METAMO™XEY™H OÚÁ¿ÓˆÓ & IÛÙÒÓ TÂÙÚ·ÌËÓÈ·›Ô E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ EÙ·ÈÚ›·˜ MÂÙ·ÌÔۯ‡ÛÂˆÓ I¢IOKTHTH™ - EK¢OTH™
E§§HNIKH ETAIPEIA METAMO™XEY™EøN
¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EÏÏËÓÈ΋˜ EÙ·ÈÚ›·˜ MÂÙ·ÌÔۯ‡ÛÂˆÓ ¶ÂÚ›Ô‰Ô˜ 2005 - 2007 ¶Úfi‰ÚÔ˜: A. KˆÛÙ¿Î˘ AÓÙÈÚfi‰ÚÔ˜: ¢. Δ·ÎÔ‡‰·˜ °ÂÓ. °Ú·ÌÌ·Ù¤·˜: π. ªfiÎÔ˜ T·Ì›·˜: ¢. ¶ÚˆÙÔÁ¤ÚÔ˘ M¤ÏË: ¢. °¿Î˘, Ã. ™Ù·ı¿Î˘ ™. ¢Ú·ÎfiÔ˘ÏÔ˜, Ã. ™ÙÚ·ÙfiÔ˘ÏÔ˜, B. ¶··ÓÈÎÔÏ¿Ô˘ EÈÌÂÏËÙ‹˜ ™‡ÓÙ·Í˘ °. AÏÂ͛Ԣ, ºÈÏfiÏÔÁÔ˜ TËÏ. (2310) 419 961
™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜: A.A. AÓÙˆÓÈ¿‰Ë˜ E›ÙÈÌÔÈ ¶Úfi‰ÚÔÈ: E. X·Ù˙ËÁÈ·ÓÓ¿Î˘, ™. P¿Ù˘, K. KÔÓÈ·‚›ÙÔ˘, A. TÔ˘ÚηÓÙÒÓ˘ M¤ÏË: ¢. °¿Î˘, ™. ¢Ú·ÎfiÔ˘ÏÔ˜, °. ÿÌ‚ÚÈÔ˜, ¶. KÒÓÛÙ·˜, XÚ. §fiÏ·˜, M. ¶··‰ËÌËÙÚ›Ô˘, Z. ¶··‰ÔÔ‡ÏÔ˘KÔ˘ÏÔ˘Ì‹, E. ™˘ÁÎÔ‡Ó·˜, £. ™˘Ú¿ÎÔ˜, ¢. T·ÎÔ‡‰·˜, A. º¿ÛÛ·˜, I. ºÂÛ·Ù›‰Ë˜ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ B. ¶··ÓÈÎÔÏ¿Ô˘ Y‡ı˘ÓÔ˜ T˘ÔÁÚ·Ê›Ԣ AÓ¿Ù˘· – EÌ‚¿ÛÌ·Ù· – ¢È·ÊËÌ›ÛÂȘ University Studio Press §.A. Mȯ¿Ï˘, AÚÌÂÓÔÔ‡ÏÔ˘ 32 £ÂÛÛ·ÏÔÓ›ÎË – 546 35 TËÏ. (2310) 209 637 & 209 837 Fax: (2310) 216 647
¢È·Ó¤ÌÂÙ·È ‰ˆÚÂ¿Ó ÛÙ· ̤ÏË Ù˘ EÏÏËÓÈ΋˜ EÙ·ÈÚ›·˜ MÂÙ·ÌÔۯ‡ÛÂˆÓ H ·ÚÔ‡Û· ¤Î‰ÔÛË ·ÔÙÂÏ› ¢ÁÂÓÈ΋ ¯ÔÚËÁ›· Ù˘ EÙ·ÈÚ›·˜ Novartis (Hellas) AEBE
AÏÏËÏÔÁÚ·Ê›· ÁÈ· ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ B. ¶··ÓÈÎÔÏ¿Ô˘ XÂÈÚ/΋ KÏÈÓÈ΋ MÂÙ/ÛÂˆÓ A.¶.£. IÔÎÚ¿ÙÂÈÔ °.¶.N. £ÂÛÛ·ÏÔӛ΢ KˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49 546 42 - £ÂÛÛ·ÏÔÓ›ÎË TËÏ. (2310) 892 068, 855 566 Fax: (2310) 862 000
Organ & Tissue TRANSPLANTATION Official Journal of the Hellenic ≈Society of Transplantation OWNERSHIP
HELLENIC TRANSPLANTATION SOCIETY Affiliated to the Transplantation Society
Executive Committee of the Hellenic Transplantation Society (2005 - 2007) President: A. Kostakis Vice President D. Takoudas Gen. Secretary: I. Mpokos Treasurer: D. Protogerou Members: D. Gakis, Ch. Stathakis S. Drakopoulos, Ch. Stratopoulos V. Papanikolaou
Editorial Board President: A.A. Antoniadis Homorary Presidents: E. Hatziyiannakis, S. Raptis, K. Koniavitou, A. Tourkantonis Members: G. Gakis, S. Drakopoulos, G. Imvrios, P. Konstas, Ch. Lolas, M. Papadimitriou, Z. PapadopoulouKoulompi, E. Sigounas, Th. Sirakos, D. Takoudas, A. Fassas, I. Fessatidis Editor-in-Chief V. Papanikolaou Publisher University Studio Press L.A. Michalis, Armenopoulou 32 Thessaloniki – 546 35, Greece Tel. (2310) 209 637 & 209 837 Fax: (2310) 216 647
Mailing address V. Papanikolaou Organ Transplantation Unit Hippokration General Hospital Konstantinoupoleos 49 546 42 – Thessaloniki – Greece Tel. (2310) 892 068, 855 566 Fax: (2310) 862 000
METAMO™XEY™H OÚÁ¿ÓˆÓ & IÛÙÒÓ TfiÌÔ˜ 12 ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ - 2007
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AÓ›¯Ó¢ÛË ·Ú·¯ı¤ÓÙˆÓ De Novo ÂȉÈÎÒÓ ÛÙÔ ÌfiÛ¯Â˘Ì· HLA ·ÓÙÈÛˆÌ¿ÙˆÓ ∞. πÓȈٿÎË, I. ¡ÙfiÎÔ˘, ª. ∞ÔÛÙÔÏ¿ÎË, ™. ª·ÚÈÓ¿ÎË, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, μ. ª›ÚÙ˙·˜, ∞. ™Ù·˘ÚÔÔ‡ÏÔ˘-°ÎÈfiη, ∞. ∫ˆÛÙ¿Î˘, π. ªÔϤÙ˘
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¶ÔÏ˘Â˘·ÈÛıËÙÔÔÈË̤ÓÔÈ Ï‹Ù˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡ÛÌ·ÙÔ˜ ™. ª·ÚÈÓ¿ÎË, ¶. ¶··‰¿ÎË, ∞. πÓȈٿÎË, ¢. º¿ÓË, ∞. °fiÌÔ˘, E. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, ª. ™˘ÚÔÔ‡ÏÔ˘, ∞. ∫ˆÛÙ¿Î˘, π. ¡. ªÔϤÙ˘
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∞Ó›¯Ó¢ÛË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌÔ‡ ÛÙ· Ô‡Ú· Î·È ÛÙÔ ·›Ì· ·ÛıÂÓÒÓ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË: ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ∫. ºÔ˘ÚÙÔ‡Ó·˜, ∞. ™˘ÚȉˆÓ›‰Ë˜, ∂. ™·‚‚ȉ¿ÎË, ¶. ∫·ÏÈ·ÎÌ¿ÓË, ∂. ¶··¯Ú‹ÛÙÔ˘, ¢. °Ô‡ÌÂÓÔ˜, ¢. ∫·Ú·‚›·˜, π. °. μÏ·¯ÔÁÈ¿ÓÓ˘
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EÎÙ›ÌËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ Δ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ∞. μÈÙÙˆÚ¿ÎË, ∞. πÓȈٿÎË, ª. ¢·ÚÂÌ¿, ∑. ™ÎÔÚ‰¿ÎË, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, ∞. °fiÌÔ˘, ∞. ™Ù·˘ÚÔÔ‡ÏÔ˘-°ÎÈfiη, π. ªÔϤÙ˘
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∂›‰Ú·ÛË ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· Ú˘ıÌÈÛÙÈο Δ-ÏÂÌÊÔ·ÙÙ·Ú· Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ∫. ºÔ˘ÚÙÔ‡Ó·˜, ∞. ªÔ˘˙¿ÎË, ¶. ™·ÎÂÏÏ·Ú¿ÎË, ª. ∫·Ú·Î¿Ù˙·, ∂. ™·‚‚ȉ¿ÎË, ¢. °Ô‡ÌÂÓÔ˜, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘
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ªÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Û ϋÙ˜ Ì ıÂÙÈ΋ ‰ÔÎÈÌ·Û›· ÈÛÙÈ΋˜ ‰È·ÛÙ·‡ÚˆÛ˘ μ-΢ÙÙ¿ÚˆÓ Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, ∞. πÓȈٿÎË, ™. ª·ÚÈÓ¿ÎË, ¶. ¶·¿˜, °. ¶·ÙÂÚ¿Î˘, °. ∑·‚‚fi˜, ∞. ∫ˆÛÙ¿Î˘, π.¡. ªÔϤÙ˘
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∏ ¯Ú‹ÛË ÙÔ˘ Everolimus ÛÙÔ˘˜ De Novo Ï‹Ù˜ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ∞Ú¯È΋ ÂÌÂÈÚ›· ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi
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ªÂÙ·ÙÚÔ‹ Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ıÂڷ›·˜ Û mTORi Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Î·È ÓÂÔϷۛ˜ ª. ¢·ÚÂÌ¿, ∫. ¶Ô˘ÁÔ‡ÓÈ·, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, π. ªfiÎÔ˜, °. ª·ÚfiÔ˘ÏÔ˜, π. ¢ÂÏÏ·‰¤ÙÛÈÌ·, °. ∑·‚‚fi˜, ∞. ∫ˆÛÙ¿Î˘, π.¡. ªÔϤÙ˘
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™‡ÁÎÚÈÛË ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ Everolimus Î·È ¯·ÌËÏ‹˜ ‰fiÛ˘ ΢ÎÏÔÛÔÚ›Ó˘ ∞ Ì mycophenolate mofetil Î·È Ï‹ÚË ‰fiÛË Î˘ÎÏÔÛÔÚ›Ó˘ ∞ Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ °. ª˘ÛÂÚÏ‹˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. μ¤ÚÁÔ˘Ï·˜, ¢. μÚÔ¯›‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¡Ù›Ó·˜, °. ÿÌ‚ÚÈÔ˜, ∞. ¶··ÁÈ¿ÓÓ˘, π. ºÔ‡˙·˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, º. ™ÔψӿÎË, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. ∫·Ú‰¿Û˘, ¢. Δ·ÎÔ‡‰·˜
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∏ Û¯¤ÛË ÙˆÓ ÚÔÂÁ¯ÂÈÚËÙÈÎÒÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Î·È ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔ Ë·ÙÈÎfi ·Ú·Û··ÛÌ· Û ÌÂÙ·ÌÔۯ‡ÛÂȘ ‹·ÙÔ˜ ÁÈ· Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∫. ¢ÈÏ¿Ú˘, ∫. ¶·ÙÛÈ·Ô‡Ú·, ∂. ∫·ÙÛ›ÎË, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, π. ºÔ‡˙·˜, ¢. μÚÔ¯›‰Ë˜, ∞. ¡Ù›Ó·˜, °. ΔÛÔ˘ÏÊ¿˜, ¢. ∫·Ú‰¿Û˘, ∂. ∫·Ùۛη, ∂. ∞Ó·ÁÓˆÛÙ¿Ú·, E. ∑·ÊÂÈÚÈ¿‰Ô˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ÿÌ‚ÚÈÔ˜, ¢. Δ·ÎÔ‡‰·˜
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∞ÂÈÎfiÓÈÛË Ì MDCT-ÛÏËÓÔ˘Ï·ÈÔÁÚ·Ê›· ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ ˘Ï·›·˜ ÊϤ‚·˜ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ∞. ¶ÂÙÚ›‰Ë˜, A. ¶·ÓÙ·˙ÔÔ‡ÏÔ˘, Δ. °ÂÚԇ΢, ∫. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘, ∞. ¶··ÁÈ¿ÓÓ˘, ∞. ¡Ù›Ó·˜, μ. ∫·Ï·Î›‰Ë˜, ¶. ¶·ÏÏ¿‰·˜
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Impact of the meld system on survival after liver transplantation for hepatocellular carcinoma G. Tsoulfas, N. Elias, D. Ko, T. Kawai, F.L. Delmonico, A.B. Cosimi, M. Hertl
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O ÎÔÚÂÛÌfi˜ Ô͢ÁfiÓÔ˘ ÛÙÔ ·›Ì· Ù˘ Ë·ÙÈ΋˜ ÊϤ‚·˜ ˆ˜ ÚÒ˚ÌÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ Ã. ¶··ÁˆÚÁ›Ô˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, ∞. ¶·ÚÏ·¿ÓË, ∂. ∫·Ùۛη, ¢. μÚÔ¯›‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, °. ÿÌ‚ÚÈÔ˜, Ã. ∫Ô‡·Ó˘, ¢. Δ·ÎÔ‡‰·˜
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OÈ Ô͢ÁÔÓÔÌÂÙÚÈΤ˜ ÌÂÙ·‚ÔϤ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ‹·ÙÔ˜ (ª.∏.) ˆ˜ ‰Â›ÎÙ˘ ÚfiÁÓˆÛ˘ Ù˘ ¿ÌÂÛ˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ∂. ∫·Ùۛη, Ã. ¶··ÁˆÚÁ›Ô˘, °. ¶·ÚÔ˘ÙÛ›‰Ô˘, Ã. ∫Ô‡·Ó˘, °. ÿÌ‚ÚÈÔ˜, £. ∞ÛÏ·Ó›‰Ë˜, ª. ªÔÁÈ·Ù˙fiÔ˘ÏÔ˜, £. §·˙·Ú›‰Ë˜, ∞. ™È‰ËÚfiÔ˘ÏÔ˜, π. °Î¤Î·˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, ∞. ¶··ÁÈ¿ÓÓ˘, ∫. ¶·ÙÛÈ·Ô‡Ú·, ¢. Δ·ÎÔ‡‰·˜, ∂. ∞Ó·ÁÓˆÛÙ¿Ú·
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£ÚfiÌ‚ˆÛË ˘Ï·›˜ ÂÈÏÔ΋ ÌÂÙ¿ ·fi ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 16 ÂÙÒÓ ¡. ™Ô˘Óȉ¿Î˘, ∂. ªÔ˘ÏÔ‡‰Ë, ∫. ∫·ÙÛ·ÓԇϷ˜, ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘, ∂. °ÂˆÚÁÈ¿‰Ô˘, ª. ∫·Ú·Ó¿ÙÛÈÔ˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¢. Δ·ÎÔ‡‰·˜, ¡. °Ú›ÙÛË - °ÂÚÔÁÈ¿ÓÓË
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™˘Ó‰˘·Ṳ̂ÓË ·ÓÔÛÔηٷÛÙÔÏ‹ Ì ·Ó·ÛÙÔÏ›˜ mTOR Î·È CNI Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È Âȉ›ӈÛË ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ÂÌÂÈÚ›· ÙÔ˘ ΤÓÙÚÔ˘ Ì·˜ μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ÿÌ‚ÚÈÔ˜, ∫. ¢ÈÏ¿Ú˘, π. ºÔ‡˙·˜, £. μ·ÛÈÏÂÈ¿‰Ë˜, ∞. ¶··ÁÈ¿ÓÓ˘, ∂. ∞ÎÚÈ‚È¿‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ∫. ¶·ÙÛÈ·Ô‡Ú·,
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OÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Û ÌÂÙ·ÌÔۯ‡ÛÂȘ ‹·ÙÔ˜ ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘, ¢. ∞˘ÁÔ˘ÛÙ‹, X. ¶··ÁˆÚÁ›Ô˘, Ã. ΔÛÈfiÙÚ·˜, ∂. ªÔ˘ÏÔ‡‰Ë, °. πÌ‚ÚÈÔ˜, ¢. Δ·ÎÔ‡‰·˜, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË
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∏ ÂͤÏÈÍË ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÏÎÔÔÏÈ΋ ΛÚÚˆÛË Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ °. ÿÌ‚ÚÈÔ˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ΔÛÔ˘ÏÊ¿˜, μ. μ·ÛÈÏÂÈ¿‰Ë˜, ¢. ∫·Ú‰¿Û˘, ∞. ¶··ÁÈ¿ÓÓ˘, π. °Ô˘Ï‹˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, π. ºÔ‡˙·˜, ¡. ∞. ∞ÓÙˆÓÈ¿‰Ë˜, ∫. ¶·ÙÛÈ·Ô‡Ú·, ∞. ¡Ù›Ó·˜, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. μÚÔÁ¯›‰Ë˜, ∂. ∫·Ùۛη, ∫. ¢ÈÏ¿Ú˘, °. ª˘ÛÂÚÏ‹˜, ¢. Δ·ÎÔ‡‰·˜
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∞˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (∞ª∞∫) Û ·ÛıÂÓ›˜ Ì ÔÏÏ·ÏÔ‡Ó Ì˘¤ÏˆÌ· (¶ª) ËÏÈΛ·˜ >60 ÂÙÒÓ. ∂ÌÂÈÚ›· ÂÓfi˜ ∫¤ÓÙÚÔ˘ μ. ∫˘ÚÈ·˙‹, §. ∂˘ÏÈ¿ÙË, ™. ¢ÂÏ‹Ì·ÛË, ¡. ÷گ·Ï¿Î˘, ∂. ¡ÈÎËÊÔÚ¿Î˘
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∞˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (∞ª∞∫) ÛÙËÓ ÔÍ›· Ì˘ÂÏÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (Oª§). ∂ÌÂÈÚ›· ÂÓfi˜ ∫¤ÓÙÚÔ˘ μ. ∫˘ÚÈ·˙‹, ∫.-°. ª·ÏˆÙ‹˜, ¢. ∫·Ú·Î¿Û˘, π. ª·ÏÙ·‰¿Î˘, ∑. ¶Ô˘ÏÔÔ‡ÏÔ˘, ∂. ª›Î·, π. ∞ÔÛÙÔÏ›‰Ë˜, ¡. ÷گ·Ï¿Î˘, ∂. ¡ÈÎËÊÔÚ¿Î˘
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O ÚÔÛٷ٢ÙÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ Ô͢ÁÔӈ̤ÓÔ˘ ÊıÔÚÈÔ¿Óıڷη ÛÙȘ ‚Ï¿‚˜ ÈÛ¯·ÈÌ›·˜-·ӷÈÌ¿ÙˆÛ˘ ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ ÙˆÓ ÎÔÓ›ÎÏˆÓ ∞. ¡Ù›Ó·˜, ¢. ∫·Ú·Ì¿ÓÔ˜, ™. ∏ÏÈ¿‰Ë˜, ∞. ∞Ï‚·ÓÔ‡-∞¯·Ú¿ÎË, ¢. ∫Ô˘ÊÔÁÈ¿ÓÓ˘, ¢. μÚÔ¯›‰Ë˜, Ã. ™˘Ú›‰Ë˜, ¢. ¶··‰ËÌËÙÚ›Ô˘, £. °ÂÚ·ÛÈÌ›‰Ë˜
37
∏ ¯ÔÚ‹ÁËÛË EGCG ηٿ ÙËÓ ÈÛ¯·ÈÌ›· Î·È Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ‹·ÙÔ˜ ÂÏ·¯ÈÛÙÔÔÈ› ÙË ·fiÙˆÛË Ì¤Ûˆ ηٷÛÙÔÏ‹˜ Ù˘ ¤ÎÊÚ·Û˘ ÙˆÓ NF-ÎB, CASPASE-3 Î·È c-Jun ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ∞. °È·ÎÔ˘ÛÙ›‰Ë˜, ∂. ∫·Ï‰ÚÈÌ›‰Ô˘, ∫. ∫ÔÏÈ¿ÎÔ˘, ™. ∏ÏÈ¿‰Ë˜, £. ¶Ô˘Ù·¯›‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ¡. O˘˙Ô˘Ó›‰Ë˜, ∞. ¶··ÁÈ¿ÓÓ˘, ¢. ∫·Ú‰¿Û˘, °. ÿÌ‚ÚÈÔ˜, °. ¶··ÁˆÚÁ›Ô˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¢. Δ·ÎÔ‡‰·˜
38
ªÂ›ˆÛË Ù˘ ·fiÙˆÛ˘ ̤ۈ ·Ó·ÛÙÔÏ‹˜ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ NF-kB, c-Jun Î·È CASPASE-3 Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÈÛ¯·ÈÌ›·/·ӷÈÌ¿ÙˆÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ÙËÓ ¯ÔÚ‹ÁËÛË EGCG ∞. °È·ÎÔ˘ÛÙ›‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ∫. ∫ÔÏ›·ÎÔ˘, ∂. ∫·Ï‰ÚÈÌ›‰Ô˘, ™. ∏ÏÈ¿‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ¡. O˘˙Ô˘Ó›‰Ë˜, ∫. ¢ÈÏ¿Ú˘, °. ÿÌ‚ÚÈÔ˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ¶··ÁˆÚÁ›Ô˘, ∫. ∞ÙÌ·Ù˙›‰Ë˜, A. ∞ÓÙˆÓÈ¿‰Ë˜, ¢. Δ·ÎÔ‡‰·˜
39
¶ÚÔÁÓˆÛÙÈ΋ ·Í›· ÚÒ˚Ì˘ ÂÌÊ¿ÓÈÛ˘ ·Ô›Ô˘ ‰È·‚‹ÙË ÛÙË ª∂£ ÌÂÙ¿ ·fi ÙÚ·˘Ì·ÙÈ΋ οΈÛË ÂÁÎÂÊ¿ÏÔ˘ Î·È Û˘Û¯¤ÙÈÛ‹ ÙÔ˘ Ì ÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ı¿Ó·ÙÔ ∂. ª¿ÛÛ·, μ. ∫·Ú·Ï‹, π. ÃÔ‡Ú˘, °. μ·ÛÈÏÂÈ¿‰Ô˘, °. ª·Ì›¯·˜, ª. ªÈÙ˙¿ÓË
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™Ù¿ÛË ÂÚÁ·˙ÔÌ¤ÓˆÓ ÛÙÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ·¤Ó·ÓÙÈ ÛÙË ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ. ¶ÚÔηٷÚÎÙÈ΋ ·Ó·ÎÔ›ÓˆÛË ª. ™˘ÁÁÂÏ¿Î˘, ∂. ™ÔÊÈ·Ófi˜, N. Δ¿ÛÎÔ˜, ª. ¶··ı·Ó·Û›Ô˘, ∂. ∫·ÏϤÚÁË, ∫. ºˆÎ¿˜
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°ÓÒÛÂȘ, ÛÙ¿ÛÂȘ Î·È ·ÓÙÈÏ‹„ÂȘ ÁÈ·ÙÚÒÓ, ÓÔÛËÏ¢ÙÒÓ Î·È ÊÔÈÙËÙÒÓ È·ÙÚÈ΋˜ Û¯ÂÙÈο Ì ÙȘ ÌÂÙ·ÌÔۯ‡ÛÂȘ Î·È ÙË ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ. ª›· ÈÏÔÙÈ΋ ¤Ú¢ӷ
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¢ˆÚ¿ ÔÚÁ¿ÓˆÓ ÌÂϤÙË ÙˆÓ ·fi„ÂˆÓ ÂÓËÏ›ÎˆÓ ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ Ù˘ £ÂÛÛ·ÏÔӛ΢ E. °ÂˆÚÁÈ¿‰Ô˘, ¶. °È·ÁÏ‹˜, ¡. ™Ô˘Óȉ¿Î˘, ∂. ªÔ˘ÏÔ‡‰Ë, ¢. ∞˘ÁÔ˘ÛÙ‹, Ã. ΔÛÈfiÙÚ·˜, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË
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¢Âη¤ÓÙ ¯ÚfiÓÈ· ‰ˆÚ¿˜ ÔÚÁ¿ÓˆÓ Û ÔÏ˘‰‡Ó·ÌË ª∂£ º. ¢Ú¿Ì·, ª. °È·ÓÓ¿ÎÔ˘, ∂. °Î¤Î·, ∞. ∂˘ı˘Ì›Ô˘, ∂. ∞Ó·ÛÙ·Û›Ô˘, ∂. ¶··ÁˆÚÁ›Ô˘, ∫. ª¿ÙÛË, ∂. ∫·ÏϤÚÁË, ¡. Δ¿ÛÎÔ˜, ∂. ™ÔÊÈ·Ófi˜
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∞ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Mycophenolate mofetil Ì ÙÔ Enteric-coated mycophenolate sodium Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Î·È ÂÌÊ·Ó›˙Ô˘Ó Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∂ÈÚ. ™·‚‚ȉ¿ÎË, ∞. ª¤Ï·˜, ∫. ºÔ˘ÚÙÔ‡Ó·˜, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË, ∂. ¶··¯Ú‹ÛÙÔ˘, ¢. °Ô‡ÌÂÓÔ˜, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘
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¶ÚÒ˚̘ ·Ú·ÙËÚ‹ÛÂȘ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ì˘ÎÔÊ·ÈÓÔÏÈÎÔ‡ ¿Ï·ÙÔ˜ Û ϋÙ˜ ÚÒÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ™. ¢Ú·ÎfiÔ˘ÏÔ˜, ª. ∫Ô˘ÎÔ˘Ï¿ÎË, £. ∞ÔÛÙfiÏÔ˘, °. ªÂÙ·Í¿ÙÔ˜, ¡. ¡ÈÎÔÏÔÔ‡ÏÔ˘, μ. ∫›ÙÛÈÔ˘, Ã. ¶··ÛÙÂÚÈ¿‰Ë, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘
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O˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Î·È ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ 10ÂÙ‹˜ ÂÌÂÈÚ›· ÙÔ˘ ÌÂÙ·ÌÔÛ¯Â˘ÙÈÎÔ‡ ΤÓÙÚÔ˘ ¶·ÙÚÒÓ (1997-2007) ∂. ºˆÎ·Â‡˜, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË, π. ª·ÚÔ‡Ï˘, ¢. °Ô‡ÌÂÓÔ˜, ¢. ∫·Ú·‚›·˜, π. μÏ·¯ÔÁÈ¿ÓÓ˘
47
O ÚfiÏÔ˜ Ù˘ ·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡ ÛÙË ‰È¿ÛˆÛË ÂÈÏÂÁÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ Èı·ÁÂÓÔ‡˜ ÓÂÊÚÔ‡ μ. ¶··ÓÈÎÔÏ¿Ô˘, π. ºÔ‡˙·˜, °. ÿÌ‚ÚÈÔ˜, ∂. ∫·Ùۛη, ∞. ¡Ù›Ó·˜, °. ª˘ÛÂÚÏ‹˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∫. ¢ÈÏ¿Ú˘, ∞. ¶ÂÙÚ›‰Ë˜, ™. ¢Ô‡Ì·, £. °ÂÚ·ÛÈÌ›‰Ë˜, ¢. Δ·ÎÔ‡‰·˜
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ª·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÌÂÙ¿ ·fi ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË Ô˘ÚËÙËÚÈÎÒÓ ÂÈÏÔÎÒÓ Ì ÂÂÌ‚·ÙÈΤ˜ ·ÎÙÈÓÔÏÔÁȤ˜ ÌÂıfi‰Ô˘˜ π. ∫·ÛηڤÏ˘, ª. ∫Ô˘ÎÔ˘Ï¿ÎË, ∂. ª·˚Ú·Ì›‰Ë˜, Ã. ∫fiÎÎÈÓÔ˜, ª. πÂÚˆÓ‡ÌÔ˘, £. °ÂˆÚÁ·ÓÙ¿˜, μ. μÔ˘Á¿˜, ™. ¢Ú·ÎfiÔ˘ÏÔ˜
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∏ ¯Ú‹ÛË Ô˘ÚËÙËÚÈÎÔ‡ ÎˉÂÌfiÓ· (Double-J Stent) ÛÙËÓ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·Ó·ÛÙfïÛË Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. ∏ ∂ÌÂÈÚ›· ÂÓfi˜ ∫¤ÓÙÚÔ˘ ∫. ¢ÈÏ¿Ú˘, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¶··ÁÈ¿ÓÓ˘, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. ∫·Ú‰¿Û˘, π. ºÔ‡˙·˜, °. ΔÛÔ˘ÏÊ¿˜, ¢. μÚÔ¯›‰Ë˜, ∞. ¡Ù›Ó·˜, °. ÿÌ‚ÚÈÔ˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¢. Δ·ÎÔ‡‰·˜
50
∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÛÙ¤ÓˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ ÙÔ˘ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘ ÓÂÊÚÔ‡ Î·È Ù˘ Û˘ÛÙÔ›¯Ô˘ Ï·ÁÔÓ›Ô˘ ·ÚÙËÚ›·˜ Ì ·ÁÁÂÈÔÏ·ÛÙÈ΋ Î·È ÛÙÂÓÙ ¶. ¶·¿˜, °. ∑·‚‚fi˜, ™. ∫·˙¿, ¶. §ÂÔÓ¿Ú‰Ô˘, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, π. ªfiÎÔ˜, π. ªÔϤÙ˘, ∞. ∫ˆÛÙ¿Î˘
51
∏ ·ÎÚ›‚ÂÈ· ÙÔ˘ ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ·Ê·ÈÚÂÙÈÎÔ‡ ÛÈÓıËÚÔÁÚ·Ê‹Ì·ÙÔ˜ ÙˆÓ ·Ú·ı˘ÚÂÔÂȉÒÓ ·‰¤ÓˆÓ ·˘Í¿ÓÂÙ·È fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ÚÔÂÁ¯ÂÈÚËÙÈΤ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÙÈ̤˜. ª›· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 453 ·ÛıÂÓÒÓ Ì ‰Â˘ÙÂÚÔ·ı‹ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi μ. ¶··ÓÈÎÔÏ¿Ô˘, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. μÚÔ¯›‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, °. ÿÌ‚ÚÈÔ˜, ∞. ¶··ÁÈ¿ÓÓ˘, π. ºÔ‡˙·˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¡Ù›Ó·˜, °. ÕÚÛÔ˜, ¢. ∫·Ú‰¿Û˘, ¢. Δ·ÎÔ‡‰·˜
7 52
∏ Ê˘ÛÈ΋ ÈÛÙÔÚ›· ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÚÔÛÂÏ¿ÛÂˆÓ ÁÈ· ·ÈÌÔ‰È¿Ï˘ÛË. ∞Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 2422 ·ÛıÂÓÒÓ ÂÓfi˜ ∫¤ÓÙÚÔ˘ μ. ¶··ÓÈÎÔÏ¿Ô˘, ∞. ¶··ÁÈ¿ÓÓ˘, ¢. μÚÔ¯›‰Ë˜, ¢. °¿Î˘, °. ÿÌ‚ÚÈÔ˜, π. ºÔ‡˙·˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¡Ù›Ó·˜, ¢. ∫·Ú‰¿Û˘, ∫. ¢ÈÏ¿Ú˘, ¢. Δ·ÎÔ‡‰·˜
53
Intravascular volume depletion - “A Triad of signs to remember”. An important aspect in the post-operative management of a simultaneous Pancreas-Kidney transplant recipient V. Hadjianastassiou, P. Moustafellos, A. Vaidya, P. Friend
54
∏ Û˘Ì‚ÔÏ‹ Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ Û ڷÁÌ·ÙÈÎfi ¯ÚfiÓÔ (REAL-TIME PCR) ÁÈ· ÙËÓ Ù·¯Â›· ·Ó›¯Ó¢ÛË CMV Ïԛ̈͢ Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜ ª. ¶·¤, ∫. ª·Ó‰Ú·‚¤ÏË, ¢. ¶··‰ÔÔ‡ÏÔ˘, ∂. ∫·˙¿ÎÔ˜, ™. ∞ÏÂ͛Ԣ-¢·ÓÈ‹Ï
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¶ÚÔÌÂÙ·ÔÛ¯Â˘ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Ì ÔÏ˘ÙÔÌÈ΋ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (MDCT) ∞. ¶ÂÙÚ›‰Ë˜, ∞. ¶··¯ÚÈÛÙÔ‰Ô‡ÏÔ˘, Δ. °ÂÚԇ΢, ∫. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘, Ã. ÷Ù˙ËÁˆÚÁ›Ô˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ¶. ¶·ÏÏ¿‰·˜
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Ingreasing organ use: large, single center experience with extended criteria donors for liver transplantation G. Tsoulfas, R. Kashyap, M. Orloff, P. Abt, A. Jain, D. Takoudas, A. Bozorgzadeh
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∞ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÔ‡˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜, ÛÙË ª.∂.£. ª. ∫Ô‡ÚÙË, ¶. μÂÚÓ›ÎÔ˜, ∂. ∞ÓÙˆÓ›Ô˘, Ã. ∫·ÚÔ‡ÓË, ¢. ªfiÚ·, ∂. ÃÚÈÛÙÔÊ›ÏÔ˘
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¶ÚÒ˚̘ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ ÌÂÙ¿ ·fi ÔÊıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Ô˘ ··›ÙËÛ·Ó Â·Ó¤̂·ÛË ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 16 ÂÙÒÓ ¡. ™Ô˘Óȉ¿Î˘, ∂. ªÔ˘ÏÔ‡‰Ë, ª. ¶·Û·ÎÈÒÙÔ˘, °.ª·Ï¿Ì˘, ∂. °ÂˆÚÁÈ¿‰Ô˘, E. ∫¯·ÁÈ¿, °. ÿÌ‚ÚÈÔ˜, ¢. Δ·ÎÔ‡‰·˜, ¡. °Ú›ÙÛË - °ÂÚÔÁÈ¿ÓÓË
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™‡ÁÎÚÈÛË ÙÚÈÒÓ Û˘ÛÙËÌ¿ÙˆÓ ·ÍÈÔÏfiÁËÛ˘ ‚·Ú‡ÙËÙ·˜ ·ÛıÂÓÒÓ Ì ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘, Ã. ΔÛÈfiÙÚ·˜, ¢. ∞˘ÁÔ˘ÛÙ‹, ¡. ™Ô˘Óȉ¿Î˘, ∂. ¶··˙·ÊÂÈÚ›Ô˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¢. Δ·ÎÔ‡‰·˜, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË
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∂›ÎÙËÙË ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· Û ·È‰È¿ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ∞. ª·˘ÚÔ˘‰‹, ¡. ∫·Ú·ÓÙ·ÁÏ‹˜, π. •˘ÓÈ¿˜, ∞. ¢ÂÏËÁÈ·ÓÓ›‰Ë˜, ∂. ¶·Ú··Ó‹ÛÈÔ˘, O. O˘Ú·‹ÏÔÁÏÔ˘, °. ÿÌ‚ÚÈÔ˜
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πÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Û ·È‰È¿ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ AÈÎ. ∫¿ÓÙ˙ÈÔ˘, μ. ¢ÂÌÂÚÙ˙›‰Ô˘, π. •˘ÓÈ¿˜, ∞. ª·˘ÚÔ˘‰‹, ª. ¶·ÓÙÈΛ‰Ô˘, O. μÚ¿ÓË, ∂. ƒÔËÏ›‰Ë˜, °. ÿÌ‚ÚÈÔ˜, ∫. ™‡ÚÔÁÏÔ˘, ¢. Δ·ÎÔ‡‰·˜
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∂˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÌÔÚ›Ô˘ U-74389 G Û ÂÈÚ·Ì·ÙÈÎfi ÚfiÙ˘Ô ÈÛ¯·ÈÌ›·˜ ·ӷÈÌ¿ÙˆÛ˘ ÓÂÊÚÔ‡ ·ÚÔ˘Ú·›Ô˘. ∂ȉÈ΋ ‚ÈÔ¯ËÌÈ΋, ÌÔÚÊÔÏÔÁÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ÌÂϤÙË ∞. ¶··ÏfiË, ∫. ¶··‰ÔÔ‡ÏÔ˘, ¶. Δ˙·Ú‰‹˜, ∂. ∫·Ú¿ÌÂÏ·, ∫. ΔÛ·Ú¤·, ª. ™È‰ÂÚ‹˜, π. ™ÊËÓÈ·‰¿Î˘, ∂. ºÂϤÎÔ˘Ú·˜, ∂. §¤·Ó‰ÚÔ˜, °. ∑ˆÁÚ¿ÊÔ˜, π. ªÚ¿Ì˘, ∏. ª·ÛÙÔ‡Ó˘
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£ÚÔÌ‚Ô΢ÙÔÂÓ›· Û ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘, Ã. ΔÛÈfiÙÚ·˜, ¢. ∞˘ÁÔ˘ÛÙ‹, ¡. ™Ô˘Óȉ¿Î˘, £. μ·ÛÈÏÂÈ¿‰Ë˜, B. ¶··ÓÈÎÔÏ¿Ô˘, ¢. Δ·ÎÔ‡‰·˜, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË
11 103
ÃÔÚ‹ÁËÛË ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ÂÓÂÚÁÔÔÈË̤ÓÔ˘ ·Ú¿ÁÔÓÙ· VII Û ̷˙È΋ ·ÈÌÔÚÚ·Á›· ÌÂÙ¿ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Û Á˘Ó·›Î· ˘Ô„ËÊ›· ÁÈ· ›ÁÔ˘Û· ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ¶. ¶·¿˜, ∂. ªÔ˘ÏÔ‡‰Ë, Ã. ¶··ÁˆÚÁ›Ô˘, ¡. ™Ô˘Óȉ¿Î˘, ∫. ∫·ÙÛ·ÓԇϷ˜, £. μ·ÛÈÏÂÈ¿‰Ë˜, ¡. °Ú›ÙÛË–°ÂÚÔÁÈ¿ÓÓË
104
The Hippocratic Oath and the related Hippocratic Aphorisms in the preliminary study of medical ethics of the laparoscopic left lateral hepatectomy in living donors K. Mammas, G. Kottis, G. Kostopanagiotou, N. Arkadopoulos, B. Smyrniotis
105
Baseline hepatic arterial doppler increases patient but not graft survival in orthotopic liver transplantation D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, P. Metrakos
106
Selection of liver transplant recipients for the treatment of HCC based on adjustable preoperative criteria with a pre-determined, center specific five-year patient survival target D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Cantarovich, M. Deschenes, P. Wong, P. Ghali, P. Metrakos
107
Persistent lymphopenia after anti-thymocyte globulin induction is associated with decreased long term survival in liver transplant recipients D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Deschenes, P. Wong, P. Ghali, P. Metrakos
108
Biliaty tree complications after OLTx are not prevented either by intraoperative insertion of ERCP stent of by primary or secondary roux en Y anastomosis D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Deschenes, P. Wong, P. Ghali, P. Metrakos
109
Prediction of postoperative mortality and long-term survival after liver transplantation, based on preoperative parameters D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Cantarovich, M. Deschenes, P. Wong, P. Ghali, P. Metrakos
110
Persistent monocyte depletion does not improve graft survival after liver, pancreas alone and kidney transplants D. Vrochides, M. Hassanain, P. Metrakos, J. Tchervenkov, P. Chaudhury, M. Cantarovich, S. Paraskevas
111
Prolonged lymphopenia after anti-thymocyte globulin induction is not associated with increased graft survival in pancreas transplant recipients D. Vrochides, M. Hassanain, P. Metrakos, J. Tchervenkov, P. Chaudhury, M. Cantarovich, S. Paraskevas
112
H Û˘Ì‚ÔÏ‹ ÙˆÓ ÙÔÈÎÒÓ Û˘ÓÙÔÓÈÛÙÒÓ Î·È ÙˆÓ Û˘ÓÙÔÓÈÛÙÒÓ ÙˆÓ ÂÚÈÊÂÚÂÈ·ÎÒÓ ÁÚ·Ê›ˆÓ ÙÔ˘ ∂.O.ª ÛÙËÓ ·‡ÍËÛË ÙˆÓ ‰ˆÚËÙÒÓ Î·È ‰ÔÙÒÓ ÔÚÁ¿ÓˆÓ ¢. ∑·¯·ÚÔ‡‰Ë, ∂. ∫·ÏϤÚÁË
113
OÚıÔÛÙ·ÙÈÎfi ÂÈÁ·ÛÙÚÈÎfi ¿ÏÁÔ˜ Û·Ó ·ıÔÁÓˆÌÔÓÈÎfi ÛËÌÂ›Ô CMV Á·ÛÙÚ›Ùȉ·˜ ¶. ªÔ˘ÛٷʤÏÏÔ˜, ¢. ∫ÔÌÓËÓÔ‡, ∂. ÷Ù˙ËÁÈ·ÓÓ¿Î˘
114
§··ÚÔÛÎÔÈ΋ ·ÚÈÛÙÂÚ¿ ÌÂÚÈ΋ Ë·ÙÂÎÙÔÌ‹: ¶Úfi‰ÚÔÌË ÌÂϤÙË ÁÈ· ÙË Ï‹„Ë ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ Û ÂÈÚ·Ì·ÙÈÎfi ÚfiÙ˘Ô ¯Ô›ÚˆÓ ∫. ª·ÌÌ¿˜, °. ∫fiÙÙ˘, ∞. ¶·Ê›ÙË, Ã. ¡ÈÎÔÏ¿Ô˘, °. ∫ˆÛÙÔ·Ó·ÁÈÒÙÔ˘,
12 ¡. ∞Úη‰fiÔ˘ÏÔ˜, μ. ™Ì˘ÚÓÈÒÙ˘ 115
E˘ÚÂÙ‹ÚÈÔ Û˘ÁÁڷʤˆÓ
117
O͇ÊÈÏ· ۈ̿ÙÈ·: ÃÚ‹ÛÈÌÔ˜ ÈÛÙÔÏÔÁÈÎfi˜ ‰Â›ÎÙ˘ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ∫. ¶·ÙÛÈ·Ô‡Ú·, O. °ÈÔ˘ÏÂ̤, £. μ·ÛÈÏÂÈ¿‰Ë˜, ∂. ∫·ÙÛ›ÎË, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ÿÌ‚ÚÈÔ˜, ¢. Δ·ÎÔ‡‰·˜
¶ÚÔÊÔÚÈΤ˜ ∞Ó·ÎÔÈÓÒÛÂȘ
1 ∞¡πá∂À™∏ ¶∞ƒ∞ã∂¡Δø¡ DE NOVO ∂π¢π∫ø¡ ™ΔO ªO™Ã∂Àª∞ HLA ∞¡Δπ™øª∞Δø¡ ∞. πÓȈٿÎË1, I. ¡ÙfiÎÔ˘1, ª. ∞ÔÛÙÔÏ¿ÎË1, ™. ª·ÚÈÓ¿ÎË2, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘2, μ. ª›ÚÙ˙·˜1, ∞. ™Ù·˘ÚÔÔ‡ÏÔ˘-°ÎÈfiη1, ∞. ∫ˆÛÙ¿Î˘2, π. ªÔϤÙ˘2 1∞ÓÔÛÔÏÔÁÈÎfi
∂ÚÁ·ÛÙ‹ÚÈÔ Î·È ∂ıÓÈÎfi ∫¤ÓÙÚÔ πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¶¡ «°. °ÂÓÓËÌ·Ù¿˜» ΔÌ‹Ì· Î·È ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ, §·ÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∞ı‹Ó·
2¡ÂÊÚÔÏÔÁÈÎfi
∏ ·ÚÔ˘Û›· de novo ÂȉÈÎÒÓ ÛÙÔ ÌfiÛ¯Â˘Ì· HLA ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È ‰Â›ÎÙ˘ ÂÓÂÚÁÔÔ›ËÛ˘ Ì˯·ÓÈÛÌÒÓ ·ÏÏÔ·Ó·ÁÓÒÚÈÛ˘, ·ÏÏ¿ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ηıÔÚÈÛÌÔ‡ Ù˘ ÂȉÈÎfiÙËÙ·˜ ÏfiÁˆ Ù˘ ÔÏ˘ÌÔÚÊ›·˜ ÙˆÓ HLA ÌÔÚ›ˆÓ Î·È Ù˘ Û˘¯Ó‹˜ Û˘Ó-¤ÎÊÚ·Û˘ ÙÔ˘˜ ‰ÂÓ Â¤ÙÚ ÙËÓ ·ÍÈoÏfiÁËÛË ÙÔ˘˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ó·˙ËÙ‹ıËÎ·Ó Û 662 Ï‹Ù˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ de novo ÂȉÈο ÛÙÔ ÌfiÛ¯Â˘Ì· HLA Ù¿Í˘ π Î·È ππ ·ÓÙÈÛÒÌ·Ù· Ì ÌÂıÔ‰ÔÏÔÁ›· ΢ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜ (Luminex) Î·È single antigen bead ·Ó¿Ï˘ÛË, ·Ó·ÁÓˆÚ›ÛıËÎ·Ó ÔÈ ÛÙfi¯Ô Ù˘ ¯˘ÌÈ΋˜ ·ÏÏÔ·¿ÓÙËÛ˘ Î·È Û˘Û¯ÂÙ›ÛıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ì ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ¶ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË 188/662 ·ÛıÂÓ›˜ ›¯·Ó ·ÓÙÈÛÒÌ·Ù· ÂÓÒ 474 ‹Ù·Ó ·ÚÓËÙÈÎÔ› ÁÈ· ·ÓÙÈÛÒÌ·Ù·. ™Â 498 ·ÛıÂÓ›˜ ÙÔ ÌfiÛ¯Â˘Ì· ›¯Â HLA Ù¿Í˘ π Î·È ππ ·Û‡Ì‚·Ù· ·ÓÙÈÁfiÓ· (··) ÂÓÒ 164 ·ÛıÂÓ›˜ ›¯·Ó ‰Â¯ı› ÌfiÛ¯Â˘Ì· ÌfiÓÔ Ì HLA Ù¿Í˘ π ··. OÈ ·ÛıÂÓ›˜ ›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ·ÈÌÔÏË„›Â˜ Î·È Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 5. 8±5. 4 ¤ÙË. OÈ 94/662 (14. 2%) ·ÛıÂÓ›˜ ·Ó¤Ù˘Í·Ó de novo ÂȉÈο ÛÙÔ ÌfiÛ¯Â˘Ì· ·ÓÙÈÛÒÌ·Ù·. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂٷ͇ ÙˆÓ Â˘·ÈÛıËÙÔÔÈËÌ¤ÓˆÓ (34/188) Î·È ÌË Â˘·ÈÛıËÙÔÔÈËÌ¤ÓˆÓ (60/474) ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÛıÂÓÒÓ (p=NS). OÈ 69/94 ·ÛıÂÓ›˜ ·Ó¤Ù˘Í·Ó HLA Ù¿Í˘ ππ ÂȉÈο ÛÙÔ ‰fiÙË ·ÓÙÈÛÒÌ·Ù· Ì 58/69 (84%) ·ÛıÂÓ›˜ Ó· ¤¯Ô˘Ó HLA-DQ ÂȉÈο ÛÙÔ ÌfiÛ¯Â˘Ì· ·ÓÙÈÛÒÌ·Ù·. OÈ ˘fiÏÔÈÔÈ 25/94 ıÂÙÈÎÔ› ·ÛıÂÓ›˜ ·Ó¤Ù˘Í·Ó HLA Ù¿Í˘ π ·ÓÙÈÛÒÌ·Ù·. ∞ÓÙÈÛÒÌ·Ù· Û ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ·ÓÙÈÁfiÓ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Û 13/94 (13. 8%) ·ÛıÂÓ›˜. ∏ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ó¤Ù˘Í·Ó ÂȉÈο ÛÙÔ ‰fiÙË ·ÓÙÈÛÒÌ·Ù· ›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ›‰· ÎÚ·ÙÈÓ›Ó˘ (2. 07±0. 89 mg/dl) Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· Ì ÌË ÂȉÈο ÛÙÔ ‰fiÙË ·ÓÙÈÛÒÌ·Ù· (1. 68±0. 9 mg/dl, p=. 008) Î·È ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ·ÓÙÈÛÒÌ·Ù· (1. 52±0. 5 mg/dl, p=. 000000) ™˘ÌÂÚ·›ÓÔ˘Ì fiÙÈ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¢·›ÛıËÙ˜ Î·È ÂȉÈΤ˜ ÌÂıfi‰Ô˘˜ ·ÓȯÓ‡ÔÓÙ·È Ù· ·Ú·¯ı¤ÓÙ· de novo ÂȉÈο ÛÙÔ ‰fiÙË HLA ·ÓÙÈÛÒÌ·Ù· ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, Ë ·ÚÔ˘Û›· ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ·ÍÈÔÏÔÁ‹ÛÈÌË ÎÏÈÓÈ΋ ÏËÚÔÊÔÚ›· ÁÈ· ÙËÓ ÔÚ›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜.
16
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
2 ¶O§À∂À∞π™£∏ΔO¶Oπ∏ª∂¡Oπ §∏¶Δ∂™ ¡∂ºƒπ∫OÀ ªO™Ã∂Àª∞ΔO™ ™. ª·ÚÈÓ¿ÎË1, ¶. ¶··‰¿ÎË1, ∞. πÓȈٿÎË2, ¢. º¿ÓË1, ∞. °fiÌÔ˘1, E. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘1, ª. ™˘ÚÔÔ‡ÏÔ˘2, ∞. ∫ˆÛÙ¿Î˘1, π. ¡. ªÔϤÙ˘1 1ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi
2∞ÓÔÛÔÏÔÁÈÎfi
∫¤ÓÙÚÔ, °¡∞ «§·˚Îfi» ∂ÚÁ·ÛÙ‹ÚÈÔ Î·È ∂ıÓÈÎfi ∫¤ÓÙÚÔ πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¶¡∞ «°. °ÂÓÓËÌ·Ù¿˜»
∞ÛıÂÓ›˜ ÚÔ˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì ˘„ËÏfi Ù›ÙÏÔ ÚÔÛ¯ËÌ·ÙÈÛÌ¤ÓˆÓ HLA ·ÓÙÈÛˆÌ¿ÙˆÓ (PRAs >70%) ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ˘ÂÚ¢·ÈÛıËÙÔÔÈË̤ÓÔÈ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰˘ÛÎÔϛ˜ ÙfiÛÔ ˆ˜ ÚÔ˜ ÙËÓ ·Ó‡ÚÂÛË Û˘Ì‚·ÙÔ‡ ÌÔۯ‡̷ÙÔ˜ fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙÔÓ Î›Ó‰˘ÓÔ ·fiÚÚȄ˘. ∞fi ÙÔ 2004, Ô ∂ıÓÈÎfi˜ OÚÁ·ÓÈÛÌfi˜ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ¤¯ÂÈ ‰ÒÛÂÈ ·fiÏ˘ÙË ÚÔÙÂÚ·ÈfiÙËÙ· ÛÙËÓ ÂÈÏÔÁ‹ ÌÂٷ͇ ÙˆÓ ˘ÂÚ¢·ÈÛıËÙÔÔÈËÌ¤ÓˆÓ ÏËÙÒÓ ÁÈ· οı ‰È·ı¤ÛÈÌÔ ÌfiÛ¯Â˘Ì·. ∏ ÂÈÏÔÁ‹ ‚·Û›˙ÂÙ·È ÛÙË Ì¤ıÔ‰Ô ÙˆÓ ·Ô‰ÂÎÙÒÓ ·Û‡Ì‚·ÙˆÓ ·ÓÙÈÁfiÓˆÓ Î·È Ì¤¯ÚÈ Û‹ÌÂÚ·, ·fi ÙÔ˘˜ 71 ÔÏ˘Â˘·ÈÛıËÙÔÔÈË̤ÓÔ˘˜ Ï‹Ù˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Ì·˜, ¤¯Ô˘Ó ÌÂÙ·ÌÔÛ¯Â˘ı› 20. ¶ÚfiÎÂÈÙ·È ÁÈ· 11 Á˘Ó·›Î˜ Î·È 9 ¿Ó‰Ú˜, ÔÈ ÔÔ›ÔÈ ‚Ú›ÛÎÔÓÙ·Ó Û ·ÈÌÔοı·ÚÛË Â› 9,3 ± 3,3 ¤ÙË. OÈ 8/20 ·ÛıÂÓ›˜ ›¯·Ó ˘Ô‚ÏËı› Û ̛· ÚÔËÁÔ‡ÌÂÓË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡, ÂÓÒ Û 2 ·ÛıÂÓ›˜ ›¯·Ó ÚÔËÁËı› 2 ÌÂÙ·ÌÔۯ‡ÂȘ. OÈ ·ÛıÂÓ›˜ ›¯·Ó HLA Ù¿Í˘ π Î·È Ù¿Í˘ ππ ·ÓÙÈÛÒÌ·Ù· Ì % PRAs 70 ± 27 Î·È 55 ± 30, ·ÓÙ›ÛÙÔȯ·. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÏËÙÒÓ ‹Ù·Ó 50,1± 8,4 ¤ÙË Î·È ÙˆÓ ‰ÔÙÒÓ 54,6 ± 14,7 ¤ÙË, ·ÓÙ›ÛÙÔȯ·. OÈ 12/20 ·ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó Î·ı˘ÛÙÂÚË̤ÓË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ‰È¿ÚÎÂÈ·˜ 13,2 ± 9,3 ̤Ú˜. ™Â 16/20 ·ÛıÂÓ›˜ ÙÔ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi Û¯‹Ì· ‹Ù·Ó: Tacrolimus 0,05 mg/Kg ™μ Ì ÂÈı˘ÌËÙ¤˜ ÛÙ¿ı̘ 4-7 ng/ml, Everolimus 2-3 mg Ì ÂÈı˘ÌËÙ¤˜ ÛÙ¿ı̘ 6-9 ng/ml, ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË Û ·Ú¯È΋ ‰fiÛË 20-40 mg/ËÌ Î·È ˆ˜ ·Ú¯È΋ ıÂڷ›· ÙÔ ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ ¤Ó·ÓÙÈ ÙÔ˘ ˘Ô‰Ô¯¤· IL-2 Daclizumab. ™Â 4/20 ·ÛıÂÓ›˜ ¯ÔÚËÁ‹ıËΠ·ÓÙ› ÙÔ˘ Everolimus, mycophenolate mofetil Û ‰fiÛË 1, 5-2 g/ËÌ. ∏ ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ Â›Ó·È 15 ± 9,4 Ì‹Ó˜. ∏ ̤ÛË ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÛÙÔÓ 1 Ì‹Ó· ‹Ù·Ó 2,3 ± 2,1 mg/dl, ÛÙÔ˘˜ 6 Ì‹Ó˜ 1,6 ± 0,9 mg/dl Î·È ÛÙÔÓ 1 ¯ÚfiÓÔ 1,4± 0,6 mg/dl. ™ËÌÂÈÒıËΠ¤Ó·˜ ı¿Ó·ÙÔ˜ ·ÛıÂÓÔ‡˜ Ì ÏÂÈÙÔ˘ÚÁÔ‡Ó ÌfiÛ¯Â˘Ì·, ·fi ηÎÔ‹ıÂÈ·, ÂÓÒ ‰ÂÓ ˘‹ÚÍ η̛· ·ÒÏÂÈ· ÌÔۯ‡̷ÙÔ˜. ¶·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Û˘ÓÔÏÈο ÙÚ›· ÂÂÈÛfi‰È· ÔÍ›·˜ ·fiÚÚȄ˘ : 2 ΢ÙÙ·ÚÈÎÔ‡ Ù‡Ô˘ ·fiÚÚÈ„Ë Î·È 1 ·ÁÁÂÈ·ÎÔ‡ Ù‡Ô˘ Ù¿Í˘ ππ∞ ηٿ Banff. ¶·Ú·ÙËÚ‹ıËÎ·Ó 5 ÂÂÈÛfi‰È· ÏÔÈÌÒ͈Ó, Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ÓÔÛËÏ›·, Û 4 ·ÛıÂÓ›˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ¿ÚÈÛÙ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡ Û ˘ÂÚ¢·ÈÛıËÙÔÔÈË̤ÓÔ˘˜ Ï‹Ù˜ Ì ٷ ÓÂfiÙÂÚ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο Û¯‹Ì·Ù· ‰ÈηÈÒÓÔ˘Ó ÙËÓ ·fiÏ˘ÙË ÚÔÙÂÚ·ÈfiÙËÙ· ηٿ ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘˜.
17
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
3 ∞¡πá∂À™∏ ªπ∫ƒOÃπª∞πƒπ™ªOÀ ™Δ∞ OÀƒ∞ ∫∞π ™ΔO ∞πª∞ ∞™£∂¡ø¡ ¶OÀ ∂ÃOÀ¡ À¶Oμ§∏£∂π ™∂ ¡∂ºƒπ∫∏ ª∂Δ∞ªO™Ã∂À™∏: ¶ƒO∫∞Δ∞ƒ∫Δπ∫∞ ∞¶OΔ∂§∂™ª∞Δ∞ ∫. ºÔ˘ÚÙÔ‡Ó·˜1, ∞. ™˘ÚȉˆÓ›‰Ë˜2, ∂. ™·‚‚ȉ¿ÎË1, ¶. ∫·ÏÈ·ÎÌ¿ÓË1, ∂. ¶··¯Ú‹ÛÙÔ˘1, ¢. °Ô‡ÌÂÓÔ˜1, ¢. ∫·Ú·‚›·˜1, π. °. μÏ·¯ÔÁÈ¿ÓÓ˘1 1¡ÂÊÚÔÏÔÁÈÎfi
2∞ÈÌ·ÙÔÏÔÁÈÎfi
∫¤ÓÙÚÔ-ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜, ΔÌ‹Ì·-¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·ÙÚÒÓ
∏ ÛËÌ·Û›· Ù˘ ‡·Ú͢ ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌÔ‡ ÛÙ· Ô‡Ú· Î·È ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ·ÛıÂÓÒÓ ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ¤Ú¢ӷ˜ Î·È ‰È¯ÔÁӈ̛·˜ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÌÂıfi‰ˆÓ ·Ó›¯Ó¢Û˘ ÙÔ˘. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹ıËÎÂ Ë ‡·ÚÍË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌÔ‡ ÛÙ· Ô‡Ú· Î·È ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Û 17 Á˘Ó·›Î˜ ·ÛıÂÓ›˜ 48±11 ÂÙÒÓ, ÔÈ Ôԛ˜ ›¯·Ó ˘Ô‚ÏËı› Û ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Â›¯·Ó Ï¿‚ÂÈ ÌfiÛ¯Â˘Ì· ·fi ¿Ó‰Ú· ‰fiÙË. ∏ ·Ó¿Ï˘ÛË ¤ÁÈÓ ·fi 61±31 Ì‹Ó˜ ·fi ÙËÓ ÂÌʇÙ¢ÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ™ÙÔ ·›Ì· Î·È ÛÙ· Ô‡Ú· ÙˆÓ ·ÛıÂÓÒÓ ¤ÁÈÓ ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (PCR) ÁÈ· ÔÏ˘ÌfiÚÊÔ˘˜ ÙˆÓ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÒÓ ÁÔÓȉ›ˆÓ D1S80, DYZ1ZP3, TH01, Î·È SE33. ∏ ‡·ÚÍË ·ÏÏËÏ›Ô˘ ÌË Â˘ÚÈÛÎfiÌÂÓÔ˘ ÛÙÔ DNA ÙÔ˘ Ï‹ÙË ‹Ù·Ó ÂÓ‰ÂÈÎÙÈ΋ ÁÈ· ÙËÓ ‡·ÚÍË DNA ÙÔ˘ ‰fiÙË, ÂÓÒ Ë ·Ó›¯Ó¢ÛË ÙÔ˘ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎÔ‡ ·ÏÏËÏ›Ô˘ DZY1ZP3 Ô˘ ·Ó¢ڛÛÎÂÙ·È ÌfiÓÔ ÛÙÔ Y-¯ÚˆÌfiۈ̷ ‹Ù·Ó ·Ô‰ÂÈÎÙÈ΋ ÁÈ· ÙËÓ ‡·ÚÍË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌÔ‡. O Ô˘‰fi˜ ¢·ÈÛıËÛ›·˜ Ù˘ ÌÂıfi‰Ô˘ ‹Ù·Ó >10%. ¢ÂÓ ·Ó¢ڤıË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌfi˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÙˆÓ ·ÛıÂÓÒÓ, ÂÓÒ ·Ó¢ڤıË ÛÙ· Ô‡Ú· Û 8 ·ÛıÂÓ›˜ (47%). OÈ ·ÛıÂÓ›˜ ÛÙȘ Ôԛ˜ ·Ó¢ڤıË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌfi˜ ›¯·Ó ·ÚfiÌÔÈ· ËÏÈΛ·, ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Â͈ÓÂÊÚÈ΋˜ οı·ÚÛ˘, ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·, ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ Î·È ‰È¿ÚÎÂÈ· ÌÂÙ·ÌfiÛ¯Â˘Û˘, Ì ·˘Ù¤˜ ÛÙȘ Ôԛ˜ ‰ÂÓ ·Ó¢ڤıË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌfi˜. ∫·È ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (Ô˘Ú›· (61. 5±22. 9 vs 61±38. 5 mg/dl) Î·È ÎÚ·ÙÈÓ›ÓË (1. 23±0. 33 vs 1. 18±0. 47 mg/dl), οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ (50. 7±13. 7 vs 67. 5±32. 3 ml/min) Î·È ÚˆÙÂ˚ÓÔ˘Ú›· (228±151 vs 338±494 mg/24h). ¢‡Ô ·ÛıÂÓ›˜ ·fi οı ÔÌ¿‰· ·ÚÔ˘Û›·˙·Ó ¯ÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ∏ ·Ó‡ÚÂÛË ÌÈÎÚÔ¯ÈÌ·ÈÚÈÛÌÔ‡ ÌfiÓÔ ÛÙ· Ô‡Ú· Î·È fi¯È ÛÙÔ ·›Ì· Î·È ÌfiÓÔ Î·Ù¿ ÙÔ ‹ÌÈÛ˘ ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÁ›ÚÂÈ ÂÚˆÙ‹Ì·Ù· ÁÈ· ÙÔÓ ·ÎÚÈ‚‹ ÚfiÏÔ ÙÔ˘ ÛÙË ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË. Δ· ÚÔηٷÚÎÙÈο ·˘Ù¿ ·ÔÙÂϤÛÌ·Ù· ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ÚÔÔÙÈ΋˜ ¤Ú¢ӷ˜ Ì ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ.
18
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
4 ∂∫Δπª∏™∏ Δø¡ ∂¶π¶∂¢ø¡ Δ∏™ §∂πΔOÀƒ°π∫∏™ π∫∞¡OΔ∏Δ∞™ Δø¡ Δ §∂ªºO∫ÀΔΔ∞ƒø¡ Δø¡ ∞™£∂¡ø¡ ª∂ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ∞. μÈÙÙˆÚ¿ÎË1, ∞. πÓȈٿÎË1, ª. ¢·ÚÂÌ¿2, ∑. ™ÎÔÚ‰¿ÎË1, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘2, ∞. °fiÌÔ˘2, ∞. ™Ù·˘ÚÔÔ‡ÏÔ˘-°ÎÈfiη1, π. ªÔϤÙ˘2 1∞ÓÔÛÔÏÔÁÈÎfi
∂ÚÁ·ÛÙ‹ÚÈÔ Î·È ∂ıÓÈÎfi ∫¤ÓÙÚÔ πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¶¡ «°. °ÂÓÓËÌ·Ù¿˜» ΔÌ‹Ì· Î·È ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ, §·ÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∞ı‹Ó·
2¡ÂÊÚÔÏÔÁÈÎfi
∏ Ú‡ıÌÈÛË Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ Û ϋÙ˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ¯ˆÚ›˜ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó·ÚÎÔ‡˜ ‹ ˘ÂÚ‚ÔÏÈ΋˜ / ÙÔÍÈ΋˜ ‰fiÛ˘ ··ÈÙ› ηϋ ÁÓÒÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ CD4+ Δ Î˘ÙÙ¿ÚˆÓ 392 ·ÓÔÛÔηٷÛÙ·ÏÌ¤ÓˆÓ ÏËÙÒÓ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ Ì ÙË Ì¤ıÔ‰Ô Cylex Immunoknown Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ÙÔÓ Ù‡Ô ÙÔ˘ ‰fiÙË, ÙÔ ¯ÚfiÓÔ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Ì ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË 82 Ê˘ÛÈÔÏÔÁÈÎÒÓ ÌË ·ÓÔÛÔηٷÛÙ·ÏÌ¤ÓˆÓ ·ÙfiÌˆÓ (º∞). ∞ÈÌÔÏË„›Â˜ ¤ÁÈÓ·Ó Û ‰È·ÊÔÚÂÙÈο ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∏ ̤ıÔ‰Ô˜ ¯ÚËÛÈÌÔÔÈ› Ï‹Ú˜ ·›Ì· Î·È ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ CD4+ Δ Î˘ÙÙ¿ÚˆÓ ÌÂ Ê˘ÙÔ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË ÁÈ¿ 15-18 ÒÚ˜ Î·È Ì¤ÙÚËÛË ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ∞Δƒ Û ÏÔ˘ÌÈÓfiÌÂÙÚÔ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· ¤Ó˙˘Ì· ÏÔ˘ÛÈÊÂÚ›ÓË /ÏÔ˘ÛÈÊÂÚ¿ÛË. OÈ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔÈ ·ÛıÂÓ›˜ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· ›‰· ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ (Û ng/ml ATP) Û ۯ¤ÛË Ì ٷ º∞ (p=. 01, Mann Whitney test), Ì cut off ÙÈÌ‹ 323 ng/ml ATP Ô˘ ‰È·ÎÚ›ÓÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ ·fi Ù· Ê˘ÛÈÔÏÔÁÈο ÌË ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ· (p=. 005, ROC analysis). ™ËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ›‰· ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ›¯·Ó ÔÈ Ï‹Ù˜ ÌÔۯ‡̷ÙÔ˜ ·Ô ∑™¢ Û ۯ¤ÛË Ì ϋÙ˜ ·fi ¶¢ (p=. 007) Î·È ∑ª™ ‰fiÙË (p=. 03, Kruscal-Wallis test). OÈ ·ÛıÂÓ›˜ Ì >3 ¤ÙË ·Ô ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›¯·Ó ˘„ËÏfiÙÂÚ· ›‰· ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ Î·È ˘„ËÏfiÙÂÚ· ›‰· Cr Û˘ÁÎÚÈÙÈο Ì ·ÛıÂÓ›˜ ≤3 ¤ÙË ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË (p=. 03 Î·È p=. 02 ·ÓÙ›ÛÙÔȯ·). ∞ÓÙ›ıÂÙ·, ÔÈ ˘ÂÚ-¢·ÈÛıËÙÔÔÈË̤ÓÔÈ (%PRA>70%) ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔÈ ·ÛıÂÓ›˜ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· ›‰· ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ Û ۯ¤ÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜ (p=. 03, Fisher s exact test). Δ¤ÏÔ˜ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂȤ‰ˆÓ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ Ì ÙËÓ ËÏÈΛ· (p<. 001, Spermans test) Δ· ÚÒÙ· ·ÔÙÂϤÛÌ·Ù· ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë Ì¤ıÔ‰Ô˜ Cylex Immunoknown ·ÓÙ·Ó·ÎÏ¿ ÙÔ Â›Â‰Ô Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ ÏËÙÒÓ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙË Û¯¤ÛË ÙÔ˘˜ Ì ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ÓÂÊÚÈ΋˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘.
19
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
5 ∂¶π¢ƒ∞™∏ ∞¡O™O∫∞Δ∞™Δ∞§Δπ∫ø¡ º∞ƒª∞∫ø¡ ™Δ∞ ƒÀ£ªπ™Δπ∫∞ Δ-§∂ªºO∫ÀΔΔ∞ƒ∞ ™∂ ∞™£∂¡∂π™ ¶OÀ ∂ÃOÀ¡ À¶Oμ§∏£∂π ™∂ ¡∂ºƒπ∫∏ ª∂Δ∞ªO™Ã∂À™∏ ∫. ºÔ˘ÚÙÔ‡Ó·˜1, ∞. ªÔ˘˙¿ÎË2, ¶. ™·ÎÂÏÏ·Ú¿ÎË2, ª. ∫·Ú·Î¿Ù˙·2, ∂. ™·‚‚ȉ¿ÎË1, ¢. °Ô‡ÌÂÓÔ˜1, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘1 2∞ÈÌ·ÙÔÏÔÁÈÎfi
1¡ÂÊÚÔÏÔÁÈÎfi ∫¤ÓÙÚÔ-ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜, ΔÌ‹Ì·-¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·ÙÚÒÓ
¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ì›· ˘ÔÔÌ¿‰· ÙˆÓ Δ ‚ÔËıËÙÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ù· Δ Ú˘ıÌÈÛÙÈο ·ÙÙ·Ú· (Tregs), ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÓÔ¯‹ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. Δ· Tregs, ʤÚÔ˘Ó ÙÔ˘˜ ‰Â›ÎÙ˜ ÂÈÊ·Ó›·˜ CD4+CD25+ Î·È ¯ˆÚ›˙ÔÓÙ·È Û ‰‡Ô ·‰Ú¤˜ ηÙËÁÔڛ˜ : Δ· Ê˘ÛÈο Tregs Ô˘ ¤¯Ô˘Ó ı˘ÌÈ΋ ÚԤϢÛË Î·È ÂÚȤ¯Ô˘Ó ÙÔÓ ÌÂÙ·ÁÚ·ÊÈÎfi ·Ú¿ÁÔÓÙ· Foxp3 Î·È Ù· ·ÁfiÌÂÓ· ÛÙË ÂÚÈʤÚÂÈ· Ô˘ ‰ÂÓ ÂÚȤ¯Ô˘Ó ÙÔÓ Foxp3. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹ıËÎ·Ó Ù· ›‰· ÙˆÓ Tregs (CD4+CD25+ ± Foxp3) Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜, ·Ó·ÊÔÚÈο Ì ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·È ÙˆÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó. ∂ÍÂÙ¿ÛÙËÎ·Ó ‰Â›ÁÌ·Ù· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ·fi 39 ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ˘Ô‚ÏËı› Û ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÈÓ ·fi 37±25 Ì‹Ó˜. ¢ÂηÂÓÓ¤· ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó ηϋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È 20 ¯ÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. OÏÔÈ Â›¯·Ó Ï¿‚ÂÈ Â·ÁˆÁ‹ Ì basiliximab Î·È ÂÏ¿Ì‚·Ó·Ó ÙÚÈÏ¿ ·ÓÔÛÔηٷÛÙ·ÏÙÈο Û¯‹Ì·Ù· ÌÂ Û˘Ó‰˘·ÛÌfi ·Ó·ÛÙÔϤ· Ù˘ ηÏÛÈÓ¢ڛÓ˘ (΢ÎÏÔÛÔÚ›ÓË, n=17 ‹ Tacrolimus, n=22), MMF (n=24) ‹ Everolimus (n=15) Î·È ÛÙÂÚÔÂȉ‹. ø˜ ÔÌ¿‰· ÂϤÁ¯Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ·fi 20 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ CD4+CD25+ ± Foxp3 T ΢ÙÙ¿ÚˆÓ ¤ÁÈÓ Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜. OÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó Û·ÊÒ˜ ÂÏ·Ùو̤ÓÔ ·fiÏ˘ÙÔ ·ÚÈıÌfi (4. 3±4. 4) Î·È ÔÛÔÛÙfi (0. 55±0. 4%) Foxp3+ Î·È Foxp3– (1. 84±0, 8%) Tregs Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (13±7,1. 74±0.8% Î·È 4±1, 4% ·ÓÙ›ÛÙÔȯ·, p<0.001). ∏ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡, οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘, eGFR, ÚˆÙÂ˚ÓÔ˘Ú›·) ‰ÂÓ ÂÌÊ¿ÓÈÛÂ Û˘Û¯¤ÙÈÛË Ì ٷ ›‰· ÙˆÓ Tregs. ¢È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ Foxp3+Tregs Ì ٷ ›‰· ÙÔ˘ Tacrolimus (r=0.63, p<0.01). ∞ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó MMF ·ÚÔ˘Û›·˙·Ó ˘„ËÏfiÙÂÚ· Foxp3+Δregs (5.7±5.2) Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó Everolimus (2.2±1.2, p=0.01), ·ÚfiÙÈ ÂÏ¿Ì‚·Ó·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚ˜ ‰fiÛÂȘ ·Ó·ÛÙÔϤˆÓ Ù˘ ηÏÛÈÓ¢ڛÓ˘. ∞ÓÙ›ıÂÙ·, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙ· ›‰· ÙˆÓ CD4+CD25+ Foxp3– Tregs ·Ó¿ÏÔÁ· Ì ٷ ·ÓÔÛÔηٷÛÙ·ÏÙÈο Û¯‹Ì·Ù·. Δ· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó ÌÈ· ·ÚÓËÙÈ΋ ›‰Ú·ÛË Ù˘ Û˘ÓÔÏÈ΋˜ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ·ÁˆÁ‹˜ ÛÙ· ›‰· ÙˆÓ Tregs ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È ·Ó·‰ÂÈÎÓ‡Ô˘Ó ‰È·ÊÔÚ¤˜ ÛÙË Â›‰Ú·ÛË ÙˆÓ ÂÈ̤ÚÔ˘˜ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· ›‰· ÙˆÓ Foxp3+ Tregs Ô˘ Èı·ÓfiÓ Ó· ÂËÚ¿˙Ô˘Ó ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
6 ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ™∂ §∏¶Δ∂™ ª∂ £∂Δπ∫∏ ¢O∫πª∞™π∞ π™Δπ∫∏™ ¢π∞™Δ∞Àƒø™∏™ μ-∫ÀΔΔ∞ƒø¡ ª∂ ∫ÀΔΔ∞ƒOª∂Δƒπ∞ ƒO∏™ ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘1, ∞. πÓȈٿÎË2, ™. ª·ÚÈÓ¿ÎË1, ¶. ¶·¿˜3, °. ¶·ÙÂÚ¿Î˘2, °. ∑·‚‚fi˜1, ∞. ∫ˆÛÙ¿Î˘1, π.¡. ªÔϤÙ˘1 1ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi
2∞ÓÔÛÔÏÔÁÈÎfi
∫¤ÓÙÚÔ, °¡∞ «§·˚Îfi» ∂ÚÁ·ÛÙ‹ÚÈÔ & ∂ıÓÈÎfi ∫¤ÓÙÚÔ πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¶¡∞ «°. °ÂÓÓËÌ·Ù¿˜» 3∞ÎÙÈÓÔÏÔÁÈÎfi ΔÌ‹Ì·, °¡∞ «§·˚Îfi»
ªÂ ÛÎÔfi ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ıÂÙÈ΋˜ ‰ÔÎÈÌ·Û›·˜ ÈÛÙÈ΋˜ ‰È·ÛÙ·‡ÚˆÛ˘ μ-΢ÙÙ¿ÚˆÓ Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ (B-FCXM) ÁÈ· ÙËÓ ¤Î‚·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÌÂÏÂÙ‹ıËÎ·Ó 18 ÌÂÙ·ÌÔۯ‡ÛÂȘ Ì B-FCXM(+) Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙÔ Î¤ÓÙÚÔ Ì·˜ ÌÂٷ͇ 2002-2007. ¢¤Î· ÌÔۯ‡̷ٷ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ˙ÒÓÙ· ‰fiÙË Î·È 8 ·fi ·Ô‚ÈÒÛ·ÓÙ·. °È· 15 ·ÛıÂÓ›˜ ‹Ù·Ó 1Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË, ÂÓÒ ÁÈ· 3 ·ÛıÂÓ›˜ ‰Â‡ÙÂÚË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ™Â 5 ·ÛıÂÓ›˜, ÙÔ ıÂÙÈÎfi B-FCXM ÔÊÂÈÏfiÙ·Ó Û ÚÔÛ¯ËÌ·ÙÈṲ̂ӷ HLA ·ÓÙÈÛÒÌ·Ù· Ì ÂȉÈÎfiÙËÙ· Û ·ÓÙÈÁfiÓ· ÙÔ˘ ‰fiÙË Î·È Û ¤Ó·Ó ·fi ·˘ÙÔ‡˜ ¤ÁÈÓ·Ó 4 Û˘Ó‰ڛ˜ Ï·ÛÌ·Ê·›ÚÂÛ˘. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÏËÙÒÓ ‹Ù·Ó 47±12 Î·È ÙˆÓ ‰ÔÙÒÓ 61±11 ¤ÙË. Δ· ·ÓÔÛÔηٷÛÙ·ÏÙÈο Û¯‹Ì·Ù· Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó ‹Ù·Ó: everolimus ‹ sirolimus /tacrolimus/ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË (MP) (N=8+3:11), MMF/tacrolimus/MP (N=4), MMF/΢ÎÏÔÛÔÚ›ÓË/MP (N=2) Î·È MMF/sirolimus/MP (N=1). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó basiliximab ‹ daclizumab. O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 19±19 Ì‹Ó˜ (1-67). ∏ ‰È¿ÌÂÛË ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÛÙÔÓ 1 Ì‹Ó·, 3 Ì‹Ó˜ Î·È ÛÙËÓ ÙÂÏÂ˘Ù·›· ·Ú·ÎÔÏÔ‡ıËÛË ‹Ù·Ó 1,6 mg/dl (0,9-4,5), 1. 6 mg/dl (0,8-3,6) Î·È 1,5 mg/dl (0,9-3,7), ·ÓÙ›ÛÙÔȯ·. ™ËÌÂÈÒıËΠ¤Ó· ÂÂÈÛfi‰ÈÔ ·fiÚÚȄ˘ ·ÁÁÂÈ·ÎÔ‡ Ù‡Ô˘ Û ·ÛıÂÓ‹ Ì ÚÔÛ¯ËÌ·ÙÈṲ̂ӷ ·ÓÙÈÛÒÌ·Ù·, ÙÔ ÔÔ›Ô ·ÓÙÈÌÂÙˆ›ÛÙËΠÂÈÙ˘¯Ò˜ Ì ·ÓÔÛÔÚÔÛÚÔÊ‹ÛÂȘ Î·È 2 ‹È· ÂÂÈÛfi‰È· ·fiÚÚȄ˘ ΢ÙÙ·ÚÈÎÔ‡ Ù‡Ô˘ Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÚÔÛ¯ËÌ·ÙÈṲ̂ӷ ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËηÓ, ›Û˘, ÂÈÙ˘¯Ò˜ Ì ÙË ¯ÔÚ‹ÁËÛË ÒÛÂˆÓ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘. ¢Â ÛËÌÂÈÒıËΠη̛· ·ÒÏÂÈ· ÌÔۯ‡̷ÙÔ˜ ÛÙÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™ÙȘ ÂÈÏÔΤ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È 4 ÂÂÈÛfi‰È· ÏÔÈÌÒÍÂˆÓ (Ô˘ÚÔÏÔÈÌÒÍÂȘ), 1 ÂÚ›ÙˆÛË ÓÂÊÚÔ¿ıÂÈ·˜ ·fi BKV Î·È ¤Ó· ÂÂÈÛfi‰ÈÔ ÂÓ Ùˆ ‚¿ıÂÈ ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘. ™ÙÔ˘˜ 4/5 ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ·ÓÙÈÛÒÌ·Ù· Ì ÂȉÈÎfiÙËÙ· ÂÓ·ÓÙ›ÔÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ‰fiÙË, Ù· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, ˘fi ÙË ¯ÔÚËÁËı›۷ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ıÂڷ›·, Ë ‚Ú·¯˘¯ÚfiÓÈ· ÂÈ‚›ˆÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ‰Â Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ‡·ÚÍË ıÂÙÈÎÔ‡ B-FCXM ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, ·ÎfiÌË Î·È ·Ó ·˘Ùfi ÂÚÌËÓ‡ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ÂȉÈÎÒÓ ¤Ó·ÓÙÈ ÙÔ˘ ‰fiÙË ·ÓÙÈۈ̿وÓ.
21
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
7 ∏ Ã∏™∏ ΔOÀ EVEROLIMUS ™ΔOÀ™ DE NOVO §∏¶Δ∂™ ¡∂ºƒπ∫ø¡ ªO™Ã∂Àª∞Δø¡. ∞ƒÃπ∫∏ ∂ª¶∂πƒπ∞ ™ΔO¡ ∂§§∏¡π∫O ¶§∏£À™ªO μ. ¶··ÓÈÎÔÏ¿Ô˘, ∞. ¡Ù›Ó·˜, ¢. μÚÔ¯›‰Ë˜, °. ª˘ÛÂÚÏ‹˜, ∞. ¶··ÁÈ¿ÓÓ˘, °. ÿÌ‚ÚÈÔ˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, π. ºÔ‡˙·˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, º. ™ÔψӿÎË, °. μ¤ÚÁÔ˘Ï·˜, ¡. O˘˙Ô˘Ó›‰Ë˜, ∫. ¢ÈÏ¿Ú˘, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢
™∫O¶O™
¶·ÚfiÏÔ Ô˘ ÙÔ everolimus ·Ô‰Â›¯ıËΠÎÏÈÓÈο ÂÍ›ÛÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfi Ì ÙÔ mycophenolate mofetil (MMF), ˘¿Ú¯Ô˘Ó ÂÚÁ·Û›Â˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÌÈÎÚ‹ ·ÓÔ¯‹. O ÛÎÔfi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÙËÓ ÂÌÂÈÚ›· ÂÓfi˜ ∂ÏÏËÓÈÎÔ‡ ªÂÙ·ÌÔÛ¯Â˘ÙÈÎÔ‡ ∫¤ÓÙÚÔ˘ fiÔ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÓ·ÏÏ¿Í ÙÔ everolimus Î·È ÙÔ MMF ÛÙÔ˘˜ de novo Ï‹Ù˜ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. A™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
™Â ·˘Ù‹ ÙËÓ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË, ÌÈ· ÔÌ¿‰· 24 ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚·Ó everolimus ÌÂÙ¿ ·fi ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË Û˘ÁÎÚ›ıËΠ̠ÌÈ· ÔÌÔÈfiÙ˘Ë (Û‡Ìʈӷ Ì ÌÈ· ÛÂÈÚ¿ ·fi 10 ÂÚÈÁÚ·ÊÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜) ÔÌ¿‰· 51 ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚·Ó MMF. ªÂÏÂÙ‹ıËÎÂ Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ô˘ ÌÂÙÚ‹ıËΠ̠ÙËÓ ÎÚ·ÙÈÓ›ÓË Î·È ÙËÓ Î¿ı·ÚÛË Ù˘, ηıÒ˜ ›Û˘ Ë ‰È¿Û·ÛË/ÂԇψÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Â˘Î·ÈÚÈ·ÎÒÓ ÏÔÈÌÒ͈Ó. ∞¶OΔ∂§∂™ª∞Δ∞
∏ ̤ÛË ÙÈÌ‹ οı·ÚÛ˘ Ù˘ ÎÚ·ÙÈÓ›Ó˘ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 61.03 ± 16.99 ml/min Î·È 60.99 ± 8.03 ml/min ÛÙÔ˘˜ Ï‹Ù˜ ·fi ˙ÒÓÙ˜ ‰fiÙ˜, ÁÈ· everolimus Î·È MMF ·ÓÙ›ÛÙÔȯ·. ∏ ̤ÛË ÙÈÌ‹ οı·ÚÛ˘ Ù˘ ÎÚ·ÙÈÓ›Ó˘ 3 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 71.24 ± 12.61 ml/min Î·È 62.61 ± 20.24 ml/min ÛÙÔ˘˜ Ï‹Ù˜ ·fi و̷ÙÈÎÔ‡˜ ‰fiÙ˜, ÁÈ· everolimus Î·È MMF ·ÓÙ›ÛÙÔȯ·. ∂› ϤÔÓ, Ë Û˘¯ÓfiÙËÙ· ‰È¿Û·Û˘ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ ‹Ù·Ó 33.34% Î·È 3.92% Î·È Ë Û˘¯ÓfiÙËÙ· CMV Ïԛ̈͢ (ÂȂ‚·ÈˆÌ¤ÓË Ì PCR) ‹Ù·Ó 8.33% Î·È 17.64% Î·È ÁÈ· ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÓÙ›ÛÙÔȯ·. ™Àª¶∂ƒ∞™ª∞TA
∏ ¯Ú‹ÛË ÙÔ˘ everolimus ÛÙÔ˘˜ de novo Ï‹Ù˜ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÛÙÔÓ ∂ÏÏ·‰ÈÎfi ¯ÒÚÔ Â›Ó·È ÂÍ›ÛÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È Ì ·ÚfiÌÔÈ· ·ÓÔ¯‹ Ì ·˘Ù‹ ÙÔ˘ MMF. ∂Í·›ÚÂÛË ·ÔÙÂÏ› Ë ÂԇψÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, Ë ÔÔ›· ÂÈ‚Ú·‰‡ÓÂÙ·È ÛËÌ·ÓÙÈο ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó everolimus.
22
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
8 ª∂Δ∞ΔƒO¶∏ Δ∏™ ∞¡O™O∫∞Δ∞™Δ∞§Δπ∫∏™ £∂ƒ∞¶∂π∞™ ™∂ MTORI ™∂ ∞™£∂¡∂π™ ª∂ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ∫∞π ¡∂O¶§∞™π∂™ ª. ¢·ÚÂÌ¿1, ∫. ¶Ô˘ÁÔ‡ÓÈ·1, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘1, π. ªfiÎÔ˜1, °. ª·ÚfiÔ˘ÏÔ˜2, π. ¢ÂÏÏ·‰¤ÙÛÈÌ·3, °. ∑·‚‚fi˜1, ∞. ∫ˆÛÙ¿Î˘1, π.¡. ªÔϤÙ˘1 1ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi
∫¤ÓÙÚÔ, °¡∞ «§·˚Îfi», ∂ÚÁ·ÛÙ‹ÚÈÔ, °¡∞ «§·˚Îfi», 3ΔÌ‹Ì· ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ 2μÈÔ¯ËÌÈÎfi
OÈ ·Ó·ÛÙÔÏ›˜ ηÏÛÈÓ¢ڛÓ˘ (CNI) Â›Ó·È ÁÓˆÛÙfi, fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Â›ÙˆÛË Î·ÎÔËıÂÈÒÓ, ÂÓÒ ÔÈ mTOR ·Ó·ÛÙÔÏ›˜ (mTORi) everolimus Î·È sirolimus, Û ÚfiÛÊ·Ù˜ ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜, Ê¿ÓËΠӷ Û˘Óԉ‡ÔÓÙ·È Ì ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ηÎÔËıÂÈÒÓ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÎÙÈÌ‹ıËÎÂ Ë ÔÚ›· Ù˘ ÂͤÏÈ͢ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·ÓÙÈηٷÛÙ¿ıËÎ·Ó ÔÈ CNI Î·È Ë ·˙·ıÂÈÔÚ›ÓË (AZA) Ì mTORi, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÔÏ·ÛÈÒÓ. ™˘ÌÂÚÈÏ‹ÊıËÎ·Ó Û˘ÓÔÏÈο 14 ·ÛıÂÓ›˜, 3 Á˘Ó·›Î˜ Î·È 11 ¿Ó‰Ú˜, Ì ̤ÛË ËÏÈΛ· 49, 1±14, 9 ¤ÙË, ÔÈ ÔÔ›ÔÈ ÂÏ¿Ì‚·Ó·Ó Ù· ·ÎfiÏÔ˘ı· ·ÓÔÛÔηٷÛÙ·ÏÙÈο Û¯‹Ì·Ù·: CNI + MMF ± MP (n= 10), CNI +MP (n= 2), CNI +AZA+MP (n= 1), CNI +MP (n = 1). O ¯ÚfiÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÓÂÔÏ·Û›·˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 8,5 ± 6,7 ¤ÙË Î·È Ë Ì¤ÛË ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÙˆÓ ·ÛıÂÓÒÓ 1, 5 ± 0, 3 mg/dl. ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜, 4/14 ÂÌÊ¿ÓÈÛ·Ó ÓÂÔϷۛ˜ ‰¤ÚÌ·ÙÔ˜, 3/14 ϤÌʈ̷, 2/14 Û¿ÚΈ̷ Kaposi Î·È 5/14 ·ÚÔ˘Û›·Û·Ó ηÎÔ‹ıÂȘ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ. ™Â fiÏÔ˘˜ ¤ÁÈÓ ÙÚÔÔÔ›ËÛË Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ·ÁˆÁ‹˜ Î·È ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ ηÏÛÈÓ¢ڛÓ˘ (CNI’s) Î·È Ù˘ ·˙·ıÂÈÔÚ›Ó˘ Ì mTORi - sirolimus ‹ everolimus - Ì ·Ú¯È΋ ‰ÔÛÔÏÔÁ›· 5,3 ± 0,6 mg Î·È 4,0 ± 1,8 mg, ·ÓÙ›ÛÙÔȯ·. ªÂÙ¿ ·fi ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ 2,0 ± 1,8 ¤ÙË, ÔÈ ·ÛıÂÓ›˜ Ï·Ì‚¿ÓÔ˘Ó mTORi + MMF+ MP (n = 5), mTORi + MP (n = 8), mTORi + MMF (n = 1). ∏ ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ Â›Ó·È 5,3 ± 0,6 mg sirolimus ËÌÂÚËÛ›ˆ˜ Ì ›‰· ÚÔ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ 5,7 ± ng/ml Î·È everolimus 4,0 ± 1,8 mg / Ë̤ڷ Î·È Ì ›‰· 5,6 ± 1,0 ng/ml, ÂÓÒ Ë Ì¤ÛË ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ Â›Ó·È 1,5 ± 0,3 mg/dl. ™Â 12 ·ÛıÂÓ›˜ Ë ÓfiÛÔ˜ ¤¯ÂÈ ˘ÊÂı› Ï‹Úˆ˜, ÂÓÒ ·fi ÙÔ˘˜ 2 ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fi ¯ËÌÂÈÔıÂڷ›·, Ô ¤Ó·˜ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÌË ÂÏÂÁ¯fiÌÂÓË ÓfiÛÔ. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, Ë ·ÏÏ·Á‹ Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ Û mTORi Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û fiÙÈ ·ÊÔÚ¿ ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ‰ÂÓ ·ÔÎÏ›ÂÙ·È Ó· ¤¯ÂÈ Â˘ÌÂÓ‹ ›‰Ú·ÛË ÛÙËÓ ÂͤÏÈÍË Ù˘ ηÎÔ‹ıÂÈ·˜.
23
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
9 ™À°∫ƒπ™∏ ∞¡O™O∫∞Δ∞™Δ∞§Δπ∫OÀ ¶ƒøΔO∫O§§OÀ EVEROLIMUS ∫∞π Ã∞ª∏§∏™ ¢O™∏™ ∫À∫§O™¶Oƒπ¡∏™ ∞ ª∂ ªÀCOPHENOLATE MOFETIL KA𠶧∏ƒ∏ ¢O™∏ ∫À∫§O™¶Oƒπ¡∏™ ∞ ™∂ ∞™£∂¡∂π™ ª∂ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ °. ª˘ÛÂÚÏ‹˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. μ¤ÚÁÔ˘Ï·˜, ¢. μÚÔ¯›‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¡Ù›Ó·˜, °. ÿÌ‚ÚÈÔ˜, ∞. ¶··ÁÈ¿ÓÓ˘, π. ºÔ‡˙·˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, º. ™ÔψӿÎË, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. ∫·Ú‰¿Û˘, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£, πÔÎÚ¿ÙÂÈÔ °¡£, £ÂÛÛ·ÏÔÓ›ÎË
H ÙÔÍÈÎfiÙËÙ· ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ ηÏÛÈÓ¢ڛÓ˘ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ¯ÚfiÓÈ·˜ ¤ÎÙˆÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È ·ÓÔ¯‹˜ ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ∂verolimus (·Ó·ÛÙÔϤ·˜ mTOR) Î·È ¯·ÌËÏ‹˜ ‰fiÛ˘ CsA Û˘ÁÎÚÈÙÈο Ì ªªF Î·È Ï‹ÚË ‰fiÛË CsA Û de novo Ï‹Ù˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ (¡ª). ™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó 74 Ï‹Ù˜ ¡ª, Ì ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ (ª±SD) 13, 11±7, 3 Ì‹Ó˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 33 (44, 6%) ¤Ï·‚·Ó ·Ú¯È΋ ·ÓÔÛÔηٷÛÙÔÏ‹ Ì ÌÂı˘ÏÔÚ‰ÓÈ˙ÔÏfiÓË, ∂verolimus, ¯·ÌËÏ‹ ‰fiÛË CsA (2 mg/KgB™/d) Î·È basiliximab (OÌ¿‰· ∞) ÂÓÒ 41 (55, 4%) Ì ÌÂı˘ÏÔÚ‰ÓÈ˙ÔÏfiÓË, ªªF, Ï‹ÚË ‰fiÛË CsA (5 mg/KgB™/d) Î·È basiliximab (OÌ¿‰· μ). ∏ ËÏÈΛ· ÙˆÓ ÏËÙÒÓ ¡ª (̤ÛË ËÏÈΛ·±SD) ‹Ù·Ó 44,5±14,2 ¤ÙË Î·È ÙˆÓ ‰ÔÙÒÓ 57, 8±16, 8 ¤ÙË. ™ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ÌÂÏÂÙ‹ıËÎ·Ó Ë ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ (Scr) Î·È Ë GFR ÙˆÓ ·ÛıÂÓÒÓ (̤ıÔ‰Ô˜ MDRD) ÛÙÔ˘˜ 1, 6 Î·È 12 Ì‹Ó˜, Ë ∞¶ Î·È ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· 24ÒÚÔ˘ ÛÙÔ˘˜ 6 Î·È 12 Ì‹Ó˜ ηıÒ˜ ›Û˘ Ù· ÏÈ›‰È· (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÙÚÈÁÏ˘ÎÂÚ›‰È·, LDL Î·È HDL ¯ÔÏËÛÙÂÚfiÏË) ÛÙÔ˘˜ 3, 6 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙË ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∂›Û˘ ηٷÁÚ¿ÊËÎ·Ó Î·È Û˘ÁÎÚ›ıËÎ·Ó Ù· ÂÂÈÛfi‰È· O∞ Î·È ÔÈ CMV ÏÔÈÌÒÍÂȘ. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Ù˘ Scr ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ ÛÙ· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· 1, 6 Î·È 12 ÌËÓÒÓ. ∏ GFR ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ 1 Î·È 12 Ì‹Ó˜. OÈ ·ÛıÂÓ›˜ Ù˘ OÌ¿‰·˜ ∞ ›¯·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË GFR ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ OÌ¿‰·˜ μ ÛÙÔ˘˜ 6 Ì‹Ó˜ ÌÂÙ¿ ÙË ¡ª (OÌ¿‰· ∞: GFR 6 m: 60,3±14,7 ml/min/1, 73 m2 vs OÌ¿‰· B: GFR 6 m: 51,3±15,8 ml/min/1, 73 m2, p<0. 05). TfiÛÔ Ë ™∞¶ fiÛÔ Î·È Ë ¢∞¶ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ ÂÓÒ Ë ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· 24ÒÚÔ˘ ·Ó Î·È ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ OÌ¿‰· ∞ ÂÓÙÔ‡ÙÔȘ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ·fi ÙËÓ OÌ¿‰· μ (OÌ¿‰· ∞: §Â˘ÎˆÌ·ÙÔ˘Ú›· 12 m: 453,18±494,01 mg/d vs OÌ¿‰· μ 262,56±332, 4 mg/d, p=NS). ∏ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ OÌ¿‰· ∞ ÛÙÔ˘˜ 6 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙË ¡ª (OÌ¿‰· ∞: T-chol 6 m: 278,48±70,98 mg/dl, 12 m: 259,29±84,67 mg/dl vs OÌ¿‰· μ: T-chol 6 m: 217,37±76,39 mg/dl, 12 m: 202,60±59,21 mg/dl, p<0.05), ÂÓÒ Ë LDL Û fiÏ· Ù· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· (OÌ¿‰· ∞: LDL 3 m: 194,11±57,90 mg/dl, 6 m: 187,66±56,97 mg/dl, 12 m: 178,47±50,31 mg/dl vs OÌ¿‰· μ: LDL 3 m: 128, 95±39,08 mg/dl, 6 m: 131,39±35,58 mg/dl, 12 m: 126,18±30,54 mg/dl, p<0. 05). H Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ O∞ ÛÙËÓ OÌ¿‰· ∞ ‹Ù·Ó 12, 1% ÂÓÒ ÛÙËÓ OÌ¿‰· μ, 22% (p=NS) Î·È Ù˘ CMV Ïԛ̈͢ 9% Î·È 12,2% ·ÓÙ›ÛÙÔȯ·. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ì ÙÔ everolimus ‰È¢ÎÔχÓÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ ÂÏ·¯ÈÛÙÔÔ›ËÛ˘ Ù˘ CsA Î·È Ì¤Ûˆ ·˘Ù‹˜ Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÔ¿ıÂÈ·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
10 ∏ ™Ã∂™∏ Δø¡ ¶ƒO∂°Ã∂πƒ∏Δπ∫ø¡ ∞¶∂π∫O¡π™Δπ∫ø¡ ∫∞π ¶∞£O§O°O∞¡∞ΔOªπ∫ø¡ ∂Àƒ∏ª∞Δø¡ ™ΔO ∏¶∞Δπ∫O ¶∞ƒ∞™∫∂À∞™ª∞ ™∂ ª∂Δ∞ªO™Ã∂À™∂π™ ∏¶∞ΔO™ °π∞ ∏¶∞ΔO∫ÀΔΔ∞ƒπ∫O ∫∞ƒ∫π¡O ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∫. ¢ÈÏ¿Ú˘, ∫. ¶·ÙÛÈ·Ô‡Ú·, ∂. ∫·ÙÛ›ÎË, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, π. ºÔ‡˙·˜, ¢. μÚÔ¯›‰Ë˜, ∞. ¡Ù›Ó·˜, °. ΔÛÔ˘ÏÊ¿˜, ¢. ∫·Ú‰¿Û˘, ∂. ∫·Ùۛη, ∂. ∞Ó·ÁÓˆÛÙ¿Ú·, E. ∑·ÊÂÈÚÈ¿‰Ô˘, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ÿÌ‚ÚÈÔ˜, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞. ¶. £., °.¡.£. πÔÎÚ¿ÙÂÈÔ ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ °.¡.£. πÔÎÚ¿ÙÂÈÔ
∂π™∞°ø°H
∏ ÎÏÈÓÈ΋ ÛÙ·‰ÈÔÔ›ËÛË ÙÔ˘ Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ (HCC) Î·È Ù· ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì HCC ˆ˜ ˘Ô„‹ÊÈÔÈ Ï‹Ù˜ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ‚·Û›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÔÓ ÚÔÌÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ·ÂÈÎÔÓÈÛÙÈÎfi CT ¤ÏÂÁ¯Ô. A™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
™ÙÔ Î¤ÓÙÚÔ Ì·˜, ‰ÈÂÓÂÚÁ‹ıËÎ·Ó 48 ÌÂÙ·ÌÔۯ‡ÛÂȘ ‹·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì ¤Ó‰ÂÈÍË HCC Û ¤‰·ÊÔ˜ ΛÚÚˆÛ˘. ∂ÎÙÈÌ‹Û·Ì ÙË Û˘Û¯¤ÙÈÛË ÚÔÂÁ¯ÂÈÚËÙÈÎÒÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ HCC Û 41 ·ÛıÂÓ›˜. ∞¶OΔ∂§∂™ª∞Δ∞
™˘Ìʈӛ· ·ÂÈÎÔÓÈÛÙÈÎÒÓ-·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ˘‹Ú¯Â Û 10 ·ÛıÂÓ›˜ (24, 4%). ™Â 10 ·ÛıÂÓ›˜ (24,4%) ‰ÂÓ ·ÂÈÎÔÓ›ÛÙËΠÙÔ HCC ÚÔÂÁ¯ÂÈÚËÙÈο. ™Â 6 (14,63%) ·ÂÈÎÔÓ›ÛıËΠHCC Ô˘ ‰ÂÓ ÂȂ‚·ÈÒıËΠÈÛÙÔÏÔÁÈο (ÛÙÔ˘˜ 2 ÚÔËÁ‹ıËΠ¯ËÌÂÈÔÂÌ‚ÔÏÈÛÌfi˜). ∞fi ·˘ÙÔ‡˜, ÛÙÔ˘˜ 4 (66,6%)ÔÈ ·ÂÈÎÔÓÈ˙fiÌÂÓÔÈ fi˙ÔÈ <1,5 ÂÎ., Î·È ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ (33,3%), 3 ÂÎ. (ÚÔËÁ‹ıËΠ¯ËÌÂÈÔÂÌ‚ÔÏÈÛÌfi˜), Î·È 2 ÂÎ. ÀÔÂÎÙ›ÌËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ fi˙ˆÓ Û 13(31,7%) ·ÛıÂÓ›˜ (Û 7 ηٿ 1-2 fi˙Ô˘˜ Î·È Û 6 ηٿ >3 fi˙Ô˘˜), ˘ÔÂÎÙ›ÌËÛË ÌÂÁ¤ıÔ˘˜ ÙÔ˘˜ Û 1 ·ÛıÂÓ‹ (‰È·ÊÔÚ¿ >1 ÂÎ.), ÛÙÔÓ fiÔ›Ô ˘‹Ú¯Â Î·È ˘ÔÂÎÙ›ÌËÛË ·ÚÈıÌÔ‡. ™Â 2 (4,8%) ·ÛıÂÓ›˜ ÈÛÙÔÏÔÁÈο ‚Ú¤ıËÎ·Ó ÏÈÁfiÙÂÚ˜ ÂÛٛ˜ ·fi fiÛ˜ ·ÂÈÎÔÓ›ÛÙËÎ·Ó ÚÔÂÁ¯ÂÈÚËÙÈο. ™ÙȘ ‰‡Ô ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ Ô ÌË ÈÛÙÔÏÔÁÈο ÂȂ‚·ÈˆÌ¤ÓÔ˜ fi˙Ô˜ ÂÎÙÈÌ‹ıËΠ<1 ÂÎ. 11 ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ˘Ô‚ÏËı› Û ¯ËÌÂÈÔÂÌ‚ÔÏÈÛÌfi ›¯·Ó Ó¤ÎÚˆÛË ÛÙÔ˘˜ fi˙Ô˘˜, 4 ¯ˆÚ›˜ Ó¤ÎÚˆÛË, ÂÓÒ Û 2 Ë ÈÛÙÔÏÔÁÈ΋ ‰ÂÓ ÂȂ‚·›ˆÛ ÓÂfiÏ·ÛÌ·. ™ÙËÓ ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÎÏÈÓÈ΋ ÛÙ·‰ÈÔÔ›ËÛË 39 (95%) ·ÛıÂÓ›˜ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ªÈÏ¿ÓÔ˘, ÂÓÒ Û‡Ìʈӷ Ì ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ÛÙ·‰ÈÔÔ›ËÛË ÔÈ 28 (68,3%). ™ÙȘ ÂÚÈÙÒÛÂȘ ·‰È¿ÁÓˆÛÙˆÓ fi˙ˆÓ, ÛÙÔ˘˜ 13 ÂÚfiÎÂÈÙÔ ÁÈ· fi˙Ô˘˜ <1,5 ÂÎ., ÛÙÔ˘˜ 7 ‹Ù·Ó 1, 5 Ì 2 ÂÎ. Î·È Û 3 >2 ÂÎ. (2, 5-4, 5 ÂÎ.). ™Àª¶∂ƒ∞™ª∞TA
∏ ·ÎÚÈ‚‹˜ ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÛÙ·‰ÈÔÔ›ËÛË ‚¿ÛÂÈ Ù˘ CT ·ÂÈÎfiÓÈÛ˘ ÙÔ˘ HCC Û ÎÈÚÚˆÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ ÏfiÁˆ Ù˘ ‰˘ÛÎÔÏ›·˜ Ù˘ ‰È·ÊÔÚԉȿÁÓˆÛ˘ ÙÔ˘ HCC ·fi ÙÔ˘˜ ·Ó·ÁÂÓÓËÙÈÎÔ‡˜ fi˙Ô˘˜ ÙÔ˘ ‹·ÙÔ˜, ȉȷ›ÙÂÚ· fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· fi˙Ô˘˜ <2 ÂÎ.
25
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
11 ∞¶∂π∫O¡π™∏ ª∂ MDCT- ™¶§∏¡O¶À§∞πO°ƒ∞ºπ∞ Δø¡ ∂¶π¶§O∫ø¡ Δ∏™ ¶À§∞π∞™ º§∂μ∞™ ª∂Δ∞ ∞¶O ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ∞. ¶ÂÙÚȉ˘1, A. ¶·ÓÙ·˙ÔÔ‡ÏÔ˘1, Δ. °ÂÚԇ΢1, ∫. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘1, ∞. ¶··ÁÈ¿ÓÓ˘2, ∞. ¡Ù›Ó·˜2, μ. ∫·Ï·Î›‰Ë˜1, ¶. ¶·ÏÏ¿‰·˜1 1∞ÎÙÈÓÔÏÔÁÈÎfi
∂ÚÁ·ÛÙ‹ÚÈÔ «°. ¶··ÓÈÎÔÏ¿Ô˘» ΔÌ‹Ì· ∞ÍÔÓÈÎÔ‡ Î·È ª·ÁÓËÙÈÎÔ‡ ΔÔÌÔÁÚ¿ÊÔ˘. 2ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£
™∫O¶O™
∏ ·Ó¿‰ÂÈÍË ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ ˘Ï·›·˜ ÊϤ‚·˜, Ì ÔÏ˘ÙÔÌÈ΋ ·ÍÔÓÈ΋-ÛÏËÓÔ˘Ï·ÈÔÁÚ·Ê›·, Û ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. A™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
ªÂÏÂÙ‹ıËÎ·Ó Ì MDCT 11 ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. ¶ÚÔËÁ‹ıËΠÂͤٷÛË ¯ˆÚ›˜ ÛÎÈ·ÛÙÈÎÔ Î·È ·ÎÔÏÔ‡ıËÛ·Ó Ï‹„ÂȘ ÙÔÌÒÓ Û ÚÒÈÌË ·ÚÙËÚȷ΋, Û ÊÏ‚È΋, Î·È Û ʿÛË ÂÍÈÛÔÚÚfiËÛ˘. ™ÙËÓ ˘Ï·›· Ê¿ÛË Ù˘ ÙÚÈÊ·ÛÈ΋˜ MDCT ¤ÁÈÓ ·Ó·Û‡ÓıÂÛË ÙˆÓ ÂÁοÚÛÈˆÓ ÙÔÌÒÓ Ì ÙȘ Ù¯ÓÈΤ˜ MIP, VRT, Vessel View, MPR, Î·È CPR Ì ÛÎÔfi Ó· ·ÂÈÎÔÓÈÛı› Ô ÛÏËÓÔ˘Ï·›Ô˜ ¿ÍÔÓ·˜ Û ‰È- Î·È ÙÚÈۉȿÛÙ·ÙÔ Â›Â‰Ô. ∞¶OΔ∂§∂™ª∞Δ∞
∞fi ÙÔ˘˜ 11 ·ÛıÂÓ›˜ ÔÈ 7 ÂÌÊ¿ÓÈÛ·Ó ·ıÔÏÔÁÈÎfi ÛÏËÓÔ˘Ï·›Ô ¿ÍÔÓ·. ™Â 4 ·ÛıÂÓ›˜ ·ÂÈÎÔÓ›ÛÙËΠÛÙ¤ÓˆÛË ˘Ï·›·˜ ÊϤ‚·˜ (¤Ó·˜ ·fi ·˘ÙÔ‡˜ ·ÚÔ˘Û›·Û ӤÔ-‰È‹ıËÛË ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Ù˘ ˘Ï·›·˜ Î·È ÂÈÚfiÛıÂÙ· ıÚfiÌ‚ˆÛË ÙÔ˘ (¢∂) ÎÏ¿‰Ô˘ ·˘Ù‹˜. ™Â 2 ·ÛıÂÓ›˜ ·ÂÈÎÔÓ›ÛÙËΠ‰È¿Ù·ÛË ˘Ï·›·˜ ÊϤ‚·˜. ∞ÚÙËÚÈÔÔ›ËÛË Ù˘ ˘Ï·›·˜ ÊϤ‚·˜ ·Ú·ÙËÚ‹ıËΠ۠2 ·ÛıÂÓ›˜ (¤Ó·˜ ·ÚÔ˘Û›·Û ·fiÊÚ·ÍË Ù˘ Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜ Î·È Ô ¿ÏÏÔ˜ ÌÂÁ¿ÏË ÂÏ¿ÙÙˆÛË Ù˘ ÚÔ‹˜ ÛÙ· Ë·ÙÈο ÊÏ‚Èο ÛÙÂϤ¯Ë). ¶·Ú¿ÏÏËÏ· ·ÂÈÎÔÓ›ÛÙËÎ·Ó Ì›· ‰È¿Ù·ÛË Î·È Ì›· ıÚfiÌ‚ˆÛË ÛÏËÓÈ΋˜ ÊϤ‚·˜. ™Àª¶∂ƒ∞™ª∞TA
O ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÛÏËÓÔ˘Ï·›Ô˘ ¿ÍÔÓ· Ì ÙËÓ MDCT-ÛÏËÓÔ˘Ï·ÈÔÁÚ·Ê›·, ·ÔÙÂÏ› ÂͤٷÛË ÂÎÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ‰ÈfiÙÈ ·ÂÈÎÔÓ›˙ÂÈ ÌÂÙ¿ ·fi ÌÈ· ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ÙÔÓ ÛÏËÓÔ˘Ï·›Ô ¿ÍÔÓ·, ÂÓÒ ·Ú¿ÏÏËÏ· ¤¯Ô˘ÌÂ Î·È Ï‹ÚË ·ÂÈÎfiÓÈÛË ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ Î·È ÊÏ‚ÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘ fiˆ˜ Î·È ÙˆÓ ·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Ù˘ ÎÔÈÏÈ¿˜.
26
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
12 IMPACT OF THE MELD SYSTEM ON SURVIVAL AFTER LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA G. Tsoulfas, N. Elias, D. Ko, T. Kawai, F.L. Delmonico, A.B. Cosimi, M. Hertl Massachussets Cener Hospital, Harvard University, New York, USA
BACKGROUND
The implementation of the model for end-stage liver disease (MELD) has significantly changed the role of liver transplantation (LT) in the treatment of hepatocellular carcinoma (HCC). However, the effect of the MELD system on the post-transplant survival has not been fully elucidated. OBJECTIVE
To review the results of LT for HCC at a tertiary referral center over a period of 10 years, with special emphasis on the effect of the MELD system since its implementation date of February, 2002. METHODS
Retrospective review of prospectively collected data in a cohort of 60 patients who underwent LT for HCC between 1995 and 2005. Twelve patients were excluded, as they expired within 2 months of the transplant, none of who had HCC recurrence. Main outcome measures included patient demographics, tumor stage at explant, patient survival, and tumor recurrence. RESULTS
The average follow-up of the 48 patients was 396 (range 60-1296) days. On pathologic review of the explanted liver, 17% of patients were classified as stage I; 38% as stage II; 21% as stage III; and 22% as stage IV. The overall actual survival rate was 80% at 1-year, 75% at 3-year, 50% at 5-year and 40% at 10year (the 5- and 10-year data does not include MELD-era patients). Overall tumor recurrence was 12. 5%, with average time to recurrence 410 (range 120-624) days. More importantly, as can be seen in the figure, survival rates were higher after the implementation of the MELD system compared to the pre-MELD era patients (3-year survival 60% before MELD vs. 80% after MELD). This was an effect of the extra MELD points assigned for HCC, as there was no difference in the calculated MELD score (16 vs. 18) or the stages between the pre- and post-MELD era patients. Furthermore, recurrence decreased from 21% to 6. 9% following the implementation of the MELD system. Other findings included no effect on survival of HCV or pretreatment for HCC. CONCLUSION
This study has shown a beneficial effect of the MELD system on post-transplant survival after LT for HCC. This was accompanied by a decrease in the recurrence rate of HCC. Before MELD
1.00
Fraction survival
After MELD 0.75
0.50
0.25
0.00 0
25
50
75
Time (months)
100
125
27
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
13 O ∫Oƒ∂™ªO™ O•À°O¡OÀ ™ΔO ∞πª∞ Δ∏™ ∏¶∞Δπ∫∏™ º§∂μ∞™ ø™ ¶ƒøπªO™ ¶ƒO°¡ø™Δπ∫O™ ¢∂π∫Δ∏™ Δ∏™ §∂πΔOÀƒ°π∞™ ΔOÀ ∏¶∞Δπ∫OÀ ªO™Ã∂Àª∞ΔO™ Ã. ¶··ÁˆÚÁ›Ô˘1, μ. ¶··ÓÈÎÔÏ¿Ô˘2, ∞. ¶·ÚÏ·¿ÓË3, ∂. ∫·Ùۛη1, ¢. μÚÔ¯›‰Ë˜2, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜2, °. ÿÌ‚ÚÈÔ˜2, Ã. ∫Ô‡·Ó˘1, ¢. Δ·ÎÔ‡‰·˜2 1∞’
∞Ó·ÈÛıËÛÈÔÏÔÁÈÎfi ΔÌ‹Ì·, ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ °.¶.¡.£. πÔÎÚ¿ÙÂÈÔ, 3¶·ÓÂÈÛÙËÌȷ΋ ∞Ó·ÈÛıËÛÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °.¶.¡.£. ∞Ã∂¶∞
2¶·ÓÂÈÛÙËÌȷ΋
™∫O¶O™
™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘ ÎÔÚÂÛÌÔ‡ Ô͢ÁfiÓÔ˘ ÛÙÔ ·›Ì· Ù˘ Ë·ÙÈ΋˜ ÊϤ‚·˜ (ShVO2) ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘ ‹·ÙÔ˜ Ì ÙËÓ ¿ÌÂÛË ‹ ÌË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. Y§π∫O
MÂÏÂÙ‹Û·Ì 35 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ª. ∏., ÛÙ·‰›Ô˘ C ηٿ Child-Pugh. XˆÚ›Û·Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Û ‰‡Ô ÔÌ¿‰Â˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ¤Î‚·ÛË ÙÔ˘˜ ÙÔÓ ÚÒÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi Ì‹Ó·: OÌ¿‰· ∞: (Ó=28) ·ÛıÂÓ›˜ Ì ¿ÚÈÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ 1 Ì‹Ó· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È OÌ¿‰· μ: (Ó=7) ·ÛıÂÓ›˜ Ì ˷ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ı¿Ó·ÙÔ ÙÔÓ ÚÒÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi Ì‹Ó·. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·ÎÔÏÔ˘ı‹ıËÎÂ Ë ›‰È· ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ Î·È ÙÔ ›‰ÈÔ ÚˆÙfiÎÔÏÏÔ ·Ó·ÈÛıËÛ›·˜. ª∂£O¢O™
∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘ ηٷÁÚ¿ÊËÎÂ Î·È ÌÂÏÂÙ‹ıËÎÂ Ë ÙÈÌ‹ ShVO2 ·fi ·›Ì· Ô˘ Ï·Ì‚¿ÓÔÓÙ·Ó ·fi ÙËÓ Ë·ÙÈ΋ ÊϤ‚· ÙÔ˘ Ï‹ÙË Û ‰È¿ÊÔÚ˜ Ê¿ÛÂȘ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘: i) 10 min ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË Ù˘ ˘Ï·›·˜ ÊϤ‚·˜ (PV) ii) 20 min ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË Ù˘ PV iii) 10 min ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË Ù˘ Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜ (∏∞) iv) 20 min ÌÂÙ¿ ·ӷÈÌ¿ÙˆÛË Ù˘ HA v) Ù¤ÏÔ˜ ¯ÂÈÚÔ˘ÚÁ›Ԣ. ∏ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ÂÎÙÈÌ‹ıËΠ‚¿ÛÂÈ ÙÔ˘ ËÎÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È Ù˘ ·ÈÌÔ‰˘Ó·ÌÈ΋˜ ÛÙ·ıÂÚfiÙËÙ·˜ ηٿ ÙÔÓ ÚÒÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi Ì‹Ó·. ∞¶OΔ∂§∂™ª∞Δ∞
OÈ ÙÈ̤˜ ÙÔ˘ ShV02 ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (p<0.05) ÛÙȘ Ê¿ÛÂȘ i, iii Î·È v ÂÓÒ ÛÙȘ ˘fiÏÔȘ Ê¿ÛÂȘ ‰ÂÓ ÌÔÚ› Ó· ·ÍÈÔÏÔÁËı› ÏfiÁˆ ·ÓÔÌÔÈÔÁ¤ÓÂÈ·˜ ÏËı˘ÛÌÔ‡. OÈ ÙÈ̤˜ ÙÔ˘ ShV02 ÛÙËÓ ÔÌ¿‰· ∞ ¤‰ÂÈ¯Ó·Ó ·ÓÔ‰È΋ Ù¿ÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÂÓÒ ÔÈ ÙÈ̤˜ ÛÙËÓ ÔÌ¿‰· μ ›¯·Ó ÌÂÈÔ‡ÌÂÓË ÔÚ›·. ™Àª¶∂ƒ∞™ª∞TA
To ShVO2 ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÚÒÈÌÔ ‰Â›ÎÙË ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ηٿ ÙËÓ ‰ÈÂÁ¯ÂÈÚËÙÈ΋ Î·È ¿ÌÂÛË ÌÂÙ·Á¯ÂÈÚËÙÈ΋ ÂÚ›Ô‰Ô.
28
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
14 Oπ O•À°O¡Oª∂Δƒπ∫∂™ ª∂Δ∞μO§∂™ ∫∞Δ∞ Δ∏ ¢π∞ƒ∫∂π∞ Δ∏™ ª∂Δ∞ªO™Ã∂À™∏™ ∏¶∞ΔO™ (ª.∏) ø™ ¢∂π∫Δ∂™ ¶ƒO°¡ø™∏™ Δ∏™ ∞ª∂™∏™ §∂πΔOÀƒ°π∞™ ΔOÀ ∏¶∞Δπ∫OÀ ªO™Ã∂Àª∞ΔO™ ∂. ∫·Ùۛη, Ã. ¶··ÁˆÚÁ›Ô˘, °. ¶·ÚÔ˘ÙÛ›‰Ô˘, Ã. ∫Ô‡·Ó˘, °. ÿÌ‚ÚÈÔ˜, £. ∞ÛÏ·Ó›‰Ë˜, ª. ªÔÁÈ·Ù˙fiÔ˘ÏÔ˜, £. §·˙·Ú›‰Ë˜, ∞. ™È‰ËÚfiÔ˘ÏÔ˜, π. °Î¤Î·˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, ∞. ¶··ÁÈ¿ÓÓ˘, ∫. ¶·ÙÛÈ·Ô‡Ú·, ¢. Δ·ÎÔ‡‰·˜, ∂. ∞Ó·ÁÓˆÛÙ¿Ú· ∞′ ∞Ó·ÈÛıËÛÈÔÏÔÁÈÎfi ΔÌ‹Ì· πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢
™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ó· Û˘Û¯ÂÙ›ÛÂÈ ÙȘ ‰ÈÂÁ¯ÂÈÚËÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ù˘ ÈÛÙÈ΋˜ Ô͢ÁfiÓˆÛ˘, Ì ÙËÓ ¿ÌÂÛË ‹ ÌË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ªÂÏÂÙ‹Û·Ì 53 ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ª. ∏. ÛÙ·‰›Ô˘ C ηٿ Child – Pugh. Èڛ۷Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Û 2 ÔÌ¿‰Â˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ¤Î‚·Û‹ ÙÔ˘˜ ÙÔÓ 10 Ì‹Ó· ÌÂÙÂÁ¯ÂÈÚËÙÈο: Oª∞¢∞ π: (n=30) ¿ÚÈÛÙË ¤Î‚·ÛË, Oª∞¢∞ ππ: (n=23) ·ÛıÂÓ›˜ ‰È·ÛˆÏËÓÔ̤ÓÔÈ >50 ÒÚ˜ ÛÙË ª. ∂. £. ‹ ı¿Ó·ÙÔ ÙÔÓ 1Ô Ì‹Ó· ·fi ÂÈÏÔ΋ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘ ηٷÁÚ¿„·Ì ÌÂÏÂÙ‹Û·ÌÂ Î·È Û˘ÁÎÚ›Ó·Ì ÙȘ ÂÍ‹˜ ·Ú·Ì¤ÙÚÔ˘˜ Î·È ÛÙȘ 2 ÔÌ¿‰Â˜: DO2 VO2, (a-v) DO2, OER, SaO2, SVO2, Shunt, ÔÍÂÔ‚·ÛÈ΋ ÈÛÔÚÚÔ›·. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ηٷÁÚ¿ÊËÎ·Ó ÔÈ ÙÈ̤˜: ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ÙÔ˘ ÔÚÔ‡ (SGOT, SGPT) Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›Ó˘ (ƒΔ), ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ¤ÓÙ ÚÒÙˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ËÌÂÚÒÓ. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ÙÈ̤˜ fiÙ·Ó p<0, 05. ∏ ÂÈ‚›ˆÛË ÌÂٷ͇ ÙˆÓ 2 ÔÌ¿‰ˆÓ ‰È¤ÊÂÚ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο. Oª∞¢∞ I: 100%, Oª∞¢∞ ππ: 65%. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙȘ 2 ÔÌ¿‰Â˜ ‚Ú¤ıËÎ·Ó ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÔ˘ O2(VO2) ÙÔ Ph, ÙÔ ¤ÏÏÂÈÌÌ· ‚¿Û˘ ηıÒ˜ Î·È ÛÙȘ ÙÈ̤˜ ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›Ó˘ ÙˆÓ 5 ÚÒÙˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ËÌÂÚÒÓ(p. <0, 05). ™Àª¶Eƒ∞™ª∞
ø˜ ‰ÈÂÁ¯ÂÈÚËÙÈÎfi˜ ÚÒÈÌÔ˜ ‰Â›ÎÙ˘ ÚfiÁÓˆÛ˘ Ù˘ ·ÌÂÛ˘ ÏÂÈÙÔ˘ÚÁÈ·˜ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ÌÔÚ› Ó· ıˆÚËı› Ë ·˘ÙfiÌ·ÙË ‰ÈfiÚıˆÛË ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ Ù˘ ‚¿Û˘ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ¤̂·Û˘.
29
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
15 £ƒOªμø™∏ ¶À§∞π∞™ ∂¶π¶§O∫∏ ª∂Δ∞ ∞¶O Oƒ£OΔO¶π∫∏ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ∞¡∞¢ƒOªπ∫∏ ª∂§∂Δ∏ 16 ∂Δø¡ ¡. ™Ô˘Óȉ¿Î˘1, ∂. ªÔ˘ÏÔ‡‰Ë1, ∫. ∫·ÙÛ·ÓԇϷ˜1, ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘1, ∂. °ÂˆÚÁÈ¿‰Ô˘2, ª. ∫·Ú·Ó¿ÙÛÈÔ˘2, μ. ¶··ÓÈÎÔÏ¿Ô˘3, ¢. Δ·ÎÔ‡‰·˜3, ¡. °Ú›ÙÛË - °ÂÚÔÁÈ¿ÓÓË1 1I·ÙÚÔ›, 2¡ÔÛËÏÂ˘Ù¤˜
3XÂÈÚÔ˘ÚÁÈ΋
ª.∂.£, ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ °¡ πÔÎÚ¿ÙÂÈÔ £ÂÛÛ·ÏÔӛ΢
∂π™∞°ø°∏
∏ ıÚfiÌ‚ˆÛË Ù˘ ˘Ï·›·˜ Â›Ó·È Û¿ÓÈ· Û¯ÂÙÈο ÂÈÏÔ΋ ÌÂÙ¿ ·fi ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜, ·ÏÏ¿ fiÙ·Ó ·ÚÔ˘ÛÈ·ÛÙ› ¯Ú‹˙ÂÈ ¿ÌÂÛ˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÏfiÁˆ ÙÔ˘ fiÙÈ ÂÌÊ·Ó›˙ÂÈ ÙÂÚ¿ÛÙÈ· ıÓËÙfiÙËÙ·. ™∫O¶O™
ªÂϤÙË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ıÚfiÌ‚ˆÛ˘ Ù˘ ˘Ï·›·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÓÔÛËχÙËÎ·Ó ÌÂÙ¿ ·fi O. ª. ∏ ÛÙËÓ ÌÔÓ¿‰· Ì·˜, Ù˘ ·ÓÙÈÌÂÙˆÈÛ‹˜ Ù˘ ηıÒ˜ Î·È Ù˘ ¤Î‚·Û˘ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ. À§π∫O – ª∂£O¢O™
∞Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 16 ÂÙÒÓ (1990-2007). ÀÔ‚Ï‹ıËÎ·Ó Û ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ 217 ·ÛıÂÓ›˜. ∞fi ·˘ÙÔ‡˜ 6 ·ÛıÂÓ›˜ 2, 7% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ O. ª. ∏, ·ÚÔ˘Û›·Û·Ó ˆ˜ ÂÈÏÔ΋ ıÚfiÌ‚ˆÛË ˘Ï·›·˜ Î·È ··›ÙËÛ·Ó ıÚÔÌ‚ÂÎÙÔÌ‹ ‹ ·ӷÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Ê˘ÛÈο ÓÔÛËÏ›· ÛÙËÓ ÌÔÓ¿‰· Ì·˜. ∂ÍÂÙ¿Û·Ì ÙÔÓ ¯ÚfiÓÔ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ Ë ÂÈÏÔ΋ ÌÂÙ¿ ÙËÓ O. ª. ∏, ÙÔÓ ÙÚfiÔ ‰È¿ÁÓˆÛ‹˜ Ù˘, ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘, ηıÒ˜ Î·È ÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ. ∞¶OΔ∂§∂™ª∞Δ∞
ŒÍÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ˆ˜ ÂÈÏÔ΋ ıÚfiÌ‚ˆÛË ˘Ï·›·˜ ÌÂÙ¿ ·fi O. ª. ∏. ∫·È ÔÈ 6 ·ÛıÂÓ›˜ ‹Ù·Ó ¿Ó‰Ú˜ Ì. Ô ËÏÈΛ·˜ 51 ¤ÙË (44-58). ¶ÚÒÈÌË ıÚfiÌ‚ˆÛË Ù˘ ˘Ï·›·˜ ÂÌÊ¿ÓÈÛ·Ó 5 ·ÛıÂÓ›˜ (2-4 Ë̤Ú˜) Î·È 1 ·ÛıÂÓ‹˜ fi„ÈÌ· (3 Ì‹Ó˜). ™Â 4 ·ÛıÂÓ›˜ Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ ÛÙËÓ ÎÏÈÓÈ΋ ÙˆÓ ªÂÙ·ÌÔۯ‡ÛÂˆÓ Î·È ·ÊÔ‡ ›¯·Ó ‰È·ÎÔÌÈÛÙ› Û ηϋ ηٿÛÙ·ÛË ÌÂÙ¿ ÙËÓ O. ª. ∏., ÂÓÒ Û 2 ·ÛıÂÓ›˜ Ë ‰È¿ÁÓˆÛË Ù¤ıËΠηٿ ÙËÓ ÓÔÛËÏ›· ÙÔ˘˜ ÛÙËÓ ª. ∂. £. ∏ ‰È¿ÁÓˆÛË Ù˘ ıÚfiÌ‚ˆÛ˘ Ù˘ ˘Ï·›·˜ ¤ÁÈÓ Û 4 ·ÛıÂÓ›˜ Ì ˘¤ÚË¯Ô ‹·ÙÔ˜ – ¯ÔÏËÊfiÚˆÓ Î·ıÒ˜ Î·È ÌÂϤÙË ÚÔÒÓ ÛÙÔ Û‡ÛÙËÌ· Ù˘ ˘Ï·›·˜, Û 1 ·ÛıÂÓ‹ Ì Spiral CT- ∫ÔÈÏ›·˜, Î·È Û 1 ·ÛıÂÓ‹ Ì MRA. ∏ Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ›‰È· Ì ¯ÔÚ‹ÁËÛË Ë·Ú›Ó˘ ¯·ÌËÏÔ‡ ÌÔÚÈÎÔ‡ ‚¿ÚÔ˘˜ (Fraxiparine, Arixtra, Î. ¿) Û ıÂڷ¢ÙÈΤ˜ ‰fiÛÂȘ. ¢‡Ô ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ıÚÔÌ‚ÂÎÙÔÌ‹ Î·È Î·ÙfiÈÓ Û ·ӷÌÂÙ·ÌfiÛ¯Â˘ÛË ÌÂÙ¿ 4 Ë̤Ú˜ ·fi ÙËÓ ıÚÔÌ‚ÂÎÙÔÌ‹. ∏̤Ú˜ ÓÔÛËÏ›·˜: Ì. Ô 8, 2 Ë̤Ú˜ (5-14). ŒÎ‚·ÛË: ·Â‚›ˆÛ·Ó Î·È ÔÈ 6 ·ÛıÂÓ›˜, (ıÓËÙfiÙËÙ· 100%). 2 ·ÛıÂÓ›˜ ·Â‚›ˆÛ·Ó ¿ÌÂÛ· ÏfiÁˆ ıÚfiÌ‚ˆÛ˘ Ù˘ ˘Ï·›·˜ (33%), ÂÓÒ 4 ·ÛıÂÓ›˜ ÏfiÁˆ Û˘ÓÔ‰ÒÓ ÂÈÏÔÎÒÓ (ÈÛ¯·ÈÌ›· ÛÙÂϤ¯Ô˘˜, O. ∞. ∞, MODS, ¯ÔÏÔÂÚÈÙÔÓ·›Ô˘). ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ıÚfiÌ‚ˆÛË Ù˘ ˘Ï·›·˜ ·Ú·Ì¤ÓÂÈ ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÌÂÙ¿ ·fi ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Ì ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛ‹ Ù˘ Î·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ›Ûˆ˜ ‚ÂÏÙÈÒÛÔ˘Ó ÛÙÔ Ì¤ÏÏÔÓ ÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ.
30
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
16 ™À¡¢À∞™ª∂¡∏ ∞¡√™√∫∞Δ∞™Δ√§∏ ª∂ ∞¡∞™Δ√§∂π™ MTOR ∫∞π CNI ™∂ ∞™£∂¡∂π™ ª∂ ª∂Δ∞ª√™Ã∂À™∏ ∏¶∞Δ√™ ∫∞π ∂¶π¢∂π¡ø™∏ ¡∂ºƒπ∫∏™ §∂πΔ√Àƒ°π∞™. ∏ ∂ª¶∂πƒπ∞ Δ√À ∫∂¡Δƒ√À ª∞™ μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ÿÌ‚ÚÈÔ˜, ∫. ¢ÈÏ¿Ú˘, π. ºÔ‡˙·˜, £. μ·ÛÈÏÂÈ¿‰Ë˜, ∞. ¶··ÁÈ¿ÓÓ˘, ∂. ∞ÎÚÈ‚È¿‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ∫. ¶·ÙÛÈ·Ô‡Ú·, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. ∫·Ú‰¿Û˘, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ °. ¡. £ÂÛÛ·ÏÔӛ΢
¢∂¢Oª∂¡∞
∏ ÓÂÊÚÔÙÔÍÈÎfiÙËÙ· Ô˘ Û˘Óԉ‡ÂÈ ÙË ¯ÔÚ‹ÁËÛË CNI ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ª. ∏. ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙȘ ÚÔ¸¿Ú¯Ô˘Û˜ ÓÂÊÚÈΤ˜ ‚Ï¿‚˜ ÏfiÁˆ ΛÚÚˆÛ˘, ηıÈÛÙÔ‡Ó ·Ó·Áη›· ÙËÓ ÂÈÛ·ÁˆÁ‹ Ó¤ˆÓ Û¯ËÌ¿ÙˆÓ ·ÓÔÛÔηٷÛÙÔÏ‹˜. ™∫O¶O™
∏ ·ÍÈÔÏfiÁËÛË Ù˘ Û˘Á¯ÔÚ‹ÁËÛ˘ mTOR ·Ó·ÛÙÔϤˆÓ Ì CNI Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ª. ∏. Î·È Âȉ›ӈÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. À§π∫O – ª∂£O¢OI
™Â 9 ·ÛıÂÓ›˜ Ì ª. ∏. Ô˘ ·ÚÔ˘Û›·Û·Ó ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (ÎÚ·ÙÈÓ›ÓË >1.8 mg/ml Ô˘Ú›· >70 mg/ml Î·È GFR <50 ml/min) ÌÂÈÒıËÎÂ Ë ¯ÔÚËÁÔ‡ÌÂÓË ‰fiÛË CNI Î·È ‰fiıËΠmTOR ·Ó·ÛÙÔϤ·˜ (Everolimus). ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 51,67 ¤ÙË (47-60 ¤ÙË), ÂÓÒ Ë Ì¤ÛË ËÏÈΛ· ηٿ ÙË ÌÂÙ·ÙÚÔ‹ ÛÙÔ Û¯‹Ì· ‹Ù·Ó Ù· 55.66 ¤ÙË (48-71 ¤ÙË). ∏ ÌÂÙ·ÙÚÔ‹ ¤ÁÈÓ Û ‰È¿ÛÙËÌ· ·fi ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ¤ˆ˜ Î·È 206 Ì‹Ó˜ (̤ÛË ÙÈÌ‹ 61,66 Ì‹Ó˜). ΔÔ ·›ÙÈÔ Ù˘ ΛÚÚˆÛ˘ ‹Ù·Ó :·ÏÎÔÔÏÈÛÌfi˜: 2 ·ÛıÂÓ›˜, HBV Î·È ·ÏÎÔÔÏÈÛÌfi˜: 2, HBV Î·È ∏∫∫: 2, PBC:1, HCV Î·È HKK:1 Î·È ÎÚ˘„ÈÁÂÓ‹ ΛÚÚˆÛË:1. EÎÙÈÌ‹ıËÎÂ Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÚÈÓ ÙË ª. ∏. ·Ì¤Ûˆ˜ ÌÂÙ¿, ÚÈÓ ÙËÓ ÌÂÙ·ÙÚÔ‹ Î·È 3 Ì‹Ó˜ ÌÂÙ¿, Ù· ÂÂÈÛfi‰È· ·fiÚÚȄ˘, ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ Î·È Ë Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·. . ∞¶OΔ∂§∂™ª∞Δ∞
∞fi ÙÔ˘˜ 9 ·ÛıÂÓ›˜ ÔÈ 8 (88, 8%) ·ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË ÛÙË ÓÂÊÚÈ΋ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›· 3 Ì‹Ó˜ ÌÂÙ¿ ÙË ÌÂÙ·ÙÚÔ‹ (‚ÂÏÙ›ˆÛË GFR ·fi 8 ¤ˆ˜ 34,5 ml/min (̤ÛË ÙÈÌ‹ 17.7 ml/min), Î·È ‚ÂÏÙ›ˆÛË ÙˆÓ ÙÈÌÒÓ Ù˘ Ô˘Ú›·˜ Î·È ÎÚ·ÙÈÓ›Ó˘. ™Â 1 ·ÛıÂÓ‹ (ÔÛÔÛÙfi 12, 2%) ÂΉËÏÒıËΠÛËÌ·ÓÙÈ΋ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· Ô˘ Ô‰‹ÁËÛ ÛÙË ‰È·ÎÔ‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ mTOR. ŒÓ·˜ ·ÛıÂÓ‹˜ ›¯Â ÂΉËÏÒÛÂÈ ¯ÚfiÓÈ· ·fiÚÚÈ„Ë ÚÔ Ù˘ ÌÂÙ·ÙÚÔ‹˜ Ë ÔÔ›· ·Ú¤ÌÂÈÓÂ Î·È ÌÂÙ¿. ∂Ì̤ÓÔ˘Û· ¯ÔÏfiÛÙ·ÛË ¯ˆÚ›˜ ÛÙÔȯ›· ·fiÚÚȄ˘ ÚÔ¸‹Ú¯Â Û ¤Ó·Ó ·ÛıÂÓ‹ Î·È Û˘Ó¤¯ÈÛ ӷ ˘¿Ú¯ÂÈ Î·È Ì ÙÔ Ó¤Ô Û¯‹Ì·. ŒÓ·˜ ·ÛıÂÓ‹˜ (ÔÛÔÛÙfi 12,2%) ÂΉ‹ÏˆÛ CMV Ïԛ̈ÍË Ì ıÂÙÈ΋ CMV-PCR. Δ¤ÏÔ˜, Û 2 ·ÛıÂÓ›˜ (22,2%) ˘‹ÚÍ ·Ó·˙ˆ‡ÚˆÛË ÙÔ˘ ÈÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ Ë ÔÔ›· ÛÙÔÓ ¤Ó· ÚÔοÏÂÛ ÂÌ̤ÓÔ˘Û· ÙÚ·ÓÛ·ÌÈÓ·Û·ÈÌ›· (HCV). ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜ Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ·Ú·Ì¤ÓÂÈ Î·Ï‹. ™Àª¶∂ƒ∞™ª∞Δ∞
™Ù· ÂÚÈÛÙ·ÙÈο Ì·˜ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ CNI Ì ÚÔÛı‹ÎË ·Ó·ÛÙÔÏÒÓ mTOR ‚ÂÏÙ›ˆÛ ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÛıÂÓÒÓ, ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÂÂÈÛfi‰È· ·fiÚÚȄ˘ ‹ Û˘ÛÙËÌ·ÙÈÎÒÓ ÏÔÈÌÒ͈Ó.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
17 O•∂π∞ ¡∂ºƒπ∫∏ ∞¡∂¶∞ƒ∫∂π∞ ™∂ ª∂Δ∞ªO™Ã∂À™∂π™ ∏¶∞ΔO™ ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘1, ¢. ∞˘ÁÔ˘ÛÙ‹1, X. ¶··ÁˆÚÁ›Ô˘1, Ã. ΔÛÈfiÙÚ·˜1, ∂. ªÔ˘ÏÔ‡‰Ë1, °. πÌ‚ÚÈÔ˜2, ¢. Δ·ÎÔ‡‰·˜2, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË1 1M.E.£.
2ÃÂÈÚÔ˘ÚÁÈ΋
πÔÎÚ·Ù›Ԣ, ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ πÔÎÚ·Ù›Ԣ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢
∏ ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· (O.¡.∞) ··ÓÙ¿Ù·È Û˘¯Ó¿ Û ·ÛıÂÓ›˜ Ì ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (O.ª.∏) ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜ ÛÙËÓ ª.∂.£. ™∫O¶O™
∏ ηٷÁÚ·Ê‹ ·ÛıÂÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· (O.¡.∞) ÌÂÙ¿ ·fi (O.ª.∏) Î·È Û˘Û¯¤ÙÈÛË Ù˘ Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓˆÓ À§π∫O – ª∂£O¢OI
ªÂÏÂÙ‹Û·Ì ·Ó·‰ÚÔÌÈο 47 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ËÏÈΛ·˜ Ì. Ô 50, 26 ¤ÙË (18-64 ¯ÚÔÓÒÓ) ÂÎ ÙˆÓ ÔÔ›ˆÓ 20 ¿Ó‰Ú˜ Î·È 17 Á˘Ó·›Î˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û O.M.H Î·È ÂÌÊ¿ÓÈÛ·Ó O. ¡. ∞. ø˜ ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÔÚ›ÛÙËÎÂ Ë ·‡ÍËÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡ ηٿ 0, 5 mg/dl (‹ 50%) ‹ Ù˘ Scr >2 mg/dl. ¶ÚÔÂÁ¯ÂÈÚËÙÈο ηٷÁÚ¿ÊÙËÎÂ Ë ÙÈÌ‹ Ù˘ Scr. ¢ÈÂÁ¯ÂÈÚËÙÈο Ë ·Ó¿ÁÎË ÁÈ· ÌÂÙ·ÁÁ›ÛÂȘ, Ë ¯Ú‹ÛË ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎÒÓ, ηıÒ˜ Î·È Ë ‰È¿ÚÎÂÈ· ·Ó·ÈÛıËÛ›·˜ Î·È ¯ÂÈÚÔ˘ÚÁ›Ԣ. ªÂÙÂÁ¯ÂÈÚËÙÈο ÌÂÏÂÙ‹ıËÎ·Ó Ë ¯ÔÚ‹ÁËÛË ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎÒÓ, ÔÈ ÙÈ̤˜ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È Ë ÂÌÊ¿ÓÈÛË ÏÔÈÌÒ͈Ó. ∞¶OΔ∂§∂™ª∞Δ∞
¢È·ÎÚ›Ó·Ì 2 ÔÌ¿‰Â˜: OÌ¿‰· ∞: 24 ·ÛıÂÓ›˜ (51, 94%) Ì O. ¡. ∞ Î·È OÌ¿‰· μ: 23 ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÂÈ‚¿Ú˘ÓÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜.
¶ƒO∂°Ã∂πƒ∏Δπ∫∞ Scr ¢π∂°Ã∂πƒ∏Δπ∫∞ ªÂÙ·ÁÁ›ÛÂȘ ¢È¿ÚÎÂÈ· ¯/Ô˘ ∞ÁÁÂÈÔÛ/ ÈÓfiÙÚÔ· ª∂Δ∂°Ã∂πƒ∏Δπ∫∞ ªÂÙ·ÁÁ›ÛÂȘ ÃÔÏÂÚ˘ıÚ›ÓË §ÔÈÌÒÍÂȘ ∞ÁÁÂÈÔÛ/ ÈÓfiÙÚÔ·
OÌ¿‰· ∞
OÌ¿‰· μ
1, 51±0,638
0,99± 0,29
Ì. Ô 18,2±11,08 Ì. Ô 8,3 h ±2,1 h Ì. Ô ÛÙÔ 72,3%
9+4,9 6,4±1,07 h ÛÙÔ 31,3%
Ì. Ô 11,5±5,6 Ì. Ô 11,5±7,45 ÛÙÔ 54,4% Ì. Ô ÛÙÔ 81,8%
7,25±6,03 7,1±6,14 ÛÙÔ 25% ÛÙÔ 33,3%
™Àª¶∂ƒ∞™ª∞Δ∞
º·›ÓÂÙ·È Ë Û˘Û¯¤ÙÈÛË Ù˘ O. ¡. ∞ Ì ÙËÓ ÚÔ˘¿Ú¯Ô˘Û· ÙÈÌ‹ Ù˘ Scr, ÙËÓ ‰È¿ÚÎÂÈ· ¯ÂÈÚÔ˘ÚÁ›Ԣ, ÙˆÓ ÌÂÙ·ÁÁ›ÛˆÓ, Ù˘ ¯Ú‹Û˘ ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎÒÓ Î·È ÈÓÔÙÚfiˆÓ(ÛÙËÓ ª. ∂. £. Î·È ÛÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô), Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È Ù˘ ›‰Ú·Û‹˜ Ù˘ ÛÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
18 ∏ ∂•E§π•∏ Δø¡ ∞™£∂¡ø¡ ª∂ ∞§∫√√§π∫∏ ∫πƒƒø™∏ ¶√À À¶√μ§∏£∏∫∞¡ ™∂ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞Δ√™ °. ÿÌ‚ÚÈÔ˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, °. ΔÛÔ˘ÏÊ¿˜, μ. μ·ÛÈÏÂÈ¿‰Ë˜, ¢. ∫·Ú‰¿Û˘, ∞. ¶··ÁÈ¿ÓÓ˘, π. °Ô˘Ï‹˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, π. ºÔ‡˙·˜, ¡. ∞. ∞ÓÙˆÓÈ¿‰Ë˜, ∫. ¶·ÙÛÈ·Ô‡Ú·, ∞. ¡Ù›Ó·˜, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. μÚÔÁ¯›‰Ë˜, ∂. ∫·Ùۛη, ∫. ¢ÈÏ¿Ú˘, °. ª˘ÛÂÚÏ‹˜, ¢. Δ·ÎÔ‡‰·˜
EI™∞°ø°∏
ΔȘ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (MH) ·ÔÙÂÏ› ÙË ‚·ÛÈ΋ ıÂڷ›· ÁÈ· ÙËÓ Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· Î·È ÙËÓ Î›ÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜. O ÚfiÏÔ˜ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÛÙËÓ ıÂڷ›· ÙˆÓ Â› ̤ÚÔ˘˜ ÓfiÛˆÓ Ô˘ ÚÔηÏÔ‡Ó ÙË Î›ÚÚˆÛË ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˘. ™∫O¶O™
∏ ÌÂϤÙË ÙÔ˘ ÚfiÏÔ˘ Ù˘ ª∏ ÛÙË ıÂڷ›· Ù˘ ·ÏÎÔÔÏÈ΋˜ ΛÚÚˆÛ˘ (∞∫). ª∂£O¢OI
Afi ÙÔ 1991 ¤ˆ˜ ÙÔ 2007 Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û˘ÓÔÏÈο 247 ª∏ ÛÙËÓ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ÙÔ˘ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, £ÂÛÛ·ÏÔӛ΢. ∞fi ·˘Ù¤˜ ÔÈ 34 (13.7%) ¤ÁÈÓ·Ó Û ·ÛıÂÓ›˜ Ì ·ÏÎÔÔÏÈ΋ ΛÚÚˆÛË ˆ˜ ÚˆÙÔ·ı‹ ÓfiÛÔ. ªÂÏÂÙ‹ıËÎ·Ó Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ, ¤ÁÈÓ ÛÙ·‰ÈÔÔ›ËÛË Ù˘ ΛÚÚˆÛ˘ Î·È Ù· ·ÔÙÂϤÛÌ·Ù·, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÈ‚›ˆÛË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ÙËÓ Ì¤ıÔ‰Ô Kaplan-Meier. ∂›Û˘, ·Ó·Ï‡ıËÎ·Ó Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ Î·È ÔÈ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜. ∞¶OΔ∂§∂™ª∞Δ∞
OÈ 34 ·ÛıÂÓ›˜ ‹Ù·Ó fiÏÔÈ ¿ÚÚÂÓ˜ Ì ̤ÛÔ fiÚÔ ËÏÈΛ·˜ 51. 8 ¤ÙË. ¶¤Ú·Ó Ù˘ ∞∫, 8 ·ÛıÂÓ›˜ (23.5%) ›¯·Ó Û˘Á¯ÚfiÓˆ˜ Ë·Ù›Ùȉ· C, 5 (14.7%) Ë·Ù›Ùȉ· μ, 3 (8.8%) Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛӈ̷, Î·È 1 (2.9%) ¯ÔÏÏ·ÁÁÂÈÔηÚΛӈ̷. O ̤ÛÔ˜ fiÚÔ˜ ÙÔ˘ ª∂LD ‹Ù·Ó 18.44. ŒÓÙÂη ·ÛıÂÓ›˜ ·Â‚›ˆÛ·Ó Î·È Ë Î·Ì‡ÏË ÂÈ‚›ˆÛ˘ Ê·›ÓÂÙ·È ÛÙÔ ‰È¿ÁÚ·ÌÌ·. Δ· ·›ÙÈ· ı·Ó¿ÙÔ˘ ‹Ù·Ó ÚˆÙÔ·ı‹˜ ÌË ÏÂÈÙÔ˘ÚÁ›· (3), ıÚfiÌ‚ˆÛË Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜ (2), ÛË„·ÈÌ›· (2), ıÚfiÌ‚ˆÛË ˘Ï·›·˜ (1), Î·È Î·Ú‰È·Îfi ÂÂÈÛfi‰ÈÔ (1). OÈ ÈÔ Û˘¯Ó¤˜ ÂÈÏÔΤ˜ ‹Ù·Ó ·fiÚÚÈ„Ë (32.4%), Ïԛ̈ÍË (26.5%), Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (11.8%), Î·È ˘ÔÙÚÔ‹ HBVÎ·È HCV, ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Î·È ¯ÔÏfiÛÙ·ÛË (8.8% Ë Î·ıÂÌ›·). ÀÔÙÚÔ‹ ·Ú·ÙËÚ‹ıËΠ۠3 (8.8%) ·ÛıÂÓ›˜, Ì ‹È· ÂÈÚÚÔ‹ ÛÙËÓ Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ¶·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ª∏ ÁÈ· ∞∫ Ù· ÙÂÏÂ˘Ù·›· 6 ¯ÚfiÓÈ·, ηıÒ˜ ÌÂÙ·ÌÔۯ‡ÙËÎ·Ó 25 ·ÛıÂÓ›˜ ¤Ó·ÓÙÈ 9 ·ÛıÂÓÒÓ Ù· ÚÒÙ· 10 ¯ÚfiÓÈ·. ™Àª¶∂ƒ∞™ª∞Δ∞
¶·Ú·ÙËÚ‹Û·Ì ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· Ù˘ ∞∫ ˆ˜ ·ÈÙ›· Ù˘ ª∏ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ∂ÏÏ¿‰·, Î·È Ì¿ÏÈÛÙ· Û ۯÂÙÈο Ó¤·˜ ËÏÈΛ·˜ (51.8 ¤ÙË) ·ÛıÂÓ›˜. ∏ ª∏ ·Ú·Ì¤ÓÂÈ Ë ÌÔÓ·‰È΋ ıÂڷ›· ÁÈ· ÙËÓ Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· ÏfiÁˆ ∞∫ Ì ηϿ Ì·ÎÚÔ¯ÚfiÓÈ· ·ÔÙÂϤÛÌ·Ù·. 1,0
Ποσοστό επιβίωσης
0,8
0,6
0,4 0,2
0,0 0,00
20,00
40,00
60,00
80,00
Χρόνος (μήνες)
100,00
120,00
140,00
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
19 ∞ÀΔO§O°∏ ª∂Δ∞ªO™Ã∂À™∏ ∞πªO¶Oπ∏Δπ∫ø¡ ∫ÀΔΔ∞ƒø¡ (∞ª∞∫) ™∂ ∞™£∂¡∂π™ ª∂ ¶O§§∞¶§OÀ¡ ªÀ∂§øª∞ (¶ª) ∏§π∫π∞™ >60 ∂Δø¡ ∂ª¶∂πƒπ∞ ∂¡O™ ∫∂¡ΔƒOÀ μ. ∫˘ÚÈ·˙‹, §. ∂˘ÏÈ¿ÙË, ™. ¢ÂÏ‹Ì·ÛË, ¡. ÷گ·Ï¿Î˘, ∂. ¡ÈÎËÊÔÚ¿Î˘ ∞ÈÌ·ÙÔÏÔÁÈ΋-§ÂÌÊˆÌ¿ÙˆÓ ∫ÏÈÓÈ΋-ªªªO, ¶°¡∞ «O ∂À∞°°∞§π™ªO™»
™∫O¶O™
∏ ‰È¿ÌÂÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ¶ª Â›Ó·È Ù· 60-65 ¤ÙË. ∏ ·ÚÔ‡Û· ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÂÈ Ù· ‰Â‰Ô̤ӷ ÙÔ˘ ΤÓÙÚÔ˘ Ì·˜ ˆ˜ ÚÔ˜ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÓÔ¯‹ Ù˘ ∞ª∞∫ Û ·ÛıÂÓ›˜ ËÏÈΛ·˜ >60 ÂÙÒÓ. À§π∫O - ª∂£O¢OI
∞fi ÙÔ˘˜ 71 ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ∞ª∞∫ ·fi 1/1996-8/2007, 18 (25%) ›¯·Ó ËÏÈΛ· >60 ÂÙÒÓ Î·È 10/18 ‹Ù·Ó ¿Ó‰Ú˜. ∏ ‰È¿ÌÂÛË ËÏÈΛ· ‰È¿ÁÓˆÛ˘ ‹Ù·Ó 60 ¤ÙË (‡ÚÔ˜ 57-70) Î·È ∞ª∞∫ 61 (‡ÚÔ˜ 60-71). ™ÙË ‰È¿ÁÓˆÛË ÙÔ ÛÙ¿‰ÈÔ ‹Ù·Ó II, III ÁÈ· ÙÔÓ ›‰ÈÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ›¯·Ó ÙÚÂȘ. ø˜ ıÂڷ›· ÂÊfi‰Ô˘ ¤Ï·‚·Ó 3-6 ·ÎÏÔ˘˜ VAD, ÂÓÒ 4 ÚÔ¯ÒÚËÛ·Ó Û 2˘ ÁÚ·ÌÌ‹˜ ıÂڷ›·. O ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ‰È¿ÁÓˆÛ˘-∞ª∞∫ ‹Ù·Ó 9,5 Ì‹Ó˜ (‡ÚÔ˜ 4-45). ªÂÙ·ÌÔۯ‡ÙËÎ·Ó Û ÌÂÚÈ΋ ‡ÊÂÛË (ªÀ) 13/18 (72%) Î·È Ì ·ÓıÂÎÙÈ΋ /ÂÍÂÏÈÛÛfiÌÂÓË ÓfiÛÔ 5/18 (28%). ø˜ Û¯‹Ì· ÚÔÂÙÔÈÌ·Û›·˜ ¤Ï·‚·Ó 15/18 (84%) Melphalan 200 mg/m2. O ‰È¿ÌÂÛÔ˜ ·ÚÈıÌfi˜ ¯ÔÚËÁÔ‡ÌÂÓˆÓ CD34+ ΢ÙÙ¿ÚˆÓ ‹Ù·Ó 5, 14 106/kg. ÀÔÛÙËÚ›¯ıËÎ·Ó Ì G-CSF ÙÚÂȘ. ∞¶OΔ∂§∂™ª∞Δ∞
O ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ÒÛÙ ANC >500/Ìl-PLTs >20000/Ìl ‹Ù·Ó 14, 3 Ë̤Ú˜ ·ÓÙ›ÛÙÔȯ·. ªÂ Ô˘‰ÂÙÂÚÔÂÓÈÎfi ˘ÚÂÙfi ÂÈÏ¿ÎËÛ·Ó 14/18 (78%), ·Ó¢ڤıËΠ·ıÔÁfiÓÔ Û ¤ÓÙÂ. ¶·ÚÔ˘Û›·Û·Ó ÛÙÔÌ·Ù›Ùȉ· gr I 5/18, gr II 7/18, ÙÔÍÈÎfiÙËÙ· ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ 3/18. ªÂÙ¿ ÙËÓ ∞ª∞∫ ‹Ù·Ó Û ϋÚË ‡ÊÂÛË (¶À) 8/18 (44%), Û ªÀ 10/18 (56%). ¢ÂÓ ÛËÌÂÈÒıËΠηӤӷ˜ ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜. ªÂ ‰È¿ÌÂÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ 17 Ì‹Ó˜ (‡ÚÔ˜ 4-53), ÂÈ‚ÈÒÓÔ˘Ó 13 ·ÛıÂÓ›˜, 8 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÙËÚÔ‡Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ∞ª∞∫ (¶À:4, ªÀ:4) Î·È 5 ÂͤÏÈÍ·Ó ÙÔ ÓfiÛËÌ·. ∏ ÙÚÈÂÙ‹˜ Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË Â›Ó·È 64%, ÂÓÒ Ë ‰ÈÂÙ‹˜ ÂÈ‚›ˆÛË ¯ˆÚ›˜ ˘ÔÙÚÔ‹/ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ Â›Ó·È 46%. ™Àª¶∂ƒ∞™ª∞
∏ ∞ª∞∫ ·ÔÙÂÏ› ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ·ÛÊ·Ï‹ ıÂڷ›· Û ·ÛıÂÓ›˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ÌÂ Û˘Ìو̷ÙÈÎfi ¶ª. Δ· ÔÛÔÛÙ¿ Û˘ÓÔÏÈ΋˜ ·ÓÙ·fiÎÚÈÛ˘ Î·È ÙÔÍÈÎfiÙËÙ·˜ Â›Ó·È Û˘ÁÎÚ›ÛÈÌ· Ì ·˘Ù¿ ÙˆÓ ÓÂfiÙÂÚˆÓ ·ÛıÂÓÒÓ.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
20 ∞ÀΔO§O°∏ ª∂Δ∞ªO™Ã∂À™∏ ∞πªO¶Oπ∏Δπ∫ø¡ ∫ÀΔΔ∞ƒø¡ (∞ª∞∫) ™ΔHN O•∂πA ªÀ∂§Oμ§∞™Δπ∫H §∂ÀÃ∞πªπA (Oª§) ∂ª¶∂πƒπ∞ ∂¡O™ ∫∂¡ΔƒOÀ μ. ∫˘ÚÈ·˙‹, ∫.-°. ª·ÏˆÙ‹˜, ¢. ∫·Ú·Î¿Û˘, π. ª·ÏÙ·‰¿Î˘, ∑. ¶Ô˘ÏÔÔ‡ÏÔ˘, ∂. ª›Î·, π. ∞ÔÛÙÔÏ›‰Ë˜, ¡. ÷گ·Ï¿Î˘, ∂. ¡ÈÎËÊÔÚ¿Î˘. ∞ÈÌ·ÙÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ - ªÔÓ¿‰· ªÂÙ·ÌfiÛ¯Â˘Û˘ ª˘ÂÏÔ‡ OÛÙÒÓ, °¡∞ «O ∂À∞°°∂§π™ªO™».
™∫O¶O™
∏ Û˘Ì‚·ÙÈ΋ ¯ËÌÂÈÔıÂڷ›· ·Ó·ÚΛ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘ÔÙÚÔÒÓ Ù˘ Oª§, ηıÒ˜ Î·È ÁÈ· ÙËÓ Oª§ ‰˘ÛÌÂÓÔ‡˜ ÚfiÁÓˆÛ˘. ∏ ∞ª∞∫ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ Ï‹ÚÔ˘˜ ‡ÊÂÛ˘ (¶À), › ·‰˘Ó·Ì›·˜ Ú·ÁÌ·ÙÔÔ›ËÛ˘ ·ÏÏÔÁÂÓÔ‡˜ ª∞∫. À§π∫O-ª∂£O¢O™
∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1992-2007, 33 ·ÛıÂÓ›˜ (19 ¿Ó‰Ú˜, 14 Á˘Ó·›Î˜), Ì ‰È¿ÌÂÛË ËÏÈΛ· Ù· 42 ¤ÙË (‡ÚÔ˜ 19-65) ˘Ô‚Ï‹ıËÎ·Ó Û ∞ª∞∫ ÁÈ· Oª§, Û ¶À1 (n=11) Î·È Û >¶À1 (n=22). O ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ‰È¿ÁÓˆÛË-ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 14 Ì‹Ó˜ (‡ÚÔ˜ 4-49). ŸÏÔÈ ¤Ï·‚·Ó Û¯‹Ì· ÚÔÂÙÔÈÌ·Û›·˜ ‚·ÛÈṲ̂ÓÔ ÛÙË ‚Ô˘ÛÔ˘ÏÊ¿ÓË. ΔÔ ÌfiÛ¯Â˘Ì· ‹Ù·Ó Ì˘ÂÏÈÎfi (n=20) ‹ ·ÈÌ·ÙÈÎfi (n=13), Ì ÈηÓÔÔÈËÙÈÎfi ·ÚÈıÌfi ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Û ¶À2, ›¯Â Á›ÓÂÈ ÌÂÙ¿ ÙËÓ Â›Ù¢͋ Ù˘. ∞¶OΔ∂§∂™ª∞Δ∞
O ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ‰ÂÓ ‰È¤ÊÂÚ ·Ó¿ÌÂÛ· Û ·˘ÙÔ‡˜ Ô˘ ¤Ï·‚·Ó Ì˘ÂÏÈÎfi ‹ ·ÈÌ·ÙÈÎfi ÌfiÛ¯Â˘Ì·. ∏ ÙÔÍÈÎfiÙËÙ· ‹Ù·Ó ÌÈÎÚ‹, ‚·ıÌÔ‡ I/II. ªÂ ‰È¿ÌÂÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ 25 Ì‹Ó˜ (‡ÚÔ˜ 4-189), Ë ÚÒÈÌË ıÓËÙfiÙËÙ· ‹Ù·Ó 9% Î·È Ë Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ· 58%. ∂Ó ˙ˆ‹ Î·È Û ¶À ‚Ú›ÛÎÔÓÙ·È ÔÈ 13 (39%). ∏ Û˘ÓÔÏÈ΋ ÙÂÙÚ·ÂÙ‹˜ ÂÈ‚›ˆÛË (OS) Î·È ÂÈ‚›ˆÛË ¯ˆÚ›˜ ÓfiÛÔ (DFS) Â›Ó·È 41% Î·È 35% ·ÓÙ›ÛÙÔȯ·. ∂˘ÓÔ˚ÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ OS Î·È DFS ‹Ù·Ó Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Û ¶À1, Ë ËÏÈΛ· <40 ÂÙÒÓ, ηıÒ˜ Î·È ‰È¿ÚÎÂÈ· ¶À1 ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ ¤ÙÔ˘˜, ÁÈ· fiÛÔ˘˜ ÌÂÙ·ÌÔۯ‡ıËÎ·Ó Û ¶À2 (OS/DFS: 55%/52% vs 32%/21%, 72%/58% vs 22%/18%, 40%/28% vs 30%/10% ·ÓÙ›ÛÙÔȯ·). ™Àª¶∂ƒ∞™ª∞
™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ Ë ÓÔÛËÚfiÙËÙ·, Ë ıÓËÙfiÙËÙ· Î·È Ë ÂÈ‚›ˆÛË ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ Ì ·˘Ù¤˜ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∏ ∞ª∞∫ ·ÔÙÂÏ› ÂÊÈÎÙ‹ ÂÈÏÔÁ‹, ˆ˜ ıÂڷ›· ÛÙ·ıÂÚÔÔ›ËÛ˘ Ù˘ Ï‹ÚÔ˘˜ ‡ÊÂÛ˘, Û ÂÈÏÂÁ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ì Oª§, Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ˘Ô‚ÏËıÔ‡Ó Û ·ÏÏÔÁÂÓ‹ ª∞∫.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
21 ¡∂∞ ª∂£O¢O™ ™À§§O°∏™ ∞À•∏ª∂¡OÀ ∞ƒπ£ªOÀ ∞ƒÃ∂°O¡ø¡ ∞πªO¶Oπ∏Δπ∫ø¡ ∫ÀΔΔ∞ƒø¡ ∞¶O Δ∏¡ Oªº∞§πO¶§∞∫OÀ¡Δπ∞∫∏ ªO¡∞¢∞, ∂¶∞ƒ∫∏ °π∞ ª∂Δ∞ªO™Ã∂À™∏ ™∂ ∂¡∏§π∫∂™ N. ΔÛ¿ÁÈ·˜1, K. ∫Ô˘˙‹-∫ÔÏÈ¿ÎÔ˘2, μ. ∫·Ú·ÁÈ¿ÓÓ˘1, °. ∫ÔÏÈ¿ÎÔ˜3,4 1°ã
°˘Ó·ÈÎÔÏÔÁÈ΋-ª·È¢ÙÈ΋ ∫ÏÈÓÈ΋, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË 2∂ÚÁ·ÛÙ‹ÚÈÔ πÛÙÔÏÔÁ›·˜-∂Ì‚Ú˘ÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹, ∞.¶.£. 3∂ÚÁ·ÛÙ‹ÚÈÔ μÈÔÏÔÁÈ΋˜ ÃËÌ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹, ∞.¶.£. 4∂ıÓÈÎfi ÿ‰Ú˘Ì· ∂Ú¢ÓÒÓ, ΔÚ¿Â˙· μÏ·ÛÙÈÎÒÓ ∫˘ÙÙ¿ÚˆÓ
™∫O¶O™
ΔÔ Úfi‚ÏËÌ· Ù˘ ¯Ú‹Û˘ ÙÔ˘ ·›Ì·ÙÔ˜ ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘ ÁÈ· ÌÂÙ·ÌÔۯ‡ÛÂȘ Û ÂÓ‹ÏÈΘ Â›Ó·È Ô ÌÈÎÚfi˜ fiÁÎÔ˜ Ô˘ Ï·Ì‚¿ÓÂÙ·È Î·Ù¿ ÙË ‰È·‰Èηۛ· Ù‹˜ ÎÏ·ÛÈ΋˜ Û˘ÏÏÔÁ‹˜, ÂÂȉ‹ ÌÂÁ¿ÏË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜ ·Ú·Ì¤ÓÂÈ Ì¤Û· ÛÙÔÓ Ï·ÎÔ‡ÓÙ· ™Â ·˘Ù‹ ÙËÓ ÂÚÁ·Û›· ·ÚÔ˘ÛÈ¿˙Ô˘Ì ÌÈ· ̤ıÔ‰Ô Û˘ÏÏÔÁ‹˜ ·fi ÙËÓ ÔÌÊ·ÏÈÔÏ·ÎÔ˘ÓÙȷ΋ ÌÔÓ¿‰·, Ë ÔÔ›· ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. À§π∫O-ª∂£O¢O™
°È· ÙËÓ ÂÚÁ·Û›· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 15 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÔÌÊ·ÏÈÔÏ·ÎÔ˘ÓÙȷ΋˜ ÌÔÓ¿‰·˜ ·fi ÙÔ ¡ÔÛÔÎÔÌÂ›Ô πÔÎÚ¿ÙÂÈÔ Ù˘ £ÂÛÛ·ÏÔӛ΢, ‡ÛÙÂÚ· ·fi Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ·›Ì·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠‰˘Ô ÛÙ¿‰È·. ™ÙÔ ÚÒÙÔ ÛÙ¿‰ÈÔ Ë Û˘ÏÏÔÁ‹ ¤ÁÈÓ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ΢‹Ì·ÙÔ˜ ·fi ÙËÓ ÔÌÊ·ÏÈ΋ ÊϤ‚· Û ÙÚÈÏfi ·ÛÎfi Û˘ÏÏÔÁ‹˜ Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ‚·Ú‡ÙËÙ·˜. ™ÙÔ ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ ¤ÁÈÓÂ Û˘ÏÏÔÁ‹ ÙÔ˘ ·›Ì·ÙÔ˜ Ô˘ ·Ú¤ÌÂÈÓ ÛÙÔÓ Ï·ÎÔ‡ÓÙ· Û ÙÚÈÏfi ·ÛÎfi Û˘ÏÏÔÁ‹˜ Ì ¤Ó· Û˘Ó‰˘·ÛÌfi ηıÂÙËÚÈ·ÛÌÔ‡ Î·È ¤Á¯˘Û˘ ·ÓÙÈËÎÙÈÎÔ‡ ̤۷ ÛÙËÓ ÔÌÊ·ÏÈ΋ ÊϤ‚· Î·È Ì·Ï¿ÍÂˆÓ ÙÔ˘ Ï·ÎÔ‡ÓÙ·. ™ÙË Û˘Ó¤¯ÂÈ· ·Ó·Ï‡ıËÎÂ Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ÛÙ·‰›Ô˘ Û˘ÏÏÔÁ‹˜ ÛÙË Û˘ÓÔÏÈ΋ ÔÛfiÙËÙ· ·›Ì·ÙÔ˜ Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi Â̇ÚËÓˆÓ Î·È ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ¶·Ú¿ÏÏËÏ· ÌÂÙÚ‹ıËÎÂ Ë ‚ȈÛÈÌfiÙËÙ· ÙˆÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ, ÂÓÒ ÁÈ· fiÏ· Ù· ‰Â›ÁÌ·Ù· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi˜ Î·È ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∞¶OΔ∂§∂™ª∞Δ∞
O Û˘ÓÔÏÈÎfi˜ fiÁÎÔ˜ ·›Ì·ÙÔ˜ Ô˘ Û˘ÏϤ¯ıËΠ·fi Ù· ‰˘Ô ÛÙ¿‰È· ‹Ù·Ó 127.3 ml (92-170). ∏ ÂÈϤÔÓ ÔÛfiÙËÙ· Â̇ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÌÔÓÔ΢ÙÙ¿ÚˆÓ ·fi ÙÔ ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ Û˘ÏÏÔÁ‹˜ ‹Ù·Ó 54±9.87 % Î·È 54±9.52 % ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ë Û˘ÓÂÈÛÊÔÚ¿ ÛÙÔ Û˘ÓÔÏÈÎfi fiÁÎÔ ÙˆÓ CD34+ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î·È HPCs Úfi‰ÚÔÌˆÓ Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó 54.3±10.35 % Î·È 46.7±11.5 % ·ÓÙ›ÛÙÔȯ·. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÈηÓfiÙËÙ· Û¯ËÌ·ÙÈÛÌÔ‡ ·ÔÈÎÈÒÓ CFU-GM and BFU-E Ù· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ‹Ù·Ó 43.2±5.5 % Î·È 39.8±4.3 %. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌfiÏ˘ÓÛ˘ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ™Àª¶∂ƒ∞™ª∞
Δ· ·ÔÙÂϤÛÌ·Ù· Ì·˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÙÔ ·›Ì· Ô˘ ·Ú·Ì¤ÓÂÈ ÛÙÔÓ Ï·ÎÔ‡ÓÙ· ÌÂÙ¿ ÙËÓ ÎÏ·ÛÈ΋ Û˘ÏÏÔÁ‹ ÂÚȤ¯ÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ Ì ÛËÌ·ÓÙÈÎfi ·ÈÌÔÔÈËÙÈÎfi ‰˘Ó·ÌÈÎfi ÈηÓfi ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË Û ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓ›˜. ∏ ‰ÈÏ‹ ·˘Ù‹ ̤ıÔ‰Ô˜ Û˘ÏÏÔÁ‹˜ ¯ˆÚ›˜ Ó· ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌÔχÓÛˆÓ, ÚÔÛʤÚÂÈ ·˘ÍË̤ÓÔ ·ÚÈıÌfi ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·ÓÔ›ÁÂÈ Ó¤Ô˘˜ ‰ÚfiÌÔ˘˜ ÁÈ· ÌÂÙ·ÌÔۯ‡ÛÂȘ Û ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓ›˜.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
22 O ¶ƒO™Δ∞Δ∂ÀΔπ∫O™ ƒO§O™ ΔOÀ O•À°O¡øª∂¡OÀ º£OƒπO∞¡£ƒ∞∫∞ ™Δπ™ μ§∞μ∂™ π™Ã∞πªπ∞™-∂¶∞¡∞πª∞Δø™∏™ ™ΔO §∂¶ΔO ∂¡Δ∂ƒO Δø¡ ∫O¡π∫§ø¡. ∞. ¡Ù›Ó·˜1, ¢. ∫·Ú·Ì¿ÓÔ˜1, ™. ∏ÏÈ¿‰Ë˜2, ∞. ∞Ï‚·ÓÔ‡-∞¯·Ú¿ÎË3, ¢. ∫Ô˘ÊÔÁÈ¿ÓÓ˘4, ¢. μÚÔ¯›‰Ë˜5, Ã. ™˘Ú›‰Ë˜1, ¢. ¶··‰ËÌËÙÚ›Ô˘6, £. °ÂÚ·ÛÈÌ›‰Ë˜1 1∂ã
ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ °.¶.¡.£. 2μÈÔ¯ËÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ∞.¶.£. 3∂ÚÁ·ÛÙ‹ÚÈÔ πÛÙÔÏÔÁ›·˜-∂‚Ú˘ÔÏÔÁ›·˜ & ∞ÓıÚˆÔÏÔÁ›·˜ ∞.¶.£. 4ΔÌ‹Ì· π·ÙÚÈ΋˜ ¶ÏËÚÔÊÔÚÈ΋˜ ∞.¶.£. 5ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ °.¶.¡.£. 6μã ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£, °.¶.¡.«°. °ÂÓÓËÌ·Ù¿˜»
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E›Ó·È Ó· ÂÎÙÈÌËı› Ë Â›‰Ú·ÛË Ù˘ ÂÓ‰Ô·˘ÏÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ô͢ÁÔӈ̤ÓÔ˘ ÊıÔÚÈÔ¿Óıڷη (O.º.) ÛÙËÓ ‚ȈÛÈÌfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û ¤Ó· ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ ÔÍ›·˜ ÈÛ¯·ÈÌ›·˜-·ӷÈÌ¿ÙˆÛ˘ (π/∂). À§π∫O-ª∂£O¢O™
ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó 20 ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘ ¯ˆÚ›ÛÙËÎ·Ó Û ٤ÛÛÂÚȘ ÔÌ¿‰Â˜ ÙˆÓ 5. OÌ¿‰· ∞: ÂϤÁ¯Ô˘. OÌ¿‰· μ: ÔÍ›· π/∂. OÌ¿‰· °: ÔÍ›· π/∂ Î·È ¯ÔÚ‹ÁËÛË O.º. 30 min ÚÈÓ ·fi ÙËÓ ÚfiÎÏËÛË Ù˘ ÈÛ¯·ÈÌ›·˜. OÌ¿‰· ¢: ÔÍ›· π/∂ Î·È ¯ÔÚ‹ÁËÛË O.º. 60 min ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË Ù˘ ÈÛ¯·ÈÌ›·˜. ∏ ÔÍ›· ÈÛ¯·ÈÌ›· ‰È·ÚΛ·˜ 120 min ÂÈÙ‡¯ıËΠ̠·ÔÎÏÂÈÛÌfi Ù˘ ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜ Î·È Û˘Óԉ‡ÙËΠ۠fiϘ ÙȘ ÔÌ¿‰Â˜ ·fi ·ӷÈÌ¿ÙˆÛË 60min. §‹ÊıËÎ·Ó ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÔͤԘ. ∂›Û˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ‚ÈÔ„›Â˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȤ‰ˆÓ Ù˘ MDA (Ì·ÏÔÓÈ΋˜ ‰È·Ï‰Â˛‰Ë˜) ηıÒ˜ Î·È ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÔÙÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘. ∞¶OΔ∂§∂™ª∞Δ∞
∏ ̤ÛË ÙÈÌ‹ Ù˘ MDA ÛÙËÓ ÔÌ¿‰· ∞ ‹Ù·Ó 1,869±0,977 ÛÙ· 120 min, 2,696±1,486 ÛÙ· 150 min Î·È 3,696±1,769 nmols/g ÛÙ· 180 min. ™ÙËÓ ÔÌ¿‰· μ ‹Ù·Ó 4,021±1,516 ÛÙ· 120 min, 5,794±1,321 ÛÙ· 150 min Î·È 5,476±1,321 ÛÙ· 180 min. ™ÙËÓ ÔÌ¿‰· ° ‹Ù·Ó 1,142±0,377 ÛÙ· 120 min, 1,033±0,307 ÛÙ· 150 min Î·È ÛÙ· 0,592±0,354180 min. Δ¤ÏÔ˜ ÛÙËÓ ÔÌ¿‰· ¢ ‹Ù·Ó 4,092±0,742 ÛÙ· 120 min, 2,741± 0,703 ÛÙ· 150 min Î·È 2,376±0,354 ÛÙ· 180 min (p<0,05). ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÔͤԘ ÛÙËÓ ÔÌ¿‰· ∞ ÛÙ· 120 min ‹Ù·Ó 39,900±4,0563, ÛÙ· 150 min 42,430±4,469 Î·È ÛÙ· 180 min 45,446±6,508 mg/dl. ™ÙËÓ ÔÌ¿‰· μ ‹Ù·Ó ÛÙ· 120 min 63,516±11,125, ÛÙ· 150 min 68,886±9,327 Î·È ÛÙ· 180 min 100,618±18,881. ™ÙËÓ ÔÌ¿‰· ° ‹Ù·Ó 95,796±19,101 ÛÙ· 120 min, 99,488±20,359 ÛÙ· 150 min Î·È 103,902±25,541 ÛÙ· 180 min. ™ÙËÓ ÔÌ¿‰· ¢ ‹Ù·Ó 76,750±12,055 ÛÙ· 120 min, 79,150±12,964 ÛÙ· 150 min Î·È 78,624±12,254 ÛÙ· 180 min. ™ÙȘ ÔÌ¿‰Â˜ ° Î·È ¢ ·Ú·ÙËÚ‹ıËΠÌÈÎÚfiÙÂÚË ‹ ÌÂÁ·Ï‡ÙÂÚË ·fiÙˆÛË ÙÔ˘ ÂÈıËÏ›Ô˘ ÂÓÒ ÛÙËÓ ÔÌ¿‰· μ ·Ú·ÙËÚ‹ıËΠϋÚ˘ Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. ™Àª¶∂ƒ∞™ª∞
º·›ÓÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Ô͢ÁÔӈ̤ÓÔ˘ ÊıÔÚÈÔ¿Óıڷη ÚÔÛٷهÂÈ ÙÔ ¤ÓÙÂÚÔ ·fi ÙȘ ‚Ï¿‚˜ π/∂.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
23 ∏ ÃOƒ∏°∏™∏ EGCG ∫∞Δ∞ Δ∏¡ π™Ã∞πªπ∞ ∫∞π ∂¶∞¡∞πª∞Δø™∏ ΔOÀ ∏¶∞ΔO™ ∂§∞Ãπ™ΔO¶Oπ∂π Δ∏ ∞¶O¶Δø™∏ ª∂™ø ∫∞Δ∞™ΔO§∏™ Δ∏™ ∂∫ºƒ∞™∏™ Δø¡ NF-∫B, CASPASE-3 ∫∞π C-JUN ¢. °È·ÎÔ˘ÛÙ›‰Ë˜1, ∞. °È·ÎÔ˘ÛÙ›‰Ë˜1, ∂. ∫·Ï‰ÚÈÌ›‰Ô˘4, ∫. ∫ÔÏÈ¿ÎÔ˘2, ™. ∏ÏÈ¿‰Ë˜3, £. ¶Ô˘Ù·¯›‰Ë˜4, ¡. ∞ÓÙˆÓÈ¿‰Ë˜1, ¡. O˘˙Ô˘Ó›‰Ë˜1, ∞. ¶··ÁÈ¿ÓÓ˘1, ¢. ∫·Ú‰¿Û˘1, °. ÿÌ‚ÚÈÔ˜1, °. ¶··ÁˆÚÁ›Ô˘3, μ. ¶··ÓÈÎÔÏ¿Ô˘1, ¢. Δ·ÎÔ‡‰·˜1 1ÃÂÈÚÔ˘ÚÁÈ΋
∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, πÛÙÔÏÔÁ›·˜ Î·È ∂Ì‚Ú˘ÔÏÔÁ›·˜, 3∂ÚÁ·ÛÙ‹ÚÈÔ μÈÔÏÔÁÈ΋˜ ÃËÌ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹, 4∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜, ∫ÙËÓÈ·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, °. ¡. πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË 2∂ÚÁ·ÛÙ‹ÚÈÔ
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∏ ÈÛ¯·ÈÌ›· ÙÔ˘ ‹·ÙÔ˜ ÚÔηÏ› ÙË ·Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Ô͢ÁfiÓÔ˘, ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ (TNF·, IL-1‚, IL-6) Ì ·ÎfiÏÔ˘ıÔ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÌÂÙ·ÁÚ·ÊÈÎÒÓ ÚÔ·ÔÙÔÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (NFÎμ, c-Jun, caspase-3) Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ÊÏÂÁÌÔÓ‹ Î·È ¤¯Ô˘Ó Û·Ó ·ÔÙÂϤÛÌ· ÙËÓ ·fiÙˆÛË ÙÔ˘ ‹·ÙÔ˜. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ÂϤÁÍÔ˘Ì ÙË ‰Ú¿ÛË ÙÔ˘ epigalocatechin gallate (EGCG), ÌÂÙ¿ ·fi ÚfiÎÏËÛË ÔÏÈ΋˜ ıÂÚÌ‹ ÈÛ¯·ÈÌ›· Î·È Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ‹·ÙÔ˜ ÛÙËÓ Ì›ˆÛË Ù˘ ·fiÙˆÛ˘ Î·È Ù˘ ÏÈȉÈ΋˜ ˘ÂÚÔÍ›‰ˆÛ˘. À§π∫O-ª∂£O¢O™
ΔÚÈ¿ÓÙ· Â›Ì˘Â˜ Ù‡Ô˘ Wistar, ¯ˆÚÈṲ̂ÓÔÈ Û ÙÚÂȘ ÔÌ¿‰Â˜. ∂ÈÎÔÓÈ΋ ¤̂·ÛË (∂/∂), πÛ¯·ÈÌ›· /∂·Ó·ÈÌ¿ÙˆÛË (π/∂), π/∂ + EGCG 50 mg/kg μ™. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ EGCG ¤ÁÈÓ 15′ Ú›Ó ·fi ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ÈÛ¯·ÈÌ›·˜. ŒÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ MDA Î·È MPO Û ˷ÙÈÎfi ÈÛÙfi Î·È ÙˆÓ AST Î·È ALT ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜. ∞ÓÔÛÔÛÔÈÛÙÔ¯ËÌÈÎfi˜ ÂϤÁ¯Ô˜ ÁÈ· TUNEL, caspase-3, NF-Îμ, cJun ÔÙÈÎfi Î·È ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Û ˷ÙÈÎfi ÈÛÙfi. Δ· ÂÈÚ·Ì·Ùfi˙ˆ· ˘Ô‚Ï‹ıËÎ·Ó Û ÔÏÈ΋ Ë·ÙÈ΋ ÈÛ¯·ÈÌ›· ÁÈ· 60ã Î·È Â·Ó·ÈÌ¿ÙˆÛË ÁÈ· 120′. ∞¶OΔ∂§∂™ª∞Δ∞
™ÙËÓ ÔÌ¿‰· π/∂ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ ·fiÙˆÛ˘ fiˆ˜ ·˘Ùfi ηٷ‰˘ÎÓ›ÂÙ ·fi ÙÔ TUNEL Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ caspase-3. ∞ÓÙ›ıÂÙ· ÛÙËÓ ÔÌ¿‰· ¯ÔÚ‹ÁËÛ˘ EGCG Ë ·fiÙˆÛË ‹Ù·Ó ÂÏ¿¯ÈÛÙË fiˆ˜ Î·È Ë ÂÓÂÚÁÔÔ›ËÛË Ù˘ caspase-3. ∏ ¯ÚÒÛË ÛÙ· ÈÛÙÔÙÂÌ¿¯È· ‹·ÙÔ˜ ÁÈ· NF-Îμ Î·È cJun ‹Ù·Ó ıÂÙÈ΋ ÛÙËÓ ÔÌ¿‰· π/∂ Î·È ·ÚÓËÙÈ΋ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ EGCG. ∏ MDA, MPO, AST Î·È ALT ÂÌÊ¿ÓÈÛ·Ó ·‡ÍËÛË Û 1.595 nmol/g, 3.23 U/g, 2715 Î·È 2193 IU/L Î·È Ì›ˆÛË Û 1.045 nmol/g, 1.76 U/g, 1196 Î·È 1108 IU/L ÛÙËÓ ÔÌ¿‰· π/∂ Î·È EGCG ·ÓÙ›ÛÙÔȯ·. ∏ ÌÈÎÚÔÛÎÔÈ΋ Î·È ˘ÂÚÌÈÎÚÔÛÎÔÈ΋ ÌÂϤÙË ·Ó¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈΤ˜ ‚Ï¿‚˜ ÛÙËÓ π/∂ Î·È ÚÔÛÙ·Û›· ÛÙËÓ ÔÌ¿‰· ÙÔ˘ EGCG. ™Àª¶∂ƒ∞™ª∞
H ¯ÔÚ‹ÁËÛË EGCG ÚÔÛٷهÂÈ ·fi ÙË ‚Ï¿‚Ë π/∂ ‰È·Ì¤ÛÔ˘ Ì›ˆÛË Ù˘ ·fiÙÔۈ˘ Î·È Ù˘ ηٷÛÙÔÏ‹˜ Ù˘ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÌÂÙ·ÁÚ·ÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ NF-Îμ Î·È c-Jun.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
24 ª∂πø™∏ Δ∏™ ∞¶O¶Δø™∏™ ª∂™ø ∞¡∞™ΔO§∏™ Δ∏™ ∂¡∂ƒ°O¶Oπ∏™∏™ Δø¡ NF-KB, C-JUN ∫∞π CASPASE-3 ¶OÀ ¶ƒO∫∞§∂πΔ∞π ∞¶O Δ∏¡ π™Ã∞πªπ∞/∂¶∞¡∞πª∞Δø™∏ ΔOÀ §∂¶ΔOÀ ∂¡Δ∂ƒOÀ ª∂ Δ∏¡ ÃOƒ∏°∏™∏ EGCG ∞. °È·ÎÔ˘ÛÙ›‰Ë˜1,2, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜1, ∫. ∫ÔÏ›·ÎÔ˘4, ∂. ∫·Ï‰ÚÈÌ›‰Ô˘5, ™. ∏ÏÈ¿‰Ë˜3, ¡. ∞ÓÙˆÓÈ¿‰Ë˜1, ¡. O˘˙Ô˘Ó›‰Ë˜1, ∫. ¢ÈÏ¿Ú˘1, °. ÿÌ‚ÚÈÔ˜1, μ. ¶··ÓÈÎÔÏ¿Ô˘1, °. ¶··ÁˆÚÁ›Ô˘3, ∫. ∞ÙÌ·Ù˙›‰Ë˜2, A. ∞ÓÙˆÓÈ¿‰Ë˜1, ¢. Δ·ÎÔ‡‰·˜1 1ÃÂÈÚÔ˘ÚÁÈ΋
∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, °. ¡. πÔÎÚ¿ÙÂÈÔ, ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋, °. ¡. °ÂÓÓËÌ·Ù¿˜, 3ΔÌ‹Ì· μÈÔÏÔÁÈ΋˜ ÃËÌ›·˜, 4ΔÌ‹Ì· πÛÙÔÏÔÁ›·˜ Î·È ∂Ì‚Ú˘ÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹, 5∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜, ∫ÙËÓÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ 2μã
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∏ ÈÛ¯·ÈÌ›· Î·È Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÚÔηÏ› ÔÍÂȉˆÙÈÎfi stress Ì ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ∂ƒO. ø˜ ·ÔÙ¤ÏÂÛÌ· ÔÈ ∂ƒO ÌÂÛÔÏ·‚Ô‡Ó ÛÙËÓ ¤ÎÊÚ·ÛË ÌÂÙ·ÁÚ·ÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÎÈÓ·ÛÒÓ, ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÙË ‰È¿‰ÔÛË ÙÔ˘ Û‹Ì·ÙÔ˜, ÚÔηÏÒÓÙ·˜ ·fiÙˆÛË, Î·È ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË. O ÛÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Ì·˜ ‹Ù·Ó Ó· ÂÍÂÙ¿ÛÔ˘Ì ÙË Èı·Ó‹ ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙÔ˘ EGCG ÛÙË Ì›ˆÛË Ù˘ ÏÈȉÈ΋˜ ˘ÂÚÔÍ›‰ˆÛ˘, ÛÙË Ì›ˆÛË Ù˘ ·fiÙˆÛ˘ Î·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ¤ÎÊÚ·Û˘ ÙˆÓ NF-Îμ, JNK, c-Jun Î·È caspase-3 Û ¤Ó· ÌoÓÙ¤ÏÔ ÈÛ¯·ÈÌ›·˜/·ӷÈÌ¿ÙˆÛ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. À§π∫O-ª∂£O¢O™
ΔÚÈ¿ÓÙ· Â›Ì˘Â˜ Ù‡Ô˘ Wistar, ¯ˆÚÈṲ̂ÓÔÈ Û ÙÚÂȘ ÔÌ¿‰Â˜. ∞1: ∂ÈÎÔÓÈ΋ ¤̂·ÛË (∂/∂) μ1: πÛ¯·ÈÌ›· /∂·Ó·ÈÌ¿ÙˆÛË (π/∂), °1: π/∂ + EGCG 50 mg/kg μ™. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ EGCG ¤ÁÈÓ 15ã Ú›Ó ·fi ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ÈÛ¯·ÈÌ›·˜. πÛ¯·ÈÌ›· ÂÁηٷÛÙ¿ıËΠÁÈ· 60 min Ì ·ÔÎÏÂÈÛÌfi Ù˘ ∞ª∞ Î·È ·ÎÔÏÔ‡ıËÛ ·ӷÈÌ¿ÙˆÛË ÁÈ· 120 min. ŒÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ MDA, MPO, TUNEL, ·ÓÔÛÔ˚ÛÙÔ¯ËÌ›· ÁÈ· NF-kB, JNK, c-Jun, caspase-3, Î·È ¤ÏÂÁ¯Ô˜ Ì ÔÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·ӷÈÌ¿ÙˆÛ˘ ∞¶OΔ∂§∂™ª∞Δ∞
∏ ·fiÙˆÛË fiˆ˜ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·fi ÙÔ TUNEL ‹Ù·Ó ·˘ÍË̤ÓË ÛÙËÓ ÔÌ¿‰· π/∂ ÛÂ Û˘ÁÎÚ›ÛË Ì ÙËÓ ÔÌ¿‰· ¤ÏÂÁ¯Ô˘ Î·È ÙËÓ ÔÌ¿‰· Ô˘ ¯ÔÚËÁ‹ıËΠEGCG. ∏ caspase-3 ‹Ù·Ó ¢ڤˆ˜ ÂÓÂÚÁÔÔÈË̤ÓË ÛÙËÓ ÔÌ¿‰· π/∂ ÂÓÒ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ EGCG Ôχ ÌÈÎÚ‹ ¤ÎÊÚ·ÛË ÂÌÊ·Ó›ÛÙËÎÂ. ΔÔ ÏÂÙfi ¤ÓÙÂÚÔ ¯ÚˆÌ·Ù›ÛÙËΠıÂÙÈο ÁÈ· NF-kB, JNK, c-Jun ÛÙËÓ ÔÌ¿‰· π/∂ ·ÏÏ¿ ·ÚÓËÙÈο ÛÙËÓ ÔÌ¿‰· ÙÔ˘ EGCG. OÈ Ì¤Û˜ ÙÈ̤˜ ÁÈ· ÙËÓ MDA (nmole/g w.t.) ‹Ù·Ó 0,524, 0.913, Î·È 0.565, ÛÙȘ ∞1, μ1 Î·È °1 ·ÓÙ›ÛÙÔȯ·. OÈ Ì¤Û˜ ÙÈ̤˜ ‹Ù·Ó ÁÈ· ÙȘ MPO (U/g): 1,8, 2,92, 1,9 ÛÙȘ ÔÌ¿‰Â˜ ∞1, μ1, Î·È °1 ·ÓÙ›ÛÙÔȯ·. OÈ ÂÍÂÙ¿ÛÂȘ ·fi ÔÙÈÎfi ÌÈÎÚÔÛfiÈÔ ¤‰ÂÈÍ·Ó ÛÔ‚·Ú¤˜ ‚Ï¿‚˜ ÛÙËÓ ÔÌ¿‰· π/∂ Î·È ÛËÌ·ÓÙÈ΋ ÚÔÛÙ·Û›· ÛÙËÓ ÔÌ¿‰· ÙÔ˘ EGCG. ™Àª¶∂ƒ∞™ª∞
∏ ¯ÔÚ‹ÁËÛË EGCG ÚÔÛٷهÂÈ ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ ·fi ÙË ‚Ï¿‚Ë ÈÛ¯·ÈÌ›·˜/·ӷÈÌ¿ÙˆÛ˘ ·Ó·ÛÙ¤ÏÔÓÙ·˜ ÙËÓ Ô‰fi Ù˘ ·ÔÙÒÛ˘ Î·È Ù˘ ‰È¿‰ÔÛ˘ ÙÔ˘ Û‹Ì·ÙÔ˜ Î·È ·Ú¿ÏÏËÏ· ÚÔÛٷهÂÈ ·fi ÙË ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË.
39
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
25 ¶ƒO°¡ø™Δπ∫∏ ∞•π∞ ¶ƒøπª∏™ ∂ªº∞¡π™∏™ ∞¶OπOÀ ¢π∞μ∏ΔOÀ ™Δ∏ ª∂£ ª∂Δ∞ ∞¶O Δƒ∞Àª∞Δπ∫∏ ∫∞∫ø™∏ ∂°∫∂º∞§OÀ ∫∞π ™À™Ã∂Δπ™∏ ΔOÀ ª∂ ΔO¡ ∂°∫∂º∞§π∫O £∞¡∞ΔO ∂. ª¿ÛÛ·1, μ. ∫·Ú·Ï‹1, π. ÃÔ‡Ú˘1, °. μ·ÛÈÏÂÈ¿‰Ô˘1, °. ª·Ì›¯·˜2, ª. ªÈÙ˙¿ÓË1 1 ∞′
2ªÔÓ¿‰·
ª∂£, Δ¯ÓËÙÔ‡ ¡ÂÊÚÔ‡, °¶¡ °. ¶··ÓÈÎÔÏ¿Ô˘, £ÂÛÛ·ÏÔÓ›ÎË
™∫O¶O™
O͇˜ ¿ÔÈÔ˜ ‰È·‚‹Ù˘ (Diabetes Insipidus,DI) Û˘Ó›· ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÔÈÛı›Ô˘ ÏÔ‚Ô‡ Ù˘ ˘ÔʇÛˆ˜ (O§À),·ÔÙÂÏ› Û·ÊÒ˜ ·Ó·ÁÓˆÚÈṲ̂ÓË ÂÈÏÔ΋ ηÙfiÈÓ ÙÚ·˘Ì·ÙÈ΋˜ οΈÛ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (traumatic brain injury,TBI) Î·È Ë ÂÌÊ¿ÓÈÛ‹ ÙÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‚·Ú‡ÙËÙ¿ Ù˘. À§π∫O-ª∂£O¢O™
¶ÚÔÔÙÈ΋ ÌÂϤÙË ÛÙËÓ ÔÔ›· ÂÎÙÈÌ‹ıËÎ·Ó 68 ·ÛıÂÓ›˜ Ì Δμπ (Ì ‹ ¯ˆÚ›˜ ¿ÏϘ Û˘ÓÔ‰Ô‡˜ ηÎÒÛÂȘ) Ô˘ ÓÔÛËχıËÎ·Ó ÛÙË ª∂£ ·fi 12/2005 ˆ˜ 8/2007. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· DI: ¡a ÔÚÔ‡>145 mmol/lt,fiÁÎÔ˜ Ô‡ÚˆÓ 24ˆÚÔ˘ >30 ml/kgμ™ ‹ >200 ml/h ÁÈ· ‰‡Ô Û˘Ó¯›˜ ÒÚ˜ Û ÂÓ‹ÏÈΘ, ÂȉÈÎfi ‚¿ÚÔ˜ (∂μ) Ô‡ÚˆÓ <1005 ‹/Î·È ˆÛ̈ÙÈÎfiÙËÙ· Ô‡ÚˆÓ <300 mOsm/kgμ™, Ì ٷ˘Ùfi¯ÚÔÓ· Ê˘ÛÈÔÏÔÁÈ΋ ‹ ·˘ÍË̤ÓË ˆÛ̈ÙÈÎfiÙËÙ· ÔÚÔ‡. ™˘ÓÂÎÙÈÌ‹ıËηÓ: ·Ú¯È΋ GCS, ISS (Injury Severity Score), Revised Trauma Score (RTS), Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, ¤Ó·ÚÍË Î·È ‰È¿ÚÎÂÈ· DI, ¤Î‚·ÛË. ∞¶OΔ∂§∂™ª∞Δ∞
¢¤Î· ¤ÍÈ ·ÛıÂÓ›˜ (63,6% ¿Ó‰Ú˜, 36,3% Á˘Ó·›Î˜), ‰ËÏ. 23,5% ÙˆÓ TBI ÂÌÊ¿ÓÈÛ·Ó DI. GCS score: ÌË ÂÈ‚ÈÒÛ·ÓÙ˜: 4,5±1,5 vs 7,8±3 ÂÈ‚ÈÒÛ·ÓÙ˜, p=0,004. ISS: 38±8 ÌË ÂÈ‚ÈÒÛ·ÓÙ˜ vs 17±7 ÂÈ‚ÈÒÛ·ÓÙ˜, p<0,001. RTS: 5,9±2,2 ÌË ÂÈ‚ÈÒÛ·ÓÙ˜ vs 6,7±2,5 ÂÈ‚ÈÒÛ·ÓÙ˜, p>0,05. ÃÚfiÓÔ˜ ¤Ó·Ú͢ DI: ÌË ÂÈ‚ÈÒÛ·ÓÙ˜ 1,7±0,7 Ë̤Ú˜ vs 7,4±3,3 ËÌ. ÂÈ‚ÈÒÛ·ÓÙ˜, p<0,001. OÈ ÌË ÂÈ‚ÈÒÛ·ÓÙ˜ ·Ó¤Ù˘Í·Ó DI ÂÓÙfi˜ ÙˆÓ ÚÒÙˆÓ 72 ˆÚÒÓ ·fi ÙËÓ TBI Ì ıÓËÙfiÙËÙ· 84% vs 26,7%, fiÙ·Ó Ô DI ÂÌÊ·Ó›ÛıËΠ۠·ÒÙÂÚÔ ¯ÚfiÓÔ. ¶·Ú·ÙËÚ‹ıËΠfiÙÈ ÔÈ ·Ô‚ÈÒÛ·ÓÙ˜ η٤ÏËÍ·Ó ·fi ÂÁÎÂÊ·ÏÈÎfi ı¿Ó·ÙÔ Î·È fi¯È ·fi ¿ÏϘ Û˘ÓÔ‰Ô‡˜ ηÎÒÛÂȘ. ™Àª¶∂ƒ∞™ª∞
O Ô͇˜ DI ·ÔÙÂÏ› Û˘¯Ó‹ Î·È ÛËÌ·ÓÙÈ΋ ÂÓ‰ÔÎÚÈÓÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ O§À ÌÂÙ¿ ·fi ‚·ÚÈ¿ TBI.¶ÚÒÈÌË ÂÌÊ¿ÓÈÛ‹ ÙÔ˘, ÛÙ· ÚÒÙ· ‰‡Ô ˆ˜ ÙÚ›· 24ˆÚ·,ıˆÚÂ›Ù·È Ì¿ÏÏÔÓ ‰Â›ÎÙ˘ ‰˘ÛÌÂÓÔ‡˜ ¤Î‚·Û˘ Î·È ·˘ÍË̤Ó˘ ıÓËÙfiÙËÙ·˜, Û˘Ó›· ÂÁÎÂÊ·ÏÈÎÔ‡ ı·Ó¿ÙÔ˘. ™·ÊÒ˜ ··ÈÙÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÙÂÎÌËÚȈ̤Ó˜ ÌÂϤÙ˜ Î·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ ÁÈ· ‰È·ÌfiÚʈÛË ·ÛʷϤÛÙÂÚˆÓ Î·È ÔÚÈÛÙÈÎfiÙÂÚˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ.
40
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
26 ™Δ∞™∏ ∂ƒ°∞∑Oª∂¡ø¡ ™ΔO °∂¡π∫O ¡O™O∫Oª∂πO ∞¶∂¡∞¡Δπ ™Δ∏ ¢øƒ∂∞ Oƒ°∞¡ø¡. ¶ƒO∫∞Δ∞ƒ∫Δπ∫∏ ∞¡∞∫Oπ¡ø™∏ ª. ™˘ÁÁÂÏ¿Î˘1,∂. ™ÔÊÈ·Ófi˜2, N. Δ¿ÛÎÔ˜, ª. ¶··ı·Ó·Û›Ô˘, ∂. ∫·ÏϤÚÁË, ∫. ºˆÎ¿˜1 1∞ã
æ˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£, °¡. “¶··ÁˆÚÁ›Ô˘”, ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜, “∞Ã∂¶∞” £ÂÛÛ·ÏÔÓ›ÎË
2ªÔÓ¿‰·
EI™∞°ø°∏
™ÙË ¯ÒÚ· Ì·˜ ÔÈ ÁÓÒÛÂȘ, Ë ÛÙ¿ÛË Î·È Ë Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ ·Ó·ÊÔÚÈο Ì ÙȘ ÌÂÙ·ÌÔۯ‡ÛÂȘ Î·È ÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ı¿Ó·ÙÔ ÂÏ¿¯ÈÛÙ· ¤¯Ô˘Ó ÌÂÏÂÙËı›. ª∂£O¢O™
ÃÚËÛÈÌÔÔÈ‹ıËΠ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô ¯ÔÚËÁ‹ıËΠ۠ÎÏÈÓÈΤ˜ °ÂÓÈÎÒÓ ¡ÔÛÔÎÔÌ›ˆÓ Ù˘ μ. ∂ÏÏ¿‰Ô˜. ∞¶OΔ∂§∂™ª∞Δ∞
Δ· 100 ÚÒÙ· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (50 ·fi È·ÙÚÔ‡˜, 42 ·fi ÓÔÛËχÙÚȘ) ÚÔ¤Ú¯ÔÓÙ·È ·fi ‰Â›ÁÌ· Ô˘ ‰ËÏÒÓÂÈ Â˘ÌÂÓ‹ ÛÙ¿ÛË ·¤Ó·ÓÙÈ ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË (98%) Î·È ÛÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ı¿Ó·ÙÔ (90%). OÈ ÂÚˆÙÒÌÂÓÔÈ ÂÈı˘ÌÔ‡Ó Ó· Á›ÓÔ˘Ó ‰fiÙ˜ ·Ó ‚ÚÂıÔ‡Ó Û ηٿÛÙ·ÛË ÂÁÎÂÊ·ÏÈÎÔ‡ ı·Ó¿ÙÔ˘ (91%) Î·È ·Ó Û˘ÁÁÂÓ‹˜ ÙÔ˘˜ ‚ÚÈÛÎfiÙ·Ó Û ·Ó¿ÏÔÁË Î·Ù¿ÛÙ·ÛË ı· ¤‰ÈÓ·Ó Û˘ÁηٿıÂÛË ÁÈ· ‰ˆÚ¿ (76%). ∂Ó ˙ˆ‹ ı· ¤‰ÈÓ·Ó fiÚÁ·Ófi ÙÔ˘˜ [ÓÂÊÚfi 92%, ÙÌ‹Ì· ‹·ÙÔ˜ 79%, Ó‡ÌÔÓ· 51%] Û ¿ÚÚˆÛÙÔ ·È‰› (84%) /Û‡˙˘ÁÔ (62%) /ÁÔÓÈfi (45%) /Ê›ÏÔ (33%). ™ÙÔ Â‰›Ô Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ 22% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤¯ÂÈ ∫¿ÚÙ· ¢ˆÚËÙÔ‡, 47% ¤¯ÂÈ ÁÓˆÛÙÔÔÈ‹ÛÂÈ ÛÂ Û˘ÁÁÂÓ›˜ ÙȘ ·fi„ÂȘ ÙÔ˘ Î·È 40% ‰ËÏÒÓÂÈ ·ÈÌÔ‰fiÙ˘. ŒÓ· ÌÈÎÚfi ÔÛÔÛÙfi (4%) ıˆÚ› ˆ˜ ‰Â ı· ‰Â¯fiÙ·Ó Ó· ˘Ô‚ÏËı› Û ÔÔÈ·‰‹ÔÙ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ó ˘‹Ú¯Â È·ÙÚÈ΋ ·Ó·ÁηÈfiÙËÙ·, ÂÓÒ ÂÚÈÛÛfiÙÂÚÔÈ (39%) ÂÎÊÚ¿˙Ô˘Ó ÂÈÊ˘Ï¿ÍÂȘ ·Ó·ÊÔÚÈο Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË /Ï‹„Ë Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÚÁ¿ÓˆÓ. ∂ÈÊ˘Ï¿ÍÂȘ ÁÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰fiÙË ‰ËÏÒÓÂÈ ÙÔ 39% ÙˆÓ ÂÚˆÙÒÌÂÓˆÓ (.¯. ı· ÂÓÔ¯ÏÔ‡Û ÌfiÛ¯Â˘Ì· ·fi ËÏÈÎȈ̤ÓÔ 21%, ÔÌÔÊ˘ÏfiÊÈÏÔ 22%, ¿ÙÔÌÔ Ô˘ ·˘ÙÔÎÙfiÓËÛ 11%). ∏ Èı·ÓfiÙËÙ· ÂÁÎÏËÌ·ÙÈÎÒÓ ÂÓÂÚÁÂÈÒÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‚ÚÂıÔ‡Ó ÌÔۯ‡̷ٷ ··Û¯ÔÏ› ÙÔ 24% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ™Àª¶∂ƒ∞™ª∞Δ∞
Δ· ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·‰ÂÈÎÓ‡Ô˘Ó ‰È¿ÛÙ·ÛË ·Ó¿ÌÂÛ· Û ÛÙ¿ÛË Î·È ÛÂ Û˘ÌÂÚÈÊÔÚ¿ È·ÙÚÒÓ Î·È ÓÔÛËÏ¢ÙÚÈÒÓ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ. ∂ÈϤÔÓ, ÔÈ ÁÓÒÛÂȘ, Ë Î·Ù·ÓfiËÛË Ù˘ ·Ó·ÁηÈfiÙËÙ·˜ Î·È Ë Â˘ÌÂÓ‹˜ ÛÙ¿ÛË ‰ÂÓ Ê·›ÓÔÓÙ·È ÈηӤ˜ Ó· ÂÍ·Ï›„Ô˘Ó ¤Ó·Ó ‘ÌË-ÏÔÁÈÎfi’ ÙÚfiÔ ÚÔÛ¤ÁÁÈÛ˘, ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙÔÓ Û˘Ó·ÈÛıËÌ·ÙÈÎfi ·Ú¿ÁÔÓÙ· ˆ˜ ÈÛ¯˘ÚfiÙÂÚÔ ·fi fiÛÔ Û˘Ó‹ıˆ˜ ˘ÔÏÔÁ›˙Ô˘ÌÂ.
41
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
27 °¡ø™∂π™, ™Δ∞™∂π™ ∫∞π ∞¡Δπ§∏æ∂π™ °π∞Δƒø¡, ¡O™∏§∂ÀΔø¡ ∫∞π ºOπΔ∏Δø¡ π∞Δƒπ∫∏™ ™Ã∂Δπ∫∞ ª∂ Δπ™ ª∂Δ∞ªO™Ã∂À™∂π™ ∫∞π Δ∏ ¢øƒ∂∞ Oƒ°∞¡ø¡. ªπ∞ ¶π§OΔπ∫∏ ∂ƒ∂À¡∞ μ. ∫fiÛÎÔ˘Ú·1,2, ∂. πˆ·ÓÓ›‰Ë1, ¢. ∞ÁÚ·ÊÈÒÙ˘1, π. ∫fiÓÙ˘2 1∂ıÓÈ΋
2μã
™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁ›·˜, ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ∞ÚÂÙ·›ÂÈÔ ¡ÔÛÔÎÔÌ›Ô
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∏ ‰ÈÂÚ‡ÓËÛË Î·È ·ÍÈÔÏfiÁËÛË ÙˆÓ ÁÓÒÛˆÓ, ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ Î·È ÙˆÓ ÛÙ¿ÛˆÓ, È·ÙÚÔÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡ ÛÙ· ı¤Ì·Ù· Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ Î·È Ù˘ ‰ˆÚ¿˜ ÔÚÁ¿ÓˆÓ. À§π∫O
140 ¿ÙÔÌ· ·fi ÙÔ ¯ÒÚÔ Ù˘ ÀÁ›·˜ (ÁÈ·ÙÚÔ›, ÓÔÛËÏÂ˘Ù¤˜, ÊÔÈÙËÙ¤˜ π·ÙÚÈ΋˜). ∏ ¤Ú¢ӷ ‰ÈÂÍ‹¯ıË ÙÔÓ ª¿˚Ô 2007, ÛÙË μ′ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÛÙÔ ∞ÚÂÙ·›ÂÈÔ ¡ÔÛÔÎÔÌ›Ô. ª∂£O¢O™
ÃÚËÛÈÌÔÔÈ‹ıËΠ‰ÔÌË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÂȉÈο ۯ‰ȷṲ̂ÓÔ ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ¤Ú¢ӷ˜, ÙÔ ÔÔ›Ô ÂÚÈÏ¿Ì‚·Ó ΢ڛˆ˜ ÂÚˆÙ‹ÛÂȘ ÎÏÂÈÛÙÔ‡ Ù‡Ô˘, ÔÏÏ·Ï‹˜ ÂÈÏÔÁ‹˜ Î·È ‰‡Ô ÎÂÓ¿ ‰›· ÁÈ· ·fi„ÂȘ ‹/Î·È Û¯fiÏÈ·. ∞¶OΔ∂§∂™ª∞Δ∞
∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚˆÙÒÌÂÓˆÓ ıˆÚ› ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÔÚÁ¿ÓˆÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂڷ›·, ı· ‰¤¯ÔÓÙ·Ó Ó· Ï¿‚ÂÈ ÌfiÛ¯Â˘Ì· Û ÂÚ›ÙˆÛË ‰È΋˜ ÙÔ˘ ·Ó¿Á΢ Î·È ÁÓˆÚ›˙ÂÈ fiÙÈ ˘¿Ú¯ÂÈ ¤ÏÏÂÈ„Ë ÔÚÁ¿ÓˆÓ. ∂Ó ÙÔ‡ÙÔȘ, ÌfiÓÔ ÔÈ ÌÈÛÔ› ÙˆÓ ÂÚˆÙÒÌÂÓˆÓ ı· Á›ÓÔÓÙ·Ó ‰fiÙ˜ ÔÚÁ¿ÓˆÓ ÌÂÙ¿ ı¿Ó·ÙÔ, ÂÓÒ ÌfiÓÔ ‰‡Ô ¿ÙÔÌ· ¤¯Ô˘Ó οÚÙ· ‰fiÙË. Δ· _ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÁÓˆÚ›˙Ô˘Ó ÁÈ· ÙËÓ ÂÓ ˙ˆ‹ ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ, ·ÏÏ¿ ÌfiÓÔ ÙÔ 45% ÙˆÓ ÂÚˆÙÒÌÂÓˆÓ ıˆÚ› ÙËÓ ÂÓ ˙ˆ‹ ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ ·ÛÊ·Ï‹ Î·È ÌfiÓÔ ÙÔ 1/3 ÙˆÓ ÂÚˆÙˆÌ¤ÓˆÓ ı· Á›ÓÔÓÙ·Ó ÂÓ ˙ˆ‹ ‰fiÙ˜ ÔÚÁ¿ÓˆÓ. ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ıˆÚ›, ˆ˜ ¤Ó· ÏÔ‡ÛÈÔ ¿ÙÔÌÔ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ‚Ú› ÌfiÛ¯Â˘Ì· Û ۯ¤ÛË Ì ¤Ó· ÊÙˆ¯fi Î·È Û¯Â‰fiÓ ÔÈ ÌÈÛÔ› ‰ÂÓ Â›Ó·È Û›ÁÔ˘ÚÔÈ ·Ó Á›ÓÂÙ·È ·ÁÔÚ·ˆÏËÛ›· ÔÚÁ¿ÓˆÓ ÛÙËÓ ∂ÏÏ¿‰·. Δ· ËıÈο ˙ËÙ‹Ì·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙȘ ÌÂÙ·ÌÔۯ‡ÛÂȘ ÎÚ›ÓÔÓÙ·È ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÚˆÙÒÌÂÓˆÓ, ˆ˜ ÂÚÈÛÛfiÙÂÚÔ ÛËÌ·ÓÙÈο ·fi Ù· ıÚËÛ΢ÙÈο Î·È Ù¤ÏÔ˜, fiÏÔÈ Û¯Â‰fiÓ, Û˘ÌʈÓÔ‡Ó fiÙÈ ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ ÂÚÈÛÛfiÙÂÚË Âη›‰Â˘ÛË Ù· ı¤Ì·Ù· Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ Î·È Ù˘ ‰ˆÚ¿˜ ÔÚÁ¿ÓˆÓ. ™Àª¶∂ƒ∞™ª∞Δ∞
Δ· ÈηÓÔÔÈËÙÈο ÔÛÔÛÙ¿ ÙˆÓ ÁÓÒÛÂˆÓ Ô˘ ηٷÁÚ¿ÊËÎ·Ó ÛÙËÓ ¤ÚÂ˘Ó¿ Ì·˜ ·fi ÁÈ·ÙÚÔ‡˜, ÓÔÛËÏÂ˘Ù¤˜ Î·È ÊÔÈÙËÙ¤˜ È·ÙÚÈ΋˜ Û¯ÂÙÈο Ì ÙȘ ÌÂÙ·ÌfiÛ¯Â˘ÛÂȘ Î·È ÙË ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ, Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ÌÂÙ·ÙÚ¤ÔÓÙ·È ··Ú·›ÙËÙ· Û ıÂÙÈ΋ ‰Ú¿ÛË ‹ Û˘ÌÂÚÈÊÔÚ¿. ¢Â‰Ô̤Ó˘ Ù˘ ÛÔ˘‰·ÈfiÙËÙ·˜ ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘˜ ÛÙȘ ÌÂÙ·ÌÔۯ‡ÛÂȘ Î·È ÙË ‰È·‰Èηۛ· Ù˘ ‰ˆÚ¿˜ ÔÚÁ¿ÓˆÓ, ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Î·È ·Ó¿Ï˘ÛË ÙˆÓ ÛÙ¿ÛÂˆÓ Î·È Û˘ÌÂÚÈÊÔÚÒÓ ÙÔ˘˜, ÎÚ›ÓÂÙ·È ·Ó·Áη›· Î·È ÂÈÙ·ÎÙÈ΋.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
28 ¢øƒ∂∞ Oƒ°∞¡ø¡ ª∂§∂Δ∏ Δø¡ ∞¶Oæ∂ø¡ ∂¡∏§π∫ø¡ ™Δ∏¡ ∂ÀƒÀΔ∂ƒ∏ ¶∂ƒπOÃ∏ Δ∏™ £∂™™∞§O¡π∫∏™ E. °ÂˆÚÁÈ¿‰Ô˘1, ¶. °È·ÁÏ‹˜1, ¡. ™Ô˘Óȉ¿Î˘2, ∂. ªÔ˘ÏÔ‡‰Ë2, ¢. ∞˘ÁÔ˘ÛÙ‹2, Ã. ΔÛÈfiÙÚ·˜2, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË2 1NÔÛËÏÂ˘Ù¤˜, 2π·ÙÚÔ›
ª∂£ °¶¡ πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË
EI™∞°ø°∏
∏ ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ Â›Ó·È Ë ÌÂÁ·Ï‡ÙÂÚË ÚÔÛÊÔÚ¿. ∏ ÌÂÁ·Ï‡ÙÂÚË ·fi‰ÂÈÍË ·Óıڈȿ˜ Î·È ÌÂÁ·ÏÔ„˘¯›·˜. ¶·ÚfiÏ· ·˘Ù¿, ÂΛÓÔÈ Ô˘ Â›Ó·È Úfiı˘ÌÔÈ Ó· ¯·Ú›ÛÔ˘Ó ÙË ˙ˆ‹ ÛÙÔÓ ¿Û¯ÔÓÙ· Û˘Ó¿ÓıÚˆfi ÙÔ˘˜, ‰ˆÚ›˙ÔÓÙ·˜ Ù· fiÚÁ·Ó¿ ÙÔ˘˜, ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Â›Ó·È Ï›ÁÔÈ ÛÙËÓ ∂ÏÏ¿‰·. ™∫O¶O™
∏ ÂÎÙ›ÌËÛË Ù˘ ¿Ô„˘ ‰Â›ÁÌ·ÙÔ˜ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ Ù˘ £ÂÛÛ·ÏÔӛ΢ ÛÙÔ ı¤Ì· Ù˘ ‰ˆÚ¿˜ ÔÚÁ¿ÓˆÓ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰È·ÌÔÚÊÒÓÔ˘Ó ÙËÓ ¿Ô„Ë ·˘Ù‹. À§π∫O - ª∂£O¢O™
¢È·ÓÂÌ‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û ÂÓ‹ÏÈΘ Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ Ù˘ £ÂÛÛ·ÏÔӛ΢. ∂Í·ÈÚ¤ıËÎ·Ó ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜. OÈ ·ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Â›Ó·È: ÙÔ Ê‡ÏÔ, Ë ËÏÈΛ·, ÙÔ Â¿ÁÁÂÏÌ· Î·È Ë ıÚËÛΛ·. ∞¿ÓÙËÛ·Ó ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ 2.263 ¿ÙÔÌ·, 1.189 ¿Ó‰Ú˜ (52,5%) ηÈ1.066 Á˘Ó·›Î˜ (47,1%) Ì Ì.Ô ËÏÈΛ·˜ 36,4 ¤ÙË. ∂·ÁÁ¤ÏÌ·Ù·: ∂ÚÁ·˙fiÌÂÓÔÈ ÛÙÔÓ È‰ÈˆÙÈÎfi ÙÔ̤· (25,6%), ÂχıÂÚÔÈ Â·ÁÁÂÏ̷ٛ˜ (23,3%), ÛÙÔ ‰ËÌfiÛÈÔ ÙÔ̤· (17,6%), ÊÔÈÙËÙ¤˜ (13,4%), Û˘ÓÙ·ÍÈÔ‡¯ÔÈ (6%), ¿ÓÂÚÁÔÈ (5,3%), ·ÁÚfiÙ˜ (1,8%). £ÚËÛΛ·: ÃÚÈÛÙ. OÚıfi‰ÔÍÔÈ (69,8%), ¢È·Ì·ÚÙ˘ÚfiÌÂÓÔÈ (10,3%), ∫·ıÔÏÈÎÔ› (9,9%), ∫·ıÔÏÈΤ˜ ÌÔÓ·¯¤˜ (1,8%), ÕıÂÔÈ (0,9%), πÔ˘‰·›ÔÈ (0,6%), ªÔ˘ÛÔ˘ÏÌ¿ÓÔÈ (0,4%), ¢ÂÓ ·¿ÓÙËÛ·Ó- ¿ÏÏ· ıÚËÛ·̷ٷ (6,3%). ∏ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì spss 14.0 chi – square & Logistic regression analysis. ∞¶OΔ∂§∂™ª∞Δ∞
°ÓÒÛË Ù˘ ¤ÓÓÔÈ·˜ ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ı·Ó¿ÙÔ˘ ›¯Â ÙÔ 89,7% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ, ÂÓÒ ÙÔ ÙÈ Â›Ó·È Ë ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ ÙÔ 97,7%. ΔÔ fiÙÈ Ë ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ ‰›ÓÂÈ ˙ˆ‹ ÛÂ Û˘Ó·ÓıÚÒÔ˘˜ Ì·˜ ÁÓÒÚÈ˙ ÙÔ 94,8%. ªfiÓÔ 3,8% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Â›Ó·È Â›ÛËÌ· ‰ˆÚËÙ¤˜ ÔÚÁ¿ÓˆÓ, 48,3% ı· ‹ıÂÏ·Ó Ó· Á›ÓÔ˘Ó ÔÈ ›‰ÈÔÈ ÂÓÒ 49,1% ı· ‰ÒÚÈ˙·Ó fiÚÁ·Ó· Û˘ÁÁÂÓÈÎÒÓ ÚÔÛÒˆÓ ·Ó Î·È ı· ¤ÓÔȈı·Ó ÂÓÔ¯¤˜ 55,7%. ™Â Û¯¤ÛË Ì ÙËÓ ıÚËÛΛ·, ı¤ÏÔ˘Ó Ó· Á›ÓÔ˘Ó ‰ˆÚËÙ¤˜ ÔÚÁ¿ÓˆÓ (63,7%) ÙˆÓ ÃÚÈÛÙ. OÚıÔ‰fi͈Ó, (40%) ÙˆÓ ªÔ˘ÛÔ˘ÏÌ¿ÓˆÓ, (2,7%) ÙˆÓ ∫·ıÔÏÈÎÒÓ, (3,4%) ÙˆÓ ¢È·Ì·ÚÙ˘ÚfiÌÂÓˆÓ, Î·È (90%) ÙˆÓ πÔ˘‰·›ˆÓ. ∏ÏÈ˘ οو ÙˆÓ 30 ¯ÚÔÓÒÓ ı¤ÏÔ˘Ó Ó· Á›ÓÔ˘Ó ‰ˆÚËÙ¤˜ ÔÚÁ¿ÓˆÓ, ÂÓÒ ·ÓÙ›ıÂÙ· ·ÚÓËÙÈο ·¿ÓÙËÛ·Ó ¿ÙÔÌ· ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 50. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ Â¿ÁÁÂÏÌ· ‹ ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ ··ÓÙ‹ÛÂȘ. ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ∂ÏÏ¿‰· Â›Ó·È Ë ÚÒÙË ¯ÒÚ· ÛÙËÓ ∂˘ÚÒË Û ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ·ÏÏ¿ Ë ÙÂÏÂ˘Ù·›· ÛÙË ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ. ∂ηÙÔÓÙ¿‰Â˜ ¿ÓıÚˆÔÈ ¯¿ÓÔÓÙ·È Î·ıËÌÂÚÈÓ¿ ÛÙÔÓ ‚ˆÌfi Ù˘ ·ÛÊ¿ÏÙÔ˘, fï˜ Ï›ÁÔÈ Â›Ó·È ÂΛÓÔÈ Ô˘ ·ÔÊ·Û›˙Ô˘Ó Ó· οÓÔ˘Ó ÙÔ ÌÂÁ¿ÏÔ ‚‹Ì· Î·È Ó· ÚÔÛʤÚÔ˘Ó Ù· fiÚÁ·Ó· ÙˆÓ ·Á·ËÌ¤ÓˆÓ ÙÔ˘˜ ÚÔÛÒˆÓ Û ·ÛıÂÓ›˜ Ô˘ Ù· ¤¯Ô˘Ó ·Ó¿ÁÎË. ΔÂÏÈο ‰ÂÓ ı· Ú¤ÂÈ Ó· Ì¿ıÔ˘Ì ӷ ϤÌ ÌfiÓÔ: °›Ó ÎÈ ÂÛ‡ ‰ˆÚËÙ‹˜ ÔÚÁ¿ÓˆÓ! ªÔÚ›˜! ∞ÏÏ¿ Î·È Ó· ÙÔ Î¿ÓÔ˘Ì ڿÍË.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
29 ¢∂∫∞¶∂¡Δ∂ ÃO¡π∞ ¢øƒ∂∞™ Oƒ°∞¡ø¡ ™∂ ¶O§À¢À¡∞ª∏ ª∂£ º. ¢Ú¿Ì·, ª. °È·ÓÓ¿ÎÔ˘, ∂. °Î¤Î·, ∞. ∂˘ı˘Ì›Ô˘, ∂. ∞Ó·ÛÙ·Û›Ô˘, ∂. ¶··ÁˆÚÁ›Ô˘, ∫. ª¿ÙÛË, ∂. ∫·ÏϤÚÁË, ¡. Δ¿ÛÎÔ˜, ∂. ™ÔÊÈ·Ófi˜ ª∂£∞ ¶·Ó. °¡£ ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË
™∫O¶O™
∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ı·Ó¿ÙÔ˘ (∂£) Î·È Ë ‚¤ÏÙÈÛÙË ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ‰˘ÓËÙÈÎÒÓ ‰ÔÙÒÓ ÔÚÁ¿ÓˆÓ Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ·ÍÈÔÔ›ËÛË ÔÏÔ¤Ó· Î·È ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ó· ‰È·ÈÛÙˆı› ·Ó Ë ÂÌÂÈÚ›· Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ù˘ ª∂£ Û˘Ó¤‚·Ï ÛÙËÓ ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË Ù˘ ÚÔÛÊÔÚ¿˜ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ. À§π∫O ∫∞π ª∂£O¢O™
ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο ÙËÓ ÂÚ›Ô‰Ô 9/1992 - 9/2007, ÔÈ ·ÛıÂÓ›˜ Ì ‰È¿ÁÓˆÛË ∂£ Ô˘ ¤ÁÈÓ·Ó ‰fiÙ˜ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ. ∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›·, Ë ‰È¿ÁÓˆÛË ÂÈÛ·ÁˆÁ‹˜, ÔÈ Îϛ̷Θ ‚·Ú‡ÙËÙ·˜ ÂÈÛ·ÁˆÁ‹˜ (APACHE II, GCS Î·È ISS ÁÈ· ÙÔ ÙÚ·‡Ì·), Ô ¯ÚfiÓÔ˜ ‰È¿ÁÓˆÛ˘ ∂£, ÙÔ Â›‰Ô˜ ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ¤ÁÈÓ Ì ¯2 ·Ó¿Ï˘ÛË. ∞¶OΔ∂§∂™ª∞Δ∞
∞fi ÙÔ˘˜ 6122 ·ÛıÂÓ›˜ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰Âη¤ÓÙ ÂÙÒÓ, ÂÙ¤ıË Ë ‰È¿ÁÓˆÛË ÙÔ˘ ∂£ Û 177 (2,9%). ∞fi ·˘ÙÔ‡˜ ÔÈ 50 (28,3%) ¤ÁÈÓ·Ó ‰fiÙ˜ (18 Á˘Ó·›Î˜ Î·È 32 ¿Ó‰Ú˜). Δ· ÛÙÔȯ›· ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. ∏ ‰È¿ÁÓˆÛË ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ˘˜ 19 ‹Ù·Ó ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË ÌÂ/¯ˆÚ›˜ Û˘ÓÔ‰¿ ÙÚ·‡Ì·Ù· Î·È ÛÙÔ˘˜ 21 ÂÓ‰ÔÎÚ·Óȷ΋ ·ıÔÏÔÁ›·. ∞fi ·˘ÙÔ‡˜ ÔÈ 15 (30%) ‹Ù·Ó ¿Óˆ ÙˆÓ 60 ÂÙÒÓ. ªÂÙ·ÌÔۯ‡ÙËÎ·Ó Û˘ÓÔÏÈο: Ó‡ÌÔÓ˜: 8, ηډȿ: 11, ¿ÁÎÚ·˜: 6, ‹·Ú: 39, ÓÂÊÚfi˜: 100. ¶›Ó·Î·˜ 1 ËÏÈΛ·
APACHE II
GCS
ISS
¢È¿ÁÓˆÛË ∂£ (ËÌ)
47.41±2.58*
19.3±0.95*
5.98±0.49*
40.14±3.17*
3.2±0.33*
*mean±SE ¶›Ó·Î·˜ 2
1992-1997 1998-2001 2002-2007
∂£ (¡)
¢fiÙ˜ (¡)
∂£/¢fiÙ˜ %
67/17 53/14 57/19
17 14 19
25,4% 26,4% 33,3%
™Àª¶∂ƒ∞™ª∞Δ∞
™ÙËÓ ÔÚ›· Ù˘ ‰ÂηÂÓÙ·ÂÙ›·˜ ·Ú·ÙËÚ‹ıËΠ·Ó·ÏÔÁÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ‰ÔÙÒÓ (ÈÓ. 2) Ô˘ ÌÔÚ› Ó· ·Ô‰Ôı› ÙfiÛÔ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙÔ˘ ∂.£ fiÛÔ Î·È ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÛÙÔ ıÂÛÌfi ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛˆÓ. ∏ ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ‰ÂÓ ·ÔÙ¤ÏÂÛ·Ó ·Ó·ÛÙ·ÏÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÚÔÛÊÔÚ¿ ÔÚÁ¿ÓˆÓ.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
30 ∞¡Δπ∫∞Δ∞™Δ∞™∏ ΔOÀ MYCOPHENOLATE MOFETIL ª∂ ΔO ENTERIC-COATED MYCOPHENOLATE SODIUM ™∂ ∞™£∂¡∂π™ ¶OÀ ∂ÃOÀ¡ À¶Oμ§∏£∂π ™∂ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ∫∞π ∂ªº∞¡π∑OÀ¡ °∞™Δƒ∂¡Δ∂ƒπ∫∂™ ¢π∞Δ∞ƒ∞Ã∂™ ∂ÈÚ. ™·‚‚ȉ¿ÎË, ∞. ª¤Ï·˜, ∫. ºÔ˘ÚÙÔ‡Ó·˜, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË, ∂. ¶··¯Ú‹ÛÙÔ˘, ¢. °Ô‡ÌÂÓÔ˜, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘ ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ ¶.°.¡. ¶·ÙÚÒÓ
∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ mycophenolate mofetil (ªªF) Û ÙÚÈÏfi ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi Û¯‹Ì· ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡, ·Ú’ fiϘ ÙȘ ·ÚÂÓ¤ÚÁÂȘ, ȉȷ›ÙÂÚ· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, ıˆÚÂ›Ù·È ··Ú·›ÙËÙË ÙfiÛÔ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ÔÍ›·˜ ·fiÚÚȄ˘ fiÛÔ Î·È ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ΔÔ enteric-coated mycophenololate sodium (EC-MPS) Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÙËÓ ›‰È· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· fï˜ Û˘Óԉ‡ÂÙ·È ·fi ÛËÌ·ÓÙÈο ËÈfiÙÂÚ˜ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜. ™∫O¶O™
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÏÂÁ¯ı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ EC-MPS Î·È Ó· Á›ÓÂÈ Û‡ÁÎÚÈÛË ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÍ ·Ó¿Á΢ ·ÓÙÈηٷÛÙ¿ıËΠÙÔ MMF Ì EC-MPS. À§π∫O - ª∂£O¢O™
MÂÏÂÙ‹ıËÎ·Ó 18 ·ÛıÂÓ›˜, 10 ¿Ó‰Ú˜ Î·È 8 Á˘Ó·›Î˜, ̤Û˘ ËÏÈΛ·˜ 48±16 ¤ÙË, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤ÁÈÓ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ªªF ÏfiÁˆ ÂÈÌÔÓ‹˜ ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ·ÎfiÌ· Î·È ÌÂÙ¿ ÙË Ì›ˆÛË Ù˘ ‰fiÛ˘ ÙÔ˘ (̤ÛË ‰fiÛË 1220±250 mg/24h) ·fi ÙÔ EC-MPS ÙÔ ÔÔ›Ô ¯ÔÚËÁ‹ıËΠ۠·ÓÙ›ÛÙÔÈ¯Ë ‰fiÛË (720±250 mg/24h). ∏ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ÙÔ˘˜ ·ÁˆÁ‹ ›Û˘ ÂÚÈÂÏ¿Ì‚·Ó CNIs (CSA n=7, TAC n=11) Î·È ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË. OÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ‹Ù·Ó ÌÂÙˆÚÈÛÌfi˜ (n=7), ‰È¿ÚÚÔȘ (n=14), ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ (n=5), Ó·˘Ù›· Î·È ÂÌÂÙÔ› (n=3). O ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 6±3 Ì‹Ó˜. ∞¶OΔ∂§∂™ª∞Δ∞
K·Ù¿ ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ MMF Ì ∂C-MPS ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÔÍ›· ·fiÚÚÈ„Ë ‹ ·ÏÏ·Á‹ ÛÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 1,45±0,51 mg/dl → 1,45±0,48 mg/dl). ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ 16 ÛÙÔ˘˜ 18 (89%) ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ™Â Ì›· ·ÛıÂÓ‹ η٤ÛÙË ·Ó·Áη›· Ë ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÏfiÁˆ Ï¢ÎÔÂÓ›·˜, ÂÓÒ Û 4 ·fi 5 ·ÛıÂÓ›˜ Ô˘ ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ·˘ÍËı› Ë ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·ÓÂÌÊ·Ó›ÛıËÎ·Ó Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜. ™Àª¶∂ƒ∞™ª∞Δ∞
H ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ªªF Ì EC-MPS ·Ô‰ÂÈÎÓ‡ÂÙ·È ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, Û˘Óԉ‡ÂÙ·È ‰Â ·fi ÛËÌ·ÓÙÈο ËÈfiÙÂÚ˜ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ ·ÏÏ¿ ÌfiÓÔ fiÙ·Ó Á›ÓÂÙ·È ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ‰fiÛÂȘ ÙˆÓ Ê·Ú̿ΈÓ.
45
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
31 ¶ƒøπª∂™ ¶∞ƒ∞Δ∏ƒ∏™∂π™ ∞¶O Δ∏ Ã√ƒ∏°∏™∏ Δ√À ªÀ∫√º∞π¡√§π∫√À ∞§∞Δ√™ ™∂ §∏¶Δ∂™ ¶ƒøΔ√À ¡∂ºƒπ∫√À ª√™Ã∂Àª∞Δ√™ ™. ¢Ú·ÎfiÔ˘ÏÔ˜1, ª. ∫Ô˘ÎÔ˘Ï¿ÎË1, £. ∞ÔÛÙfiÏÔ˘2, °. ªÂÙ·Í¿ÙÔ˜2, ¡. ¡ÈÎÔÏÔÔ‡ÏÔ˘2, μ. ∫›ÙÛÈÔ˘3, Ã. ¶··ÛÙÂÚÈ¿‰Ë3, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘2 1ªÔÓ¿‰·
ªÂÙ·ÌÔۯ‡ÛˆÓ, ΔÌ‹Ì·, 3∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜ Î·È πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜» 2¡ÂÊÚÔÏÔÁÈÎfi
ΔÔ Ì˘ÎÔÊ·ÈÓÔÏÈÎfi Ô͇ ‰Ú· ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ Ì ÂÎÏÂÎÙÈÎfi Î·È ·Ó·ÛÙÚ¤„ÈÌÔ ÙÚfiÔ ÙÔÓ ·Ó·ÛÙÔϤ· Ù˘ ÈÓÔÛ›Ó˘ Ù˘ ÌÔÓÔʈÛÊÔÚÈ΋˜ ‰Â¸‰ÚÔÁÂÓ¿Û˘, ÂÌÔ‰›˙ÔÓÙ·˜ Ì ÙÔÓ ÙÚfiÔ ·˘Ùfi ÙË Û‡ÓıÂÛË ÙˆÓ Ô˘ÚÈÓÒÓ. ∏ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ¤¯ÂÈ Û˘Ì‚¿ÏÏÂÈ ÛÙË Ì›ˆÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÔÍ›·˜ ·fiÚÚȄ˘ Î·È ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂÈ‚›ˆÛ˘ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·È ·ÛıÂÓÒÓ. ∏ ¯ÔÚËÁ‹ÛË ÙÔ˘ Ì˘ÎÔÊ·ÈÓÔÏÈÎÔ‡ ÔͤԘ ˘fi ÙË ÌÔÚÊ‹ Ì˘ÎÔÊ·ÈÓÔÏÈÎÔ‡ ¿Ï·ÙÔ˜ ˘fiÛ¯ÂÙ·È ›‰È· ÏÂÈÙÔ˘ÚÁÈ΋ ‰Ú¿ÛË Ì ÏÈÁfiÙÂÚ˜ ·ÚÂÓ¤ÚÁÂȘ. ™ÙË ÌÂϤÙ˘ ·˘Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÈÌË ÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ÙÔ˘ Ì˘ÎÔÊ·ÈÓÔÏÈÎÔ‡ ¿Ï·ÙÔ˜ (enteric-coated mycophenolic sodium, Myfortic®) Û ϋÙ˜ ÚÒÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ªÂÏÂÙ‹ıËÎ·Ó 14 Ï‹Ù˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜, 57% (8/14) ¿Ó‰Ú˜, Ì ‰È¿ÌÂÛË ÙÈÌ‹ ËÏÈΛ·˜ 47 ¤ÙË (29-63 ¤ÙË). ¶‹Ú·Ó ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ Ì ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ ¤Ó·ÓÙÈ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 2 Î·È ÙÚÈÏfi ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi Û¯‹Ì· Ì ΢ÎÏÔÛÔÚ›ÓË (3 mg/kgr), myfortic (720 mg ‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤ڷ) Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ¶·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, ˙ˆÙÈο ÛËÌ›· Î·È fiϘ ÔÈ ·Ú¿ÌÂÙÚÔÈ Ù˘ ·ÈÌÔÔÈËÙÈ΋˜, ÓÂÊÚÈ΋˜ Î·È Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηıËÌÂÚÈÓ¿ ÁÈ· ÙËÓ ÂÚ›Ô‰Ô ÓÔÛËÏ›·˜ Î·È ·ÎÔÏÔ‡ıˆ˜ ÌËÓÈ·›ˆ˜. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÔÙÂϤÛÌ·Ù· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ÏËÙÒÓ ÁÈ· ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. ™Â 3 ÂÚÈÙÒÛÂȘ ÙÔ ÌfiÛ¯Â˘Ì· ÚÔÂÚ¯fiÙ·Ó ·fi ˙ÒÓÙ· ‰fiÙË. Δ· 6 ÌÔۯ‡̷ٷ ›¯·Ó ¿ÌÂÛË ÏÂÈÙÔ˘ÚÁ›· Î·È Ù· ˘fiÏÔÈ· ηı˘ÛÙÂÚË̤ÓË, Ô˘ ¯ÚÂÈ¿ÛÙËΠ4±1,2) Û˘Ó‰ڛ˜ ·ÈÌÔοı·ÚÛ˘. ¶·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÂÂÈÛfi‰È· ·fiÚÚȄ˘, ÙÔ ¤Ó· ÏfiÁˆ ÌË Û˘ÌÌfiÚʈÛ˘ ÛÙËÓ ·ÁˆÁ‹, Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì ÒÛÂȘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ. ª¤ÛÔ˜ ¯ÚfiÓÔ˜ ÓÔÛËÏ›·˜: 23±8,3 Ë̤Ú˜ Î·È Ì¤ÛË ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ηٿ ÙËÓ ¤ÍÔ‰Ô: 1,4±0,7 mg/dl. ΔÔÓ 3Ô Ì‹Ó· Ë ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ‹Ù·Ó 1,1±0,6. ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ ·Ú·ÙËÚ‹ıËÎ·Ó Ù¤ÛÛÂÚ· ÂÂÈÛfi‰È· Ô˘ÚÔÏÔÈÌÒÍÂˆÓ ÂÓÒ ‰ÂÓ ÛËÌÂÈÒıËÎ·Ó ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· (Ó·˘Ù›·, ¤ÌÂÙÔÈ, ‰È¿ÚÚÔȘ, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜) Ô˘ Ó· Ô‰‹ÁËÛ·Ó ÛÙË Ì›ˆÛË ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ‰fiÛÂˆÓ myfortic. ªÂ ÙËÓ ÂÈʇϷÍË ÙÔ˘ ÌÈÎÚÔ‡ ‰Â›ÁÌ·ÙÔ˜ ·ÛıÂÓÒÓ Î·È Ù˘ ÂÚÈfi‰Ô˘ ·Ú·ÎfiÏÔ˘ıËÛ˘, Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Ì˘ÎÔÊ·ÈÓÔÏÈÎÔ‡ ¿Ï·ÙÔ˜, Myfortic, ÎÚ›ÓÂÙ·È ·ÛÊ·Ï‹˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙÔ ÓÂÊÚÈÎfi ÌfiÛ¯Â˘Ì·.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
32 OÀƒO§O°π∫∂™ ∂¶π¶§O∫∂™ ∫∞π ∞¡Δπª∂Δø¶π™∏ ΔOÀ™ ™Δ∏ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ – 10∂Δ∏™ ∂ª¶∂πƒπ∞ ΔOÀ ª∂Δ∞ªO™Ã∂ÀΔπ∫OÀ ∫∂¡ΔƒOÀ ¶∞Δƒø¡ (1997-2007) ∂. ºˆÎ·Â‡˜, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË, π. ª·ÚÔ‡Ï˘, ¢. °Ô‡ÌÂÓÔ˜, ¢. ∫·Ú·‚È¿˜, π. μÏ·¯ÔÁÈ¿ÓÓ˘ ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ¶·ÙÚÒÓ
™∫O¶O™
∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡, ·ÔÙÂÏ› ÙËÓ ıÂڷ›· ÂÎÏÔÁ‹˜ ÁÈ· ÙË ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. OÈ Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Ù˘ ÌÂÙ·-ÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋ ÂÚÈfi‰Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË ÙˆÓ Ô˘ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ Î·È Ù˘ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜ Û ·ÛıÂÓ›˜ Ô˘ ÌÂÙ·ÌÔۯ‡ÙËÎ·Ó ÛÙÔ Î¤ÓÙÚÔ Ì·˜. À§π∫O ∫∞π ª∂£O¢O™
ªÂÏÂÙ‹ıËÎ·Ó 173 ·ÛıÂÓ›˜ (118 ¿ÓÙÚ˜, 55 Á˘Ó·›Î˜) ËÏÈΛ·˜ 43±12, Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ (·fi ˙ÒÓÙ· Û˘ÁÁÂÓ‹, n=20 ‹ و̷ÙÈÎfi ‰fiÙË, n=153) ÛÙÔ ¶°¡ ¶·ÙÚÒÓ ·fi ÙÔ ª¿ÈÔ 1997 ¤ˆ˜ ÙÔ ™Â٤̂ÚÈÔ 2007. ∞¶OΔ∂§∂™ª∞Δ∞
∫·Ù·ÁÚ¿ÊËÎ·Ó 39 Ô˘ÚÔÏÔÁÈΤ˜ ›ÏÔΘ (›وÛË 17,34%) Û 30 ·ÛıÂÓ›˜ (23 ¿Ó‰Ú˜ Î·È 7 Á˘Ó·›Î˜). ∫·Ù¿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜ ‹Ù·Ó: Û˘ÏÏÔÁ‹ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ Ï·ÁfiÓÈˆÓ (17/39) (9 ÏÂÌÊÔ΋Ϙ, 8 Ô˘ÚÈÓÒÌ·Ù·), ÛÙÂÓÒÌ·Ù· Ô˘ÚËÙ‹Ú· (10/39), ÏÔÈÌÒÍÂȘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (4/39), ÏÂÌÊÔ΋ÏË ÔÛ¯¤Ô˘ (3/39), ·ÈÌÔÚÚ·Á›· Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙË (2/39), Ë ‰È·Ê˘Á‹ Ô‡ÚˆÓ (2/39) Î·È Ó¤ÎÚˆÛË Ô˘ÚËÙ‹Ú· (1/39). ¶¤ÓÙ ·ÛıÂÓ›˜ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙËÚËÙÈο, ÂÓÒ ¤Ó·˜ ˘Ô‚Ï‹ıËΠ۠‰ÈÔ˘ÚËıÚÈ΋ ·ÈÌfiÛÙ·ÛË. ™Â 7 ·ÛıÂÓ›˜ ¤ÁÈÓ ‰È·‰ÂÚÌÈ΋ ÓÂÊÚÔÛÙÔÌ›· ÂÓÒ ÔÈ 6 ·fi ·˘ÙÔ‡˜ ˘Ô‚Ï‹ıËÎ·Ó ÛÙË Û˘Ó¤¯ÂÈ· Û ÂÓ‰ÔÔ˘ÚÔÏÔÁÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ (‰È·ÛÙÔÏ‹ Ì ̷ÏfiÓÈ-Ô˘ÚËÙËÚÔÏ·ÛÙÈ΋-ÙÔÔı¤ÙËÛË ·˘ÙÔÛÙËÚÈ˙fiÌÂÓÔ˘ Ô˘ÚËÙËÚÈÎÔ‡ ηıÂÙ‹Ú·). Δ¤ÏÔ˜, Û 19 ·ÛıÂÓ›˜ ¤ÁÈÓ·Ó 22 ·ÓÔÈÎÙ¤˜ ÂÂÌ‚¿ÛÂȘ, Û 5 › ·ÔÙ˘¯›·˜ ÂÓ‰ÔÔ˘ÚÔÏÔÁÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ Î·È Û 3 › ·ÔÙ˘¯›·˜ ·ÓÔÈÎÙ‹˜ ¤̂·Û˘ [·ÓÂÌʇÙ¢ÛË Ô˘ÚËÙ‹Ú· (9/22), ˘ÂÏÔ΢ÛÙÂÔÛÙÔÌ›· (1/22), ·Ó·ÛÙfïÛË ˘¤ÏÔ˘ ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙ· ÓÂÊÚÔ‡ Ì ÁËÁÂÓ‹ Ô˘ÚËÙ‹Ú· (3/22), Ô˘ÚËÙËÚfiÏ˘ÛË (3/22), ¯Ú‹ÛË ÛˆÏËÓÔÔÈË̤ÓÔ˘ ·ÁÁÂÈÔ‡ÌÂÓÔ˘ ÎÚËÌÓÔ‡ ·fi ÙÔ ÚfiÛıÈÔ ÙÔ›¯ˆÌ· Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ (1/22) Î·È ‰ËÌÈÔ˘ÚÁ›· ·Ú·ı‡ÚÔ˘ (5/22)]. ™Àª¶∂ƒ∞™ª∞Δ∞
OÈ Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ÛÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡, ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯ÓfiÙÂÚ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÈÏÔΤ˜. ∫Ú›ÓÂÙ·È ·Ó·Áη›· Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙˆÓ ·ÛıÂÓÒÓ, ÒÛÙ ӷ ÂÈÙ˘Á¯¿ÓÂÙ·È ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÂÈÏÔÎÒÓ Î·È ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. πηÓfi ÔÛÔÛÙfi ÙÔ˘˜ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Û˘ÓÙËÚËÙÈο ‹ Ì ÂÓ‰ÔÔ˘ÚÔÏÔÁÈΤ˜ Ù¯ÓÈΤ˜ Î·È Â› ·ÔÙ˘¯›·˜ ·˘ÙÒÓ Ì ·ÓÔȯً ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
33 O ƒO§O™ Δ∏™ ∞ÀΔOª∂Δ∞ªO™Ã∂À™∏™ ¡∂ºƒOÀ ™Δ∏¡ ¢π∞™ø™∏ ∂¶π¶§∂°ª∂¡ø¡ ¶∂ƒπ¶Δø™∂ø¡ π£∞°∂¡OÀ™ ¡∂ºƒOÀ μ. ¶··ÓÈÎÔÏ¿Ô˘1, π. ºÔ‡˙·˜1, °. ÿÌ‚ÚÈÔ˜1, ∂. ∫·Ùۛη, ∞. ¡Ù›Ó·˜1, °. ª˘ÛÂÚÏ‹˜1, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜1, ¡. ∞ÓÙˆÓÈ¿‰Ë˜1, ∫. ¢ÈÏ¿Ú˘1, ∞. ¶ÂÙÚ›‰Ë˜2, ™. ¢Ô‡Ì·3, £. °ÂÚ·ÛÈÌ›‰Ë˜4, ¢. Δ·ÎÔ‡‰·˜1 1ÃÂÈÚÔ˘ÚÁÈ΋
∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ΔÌ‹Ì· ¡ÔÛÔÎÔÌÂ›Ô ¶··ÓÈÎÔÏ¿Ô˘, £ÂÛÛ·ÏÔÓ›ÎË 3μã ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô 4∂ã ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô 2∞ÎÙÈÓÔÏÔÁÈÎfi
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¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÚfiÊ·ÙË ÂÌÂÈÚ›· Ù˘ ÎÏÈÓÈ΋˜ Ì·˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‰‡Ô ÂÈÂÏÂÁÌ¤ÓˆÓ ÓÂÊÚÔÏÔÁÈÎÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ì ·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. À§π∫O ∫∞π ª∂£O¢O™
∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚ¿ ¿ÚÚÂÓ· ·ÛıÂÓ‹ 53 ÂÙÒÓ, Ì ‰Â˘ÙÂÚÔ·ı‹ ÔÈÛıÔÂÚÈÙÔÓ·˚΋ ›ÓˆÛË, ÌÂÙ¿ ·fi ÔÚ¯ÂÎÙÔÌ‹ Î·È ·ÎÙÈÓÔıÂڷ›· ÁÈ· ÂÌ‚Ú˘ïÎfi ηÚΛӈ̷ fiÚ¯ÂÔ˜, ÚÔ ÙÚÈ¿ÓÙ· ÂÙÒÓ. ¶·ÚÔ˘Û›·Û ˘‰ÚÔÓ¤ÊÚˆÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂÊÚÔ‡, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛıËΠ·Ú¯Èο ÌÂ Û˘ÌÊ˘ÛÈfiÏ˘ÛË ÙÔ˘ ÔÈÛıÔÂÚÈÙÔÓ·ïÎÔ‡ ¯ÒÚÔ˘ Î·È ÙÔÔı¤ÙËÛË Î·ıÂÙ‹Ú· pig-tail. ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ pigtail Ë ˘‰ÚÔÓ¤ÊÚˆÛË ˘ÔÙÚÔ›·ÛÂ, ÏfiÁˆ Ú›ÎÓˆÛ˘ Î·È ·fiÊڷ͢ ÙÔ˘ Ô˘ÚËÙ‹Ú· Ô˘ Ô‰‹ÁËÛ Û ÌfiÓÈÌË ÓÂÊÚÔÛÙÔÌ›· Î·È Â·ÓÂÈÏËÌ̤Ó˜ Ô˘ÚÔÏÔÈÌÒÍÂȘ. O ·ÛıÂÓ‹˜ ˘Â‚Ï‹ıË Û ·Ú. ÓÂÊÚÂÎÙÔÌ‹ Î·È ·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘ÛË ÛÙÔÓ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ (ÙÂÏÈÎÔ-Ï·Á›· ·Ó·ÛÙfïÛË Ù˘ ÓÂÊÚÈ΋˜ ʤ‚·˜ ÛÙËÓ ¤Íˆ Ï·ÁfiÓÈÔ ÊϤ‚·, ÙÂÏÈÎÔ-ÙÂÏÈ΋ ·Ó·ÛÙfïÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ Ì ÙËÓ ¤Ûˆ Ï·ÁfiÓÈÔ ·ÚÙËÚ›· Î·È ÂÍˆÎ˘ÛÙÈ΋ ÂÌʇÙ¢ÛË ÙÔ˘ Ô˘ÚËÙ‹Ú· ÛÙËÓ Î‡ÛÙË). ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË ·ÊÔÚ¿ ·ÛıÂÓ‹ 24 ÂÙÒÓ, Ô ÔÔ›Ô˜ ·ÚÔ˘Û›·Û ÌË ÂÏÂÁ¯fiÌÂÓË ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË. ¢È·ÈÛÙÒıËΠÛÙ¤ÓˆÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ Î·È ¤ÁÈÓ ‰È·ÛÙÔÏ‹ Î·È ÙÔÔı¤ÙËÛË stent. À‹ÚÍ ·ÚÔ‰È΋ ‚ÂÏÙ›ˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘, ·ÏÏ¿ ÌÂÙ¿ ¤Ó· ¯ÚfiÓÔ Ó¤· Âȉ›ӈÛË, Ë ÔÔ›· ·Ô‰fiıËΠ۠ÌÂٷΛÓËÛË ÙÔ˘ stent Î·È Â·Ó·ÛÙ¤ÓˆÛË. ¢ÈÂÓÂÚÁËıËΠ‰È·ÛÙÔÏ‹ Î·È ÔÌÔ·ÍÔÓÈ΋ ÙÔÔı¤ÙËÛË Ó¤Ô˘ stent ÂÓÙfi˜ ÙÔ˘ ·Ï·ÈÔ‡. ªÂÙ¿ ·ÚÔ‰È΋ ‚ÂÏÙ›ˆÛË, ˘‹ÚÍ Ӥ· ˘ÔÙÚÔ‹ Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È Âȉ›ӈÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·Ú. ÓÂÊÚÔ‡ Ì ıÂÙÈ΋ ‰ÔÎÈÌ·Û›· ηÙÚÔÚ›Ï˘ ÛÙÔ ÓÂÊÚfiÁÚ·ÌÌ· (99mTc-DTPA GFR 99 ml/min (Gates) ∞ƒ 33%, ¢∂ 67%). ¢ÈÂÓÂÚÁ‹ıËΠ·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂÊÚÔ‡ ÛÙÔÓ ·ÚÈÛÙÂÚfi Ï·ÁfiÓÈÔ ‚fiıÚÔ ÌÂÙ¿ ·fi ·Ê·›ÚÂÛË ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜, ÙÔ ÔÔ›Ô ¤ÊÂÚ ٷ stents (ÙÂÏÈÎÔ-Ï·Á›· ·Ó·ÛÙfïÛË Ù˘ ÓÂÊÚÈ΋˜ ʤ‚·˜ ÛÙËÓ ¤Íˆ Ï·ÁfiÓÈÔ ÊϤ‚·, ÙÂÏÈÎÔ-Ï¿ÁÈ· ·Ó·ÛÙfïÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ Ì ÙËÓ ¤Íˆ Ï·ÁfiÓÈÔ ·ÚÙËÚ›· Î·È ÙÂÏÈÎÔ-ÙÂÏÈ΋ ·Ó·ÛÙfïÛË ÙÔ˘ Ô˘ÚËÙ‹Ú· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Ì ÙÔÓ Èı·ÁÂÓ‹ Ô˘ÚËÙ‹Ú· ÙÔ˘ Ï‹ÙË). ∞¶OΔ∂§∂™ª∞Δ∞
O ÚÒÙÔ˜ ·ÛıÂÓ‹˜, 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘ÛË, ·ÚÔ˘ÛÈ¿˙ÂÈ ‚ÂÏÙ›ˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, GFR: ·fi 70 Û 85 ml/min/1,73 m2, ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 0.79 mg/dl) Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·Ô¯¤Ù¢ÛË. O ‰Â‡ÙÂÚÔ˜ ·ÛıÂÓ‹˜, ÌÂÙÂÁ¯ÂÈÚËÙÈο, ·ÚÔ˘Û›·Û ‚ÂÏÙ›ˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, GFR: ·fi 99 Û 113 ml/min/1,73 m2, ÓÂÊÚfiÁÚ·ÌÌ· Ì 99mTc-MAG: Û˘ÌÌÂÙÔ¯‹ ∞ƒ ÓÂÊÚÔ‡ 40%, ¢∂ ÓÂÊÚÔ‡ 60%) Î·È ‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ™Àª¶∂ƒ∞™ª∞Δ∞
H ·˘ÙÔÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ÚÔÛʤÚÂÈ ıÂڷ¢ÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ Û ÂÈÏÂÁ̤ӷ ÓÂÊÚÔÏÔÁÈο ÂÚÈÛÙ·ÙÈο ÛÙ· ÔÔ›· ÔÈ ÎÏ·ÛÈΤ˜ ·ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ Î·È Ô˘ÚÔÏÔÁÈΤ˜ Ù¯ÓÈΤ˜ ¤¯Ô˘Ó ÂÍ·ÓÙÏËı›.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
34 ª∞∫ƒOÃO¡π∞ ∂¶πμπø™∏ ¡∂ºƒπ∫ø¡ ªO™Ã∂Àª∞Δø¡ ª∂Δ∞ ∞¶O ∂¶πΔÀÃ∏ ∞¡Δπª∂Δø¶π™∏ OÀƒ∏Δ∏ƒπ∫ø¡ ∂¶π¶§O∫ø¡ ª∂ ∂¶∂ªμ∞Δπ∫∂™ ∞∫Δπ¡O§O°π∫∂™ ª∂£O¢OÀ™ π. ∫·ÛηڤÏ˘1, ª. ∫Ô˘ÎÔ˘Ï¿ÎË2, ∂. ª·˚Ú·Ì›‰Ë˜2, Ã. ∫fiÎÎÈÓÔ˜2, ª. πÂÚˆÓ‡ÌÔ˘2, £. °ÂˆÚÁ·ÓÙ¿˜2, μ. μÔ˘Á¿˜2, ™. ¢Ú·ÎfiÔ˘ÏÔ˜2 1∂ÚÁ·ÛÙ‹ÚÈÔ 2ªÔÓ¿‰·
∞ÎÙÈÓÔÏÔÁ›·˜/ΔÌ‹Ì· ∂ÂÌ‚·ÙÈ΋˜ ∞ÎÙÈÓÔÏÔÁ›·˜ ªÂÙ·ÌÔۯ‡ÛˆÓ, °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
OÈ Ô˘ÚËÙËÚÈΤ˜ ÂÈÏÔΤ˜ ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙÔ 8% ÙˆÓ ÂÈÏÔÎÒÓ Î·È Û˘¯Ó¿ Ô‰ËÁÔ‡Ó Û ·ÒÏÂÈ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ™ÙËÓ ·Ó·‰ÚÔÌÈ΋ ·˘Ù‹ ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÌÂÈÚ›· Ì·˜ ·fi ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ô˘ÚËÙËÚÈÎÒÓ ÂÈÏÔÎÒÓ Ì ÌÂıfi‰Ô˘˜ ÂÂÌ‚·ÙÈ΋˜ ·ÎÙÈÓÔÏÔÁ›·˜ Î·È ÂÚÈÁÚ¿ÊÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· 5ÂÙÔ‡˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ÏËÙÒÓ. ∞ӷχÔÓÙ·È 21 ÂÚÈÛÙ·ÙÈο ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡ Ì ԢÚËÙËÚÈΤ˜ ÂÈÏÔΤ˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÌÂıfi‰Ô˘˜ ÂÂÌ‚·ÙÈ΋˜ ·ÎÙÈÓÔÏÔÁ›·˜. ™˘ÁÎÂÎÚÈ̤ӷ ·Ú·ÙËÚ‹ıËÎ·Ó 9 ‰È·Ê˘Á¤˜ ·fi ÙËÓ Ô˘ÚËÙËÚÔ-΢ÛÙÈ΋ ÂÌʇÙ¢ÛË, ¤ÍÈ Ô˘ÚËÙËÚÈΤ˜ ÛÙÂÓÒÛÂȘ Î·È ¤ÍÈ ÛÙ¤ÓˆÛÂȘ ÌÂÙ¿ ÚÔËÁËı›۷ ‰È·Ê˘Á‹. ™˘Ó¤‚ËÛ·Ó Û ϋÙ˜ ̤Û˘ ËÏÈΛ·˜ 48 ¤ÙÒÓ (‰È·Î‡Ì·ÓÛË 20-63 ¤ÙË), 71% ¿ÚÚÂÓ˜ (15/21) Î·È Û ÔÛÔÛÙfi 66,6% (14/21) Û ÌÔۯ‡̷ٷ ·fi ·Ô‚ÈÒÛ·ÓÙ˜. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ‰ÔÙÒÓ ‹Ù·Ó 52 ¤ÙË (15-75 ¤ÙË). OÈ ÂÈÏÔΤ˜ ÂΉËÏÒıËÎ·Ó Î·Ù¿ ̤ÛÔ fiÚÔ 18 ̤Ú˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ™Â fiÏÔ˘˜ ¤ÁÈÓ ·Ú¯Èο ‰È·‰ÂÚÌÈ΋ ·Ú·Î¤ÓÙËÛË Ù˘ ÓÂÊÚÈ΋˜ ˘¤ÏÔ˘ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Î·È ‰È¿ÁÓˆÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. OÈ ÂÚÈÙÒÛÂȘ ‰È·Ê˘Á‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÚÔÛˆÚÈÓ‹ ÓÂÊÚÔÛÙÔÌ›· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰È·‰ÂÚÌÈ΋ ÙÔÔı¤ÙËÛË Ô˘ÚËÙËÚÈ΋˜ ÂÓ‰ÔÚfiıÂÛ˘ (ÓÂÊÚÔ-Ô˘ÚËÙÈÎÔ‡ stent ‹ double J stent) ÂÓÒ ÔÈ ÂÚÈÙÒÛÂȘ ÛÙ¤ÓˆÛ˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ‰È·ÛÙÔÏ‹ Ì ̷ÏfiÓÈ Î·È ·ÎÔÏÔ‡ıˆ˜ Ô˘ÚËÙËÚÈ΋ ÂÓ‰ÔÚfiıÂÛË. ª¤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ú¤Ì‚·Û˘ ‹Ù·Ó 53 Ë̤Ú˜. ª¤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË Â›Ó·È 57 Ì‹Ó˜. ªÂÙ¿ ÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ Ô˘ÚËÙËÚÈ΋˜ ÂÈÏÔ΋˜ ·Ú·ÙËÚ‹ıËΠÛÙ·ÛÙÈο ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ̤ÛË ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÔÚÔ‡ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ‹Ù·Ó 4,8±2,12 mg/dl Î·È 1,79±0,58 mg/dl ·ÓÙ›ÛÙÔȯ· (p<0.0001). ∏ ÂÈ‚›ˆÛË ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·˘ÙÒÓ ‹Ù·Ó 100% ÙÔ ÚÒÙÔ ¤ÙÔ˜, Ë ÙÚÈÂÙ‹˜ 95,2% Î·È Ë ÂÓÙ·ÂÙ‹˜ 80,9%. ¢ÂÓ ˘‹ÚÍ ·ÒÏÂÈ· ÌÔۯ‡̷ÙÔ˜ ÂÍ·ÈÙ›·˜ Ù˘ Ô˘ÚËÙËÚÈ΋˜ ÂÈÏÔ΋˜. ∏ Û˘Ì‚ÔÏ‹ Ù˘ ÂÂÌ‚·ÙÈ΋˜ ·ÎÙÈÓÔÏÔÁ›·˜ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¿ÌÂÛˆÓ Î·È ·ÒÙÂÚˆÓ Ô˘ÚËÙËÚÈÎÒÓ ÂÈÏÔÎÒÓ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ï‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Î·È ÂÈ‚›ˆÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
35 ∏ Ã∏™∏ OÀƒ∏Δ∏ƒπ∫√À ∫∏¢∂ª√¡∞ (DOUBLE-J STENT) ™Δ∏¡ ∫À™Δ∂√√Àƒ∏Δ∏ƒπ∫∏ ∞¡∞™Δ√ªø™∏ ™∂ ª∂Δ∞ª√™Ã∂À™∏ ¡∂ºƒ√À ∏ ∂ª¶∂πƒπ∞ ∂¡√™ ∫∂¡Δƒ√À ∫. ¢ÈÏ¿Ú˘, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¶··ÁÈ¿ÓÓ˘, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. ∫·Ú‰¿Û˘, π. ºÔ‡˙·˜, °. ΔÛÔ˘ÏÊ¿˜, ¢. μÚÔ¯›‰Ë˜, ∞. ¡Ù›Ó·˜, °. ÿÌ‚ÚÈÔ˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£, °.¡. πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË
™∫O¶O™
OÈ Ì›˙ÔÓ˜ Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ·˘Í¿ÓÔ˘Ó ÙË ÓÔÛËÚfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Î·È ‰˘ÓËÙÈο ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ªÂÏÂÙ‹ıËÎÂ Ë ¯ÚËÛÈÌÔÔ›ËÛË Ô˘ÚËÙËÚÈÎÔ‡ ÎˉÂÌfiÓ· (Double-J stent) ÛÙËÓ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·Ó·ÛÙfïÛË Û ÌÂÙ·Ìfi¯Â˘ÛÂȘ ÓÂÊÚÔ‡ ·fi ˙ÒÓÙ˜ Î·È ·Ô‚ÈÒÛ·ÓÙ˜ ‰fiÙ˜. À§π∫O ∫∞π ª∂£O¢O™
∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2005 ̤¯ÚÈ ÙÔ ™Â٤̂ÚÈÔ ÙÔ˘ 2007 Ú·ÁÌ·ÙÔÔ›ËıËÎ·Ó ÛÙÔ Î¤ÓÙÚÔ Ì·˜ 172 ÌÂÙ·ÌÔۯ‡ÛÂȘ ÓÂÊÚÔ‡. ∞fi ˙ÒÓÙ˜ ‰fiÙ˜ ¤ÁÈÓ·Ó 65 ÌÂÙ·ÌÔۯ‡ÛÂȘ ÓÂÊÚÔ‡ Î·È 107 ·fi ·Ô‚ÈÒÛ·ÓÙ˜ ‰fiÙ˜. ∞fi ÙÔ˘ 172 ·ÛıÂÓ›˜ ÔÈ 24 ˘Ô‚Ï‹ıËÎ·Ó Û ԢÚËÙËÚÔÛÙÔÌ›·, 10 ˘Ô‚Ï‹ıËÎ·Ó Û ΢ÛÙÂÔÚÔ˘ÙËÚÈ΋ ·Ó·ÛÙfïÛË Î·Ù¿ Politano-Leadbetter Î·È ÂÍ·ÈÚ¤ıËÎ·Ó ·fi ÙËÓ ÌÂϤÙË. ∂ÈϤÔÓ 21 ·ÛıÂÓ›˜ ·ÒÏÂÛ·Ó ÙÔ ÌfiÛ¯Â˘Ì· ÏfiÁˆ ÔÍ›·˜ ‹ ˘ÂÚÔÍ›·˜ ·fiÚÚȄ˘, ·ÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È CMV Ïԛ̈͢ Î·È ÂÍ·ÈÚ¤ıËÎ·Ó ·fi ÙËÓ ÌÂϤÙË. OÈ ˘fiÏÔÈÔÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·Ó·ÛÙfïÛË Î·Ù¿ Lich-Gregoir Î·È ¯ˆÚ›ÛıËÎ·Ó Û 2 ÔÌ¿‰Â˜. ™ÙËÓ ÔÌ¿‰· ∞ Ô˘ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 44 ·ÛıÂÓ›˜ Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠԢÚËÙËÚÈÎfi˜ ÎˉÂÌfiÓ·˜ (Double-J stent) Î·È ÛÙËÓ ÔÌ¿‰· μ Ô˘ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 73 ·ÛıÂÓ›˜ Î·È ‰ÂÓ ÙÔÔıÂÙ‹ıËΠԢÚËÙËÚÈÎfi˜ ÎˉÂÌfiÓ·˜. OÈ 2 ÔÌ¿‰Â˜ ‹Ù·Ó ·ÚfiÌÔȘ ˆ˜ ÚÔ˜ Ù· ‰ËÌÔÁÚ·ÊÈο ÙÔ˘˜ ÛÙÔȯ›·, ÙËÓ ÚˆÙÔ·ı‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ (DGF), ÙËÓ ·ÓÔÛÔηٷÛÙÔÏ‹ Î·È ÙȘ ÒÚ˜ „˘¯Ú‹˜ ÈÛ¯·ÈÌ›·˜. ∞¶OΔ∂§∂™ª∞Δ∞
¢È·Ê˘Á‹ ·fi ÙËÓ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·Ó·ÛÙfïÛË ÂÌÊ¿ÓÈÛ·Ó 1/44 (2,3%) Î·È 3/73 (4,1%) ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È μ ·ÓÙ›ÛÙÔȯ·. ∂·Ó¤̂·ÛË ÁÈ· ·Ó·Î·Ù·ÛÎÂ‡Ë Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·Ó·ÛÙfïÛË ¤ÁÈÓ Û 0/44 (0%) Î·È 2/73 (2,7%) ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È μ ·ÓÙ›ÛÙÔȯ·. §ÔÈÌÒÍÂȘ ÙÔ˘ ÔÚÔÔÈËÙÈÎÔ‡ ÂÌÊ¿ÓÈÛ·Ó 9/44 (20,4%) Î·È 14/73 (19,2%) ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È μ ·ÓÙ›ÛÙÔȯ·. ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ¯Ú‹ÛË Ô˘ÚËÙËÚÈÎÔ‡ ÎˉÂÌfiÓ· (Double-J stent) ÛÙËÓ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·Ó·ÛÙfïÛË Û ÌÂÙ·Ìfi¯Â˘ÛÂȘ ÓÂÊÚÔ‡ ÌÂÈÒÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ê˘Á‹˜ Î·È ÙËÓ ·Ó¿ÁÎË Â·Ó¤̂·Û˘. ∂ÈϤÔÓ ·˘Í¿ÓÂÈ ÂÏ·ÊÚÒ˜ ÙËÓ ÂÌÊ¿ÓÈÛË ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ÔÚÔÔÈËÙÈÎÔ‡.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
36 ∞¡Δπª∂Δø¶π™∏ Δ∏™ ™Δ∂¡ø™∏™ Δ∏™ ¡∂ºƒπ∫∏™ ∞ƒΔ∏ƒπ∞™ ΔOÀ ª∂Δ∞ªO™Ã∂Àª∂¡OÀ ¡∂ºƒOÀ ∫∞π Δ∏™ ™À™ΔOπÃOÀ §∞°O¡πOÀ ∞ƒΔ∏ƒπ∞™ ª∂ ∞°°∂πO¶§∞™Δπ∫∏ ∫∞π ™Δ∂¡Δ ¶. ¶·¿˜, °. ∑·‚‚fi˜, ™. ∫·˙¿, ¶. §ÂÔÓ¿Ú‰Ô˘, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘, π. ªfiÎÔ˜, π. ªÔϤÙ˘, ∞. ∫ˆÛÙ¿Î˘ ¶°¡∞ §∞´∫O¡ ∞ÎÙÈÓÔÏÔÁÈÎfi ΔÌ‹Ì·, ¡ÂÊÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ Î·È ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ
™∫O¶O™
∏ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ Ì ÂÓ‰ÔÚfiıÂÛË (ÛÙÂÓÙ) Û ÂÚÈÙÒÛÂȘ ÛÙ¤ÓˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘ ÓÂÊÚÔ‡ ‹ Ù˘ Û˘ÛÙÔ›¯Ô˘ Ï·ÁfiÓÈÔ˘ ·ÚÙËÚ›·˜, Ô˘ ÚÔηÏÔ‡Ó ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. À§π∫O ∫∞π ª∂£O¢O™
∏ ÂÚÁ·Û›· Ì·˜ ·ÊÔÚ¿ 24 ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘¤ÚÙ·ÛË ‰‡ÛÎÔÏ· ÂÏÂÁ¯fiÌÂÓË ‹ Î·È ·‡ÍËÛË ÙˆÓ ÙÈÌÒÓ ÎÚ·ÙÈÓ›Ó˘ ÛÙÔ ·›Ì·, ÛËÌ›· Èı·Ó‹˜ ÛÙ¤ÓˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜. O ¤ÏÂÁ¯Ô˜ Ì ¤Á¯ÚˆÌÔ Doppler ÀÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ª·ÁÓËÙÈ΋ ∞ÁÁÂÈÔÁÚ·Ê›· ÚÔËÁ‹ıËÎ Ù˘ ÂÓ‰·ÚÙËÚȷ΋˜ ‰ÈÂÚ‡ÓËÛ˘, Ì ˘„ËÏ¿ ÔÛÔÛÙ¿ „¢‰Ò˜ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ 18,2% Î·È 13,6% ·ÓÙ›ÛÙÔȯ·. ™Â 2 ·fi ÙÔ˘˜ 24 ·ÛıÂÓ›˜ Ë ·ÚÙËÚÈÔÁÚ·Ê›· ‰ÂÓ ·Ó¤‰ÂÈÍ ÛÙ¤ÓˆÛË ·Ú¿ ÙËÓ ÈÛ¯˘Ú‹ ÎÏÈÓÈ΋ ˘Ô„›·. ™Â 2 ·ÛıÂÓ›˜ ÛËÌ·ÓÙÈ΋ ÛÙ¤ÓˆÛË ·Ó·‰Â›¯ıËΠÛÙËÓ Û‡ÛÙÔÈ¯Ë Ï·ÁfiÓÈÔ ·ÚÙËÚ›· ÎÂÓÙÚÈο, Î·È ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 20 Ë ÛÙ¤ÓˆÛË ·ÊÔÚÔ‡Û ÙËÓ ÓÂÊÚÈ΋ ·ÚÙËÚ›· ÙÔ˘ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘ ÓÂÊÚÔ‡. ∂ÈÙ˘¯‹˜ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ì ÛÙÂÓÙ ÂÊ·ÚÌfiÛıËΠÛÙÔ˘˜ 22 ·˘ÙÔ‡˜ ·ÚÚÒÛÙÔ˘˜. ∞¶OΔ∂§∂™ª∞Δ∞
∏ Ù¯ÓÈ΋ ÂÈÙ˘¯›· Ù˘ ¤̂·Û˘ ¤Êı·Û ÙÔ 100%. ∏ ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î˘Ì¿ÓıËΠ·fi 3 Ì‹Ó˜ ¤ˆ˜ 8 ¯ÚfiÓÈ· Î·È 8 Ì‹Ó˜. ¢‡Ô ·ÛıÂÓ›˜ ·Â‚›ˆÛ·Ó ÛÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ 2 ¿ÏÏÔÈ Ì ¯ÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ· ÂÓÙ¿¯ıËÎ·Ó Û ÚfiÁÚ·ÌÌ· ÂÚÈÔ‰È΋˜ ·ÈÌÔοı·ÚÛ˘. OÈ ˘fiÏÔÈÔÈ 18 ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÛÙ·ıÂÚ‹ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ì ÈηÓÔÔÈËÙÈΤ˜ ÙÈ̤˜ ÎÚ·ÙÈÓ›Ó˘ Î·È Â‡ÎÔÏ· Ú˘ıÌÈ˙fiÌÂÓË ·ÚÙËÚȷ΋ ›ÂÛË. ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ‰È·‰ÂÚÌÈ΋ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ì ÛÙÂÓÙ Û ÂÚÈÙÒÛÂȘ ·ÚÙËÚȷ΋˜ ÛÙ¤ÓˆÛ˘ Ô˘ ÂËÚ¿˙ÂÈ ÙËÓ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ·ÛÊ·Ï‹˜ ̤ıÔ‰Ô˜. ∏ ÈÛ¯˘Ú‹ ÎÏÈÓÈ΋ ˘Ô„›· Ú¤ÂÈ Ó· Ô‰ËÁ› ÙÔÓ ·ÛıÂÓ‹ Û ·ÁÁÂÈÔÁÚ·ÊÈ΋ ‰ÈÂÚ‡ÓËÛË Î·È Èı·Ó‹ ¿ÌÂÛË ·ÔηٿÛÙ·ÛË ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÂÍÂÙ¿ÛˆÓ.
51
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
37 ∏ ∞∫ƒπμ∂π∞ ΔOÀ ¶ƒO∂°Ã∂πƒ∏Δπ∫OÀ ∞º∞πƒ∂Δπ∫OÀ ™¶π¡£∏ƒO°ƒ∞º∏ª∞ΔO™ Δø¡ ¶∞ƒ∞£Àƒ∂O∂π¢ø¡ ∞¢∂¡ø¡ ∞À•∞¡∂Δ∞π OΔ∞¡ ™À¡¢À∞∑∂Δ∞π ª∂ ¶ƒO∂°Ã∂πƒ∏Δπ∫∂™ ∂ƒ°∞™Δ∏ƒπ∞∫∂™ Δπª∂™. ªπ∞ ∞¡∞¢ƒOªπ∫∏ ª∂§∂Δ∏ 453 ∞™£∂¡ø¡ ª∂ ¢∂ÀΔ∂ƒO¶∞£∏ À¶∂ƒ¶∞ƒ∞£Àƒ∂O∂π¢π™ªO μ. ¶··ÓÈÎÔÏ¿Ô˘, ¡. O˘˙Ô˘Ó›‰Ë˜, ¢. μÚÔ¯›‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, °. ÿÌ‚ÚÈÔ˜, ∞. ¶··ÁÈ¿ÓÓ˘, π. ºÔ‡˙·˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¡Ù›Ó·˜, °. ÕÚÛÔ˜, ¢. ∫·Ú‰¿Û˘, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢
™∫O¶O™
∂Ú¢ӋıËÎÂ Â¿Ó Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ MIBI Ì ÔÚÈṲ̂Ó˜ ÚÔÂÁ¯ÂÈÚËÙÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ·˘Í¿ÓÂÈ ÙËÓ ·ÎÚ›‚ÂÈ¿ ÙÔ˘. À§π∫O ∫∞π ª∂£O¢O™
ªÂÏÂÙ‹ıËÎ·Ó 453 ·ÛıÂÓ›˜ Ì ‰Â˘ÙÂÚÔ·ı‹ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·Ú·ı˘ÚÂÔÂȉÂÎÙÔÌ‹ ·fi ÙÔ 1986 ¤ˆ˜ ÙÔ 2005. OÈ ÂÈÎfiÓ˜ ÙÔ˘ ÛÈÓıËÚÔÁÚ·Ê‹Ì·ÙÔ˜ Û˘ÁÎÚ›ıËÎ·Ó Ì ٷ ÂÁ¯ÂÈÚËÙÈο Â˘Ú‹Ì·Ù·. ¢ËÌÈÔ˘ÚÁ‹ıËÎ·Ó 4 ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Û‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù·: ∞£ ÁÈ· ÙÔ ·ÏËı¤˜ ıÂÙÈÎfi, ∞∞ ÁÈ· ÙÔ ·ÏËı¤˜ ·ÚÓËÙÈÎfi, æ£ ÁÈ· ÙÔ „¢‰¤˜ ıÂÙÈÎfi Î·È æ∞ ÁÈ· ÙÔ „¢‰¤˜ ·ÚÓËÙÈÎfi. ∞¶OΔ∂§∂™ª∞Δ∞
∏ ¢·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙËÙ·, Ë ıÂÙÈ΋ Î·È Ë ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ÙÈÌ‹ ÙÔ˘ MIBI ‹Ù·Ó 66.4%, 50%, 76.3% Î·È 37.9% ·ÓÙ›ÛÙÔȯ·. ∏ ̤ÛË ËÏÈΛ·, Ë ·Ú·ıÔÚÌfiÓË (PTH), Ô ÊˆÛÊfiÚÔ˜ (P) Î·È Ë ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (alp) ‹Ù·Ó 55 ¤ÙË, 869 IU/ml, 9.6 mg/dl, 5.8 mg/dl and 189.5 IU/ml ·ÓÙ›ÛÙÔȯ·. °È· ÙËÓ ÔÌ¿‰· ∞£, Ë Ì¤ÛË ËÏÈΛ· Î·È Ë Ì¤ÛË ÙÈÌ‹ Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ‹Ù·Ó 56.55 Î·È 188.58 ·ÓÙ›ÛÙÔȯ·. ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ Â͛ۈÛË (p = .027) Ô˘ ‰Â›¯ÓÂÈ ÙËÓ ÚfiÁÓˆÛË (1) ‹ fi¯È (2) ÙÔ˘ ·ÏËıÒ˜ ıÂÙÈÎÔ‡ Â›Ó·È 1.040 + ËÏÈΛ·* (- .028) + ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË*0.002. °È· ÙËÓ ÔÌ¿‰· ∞∞, Ë Ì¤ÛË ËÏÈΛ· Î·È Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ʈÛÊfiÚÔ˘ Â›Ó·È 49.55 Î·È 5.24 ·ÓÙ›ÛÙÔȯ·. ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ Â͛ۈÛË (p = .027) Ô˘ ‰Â›¯ÓÂÈ ÙËÓ ÚfiÁÓˆÛË (1) ‹ fi¯È (2) ÙÔ˘ ·ÏËıÔ‡˜ ·ÚÓËÙÈÎÔ‡ Â›Ó·È -1.463 + ËÏÈΛ·*(- .029) + P*0.233. ™Àª¶∂ƒ∞™ª∞
∏ ¢·ÈÛıËÛ›· ÙÔ˘ MIBI ·˘Í¿ÓÂÙ·È fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·È fiÛÔ ¯·ÌËÏfiÙÂÚË Â›Ó·È Ë ÙÈÌ‹ Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘. ∏ ÂȉÈÎfiÙËÙ· ÙÔ˘ MIBI ·˘Í¿ÓÂÙ·È fiÛÔ ÓÂÒÙÂÚÔÈ Â›Ó·È ÔÈ ·ÛıÂÓ›˜ Î·È fiÛÔ ¯·ÌËÏfiÙÂÚË Â›Ó·È Ë ÙÈÌ‹ ÙÔ˘ ʈÛÊfiÚÔ˘.
52
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
38 ∏ ºÀ™π∫∏ π™ΔOƒπ∞ Δø¡ ∞°°∂π∞∫ø¡ ¶ƒO™¶∂§∞™∂ø¡ °π∞ ∞πªO¢π∞§À™∏. ∞¡∞¢ƒOªπ∫∏ ª∂§∂Δ∏ 2422 ∞™£∂¡ø¡ ∂¡O™ ∫∂¡ΔƒOÀ μ. ¶··ÓÈÎÔÏ¿Ô˘, ∞. ¶··ÁÈ¿ÓÓ˘, ¢. μÚÔ¯›‰Ë˜, ¢. °¿Î˘, °. ÿÌ‚ÚÈÔ˜, π. ºÔ‡˙·˜, ¡. ∞ÓÙˆÓÈ¿‰Ë˜, ∞. ¡Ù›Ó·˜, ¢. ∫·Ú‰¿Û˘, ∫. ¢ÈÏ¿Ú˘, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢
™∫O¶O™
O ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ÛÙÔȯ›ˆÓ ‚·ÙfiÙËÙ·˜, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏÔÎÒÓ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÚÔÛÂÏ¿ÛˆÓ ÁÈ· ·ÈÌÔ‰È¿Ï˘ÛË. ∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
ªÂÏÂÙ‹ıËÎ·Ó 2422 ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û 3685 ÂÂÌ‚¿ÛÂȘ ·ÁÁÂȷ΋˜ ÚÔۤϷÛ˘ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó·Ó ÙËÓ ÎÂÚÎȉÔÎÂÊ·ÏÈ΋ ·ÚÙËÚÈÔÊÏ‚È΋ ÂÈÎÔÈÓˆÓ›· (∫∫∞º∂), ÙË ‚Ú·¯ÈÔÎÂÊ·ÏÈ΋ ·ÚÙËÚÈÔÊÏ‚È΋ ÂÈÎÔÈÓˆÓ›· (μ∫∞º∂), ÙÔ ÔÏ˘-ÙÂÙÚ·-ÊıÔÚÈÔ-·Èı˘Ï¤ÓÈÔ ÌfiÛ¯Â˘Ì· (¶Δº∂), ÙË ‚Ú·¯ÈÔ‚·ÛÈÏÈ΋ ·ÚÙËÚÈÔÊÏ‚È΋ ÂÈÎÔÈÓˆÓ›· (μμ∞º∂) Î·È ÙÔ ÌfiÓÈÌÔ ÎÂÓÙÚÈÎfi ÊÏ‚ÈÎfi ηıÂÙ‹Ú· (ª∫º∫). ∏ ̤ÁÈÛÙË ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 20 ¯ÚfiÓÈ·. ªÂÏÂÙ‹ıËÎ·Ó Ù· ÔÛÔÛÙ¿ ‚·ÙfiÙËÙ·˜ ÛÙȘ ÚÒÈ̘ Î·È ·ÒÙÂÚ˜ ·ÓÂÂÌ‚¿ÛÂȘ, ÔÈ ÂÈÏÔΤ˜ Î·È ÙÔ ÎfiÛÙÔ˜. ∞¶OΔ∂§∂™ª∞Δ∞
∏ ̤ÛË ÚˆÙÂ‡Ô˘Û· ‚·ÙfiÙËÙ· ÙˆÓ ÈÔ Û˘¯ÓÒÓ ÚÒÙˆÓ ÂÈÏÔÁÒÓ ·ÁÁÂȷ΋˜ ÚÔۤϷÛ˘ ‹Ù·Ó 712 (∞.™. 95%: 606, 818), 1009 (∞.™. 95%: 823, 1195) Î·È 384 (∞.™. 95%: 273, 945) Ë̤Ú˜ ÁÈ· ÙËÓ ∫∫∞º∂, ÙË μ∫∞º∂ Î·È ÙÔ ¶Δº∂ ·ÓÙ›ÛÙÔȯ·. ∏ ̤ÛË ÚˆÙÂ‡Ô˘Û· ‚·ÙfiÙËÙ· ‹Ù·Ó 490 (∞.™. 95%: 301, 679) Ë̤Ú˜ ÁÈ· ÙÔÓ ª∫º∫. ∏ ̤ÛË ‰Â˘ÙÂÚÂ‡Ô˘Û· ‚·ÙfiÙËÙ· ‹Ù·Ó 1809 (∞.™. 95%: 1692, 1926) Ë̤Ú˜ ÁÈ· ÙËÓ ∫∫∞º∂. ∏ ·ıÚÔÈÛÙÈ΋ Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ∫∫∞º∂, μ∫∞º∂, μμ∞º∂ Î·È ¶Δº∂ ‹Ù·Ó 0.25, 0.57, 0.33 Î·È 0.61 ÁÈ· οı ·ÛıÂÓ‹/¯ÚfiÓÔ ·ÓÙ›ÛÙÔȯ·. ™Àª¶∂ƒ∞™ª∞
¶ÚÔÙ›ÓÔ˘Ì ÙËÓ Ì¤ÁÈÛÙÔÔ›ËÛË Ù˘ ¯Ú‹Û˘ ÙˆÓ ·˘ÙfiÏÔÁˆÓ Ô‰ÒÓ ÊÏ‚È΋˜ ·ÔÚÚÔ‹˜, ÍÂÎÈÓÒÓÙ·˜ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ηÚÔ‡. ∂Í·ÈÚÂ›Ù·È Ë ÂÚ›ÙˆÛË ÙÔ˘ ËÏÈÎȈ̤ÓÔ˘ ‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓÔ‡˜, fiÔ˘ ÚÒÙË ÂÈÏÔÁ‹ Ú¤ÂÈ Ó· Â›Ó·È Ë ÚÔۤϷÛË ÛÙÔ ‡„Ô˜ Ù˘ ηْ ·ÁÎÒÓ· ¿ÚıÚˆÛ˘. ∏ μμ∞º∂ Â›Ó·È ÌÈ· ÂÍ·›ÚÂÙË ·ÚÙËÚÈÔÊÏ‚È΋ ÂÈÎÔÈÓˆÓ›· Î·È ›Ûˆ˜ Ú¤ÂÈ Ó· ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÚÔÛıÂÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ
53
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
39 INTRAVASCULAR VOLUME DEPLETION - “A TRIAD OF SIGNS TO REMEMBER”. AN IMPORTANT ASPECT IN THE POST-OPERATIVE MANAGEMENT OF A SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANT RECIPIENT V. Hadjianastassiou, P. Moustafellos, A. Vaidya, P. Friend Oxford Transplant Unit, Oxford Radcliffe NHS Trust
PURPOSE
In simultaneous Pancreas-Kidney (SPK) transplant, venous thrombosis of the pancreatic graft is the most common non immunological complication.still prevalent with intravascular volume depletion contributing to this. Early identification in the post-operative period of clinical and laboratory signs indicative of volume depletion may prompt intervention to reverse this. We aimed to identify whether intravascular volume depletion was more prevalent in patients who sustained pancreatic graft venous thrombosis. METHODS
From March 2002 to February 2006, 22 SPK transplants were undertaken in a single centre. Clinical records from the immediate post-operative period to hospital discharge were reviewed. The following unfavourable “triad” of clinical signs and laboratory values indicative of intravascular volume depletion were analysed: significant weight loss; presence of orthostatic hypotension; and an increasing serum Urea-to-Creatinine ratio. Fludrocortisone administration for orthostatic hypotension and anticoagulation treatment were also noted for each patient. RESULTS
All kidneys except for one demonstrated immediate graft function. All pancreas grafts had primary function. 7 patients had at least two abnormal signs of the triad, of which 2 were treated with fludrocortisone and 1 anticoagulated with iv heparin. The 4 patients who did not receive any treatment, experienced venous thrombosis leading to pancreatic graft excision. Patients with none or one isolated unfavourable sign from the triad did not experience any venous thrombosis of the pancreatic graft, irrespective of concurrent fludrocortisone or anticoagulation treatment. CONCLUSION
Intravascular volume depletion may be an important determinant of post-operative pancreatic venous graft thrombosis in SPK recipients. The triad of significant weight loss, postural hypotension and a rising serum Urea-to-Creatinine ratio may be a harbinger of venous thrombosis if left untreated.
54
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
40 ∏ ™ÀªμO§∏ Δ∏™ ∞§À™π¢øΔ∏™ ∞¡Δπ¢ƒ∞™∏™ ¶O§Àª∂ƒ∞™∏™ ™∂ ¶ƒ∞°ª∞Δπ∫O ÃO¡O (REAL-TIME PCR) °π∞ Δ∏¡ Δ∞Ã∂π∞ ∞¡πá∂À™∏ CMV §Oπªø•∏™ ™∂ ª∂Δ∞ªO™ÃEYª∂¡OÀ™ ∞™£∂¡∂π™ ª. ¶·¤, ∫. ª·Ó‰Ú·‚¤ÏË, ¢. ¶··‰ÔÔ‡ÏÔ˘, ∂. ∫·˙¿ÎÔ˜, ™. ∞ÏÂ͛Ԣ-¢·ÓÈ‹Ï ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¶°¡£ ∞Ã∂¶∞
∏ CMV Ïԛ̈ÍË ıˆÚÂ›Ù·È ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÛÙÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜. ∏ Ù·¯Â›· Î·È ·ÍÈfiÈÛÙË ‰È¿ÁÓˆÛ‹ Ù˘ Û˘Ì‚¿ÏÂÈ ÛÙËÓ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘. ªÂ ÙËÓ PCR Ú·ÁÌ·ÙÈÎÔ‡ ¯ÚfiÓÔ˘ (Real-time PCR) ÂÈÙ˘Á¯¿ÓÂÙ·È Ë ¿ÌÂÛË-Ù·¯Â›· ·Ó›¯Ó¢ÛË Î·È Ô ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡. ™∫O¶O™
∏ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Real-time PCR ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË CMV Ïԛ̈͢ Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ÌÂ Û˘Ì·Á‹ fiÚÁ·Ó· ·ÛıÂÓ›˜. ∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
∫·Ù¿ ÙË ÙÚÈÂÙ›· 2005-2007 ‰ÈÂÚ¢ӋıËÎ·Ó 98 ‰Â›ÁÌ·Ù· Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Û 90 ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ˘fiÓÔÈ· CMV Ïԛ̈͢. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ë Real-time PCR Ì ÂÎÎÈÓËÙ¤˜ ÁÈ· ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi 105 bp ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ (RealArt CMV LC, QIAGEN), Ë ELISA (Bouty) ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÂȉÈÎÒÓ IgG/IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÔÈ ÂȂ‚·ÈˆÙÈΤ˜ IFA (Focus), Capture-ELISA (CE-Bouty), Western-blot (Wb-Immunogenetics) ÁÈ· ÂȂ‚·›ˆÛË ÙˆÓ (+) IgM. ¶·Ú¿ÏÏËÏ· Ë Real-time PCR ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ EBV Û 67 ‰Â›ÁÌ·Ù· Î·È ÙˆÓ HSV/ VZV Û 38 ‰Â›ÁÌ·Ù·. ∞¶OΔ∂§∂™ª∞Δ∞
™Â 20/90 ·ÛıÂÓ›˜ (22%) ·ÓȯÓ‡ÙËΠÁÂÓÂÙÈÎfi ˘ÏÈÎfi ·fi CMV, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÛÙÔ˘˜ 7(8%) ·ÓȯÓ‡ÙËÎÂ Û˘Á¯ÚfiÓˆ˜ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ·fi EBV. °ÂÓÂÙÈÎfi ˘ÏÈÎfi ÌfiÓÔ ·fi EBV ·ÓȯÓ‡ÙËΠ۠14/90 ·ÛıÂÓ›˜ (16%). ™Â ηӤӷ ‰ÂÓ ·ÓȯÓ‡ÙËΠÁÂÓÂÙÈÎfi ˘ÏÈÎfi ·fi HSV/VZV. ™Â fiÏÔ˘˜ ÙÔ˘˜ PCR (+) Î·È PCR (-) ÁÈ· CMV ·ÛıÂÓ›˜ ·ÓȯÓ‡ÙËÎ·Ó IgG ·ÓÙÈÛÒÌ·Ù· Û ÔÛÔÛÙfi 90%. ™ÙÔ˘˜ PCR (+) ·ÛıÂÓ›˜ ·ÓȯÓ‡ÙËÎ·Ó IgM ·ÓÙÈÛÒÌ·Ù· Û ÔÛÔÛÙfi 85% ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ÂȂ‚·ÈˆÙÈΤ˜ ̤ıÔ‰ÔÈ ¤‰ˆÛ·Ó Ù· ÂÍ‹˜ ·ÔÙÂϤÛÌ·Ù·: IFA (+) 71%, CE (+) 84%, Wb (+) 88%. ™ÙÔ˘˜ PCR (-) ·ÛıÂÓ›˜ ·ÓȯÓ‡ÙËÎ·Ó IgM Û ÔÛÔÛÙfi 18%, ÁÈ· Ù· ÔÔ›· ÔÈ ÂȂ‚·ÈˆÙÈΤ˜ ̤ıÔ‰ÔÈ ‹Ù·Ó ·ÚÓËÙÈΤ˜ Û ÔÛÔÛÙfi 76%, ÂÓÒ ÁÈ· Ù· ˘fiÏÔÈ· (+) IgM ‰ÂÓ ˘‹ÚÍ ۇÌÙˆÛË ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ÙȘ ÔÚÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜. ™Àª¶∂ƒ∞™ª∞
∏ Real-time PCR ÏÂÔÓÂÎÙ› Û ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÙˆÓ ÔÚÔÏÔÁÈÎÒÓ ÌÂıfi‰ˆÓ ÛÙËÓ ‰È¿ÁÓˆÛË Ù˘ ÚfiÛÊ·Ù˘ CMV Ïԛ̈͢ Î·È Ù˘ Û˘ÏÏԛ̈͢.
55
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
41 ¶ƒOª∂Δ∞ªO™Ã∂ÀΔπ∫O™ ∂§∂°ÃO™ ¡∂ºƒπ∫ø¡ ªO™Ã∂Àª∞Δø¡ ª∂ ¶O§ÀΔOªπ∫∏ ∞•O¡π∫∏ ΔOªO°ƒ∞ºπ∞ (MDCT) ∞. ¶ÂÙÚȉ˘1, ∞. ¶··¯ÚÈÛÙÔ‰Ô‡ÏÔ˘1, Δ. °ÂÚԇ΢1, ∫. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘1, Ã. ÷Ù˙ËÁˆÚÁ›Ô˘1, μ. ¶··ÓÈÎÔÏ¿Ô˘2, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜2, ¶. ¶·ÏÏ¿‰·˜1 1∞ÎÙÈÓÔÏÔÁÈÎfi
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ªÂÏÂÙ‹ıËÎ·Ó Ì MDCT 223 ˘Ô„‹ÊÈÔÈ ‰fiÙ˜ ÓÂÊÚÔ‡ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ Ù· ‰‡Ô ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ÃÚËÛÈÌÔÔÈ‹ıËΠ·ÍÔÓÈÎfi˜ ÙÔÌÔÁÚ¿ÊÔ˜ 4 ÛÂÈÚÒÓ. ∞Ú¯Èο ¤ÁÈÓ ̛· ÂͤٷÛË ¯ˆÚ›˜ ¯ÔÚ‹ÁËÛË ÛÎÈ·ÛÙÈÎÔ‡ Î·È ·ÎÔÏÔ‡ıËÛ·Ó Ï‹„ÂȘ ÙÔÌÒÓ Û ÚÒÈÌË ·ÚÙËÚȷ΋ Ê¿ÛË, Û ÊÏ‚È΋ ηıÒ˜ Î·È Û ʿÛË ÂÍÈÛÔÚÚfiËÛ˘. ∏ ¤Ó·ÚÍË Ù˘ Û¿ÚˆÛ˘ ηıÔÚ›ÛÙËΠ̠ÙË Ì¤ıÔ‰Ô bolus triggering («ÛηӉ·ÏÈÛÌÔ‡»). ∞ÎÔÏÔ‡ıËÛ ·Ó·Û‡ÓıÂÛË ÙˆÓ ÂÁοÚÛÈˆÓ ÙÔÌÒÓ Ì ÙȘ Ù¯ÓÈΤ˜ MIP, MPR, VRT, Vessel View Î·È CPR. ∞¶OΔ∂§∂™ª∞Δ∞
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∏ MDCT ·ÔÙÂÏ› ÚÒÙË Ì¤ıÔ‰Ô ÚÔÛ¤ÁÁÈÛ˘ ÁÈ· ÙËÓ ÚÔÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÂÊfiÛÔÓ ‰‡Ó·Ù·È Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙÔÓ ·ÚÈıÌfi, ÙÔ Û¯‹Ì·, ÙËÓ ÔÚ›·, ÙËÓ ÌÔÚÊÔÏÔÁ›· Î·È ÙËÓ ·ıÔÏÔÁ›· ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÁÁ›ˆÓ (·ÚÙËÚÈÒÓ Î·È ÊÏ‚ÒÓ). ∂ÈÚfiÛıÂÙ· ·ÔÙÂÏ› Ì›· Ù·¯Â›·, ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô Ë ÔÔ›· ÂÈÙÚ¤ÂÈ Î·È ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÙÔÔÁÚ·Ê›·˜, Ù˘ ÌÔÚÊÔÏÔÁ›·˜, Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ Î·È Ù˘ ·ÂÎÎÚÈÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Û ¤Ó· ¯ÚfiÓÔ Î·È Ì ÂÓ‰ÔÊϤ‚È· ÌfiÓÔ ¤Á¯˘ÛË ÛÎÈ·ÛÙÈÎÔ‡ ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·Ú¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ·ÂÈÎfiÓÈÛ˘ Î·È ÌÂϤÙ˘ fiÏˆÓ ÙˆÓ ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ‰ÔÌÒÓ.
56
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
42 INCREASING ORGAN USE: LARGE, SINGLE CENTER EXPERIENCE WITH EXTENDED CRITERIA DONORS FOR LIVER TRANSPLANTATION G. Tsoulfas, R. Kashyap, M. Orloff, P. Abt, A. Jain, D. Takoudas, A. Bozorgzadeh University Rochester Medical Center, New York, USA
BACKGROUND
The severe disparity between recipient demand and donor supply in liver transplantation, has led several centers to the use of hepatic grafts from “extended criteria” donors (ECD) or “marginal donors”. These are organs that were turned down in the geographic regions where they were procured, and are now exported to regions of greater donor paucity to be allocated at the discretion of the accepting center. OBJECTIVE
Compare the outcomes of ECD and “standard criteria” donor (SCD) allocation, to determine the utility of ECD as a viable answer to organ shortage. METHODS
A single center, retrospective analysis was performed of 363 deceased-donor liver transplants at a major academic center between January 2003 and March 2006.This included 165 SCD (45.5%) and 198 imported organs/ECD (54.5%), which were the two groups compared. Recipient and donor characteristics were analyzed (see table, *p=0.01), as well as patient survival (see figure). RESULTS
There was no difference in the recipient age, cold ischemic time (CIT) or number of pressors used in the donor. However, there were statistically significant differences in the donor age, a finding that went along with the higher Donor Risk Index in the ECD vs. the SCD group. Overall 1-year patient survival between the two groups was not statistically significant. However, the prevalence of hepatocellular carcinoma (HCC) (and especially outside Milan criteria) was significantly higher in the ECD group and when patients with HCC were excluded (69 pts), there was a statistically significant benefit in 1-year survival for the ECD group (87% vs. 79%).
SCD (n=165)
Recipient Age Donor Age MELD score DRI CIT (hrs) #Pressors
ECD (n=198)
Mean
Median
Mean
Median
52.5 46.9 32.3 1.6 8.9 1.7
52.8 49.0* 34.0* 1.6 8.7 2.0
54.9 52.6 18.9 2.1 10.9 2.1
54.9 54.0 19.0 2.1* 10.8 2.0
10.8%
N=52
Frequency HCC pts
N=17
Frequency 29.2%*
57
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
DDLT, N= 224, 1st TX, HCC Exclyded Log Rank= 0.03
1.0
87%
MELD 20
0.8 Cum survival
79%
0.6
Import MELD 34
Standard
0.4
0.2
0.0 0.00
1.00 2.00 3.00 Patient survival years
4.00
CONCLUSION
These very promising results regarding the use of ECD livers represent one of the largest single center experiences in the topic to date. Although their use should be tempered with careful selection of the recipient, they undeniably represent a viable option for expanding the donor pool.
58
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
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59
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
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∏ ÌÂϤÙË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ¿ÌÂÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·ÈÌÔÚÚ·Á›·˜,ÙˆÓ ÂÈÏÔÎÒÓ Î·È Ù˘ ¤Î‚·Û˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ··ÈÙ‹ıËΠ·ÓÂÁ¯Â›ÚËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘. Y§π∫O ∫∞π ª∂£O¢O™
∞Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 16 ÂÙÒÓ (1990-2007). ÀÔ‚Ï‹ıËÎ·Ó Û ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ 217 ·ÛıÂÓ›˜. ΔÚÈ¿ÓÙ· ‰‡Ô ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ¿ÌÂÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·ÈÌÔÚÚ·Á›·. ∞fi ·˘ÙÔ‡˜ 11 ·ÛıÂÓ›˜ (5,06% ÙÔ˘ Û˘ÓfiÏÔ˘ O.ª.∏) ··›ÙËÛ·Ó Â·ÓÂÁ¯Â›ÚËÛË ÙÔ ÚÒÙÔ 24ÒÚÔ ÁÈ· ‰ÈÂÚ‡ÓËÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·ÈÌÔÚÚ·Á›·˜. ∂ÍÂÙ¿Û·Ì ٷ ·›ÙÈ· ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛˆÓ, ÙËÓ ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Î·È ·Ú·ÁÒÁˆÓ ηıÒ˜ Î·È ÙȘ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ¤ÎÚÈÓ·Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· ·ÓÂÁ¯Â›ÚËÛË. ∞¶OΔ∂§∂™ª∞Δ∞
ŒÓÙÂη ·ÛıÂÓ›˜ ··›ÙËÛ·Ó Â·ÓÂÁ¯Â›ÚËÛË ÙÔ ÚÒÙÔ 24ÒÚÔ. ∂Ù¿ ¿Ó‰Ú˜ Ì.Ô ËÏÈΛ·˜ 49,1 ¤ÙË (28-61) Î·È 4 Á˘Ó·›Î˜ Ì.Ô ËÏÈΛ·˜ 40,5 ¤ÙË (29-53). ∫‡ÚÈ· ·›ÙÈ· ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛÂˆÓ ‹Ù·Ó: ΛÚÚˆÛË ·fi HCV 4, HBV 3, HCV + HBV 1, ·ÏÎÔÔÏÈ΋ 1, ·˘ÙÔ¿ÓÔÛÔ˜ 1, ‰Â˘ÙÂÚÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË 1. ¢ÈÂÁ¯ÂÈÚËÙÈ΋ ÌÂÙ¿ÁÁÈÛË Ô˘ ··ÈÙ‹ıËΠ(ηٿ ̤ÛÔ fiÚÔ): ÌÔÓ¿‰Â˜ ·›Ì·ÙÔ˜ 15,3, FFP 19,6, PLT 11,3, ÎÚ˘ÔηıÈ˙‹Ì·Ù· 5,8. ∞ÈÌÔ‰˘Ó·ÌÈ΋ ·ÛÙ¿ıÂÈ· ·ÚÔ˘Û›·Û·Ó fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÁÁÂÈÔÛ˘Û·ÛÙÈο/ÈÓfiÙÚÔ· Ê¿Ú̷η. ∫·Ù¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘˜ ÛÙËÓ ª.∂.£ ·ÈÌÔ‰˘Ó·Ì΋ ·ÛÙ¿ıÂÈ· ›¯·Ó 9 ·ÛıÂÓ›˜ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÁÁÂÈÔÛ˘Û·ÛÙÈο/ÈÓfiÙÚÔ· Ê¿Ú̷η ηıÒ˜ Î·È ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜ Î·È ·Ú·ÁÒÁˆÓ. O Ú˘ıÌfi˜ ·ÒÏÂÈ·˜ ·›Ì·ÙÔ˜ ·fi ÙȘ ÎÔÈÏȷΤ˜ ·ÚÔ¯ÂÙ‡ÛÂȘ ηٿ ̤ÛÔ fiÚÔ ‹Ù·Ó >200 ml/ÒÚ·, Ì ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÚÔ¯¤Ù¢Û˘ >3 gr/dl ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÒÚ˜. ™ÙËÓ ª.∂.£ ηٿ ̤ÛÔ fiÚÔ ··ÈÙ‹ıËΠÌÂÙ¿ÁÁÈÛË Î·Ù¿ ÙÔ ÚÒÙÔ 24ÒÚÔ: ÌÔÓ¿‰Â˜ ·›Ì·ÙÔ˜ 8,4, FFP 11,1, PLT 7,6, ÎÚ˘ÔηıÈ˙‹Ì·Ù· 4,5. ªÂÙÂÁ¯ÂÈÚËÙÈÎÔ› ‰Â›ÎÙ˜ ÙÔ˘ ËÎÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ‹Ù·Ó (ηٿ ̤ÛÔ fiÚÔ): INR 1,7, PT 19,8 sec, PTT 68,2 sec, πÓˆ‰ÔÁ. 209 mg/dl. ŒÓ·˜ ·ÛıÂÓ‹˜ ¯ÚÂÈ¿ÛÙËÎÂ Î·È 2Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÈÌÔÚÚ·Á›·˜. ∏̤Ú˜ ÓÔÛËÏ›·˜: Ì.Ô 6 Ë̤Ú˜ (2-15). ŒÎ‚·ÛË: ·Â‚›ˆÛ·Ó 6 ·ÛıÂÓ›˜. (ıÓËÙfiÙËÙ· 54,5%). ™Àª¶∂ƒ∞™ª∞TA
∏ ÚÒÈÌË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·ÈÌÔÚÚ·Á›· ÌÂÙ¿ ·fi O.ª.∏ Ô˘ ı· ··ÈÙ‹ÛÂÈ Â·ÓÂÁ¯Â›ÚËÛË ÙÔ ÚÒÙÔ 24ÒÚÔ, Û˘Óԉ‡ÂÙ·È ·fi ˘„ËÏ‹ ıÓËÙfiÙËÙ·. ∏ ·‡ÍËÛË Ù˘ ‰ÈÂÁ¯ÂÈÚËÙÈ΋˜ ÌÂÙ¿ÁÁÈÛ˘ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ ÙËÓ ·Ó¿ÁÎË Â·Ó¤̂·Û˘. ∏ Û˘Ó¯‹˜ ‚ÂÏÙ›ˆÛË ÙˆÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Ù¯ÓÈÎÒÓ ı· ÂϤÁÍÂÈ Î·Ï‡ÙÂÚ· ÙȘ ‰ÈÂÁ¯ÂÈÚËÙÈΤ˜ ·ÒÏÂȘ ·›Ì·ÙÔ˜ Î·È ı· ·˘Í‹ÛÂÈ ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ O.ª.∏.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
45 ™À°∫ƒπ™∏ Δƒπø¡ ™À™Δ∏ª∞Δø¡ ∞•πO§O°∏™∏™ μ∞ƒÀΔ∏Δ∞™ ∞™£∂¡ø¡ ª∂ Oƒ£OΔO¶π∫∏ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘1, Ã. ΔÛÈfiÙÚ·˜1, ¢. ∞˘ÁÔ˘ÛÙ‹1, ¡. ™Ô˘Óȉ¿Î˘1, ∂. ¶··˙·ÊÂÈÚ›Ô˘1, μ. ¶··ÓÈÎÔÏ¿Ô˘2, ¢. Δ·ÎÔ‡‰·˜2, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË1 1M.E.£., 2ÃÂÈÚÔ˘ÚÁÈ΋
∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ πÔÎÚ·Ù›Ԣ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢
À¿Ú¯Ô˘Ó ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ·ÍÈÔÏfiÁËÛ˘ Ù˘ ‚·Ú‡ÙËÙ·˜ Î·È Ù˘ ¤Î‚·Û˘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙËÓ ª.∂.£. ∞˘Ù¿ ·Ó Î·È ·ÊÔÚÔ‡Ó ÂÙÂÚÔÁÂÓ›˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ, ¤¯Ô˘Ó ·Ô‰Âȯı› ·ÍÈfiÈÛÙ· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Î·È Ù˘ ¤Î‚·Û˘ ÛÙËÓ ª.∂.£. ™∫O¶O™
∏ ÌÂϤÙË 3 Û˘ÛÙËÌ¿ÙˆÓ ·ÍÈÔÏfiÁËÛ˘ ‚·Ú‡ÙËÙ·˜ – ¤Î‚·Û˘ Ô˘ ÂÊ·ÚÌfiÛÙËÎ·Ó Û ·ÛıÂÓ›˜ Ì ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Y§π∫O ∫∞π ª∂£O¢O™
ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο 78 ‰È·‰Ô¯ÈΤ˜ ÌÂÙ·ÌÔۯ‡ÛÂȘ ‹·ÙÔ˜. ∞fi ·˘ÙÔ‡˜ ·ÔÎÏ›ÛÙËÎ·Ó 4 ·ÛıÂÓ›˜ Ô˘ η٤ÏËÍ·Ó Ï›Á˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ª.∂.£. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ËÏÈΛ·˜ Ì.Ô 48,7 ¤ÙË (18 – 64 ÂÙÒÓ), 53 ¿Ó‰Ú˜ Î·È 25 Á˘Ó·›Î˜ ÌÂÏÂÙ‹ıËÎÂ Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ : APACHE II score, SAPS II score Î·È ÙÔ ·Ú¯ÈÎfi SOFA score, ηıÒ˜ Î·È Ë ÂÈ‚›ˆÛË ÛÙËÓ ª.∂.£ Î·È Ë ÙÚ›ÌËÓË ÂÈ‚›ˆÛË. ∞¶OΔ∂§∂™ª∞Δ∞
ΔÔ APACHE II score ˘ÔÏÔÁ›ÛÙËΠÌ.Ô 16,47 Ì ÚÔ‚ÏÂfiÌÂÓË ıÓËÙfiÙËÙ· Ó· ·Ó¤Ú¯ÂÙ·È Û 25,64%. ΔÔ SAPS II score ‚Ú¤ıËΠÌ.Ô 36,88 Ì ÚÔ‚ÏÂfiÌÂÓË ıÓËÙfiÙËÙ· ÛÙÔ 38,75%. ∂ÓÒ ÙÔ ·Ú¯ÈÎfi SOFA score Û 11,27 ± 1,41. ∏ ıÓËÙfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ì ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ÛÙËÓ ª.∂.£ ·Ó‹Ïı Û 23,91% ÂÓÒ Ë ıÓËÙfiÙËÙ· ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Û 32,6%. ™Àª¶∂ƒ∞™ª∞TA
ΔÔ APACHE II score, ÙÔ Â˘Ú‡ÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ Û‡ÛÙËÌ· ·ÍÈÔÏfiÁËÛ˘ Û ۯ¤ÛË Ì ٷ ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù·-Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Î·Ï¿ Ì ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È ı· ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› Î·È Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ fiÛÔ ·ÊÔÚ¿ ÛÙËÓ ¤Î‚·ÛË ÛÙËÓ ª.∂.£.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
46 ∂¶π∫Δ∏Δ∏ ΔƒOºπ∫∏ ∞§§∂ƒ°π∞ ™∂ ¶∞π¢π∞ ª∂Δ∞ ∞¶O ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ∞. ª·˘ÚÔ˘‰‹2, ¡. ∫·Ú·ÓÙ·ÁÏ‹˜2, π. •˘ÓÈ¿˜2, ∞. ¢ÂÏËÁÈ·ÓÓ›‰Ë˜3, ∂. ¶·Ú··Ó‹ÛÈÔ˘3, O. O˘Ú·‹ÏÔÁÏÔ˘2, °. ÿÌ‚ÚÈÔ˜1 1ÃÂÈÚÔ˘ÚÁÈ΋
ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£, ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£, 3∞ÓÔÛÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ 2°ã
∏ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· Â›Ó·È Û˘¯Ófi ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ΔËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂȘ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ Û ·È‰È¿ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. ∂›Û˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ·Ó·Ê˘Ï·ÎÙÈÎÔ‡ ÛÔÎ Û ÎÔÈÓ¿ ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ· ÌÂÙ¿ ·fi ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. ™∫O¶O™
™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ô ·ÏÏÂÚÁÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È Ë ·Ó·˙‹ÙËÛË Èı·Ó‹˜ ·Ó¿Ù˘Í˘ IgE ÌÂÛÔÏ·‚Ô‡ÌÂÓ˘ ·ÏÏÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
∂ϤÁ¯ıËÎ·Ó ÔÎÙÒ (8) ·È‰È¿ Ì ̤ÛË ËÏÈΛ· 8,25 ¤ÙË Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙË °ã ¶·È‰È·ÙÚÈ΋ ∞¶£ ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞.¶.£. ∫·Ù¿ ÙÔÓ Ù·ÎÙÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ, ¤ÁÈÓÂ Ô ÂÍ‹˜ ·ÏÏÂÚÁÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: 1. Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ ÁÈ· ·Ó·˙‹ÙËÛË ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ·ÏÏÂÚÁ›·˜ 2. ÎÏÈÓÈ΋ ÂͤٷÛË 3. ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂÚÈÊÂÚÈ΋ ˈÛÈÓÔÊÈÏ›·, ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÔÏÈ΋˜ IgE, ¤ÏÂÁ¯Ô˜ Ì ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Û ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓÓ· Î·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂȉÈÎÒÓ IgE ·ÓÙÈÛˆÌ¿ÙˆÓ Û ÎÔÈÓ¿ ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ·. ∞¶OΔ∂§∂™ª∞Δ∞
ΔÚÔÊÈ΋ ·ÏÏÂÚÁ›· ‰È·ÈÛÙÒıËΠ۠2 ·ÛıÂÓ›˜. ·) Û ÎÔÚ›ÙÛÈ 7 ÂÙÒÓ, Ô˘ ÎÏÈÓÈο ÂÌÊ¿ÓÈ˙ ¤Î˙ÂÌ·, Ì ıÂÙÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Î·È ıÂÙÈο ÂȉÈο IgE ·ÓÙÈÛÒÌ·Ù· Û Á¿Ï· Î·È ¯ÔÈÚÈÓfi, ÌÂ Û˘ÌÙÒÌ·Ù· ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ÂÚ›Ô˘ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È ‚) Û ·ÁfiÚÈ 16 ÂÙÒÓ,ÔÈ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ‹Ù·Ó ·ÛıÂÓÒ˜ ıÂÙÈΤ˜ ÛÙÔ ÔÏÈÎfi Á¿Ï·, ·ÚÔ˘Û›·Û ıÂÙÈο ÂȉÈο IgE ·ÓÙÈÛÒÌ·Ù· ÛÙËÓ ·-Ï·ÎÙ·Ï‚Ô˘Ì›ÓË Î·È ‚-Ï·ÎÙÔÛÊ·ÈÚ›ÓË, ÂÓÒ ÂÌÊ¿ÓÈ˙ ‹È· Û˘ÌÙÒÌ·Ù· ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜. ∏ ÔÏÈ΋ IgE ‹Ù·Ó ·˘ÍË̤ÓË Î·È ÛÙÔ˘˜ 2 ·ÛıÂÓ›˜, ÂÓÒ Ù· ˈÛÈÓfiÊÈÏ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ™Àª¶∂ƒ∞™ª∞TA
∏ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ·ÔÙÂÏ› Û¯ÂÙÈο Û˘¯Ó‹ ÂÈÏÔ΋. OÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË, Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÏÏÂÚÁÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ·Ó·˙‹ÙËÛË Èı·Ó‹˜ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ Ì ÛÙfi¯Ô ÙËÓ ÂÍ¿ÏÂÈ„Ë ÙˆÓ ‰˘ÛÌÂÓÒÓ ÂÈÙÒÛÂÒÓ Ù˘.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
47 ∏ ∂•∂§π•∏ Δø¡ ∞™£∂¡ø¡ ª∂ HCV ∫πƒƒø™∏ ¶OÀ À¶Oμ§∏£∏∫∞¡ ™∂ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ °. ÿÌ‚ÚÈÔ˜, μ. ¶··ÓÈÎÔÏ¿Ô˘, ¶. ∞ÁÔÚ·ÛÙÔ‡, ∂. ∞ÎÚÈ‚È¿‰Ë˜, π. ºÔ‡˙·˜, £. μ·ÛÈÏÂÈ¿‰Ë˜, ¢. °È·ÎÔ˘ÛÙ›‰Ë˜, π. °Ô˘Ï‹˜, ∫. ¶·ÙÛÈ·Ô‡Ú·, ¡.∞. ∞ÓÙˆÓÈ¿‰Ë˜, O. °ÈÔ˘ÏÂ̤, ∂. ∞Ó·ÁÓˆÛÙ¿Ú·, ¢. Δ·ÎÔ‡‰·˜ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£, «πÔÎÚ¿ÙÂÈÔ» ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢
™∫O¶O™
∏ ·ÍÈÔÏfiÁËÛË Ù˘ ÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋˜ ÔÚ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Ì HCV ΛÚÚˆÛË Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (ª∏) ηıÒ˜ Î·È ÙˆÓ ·ÛıÂÓÒÓ Ì HCV Ïԛ̈ÍË Ô˘ Û˘Ó˘‹Ú¯Â Î·È Ì ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ΛÚÚˆÛË. ∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
™Â Û‡ÓÔÏÔ 246 ª∏ Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎ·Ó ·fi ÙÔÓ 5/1990 ¤ˆ˜ ÙÔÓ 10/2007, 19 ·ÛıÂÓ›˜ (7,72%) ˘Ô‚Ï‹ıËÎ·Ó Û ª∏ ÏfiÁˆ ΛÚÚˆÛ˘ HCV ·ÈÙÈÔÏÔÁ›·˜ Î·È 11 (4,47%) ÏfiÁˆ ΛÚÚˆÛ˘ ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Û˘Ó˘‹Ú¯Â HCV Ïԛ̈ÍË. ™ÙËÓ ÔÌ¿‰· ∞ (13 ¿Ó‰Ú˜/6 Á˘Ó·›Î˜, ̤ÛË ËÏÈΛ·: 50,05 ¤ÙË) ÔÈ ·ÛıÂÓ›˜ ›¯·Ó ·ÌÈÁ‹ HCV ΛÚÚˆÛË ÂÓÒ Û 3 Û˘Ó˘‹Ú¯Â ∏∫∫. ™ÙËÓ ÔÌ¿‰· μ (9 ¿Ó‰Ú˜/2 Á˘Ó·›Î˜, ̤ÛË ËÏÈΛ·: 48,45 ¤ÙË) 4 ÂÌÊ¿ÓÈ˙·Ó Û˘ÏÏԛ̈ÍË Ì HBV Î·È 1 Ì HDV, Ì›· ¤·Û¯Â ·fi ÓfiÛÔ Wilson, 6 ·Ó¤ÊÂÚ·Ó Î·Ù¿¯ÚËÛË ·Èı·ÓfiÏ˘ Î·È Û 2 Û˘Ó˘‹Ú¯Â ∏∫∫. ∞ÍÈÔÏÔÁ‹ıËÎ·Ó ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ÚÈÓ ÙË ª∏, ÔÈ ÂÈÏÔΤ˜, Ë ·fiÚÚÈ„Ë, Ë ˘ÔÙÚÔ‹ Ù˘ Ïԛ̈͢ ÛÙÔ ÌfiÛ¯Â˘Ì· (ÈÛÙÔÏÔÁÈ΋), Ë ıÂڷ›· Ì peg-IFN Î·È ÚÈÌ·‚ÈÚ›ÓË Î·È Ë ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ. ∞¶OΔ∂§∂™ª∞Δ∞
™ÙËÓ ÔÌ¿‰· ∞ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ηٿ Child Pugh ‹Ù·Ó: A Û 1 ·ÛıÂÓ‹ (5,26%), μ Û 6 (31,57%) Î·È C Û 12 (63,15%). ™ÙËÓ ÔÌ¿‰· B ‹Ù·Ó: ∞ Û 1 (9,09%), μ Û 2 (18,18%) Î·È C Û 8 (72,72%). ŒÓ·˜ ·ÛıÂÓ‹˜ οı ÔÌ¿‰·˜ ˘Â‚Ï‹ıË ÂÓÙfi˜ 3Ì‹ÓÔ˘ Û ·ӷÌÂÙ·ÌfiÛ¯Â˘ÛË. ΔÚÂȘ ·ÛıÂÓ›˜, 1 Ù˘ ÔÌ¿‰·˜ ∞ Î·È 2 Ù˘ μ ˘Â‚Ï‹ıËÛ·Ó Û ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÙÔÌ›· ÏfiÁˆ ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ¯ÔÏÔÂÚÈÙfiÓ·ÈÔ˘ ·ÓÙ›ÛÙÔȯ·. OÎÙÒ Ù˘ ÔÌ¿‰·˜ ∞ (42,1%) Î·È 9 Ù˘ μ (81,81%) ÂÌÊ¿ÓÈÛ·Ó ÏÔÈÌÒÍÂȘ. ∞fiÚÚÈ„Ë ‰È·ÈÛÙÒıËΠÈÛÙÔÏÔÁÈο Û 4 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ (21,05%) Î·È 5 Ù˘ μ (45,45%). πÛÙÔÏÔÁÈ΋ ˘ÔÙÚÔ‹ Ù˘ HCV Ïԛ̈͢ ˘‹ÚÍ Û 4 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ (21,05%) Î·È Û 4 Ù˘ μ (36,36%). ŸÏÔÈ ¤Ï·‚·Ó ·ÁˆÁ‹ Ì peg-IFN Î·È ÚÈÌ·‚ÈÚ›ÓË. ª›· ·ÛıÂÓ‹˜ ¤Ù˘¯Â ÈÔÏÔÁÈ΋ ·ÓÙ·fiÎÚÈÛË. ŒÍÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ (31,57%) Î·È 4 Ù˘ μ (36,36%) ÂÌÊ¿ÓÈÛ·Ó ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. £ÓËÙfiÙËÙ· 1Ô˘ ÌËÓfi˜: 47,36% ÛÙËÓ ÔÌ¿‰· ∞, Î·È 9,09% ÛÙË μ. ∏ Û˘ÓÔÏÈ΋ ÚÔ‚ÏÂfiÌÂÓË 5ÂÙ‹˜ ÂÈ‚›ˆÛË Â›Ó·È 20% ÛÙËÓ ÔÌ¿‰· ∞ Î·È 55% ÛÙË μ. ∏ ÚÔ‚ÏÂfiÌÂÓË 5ÂÙ‹˜ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ù·Ó ˙ˆÓÙ·ÓÔ› ÌÂÙ¿ ÙÔÓ 1Ô ÌÂÙ·ÌÔÛ¯Â˘ÙÈÎfi Ì‹Ó· Â›Ó·È 32% ÛÙËÓ ÔÌ¿‰· ∞ Î·È 65% ÛÙË μ. ™Àª¶∂ƒ∞™ª∞TA
OÈ ·ÛıÂÓ›˜ fiÔ˘ Ë HCV Ïԛ̈ÍË Û˘Ó˘¿Ú¯ÂÈ Ì ¿ÏÏË ·ÈÙ›· ΛÚÚˆÛ˘, ·Ú¿ ÙÔ fiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·fiÚÚȄ˘ (45,45% vs 21,05%), ÏÔÈÌÒÍÂˆÓ (81,81% vs 42,1%) Î·È ÈÛÙÔÏÔÁÈ΋˜ ˘ÔÙÚÔ‹˜ (36,36% vs 21,05%), ¤¯Ô˘Ó ηχÙÂÚË 5ÂÙ‹ ÂÈ‚›ˆÛ‹ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÌÈÁ‹ HCV ΛÚÚˆÛË.
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48 ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ™∂ ¶∞π¢π∞- ∂ª¶∂πƒπ∞ 15 ∂Δø¡ ™∂ ∂¡∞ ∫∂¡ΔƒO O. μÚ¿ÓË1, °. ÿÌ‚ÚÈÔ˜2, π. •˘ÓÈ¿˜1, ª. ¶·ÓÙÈΛ‰Ô˘1, ∞. ∫¿ÓÙ˙ÈÔ˘1, ∞. ª·˘ÚÔ˘‰‹1, ¢. Δ·ÎÔ‡‰·˜2, £. ¶··ÛÙ·‡ÚÔ˘1, ∫. ™‡ÚÔÁÏÔ˘1, μ. ¢ÂÌÂÚÙ˙›‰Ô˘1 1°’
2ÃÂÈÚÔ˘ÚÁÈ΋
¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢
∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (ª∏) ÛÙ· ·È‰È¿ ·ÔÙÂÏ› ÙË ÌÔÓ·‰È΋ ıÂڷ›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÌË ·Ó·ÛÙÚ¤„ÈÌ˘ Ë·ÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. ™∫O¶O™
H ·Ó·ÊÔÚ¿ Ù˘ ÂÌÂÈÚ›·˜ Ì·˜ ·fi ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. ∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
∞fi ÙÔ 1990 ¤ˆ˜ Û‹ÌÂÚ· 17 ·ÛıÂÓ›˜ Ù˘ °′ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜, ËÏÈΛ·˜ 6 ÌËÓÒÓ ¤ˆ˜ 13 ÂÙÒÓ, ˘Ô‚Ï‹ıËÎ·Ó Û ª∏. ∞fi Ù· ·È‰È¿ ·˘Ù¿, 9 ›¯·Ó ·ÙÚËÛ›· Â͈˷ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ, 2 ÔÍ›· Ë·ÙÈ΋ Ó¤ÎÚˆÛË ÌÂÙ¿ ·fi ‚ÚÒÛË ÙÔÍÈÎÒÓ Ì·ÓÈÙ·ÚÈÒÓ, 1 Û‡Ó‰ÚÔÌÔ Alagille, 1 ÂÓ‰ÔË·ÙÈ΋ ˘ÔÏ·Û›· ÙˆÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ ÌË Û˘Ó‰ÚÔÌÈÎÔ‡ Ù‡Ô˘, 2 ÓfiÛÔ ÙÔ˘ Wilson, 1 ÚˆÙÔ·ı‹ ˘ÂÚÔÍ·ÏÔ˘Ú›· Î·È 1 Ë·ÙÔ‚Ï¿Ûو̷. Δ· ¤ÓÙÂη ·È‰È¿ ˘Ô‚Ï‹ıËÎ·Ó Û ª∏ ÛÙË ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ÙÔ˘ ∞.¶.£. Î·È Ù· ˘fiÏÔÈ· Û ΤÓÙÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡. ΔÚÂȘ ÌÂÙ·ÌÔۯ‡ÛÂȘ ¤ÁÈÓ·Ó ·fi ˙ÒÓÙ· Û˘ÁÁÂÓ‹ Î·È 14 ·fi و̷ÙÈÎfi ‰fiÙË. ∞fi Ù· ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ıԇ̠ۋÌÂÚ·, ¤ÍÈ ¤Ï·‚·Ó ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ Ì ΢ÎÏÔÛÔÚ›ÓË, MMF Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È 7 ·È‰È¿ tacrolimus ·ÓÙ› ΢ÎÏÔÛÔÚ›Ó˘. A¶OΔ∂§∂™ª∞Δ∞
∞fi Ù· 17 ·È‰È¿ Ô˘ ÌÂÙ·ÌÔۯ‡ıËηÓ, 4 η٤ÏËÍ·Ó ÙÔÓ ÚÒÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi Ì‹Ó·. ∞fi Ù· ˘fiÏÔÈ· Ô˘ ·Ú·ÎÔÏÔ˘ıԇ̠¤ˆ˜ Û‹ÌÂÚ·, 3 ·ÚÔ˘Û›·Û·Ó ÔÍ›· Î·È 1 ¯ÚfiÓÈ· ·fiÚÚÈ„Ë ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ¶¤ÓÙ ·È‰È¿ ÂÌÊ¿ÓÈÛ·Ó Ïԛ̈ÍË ·fi CMV, 5 ·fi EBV, 2 ·fi HSV, 2 ·fi Èfi Parvo μ19, 1 ·fi Èfi Coxsackie, 1 ·fi C.albicans Î·È 2 ·fi VZV. ∂›Û˘, ¤Ó· ·È‰› ·ÚÔ˘Û›·Û ·ÈÌÔÚÚ·Á›· ÙÔ˘ ·ÓÒÙÂÚÔ˘ °∂™ Î·È ¤Ó· ÓfiÛÔ ÂÍ·Ê¿ÓÈÛ˘ ÙˆÓ ÌÈÎÚÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ. ∏ ¤Î‚·ÛË ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ηϋ, Ì ηϋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ë·ÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ÂÎÙfi˜ ·fi ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ÙË ÓfiÛÔ ÂÍ·Ê¿ÓÈÛ˘ ÙˆÓ ÌÈÎÚÒÓ ¯ÔÏËÊfiÚˆÓ Ô˘ ¯ÚÂÈ¿ÛıËΠ·ӷÌÂÙ·ÌfiÛ¯Â˘ÛË. ™Àª¶∂ƒ∞™ª∞Δ∞
∏ Ì·ÎÚÔ¯ÚfiÓÈ· ÔÚ›· Î·È ¤Î‚·ÛË ·È‰ÈÒÓ Ì ˷ÙÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È Î·Ï‹ Ì ÙËÓ ÚÔ¸fiıÂÛË Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ΤÓÙÚ·.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
49 πO°∂¡∂π™ §Oπªø•∂π™ ™∂ ¶∞π¢π∞ ª∂ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ AÈÎ. ∫¿ÓÙ˙ÈÔ˘1, μ. ¢ÂÌÂÚÙ˙›‰Ô˘1, π. •˘ÓÈ¿˜1, ∞. ª·˘ÚÔ˘‰‹1, ª. ¶·ÓÙÈΛ‰Ô˘1, O. μÚ¿ÓË1, ∂. ƒÔËÏ›‰Ë˜1, °. ÿÌ‚ÚÈÔ˜2, ∫. ™‡ÚÔÁÏÔ˘1, ¢. Δ·ÎÔ‡‰·˜2 13Ë
¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢
2∫ÏÈÓÈ΋
∂π™∞°ø°∏
∏ ÚfiÔ‰Ô˜ Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ıÂڷ›·˜ ‚ÂÏÙ›ˆÛ ‰Ú·Ì·ÙÈο ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·. øÛÙfiÛÔ Ô Î›Ó‰˘ÓÔ˜ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ·Ú·Ì¤ÓÂÈ ˘„ËÏfi˜ ÛÙÔ˘˜ ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜, ÌÂ Û˘Ó¤ÂÈ· ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È Â›‰Ú·ÛË ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ™∫O¶O™
¡· ·ÚÔ˘ÛÈ·Ûı› Ë ÂÌÂÈÚ›· Ì·˜ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Û ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. ∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
™Â 10 ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È ‚Ú›ÛÎÔÓÙ·È Û ٷÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ô ·ÚÈıÌfi˜, Ë Û˘¯ÓfiÙËÙ·, Ë ÎÏÈÓÈ΋ ÂÈÎÔÓ· Î·È Ë ¤Î‚·ÛË ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, Ë ıÂڷ›· ηıÒ˜ Î·È Ù˘¯fiÓ ÂÈÏÔΤ˜ ÙÔ˘˜. ∞¶OΔ∂§∂™ª∞Δ∞
¢‡Ô ·È‰È¿ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó οÔÈÔ ÂÂÈÛfi‰ÈÔ Ïԛ̈͢. ∫·Ù·ÁÚ¿ÊËÎ·Ó Û˘ÓÔÏÈο 23 ÂÂÈÛfi‰È· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Û 8 ·ÛıÂÓ›˜: 8 ÏÔÈÌÒÍÂȘ ·fi CMV Û 6 ·ÛıÂÓ›˜ (4 ·Û˘Ìو̷ÙÈΤ˜) Î·È 7 ÏÔÈÌÒÍÂȘ ·fi EBV Û 4 ·ÛıÂÓ›˜ (4 ·Û˘Ìو̷ÙÈΤ˜). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ηٿÏÏËÏË ıÂڷ›· Î·È Î·Ù·ÁÚ¿ÊËΠ̛· ÔÍ›· ·fiÚÚÈ„Ë ÌÔۯ‡̷ÙÔ˜ Û ̛· ·ÛıÂÓ‹ Ì EBV Ïԛ̈ÍË. ΔÚ›· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó Ïԛ̈ÍË ·fi Èfi Parvo B19. ª›· ·ÛıÂÓ‹˜ ·Ú¤ÌÂÈÓ ·Û˘Ìو̷ÙÈ΋. O ‰Â‡ÙÂÚÔ˜ ÂÌÊ¿ÓÈÛ ›ÎÙÂÚÔ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ Ïԛ̈͢ Î·È ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ ¤‰ÂÈÍ ÂÍ·Ê¿ÓÈÛË ÙˆÓ ÌÈÎÚÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ. ŒÏ·‚ ıÂڷ›· Ì Á-ÛÊ·ÈÚ›ÓË, ˆÛÙfiÛÔ ÂÍÂÏ›¯ÙËΠ۠˷ÙÈ΋ ·Ó¿ÚÎÂÈ· Î·È ··›ÙËÛ ·ӷÌÂÙ·ÌfiÛ¯Â˘ÛË. O ÙÚ›ÙÔ˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÔÍ›· ·fiÚÚÈ„Ë ÛÙÔ ‰È¿ÛÙËÌ· Ù˘ Ïԛ̈͢, Ë ÔÔ›· ‹Ù·Ó ÎÔÚÙÈÎÔ·ÓıÂÎÙÈ΋ Î·È ··›ÙËÛ ıÂڷ›· Ì ATG. ¢‡Ô ·ÛıÂÓ›˜ ÓfiÛËÛ·Ó ·fi ·ÓÂÌÔ‚ÏÔÁÈ¿ Î·È Û ¤Ó·Ó ¿ÏÏÔ ·ÛıÂÓ‹ ·ÓȯÓ‡ÙËΠٷ˘Ùfi¯ÚÔÓ· Ïԛ̈ÍË ·fi Coxsackie Î·È EBV.Δ¤ÏÔ˜ 2 ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó Ïԛ̈ÍË ·fi HSV. ™Àª¶∂ƒ∞™ª∞TA
OÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Â›Ó·È ·ÈÙ›· ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙËÙ·˜ Û ·È‰È¿ ·Ô‰¤ÎÙ˜ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÔÊ›ÏÂÙ·È Û ÂÚËÙÔ˚Ô‡˜ (΢ڛˆ˜ CMV Î·È EBV). OÈ ÏÔÈÌÒÍÂȘ ·fi ÙÔÓ Èfi Parvo Ê·›ÓÂÙ·È Ó· ‰È·‰Ú¿ÌÔ˘Ó ‚·Ú‡ÙÂÚ· Û ·È‰È¿ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È Ó· Á›ÓÔÓÙ·È ·ÈÙ›· Ì›˙ÔÓÔ˜ ‚Ï¿‚˘ ÛÙÔ ÌfiÛ¯Â˘Ì·. ∂›Ó·È ·Ó·Áη›· Ë Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Î·È ıÂڷ›· ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
50 ∂¶∏ƒ∂∞∑∂π ∏ ª∂Δ∞°°π™∏ ∞πª∞ΔO™ ∫∞π ¶∞ƒ∞°O¡Δø¡ Δ∏¡ ∂¶πμπø™∏ ∞™£∂¡ø¡ ¶OÀ À¶Oμ∞§§O¡Δ∞π ™∂ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™; X. ¶··ÁˆÚÁ›Ô˘1, ∂. ∫·Ùۛη1, μ. ¶··ÓÈÎÔÏ¿Ô˘2, ¢. μÚÔ¯›‰Ë˜2, °. ÿÌ‚ÚÈÔ˜2, °. ¶·ÚÔ˘ÙÛ›‰Ô˘1, Ã. ∫Ô‡·Ó˘1, £. ∞ÛÏ·Ó›‰Ë˜1, ¢. Δ·ÎÔ‡‰·˜2, ∂. ∞Ó·ÁÓˆÛÙ¿Ú·1 1∞’
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∞Ó·ÈÛıËÛÈÔÏÔÁÈÎfi ΔÌ‹Ì·, ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ °.¶.¡.£. ‘πÔÎÚ¿ÙÂÈÔ’
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™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë Û˘Û¯¤ÙÈÛË Ù˘ ‰ÈÂÁ¯ÂÈÚËÙÈ΋˜ ÌÂÙ¿ÁÁÈÛ˘ ·›Ì·ÙÔ˜ Î·È ·Ú·ÁÒÁˆÓ ·˘ÙÔ‡ Ì ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (ª.∏.) Y§π∫O
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OÈ ·ÛıÂÓ›˜ ÌÂÙ·ÁÁÈ˙fiÙ·Ó ÌÂ Û˘ÌËÎӈ̤ӷ ÂÚ˘ıÚ¿ Î·È ·Ú¿ÁÔÓÙ˜ ·›Ì·ÙÔ˜ ηٿ ÙËÓ ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ÂÚ›Ô‰Ô ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁ›Ԣ,ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË Î·È ÙÔÓ ËÎÙÈÎfi Ì˯·ÓÈÛÌfi ( Hb <8 mg/dl, INR >1.5, PLT <50.000). OÈ ÌÂÙÚ‹ÛÂȘ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÙÔ˘ ËÎÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ÁÈÓfiÙ·Ó ·Ó¿ ÒÚ· Î·È ÂÎÙ¿ÎÙˆ˜ fiÔÙ ˘‹Ú¯Â ÂÌÊ·Ó‹˜ ·ÈÌÔÚÚ·Á›· ÛÙÔ ¯ÂÈÚÔ˘ÚÁÈÎfi ‰›Ô Î·È ·ÈÌÔ‰˘Ó·ÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ∏ ÛÙ·ÙÈÛÙÈ΋ ÌÂϤÙË ¤ÁÈÓ Ì ÙËÓ Ì¤ıÔ‰Ô ∞NOVA Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ÙÈ̤˜ p<0.05 ∞¶OΔ∂§∂™ª∞Δ∞
∞Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÈ‚›ˆÛË ÌËÓfi˜ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË. Δ· ·ÔÙÂϤÛÌ·Ù· Ê·›ÓÔÓÙ·È ÛÙÔÓ ·Ú·Î¿Ùˆ ›Ó·Î·:
RBC FFP CRYO PLT
Oª∞¢∞ ∞ (95% CI)
Oª∞¢∞ μ (95% CI)
p
14.67 (11.91-17.42) 32.97 (28.8 - 37.12) 10.56 (5.51- 15.6) 11.04 (8.94 - 13.14)
16.06 (11.48 - 20.63) 34.07 (26.97 – 43.07) 7.63 ( 5.72 – 9.5) 14.5 ( 10.63 – 18.37)
0.63 0.71 0.12 0.13
™Àª¶∂ƒ∞™ª∞Δ∞
∏ ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Î·È ·Ú·ÁfiÓÙˆÓ ‰ÂÓ ·ÔÙÂÏ› ·fi ÌfiÓË Ù˘ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÂÈ‚›ˆÛ˘ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÔÚıÔÙÔÈ΋ ª.∏.
66
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
51 SALVAGE PLASMAPHERESIS FOR SMALL-FOR-SIZE SYNDROME FOLLOWING HEPATIC RESECTION G.C. Sotiropoulos1, H. Lang1, I. Fouzas1,4, S. Herget-Rosenthal2, E.P. Molmenti1, H.A. Baba3, C.E. Broelsch1, F.H. Saner1 1Department
of General, Visceral and Transplantation Surgery, 2Department of Nephrology, of Pathology and Neuropathology, University Hospital Essen, Essen, Germany, 4Organ Transplant Unit Hippocration University Hospital, Thessaloniki, Greece
3Institute
BACKGROUND
Although the role of plasmapheresis in liver failure is not clearly established yet, encouraging reports have addressed its efficacy in the setting of small-for-size syndrome after live donor liver transplantation, resections for liver malignancies, and acute liver failure. PATIENTS AND METHODS
We present the case of 56 year old man who underwent a low anterior resection for rectal adenocarcinoma pT2 N0 M1 (liver) G1-2 in May 2004. The liver lesion was treated with one session of radiofrequency ablation and 2 courses of transarterial chemoembolization and repeated cycles of systemic chemotherapy, initially with 5-flurouracil/leucovorin and more recently with capecitabine/oxaliplatin. In March 2006, he presented with a 11 cm solitary liver metastasis (segment VIII), with involvement of both right and middle hepatic veins. The volume of segments I, II, and III was 420ml and considered adequate for his BMI of 26. There were no macroscopic sings of cirrhosis or steatosis. We performed a right trisectionectomy (segments IV-VIII), with partial resection of the diaphragm, hilar lymphadenectomy, portal vein resection and reconstruction, cholecystectomy, and insertion of a T-tube. Histological exam showed a G2-3 colorectal metastasis and liver parenchyma characterized by 25% steato-hepatitis. Postoperatively, he developed liver insufficiency (bilirubin 42mg/dl), and multi-organ failure requiring high doses of vasopressors, mechanical ventilation, and continuous veno-venous hemodialysis. He received nine consecutive sessions of plasmapheresis, starting on the first postoperative day. RESULTS
The patient gradually recovered, and was discharged from the hospital on postoperative day 47. He is currently alive and well, with normal liver function and no evidence of tumor recurrence 12 months post-operatively. CONCLUSIONS
We hope this report will provide useful additional information on the short and long term effects of plasmapharesis, especially as supportive procedure after major hepatectomy, for hepaic neoplasms or living donor liver transplantsation.
67
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
52 PORTAL VEIN THROMBOSIS IN LIVER TRANSPLANT SURGERY FOR HEPATOCELLULAR CARCINOMA IN CIRRHOSIS G.C. Sotiropoulos1, I.P. Fouzas1,4, K.J. Schmitz2, E.P. Molmenti1, T.Schroeder3, H.A. Baba2, M. Malago1, C.E. Broelsch1, H. Lang1 1Department
of General, Visceral and Transplantation Surgery, of Pathology and Neuropathology, 3Department of Diagnostic and Interventional Radiology University Hospital Essen, Essen, Germany, 4Organ Transplant Unit, Hippocration University Hospital, Thessaloniki, Greece 2Institute
BACKGROUND
Portal vein thrombosis (PVT) represents a potentially unfavourable prognostic factor in liver transplantation (LT) for hepatocellular carcinoma (HCC). However, it is frequently difficult to establish preoperatively whether the thrombus is associated with tumor invasion or with stagnant flow. The purpose of this study was to further address this controversial issue. PATIENTS AND METHODS
We evaluated 12 consecutive patients who underwent liver transplantation for HCC in the setting of PVT. RESULTS
The origin of PVT in HCC patients could be accurately evaluated in 58% of the patients. Forty two percent of patients had no evident portal vein invasion and only 17% of cases had tumor thrombi. One third of patients experienced tumor recurrence within the first posttransplant year, and one third of patients became long-term survivors (median survival of 36 months) with no evidence of tumor recurrence. One year survival was 92%. Nine patients are currently alive after a median follow-up period of 25 months. CONCLUSIONS
PVT in the setting of HCC is characterized by poor patient outcome. However, a respectable number of instances are not accurately evaluated preoperatively, making the decision to exclude these patients from LT sometimes a challenging dilemma.
68
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
53 LIVING DONOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN PATIENTS EXCEEDING THE UCSF CRITERIA G.C. Sotiropoulos1, I.P. Fouzas1,2, H. Lang1, M. Malago1, C.E. Broelsch1 1Department 2Organ
of General, Visceral and Transplantation Surgery, Transplant Unit, Hippocration University Hospital, Thessaloniki, Greece
BACKGROUND
Living Donor Liver Transplantation (LDLT) represents the most likely alternative for the expansion of the organ pool for adult patients with hepatocellular carcinoma (HCC) and end-stage liver disease. The purpose of this study was to demonstrate our institutional experience about LDLT for HCC, also in the era outside University of California San Francisco (UCSF) criteria. MATERIAL AND METHODS
Between September 1998 and December 2006, 22 LDLTs were performed for HCC in patients exceeding the UCSF criteria. RESULTS
There were 17 men and 5 women with a median age of 55 years. Pretransplant indications were: HCV cirrhosis (n=12), HBV cirrhosis (n=4), alcoholic cirrhosis (n=3), cryptogenic cirrhosis (n=2), and no cirrhosis (n=1). Bridging treatments were performed in 6 patients. Multifocal tumors were present in 19 of 22 patients. Tumor grading was: grade I 8 patients, grade II 10 patients, and grade III 4 patients. Microvascular invasion was found in 7 liver explants. Five patients died from complications irrelevant to HCC recurrence at 2, 6, 9, 10 and 14 months post transplant. Seven patients developed tumor recurrence at 3, 3, 5, 7, 9, 10, and 35 months after LDLT and 4 of them died at 6, 10, 17 and 75 months post transplant. Currently, 13 patients are alive (3 of them with tumor recurrence) at a median of 24 months post transplant. Rates for 1 and 3 years overall and recurrence free survival are 73%, 62% and 54%, 34%, respectively. CONCLUSIONS
LDLT for HCC patients exceeding the UCSF criteria is characterized by an acceptable overall but poor recurrence-free survival and its application requires a very honest donor and recipient information.
69
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
54 ¢π∂ƒ∂À¡∏™∏ TøN ∂¶π¶§O∫ø¡ ª∂Δ∞ ∞¶O ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ª∂ ∞•O¡π∫O ΔOªO°ƒ∞ºO ¶O§§∞¶§ø¡ ΔOªø¡ (MDCT) ∞. ¶ÂÙÚȉ˘1, Ã. ∫·Ú·Ù˙Ô˘1, ∫. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘1, Δ. °ÂÚԇ΢1, °. πÌ‚ÚÈÔ˜2, ª. ∞ÓÙˆÓÈ¿‰Ë˜2, μ. ∫·Ï·Î›‰Ë˜1, ¶. ¶·ÏÏ¿‰·˜1 1∞ÎÙÈÓÔÏÔÁÈÎfi
∂ÚÁ·ÛÙ‹ÚÈÔ «°. ¶··ÓÈÎÔÏ¿Ô˘» ΔÌ‹Ì· ∞ÍÔÓÈÎÔ‡ Î·È ª·ÁÓËÙÈÎÔ‡ ΔÔÌÔÁÚ¿ÊÔ˘. 2ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£
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™ÙÔ˘˜ ¤ÓÙÂη ·ÛıÂÓ›˜, ÌfiÓÔ ‰‡Ô ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞fi ÙÔ˘˜ ˘ÔÏÔ›Ô˘˜ Û ‰‡Ô ·ÂÈÎÔÓ›ÛÙËΠ·fiÊÚ·ÍË Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜ ‹ ÎÏ¿‰ˆÓ Ù˘ Û ¤Ó·Ó ÂÎ’ ÙˆÓ ÔÔ›ˆÓ ·ÂÈÎÔÓ›ÛÙËÎÂ Î·È ¤ÌÊÚ·ÎÙÔ ‹·ÙÔ˜. ΔÚÂȘ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ÛÙ¤ÓˆÛË ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜, ¤Ó·˜ ·Ó‡ڢÛÌ· Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜, ¤ÓÙ ÛÙ¤ÓˆÛË ˘Ï·›·˜ ÊϤ‚·˜, ¤Ó·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ıÚfiÌ‚ˆÛË ÎÏ¿‰Ô˘ ˘Ï·›·˜ ÊϤ‚·˜ Î·È ‰‡Ô ·ÚÙËÚÈÔÔ›ËÛË ·˘Ù‹˜ ÂÓÒ ‰È¿Ù·ÛË Ù˘ ˘Ï·›·˜ ÂÌÊ·Ó›ÛÙËΠ۠‰‡Ô ·ÛıÂÓ›˜. ™Â 2 ·ÛıÂÓ›˜ ˘‹Ú¯Â ıÚfiÌ‚ˆÛË ∫∫º, ÂÓÒ Û ¤Ó·Ó ›¯·Ì ÂÏ¿ÙÙˆÛË Ù˘ ·Ô¯¤Ù¢Û˘ ÙˆÓ Ë·ÙÈÎÒÓ ÊÏ‚ÒÓ. ∂ÈÚÔı¤ÙˆÓ ›¯·Ì ¤Ó· „¢‰Ô·Ó‡ڢÛÌ· ·ÔÚÙ‹˜, ¤Ó· ·Ó‡ڢÛÌ· ÛÏËÓÈ΋˜ ·ÚÙËÚ›·˜, Ì›· ÛÙ¤ÓˆÛË ·Ú. Á·ÛÙÚÈ΋˜ ·ÚÙËÚ›·˜ Î·È ¤Ó· ¯fiψ̷. ™Â ‰‡Ô ·ÛıÂÓ›˜ ›¯·Ì ·Ó¿Ù˘ÍË ÓÂÔÂÍÂÚÁ·ÛÈÒÓ ÛÙÔ ÌÂÙ·ÌÔÛ¯Â˘ı¤Ó ‹·Ú. (™ËÌÂȈ٤ÔÓ fiÙÈ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ï‹Ó ÂÓfi˜ ÂÌÊ¿ÓÈÛ·Ó ÔÏϷϤ˜ ‚Ï¿‚˜). ™Àª¶∂ƒ∞™ª∞
∏ ÙÚÈÊ·ÛÈ΋ MDCT ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ Ì¤ıÔ‰Ô ÚÒÙ˘ ÚÔÛ¤ÁÁÈÛ˘ ÛÙË ÌÂϤÙË ÙˆÓ ÂÈÏÔÎÒÓ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ÂÂȉ‹ Û ¤Ó· ¯ÚfiÓÔ Î·È Ì ̛· ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ÌÔÚԇ̠ӷ ·ÂÈÎÔÓ›ÛÔ˘Ì ÙÔ ·ÚÙËÚÈ·Îfi ‰¤ÓÙÚÔ, ÙÔ ˘Ï·›Ô Î·È ÙÔ ÊÏ‚ÈÎfi ‰›ÎÙ˘Ô ÙÔ˘ ‹·ÙÔ˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·ÂÈÎÔÓ›˙ÔÓÙ·È Ù· ·ÚÂÁ¯˘Ì·ÙÒ‰Ë fiÚÁ·Ó· Ù˘ ÎÔÈÏȷ΋˜ ÎÔÈÏfiÙËÙ·˜.
70
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
55 ∂∫μ∞™∏ Δ∏™ ¡∂ºƒπ∫∏™ §∂πΔOÀƒ°π∞™ ™∂ ¢OΔ∂™ ¡∂ºƒπ∫OÀ ªO™Ã∂Àª∞ΔO™ ¢. OÈÎÔÓÔÌ›‰Ô˘1, ¶. ¶·ÙÂÈÓ¿Î˘1, Ã. ÷Ù˙Ë·ÚÎÔ˘1, ™. ¡Ùfi‚·˜1, N. ∫Ú·‚›‰·3, °. ÕÚÛÔ˜3, A.-M. ªÂϯڋ1, ∂. ∞ÏÂÍfiÔ˘ÏÔ˜1, ¢. Δ·ÎÔ‡‰·˜2, ¢. ª¤ÌÌÔ˜1 1¡ÂÊÚÔÏÔÁÈ΋ 3ΔÌ‹Ì·
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∏ ÌÂϤÙË Ù˘ ¤Î‚·Û˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û ‰fiÙ˜ ÓÂÊÚÔ‡ Î·È Ë Èı·Ó‹ ÌÂÙ·‚ÔÏ‹ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ∞™£∂¡∂π™-ª∂£O¢Oπ
ªÂÏÂÙ‹ıËÎ·Ó 30 ‰fiÙ˜ ÓÂÊÚÔ‡, Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÓÂÊÚÂÎÙÔÌ‹ ÙÔ 1990-2006. ªÂÙÚ‹ıËÎ·Ó Ô Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ (GFR) Ì Cr59 EDTA, ÙÔ Ï‡Έ̷ Ô‡ÚˆÓ 24ÒÚÔ˘, Ë ·ÚÙËÚȷ΋ ›ÂÛË, Ë Ô˘Ú›· Î·È ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ Î·È Û˘ÁÎÚ›ıËÎ·Ó Ì ٷ ·ÓÙ›ÛÙÔȯ· Â˘Ú‹Ì·Ù· ÚÈÓ ÙË ÓÂÊÚÂÎÙÔÌ‹. ∞¶OΔ∂§∂™ª∞Δ∞
™ÙÔ˘˜ 30 ‰fiÙ˜ (11 ¿Ó‰Ú˜), Ë ËÏÈΛ· ηٿ ÙË ÓÂÊÚÂÎÙÔÌ‹ ‹Ù·Ó ª± SD 54±9 (33-66) ¤ÙË. ∏ ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ‹Ù·Ó 0,84±0,14 mg/dL, Ë Ô˘Ú›· 33±9 mg/dL Î·È Ë GFR ª± SD 100±21 ml/min, fiÏÔÈ Â›¯·Ó χΈ̷ 24ÒÚÔ˘ <150 mg/24h Î·È 14 ‹Ù·Ó ˘ÂÚÙ·ÛÈÎÔ› ˘fi ·ÁˆÁ‹. ™ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔÏÔ‡ıËÛ˘, Ô˘ ‹Ù·Ó ª± SD 68± 62(12-184) Ì‹Ó˜, Ë ÎÚ·ÙÈÓ›ÓË ‹Ù·Ó ª± SD 1,17 ±0,1814 mg/dL, Ë Ô˘Ú›· ª± SD 39±14 mg/dL Î·È Ë GFR 5 ª± SD 7±15 ml/min. ¢‡Ô ‰fiÙ˜ ÂÌÊ¿ÓÈÛ·Ó de novo ·ÚÙËÚȷ΋ ›ÂÛË ÂÓÒ Û 10/14 ‰fiÙ˜ ¯ÚÂÈ¿ÛÙËΠ·‡ÍËÛË Ù˘ ‰fiÛ˘ ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ¢¤Î· ¤ÍÈ ‰fiÙ˜ Ì ÙÂÏÈ΋ GFR <60 ml/min ›¯·Ó ·Ú¯È΋ GFR ª± SD 92±17 ml/min Î·È ËÏÈΛ· ª± SD 57±7 ¤ÙË. ∞ÓÙ›ıÂÙ· ÔÈ ‰fiÙ˜ Ì ÙÂÏÈ΋ GFR >60 ml/min ›¯·Ó ·Ú¯È΋ GFR ª± SD 110±21 ml/min Î·È ËÏÈΛ· ª± SD 49±10 ¤ÙË ™Àª¶∂ƒ∞™ª∞Δ∞
ªÂÙ¿ ÙË ÓÂÊÚÂÎÙÔÌ‹ ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ ηٿ 40% ÂÚ›Ô˘. ∂ÁηٿÛÙ·ÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·Ú·ÙËÚÂ›Ù·È Û ÌÈÎÚfi ÔÛÔÛÙfi. ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‰ÔÙÒÓ Ì GFR <90 ml/min ÌÂÙ·›ÙÂÈ Û ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· 2Ô˘ ‹ 3Ô˘ ÛÙ·‰›Ô˘.
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56 A™∏¶Δ∏ O™Δπ∫∏ ¡∂∫ƒø™∏ ™∂ ∞™£∂¡∂π™ ª∂ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ™. ¡Ùfi‚·˜1, μ. §È·ÎfiÔ˘ÏÔ˜1, §. ¶··ıÂÔ‰ÒÚÔ˘2, £. ™ÈÌÔÔ‡ÏÔ˘1, °. ºÈÏÈ›‰Ë˜1, ∫. ª·Ï›˙Ô˜2, π. ™ÙÂÊ·Ó›‰Ë˜1 1¡ÂÊÚÔÏÔÁÈ΋
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∫ÏÈÓÈ΋, ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·Ï›·˜, §¿ÚÈÛ·
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¡· ÌÂÏÂÙËıÔ‡Ó ÔÈ ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÔÛÙÈ΋˜ Ó¤ÎÚˆÛ˘ (∞¡) Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ (¡ª), ÔÈ ıÂڷ¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ Î·È Ë ¤Î‚·Û‹ ÙÔ˘˜. ∞™£∂¡∂π™-ª∂£O¢Oπ
ªÂÏÂÙ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ 17 ·ÛıÂÓÒÓ Ì ¡ª Ô˘ ·Ú·¤ÌÊıËÎ·Ó ÛÙÔ ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô §¿ÚÈÛ·˜ ÁÈ· ·ÓÙÈÌÂÙÒÈÛË ·fi ÙÔ 2002. ∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ÚÔÛ‚ÏËı¤ÓÙ· ÔÛÙ¿, Ë ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È ÔÈ ÂÈÏÔΤ˜. ∏ ÛÙ·‰ÈÔÔ›ËÛË Ù˘ ∞¡ Ù˘ ÎÂÊ·Ï‹˜ ÙÔ˘ ÌËÚÈ·›Ô˘ ¤ÁÈÓ Ì ÙÔ Û‡ÛÙËÌ· ARCO. ∏ ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË ¤ÁÈÓ Ì ÙÔ Harris hip score (HHS). ∞¶OΔ∂§∂™ª∞Δ∞
17 ·ÛıÂÓ›˜ (15 ¿Ó‰Ú˜), ̤ÛË ËÏÈΛ· 37±10 ¤ÙË, ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ·ÓÙÈÌÂÙÒÈÛË. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ë ∞¡ ÂÌÊ·Ó›ÛÙËΠÛÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ¡ª. ™˘ÓÔÏÈο ÚÔÛ‚Ï‹ıËÎ·Ó 24 ÎÂʷϤ˜ ÌËÚÈ·›ˆÓ, 6 ÁfiÓ·Ù·, ÂÓÒ ¤Ó·˜ ·ÛıÂÓ‹˜ ›¯Â ÔÏϷϤ˜ ÂÓÙÔ›ÛÂȘ. ™Â 11 ÂÚÈÙÒÛÂȘ Ë ∞¡ ‹Ù·Ó ·ÌÊÔÙÂÚfiÏ¢ÚË. ¶¤ÓÙ ÂÚÈÙÒÛÂȘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Û˘ÓÙËÚËÙÈο Î·È 14 ¯ÂÈÚÔ˘ÚÁÈο. ∞ÛıÂÓ›˜ Ì ·Ú¯Èο ÛÙ¿‰È· ∞¡ ÎÂÊ·Ï‹˜ ÌËÚÈ·›Ô˘ (ARCO I-II) ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÁÁÂÈÔ‡ÌÂÓ· ÌÔۯ‡̷ٷ ÂÚfiÓ˘, ÔÚ҉˜ Ù·ÓÙ¿ÏÈÔ ‹ ·ÔÛ˘Ì›ÂÛË. ™Â 11 ÂÚÈÙÒÛÂȘ Ì ARCO III-IV ¤ÁÈÓ ÔÏÈ΋ ·ÚıÚÔÏ·ÛÙÈ΋ ÈÛ¯›Ô˘ (O∞π). ∞fi ÙȘ 6 ÂÚÈÙÒÛÂȘ ∞¡ ÁÔÓ¿ÙˆÓ ÛÙȘ 5 ÂÊ·ÚÌfiÛÙËΠ·ÔÛ˘Ì›ÂÛË. ÃÂÈÚÔ˘ÚÁÈΤ˜ ÂÈÏÔΤ˜ ˘‹ÚÍ·Ó Û 2 ÂÚÈÙÒÛÂȘ (7%). ΔÔ HHS ÚÔ-ÂÁ¯ÂÈÚËÙÈο ‹Ù·Ó 47,4±14,0 ÂÓÒ ÌÂÙÂÁ¯ÂÈÚËÙÈο 88,4±9,4 (p<0,0001). ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ∞¡ Û ·ÛıÂÓ›˜ Ì ¡ª ·ÊÔÚ¿ ΢ڛˆ˜ ÙȘ ÎÂʷϤ˜ ÙˆÓ ÌËÚÈ·›ˆÓ Î·È Û˘¯Ó¿ Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢ÚË. ∏ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘. ¢˘ÛÙ˘¯Ò˜ ÔÏÏÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÚÔ¯ˆÚË̤ӷ ÛÙ¿‰È· ∞¡ Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ÌfiÓÔ Ì O∞π. ™Â ÚÒÈÌ· ÛÙ¿‰È· Ë ÂÊ·ÚÌÔÁ‹ ÏÈÁfiÙÂÚÔ ÂÂÌ‚·ÙÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ ÌÔÚ› Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÙËÓ ·Ó¿ÁÎË O∞π. ™Â οı ÂÚ›ÙˆÛË ÔÈ ÂÈÏÔΤ˜ Â›Ó·È Ï›Á˜ Î·È Ë ÎÏÈÓÈ΋ ¤Î‚·ÛË ÂÍ·ÈÚÂÙÈ΋. ∏ MRI Â›Ó·È Ë ÈÔ Â˘·›ÛıËÙË Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ∞¡ Û ÚÒÈÌ· ÛÙ¿‰È·. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË Ù˘ ∞¡ Û ·ÛıÂÓ›˜ Ì ¡ª. ¶ÚÔÙ›ÓÔ˘Ì ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô Ì MRI ·Ó¿ ÙÚ›ÌËÓÔ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ¡ª ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ 12 Ì‹Ó˜ Ù˘ ¡ª.
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57 ¶ƒO°¡ø™Δπ∫∏ ∞•π∞ Δ∏™ μπOæπ∞™ ∂ªºÀΔ∂À™∏™ ΔOÀ ¡∂ºƒπ∫OÀ ªO™Ã∂Àª∞ΔO™ ™Δ∏¡ ∞ª∂™∏ ∫∞π ∞¶øΔ∂ƒ∏ §∂πΔOÀƒ°π∞ ΔOÀ ¢.™. °Ô‡ÌÂÓÔ˜, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË, ∞. ΔÛ·Ì·ÓÙ¿˜, π. ª·ÚÔ‡Ï˘, ∂. ™·‚‚ȉ¿ÎË, ∂. ºˆÎ·Â‡˜, ∂. ¶··¯Ú‹ÛÙÔ˘, ∫. ºÔ˘ÚÙÔ‡Ó·˜, ¢. ∫·Ú·‚›·˜, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘ ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶·ÙÚÒÓ
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∏ Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·Ù‹ÚËÛË ÈηÓÔÔÈËÙÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ÛÙfi¯Ô ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. ∏ ÂÎÙ›ÌËÛË Ù˘ ÚÔÁÓˆÛÙÈ΋˜ ·Í›·˜ Ù˘ ‚ÈÔ„›·˜ ÂÌʇÙ¢Û˘ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ÛÙËÓ ¿ÌÂÛË Î·È ·ÒÙÂÚË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·ÔÙ¤ÏÂÛ·Ó ÙÔÓ ÛÎÔfi Ù˘ ÌÂϤÙ˘. À§π∫O ∫∞π ª∂£O¢O™
ªÂÏÂÙ‹ıËÎ·Ó 173 ·ÛıÂÓ›˜ (118 ¿Ó‰Ú˜ Î·È 55 Á˘Ó·›Î˜), ËÏÈΛ·˜ 43,3±12 ÂÙÒÓ, Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ (·fi ˙ÒÓÙ· Û˘ÁÁÂÓ‹, n=20 ‹ و̷ÙÈÎfi ‰fiÙË, n=153) ηٿ ÙË ÙÂÏÂ˘Ù·›· 10ÂÙ›·. ∏ ËÏÈΛ· ÙˆÓ ‰ÔÙÒÓ ‹Ù·Ó 46,2±18 ¤ÙË Î·È Ô ¯ÚfiÓÔ˜ „˘¯Ú‹˜ ÈÛ¯·ÈÌ›·˜ 16±8 ÒÚ˜. ™Â 74 ÂÚÈÙÒÛÂȘ ÂÏ‹ÊıË ‚ÈÔ„›· Ì ‚ÂÏfiÓ· ηٿ ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÂÌʇÙ¢Û˘ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È ·ÎÔÏÔ‡ıËÛ ٷ¯Â›· ÂÂÍÂÚÁ·Û›· ÁÈ· ÂÎÙ›ÌËÛË ÙÔ˘ ‚·ıÌÔ‡ ÔÍ›·˜ ÛˆÏËÓ·Úȷ΋˜ ‚Ï¿‚˘, ›ÓˆÛ˘ Î·È ·ÚÙËÚÈÔÏÔÓÂÊÚÔÛÎÏ‹Ú˘ÓÛ˘. ∏ Û¯¤ÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÈÛÙÔÏÔÁÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ì ÙËÓ ¿ÌÂÛË Î·È ·ÒÙÂÚË (3 Ì‹Ó˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË) ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ÂÎÙÈÌ‹ıËΠ̠ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË. ∞¶OΔ∂§∂™ª∞Δ∞
ÕÌÂÛË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ·Ú·ÙËÚ‹ıËΠ۠100 ·ÛıÂÓ›˜ (58%) Î·È Ë ÂÌÊ¿ÓÈÛ‹ Ù˘ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ‰fiÙË (p=0.00) Î·È ÙÔÓ ¯ÚfiÓÔ „˘¯Ú‹˜ ÈÛ¯·ÈÌ›·˜ (p=0.05). ∏ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ÛÙ·ıÂÚÔÔÈ‹ıËΠ۠›‰· ÎÚ·ÙÈÓ›Ó˘ ÔÚÔ‡ <2 mg/dl Î·È >2 mg/dl Û 101 (58%) Î·È 60 ·ÛıÂÓ›˜ (35%) ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Û 12 ·ÛıÂÓ›˜ (7%) ÙÔ ÌfiÛ¯Â˘Ì· ÂÍ·ÈÚ¤ıËΠ¯ÂÈÚÔ˘ÚÁÈο, ÏfiÁˆ ÌË ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ËÏÈΛ· ÙÔ˘ ‰fiÙË Î·È Ë ‚·Ú‡ÙËÙ· Ù˘ ÛˆÏËÓ·Úȷ΋˜ ‚Ï¿‚˘ ηٿ ÙË ‚ÈÔ„›· Û¯ÂÙ›˙ÔÓÙ·Ó ·ÓÙ›ÛÙÚÔÊ· Ì ÙËÓ ·ÒÙÂÚË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (p=0.003 Î·È p=0.043). ™ËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ Ù˘ ËÏÈΛ·˜ ÙÔ˘ ‰fiÙË Î·È Ù˘ ·ÚÔ˘Û›·˜ ·ÚÙËÚÈÔÏÔÓÂÊÚÔÛÎÏ‹Ú˘ÓÛ˘ (p=0.00), Ô˘ ·ÔÙÂÏ› ‰˘ÛÌÂÓ‹ ·Ú¿ÁÔÓÙ· ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ™Àª¶∂ƒ∞™ª∞
∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ÚÈÓ ÙËÓ ÂÌʇÙÂ˘Û‹ ÙÔ˘ Ì ÙË Ì¤ıÔ‰Ô Ù˘ Ù·¯Â›·˜ ‚ÈÔ„›·˜ ‰›ÓÂÈ ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ¿ÌÂÛË Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘. ∏ ‚·Ú‡ÙËÙ· Ù˘ ÛˆÏËÓ·Úȷ΋˜ ‚Ï¿‚˘ Î·È Ë ÚÔ¯ˆÚË̤ÓË ËÏÈΛ· ÙÔ˘ ‰fiÙË Ô˘ Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·ÚÙËÚÈÔÏÔÓÂÊÚÔÛÎÏ‹Ú˘ÓÛË ¤¯Ô˘Ó ‰˘ÛÌÂÓ‹ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
58 ∂¶π¶∂¢∞ FGF-23 ¶ƒπ¡ ∫∞π ª∂Δ∞ ∞¶O ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ¢. OÈÎÔÓÔÌ›‰Ô˘, ™. ¡Ùfi‚·˜, ∞. ¶··ÁÈ¿ÓÓË, ¶. ¶·ÙÂÈÓ¿Î˘, ∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ¢. Δ·ÎÔ‡‰·˜, ¢. ª¤ÌÌÔ˜ ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶·ÙÚÒÓ
™∫O¶O™
∏ ʈÛÊ·ÙÔÓ›ÓË FGF-23 (fibroblast growth factor-23) ÂÌϤÎÂÙ·È ÛÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ ʈÛÊfiÚÔ˘ Î·È ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ‚ÈÙ·Ì›Ó˘ D, ·ÏÏ¿ Ô ÚfiÏÔ˜ Ù˘ ÛÙËÓ ˘ÔʈÛÊ·Ù·ÈÌ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË (¡ª) ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ˜. O ÛÎÔfi˜ ·˘Ù‹˜ Ù˘ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÌÂÏÂÙ‹ÛÂÈ Ù· ›‰· ÙÔ˘ FGF-23 Û ·ÛıÂÓ›˜ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜ ÔÛÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÚÈÓ Î·È ÌÂÙ¿ ·fi ¡ª. À§π∫O-ª∂£O¢O™
Δ· ›‰· ÙÔ˘ FGF-23 ÌÂÙÚ‹ıËÎ·Ó Û 18 ·ÛıÂÓ›˜ Ì ¡ª (̤ÛË ËÏÈΛ· 31±11 ¤ÙË) Ì ELISA ÚÈÓ Î·È 3, 6 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙË ¡ª. Δ· ›‰· ÙÔ˘ ·Î¤Ú·ÈÔ˘ ÌÔÚ›Ô˘ Ù˘ ·Ú·ıÔÚÌfiÓ˘ (iPTH), ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (Ca), ÙÔ˘ ʈÛÊfiÚÔ˘ (P), Ù˘ 25(O∏) ‚ÈÙ·Ì›Ó˘ D Î·È Ù˘ 1,25(O∏)2 ‚ÈÙ·Ì›Ó˘ D ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙȘ ›‰È˜ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜. ∞¶OΔ∂§∂™ª∞Δ∞
™ÙÔÓ 3Ô Ì‹Ó· Ù˘ ¡ª, Ë ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ‹Ù·Ó 1,3±0,1 mg/dl Î·È Ë GFR (Cr-EDTA) 50±18 ml/min/1,73 m2 Î·È ·Ú¤ÌÂÈÓ·Ó ÛÙ·ıÂÚ¿ ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. ™˘ÁÎÚÈÓfiÌÂÓ· Ì ٷ ›‰· ÙÔ˘ FGF-23 ÚÈÓ ÙË ¡ª, Ù· ›‰· ÙÔ˘ FGF-23 ÛÙÔ˘˜ 3, 6 Î·È 12 Ì‹Ó˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂȈ̤ӷ (346±146 vs 37±9; vs 32±20; vs 31±14 pg/ml, p<0,01 ÁÈ· ÙÔ Î·ı¤Ó·). ™ÙȘ ›‰È˜ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜, Ù· ›‰· ÙÔ˘ P (5,1±1,3 vs 3,2±0,6; vs 3,3±0,6; vs 3,6±0,5 mg/dl, p<0,005 ÁÈ· ÙÔ Î·ı¤Ó·) ηıÒ˜ Î·È Ù· ›‰· Ù˘ iPTH (164±181 vs 59±47; vs 65±47; vs 55±47 pg/ml, p<0,05 ÁÈ· ÙÔ Î·ı¤Ó·) ‹Ù·Ó ›Û˘ ÛËÌ·ÓÙÈο ÌÂȈ̤ӷ. ∂ÈϤÔÓ, ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ·Ú·ÙËÚ‹ıËΠÛÙ· ›‰· ÙÔ˘ Ca (9,3±0,8 vs 9,8±0,4; vs 9,9±0,5; vs 10,2±0,5 mg/dl, p<0,05 ÁÈ· ÙÔ Î·ı¤Ó·) Î·È Ù˘ 1,25(O∏)2 ‚ÈÙ·Ì›Ó˘ D (15,3±5,0 vs 37,6±16,1; vs 31,5±12,0; vs 33,1±16,7 pg/ml, p<0,05 ÁÈ· ÙÔ Î·ı¤Ó·). ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ P (FeP) Î·È ÛÙ· ›‰· Ù˘ 25(O∏) ‚ÈÙ·Ì›Ó˘ D. ¶·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ FeP Î·È ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ P ÛÙÔ˘˜ 3, 6 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙË ¡ª (p<0,0001, p<0,002 Î·È p<0,0001 ·ÓÙ›ÛÙÔȯ·). ∂ÈϤÔÓ, Ù· ›‰· ÙÔ˘ FGF-23 ÚÈÓ ÙË ¡ª Î·È Ù· ›‰· ÙÔ˘ P ÂÌÊ¿ÓÈ˙·Ó ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË (p<0,005). ™Àª¶∂ƒ∞™ª∞Δ∞
Δ· ›‰· ÙÔ˘ FGF-23 Û ·ÛıÂÓ›˜ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Û˘Û¯ÂÙ›˙ÔÓÙ·È ÛËÌ·ÓÙÈο Ì ٷ ›‰· ÙÔ˘ P ÌÂÙ¿ ·fi ¡ª. ªÂÙ¿ ·fi ¡ª Ù· ›‰· ÙÔ˘ FGF-23 ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ô˘ Û˘Ì‚·‰›˙ÂÈ Ì ·˘Ù‹ Ù˘ iPTH Î·È ÙÔ˘ P.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
59 ∏ ∫§π¡π∫∏ ™∏ª∞™π∞ Δ√À ∞¡∞¢π¶§∞™π∞™ª√À Δ√À π√À μ∫ ™∂ §∏¶Δ∂™ ¡∂ºƒπ∫√Y ª√™Ã∂Àª∞Δ√™ ª. ∫Ô˘ÎÔ˘Ï¿ÎË1, ¢. ¶ÈÛÙfiÏ·˜1, ∫. ª·Ï¿Ûη1, ∂. °Ú›ÛÔ˘2, £. ∞ÔÛÙfiÏÔ˘1, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘1, O. ¶·ÓÈ¿Ú·2, °. ™·ÚfiÁÏÔ˘1, ™. ¢Ú·ÎfiÔ˘ÏÔ˜1 1ªÔÓ¿‰· 2ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi
ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∂ÚÁ·ÛÙ‹ÚÈÔ, °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
¶·Ú’ fiÏÔ Ô˘ Ë ‰È¿ÁÓˆÛË Ù˘ μ∫ ÓÂÊÚÔ¿ıÂÈ·˜ Ù›ıÂÙ·È Ì ‚ÈÔ„›· ÓÂÊÚÔ‡, Ë ·Ó·˙‹ÙËÛË ÙÔ˘ ÈÔ‡ μ∫ Ì ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜ ÛÙÔ ·›Ì· Î·È Ù· Ô‡Ú· Û˘ÓÈÛÙÔ‡Ó ÙÔÓ ÂӉ‰ÂÈÁ̤ÓÔ ÙÚfiÔ Û˘ÛÙËÌ·ÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ. ™¯Â‰È¿ÛıËΠ̛· ÚÔÔÙÈ΋ ÌÂϤÙË ·Ó·˙‹ÙËÛ˘ ÙÔ˘ ÈÔ‡ μ∫ Û ϋÙ˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ Ì PCR. ªÂÏÂÙ‹ıËÎ·Ó 3 ÔÌ¿‰Â˜, Ë ÚÒÙË Ì 32 Ï‹Ù˜ ÚÒÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜, Û˘ÏϤ¯ıËÎ·Ó ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ÙËÓ ÚÒÙË Ë̤ڷ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Î¿ı 3 Ì‹Ó˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 18 ÌËÓÒÓ. ∏ ‰Â‡ÙÂÚË ÔÌ¿‰· ÂÚÈÂÏ¿Ì‚·Ó 34 ¿ÏÏÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÏϤ¯ıËÎ·Ó ‰‡Ô ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Ì ¯ÚÔÓÈ΋ ‰È·ÊÔÚ¿ ÙÚÈÒÓ ÌËÓÒÓ Î·È Ë ÙÚ›ÙË ÔÌ¿‰· ·ÔÙÂÏ›ÙÔ ·fi 30 ˘ÁÈ›˜ ÂÓ‹ÏÈΘ. ∏ ÂÈÏÔÁ‹ ÙˆÓ ·ÙfiÌˆÓ ÛÙȘ ÔÌ¿‰Â˜ μ Î·È ° ¤ÁÈÓ ¤ÙÛÈ ÒÛÙ ӷ ·ÚÔ˘ÛÈ¿˙Ô˘Ó fiÌÔÈ· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· Ì ÙËÓ ÔÌ¿‰· ∞.
¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ / £ÂÙÈο ‰Â›ÁÌ·Ù· ¢Â›ÁÌ·Ù· Ô‡ÚˆÓ / £ÂÙÈο ‰Â›ÁÌ·Ù·
¶ÚÒÙË ªÂÙ·ÌfiÛ¯Â˘ÛË
¶·Ï·ÈÔ› ªÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔÈ
ÀÁÈ›˜ ª¿ÚÙ˘Ú˜
228 / 31
63 / 1
30 / 0
228 /56
63 / 5
30 / 1
Δ· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÂϤÁ¯Ô˘ Ì PCR ÁÈ· ÙÔÓ Èfi μ∫ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î·. ™ÙËÓ 1Ë ÔÌ¿‰· ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ıÂÙÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ÙÔÓ ÙÚ›ÙÔ Ì‹Ó· ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Ê·›ÓÂÙ·È fiÙÈ Ë ÈÔ˘Ú›· ÚÔËÁÂ›Ù·È Ù˘ È·ÈÌ›·˜. ∏ ·ÓÔÛÔηٷÛÙÔÏ‹ Ì tacrolimus ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ÈÔ‡ μ∫ ÛÙ· Ô‡Ú· (p=0,027). ∏ ›وÛË Ù˘ ÈÔ˘Ú›·˜ Î·È Ù˘ È·ÈÌ›·˜ ÌÂÙ¿ ÙÔ 1Ô ¤ÙÔ˜ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È fiÌÔÈ· Ì ÙËÓ Â›ÙˆÛË ÛÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜. ∏ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‰ÂÓ ·ÚÔ˘Û›·Û ‰È·ÊÔÚÔÔ›ËÛË ÛÙȘ ÂÚÈÙÒÛÂȘ ÂÓÂÚÁÔ‡ ÈÈÎÔ‡ ·Ó·‰ÈÏ·ÛÈ·ÛÌÔ‡. ∏ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ μ∫ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÈÛ¯‡ Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ ·ÊÔ‡ ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· È·ÈÌ›·˜ Î·È ÈÔ˘Ú›·˜ ÛÙÔ ÚÒÙÔ 3ÌËÓÔ (ÈÛ¯˘ÚfiÙÂÚË ·ÓÔÛÔηٷÛÙÔÏ‹) Î·È ÂÂȉ‹ Ë ¯ÔÚ‹ÁËÛË tacrolimus Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÈÔ‡. ∏ ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Ë ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙË ¯ÚÔÓ›· ·ÓÔÛÔηٷÛÙÔÏ‹ Û˘Ì‚¿ÏÂÈ ÛÙËÓ Â¿ÓÔ‰Ô ÙÔ˘ ÈÔ‡ μ∫ ÛÙË Ï·Óı¿ÓÔ˘Û· ηٿÛÙ·ÛË.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
60 £∂ƒ∞¶∂π∞ ª∂ LEFLUNOMIDE °π∞ Δ∏¡ ∞¡Δπª∂Δø¶π™∏ Δ∏™ ¡∂ºƒO¶∞£∂π∞™ ∞¶O ΔO¡ πO BK ª∂Δ∞ ¡∂ºƒπ∫∏ ª∂Δ∞ªO™Ã∂À™∏ ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘1, ∂. ™˘ÓÔ‰ÈÓÔ‡1, °. §È¿Ë˜2, ∞. §¿˙·Ú˘2, ∫. ƒÂ‚¤Ó·˜3, ∞. ∞˘Ï¿ÌË4, π.¡. ªÔϤÙ˘1 1ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi
2ΔÌ‹Ì·
∫¤ÓÙÚÔ, °¡∞ «§·˚Îfi» ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ 3∞ÎÙÈÓÔÏÔÁÈÎfi ΔÌ‹Ì·, °¡∞ «§·˚Îfi» 4ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ΔÌ‹Ì·, °¡∞ «§·˚Îfi»
∏ Ì›ˆÛË Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜ ·ÔÙÂÏ› ÙË ‚·ÛÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓÂÊÚ¿ıÂÈ·˜ ·fi Èfi BK (BKV). ∏ ·Ú¿ÏÏËÏË ¯ÔÚ‹ÁËÛË ÙÔ˘ leflunomide (Arava®) Ê·›ÓÂÙ·È, fiÙÈ ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ÈÔ‡ Î·È ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·fiÚÚȄ˘. ™Â 5 ·ÛıÂÓ›˜ ‰È·ÈÛÙÒıËΠÓÂÊÚÔ¿ıÂÈ· ·fi BKV Ì ‚ÈÔ„›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÏfiÁˆ ·‡ÍËÛ˘ Ù˘ ÎÚ·ÙÈÓ›Ó˘, Û ‰È¿ÌÂÛÔ ¯ÚfiÓÔ 3 ÌËÓÒÓ (2-5) ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∏ ‰È¿ÌÂÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 33 ¤ÙË (22-50). OÈ 4 ›¯·Ó Ï¿‚ÂÈ ÌfiÛ¯Â˘Ì· ·fi ˙ÒÓÙ· ‰fiÙË Î·È ˘Ô‚Ï‹ıËÎ·Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÁÈ· 1Ë ÊÔÚ¿ Î·È 1 ·fi ·Ô‚ÈÒÛ·ÓÙ· Î·È ÌÂÙ·ÌÔۯ‡ıËΠÁÈ· 2Ë ÊÔÚ¿. ΔÔ ·Ú¯ÈÎfi ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi Û¯‹Ì· ÂÚÈÏ¿Ì‚·ÓÂ: ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË (5/5), tacrolimus (4/5), everolimus (3/5), MMF (2/5) Î·È Î˘ÎÏÔÛÔÚ›Ó˘ (1/5). ΔÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, ÙÔ everolimus ·ÓÙÈηٷÛÙ¿ıËΠ̠MMF. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó Ï¿‚ÂÈ daclizumab (4/5) ‹ basiliximab (1/5). ∂ÈϤÔÓ, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ‰fiÙË Ì ·Û‡Ì‚·ÙË ÔÌ¿‰· ·›Ì·ÙÔ˜ (n=3) ¯ÔÚËÁ‹ıËΠrituximab Î·È ˘Ô‚Ï‹ıËÎ·Ó Û ·ÓÔÛÔÚÔÛÚÔÊ‹ÛÂȘ (Glucosorb®). ∏ ‚·ÛÈ΋ ‰.Ù. ÎÚ·ÙÈÓ›Ó˘ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 1.4 mg (1.0-2.3) Î·È Î·Ù¿ ÙË ‚ÈÔ„›· 1.8 mg/dl (1.4-2.7). OÈ 5/5 ·ÛıÂÓ›˜ ›¯·Ó ıÂÙÈÎfi ÈÈÎfi ÊÔÚÙ›Ô ÁÈ· BKV ÛÙÔ ·›Ì· Ì ‰.Ù. 4.5 × 104 copies/ml (651-3.3 × 105) Î·È ıÂÙÈÎfi ÈÈÎfi ÊÔÚÙ›Ô ÛÙ· Ô‡Ú· Ì ‰.Ù 5.9 × 108 (2 × 105-2.9 × 1011), ÂÓÒ ÛÙ· Ô‡Ú· ‚Ú¤ıËÎ·Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ¤ÁÎÏÂÈÛÙ· ÙÔ˘ ÈÔ‡. ∏ ·ÓÔÛÔηٷÛÙÔÏ‹ ÌÂÈÒıËΠ̠‰È·ÎÔ‹ ÙÔ˘ MMF Î·È ·ÓÙÈηٿÛÙ·ÛË Ì leflunomide Î·È Ì›ˆÛË ÙÔ˘ ·Ó·ÛÙÔϤ· Ù˘ ηÏÛÈÓ¢ڛÓ˘ ÛÙ· ¯·ÌËÏfiÙÂÚ· ‰˘Ó·Ù¿ ›‰·. ªÂÙ¿ 12 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ (7-23), Ë ‰.Ù. ÎÚ·ÙÈÓ›Ó˘ Â›Ó·È 1.6 mg/dl (1.3-3.0). ∏ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‚ÂÏÙÈÒıËΠ۠3 ·ÛıÂÓ›˜ ÂÓÒ Û 2 ·Ú¤ÌÂÈÓ ÛÙ·ıÂÚ‹. O Èfi˜ ·ÚÓËÙÈÎÔÔÈ‹ıËΠÛÙÔ ·›Ì· ÌÂÙ¿ ·fi 1 Ì‹Ó· (0.5-3) ıÂڷ›·˜ Î·È ·Ú·Ì¤ÓÂÈ ·ÚÓËÙÈÎfi˜ ̤¯ÚÈ Û‹ÌÂÚ·. ŒÓ· ÂÂÈÛfi‰ÈÔ ÔÍ›·˜ ·fiÚÚȄ˘ ΢ÙÙ·ÚÈÎÔ‡ Ù‡Ô˘ ÛËÌÂÈÒıËΠ1 Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠÂÈÙ˘¯Ò˜. ∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË leflunomide ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¯ÔÚ‹ÁËÛË leflunomide Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ÌÔÚ› Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ·fi μ∫V.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
61 ∫ÀΔΔ∞ƒ√§√°π∫∏ ∂•∂Δ∞™∏ Δø¡ √Àƒø¡ °π∞ ∂§∂°ÃO Δ∏™ §√Iªø•∏™ ∞¶O Δ√¡ πO μ∫ ™∂ §H¶Δ∂™ ¡∂ºƒπ∫√Y ª√™Ã∂Yª∞Δ√™ ª. ∫Ô˘ÎÔ˘Ï¿ÎË1, M. O’ Donovan3, S. Pursglove3, ¢. ∞ÏÂÍÔÔ‡ÏÔ˘2, ™. ¢Ú·ÎfiÔ˘ÏÔ˜1 1ªÔÓ¿‰·
ªÂÙ·ÌÔۯ‡ÛˆÓ, ∫˘ÙÙ·ÚÔÏÔÁ›·˜ °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜, 3Department of Cytopathology, Addenbrooke’s Hospital, Cambridge, UK. 2∂ÚÁ·ÛÙ‹ÚÈÔ
O Èfi˜ μ∫ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ÙËÓ μ∫ ÓÂÊÚÔ¿ıÂÈ· Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ¯ÚÔÓ›· ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ıˆÚÂ›Ù·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ¤Î‚·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÔÙÂÏÂÛÌÙÈ΋ ·ÓÙÈ-ÈÈ΋ ıÂڷ›·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ΢ÙÙ·ÚÔÏÔÁÈ΋˜ ÂͤٷÛ˘ ÙˆÓ Ô‡ÚˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi ÙÔÓ Èfi μ∫ Û ϋÙ˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ªÂÏÂÙ‹Û·Ì ÚÔÔÙÈο 32 Ï‹Ù˜ ÚÒÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ Ì ΢ÙÙ·ÚÔÏÔÁÈ΋ ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ ÙËÓ ÚÒÙË Ë̤ڷ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È ÂÓ Û˘Ó¯›· οı ÙÚÂȘ Ì‹Ó˜ ̤¯ÚÈ ÙË Û˘ÌÏ‹ÚˆÛË ÂÓfi˜ ¤ÙÔ˘˜. °È· ÙËÓ Î˘ÙÙ·ÚÔÏÔÁÈ΋ ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ¯ÚÒÛË ¶··ÓÈÎÔÏ¿Ô˘ Î·È ·Ú·Ù‹ÚËÛË ÙˆÓ Ï·Îȉ›ˆÓ ÛÙÔ ·Ïfi ÌÈÎÚÔÛÎfiÈÔ. Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ΢ÙÙ·ÚÔÏÔÁ›·˜ Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (polymerase chain reaction, PCR) ÛÙ· Ô‡Ú· Î·È ÙÔ ·›Ì·. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 190 ÂÍÂÙ·Ûı¤ÓÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ, ·ÙÙ·Ú· decoy, ÂÓ‰ÂÈÎÙÈο Ïԛ̈͢ ·fi Èfi μ∫, ·Ú·ÙËÚ‹ıËÎ·Ó Û 7 ‰Â›ÁÌ·Ù· Î·È Û ¿ÏÏ· 7 ıˆڋıËΠÔχ Èı·Ó‹ Ë ·ÚÔ˘Û›· ÙÔ˘˜ ·ÏÏ¿ ‰ÂÓ ÌfiÚÂÛ ӷ Á›ÓÂÈ ‰È·ÊÔÚԉȿÁÓˆÛË ÌfiÓÔ Ì ·Ïfi ÌÈÎÚÔÛÎfiÈÔ. ∞ıÚÔ›˙ÔÓÙ·˜ Ù· ıÂÙÈο Î·È Ù· Èı·Ó¿ Â˘Ú‹Ì·Ù·, 14 ‰Â›ÁÌ·Ù· ·ÚÔ˘Û›·˙·Ó ¯·Ú·ÎÙËÚÈÛÙÈο ÁÈ· ·ÙÙ·Ú· «decoy» (14/190, 7.3%). Δ· ‰Â›ÁÌ·Ù· ·˘Ù¿ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi 11 Ï‹Ù˜. ™Â ÙÚÂȘ ÂÚÈÙÒÛÂȘ ˘‹Ú¯·Ó Ù·˘Ùfi¯ÚÔÓ· ıÂÙÈο ‰Â›ÁÌ·Ù· Ì ÙËÓ PCR ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ηıÒ˜ Î·È Ì ÙËÓ Î˘ÙÙ·ÚÔÏÔÁÈ΋ ÛÙ· Ô‡Ú·. ™Â 3 ÂÚÈÙÒÛÂȘ ˘‹ÚÍ·Ó Ù·˘Ùfi¯ÚÔÓ· ıÂÙÈο ‰Â›ÁÌ·Ù· ÛÙ· Ô‡Ú· Ì PCR Î·È Ì ΢ÙÙ·ÚÔÏÔÁ›· ¯ˆÚ›˜ ıÂÙÈÎfi ‡ÚËÌ· ÛÙÔ ·›Ì·. ∂ÓÒ ÛÙȘ ˘fiÏÔȘ ÔÎÙÒ ÂÚÈÙÒÛÂȘ Ë ·Ó›¯Ó¢ÛË Î˘ÙÙ¿ÚˆÓ decoy ÛÙ· Ô‡Ú· ‰ÂÓ Û˘Óԉ¢fiÙ·Ó Ì ·Ó›¯Ó¢ÛË ÙÔ˘ ÈÔ‡ Ì ÌÔÚȷ΋ ̤ıÔ‰Ô. ∏ ΢ÙÙ·ÚÔÏÔÁ›· Â›Ó·È Â‡ÎÔÏË Î·È ÁÚ‹ÁÔÚË Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË Î˘ÙÙ¿ÚˆÓ decoy fiÙ·Ó ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹ Ë Ï‹„Ë ‚ÈÔ„ÈÒÓ. ∏ ·Ó›¯Ó¢ÛË Î˘ÙÙ¿ÚˆÓ decoy ÛÙË ÌÂϤÙË ·˘Ù‹ ‹Ù·Ó ÂÚÈÔÚÈṲ̂ÓË (7,3%) Î·È Ô ÂÓÙÔÈÛÌfi˜ ÙÔ˘˜ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËΠ̠ٷ˘Ùfi¯ÚÔÓË ·Ó›¯Ó¢ÛË ÙÔ˘ ÈÈÎÔ‡ ÁÔÓȉÈÒÌ·ÙÔ˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ PCR. ™˘ÓÂÒ˜ Ë Î˘ÙÙ·ÚÔÏÔÁ›· ‰ÂÓ Â·ÚΛ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ μ∫ Ïԛ̈͢.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
62 ª∂§∂Δ∏ §π¶π¢∞πªπ∫OÀ ¶ƒOºπ§ ™∂ §∏¶Δ∂™ ¡∂ºƒπ∫OÀ ªO™Ã∂Àª∞ΔO™ ¢. ¶ÈÛÙfiÏ·˜1, ∫. ª·Ï¿Ûη1, ª. ∫Ô˘ÎÔ˘Ï¿ÎË1, £. ∞ÔÛÙfiÏÔ˘1, Ã. μÏ·¯fiÔ˘ÏÔ˜2, ∂. ∫˘Ú›ÛÙË3, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘1, Ã. ™ÙÂÊ·Ó¿‰Ë˜2, ™. ¢Ú·ÎfiÔ˘ÏÔ˜1 1ªÔÓ¿‰· 2∞’
ªÂÙ·ÌÔۯ‡ÛÂˆÓ °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜», ¶·ÓÂÈÛÙËÌȷ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °.¡.∞. πÔÎÚ¿ÙÂÈÔ, 3∞ã ΔÌ‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜, Δ∂π ∞ıËÓÒÓ
∏ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ ‰È·Ù·Ú¿ÛÛÂÈ ÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ ·ÛıÂÓÒÓ ÂËÚ¿˙ÔÓÙ·˜ Ì·ÎÚÔÚfiıÂÛÌ· ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ∏ ·ıËÚÔÛÎÏ‹Ú˘ÓÛË Â›Ó·È Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ˜ ÙˆÓ ·ÁÁ›ˆÓ Î·È ·ÛıÂÓ›˜ Ì ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ·ıËÚÔÛÎÏËÚˆÙÈ΋˜ ÓfiÛÔ˘ Û ¤Ó· ·ÁÁÂ›Ô ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ Û˘Ì‚·Ì¿ÙˆÓ Î·È Û ¿ÏÏ· ÙÌ‹Ì·Ù· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘, ªÂÏÂÙ‹ıËÎ·Ó 50, Ì‹ ‰È·‚ËÙÈÎÔ›, Ï‹Ù˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ (37 ¿Ó‰Ú˜, 13 Á˘Ó·›Î˜) ̤Û˘ ËÏÈΛ·˜ 47,5 ÂÙÒÓ. ŒÁÈÓ triplex ηڈٛ‰ˆÓ ÚÈÓ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Î·È ¤Ó· ¤ÙÔ˜ ÌÂÙ¿. ¶·Ú¿ÏÏËÏ· Ú·ÁÌ·ÙÔÔÈ‹ıËΠ¤ÏÂÁ¯Ô˜ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Î¿ı ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿, ̤¯ÚÈ ÙË Û˘ÌÏ‹ÚˆÛË ÂÓfi˜ ¤ÙÔ˘˜. OÈ Ï‹Ù˜ ¤Ï·‚·Ó ıÂڷ›· ÂÈÛ·ÁˆÁ‹˜ Î·È ÙÚÈÏfi ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi Û¯‹Ì· ÂÓÒ ‰ÂÓ ¤Ï·‚·Ó ÛÙ·Ù›Ó˜. Δ· Â˘Ú‹Ì·Ù· ·fi ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, HDL, Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î·. ◊Ș ·ıËڈ̷ÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‚Ú¤ıËÎ·Ó Ì ÙÔ triplex ÛÙÔ 50% ÙˆÓ ÏËÙÒÓ. ŒÓ· ¤ÙÔ˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, 18% ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ·ÚÔ˘Û›·˙ ·ıËڈ̷ÙÈΘ ·ÏÏÔÈÒÛÂȘ ÛÙÔ triplex ηڈٛ‰ˆÓ, 54% ›¯Â ‹È˜ Î·È 28% ÂÓÙÔÓfiÙÂÚ˜ ·ÏÏÔÈÒÛÂȘ. O ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÛÙȘ ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘ (·Ó¿Ï˘ÛË ÌÂÙ·‚ÏËÙ‹˜ ηٿ Ì›· ‰È‡ı˘ÓÛË, one way ANOVA, P<0.001) Î·È ÛÙÔ ‚·ıÌfi ÛÙ¤ÓˆÛ˘ ÙˆÓ Î·ÚˆÙ›‰ˆÓ (t-test ηٿ ˙‡ÁË, p=0.0013). OÈ ÏÈȉ·ÈÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ÙÔ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi Û¯‹Ì·. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ÚÔ·ÙÂÈ fiÙÈ ÛÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 12 ÌËÓÒÓ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ˘„ËÏfi ÔÛÔÛÙfi ÙˆÓ ÏËÙÒÓ ·ÚÔ˘Û›·Û ‹È˜ ‹ ÂÓÙÔÓfiÙÂÚ˜ ·ıËڈ̷ÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙȘ ηڈٛ‰Â˜ Î·È Î·Ù’ ¤ÎÙ·ÛË Û ¿ÏÏÔ ÙÌ‹Ì· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘ fiˆ˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. ª‹Ó·˜ ÃÔÏËÛÙÂÚfiÏË HDL ΔÚÈÁÏ˘ÎÂÚ›‰È·
0
3
6
12
169.56±44.04 44.2±11.28 144.2±9.82
211.46±44.22 52.12±13.29 182.58±8.28
201.56±35.29 53.0±14.42 175.36±9.71
198.64±41.05 54.84±16.25 147.76±7.77
∏ ÌÂϤÙË Û˘Ó¯›˙ÂÙ·È.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
63 ∞¡Δπª∂Δø¶π™∏ ª∏ ∂§∂°ÃOª∂¡∏™ À¶∂ƒ§π¶π¢∞πªπ∞™ ª∂ EZETIMIBE ™∂ ∞™£∂¡∂π™ ¶OÀ ∂ÃOÀ¡ À¶Oμ§∏£∂π ™∂ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ∂. ™·‚‚ȉ¿ÎË, ∞. ª¤ÓÔ˘, ∫. ºÔ˘ÚÙÔ‡Ó·˜, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË, ∂. ¶··¯Ú‹ÛÙÔ˘, ¢. °Ô‡ÌÂÓÔ˜, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘ ªÂÙ·ÌÔÛ¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ ¶.°.¡.¶·ÙÚÒÓ
∏ ezetimibe (EZETROL) Â›Ó·È ¤Ó·˜ ˘ÔÏÈȉ·ÈÌÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·ÔÚÚfiÊËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ‰È·ÈÙËÙÈΤ˜ Î·È ¯ÔÏÈΤ˜ ËÁ¤˜. ™∫O¶O™ – ªE£O¢Oπ
H ·ÛÊ¿ÏÂÈ· Î·È Ë Ì·ÎÚÔ¯ÚfiÓÈ· ˘ÔÏÈȉ·ÈÌÈ΋ ‰Ú¿ÛË Ù˘ ezetimibe (10 mg/24h) ÂÎÙÈÌ‹ıËΠ۠ÌÈ· ÌÂÁ¿ÏË ÔÌ¿‰· ·ÛıÂÓÒÓ (n=67), ̤Û˘ ËÏÈΛ·˜ 50±12 ÂÙÒÓ, 52 ¿Ó‰Ú˜ Î·È 15 Á˘Ó·›Î˜ Ì ÌË ÂÏÂÁ¯fiÌÂÓË ˘ÂÚÏÈȉ·ÈÌ›· Ô˘ ›¯·Ó ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. To Ê¿ÚÌ·ÎÔ ¯ÔÚËÁ‹ıËΠÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛÙ·Ù›ÓË (n=45: simvastatin n=13, atorvastatin n=20, pravastatin n=8, fluvastatin n=4), Û ¤ÙÔÈÌÔ Û˘Ó‰˘·ÛÌfi Ì simvastatin (Inegy) (n=11) Î·È Û·Ó ÌÔÓÔıÂڷ›· (n=11). O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 18±6 Ì‹Ó˜. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÎÙÈÌ‹ıËΠ‚¿ÛÂÈ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), LDL ¯ÔÏËÛÙÂÚfiÏË (LDL-C), HDL ¯ÔÏËÛÙÂÚfiÏË (HDL-C), ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG)), Ë ‰Â ·ÛÊ¿ÏÂÈ· ‚¿ÛÂÈ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ Ë·ÙÈ΋˜ (ALT, AST, LDH, CPK) Î·È ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ (Cr)) Î·È ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (cyclosporine n=40, tacrolimus n=16, everolimus n=10, sirolimus n=1). ∞¶OΔ∂§E™ª∞Δ∞
H ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ TC Î·È Ù˘ LDL-C ηٿ 25% Î·È 34% ·ÓÙ›ÛÙÔȯ· ‰È·ÈÛÙÒıËΠ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ Ì‹Ó· ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÂÚ¤ÌÂÈÓ ÛÙ·ıÂÚ‹ (TC: 230±34, 172±29 mg/dl Î·È LDL-C:147±25, 87±22 mg/dl) (p<0.001). OÈ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ezetimibe ˆ˜ ÌÔÓÔıÂڷ›· ·ÚÔ˘Û›·Û·Ó Ù· ›‰È· ÔÛÔÛÙ¿ Ì›ˆÛ˘ ¯ˆÚ›˜ fï˜ Ó· Êı¿ÛÔ˘Ó Ù· ÂÈı˘ÌËÙ¿ ›‰· ÏÈȉ›ˆÓ. ∏ ‰Ú¿ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‰ÂÓ ¤‰ÂÈÍ ӷ ÂÍ·ÚÙ¿Ù·È ·ÏÏ¿ Ô‡Ù ӷ ÂËÚ¿˙ÂÈ ÙËÓ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ Î·È Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·Ú¤ÌÂÈÓ ÛÙ·ıÂÚ‹ ηıã fiÏËÓ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ (Cr: 1.7±0.5, 1.5±0.5 mg/dl). Δ· Ë·ÙÈο ¤Ó˙˘Ì·, Ë LDH Î·È Ë CPK ·Ú¤ÌÂÈÓ·Ó Â›Û˘ ·ÌÂÙ¿‚ÏËÙ· ÂÎÙfi˜ ÂÓfi˜ ‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓÔ‡˜ Ô ÔÔ›Ô˜ ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (Inegy) ÂÌÊ¿ÓÈÛ ڷ‚‰ÔÌ˘fiÏ˘ÛË ÂÓÒ Û ‰‡Ô ¿ÏÏÔ˘˜ ·Ú·ÙËÚ‹ıËÛ·Ó Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÛÙ·Ì¿ÙËÛÂ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ™Àª¶∂ƒ∞™ª∞Δπ∫A
B¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ë ˘ÂÚÏÈȉ·ÈÌ›· Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο Î·È Ì ·ÛÊ¿ÏÂÈ· Ì ÙÔÓ Û˘Ó‰˘·ÛÌfi Ù˘ ezetimibe Ì ÛÙ·Ù›ÓË.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
64 ∏ ∂¶π¢ƒ∞™∏ Δ∏™ ∞ƒΔ∏ƒπ∞∫∏™ ¶π∂™∏™ ™Δ∏¡ ∂¶πμπø™∏ Δ√À ª√™Ã∂Àª∞Δ√™ ª∂Δ∞ ∞¶√ ª∂Δ∞ª√™Ã∂À™∏ ¡∂ºƒ√À °. μ¤ÚÁÔ˘Ï·˜, ∞. μ·ÁȈӿ, ∏. πˆ·ÓÓ›‰Ë˜, ª. ™È‰ËÚÔÔ‡ÏÔ˘, °Ú. ª˘ÛÂÚÏ‹˜, ¢. Δ·ÎÔ‡‰·˜ ªÔÓ¿‰· ªÂÙ·ÌÔۯ‡ÛˆÓ, ∞.¶.£, πÔÎÚ¿ÙÂÈÔ °.¡, £ÂÛÛ·ÏÔÓ›ÎË
™∫O¶O™
∏ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Û¯ÂÙ›˙ÂÙ·È Ì ÂÏ·Ùو̤ÓË ÂÈ‚›ˆÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ¢ÂÓ Â›Ó·È ÁÓˆÛÙ‹ fï˜ ̤¯ÚÈ Û‹ÌÂÚ· Ë Â›‰Ú·ÛË Ù˘ ÂÈÙ¢¯ı›Û˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Ô‡ÙÂ Ë Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ™Ùfi¯Ô˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ›‰Ú·Û˘ Ù˘ Û˘ÛÙÔÏÈ΋˜ (™∞¶), Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (¢∞¶) Î·È Ù˘ ›ÂÛ˘ ·ÏÌÔ‡ (¶¶) ÛÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. À§π∫O - ªE£O¢Oπ
∫·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ™∞¶ Î·È ¢∞¶ Î·È ˘ÔÏÔÁ›ÛıËΠÔÈ ¶¶ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘, 2Ô˘,3Ô˘,4Ô˘ Î·È 5Ô˘ ¯ÚfiÓÔ˘ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Û ÙÚÈ·ÎfiÛÈÔ˘˜ ÂÓ‹ÓÙ· ¤ÍÈ Ï‹Ù˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜ (123 Á˘Ó·›Î˜, ÂÚ›Ô‰Ô˜: π·ÓÔ˘¿ÚÈÔ˜ 1987 - OÎÙÒ‚ÚÈÔ˜ 2001) Ì ̤ÛË ËÏÈΛ· 38 ¤ÙË. ∞fi ÙËÓ ÌÂϤÙË ·ÔÎÏ›ÛıËÎ·Ó ÔÈ ·ÛıÂÓ›˜ οو ÙˆÓ 16 ÂÙÒÓ, ·ÛıÂÓ›˜ Ì ÂÈ‚›ˆÛË ÌÔۯ‡̷ÙÔ˜ ÌÈÎÚfiÙÂÚË ÙÔ˘ ¤ÙÔ˘˜ Î·È ·ÛıÂÓ›˜ Ô˘ ¯¿ıËÎ·Ó ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË. ΔÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ÛÙȘ 31 ª·˚Ô˘ 2007. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì Cox regression analysis Î·È Cox regression for Segmented TimeDependent covariates. OÈ ÙÈ̤˜ Ô˘ ¤ÏÂÈ·Ó ·ÓÙÈηٷÛÙ¿ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô ·˘ÙfiÌ·ÙÔ˘ ˘ÔÏÔÁÈÛÌÔ‡ “series mean”. ∞¶OΔ∂§E™ª∞Δ∞
O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ·ÒÏÂÈ·˜ ÌÔۯ‡̷ÙÔ˜ ÏfiÁˆ ™∞¶, ¢∞¶ Î·È PP ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· Ex(B)=1.005, E(x)B=0.993 Î·È E(x)B=1.011 Î·È Ë ÛÙ·ÙÈÛÙÈ΋ Wald ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û η̛· ·fi ÙȘ ÂÚÈÙÒÛÂȘ. ∏ ™∞¶, ¢∞¶ Î·È ¶¶ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ ¯ÚfiÓÔ˘ ÌÂÙ¿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹Ù·Ó 134,53±16,2 mmHg, 85,90±12,38 mmHg Î·È 48,62±12,38 mmHg ·ÓÙ›ÛÙÔȯ·. O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ·ÒÏÂÈ·˜ ÌÔۯ‡̷ÙÔ˜ ÏfiÁˆ ™∞¶, ¢∞¶ Î·È PP ‹Ù·Ó Ex(B)=1.018, Ex(B)=1.017 Î·È Ex(B)=1.019 ·ÓÙ›ÛÙÔȯ· Î·È Ë ÛÙ·ÙÈÛÙÈ΋ Wald ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ (p=0.0005, p=0.037, p=0.02 ·ÓÙ›ÛÙÔȯ·). ∂Í·ÈÚÒÓÙ·˜ Ù· ÌÔۯ‡̷ٷ Ô˘ ¯¿ıËÎ·Ó ÏfiÁˆ ı·Ó¿ÙÔ˘ Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÏfiÁˆ ™∞¶, ¢∞¶ Î·È PP ‹Ù·Ó Ex(B)=1.017, Ex(B)=1.020 Î·È Ex(B)=1.016 ·ÓÙ›ÛÙÔȯ· Î·È Ë ÛÙ·ÙÈÛÙÈ΋ Wald ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ (p=0.004, p=0.038, p=0.037 ·ÓÙ›ÛÙÔȯ· ). ™Àª¶∂ƒ∞™ª∞Δ∞
O Ì·ÎÚÔ¯ÚfiÓÈÔ˜ ΛӉ˘ÓÔ˜ ·ÒÏÂÈ·˜ ÌÔۯ‡̷ÙÔ˜ Û ۯ¤ÛË Ì ÙËÓ ™∞¶, ÙËÓ ¢∞¶ Î·È ÙË PP ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ ·Ô‰Â›¯ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi˜, ÂÓÒ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÓÙ·ÂÙ›·˜ Ë ™∞¶, Ë ¢∞¶ Î·È Ë PP Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÒÏÂÈ·˜ ÌÔۯ‡̷ÙÔ˜, Ë ÔÔ›· fï˜ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
65 ¶ƒ√™¢π√ƒπ™ª√™ Δ√À GFR ª∂ 51CR-EDTA ∫∞π ∞•π√§Ÿ°∏™∏ Δø¡ ∂•π™fl™∂ø¡ MDRD6 ∫∞π COCKCROFT-GAULT (CG) ™∂ ∞™£∂¡∂ÿ˜ ª∂ ¡∂ºƒπ∫Ÿ ªŸ™Ã∂Àª∞. °. μ¤ÚÁÔ˘Ï·˜1, °Ú. ª˘ÛÂÚÏ‹˜1, °. ÕÚÛÔ˜2, ™. ∫·Ú·Ì¿, °Ú. ¢‹Ì·˜, ∞. μÏ¿¯Ô˘, ª. ¡ÈÎÔ‰ËÌÔÔ‡ÏÔ˘1, ª. Δ¤ÚÛË1, ∞. ¡Ù›Ó·˜, ¢. Δ·ÎÔ‡‰·˜1 1ÃÂÈÚÔ˘ÚÁÈ΋ 2A’
∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, ∞.¶.£, πÔÎÚ¿ÙÂÈÔ °.¡. £ÂÛÛ·ÏÔӛ΢ ∂ÚÁ·ÛÙ‹ÚÈÔ ¶˘ÚËÓÈ΋˜ π·ÙÚÈ΋˜, ∞.¶.£, πÔÎÚ¿ÙÂÈÔ °.¡. £ÂÛÛ·ÏÔӛ΢
™∫O¶O™
∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ›‰· ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡ (SCr) ÂÍ·ÚÙÒÓÙ·È ·fi ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·ÓÂÍ¿ÚÙËÙÔ˘˜ ·fi ÙÔÓ GFR. O ·ÛıÂÓ‹˜ Ì ÓÂÊÚÈÎfi ÌfiÛ¯Â˘Ì· ¤¯ÂÈ ·Ó¿ÁÎË Ù·ÎÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÙÔ˘ GFR (ÌÔÓfiÓÂÊÚÔ˜, ›‰Ú·ÛË ÓÂÊÚÔÙÔÍÈÎÒÓ Ê·Ú̿ΈÓ). OÈ ÂÍÈÛÒÛÂȘ MDRD6 (6 ·Ú·ÁfiÓÙˆÓ) Î·È CG Ô˘ ‚·Û›˙ÔÓÙ·È ÛÙË Ì¤ÙÚËÛË Ù˘ SCr, ÏfiÁˆ ·ÏfiÙËÙ·˜ ÂÊ·ÚÌfi˙ÔÓÙ·È Û˘¯Ó¿ ÛÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ GFR (GFR-MDRD6 Î·È GFR-CG ·ÓÙ›ÛÙÔȯ·) ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË. ™ÙËÓ ÂÚÁ·Û›· Ì·˜ ÂϤÁ¯ıËÎÂ Ë ·ÎÚ›‚ÂÈ· Î·È Î·Ù·ÏÏËÏfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ÂÍÈÛÒÛÂˆÓ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË, Ì ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ GFR Ì ÙËÓ Î¿ı·ÚÛË ÙÔ˘ 51Cr-EDTA (GFR-Cr). ∞™£∂¡∂π™ - ªE£O¢Oπ
™Â ÂηÙfiÓ Û·Ú¿ÓÙ· ‰‡Ô ·ÛıÂÓ›˜ (49 Á˘Ó·›Î˜) ̤Û˘ ËÏÈΛ·˜ 40 ÂÙÒÓ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ÌÂÙÚ‹ıËÎÂ Ô GFR-Cr Î·È ˘ÔÏÔÁ›ÛıËÎ·Ó ÔÈ GFR-MDRD6 Î·È GFR-CG. ∞ÔÎÏ›ÛıËÎ·Ó ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 16 ÂÙÒÓ. H ÛÙ·‰ÈÔÔ›ËÛË Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ (á¡) ¤ÁÈÓ Ì ‚¿ÛË ÙȘ ÙÈ̤˜ GFR-Cr Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ K/DOQI (¡KF, 2002). ΔÔ t test ÁÈ· Û˘˙¢Á̤ӷ Î·È ÌË ‰Â›ÁÌ·Ù· Î·È Ë Û˘Ó‹ı˘ ÂÚÈÁÚ·ÊÈ΋ ÛÙ·ÙÈÛÙÈ΋ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÂÚÁ·Û›·. ∞¶OΔ∂§E™ª∞Δ∞
OÈ GFR-Cr, GFR-MDRD6 Î·È GFR-CG (Û ml/min/1,73 m2) ‹Ù·Ó, ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ, 35,9± 16,6, 46,3 ±19,2 Î·È 51,1 ±17,8 (p < 0,0005 ÁÈ· fiϘ ÙȘ ·Ó¿ ˙‡ÁË Û˘ÁÎÚ›ÛÂȘ). ™Â 8/142 ·ÛıÂÓ›˜ Ì 5Ô˘ ÛÙ·‰›Ô˘ á¡ oÈ GFR-MDRD6 (20,8 ±6,6) Î·È GFR-CG (27,0±9,2) ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο (p = 0,002 Î·È p=0,001 ·ÓÙ›ÛÙÔȯ·) ·fi ÙÔÓ GFR-Cr (11,6 ±1,9). ™Â 50/142 ·ÛıÂÓ›˜ Ì 4Ô˘ ÛÙ·‰›Ô˘ á¡ oÈ GFR-MDRD6 (32,3 ±9,2) Î·È GFR-CG (38,9 ±10,0) ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο (p= 0,002 Î·È p=0,001 ·ÓÙ›ÛÙÔȯ·) ·fi ÙÔÓ GFR-Cr (22,9±4,5). OÌÔ›ˆ˜, Û 72/142 ·ÛıÂÓ›˜ Ì 3Ô˘ ÛÙ·‰›Ô˘ á¡ oÈ GFR-MDRD6 (52,1 ±11,3) Î·È GFR-CG (56,6 ±11,8) ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο (p= 0,002 Î·È p=0,001 ·ÓÙ›ÛÙÔȯ·) ·fi ÙÔÓ GFR-Cr (41,3 ± 6,9). Δ¤ÏÔ˜, Û 12/142 ·ÛıÂÓ›˜ Ì 2Ô˘ ‹ 1Ô˘ ÛÙ·‰›Ô˘ á¡, oÈ GFR-MDRD6 (86,0± 12,6) Î·È GFR-CG (85,1 ±9,5) ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο (p= 0,016 Î·È p=0,001 ·ÓÙ›ÛÙÔȯ·) ·fi ÙÔÓ GFR-Cr (74,5 ±9,8). ™Àª¶∂ƒ∞™ª∞Δ∞
™Â ·ÛıÂÓ›˜ Ì ÓÂÊÚÈÎfi ÌfiÛ¯Â˘Ì·, ÔÈ ÂÍÈÛÒÛÂȘ MDRD6 Î·È CG ˘ÂÚÂÎÙÈÌÔ‡Ó ÙÔÓ GFR ηٿ 80,8% Î·È 133,9% Û á¡ 5Ô˘ ÛÙ·‰›Ô˘, ηٿ 41,5% Î·È 70,0% Û á¡ 4Ô˘ ÛÙ·‰›Ô˘, ηٿ 26,1% Î·È 36,9% Û á¡ 3Ô˘ ÛÙ·‰›Ô˘ Î·È Î·Ù¿ 15,4 % Î·È 14,1% Û á¡ 1Ô˘ ‹ 2Ô˘ ÛÙ·‰›Ô˘ ·ÓÙ›ÛÙÔȯ·. ™˘ÓÂÒ˜, ‰ÂÓ Â›Ó·È Î·ÏÔ› ‰Â›ÎÙ˜ ÂϤÁ¯Ô˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ ·ÛıÂÓÒÓ Ô˘ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ¤¯Ô˘Ó á¡ 3Ô˘ Î·È 4Ô˘ ÛÙ·‰›Ô˘.
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66 ∏ ∫À∫§O™¶Oƒπ¡∏ ΔƒO¶O¶Oπ∂π Δ∞ ™À™Δ∏ª∞Δ∞ ¡πΔƒπ∫OÀ O•∂π¢πOÀ ∫∞π ∂¡¢O£∏§π¡∏™ ™∂ ¡∂ºƒπ∫∞ ™ø§∏¡∞ƒπ∞∫∞ ∫ÀΔΔ∞ƒ∞ ∂. ¶··¯Ú‹ÛÙÔ˘1, ¶. ∫ˆÙÛ·ÓÙ‹˜2, ¢. °Ô‡ÌÂÓÔ˜1, ¶. ∫·ÏÏÈ·ÎÌ¿ÓË1, ∂. ™·‚‚ȉ¿ÎË1, ∫. ºÔ˘ÚÙÔ‡Ó·˜1, ¶. ∫·ÙÛÒÚ˘2, π.°. μÏ·¯ÔÁÈ¿ÓÓ˘1 1¶·ÓÂÈÛÙ‹ÌÈÔ
¶·ÙÚÒÓ, ΔÌ‹Ì· π·ÙÚÈ΋˜, ¶·ıÔÏÔÁÈÎfi˜ ΔÔ̤·˜, ¡ÂÊÚÔÏÔÁÈÎfi ∫¤ÓÙÚÔ 2¶·ÓÂÈÛÙ‹ÌÈÔ ¶·ÙÚÒÓ, ΔÌ‹Ì· μÈÔÏÔÁ›·˜
™∫O¶O™
ΔÔ Î‡ÚÈÔ ÌÂÈÔÓ¤ÎÙËÌ· ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ ηÏÛÈÓ¢ڛÓ˘ fiˆ˜ Ë Î˘ÎÏÔÛÔÚ›ÓË (CsA) Â›Ó·È Ë ÓÂÊÚÔÙÔÍÈÎfiÙËÙ·, Ë ÔÔ›· ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛı›. Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Ë CsA ÚÔηÏ› ÓÂÊÚÈ΋ ·ÁÁÂÈÔÛ‡Û·ÛË Î·È ÙÚÔÔÔ›ËÛË ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙˆÓ ÂÈıËÏÈ·ÎÒÓ ÛˆÏËÓ·ÚÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ÌÂϤÙË Ù˘ ‰Ú¿Û˘ Ù˘ CsA ÛÙË ·Ú·ÁˆÁ‹ NO Î·È ET-1 Û ηÏÏȤÚÁÂȘ ÂÈıËÏÈ·ÎÒÓ ÛˆÏËÓ·ÚÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È Ë ·ÏÏËÏ›‰Ú·ÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÌÔÚ›ˆÓ. À§π∫O-ª∂£O¢Oπ
∞ÓıÚÒÈÓ· ÛˆÏËÓ·Úȷο ·ÙÙ·Ú· (HK-2) ˆ¿ÛıËÎ·Ó ÁÈ· ÔÈΛϷ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· Î·È Ì ‰È¿ÊÔÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ CsA. ªÂÏÂÙ‹ıËÎÂ Ë Â›‰Ú·ÛË Ù˘ CsA ÛÙË ·Ú·ÁˆÁ‹ NO Î·È ET-1, Ë ÁÔÓȉȷ΋ ¤ÎÊÚ·ÛË Î·È Û˘ÛÛÒÚ¢ÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ A Î·È B Ù˘ ÂÓ‰ÔıËÏ›Ó˘ (∂Δr-∞ Î·È ETr-B), ÙˆÓ Û˘ÓıÂÙ·ÛÒÓ ÙÔ˘ NO (e-NOS Î·È i-NOS), ηıÒ˜ Î·È Ë ·ÏÏËÏ›‰Ú·ÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÌÂÙ¿ ·fi ›‰Ú·ÛË ·Ó·ÛÙÔϤ· Ù˘ ·Ú·ÁˆÁ‹˜ ¡O (L-NAME) Î·È ·Ó·ÛÙÔϤˆÓ Ù˘ ‰Ú¿Û˘ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ∂Δr-∞ (BQ-123) Î·È ETr-B (BQ-788). ∞¶OΔ∂§∂™ª∞Δ∞
∏ ÂÒ·ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì CsA ·˘Í¿ÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ET-1 Î·È NO. ∂›Û˘ Ë CsA Ô‰ËÁ› Û ÁÔÓȉȷ΋ ·ÁˆÁ‹ ÙˆÓ ∂Δr-∞ Î·È ETr-B, ÙˆÓ i-NOS Î·È e-NOS Î·È ÛÂ Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÚˆÙÂ˚ÓÒÓ. ∂Ò·ÛË Ì CsA ·ÚÔ˘Û›· L-NAME ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ ·ÁˆÁ‹˜ ÙÔ˘ ˘Ô‰Ô¯¤· ∂Δr-μ, ÂÓÒ ‰ÂÓ ÙÚÔÔÔÈÂ›Ù·È Ë Â·ÁˆÁ‹ ÙÔ˘ ˘Ô‰Ô¯¤· ∂Δr-∞. ∂Ò·ÛË Ì BQ123 Î·È BQ-788 Û˘Óԉ‡ÂÙ·È ·fi ηٷÛÙÔÏ‹ Ù˘ Û˘ÛÛÒÚ¢Û˘ Ù˘ e-NOS, ÂÓÒ Ë ·Ú·ÁˆÁ‹ Î·È Û˘ÛÛÒÚ¢ÛË i-NOS ‰ÂÓ ÂËÚ¿˙ÂÙ·È. ™Àª¶∂ƒ∞™ª∞Δ∞
∞fi Ù· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· Ê·›ÓÂÙ·È fiÙÈ Ë ÓÂÊÚÔÙÔÍÈÎfiÙËÙ· Ù˘ CsA ÔÊ›ÏÂÙ·È Û ÂÓÂÚÁÔÔ›ËÛË ÙfiÛÔ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ NO, fiÛÔ Î·È Ù˘ ET-1. ∏ ‰Ú¿ÛË ·˘Ù‹ Â›Ó·È ¿ÌÂÛË Î·È ‰ÂÓ ·Ó·ÛÙ¤ÏÏÂÙ·È ·fi ÙÔÓ ‚·ıÌfi ÂÓÂÚÁÔÔ›ËÛ˘ ÂοÛÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ¯ˆÚÈÛÙ¿. ¶ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ··ÈÙÔ‡ÓÙ·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍÂÙ·Ûı› Â¿Ó Ë ÓÂÊÚÔÙÔÍÈÎfiÙËÙ· Ù˘ CsA ·Ó·ÛÙ¤ÏÏÂÙ·È Ì ÙÔÓ Ù·˘Ùfi¯ÚÔÓÔ ·ÔÎÏÂÈÛÌfi ÙˆÓ ‰‡Ô Û˘ÛÙËÌ¿ÙˆÓ.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
67 TAMOXIFEN THERAPY IN ENCAPSULATING SCLEROSING PERITONITIS IN PATIENTS ON CONTINUOUS AMPULATORY PERITONEAL DIALYSIS AFTER KIDNEY TRANSPLANTATION P. Moustafellos, V. Hadjianastassiou, A. Vaidya, P.J. Friend Oxford Transplant Unit, Oxford Radcliffe NHS Trust, Oxford
Sclerosing encapsulating peritonitis (SEP) is a serious complication of long-term continuous ambulatory peritoneal dialysis (CAPD) associated with ileus symptoms and sclerosis of the peritoneal membrane. There is no evidence based therapy for SEP. we present two cases that were successfully treated with tamoxifen and corticosteroids. Case 1: A 40 year old patient developed end stage renal failure (ESRF) due to diabetes type I and was started on peritoneal dialysis. He was hospitalised with symptoms of small bowel obstruction. He underwent laparotomy that revealed enlarged small bowel loops with increased thickening of the peritoneum, non-purulent ascites and multiple fibrinous adhesions. Peritoneal biopsies were taken confirming the diagnosis of SEP. The patient was given Tamoxifen 20 mg twice a day. Case 2: A 55 year old patient with ESRF secondary to membranous glomerulonephritis. He had a cadaveric renal transplant in 1978 that failed 20 years later the patient returned to (CAPD). Six years later he had an uneventful kidney transplant and the peritoneal dialysis catheter was removed. However he presented 8 months later with gross blood stained ascites and symptoms of small bowel obstruction. He also underwent a laparotomy that confirmed the diagnosis of SEP. The patient was started on 20 mg of Tamoxifen twice a day. Both patients symptoms were improved gradually with an increase of serum albumin and body weight. Tamoxifen may be useful in the treatment of patients diagnosed with SEP.
83
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
68 OÀƒO§O°π∫∂™ ∂¶π¶§O∫∂™ ™∂ 1525 ¶∂ƒπ¶Δø™∂π™ ª∂Δ∞ªO™Ã∂À™∏™ ¡∂ºƒOÀ °. ∑·‚‚fi˜1, ¶. ¶·¿˜2, £. ∫·Ú·Ù˙¿˜3, ¡. ∫·Ú‡‰Ë˜3, π. ªfiÎÔ˜1, ∂. £ÂÔ‰ˆÚÔÔ‡ÏÔ˘4, ∫. ™ÙÚ·‚Ô‰‹ÌÔ˜5, ∞. μÔ˘ÙÛ·Ú¿Î˘1, ¢. ∫¿ÚϘ1, ∂ÈÚ. ™˘ÓÔ‰ÈÓÔ‡1, ¶. ¶··‰¿ÎË1, π. ªÔϤÙ˘4, ∞. ∫ˆÛÙ¿Î˘3 1∫ÏÈÓÈ΋
ªÂÙ·ÌÔۯ‡ÛˆÓ, 2∞ÎÙÈÓÔÏÔÁÈÎfi ΔÌ‹Ì·, 3μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋, ∫ÏÈÓÈ΋, 5O˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, “§∞´∫O” °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ
4¡ÂÊÚÔÏÔÁÈ΋
OÈ Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·ÔÙÂÏÔ‡Ó ÛÔ‚·Ú‹ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜, ÚÔηÏÔ‡Ó Î·ı˘ÛÙÂÚË̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ·ÒÏÂÈ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È /‹ ı¿Ó·ÙÔ ÙÔ˘ Ï‹ÙË. ∂Ó›ÔÙ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ‰È·ÁÓˆÛÙÈ΋ ‰˘ÛÎÔÏ›· Ô˘ ÚÔ‚ÏËÌ·Ù›˙ÂÈ ÙÔ ¯ÂÈÚÔ˘ÚÁfi. ¶ÚÒ˚ÌË ‰È¿ÁÓˆÛË ‚·ÛÈṲ̂ÓË ÛÙÔÓ ˘„ËÏfi ‰Â›ÎÙË ˘Ô„›·˜ Î·È ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ·Ú·Ì¤ÓÔ˘Ó Ù· ÎÚ›ÛÈÌ· ÛËÌ›· ÁÈ· ÙË ÛˆÛÙ‹ ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘. ∞ӷχıËÎ·Ó ·Ó·‰ÚÔÌÈο ÔÈ Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ÙÔ˘ ÌÂÙ·ÌÔÛ¯Â˘ÙÈÎÔ‡ Ì·˜ ΤÓÙÚÔ˘ Ì ÛÙfi¯Ô Ó· ηٷÁÚ·ÊÔ‡Ó ÙÔ Â›‰Ô˜, Ë Û˘¯ÓfiÙËÙ· Î·È Ô ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÂÈÏÔÎÒÓ, Û ۯ¤ÛË Ì ÙËÓ ¤Î‚·ÛË ÌÔۯ‡̷ÙÔ˜ Î·È ·ÚÚÒÛÙÔ˘. À§π∫O-ª∂£O¢Oπ
ªÂٷ͇ π·ÓÔ˘·Ú›Ô˘ 1983 Î·È ª·ÚÙ›Ô˘ 2007, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó 1525 ÌÂÙ·ÌÔۯ‡ÛÂȘ ÓÂÊÚÔ‡, 814 ·fi ˙ÒÓÙ˜ Î·È 711 ·fi و̷ÙÈÎÔ‡˜ ‰fiÙ˜. 96 ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔÈ ·ÚÔ˘Û›·Û·Ó Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜, 69 ¿Ó‰Ú˜ Î·È 27 Á˘Ó·›Î˜. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ÙÚÔÔÔÈË̤ÓË Lich-Gregoire Ô˘ÚËÙËÚÔ΢ÛÙÈ΋ ÂÌʇÙ¢ÛË Ì ÂÏ¿¯ÈÛÙË ·Ú·Û΢‹ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘. O˘ÚËÙËÚÈ΋ ÚÔÛı‹ÎË ‰ÈÏÔ‡ J ÙÔÔıÂÙ‹ıËΠ۠ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ, ΢ڛˆ˜ Û ϋÙ˜ و̷ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜, Ô˘ ·Ê·ÈÚ›ÙÔ Û 11/2 Ì‹Ó·. ∏ ·ÓÔÛÔηٷÛÙÔÏ‹ ‚·ÛÈ˙fiÙ·Ó Û ÙÚÈÏfi ‹/Î·È ÙÂÙÚ·Ïfi Û¯‹Ì·. DTPA ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÁÈÓfiÙ·Ó ÙËÓ 1Ë ‹ 2Ë ÌÌ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Î·È ¤Á¯ÚˆÌÔ Doppler ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Û ÂÈÏÂÁ̤ӷ ÂÚÈÛÙ·ÙÈο ÌÂÙ¿ ·fi ÎÏÈÓÈ΋ ˘Ô„›· ηÈ/‹ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜. OÈ Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û‡Ìʈӷ Ì ÙÔ Ì˯·ÓÈÛÌfi Î·È ÙË ı¤ÛË ÙÔ˘˜ ÛÙÔ Ô˘ÚÔÔÈËÙÈÎfi Î·È ÂÚÈÏ¿Ì‚·Ó·Ó: ∞) ÛÙ¤ÓˆÛË/·fiÊÚ·ÍË ˘ÂÏÔÔ˘ÚËÙËÚÈ΋˜ Û˘Ì‚ÔÏ‹˜, μ) ÛÙ¤ÓˆÛË/·fiÊÚ·ÍË Ô˘ÚËÙ‹Ú·, °) ÛÙ¤ÓˆÛË/·fiÊÚ·ÍË Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ Û˘Ì‚ÔÏ‹˜, ¢) ‰È·Ê˘Á‹ Ô‡ÚˆÓ Î·È ∂) ¿ÏϘ. ∞¶OΔ∂§∂™ª∞Δ∞
∞fi ÙȘ 96 Ô˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Û ۇÓÔÏÔ 1525 ÌÂÙ·ÌÔۯ‡ÛÂˆÓ (6,3%), ÔÈ 44 (45,8%) Û˘Ó¤‚ËÛ·Ó ÙÔ 1Ô ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi Ì‹Ó·, 28 (29,2% ) ÌÂٷ͇ 2Ô˘ Î·È 6Ô˘ Ì‹Ó· Î·È 24 (25,0%) ÌÂÙ¿ ÙÔ 1Ô 6ÌËÓÔ. O ·Ú·Î¿Ùˆ ›Ó·Î·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi Î·È ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏÔÎÒÓ ÛÙȘ ‰È¿ÊÔÚ˜ ÔÌ¿‰Â˜. OÌ¿‰· ∞ μ C D E
O˘ÚÔÏÔÁÈ΋ ÂÈÏÔ΋ ™Ù¤ÓˆÛË/∞fiÊÚ·ÍË ˘ÂÏÔÔÔ˘ÚËÙËÚÈ΋˜ Û˘Ì‚ÔÏ‹˜ ™Ù¤ÓˆÛË/∞fiÊÚ·ÍË Ô˘ÚËÙ‹Ú· ™Ù¤ÓˆÛË/∞fiÊÚ·ÍË Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·Ó·ÛÙfïÛ˘ ¢È·Ê˘Á‹ Ô‡ÚˆÓ ÕÏÏÔ
N
%
12 27 29 25 3
12,5% 28,1% 30,2% 26,0% 3,1%
ÃÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ¯ÚÂÈ¿ÛıËΠ۠49 (51,0%) ÂÚÈÙÒÛÂȘ. ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ÚÒ˚ÌË ‰È¿ÁÓˆÛË Î·È Ë ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ô˘ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙË ÌÂÁ¿ÏË ÏÂÈÔÓfiÙËÙ· (93,8%) ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ì·˜. ∏ ÚfiÏË„Ë ÙˆÓ ÂÈÏÔÎÒÓ ·˘ÙÒÓ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙË ÛˆÛÙ‹ Ù¯ÓÈ΋ Ï‹„˘ Î·È ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÙÔ˘ ÓÂÊÚÔ‡.
84
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
69 ∞•πO¶Oπ∏™∏ Δø¡ “Oƒπ∞∫ø¡” ¢OΔø¡ ™Δ∏ ¶Δøª∞Δπ∫∏ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ∞. °fiÌÔ˘1, £. ∫·Ú·Ù˙¿˜2, °. ∑·‚‚fi˜3, μ. ¶··ÓÈÎÔÏ¿Ô˘4, °. ª˘ÛÂÚÏ‹˜4, ™. ¢Ú·ÎfiÔ˘ÏÔ˜5, ª. ∫Ô˘ÎÔ˘Ï¿ÎË5, ∫. •ËÚÔÌÂÚ›Ù˘6, Ã. ™Ù·ı¿Î˘7, π. ªÔϤÙ˘7, ∞. ∫ˆÛÙ¿Î˘1,2 1∂ıÓÈÎfi˜
OÚÁ·ÓÈÛÌfi˜ ªÂÙ·ÌÔۯ‡ÛˆÓ, 2μã ¶ÚÔ·È‰Â˘ÙÈ΋ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛˆÓ, 4ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ∞¶£, 5ªÔÓ¿‰· ªÂÙ·ÌÔۯ‡ÛÂˆÓ OÚÁ¿ÓˆÓ, £ÂÚ·Â˘Ù‹ÚÈÔ “∂À∞°°∂§π™ªO™”, 6∞ã ÃÂÈÚÔ˘ÚÁÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, 7¡ÂÊÚÔÏÔÁÈ΋ KÏÈÓÈ΋ “§·˚Îfi” ¡ÔÛÔÎÔÌÂ›Ô 3∫ÏÈÓÈ΋
∏ ÌfiÓÈÌË ¤ÏÏÂÈ„Ë ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·ÁÎÔÛÌ›ˆ˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â¤ÎÙ·ÛË ÙˆÓ ÎÚÈÙËÚ›ˆÓ ¤Ó‰ÂÈ͢ ‰fiÙË Î·È ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÓÂÊÚÒÓ ·fi “ÔÚÈ·ÎÔ‡˜” و̷ÙÈÎÔ‡˜ ‰fiÙ˜. ™‹ÌÂÚ·, Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ‰ÈÂıÓÒ˜ ¤Ó·˜ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌfi˜ ÌÂÙ·ÌÔۯ‡ÛÂˆÓ ÓÂÊÚÔ‡ ·fi “ÔÚÈ·ÎÔ‡˜” ‰fiÙ˜ ÔÈ ÔÔ›ÔÈ ı· ›¯·Ó ÎÚÈı› ÛÙÔ ·ÚÂÏıfiÓ ·Î·Ù¿ÏÏËÏÔÈ. ∏ ÌÂϤÙË ·˘Ù‹ ÛÎÔfi ¤¯ÂÈ Ó· ‰ÈÂÚ¢ӋÛÂÈ ·Ó·‰ÚÔÌÈο ηٿ fiÛÔÓ ÔÈ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔÈ ÓÂÊÚÔ› ·fi “ÔÚÈ·ÎÔ‡˜” ‰fiÙ˜ ›¯·Ó ÙËÓ ›‰È· ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ÓÔÛËÚfiÙËÙ· Î·È Ì·ÎÚfi¯ÚÔÓË ÂÈ‚›ˆÛË Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ÓÂÊÚÔ‡˜ ·fi Û˘Ì‚·ÙÈÎÔ‡˜ ‰fiÙ˜. À§π∫O - ª∂£O¢Oπ
∞fi Ù· ÛÙÔȯ›· ÙÔ˘ ∂ıÓÈÎÔ‡ OÚÁ·ÓÈÛÌÔ‡ ªÂÙ·ÌÔۯ‡ÛÂˆÓ (∂Oª) ·Ó·ÊÔÚÈο Ì ÙȘ و̷ÙÈΤ˜ ÌÂÙ·ÌÔۯ‡ÛÂȘ ÓÂÊÚÔ‡ Ô˘ ¤ÁÈÓ·Ó ÛÙË ¯ÒÚ· Ì·˜ ÙÔ ‰È¿ÛÙËÌ· 2001-2006 ÚÔ·ÙÂÈ fiÙÈ Û˘ÓÔÏÈο Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó 508 ÌÂÙ·ÌÔۯ‡ÛÂȘ ·fi و̷ÙÈÎÔ‡˜ ‰fiÙ˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 197 ÓÂÊÚÔ› (38.8%) ÚÔ‹Ïı·Ó ·fi “ÔÚÈ·ÎÔ‡˜” ‰fiÙ˜. Δ· ‰ÈÂ˘Ú˘Ì¤Ó· ÎÚÈÙ‹ÚÈ· ‰fiÙË ¤¯Ô˘Ó ‰ÈÂıÓÒ˜ ηıÔÚÈÛı› ·fi ÙËÓ ∂ȉÈ΋ ∂ÈÙÚÔ‹ ¢ˆÚ¿˜ ÙÔ˘ ∏ӈ̤ÓÔ˘ ¢ÈÎÙ‡Ô˘ ∫·Ù·ÓÔÌ‹˜ OÚÁ¿ÓˆÓ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ù· ÂÍ‹˜: 1) ¤ÎÙ·ÛË ÙˆÓ ÔÚ›ˆÓ ËÏÈΛ·˜ (≥65 ¯ÚfiÓˆÓ, ≤5 ¯ÚfiÓˆÓ), 2) ËÏÈΛ· ≥55 Ì 1 ‹ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·Ú·Î¿Ùˆ: ·) ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË >10 ¯ÚfiÓÈ·, ‚) ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË >10 ¯ÚfiÓÈ·, Á) ı¿Ó·ÙÔ ·fi ∞∂∂, ‰) ÎÚ·ÙÈÓ›ÓË >1,5. ∏ ÚԤϢÛË ÙˆÓ ÓÂÊÚÈÎÒÓ Ì·˜ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·fi ‰fiÙ˜ Ì ‰ÈÂ˘Ú˘Ì¤Ó· ÎÚÈÙ‹ÚÈ· ‹Ù·Ó: 71 ÓÂÊÚÔ› ÚÔ‹Ïı·Ó ·fi ‰fiÙ˜ ≥65 ¯ÚfiÓˆÓ, 11 ·fi ·È‰È¿ ≤5 ¯ÚfiÓˆÓ, 51 ·fi ˘ÂÚÙ·ÛÈÎÔ‡˜ ‰fiÙ˜, 7 ·fi ‰È·‚ËÙÈÎÔ‡˜ Î·È 57 ·fi ∞∂∂ Î·È ÎÚ·ÙÈÓ›ÓË >1,5. ∞¶OΔ∂§∂™ª∞Δ∞
OÈ ‰‡Ô ηÙËÁÔڛ˜ ÙˆÓ ÏËÙÒÓ Ô˘ ÌÂÙ·ÌÔۯ‡ıËÎ·Ó ·fi Û˘Ì‚·ÙÈÎÔ‡˜ Î·È “ÔÚÈ·ÎÔ‡˜” ‰fiÙ˜ ›¯·Ó ·ÚfiÌÔÈ· ¯·Ú·ÎÙËÚÈÛÙÈο fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ËÏÈΛ·, ¯ÚfiÓÔ „˘¯Ú‹˜ ÈÛ¯·ÈÌ›·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜, ÔÛÔÛÙfi PRA Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∏ Û˘ÓÔÏÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ÌÂٷ͇ ÙˆÓ 2 ÔÌ¿‰ˆÓ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ, ‰ÂÓ ·Ó¤‰ÂÈÍ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·Ó·ÏÔÁÈÛÙÈ΋ ÂÈ‚›ˆÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜, ÛÙ· ÂÂÈÛfi‰È· ÔÍ›·˜ Î·È ¯ÚfiÓÈ·˜ ·fiÚÚȄ˘, ÛÙȘ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜, ·Ú·ÌÔÓ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ (Ô˘Ú›·, ÎÚ·ÙÈÓ›ÓË, GFR), ηı˘ÛÙÂÚË̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È ÂÈ‚›ˆÛË ÙÔ˘ ·ÚÚÒÛÙÔ˘. ∏ ·Ó¿Ï˘ÛË ı· ÔÏÔÎÏËÚˆı› Ì ÙË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙˆÓ ˘Ô-ÔÌ¿‰ˆÓ ÙˆÓ “ÔÚÈ·ÎÒÓ” ‰ÔÙÒÓ Ì ÙÔ˘˜ Û˘Ì‚·ÙÈÎÔ‡˜. ™Àª¶∂ƒ∞™ª∞Δ∞
∏ ·ÍÈÔÔ›ËÛË ÙˆÓ ÓÂÊÚÒÓ ·fi “ÔÚÈ·ÎÔ‡˜” ‰fiÙ˜ ·ÔÙÂÏ› ÌÈ· ·Ô‰ÂÎÙ‹ χÛË ·‡ÍËÛ˘ Ù˘ ‰ÂÍ·ÌÂÓ‹˜ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ηıfiÛÔÓ Ù· ·ÔÙÂϤÛÌ·Ù· ÓÔÛËÚfiÙËÙ·˜, ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Î·È ÂÈ‚›ˆÛ˘ ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·˘ÙÒÓ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ·fi ÂΛӷ ÙˆÓ Û˘Ì‚·ÙÈÎÒÓ ‰ÔÙÒÓ.
∞Ó·ÚÙË̤Ó˜ ∞Ó·ÎÔÈÓÒÛÂȘ
86
1 ∫§π¡π∫∏ ™∏ª∞™π∞ ΔOÀ O•∂π¢πOÀ ΔOÀ ∞∑øΔOÀ ø™ ¶ƒøπªO™ O•∂π∞™ ¡∂ºƒπ∫∏™ ¢∂π∫Δ∏™ ∞¡πá∂À™∏™ ∞¶Oƒƒπæ∏™ (¶∞ƒOÀ™π∞™∏ ∂¡¢π∞º∂ƒOÀ™∞™ ¶∂ƒπ¶Δø™∏™) π. ª¤ÏÏÔ˜1, ¢. ¶ÂÚÚ¤·2, π. μÏ¿¯Ô˜2, π. ∫ˆÛÙ¿Î˘2, ¢. μÏ·¯¿ÎÔ˜1, ∞. ¶··¯ÚÈÛÙÔ‰Ô‡ÏÔ˘1, ∞. ∫ˆÛÙ¿Î˘1 2∂ÚÁ·ÛÙ‹ÚÈÔ
1μ’ ¶ÚÔ. ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜, ∂∫¶∞ ¶ÂÈÚ·Ì·ÙÈ΋˜ ÃÂÈÚÔ˘ÚÁÈ΋˜ Î·È ÃÂÈÚÔ˘ÚÁÈ΋˜ ∂Ú‡Ó˘ «¡.™. ÃÚËÛÙ¤·˜», ∂.∫.¶.∞.
™∫O¶O™
Œˆ˜ Û‹ÌÂÚ·, ÂÏ¿¯ÈÛÙ· Â›Ó·È ÁÓˆÛÙ¿ ÁÈ· ÙÔ ÚfiÏÔ ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (¡O) ÛÙËÓ ÔÍ›· ÓÂÊÚÈ΋ ·fiÚÚÈ„Ë. O ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û˘ ÌÂϤÙ˘ Â›Ó·È Ó· ‰ÈÂÚ¢ӋÛÂÈ Èı·Ó¤˜ ÌÂÙ·‚ÔϤ˜ ÛÙ· ›‰· ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘ ¡O ÛÙÔÓ ÔÚfi, Û ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ÔÍ›· ÓÂÊÚÈ΋ ·fiÚÚÈ„Ë, ηıÒ˜ Î·È Ó· ÂÍÂÙ¿ÛÂÈ ·Ó ÙÔ ¡O ı· ÌÔÚÔ‡Û ÌÂÏÏÔÓÙÈο Ó· ÌÂÏÂÙËı› ˆ˜ ÚÒÈÌÔ˜ ‰Â›ÎÙ˘ ÚfiÁÓˆÛ˘ ÂÂÈÛÔ‰›Ô˘ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·fiÚÚȄ˘. À§π∫O
¶ÂÓ‹ÓÙ· ·ÛıÂÓ›˜ Ô˘ ˘Â‚Ï‹ıËÛ·Ó ÛÂ Û˘ÁÁÂÓÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ÛÙË ÌÔÓ¿‰· ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡ ÛÙÔ °.¡.∞. «§·˚Îfi», ηٿ ÙËÓ ÂÚ›Ô‰Ô 2003-2004. ª∂£O¢O™
ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ÙÚÈÏ‹ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ (΢ÎÏÔÛÔÚ›ÓË, Ú‰ÓÈ˙fiÓË Î·È ÌÔ˘ÎÔÊ·ÈÓÔÏÈÎfi Ô͇). ™ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂÙÚ‹ıËÎ·Ó Ù· ›‰· ÌÂÙ·‚ÔÏÈÙÒÓ ÙÔ˘ ¡O (¡Ox): ηٿ ÙËÓ ·Ú·ÌÔÓ‹ ÛÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô, ÌÈÛ‹ ÒÚ· ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜, ÙËÓ ÚÒÙË, ¤ÌÙË Î·È ‰¤Î·ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ. ∞¶OΔ∂§∂™ª∞Δ∞
¶·ÚÔ˘ÛÈ¿ÛÙËΠ¤Ó· ÂÂÈÛfi‰ÈÔ ÔÍ›·˜ ·fiÚÚȄ˘, Ô˘ ÂȂ‚·ÈÒıËÎÂ Î·È Ì ‚ÈÔ„›· ÓÂÊÚÔ‡ ÙË 10Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ. ∏ ÙÈÌ‹ ÙˆÓ ¡Ox Ù˘ ·ÛıÂÓÔ‡˜ ÙË ÚÒÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ ‹Ù·Ó ·˘ÍË̤ÓË Î·Ù¿ 380% Û˘ÁÎÚÈÓfiÌÂÓË Ì ÌÈÛ‹ ÒÚ· ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È Î·Ù¿ 90% ·fi ÙËÓ ÚÔÂÁ¯ÂÈÚËÙÈ΋ ̤ÙÚËÛË. ∏ ÔÛÔÛÙÈ·›· ÌÂÙ·‚ÔÏ‹ ÛÙȘ ÙÈ̤˜ ÙˆÓ ¡Ox Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠÌÂٷ͇ 30′ Î·È ÚÒÙ˘ Ë̤ڷ˜ ‹Ù·Ó ·ÓÙ›ÚÚÔË Û ۯ¤ÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜, Ô˘ ·ÚÔ˘Û›·Û·Ó ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ̤ÛË Ì›ˆÛË Î·Ù¿ 12% (∞fiÚÚÈ„Ë: +380%, ª.O. ·ÛıÂÓÒÓ -12±5%, p<0.05) ™Àª¶∂ƒ∞™ª∞
∏ ·ÓÙ›ÚÚÔË ÔÛÔÛÙÈ·›· ÌÂÙ·‚ÔÏ‹ ÛÙȘ ÙÈ̤˜ ÙˆÓ ¡Ox Ù˘ ·ÛıÂÓÔ‡˜ Ì ÔÍ›· ·fiÚÚÈ„Ë, Û ۯ¤ÛË Ì ÙËÓ ˘fiÏÔÈË ÔÌ¿‰· ÂÈÙ˘¯Ô‡˜ Â΂¿Ûˆ˜, ʤÚÓÂÈ ÛÙÔ Êˆ˜ Èı·Ó‹ ÂÌÏÔ΋ ÙÔ˘ ¡O ÛÙËÓ ÔÍ›· ÓÂÊÚÈ΋ ·fiÚÚÈ„Ë. ΔÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÙÈ̤˜ ÙˆÓ ¡Ox ‰È·ÊÔÚÔÔÈ‹ıËÎ·Ó ·fi ÙËÓ ÚÒÙË ÌfiÏȘ Ë̤ڷ, ·Ó·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó¿ÁÎË ÂÚÂÙ·›Úˆ ÌÂϤÙ˘ Ù˘ Èı·ÓfiÙËÙ·˜ ¯Ú‹Û˘ ÙˆÓ ¡Ox, ˆ˜ ÚÒÈÌˆÓ ‰ÂÈÎÙÒÓ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·fiÚÚȄ˘.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
2 O•∂π∞ ∫Oπ§π∞ ™∂ ª∂Δ∞ªO™Ã∂Àª∂¡O ∞™£∂¡∏ ª∂ ºÀª∞Δπø¢∏ ∫O§πΔπ¢∞ §. ªÔ˘ÓÙ˙·ÏÈ¿, ¡. ™ÈηÏÈ¿˜, ∫. ∞ÏÂ͛Ԣ, B. ΔÚÈ·ÓٷʇÏ˘, °. ∞ÓÙÛ·ÎÏ‹˜ XÂÈÚÔ˘ÚÁÈ΋ ÎÏÈÓÈ΋ °¡∞ ™ÈÛÌ·ÓfiÁÏÂÈÔ
∏ Ê˘Ì·ÙÈ҉˘ ÎÔÏ›ÙȘ Â›Ó·È ÌÈ· ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÓÙfiÈÛË Ù˘ Ê˘Ì·ÙÈÒÛˆ˜ Î·È ÂΉËÏÒÓÂÙ·È Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ¿ÙÔÌ· Û˘Ó‹ıˆ˜ Ì ÙËÓ ÂÈÎfiÓ· Ù˘ Ó. Crohn. ™∫O¶O™
∞Ó·ÎÔÈÓÒÓÔ˘Ì ۿÓÈ· ÂÚ›ÙˆÛË Ê˘Ì·ÙÈÒ‰Ô˘˜ ÎÔÏ›Ùȉ·˜ Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ ·ÛıÂÓ‹, Ô˘ ÂΉËÏÒıËΠ̠ÂÈÎfiÓ· ÂÈÏÂÔ‡ Î·È ÔÍ›·˜ ÎÔÈÏ›·˜. À§π∫O - ªE£O¢O™ ÕÚÚÂÓ ·ÛıÂÓ‹˜ ËÏÈΛ·˜ 51 ÂÙÒÓ Ì ÈÛÙÔÚÈÎfi ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡ Û ¯ÒÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ÚÔ 19 ÌËÓÒÓ, ÚÔÛ‹Ïı ÛÙ· ›ÁÔÓÙ· Â͈ÙÂÚÈο ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ·fi ΤÓÙÚÔ ˘Á›·˜, Ì ·Ó·ÛÙÔÏ‹ ·Ô‚ÔÏ‹˜ ·ÂÚ›ˆÓ Î·È ÎÔÚ¿ÓˆÓ ·fi ‚‰ÔÌ¿‰Ô˜ Î·È ÂÈÎfiÓ· ÔÍ›·˜ ÎÔÈÏ›·˜. ¶ÚÔ 5ÓıË̤ÚÔ˘ Ô ·ÛıÂÓ‹˜ ÂϤÁ¯ıËΠ̠ÎÔÏÔÛÎfiËÛË fiÔ˘ ·Ó¢ڤıË ÂÓ‰Ô·˘ÏÈ΋ Ì¿˙· Ô˘ ·¤ÊÚ·ÛÛ ÌÂÚÈÎÒ˜ ÙÔÓ ·˘Ïfi ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ·Ó¢ڤıËΠ‹È· Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Î·È ·Ó·ÈÌ›·. ∞fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ·Ó‰›¯ıË ·¤Ú·˜ ÂÓÙfi˜ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÂχıÂÚÔ ˘ÁÚfi ÛÙËÓ ÂÏ¿ÛÛÔÓ· ‡ÂÏÔ. ªÂ ÙËÓ ‰È¿ÁÓˆÛË Ù˘ ڋ͢ ÎÔ›ÏÔ˘ ÛÏ¿Á¯ÓÔ˘ Ô‰ËÁ‹ıËΠÛÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô. ∞¶OΔ∂§∂™ª∞Δ∞ ∫·Ù¿ ÙËÓ Ï··ÚÔÙÔÌ›· ÂÓÙÔ›ÛÙËΠڋÍË ÙÔ˘ Ù˘ÊÏÔ‡ Î·È Â‡ıÚ˘ÙË Ì¿˙· („¢‰ÔÔχԉ·˜) Ô˘ ·¤ÊÚ·ÛÛ ÙÔÓ ·˘Ïfi ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÂÚ›Ô˘ ÛÙËÓ ÌÂÛfiÙËÙ· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘, ηıÒ˜ Î·È ‰È¿¯˘Ù˜ ‰È·‚ÚÒÛÂȘ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È „¢‰ÔÌÂÌ‚Ú¿Ó˜. ∂ÈÚÔÛı¤Ùˆ˜ ÂÓÙÔ›ÛÙËÎÂ Ê˘ÙÔ›ÏËÌ· ÂÓÛÊËӈ̤ÓÔ ÛÙÔ ‡„Ô˜ Ù˘ ·fiÊڷ͢. ™˘Á¯ÚfiÓˆ˜ Û˘Ó˘‹Ú¯Â ¤ÓÙÔÓË ÏÂÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ÛÙÔ ÌÂÛÂÓÙ¤ÚÈÔ Î·È ÂÈÎfiÓ· ÈÛ¯·ÈÌ›·˜ ÙÔ˘ Ù˘ÊÏÔ‡. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ù˘È΋ ‰ÂÍÈ¿ ÎÔÏÂÎÙÔÌ‹, Ì ȉȷ›ÙÂÚË ÚÔʇϷÍË ÒÛÙ ӷ ÌËÓ ÙÚ·˘Ì·ÙÈÛÙ› ÙÔ ÓÂÊÚÈÎfi ÌfiÛ¯Â˘Ì· ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ. ∞fi ÙËÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ÂͤٷÛË Î·È ÙÔÓ ÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô (ÂχıÂÚÔ˘ ˘ÁÚÔ‡ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÎÔÈÏfiÙËÙ·˜) ÂÙ¤ıË Ë ‰È¿ÁÓˆÛË Ù˘ Ê˘Ì·ÙÈÒ‰Ô˘˜ ÎÔÏ›Ùȉ·˜. ∞fi ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È ·Ó·Ó¢ÛÙÈÎfi ¤ÏÂÁ¯Ô Ô˘ ·ÎÔÏÔ‡ıËÛ ‰È·ÁÓÒÛıËΠÂÓÂÚÁfi˜ Ê˘Ì·Ù›ˆÛË Ì ÚÔ˜ ÙÔ ·ÚfiÓ ÚˆÙÔ·ı‹ ÂÓÙfiÈÛË ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ. O ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËΠÛÙËÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹. ™Àª¶∂ƒ∞™ª∞Δ∞ H Ê˘Ì·ÙÈ҉˘ ÎÔÏ›ÙȘ ·ÔÙÂÏ› Û¿ÓÈ· ÂΉ‹ÏˆÛË Ù˘ Ê˘Ì·ÙÈÒÛˆ˜ Î·È ÂΉËÏÒÓÂÙ·È Û ¿ÙÔÌ· Ì ·ÓÔÛÔÎÛÙ·ÛÙÔÏ‹, ·ÔÙÂÏÒÓÙ·˜ ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ·fi ¿ÏϘ ÂȉÈΤ˜ ÎÔÏ›Ùȉ˜, ¯ˆÚ›˜ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ Ó· ÚÔηÏ› ÔÍ›· ¯ÂÈÚÔ˘ÚÁÈ΋ ÎÔÈÏ›·. ΔÔ ÂӉ¯fiÌÂÓÔ ÂΉ‹ÏˆÛ˘ Ù˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÛÙÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜.
88
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
3 £ƒ√ªμ√¶∂¡I∞ √º∂π§Oª∂¡∏ ™Δ∏¡ ∏¶∞ƒI¡∏ (HEPARIN-INDUCED THROMBOCYTOPENIA, HIT) ™∂ ¶ƒO§∏¶Δπ∫H (PRE-EMPTIVE) ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒ√Y ™. ¢Ú·ÎfiÔ˘ÏÔ˜1, £. ∫·ÛÈÌ¿Ù˘2, ª. ∫Ô˘ÎÔ˘Ï¿ÎË1, £. ∞ÔÛÙfiÏÔ˘2, £. £ÂÔ‰ˆÚ›‰Ë˜3, ª·¯ÌÔ‡Ù ∂Ï-∞Ï›3, μ. ∫ÔÎΛÓÔ˘3, Ã. ¶··ÛÙÂÚÈ¿‰Ë1, μ. μÔ˘Á¿˜1, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘2 1ªÔÓ¿‰·
ªÂÙ·ÌÔۯ‡ÛˆÓ, 2¡ÂÊÚÔÏÔÁÈÎfi ΔÌ‹Ì· ∂ÚÁ·ÛÙ‹ÚÈÔ °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
3∞ÈÌ·ÙÔÏÔÁÈÎfi
∏ ıÚÔÌ‚ÔÂÓ›· ÔÊÂÈÏfiÌÂÓË ÛÙËÓ Ë·Ú›ÓË Ù‡Ô˘ ππ (Heparin-induced thrombocytopenia, HIT) Û˘ÓÈÛÙ¿ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ì ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ Ë·Ú›ÓË·Ú¿ÁˆÓ 4 ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ¶·Ú·ÙËÚÂ›Ù·È ÌÂ Û˘¯ÓfiÙËÙ· 0,2-3% Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Ë·Ú›ÓË ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ·fi 4-10 ̤Ú˜ Î·È Ô‰ËÁ› Û ηٷÛÙÚÔÊ‹ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ıÚÔÌ‚ÒÛÂȘ ÊÏ‚ÒÓ Î·È ·ÚÙËÚÈÒÓ. ∏ ›وÛË Ù˘ Û ϋÙ˜ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ Â›Ó·È ¿ÁÓˆÛÙË. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË Á˘Ó·›Î·˜ 27 ÂÙÒÓ Û ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÏfiÁˆ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰fiÌËÛ˘ Ô˘ ¤Ï·‚ ÓÂÊÚÈÎfi ÌfiÛ¯Â˘Ì· ·fi ÙË ÌËÙ¤Ú· Ù˘ (ÂÙÒÓ 59). ∏ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ÂÓÙ·¯ı› Û ÚfiÁÚ·ÌÌ· ¯ÚfiÓÈ·˜ ·ÈÌÔοı·ÚÛ˘ Î·È ÁÈ· ÙËÓ ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÚÔÂÙÔÈÌ·Û›· ˘Â‚Ï‹ıË Û ٤ÛÛÂÚȘ ·ÈÌÔηı¿ÚÛÂȘ ·›ÚÓÔÓÙ·˜ ÎÏ·ÛÛÈ΋ Î·È ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË. ΔȘ ÚÒÙ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÒÚ˜ ·ÚÔ˘Û›·Û ԛ‰ËÌ· ‰ÂÍÈÔ‡ οو ¿ÎÚÔ˘. ΔÔ triplex ¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ıÚfiÌ‚ˆÛË Ù˘ ÎÔÈÓ‹˜ Ï·ÁÔÓ›Ô˘ ÊϤ‚·˜ Î·È ·Ô˘Û›· ·ÈÌ·ÙÒÛˆ˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ™ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ‰È·ÈÛÙÒıËΠıÚfiÌ‚ˆÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ Î·È ÊϤ‚·˜ Î·È ÂÎÙÂٷ̤ÓË ıÚfiÌ‚ˆÛË Ù˘ ÎÔÈÓ‹˜ Ï·ÁÔÓ›Ô˘ ÊϤ‚·˜. ŒÁÈÓ ıÚÔÌ‚ÂÎÙÔÌ‹ Î·È ¤ÎÏ˘ÛË ÙˆÓ Ï·ÁÔÓ›ˆÓ ·ÁÁ›ˆÓ Ì ˷ÚÈÓÔ‡¯Ô ‰È¿Ï˘Ì·. ΔÔ ÌfiÛ¯Â˘Ì· ·Ê·ÈÚ¤ıËÎÂ. ªÂÙÂÁ¯ÂÈÚËÙÈο ‹Ú ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË. ΔËÓ ÂfiÌÂÓË Ë̤ڷ ‰È·ÈÛÙÒıËΠÙÒÛË ·ÈÌÔÂÙ·Ï›ˆÓ ·fi 120.000/ÌL Û 20.000/ÌL. O ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Û˘ÌÏfiÎÔ˘ ·Ú¿ÁÔÓÙ· 4 ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ - Ë·Ú›Ó˘ Ì ELISA ‹Ù·Ó ıÂÙÈÎfi˜ Î·È ‰È·ÁÓˆÛÙÈÎfi˜ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ ∏πΔ. ÃÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· ÏÂÈÚÔ˘‰›ÓË (Refludan®) 0.15 mg/kg/ÒÚ· › ‰Ò‰Âη Ë̤Ú˜ ÚÔÛ·ÚÌfi˙ÔÓÙ·˜ ÙȘ ‰fiÛÂȘ ÛÙÔ aPTT (70-90 sec) Î·È ÌÂÙ¿ ‚·ÚÊ·Ú›ÓË. ΔÔÔıÂÙ‹ıËΠÂÓ‰·ÁÁÂȷο Ê›ÏÙÚÔ ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊϤ‚·. O ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ·ÔηٷÛÙ¿ıËΠÚÔԉ¢ÙÈο. ∏ ·ÛıÂÓ‹˜ ÂÓÙ¿¯ıËΠ۠ÚfiÁÚ·ÌÌ· Û˘Ó¯ԇ˜ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ÙÔ ÂÚÈÛÙ·ÙÈÎfi ÁÈ· ÙË Û·ÓÈfiÙËÙ¿ ÙÔ˘ Î·È Ó· ÙÔÓ›ÛÔ˘Ì ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ∏πΔ Û ÚÔÏËÙÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡, ÙË ‰˘ÛÎÔÏ›· ‰È¿ÁÓˆÛ˘ Ù˘ ‰È·Ù·Ú·¯‹˜ ηıÒ˜ Î·È ÁÈ· ÙËÓ ÚfiÏË„Ë ÂÌÊ·Ó›ÛÂÒ˜ ÙÔ˘ Û Ӥ· ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
4 ∂¶πΔÀÃ∏™ ∞¡Δπª∂Δø¶π™∏ ∂¶∂π™O¢πOÀ O•∂π∞™ ∞¶Oƒƒπæ∏™ ™∂ ª∂Δ∞ªO™Ã∂Àª∂¡∏ °À¡∞π∫∞ ∫∞Δ∞ Δ∏ ¢π∞ƒ∫∂π∞ Δ∏™ ∂°∫ÀªO™À¡∏™ °. μÈÛ‚¿Ú‰Ë˜1, ¶. ∫˘ÚÈÎÏ›‰Ô˘1, ∂. ª›ÏÏË2, ∂. ªËÙÛfiÔ˘ÏÔ˜1, ∂. ª¿ÓÔ˘1, ∂. °ÈÓÈÎÔÔ‡ÏÔ˘1, ¢. ¶··‰ÔÔ‡ÏÔ˘1 1¡ÂÊÚÔÏÔÁÈÎfi
2∞’
ΔÌ‹Ì· ¶·ÓÂÈÛÙËÌȷ΋ ª·È¢ÙÈ΋ °˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °.¡. «¶··ÁˆÚÁ›Ô˘» £ÂÛÛ·ÏÔӛ΢
¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ÌÂÙ·ÌÔÛ¯Â˘Ì¤Ó˘ Á˘Ó·›Î·˜ 35 ÂÙÒÓ, Ë ÔÔ›·, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÌÂÙ¿ ·fi Â͈ۈ̷ÙÈ΋ ÁÔÓÈÌÔÔ›ËÛË, ·ÚÔ˘Û›·Û ÂÂÈÛfi‰ÈÔ ÔÍ›·˜ ·fiÚÚȄ˘. ∏ ·ÛıÂÓ‹˜ ›¯Â ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·fi ˙ÒÓÙ· ‰fiÙË(ÌËÙ¤Ú·) ÚÔ ÙÂÙÚ·ÂÙ›·˜ (4/2003), ¤ÊÂÚ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÌfiÛ¯Â˘Ì· (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡: 0,9 mg/dl) Î·È ÂÏ¿Ì‚·Ó ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘, mycophenolate sodium Î·È Î˘ÎÏÔÛÔÚ›Ó˘. ∞̤ۈ˜ ÌÂÙ¿ ÙË ‰È·›ÛÙˆÛË Ù˘ ·ËÛ˘, ¤ÁÈÓ ÙÚÔÔÔ›ËÛË Ù˘ ·ÓÔÛÔηٷÛÙÔÏ‹˜, Ì ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ mycophenolate sodium Ì ·˙·ıÂÈÔÚ›ÓË. ∏ ·ÛıÂÓ‹˜ Ù¤ıËΠ۠ٷÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È, ÙË 16Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘, ·ÚÔ˘Û›·Û Âȉ›ӈÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡: 4,1 mg/dl). ÀÔ‚Ï‹ıËΠ۠ϋÚË ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi Î·È ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·fiÊڷ͢ ‹ ¿ÏÏ˘ ·ÈÙ›·˜ ÔÍ›·˜ Âȉ›ӈÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ªÂ ‚¿ÛË Ù· Â˘Ú‹Ì·Ù¿ ÙÔ˘˜, Ë Âȉ›ӈÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ıˆڋıËΠÂÂÈÛfi‰ÈÔ ÔÍ›·˜ ·fiÚÚȄ˘ Î·È ÛÙËÓ ·ÛıÂÓ‹ ¯ÔÚËÁ‹ıËΠ·ÓÙÈ·ÔÚÚÈÙÈ΋ ·ÁˆÁ‹, Ì ÒÛÂȘ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ (Û˘ÓÔÏÈ΋ ‰fiÛË 4 g). ∂›Û˘, ¤ÁÈÓ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰ÔÛÔÏÔÁ›·˜ Ù˘ ΢ÎÏÔÛÔÚ›Ó˘, ÂÍ·ÈÙ›·˜ ÙˆÓ ¯·ÌËÏÒÓ ÂȤ‰ˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi. ™Â fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ Ù˘ ·ÛıÂÓÔ‡˜, ÁÈÓfiÙ·Ó ·Ú¿ÏÏËÏ· Ù·ÎÙÈÎfi˜ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∏ ÓÔÛËÏ›· Ù˘ ·ÛıÂÓÔ‡˜ Û˘Ó¯›˙ÂÙ·È ¤ˆ˜ Î·È Û‹ÌÂÚ·, Ì ÛÙ·ıÂÚ‹ ‚ÂÏÙ›ˆÛË Ù˘ ÓÂÊÚÈ΋˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡: 2,0 mg/dl).
91
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
5 PROLONGED LYMPHOPENIA AFTER ANTI-THYMOCYTE GLOBULIN INDUCTION IS NOT ASSOCIATED WITH INCREASED GRAFT SURVIVAL IN RENAL TRANSPLANT RECIPIENTS D. Vrochides, P. Metrakos, J. Tchervenkov, P. Chaudhury, M. Hassanain, M. Cantarovich, D. Keith, S. Paraskevas Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Anti-thymocyte globulin (ATG) induction is associated with higher graft survival, as well as freedom from acute cellular rejection (ACR) after renal transplantation. ATG may induce prolonged (>30 days) lymphopenia. PURPOSE
To determine whether prolonged lymphopenia after ATG induction contributes to superior long term results after renal transplantation. METHODS
Anti-thymocyte globulin induction was used in 415 primary adult kidney transplants. Recipients with normal graft function comprised group 1 and those with slow or delayed graft function (S/DGF) comprised group 2. Recipients with an average value of ≤200 lymphocytes/mm3 for the first 30 postoperative days comprised the cohorts of prolonged lymphopenia (group 1a and 2a), whereas the rest comprised the non-lymphodepleted cohorts (group 1b and 2b). RESULTS
Prolonged lymphopenia was achieved in 53.4% (n=141) and 68.8% (n=104) of recipients with normal (group 1a) and slow/delayed (group 2a) postoperative graft function respectively. For both the normal and the S/DGF groups, there were no differences in mean actuarial graft and patient survival for the lymphopenic and the non-lymphopenic cohorts (Table 1). Incidence of ACR was similar between the non-depleted and the depleted groups. CMV incidence was similar between the two groups. CONCLUSIONS
Lymphocyte depletion that persists for more than one postoperative month after induction with ATG is not associated with improved long-term results. Table 1. Mean actuarial graft survival in years (95% CI) Group 1 (normal function) 1a (+LD) 12.93 (11.90, 13.97)
Group 2 (S/DGF)
1b (-LD) 12.75 (11.43, 14.07)
p = .7690
2a (+LD)
2b (-LD)
9.50 (8.14, 10.86)
7.69 (6.30, 9.07)
p = .8288
92
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
6 ALLOCATION OF NON-ECD RENAL GRAFTS TO OLDER PATIENTS RESULTS IN LOSS OF FUNCTIONING GRAFT-YEARS SECONDARY TO RECIPIENTS’ LOWER LIFE EXPECTANCY D. Vrochides, M. Hassanain, P. Metrakos, J. Tchervenkov, P. Chaudhury, M. Cantarovich, S. Paraskevas Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Patient’s age is not considered a selection criterion for the allocation of renal grafts in North America. PURPOSE
To investigate whether allocation of non-ECD grafts to older patients results in loss of ‘graftyears’. METHODS
Of 640 patients with a kidney transplant, 414 received a non-ECD, whereas 226 received an ECD graft. Patients were divided into four groups; group 1: <41 yo, group 2: 41- 50 yo, group 3: 51-60 yo and group 4: >60 yo. RESULTS
35.3% of patients received an ECD graft. 17.3% of patients received graft from an over 60years old donor. Non-ECD grafts were uniformely allocated among the study cohorts. The 10-year graft survival was 75%, 72%, 60% and 55% for groups 1, 2 ,3 and 4 respectively (p = .003). Group 1 and 2 superior graft survival was still present when graft ECD status was considered (p = .017). One out of five patients older than 60 years, compared to one out of forty patients younger than 41 years, died with a functioning graft (table1). Graft/Patient Status, n (%) Functional/Deceased
Functional/Alive
Dialysis
Total
< 41 yo 41 – 50 yo 51 – 60 yo > 60 yo
4 (2.4) 14 (9.7) 16 (9.8) 32 (19.4)
123 (74.5) 112 (77.2) 115 (70.1) 113 (68.5)
36 (21.8) 16 (11.0) 33 (20.1) 19 (11.5)
165 145 165 165
Total
66 (10.3)
463 (72.5)
104 (16.3)
640
CONCLUSIONS Allocation of non-ECD renal grafts to older patients results in loss of functioning graft-years secondary to recipients’ lower life expectancy.
93
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
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∏ ∂™™ ˘ÔÙÚÔÈ¿˙ÂÈ ÚÒÈÌ· Î·È Û ˘„ËÏfi ÔÛÔÛÙfi ÛÙÔ ÓÂÊÚÈÎfi ÌfiÛ¯Â˘Ì· (¤ˆ˜ Î·È 60%). ∏ ÁÚ‹ÁÔÚË ÔÚ›· ÚÔ˜ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Î·È Ë ‚·Ú‡ÙËÙ· Ù˘ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜ ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ÓÔÛ‹Ì·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ·ÒÏÂÈ· ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜.
94
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
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95
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
9 ∞¡Δπª∂Δø¶π™∏ ∂¡¢√¡∂ºƒπ∫ø¡ ∞ƒΔ∏ƒπ∞∫ø¡ ™Δ∂¡ø™∂ø¡ ™∂ §∏¶Δ∂™ ¡∂ºƒπ∫ø¡ ªO™Ã∂Àª∞Δø¡ ª∂ ª∂£√¢√À™ ∂¶∂ªμ∞Δπ∫∏™ ∞∫Δπ¡O§O°π∞™ ∏. ªÚÔ‡ÓÙ˙Ô˜1, ª. ∫Ô˘ÎÔ˘Ï¿ÎË2, ª. ¶ÔÌÒÓË1, π. §Ô˘ÎfiÔ˘ÏÔ˜2, ∂. ∞ÓÙ‡·2, £. ∞ÔÛÙfiÏÔ˘2, μ. μÔ˘Á¿˜2, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘2, ™. ¢Ú·ÎfiÔ˘ÏÔ˜2, ¢. ∫ÂϤ΢1 1ªÔÓ¿‰·
ŒÚ¢ӷ˜ ∞ÎÙÈÓÔÏÔÁ›·˜ & π·ÙÚÈ΋˜ ∞ÂÈÎfiÓÈÛ˘ «∂˘ÁÂÓ›‰ÂÈÔ £ÂÚ·Â˘Ù‹ÚÈÔ» l 2ªÔÓ¿‰· ªÂÙ·ÌÔۯ‡ÛÂˆÓ °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
∏ ÛÙ¤ÓˆÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÈÏÔ΋ ÙˆÓ ÚÒÙˆÓ ÌËÓÒÓ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∞ÔÙÂÏ› ÌÈ· ·fi ÙȘ ·ÚȘ ·Èٛ˜ ˘¤ÚÙ·Û˘, ÚÔԉ¢ÙÈ΋˜ Ì›ˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙÂÏÈο ·ÒÏÂÈ·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ΔÔ ÛËÌÂ›Ô Ù˘ ÛÙ¤ÓˆÛ˘ Û¿ÓÈ· ÂÓÙÔ›˙ÂÙ·È ÂÓÙfi˜ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰‡Ô ÂÚÈÙÒÛÂȘ ÂÓ‰ÔÓÂÊÚÈ΋˜ ÛÙ¤ÓˆÛ˘ Ù˘ ·ÚÙËÚ›·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Ì ‰È·‰ÂÚÌÈÎfi ÂÓ‰Ô·ÁÁÂÈ·Îfi ηıÂÙËÚÈ·ÛÌfi ÙÔ˘ ÛËÌ›Ԣ Ù˘ ÛÙ¤ÓˆÛ˘. ™ÙËÓ ÚÒÙË, Ï‹Ù˘ ÓÂÊÚÔ‡ 44 ÂÙÒÓ, Ù¤ÛÛÂÚȘ Ì‹Ó˜ ÌÂÙ¿ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi ·Ô‚ÈÒÛ·ÓÙ· ‰fiÙË ¯ˆÚ›˜ ÂÈÏÔΤ˜, ·ÚÔ˘Û›·Û ÂȉÂÈÓÔ‡ÌÂÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 4,2 mg/dl) Î·È ˘¤ÚÙ·ÛË (∞¶ 180/100 mmHg). O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·Ó¤‰ÂÈÍ ÌÂÁ¿ÏË ÛÙ¤ÓˆÛË (70%) Û ÎÏ¿‰Ô Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ ÛÙȘ ‡Ï˜ ÙÔ˘ ÓÂÊÚÔ‡ ηıÒ˜ Î·È ÛÙ¤ÓˆÛË Û ÂÓ‰ÔÓÂÊÚÈÎfi ÎÏ¿‰Ô Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜. ∏ ·ÁÁÂÈÔÁÚ·Ê›· ÂȂ‚·›ˆÛ ÙË ÛÙ¤ÓˆÛË, ·ÎÔÏÔ‡ıËÛ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Î·È ·ÔηٿÛÙ·ÛË Ù˘ ‚·ÙfiÙËÙ·˜ ÙˆÓ ·ÁÁ›ˆÓ Ì ÙË ‚Ô‹ıÂÈ· ÂÓ‰Ô·ÚÙËÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ. ªÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Ë ÎÚ·ÙÈÓ›ÓË Ì›ˆıËΠÚÔԉ¢ÙÈο ̤¯ÚÈ 2,8 mg/dl. O Ï‹Ù˘, Ì›· ‚‰ÔÌ¿‰· ·ÚÁfiÙÂÚ·, ›¯Â ‚ÂÏÙȈ̤ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 2,3 mg/dl) Î·È ¤Ó· ¤ÙÔ˜ ÌÂÙ¿, ‚Ú›ÛÎÂÙ·È Û Ôχ ηϋ ηٿÛÙ·ÛË. ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Û ϋÙË 55 ÂÙÒÓ Ô˘ ›¯Â ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·fi ·Ô‚ÈÒÛ·ÓÙ· ‰fiÙË ÚÔ 2 ÌËÓÒÓ ‰È·ÈÛÙÒıËΠ۠¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ·‡ÍËÛË ÎÚ·ÙÈÓ›Ó˘ ÔÚÔ‡ (4,7 mg/dl). ΔÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ÛÙ¤ÓˆÛË ÛÙÔ˘˜ ‰‡Ô ·ÚÈÔ˘˜ ÎÏ¿‰Ô˘˜ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ ÛÙ· fiÚÈ· Ù˘ ‡Ï˘ ÙÔ˘ ÓÂÊÚÔ‡. ∏ ·ÁÁÂÈÔÁÚ·Ê›· ÂȂ‚·›ˆÛ ٷ Â˘Ú‹Ì·Ù· Î·È ·ÎÔÏÔ‡ıËÛ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ô˘ ·Âη٤ÛÙËÛ ÙË ‚·ÙfiÙËÙ· ÙˆÓ ·Û¯fiÓÙˆÓ ·ÁÁ›ˆÓ. ∏ ÎÚ·ÙÈÓ›ÓË ÌÂÈÒıËΠÚÔԉ¢ÙÈο ̤¯ÚÈ 1,8 mg/dl. ¢Âη¤ÓÙ ̋Ó˜ ÙÔ ÌfiÛ¯Â˘Ì· ÏÂÈÙÔ˘ÚÁ› ÈηÓÔÔÈËÙÈο. OÈ ÂÓ‰ÔÓÂÊÚÈΤ˜ ·ÚÙËÚȷΤ˜ ÛÙÂÓÒÛÂȘ Â›Ó·È Û¿ÓȘ ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘˜ Â›Ó·È ‰˘Û¯ÂÚ‹˜ Î·È Ë Û˘Ì‚ÔÏ‹ Ù˘ ÂÂÌ‚·ÙÈ΋˜ ·ÎÙÈÓÔÏÔÁ›·˜ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙË ıÂڷ›· ÙÔ˘˜.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
10 ∂•ø∞¡∞ΔOªπ∫∏ ¶∞ƒ∞∫∞ªæ∏ ∫Àƒπø¡ ∞ƒΔ∏ƒπ∞∫ø¡ ™Δ∂§∂Ãø¡ °π∞ Δ∏¡ ΔO¶O£∂Δ∏™∏ ∂¡¢O∞ƒΔ∏ƒπ∞∫∏™ ¶ƒO£∂™∂ø™ ∂¶π ƒ∏•∂ø™ ∞¡∂ÀƒÀ™ª∞ΔO™ ∫Oπ§π∞∫∏™ ∞OƒΔ∏™ ™∂ §∏¶Δ∏ ¡∂ºƒπ∫OÀ ªO™Ã∂Àª∞ΔO™ π. ∫ÔÎÔÙÛ¿Î˘1, π. ∫·ÛηڤÏ˘2, ª. ∫Ô˘ÎÔ˘Ï¿ÎË3, ∂. ∞ÓÙ‡·2, ∫. ∫·Ó·Î¿Î˘1, ª. πÂÚˆÓ‡ÌÔ˘3, μ. ¢Ú·ÎfiÔ˘ÏÔ˜3, ∂. ™ÎÔ˘Ù¤ÏË1, μ. μÔ˘Á¿˜3, ™. ¢Ú·ÎfiÔ˘ÏÔ˜3 1μ’
∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ΔÌ‹Ì·, 2∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜/ΔÌ‹Ì· ∂ÂÌ‚·ÙÈ΋˜ ∞ÎÙÈÓÔÏÔÁ›·˜ 3ªÔÓ¿‰· ªÂÙ·ÌÔۯ‡ÛˆÓ, °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
∏ Ú‹ÍË ÙˆÓ ·Ó¢ڢÛÌ¿ÙˆÓ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜ ·Ú¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ıÓËÙfiÙËÙ· ÂÓÒ È‰È·›ÙÂÚfiÙËÙ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ϋÙ˜ ÓÂÊÚÈÎÔ‡ ÌÔÛ¯¤‡Ì·ÙÔ˜ ·ÊÔ‡ ··ÈÙÂ›Ù·È ÚÔʇϷÍË Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ÂÚ›ÙˆÛË Â͈·Ó·ÙÔÌÈ΋˜ ·Ú¿Î·Ì„˘ ÙˆÓ Î˘Ú›ˆÓ ·ÚÙËÚÈÒÓ (¿Óˆ ÌÂÛÂÓÙÂÚÈÔ˘ ·ÚÙËÚ›·˜ Î·È ÎÔÈÓ‹˜ Ë·ÙÈ΋˜) ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÂÓ‰Ô·ÔÚÙÈÎÔ‡ stent Û ڋÍË ·Ó¢ڇÛÌ·ÙÔ˜ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜ Ô˘ Û˘Ó¤‚Ë Û ϋÙË ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. O ·ÛıÂÓ‹˜ 73 ÂÙÒÓ, Ô˘ ›¯Â ˘Ô‚Ëı› ÚÔ 3,5 ÂÙÒÓ Û ÂÈÙ˘¯‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡, ·ÚÔ˘ÛÈ¿ÛÙËΠ̠¿ÏÁÔ˜ ÛÙË ÂÚÈÔ¯‹ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ◊Ù·Ó ÁÓˆÛÙfi fiÙÈ ÂÓÓ¤· ̤Ú˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ Ú‹ÍË ·Ó¢ڇÛÌ·ÙÔ˜ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËΠÂÈÙ˘¯Ò˜ Ì ÂÓ‰Ô·ÚÙËÚȷ΋ ÙÔÔı¤ÙËÛË ÚfiıÂÛ˘. ŒÓ· ¤ÙÔ˜ ·ÚÁfiÙÂÚ· ›¯Â ˘Ô‚ÏËı› Û ÂÚ·ÈÙ¤Úˆ ·ÔηٿÛÙ·ÛË ·Ó¢ڇÛÌ·ÙÔ˜ ıˆÚ·ÎÈ΋˜ ·ÔÚÙ‹˜ Ì ÙÔÔı¤ÙËÛË ÂÓ‰Ô·ÚÙËÚȷ΋˜ ÚfiıÂÛ˘. ªÂÙ¿ ÙËÓ ÙÂÏÂ˘Ù·›· Û˘Ìو̷ÙÔÏÔÁ›· ˘Â‚Ï‹ıË Û ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ Ô˘ ¤‰ÂÈÍ ۷ÎÔÂȉ¤˜ ·Ó‡ڢÛÌ· ·ÔÚÙ‹˜ ÙÔ ¿Óˆ fiÚÈÔ ÙÔ˘ ÔÔ›Ô˘ ÂÓÙÔÈ˙fiÙ·Ó ÛÙÔ ‡„Ô˜ Ù˘ ¤ÎÊ˘Û˘ Ù˘ ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜, ÌÂÁ›ÛÙ˘ ‰È·Ì¤ÙÚÔ˘ 9,5 cm ηıÒ˜ Î·È ‰È·Ê˘Á‹ Ì ·ÚÔ˘Û›· ÙÔȯˆÌ·ÙÈÎÔ‡ ıÚfiÌ‚Ô˘. ∂ÎÎÚ›ıË ··Ú·›ÙËÙË Ë ÙÔÔı¤ÙËÛË ÂÓ‰Ô·ÔÚÙÈ΋˜ ÚfiıÂÛ˘ Û fiÏÔ ÙÔ Ì‹ÎÔ˜ Ù˘ ıˆÚ·ÎÈ΋˜ Î·È ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¤ÁÈÓ Â͈·Ó·ÙÔÌÈ΋ ·Ú¿Î·Ì„Ë Ù˘ ÎÔÈÓ‹˜ Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜ Î·È ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ Ì ‰‡Ô Û˘ÓıÂÙÈο ÌÔۯ‡̷ٷ Ù‡Ô˘ Gorotex Ì ·ÈÌ¿ÙˆÛË ·fi ÙËÓ ¿Óˆ Ï·ÁfiÓÈÔ ·ÚÙËÚ›·. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ˘‹ÚÍ ÂÈÙ˘¯‹˜ ÁÂÁÔÓfi˜ Ô˘ ¤ÙÚ„ ÙËÓ ÙÔÔı¤ÙËÛË Ù˘ ÂÓ‰Ô·ÚÙËÚȷ΋˜ ÚfiıÂÛ˘. ΔÔ ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˆ˜ Û·ÓÈfiÙ·ÙÔ ÛÙË ‰ÈÂıÓ‹ Î·È ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
11 °∂¡π∫∂ÀªE¡∏ º§À∫Δ∞π¡ø¢∏™ æøƒπ∞™∏ (VON ZUMBUSCH) ™∂ §∏¶Δ∏ ¡∂ºƒπ∫√À ª√™Ã∂Àª∞Δ√™ μ. μÔ˘Á¿˜1, °. ¢Â‰ÂÌ¿‰Ë1, ª. ∫Ô˘ÎÔ˘Ï¿ÎË1, ∫. ¡Ô‡ÙÛ˘2, ∫. ¶·ÓÙÂÏȉ¿ÎË3, £. ∞ÔÛÙfiÏÔ˘1, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘1, ™. ¢Ú·ÎfiÔ˘ÏÔ˜1 2 1ªÔÓ¿‰· ªÂÙ·ÌÔۯ‡ÛˆÓ, ¢ÂÚÌ·ÙÔÏÔÁÈÎfi ΔÌ‹Ì· 3∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜ °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
∏ ÁÂÓÈÎÂ˘Ì¤ÓË ÊÏ˘ÎÙ·ÈÓ҉˘ „ˆÚ›·ÛË von Zumbusch Â›Ó·È ÌÈ· Û¿ÓÈ· ‰ÂÚÌ·ÙÔÏÔÁÈ΋ ¿ıËÛË ·ÓıÂÎÙÈ΋ ÛÙË ıÂڷ›·, Ô˘ ÂΉËÏÒÓÂÙ·È Ì ÂÎÙÂٷ̤ÓÔ ÂÚ˘ıËÌ·Ù҉˜ ÂÍ¿ÓıËÌ· Î·È ÔÏϷϤ˜ ÌÈÎÚ¤˜ ÊχÎÙ·ÈÓ˜. ∞ÛıÂÓ‹˜ 39 ÂÙÒÓ Û ¯ÚfiÓÈ· ·ÈÌÔοı·ÚÛË ÁÈ· ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ˘Â‚Ï‹ıË Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·fi ·Ô‚ÈÒÛ·ÓÙ· ‰fiÙË. Œ·Û¯Â ·fi ÌÈÎÚfi˜ ·fi ‰ÂÚÌ·ÙÈ΋ „ˆÚ›·ÛË Ô˘ ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó Ì ÙÔÈο ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ∏ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ ‹Ù·Ó ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ ¤Ó·ÓÙÈ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-2 (ıÂڷ›· ÂÈÛ·ÁˆÁ‹˜) Î·È ÙÚÈÏfi Û¯‹Ì· Ì tacrolimus, mycophenolate mofetil Î·È Ú‰ÓÈ˙ÔÏfiÓË. ΔËÓ 6Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ ÂÌÊ¿ÓÈÛ ÂÚ˘ıËÌ·Ù҉˜ ÂÍ¿ÓıËÌ· ÎÔÚÌÔ‡ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÙÔÈ΋ fluticasone. ΔË 12Ë Ì¤Ú·, ÙÔ ÂÍ¿ÓıËÌ· ÂȉÂÈÓÒıËΠ̠¤ÎÙ·ÛË ÛÙ· ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· ηıÒ˜ Î·È ÂΉ‹ÏˆÛË ÔÏÏ·ÏÒÓ Û˘Ó·ıÚÔ›ÛÂˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ ÊÏ˘ÎÙ·ÈÓÒÓ ‰È·Ì¤ÙÚÔ˘ 2-3 mm. ∏ ¯ÚÒÛË Gram Î·È Ë Î·ÏÏȤÚÁÂÈ· ˘ÁÚÔ‡ ·fi ÙȘ Ê˘ÛÛ·Ï›‰Â˜ ‰ÂÓ ·Ó¤‰ÂÈÍ ·ıÔÁfiÓÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi. O ·ÛıÂÓ‹˜ ·Âη٤ÛÙËÛ ÚÔԉ¢ÙÈο ÈηÓÔÔÈËÙÈ΋ ‰ÈÔ‡ÚËÛË Î·È ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 2,4 mg/dl). ΔËÓ 30Ë Ì¤Ú· ÙÔ ÊÏ˘ÎÙ·ÈÓ҉˜ ÂÍ¿ÓıËÌ· ÂÂÎÙ¿ıËΠ۠fiÏÔ ÙÔ ÛÒÌ·. ∏ ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ¤‰ÂÈÍ ÊÏ˘ÎÙ·ÈÓÒ‰Ë „ˆÚ›·ÛË von Zumbusch Ì ‰È‹ıËÛË ·fi ˈÛÈÓfiÊÈÏ·, ÂÓ‰ÂÈÎÙÈο Ê·Ú̷΢ÙÈ΋˜ ÙÔÍÈÎfiÙËÙ·˜. ΔËÓ 37Ë Ë̤ڷ Ô Ï‹Ù˘ ÚÔÛÙ¤ıËΠ˘ÚÂÙfi˜ Î·È Ì›ˆÛË Ù˘ ‰ÈÔ‡ÚËÛ˘. OÈ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÂÂÎÙ›ÓÔÓÙ·Ó ·Ú¿ ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ tacrolimus Û ΢ÎÏÔÛÔÚ›ÓË Î·È ˆ˜ ÙÂÏÂ˘Ù·›· χÛË ·ÔÊ·Û›ÛÙËÎÂ Ë ¯ÔÚ‹ÁËÛË ÌÂıÔÙÚÂÍ¿Ù˘ (50 mg/‚‰ÔÌ¿‰·, ̤ڷ 39Ë Î·È 46Ë). ∏ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÂÈ‚·Ú‡ÓıËÎÂ, ·Ó¤Ù˘Í ۋ„Ë, ·Ó΢ÙÙ·ÚÔÂÓ›·, ÛËÌ›· ‰È¿¯˘Ù˘ ÂÓ‰·ÁÁÂȷ΋˜ ‹Í˘, ÔÏÈÁÔ˘Ú›· Î·È ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· Î·È Î·Ù¤ÏËÍ ÙËÓ 57Ë Ë̤ڷ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi ÔÏ˘ÔÚÁ·ÓÈ΋ ·Ó¿ÚÎÂÈ·. ¶·Ú¿ Ùfi fiÙÈ ÔÈ ˘¿Ú¯Ô˘Û˜ Ô‰ËÁ›Â˜ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ „ˆÚ›·ÛË ÛÙȘ ·ÓÙÂӉ›ÍÂȘ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË ÂÁÚ‹ÁÔÚÛË Î·È Û ηÌÈ¿ ÂÚ›ÙˆÛË ‰ÂÓ ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÌÂıÔÙÚÂÍ¿ÙË Û ÓÂÊÚÔ·ı›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
12 ∂¡ΔO¶π™ªO™ À¶∂ƒ¶§∞™Δπ∫ø¡ O∑ø¡ ¶∞ƒ∞£Àƒ∂O∂π¢ø¡ ∞¢∂¡ø¡ ª∂ À¶∂ƒ∏ÃO°ƒ∞º∏ª∞ (ÀÃ) ∫∞𠙶π¡£∏ƒO°ƒ∞º∏ª∞ ªπμπ ™∂ ∞™£∂¡∂π™ ª∂ ΔƒπΔO¶∞£∏ À¶∂ƒ¶∞ƒ∞£Àƒ∂O∂π¢π™ªO (ΔÀ¶£) ™∂ ∞πªO∫∞£∞ƒ™∏ ◊ ª∂Δ∞ªO™Ã∂À™∏ ¡∂ºƒOÀ ¶ƒπ¡ ∞¶O ¶∞ƒ∞£Àƒ∂O∂π¢∂∫ΔOª∏. ™À™Ã∂Δπ™ªO™ ª∂ π™ΔO§O°π∫∞ ∂Àƒ∏ª∞Δ∞ £. ∞ÔÛÙfiÏÔ˘, ∂. °ÂˆÚÁÈ¿‰Ô˘, ª. ∫Ô˘ÎÔ˘Ï¿ÎË, ∫. ¢ËÌÔÛı¤ÓÔ˘˜, Ã. μÔ˘ÚÏ¿ÎÔ˘, ∂. ∞ÓÙ‡·, °. ∫Ô˘ÙÚԇ̷˜, ∫. ª·Ï¿Ûη, ¢. ¶ÈÛÙfiÏ·˜, μ. μÔ˘Á¿˜, ™. ¢Ú·ÎfiÔ˘ÏÔ˜, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ °¡∞ «O ∂˘·ÁÁÂÏÈÛÌfi˜» ΔÌ‹Ì·Ù· ¡ÂÊÚÔÏÔÁÈÎfi, ªÂÙ·ÌfiÛ¯Â˘Û˘ ÓÂÊÚÔ‡, ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi, ∞ÎÙÈÓÔÏÔÁ›·˜, ∞ı‹Ó·
O ÂÓÙÔÈÛÌfi˜ ˘ÂÚÏ·ÛÙÈÎÒÓ ·Ú·ı˘ÚÂÔÂȉÒÓ ·‰¤ÓˆÓ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ Û ·ÈÌÔοı·ÚÛË ‹ ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË, Ì ÔÔÈ·‰‹ÔÙ ̤ıÔ‰Ô ·Ó›¯Ó¢Û˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘ÛÎÔϛ˜. ∞ӷʤÚÂÙ·È ¿ÓÙˆ˜ fiÙÈ Û ˘ÂÚÏ·ÛÙÈÎÔ‡˜ ·Ú·ı˘ÚÂÔÂȉ›˜ ·‰¤Ó˜, Ù· Ô͇ÊÈÏ· ·ÙÙ·Ú· ·˘ÙÒÓ , Ô˘ ‚Ú›ıÔ˘Ó ·fi ÌÈÙÔ¯fiÓ‰ÚÈ·, ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ÛÈÓıËÚÔÁÚ·ÊÈο ÙÔ ªπμπ Î·È ÂÓÙÔ›˙ÔÓÙ·È ¤ÙÛÈ ÔÈ ˘ÂÚÏ·ÛÙÈÎÔ› fi˙ÔÈ. ªÂ ÛÎÔfi ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ˘ÂÚÏ·ÛÙÈÎÒÓ ·‰¤ÓˆÓ Ì ÀÃ Î·È ªπμπ ÚÈÓ ·fi ·Ú·ı˘ÚÂÔÂȉÂÎÙÔÌ‹ Û ·ÛıÂÓ›˜ Ì ΔÀ¶£ Î·È ÙÔÓ Û˘Û¯ÂÙÈÛÌfi ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ì ٷ ÛÈÓıËÚÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·, ÂÍÂÙ¿Û·Ì 35 ·ÛıÂÓ›˜ (23 ˘fi ·ÈÌÔοı·ÚÛË Î·È 12 Ì ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË (22 ¿Ó‰Ú˜), 53±12 ÂÙÒÓ Û Â͈ÓÂÊÚÈ΋ ˘ÔÛÙ‹ÚÈÍË ÁÈ· 7±48 Ì‹Ó˜ ÚÈÓ ·fi ÙËÓ ·Ú·ı˘ÚÂÔÂȉÂÎÙÔÌ‹ Ì ΔÀ¶£ (·Î¤Ú·ÈÔ ÎÏ¿ÛÌ· ·Ú·ıÔÚÌfiÓ˘ (iPTH) ̤ÛË ÙÈÌ‹± SD (1011±572 pg/ml). ∂Í·ÈÚ¤ıËÎ·Ó Î·È ÂÍÂÙ¿ÛıËÎ·Ó 109 ·‰¤Ó˜ ( 3,1/·ÛıÂÓ‹). ¶ÚÈÓ ÙËÓ ·Ú·ı˘ÚÂÔÂȉÂÎÙÔÌ‹, Ì ÙËÓ ¯Ú‹ÛË ÀÃ Î·È ªπμπ ÂÓÙÔ›ÛıËÎ·Ó 55 fi˙ÔÈ (1,7/·ÛıÂÓ‹) Î·È 60 (1,8/·ÛıÂÓ‹) ·ÓÙ›ÛÙÔȯ· , ÂÓÒ 8/35 Î·È 3/35 ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ˘ÂÚ˯ÔÁÚ·ÊÈο Î·È ÛÈÓıËÚÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· πÛÙÔÏÔÁÈο fiÏÔÈ ÔÈ ·‰¤Ó˜ ÏËÓ ÂÓfi˜ ·ÚÔ˘Û›·˙·Ó Ô˙Ò‰Ë ˘ÂÚÏ·Û›· Ì ÌÈÎÙfi ÏËı˘ÛÌfi ΢ÙÙ¿ÚˆÓ (‰È·˘Á‹, Ô͇ÊÈÏ· Î·È ıÂ̤ÏÈ· ·ÙÙ·Ú·). ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ‰ÂÓ ·ÔÎ¿Ï˘„Â Û˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ ÙÔ˘ ›‰Ô˘˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ·˘ÙÔ‡˜ ÙÔ˘˜ ÂÈÏÂÁ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ΔÀ¶£ ÔÈ ÀÃ Î·È ÙÔ ªπμπ ‹Ù·Ó ÌÂÚÈÎÒ˜ ¢·›ÛıËÙ· ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ˘ÂÚÏÂÈÙÔ˘ÚÁÔ‡ÓÙˆÓ ·‰¤ÓˆÓ ÂÓÒ Ô Î˘ÙÙ·ÚÈÎfi˜ ÏËı˘ÛÌfi˜ (Î·È ÂȉÈο Ù· Ô͇ÊÈÏ· ·ÙÙ·Ú· ÏÔ‡ÛÈ· Û ÌÈÙÔ¯fiÓ‰ÚÈ·) ‰ÂÓ Û˘Û¯ÂÙ›ÛıËΠ̠ٷ ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·˘ÙÒÓ ÙˆÓ Ù¯ÓÈÎÒÓ ·ÎfiÌË Î·È Û ·Ú·ı˘ÚÂÔÂȉ›˜ Ô˘ Â›Ó·È de facto ˘ÂÚÏ·ÛÙÈÎÔ›.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
13 ∏ ¶∞ƒ∞£Àƒ∂O∂π¢π∫∏ §∂πΔOÀƒ°π∞ ™∂ §∏¶Δ∂™ ¡∂ºƒπ∫ø¡ ªO™Ã∂Àª∞Δø¡ £. ∞ÔÛÙfiÏÔ˘, ª. ∫Ô˘ÎÔ˘Ï¿ÎË, ∫. ª·Ï¿Ûη, ¢. ¶ÈÛÙfiÏ·˜, ∂. ÷ÚÈÙ¿ÎË, °. ªÂÙ·Í¿ÙÔ˜, ∞. ª·ÏÈÙÛ¿ÚË, μ. ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘, ™. ¢Ú·ÎfiÔ˘ÏÔ˜ ªÔÓ¿‰· ªÂÙ·ÌÔۯ‡ÛÂˆÓ Î·È ¡ÂÊÚÔÏÔÁÈÎfi ΔÌ‹Ì·, °.¡.∞. «O ∂˘·ÁÁÂÏÈÛÌfi˜»
O ‰Â˘ÙÂÚÔ·ı‹˜ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ (¢À¶£) Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÌÔÚ› Ó· ˘ÔÛÙÚ·Ê› ÌÂÚÈÎÒ˜ ÌÂÙ¿ ·fi ÂÈÙ˘¯‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. ™ÎÔfi˜ Ù˘ ÚÔÔÙÈ΋˜ ·˘Ù‹˜ ÌÂϤÙ˘ Â›Ó·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÔÚ›·˜ ÙÔ˘ ¢À¶£ Û ϋÙ˜ ÓÂÊÚÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜. ™ÙËÓ ÂÚ›Ô‰Ô ∞‡ÁÔ˘ÛÙÔ˜ 2004 - ¢ÂΤ̂ÚÈÔ˜ 2006, 42 ·ÛıÂÓ›˜ (32 ¿Ó‰Ú˜) ‰È¿ÌÂÛ˘ ËÏÈΛ·˜ 49,9 ÂÙÒÓ (‡ÚÔ˜ 21–72), Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÂÈÙ˘¯‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ (ÌÔۯ‡̷ٷ: 32 ·fi ·Ô‚ÈÒÛ·ÓÙ· ‰fiÙË - 10 ·fi ˙ÒÓÙ·), ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË. μÈÔ¯ËÌÈÎfi˜ Î·È ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ·Ú·ı˘ÚÂÔÂȉÈ΋˜ Î·È ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Î¿ı 3 Ì‹Ó˜ ̤¯ÚÈ ÙÔ˘˜ 12. O ¯ÚfiÓÔ˜ ÛÙËÓ ·ÈÌÔοı·ÚÛË ‹Ù·Ó 43,6 Ì‹Ó˜ (‰È·Î‡Ì·ÓÛË 4-131) Î·È ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÙÔ Ï·›ÛÈÔ Ù˘ ÌÂϤÙ˘ 9 Ì‹Ó˜ (‰È·Î‡Ì·ÓÛË 3-12 Ì‹Ó˜). ŸÏÔÈ ·Ôη٤ÛÙËÛ·Ó Î·Ï‹ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ¶·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ·Ú·ıÔÚÌfiÓ˘ (iPTH) ÛÙËÓ ¿ÌÂÛË Î·È ÛÙËÓ ·ÒÙÂÚË ÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋ ÂÚ›Ô‰Ô. §‹Ù˜ Ô˘ ›¯·Ó ·Ú·Ì›ÓÂÈ Û ·ÈÌÔοı·ÚÛË >5 ¤ÙË Â›¯·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤Ó˜ ÙÈ̤˜ ·Ú·ıÔÚÌfiÓ˘ ÙfiÛÔ ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË fiÛÔ Î·È ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· (r=0,71, p=0,01). OÈ ÙÈ̤˜ iPTH ·Ó Î·È ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο, ‰ÂÓ ¤Êı·Û·Ó ÛÙÔ Â›Â‰Ô < ÙˆÓ 70 ng/ml Ô˘ ıˆÚÂ›Ù·È ÙÔ È‰·ÓÈÎfi Î·È ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ 3Ô˘ ÛÙ·‰›Ô˘. ∂È̤ÓÔ˘Û· ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· (sCa>10.5 mg/dl) ·Ú·ÙËÚ‹ıËΠ۠6/42, (14,3%) Ï‹Ù˜. O ÚÔÌÂÙ·ÌÔÛ¯Â˘ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ¤ÏÏÂÈ„Ë 25OH μÈÙ·Ì›Ó˘ D (<30 ng/dl) Û 36/42, 85,7% Ï‹Ù˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 4 ›¯·Ó ·Ó¿ÚÎÂÈ· [25(OH) μÈÙ D <7ng/dl]. ª‹Ó·˜ eGFR (ml/min) iPTH (pg/ml) ∞Û‚¤ÛÙÈÔ ÔÚÔ‡ (mg/dl) ºÒÛÊÔÚÔ˜ ÔÚÔ‡ (mg/dl) 25(OH) μÈÙ. D (ng/ml)
0
3
6
12
p
N/A 411.1±351.7 9.4±1 5.3±1.9 19.3±12.9
50.4±20.8 166.1±104.3 10.3±0.9 3.3±1.3 14.9±6.7
47.7±20.9 174.9±97.3 10.2±0.7 3.3±0.8 16.2±9.2
50.8±20.06 143.6±112 10 ±0.8 3.4±0.7 19.4±8.4
– p<0.001 p<0.001 p<0.001 p=0.146
∏ ÂÈÙ˘¯‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Û˘Ì‚¿ÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ¢À¶£, ÙÔ˘ ÔÔ›Ô˘ Ë ÂͤÏÈÍË ÂËÚ¿˙ÂÙ·È ·fi ÙÔ ÌÂÁ¿ÏÔ ¯ÚfiÓÔ ·Ú·ÌÔÓ‹˜ ÙÔ˘ Ï‹ÙË ÛÙËÓ ·ÈÌÔοı·ÚÛË. ∏ ˘Ô‚Èٷ̛ӈÛË D, Ô˘ Û˘Ì‚¿ÏÏÂÈ ÂÓ Ì¤ÚÂÈ ÛÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ¢À¶£, Ê·›ÓÂÙ·È Ó· ÌËÓ ˘ÔÛÙÚ¤ÊÂÈ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡, ÙÔ˘Ï¿¯ÈÛÙÔ ÛÙÔ ÚÒÙÔ ¤ÙÔ˜.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
14 ∂À∂ƒ°∂Δπ∫∏ ¢ƒ∞™∏ ΔOÀ ªOƒπOÀ U-74389 G ™∂ ¶∂πƒ∞ª∞Δπ∫O ¶ƒOΔÀ¶O O•∂π∞™ π™Ã∞πªπ∞™ ∫∞π ∞∫O§OÀ£ø™ ∂¶∞¡∞πª∞Δø™∏™ ∏¶∞ΔO™, ™∂ ¶∂πƒ∞ª∞Δπ∫O ¶ƒOΔÀ¶O ∞ƒOÀƒ∞πOÀ ∞. ¶··Ïfi˘2, I. ∫¿·˜1,2, ∫. ª›ÚÌ·˜1, π. ∫·ÎÏ·Ì¿ÓÔ˜1, ¢. μÏ·¯Ô‰ËÌËÙÚfiÔ˘ÏÔ˜3, ∂. ∫·Ú¿ÌÂÏ·2, ª. ™È‰ÂÚ‹˜2, ∫. ΔÛ·Ú¤·2, °. ªÔÓ¿ÙÛÔ˜1 1ÃÂÈÚÔ˘ÚÁÈ΋
∫ÏÈÓÈ΋, ¡ÔÛËÏ¢ÙÈÎÔ‡ ΔÌ‹Ì·ÙÔ˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ – ¶ÂÈÚ·Ì·ÙÈÎfi ∫¤ÓÙÚÔ ELPEN A.E. 3π·ÙÚÔ‰ÈηÛÙÈÎfi ΔÌ‹Ì·-¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2∂Ú¢ÓËÙÈÎfi
™∫O¶O™
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ÂÍÂÙ¿ÛÂÈ ÙËÓ ‰Ú¿ÛË ÙÔ˘ ÂÈÚ·Ì·ÙÈÎÔ‡ ÌÔÚ›Ô˘ U-74389G Û ÔÍ›· Ë·ÙÈ΋ ÈÛ¯·ÈÌ›· (È) Î·È Â·Ó·ÈÌ¿ÙˆÛË (Â) ‹·ÙÔ˜ Û ·ÚÔ˘Ú·›Ô˘˜. ∂Ô̤ӈ˜ ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÌfiÚÈÔ ÌÔÚ› Ó· ‰È·‰Ú·Ì·Ù›ÛÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚÔÛÙ·Û›· ÙÔ˘ ÔÚÁ¿ÓÔ˘ ηٿ ÙËÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È ÂӉ¯Ô̤ӈ˜ Î·È ÛÙÔ ‰È¿Ï˘Ì· Û˘ÓÙ‹ÚËÛ˘. À§π∫O ∫∞π ªE£O¢O™
™˘ÓÔÏÈÎÒ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 60 ·ÚÛÂÓÈÎÔ› ·ÚÔ˘Ú·›ÔÈ Wistars (∂∫∂º∂ «¢ËÌfiÎÚÈÙÔ˜») ‚¿ÚÔ˘˜ 220 – 290 g. Δ· ÂÈÚ·Ì·Ùfi˙ˆ· ¯ˆÚ›ÛÙËÎ·Ó Û 6 ÔÌ¿‰Â˜ Ì 10 ˙Ò· ¤Î·ÛÙË. OÌ¿‰· 1: OÌ¿‰· ÂϤÁ¯Ô˘, 30 min È. Î·È 60 min Â. OÌ¿‰· 2: OÌ¿‰· ÂϤÁ¯Ô˘, 30 min È. Î·È 120 min Â. OÌ¿‰· 3: 30 min È., ¯ÔÚ‹ÁËÛË ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ Î·È 60 min Â. OÌ¿‰· 4: 30 min È., ¯ÔÚ‹ÁËÛË ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ Î·È 120 min Â. OÌ¿‰· 5: 30 min È., ¯ÔÚ‹ÁËÛË U-74389G Î·È 60 min Â. OÌ¿‰· 6: 30 min È., ¯ÔÚ‹ÁËÛË U74389G Î·È 120 min Â. ∏ È. ÙÔ˘ ‹·ÙÔ˜ ÚÔÎÏ‹ıËΠ̠ÙËÓ ¯Ú‹ÛË Î·Ù¿ÏÏËÏˆÓ ÌÈÎÚÔ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Ï·‚›‰ˆÓ ÛÙËÓ Ë·ÙÈ΋ ·ÚÙËÚ›· Î·È ÙËÓ ˘Ï·›· ÊϤ‚·. ™ÙÔ Ù¤ÏÔ˜ Ù˘ È., ¯ÔÚËÁÔ‡ÓÙ·Ó ·ÛÎÔÚ‚ÈÎfi Ô͇ ‹ U-74389G ÂÓ‰ÔÊÏ‚›ˆ˜ Î·È ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë ÂÚ›Ô‰Ô˜ Â. ∏ ‰Ú¿ÛË ÙˆÓ ÌÔÚ›ˆÓ ÂÍÂÙ¿ÛÙËΠ̠·Ó·Ï˘ÙÈ΋ ÈÛÙÔ·ıÔÏÔÁÈ΋ ÌÂϤÙË, Ì ÙËÓ Ì¤ÙÚËÛË ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Î·È Ì ÙËÓ Ì¤ÙÚËÛË ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ MDA (ÔÍÂȉˆÙÈÎfi ÛÙÚ¤˜) Î·È TNF-· (ÊÏÂÁÌÔÓ‹). ∞¶OΔ∂§E™ª∞Δ∞
™ÙȘ ÔÌ¿‰Â˜ ÂϤÁ¯Ô˘, Ë ‚Ï¿‚Ë ÙÔ˘ ‹·ÙÔ˜ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ Û fiϘ ÙȘ ÂÍÂÙ·˙fiÌÂÓ˜ ·Ú·Ì¤ÙÚÔ˘˜. ∞˘Ù‹ Ë ·‡ÍËÛË ÌÂÈÒıËΠÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ÛÙȘ ÔÌ¿‰Â˜ 5 Î·È 6, ÙfiÛÔ Û ۇÁÎÚÈÛË Ì ÙȘ ÔÌ¿‰Â˜ ÂϤÁ¯Ô˘ fiÛÔ Î·È Û ۇÁÎÚÈÛË Ì ÙȘ ÔÌ¿‰Â˜ ÙÔ˘ ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ. ™Àª¶Eƒ∞™ª∞
ΔÔ U-74389G Â›Ó·È È‰È·ÈÙ¤Úˆ˜ ¢ÂÚÁÂÙÈÎfi ÌfiÚÈÔ Ì ÈÛ¯˘Ú‹ ·ÓÙÈÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË.
101
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
15 ∂À∂ƒ°∂Δπ∫∏ ¢ƒ∞™∏ ΔOÀ ªOƒπOÀ U-74389 G ™∂ ¶∂πƒ∞ª∞Δπ∫O ¶ƒOΔÀ¶O π™Ã∞πªπ∞™ / ∂¶∞¡∞πª∞Δø™∏™ ¡∂ºƒOÀ ∞ƒOÀƒ∞πOÀ. ∂π¢π∫∏ μπOÃ∏ªπ∫∏, ªOƒºO§O°π∫∏ ∫∞π §∂πΔOÀƒ°π∫∏ ª∂§∂Δ∏ ∞. ¶··Ïfi˘3, ∫. ¶··‰ÔÔ‡ÏÔ˘1-3, ¶. Δ˙·Ú‰‹˜5, ∂. ∫·Ú¿ÌÂÏ·3, ∫. ΔÛ·Ú¤·3, ª. ™È‰ÂÚ‹˜3, π. ™ÊËÓÈ·‰¿Î˘4, ∂. ºÂϤÎÔ˘Ú·˜1, ∂. §¤·Ó‰ÚÔ˜2, °. ∑ˆÁÚ¿ÊÔ˜2, π. ªÚ¿Ì˘2, ∏. ª·ÛÙÔ‡Ó˘1 1∞ã ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋, 21Ë ¶ÚÔ·È‰Â˘ÙÈ΋ ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋, ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ∂Ú¢ÓËÙÈÎfi - ¶ÂÈÚ·Ì·ÙÈÎfi ∫¤ÓÙÚÔ ELPEN A.E. 4∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜, ¡·˘ÙÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∞ıËÓÒÓ 5∞ã ÃÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛ/Ì›Ԣ ∂ÏÏËÓÈÎÔ‡ ∂Ú˘ıÚÔ‡ ™Ù·˘ÚÔ‡
3π·ÙÚÈ΋˜
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™˘ÓÔÏÈÎÒ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 60 ·ÚÛÂÓÈÎÔ› ·ÚÔ˘Ú·›ÔÈ Wistars (EKEº∂ «¢ËÌfiÎÚÈÙÔ˜») ‚¿ÚÔ˘˜ 280 – 350 g.Δ· ÂÈÚ·Ì·Ùfi˙ˆ· ¯ˆÚ›ÛÙËÎ·Ó Û 6 ÔÌ¿‰Â˜ Ì 10 ˙Ò· ¤Î·ÛÙË. OÌ¿‰· 1: OÌ¿‰· ÂϤÁ¯Ô˘, 30 min È. Î·È 60 min Â. OÌ¿‰· 2: OÌ¿‰· ÂϤÁ¯Ô˘, 30 min È. Î·È 120 min Â. OÌ¿‰· 3: 30 min È., ¯ÔÚ‹ÁËÛË ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ Î·È 60 min Â. OÌ¿‰· 4: 30 min È., ¯ÔÚ‹ÁËÛË ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ Î·È 120 min Â. OÌ¿‰· 5: 30 min È., ¯ÔÚ‹ÁËÛË U-74389G Î·È 60 min Â. OÌ¿‰· 6: 30 min È., ¯ÔÚ‹ÁËÛË U74389G Î·È 120 min Â. ∏ È. ÙÔ˘ ÓÂÊÚÔ‡ ÚÔÎÏ‹ıËΠ̠ÙËÓ ¯Ú‹ÛË Î·Ù¿ÏÏËÏˆÓ ÌÈÎÚÔ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Ï·‚›‰ˆÓ ÛÙËÓ ÓÂÊÚÈ΋ ·ÚÙËÚ›· Î·È ÙË ÊϤ‚· ™ÙÔ Ù¤ÏÔ˜ Ù˘ È., ¯ÔÚËÁÔ‡ÓÙ·Ó ·ÛÎÔÚ‚ÈÎfi Ô͇ ‹ U74389G ÂÓ‰ÔÊÏ‚›ˆ˜ Î·È ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë ÂÚ›Ô‰Ô˜ Â. ∏ ‰Ú¿ÛË ÙˆÓ ÌÔÚ›ˆÓ ÂÍÂÙ¿ÛÙËΠ̠·Ó·Ï˘ÙÈ΋ ÈÛÙÔ·ıÔÏÔÁÈ΋ ÌÂϤÙË, Ì ÙËÓ Ì¤ÙÚËÛË ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Î·È Ì ÙËÓ Ì¤ÙÚËÛË ÛÙÔÓ ÓÂÊÚÈÎfi ÈÛÙfi ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ MDA (ÔÍÂȉˆÙÈÎfi ÛÙÚ¤˜) Î·È TNF-· (ÊÏÂÁÌÔÓ‹). ∞¶OΔ∂§E™ª∞Δ∞
™ÙȘ ÔÌ¿‰Â˜ ÂϤÁ¯Ô˘, Ë ‚Ï¿‚Ë ÙÔ˘ ÓÂÊÚÔ‡ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ Û fiϘ ÙȘ ÂÍÂÙ·˙fiÌÂÓ˜ ·Ú·Ì¤ÙÚÔ˘˜. ∞˘Ù‹ Ë ·‡ÍËÛË ÌÂÈÒıËΠÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ÛÙȘ ÔÌ¿‰Â˜ 5 Î·È 6, ÙfiÛÔ Û ۇÁÎÚÈÛË Ì ÙȘ ÔÌ¿‰Â˜ ÂϤÁ¯Ô˘ fiÛÔ Î·È Û ۇÁÎÚÈÛË Ì ÙȘ ÔÌ¿‰Â˜ ÙÔ˘ ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ. ™Àª¶Eƒ∞™ª∞
ΔÔ U-74389G Â›Ó·È È‰È·ÈÙ¤Úˆ˜ ¢ÂÚÁÂÙÈÎfi ÌfiÚÈÔ Ì ÈÛ¯˘Ú‹ ·ÓÙÈÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË.
102
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
16 £ƒOªμO∫ÀΔO¶∂¡π∞ ™∂ Oƒ£OΔO¶π∫∏ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ (¶ƒO¢ƒ√ª∏ ª∂§EΔ∏) ∞. ∫·Ú··Ó·ÁÈÒÙÔ˘1, Ã. ΔÛÈfiÙÚ·˜1, ¢. ∞˘ÁÔ˘ÛÙ‹1 ¡. ™Ô˘Óȉ¿Î˘1, £. μ·ÛÈÏÂÈ¿‰Ë˜2, B. ¶··ÓÈÎÔÏ¿Ô˘3, ¢. Δ·ÎÔ‡‰·˜3, ¡. °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË1 1M.∂.£., 2μ′
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¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ KÏÈÓÈ΋ ªÂÙ·ÌÔۯ‡ÛÂˆÓ πÔÎÚ·Ù›Ԣ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢
∏ ıÚÔÌ‚Ô΢ÙÔÂÓ›· Â›Ó·È Û˘¯Ó‹ Î·È ‰˘ÓËÙÈο ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÌÂÙ¿ ·fi ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (O.ª.∏). Œ¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·˘ÍË̤ӷ ›‰· ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È ¤¯ÂÈ ‰È·Ù˘ˆı› fiÙÈ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ӷ ÔÛÔÛÙ¿ ÏÔÈÌÒ͈Ó. ™∫O¶O™
∞Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Û ·ÛıÂÓ›˜ Ì ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜, Ù˘ ıÚÔÌ‚Ô΢ÙÙÔÂÓ›·˜ ,ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Ù˘ ÂÌÊ¿ÓÈÛ˘ ÏÔÈÌÒÍÂˆÓ Î·ıÒ˜ Î·È Ù˘ ¤Î‚·Û˘ ·˘ÙÒÓ. À§π∫O ∫∞π ªE£O¢O™
ªÂÏÂÙ‹Û·Ì ·Ó·‰ÚÔÌÈο 47 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ËÏÈΛ·˜ Ì.Ô 50,26 ¤ÙË (18-64 ¯ÚÔÓÒÓ) ÂÎ ÙˆÓ ÔÔ›ˆÓ 20 ¿Ó‰Ú˜ Î·È 17 Á˘Ó·›Î˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û O.M.H. ŒÁÈÓ ηٷÁÚ·Ê‹ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È ÙˆÓ ÔÛÔÛÙÒÓ ÙˆÓ ÏÔÈÌÒ͈Ó. ∞¶OΔ∂§E™ª∞Δ∞
¶ÚÔÂÁ¯ÂÈÚËÙÈο Ô ·ÚÈıÌfi˜ ÙˆÓ PLT ‚Ú¤ıËΠηٿ Ì.Ô ÛÙȘ 70,34×103 Î.Î.¯. ªÂÙ¿ ÙËÓ ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Ë ¯·ÌËÏfiÙÂÚË ÙÈÌ‹ ηٷÁÚ¿ÊËΠ۠ÔÛÔÛÙfi 77,22% ÙËÓ 3Ë-4 Ë Ë̤ڷ Î·È ‹Ù·Ó ηٿ Ì.Ô 35,19×103 (13 – 107×103) Î.Î.¯. ∞ÓÙ›ÛÙÔȯ· ÌÂÙÚ‹ıËÎ·Ó Î·È ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Ì.Ô 11,8±9,3. §ÔÈÌÒÍÂȘ ÂÌÊ·Ó›ÛÙËÎ·Ó Û ÔÛÔÛÙfi 34,02%, ÂÓÒ ÔÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ·Ó‹Ïı·Ó Û 14,89%. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ Ù· ·ÈÌÔÂÙ¿ÏÈ· ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· ÙˆÓ 35×103 Î.Î.¯. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÈÌÔÂÙ¿ÏÈ· <35×103 Î.Î.¯. Ë ıÓËÙfiÙËÙ· ˘ÔÏÔÁ›ÛÙËΠ۠˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi (36,3 %) Û ۯ¤ÛË Ì ÂΛÓÔ˘˜ Ì ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ. ™Àª¶Eƒ∞™ª∞
∏ ıÚÔÌ‚Ô΢ÙÔÂÓ›· Â›Ó·È ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÙˆÓ ·ÛıÂÓÒÓ Ì ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. º·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ӷ ›‰· ¯ÔÏÂÚ˘ıÚ›Ó˘ ·ÏÏ¿ Î·È ÙËÓ ÌÂÁ·Ï‡ÙÂÚË ÂÌÊ¿ÓÈÛË ÏÔÈÌÒ͈Ó. ÃÚÂÈ¿˙ÂÙ·È fï˜ ÌÂÁ·Ï‡ÙÂÚÔ ‰Â›ÁÌ· ·ÛıÂÓÒÓ ÁÈ· ÂȂ‚·›ˆÛË.
103
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
17 ÃOƒ∏°∏™∏ ∞¡∞™À¡¢À∞™ª∂¡OÀ ∂¡∂ƒ°O¶Oπ∏ª∂¡OÀ ¶∞ƒ∞°O¡Δ∞ VII ™∂ ª∞∑π∫∏ ∞πªOƒƒ∞°π∞ ª∂Δ∞ ºÀ™πO§O°π∫O ΔO∫∂ΔO ™∂ °À¡∞π∫∞ À¶Oæ∏ºπ∞ °π∞ ∂¶∂π°OÀ™∞ ª∂Δ∞ªO™Ã∂À™∏ ∏¶∞ΔO™ ¶. ¶·¿˜1, ∂. ªÔ˘ÏÔ‡‰Ë1, Ã. ¶··ÁˆÚÁ›Ô˘1, ¡. ™Ô˘Óȉ¿Î˘1, ∫. ∫·ÙÛ·ÓԇϷ˜1, £. μ·ÛÈÏÂÈ¿‰Ë˜2, ¡. °Ú›ÙÛË–°ÂÚÔÁÈ¿ÓÓË1 1ª.∂.£.
∂ÓËϛΈÓ, 2°·ÛÙÚÂÓÙÂÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ μ’ ¶ÚÔ.¶·ıÔÏ.∫ÏÈÓÈ΋˜, °.¶.¡.£. “πÔÎÚ¿ÙÂÈÔ”
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¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡: ÀÂÚÔÍ›· Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· (YHA) ÌÂÙ¿ ÎÂÚ·˘ÓÔ‚fiÏÔ Ë·Ù›Ùȉ· μ Û ¤ÁÎ˘Ô (32w ·ËÛ˘), 33 ÂÙÒÓ. ∏·ÙÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· II ÛÙ·‰›Ô˘, INR >7, Factor V <10%, ÔÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË ÔÚÔ‡ 11.6 mg/ml. ™ÙËÓ ª.∂.£. Ë ·ÛıÂÓ‹˜ ÎÚ›ıËΠ˘Ô„‹ÊÈ· ÁÈ· ›ÁÔ˘Û· ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜. ªÂÙ¿ 30 ÒÚ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ª.∂.£., ¿Ú¯ÈÛ·Ó ÔÈ ˆ‰›Ó˜ ÙÔ˘ ÙÔÎÂÙÔ‡. ∏ ·ÛıÂÓ‹˜ Ì ‚ÂÏÙȈ̤ÓÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘ Î·È Ì ‰Â›ÎÙ˜ ‹Í˘: INR: 1.56, aPTT:38.6, Fib:194 mg/dl, Factor V:56% (ÌÂÙ¿ ÙËÓ ¯ÔÚ‹ÁËÛË Û˘ÓÔÏÈο 29 U FFP, 29 U ÎÚ˘ÔηıÈ˙‹Ì·Ù· Î·È 7 U RBC) Á¤ÓÓËÛ ¤Ó· ˘ÁȤ˜ ·ÁfiÚÈ. Δ¤ÛÛÂÚȘ ÒÚ˜ ·ÚÁfiÙÂÚ· ÂÂÏ¿ÎË Ì ̷˙È΋ ÎÔÏÈ΋ ·ÈÌÔÚÚ·Á›· Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËΠ̷̠˙È΋ ÌÂÙ¿ÁÁÈÛË Î·È Ì ¿ÌÂÛË ¯ÔÚ‹ÁËÛË 2.4 mg ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ÂÓÂÚÁÔÔÈË̤ÓÔ˘ ·Ú¿ÁÔÓÙ· VII (rFVIIa). ∏ ÎÔÏÈ΋ ·ÈÌÔÚÚ·Á›· Ù¤ıËΠ˘fi ÈηÓÔÔÈËÙÈÎfi ¤ÏÂÁ¯Ô Î·È ÂϤÁ¯ıËΠϋڈ˜ 6 ÒÚ˜ ·ÚÁfiÙÂÚ· Ì ÂÌ‚ÔÏÈÛÌfi, ˘fi ·ÎÙÈÓÔÛÎÔÈÎfi ¤ÏÂÁ¯Ô, ÙˆÓ ˘ÔÁ·ÛÙÚ›ˆÓ ·ÚÙËÚÈÒÓ ¿Ìʈ. ∏ ·ÛıÂÓ‹˜ ¤Ï·‚Â Û˘ÓÔÏÈο 32 U FFP, 28 U ÎÚ˘ÔηıÈ˙‹Ì·ÙÔ˜, 16 U RBC ̤¯ÚÈ ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÈÌÔÚÚ·Á›·˜. ªÂÙ¿ 36 ÒÚ˜ Ë ·ÛıÂÓ‹˜ ‰È·ÛˆÏËÓÒıËΠÏfiÁˆ ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜, ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Ì ˷ÙÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· III ÛÙ·‰›Ô˘. ∞‚›ˆÛ 11 Ë̤Ú˜ ÌÂÙ¿ ·fi Û‡Ó‰ÚÔÌÔ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÔÏÏ·ÏÒÓ ÔÚÁ¿ÓˆÓ ÏfiÁˆ Û‹„˘ Î·È À.∏.∞. ™Àª¶Eƒ∞™ª∞TA
∏ À.∏.∞. ·ÔÙÂÏ› ‰Ú·Ì·ÙÈ΋ ÂÈÏÔ΋ Ù˘ ·ËÛ˘ Ì ˘„ËÏfiÙ·ÙË ÌËÙÚÈ΋ Î·È ÂÌ‚Ú˘È΋ ıÓËÙfiÙËÙ· (>80%). ∏ ·ÛıÂÓ‹˜ Ì·˜ Á¤ÓÓËÛÂ Ê˘ÛÈÔÏÔÁÈο ¤Ó· ˘ÁȤ˜ ·ÁfiÚÈ, Ë Ì·˙È΋ ·ÈÌÔÚÚ·Á›· ·ÓÙÈÌÂÙˆ›ÛÙËΠÂÈÙ˘¯Ò˜ Î·È Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ rFVIIa, fï˜ ÔÈ Ì›˙ÔÓ˜ ÂÈÏÔΤ˜ Ù˘ À.∏.∞. Ô‰‹ÁËÛ·Ó ÛÙÔÓ ı¿Ó·Ùfi Ù˘.
104
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
18 THE HIPPOCRATIC OATH AND THE RELATED HIPPOCRATIC APHORISMS IN THE PRELIMINARY STUDY OF MEDICAL ETHICS OF THE LAPAROSCOPIC LEFT LATERAL HEPATECTOMY IN LIVING DONORS K. Mammas, G. Kottis, G. Kostopanagiotou, N. Arkadopoulos, B. Smyrniotis Experimental Sugical laboratory’’K. TOYNTAS’’, Aretaieion Hospital of Athens University of Athens
AIM
The Hippocratic Oath is the most admired work in world’s medical ethics. The aim of the study is to examine the medical ethics of the Oath and related Hippocratic Aphorisms in relation to the application of methods of contemporary minimally invasive liver surgery, in the laparoscopic left lateral hepatectomy, in living donors . METHOD
Qualitative and quantitative data related to the contemporary laparoscopic liver surgery and the conditions that should exist for the development of innovative methods in the left partial hepatectomy in living donors, are examined under the perspective of the ethical precepts and the humanistic concepts o the Hippocratic Oath and the related Hippocratic Aphorisms. The study then assesses the assumption of the impact of laparoscopic liver surgery on the rights of donors with an emphasis on the need to provide them with a medical care as expeditiously, as safely, as effectively and as humanely as possible. RESULTS
The study shows that the Hippocratic Oath and the related Hippocratic Aphorisms can be used as an applicable and useful ethical guidance in the use of laparoscopic liver surgery for the left lateral hepatectomy in living donors. CONCLUSIONS
The use of the Hippocratic Oath and the related Hippocratic Aphorisms in the preliminary study of medical ethics of the laparoscopic left lateral hepatectomy in living donors, shows that contemporary laparoscopic liver surgery protects the rights of living donors under the conditions that innovations justify the acceptance of some risk, the risk and the benefit for the donor are acceptable, the need for a structured process for informed consent is fulfilled and the harvested graft is similar with that of laparotomy.
105
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
19 BASELINE HEPATIC ARTERIAL DOPPLER INCREASES PATIENT BUT NOT GRAFT SURVIVAL IN ORTHOTOPIC LIVER TRANSPLANTATION D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, P. Metrakos Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Liver enzyme elevation is the major marker of graft dysfunction secondary to an acute vascular event in the immediate postoperative period after liver transpalantation. PURPOSE
To investigate whether a baseline arterial doppler coupled with an aggressive surgical approach in cases of arterial flow absence leads to higher patient survival. METHODS
566 adult liver transplants were performed between 1990 and 2006. Hepatic arterial doppler was performed on the first postoperative day (baseline) and each time that an elevation of the liver enzymes was observed. Patients with abnormal doppler findings (with or without enzymes elevation) during the first postoperative week were re-explored. Abnormal doppler findings that were discovered after the first postoperative week were verified by CT angiogram. The 47 patients that were diagnosed with arterial thrombosis either intraoperatively or by CT angiogram were divided into three goups. No further action was taken for group 0, thrombectomy alone was performed for group 1, thrombectomy and anastomotic revision was employed for group 2. RESULTS
79 (13.9%) patients were diagnosed with arterial inflow complications either intraoperatively or by CT angiogram. 47 (8.3%) of those had arterial thrombosis, either alone or in conjunction with arterial stenosis. 32 (5.6%) patients had arterial stenosis alone. Actuarial 4-year patient survival was 58%, 50% and 20% for groups 1, 2 and 0 respectively (p = .131). Actuarial 4-year graft survival was 32%, 35% and 18% for groups 1, 2 and 0 respectively (p = .589). Re-transplant rate (re-graft per graft) was 0.4, 0.29 and 0.09 for groups 1, 2, and 0 respectively (p = .098). CONCLUSIONS
Baseline hepatic arterial doppler coupled with an aggressive surgical approach, despite low secondary patency rates, increases patient survival in orthotopic liver transplantation, because it allows stabilization and therefore increased re-transplant rates, in patients with hepatic artery thrombosis.
106
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
20 SELECTION OF LIVER TRANSPLANT RECIPIENTS FOR THE TREATMENT OF HCC BASED ON ADJUSTABLE PREOPERATIVE CRITERIA WITH A PRE-DETERMINED, CENTER SPECIFIC, FIVE-YEAR PATIENT SURVIVAL TARGET D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Cantarovich, M. Deschenes, P. Wong, P. Ghali, P. Metrakos Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Patient with HCC selection criteria for liver transplantion (Milan, UCSF) are under constant revalidation. PURPOSE
To identify preoperative parameters that would construct a prediction nomogram with adjustable 5-year patient survival target for the selection of liver transplant recipients with HCC. METHODS
110 primary adult liver transplants were performed between 1990 and 2006 for HCC. Multi-organ recipients (n=1) and patients that died during the first three postoperative months (n=12) were excluded from the study population. A total of 97 patients were analyzed. Patients outside Milan classification as calculated by pre-transplant imaging (n=24) received downstaging chemoembolization. RESULTS
Actuarial 10-year patient survival was 44%. Mean preoperative AFP level, diameter of the biggest tumor and cumulative size of all identified tumors were identified to be significant predictors of patient survival by univariate analysis. The same parameters were significant predictors of patient survival in a multivariate model (p = .020, coefficients: .172 for mean AFP, .576 for diameter of the biggest, .355 for cumulative size). Univariate Analysis Parameter
Mean
Significance
Preoperative AFP AFP trend Number of tumors Diameter of the biggest tumor Cumulative tumor size
201 Binary 1.84 4.59 6.35
0.020 0.078 0.424 0.007 0.001
CONCLUSIONS
5-year patient survival nomograms could be constracted based on the mean preoperative AFP, on the diameter of the biggest tumor and the cumulative tumor size, as determined by imaging.
107
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
21 PERSISTENT LYMPHOPENIA AFTER ANTI-THYMOCYTE GLOBULIN INDUCTION IS ASSOCIATED WITH DECREASED LONG TERM SURVIVAL IN LIVER TRANSPLANT RECIPIENTS D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Deschenes, P. Wong, P. Ghali, P. Metrakos Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Anti-thymocyte globulin (ATG) induction is associated with higher graft survival, as well as freedom from acute cellular rejection (ACR) after liver transplantation. PURPOSE
To determine whether prolonged (>365 days) lymphopenia after ATG induction contributes to inferior long term results after liver transplantation. METHODS
378 primary adult liver transplants were performed between 1990 and 2006, with anti-thymocyte globulin for induction. Re-transplants and multi-organ recipients were excluded from the study population. 21 patients died during the first three postoperative months. Of the remaining 357 recipients, 266 were followed-up for more than one year. Patient survival, graft survival censored for patient death, acute cellular rejection incidence and primary disease recurrence were retrospectively analyzed. RESULTS
Persistent lymphodepletion correlates inversely with survival [B = -0.620, p = 0.034, Exp(B) = 0.538, 95% CI Exp(B): 0.303-0.956]. The 10-year survival was 77%, 69% and 50% for recipients whose one-year post-transplant lymphocyte count was <500/mm3, 500–1200/mm3 and >1200/mm3 respectively. This correlation was still present when patient’s primary disease was inserted into the model. Incidence of ACR was 0.23, 0.38 and 0.45 for the same patient cohorts. That was a statistically significant difference (p = 0.05). CONCLUSIONS
After induction with ATG, lymphocyte depletion that persists for more than one postoperative year is associated with inferior long-term survival. To what degree this reflects the mechanism of action of ATG remains to be studied. Further investigations, including immunophenotyping and functional assays, should confirm the benefit of avoiding persistent lymphodepletion in liver transplant recipients.
108
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
22 BILIARY TREE COMPLICATIONS AFTER OLTX ARE NOT PREVENTED EITHER BY INTRAOPERATIVE INSERTION OF ERCP STENT OR BY PRIMARY OR SECONDARY ROUX EN Y ANASTOMOSIS D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Deschenes, P. Wong, P. Ghali, P. Metrakos Department of Surgery, Multi-Organ Transplant Program, McGill University Health Centre, Montreal, Quebec, Canada
INTRODUCTION
ERCP and Roux en Y conversion are the primary modalities of correcting biliary tree complications after orthotopic liver transplantation. PURPOSE
To investigate the outcomes of surgical and endoscopic interventions for biliary tree complications after orthotopic liver transplant. METHODS
Of 497 patients who underwent OLTx, 398 and 99 underwent choledochocholedochostomy (CC) and Roux en Y (RY) respectively. Patient survival, graft survival censored for patient death, biliary tree re-operations, ERCP performance and findings, stent placement and re-admission rate were retrospectively analyzed. RESULTS
62 patients underwent 73 biliary tree re-operations. 48 more patients underwent therapeutic ERCP alone (Table 1). The combined (n=110) lifetime post-transplant incidence of biliary complications (surgically and endoscopically treated) was 22.1%. The type of primary biliary anastomosis had no impact on the incidence of biliary complications (p = .058). The type of repair did not correlate with graft survival (p = .417). Insertion of stent correlated inveresly with survival (p = .031). The type of repair did not correlate with re-admission rate (p = .186). Table1: Biliary tree complications according to location and intervention
Extrahepatic Intrahepatic Undetermined Total
CC
RY
Both
ERCP alone
All
0 1 9 10 (9.1%)
8 2 31 41 (37.3%)
6 0 5 11 (10%)
42 5 1 48 (43.6%)
56 8 46 110
CONCLUSIONS
Biliary tree complications after orthotopic liver transplant are not prevented either by intraoperative insertion of ERCP stent or by primary or secondary Roux en Y anastomosis.
109
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
23 PREDICTION OF POSTOPERATIVE MORTALITY AND LONG-TERM SURVIVAL AFTER LIVER TRANSPLANTATION, BASED ON PREOPERATIVE PARAMETERS D. Vrochides, M. Hassanain, J. Barkun, J. Tchervenkov, P. Chaudhury, M. Cantarovich, M. Deschenes, P. Wong, P. Ghali, P. Metrakos Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
MELD score predicts mortality of potential liver graft recipients while waiting on the transplant list. There is no pre-engraftment model predicting postoperative mortality and long-term survival after OLTx. PURPOSE
To determine the preoperative parameters that can predict postoperative mortality and longterm survival after OLTx. METHODS
454 primary adult liver transplants were performed between 1990 and 2006. Re-transplants and multi-organ recipients were excluded. 41 (9.03%) died during the first postoperative month. 16 more (3.52%) died within the second and third postoperative months. Of the remaining 397 recipients, patient survival and graft survival censored for patient death were retrospectively analyzed. RESULTS
Total bilirubin was 172.6 and 100.2 mmol/lt (p<0.0001), serum creatinine was 168.9 and 114.1 mmol/lt (p<0.001), INR was 3.06 and 2.23 (p=0.002) and warm ischemia time was 1.07 and 0.93 hours (p=0.003) for the patients who respectively died and survived during the first 3 postoperative months. Long-survival was positively correlated with female sex [p=0.001, Exp(B)=0.451, 95% Exp(B) CI:0.2810.725], with recipient’s age < 50 years [p=0.003, Exp(B)=1.028, 95% Exp(B) CI:1.009-1.047] and with absence of cancer from the explant [p<0.0001, Exp(B)=2.283, 95% Exp(B) CI:1.550-3.3362]. MELD score was not a predictor of long term survival [p=0.444, Exp(B)=0.992, 95% Exp(B) CI:0.972-1.013]. CONCLUSIONS
Postoperative (three-month) mortality after OLTx correlates with preoperative total bilirubin, serum creatinine, INR and warm ischemia time. On the other hand, long-term survival correlates with recipient’s sex, age and presence of cancer in the explant. MELD score can’t predict long-term survival.
110
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
24 PERSISTENT MONOCYTE DEPLETION DOES NOT IMPROVE GRAFT SURVIVAL AFTER LIVER, PANCREAS ALONE AND KIDNEY TRANSPLANTS D. Vrochides, M. Hassanain, P. Metrakos, J. Tchervenkov, P. Chaudhury, M. Cantarovich, S. Paraskevas Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Monocytes and platelets are markers of innate immunity. In kidney transplant biopsies, the combination of lymphocyte and monocyte infilatration is related with the clinically most severe cases of rejection. PURPOSE
To investigate whether persistent monocyte or platelet depletion is associated with decreased incidence of rejection and increased graft survival. METHODS
A total of 390 primary adult liver transplants, 29 primary adult pancreas alone transplants and 613 primary adult kideny transplants were performed between 1990 and 2006. Monocyte depletion was defined as a postoperative, 30-day average monocyte count of =<300. Platelet depletion was defined as a postoperative, 30-day average platelet count of =<150. Patient survival, graft survival censored for patient death and acute cellular rejection incidence were retrospectively analyzed. RESULTS
Persistent monodepletion was achieved in 48%, 38%, 52% of liver, pancreas alone and kidney graft recipients respectively. Persistent monodepletion does not correlate with graft survival after liver transplant (p = 0.635, 95% CI: 0.790-1.472), pancreas alone transplant (p = 0.254, 95% CI: 0.0791.958) and kidney transplant (p = 0.995, 95% CI: 0.727-1.361). Persistent platelet depletion correlates inversely with graft survival in liver transplants (p = 0.001, 95% CI: 0.431-0.797) and kidney transplant (p = 0.001, 95% CI: 0.434-0.815). There is no correlation between monocyte count and acute rejection incidence in liver (r2 = 0.01), pancreas alone (r2 = 0.08) and kidney transplants (r2 = 0.00). CONCLUSIONS
Persistent monodepletion does not improve graft survival after liver, pancreas alone and kidney transplants. When persistent platelet depletion is observed after orthotopic liver or kidney transplant, graft survival is significantly decreased.
111
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
25 PROLONGED LYMPHOPENIA AFTER ANTI-THYMOCYTE GLOBULIN INDUCTION IS NOT ASSOCIATED WITH INCREASED GRAFT SURVIVAL IN PANCREAS TRANSPLANT RECIPIENTS D. Vrochides, M. Hassanain, P. Metrakos, J. Tchervenkov, P. Chaudhury, M. Cantarovich, S. Paraskevas Department of Surgery, Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada
INTRODUCTION
Anti-thymocyte globulin (ATG) induction is associated with higher graft survival, as well as freedom from acute cellular rejection (ACR) after pancreas transplantation. ATG may induce prolonged (>30 days) lymphopenia. PURPOSE
To determine whether prolonged lymphopenia after ATG induction contributes to superior long term results after pancreas transplantation. METHODS
A total of 35 adult pancreas alone transplants were performed between 1998 and 2006, with antithymocyte globulin for induction. Re-transplants, multi-organ recipients and perioperative deaths were excluded (n=7) from the study population. Recipients with an average value of ≤ 300 lymphocytes/mm3 for the first 30 postoperative days comprised the cohort of prolonged lymphopenia, whereas the rest comprised the non-lymphodepleted cohort. Graft survival censored for patient death, patient survival, ACR (incidence/patient), CMV infection and LOS were retrospectively analyzed. RESULTS
Prolonged lymphopenia was achieved in 50% (n=14). Although there was a trend favoring nondepleted recipients there was no statistically significant difference in the mean actuarial graft survival for the lymphopenic and the non-lymphopenic cohorts (p = 0.572, 95% CI: .156 - 2.787). The incidence of ACR was identical (p = 1.0) between the non-depleted and the depleted group. No CMV infection was diagnosed. LOS was similar between the two groups (p = .635). CONCLUSIONS
Lymphocyte depletion that persists for more than one postoperative month after induction with ATG is not associated with improved long-term results. Further investigations, including immunophenotyping and functional assays, should confirm or reject the theory of benefit from lymphocyte subpopulations “molding” in pancreas alone transplant recipients.
112
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
26 H ™Àªμ√§H Δø¡ Δ√¶π∫ø¡ ™À¡Δ√¡π™Δø¡ ∫∞π Δø¡ ™À¡Δ√¡π™Δø¡ Δø¡ ¶∂ƒπº∂ƒ∂π∞∫ø¡ °ƒ∞º∂Iø¡ Δ√À ∂.O.ª ™Δ∏¡ ∞À•∏™∏ Δø¡ ¢øƒ∏Δø¡ ∫∞π ¢√Δø¡ √ƒ°∞¡ø¡ ¢. ∑·¯·ÚÔ‡‰Ë, ∂. ∫·ÏϤÚÁË ¶ÂÚÈÊÂÚÂÈ·Îfi °Ú·ÊÂ›Ô ™˘ÓÙÔÓÈÛÌÔ‡ ªÂÙ·ÌÔۯ‡ÛÂˆÓ ¡ÔÛ. å∞Ã∂¶∞å, £ÂÛÛ·ÏÔÓ›ÎË
ΔÚÂȘ Â›Ó·È ÔÈ Î‡ÚȘ ·Èٛ˜ ÁÈ· ÙË ÌÂȈ̤ÓË ÚÔÛÊÔÚ¿ ÔÚÁ¿ÓˆÓ: – ∏ ÌË ÂÓÙfiÈÛË ÙˆÓ ÂÁÎÂÊ·ÏÈο ÓÂÎÚÒÓ – ∏ ÌË ÚÔÛ¤ÁÁÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ – ∏ ¿ÚÓËÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ªÂÏÂÙÒÓÙ·˜ ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜ Ë ÔÏÈÙ›· ÛÂ Û˘ÓÂÚÁ·Û›· Ì ٷ ·ÚÌfi‰È· fiÚÁ·Ó· ÂÈÛ‹Á·ÁÂ Î·È ıÂÛÌÔı¤ÙËÛ ÙÔÓ “ΔÔÈÎfi ™˘ÓÙÔÓÈÛÙ‹” Î·È ÙÔÓ “™˘ÓÙÔÓÈÛÙ‹ ÙÔ˘ ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ °Ú·Ê›Ԣ ÙÔ˘ ∂.O.ª” Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜. O ηıÔÚÈÛÌfi˜ ÙˆÓ ÂȉÈÎÒÓ ÚÔÛfiÓÙˆÓ Î·È Ù· ηı‹ÎÔÓÙ· ÙˆÓ ΔÔÈÎÒÓ ™˘ÓÙÔÓÈÛÙÒÓ ¤ÁÈÓ Ì ¶ÚÔ‰ÚÈÎfi ¢È¿Ù·ÁÌ· (¶.¢. 93 12/4/2002) ∏ ·ÓÙ·fiÎÚÈÛË ·fi Ù· ÓÔÛÔÎÔÌ›· ˘‹ÚÍ ÂÈÊ˘Ï·ÎÙÈ΋ ÌÂÓ, ¿ÌÂÛË ‰Â. ∞˘Ù‹ ÙË ÛÙÈÁÌ‹ ˘¿Ú¯ÂÈ ΔÔÈÎfi˜ ™˘ÓÙÔÓÈÛÙ‹˜ Û fiÏ· ۯ‰fiÓ Ù· ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ fiÔ˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜. ∂›Û˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ‹ ¤¯Ô˘Ó ‰ÚÔÌÔÏÔÁËı› ÁÈ· Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ¶ÂÚÈÊÂÚÂȷο ÁÚ·Ê›· ™˘ÓÙÔÓÈÛÌÔ‡ ªÂÙ·ÌÔۯ‡ÛÂˆÓ Û οı ÁˆÁÚ·ÊÈÎfi ‰È·Ì¤ÚÈÛÌ·. ŒÙÛÈ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›· ηıÔÚ›ÛÙËηÓ, Âηȉ‡ÙËÎ·Ó Î·È ÏÂÈÙÔ‡ÚÁËÛ·Ó ÔÈ ·Ú·¿Óˆ ™˘ÓÙÔÓÈÛÙ¤˜ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ó· Â›Ó·È ÂÌÊ·Ó‹ È· Û fiÏÔ˘˜. ∞ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ì ·˘ÍË̤ӷ ÙfiÛÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ˆÚËÙÒÓ fiÛÔ Î·È ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ÔÙÒÓ ÔÚÁ¿ÓˆÓ.
113
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
27 Oƒ£√™Δ∞Δπ∫O ∂¶π°∞™Δƒπ∫O A§°√™ ™∞¡ ¶∞£√°¡øª√¡π∫O ™∏ª∂I√ CMV °∞™ΔƒIΔπ¢∞™ ¶. ªÔ˘ÛٷʤÏÏÔ˜, ¢. ∫ÔÌÓËÓÔ‡, ∂. ÷Ù˙ËÁÈ·ÓÓ¿Î˘ ¡ÔÛÔÎÔÌÂ›Ô Mitropolitan
∏ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi (CMV) ·ÔÙÂÏ› ÌÈ· Û˘¯Ó‹ ·ÈÙ›· ÙfiÛÔ ÓÔÛËÚfiÙËÙ·˜ fiÛÔ Î·È ıÓËÙfiÙËÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÔÛÔηٷÛÙÔÏ‹ ÂÓÒ ıˆÚÂ›Ù·È ÌÈ· ·fi ÙȘ ÈÔ ÛËÌ·ÓÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. H CMV Á·ÛÙÚ›Ùȉ· ¤¯ÂÈ ·Ó·ÊÂÚı› Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜ ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ¤Ó·Ó ·ÛıÂÓ‹ Ô ÔÔ›Ô˜ ·Ó·Ê¤ÚÂÈ ÂÈÁ·ÛÙÚÈÎfi fiÓÔ Ô˘ ‚ÂÏÙÈÒÓÂÙ·È ÛÙË Î·Ù·ÎÂÎÏÈ̤ÓË ı¤ÛË ÂÓÒ, ÂȉÂÈÓÒÓÂÙ·È ÛÙË Î·ıÈÛÙ‹ ı¤ÛË Î·È È‰È·›ÙÂÚ· ÛÙËÓ fiÚıÈ· ı¤ÛË Î·È ÛÙË ‚¿‰ÈÛË. ¶ÈÛÙ‡ԢÌ fiÙÈ ·˘Ù‹ Â›Ó·È Ë ÙÚ›ÙË ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·.
114
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
28 §∞¶∞ƒ√™∫√¶π∫∏ ∞ƒπ™Δ∂ƒ∞ ª∂ƒπ∫∏ ∏¶∞Δ∂∫Δ√ª∏: ¶ƒ√¢ƒ√ª∏ ª∂§∂Δ∏ °π∞ Δ∏ §∏æ∏ Δ√À ∏¶∞Δπ∫√À ª√™Ã∂Àª∞Δ√™ ™∂ ¶∂πƒ∞ª∞Δπ∫√ ¶ƒ√ΔÀ¶√ Ã√πƒø¡ ∫. ª·ÌÌ¿˜, °. ∫fiÙÙ˘, ∞. ¶·Ê›ÙË, Ã. ¡ÈÎÔÏ¿Ô˘, °. ∫ˆÛÙÔ·Ó·ÁÈÒÙÔ˘, ¡. ∞Úη‰fiÔ˘ÏÔ˜, μ. ™Ì˘ÚÓÈÒÙ˘ ¶ÂÈÚ·Ì·ÙÈÎfi ÃÂÈÚÔ˘ÚÁÂ›Ô ‘’∫.ΔÔ‡ÓÙ·˜’’, ∞ÚÂÙ·›ÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌ›Ô ∞ıËÓÒÓ
∂π™∞°ø°∏
H Ë·ÙÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi ˙ÒÓÙ· ‰fiÙË ·ÔÙÂÏ› Ì›· ·fi ÙȘ Èfi ÛËÌ·ÓÙÈΤ˜ ηÈÓÔÙƠ̂˜ ÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛˆÓ. μ·ÛÈ΋ ÚÔ˘fiıÂÛË ÁÈ· ÙË Ú·ÁÌ·ÙÔÔ›ËÛË Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È fiÙÈ Ë ·ÚÈÛÙÂÚ¿ ÌÂÚÈ΋ Ë·ÙÂÎÙÔÌ‹ ÛÙÔ ˙ÒÓÙ· ‰fiÙË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÙÔÓ ÂÏ¿¯ÈÛÙÔ ‰˘Ó·Ùfi ¯ÂÈÚÔ˘ÚÁÈÎfi ΛӉ˘ÓÔ, ÂÓÒ ·Ú¿ÏÏËÏ· ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë ‚ȈÛÈÌfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. ∏ ÂÚÁ·Û›· ·˘Ù‹ ·ÍÈÔÏÔÁ› ÙË ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜, ÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ÙËÓ Â·Ó·ÏË„ÈÌfiÙËÙ· Ù˘ Ï··ÚÔÛÎÔÈ΋˜ ·ÚÈÛÙÂÚ¿˜ ÌÂÚÈ΋˜ Ë·ÙÂÎÙÔÌ‹˜ ·fi ˙ÒÓÙ· ‰fiÙË Û ÂÈÚ·Ì·ÙÈÎfi ÚfiÙ˘Ô ¯Ô›ÚˆÓ. À§π∫∞ ª∂£O¢O™
∂ÍÈ ÔÈÎfiÛÈÙ· ¯ÔÈÚ›‰È· ‚¿ÚÔ˘˜ 20-25 kg ˘Â‚Ï‹ıËÎ·Ó Û Ϸ·ÚÔÛÎÔÈ΋ ·ÚÈÛÙÂÚ¿ ÌÂÚÈ΋ Ë·ÙÂÎÙÔÌ‹ ˘fi ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›·. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ¤Ï·‚ ¯ÒÚ· Ì ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÚÈÒÓ ˘ÏÒÓ ÂÈÛfi‰Ô˘ ÛÙÔ ÙÔ›¯ˆÌ· Ù˘ ÎÔÈÏ›·˜ ÁÈ· ÙË ¯Ú‹ÛË Ù˘ οÌÂÚ·˜ Ù˘ Ï··ÚÔÛÎÔÈ΋˜ Ï·‚›‰·˜ ‹ ÂȉÈÎÔ‡ Ï··ÚÔÛÎÔÈÎÔ‡ ·ÁΛÛÙÚÔ˘ Î·È ÙÔ˘ ·˘ÙfiÌ·ÙÔ˘ ÎÔÙÔÚ¿ÙË. OÈ ·ÈÌÔ‰˘Ó·ÌÈΤ˜, ·ÈÌ·ÙÔÏÔÁÈΤ˜, Î·È ‚ÈÔ¯ËÌÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÂÍÂÙ¿ÛıËÎ·Ó ·Ó¿ ÂÈÚ·Ì·Ùfi˙ˆÔ, ÙfiÛÔ ÚÔÂÁ¯ÂÈÚËÙÈο fiÛÔ Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈο ÂÓÒ Ù· Ë·ÙÈο ÌÔۯ‡̷ٷ ˘Â‚Ï‹ıËÎ·Ó Û ÏÂÙÔÌÂÚ‹ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ÂͤٷÛË ¿ÌÂÛ· ÌÂÙÂÁ¯ÂÈÚËÙÈο. Δ· ·ÔÙÂϤÛÌ·Ù· Û˘ÁÎÚ›ıËÎ·Ó Ì ÂΛӷ ·fi ·ÓÙ›ÛÙÔȯ˜ ·Ó·Ï‡ÛÂȘ ‰ÂÈÁÌ¿ÙˆÓ Ô˘ ÂÏ‹ÊıËÛ·Ó ÌÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÓÔȯً˜ ·ÚÈÛÙÂÚ¿˜ Ë·ÙÂÎÙÔÌ‹˜ Û ¤ÍÈ ¿ÏÏ· ¯ÔÈÚ›‰È· ‚¿ÚÔ˘˜ 20-25 kg. ∞¶OΔ∂§E™ª∞Δ∞
∏ ·ÚÈÛÙÂÚ¿ ÌÂÚÈ΋ Ë·ÙÂÎÙÔÌ‹ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÈηÓÔÔÈËÙÈο Û 6 ÂÈÚ·Ì·Ùfi˙ˆ· ¯ˆÚ›˜ ÌÂÈ˙ÔÓ˜ ‰ÈÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜ Ô˘ Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙË ÌÂÙ·ÙÚÔ‹ Û ·ÓÔȯً ̤ıÔ‰Ô.¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ¿ÌÂÛ˜ Î·È ·ÒÙÂÚ˜ Ì›˙ÔÓ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜, ÂÓÒ ÙÔ ÌfiÛ¯Â˘Ì· ·ÍÈÔÏÔÁ‹ıËÎÂ Î·È ÎÚ›ıËΠÈηÓÔÔÈËÙÈÎfi ˆ˜ › ÌÔۯ‡̷ÙÔ˜ ÚÔ˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∏ ıÓËÙfiÙËÙ· ‹Ù·Ó ·ÚfiÌÔÈ· Î·È ÛÙȘ ‰‡Ô ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÔÌ¿‰Â˜, ÂÓÒ Ô ¯ÚfiÓÔ˜ Ù˘ ¤̂·Û˘, Ë ·ÒÏÂÈ· ·›Ì·ÙÔ˜ Î·È Ô ¯ÚfiÓÔ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ·ÔηٿÛÙ·Û˘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi˜ ÚÔ˜ fiÊÂÏÔ˜ Ù˘ Ï··ÚÔÛÎÔÈ΋˜ ÔÌ¿‰Ô˜. ™Àª¶∂ƒA™ª∞Δ∞
∏ Ï··ÚÔÛÎÔÈ΋ ·ÚÈÛÙÂÚ¿ ÌÂÚÈ΋ Ë·ÙÂÎÙÔÌ‹, ˆ˜ › ˙ÒÓÙ· ‰fiÙË, Û ÂÈÚ·Ì·ÙÈÎfi ÚfiÙ˘Ô ¯Ô›ÚÔ˘, Â›Ó·È Ì›· ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË, Ù¯ÓÈο Ú·ÁÌ·ÙÔÔÈ‹ÛÈÌË, ·ÛÊ·Ï‹˜ Î·È ˘fi ÔÚÈṲ̂Ó˜ ÚÔ˘Ôı¤ÛÂȘ ·ӷϋ„ÈÌË, ÚÔ˜ fiÊÂÏÔ˜ ÙÔ˘ ˙ÒÓÙ· ‰fiÙË, fiÛÔÓ ·ÊÔÚ¿ ÙË ‰ÈÂÁ¯ÂÈÚËÙÈ΋ Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›·, ·ÏÏ¿ Î·È ÙÔ˘ Ï‹ÙË, fiÛÔÓ ·ÊÔÚ¿ ÙË ‚ȈÛÈÌfiÙËÙ· ÙÔ˘ ÌÔۯ‡̷ÙÔ˜.
115
MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
29 O•Àºπ§∞ ™øª∞Δπ∞: Ã∏™πªO™ π™ΔO§O°π∫O™ ¢∂π∫Δ∏™ πO°∂¡OÀ™ §Oπªø•∏™ ΔOÀ ∏¶∞Δπ∫OÀ ªO™Ã∂Àª∞ΔO™ ∫. ¶·ÙÛÈ·Ô‡Ú·1, O. °ÈÔ˘ÏÂ̤2, £. μ·ÛÈÏÂÈ¿‰Ë˜2, ∂. ∫·ÙÛ›ÎË1, μ. ¶··ÓÈÎÔÏ¿Ô˘3, °. ÿÌ‚ÚÈÔ˜3, ¢. Δ·ÎÔ‡‰·˜3 1¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi
∂ÚÁ·ÛÙ‹ÚÈÔ, ∫ÏÈÓÈ΋ ∞¶£, 3Ã∫ª ∞¶£, πÔÎÚ¿ÙÂÈÔ °¡ £ÂÛÛ·ÏÔӛ΢ 2춶
∏ ‰È¿ÎÚÈÛË ÌÂٷ͇ ÔÍ›·˜ ·fiÚÚȄ˘ (O∞) Î·È ÚÒÈÌ˘ ˘ÔÙÚÔ‹˜ ‹ Î·È de novo ÂÌÊ¿ÓÈÛ˘ Ù˘ HCV Ïԛ̈͢ ÌÂÙ¿ ÙËÓ ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (OLT) Â›Ó·È Û˘¯Ó¿ ȉȷ›ÙÂÚ· ‰‡ÛÎÔÏË. ¶ÚfiÎÂÈÙ·È ÁÈ· ¿Ó‰Ú·, ËÏÈΛ·˜ 62 ÂÙÒÓ, Ô ÔÔ›Ô˜ ˘Ô‚Ï‹ıËΠ۠OLT ÏfiÁˆ HBV+HDV ΛÚÚˆÛ˘ Î·È Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚÎÈÓÒÌ·ÙÔ˜. ∏ ¿ÌÂÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ·Ó›ÏÂÎÙË Î·È Ô ·ÛıÂÓ‹˜ ÂÏ¿Ì‚·Ó ÙËÓ ÎÏ·ÛÛÈ΋ ·ÓÙÈ·ÔÚÚÈÙÈ΋ Î·È ·ÓÙÈ˚΋ ·ÁˆÁ‹. ΔËÓ 25Ë ÌÂÙ·ÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋ Ë̤ڷ ÂÌÊ¿ÓÈÛ ÙÚ·ÓÛ·ÌÈÓ·Û·ÈÌ›· Î·È ˘Ô‚Ï‹ıËΠ۠‚ÈÔ„›· ‹·ÙÔ˜ Ù˘ ÔÔ›·˜ Ù· Â˘Ú‹Ì·Ù· ‹Ù·Ó Û˘ÓËÁÔÚËÙÈο O∞, ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ ‚·Ú‡ÙËÙ·˜. ™ÙÔÓ ·ÛıÂÓ‹ ¯ÔÚËÁ‹ıËΠ·ÓÙÈ·ÔÚÚÈÙÈ΋ ·ÁˆÁ‹ ¯ˆÚ›˜ fï˜ ‚ÈÔ¯ËÌÈ΋ ‚ÂÏÙ›ˆÛË. ΔËÓ 54Ë Ë̤ڷ ÌÂÙ¿ ÙËÓ OLT ‰ÈÂÓÂÚÁ‹ıËΠÂÎ Ó¤Ô˘ ‚ÈÔ„›· ‹·ÙÔ˜ ÛÙËÓ ÔÔ›· ‰ÂÓ ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó ÛÙÔȯ›· O∞, ·Ú·ÙËÚ‹ıËÎ·Ó fï˜ ·ÚÎÂÙ¿ Ô͇ÊÈÏ· ۈ̿ÙÈ·. O ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ˘ÔÙÚÔ‹ Ù˘ HBV Ïԛ̈͢ ·¤‚Ë ·ÚÓËÙÈÎfi˜. ∞ÔÎÏ›ÛıËÎ·Ó ¿ÏÏ· ·›ÙÈ· ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ Î·È ¤ÁÈÓ ÙÚÔÔÔ›ËÛË Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ·ÁˆÁ‹˜, ¯ˆÚ›˜ ‚ÈÔ¯ËÌÈ΋ ·ÓÙ·fiÎÚÈÛË. ¢‡Ô Ì‹Ó˜ ·ÚÁfiÙÂÚ·, Î·È ÏfiÁˆ ÂÌ̤ÓÔ˘Û·˜ ÙÚ·ÓÛ·ÌÈÓ·Û·ÈÌ›·˜, Ô ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËΠ۠3Ë ‚ÈÔ„›· ‹·ÙÔ˜ ÛÙËÓ ÔÔ›· ·Ú·ÙËÚ‹ıËÎ·Ó ÔÏÏ¿ Ô͇ÊÈÏ· ۈ̿ÙÈ·, ÛÙÔȯ›· ÂÓ‰ÔÏfi‚È·˜ ÊÏÂÁÌÔÓ‹˜ Î·È ‰È¿¯˘ÙË ˘‰ÚˆÈ΋ ÂÎʇÏÈÛË Ë·ÙÔ΢ÙÙ¿ÚˆÓ, ¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ˘Ï·›ˆÓ ‰È·ÛÙËÌ¿ÙˆÓ. Δ· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û˘Ó¯‹ ·ÚÔ˘Û›· Ô͇ÊÈÏˆÓ ÛˆÌ·Ù›ˆÓ ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ‚ÈÔ„›Â˜ ¤ıÂÛ·Ó ¤ÓÙÔÓË ˘fiÓÔÈ· ÈÔÁÂÓÔ‡˜ Ïԛ̈͢. O ¤ÏÂÁ¯Ô˜ ÁÈ· CMV, EBV, HSV, HBV Î·È anti-HCV ·¤‚Ë ·ÚÓËÙÈÎfi˜ ÂÓÒ ‚Ú¤ıËΠıÂÙÈÎfi ÙÔ HCV-RNA (ÁÔÓfiÙ˘Ô˜ 1‚). ∂ÚfiÎÂÈÙÔ Û˘ÓÂÒ˜ ÁÈ· de novo HCV Ïԛ̈ÍË. ªÂÙ¿ ·fi ‰È¿ÛÙËÌ· 2 ÌËÓÒÓ Û Ӥ· ‚ÈÔ„›· ‹·ÙÔ˜ (4Ë) ·Ú·ÙËÚ‹ıËÎ·Ó ÔÈ ÎÏ·ÛÈΤ˜ ÈÛÙÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ HCV Ïԛ̈͢. O ·ÛıÂÓ‹˜ Ù¤ıËΠ۠·ÓÙÈ˚΋ ·ÁˆÁ‹ ÁÈ· ¤Ó· ¯ÚfiÓÔ. ™ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂڷ›·˜ ·Ú·ÙËÚ‹ıËΠϋÚ˘ ÈÔÏÔÁÈ΋ Î·È ‚ÈÔ¯ËÌÈ΋ ·ÓÙ·fiÎÚÈÛË Î·È Ë ‚ÈÔ„›· ‹·ÙÔ˜ (5Ë) ¤‰ÂÈÍ ‚ÂÏÙ›ˆÛË ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÚÔ˘Û›· Û ÚÒÈÌ· ÛÙ¿‰È· ÌÂÙ¿ ÙËÓ OLT Û ÈÛÙÔÏÔÁÈÎfi Â›Â‰Ô ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ Ô͇ÊÈÏˆÓ ÛˆÌ·Ù›ˆÓ, ·ÎfiÌË Î·È Â› ‰¿ÊÔ˘˜ O∞, ·ÔÙÂÏ› ÈÛ¯˘Ú‹ ·Ú¿ÌÂÙÚÔ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜, Î·È È‰È·›ÙÂÚ· ÔÍ›·˜ Ê¿Û˘ HCV Ïԛ̈͢.
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MÂÙ·ÌfiÛ¯Â˘ÛË OÚÁ¿ÓˆÓ & IÛÙÒÓ, ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜, 2007
E˘ÚÂÙ‹ÚÈÔ Û˘ÁÁڷʤˆÓ ÚÔÊÔÚÈÎÒÓ ·Ó·ÎÔÈÓÒÛÂˆÓ ABT P., 42 BABA H.A., 51, 52 BOZORGZADEH 42 BROELSCH C.E., 51, 52 COSIMI A.B., 12 DELMONICO F.L., 12 ELIAS N., 12 FRIEND P., 39, 67 HADJIANASTASSIOU V., 39, 67 HERGET-ROSENTHAL S., 51 HERTL M. 12 JAIN A., 42 KASHYAP R., 42 KAWAI T., 12 KO D., 12 LANG H., 51, 52, 53 MALAGO M., 52, 53 MOLMENTI E.P., 51, 52 MOUSTAFELLOS P., 39, 67 O' DONOVAN M., 61 ORLOFF M., 42 PURSGLOVE S., 61 SANER F.H., 51 SCHMITZ K.J., 52 SCHROEDER T., 52 SOTIROPOULOS G.C., 51, 52, 53 VAIDYA A., 39, 67 ∞°Oƒ∞™ΔOÀ ¶., 47 ∞°ƒ∞ºπøΔ∏™ ¢., 27 ∞∫ƒπμπ∞¢∏™ ∂., 16, 47 ∞§μ∞¡OÀ-∞ö∞ƒ∞∫∏ ∞., 22 ∞§∂•πOÀ-¢∞¡π∏§ ™., 40 ∞§∂•O¶OÀ§O™ ∂., 55, 58 ∞§∂•O¶OÀ§OÀ ¢., 61 ∞¡∞°¡ø™Δ∞ƒ∞ ∂., 10, 14, 47, 50 ∞¡∞™Δ∞™π∞¢OÀ ∫., 11, 41, 54 ∞¡∞™Δ∞™πOÀ ∂., 29 ∞¡Δø¡π∞¢∏™ ∞., 24 ∞¡Δø¡π∞¢∏™ ª., 54 ∞¡Δø¡π∞¢∏™ ¡.,∞., 7, 9, 10, 16, 18, 23, 24, 33, 35, 37, 38, 47 ∞¡Δø¡πOÀ ∂., 43 ∞¶O™ΔO§∞∫∏ ª., 1 ∞¶O™ΔO§π¢∏™ π., 20 ∞¶O™ΔO§OÀ £., 31, 59, 62
∞ƒ™O™ °., 37, 55, 65 ∞™§∞¡π¢∏™ £., 14, 50 ∞Δª∞Δ∑π¢∏™ ∫., 24 ∞À°OÀ™Δ∏ ¢., 17, 28, 45 ∞À§∞ª∏ ∞£., 60 μ∞°πø¡∞ ∞., 64 μ∞™π§∂π∞¢∏™ μ., 18 μ∞™π§∂π∞¢∏™ £., 16, 47 μ∞™π§∂π∞¢OÀ °., 25 μ∂ƒ°OÀ§∞™ °., 7, 9, 64, 65 μ∂ƒ¡π∫O™ ¶., 43 μπΔΔøƒ∞∫∏ ∞., 4 μ§∞ÃO°π∞¡¡∏™ π.,°., 3, 5, 30, 32, 57, 63, 66 μ§∞ÃO¶OÀ§O™ Ã., 62 μ§∞ÃOÀ ∞., 65 μOÀ°∞™ μ., 34 μƒ∞¡∏ O., 48, 49 μƒOÃπ¢∏™ ¢., 7, 9, 10, 13, 18, 22, 35, 37, 38, 50 °∂ƒ∞™πªπ¢∏™ £., 22, 33 °∂ƒOÀ∫∏™ Δ., 11, 41, 54 °∂øƒ°∞¡Δ∞™ £., 34 °∂øƒ°π∞¢OÀ ∂., 15, 28, 44 °π∞°§∏™ ¶., 28 °π∞∫OÀ™Δπ¢∏™ ∞., 23, 24 °π∞∫OÀ™Δπ¢∏™ ¢., 7, 9, 10, 13, 16, 18, 23, 24, 33, 35, 37, 41, 47 °π∞¡¡∞∫OÀ ª., 29 °πOÀ§∂ª∂ O., 47 °∫∂∫∞ ∂., 29 °∫∂∫∞™ π., 14 °Oª¶OÀ ∞., 2, 4 °OÀ§∏™ π., 18, 47 °OÀª∂¡O™ ¢., 3, 5, 30, 32, 57, 63, 66 °ƒπ™¶OÀ ∂., 59 °ƒπΔ™∏-°∂ƒO°π∞¡¡∏ ¡., 15, 17, 28, 44, 45 ¢∞ƒ∂ª∞ ª., 4, 8 ¢∂§∏°π∞¡¡π¢∏™ ∞., 46 ¢∂§∏ª¶∞™∏ ™., 19 ¢∂§§∞¢∂Δ™πª∞ π., 8 ¢∂ª∂ƒΔ∑π¢OÀ μ., 48, 49 ¢∏ª∞™ °ƒ., 65 ¢π¶§∞ƒ∏™ ∫., 7, 10, 16, 18, 24, 33, 35, 38 ¢OÀª∞ ™Δ., 33 ¢ƒ∞∫O¶OÀ§O™ ™., 31, 34, 59, 61, 62 ¢ƒ∞ª¶∞ º., 29
OÈ ·ÚÈıÌÔ› ·Ú·¤ÌÔ˘Ó ÛÙÔÓ ·‡ÍÔÓÙ· ·ÚÈıÌfi ÙˆÓ ·Ó·ÎÔÈÓÒÛˆÓ.
118 ∂À£ÀªπOÀ ∞π∫., 29 ∂À§π∞Δ∏ §., 19 ∑∞μμO™ °., 6, 8, 36 ∑∞º∂πƒπ∞¢OÀ ∂., 10 ∏§π∞¢∏™ ™., 22, 23, 24 £∂O¢øƒO¶OÀ§OÀ ∂., 1, 2, 4, 6, 8, 36, 60 π∂ƒø¡ÀªOÀ ª., 34 πªμƒπO™ °., 7, 9, 10, 13, 14, 16, 17, 18, 23, 24, 33, 35, 37, 38, 44, 46, 47, 48, 49, 50, 54 π¡πøΔ∞∫∏ ∞., 1, 2, 4, 6 πø∞¡¡π¢∏ ∂., 27 πø∞¡¡π¢∏™ ∏., 64 ∫∞∑∞ ™., 36 ∫∞∑∞∫O™ ∂., 40 ∫∞§¢ƒπªπ¢OÀ ∂., 23, 24 ∫∞§π∞∫ª∞¡∏ ¶., 3, 63, 66 ∫∞§§∂ƒ°∏ ∂., 26, 29 ∫∞§§π∞∫ª∞¡∏ ¶., 30, 32, 57 ∫∞§¶∞∫π¢∏™ μ., 11, 54 ∫∞¡Δ∑πOÀ ∞π∫., 48, 49 ∫∞ƒ∞μπ∞™ ¢., 3, 32, 57 ∫∞ƒ∞°π∞¡¡∏™ μ., 21 ∫∞ƒ∞∫∞™∏™ ¢., 20 ∫∞ƒ∞∫∞Δ∑∞ ª., 5 ∫∞ƒ∞§∏ μ., 25 ∫∞ƒ∞ª∞¡O™ ¢., 22 ∫∞ƒ∞ª¶∞ ™., 65 ∫∞ƒ∞¡∞Δ™πOÀ ª., 15 ∫∞ƒ∞¡Δ∞°§∏™ ¡., 46 ∫∞ƒ∞¶∞¡∞°πøΔOÀ ∞., 15, 17, 45 ∫∞ƒ∞Δ∑OÀ Ã., 54 ∫∞ƒ¢∞™∏™ ¢., 9, 10, 16, 18, 23, 35, 37, 38 ∫∞ƒOÀ¡∏ Ã., 43 ∫∞™∫∞ƒ∂§∏™ ª., 34 ∫∞Δ™∞¡OÀ§∞™ ∫., 15 ∫∞Δ™π∫∞ ∂., 10, 13, 14, 18, 33, 50 ∫∞Δ™π∫∏ ∂., 10 ∫∞Δ™øƒ∏™ ¶., 66 ∫∂Ã∞°π∞ ∂., 44 ∫πΔ™πOÀ μ., 31 ∫O∫∫π¡O™ Ã., 34 ∫O§π∞∫O™ °., 21 ∫O§π∞∫OÀ ∫., 23, 24 ∫O¡Δ∏™ π., 27 ∫O™∫OÀƒ∞ μ., 27 ∫OÀ∑∏-∫O§π∞∫OÀ ∫., 21 ∫OÀ∫OÀ§∞∫∏ ª., 31, 34, 59, 61, 62 ∫OÀ¶∞¡∏™ Ã., 13, 14, 50 ∫OÀƒΔ∏ ª., 43 ∫OÀºO°π∞¡¡∏™ ¢., 22 ∫ƒ∞μπ¢∞ ¡., 55 ∫Àƒπ∞∑∏ μ., 19, 20 ∫Àƒπ™Δ∏ ∂., 62 ∫ø™Δ∞∫∏™ ∞., 1, 2, 6, 8, 36 ∫øΔ™∞¡Δ∏™ ¶., 66 §∞∑∞ƒ∏™ ∞., 60
§∞∑∞ƒπ¢∏™ £., 14 §∂O¡∞ƒ¢OÀ ¶., 36 §π∞∫O¶OÀ§O™ μ., 56 §π∞¶∏™ °., 60 ª∞§∞ª∏™ °., 44 ª∞§π∑O™ ∫., 56 ª∞¡¢ƒ∞μ∂§∏ ∫., 40 ª∞ƒπ¡∞∫∏ ™., 1, 2, 6 ª∞ƒO¶OÀ§O™ °., 8 ª∞ƒOÀ§∏™ π., 32, 57 ª∞™™∞ ∂., 25 ª∞Δ™∏ ∫., 29 ª∞ÀƒOÀ¢∏ ∞., 46, 48, 49 ª∂ªªO™ ¢., 55, 58 ª∂Δ∞•∞ΔO™ °., 31 ªOÀ∑∞∫∏ ∞., 5 ªOÀ§OÀ¢∏ ∂., 15, 17, 28, 44 ª¶∞´ƒ∞ªπ¢∏™ ∂., 34 ª¶∞§∞™∫∞ ∫., 59, 62 ª¶∞§Δ∞¢∞∫∏™ ¢., 20 ª¶∞§øΔ∏™ ∫.,-°., 20 ª¶∞ªπÃ∞™ °∂ƒ., 25 ª¶∂§∞™ ∞£., 30 ª¶∂§∂Ã∏ ∞.,-ª., 55 ª¶∂¡OÀ ∞π∫., 63 ª¶π∫∞ ∂., 20 ª¶πƒΔ∑∞™ μ., 1 ª¶πΔ∑∞¡∏ ª., 25 ª¶O°π∞Δ∑O¶OÀ§O™ ª., 14 ª¶O∫O™ π., 8, 36 ª¶O§∂Δ∏™ π., 1, 2, 4, 6, 8, 36, 60 ª¶Oƒ∞ ¢., 43 ªÀ™∂ƒ§∏™ °., 7, 9, 18, 33, 64, 65 ¡π∫∏ºOƒ∞∫∏™ ∂ª., 19, 20 ¡π∫O¢∏ªO¶OÀ§OÀ ª., 65 ¡π∫O§O¶OÀ§OÀ ¡., 31 ¡Δπ¡∞™ ∞., 7, 9, 10, 11, 18, 22, 33, 35, 37, 38, 65 ¡ΔOμ∞™ ™., 55, 56, 58 ¡ΔO∫OÀ π.,-™., 1 •À¡π∞™ π., 46, 48, 49 Oπ∫O¡Oªπ¢OÀ ¢., 55, 58 OÀ∑OÀ¡π¢∏™ ¡., 7, 9, 16, 18, 23, 24, 35, 37 OÀƒ∞∏§O°§OÀ O., 46 ¶∞§§∞¢∞™ ¶., 11, 41, 54 ¶∞¡π∞ƒ∞ O., 59 ¶∞¡Δ∞∑O¶OÀ§OÀ ∞., 11 ¶∞¡Δπ∫π¢OÀ ª., 48, 49 ¶∞¶∞°∂øƒ°πOÀ °., 23, 24 ¶∞¶∞°∂øƒ°πOÀ ∂., 29 ¶∞¶∞°∂øƒ°πOÀ Ã., 13, 14, 17, 50 ¶∞¶∞°π∞¡¡∏ ∞π∫., 58 ¶∞¶∞°π∞¡¡∏™ ∞., 7, 9, 11, 14, 16, 18, 23, 35, 37, 38 ¶∞¶∞¢∞∫∏ ¶., 2 ¶∞¶∞¢∏ª∏ΔƒπOÀ ¢., 22 ¶∞¶∞s¢O¶OÀ§OÀ ¢., 40 ¶∞¶∞∑∞º∂πƒπOÀ 45
119 ¶∞¶∞£∞¡∞™πOÀ ª., 26 ¶∞¶∞£∂O¢øƒOÀ §., 56 ¶∞¶∞¡π∫O§∞OÀ μ., 7, 9, 10, 13, 14, 15, 16, 18, 23, 24, 33, 35, 37, 38, 41, 45, 47, 50 ¶∞¶∞™Δ∞ÀƒOÀ £., 48 ¶∞¶∞™Δ∂ƒπ∞¢∏ Ã., 31 ¶∞¶∞Ã∏™ΔOÀ ∂., 3, 30, 57, 63, 67 ¶∞¶∞Ãπ™ΔO¢OÀ§OÀ ∞., 41 ¶∞¶∂ ª., 40 ¶∞¶¶∞™ ¶., 6, 36 ¶∞ƒ∞¶∞¡∏™πOÀ ∂., 46 ¶∞ƒ§∞¶∞¡∏ ∞., 13 ¶∞ƒOÀΔ™π¢OÀ °., 14, 50 ¶∞™∞∫πøΔOÀ ª., 44 ¶∞Δ∂π¡∞∫∏™ ¶., 55, 58 ¶∞Δ∂ƒ∞∫∏™ °., 6 ¶∞Δ™π∞OÀƒ∞ ∫., 10, 14, 16, 18, 47 ¶∂Δƒπ¢∏™ ∞., 11, 33, 41, 54 ¶π™ΔO§∞™ ¢., 59, 62 ¶OÀ°OÀ¡π∞ ∫., 8 ¶OÀ§O¶OÀ§OÀ ∑., 20 ¶OÀΔ∞Ãπ¢∏™ £., 23 ƒ∂μ∂¡∞™ ∫., 60 ƒO∏§π¢∏™ ∂., 49 ™∞μμπ¢∞∫∏ ∂., 3, 5, 30, 57, 63, 66 ™∞∫∂§§∞ƒ∞∫∏ ¶., 5 ™∞ƒO°§OÀ °., 59 ™π¢∏ƒO¶OÀ§O™ ∞., 14 ™π¢∏ƒO¶OÀ§OÀ ª., 64 ™πªO¶OÀ§OÀ £., 56 ™∫Oƒ¢∞∫∏ ∑., 4 ™O§ø¡∞∫∏ º., 7, 9
™OÀ¡π¢∞∫∏™ ¡., 15, 28, 44, 45 ™Oºπ∞¡O™ ∂., 26, 29 ™¶Àƒπ¢∏™ Ã., 22 ™¶Àƒπ¢ø¡π¢∏™ ∫., 3 ™¶ÀƒO°§OÀ ∫., 48, 49 ™¶ÀƒO¶OÀ§OÀ ª., 2 ™Δ∞ÀƒO¶OÀ§OÀ-°∫πO∫∞ ∞., 1, 4 ™Δ∂º∞¡∞¢∏™ Ã., 62 ™Δ∂º∞¡π¢∏™ π., 56 ™À°°∂§∞∫∏™ ª., 26 ™À¡O¢π¡OÀ ∂., 60 Δ∞∫OÀ¢∞™ ¢., 7, 9, 10, 13, 14, 15, 16, 17, 18, 23, 24, 33, 35, 37, 38, 42, 44, 45, 47, 48, 49, 50, 55, 58, 64, 65 Δ∞™∫O™ ¡., 26, 29 Δ∂ƒ™∏ ª., 65 Δ™∞°π∞™ ¡., 21 Δ™∞ª∞¡Δ∞™ ∞£., 57 Δ™πOΔƒ∞™ Ã., 17, 28, 45 Δ™OÀ§º∞™ °., 10, 12, 18, 35, 42 º∞¡∏ ¢., 2 ºπ§π¶¶π¢∏™ °., 56 ºOÀ∑∞™ π., 7, 9, 10, 16, 18, 33, 35, 37, 38, 47, 51, 52, 53 ºOÀƒΔOÀ¡∞™ ∫., 3, 5, 30, 57, 63 ºø∫∞∂À™ ∂., 32, 57 ºø∫∞™ ∫., 26 Ã∞ƒÃ∞§∞∫∏™ ¡., 19, 20 Ã∞Δ∑∏°∂øƒ°πOÀ Ã., 41 Ã∞Δ∑∏∫Àƒ∫OÀ Ã., 55 Ã∞Δ∑∏∫ø¡™Δ∞¡Δπ¡OÀ μ., 31, 59, 62 ÃOÀƒ∏™ π., 25 Ãπ™ΔOºπ§OÀ ∂., 43
E˘ÚÂÙ‹ÚÈÔ Û˘ÁÁڷʤˆÓ ·Ó·ÚÙËÌ¤ÓˆÓ ·Ó·ÎÔÈÓÒÛÂˆÓ Arkadopoulos ¡. 18 Barkun Jeffrey 19, 20, 21, 22, 23 Cantarovich Marcelo 5, 6, 20, 23, 24, 25 Chaudhury Prosanto 5, 6, 19, 20, 21, 22, 23, 24, 25 Deschenes Mark 20, 21, 22, 23 Ghali Peter 20, 21, 22, 23 Hassanain Mazen 5, 6, 19, 20, 21, 22, 23, 24, 25 Keith Douglas 5 Kostopanagiotou G. 18 Kottis G. 18 Mammas K. 18 Metrakos Peter 5, 6, 19, 20, 21, 22, 23, 24, 25 Paraskevas Steve 5, 6, 24, 25
Smyrniotis μ. 18 Tchervenkov Jean 5, 6, 19, 20, 21, 22, 23, 24, 25 Vrochides Dionisios 5, 6, 19, 20, 21, 22, 23, 24, 25 Wong Phil 20, 21, 22, 23 ∞ÏÂ͛Ԣ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ 2 ∞ÏÂÍfiÔ˘ÏÔ˜ ∂˘ÛÙ¿ıÈÔ˜ 7 ∞ÓÙÛ·ÎÏ‹˜ °ÂÒÚÁÈÔ˜ 2 ∞ÓÙ‡· ∂ϤÓË 9, 10, 12 ∞ÔÛÙfiÏÔ˘ £ÂÔÊ¿Ó˘ 3, 9, 11, 12, 13 ∞Úη‰fiÔ˘ÏÔ˜ ¡. 28 ∞˘ÁÔ˘ÛÙ‹ ¢. 16 μ·ÛÈÏÂÈ¿‰Ë˜ £ÂÌÈÛÙÔÎÏ‹˜ 16, 17 μÈÛ‚¿Ú‰Ë˜ °. 4
120 μÏ·¯¿ÎÔ˜ ¢ËÌ‹ÙÚÈÔ˜ 1 μÏ·¯Ô‰ËÌËÙÚfiÔ˘ÏÔ˜ ¢ËÌ‹ÙÚÈÔ˜ 14 μÏ¿¯Ô˜ πˆ¿ÓÓ˘ 1 μÔ˘Á¿˜ μ·Û›ÏÂÈÔ˜ 3, 9, 10, 11, 12 μÔ˘ÚÏ¿ÎÔ˘ ÃÚÈÛÙ›Ó· 12 °ÂˆÚÁÈ¿‰Ô˘ ∂ÊÚÔÛ‡ÓË 12 °ÈÓÈÎÔÔ‡ÏÔ˘ ∂. 4 °Ú›ÙÛË-°ÂÚÔÁÈ¿ÓÓË ¡ÈÎÔϤÙÙ· 16, 17 ¢·˝ÎÔ˜ °ÈÒÚÁÔ˜ 8 ¢·ÚÂÌ¿ ª·Ú›· 8 ¢Â‰ÂÌ¿‰Ë °ÂˆÚÁ›· 11 ¢ËÌÔÛı¤ÓÔ˘˜ ∫‡ÚÔ˜ 12 ¢Ú·ÎfiÔ˘ÏÔ˜ μ·Û›ÏÂÈÔ˜ 10 ¢Ú·ÎfiÔ˘ÏÔ˜ ™‡ÚÔ˜ 3, 9, 10, 11, 12, 13 ∂Ï-∞Ï› ª·¯ÌÔ‡Ù 3 ∑·‚‚fi˜ °ÈÒÚÁÔ˜ 8 ∑·¯·ÚÔ‡‰Ë ¢. 26 ∑ˆÁÚ¿ÊÔ˜ °ÂÒÚÁÈÔ˜ 15 £ÂÔ‰ˆÚ›‰Ë˜ £Âfi‰ˆÚÔ˜ 3 £ÂÔ‰ˆÚÔÔ‡ÏÔ˘ ∂ϤÓË 8 πÂÚˆÓ‡ÌÔ˘ ª¿ÚÈÔ˜ 10 ∫·ÎÏ·Ì¿ÓÔ˜ πˆ¿ÓÓ˘ 14 ∫·ÏϤÚÁË ∂. 26 ∫·Ó·Î¿Î˘ ∫ÒÛÙ·˜ 10 ∫¿·˜ πˆ¿ÓÓ˘ 14 ∫·Ú¿ÌÂÏ· ∂Ï¢ıÂÚ›· 14, 15 ∫·Ú··Ó·ÁÈÒÙÔ˘ ∞. 16 ∫·ÛÈÌ¿Ù˘ £Âfi‰ˆÚÔ˜ 3 ∫·ÛηڤÏ˘ πˆ¿ÓÓ˘ 10 ∫·ÙÛ·ÓԇϷ˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ 17 ∫ÂϤ΢ ¢ËÌ‹ÙÚÈÔ˜ 9 ∫ÔÎΛÓÔ˘ μ·ÛÈÏÈ΋ 3 ∫ÔÎÔÙÛ¿Î˘ πˆ¿ÓÓ˘ 10 ∫ÔÌÓËÓÔ‡ ¢¤ÛÔÈÓ· 27 ∫fiÙÙ˘ °. 28 ∫Ô˘ÎÔ˘Ï¿ÎË ª·Ú›· 3, 9, 10, 11, 12, 13 ∫Ô˘ÙÚԇ̷˜ °ÂÒÚÁÈÔ˜ 12 ∫˘ÚÈÎÏ›‰Ô˘ ¶. 4 ∫ˆÛÙ¿Î˘ ∞ÏÎÈ‚È¿‰Ë˜ 1 ∫ˆÛÙ¿Î˘ πˆ¿ÓÓ˘ 1 ∫ˆÛÙÔ·Ó·ÁÈÒÙÔ˘ °. 28 §¤·Ó‰ÚÔ˜ ∂ÌÌ·ÓÔ˘‹Ï 15 §Ô˘ÎfiÔ˘ÏÔ˜ πˆ¿ÓÓ˘ 9 ª·ÌÌ¿˜ ∫. 28 ª¿ÓÔ˘ ∂. 4 ª¤ÌÌÔ˜ ¢ËÌ‹ÙÚÈÔ˜ 7 ªÂÙ·Í¿ÙÔ˜ °ÂÒÚÁÈÔ˜ 13 ªËÙÛfiÔ˘ÏÔ˜ ∂. 4
ªÔ˘ÏÔ‡‰Ë ∂ϤÓË 17 ªÔ˘ÓÙ˙·ÏÈ¿ §·ÌÚÈÓ‹ 2 ªÔ˘ÛٷʤÏÏÔ˜ ¶·Ó·ÁÈÒÙ˘ 27 ª·Ï¿Ûη ∫·ÙÂÚ›Ó· 12, 13 ª·Ï¿Ûη ÃÚÈÛÙ›Ó· 8 ª·ÏÈÙÛ¿ÚË ∞Óı‹ 13 ª·ÛÙÔ‡Ó˘ ∏Ï›·˜ 15 ªÂϯڋ ÕÓÓ·- ª·Ú›· 7 ª¤ÏÏÔ˜ πˆ¿ÓÓ˘ 1 ª›ÏÏË ∂. 4 ª›ÚÌ·˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ 14 ªfiÎÔ˜ πˆ¿ÓÓ˘ 8 ªÔϤÙ˘ πˆ¿ÓÓ˘ ¡. 8 ªÔÓ¿ÙÛÔ˜ °ÂÚ¿ÛÈÌÔ˜ 14 ªÚ¿Ì˘ πˆ¿ÓÓ˘ 15 ªÚÔ‡ÓÙ˙Ô˜ ∏Ï›·˜ 9 ¡ÈÎÔÏ¿Ô˘ Ã. 28 ¡Ô‡ÙÛ˘ ∫ÒÛÙ·˜ 11 OÈÎÔÓÔÌ›‰Ô˘ ¢ÔÌÓ›ÎË 7 ¶·ÓÙÂÏȉ¿ÎË ∫·ÙÂÚ›Ó· 11 ¶··ÁˆÚÁ›Ô˘ ÃÚ˘ÛԇϷ 17 ¶··‰ÔÔ‡ÏÔ˘ ¢. 4 ¶··‰ÔÔ‡ÏÔ˘ ∫ˆÓÛÙ·ÓÙ›Ó· 15 ¶··Ïfi˘ ∞fiÛÙÔÏÔ˜ 14, 15 ¶··ÓÈÎÔÏ¿Ô˘ μ. 16 ¶··ÛÙÂÚÈ¿‰Ë ÃÚ‡Û· 3 ¶··¯ÚÈÛÙÔ‰Ô‡ÏÔ˘ ∞ÓÙÒÓÈÔ˜ 1 ¶·¿˜ ¶¤ÙÚÔ˜ 17 ¶·Ê›ÙË ∞. 28 ¶ÂÚÚ¤· ¢¤ÛÔÈÓ· 1 ¶ÈÛÙfiÏ·˜ ¢ËÌ‹ÙÚ˘ 12, 13 ¶ÔÌÒÓË ª·Ú›· 9 ™È‰ÂÚ‹˜ ªÈ¯·‹Ï 14, 15 ™ÈηÏÈ¿˜ ¡ÈÎfiÏ·Ô˜ 2 ™ÎÔ˘Ù¤ÏË ∂ϤÓË 10 ™Ì˘ÚÓÈÒÙ˘ μ. 28 ™Ô˘Óȉ¿Î˘ ¡›ÎÔ˜ 16, 17 ™ÊËÓÈ·‰¿Î˘ πˆ¿ÓÓ˘ 15 Δ·ÎÔ‡‰·˜ ¢. 16 Δ˙·Ú‰‹˜ ¶ÂÚÈÎÏ‹˜ 15 ΔÚÈ·ÓٷʇÏ˘ B·Û›ÏÂÈÔ˜ 2 ΔÛ·Ú¤· ∫·ÏÏÈfiË 14, 15 ΔÛÈ·ÓÙԇϷ˜ ∞fiÛÙÔÏÔ˜ 7 ΔÛÈfiÙÚ·˜ Ã. 16 ºÂϤÎÔ˘Ú·˜ ∂˘¿ÁÁÂÏÔ˜ 15 ÷ÚÈÙ¿ÎË ∂˘·ÁÁÂÏ›· 13 ÷Ù˙ËÁÈ·ÓÓ¿Î˘ ∂˘¿ÁÁÂÏÔ˜, 27 ÷Ù˙ËΈÓÛÙ·ÓÙ›ÓÔ˘ μ·ÏÛ·Ì¿Î˘ 3, 9, 11, 12, 13