ΠΑΡΗ.ΣΥ.Α. // ΠΑΡΗΓΟΡΙΚΗ ΦΡΟΝΤΙΔΑ // ΤΕΥΧΟΣ 7

T‡¯Ô˜ 7

∆Ô ¤ÓÙ˘Ô ·˘Ùfi ‰È·Ó¤ÌÂÙ·È ‰ˆÚ¿Ó

Io‡ÏÈÔ˜ 2008

¶∂ƒπ√¢π∫∏ ∂∫¢√™∏ ∆∏™ ∂ § § ∏ ¡ π ∫ ∏ ™ E TA I ƒ ∂ π ∞ ™ ¶ ∞ ƒ ∏ ° √ ƒ ∏ ∆ π ∫ ∏ ™ ∫ ∞ π ™ À ª ¶ ∆ ø ª ∞ ∆ π ∫ ∏ ™ º ƒ √ ¡ ∆ π ¢ ∞ ™ ∫ ∞ ƒ ∫ π ¡ √ ¶ ∞ £ ø ¡ ∫ ∞ π ª ∏ ∞ ™ £ ∂ ¡ ø ¡

M‹Ó˘Ì· ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ·Á·ËÙÔ› Ê›ÏÔÈ, ™˘ÓÂ›˜ ÛÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ı¤Û·Ì ‹‰Ë ·fi ÙËÓ ¤Î‰ÔÛË ÙÔ˘ 1Ô˘ Ù‡¯Ô˘˜ ÙÔ˘ ÂÓÙ‡Ô˘ Ì·˜,Û˘Ó¯›˙Ô˘Ì ӷ ÚÔ‚¿ÏÏÔ˘Ì ÙȘ ·Ú¯¤˜, ÙÔ˘˜ ÛÎÔÔ‡˜ Î·È ÙËÓ ÛËÌ·Û›· Ù˘ ¶·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Ó· ÚÔÙ›ÓÔ˘Ì ÙÚfiÔ˘˜ ·ÓÙÈÌÂÙÒÈÛ˘ ·ÛıÂÓÒÓ Ì ÓfiÛÔ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Î·È Ó· ÛÙËÚ›˙Ô˘Ì ÚˆÙÔ‚Ô˘Ï›Â˜ Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÛÙË ‰È·ÌfiÚʈÛË Î·È ÛÙË ‰È¿‰ÔÛË ÌÈ·˜ ÎÔ˘ÏÙÔ‡Ú·˜ ÊÚÔÓÙ›‰·˜, ÂÈÎÂÓÙڈ̤Ó˘ ÛÙȘ ·Ó¿ÁΘ Î·È ÛÙ· ‰ÈηÈÒÌ·Ù· ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ¶·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Î·È Î˘Ú›ˆ˜ ÛÙÔ ‰Èη›ˆÌ· ·˘ÙÔÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘˜. ∆¤ÙÔȘ ÚˆÙÔ‚Ô˘Ï›Â˜ ‚ÔËıÔ‡Ó Ó· ·ÏÏ¿ÍÂÈ Ë ·ÙÂÚÓ·ÏÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÂΠ̤ÚÔ˘˜ ÙˆÓ ÊÔÚ¤ˆÓ ˘Á›·˜, Û˘ÌÂÚÈÊÔÚ¿ Ô˘ ÛÙÚ¤ÊÂÙ·È ÚÔ˜ ÙËÓ ·ÚÚÒÛÙÈ· Ì¿ÏÏÔÓ ·Ú¿ ÚÔ˜ ÙÔÓ ¿ÚÚˆÛÙÔ, ÌÂ Û˘Ó¤ÂÈ· Ô ·ÛıÂÓ‹˜ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰· ‹ Ó· ˘Ô‚¿ÏÏÂÙ·È Û ·ÓÒÊÂϘ Î·È ‚·Û·ÓÈÛÙÈΤ˜ ıÂÚ·›˜ Ì ÛÎÔfi ÙËÓ ·Ú¿Ù·ÛË ˙ˆ‹˜ Ì ÔÔÈÔ‰‹ÔÙ ÎfiÛÙÔ˜ ‹ Ó· ‚Ú›ÛÎÂÙ·È ÂÁηٷÏÂÏÂÈ̤ÓÔ˜ Ì ¿Ï˘Ù˜ ÙȘ ۈ̷ÙÈΤ˜, Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ Î·È „˘¯ÔÏÔÁÈΤ˜ ÙÔ˘ ·Ó¿ÁΘ. ªÈ· Ù¤ÙÔÈ· ·ÍÈfiÏÔÁË ÚˆÙÔ‚Ô˘Ï›· ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ·Ô ÙÔ˘˜ ∞Ó·ÈÛıËÛÈÔÏfiÁÔ˘˜ ÙÔ˘ °.¡.

•¿Óı˘. ™ÙËÓ 4Ë ÂÈÛÙËÌÔÓÈ΋ Û˘Ó¿ÓÙËÛË Ô˘ ÔÚÁ¿ÓˆÛ·Ó ÙÔ È·ÙÚÂ›Ô ¯ÚfiÓÈÔ˘ fiÓÔ˘ ÙÔ˘ °.¡. •¿Óı˘ Î·È Ë ¶∞ƒ∏.™À.∞., ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ÏÁÔÏÔÁ›·˜ Î·È ÙÔ˘ π·ÙÚÈÎÔ‡ ™˘ÏÏfiÁÔ˘ •¿Óı˘, ‰È·ÈÛÙÒıËÎ·Ó Ù· ÛËÌ·ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÂÚÈÔ¯‹˜. ∆· ı¤Ì·Ù· Ù˘ ËÌÂÚ›‰·˜ ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘˜ ˘‹ÚÍ·Ó ¿ÎÚˆ˜ ÂӉȷʤÚÔÓÙ·. ∏ ¶∞ƒ∏.™À.∞ Ô˘ ˘ÔÛÙËÚ›˙ÂÈ Ù¤ÙÔȘ ÚˆÙÔ‚Ô˘Ï›Â˜, ÊÈÏÔÍÂÓ› ÛÙȘ ÛÂÏ›‰Â˜ ÙÔ˘ 7Ô˘ Ù‡¯Ô˘˜ Ù˘ ¤Ó· ̤ÚÔ˜ Ù˘ ÂÍ·ÈÚÂÙÈ΋˜ ‰Ô˘ÏÂÈ¿˜ ÙˆÓ ∞ÏÁÔÏfiÁˆÓ ÙÔ˘ °.¡. •¿Óı˘ Î·È ÙÈÌ¿ ÙËÓ Û˘ÓÂÚÁ·Û›·˜ ÙÔ˘˜ Ì ÙȘ ÎÔÈÓˆÓÈΤ˜ ˘ËÚÂۛ˜ ÙˆÓ ¢‹ÌˆÓ ÙÔ˘ ¡ÔÌÔ‡. ªÂ ÙȘ ıÂÚÌfiÙÂÚ˜ ¢¯¤˜ ÁÈ· ηÏfi ηÏÔη›ÚÈ °È· ÙËÓ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹

∞Û·Û›· √ÈÎÔÓfiÌÔ˘ À‡ı˘ÓË ŒÎ‰ÔÛ˘

§›Á· ÏfiÁÈ· ÁÈ· ÙË ‰Ô˘ÏÂÈ¿ Ì·˜ ÛÙÔ π·ÙÚÂ›Ô ¶fiÓÔ˘ ÙÔ˘ °.¡. •¿Óı˘ ÁÔ, ÓÔÛËÏÂ˘Ù‹ Î·È ÔÈÎȷ΋ ‚ÔËıfi. √È Î·Ù¿ ÙfiÔ˘˜ ˘ËÚÂۛ˜ Ù˘ «∫ÔÈÓˆÓÈ΋˜ ª¤ÚÈÌÓ·˜» Î·È Ë «µÔ‹ıÂÈ· ÛÙÔ ™›ÙÈ», ÂÓËÌÂÚÒÓÔÓÙ·È ·fi ÙËÓ ÔÌ¿‰· ÙÔ˘ π·ÙÚ›Ԣ ¶fiÓÔ˘ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÁÈ· ÙËÓ ·Ó¿ÁÎË ÊÚÔÓÙ›‰·˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·ÛıÂÓÔ‡˜.

∆Ô π·ÙÚÂ›Ô ¶fiÓÔ˘ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô •¿Óı˘ ÏÂÈÙÔ˘ÚÁ› ·fi ÙÔ 1996, ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔ˘˜ ∞Ó·ÈÛıËÛÈÔÏfiÁÔ˘˜ Î·È ÙÔ˘˜ ¡ÔÛËÏÂ˘Ù¤˜ ÙÔ˘ ∞Ó·ÈÛıËÛÈÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Î·È Â͢ËÚÂÙ› ÙÔ˘˜ ηÙÔ›ÎÔ˘˜ ÙÔ˘ ¡ÔÌÔ‡ •¿Óı˘. ™ÙÔ π.¶ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÂÒ‰˘Ó· Û‡Ó‰ÚÔÌ· ηıÒ˜ Î·È ·ÛıÂÓ›˜ Ì ηÚΛÓÔ, Ì fiϘ ÙȘ ‰fiÎÈ̘ ÌÂıfi‰Ô˘˜ ÂϤÁ¯Ô˘ ÙÔ˘ fiÓÔ˘ Î·È ÙˆÓ ÏÔÈÒÓ Û˘ÌÙˆÌ¿ÙˆÓ (Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Î·È ·ÚÂÌ‚·ÙÈΤ˜ Ù¯ÓÈΤ˜, fiˆ˜ ÂÚÈÊÂÚÈÎÔ› ۈ̷ÙÈÎÔ› Î·È Û˘Ì·ıËÙÈÎÔ› ·ÔÎÏÂÈÛÌÔ›, ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ Ì ‹ ¯ˆÚ›˜ PCA, ÂÈÛÎÏËÚ›‰ÈÔ˜ ·Ó·ÏÁËÛ›·, Û˘Ó¯‹˜ ‹ ηْ Â›ÎÏËÛË Î.¿.). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÚÁ·ÓÒıËÎÂ Ë ÊÚÔÓÙ›‰· ÛÙÔ Û›ÙÈ ÁÈ· ·ÛıÂÓ›˜ Ì ÓfiÛÔ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. ∏ ÛËÌ·ÓÙÈ΋ ·˘Ù‹ ÚˆÙÔ‚Ô˘Ï›· ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ÂÍ·ÈÚÂÙÈ΋ Û˘ÓÂÚÁ·Û›· Ì ÙȘ ˘ËÚÂۛ˜ ÙˆÓ ¢‹ÌˆÓ ÙÔ˘ ¡ÔÌÔ‡, «∫ÔÈÓˆÓÈ΋ ª¤ÚÈÌÓ·» Î·È «µÔ‹ıÂÈ· ÛÙÔ ™›ÙÈ». √È ˘ËÚÂۛ˜ ·˘Ù¤˜ Â›Ó·È ÛÙÂϯˆÌ¤Ó˜ Ì ÎÔÈÓˆÓÈÎfi ÏÂÈÙÔ˘ÚÁfi, „˘¯ÔÏfi-

√ ÎÔÈÓˆÓÈÎfi˜ ÏÂÈÙÔ˘ÚÁfi˜, Ô˘ Â›Ó·È Ô Û˘ÓÙÔÓÈÛÙ‹˜ Ù˘ ÔÌ¿‰·˜ ÂÚÁ·Û›·˜, ñ ∂ÈÛΤÙÂÙ·È ÙÔÓ ·ÛıÂÓ‹ ÛÙÔ Û›ÙÈ ÙÔ˘ ñ ∂ÎÙÈÌ¿ ÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ ñ ºÚÔÓÙ›˙ÂÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ¿ÌÂÛˆÓ ÎÔÈÓˆÓÈÎÒÓ ‹ ÛÔ‚·ÚÒÓ ÔÈÎÔÓÔÌÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ñ ¢È¢ÎÔχÓÂÈ Î·È ·ÓÔ›ÁÂÈ ÙÔ ‰ÚfiÌÔ ÁÈ· ‰Ú¿ÛË Ù˘ ˘fiÏÔÈ˘ ÔÌ¿‰·˜. √ „˘¯ÔÏfiÁÔ˜ ñ ™ÙËÚ›˙ÂÈ ÙÔÓ ·ÛıÂÓ‹ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ñ ∂Óı·ÚÚ‡ÓÂÈ ÙË Û˘ÓÂÚÁ·Û›· ñ ¶ÚÔÂÙÔÈÌ¿˙ÂÈ ÙÔÓ ·ÛıÂÓ‹ Ó· ÂÓÙ·¯ı› ÛÙÔ ıÂÚ·¢ÙÈÎfi ÚfiÁÚ·ÌÌ·. √ ÓÔÛËÏÂ˘Ù‹˜ ÂȉÈÎÂ˘Ì¤ÓÔ˜ ÛÙËÓ ¶.º. ñ ∂ÈÛΤÙÂÙ·È Î·ıËÌÂÚÈÓ¿ ÙÔÓ ·ÛıÂÓ‹ ηٿ ÙȘ ÂÚÁ¿ÛÈ̘ Ë̤Ú˜ Î·È ÚÔÛʤÚÂÈ ÙȘ ˘ËÚÂۛ˜ ÙÔ˘ ˘fi ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ Â‡ı˘ÓÔ˘ ÁÈ·ÙÚÔ‡ ÙÔ˘ π.¶. ñ ºÚÔÓÙ›˙ÂÈ ÁÈ· ÙËÓ ˘ÁÈÂÈÓ‹, ÙË ‰È·ÙÚÔÊ‹, ÙËÓ ÂÚÈÔ›ËÛË ÙÚ·˘Ì¿ÙˆÓ ‹ ηıÂÙ‹ÚˆÓ. ñ ∂Î·È‰Â‡ÂÈ ÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÛÙË ÊÚÔÓÙ›‰· ÙÔ˘ ¿Û¯ÔÓÙ· ñ ªÂÚÈÌÓ¿ ÁÈ· ÙËÓ ¤ÁηÈÚË ÚÔÌ‹ıÂÈ· ÙÔ˘ ··ÈÙÔ‡ÌÂÓÔ˘ Ê·Ú̷΢ÙÈÎÔ‡ Î·È ÓÔÛËÏ¢ÙÈÎÔ‡ ˘ÏÈÎÔ‡ ñ ∂ÎÙÈÌ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ó·ÏÁËÛ›·˜ Î·È ÂÓËÌÂÚÒÓÂÈ ÙÔ Î¤ÓÙÚÔ ñ ∞ÔÙÂÏ› ÙÔÓ Û˘Ó‰ÂÙÈÎfi ÎÚ›ÎÔ ÌÂٷ͇ Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜ Î·È Ù˘ ÌÔÓ¿‰·˜ ÊÚÔÓÙ›‰·˜ (·ÛıÂÓ‹˜ – ÔÈÎÔÁ¤ÓÂÈ·). ∆Ô ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ÙÔ˘ ·Ó·ÈÛıËÛÈÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ, ÙË Ú‡ıÌÈÛË Î·È ·ÛÊ·Ï‹ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÓÙÏÈÒÓ, ηıÒ˜ Î·È ÙËÓ ÂÎ·›‰Â˘ÛË ÙÔ˘ ÓÔÛËÏÂ˘Ù‹ Ô˘ ‰Ú·ÛÙËÚÈÔÔÈÂ›Ù·È ÛÙËÓ Î·Ù’Ô›ÎÔÓ ÊÚÔÓÙ›‰·. ∏ ÔÌ¿‰· ÙÔ˘ π.¶. Â›Ó·È ‰È·ı¤ÛÈÌË ÙËÏÂʈÓÈο 24 ÒÚ˜ ÙÔ 24ˆÚÔ. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ‰Ô˘ÏÂÈ¿˜ Ì·˜, Ë ·Ó·ÁÓÒÚÈÛË Ù˘ ·Ó·ÁηÈfiÙËÙ·˜ ·ÚÔ¯‹˜ ¶.º. ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ Û˘ÌÔϛ٘ Ì·˜, Ô‰‹ÁËÛ·Ó ÛÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ›‰Ú˘Û˘ Î·È ÏÂÈÙÔ˘ÚÁ›·˜ •ÂÓÒÓ· ¶·ÚËÁÔÚËÙÈ΋˜ ºÚÔÓÙ›‰·˜ ÛÙÔÓ ¡ÔÌfi Ì·˜ ÙÔÓ ÂfiÌÂÓÔ ¯ÚfiÓÔ. ∆¤ÏÔ˜, ÛÙ· Ï·›ÛÈ· Ù˘ Û˘Ó¯ԇ˜ ÂÎ·›‰Â˘Û˘ Î·È ÂÓË̤ڈÛ˘, ÙÔ π.¶. •¿Óı˘ ÔÚÁ·ÓÒÓÂÈ ·Ó¿ ‰ÈÂÙ›·, οı ª¿ÚÙÈÔ, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ¶∞ƒ∏.™À.∞., ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰·, Ì ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔÓ ¯ÚfiÓÈÔ fiÓÔ Î·È ÙËÓ ·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰·.

∂§§∏¡π∫∏ ∂∆∞πƒ∂π∞ ¶∞ƒ∏°√ƒ∏∆π∫∏™ – ™Àª¶∆øª∞∆π∫∏™ ºƒ√¡∆π¢∞™ ∫∞ƒ∫π¡√¶∞£ø¡ ∫∞π ª∏ ∞™£∂¡ø¡ (¶∞ƒ∏.™À.∞.) ∂§§∏¡π∫√ ∆ª∏ª∞ EAPC ª∂§√™ ECEPT •ÈÊ›Ô˘ 7, ∞ı‹Ó· 11471 ∆ËÏ. 210-6457878 Fax 210-6421710 www.grpalliative.org email:info@grpalliative.org

¢.™. ¶∞ƒ∏.™À.∞ ¶Úfi‰ÚÔ˜: ∞ıËÓ¿ µ·‰·Ïԇη ∞ÓÙÈÚfi‰ÚÔ˜: πˆ¿ÓÓ· ™È·Ê¿Î· °Ú·ÌÌ·Ù¤·˜: ¢ÈÔÓ‡ÛÈÔ˜ ¢›Ï·˜ ∆·Ì›·˜: ∞Ó. ∆·Ì›·˜: ª¤ÏË:

ºˆÙÂÈÓ‹ ∫ˆÓÛÙ·ÓÙ¿ÎË ª·Ú›· ∫ÔÎÔÏ¿ÎË ∂˘ÓÔÌ›· AÏÂÍÔÔ‡ÏÔ˘ µÚ·¯ÓÔ‡ ∂ÚÈʇÏÏË ∞ÚÁ‡Ú· ÃÚ˘ÛԇϷ ∫·Ú·Ó·ÛÙ¿ÛË ∫·ÏÏÈfiË ¶·Ó·ÁȈٿÎË

ªÂ ÊÈÏÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜ ∫. ¶··˚ˆ¿ÓÓÔ˘ - ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘ - ∞ÈÎ. ∆·Ù·Ú¿ÎË

∂›Ù. ¶Úfi‰ÚÔ˜: µ·ÛÈÏÈ΋ ÃÂÈ̈ӛÙÛË-∫˘Ú›Ô˘ ™À¡∆∞∫∆π∫∏ ∂¶π∆ƒ√¶∏ Y‡ı˘ÓÔ˜ ŒÎ‰ÔÛ˘: ∞Û·Û›· √ÈÎÔÓfiÌÔ˘ ª¤ÏË:

∂˘ÓÔÌ›· AÏÂÍÔÔ‡ÏÔ˘ µÚ·¯ÓÔ‡ ¢ÈÔÓ‡ÛÈÔ˜ ¢›Ï·˜ ÃÚ˘ÛԇϷ ∫·Ú·Ó·ÛÙ¿ÛË ª·Ú›· ∫ÔÎÔÏ¿ÎË ∂ϤÓË ªfiη ∫·ÏÏÈfiË ¶··˚ˆ¿ÓÓÔ˘

2

¡ÂÊÚÈ΋ ∞ÓÂ¿ÚÎÂÈ· Û ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Inger Karin Loegreid, Stein Hallan, EJPC March/April 2008, vol.15-No 2 ªÂÙ¿ÊÚ·ÛË-∂χıÂÚË ·fi‰ÔÛË: ∏ ·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰· Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ·ÔÎÙ‹ÛÂÈ ¤ÓÙÔÓÔ ÂӉȷʤÚÔÓ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·.1 ∞ÓÙ›ıÂÙ·, ÙÔ Úfi‚ÏËÌ· ÙˆÓ Î·ÚÎÈÓÔ·ıÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ıÂÚ·›˜ Ì ‰˘ÓËÙÈο ÙÔÍÈ΋ Â›‰Ú·ÛË ÛÙÔ˘˜ ÓÂÊÚÔ‡˜ ‰ÂÓ ¤¯ÂÈ ÚÔÛÂÏ·ÛÂÈ ÙËÓ ÚÔÛÔ¯‹ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∏ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Û ηÚÎÈÓÔ·ı›˜ Â›Ó·È Èı·Ófi Ó· Û˘Ì‚Â›, Û˘¯Ó¿ ˆÛÙfiÛÔ ·Ú·Ì¤ÓÂÈ ·‰È¿ÁÓˆÛÙË. °·ÏÏÈ΋ ÌÂϤÙË Û 1435 ·ÛıÂÓ›˜, ·fi ¤ÓÙ ·ÓÙÈηÚÎÈÓÈο ΤÓÙÚ·, ¤‰ÂÈÍ fiÙÈ 18% ÙˆÓ ·ÛıÂÓÒÓ Â›¯·Ó ¯·ÌËÏ‹ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∏ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ηıÔÚ›˙ÂÙ·È ·fi ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ (eGFR). ŸÙ·Ó Ë GFR Â›Ó·È Î¿Ùˆ ·fi ÙÔ fiÚÈÔ ÙˆÓ 60ml/min/1.73 m2, ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂÈÙÒÛÂȘ2. ∏ ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÛıÂÓÒÓ ÙˆÓ ÌÔÓ¿‰ˆÓ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ¯ˆÚ›˜ Ó· Â›Ó·È ·Ôχو˜ ÁÓˆÛÙ‹, ‰ÂÓ Ú¤ÂÈ Ó· ˘ÔÙÈÌ¿Ù·È, ηıÒ˜ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ÎÔÈÓÒÓ Ê·Ú̿ΈÓ, Ó· ÌÂÈÒÛÂÈ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ Î·È Ó· ÂÈ‚·Ú‡ÓÂÈ ÙÔÓ ·ÛıÂÓ‹ ÌÂ Û˘ÌÙÒÌ·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·.

∫. ¶··˚ˆ¿ÓÓÔ˘

Ù· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÓÂÊÚÈ΋ ·Ó·ÈÌ›· Î·È ÌÔÚÔ‡Ó ·ÔÙÂÏÂÛÌ·ÙÈο Ó· ıÂÚ·¢ıÔ‡Ó Ì ÂÚ˘ıÚÔÔÈËÙ›ÓË. ŸÙ·Ó ÙÔ Û‡ÛÙËÌ· ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ÂËÚ¿˙ÂÙ·È, Ù· ΢ڛ·Ú¯· Û˘ÌÙÒÌ·Ù· Â›Ó·È ÔÏ˘Ô˘Ú›·, ·›ÛıËÌ· ‰›„·˜ Î·È ·Ê˘‰¿ÙˆÛË. ∏ ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Ôχ Û˘¯Ó¿ ÂÌÊ·Ó›˙ÂÙ·È Ì ԛ‰ËÌ·, ÔÏÈÁÔ˘Ú›·, ˘ÂÚηÏÈ·ÈÌ›· Î·È ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË. ¶›Ó·Î·˜ 1. ¢ÈÂıÓ‹˜ Ù·ÍÈÓfiÌËÛË Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ ™Ù·‰ÈÔÔ›ËÛË

√ÚÈÛÌfi˜, ‰È¿ÁÓˆÛË Î·È Û˘ÌÙÒÌ·Ù· ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜

™˘ÌÙÒÌ·Ù·

á∞ ÛÙ¿‰ÈÔ 1 º˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (GFR*>90)+ÚˆÙÂ˚ÓÔ˘Ú›·

∫·Ó¤Ó·

á∞ ÛÙ¿‰ÈÔ 2 ∂Ï·ÊÚÒ˜ ÌÂȈ̤ÓË GFR (60-89) +ÚˆÙÂ˚ÓÔ˘Ú›·

∫·Ó¤Ó·

á∞ ÛÙ¿‰ÈÔ 3 ∞ÚÎÂÙ¿ ÌÂȈ̤ÓË GFR (30-59)

∫fiˆÛË ÏfiÁˆ ·Ó·ÈÌ›·˜, Ì˘ÈΤ˜ ÎÚ¿Ì˜

á∞ ÛÙ¿‰ÈÔ 4 ™ËÌ·ÓÙÈο ÌÂȈ̤ÓË GFR (15-29) ∂ÈϤÔÓ Ó·˘Ù›·, Ô›‰ËÌ·, ÌÂȈ̤ÓË fiÚÂÍË, ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘/Û˘ÁΤÓÙÚˆÛ˘, Ó¢ÚÔ¿ıÂÈ·

√È ÚfiÛÊ·Ù˜ ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜, Ù·ÍÈÓÔÌÔ‡Ó ÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ Û ¤ÓÙ ÛÙ¿‰È· Ô˘ ‚·Û›˙ÔÓÙ·È ÛÙË ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË(GFR), Ë ÔÔ›· ·ÔÙÂÏ› ÙÔ Î·Ï‡ÙÂÚÔ ÎÚÈÙ‹ÚÈÔ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙˆÓ ÛËÌ›ˆÓ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘.3 ™ÙÔÓ ¶›Ó·Î· 1 Ù· ÛÙ¿‰È· 1-2 ·ÊÔÚÔ‡Ó ·ÛıÂÓ›˜ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÂÏ·ÊÚÒ˜ ÂÏ·Ùو̤ÓË ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË (GFR) Î·È ÚˆÙÂ˚ÓÔ˘Ú›· (‹ ¿ÏÏ· ÛËÌ›· ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ , ÛÙË ‚ÈÔ„›· ‹ ÛÙȘ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜). ∆· ÛÙ¿‰È· 3-5 ·ÊÔÚÔ‡Ó ·ÛıÂÓ›˜ Ì ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË <60ml/min/1.73 m2 . ∏ ÙÈÌ‹ ·˘Ù‹ Â›Ó·È ÏÈÁfiÙÂÚË ·fi ÙÔ ‹ÌÈÛ˘ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ Î·È Â›Ó·È ÙÔ fiÚÈÔ Ô˘ ÔÈ ·ÛıÂÓ›˜ ·Ú¯›˙Ô˘Ó Ó· ÂÌÊ·Ó›˙Ô˘Ó ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ·˘ÍË̤ÓÔ Î·Ú‰ÈÔ·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ∞ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÛÙ·‰›Ô˘ 5 ¤¯Ô˘Ó GFR <15ml/min/1.73 m2 Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÍ ·˘ÙÒÓ ı· ¯ÚÂÈ·ÛÙÔ‡Ó ·ÈÌÔοı·ÚÛË ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ÁÈ· Ó· ÂÈ‚ÈÒÛÔ˘Ó.

H ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË ÌÔÚ› Â·ÎÚÈ‚Ò˜ Ó· ÌÂÙÚËı› ˆ˜ Ë Î¿ı·ÚÛË Ú·‰ÈÂÓÂÚÁÒÓ ÛÙÔȯ›ˆÓ (.¯, 51Cr-EDTA) ‹ ·ÎÙÈÓÔÛÎÈÂÚÒÓ ·Ú·ÁfiÓÙˆÓ (.¯. iohexol) ·fi ÙÔ Ï¿ÛÌ·. ∏ ̤ıÔ‰Ô˜ Â›Ó·È Ì¿ÏÏÔÓ ‰‡Û¯ÚËÛÙË Î·È ·ÎÚÈ‚‹. °È· ·˘Ùfi ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Û˘ÛÙ‹ÓÂÙ·È Ë ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË Ó· ˘ÔÏÔÁ›˙ÂÙ·È Ì ÌÂıfi‰Ô˘˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·È ÛÙËÓ ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡, ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ. ™˘ÓËı¤ÛÙÂÚ˜ ÂÍ ·˘ÙÒÓ Â›Ó·È ÔÈ MDRD (Modification of Diet in Renal Disease) Î·È Ë Cockroft-Gault.4-6 °ÂÓÈÎÒ˜, Ë Î¿ı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘, Ô˘ ‚·Û›˙ÂÙ·È ÛÙËÓ 24ˆÚË Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ϤÔÓ, ÂÂȉ‹ Â›Ó·È ÏÈÁfiÙÂÚÔ ·ÎÚÈ‚‹˜. ∞ÏÏ¿ Î·È ÔÈ Û‡Á¯ÚÔÓ˜ ÂÍÈÛÒÛÂȘ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ ‰ÂÓ ‰›ÓÔ˘Ó ·ÎÚÈ‚‹ ·ÔÙÂϤÛÌ·Ù· Û ηÚÎÈÓÔ·ı›˜, ÏfiÁˆ Ù˘ ÂÏ·Ùو̤Ó˘ Ì˘˚΋˜ Ì¿˙·˜. ∂Ô̤ӈ˜, Ë Î¿ı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È ·ÎfiÌË Ë Ì¤ÙÚËÛË Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ Ì Â͈ÁÂÓ‹ ÛÙԯ›· Â›Ó·È ··Ú·›ÙËÙ· Û ÂȉÈΤ˜ ÂÚÈÙÒÛÂȘ. ¶ÔÏÏ¿ ·fi Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ‰È·ÊÔÚԉȷÁÓˆÛÙÔ‡Ó ·fi ÙÔÓ Î·ÚΛÓÔ. ∆· Û˘ÌÙÒÌ·Ù· ·fi ÙËÓ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Û˘Ó‹ıˆ˜ ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È, ¤ˆ˜ fiÙÔ˘ Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÂÏ·ÙÙˆı› ÛÙÔ ÛÙ¿‰ÈÔ 4 Î·È 5 (GFR <60ml/min/1.73 m2). ∆· ÈÔ Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Â›Ó·È ÎfiˆÛË, ·ÓÔÚÂÍ›·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÎÓËÛÌfi˜ Î·È Û‡Ó‰ÚÔÌÔ «·Ó‹Û˘¯ˆÓ Ô‰ÈÒÓ». ªÂÚÈο ·fi ·˘Ù¿ Ù· Û˘ÌÙÒÌ·-

á∞ ÛÙ¿‰ÈÔ 5 ¡ÂÊÚÈ΋ (GFR<15)

∂ÈϤÔÓ ÎÂÊ·Ï·ÏÁ›·, ÎÓËÛÌfi˜, ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ı¿Ó·ÙÔ˜

*GFR=‚·ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘

™˘Ó‹ıÂȘ ·Èٛ˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Û ·ÛıÂÓ›˜ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ∞ÓÙÈηÚÎÈÓÈ΋ ·ÁˆÁ‹ ∞ÚÎÂÙ¿ ·ÓÙÈηÚÎÈÓÈο Ê¿Ú̷η (Carmustine, Cisplatin, Capboplatin, Methotrexate) ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË ÓÂÊÚÔÙÔÍÈÎfiÙËÙ·.7 ∏ ·ÓÙÈηÚÎÈÓÈ΋ ıÂÚ·›· ηٿ ηÓfiÓ·, ÂËÚ¿˙ÂÈ ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ì ÙÚ›˜ ÙÚfiÔ˘˜: 1) Ì ¿ÌÂÛË ÙÔÍÈ΋ ‰Ú¿ÛË ÛÙÔ˘˜ ÓÂÊÚÔ‡˜, 2) ¤ÌÌÂÛ· ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ÚÂÓÂÚÁÂÈÒÓ, fiˆ˜ ¤ÌÂÙÔ˜ Î·È ‰È¿ÚÚÔÈ· Ô˘ Ô‰ËÁÔ‡Ó Û ˘ÔÔÁηÈÌ›·, 3) Ì Ïԛ̈ÍË ‹ ÛË„·ÈÌ›· ÏfiÁˆ Ù˘ Ï¢ÎÔÂÓ›·˜ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ. ∏ ÌÂÙ¿ ¯ËÌÂÈÔıÂÚ·›· ÓÂÊÚÈ΋ ‚Ï¿‚Ë ÔÊ›ÏÂÙ·È Û ‰ÔÌÈ΋ ηٷÛÙÚÔÊ‹ ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Î·È ÙÔ˘ ÛÂÈÚ·Ì·ÙÈÎÔ‡ Û˘ÛÙ‹Ì·-

3

Ì ÔÏÏ¿ ÁÈ· ÙÔ Ì˯·ÓÈÛÌfi Ù˘ ·ıÔÁ¤ÓÂÈ·˜. ∫¿ÔÈ· ·fi ·˘Ù¿ Ù· Ê˘ÙÈο Û΢¿ÛÌ·Ù· ¤¯Ô˘Ó ÂÈÛ¤ÏıÂÈ ÚfiÛÊ·Ù· ÛÙÔ ¢˘ÙÈÎfi ÎfiÛÌÔ. ¡ÂÊÚÈ΋ ‚Ï¿‚Ë ·fi Û˘ÛÙ·ÙÈο Ô˘ ÂÈÌÔχÓÔ˘Ó ‹ ÓÔıÂ‡Ô˘Ó Ù· ‚·ÛÈο Û΢¿ÛÌ·Ù· Â›Ó·È Â·ÚÎÒ˜ ηٷÁÂÁÚ·Ì̤ӷ. Œ¯Ô˘Ó ‚ÚÂı› ˘„ËÏ¿ Â›‰· η‰Ì›Ô˘ Î·È ÌÔχ‚‰Ô˘ Ù· ÔÔ›· ÚÔηÏÔ‡Ó ÛÔ‚·Ú‹ ÙÔÍÈÎfiÙËÙ· Û ÔÏÏ¿ fiÚÁ·Ó·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÓÂÊÚÒÓ. √ÚÈṲ̂ӷ ∫ÈÓ¤˙Èη Ê˘ÙÈο Û΢¿ÛÌ·Ù· ¤¯Ô˘Ó ·Ó·Ï˘ı› Î·È ‚Ú¤ıËΠfiÙÈ ÂÚȤ¯Ô˘Ó ÛÙÂÚÔÂȉ‹, ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η Î·È ËÚÂÌÈÛÙÈο.9 ∏ ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ È·ÙÚÈ΋˜ ¤¯ÂÈ ÂÛÙÈ¿ÛÂÈ ÛÙËÓ ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. øÛÙfiÛÔ, ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ΢ڛˆ˜ ¯ÒÚ˜, Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‰ÂÓ ·ÍÈÔÏÔÁÂ›Ù·È Ï‹Úˆ˜ Î·È ÔÏÏÔ› ·ÛıÂÓ›˜ ÂͤگÔÓÙ·È ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÓÂÊÚÈ΋ ‚Ï¿‚Ë13 ¢ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ Û˘ÛÙËÌ·ÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ È·ÙÚÈ΋˜ Î·È Ù· ÂÚÈÛÛfiÙÂÚ· ÛÙÔȯ›· ¤¯Ô˘Ó ηٷÁÚ·Ê› ˆ˜ ·ÚÔ˘Û›·ÛË ÂÓfi˜ ‹ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÂÚÈÛÙ·ÙÈÎÒÓ. ∫¿ı ·ÛıÂÓ‹˜ Ô˘ ı· ·ÔÊ·Û›ÛÂÈ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÙȘ ıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ È·ÙÚÈ΋˜ Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÂÙ·È ÁÈ· ÙȘ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, Ó· ·Ú·ÎÔÏÔ˘ı¤ÈÙ·È Û˘ÛÙËÌ·ÙÈο Î·È Ó· ÁÓˆÚ›˙ÂÈ ÔÈ· Ê˘ÙÈο Û΢¿ÛÌ·Ù· Ú¤ÂÈ Ó· ·ÔʇÁÂÈ.

ÕÔ„Ë È·ÙÚ›Ԣ fiÓÔ˘ °.¡. •¿Óı˘

ÙÔ˜, ηٷÛÙÚÔÊ‹ Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÔͤˆÛË, Ì ÂÏÏ¿ÙˆÛË Ù˘ GFR. √ ΛӉ˘ÓÔ˜ ÌfiÓÈÌ˘ ÓÂÊÚÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÌÂÙ¿ ·Ô ·ÓÙÈηÚÎÈÓÈ΋ ıÂÚ·›· Â›Ó·È ·˘ÍË̤ÓÔ˜ fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÓÔÛ‹Ì·Ù· fiˆ˜ ˘¤ÚÙ·ÛË, ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘. ∞ÏÏ¿ Î·È Ë ÂÏÏ¿ÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÈÌ¿ÙˆÛ˘ ›Ù ÏfiÁˆ ˘ÔÔÁηÈÌ›·˜ ›Ù ÏfiÁˆ ηډÈÔÁÂÓÔ‡˜ ‹ ÛËÙÈ΋˜ ηٷÏËÍ›·˜, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∏ ·ÔÊ˘Á‹ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ Û ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÓÙÈηÚÎÈÓÈ΋ ıÂÚ·›· ÌÔÚ› ˆ˜ ¤Ó· ‚·ıÌfi Ó· ·ÔÊ¢¯ı› Ì ÙËÓ ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰ÔÛÔÏÔÁ›·˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È Â·Ú΋ ÂÓ˘‰¿ÙˆÛË. ∏ ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰ÔÛÔÏÔÁ›·˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚ› Ó· Á›ÓÂÈ: ·) Ì ÂÏÏ¿ÙˆÛË Ù˘ ‰fiÛ˘ Î·È ‰È·Ù‹ÚËÛË ÙˆÓ ‰È·ÛÙËÌ¿ÙˆÓ ÌÂٷ͇ ÙˆÓ ‰fiÛÂˆÓ , ‚) Ì ·‡ÍËÛË ÙˆÓ ÌÂÛԉȷÛÙËÌ¿ÙˆÓ Î·È ‰È·Ù‹ÚËÛË Ù˘ ‰fiÛ˘ Î·È Á) Ì ÂÏÏ¿ÙˆÛË Ù˘ ‰fiÛ˘ Î·È ·‡ÍËÛË ÙˆÓ ÌÂÛԉȷÛÙËÌ¿ÙˆÓ.

∞ÔÊÚ·ÎÙÈ΋ ÓÂÊÚÔ¿ıÂÈ· ™Â ·ÛıÂÓ›˜ Ì ÚÔ˚Ô‡Û· ÌÔÚÊ‹ ηÚΛÓÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ˘¤ÏÔ˘ fiˆ˜ ÚÔÛÙ¿ÙË, Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙˆ˜ Î·È Ì‹ÙÚ·˜, ÌÔÚ› Ó· Û˘Ì‚Â› ·fiÊÚ·ÍË Ô˘ÚËÙ‹Ú·. ∞˘Ùfi ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÓÂÊÚÈ΋ ·ÓÂ¿ÚÙÎÂÈ·, ˘‰ÚÔÓ¤ÊÚˆÛË Ì ÔÛÊ˘ÈÎfi ¿ÏÁÔ˜ ‹ Ô˘ÚÔÏԛ̈ÍË. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ·fiÊÚ·ÍË ÂÊ·ÚÌfi˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÔÓfiÏ¢ÚË ÓÂÊÚÔÛÙÔÌ›· Ô˘ ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜.14-15 ™Â οÔÈ· ÓÔÛÔÎÔÌ›· Ë ÓÂÊÚÔÛÙÔÌ›· ÌÂÙ¿ ·Ô Û‡ÓÙÔÌÔ ‰È¿ÛÙËÌ· ·ÓÙÈηı›ÛÙ·Ù·È Ì stent. ∞˘Ùfi ··Ï¿ÛÛÂÈ ÌÂÓ ÙÔÓ ·ÛıÂÓ‹ ·Ô ÙÔÓ Î·ıÂÙ‹Ú·, ·ÏÏ¿ Û˘¯Ó¿ ÌÔÚ› Ó· Û˘Ì‚Â› ·fiÊÚ·ÍË Î·È ··ÈÙÂ›Ù·È Û˘¯Ó‹ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ stent. Œ¯ÂÈ ‰È·ÈÛÙˆı› ÔÙÈ Ë ÓÂÊÚÔÛÙÔÌ›· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ·Ó·ÎÔ˘Ê›˙ÂÈ ·fi ÙÔÓ fiÓÔ Î·È Ù· Û˘ÌÙÒÌ·Ù· Ù˘ Ô˘Ú·ÈÌ›·˜, ÂÊ·ÚÌfi˙ÂÙ·È Â‡ÎÔÏ· Î·È ¤¯ÂÈ Ï›Á˜ ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜. ∂›Ó·È ÂÔ̤ӈ˜ ÛËÌ·ÓÙÈÎfi Ó· ÙÔÓÈÛÙ› fiÙÈ fiÏÔÈ ÔÈ ÁÈ·ÙÚÔ› Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ ·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰· ı· Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ó ·˘Ù‹ ÙË ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË.

∂Ó·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋ ∏ Û˘ÌÏËڈ̷ÙÈ΋ ‹ Ë ÂÓ·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋ ÂÊ·ÚÌfi˙ÔÓÙ·È Û ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ ÛÙ· Ï·›ÛÈ· Ù˘ ÚÔÏËÙÈ΋˜ ‹ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜. ™‡Ìʈӷ Ì ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜, ¿Óˆ ·fi ÙÔ 50% ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ ∂˘ÚÒ˘, Ù˘ µfiÚÂÈ·˜ ∞ÌÂÚÈ΋˜ Î·È ¿ÏÏˆÓ ‚ÈÔÌ˯·ÓÔÔÈËÌ¤ÓˆÓ ÂÚÈÔ¯ÒÓ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ÙËÓ ÂÓ·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿, ÂÓÒ ÙÔ 20% ÙË ¯ÚËÛÈÌÔÔÈÔ‡Ó Û˘ÛÙËÌ·ÙÈο.8 ¶Ôχ Û˘¯Ó¿, ÔÈ ÁÈ·ÙÚÔ› ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó ÔÙÈ ÔÈ ·ÛıÂÓ›˜ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó Ê¿Ú̷η Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ È·ÙÚÈ΋˜. °ÂÁÔÓfi˜ ¿ÓÙˆ˜ Â›Ó·È ˆ˜ Ë ¯Ú‹ÛË ·˘Ù‹ ÌÔÚ› Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÔÍ›·˜ ‹ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘, ÂÓÒ ˘¿Ú¯ÂÈ Â›Û˘ ˘„ËÏfi˜ ΛӉ˘ÓÔ˜ Ê·Ú̷΢ÙÈÎÒÓ ·ÏÏËÏÂȉڿÛˆÓ.9 ∏ ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ¯Ú‹Û˘ Ê·ÚÌ¿ÎˆÓ Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ È·ÙÚÈ΋˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ¿ÌÂÛË ÙÔÍÈÎfiÙËÙ· Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ Ô˘Û›·˜ ‹ Û ÙÔÍÈÎfiÙËÙ· Ô˘ÛÈÒÓ Ô˘ ÂÈÌÔχÓÔ˘Ó ‹ ÓÔıÂ‡Ô˘Ó Ù· Û΢¿ÛÌ·Ù· Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ È·ÙÚÈ΋˜. Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ηٿ ÙȘ Ôԛ˜ ÙÔ ÂÚÈÁÚ·ÊfiÌÂÓÔ ‚fiÙ·ÓÔ Â›¯Â ·ÓÙÈηٷÛÙ·ı› ·fi οÔÈÔ ÙÔÍÈÎfi Ê˘Ùfi. ∆Ô ∫ÈÓ¤˙ÈÎÔ ‚fiÙ·ÓÔ Stephania tetrandra Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ÂÓ·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋, ‚Ú¤ıËΠÔÙÈ Â›¯Â ·ÓÙÈηٷÛÙ·ı› ÌÂ Ê˘Ù¿ Ô˘ ÂÚÈ›¯·Ó ÛfiÚÔ˘˜ aristolochia, Ù· ÔÔ›· Â›Ó·È ˘„ËÏ‹˜ ÙÔÍÈÎfiÙËÙ·˜ ÁÈ· ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ÌfiÓÈÌË ÓÂÊÚÈ΋ ‚Ï¿‚Ë (ÁÓˆÛÙ‹ ˆ˜ ÎÈÓ¤˙ÈÎË Ê˘ÙÈ΋ ÓÂÊÚÔ¿ıÂÈ·).10 ∆Ô Ê˘Ùfi St John’s wort (Hypericum perforatum), Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÚÔηÏ› ·ÏÏËÏÂȉڿÛÂȘ Ì ÙËÓ Î˘ÎÏÔÛÔÚ›ÓË, ¤Ó· ·ÓÔÛÔηٷÛÙ·ÏÙÈÎfi ÙÔ ÔÔ›Ô ¯ÔÚËÁÂ›Ù·È ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÔÚÁ¿ÓˆÓ. ∆Ô St John’s wort ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ Ù· Â›‰· Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ ηٿ 50-70%, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ ÛÙÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜.11 ™ÙËÓ ∞ÊÚÈ΋, Ë ¯Ú‹ÛË ·Ú·‰ÔÛÈ·ÎÒÓ Ê˘ÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› ÁÈ· Û˘ÌÌÂÙÔ¯‹ ÛÙÔ 35% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜.12 ™˘¯Ó¿ ÙÔ ·›ÙÈÔ ‰ÂÓ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Î·È ‰Â ÁÓˆÚ›˙Ô˘-

ªË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η ∆· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë (ª™∞º) Ê¿Ú̷η, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ ΢ÎÏÔ-Ô͢ÁÂÓ¿Û˘-2 (COX-2) ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘¯Ó¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙ· Ï·›ÛÈ· Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜. ∆· ª™∞º ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ‰‡Ô ÌÔÚʤ˜ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘: ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· (√¡∞) Ô˘ ÔÊ›ÏÂÙ·È Û ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÔÍ›· ‰È¿ÌÂÛË ÓÂÊÚ›Ùȉ·. ∏ √¡∞ Â›Ó·È Ë Û˘¯ÓfiÙÂÚË Î·È Û˘Ó‰¤ÂÙ·È Ì ÙËÓ Û‡ÓıÂÛË ÙˆÓ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ. ∆· ª™∞º ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ Û‡ÓıÂÛË ÙˆÓ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, ÔÈ Ôԛ˜ Â›Ó·È ·ÁÁÂȉȷÛÙ·ÏÙÈΤ˜ Ô˘Û›Â˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜. √ ΛӉ˘ÓÔ˜ ÔÍ›·˜ ¤ÎÙˆÛ˘ Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ Î·È ·Ó¿Ù˘Í˘ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó Î·È ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÔÈ ÔÔ›ÔÈ ÌÂÈÒÓÔ˘Ó ÙË ÓÂÊÚÈ΋ ·ÈÌ·ÙÈ΋ ÚÔ‹ fiˆ˜ ˘ÔÔÁηÈÌ›·, ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ÂÁÁÂÓ‹ ÓÂÊÚÈ΋ ÓfiÛÔ ‹ ·ÛıÂÓ›˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ·Ó·ÛÙÔÏ›˜ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘-ππ. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, Ù· ª™∞º Î·È ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ COX-2 ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ì ·˘ÍË̤ÓË ÚÔÛÔ¯‹.16-17

ÕÏÏ· ÎÏÈÓÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ˘˜ ÓÂÊÚÔ‡˜ ¢ÔÛÔÏÔÁ›· ÙˆÓ ÔÈÔÂȉÒÓ ™Â ÔÏÏÔ‡˜ ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ··ÈÙÂ›Ù·È ·Ó·Ï4

ÚˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙËÓ ÔÌ¿‰· Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÙËÓ ÓÂÊÚÔÏÔÁÈ΋ ÔÌ¿‰·. √ ·ÛıÂÓ‹˜ ı· Ú¤ÂÈ Â›Û˘ Ó· ÏËÚÔÊÔÚËı› ÁÈ· ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Ô˘ ÙÔ˘ ·Ú¤¯ÂÈ Ë ·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰·, Â¿Ó ·ÔÊ·Û›ÛÂÈ Ó· ‰È·Îfi„ÂÈ ‹ Ó· ÌËÓ ÍÂÎÈÓ‹ÛÂÈ ÙËÓ ·ÈÌÔοı·ÚÛË.

™˘Ì¤Ú·ÛÌ· √È ÁÈ·ÙÚÔ› Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÛÔ‚·Ú¿ ˘fi„ÈÓ ÙËÓ ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË Î·È ÙËÓ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘˜ Ú›Ó ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. £· Ú¤ÂÈ Ó· ˘ÔÏÔÁ›˙Ô˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ì ‚¿ÛË ÙËÓ ÂÈÏÔÁ‹ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·ÁˆÁ‹˜, ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÂÓ˘‰¿ÙˆÛË. ∏ ıÂÚ·›· Î·È ÔÈ ‰È¿ÊÔÚ˜ ‰È·ÁÓˆÛÙÈΤ˜ ̤ıÔ‰ÔÈ ı· Ú¤ÂÈ Ó· ÂÈϤÁÔÓÙ·È Û‡Ìʈӷ Ì ÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∆Ô ÂÚÒÙËÌ· Ù˘ Û˘Ó¤¯ÈÛ˘ ‹ Ù˘ ¤Ó·Ú͢ Ù˘ ·ÈÌÔοı·ÚÛ˘ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ÓfiÛÔ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ·ÔÙÂÏ› È·ÙÚÈ΋ Î·È ËıÈ΋ ÚfiÎÏËÛË, ÁÈ· ·˘Ùfi Î·È Ë ÔÌ¿‰· Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ fiˆ˜ Î·È Ë ÓÂÊÚÔÏÔÁÈ΋ ÔÌ¿‰· ı· Ú¤ÂÈ Ó· Û˘ÓÂÚÁ¿˙ÔÓÙ·È ÛÙÂÓ¿.

∏ ÔÌ¿‰· ÂÚÁ·Û›·˜, ÛÙÔ °.¡. •¿Óı˘

ÁËÛ›· Ì ÔÈÔÂȉ‹ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛÙ› ÈηÓÔÔÈËÙÈ΋ ·Ó·ÎÔ‡ÊÈÛË ·fi ÙÔÓ fiÓÔ. ŸÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Ë ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÈÏÔΤ˜ ÏfiÁˆ Û˘ÛÛÒÚ¢Û˘ ÙˆÓ ÂÓÂÚÁÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ M-3-G Î·È M-6-G ÛÙÔ Ï¿ÛÌ· Î·È ÛÙÔ ∂¡À. À¿Ú¯ÂÈ ÁÚ·ÌÌÈ΋ Û˘Ó¿ÚÙËÛË ÌÂٷ͇ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ Î·È ÓÂÊÚÈ΋˜ οı·ÚÛ˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÌÂÙ·‚ÔÏÈÙÒÓ. ∏ Û˘ÁΤÓÙÚˆÛË M-6-G 24 ÒÚ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘ Â›Ó·È 15 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚË Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∂Ô̤ӈ˜ Ë ‰fiÛË ÌÔÚÊ›Ó˘ ‹ ˘‰ÚÔÌÔÚÊfiÓ˘ ÛÙÔ˘˜ ÂÓ ÏfiÁˆ ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ÌÂÈÒÓÂÙ·È ¤ˆ˜ Î·È 50% ÂÓÒ Ù· ÌÂÛԉȷÛÙ‹Ì·Ù· ÌÂٷ͇ ÙˆÓ ‰fiÛÂˆÓ Ó· ·˘Í¿ÓÔÓÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ ÎÏÈÓÈÎfi ·ÔÙ¤ÏÂÛÌ·. ∏ οı·ÚÛË ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ Âıȉ›Ó˘ ÂÍ·ÚÙ¿Ù·È Â›Û˘ ·Ô ÙË ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË. ∞·ÈÙÂ›Ù·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ·Ó·ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ‰fiÛÂˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ì ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. °È· ÙË ÊÂÓÙ·Ó‡ÏË, ÌÂı·‰fiÓË Î·È ÔÍ˘Îˆ‰fiÓË, ‰ÂÓ ··ÈÙÂ›Ù·È ·Ó·ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ‰fiÛˆÓ.19

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kiberd BA, Clase CM. Cumulative risk for developing end-stage renal disease in the US population. J Am Soc Nephrol 2002; 13: 1635-1644.

2. Launay-Vacher V, Oudard S, Janus N et al. Prevalence of renal insufficiency in cancer patients and implications for anticancer drug management: the renal insufficiency and anticancer medications (IRMA) study. Cancer 2007; 110: 1376-1384.

3. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39: S1266.

4. Levey AS, Coresh JP, Lewis JB et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-470.

5. Levey AS, Coresh JP, Greene T et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247-254.

6. Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.

Nephron 1976; 16: 31-41.

7. Kintzel PE. Anticancer drug-induced kidney disorders. Drug Saf 2001; 24: 19-38.

8. WHO Media Centre. Traditional medicine. http://www.who.int/mediacentre/factsheets /fs134/en (last accessed 3/12/2007) 9. Colson CR, de Broe ME. Kidney injury from alternative medicines. Adv Chronic Kidney Dis 2005; 12: 261-275.

10. Vanherweghem JL, Depierreux M, Tielemans C et al. Rapidly progressive interstitial renal fibrosis in young women: association with slimming regiment including Chinese herbs. Lancet 1993; 341: 387-391.

11. Moschella C, Jaber BL. Interaction between cyclosporine and Hypericum perforatum (St John’s wort) after organ transplantation. Am J Kidney Dis 2001; 38: 1105-1107.

12. Adelekum TA, Ekwere TR, Akinsola A. The pattern on acute toxin nephropathy in Ife, Nigeria. West Afr J Med 1999; 18: 60-63.

13. Guh JY, Chen HC, Tsai JF, Chuang LY. Herbal therapy is associated with the risk of CKD in adults not using analgesics in Taiwan. Am J Kidney Dis 2007; 49: 626-633.

14. Little B, Ho KJ, Gawley S, Young M. Use of nephrostomy tubes in ureteric obstruction from incurable malignancy. Int J Clin Pract 2003; 57: 180-181.

15. Kinn AC, Ohlsén H. Percutaneous nephrostomy – a retrospective study focused on palliative indications. APMIS Suppl 2003; (109): 66-70.

16. Whelton A. Renal and related cardiovascular effects of conventional and COX-2specific NSAIDs and non-NSAID analgesics. Am J Ther 2000; 7: 63-74.

17. Murray MD, Brater DC. Renal toxicity of the nonsteroidal anti-inflammatory drugs. Annu Rev Pharmacol Toxicol 1993; 33: 435-465.

18. Davies G, Kingswood C, Street M. Pharmacokinetics of opioides in renal dysfunction.

Clin Pharmacokinet 1996; 31: 410-422.

19. Böger RH. Renal impairment: a challenge fog opioid treatment? The role of buprenorphine. Palliat Med 2006; 20: s17-23.

20. Broadbent A, Glare P, Crawford B. Bisphosphonate-induced hypocalcemia associated with vitamin D deficiency in a patient with advanced cancer. Am J Hosp Palliat Care 2005; 22: 382-384.

21. Maalouf NM, Heller HJ, Odvina CV, Kim PJ, Sakhaee K. Bisphosphonate-indused hypocalcemia: report of 3 cases and reciew of literature. Endocr Pract 2006; 12: 48-53.

22. Henley D, Kaye J, Walsh G. Symptomatic hypocalcaemia and renal impairment associated with bisphosphonate treatment in patients with multiple myeloma. Intern Med J 2005; 35: 726-728.

23. Germain MJ, Cohen LM, Davison SN. Withholding and withdrawal from dialysis: what we know about how our patients die. Semin Dial 2007; 20: 195-199.

¢ÈʈÛÊÔÓÈο ∏ ¯Ú‹ÛË ÙˆÓ ‰ÈʈÛÊÔÓÈÎÒÓ ÛÙËÓ ÔÁÎÔÏÔÁ›· Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ηıËÌÂÚÈÓ¿ ·˘Í¿ÓÂÙ·È. √È ÂӉ›ÍÂȘ ¯ÔÚ‹ÁËÛ˘ ‰ÈʈÛÊÔÓÈÎÒÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó, ·fi ÙË Û˘Ìو̷ÙÈ΋ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· Î·È ÙÔÓ ÔÛÙÈÎfi fiÓÔ Ì¤¯ÚÈ ÙËÓ ÚfiÏË„Ë Ù˘ ÛÎÂÏÂÙÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Û ÌÂÙ·ÛÙ·ÙÈÎfi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ Î·È ÔÏÏ·ÏÔ‡Ó Ì˘¤ÏˆÌ·. ™ËÌ·ÓÙÈ΋ ˘Ô·Û‚ÂÛÙÈ·ÈÌ›· ¤¯ÂÈ ·Ó·ÊÂÚı› ˆ˜ ÂÈÏÔ΋ Ù˘ ¯ÔÚ‹ÁËÛ˘ ‰ÈʈÛÊÔÓÈÎÒÓ. ∏ ˘Ô·Û‚ÂÛÙÈ·ÈÌ›· ‰ÂÓ Â›Ó·È ‚Ï·ÙÈ΋ ÁÈ· ÙÔÓ ÓÂÊÚfi, ÚÔηÏ› fï˜ ¿ÏÏ· ÛÔ‚·Ú¿ Û˘ÌÙÒÌ·Ù· fiˆ˜, Ì˘ïÎÔ‡˜ Û·ÛÌÔ‡˜, ηٿıÏÈ„Ë Î·È „‡¯ˆÛË, ηıÒ˜ Î·È ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜, ÂÓÒ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·Ó·Ó¢ÛÙÈ΋ ·Ó·ÎÔ‹. √È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ˘Ô·Û‚ÂÛÙÈ·ÈÌ›·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ D, ÙËÓ ÚÔïÔ‡Û· ÓÂÊÚÈ΋ ‚Ï¿‚Ë Î·È ÙÔÓ ˘ÔÎÏÈÓÈÎfi ˘Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi. ∏ ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ D ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÔÊ›ÏÂÙ·È Èı·ÓfiÓ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ·fi ÙÔ ÛÙfiÌ·, ·ÓÂ·ÚÎÔ‡˜ ¤ÎıÂÛ˘ ÛÙÔÓ ‹ÏÈÔ Î·È ÂËÚ·Ṳ̂Ó˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ™ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·È, Ù· Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ D (25-hydroxy vitamin D test), Ë ÚfiÛÏË„Ë ·Û‚ÂÛÙ›Ô˘, Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (eGFR), Ô ÊˆÛÊfiÚÔ˜, ÙÔ Ì·ÁÓ‹ÛÈÔ Î·È ÔÈ ·Ï‚Ô˘Ì›Ó˜, ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì ‰ÈʈÛʈÓÈο.20-22

∂Ӊ›ÎÓ˘Ù·È Ë ·ÈÌÔοı·ÚÛË ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜; ™Â ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÈÌÔοı·ÚÛË ÚÈÓ ÙË ‰È¿ÁÓˆÛË Î·ÚΛÓÔ˘ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ‹ Ô˘ ÍÂÎÈÓÔ‡Ó ·ÈÌÔοı·ÚÛË ÌÂÙ¿ ·Ô ÌÈ· Ù¤ÙÔÈ· ‰È¿ÁÓˆÛË, ÌÔÚ› Ó· ·ÔÊ·ÛÈÛÙ› Ë ‰È·ÎÔ‹ Ù˘ ·ÈÌÔοı·ÚÛ˘. ∏ ·ÈÌÔοı·ÚÛË ‰ÂÓ ·ÔÙÂÏ› ̤ÙÚÔ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ·ÏÏ¿ ̤ÙÚÔ ·Ú¿Ù·Û˘ Ù˘ ˙ˆ‹˜ ‹ ̤ÙÚÔ ·Ú¿Ù·Û˘ Ù˘ ‰È·‰Èηۛ·˜ ÙÔ˘ ı·Ó¿ÙÔ˘ Î·È Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ԃ› ȉȷ›ÙÂÚ· ÂÈ‚·Ú˘ÓÙÈ΋. ∏ ÙÂÏÈ΋ ·fiÊ·ÛË ÁÈ· ·ÈÌÔοı·ÚÛË ı· Ú¤ÂÈ Ó· ÏËÊı› ÌÂÙ¿ ·Ô ÂÓË̤5

¶·ÚËÁÔÚËÙÈ΋ ºÚÔÓÙ›‰· ·ÛıÂÓÒÓ Ì ¶ÚÔ¯ˆÚË̤ÓË ¡ÂÊÚÈ΋ ∞ÓÂ¿ÚÎÂÈ· ¢È¿ÏÂÍË, ¶·Ó·ÁȈٿÎË

ª™∞º: ∂›Ó·È Ê¿Ú̷η Ù˘ 1˘ Î·È 2˘ ‚·ıÌ›‰·˜ Ù˘ Îϛ̷η˜ ÙÔ˘ ¶√À Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ fiÓÔ˘ ·ÛıÂÓÒÓ Ì ¡∞ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. ∆· ÂÚÈÛÛfiÙÂÚ· ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ÛÙÔ ‹·Ú Ì ÔÍ›‰ˆÛË ‹ Û˘Ó‰¤ÔÓÙ·È Ì ÁÏ˘ÎÔ˘ÚÔÓ›‰È·. ∂Ô̤ӈ˜ Û ·ÛıÂÓ›˜ Ì ÂÏ·Ùو̤ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‰˘Ó·ÙfiÓ Ó· ¤¯Ô˘ÌÂ Û˘ÛÛÒÚ¢ÛË ·Î˘ÏÁÏ˘ÎÔ˘ÚÔÓȉ›ˆÓ (ÎÂÙÔÚÔÊ·›ÓË, Ó·ÚÔͤÓË, Ê·ÈÓÔÚÔÊ·›ÓË) Î·È ÁÈ· ·˘Ùfi ı· Ú¤ÂÈ ÔÈ ‰fiÛÂȘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ Ó· ÚÔÛ·ÚÌfi˙ÔÓÙ·È ·Ó¿ÏÔÁ·. ∞˘Ùfi ‰ÂÓ ··ÈÙÂ›Ù·È ÂÊfiÛÔÓ ¯ÔÚËÁËıÔ‡Ó ª™∞º (È‚Ô˘ÚÔÊ·›ÓË, ˘ÚÔÍÈοÌË, ‰ÈÎÏÔÊ·ÈÓ¿ÎË), Ù· ÔÔ›· ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È Ì¤Ûˆ ÔÍ›‰ˆÛ˘ ÛÙÔ ◊·Ú. ( ¶›Ó·Î·˜ IV).

√È ·ÛıÂÓ›˜ Ì ¡ÂÊÚÈ΋ ∞ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ¤¯Ô˘Ó 25% ıÓËÛÈÌfiÙËÙ· Î·È 20 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ı·Ó¿ÙÔ˘ ηÙã¤ÙÔ˜ ·fi ÙÔÓ ÏËı˘ÛÌfi Ù˘ ·˘Ù‹˜ ËÏÈΛ·˜, Ô˘ ‰ÂÓ ¤¯ÂÈ ÙË ÓfiÛÔ. ∆· 2/3 ÙˆÓ ·ÛıÂÓÒÓ Ì ¡∞ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ‰ËÏÒÓÔ˘Ó ·Ú¿ÏÏËÏ· η΋ ÔÈfiÙËÙ· ˙ˆ‹˜. √È ÓÂÊÚÔ·ı›˜ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ÔÈÎÈÏ›· Û˘Ìو̿وÓ, Ù· ÔÔ›· Ù·ÍÈÓÔÌÔ‡ÓÙ·È ·. ÛÂ Û˘ÌÙÒÌ·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙËÓ ·ÈÌÔοı·ÚÛË (›Ó·Î·˜ π) Î·È ‚. ÛÂ Û˘ÌÙÒÌ·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË ÓfiÛÔ Ô˘ ÚÔοÏÂÛ ÙË ¡∞ (›Ó·Î·˜ ππ).

¶›Ó·Î·˜ π ™˘ÌÙÒÌ·Ù· Û¯ÂÙÈο Ì ÙËÓ ·ÈÌÔοı·ÚÛË ¶fiÓÔ˜ ∫fiˆÛË ÀfiÙ·ÛË ∞ÓÔÚÂÍ›· ¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘ §‹ı·ÚÁÔ˜ ∫ÓËÛÌfi˜ ∫Ú¿Ì˜ ¡·˘Ù›·–¤ÌÂÙÔ˜ ¢˘ÛÎÔÈÏÈfiÙËÙ· √˘Ú·ÈÌÈ΋ Ó¢ÚÔ¿ıÂÈ· ∫·Ù¿ıÏÈ„Ë ™‡Ó‰Ú.·Ó‹Û˘¯ˆÓ οو ¿ÎÚˆÓ À·ÚÍȷο ÚÔ‚Ï‹Ì·Ù·

¶›Ó·Î·˜ IV ª™∞º

50% 71%

∞΢ÏÁÏ˘ÎÔ˘ÚÔÓ›‰È·: ∞·ÈÙÂ›Ù·È ÚÔÛ·ÚÌÔÁ‹ ‰fiÛ˘ ∫ÂÙÔÚÔʤÓË (Oruvail) ¡·ÚÔͤÓË (Naprosyn) º·ÈÓÔÚÔÊ·›ÓË Donator-R

49% 44% 60% 36% 33% 53% 27% 30% 25%

¶›Ó·Î·˜ V ∆ÈÙÏÔÔ›ËÛË Ù˘ ‰fiÛ˘ ÙÔ˘ ·ÓÙÈηٷıÏÈÙÈÎÔ‡ º¿ÚÌ·ÎÔ ∆ÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο ∞Ó·ÛÙÔÏ›˜ ª∞√ ºÏÔ˘ÔÍÂÙ›ÓË ¶·ÚÔÍÂÙ›ÓË µÂÓÏ·Ê·Í›ÓË ¡ÙÔ˘ÏÔÍÂÙ›ÓË

¶ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈÔ¿ıÂÈ· ¢È·‚ËÙÈÎfi fi‰È ∫·ÏÛÈʇϷÍË √ÛÙÂÔ‰˘ÛÙÚÔÊ›·-¶ÙÒÛÂȘ-∫·Ù¿ÁÌ·Ù· ŒÏÎË Î·Ù¿ÎÏÈÛ˘

∆ÈÙÏÔÔ›ËÛË ¢ÂÓ ··ÈÙÂ›Ù·È ÚÔÛ·ÚÌÔÁ‹ ¢ÂÓ ··ÈÙÂ›Ù·È ÚÔÛ·ÚÌÔÁ‹ –50%.

10-40 mg/d –50%.

–50%.

√ÈÔÂȉ‹ ·Ó·ÏÁËÙÈο: ∫ˆ‰Â˝ÓË: ∂›Ó·È Ê˘ÛÈÎfi ·ÏηÏÔÂȉ¤˜ ÙÔ˘ Ô›Ô˘ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Ê·ÈÓfiÌÂÓÔ ÔÚÔÊ‹˜. ªÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ ‹·Ú Û ÌÔÚÊ›ÓË Î·È ÓÔÚΈ‰Â˝ÓË. ªÔÚ› Ó· ÚÔηϤÛÂÈ ÙÔÍÈÎfiÙËÙ· ·ÎfiÌË Î·È ÌÂÙ¿ ·fi ÌÈÎÚ¤˜ ‰fiÛÂȘ. ¶·ÚfiÏ· ·˘Ù¿ ¯ÔÚËÁ›ٷÈ. ∞·ÈÙÂ›Ù·È ÚÔÛÔ¯‹. ∆Ú·Ì·‰fiÏË: ∏ ÙÚ·Ì·‰fiÏË(tramadol) Â›Ó·È ¤Ó· Û˘ÓıÂÙÈÎfi ·Ó·ÏÁËÙÈÎfi Ì ‰ÈÙÙ‹ ‰Ú¿ÛË. ∞ÊÂÓfi˜ ‰Ú· ÛÙÔ˘˜ Ì- ˘ԉԯ›˜ ÔÈÔÂȉÒÓ ·ÊÂÙ¤ÚÔ˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Â·Ó·ÚfiÛÏË„Ë ÓÔÚÂÈÓÂÊÚ›Ó˘ Î·È ÛÂÚÔÙÔÓ›Ó˘. Œ¯ÂÈ Î·Ï¿ ·ÔÙÂϤÛÌ·Ù· ÛÙÔÓ Î·ÚÎÈÓÈÎfi fiÓÔ. ∏ ‰fiÛË Û ·ÛıÂÓ›˜ Ì ¡∞ Î·È Î¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ <30ml/min Â›Ó·È 50-100 mg/12 ÒÚ˜. ªÔÚÊ›ÓË: ∏ ªÔÚÊ›ÓË ‚Ú·‰Â›·˜ ·Ô‰¤ÛÌ¢Û˘ ‰ÂÓ Â›Ó·È Î·Ï¿ ·ÓÂÎÙ‹ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ <30 ml/min ÏfiÁˆ Û˘ÛÛÒÚ¢Û˘ ÂÓÂÚÁÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ fiˆ˜ ÌÔÚÊ›ÓË-3ÁÏ˘ÎÔ˘ÚÔÓ›‰ÈÔ(M3G) Î·È ÌÔÚÊ›ÓË-6ÁÏ˘ÎÔ˘ÚÔÓ›‰ÈÔ(M-6G). ∂¿Ó ·ÚfiÏ· ·˘Ù¿ ··ÈÙÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË ÌÔÚÊ›Ó˘, Û˘ÓÈÛÙ¿Ù·È Ó· Â›Ó·È ¿ÌÂÛ˘ ·fi‰ÔÛ˘ Î·È Ô ·ÛıÂÓ‹˜ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘¯Ó¿. ºÂÓÙ·Ó‡ÏË: ∏ Ê·ÈÓÙ·Ó‡ÏË Â›Ó·È ÙÔ ϤÔÓ ·ÛʷϤ˜ Ê¿ÚÌ·ÎÔ ÁÈ· ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. ¢ÂÓ ¤¯ÂÈ ÂÓÂÚÁÔ‡˜ ÌÂÙ·‚Ôϛ٘ Î·È ‰ÂÓ ·ÔÌ·ÎÚ‡ÓÂÙ·È Î·Ù¿ ÙËÓ ·ÈÌÔοı·ÚÛË ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ Û˘Ó‰ÂÛÌÈÎfiÙËÙ·˜ Ì ÙȘ ÚˆÙ½Ó˜ Î·È ÙÔ˘ ÌÂÁ¿ÏÔ˘ fiÁÎÔ˘ ηٷÓÔÌ‹˜ Ù˘. √È ‰fiÛÂȘ ÁÂÓÈο ÙˆÓ ÔÔÈÔÂȉÒÓ Û ·ÛıÂÓ›˜ Ì ¡∞ ηıÔÚ›˙ÔÓÙ·È ·Ó¿ÏÔÁ· Ì ÙËÓ Î¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ ( ¶›Ó·Î·˜ Vπ).

ŒÓ· ÌÂÁ¿ÏÔ ÙÚÈÙÔ‚¿ıÌÈÔ ÓÔÛÔÎÔÌ›Ô, ÙÔ 1990, (Baystate Medical Center) Î·È ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÔÎÙÒ ÌÔÓ¿‰Â˜ Ù¯ÓËÙÔ‡ ÓÂÊÚÔ‡, ÔÚÁ¿ÓˆÛ ¤Ó· ÚfiÁÚ·ÌÌ· ˘ÔÛÙ‹ÚÈ͢ ÙˆÓ ÓÂÊÚÔ·ıÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜, Ô˘ ÛÎÔfi ¤¯ÂÈ, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Û˘Ìو̿وÓ, ÙËÓ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ̤ۈ ÚˆÙÔÎfiÏψÓ, ÙËÓ ÔÚÁ¿ÓˆÛË Û˘Ó·ÓÙ‹ÛÂˆÓ ÁÈ· Û˘˙‹ÙËÛË Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ÙËÓ ·ÚÔ¯‹ ÚÔ¯ˆÚË̤Ó˘ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÙÔÓ Û˘Ó˘ÔÏÔÁÈÛÌfi ÙˆÓ ÂÈı˘ÌÈÒÓ ·ÛıÂÓÒÓ Î·È Û˘ÁÁÂÓÒÓ, ÙËÓ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜, ÙË Û˘ÓÂÚÁ·Û›· Ì •ÂÓÒÓ˜. ∏ ÚÔÛ¿ıÂÈ· ·˘Ù‹ ·ÔÙ¤ÏÂÛ ÙËÓ ·Ú¯‹ ‰ËÌÈÔ˘ÚÁ›·˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÔÏÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ô˘ ·¢ı‡ÓÔÓÙ·È Û ·ÛıÂÓ›˜ Ì ¡∞ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ (Renal Palliative Care Initiative) Î·È Â›Ó·È ϤÔÓ ¤Ó· ·Ó·ÁÓˆÚÈṲ̂ÓÔ ÌÔÓÙ¤ÏÔ ·ÚËÁÔÚËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ·ÛıÂÓÒÓ ÛÙËÓ ∞ÌÂÚÈ΋. √ fiÓÔ˜ ·ÔÙÂÏ› ¤Ó· Û‡ÓËı˜ Û‡Ìو̷ ÙˆÓ ·ÛıÂÓÒÓ Ì ¡∞ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Î·È ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ·fi ÙËÓ ÌÂÁ¿ÏË ÔÈÎÈÏ›· Û˘Ìو̿وÓ, Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ›. ∆· ·›ÙÈ· ÙÔ˘ fiÓÔ˘ ÙˆÓ ÓÂÊÚÔ·ıÒÓ Â›Ó·È ÔÏÏ¿ (¶›Ó·Î·˜ πππ). √ fiÓÔ˜ ÙÔ˘˜ ‰˘Ó·ÙfiÓ Ó· ›ӷÈ: ·ÏÁ·ÈÛıËÙÈÎfi˜, ۈ̷ÙÈÎfi˜ Î·È ÛÏ·¯ÓÈÎfi˜ ‹ Ó¢ÚÔ·ıËÙÈÎfi˜.

¶›Ó·Î·˜ πππ ∞›ÙÈ· fiÓÔ˘ ∞Ú¯È΋ ÓfiÛÔ˜ (.¯ ÔÏ˘Î˘ÛÙÈÎfi˜ ÓÂÊÚfi˜) ™˘Ó˘¿Ú¯Ô˘Û˜ ÓfiÛÔÈ ¢È·‚ËÙÈ΋ Ó¢ÚÔ¿ıÂÈ· ¶ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈÔ¿ıÂÈ· ∞ÈÌÔοı·ÚÛË ª˘ÔÛÎÂÏÂÙÈο ÚÔ‚Ï‹Ì·Ù· ∫·ÏÛÈʇϷÍË √ÛÙÂÔ‰˘ÛÙÚÔÊ›·

√Í›‰ˆÛË: ¢ÂÓ ··ÈÙÂ›Ù·È ÚÔÛ·ÚÌÔÁ‹ ‰fiÛ˘ π‚Ô˘ÚÔÊ·›ÓË (Brufen) ¶ÈÚÔÍÈοÌË (Feldene) ¢ÈÎÏÔÊÂÓ¿ÎË

∞ÓÙÈηٷıÏÈÙÈο: ∆· ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο Î·È ÔÈ ·Ó·ÛÙÔÏ›˜ ª.∞.√. ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ ÙÔ˘˜. ∆· SSRIs fiˆ˜ Ë ÊÏÔ˘ÔÍÂÙ›ÓË ¯ÚÂÈ¿˙ÔÓÙ·È ¯·ÌËÏfiÙÂÚË ‰fiÛË. °È· ÙËÓ ·ÚÔÍÂÙ›ÓË ÚÔÙ›ÓÂÙ·È Ë ‰fiÛË 10-40 mg/ËÌ. °È· ÙË ‚ÂÓÏ·Ê·Í›ÓË Î·È ÓÙÔ˘ÏÔÍÂÙ›ÓË (SNRI’S) ··ÈÙÂ›Ù·È ÙÈÙÏÔÔ›ËÛË Ù˘ ‰fiÛ˘ ÛÙÔ 50%.( ¶›Ó·Î·˜ V)

¶›Ó·Î·˜ ππ ™˘ÌÙÒÌ·Ù· Û¯ÂÙÈο Ì ÙË Û˘ÓÔ‰fi ÓfiÛÔ ∞˘ÙfiÓÔÌË ‰È·‚ËÙÈ΋ ÂÓÙÂÚÔ¿ıÂÈ· ·. ¢È·‚ËÙÈ΋ Á·ÛÙÚÔ¿ÚÂÛË ‚. ¢È·‚ËÙÈ΋ ÂÓÙÂÚÔ¿ıÂÈ· ªË ·˘ÙfiÓÔÌË ‰È·‚ËÙÈ΋ Ó¢ÚÔ¿ıÂÈ· ∫·Ú‰ÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·

- ¢·˘˝‰ ∫·ÏÏÈfiË – 4Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË °.¡. •¿Óı˘

∞Ì˘ÏÔÂȉÈ΋ ·ÚıÚÔ¿ıÂÈ· √ÛÙÂÔÌ˘ÂÏ›ÙȘ ¢ÈÛΛÙȘ Fistula πÛ¯·ÈÌÈ΋ Ó¢ÚÔ¿ıÂÈ· ¶ÂÚÈÙÔÓ·˚΋ ‰È¿Ï˘ÛË ™Ï·¯ÓÈ΋ ‰È¿Ù·ÛË ¶ÂÚÈÙÔÓ›Ùȉ· ‹ strain Ù˘ √ª™™

¶›Ó·Î·˜ Vπ ™¯¤ÛË Î¿ı·ÚÛ˘ ÎÚ·ÙÈÓ›Ó˘- ‰fiÛ˘ ÔÈÔÂȉԇ˜ ∫¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ > 50 ml/min = 10-50 ml/min < 10 ml/min

¢fiÛË ÔÈÔÂȉԇ˜ ∫·ÓÔÓÈ΋ ‰fiÛË 75% Ù˘ ηÓÔÓÈ΋˜ ‰fiÛ˘ 50% Ù˘ ηÓÔÓÈ΋˜ ‰fiÛ˘

µÈ‚ÏÈÔÁÚ·Ê›· 1. D. Poppel, et al. The Renal Palliative Care Initiative Journal of Palliative Medicine Volume 6,Number 2, 2003 pp 321-6 2. H.Noble et al. Decision-making for renal patients at the end of life.European Journal of palliative care, 2007;14(5) pp204-7 3. Chambers EJ, German M, Brown E, eds Supportive Care for the Renal Patient.Oxford University Press; 2004 4. Davinson SN. Pain in hemodialysis patients: prevalence,cause,severity and management. American Journal of Kidney Diseases 2003, 42(6) :1239-47 5. ™. ∫·Ó‰Ú‚ÈÒÙÔ˘ ¶·ÚËÁÔÚËÙÈ΋ ÊÚÔÓÙ›‰· Û ·ÛıÂÓ›˜ ˘fi ·ÈÌÔοı·ÚÛË. 9Æ ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÔ¯È΋˜ ∞Ó·ÈÛıËÛ›·˜, £ÂÚ·›·˜ ¶fiÓÔ˘ Î·È ¶·ÚËÁÔÚËÙÈ΋˜ ∞ÁˆÁ‹˜ 4-7 √ÎÙˆ‚Ú›Ô˘ 2007, Du Lac, πˆ¿ÓÓÈÓ·

∞Ó Î·È ‰Â ÁÓˆÚ›˙Ô˘Ì ·ÎÚÈ‚Ò˜ ÙÔ ÔÛÔÛÙfi, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÂÚ›Ô˘ ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ ÔÓÔ‡Ó ÂÓÒ ¤Ó· 30% ÂÌÊ·Ó›˙ÂÈ ÛÔ‚·Úfi fiÓÔ. √ fiÓÔ˜ ÂËÚ¿˙ÂÈ ÙËÓ ‹‰Ë ‰È·Ù·Ú·Á̤ÓË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ÓÂÊÚÔ·ıÒÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. °È· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ ·ÎÔÏÔ˘ıÂ›Ù·È Ë Îϛ̷η ÙÚÈÒÓ ‚·ıÌ›‰ˆÓ ÙÔ˘ ¶√À (¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜). ∞·Ú·›ÙËÙË Â›Ó·È Ë ÙÈÙÏÔÔ›ËÛË ÙˆÓ ‰fiÛÂˆÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ‰ÈfiÙÈ ÏfiÁˆ Ù˘ ÂËÚ·Ṳ̂Ó˘ ·ÔÚÚfiÊËÛ˘, ÌÂÙ·‚ÔÏÈÛÌÔ‡ Î·È ·¤ÎÎÚÈÛ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¡∞, ˘¿Ú¯ÂÈ ÌÂÁ¿ÏÔ˜ ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ. º¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ›ӷÈ: 6

∂ÓË̤ڈÛË ÁÈ· ÙËÓ 5Ë ∂Ú¢ÓËÙÈ΋ ™˘Ó¿ÓÙËÛË Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ¶·ÚËÁÔÚËÙÈ΋˜ ºÚÔÓÙ›‰·˜ (5th Research Forum for the European Association for Palliative Care) ÛÙÔ Trodheim, NoÚ‚ËÁ›· 29-31 ª·›Ô˘ 2008. ∏ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·ÚËÁÔÚËÙÈ΋˜ ºÚÔÓÙ›‰·˜ (∂uropean Association for Palliative Care) ÔÚÁ¿ÓˆÛ ÙËÓ 5Ë Û˘Ó¿ÓÙËÛË Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ ŒÚ¢ӷ ÛÙËÓ ¶·ÚËÁÔÚËÙÈ΋ ºÚÔÓÙ›‰·, ÛÙÔ Trodheim ÛÙË ¡ÔÚ‚ËÁ›·, ÛÙȘ 29-31 ª·˚Ô˘ ÙÔ˘ 2008. ™ÙË Û˘Ó¿ÓÙËÛË ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó 100 ÚÔÊÔÚÈΤ˜ ÂÈÛÙËÌÔÓÈΤ˜ ·Ó·ÎÔÈÓÒÛÂȘ Î·È 356 ·Ó·ÚÙË̤Ó˜. √È ‰‡Ô ÂÈÎÂÊ·Ï‹˜ Ù˘ Û˘Ó¿ÓÙËÛ˘, ∞ugusto Caraceni (Chair of Scientific Committee) Î·È Stein Kaassa (Chair of the local Organising Committee), ÙfiÓÈÛ·Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ·Ó¿Ù˘Í˘ ¤Ú¢ӷ˜ ÛÙËÓ ¶.º., ÂÓÒ È‰Ú‡ıËΠÙÔ Forum Ó¤ˆÓ ÂÚ¢ÓËÙÒÓ.

∞fi ÙËÓ ÎÔ‹ ›ÙÙ·˜ 2008 Ù˘ ¶∞ƒ∏.™À.∞. ∆ËÓ ¿ÓÔÈÍË ÙÔ˘ 2008 Ë ¶∞ƒ∏.™À.∞. ·ÓÙ·ÔÎÚ›ıËΠÛÙËÓ ÚfiÛÎÏËÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ∫ÔÈÓˆÓÈ΋˜ ∞ÏÏËÏÂÁÁ‡Ë˜ ÁÈ· ÙËÓ ˘ÏÔÔ›ËÛË «∂ıÓÈÎÔ‡ ™¯Â‰›Ô˘ ¢Ú¿Û˘ ÁÈ· ÙÔÓ ∫·ÚΛÓÔ» Î·È ÚfiÙÂÈÓ ¤Ó· ÔÏÔÎÏËڈ̤ÓÔ ÚfiÁÚ·ÌÌ· ·Ó¿Ù˘Í˘ Ù˘ ¶·ÚËÁÔÚËÙÈ΋˜ ºÚÔÓÙ›‰·˜ ÛÙË ¯ÒÚ· Ì·˜.

™‡ÓÙÔÌÔ ÈÛÙÔÚÈÎfi: ∆Ô 1996 ȉڇıËΠÙÔ ÂÚ¢ÓËÙÈÎfi ‰›ÎÙ˘Ô Ù˘ EAPC (EAPC RN) Ì ÛÙfi¯Ô ÙË Û‡ÓÙ·ÍË ÚԉȷÁÚ·ÊÒÓ ÚÔÎÂÈ̤ÓÔ˘ Ë ¿ÛÎËÛË Ù˘ ¶º Ó· ‚·Û›˙ÂÙ·È Û ÂӉ›ÍÂȘ. √È Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÔÈÔÂȉÒÓ, ·ÔÙ¤ÏÂÛ·Ó Î·Úfi ·˘Ù‹˜ Ù˘ ÚÔÛ¿ıÂÈ·˜. ∞ÚÁfiÙÂÚ· ‰È·ÈÛÙÒıËÎÂ Ô ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÂÚ¢ÓËÙÈÎÒÓ ÌÂÏÂÙÒÓ ÈηÓÒÓ Ó· ÛÙËÚ›ÍÔ˘Ó ÌÂÏÏÔÓÙÈΤ˜ ηÙ¢ı‡ÓÛÂȘ Î·È ·ÔÊ·Û›ÛÙËÎÂ Ë ·Ó¿Ù˘ÍË Ù˘ ¤Ú¢ӷ˜ Û ÂıÓÈÎfi Î·È ‰ÈÂıÓ¤˜ Â›‰Ô. ∏ ∂˘Úˆ·˚΋ ŒÓˆÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓÈÛ¯‡ÛÂÈ ÙËÓ ÚÔÛ¿ıÂÈ· ÁÈ· ¤Ú¢ӷ ¯ÚËÌ·ÙÔ‰ÔÙ› ‰È¿ÊÔÚ· ÂÚ¢ÓËÙÈο ÚÔÁÚ¿ÌÌ·Ù· fiˆ˜ Ù·: European Palliative Care Research Collaborative (EPCRC), EU Public Health Executive Agency health information project, (PRISMA project) Î·È ÙÔ Optimising Cancer Patient Care (OPCARE).

K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ™˘Ó¿ÓÙËÛ˘ ¤ÁÈÓ ¤ÎÎÏËÛË ÁÈ· Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÔÚÁ·ÓÒÛÂˆÓ Î·È ÂÙ·ÈÚÂÈÒÓ ÛÙ· ·ÓˆÙ¤Úˆ ÚÔÁÚ¿ÌÌ·Ù· ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ó·Ù˘¯ı› Ë ¶º, Ë ¤Ú¢ӷ Î·È Ë Û˘ÓÂÚÁ·Û›·.

√È LIONS ¤Î·Ó·Ó ÛÙËÓ ¶∞ƒ∏.™À.∞. ‰ˆÚ¿ ¤Ó· ʈÙÔÙ˘ÈÎfi Ì˯¿ÓËÌ· ÎÈ ¤Ó·Ó ÚÔÙ˙¤ÎÙÔÚ· ÁÈ· ÙȘ ÏÂÈÙÔ˘ÚÁÈΤ˜ Î·È ÂÎ·È‰Â˘ÙÈΤ˜ ·Ó¿ÁΘ Ù˘ ÂÙ·ÈÚ›·˜ Ì·˜.

™ÙËÓ ¤ÎÎÏËÛË ·˘Ù‹, Ë ¶∞ƒ∏.™À.∞. ·ÓÙ·ÔÎÚ›ıËΠ¿ÌÂÛ· Ì ÙËÓ ÂÓÂÚÁfi Û˘ÌÌÂÙÔ¯‹ ÙfiÛÔ ÂÎÚÔÛÒˆÓ ÙÔ˘ ¢.™., fiÛÔ Î·È Ì ÙËÓ ·ÚÔ˘Û›· ÌÂÏÒÓ Ù˘.

7

∂∫¢∏§ø™∂π™ ∆∏™ ∂∆∞πƒ∂π∞™ 2008 ™YNE¢PIA 2008 ñ ∂ÈÛÙËÌÔÓÈο ™˘ÌfiÛÈ· ÛÙËÓ ∞ı‹Ó·, Ì ÛÎÔfi ÙËÓ ÂÓË̤ڈÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¶fiÓÔ˘ Î·È ÙËÓ ·ÚÔ¯‹ ¶.º. ÛÙÔ˘˜ ·ÛıÂÓ›˜. ∆· Û˘ÌfiÛÈ· ·¢ı‡ÓÔÓÙ·È Û ÁÈ·ÙÚÔ‡˜ ‰È·ÊfiÚˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È Ê·ÚÌ·ÎÔÔÈÔ‡˜ Î·È ‰ÈÔÚÁ·ÓÒÓÔÓÙ·È Ì ÙËÓ Â˘ÁÂÓÈ΋ ¯ÔÚËÁ›· Ù˘ ÂÙ·ÈÚ›·˜ Phizer.

4,13, 20 & 25 ºÂ‚ÚÔ˘·Ú›Ô˘ 2008 Î·È 12 ª·ÚÙ›Ô˘ 2008 ñ ∫Ô‹ ¶ÚˆÙÔ¯ÚÔÓÈ¿ÙÈ΢ ›ÙÙ·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ı·ÙÚÈ΋˜ ·Ú¿ÛÙ·Û˘.

20 ºÂ‚ÚÔ˘·Ú›Ô˘ 2008. ñ ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· ÛÙËÓ •¿ÓıË 22 ª·ÚÙ›Ô˘ 2008 ñ ¶·ÚÔ˘Û›·ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ √xalgan Ù˘ ÂÙ·ÈÚ›·˜ Meditrina ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ¶∞ƒ∏.™À.∞., ÕÓÔÈÍË 2008 ∞ı‹Ó· ñ ¶·ÚÔ˘Û›·ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Cybalta Ù˘ ÂÙ·ÈÚ›·˜ Lilly ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ¶∞ƒ∏.™À.∞., ÕÓÔÈÍË 2008, ∞ı‹Ó· ñ 5th Research Forum of the European Association for Palliative Care 29-31 May 2008, Norway

ñ 12th World Congress on Pain 17-22 August 2008, Glaskow ñ 27th Annual ESRA Congress 24-27 September 2008, Genoa ñ 7o ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶fiÓÔ˘ 9-12 √ÎÙˆ‚Ú›Ô˘ 2008, ∫¤Ú΢ڷ ñ ∂ÔÚÙ·ÛÌfi˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ ∏̤ڷ˜ ¶·ÚËÁÔÚËÙÈ΋˜ ºÚÔÓÙ›‰·˜ 11 √ÎÙˆ‚Ú›Ô˘ 2008, ∞ı‹Ó· ñ 10Ô ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÔ¯È΋˜ ∞Ó·ÈÛıËÛ›·˜, ¶fiÓÔ˘ Î·È ¶·ÚËÁÔÚËÙÈ΋˜ ∞ÁˆÁ‹˜ 20-22 NoÂÌ‚Ú›Ô˘ 2008, ∫‡ÚÔ˜ ñ 7Ë ∏ÌÂÚ›‰· «°ÓˆÚÈÌ›· Ì ÙËÓ ¶·ÚËÁÔÚËÙÈ΋ ºÚÔÓÙ›‰·» 13 ¢ÂÎÂÌ‚Ú›Ô˘ 2008, ∞ı‹Ó·

To ÂÓËÌÂÚˆÙÈÎfi ‰ÂÏÙ›Ô Ù˘ ¶APH.™Y.A ÂΉ›‰ÂÙ·È Î·È ‰È·Ó¤ÌÂÙ·È Ì ÙËÓ Â˘ÁÂÓÈ΋ ¯ÔÚËÁ›· ÙˆÓ ÂÙ·ÈÚÂÈÒÓ

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