÂıÈÎÈÏ›ÓË ‹ Ë Ó·ÊıÈÎÈÏ›ÓË ı· Ú¤ÂÈ Ó· ·ÓÙÈηıÈÛÙÔ‡Ó ÙËÓ ÂÓÈÎÈÏ›ÓË fiÙ·Ó ˘¿Ú¯ÂÈ Ë
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·293
293
∂ÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù· Û ·È‰› Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ
Èı·ÓfiÙËÙ· ÙÔ˘ S. aureus. ∏ ‚·ÓÎÔÌ˘Î›ÓË ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› › ·ÏÏÂÚÁ›·˜ ÛÙËÓ ÂÓÈÎÈÏ›ÓË (¶›Ó·Î·˜ 1). ∏ ‰ÂÍ·ÌÂı·˙fiÓË ‹ Ë ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË Ê·›ÓÂÙ·È Ó· Â›Ó·È ¯Ú‹ÛÈ̘ ÛÙË Ì›ˆÛË ÙÔ˘ Ôȉ‹Ì·ÙÔ˜ Á‡Úˆ ·fi ÙÔ ·fiÛÙËÌ·, ηıÒ˜ Î·È ÛÙË Ì›ˆÛË Ù˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛ˘, ¯ˆÚ›˜ Ó· ÌÂÈÒÓÔ˘Ó ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ÛÙÔ ·fiÛÙËÌ·. ™‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ‰‡Ô ·Ô‰ÂÎÙÔ› ÙÚfiÔÈ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ıÂڷ›·˜ (20-22) ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜: Ë ÔÏÈ΋ ÂÎÙÔÌ‹ Î·È Ë ÛÙÂÚÂÔÙ·ÎÙÈ΋ (23) ·Ó·ÚÚfiÊËÛË ‰È¿ ‚ÂÏfiÓ˘. ∏ ÔÏÈ΋ ÂÎÙÔÌ‹ ÌÔÚ› Ó· ˘ÂÚ¤¯ÂÈ Ù˘ ÛÙÂÚÂÔÙ·ÎÙÈ΋˜ ·Ó·ÚÚfiÊËÛ˘, Ù· ·ÔÙÂϤÛÌ·Ù· ˆÛÙfiÛÔ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÛÔ‰‡Ó·Ì·. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÎÙÔÌ‹ ÚÔÙÈÌ¿Ù·È ÁÈ· ·ÔÛÙ‹Ì·Ù· ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ ·ÏÏ¿ Î·È ÁÈ· ÂΛӷ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ̇ÎËÙ˜, ÂÂȉ‹ Ë ‰È·ı¤ÛÈÌË ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ıÂڷ›· Â›Ó·È Û˘¯Ó¿ ·Ó·Ú΋˜. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ (24) ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÂÈÏÂÁ̤ÓÔÈ ·ÛıÂÓ›˜ Ì ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌfiÓÔ Ì ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹, fiˆ˜ fiÛÔÈ ¤¯Ô˘Ó ÌÈÎÚ¿ ·ÔÛÙ‹Ì·Ù· (<2 cm) Î·È fiÛÔÈ Â›Ó·È Û ÂÁÚ‹ÁÔÚÛË ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·.
™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Ë ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· Û˘Ó¯›˙ÂÙ·È ÁÈ· 4-6 ‚‰ÔÌ¿‰Â˜ ·ÚÂÓÙÂÚÈο, ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ıÂڷ›· ·fi ÙÔ ÛÙfiÌ· ÁÈ· 2-6 Ì‹Ó˜, Û‡Ìʈӷ Ì ÂÌÂÈÚÈΤ˜ ÎÏÈÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ. Èڛ˜ ıÂڷ›·, ÙÔ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· ¤¯ÂÈ Û¯Â‰fiÓ ¿ÓÙÔÙ ı·Ó·ÙËÊfiÚÔ ¤Î‚·ÛË. ¶ÚÈÓ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ë ıÓËÙfiÙËÙ· Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ 3050%. ªÂ ÙË ¯Ú‹ÛË ÙˆÓ Û‡Á¯ÚÔÓˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È ÙËÓ ¤ÁηÈÚË ¤Ó·ÚÍË ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜, Ë ıÓËÙfiÙËÙ· ÌÂÈÒıËΠÛÙÔ 10%. ∞ÓÔÛÔ·Ó¿ÚÎÂÈ·, ΢·ÓˆÙÈ΋ ηډÈÔ¿ıÂÈ·, Ó¢ÌÔÓÈÎfi ·fiÛÙËÌ·, Ôχ ÌÈÎÚ‹ ‹ Ôχ ÌÂÁ¿ÏË ËÏÈΛ·, Ú‹ÍË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ ÛÙȘ ÎÔÈϛ˜ Î·È ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ·ÔÛÙËÌ¿ÙˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈο ·ÔÙÂÏÔ‡Ó ‰˘ÛÌÂÓ›˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¶ÔÛÔÛÙfi ÂÚ›Ô˘ 25% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤¯Ô˘Ó ÓÔÛ‹ÛÂÈ ·fi ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·, ı· ÂÌÊ·Ó›ÛÂÈ ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜ fiˆ˜ Â›Ó·È Ë ÂÈÏË„›·, ÔÈ ÂÛÙȷΤ˜ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ë ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ÛÙ· ÌÈÎÚ¿ ·È‰È¿. ™‹ÌÂÚ·, ˘ÔÙÚÔ‹ ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Û˘Ì‚·›ÓÂÈ Û¿ÓÈ·, ÂÓÒ ÌÂٿوÛË Û ¯ÚÔÓÈfiÙËÙ· ¤گÂÙ·È Û Ôχ ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ (25).
¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎfi ÌÈÎÚÔ‚È·Îfi Ê¿ÛÌ· Î·È ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ¶·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘
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À‡ı˘ÓÔ˜ ∞Ó·ÂÚfi‚È· ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ B. fragilis ™ÙÚÂÙfiÎÔÎÎÔ˜ ™Ù·Ê˘ÏfiÎÔÎÎÔ˜ ¯Ú˘Û›˙ˆÓ ∞ÈÌfiÊÈÏÔ˜ ÈÓÊÏÔ˘¤ÓÙ˙·˜
∫Ú·ÓÈ·Îfi ÙÚ·‡Ì·
∂͈ÎÚ·Óȷ΋ ÂÛÙ›· Ïԛ̈͢
∞ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔÈ ÕÁÓˆÛÙÔ˜ ·ÛıÂÓ›˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘
∞Ó·ÂÚfi‚È· Gram ·ÚÓËÙÈÎÔ› ‚¿ÎÈÏÔÈ
™Ù·Ê˘ÏfiÎÔÎÎÔ˜ ¯Ú˘Û›˙ˆÓ ™Ù·Ê˘ÏfiÎÔÎÎÔ˜ ÂȉÂÚÌÈÎfi˜ ∫ÔÏÔ‚·ÎÙËÚ›‰ÈÔ ∫ÏÂÌÛȤÏÏ· ∞ÈÌfiÊÈÏÔ˜ ÈÓÊÏÔ˘¤ÓÙ˙·˜ 梉ÔÌÔÓ¿‰· Gram ·ÚÓËÙÈο
ŸÏ· Ù· ÚÔ·Ó·ÊÂÚı¤ÓÙ· Fusobacterium Actinomyces Nocardia asteroids Cryptococcus Listeria monocytogenes Toxoplasma CMV ª‡ÎËÙ˜ ª˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ê˘Ì·Ù›ˆÛ˘ ∫ÂÊÙ·˙ȉ›ÌË ∞ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë ªÂÙÚÔÓȉ·˙fiÏË ÃψڷÌÊ·ÈÓÈÎfiÏË µ·ÓÎÔÌ˘Î›ÓË
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¶ÂÓÈÎÈÏ›ÓË ∫ÂÊÔÙ·Í›ÌË ∫ÂÊÔÙ·Í›ÌË ÃψڷÌÊ·ÈÓÈÎfiÏË ªÂÙÚÔÓȉ·˙fiÏË ¢ÈÎÏÔÍ·ÎÈÏ›ÓË
∂Ó·ÏÏ·ÎÙÈο
∫ÂÊÔÙ·Í›ÌË ªÂÙÚÔÓȉ·˙fiÏË
™Â Û˘Ó‰˘·ÛÌfi
µ·ÓÎÔÌ˘Î›ÓË
™ÙÚÂÙfiÎÔÎÎÔÈ ™Ù·Ê˘ÏfiÎÔÎÎÔÈ ∫ÔÏÔ‚·ÎÙËÚ›‰ÈÔ ∫ÏÂÌÛȤÏÏ· ∞ÈÌfiÊÈÏÔ˜ ÈÓÊÏÔ˘¤ÓÙ˙·˜ 梉ÔÌÔÓ¿‰· Gram ·ÚÓËÙÈο B. fragilis
∫ÂÊÙ·˙ȉ›ÌË ∞ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë
ÃψڷÌÊ·ÈÓÈÎfiÏË
∫ÂÊÙ·˙ȉ›ÌË ∞ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë (› ˘Ô„›·˜ ∞ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ „¢‰ÔÌÔÓ¿‰·˜) ·ÁˆÁ‹ ¶·È‰È·ÙÚÈ΋ 2005;68:289-294
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µÈ‚ÏÈÔÁÚ·Ê›· 1. Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis 1997;25:763-779. 2. Sennaroglu L, Sozeri B. Otogenic brain abscess: review of 41 cases. Otolaryngol Head Neck Surg 2000; 123:751-755. 3. Law DA, Aronoff SC. Anaerobic meningitis in children: case report and review of the literature. Pediatr Infect Dis J 1992;11:968-971. 4. Sofianou D, Selviarides P, Sofianos E, Tsakris A, Foroglou G. Etiological agents and predisposing factors of intracranial abscesses in a Greek university hospital. Infection 1996;24:144-146. 5. Ralph E, Shoemaker G. Group A streptococcal brain abscess. Scand J Infect Dis 1999;31:206-207. 6. Givner LB, Kaplan SL. Meningitis due to Staphylococcus aureus in children. Clin Infect Dis 1993;16:766-771. 7. Artico M, Pastore FS, Polosa M, Sherkat S, Neroni M. Intracerebral Aspergillus abscess: case report and review of the literature. Neurosurg Rev 1997;20:135138. 8. Gupta SK, Manjunath-Prasad KS, Sharma BS, Khosla VK, Kak VK, Minz M et al. Brain abscess in renal transplant recipients: report of three cases. Surg Neurol 1997;48:284-287. 9. Kratimenos G, Crockard HA. Multiple brain abscess: a review of fourteen cases. Br J Neurosurg 1991;5:153-161. 10. Brook I. Brain abscess in children: microbiology and management. J Child Neurol 1995;10:283-288. 11. Selby R, Ramirez CB, Singh R, Kleopoulos I, Kusne S, Starzl TE et al. Brain abscess in solid organ transplant recipients receiving cyclosporine-based immunosuppression. Arch Surg 1997;132:304-310. 12. Skogberg K, Syrjanen J, Jahkola M, Renkonen OV, Paavonen J, Ahonen J et al. Clinical presentation and outcome of listeriosis in patients with and without immunosuppressive therapy. Clin Infect Dis 1992;14:815-821. 13. Cherubin CE, Appleman MD, Heseltine PN, Khayr W, Stratton CW. Epidemiological spectrum and
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current treatment of listeriosis. Rev Infect Dis 1991;13:1108-1114. Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes. 33 years’ experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998;77:313-336. Erny O, Rousseaux M, Pruvo JP, Guerouaou D, Savage C. A case of listeriosis revealed by voluminous cerebral abscesses. Rev Med Interne 1999;20:541-542. Calfee DP, Wispelwey B. Brain abscess. Semin Neurol 2000;20:353-360. Latchaw RE, Hirsch WL Jr, Yock DH Jr. Imaging of intracranial infection. Neurosurg Clin N Am 1992;3:303-322. Enzmann DR, Brant-Zawadzki M, Britt RH. CT of central nervous system infections in immunocompromised patients. AJR Am J Roentgenol 1980;135: 263-267. Takeshita M, Kagawa M, Izawa M, Takakura K. Current treatment strategies and factors influencing outcome in patients with bacterial brain abscess. Acta Neurochir (Wien) 1998;140:1263-1270. Sommer F, Aldini R, Kolodziejczyk D. Systemic antibiotic therapy on multiple intracerebral abscesses of unknown origin. Acta Neurochir (Wien) 1998; 140:1095-1096. Emery E, Redondo A, Berthelot JL, Bouali I, Ouahes O, Rey A. Intracranial abscess and empyema: neurosurgical management. Ann Fr Anesth Reanim 1999; 18:567-573. Ciurea AV, Stoica F, Vasilescu G, Nuteanu L. Neurosurgical management of brain abscesses in children. Childs Nerv Syst 1999;15:309-317. Lunsford LD. Stereotactic drainage of brain abscesses. Neurol Res 1987;9:270-274. Rosenblum ML, Mampalam TJ, Pons VG. Controversies in the management of brain abscesses. Clin Neurosurg 1986;33:603-632. Buonaguro A, Colangelo M, Daniele B, Cantone G, Ambrosio A. Neurological and behavioral sequelae in children operated on for brain abscess. Childs Nerv Syst 1989;5:153-155.
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Multiple brain abscesses caused by Listeria monocytogenes in a 12 year-old boy suffering from nephrotic syndrome. A case report S. Delicou1, F. Haliotis1, K. Karavanaki1, P. Prodromou2, S. Avlonitis1
Abstract Brain abscesses are rare in children because of the prompt use of antibiotics in bacterial infections. The causative organism and prognosis vary with the population under study. Immunocompromised patients have an increased incidence of brain abscesses caused by bacteria (aerobic and anaerobic species) and fungal and protozoan organisms. CT imaging of the brain (with and without contrast) is the most readily available examination for establishing the diagnosis of brain abscess. Empirical regimens of antibiotic therapy constitute the first line pharmacologic treatment for brain abscess. Immediate neurosurgical consultation is mandatory. The case is described of a 12 year-old boy with multiple purulent brain abscesses, who was treated with cyclosporine and prednisolone, because of relapsing nephrotic syndrome.
1 2nd Paediatric Clinic, “Aghia Sophia” Children’s Hospital, Athens 2 Clinic of Neurosurgery, “Aghia Sophia” Children’s Hospital, Athens
Correspondence: Sophia Delicou 7 Varnava Str., Pagrati 116 36, Athens E-mail: sophiadelicou@in.gr Date of submission: 13-07-2004 Date of approval: 17-05-2005
Key words Central nervous system infection, brain abscess, immunosuppression, cyclosporine, prednisolone, Listeria monocytogenes.
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™˘ÁÁÂÓ¤˜ ÎÔÏfi‚ˆÌ· ›Úȉ·˜-¯ÔÚÈÔÂȉԇ˜: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ, ∫¤ÓÙÚÔ ÀÁ›·˜ πηڛ·˜ 2 OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∫·ÙÂÚ›Ó· ªfiÓÙË °ÚËÁÔÚ›Ô˘ ∂’ 15 ∆.∫. 551 33, ∫·Ï·Ì·ÚÈ¿, £ÂÛÛ·ÏÔÓ›ÎË E-mail: monthcon@ika.forthnet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-07-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 27-04-2005
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¶ÂÚ›ÏË„Ë ∆· Û˘ÁÁÂÓ‹ ÔÊı·ÏÌÈο ÎÔÏÔ‚ÒÌ·Ù· ··ÓÙÒÓÙ·È Û·Ó ÌÂÌÔӈ̤ÓË ‚Ï¿‚Ë ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‚Ï¿‚˜ ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·, ÔÏϤ˜ ÊÔÚ¤˜ ˆ˜ ·Ó·ÁÓˆÚ›ÛÈÌ· Û‡Ó‰ÚÔÌ·. ∏ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Ù· ıÂڷ¢ÙÈο ̤ÙÚ· ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÏÔÎÒÓ, ÛÙË ‰ÈfiÚıˆÛË Ù˘ fiÚ·Û˘ ·ÏÏ¿ Î·È ÛÙËÓ Â›Ï˘ÛË ÙˆÓ ·ÈÛıËÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ™Â οı ÂÚ›ÙˆÛË Ú¤ÂÈ Ó· Á›ÓÂÈ ÁÂÓÂÙÈ΋ ÂÎÙ›ÌËÛË Î·È ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·ÚÌfi˙Ô˘Û· Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (2,3). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ‚Ú¤ÊÔ˘˜ 2 ÌËÓÒÓ ÌÂ Û˘ÁÁÂÓ¤˜ ·ÌÊÔÙÂÚfiÏ¢ÚÔ ÎÔÏfi‚ˆÌ· Ù˘ ›Úȉ·˜, ¯ˆÚ›˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·. §¤ÍÂȘ ÎÏÂȉȿ ∫ÔÏfi‚ˆÌ·, ›Úȉ·, ÔÊı·ÏÌÈΤ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜.
∂ÈÛ·ÁˆÁ‹ ∆· Û˘ÁÁÂÓ‹ ÔÊı·ÏÌÈο ÎÔÏÔ‚ÒÌ·Ù· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÙÂÏÔ‡˜ ÂÌ‚Ú˘ÔÁ¤ÓÂÛ˘ (ÌÂٷ͇ 5˘-7˘ ‚‰ÔÌ¿‰·˜ ·ËÛ˘) Î·È ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó Û fiϘ ÙȘ ÔÊı·ÏÌÈΤ˜ ÛÙÈ‚¿‰Â˜: ÎÂÚ·ÙÔÂȉ‹, ›Úȉ·, Ê·Îfi, ·ÎÙÈÓˆÙfi ÛÒÌ· Î·È ˙›ÓÂÈÔ ˙ÒÓË, ¯ÔÚÈÔÂȉ‹, ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹ Î·È ÔÙÈÎfi Ó‡ÚÔ. ∏ Û˘ÓÔ‰fi˜ ÌÈÎÚÔÊı·ÏÌ›· ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ‚ÔÏ‚Ô‡ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿, ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÂÌ‚Ú˘ÔÏÔÁÈο ·›ÙÈ· ÙˆÓ ÎÔÏÔ‚ˆÌ¿ÙˆÓ ÚÔηÏÔ‡Ó Â›Û˘ Î·È ÌÈÎÚÔÊı·ÏÌ›·, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ÈÛ¯‡ÂÈ ÙÔ ·ÓÙ›ÛÙÚÔÊÔ. ∏ Û˘¯ÓfiÙËÙ· ·Ó¤Ú¯ÂÙ·È Û 1,8:10.000 ÁÈ· ÙË ÌÈÎÚÔÊı·ÏÌ›· Î·È Û 0,7:10.000 ÁÈ· Ù· ÎÔÏÔ‚ÒÌ·Ù· (2). ∆· ÎÔÏÔ‚ÒÌ·Ù· ÛÙÔ˘˜ Ù˘ÊÏÔ‡˜ ÂÓ‹ÏÈΘ ¤¯Ô˘Ó ˘ÔÏÔÁÈÛÙ› Û ÔÛÔÛÙfi 0,6-1,9% Î·È ÛÙ· Ù˘ÊÏ¿ ·È‰È¿ Û 3,2-11,2%, Ì ÙȘ ‰È·Î˘Ì¿ÓÛÂȘ Ó· ÔÊ›ÏÔÓÙ·È ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÂıÓfiÙËÙ˜ ÙˆÓ ÏËı˘ÛÌÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (2). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÎÔÏÔ‚ˆÌ¿ÙˆÓ ÔÈΛÏÏÂÈ Î·È Ë ÚfiÁÓˆÛË Ù˘ fiÚ·Û˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ı¤ÛË ÙÔ˘˜ Î·È ·fi Èı·Ó¤˜ Û˘ÓÔ‰¤˜ ‚Ï¿‚˜ (1).
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ı‹ÏÂÔ˜ ‚Ú¤ÊÔ˘˜ (∂ÈÎfiÓ· 1), ËÏÈΛ·˜ 2 ÌËÓÒÓ, ÌÂ Û˘ÁÁÂÓ¤˜ ¶·È‰È·ÙÚÈ΋ 2005;68:296-299
∂ÈÎfiÓ· 1. ∞ÌÊÔÙÂÚfiÏ¢ÚÔ Ù˘ÈÎfi ÔÏÈÎfi ÎÔÏfi‚ˆÌ· ›Úȉ·˜: ›Úȉ· Ì ۯ‹Ì· “ÎÏÂȉ·ÚfiÙÚ˘·˜”.
·ÌÊÔÙÂÚfiÏ¢ÚÔ Ù˘ÈÎfi Î·È ÔÏÈÎfi ÎÔÏfi‚ˆÌ· Ù˘ ›Úȉ·˜, ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËΠ۠·È‰È·ÙÚÈ΋ ÂͤٷÛË ÚÔ˘Ù›Ó·˜. ∏ ·‰Ú‹ ÂÎÙ›ÌËÛË Ù˘ fiÚ·Û˘ Ì ÙË ‰ÔÎÈÌ·Û›· ·Ú·ÎÔÏÔ‡ıËÛ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘ ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋ Î·È Ì ÙËÓ ÚÒÙË ÂÈÛÎfiËÛË Ë ‚Ï¿‚Ë ‰ÂÓ ‹Ù·Ó Ê·ÓÂÚ‹ ηıÒ˜ Î·Ï˘ÙfiÙ·Ó ·fi ÙÔ Î¿Ùˆ ‚ϤʷÚÔ, Ë ‚Ï¿‚Ë fï˜ ¤ÁÈÓ ÂÌÊ·Ó‹˜ ηٿ ÙËÓ ÂͤٷÛË ·ÓÙ›‰Ú·Û˘ ÛÙÔ Êˆ˜. ¶·Ú·ÙËÚ‹ıËÎÂ, ›Û˘, ·Û˘ÌÌÂÙÚ›· ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ‚ÔÏ‚ÒÓ, ¯ˆÚ›˜ ÛÙÚ·‚ÈÛÌfi, Ó˘ÛÙ·ÁÌfi ‹ ¿ÏÏ· ÛËÌ›· ·fi ÙÔ˘˜
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™˘ÁÁÂÓ¤˜ ÎÔÏfi‚ˆÌ· ›Úȉ·˜-¯ÔÚÈÔÂȉԇ˜
ÔÊı·ÏÌÔ‡˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ¿ÏϘ ÂÌÊ·Ó›˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∏ ۈ̷ÙÈ΋ Î·È „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ Î·È ÙÔ Ì·È¢ÙÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ÂχıÂÚ·. OÈ ÁÔÓ›˜ Î·È Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·‰ÂÏÊfi˜ ‹Ù·Ó Ê·ÈÓÔÙ˘Èο ˘ÁÈ›˜. ∏ ÌÈÎÚ‹ ·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËΠÁÈ· ÂȉÈ΋ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË Î·È ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ·Ú·ÎÔÏÔ‡ıËÛ˘, ηıÒ˜ Î·È ÁÈ· Û˘ÓÔÏÈÎfiÙÂÚË ÂÎÙ›ÌËÛË Î·È ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∞fi ÙËÓ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË: ¢ÂÍÈfi˜ ÔÊı·ÏÌfi˜: ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ÌÈÎÚÔÊı·ÏÌ›·-Ï¢ÎÔÎÔÚ›·, Ê·Îfi˜ ‰È·˘Á‹˜. ∞fi ÙË Û¯ÈÛÌÔÂȉ‹ Ï˘¯Ó›·: Ô›ÛıȘ Û˘Ó¤¯ÂȘ ›ÚȉԘ, ·Ú·ÌÔÓ‹ ÈÚȉÔÎÔÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È ÎÔÏfi‚ˆÌ· ›ÚȉԘ. ™ÙÔÓ ‚˘ıfi Ù· Â˘Ú‹Ì·Ù· ‹Ù·Ó Û˘Ì‚·Ù¿ Ì ÎÔÏfi‚ˆÌ· ›ÚȉԘ Î·È ¯ÔÚÈÔÂȉԇ˜. ∞ÚÈÛÙÂÚfi˜ ÔÊı·ÏÌfi˜: Ï¢ÎÔÎÔÚ›·, Ê·Îfi˜ ‰È·˘Á‹˜. ∞fi ÙË Û¯ÈÛÌÔÂȉ‹ Ï˘¯Ó›·: ÎÔÏfi‚ˆÌ· ›ÚȉԘ Î·È ¯ÔÚÈÔÂȉԇ˜. ™ÙÔÓ ‚˘ıfi ·Ú·ÙËÚ‹ıËΠ·ÁÁÂȷ΋ ‰˘ÛÏ·Û›· ·ÓÒÙÂÚ˘ ÂÚÈÔ¯‹˜ (10Ë-2Ë ÒÚ·) ÌË Û˘Û¯ÂÙÈ˙fiÌÂÓË ·Ì¤Ûˆ˜ Ì ÙÔ ÎÔÏfi‚ˆÌ·. OÙÈ΋ ıËÏ‹, ˆ¯Ú¿, Ô›ÛıÈÔ˜ fiÏÔ˜ Î.Ê. ∏ ÂÓ‰ÔÊı¿ÏÌÈ· ›ÂÛË ‚Ú¤ıËÎÂ Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÛÙÔ˘˜ ‰‡Ô ÔÊı·ÏÌÔ‡˜ (10 mmHg ¿Ìʈ). ∞fi ÙË ÛÎÈ·ÛÎÔ›· ÚԤ΢„ fiÙÈ Ô ‰ÂÍÈfi˜ ÔÊı·ÏÌfi˜ ‹Ù·Ó ˘ÂÚÌÂÙÚˆÈÎfi˜ ÂÓÒ Ô ·ÚÈÛÙÂÚfi˜ ‹Ù·Ó ÂÌÌÂÙÚˆÈÎfi˜, ‡ÚËÌ· Ô˘ Û˘ÓËÁÔÚÔ‡Û ˘¤Ú ÙÔ˘ ÌÈÎÚfiÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ‰ÂÍÈÔ‡ Û ۯ¤ÛË Ì ÙÔÓ ·ÚÈÛÙÂÚfi ÔÊı·ÏÌfi. ™˘ÌÏËڈ̷ÙÈο ‰ÈÂÓÂÚÁ‹ıËΠU/S ÓÂÊÚÒÓ Î·È ÂÁÎÂÊ¿ÏÔ˘, ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È Î·Ú˘fiÙ˘Ô˜, Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο.
™˘˙‹ÙËÛË ∆· ÎÔÏÔ‚ÒÌ·Ù· ›Úȉ·˜-¯ÔÚÈÔÂȉԇ˜ Î·È Ë ÌÈÎÚÔÊı·ÏÌ›· ÌÔÚÔ‡Ó - ÌfiÓ· ÙÔ˘˜ ‹ Û˘Ó‰˘·Ṳ̂ӷ - Ó· ·ÔÙÂÏÔ‡Ó ÂΉËÏÒÛÂȘ ‰È·ÊfiÚˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, ‰È·ÊfiÚˆÓ ÌÔÓÙ¤ÏˆÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, Û˘¯Ó¿ ·‰È¢ÎÚ›ÓÈÛÙˆÓ (2,3). ø˜ ÌÂÌÔӈ̤ÓÔ ÔÊı·ÏÌÈÎfi Û‡Ó‰ÚÔÌÔ ÎÏËÚÔÓÔÌÂ›Ù·È Î·Ù¿ ηÓfiÓ· Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, Ì ‰È¿ÊÔÚË ÂÎÊÚ·ÛÙÈÎfiÙËÙ· Î·È ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, Ì ·ÔÙ¤ÏÂÛÌ· Û ÌÂÚÈο ÚÔۂ‚ÏË̤ӷ ¿ÙÔÌ· Ó· ÌËÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÂΉËÏÒÛÂȘ. ™Â ·˘Ù¤˜ ÙȘ ÔÈÎÔÁ¤ÓÂȘ ¤Ó· Ê·ÈÓÔÙ˘Èο ˘ÁȤ˜ ¿ÙÔÌÔ ¤¯ÂÈ 8,6% Èı·ÓfiÙËÙ˜ ·fiÎÙËÛ˘ ÚÔۂ‚ÏË̤-
ÓÔ˘ ·ÔÁfiÓÔ˘. ∏ ÂÎÙ›ÌËÛË ÁÈ· ÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ Â›Ó·È fiÙÈ ·Ó‹ÎÂÈ Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›·, ηıÒ˜ ‰ÂÓ Â›¯Â η̛· ¿ÏÏË Û˘ÓÔ‰fi ·ÓˆÌ·Ï›· Î·È Ô ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓ ·¤‚Ë ·ÚÓËÙÈÎfi˜. ø˜ ÌÂÌÔӈ̤ÓÔ Û‡Ó‰ÚÔÌÔ, Ë ÌÂÙ¿‰ÔÛË Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· ‰ÂÓ ¤¯ÂÈ ÂȂ‚·Èˆı›. ™ÙÔ˘˜ ¶›Ó·Î˜ 1 Î·È 2 ·Ó·Ê¤ÚÔÓÙ·È Ù· ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÌÔÓÔÁÔÓȉȷο ÓÔÛ‹Ì·Ù· Î·È ÔÈ ¯ÚˆÌ·ÙÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ ÔÊı·ÏÌÈο ÎÔÏÔ‚ÒÌ·Ù·, ·ÓÙ›ÛÙÔȯ·. ªÂÚÈο ·fi ·˘Ù¿ Â›Ó·È ·Û˘Ì‚›‚·ÛÙ· Ì ÙË ˙ˆ‹ Î·È Ù· ÂÚÈÛÛfiÙÂÚ· Â›Ó·È Û·ÊÒ˜ ·Ó·ÁÓˆÚ›ÛÈÌ·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û ÂÚ›ÙˆÛË Ô˘ Ù· ÎÔÏÔ‚ÒÌ·Ù· Û˘Ó‰˘¿˙ÔÓÙ·È Î·È Ì ¿ÏϘ ·ÓˆÌ·Ï›Â˜, ÂӉ›ÎÓ˘Ù·È ¤ÏÂÁ¯Ô˜ Ì ηڢfiÙ˘Ô ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. ∞fi ÙÔ˘˜ ÂÌ‚Ú˘ÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›ÛÙËÎ·Ó Ì ÔÊı·ÏÌÈο ÎÔÏÔ‚ÒÌ·Ù· Î·È ÌÈÎÚÔÊı·ÏÌ›·, ·fiÏ˘Ù· ÂȂ‚·ÈˆÌ¤ÓË Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ Â›Ó·È ÌfiÓÔ Ë ı·ÏȉÔÌ›‰Ë (2). ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·fi ÂÈÚ¿Ì·Ù· Û ˙Ò· ‹ ÛÔÚ·‰Èο ÂÚÈÛÙ·ÙÈο Â›Ó·È Ë ·Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ ∞, Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÙÔ ·ÏÎÔfiÏ Î·È ÏÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ (ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi˜, ·ÓÂÌ¢ÏÔÁÈ¿, ¤Ú˘, EpsteinBarr). OÈ ÙÂÏÂ˘Ù·›ÔÈ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÌÈÎÚÔÊı·ÏÌ›· ¯ˆÚ›˜ ÎÔÏÔ‚ÒÌ·Ù·. ø˜ Èı·Ó¿ ·›ÙÈ· ¤¯Ô˘Ó, ›Û˘, ·Ó·ÊÂÚı› Ë ·ÎÙÈÓÔ‚ÔÏ›· Î·È Ô ˘„ËÏfi˜ ˘ÚÂÙfi˜ ηٿ ÙËÓ Î‡ËÛË. ¶›Ó·Î·˜ 1. ªÔÓ٤Ϸ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÔÊı·ÏÌÈÎÒÓ ÎÔÏÔ‚ˆÌ¿ÙˆÓ 1. ªÂÌÔӈ̤ÓÔ ÔÊı·ÏÌÈÎfi Û‡Ó‰ÚÔÌÔ ∞˘ÙÔۈ̷ÙÈÎfi˜ ÂÈÎÚ·ÙÒÓ ¯·Ú·ÎÙ‹Ú·˜ 2. ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÌÔÓÔÁÔÓȉȷο ÓÔÛ‹Ì·Ù· ·. ∞˘ÙÔۈ̷ÙÈÎfi˜ ÂÈÎÚ·ÙÒÓ ¯·Ú·ÎÙ‹Ú·˜ - ™‡Ó‰ÚÔÌÔ ‚·ÛÈÎÔ΢ÙÙ·ÚÈÎÔ‡ Û›ÏÔ˘ - ¯ÚˆÌfiۈ̷ 9 - “Marfan-like” Û‡Ó‰ÚÔÌÔ - ¯ÚˆÌfiۈ̷ 5 - ∞ӈ̷ϛ˜ Ô˘ÚÔÁÂÓÓËÙÈÎÔ‡ Î·È ∫¡™ - ÌÂÙ¿ÏÏ·ÍË ÁÔÓȉ›Ô˘ PAX 2 ‚. ∞˘ÙÔۈ̷ÙÈÎfi˜ ˘ÔÏÂÈfiÌÂÓÔ˜ ¯·Ú·ÎÙ‹Ú·˜ - ™‡Ó‰ÚÔÌÔ ªeckel-Gruber (ÌÔÈ¿˙ÂÈ Ì ÙÚÈۈ̛· 13) - ™‡Ó‰ÚÔÌÔ Sjogren-Larsson - ™‡Ó‰ÚÔÌÔ Walker-Warburg - ¢È¿ÊÔÚ· “·ÓÒÓ˘Ì·” Û¿ÓÈ· Û‡Ó‰ÚÔÌ· Ô˘ Û˘Ó‰˘¿˙Ô˘Ó ÙȘ ÔÊı·ÏÌÈΤ˜ ‚Ï¿‚˜ Ì ¿ÏϘ, ΢ڛˆ˜ ÙÔ˘ ∫¡™ Á. º˘ÏÔÛ‡Ó‰ÂÙÔ˜ ¯·Ú·ÎÙ‹Ú·˜ - ™‡Ó‰ÚÔÌÔ Lenz - ™‡Ó‰ÚÔÌÔ Aicardi - ™‡Ó‰ÚÔÌÔ MIDAS ‹ MLS (ÁÔÓ›‰ÈÔ Xp22.3) - Catel-Manzke (ÌÔÈ¿˙ÂÈ Ì Pierre-Robin) 3. ∞‰È¢ÎÚ›ÓÈÛÙ· - ™˘Ó‰˘·ÛÌfi˜ CHARGE ¶·È‰È·ÙÚÈ΋ 2005;68:296-299
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·298
298
∫. ªfiÓÙË Î·È Û˘Ó.
¶›Ó·Î·˜ 2. ÃÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÔÊı·ÏÌÈο ÎÔÏÔ‚ÒÌ·Ù· Ì ÌÈÎÚÔÊı·ÏÌ›· 1. ∆ÚÈÏÔÂȉ›· 2. ∆ÚÈۈ̛˜ - ∆ÚÈۈ̛· 13 - ∆ÚÈۈ̛· 18 - ∆ÚÈۈ̛· 22 3. ∞Ó·‰ÈÏ·ÛÈ·ÛÌÔ› - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 4q+ - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 7q+ - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 9p+ - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 9p+q+ - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 13q+ - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 14q+ - ∞Ó·‰ÈÏ·ÛÈ·ÛÌfi˜ 22q+ 4. ∞ÒÏÂȘ - ∞ÒÏÂÈ· 2p22 - ∞ÒÏÂÈ· 4p- ∞ÒÏÂÈ· 4del(q12q12.1) - ∞ÒÏÂÈ· 4r - ∞ÒÏÂÈ· 5(q15q22) - ∞ÒÏÂÈ· Dq- ∞ÒÏÂÈ· Dr - ∞ÒÏÂÈ· 11q- ∞ÒÏÂÈ· 13q- ∞ÒÏÂÈ· 13r- ∞ÒÏÂÈ· 18q- ∞ÒÏÂÈ· 18r 5. ¶ÂÚÈÎÂÓÙÚÈΤ˜ ·Ó·ÛÙÚÔʤ˜ ∞Ó·ÛÙ(6)(p23q23.1) 6. ∞ӈ̷ϛ˜ Ê˘ÏÂÙÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÃÀÀ
ŸÙ·Ó ÙÔ ÎÔÏfi‚ˆÌ· ‚Ú›ÛÎÂÙ·È ÛÙÔ Î¿Ùˆ ÚÈÓÈÎfi ÙÂÙ·ÚÙËÌfiÚÈÔ Î·ÏÂ›Ù·È Ù˘ÈÎfi, ÁÈ·Ù› ·˘Ù‹ Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ÂÓÙfiÈÛË. ™Â ÔÔÈÔ‰‹ÔÙ ¿ÏÏÔ ÙÌ‹Ì· ÙÔ˘ ‚ÔÏ‚Ô‡ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ¿Ù˘Ô. ŸÙ·Ó ÙÔ ¤ÏÏÂÈÌÌ· Ù˘ ›Úȉ·˜ ÂÎÙ›ÓÂÙ·È ¤ˆ˜ ÙË ‚¿ÛË Ù˘ Î·È ‰›ÓÂÈ ÛÙËÓ ÎfiÚË Û¯‹Ì· “ÎÏÂȉ·ÚfiÙÚ˘·˜” (fiˆ˜ Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘), ÙÔ ÎÔÏfi‚ˆÌ· ÔÓÔÌ¿˙ÂÙ·È ÔÏÈÎfi, ÂÓÒ ¤Ó· ÙÌËÌ·ÙÈÎfi ÎÔÏfi‚ˆÌ· ı· ÂËÚ¤·˙ ÙÔ ÂÚ›ÁÚ·ÌÌ· Ù˘ ÎfiÚ˘ ‰›ÓÔÓÙ¿˜ Ù˘ ¤Ó· ÂÏ·ÊÚÒ˜ Ô‚¿Ï Û¯‹Ì·. ∂ÈÎfiÓ· ÎÔÏÔ‚ÒÌ·ÙÔ˜ Ù˘ ›Úȉ·˜ ÌÔÚÔ‡Ó Ó· ÌÈÌËıÔ‡Ó Ë ·ÓÈÚȉ›·, ÙÔ ÙÚ·‡Ì·, Ô Û›ÏÔ˜ ‹ Ë ÂÙÂÚԯڈ̛· Ù˘ ›Úȉ·˜, Ë ·ÙÚÔÊ›· Ù˘ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Rieger (5). ∞Ó Î·È ÙÔ ÎÔÏfi‚ˆÌ· Ù˘ ›Úȉ·˜ ÌÔÚ› Ó· Â›Ó·È ÌÂÌÔӈ̤ÓË ·ÓˆÌ·Ï›·, Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÂÏÏ›ÌÌ·Ù· Î·È ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ¯ÈÙÒÓ˜ ÙÔ˘ Ì·ÙÈÔ‡. ªÔÚ›, ›Û˘, Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ·Ú·ÌÔÓ‹ ˘·ÏÔÂȉԇ˜ ·ÚÙËÚ›·˜, Û˘ÁÁÂÓ‹ ηٷÚÚ¿ÎÙË ‹ ÂÓ‰ÔÎÔÁ¯È΋ ·ÛÙË Ì ÂÚȯfiÌÂÓÔ ∂¡À (2). °È· ÙËÓ ÚfiÁÓˆÛË Ù˘ fiÚ·Û˘ ÛËÌ·ÓÙÈÎfiÙÂÚË ·Ú¿ÌÂÙÚÔ˜ Â›Ó·È Ô ‚·ıÌfi˜ ¶·È‰È·ÙÚÈ΋ 2005;68:296-299
Ù˘ ‚Ï¿‚˘ ÙÔ˘ ÔÙÈÎÔ‡ Ó‡ÚÔ˘ Î·È Ù˘ ˆ¯Ú¿˜ ÎËÏ›‰·˜ (1). ∏ Û˘ÓËı¤ÛÙÂÚË ÂÈÏÔ΋ ÙÔ˘ ¯ÔÚÈÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉÈÎÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜ Â›Ó·È Ë ·ÔÎfiÏÏËÛË ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ (2), Û˘ÁÁÂÓ‹˜ ‹ Û˘¯ÓfiÙÂÚ· ›ÎÙËÙË, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂͤÏÈ͢ ÙˆÓ ‚Ï·‚ÒÓ. ™Â ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ‚Ú›ÛÎÔÓÙ·È Ù· Ì¿ÙÈ· ÌÂ Ô˘Ï¤˜ ÙÔ˘ ÔÙÈÎÔ‡ Ó‡ÚÔ˘. ∂›Û˘, ÌÔÚ› Ó· ÚÔ·„Ô˘Ó ÁÏ·‡ÎˆÌ·, ·Ì‚Ï˘ˆ›·, ·ÓÈÛÔÌÂÙÚˆ›· Î·È ÛÙÚ·‚ÈÛÌfi˜.
∂ÎÙ›ÌËÛË - ·ÓÙÈÌÂÙÒÈÛË ∏ ‡·ÚÍË Î·È ÌfiÓÔ ÎÔÏÔ‚ÒÌ·ÙÔ˜ ›Úȉ·˜¯ÔÚÈÔÂȉԇ˜ ‰ÂÓ Û˘Ó¿ÁÂÙ·È ¿ÓÙ· ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂͤÏÈÍË Ù˘ fiÚ·Û˘, ›Ù Û ÂÙÂÚfiÏ¢ÚË Â›Ù Û ·ÌÊÔÙÂÚfiÏ¢ÚË ÚÔÛ‚ÔÏ‹. ¶·ÚÂÌ‚¿ÛÂȘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ·ÈÛıËÙÈÎÔ‡˜ ÏfiÁÔ˘˜, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÈÏÔÎÒÓ ‹ Û˘ÓÔ‰ÒÓ ‚Ï·‚ÒÓ ‹ Û ÂÚÈÙÒÛÂȘ ÂÈÙÒÛÂˆÓ ÛÙËÓ fiÚ·ÛË. °È· ÙËÓ ÚÔۂ‚ÏË̤ÓË ›Úȉ· ˘¿Ú¯Ô˘Ó Ù¯ÓÈΤ˜ Û˘ÚÚ·Ê‹˜ Ù˘ ‹ ÙÔÔı¤ÙËÛ˘ ÂȉÈÎÒÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ (8). £¤ÛË ¤¯Ô˘Ó, ›Û˘, ÂȉÈÎÔ› Ê·ÎÔ› ·ʋ˜. ÃÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ›Ûˆ˜ Â›Ó·È ¯Ú‹ÛÈ̘ ÛÙËÓ ÂÚ›ÙˆÛË Î·Ù·ÚÚ¿ÎÙË (6) ‹ ·ÔÎfiÏÏËÛ˘ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ (ÁÈ· ÙËÓ ÔÔ›· ÂӉ›ÎÓ˘Ù·È Î·È ÚÔÊ˘Ï·ÎÙÈ΋ ÎÚ˘ÔËÍ›·) (2,7), ηıÒ˜ ›Û˘ Î·È ÁÈ· ‰ÈfiÚıˆÛË Èı·ÓÔ‡ ÛÙÚ·‚ÈÛÌÔ‡ ‹ Ó˘ÛÙ·ÁÌÔ‡. °È· ÙËÓ ÂÚ›ÙˆÛË ÛÔ‚·Ú‹˜ ÌÈÎÚÔÊı·ÏÌ›·˜ ˘¿Ú¯ÂÈ Ë Ù¯ÓÈ΋ ÂÊ·ÚÌÔÁ‹˜ ÂȉÈÎÒÓ ÔÊı·ÏÌÈÎÒÓ ÚÔı¤ÛˆÓ, ÔÈ Ôԛ˜ ÛÙ·‰È·Î¿ ·˘Í·ÓfiÌÂÓ˜ Û ̤ÁÂıÔ˜ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰È·ÛÙÔÏ›˜ ÙÔ˘ ÎfiÁ¯Ô˘, ÂÍ·ÛÊ·Ï›˙Ô˘Ó Û ÈηÓÔÔÈËÙÈÎfi ‚·ıÌfi ÙË Û˘ÌÌÂÙÚÈ΋ ÂÌÊ¿ÓÈÛË ÙˆÓ ‚ÔÏ‚ÒÓ (2). ∆Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ ˙‹ÙËÌ· Â›Ó·È Ë ÚfiÁÓˆÛË Ù˘ fiÚ·Û˘ (1,2), Ë ÔÔ›· ı· ˘Ô‰Â›ÍÂÈ ÙÔÓ Û¯Â‰È·ÛÌfi Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘. ∏ Û¯ÔÏ·ÛÙÈ΋ ‰ÈÂÚ‡ÓËÛË ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË, fiˆ˜ Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ·ÚÔ˘ÛÈ¿˙ÂÈ Ù¯ÓÈΤ˜ ‰˘ÛÎÔϛ˜, ÁÈ’ ·˘Ùfi Î·È ··ÈÙÂ›Ù·È Û˘¯Ó‹ ·Ú·ÎÔÏÔ‡ıËÛË. ∑ˆÙÈ΋˜ ÛËÌ·Û›·˜ Â›Ó·È Ë ‰ÈfiÚıˆÛË ÙˆÓ ‰È·ıÏ·ÛÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë ·Ì‚Ï˘ˆ›·˜, fiˆ˜ ›Û˘ Î·È Ë ‰È·Ú΋˜ ÚÔʇϷÍË ÙÔ˘ ˘ÁÈÔ‡˜ Ì·ÙÈÔ‡ (ÂÓË̤ڈÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Âη›‰Â˘ÛË ÁÈ· ¯Ú‹ÛË ÚÔÊ˘Ï·ÎÙÈÎÒÓ Á˘·ÏÈÒÓ Î·È ¿ÏÏˆÓ ÂȉÈÎfiÙÂÚˆÓ Ì¤ÙÚˆÓ, .¯. ÛÙËÓ ¿ıÏËÛË). ∏ Î¿Ï˘„Ë ÙÔ˘ ˘ÁÈÔ‡˜ Ì·ÙÈÔ‡ Û˘Ì‚¿ÏÏÂÈ ¤ÛÙˆ Î·È ÂÏ¿¯ÈÛÙ· ÛÙË ‰Ú¿ÛË ÙÔ˘ ·Ì‚Ï˘ˆÈÎÔ‡, ÂÓÒ ‚ÔËı¿ Î·È ÙÔ˘˜ ÁÔÓ›˜ Ó· Û˘ÓÂȉËÙÔÔÈ‹ÛÔ˘Ó ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ‚Ï¿‚˘.
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µÈ‚ÏÈÔÁÚ·Ê›· 1. Hornby SJ, Adolph S, Gilbert CE, Dandona L, Foster A. Visual acuity in children with coloboma: clinical features and a new phenotypic classification system. Ophthalmology 2000;107:511-520. 2. Onwochei BC, Simon JW, Bateman JB, Couture KC, Mir E. Ocular colobomata. Surv Ophthalmol 2000;45:175-194. 3. Michel-Awad A. Genetic counseling in pediatric ophthalmology. Soins Gynecol Obstet Pueric Pediatr 1991;120:36-38. 4. ºÚ˘Û›Ú· ∂, ™Ù¤ÚË ¶, ¶··‰fiÔ˘ÏÔ˜ °, °È·ÓÓÔ‡ÏÈ·-∫·Ú·ÓÙ·Ó¿ ∞. ™˘Ó‰˘·ÛÌfi˜ CHARGE (CHARGE association). ¢ÂÏÙ ∞’ ¶·È‰È·ÙÚ ∫ÏÈÓ ¶·Ó ∞ıËÓÒÓ 1999;46:171-173.
5. Grosso S, Farnetani MA, Berardi R, Vivarelli R, Vanni M, Morgese G et al. Familial Axenfeld-Rieger anomaly, cardiac malformations, and sensorineural hearing loss: a provisionally unique genetic syndrome? Am J Med Genet 2002;111:182-186. 6. Volcker HE, Tetz MR, Daus W. Cataract surgery in eyes with colobomas. Dev Ophthalmol 1991;22:94100. 7. de Laage de Meux P. Modern therapeutic approach to congenital abnormalities of the anterior eye segment in pediatric patients. J Fr Ophtalmol 2000;23: 908-916. 8. Burk SE, Da Mata AP, Snyder ME, Cionni RJ, Cohen JS, Osher RH. Prosthetic iris implantation for congenital, traumatic, or functional iris deficiencies. J Cataract Refract Surg 2001;27:1732-1740.
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Congenital coloboma of the iris-choroid: case report and literature review K. Monti1, N. Manios2 1 Paediatric Clinic of the General Hospital, Health Care Center of Ikaria 2 Eye Clinic, Penteli Children’s Hospital, Athens Correspondence: Katerina Monti 15 Grigoriou E’ Str. 551 33, Kalamaria, Thessaloniki E-mail: monthcon@ika.forthnet.gr Date of submission: 19-07-2004 Date of approval: 27-04-2005
Paediatriki 2005;68:300
Abstract Ocular congenital colobomata may be found as an isolated malformation, or in association with other congenital anomalies, sometimes as a part of specific syndromes. The follow-up and treatment involve the management of complications, visual correction and solution of the cosmetic problems. In all cases, genetic evaluation and family consultation is recommended. The case of a 2 month-old female baby is described with congenital bilateral iris coloboma, with no congenital anomalies in other systems. Key words Coloboma, iris, ocular congenital anomalies.
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∫·Ú‰ÈÔÏÔÁÈÎÔ› ΛӉ˘ÓÔÈ ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË ™. ∞ÓÙˆÓÈ¿‰Ë˜
¶ÂÚ›ÏË„Ë ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·ıÒ˜ Î·È ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ú˘ıÌÔ‡ ‹ ¿ÏÏˆÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi Û‡ÛÙËÌ· Û˘Ó‹ıˆ˜ ¤¯ÂÈ Û·Ó ·ÊÂÙËÚ›· ÙËÓ ·Ï‹ ηıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË. ∏ ·Ú·ÔÌ‹ Û ·È‰ÔηډÈÔÏfiÁÔ ÌÂÙ¿ ÙÔ ¿ÎÔ˘ÛÌ· ÂÓfi˜ Ê˘Û‹Ì·ÙÔ˜ ‹ ÙË ‰È·›ÛÙˆÛË Ù˘ ‡·Ú͢ οÔÈÔ˘ ¿ÏÏÔ˘ ‡ÔÙÔ˘ Â˘Ú‹Ì·ÙÔ˜, ·ÔÙÂÏ› ·ÁÎfiÛÌÈ· ÙËÓ ÈÔ ÁÓˆÛÙ‹ Î·È Î·ıÈÂڈ̤ÓË Ô‰fi ÁÈ· ÙË ÛˆÛÙ‹ ‰ÈÂÚ‡ÓËÛË ·ÏÏ¿ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Èı·ÓÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙÔÓ È‰·ÓÈÎfi ¯ÚfiÓÔ. ∞ÓÙ›ıÂÙ·, Ë ·fi‰ÔÛË ÂÓfi˜ ‹ÈÔ˘ Ê˘Û‹Ì·ÙÔ˜ Û ÏÂÈÙÔ˘ÚÁÈο ·›ÙÈ·, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙËÓ Î·Ï‹ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÙËÓ ·Ó˘·ÚÍ›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·ÓÙÔ¯‹ Î·È ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂϤÛÂÈ ·ÈÙ›· ÛÔ‚·ÚÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. OÈ ·ı‹ÛÂȘ Ô˘ Û˘ÓËı¤ÛÙÂÚ· ·Ú·Ï·ÓÔ‡Ó ÙÔÓ ·È‰›·ÙÚÔ Â›Ó·È Ë ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·, Ë ‹È· ÈÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜, ηıÒ˜ Î·È ¿ÏϘ ‹È˜ ÌÔÚʤ˜ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Ì fi¯È ÂÓÙ˘ˆÛÈ·Îfi ‹ ۯ‰fiÓ ·Ó‡·ÚÎÙÔ Ê‡ÛËÌ·, ÔÈ Ôԛ˜ fï˜ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÛÔ‚·ÚÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ·ÎfiÌË Î·È ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜ (.¯. ÂÓ‰Ôηډ›Ùȉ·). ∂Í¿ÏÏÔ˘, Ë ‰È·›ÛÙˆÛË Ù˘ ‡·Ú͢ ÔÚÁ·ÓÈ΋˜ ¿ıËÛ˘ ÛÙË ËÏÈΛ· ÙˆÓ 5-10 ÂÙÒÓ Ô˘ ÔÈ ÁÔÓ›˜ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È fiÙÈ ˘‹Ú¯Â ·fi ÙË Á¤ÓÓËÛË Î·È ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó Û·Ó Î¿ÙÈ ·ıÒÔ, ÂÓÒ ÙÒÚ· Á›ÓÂÙ·È Û˘˙‹ÙËÛË ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Ì Èı·ÓfiÙËÙ· ·ÎfiÌ· Î·È ÁÈ· ÂÁ¯Â›ÚËÛË ·ÓÔÈÎÙ‹˜ ηډȿ˜, ÌfiÓÔ ¤ÓÙÔÓË ‰˘Û·Ó·Û¯¤ÙËÛË Î·È ·ÓÙȉڿÛÂȘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ. ∂¿Ó Û fiÛ· ·Ó·Ê¤ÚıËÎ·Ó ÚÔÛÙÂıÔ‡Ó Î·È ÔÈ Î›Ó‰˘ÓÔÈ ÔÈ ÔÔ›ÔÈ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙȘ ÚˆÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡ ‹ ¿ÏϘ ÛÔ‚·Ú¤˜ ·ı‹ÛÂȘ Ô˘ ÌÔÚ› Ó· ÌË ‰›ÓÔ˘Ó Î·Ó¤Ó· ÎÏÈÓÈÎfi ‡ÚËÌ·, fiˆ˜ Ë ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ¯ˆÚ›˜ ÛÙ¤ÓˆÛË, ÙfiÙ Á›ÓÂÙ·È ·fiÏ˘Ù· ηٷÓÔËÙ‹ Ë ¤ÎÙ·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ∆¤ÏÔ˜, Ë ˘ÔÁÚ·Ê‹ ÂÓfi˜ ÈÛÙÔÔÈËÙÈÎÔ‡ ÁÈ· ¿ıÏËÛË Â›Ó·È ¿ÓÙ· ÂÈΛӉ˘ÓË fiÙ·Ó ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ÚÔËÁÔ˘Ì¤Óˆ˜ Ô Î·Ù¿ÏÏËÏÔ˜ ¤ÏÂÁ¯Ô˜. øÛÙfiÛÔ, Ù· ÚfiÛÊ·Ù· ·Ù˘¯‹ Û˘Ì‚¿ÓÙ· ·Ó·ÌÊ›‚ÔÏ· ηıÈÛÙÔ‡Ó Â›Î·ÈÚË ·˘Ù‹ ÙË ‰ËÌÔÛ›Â˘ÛË.
¶·È‰ÔηډÈÔÏfiÁÔ˜ ∫·ıËÁËÙ‹˜ ∞ÓÒÙ·ÙÔ˘ ∆¯ÓÔÏÔÁÈÎÔ‡ ∂Î·È‰Â˘ÙÈÎÔ‡ π‰Ú‡Ì·ÙÔ˜ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ™Ù˘ÏÈ·Ófi˜ ∞ÓÙˆÓÈ¿‰Ë˜ ∏Ú·ÎÏ›ÙÔ˘ 4, ∫ÔψӿÎÈ ∆.∫. 106 73, ∞ı‹Ó· E-mail: prdrsant@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-08-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 27-04-2005
§¤ÍÂȘ ÎÏÂȉȿ ∫·Ú‰ÈÔÏÔÁÈÎÔ› ΛӉ˘ÓÔÈ, ·È‰È·ÙÚÈ΋ Ú¿ÍË.
∂ÈÛ·ÁˆÁ‹ ∏ ηı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË ÔÚÈÛÌ¤ÓˆÓ ÌÔÚÊÒÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ ‰ÂÓ Â›Ó·È Û¿ÓÈ·. ∏ ‰È·›ÛÙˆÛË ‹ÈÔ˘ Ê˘Û‹Ì·ÙÔ˜ ÛÙËÓ ·ÎÚfi·ÛË ÂÓfi˜ ·È‰ÈÔ‡ ¯ˆÚ›˜ ηӤӷ Û‡Ìو̷ ‹ ‡ÚËÌ· ÌÔÚ› ‡ÎÔÏ· Ó· ·Ô‰Ôı› Û ·ıÒ· ·›ÙÈ· Î·È Û ÌÂÚÈΤ˜, Â˘Ù˘¯Ò˜ Ôχ Û¿ÓȘ, ÂÚÈÙÒÛÂȘ Ó· ÌËÓ ·Ó·ÊÂÚı› ÛÙÔ˘˜ ÁÔÓ›˜. øÛÙfiÛÔ, ·˘Ù‹ Ë Ï·Óı·Ṳ̂ÓË Ù·ÎÙÈ΋ ÌÔÚ› ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ‰˘Û¿ÚÂÛÙ˜ ηٷÛÙ¿ÛÂȘ fiÙ·Ó - Ì ÙËÓ Â˘Î·ÈÚ›· Ù˘ ÂͤٷÛ˘ ÙÔ˘ ·È‰ÈÔ‡ ·fi ¤Ó·Ó ¿ÏÏÔ, ÂÎÙfi˜ ·fi ÙÔÓ ıÂÚ¿ÔÓÙ·, ·È‰›·ÙÚÔ - ‰È·ÈÛÙˆı› fiÙÈ ÙÔ Ê‡ÛËÌ· Ô˘ ˆ˜ ÙÒÚ· ıˆÚÔ‡ÓÙ·Ó ¿Ó¢ ÛËÌ·Û›·˜ Â›Ó·È ÔÚÁ·ÓÈÎfi (·Ô˘Û›· ÁÈ·ÙÚÔ‡, ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ ÓËÈ·ÁˆÁ›Ô-Û¯ÔÏ›Ô, ÚÔ·ıÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜). OÈ Î·Ù·ÛÙ¿ÛÂȘ
·˘Ù¤˜, fiˆ˜ Â›Ó·È Â˘ÓfiËÙÔ, ÂÎÙfi˜ ·fi ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÂÚˆÙËÌ·ÙÈο, ·Ôڛ˜ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ‰ÈηÈÔÏÔÁË̤Ó˜ ·ÓÙȉڿÛÂȘ, ΢ڛˆ˜ fiÙ·Ó ¯ÚÂÈ¿˙ÂÙ·È ÂÂÌ‚·ÙÈ΋ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË. ∏ Âη›‰Â˘ÛË ÂÓfi˜ ·È‰È¿ÙÚÔ˘, ·ÏÏ¿ Î·È Ë ÂÌÂÈÚ›· ÙÔ˘ ÛÙ· ηډÈÔÏÔÁÈο ÂÚÈÛÙ·ÙÈο Û˘Ó‹ıˆ˜ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È Û ٤ÙÔÈÔ Â›Â‰Ô Ô‡Ùˆ˜ ÒÛÙ ӷ ÙÔ˘ ‰›ÓÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· Ó· ÌÔÚ› Ó· ‰È·ÁÓÒÛÂÈ ¤Ó· ‡ÔÙÔ Ê‡ÛËÌ· Ì ‚‚·ÈfiÙËÙ·. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯Ô˘Ó ¤ÓÙÔÓ· Ê˘Û‹Ì·Ù· ‹ ¿ÏÏ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, fiˆ˜ ÛËÌ›· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, ΢¿ÓˆÛË, ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘, Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ Î.Ï., Ë ‰È¿ÁÓˆÛË Â›Ó·È Â‡ÎÔÏË. ™Â οı ÂÚ›ÙˆÛË, fï˜, Ô˘ ÙÔ ·È‰› ‰ÂÓ ¤¯ÂÈ Î·Ó¤Ó· ¿ÏÏÔ Â‡ÚËÌ· ÂÎÙfi˜ ·fi ¤Ó· ‹ÈÔ Ê‡ÛËÌ·, ÙÔ ÔÔ›Ô fï˜ ‰ËÌÈÔ˘ÚÁ› ÂÚˆÙËÌ·ÙÈο, ¶·È‰È·ÙÚÈ΋ 2005;68:301-306
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ı· Ú¤ÂÈ Ó· ‰Ôı› ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ (΢ڛˆ˜ Û ÂÚÈÙÒÛÂȘ ·ıÏËÙÈÛÌÔ‡-ÚˆÙ·ıÏËÙÈÛÌÔ‡) ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂȈıÔ‡Ó ÔÈ Èı·ÓfiÙËÙ˜ Ï·Óı·Ṳ̂Ó˘ ‰È¿ÁÓˆÛ˘. °È· Ù· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ ›Ûˆ˜ Ó· Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË Ë ·ÎfiÏÔ˘ıË ·Ó·ÊÔÚ¿ ÛÙȘ ·ı‹ÛÂȘ Ô˘ ÌÔÚ› Ó· ·ÔÙÂϤÛÔ˘Ó ·Á›‰Â˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ Ú¿ÍË.
∞›ÙÈ· OÈ Î·Ú‰È·Î¤˜ ·ı‹ÛÂȘ Ô˘ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ÌÔÚ› ‡ÎÔÏ· Ó· ‰È·Ï¿ıÂÈ Ù˘ ÚÔÛÔ¯‹˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÏfiÁˆ ‹È·˜ ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜, Û˘Ó‹ıˆ˜ ÔÊ›ÏÔÓÙ·È Û ̛· ·fi ÙȘ ·ÎfiÏÔ˘ı˜ ηÙËÁÔڛ˜:
·) ªÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· ∞ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË ¿ıËÛË Ô˘ ÌÔÚ› Ó· ·Ú·Ï·Ó‹ÛÂÈ ÙÔÓ ·È‰›·ÙÚÔ. ∆· ·È‰È¿ ·ÎfiÌË Î·È Ì ÌÂÁ¿Ï˜ ÌÂÛÔÎÔÏÈΤ˜ ÂÈÎÔÈӈӛ˜, Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, Â›Ó·È ·fiÏ˘Ù· ˘ÁÈ‹, ¯ˆÚ›˜ ÏÔÈÌÒÍÂȘ, Ì ¿ÚÈÛÙË ·ÓÙÔ¯‹ Î·È ·Ó¿Ù˘ÍË. ∆Ô Ê‡ÛËÌ· Â›Ó·È ‹ÈÔ (ËÈfiÙ·ÙÔ Û ÌÈÎÚ‹ ÌÂÛÔÎÔÏÈ΋), ¤ÙÛÈ ÒÛÙ ӷ Â›Ó·È Â‡ÎÔÏÔ Ó· ‰È·Ê‡ÁÂÈ (1-4). ∂›Ó·È ÎÔÈÓfi Ì˘ÛÙÈÎfi fiÙÈ ÔÏϤ˜ ÊÔÚ¤˜ Ë ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· - ·ÎfiÌ· Î·È ÁÈ· ¤Ó·Ó ¤ÌÂÈÚÔ ·È‰ÔηډÈÔÏfiÁÔ - ‰ÂÓ Â›Ó·È ·fi ÙȘ ·ı‹ÛÂȘ Ô˘ ÌÔÚÔ‡Ó Ó· ‰È·ÁÓˆÛÙÔ‡Ó ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ÙÔÔı¤ÙËÛË ÙÔ˘ ÛÙËıÔÛÎÔ›Ô˘ ÁÈ· ·ÎÚfi·ÛË. π‰È·›ÙÂÚ· ÛÙȘ ̤ÙÚȘ ‹ ÌÈÎÚ¤˜ ÌÂÛÔÎÔÏÈΤ˜ ÂÈÎÔÈӈӛ˜, Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈ΋, fiˆ˜ Â›Ó·È Ôχ Û˘¯Ó¿ Î·È ÙÔ ËÏÂÎÙÚoηډÈÔÁÚ¿ÊËÌ·. ™ÙÔ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ‰‡Ô ‰È·ÛÙ¿ÛˆÓ, ›Û˘, ¯ÚÂÈ¿˙ÂÙ·È ÌÂÁ¿ÏË ÂÌÂÈÚ›· fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÌÂÛÔÎÔÏÈ΋˜, ηıÒ˜ ¿ÏÏÔÙ “·Ó·Î·Ï‡ÙÔÓÙ·È” ÌÂÛÔÎÔÏÈΤ˜ Ô˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏÔÙ ‰È·Ê‡ÁÔ˘Ó ˘·ÚÎÙ¤˜. ∆Ô ÌfiÓÔ Â‡ÚËÌ· Ô˘ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È¿ÁÓˆÛË Â›Ó·È Ë ‰È¿Ù·ÛË ÙˆÓ ‰ÂÍÈÒÓ Î·Ú‰È·ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ (5-7). ªÂÙ¿ ·fi ÙË ‰È¿ÁÓˆÛË Û˘Ó‹ıˆ˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ‰˘Û¿ÚÂÛÙ˜ ηٷÛÙ¿ÛÂȘ, fiÙ·Ó ÂÓËÌÂÚˆıÔ‡Ó ÔÈ ÁÔÓ›˜ fiÙÈ ÙÔ ÌÈÎÚfi ·È‰› ÙÔ˘˜ ¤¯ÂÈ Ì›· ¿ıËÛË ·fi ÙË Á¤ÓÓËÛË, Ë ÔÔ›· ¯ÚÂÈ¿˙ÂÙ·È ÂÂÌ‚·ÙÈ΋ “ÔÌڤϷ” (8-13) ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË (14-17). ∂¿Ó ÏËÊı› ˘’ fi„ÈÓ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ‰Â˘ÙÂÚÔÁÂÓ¤˜ ¤ÏÏÂÈÌÌ· (Ostium secundum) Â›Ó·È Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, ¶·È‰È·ÙÚÈ΋ 2005;68:301-306
ÙfiÙ Á›ÓÂÙ·È Â˘ÎÔÏfiÙÂÚ· ·ÓÙÈÏËÙ‹ Ë ¤ÎÙ·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜.
‚) ªÈÎÚÔ‡ ‚·ıÌÔ‡ ÈÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, Ë ·Ú·Ï¿ÓËÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ Ô ÛÊ˘ÁÌfi˜ ÛÙȘ ÌËÚÈ·›Â˜ ·ÚÙËڛ˜ Â›Ó·È „ËÏ·ÊËÙfi˜, fï˜ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ·fi ÙÔÓ ÎÂÚÎȉÈÎfi ÛÊ˘ÁÌfi, Ô ÔÔ›Ô˜ Â›Ó·È ÂÓÙÔÓfiÙÂÚÔ˜. ™ÙË Ì¤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·Ú·ÙËÚÂ›Ù·È Ì›· ÂÏ·ÊÚ¿ ¿ÓÔ‰Ô˜, Ë ÔÔ›· fï˜ Â›Ó·È Ôχ ÏÔÁÈÎfi Ó· ·Ô‰Ôı› ÛÙËÓ ·ÓËÛ˘¯›·, ÙÔ ¿Á¯Ô˜ Î·È ÙÔÓ ÂÎÓ¢ÚÈÛÌfi ÙÔ˘ ·È‰ÈÔ‡. ¢ÂÓ ˘¿Ú¯Ô˘Ó ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Î·È Ë ·Ó¿Ù˘ÍË ‰ÂÓ ÂËÚ¿˙ÂÙ·È. øÛÙfiÛÔ, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ Â¿Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛÙ› Ë ¿ıËÛË, Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ı· ηٷϋÍÂÈ Û ˘ÂÚÙ·ÛÈÎfi ÂÓ‹ÏÈη (1822). Ÿˆ˜ Â›Ó·È Â˘ÓfiËÙÔ Î·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, fiÙ·Ó ÁÓˆÛÙÔÔÈËı› ÛÙÔ˘˜ ÁÔÓ›˜ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Ô˘ ı· Ú¤ÂÈ ÂӉ¯Ô̤ӈ˜ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ÂÂÌ‚·ÙÈο (23-26) ‹ ¯ÂÈÚÔ˘ÚÁÈο (2730), Ë ÔÔÈ·‰‹ÔÙ ·ÓÙ›‰Ú·ÛË ‰ÂÓ Â›Ó·È ·‰ÈηÈÔÏfiÁËÙË (31-35). Á) ◊Ș ÌÔÚʤ˜ Ôχ Û˘¯ÓÒÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ i) ªÈÎÚÔ‡ ‚·ıÌÔ‡ ‚·Ï‚ȉÈ΋-˘Ô‚·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜, ‰›Ù˘¯Ë ·ÔÚÙÈ΋ ‚·Ï‚›‰· ∞ÎfiÌ· Î·È ÛÙȘ ‹È˜ ÌÔÚʤ˜, ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‰ÂÓ Â›Ó·È ÔÙ¤ ·Î›Ó‰˘Ó˜, ΢ڛˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ¿ÛÎËÛ˘-¿ıÏËÛ˘-ÚˆÙ·ıÏËÙÈÛÌÔ‡. £· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ¿ÓÙ· ˘’ fi„ÈÓ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ ·ÔÙÂÏ› Ì›· ·fi ÙȘ ΢ÚÈfiÙÂÚ˜ ·Èٛ˜ ı·Ó¿ÙÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∏ ÂÛÊ·Ï̤ÓË ÂÓÙ‡ˆÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÏϤ˜ ÊÔÚ¤˜ ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÚÔÌÔ›ˆÛË ÙÔ˘ Ê˘Û‹Ì·ÙÔ˜ Ì ÊÏ‚ÈÎfi ‚fiÌ‚Ô (36-39). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ‰›Ù˘¯Ë˜ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜, Ë Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË Â›Ó·È ¿ÓÙ· ÛÎfiÈÌË (40). ii) ªÈÎÚÔ‡ ‚·ıÌÔ‡ ‚·Ï‚ȉÈ΋-˘Ô‚·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ∏ ‰È¿ÁÓˆÛË Î·È Ë ÏÂÙÔÌÂÚ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Û ·˘Ù‹ ÙË Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Â›Ó·È ··Ú·›ÙËÙË, ‰ÈfiÙÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Ë ÌÈÎÚ‹ ÎÏ›ÛË ›ÂÛ˘ ÌÔÚ› Ó· ·˘ÍËı›, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ··Ú·›ÙËÙË Ë ÂÂÌ‚·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ì ‚·Ï‚ȉÔÏ·ÛÙÈ΋ Ì ̷ÏfiÓÈ (41-44).
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∫·Ú‰ÈÔÏÔÁÈÎÔ› ΛӉ˘ÓÔÈ ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË
iii) ªÈÎÚ‹ ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, ÌÈÎÚfi˜ ·ÓÔȯÙfi˜ ·ÚÙËÚÈ·Îfi˜ fiÚÔ˜ ™ÙȘ ·ı‹ÛÂȘ ·˘Ù¤˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ΛӉ˘ÓÔÈ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡, fï˜ ÂÏÏԯ‡ÂÈ ¿ÓÙ· Ô Î›Ó‰˘ÓÔ˜ Ù˘ ÂÓ‰Ôηډ›Ùȉ·˜. ∆· Ê˘Û‹Ì·Ù· Â›Ó·È ‹È·, ‰ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù· Î·È Â›Ó·È Â‡ÎÔÏÔ Ó· ıˆÚËıÔ‡Ó ÏÂÈÙÔ˘ÚÁÈο. ∏ ÁÓÒÛË ÙÔ˘ ··Ú·›ÙËÙÔ˘ Ù˘ ¯ËÌÂÈÔÚÔʇϷ͢ Û ÔÔÈ·‰‹ÔÙ ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ‹ ·ÈÌ·ÙËÚ‹ Ô‰ÔÓÙÈ΋ ÂÚÁ·Û›· Â›Ó·È Î¿ÙÈ Ô˘ ÔÈ ÁÔÓ›˜ Ú¤ÂÈ ÔˆÛ‰‹ÔÙ ӷ ÌË ÏËÛÌÔÓÔ‡Ó (45-48). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙË ÌÂÏÏÔÓÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ·›˙Ô˘Ó ÔÈ ·fi„ÂȘ ÙÔ˘ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚÔ‡, ηıÒ˜ Î·È ·˘Ù¤˜ Ù˘ ‰ÈÂıÓÔ‡˜ ·È‰ÔηډÈÔÏÔÁÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ (49-52). iv) ¶ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ ∏ ‰È¿ÁÓˆÛË ·˘Ù‹˜ Ù˘ ¿ıËÛ˘ ‚Ú›ÛÎÂÙ·È Û “·ÌÊÔÙÂÚ›˙Ô˘Û·” ηٿÛÙ·ÛË. ÕÏÏÔÙ ‰È·Ê‡ÁÂÈ Î·È ¿ÏÏÔÙ ˘ÂډȷÁÈÁÓÒÛÎÂÙ·È (Ë ˘ÂډȿÁÓˆÛË Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚË). ¶·Ú’ fiÏ· ·˘Ù¿, ÛÙËÓ ÂÚ›ÙˆÛË ‡·Ú͢ Ú·ÁÌ·ÙÈ΋˜ ÚfiÙˆÛ˘ ¯ÚÂÈ¿˙ÂÙ·È Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË Î·È ¯ËÌÂÈÔÚÔʇϷÍË. ‰) ª˘ÔηډÈÔ¿ıÂȘ ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë Û˘ÌÊÔÚËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È ¿ÏϘ ÌÔÚʤ˜ ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ·ı‹ÛÂˆÓ ‡„ÈÛÙÔ˘ ÎÈÓ‰‡ÓÔ˘. ™ÙȘ ÂÚÈÙÒÛÂȘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ¯ˆÚ›˜ ÛÙ¤ÓˆÛË ·Ú’ fiÏË ÙËÓ ˘ÂÚÙÚÔÊ›· Î·È ÙËÓ - Û ¿ÏÏÔÙ ¿ÏÏÔ ‚·ıÌfi - ·ÚÂÌfi‰ÈÛË Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Û˘Ó‹ıˆ˜ ‰ÂÓ ˘¿Ú¯ÂÈ Ê‡ÛËÌ·. ∞ÓÙ›ıÂÙ·, ÛÙȘ ÂÚÈÙÒÛÂȘ Ì ‹È· ÛÙ¤ÓˆÛË ˘¿Ú¯ÂÈ ¤Ó· ‹ÈÔ Ê‡ÛËÌ·, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ. ™ÙȘ ‚·Ú‡ÙÂÚ˜ ÂÚÈÙÒÛÂȘ Û˘Ó‹ıˆ˜ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ¤ÁηÈÚ·. ™ÙȘ ‹È˜ ÌÔÚʤ˜ Ù˘ ¿ıËÛ˘, ·Ú’ fiÏÔ Ô˘ fiˆ˜ ·Ó·Ê¤ÚıËΠ‰ÂÓ ˘¿Ú¯Ô˘Ó ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ‹ Û˘ÌÙÒÌ·Ù· Û ËÚÂÌ›·, ηٿ ÙË ‰È¿ÚÎÂÈ· ¿ÛÎËÛ˘-·ıÏËÙÈÛÌÔ‡ÚˆÙ·ıÏËÙÈÛÌÔ‡ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÔÈ Ôԛ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔηϤÛÔ˘Ó Ôχ ÂÈΛӉ˘Ó˜ ηٷÛÙ¿ÛÂȘ (53-57). ¢ÂÓ Ú¤ÂÈ Ó· ͯӿÌ fiÙÈ ·ÔÙÂÏÔ‡Ó Ì›· ·fi ÙȘ ΢ÚÈfiÙÂÚ˜ ·Èٛ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ÁÈ’ ·˘Ùfi Î·È Î¿ı ·È‰› Ô˘ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙÔ Û˘ÓËıÈṲ̂ÓÔ ÚfiÁÚ·ÌÌ· Á˘ÌÓ·ÛÙÈ΋˜ ÙÔ˘ Û¯ÔÏ›Ԣ, ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Ï‹Úˆ˜ ·fi ·È‰ÔηډÈÔÏfiÁÔ. ∏ ‰È¿ÁÓˆÛË Ù˘ ˘ÂÚ-
ÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, ηıÒ˜ Î·È ÙˆÓ ˘fiÏÔÈˆÓ Û·ÓÈfiÙÂÚˆÓ ÌÔÚÊÒÓ, Â›Ó·È Û¯ÂÙÈο ‡ÎÔÏË ÙfiÛÔ Ì ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· fiÛÔ Î·È Ì ÙÔ˘˜ ˘ÂÚ‹¯Ô˘˜. ∫¿ı ·È‰› Ô˘ ·Ú·ÔÓÂ›Ù·È ÁÈ· ÚÔοډȷ ¿ÏÁË ‹ ÂÂÈÛfi‰ÈÔ ·ÒÏÂÈ·˜ Û˘Ó›‰ËÛ˘ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Î·È ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· Ì˘ÔηډÈÔ¿ıÂÈ·˜. ∆Ô ÈÛÙÔÚÈÎfi ‡·Ú͢ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‹ ÌÂÏÒÓ ÌÂ Ì˘ÔηډÈÔ¿ıÂÈ· ‰ËÌÈÔ˘ÚÁ› ·Ó¿ÁÎË ¿ÌÂÛÔ˘ Î·È Ï‹ÚÔ˘˜ ÂϤÁ¯Ô˘ (58-61).
Â) ¢È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡ ∆Ô Û‡Ó‰ÚÔÌÔ Wolf-Parkinson-White, ÙÔ Û‡Ó‰ÚÔÌÔ Ì·ÎÚÔ‡ Q-T, ÔÈ ·ÔÎÏÂÈÛÌÔ›, Ë ·ÚÔ͢ÛÌÈ΋ Ù·¯˘Î·Ú‰›· Î·È Ë ÂÎÙ·ÎÙÔÛ˘ÛÙÔÏÈ΋ ·ÚÚ˘ıÌ›· Â›Ó·È ·ı‹ÛÂȘ Ô˘ ·ÔÙÂÏÔ‡Ó Â›Û˘ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ·È‰È·ÙÚÈ΋ ηıËÌÂÚÈÓfiÙËÙ·. OÈ ÚÒÙ˜ ÙÚÂȘ ÂÚÈÙÒÛÂȘ Â›Ó·È ·‰‡Ó·ÙÔ Ó· ‰È·ÁÓˆÛÙÔ‡Ó Â¿Ó ‰ÂÓ ˘¿ÚÍÔ˘Ó Û˘ÌÙÒÌ·Ù·. ŒÙÛÈ, ÔÈ Î›Ó‰˘ÓÔÈ Â›Ó·È ¿ÓÙ· ˘·ÚÎÙÔ› Î·È ÙÔ Úfi‚ÏËÌ· ÌÔÚ› Ó· Á›ÓÂÈ Ê·ÓÂÚfi ÌfiÓÔ Û ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô (62-67). OÈ Î›Ó‰˘ÓÔÈ ·˘ÙÔ› Â›Ó·È ·Â›Úˆ˜ ÌÂÁ·Ï‡ÙÂÚÔÈ ÛÙ· ·È‰È¿ ÌÂÙ¿ ·fi ηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË, fï˜ Û˘Ó‹ıˆ˜ ·˘Ù¿ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÂÈÌÂÏË̤ӷ Î·È Ù· ÚÔ‚Ï‹Ì·Ù¿ ÙÔ˘˜ ÔÊ›ÏÔÓÙ·È fi¯È ÛÙËÓ ·‰˘Ó·Ì›· ‰È¿ÁÓˆÛ˘, ·ÏÏ¿ ÛÙË ‰˘ÛÎÔÏ›· ·ÓÙÈÌÂÙÒÈÛ˘. ∏ ·ÚÔ͢ÛÌÈ΋ Ù·¯˘Î·Ú‰›· Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ ·fi ÙÔ ›‰ÈÔ ÙÔ ·È‰› (οÙÈ Ô˘ ÙÚ¤¯ÂÈ ÛÙÔ ÛÙ‹ıÔ˜, ÊÙÂÚÔ‡ÁÈÛÌ· Î.Ï.) ‹ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÂ Ù˘¯·›· „ËÏ¿ÊËÛË. ∂Âȉ‹ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÚÔ͢ÛÌÈ΋ Ù·¯˘Î·Ú‰›· ‰ÂÓ ¤¯ÂÈ ÔÚÁ·ÓÈÎfi ˘fiÛÙڈ̷ Î·È ‰ÂÓ ˘Ê›ÛÙ·Ù·È ·fi ÙË Á¤ÓÓËÛË, ‰ÂÓ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÛÙÔ˘˜ ÁÔÓ›˜ ·›ÛıËÛË ·Ú·Ì¤ÏËÛ˘ ÂΠ̤ÚÔ˘˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘. øÛÙfiÛÔ, fiÙ·Ó Á›ÓÂÈ ·ÓÙÈÏËÙfi fiÙÈ ÙÔ 1/3 ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÔÊ›ÏÂÙ·È Û ÈÒÛÂȘ Î·È Î·Ù·ÓÔËı› ÙÔ Â›ÎÙËÙÔ Ù˘ ¿ıËÛ˘, ·Ô‰¤¯ÔÓÙ·È Â˘ÎÔÏfiÙÂÚ· ÙËÓ Î·Ù¿ÛÙ·ÛË. OÈ ÂÚÈÙÒÛÂȘ Ô˘ Ë ·ÚÔ͢ÛÌÈ΋ Ù·¯˘Î·Ú‰›· ÔÊ›ÏÂÙ·È Û ÔÚÁ·ÓÈÎfi ˘fiÛÙڈ̷, ˘¿ÁÔÓÙ·È Û ¿ÏϘ ηÙËÁÔڛ˜ Ô˘ ‹‰Ë ·Ó·Ê¤ÚıËÎ·Ó ÂÈÁÚ·ÌÌ·ÙÈο, ÂÓÒ Ë ÁÂÓÈÎfiÙÂÚË ÂÚÈÁÚ·Ê‹ Ù˘ ÍÂÂÚÓ¿ÂÈ Ù· fiÚÈ· ÙÔ˘ ·ÚfiÓÙÔ˜ ¿ÚıÚÔ˘. ∏ ÂÎÙ·ÎÙÔÛ˘ÛÙÔÏÈ΋ ·ÚÚ˘ıÌ›· Á›ÓÂÙ·È Â›Û˘ Ôχ Û˘¯Ó¿ ·ÓÙÈÏËÙ‹ ·fi ÙÔ ·È‰› ‹ ÙÔ˘˜ ÁÔÓ›˜ (¤ÓÙÔÓ· ¯Ù˘‹Ì·Ù·). O ¤ÏÂÁ¯Ô˜ ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ Ì ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, ÙÔ 24ˆÚÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· (Holter) Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·È Û fiϘ ¶·È‰È·ÙÚÈ΋ 2005;68:301-306
Pediatr July-Aug 05 new
22-07-05
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ÙȘ ¿ÏϘ ÂÚÈÙÒÛÂȘ ·ÚÚ˘ıÌ›·˜, Èı·Ófiٷٷ ı· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË (68-70). ∆· ÂÂÈÛfi‰È· ·ÒÏÂÈ·˜ Û˘Ó›‰ËÛ˘ Î·È Ë ˙¿ÏË, Ô˘ ·ÔÙÂÏÔ‡Ó Â›Û˘ Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Û ÛÔ‚·Ú¿ ·›ÙÈ· (οÔÈ· ·fi ÙȘ ηÙËÁÔڛ˜ Ô˘ ÚԷӷʤÚıËηÓ), Û˘Ó‹ıˆ˜ ÂϤÁ¯ÔÓÙ·È ·fi ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ÂÈÌÂÏÒ˜ Î·È ¤ÙÛÈ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù·. ∂Í¿ÏÏÔ˘, ÛÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙËÚÂ›Ù·È ÙÔ ·Í›ˆÌ· ÙÔ˘ ÂϤÁ¯Ô˘ οı ·È‰ÈÔ‡ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ó·›ÙÈ· ÂÂÈÛfi‰ÈÔ ·ÒÏÂÈ·˜ Û˘Ó›‰ËÛ˘.
¶ÈÛÙÔÔÈËÙÈο ∞ÎfiÌË Î·È Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ ·ÏÔ‡ ÈÛÙÔÔÈËÙÈÎÔ‡ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ·ÈÙ›· ÛÔ‚·ÚÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ, ÙfiÛÔ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ fiÛÔ Î·È ÁÈ· ÙËÓ ÂÈÛÙËÌÔÓÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ÔÚ›· ÂÓfi˜ ·È‰È¿ÙÚÔ˘, ÁÈ’ ·˘Ùfi Î·È Ú¤ÂÈ ¿ÓÙ· Ó· ¯ÔÚËÁÂ›Ù·È Î¿Ùˆ ·fi ÔÚÈṲ̂Ó˜ ··Ú¿‚·Ù˜ ÚÔ¸Ôı¤ÛÂȘ. ∏ ËÌÂÚÔÌËÓ›· Î·È Ë ·Ó·ÊÔÚ¿ ÛÙË “ÛËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ ÂͤٷÛË” ÌÔÚÔ‡Ó Ó· ··ÏÏ¿ÍÔ˘Ó ·fi ·ÚÎÂÙ¤˜ ‰˘Û¿ÚÂÛÙ˜ Û˘Ó¤ÂȘ. °È· ÌÂÁ·Ï‡ÙÂÚË ·ÛÊ¿ÏÂÈ·, οı ·È‰› Ô˘ ı· ·Û¯ÔÏËı› ÛÔ‚·Ú¿ Ì ÙÔÓ ·ıÏËÙÈÛÌfi-ÚˆÙ·ıÏËÙÈÛÌfi, ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ·fi ·È‰ÔηډÈÔÏfiÁÔ Ì ˘Â‡ı˘ÓË Î·È ÔÏÔÎÏËڈ̤ÓË ·È‰ÔηډÈÔÏÔÁÈ΋ ÂͤٷÛË Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÎÏÈÓÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ‹ fiÔÈ· ¿ÏÏË ÂͤٷÛË ÎÚÈı› ··Ú·›ÙËÙË (·ÎÙÈÓÔÁÚ·Ê›· ÙËÏÂηډ›·˜, ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘, 24ˆÚÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·-Holter). ∏ ·Ú·ÔÌ‹ ÌfiÓÔ ÁÈ· ¤Ó· ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Ô˘ ˙ËÙÂ›Ù·È Û˘¯Ó¿ ·fi ÔÚÈṲ̂ÓÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ‰ÂÓ Â›Ó·È Î·ıfiÏÔ˘ ·ÛÊ·Ï‹˜ Ù·ÎÙÈ΋, ȉȷ›ÙÂÚ· ‰Â fiÙ·Ó ·˘Ùfi Á›ÓÂÙ·È Û οÔÈÔ - fi¯È ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÁÈ· ·È‰È¿ - ‰È·ÁÓˆÛÙÈÎfi ΤÓÙÚÔ ‹ ·fi ηډÈÔÏfiÁÔ ÂÓËϛΈÓ. £· Ú¤ÂÈ, ‚¤‚·È·, Ó· Ï·Ì‚¿ÓÂÙ·È ¿ÓÙ· ˘’ fi„ÈÓ fiÙÈ ÙÔ ¤Á¯ÚˆÌÔ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ‰ÂÓ ·ÚΛ ÁÈ· ÙË ‰È¿ÁÓˆÛË, fiˆ˜ ‰ÂÓ ·ÚΛ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÁÈ· ÙË ‰È¿ÁÓˆÛË ÂÓfi˜ ·È‰È·ÙÚÈÎÔ‡ ·Ó·Ó¢ÛÙÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜.
™˘ÌÂÚ¿ÛÌ·Ù· ∞fi fiÛ· ·Ó·Ê¤ÚıËÎ·Ó Á›ÓÂÙ·È Ê·ÓÂÚfi fiÙÈ ÔÈ Î·Ú‰ÈÔÏÔÁÈÎÔ› ΛӉ˘ÓÔÈ Ô˘ ÛÔ‚Ô‡Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ Ú¿ÍË Â›Ó·È ÔÏÏÔ›. ¶·È‰È·ÙÚÈ΋ 2005;68:301-306
O ·È‰›·ÙÚÔ˜, ¿ÏÏÔÙ ‰ÈηÈÔÏÔÁË̤ӷ Î·È ¿ÏÏÔÙ fi¯È, ÌÔÚ› Ó· ‚ÚÂı› Û ‰‡ÛÎÔÏË ı¤ÛË ÏfiÁˆ ηı˘ÛÙÂÚË̤Ó˘ ‹ Ï·Óı·Ṳ̂Ó˘ ‰È¿ÁÓˆÛ˘. °È· ÙËÓ ·ÔÛfi‚ËÛË fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ, Ô ÛˆÛÙfi˜ ¤ÏÂÁ¯Ô˜ Û οı ·È‰› Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ¤Ó· ‡ÔÙÔ Ê‡ÛËÌ·, ¤ÛÙˆ Î·È ·Ó ·˘Ùfi ÌÔÈ¿˙ÂÈ Ì ÏÂÈÙÔ˘ÚÁÈÎfi, Â›Ó·È ··Ú·›ÙËÙÔ˜. ∂Í›ÛÔ˘ ··Ú·›ÙËÙÔ˜ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ Î·È Û οı ·È‰› Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈÔ Û‡Ìو̷ ‹ ·Ú·ÔÓÂ›Ù·È ÁÈ· ÊÙÂÚÔ‡ÁÈÛÌ· ÛÙËÓ Î·Ú‰È¿, ¤ÓÙÔÓÔ˘˜ ÎÙ‡Ô˘˜, fiÓÔ ÛÙÔ ÛÙ‹ıÔ˜, ˙¿ÏË Î.Ï. ∆¤ÏÔ˜, ÛÙȘ ÂÚÈÙÒÛÂȘ ¿ıÏËÛ˘-ÚˆÙ·ıÏËÙÈÛÌÔ‡ ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÈÛÙÔÔÈËÙÈÎÒÓ, ·ÎfiÌË Î·È ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙÔ ·ÙÔÌÈÎfi ‹ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi οÙÈ ·ıÔÏÔÁÈÎfi, Â›Ó·È Ôχ ·ÛʷϤÛÙÂÚÔ Ó· Á›ÓÂÙ·È ¤Ó·˜ ÚÔÏËÙÈÎfi˜ ·È‰ÔηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∫·ıÒ˜ Ë È·ÙÚÈ΋ Â›Ó·È Ì›· ‰‡ÛÎÔÏË ÂÈÛÙ‹ÌË Î·È Ë Î·ÚȤڷ ÔÈÎÔ‰ÔÌÂ›Ù·È Ì ÌÂÁ¿Ï˜ ÚÔÛ¿ıÂȘ, Â›Ó·È ¿‰ÈÎÔ ·‰ÈηÈÔÏfiÁËÙ· ¯¿ÚÈÓ “·Ó‰Ú·Á·ı‹Ì·ÙÔ˜” - Ó· ÚÈ„ÔÎÈÓ‰˘Ó‡ԢÌÂ.
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Cardiac dangers in paediatric practice S. Antoniadis
Abstract The early diagnosis of congenital heart disease, rhythm disturbances and other cardiovascular malformations, starts with the basic paediatric clinical examination. The referral of the patient to a paediatric cardiologist because of a murmur or other suspicious findings is the universal usual practice for the timely diagnosis and subsequent appropriate management of heart problems in childhood. Conversely, the estimation by the paediatrician that the murmur is innocent because it is mild in intensity, the child’s general situation is good, there are no signs or symptoms and there is good exercise tolerance and growth, could result in serious trouble. Cardiac malformations such as atrial septal defect, mild coarctation of the aorta or other forms of mild congenital heart disease are usual pitfalls that can cause severe risk, even for the small patient’s life (through endocarditis). Whatever the case, for parents to see that the findings in their child, that for 5-10 years were thought to be benign, are in fact not, but on the contrary are indications of congenital heart disease, causes them great dissatisfaction. The situation becomes even worse when there is need for open heart surgery. When the dangers from conditions such as rhythm disturbances or hypertrophic cardiomyopathy without left ventricular obstruction, which gives no clinical signs, are added to the list, the severity of the situation can be easily appreciated. Lastly but not least, the signature on any certificate for participation in competitive sports can also give rise to danger if it is given in the absence of a proper check-up. The recent unfortunate events involving cardiac complications in certain children clearly show the importance of the timing of this review.
Paediatric Cardiologist Professor of the Highest Technological Educational Institution of Athens Correspondence: Stilianos Antoniadis 4 Irakleitou Str., Kolonaki 106 73, Athens E-mail: prdrsant@otenet.gr Date of submission: 26-08-2003 Date of approval: 27-04-2005
Key words Cardiac pitfalls, paediatric practice.
Paediatriki 2005;68:307
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O ¤ÊË‚Ô˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ª. §È·ÎÔÔ‡ÏÔ˘1, ∂. ¶Ï·ÙÔÎÔ‡ÎË - ∫ÔÌÈÙÔÔ‡ÏÔ˘2, Ã. ∫·Ó·Î¿ - Gantenbein3, ∆. ∞ÏÈÊÈÂÚ¿ÎË1, ª. ∫Ô˘ÙÛ·Ó¤ÏÏÔ˘ - ªeyer2, £. ∫Ô‚¿Ó˘4 1 ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰Ô„˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ªÔÓ¿‰· ∞ÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛˆÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ∞’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ªÔÓ¿‰·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 4 ¡Â˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ª¿Á‰· §È·ÎÔÔ‡ÏÔ˘ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰Ô„˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∆.∫. 115 27, °Ô˘‰› ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-11-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 07-06-2005
¶ÂÚ›ÏË„Ë ∏ ÂÊ˂›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙË ‰È·‰Èηۛ· ·ÓÂÍ·ÚÙËÙÔÔ›ËÛ˘. øÛÙfiÛÔ, ÁÈ· ÙÔÓ ¤ÊË‚Ô Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ·, ÙfiÛÔ Ë ›‰È· Ë ·Ûı¤ÓÂÈ· fiÛÔ Î·È Ô Â·˘Ùfi˜ ÙÔ˘ ·ÏÏ¿ Î·È ÔÈ ÁÔÓ›˜ Ì ÙËÓ ˘ÂÚÚÔÛÙ·Û›· ÙÔ˘˜ ·ÔÙÂÏÔ‡Ó ÙÚÔ¯Ô¤‰Ë ÁÈ· ÙË ‰È·‰Èηۛ· ·˘Ù‹. ∂ÈϤÔÓ, Ë ÛÂÍÔ˘·ÏÈÎfiÙËÙ¿ ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁ› ¿Á¯Ô˜, ÙÔ ÔÔ›Ô Ô ÂȉÈÎfi˜ - Ì ÙË ÁÓÒÛË Î·È ÙȘ Û˘Ì‚Ô˘Ï¤˜ ÙÔ˘ - ÌÔÚ› Ó· ÌÂÈÒÛÂÈ. ª›· ÂÈÙ˘¯Ë̤ÓË ıÂڷ¢ÙÈ΋ ÂÈÏÔÁ‹, Ô˘ ‚ÔËı¿ ÙÔ˘˜ ÁÔÓ›˜ Î·È ÂÌ̤ۈ˜ ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ·ÔÙÂÏÔ‡Ó ÔÈ ÔÌ¿‰Â˜ ˘ÔÛÙ‹ÚÈ͢ ÁÔÓ¤ˆÓ, fiÔ˘ Á›ÓÂÙ·È ÂÂÍÂÚÁ·Û›· ‰È·ÊfiÚˆÓ ıÂÌ¿ÙˆÓ, fiˆ˜ Ë ÂÓÔ¯‹ ÙˆÓ ÌËÙ¤ÚˆÓ, Ë ˘ÂÚÚÔÛÙ·Û›· ÙˆÓ ÁÔÓ¤ˆÓ Î·È Ë ‰È¢ÎfiÏ˘ÓÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ÛÙfi¯ˆÓ ÙˆÓ ·È‰ÈÒÓ. OÈ ¤ÊË‚ÔÈ Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ‰È·ı¤ÛÂȘ ·ÔÎÚ‡ÙÔ˘Ó ·ÈÌÔÚÚ·ÁÈο ÂÂÈÛfi‰È· ÏfiÁˆ Ù˘ Ù¿Û˘ ÁÈ· ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË. OÈ ·ÈÌÔÚÚ·Á›Â˜ Û ÂÚÈÔ¯¤˜ fiˆ˜ Ù· ÁÂÓÓËÙÈο fiÚÁ·Ó·, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÈÚfiÛıÂÙÔ ¿Á¯Ô˜. OÈ ÁÔÓ›˜ ÙÔ˘˜ Ì·ı·›ÓÔ˘Ó Ó· ¯ÂÈÚ›˙ÔÓÙ·È Î·Ï‡ÙÂÚ· ÙȘ ·ÓÙȉڿÛÂȘ ÙÔ˘˜ ̤۷ ·fi ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙËÓ ÔÌ¿‰· ÁÔÓ¤ˆÓ. ∏ ΢ÛÙÈ΋ ›ÓˆÛË Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ÁÂÓÂÙÈÎfi ÓfiÛËÌ· ÛÙË Ï¢΋ Ê˘Ï‹ Ì η΋ ÚfiÁÓˆÛË. OÈ ¤ÊË‚ÔÈ Ô˘ ¿Û¯Ô˘Ó ·fi ·˘Ù‹, ¯ÚÂÈ¿˙ÔÓÙ·È ˘ÔÛÙ‹ÚÈÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜ ÁÈ· ÙËÓ Â›Ù¢ÍË Ì›·˜ ηχÙÂÚ˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π (™¢) ·˘Í¿ÓÂÙ·È Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô. ∆· ÎÔÚ›ÙÛÈ· Ì ™¢ ·ÔÚÚ˘ıÌ›˙ÔÓÙ·È ÈÔ Û˘¯Ó¿ ηٿ ÙËÓ ÂÊ˂›·, ÂÓÒ fiÙ·Ó ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ù¿ıÏÈ„Ë ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·. ∏ „˘¯Ô·ıÔÏÔÁ›· Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ™¢ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÌËÙÚÈ΋ ηٿıÏÈ„Ë Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηٿıÏÈ„Ë ÛÙÔÓ ¤ÊË‚Ô Ì ™¢. OÚÈṲ̂ӷ ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ·, fiˆ˜ ÔÈ ·Ê·ÈÚ¤ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÂÍ·Ê·Ó›˙ÔÓÙ·È ÛÙËÓ ÂÊ˂›·, ÂÓÒ ¿ÏÏ·, fiˆ˜ Ë ÂÈÏË„›· ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡, ·Ú¯›˙Ô˘Ó ÙfiÙÂ. OÈ ¤ÊË‚ÔÈ Ì ÂÈÏË„›· ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ‹È˜ ÎÚ›ÛÂȘ ‰ÈfiÙÈ ÊÔ‚Ô‡ÓÙ·È Ù˘¯fiÓ ·‡ÍËÛË Ù˘ ‰ÔÛÔÏÔÁ›·˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÙÔ˘˜. OÈ ¤ÊË‚ÔÈ ·˘ÙÔ› ¯ÚÂÈ¿˙ÔÓÙ·È Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ·ÔηٿÛÙ·Û‹ ÙÔ˘˜. O ÁÈ·ÙÚfi˜ Ô˘ ı· Û˘Ì‚Ô˘Ï‡ÛÂÈ ÙÔÓ ¤ÊË‚Ô Ì ¯ÚfiÓÈÔ Úfi‚ÏËÌ· Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, ı· Ú¤ÂÈ Ó· Â›Ó·È ÁÓÒÛÙ˘ ÙÔ˘ È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÂÓÂÚÁ¿ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙÔ˘ Î·È ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ÙÔ˘ ·ÔηٿÛÙ·ÛË. §¤ÍÂȘ ÎÏÂȉȿ ∂Ê˂›·, ·ÈÌÔÚÚ·ÁÈΤ˜ ‰È·ı¤ÛÂȘ, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ÂÈÏË„›·.
∆Ô °Ú·Ùfi ™˘ÌfiÛÈÔ ·ÚÔ˘ÛÈ¿ÛÙËΠˆ˜ ™ÙÚÔÁÁ˘Ïfi ∆Ú·¤˙È ÛÙÔ 3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Ù˘ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ∂ÏÏ¿‰Ô˜, ∞ı‹Ó·, 8-11/5/2003. ™˘ÓÙÔÓ›ÛÙÚÈ· ÙÔ˘ ™ÙÚÔÁÁ˘ÏÔ‡ ∆Ú·Â˙ÈÔ‡: ª¿Á‰· §È·ÎÔÔ‡ÏÔ˘, ¶·È‰Ô„˘¯›·ÙÚÔ˜-æ˘¯›·ÙÚÔ˜, ∞Ó·ÏËÚÒÙÚÈ· ¢È¢ı‡ÓÙÚÈ· ∂™À, ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰Ô„˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”. ∂ÈÌÂÏ‹ÙÚÈ· °Ú·ÙÔ‡ ™˘ÌÔÛ›Ô˘: ª¿Á‰· §È·ÎÔÔ‡ÏÔ˘. ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
∂ÈÛ·ÁˆÁ‹ ª. §È·ÎÔÔ‡ÏÔ˘ ∆Ô 5-10% ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ˘ÔʤÚÂÈ ·fi ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· (1). ∆Ô ·È‰› ‹ Ô ¤ÊË‚Ô˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· Ú¤ÂÈ Ó· ÚÔÛ·ÚÌÔÛÙ› ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÛÙȘ ··ÈÙ‹ÛÂȘ Ù˘ ·Ûı¤ÓÂÈ·˜, ·ÏÏ¿ Î·È ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·Ó·Ù˘ÍÈ·ÎÔ‡ ÛÙ·‰›Ô˘ ÛÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È. ∏ ·Ó¿Ù˘ÍË Î·È Ë ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· ÂȉÚÔ‡Ó
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Ë Ì›· ÛÙËÓ ¿ÏÏË Ì ·ÌÔÈ‚·›Ô ÙÚfiÔ. ∆· ÌÈÎÚ¿ ·È‰È¿ ÂËÚ¿˙ÔÓÙ·È ÛÙËÓ ·Î·‰ËÌ·˚΋ ÙÔ˘˜ ÂͤÏÈÍË (2), ÂÓÒ Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· Ì ÙËÓ ÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹ (3). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÂÚ¢ÓËÙ¤˜ Î·È ÎÏÈÓÈÎÔ› ÚÔÙ›ÓÔ˘Ó ÙËÓ ÂÓ‰˘Ó¿ÌˆÛË ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÙÔ˘˜ ÈηÓÔÙ‹ÙˆÓ ˆ˜ ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ˘ ·˘ÙÒÓ ÙˆÓ ‰˘ÛÎÔÏÈÒÓ (4). ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë È‰ÈÔÛ˘ÁÎÚ·Û›· ÙÔ˘ ·È‰ÈÔ‡, ÔÈ Ì˯·ÓÈÛÌÔ› ¿Ì˘Ó·˜ Ô˘ ‰È·ı¤ÙÂÈ, Ë ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, Ë ÚÔÛˆÈÎfiÙËÙ· ÙˆÓ ÁÔÓ¤ˆÓ, Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (4) Î·È Ë ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË ÂËÚ¿˙Ô˘Ó ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ·. ∆Ô Ó·ÚÎÈÛÛÈÛÙÈÎfi ÙÚ·‡Ì· Ì ÙÔ ÔÔ›Ô Â›Ó·È ·ÓÙÈ̤وԘ Ô ¤ÊË‚Ô˜ ÏfiÁˆ Ù˘ ¯ÚfiÓÈ·˜ ·Ûı¤ÓÂÈ·˜, ÙÔÓ Ô‰ËÁ› Û Ì›ˆÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ‹˜ ÙÔ˘ ηÈ, ÌÂÚÈΤ˜ ÊÔÚ¤˜, Û ·Ú·›ÙËÛË ·fi ÙËÓ ÚÔÛ¿ıÂÈ· (5) Î·È Î·Ù¿ıÏÈ„Ë. ™Â ÔÏϤ˜ ¯ÚfiÓȘ ·ı‹ÛÂȘ ·Ú·ÙËÚÂ›Ù·È Ì›· ÂÏÏÈ‹˜ Û˘ÌÌfiÚʈÛË ÚÔ˜ ÙȘ È·ÙÚÈΤ˜ Ô‰ËÁ›Â˜, Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ÚÔÛ¿ıÂÈ· ÙÔ˘ ÂÊ‹‚Ô˘ Ó· ÌËÓ Ê·›ÓÂÙ·È ‰È·ÊÔÚÂÙÈÎfi˜ ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜ (4). Ÿˆ˜ fiÏÔÈ ÔÈ ¤ÊË‚ÔÈ, Ô ¤ÊË‚Ô˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· ÂÈÛ¤Ú¯ÂÙ·È ÛÙË ‰È·‰Èηۛ· ·ÓÂÍ·ÚÙËÙÔÔ›ËÛ˘, Ë ÔÔ›· ÂËÚ¿˙ÂÙ·È ·fi ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚԷӷʤÚıËηÓ. ∫·Ù’ ·˘Ù‹Ó Á›ÓÔÓÙ·È ‚‹Ì·Ù· ÚÔ˜ Ù· ÂÌÚfi˜ Î·È ÚÔ˜ Ù· ›Ûˆ. OÈ ÁÔÓ›˜ Â›Ó·È ¿ÏÏÔÙ ÙÚÔ¯Ô¤‰Ë Î·È ¿ÏÏÔÙ ‚ÔËıÔ› Û ·˘Ù‹ ÙË ‰È·‰Èηۛ·, ÂÓÒ ÔÈ ÁÈ·ÙÚÔ› Î·È fiÛÔÈ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· ÌÔÚÔ‡Ó Ó· Â›Ó·È ·ÚˆÁÔ› fiÙ·Ó ·ÚÂÌ‚·›ÓÔ˘Ó ‰È¢ÎÔχÓÔÓÙ·˜ Î·È ‚ÔËıÒÓÙ·˜. ∆¤ÏÔ˜, Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› Ë È‰È·›ÙÂÚË ÛËÌ·Û›· ÙÔ˘ ı¤Ì·ÙÔ˜ Ù˘ ÛÂÍÔ˘·ÏÈÎfiÙËÙ·˜ ÙˆÓ ÂÊ‹‚ˆÓ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ·. ∆Ô ¿Á¯Ô˜ ·˘ÙÒÓ ÙˆÓ ÂÊ‹‚ˆÓ ËÁ¿˙ÂÈ ·fi ‰‡Ô ÛËÌ›·: ·) ·fi Ù· ۈ̷ÙÈο ÙÔ˘˜ ÚÔ‚Ï‹Ì·Ù· Î·È ‚) ·fi ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ·ÏÏ·Á¤˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ηٿ ÙËÓ ÂÊ˂›· Î·È ÙÔÓ ÙÚfiÔ Ô˘ ÙȘ ·Ô‰¤¯ÔÓÙ·È. OÈ ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÁÔÓÈÌfiÙËÙ· Î·È ÙËÓ ·˘Ù¿ÚÎÂÈ¿ ÙÔ˘˜ ̤۷ Û ̛· Û¯¤ÛË, ÙÔ˘˜ ··Û¯ÔÏÔ‡Ó ÂÛˆÙÂÚÈο Î·È ÂΉËÏÒÓÔÓÙ·È Â͈ÙÂÚÈο. ∂›Ó·È Èı·Ófi Ë ·Ûı¤ÓÂÈ· Î·È Ë ÂÌÌÔÓ‹ Û ·˘Ù‹ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ‰ËÌÈÔ˘ÚÁ›·˜ Û¯¤ÛˆÓ, ηıÒ˜ ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÁÂÓÈο Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ì›· Û¯¤ÛË Î·È Ó· ·ÓÙÂÂͤÏıÔ˘Ó Û ·˘Ù‹ (6). O ÂȉÈÎfi˜, ˆÛÙfiÛÔ, ı· Ú¤ÂÈ Ó· ÚÔÛ·ı‹ÛÂÈ Ó· Ì¿ıÂÈ ·fi ÙÔÓ ¤ÊË‚Ô Ô‡ ‚Ú›ÛÎÂÙ·È Ë ÂͤÏÈÍË Ù˘ ÛÂÍÔ˘·ÏÈÎfiÙËÙ¿˜ ÙÔ˘, ÚÈÓ ÙÔÓ Û˘Ì‚Ô˘Ï‡ÛÂÈ.
™ÙÔ Û˘ÌfiÛÈÔ ·˘Ùfi ·Ó·Ê¤ÚÔÓÙ·È ÂÈÏÂÎÙÈο Ù· „˘¯ÔÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÂÊ‹‚ˆÓ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ·. ∆· ÚÔ‚Ï‹Ì·Ù· Û ·˘Ù¤˜ ÙȘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ¤¯Ô˘Ó ·ÚÎÂÙ¤˜ ÔÌÔÈfiÙËÙ˜ ÌÂٷ͇ ÙÔ˘˜ ηÈ, ·Ó·ÌÊÈÛ‚‹ÙËÙ·, ·Ó¿ÏÔÁ· ÚÔ‚Ï‹Ì·Ù· ÂÌÊ·Ó›˙Ô˘Ó Î·È ¿ÏϘ ηÙËÁÔڛ˜ ÂÊ‹‚ˆÓ Ì ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.
æ˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ÂÊ‹‚Ô˘ Ì ·ÈÌÔÚÚÔÊÈÏ›· Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘ ∂. ¶Ï·ÙÔÎÔ‡ÎË - ∫ÔÌÈÙÔÔ‡ÏÔ˘, ª. ∫Ô˘ÙÛ·Ó¤ÏÏÔ˘ - ª¤ÁÈÂÚ ∏ ·ÈÌÔÚÚÔÊÈÏ›· ∞ ‹ µ Â›Ó·È ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌfiÛÙ·Û˘ Î·È ÔÊ›ÏÂÙ·È Û ·Ó¿ÚÎÂÈ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ VIII ‹ πÃ, ·ÓÙÈÛÙÔ›¯ˆ˜, ÂÓÒ ÚÔηÏÂ›Ù·È ·fi ‰È·Ù·Ú·¯¤˜ ÛÙ· ÁÔÓ›‰È· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÚˆÙ½Ó˜ (FVIII Î·È FIX) (1). OÈ Á˘Ó·›Î˜ Â›Ó·È ·ÏÒ˜ ÊÔÚ›˜ Ù˘ ÓfiÛÔ˘, ÂÓÒ ÔÈ ¿ÚÚÂÓ˜ ¿Û¯Ô˘Ó. ∏ Û˘¯ÓfiÙËÙ· Ì ÙËÓ ÔÔ›· Ë ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ·ÁÎÔÛÌ›ˆ˜ Â›Ó·È 1:5000 ÁÂÓÓ‹ÛÂȘ ·ÁÔÚÈÒÓ. ¶·ÚfiÌÔÈ· Û˘¯ÓfiÙËÙ· ·Ó·Ê¤ÚÂÙ·È Î·È ÁÈ· ÙËÓ ∂ÏÏ¿‰· (2). ∏ ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ ÛÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÓfiÛÔ˘ ¤‰ˆÛ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó·Ù˘¯ıÔ‡Ó Û ·ÈÌÔÚÚÔÊÈÏÈο ·È‰È¿ Û¯‹Ì·Ù· ÚÔÊ˘Ï·ÎÙÈ΋˜ ıÂڷ›·˜ Ì ÛÎÔfi ÙËÓ ·ÔÊ˘Á‹ οı ·ÈÌÔÚÚ·Á›·˜ Û ·ÚıÚÒÛÂȘ (3), ¤ˆ˜ fiÙÔ˘ Ì›· ÂÈÙ˘¯Ë̤ÓË ·ÁˆÁ‹, .¯. ÁÔÓȉȷ΋ ıÂڷ›·, ÂÈÙÚ¤„ÂÈ ÙËÓ ›·ÛË Ù˘ ÓfiÛÔ˘ (4-6). ™ÙËÓ ÂÔ¯‹ Ì·˜, Ô ÛˆÛÙfi˜ ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ·ÈÌÔÚÚÔÊÈÏÈÎÔ‡ ·È‰ÈÔ‡ ‹ ÂÊ‹‚Ô˘ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ Â›Ó·È Ì¤Ûˆ Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜ Ô˘ ·Û¯ÔÏÂ›Ù·È ÛÊ·ÈÚÈο Ì ÙÔÓ ·ÛıÂÓ‹, ·ÔÙÂÏÔ‡ÌÂÓË ·fi ·È‰›·ÙÚÔ/·ÈÌ·ÙÔÏfiÁÔ, ÔÚıԷȉÈÎfi, Ê˘ÛÈÎÔıÂÚ·Â˘Ù‹, Ô‰ÔÓÙ›·ÙÚÔ Î·È ÏÂÈÙÔ˘ÚÁÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜ (7-9). £· Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ë Û˘ÓÂÚÁ·Û›· Ì ·È‰Ô„˘¯›·ÙÚÔ ‹ „˘¯ÔÏfiÁÔ Î·È ÎÔÈÓˆÓÈ΋ ÏÂÈÙÔ˘ÚÁfi Â›Ó·È ÛËÌ·ÓÙÈÎfi ÛÙ‹ÚÈÁÌ· ÁÈ· ÙÔÓ ÂȉÈÎfi ·È‰›·ÙÚÔ.
O ¤ÊË‚Ô˜ Ì ·ÈÌÔÚÚÔÊÈÏ›· ∆Ú·ÁÈÎfi ÛÊ¿ÏÌ· ÛÙÔ ÔÔ›Ô ˘Ô·ÙÔ˘Ó ÔÈ ¤ÊË‚ÔÈ Ì ·ÈÌÔÚÚÔÊÈÏ›·, ·ÔÙÂÏ› Ë ·fiÎÚ˘„Ë ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È Ë Û˘Ó·ÁfiÌÂÓË Î·ı˘ÛÙ¤ÚËÛË Ù˘ ıÂڷ¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ÏfiÁˆ ˘ÂÚ‚ÔÏÈ΋˜ ·˘ÙÔÂÔ›ıËÛ˘ Î·È ˘ÂÚÂÎÙ›ÌËÛ˘ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘˜, ÂÓÒ Û˘¯Ó¿ ‰È·ÎfiÙÔ˘Ó ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋ ¤Á¯˘ÛË ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·310
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ª. §È·ÎÔÔ‡ÏÔ˘ Î·È Û˘Ó.
·Ú·ÁfiÓÙˆÓ, ÁÈ·Ù› ıˆÚÔ‡Ó fiÙÈ ÙÔ˘˜ ‰ÂÛ̇ÂÈ. ª¿ÏÈÛÙ·, ·ÈÌÔÚÚ·Á›Â˜ Û ·Û˘Ó‹ıÈÛÙ˜ - ηٿ ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÂÚ›Ô‰Ô - ı¤ÛÂȘ (.¯. ‚Ô˘‚ˆÓÈ΋ ÂÚÈÔ¯‹, ÁÂÓÓËÙÈο fiÚÁ·Ó·) ÂÓ‰¤¯ÂÙ·È Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÂÈÚfiÛıÂÙÔ ¿Á¯Ô˜. OÈ ÈÛfiÙÈ̘ Û¯¤ÛÂȘ ÙÔ˘ ÂÊ‹‚Ô˘ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ ··ÈÙÔ‡Ó ÂÈÏÈÎÚ›ÓÂÈ·. ∏ ÂÓË̤ڈÛË ÙˆÓ Ê›ÏˆÓ Î·È ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÁÈ· ÙË ÓfiÛÔ, Ë ‰˘Ó·ÙfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ Î·È ‰È·Ù‹ÚËÛ˘ ÙˆÓ Û΢·ÛÌ¿ÙˆÓ Û „˘Á›· Î·È Ë ‰È‡ڢÓÛË ÙˆÓ ·ıÏËÙÈÎÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ·Ú¤¯Ô˘Ó ÌÂÁ¿ÏË ÂÏ¢ıÂÚ›· ÎÈÓ‹ÛÂˆÓ ÛÙÔÓ ·ÈÌÔÚÚÔÊÈÏÈÎfi, ·ÚΛ Ó· ‰È·¯ÂÈÚÈÛÙ› Ì ̤ÙÚÔ ·˘Ù‹ ÙË Ó¤· Ú·ÁÌ·ÙÈÎfiÙËÙ·. ∏ ÂÈÏÔÁ‹ ÛÔ˘‰ÒÓ Î·È Â·ÁÁ¤ÏÌ·ÙÔ˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ‚¿ÛË ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Î·È ÙȘ ÈηÓfiÙËÙ˜ ÙÔ˘ ÂÊ‹‚Ô˘ Ì ·ÈÌÔÚÚÔÊÈÏ›·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·ÔÎÏ›ÔÓÙ·È Â·ÁÁ¤ÏÌ·Ù· ηٿ ÙËÓ ¿ÛÎËÛË ÙˆÓ ÔÔ›ˆÓ ÌÔÚ› Ó· Û˘Ì‚Â› ÛÔ‚·Úfi˜ ÙÚ·˘Ì·ÙÈÛÌfi˜. ∂ÈϤÔÓ, Ë ÂÊ˂›· ÁÈ· ÙÔ ·ÈÌÔÚÚÔÊÈÏÈÎfi ·ÁfiÚÈ ·ÔÙÂÏ› Ì›· ÂÚ›Ô‰Ô ·Ó·Ù·Ú·¯‹˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÛÂÍÔ˘·ÏÈÎfiÙËÙ¿ ÙÔ˘. °È· ·Ú¿‰ÂÈÁÌ·, ÔÈ Ó¿ÚıËΘ ÌÔÚ› Ó· ıˆÚËı› fiÙÈ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ·‰˘Ó·Ì›·, ¤ÏÏÂÈ„Ë ·ÚÚÂÓˆfiÙËÙ·˜ ‹ οÔÈÔÓ Ô˘ ÙÚ·‚¿ ÙËÓ ÚÔÛÔ¯‹.
∏ ÔÈÎÔÁ¤ÓÂÈ· °È· ÙËÓ ·ÈÌÔÚÚÔÊÈÏ›· ¤¯Ô˘Ó Á›ÓÂÈ Û¯ÂÙÈο Ï›Á˜ ÌÂϤÙ˜ Ô˘ ÂÈÎÂÓÙÚÒÓÔÓÙ·È ÛÙȘ „˘¯ÔÏÔÁÈΤ˜ Û˘Ó¤ÂȘ Ù˘ ·Ûı¤ÓÂÈ·˜ ·˘Ù‹˜ ÛÙÔ ·È‰› Î·È ÛÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘. OÈ Madden Î·È Û˘Ó (10) ÂÈÎÂÓÙÚÒÓÔÓÙ·È ÛÙÔ˘˜ Êfi‚Ô˘˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ÏÈÁfiÙÂÚÔ ÛÙËÓ ÂÓÔ¯‹ Ù˘, ÂÓÒ Ë Fletcher (11) ·Ó·Ê¤ÚÂÈ fiÙÈ Ë Á˘Ó·›Î·-ÊÔÚ¤·˜ ÓÈÒıÂÈ ¤ÓÔ¯Ë Ô˘ ‰ÂÓ ¤‰ˆÛ ÛÙÔÓ Û‡ÓÙÚÔÊfi Ù˘ ¤Ó·Ó ˘ÁÈ‹ ÁÈÔ. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Â¿Ó ·ÔÊ·Û›ÛÂÈ Ó· ÌËÓ Î¿ÓÂÈ ·È‰È¿ ‹ Ó· ÂÚÈÔÚ›ÛÂÈ ÙÔÓ ·ÚÈıÌfi ÙÔ˘˜, ·ÈÛı¿ÓÂÙ·È fiÙÈ ¤¯ÂÈ ·ÔÙ‡¯ÂÈ ÛÙÔÓ ÚfiÏÔ Ù˘ Û˘˙‡ÁÔ˘. ∏ ÂÓÔ¯‹ ·˘Ù‹ ÌÔÚ› Ó· ÂÍÂÏȯı› Û ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ·, ȉȷ›ÙÂÚ· Â¿Ó ·ÈÛı¿ÓÂÙ·È fiÙÈ Î·È ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙËÓ Î·ÙËÁÔÚÔ‡Ó ÁÈ’ ·˘Ùfi. ∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋ ∏ ¤ÓÙ·ÍË ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÌÔÚÚÔÊÈÏ›· Û ÔÌ¿‰Â˜ (ȉȷ›ÙÂÚ· ˘ÔÛÙËÚÈÎÙÈΤ˜) ÚÔÛʤÚÂÈ Û ·˘Ù¤˜ ÙȘ ÔÈÎÔÁ¤ÓÂȘ Ì›· ıÂڷ¢ÙÈ΋ ÂÈÏÔÁ‹ Ô˘ ÌÔÚ› Ó· ÙÔ˘˜ ‚ÔËı‹ÛÂÈ ÛËÌ·ÓÙÈο Ó· ¯ÂÈÚÈÛÙÔ‡Ó ÙËÓ ·ÔÁÔ‹ÙÂ˘Û‹ ÙÔ˘˜ ·fi ÙËÓ “·Ó·ËÚ›·” ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙËÓ ·ÓËÛ˘¯›· ÙÔ˘˜. ∆· ̤ÏË ·˘ÙÒÓ ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
ÙˆÓ ÔÌ¿‰ˆÓ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó Ù· ÎÔÈÓ¿ ÙÔ˘˜ ÚÔ‚Ï‹Ì·Ù·, ·Ú¤¯ÔÓÙ·˜ ÌÂٷ͇ ÙÔ˘˜ ˘ÔÛÙ‹ÚÈÍË (12). ∫·Ù¿ ÙË ‰ÈÂÍ·ÁˆÁ‹ ÙˆÓ ÂÚÁ·ÛÈÒÓ ·˘ÙÒÓ ÙˆÓ ıÂڷ¢ÙÈÎÒÓ ÔÌ¿‰ˆÓ, ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂ӷ ¯·Ú·ÎÙËÚÈÛÙÈο ı¤Ì·Ù· Ô˘ Û˘˙ËÙÈÔ‡ÓÙ·È Û˘¯Ó¿, fiˆ˜ Ù· ·ÎfiÏÔ˘ı·: ·) ∆· Û˘Ó·ÈÛı‹Ì·Ù· ÙˆÓ ÁÔÓ¤ˆÓ. OÈ ÁÔÓ›˜ ÌÔÚ› Ó· ÓÈÒıÔ˘Ó fiÙÈ ÂÈ‚·Ú‡ÓÔÓÙ·È ·fi ·ÈÛı‹Ì·Ù· ¢ı‡Ó˘. OÈ ÌËÙ¤Ú˜ ÌÔÚ› Ó· ·ÈÛı¿ÓÔÓÙ·È ıÏ›„Ë Î·È ·ÔÁÔ‹Ù¢ÛË, ȉȷ›ÙÂÚ· Â¿Ó Î¿ÓÔ˘Ó ÂÓ¤ÛÂȘ ÛÙÔ ·È‰› ÙÔ˘˜ ÛÙÔ Ï·›ÛÈÔ Ù˘ ηْ Ô›ÎÔÓ ıÂڷ›·˜. ‚) ∆· Û˘Ó·ÈÛı‹Ì·Ù· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙË ‰È¿ÚÎÂÈ· ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. O ·Ú¯ËÁfi˜ Ù˘ ÔÌ¿‰·˜ ÂÓı·ÚÚ‡ÓÂÈ Ù· ̤ÏË Ó· ÌÈÏ‹ÛÔ˘Ó ÁÈ· Ù· Û˘Ó·ÈÛı‹Ì·Ù· ·˘Ù¿ Î·È Ó· Ù· ÌÔÈÚ·ÛÙÔ‡Ó. ∞˘Ùfi ÙÔ˘˜ ‚ÔËı¿ Ó· Ù· ÂÂÍÂÚÁ·ÛÙÔ‡Ó Î·È Ó· ÓÈÒÛÔ˘Ó fiÙÈ ÂϤÁ¯Ô˘Ó ÙËÓ Î·Ù¿ÛÙ·ÛË. Á) ∏ ÏËÚÔÊfiÚËÛË ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÙËÓ ·Ûı¤ÓÂÈ·. ∂›Ó·È ‚·ÛÈÎfi Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ó· ηٷϿ‚Ô˘Ó ÙÈ Â›Ó·È ·˘Ùfi Ô˘ ÙÔ˘˜ Û˘Ì‚·›ÓÂÈ. OÈ ÁÔÓ›˜ ÂÎÊÚ¿˙Ô˘Ó ¤ÓÙÔÓÔ ¿Á¯Ô˜ fiÙ·Ó ÙÔ ·È‰› ÊÙ¿ÛÂÈ ÛÙËÓ ËÏÈΛ· Ô˘ ı· Ú¤ÂÈ Ó· Ì¿ıÂÈ ÏÂÙÔ̤ÚÂȘ ÁÈ· ÙËÓ ·ÈÌÔÚÚÔÊÈÏ›·. ∆Ô ÎÚ›ÛÈÌÔ ÂÚÒÙËÌ· ·ÊÔÚ¿ ÛÙÔ Ò˜ ÎÏËÚÔÓÔÌ›ٷÈ. OÈ ÁÔÓ›˜ ‰ÈÛÙ¿˙Ô˘Ó Ó· ‰ÒÛÔ˘Ó ·˘Ù¤˜ ÙȘ ÏËÚÔÊÔڛ˜, ‰ÈfiÙÈ ı¤ÏÔ˘Ó Ó· ÚÔÛٷ٤„Ô˘Ó ÙÔ ·È‰› ·fi ÙÔÓ „˘¯ÈÎfi fiÓÔ, ÂÓÒ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÂÌÔ‰›˙Ô˘Ó ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘. ‰) ∏ ÂÓÔ¯‹ ÙˆÓ ÌËÙ¤ÚˆÓ. ∏ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· ¯ÂÈÚÈÛÙÔ‡Ó ·˘Ù¿ Ù· Û˘Ó·ÈÛı‹Ì·Ù· ÂÓÔ¯‹˜ (13) ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÙÂÏÈ΋ ÔÚ›· Ù˘ ÚÔÛ·ÚÌÔÁ‹˜ ÙÔ˘ ÁÔÓ¤· ÛÙÔ ı¤Ì· Ù˘ ÓfiÛÔ˘. Â) ∏ ˘ÂÚÚÔÛÙ·Û›· ÙˆÓ ÁÔÓ¤ˆÓ, fiˆ˜ Û fiϘ ÙȘ ¯ÚfiÓȘ ·Ûı¤ÓÂȘ. ∏ ˘ÂÚÚÔÛÙ·Û›· ÌÔÚ› Ó· ÂÌÔ‰›ÛÂÈ ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ·È‰ÈÔ‡, ηıÒ˜ ÌÔÚ›: ·) Ó· ÂÓÙ›ÓÂÈ ÙÔÓ ·ÓÙ·ÁˆÓÈÛÌfi ·Ó¿ÌÂÛ· ÛÙ· ·‰¤ÏÊÈ· Î·È ‚) Ó· ·Ó·ÛÙ›ÏÂÈ ÙËÓ ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË Î·È ÙËÓ ÎÔÈÓˆÓÈÎÔÔ›ËÛË ÙÔ˘ ·È‰ÈÔ‡. ÛÙ) OÈ ·Ó·Ù˘ÍÈ·ÎÔ› ÛÙfi¯ÔÈ ·È‰ÈÒÓ-ÂÊ‹‚ˆÓ. ŒÓ·˜ ·Ó·Ù˘ÍÈ·Îfi˜ ÛÙfi¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Ë ·Ó‡ÚÂÛË ËÁÒÓ ˘ÔÛÙ‹ÚÈ͢ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ ÂÁÁ‡ÙËÙ·˜ ¤Íˆ ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. °È· ·Ú¿‰ÂÈÁÌ·, Û ̛· Û¯ÔÏÈ΋ ÂΉÚÔÌ‹, ÔÈ Ê›ÏÔÈ ÂÓfi˜ ÂÊ‹‚Ô˘ ÌÔÚÔ‡Ó Ó· ÂÎ·È‰Â˘ÙÔ‡Ó ·fi ·˘ÙfiÓ ÛÙÔÓ ÙÚfiÔ Ô˘ ÌÔÚÔ‡Ó Ó· ÙÔÓ ‚ÔËı‹ÛÔ˘Ó fiÙ·Ó Î¿ÓÂÈ ÌfiÓÔ˜ ÙÔ˘ ÙËÓ ¤ÓÂÛË Ì ÙÔÓ Û˘Ì˘Îӈ̤ÓÔ ·Ú¿ÁÔÓÙ·.
Pediatr July-Aug 05 new
22-07-05
12:16
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O ¤ÊË‚Ô˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ·
∏ Û˘Ó¿ÓÙËÛË Ù˘ ÔÌ¿‰·˜ ‚ÔËı¿ ÙÔ˘˜ ÁÔÓ›˜ Ó· ·Ó·ÏÔÁÈÛÙÔ‡Ó ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜. OÈ Ó¤ÔÈ ÁÔÓ›˜ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‚ÚÔ˘Ó ÚfiÙ˘· ÚÔ˜ Ì›ÌËÛË Ì¤Û· Û ·˘Ù‹. O ·Ú¯ËÁfi˜ Ù˘ ÔÌ¿‰·˜ ·Ú¤¯ÂÈ ˘ÔÛÙ‹ÚÈÍË ·Ó·ÁÓˆÚ›˙ÔÓÙ·˜ Ù· ¤ÓÙÔÓ· Û˘Ó·ÈÛı‹Ì·Ù· Î·È ÙË ÁÓ‹ÛÈ· ÂÈı˘Ì›· ÙˆÓ ÁÔÓ¤ˆÓ Ó· “‰ÒÛÔ˘Ó” ÛÙÔ ·È‰›. ¶·Ú¿ÏÏËÏ·, fï˜, ÚfiÏÔ˜ ÙÔ˘ ·Ú¯ËÁÔ‡ Â›Ó·È Ó· ÙÔÓ›ÛÂÈ fiÙÈ, ÙÂÏÈο, Ë Û·Ê‹˜ ÔÚÈÔı¤ÙËÛË Â›Ó·È Ì·ÎÚÔÚfiıÂÛÌ· Ôχ ‚ÔËıËÙÈ΋. ˙) OÈ ÂÓ‰ÔÔÈÎÔÁÂÓÂȷΤ˜ Û¯¤ÛÂȘ. ŒÓ· ı¤Ì· Ô˘ Ù›ıÂÙ·È Û˘¯Ó¿ ·fi ÙȘ ÌËÙ¤Ú˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘Ó·ÈÛı‹Ì·Ù· Ô˘ ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁ› Ë Û˘¯Ó¿ ·fiÌ·ÎÚË ÛÙ¿ÛË ÙÔ˘ Û˘˙‡ÁÔ˘ ˆ˜ ÚÔ˜ ÙËÓ ·Ûı¤ÓÂÈ·. ∞˘Ù‹ Ë ·fiÌ·ÎÚË ÛÙ¿ÛË ÙȘ ı˘ÌÒÓÂÈ. ª¤Û· ·fi ÙË Û˘˙‹ÙËÛË Ù˘ ÔÌ¿‰·˜ ÊÙ¿ÓÔ˘Ó ÛÙÔ ÛËÌÂ›Ô Ó· ·Ó·ÚˆÙËıÔ‡Ó Â¿Ó Ë ‰È΋ ÙÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿ ‚ÔËı¿ ÙÔÓ Û‡˙˘ÁÔ Ó· ÂÌϷΛ ‹ ÙÔÓ ·Ôı·ÚÚ‡ÓÂÈ. Ë) ∏ ÂÓËÏÈΛˆÛË ÙÔ˘ ·È‰ÈÔ‡. ∞ÔÙÂÏ› ¤Ó· ı¤Ì· Ô˘ Ù›ıÂÙ·È È‰È·›ÙÂÚ· ·fi ÌËÙ¤Ú˜ Ô˘ ¤¯Ô˘Ó ·È‰È¿ Û ÚÔ¯ˆÚË̤ÓË ÂÊ˂›·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÛÙÚ·ÙȈÙÈ΋ ıËÙ›·, Ù· ·ÈÌÔÚÚÔÊÈÏÈο ·È‰È¿ ‰ÂÓ ˘ËÚÂÙÔ‡Ó ÛÙÔ ÛÙÚ·Ùfi. ∫¿ÔÈÔÈ Ó¤ÔÈ ÂÎÊÚ¿˙Ô˘Ó ÙËÓ ÂÈı˘Ì›· Ó· οÓÔ˘Ó ıËÙ›·, ηıÒ˜ ÙÔ ı¤Ì· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ ·Ó‰ÚÈÛÌfi ÙÔ˘˜, Ì ÙË ‰È·ÊÔÚÂÙÈÎfiÙËÙ· ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜ ‹ ÙËÓ ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË. ŒÓ· ¿ÏÏÔ ı¤Ì· Ô˘ ÚÔ·ÙÂÈ ·ÊÔÚ¿ ÛÙȘ ÛÔ˘‰¤˜, ηıÒ˜ Ë Â›ÛÔ‰Ô˜ ÙÔ˘ ÂÊ‹‚Ô˘ Û ·ÓÂÈÛÙËÌȷΤ˜ Î·È ·ÓÒÙÂÚ˜ Û¯ÔϤ˜ Â›Ó·È ¤Ó·˜ ÛÙ·ıÌfi˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ‰›ÓÂÈ ÛÙÔ ·È‰› Ì›· Ù·˘ÙfiÙËÙ· ‰È·ÊÔÚÂÙÈ΋ ·fi ÂΛÓË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌÔÚÚÔÊÈÏ›·. ı) ∏ ÛÂÍÔ˘·ÏÈÎfiÙËÙ· ÙÔ˘ ÂÊ‹‚Ô˘. ª›· ÛËÌ·ÓÙÈ΋ ·ÓËÛ˘¯›· Â›Ó·È Ì‹ˆ˜ ÙÔ ·ÁfiÚÈ ÏËÁˆı› ·fi ¤Ó· ÎÔÚ›ÙÛÈ ÁÈ· ÙÔ ÔÔ›Ô ¤¯ÂÈ ÚÔÌ·ÓÙÈο Û˘Ó·ÈÛı‹Ì·Ù·. ∞˘ÙÔ› ÔÈ Êfi‚ÔÈ Û˘˙ËÙÈÔ‡ÓÙ·È ÛÙËÓ ÔÌ¿‰· Î·È Ù· ̤ÏË ÙÔ‡˜ Û˘ÌÌÂÚ›˙ÔÓÙ·È. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·È‰› ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Ì›· Û¯¤ÛË, ÂȂ‚·ÈÒÓÂÈ ÛÙȘ ÌËÙ¤Ú˜ ·˘Ù¤˜ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ÁÈÔ˜ ÙÔ˘˜ Ó· Â›Ó·È ¤Ó·˜ Ê˘ÛÈÔÏÔÁÈÎfi˜ ¿Ó‰Ú·˜. O ÚfiÏÔ˜ ÙÔ˘ ·Ú¯ËÁÔ‡ Ù˘ ÔÌ¿‰·˜ Â›Ó·È Ó· ‚ÔËı‹ÛÂÈ ÙÔ˘˜ ÁÔÓ›˜ Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ó Ù· ÚÔ‚Ï‹Ì·Ù· Î·È ÙȘ ÂÓ·ÏÏ·ÎÙÈΤ˜ χÛÂȘ ÙÔ˘˜.
∏ ‰ڷ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ÔÌ¿‰·˜ ŸÙ·Ó ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë ÔÌ¿‰· ÁÔÓ¤ˆÓ ÛÙË ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘ Î·È ∞ÈÌÔÚÚÔÊÈÏ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, οÔȘ ÔÈÎÔÁ¤ÓÂȘ Ô˘ ‹‰Ë ‚Ú›ÛÎÔÓÙ·Ó Û ·Ú·ÎÔÏÔ‡ıËÛË Î·È Â›¯·Ó Ì·ÎÚÔ¯ÚfiÓÈ· Û¯¤ÛË Ì ÙË
ªÔÓ¿‰·, ·ÌÊÈÛ‚‹ÙËÛ·Ó ÙË ¯ÚËÛÈÌfiÙËÙ· ·˘Ù‹˜ Ù˘ ·Ú¤Ì‚·Û˘. øÛÙfiÛÔ, ÔÈ ÔÈÎÔÁ¤ÓÂȘ ·˘Ù¤˜ ÂÓÙ¿¯ıËÎ·Ó ÛÙËÓ ÔÌ¿‰· Î·È ¤Ï·‚·Ó ÌÂÁ¿ÏË ‚Ô‹ıÂÈ· ·fi ·˘Ù‹. ŒÓ·˜ ·fi ÙÔ˘˜ ÏfiÁÔ˘˜ Ô˘ Ë ÔÌ¿‰· ·˘Ù‹ ÏÂÈÙÔ˘ÚÁ› Ì ÂÈÙ˘¯›· Â›Ó·È fiÙÈ ¤¯ÂÈ Ï·ÈÛȈı› ·fi ÙË ‰ÈÂÈÛÙËÌÔÓÈ΋ ÔÌ¿‰· ÙÔ˘ ÙÌ‹Ì·ÙÔ˜. OÈ ÁÈ·ÙÚÔ› ÂÓËÌÂÚÒÓÔ˘Ó ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ÔÌ¿‰· ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘ Î·È Û˘ÓÈÛÙÔ‡Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ Û ·˘Ù‹.
O ¤ÊË‚Ô˜ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ∆. ∞ÏÈÊÈÂÚ¿ÎË ∏ ΢ÛÙÈ΋ ›ÓˆÛË (1) Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ÁÂÓÂÙÈÎfi ÓfiÛËÌ· ÛÙË Ï¢΋ Ê˘Ï‹. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi ÁÔÓ›‰ÈÔ. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Û ÔÛÔÛÙfi 70% Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ·Ó·ÎÔ›ÓˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ÈÓÔ΢ÛÙÈ΋˜ ÓfiÛÔ˘, ÂÓfi˜ ¯ÚfiÓÈÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Ì η΋ ÚfiÁÓˆÛË Î·È ‰‡ÛÎÔÏË Î·È Â›ÔÓË ÔÚ›·, ·ÔÙÂÏ› ¤Ó· ¤ÓÙÔÓ· ÙÚ·˘Ì·ÙÈÎfi ÁÂÁÔÓfi˜, ¤Ó· Ó·ÚÎÈÛÛÈÛÙÈÎfi Ï‹ÁÌ· ÁÈ· ÙÔ˘˜ ÁÔÓ›˜. ÃÚÂÈ¿˙ÔÓÙ·È ¯ÚfiÓÔ, ‚Ô‹ıÂÈ· Î·È ˘ÔÛÙ‹ÚÈÍË ÒÛÙ ӷ ÌÔÚ¤ÛÔ˘Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ‰‡ÛÎÔϘ „˘¯ÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, Ó· ıÚËÓ‹ÛÔ˘Ó ÙÔ ¯·Ì¤ÓÔ Ê˘ÛÈÔÏÔÁÈÎfi ·È‰› ÙÔ˘˜ (ÚÔ·Ú·Û΢·ÛÙÈÎfi˜ ıÚ‹ÓÔ˜) (2) ηÈ, ÙÂÏÈο, Ó· ‚ÚÔ˘Ó ÙÚfiÔ˘˜ ÚÔÛ·ÚÌÔÁ‹˜ ÛÙË ÓfiÛÔ, ·ÔʇÁÔÓÙ·˜ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ (·fiÚÚÈ„Ë, ˘ÂÚÚÔÛÙ·Û›·). O ÛÙfi¯Ô˜ Ù˘ ¢È·Û˘Ó‰ÂÙÈ΋˜ Ì ÙÔ ∆Ì‹Ì· πÓÔ΢ÛÙÈ΋˜ Â›Ó·È Ë ‰È¿ÁÓˆÛË, Ë ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÂÊ‹‚ˆÓ Ô˘ ‰È·Ê·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó ÛÙÔȯ›· „˘¯Ô·ıÔÏÔÁ›·˜, ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ηıÒ˜ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Ï¤ÔÓ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘.
∞ÓÙȉڿÛÂȘ ηٿ ÙËÓ ÂÊ˂›· ∆· ·È‰È¿ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Ô˘ ÊÙ¿ÓÔ˘Ó ÛÙËÓ ÂÊ˂›·, ¤¯Ô˘Ó ‰È·Ó‡ÛÂÈ Ì›· ÔÚ›· Û˘Ó‹ıˆ˜ ‰‡ÛÎÔÏË, Ì ·ÓÂÈÏËÌ̤Ó˜ ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (3), ·Ô˘Û›Â˜ ·fi ÙÔ Û¯ÔÏ›Ô, ηıËÌÂÚÈÓ‹ Û¯ÔÏ·ÛÙÈ΋ ıÂڷ›·, ÂÈı·Ú¯›· Î·È ÂÚÈÔÚÈÛÌÔ‡˜, ÒÛÙ ӷ ·ÔʇÁÂÙ·È Ô Î›Ó‰˘ÓÔ˜ Ó¢ÌÔÓÈÎÒÓ ÏÔÈÌÒ͈Ó. ¶¿ÓÙ· ‰Â, ·Ú·ÌÔÓ‡ÂÈ Ô Êfi‚Ô˜ ÙÔ˘ ı·Ó¿ÙÔ˘. ™Â ÌÂϤÙ˜ (4,5) Ì ÂÊ‹‚Ô˘˜ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ÙÔÓ›˙ÂÙ·È Ô ÚfiÏÔ˜ Ù˘ „˘¯ÔÏÔÁÈ΋˜ ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
Pediatr July-Aug 05 new
22-07-05
12:16
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ª. §È·ÎÔÔ‡ÏÔ˘ Î·È Û˘Ó.
ÚÔÛ·ÚÌÔÁ‹˜ Ù˘ ÌËÙ¤Ú·˜, ηıÒ˜ Î·È Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ˘ ÙÔ˘ ÂÊ‹‚Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ÛÙË ÓfiÛÔ Î·È ÛÙË ÁÂÓÈÎfiÙÂÚË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘. ÕÏÏÔÈ ÌÂÏÂÙËÙ¤˜ (6) ·Ó·Ê¤ÚıËÎ·Ó ÛÙȘ ÂÈΛӉ˘Ó˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ Âȉ›‰ÔÓÙ·È ÔÈ ¤ÊË‚ÔÈ Ì ·˘Ù‹ ÙË ÓfiÛÔ, ηıÒ˜ Î·È ÛÙËÓ ¿ÚÓËÛË (7) ÔÏÏÒÓ ·fi ·˘ÙÔ‡˜ Ó· ¤¯Ô˘Ó ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙËÓ ÚfiÁÓˆÛË. ∞ÚÎÂÙÔ› ¤ÊË‚ÔÈ ·Ì‡ÓÔÓÙ·È Ì ·ÍÈÔı·‡Ì·ÛÙÔ ÙÚfiÔ ÛÙÔ ¿Á¯Ô˜ Î·È ÙÔÓ „˘¯ÈÎfi fiÓÔ ÂÍ·ÈÙ›·˜ Ù˘ ·ÚÚÒÛÙÈ·˜, Û ̛· ÚÔÛ·ÚÌÔÛÙÈ΋ ÚÔÛ¿ıÂÈ· ÙÔ˘ ∂ÁÒ ÙÔ˘˜ Î·È Ì ÙË ÛÙ‹ÚÈÍË Ì›·˜ ȉȷ›ÙÂÚ· ÛÙÔÚÁÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ÙÔ˘˜ ÂÍ·ÛÊ·Ï›˙ÂÈ ÙËÓ Ï‹ÚË ·Ô‰Ô¯‹ Î·È ·ÛÊ¿ÏÂÈ·. øÛÙfiÛÔ, οÔÈÔÈ ¤ÊË‚ÔÈ ·Ô‰›‰Ô˘Ó ÛÙËÓ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Î¿ı ¿Á¯Ô˜ Î·È ‰˘ÛÎÔÏ›·. ∑ËÙÔ‡Ó ··ÓÙ‹ÛÂȘ ÛÙÔ ÂÚÒÙËÌ· “ÁÈ·Ù› Û ̤ӷ;” Î·È ÂÎÊÚ¿˙Ô˘Ó ı˘Ìfi, ·Á·Ó¿ÎÙËÛË Î·È Â¯ıÚfiÙËÙ· ÚÔ˜ Ù· ˘ÁÈ‹ ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÙÔ˘˜ Ê›ÏÔ˘˜, ·ÏÏ¿ Î·È ÙÔÓ Â·˘Ùfi ÙÔ˘˜ ηıÒ˜ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙȘ ··ÈÙ‹ÛÂȘ Î·È ÙȘ ÚÔÛ‰Ô˘ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ∏ ·Ú¤Ì‚·ÛË ÛÙԯ‡ÂÈ ÛÙËÓ ÂÓı¿ÚÚ˘ÓÛË Ù˘ ¤ÎÊÚ·Û˘ Î·È Ù˘ ‰ÈÂÚÁ·Û›·˜ ·˘ÙÒÓ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ Î·Ù·ÛÙ¿ÛˆÓ, ηıÒ˜ Î·È ÛÙËÓ ˘ÔÛÙ‹ÚÈÍË Î·È ÙËÓ Î·Ï‡ÙÂÚË ÚÔÛ·ÚÌÔÁ‹ ÛÙËÓ ·Ûı¤ÓÂÈ· Î·È ÙËÓ ÔÚ›· Ù˘. À¿Ú¯Ô˘Ó, ›Û˘, ¤ÊË‚ÔÈ Ì ·ıÔÏÔÁÈ΋ ÂÍ¿ÚÙËÛË ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜, ·ıËÙÈÎÔ›, Ì ¤ÏÏÂÈ„Ë ÂӉȷʤÚÔÓÙÔ˜ ÁÈ· ·ÙÔÌÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. OÈ ÌËÙ¤Ú˜ ÙÔ˘˜ Â›Ó·È Û ̛· ÌfiÓÈÌË ·ÁˆÓ›·, ˘ÂÚÚÔÛٷ٢ÙÈΤ˜ Î·È Ì ·ÈÛı‹Ì·Ù· ÂÓÔ¯‹˜. ÷ڷÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· ·ÔÙÂÏ› Ë ÂÚ›ÙˆÛË ÙÔ˘ ¡›ÎÔ˘, ËÏÈΛ·˜ 15 ÂÙÒÓ, ÙÔÓ ÔÔ›Ô Ù¿È˙ ·ÎfiÌË Ë ÌËÙ¤Ú· ÙÔ˘. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚ fiÙÈ ÛÙÔ Ï·›ÛÈÔ Ù˘ ·ıÔÏÔÁÈ΋˜ Û¯¤Û˘ Ì ÙÔÓ ¡›ÎÔ, ¤ÓȈı fiÙÈ ÂΛÓÔ˜ ÙËÓ ÙÈ̈ÚÔ‡ÛÂ, ÂÓÒ ÂΛÓË Â‡ÚÈÛΠ‰È¤ÍÔ‰Ô ÛÙËÓ Î·Ù¿ıÏÈ„Ë Î·È ÙËÓ ÂÓÔ¯‹ Ù˘. ÕÏÏÔÈ ¤ÊË‚ÔÈ ÂȉÂÈÎÓ‡Ô˘Ó Ì›· Ù¿ÛË ·ÓÂÍ·ÚÙËÙÔÔ›ËÛ˘ ‹ ¿ÛÎËÛ˘ ÂÈΛӉ˘ÓˆÓ ‰Ú·ÛÙËÚÈÔًوÓ, ÂÓÒ ÛÙÔ Ï·›ÛÈÔ Î·Ù·ıÏÈÙÈ΋˜ ·ÓÙ›‰Ú·Û˘ Ì ·˘ÙÔηٷÛÙÚÔÊÈο ÛÙÔȯ›·, ·ÚÎÂÙÔ› ‰ÂÓ Û˘ÌÌÔÚÊÒÓÔÓÙ·È ÛÙË ıÂڷ›·. O ÚfiÏÔ˜ ÙÔ˘ ·È‰Ô„˘¯È¿ÙÚÔ˘ Û ·˘ÙfiÓ ÙÔÓ ‰‡ÛÎÔÏÔ ¯ÒÚÔ Ù˘ È·ÙÚÈ΋˜ Â›Ó·È ÔÏÏ·Ïfi˜. ¶¤Ú·Ó Ù˘ ‚Ô‹ıÂÈ·˜ Ô˘ ·Ú¤¯ÂÈ ÛÙËÓ Â›Ï˘ÛË ÔχÏÔÎˆÓ ÂÓ‰Ô„˘¯ÈÎÒÓ Û˘ÁÎÚÔ‡ÛˆÓ, ÂÓÈÛ¯‡ÂÈ Î·È ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ÚÔÛ¿ıÂÈ· ÙˆÓ ÂÊ‹‚ˆÓ ÁÈ· ÔÈfiÙËÙ· ˙ˆ‹˜, ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘˜ ÛÙË ÓfiÛÔ, ÙË Û¯ÔÏÈ΋ Î·È Â˘Ú‡ÙÂÚË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘˜, ηıÒ˜ Î·È ÙË Û˘ÓÔÏÈ΋ ÏÂȶ·È‰È·ÙÚÈ΋ 2005;68:308-319
ÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ¶·ÚÂÌ‚·›ÓÂÈ Ê·Ú̷΢ÙÈο fiÔ˘ ··ÈÙ›ٷÈ, ÂÓÒ ¯ÂÈÚ›˙ÂÙ·È Ì Û‚·ÛÌfi Î·È ˘ÔÌÔÓ‹ ÙËÓ ¿ÚÓËÛËÌ˯·ÓÈÛÌfi ¿Ì˘Ó·˜ Ô˘ ··ÓÙ¿Ù·È Û˘¯Ó¿ ÛÙÔ ÂÒ‰˘ÓÔ ·˘Ùfi ‰›Ô Ù˘ È·ÙÚÈ΋˜. ∂Í›ÛÔ˘ ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ˘ÔÛÙ‹ÚÈÍË Ô˘ ·Ú¤¯ÂÈ Ô ·È‰Ô„˘¯›·ÙÚÔ˜ ÛÙ· ̤ÏË Ù˘ £Âڷ¢ÙÈ΋˜ OÌ¿‰·˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ πÓÔ΢ÛÙÈ΋˜, Ô˘ Û˘¯Ó¿ ηٷÎχ˙ÔÓÙ·È ·fi ÛΤ„ÂȘ Î·È Û˘Ó·ÈÛı‹Ì·Ù· ıÏ›„˘, Ì·Ù·›ˆÛ˘ Î·È ÂÓÔ¯‹˜.
™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Î·È ÂÊ˂›·: Ì›· ‰‡ÛÎÔÏË Û˘Ó‡·ÚÍË ª. §È·ÎÔÔ‡ÏÔ˘, Ã. ∫·Ó·Î¿ - Gantenbein ¢È·ÎÚ›ÓÔÓÙ·È Î˘Ú›ˆ˜ ‰‡Ô Ù‡ÔÈ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË: Ô Ù‡Ô˜ 1 (™¢Ù1) Ô˘ Â›Ó·È Î·È Ô Û˘¯ÓfiÙÂÚÔ˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÔÊ›ÏÂÙ·È Û ·˘ÙÔ¿ÓÔÛË Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Ì ·ÔÙ¤ÏÂÛÌ· ÈÓÛÔ˘ÏÈÓÔÂÓ›· (1) Î·È Ô Ù‡Ô˜ 2 (™¢Ù2) Ô˘ ··ÓÙ¿Ù·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ú΋, Ì¿ÏÈÛÙ· ˘ÂÚ‚ÔÏÈ΋ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ (˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜) Ì ·Ó·Ú΋ ‰Ú¿ÛË, Ë ÔÔ›· Ô‰ËÁ› Î·È ¿ÏÈ Û ˘ÂÚÁÏ˘Î·ÈÌ›· (2). O ™¢Ù1 ÂÌÊ·Ó›˙ÂÙ·È ·ÁÎÔÛÌ›ˆ˜ Ì ̛· Û˘¯ÓfiÙËÙ· Ô˘ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙË ¯ÒÚ·, Î˘Ì·ÈÓfiÌÂÓË ·fi 0,6 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÛÙËÓ π·ˆÓ›· - ÙË ¯ÒÚ· Ì ÙË ¯·ÌËÏfiÙÂÚË Â›ÙˆÛË - ¤ˆ˜ 45 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ÂÙÒÓ ÛÙË ºÈÓÏ·Ó‰›· - ÙË ¯ÒÚ· Ì ÙË ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË. ∏ ∂ÏÏ¿‰· ·ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ÂӉȿÌÂÛË Û˘¯ÓfiÙËÙ·, ÂÚ›Ô˘ 8 Ӥ˜ ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∏ Û˘¯ÓfiÙËÙ· ‰˘ÛÙ˘¯Ò˜ ·˘Í¿ÓÂÈ ·ÁÎÔÛÌ›ˆ˜ ηٿ 2-5% ·Ó¿ ¤ÙÔ˜, ·Ó¿ÏÔÁ· Ì ÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (3). ŸÙ·Ó ÙÂı›, ηٿ ÙËÓ ·È‰È΋-ÂÊË‚È΋ ËÏÈΛ·, Ë ‰È¿ÁÓˆÛË ÙÔ˘ ™¢Ù1, ÛËÌ·ÙÔ‰ÔÙÂ›Ù·È ÁÈ· ÙÔ ·È‰› ‹ ÙÔÓ ¤ÊË‚Ô ÙÔ ÍÂΛÓËÌ· ÂÓfi˜ ¿ÏÏÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. ∞Ú¯›˙ÂÈ Ì›· ÂÓÙ·ÙÈÎÔÔÈË̤ÓË ıÂڷ›· Ô˘ Â›Ó·È ··Ú·›ÙËÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Â›Ó·È Ë ÌfiÓË Ô˘ ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙË ÛËÌ·ÓÙÈ΋ ηı˘ÛÙ¤ÚËÛË ‹ Î·È ÙËÓ ·ÔÊ˘Á‹ ÂÌÊ¿ÓÈÛ˘ Ì·ÎÚÔ¯ÚfiÓÈˆÓ ÂÈÏÔÎÒÓ (4-6). ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ô ™¢ ı¤ÙÂÈ Ôχ Û˘¯Ó¿ ÙÔ ·È‰› Î·È ÙÔÓ ¤ÊË‚Ô ˘fi ÁÔÓÂ˚΋ ›‚ÏÂ„Ë ÁÈ· ÙËÓ Ù‹ÚËÛË ÙˆÓ ˆÚ·Ú›ˆÓ, ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÂÓ¤ÛÂˆÓ Î·È ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ ÛˆÛÙ‹˜ ‰È·ÙÚÔÊ‹˜ ηÈ, ·Ó·fiÊ¢ÎÙ·, οو ·fi ÙÔÓ
Pediatr July-Aug 05 new
22-07-05
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313
O ¤ÊË‚Ô˜ Ì ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ·
È·ÙÚÈÎfi ¤ÏÂÁ¯Ô ÁÈ· Û˘¯Ó‹ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÁÏ˘Î·ÈÌÈ΋˜ Ú‡ıÌÈÛ˘ Î·È ÓÔ˘ıÂÛ›· ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÌÂÙÚ‹ÛˆÓ. ∂ÈϤÔÓ, ηٿ ÙË Ê¿ÛË Ù˘ ÂÊ˂›·˜, ‚ÈÔÏÔÁÈο, Ì ÙËÓ ·‡ÍËÛË ¤ÎÎÚÈÛ˘ ÙfiÛÔ ÙˆÓ ÔÚÌÔÓÒÓ ÙÔ˘ ʇÏÔ˘, fiÛÔ Î·È Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, ˘¿Ú¯ÂÈ Ì›· Ê˘ÛÈÔÏÔÁÈ΋ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ô˘ ÌÂÙ·ÊÚ¿˙ÂÙ·È Û ·˘ÍË̤Ó˜ ·Ó¿ÁΘ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘ (7). O ¤ÊË‚Ô˜, ÏÔÈfiÓ, ÂÓÒ ¯ÚÂÈ¿˙ÂÙ·È ÂÚÈÛÛfiÙÂÚË ‰fiÛË ÈÓÛÔ˘Ï›Ó˘, ÏfiÁˆ Ù˘ ·Ó¿Á΢ ÙÔ˘ Ó· ͯ¿ÛÂÈ ÙËÓ È‰È·ÈÙÂÚfiÙËÙ¿ ÙÔ˘, Û˘¯Ó¿ ·Ú·Ï›ÂÈ ÂÓ¤ÛÂȘ, ÌÂ Û˘Ó¤ÂÈ· ÙË ÛËÌ·ÓÙÈ΋ Âȉ›ӈÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘ ηٿ ÙËÓ ÂÊ˂›· (7-9). ∞ÓÙÈı¤Ùˆ˜, ¿ÏϘ ÊÔÚ¤˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· Ê¿ÂÈ ÙÔ ··ÁÔÚÂ˘Ì¤ÓÔ Ê·ÁËÙfi, ÚÔÛı¤ÙÂÈ ÂÈϤÔÓ ‰fiÛÂȘ ÈÓÛÔ˘Ï›Ó˘, ÌÂ Û˘Ó¤ÂÈ· Ó· ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ Ù˘ ·¯˘Û·ÚΛ·˜, ΢ڛˆ˜ ÛÙ· ÎÔÚ›ÙÛÈ· ηٿ ÙËÓ ÂÊË‚È΋ ÂÚ›Ô‰Ô. ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ ·Ú·Ï›ÂÈ Á‡̷ٷ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·‰˘Ó·Ù›ÛÂÈ, ÌÂ Û˘Ó¤ÂÈ· ÔÏϤ˜ ÊÔÚ¤˜ ˘ÔÁÏ˘Î·ÈÌÈο ÂÂÈÛfi‰È·, ¿ÏÏÔÙ ¿ÏÏ˘ ‚·Ú‡ÙËÙ·˜. ∂›Û˘, Ôχ Û˘¯Ó¿ ηٷʇÁÂÈ ÛÙËÓ Î·Ù·ÁÚ·Ê‹ „¢‰ÒÓ ÙÈÌÒÓ ÛÙÔ ‚È‚ÏÈ·Ú¿ÎÈ ÂϤÁ¯Ô˘ ÁÈ· Ó· ·ÔʇÁÂÈ ÙË ÁÔÓÂ˚΋ ›ÏËÍË ‹ ÙËÓ È·ÙÚÈ΋ ÓÔ˘ıÂÛ›·, fiˆ˜ ·ÔʇÁÂÈ Ó· ·Ó·Ê¤ÚÂÈ fiÙÈ Î·Ó›˙ÂÈ (7-9,11). ∏ ¯Ú‹ÛË Ô˘ÛÈÒÓ Î·È Ë Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ ÔÙÒÓ ÛÙËÓ ÂÊ˂›· Â›Ó·È Û˘¯Ófi Ê·ÈÓfiÌÂÓÔ Ô˘ ·ÚÂÚÌËÓ‡ÂÙ·È ·fi ÔÏÏÔ‡˜ ÂÊ‹‚Ô˘˜ Û·Ó ÂΉ‹ÏˆÛË ÂÓËÏÈΛˆÛ˘. £· ‹Ù·Ó, ÂÔ̤ӈ˜, ¿ÛÙÔ¯Ë Ë ·fiÏ˘ÙË ··ÁfiÚÂ˘Û‹ ÙÔ˘˜ ÛÙÔÓ ¤ÊË‚Ô Ì ‰È·‚‹ÙË, Ô ÔÔ›Ô˜ ·Ó·˙ËÙ› ÙÚfiÔ˘˜ ÂÍÔÌÔ›ˆÛ‹˜ ÙÔ˘ Ì ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ (7,10,11). ∞ÓÙÈı¤Ùˆ˜, Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÁÓˆÚ›˙ÂÈ fiÙÈ ÙÔ ·ÏÎÔfiÏ - ̤ۈ ηٷÛÙÔÏ‹˜ Ù˘ ÓÂÔÁÏ˘ÎÔÁ¤ÓÂÛ˘ Î·È Ù˘ ·Ó·ÁÓÒÚÈÛ˘ Ù˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ - ÌÔÚ› Ó· ÙÔÓ Ô‰ËÁ‹ÛÂÈ Û ‚·ÚÈ¿ ˘ÔÁÏ˘Î·ÈÌ›· ‹ Î·È ÎÒÌ·. ŒÙÛÈ, ı· Ú¤ÂÈ Ó· ÂÎ·È‰Â˘ı› ÒÛÙ ӷ ηٷӷÏÒÓÂÈ ·ÏÎÔfiÏ Ì ̤ÙÚÔ, Ì ÁÂÌ¿ÙÔ ÙÔ ÛÙÔÌ¿¯È ηÈ, ‚¤‚·È·, Ó· ÌÂÙÚ¿ ÙËÓ ÙÈÌ‹ ۷ί¿ÚÔ˘ ÂÈÛÙÚ¤ÊÔÓÙ·˜ ÛÙÔ Û›ÙÈ, ÚÔ ÙÔ˘ ‡ÓÔ˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Î¿ÓÈÛÌ·, Ë ·˘Ù·Ú¯È΋ ··ÁfiÚ¢ÛË Î·È ¿ÏÈ ‰ÂÓ ı· ÂÈʤÚÂÈ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· (7,10). ∞ÓÙ›ıÂÙ·, Ú¤ÂÈ Ó· ÂÓËÌÂÚˆı› Ô ¤ÊË‚Ô˜ fiÙÈ Ô ™¢ Û ÂÚ›ÙˆÛË Î·Î‹˜ Ú‡ıÌÈÛ˘ ÂÓ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌÈÎÚÔ- Î·È Ì·ÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·˜, ηıÒ˜ ÙÔ ›‰ÈÔ ÙÔ Î¿ÓÈÛÌ· ·Ó‚¿˙ÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ ·ÁÁÂÈÔ¿ıÂÈ·˜.
∏ ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË ∏ ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË Â›Ó·È ‚·ÛÈÎfi ı¤Ì· Î·È ÁÈ· ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ™¢. O ¤ÊË‚Ô˜ ı¤ÏÂÈ ÙËÓ
·ÓÂÍ·ÚÙËÛ›· ÙÔ˘, Ô ‰È·‚‹Ù˘ fï˜ ÙÔÓ Ô‰ËÁ› ÛÙËÓ ÂÍ¿ÚÙËÛË Î·È ÙËÓ ·ıËÙÈÎfiÙËÙ·. ∏ ¿ÏË ÌÂٷ͇ ÂÍ¿ÚÙËÛ˘ Î·È ·ÓÂÍ·ÚÙËÛ›·˜ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ™¢ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÌÊÈ‚ÔÏ›· ÁÈ· ÙÔ Â¿Ó ı· ηٷʤÚÔ˘Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÌfiÓÔÈ ÙÔ˘˜ ÙËÓ ·Ûı¤ÓÂÈ· Î·È ·fi ÙÔÓ Êfi‚Ô ÙÔ˘ ı·Ó¿ÙÔ˘. ∞˘Ù¿ ¤¯Ô˘Ó ÙȘ Ú›˙˜ ÙÔ˘˜ ·ÊÂÓfi˜ ÛÙËÓ ‡·ÚÍË ÙÔ˘ È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜, ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ Ù·‡ÙÈÛË Ì ÙËÓ ˘ÂÚÚÔÛÙ·Û›· Î·È ÙÔÓ Êfi‚Ô ÙˆÓ ÁÔÓ¤ˆÓ Î·È È‰È·›ÙÂÚ· Ù˘ ÌËÙ¤Ú·˜ Ô˘ ¤¯ÂÈ ‰ÂÈ ÙÔ ·È‰› Ù˘ Û ˘ÔÁÏ˘Î·ÈÌÈΤ˜ ÎÚ›ÛÂȘ. ¶ÚÔÛ·ıÒÓÙ·˜ Ô ¤ÊË‚Ô˜ Ó· Ê·Ó› ·ÓÂÍ¿ÚÙËÙÔ˜ Î·È ÌË ÚÔÛ¤¯ÔÓÙ·˜ ÙÔ ‰È·ÈÙÔÏfiÁÈfi ÙÔ˘, ÚÔηÏ› ÙËÓ ·Ú¤Ì‚·ÛË ÙˆÓ ÁÔÓ¤ˆÓ, ‰ËÏ·‰‹ ÙËÓ ÂÍ¿ÚÙËÛ‹ ÙÔ˘. ¶›Ûˆ ·fi ÙËÓ ·Ì¤ÏÂÈ¿ ÙÔ˘ ÎÚ‡‚ÂÙ·È Ô Êfi‚Ô˜ ·Ô¯ˆÚÈÛÌÔ‡, Ô˘ ¤¯ÂÈ ·ÓÙÈÛÙÔȯ›· ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘. ¶ÂÚ›Ô˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 17-18 ÂÙÒÓ ·Ú¯›˙Ô˘Ó Ó· Ê·›ÓÔÓÙ·È Ù· ÚÒÙ· ÛËÌ¿‰È· ·Ô‰Ô¯‹˜ Ù˘ ·Ûı¤ÓÂÈ·˜, ÔfiÙ ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙˆÓ Û˘ÁÎÚÔ‡ÛÂˆÓ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Ì›ˆÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ¿ÚÓËÛ˘ Î·È ÙÔ˘ ¿Á¯Ô˘˜ Î·È ÂÌÊ¿ÓÈÛË ÛÙÔȯ›ˆÓ Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·Ô‰Ô¯‹ ÙÔ˘ ·˘ÙÔ‡ Ì ÙÔÓ ™¢. ∂Ô̤ӈ˜, Â¿Ó ¤Ó·˜ ¤ÊË‚Ô˜ Û˘Ó¯›˙ÂÈ Ó· ¤¯ÂÈ Î·Îfi ‰È·‚ËÙÈÎfi ¤ÏÂÁ¯Ô, ÂÓ‰¤¯ÂÙ·È Ë ·Ûı¤ÓÂÈ· Ó· ÌËÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌË ·Ô‰ÂÎÙ‹.
OÈ ¿Ì˘Ó˜, ÙÔ Ê‡ÏÔ Î·È Ë „˘¯Ô·ıÔÏÔÁ›· ÛÙËÓ ÂÊ˂›· ŸÙ·Ó Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ·ÔʇÁÔ˘Ó ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ™¢ ·fi ÙËÓ ·Ú¯‹ Ù˘ ·Ûı¤ÓÂÈ·˜, Ê·›ÓÂÙ·È fiÙÈ Û˘Ó¯›˙Ô˘Ó ·˘Ù‹ ÙË ÛÙ¿ÛË - Û·Ó ¿Ì˘Ó· - ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·Ó ¯ÚfiÓÔ ÌÂÙ¿, ‡ÚËÌ· Û¯ÂÙÈ˙fiÌÂÓÔ Ì ηÎfi ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô (12). ∏ ÌÂϤÙË Ô˘ ·Ó·Ê¤ÚÂÙ·È ¤‰ÂÈÍ fiÙÈ ÔÛÔÛÙfi 30% ÙˆÓ ·È‰ÈÒÓ (› Û˘ÓfiÏÔ˘ 90 ·È‰ÈÒÓ) ·ÚÔ˘Û›·Û ·˘Ù‹ ÙËÓ ¿Ì˘Ó·, ȉȷ›ÙÂÚ· Ù· ÎÔÚ›ÙÛÈ·. ∆· ÎÔÚ›ÙÛÈ· ÛÙËÓ ÂÊ˂›· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ‰˘ÛÎÔÏ›· ÛÙËÓ Ù‹ÚËÛË ÙÔ˘ ‰È·‚ËÙÈÎÔ‡ ÂϤÁ¯Ô˘, Û‡Ìʈӷ Ì ÌÂϤÙ˜ (13,14). √È ·ÏÏ·Á¤˜ ÛÙË Ê˘ÛÈÔÏÔÁ›· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û˘Ì‚¿ÏÏÔ˘Ó ÚÔ˜ ·˘Ù‹ ÙËÓ Î·Ù‡ı˘ÓÛË, fiˆ˜ Î·È ÔÈ Û˘ÁÎÚÔ‡ÛÂȘ ÌÂٷ͇ ÌËÙ¤Ú·˜ Î·È ÎfiÚ˘ (14). OÈ ‰È·Ù·Ú·¯¤˜ ÏfiÁˆ ¿Á¯Ô˘˜ Î·È Î·Ù¿ıÏȄ˘ Â›Ó·È ·˘Ù¤˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÈÔ Û˘¯Ó¿ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ™¢. ∫·Ù¿ıÏÈ„Ë ‹ ηٷıÏÈÙÈÎÔ‡ Ù‡Ô˘ Û˘Ó·ÈÛı‹Ì·Ù· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÈÔ Û˘¯Ó¿ Û ·˘ÙÔ‡˜ Û ۇÁÎÚÈÛË Ì ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ (15,16). ™Â ÌÂϤÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ·È‰ÈÒÓ Ì ™¢ ÁÈ· 9 ¯ÚfiÓÈ·, Ë ÌË ÚÔÛ·ÚÌÔÁ‹ ÛÙË ıÂڷ›· ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·314
314
ª. §È·ÎÔÔ‡ÏÔ˘ Î·È Û˘Ó.
·Ó¤Î˘„ ÛÙË Ì¤ÛË Ù˘ ÂÊ˂›·˜, ‹Ù·Ó ·Ú·ÙÂٷ̤ÓË Î·È Û˘Û¯ÂÙ›ÛÙËΠ̛̠˙ÔÓ· „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÂÌÊ·Ó›ÛÙËΠ·ÚÁfiÙÂÚ· (17). ∞˘ÍË̤ÓÔ˜ ·˘ÙÔÎÙÔÓÈÎfi˜ ȉ·ÛÌfi˜ ¤¯ÂÈ ‚ÚÂı› Û ÂÊ‹‚Ô˘˜ Ì ™¢ (fi¯È fï˜ ·fiÂÈÚ˜). ∞˘ÙÔ› ÔÈ ¤ÊË‚ÔÈ Â›¯·Ó ™¢ › Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹, ‰ÂÓ Â›¯·Ó Û˘Ì·Á‹ ÔÈÎÔÁ¤ÓÂÈ· Î·È ‰ÂÓ ÂÊ¿ÚÌÔ˙·Ó ÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ (18). ∏ „˘¯Ô·ıÔÏÔÁ›· Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ™¢ ·‡ÍËÛ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÂÓÒ Ë Î·Ù¿ıÏÈ„Ë Ù˘ ÌËÙ¤Ú·˜ ‹Ù·Ó ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηٿıÏÈ„Ë ÛÙÔÓ ¤ÊË‚Ô (19).
OÈ Û˘ÓÔÌ‹ÏÈÎÔÈ ÛÙËÓ ÂÊ˂›· ∏ ª·Ú›·, ËÏÈΛ·˜ 12 ÂÙÒÓ, Ì ™¢ › 2 ¯ÚfiÓÈ·, ·Ó·Ê¤ÚÂÈ ÛÙË Û˘Ó¤ÓÙ¢ÍË: “Œ¯Ô˘Ì ‰È·ÊÔÚ¿ ·fi Ù· ¿ÏÏ· ·È‰È¿. £· ‹ıÂÏ· Ó· ‚Ϥˆ ÙËÓ ÂÈÎfiÓ· ÙÔ˘ ·˘ÙÔ‡ ÌÔ˘ fiˆ˜ ‹Ù·Ó ÚÈÓ”. OÈ ¤ÊË‚ÔÈ ÂÈı˘ÌÔ‡Ó ÙËÓ ¤ÓÙ·Í‹ ÙÔ˘˜ Û ÔÌ¿‰Â˜ Û˘ÓÔÌËϛΈÓ. øÛÙfiÛÔ, fi,ÙÈ ÚÔηÏ› ÙË ‰È·ÊÔÚÔÔ›ËÛ‹ ÙÔ˘˜ ·fi ÙËÓ ÔÌ¿‰· ·˘Ù‹, ÙÔ˘˜ ÚÔηÏ› ¿Á¯Ô˜. ∏ ‰È·ÊÔÚÔÔ›ËÛË Ì¤Ûˆ Ù˘ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜ ÙÔ˘ ™¢ Â›Ó·È Ì›· ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ¿Á¯Ô˘˜. ŒÓ·˜ ·fi ÙÔ˘˜ ÏfiÁÔ˘˜ Ô˘ ·È‰È¿ Î·È ¤ÊË‚ÔÈ ÎÚ·ÙÔ‡Ó ÙÔÓ ™¢ Ì˘ÛÙÈÎfi Â›Ó·È Ô Êfi‚Ô˜ ·˘Ù‹˜ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘. ™‡Ìʈӷ Ì ̛· ÌÂϤÙË, ÔÛÔÛÙfi 66% ÂÊ‹‚ˆÓ Ì ™¢ ·Ú¤ÏÂÈ ÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹, ‰ËÏ·‰‹ ‰ÂÓ ÙËÚÔ‡Û ÙÔ ˆÚÔÏfiÁÈÔ ÚfiÁÚ·ÌÌ· ÁÈ· ÙÔ Ê·ÁËÙfi Î·È ÙËÓ ÈÓÛÔ˘Ï›ÓË, ÁÈ· Ó· ÌËÓ ·ÔÛÙ·ÛÈÔÔÈËı› ·fi ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ (20). OÈ Ê›ÏÔÈ ÌÔÚ› Ó· Â›Ó·È ˘ÔÛÙËÚÈÎÙÈÎÔ› ÛÙÔ ıÂڷ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ÙÔ˘ ™¢, ·ÏÏ¿ ÌÔÚ› Î·È Ó· ÌËÓ Â›Ó·È (21). º·›ÓÂÙ·È fiÙÈ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÚÔÛ·ÚÌÔÁ‹ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ ¯ÚÂÈ¿˙ÂÙ·È Ë ˘ÔÛÙ‹ÚÈÍË ÙfiÛÔ ÙˆÓ Ê›ÏˆÓ fiÛÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (22,23). ∏ ÛÂÍÔ˘·ÏÈÎfiÙËÙ· OÈ ·Ó·ÛÙÔϤ˜ ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÛÂÍÔ˘·ÏÈÎfiÙËÙ·˜ ÚÔ¤Ú¯ÔÓÙ·È Û˘¯Ó¿ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ™¢. ∂›Ó·È Èı·Ófi Ó· ÙÔ˘˜ ÚÔÍÂÓ› ¿Á¯Ô˜ Ë ÂÈÎfiÓ· ÙÔ˘ ·˘ÙÔ‡ ÙÔ˘˜ Î·È Ó· ·ÔʇÁÔ˘Ó Ó· ÂÎÙÂıÔ‡Ó Û ̛· Û¯¤ÛË ‹ Ó· ÙÔ˘˜ ··Û¯ÔÏ› ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ¿ ÙÔ˘˜ (Û ÂÚ›ÙˆÛË ·Ú·ÌÂÏË̤ÓÔ˘ ‰È·‚‹ÙË) ‹ οÔȘ ÏÈÔ‰˘ÛÙÚÔʛ˜ ÏfiÁˆ ÙˆÓ ÂÓ¤ÛˆÓ. ªÔÚ› Ó· ¤¯Ô˘Ó ÁÂÓÈÎfiÙÂÚË ‰˘ÛÎÔÏ›· ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ì›·˜ Û¯¤Û˘ Î·È Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙËÓ ·Ûı¤ÓÂÈ· ˆ˜ ÙÚfiÔ ·ÔÊ˘Á‹˜ Ù˘. ∏ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ·ÔÙÂÏ›, ›Û˘, ¤Ó· ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
ı¤Ì· Ô˘ ··Û¯ÔÏ› ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ™¢: “°È·Ù› Ó· οӈ ·È‰È¿; °È· Ó· ¤¯Ô˘Ó ÙÔ ›‰ÈÔ Úfi‚ÏËÌ· Ì Â̤ӷ;”. ∏ ‡·ÚÍË ÙÔ˘ ™¢ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÙÂÚÔÊ˘ÏÔÊÈÏÈ΋ Û¯¤ÛË ‰ËÌÈÔ˘ÚÁ› Êfi‚Ô˘˜ Î·È ¿Á¯Ô˜. ªÂÚÈÎÔ› ¤ÊË‚ÔÈ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó Â¿Ó Ô ™¢ ¤¯ÂÈ Û¯¤ÛË Ì ÛÂÍÔ˘·ÏÈο ÌÂÙ·‰È‰fiÌÂÓ· ÓÔÛ‹Ì·Ù·. ŒÙÛÈ, ¤Ó·˜ ¤ÊË‚Ô˜ ËÏÈΛ·˜ 17 ÂÙÒÓ ÚÒÙËÛÂ: “O ™¢ ÎÔÏÏ¿ÂÈ Ì ÙÔ ÛÂÍ;”. ∂›Ó·È ÛËÌ·ÓÙÈÎfi, ÏÔÈfiÓ, Ô ¤ÊË‚Ô˜ Ì ™¢ Ó· ÂÓı·ÚÚ˘Óı› fiÙÈ ÌÔÚ› Ó· ·ÓÙÂÂͤÏıÂÈ Û ̛· Û¯¤ÛË fiˆ˜ οıÂ Û˘ÓÔÌ‹ÏÈÎfi˜ ÙÔ˘, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· Ï¿‚ÂÈ ˘’ fi„ÈÓ ÙÔ˘ ÙË ÛËÌ·Û›· Ù˘ ˘ÁÈÂÈÓ‹˜ Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÂÚÈÔ¯‹˜ Î·È Ó· ÂÓËÌÂÚˆı› Ï‹Úˆ˜ ÙfiÛÔ ÁÈ· Ù· ÛÂÍÔ˘·ÏÈÎÒ˜ ÌÂÙ·‰È‰fiÌÂÓ· ÓÔÛ‹Ì·Ù· fiÛÔ Î·È ÁÈ· ÙȘ ÌÂıfi‰Ô˘˜ ·ÓÙÈÛ‡ÏÏ˄˘, fiˆ˜ Î·È Î¿ı ¿ÏÏÔ˜ Ó¤Ô˜ ‹ Ó¤· Ù˘ ËÏÈΛ·˜ ÙÔ˘. π‰È·›ÙÂÚ· ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚˆı› ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ ηٿ ‹ ÌÂÙ¿ ÙË ÛÂÍÔ˘·ÏÈ΋ Ú¿ÍË.
∞Ó›¯Ó¢ÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÚÔ‚ÏËÌ¿ÙˆÓ ∏ ÂÙ‹ÛÈ· È·ÙÚÈ΋ ÂͤٷÛË ÁÈ· ÙËÓ ÚfiÏË„Ë ÂÈÏÔÎÒÓ ‰ËÌÈÔ˘ÚÁ› ·ÈÛı‹Ì·Ù· ¿Á¯Ô˘˜ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÔÈ ÔÔ›ÔÈ ÌÔÚ› Ó· ÌËÓ ÚÔÛ¤Ú¯ÔÓÙ·È ÁÈ· ·˘Ùfi ÙÔÓ ÏfiÁÔ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· (28). £· Ú¤ÂÈ, ÏÔÈfiÓ, Ó· ‰›ÓÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙËÓ Ù·ÎÙÈ΋ ÚÔۤϢÛË ÙÔ˘ ÂÊ‹‚Ô˘ ÛÙ· Ú·ÓÙ‚ԇ ÙÔ˘. OÈ ¤ÊË‚ÔÈ Ô˘ ‰ÂÓ ÚÔÛ¤Ú¯ÔÓÙ·È ÁÈ· Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË, ¤¯Ô˘Ó ηÎfi ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô, ·Ó·Ù‡ÛÛÔ˘Ó ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ· Î·È ÚÔ¤Ú¯ÔÓÙ·È ·fi ÔÈÎÔÁ¤ÓÂȘ ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘, Ì ÈÛÙÔÚÈÎfi ‰È·˙˘Á›Ô˘ ‹ ¯ˆÚÈÛÌÔ‡ ‹ ÂÚÈ‚¿ÏÏÔÓ fiÔ˘ ÂÎÊÚ¿˙ÔÓÙ·È ·ÚÓËÙÈο Û˘Ó·ÈÛı‹Ì·Ù· (25). ™Ù· ÎÔÚ›ÙÛÈ· Ì ™¢ Ú¤ÂÈ Ó· ‰›ÓÂÙ·È ÌÂÁ·Ï‡ÙÂÚË ÚÔÛÔ¯‹ ÁÈ·Ù› ·ÔÚÚ˘ıÌ›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ ÙËÓ ÂÊ˂›· (26), ÂÓÒ fiÙ·Ó ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·Ù¿ıÏÈ„Ë ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·. ∏ ηٿıÏÈ„Ë Û ÂÊ‹‚Ô˘˜ Ì ™¢ ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰Èfi Ù˘, ·ÓÙÈÌÂÙˆ›ÛÙËΠÌfiÓÔ Û ÔÛÔÛÙfi 35% (27). OÈ ¤ÊË‚ÔÈ Ì ™¢ ¤¯Ô˘Ó ¿Á¯Ô˜ ÁÈ· ÙËÓ ˘ÔÁÏ˘Î·ÈÌ›·. ∂ΛÓÔÈ Ô˘ ÊÔ‚Ô‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ¤¯Ô˘Ó ¯ÂÈÚfiÙÂÚÔ ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô (22) Î·È ı· Ú¤ÂÈ Èı·ÓÒ˜ Ó· ÂÎ·È‰Â˘ÙÔ‡Ó ÁÈ· Ó· ÙÔÓˆı› Ë ·˘ÙÔÂÔ›ıËÛ‹ ÙÔ˘˜ Î·È ÁÈ· Ó· ÌÔÚÔ‡Ó Ó· Ï·Ì‚¿ÓÔ˘Ó ÚÔÏËÙÈο ̤ÙÚ·, ¤ÁηÈÚ·, fiÙ·Ó ·ÓȯÓ¢ı› (28). OÈ ¤ÊË‚ÔÈ ¯ÚÂÈ¿˙ÂÙ·È Ó· ·Ó·Ï¿‚Ô˘Ó Ì¤ÚÔ˜
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Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ™¢, fi¯È fï˜ ÙÔ Û‡ÓÔÏfi Ù˘. ŸÙ·Ó ·Ó·Ï·Ì‚¿ÓÔ˘Ó ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ÙËÓ Â˘ı‡ÓË, Ô ÌÂÙ·‚ÔÏÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È ¯ÂÈÚfiÙÂÚÔ˜ (29). √È ¤ÊË‚ÔÈ Ô˘ ÂÈÛ¿ÁÔÓÙ·Ó Û˘¯Ó¿ ÛÙ· ÓÔÛÔÎÔÌ›· Ì ÎÂÙÔͤˆÛË, ‰ÂÓ Â›¯·Ó ÊÚÔÓÙ›‰· ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ÁÈ· ÙÔÓ ™¢. °ÔÓ›˜ Î·È ¤ÊË‚ÔÈ ı· Ú¤ÂÈ Ó· ÂÛÙÈ¿ÛÔ˘Ó ÙËÓ ÚÔÛÔ¯‹ ÙÔ˘˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ Ù˘ ÊÚÔÓÙ›‰·˜ Î·È ÛÙÔÓ ‚·ıÌfi ·Ó¿ÌÂÈ͢ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· Ó· ÂÈÙ¢¯ı› Ì›· ÛˆÛÙ‹ ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ (28). ™ÎÔfi˜ Â›Ó·È Ë ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ·Ó¿ÌÂÈ͢ ÙÔ˘ ÁÔÓ¤· Ì ÙËÓ ·‡ÍËÛË Ù˘ ˘Â˘ı˘ÓfiÙËÙ·˜ ÙÔ˘ ÂÊ‹‚Ô˘. ∏ Û¯¤ÛË Ì ÙËÓ È·ÙÚÈ΋ ÔÌ¿‰· Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ÚfiÏÔ ÁÈ· ÙÔÓ Î·Ïfi ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô (30). ™‡Ìʈӷ Ì ̛· ÌÂϤÙË (31), Ë ·ÓÙ›ÏË„Ë ÙÔ˘ ÂÊ‹‚Ô˘ ÁÈ· ÙȘ ÚÔÛˆÈΤ˜ ȉÈfiÙËÙ˜ ÙÔ˘ ÁÈ·ÙÚÔ‡ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙË Û˘ÌÂÚÈÊÔÚ¿ Ù‹ÚËÛ˘ Ù˘ ·ÁˆÁ‹˜, ÂÓÒ ÔÈ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÁÈ·ÙÚÔ‡ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ Ù‹ÚËÛË Ù˘ ·ÁˆÁ‹˜. ™Â Ì›· ¿ÏÏË ÌÂϤÙË, ÔÈ Ó¤ÔÈ Ô˘ ÂÚȤÁÚ·„·Ó ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙȘ ÓÔÛËχÙÚȘ ˆ˜ Úfiı˘ÌÔ˘˜ Ó· ÙÔ˘˜ ÎÈÓËÙÔÔÈ‹ÛÔ˘Ó, ÂÊ¿ÚÌÔ˙·Ó Ì ÙÔÓ Î·Ï‡ÙÂÚÔ ÙÚfiÔ ÙËÓ ·ÁˆÁ‹, ÂÓÒ ÂΛÓÔÈ Ô˘ ÙÔ˘˜ ¤‚ÏÂ·Ó ·Úfiı˘ÌÔ˘˜ ·¤Ó·ÓÙ› ÙÔ˘˜ ÂÌÊ¿ÓÈ˙·Ó ÂÏÏÈ‹ ·˘Ùԉȷ¯Â›ÚÈÛË Ù˘ ·ÁˆÁ‹˜ ÙÔ˘˜ (32).
æ˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË O ÂȉÈÎfi˜ Ú¤ÂÈ Ó· ·ÎÔ‡ÂÈ ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ™¢, ηıÒ˜ Ë ¤ÎÊÚ·ÛË Ù˘ ·ÁˆÓ›·˜ ÙÔ˘˜ ηı·˘Ù‹ Â›Ó·È ıÂڷ¢ÙÈ΋ ÁÈ’ ·˘ÙÔ‡˜. ∂›Û˘, ¯ÚÂÈ¿˙ÂÙ·È Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÔÏϷϤ˜ ÛÙÚ·ÙËÁÈΤ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‚ÔËıËıÔ‡Ó ÔÈ ¤ÊË‚ÔÈ ·˘ÙÔ› ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜. ª›· ·fi ÙȘ ıÂڷ¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Ó·È Ë Â·‡ÍËÛË ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ ÙÔ˘ ÂÊ‹‚Ô˘, ÒÛÙ ӷ ÌÔÚ› Ó· ·ÓÙÈÛÙ·ı› ÛÙËÓ ›ÂÛË ‹ ÙËÓ ÂÈÚÚÔ‹ ·fi ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ (33). ™ÙËÓ „˘¯ÔıÂڷ›· „˘¯Ô‰˘Ó·ÌÈÎÔ‡ Ù‡Ô˘, Ô ¤ÊË‚Ô˜ ı· ÂÓı‹ÛÂÈ ÁÈ· ÙË ¯·Ì¤ÓË ÙÂÏÂÈfiÙËÙ· Ù˘ ˘Á›·˜ ÙÔ˘. ∞˘Ù‹ Ë ‰È·‰Èηۛ· ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙËÓ Î·Ù¿ıÏÈ„Ë, ·ÏÏ¿ Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô. O „˘¯›·ÙÚÔ˜, ›Û˘, ı· ‚ÔËı‹ÛÂÈ ÙÔÓ ¤ÊË‚Ô Ì ™¢ ÛÙË ‰È·‰Èηۛ· ·ÓÂÍ·ÚÙËÙÔÔ›ËÛ˘ Î·È ÂÍ·ÙÔÌ›Î¢Û˘. ¶·Ú¿ÏÏËÏ·, Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË Ë Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÛÙÔ˘˜ ÁÔÓ›˜, ÒÛÙ ӷ ÌÂȈı› ÙÔ ¿Á¯Ô˜ ·Ô¯ˆÚÈÛÌÔ‡ Ô˘ ÓÈÒıÔ˘Ó Î·È Ó· ÂÈÙÚ¤„Ô˘Ó ÛÙÔ ·È‰› Ó· ‰ÔÎÈÌ¿ÛÂÈ Ó¤· Ú¿ÁÌ·Ù·, ·Ú¿ ÙÔÓ Êfi‚Ô Ù˘ ˘ÔÁÏ˘Î·È-
Ì›·˜ Ô˘ ÙÔ˘˜ ΢ÚȇÂÈ. £· Ú¤ÂÈ Ó· ÏËÊı› ˘’ fi„ÈÓ fiÙÈ ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ Ó· ÛÙ·Ì·Ù‹ÛÔ˘Ó ÙÂÏ›ˆ˜ ÙÔÓ ¤ÏÂÁ¯Ô, ηıÒ˜ Û ÂÚ›ÙˆÛË ·Ù˘¯‹Ì·ÙÔ˜ ı· ¤¯Ô˘Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÙfiÛÔ ÙȘ ÂÓÔ¯¤˜ ÙÔ˘˜ fiÛÔ Î·È ÙËÓ ÎÚÈÙÈ΋ ÙˆÓ ¿ÏψÓ.
∏ ÂÈÏË„›· ÛÙËÓ ÂÊ˂›·. æ˘¯ÔÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù· £. ∫Ô‚¿Ó˘ ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÂÈÏË„›·˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î˘Ì·›ÓÂÙ·È ·fi 1,5% ¤ˆ˜ 2%. ¶·ÁÎÔÛÌ›ˆ˜ 50 ÂηÙÔÌ̇ÚÈ· ¿ÓıÚˆÔÈ ¤¯Ô˘Ó ÂÈÏË„›·, 85% ÂÎ ÙˆÓ ÔÔ›ˆÓ ηÙÔÈΛ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ (1). ¢È¿ÊÔÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ·ÌÊÈÛ‚ËÙ‹ÛÈÌ· ·ÔÙÂϤÛÌ·Ù· Û¯ÂÙÈο Ì ÙÔ Â¿Ó Ë ÂÊ˂›· Â›Ó·È ‹ fi¯È ·Ú¿ÁÔÓÙ·˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. ∂›Ó·È Û›ÁÔ˘ÚÔ fiÙÈ ÔÈ ÎÚ›ÛÂȘ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ ÛÙËÓ ·È‰È΋ ·’ fi,ÙÈ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· (2), ÂÎÙfi˜ Â¿Ó ·Ú¯›˙Ô˘Ó ÛÙËÓ ÂÊ˂›·. OÈ Û˘¯ÓfiÙÂÚ˜ ÂÈÏË„›Â˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· Â›Ó·È ÔÈ ·ÎfiÏÔ˘ı˜: Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜, ·Ê·ÈÚ¤ÛÂȘ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜, Ì˘ÔÎÏÔӛ˜ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Î·È ·Ê·ÈÚ¤ÛÂȘ - Û‡Ó‰ÚÔÌÔ Jeavons, ÂÈÏË„›· Ì ÁÂÓÈÎÂ˘Ì¤Ó˜ ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÎÚ›ÛÂȘ ηٿ ÙËÓ ·Ê‡ÓÈÛË, ʈÙÔ¢·›ÛıËÙ˜ ÂÈÏË„›Â˜ Î·È ÂÈÏË„›· ÙÔ˘ ¤Ûˆ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë Î·Ï‡ÙÂÚË ÁÓÒÛË ÙˆÓ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ¤¯ÂÈ ‚ÔËı‹ÛÂÈ ÛÙË ·Ó·Î¿Ï˘„Ë Ó¤ˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, Ù· ÔÔ›· ¤¯Ô˘Ó Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ó·‚¿ıÌÈÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÓıÚÒˆÓ Ì ÂÈÏË„›·. ¶·Ú’ fiÏ· ·˘Ù¿, ·ÎfiÌË Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚÔ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ÛÙÔÓ ÎfiÛÌÔ, ˘¿Ú¯Ô˘Ó ÊÚ·ÁÌÔ› fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Âη›‰Â˘ÛË, ÙËÓ ÂÚÁ·Û›· Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ. °›ÓÂÙ·È, ÂÔ̤ӈ˜, fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÂÈÙ·ÎÙÈÎfi fiÙ·Ó ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ¤Ó· ¿ÙÔÌÔ Ì ÂÈÏË„›· Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ·Ú¿ÏÏËÏ· Ì ÙÔ ıÂڷ¢ÙÈÎfi ÎÔÌÌ¿ÙÈ, Ë ÔÈÎÔÁ¤ÓÂÈ·, ÔÈ „˘¯ÔÏÔÁÈΤ˜ Î·È „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÔÈ ÎÔÈÓˆÓÈÎÔ› Î·È ÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜. ™Ù· ÓÂfiÙÂÚ· ¿ÙÔÌ· Ì ÂÈÏË„›·, ÛÙȘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÚÔÛÙ›ıÂÓÙ·È Î·È ÔÈ ‰˘ÛÎÔϛ˜ Ô˘ ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
Pediatr July-Aug 05 new
22-07-05
12:16
™ÂÏ›‰·316
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ª. §È·ÎÔÔ‡ÏÔ˘ Î·È Û˘Ó.
ËÁ¿˙Ô˘Ó ·fi ÙȘ ‰È·Ù·Ú·Á̤Ó˜ - ÏfiÁˆ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ - Û¯¤ÛÂȘ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È Ù· ·‰¤ÚÊÈ·. ∆· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÎfiÌË Î·È ÛÙ· ¿ÙÔÌ· Ô˘ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÓÔËÌÔÛ‡ÓË Î·È ÙˆÓ ÔÔ›ˆÓ ÔÈ ÎÚ›ÛÂȘ Â›Ó·È ·fiÏ˘Ù· Ú˘ıÌÈṲ̂Ó˜. ∞˘Ù¤˜ ÔÈ ·Ï¤˜ ‰È·ÈÛÙÒÛÂȘ ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ì›· ÂÈÙ˘¯Ë̤ÓË ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ Â·ÚΛ ÁÈ· Ó· ÚÔÛٷهÛÂÈ Ù· ¿ÙÔÌ· Ì ÂÈÏË„›· ·fi Ù· „˘¯ÔÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù·, ·ÏÏ¿ Â›Ó·È ··Ú·›ÙËÙË Ë Û˘Ì‚Ô˘Ï‹ ÙÔ˘ ÂȉÈÎÔ‡ ÁÈ·ÙÚÔ‡ Î·È - fiÙ·Ó ··ÈÙÂ›Ù·È - ÙˆÓ ÂȉÈÎÒÓ „˘¯È΋˜ ˘Á›·˜.
∆· ÚÔ‚Ï‹Ì·Ù· Ù˘ ‰È¿ÁÓˆÛ˘ ªÂ ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ·, ÔÈ ÁÔÓ›˜ ÂÎÊÚ¿˙Ô˘Ó ÙËÓ ·ÓËÛ˘¯›· ÁÈ· ÙÔ Ì¤ÏÏÔÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ™˘¯Ó¿ ·Ó·ÚˆÙÈÔ‡ÓÙ·È ÁÈ· Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ı· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙÔ ·È‰› ÙÔ˘˜ ÛÙÔ Û¯ÔÏ›Ô, ÙÔÓ ÎÔÈÓˆÓÈÎfi ·ÓÙ›ÎÙ˘Ô Î·È Â¿Ó ÙÔ ·È‰› ÙÔ˘˜ ÌÔÚ› Ó· ·ÓÙÚ¢Ù›, Ó· ÙÂÎÓÔÔÈ‹ÛÂÈ, Ó· Ô‰ËÁ‹ÛÂÈ ·˘ÙÔΛÓËÙÔ ‹ ·ÎfiÌË Î·È Ó· ÂÚÁ·ÛÙ›. ∂›Ó·È, ÂÔ̤ӈ˜, ÚˆÙ·Ú¯È΋ ·Ó¿ÁÎË Ó· ÂÎÙÈÌ‹ÛÂÈ Ô ÁÈ·ÙÚfi˜ ÛˆÛÙ¿ ÙËÓ Î·Ù¿ÛÙ·ÛË Î·È Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Ì ·ÎÚ›‚ÂÈ· ÙËÓ ÂÈÏË„›· ‹ ÙÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ, ÒÛÙ ӷ ‰ÒÛÂÈ ÙË ÛˆÛÙ‹ ·ÁˆÁ‹ Î·È Ó· ı¤ÛÂÈ ÛˆÛÙ¿ ÙËÓ ÚfiÁÓˆÛË (3). ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ·Î·Ù¿ÏÏËÏË ‹ ·Ó·Ú΋˜ ıÂڷ›·, Ô ÂÏÏÈ‹˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛˆÓ, Ë ‰È¿ÚÎÂÈ· Ù˘ ÂÈÏË„›·˜ Î·È Ë ÔÏ˘ıÂڷ›·, Â›Ó·È ˘Â‡ı˘ÓÔÈ ÁÈ· Ù· ÂÚÈÛÛfiÙÂÚ· „˘¯ÔÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ‰È·¯ÚÔÓÈο ÛÙ· ¿ÙÔÌ· Ì ÂÈÏË„›·. OÈ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ÊÏÔÈÔ‡ ÔÈΛÏÏÔ˘Ó ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Î·È Û˘Ì‚¿ÏÏÔ˘Ó ÛËÌ·ÓÙÈο ÛÙËÓ „˘¯Ôۈ̷ÙÈ΋ ÓÔÛËÚfiÙËÙ·. ∆· ÚÔ‚Ï‹Ì·Ù· Ù˘ ÂÊ˂›·˜ OÈ ¤ÊË‚ÔÈ ·ÔÎÙÔ‡Ó ¤Ó·Ó ·ÓÂÍ¿ÚÙËÙÔ ÙÚfiÔ ÛΤ„˘ Ô˘ ·ÓÙ·Ó·ÎÏ¿ ÛÙȘ Û¯¤ÛÂȘ ÙÔ˘˜ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙËÓ ÎÔÈÓˆÓ›·. ¶ÚÔÙÈÌÔ‡Ó Ó· ‚Á·›ÓÔ˘Ó ¤Íˆ Ì ʛÏÔ˘˜, Ó· ÍÂÓ˘¯ÙÔ‡Ó, Ó· ηӛ˙Ô˘Ó, Ó· ›ÓÔ˘Ó, Ó· ‰ËÌÈÔ˘ÚÁÔ‡Ó Ó¤Â˜ Û¯¤ÛÂȘ, Ó· οÓÔ˘Ó ¤ÚˆÙ· Î·È - Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ - Ó· οÓÔ˘Ó ¯Ú‹ÛË ··ÁÔÚÂ˘Ì¤ÓˆÓ Ô˘ÛÈÒÓ. ™˘¯Ó¿ οÓÔ˘Ó Ì·ÎÚÈÓ¿ Ù·Í›‰È· Ô˘ Ô‰ËÁÔ‡Ó Û ¤ÏÏÂÈ„Ë ‡ÓÔ˘, Ë ÔÔ›· Û ÔÚÈṲ̂ӷ ¿ÙÔÌ· ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. O ÂȉÈÎfi˜ È·ÙÚfi˜ ÔÊ›ÏÂÈ Ó· ¤¯ÂÈ ÙȘ ··Ú·›ÙËÙ˜ ÁÓÒÛÂȘ ÒÛÙ ӷ Û˘Ì‚Ô˘Ï‡ÛÂÈ ÛˆÛÙ¿ ÙÔÓ ¤ÊË‚Ô Û¯ÂÙÈο Ì ÙËÓ ·fiÎÙËÛË ¶·È‰È·ÙÚÈ΋ 2005;68:308-319
¿‰ÂÈ·˜ Ô‰‹ÁËÛ˘, ÙÔ Ò˜ Ô ‡ÓÔ˜ ÂËÚ¿˙ÂÈ ÙȘ ÎÚ›ÛÂȘ Î·È ÔÈ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ÂËÚ¿˙Ô˘Ó ÙË ‰Ú¿ÛË ÙˆÓ ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ ¯·ÈÒÓ, Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡Ó Ù· ÎÔÚ›ÙÛÈ· Ì ÂÈÏË„›·. ∆Ô Î¿ÓÈÛÌ·, Ô Î·Ê¤˜, Ë Ì¤ÙÚÈ· ηٷӿψÛË ·ÏÎÔfiÏ Î·È ÔÈ ‹È˜ ··ÁÔÚÂ˘Ì¤Ó˜ Ô˘Û›Â˜ (.¯. Ì·ÚÈ¯Ô˘¿Ó·) ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÚÔηÏÔ‡Ó ÎÚ›ÛÂȘ. OÈ ÁÔÓ›˜, ·fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ı¤ÙÔ˘Ó Î·ÓfiÓ˜ Î·È ÂÚÈÔÚÈÛÌÔ‡˜, ÔÈ ÔÔ›ÔÈ ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ÂÈÏË„›·˜ Â›Ó·È ·˘ÍË̤ÓÔÈ Î·È ·˘ÛÙËÚÔ›, ΢ڛˆ˜ fiÙ·Ó Ë ÂÈÏË„›· ·Ú¯›˙ÂÈ Î·Ù¿ ÙËÓ ÂÊ˂›·. OÈ ¤ÊË‚ÔÈ Ì ÂÈÏË„›· ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÔ˘Ó ·Ó¿ÚÌÔÛÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ·ÓÙȉڷÛÙÈÎfiÙËÙ·. ∆· Ê¿Ú̷η Á›ÓÔÓÙ·È ÂÌfi‰ÈÔ ÛÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ ÙÔ˘˜, ÁÈ’ ·˘Ùfi ÂȯÂÈÚÔ‡Ó Ó· ÌËÓ Ù· Ï·Ì‚¿ÓÔ˘Ó. ∂ÈϤÔÓ, ÔÈ ¤ÊË‚ÔÈ Û˘¯Ó¿ ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ÙȘ ‹È˜ ÎÚ›ÛÂȘ ·fi ÙÔÓ Êfi‚Ô ·‡ÍËÛ˘ Ù˘ ‰ÔÛÔÏÔÁ›·˜. ∫¿ÓÔ˘Ó ÔÙȉ‹ÔÙÂ Â›Ó·È ‰˘Ó·ÙfiÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌËÓ ·ÔÚÚÈÊıÔ‡Ó ·fi ÙÔ˘˜ Ê›ÏÔ˘˜ ÙÔ˘˜ Î·È ¤ÙÛÈ ·˘Í¿ÓÂÙ·È Ë ÂÍ¿ÚÙËÛ‹ ÙÔ˘˜ ·fi ·˘ÙÔ‡˜. ŸÛÔÈ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› ÚfiÛÊ·Ù·, Û˘¯Ó¿ ·ÚÓÔ‡ÓÙ·È ÙË ‰È¿ÁÓˆÛË Î·È ÙË ıÂڷ›·. ∏ ÙÂÏÂ˘Ù·›· ‰ÂÓ Â›Ó·È ¿ÓÙ· ··Ú·›ÙËÙË, ȉȷ›ÙÂÚ· fiÙ·Ó ÔÈ ÎÚ›ÛÂȘ Â›Ó·È ·Ú·È¤˜ ‹ ÚÔηÏÔ‡ÓÙ·È ·fi ÁÓˆÛÙÔ‡˜ ·Ú¿ÁÔÓÙ˜. OÈ ¤ÊË‚ÔÈ Ì ÂÈÏË„›· ÂÈı˘ÌÔ‡Ó Ó· ·ÔÎÙ‹ÛÔ˘Ó ¿‰ÂÈ· Ô‰‹ÁËÛ˘ (4,5) Î·È ÂȉÈÒÎÔ˘Ó Ó· ÂÚÁ·ÛÙÔ‡Ó. ™˘¯Ó¿ Û˘˙ËÙÔ‡Ó ÁÈ· ÙÔ Ì¤ÏÏÔÓ, ÙËÓ ·ÓÙÈÛ‡ÏÏË„Ë, ÙÔÓ Á¿ÌÔ, ÙËÓ ÙÂÎÓÔÔ›ËÛË, ·ÏÏ¿ Î·È ÙËÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· Ù˘ ÂÈÏË„›·˜.
∏ ·ÓÙÈÌÂÙÒÈÛË ·fi ÙÔÓ ÂȉÈÎfi ÁÈ·ÙÚfi O ÂȉÈÎfi˜ ÁÈ·ÙÚfi˜ ÔÊ›ÏÂÈ Ó· ÁÓˆÚ›˙ÂÈ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ÎÚ›ÛÂȘ, fiˆ˜ Ë ¤ÏÏÂÈ„Ë ‡ÓÔ˘, Ë ÔÔ›· ˘Ô‰ËÏÒÓÂÈ fiÙÈ ÙÔ ¿ÙÔÌÔ Ú¤ÂÈ Ó· ÂÚÁ¿˙ÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. ∂›Û˘, ÙÔ ¿ÙÔÌÔ Ì ʈÙÔ¢·›ÛıËÙË ÂÈÏË„›·, Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÂÈ ıÂڷ›· ‹ ÂΛÓÔ Ô˘ ‰ÂÓ ¤¯ÂÈ ÂÏÂÁ¯ı› Ï‹Úˆ˜, Ú¤ÂÈ Ó· ·ÔʇÁÂÈ ÂÚÁ·ÛÈ·ÎÔ‡˜ ¯ÒÚÔ˘˜ Ì ‰È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·. ∂Ô̤ӈ˜, ÁÈ· ÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ·ÔηٿÛÙ·ÛË, Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ ÙÔ Û‡Ó‰ÚÔÌÔ, ÙÔ Â›‰Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ Î·È ÙË Û˘¯ÓfiÙËÙ·, ÙȘ Ù˘¯fiÓ ·ÚÔÂȉÔÔ›ËÙ˜ ÙÒÛÂȘ, ÙË ‰ÔÌ‹ ÙÔ˘ ÂÚÁ·ÛÈ·ÎÔ‡ ¯ÒÚÔ˘ Î·È ÙÔ ÓÔÌÈÎfi Ï·›ÛÈÔ Ô˘ ÈÛ¯‡ÂÈ ÁÈ· ÙË Û¯ÂÙÈ΋ ‹ ·fiÏ˘ÙË ·ÓÙ¤Ó‰ÂÈÍË ‰È·ÊfiÚˆÓ Â·ÁÁÂÏÌ¿ÙˆÓ. ∂›Ó·È ‚¤‚·ÈÔ fiÙÈ Ù· ¿ÙÔÌ· Ì ÂÈÏË„›· ÌÔÚÔ‡Ó Ó· οÓÔ˘Ó ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜,
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·ÊÔ‡ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Ë ·fi‰ÔÛ‹ ÙÔ˘˜ ‹ Ù· ·Ù˘¯‹Ì·Ù¿ Ô˘ ÛËÌÂÈÒÓÔÓÙ·È Â›Ó·È ·ÚfiÌÔÈ· ÙˆÓ ·ÓıÚÒˆÓ ¯ˆÚ›˜ ÂÈÏË„›· (6-8). ¶·Ú’ fiÏ· ·˘Ù¿, Ë ÚÔÛ·ÚÌÔÛÙÈÎfiÙËÙ· ÛÙÔÓ ÂÚÁ·ÛÈ·Îfi ¯ÒÚÔ ÙˆÓ ·ÙfiÌˆÓ Ì ÂÈÏË„›· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË, ÏfiÁˆ Ù˘ ‰È·¯ÚÔÓÈ΋˜ ¿ıÚÔÈÛ˘ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÔÈ ‰˘ÛÎÔϛ˜ ÛÙÔ Û¯ÔÏ›Ô, ÔÈ „˘¯ÔÏÔÁÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‹ ÚÔ‚Ï‹Ì·Ù·, Ë ·Ó·ÛÊ¿ÏÂÈ·, Ô Êfi‚Ô˜ Ù˘ ·ÔÙ˘¯›·˜, Ë ¤ÏÏÂÈ„Ë ÂÌÈÛÙÔÛ‡Ó˘, Ë ‚Ú·‰‡ÙËÙ· Ù˘ ÛΤ„˘ Î.Ï.
∏ Ú·ÁÌ·ÙÈÎfiÙËÙ· ∏ ÂÈÏË„›· ıˆÚÂ›Ù·È ÎÔÈÓˆÓÈÎfi ÛÙ›ÁÌ·, ·ÎfiÌË Î·È ÛÙȘ ÈÔ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ÛÙÔÓ ÎfiÛÌÔ. ™ÙË ÓÔÌÔıÂÛ›·, Ë ÂÈÏË„›· ÂÎÙÈÌ¿Ù·È ÛÊ·ÈÚÈο Î·È ‰ÂÓ ÂÍÂÙ¿˙ÔÓÙ·È ÔÈ ‰È¿ÊÔÚ˜ ÂÚÈÙÒÛÂȘ ÌÂÌÔӈ̤ӷ. ŒÙÛÈ, ··ÁÔÚ‡ÔÓÙ·È ÔÚÈṲ̂ӷ ·ÁÁ¤ÏÌ·Ù·, fiˆ˜ ÈÏfiÙÔ˜ Î·È Ô‰ËÁfi˜ ÙÚ¤ÓÔ˘ ‹ ψÊÔÚ›Ԣ, Ë Â·ÁÁÂÏÌ·ÙÈ΋ ·ÔηٿÛÙ·ÛË ÛÙÔÓ ÛÙÚ·Ùfi ‹ ÙËÓ ·ÛÙ˘ÓÔÌ›· Î·È Ë ¯ÔÚ‹ÁËÛË ¿‰ÂÈ·˜ Ô‰‹ÁËÛ˘ ηÙËÁÔÚ›·˜ ππ. °È· ÌÂÚÈΤ˜ ÂÚÁ·Û›Â˜, Ë ··ÁfiÚ¢ÛË Â›Ó·È Û¯ÂÙÈ΋, fiˆ˜ ÁÈ· ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ‹ ÛÙËÓ È·ÙÚÈ΋. ∂›Ó·È ·Ó·Áη›Ô, ÏÔÈfiÓ, Ó· ÂÎ·È‰Â˘ÙÔ‡Ó ÔÈ È·ÙÚÔ›, ÔÈ ÓÔÛËÏÂ˘Ù¤˜, ÔÈ ÂÎ·È‰Â˘Ù¤˜, ÔÈ ÂÚÁÔ‰fiÙ˜, ÔÈ ÂÎ·È‰Â˘fiÌÂÓÔÈ Î·È ÔÏfiÎÏËÚË Ë ÎÔÈÓˆÓ›· Û¯ÂÙÈο Ì ÙËÓ ÂÈÏË„›·, ·ÏÏ¿ Î·È Ó· ¤ÏıÔ˘Ó ÛÙÔ Êˆ˜ ·Ú·ÓÔ‹ÛÂȘ, ÚÔÛ‰Ô˘ Î·È ·Ó¿ÁΘ ÒÛÙÂ Ë ÚÔÛ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ Ó· Â›Ó·È Ë Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹.
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æ˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ÂÊ‹‚Ô˘ Ì ·ÈÌÔÚÚÔÊÈÏ›· Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘ 1. Brocker-Vriends AHJT. Genetics of haemophilia. The contribution of DNA analysis. University of Leiden: Pasmans Offsetdrukkerij b.v. Gravenhage; 1990. 2. Koumbarelis E, Rosendaal FR, Gialeraki A, Karafoulidou A, Noteboom WM, Loizou C et al. Epidemiology of haemophilia in Greece: an overview. Thromb Haemost 1994;72:808-813. 3. Rodriguez-Merchan EC, Goddard NJ, Lee CA. Musculoskeletal aspects of haemophilia. 1st ed. Oxford, UK: Blackwell Science; 2000. 4. Mannucci PM. Hemophilia and related bleeding disorders: a story of dismay and success. Hematology 2002;1-9. 5. Berntorp E, Boulyjenkov V, Brettler D, Chandy M, Jones P, Lee C et al. Modern treatment of haemophilia. Bull World Health Organ 1995;73:691-701. 6. Medical and Scientific Advisory Counsil, MASAC. Recommendations Concerning Prophylaxis. Medical Bulletin 193 (chapter advisory 197); 1994. 7. Busing R, Johnson SB. Psychosocial issues in hemophilia before and after the HIV crisis: a review of current research. Gen Hosp Psychiatry 1992;14:287-403. 8. Arranz P, Costa M, Bayes R, Cancio H, Magalion M, Hernandez F. Emotional support in hemophilia. 1st ed. World Federation of Hemophilia; 1999. 9. ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘ ∂. °ÔÓÂ˚΋ ÂÍ¿ÚÙËÛË, ÎÔÈÓˆÓÈ΋ ÚÔÛ·ÚÌÔÁ‹ Î·È ÂÈıÂÙÈÎfiÙËÙ· ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·È‰ÈÒÓ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1984. 10. Madden NA, Terrizzi J, Friedman SB. Psychological issues in mothers of children with hemophilia. J Dev Behav Pediatr 1982;3:136-142. 11. Fletcher M. The impact of haemophilia on the patient and family. In: Rizza C, Lowe G, editors. Haemophilia and other inherited bleeding disorders. London: W.B. Saunders; 1997. p. 407-419. 12. Vugia HD. Support groups in oncology: building hope through the human bond. J Psychosoc Oncol 1991;9:89-104. 13. Mattsson A, Gross S. Adaptational and defensive behavior in young hemophiliacs and their parents. Am J Psychiatry 1966;122:1349-1356.
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The adolescent with a chronic medical problem and his family M. Liakopoulou1, E. Platokouki - Komitopoulou2, C. Kanaka - Gantenbein3, T. Alifieraki1, M. Koutsanelou - Meyer2, T. Kovanis4 1 Clinic of Paediatric Psychiatry, “Aghia Sophia” Children’s Hospital, Athens 2 Bleeding Disorder Unit, “Aghia Sophia” Children’s Hospital, Athens 3 1st Paediatric Clinic of the University of Athens, “Aghia Sophia” Children’s Hospital, Athens 4 Neurology Clinic, “Aghia Sophia” Children’s Hospital, Athens Correspondence: Magda Liakopoulou Clinic of Paediatric Psychiatry, “Aghia Sophia” Children’s Hospital 115 27, Athens Date of submission: 28-11-2003 Date of approval: 07-06-2005
Abstract Adolescence is characterized by the process of becoming an independent individual. For the adolescent with chronic illness, the illness, the individual himself and his parents all become obstacles to this process. In addition, the adolescent’s sexuality creates anxiety, which can be alleviated by the specialist who answers his questions in a knowledgeable way. Several paradigms of chronic illness and their interaction with adolescence are described. In support groups for parents of children with chronic illness a variety of issues, such as the mother’s remorse, parental overprotection and facilitation of the adolescent’s developmental goals are worked through. Specific illnesses are associated with special problems. Adolescents with haemophilia may hide episodes of bleeding, because of fear of loss of independence. Bleeding in the genitals, in particular, gives rise to anxiety. Their parents learn to handle more effectively their children’s reactions through participation in the parents’ group. Cystic fibrosis is the most frequent chronic childhood disease for people of the white race. Patients live today up to the age of 25-30 years and need support during adolescence for the achievement of a better quality of life. The frequency of diabetes mellitus type I is increasing worldwide. Preschool children and adolescents are mostly affected. Adolescent girls with diabetes more frequently have poor metabolic control, and if they become depressed they have a relapse more often than boys. Maternal psychopathology at the time of onset of the child’s diabetes increases the likelihood of appearance of psychiatric disorder in the adolescent with diabetes. Maternal depression is a risk factor for depression in these adolescents. Certain epileptic syndromes, such as the absences of childhood, disappear in adolescence and others, such as temporal lobe epilepsy, make their appearance. Adolescents with epilepsy avoid mentioning epileptic episodes for fear of medication increase. Adolescents with epilepsy are in particular need of job counselling. The physician who is monitoring the adolescent with a chronic medical problem and his family should have good knowledge of the problem and should actively participate in issues concerning quality of life and professional orientation. Key words Adolescence, haemophilia, cystic fibrosis, diabetes mellitus, epilepsy.
Paediatriki 2005;68:320
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∞ÁfiÚÈ ÙÂÏÂÈfiÌËÓÔ, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3800 g, ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi, ·ÏÏ¿ ‰‡ÛÎÔÏÔ ÙÔÎÂÙfi. ∆Ô Apgar score ‹Ù·Ó 3, 7 Î·È 8 ÛÙÔ 1Ô, 5Ô Î·È 10Ô ÏÂÙfi ˙ˆ‹˜, ·ÓÙ›ÛÙÔȯ·. ∆Ô ÓÂÔÁÓfi ¯ÚÂÈ¿ÛÙËΠ·Ó¿ÓË„Ë Ì ·ÛÎfi Î·È Ì¿Ûη, ÛÙË Û˘Ó¤¯ÂÈ· fï˜ Ë Î·Ù¿ÛÙ·Û‹ ÙÔ˘ ‚ÂÏÙÈÒıËÎÂ. ◊Ù·Ó ·ÚÙÈÌÂϤ˜, ¯ˆÚ›˜ ÂÌÊ·Ó›˜ ·ÓˆÌ·Ï›Â˜ Î·È Ë ·ÓÙÈÎÂÈÌÂÓÈ΋ ÙÔ˘ ÂͤٷÛË ‹Ù·Ó ∫º. ∆Ô Ì·È¢ÙÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚ·. ∆ËÓ 3Ë Ë̤ڷ ÙÔ ‚Ú¤ÊÔ˜ ÂÌÊ¿ÓÈÛ ÂͤڢıÚË ÂÒ‰˘ÓË Ô˙Ò‰Ë Ì¿˙· ÛÙË Ú¿¯Ë, ‰È·Ì¤ÙÚÔ˘ 8 cm (∂ÈÎfiÓ· 1). ªÂ ÙËÓ ˘Ô„›· Ù˘ Ïԛ̈͢ ÂÏ‹ÊıË Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ Î·È ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È ¯ÔÚËÁ‹ıËΠ‰ÈÏfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· (ÙÂ˚ÎÔÏ·Ó›ÓË Ì ÓÂÙÚÔÌ˘Î›ÓË ÂÓ‰ÔÊÏ‚›ˆ˜). ∏ ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ¤‰ÂÈÍÂ: ·ÈÌÔÛÊ·ÈÚ›ÓË 15,8 g, ÏÂ˘Î¿ 14.000, ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 6.000, ·ÈÌÔÂÙ¿ÏÈ· 320.000, ·Ú¿ÁÔÓÙ˜ ‹Í˘ Ê˘ÛÈÔÏÔÁÈÎÔ›. ∆Ô ÔÏÈÎfi ·Û‚¤ÛÙÈÔ ‹Ù·Ó 11,2 mg/dL (ÈÔÓÙÈṲ̂ÓÔ 6,2 mg), Ë 1,25-˘‰ÚÔ͢‚ÈÙ·Ì›ÓË D 160 pmol/L (Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜: 40-140 pmol) Î·È Ë ·Ú·ıÔÚÌfiÓË <1,0
∂ÈÎfiÓ· 1.
pmol. ∆· ›‰· ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Û˘Ó¤¯ÈÛ·Ó Ó· ·˘Í¿ÓÔ˘Ó Î·È ¤Êı·Û·Ó Ù· 12 mg ÛÙȘ 30 Ë̤Ú˜ ˙ˆ‹˜. ¶·Ú¿ ÙË ıÂڷ›· Ì ·˘ÍË̤ÓË ÂÓ˘‰¿ÙˆÛË (180 ml/kg/Ë̤ڷ) Î·È ÊÔ˘ÚÔÛÂÌ›‰Ë, ÙÔ ÓÂÔÁÓfi ·Ó¤Ù˘ÍÂ Û˘ÌÙÒÌ·Ù· ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·˜, ‰ËÏ·‰‹ ¤ÌÂÙÔ Î·È ·ÓÔÚÂÍ›·. ™ÙËÓ ·Ú·¿Óˆ ıÂڷ›· ÚÔÛÙ¤ıËΠډÓÈ˙ÔÏfiÓË (2 mg/kg/Ë̤ڷ) Î·È ¯ÔÚËÁ‹ıËΠÁ¿Ï· Ì ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ·Û‚¤ÛÙÈÔ. ªÂÙ¿ ·fi ÙËÓ ¿ÚÔ‰Ô 5 ËÌÂÚÒÓ, Ù· ›‰· ·Û‚ÂÛÙ›Ô˘ ·ÔηٷÛÙ¿ıËÎ·Ó ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ıÂڷ›· Ì ÎÔÚÙÈÎÔÂȉ‹ Û˘Ó¯›ÛÙËΠÁÈ· ¿ÏϘ 7 Ë̤Ú˜, ÂÓÒ Ù· ‰ÈÔ˘ÚËÙÈο ÁÈ· 30 ÂÈϤÔÓ Ë̤Ú˜. ™ÙÔ Ï·›ÛÈÔ ÙÔ˘ ÂϤÁ¯Ô˘ ¤ÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ (∂ÈÎfiÓ· 2) Ô˘ ¤‰ÂÈÍ ˘ÂÚ˯ÔÁÂÓ‹ ÂÛÙ›· ÛÙÔ ÌÂÛÔÎÔÏÈÎfi ‰È¿ÊÚ·ÁÌ·, Ô˘ ·Ô‰Â›¯ÙËΠÛÙË Û˘Ó¤¯ÂÈ· Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÂÛÙ›· ·ÔÙÈÙ¿ÓˆÛ˘. ∏ ÂÚ·ÈÙ¤Úˆ ÔÚ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó ηϋ. ∏ ‰ÂÚÌ·ÙÈ΋ ‚Ï¿‚Ë ÚÔԉ¢ÙÈο ·ÔηٷÛÙ¿ıËÎÂ. ¶ÔÈ· Â›Ó·È Ë ‰È¿ÁÓˆÛ‹ Û·˜;
¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜ E-mail: ccostalos@yahoo.gr
∂ÈÎfiÓ· 2. ∂ÛÙ›· ·ÔÙÈÙ¿ÓˆÛ˘ ÛÙÔ ÌÂÛÔÎÔÏÈÎfi ‰È¿ÊÚ·ÁÌ·.
∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 324
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∏ÏÂÎÙÚÔÓÈÎfi ÊÚÔÓÙÈÛÙ‹ÚÈÔ ·È‰È·ÙÚÈ΋˜ ÁÈ· Ó¤Ô˘˜ ÁÔÓ›˜ http://www.mothereducation.gr ¶ÚÔ˚fiÓ È‰ÈˆÙÈ΋˜ ÚˆÙÔ‚Ô˘Ï›·˜, Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ www.mothereducation.gr ·ÔÙÂÏ› Ì›· ¤Á΢ÚË Î·È ÛÊ·ÈÚÈ΋ ËÁ‹ ÏËÚÔÊfiÚËÛ˘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋. ∞¢ı‡ÓÂÙ·È Û Ӥ˜ ÌËÙ¤Ú˜ Ì fiÚÂÍË ÁÈ· ÁÓÒÛË, ·ÏÏ¿ Î·È Û ÊÔÈÙËÙ¤˜ Î·È Ó¤Ô˘˜ ÂÈÛÙ‹ÌÔÓ˜ ÔÈ ÔÔ›ÔÈ ÂÈı˘ÌÔ‡Ó Ó· ÂÌÏÔ˘Ù›ÛÔ˘Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ ÛÙȘ ÂÍÂÏ›ÍÂȘ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ∏ ‰ÔÌ‹ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ‰È·ÎÚ›ÓÂÙ·È Û ¤ÓÙ ‚·ÛÈΤ˜ ηÙËÁÔڛ˜, ηχÙÔÓÙ·˜ Ì›· ¢Ú›· Áο̷ ıÂÌ¿ÙˆÓ, ·fi ÙÔÓ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô, ̤¯ÚÈ Ù· ÛÙ¿‰È· Ù˘ ‚ÚÂÊÈ΋˜ Î·È ·È‰È΋˜ ·Ó¿Ù˘Í˘, ‰È·ÙÚÔÊ‹˜ Î·È ÊÚÔÓÙ›‰·˜. ™Â οı ηÙËÁÔÚ›· ˘¿Ú¯ÂÈ ÏËıÒÚ· ·Ó·ÊÔÚÒÓ Î·È ÏËÚÔÊÔÚÈÒÓ, ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Ó ÙfiÛÔ ·ÌÈÁÒ˜ Û ȷÙÚÈο ˙ËÙ‹Ì·Ù·, fiˆ˜ Ô ·Ú¿ÁÔÓÙ·˜ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ÙÔ Î¿ÓÈÛÌ· ÛÙȘ Ӥ˜ ÌËÙ¤Ú˜ Î·È Ë ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, fiÛÔ Î·È Û ÚÔ‚Ï‹Ì·Ù· Ù˘ ηıËÌÂÚÈÓfiÙËÙ·˜, ÌÂ Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÓfiÙËÙ· “¶ÚÔ‚Ï‹Ì·Ù·”, Ì ¯Ú‹ÛÈ̘ Ô‰ËÁ›Â˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ Û˘ÓËı¤ÛÙÂÚˆÓ ·È‰ÈÎÒÓ ·ÛıÂÓÂÈÒÓ. ∂ÎÙÂٷ̤ÓË ÏËÚÔÊfiÚËÛË ˘¿Ú¯ÂÈ Î·È ÛÙËÓ ÂÓfiÙËÙ· “¢È·ÙÚÔÊ‹-∞Ó¿Ù˘ÍË”, Ì ڷÎÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· Ù· ÚÒÙ· ÛÙ¿‰È· Ù˘ ‚ÚÂÊÈ΋˜ Î·È ·È‰È΋˜ ·Ó¿Ù˘Í˘. ∏ ÏÔ‹ÁËÛË ÛÙÔÓ ‰ÈÎÙ˘·Îfi ÙfiÔ Â›Ó·È ·ÚÎÂÙ¿ ·Ï‹, Ì ‰È·ÎÚÈÙ¤˜ ÙȘ ‚·ÛÈΤ˜ ηÙËÁÔڛ˜, ÂÓÒ ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· ·ÔÙÂÏ› Ë ¯Ú‹ÛË Ù˘ ÂÏÏËÓÈ΋˜ ÁÏÒÛÛ·˜.
COMSEP - ¶Ú·ÎÙÈΤ˜ ÂÎÌ¿ıËÛ˘ ÛÙËÓ ÂÈÛÙ‹ÌË Ù˘ ·È‰È·ÙÚÈ΋˜ http://www.comsep.org O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙÔ˘ COMSEP (Council on Medical Student Education in Pediatrics) ·ÔÙÂÏ› ÚÔ˚fiÓ Ì›·˜ ÔÌ¿‰·˜ ÂÈÛÙËÌfiÓˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ Ì ¤‰Ú· ÙȘ ∏¶∞. ∞¢ı‡ÓÂÙ·È Û ÚÔÙ˘¯È·ÎÔ‡˜ ÊÔÈÙËÙ¤˜ Î·È Ó¤Ô˘˜ ÂÈÛÙ‹ÌÔÓ˜, ·Ú¤¯ÔÓÙ·˜ ÔÏϷϤ˜ ‰˘Ó·ÙfiÙËÙ˜ “Âη›‰Â˘Û˘ ·fi ·fiÛÙ·ÛË”. O ·ÌÂÚÈηÓÈÎfi˜ ÔÚÁ·ÓÈÛÌfi˜ COMSEP, ÛÙËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘, ÚÔˆı› ¤Ó· “‰›ÎÙ˘Ô ·ÚÈÛÙ›·˜” ÛÙËÓ ¶·È‰È·ÙÚÈ΋, ÚÔÛʤÚÔÓÙ·˜ ·Ú¿ÏÏËÏ· ‰˘Ó·ÙfiÙËÙ˜ ·ÁÁÂÏÌ·ÙÈ΋˜ ÚÔ‚ÔÏ‹˜ Î·È ·Î·‰ËÌ·˚΋˜ ηÚȤڷ˜ ÛÙ· ÂÁÁÂÁÚ·Ì̤ӷ ̤ÏË ÙÔ˘. OÈ ÊÔÈÙËÙ¤˜ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· ·ÁÁÂÏÌ·ÙÈÎÔ‡ ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ Î·È ‰È·ÚÎÔ‡˜ ÂÈÌfiÚʈÛ˘, ηıÒ˜ ¤Ú¯ÔÓÙ·È Û ¶·È‰È·ÙÚÈ΋ 2005;68:322-323
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·ʋ Ì ÂÌÂÈÚfiÙÂÚÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ó·Ù‡ÛÛÔ˘Ó ‰È·‰ÈÎÙ˘·Î‹ ÂÈÎÔÈÓˆÓ›·. ∂ÈϤÔÓ, ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ COMSEP ÌÔÚ› ηÓ›˜ Ó· ·Ó·˙ËÙ‹ÛÂÈ ÏËÚÔÊÔڛ˜ ÁÂÓÈÎÔ‡ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ Û¯ÂÙÈο Ì ÙË ‰Ú¿ÛË ÙÔ˘ OÚÁ·ÓÈÛÌÔ‡ (Û˘Ó¤‰ÚÈ·, ÂÙ‹ÛȘ Û˘Ó·ÓÙ‹ÛÂȘ), ÙȘ Û¯ÂÙÈΤ˜ ÂΉfiÛÂȘ Î·È Ù· ÙÚ¤¯ÔÓÙ· ÂÎ·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù·. ∆¤ÏÔ˜, ÛÙ· ̤ÏË ÙÔ˘ COMSEP ÚÔÛʤÚÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ÂÈÎÔÈÓˆÓ›·˜ ̤ۈ ÂÓfi˜ ·ÓÂÙ˘Á̤ÓÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ‰ÈÎÙ‡Ô˘ - Intranet, ÙÔ ÔÔ›Ô Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË ‰ÈÎÙ‡ˆÛË ÙˆÓ ÌÂÏÒÓ ÙÔ˘ Î·È ÛÙËÓ ÚÔÒıËÛË ÎÔÈÓÒÓ Û¯Â‰›ˆÓ Î·È ‰Ú¿ÛˆÓ. ∏ ÂÓË̤ڈÛË ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ÙÔ˘ COMSEP Á›ÓÂÙ·È ·fi ÂȉÈ΋ ÂÈÙÚÔ‹, ÂÓÙÔ‡ÙÔȘ οÔȘ ÂÓfiÙËÙ˜ ‰ÂÓ ·Ó·ÓÂÒÓÔÓÙ·È Û ٷÎÙÈ΋ ‚¿ÛË.
™˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ ·È‰È΋ ÊÚÔÓÙ›‰· Î·È ·ÛÊ¿ÏÂÈ· - http://www.keepkidshealthy.com O Ó·ÓÈÎfi˜ Î·È ¯·ÚÔ‡ÌÂÓÔ˜ ۯ‰ȷÛÌfi˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙȘ ¯Ú‹ÛÈ̘ Û˘Ì‚Ô˘Ï¤˜ Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ˘Á›·, ÊÚÔÓÙ›‰· Î·È ·ÛÊ¿ÏÂÈ· ÙˆÓ ·È‰ÈÒÓ, ·ÔÙÂÏÔ‡Ó Ù· ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ portal www.keepkidshealthy.com. ªÂ ÙÔ Û‡ÓıËÌ· “∫Ú·Ù‹ÛÙ ٷ ·È‰È¿ ˘ÁÈ‹” Î·È Ì ¤ÌÊ·ÛË ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÚfiÏË„Ë ·Ú¿ ÛÙË ıÂڷ›· ÙˆÓ ·È‰ÈÎÒÓ ·ÛıÂÓÂÈÒÓ, Ë ÏÔ‹ÁËÛË ÛÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÍÂÎÈÓ¿ ·fi ÙÔ ‚ÚÂÊÈÎfi ÛÙ¿‰ÈÔ Î·È ÊÙ¿ÓÂÈ Ì¤¯ÚÈ ÙËÓ ÂÊ˂›·, ÚÔÛʤÚÔÓÙ·˜ ÂÍÂȉÈÎÂ˘Ì¤ÓË ÏËÚÔÊfiÚËÛË ·Ó¿ ËÏÈÎȷ΋ ηÙËÁÔÚ›·. ∞¢ı‡ÓÂÙ·È Û ÁÔÓ›˜ Î·È ÎˉÂÌfiÓ˜, ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó Î·È ÙËÓ ÂÈÚfiÛıÂÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ‰È·‰Ú·ÛÙÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ·È‰È¿ÙÚÔ˘˜. ∏ ·ÈÛıËÙÈ΋ ÙÔ˘ www.keepkidshealthy.com ¤¯ÂÈ ¤ÓÙÔÓÔ ÂÌÔÚÈÎfi, ·ÏÏ¿ Î·È Â˘Ê¿ÓÙ·ÛÙÔ ¯·Ú·ÎÙ‹Ú·, Ì ‰È·‰ÈÎÙ˘·Î¤˜ ÂÊ·ÚÌÔÁ¤˜ fiˆ˜ on-line forums, Ô‰ËÁfi ‰ËÌÈÔ˘ÚÁ›·˜ ·È‰ÈÎÔ‡ ÚÔÛˆÈÎÔ‡ ÚÔÊ›Ï, ÚÔÙ¿ÛÂȘ ÂÈÏÔÁ‹˜ ÔÓfiÌ·ÙÔ˜ Î.¿., ÂÓÒ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Ï›ÛÙ· Ì ٷ ÚÔÙÂÈÓfiÌÂÓ· ‚È‚Ï›· ·fi ÙÔ ËÏÂÎÙÚÔÓÈÎfi ‚È‚ÏÈÔˆÏÂ›Ô Amazon.com. ÃÚ‹ÛÈÌË Â›Ó·È Î·È Ë Î·ÙËÁÔÚ›· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙ· Û˘ÌÙÒÌ·Ù· ÙˆÓ Û˘ÓËı¤ÛÙÂÚˆÓ ·È‰ÈÎÒÓ ·ÛıÂÓÂÈÒÓ Î·È ÛÙÔ˘˜ ÙÚfiÔ˘˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜, ηıÒ˜ Ô ¯Ú‹ÛÙ˘ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ·Ó·˙‹ÙËÛ˘ ̤۷ ·fi Ì›· ‡¯ÚËÛÙË ‚¿ÛË ‰Â‰Ô̤ӈÓ.
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CLINICAL QUIZ ∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏
∆· ·›ÙÈ· Ù˘ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·˜ Û ¤Ó· ÓÂÔÁÓfi ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÂÚ‚Èٷ̛ӈÛË ∞ ‹ D, ·ÚÔ‰ÈÎfi ‹ ÔÈÎÔÁÂÓ‹ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi, ˘Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi ÌËÙ¤Ú·˜, ·Ó·Ú΋ ÚfiÛÏË„Ë ÊˆÛÊfiÚÔ˘, ˘ÔʈÛÊ·Ù·Û›·, Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. O Û˘Ó‰˘·ÛÌfi˜ Ù˘ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·˜ Ì ÙË ‰ÂÚÌ·ÙÈ΋ ‚Ï¿‚Ë ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ‚Ú¤ÊÔ˜ ı¤ÙÔ˘Ó ÙË ‰È¿ÁÓˆÛË Ù˘ Ó¤ÎÚˆÛ˘ ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜. ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ¿ÁÓˆÛÙË. ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·, ˘ÔıÂÚÌ›· ‹ ÙÔÈÎfi ÙÚ·‡Ì· Ô‰ËÁÔ‡Ó Û ӤÎÚˆÛË ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ Ì ·Ó¿Ù˘ÍË ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÈÛÙÔ‡. ∏ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·, Ô˘ Û¿ÓÈ· Û˘Óԉ‡ÂÈ ÙËÓ ¿ıËÛË, ÔÊ›ÏÂÙ·È Û ̛· ·fi ÙȘ ·ÎfiÏÔ˘ı˜ ·Èٛ˜: ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, ·ÂÏ¢ı¤ÚˆÛË ·Û‚ÂÛÙ›Ô˘ ·fi ÙÔÓ ÓÂÎڈ̤ÓÔ ÏÈÒ‰Ë ÈÛÙfi ‹ ·Ú·ÁˆÁ‹ 1,25 ‰È˘‰ÚÔ͢-‚ÈÙ·Ì›Ó˘ D ·fi Ù· Ì·ÎÚÔÊ¿Á·
¶·È‰È·ÙÚÈ΋ 2005;68:321, 324
ÛÙÔ ÛËÌÂ›Ô Ù˘ ‚Ï¿‚˘. ª›· ¿ÏÏË ÂÈÏÔ΋ Ô˘ ÌÔÚ› Ó· ·Ú·ÙËÚËı› Â›Ó·È ıÚÔÌ‚ÔÂÓ›· Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÎÏ˘ÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ ∂. ∏ ·ÈÙ›· ÙˆÓ Î·Ú‰È·ÎÒÓ ·ÔÙÈÙ·ÓÒÛÂˆÓ ·Ô‰›‰ÂÙ·È ÛÙËÓ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·. ∏ ¿ıËÛË ¤¯ÂÈ ÁÂÓÈο ηϋ ÚfiÁÓˆÛË, ÂÎÙfi˜ Â¿Ó ÂÈϷΛ ·fi ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·, ÔfiÙ ··ÈÙÂ›Ù·È ÂȉÈ΋ ıÂڷ›·. ∏ ıÂڷ›· Ù˘ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·˜ Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ·˘ÍË̤Ó˘ ÔÛfiÙËÙ·˜ ·ÚÂÓÙÂÚÈÎÒÓ ˘ÁÚÒÓ, Ô˘ ‚ÔËıÔ‡Ó ÛÙËÓ ·Ô‚ÔÏ‹ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ·fi Ù· ÓÂÊÚ¿. ÃÔÚËÁ›ٷÈ, ›Û˘, ÊÔ˘ÚÔÛÂÌ›‰Ë ÁÈ· ÙÔÓ ›‰ÈÔ ÛÎÔfi. ¶·Ú¿ÏÏËÏ·, ÌÂÈÒÓÂÙ·È Ë ÚfiÛÏË„Ë ·Û‚ÂÛÙ›Ô˘ Î·È ‚ÈÙ·Ì›Ó˘ D. ™Â ·ÔÙ˘¯›· ÙˆÓ ·Ú·¿Óˆ, ¯ÔÚËÁÔ‡ÓÙ·È Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ù· ÔÔ›· ÂÌÔ‰›˙Ô˘Ó ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ ‚ÈÙ·Ì›Ó˘ D Û 1,25 ‰È˘‰ÚÔ͢‚ÈÙ·Ì›ÓË D. ¶ÚfiÛÊ·Ù·, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ì ÂÈÙ˘¯›· Î·È Ù· ‰ÈʈÛÊÔÓÈο.
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¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞
xxi
1-4 ™ÂÙÂÌ‚Ú›Ô˘ 2005
4th World Congress of the World Society for Pediatric Infectious Diseases ¶ÏËÚÔÊÔڛ˜: Kenes International ∆ËÏ.: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: wspid2005@kenes.com Website: www.kenes.com/wspid2005
Warsaw, Poland
4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005
ESPGHAN Summer School on Nutrition “Research Challenges in Clinical Nutrition” Eden Beach Hotel Club European Society for Paediatric Gastroenterology, Hepatology and Nutrition ¶ÏËÚÔÊÔڛ˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 7726 355, 6945 29 30 71 E-mail: papadop5@otenet.gr
∞Ó¿‚˘ÛÛÔ˜
10-13 ™ÂÙÂÌ‚Ú›Ô˘ 2005 39th Annual Meeting of the European Society for Paediatric Nephrology ¶ÏËÚÔÊÔڛ˜: Flap Tours ∆ËÏ.: +90 (312) 454 00 00 Fax: +90 (312) 454 00 01 Website: www.espn2005.org
Istanbul, Turkey
14-17 ™ÂÙÂÌ‚Ú›Ô˘ 2005 29th UMEMPS - Union Middle Eastern & Mediterranean Pediatric Societies Congress •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: Pr. Enver Hasanoglu Fax: +90 312 2237 469, +90 216 3477 095 E-mail: enverh@gazi.edu.tr Website: www.istanbul-umemps2005.org
Istanbul, Turkey
16-18 ™ÂÙÂÌ‚Ú›Ô˘ 2005 26Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÃÂÈÚÔ˘ÚÁÈ΋˜ ¶·›‰ˆÓ ™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ ¶¤ÙÚÔ˘ ¡ÔÌÈÎÔ‡ ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ÃÂÈÚÔ˘ÚÁÈ΋˜ ¶·›‰ˆÓ ¶ÏËÚÔÊÔڛ˜: ERA ∂¶∂ ∆ËÏ: +30 210 3634 944 Fax: +30 210 3631 690 E-mail: info@era.gr Website: www.era.gr
™·ÓÙÔÚ›ÓË
18-22 ™ÂÙÂÌ‚Ú›Ô˘ 2005 4th World Congress of Pediatric Cardiology and Cardiac Surgery ¶ÏËÚÔÊÔڛ˜: Congress Secretariat E-mail: pccs2005@congresosint.com.ar Website: www.congresosint.com.ar/pccs2005
Buenos Aires, Argentina
23-25 ™ÂÙÂÌ‚Ú›Ô˘ 2005 ∂˘Úˆ·˚Îfi ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ “∞fi ÙÔ˘˜ °ÔÓ›˜ ÛÙ· ¶·È‰È¿” ¶ÔÏ˘¯ÒÚÔ˜ ∞ıËÓ·˝˜ “OÈ ÂÈÙÒÛÂȘ Ù˘ „˘¯È΋˜ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙ· ·È‰È¿” ¶ÏËÚÔÊÔڛ˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100 Fax: +30 210 6844 777 Website: www.parentsonchildren.gr
∞ı‹Ó·
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28 ™ÂÙÂÌ‚Ú›Ô˘1 √ÎÙˆ‚Ú›Ô˘ 2005
Pre-event to 1st European Conference on Injury Prevention and Safety Promotion “Increasing efficiency in injury prevention” •ÂÓÔ‰Ô¯Â›Ô Malaconda ¶ÏËÚÔÊÔڛ˜: ∫∂¶¶∞ ∆ËÏ.: +30 210 7462 187 Fax: +30 210 7462 105 E-mail: preevent@med.uoa.gr Website: www.cc.uoa.gr/health/socmed/hygien/pre_event
∂Ú¤ÙÚÈ·
30 ™ÂÙÂÌ‚Ú›Ô˘5 OÎÙˆ‚Ú›Ô˘ 2005
17th International Congress of Pediatrics ¶ÏËÚÔÊÔڛ˜: Ali Rabbani ∆ËÏ.: 98 216 428 998 Fax: 98 216 923 054 E-mail: pedcong@tums.ac.ir Website: www.tums.ac.ir/conferences/index.asp
Tehran, Iran
8-9 OÎÙˆ‚Ú›Ô˘ 2005
16th Congress of the European Society of Ambulatory Pediatrics (2005) ¶ÏËÚÔÊÔڛ˜: Grupo Pacifico S.A. Fax: +34 93 23 87 488 E-mail: midelsohn@pacifico-meetings.com Website: www.sepa-esap.org
Barcelona, Spain
21-23 OÎÙˆ‚Ú›Ô˘ 2005
1Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÈÏË„›·˜ ∞ı‹Ó· “∞fi ÙËÓ ·È‰È΋ ËÏÈΛ· ÛÙËÓ ÂÓËÏÈΛˆÛË” ¶ÔÏ˘¯ÒÚÔ˜ ∞ıËÓ·˝˜ ¶·ÓÂÏÏ‹ÓÈÔ˜ ∂ÈÛÙËÌÔÓÈÎfi˜ ™‡ÏÏÔÁÔ˜ ηٿ Ù˘ ∂ÈÏË„›·˜ ∂ÏÏËÓÈ΋ ∂ıÓÈ΋ ŒÓˆÛË Î·Ù¿ Ù˘ ∂ÈÏË„›·˜ ∫˘Úȷ΋ ∂Ù·ÈÚ›· ∂ÈÏË„›·˜ ¶ÏËÚÔÊÔڛ˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100 Fax: +30 210 6844 777 E-mail: epilepsy2005@cnc.gr Website: www.epilepsy2005.com
22-23 OÎÙˆ‚Ú›Ô˘ 2005
5Ë ¢ÈËÌÂÚ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ¶·Ú¿ÚÙËÌ· £ÂÛÛ·Ï›·˜ ∂∂∫¶¶À ¶ÓÂ˘Ì·ÙÈÎfi ∫¤ÓÙÚÔ Ù˘ ªËÙÚfiÔÏ˘ ¶ÏËÚÔÊÔڛ˜: ∞Ó·ÛÙ·Û›Ô˘ ∞Ó·ÛÙ·Û›· ∆ËÏ.: +30 6937 6767 25, +30 24210 31341-2
µfiÏÔ˜
3-5 ª·˝Ô˘ 2006
24th Annual Meeting of the European Society for Paediatric Infectious Diseases - ESPID ¶ÏËÚÔÊÔڛ˜: Kenes International / ESPID 2006 ∆ËÏ.: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: espid@kenes.com Website: www.kenes.com/espid/index2006.asp
Basel, Switzerland