EÏÏËÓÈÎË I·ÙÚÈÎËTfiÌÔ˜ 66 • T‡¯Ô˜ 3 - 4 M¿˚Ô˜ – A‡ÁÔ˘ÛÙÔ˜ 2000

¶ÂÚȯfiÌÂÓ·

EÓËÌÂÚˆÙÈο 213 EÈÏÔÁ‹ Î·È ¯Ú‹ÛË ·ÛÈÚ›Ó˘ ÛÙËÓ ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌ›·.¿ÚıÚ· °È·Ù›, fiÙÂ Î·È ÔÈ¿ ‰fiÛË;

¢. K·Ú·ÎÒÛÙ·˜

220 AÓ‰ÚÔÁÂÓÂÙÈ΋ ·ÏˆÂΛ·°.X. X·˚‰Â̤ÓÔ˜, º. XÚ˘ÛÔÌ¿ÏÏ˘

227 M˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ·B. °·Ú˘›‰Ô˘

237 T· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÓÂÊÚÒÓ Î·È ÙËÓ ÔÍ›·ÛˆÏËÓ·Úȷ΋ Ó¤ÎÚˆÛËK. X·Ú·Ï·ÌfiÔ˘ÏÔ˜, B. ¶··ÏÈÌÓ·›Ô˘

EÚ¢ÓËÙÈΤ˜ 243 ™¯¤ÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ ÛÙÔ Ï¿ÛÌ· ηÈÂÚÁ·Û›Â˜ Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ÛÙËÓ È‰ÈÔ·ı‹ ·ÚÙËÚȷ΋

˘¤ÚÙ·ÛËA. K·Ú·ÁÈ¿ÓÓ˘, M. A‚Ú·Ì›‰Ë˜, K. M·Ï¿Ûη, X. §·Ê¿Ú·˜, A. TÚ‡ÊÔ˜,A. KÔÓÙfiÔ˘ÏÔ˜, A. B˘˙·ÓÙÈ¿‰Ë˜, X. Z·ÌÔ‡Ï˘

249 BÚ·¯Â›· ‹ ·Ú·ÙÂٷ̤ÓË ¯ËÌÂÈÔÚÔʇϷÍË ÛÙȘ ÂÁ¯ÂÈÚ‹ÛÂȘ ÙÔ˘ ·¯¤Ô˜ÂÓÙ¤ÚÔ˘A. ™·Î·ÓÙ¿Ì˘, A. K·Ì·ÚÔ‡‰Ë˜, K. M·ÏÏ¿˜

254 KÔÏÏ·ÁÔÓÔÏ˘ÙÈο ¤Ó˙˘Ì· ÛÙÔÓ ÔÚıÔ-ÎÔÏÈÎfi ηÚΛÓÔI.K. T¤ÓÙ˜, A-A.K. T¤ÓÙ˜, ™.K. M·ÚηΛ‰Ë˜, X.N. K·Ú·ÓÈÎÈÒÙ˘

259 H ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÎÈÓËÙÈÎÒÓ Ê·ÈÓÔÌ¤ÓˆÓ Ù˘ ÓfiÛÔ˘ ÙÔ˘ Parkinson Ì·ÔÌÔÚÊ›ÓË™. MÔÛÙ·ÓÙ˙ÔÔ‡ÏÔ˘, Z. K·ÙÛ·ÚÔ‡, ™. ¶··ÁÈ·ÓÓfiÔ˘ÏÔ˜, A. K¿˙˘

263 OÈ ·ıÏËÙÈÎÔ› ÙÚ·Ì·ÙÈÛÌÔ› ÛÙË ¯ÂÈÚÔÛÊ·›ÚÈÛË: H ·Ú·ÎÔÏÔ‡ıËÛËÔÌ¿‰·˜ A1 ¯ÂÈÚÔÛÊ·›ÚÈÛ˘ ηٿ ÙËÓ ÂÚ›Ô‰Ô ÂÓfi˜ ¤ÙÔ˘˜EÌ. ¶··ÎÒÛÙ·˜, ™Ù. ¶··ÏÂÍ·Ó‰Ú‹˜, N. M·ÏÏÈ·ÚfiÔ˘ÏÔ˜

268 ™ÂÚÌ·ÙÔ˙ˆ¿ÚÈ· ¯ˆÚ›˜ ·ÎÚÔÛÒÌÈÔ Û ‰Â›ÁÌ·Ù· Û¤ÚÌ·ÙÔ˜ ˘ÔÁfiÓÈ̈ÓÎ·È ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ¢. ¶·Ó›‰Ë˜, A. KÔ‡ÚÙ˘, I. ¶Ë‰ÒÓÈ·, ¢. PÔ‡ÛÛÔ˜, °. M·˘ÚÔÌ·Ù›‰Ë˜,K. ™ÙÂÚÁÈfiÔ˘ÏÔ˜, ¢. B·‚›Ï˘

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274 MÂϤÙË ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ÂÓ‹ÏÈÎˆÓ ÂÈ̇ˆÓ, ÌÂÙ¿ ·fiı˘ÌÂÎÙÔÌ‹ Û ‰È·ÊÔÚÂÙÈ΋ ÓÂÔÁÓÈ΋ ËÏÈΛ·A. K·˝ÎË-AÛÙ¿Ú·, ¢. OÈÎÔÓfiÌÔ˘, °. °Î›Ì·˜

EȉÈÎfi 279 °È·Ù› OÚıԷȉÈ΋ Î·È fi¯È OÚıÔ‰È΋¿ÚıÚÔ I.¢. ¶Ô˘ÚÓ¿Ú·˜

EӉȷʤÚÔ˘Û˜ 281 §ÔÈÌ҉˘ ÂÓ‰Ôηډ›Ùȉ· Ì ·Û‡ÓËıË ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ó¢ÚÔÏÔÁÈ΋˜ÂÚÈÙÒÛÂȘ Û˘Ó‰ÚÔÌ‹˜

M. AÚ‚·ÓÈÙ¿Î˘, S. Zahir

286 B·ÚÈ¿ Ú·‚‰ÔÌ˘fiÏ˘ÛË Î·È ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÔÊÂÈÏÔ̤ÓËÛ Èfi Áڛ˘ AM. ™ÈÒÓ

291 P·‰‚ÔÌ˘fiÏ˘ÛË Û ·ÛıÂÓ‹ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi salmonella enteritidisK. AÔÛÙÔÏ›‰Ô˘, M. M·ÏÙ·Ù˙‹, B. Iˆ·ÓÓ›‰Ô˘, I. °Ô˘ÁÔ‡Û˘, I. °ÂˆÚÁÈ¿‰Ë˜

295 AÁÁÂÈÔÔ›‰ËÌ· ÁÏÒÛÛ·˜ ÔÊÂÈÏfiÌÂÓÔ Û ϋ„Ë ·Ó·ÛÙÔϤˆÓÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘E. ºÔ˘ÓÙÔ˘Ï¿Î˘, ¢. K˘ÚÌÈ˙¿Î˘, X. ¶··‰¿Î˘, °. ¶ÂÚÔÁ·Ì‚Ú¿Î˘,E. K·Ú·ÎÒÛÙ·˜, I. ™ÎÔ˘Ï¿˜, Z. AÌ·Ó¿Î˘

299 ¶ÂÏÏ¿ÁÚ·. ¶·ÚÔ˘Û›·ÛË ‰‡Ô ÂÚÈÙÒÛˆӰ. ™Î·Ú·Áο˜, A. K˘ÚÎÔ‡‰Ë˜, K. M¿ÈÓ·˜, A. ™ÙÂÊ·Ó‹˜, O. KÔ˘ÙÛÔÁÈ¿ÓÓ˘,N. ¶·¿˙ÔÁÏÔ˘

302 EÈÏÂÔÏË΢ıÔÚˆÎÙÈ΋ ·Ó·ÛÙfïÛË: ÂËÚ¿˙ÂÈ ÙËÓ Î‡ËÛË Î·È ÙÔÓ ÙÔÎÂÙfiÎ·È ÂËÚ¿˙ÂÙ·È Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·fi ÙËÓ Î‡ËÛË Î·È ÙÔÓ ÙÔÎÂÙfi;B. N¿ÙÛÈη˜, X. ™¤ÌÔÁÏÔ˘, I. T˙·Ê¤Ù·˜, B. ¢·Ï·˝Ó·˜

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Helliniki IatrikiVolume 66 • No 3 - 4

May – August 2000

Contents

Brief Reviews 213 Selection and use of aspirin in cerebral ischemia.Why, when and which dose?Karacostas D.

220 Andregenetic alopeciaChaidemenos G.Ch, Chrysomallis F.

227 Myelodysplastic syndromesGaripidou V.

237 Adhesion molecules in renal development and acute renal necrosisCharalabopoulos K, Papalimneou V.

Investigative 243 Relationship between plasma levels of natriuretic peptides andpapers left ventricular hypertrophy in essential hypertension

Karayiannis A, Avramidis M, Balaska K, Lafaras Ch, Trifos A,Kontopoulos A, Vizantiadis A, Zamboulis Ch.

249 Short term or long term chemoprophylaxis in colon surgerySakadamis A, Kamparoudis Ap, Ballas K.

254 Collagenolytic enzymes in the cancer of rectum and colonTentes IK, Tentes A-AK, Markakidis SK, Karanikiotis Ch.N.

259 Subcutaneous apomorphine in motor fluctuations of advancedParkinson’s diseaseBostantjopoulou S, Katsarou Z, Papayiannopoulos S, Kazis A.

263 Athletic injuries in handball. A one year prospective study of A1 team

handballPapakostas E, Papalexandris S, Malliaropoulos N.

268 Round-headed human spermatozoa in semen specimens of infertileand fertile menPanidis D, Kourtis A, Pidonia I, Rousso D, Mavromatidis G, Stergiopoulos K,Vavilis D.

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274 The study of the adult rats’ spermatic epithelium,after thymectomy in different neonatal age Kaiki-Astara A, Ekonomou D, Guibas G.

Special article 279 Why Orthopaedics and not OrtopedicsPournaras I.D.

Case reports 281 Infectious endocarditis presenting with neurolgical manifestationsArvanitakis M, Zahir S.

286 Severe rhabdomyolysis and acute renal failure associatedwith influenza A infectionSion ML, Hatzitolios A, Armenaka M, Toulis E, Mikoudi K.

291 Salmonella enteritidis infection, associated with rhabdomyolysisApostolidou K, Baltatzi M, Ioannidou V, Gougousis I, Georgiadis I.

295 Tongue angioedema after long-term use of angiotensin-converting enzymeinhibitorsFountoulakis E, Kyrmizakis D, Papadakis Ch, Perogamvrakis G, KarakostasE, Skoulas J, Amanakis Z.

299 Pellagra: report of two casesSkaragkas G, Kirkoudis A, Mainas K, Stefanis A, Koutsoyiannis O,Papazoglou N.

302 Ilealpouch-anal anastomosis: The effect of pregnancy and delivery onthe pouch and the effect of the pouch on pregnancy and deliveryNatsikas B, Semoglou Ch, Jafetas I, Dalainas B.

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EÈÏÔÁ‹ Î·È ¯Ú‹ÛË ·ÛÈÚ›Ó˘ ÛÙËÓ ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌ›·.°È·Ù›, fiÙÂ Î·È ÔÈ¿ ‰fiÛË;

¢ËÌ‹ÙÚÈÔ˜ K·Ú·ÎÒÛÙ·˜

B′ N¢ÚÔÏÔÁÈ΋ KÏÈÓÈ΋, A¶£, NÔÛÔÎÔÌÂ›Ô AXE¶A, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë. M ·Ó·ÛÎfiËÛË Ù˘ Û‡Á¯ÚÔÓ˘ ‚È‚ÏÈÔ-ÁÚ·Ê›·˜ ÂȯÂÈÚÂ›Ù·È ÂÍ·ÁˆÁ‹ Ú·ÎÙÈÎÒÓ Û˘ÌÂ-Ú·ÛÌ¿ÙˆÓ ÁÈ¿ ÙËÓ ·oÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ÂÈÏÔÁ‹Î·È ·ÛʷϤÛÙÂÚË ¯Ú‹ÛË Ù˘ ·ÛÈÚ›Ó˘ ÛÙËÓ ÂÁÎÂ-Ê·ÏÈ΋ ÈÛ¯·ÈÌ›·. ™ÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Ù· ‰Â-‰Ô̤ӷ Û‹ÌÂÚ· Û˘ÓËÁÔÚÔ‡Ó fiÙÈ: 1) AÛ˘Ìو̷ÙÈ-ÎÔ› ÂÓ‹ÏÈΘ, ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ ·ÁÁÂÈ-·Î‹ ÓfiÛÔ, ‰ÂÓ ¤¯Ô˘Ó ηÌÈ¿ ÂÈÛÙËÌÔÓÈ΋ ¤Ó‰ÂÈÍË ÁÈ¿Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. 2) ™Â Û˘Ó‡·ÚÍË ·Ú·Áfi-ÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ë Î·Ù¿ÏÏËÏË Ú‡ıÌÈÛ‹ ÙÔ˘˜ Î·È ÌfiÓÔ·ÚΛ ÁÈ¿ ÙËÓ ÚfiÏË„Ë ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜. 3)™ÙË ÌË ‚·Ï‚ȉÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ¯·ÌËÏÔ‡ ÎÈÓ-‰‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È ‹ ‰fiÛË 300mg ‹ Ù›ÔÙ·. H ›‰È·‰fiÛË Û˘ÓÈÛÙ¿Ù·È Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fi-Ù·Ó ˘¿Ú¯ÂÈ ·ÓÙ¤Ó‰ÂÈÍË ¯Ú‹Û˘ ·ÓÙÈËÎÙÈÎÒÓ ‹ ËËÏÈΛ· ÍÂÂÚÓ¿ Ù· 80 ¤ÙË. ™ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË-„Ë ÔÈ “fiÏÂÌÔÈ” ÁÈ¿ ÙËÓ Èfi ηٿÏÏËÏË ‰fiÛË AÛÈ-Ú›Ó˘ Û˘Ó¯›˙ÔÓÙ·È, ·Ó Î·È Û‹ÌÂÚ· ˘¿Ú¯ÂÈ Ë Ù¿ÛËÓ· ÚÔÙÈÌÒÓÙ·È ÔÈ ‰fiÛÂȘ 160-325mg ÛÂ: 1) ¶ÚˆÙÔ-

·ı‹-ÌË Î·Ú‰ÈÔÂÌ‚ÔÏÈ΋ ÈÛ¯·ÈÌ›· (ÂÓ‰ÔÎÚ·Óȷ΋ÛÙ¤ÓˆÛË, ÓfiÛÔ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ, ÎÚ˘ÙÔÁÂÓ‹) ˆ˜ÚÒÙË ÂÈÏÔÁ‹. 2) NfiÛÔ ÙˆÓ ÌÂÁ¿ÏˆÓ Â͈ÎÚ·ÓÈ·-ÎÒÓ ·ÁÁ›ˆÓ, ÂÓÒ ‰È·ÙËÚÂ›Ù·È Ë ÂÓ·ÏÏ·ÎÙÈ΋ χÛËÙ˘ ÂÓ‰·ÚÙËÚÂÎÙÔÌ‹˜. 3) K·Ú‰ÈÔÂÌ‚ÔÏÈÛÌfi Î·È ÌË‚·Ï‚ȉÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ Ë ‰fiÛË 325mg ıˆ-ÚÂ›Ù·È ÚÒÙË ÂÈÏÔÁ‹ ÌfiÓÔ ÛÙȘ ÂÚÈÙÒÛÂȘ ¯·-ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‹ fiÙ·Ó ·ÓÙÂӉ›ÎÓ˘Ù·È Ë ÎÔ˘Ì·Ú›ÓË.4) M˯·ÓÈΤ˜ ÚÔÛıÂÙÈΤ˜ ηډȷΤ˜ ‚·Ï‚›‰Â˜ ˘-„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È Ë Û˘Á¯ÔÚ‹ÁËÛË ÎÔ˘Ì·-Ú›Ó˘ Î·È 100-160mg AÛÈÚ›Ó˘, ÂÓÒ ÛÙȘ ‚ÈÔÏÔÁÈΤ˜‚·Ï‚›‰Â˜ ¯ÔÚËÁÔ‡ÓÙ·È 325mg ÌÂÙ¿ ÙÔ˘˜ 3 ÚÒÙÔ˘˜Ì‹Ó˜ ·fi ÙËÓ Â¤Ì‚·ÛË, ÌfiÓÔ Û ·ÛıÂÓ›˜ ¯·ÌË-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘. 5) ¶ÚÒÙ˜ 24-28 ÒÚ˜ ÂÓfi˜ ÈÛ¯·ÈÌÈ-ÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Û ‰fiÛË 160-300mg, ˆ˜ ÚÒÙË ÂÈ-ÏÔÁ‹, ÛÙËÓ ÚÒÈÌË ÚfiÏË„Ë ˘ÔÙÚÔ‹˜ Ù˘ ÂÁÎÂ-Ê·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜. EÏÏËÓ I·ÙÚ 2000, 66: 213 - 219.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 213 - 219

ŒÓ·Ó ·ÈÒÓ· ÚÈÓ, ÙÔ 1899, Ë Ê·ÚÌ·ÎÔ‚ÈÔÌ˯·Ó›·Bayer ÂÈÛ‹Á·Á ÙÔ ·ÎÂÙ˘ÏÔÛ·ÏÈ΢ÏÈÎfi Ô͇ Ì ÙËÓÂÌÔÚÈ΋ ÔÓÔÌ·Û›· ·ÛÈÚ›ÓË (A) ÁÈ¿ ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ÙÔ˘ ˘ÚÂÙÔ‡ Î·È ÙÔ˘ ÚÂ˘Ì·ÙÈÛÌÔ‡, ‰È·‚Â-‚·ÈÒÓÔÓÙ·˜ ÙÔ˘˜ ηٷӷψ٤˜ fiÙÈ ‰ÂÓ ¤¯ÂÈ Î·ÌÈ¿‰Ú¿ÛË ÛÙË Î·Ú‰È¿1. ¶ÚÈÓ ·fi 35 ¯ÚfiÓÈ· ¤ÁÈÓÂÁÓˆÛÙ‹ Ë ·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋ ‰Ú¿ÛË Ù˘ A2, ÌÂÙ¿10 ¯ÚfiÓÈ· ‰ËÌÔÛȇÙËÎÂ Ë Â˘ÂÚÁËÙÈ΋ Ù˘ ‰Ú¿ÛËÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·È-Ì›·˜ (EI)3 Î·È ÌfiÏȘ ÙÔ 1989 ˘‹ÚÍÂ Ë ÚÒÙË ·Ú-ÓËÙÈ΋ ·Ó·ÊÔÚ¿ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë4, ÂÓÒÔÈ “fiÏÂÌÔÈ” fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÈÔ Î·Ù¿ÏÏËÏË ‰fiÛËÙ˘ Û˘Ó¯›˙ÔÓÙ·È ˆ˜ Û‹ÌÂÚ·5,6.

M ‰Â‰Ô̤ÓË ÏÔÈfiÓ ÙËÓ ·ÓÙÈıÚÔÌ‚ˆÙÈ΋

‰Ú¿ÛË Ù˘ A, Ô˘ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Û‡Ó-ıÂÛ˘ ıÚÔÌ‚ÔÍ¿Ó˘ ̤ۈ Ù˘ Ô‰Ô‡ Ù˘ ΢ÎÏÔ-Ô͢-ÁÂÓ¿Û˘7, ÔÈ ÙÂÏÈÎÔ› ÛÙfi¯ÔÈ ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓÎ·È È‰È·›ÙÂÚ· ÙˆÓ ÌÂÙ·-·Ó·Ï‡ÛˆÓ, Û˘ÌÂÚȤϷ-‚·Ó ÙËÓ EI Ì ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (EM)Î·È ÙÔÓ ·ÁÁÂÈ·Îfi ı¿Ó·ÙÔ (A£)8. H ÁÂӛ΢ÛË ·˘-Ù‹, Ô˘ ÏÔÁÈο ÌÂÓ, ·ÏÏ¿ ·˘ı·›ÚÂÙ·, ıÂÒÚËÛ fiÙÈË ıÚÔÌ‚ˆÙÈ΋ ‰ÈÂÚÁ·Û›· Â›Ó·È ›‰È·, ·ÓÂÍ¿ÚÙËÙ·ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘ ÙÔ˘ ÔÚÁ¿ÓÔ˘-ÛÙfi¯Ô˘ Ô˘ÙËÓ ˘Ê›ÛÙ·Ù·È (Ì˘ÔοډÈÔ, ÂÁΤʷÏÔ˜, ÂÚÈÊÂÚÈ-Îfi ·ÁÁ›Ô) Î·È ·ÓÂÍ¿ÚÙËÙ· ÙˆÓ Û˘ÓıËÎÒÓ Ô˘ ÂÈ-ÎÚ·ÙÔ‡Ó ÙfiÙ (·Û˘Ìو̷ÙÈÎÔ› ÂÓ‹ÏÈΘ-ÚˆÙÔÁÂ-Ó‹˜ ÚfiÏË„Ë, Û˘Ìو̷ÙÈÎÔ› ·ÛıÂÓ›˜ Ì ·ÚÔ‰È-ο ÈÛ¯·ÈÌÈο ÂÂÈÛfi‰È· ‹ ÂÁηٿÛÙ·ÛË ÌfiÓÈÌÔ˘

213

ÂÂÈÛÔ‰›Ô˘-‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë), ¤ÊÂÚ ÛÙËÓÂÈÊ¿ÓÂÈ· ·ÔÙÂϤÛÌ·Ù· ÌÂÏÂÙÒÓ Ô˘ ·ÓÙ› Ó· ·-·ÓÙ‹ÛÔ˘Ó, ‰ËÌÈÔ‡ÚÁËÛ·Ó ÚfiÛıÂÙ· ÂÚˆÙËÌ·ÙÈοÙfiÛÔ ÁÈ¿ ÙË ‰Ú·ÛÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· Ù˘ A6,9,fiÛÔ Î·È ÁÈ¿ ÙË ‰Ú¿ÛË ÙˆÓ ÓÂfiÙÂÚˆÓ ·ÓÙÈ·ÈÌÔÂÙ·-ÏÈ·ÎÒÓ Ô˘ Û˘ÁÎÚ›ıËÎ·Ó ¿ÌÂÛ· Ì ÙËÓ A, fiˆ˜Ù˘ ÙÈÎÏÔȉ›Ó˘10, ÙÔ˘ clopidogrel11 Î·È ÙÔ˘ Û˘Ó-‰˘·ÛÌÔ‡ A Î·È ‰È˘Úȉ·ÌfiÏ˘12.

™Ùfi¯Ô˜ ÙÔ˘ ¿ÚıÚÔ˘ ·˘ÙÔ‡ ›ӷÈ, Ì ÙËÓ ·Ó·-ÛÎfiËÛË Ù˘ Û‡Á¯ÚÔÓ˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, Ó· ÚÔ-ÛʤÚÂÈ Ú·ÎÙÈο Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ¿ ÙËÓ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙÂÚË ÂÈÏÔÁ‹ Î·È ·ÛʷϤÛÙÂÚË ¯Ú‹ÛË Ù˘A. ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë, η-ıÒ˜ Î·È ÛÙËÓ ÔÍ›· Ê¿ÛË ÂÁηٿÛÙ·Û˘ Ù˘ EI.

¶ƒø∆√°∂¡◊™ ¶ƒŸ§∏æ∏TÔ ÛΤÏÔ˜ ·˘Ùfi ·ÊÔÚ¿ ÂÓ‹ÏÈΘ ¯ˆÚ›˜ Û˘Ìو̷-ÙÔÏÔÁ›· ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· (KN™) Ì‹ ¯ˆÚ›˜ ÂÈÚfiÛıÂÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ ·Á-ÁÂȷ΋ ÓfiÛÔ (˘¤ÚÙ·ÛË, ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, οÓÈ-ÛÌ·, ÏÈȉ·ÈÌ›·, ηډȷ΋ ·ÚÚ˘ıÌ›· ÎÏ). H ·fi-Ê·ÛË ÁÈ¿ ÂÈÏÔÁ‹ Î·È ¯Ú‹ÛË A Û ÔÔÈ·‰‹ÔÙ ‰fiÛË(ÌÈÎÚ‹ 80 mg/ËÌ, ̤ÛË 300 mg/ËÌ, ÌÂÁ¿ÏË 900 mg/ËÌ)ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ·˘ÙÔ‡˜ ‰ÂÓ Â›Ó·È Î·ıfiÏÔ˘ ·Ï‹.

AÓ Î·Ó›˜ ‰Â¯ı› ÙÔ ·‰È·ÌÊÈÛ‚‹ÙËÙÔ, ·ÏÏ¿ÁÂÓÈÎfi Û˘Ì¤Ú·ÛÌ· Ù˘ ÙÂÚ¿ÛÙÈ·˜ ÌÂÙ·-·Ó¿Ï˘Û˘100 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ8 ÛÙË ‰Â˘-ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë EI, fiÔ˘ Ë A ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ÁÈ¿ EI ηٿ 18-25% (·Ó¿ÏÔÁ· Ì ÙË ‰fiÛË),ÏÔÁÈο ÌÔÚ› Ó· ·ÔÊ·Û›ÛÂÈ fiÙÈ ÌÔÚ› Ó· ¯ÚË-ÛÈÌÔÔÈËı› Î·È ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë. T·Ú·ÁÌ·ÙÈο ‰Â‰Ô̤ӷ fï˜ Â›Ó·È ÙÂÏ›ˆ˜ ‰È·ÊÔ-ÚÂÙÈο. ¶Ú¤ÂÈ Ó· Û˘Ó˘ÔÏÔÁÈÛÙ› Ë ËÏÈΛ·, Ë Û˘-Ó‡·ÚÍË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Î·È Ô ÛÙfi¯Ô˜ Ô˘¤¯ÂÈ Ë ÂÈÏÔÁ‹ Ù˘ A Û ۯ¤ÛË Ì ÙÔ Èı·Ófi fiÊÂÏÔ˜(ÚÔʇϷÍË ·fi ÈÛ¯·ÈÌ›· Ì˘Ôηډ›Ô˘ ‹ EI) ÚÔ˜ÙÔÓ Â›Û˘ Èı·Ófi ΛӉ˘ÓÔ (Â͈ÎÚ·Óȷ΋ ‹ ÂÓ‰Ô-ÎÚ·Óȷ΋ ·ÈÌÔÚÚ·Á›·)9.

¶¤ÓÙ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏË-„˘ ÌÂ Û˘ÓÔÏÈο 52250 Û˘ÌÌÂÙ¤¯ÔÓÙ˜, ̤Û˘ ËÏÈ-Λ·˜ 57 ÂÙÒÓ, ÛÙËÓ ÏÂÈÔ„ËÊ›· ¿Ó‰Ú˜ (20% Á˘-Ó·›Î˜), ¯ÚËÛÈÌÔÔ›ËÛ·Ó A (75-650mg/ËÌ) ‹ pla-cebo Û ̤ÛË ·Ú·ÎÔÏÔ‡ıËÛË 4,6 ÂÙÒÓ. ™ÙȘ ‰‡Ô·fi ÙȘ ÌÂϤÙ˜4,13 Û˘ÌÌÂÙ›¯·Ó ÌfiÓÔ ˘ÁÈ›˜ ¿Ó‰Ú˜ÁÈ·ÙÚÔ›, 50-60 ÂÙÒÓ, ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ-‰‡ÓÔ˘, ÂÓÒ ÛÙȘ ˘fiÏÔȘ ÙÚÂȘ ÌÂϤÙ˜14-16 ÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·Ó ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË14,ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ15 Î·È ˘¤ÚÙ·ÛË16.

T· ·ÔÙÂϤÛÌ·Ù·, ÙfiÛÔ ¯ˆÚÈÛÙ¿ Û οı ̛·ÌÂϤÙË, fiÛÔ Î·È Û˘ÁÎÂÓÙÚˆÙÈο Û ÌÂÙ·-·Ó¿Ï˘ÛË9,‹Ù·Ó ÂÓÙ˘ˆÛȷο Î·È ·ÚÓËÙÈο, ÙÔ˘Ï¿¯ÈÛÙÔÓ fi-

ÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚÔʇϷÍË ·fi EI. AÓÙ› ÁÈ¿ Ì›ˆ-ÛË, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ EI ÌÂÙËÓ A ηٿ 8% Û˘ÁÎÂÓÙÚˆÙÈο (ÌË ÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋). AÓÙ›ıÂÙ·, ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ (p<0,001)Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ EM ηٿ 26%, ÛÙȘ ÔÌ¿-‰Â˜ Ô˘ ‹Ú·Ó A, Û ۇÁÎÚÈÛË Ì ÙÔ placebo.

TÔ Èfi ÂÓÙ˘ˆÛÈ·Îfi ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó Ù˘ A-ÌÂÚÈηÓÈ΋˜ ÌÂϤÙ˘4, fiÔ˘ ÛÙÔ˘˜ ˘ÁÈ›˜ ÂÓ‹ÏÈΘ¿Ó‰Ú˜ ÁÈ·ÙÚÔ‡˜ Ì A (325 mg ̤ڷ ·Ú¿ ̤ڷ)·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ EI ηٿ21% (p=0.14) Î·È ·Ú¿ÏÏËÏ· Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡-ÓÔ˘ ÁÈ¿ EM ηٿ 42% (p<0,001). ŸÛÔÓ ·ÊÔÚ¿ ÙȘ·ÚÂÓ¤ÚÁÂȘ Ù˘ A ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë(Ì›˙ÔÓ˜ Â͈ÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜), Ô Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜ ·˘Í¿ÓÂÙ·È Î·Ù¿ 1,5 ÊÔÚ¿ Û ‰fiÛÂȘ 75mg/ËÌ Î·È 325 mg ̤ڷ ·Ú¿ ̤ڷ4,15,16 Î·È Ê·›ÓÂ-Ù·È fiÙÈ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ËÏÈΛ·17.

™Â ·ÌÈÁ‹ ÌÂϤÙË ˘ÁÈÒÓ Á˘Ó·ÈÎÒÓ-ÓÔÛËÏ¢ÙÚÈ-ÒÓ18, Ô˘ Û˘Ó¯›˙ÂÙ·È ·ÎfiÌË ÛÙËÓ ÚˆÙÔÁÂÓ‹ Úfi-ÏË„Ë, Ê¿ÓËÎÂ Î·È ¿ÏÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ÎÈÓ-‰‡ÓÔ˘ ÁÈ¿ EM ηٿ 32% Î·È Î·ÌÈ¿ ÚÔʇϷÍË ÁÈ¿EI, Ì ‰fiÛÂȘ A 100 mg ̤ڷ ·Ú¿ ̤ڷ-325 mg/ËÌ Û ۇÁÎÚÈÛË Ì placebo18.

T· ·ÚÓËÙÈο ·˘Ù¿ ·ÔÙÂϤÛÌ·Ù· Ù˘ ¯Ú‹Û˘A ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë EI Î·È Ë ·Ú¿‰ÔÍ·ıÂÙÈ΋ ‰Ú¿ÛË ÛÙËÓ ÚÔʇϷÍË ·fi EM Èı·ÓÒ˜Ó· ÔÊ›ÏÔÓÙ·È ÛÙÔ˘˜ ÂÍ‹˜ ·Ú¿ÁÔÓÙ˜:

·) ™ÙËÓ ËÏÈΛ· 50-60 ÂÙÒÓ, Ô˘ Â›Ó·È Ë ËÏÈΛ·ÙˆÓ ÌÂÏÂÙÒÓ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘4,13-15, Ô ÂÙ‹-ÛÈÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· EI Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚÔ˜(<50%) ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ EM (0,3 Ì 0,7% ·ÓÙ›-ÛÙÔȯ·)9 Î·È ¿Ú· Ë ÚÔʇϷÍË Ù˘ A ‰È·ÊÔÚÂÙÈ΋.

‚) H ¯Ú‹ÛË A ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÚÔηÏ›·‡ÍËÛË Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ȉÈ-·›ÙÂÚ· ÛÙËÓ Î·Ù¿ÎÏÈÛË, Î·È Â›Û˘ fiÙÈ ·ÓÙ·ÁˆÓ›-˙ÂÙ·È ÙË ‰Ú¿ÛË ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú-̿ΈÓ19.

Á) Œ¯ÂÈ ·Ó·ÊÂÚı› ÂÈÚ·Ì·ÙÈο, Î·È È‰È·›ÙÂ-Ú· Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ (900-1300 mg), fiÙÈ Ë A ·Ó·-ÛÙ¤ÏÏÂÈ ÙË Û‡ÓıÂÛË ÂÓ‰ÔıËÏȷ΋˜ ÚÔÛÙ·Î˘ÎÏ›-Ó˘, Ì ·ÔÙ¤ÏÂÛÌ· ÛÙȘ ‰fiÛÂȘ ·˘Ù¤˜ Ë ‰Ú¿ÛË Ù˘ӷ ÌÂÙ·ÙÚ¤ÂÙ·È Û ıÚÔÌ‚ÔÁfiÓÔ20. H ‰Ú¿ÛË ·˘Ù‹‰ËÌÈÔ‡ÚÁËÛ ÛÙËÓ ÚˆÙÔÁÂÓ‹, ·ÏÏ¿ Î·È ‰Â˘ÙÂÚÔ-ÁÂÓ‹ ÚfiÏË„Ë, ÙÔ ÏÂÁfiÌÂÚÓÔ “‰›ÏËÌÌ· Ù˘ A”21,·ÏÏ¿ Ë ÎÏÈÓÈ΋ ÚÔ¤ÎÙ·ÛË Ù˘ ·Ó·ÛÙÔÏ‹˜ ÚÔÛÙ·-΢ÎÏ›Ó˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË22.

T¤ÏÔ˜, Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÁÈ¿ ·Û˘Ìو̷ÙÈ-ÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÌË ‚·Ï‚ȉÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘-Á‹ (MBKM), Ù· Û˘ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· 4Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ‰Â›¯ÓÔ˘Ó Ì›ˆÛË ÙÔ˘ÎÈÓ‰‡ÓÔ˘ ÁÈ· EI ηٿ 21% Ì ÙË ¯Ú‹ÛË 300 mg/ËÌ,

214 ¢. ∫∞ƒ∞∫ø™∆∞™

Û ۇÁÎÚÈÛË Ì placebo23. H ·fiÊ·ÛË ÁÈ¿ ÂÈÏÔÁ‹ÎÔ˘Ì·ÚÈÓÈÎÔ‡ ·ÓÙÈËÎÙÈÎÔ‡ ‹ A ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ (fiÚÈÔ Ù· 65 ¤ÙË), ÙË Û˘Ó‡·Ú-ÍË ˘¤ÚÙ·Û˘, ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙÔ˘, ·Ó¿Ú-ÎÂÈ·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜, ÙËÓ Ë·ÙÈ΋ ÏÂÈÙÔ˘Ú-Á›· Î·È ÙÔ ÈÛÙÔÚÈÎfi ·ÈÌÔÚÚ·ÁÈÒÓ (Á·ÛÙÚÈÎÔ‡ ¤Ï-ÎÔ˘˜ ‹ ÂÓ‰ÔÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜)24,25.

™˘ÌÂÚ·ÛÌ·ÙÈο ÏÔÈfiÓ, Î·È fiÛÔÓ ·ÊÔÚ¿ Ù˯ڋÛË A ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ EI, Ù· ‰Â-‰Ô̤ӷ Û‹ÌÂÚ·9,26 Û˘ÓËÁÔÚÔ‡Ó fiÙÈ:

1. AÛ˘Ìو̷ÙÈÎÔ› ÂÓ‹ÏÈΘ, ¯ˆÚ›˜ ·Ú¿ÁÔ-ÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ ·ÁÁÂȷ΋ ÓfiÛÔ, ‰ÂÓ ¤¯Ô˘Ó η̛·ÂÈÛÙËÌÔÓÈ΋ ¤Ó‰ÂÈÍË ÁÈ¿ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹4.9.

2. AÛ˘Ìو̷ÙÈÎÔ› ÂÓ‹ÏÈΘ Ì ·Ú¿ÁÔÓÙ˜ÎÈÓ‰‡ÓÔ˘26, ·ÚΛ Ó· Ú˘ıÌ›ÛÔ˘Ó Ê·Ú̷΢ÙÈο ‹·ÏÏÈÒ˜ (‰È·ÎÔ‹ ηӛÛÌ·ÙÔ˜, ·ÏÏ·Á‹ ‰È·ÙÚÔÊ‹˜)ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜, Ì ÛÙfi¯Ô ÙËÓ ÚfiÏË„ËEI. H ‡·ÚÍË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ۷ί·ÚÒ‰Ô˘˜‰È·‚‹ÙÔ˘ Û˘ÓÈÛÙ¿ ÙË ¯Ú‹ÛË A (80-100 mg/ËÌ), ΢-Ú›ˆ˜ ÁÈ¿ ÚfiÏË„Ë EM9.

3. ™ÙËÓ ‡·ÚÍË MBKM23-25, ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ÂÈ-‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ËÏÈΛ· οو ÙˆÓ 65ÂÙÒÓ, Û˘ÓÈÛÙ¿Ù·È A 300-325 mg/ËÌ ‹ Ù›ÔÙ·. H ›‰È·‰fiÛË Û˘ÓÈÛٿٷÈ, ¿Óˆ ÙˆÓ 65 ÂÙÒÓ, Ì ÂÈÚfiÛıÂ-ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, fiÙ·Ó ˘¿Ú¯ÂÈ ·ÓÙ¤Ó-‰ÂÈÍË ¯Ú‹Û˘ ·ÓÙÈËÎÙÈÎÒÓ ‹ Ë ËÏÈΛ· ÍÂÂÚÓ¿ Ù·80 ¤ÙË.

¢∂À∆∂ƒ√°∂¡◊™ ¶ƒŸ§∏æ∏TÔ ÛΤÏÔ˜ ·˘Ùfi ·ÊÔÚ¿ ·ÛıÂÓ›˜ ϤÔÓ ÌÂ Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›· ·fi ÙÔ KN™ ‹ ÙÔÓ ÔÊı·ÏÌfi Ì ÙË ÌÔÚ-Ê‹ ·ÚÔ‰ÈÎÒÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (¶IE) ‹ ÙËÓÔÍ›· ÂÁηٿÛÙ·ÛË ÌfiÓÈÌÔ˘ ÈÛ¯·ÈÌÈÎÔ‡ ÂÂÈÛÔ‰›-Ô˘ Ì Ó¢ÚÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·, ·ÓÂÍ¿ÚÙËÙ· Ù˘ ‡-·Ú͢ ‹ fi¯È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ ·Á-ÁÂȷ΋ ÓfiÛÔ. H ·fiÊ·ÛË ÁÈ¿ ÂÈÏÔÁ‹ Î·È ¯Ú‹ÛËÙÔ˘ ÈÔ Î·Ù¿ÏÏËÏÔ˘ ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÔ‡ Ê·ÚÌ¿-ÎÔ˘, Ë ÂÈÏÔÁ‹ Ù˘ ‰fiÛ˘ Ù˘ A ‹ Ô Û˘Ó‰˘·ÛÌfi˜‰‡Ô Ê·Ú̿ΈÓ, ··ÈÙ› Èfi Û‡ÓıÂÙË ÛΤ„Ë Î·È·Ó¿Ï˘ÛË ÂÚÈÛÛfiÙÂÚˆÓ ˘·ÚÎÙÒÓ ‰Â‰ÔÌ¤ÓˆÓ ·fifi,ÙÈ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë26. EÎÙfi˜ Ù˘ ËÏÈΛ·˜,ÙÔ˘ ʇÏÔ˘, ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, Ù˘ ¢·È-ÛıËÛ›·˜ ‹ ·ÓÙÔ¯‹˜ ÙÔ˘ ·ÙfiÌÔ˘ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓËÔ˘Û›·, Ú¤ÂÈ Ó· ÏËÊı› ˘fi„Ë ÙÔ ÚÔËÁÔ‡ÌÂÓÔÈÛÙÔÚÈÎfi, Ë ÌÔÚÊÔÏÔÁ›· Î·È Ô ‚·ıÌfi˜ ÙˆÓ Â͈ÎÚ·-ÓÈ·ÎÒÓ ‹ ÂÓ‰ÔÎÚ·ÓÈ·ÎÒÓ ·ÚÙËÚÈ·ÎÒÓ ÛÙÂÓÒÛˆÓ(Ì ˘¤ÚË¯Ô˘˜ ‹ ·ÁÁÁÂÈÔÁÚ·Ê›·), Ë ‡·ÚÍË, Ô ·-ÚÈıÌfi˜, ÙÔ Ì¤ÁÂıÔ˜ Î·È Ë ÙÔÔÁÚ·Ê›· ÙˆÓ Èı·ÓÒÓÈÛ¯·ÈÌÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ ÛÙÔÓ ÂÁΤʷÏÔ (Ì AÍÔÓÈ-΋ ‹ M·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·) Î·È Ù¤ÏÔ˜, Ô Èı·Ófi˜

Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ù˘ EI (ÓfiÛÔ˜ ÌÂÁ¿ÏÔ˘ ·Á-Á›Ԣ, ÌÈÎÚÒÓ ·ÁÁ›ˆÓ, ÂÌ‚ÔÏÈÛÌfi˜ Î·È ·fi ÔÈ¿ËÁ‹, ¿ÏÏË ·ÈÙ›·)27,28.

O𠫶Ÿ§∂ª√π« ∆∏™ A™¶πƒÿ¡∏™5

H A ·Ú¿ Ù· 30 ¯ÚfiÓÈ· ¯Ú‹Û˘ Ù˘ ÛÙË ‰Â˘ÙÂÚÔÁÂ-Ó‹ ÚfiÏË„Ë EI, ·Ú¿ ÙȘ ÔÏϷϤ˜ ÎÏÈÓÈΤ˜ ÌÂϤ-Ù˜ Î·È ÙÂÚ¿ÛÙȘ ÌÂÙ·-·Ó·Ï‡ÛÂȘ Ì ÙȘ Ôԛ˜ÎÚ›ıËÎÂ, ÙȘ ÁÓˆÛÙ¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙË˜Î·È ÙȘ Û·ÓÈfiÙÂÚ˜, ·ÏÏ¿ ÛÔ‚·Ú¤˜ Â͈ÎÚ·ÓȷΤ˜Î·È ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔΤ˜, η-ıÒ˜ Î·È ÙȘ ·ÔÙ˘¯›Â˜ Ô˘ Û·Ó Ê¿ÚÌ·ÎÔ ¤¯ÂÈ ÛÙÔ˘˜ÛÙfi¯Ô˘˜ ¯Ú‹Û˘ Ù˘, ·Ú·Ì¤ÓÂÈ Û‹ÌÂÚ· Ë ÚÒÙËÂÈÏÔÁ‹ Î·È ÙÔ Û··ÛÌ· ·Ó·ÊÔÚ¿˜ Ì ÙÔ ÔÔ›ÔÂȉÈÒÎÔ˘Ó Ó· Û˘ÁÎÚ›ÓÔÓÙ·È fiÏ· Ù· ÓÂfiÙÂÚ· ·ÓÙÈ-·ÈÌÔÂÙ·Ïȷο Ê¿Ú̷η8,10-12,26,29,30.

¢˘ÛÙ˘¯Ò˜ fï˜, ·ÎfiÌË Î·È Û‹ÌÂÚ·, ÙÔ ı¤Ì·Ù˘ ÈÔ Î·Ù¿ÏÏËÏ˘ ‰fiÛ˘ ÛÙËÓ ÚfiÏË„Ë Ù˘ EI‰ÂÓ ¤¯ÂÈ ÎÏ›ÛÂÈ Î·È Ë ‰È·Ì¿¯Ë Û˘Ó¯›˙ÂÙ·È26,30,31.OÈ ÂӉ›ÍÂȘ Î˘Ì·›ÓÔÓÙ·È ·fi ÙË ¯·ÌËÏ‹ ‰fiÛË30mg/ËÌ ¤ˆ˜ ÙËÓ ˘„ËÏ‹ 1300 mg/ËÌ, Ì ÂӉȿÌÂÛË160-325 mg/ËÌ. ÿÛˆ˜ Ë Û‡Á¯˘ÛË ·˘Ù‹ ÔÊ›ÏÂÙ·ÈÛÙÔ fiÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Î·È ÌÂ-Ù·-·Ó·Ï‡ÛÂȘ, Ë Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ‰fiÛÂˆÓ Î·È ÙÔ˘ placebo ‰ÂÓ Â›Ó·È ¿ÌÂÛ˜, ·ÏÏ¿ ¤Ì-ÌÂÛ˜, ÂÓÒ ÔÈ ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÂÙ¤-¯Ô˘Ó ‰ÂÓ Â›Ó·È ÔÌÔÈÔÁÂÓ›˜ ÛÙȘ ÌÂϤÙ˜ Ô˘ ·ıÚÔÈ-ÛÙÈο Û˘ÁÎÚ›ÓÔÓÙ·È, fiÛÔÓ ÛÊÔÚ¿ ÙËÓ ËÏÈΛ·, ÙÔ Ê‡-ÏÔ, Ù· ÎÚÈÙ‹Ú· ÂÈÛfi‰Ô˘, ÙÔ Ì˯·ÓÈÛÌfi EI Î·È ÙÔ˘˜ÙÂÏÈÎÔ‡˜ ÛÙfi¯Ô˘˜6,8,9. A˘Ùfi ‚¤‚·È· ·ÔÙÂÏ› ÁÂÓÈ-Îfi Úfi‚ÏËÌ· ÙˆÓ ÌÂÙ·-·Ó·Ï‡ÛÂˆÓ Î·È ‰ÂÓ Û˘Ì-‚·›ÓÂÈ ·ÔÎÏÂÈÛÙÈο ÛÙËÓ ¤Ú¢ӷ ÙˆÓ ·ÓÙÈ·ÈÌÔÂ-Ù·ÏÈ·ÎÒÓ Î·È Ù˘ A32,33.

Œ¯ÔÓÙ·˜ Ù· ·Ú·¿Óˆ ÛÙÔȯ›· ˘fi„Ë Ì·˜,·Ú·ÙËÚԇ̠fiÙÈ Û ¤ÌÌÂÛË Û‡ÁÎÚÈÛË ÙˆÓ ÙÚÈÒÓ ‰fi-ÛÂˆÓ A30, Ë Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ EI ÁÈ¿ ÙË ÌÈÎÚ‹‰fiÛË (<100 mg/ËÌ) ‹Ù·Ó 13%, ÁÈ¿ ÙË Ì¤ÛË (300mg/ËÌ) 10% Î·È ÙËÓ ˘„ËÏ‹ (>900 mg/ËÌ) 14%, ¯ˆ-Ú›˜ ‰ËÏ·‰‹ Ô˘ÛÈ·ÛÙÈ΋ ‰È·ÊÔÚ¿. ™Ù· ›‰È· ÂÚ›Ô˘Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ¿ ÙËÓ ÚfiÏË„Ë EI η٤ÏËÍÂ Î·È ËÌÂÁ¿ÏË ÌÂÙ·-·Ó¿Ï˘ÛË8, ·ÏÏ¿ Î·È Û‡Á¯ÚÔÓ˜ ·Ó·-ÛÎÔ‹ÛÂȘ30,31,34 Î·È ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ì ¿ÌÂÛË Û‡-ÁÎÚÈÛË 300 Î·È 1200 mg35 Î·È ·ÓÙ›ıÂÙ· 30 Î·È 283mg/ËÌ36. OÈ ‰Â Á·ÛÙÚÂÓÙÂÚÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ Û˘Ì-‚·›ÓÔ˘Ó Î·Ù¿ 1% ÛÙÔ placebo, 3% ÛÙ· 300mg ηÈ5% ÛÙ· 1200 mg, ÂÓÒ ÔÈ Èfi ·Ï¤˜ ·ÓÂÈı‡ÌËÙ˜ Â-Ó¤ÚÁÂȘ (η‡ÛÔ˜, Ó·˘Ù›·, ¤ÌÂÙÔÈ) ηٿ 26% ÛÙÔplacebo, 31% ÛÙ· 300 mg Î·È 41% ÛÙ· 1200 mg30.

T¤ÏÔ˜, Ê·›ÓÂÙ·È fiÙÈ ÔÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂÈ-˜ Î·È ÔÈ Ì›˙ÔÓ˜ Â͈ÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜ Â-Í·ÚÙÒÓÙ·È ¿ÌÂÛ· ·fi ÙË ‰fiÛË5,36-38, ÂÓÒ ÔÈ Û·-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 215

ÓÈfiÙÂÚ˜ ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔΤ˜Û˘Ì‚·›ÓÔ˘Ó 2-3 ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· Ì A Û ۇÁÎÚÈ-ÛË Ì placebo5,8, ·ÏÏ¿ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ÙfiÛÔ Ì ÙˉfiÛË Ù˘ A35,36, fiÛÔ Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂ-ÓÔ‡˜39,40.

™Â ÌÂϤÙË-ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔÛÂÓ¿ÚÈÔ ÁÈ¿ ‰Â˘ÙÂÚÔÁÂÓ‹ ÚÔʇϷÍË ·ÛıÂÓÔ‡˜ ·-fi EI Ì ÙË ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ‰fiÛÂˆÓ A, Ë ÏÂÈÔ-„ËÊ›· ÙˆÓ ÁÈ·ÙÚÒÓ ·ÁÎfiÛÌÈ· (45-61%) ÚÔÙÈÌ¿Ù· 300-325 mg/ËÌ, ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi (35-51%) ¯ÚËÛÈÌÔÔÈ› ÌÈÎÚ¤˜ ‰fiÛÂȘ 80-160mg, ÂÓÒÌfiÓÔ ÙÔ 4% ÚÔÙÈÌ¿ ÙȘ ÌÂÁ¿Ï˜ ‰fiÛÂȘ 600-1300mg41. E›Û˘, Û ÌÂϤÙË ÂȉÈÎÒÓ ÁÈ·ÙÚÒÓ, ȉȷ›ÙÂ-Ú· ·Û¯ÔÏÔ‡ÌÂÓˆÓ Ì ÙËÓ EI, ÔÈ E˘Úˆ·›ÔÈ Û˘¯Ófi-ÙÂÚ· (57%) ÚÔÙÈÌÔ‡Ó ÙȘ ÌÈÎÚ¤˜ Î·È ÌÂÛ·›Â˜ ‰fi-ÛÂȘ A, ÂÓÒ ÌfiÓÔ ÙÔ 2% ÙȘ ÌÂÁ¿Ï˜. ™Â ·ÓÙ›ıÂÛË,ÔÈ AÌÂÚÈηÓÔ› ÂȉÈÎÔ› ¯ÚËÛÈÌÔÔÈÔ‡Ó Û˘¯ÓfiÙÂÚ·(36%) ÙȘ ÌÂÁ¿Ï˜ ‰fiÛÂȘ, ÂÓÒ ÌfiÓÔ ÙÔ 2% ·fi ·˘-ÙÔ‡˜ ÙȘ ÌÈÎÚ¤˜ ‰fiÛÂȘ42.

T· ·›ÙÈ· Ù¤ÏÔ˜ ·ÔÙ˘¯›·˜ Î·È ˘ÔÙÚÔÒÓ Ô˘·Ú·ÙËÚÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ ·Ú¿ ÙË ¯Ú‹ÛË A,Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó ÛÙ· ÂÍ‹˜:

·) TÔ ·ÓÒÙÂÚÔ fiÚÈÔ Ì›ˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ EI,Ô˘ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ Ë ÌÂÁ¿ÏË ‰fiÛË A (900mg/ËÌ) Î˘Ì·›ÓÂÙ·È ·fi 25-42%8, Ì Èfi Û˘¯Ó¿ ٷηÙÒÙÂÚ· fiÚÈ· ·˘Ù‹˜ Ù˘ ‰È·Î‡Ì·ÓÛ˘8,30.

‚) AÂÈı·Ú¯›· ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ Î·ıËÌÂÚÈÓ‹Ï‹„Ë, ȉȷ›ÙÂÚ· ÙˆÓ ÌÂÁ¿ÏˆÓ ‰fiÛˆÓ29,30,38 ‹ ¯Ú‹-ÛË Ôχ ÌÈÎÚ‹˜ ‰fiÛË, (<50 mg/ËÌ) 29,43.

Á) H A Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·Ó·ÛÙ¤ÏÏÂÈ ÙË ıÚÔÌ-‚ÔÍ¿ÓË, ÌÏÔοÚÔÓÙ·˜ ÙËÓ Ô‰fi Ù˘ ΢ÎÏÔ-Ô͢ÁÂ-Ó¿Û˘7, ·ÏÏ¿ ‰ÂÓ Ú¤ÂÈ Ó· ͯӿÌ fiÙÈ Ë ›‰È· A‰ÂÓ ¤¯ÂÈ ÙËÓ ›‰È· ‰Ú¿ÛË ÛÙË ÏÈÔ-Ô͢ÁÂÓ¿ÛË Ô˘ÂÌϤÎÂÙ·È ·Ú¿ÏÏËÏ· ÛÙËÓ ·ÈÌÔÂÙ·Ïȷ΋ Û˘-ÁÎfiÏÏËÛË44.

‰) E›Û˘, ‰ÂÓ Ú¤ÂÈ Ó· ͯӿÌ ÙË ‰È·ÊÔÚÂ-ÙÈ΋ ÈÛ¯‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘29,45, Ù˘ ˘‰ÚfiÏ˘Û˘ ÙÔ˘Û·ÏÈ΢ÏÈÎÔ‡45 Î·È ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ù˘ ÂÓ‰Ô·˘-ÏÈ΋˜ Ù¿Û˘ (shear stress)46 ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ-‚Ô˘ (˘„ËÏÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË-˘„ËÏ‹ Ù·¯‡ÙËÙ·)ÛÙȘ ‰È¿ÊÔÚ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ (ÂÛÙȷ΋ ÛÙ¤ÓˆÛË-‰È¿¯˘ÙË ·ÁÁÂÈÔ¿ıÂÈ·) Î·È Û ‰È¿ÊÔÚ· ·ÚÙËÚÈ·Î¿Û˘ÛÙ‹Ì·Ù· (Â͈ÎÚ·Óȷο-ÂÓ‰ÔÎÚ·Óȷο ·ÁÁ›·,ÛÙÂÊ·ÓÈ·›· ‹ ÂÚÈÊÂÚÈο ·ÁÁ›·)29,45,46. H A ‰Ú·Î·Ï‡ÙÂÚ· Û ηٷÛÙ¿ÛÂȘ ˘„ËÏ‹˜ Ù¿Û˘46.

Â) T¤ÏÔ˜, ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ·ÎfiÌË Î·È ÌÂÙË ¯Ú‹ÛË Ù˘ ̤ÁÈÛÙ˘ ‰fiÛ˘ 1400 mg/ËÌ, ÙÔ 8%ÙˆÓ ·ÓıÚÒˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÙÔ¯‹, Ë ·ÈÌÔÂÙ·-Ïȷ΋ Û˘ÁÎfiÏÏËÛË Û˘Ó¯›˙ÂÙ·È47 Î·È Ù· Û˘ÌÙÒÌ·-Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ӷϷ̂¿ÓÔÓÙ·È, ·Ú¿ ÙË ¯Ú‹-ÛË A.

¶·Ú¿ ÙËÓ “ηٷÈÁ›‰·” ÙˆÓ ÌÂÏÂÙÒÓ Ù˘ A, ̤-¯ÚÈ Î·È ÚfiÛÊ·Ù· ‰ÂÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› ·ÚÎÒ˜ ËÂÈÏÂÎÙÈ΋ ‰Ú¿ÛË Ù˘ ÛÙËÓ ÚˆÙÔ·ı‹-ÌË Î·Ú‰ÈÔ-ÂÌ‚ÔÏÈ΋ EI (ÂÓ‰ÔÎÚ·Óȷ΋ ·ÚÙËÚȷ΋ ÛÙ¤ÓˆÛË,ÓfiÛÔ ÙˆÓ ÌÈÎÚÒÓ ÂÓ‰Ô·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ·ÁÁ›ˆÓ,ÎÚ˘ÙÔÁÂÓ‹ EI)31. TÔ 1995, ÛÙË ÌÂϤÙË WASID48

Û˘ÁÎÚ›ıËÎÂ Ë A (325 mg/ËÌ) Ì ÙËÓ ÎÔ˘Ì·Ú›ÓË(INR 2,0-3,0) Û 151 ·ÛıÂÓ›˜ Ì ·ÁÁÂÈÔÁÚ·ÊÈο‚‚·ÈˆÌ¤ÓË ÂÓ‰ÔÎÚ·Óȷ΋ ÛÙ¤ÓˆÛË 50-99% ηÈÂÂÈÛfi‰È· EI (¶IE ‹ ‹È·). ™ËÌ·ÓÙÈ΋ (49%) ‹Ù·ÓË Û˘ÓÔÏÈ΋ ÂÙ‹ÛÈ· Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ¿ EI,EM Î·È A£ Ì ÙËÓ ÎÔ˘Ì·Ú›ÓË (K), ·ÏÏ¿ ›Û˘ÛËÌ·ÓÙÈΤ˜ (p<0,01) ‹Ù·Ó ÔÈ ÂÙ‹ÛȘ Ì›˙ÔÓ˜ ·È-ÌÔÚÚ·Á›Â˜48. TÔ 1997, Ë ÌÂϤÙË SPIRIT49 ‰È·ÎfiË-ΠÚfiˆÚ·, fiÙ·Ó Û 1316 ·ÛıÂÓ›˜ Ì ÌË Î·Ú‰ÈÔ-ÂÌ‚ÔÏÈ΋ EI, Ë K Û ÌÂÁ¿ÏË ‰fiÛË (INR 3,0-4,0) ÛÂÛ‡ÁÎÚÈÛË Ì ÙËÓ A Û ÌÈÎÚ‹ ‰fiÛË (30 mg), ¤‰ÂÈÍÂ,ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ, Û·Ê‹ ˘ÂÚÔ¯‹ ÙˆÓ Ì›˙ÔÓˆÓ·ÈÌÔÚÚ·ÁÈÒÓ Ì K (8%) ¤Ó·ÓÙÈ Ù˘ A (0,9%).

M ·ÚfiÌÔÈÔ ˘ÏÈÎfi ·ÛıÂÓÒÓ, ÙËÓ ÚˆÙÔ·-ı‹-ÌË Î·Ú‰ÈÔÂÌ‚ÔÏÈ΋ ÈÛ¯·ÈÌ›·, ‚Ú›ÛÎÔÓÙ·È Û‹ÌÂ-Ú· Û ÂͤÏÈÍË ‰‡Ô ÌÂϤÙ˜50,51. ™ÙËÓ ÚÒÙË50, Û˘-ÁÎÚ›ÓÂÙ·È Ë K (INR 2,0-3,0) Ì A (325 gr/ËÌ) Ì ‹¯ˆÚ›˜ ‰È˘Úȉ·ÌfiÏË (400 mg/ËÌ) Î·È ÛÙË ‰Â‡ÙÂÚË51

Ë K (INR 1,4-2,8) Ì A (325 mg/ËÌ), fiÔ˘ fï˜ÂÍ·ÈÚÔ‡ÓÙ·È ·ÛıÂÓ›˜ Ì ηډÈÔÂÌ‚ÔÏ‹, Â͈ÎÚ·-Óȷ΋ ·ÚÙËÚȷ΋ ÛÙ¤ÓˆÛË ‹ ¶IE51. T· ·ÔÙÂϤ-ÛÌ·Ù· Î·È ÙˆÓ ‰‡Ô ·Ó·Ì¤ÓÔÓÙ·È ÌÂÙ¿ ÙÔ 2000.

§ÈÁfiÙÂÚÔ ÈÛ¯˘Ú‹ Ê·›ÓÂÙ·È Ë ı¤ÛË Ù˘ A ÛÙˉ¢ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë EI Û ·ÛıÂÓ›˜ Ì MBKM26,30,31. Ÿˆ˜ Ê¿ÓËΠÛÙË ÌÂϤÙË SPAF-III52 Ë AÛ ‰fiÛË 325mg/ËÌ ÌÔÚ› Ó· Â›Ó·È Ë ÚÒÙË ÂÈÏÔ-Á‹ ÌfiÓÔ Û ·ÛıÂÓ›˜ Ì MBKM ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘(<65 ÂÙÒÓ, ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ-‰‡ÓÔ˘)34,52. TÔ ›‰ÈÔ ·Ó›Û¯˘ÚË ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë AÛÙËÓ ÚfiÏË„Ë Î·Ú‰ÈÔÂÌ‚ÔÏÈÛÌÔ‡ Û ·ÛıÂÓ›˜ ÌÂÚÔÛıÂÙÈΤ˜ ηډȷΤ˜ ‚·Ï‚›‰Â˜ (¶KB)31. ™˘ÓÈ-ÛÙ¿Ù·È ÌfiÓÔ ˆ˜ Û˘Á¯ÔÚ‹ÁËÛË Ì K, ÛÙȘ Ì˯·ÓÈΤ˜¶KB, Ë ÌÈÎÚ‹ ‰fiÛË 100-160 mg/ËÌ Û ·ÛıÂÓ›˜˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (ÈÛÙÔÚÈÎfi EI, ÎÔÏÈ΋ Ì·ÚÌ·Ú˘-Á‹, ‰‡Ô ¶KB)53, ηıÒ˜ Î·È ÛÙȘ ‚ÈÔÏÔÁÈΤ˜ ¶KB Ë̤ÛË ‰fiÛË 325 mg/ËÌ ÌÂÙ¿ ÙÔ˘˜ ÙÚÂȘ ÚÒÙÔ˘˜ Ì‹-Ó˜ ·fi ÙËÓ Â¤Ì‚·ÛË (Î¿Ï˘„Ë Ì K) Î·È ÌfiÓÔ Û·ÛıÂÓ›˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘53.

T¤ÏÔ˜, ‰‡Ô Â›Ó·È ÔÈ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ¿ÌÂÛË ¯Ú‹ÛË A ÛÙÔ Ô͇ ÈÛ¯·ÈÌÈÎfi ÂÁÎÂÊ·ÏÈÎfi Â-ÂÈÛfi‰ÈÔ (OIEE)54,55. ™ÙË ÌÂϤÙË IST54 (Ù˘¯·ÈÔ-ÔÈË̤ÓË , ÌË Ù˘ÊÏ‹), 9500 ·ÛıÂÓ›˜ Ì OIEE ‹-Ú·Ó A 300 mg/ËÌ ‹ Ù›ÔÙ· ÁÈ¿ 14 ̤Ú˜. H ·ÁˆÁ‹¿Ú¯È˙ ̤¯ÚÈ Î·È 48 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ì-و̿وÓ. ™ÙȘ 2 ‚‰ÔÌ¿‰Â˜ Ë A Ì›ˆÛ ÛËÌ·ÓÙÈ-

216 ¢. ∫∞ƒ∞∫ø™∆∞™

ο (2p<0,001) ÙËÓ ˘ÔÙÚÔ‹ EI (2,8% Ì 3,9%),ηıÒ˜ Î·È ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ ‹ ÌË ı·Ó·ÙËÊfiÚÔ˘Ó¤Ô˘ ÈÛ¯·ÈÌÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (2p<0,02, 11,3% ÌÂ12,4%) Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ A.™ÙÔ˘˜ ‰Â 6 Ì‹Ó˜ Ë A ÂÚÈfiÚÈÛ ÛËÌ·ÓÙÈο (2p<0,03) ÙË ıÓËÙfiÙËÙ· Î·È Ù· ‚·ÚÈ¿ Ó¢ÚÔÏÔÁÈο ÂÏ-Ï›ÌÌ·Ù· (61,2% Ì 63,5%). ™ÙË ÌÂϤÙË CAST55

(Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ‹-Ù˘ÊÏ‹) 21000 KÈÓ¤˙ÔÈ·ÛıÂÓ›˜ Ì OIEE ‹Ú·Ó A 160 mg/ËÌ ‹ placeboÁÈ¿ 1 Ì‹Ó· Î·È Ë ·ÁˆÁ‹ ¿Ú¯È˙ ̤۷ ÛÙȘ 25 ÚÒ-Ù˜ ÒÚ˜. ™˘ÁÎÚÈÙÈο Ì ÙÔ placebo Ë A Ì›ˆÛ ηȿÏÈ ÛËÌ·ÓÙÈο (2p=0,04) ÙËÓ ˘ÔÙÚÔ‹ EI (1,6%Ì 2,1%), ηıÒ˜ Î·È ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ ‹ ÌË ı·-Ó·ÙËÊfiÚÔ˘ Ó¤Ô˘ ÈÛ¯·ÈÌÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (2p=0,03,5,3% Ì 5,9%) ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ÌÂÙ¿ ÙÔ ·Ú¯ÈÎfiÂÂÈÛfi‰ÈÔ.

™˘ÁÎÂÓÙÚˆÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓÎ·È ÙˆÓ ‰‡Ô ·ÓˆÙ¤Úˆ ÌÂÏÂÙÒÓ ¤‰ÂÈÍ fiÙÈ Â¿Ó ¯Ô-ÚËÁËı› A 160-300 mg/ËÌ, ̤۷ ÛÙȘ ÚÒÙ˜ 24-48ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ, Û 100·ÛıÂÓ›˜ Ì OIEE, ÚÔÏ·Ì‚¿ÓÂÙ·È 1 ı¿Ó·ÙÔ˜ ‹Ó¤Ô ÈÛ¯·ÈÌÈÎfi ÂÂÈÛfi‰ÈÔ ‹ 1 ‚·Ú‡ Ó¢ÚÔÏÔÁÈÎfi ¤Ï-ÏÂÈÌÌ·56.57, ̤۷ ÛÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ ·fi ÙËÓÂÁηٿÛÙ·ÛË ÙÔ˘ OIEE. TÔ ıÂÙÈÎfi ·˘Ùfi ·ÔÙ¤ÏÂ-ÛÌ·, ·Ó Î·È Î·ıfiÏÔ˘ ÂÓÙ˘ˆÛÈ·Îfi, ˆ˜ ·ÚÈıÌfi˜, ›-Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi, ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰È-¢ÎÚÈÓÈÛı›58 Â¿Ó ÔÊ›ÏÂÙ·È Û ‰Ú¿ÛË Ù˘ A ÛÙÔηı·˘Ùfi ¤ÌÊÚ·ÎÙÔ ‹ ÛÙËÓ ÚÒÈÌË ÚfiÏË„Ë EI.

™˘ÌÂÚ·ÛÌ·ÙÈο ÈÛÙ‡ԢÌ fiÙÈ Ë ‰È¯ÔÁÓˆ-Ì›· ÁÈ¿ ÙËÓ ÈÔ Î·Ù¿ÏÏËÏË ‰fiÛË A ÛÙË ‰Â˘ÙÂÚÔÁÂ-Ó‹ ÚfiÏË„Ë EI ‰ÂÓ ¤¯ÂÈ ÙÂÏÂÈÒÛÂÈ30,31, ·Ó Î·È Û‹-ÌÂÚ· ˘¿Ú¯ÂÈ Ë Ù¿ÛË Ó· ÚÔÙÈÌÒÓÙ·È ÔÈ ‰fiÛÂȘ160-325 mg/ËÌ26,31,41,57,58 ÛÂ:

1. AÛıÂÓ›˜ Ì ڈÙÔ·ı‹-ÌË Î·Ú‰ÈÔÂÌ‚ÔÏÈ-΋ EI (ÂÓ‰ÔÎÚ·Óȷ΋ ·ÚÙËÚȷ΋ ÛÙ¤ÓˆÛË, ÓfiÛÔÌÈÎÚÒÓ ·ÁÁ›ˆÓ, ÎÚ˘ÙÔÁÂÓ‹) Ì ÙË ÌÔÚÊ‹ ¶IE ‹‹ÈˆÓ ÂÂÈÛÔ‰›ˆÓ, ˆ˜ ÚÒÙË ÂÈÏÔÁ‹31,48. H ‰Ú¿ÛËÙ˘ ıˆÚÂ›Ù·È ›‰È·, ·ÓÂÍ¿ÚÙËÙ· ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈ-Λ·˜ Î·È Ù˘ ‡·Ú͢ ˘¤ÚÙ·Û˘ ‹ ۷ί·ÚÒ‰Ô˘˜‰È·‚‹ÙË8,31.

2. AÛıÂÓ›˜ Ì ÓfiÛÔ ÌÂÁ¿ÏˆÓ Â͈ÎÚ·ÓÈ·ÎÒÓ·ÁÁ›ˆÓ, fiÔ˘ fï˜ Û˘ÓÂÎÙÈÌ¿Ù·È Ô ‚·ıÌfi˜ Î·È ËÌÔÚÊÔÏÔÁ›· Ù˘ ÛÙ¤ÓˆÛ˘ Ì ˘ÂÚ˯ÔÁÚ·ÊÈο‹/Î·È ·ÁÁÂÈÔÁÚ·ÊÈο ÎÚÈÙ‹ÚÈ·38, ˆ˜ ÚÒÙË ÂÈÏÔ-Á‹, ÂÓÒ ‰È·ÙËÚÂ›Ù·È Ë ÂÓ·ÏÏ·ÎÙÈ΋ χÛË Ù˘ ÂÓ-‰·ÚÙËÚÂÎÙÔÌ‹˜, ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ÎÚÈÙ‹ÚÈ·38,57.

3. AÛıÂÓ›˜ Ì ηډÈÔÂÌ‚ÔÏÈÛÌfi Î·È MBKM,Ë ‰fiÛË 325 mg/ËÌ ıˆÚÂ›Ù·È ÚÒÙË ÂÈÏÔÁ‹, ÌfiÓÔÛÙȘ ÂÚÈÙÒÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘34,52 ‹ fiÙ·Ó·ÓÙÂӉ›ÎÓ˘Ù·È Ë K26,34.

4. AÛıÂÓ›˜ Ì Ì˯·ÓÈΤ˜ ¶KB ˘„ËÏÔ‡ ÎÈÓ‰‡-

ÓÔ˘, Û˘ÓÈÛÙ¿Ù·È Ë Û˘Á¯ÔÚ‹ÁËÛË K Î·È ÌÈÎÚ‹˜ ‰fi-Û˘ A 100-160 mg/ËÌ53, ÂÓÒ ÛÙȘ ‚ÈÔÏÔÁÈΤ˜ ¶KBÌÔÚ› Ó· ‰ÔÎÈÌ·ÛÙ› Ë ‰fiÛË 325 mg/ËÌ, ÌÂÙ¿ ÙÔ˘˜ÙÚÂȘ ÚÒÙÔ˘˜ Ì‹Ó˜ ·fi ÙËÓ Â¤Ì‚·ÛË, ÌfiÓÔ Û·ÛıÂÓ›˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘53.

5. AÚ¯È΋ Ê¿ÛË (24-48 ÒÚ˜) ÂÓfi˜ OIEE, Û‰fiÛË 160-300 mg/ËÌ, ˆ˜ ÚÒÙË ÂÈÏÔÁ‹ ÛÙËÓ ÚÒ-ÈÌË ÚfiÏË„Ë ˘ÔÙÚÔ‹˜ EI 56-58.

ABSTRACTKaracostas D. Selection and use of aspirin incerebral ischemia. Why, when and which do-se? Hell Iatr 2000, 66: 213 - 219.

By reviewing recent literature data, an attemptis made to reach practical conclusions for the mosteffective selection and safer use of aspirin in cere-bral ischemia. In primary prevention recent data in-dicate that: 1) There is no scientific support for pre-scribing aspirin in asymptomatic adults, with no va-scular risk factors. 2) In the presence of these fa-ctors, the appropriate modification in the individualpatient can lead by itself to a reduction in strokerisk. 3) Non-valvular atrial fibrillation, at low risk,should be treated with aspirin 300mg or nothing.The same dose is indicated in high risk patients,who are unable to receive anticoagulants or are over80 years. In secondary prevention, aspirin “wars”for the most suitable dose continue, although todaythere is a tendency to prescribe doses 160-325mgin: 1) Primary-non cardioembolic ischemia (intra-cranial arterial stenosis, small vessel disease, cry-ptogenic) as first choice. 2) Large extracranial vesseldisease, while the alternative solution for endarte-rectomy is maintained. 3) Cardioembolism and n-on-valvular atrial fibrillation the dose of 325mg isonly considered as first choice, in low risk or thoseunable to receive coumarin. 4) Mechanical prost-hetic heart valves at high risk the combination ofaspirin 100-160 mg with coumarin is indicated,while those with biological valves could be treatedwith 325 mg after the first three months post-surgery, only if at low risk. 5) The initial 24-48 hoursof an ischemic stroke, the dose of 160-300mg isconsidered as the first choice agent for early pre-vention of stroke recurrence.

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AÏÏËÏÔÁÚ·Ê›·:¢. K·Ú·ÎÒÛÙ·˜B′ N¢Ú/΋ KÏÈÓÈ΋NÔÛÔÎÔÌÂ›Ô AXE¶A£ÂÛÛ·ÏÔÓ›ÎË

Corresponding author:D. KarakostasB′ Neurology DepartmentAHEPA HospitalThessaloniki, Greece

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 219

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 220 - 226

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¶ÂÚ›ÏË„Ë. ∏ ·Ó‰ÚoÁÂÓÂÙÈ΋ ·ÏˆÂΛ· Â›Ó·È Ë Ï¤-oÓ ÎoÈÓ‹ ÌoÚÊ‹ ·ÒÏÂÈ·˜ ÙˆÓ ÙÚȯÒÓ ÛÙoÓ ¿ÓıÚˆ-o. ∏ ·ıoÊ˘ÛÈoÏoÁ›· Ù˘ ηٿÛÙ·Û˘ ·˘Ù‹˜ ¤¯ÂÈηٿ Ùo ÌÂÁ·Ï‡ÙÂÚo ̤Úo˜ Ù˘ ·oÛ·ÊËÓÈÛı›. °Â-ÓÂÙÈÎo› ·Ú¿ÁoÓÙ˜ ‰È·ÌoÚÊÒÓo˘Ó ÙÚȯÈÎfi ÂÚÈ-‚¿ÏÏoÓ Ïo‡ÛÈo Û ÈÛ¯˘Ú¿ ·Ó‰ÚoÁfiÓ·. ∏ ·Îfi-Ïo˘ıË ·‡ÍËÛË ÙˆÓ ÌÈÙÒÛÂˆÓ ÙˆÓ ÎÂÚ·ÙÈÓo΢ÙÙ¿-ÚˆÓ o‰ËÁ› Û ·‰˘Ó·Ì›· Ï‹Úo˘˜ ‰È·ÊoÚoo›ËÛ˘Ù˘ ÙÚ›¯·˜ Î·È Û˘ÓÙfiÌ¢ÛË Ùo˘ ·ÎÏo˘ ˙ˆ‹˜ Ù˘.¡ÂfiÙÂÚ˜ ÌoÚʤ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ì ·ÏËı‹ ·ÓÙÈ·Ó-‰ÚoÁfiÓ·, fiˆ˜ Ë ÔÍÂÈ΋ ΢ÚoÙÂÚfiÓË, ÊÏo˘Ù·Ì›‰Ë

Î·È ÛÈÚoÓoÏ·ÎÙfiÓË, ÁÈ· ÙË Á˘Ó·›Î· Î·È ·Ó·ÛÙoÏ›˜Ù˘ 5-· ·Ó·ÁˆÁ¿Û˘, fiˆ˜ Ë ÊÈÓ·ÛÙÂÚ›‰Ë, ÁÈ· ÙoÓ¿Ó‰Ú· ¤¯o˘Ó ¯ÚËÛÈÌooÈËı› Ì ÂÈÙ˘¯›·. ∆oÈοÛ΢¿ÛÌ·Ù· Ì ¿ÁÓˆÛÙo ·ÎfiÌË ÙÚfio ‰Ú¿Û˘,fiˆ˜ Ë ªÈÓoÍȉ›ÏË, ÌoÚo‡Ó ›Û˘ Ó· ‚oËı‹Ûo˘Ó.∆· ·oÙÂϤÛÌ·Ù· fï˜ ‰ÂÓ Â›Ó·È ÌfiÓÈÌ·. ∏ ÂͤÏÈÍËÙ˘ ¯ÂÈÚo˘ÚÁÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÓfiÛo˘, ÂÚÈ-Ï·Ì‚·ÓoÌ¤ÓˆÓ Î·È ÙˆÓ Ù¯ÓÈÎÒÓ Ù˘ ¯Ú‹Û˘ ÙˆÓ·ÎÙ›ÓˆÓ Laser, Ê·›ÓÂÙ·È Ï¤oÓ ÂÓÙ˘ˆÛȷ΋ ηÈoÏÏ¿ ˘oÛ¯fiÌÂÓË ÛÙo ̤ÏÏoÓ.EÏÏËÓ I·ÙÚ 2000, 66: 220 - 226.

∏ ∫oÈÓ‹ ‹ ∞Ó‰ÚoÁÂÓÂÙÈ΋ ∞ψÂΛ· (∞°∞)Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÌoÚÊ‹ ·ÒÏÂÈ·˜ ÙˆÓ ÙÚȯÒÓ Ù˘ÎÂÊ·Ï‹˜. ¢ÂÓ ·oÙÂÏ› ÓfiÛo Ì ÙË Û˘Ì‚·ÙÈ΋ ¤Ó-ÓoÈ· Ùo˘ fiÚo˘. ™˘ÓÈÛÙ¿ ÌÈ· ‚ÈoÏoÁÈο ηÏo‹ıËηٿÛÙ·ÛË Ë oo›· ˆÛÙfiÛo ÌÂÙ·‚¿ÏÏÂÈ ÙËÓ ÂÌÊ¿-ÓÈÛË Ùo˘ ·ÓıÚÒo˘ Î·È ÂËÚ¿˙ÂÈ, ÌÂÚÈΤ˜ ÊoÚ¤˜oχ ÛËÌ·ÓÙÈο, ÙȘ „˘¯oÏoÁÈΤ˜ Î·È ÎoÈÓˆÓÈΤ˜ÂÌÂÈڛ˜, Âo̤ӈ˜ Î·È ÙËÓ oÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ·ÓıÚÒˆÓ1. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ Úoo‰Â˘ÙÈ-΋ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÙÂÏÈÎÒÓ ÙÚȯÒÓ ·fi ÌÈÎÚfi-ÙÂÚ˜ ¤ˆ˜ ¯ÓoÒ‰ÂȘ ÙÚ›¯Â˜ Î·È Û˘Ó·ÎfiÏo˘ıË ·Ú·›-ˆÛË Ùo˘ ÙÚȯˆÙo‡ Ù˘ ÎÂÊ·Ï‹˜ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓËÌoÚÊ‹ ·Ó¿ÏoÁ· Ì Ùo ʇÏo.

∂¶π¢∏ªπO§O°ÿ∞ – ∫§π¡π∫◊ ∂π∫Ÿ¡∞OÈ ÂȉËÌÈoÏoÁÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ o˘ ·Ó·Ê¤Úo-ÓÙ·È ÛÙËÓ ∞°∞ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ·ÎÚȂ›˜ ‰ÈfiÙÈ ËηٿÛÙ·ÛË Â›Ó·È ÙfiÛo ÎoÈÓ‹ ÒÛÙ ӷ ıˆÚ›ٷȷfi ÌÂÚÈÎo‡˜ ÌÂÏÂÙËÙ¤˜ ˆ˜ “Ê˘ÛÈoÏoÁÈ΋”2. °ÂÓÈ-ο, ÈÛÙ‡ÂÙ·È fiÙÈ ÚoÛ‚¿ÏÏÂÙ·È Ùo 50% ÙˆÓ ·Ó-

‰ÚÒÓ Î·È Ùo 40% ÙˆÓ Á˘Ó·ÈÎÒÓ Ù˘ ∫·˘Î¿ÛÈ·˜Ê˘Ï‹˜ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 50 ÂÙÒÓ.

À¿Ú¯o˘Ó ‰‡o ÎÏÈÓÈÎo› Ê·ÈÓfiÙ˘oÈ Ù˘ ∞°∞.™ÙoÓ ¿ÚÚÂÓ· ÚoÛ‚¿ÏÏÂÙ·È Ë ÌÂÙˆoÎÚoÙ·ÊÈÎ‹Î·È Ë ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈo¯‹ (∂ÈÎ. 1,2). ∞Ó¿ÏoÁ· ÌÂÙËÓ ¤ÎÙ·ÛË Î·È ÙËÓ ÂÓÙfiÈÛË Ù˘ ·ÏˆÂΛ·˜, o ·Ó-‰ÚÈÎfi˜ Ê·ÈÓfiÙ˘o˜ ÛÙ·‰ÈooÈ‹ıËΠ·fi ÙoÓ Ha-milton3 Î·È ÙÚoooÈ‹ıËΠ·fi ÙoÓ Norwood4 ÛÂ8 (I-VIII) ‚·ıÌ›‰Â˜. ™ÙË Á˘Ó·›Î·, ‰È·ÙËÚÂ›Ù·È ËÌÂوȷ›· ÁÚ·ÌÌ‹ ÙˆÓ ÙÚȯÒÓ Î·È Ë ·ÏˆÂΛ· ·-ÊoÚ¿ ÛÙËÓ ÎoÚfiÓ· Ù˘ ÎÂÊ·Ï‹˜ (∂ÈÎ. 3). ÷ڷ-ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· Ì ȉȷ›ÙÂÚË ‰È·ÁÓˆÛÙÈ΋·Í›· ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛo˘ ·oÙÂÏ› Ë·oÎ¿Ï˘„Ë Ù˘ ·Ú·›ˆÛ˘ Ì ÂÈÎfiÓ· “ÃÚÈÛÙo˘-ÁÂÓÓÈ¿ÙÈÎo˘ ¢¤Ó‰Úo˘”, fiÙ·Ó oÈ ÙÚ›¯Â˜ Ù˘ ÎÂÊ·-Ï‹˜ ¯ˆÚÈÛıo‡Ó Ì ÙËÓ ÎÙ¤Ó· ÛÙo ̤Ûo Î·È o‚ÂÏÈ-·›· (∂ÈÎ. 4). ∏ Á˘Ó·ÈΛo˘ Ù‡o˘ ·ÏˆÂΛ· ÛÙ·-‰ÈooÈ‹ıËΠ·fi ÙoÓ Ludwig5 Û ÙÚÂȘ (I-III)‚·ıÌ›‰Â˜.

220

¶∞£OºÀ™πO§O°ÿ∞Oˆ˜ Ë oÓoÌ·ÙoÏoÁ›· Ù˘ ÓfiÛo˘ ˘o‰ËÏÒÓÂÈ, Ë ·Ó-‰ÚoÁÂÓÂÙÈ΋ ·ÏˆÂΛ· (∞°∞) ¤¯ÂÈ Úo¤Ï¢ÛË ÁÂ-ÓÂÙÈ΋ Î·È oÚÌoÓÈ΋ (·Ó‰ÚoÁfiÓ·). ∏ ‰È·Ù‹ÚËÛË ÙˆÓÙÚȯÒÓ Ù˘ ÎÂÊ·Ï‹˜ ÛÙo˘˜ ¢Óo‡¯o˘˜ ‹Ù·Ó ÁÓˆÛÙ‹·fi ÙËÓ Âo¯‹ Ùo˘ πoÎÚ¿ÙË, ·ÏÏ¿ Ë ÛËÌ·Û›· ÙˆÓ·Ó‰ÚoÁfiÓˆÓ ¤ÁÈÓ ¢ڇÙÂÚ· ÁÓˆÛÙ‹ ÚÈÓ 60 ¤ÙË, fi-Ù·Ó Î·Ù·‰Â›¯ıËΠfiÙÈ o ¢Óo˘¯ÈÛÌfi˜ ÚÈÓ ·fi ÙËÓÂÊ˂›· ÂÌo‰›˙ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ∞°∞, ÂÓÒ ÌÂ-Ù¿ ÙËÓ ÂÊ˂›· ‰È·ÎfiÙÂÈ ÙËÓ Âȉ›ӈۋ Ù˘6. ¶ÚÈÓ25 ¤ÙË ¤ÁÈÓ ۷ʤ˜ fiÙÈ ‰ÂÓ ‹Ù·Ó Ë ÙÂÛÙoÛÙÂÚfiÓË(∆™∆) ·ÏÏ¿ Ë ‰È¸‰ÚoÙÂÛÙoÛÙÂÚfiÓË (¢À∆) Ùo ·ÚÈo˘Â‡ı˘Óo ·Ó‰ÚoÁfiÓo ÁÈ· ÙËÓ ∞°∞ ·Ó‰ÚÈÎo‡ Ê·ÈÓfi-Ù˘o˘. ¶·Ú·ÙËÚ‹ıËÎÂ Û˘ÁÎÂÎÚÈ̤ӷ fiÙÈ ‰ÂÓ ÂΉ‹-

ÏˆÓ·Ó ÙË ÓfiÛo oÈ ¿ÚÚÂÓ˜ Ì ÎÏËÚoÓoÌÈ΋ ·Ó¿Ú-ÎÂÈ· Ù˘ ÈÛoÌÂÚ¿Û˘ ππ Ù˘ 5·–·Ó·ÁˆÁ¿Û˘, Ë o-o›· o‰ËÁ› Û ¯·ÌËÏ¿ ›‰· ¢À∆ Î·È Ê˘ÛÈoÏo-ÁÈο ‹ ·˘ÍË̤ӷ ›‰· ∆™∆7. ∫·Ù·‰Â›¯ıËΠ›-Û˘ fiÙÈ Ë ‰Ú¿ÛË ÙˆÓ ·Ó‰ÚoÁfiÓˆÓ ÛÙ· ·ÙÙ·Ú·-ÛÙfi-¯o˘˜ ÂÎÊÚ¿˙ÂÙ·È Ì¤Ûˆ ÂȉÈÎÒÓ ÚˆÙÂ˚ÓÒÓ, ÙˆÓ·oηÏo˘Ì¤ÓˆÓ “˘o‰o¯¤ˆÓ”, oÈ oo›oÈ ÌÂÙ¿ ÙËÓÂÊ˂›· ÂÓÙo›˙oÓÙ·È Ì¤Û· ÛÙoÓ ˘Ú‹Ó·, Û ˘„ËÏfi-ÙÂÚo ·ÚÈıÌfi ÛÙo˘˜ ·Ó‰ÚoÁoÓoÂÍ·ÚÙÒÌÂÓo˘˜, .¯.Ùo˘ ÁÂÓ›o˘, ·fi Ùo˘˜ ÌË ·Ó‰ÚoÁoÓoÂÍ·ÚÙÒÌÂÓo˘˜ı˘Ï¿Îo˘˜ Ùo˘ ÈÓ›o˘ Ù˘ ÎÂÊ·Ï‹˜2.

™‹ÌÂÚ· ÈÛÙ‡ÂÙ·È fiÙÈ Á‡Úˆ ·fi ÙoÓ ÙÚȯÈÎfiı‡Ï·Îo ‰ËÌÈo˘ÚÁÂ›Ù·È ¤Ó· ÂÚÈ‚¿ÏÏoÓ Ïo‡ÛÈo ÛÂÈÛ¯˘Ú¿ ·Ó‰ÚoÁfiÓ·, ›Ù ̤ۈ Ù˘ ‰Ú¿Û˘ Ù˘ 5·-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 221

∂ÈÎ. 1. ∞Ó‰ÚoÁÂÓÂÙÈ΋ ·ÏˆÂΛ· ¿Ó‰Ú· Ì ÚoÛ‚oÏ‹Ù˘ ÌÂÙˆoÎÚoÙ·ÊÈ΋˜ Î·È ‚ÚÂÁÌ·ÙÈ΋˜ ÂÚÈo¯‹˜.

∂ÈÎ. 3. ∞Ó‰ÚoÁÂÓÂÙÈ΋ ·ÏˆÂΛ· Á˘Ó·›Î·˜ Ì ÙËÓ ¯·Ú·-ÎÙËÚÈÛÙÈ΋ ‰È·Ù‹ÚËÛË Ù˘ ÌÂوȷ›·˜ ÁÚ·ÌÌ‹˜ ÙˆÓ ÙÚȯÒÓ.

∂ÈÎ. 2. ∞Ó‰ÚoÁÂÓÂÙÈ΋ ·ÏˆÂΛ· ¿Ó‰Ú·.∂ÈÎ. 4. ∞Ó‰ÚoÁÂÓÂÙÈ΋ ·ÏˆÂΛ· Á˘Ó·›Î·˜ Ì fi„Ë“ÃÚÈÛÙo˘ÁÂÓÓÈ¿ÙÈÎo˘ ‰¤Ó‰Úo˘”.

·Ó·ÁˆÁ¿Û˘ Ë oo›· ÌÂÙ·‚¿ÏÏÂÈ ÙËÓ ∆™∆ Û ¢À∆,Ë oo›· ¤¯ÂÈ 5 ÊoÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ¯ËÌÈ΋ Û˘ÁÁ¤-ÓÂÈ· Úo˜ Ùo˘˜ ˘o‰o¯Â›˜, ›Ù ̤ۈ Ù˘ 17‚-∏SD(˘‰Úo͢ÛÙÂÚoÂȉÈ΋˜ ‰Â¸‰ÚoÁÂÓ¿Û˘), Ë oo›·ÌÂÙ·ÙÚ¤ÂÈ Ù· ·ÛıÂÓ‹ 17-ÎÂÙoÛÙÂÚoÂȉ‹ Û ∆™∆8,›Ù ̤ۈ Ù˘ ÂÏ·Ùو̤Ó˘ ‰Ú·ÛÙËÚÈfiÙËÙo˜ Ù˘·ÚˆÌ·Ù¿Û˘ Ë oo›· ÌÂÙ·‚oÏ›˙ÂÈ ÙËÓ ∆™∆ Û ÔÈ-ÛÙÚoÁfiÓ·9. ™ÙȘ Á˘Ó·›Î˜ Ë ¢4-·Ó‰ÚoÛÙÂÓ‰ÈfiÓËÙˆÓ ˆoıËÎÒÓ Î·È Ë ‰Â¸‰ÚoÂÈ·Ó‰ÚoÛÙÂÚfiÓË ÙˆÓÂÈÓÂÊÚȉ›ˆÓ ·oÙÂÏo‡Ó Ùo ˘fiÛÙڈ̷ ÁÈ· ÙËÓ ‰È-¸‰ÚoÙÂÛÙoÛÙÂÚfiÓË2.

∆· ·Ó‰ÚoÁfiÓ· ·˘Í¿Óo˘Ó ÙȘ ÌÈÙÒÛÂȘ ÙˆÓ ÎÂÚ·-ÙÈÓo΢ÙÙ¿ÚˆÓ Ùo˘ ¤Íˆ ÂχÙÚo˘ Ù˘ ÙÚ›¯·˜, ÂÊfiÛoÓ‚¤‚·È· ·˘Ù¿ Â›Ó·È Û ÛÙÂÓ‹ Û˘Ó¿ÊÂÈ· Ì Ùo˘˜ ÈÓo-‚Ï¿ÛÙ˜ ÙˆÓ ıËÏÒÓ Ù˘ ÙÚ›¯·˜10. ∏ ·‡ÍËÛË ÙˆÓ ÌÈÙÒ-ÛÂˆÓ o‰ËÁ› Û ÂÈÙ¿¯˘ÓÛË Ùo˘ Ú˘ıÌo‡ ˙ˆ‹˜ Ù˘ ÙÚ›-¯·˜ Î·È Û˘ÓÙfiÌ¢ÛË Ùo˘ ·Ó·ÁÂÓo‡˜ ÛÙ·‰›o˘ Ù˘.ŒÙÛÈ, ‰ÂÓ ÂÈÙÚ¤ÂÙ·È ÛÙËÓ ÙÚ›¯· Ó· ‰È·ÊoÚooÈËı›ϋڈ˜ Ì ·oÙ¤ÏÂÛÌ· Ë ÙÚ›¯· Ó· Á›ÓÂÙ·È oÏo¤Ó· Â-ÚÈÛÛfiÙÂÚo ÎoÓÙ‹ Î·È ÏÂÙ‹ Î·È Ó· ηٷϋÁÂÈ ÛÙo¯Óo‡‰È. ∆o ÁÂÁoÓfi˜ fiÙÈ ˘¿Ú¯o˘Ó ÂÚÈo¯¤˜ ÛÙȘ o-o›Â˜ ·o˘ÛÈ¿˙ÂÈ ·ÎfiÌË Î·È Ùo ¯Óo‡‰È, ı· Ú¤ÂÈ Ó··o‰oı› ÛÙo Ê·ÈÓfiÌÂÓo ÙˆÓ “ÎÂÓÒÓ ı˘Ï¿ÎˆÓ” Û‡Ì-ʈӷ Ì Ùo oo›o ÌÂÛoÏ·‚› ÛËÌ·ÓÙÈÎfi ¯ÚoÓÈÎfi ‰È-¿ÛÙËÌ· ·fi ÙËÓ ÙÒÛË Ù˘ ÙÂÏoÁÂÓo‡˜ ÙÚ›¯·˜ ¤ˆ˜ÙËÓ ·ÓÙÈηٿÛÙ·Û‹ Ù˘ ·fi ÙËÓ ·Ó·ÁÂÓ‹2.

O ‰È·ÊoÚÂÙÈÎfi˜ Ê·ÈÓfiÙ˘o˜ ÙˆÓ ‰‡o ʇψÓÂÚÌËÓ‡ÂÙ·È ·fi ÙË ‰È·ÊoÚÂÙÈ΋ ηٷÓoÌ‹ Ù˘ 5·-·Ó·ÁˆÁ¿Û˘, Ë oo›· Â›Ó·È 3-3,5 ÊoÚ¤˜ ÏÈÁfiÙÂÚoÛ˘¯Ó‹ ÛÙo ̤وo ÙˆÓ Á˘Ó·ÈÎÒÓ ·' fi,ÙÈ ÙˆÓ ·Ó-‰ÚÒÓ, ÙˆÓ ˘o‰o¯¤ˆÓ ÙˆÓ ·Ó‰ÚoÁfiÓˆÓ Ù· oo›·Â›Ó·È ηٿ 40% ÏÈÁfiÙÂÚ· ÛÙȘ Á˘Ó·›Î˜, ÂÓÒ Ë·ÚˆÌ·Ù¿ÛË Â›Ó·È ¤ÍÈ ÊoÚ¤˜ ÂÚÈÛÛfiÙÂÚo ·˘ÍË̤-ÓË ·' fi,ÙÈ ÛÙo˘˜ ¿Ó‰Ú˜9.

¢πÕ°¡ø™∏∏ ∞°∞ ÂÁηı›ÛÙ·Ù·È ‚·ıÌÈ·›· Ì ÙËÓ ¿Úo‰o ÙˆÓÂÙÒÓ. ∏ ‰È¿ÁÓˆÛË Â›Ó·È Û˘Ó‹ıˆ˜ ‡ÎoÏË Ì ÙËÓ·Ó·ÁÓÒÚÈÛË Ù˘ ‰È·ÊoÚÂÙÈ΋˜ ηٷÓoÌ‹˜ Ù˘ ·Ïˆ-ÂΛ·˜ ÛÙ· ‰‡o ʇϷ, ·ÚfiÙÈ Ë ÌÂÙÂÌÌËÓo·˘Ûȷ΋Á˘Ó·›Î· ÌoÚ› Ó· ·Úo˘ÛÈ¿˙ÂÈ ·Ó‰ÚÈÎo‡ Ù‡o˘·ÏˆÂΛ·, Ì ÚoÛ‚oÏ‹ Ù˘ ÌÂÙˆoÎÚoÙ·ÊÈ΋˜ Â-ÚÈo¯‹˜ Î·È Ùo˘ ‚Ú¤ÁÌ·Ùo˜. ∆· ÎÚÈÙ‹ÚÈ· Ù· oo›·ÂÓÈÛ¯‡o˘Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ∞°∞ ÂÚÈÏ·Ì‚¿Óo˘ÓÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛo˘ ÌÂÙ¿ ÙËÓ ÂÊ˂›· Î·È Ùo ıÂÙÈ-Îfi oÈÎoÁÂÓÂÈ·Îfi ÈÛÙoÚÈÎfi ÛÙo˘˜ Û˘ÁÁÂÓ›˜ ·′ Î·È ‚′‚·ıÌo‡11. ™ËÌ·ÓÙÈ΋ ‚o‹ıÂÈ· ÚoÛʤÚÂÈ Ë ‰oÎÈÌ·-Û›· ·fiÛ·Û˘ ÙˆÓ ÙÚȯÒÓ (pull test) Ì ÙËÓ oo›·ÂÍÂÙ¿˙ÂÙ·È Ùo ›‰o˜ 20-40 ÙÚȯÒÓ o˘ ¤ÏÎoÓÙ·È ·fi‰È·ÊoÚÂÙÈΤ˜ ı¤ÛÂȘ Ù˘ ÎÂÊ·Ï‹˜. OÈ ÙÂÏoÁÂÓ›˜ÙÚ›¯Â˜ ‰È·ÈÛÙÒÓoÓÙ·È Â‡ÎoÏ· Ì ÙËÓ ·Ú·Ù‹ÚËÛË

Î·È ÙËÓ „ËÏ¿ÊËÛË Ùo˘ ‚oÏ‚o‡ o oo›o˜ ¤¯ÂÈ ¯¿ÛÂÈÙo ¯ÚÒÌ· Ùo˘ Î·È Â›Ó·È ‰ÈoÁΈ̤Óo˜12.

∆o ÙÚȯfiÁÚ·ÌÌ· ‚oËı¿ ·oηχÙoÓÙ·˜ ÙÂ-ÏoÁÂÓ›˜ ÙÚ›¯Â˜ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 3 cm, ÛÙoȯ›o Ùooo›o ıˆÚÂ›Ù·È ‰È·ÁÓˆÛÙÈÎfi Ù˘ ÓfiÛo˘12. ∏ ‰È¿-ÌÂÙÚo˜ Ùo˘ ÛÙÂϤ¯o˘˜ Ù˘ ÙÚ›¯·˜ oÈΛÏÏÂÈ Ì ÙȘ·Ó·ÁÂÓ›˜ Ó· Â›Ó·È ÏÂÙfiÙÂÚ˜ ·fi 40 Ìm11 Î·È ËÛ¯¤ÛË Ùo˘˜ Úo˜ ÙȘ ÙÂÏoÁÂÓ›˜ Ó· ÌÂÈÒÓÂÙ·È ·fi9:1 Û 4:113. ∆o ʈÙoÙÚȯfiÁÚ·ÌÌ·, ÏÂÙo̤ÚÂȘÙo˘ oo›o˘ ·Ó·Ê¤ÚoÓÙ·È Û ÚoÛÈÙ¿ ÛÙoÓ ‰ÂÚÌ·-ÙoÏfiÁo ¿ÚıÚ·14, ·Ú¤¯ÂÈ ÈÛ¯˘ÚfiÙÂÚ· ‰È·ÁÓˆÛÙÈοÛÙoȯ›· ·ÏÏ¿ ‰ÂÓ ·oÙÂÏ› ÂͤٷÛË Úo˘Ù›Ó·˜. ∏πÛÙoÏoÁÈ΋ ÂͤٷÛË ¯ÚÂÈ¿˙ÂÙ·È ÛÙȘ ÂÚÈÙÒÛÂȘfio˘ ‰ÂÓ ÌoÚ› ÎÏÈÓÈο Ó· ·oÎÏÂÈÛı› Ë inco-gnita Á˘ÚoÂȉ‹˜ ·ÏˆÂΛ· Î·È Ë ¯ÚfiÓÈ· ÙÂÏoÁÂÓ‹˜·ÏˆÂΛ·. ÃÚÂÈ¿˙oÓÙ·È Â·ÓÂÈÏËÌ̤Ó˜ Ùo̤˜, ο-ıÂÙ· ‹ ·Ú¿ÏÏËÏ· Úo˜ ÙȘ ÂÎÊ˘fiÌÂÓ˜ ÙÚ›¯Â˜11,13,ÒÛÙ ӷ Â›Ó·È ‰˘Ó·Ù‹ Ë ÌoÚÊoÌÂÙÚÈ΋ ·Ó¿Ï˘ÛË. ∏∞°∞ ÈÛÙoÏoÁÈο ı· ‰È·ÎÚÈı› Ì ‚¿ÛË ÙËÓ ·‡ÍËÛËÙˆÓ ÂÚÈı˘Ï·ÎÈÎÒÓ ÛÙڈ̿وÓ, ÙËÓ ·o˘Û›· ÏÂÌ-Êo΢ÙÙ·ÚÈÎÒÓ Û˘ÛÛˆÚ‡ÛÂˆÓ Á‡Úˆ ·fi ÙoÓ ‚oÏ-‚fi, ÙËÓ ·o˘Û›· o˘Ï‹˜, ÙË Ì›ˆÛË ÙˆÓ ÙÂÏÈÎÒÓ Î·È·‡ÍËÛË ÙˆÓ ¯Óoˆ‰ÒÓ ÙÚȯÒÓ ÒÛÙÂ Ë ·Ó·ÏoÁ›· Ùo˘˜Ó· Êı¿ÓÂÈ Ùo 1,9 Úo˜ 113.

∂ÎÙÂٷ̤Óo˜ oÚÌoÓÈÎfi˜ ¤ÏÂÁ¯o˜ ı· ¯ÚÂÈ·Ûı›ÛÙËÓ ÚoÂÌÌËÓo·˘Ûȷ΋ Á˘Ó·›Î· Ì ·Ó‰ÚÈÎfi Ê·È-ÓfiÙ˘o ·ÏˆÂΛ·˜ ‹ ÛÙË Û˘Ó‡·ÚÍË ∞°∞ Î·È ·ÎÌ‹˜‹/Î·È ‰·Û˘ÙÚȯÈÛÌo‡15. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙoÓ ¤ÏÂÁ¯oÁÈ· ˆoıËÎÈ΋ (oÏ˘Î˘ÛÙÈ΋ ÓfiÛo) ‹ ÂÈÓÂÊÚȉȷ΋(Û˘ÁÁÂÓ‹˜ ÂÈÓÂÊÚȉȷ΋ ˘ÂÚÏ·Û›· Ì ηı˘ÛÙÂ-ÚË̤ÓË ÂÌÊ¿ÓÈÛË) ˘ÂÚ·Ó‰ÚoÁoÓ·ÈÌ›·15,16. ∆· ›-‰· Ù˘ ÙÂÛÙoÛÙÂÚfiÓ˘, ‰È¸‰ÚoÙÂÛÙoÛÙÂÚfiÓ˘, ÔÈ-ÛÙÚ·‰ÈfiÏ˘ Î·È Î˘Ú›ˆ˜ ÚoÏ·ÎÙ›Ó˘, Ú¤ÂÈ oˆÛ-‰‹oÙ ӷ ÂÚ¢ÓÒÓÙ·È. ∆o Û‡Ó‰ÚÔÌÔ Cushing ÂϤÁ-¯ÂÙ·È Ì ÙË Ì¤ÙÚËÛË Ù˘ ÂχıÂÚ˘ ÎoÚÙÈ˙fiÏ˘ ÙˆÓo‡ÚˆÓ, oÈ fiÁÎoÈ ÙˆÓ ˆoıËÎÒÓ ‹ ÂÈÓÂÊÚȉ›ˆÓ Ì ÙË¢4∞ Î·È ‰Â¸‰ÚoÂÈ·Ó‰ÚoÛÙÂÚfiÓË (DHEAS) Ùo˘·›Ì·Ùo˜, ÂÓÒ Ë ˆoıËÎÈ΋ ‰˘ÛÏÂÈÙo˘ÚÁ›· ı· ·o-ÎÏÂÈÛı› Ì ÙË ¢4∞ Î·È ˆ¯ÚÈÓoÙÚfio Ì·˙› Ì Ùo ÂÓ-‰oÎoÏÈÎfi ˆoıËÎÈÎfi ˘ÂÚ˯oÁÚ¿ÊËÌ·16. ∂ÈÛË-Ì·›ÓÂÙ·È ˆÛÙfiÛo fiÙÈ ÌoÚ› Ó· ÌË ‰È·ÈÛÙˆıo‡Ó ÂÓ-‰oÎÚÈÓoÏoÁÈΤ˜ ·ÏÏoÈÒÛÂȘ ·ÎfiÌË Î·È ÛÙo ™‡Ó‰Úo-Ìo ™∞¢∞ Ùo oo›o Û˘Ó‰˘¿˙ÂÈ ÛÌËÁÌ·ÙfiÚÚoÈ·, ·Î-Ì‹, ‰·Û˘ÙÚȯÈÛÌfi Î·È ·ÏˆÂΛ· ‰È¿¯˘ÙË11. ™ÙȘ Â-ÚÈÙÒÛÂȘ Û˘Ó‡·Ú͢ ∞°∞ Î·È ¯ÚfiÓÈ·˜ ÙÂÏoÁÂ-Óo‡˜ ·ÏˆÂΛ·˜ ı· Ú¤ÂÈ Ó· ÂϤÁ¯oÓÙ·È Ù· ›Â-‰· Ù˘ ı˘Úo͛Ӣ, TSH, Ûȉ‹Úo˘ Î·È ÊÂÚÚÈÙ›Ó˘ o-Úo‡11,14. ÀoÛÙËÚ›˙ÂÙ·È Ì¿ÏÈÛÙ· fiÙÈ ·ÎfiÌË Î·È ÁÈ·ÙËÓ ·Ï‹ ∞°∞ ÙˆÓ Á˘Ó·ÈÎÒÓ Ù· ›‰· Ù˘ ÊÂÚÚÈ-Ù›Ó˘ Î·È ‚ÈÙ·Ì›Ó˘ B12 ı· Ú¤ÂÈ Ó· Â›Ó·È Ùo˘Ï¿¯È-ÛÙoÓ 150 Ìg/L Î·È 300 ng/L ·ÓÙ›ÛÙoȯ·14.

222 °. Ã∞´¢∂ª∂¡O™ KAI ™YN.

™ÙË ‰È·ÊoÚÈ΋ ‰È¿ÁÓˆÛË ı· Û˘ÌÂÚÈÏËÊıo‡ÓoÈ ·ÏˆÂ˘ ‰È¿ÚÎÂÈ·˜ ¿Óˆ Ùo˘ ¤Ùo˘˜ Ì ·ÚÈoÂÎÚfiÛˆo ÙËÓ ¯ÚfiÓÈ· ÙÂÏoÁÂÓ‹ ·ÏˆÂΛ·. ™ÙˉȿÁÓˆÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ ı· ‚oËı‹ÛÂÈ Ë ·Ó¿ÌÓËÛËÙ˘ oÍ›·˜ Î·È ·ÈÊÓ›‰È·˜ ·ÒÏÂÈ·˜ ÙˆÓ ÙÚȯÒÓ, ÙoÈÛÙoÚÈÎfi ÂÂÈÛo‰È·Î‹˜ ÂͤÏÈ͢ Ù˘ ÓfiÛo˘ Î·È ËıÂÙÈ΋ ‰oÎÈÌ·Û›· ·fiÛ·Û˘ ÙˆÓ Â˘ÌÂÁ¤ıˆÓ ÙÂ-ÏoÁÂÓÒÓ ÙÚȯÒÓ ·ÎfiÌË Î·È ·fi Ùo ÈÓ›o. ªoÚ› ‚Â-‚·›ˆ˜ Ó· Û˘Ó˘¿Ú¯o˘Ó Î·È oÈ ‰‡o ÌoÚʤ˜ ·ÏˆÂ-Λ·˜, oÈ oo›Â˜ Û˘Ó·oÙÂÏo‡Ó Ùo 90% fiÏˆÓ ÙˆÓ ·È-ÙÈ¿ÛÂˆÓ ·ÒÏÂÈ·˜ ÙÚȯÒÓ ÌÂٷ͇ ÙˆÓ Ê·ÈÓoÌÂÓÈο˘ÁÈÒÓ Á˘Ó·ÈÎÒÓ14. ∆· ·ÚÈ· ‰È·ÊoÚÈο ÁÓˆÚ›ÛÌ·-Ù¿ Ùo˘˜ ηٷÁÚ¿ÊoÓÙ·È ÛÙoÓ ›Ó·Î· 1.

∞fi ÙȘ Ì·ÎÚoÛÎÂÏ›˜ ÛÂÈÚ¤˜ ÙˆÓ Ê·Ú̿ΈÓÙ· oo›· ÌoÚo‡Ó Ó· ÚoηϤÛo˘Ó ·ÏˆÂΛ·14, ËÚoÛo¯‹ Â›Ó·È ÚoÙÈÌfiÙÂÚo Ó· ÂÛÙÈ·Ûı› ÛÙ· Ϥ-oÓ Û˘¯Ó¿, fiˆ˜ oÈ ‚-·Ó·ÛÙoÏ›˜, Ë·Ú›ÓË, Ï›ıÈo,ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο, ÚÂÙÈÓoÂȉ‹, ·ÌÊÂÙ·-̛Ә, ÂÌ‚fiÏÈ· ȉ›ˆ˜ ηٿ Ù˘ ∏·Ù›Ùȉ·˜ µ, ηÈϤoÓ ÚfiÛÊ·Ù· Ë ÔÌÂÚ·˙fiÏË17. ™ ' fiϘ ÙȘ ÂÚÈ-ÙÒÛÂȘ, Ë Û˘Û¯¤ÙÈÛË Ù˘ ·ÒÏÂÈ·˜ ÙˆÓ ÙÚȯÒÓ Î·ÈÙ˘ Ï‹„˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È Â‡ÎoÏË ÁÈ· ÙoÓ·ÛıÂÓ‹ Î·È ÙoÓ ÂÚˆÙÒÓÙ· È·ÙÚfi. ªÈ· ȉȷ›ÙÂÚ·Û¿ÓÈ· ÌoÚÊ‹ ·ÏˆÂΛ·˜ ÙˆÓ ÚoÂÌÌËÓo·˘ÛÈ·-ÎÒÓ Á˘Ó·ÈÎÒÓ Û˘Ó‰˘¿˙ÂÙ·È Ì ¯·ÌËÏ¿ ›‰· oÈ-ÛÙÚ·‰ÈfiÏ˘ Î·È ÚoÁÂÛÙÂÚfiÓ˘ οو ·fi 300pmol/L Î·È 30 nmol/L ·ÓÙ›ÛÙoȯ·, ηٿ ÙËÓ 21ËË̤ڷ Ùo˘ ·ÎÏo˘14. ™·ÓÈÒÙ·ÙË Â›Ó·È Â›Û˘ Ë›ÎÙËÙË ÙÚÈÁˆÓÈ΋ ÎÚoÙ·ÊÈ΋ ·ÏˆÂΛ· ÙˆÓ ÂÓË-ϛΈÓ18. ∏ ÂÓÙfiÈÛË Î·È o ÌË o˘ÏˆÙÈÎfi˜ ¯·Ú·ÎÙ‹-Ú·˜ Ù˘ ‰ÂÓ ÙËÓ ‰È·ÎÚ›Óo˘Ó ·fi ÙËÓ ∞°∞, ·ÏÏ¿ ›-Ó·È ÂÙÂÚfiÏ¢ÚË Î·È ¤¯ÂÈ ÏoÁ¯oÂȉ¤˜ Û¯‹Ì·.

∏ ‰˘ÛÌoÚÊo‚›· Ì ÙËÓ ·Úo˘Û›· Ê˘ÛÈoÏoÁÈÎo‡ÙÚȯˆÙo‡ Û ηٷӷÁηÛÙÈÎfi ¿ÙoÌo Ùo oo›o ·Ú·-oÓÂ›Ù·È ÁÈ· ÙÚȯfiÙˆÛË, Â›Ó·È ·Û˘Ó‹ıÈÛÙË. ∏ ¤Ú¢-Ó· ÙˆÓ Û¯¤ÛÂˆÓ Ì Ùo ¿ÏÏo ʇÏo ı· ‰ÒÛÂÈ ··ÓÙ‹-ÛÂȘ, ·ÏÏ¿ oÏϤ˜ ÊoÚ¤˜ ı· ¯ÚÂÈ·Ûı› Ë „˘¯È·ÙÚÈ΋˘oÛÙ‹ÚÈÍË19. ™ÙË ‰È·ÊoÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ∞°∞ÌoÚ› Ù¤Ïo˜ Ó· Û˘ÌÂÚÈÏËÊı› Ë ÌË ·Ó·ÁÓˆÚ›ÛÈÌË(incognita) ÌoÚÊ‹ Ù˘ Á˘ÚoÂȉo‡˜ ·ÏˆÂΛ·˜. ∞˘Ù‹Ù·¯¤ˆ˜ ÂÍÂÏ›ÛÛÂÙ·È Û ηıoÏÈ΋ ÓfiÛo Î·È ¯·Ú·ÎÙË-Ú›˙ÂÙ·È ·fi ÙËÓ Ù·¯Â›· Î·È ‰È¿¯˘ÙË ·ÒÏÂÈ· ÙˆÓ ÙÚÈ-

¯ÒÓ Î·È Ùo ¤ÓÙoÓ· ıÂÙÈÎfi Pull Test ÁÈ· ÙÂÏoÁÂÓ›˜ÙÚ›¯Â˜ ·' fiϘ ÙȘ ı¤ÛÂȘ Ù˘ ÎÂÊ·Ï‹˜. ∏ ̄ ÚfiÓÈ· ‰È¿-¯˘ÙË Á˘ÚoÂȉ‹˜ ·ÏˆÂΛ· Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·Î·È ÌoÚ› Ó· ÌË Û˘Óo‰Â‡ÂÙ·È ·fi ÂÓÂÚÁfi ÙÚȯfiÙˆ-ÛË20. ™˘Ó‹ıˆ˜ fï˜ ·ÎoÏo˘ı› Ù˘È΋ ÓfiÛo ‹ ˘¿Ú-¯ÂÈ ıÂÙÈÎfi ·ÙoÌÈÎfi ÈÛÙoÚÈÎfi.

£∂ƒ∞¶∂À∆π∫◊ ∞¡∆πª∂∆fl¶π™∏¢È·ÎÚ›ÓÂÙ·È ÛÙË Û˘ÓÙËÚËÙÈ΋ Î·È ¯ÂÈÚo˘ÚÁÈ΋. ™'fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ı· Ú¤ÂÈ Ó· ÚoËÁÂ›Ù·È ËÏ‹Ú˘ ÂÓË̤ڈÛË Ùo˘ ·ÛıÂÓo‡˜ Û¯ÂÙÈο Ì ÙËÓ·ıoÁ¤ÓÂÈ· Ù˘ ∞°∞, ÙËÓ oÈΛÏÏo˘Û· oÚ›· ÙË˜Î·È Ù· ·Ó·ÌÂÓfiÌÂÓ· ·o ÙË ıÂڷ›· ·oÙÂϤÛÌ·-Ù·. ∏ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ·ÓÙÈ·Ó-‰ÚoÁfiÓ· Î·È Ùo˘˜ ·˘ÍËÙÈÎo‡˜ Ù˘ ·Ó·ÁÂÓo‡˜ Ê¿Û˘·Ú¿ÁoÓÙ˜12,14.

∆· ·ÓÙÈ·Ó‰ÚoÁfiÓ· ‰È·ÎÚ›ÓoÓÙ·È ÛÙo˘˜ ·ÓÙ·-ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘o‰o¯¤ˆÓ (·ÏËı‹ ·ÓÙÈ·Ó‰ÚoÁfiÓ·),oÈ oo›oÈ ¯ÚËÛÈÌooÈo‡ÓÙ·È ÌfiÓo ÛÙȘ Á˘Ó·›Î˜,Î·È ÛÙo˘˜ ·Ó·ÛÙoÏ›˜ Ù˘ 5· ·Ó·ÁˆÁ¿Û˘, Ì ·-ÚÈo ÂÎÚfiÛˆo ÙË ÊÈÓ·ÛÙÂÚ›‰Ë, Ë oo›· ¯ÚËÛÈÌo-oÈÂ›Ù·È ÛÙo˘˜ ¿Ó‰Ú˜ Î·È Û ÂÈÏÂÁ̤Ó˜ ÂÚÈ-ÙÒÛÂȘ Á˘Ó·ÈÎÒÓ ÌÂÙÂÌÌËÓo·˘Ûȷ΋˜ ËÏÈΛ·˜.∆· ·ÏËı‹ ·ÓÙÈ·Ó‰ÚoÁfiÓ· ‰È·ÎÚ›ÓoÓÙ·È ÛÙËÓ ÔÍÂÈ-΋ ΢ÚoÙÂÚfiÓË, ÙË ÊÏo˘Ù·Ì›‰Ë Î·È ÙË ÛÈÚoÓoÏ·-ÎÙfiÓË. ∏ ÔÍÂÈ΋ ΢ÚoÙÂÚfiÓË Û ‰fiÛË 50 mg ·fiÙËÓ 5Ë ¤ˆ˜ 15Ë Ë̤ڷ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂıÈ-Ó˘ÏoÈÛÙÚ·‰ÈfiÏË ·fi ÙËÓ 5Ë ¤ˆ˜ 24Ë Ë̤ڷ Ùo˘ ·-ÎÏo˘ ‰È·ÎfiÙo˘Ó ‰Ú·ÛÙÈο ÙËÓ ÂͤÏÈÍË Ù˘ ÙÚȯfi-ÙˆÛ˘ Î·È ‚ÂÏÙÈÒÓo˘Ó ÙËÓ ÙÚȯoÊ˘˚· ÛÙo 1/3 ÙˆÓ·ÛıÂÓÒÓ. ÀoÛÙËÚ›˙ÂÙ·È fiÙÈ Ù· ˘„ËÏ¿ ›‰·ÊÂÚÚÈÙ›Ó˘, ¿Óˆ ÙˆÓ 40 Ìm/L ·›˙o˘Ó ÛËÌ·ÓÙÈÎfiÚfiÏo ÛÙo ηÏfi ·oÙ¤ÏÂÛÌ·21. ∏ Û‡Á¯ÚoÓË ¯oÚ‹ÁË-ÛË 100-200 Ìg µÈÙ·Ì›Ó˘ µ12 ÈÛÙ‡ÂÙ·È fiÙÈ Úo-Ï·Ì‚¿ÓÂÈ ÙËÓ Î·Ù¿ıÏÈ„Ë Ë oo›· Û˘Ó‹ıˆ˜ Û˘Óo-‰Â‡ÂÈ ÙËÓ ·ÓˆÙ¤Úˆ ·ÓÙÈ·Ó‰ÚoÁfiÓo ıÂڷ›·22.

H ¯oÚ‹ÁËÛË Û΢·ÛÌ¿ÙˆÓ oÈÛÙÚ·‰ÈfiÏ˘ ηÈÔÍÂÈ΋˜ ΢ÚoÙÂÚfiÓ˘ Û ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ·(.¯ 2 mg) ÌoÚ› Ó· ‚oËı‹ÛÂÈ ÛÙoÓ Û˘Ó˘¿Ú¯oÓÙ·‰·Û˘ÙÚȯÈÛÌfi, ·ÏÏ’ fi¯È ÛÙËÓ ∞°∞14. ∏ ÛÈÚoÓoÏ·-ÎÙfiÓË ‰Ú· ÛÙo˘˜ ˘o‰o¯Â›˜ Î·È ÌÂÈÒÓÂÈ Ù· ›‰·

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 223

¶›Ó·Î·˜ 1. ¢È·ÊoÚo‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÌÂٷ͇ Ù˘ ¯ÚfiÓÈ·˜ ÙÂÏoÁÂÓo‡˜ Î·È ·Ó‰ÚoÁÂÓÂÙÈ΋˜ ·ÏˆÂΛ·˜ ÛÙË Á˘Ó·›Î·

ÃÚfiÓÈ· ∆ÂÏoÁÂÓ‹˜ ∞Ó‰ÚoÁÂÓÂÙÈ΋

OÁÎo˜ Ì·ÏÏÈÒÓ ªÂȈ̤ÓË o˘Ú¿ (Pony) ªÂȈ̤ÓË ÛÙo ‚Ú¤ÁÌ·¢È¿ÎÂÓ· ÛÙo ÎÙ¤ÓÈÛÌ· ∞ÌÂÙ¿‚ÏËÙË ∞˘ÍË̤Ó˶˘ÎÓfiÙËÙ· ÙÚȯÒÓ º˘ÛÈoÏoÁÈ΋ ªÂȈ̤Ó˪Âوȷ›· ÁÚ·ÌÌ‹ ∫oÓÙ‹, ÌË ¯Óo҉˘ ÙÚ›¯· (ÌÂÙˆoÎÚoÙ·ÊÈ΋) ¢È·Ù‹ÚËÛË (ÂÎÙfi˜ ·fi ˘ÂÚ·Ó‰ÚoÁoÓ·ÈÌ›·)™˘¯ÓfiÙËÙ· ¯ÓoÒ‰o˘˜ ÙÚ›¯·˜ ∞ÌÂÙ¿‚ÏËÙË ∞˘ÍË̤ÓË∆ÂÏoÁÂÓ›˜ ∞˘ÍË̤Óo˜ ·ÚÈıÌfi˜ ™ÙËÓ ÂÓÂÚÁfi Ê¿ÛË

Ù˘ 17‚-˘‰ÚoÍ˘Ï¿Û˘ Î·È ‰ÂÛÌoÏ¿Û˘, Ù· oo›·¯ÚÂÈ¿˙oÓÙ·È ÁÈ· ÙË Û‡ÓıÂÛË ÙˆÓ ·Ó‰ÚoÁfiÓˆÓ. ∂¯ÂÈÚoÙ·ı› Ë ¯oÚ‹ÁËÛË 200 mg/ËÌ Î·È ¤¯ÂÈ ·Ó·ÊÂÚ-ı› ηı˘ÛÙ¤ÚËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ∞°∞23. OÈ Â-ÚÈÛÛfiÙÂÚoÈ ˆÛÙfiÛo Û˘ÁÁÚ·Ê›˜ ÚoÙÈÌo‡Ó ÙËÓ Ô-ÍÂÈ΋ ΢ÚoÙÂÚfiÓË ·fi ÙË ÛÈÚoÓoÏ·ÎÙfiÓË14. ∏ÊÏo˘Ù·Ì›‰Ë, fiˆ˜ Î·È Ë ÛÈÚoÓoÏ·ÎÙfiÓË, Â›Ó·È Â-ÚÈÛÛfiÙÂÚo ‰Ú·ÛÙÈ΋ ÛÙo ‰·Û˘ÙÚȯÈÛÌfi Î·È ÙË ÛÌË-ÁÌ·ÙfiÚÚoÈ· ·Ú¿ ÛÙËÓ ∞°∞24. ∂¯ÂÈ Â›Û˘ ¯ÚËÛÈ-ÌooÈËı› Î·È ˆ˜ ÙoÈÎfi ‰È¿Ï˘Ì· 5%2. ∂Ó· ¿ÏÏoÙoÈÎfi ·ÓÙÈ·Ó‰ÚoÁfiÓo Ùo oo›o ¤¯ÂÈ ‰oı› Û ÂÈ-Ú·Ì·Ùfi˙ˆ· Ì ÂÏȉoÊfiÚ· ·oÙÂϤÛÌ·Ù· Â›Ó·È ÙoRU 5884114.

∏ ÊÈÓ·ÛÙÂÚ›‰Ë Â›Ó·È ¤Ó· 4-·˙·ÛÙÂÚoÂȉÈÎfi·Ú¿ÁˆÁo Ùo oo›o ·ÓÙ·ÁˆÓÈÛÙÈο ÛÙ·Ì·Ù¿ ÙˉڿÛË Ùo˘ ÈÛoÂÓ˙‡Ìo˘ 2 Ù˘ 5 ·-·Ó·ÁˆÁ¿Û˘, o‰Ë-ÁÒÓÙ·˜ ÛÙË Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ‰È¸‰ÚoÙÂÛÙo-ÛÙÂÚfiÓ˘ ÛÙo ‰¤ÚÌ· Ùo˘ ÙÚȯˆÙo‡ Î·È ÛÙoÓ oÚfi25.™Â ‰ÈϤ˜, Ù˘ÊϤ˜ ÂÏÂÁ̤Ó˜ ÌÂϤÙ˜ ¤¯ÂÈ ·o‰ÂÈ-¯ı› ‰Ú·ÛÙÈ΋ ÛÙË ‰È·Îo‹ Ù˘ ¤ÎÙ·Û˘ Ù˘∞°∞ Ùo˘ ¿Ó‰Ú· Ì ÌÂÙˆoÎÚoÙ·ÊÈ΋ ‹ ‚ÚÂÁÌ·ÙÈ-΋ ÂÓÙfiÈÛË26. ∏ ‰fiÛË 1 mg/kg/ËÌ. ÚoÛʤÚÂÈ ‚ÂÏ-Ù›ˆÛË Ë oo›· Á›ÓÂÙ·È ÂÌÊ·Ó‹˜ ÛÙo˘˜ 3-6 Ì‹Ó˜ ηȷÊoÚ¿ ÛÙo 50% ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ 1 ¤Ùo˜ Î·È 68%ÌÂÙ¿ 2 ¤ÙË ¯oÚ‹ÁËÛ˘12. OÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂÈ-˜ oÈ oo›Â˜ ·Ú·ÙËÚo‡ÓÙ·È ÛÙo 2% ÙˆÓ ·ÛıÂÓÒÓ,ÂÚÈÏ·Ì‚¿Óo˘Ó ÌÂȈ̤ÓË libido, ‰È·Ù·Ú·¯‹ ÛÙ‡-Û˘ Î·È Ì›ˆÛË Ùo˘ ÛÂÚÌ·ÙÈÎo‡ fiÁÎo˘. ¶·Ú·ÙË-Úo‡ÓÙ·È fï˜ ÂÏ¿¯ÈÛÙ· Û˘¯ÓfiÙÂÚ· ·fi ÙËÓ oÌ¿‰·ÂϤÁ¯o˘ Î·È oˆÛ‰‹oÙ ÂÍ·Ê·Ó›˙oÓÙ·È Ì ÙË ‰È·-Îo‹ ‹ ·ÎfiÌË Î·È ÙË Û˘Ó¤¯ÈÛË Ùo˘ Ê·ÚÌ¿Îo˘12,26.

O ÙÚfio˜ ‰Ú¿Û˘ Ù˘ ÌÈÓoÍȉ›Ï˘ ÂÚÂ˘Ó¿Ù·È·ÎfiÌË. In vitro ÛÙȘ ηÏÏȤÚÁÂȘ, ·˘Í¿ÓÂÈ ÙoÓ ¯Úfi-Óo ÂÈ‚›ˆÛ˘ ÂÈ‚Ú·‰‡ÓoÓÙ·˜ ÙË Á‹Ú·ÓÛË ÙˆÓ ·Ó-ıÚÒÈÓˆÓ ÎÂÚ·ÙÈÓo΢ÙÙ¿ÚˆÓ27. ∂›Û˘ Úo¿ÁÂÈ ÙËÓ·ÁÁÂÈoÁ¤ÓÂÛË ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ıËÏÒÓ, ·ÚfiÙÈ Ë ·Á-ÁÂÈo‰È·ÛÙoÏ‹ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙËÓ ·‡ÍË-ÛË Ù˘ ÙÚ›¯·˜11. ¶Ï¤oÓ ÚfiÛÊ·Ù· ‰È·ÈÛÙÒıËΠfiÙÈ·˘Í¿ÓÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ 17‚-˘‰Úo͢ÛÙÂÚoÂÈ-‰È΋˜ ‰Â¸‰ÚoÁÂÓ¿Û˘ Î·È Ù˘ 5·-·Ó·ÁˆÁ¿Û˘ ÛÙȘηÏÏȤÚÁÂȘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ·ÓıÚÒÈÓˆÓ ÙÚȯÈ-ÎÒÓ ı˘Ï¿ÎˆÓ ÙˆÓ ·ÏˆÂÎÈ·ÛÈÎÒÓ ı¤ÛÂˆÓ Ù˘ ÎÂ-Ê·Ï‹˜28, ‡ÚËÌ· ·ÍÈoÏoÁ‹ÛÈÌo ÛÙo Ï·›ÛÈo ÙˆÓ·Ó·ÊÂÚı¤ÓÙˆÓ ‹‰Ë ÛÙËÓ ·ıoÁ¤ÓÂÈ· Ù˘ ∞°∞.

∏ ÌÈÓoÍȉ›ÏË Â›Ó·È ‰Ú·ÛÙÈ΋ fiÙ·Ó ¯ÚËÛÈÌooÈ-Â›Ù·È ÛÙË ‰È¿¯˘ÙË ∞°∞ ÙˆÓ ·Ó‰ÚÒÓ (Ù‡o˜ Lud-wig), fio˘ ıˆÚÂ›Ù·È fiÙÈ ¤¯ÂÈ Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛËÛÙo˘˜ “ÎÂÓo‡˜”, Û ‡ÓˆÛË ı˘Ï¿Îo˘˜14. ∂Ê·ÚÌfi-˙ÂÙ·È Û oÛfiÙËÙ· 1 ml ‰‡o ÊoÚ¤˜ ÙË Ì¤Ú·, Ì ȉÈ-·›ÙÂÚË ¤Ó‰ÂÈÍË ÛÙË ‚ÚÂÁÌ·ÙÈ΋ ·ÏˆÂΛ·, fiÙ·Ó·˘Ù‹ ¤¯ÂÈ ‰È¿ÌÂÙÚo ÌÈÎÚfiÙÂÚË ÙˆÓ 10 cm (ÛÙ¿‰Èo

IV ηٿ Hamilton) Î·È ‰È¿ÚÎÂÈ· ÓfiÛo˘ ÌÈÎÚfiÙÂÚËÙˆÓ 5 ÂÙÒÓ12. OÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÂÚÈÏ·Ì-‚¿Óo˘Ó ÙËÓ ·ÏÏÂÚÁÈ΋ ÂÍ Â·Ê‹˜ ‰ÂÚÌ·Ù›Ùȉ· ηÈÙËÓ ÙoÈ΋ ‹ ·oÌ·ÎÚ˘Ṳ̂ÓË ˘ÂÚÙÚ›¯ˆÛË, Ëoo›· Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌË Î·È ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹-ıˆ˜ Ì ÙËÓ ˘ÎÓfiÙËÙ· 5%29. ™ÙȘ Á˘Ó·›Î˜ ¤¯ÂÈ ÂÈ-Ùڷ› ÌfiÓoÓ Ë ˘ÎÓfiÙËÙ· 2%. ∆· ·oÙÂϤÛÌ·Ù·Â›Ó·È ÂÌÊ·Ó‹ ÌÂÙ¿ 6 Ì‹Ó˜ Î·È ÎoÛÌËÙÈο ·o‰Â-ÎÙ¿ ÛÙo 40-60% ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ¤Ó· ¤Ùo˜. ∂Í·-Ê·Ó›˙oÓÙ·È fï˜ ÛÙo˘˜ 6 Ì‹Ó˜ o˘ ·ÎoÏo˘ıo‡Ó ÙˉȷÎo‹ Ùo˘ Ê·ÚÌ¿Îo˘30. O Û˘Ó‰˘·ÛÌfi˜ ÌÈÓoÍȉ›-Ï˘ Î·È ÙÚÂÙÈÓo˚Ó˘ 0,025%, Ë oo›· Ú˘ıÌ›˙ÂÈ ÙËÓ·‡ÍËÛË Î·È ‰È·ÊoÚoo›ËÛË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘Ù-Ù¿ÚˆÓ, ı· ÌoÚo‡Û ӷ ‚oËı‹ÛÂÈ ÂÚÈÛÛfiÙÂÚo ÂÊ’fiÛoÓ ˘‹Ú¯Â Ë ‰˘Ó·ÙfiÙËÙ· Û˘Û΢·Û›·˜ Û ¤Ó·Úo˚fiÓ Î·È Ë ·oÊ˘Á‹ Ùo˘ ÂÚÂıÈÛÌo‡ ·fi ÙËÓ ÙÚÂ-ÙÈÓo˚ÓË11. O Û˘Ó‰˘·ÛÌfi˜ ÊÈÓ·ÛÙÂÚ›‰Ë˜–ÌÈÓoÍȉ›-Ï˘ ¤¯ÂÈ ‰Â›ÍÂÈ ‰Ú·ÛÙÈ΋ Û˘Ó¤ÚÁÂÈ· ÛÙ· ÂÈÚ·Ì·-Ùfi˙ˆ·, ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ¯ÚËÛÈÌooÈËı› ¢ڤˆ˜ÛÙo˘˜ ·ÓıÚÒo˘˜12.

OϘ oÈ Ì¤ıo‰oÈ Û˘ÓÙËÚËÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘o˘ ¤¯o˘Ó ÂÚÈÁÚ·Ê› ¤¯o˘Ó ·Úo‰ÈÎfi ·oÙ¤ÏÂ-ÛÌ· ‰ÈfiÙÈ Ë ∞°∞ ·ÓÂÌÊ·Ó›˙ÂÙ·È Ì ÙË ‰È·Îo‹Ùo˘˜. OÙ·Ó Ë ·ÏˆÂΛ· Â›Ó·È Û Úo¯ˆÚË̤Óo ÛÙ¿-‰Èo (Ù‡o˜ VI Î·È VII ηٿ Hamilton) Î·È ÛÙȘ Â-ÚÈÙÒÛÂȘ fio˘ Ë Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ·oÙ˘Á¯¿-ÓÂÈ, Ë ¯ÂÈÚo˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Ë Î·Ï‡ÙÂÚËÂÈÏoÁ‹12. ∞˘Ù‹ fï˜ ‰ÂÓ ÂӉ›ÎÓ˘Ù·È ÛÙo˘˜ Ó·-Úo‡˜ ·ÛıÂÓ›˜ Ì ÚÒÈÌË ∞°∞ Ë oo›· ÌoÚ› Ó·ÂÍÂÏȯı› Î·È ÌÂÙ¿ ÙË ¯ÂÈÚo˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË11.¶¿ÓÙˆ˜, ÙËÓ ÙÂÏÂ˘Ù·›· ÌoÚ› Ó· ·ÎoÏo˘ı‹ÛÂÈ ËÛ˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙË ‰È·Ù‹ÚËÛË Î·È ‚ÂÏÙ›ˆÛËÙˆÓ ·oÙÂÏÂÛÌ¿ÙˆÓ. ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙˆÓ ÙÚȯÒÓÌ ÌÈÓÈ/ÌÈÎÚo ·˘ÙoÌoۯ‡̷ٷ31 Î·È ÌÈ· ÛÂÈÚ¿ ÓÂ-fiÙÂÚˆÓ Ù¯ÓÈÎÒÓ fiˆ˜ Ùo˘ Strip Harvesting, fio˘¯ÚËÛÈÌooÈo‡ÓÙ·È oÏϷϤ˜ Ï›‰Â˜, ‰›‰o˘Ó Îo-ÛÌËÙÈο ·oÙÂϤÛÌ·Ù· ˘„›ÛÙ˘ oÈfiÙËÙ·˜32.

™Àª¶Œƒ∞™ª∞∆· ÙÂÏÂ˘Ù·›· 60 ¤ÙË ¤¯ÂÈ ÚoˆıËı› Ë ¤Ú¢ӷ Û¯Â-ÙÈο Ì ÙËÓ ·ıoÁ¤ÓÂÈ· Ù˘ ∞°∞ Î·È ÙË ÛËÌ·Û›·ÙˆÓ ·Ó‰ÚoÁfiÓˆÓ. ¶Ï¤oÓ ÚfiÛÊ·Ù·, ¤ÁÈÓ ÚoÛ¿-ıÂÈ· ηıoÚÈÛÌo‡ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ o˘Â˘ı‡ÓoÓÙ·È ÁÈ’ ·˘Ù‹Ó. ŒÙÛÈ, ÂÚ¢ӋıËÎ·Ó Ù· ÁoÓ›-‰È· Ù· oo›· Έ‰ÈÎooÈo‡Ó ÙËÓ ¤ÎÊÚ·ÛË Ùo˘mRNA Ù˘ 5·-·Ó·ÁˆÁ¿Û˘ ‹ ÙˆÓ ˘o‰o¯¤ˆÓ ÙˆÓ·Ó‰ÚoÁfiÓˆÓ33, o ÚfiÏo˜ ÙˆÓ oo›ˆÓ ÛÙËÓ ÂΉ‹ÏˆÛËÙ˘ ∞°∞ Â›Ó·È ÁÓˆÛÙfi˜. ™Ùo ı¤Ì· Ù˘ ·ÓÙÈÌÂÙÒÈ-Û˘ Ù˘ ÓfiÛo˘ ¤¯o˘Ó Û˘ÁÎÂÎÚÈÌÂÓooÈËı› oÈ Î˘Ú›-·Ú¯Â˜ ÂÈÏoÁ¤˜: °È· ÙË Á˘Ó·›Î· ÚoÙ›ÓÂÙ·È ÙoÈ-ο Ë ÌÈÓoÍȉ›ÏË 2% Î·È Û˘ÛÙËÌ·ÙÈο Ë oÍÂÈ΋ ΢-

224 °. Ã∞´¢∂ª∂¡O™ KAI ™YN.

ÚoÙÂÚfiÓË Ì ÂıÈÓ˘ÏoÈÛÙÚ·‰ÈfiÏË, ȉȷ›ÙÂÚ· fiÙ·Ó˘¿Ú¯ÂÈ ˘ÂÚ·Ó‰ÚoÁoÓ·ÈÌ›·. ™ÙoÓ ¿Ó‰Ú· ÚoÙÈ-Ì¿Ù·È Ë ÌÈÓoÍȉ›ÏË 5% Î·È Ë ÊÈÓ·ÛÙÂÚ›‰Ë, Ë oo›·Û ÂÍ·ÈÚÂÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÌoÚ› Ó· ¯ÚËÛÈÌo-oÈËı› Î·È ÛÙË ÌÂÙÂÌÌËÓo·˘Ûȷ΋ Á˘Ó·›Î·. OÙo̤·˜ ÛÙoÓ oo›o Ú¤ÂÈ Ó· ¢·ÈÛıËÙooÈËı› oÈ·ÙÚÈÎfi˜ ÎfiÛÌo˜ ·ÊoÚ¿ ÛÙËÓ oÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ·Û¯fiÓÙˆÓ ·fi ∞°∞. OÈ Á˘Ó·›Î˜ Û˘Ó‹ıˆ˜ ·Ú·-oÓo‡ÓÙ·È fiÙÈ Ù· Úo‚Ï‹Ì·Ù· Ì ٷ Ì·ÏÏÈ¿ Ùo˘˜‰ÂÓ ·ÓÙÈÌÂÙˆ›˙oÓÙ·È Ì ÙË ‰¤o˘Û· ÚoÛo¯‹ ηÈÛo‚·ÚfiÙËÙ· ·fi Ùo˘˜ È·ÙÚo‡˜. πÛˆ˜ ·˘Ùfi˜ Â›Ó·È oÏfiÁo˜ ÁÈ· ÙoÓ oo›o oÈ 3 ÛÙȘ 4 ‰ÂÓ ˙ËÙo‡Ó ÂȉÈ΋‰ÂÚÌ·ÙoÏoÁÈ΋ ‚o‹ıÂÈ· Î·È Û˘Ó¯›˙o˘Ó Ó· ÂÈÛΤ-ÙoÓÙ·È ÛÙo ›‰Èo oÛoÛÙfi Ùo˘˜ ‰ÂÚÌ·ÙoÏfiÁo˘˜ È·-ÙÚo‡˜, Ùo˘˜ ÁÂÓÈÎo‡˜ È·ÙÚo‡˜, Ùo˘˜ ÎoÌ̈٤˜ ηȷÎfiÌË Û˘¯ÓfiÙÂÚ· Ùo˘˜ Ê·ÚÌ·ÎooÈo‡˜14.

ABSTRACTChaidemenos G.Ch, Chrysomallis F. Androge-netic alopecia. Hell Iatr 2000, 66: 220 - 226.

Androgenetic alopecia is the commonest formof hair loss in human. Its pathophysiology has beenmostly clarified. Genetic factors permit the develop-ment of a hair environment that is rich in powerfulandrogens. The subsequent increase of the mitosesof keratinocytes lead to an imperfect differentiationand a short life span of the hairs. Newer treatmentmodalities consisting of true antiandrogens, such ascyproterone acetate, flutamide and spironolactone,for women and 5-a reductase inhibitors, such asfinasteride, for men have been used with success.Topical drugs with as yet unknown mode of action,such as Minoxidil, are also beneficial. However,these favorable effects are temporary. Surgicaltechniques and Laser procedures are impressiveand promising.

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33. Carey A, Waterworth D, Patel K, White D, Little J, NovelliP, et al. Polycystic ovaries and premature male patternbaldness are associated with one allele of the steroidmetabolism gene CYP17. Hum Mol Genet 1994, 3:1873-6.

AÏÏËÏÔÁÚ·Ê›·:°. ÷˚‰Â̤Óo˜NoÛÔÎÔÌ›ÔAÊÚÔ‰ÈÛ›ˆÓÎ·È ¢ÂÚÌ·ÙÈÎÒÓ NfiÛˆÓ÷ÏÎȉÈ΋˜ 51,54644 – £ÂÛ/Ó›ÎË

Corresponding author:G. ChaidemenosHospital of Venereal andSkin Diseases51 Halkidikis Str.546 44 – Thessaloniki,Greece

226 °. Ã∞´¢∂ª∂¡O™ KAI ™YN.

M˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ·

B·ÛÈÏ›· °·Ú˘›‰Ô˘

B′ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋, A¶£, NÔÛÔÎÔÌÂ›Ô IÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë. M ÙÔÓ fiÚÔ M˘ÂÏÔ‰˘ÛÏ·ÛÙÈο ™‡Ó‰ÚÔ-Ì· (M¢™) ÂÚÈÁÚ¿ÊÂÙ·È ÂÙÂÚÔÁÂÓ‹˜ ÔÌ¿‰· ÎψÓÈ-ÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢Ù-Ù¿ÚÔ˘ (stem cell), ÚˆÙÔ·ıÒÓ Î·È ‰Â˘ÙÂÚÔ·ıÒÓ,Ì ·˘Í·ÓfiÌÂÓË Èı·Ófiٷٷ Û˘¯ÓfiÙËÙ· Ù· ÙÂÏ¢-Ù·›· ¯ÚfiÓÈ·, Ô˘ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ¿ÙÔÌ· ÌÂÁ¿Ï˘ËÏÈΛ·˜. T· M¢™ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ΢ÙÙ·ÚÔ‚ÚÈ-ı‹ ‹ Î·È ˘ÂÚÏ·ÛÙÈÎfi Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È Î˘ÙÙ·-ÚÔÂӛ˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Ì ·ÔÙ¤ÏÂÛÌ· ·Ó·È-Ì›·, ÏÔÈÌÒÍÂȘ ‹ ·ÈÌÔÚÚ·Á›Â˜. ™ÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘“ÌË ·Ô‰ÔÙÈ΋˜” ·˘Ù‹˜ ·ÈÌÔÔ›ËÛ˘ Ê·›ÓÂÙ·È fiÙÈÛËÌ·ÓÙÈÎfi ÚfiÏÔ ·›˙ÂÈ Ô Ì˯·ÓÈÛÌfi˜ Ù˘ ·fiÙˆ-Û˘. ¶ÔÏϤ˜ ·fi ÙȘ ηٷÛÙ¿ÛÂȘ ·˘Ù¤˜ ÂÍÂÏ›ÛÛÔ-ÓÙ·È ÙÂÏÈο Û OÍ›· M˘ÂÏÔÁÂÓ‹ §Â˘¯·ÈÌ›· (OM§),ÂÓÒ Ë ÂÈ‚›ˆÛË ÔÈΛÏÏÂÈ ·fi οو ·fi 1 ̤¯ÚÈ Ô-χ ¿Óˆ ·fi 5 ¤ÙË. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È Ù· ÂÚÁ·ÛÙËÚÈ·-ο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ Â›Ó·È ‚·ÛÈοÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È Ë Î·Ù¿Ù·ÍË FAB Û ¤ÓÙ ˘Ô-ÔÌ¿‰Â˜Ø ÙËÓ ·ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· (RA), ÙËÓ ·ÓıÂÎÙÈ΋·Ó·ÈÌ›· Ì ÛȉËÚÔ‚Ï¿ÛÙ˜ (RARS), ÙË ¯ÚÔÓ›· Ì˘ÂÏÔ-ÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·(CMML), ÙËÓ ·ÓıÂÎÙÈ΋ ·-Ó·ÈÌ›· Ì ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ (RAEB) ηÈÙËÓ ·ÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì ÂÚ›ÛÛÂÈ· ‚Ï·ÛÙÒÓ Û ÌÂ-

Ù·ÙÚÔ‹ (RAEBT). H ηٿٷÍË FAB ·Ú’ fiÙÈ ¤Ù˘¯Â¢Ú›·˜ ·Ô‰Ô¯‹˜ Î·È ‚Ô‹ıËÛ ÛËÌ·ÓÙÈο ÛÙË ÌÂϤ-ÙË ÙˆÓ M¢™ Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Î·Ï‡ÙÂÈ Ï‹Úˆ˜ ÙÔÊ¿ÛÌ· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ÔÏÔ¤Ó· ‰È¢ڇÓÂÙ·È Î·È¯Ú‹˙ÂÈ ·Ó·ıÂÒÚËÛ˘ Û ÔÚÈṲ̂ӷ ÛËÌ›· Ù˘. I‰È·›-ÙÂÚË ¤ÌÊ·ÛË ‰›ÓÂÙ·È ÛÙ· Â˘Ú‹Ì·Ù· Ù˘ ΢ÙÙ·ÚÔÁÂ-ÓÂÙÈ΋˜ ·Ó¿Ï˘Û˘ Ô˘ Ì·˙› Ì ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·-ÛÙÒÓ ÙÔ˘ Ì˘ÂÏÔ‡ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ·ÚÔÂ-ÓÈÒÓ ·ÔÙÂÏÔ‡Ó Ù· ‚·ÛÈο ÚÔÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·Û‡Ìʈӷ Ì ÙÔ ‰ÈÂıÓ¤˜ ÚÔÁÓˆÛÙÈÎfi Û‡ÛÙËÌ· ‚·ı-ÌÔÏfiÁËÛ˘ ÁÈ· Ù· M¢™. OÈ ıÂڷ¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ÔÈΛÏÏÔ˘Ó ·fi ηÌÌ›· ıÂڷ›· ̤¯ÚÈ ÙË ÌÂÙ·Ìfi-Û¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. XËÌÂÈÔıÂڷ›· Ù‡Ô˘OM§, ¯·ÌËÏ‹ ‰fiÛË ¯ËÌÂÈÔıÂڷ›·˜, ˘ÔÛÙ‹ÚÈÍËÌfiÓÔ Ì ÌÂÙ·ÁÁ›ÛÂȘ, ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ΢ÙÙ·-ÚÔΛÓ˜, ‰È·ÊÔÚÔÔÈËÙÈÎÔ› Î·È ·ÓÙÈ·ÔÙˆÙÈÎÔ› ·-Ú¿ÁÔÓÙ˜ ·ÏÏ¿ Î·È ÁÔÓȉȷ΋ ıÂڷ›· ÂÚÈÏ·Ì‚¿-ÓÔÓÙ·È ÛÙÔ Â˘Ú‡ Ê¿ÛÌ· ÙˆÓ ‰ÔÎÈÌ·ÛÌ¤ÓˆÓ ‹ ˘fiÌÂϤÙË Û¯ËÌ¿ÙˆÓ ·ÓÙÈÌÂÙÒÈÛ˘. H ÂÈÙ˘¯›· ÙÔ˘˜ı· ÂÍ·ÚÙËı› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙËÓ ÂÈÏÔÁ‹ Áȷοı ˘ÔÔÌ¿‰· ÂΛӢ Ù˘ ·ÁˆÁ‹˜ Ô˘ ı· ·Ô‰fi-ÛÂÈ Ù· ηχÙÂÚ· ‰˘Ó·Ù¿ ·ÔÙÂϤÛÌ·Ù·. EÏÏËÓ I·ÙÚ 2000, 66: 227 - 236.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 227 - 236

T· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ·ÔÙÂÏÔ‡Ó ÂÙÂÚÔ-ÁÂÓ‹ ÔÌ¿‰· ÎψÓÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ·Ú¯ÂÁfiÓˆÓ·ÈÌÔÔÈËÙÈÎÒÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (stem cells),Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ˘ÂÚ΢ÙÙ·ÚÈÎfi Ì˘ÂÏfi ÌÂÂÚÈÊÂÚÈ΋ ΢ÙÙ·ÚÔÂÓ›· Î·È ‚Ú›ÛÎÔÓÙ·È Û ÛÙÂÓ‹Û˘Û¯¤ÙÈÛË Ì ¿ÏϘ ÎψÓÈΤ˜ ÓfiÛÔ˘˜ ÙÔ˘ Ì˘ÂÏÔ‡fiˆ˜ ÔÈ Ï¢¯·È̛˜ Î·È Ù· Ì˘ÂÏÔ·Ú·ÁˆÁ¿ Û‡Ó-‰ÚÔÌ·. H ÚÒÙË ·Ó·ÊÔÚ¿ Û ‰‡Ô ‚·ÛÈΤ˜ ˘Ôη-ÙËÁÔڛ˜ ·˘ÙÔ‡ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤ÁÈÓ ÛÙȘ ·Ú¯¤˜ Ù˘‰ÂηÂÙ›·˜ ÙÔ˘ 70 fiÙ·Ó Ì›· ÔÌ¿‰· ·fi ÂȉÈÎÔ‡˜(French American British working group) ηıfiÚÈÛÂÙËÓ Î·Ù¿Ù·ÍË ÙˆÓ ÔÍÂÈÒÓ Ï¢¯·ÈÌÈÒÓ1. OÈ ›‰ÈÔÈ

ÂÚ¢ÓËÙ¤˜ ÚfiÙÂÈÓ·Ó ÙÔ 1982 ÙËÓ Î·Ù¿Ù·ÍË Û ̛·ÔÌ¿‰· fiÏˆÓ ÂÎÂ›ÓˆÓ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ·ÚÔ˘-ÛÈ¿˙Ô˘Ó Ì˘ÂÏfi Ô˘ ı˘Ì›˙ÂÈ ÔÍ›· Ï¢¯·ÈÌ›· (O§)¯ˆÚ›˜ fï˜ ÙÔ ··ÈÙÔ‡ÌÂÓÔ ˘„ËÏfi (> 30%) ÔÛÔ-ÛÙfi ‚Ï·ÛÙÒÓ Î·È ·Ú¿ÏÏËÏ· ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ˆÚ›-Ì·ÓÛË ÙˆÓ ÙÚÈÒÓ Ì˘ÂÏÈÎÒÓ ÛÂÈÚÒÓ —ÂÚ˘ıÚ¿˜, Ì˘Â-ÏÈ΋˜, ÌÂÁ·Î·Ú˘Ô΢ÙÙ·ÚÈ΋˜— Ô˘ ηٷϋÁÔ˘Ó ÛÂ΢ÙÙ·ÚÔÂӛ˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·2. O fiÚÔ˜ Ì˘Â-ÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (M¢™) Ô˘ ¯ÚËÛÈÌÔÔÈ-‹ıËΠ˘Ô‰ËÏÒÓÂÈ ÎÔÈÓfi ·ıÔÁÂÓÂÙÈÎfi Ì˯·ÓÈÛÌfiÌ ‚Ï¿‚Ë Û ¤Ó· ·Ú¯¤ÁÔÓÔ Î‡ÙÙ·ÚÔ. H ÂͤÏÈÍËfï˜ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÌÔÚ› Ó· ÔÈΛÏÏÂÈ Â˘Ú¤ˆ˜Ø

227

οÔȘ ·’ ·˘Ù¤˜ ı· ÂÍÂÏȯıÔ‡Ó Ôχ Û‡ÓÙÔÌ· ÛÂÔÍ›· Ï¢¯·ÈÌ›· ÂÓÒ ¿ÏϘ ‰ÂÓ ı· ÌÂÙ·ÙÚ·Ô‡Ó Ô-Ù¤. T¤ÙÔȘ ηٷÛÙ¿ÛÂȘ ·Ó·Ê¤ÚÔÓÙ·Ó Ì¤¯ÚÈ ÙfiÙÂÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ì ÔÈΛϘ ÔÓÔ̷ۛ˜ fiˆ˜ ÛȉË-ÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, ·ÓıÂÎÙÈ΋ ·Ó·ÈÌ›·, ‰˘ÛÌ˘ÂÏÔ-ÔÈËÙÈ΋ ·Ó·ÈÌ›·, ÚÔÏ¢¯·ÈÌ›·, ˘ÔÍ›· ÔÏÈÁÔ‚Ï·-ÛÙÈ΋ ‹ ¤ÚÔ˘Û· Ï¢¯·ÈÌ›·.

KÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ M¢™ Â›Ó·È Ô Î˘Ù-Ù·ÚÔ‚ÚÈı‹˜ ‹ Î·È ˘ÂÚÏ·ÛÙÈÎfi˜ ‰˘ÛÏ·ÛÙÈÎfi˜Ì˘ÂÏfi˜ Ì ÂÚÈÊÂÚÈΤ˜ ΢ÙÙ·ÚÔÂӛ˜ Û ÙÔ˘Ï¿¯È-ÛÙÔÓ ‰‡Ô ·fi ÙȘ ÙÚ›˜ ÛÂÈÚ¤˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·›-Ì·ÙÔ˜3. H ··Ú·›ÙËÙË ÁÈ· ÙË ‰È¿ÁÓˆÛË ‰˘ÛÔ›ËÛËıˆÚÂ›Ù·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ÎψÓÈ΋˜ ¤ÎÙ·Û˘ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ stem cell, Ë ‚Ï¿‚Ë ÙÔ˘ ÔÔ›Ô˘Ô‰ËÁ› Û ·ÓÒÌ·ÏË ‰È·ÊÔÚÔÔÈËÙÈ΋ ‰È·‰Èηۛ·.TÔ ·Ú¿‰ÔÍÔ ·˘Ùfi ÙÔ˘ ˘ÂÚ΢ÙÙ·ÚÈÎÔ‡ Ì˘ÂÏÔ‡ ÌÂ΢ÙÙ·ÚÔÂÓ›· ÛÙËÓ ÂÚÈʤÚÂÈ· Ë “ÌË ·Ô‰ÔÙÈ΋·ÈÌÔÔ›ËÛË” fiˆ˜ ϤÁÂÙ·È ¤¯ÂÈ ·Ú¯›ÛÂÈ Ó· ÂÚÌË-Ó‡ÂÙ·È ÙÂÏÂ˘Ù·›ˆ˜ Ì ‰È·Ù·Ú·¯¤˜ ÛÙÔ Ì˯·ÓÈÛÌfiÙ˘ “·fiÙˆÛ˘”. H ·fiÙˆÛË ‹ ÚÔÁÚ·ÌÌ·ÙÈ-Ṳ̂ÓÔ˜ ΢ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ ·ÔÙÂÏ› Ì›· ÌÔÚÊ‹Î˘ÙÙ·ÚÈÎÔ‡ ı·Ó¿ÙÔ˘ Ô˘ ÛÙËÓ ·ÈÌÔÔ›ËÛË ÂÓÔ¯Ô-ÔÈÂ›Ù·È ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ÙÂ-ÏÈο ‰È·ÊÔÚÔÔÈËÌ¤ÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ,·ÏÏ¿ Î·È ÁÈ· ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ¯·Ú·-ÎÙËÚ›˙ÔÓÙ·È ·fi ÂÎÙÂٷ̤ÓË ÌË ·Ô‰ÔÙÈ΋ ·ÈÌÔ-Ô›ËÛË. º·›ÓÂÙ·È fiÙÈ ‚ÈÔÏÔÁÈο Ù· M¢™ ÚÔ·-ÙÔ˘Ó ·fi ÙÔ Û˘Ó‰˘·ÛÌfi ·˘ÍË̤ÓÔ˘ ÔÏÏ·Ï·-ÛÈ·ÛÌÔ‡ Î·È ÂÈÙ·¯˘ÓfiÌÂÓ˘ ·fiÙˆÛ˘4,5.

E¶π¢∏ªπ√§√°ÿ∞T· M¢™ Â›Ó·È ‚·ÛÈο ÓfiÛÔ˜ ÙˆÓ ËÏÈÎȈ̤ӈÓ. AÓÎ·È Ë ·ÎÚÈ‚‹˜ Û˘¯ÓfiÙËÙ· Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ˘ÔÏÔ-ÁÈÛı›, Â›Ó·È Û·ÊÒ˜ Û˘¯ÓfiÙÂÚ· Ù˘ ÔÍ›·˜ Ì˘ÂÏÔ-ÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜ (OM§) Î·È ˘ÔÏÔÁ›˙ÔÓÙ·È Â-Ú›Ô˘ Û 6-10 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌÔ‡·Ó¿ ¤ÙÔ˜. E›Ó·È Û˘¯ÓfiÙÂÚ· Û ¿ÙÔÌ· ¿Óˆ ÙˆÓ 60ÂÙÒÓ, ÂÓÒ ‰ÂηϷÛÈ¿˙ÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÙÔ˘˜ Û¿ÙÔÌ· > 80 ÂÙÒÓ6. H ›وÛË Û ‰È¿ÊÔÚ˜ Â-ÚÈÔ¯¤˜ ÙÔ˘ Ï·Ó‹ÙË ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈ-Τ˜ ‰È·ÊÔÚ¤˜. H ÂÓÙ‡ˆÛË fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ·˘Í¿ÓÂÈ Ê·›ÓÂÙ·È Ó· ÂÎÊÚ¿˙ÂÈÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ·Ú’ fiÙÈ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë·‡ÍËÛË ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ ËÏÈΛ·˜, Ë Â˘ÎÔÏfiÙÂÚË ‰È-¿ÁÓˆÛË ·ÏÏ¿ Î·È Ë ·‡ÍËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ Ô˘ÂÎÙ›ıÂÙ·È Û ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (.¯. ¯ËÌÂÈÔıÂ-ڷ›·), ‰ÂÓ ÌÔÚ› Ó· ·ÁÓÔËı› Î·È Û›ÁÔ˘Ú· Û˘Ì-‚¿ÏÏÂÈ Û’ ·˘Ù‹.

Ÿˆ˜ Î·È Ë OM§ Ù· M¢™ ÌÔÚ› Ó· ˘¿Ú-¯Ô˘Ó ˆ˜ ÚˆÙÔ·ı‹ ‹ de novo, Ô˘ Â›Ó·È Î·È Ù·Û˘¯ÓfiÙÂÚ·, ‹ ˆ˜ ‰Â˘ÙÂÚÔ·ı‹ ‹ ÌÂÙ¿ ıÂڷ›·

(¯ËÌÂÈÔıÂڷ›· ‹ / Î·È ·ÎÙÈÓÔıÂڷ›·). H ÌfiÓË·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÁÈ· Ù· ÚˆÙÔ·ı‹ M¢™ ¤-ÁÈÓ Ì ÙÔ ‚ÂÓ˙¤ÓÈÔ (fiˆ˜ ‚¤‚·È· Û˘Ì‚·›ÓÂÈ Î·È ÌÂÙËÓ OM§), ÂÓÒ Û˘Û¯¤ÙÈÛË Ì οÓÈÛÌ· ‹ ¿ÏÏÔ˘˜‚Ï·ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı›7. T·‰Â˘ÙÂÚÔ·ı‹ M¢™ ηٷٿÛÛÔÓÙ·È Û ‰‡Ô ˘Ôη-ÙËÁÔڛ˜. A˘Ù¿ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ·ÚÁ¿ (5-15¤ÙË) ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ·Ï΢ÏȈÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙ˜ (̯ψÚÂı·Ì›ÓË, ÚÔηڂ·˙›ÓË, ÌÂÏÊ·Ï¿ÓË,΢ÎÏÔʈÛÊ·Ì›‰Ë) Î·È ÂΛӷ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·ÈÔχ ÈÔ Û‡ÓÙÔÌ· Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û·ӷÛÙÔÏ›˜ Ù˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ II (ÂÙÔÔÛ›‰Ë, ·Ó-ıڷ΢ÎϛӘ, Ï·Ù›Ó·). K·È ÔÈ ‰‡Ô ˘ÔÔÌ¿‰Â˜ ¯·-Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰˘ÛÏ·Û›· Î·È ÙˆÓ ÙÚÈÒÓ ÛÂÈ-ÚÒÓ, Û˘¯Ó¿ ›ÓˆÛË ÙÔ˘ Ì˘ÂÏÔ‡ Î·È ÁÚ‹ÁÔÚË ÂͤÏÈÍËÛ OM§8,9.

X∞ƒ∞∫∆∏ƒπ™∆π∫Õ ∫∞π ∫∞∆Õ∆∞•∏ ∆ø¡ M¢™A·Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË M¢™Â›Ó·È Ë ·ÚÔ˘Û›· ÛÙÔ 10% ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙˆÓ Î˘ÙÙ¿-ÚˆÓ Ù˘ ÂÍÂÙ·˙fiÌÂÓ˘ ÛÂÈÚ¿˜ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈ-ÎÒÓ ‰˘ÛÏ·ÛÙÈÎÒÓ Î˘ÙÙ·ÚÔÌÔÚÊÔÏÔÁÈÎÒÓ ÛÙÔÈ-¯Â›ˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙË ‰È·Ù·Ú·¯‹ Ù˘ ˆÚ›Ì·ÓÛË˜Î·È Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘2. T¤ÙÔÈ· ÛÙÔȯ›· ÙÔ˘ ·›-Ì·ÙÔ˜ Ô˘ Ô‰ËÁÔ‡Ó ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë Û M¢™Â›Ó·È: °È· ÙËÓ ÂÚ˘ıÚ¿ ÛÂÈÚ¿ Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË, ‚·-ÛÂfiÊÈÏË ÛÙ›ÍË, ÔÈÎÈÏÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ÂÚÈÊÂÚÈÎfi·›Ì· Î·È ÌÂÁ·ÏÔ‚Ï¿ÛÙˆÛË (·Ó·ÓÙÈÛÙÔȯ›· ˆÚ›Ì·Ó-Û˘ ˘Ú‹Ó· - ÚˆÙÔÏ¿ÛÌ·ÙÔ˜), ÌÈÙÒÛÂȘ, ÂÓ‰Ô˘-ÚËÓÈΤ˜ Á¤Ê˘Ú˜, ÂÚ›ÂÚÁ· Û¯‹Ì·Ù· ÂÚ˘ıÚÔ‚Ï·-ÛÙÒÓ ‹ ‰·ÎÙ˘ÏÈÔÂȉ›˜ ÛȉËÚÔ‚Ï¿ÛÙ˜ ÛÙÔ Ì˘ÂÏfi.°È· ÙË Ì˘ÂÏÈ΋ ÛÂÈÚ¿ ÂÏ·Ùو̤ÓË ÎÔÎΛˆÛË ÙԢ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ Î·È ÂÏ·Ùو̤ÓË Ïfi‚ˆÛË ÙÔ˘˘Ú‹Ó· („¢‰Ô Pelget-Huet ·ÓˆÌ·Ï›·) ÛÙÔ ÂÚÈ-ÊÂÚÈÎfi ·›Ì·, ÂÏ·Ùو̤ÓË ‹ Î·È Î·ıfiÏÔ˘ ÎÔÎΛˆÛËÛÙÔ Ì˘ÂÏfi Ì·˙› Ì ˘ÔÏfi‚ˆÛË Î·È ÛÙÚÔÊ‹ ÚÔ˜ Ù··ÚÈÛÙÂÚ¿ Î·È ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ·‡ÍËÛË ÙˆÓ ‚Ï·-ÛÙÒÓ. ¶Ôχ Û·ÓÈfiÙÂÚ· ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓËÎÔÎΛˆÛË Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ Ì ÌÂÁ¿Ï· ÎÔÎΛ·.°È· ÙË ÌÂÁ·Î·Ú˘Ô΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ ÌÂÁ¿Ï· ‹ ÁÈÁ¿-ÓÙÈ· ·ÈÌÔÂÙ¿ÏÈ· ÛÙÔ ÂÚÈÊÂÚÈÎfi, ÌÈÎÚÔÌÂÁ·Î·-Ú˘Ô·ÙÙ·Ú·, ÌÔÓÔ‡ÚËÓ· ‹ Ì ÌÈÎÚÔ‡˜ ÔÏÏ·ÏÔ‡˜˘Ú‹Ó˜ ÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú· ÛÙÔ Ì˘ÂÏfi.

H ηٿٷÍË Ù˘ ÔÌ¿‰·˜ FAB ‰È·ÈÚ› Ù· M¢™Û ¤ÓÙ ˘ÔηÙËÁÔڛ˜ Û‡Ìʈӷ Ì ÙÔ ÔÛÔÛÙfiÙˆÓ ‚Ï·ÛÙÒÓ, ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ‰·ÎÙ˘ÏÈÔÂȉÒÓ ÛÈ-‰ËÚÔ‚Ï·ÛÙÒÓ, ÙËÓ ·ÚÔ˘Û›· ÌÔÓÔ΢ÙÙ¿ÚˆÓ Î·È ÙË‚·Ú‡ÙËÙ· Ù˘ ‰˘ÛÏ·Û›·˜2. T· ‚·ÛÈο ¯·Ú·ÎÙËÚÈ-ÛÙÈο ÙˆÓ ¤ÓÙ ˘ÔηÙËÁÔÚÈÒÓ Î·Ù¿ FAB Ê·›ÓÔ-ÓÙ·È ÛÙÔÓ ›Ó·Î· 12,3. H‰Ë Ì ÙËÓ Î·Ù¿Ù·ÍË ·˘Ù‹‰È·ÎÚ›ÓÔÓÙ·È Ù· ηϋ˜ ÚfiÁÓˆÛ˘ M¢™ (RA ηÈ

228 B. °∞ƒÀ¶π¢OÀ

RARS) Ì ̤ÛË ÂÈ‚›ˆÛË ÂÚ› Ù· 5-6 ¤ÙË Î·È Ù·Î·Î‹˜ ÚfiÁÓˆÛ˘ (CMML, RAEB, RAEBT) ÌÂ̤ÛË ÂÈ‚›ˆÛË < 1 ¤ÙÔ˜. AÓ·Ï˘ÙÈÎfiÙÂÚ· Ë Û˘¯Ófi-ÙËÙ·, Ë ÂÈ‚›ˆÛË Î·È Ë ÌÂÙ·ÙÚÔ‹ Û OM§ ÛÙȘ‰È¿ÊÔÚ˜ ηٿ FAB ˘ÔηÙËÁÔڛ˜ ÙˆÓ M¢™ Ê·›-ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 22,3.

™ÃŸ§π∞ – ∫ƒπ∆π∫◊ °π∞ ∆∏¡ ∆∞•π¡Ÿª∏™∏ FABH Ù·ÍÈÓfiÌËÛË ÙˆÓ M¢™ Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ·Ù˘ ÔÌ¿‰·˜ FAB ¤¯ÂÈ Ù‡¯ÂÈ ÁÂÓÈ΋˜ ·Ô‰Ô¯‹˜ ηȂڤıËΠÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ‡ÎÔÏË Î·È ·Ó··-Ú·ÁÒÁÈÌË Û ÌÂÁ¿Ï˜ ÛÂÈÚ¤˜ ·ÛıÂÓÒÓ, ÙˆÓ ÔÔ›-ˆÓ ‰È¢ÎfiÏ˘Ó ÛËÌ·ÓÙÈο ÙË ÌÂϤÙË. ¶·Ú’ fiÏ··˘Ù¿ Ê¿ÓËΠfiÙÈ ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ fiÔ˘ Ù··ÈÌ·ÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‰ÂÓ ·ÓÙÈÛÙÔȯԇÓÌ ·ÎÚ›‚ÂÈ· ÛÙÔ˘˜ ÔÚÈÛÌÔ‡˜ ÙˆÓ ˘ÔÔÌ¿‰ˆÓ ηȤÙÛÈ Ë ¤ÓÙ·ÍË Û οÔÈ· ·’ ·˘Ù¤˜ Â›Ó·È ÚÔ‚ÏË-Ì·ÙÈ΋. T¤ÙÔȘ Â›Ó·È ÔÈ ÂÚÈÙÒÛÂȘ Ì ¯·Ú·ÎÙË-ÚÈÛÙÈ΋ ‰˘ÛÏ·ÛÙÈ΋ ÂÌÊ¿ÓÈÛË ·ÏÏ¿ Ì ˘ÔÏ·-ÛÙÈÎfi Ì˘ÂÏfi ‹ Ì ›ÓˆÛË ÙÔ˘ Ì˘ÂÏÔ‡. ¶ÂÚÈÙÒÛÂȘÂÍ¿ÏÏÔ˘ Ì ÌfiÓÔ ıÚÔÌ‚ÔÂÓ›· Î·È Ï¢ÎÔÂÓ›·,¯ˆÚ›˜ ·Ó·ÈÌ›·, ı· ¤Ú ۇÌʈӷ Ì ÙË FAB Ó·ÙȘ ¯·Ú·ÎÙËÚ›ÛÔ˘Ì ˆ˜ ·ÓıÂÎÙÈΤ˜ “·Ó·È̛˜”.K·È ‚¤‚·È· ÌÂÁ¿ÏË Û˘˙‹ÙËÛË ¤¯ÂÈ Á›ÓÂÈ ÁÈ· ÙË

¯ÚfiÓÈ· Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·, Ë ÔÔ›·ÌfiÓË ÌÂٷ͇ ÙˆÓ ¤ÓÙ ˘ÔηÙËÁÔÚÈÒÓ ÎÚ·Ù¿ ÙÔÓfiÚÔ Ï¢¯·ÈÌ›· ÛÙËÓ ÔÓÔÌ·ÙÔÏÔÁ›· Ù˘, Î·È ËÔÔ›· ÌÂÚÈΤ˜ ÊÔÚ¤˜ ‰‡ÛÎÔÏ· ‰È·ÎÚ›ÓÂÙ·È ·fiÏ¢¯·ÈÌÈΤ˜ ‹ ·Ú·ÁˆÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ì˘Â-ÏÔ‡ fiˆ˜ .¯. Ë ¿Ù˘Ë ¯ÚÔÓ›· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·È-Ì›· ÂÓÒ Û˘¯Ó¿ ··ÈÙ› Î·È ·Ó¿ÏÔÁË ıÂڷ›·10.T¤ÏÔ˜ ·fi ÙËÓ ÂÂÍÂÚÁ·Û›· ÙˆÓ ˘ÔÔÌ¿‰ˆÓ Ê¿-ÓËΠfiÙÈ ÂÚÈÛÙ·ÙÈο Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜RAEB ÂÊ’ fiÛÔÓ ¤¯Ô˘Ó ‚Ï¿ÛÙ˜ > 10% Û˘ÌÂÚÈ-ʤÚÔÓÙ·È Ô˘ÛÈ·ÛÙÈο ˆ˜ RAEBT. AÊÔ‡ ¤¯ÂÈ·Ô‰Âȯı› fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ ÙÔ˘ Ì˘Â-ÏÔ‡ ·ÔÙÂÏ› ‚·ÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÚfiÁÓˆ-ÛË ÚÔÙ›ÓÂÙ·È Ï¤ÔÓ Î·È ·fi ̤ÏË Ù˘ ÔÌ¿‰·˜FAB, ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ ÁÈ· ÙË RAEBT Ó·Â›Ó·È 11-30% Î·È fi¯È 20-30%, fiˆ˜ ›¯Â ·Ú¯ÈοÔÚÈÛı›11. ¢¤Î· ÂÓÓÈ¿ ȉȷ›ÙÂÚÔÈ Ù‡ÔÈ M¢™ Ô˘‰ÂÓ Î·Ù·Ù¿ÛÛÔÓÙ·È ÛÙË FAB ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·.

K§π¡π∫◊ ∂π∫Ÿ¡∞ – ¢πÕ°¡ø™∏I‰È·›ÙÂÚ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ¤Ú·Ó ÙˆÓÛ˘ÓÂÂÈÒÓ Ù˘ ΢ÙÙ·ÚÔÂÓ›·˜ ‹ ÂȉÈο ·ÓÙÈÎÂÈ-ÌÂÓÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ· M¢™. OÈ

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 229

¶›Ó·Î·˜ 1. X·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Î·ÙËÁÔÚÈÒÓ Ù˘ FAB Ù·ÍÈÓfiÌËÛ˘ ÙˆÓ M¢™

K·ÙËÁÔÚ›· ¶ÂÚÈÊÂÚÈÎfi ·›Ì· M˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ

AÓıÂÎÙÈ΋ ·Ó·ÈÌ›· (RA) BÏ¿ÛÙ˜ < 1% BÏ¿ÛÙ˜ < 5%AÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì BÏ¿ÛÙ˜ < 1% BÏ¿ÛÙ˜ < 5%‰·ÎÙ˘ÏÈÔÂȉ›˜ ÛȉËÚÔ‚Ï¿ÛÙ˜ ™È‰ËÚÔ‚Ï¿ÛÙ˜(RARS) >15%XÚÔÓ›· Ì˘ÂÏÔÌÔÓÔ- BÏ¿ÛÙ˜ < 5% BÏ¿ÛÙ˜ <5-20%΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· MÔÓÔ·ÙÙ·Ú· + ÚÔÌÔÓÔ‡ÚËÓ·(CMML) > 1X 109/LAÓıÂÎÙÈ΋ ·Ó·ÈÌ›· Ì BÏ¿ÛÙ˜ < 5% BÏ¿ÛÙ˜ 5-20%ÂÚ›ÛÂÈ· ‚Ï·ÛÙÒÓ (RAEB)AÓıÂÎÙÈ΋ ·Ó·ÈÌ›· BÏ¿ÛÙ˜ > 5% BÏ¿ÛÙ˜ 20-30%Ì ÂÚ›ÛÂÈ· ‚Ï·ÛÙÒÓ Û ÌÂÙ·ÙÚÔ‹ (RAEB-T)

¶›Ó·Î·˜ 2. K·Ù¿Ù·ÍË FAB ÙˆÓ M¢™. E›ÙˆÛË Î·È ÌÂÙ·ÙÚÔ‹ Û OM§

K·ÙËÁÔÚ›· ™˘¯ÓfiÙËÙ· MÂÙ·ÙÚÔ‹ EÈ‚›ˆÛË (¤ÙË)FAB % Û OM§ % ¢È·Î‡Ì·ÓÛË M¤ÛË

K·Ï‹˜ ÚfiÁÓˆÛ˘RA 15-30 10 2-5 4RARS 10-15 5 3-10 4

K·Î‹˜ ÚfiÁÓˆÛ˘CMML 10-20 15 1-5 2RAEB 25-30 45 0,5-2 1,5RAEB-T 20-30 60 < 1 0,5

·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ·Ó·ÈÌÈο Û˘ÌÙÒÌ·Ù·, ¢-¿ıÂÈ· Û ÏÔÈÌÒÍÂȘ ‹ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒ-ÛÂȘ ·Ó¿ÏÔÁ· Ì ÙËÓ ˘¿Ú¯Ô˘Û· ΢ÙÙ·ÚÔÂÓ›·Î·È ÙË ‚·Ú‡ÙËÙ¿ Ù˘. H ‰È¿ÁÓˆÛË ÙˆÓ M¢™ ÛÙË-Ú›˙ÂÙ·È Î·Ù’ ·Ú¯‹Ó ÛÙËÓ ÂͤٷÛË ÚÔ˘Ù›Ó·˜ ÙÔ˘ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ fiÔ˘ ÙÔ ¤ÌÂÈÚÔ Ì¿ÙÈ ı·‰È·ÎÚ›ÓÂÈ Ù· ‰˘ÛÏ·ÛÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÛÂÌÈ¿ ΢ÙÙ·ÚÔÂÓ›·. H ÂͤٷÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓÔÛÙÒÓ ÌÂ Ì˘ÂÏfiÁÚ·ÌÌ· ηÈ, ÂÈ ‰˘Ó·ÙfiÓ, ΢ÙÙ·-ÚÔÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ı· ÔÏÔÎÏËÚÒÛÂÈ ‹ ı· ÂÈ-‚‚·ÈÒÛÂÈ ÙË ‰È¿ÁÓˆÛË. ™ÙËÓ ÔÛÙÔÌ˘ÂÏÈ΋ ‚ÈÔ-„›· Ë ·ÓÒÌ·ÏË ÙÔÔÁÚ·Ê›· ÙˆÓ ·ÒÚˆÓ ÚÔ‰ÚÔ-ÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (ALIP) ÂÓÈÛ¯‡ÂÈ Â›Û˘ ÙË ‰È¿-ÁÓˆÛË ÙÔ˘ M¢™ Î·È ¤¯ÂÈ Èı·ÓfiÓ Î·È ÚÔÁÓˆ-ÛÙÈ΋ ÛËÌ·Û›·12. ™¿ÓÈ·, Û ȉȷ›ÙÂÚ· ÂÏ·ÊÚ¤˜ÂÚÈÙÒÛÂȘ Ì ‹È· ‰˘ÛÏ·Û›· Î·È ¯·ÌËÏfi Ô-ÛÔÛÙfi ‚Ï·ÛÙÒÓ ÛÙÔ Ì˘ÂÏfi, ı· ¯ÚÂÈ·Ûı› ÂÊ’fiÛÔÓ ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· Ó· ÂȂ‚·Èˆı› ˉȿÁÓˆÛË Ì ȉȷ›ÙÂÚ˜ Ù¯ÓÈΤ˜ fiˆ˜ ÔÈ Î˘ÙÙ·-ÚÈΤ˜ ηÏÏȤÚÁÂȘ, fiÔ˘ Ë in vitro ·Ó¿Ù˘ÍË·ÔÈÎÈÒÓ BFU-E Î·È CFU-GM Â›Ó·È ÂÏ·Ùو̤-ÓË ‹ Ì ÙËÓ ·fi‰ÂÈÍË ÎψÓÈ΋˜ ·ÈÌÔÔ›ËÛ˘ Ô˘ÌÔÚ› Ó· Á›ÓÂÈ ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙË ÔÏ˘ÌÔÚÊÈ΋·Ó¿Ï˘ÛË (RFLP), ΢ÙÙ·ÚÔÁÂÓÈ΋ ·Ó¿Ï˘ÛË ·Ï‹‹ in situ ˘‚ÚȉÈÛÌfi (FISH), Ë ·ÎfiÌ· Î·È Ì ÙËÓ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÔÁÎÔÁÔÓȉ›ˆÓ Ô˘ Û˘Ó-‰¤ıËÎ·Ó Ì ٷ M¢™ (.¯. Ù˘ ÔÌ¿‰·˜ RAS).

H Û˘Ó‹ı˘ ‰È·ÁÓˆÛÙÈ΋ ‰È·‰Èηۛ· ÂÚÈÁÚ¿-ÊÂÙ·È Û¯ËÌ·ÙÈο ÛÙÔÓ ›Ó·Î· 3.

KÀ∆∆∞ƒ√°∂¡∂∆π∫Õ ∂Àƒ◊ª∞∆∞I‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙË ‰È¿ÁÓˆÛË ·ÏÏ¿ ΢ڛˆ˜ÙËÓ ÚfiÁÓˆÛË ÙˆÓ M¢™ ¤¯Ô˘Ó Ù· Â˘Ú‹Ì·Ù· ÙË˜Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ·Ó¿Ï˘Û˘ ÙÔ˘ Ì˘ÂÏÔ‡.

KψÓÈΤ˜ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ·Ú·ÙË-ÚÔ‡ÓÙ·È ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÛÙÔ 60-65% ÙˆÓ denovo Î·È ÙÔ 80-90% ÙˆÓ ‰Â˘ÙÂÚÔ·ıÒÓ Ì˘ÂÏÔ‰˘-ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfïÓ. K·ÌÌ›· ·fi ·˘Ù¤˜ ‰ÂÓ Â›-Ó·È ÂȉÈ΋ ÙˆÓ M¢™ ·ÏÏ¿ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛı› ηÈÛ ¿ÏϘ Ì˘ÂÏÔÂȉ›˜ ‰È·Ù·Ú·¯¤˜. AÓÙ›ıÂÙ· ÔÚÈ̤-Ó˜ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ΢ڛˆ˜ ÌÂÙ·ı¤-ÛÂȘ, Ù˘ÈΤ˜ Ù˘ ÔÍ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜(OM§) Î·È ÙˆÓ Ì˘ÂÏÔ·Ú·ÁˆÁÒÓ Û˘Ó‰ÚfïÓfiˆ˜ ÔÈ t (9;22), t (15;17), t (8;21), inv (16), ‰ÂÓ ·-Ú·ÙËÚÔ‡ÓÙ·È Î·ıfiÏÔ˘ ÛÙ· M¢™. OÈ Û˘¯ÓfiÙÂÚÂ˜Î˘ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙ· M¢™ ÂÚÈÏ·Ì-‚¿ÓÔ˘Ó Î˘Ú›ˆ˜ ¯ÚˆÌÔÛˆÌÈΤ˜ ÂÏÏ›„ÂȘ, ÔÏÈΤ˜ ‹ÌÂÚÈΤ˜, Û¯ÂÙÈο Û˘¯Ó¿ ÂÈϤÔÓ ¯ÚˆÌÔÛÒÌ·Ù· ‹ÙÌ‹Ì·Ù· ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Î·È Û¿ÓÈ· ÌÂÙ·ı¤-ÛÂȘ13,14.

¶ÂÚ›Ô˘ ÙÔ 50% ÙˆÓ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·-ÏÈÒÓ ÛÙ· M¢™ ·ÊÔÚÔ‡Ó ·ÒÏÂÈ· ¯ÚˆÌÔÛˆÌÈÎÔ‡˘ÏÈÎÔ‡. ™˘¯ÓfiÙÂÚË ÌÂÚÈ΋ ¤ÏÏÂÈ„Ë Â›Ó·È Ë ¤ÏÏÂÈ„Ë5q (del 5q) Î·È Î·ÙfiÈÓ ÔÈ del 20q, del 11q, del 7q,del 12p Î·È Û·ÓÈÒÙÂÚ· Ë del 13q. OÈ ÂÏÏ›„ÂȘ ·˘-Ù¤˜ Â›Ó·È Û˘¯ÓfiÙÂÚ· ÂӉȿÌÂÛ˜ ·Ú¿ ÙÂÏÈΤ˜ ηȷڒ fiÙÈ ÙÔ Â‡ÚÔ˜ ÙÔ˘˜ ‰È·Ê¤ÚÂÈ ÛÙȘ ‰È¿ÊÔÚ˜ Â-ÚÈÙÒÛÂȘ, ÂÓ ÙÔ‡ÙÔȘ ¤Ó· ÛÙ·ıÂÚ¿ ÂÏÏ›ÔÓ ÙÌ‹Ì·Â›Ó·È ÎÔÈÓfi ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙË Û˘ÁÎÂ-

230 B. °∞ƒÀ¶π¢OÀ

¶›Ó·Î·˜ 3. MDS: ¢È¿ÁÓˆÛË Î·È Î·ıÔÚÈÛÌfi˜ ˘ÔηÙËÁÔÚ›·˜ ηٿ FAB

ÎÚÈÌ̤ÓË ¤ÏÏÂÈ„Ë Î·È ÂΛ ‚¤‚·È· ÂÛÙÈ¿˙ÔÓÙ·È ÔÈÚÔÛ¿ıÂȘ ÁÈ· ÂÓÙfiÈÛË Ù˘¯fiÓ ÔÁÎÔηٷÛÙ·ÏÙÈ-ÎÒÓ ÁÔÓȉ›ˆÓ. OÈ ÔÏÈΤ˜ ÂÏÏ›„ÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó΢ڛˆ˜ ÙȘ ÂÏÏ›„ÂȘ ÙÔ˘ 7 (-7) Î·È Î·ÙfiÈÓ ÙÔ˘ Y(-Y), ÂÓÒ ¿ÏϘ ÂÏÏ›„ÂȘ Â›Ó·È Û·ÓÈÒÙÂÚ˜ ηÈÛ˘¯Ó¿ Û˘Ó‰È¿˙ÔÓÙ·È Ì ¿ÏϘ ·ÓˆÌ·Ï›Â˜. ™˘¯ÓfiÙÂ-ÚË ÙÚÈۈ̛· Â›Ó·È Ë ÙÚÈۈ̛· 8 (+8) Î·È Î·ÙfiÈÓÔÈ ÙÚÈۈ̛˜ 11 Î·È 2115. ¶ÔÏϷϤ˜ ¯ÚˆÌÔÛˆÌÈ-Τ˜ ·ÓˆÌ·Ï›Â˜, ·˘Ù¤˜ ‰ËÏ·‰‹ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ˘Ï¿-¯ÈÛÙÔÓ 3 ¯ÚˆÌÔÛÒÌ·Ù·, ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ 15-20% ÙˆÓ ÚˆÙÔ·ıÒÓ Î·È ÙÔ 50% ÙˆÓ ‰Â˘ÙÂÚÔ·-ıÒÓ M¢™. I‰È·›ÙÂÚ· Û˘¯Ó‹ Â›Ó·È Ë Û˘ÌÌÂÙÔ¯‹Û’·˘Ù¤˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ 7 Î·È 5 (60 Î·È 40%·ÓÙ›ÛÙÔȯ·)13.

TÔ Â›‰Ô˜ Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ¯ÚˆÌÔÛˆÌÈÎÒӷӈ̷ÏÈÒÓ ‰È·Ê¤ÚÂÈ ÌÂٷ͇ ÙˆÓ ˘ÔηÙËÁÔÚÈÒÓÙ˘ Ù·ÍÈÓfiÌËÛ˘ FAB. ™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜ ÔÈ ¯Úˆ-ÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È ÏÈÁfiÙÂÚ˜ ÛÙË RA ηÈRARS Î·È ÂÚÈÛÛfiÙÂÚ˜ ÛÙȘ RAEB Î·È RAEBT.™ÙËÓ RA ÂÈÎÚ·ÙÔ‡Ó ÔÈ del 5q Î·È del 20q Ô˘ Û˘Ó-‰È¿˙ÔÓÙ·È Ì ηϋ ÚfiÁÓˆÛË ÂÓÒ ÛÙË RARS ›ӷÈÛ˘¯Ó¤˜ ÔÈ ‚Ï¿‚˜ ÙÔ˘ 11q, Ô˘ Û¿ÓÈ· ··ÓÙÒÓÙ·ÈÛ ¿ÏÏ· M¢™. ™ÙË CMML ‚Ï¿‚Ë ÙÔ˘ 12p, Î·È È‰È-·›ÙÂÚ· Ë ÌÂÙ¿ıÂÛË t (5;12) Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜,ÂÓÒ Ë del 5q ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·13.

T¤ÏÔ˜ Ù· ‰Â˘ÙÂÚÔ·ı‹ (ÌÂÙ¿ ¯ËÌÂÈÔıÂڷ›·±·ÎÙÈÓÔ‚ÔÏ›·) M¢™ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÔÏÏ·-Ϥ˜ ·ÓˆÌ·Ï›Â˜ (50%), ¤ÏÏÂÈ„Ë ÙÔ˘ 7 (50%) ‹ del5q (25%) Î·È Û·ÓÈfiÙÂÚ· ·fi ÂÏÏ›„ÂȘ ÔÏÈΤ˜ ‹ÌÂÚÈΤ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 5. ™˘¯ÓfiÙÂÚ˜, Û ۯ¤-ÛË Ì ٷ ÚˆÙÔ·ı‹ M¢™, Â›Ó·È Â‰Ò ÔÈ ÌÂÙ·ı¤-ÛÂȘ (15%) ÌÂ Û˘¯Ó‹ Û˘ÌÌÂÙÔ¯‹ Ù˘ Ì¿ÓÙ·˜11q23, Î·È Ë ÂÌÏÔ΋ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ 17q, 21,12p, 3q. AÏ΢ÏȈÙÈο Ê¿Ú̷η Û˘Ó‰¤ÔÓÙ·È Ì ΢-Ú›ˆ˜ ‚Ï¿‚˜ ÙÔ˘ 5 Î·È ÙÔ˘ 7 ÂÓÒ ÔÈ ÂÈÔ‰ÔÊ˘ÏÏÔ-ÙÔ͛Ә Ì ‚Ï¿‚˜ ÙÔ˘ 11q Î·È ÙÔ˘ 21q13,15.

AÓ Î·È Ô ÂÓÙÔÈÛÌfi˜ ˘ÔÙ‡ˆÓ Ì ‚¿ÛË ÌÔÚ-ÊÔÏÔÁÈΤ˜, ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ Î·È ÁÔÓȉȷΤ˜ ‚Ï¿-‚˜ fiˆ˜ ‰È·ÌÔÚÊÒıËΠ۠¿ÏϘ ·ÈÌ·ÙÔÏÔÁÈΤ˜Î·ÎÔ‹ıÂȘ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÂÈÙ¢¯ı› ÛÙ· M¢™ ,ÂÓ ÙÔ‡ÙÔȘ οÔȘ ÂȉÈΤ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ·Óˆ-̷ϛ˜ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ÌÔÚÊÔÏÔÁÈ-ο Î·È ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ì οÔÈ· È-ı·Ó¿ ˘Â‡ı˘Ó· ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÁÔÓ›‰È· ÌÂÚÈ-Τ˜ ÊÔÚ¤˜. H ÈÔ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÚ›ÙˆÛË Â›Ó·È·˘Ù‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ 5q-. H del 5q (‹ 5q-) ÛÙ· M¢™·Ó¢ڛÛÎÂÙ·È Î·Ù¿ 50% ˆ˜ ÌÔÓ‹Ú˘ ‚Ï¿‚Ë Î·È Î·-Ù¿ 50% ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· ·ıÔÏÔÁÈο ΢ÙÙ·-ÚÔÁÂÓÂÙÈο Â˘Ú‹Ì·Ù·. H del 5q (q13q33) ˆ˜ ÌÂÌÔ-ӈ̤ÓË ‚Ï¿‚Ë Â›Ó·È Û˘¯Ó‹ Û Á˘Ó·›Î˜ Ì M¢™,Û˘Ó‰È¿˙ÂÙ·È Î·Ù¿ 75% Ì RA Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È

·fi Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË, ÂÚ˘ıÚÔ‚Ï·ÛÙÔÂÓ›·, Ê˘-ÛÈÔÏÔÁÈο ‹ ·˘ÍË̤ӷ ·ÈÌÔÂÙ¿ÏÈ· Î·È ˘ÔÏԂȈ-̤ӷ ÌÂÁ·Î·Ú˘Ô·ÙÙ·Ú·. OÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ·Ó¿-ÁÎË Û˘¯ÓÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ Î·È Âı·›ÓÔ˘Ó Û˘¯Ó¿·fi ÂÈÏÔΤ˜ Ù˘ ·ÈÌÔÛȉ‹ÚˆÛ˘ Î·È fi¯È ·fi ÌÂ-Ù·ÙÚÔ‹ Û OM§ Ô˘ Â›Ó·È Û¿ÓÈ·. O Û˘Ó‰˘·-ÛÌfi˜ ·˘ÙÒÓ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Û˘ÓÈÛÙ¿ ÙÔ Û‡Ó-‰ÚÔÌÔ 5q-16.

H ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ·-Ó¿Ï˘Û˘ ÛÙ· MDS Â›Ó·È Û·Ê‹˜ ·fi ÔÏϤ˜ ÌÂϤ-Ù˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. H ·ÚÔ˘Û›· ÌÈ¿˜ ‹ ÂÚÈÛ-ÛÔÙ¤ÚˆÓ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÁÂÓÈο Û˘Ó-‰˘¿˙ÂÙ·È Ì ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË ·fi fiÙÈ Ô Ê˘ÛÈÔ-ÏÔÁÈÎfi˜ ηڢfiÙ˘Ô˜, Ì ÙËÓ ÂÍ·›ÚÂÛË Ù˘ del 5qfiÙ·Ó Â›Ó·È ÌÔÓ·‰È΋ ·ÓˆÌ·Ï›· Î·È Û˘Ó‰˘¿˙ÂÙ·È Ì¯·ÌËÏfi ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ ÛÙÔ Ì˘ÂÏfi. MÂÌÔӈ̤ÓËdel 20q ›Û˘ Û˘Ó‰˘¿˙ÂÙ·È Ì ηϋ ÚfiÁÓˆÛË, ·ÓÎ·È ˘¿Ú¯ÂÈ Î·È ·ÓÙ›ıÂÙË ¿Ô„Ë ÛÙË ‚È‚ÏÈÔÁÚ·-Ê›·. Afi ÙȘ ÏÔȤ˜ ÌÔÓ‹ÚÂȘ ‚Ï¿‚˜ ÔÈ +8, iso(17p) Î·È del 12p Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÊÙˆ¯fiÙÂÚË Úfi-ÁÓˆÛË , ÂÓÒ Ë ÚfiÁÓˆÛË Ù˘ -Y ÌÔÈ¿˙ÂÈ Ó· ›ӷȷӿÏÔÁË Ì ·˘Ù‹ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ηڢÔÙ‡Ô˘.I‰È·›ÙÂÚ· η΋ ÚfiÁÓˆÛË ¤¯Ô˘Ó ÔÈ ÔÏϷϤ˜ ΢Ù-Ù·ÚÔÁÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ÔÈ ·ÓˆÌ·Ï›Â˜ ÙÔ˘713.

AÓ Î·È ÔÈ “ηÏÔ‹ıÂȘ” ‰È·Ù·Ú·¯¤˜ 5q- ηÈ20q- Â›Ó·È Û˘¯Ó¤˜ ÛÙË RA ÂÓÒ ÔÈ ÔÏϷϤ˜ ·Óˆ-̷ϛ˜ ÛÙ· RAEB Î·È RAEBT ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜·¤‰ÂÈÍ·Ó Î·È ·ÓÂÍ¿ÚÙËÙË ·fi ¿ÏϘ ·Ú·Ì¤-ÙÚÔ˘˜ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋˜·Ó¿Ï˘Û˘ ÛÙ· M¢™. ŒÙÛÈ Ë RA Î·È RARS Ì ÔÏ-ϷϤ˜ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ¤¯Ô˘Ó Û·ÊÒ˜‚·Ú‡ÙÂÚË ÚfiÁÓˆÛË. ™›ÁÔ˘Ú· Ë ÚÔÛı‹ÎË ÙˆÓ΢ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙ· ‰È¿ÊÔÚ· ÚÔ-ÁÓˆÛÙÈο Û˘ÛÙ‹Ì·Ù· ‚·ıÌÔÏfiÁËÛ˘ Ô˘ ‚·Û›˙Ô-ÓÙ·Ó ÌfiÓÔ ÛÙÔ ÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ Î·È ÙȘ ΢ÙÙ·-ÚÔÂӛ˜ ¤¯ÂÈ ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÚÔÁÓˆÛÙÈ-΋ ÙÔ˘˜ ·Í›·17,18.

EÎÙfi˜ ·fi ÙÔÓ ·Ú¯ÈÎfi ηڢfiÙ˘Ô ÛÙË ‰È¿ÁÓˆ-ÛË ÙÔ˘ M¢™ Ë Â·Ó¿ÏË„Ë ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛËÙ˘ ÓfiÛÔ˘ ÌÔÚ› Ó· ‰ÒÛÂÈ Â› ϤÔÓ ÏËÚÔÊÔ-ڛ˜. º˘ÛÈÔÏÔÁÈÎfi˜ ηڢfiÙ˘ÙÔ˜ Ô˘ ÌÂÙ·ÙÚ¤Â-Ù·È Û ·ıÔÏÔÁÈÎfi ÚÔËÁÂ›Ù·È Û˘Ó‹ıˆ˜ Ù˘ ÌÂÙ·-ÙÚÔ‹˜ Û OM§, ȉȷ›ÙÂÚ· ÁÈ· ÙȘ RA Î·È RARS.H ·ÓˆÌ·Ï›· -7 ›Û˘ Û˘Ó‰˘¿ÛÙËΠ̠ÙËÓ ÚfiÔ‰ÔÙ˘ ÓfiÛÔ˘, fiˆ˜ ÚԷӷʤÚıËÎÂ13.

¶ƒ√°¡ø™∆π∫Õ ™À™∆◊ª∞∆∞H ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤Î·Ó ÂÈ-Ù·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÚÔÁÓˆ-ÛÙÈÎÒÓ ‰ÂÈÎÙÒÓ Î·È Û˘ÛÙËÌ¿ÙˆÓ ÌÂ Û˘Ó¤ÂÈ· Û¯Â-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 231

‰fiÓ Î¿ı fiÏË ‹ ¯ÒÚ· Ô˘ Û˘ÁΤÓÙÚˆÓ ¤Ó· ÛË-Ì·ÓÙÈÎfi ·ÚÈıÌfi ·ÛıÂÓÒÓ Ó· ·Ó·Ù‡ÛÛÂÈ ¤Ó· ‰ÈÎfiÙ˘ ÚÔÁÓˆÛÙÈÎfi Û‡ÛÙËÌ· ‚·ıÌÔÏfiÁËÛ˘19,20. TÔ‰ÈÂıÓ¤˜ ÚÔÁÓˆÛÙÈÎfi Û‡ÛÙËÌ· ‚·ıÌÔÏfiÁËÛ˘ ÚÔ-Û¿ıËÛ ӷ ‚ÂÏÙÈÒÛÂÈ Ù· ÚÔËÁÔ‡ÌÂÓ· Î·È Ó· η-ıÔÚ›ÛÂÈ ÌÂÙ¿ ·fi ·Ó¿Ï˘ÛË 816 ÂÚÈÙÒÛÂˆÓ denovo M¢™ Ù¤ÛÛÂÚȘ ÔÌ¿‰Â˜ ÚÔÁÓˆÛÙÈ΋˜ ÛËÌ·-Û›·˜.`EÙÛÈ ‰È·ÎÚ›ÓÔÓÙ·È ÔÈ ¯·ÌËÏÔ‡, ÂӉȷ̤ÛÔ˘ I ,ÂӉȷ̤ÛÔ˘ II Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ηÙËÁÔڛ˜M¢™ Ì ‚¿ÛË Ù· ΢ÙÙ·ÚÔÁÂÓÂÙÈο Â˘Ú‹Ì·Ù·, ÙÔÔÛÔÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ·-ÚÔÂÓÈÒÓ2. H ‚·ıÌÔÏfiÁËÛË, Ë ÂÈ‚›ˆÛË Î·È Ë ÌÂ-Ù·ÙÚÔ‹ Û OM§ Ì ‚¿ÛË ·˘Ùfi ÙÔ Û‡ÛÙËÌ· Ê·›-ÓÔÓÙ·È ÛÙÔ˘˜ ›Ó·Î˜ 4 Î·È 5.

A¡∆πª∂∆fl¶π™∏ ∆ø¡ ∞™£∂¡fl¡ ª∂ M¢™AÊÔ‡ ÙÔ 30% ÙÔ˘ Û˘ÓfiÏÔ˘, ÙÔ 50% ÙˆÓ ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘ Î·È ÙÔ 85-90% ÙˆÓ ‰Â˘ÙÂÚÔ·ıÒÓ M¢™ı· ÂÍÂÏȯı› ÙÂÏÈο Û OM§ Ë ÔÔ›· Ì¿ÏÈÛÙ· ›-Ó·È È‰È·›ÙÂÚ· ·ÓıÂÎÙÈ΋ ÛÙË ıÂڷ›·, Á›ÓÂÙ·È Û·-ʤ˜ fiÙÈ ÛÙfi¯Ô˜ Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ·˘ÙÒÓ ÙˆÓ ·ÛıÂ-ÓÒÓ Â›Ó·È fi¯È ÌfiÓÔ Ë ‚ÂÏÙ›ˆÛË ÙˆÓ Î˘ÙÙ·ÚÔÂÓÈÒÓ,·fi ÙȘ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ‚¤‚·È· Î·È ÔÈ ÎÏÈÓÈΤ˜ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ·ÏÏ¿ ›Û˘ Ë ·ÚÂ-Ìfi‰ÈÛË Ù˘ ÂͤÏÈ͢ Û ÔÍ›· Ï¢¯·ÈÌ›·. OÈ ıÂ-ڷ¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ ı· ÛÙËÚȯıÔ‡Ó Î·Ù’ ·Ú¯‹ÓÛÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·Ê ÂÓfi˜ Î·È ÛÙÔ ÔÛÔ-ÛÙfi ÙˆÓ ‚Ï·ÛÙÒÓ ÛÙÔ Ì˘ÂÏfi ·Ê’ ÂÙ¤ÚÔ˘Ø ‚¿ÛÂÈ ·˘-ÙÒÓ ı· Á›ÓÂÈ Ë ÂÈÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı· ˘Ô-

ÛÙËÚȯıÔ‡Ó ÌfiÓÔ Î·È ·˘ÙÒÓ fiÔ˘ ı· ÂȯÂÈÚËı››‰Ú·ÛË ÛÙÔ ·ıÔÏÔÁÈÎfi stem cell ›Ù ηٷÛÙÚÔ-ÊÈ΋ Ì ¯ËÌÂÈÔıÂڷ›· (Ì ‹ ¯ˆÚ›˜ ÌÂÙ·ÌfiÛ¯Â˘-ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ) ‹ Î·È Ì ·Ú¿ÁÔÓÙ˜ Ô˘‰ÈÂÁ›ÚÔ˘Ó ÙË ÛˆÛÙ‹ ·Ó¿Ù˘ÍË Î·È ‰È·ÊÔÚÔÔ›ËÛËÙÔ˘7 (¶›Ó. 6).

°È· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ M¢™ ÌÔÚ› Ó· ¯ÚËÛÈÌÔ-ÔÈËı› ¯ËÌÂÈÔıÂڷ›· Ù‡Ô˘ OM§ ÂÊ’ fiÛÔÓ ‚ÔË-ıÔ‡Ó Ë ËÏÈΛ· (< 70) Î·È Ë Î·Ï‹ ÁÂÓÈ΋ ηٿÛÙ·ÛËÙÔ˘ ·ÛıÂÓÔ‡˜. OÈ Û˘Ó‹ıÂȘ Û˘Ó‰˘·ÛÌÔ› ΢ÙÙ·ÚÔ-ÛÙ·ÙÈÎÒÓ .¯. ΢ÙÙ·Ú·‚›ÓË Ì ·Óıڷ΢ÎϛӘ ¤¯Ô˘ÓÊÙˆ¯fiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ÛÙ· M¢™ ·fi fiÙÈ ÛÙËÓOM§22-24. K·Ï‡ÙÂÚË ·¿ÓÙËÛË ÛÙË ¯ËÌÂÈÔıÂÚ·-›· ¤¯Ô˘Ó Ù· de novo Û ۯ¤ÛË Ì ٷ ‰Â˘ÙÂÚÔ·ı‹M¢™. H ·ÏÏÔÁÂÓ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓÔÛÙÒÓ Â›Ó·È Ë ÌfiÓË Û‹ÌÂÚ· ıÂڷ›· Ô˘ ‰›ÓÂÈ ÌÂ-Á¿Ï˜ Èı·ÓfiÙËÙ˜ (40-70%) ÔÚÈÛÙÈ΋˜ ··ÏÏ·Á‹˜·fi ÙË ÓfiÛÔ25,26. EÓ ÙÔ‡ÙÔȘ ÔÈ ˘Ô„‹ÊÈÔÈ ·ÛıÂÓ›˜Â›Ó·È ÂÏ¿¯ÈÛÙÔÈ ·Ó ˘ÔÏÔÁ›ÛÂÈ Î·Ó›˜ fiÙÈ ÌfiÓÔ ¤Ó·10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì M¢™ Â›Ó·È < 55ÂÙÒÓ Î·È ÌÔÚÔ‡Ó Ó· ˘Ô‚ÏËıÔ‡Ó Û ÌÂÙ·ÌfiÛ¯Â˘ÛËÎ·È ÁÈ ·˘ÙÔ‡˜, ÂÊ’ fiÛÔÓ ‚¤‚·È· ·Ó‹ÎÔ˘Ó Û ηÙËÁÔ-Ú›· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ı· Ú¤ÂÈ Ó· ¢ÚÂıÔ‡Ó Û˘Ì-‚·ÙÔ› ‰fiÙ˜ Ì˘ÂÏÔ‡. °È· Ó¤· ¿ÙÔÌ· Ì ηϋ˜ Û¯ÂÙÈ-ο ÚfiÁÓˆÛ˘ M¢™ ÙÔ ‰›ÏËÌ· ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹ Û˘-ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ÙÂÚ¿ÛÙÈÔ ·ÊÔ‡ Ë ÌÂ-Ù·ÌfiÛ¯Â˘ÛË Ô˘ ÚÔÛʤÚÂÈ ÙËÓ ÚÔÔÙÈ΋ Ù˘ ›·-Û˘ ‰ÂÓ Â›Ó·È ÂÓ ÙÔ‡ÙÔȘ ¿ÌÔÈÚË ¿ÌÂÛˆÓ Î·È ‚·ÚÂÈ-ÒÓ ÂÈÏÔÎÒÓ Û ̛· ηٿÛÙ·ÛË fiÔ˘ Ë Û˘ÓÙËÚËÙÈ-

232 B. °∞ƒÀ¶π¢OÀ

¶›Ó·Î·˜ 4. ¢ÈÂıÓ¤˜ ÚÔÁÓˆÛÙÈÎfi Û‡ÛÙËÌ· ‚·ıÌÔÏfiÁËÛ˘ (IPSS) ÁÈ· M¢™. KÚÈÙ‹ÚÈ· Î·È ‚·ıÌÔÏfiÁËÛË ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË

B·ıÌÔÏÔÁ›·¶ÚÔÁÓˆÛÙÈ΋ ·Ú¿ÌÂÙÚÔ˜ 0 0,5 1 1,5 2,0

BÏ¿ÛÙ˜ M˘ÂÏÔ‡ (%) <5 5-10 — 11-20 21-30K·Ú˘fiÙ˘Ô˜* ηϋ˜ EӉȿÌÂÛ˘ K·Î‹˜

ÚfiÁÓˆÛ˘ ÚfiÁÓˆÛ˘ ÚfiÁÓˆÛ˘K˘ÙÙ·ÚÔÂӛ˜ 0/1 2/3

*K·Ú˘fiÙ˘Ô˜ ηϋ˜ ÚfiÁÓˆÛ˘: º˘ÛÈÔÏÔÁÈÎfi˜, 5q-, -Y, 20q-.K·Ú˘fiÙ˘Ô˜ η΋˜ ÚfiÁÓˆÛ˘: ¶ÔÏϷϤ˜ (> 3) ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, ‹ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ 7K·Ú˘fiÙ˘Ô˜ ÂӉȿÌÂÛ˘ ÚfiÁÓˆÛ˘: OÈ ÏÔȤ˜ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜

¶›Ó·Î·˜ 5. IPSS. EÈ‚›ˆÛË Î·È ÂͤÏÈÍË Û OM§ ÛÙȘ 4 ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘

OÌ¿‰· ÎÈÓ‰‡ÓÔ˘ B·ıÌÔÏÔÁ›· M¤ÛË ÂÈ‚›ˆÛË OM§ EÌÊ¿ÓÈÛË% (¤ÙË)

X·ÌËÏÔ‡ 0 5,7 ¤ÙË 25 9,4EӉȷ̤ÛÔ˘ I 0,5-1 3,5 ¤ÙË 25 3,3EӉȷ̤ÛÔ˘ II 1,5-2 1,2 ¤ÙË 25 1,1Y„ËÏÔ‡ >2 4,5 Ì‹Ó˜ 75

΋ ·ÓÙÈÌÂÙÒÈÛË Ì ٷ fiÔÈ· ÚÔ‚Ï‹Ì·Ù¿ Ù˘ ÂÍ·-ÛÊ·Ï›˙ÂÈ Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË.

™Â ·ÛıÂÓ›˜ Ì ÔÛÔÛÙfi ‚Ï·ÛÙÒÓ ÛÙÔ Ì˘ÂÏfi(5-10%) Ë ¯·ÌËÏ‹ ‰fiÛË ·Ú·Û˘Ù›Ó˘ Ô˘ ¯ÔÚËÁ‹-ıËΠˆ˜ ‰È·ÊÔÚÔÔÈËÙÈ΋ ıÂڷ›· ·Ú¯Èο ·Â-‰Â›¯ıË fiÙÈ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÌfiÓÔ Ì¤Ûˆ Ì˘ÂÏÈ-΋˜ ·Ï·Û›·˜ Û ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÌÂM¢™27. X·ÌËÏ‹ ›Û˘ ‰fiÛË ÂÙÔÔÛ›‰Ë˜ Â›Ó·È ÌÂ-ÚÈΤ˜ ÊÔÚ¤˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙË CMML, ÂÓÒ Ë 5-·˙·Û˘Ùȉ›ÓË Ô˘ ÈÔ ÚfiÛÊ·Ù· ¯ÚËÛÈÌÔÔÈ‹ıËΉڿ ÛÙÔ Ì˘ÂÏfi ÏÈÁfiÙÂÚÔ ÙÔÍÈο Î·È ÂÚÈÛÛfiÙÂÚԉȷÊÔÚÔÔÈËÙÈο28.

°È· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÎÚ›ÓÔÓÙ·È ·Î·Ù¿ÏÏËÏÔÈÁÈ· ¯ËÌÂÈÔıÂڷ›· ı· ÂÊ·ÚÌÔÛÙ› ˘ÔÛÙËÚÈÎÙÈ΋·ÁˆÁ‹ Ì ÌÂÙ·ÁÁ›ÛÂȘ ‹ /Î·È ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙ˜. H ÌÂÙ¿ÁÁÈÛË ÂÚ˘ıÚÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙ˘ Û˘Ìو̷ÙÈ΋˜ ·Ó·ÈÌ›·˜ Û˘ÓÙËÚ› Ô˘ÛÈ·ÛÙÈοÙÔ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì M¢™ Î·È Á›-ÓÂÙ·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, Û˘Ó‹ıˆ˜ ·Ó¿Ì‹Ó·. ™Â ηϋ˜ ÚfiÁÓˆÛ˘ M¢™ Ë ÔÏ˘ÌÂÙ¿ÁÁÈÛËÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÈÌÔÛȉ‹ÚˆÛË Î·È ··ÈÙ›¤ÁηÈÚÔ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ıÂڷ›·˜ Ì ‰ÂÛÊÂÚÈÔ-Í·Ì›ÓË, ·ÊÔ‡ Û˘¯Ó¿ Û ٤ÙÔȘ ÂÚÈÙÒÛÂȘ Ë ·ÈÙ›·ı·Ó¿ÙÔ˘ Â›Ó·È ÂÈÏÔΤ˜ Ù˘ ·ÈÌÔÛȉ‹ÚˆÛ˘ ηÈfi¯È ÔÈ Î˘ÙÙ·ÚÔÂӛ˜ (Ì ÌÂÙ·ÙÚÔ‹ ‹ fi¯È Û ÔÍ›·Ï¢¯·ÈÌ›·), fiˆ˜ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ. H ÌÂÙ¿ÁÁÈÛË·ÈÌÔÂÙ·Ï›ˆÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙȘ ÂÚÈÙÒÛÂȘ ÛÔ-‚·Ú‹˜ ıÚÔÌ‚ÔÂÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜.

H ÚÔÛ¿ıÂÈ· ‰ÈfiÚıˆÛ˘ ÙˆÓ Î˘ÙÙ·ÚÔÂÓÈÒÓ‚ÔËı‹ıËΠÛËÌ·ÓÙÈο Ì ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿-ÁÔÓÙ˜, ΢ڛˆ˜ ÙËÓ ÂÚ˘ıÚÔÔÈËÙ›ÓË (Epo). YÔÏÔ-Á›˙ÂÙ·È fiÙÈ 20-25% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ Ì M¢™··ÓÙÔ‡Ó ÛÙË ¯ÔÚ‹ÁËÛË Â͈ÁÂÓÔ‡˜ Epo Ì ·‡ÍË-ÛË ÙÔ˘ Ht Î·È ÂÏ¿ÙÙˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ‹ ··ÏÏ·Á‹

·fi ÙË ÌÂÙ¿ÁÁÈÛË ÂÚ˘ıÚÒÓ. K·Ï‡ÙÂÚ· ·ÓÙ·ÔÎÚ›-ÓÔÓÙ·È ÔÈ Î·ÙËÁÔڛ˜ RA Î·È RAEB (Î·È fi¯È ËRARS) Î·È ÔÈ ·ÛıÂÓ›˜ Ì ›‰· Epo ÙÔ˘ ÔÚÔ‡< 200 U/L29. ™˘Ó‰˘·ÛÌfi˜ Epo Ì G-CSF ·˘Í¿ÓÂÈ̤¯ÚÈ ‰ÈÏ·ÛÈ·ÛÌÔ‡ ÙËÓ ·ÓÙ·fiÎÚÈÛË ·ÏÏ¿ ·˘Í¿-ÓÂÈ ˘¤ÚÔÁη Î·È ÙÔ ÎfiÛÙÔ˜ Ù˘ ıÂڷ›·˜30. H·ÍÈÔÏfiÁËÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ì ·˘-Ùfi ÙÔ Û˘Ó‰˘·ÛÌfi ÂȯÂÈÚÂ›Ù·È Û ÌÂÁ¿ÏË ÔÏ˘ÂıÓÈ-΋ ÌÂϤÙË Ô˘ ‚Ú›ÛÎÂÙ·È Û ÂͤÏÈÍË.

¶·ÚÔ˘Û›· Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÔÈ GM Î·È G-CSF·Â‰Â›¯ıË fiÙÈ ·˘Í¿ÓÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÔÏ˘ÌÔÚ-ÊÔ˘Ú‹ÓˆÓ Î·È Èı·ÓfiÓ ÂÏ·ÙÙÒÓÔ˘Ó Î·È ÙȘ ÏÔÈÌÒ-ÍÂȘ ÛÙ· M¢™31. ¢ÚÔ‡Ó fï˜ ÁÈ· fiÛÔ ‰È¿ÛÙËÌ· ¯Ô-ÚËÁÔ‡ÓÙ·È ¯ˆÚ›˜ fiˆ˜ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ›‰Ú·-ÛË ÛÙËÓ ÙÂÏÈ΋ ÂÈ‚›ˆÛË ·ÏÏ¿ Ô‡ÙÂ Î·È ÛÙË ÌÂÙ·-ÙÚÔ‹ Û ÔÍ›· Ï¢¯·ÈÌ›· ÁÈ· ÙËÓ ÔÔ›· ›¯Â ÂÎ-ÊÚ·Ûı› ·Ú¯Èο Êfi‚Ô˜ fiÙÈ ÂÈÙ·¯‡ÓÂÙ·È.

°È· ÙË ıÚÔÌ‚ÔÂÓ›· ‰ÂÓ ˘¿Ú¯ÂÈ ÈηÓÔÔÈËÙÈ-΋ ̤¯ÚÈ Û‹ÌÂÚ· ·ÓÙÈÌÂÙÒÈÛË Ì ΢ÙÙ·ÚÔΛÓ˜.ºÙˆ¯¿ ·ÔÙÂϤÛÌ·Ù· ¤‰ˆÛ·Ó ÔÈ IL-6 Î·È IL-11ηıÒ˜ Î·È ÔÈ Û˘Ó‰˘·ÛÌÔ› Epo Î·È Î˘ÙÙ·ÚÔÎÈÓÒÓ,ÂÓÒ ‰ÔÎÈÌ¿˙ÔÓÙ·È Ë ·ÌÈÊÔÛÙ›ÓË32 Ô˘ Ê·›ÓÂÙ·È·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È Ë ıÚÔÌ‚ÔÔÈËÙ›ÓË.

M∂§§√¡∆π∫Œ™ ¶ƒ√√¶∆π∫Œ™NÂfiÙÂÚÔÈ Û˘Ó‰˘·ÛÌÔ› ΢ÙÙ·ÚÔÛÙ·ÙÈÎÒÓ, ÂÊ’ fiÛÔÓ¤¯ÂÈ ·ÔÊ·ÛÈÛı› ¯ËÌÂÈÔıÂڷ›·, fiˆ˜ .¯.FLAG-Ida (idarubicin, fludarabine, cytarabine ηÈG-CSF)33 Ê·›ÓÂÙ·È Î·Ù’ ·Ú¯‹Ó Ó· ‰›ÓÔ˘Ó Ôχ η-χÙÂÚ· ·ÔÙÂϤÛÌ·Ù·. MÈ· ÙÂÏ›ˆ˜ ‰È·ÊÔÚÂÙÈ΋˜‰Ú¿Û˘ ıÂڷ›·, Ë ıÂڷ›· Ì ·ÓÙÈı˘ÌÔ΢ÙÙ·-ÚÈ΋ ÛÊ·ÈÚ›ÓË, Ô˘ ·Ú¯Èο ¯ÚËÛÈÌÔÔÈ‹ıËΠÈη-ÓÔÔÈËÙÈο Û ˘ÔÏ·ÛÙÈο M¢™, ηٿÛÙ·ÛË ÌÂÔÏϤ˜ ÔÌÔÈfiÙËÙ˜ Ì ÙËÓ ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Ê·›-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 233

¶›Ó·Î·˜ 6. AÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì MDS. K·ıfiÏÔ˘ - ¯·ÌËÏ‹ ‹ ˘„ËÏ‹ ‰fiÛË ¯ËÌÂÈÔıÂڷ›·˜;

™Ô‚·ÚfiÙËÙ· T‡Ô˜ FAB BÏ¿ÛÙ˜ AÓÙÈÌÂÙÒÈÛË΢ÙÙ·ÚÔÂÓ›·˜ %

EÏ·ÊÚ¿ RA/RARS < 5 YÔÛÙËÚÈÎÙÈ΋ ıÂڷ›·AÓ·ÈÌ›·:MÂÙ·ÁÁ›ÛÂȘ±EpoO˘‰ÂÙÂÚÔÂÓ›·:G-CSF,GM-CSF£ÚÔÌ‚ÔÂÓ›·:amifostine,·ÓÙ·ÔÙˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜,IL11Epo+Û˘Ó‰˘·ÛÌÔ› ΢ÙÙ·ÚÔÎÈÓÒÓ

M¤ÛË RAEB/CMML 5-10 T· ·Ú·¿Óˆ ‹ X·ÌËÏ‹ ‰fiÛË Ara -C ‹X·ÌËÏ‹ ‰fiÛË Ara-C+΢ÙÙ·ÚÔΛÓ˜X·ÌËÏ‹ ‰fiÛË Etoposide (CMML)

B·ÚÂÈ¿ RAEB/RAEB-T 11-30 XËÌÂÈÔıÂڷ›· Ù‡Ô˘ OM§< 55 ÂÙÒÓ : ·˘ÙfiÏÔÁË ‹ ·ÏÏÔÁÂÓ‹˜ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ

ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ÛÙ· ÎÏ·ÛÛÈοM¢™ Î·È ·Í›˙ÂÈ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ˘34. ¶·Ú¿-ÁÔÓÙ˜ Ô˘ ÚÔ¿ÁÔ˘Ó ÙË ‰È·ÊÔÚÔÔ›ËÛË fiˆ˜ Ë 5-·˙·Û˘Ùȉ›ÓË, Ë ‚ÈÙ·Ì›ÓË D3 Î·È Ë Î·ÏÙÛÈÙÚfiÏË, ËÙÔÔÙÂοÓË, Û˘Ó‰˘·ÛÌÔ› ·˘ÍËÙÈÎÒÓ Î·È ‰È·ÊÔÚÔ-ÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ‹ ¯ˆÚ›˜ ΢ÙÙ·ÚÔÛÙ·ÙÈÎ¿Î·È Î˘Ú›ˆ˜ Ë ·ÌÈÊÔÛÙ›ÓË ‰›ÓÔ˘Ó ÂÏ›‰Â˜ ÁÈ· ‰È·-ÊÔÚÔÔÈËÙÈ΋ ıÂڷ›· ÛÙ· M¢™32,35. AÎfiÌË ·Ó·-ÛÙÚÔÊ‹ ÙˆÓ ÂÌÏÂÎÔÌ¤ÓˆÓ Ì˯·ÓÈÛÌÒÓ Î·È Î˘-Ú›ˆ˜ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È Ù˘·fiÙˆÛ˘ Ì ÂÓÙÔ͢ÊÈÏÏ›ÓË, ÛÈÚÔÊÏÔÍ·Û›ÓËÎ·È ÛÙÂÚÔÂȉ‹ ‹ ·Ú¿ÁˆÁ· ÙÔ˘ ‚Ô˘Ù˘ÚÈÎÔ‡ ÔͤԘ‰ÔÎÈÌ¿˙ÔÓÙ·È Â›Û˘36.

T¤ÏÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Î·È Â›‰Ú·ÛË ÛÂ Ù˘¯fiÓÂÌÏÂÎfiÌÂÓ· ÁÔÓ›‰È· (ÔÁÎÔÁÔÓ›‰È· ‹ ÔÁÎÔηٷ-ÛÙ·ÏÙÈο ÁÔÓ›‰È·) Ì ÁÔÓȉȷ΋ ıÂڷ›· ·ÔÙÂ-Ï› ÛÔ‚·Ú‹ ÚÔÔÙÈ΋ ÚÈ˙È΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ô˘fï˜ Â›Ó·È ·ÎfiÌË Ôχ Ì·ÎÚÈÓ‹. M›· ‰È·ÊÔÚÈ΋ÂÊ·ÚÌÔÁ‹ Ù˘ ÁÔÓȉȷ΋˜ ıÂڷ›·˜ fiˆ˜ .¯. ˷ڤ̂·ÛË Ù˘ ÛÙË Û˘Ì‚·ÙÈ΋ ¯ËÌÂÈÔıÂڷ›· ÌÂÙËÓ ÂÈÛ·ÁˆÁ‹ ÁÔÓȉ›ˆÓ ·ÓÙÔ¯‹˜ ÛÙË ¯ËÌÂÈÔıÂÚ·-›· ÛÙ· Ê˘ÛÈÔÏÔÁÈο ·Ú¯¤ÁÔÓ· ·ÙÙ·Ú· Ì ÛÎÔ-fi Ó· Ù· ÚÔÊ˘Ï¿ÍÂÈ ·fi ÙËÓ ÙÔÍÈ΋ ‰Ú¿ÛË ÙˆÓÊ·ÚÌ¿ÎˆÓ Ê·›ÓÂÙ·È fiÙÈ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ¢-ÎÔÏfiÙÂÚ·. AÎfiÌË Ë ¯ÔÚ‹ÁËÛË ·ÓÔÛÔ‰ÈÂÁÂÚÙÈÎÒÓ΢ÙÙ·ÚÔÎÈÓÒÓ ‹ Î·È ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÌÂ-ıfi‰Ô˘˜ ÁÔÓȉȷ΋˜ ıÂڷ›·˜ Î·È ÛÙfi¯Ô ¿ÏÈ Ù·Ê˘ÛÈÔÏÔÁÈο ·Ú¯¤ÁÔÓ· ·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú· ηÈÙÔ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ì˘ÂÏÔ‡ Ê·›ÓÂÙ·È Ôχ ÈÔ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·fi ÙË Û˘Ì‚·ÙÈ΋ Â͈ÙÂÚÈ΋ ¯Ô-Ú‹ÁËÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ Ô˘ÛÈÒÓ ÛÙÔÓ ·ÛıÂÓ‹ ‰Ô-ÛÔÏÔÁ›· ÙˆÓ ÔÔ›ˆÓ ÂÚÈÔÚ›˙ÂÙ·È ÛËÌ·ÓÙÈο ·fiÙË Û˘ÛÙËÌ·ÙÈ΋ ÙÔÍÈÎfiÙËÙ·37,38.

™Â Ì›· ηٿÛÙ·ÛË fiˆ˜ Ù· M¢™ fiÔ˘ ÔÈÂÌÏÂÎfiÌÂÓÔÈ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ì˯·ÓÈÛÌÔ› ›ӷÈfiˆ˜ Ê·›ÓÂÙ·È ÔÏÏ·ÏÔ›, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ë Ô-Ú›· Î·È Ë ÂͤÏÈÍË ÔÈΛÏÏÔ˘Ó Â˘Ú¤ˆ˜ Î·È ÔÈ ıÂÚ·-¢ÙÈΤ˜ ÚÔÔÙÈΤ˜, ÂÏÏ›„ÂÈ È‰·ÓÈ΋˜ Î·È ÚÈ˙È-΋˜ ıÂڷ›·˜, ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¤Ó· ¢ڇ Ê¿ÛÌ·¯ÂÈÚÈÛÌÒÓ, Ë ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË Î·È Ë ÂÈÏÔÁ‹ Ù˘ηٷÏÏËÏfiÙÂÚ˘ ·ÁˆÁ‹˜ ÁÈ· οı ÂÚ›ÙˆÛË Â›Ó·È·˘Ù‹ Ô˘ ı· Û˘Ì‚¿ÏÏÂÈ Ô˘ÛÈ·ÛÙÈο ÛÙËÓ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ıÂڷ¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ Î·È ÙËÓηχÙÂÚË ‰˘Ó·Ù‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÚÒÛÙˆÓ.

ABSTRACTGaripidou V. Myelodysplastic syndromes. HellIatr 2000, 66: 227 - 236.

Myelodysplastic syndromes (MDS) are a hete-rogeneous group of clonal disorders of hematopoi-

etic stem cells interrelated with other clonal bonemarrow diseases such as the myeloid leukemias andmyeloproliferative syndromes. MDS are charaderi-zed by ineffective hematopoiesis leading to bloodcytopenias despite normal or hypercellular bonemarrow. Many of them will progress to acute leu-kemia. MDS is primarily a disease of the elderly. Itis more common than acute myeloid leukemia(AML) and appears to be increasing in incidence.Like AML, MDS can occur as a primary or de novodisease or as a treatment related or secondary e-vent. Anemia, increased risk of infection and bleed-ing results from an alteration in maturation at leasttwo of the three major cell lines in the marrow. Bio-logically MDS seems to be a blend of increased pro-liferation and accelerated apoptosis (programmedcell death). FAB classification divides MDS into fivesubgroups: refractory anemia (RA), refractory ane-mia with ringed sideroblasts (RARS) chronic myelo-monocytic leukemia, refractory anemia with excessblasts (RAEB), refractory anemia with excess blastsin transformation (RAEBT) - according to the per-centage of blasts in the marrow, percentage of rin-ged sideroblasts, presence of monocytes and seve-rity of dyspoiesis. Survival curves range from 5 to 6years for the most favorable prognostic groups (RA,RARS) to less than 1 year for the least favorable(CMML, RAEB, RAEBT). FAB classification has notbeen without critics and modifications have beensuggested. A number of indexes have been propo-sed to aid in predÈcting clinical outcome for patientswith MDS. The intenational prognostic scoring sy-stem includes four groups of patients classified ac-cording to cytogenetics, percentage of blasts in thebone marrow and number of cytopenias. Currentclinical strategies include supportive care (tranfu-sions, erythropoietin, growth factors) or methods ofmanipulating the stem cell by either destroying it(aggressive or low dose chemotherapy) or stimula-ting its growth and differentiation (differentiation orantiapoptotic agents, combinations of cytokines oreven gene therapy). The aim should be to assess thepotentially best responsive subgroup of patients toany of these therapeutic options to enhance the rateof success.

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234 B. °∞ƒÀ¶π¢OÀ

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AÏÏËÏÔÁÚ·Ê›·:B. °·Ú˘›‰Ô˘N. T¤ÏÏÔÁÏÔ˘ 9546 36 – £ÂÛÛ·ÏÔÓ›ÎË

Corresponding author:V. Garipidou9, N. Telloglou, Str.546 36 – ThessalonikiGreece

236 B. °∞ƒÀ¶π¢OÀ

∆· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÓÂÊÚÒÓÎ·È ÙËÓ ÔÍ›· ÛˆÏËÓ·Úȷ΋ Ó¤ÎÚˆÛË

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ÷ڷϷÌfiÔ˘ÏÔ˜, µ·ÛÈÏÈ΋ ¶··ÏÈÌÓ·›Ô˘

∂ÚÁ. º˘ÛÈÔÏÔÁ›·˜, ∫ÏÈÓÈ΋ ªÔÓ¿‰·, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¶ÂÚ›ÏË„Ë. ∆· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ‰È·‰Ú·Ì·Ù›˙Ô˘ÓÛÔ˘‰·›Ô ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÔÏ˘Î˘ÙÙ¿ÚˆÓÔÚÁ·ÓÈÛÌÒÓ. ¢È·‰Èηۛ˜ fiˆ˜ Ë ÂÌ‚˘ÔÁ¤ÓÂÛË, Ë ‰Ë-ÌÈÔ˘ÚÁ›· Î·È Ë ‰È·Ù‹ÚËÛË Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙˆÓÈÛÙÒÓ, ÂÍ·ÚÙÒÓÙ·È Î·Ù¿ Ôχ ·fi ÔÚÈṲ̂ӷ ÌfiÚÈ·ÚÔÛÎfiÏÏËÛ˘. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi Û˘˙ËÙÂ›Ù·È ÂȉÈÎfiÙÂ-Ú· Ô ÚfiÏÔ˜ ÌÂÚÈÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘, ÛÙËÓ·Ó¿Ù˘ÍË ÙˆÓ ÓÂÊÚÒÓ Î·È ÛÙËÓ ·ıÔÏÔÁÈ΋ ηٿ-ÛÙ·ÛË Ù˘ ÔÍ›·˜ ÛˆÏËÓ·Úȷ΋˜ Ó¤ÎÚˆÛ˘. OÈ ÈÓÙÂ-

ÁÎÚ›Ó˜, o˘ Â›Ó·È Ë Î·Ï‡ÙÂÚ· ÌÂÏÂÙË̤ÓË oÌ¿‰·ÌoÚ›ˆÓ ÚoÛÎfiÏÏËÛ˘ ¿Óˆ Û’ ·˘Ùfi Ùo ı¤Ì·,ÂÌϤÎoÓÙ·È Ì ‰È¿ÊoÚo˘˜ Ì˯·ÓÈÛÌo‡˜ ÛÙËÓ ‰È·-‰Èηۛ· Ù˘ oÍ›·˜ ÛˆÏËÓ·Úȷ΋˜ Ó¤ÎÚˆÛ˘ Î·È Â-ÚÈÁÚ¿ÊoÓÙ·È ·Ó·Ï˘ÙÈÎfiÙÂÚ· Û’ ·˘Ùfi Ùo ¿ÚıÚo. ™˘-˙ËÙo‡ÓÙ·È ·ÎfiÌË Ù· ·ıoÊ˘ÛÈoÏoÁÈο ·ÎfiÏo˘ı·Ù˘ ÓfiÛo˘ o˘ Û¯ÂÙ›˙oÓÙ·È Ì ٷ ÌfiÚÈ· ÚoÛ-ÎfiÏÏËÛ˘ Î·È Á›ÓÂÙ·È Û‡ÓÙoÌË ·Ó·ÛÎfiËÛË Ù˘ ‰ÈÂı-Óo‡˜ ‚È‚ÏÈoÁÚ·Ê›·˜. EÏÏËÓ I·ÙÚ 2000, 66: 237 - 242.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 237 - 242

°∂¡π∫∞∏ ‰ËÌÈo˘ÚÁ›· ‰ÂÛÌÒÓ ÚoÛÎfiÏÏËÛ˘ ÌÂٷ͇ ÙˆÓ΢ÙÙ¿ÚˆÓ ‹ ÌÂٷ͇ ΢ÙÙ¿ÚˆÓ Î·È ÛÙoȯ›ˆÓ Ù˘ÂÍˆÎ˘ÙÙ·ÚÈ΋˜ ıÂ̤ÏÈ·˜ o˘Û›·˜, ·oÙÂÏ› Ì›· ‚·-ÛÈ΋ ‰È·‰Èηۛ· o˘ ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏo ÙfiÛoηٿ ÙËÓ ·Ú¯È΋ Ê¿ÛË Ù˘ Û˘ÁÎÚfiÙËÛ˘ ÙˆÓ ÈÛÙÒÓfiÛo Î·È ÌÂÙ¤ÂÈÙ·. ∞˘Ùfi ‰Â ÂÂȉ‹ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂ-Û· Ì ÙË ‰È·ÊoÚoo›ËÛË, ÙËÓ ·Ú¯ÈÙÂÎÙoÓÈ΋, ÙËÊ˘ÛÈoÏoÁÈ΋ ·Ó¿Ù˘ÍË Î·È ÙË ‰È·Ù‹ÚËÛË Ù˘ ‰o-Ì‹˜ ÙˆÓ ÈÛÙÒÓ ÙˆÓ oÏ˘Î˘ÙÙ¿ÚˆÓ oÚÁ·ÓÈÛÌÒÓ.∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ÛËÌÂÈÒıËΠ̛· ¤ÎÚËÍËÁÓÒÛÂˆÓ ÛÙo˘˜ ÙoÌ›˜ Ù˘ Ê˘ÛÈoÏoÁ›·˜, Ù˘ ‚Èo¯Ë-Ì›·˜ Î·È Ù˘ ÁÂÓÂÙÈ΋˜ ¿Óˆ ÛÙo ı¤Ì· Ù˘ ΢ÙÙ·-ÚÈ΋˜ ÚoÛÎfiÏÏËÛ˘, ηıÒ˜ ¤ÁÈÓ ʷÓÂÚfi ˆ˜ ÛÂoÏϤ˜ ·fi ÙȘ ·ÓÙȉڿÛÂȘ ΢ÙÙ¿Úo˘ Úo˜ ·ÙÙ·-Úo (cell–cell) ‹ ΢ÙÙ¿Úo˘ Úo˜ ÛÙoȯ›· Ù˘ Â͈-΢ÙÙ·ÚÈ΋˜ ıÂ̤ÏÈ·˜ o˘Û›·˜ (cell–matrix) ÌÂÛoÏ·-‚o‡Ó o˘Û›Â˜ o˘ oÓoÌ¿˙oÓÙ·È ÌfiÚÈ· ÚoÛÎfiÏÏË-Û˘1,2. ™ÙËÓ ÂÈÎfiÓ· 1 ·Úo˘ÛÈ¿˙oÓÙ·È Û¯ËÌ·ÙÈοoÈ ¤ÓÙ Ì›˙oÓ˜ oÈÎoÁ¤ÓÂȘ ÙˆÓ ÌoÚ›ˆÓ ÚoÛ-ÎfiÏÏËÛ˘ Î·È ·Ó·Ê¤ÚoÓÙ·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· ·fi·˘Ù¿ Ì·˙› Ì ÌÂÚÈο ÁÂÓÈο Û¯fiÏÈ·. ∆· ÌfiÚÈ· ·˘-Ù¿ ¤¯o˘Ó ȉȷ›ÙÂÚË ÛËÌ·Û›· ÌÈ·˜ Î·È ·›˙o˘Ó η-ıoÚÈÛÙÈÎfi ÚfiÏo ÛÙo Â¿Ó ¤Ó· ·ÙÙ·Úo ı· ·Ú·Ì›-

ÓÂÈ Î¿o˘ Î·È o‡ ‹ Â¿Ó ı· ÎÈÓËı› Î·È Úo˜ Ù·o‡, ηıÒ˜ Î·È ÛÙo fiÙ ı· ÛÙ·Ì·Ù‹ÛÂÈ Ó· ÌÂÙ·-Ó·ÛÙ‡ÂÈ. ∆· ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘ Û˘ÌÌÂÙ¤¯o˘ÓÛÙȘ ‰È·‰Èηۛ˜ ÂÌ‚Ú˘oÁ¤ÓÂÛ˘, Ù˘ ηÓoÓÈ΋˜·Ó¿Ù˘Í˘, Ù˘ ‰È·Ù‹ÚËÛ˘ Ù˘ ·Ú¯ÈÙÂÎÙoÓÈ΋˜ ηÈÙ˘ ÌoÚÊoÏoÁ›·˜ ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ‰È·ÊfiÚˆÓ ÈÛÙÒÓ,Ù˘ ÂÍ·ÁÁ›ˆÛ˘ ÙˆÓ Ï¢ÎÒÓ ·ÈÌoÛÊ·ÈÚ›ˆÓ, Ù˘Âo‡ÏˆÛ˘ ÙˆÓ ÙÚ·˘Ì¿ÙˆÓ Î·È Ù˘ ÊÏÂÁÌoÓ‹˜.∂ÌϤÎoÓÙ·È fï˜ Î·È ÛÙȘ ‰È·‰Èηۛ˜ Ù˘ ηÚÎÈ-ÓÈ΋˜ ‰È‹ıËÛ˘ Î·È ÙˆÓ ÌÂÙ·ÛÙ¿ÛˆÓ3. O ÙÂÏ¢-Ù·›o˜ ·˘Ùfi˜ Ùo̤·˜ Â›Ó·È Î·È o ÂÚÈÛÛfiÙÂÚo ÌÂÏÂ-ÙË̤Óo˜ ̤¯ÚÈ Û‹ÌÂÚ·. À¿Ú¯o˘Ó ÈÛ¯˘Ú¤˜ ÂӉ›-ÍÂȘ fiÙÈ Ù· ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘ Î·È oÈ Û¯ÂÙÈ˙fiÌÂ-Ó˜ Ì ·˘Ù¿ ÚˆÙ½Ó˜ Ùo˘ ΢ÙÙ·ÚoÛÎÂÏÂÙo‡, ‰˘-Ó·ÙfiÓ Ó· ÌÂٷʤÚo˘Ó ÂÓ‰o΢ÙÙ·ÚÈο ÌËӇ̷ٷ ̉ÈÂÁÂÚÙÈ΋ ‹ ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË4,5. ª¤¯ÚÈ Û‹ÌÂÚ·ÂÚÈÛÛfiÙÂÚ· ·fi ÂηÙfi ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘ ¤-¯o˘Ó ·ÓȯÓ¢Ù› Î·È ÚoÛ‰ÈoÚÈÛÙ›. ∫·Ù·Ó¤ÌoÓÙ·ÈÛ ¤ÓÙ oÌ¿‰Â˜ o˘ ÙȘ ·oÙÂÏo‡Ó oÈ ÈÓÙÂÁÎÚ›Ó˜,oÈ Î·ÓÙÂÚ›Ó˜, Ë ˘ÂÚoÈÎoÁ¤ÓÂÈ· ÙˆÓ ·ÓoÛoÛÊ·È-ÚÈÓÒÓ, oÈ ÛÂÏÂÎÙ›Ó˜ Î·È Ùo CD44. ∫·ıÒ˜ Ë Î·Ù·-ÓfiËÛË fiÏo Î·È ÂÚÈÛÛfiÙÂÚˆÓ ÛÙoȯ›ˆÓ Á‡Úˆ ·fiÙ· ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘ Î·È ÙoÓ ÚfiÏo Ùo˘˜ ÛÂ Ê˘-ÛÈoÏoÁÈΤ˜ ‹ ·ıoÏoÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ·˘Í¿ÓÂÙ·È

237

Û˘Ó¯Ҙ, ‰È¿ÊoÚoÈ ÂÚ¢ÓËÙ¤˜ ¤ÛÙÚ„·Ó Ùo ÂӉȷ-ʤÚoÓ Ùo˘˜ Î·È Úo˜ Ùo˘˜ ÓÂÊÚo‡˜, ÁÈ· Ó· ·Ó·Ï‡-Ûo˘Ó Ù· Û˘Ì‚·›ÓoÓÙ· ÙfiÛo ηٿ ÙËÓ Î·ÓoÓÈ΋ Ùo˘˜·Ó¿Ù˘ÍË, fiÛo Î·È ÁÈ· Ó· ÌÂÏÂÙ‹Ûo˘Ó ‰È¿ÊoÚ˜ ÂÈ-‰ÈΤ˜ ·ıoÏoÁÈΤ˜ ηٷÛÙ¿ÛÂȘ. ∞fi Ù· ÌfiÚÈ·ÚoÛÎfiÏÏËÛ˘ ÛÙoÓ ÓÂÊÚfi ¤¯o˘Ó ÌÂÏÂÙËı› Â-ÚÈÛÛfiÙÂÚo oÈ ÈÓÙÂÁÎÚ›Ó˜6. °È· ÙoÓ ÏfiÁo ·˘Ùfi ÛÙËÓ·Úo‡Û· ·Ó·ÛÎfiËÛË ·Ó·ÊÂÚfiÌ·ÛÙ ‰ÈÂÍo‰È-ÎfiÙÂÚ· Û ·˘Ù¤˜. °›ÓÂÙ·È fï˜ ÏfiÁo˜ Î·È ÁÈ· Ù·¿ÏÏ· ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘ fiÙ·Ó ‰È·Ù›ıÂÓÙ·È ÁÈ’ ·˘-Ù¿ ÙÂÎÌËÚȈ̤ӷ ÂÈÛÙËÌoÓÈο ÛÙoȯ›· Ùo˘ ÚfiÏo˘Ùo˘˜ ÛÂ Û˘ÁÎÂÎÚÈÌ̤Ó˜ ÓÂÊÚÈΤ˜ ÓfiÛo˘˜7.

∞¡∞¶∆À•∏ ∆ø¡ ¡∂ºƒø¡ ∫∞π ªOƒπ∞¶ƒO™∫O§§∏™∏™

OÈ ÏËÚoÊoڛ˜ ÁÈ· ÙoÓ ÚfiÏo ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ ÛÙËÓ·Ó¿Ù˘ÍË ÙˆÓ ÓÂÊÚÒÓ Î·È ÙȘ Û¯ÂÙÈΤ˜ ‰È·‰Èηۛ˜ÚoÛÎfiÏÏËÛ˘ Úo¤Ú¯oÓÙ·È ·fi ÌÂϤÙ˜ ηÏ-ÏÈÂÚÁÂÈÒÓ ÓÂÊÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·fi ÌÂϤÙ˜ ̉ȿÊoÚ˜ ·ÓoÛo˚ÛÙo¯ËÌÈΤ˜ ÌÂıfi‰o˘˜. ∏ ÈÓÙÂÁÎÚ›-ÓË o˘ ΢Úȷگ› ÛÙoÓ ÂÌ‚Ú˘˚Îfi ·‰È·ÊoÚoo›ËÙoÓÂÊÚÈÎfi ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ÈÛÙfi Â›Ó·È Ë ·1 ÈÓÙÂÁÎÚ›ÓË.∫˘Ú›ˆ˜ ·Ó¢ڛÛÎÂÙ·È Ë ·1‚1 ‹ CD49a/CD29 ÈÓÙÂ-ÁÎÚ›ÓË, o˘ Û˘Ó‰¤ÂÙ·È Ì ÎoÏÏ·ÁfiÓo Î·È Ï·ÌÈÓ›ÓË.∫·Ù¿ ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ËÈÓÙÂÁÎÚ›ÓË ·˘Ù‹ ÂÚÈoÚ›˙ÂÙ·È Û˘Ó¯Ҙ Î·È ¤ÙÛÈ ÙÂÏÈ-ο ‰ÂÓ ·ÓȯÓ‡ÂÙ·È ÛÙ· ÂÈıËÏȷο ·ÙÙ·Ú· ÙˆÓ ÓÂ-ÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ÙˆÓ ÂÓËÏ›ÎˆÓ ·ÙfïÓ. ∂ÓÙo›-˙ÂÙ·È fï˜ ÛÙ· ·ÙÙ·Ú· Ùo˘ ‰È¿ÌÂÛo˘ ¯ÒÚo˘. ™Ù··Ó·Ù˘ÛÛfiÌÂÓ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· ·Ú¿ÁoÓÙ·È¿ÏϘ ÈÓÙÂÁÎÚ›Ó˜ Ùo˘ Ù‡o˘ ‚1. ∆· ÂÁÁ‡˜ Î·È Ù·¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· ÂÎÎÚ›Óo˘Ó ÂÈϤoÓ·6 ÈÓÙÂÁÎÚ›ÓË o˘ Û˘Ó‰¤ÂÙ·È Ì ϷÌÈÓ›ÓË Î·È Û ÌÈ-ÎÚfiÙÂÚo ‚·ıÌfi ÂÎÎÚ›Óo˘Ó ·3 ÈÓÙÂÁÎÚ›ÓË o˘ Û˘Ó‰¤-ÂÙ·È Ì ÈÓoÓÂÎÙ›ÓË, Ï·ÌÈÓ›ÓË Î·È ÎoÏÏ·ÁfiÓo. ªfiÓoÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· ÂÎÎÚ›ÓÂÙ·È ÂÈ-ÚfiÛıÂÙ· Î·È ·2 ÈÓÙÂÁÎÚ›ÓË o˘ Û˘Ó‰¤ÂÙ·È ÌÂÎoÏÏ·ÁfiÓo Î·È Ï·ÌÈÓ›ÓË. ∏ ·Ú·ÁˆÁ‹ ·6 ÈÓÙÂÁÎÚ›-Ó˘ ·fi Ù· ·Ó·Ù˘ÛÛfiÌÂÓ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· η-Ù¿ ÙË Ê¿ÛË Ù˘ ÌÂÙ·ÙÚo‹˜ Ùo˘ ·‰È·ÊoÚoo›ËÙo˘ÌÂÙ·ÓÂÊÚÈÎo‡ ÌÂÛÂÁ¯‡Ì·Ùo˜ Û ۈÏËÓ¿ÚÈ·, ÂÓ¤¯ÂÈÎÚÈÙÈ΋ ÛËÌ·Û›· ÛÙËÓ ˆÚ›Ì·ÓÛË Î·È ÂͤÏÈÍ‹ Ùo˘˜.¡· ÛËÌÂȈı› fiÙÈ Ë Ï·ÌÈÓ›ÓË Û˘ÌÌÂÙ¤¯ÂÈ ÂÓÂÚÁ¿ÛÙËÓ ‰È·‰Èηۛ· Ù˘ ÛˆÏËÓ·ÚÈoÁ¤ÓÂÛ˘ ηıÒ˜ Û˘Ì-ÌÂÙ¤¯ÂÈ ÛÙo Û¯ËÌ·ÙÈÛÌfi Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Ùo˘ÛˆÏËÓ·Ú›o˘. ∏ · ¿Ï˘Ûo˜ Ù˘ Ï·ÌÈÓ›Ó˘ ·Ó·ÁÓˆÚ›˙Â-Ù·È ·fi ÙËÓ ·6‚1 ÈÓÙÂÁÎÚ›ÓË. ∞ÓÙÈÛÒÌ·Ù· ηٿ Ù˘·6‚1 ÈÓÙÂÁÎÚ›Ó˘ ηٷÚÁo‡Ó ÙË ‰È·‰Èηۛ· Ù˘ Ûˆ-ÏËÓ·ÚÈoÁ¤ÓÂÛ˘. ™Ù· ÂÁÁ‡˜ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿-ÚÈ· ·Ú·ÙËÚÂ›Ù·È ÚoÛÎoÏÏËÙÈ΋ ‰È·‰Èηۛ· Ì ÙËÓÈÓoÓÂÎÙ›ÓË Ì ÌÂÛoÏ¿‚ËÛË ÙˆÓ ·5‚1 Î·È ·Ó‚3 ÈÓÙÂ-ÁÎÚÈÓÒÓ. OÈ ÚoÛÎoÏÏËÙÈΤ˜ ·˘Ù¤˜ ‰È·‰Èηۛ˜ η-Ù·ÚÁo‡ÓÙ·È Ï‹Úˆ˜ Ì ÂÙ›‰È· o˘ ÂÚȤ¯o˘Ó ÙËÓRGD ·ÏÏËÏo˘¯›· ·ÌÈÓoͤˆÓ (·ÚÁÈÓ›ÓË–ÁÏ˘Î›ÓË–·Û·ÚÙÈÎfi o͇), o˘ ·oÙÂÏo‡Ó Î·È ÙoÓ Â›Ùoo ÙˆÓÈÓÙÂÁÎÚÈÓÒÓ8,9. ™ÙËÓ ·Ú¯È΋ ÚoÛÎoÏÏËÙÈ΋ ‰È·‰Èη-Û›· Ì ÙËÓ Ï·ÌÈÓ›ÓË, Û˘Ì‚¿ÏÏÂÈ ÏËÓ Ù˘ ·6‚1 Î·È Ë·3‚1 ÈÓÙÂÁÎÚ›ÓË. ∏ ÚoÛÎfiÏÏËÛË Ì Ùo ÎoÏÏ·ÁfiÓoÁ›ÓÂÙ·È Ì¤Ûˆ ÙˆÓ ·2‚1 Î·È ·Ó‚3 ÈÓÙÂÁÎÚÈÓÒÓ. ¶Èı·-ÓÒ˜ Ó· Û˘ÌÌÂÙ¤¯ÂÈ Î·È Ì›· ·ÚoÛ‰ÈfiÚÈÛÙË ·ÎfiÌË ‚1ÈÓÙÂÁÎÚ›ÓË.

∆· ÓÂÊÚÈο ۈ̿ÙÈ· ·Úo˘ÛÈ¿˙o˘Ó ›Û˘ÌÂÙ·‚oϤ˜ ÛÙËÓ ¤ÎÎÚÈÛË ÈÓÙÂÁÎÚÈÓÒÓ Î·Ù¿ ÙËÓ ‰È·-‰Èηۛ· Ù˘ ˆÚ›Ì·ÓÛ‹˜ Ùo˘˜. ™ÙoÓ ÂÌ‚Ú˘˚Îfi ÈÛÙfi

238 K. XAPA§AM¶O¶OY§O™ KAI ™YN.

∂ÈÎ. 1. OÈ ¤ÓÙ Ì›˙oÓ˜ oÈÎoÁ¤ÓÂȘ ˘o‰o¯¤ˆÓ ÚoÛÎfiÏ-ÏËÛ˘ ΢ÙÙ¿Úo˘ Úo˜ ·ÙÙ·Úo (CAM) Î·È Î˘ÙÙ¿Úo˘ Úo˜˘fiÛÙڈ̷ (SAM). (∞) °oÓȉȷ΋ ˘ÂÚoÈÎoÁ¤ÓÂÈ· ·Óo-ÛoÛÊ·ÈÚÈÓÒÓ (¡CAM, VCAM, CEA, DCC): ÌfiÚÈ· o˘ ¤¯o˘ÓÎoÈÓ‹ ÙËÓ ·ÓoÛoÛÊ·ÈÚÈÓÈ΋ ‰oÌÈ΋ oÌfiÏoÁo ÌoÓ¿‰· o˘·oÙÂÏÂ›Ù·È ·fi 70 ¤ˆ˜ 100 ·ÌÈÓoͤ· Î·È Û˘ÓÙ›ıÂÙ·È ·fi‰‡o ·Ï‡Ûo˘˜ Û˘Ó‰Â‰Â̤Ó˜ Ì ¤Ó· ‰ÈÛo˘ÏÊȉÈÎfi ‰ÂÛÌfi. (µ)IÓÙÂÁÎÚ›Ó˜: ‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÁÏ˘ÎoÚˆÙ½Ó˜ o˘ ·oÙÂ-Ïo‡ÓÙ·È ·fi · Î·È ‚ ‰ÈÌÂÚ‹. (°) K·ÓÙÂÚ›Ó˜ (∂,P,N): ‰È·-ÌÂÌ‚Ú·ÓÈΤ˜ ÁÏ˘ÎoÚˆÙ½Ó˜ o˘ ·ÚÈÛÙo‡Ó Ùo˘˜ ·ÚÈo˘˜ÌÂÛoÏ·‚ËÙ¤˜ Ù˘ ÂÍ ÈfiÓÙˆÓ ·Û‚ÂÛÙ›o˘ Ca++ ÂÍ·ÚÙÒÌÂÓ˘ÚoÛÎfiÏÏËÛ˘ ΢ÙÙ¿Úo˘ Úo˜ ·ÙÙ·Úo, ̤ۈ oÌoÙ˘ÈÎÒÓ·ÓÙȉڿÛÂˆÓ .¯ ¤Ó· ÌfiÚÈo › ÂÓfi˜ ΢ÙÙ¿Úo˘ ‰ÂÛ̇ÂÈ Ìfi-ÚÈ· Ùo˘ ›‰Èo˘ Ù‡o˘ ÂÓfi˜ ¿ÏÏo˘ ΢ÙÙ¿Úo˘. (¢) ™ÂÏÂÎÙ›Ó˜:‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÁÏ˘ÎoÚˆÙ½Ó˜ o˘ Û¯ËÌ·Ù›˙oÓÙ·È Ì ·-Ó·Ï‹„ÂȘ oÈΛÏo˘ ·ÚÈıÌo‡ Ù˘ ›‰È·˜ Ïo‡ÛÈ·˜ Û ÏÂÎÙ›ÓËÂÚÈo¯‹˜. ªÂ ÙËÓ ·Úo˘Û›· ·Û‚ÂÛÙ›o˘ Ë ÂÚÈo¯‹ Ù˘ ÏÂÎÙ›-Ó˘ Û˘Ó‰¤ÂÙ·È Ì Ùo ·ÓÙÈÁfiÓo Lewis ÁÂÈÙoÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ.(E) CD44: ÁÏ˘ÎoÚˆÙ½ÓË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÈÊ·Ó›·˜ Ûo˘-‰·›· ÁÈ· ÙËÓ ÏÂÌÊo΢ÙÙ·ÚÈ΋ ÂÁηÙo›ÎËÛË, ÙËÓ ÂÓÂÚÁoo›-ËÛË ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ Î·È ÙËÓ ÚoÛÎfiÏÏËÛË Ì ÙȘ ˘·Ïo˘-ÚoÓÈΤ˜ Î·È ¿ÏϘ ÚˆÙ½Ó˜ Ù˘ ıÂÌÂÏ›o˘ o˘Û›·˜.

ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÌ·Ù›ˆÓ ΢Úȷگ› Ë ·2 ÈÓÙÂÁÎÚ›-ÓË, o˘ Úoo‰Â˘ÙÈο ÌÂÈÒÓÂÙ·È Î·È ¤ÙÛÈ ÛÙoÓ ÂÓ‹-ÏÈη ˘¿Ú¯ÂÈ Û oχ ÌÈÎÚfiÙÂÚ˜ Û˘ÁÎÚÈÙÈο ˘-ÎÓfiÙËÙ˜, ÂÓÒ ÂÌÊ·Ó›˙oÓÙ·È ÙÒÚ· oÈ ·3 Î·È ·5 ÈÓ-ÙÂÁÎÚ›Ó˜. ™Ùo ¤Ì‚Ú˘o Ù· ÂÈıËÏȷο ·ÙÙ·Ú· ÙˆÓÓÂÊÚÈÎÒÓ ÛˆÌ·Ù›ˆÓ ÂÎÎÚ›Óo˘Ó ÂÈϤoÓ Î·È ·6 ÈÓ-ÙÂÁÎÚ›ÓË o˘ ·‡ÂÈ Ó· ·ÓȯÓ‡ÂÙ·È ÛÙoÓ ÂÓ‹ÏÈη.∏ ·3‚1 ÈÓÙÂÁÎÚ›ÓË o˘ ÂÈÎÚ·Ù› ÛÙ· ÂÈıËÏȷο·ÙÙ·Ú· ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÌ·Ù›ˆÓ ÌÂÛoÏ·‚› ÛÂÛ˘Ó‰¤ÛÂȘ Ì ÎoÏÏ·ÁfiÓo, Ï·ÌÈÓ›ÓË Î·È ÈÓoÓÂÎÙ›ÓË.

∆· ÌÂÛ·ÁÁÂȷο ·ÙÙ·Ú· ÂÎÎÚ›Óo˘Ó ·1, ·2, ·3,·5 Î·È ·Ó‚3 ÈÓÙÂÁÎÚ›Ó˜. ∂ÎÙfi˜ ·fi ÙȘ ÈÓÙÂÁÎÚ›Ó˜ÛÙo ·‰È·ÊoÚoo›ËÙo ÌÂÛ¤Á¯˘Ì· ÂÓÙo›˙ÂÙ·È Î·È ÙoÌfiÚÈo ÚoÛÎfiÏÏËÛ˘ ÙˆÓ Ó¢ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓNCAM (neural cell adhesion molecule) o˘ ÂÍ·-Ê·Ó›˙ÂÙ·È Úoo‰Â˘ÙÈο ηٿ ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÓÂ-ÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ. ∏ ∂-ηÓÙÂÚ›ÓË ‹ uvomorulin(ÛÙo˘˜ ÂÈ̇˜) ‹ rr–1 Î·È arc–1 (ÛÙo Û·Ïo) ‹ gp140(ÛÙo xenopus) ‹ LCAM Î·È CAM 120/80 (ÛÙoÓ ¿Ó-ıÚˆo), ·Ú¯›˙ÂÈ Ó· ÂÎÎÚ›ÓÂÙ·È Úoo‰Â˘ÙÈο Î·È Û·ӿÛÙÚoÊË oÚ›· Û ۯ¤ÛË Ì Ùo NCAM ÛÙ· ÓÂ-ÊÚÈο ÛˆÏËÓ¿ÚÈ· ÂÓ¤¯oÓÙ·˜ ÎÚÈÙÈ΋ ÛËÌ·Û›·. ™ÙoÓÂÓ‹ÏÈη ˘¿Ú¯ÂÈ Î·È Ì›· ·ÎfiÌË Î·ÓÙÂÚ›ÓË, Ë ACAMηÓÙÂÚ›ÓË. Œ¯ÂÈ ÂÚ¢ÓËı› ·ÎfiÌË Ë ·Úo˘Û›· Ùo˘ÌoÚ›o˘ ÌÂÛo΢ÙÙ·ÚÈ΋˜ ÚoÛÎfiÏÏËÛ˘–1, ICAM–1‹ CD54 (intercellular adhesion molecule) Î·È Ùo˘ÌoÚ›o˘ ÚoÛÎfiÏÏËÛ˘ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ–1,VCAM–1 ‹ CD106 (vascular cell adhesion mole-cule–1). ∫·È Ù· ‰‡o ·Ó‹Îo˘Ó ÛÙËÓ ˘ÂÚoÈÎoÁ¤ÓÂÈ·ÙˆÓ ·ÓoÛoÛÊ·ÈÚÈÓÒÓ9,10. ∆o ICAM–1 ·Ó¢ڛÛÎÂÙ·ÈÛÙ· ÓÂÊÚÈο ۈ̿ÙÈ· Î·È ÛÙ· ÌÂÛ·ÁÁÂȷο ·ÙÙ·Ú·.¢ÂÓ ‚Ú›ÛÎÂÙ·È ÛÙ· ÂÈıËÏȷο ·ÙÙ·Ú· ÙˆÓ ÓÂÊÚÈ-ÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ÛÙoÓ ¿ÓıÚˆo. ∂ÓÙo›˙ÂÙ·È fï˜ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· Â›Ì˘ˆÓ. ∆o VCAM–1 ‚Ú›-ÛÎÂÙ·È ÛÙ· ÓÂÊÚÈο ۈ̿ÙÈ·, ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿-ÚÈ· Î·È ÛÙ· ÌÂÛ·ÁÁÂȷο ·ÙÙ·Ú·. ∫·Ù¿ ÙȘ ‰ÈÂÚÁ·-ۛ˜ Ù˘ ÊÏÂÁÌoÓ‹˜ ÙˆÓ ÓÂÊÚÒÓ, ·Ú·ÙËÚo‡ÓÙ·È Â-Ó·ÏÏ·Á¤˜ ÛÙȘ ÛÙ¿ı̘ ·Ú·ÁˆÁ‹˜ ÙˆÓ ICAM–1 ηÈVCAM–1 ÌoÚ›ˆÓ ÚoÛÎfiÏÏËÛ˘11,12. ∏ ÓÂÊÚÈ΋ÈÛ¯·ÈÌ›· Î·È Ë Â·Ó·ÈÌ¿ÙˆÛË ÚoηÏo‡Ó ÛËÌ·ÓÙÈ΋·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ¤ÎÎÚÈÛ˘ Ù˘ ƒ–ÛÂÏÂÎÙ›Ó˘12.

O•∂π∞ ™ø§∏¡∞ƒπ∞∫∏ ¡∂∫ƒø™∏ ∫∞π ªOƒπ∞¶ƒO™∫O§§∏™∏™

º˘ÛÈÔÏÔÁ›· – ¶·ıÔÊ˘ÛÈÔÏÔÁ›· Î·È ‚ÈÔ¯Ë-ÌÈο ·ÎfiÏÔ˘ı·™ÙoÓ Ù‡o ·˘Ùfi Ù˘ oÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜o˘ ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi ÈÛ¯·ÈÌ›· ‹ ÌÂÙ¿ ·fiÙoÍÈΤ˜ ÚoÛ‚oϤ˜ ÙˆÓ ÓÂÊÚÒÓ, o ÚfiÏo˜ ÙˆÓ ÌoÚ›-ˆÓ ÚoÛÎfiÏÏËÛ˘ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜. OÈ ÈÓÙÂÁÎÚ›-

Ó˜ ÂȉÈÎfiÙÂÚ· ·›˙o˘Ó Ûo˘‰·›o ÚfiÏo ÛÙËÓ ·ıo-Á¤ÓÂÈ· Ù˘ oÍ›·˜ ÛˆÏËÓ·Úȷ΋˜ Ó¤ÎÚˆÛ˘14. ∞˘-Ùfi ÂÂȉ‹ ÂÌϤÎoÓÙ·È ÛÙȘ ‰È·‰Èηۛ˜:

– ·ÒÏÂÈ·˜ Ù˘ ÚoÛÎfiÏÏËÛ˘ ΢ÙÙ¿Úo˘ Úo˜Î‡ÙÙ·Úo.

– ·ÒÏÂÈ·˜ Ù˘ ÚoÛÎfiÏÏËÛ˘ ΢ÙÙ¿Úo˘ Úo˜ÙËÓ ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË.

– ·fiÊڷ͢ Ùo˘ ·˘Ïo‡ ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ Ì ·o-ÂÙˆÎfiÙ· ·ÙÙ·Ú·.

– ·Ó·Û˘ÁÎÚfiÙËÛ˘ Ù˘ ·oÁ˘Ìӈ̤Ó˘ ‚·ÛÈ΋˜ÌÂÌ‚Ú¿Ó˘.

– ‰È‹ıËÛ˘ Ùo˘ ÓÂÊÚo‡ ·fi o˘‰ÂÙÂÚfiÊÈÏ· Ï¢Îo-·ÙÙ·Ú·.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ ‰È¿ÊoÚ· ÌfiÚÈ· ÚoÛÎfiÏÏË-Û˘, fiˆ˜ oÈ Î·ÓÙÂÚ›Ó˜, oÈ ÈÓÙÂÁÎÚ›Ó˜ ·2‚1, ·5‚1Î·È Ùo ÌfiÚÈo ÚoÛÎfiÏÏËÛ˘ ·ÈÌoÂÙ·Ï›ˆÓ–ÂÓ‰o-ıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ PECAM (platelet endothelialcell adhesion molecule), Û˘ÌÌÂÙ¤¯o˘Ó Ì ÙȘ Û¯ÂÙÈ-˙fiÌÂÓ˜ Ì ·˘Ù¿ ÚˆÙ½Ó˜ occludin, zo–1, zo–2,cingulin, rab13, ·, ‚, Á ηÙÂÓ›Ó˜, zyxin, moexin,connexins Î·È ‰ÂÛÌoϷΛÓË, ÛÙËÓ ‰È·ÌfiÚʈÛËÙˆÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÂÓ‰oıËÏÈ·ÎÒÓ ‰È·Î˘ÙÙ·ÚÈ-ÎÒÓ ‰È·Û˘Ó‰¤ÛˆÓ. OÈ Î·ÓÙÂÚ›Ó˜ ΢ÚÈ·Ú¯o‡ÓÛÙȘ Û˘ÌÊ˘ÙÈÎo‡ (adherence junction) Î·È Û˘Ó‰Â-ÛÌÈÎo‡ (syndesmos) Ù‡o˘ ‰È·Î˘ÙÙ·ÚÈΤ˜ ‰È·Û˘Ó-‰¤ÛÂȘ (¶›Ó. 1). ™ÙoÓ ›Ó·Î· ·˘Ùfi ·Úo˘ÛÈ¿˙oÓÙ·ÈoÈ Ù¤ÛÛÂÚȘ ·ÚÈoÈ Ù‡oÈ ÙˆÓ ‰È·Î˘ÙÙ·ÚÈÎÒÓ ‰È·-Û˘Ó‰¤ÛÂˆÓ ( cell–cell junctions) Î·È ·Ú·Ù›ıÂÓÙ·ÈÙ· ΢ÚÈfiÙÂÚ· ÌfiÚÈ· o˘ ÌÂÛoÏ·‚o‡Ó Û ·˘Ù¤˜ ÙȘ‰È·Û˘Ó‰¤ÛÂȘ. ∏ ·ÎÙ›ÓË Ùo˘ ΢ÙÙ·ÚoÛÎÂÏÂÙo‡ ·o-ÙÂÏ› ̤ۈ ÙˆÓ Î·ÙÂÓÈÓÒÓ Î·È Ù˘ Ï·ÎoÛÊ·ÈÚ›Ó˘Ùo ·Á΢Úo‚fiÏÈo ÙˆÓ Î·ÓÙÂÚÈÓÒÓ. ∏ ÚˆÙ½ÓË p120ıˆÚÂ›Ù·È Ì›· Ó¤· ηÙÂÓ›ÓË Î·ıÒ˜ ¤¯ÂÈ ÙËÓ ›‰È·ÏÂÈÙo˘ÚÁ›· Ì ÙȘ ÁÓˆÛÙ¤˜ ηÙÂÓ›Ó˜15.

™Â ÈÛ¯·ÈÌ›· o˘ ÚoÎÏ‹ıËΠÛÂ Â›Ì˘Â˜ Ì Â-Ú›‰ÂÛË Ùo˘ ̛ۯo˘ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ ÁÈ· 5 min,Ë ‰È·ÂÚ·ÙfiÙËÙ· ÙˆÓ Û˘Ó‰ÂÛÌÈÎo‡ Ù‡o˘ ‰È·Î˘ÙÙ·-ÚÈÎÒÓ ‰È·Û˘Ó‰¤ÛÂˆÓ ·˘Í‹ıËΠÛËÌ·ÓÙÈο. ™ÙȘ ÛÙÂ-Á·Óo‡ Ù‡o˘ (tight junctions) ‰È·Û˘Ó‰¤ÛÂȘ, ‰È·Îfi-ËÎÂ Ë ÏÂÈÙo˘ÚÁ›· “ÎoÛÎÈÓ›ÛÌ·Ùo˜” ÙˆÓ ‰È·ÊfiÚˆÓÌoÚ›ˆÓ Î·È Î·Ù·ÚÁ‹ıËΠ¤ÙÛÈ Ë ÂÎÏÂÎÙÈ΋ ‰È·ÂÚ·-ÙfiÙËÙ·. ∂ÈÚfiÛıÂÙ· ηٿ ÙËÓ ÈÛ¯·ÈÌ›· ·Ú·ÙËÚ›-Ù·È ·Ó·Î·Ù·ÓoÌ‹ ÙˆÓ ∞∆ƒ–·ÛÒÓ ∫+ Î·È ¡·+ ηÈÂÈϤoÓ ·Ú·ÙËÚÂ›Ù·È ·Ó¿ÌÈÍË ÙˆÓ ÏÈȉ›ˆÓ ÌÂÙ·-͇ ÙˆÓ ÎoÚ˘Ê·›ˆÓ Î·È ÙˆÓ ‚·ÛÈÎÒÓ ÂÚÈo¯ÒÓ Ùo˘Î˘ÙÙ¿Úo˘. ∆· ÛÙoȯ›· ·˘Ù¿ ·oÙÂÏo‡Ó ÂӉ›ÍÂȘ fiÙÈÛÙȘ ‰È·Î˘ÙÙ·ÚÈΤ˜ ‰È·Û˘Ó‰¤ÛÂȘ ¤¯ÂÈ Î·Ù·ÚÁËı› ËÏÂÈÙo˘ÚÁ›· Ùo˘ “ϤÁÌ·Ùo˜”. OÈ ·ÎÚȂ›˜ Ì˯·ÓÈ-ÛÌo› ‰ÂÓ ¤¯o˘Ó ‰È¢ÎÚÈÓÈÛı› Ï‹Úˆ˜. ¶¿ÓÙˆ˜ ›ӷÈÁÓˆÛÙfi ˆ˜ Ì ÙËÓ ÈÛ¯·ÈÌ›· Ë ·ÎÙ›ÓË Ùo˘ ΢Ù-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 239

Ù·ÚoÛÎÂÏÂÙo‡ ÂÌÊ·Ó›˙ÂÈ ÂÓ·ÏÏ·Á¤˜16. ∆· ÌÈÎÚoÓË-Ì¿ÙÈ¿ Ù˘ ÛÙ· ÂÁÁ‡˜ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ··o‰ÈoÚÁ·ÓÒÓoÓÙ·È Ï‹Úˆ˜ Û 15 min ÈÛ¯·ÈÌ›·˜. ∏∞∆ƒ ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο Î·È ·˘Ùfi Â›Ó·È ÎÚÈÙÈ΋˜ÛËÌ·Û›·˜ ÁÈ· ÙË ÏÂÈÙo˘ÚÁ›· Ù˘ ·ÎÙ›Ó˘. ÿÛˆ˜ Ë∞∆ƒ Ó· ·oÙÂÏ› ¤Ó·Ó ÂӉȷʤÚoÓÙ· ÌÂÛoÏ·‚ËÙ‹ÛÙË ‚Ï¿‚Ë Ùo˘ ΢ÙÙ·ÚoÛÎÂÏÂÙo‡ o˘ ·Ú·ÙËÚ›ٷÈÌÂÙ¿ ÙËÓ ÈÛ¯·ÈÌ›·. ∂›Ó·È fï˜ ‰˘Ó·ÙfiÓ Ó· ˘ÂÈÛ¤Ú-¯oÓÙ·È Î·È ¿ÏÏoÈ Ì˯·ÓÈÛÌo›. ∆o ÂÓ‰o΢ÙÙ¿ÚÈo·Û‚¤ÛÙÈo ·˘Í¿ÓÂÙ·È ÛÙËÓ ÈÛ¯·ÈÌ›· Î·È Î·Ù·ÛÙÚ¤ÊÂÈÙËÓ ·ÎÙ›ÓË. ∂ÈϤoÓ ‰ÚÒÓÙ·˜ ·Â˘ı›·˜ Û ڈ-Ù½Ó˜ o˘ Û¯ÂÙ›˙oÓÙ·È Ì ÙËÓ ·ÎÙ›ÓË, ÙȘ ·‰Ú·ÓooÈ-› Î·È ·Ú¿ÏÏËÏ· ÂÓÂÚÁooÈ› ·Û‚ÂÛÙÈo-¢·›ÛıËÙ˜ڈÙ¿Û˜ o˘ oÓoÌ¿˙oÓÙ·È calpains Î·È ÂËÚÂ-¿˙o˘Ó ÙËÓ ·ÎÙ›ÓË. ∆· ÏÂÈÙo˘ÚÁÈο ·ÎfiÏo˘ı· ÙˆÓÂÓ·ÏÏ·ÁÒÓ ÛÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙˆÓ ‰È·Î˘ÙÙ·ÚÈÎÒÓ‰È·Û˘Ó‰¤ÛˆÓ, Â›Ó·È Ë ·‡ÍËÛË Ù˘ ·Ï›Ó‰ÚoÌ˘(Úo˜ Ù· ›Ûˆ ) ·ÒÏÂÈ·˜ Ùo˘ ‰ÈËı‹Ì·Ùo˜. ªÂ ÙȘÂȉڿÛÂȘ ÛÙȘ ∞∆ƒ-¿Û˜ ∫+ Î·È ¡·+ ‰ËÌÈo˘ÚÁo‡-ÓÙ·È ‰È·Ù·Ú·¯¤˜ o˘ o‰ËÁo‡Ó ÙÂÏÈο ÛÙËÓ ÂÏÏÂÈÌÌ·-ÙÈ΋ ÌÂٷΛÓËÛË ÓÂÚo‡ Î·È ·Ï¿ÙˆÓ ÛÙ· o˘ÚoÊfiÚ·ÛˆÏËÓ¿ÚÈ·.

™ˆÏËÓ·Úȷ΋ ·fiÊÚ·ÍËO ÚfiÏo˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ o˘ ·o›Ùo˘Ó ηٿ ÙËÓoÍ›· ÛˆÏËÓ·Úȷ΋ Ó¤ÎÚˆÛË ÛÙoÓ ·˘Ïfi ÙˆÓ o˘Úo-ÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ ·oÙ¤ÏÂÛ Ùo ·ÓÙÈΛÌÂÓo ‰È·-Ì¿¯Ë˜ Û ÌÂϤÙ˜ ÙˆÓ ‰ÂηÂÙÈÒÓ Ùo˘ ‘40 Î·È Ùo˘ ‘50.OÈ ÌÂϤÙ˜ ÙfiÙ Á›ÓoÓÙ·Ó Â˘Ú¤ˆ˜ Û ‰Â›ÁÌ·Ù· ˘ÏÈ-Îo‡ ÓÂÎÚo„ÈÒÓ. £ÂˆÚo‡ÓÙ·Ó ÏoÈfiÓ fiÙÈ Ë ·fiÙˆ-ÛË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó Ùo Û˘ÓËıÈṲ̂Óo·ÎfiÏo˘ıo Ù˘ oÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∞˘-Ùfi o‰‹ÁËÛ ÛÙËÓ ¯Ú‹ÛË Ùo˘ fiÚo˘ “oÍ›· ÛˆÏËÓ·ÚÈ-·Î‹ Ó¤ÎÚˆÛË”. ∞ÚÁfiÙÂÚ· fï˜, fiÙ·Ó ÛÙȘ ÌÂϤÙ˜·ÍÈooÈ‹ıËÎÂ Ë ¯Ú‹ÛË Ù˘ ‚Èo„›·˜ ÙˆÓ ÓÂÊÚÒÓ,

·o‰Â›¯ıËΠfiÙÈ ÂÎÙÂٷ̤ÓË ÛˆÏËÓ·Úȷ΋ Ó¤ÎÚˆ-ÛË ‰ÂÓ ·Ú·ÙËÚo‡ÓÙ·Ó Ï¤oÓ. OÈ ÂÚÈÛÛfiÙÂÚ˜ ·fiÙȘ ÓÂÎÚÒÛÂȘ o˘ ·Ó·ÊÂÚfiÙ·Ó Û ÚoËÁo‡ÌÂÓ˜¯ÚoÓÈο ÌÂϤÙ˜, oÊÂÈÏfiÙ·Ó Û ÌÂÙ·ı·Ó¿ÙȘ ‰È·Ù·-Ú·¯¤˜. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, ÙoÓ›-˙ÂÙ·È Ì ¤ÌÊ·ÛË Ë ÛËÌ·ÓÙÈÎfiÙËÙ· Ù˘ ·ÒÏÂÈ·˜ ÙˆÓÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙËÓ ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓËÙˆÓ o˘ÚoÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ ÛÙËÓ ·ıoÁ¤ÓÂÈ· Ù˘oÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜17. ¶ÚoÛÂÎÙÈΤ˜ ÌÂϤ-Ù˜ o˘ ¤ÁÈÓ·Ó Ì ËÏÂÎÙÚoÓÈÎfi ÌÈÎÚoÛÎfiÈo, ·¤-‰ÂÈÍ·Ó fiÙÈ Ù· ·ÂÙˆÎfiÙ· ·ÙÙ·Ú· Â›Ó·È ‚ÈÒÛÈÌ·.∞ÚÎÂÙ¿ Û˘¯Ó¿ ·Ó¢ڛÛÎoÓÙ·È Î·È ÌË ‚ÈÒÛÈÌ· ·Ù-Ù·Ú·. ∞˘Ùfi ÂÈÛÊÚ·Á›ÛıËΠ̠ηÏÏȤÚÁÂȘ ÙˆÓ·oÂÙˆÎfiÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ o˘ÚoÊfi-ÚˆÓ ÛˆÏËÓ·Ú›ˆÓ o˘ Ï‹ÊıËÎ·Ó ·fi Ù· o‡Ú·. ™ÙËÓoÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Â›Ó·È ‰˘Ó·ÙfiÓ fiÓÙˆ˜ ӷηÏÏÈÂÚÁËıo‡Ó —Î·È Ì¿ÏÈÛÙ· ‡ÎoÏ·— ·ÙÙ·Ú·ÙˆÓ o˘ÚoÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ o˘ Ï‹ÊıËÎ·Ó ·fi Ù·o‡Ú·. ∆oÓ›ÛÙËΠ·Ú·¿Óˆ fiÙÈ Ë ‚Ï¿‚Ë ÛÙËÓ ·ÎÙ›-ÓË Ùo˘ ΢ÙÙ·ÚoÛÎÂÏÂÙo‡ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓηÓoÓÈ΋ ·ʋ ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓo˘ÚoÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ Ì ÙË ‚·ÛÈ΋ Ùo˘˜ ÌÂÌ-‚Ú¿ÓË. OÈ ÈÓÙÂÁÎÚ›Ó˜ Û¯ËÌ·Ù›˙oÓÙ·˜ ÂÓ‰o΢ÙÙ·ÚÈ-Îo‡˜ ı˘ÛÛ¿Óo˘˜ ÛÙËÓ ÂÓ‰o΢ÙÙ·ÚÈ΋ ÂÚÈo¯‹ Ùo˘Î˘ÙÙ¿Úo˘ o˘ ‚Ú›ÛÎÂÙ·È Úo˜ ÙË ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË,Â›Ó·È ıÂÌÂÏÈÒ‰o˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ‰ËÌÈo˘ÚÁ›· Ù˘ÂÛÙȷ΋˜ ÚoÛÎoÏÏËÙÈ΋˜ Ͽη˜. ¶Úo˜ ÙËÓ Ï¿Î··˘Ù‹ Û˘ÁÎÏ›ÓÂÈ Î·È Ë ·ÎÙ›ÓË. ∏ ‰oÌ‹ ·˘Ù‹ ÙˆÓ ı˘Û-Û¿ÓˆÓ ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ Ì·˙› Ì ٷ ‰ÂÌ¿ÙÈ· Ù˘ ·ÎÙ›-Ó˘ Â›Ó·È ··Ú·›ÙËÙoÈ Û¯ËÌ·ÙÈÛÌo› ÁÈ· ÙËÓ ÚoÛ-ÎfiÏÏËÛË ÙÂÏÈο ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì ÙËÓ ÂÍˆÎ˘ÙÙ·ÚÈ΋ıÂ̤ÏÈ· o˘Û›·. ªÂϤÙ˜ Ì Bsc-1 ·ÙÙ·Ú· o˘ ˘o-‚Ï‹ıËÎ·Ó Û oÍ›‰ˆÛË Ì ˘ÂÚoÍ›‰Èo Ùo˘ ˘‰Úo-ÁfiÓo˘, ¤‰ÂÈÍ·Ó fiÙÈ Û 15 min Ù· ·ÙÙ·Ú· ·˘Ù¿ ¯¿-Óo˘Ó ÙË ÛÙÂÁ·Ó‹ ÚoÛÎfiÏÏËÛ‹ Ùo˘˜ Ì ÛÙoȯ›· Ùo˘˘oÛÙÚÒÌ·Ùo˜, fiˆ˜ .¯. ÙËÓ Ù·Ï›ÓË. ™ÙoÓ ›‰Èo ·˘Ùfi

240 K. XAPA§AM¶O¶OY§O™ KAI ™YN.

¶›Ó·Î·˜ 1. MÔÚȷο ÛÙÔȯ›· Ù˘ ÌÂÛÔ΢ÙÙ·ÚÈÎÒÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ ‰È·Û˘Ó‰¤ÛˆÓ*

¢È·Û‡Ó‰ÂÛË ¢È·ÌÂÌ‚Ú·ÓÈο K˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈο

ÛÙÂÁ·Ófi˜ Ù‡Ô˜ occludin Z0-1, Z0-2, cingulin, Rab 13

¯·ÛÌ·ÙÈÎfi˜ Ù‡Ô˜ connexins(Co37, Co40, Co43)

Û˘ÌÊ˘ÙÈÎfi˜ Ù‡Ô˜ ηÓÙÂÚ›Ó˜ (VE, ¿ÏϘ;) ·, ‚-catenins, plakoglobin,vinculin, a-actin, Z0-1,

zyxin, moesin

Û˘Ó‰ÂÛÌÈÎfi˜ Ù‡Ô˜ cadherin (VE); desmoplakin

¿ÏÏÔ˘ Ù‡Ô˘ PECAM, ÈÓÙÂÁÎÚ›Ó˜·2‚1, ·5‚1

* ÂÌÊ·Ó›˙ÔÓÙ·È ÌfiÓÔ ÛÙÔȯ›· Ô˘ ıˆÚÔ‡ÓÙ·È ·ÚfiÓÙ· ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (ÏÂÙÔ̤ÚÂȘ ÛÙÔ Î›ÌÂÓÔ).

¯ÚfiÓo ·Ú·ÙËÚÂ›Ù·È ·Ó·Î·Ù·ÓoÌ‹ ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ.∂ÓÒ Î·ÓoÓÈο ‚Ú›ÛÎoÓÙ·Ó ÛÙË ‚·ÛÈ΋ ÏÂ˘Ú¿ Ùo˘Î˘ÙÙ¿Úo˘, ÙÒÚ· Û˘ÚÚ¤o˘Ó ÛÙËÓ ÎoÚ˘Ê·›· ÂÚÈo¯‹,ı˘Ì›˙oÓÙ·˜ ÙËÓ ·Ó¿ÏoÁË ·Ó·Î·Ù·ÓoÌ‹ ÙˆÓ ∞∆ƒ·-ÛÒÓ ∫+ Î·È ¡·+. ∂ÎÙfi˜ ·fi ÙË ‰Ú¿ÛË ÛÙËÓ ·ÎÙ›ÓË,Ë ÊˆÛÊoÚ˘Ï›ˆÛË ¿ÏÏˆÓ ÚoÛÎoÏÏËÙÈÎÒÓ ÚˆÙÂ˚-ÓÒÓ Î·È oÈ ÌÂÙ·‚oϤ˜ Û’ ·˘Ù‹Ó ÙËÓ ›‰È· ÙË ‚·ÛÈ΋ÌÂÌ‚Ú¿ÓË, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·oÙÂÏo‡Ó Ì˯·ÓÈ-ÛÌo‡˜ Ì Ùo˘˜ oo›o˘˜ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ÚoÛÎfiÏ-ÏËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û ÂÚÈÙÒÛÂȘ ÈÛ¯·ÈÌ›·˜ ÙˆÓÓÂÊÚÒÓ ‹ ÙoÍÈ΋˜ ÚoÛ‚oÏ‹˜ Ùo˘˜.

∏ ·oÎfiÏÏËÛË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓÙˆÓ o˘ÚoÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ ·fi ÙË ‚·ÛÈ΋ Ùo˘˜ÌÂÌ‚Ú¿ÓË —·fi ÏÂ˘Ú¿˜ ÏÂÈÙo˘ÚÁÈ΋˜— o‰ËÁÂ›Î·È ·˘Ù‹ ÙÂÏÈο Û ‰È·Ê˘Á‹ Ùo˘ ‰ÈËı‹Ì·Ùo˜ Úo˜Ù· ›Ûˆ. ∂Ï·ÙÙÒÓÂÈ ‰ËÏ·‰‹ ÙË ‰Ú·ÛÙÈ΋ ‰È‹ıËÛË,ÂÓÒ Ù·˘Ùfi¯ÚoÓ· ÚoηÏ› Û˘Ì‚¿Ì·Ù· ÏfiÁˆ Ù˘·fiÊڷ͢ ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ. ∏ ÛˆÏËÓ·Úȷ΋·fiÊÚ·ÍË ·o‰Â›¯ÙËΠ۠ÌÂÁ¿Ïo ·ÚÈıÌfi ÂÚÈ-ÙÒÛÂˆÓ oÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ o˘ Úo-ÎÏ‹ıËΠÂÈÚ·Ì·ÙÈο.

ªÂ Ù¯ÓÈΤ˜ ÌÈÎÚo·Ú·ÎÂÓÙ‹ÛˆÓ, Ë ÂÓ‰oÛˆ-ÏËÓ·Úȷ΋ ›ÂÛË ‚Ú¤ıËΠ·˘ÍË̤ÓË. ™Ù· o‡Ú· ÂÌ-Ê·Ó›˙oÓÙ·Ó Î‡ÏÈÓ‰ÚoÈ o˘ ·oÙÂÏo‡ÓÙ·È ·fi ÙËÓÚˆÙ½ÓË Tamm–Hosfall ‹ Â›Ó·È Û˘Ó‰˘·ÛÌfi˜ Ù˘ڈÙ½Ó˘ Tamm–Hosfall Ì ·ÁÈ‰Â˘Ì¤Ó· ·ÙÙ·-Ú· ‹ ˘oÏ›ÌÌ·Ù· ΢ÙÙ¿ÚˆÓ. ∏ ÚˆÙ½ÓË ·˘Ù‹ ›-Ó·È ÁÏ˘ÎoÚˆÙ½ÓË Î·È ·Ú¿ÁÂÙ·È ÛÙ· ÂÈıËÏȷο·ÙÙ·Ú· ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ. ∂›Ó·È ÁÓˆÛÙ‹ Î·È Û·Óuromodulin. ∏ ÚˆÙ½ÓË Tamm–Hosfall ÂÚȤ¯ÂÈÙËÓ ·ÏÏËÏo˘¯›· RGD ·Ú¤¯oÓÙ·˜ ¤ÙÛÈ Ì›· ‰˘Ó·ÌÈ-΋ ı¤ÛË ‰¤ÛÌ¢Û˘ ÁÈ· Ù· ·oÂÙˆÎfiÙ· ·ÙÙ·Ú·‹ Ù· ÌÂÌ‚Ú·ÓÈο ˘oÏ›ÌÌ·Ù· ‰È· ÙˆÓ RGD ‰Â-ÛÌ¢ÙÈÎÒÓ ÂÚÈo¯ÒÓ ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ Ùo˘˜. ¶ÂÈÚ¿-Ì·Ù· in vitro Ì Bsc–1 ·ÙÙ·Ú· Î·È in vivo Û ›-Ì˘Â˜ ¤¯o˘Ó ·o‰Â›ÍÂÈ fiÙÈ Ë ÛˆÏËÓ·Úȷ΋ ·fiÊÚ·-ÍË ‰˘Ó·ÙfiÓ Ó· Ú·ÁÌ·ÙooÈÂ›Ù·È Ì ÙËÓ ÌÂÛoÏ¿‚Ë-ÛË ÂÚÈo¯ÒÓ RGD8,9. ∆· RGD ÂÙ›‰È· ‰˘Ó·ÙfiÓÓ· ‰Úo˘Ó Î·È Ì ¿ÏÏo˘˜ ÙÚfio˘˜ ¤Ú·Ó Ù˘ ÚoÛ-ÎfiÏÏËÛ˘ ΢ÙÙ¿Úo˘ Úo˜ ·ÙÙ·Úo. ¶Èı·ÓÒ˜ Û ÓÂ-ÊÚÈ΋ ‚Ï¿‚Ë Ó· ÂËÚ¿˙o˘Ó ÙȘ ÂȉڿÛÂȘ ÙˆÓo˘‰ÂÙÂÚoÊ›ÏˆÓ ‹ ÙˆÓ ·ÈÌoÂÙ·Ï›ˆÓ. ∏ ·ÏÏËÏo˘-¯›· ·ÌÈÓoͤˆÓ RGD (·ÚÁÈÓ›ÓË, ÁÏ˘Î›ÓË, ·Û·ÚÙÈ-Îfi o͇) ·oÙÂÏ› ÙoÓ Â›Ùoo ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ, ›-Ó·È ‰ËÏ·‰‹ Ë ÂÚÈo¯‹ ÂΛÓË ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ o˘Û˘Ó‰¤ÂÙ·È Ì Ùo ˘fiÛÙڈ̷. ™‹ÌÂÚ· Á›ÓÂÙ·È ÚoÛ-¿ıÂÈ·, ÂÎÌÂÙ·ÏÏ¢fiÌÂÓoÈ ÙËÓ RGD ·ÏÏËÏo˘¯›··ÌÈÓoͤˆÓ, Ó· ÈÛ¯˘ÚooÈËı› Ë ¯Ú‹ÛË oÚÈṲ̂ӈÓÈÓÙÂÁÎÚÈÓÒÓ ÁÈ· ıÂڷ¢ÙÈÎo‡˜ ÏfiÁo˘˜. O JeanOliver ÙȘ ‰ÂηÂٛ˜ Ùo˘ ‘40 Î·È Ùo˘ ‘50, ¤‰ÂÈÍ ÌÂÎÏ·ÛÈΤ˜ ÌÂϤÙ˜ ˆ˜ ·Ó ÌÂÙ¿ oÍ›· ÙoÍÈ΋ ‚Ï¿‚Ë

ÙˆÓ ÓÂÊÚÒÓ Ë ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ o˘ÚoÊfiÚˆÓÛˆÏËÓ·Ú›ˆÓ ·Ú·Ì›ÓÂÈ ¿ıÈÎÙo˜, ÙfiÙ ÌoÚ› ӷ·ӷÁηٷÛÙ·ıo‡Ó Û’ ·˘Ù‹ Ó¤· ÛˆÏËÓ·Úȷο·ÙÙ·Ú· o˘ ı· Úo¤Ú¯oÓÙ·È ·fi Ù· ¯Â›ÏË Ù˘‚Ï¿‚˘. ªÂÙ¿ ÙËÓ ·oÎfiÏÏËÛË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ΢ÙÙ¿ÚˆÓ ·fi ÙË ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË, Ù· ·Ú·Ï‹-ÛÈ· ·ÙÙ·Ú· Ù›Óo˘Ó Ó· ηχ„o˘Ó Ù· ÎÂÓ¿ Î·È Ó·ÁÂÌ›Ûo˘Ó Ùo ¤ÏÏÂÈÌÌ·. ª›· ¿ÏÏË È‰ÈfiÙËÙ· ÙˆÓ ÂÈ-ıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÁÂÓÈο Â›Ó·È Ë ÈηÓfiÙËÙ¿ Ùo˘˜Ó· ÌÂÙ·Ó·ÛÙ‡o˘Ó. ∂ÈıËÏȷο ·ÙÙ·Ú· ÂÓÙ¤Úo˘,fiˆ˜ Ë ÛÂÈÚ¿ Caco–2 ÌÂÙ·Ó·ÛÙ‡o˘Ó Û ηÏÏȤÚ-ÁÂȘ ηٿ ÙÚfio o˘ ·fiÏ˘Ù· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ·Úo˘Û›· ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ. ∏ ‰È·‰Èηۛ· ÌÂÙ·Ó¿-ÛÙ¢Û˘ ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ o˘ÚoÊfi-ÚˆÓ ÛˆÏËÓ·Ú›ˆÓ ÙˆÓ ÓÂÊÚÒÓ ¤¯ÂÈ ÌÂÏÂÙËı› ÏÈÁfi-ÙÂÚo. O ÂoÈÎÈÛÌfi˜ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È ËÎ¿Ï˘„Ë Ùo˘ ¯·ÛÌ·ÙÈÎo‡ ÎÂÓo‡ o˘ ‰ËÌÈo˘ÚÁ›ٷȷfi ÙËÓ ·oÎfiÏÏËÛË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓÁ›ÓÂÙ·È Ì ΢ÙÙ·ÚÈ΋ ˘ÂÚÏ·Û›· ÌÂÚÈÎÒ˜, ΢ڛˆ˜fï˜ Ú·ÁÌ·ÙooÈÂ›Ù·È Ì ÂÈÌ‹Î˘ÓÛË Ùo˘ ΢ÙÙ¿-Úo˘. °È· Ó· ÌÂÙ·Ó·ÛÙ‡Ûo˘Ó Ù· ÂÈıËÏȷο ·ÙÙ·-Ú· Úo˜ ÙËÓ ·oÁ˘Ìӈ̤ÓË ‚·ÛÈ΋ ÌÂÌ‚Ú¿Ó˯ÚÂÈ¿˙ÂÙ·È ÚoËÁo˘Ì¤Óˆ˜ Ó· ˘oÛÙo‡Ó ‰È·ÊoÚo-o›ËÛË. ∏ ·ӷ‰È·ÊoÚoo›ËÛË Ùo˘˜ ·˘Ù‹ —Ϥ-oÓ ‰ËÏ·‰‹ Ù˘ ·Ú¯È΋˜ ÚˆÙoÁÂÓo‡˜ ÌÂÛÂÁ¯˘Ì·ÙÈ-΋˜ ‰È·ÊoÚoo›ËÛ˘— ··ÈÙ› ÙËÓ ·Úo˘Û›· ÈÓÙÂ-ÁÎÚÈÓÒÓ. OÈ ÈÓÙÂÁÎÚ›Ó˜ ‰ËÏ·‰‹ Û˘ÌÂÚ·ÛÌ·ÙÈοηÙ¢ı‡Óo˘Ó ÙȘ ‰È·‰Èηۛ˜ ÙfiÛoÓ Ù˘ ·Ú¯È΋˜‰È·ÊoÚoo›ËÛ˘ Ùo˘ ÌÂÛÂÁ¯‡Ì·Ùo˜ fiÛoÓ Î·È Ù˘·ӷ‰È·ÊoÚoo›ËÛ˘ ÙˆÓ ‹‰Ë ‰È·ÊoÚooÈË̤-ÓˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ o˘ÚoÊfiÚˆÓ ÛˆÏË-Ó·Ú›ˆÓ, Ì ÛÎofi Ó· Ùo˘˜ ÚoÛ‰ÒÛo˘Ó ÙË ÌÂÙ·Ó·-ÛÙ¢ÙÈ΋ ÈηÓfiÙËÙ· Î·È Ó· ÂÂÓ‰‡Ûo˘Ó ¤ÙÛÈ Î·È¿ÏÈ ÙËÓ ·oÁ˘Ìӈ̤ÓË ÏfiÁˆ Ù˘ oÍ›·˜ ÛˆÏËÓ·-Úȷ΋˜ Ó¤ÎÚˆÛ˘ ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË.

∂¶π§O°O™ – ∫∞∆∂À£À¡™∂π™ªÂÁ¿Ï˜ ¤Ú¢Ó˜ ‚Ú›ÛÎoÓÙ·È Û ÂͤÏÈÍË Û fiÙÈ ·-ÊoÚ¿ ÛÙËÓ ·oηٿÛÙ·ÛË Ùo˘ ÓÂÊÚo‡ ·fi Ï¢-Ú¿˜ ÌoÚÊoÏoÁÈ΋˜ Î·È ÏÂÈÙo˘ÚÁÈ΋˜ ÌÂÙ¿ Ì›· o-Í›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∆o ÂӉȷʤÚoÓ ÙˆÓ Â-Ú¢ÓËÙÒÓ ÂÛÙÈ¿˙ÂÙ·È ÛÙ· ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘ ηÈÛ ÂÓ‰oÁÂÓÒ˜ ·Ú·ÁfiÌÂÓo˘˜ oÏ˘ÂÙȉÈÎo‡˜ ·-Ú¿ÁoÓÙ˜ ·‡ÍËÛ˘ o˘ ıˆÚo‡ÓÙ·È fiÙÈ Â›Ó·È oÈ Î‡-ÚÈoÈ ÌÂÛoÏ·‚ËÙ¤˜ ÛÙËÓ ˘ÂÚÏ·Û›· Î·È ÙËÓ ·Ó·‰Ë-ÌÈo˘ÚÁ›· ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓÙˆÓ o˘ÚoÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ. O ÚfiÏo˜ ÙˆÓ ÌoÚ›ˆÓÚoÛÎfiÏÏËÛ˘ ·Ó·Ê¤ÚıËΠ‹‰Ë Ì oÏϤ˜ ÏÂÙo-̤ÚÂȘ ÛÙo ¿ÚıÚo ·˘Ùfi. ∞ÎÚoıÈÁÒ˜ ÌfiÓo ·Ó·Ê¤-ÚÂÙ·È Â‰Ò fiÙÈ ·fi Ùo˘˜ ·Ú¿ÁoÓÙ˜ ·‡ÍËÛ˘ ÛË-Ì·ÓÙÈÎo› ıˆÚo‡ÓÙ·È o ÓÂÊÚÈÎfi˜ ÂȉÂÚÌÈÎfi˜ ·-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 241

Ú¿ÁoÓÙ·˜ ·‡ÍËÛ˘ EGF (renal epidermal growthfactor) Î·È o Úo˜ ÙËÓ ÈÓÛo˘Ï›ÓË ÚoÛoÌoÈ¿˙ˆÓ·Ú¿ÁoÓÙ·˜ ·‡ÍËÛ˘–1 IGF–1 (insulin like growthfactor–1). ‘Ö˜ ÏÂÙoÌÂÚ‹˜ ·Ó·ÊoÚ¿ Û ·-Ú¿ÁoÓÙ˜ ¿ÏÏo˘˜ ¤Ú·Ó ÙˆÓ ÌoÚ›ˆÓ ÚoÛÎfiÏÏËÛ˘ÂÎʇÁÂÈ ÙˆÓ ÛÎoÒÓ Ùo˘ ·ÚfiÓÙo˜ ¿ÚıÚo˘. ∆·ÌfiÚÈ· ÚoÛÎfiÏÏËÛ˘, oÈ ·Ú¿ÁoÓÙ˜ ·‡ÍËÛ˘ η-ıÒ˜ Î·È o ÚfiÏo˜ ÙˆÓ Ï¢Îo΢ÙÙ¿ÚˆÓ ÛÙËÓ oÍ›·ÛˆÏËÓ·Úȷ΋ Ó¤ÎÚˆÛË ·ÏÏ¿ Î·È Û οı ʇÛˆ˜ÊÏÂÁÌoÓÒ‰Ë ‰È·‰Èηۛ· ÙˆÓ ÓÂÊÚÒÓ, ÌÂÏÂٿٷÈÂÓÙ·ÙÈο ÛÙȘ ̤Ú˜ Ì·˜.

∂›Ó·È ‚¤‚·ÈoÓ ˆ˜ Ù· Ï¢Îo·ÙÙ·Ú· ¤Ú·ÓÙ˘ ·Ú·ÁˆÁ‹˜ ·ÁÁÂÈoÛ˘Û·ÛÙÈÎÒÓ o˘ÛÈÒÓ fiˆ˜Ë ıÚoÌ‚oÍ¿ÓË Î·È oÈ Ï¢ÎoÙÚȤÓ˜, ¤Ú·Ó Ù˘ Èη-ÓfiÙËÙ¿˜ Ùo˘˜ Ó· ÚoηÏo‡Ó ÙËÓ ·Ú·ÁˆÁ‹ ·˘ÙÒÓÙˆÓ o˘ÛÈÒÓ o˘ ·˘Í¿Óo˘Ó ÙËÓ ‰È·‚·ÙfiÙËÙ· ÙˆÓÙÚȯoÂȉÒÓ Î·È ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ Ì ̷ÎÚoÌoÚÈ·-Τ˜ o˘Û›Â˜, Â›Ó·È ‰˘Ó·ÙfiÓ Î·È Ì ¿ÏÏo˘˜ Ì˯·ÓÈ-ÛÌo‡˜ Ó· Û˘ÌÌÂÙ¤¯o˘Ó ÛÙȘ ‰È·‰Èηۛ˜ o˘ ·Îo-Ïo˘ıo‡Ó Ì›· oÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ooÈ·Û‰‹-oÙ ÌoÚÊ‹˜. ¶¿ÓÙˆ˜ Â›Ó·È ‚¤‚·ÈoÓ ˆ˜ ̤ۈ ÙˆÓ‚2 ÈÓÙÂÁÎÚÈÓÒÓ Ùo˘˜ ÌÂÙÚÈ¿˙o˘Ó ÙËÓ ÚoηÏo‡ÌÂ-ÓË ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∏ ·Úo˘Û›· ÙˆÓ ÌoÓo‡-ÚËÓˆÓ Ï¢Îo΢ÙÙ¿ÚˆÓ ÛÙoÓ ‰È¿ÌÂÛo ÈÛÙfi ıˆÚ›-Ù·È fiÙÈ Â˘Óo› ÙËÓ ·Ó·ÁÂÓÓËÙÈ΋ ‰È·‰Èηۛ· Ùo˘ ÓÂ-ÊÚo‡, ÂÓÒ ·ÓÙ›ıÂÙ· Ë ÂÌ̤Óo˘Û· Û˘ÁΤÓÙÚˆÛËÏ¢Îo΢ÙÙ¿ÚˆÓ ÛÙo ‰È¿ÌÂÛo ¯ÒÚo ¤¯ÂÈ ÚoÁÓˆÛÙÈ-Îfi ¯·Ú·ÎÙ‹Ú· η΋˜ ¤Î‚·Û˘ ηıÒ˜ ·ÎoÏo˘ı›-Ù·È ·fi ·Ó¿Ù˘ÍË ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜Î·È ›ÓˆÛË Ùo˘ ÓÂÊÚo‡18.

ABSTRACTCharalambopoulos K, Papalimneou V. Adhesi-on molecules in renal development and acuterenal necrosis. Hell Iatr, 2000, 66: 237 - 242.

Adhesion molecules play an important role inthe development of multicellular organisms. Embry-ogenesis, tissues maintenance and architecture,mainly depend on some adhesion molecules. He-reby, we provide an overreview of current knowledgeregarding the role of adhesion molecules in normalrenal development and in the renal pathologic stateof acute tubular necrosis. Integrins is the best studiedfamily among these molecules. They are implicatedin various mechanisms in these processes. That ‘swhy they are mainly described in detail in this article.Furthermore, the pathophysiologic events regardingthe role of these adhesion molecules are discussed.

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AÏÏËÏÔÁÚ·Ê›·:K. X·Ú·Ï·ÌfiÔ˘ÏÔ˜™ÔψÌÔ‡ 13Iˆ¿ÓÓÈÓ· 452 21

Corresponding author:K. Charalambopoulos13, Solomou Str.452 21 Ioannina, Greece

242 K. XAPA§AM¶O¶OY§O™ KAI ™YN.

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A. TÚ‡ÊÔ˜, A. KÔÓÙfiÔ˘ÏÔ˜, A. B˘˙·ÓÙÈ¿‰Ë˜, X. Z·ÌÔ‡Ï˘

B′ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋ A¶£, NÔÛÔÎÔÌÂ›Ô IÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛËÙ˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÛÙÔ Ï¿ÛÌ·ÙÔ˘ ÎÔÏÈÎÔ‡ Ó·ÙÚÈÔ˘ÚËÙÈÎÔ‡ ÂÙȉ›Ô˘ (ANP, atrialnatriuretic peptide) Î·È ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ Ó·ÙÚÈÔ˘ÚËÙÈ-ÎÔ‡ ÂÙȉ›Ô˘ (BNP, brain natriuretic peptide) Ì ÙËÓ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Ù˘ ηډȿ˜ ÛÙËÓȉÈÔ·ı‹ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË. MÂÏÂÙ‹ıËÎ·Ó 12˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜ (ÔÌ¿‰· A) Î·È 28 ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂ-Ó›˜ (ÔÌ¿‰· B) ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ‰È¿ÁÓˆÛË Ù˘ ·ÚÙË-Úȷ΋˜ ˘¤ÚÙ·Û˘ Ù¤ıËΠÁÈ· ÚÒÙË ÊÔÚ¿, ‰ÂÓ Â›-¯·Ó Ï¿‚ÂÈ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Î·È Ì ηٿÏÏËϘÂÍÂÙ¿ÛÂȘ ·ÔÎÏ›ÛıËÎÂ Ë ‰Â˘ÙÂÚÔ·ı‹˜ ˘¤ÚÙ·ÛË.™Â fiÏÔ˘˜ ¤ÁÈÓ ϋÚ˘ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜¤ÏÂÁ¯Ô˜, ÚÔÛ‰ÈÔÚ›ÛıËÎ·Ó Ë ‰Ú·ÛÙÈÎfiÙËÙ· ÚÂÓ›Ó˘ϿÛÌ·ÙÔ˜ (PRA, plasma renin activity), Ë ·Ï‰ÔÛÙÂÚfi-ÓË ÔÚÔ‡ (ALD, aldosterone), ÙÔ ANP Î·È ÙÔ BNP ηȤÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜. T· ·ÔÙÂϤÛÌ·Ù·

(m±SEM) ÛÙËÓ ÔÌ¿‰· A ‹Ù·Ó: PRA=0,54±0,17 ngAI/ml/h, ALD=7,05±1,35 ng/dl, ANP=52,81±5,01 pg/mlÎ·È BNP= 32,95±2,45 pg/ml, ÂÓÒ ÛÙËÓ ÔÌ¿‰· B ‹-Ù·Ó: PRA=0,56±0,19ngAI/ml/h, ALD=8,43±0,85 ng/dl, ANP=59,81±3,97 pg/ml Î·È BNP=38,34±3,04pg/ml. T· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ‰È¤ÊÂÚ·ÓÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙÔ˘˜ (Student’s t-test).T· ›‰· ÙÔ˘ BNP, fi¯È fï˜ Î·È ÙÔ˘ ANP, ÂÌÊ¿ÓÈ-˙·Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‰Â›ÎÙË Ì¿˙·˜ Ù˘ ·ÚÈ-ÛÙÂÚ¿˜ ÎÔÈÏ›·˜ (LV mass index) ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜·ÛıÂÓ›˜ (p<0,0001). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈÙ· ›‰· ÙˆÓ Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ ANP ηÈBNP Â›Ó·È ·ÚfiÌÔÈ· Û ˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜ Î·È Û ·ÛıÂ-Ó›˜ Ì ȉÈÔ·ı‹ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË. TÔ BNP ÌÔ-Ú› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ‰Â›ÎÙ˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Ù˘ ηډȿ˜.EÏÏËÓ I·ÙÚ 2000, 66: 243 - 248.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 243 - 248

Eπ™∞°ø°◊H Û˘ÌÌÂÙÔ¯‹ Ù˘ ηډȿ˜ Î·È ÂȉÈÎfiÙÂÚ· ÙˆÓ Î·Ú-‰È·ÎÒÓ ÎfiÏˆÓ ÛÙË Ú‡ıÌÈÛË Ù˘ ÓÂÊÚÈ΋˜ ·¤ÎÎÚÈ-Û˘ Ó·ÙÚ›Ô˘ Î·È ‡‰·ÙÔ˜ Î·È ÂÔ̤ӈ˜ ÛÙË Ú‡ıÌÈÛËÙÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ fiÁÎÔ˘ ˘ÁÚÒÓ Â›¯Â Èı·ÓÔÏÔÁËı›ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 19501. O ÚfiÏo˜ Ù˘ ηÚ-‰È¿˜ ˆ˜ ÂÓ‰oÎÚÈÓo‡˜ oÚÁ¿Óo˘ ·o‰Â›¯ıËΠ̠ÙËÓÎÏ·ÛÈ΋ ÂÚÁ·Û›· ÙˆÓ de Bold Î·È Û˘Ó., Ùo 19812, oÈoo›oÈ ÌÂϤÙËÛ·Ó ÙËÓ Â›‰Ú·ÛË Ù˘ ¤Á¯˘Û˘ ˘‰·ÙÈ-ÎÒÓ Âί˘ÏÈÛÌ¿ÙˆÓ Î·Ú‰È·Îo‡ ÈÛÙo‡ ·Úo˘Ú·›ˆÓ Û·ӷÈÛıËÙooÈË̤Óo˘˜ ·Úo˘Ú·›o˘˜. ªÂ ÙËÓ ¤Á¯˘ÛËÂί˘ÏÈÛÌ¿ÙˆÓ ·fi Ùo˘˜ ηډȷÎo‡˜ ÎfiÏo˘˜ ·ÚÂ-Ù‹ÚËÛ·Ó ¤ÓÙoÓË ‰Èo˘ÚËÙÈ΋ Î·È Ó·ÙÚÈo˘ÚËÙÈ΋ ‰Ú¿-ÛË, Ê·ÈÓfiÌÂÓ· o˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ¿ ·fi

¤Á¯˘ÛË Âί˘ÏÈÛÌ¿ÙˆÓ ·fi ÙȘ ÎoÈϛ˜ Ù˘ ηډȿ˜Ø›Û˘, Ù· Âί˘Ï›ÛÌ·Ù· ÙˆÓ Î·Ú‰È·ÎÒÓ ÎfiψÓÚoηÏo‡Û·Ó ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηȷ‡ÍËÛË Ùo˘ ·ÈÌ·ÙoÎÚ›ÙË. ∏ ‰Ú·ÛÙÈ΋ o˘Û›· ·oÌo-ÓÒıËΠ·ÚÁfiÙÂÚ· Î·È Â›Ó·È Û‹ÌÂÚ· ÁÓˆÛÙ‹ ˆ˜ ÎoÏ-ÈÎfi Ó·ÙÚÈo˘ÚËÙÈÎfi ÂÙ›‰Èo (∞¡P, atrial natriure-tic peptide)3.

H ¤Ú¢ӷ o˘ ·ÎoÏo‡ıËÛ ٷ ÂfiÌÂÓ· ¯ÚfiÓȷ›¯Â ˆ˜ ·oÙ¤ÏÂÛÌ· ÙËÓ ·Ó·Î¿Ï˘„Ë, Ùo 1988, ÂÓfi˜ÂÙȉ›o˘ ·fi ÙoÓ ÂÁΤʷÏo ¯o›Úo˘ o˘ ¤¯ÂÈ oÌfi-ÏoÁË ‰oÌ‹ Î·È ·ÚfiÌoȘ ‚ÈoÏoÁÈΤ˜ ȉÈfiÙËÙ˜ ÌÂÙo ÎoÏÈÎfi Ó·ÙÚÈo˘ÚËÙÈÎfi ÂÙ›‰Èo4. OÓoÌ¿ÛÙËÎÂÂÁÎÂÊ·ÏÈÎfi Ó·ÙÚÈo˘ÚËÙÈÎfi ÂÙ›‰Èo (BNP, brainnatriuretic peptide), ·Ó Î·È oÈ ÌÂϤÙ˜ o˘ ·ÎoÏo‡-

243

ıËÛ·Ó Û ·ÓıÚÒo˘˜ ·¤‰ÂÈÍ·Ó fiÙÈ ÂÎÎÚ›ÓÂÙ·È Î˘-Ú›ˆ˜ ·fi ÙËÓ Î·Ú‰È¿5,6. ∆o 1990, Ë oÈÎoÁ¤ÓÂÈ· ÙˆÓÓ·ÙÚÈo˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ ·¤ÎÙËÛ ¤Ó· Ó¤o ̤Ïo˜,Ùo C-Ó·ÙÚÈo˘ÚËÙÈÎfi ÂÙ›‰Èo (CNP, C-type natriu-retic peptide), o˘ ·oÌoÓÒıËΠ·Ú¯Èο Î·È ·˘Ùfi,fiˆ˜ Ùo µ¡ƒ, ·fi ÙoÓ ÂÁΤʷÏo ¯o›Úo˘, ·ÚÁfiÙÂÚ·fï˜ Î·È ·fi ÙoÓ ÂÁΤʷÏo ·ÓıÚÒo˘ Î·È ·fi Â-ÚÈÊÂÚÈÎo‡˜ ÈÛÙo‡˜7,8.

™Îofi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛËÙ˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÛÙo Ï¿ÛÌ·Ùo˘ ANP Î·È Ùo˘ BNP Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·ÈÙËÓ ˘ÂÚÙÚoÊ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ Ù˘ ηÚ-‰È¿˜, Û ·ÛıÂÓ›˜ Ì ‹È· Î·È Ì¤ÙÚÈ· ȉÈo·ı‹ ·Ú-ÙËÚȷ΋ ˘¤ÚÙ·ÛË.

A™£∂¡∂ÿ™ ∫∞π ªŒ£O¢OπMÂÏÂÙ‹ıËÎ·Ó 12 ˘ÁÈ›˜ ÂıÂÏoÓÙ¤˜ Î·È 28 ·ÛıÂÓ›˜ Ì ‹È·Î·È ̤ÙÚÈ· ȉÈo·ı‹ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË (‰È·ÛÙoÏÈ΋ ·ÚÙË-Úȷ΋ ›ÂÛË ÌÂٷ͇ 95 Î·È 110mmHg Û ÙÚÂȘ ‰È·‰o¯ÈΤ˜ ÌÂ-ÙÚ‹ÛÂȘ Ì ÌÂÛo‰È¿ÛÙËÌ· Ì›·˜ ‚‰oÌ¿‰·˜ Ë Ì›· ·fi ÙËÓ ¿Ï-ÏË), ÛÙo˘˜ oo›o˘˜ Ë ‰È¿ÁÓˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Ù¤-ıËΠÁÈ· ÚÒÙË ÊoÚ¿ Î·È ‰ÂÓ Â›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋·ÁˆÁ‹. MÂÙ¿ ÙË Ï‹„Ë Ùo˘ ÈÛÙoÚÈÎo‡, fiÏoÈ ˘o‚Ï‹ıËÎ·Ó ÛÂÊ˘ÛÈ΋ ÂͤٷÛË, ËÏÂÎÙÚoηډÈoÁÚ¿ÊËÌ· Î·È Ï‹ÚË ·ÈÌ·Ùo-ÏoÁÈÎfi Î·È ‚Èo¯ËÌÈÎfi ¤ÏÂÁ¯o. H ‰Â˘ÙÂÚo·ı‹˜ ˘¤ÚÙ·ÛË·oÎÏ›ÛÙËΠ̠‚¿ÛË Ùo ÈÛÙoÚÈÎfi, ÙoÓ ÚoÛ‰ÈoÚÈÛÌfi ÙˆÓηÙ¯oÏ·ÌÈÓÒÓ ÛÙ· o‡Ú· 24ÒÚo˘ Î·È Ùo Ú·‰Èo˚ÛoÙoÈÎfi ÓÂ-ÊÚfiÁÚ·ÌÌ· ÌÂÙ¿ ·fi ¯oÚ‹ÁËÛË Î·ÙoÚ›Ï˘.

TËÓ Ë̤ڷ Ù˘ ÂͤٷÛ˘, fiÏoÈ oÈ Û˘ÌÌÂÙ¤¯oÓÙ˜ ÛÙoÚˆÙfiÎoÏÏo Ù˘ ÌÂϤÙ˘ ÚoÛ¤Ú¯oÓÙ·Ó Ó‹ÛÙÂȘ ÛÙȘ 8.00 .Ì.ÛÙo Â͈ÙÂÚÈÎfi È·ÙÚ›o Ì›·˜ Ë̤ڷ˜ Ù˘ ÎÏÈÓÈ΋˜ Ì·˜. MÂÙ¿·fi ηٿÎÏÈÛË 90min ÁÈÓfiÙ·Ó ·Ú·Î¤ÓÙËÛË ÎÂÓÙÚÈ΋˜ ÊϤ-‚·˜ Ùo˘ ·ÓÙÈ‚Ú·¯›o˘ Î·È 30min ·ÚÁfiÙÂÚ· ÁÈÓfiÙ·Ó ·ÈÌoÏË„›·ÁÈ· ÙoÓ ÚoÛ‰ÈoÚÈÛÌfi Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÚÂÓ›Ó˘ Ï¿ÛÌ·Ùo˜,Ù˘ ·Ï‰oÛÙÂÚfiÓ˘ oÚo‡, Ùo˘ ÎoÏÈÎo‡ Î·È Ùo˘ ÂÁÎÂÊ·ÏÈÎo‡Ó·ÙÚÈo˘ÚËÙÈÎo‡ ÂÙȉ›o˘. ™ÙË Û˘Ó¤¯ÂÈ·, ¤ÁÈÓ Û fiÏo˘˜ Ï‹-Ú˘ ˘ÂÚ˯oηډÈoÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯o˜ (M-mode-2D-Dop-pler) Ì Ì˯¿ÓËÌ· Ù˘ Kontron Instruments, Sigma 1AC. OÈÌÂÙÚ‹ÛÂȘ o˘ ·ÍÈoÏoÁ‹ıËÎ·Ó ‹Ù·Ó ·fi ·Ú·ÛÙÂÚÓÈ΋ Ï‹„ËÎ·È ·ÊoÚo‡Û·Ó ÛÙo ¿¯o˜ ÙˆÓ ÙoȯˆÌ¿ÙˆÓ, ÙËÓ ÙÂÏoÛ˘ÛÙoÏÈ-΋ Î·È ÙÂÏo‰È·ÛÙoÏÈ΋ ‰È¿ÌÂÙÚo Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜. °È·ÙoÓ ÚoÛ‰ÈoÚÈÛÌfi Ù˘ Ì¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ (LVmass) ¯ÚËÛÈÌooÈ‹ıËΠo ·Ú·Î¿Ùˆ Ù‡o˜9: LV mass(g)=1,05 × [(ÙÂÏo‰È·ÛÙoÏÈ΋ ‰È¿ÌÂÙÚo˜ + ¿¯o˜ ÌÂÛoÎoÈÏÈ·-Îo‡ ‰È·ÊÚ¿ÁÌ·Ùo˜ + ¿¯o˜ oÈÛı›o˘ ÙoȯÒÌ·Ùo˜)3 – (ÙÂÏo-‰È·ÛÙoÏÈ΋ ‰È¿ÌÂÙÚo˜)3]. O ‰Â›ÎÙ˘ Ì¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈ-Ï›·˜ (LV mass index) ÚoÛ‰ÈoÚ›ÛıËΠ·fi Ùo ËÏ›Îo Ù˘ Ì¿-˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ Úo˜ ÙËÓ ÂÈÊ¿ÓÂÈ· ÛÒÌ·Ùo˜. °È·ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·oÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌooÈ‹ıËÎÂÙo Student’s t-test Î·È Ë ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË. ¶Èı·ÓfiÙËÙ· (p)ÌÈÎÚfiÙÂÚË ·fi 0,05 ıˆڋıËΠÛËÌ·ÓÙÈ΋.

¶ÚoÛ‰ÈoÚÈÛÌo›T· ‰Â›ÁÌ·Ù· ·›Ì·Ùo˜ (8ml) ÁÈ· ÙoÓ ÚoÛ‰ÈoÚÈÛÌfi ÙˆÓ Ó·ÙÚÈ-o˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ Û˘ÏϤÁoÓÙ·Ó Û ۈÏËÓ¿ÚÈ· oÏ˘Úo˘-ÏÂÓ›o˘ ÂÌ‚˘ıÈṲ̂ӷ Û ¿Áo, Ù· oo›· ÂÚÈ›¯·Ó EDTA

(1mg/ml ·›Ì·Ùo˜), (‰ÈÓ·ÙÚÈo‡¯o ¿Ï·˜ Ùo˘ ·Èı˘ÏÂÓo‰È·ÌÈÓo-ÙÂÙÚ·oÍÂÈÎo‡ oͤo˜, Boehringer Mannheim GmbH), Î·È ·Ó·-ÛÙoϤ· ÚˆÙ·ÛÒÓ ·ÚoÙÈÓ›ÓË (500 kallikrein inactivatorunits/ml ·›Ì·Ùo˜), (aprotinin, Bovine Lung, lyophilized, Cal-biochem). AÎoÏo˘ıo‡ÛÂ Ê˘ÁoΤÓÙÚËÛË ÁÈ· 20min ÛÙȘ 3000rpm (ı= 4oC), Î·È Ùo Ï¿ÛÌ· ·oıË·oÓÙ·Ó ÛÙo˘˜ -70°C.

Eί‡ÏÈÛË ÙˆÓ ÂÙȉ›ˆÓ ·fi Ùo Ï¿ÛÌ·T· ‰Â›ÁÌ·Ù· oÍÈÓ›˙oÓÙ·Ó Ì 1% TFA (trifluoroacetic acid,HPLC grade) Û ‰ÈÛ·ÂÛÙ·Á̤Óo ‡‰ˆÚ Î·È Ê˘ÁoÎÂÓÙÚo‡-ÓÙ·Ó ÛÙȘ 3000 rpm ÁÈ· 20min Û ı=4°C. ¶·Ú¿ÏÏËÏ· ÂÍÈÛoÚ-Úoo‡ÓÙ·Ó ÛًϘ C-18 (SEP Columns RIK-SEPCOL-1, Pe-ninsula Laboratories, INC) ÌÂ: ·) 1ml 60% CH3CN (HPLCgrade) Û 1% TFA Î·È ‚) 3ml 1% TFA, ÙÚÂȘ ÊoÚ¤˜.

T· oÍÈÓÈṲ̂ӷ ‰Â›ÁÌ·Ù·, ··ÏÏ·Á̤ӷ ·fi ·ÓÂÈı‡ÌË-Ù˜ o˘Û›Â˜, ÊoÚÙÒÓoÓÙ·Ó ÛÙȘ ÂÍÈÛoÚÚoË̤Ó˜ ÛًϘ ηÈÌÂÙ¿ ÙË ‰›o‰fi Ùo˘˜ ·ÎoÏo˘ıo‡Û ¤ÎÏ˘ÛË Ì 3ml ‰È·Ï‡Ì·Ùo˜1% TFA, ‰‡o ÊoÚ¤˜. T· Û˘ÁÎÚ·ÙË̤ӷ ÛÙȘ ÛًϘ ÂÙ›‰È·ÂÎÏo‡oÓÙ·Ó Ì 3ml ‰È·Ï‡Ì·Ùo˜ 60% CH3CN Û 1% TFA. T·ÂÎÏo‡ÛÌ·Ù· ˘o‚¿ÏÏoÓÙ·Ó Û ÂÍ¿ÙÌÈÛË Ì¤¯ÚÈ ÍËÚo‡ (ÛÂ Û˘-Û΢‹ SC 210A SPEEDVAC) fiÏË ÙË Ó‡¯Ù·.

P·‰Èo·ÓoÛoÏoÁÈ΋ ̤ıo‰o˜T· ›‰· ÙˆÓ ÂÙȉ›ˆÓ ÚoÛ‰ÈoÚ›ÛÙËÎ·Ó Ì ڷ‰Èo·ÓoÛo-ÏoÁÈ΋ ̤ıo‰o (Peninsula Laboratories, INC) ηٿ ÙËÓ oo›·Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ·ÓÙ·ÁˆÓÈÛÌfi˜ ÙˆÓ ÂÈÛËÌ·ÛÌ¤ÓˆÓ Ì 125I Â-Ùȉ›ˆÓ Ì ٷ ÌË ÂÈÛËÌ·Ṳ̂ӷ, ÁÈ· ‰¤ÛÌÂ˘Û‹ Ùo˘˜ Û ÂȉÈο,ÁÈ· Ùo οı ÂÙ›‰Èo, ·ÓÙÈÛÒÌ·Ù·. H ̤ıo‰o˜ oÏoÎÏËÚÒıËÎÂÛ ÙÚÂȘ Ë̤Ú˜ Î·È ÂÚÈÏ¿Ì‚·Ó ٷ ÂÍ‹˜ ÛÙ¿‰È·:1. AÚ¯Èο, Ù· È˙‹Ì·Ù· ÙˆÓ ÂÙȉ›ˆÓ ‰È·Ï˘ÙooÈ‹ıËÎ·Ó ÛÂ

RIA buffer (Peninsula Laboratories, INC) Î·È 100Ìl ¯ÚË-ÛÈÌooÈ‹ıËÎ·Ó ÁÈ· ÙË Ì¤ıo‰o. ŸÏ· Ù· ‰Â›ÁÌ·Ù· Î·È Ù·‰È·Ï‡Ì·Ù· ÚfiÙ˘ˆÓ o˘ÛÈÒÓ (standards) ÚoÛ‰ÈoÚ›ÛıË-Î·Ó ÂȘ ‰ÈÏo‡Ó. T· standards ·Ú·Û΢¿ÛÙËÎ·Ó Ì ‰È·-‰o¯ÈΤ˜ ·Ú·ÈÒÛÂȘ ÚfiÙ˘Ë˜ o˘Û›·˜ Î·È Û ÙÂÏÈΤ˜ Û˘-ÁÎÂÓÙÚÒÛÂȘ 1-128 pg/tube ÁÈ· Ùo ANP 1-28 Î·È Ùo BNP32 (Peninsula Laboratories, INC). ™Â fiÏ· Ù· ÛˆÏËÓ¿ÚÈ·ÚoÛÙ¤ıËΠ·Óٛۈ̷ (100 Ìl rabbit anti-peptide serum)Î·È ·ÎoÏo‡ıËÛ ÂÒ·ÛË ÛÙo˘˜ 4°C ÁÈ· 24h.

2. ™Ù· ·ÓÙ›ÛÙoȯ· ÛˆÏËÓ¿ÚÈ· ÚoÛÙ¤ıËΠÂÈÛËÌ·Ṳ̂Óo ÌÂ125I ÂÙ›‰Èo (125I ANP 1-28 10444 cpm, 125I BNP 10847cpm). AÎoÏo‡ıËÛ ÂÒ·ÛË ÁÈ· 24h ÛÙo˘˜ 40°C.

3. MÂÙ¿ Ùo ¤Ú·˜ Ù˘ ÂÒ·Û˘, Û οı ۈÏËÓ¿ÚÈo ÚoÛÙ¤-ıËÎ·Ó 100 Ìl Goat anti-rabbit antiserum (GARGG, Pe-ninsula Laboratories) Î·È 100 Ìl normal rabbit serum(NRS, Peninsula Laboratories) Î·È ¤ÁÈÓ ÂÒ·ÛË Û ıÂÚ-ÌoÎÚ·Û›· ‰ˆÌ·Ù›o˘ ÁÈ· 90 min. T¤Ïo˜, 500 Ìl RIA bufferÚoÛÙ¤ıËÎ·Ó Û οı ۈÏËÓ¿ÚÈo Î·È ·ÎoÏo‡ıËÛÂ Ê˘Áo-ΤÓÙÚËÛË ÛÙȘ 3000rpm ÁÈ· 20min ÛÙo˘˜ 4°C. To ˘ÂÚ-ΛÌÂÓo ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ ·Ó·ÚÚoÊ‹ıËÎÂ Î·È Ùo ˘fiÏÂÈÌ-Ì· ÌÂÙÚ‹ıËΠ۠ÌÂÙÚËÙ‹ Á–·ÎÙÈÓo‚oÏ›·˜ ÁÈ· 5min.

™Â ËÌÈÏoÁ·ÚÈıÌÈÎfi ¯·ÚÙ› ηٷÛ΢¿ÛÙËÎ·Ó ÚfiÙ˘Â˜Î·Ì‡Ï˜ ÁÈ· οı ÂÙ›‰Èo Ì ÙÂÙ·Á̤ÓË Ùo ÏfiÁo %B/B0 ηÈÙÂÙÌË̤ÓË Ùo ‰Âη‰ÈÎfi ÏoÁ¿ÚÈıÌo ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓÚfiÙ˘ˆÓ ÂÙȉ›ˆÓ. M ‚¿ÛË ÙȘ ÚfiÙ˘Â˜ η̇Ϙ, oÈÎÚo‡ÛÂȘ ·Ó¿ ÏÂÙfi ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ (cpm) ÌÂÙ·ÙÚ¤oÓÙ·È ÛÂÛ˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ·ÓÙ›ÛÙoȯˆÓ ÂÙȉ›ˆÓ (pg/100Ìl).

H ‰Ú·ÛÙÈÎfiÙËÙ· ÚÂÓ›Ó˘ Ï¿ÛÌ·Ùo˜ ÚoÛ‰ÈoÚ›ÛÙËΠÌÂÚ·‰Èo·ÓoÛoÏoÁÈ΋ ̤ıo‰o (RENCTK, Sorin Biomedica, Ita-ly). H ·Ï‰oÛÙÂÚfiÓË oÚo‡ ÚoÛ‰ÈoÚ›ÛÙËΠ›Û˘ Ì ڷ‰Èo-·ÓoÛoÏoÁÈ΋ ̤ıo‰o (ALDOCTK-2, Sorin Biomedica, Italy).

244 A. KAPA°IANNH™ KAI ™YN.

A¶O∆∂§Œ™ª∞∆∞™ÙoÓ ›Ó·Î· 1 Ê·›ÓoÓÙ·È Ù· ‚·ÛÈο ÎÏÈÓÈο Î·È ÂÚ-Á·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ˘ÁÈÒÓ ÂıÂÏoÓÙÒÓ(oÌ¿‰· A) Î·È ÙˆÓ ̆ ÂÚÙ·ÛÈÎÒÓ ·ÛıÂÓÒÓ (oÌ¿‰· B).

T· Â˘Ú‹Ì·Ù· ÙˆÓ ÂȉÈÎÒÓ ÚoÛ‰ÈoÚÈÛÌÒÓ(m±SEM) ÛÙËÓ oÌ¿‰· A ‹Ù·Ó: PRA=0,54±0,17ngAI/ml/h, ALD=7,05±1,35 ng/dl, ANP=52,81±5,01 pg/ml Î·È BNP= 32,95±2,45 pg/ml, ÂÓÒ ÛÙËÓoÌ¿‰· B ‹Ù·Ó: PRA=0,56±0,19ngAI/ml/h, ALD=8,43±0,85 ng/dl, ANP=59,81±3,97 pg/ml ηÈBNP=38,34±3,04 pg/ml (¶›Ó. 2, EÈÎ. 1). T· ·Ú·-¿Óˆ ·oÙÂϤÛÌ·Ù· ‰ÂÓ Â›¯·Ó ÛËÌ·ÓÙÈ΋ ÛÙ·ÙÈÛÙÈ-΋ ‰È·ÊoÚ¿ ÌÂٷ͇ Ùo˘˜ (Student’s t-test). E›Û˘,Ù· ›‰· Ùo˘ ANP Î·È Ùo˘ BNP ÛÙo Ï¿ÛÌ· ‰ÂÓ›¯·Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Û˘ÛÙoÏÈ΋, ÙË ‰È·ÛÙo-ÏÈ΋ Î·È ÙË Ì¤ÛË ·ÚÙËÚȷ΋ ›ÂÛË.

H Ì¿˙· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ ‹Ù·Ó 197± 14,5g ÛÙËÓ oÌ¿‰· A Î·È 262,6±12.6 ÛÙËÓ oÌ¿‰· B(p<0,01). O ‰Â›ÎÙ˘ Ì¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜‹Ù·Ó 105,6±5,2 g/m2 Î·È 139,6±6,4 g/m2, ·ÓÙ›ÛÙoÈ-¯· (p<0,01), (¶›Ó. 1). ™Ùo˘˜ ˘ÂÚÙ·ÛÈÎo‡˜ ·ÛıÂ-Ó›˜, Ù· ›‰· Ùo˘ BNP ÛÙo Ï¿ÛÌ· ›¯·Ó ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË Ì Ùo ‰Â›ÎÙË Ì¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈ-Ï›·˜ (r=0,86, p<0,0001), Û ·ÓÙ›ıÂÛË Ì ٷ ·ÓÙ›-ÛÙoȯ· ›‰· Ùo˘ ANP o˘ ‰ÂÓ Â›¯·Ó ·ÚfiÌoÈ·Û˘Û¯¤ÙÈÛË (r=0,33, p=0,07), (EÈÎ. 2,3).

™À∑◊∆∏™∏™ÙËÓ ·Úo‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹ıËÎ·Ó Ù· ›‰·Ùo˘ ÎoÏÈÎo‡ Î·È Ùo˘ ÂÁÎÂÊ·ÏÈÎo‡ Ó·ÙÚÈo˘ÚËÙÈÎo‡ÂÙȉ›o˘ ÛÙo Ï¿ÛÌ·, Û ˘ÁÈ›˜ ÂıÂÏoÓÙ¤˜ Î·È Û·ÛıÂÓ›˜ Ì ‹È· Î·È Ì¤ÙÚÈ· ȉÈo·ı‹ ·ÚÙËÚȷ΋˘¤ÚÙ·ÛË o˘ ‰ÂÓ Â›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋·ÁˆÁ‹. T· ›‰· Ùo˘ ANP Î·È Ùo˘ BNP ÛÙo Ï¿-

ÛÌ· ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙo˘˜ ˘ÂÚÙ·ÛÈÎo‡˜ ·ÛıÂ-Ó›˜ Û ۯ¤ÛË Ì Ùo˘˜ ˘ÁÈ›˜ ÂıÂÏoÓÙ¤˜, ·ÏÏ¿ ‰ÂӉȷÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊoÚ¤˜ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ. E›Û˘, ‰ÂÓ ˘‹Ú¯Â ıÂÙÈ-΋ Û˘Û¯¤ÙÈÛË ÙˆÓ Ó·ÙÚÈo˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ Ì ÙËÛ˘ÛÙoÏÈ΋, ÙË ‰È·ÛÙoÏÈ΋, ÙË Ì¤ÛË ·ÚÙËÚȷ΋ ›Â-ÛË, Ù· ›‰· Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÚÂÓ›Ó˘ Ï¿ÛÌ·-Ùo˜ Î·È Ù˘ ·Ï‰oÛÙÂÚfiÓ˘ oÚo‡. ŸÌˆ˜, Ù· ›‰·Ùo˘ BNP ÛÙo Ï¿ÛÌ· ÂÌÊ¿ÓÈ˙·Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛËÌ Ùo ‰Â›ÎÙË Ì¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜, ÂÓÒ ·-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 245

¶›Ó·Î·˜ 1. K‡ÚÈ· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ÙˆÓ ˘ÁÈÒÓ ÂıÂÏoÓÙÒÓ (oÌ¿‰· A) Î·È ÙˆÓ ˘ÂÚÙ·ÛÈÎÒÓ ·ÛıÂ-ÓÒÓ (oÌ¿‰· B).

OÌ¿‰· A OÌ¿‰· B

AÚÈıÌfi˜ ÌÂÏÂÙËı¤ÓÙˆÓ 12 28º‡Ïo (A/°) 7/5 16/12HÏÈΛ· 39±4 41±2BMI (Kg/m2) 25,8±6,1 27,1±3,8™˘ÛÙoÏÈ΋ A¶ (mmHg) 125±6 162±5¢È·ÛÙoÏÈ΋ A¶ (mmHg) 81±4 97±3KÚ·ÙÈÓ›ÓË (mg/dl) 0,8±0,1 0,8±0,2Na o‡ÚˆÓ (mEq/24ˆÚo) 142±14 144±13LV mass (g) 197,1±14,5 262,6±12,6LV mass index (g/m2) 105,6±5,2 139,6±6,4

(A=¿Ó‰Ú˜, °=Á˘Ó·›Î˜, A¶=·ÚÙËÚȷ΋ ›ÂÛË, BMI=BodyMass Index, ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·Ùo˜, LV=·ÚÈÛÙÂÚ¿ ÎoÈÏ›·)

¶›Ó·Î·˜ 2. ¢Ú·ÛÙÈÎfiÙËÙ· ÚÂÓ›Ó˘ Ï¿ÛÌ·Ùo˜ (PRA), ·Ï‰o-ÛÙÂÚfiÓË oÚo‡ ALD), ÎoÏÈÎfi (ANP) Î·È ÂÁÎÂÊ·ÏÈÎfi Ó·ÙÚÈo˘-ÚËÙÈÎfi ÂÙ›‰Èo (BNP) ÛÙȘ ‰‡o ˘fi ÌÂϤÙË oÌ¿‰Â˜.

OÌ¿‰· A OÌ¿‰· B

PRA (ngAI/ml/h) 0,54±0,17 0,56±0,19ALD (ng/dl) 7,05±1,35 8,43±0,85ANP (pg/ml) 52,81±5,01 59,81±3,97BNP (pg/ml) 32,95±2,45 38,34±3,04

OÌ¿‰· A=˘ÁÈ›˜ ÂıÂÏoÓÙ¤˜OÌ¿‰· B=˘ÂÚÙ·ÛÈÎo› ·ÛıÂÓ›˜

EÈÎ. 1. E›Â‰· ÛÙo Ï¿ÛÌ· Ùo˘ ÎoÏÈÎo‡ Î·È Ùo˘ ÂÁÎÂ-Ê·ÏÈÎo‡ Ó·ÙÚÈo˘ÚËÙÈÎo‡ ÂÙȉ›o˘ (oÌ¿‰· A: ˘ÁÈ›˜ ÂıÂ-ÏoÓÙ¤˜, oÌ¿‰· B: ˘ÂÚÙ·ÛÈÎo› ·ÛıÂÓ›˜).

ÚfiÌoÈ· Û˘Û¯¤ÙÈÛË ‰ÂÓ ˘‹Ú¯Â ÁÈ· Ùo ANP. A˘Ù‹ Ë·Ú·Ù‹ÚËÛË ÌoÚ› Ó· ÂÚÌËÓ¢ı› ·fi ÙË ÁÓÒÛËfiÙÈ Ùo BNP Û˘ÓÙ›ıÂÙ·È Î·È ÂÎÎÚ›ÓÂÙ·È Î˘Ú›ˆ˜ ·fiÙȘ ÎoÈϛ˜ Ù˘ ηډȿ˜6. ™Â ˘ÂÚÙ·ÛÈÎo‡˜ ·ÛıÂ-Ó›˜, o˘ ¤Ï·‚·Ó ıÂڷ›· Ì ·Ó·ÛÙoÏ›˜ Ùo˘ ÌÂ-Ù·ÙÚÂÙÈÎo‡ ÂÓ˙‡Ìo˘, ¤¯ÂÈ ·Ó·ÊÂÚı› ÂÏ¿ÙÙˆÛËÙˆÓ ÂȤ‰ˆÓ Ùo˘ BNP ÌÂÙ¿ ·fi ˘oÛÙÚoÊ‹ Ù˘˘ÂÚÙÚoÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜, ÁÂÁoÓfi˜ o˘‰Â›¯ÓÂÈ fiÙÈ Ë ÂÏ¿ÙÙˆÛË Ù˘ Ì¿˙·˜ Ù˘ ηډȿ˜ ¤¯ÂȈ˜ ·oÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¤ÎÎÚÈÛ˘ Ùo˘BNP ·fi ÙȘ ÎoÈϛ˜10.

H Ú‡ıÌÈÛË Ù˘ ÏÂÈÙo˘ÚÁ›·˜ Ùo˘ ηډȷÁÁÂÈ·-Îo‡ Û˘ÛÙ‹Ì·Ùo˜ Î·È Ë oÌoÈfiÛÙ·ÛË ÙˆÓ ˘ÁÚÒÓ Î·ÈÙˆÓ ËÏÂÎÙÚoÏ˘ÙÒÓ Ùo˘ oÚÁ·ÓÈÛÌo‡ oÊ›ÏÂÙ·È ÛÙËÓ·ÏÏËÏ›‰Ú·ÛË oÏÏÒÓ Û˘ÛÙËÌ¿ÙˆÓ. °È· oÏÏ¿¯ÚfiÓÈ· ‹Ù·Ó ·o‰ÂÎÙfi fiÙÈ ÂÎÙfi˜ ·fi Ùo Ó¢ÚÈÎfiÛ‡ÛÙËÌ· ˘¿Ú¯o˘Ó Î·È Î¿oÈoÈ ¯˘ÌÈÎo› Ì˯·ÓÈ-ÛÌo› o˘ ÂÓ¤¯oÓÙ·È ÛÙËÓ ·‡ÍËÛË Ùo˘ fiÁÎo˘ ÙˆÓ o‡-ÚˆÓ, Ë oo›· ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË ÙˆÓÙ·ÛÂo¸o‰o¯¤ˆÓ ÙˆÓ ÎfiψÓ. ªoÚÊoÏoÁÈΤ˜ ·-Ú·ÙËÚ‹ÛÂȘ ›¯·Ó ‰Â›ÍÂÈ ÙËÓ ‡·ÚÍË ÂÎÎÚÈÙÈÎÒÓÎoÎΛˆÓ ÌfiÓo ÛÙo˘˜ ÎfiÏo˘˜ Î·È fi¯È ÛÙȘ ÎoÈϛ˜Ù˘ ηډȿ˜11, ·ÏÏ¿ Î·È ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÌÂÙ·‚o-ÏÒÓ Ùo˘ ÈÛo˙˘Á›o˘ Ó·ÙÚ›o˘ Î·È ‡‰·Ùo˜ ‹ Ù˘ ÂÈÓÂ-ÊÚȉÂÎÙoÌ‹˜ ÛÙo ‚·ıÌfi ÎoÎΛˆÛ˘ ÙˆÓ Ì˘˚ÎÒÓ΢ÙÙ¿ÚˆÓ ÙˆÓ Î·Ú‰È·ÎÒÓ ÎfiψÓ12,13.

ø˜ ·ÚÈoÈ ·Ú¿ÁoÓÙ˜ o˘ ÂϤÁ¯o˘Ó ÙËÓ ·o‚o-Ï‹ Ó·ÙÚ›o˘ Î·È ‡‰·Ùo˜ ·fi Ùo˘˜ ÓÂÊÚo‡˜ ıˆÚo‡-ÓÙ·Ó o Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ Î·È Ë ·Ï‰o-ÛÙÂÚfiÓË. øÛÙfiÛo, Ùo 1961 ÚoÙ¿ıËÎÂ Ë ¤ÓÓoÈ· Ùo˘“ÙÚ›Ùo˘ ·Ú¿ÁoÓÙ·” o˘ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ‰È·Ù‹ÚËÛËÙo˘ ÈÛo˙˘Á›o˘ Ó·ÙÚ›o˘ Î·È ‡‰·Ùo˜, fiÙ·Ó ·o‰Â›¯ıËÎÂÛ ÂÈÚ·Ì·Ùfi˙ˆ· fiÙÈ Ë Ó·ÙÚÈo‡ÚËÛË o˘ ·ÎoÏo˘ı›

ÙËÓ ¤Á¯˘ÛË Ó·ÙÚ›o˘ ‰ÂÓ ·Ó·ÛÙ¤ÏÏoÓÙ·Ó fiÙ·Ó ·ÚÂ-Ìo‰›˙oÓÙ·Ó oÈ ÌÂÙ·‚oϤ˜ Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıË-Û˘ Î·È ÙˆÓ ÂȤ‰ˆÓ Ù˘ ·Ï‰oÛÙÂÚfiÓ˘14.

H ¤Ú¢ӷ o˘ ·ÎoÏo‡ıËÛ ÙËÓ ÂÚÁ·Û›· ÙˆÓ deBold Î·È Û˘Ó. Ùo 19816, ›¯Â ̂ ˜ ·oÙ¤ÏÂÛÌ· ÙËÓ ·Ó·-Î¿Ï˘„Ë ÙˆÓ Ó·ÙÚÈo˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ, ·Ú¯Èο Ùo˘ÎoÏÈÎo‡ (ANP) o˘ ÂÎÎÚ›ÓÂÙ·È ˆ˜ ·¿ÓÙËÛË ÛÂÌÂÙ·‚oϤ˜ Ù˘ Ù¿Ûˆ˜ ÙˆÓ ÙoȯˆÌ¿ÙˆÓ ÙˆÓ Î·Ú‰È·-ÎÒÓ ÎfiÏˆÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ùo˘ ÂÁÎÂÊ·ÏÈÎo‡(BNP), Ù· ›‰· Ùo˘ oo›o˘ ÛÙo Ï¿ÛÌ· ·ÓÙ·Ó·-ÎÏo‡Ó ÙË Ì¿˙· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ Ù˘ ηډȿ˜Î·È Ùo ÊoÚÙ›o o˘ ‰¤¯ÂÙ·È ·˘Ù‹. T· Ó·ÙÚÈo˘ÚËÙÈοÂÙ›‰È· ·ÛÎo‡Ó ÛËÌ·ÓÙÈΤ˜ ‚ÈoÏoÁÈΤ˜ ‰Ú¿ÛÂȘ.To ANP ÂÎÎÚ›ÓÂÙ·È Î˘Ú›ˆ˜ ·fi Ùo˘˜ ηډȷÎo‡˜ÎfiÏo˘˜ Î·È ÚoηÏ› ‰Èo‡ÚËÛË, Ó·ÙÚÈo‡ÚËÛË15-19,·ÁÁÂÈo‰È·ÛÙoÏ‹20,21 Î·È ÂÏ¿ÙÙˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜ Ùo˘ Û˘ÛÙ‹Ì·Ùo˜ ÚÂÓ›Ó˘-·ÁÁÂÈoÙÂÓÛ›Ó˘22,23. ToBNP ÂÎÎÚ›ÓÂÙ·È Î˘Ú›ˆ˜ ·fi ÙȘ ÎoÈϛ˜ Ù˘ ηډȿ˜Î·È ¤¯ÂÈ ·ÚfiÌoȘ ‰Ú¿ÛÂȘ Ì Ùo ÎoÏÈÎfi Ó·ÙÚÈo˘-ÚËÙÈÎfi ÂÙ›‰Èo24.

OÈ ÚÒÙoÈ ÚoÛ‰ÈoÚÈÛÌo› ÙˆÓ ÂȤ‰ˆÓ Ùo˘ÎoÏÈÎo‡ Ó·ÙÚÈo˘ÚËÙÈÎo‡ ÂÙȉ›o˘ ÛÙo Ï¿ÛÌ·, Û·ÛıÂÓ›˜ Ì ȉÈo·ı‹ ·ÚÙËÚȷ΋ ̆ ¤ÚÙ·ÛË, ¤‰ÂÈÍ·ÓfiÙÈ Â›Ó·È ·˘ÍË̤ӷ Ùo˘Ï¿¯ÈÛÙoÓ ÛÙo ‰ÈÏ¿ÛÈo ÛÂÛ¯¤ÛË Ì ٷ ·ÓÙ›ÛÙoȯ· ›‰· ˘ÁÈÒÓ ÓoÚÌoÙ·ÛÈ-ÎÒÓ ·ÙfïÓ, ÂÌÊ·Ó›˙o˘Ó ‰Â ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛËÙfiÛo Ì ÙË Û˘ÛÙoÏÈ΋ fiÛo Î·È Ì ÙË ‰È·ÛÙoÏÈ΋ ·Ú-ÙËÚȷ΋ ›ÂÛË25,26. ∂ÓÒ fï˜ Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈoÌoʈӛ· Û¯ÂÙÈο Ì ÙËÓ ‡·ÚÍË ·˘ÍËÌ¤ÓˆÓ ÂȤ-‰ˆÓ Ùo˘ ∞¡ƒ ÛÙË Ûo‚·Ú‹ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ù·‰Â‰o̤ӷ o˘ ˘¿Ú¯o˘Ó ÁÈ· ÙË ÌÂÁ¿ÏË ÏÂÈoÓfiÙËÙ·ÙˆÓ ·ÛıÂÓÒÓ Ì ‹È· Î·È Ì¤ÙÚÈ· ·Ó›ÏÂÎÙË È‰Èo-·ı‹ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Â›Ó·È ·ÓÙÈÎÚo˘fiÌÂÓ·. ™Â

246 A. KAPA°IANNH™ KAI ™YN.

EÈÎ. 2. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂȤ‰ˆÓ ÛÙo Ï¿ÛÌ· Ùo˘ ÂÁÎÂÊ·-ÏÈÎo‡ Ó·ÙÚÈo˘ÚËÙÈÎo‡ ÂÙȉ›o˘ (BNP) Î·È Ùo˘ ‰Â›ÎÙËÌ¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ (LVMI).

EÈÎ. 3. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂȤ‰ˆÓ ÛÙo Ï¿ÛÌ· Ùo˘ ÎoÏÈ-Îo‡ Ó·ÙÚÈo˘ÚËÙÈÎo‡ ÂÙȉ›o˘ (ANP) Î·È Ùo˘ ‰Â›ÎÙË Ì¿-˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ (LVMI).

‰È¿ÊoÚ˜ ÌÂϤÙ˜ ‰È·ÈÛÙÒıËÎ·Ó ·ÚfiÌoÈ· ›Â-‰· Ùo˘ ∞¡ƒ Û ·ÛıÂÓ›˜ Ì ‹È· ȉÈo·ı‹ ·ÚÙËÚÈ-·Î‹ ˘¤ÚÙ·ÛË Î·È ˘ÁÈ›˜ ÓoÚÌoÙ·ÛÈÎo‡˜27-29. ™Â Ì›·ÌÂÙ·–·Ó¿Ï˘ÛË 17 ÂÚÁ·ÛÈÒÓ, ÛÙȘ oo›Â˜ ·Ó·Ê¤ÚÂ-Ù·È fiÙÈ oÈ oÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ‹È· ȉÈo·ı‹ ·Ú-ÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È ÙˆÓ ˘ÁÈÒÓ ÓoÚÌoÙ·ÛÈÎÒÓ·ÙfiÌˆÓ Â›¯·Ó ÂÏÂÁ¯ı› ˆ˜ Úo˜ ÙËÓ ËÏÈΛ· Î·È ÙË ‰È-·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ó·ÙÚ›o˘, ‰È·ÈÛÙÒıËΠfiÙÈ 8/17ÌÂϤÙ˜ ·Ó¤ÊÂÚ·Ó ˘„ËÏfiÙÂÚ· ›‰· ∞¡ƒ ÛÙo˘˜˘ÂÚÙ·ÛÈÎo‡˜, 8/17 ·ÚfiÌoÈ· ›‰·, ÂÓÒ Û ̛·ÌÂϤÙË oÈ ˘ÁÈ›˜ ›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ˘„ËÏfi-ÙÂÚ· ›‰· ∞¡ƒ ·fi fi,ÙÈ oÈ ˘ÂÚÙ·ÛÈÎo›30.

ªÂÚÈο ·fi Ù· ·Ú·¿Óˆ ·ÓÙÈÊ·ÙÈο Â˘Ú‹Ì·-Ù· ÌoÚo‡Ó Ó· ·o‰oıo‡Ó Û ·Ó·Ú΋ ¤ÏÂÁ¯o ÙˆÓ·Ú·ÁfiÓÙˆÓ o˘ ÂËÚ¿˙o˘Ó Ù· ›‰· Ùo˘ ∞¡ƒÛÙo Ï¿ÛÌ·, fiˆ˜ Ë ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ó·ÙÚ›o˘,Ë ËÏÈΛ·, Ë ı¤ÛË Ùo˘ ÛÒÌ·Ùo˜ Î·È Ë Ê˘ÛÈ΋ ‰Ú·ÛÙË-ÚÈfiÙËÙ·. ∂›Û˘, ÌÂıo‰oÏoÁÈο Úo‚Ï‹Ì·Ù· ηٿÙoÓ ÚoÛ‰ÈoÚÈÛÌfi Ùo˘ ∞¡ƒ Èı·ÓfiÓ Ó· Û˘Áηχ-Ùo˘Ó Ì›· ÌÈÎÚ‹ ÌÂÓ ·ÏÏ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡-ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ùo˘ ∞¡ƒ ÛÙËÓ ‹È· ȉÈo·ı‹·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË. ∂Í¿ÏÏo˘, ·ÚfiÌoÈoÈ ·Ú¿Áo-ÓÙ˜ Èı·ÓfiÓ Ó· ÌËÓ ·oηχÙo˘Ó Ì›· ¤ÏÏÂÈ„Ë Ù˘·Ó·ÌÂÓfiÌÂÓ˘ ·ÓÙÈÛÙ·ıÌÈÛÙÈ΋˜ ·‡ÍËÛ˘ Ùo˘ ∞¡ƒÛÙ· ÚÒÈÌ· ÛÙ¿‰È· Ù˘ ȉÈo·ıo‡˜ ·ÚÙËÚȷ΋˜˘¤ÚÙ·Û˘, ÁÂÁoÓfi˜ o˘ ı· ÌoÚo‡Û ӷ ‰È·‰Ú·-Ì·Ù›˙ÂÈ Î¿oÈo ·ıoÁÂÓÂÙÈÎfi ÚfiÏo.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ Ù· ›‰· Ùo˘ÂÁÎÂÊ·ÏÈÎo‡ Ó·ÙÚÈo˘ÚËÙÈÎo‡ ÂÙȉ›o˘ ÛÙo Ï¿-ÛÌ· ·ÓÙ·Ó·ÎÏo‡Ó Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÙËÓ ˘ÂÚ-ÙÚoÊ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎoÈÏ›·˜ Ù˘ ηډȿ˜. MÂÏÏo-ÓÙÈΤ˜ ÌÂϤÙ˜ ı· ‰Â›Ío˘Ó ·Ó ÌoÚ› Ó· ¯ÚËÛÈÌo-oÈËı› Î·È ˆ˜ ÚoÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Û ·ÛıÂÓ›˜Ì ȉÈo·ı‹ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË.

ABSTRACTKarayiannis A, Avramidis M, Balaska K, LafarasCh, Trifos A, Kontopoulos A, Vizantiadis A, Zam-boulis Ch. Relationship between plasma levelsof natriuretic peptides and left ventricular hy-pertrophy in essential hypertension. Hell Iatr2000, 66: 243 - 248.

The aim of this study was to investigate thepossible relationship between plasma levels of atrialnatriuretic peptide (ANP) and brain natriuretic pep-tide (BNP) with left ventricular mass in patients withessential hypertension. Twelve normotensive sub-jects (group A) and 28 patients with never treated,uncomplicated mild to moderate essential hyper-tension (group B) were studied. After a medical hi-

story and a complete physical and laboratory exami-nation, plasma renin activity (PRA), serum aldoste-rone (ALD), ANP and BNP were measured. All parti-cipants underwent a M-mode-2D-Doppler echocar-diography study. The results (m±SEM) in group Awere: PRA= 0.54±0.17 ngAI/ ml/h, ALD= 7.05±1.35 ng/dl, ANP=52.81± 5.01 pg/ml and BNP=32.95±2.45 pg/ml, while in group B were: PRA=0.56± 0.19ngAI/ml/h, ALD= 8.43± 0.85 ng/dl,ANP= 59.81±3.97 pg/ml and BNP= 38.34±3.04pg/ml. There was no statistically significant differen-ce between the above results. In hypertensive pa-tients, plasma BNP levels were positively correlatedwith left ventricular mass index (p<0.0001), whileplasma ANP levels did not have similar correlation.In conclusion, plasma levels of natriuretic peptidesANP and BNP are similar in normal subjects andpatients with mild to moderate essential hyper-tension. In hypertensive patients, brain natriureticpeptide may be a useful noninvasive marker of leftventricular hypertrophy.

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∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 247

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ÙËÙ· Ù˘ ÙÂÎÌËÚÈÒıËΠÛÂ Ù˘¯·ÈooÈË̤Ó˜ ÌÂϤ̠٘ÙË Ì¤ÙÚËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜Ïo›ÌˆÍ˘ Ùo˘ ¯ÂÈÚo˘ÚÁÈÎo‡ ÙÚ·‡Ì·Ùo˜. ŒÙÛÈ, ÛÙȘÛËÙÈΤ˜ ‹ ‰˘ÓËÙÈο ÛËÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ ·Ú·ÙË-Ú‹ıËΠÂÏ¿ÙÙˆÛË Ùo˘ oÛoÛÙo‡ ÙˆÓ ÏoÈÌÒ͈ӷfi 40% Û 9-10%2-4. ∫·Ù¿ ÙËÓ ÂÈÏoÁ‹ ÙˆÓ ·ÓÙÈ‚È-oÙÈÎÒÓ o˘ ı· ¯ÚËÛÈÌooÈËıo‡Ó Û ÂÚÈÂÁ¯ÂÈÚËÙÈ-ο Û¯‹Ì·Ù· ¯ËÌÂÈoÚoʇϷ͢ Ú¤ÂÈ Ó· Ï·Ì‚¿-ÓÂÙ·È ˘fi„Ë Ë ÌÈÎÚo‚ȷ΋ ¯ÏˆÚ›‰· Ùo˘ oÚÁ¿Óo˘ ‹

249

Ù˘ ÂÚÈo¯‹˜ o˘ ı· Ú·ÁÌ·ÙooÈËı› Ë Â¤Ì‚·ÛË.™ÙȘ ÂÁ¯ÂÈÚ‹ÛÂȘ Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘ ÏoÈfiÓ Ú¤ÂÈÓ· ¯ÚËÛÈÌooÈo‡ÓÙ·È Û˘Ó‰˘·ÛÌo› ·ÓÙÈ‚ÈoÙÈÎÒÓ o˘Ó· ηχÙo˘Ó Ùo Ê¿ÛÌ· ÙfiÛo ÙˆÓ ·ÂÚfi‚ÈˆÓ fiÛo ηÈÙˆÓ ·Ó·ÂÚfi‚ÈˆÓ ÌÈÎÚo‚›ˆÓ. ∆·˘Ùfi¯ÚoÓ· Ú¤ÂÈ Ó·Ï·Ì‚¿ÓÂÙ·È Ì¤ÚÈÌÓ· ÁÈ· ÙoÓ ÈηÓooÈËÙÈÎfi Ì˯·ÓÈ-Îfi ηı·ÚÈÛÌfi Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘, ÒÛÙ ӷ ÌÂȈı›ÛÙÔ ÂÏ¿¯ÈÛÙÔ o ÌÈÎÚo‚È·Îfi˜ ÏËı˘ÛÌfi˜5.

∏ ÚooÙÈ΋ ÎÏÈÓÈ΋ ÌÂϤÙË o˘ Ú·ÁÌ·Ùo-oÈ‹Û·Ì ›¯Â ˆ˜ ÛÎofi ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·oÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÚÈÂÁ¯ÂÈ-ÚËÙÈ΋˜ ¯ËÌÂÈoÚoʇϷ͢ Ì ÂȉÈο ·ÓÙÈ‚ÈoÙÈο,ÛÙo oÛoÛÙfi ÙˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ ÛÂÂÂÌ‚¿ÛÂȘ Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘.

∞™£∂¡∂π™ ∫∞π ª∂£O¢OI™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó 250 ‰È·‰o¯ÈÎo› ·ÛıÂÓ›˜, 112 ¿Ó-‰Ú˜ Î·È 138 Á˘Ó·›Î˜, ËÏÈΛ·˜ 29-87 ÂÙÒÓ, o˘ ˘o‚Ï‹ıËηÓÛ ÂÁ¯Â›ÚËÛË ÛÙo ·¯‡ ¤ÓÙÂÚo. ™Îofi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó·Û˘ÁÎÚÈı› Ë ·oÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ‰‡o ‰È·ÊoÚÂÙÈÎÒÓ Û¯ËÌ¿-ÙˆÓ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜ ¯ËÌÂÈoÚoʇϷ͢. OÈ ·ÛıÂÓ›˜ ¯ˆÚ›-ÛıËÎ·Ó Û ‰‡o oÌ¿‰Â˜.

∏ oÌ¿‰· ∞, ÂÚÈÂÏ¿Ì‚·Ó 125 ·ÛıÂÓ›˜ (56 ¿Ó‰Ú˜ ηÈ69 Á˘Ó·›Î˜) ËÏÈΛ·˜ 36-87 ÂÙÒÓ (̤ÛË ÙÈÌ‹ 61 ¤ÙË). ™Ùo˘˜ ·ÛıÂ-Ó›˜ Ù˘ oÌ¿‰·˜ ∞, ¯oÚËÁ‹ıËΠ·˙ÙÚÂÔÓ¿ÌË (Azactam®) 1 grÎ·È ÎÏÈÓ‰·Ì˘Î›ÓË (Dalacin®) 600 mg Û ÙÚÂȘ ‰fiÛÂȘ. ∏ ÚÒÙˉfiÛË ¯oÚËÁ‹ıËΠηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ùo˘ ·ÛıÂÓo‡˜ ÛÙËÓ ·Ó·È-ÛıËÛ›· Î·È oÈ ÂfiÌÂÓ˜ ‰‡o ‰fiÛÂȘ 8 Î·È 16 ÒÚ˜ ·ÚÁfiÙÂÚ·.

∆ËÓ oÌ¿‰· µ ·oÙ¤ÏÂÛ·Ó 125 ·ÛıÂÓ›˜ (56 ¿Ó‰Ú˜ ηÈ69 Á˘Ó·›Î˜), ËÏÈΛ·˜ 29-83 ÂÙÒÓ (̤ÛË ÙÈÌ‹ 63 ¤ÙË). ™Ùo˘˜·ÛıÂÓ›˜ ·˘Ùo‡˜ ¯oÚËÁ‹ıËΠÎÂÊÔ˘ÚÔÍ›ÌË (Zinacef®) 750mg Î·È ÌÂÙÚÔÓȉ·˙fiÏË (Flagyl®) 1 gr, Û ÙÚÂȘ ‰fiÛÂȘ Î·È ÁÈ·Ù¤ÛÛÂÚȘ Ë̤Ú˜ – ÙËÓ ÚoÂÁ¯ÂÈÚËÙÈ΋, ÙËÓ Ë̤ڷ Ùo˘¯ÂÈÚo˘ÚÁ›o˘ Î·È ÙȘ ‰‡o ÚÒÙ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ Ë̤Ú˜.

∏ ¤ÓÙ·ÍË ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ˘fi ÌÂϤÙË oÌ¿‰Â˜ Á›Óo-ÓÙ·Ó ÙËÓ ÚoËÁo˘Ì¤ÓË Ùo˘ ¯ÂÈÚo˘ÚÁ›o˘ Û‡Ìʈӷ Ì ÙËÓ“·Ú¯‹ Ùo˘ ÎÏÂÈÛÙo‡ ʷΤÏo˘”.

O Ì˯·ÓÈÎfi˜ ηı·ÚÈÛÌfi˜ Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘ ‹Ù·Ó o›‰Èo˜ ÁÈ· fiÏo˘˜ Ùo˘˜ ·ÛıÂÓ›˜ Î·È ÂÚÈÂÏ¿Ì‚·Ó ˘‰ÚÈ΋ ‰›·È-Ù·, ·Ï·Ùo‡¯o ηı·ÚÙÈÎfi, ÙÚ›˜ ˘oÎÏ˘ÛÌo‡˜ ÙËÓ ÚoËÁo˘Ì¤-ÓË Ùo˘ ¯ÂÈÚo˘ÚÁ›o˘ Î·È ¤Ó·Ó ˘oÎÏ˘ÛÌfi Ùo Úˆ› Ù˘ Ë̤ڷ˜Ùo˘ ¯ÂÈÚo˘ÚÁ›o˘.

ŸÏoÈ oÈ ·ÛıÂÓ›˜ ¯ÂÈÚo˘ÚÁ‹ıËÎ·Ó ÚoÁÚ·ÌÌ·ÙÈṲ̂ӷÂÎÙfi˜ ·fi 8 Ù˘ oÌ¿‰·˜ ∞ Î·È 14 Ù˘ oÌ¿‰·˜ µ. OÈ ÂÚÈÙÒ-ÛÂȘ ›Áo˘Û·˜ ¤̂·Û˘ ‰ÂÓ ÂÍ·ÈÚ¤ıËÎ·Ó Ù˘ ÌÂϤÙ˘,·ÏÏ¿ ÙÚoooÈ‹ıËÎÂ Ë Ì¤ıo‰o˜ ηı·ÚÈÛÌo‡ Ùo˘ ·¯¤o˜ ÂÓ-Ù¤Úo˘. ∏ ÙÚoooÈË̤ÓË Ì¤ıo‰o˜ ‹Ù·Ó Ë ›‰È· Î·È ÁÈ· ÙȘ ‰‡ooÌ¿‰Â˜ Î·È ÂÚÈÂÏ¿Ì‚·Ó ÌfiÓo ˘oÎÏ˘ÛÌo‡˜.

110 ·ÛıÂÓ›˜ Ù˘ oÌ¿‰·˜ ∞ Î·È 118 Ù˘ oÌ¿‰·˜ µ ¤·Û¯·Ó·fi ηÎo‹ıË ÓfiÛo (¶›Ó. 1). ∂ÈϤoÓ fiˆ˜ Ê·›ÓÂÙ·È ÛÙo˘˜ ›-ӷΘ 2 Î·È 3, ‰ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊoÚ¿ fiÛoÓ ·ÊoÚ¿ ÙËÛ˘¯ÓfiÙËÙ· Ùo˘ ›‰o˘˜ ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÂÚÈfi‰o˘ ηٷÁÚ¿-ÊoÓÙ·Ó ·Ó·Ï˘ÙÈο Ë ÂÌÊ¿ÓÈÛË ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÂÈÏoÎÒÓ Î·Èȉȷ›ÙÂÚ· Ë ·Ó¿Ù˘ÍË ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒ͈Ó. ŸÛoÓ ·ÊoÚ¿ÙȘ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÏoÈÌÒÍÂȘ ÌÂÁ¿ÏË ÛËÌ·Û›· ‰fiıËΠÛÙËÓ ·o-ÌfiÓˆÛË Ùo˘ ˘Â‡ı˘Óo˘ ÌÈÎÚooÚÁ·ÓÈÛÌo‡. ™˘Ó¤¯ÈÛË ‹ Î·È ÙÚoo-

250 A. ™AKANTAMH™ KAI ™YN.

¶›Ó·Î·˜ 1. ∏ ηٷÓoÌ‹ ÙˆÓ ·ı‹ÛÂˆÓ Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘ÛÙȘ ‰‡o oÌ¿‰Â˜.

¡ÔÛ‹Ì·Ù· ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘¡fiÛÔ˜ OÌ¿‰· ∞ OÌ¿‰· µ

∫·ÚΛÓo˜ oÚıo‡ 26 28∫·ÚΛÓo˜ oÚıoÛÈÁÌoÂȉo‡˜ 14 14∫·ÚΛÓo˜ ÛÈÁÌoÂȉo‡˜ 20 31∫·ÚΛÓo˜ ηÙÈfiÓÙo˜ 7 6∫·ÚΛÓo˜ ·Ú. ÎoÏÈ΋˜ η̋˜ 3 2∫·ÚΛÓo˜ ÂÁηÚÛ›o˘ 7 10∫·ÚΛÓo˜ ¢Â. ÎoÏÈ΋˜ η̋˜ - 5∫·ÚΛÓo˜ ·ÓÈfiÓÙo˜ 13 7∫·ÚΛÓo˜ Ù˘ÊÏo‡ 12 12¶ÚoËÁËı›۷ ÂÎÙoÌ‹ ·¯¤o˜ ÂÓÙ¤Úo˘ 7 1§·¯ÓˆÙfi ı‹ÏˆÌ· oÚıo‡ 1 1ªÂÛÂÁ¯˘Ì·ÙoÁÂÓ‹˜ fiÁÎo˜ – 1

ÌÂÛoÛÈÁÌoÂȉo‡˜¶oχo‰Â˜ ·¯¤o˜ ÂÓÙ¤Úo˘ 7 5∫·Ïo‹ı˘ ÛÙ¤ÓˆÛË ·Ú. ÎoÏÈ΋˜ η̋˜ – 1ªÂÁ¿ÎoÏo ÂÓËÏ›ÎˆÓ – 1∂ÏÎ҉˘ ÎoÏ›Ùȉ· 2 –∂¯ÈÓoÎoÎΛ·ÛË ¢Â ÎoÏÈ΋˜ η̋˜ 1 –¶ÚfiÙˆÛË oÚıo‡ 1 –§·¯ÓˆÙfi ı‹ÏˆÌ· 3 –∫·ÚΛÓo˜ ÛΈÏËÎoÂȉo‡˜ 1 –

¶›Ó·Î·˜ 2. ∆o ›‰o˜ ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ÛÙȘ oo›Â˜ ˘o‚Ï‹-ıËÎ·Ó ÔÈ ·ÛıÂÓ›˜ ÙˆÓ ‰‡o oÌ¿‰ˆÓ.

∂›‰Ô˜ ¤̂·Û˘OÌ¿‰· ∞ OÌ¿‰· µ

∫oÈÏÈoÂÚÈÓÂÈ΋ ÂÎÙoÌ‹ 12 14÷ÌËÏ‹ ÚfiÛıÈ· oÚıoÛÈÁÌoÂȉÂÎÙoÌ‹ 23 19÷ÌËÏ‹ ÚfiÛıÈ· oÚıoÛÈÁÌoÂȉÂÎÙoÌ‹ 3 5

Ì ÚoÛٷ٢ÙÈ΋ ÛÙoÌ›·™ÈÁÌoÂȉÂÎÙoÌ‹ 20 16™ÈÁÌoÂȉÂÎÙoÌ‹ Ì ÚoÛٷ٢ÙÈ΋ – 2

ÛÙoÌ›·™ÈÁÌoÂȉÂÎÙoÌ‹ Ì ÂÎÙoÌ‹ – 1

ÏÂÙo‡ ÂÓÙ¤Úo˘∞Ú. ÎoÏÂÎÙoÌ‹ 8 9∞Ú. ÎoÏÂÎÙoÌ‹ Ì ÚoÛٷ٢ÙÈ΋ – 1

ÛÙoÌ›·∂ÎÙoÌ‹ Hartman 7 7∂ÎÙoÌ‹ Hartman Ì ÂÈÏÂoÂÁηÚÛ›· – 1

·Ó·ÛÙfïÛË∂ÁηÚÛÈÂÎÙoÌ‹ 4 4ÀÊoÏÈ΋ ÎoÏÂÎÙoÌ‹ 2 1∞oηٿÛÙ·ÛË Û˘Ó¯›·˜ 5 1

·¯¤o˜ ÂÓÙ¤Úo˘™ÙoÌ›· Mikulitz 1 4™ÙoÌ›· 3 9¢Â. ÎoÏÂÎÙoÌ‹ 26 22∂ÈÏÂoÂÁηÚÛ›· ¶-¶ ·Ó·ÛÙfïÛË 2 4¶oÏ˘ÂÎÙoÌ‹ 3 4¢ÈoÚıÈ΋ ·Ê·›ÚÂÛË 4 1OÏÈ΋ ÎoÏÂÎÙoÌ‹ 1 –∞Ó¿ÚÙËÛË oÚıo‡ 1 –

o›ËÛË Ù˘ ·ÓÙÈÌÈÎÚo‚ȷ΋˜ ·ÁˆÁ‹˜ ÁÈÓfiÙ·Ó ÌfiÓo Û ÂÚÈÙÒ-ÛÂȘ o˘ ˘‹Ú¯Â ·fiÏ˘ÙË ¤Ó‰ÂÈÍË Î·È Ì ‚¿ÛË Ùo ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·.

∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·oÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ ÌÂÙË ‰oÎÈÌ·Û›· ¯2 ÁÈ· ·ÓÂÍ¿ÚÙËÙ· ‰Â›ÁÌ·Ù·, Ì ÙË ‚o‹ıÂÈ· Ùo˘ÛÙ·ÙÈÛÙÈÎo‡ ÚoÁÚ¿ÌÌ·Ùo˜ STATISTIKA 5.0

∞¶O∆∂§∂™ª∞∆∞™ÙËÓ oÌ¿‰· o˘ ¯oÚËÁ‹ıËΠÙo ‚Ú·¯‡ Û¯‹Ì· ¯Ë-ÌÂÈoÚoʇϷ͢ Ì ·˙ÙÚÂoÓ¿ÌË Î·È ÎÏÈÓ‰·Ì˘Î›ÓË(Oª∞¢∞ ∞) 13 ·fi Ùo˘˜ 125 ·ÛıÂÓ›˜ (10,4%) ·-Úo˘Û›·Û·Ó ÂÈÏoΤ˜ (¶›Ó. 4). ªÂÙÂÁ¯ÂÈÚËÙÈ΋ Ïo›-̈ÍË ÂÌÊ¿ÓÈÛ·Ó oÈ 8 (6,4%) Î·È ‰Â˘ÙÂÚoÁÂÓ‹ ÛË-ÙÈ΋ ηٷÏËÍ›· 2 o˘ ÙÂÏÈÎÒ˜ η٤ÏËÍ·Ó. ∂·ÓÂ-¤Ì‚·ÛË ··ÈÙ‹ıËΠ۠3 (2,4%) o˘ ·Úo˘Û›·Û·Ó‰È·Ê˘Á‹ ·fi ÙËÓ ·Ó·ÛÙfïÛË. O ¯ÚfiÓo˜ ÌÂÙÂÁ¯ÂÈ-ÚËÙÈ΋˜ ÓoÛËÏ›·˜ Î˘Ì¿ÓıËΠ·fi 2 ¤ˆ˜ 83 Ë̤Ú˜(̤ÛË ÙÈÌ‹ 11,6) Î·È Î·Ù¤ÏËÍ·Ó 2 (1,6%). OÈ 2 ·fiÙo˘˜ oÎÙÒ ·ÛıÂÓ›˜ Ì ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ïo›ÌˆÍË ¯ÂÈ-Úo˘ÚÁ‹ıËÎ·Ó ÂÂÈÁfiÓÙˆ˜ fiˆ˜ Î·È o ¤Ó·˜ ·fi Ùo˘˜‰‡o o˘ η٤ÏËÍ·Ó. ™Â 18 ·ÛıÂÓ›˜ (14,4%) ÎÚ›ıË-Π··Ú·›ÙËÙË Ë Û˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈ‚ÈoÙÈ΋˜ ·ÁˆÁ‹˜Î·È Û 8 ·fi ·˘Ùo‡˜ Ë ·ÏÏ·Á‹ ·ÓÙÈ‚ÈoÙÈÎÒÓ ‚¿ÛÂÈ·ÓÙÈ‚ÈoÁÚ¿ÌÌ·Ùo˜ (¶›Ó. 4).

™ÙËÓ oÌ¿‰· o˘ ¯oÚËÁ‹ıËΠ¯ËÌÂÈoıÂڷ¢ÙÈ-Îfi Û¯‹Ì· 4 ËÌÂÚÒÓ Ì ÎÂÊo˘ÚoÍ›ÌË Î·È ÌÂÙÚoÓȉ·-˙fiÏË (oÌ¿‰· µ), 15 ·fi Ùo˘˜ 125 ·ÛıÂÓ›˜ (12%) ·-Úo˘Û›·Û·Ó ÂÈÏoΤ˜ (¶›Ó. 4). ªÂÙÂÁ¯ÂÈÚËÙÈ΋ Ïo›-

̈ÍË ÂÌÊ¿ÓÈÛ·Ó oÈ 9 (7,2%) Î·È ‰Â˘ÙÂÚoÁÂÓ‹ ÛËÙÈ-΋ ηٷÏËÍ›· oÈ 3 o˘ ÙÂÏÈÎÒ˜ η٤ÏËÍ·Ó. ∂·ÓÂ-¤Ì‚·ÛË ··ÈÙ‹ıËΠ۠4 (3,2%) ·ÛıÂÓ›˜, ÙÚÂȘ ÌÂ‰È·Ê˘Á‹ ·fi ÙËÓ ·Ó·ÛÙfïÛË Î·È ¤Ó·Ó Ì ÙË ‰È¿-Û·ÛË Ùo˘ ÙÚ·‡Ì·Ùo˜. O ¯ÚfiÓo˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ Óo-ÛËÏ›·˜ Î˘Ì¿ÓıËΠ·fi 4 ¤ˆ˜ 53 Ë̤Ú˜ (̤ÛË ÙÈÌ‹15,9) Î·È Î·Ù¤ÏËÍ·Ó 5 ·ÛıÂÓ›˜. OÈ 4 ·fi Ùo˘˜ ·ÛıÂ-Ó›˜ Ì ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ïo›ÌˆÍË ¯ÂÈÚo˘ÚÁ‹ıËηÓÂÂÈÁfiÓÙˆ˜, fiˆ˜ Î·È oÈ ÙÚÂȘ ·fi Ùo˘˜ ¤ÓÙ o˘Î·Ù¤ÏËÍ·Ó. ™Â 11 ·ÛıÂÓ›˜ ÎÚ›ıËΠ··Ú·›ÙËÙË Ë·ÏÏ·Á‹ ·ÓÙÈ‚ÈoÙÈÎo‡ ‚¿ÛÂÈ ·ÓÙÈ‚ÈoÁÚ¿ÌÌ·Ùo˜.

∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Î·È ÛÙȘ ‰‡o oÌ¿‰Â˜Ë Û˘Ó¤¯ÈÛË ‹ ·ÏÏ·Á‹ Ù˘ ·ÓÙÈ‚›ˆÛ˘, ·ÊoÚo‡Û ÛÂÂÚÈÙÒÛÂȘ ÛÙȘ oo›Â˜ ›Ù ›¯Â ÂÌÊ·ÓÈÛı› ÌÂ-ÙÂÁ¯ÂÈÚËÙÈ΋ Ïo›ÌˆÍË Â›Ù o ·ÛıÂÓ‹˜ ÂÌÊ¿ÓÈÛ ·-Ú·ÙÂٷ̤ÓË ˘ÚÂÙÈ΋ ΛÓËÛË ¯ˆÚ›˜ Ó· ·ÓȯÓ¢ı››ÛËÌ· Ïo›ÌˆÍË. ™ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÂÚÈÙÒÛÂȘ ËÛ˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈ‚›ˆÛ˘ ‹Ù·Ó ÚoÛˆÈ΋ ÂÈı˘-Ì›· Ùo˘ ˘Â‡ı˘Óo˘ ¯ÂÈÚo˘ÚÁo‡.

∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· o˘ ·ÎoÏo‡ıËÛ¤‰ÂÈÍ fiÙÈ oÈ ÌÈÎÚ¤˜ ‰È·ÊoÚ¤˜ o˘ ·Ú·ÙËÚ‹ıË-Î·Ó ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ ÙfiÛo ˆ˜ Úo˜ ÙooÛoÛÙfi ÂÌÊ¿ÓÈÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒ͈Ó,fiÛo Î·È Úo˜ Ùo ¯ÚfiÓo ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÓoÛËÏ›-·˜, ‰ÂÓ ¿ÁÁÈÍ·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ›‰·(p>0,05).

™À∑∏∆∏™∏∏ ÂÌÊ¿ÓÈÛË ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ ÂËÚ¿-˙ÂÙ·È ·fi oÏÏo‡˜ ·Ú¿ÁoÓÙ˜ fiˆ˜ ÙËÓ ËÏÈΛ·Ùo˘ ·ÛıÂÓo‡˜, ÙËÓ Î·Î‹ ‰È·ÙÚoÊ‹, ÙËÓ ·¯˘Û·Ú-Λ·, ÙËÓ ·ÎÙÈÓo‚fiÏÈÛË Ù˘ ÂÚÈo¯‹˜ Ù˘ ¤̂·-Û˘, ÙoÓ Â˘ÚÂÈÛÌfi Ùo˘ ¯ÂÈÚo˘ÚÁÈÎo‡ ‰›o˘, ÙˉȿÚÎÂÈ· Ùo˘ ¯ÂÈÚo˘ÚÁ›o˘, ÙËÓ ÂÌÂÈÚ›· Ùo˘¯ÂÈÚo˘ÚÁo‡ o˘ ÂÎÙÂÏ› ÙËÓ Â¤Ì‚·ÛË, ÙËÓ ·-Úo˘Û›· Û˘Óo‰ÒÓ ÓfiÛˆÓ, ÙËÓ ·ÓoÛoηٷÛÙoÏ‹ ηÈÙË ÌÈÎÚo‚ȷ΋ ¯ÏˆÚ›‰· Ùo˘ ÂÁ¯ÂÈÚËÙÈÎo‡ ‰›o˘.O ¯ÂÈÚo˘ÚÁfi˜ Ú¤ÂÈ Ó· Ï¿‚ÂÈ ˘fi„Ë fiϘ ·˘Ù¤˜ÙȘ ·Ú·Ì¤ÙÚo˘˜ ÚoÎÂÈ̤Óo˘ Ó· ÂÏ·ÙÙÒÛÂÈ ÙoÓΛӉ˘Óo ÂÌÊ¿ÓÈÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ Ïo›ÌˆÍ˘ ηÈÓ· ¯oÚËÁ‹ÛÂÈ Ùo ÛˆÛÙfi Û¯‹Ì· ¯ËÌÂÈoÚoʇϷ-͢6-9.

∂ÈÙ·ÎÙÈ΋ ·Ó¿ÁÎË ¯oÚ‹ÁËÛ˘ ¯ËÌÂÈoÚoʇ-Ï·Í˘ ˘¿Ú¯ÂÈ ÛÙȘ ÂÂÌ‚¿ÛÂȘ Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘·Êo‡ ·˘Ù¤˜ ¯·Ú·ÎÙËÚ›˙oÓÙ·È ‰˘ÓËÙÈο ÌoÏ˘Ṳ̂Ó˜¤ˆ˜ Ú˘·Ú¤˜ Î·È o ΛӉ˘Óo˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ïo›Ìˆ-͢ ·Ó¤Ú¯ÂÙ·È Û 9-40%7,8. ¶Èo Û˘ÁÎÂÎÚÈ̤ӷ, Ùo·¯‡ ¤ÓÙÂÚo ÂÚȤ¯ÂÈ 1010 ÌÈÎÚooÚÁ·ÓÈÛÌo‡˜ ·Ó¿ÁÚ·ÌÌ¿ÚÈo ÎoÚ¿ÓˆÓ, ÂÓÒ ̆ oÏoÁ›˙ÂÙ·È fiÙÈ Ù· ·Ó·-ÂÚfi‚È· ÌÈÎÚfi‚È· Â›Ó·È 1000 ¤ˆ˜ 10000 ÊoÚ¤˜ ÂÚÈÛ-ÛfiÙÂÚ· ·fi Ù· ·ÂÚfi‚È·. ∆· ΢ÚÈfiÙÂÚ· ·Ó·ÂÚfi‚È·

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 251

¶›Ó·Î·˜ 3. To ›‰o˜ Ù˘ ÎoÏoÛÙoÌ›·˜ Î·È ÙˆÓ ·Ó·ÛÙoÌÒÛÂ-ˆÓ ÛÙȘ ‰‡o oÌ¿‰Â˜.

∂ÂÌ‚¿ÛÂȘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘OÌ¿‰· ∞ OÌ¿‰· µ

∫oÏoÛÙoÌ›· 25 43∆ÂÏÈ΋ 21 31¶Ï¿ÁÈ· 4 12

∞Ó·ÛÙfïÛË 93 86∂͈ÂÚÈÙoÓ·È΋ oÚıoÎoÏÈ΋ 23 24∫oÏoÎoÏÈ΋ 41 34∂ÈÏÂoÎoÏÈ΋ 29 28

∞Ó·ÛÙfïÛË 93 86ªÂ Û˘ÚÚ·ÙÈÎfi 17 25Èڛ˜ Û˘ÚÚ·ÙÈÎfi 76 61

¶›Ó·Î·˜ 4. ∂ÈÏoΤ˜ o˘ ÂÌÊ·Ó›ÛıËÎ·Ó ÛÙȘ ‰‡o oÌ¿‰Â˜.

∂ÈÏÔΤ˜OÌ¿‰· ∞ OÌ¿‰· µ

¢È·‡ËÛË ÙÚ·‡Ì·Ùo˜ 7 8¢È¿Û·ÛË ÙÚ·‡Ì·Ùo˜ – 1 1

ÛËÙÈ΋ ηٷÏËÍ›·¢Â˘ÙÂÚoÁÂÓ‹˜ ÛËÙÈ΋ ηٷÏËÍ›· 2 3¢È·Ê˘Á‹ ·Ó·ÛÙfïÛ˘ 3 3™‡ÓÔÏÔ 11(8,8%) 12(9,6%)

·ıoÁfiÓ· ÌÈÎÚfi‚È· Ù˘ ÌÈÎÚo‚ȷ΋˜ ¯ÏˆÚ›‰·˜ Ùo˘·¯¤o˜ ÂÓÙ¤Úo˘ Â›Ó·È Ùo B. Fragilis, Ù· ÎψÛÙËÚ›‰È·Î·È oÈ ·Ó·ÂÚfi‚Èo ÎfiÎÎoÈ, ÂÓÒ Ù· ΢ÚÈfiÙÂÚ· ·ÂÚfi-‚È· Ùo ÎoÏo‚·ÎÙËÚ›‰Èo (E. Coli), o ÚˆÙ¤·˜ Î·È Ë„Â˘‰oÌoÓ¿‰·. OÈ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÏoÈÌÒÍÂȘ ÌÂÙ¿·fi ¤̂·ÛË ÛÙo ·¯‡ ¤ÓÙÂÚo Â›Ó·È Û¯Â‰fiÓ ¿ÓÙo-Ù oÏ˘ÌÈÎÚo‚ȷΤ˜ ÌÂ Û˘¯ÓfiÙÂÚ· ˘Â‡ı˘Ó· ÛÙÂϤ-¯Ë Ùo B. Fragilis Î·È Ùo E. Coli6. ¶ÚˆÙ·Ú¯È΋ Úo-Û¿ıÂÈ· ÏoÈfiÓ ÁÈ· ÙËÓ ÂÏ¿ÙÙˆÛË Ùo˘ oÛoÛÙo‡ ÙˆÓÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ Â›Ó·È Ë ÂÏ¿ÙÙˆÛË Ùo˘·ÚÈıÌo‡ ÙˆÓ ÌÈÎÚo‚›ˆÓ. ∞˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÂÈηÓooÈËÙÈÎfi ‚·ıÌfi Ì ÙoÓ Ì˯·ÓÈÎfi ηı·ÚÈÛÌfiÙo˘ ·¯¤o˜ ÂÓÙ¤Úo˘. ∏ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋ ¯oÚ‹ÁËÛËÙˆÓ Î·Ù¿ÏÏËÏˆÓ ·ÓÙÈÌÈÎÚo‚È·ÎÒÓ ·Ú·ÁfiÓÙˆÓ‰Ú·ÛÙÈÎÒÓ ¤Ó·ÓÙÈ ·ÂÚfi‚ÈˆÓ Î·È ·Ó·ÂÚfi‚ÈˆÓ ÌÈÎÚo-‚›ˆÓ ·oÙÂÏ› Ùo ‰Â‡ÙÂÚo ‚‹Ì·. OÈ ÎÂÊ·ÏoÛoÚ›-Ó˜ ‰Â‡ÙÂÚ˘ ÁÂÓÈ¿˜ Â›Ó·È ·fi Ù· ·ÓÙÈ‚ÈoÙÈο ÂÎÏo-Á‹˜ ÁÈ· ¯ËÌÂÈoÚoʇϷÍË ÁÈ·Ù› Â›Ó·È Â‡ÎoϘ ÛÙ˯ڋÛË, ¤¯o˘Ó ̄ ·ÌËÏ‹ ÙoÍÈÎfiÙËÙ·, Û¯ÂÙ›˙oÓÙ·È Ì ̄ ·-ÌËÏ¿ oÛoÛÙ¿ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ, Â›Ó·È ÊıË-Ó¤˜ Î·È ÂÌÊ·Ó›˙o˘Ó ÈηÓooÈËÙÈ΋ ·ÓÙÈÌÈÎÚo‚ȷ΋‰Ú·ÛÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ Ù˘ ¯ÏˆÚ›‰·˜ Ùo˘ ‰¤ÚÌ·Ùo˜Î·È Ù˘ Á·ÛÙÚÂÓÙÂÚÈ΋˜ o‰o‡. ™ÙÂÚo‡ÓÙ·È fï˜ o-oÈ·Û‰‹oÙ ‰Ú¿Ûˆ˜ ¤Ó·ÓÙÈ ·Ó·ÂÚfi‚ÈˆÓ ÌÈÎÚooÚ-Á·ÓÈÛÌÒÓ. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ··Ú·›ÙËÙo˜ ›-Ó·È o Û˘Ó‰˘·ÛÌfi˜ ›Ù Ì ÌÂÙÚoÓȉ·˙fiÏË, o˘ ¤¯ÂÈۯ‰fiÓ ·oÎÏÂÈÛÙÈ΋ ‰Ú¿ÛË ÛÙ· ·Ó·ÂÚfi‚È· ÌÈÎÚfi-‚È· ›Ù Ì ÎÏÈÓ‰·Ì˘Î›ÓË Ë oo›· fï˜ ¤¯ÂÈ ‰Ú¿ÛËÎ·È ¤Ó·ÓÙÈ gram–ıÂÙÈÎÒÓ ÎfiÎÎˆÓ Î·È Ú·‚‰›ˆÓ. ™ÙËÌÂϤÙË Ì·˜ ¤ÁÈÓ ÚoÛ¿ıÂÈ· Ó· Û˘ÁÎÚÈı› Ë ·o-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÂÓfi˜ ηıÈÂڈ̤Óo˘ Û¯‹Ì·Ùo˜ Ì·-ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ¯ËÌÂÈoÚoʇϷ͢ (oÌ¿‰· B: ÎÂ-Êo˘ÚoÍ›ÌË + ÌÂÙÚoÓȉ·˙fiÏË ÁÈ· Ù¤ÛÛÂÚȘ Ë̤Ú˜)Ì ¤Ó· ÓÂfiÙÂÚo Û¯‹Ì· (oÌ¿‰· ∞). ∆o ÓÂfiÙÂÚo Û¯‹-Ì· ÂÚÈÂÏ¿Ì‚·Ó ÙËÓ ·˙ÙÚÂoÓ¿ÌË ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÎÏÈÓ‰·Ì˘Î›ÓË Û ¤Ó· Û¯‹Ì· ‚Ú·¯Â›·˜ ¯oÚ‹ÁËÛ˘(ÙÚÂȘ ‰fiÛÂȘ). ∏ ·˙ÙÚÂoÓ¿ÌË Â›Ó·È o ΢ÚÈfiÙÂÚo˜ÂÎÚfiÛˆo˜ ÙˆÓ ÌoÓo‚·ÎÙ·ÌÒÓ Î·È ÂÌÊ·Ó›˙ÂȉڷÛÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ Î˘Ú›ˆ˜ ÙˆÓ gram (-) ‚·ÎÙËÚ›-ˆÓ ·ÏÏ¿ Î·È ¤Ó·ÓÙÈ Ù˘ Pseudomonas aerugino-sa7,8,10. ∂ÈϤ¯ıËΠ¤Ó· Û¯‹Ì· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜·Êo‡ Ê·›ÓÂÙ·È fiÙÈ Ë Ì·ÎÚfi¯ÚoÓË ̄ oÚ‹ÁËÛË ·ÓÙÈ‚Èo-ÙÈÎÒÓ ‰ÂÓ ¤¯ÂÈ ̂ ʤÏÈÌË ‰Ú¿ÛË, ÂÓÒ ·ÓÙ›ıÂÙ· ÌoÚ›ӷ ·˘Í‹ÛÂÈ ÙoÓ Î›Ó‰˘Óo ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈ-ÒÓ Î·È Ó· ÚoηϤÛÂÈ ÂÓÙoÓfiÙÂÚË Â›‰Ú·ÛË ÛÙË ÌÈ-ÎÚo‚ȷ΋ ¯ÏˆÚ›‰·, ÂÓÈÛ¯‡oÓÙ·˜ ÙËÓ ·‡ÍËÛË Î·È·Ó¿Ù˘ÍË ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ11-14. ¶Ú¿ÁÌ·ÙÈ ÛÙËÌÂϤÙË Ì·˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊoÚ¤˜ ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈΤ˜ fiÛoÓ ·ÊoÚ¿ ÙËÓ ·Ó¿Ù˘ÍË ÌÂÙÂÁ¯ÂÈ-ÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡o ˘fi ÌÂϤÙËoÌ¿‰Â˜. ∆· ·oÙÂϤÛÌ·Ù· Û˘ÌʈÓo‡Ó Ì ·˘Ù¿ ·Ó¿-

ÏoÁˆÓ ÌÂÏÂÙÒÓ o˘ Û˘ÁÎÚ›Óo˘Ó ÙȘ ‰È·ÊoÚ¤˜ ÌÂÙ·-͇ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜ ¯ËÌÂÈo-ÚoʇϷ͢ Î·È Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ¯ËÌÂÈoıÂڷ›-·˜15-18. ∫·È Û ·˘Ù¤˜ ÙȘ ÌÂϤÙ˜ ‰ÂÓ ·ÓȯÓ‡ıËηÓÌÂٷ͇ ÙˆÓ ˘fi ÌÂϤÙË oÌ¿‰ˆÓ ‰È·ÊoÚ¤˜ ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈΤ˜. ∂ÈϤoÓ, Û ÌÈ· Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙËÛÙË µÚÂÙ·Ó›· ÌÂٷ͇ ÌÈ·˜ ÂÊ¿·Í ‰fiÛ˘ ÎÂÊoÙ·Í›-Ì˘ Î·È ÌÂÙÚoÓȉ·˙fiÏ˘ Î·È ÙÚÈÒÓ ‰fiÛÂˆÓ ÎÂÊo˘-ÚoÍ›Ì˘ Î·È ÌÂÙÚoÓȉ·˙fiÏ˘ Û ÚoÁÚ·ÌÌ·ÙÈṲ̂Ó˜ÂÂÌ‚¿ÛÂȘ Ùo˘ ·¯¤o˜ ÂÓÙ¤Úo˘ Î·È oÚıo‡ ‰ÂÓ ·-Ú·ÙËÚ‹ıËΠ‰È·ÊoÚ¿ ÛÙo oÛoÛÙfi ÂÌÊ¿ÓÈÛ˘ ÌÂ-ÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ5.

∂›Ó·È ÛËÌ·ÓÙÈÎfi fiÙÈ ÛÙË ÌÂϤÙË Ì·˜ ‰ÂÓ ·Ú·-ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊoÚ¿ ÛÙË Û˘¯Ófi-ÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒ͈Ó, ÌÂ-ٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ ·Ú¿ Ùo ‰È·ÊoÚÂÙÈÎfi ¯ÚfiÓo¤Ó·Ú͢ Ù˘ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋˜ ¯ËÌÂÈoÚoʇϷ͢.ŸÛoÓ ·ÊoÚ¿ ÙoÓ È‰·ÓÈÎfi ¯ÚfiÓo ¤Ó·Ú͢ Ù˘ ¯oÚ‹-ÁËÛ˘ Ù˘ ¯ËÌÂÈoÚoʇϷ͢ ÈÛÙ‡ÂÙ·È fiÙÈ ·˘Ù‹Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÙË Ì›· ÒÚ· ÚÈÓ ·fi ÙËÓ ÂÁ¯Â›-ÚËÛË Î·È ÛÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË Î·Ù¿ ÙËÓ ÂÈÛ·-ÁˆÁ‹ Ùo˘ ·ÛıÂÓo‡˜ ÛÙËÓ ·Ó·ÈÛıËÛ›·19,20. O ȉ·ÓÈÎfi˜¯ÚfiÓo˜ ¯oÚ‹ÁËÛ˘ Ù˘ ÚÒÙ˘ ‰fiÛ˘ Ù˘ ¯ËÌÂÈoÚo-ʇϷ͢ ·Úo˘ÛÈ¿ÛıËΠ۠ÌÈ· ηϿ ۯ‰ȷṲ̂ÓËÌÂϤÙË ÛÙo Salt Lake City Ì 2847 ·ÛıÂÓ›˜ o˘ ˘o-‚Ï‹ıËÎ·Ó Û ÚoÁÚ·ÌÌ·ÙÈṲ̂Ó˜ ηı·Ú¤˜ Ë ‰˘ÓËÙÈ-ο ÌoÏ˘Ṳ̂Ó˜ ¯ÂÈÚo˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ. ™ÙË ÌÂϤÙË·˘Ù‹ Ê¿ÓËΠfiÙÈ Ùo ¯·ÌËÏfiÙÂÚo oÛoÛÙfi ÌÂÙÂÁ¯ÂÈ-ÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ ÂÈÙ˘Á¯¿ÓÂÙ·È fiÙ·Ó Ë ¯ËÌÂÈo-ÚoʇϷÍË ¯oÚËÁËı› ̤۷ ÛÙȘ ‰‡o ÒÚ˜ ÚÈÓ ·fiÙËÓ ¤Ó·ÚÍË Ù˘ ¤̂·Û˘12,13.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ fiˆ˜ Úo·-ÙÂÈ ÙfiÛo ·fi ÙË ÌÂϤÙË Ì·˜ fiÛo Î·È ·fi Ù· ‚È‚ÏÈ-oÁÚ·ÊÈο ‰Â‰o̤ӷ, o Û˘Ó‰˘·ÛÌfi˜ ·˙ÙÚÂoÓ¿ÌË˜Î·È ÎÏÈÓ‰·Ì˘Î›Ó˘ Û ۯ‹Ì· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜¤¯ÂÈ ÙËÓ ›‰È· ·oÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÙˆÓ ÌÂ-ÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏoÈÌÒÍÂˆÓ ÛÙË ¯ÂÈÚo˘ÚÁÈ΋ Ùo˘ ·-¯¤o˜ ÂÓÙ¤Úo˘ Û ۯ¤ÛË Ì ٷ ·Ï·ÈfiÙÂÚ· Û¯‹Ì·Ù·¯ËÌÂÈoÚoʇϷ͢ Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜.

∂ÈϤoÓ Ú¤ÂÈ Ó· ÙoÓÈÛıo‡Ó Ù· oÈÎoÓoÌÈ-ο ÏÂoÓÂÎÙ‹Ì·Ù· ·ÏÏ¿ Î·È Ë ÂÏ¿¯ÈÛÙË Â›‰Ú·ÛËÛÙË ‰ËÌÈo˘ÚÁ›· ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ ÙˆÓ ÌÈÎÚo-‚›ˆÓ o˘ ¤¯ÂÈ Ë ¯oÚ‹ÁËÛË Ùo˘ Û¯‹Ì·Ùo˜ ‚Ú·¯Â›-·˜ ‰È¿ÚÎÂÈ·˜.

ABSTRACTSakadamis A, Kamparoudis Ap, Ballas K. Shortterm or long term chemoprophylaxis in colon sur-gery. Hell Iatr, 2000, 66: 249 - 253.

It is worldwide accepted that bowel irrigation and

252 A. ™AKANTAMH™ KAI ™YN.

antibiotic administration are necessary for satisfying lar-ge bowel preparation preoperatively. The purpose of thisprospective randomized study was to access the efficacyof a short lasting preoperative administration of specificantibiotics to decrease the incidence of postoperativeinfections. Two hundred fifty patients that underwent lar-ge bowel operation have been randomly separated intotwo groups. Group A: In the 125 patients of group Athree doses of Aztreonam 1gr and Clindamycin 600mghave been administered (during the induction of ane-sthesia, 8 and 16 hours thereafter). Group B: In the 125patients of group B Cefuroxime 750mg and Metronidazol1gr three times daily and for four consecutive days havebeen administered. Antibiotic administration started theday before the operation. Evidence of infection was re-corded during hospitalization and for the first 30 postope-rative days. Results: Thirteen patients of Group A (10,4%)developed some postoperative complication: anastomoticdehiscence 3, wound infection 7, wound rupture 1 and se-condary septic shock 2. Two patients (1,36%) died andthree were reoperated (2,4%). In 18 cases (14,4%) con-tinuation of antibiotic administration was considered ne-cessary and in 8 of them with a different antibiotic accor-ding to microbial sensitivity tests. Mean hospital stay was11,6 days. Fifteen patients of Group B developed somepostoperative complication: anastomotic dehiscence 3,septic shock 1, wound infection 8 and secondary septicshock 3. Five patients (4%) died and four other (3,2%)were reoperated. Change of antibiotic therapy accordingto sensitivity test was considered necessary in 11 (8,8%)cases. Mean hospital stay was 15,9 days. From theanalysis of the results, it is concluded that preoperativeshort lasting Aztreonam and Clindamycin administrationfor the prevention of postoperative infections in largebowel operations, is equally effective with preoperativelong lasting antibiotic administration.

µπµ§πO°ƒ∞ºπ∞1. Townsend R. Post-marketing drug research and development.

Drug Intell. Clin Pharm 1987, 21: 134-6.2. Stone HH. Basic principle in the use of prophylactic antibio-

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1983, 93: 172-3.4. Wenzel RP. Preoperative antibiotic prophylaxis N Engl J Med

1992, 326: 337-8.5. Rowe Jones DC, Pell ALG, Kongston RD, Shaw SFL, Teesdale C,

Cole DS. Single dose cefotaxime plus mentronidazole versusthree dose cefuroxime plus metronidazole as prophylaxisagainst wound infection in colorectal surgery. [Multi-centerprospective randomized study]. BMJ 1990, 300: 18-22.

6. Kaiser A. Antimicrobial prophylaxis in surgery. N Engl J Med1986, 315: 1129-38.

7. Bremmelgaard A, Raahave D, Beier Holgersen R. Computer ai-ded surveillance of surgical infections and identification ofrisk factors. J Hosp Infect 1988, 13: 1-18.

8. Raahave D, Friis Moller A. Measuring operative wound conta-mination predicts post operative wound infection. SurgRes Comm 1989, 5: 31-9.

9. ∫·Ì·Úo‡‰Ë˜ ∞, ¶··‚·ÛÈÏ›o˘ ÃÚ, º·Ú‰¤ÏÏ·˜ π, ™Ì·Úo‡-Ó˘ á. ∏ Ïo›ÌˆÍË Ùo˘ ̄ ÂÈÚo˘ÚÁÈÎo‡ ÙÚ·‡Ì·Ùo˜. ¶Ú·ÎÙÈο6o˘ µoÚÂÈoÂÏÏ·‰ÈÎo‡ π·ÙÚÈÎo‡ ™˘Ó‰ڛo˘. 1991, 201-5.

10. Andrew B, Cisneros O, Cisneros R. ™‡ÁÎÚÈÛË Clindamycin ηÈMetronidazole ÛÙË ıÂڷ›· ÂÈÚ·Ì·ÙÈο ÚoηÏo‡-ÌÂÓ˘ ÂÓ‰oÎoÈÏȷ΋˜ Û‹„˘ ·fi Bacteroides fragilis ηÈStreptococcus Indermedius Û ÂÈÚ·Ì·Ùfi˙ˆ·. CurrentTherapeutic Research 1985, 38: 51-6.

11. Song F, Glenny AM. Antimicrobial prophylaxis in colorectalsurgery: a systematic review of randomized controlled trial.Br J Surg 1998, 85: 1232-41.

12. Mosimann F, Cornu P, N’ Ziya Z. Amoxycilline/Clavulanicacid prophylaxis in elective colorectal surgery: a prospe-ctive randomized trial. J Hosp Infect 1997, 37: 55-64.

13. Conte J, Jacob LS, Polk HC. Antibiotic prophylaxis in Surge-ry. A comprehensive review. Philadelphia: J B Lippincott,1984.

14. Polk HC. Prevention of surgical wound infection. Ann InternMed 1978, 89: 770-5.

15. Petropoulos P, Dietrich PY, Ammann J, Ayer G, Buchmann P,Martinoli S. Single dose antimicrobial prophylaxis in ele-ctive colorectal surgery [a multi center study in Switzer-land] 4th Mediterranean Congress of Chemotherapy.Rodes 1984.

16. Petropoulos P, Dietrich PY, Roche B.G., Kuttel SC. Single doseantimicrobial prophylaxis in elective colorectal and inreconstructive surgery 5th Mediterranean Congress ofChemotherapy. Cairo 1986.

17. Meier LR, Mauer W. Prophylaxis in colon surgery and thera-py of serious abdominal surgical infections. 4th Mediter-ranean Congress of Chemotherapy. Rodes 1984.

18. Giamarellou H, Dimoulas D, Phyllipakis M, Voros D, Georgant-as D, Voutsinas D. Ceftriaxone versus ceftriaxone plus orni-dazole in large bowel prophylaxis. A preliminary report. 4thMediterranean Congress of Chemotherapy. Rodes 1984.

19. Kanellos I, Odisseos C, Kazantzidou D, Galovatsea K, Zara-boukas T, Dadoukis I. Effect of early versus delayed po-stoperative injection of 5-Fluorouracil plus interferon al-pha on colonic healing. Eur Surg Res 1998, 30: 414-8.

20. Kanellos I, Kavouni A, Zaraboukas T, Odisseos C, GalovatseaK, Dadoukis I. Healing of colonic anastomoses after im-mediate and delayed administration of 5-Fluorouracil plusfolinic acid. Eur Surg Res 1998, 30: 312-7.

AÏÏËÏÔÁÚ·Ê›·:∞. ™·Î·ÓÙ¿Ì˘OÌ‹Úo˘ 5,552 36 – ¶·ÓfiÚ·Ì· £ÂÛÛ·ÏoÓ›ÎËCorresponding author:A. Sakadamis5, Omirou Str,55236 – PanoramaThessaloniki, Greece

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∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 254- 258

KÔÏÏ·ÁÔÓÔÏ˘ÙÈο ¤Ó˙˘Ì· ÛÙÔÓ ÔÚıÔ-ÎÔÏÈÎfi ηÚΛÓÔ

I.K. T¤ÓÙ˜, A-A.K. T¤ÓÙ˜, ™.K. M·ÚηΛ‰Ë˜, X.N. K·Ú·ÓÈÎÈÒÙ˘

EÚÁ·ÛÙ‹ÚÈÔ BÈÔ¯ËÌ›·˜, TÌ‹Ì· I·ÙÚÈ΋˜ ¢¶£XÂÈÚÔ˘ÚÁÈ΋ KÏÈÓÈ΋, °ÂÓÈÎfi NÔÌ·Ú¯ÂÈ·Îfi NÔÛÔÎÔÌÂ›Ô ¢È‰˘ÌÔÙ›¯Ô˘

T· ÛˆÏËÓÒ‰Ë ·‰ÂÓÒÌ·Ù· ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Â-ÍÂÏ›ÛÛÔÓÙ·È ‚·ıÌÈ·›· Û¤ ·‰ÂÓÔηÚÎÈÓÒÌ·Ù·, ÌÂÛ‡ÓıÂÙ˜ ÌÔÚȷΤ˜ ‰ÈÂÚÁ·Û›Â˜. H ΢ÙÙ·ÚÈ΋ ÂÈ-Û‚ÔÏ‹, Ì ‰È‹ıËÛË ÙˆÓ ·Ú·ÎÂÈÌ¤ÓˆÓ ÈÛÙÒÓ, ›ӷÈÙÔ ·ÔÙ¤ÏÂÛÌ· ÌÈ·˜ ÛÂÈÚ¿˜ ·ÏÏËÏÂȉڿÛÂˆÓ ÌÂ-ٷ͇ ΢ÙÙ¿ÚˆÓ Î·È ÂÍˆÎ˘ÙÙ·Ú›Ô˘ ¯ÒÚÔ˘, Û ÙÚÂȘ‰È·ÎÚÈÙ¤˜ Ê¿ÛÂȘ: 1. ÌÂÙ·‚ÔÏ‹ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ ÌÂ-ٷ͇ ΢ÙÙ¿ÚˆÓ Î·È ÂÚÈ‚¿ÏÏÔÓÙÔ˜, 2. ÚˆÙÂÔÏ˘ÙÈ-΋ ‰È¿Û·ÛË Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È 3. ‰È›Û-‰˘ÛË ‰È·Ì¤ÛÔ˘ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘. OÈ ÌÂÙ·Ï-ÏÔÚˆÙÂ˚Ó¿Û˜ (MMPs) ‹ Ù‡Ô˘ IV ÎÔÏÏ·ÁÔÓ¿-Û˜–˙ÂÏ·ÙÈÓ¿Û˜ ÂÌϤÎÔÓÙ·È ÛÙËÓ ÚˆÙÂÔÏ˘ÙÈ΋‰È¿Û·ÛË Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ÛÙ· ·Ú¯ÈοÛÙ¿‰È· Ù˘ ÌÂÙ·ÛÙ·ÙÈ΋˜ ‰È·‰Èηۛ·˜.

H Ù‡Ô˘ IV ÎÔÏÏ·ÁÔÓÔÏ˘ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·¤¯ÂÈ Û˘Ó‰Âı› ̤ ÙÔ ÌÂÙ·ÛÙ·ÙÈÎfi ‰˘Ó·ÌÈÎfi ΢ÙÙ¿-

ÚˆÓ Û ÔÏÏÔ‡˜ ηÎÔ‹ıÂȘ fiÁÎÔ˘˜. EȉÈΤ˜ ÌÔÚ-ʤ˜ MMPs, fiˆ˜ Ë 92-kDa MMP-9 Î·È Ë 72-kDaMMP-2 ÚÔ-ÎÔÏÏ·ÁÔÓ¿Û˜, Ô˘ ˘¿Ú¯Ô˘Ó ÛÂ Ê˘-ÛÈÔÏÔÁÈο Î·È ·ıÔÏÔÁÈο ·ÙÙ·Ú· ÌÂÙ·ÙÚ¤ÔÓÙ·ÈÛÙȘ ÂÓÂÚÁÔÔÈË̤Ó˜ ÙÔ˘˜ ÌÔÚʤ˜ Ì ۯÂÙÈ΋ ÌÔ-Úȷ΋ Ì¿˙· 80-84 Î·È 64 kDa ·ÓÙ›ÛÙÔȯ·, ÌÂÙ¤¯Ô˘ÓÛÙËÓ ÙÔÈ΋ ‰È›ۉ˘ÛË Î·È Èı·ÓfiÓ ·ÔÙÂÏÔ‡Ó ÊÔ-Ú›˜ Ù˘ ηÚÎÈÓÈ΋˜ ‰È›ۉ˘Û˘1.

™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ›ӷÈ: 1) Ë ÌÂϤÙË ÙˆÓÎÔÏÏ·ÁÔÓÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ (MMP) Ô˘ ÂÓÂÚÁÔ-ÔÈÔ‡ÓÙ·È Î·Ù¿ ÙËÓ ÂͤÏÈÍË ÙˆÓ ÚˆÙÔ·ıÒÓ ·‰Â-ÓÔηÚÎÈÓˆÌ¿ÙˆÓ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÙÔ˘ ÌÂ-Ù·ÛÙ·ÙÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘, 2) Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ÂȉÈ-ÎÒÓ ÌÔÚÊÒÓ ÙÔ˘˜ Ì ÈÛÙÔÏÔÁÈο ‰Â‰Ô̤ӷ Î·È 3) ˉÈÂÚ‡ÓËÛË Ù˘ ÚÔÔÙÈ΋˜ ·ÍÈÔÔ›ËÛ‹˜ ÙÔ˘˜ ˆ˜‰ÂÈÎÙÒÓ ÚfiÁÓˆÛ˘ Ù˘ ÓfiÛÔ˘.

¶ÂÚ›ÏË„Ë. M ÛÎÔfi ÙËÓ ÔÈÔÙÈ΋ Î·È ÔÛÔÙÈ΋ÌÂϤÙË Ù˘ ηٷÓÔÌ‹˜ ÙˆÓ ÎÔÏÏ·ÁÔÓÔÏ˘ÙÈÎÒÓ ÂÓ˙‡-ÌˆÓ (MMPs) ÛÙÔÓ ÔÚıÔ-ÎÔÏÈÎfi ηÚΛÓÔ, ¤ÁÈÓ ·Ó¿Ï˘-ÛË Î·È Ù·˘ÙÔÔ›ËÛË ÙˆÓ ÂȉÈÎÒÓ ÌÔÚÊÒÓ MMP ÌÂ˙˘ÌÔÁÚ·Ê›· ˙ÂÏ·Ù›Ó˘ Û ¯ÂÈÚÔ˘ÚÁÈο ·Ú·Û¢¿-ÛÌ·Ù· (Ê˘ÛÈÔÏÔÁÈο Î·È ·ıÔÏÔÁÈÎfi ÈÛÙfi) ·fi 37·ÛıÂÓ›˜ Ì ηÚΛÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÔÚıÔ‡.E›Û˘ ¤ÁÈÓ ÔÛÔÙÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ ÂȤ‰ˆÓMMP, Ì ۿڈÛË Î·È „ËÊȷ΋ ·Ó¿Ï˘ÛË ÙˆÓ ˙˘ÌÔ-ÁÚ·ÌÌ¿ÙˆÓ Î·È Û˘Û¯¤ÙÈÛË ÙˆÓ ÚÔ-ÂÓ˙˘ÌÈÎÒÓ Î·ÈÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ÌÔÚÊÒÓ Ì ÎÏÈÓÈÎÔ‡˜, ÈÛÙÔÏÔÁÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È Î·ÚÎÈÓÈÎÔ‡˜ ‰Â›ÎÙ˜. H ÛÙ·ÙÈ-ÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙË ‰ÔÎÈÌ·Û›· x2. OÈ ÚÔÂÓ˙˘-ÌÈΤ˜ ÌÔÚʤ˜ ÙˆÓ MMP-9 Î·È MMP-2 ‚Ú¤ıËÎ·Ó ÛÂfiÏ· Ù· ‰Â›ÁÌ·Ù· ÈÛÙÒÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. EÓÂÚÁÔ-ÔÈË̤Ó˜ ÌÔÚʤ˜ ÙˆÓ MMPs ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛٷηÚÎÈÓÒÌ·Ù· ÛÙ·‰›Ô˘ A. ™ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ È-ÛÙÔ‡˜ Ë ÚÔ-MMP-2 Û¯ÂÙ›ÛıËΠ̠ÙÔ ÛÙ¿‰ÈÔ Ù˘ÓfiÛÔ˘, ÙÔ ‚·ıÌfi ηÎÔ‹ıÂÈ·˜, ÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌ-

Ê·‰¤ÓˆÓ Î·È ÙË ‰È‹ıËÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·fi ÙÔÓfiÁÎÔ (p < 0,05), ÂÓÒ Ë ÂÓÂÚÁÔÔÈË̤ÓË MMP-2, ÌÂÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (p = 0,002). ™ÙÔ˘˜ ·-ıÔÏÔÁÈÎÔ‡˜ ÈÛÙÔ‡˜, Ë ÚÔ-MMP-2 ›¯Â Û¯¤ÛË Ì ÙˉȋıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ, ÙËÓ ‡·ÚÍË ÌÂÙ·ÛÙ¿ÛÂ-ˆÓ, ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ ‚·ıÌfi ηÎÔ‹ıÂÈ·˜ÙÔ˘ fiÁÎÔ˘ (p < 0,05). H ‰È‹ıËÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜Î·È ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›ÛıËÎ·Ó Î·È Ì ٿ ‰‡ÔÂÓÂÚÁÔÔÈË̤ӷ ¤Ó˙˘Ì· (p<0,05). T¤ÏÔ˜, Ë MMP-9›¯Â Û¯¤ÛË Ì ÙËÓ ‡·ÚÍË ÌÂÙ·ÛÙ¿ÛÂˆÓ (p = 0,01),ÂÓÒ Ë MMP-2 Ì ÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È ÙÔ‚·ıÌfi ‰È·ÊÔÚÔÔ›ËÛ˘ ÙÔ˘ fiÁÎÔ˘ (p < 0,05). H·Ó‡ÚÂÛË ÌfiÓÔ Ù˘ MMP-2 Û ‰Â›ÁÌ·Ù· ·ıÔÏÔÁÈ-ÎÒÓ ÈÛÙÒÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÚÔ¯ˆÚË̤Ó˘ ÓfiÛÔ˘ (‰È-‹ıËÛË ÏÂÌÊ·‰¤ÓˆÓ), ÂÓÒ Ë ·Ó‡ÚÂÛË Î·È ÙˆÓ ‰‡ÔÂÓ˙‡ÌˆÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÌÂÙ·ÛÙ·ÙÈ΋˜ ÓfiÛÔ˘. H Ô-ÚÈÛÙÈ΋ ÂȂ‚·›ˆÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ··ÈÙ› ÙË ‰È-ÂÓ¤ÚÁÂÈ· ÈÔ ÂÎÙÂٷ̤Ó˘ ÌÂϤÙ˘.EÏÏËÓ I·ÙÚ 2000, 66: 254 - 258.

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Y§π∫Ÿ ∫∞π ªŒ£√¢√πTÔ ˘ÏÈÎfi ÚÔ¤Ú¯ÂÙ·È ·fi ÙÂÌ¿¯È· ÊÚ¤ÛÎˆÓ ÈÛÙÒÓ (ÂÓfi˜ ‰Â›Á-Ì·ÙÔ˜ ·fi ÙÔÓ fiÁÎÔ Î·È ÂÓfi˜ ‰Â›ÁÌ·ÙÔ˜ ·fi ·Ú·Î›ÌÂÓÔ Ê˘-ÛÈÔÏÔÁÈÎfi ÈÛÙfi), 37 ·ÛıÂÓÒÓ Ì ÔÚıÔ-ÎÔÏÈÎfi ηÚΛÓÔ, Ô˘·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈο. OÈ ÈÛÙÔ› ·˘ÙÔ› ‰È·ÙËÚ‹ıË-Î·Ó Û ıÂÚÌÔÎÚ·Û›· -20o C.

T· ÈÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·ÓÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ (ÙÚÔÔÔ›ËÛË Î·Ù¿ Gunderson), ÙÔ ‚¿-ıÔ˜ ‰È‹ıËÛ˘ ÙÔ˘ ÔÚÁ¿ÓÔ˘ ·fi ÙÔÓ fiÁÎÔ (T), Ë ‰È‹ıËÛË ÙˆÓÏÂÌÊ·‰¤ÓˆÓ (N), Ë ‡·ÚÍË ÌÂÙ·ÛÙ¿ÛÂˆÓ (M), Ô ÈÛÙÔÏÔÁÈÎfi˜‚·ıÌfi˜ ηÎÔ‹ıÂÈ·˜ ÙÔ˘ fiÁÎÔ˘ Î·È Ô ‚·ıÌfi˜ ‰È·ÊÔÚÔÔ›ËÛ˘ÙÔ˘ fiÁÎÔ˘ (G). H ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ fiÁÎˆÓ ¤ÁÈÓ Ì ÙËÓ ÙÚÔ-ÔÔ›ËÛË Î·Ù¿ Gunderson. OÈ fiÁÎÔÈ ¯·Ú·ÎÙËÚ›ÛıËÎ·Ó Û·Ó˘„ËÏÔ‡ Î·È ¯·ÌËÏÔ‡ ÈÛÙÔÏÔÁÈÎÔ‡ ‚·ıÌÔ‡ ηÎÔ‹ıÂÈ·˜ Î·È Ô‚·ıÌfi˜ ‰È·ÊÔÚÔÔ›ËÛ˘ ˆ˜ ˘„ËÏÔ‡ (G1), ̤ÛÔ˘ (G2) η› ¯·-ÌËÏÔ‡ (G3).

BÈÔ¯ËÌÈ΋ ·Ó¿Ï˘ÛË – ˙˘ÌÔÁÚ·Ê›· ˙ÂÏ·Ù›Ó˘: ¢Â›ÁÌ·Ù·ÈÛÙÒÓ (10 mg) ÔÌÔÁÂÓÔÔÈ‹ıËÎ·Ó Û 10 Ìl/mg Ú˘ıÌÈÛÙÈÎÔ‡‰È·Ï‡Ì·ÙÔ˜ Tris-HCl 50 mM, pH 6,8, Ô˘ ÂÚÈ›¯Â 0,1% SDS(ÛÔ˘ÏÊÔ‰ˆ‰Â΢ÏÈÎfi Ó¿ÙÚÈÔ) η› 0,02% ÁÏ˘ÎÂÚfiÏË. ™ÙË Û˘-Ó¤¯ÂÈ· ˆ¿ÛÙËÎ·Ó Û 25Ô C › 10 ÏÂÙ¿.

AÎÔÏÔ‡ıËÛÂ Ê˘ÁÔΤÓÙÚËÛË Û 12000 ÛÙÚÔʤ˜/ÏÂÙfi Â-› 5 ÏÂÙ¿. ™ÙÔ ˘ÂÚΛÌÂÓÔ ¤ÁÈÓ ̤ÙÚËÛË ÚˆÙ½Ó˘2 ÂÓÒ,20 Ìg ÚˆÙ½Ó˘ ·fi οı ‰Â›ÁÌ· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ·-Ó¿Ï˘ÛË Ì ËÏÂÎÙÚÔÊfiÚËÛË Û ËÎÙ‹ SDS-ÔÏ˘·ÎÚ˘Ï·Ì›‰Ë˜(9% w/v) Ô˘ ›Û˘ ÂÚÈ›¯Â ˙ÂÏ·Ù›ÓË (0,75 mg/ml).

MÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ËÏÂÎÙÚÔÊfiÚËÛ˘, Ë ËÎÙ‹ ˆ¿ÛÙË-Π۠‰È¿Ï˘Ì· 2,5% (v/v) Triton X-100 Û 25Ô C › 30 ÏÂÙ¿.

K·ÙfiÈÓ ·ÎÔÏÔ‡ıËÛ ۇÓÙÔÌË Ï‡ÛË Û ڢıÌÈÛÙÈÎfi ‰È-¿Ï˘Ì· Tris-HCl 50 mM, pH 7,5 Ô˘ ›Û˘ ÂÚÈ›¯Â 200 mMNaCl, 10 mM CaCl2 Î·È 0,005% Brij 35.

⁄ÛÙÂÚ·, Ë ËÎÙ‹ ˆ¿ÛÙËΠ۠37Ô C › 18 ÒÚ˜ ÛÙÔ›‰ÈÔ Ú˘ıÌÈÛÙÈÎfi ‰È¿Ï˘Ì· Î·È ·ÎÔÏÔ‡ıËÛ ¯ÚÒÛË Â› 30-60 ÏÂ-Ù¿ Ì ΢·ÓÔ‡Ó ÙÔ˘ Coomassie (1 g/l Û 15% ÌÂı·ÓfiÏË Î·È7,5% ÔÍÈÎfi Ô͇). H ËÎÙ‹ ·Ô¯ÚˆÌ·Ù›ÛÙËΠ̠15% ÌÂı·ÓfiÏËÎ·È 7,5% ÔÍÈÎfi Ô͇ Î·È ÔÈ MMPs ÂÌÊ·Ó›ÛÙËÎ·Ó ˆ˜ Ï¢Τ˜ ˙Ò-Ó˜. ¶ÔÛÔÙÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ MMPs ¤ÁÈÓ Ì ۿ-ÚˆÛË Î·È „ËÊȷ΋ ·Ó¿Ï˘ÛË ÙˆÓ ˙˘ÌÔÁÚ·ÌÌ¿ÙˆÓ, ¯ÚËÛÈÌÔÔÈ-ÒÓÙ·˜ ηٿÏÏËÏÔ ÏÔÁÈÛÌÈÎfi (Gelpro 3 Ù˘ Media Cybernetics).

A¶√∆∂§Œ™ª∞∆∞™ÙÔÓ ›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ·Ú·Û΢·ÛÌ¿ÙˆÓ, ÂÓÒ ÛÙÔÓ ›Ó·Î· 2 Ù· ÏÂÙÔÌÂÚ‹

ÈÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·Ú·Û΢·ÛÌ¿ÙˆÓ.ŸÏ· Ù· ·Ú·Û΢¿ÛÌ·Ù· Ô˘ ÌÂÏÂÙ‹ıËηÓ,

ÂÚÈ›¯·Ó ÙȘ ÚÔÂÓ˙˘ÌÈΤ˜ ÌÔÚʤ˜ ÙˆÓ MMP-9 (92kDa) η› MMP-2 (72 kDa). Afi ÙËÓ ÔÈÔÙÈ΋ ÌÂϤ-ÙË, ÂÓÂÚÁÔÔÈË̤Ó˜ ÌÔÚʤ˜ ÙˆÓ ‰‡Ô ÂÓ˙‡ÌˆÓ ‚Ú¤-ıËÎ·Ó Û fiÏ· Ù· ‰Â›ÁÌ·Ù· ·ıÔÏÔÁÈÎÒÓ ÈÛÙÒÓ, Â-ÎÙfi˜ ·fi ·˘Ù¿ ÙˆÓ ·ÛıÂÓÒÓ ÛÙ·‰›Ô˘ A (EÈÎ. 1). E-ÈϤÔÓ, Û ‰Â›ÁÌ·Ù· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÈÛÙÒÓ ·fi ·-Ú·Û΢¿ÛÌ·Ù· fiÁÎˆÓ ÛÙ·‰›ˆÓ B2, B3, C1, C2, C3Î·È D ‚Ú¤ıËÎÂ Ë ÂÓÂÚÁÔÔÈË̤ÓË MMP-9. H ÂÓÂÚ-ÁÔÔÈË̤ÓË MMP-2 ‚Ú¤ıËΠÛÂ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ È-ÛÙÔ‡˜ ·Ú·Û΢·ÛÌ¿ÙˆÓ ·ÛıÂÓÒÓ ÛÙ·‰›ˆÓ C3 ηÈD. Afi ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi, ‰È·ÈÛÙÒıËÎÂfiÙÈ Ù· ›‰· ÙˆÓ ÚÔÂÓ˙˘ÌÈÎÒÓ Î·È ÂÓÂÚÁÔÔÈË-Ì¤ÓˆÓ MMPs ‹Ù·Ó ·˘ÍË̤ӷ ÛÙÔ˘˜ ·ıÔÏÔÁÈÎÔ‡˜ÈÛÙÔ‡˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ Ê˘ÛÈÔÏÔ-ÁÈÎÔ‡˜ (¶›Ó. 3).

™ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÈÛÙÔ‡˜ (¶›Ó. 4), Ë ÚÔ-MMP-2 ›¯Â Û¯¤ÛË Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Î·È ÙˉȋıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (p < 0,05). H ÂÓÂÚÁÔÔÈ-Ë̤ÓË MMP-9 ›¯Â Û¯¤ÛË Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘,ÙÔ ‚·ıÌfi ηÎÔ‹ıÂÈ·˜, ÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓÎ·È ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·fi ÙÔÓ fiÁÎÔ (p < 0,05), ÂÓÒ ËÂÓÂÚÁÔÔÈË̤ÓË MMP-2, Ì ÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌÊ·-‰¤ÓˆÓ (p = 0,002). ™ÙÔ˘˜ ·ıÔÏÔÁÈÎÔ‡˜ ÈÛÙÔ‡˜, ËÚÔ-MMP-2 ›¯Â Û¯¤ÛË Ì ÙËÓ ‡·ÚÍË ·ÔÌ·ÎÚ˘-

¶›Ó·Î·˜ 1. ™Ù·‰ÈÔÔ›ËÛË

™Ù¿‰ÈÔ AÚÈıÌfi˜ %

A 2 5,4B1 3 8,1B2 10 27B3 4 10,8C1 1 2,7C2 5 13,5C3 6 16,2D 6 16,2

¶›Ó·Î·˜ 2. IÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο (pTNM)

T N M

T1 = 2 (5,4%) N0 = 20 (54,1%) M0 = 31 (83,8%)T2 = 3 (8,1%) N1 = 8 (21,6%) M0 = 6 (16,2%)T3 = 20 (54,1%) N2 = 7 (18,9%)T4 = 12 (32,4%) N3 = 2 (5,4%)

ÕÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο

‚·ıÌfi˜ ηÎÔ‹ıÂÈ·˜ ˘ÔÙÚÔ‹ ÓfiÛÔ˘ ‚·ıÌfi˜ ‰È·ÊÔÚÔÔ›ËÛ˘

˘„ËÏ‹ = 29 (78,4%) Ó·È = 2 (5,4%) G1 = 21 (56,8%)¯·ÌËÏ‹ = 8 (21,6%) Ó·È = 30 (81,1%) G2 = 10 (27%)

G3 = 2 (5,4%)

¶›Ó·Î·˜ 4. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÔÛÔÙÈ΋˜ ÌÂϤÙ˘ ‰ÂÈÁÌ¿ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÈÛÙÔ‡

TÈÌ‹ p¶·Ú¿ÁÔÓÙ·˜ MMP-9 ÚÔ-MMP-2 MMP-2

T 0,003 >0,05 >0,05N 0,047 0,001 0,002ÛÙ¿‰ÈÔ 0,001 0,007 >0,05‚·ıÌfi˜ ηÎÔ‹ıÂÈ·˜ 0,04 >0,05 >0,05

256 I.K. TENTE™ ∫∞π ™À¡.

ÛÌ¤ÓˆÓ ÌÂÙ·ÛÙ¿ÛˆÓ, ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ‚·ıÌfi ηÎÔ‹ıÂÈ·˜ ÙÔ˘ fiÁÎÔ˘ (p < 0,05). E›Û˘ ˉȋıËÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·fi ÙÔÓ fiÁÎÔ Î·È ÙÔ ÛÙ¿-‰ÈÔ Ù˘ ÓfiÛÔ˘ Û˘Û¯ÂÙ›ÛıËÎ·Ó Î·È Ì ٷ ‰‡Ô ÂÓÂÚ-ÁÔÔÈË̤ӷ ¤Ó˙˘Ì· (p < 0,005). T¤ÏÔ˜, Ë MMP-9›¯Â Û¯¤ÛË Ì ÙËÓ ‡·ÚÍË ·ÔÌ·ÎÚ˘ÛÌ¤ÓˆÓ ÌÂÙ·-ÛÙ¿ÛÂˆÓ (p = 0,01), ÂÓÒ Ë MMP-2 Ì ÙË ‰È‹ıËÛËÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È ÙÔ ‚·ıÌfi ‰È·ÊÔÚÔÔ›ËÛ˘ ÙÔ˘fiÁÎÔ˘ (p < 0,05).

OÈ Î·ÚÎÈÓÈÎÔ› ‰Â›ÎÙ˜ CEA Î·È CA 19-9 ‰ÂÓ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ ›‰· ÙˆÓ ÎÔÏÏÔ-ÁÔÓÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ.

™À∑◊∆∏™∏T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ·˘ÍËı› ÔÈ ÂӉ›ÍÂȘ fiÙÈÚˆÙÂÔÏ˘ÙÈο ¤Ó˙˘Ì·, Ô˘ ‰È·ÛÔ‡Ó Ù· Û˘ÛÙ·ÙÈοÙ˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ (MMPs), Â›Ó·È ·Ú¿ÌÂÙÚÔÈ,Ô˘ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ηıÔÚ›˙Ô˘Ó ÙÔ ÌÂÙ·ÛÙ·ÙÈÎfi‰˘Ó·ÌÈÎfi ÔÏÏÒÓ Ù‡ˆÓ ηÚÎÈӈ̿وÓ3,4. ¶ÚÔÛÂÁ-

Á›ÛÂȘ ÂÎÙ›ÌËÛ˘ ÙÔ˘ ‚·ıÌÔ‡ ¤ÎÊÚ·Û˘ ÙˆÓ ·ÓÙ›-ÛÙÔȯˆÓ ÁÔÓȉ›ˆÓ5 Î·È Ì¤ÙÚËÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓÎÔÏÏ·ÁÔÓÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ›Ù ÂÈÚ·Ì·ÙÈο6 ›ÙÂÎÏÈÓÈο7, ‰Â›¯ÓÔ˘Ó fiÙÈ ˘¿Ú¯ÂÈ Û·Ê‹˜ ‰È·ÊÔÚ¿ Ûٷ›‰· ¤ÎÊÚ·Û˘ ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ MMPs ÌÂÙ·Í‡Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Î·ÈfiÙÈ Ù· ›‰· ÙˆÓ ÂÓ˙‡ÌˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ·˘ÍË̤ӷÛ ÂÚÈÙÒÛÂȘ ·ıÔÁ¤ÓÂÈ·˜ Î·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÌÂÙÔ ÛÙ¿‰ÈÔ ÙˆÓ ÔÚıÔÎÔÏÈÎÒÓ Î·ÚÎÈӈ̿وÓ8,9.

OÈ ÚÔÎÔÏÏ·ÁÔÓ¿Û˜ MMP-9 Î·È MMP-2 ÌÂÛ¯ÂÙÈ΋ ÌÔÚȷ΋ Ì¿˙· 92 Î·È 72 kDa ·ÓÙ›ÛÙÔȯ·,ÌÂÙ·ÙÚ¤ÔÓÙ·È ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ ¤Ó˙˘Ì· Ì ·-ÔÎÔ‹ ÌÈÎÚÔ‡ ÂÙȉÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ·fi ÙÔ ·ÌÈÓÔ-ÙÂÏÈÎfi ÙÔ˘˜ ¿ÎÚÔ10, Èı·Ófiٷٷ ·fi ¿ÏϘ ÚˆÙ¿-Û˜, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ·ÓÙ›ÛÙÔȯ˜ ÂÓÂÚÁÔÔÈË̤-Ó˜ ÌÔÚʤ˜ Ì ÌÔÚȷ΋ Ì¿˙· 80-84 Î·È 64 kDa Ó·Â›Ó·È Û·ÊÒ˜ ‰È·ÎÚÈÙ¤˜ ‰ÈfiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·ÊÔ-ÚÂÙÈ΋ ËÏÂÎÙÚÔÊÔÚËÙÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ·fi Ù· ÚÔ-¤Ó˙˘Ì¿ ÙÔ˘˜. ŒÙÛÈ Ë Ù¯ÓÈ΋ Ù˘ ˙˘ÌÔÁÚ·Ê›·˜ ˙Â-

¶›Ó·Î·˜ 3. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÔÛÔÙÈ΋˜ ÌÂϤÙ˘ ‰ÂÈÁÌ¿ÙˆÓ ·ıÔÏÔÁÈÎÔ‡ ÈÛÙÔ‡

TÈÌ‹ p¶·Ú¿ÁÔÓÙ·˜ MMP-9 ÚÔ-MMP-2 MMP-2

T 0,004 >0,05 0,000N >0,05 0,003 0,001M 0,01 0,027 >0,05ÛÙ¿‰ÈÔ 0,000 0,000 0,000G 0,036 >0,05 >o,05‚·ıÌfi˜ ηÎÔ‹ıÂÈ·˜ >0,05 0,045 >0,05

EÈÎ. 1. Z˘ÌÔÁÚ·Ê›· ˙ÂÏ·Ù›Ó˘ fiÔ˘ Ê·›ÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ÎÔÏÏ·ÁÔÓÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ (MMPs) ηٿ ÛÙ¿‰ÈÔ ÛÙÔÓÔÚıÔ-ÎÔÏÈÎfi ηÚΛÓÔ. AÓ¿ ‰‡Ô, Ù· ‰Â›ÁÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹, (1) Ê˘ÛÈÔÏÔÁÈÎfi˜ ÈÛÙfi˜, (2) Ô fiÁÎÔ˜Ô˘ ·Ê·ÈÚ¤ıËÎÂ.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 257

Ï·Ù›Ó˘ ÚÔÛʤÚÂÙ·È ÁÈ· ÙË ÌÂϤÙË Ù˘ ηٷÓÔÌ‹˜ÙˆÓ ÚÔÂÓ˙˘ÌÈÎÒÓ Î·È ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ MMPsÎ·È ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÁÈ·ÙËÓ ÔÈÔÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÂÓ˙‡ÌˆÓ ·˘ÙÒÓ Û ¯ÂÈ-ÚÔ˘ÚÁÈο ·Ú·Û΢¿ÛÌ·Ù· ÚÔÂÚ¯fiÌÂÓ· ·fi ·-ÛıÂÓ›˜ Ì ηÚΛÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ¶ÔÛÔÙÈ΋ÂÎÙ›ÌËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ MMPs ¤ÁÈÓ Ì ۿڈ-ÛË Î·È „ËÊȷ΋ ÂÂÍÂÚÁ·Û›· ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜Ù˘ ˙˘ÌÔÁÚ·Ê›·˜.

H ÂÈÎfiÓ· 1, ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÈ· Û˘ÓÔÏÈ΋ ·-ÚÔ˘Û›·ÛË Ù˘ ηٷÓÔÌ‹˜ ÙˆÓ ÎÔÏÏ·ÁÔÓÔÏ˘ÙÈÎÒÓÂÓ˙‡ÌˆÓ ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘. ™ÙÔ Û‡ÓÔ-ÏÔ ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ÔÈÔÙÈ΋ Î·È ÔÛÔÙÈ΋ η-Ù·ÓÔÌ‹ ÙˆÓ ÚÔÂÓ˙˘ÌÈÎÒÓ Î·È ÂÓÂÚÁÔÔÈË̤ӈÓMMPs ‹Ù·Ó Û‡ÌʈÓË Ì ٷ ÈÛÙÔ·ıÔÏÔÁÈο ‰Â‰Ô-̤ӷ Î·È ·Ï·ÈfiÙÂÚ˜ ·Ó·ÊÔÚ¤˜8,9. OÈ ÂÓÂÚÁÔÔÈË-̤Ó˜ ÌÔÚʤ˜ ÙˆÓ MMP-9 Î·È MMP-2 ‹Ù·Ó ÂÌÊ·-Ó›˜ ÛÙÔ ÛÙ¿‰ÈÔ B1 Î·È ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙˆÓÂȤ‰ˆÓ ÙÔ˘˜ ·Ó·ÏÔÁÈο Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘.Œ¯ÂÈ ·Ó·ÊÂÚı› ·fi ÙÔ˘˜ Zeng Î·È Guillem9, fiÙÈ ËÂÓÂÚÁÔÔÈË̤ÓË MMP-9 Ô˘ ÂÓÙÔ›ÛıËΠÂȉÈοÛ ˷ÙÈΤ˜ ÌÂÙ·ÛÙ¿ÛÂȘ ÔÚıÔÎÔÏÈÎÒÓ Î·ÚÎÈӈ̿-ÙˆÓ, Èı·Ófiٷٷ ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ·-ÛÙ·ÙÈ΋ ‰È·‰Èηۛ·. H ¯·Ú·ÎÙËÚÈÛÙÈ΋ ηٷÓÔÌ‹Ù˘ MMP-9 ÛÙ· ‰Â›ÁÌ·Ù· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·Ù¿ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, Î·È Ë ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛ‹ Ù˘Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, ÙÔ ‚·ıÌfi ηÎÔ‹ıÂÈ·˜, ÙˉȋıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·fiÙÔÓ fiÁÎÔ, ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·‡ÍËÛËÙˆÓ Èı·ÓÔÙ‹ÙˆÓ ÁÈ· ÌÂÙ¿ÛÙ·ÛË, ¤ÌÌÂÛ· Û˘Ìʈӛ̠ٷ Â˘Ú‹Ì·Ù· ÙˆÓ Zeng Î·È Guillem9. ŒÙÛÈ, Ê·›-ÓÂÙ·È Èı·Ófi fiÙÈ Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ MMP-9 ηÈMMP-2, Â›Ó·È ·ÎfiÌ· ¤Ó· ·fi Ù· ÌÔÚȷο ÁÂÁÔÓfi-Ù· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ̤۷ ÛÙ· Ï·›ÛÈ· Ù˘ Ô‡-Ùˆ˜ ‹ ¿Ïψ˜ Û‡ÓıÂÙ˘ ‰È·‰Èηۛ·˜ Ù˘ ÂͤÏÈÍË˜ÙˆÓ ÔÚıÔÎÔÏÈÎÒÓ Î·ÚÎÈӈ̿وÓ11. AÍÈÔÛËÌ›ˆÙÔ‹Ù·Ó Â›Û˘ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÂÓÂÚÁÔÔÈË̤Ó˜MMP-9 Î·È MMP-2 ‚Ú¤ıËÎ·Ó Î·È Û ‰Â›ÁÌ·Ù· Ê˘-ÛÈÔÏÔÁÈÎÒÓ ÈÛÙÒÓ, ·Ú·Ï‡ڈ˜ ÙˆÓ fiÁÎˆÓ Ô˘·Ê·ÈÚ¤ıËÎ·Ó (Ì¿ÚÙ˘Ú˜). ™˘ÁÎÂÎÚÈ̤ӷ, Ë MMP-9 ‚Ú¤ıËΠ۠̿ÚÙ˘Ú˜ ÛÙ·‰›ˆÓ B2, B3, C1, C2, C3Î·È D (EÈÎ. 1). ¶·Ï·ÈfiÙÂÚ˜ ·Ó·ÊÔÚ¤˜, ‚·ÛÈṲ̂Ó˜Û ÈÛÙÔ·ıÔÏÔÁÈο ‰Â‰Ô̤ӷ9,12, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈÙ· ·ÙÙ·Ú· ÙÔ˘ ÔÚıÔÎÔÏÈÎÔ‡ ηÚÎÈÓÈÎÔ‡ ÂÈıËÏ›Ô˘Â¿ÁÔ˘Ó Ì ·Ú·ÎÚÈÓ›˜ Ì˯·ÓÈÛÌÔ‡˜ ÙËÓ ¤ÎÎÚÈÛËÙˆÓ ÎÔÏÏ·ÁÔÓÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ·fi Ô˘‰ÂÙÂÚfiÊÈ-Ï·, Ì·ÎÚÔÊ¿Á· Î·È ÈÓÔ‚Ï¿ÛÙ˜ ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜13,14.™ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·Ù¿ ÙËÓ ·ÚÔ‡-Û· ÂÚÁ·Û›·, Ù· ›‰· Ù˘ MMP-9 Û¯ÂÙ›ÛıËηÓÌ ÙÔ ‚·ıÌfi ηÎÔ‹ıÂÈ·˜ Î·È ÙË ‰È‹ıËÛË ÙÔ˘ ÙÔȯÒ-Ì·ÙÔ˜ ·fi ÙÔÓ fiÁÎÔ, ÂÓÒ Ë ÂÓÂÚÁÔÔÈË̤ÓË MMP-

2, Ì ÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ.™˘ÓÂÎÙ›ÌËÛË ÙˆÓ ·Ú·¿Óˆ ‰Â‰Ô̤ӈÓ, ‰›ÓÂÈ

ÌÈ· ·ÚÎÂÙ¿ Èı·Ó‹ ÂÍ‹ÁËÛË Ù˘ ·ÚÔ˘Û›·˜ ÙˆÓ ÓÂÚ-ÁÔÔÈËÌ¤ÓˆÓ MMPs ÂÎÙfi˜ ÙˆÓ Ì·ÎÚÔÛÎÔÈÎÒÓÔÚ›ˆÓ ÙˆÓ fiÁÎˆÓ Ô˘ ·Ê·ÈÚ¤ıËηÓ. A‡ÍËÛË ÙˆÓÈı·ÓÔÙ‹ÙˆÓ ÁÈ· ÌÂÙ¿ÛÙ·ÛË Ô˘ Û˘Óԉ‡ÂÙ·È ·fi·˘ÍË̤ÓÔ ‚·ıÌfi ‰È›ۉ˘Û˘ ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ Ì ‰È‹ıËÛË ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÈÛÙÒÓ, Ê·›ÓÂÙ·ÈfiÙÈ ‰È¢ÎÔχÓÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÂÓÂÚÁÔ-ÔÈËÌ¤ÓˆÓ MMPs (ȉ›ˆ˜ ÙˆÓ MMP-9) fi¯È ÌfiÓÔÛÙÔÓ ·ıÔÏÔÁÈÎfi, ·ÏÏ¿ Î·È ÛÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÈÛÙfi.

EÈϤÔÓ, Ù· ·˘ÍË̤ӷ ›‰· Ù˘ MMP-2,˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ô ÔÚıÔÎÔÏÈÎfi˜ ηÚΛÓÔ˜ Â›Ó·È ‹‰ËÚÔ¯ˆÚË̤ÓÔ˘ ÛÙ·‰›Ô˘ Î·È ˘¿Ú¯ÂÈ ‰È‹ıËÛË ÙˆÓÏÂÌÊ·‰¤ÓˆÓ.

™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ù· ·˘ÍË̤ӷ ›‰· MMP-2 Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È‹ıËÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ, ÂÓ‰ÂÈ-ÎÙÈÎfi ÛËÌÂ›Ô ÚÔ¯ˆÚË̤Ó˘ ÓfiÛÔ˘, ÂÓÒ Ù· ·˘ÍË̤-Ó· ›‰· Î·È ÙˆÓ ‰‡Ô ÂÓ˙‡ÌˆÓ ÂÈÛËÌ·›ÓÔ˘Ó fiÙÈ ËÓfiÛÔ˜ Â›Ó·È ‹‰Ë ÌÂÙ·ÛÙ·ÙÈ΋. T· ·Ú·¿Óˆ ¢ڋ-Ì·Ù· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂӉȷʤÚÔÓ, ‰ÈfiÙÈ Î·Ù·‰ÂÈÎÓ‡-Ô˘Ó Ì¤ÚË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‰È·ÛÔÚ¿˜ ÙÔ˘ ÔÚıÔ-ÎÔÏÈÎÔ‡ ηÚΛÓÔ˘, fiÔ˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÎÔÏÏ·ÁÔÓÔÏ˘-ÙÈο ¤Ó˙˘Ì·. E›Ó·È fï˜ ·Ó·Áη›· Ë Â¤ÎÙ·ÛË Ù˘ÌÂϤÙ˘ Û ÂÚÈÛÛfiÙÂÚ· ‰Â›ÁÌ·Ù· ÁÈ· ÔÚÈÛÙÈ΋ ÂÈ-‚‚·›ˆÛË.

ABSTRACTTentes IK, Tentes A-AK, Markakidis SK, Karani-kiotis Ch.N. Collagenolytic enzymes in thecancer of rectum and colon. Hell Iatr 2000, 66:254-258.

The distribution of collagen-degrading enzy-mes (MMPs) was studied in surgical specimens (tu-mor and adjacent normal tissue) from 37 patentswith colo-rectal carcinomas. Qualitative analysiswas done with gelatin zymography. Scanning anddigital analysis of the zymograms effected quan-titative estimation of the levels of MMPs (proenzy-mes and active forms) in relation to clinical, hi-stological parameters as well as cancer antigens.Statisitcal analysis was performed with the use ofx2. The proenzyme forms of MMP-9 and MMP-2were detected in all tissues analyzed. Active MMPswere not found in stage A carcinomas. In normaltissue samples, pro-MMP-2 was related to the sta-ge, the degree of malignancy, and depth of invasion(p < 0,05); on the other hand, the activated MMP-2 enzyme was related to N (p=0,002). In tumortissues, pro-MMP-2 was related to N, M, stage, and

258 I.K. TENTE™ ∫∞π ™À¡.

degree of malignancy (p < 0.05). Both activatedenzymes were related to depth of invasion and sta-ge (p< 0.005). Finally, the activated MMP-9 wasrelated to M (p=0.01), whereas the activated MMP-2 was related to N and the degree of tumor differen-tation (p < 0.05). The exclusive presence of the a-ctivated MMP-2 in malignant tissues is indicative ofadvanced disease (lymph node infiltration), whereasthe presence of both activated enzymes (MMP-2,and MMP-9) is indicative of metastatic disease. Fur-ther studies are required in order to ascertain thefindings stated above.

Bπµ§π√°ƒ∞ºÿ∞1. Liotta L, Stetler-Stevenson W.Metalloproteinases and can-

cer invasion. Semin Cancer Biol 1990, 1: 99-106.

2. Bradford MM. A refined and sensitive method for the qua-ntitation of microgram quantities of protein utilizingthe principle of protein-dye binding. An Biochem 1976,72: 248.

3. D’ Enrico A, Garbisa S, Liotta L, Castronov V, Stetler-Ste-venson W, Grigioni W. Augmentation of type IV colla-genase, laminin receptor and Ki67 proliferation anti-gen associated with human colon, gastric and breastcarcinoma progression. Mol Pathol 1991, 4: 239-46.

4. Irimura T, Yamori T, Bennet S, Ota D, Cleary K. The rela-tionship of collagenolytic activity to stage of humancolorectal carcinoma. Int J Cancer 1987, 40: 24-31.

5. Levy A, Cioce V, Sobel M, et al. Increased expression ofthe Mr 72000 type IV collagenase in human adenocar-cinoma. Cancer Res 1991, 51: 439-44.

6. Nakajima M, Welch D, Tsuruo T, Nicolson G. Serum andplasma Mr 91000 progelatinase levels correlate withspontaneous metasasis of rat 13762NF mammary ade-nocarcinoma. Cancer Res 1993, 53: 5802-7.

7. Zucker S, Lysik R, Zarrabi M, Moli U. Mr 92000 type IVcollagenase is increased in plasma of patients with coloncancer and breast cancer. Cancer Res 1993, 53: 14-146.

8. Karakiulakis G, Papanikolau C, Jancovich SM, et al. In-creased type IV collagen-degrading activity in meta-stases originating from primary tumors of the humancolon. Invasion Metastasis 1997, 17: 158-168.

9. Zeng ZS, Guillem JG. Unique activation of matrix metal-loproteinase-9 within human liver metastasis from co-lorectal cancer. Br J Cancer 1998, 78: 349-53.

10. Stetler-Stevenson W, Hewitt R, Corcoran M. Matrix metal-loproteinases and tumor invasion: from correlationand causality to the clinic. Cancer Biol 1996, 7: 147-54.

11. Tomita T, Iwata K. Matrix metalloproteinases and tissueinhibitors of metalloproteinase in colonic adenomas–a-denocarcinomas. Dis Colon Rectum 1996, 39: 1255-64.

12. Peters G, Vousden KH. Oncogenes and tumor suppressors.Oxford IRL Press. 1997: 293-307.

13. Nielsen BS, Timshel S, Kjieldsen L, et al. 92 kDa type IVcollagenase (MMP-9) is expressed in neutrophils andmacrophages but not in malignant epithelial cells in hu-man colon cancer. Int J Cancer 1996, 65: 57-62.

14. Kanellos I, Odisseos C, Zaraboukas T, Kavouni A, Galova-tsea K, Dadoukis I. Colonic healing after early intraperi-toneal administration of 5-Fluorouracil and interferonin rats. Int J Colorect Dis 1997, 12: 45-48.

AÏÏËÏÔÁÚ·Ê›·:K. T¤ÓÙ˜EÚÁ·ÛÙ‹ÚÈÔ BÈÔ¯ËÌ›·˜ TÌ‹Ì·ÙÔ˜I·ÙÚÈ΋˜ ¢.¶. £Ú¿Î˘6Ô ¯ÈÏ. AÏÂÍ·Ó‰ÚÔ‡ÔÏ˘-KÔÌÔÙËÓ‹˜(¢Ú·Á¿Ó·)681 00 - AÏÂÍ·Ó‰ÚÔ‡ÔÏË

Corresponding author:I.K. TentesLab. of Biochemistry, Faculty of MedicineDemocritus University of Trace - Dragana681 00 - AlexandroupolisGreece

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 259

∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÎÈÓËÙÈÎÒÓ Ê·ÈÓÔ̤ӈÓÙ˘ ÓfiÛÔ˘ ÙÔ˘ Parkinson Ì ·ÔÌÔÚÊ›ÓË

™. ªoÛÙ·ÓÙ˙oo‡Ïo˘, ∑. ∫·ÙÛ·Úo‡, ™. ¶··ÁÈ·ÓÓfio˘Ïo˜, ∞. ∫¿˙˘

°′ ¡Â˘ÚoÏoÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, NÔÛÔÎÔÌÂ›Ô “°. ¶··ÓÈÎÔÏ¿Ô˘”, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë. ªÂÏÂÙ‹ıËÎÂ Ë ¿ÌÂÛË ıÂڷ¢ÙÈ΋›‰Ú·ÛË Ù˘ ˘o‰fiÚÈ·˜ ¤ÓÂÛ˘ ·oÌoÚÊ›Ó˘ ÛÂ20 ·ÛıÂÓ›˜ Ì Úo¯ˆÚË̤ÓË ÓfiÛo Ùo˘ Parkin-son Î·È ÌÂȈ̤ÓË ıÂڷ¢ÙÈ΋ ·¿ÓÙËÛË ÛÙËÓL–dopa, Ì ȉȷ›ÙÂÚ· ·Ú·ÙÂٷ̤ÓË Ê¿ÛË “off”.∏ ·oÌoÚÊ›ÓË ¯oÚËÁ‹ıËΠ۠ʿÛË “off” Û ‰fi-ÛË 2–6 mg ˘o‰fiÚÈ·, ¯ˆÚ›˜ ·ÏÏ·Á‹ Ù˘ Û˘Ó‹ıo˘˜·ÓÙÈ·ÚÎÈÓÛoÓÈ΋˜ ·ÁˆÁ‹˜. ∞ÍÈoÏoÁ‹ıËÎÂ Ë Ù·-¯‡ÙËÙ· ÌÂٿوÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê¿ÛË “on”,Ùo oÛoÛÙfi ‚ÂÏÙ›ˆÛ˘ Ù˘ ÎÈÓËÙÈ΋˜ Ùo˘˜ ·ÓÈη-

ÓfiÙËÙ·˜ Ì ‚¿ÛË ÙËÓ Îϛ̷η UPDRS Î·È Ë ‰È-¿ÚÎÂÈ· Ù˘ “on” Ê¿Û˘. ŸÏoÈ oÈ ·ÛıÂÓ›˜ ‚ÂÏ-ÙÈÒıËÎ·Ó ÌÂÙ¿ ·fi 11,2±2,2 min Î·È Ë “on” Ê¿-ÛË Ùo˘˜ ‰È‹ÚÎÂÛ 79±12 min. ∏ ‚ÂÏÙ›ˆÛË Ù˘ ÎÈ-ÓËÙÈ΋˜ Ùo˘˜ ·ÓÈηÓfiÙËÙ·˜ ‹Ù·Ó 70,5±5,2%. ∆·Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰Â›¯Óo˘Ó fiÙÈ Ë ˘o‰fi-ÚÈ· ¤ÓÂÛË ·oÌoÚÊ›Ó˘ ÚoÛʤÚÂÈ Ù·¯Â›· ‚ÂÏÙ›-ˆÛË Ù˘ ÎÈÓËÙÈ΋˜ ·ÓÈηÓfiÙËÙ·˜ Ùo˘ ·ÚÎÈÓÛoÓÈ-Îo‡ ·ÚÚÒÛÙo˘, o˘ ‚Ú›ÛÎÂÙ·È Û ʿÛË “off”.EÏÏËÓ I·ÙÚ 2000, 66: 259 - 262.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 259 - 262

∏ ıÂڷ›· Ù˘ ÓfiÛo˘ Ùo˘ Parkinson ·Ú¿ ÙË ÌÂÁ¿-ÏË oÈÎÈÏ›· Ê·ÚÌ¿ÎˆÓ o˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Â›Ó·È Ìfi-ÓoÓ Û˘Ìو̷ÙÈ΋ Î·È ·Ó·Îo˘ÊÈÛÙÈ΋. ∏ L–Dopa·Ú·Ì¤ÓÂÈ o ·ÎÚoÁˆÓÈ·›o˜ Ï›ıo˜ Ù˘ ıÂڷ›·˜ Ù˘ÓfiÛo˘. ∏ Ì·ÎÚo¯ÚfiÓÈ· ıÂڷ›· fï˜ Ì L– DopaÂÈÛÎÈ¿˙ÂÙ·È ·fi ÙȘ ¯ÚfiÓȘ ·ÚÂÓ¤ÚÁÂȘ Ùo˘Ê·ÚÌ¿Îo˘ (·ÎÈÓËÙÈο Ê·ÈÓfiÌÂÓ·, ‰˘ÛÎÈÓËۛ˜ ηÈÌË ÎÈÓËÙÈÎo‡ Ù‡o˘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ)1. ™Ù··ÎÈÓËÙÈο Ê·ÈÓfiÌÂÓ· ÂÓÙ¿ÛÛoÓÙ·È Ë Âȉ›ӈÛËÛÙo Ù¤Ïo˜ Ù˘ ‰fiÛ˘, Ù· “on–off” Ê·ÈÓfiÌÂÓ· ÌÂ Ù˘-¯·›· ¯ÚoÓÈ΋ ηٷÓoÌ‹, Ë ÂÂÈÛo‰È·Î‹ ·oÙ˘¯›·ıÂڷ¢ÙÈ΋˜ ·¿ÓÙËÛ˘ Û ÌÂÌoӈ̤Ó˜ ‰fiÛÂȘL–Dopa Î·È Ùo “¿ÁˆÌ·” (freezing)1.

∏ ·oÌoÚÊ›ÓË Â›Ó·È ¤Ó·˜ ÈÛ¯˘Úfi˜ ÓÙo·ÌÈ-ÓÂÚÁÈÎfi˜ ·ÁˆÓÈÛÙ‹˜ Ì ‰˘Ó·ÙfiÙËÙ· ÈÛ¯˘Ú‹˜ Û‡Ó‰Â-Û˘ Ì Ùo˘˜ D2, D3 Î·È D4 ÓÙo·ÌÈÓÂÚÁÈÎo‡˜ ˘o-‰o¯Â›˜ Î·È ÏÈÁfiÙÂÚo Ì Ùo˘˜ D1 Î·È D5 ˘o‰o-¯Â›˜2,3. ÃoÚËÁo‡ÌÂÓË ˘o‰oÚ›ˆ˜ ¤¯ÂÈ Ù·¯Â›· ¤Ó·Ú-ÍË (6–8 min) Î·È ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ (40–90min)2,4. µÂÏÙÈÒÓÂÈ fiÏ· Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛo˘ÂÚ›o˘ fiˆ˜ Î·È Ë L–dopa5,6. ∂ÈϤoÓ, ÌoÚ›

Ó· ‰È·ÙËÚ› ÙËÓ Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ·¿ÓÙËÛË ÛÙËÓL–Dopa Û ·ÛıÂÓ›˜ Ì ‰È·Î˘Ì¿ÓÛÂȘ Ù˘ Û˘ÌÙˆ-Ì·ÙoÏoÁ›·˜7.

™Îofi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë ·ÍÈoÏfiÁËÛË Ù˘ıÂڷ¢ÙÈ΋˜ ›‰Ú·Û˘ Ù˘ ˘o‰fiÚÈ·˜ ¤ÓÂÛ˘ ·o-ÌoÚÊ›Ó˘ Û ·ÛıÂÓ›˜ Ì Úo¯ˆÚË̤ÓË ÓfiÛo Ùo˘Parkinson oÈ oo›oÈ ÂÌÊ¿ÓÈ˙·Ó ·Ú·ÙÂٷ̤ӷ ·ÎÈ-ÓËÙÈο Ê·ÈÓfiÌÂÓ· (Ê¿ÛË off).

∞™£∂¡∂π™ ∫∞π ª∂£O¢Oππ. ∂ÈÏoÁ‹ ·ÛıÂÓÒÓ°È· ÙËÓ ÌÂϤÙË ÂÈϤ¯ıËÎ·Ó 20 ·ÚÎÈÓÛoÓÈÎo› ·ÛıÂÓ›˜ Ì‚¿ÛË Ù· ·Ú·Î¿Ùˆ ÎÚÈÙ‹ÚÈ·:·) ¶Úo¯ˆÚË̤ÓË ÌoÚÊ‹ ÓfiÛo˘ Ùo˘ Parkinson (ÛÙ¿‰Èo 3–4

ηٿ Hoehn Î·È Yahr)8

‚) M›ˆÛË Ù˘ ıÂڷ¢ÙÈ΋˜ Ùo˘˜ ·¿ÓÙËÛ˘ ÛÙËÓ L–DopaÌ ·Ú·ÙÂٷ̤ÓË ·ÎÈÓËÙoo›ËÛË (Ê¿ÛË off) ÛÙËÓ ‰È¿Ú-ÎÂÈ· Ù˘ Ë̤ڷ˜

Á) ∞o˘Û›· ¿ÓoÈ·˜ ‹ ¿ÏÏ˘ „˘¯È΋˜ ÓfiÛo˘.‰) ∞o˘Û›· ηډÈo·ÁÁÂȷ΋˜, Ë·ÙÈ΋˜, ÓÂÊÚÈ΋˜ Î·È ¿Ï-

Ï˘ Ûo‚·Ú‹˜ Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛo˘∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ ·Úo˘-

ÛÈ¿˙oÓÙ·È ÛÙoÓ ›Ó·Î· 1.

259

260 ™. M¶O™TANTZO¶OY§OY KAI ™YN.

¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÚÎÈÓÛoÓÈÎÒÓ ·ÛıÂÓÒÓ

¡ ª¤ÛË ÙÈÌ‹ ± ∆.∞.

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 20ÕÓ‰Ú˜ 12°˘Ó·›Î˜ 8∏ÏÈΛ· (¤ÙË) 61,2±5,2¢È¿ÚÎÂÈ· ÓfiÛo˘ (¤ÙË) 11,2±3,7™Ù¿‰Èo ÓfiÛo˘ (Hoehn & Yahr) 3,6±0,6∏ÌÂÚ‹ÛÈ· ‰fiÛË L-dopa (mg) 968±150,6

ŸÏoÈ oÈ ·ÛıÂÓ›˜ ¤‰ˆÛ·Ó ÙË Û˘ÁηٿıÂÛ‹ Ùo˘˜ ·Êo‡ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙË ¯ÚËÛÈÌfiÙËÙ· Î·È ÙȘ ·ÓÂÈı‡ÌËÙ˜ Â-Ó¤ÚÁÂȘ Ùo˘ Ê·ÚÌ¿Îo˘.

ππ. Ào‰fiÚÈ· ¤Á¯˘ÛË ·oÌoÚÊ›Ó˘∏ ·oÌoÚÊ›ÓË Û ÂÓ¤ÛÈÌË ÌoÚÊ‹ (inj APOKINON®, 10 mg/ml) ÂÈÛ‹¯ıË ·fi ÙoÓ ∂Oº ÁÈ· ÙËÓ °′ ¡Â˘ÚoÏoÁÈ΋ ∫ÏÈÓÈ΋Ùo˘ ∞¶£, ÌÂÙ¿ ·fi ÁÓˆÌo‰fiÙËÛË Ù˘ ÂÈÛÙËÌoÓÈ΋˜ ÂÈÙÚo-‹˜ Ùo˘ °ÂÓ. ¡oÛoÎoÌ›o˘ °. ¶··ÓÈÎoÏ¿o˘, ÚoÎÂÈ̤Óo˘Ó· ¯ÚËÛÈÌooÈËı› Û ·ÚÎÈÓÛoÓÈÎo‡˜ ·ÛıÂÓ›˜ Ù˘ ÎÏÈÓÈ΋˜.

∏ ÎÏÈÓÈ΋ ‰oÎÈÌ‹ ÁÈÓfiÙ·Ó Ùo Úˆ› ¯ˆÚ›˜ Ó· ¤¯ÂÈ ¿ÚÂÈo ·ÛıÂÓ‹˜ ÙËÓ ÚÒÙË ‰fiÛË L–dopa. ∞Ú¯Èο ¯oÚËÁo‡ÓÙ·Ó 0,1ml Ê˘ÛÈoÏoÁÈÎo‡ oÚo‡, ˘o‰fiÚÈ·, Î·È ·ÍÈoÏoÁo‡ÓÙ·Ó Ë ÎÏÈÓÈ-΋ ·¿ÓÙËÛË ÌÂÙ¿ 15 min.

∞ÎoÏo‡ıˆ˜ ÁÈÓfiÙ·Ó ̆ o‰fiÚÈ· ¤ÓÂÛË 1 mg ·oÌoÚÊ›ÓË˜Î·È ·Ú·ÎoÏo˘ıo‡ÓÙ·Ó Ë ÎÏÈÓÈ΋ ·¿ÓÙËÛË Ùo˘ ·ÛıÂÓo‡˜.ø˜ ÈηÓooÈËÙÈ΋ ıÂڷ¢ÙÈ΋ ·¿ÓÙËÛË ıˆÚo‡Û·Ì ÙËÓ‚ÂÏÙ›ˆÛË Ù˘ ÎÈÓËÙÈ΋˜ ·ÓÈηÓfiÙËÙ·˜ Ùo˘Ï¿¯ÈÛÙoÓ Î·Ù¿ 33%Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· Ù˘ ÂÚ¢ÓËÙÈ΋˜ ÂÈÙÚo‹˜ CAPIT9.

™Â ÂÚ›ÙˆÛË o˘ Ë ıÂڷ¢ÙÈ΋ ·¿ÓÙËÛË ‹Ù·Ó Ìˉ·-ÌÈÓ‹ ‹ ·Ó·Ú΋˜, ÌÂÙ¿ 90 min ·ӷϷ̂·ÓfiÙ·Ó Ë ¯oÚ‹ÁË-ÛË Ù˘ ·oÌoÚÊ›Ó˘ Û ‰fiÛË 2mg. ∂› ϤoÓ ‰fiÛÂȘ ηٿ 1mg ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙËÓ ÚoËÁo‡ÌÂÓË (̤ÁÈÛÙË ‰fiÛË 6 mg),¯oÚËÁo‡ÓÙ·Ó Ì ÌÂÛo‰È·ÛÙ‹Ì·Ù· 90 min ̤¯ÚÈ Ó· ÂÈÙ¢¯ı›ÈηÓooÈËÙÈ΋ ıÂڷ¢ÙÈ΋ ·¿ÓÙËÛË. ∏ ¯oÚ‹ÁËÛË ‰È·Îfi-ÙoÓÙ·Ó Û ÂÚ›ÙˆÛË ÂÌÊ¿ÓÈÛ˘ ¤ÓÙoÓˆÓ ·ÓÂÈı‡ÌËÙˆÓ Â-ÓÂÚÁÂÈÒÓ.

¢‡o Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ ¤ÓÂÛË Ù˘ ·oÌoÚÊ›Ó˘ Î·È Î·-Ù¿ ÙËÓ Ë̤ڷ Ù˘ ¤ÓÂÛ˘ ÔÈ ·ÛıÂÓ›˜ ¤·ÈÚÓ·Ó ‰oÌÂÚȉfiÓË, 60mg ËÌÂÚËÛ›ˆ˜ per os, ÁÈ· Ó· ÚoÛٷ٢ıo‡Ó ·fi ÙȘ ·ÓÂÈı‡-ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ù˘ ·oÌoÚÊ›Ó˘ ·fi Ùo ÂÙÈÎfi Û‡ÛÙËÌ·.

πππ. ∞ÍÈoÏfiÁËÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ù˘ıÂڷ¢ÙÈ΋˜ ·¿ÓÙËÛ‹˜ Ùo˘˜ ÛÙËÓ·oÌoÚÊ›ÓË

∞) ∞ÍÈoÏfiÁËÛË ·ÛıÂÓÒÓ

¶ÚÈÓ ·fi ÙËÓ ¤ÓÂÛË Ù˘ ·oÌoÚÊ›Ó˘ oÈ ·ÛıÂÓ›˜ ·ÍÈoÏoÁ‹-ıËÎ·Ó Ì ‚¿ÛË ÙËÓ Îϛ̷η UPDRS (ÎÈÓËÙÈÎfi ̤Úo˜)6 ηÈÌÂÙÚ‹ıËÎÂ Ë ·ÚÙËÚȷ΋ ›ÂÛË Î·È o ηډȷÎfi˜ Ú˘ıÌfi˜ Û η-Ù·ÎÂÎÏÈ̤ÓË Î·È fiÚıÈ· ı¤ÛË. OÈ ·ÛıÂÓ›˜ ·Ú·ÎoÏo˘ıo‡-ÓÙ·Ó Û˘Ó¯Ҙ ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ¤ÓÂÛ˘ Ù˘ ·oÌoÚÊ›Ó˘ ̤-¯ÚÈ Î·È 5 ÒÚ˜ ·ÚÁfiÙÂÚ·, fiÛoÓ ·ÊoÚ¿ ÛÙ· ˙ˆÙÈο Ùo˘˜ ÛË-Ì›·, ÙËÓ ÎÈÓËÙÈ΋ Ùo˘˜ ηٿÛÙ·ÛË (ÎÈÓËÙÈÎfi ̤Úo˜ UPDRS)Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ.

µ) ∞ÍÈoÏfiÁËÛË Ù˘ ıÂڷ¢ÙÈ΋˜ ·¿ÓÙËÛ˘ ÛÙËÓ·oÌoÚÊ›ÓË

¶ÚoÛ‰ÈoÚ›ÛÙËÎÂ Ë ‰fiÛË Ùo˘ Ê·ÚÌ¿Îo˘ Ì ÙËÓ oo›· ÂÈÙ‡-¯ıËÎÂ Ë ÈηÓooÈËÙÈ΋ ıÂڷ¢ÙÈ΋ ·¿ÓÙËÛË Û οı ·ÛıÂ-Ó‹, o ¯ÚfiÓo˜ ¤Ó·Ú͢ Ù˘ ‰Ú¿Û˘ Î·È Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ùo˘Ê·ÚÌ¿Îo˘.

∞¶O∆∂§∂™ª∞∆∞¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿وÓÙ˘ ÓfiÛo˘ Ùo˘ Parkinson ÌÂÙ¿ ÙËÓ ˘o‰fiÚÈ· ¯oÚ‹-ÁËÛË Ê˘ÛÈoÏoÁÈÎo‡ oÚo‡. ŸÏ· Ù· Û˘ÌÙÒÌ·Ù· Ù˘ÓfiÛo˘ Ùo˘ Parkinson ‚ÂÏÙÈÒıËÎ·Ó ÛËÌ·ÓÙÈο ÌÂÙ¿ÙËÓ ˘o‰fiÚÈ· ¯oÚ‹ÁËÛË ·oÌoÚÊ›Ó˘. O ̤Ûo˜¯ÚfiÓo˜ ¤Ó·Ú͢ Ù˘ ıÂڷ¢ÙÈ΋˜ ·¿ÓÙËÛ˘ ‹Ù·Ó11,2±2,2 min ÌÂÙ¿ ÙËÓ ˘o‰fiÚÈ· ¤ÓÂÛË. ∆o ÈηÓo-oÈËÙÈÎfi ıÂڷ¢ÙÈÎfi ·oÙ¤ÏÂÛÌ· ÂÈÙ‡¯ıËΠ̉fiÛË 2–6mg ·oÌoÚÊ›Ó˘ (̤ÛË ÙÈÌ‹ ± Ù˘È΋·fiÎÏÈÛË=3,8±1,2 mg). ∏ ̤ÛË ‰È¿ÚÎÂÈ· Ù˘ ‚ÂÏ-Ù›ˆÛ˘ ‹Ù·Ó 79±12 min. ∏ ̤ÛË ‚ÂÏÙ›ˆÛË Ù˘ ÎÈ-ÓËÙÈ΋˜ ·ÓÈηÓfiÙËÙ·˜, fiˆ˜ Úo¤Î˘„ ·fi ÙËÓÎϛ̷η UPDRS ‹Ù·Ó 70,5±5,2%. ™ÙËÓ ÂÈÎfiÓ· 1·Úo˘ÛÈ¿˙ÂÙ·È Ë Ì¤ÛË ‚·ıÌoÏoÁ›· ÛÙ· ÙÚ›· ·ÚÈ·ÛËÌ›· Ù˘ ÓfiÛo˘, ÂÓÒ ÛÙËÓ ÂÈÎfiÓ· 2 Ê·›ÓoÓÙ·È oÈ

EÈÎ. 1. ª¤ÛË ‚·ıÌoÏoÁ›· ÛÙ· ·ÚÈ· ÛËÌ›· Ù˘ ÓfiÛo˘ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·ÁˆÁ‹ (*p<0,001, **p<0,05) (M.O =

EÈÎ. 2. ª¤ÛË ‚·ıÌoÏoÁ›· ÛÙËÓ Îϛ̷η UPDRS ÚÈÓÎ·È ÌÂÙ¿ ÙËÓ ·ÁˆÁ‹ (p<0,001). (M.O. = ̤Ûo˜ fiÚo˜,∆.∞. = Ù˘È΋ ·fiÎÏÈÛË).

ÂȉfiÛÂȘ ÛÙËÓ Îϛ̷η UPDRS, ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ˘o‰fiÚÈ· ¯oÚ‹ÁËÛË ·oÌoÚÊ›Ó˘.

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó Ûo‚·Ú¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ-¤ÚÁÂȘ o˘ Ó· o‰ËÁ‹Ûo˘Ó Û ‰È·Îo‹ Ù˘ ıÂڷ›-·˜. ™ÙoÓ ›Ó·Î· 2 ·Úo˘ÛÈ¿˙oÓÙ·È oÈ ·ÓÂÈı‡ÌËÙ˜ÂÓ¤ÚÁÂȘ ·fi ÙËÓ ·oÌoÚÊ›ÓË, oÈ oo›Â˜ ‹Ù·Ó ‹È˜.

™À∑∏∆∏™∏OÈ Schwab Î·È Û˘Ó.10, ÚÒÙoÈ Ùo 1951, ÚfiÙÂÈÓ·Ó Ù˯ڋÛË Ù˘ ·oÌoÚÊ›Ó˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ùo˘ÙÚfiÌo˘ Î·È Ù˘ ‰˘Ûη̄›·˜ ÛÙË ÓfiÛo Ùo˘ Parkinson.∆o Ê¿ÚÌ·Îo fï˜ ÂÁηٷÏ›ÊıËΠÏfiÁˆ ÙˆÓ oÏ-Ï·ÏÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ (Ó·˘Ù›·, ¤ÌÂÙoÈ,oÚıoÛÙ·ÙÈ΋ ˘fiÛÙ·ÛË). •·Ó·ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓÂÈηÈÚfiÙËÙ· ÛÙË ‰ÂηÂÙ›· Ùo˘ ’705,11 ¯ˆÚ›˜ fï˜Ó· ‰ڷȈı› ÛÙËÓ ıÂڷ›· Ù˘ ÓfiÛo˘ Ùo˘ Parkin-son ÏfiÁˆ Ù˘ ‚Ú·¯Â›·˜ ‰Ú¿Û˘ Ù˘ Î·È Ù˘ ·ÚÂÓÙÂ-ÚÈ΋˜ ¯oÚ‹ÁËÛ˘. ªÂ ÙËÓ ÂÌÊ¿ÓÈÛË fï˜ ÙˆÓ Úo-‚ÏËÌ¿ÙˆÓ Ù˘ ¯ÚfiÓÈ·˜ ıÂڷ›·˜ Ì L–Dopa ·Ú¯›-˙ÂÈ Ì›· Ó¤· Âo¯‹ ÁÈ· ÙËÓ ·oÌoÚÊ›ÓË.

™Ùo˘˜ ·ÛıÂÓ›˜ Ì·˜ Ë ˘o‰fiÚÈ· ¤ÓÂÛË ·oÌoÚ-Ê›Ó˘ ‚ÂÏÙ›ˆÛ ÁÚ‹ÁoÚ· (̤۷ Û 11 min) Ù· ·ÚÈ·Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛo˘ Ùo˘ Parkinson Î·È ÙËÓ Û˘Óo-ÏÈ΋ ÎÈÓËÙÈ΋ ·ÓÈηÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ. ∏ ‚ÂÏÙ›ˆ-ÛË Ù˘ Û˘Ìو̷ÙoÏoÁ›·˜ o˘ ‹Ù·Ó ÂÚ›o˘ 70%‰È·ÙËÚo‡ÓÙ·Ó ÁÈ· 80 min. ªÂ ÙoÓ ÙÚfio ·˘Ùfi Ë ·o-ÌoÚÊ›ÓË Û˘Ó¤‚·Ï ÛÙË ÁÚ‹ÁoÚË ÌÂٿوÛË ÙˆÓ ·Û-ıÂÓÒÓ Ì·˜ ·fi ÙËÓ Ê¿ÛË “off” ÛÙËÓ Ê¿ÛË “on”.

ªÂÙ¿ ÙËÓ ·Ú¯È΋ ·Ó·ÊoÚ¿ ÙˆÓ Hardie ηÈÛ˘Ó.12 ˆ˜ Úo˜ ÙËÓ ·oÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·o-ÌoÚÊ›Ó˘ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÎÈÓËÙÈ΋˜ Û˘Ìو̷Ùo-ÏoÁ›·˜ ÙˆÓ ·ÚÎÈÓÛoÓÈÎÒÓ ·ÛıÂÓÒÓ oÏÏo› ÂÚ¢-ÓËÙ¤˜ ‰oÎ›Ì·Û·Ó ÙË ¯oÚ‹ÁËÛË Ùo˘ Ê·ÚÌ¿Îo˘ Û·ӷϷ̂·ÓfiÌÂÓ˜ ËÌÂÚ‹ÛȘ ˘o‰fiÚȘ ÂÁ¯‡-ÛÂȘ. ™ÙË ÌÂϤÙË ÙˆÓ Stibe Î·È Û˘Ó.13 oÈ 8 ·ÛıÂÓ›˜o˘ ¤Î·Ó·Ó oÏϷϤ˜ ÂÓ¤ÛÂȘ ·oÌoÚÊ›Ó˘ ›¯·Ó̤ÛË ËÌÂÚ‹ÛÈ· Ì›ˆÛË Ù˘ Ê¿Û˘ off ηٿ 3,3ÒÚ˜. ∏ ‚ÂÏÙ›ˆÛË ÂÌÊ·Ó›˙oÓÙ·Ó Û 5–15 min ηȉȷÚÎo‡Û 40–90 min. ™Â ¿ÏϘ 7 ÌÂϤÙ˜ Ì ۇ-ÓoÏo 82 ·ÛıÂÓÒÓ Ë Ì¤ÛË Ì›ˆÛË Ù˘ Ê¿Û˘ off ÌÂ-

Ù¿ ·fi ¯oÚ‹ÁËÛË oÏÏ·ÏÒÓ ÂÓ¤ÛÂˆÓ ·oÌoÚÊ›-Ó˘ ‹Ù·Ó 46,7% (8,5%–63,3%)2,6,14,15, Î·È o ̤Ûo˜·ÚÈıÌfi˜ ÙˆÓ ÂÓ¤ÛÂˆÓ ÙËÓ Ë̤ڷ ‹Ù·Ó 3,9 (3,3–4,8). OÈ Gasser Î·È Û˘Ó.16 ·Ó·Ê¤Úo˘Ó Ì›· ̤ÛË‚ÂÏÙ›ˆÛË ÛÙËÓ Îϛ̷η UPDRS (ÎÈÓËÙÈÎfi ̤Úo˜)ÌÂÙ¿ ÙËÓ ¤ÓÂÛË ·oÌoÚÊ›Ó˘ 40,7%, Ë oo›· ÛÂÌÂÚÈÎo‡˜ ·ÛıÂÓ›˜ ¤ÊÙ·Û ÛÙo 90,9%.

∆· ηϿ ·oÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÌoÓˆÌ¤ÓˆÓ ÂÓ¤-ÛÂˆÓ ·oÌoÚÊ›Ó˘ o‰‹ÁËÛ·Ó ÛÙË ¯ÚËÛÈÌoo›ËÛË,Û ÂÚÈoÚÈṲ̂Óo ·ÚÈıÌfi ·ÛıÂÓÒÓ, ·ÓÙÏ›·˜ Û˘ÓÂ-¯o‡˜ ¯oÚ‹ÁËÛ˘ Ùo˘ Ê·ÚÌ¿Îo˘2. OÈ Hughes ηÈÛ˘Ó.17 ·Ú·ÎoÏo‡ıËÛ·Ó Ùo˘˜ ·ÛıÂÓ›˜, o˘ ‹Ù·Ó ÛÂıÂڷ›· Ì ·ӷϷ̂·ÓfiÌÂÓ˜ ÂÓ¤ÛÂȘ ‹ ÛÂ Û˘-Ó¯‹ ¤Á¯˘ÛË ·oÌoÚÊ›Ó˘ ÁÈ· 5 ¯ÚfiÓÈ·. O ̤Ûo˜ËÌÂÚ‹ÛÈo˜ ¯ÚfiÓo˜ off ÌÂÈÒıËΠηٿ 50%. ∏ ‚ÂÏÙ›-ˆÛË Ù˘ Û˘Ìو̷ÙoÏoÁ›·˜ ‰È·ÙËÚ‹ıËΠfiÏo Ùo¯ÚoÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎoÏo‡ıËÛ˘ ¯ˆÚ›˜ Ó· Ê·Ó›fiÙÈ Ë ·oÌoÚÊ›ÓË ¤¯·Û ÙËÓ ·oÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿Ù˘ ‹ fiÙÈ ·Ó·Ù‡¯ıËΠοoÈ· ·Óo¯‹. ™Ù· ›‰È· ·o-ÙÂϤÛÌ·Ù· ηٷϋÁÂÈ Î·È ÌÈ· ÚfiÛÊ·ÙË ÌÂϤÙË 49·ÛıÂÓÒÓ Ì ‚·ÚÂÈ¿ ÓfiÛo Ùo˘ Parkinson Î·È ÌÂ Û˘-Ó¯‹ ¯oÚ‹ÁËÛË ·oÌoÚÊ›Ó˘ ÁÈ· 3 ¤ˆ˜ 66 Ì‹Ó˜18.∆· ηϿ ·˘Ù¿ ·oÙÂϤÛÌ·Ù· o‰‹ÁËÛ·Ó Ù· ÙÂÏ¢-Ù·›· ¯ÚfiÓÈ· Ùo˘˜ ÂÚ¢ÓËÙ¤˜ ÛÙËÓ ÚoÛ¿ıÂÈ· ·Ó‡-ÚÂÛ˘ ¿ÏÏˆÓ o‰ÒÓ ¯oÚ‹ÁËÛ˘ Ùo˘ Ê·ÚÌ¿Îo˘ (˘o-ÁÏÒÛÛÈ·, Ì ÚÈÓÈÎfi spray, ·fi Ùo oÚıfi).

∏ ·ÎÚÈ‚‹˜ ı¤ÛË ‰Ú¿Û˘ Ù˘ ·oÌoÚÊ›Ó˘ ›-Ó·È oÈ ÌÂÙ·Û˘Ó·ÙÈÎo› D1 Î·È D2 ˘o‰o¯Â›˜ Ùo˘Ú·‚‰ˆÙo‡ ÛÒÌ·Ùo˜, oÈ oo›oÈ ÚoηÏo‡Ó ‰È¤ÁÂÚ-ÛË Ù˘ ·Ì¤Ûo˘ Ú·‚‰o–ˆ¯Ú¿˜ o‰o‡ Î·È ·Ó·ÛÙoÏ‹Ù˘ ÂÌ̤Ûo˘, ·ÓÙ›ÛÙoȯ·. ∏ ¯oÚ‹ÁËÛË ·oÌoÚÊ›-Ó˘ ·˘Í¿ÓÂÈ ÙoÓ Ú˘ıÌfi ÂÎÊfiÚÙÈÛ˘ ÙˆÓ Ó¢ÚÒÓˆÓÙ˘ ¤Íˆ Ìo›Ú·˜ Ù˘ ˆ¯Ú¿˜ ÛÊ·›Ú·˜ Î·È ÌÂÈÒÓÂÈ ÙoÓÚ˘ıÌfi ÂÎÊfiÚÙÈÛ˘ ÙˆÓ Ó¢ÚÒÓˆÓ Ù˘ ¤Ûˆ Ìo›Ú·˜Ù˘ ˆ¯Ú¿˜ ÛÊ·›Ú·˜19. ªÂ ÙoÓ ÙÚfio ·˘Ùfi ÂÍo̷χ-ÓÂÙ·È Ë ·ÓÈÛoÚÚo›· Ù˘ ÓÂ˘ÚˆÓÈ΋˜ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜ ÛÙËÓ ¿ÌÂÛË Î·È ¤ÌÌÂÛË Ú·‚‰o–ˆ¯Ú¿ o‰fi.

∞fi ÙË ÌÂϤÙË Ì·˜ Û˘ÌÂÚ·›Óo˘Ì fiÙÈ Ë ·o-ÌoÚÊ›ÓË ·oÙÂÏ› ¤Ó· ÛËÌ·ÓÙÈÎfi ıÂڷ¢ÙÈÎfi ̤-Ûo ÁÈ· Ùo˘˜ ·ÛıÂÓ›˜ Ì ‚·ÚÂÈ¿ ÓfiÛo Ùo˘ Parkin-son Î·È ¤ÓÙoÓ· ·ÎÈÓËÙÈο Ê·ÈÓfiÌÂÓ·.

ABSTRACTBostantjopoulou S, Katsarou Z, Papayianno-poulos S, Kazis A. Subcutaneous apomorphinein motor fluctuations of advanced Parkinson’sdisease. Hell Iatr, 2000, 66: 259 - 262.

Twenty patients with advanced Parkinson’s di-sease and refractory motor fluctuations were stu-died with repeated injections of apomorphine in

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 261

¶›Ó·Î·˜ 2. AÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ù˘ ˘Ô‰fiÚÈ·˜ ¤Á¯˘-Û˘ Ù˘ ·ÔÌÔÚÊ›Ó˘

E›‰Ô˜ ·ÓÂÈı‡ÌËÙ˘ AÚÈıÌfi˜ÂÓ¤ÚÁÂÈ·˜ ·ÛıÂÓÒÓ

N·˘Ù›· 5Z¿ÏË 2X¿ÛÌËÌ· 11¢˘ÛÎÈÓËۛ˜ 7

order to determine the efficacy of the drug on mo-tor performance during the “off” phase of parkin-sonism. All patients received repeated subcutaneo-us injections of apomorphine (mean total dose 38±1.2 mg). The therapeutic repsonse to the drug wasevaluated by means of percentage improvement oftheir motor disability as assessed by the UPDRS andthe duration of their “on” phase. All patients impro-ved after 11.2±2.2 min of apomorphine injection.Their mean improvement in the UPDRS was 70.5±5.2% and the mean duration of “on” phase was 79±12 min. Our findings indicate that apomor-phineinduces quick improvement of severe akine-sia inparkinsonian patients and can be used as a “rescuedrug” in advanced stages of parkinsonism.

µπµ§πO°ƒ∞ºπ∞1. Quinn NP. Classification of fluctuations in patients with

Parkinson’s disease. Neurology 1998, 51 (suppl 2):525-9.

2. Colosimo C, Merello M, Albanese A. Clinical usefulness ofapomorphine in movement disorders. Clin Neuro-pharmacol 1994, 17: 243-59.

3. Strange PG. Dopamine receptors in the basal ganglia: re-levance to Parkinson’s disease. Mov Disord 1993, 8:263-70.

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9. CAPIT Committee: Langston JW, Widner H, Goetz CC etal. Core Assessment Program for Intracerebral Trans-plantation (CAPIT). Mov Disord 1992, 7: 2-13.

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11. Cotzias GC, Papavasiliou PS, Tolosa ES, Mendez JS,Bell–Midura M. Treatment of Parkinson’s disease withapomorphines. N Engl J Med 1976, 294: 567-72.

12. Hardie RJ, Lees AJ, Stern GM. On–off fluctuations inParkinson’s disease: a clinical and neuropharmacolo-gical study. Brain 1984, 107: 487-506.

13. Stibe CMH, Lees AJ, Stern GM. Subcutaneous infusion ofapomorphine and lisuride in the treatment of parkin-sonian on–off fluctuations. Lancet 1987, 1: 871.

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15. Pollak P, Champay AS, Gaio JM, Hommel M, Benabid AL,Pert J. Administration sous–cutanée d’ apomorphinedans les fluctuations motrices de la maladie de Parkin-son. Rev Neurol 1990, 146: 116-23.

16. Gasser T, Schwarz J, Arnold G, Trenkwalder C, Oertel W.Apomorphine test for dopaminergic responsiveness inpatients with previously untreated Parkinson’s disease.Arch Neurol 1992, 49: 1131-4.

17. Hughes AJ, Lees AJ, Stern GM. The motor response tosequential apomorphine in parkinsonian fluctuations.J Neurol Neurosurg Psychiatry 1991, 54: 358-60.

18. Pietz K, Hagell P, Ordin P. Subcutaneous apomorphine inlate stage Parkinson’s disease: a long-term follow up. JNeurol Neurosurg Psychiatry 1998, 65: 709-16.

19. Hatchison WD, Levy R, Dostrovsky JO, Lozano AM, LangAE. Effects of apomorphine on globus pallidus neu-rons in parkinsonian patients. Ann Neurol 1997, 42:767-75.

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Corresponding author:S. Bostantjopoulou9 Navarinou Square546 22 – Thessaloniki, Greece

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1 I·ÙÚÈ΋ ÔÌ¿‰· °A™ AÚ¯¤Ï·Ô˜ K·ÙÂÚ›Ó˘2 I·ÙÚÈÎfi ΤÓÙÚÔ ™E°A™ £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë. °È· ÙË ¯ÂÈÚÔÛÊ·›ÚÈÛË, ¿ıÏËÌ· ȉȷ›ÙÂÚ·‰È·‰Â‰Ô̤ÓÔ ÛÙËÓ ∂˘ÚÒË ·ÏÏ¿ Î·È ÙËÓ ∂ÏÏ¿‰·, ÔÈ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ Â›Ó·ÈÂÚÈÔÚÈṲ̂Ó˜. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Ì·˜ ‹Ù·Ó ËηٷÁÚ·Ê‹ Î·È ÌÂϤÙË ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ ÙˆÓ·ÈÎÙÒÓ ÌÈ·˜ ÔÌ¿‰·˜ ¯ÂÈÚÔÛÊ·›ÚÈÛ˘ Ù˘ ∞1 ηÙË-ÁÔÚ›·˜, Û ·ÁÒÓ˜ Î·È ÚÔÔÓ‹ÛÂȘ Ù˘ ·ÁˆÓÈÛÙÈ-΋˜ ÂÚÈfi‰Ô˘ 1998-1999 (1/10/1998 - 31/3/ 1999).™˘ÌÌÂÙ›¯·Ó 16 ·ıÏËÙ¤˜ Ù˘ ÔÌ¿‰·˜ °∞™ ∞Ú¯¤Ï·Ô˜∫·ÙÂÚ›Ó˘ ̤Û˘ ËÏÈΛ·˜ 22,8 ÂÙÒÓ (SD=5,23), ̤-ÛÔ˘ ‚¿ÚÔ˘˜ 84,4 kg (SD=4,55) Î·È Ì¤ÛÔ˘ ‡„Ô˘˜1,87cm (SD=0,04), Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÚÔÏË-ÙÈÎfi È·ÙÚÈÎfi ¤ÏÂÁ¯Ô ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ·ÁˆÓÈÛÙÈÎÒÓ ÙÔ˘˜ ˘Ô¯ÚÂÒÛˆÓ. OÈ ÙÚ·˘Ì·ÙÈÛÌÔ›Ù·ÍÈÓÔÌ‹ıËÎ·Ó Ì ‚¿ÛË ÙËÓ ·Ó·ÙÔÌÈ΋ ÙÔ˘˜ ÂÓÙfi-ÈÛË Î·È ‰È·ÎÚ›ıËÎ·Ó Û ÔÍ›˜ Î·È ¯ÚfiÓÈÔ˘˜. ¢È·-ÁÓÒÛıËÎ·Ó Î·È ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÔÏÈο 38

ÙÚ·˘Ì·ÙÈÛÌÔ›, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 19 (50%) ‹Ù·ÓÔÍ›˜ Î·È 19 (50%) Û‡Ó‰ÚÔÌ· ˘¤Ú¯ÚËÛ˘. ∞fiÙÔ˘˜ 19 ÔÍ›˜, ÔÈ 14 (74%) Û˘Ó¤‚ËÛ·Ó Û ·ÁÒÓ· ηÈÔÈ ˘fiÏÔÈÔÈ 5 (26%) Û ÚÔfiÓËÛË. ªÂ ‚¿ÛË ÙËÛ˘ÓÔÏÈ΋ “¤ÎıÂÛË” ÙˆÓ ·ıÏËÙÒÓ ˘ÔÏÔÁ›ÛÙËΠ˛وÛË ·Ó¿ 1000 ÒÚ˜ ¤ÎıÂÛ˘ Î·È Ë Û˘¯ÓfiÙËÙ·ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙˆÓ ·ıÏËÙÒÓ. ∆· ·ÔÙÂϤÛÌ·Ù¿Ì·˜ (›وÛË 18,94 ·Ó¿ 1000 ÒÚ˜ ·ÁÒÓ·, 7,82·Ó¿ 1000 ÒÚ˜ ÚÔfiÓËÛ˘ Î·È Û˘¯ÓfiÙËÙ· ÙÚ·˘-Ì·ÙÈÛÌÔ‡ 1,18 ÙÚ·˘Ì·ÙÈÛÌÔ› ·Ó¿ ·›ÎÙË ÙÔ ¯ÚfiÓÔ)Û˘ÁÎÚ›ıËÎ·Ó Ì ·˘Ù¿ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.T¤ÏÔ˜, ·Ó·˙ËÙ‹ıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ(ÔͤˆÓ Î·È Û˘Ó‰ÚfiÌˆÓ ˘¤Ú¯ÚËÛ˘) Ì ÙË Û˘¯Ófi-ÙËÙ· ÚÔÔÓËÙÈÎÒÓ Î·È ·ÁˆÓÈÛÙÈÎÒÓ ˘Ô¯ÚÂÒÛÂ-ˆÓ Î·È ÂȯÂÈÚ‹ıËΠÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÚԉȷıÂ-ÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· ÙÚ·˘Ì·ÙÈÛÌfi.EÏÏËÓ I·ÙÚ 2000, 66: 263 - 267.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 263 - 267

∏ ¯ÂÈÚoÛÊ·›ÚÈÛË Â›Ó·È ·fi Ù· Èo ‰È·‰Â‰o̤ӷoÌ·‰Èο ·ıÏ‹Ì·Ù·. °È· ÚÒÙË ÊoÚ¿ Û˘ÌÂÚÈÏ‹-ÊıËΠÛÙo ÚfiÁÚ·ÌÌ· ÙˆÓ OÏ˘ÌÈ·ÎÒÓ ·ÁÒÓˆÓÛÙo ªfiÓ·¯o Ùo 19721. ¶·›˙ÂÙ·È ·fi ‰‡o oÌ¿‰Â˜ÙˆÓ ÂÙ¿ ·ÈÎÙÒÓ, Û ÎÏÂÈÛÙfi Á‹Â‰o ‰È·ÛÙ¿ÛˆÓ40 à 20 m. ∏ οı oÌ¿‰· ¤¯ÂÈ Î·È ¤ÓÙ ·Ó·ÏË-ڈ̷ÙÈÎo‡˜ ·›ÎÙ˜ o˘ ÌoÚo‡Ó Ó· ·ÏÏ¿Ío˘ÓÙo˘˜ Ù·ÎÙÈÎo‡˜ fiÛ˜ ÊoÚ¤˜ ¯ÚÂÈ·ÛÙ›. O ·ÁÒÓ·˜‰È·ÚΛ 60 ÏÂÙ¿ Û ‰‡o ËÌ›¯ÚoÓ· ÙˆÓ 30′. O ‰˘-Ó·ÌÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ Ùo˘ ·ıÏ‹Ì·Ùo˜, Î·È oÈ ÏÈÁfi-ÙÂÚo ÂÚÈoÚÈÛÙÈÎo› ηÓoÓÈÛÌo› Ùo˘, Û ۯ¤ÛË ÌÂÙËÓ Î·Ï·ıoÛÊ·›ÚÈÛË, Ê·›ÓÂÙ·È ˆ˜ Û˘Ì‚¿ÏÏo˘ÓÛÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ. ŒÙÛÈ Ë

¯ÂÈÚoÛÊ·›ÚÈÛË ıˆÚÂ›Ù·È ˆ˜ Ë ‰Â‡ÙÂÚË Û˘¯ÓfiÙÂÚË·ÈÙ›· ·ıÏËÙÈÎÒÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ2 3.

™ÙËÓ ·Úo‡Û· ÌÂϤÙË Î·Ù·ÁÚ¿ÊËÎ·Ó Î·È ÌÂ-ÏÂÙ‹ıËÎ·Ó oÈ ÙÚ·˘Ì·ÙÈÛÌo› ÙˆÓ ·ÈÎÙÒÓ ÌÈ·˜ oÌ¿-‰·˜ ¯ÂÈÚoÛÊ·›ÚÈÛ˘ Ù˘ ∞1 ·ÁÁÂÏÌ·ÙÈ΋˜ η-ÙËÁoÚ›·˜, ÙfiÛo ÛÙo˘˜ ·ÁÒÓ˜ fiÛo Î·È ÛÙȘ Úoo-Ó‹ÛÂȘ, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÁˆÓÈÛÙÈ΋˜ ÂÚÈfi-‰o˘ 1998-1999. ¶ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÚÈfi‰o˘oÈ ·ıÏËÙ¤˜ ˘o‚Ï‹ıËÎ·Ó Û ÚoÏËÙÈÎfi È·ÙÚÈÎfi¤ÏÂÁ¯o. ŒÁÈÓ ‰È¿ÎÚÈÛË Û oÍ›˜ ÙÚ·˘Ì·ÙÈÛÌo‡˜Î·È Û‡Ó‰ÚoÌ· ˘¤Ú¯ÚËÛ˘. µ·ÛÈÎfi˜ ‹Ù·Ó o ˘o-ÏoÁÈÛÌfi˜ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÚ·˘Ì·ÙÈÛÌÒÓ ÛÙË ¯ÂÈÚo-ÛÊ·›ÚÈÛË Î·È o ÚoÛ‰ÈoÚÈÛÌfi˜ Èı·Ó‹˜ Û˘Û¯¤ÙÈ-

263

Û˘ Ì ÙËÓ ÚooÓËÙÈ΋ ÂÈ‚¿Ú˘ÓÛË ‹ ÙȘ ·˘ÍË̤-Ó˜ ·ÁˆÓÈÛÙÈΤ˜ ˘o¯ÚÂÒÛÂȘ. ∆o ÙÂÏÂ˘Ù·›o ·˘Ùfi,·ÊoÚ¿ ΢ڛˆ˜ ÛÙË Û˘ÓoÏÈ΋ ‰È¿ÚÎÂÈ· Ù˘ ·ÁˆÓÈ-ÛÙÈ΋˜ ÂÚÈfi‰o˘, ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÁÒÓˆÓ, ÛÙËÓ¤ÓÙ·Û‹ Ùo˘˜ Î·È ÛÙo˘˜ ÛÎoo‡˜ Ù˘ oÌ¿‰·˜. ∆¤Ïo˜,Ë ÌÂϤÙË Ùo˘ Ì˯·ÓÈÛÌo‡, Ùo˘ Ù‡o˘ Î·È Ù˘ ‚·Ú‡-ÙËÙ·˜ Ùo˘ ÙÚ·˘Ì·ÙÈÛÌo‡ ÛÙfi¯Â˘Û ÛÙËÓ ·oÎ¿Ï˘-„Ë ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡Óo˘ Úo˜ ÙÚ·˘Ì·ÙÈÛÌfi.

™ÙË Û‡ÓÙoÌË ‚È‚ÏÈoÁÚ·ÊÈ΋ ·Ó·ÊoÚ¿ (Û˘˙‹ÙË-ÛË), Ê·›ÓÂÙ·È Ë oÈÎÈÏ›· Î·È Ë ·ÓoÌoÈoÁ¤ÓÂÈ· ˆ˜Úo˜ Ùo˘˜ ÌÂÏÂÙo‡ÌÂÓo˘˜ ÏËı˘ÛÌo‡˜, ÙoÓ ¯·Ú·-ÎÙËÚÈÛÌfi ‰È·ÊfiÚˆÓ Î·È ‰È·ÊoÚÂÙÈÎÒÓ Û˘Ì‚·Ì¿ÙˆÓˆ˜ ÙÚ·˘Ì·ÙÈÛÌÒÓ Î·È ÙȘ ¯ÚËÛÈÌooÈo‡ÌÂÓ˜ ÛÙ·ÙÈ-ÛÙÈΤ˜ ÌÂıfi‰o˘˜ ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ‰Â‰o̤ӈÓ. ∆··Ú·¿Óˆ ÂÍËÁÔ‡Ó ÙË ‰˘Û¯¤ÚÂÈ· Û‡ÁÎÚÈÛ˘ ÙˆÓ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚ¢ÓÒÓ Î·È ÙËÓ ·fiÔÏϤ˜ Ï¢ڤ˜ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ı¤Ì·ÙÔ˜.

À§π∫√ – ª∂£√¢√π∏ ¤ÚÂ˘Ó¿ Ì·˜ ·ÊoÚo‡Û ÌÈ· oÌ¿‰· ∞1 ηÙËÁoÚ›·˜ ¯ÂÈÚo-ÛÊ·›ÚÈÛ˘ (°.∞.™. ∞Ú¯¤Ï·o˜ ∫·ÙÂÚ›Ó˘ ) Î·È ‰ÈÂÍ‹¯ıË ÙËÓ·ÁˆÓÈÛÙÈ΋ ÂÚ›o‰o 1998-1999 (10/98-5/99).

∏ È·ÙÚÈ΋ ·Ú·ÎoÏo‡ıËÛË Ù˘ oÌ¿‰·˜ ‹Ù·Ó Û˘Ó¯‹˜.À‹Ú¯Â ηıËÌÂÚÈÓ‹ ·ʋ Ì Ùo˘˜ ÙÚ·˘Ì·ÙÈṲ̂Óo˘˜ ·›-ÎÙ˜, ·ÓÂÏÏÈ‹˜ ·Úo˘Û›· ÛÙo˘˜ ·ÁÒÓ˜ Î·È ÛÙȘ ÂÚÈÛÛfiÙÂ-Ú˜ ÚooÓ‹ÛÂȘ ηıÒ˜ Î·È Â‚‰oÌ·‰È·›· ÂÈÎoÈÓˆÓ›·-ÂÓË-̤ڈÛË Ì ÙoÓ ÚooÓËÙ‹ Î·È ÙoÓ Á˘ÌÓ·ÛÙ‹ Ù˘ oÌ¿‰·˜. ∞˘-Ùfi ÂÍ·ÛÊ¿ÏÈÛ ÙËÓ Î·Ù·ÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ, ÙËÓ·ÎÚ›‚ÂÈ· ÛÙË ‰È¿ÁÓˆÛË Î·È ÙË ÏÂÙoÌÂÚ‹ ηıo‰‹ÁËÛË ˆ˜Úo˜ ÙË ıÂڷ›· Î·È ÙËÓ ·oηٿÛÙ·ÛË.

¶ÚÈÓ ·ÎfiÌË ·Ú¯›Ûo˘Ó oÈ ÚooÓËÙÈΤ˜ ˘o¯ÚÂÒÛÂÈ˜ÙˆÓ ·ÈÎÙÒÓ (Ë=16), Ú·ÁÌ·ÙooÈ‹ıËΠÚoÏËÙÈÎfi˜ È·ÙÚÈ-Îfi˜ ¤ÏÂÁ¯o˜. Àfi ÌoÚÊ‹ Û˘Ó¤ÓÙ¢Í˘ oÈ ·›ÎÙ˜ ÂÚˆÙ‹ıËηÓÁÈ· ¯ÚfiÓÈ· Úo‚Ï‹Ì·Ù· ˘Á›·˜, ÁÈ· ·Ï·Èo‡˜ Î·È ÚfiÛÊ·-Ùo˘˜ ÙÚ·˘Ì·ÙÈÛÌo‡˜, ¯Ú‹ÛË ÚoÊ˘Ï·ÎÙÈÎo‡ ÂÍoÏÈÛÌo‡ ηÈÈ·ÙÚÈ΋ ÂÈÙ‹ÚËÛË-·Ú·ÎoÏo‡ıËÛË Û ٷÎÙÈ΋ ‹ ¤ÎÙ·ÎÙË, Ì·ÊoÚÌ‹ ÙÚ·˘Ì·ÙÈÛÌfi, ‚¿ÛË. ∞ÎoÏo‡ıËÛ ÚoÛ‰ÈoÚÈÛÌfi˜ ‚·-ÛÈÎÒÓ ÛˆÌ·ÙoÌÂÙÚÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·ıÏËÙÒÓ Î·ÈÏÂÙoÌÂÚ‹˜ ÎÏÈÓÈ΋ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· oÚÁ¿ÓˆÓ ÌÂȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙo Ì˘oÛÎÂÏÂÙÈÎfi. OÈ ··ÓÙ‹ÛÂȘ Ù˘ Û˘-Ó¤ÓÙ¢Í˘ Î·È Ù· Â˘Ú‹Ì·Ù· Ù˘ Ê˘ÛÈ΋˜ ÂͤٷÛ˘ ηٷÁÚ¿-ÊËÎ·Ó ÁÈ· ÙoÓ Î¿ı ÂÍÂÙ·˙fiÌÂÓo ¯ˆÚÈÛÙ¿ Û ÚoÛˆÈÎfi È·-ÙÚÈÎfi ‰ÂÏÙ›o. ™Â ÂÚ›ÙˆÛË ‰È·›ÛÙˆÛ˘ ÙÚ·˘Ì·ÙÈÛÌo‡ ÂÍ·-ÎÚÈ‚ÒÓoÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Ùo˘, fiˆ˜ o Ì˯·ÓÈÛÌfi˜ÚfiÎÏËÛ˘, o ¯ÚfiÓo˜ Î·È Ë ı¤ÛË ÙÚ·˘Ì·ÙÈÛÌo‡ (·ÁÒÓ·˜ ‹ÚofiÓËÛË), Èı·Óo› Â͈ÁÂÓ›˜ ·Ú¿ÁoÓÙ˜ o˘ Û˘Ì‚¿Ïo˘ÓÛ ·˘ÙfiÓ, ·o¯‹ ·fi ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜.

¶·ÚfiÌoÈ· Ì ¿ÏϘ ÌÂϤÙ˜, ˆ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ oÚ›ÛÙËÎÂοı οΈÛË Ì˘oÛÎÂÏÂÙÈ΋˜ ·Ú¯‹˜ o˘ Û˘Ó¤‚Ë Û ÚofiÓË-ÛË ‹ ·ÁÒÓ· Î·È o‰‹ÁËÛ Û ·o¯‹ ‹ ÌÂȈ̤ÓË ·fi‰oÛË Û¤ӷ Ùo˘Ï¿¯ÈÛÙoÓ ·ÁÒÓ· ‹ ÚofiÓËÛË4-6. ∏ ·o¯‹ ·fi ·ıÏË-ÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ηıfiÚÈÛÂ Î·È ÙËÓ ‚·Ú‡ÙËÙ· Ùo˘ ÙÚ·˘-Ì·ÙÈÛÌo‡7. ∂Ï·ÊÚ›˜ ¯·Ú·ÎÙËÚ›ÛıËÎ·Ó oÈ ÙÚ·˘Ì·ÙÈÛÌo› o˘ÚoηÏo‡Û·Ó ·o¯‹ ¤ˆ˜ Ì›· ‚‰oÌ¿‰· ÂÓÒ oÈ Ì¤ÙÚÈ·˜ ‚·-Ú‡ÙËÙ·˜ ·fi Ì›· ¤ˆ˜ ‰‡o ‚‰oÌ¿‰Â˜. ¢È¿ÛÙËÌ· ‰‡o ¤ˆ˜ ÙÂÛ-Û¿ÚˆÓ Â‚‰oÌ¿‰ˆÓ ¯ÚÂÈ·˙fiÙ·Ó ÁÈ· ÙËÓ Â¿Óo‰o ÌÂÙ¿ ·fi ÛÔ-

‚·Úfi ÙÚ·˘Ì·ÙÈÛÌfi Î·È ÂÚÈÛÛfiÙÂÚ˜ ·fi Ù¤ÛÛÂÚȘ ÁÈ· ¤Ó·Ó‚·Ú‡.

O ˘oÏoÁÈÛÌfi˜ Ù˘ ›وÛ˘ ¤ÁÈÓ Ì ·Ó·ÁˆÁ‹ Ùo˘·ÚÈıÌo‡ ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ Û ¯›ÏȘ ÒÚ˜ ·ÁÒÓˆÓ ‹ Úofi-ÓËÛ˘ (·ÚÈıÌfi˜ ÙÚ·˘Ì·ÙÈÛÌÒÓ / 1000 ÒÚ˜). ∏ ηٷÁÚ·Ê‹ÙˆÓ È·ÙÚÈÎÒÓ Úo‚ÏËÌ¿ÙˆÓ ÛÙËÓ ÂÚ›o‰o OÎÙ.- ª·Ú., ÁÈÓfi-Ù·Ó Û ηıËÌÂÚÈÓ‹ ‚¿ÛË, Ì ·ʋ Ì ÙoÓ È·ÙÚfi Ù˘ oÌ¿‰·˜.™˘ÌÏËÚˆÓfiÙ·Ó Ï›ÛÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ Î·ıËÌÂÚÈÓ¿ ·fi Ùo˘˜ÚooÓËÙ¤˜ Î·È Î·Ù·ÚÙÈ˙fiÙ·Ó ÚfiÁÚ·ÌÌ· ·oηٿÛÙ·Û˘˘fi ÙËÓ Â›‚ÏÂ„Ë Ùo˘ È·ÙÚo‡. ∏ ηıËÌÂÚÈÓ‹ ÂÈÎoÈÓˆÓ›· Â›ÙˆÓ È·ÙÚÈÎÒÓ Úo‚ÏËÌ¿ÙˆÓ ÂÍ·ÛÊ¿ÏÈÛ ÙËÓ ·ÎÚ›‚ÂÈ· ÛÙˉȿÁÓˆÛË Î·È ÙËÓ Ù·¯‡ÙÂÚË Î·È ·ÛʷϤÛÙÂÚË Â·Ó¤ÓÙ·ÍËÙo˘ ·ıÏËÙ‹.

∞¶√∆∂§∂™ª∞∆∞

∞Ó·ÁÓˆÚ›ÛıËÎ·Ó 19 oÍ›˜ ÙÚ·˘Ì·ÙÈÛÌo› (5 Û ·-ÁÒÓ· Î·È 14 Û ÚofiÓËÛË), 19 Û‡Ó‰ÚoÌ· ˘¤Ú-¯ÚËÛ˘ Î·È ÙÚ›· ¿ÏÏ· È·ÙÚÈο Úo‚Ï‹Ì·Ù· (Û‡Ó-‰ÚoÌo ˘ÂÚÚofiÓËÛ˘, ¤Áη˘Ì· ÙÚÈ‚‹˜ Î·È o-Í›· ·Ì˘Á‰·Ï›Ùȉ·).

ÀoÏoÁ›ÛıËΠfiÙÈ oÈ ·ıÏËÙ¤˜ ÂÍÂÙ¤ıËÛ·Ó ÛÂΛӉ˘Óo ÙÚ·˘Ì·ÙÈÛÌo‡ Û 264 ÒÚ˜ ·ÁÒÓ· ηÈ1790 ÒÚ˜ ÚofiÓËÛ˘. µÚ¤ıËΠ¤ÙÛÈ Ë Â›ÙˆÛËÙÚ·˘Ì·ÙÈÛÌo‡ ·Ó¿ 1000 ÒÚ˜ “¤ÎıÂÛ˘”, o˘·Ó‹Ïı Û 18,94 / 1000 ÒÚ˜ ·ÁÒÓ· Î·È 7,82 / 1000ÒÚ˜ ÚÔfiÓËÛ˘.

º˘ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ıÏËÙÒÓO ̤Ûo˜ fiÚo˜ ËÏÈΛ·˜ ÙˆÓ ·ÈÎÙÒÓ ‹Ù·Ó 22,8 ¤ÙË(SD=5,23). O ÌÈÎÚfiÙÂÚo˜ ·ıÏËÙ‹˜ ‹Ù·Ó 16 ÂÙÒÓÎ·È o ÌÂÁ·Ï‡ÙÂÚo˜ 33. ∆o ̤Ûo ‡„o˜ ‹Ù·Ó 1,87 m(SD=0,04) Î·È Ùo ̤Ûo ‚¿Úo˜ 84,4 kg (SD=4,55).ªÂ ÙË Ì¤ıo‰o ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ ˘oÏoÁ›-ÛÙËΠÙo oÛoÛÙfi ۈ̷ÙÈÎo‡ Ï›o˘˜ o˘ ‚Ú¤ıËÎÂ12,56% (SD=2,54).

¶ÚÔ·ÁˆÓÈÛÙÈο È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·∫·Ù¿ ÙoÓ ÚoÏËÙÈÎfi È·ÙÚÈÎfi ¤ÏÂÁ¯o ·ıÏËÙÒÓ Î·È·fi ÙË Ï‹„Ë Ùo˘ ÈÛÙoÚÈÎo‡, ·Ó·ÁÓˆÚ›ÛıËÎ·Ó È·-ÙÚÈο Úo‚Ï‹Ì·Ù· o˘ ··Û¯oÏo‡Û·Ó Ùo˘˜ ·ıÏË-Ù¤˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ·ÁˆÓÈÛÙÈÎÒÓ ˘o¯ÚÂÒÛÂ-ˆÓ. ∆· ÂÚÈÛÙ·ÙÈο ·˘Ù¿, o˘ Ê·›ÓoÓÙ·È ·Ó·Ï˘ÙÈ-ο ÛÙoÓ ›Ó·Î· 1, ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì ÙÚfio Ò-ÛÙ ÙoÓ OÎÙÒ‚ÚÈo 1998 (¤Ó·ÚÍË ÚˆÙ·ıÏ‹Ì·Ùo˜),‰‡o ÌfiÓo Ó· ÂÍ·ÎoÏo˘ı‹Ûo˘Ó Ó· ˘Ê›ÛÙ·ÓÙ·È, ¯ˆ-Ú›˜, ‚¤‚·È·, Ó· Û˘ÌÂÚÈÏËÊıo‡Ó ÛÙË ÌÂϤÙË.

OÍ›˜ ÙÚ·˘Ì·ÙÈÛÌÔ›∫·Ù¿ ÙËÓ ÂÚ›o‰o o˘ ¤ÁÈÓÂ Ë ÌÂϤÙË Î·Ù·ÁÚ¿ÊË-Î·Ó 19 oÍ›˜ ÙÚ·˘Ì·ÙÈÛÌo› Û 6 ·ıÏËÙ¤˜. ∞fi ·˘-Ùo‡˜ oÈ 5 Û˘Ó¤‚ËÛ·Ó Û ·ÁÒÓ· (26%), Î·È oÈ 14

264 EM. ¶∞¶∞∫ø™∆∞™ ∫∞π ™À¡.

(74%) Û ÚofiÓËÛË.O Ú˘ıÌfi˜ ÙÚ·˘Ì·ÙÈÛÌo‡, o˘ oÚ›˙ÂÙ·È ˆ˜ o

·ÚÈıÌfi˜ ÙÚ·˘Ì·ÙÈÛÌÒÓ ·Ó¿ ·›ÎÙË, ·Ó¿ ¤Ùo˜, ˘-oÏoÁ›ÛÙËΠ۠1,18.

™Â 22 ·ÁÒÓ˜ Ë Û˘ÓoÏÈ΋ “¤ÎıÂÛË” ÙˆÓ ·È-ÎÙÒÓ ‹Ù·Ó 264 ·ÁˆÓÈÛÙÈΤ˜ ÒÚ˜, ÂÓÒ ˘oÏoÁ›ÛÙË-Î·Ó Î·È 1790 ÚooÓËÙÈΤ˜ ÒÚ˜. ∏ Û˘¯ÓfiÙËÙ·ÙÚ·˘Ì·ÙÈÛÌÒÓ ·Ó¿ 1000 ÒÚ˜ ÚofiÓËÛ˘ ‹ ·ÁÒ-Ó·, o˘ oÚ›˙ÂÙ·È ̂ ˜ ›وÛË ̆ oÏoÁ›ÛÙËΠ۠7,82Î·È 18,94 ·ÓÙÈÛÙo›¯ˆ˜. ™‡Ìʈӷ Ì ٷ ·Ú·¿Óˆ,·Úo˘ÛÈ¿˙ÂÙ·È 2,4 ÊoÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ·ÙÚ·˘Ì·ÙÈÛÌo‡ Û ·ÁÒÓ· ·Ú¿ Û ÚofiÓËÛË.

∆‡Ô˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡, ‚·Ú‡ÙËÙ· Î·È ·Ó·ÙÔ-ÌÈ΋ ÂÓÙfiÈÛËOÈ Èo Û˘¯Óo› Ù‡oÈ ÙÚ·˘Ì·ÙÈÛÌo‡ ‹Ù·Ó oÈ Û˘Ó‰Â-ÛÌÈΤ˜ ηÎÒÛÂȘ (¡=9, 47,4%), oÈ ıÏ¿ÛÂȘ Ì˘ÒÓÎ·È oÈ ıÏ¿ÛÂȘ ÙÂÓfiÓÙˆÓ (¡=8, 42%), ÂÓÒ ‰È·ÁÓÒ-ÛıËÎ·Ó 1 Ú‹ÍË ÌËÓ›ÛÎo˘ Î·È 1 οٷÁÌ· Ï¢ÚÒÓ.OÈ Û˘Ó‰ÂÛÌÈΤ˜ ηÎÒÛÂȘ ·ÊoÚo‡Û·Ó ÙËÓ o‰o-ÎÓËÌÈ΋ (¡=6), ÙËÓ ÌÂٷηÚÈoÊ·Ï·ÁÁÈ΋ ¿Ú-ıÚˆÛË Î·ıÒ˜ Î·È Ì›· Ê·Ï·ÁÁoÊ·Ï·ÁÁÈ΋. £Ï¿-ÛÂȘ Ì˘ÒÓ Î·È ÙÂÓfiÓÙˆÓ ÂÌÊ·Ó›ÛıËÎ·Ó ÛÙË Ú¿¯ËÎ·È ÙËÓ Oª™™ (¡=4), Ùo˘˜ ÎoÈÏÈ·Îo‡˜ (¡=3) ηÈÙoÓ Ì¤Á· ÚoÛ·ÁˆÁfi (¶›Ó. 2).

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 265

¶›Ó·Î·˜ 1. ¶ÚÔ·ÁˆÓÈÛÙÈο È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·

∞ÛÙ¿ıÂÈ· ¶¢∫ 2O/∞ ¶¢∫ 1∂ÈÁoÓ·ÙȉoÌËÚÈ·›o Û‡Ó‰ÚoÌo 2O/∞ ÁfiÓ·Ùo˜ 1OÛÙÈ΋ ·ÓÙ›‰Ú·ÛË ÛoÓ‰˘ÏÈÎo‡ ÙfiÍo˘ O5(Èı·Ó‹ ÛoÓ‰˘ÏfiÏ˘ÛË) 1∆ÂÓoÓÙ›Ùȉ· ÛÙÚoʤˆÓ ÒÌo˘ 2∆ÂÓoÓÙ›Ùȉ· ηÌÙ‹ÚˆÓ ¶Ã∫ 1∂Óo¯Ï‹Ì·Ù· › ·Ï·Èo‡ ηٿÁÌ·Ùo˜ ÛηÊoÂȉo‡˜ 2¶·Ï·È¿ Û˘Ó‰ÂÛÌÈ΋ οΈÛË ‰·ÎÙ‡Ïo˘ Ì ·ÛÙ¿ıÂÈ· 3

¶›Ó·Î·˜ 2. T‡ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ‡

∫¿Ù·ÁÌ· Ï¢ÚÒӣϿÛË ÙÚ·Â˙ÔÂȉԇ˜£Ï¿ÛË ÈÂÚÔÓˆÙÈ·›Ô˘ (3)ƒ‹ÍË Â·Î·Óı›Ô˘£Ï¿ÛË Î·Ù·Ê˘ÙÈÎÔ‡ Ù¤ÓÔÓÙ· ÔÚıÔ‡ ÎÔÈÏÈ·ÎÔ‡(‰‡Ô 1Ô˘ & Ì›· 2Ô˘ ‚·ıÌÔ‡)£Ï¿ÛË ÚÔÛ·ÁˆÁÔ‡ (1Ô˘ ‚·ıÌÔ‡)ƒ‹ÍË ¤Ûˆ ÌËÓ›ÛÎÔ˘ (ÂÚÈÊÂÚÈ΋ ÔÈÛı›Ô˘ ΤڷÙÔ˜)™˘Ó‰ÂÛÌÈΤ˜ ηÎÒÛÂȘ ¶¢∫ (Ù¤ÛÛÂÚÂȘ 1Ô˘ & ‰‡Ô 2Ô˘)™˘Ó‰ÂÛÌÈ΋ οΈÛË ª∆∫º∞ (ˆÏ¤ÓÈÔ˜ Ï¿ÁÈÔ˜ Û‡Ó‰ÂÛÌÔ˜·ÓÙ›¯ÂÈÚ·)™˘Ó‰ÂÛÌÈ΋ οΈÛË ºº∞ (ÎÂÚÎȉÈÎfi˜ Ï¿ÁÈÔ˜ 1˘ ºº∞ ‰Â›-ÎÙË)

¶›Ó·Î·˜ 3. AÓ·ÙÔÌÈ΋ ÂÓÙfiÈÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ

£Òڷη˜ - Ú¿¯Ë 2(10,55%)Oª™™ 4(21,1%)§ÂοÓË - ÈÛ¯›· - ‚o˘‚ˆÓÈ΋ ¯ÒÚ· 4(21,1%)°fiÓ·Ùo - ÎÓ‹ÌË 1(5,25%)¶¢∫ - ¿ÎÚo˜ o˘˜ 6(31,45%)flÌo˜ -¶Ã∫ - ¿ÎÚ· ¯Â›Ú· 2(10,55%)

EÈÎ. 1. ™Ô‚·ÚfiÙËÙ· ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ.

O Û˘¯ÓfiÙÂÚo˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ ‹Ù·Ó, ‚¤‚·È·, oÈÛ˘Ó‰ÂÛÌÈΤ˜ ηÎÒÛÂȘ Ù˘ ¶¢∫, Î·È ·ÊoÚo‡Û·ÓÙo ¤Íˆ ı˘Ï·ÎoÛ˘Ó‰ÂÛÌÈÎfi Û‡ÛÙËÌ·. ∂ÚfiÎÂÈÙoÁÈ· 1Ô˘ & 2Ô˘ ‚·ıÌo‡ Ú‹ÍÂȘ Û˘Ó‰¤ÛÌˆÓ (‰È¿ÁÓˆ-ÛË Ì ·ÎÙÈÓoÁڷʛ˜ ˘fi Ù¿ÛË).

∏ ·Ó·ÙoÌÈ΋ ÂÓÙfiÈÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓÊ·›ÓÂÙ·È ÛÙoÓ ›Ó·Î· 3.

OÎÙÒ ÙÚ·˘Ì·ÙÈÛÌo› (42,1%) Ù·ÍÈÓoÌ‹ıËηӈ˜ ÂÏ·ÊÚ›˜, 5 (26,3%) ˆ˜ ̤ÙÚÈÔÈ, 4 (21,1%) ¯·-Ú·ÎÙËÚ›ÛıËÎ·Ó ÛÔ‚·ÚÔ›, ÂÓÒ ˘‹ÚÍ·Ó Î·È 2(10,5%) ‚·Ú›˜ ÙÚ·˘Ì·ÙÈÛÌo› (EÈÎ. 1).

∏ ̤ÛË ·o¯‹ ·fi ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜˘oÏoÁ›ÛÙËΠ۠7.191 ÚooÓËÙÈΤ˜ ÌoÓ¿‰Â˜ η-Ù¿ ̤Ûo fiÚo. ø˜ ÚooÓËÙÈ΋ ÌoÓ¿‰· oÚ›˙ÂÙ·È Ë·˘ÙoÙÂÏ‹˜ ÚofiÓËÛË ·ÓÂÍ·Úًو˜ ËÌÂÚ‹ÛÈ·˜ ‹Â‚‰oÌ·‰È·›·˜ Û˘¯ÓfiÙËÙ·˜ (ÊoÚ¤˜ / ‚‰oÌ¿‰·).

™‡Ó‰ÚÔÌ· ˘¤Ú¯ÚËÛ˘∂Ù¿ ·ıÏËÙ¤˜ ÂÌÊ¿ÓÈÛ·Ó Î·Ù¿ ÙËÓ ÂÍÂÙ·˙fiÌÂÓËÂÚ›o‰o, Û˘ÓoÏÈο, 19 È·ÙÚÈο Úo‚Ï‹Ì·Ù· ·fi ˘-¤Ú¯ÚËÛË.

∏ ÙooÁÚ·ÊÈ΋ ÂÓÙfiÈÛË ÙˆÓ Û˘Ó‰ÚfiÌˆÓ˘¤Ú¯ÚËÛ˘ o˘ ‰È·ÁÓÒÛıËÎ·Ó Ê·›ÓÂÙ·È ÛÙoÓ ›-ӷη 4. ∆o ÁfiÓ·Ùo ·oÙ¤ÏÂÛ ÙËÓ ÂÚÈo¯‹ Ì ÙËÓÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Úo‚ÏËÌ¿ÙˆÓ (47,3%),ÂÓÒ oχ Ï›Á· ‹Ù·Ó Ù· ÂÓo¯Ï‹Ì·Ù· ÙˆÓ ·ıÏËÙÒÓÛÙoÓ ÒÌo Î·È Î·ıfiÏo˘ ÛÙËÓ Oª™™.

OÈ ‰È·ÁÓÒÛÂȘ o˘ ÂÙ¤ıËÛ·Ó Î·Ù·ÁÚ¿ÊoÓÙ·ÈÛÙoÓ ›Ó·Î· 5.

™À∑∏∆∏™∏∏ ¯Ú‹ÛË ÂÚˆÙËÌ·ÙoÏoÁ›o˘ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ÙÚ·˘Ì·ÙÈÛÌÒÓ Â›Ó·È ÌÈ· ·Ï‹ Î·È ÂÍ·ÈÚÂÙÈο ·o-‰oÙÈ΋ ̤ıo‰o˜ ÁÈ· ÙoÓ Î·ıoÚÈÛÌfi ÂȉËÌÈoÏoÁÈ-ÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ∞˘ÙoÓfiËÙo Â›Ó·È fï˜, fiÙÈ Ë Î·-ıËÌÂÚÈÓ‹ ηٷÁÚ·Ê‹ Û˘Ì‚·Ì¿ÙˆÓ, Î·È Ì¿ÏÈÛÙ··fi ÙoÓ ›‰Èo È·ÙÚfi, o‰ËÁ› Û Èo ·ÓÙÈÎÂÈÌÂÓÈÎ¿Û˘ÌÂÚ¿ÛÌ·Ù·. °›ÓÂÙ·È ¤ÙÛÈ Î·Ù·ÓoËÙ‹ Ë ‰È·ÊoÚ¿o˘ Â›Ó·È ‰˘Ó·Ùfi Ó· Úo·„ÂÈ fiÙ·Ó ‰È·Ê¤ÚÂÈ Ë̤ıo‰o˜ Û˘ÏÏoÁ‹˜ È·ÙÚÈÎÒÓ ÏËÚoÊoÚÈÒÓ.

™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈoÁÚ·Ê›·, oÈ ·Ó·ÊoÚ¤˜ ÙˆÓÙÚ·˘Ì·ÙÈÛÌÒÓ ÛÙË ¯ÂÈÚoÛÊ·›ÚÈÛË, Úo¤Ú¯oÓÙ·È·fi ÂÚÁ·Û›Â˜ Ì ÂÚˆÙËÌ·ÙoÏfiÁÈ· › ÙˆÓ ÙÚ·˘Ì·-ÙÈÛÌÒÓ7-9. °È· Ó· Á›Óo˘Ó Û˘ÁÎÚ›ÛÈÌ· Ù· ÌÂÁ¤ı˯ÚËÛÈÌooÈ‹ıËÎ·Ó oÈ ›‰ÈoÈ oÚÈÛÌo› ÁÈ· Ùo˘˜ ÙÚ·˘-Ì·ÙÈÛÌo‡˜ Î·È ÙË Ûo‚·ÚfiÙËÙ· Ùo˘˜.

ŒÙÛÈ, Ë Â›ÙˆÛË ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ ·Ó¿ 1000ÒÚ˜ ·ÁÒÓ· (18,94) o˘ ˘oÏoÁ›ÛÙËΠÛÙËÓ ÂÚÁ·-Û›· Ì·˜, Â›Ó·È Û˘Ì‚·Ù‹ Ì ٷ ‰ÈÂıÓ‹ ‰Â‰o̤ӷ7,10-

12, ·Ó Î·È ˘¿Ú¯o˘Ó ·Ó·ÊoÚ¤˜ Ì ·ÎfiÌË ÌÂÁ·Ï‡ÙÂ-ÚË Â›ÙˆÛË ÙÚ·˘Ì·ÙÈÛÌÒÓ13. ∆o ·˘ÍË̤Óo ‰ÈÎfiÌ·˜ ·oÙ¤ÏÂÛÌ· ÂÍËÁ›ٷÈ, ÚoÊ·ÓÒ˜, ·fi ÙËÓ·ÎÚ›‚ÂÈ· ÛÙËÓ Î·Ù·ÁÚ·Ê‹, Ùo ˘„ËÏfiÙÂÚo ›‰o

·ıÏËÙÒÓ Î·È Ùo ÌÈÎÚfi Ì·˜ ‰Â›ÁÌ·. OÈ ›‰ÈoÈ ÏfiÁoÈÂÍËÁo‡Ó Î·È ÙËÓ ·fiÎÏÈÛË Ùo˘ ·oÙÂϤÛÌ·Ùo˜ Ù˘›وÛ˘ ·Ó¿ 1000 ÒÚ˜ ÚofiÓËÛ˘ (7,82), ÛÂÛ¯¤ÛË Ì ÙȘ ‚È‚ÏÈoÁÚ·ÊÈΤ˜ ·Ó·ÊoÚ¤˜7.

ÀoÏoÁ›Û·Ì ÙË Û˘¯ÓfiÙËÙ· ÙÚ·˘Ì·ÙÈÛÌo‡ ÛÂ1,18 ·Ó¿ ·›ÎÙË Ùo ¯ÚfiÓo, o˘ Â›Ó·È ‚¤‚·È· ·ÚÎÂ-Ù¿ ˘„ËÏ‹, fiÙ·Ó Û˘ÁÎÚÈı› Ì ٷ ‰ÈÂıÓ‹ ‰Â‰o̤ӷÁÈ· Ù· oÌ·‰Èο ·ıÏ‹Ì·Ù· ·ÏÏ¿ Î·È ÙË ¯ÂÈÚoÛÊ·›-ÚÈÛË ÂȉÈÎfiÙÂÚ·7,9,14. ∞˜ ÛËÌÂȈı›, fï˜, fiÙÈ Î·Ù¿ÙËÓ ·ÁˆÓÈÛÙÈ΋ ÂÚ›o‰o 1998-1999, ‰ÈÂÍ‹¯ıËÛ·Ó22 ·ÁÒÓ˜ Û ‰È¿ÛÙËÌ· ÌfiÏȘ 5,5 ÌËÓÒÓ, ÁÈ· ÚÒ-ÙË ÊoÚ¿ ÛÙËÓ ÈÛÙoÚ›· Ùo˘ ÚˆÙ·ıÏ‹Ì·Ùo˜ Ù˘ ∞1.∆o ·Ú·¿Óˆ Èı·ÓÒ˜ Ó· ÂÍËÁ› ÙË ‰È·ÊoÚ¿ ÛÙ··oÙÂϤÛÌ·Ù·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÎÚÈ‚¤ÛÙ·ÙËηٷÁÚ·Ê‹ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ. ™Ù‹ÚÈÍË ÛÙËÓ ˘fi-ıÂÛ‹ Ì·˜ ·Ú¤¯ÂÙ·È Î·È ·fi Ù· ·oÙÂϤÛÌ·Ù· ÙË˜Û˘Ó¤¯ÂÈ·˜ Ù˘ ¤ÚÂ˘Ó¿˜ Ì·˜ ÁÈ· ÙËÓ ÂÚ›o‰o 1999-2000, o˘ Â›Ó·È ·ÎfiÌË ˘fi ÂÂÍÂÚÁ·Û›·, Î·È ‰Â›-¯Óo˘Ó Û·Ê‹ Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÚ·˘Ì·ÙÈÛÌo‡Ì ÙËÓ ÂÈÌ‹Î˘ÓÛË Ù˘ ‰È¿ÚÎÂÈ·˜ Ùo˘ ÚˆÙ·ıÏ‹-Ì·Ùo˜.

™Ùo˘˜ oÍ›˜ ÙÚ·˘Ì·ÙÈÛÌo‡˜ ‰ÂÓ ·Úo˘ÛÈ¿ÛÙË-Î·Ó Î·ÎÒÛÂȘ ÛÙo ÁfiÓ·Ùo Î·È ÙoÓ ÒÌo, Ùo˘Ï¿¯È-ÛÙoÓ ÛÙË Û˘¯ÓfiÙËÙ· o˘ ı· ·Ó·ÌÂÓfiÙ·Ó7. ∞˜ ÛË-ÌÂȈı›, ‰Ò, fiÙÈ ·fi ÙËÓ ·Ú¯‹ Ù˘ ÂÚÈfi‰o˘, ηÈηı’ fiÏË ÙË ‰È¿ÚÎÂÈ¿ Ù˘, ‰fiıËΠȉȷ›ÙÂÚË ‚·Ú‡-ÙËÙ· ÛÙËÓ ÂÓ‰˘Ó¿ÌˆÛË ÙˆÓ ÛÙÚoʤˆÓ Ùo˘ ÒÌo˘Î·È ÙˆÓ Î·ÌÙ‹ÚˆÓ - ÂÎÙÂÈÓfiÓÙˆÓ Ùo˘ ÁfiÓ·Ùo˜. ∆o·Ú·¿Óˆ ÁÂÁoÓfi˜, Ì¿ÏÏoÓ, ÂÍËÁ› Ù· ¯·ÌËÏ¿oÛoÛÙ¿ ÙÚ·˘Ì·ÙÈÛÌÒÓ ÂÚ› ÙȘ ·ÚıÚÒÛÂȘ ·˘Ù¤˜.

™ÙËÓ ÌÂϤÙË Ì·˜ ‰ÂÓ Î·Ù·ÁÚ¿ÊËÎ·Ó oÍ›˜ÙÚ·˘Ì·ÙÈÛÌo› ‹ Û‡Ó‰ÚoÌ· ˘¤Ú¯ÚËÛ˘ o˘ Ó··ÊoÚo‡Ó ÙËÓ ¿ÚıÚˆÛË Ùo˘ ·ÁÎÒÓ·, fiˆ˜ Ùo “Û‡Ó-‰ÚoÌo Ùo˘ ·ÁÎÒÓ· ÙˆÓ ÙÂÚÌ·ÙoÊ˘Ï¿ÎˆÓ Ù˘ ¯ÂÈ-ÚoÛÊ·›ÚÈÛ˘”, ·Ú¿ ÙË Û˘¯ÓfiÙËÙ· Ùo˘˜ ÛÙȘ ‚È-‚ÏÈoÁÚ·ÊÈΤ˜ ·Ó·ÊoÚ¤˜15.

™Àª¶∂ƒ∞™ª∞∆∞1. ∂ÌÊ·Ó›˙ÂÙ·È ˘„ËÏ‹ ÂÈÎÈÓ‰˘ÓfiÙËÙ· Î·È Û˘¯Ófi-

ÙËÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ ÛÙË ¯ÂÈÚoÛÊ·›ÚÈÛË Û ›-‰o ∞1, ̤ÙÚÈ·˜, fï˜, Ûo‚·ÚfiÙËÙ·˜. ¶Èı·ÓfiÓ·˘Ùfi Ó· Â›Ó·È ·oÙ¤ÏÂÛÌ· ÂÏÏÈo‡˜ ˘o‰oÌ‹˜Î·È ÚoÂÙoÈÌ·Û›·˜ ηıÒ˜ Î·È Û˘ÓÙfiÌ¢Û˘ Ù˘·ÁˆÓÈÛÙÈ΋˜ ÂÚÈfi‰o˘. ™ËÌ·ÓÙÈÎfi ÛÙoȯ›o ·-oÙÂÏ› ›Û˘ Ë, ÁÈ· ÚÒÙË ÊÔÚ¿, ·Ó·ÁÓÒÚÈÛËÈ·ÙÚÈÎÒÓ Úo‚ÏËÌ¿ÙˆÓ Ô˘ ˘fi ¿ÏϘ Û˘Óı‹Î˜‰Â ı· ηٷÁÚ·ÊfiÙ·Ó.

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266 EM. ¶∞¶∞∫ø™∆∞™ ∫∞π ™À¡.

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∆ÂÓÔÓÙ›Ùȉ· Ì·ÎÚÔ‡ ÚÔÛ·ÁˆÁÔ‡∏‚È΋ ÔÛÙÂ˚ÙȘ (2)O/∞ ÈÛ¯›Ô˘∆ÂÓÔÓÙ›Ùȉ· Î·Ù·Ê˘ÙÈÎÔ‡ Ù¤ÓÔÓÙ· ÎÔÈÏÈ·ÎÒÓ∂ÈÁÔÓ·ÙȉÔÌËÚÈ·›Ô Û‡Ó‰ÚÔÌÔ (3)OÚÔÁÔÓÔı˘Ï·Î›ÙȘ ¯ËÓ›Ԣ Ô‰fi˜O/∞ ÁfiÓ·ÙÔ˜ (2)∆ÂÓÔÓÙ›Ùȉ· ÈÁÓ˘·ÎÔ‡™‡Ó‰ÚÔÌÔ ÙÚÈ‚‹˜ Ï·ÁÔÓÔÎÓËÌÈ·›·˜ Ù·ÈÓ›·˜∆ÂÓÔÓÙ›Ùȉ· ÚÔÛı›Ô˘ ÎÓËÌÈ·›Ô˘O/∞ ¶¢∫∆ÂÓÔÓÙ›Ùȉ· Ì·ÎÚÔ‡ ÂÎÙ›ÓÔÓÙ· ÙÔÓ Ì¤Á· ‰¿ÎÙ˘ÏÔ™ËÛ·ÌÔÂȉ›Ùȉ· 1Ô˘ ‰·ÎÙ‡ÏÔ˘∆ÂÓÔÓÙ›Ùȉ· ˘ÂڷηÓı›Ô˘ (2)

ÏÂÈÙo‡ÚÁËÛ ÚoÏËÙÈο ˆ˜ Úo˜ ÙË Û˘¯ÓfiÙËÙ·Î·È ÙË Ûo‚·ÚfiÙËÙ· ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ.

3. ªÂ ÙoÓ ÚoÏËÙÈÎfi È·ÙÚÈÎfi ¤ÏÂÁ¯o ·ıÏo˘Ì¤ÓˆÓ·Ó·ÁÓˆÚ›ÛıËÎ·Ó Úo¸¿Ú¯oÓÙ· Úo‚Ï‹Ì·Ù·Î·È ÌÂÈÒıËΠÂÍ·ÈÚÂÙÈο Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈ-Û˘ ‰˘Û¿ÚÂÛÙˆÓ, ÁÈ· ÙËÓ ˘Á›· ÙˆÓ ·ıÏËÙÒÓ,Û˘Ì‚·Ì¿ÙˆÓ.

4. ∏ Ï‹Ú˘ ·ıÏËÙÈ·ÙÚÈ΋ ·Ú·ÎoÏo‡ıËÛË o˘ Â-Ê·ÚÌfiÛıËÎÂ, ÛÙÔ Ì¤ÙÚÔ ÙÔ˘ ‰˘Ó·ÙÔ‡, ÛÙËÓ oÌ¿-‰· ¯ÂÈÚoÛÊ·›ÚÈÛ˘ Ùo˘ °∞™ ∞Ú¯¤Ï·o˜ ∫·ÙÂÚ›-Ó˘ ηٿ ÙËÓ ÂÚ›o‰o1998-1999, Î·È Û˘Ó¯›˙ÂÙ·ÈÛÙËÓ ÙÚ¤¯o˘Û· ·ÁˆÓÈÛÙÈ΋ ¯ÚoÓÈ¿ Ì ·ÎfiÌË ÈoÂÏȉoÊfiÚ· ÌËӇ̷ٷ, ‰Â ı· o‰ËÁ‹ÛÂÈ oÙ¤ÛÙËÓ ·Ó¿Ù˘ÍË Ùo˘ ·ıÏ‹Ì·Ùo˜ Î·È Û ÂÈÙ˘¯›Â˜,·Ó ‰ÂÓ ÂÊ·ÚÌoÛı› Û ¢ڇÙÂÚË Îϛ̷η Î·È˘fi ηχÙÂÚ˜ Úo¸oı¤ÛÂȘ.

ABSTRACTPapakostas Em., Papalexandris St., Malliaro-poulos N. Athletic injuries in handball. A oneyear prospective study of A1 team handball.Hell Iatr 2000, 66: 263-267.

µπµ§π√°ƒ∞ºπ∞1. Mezey Aa. Handball in Killanin, Rodda J. (eds) The oly-

mpic games. London Rainbird Reference Books, Ltd.,1976.

2. Folksam 1974. Idrottskador. Olyckasfall I bandy, fotboll,handboll och ishockey. Folksams Haelsorads Skrif-tserie 10: 1974.

3. Nilsson E., Hogberg P., Mattson R. Handbollskador. Folk-sams Haelsorads Skriftserie 1965, 2: 2–41.

4. Yde J, Nielsen AB. Sports injuries in adolescent’s ballgames: Soccer, handball and basketball. Br J SportsMed 1990, 24: 51-4.

5. Ekstrand J, Gillquist J, Moller M, et al. Incidence of soccerinjuries and their relation to training and team success.Am J Sports Med 1983, 11: 63-7.

6. Lorentzon R, Wedren H, Pietila T. Incidence, nature andcauses of ice hockey injuries. A three year prospective

study of a Swedish elite ice hockey team. Am J SportsMed 1988, 16: 392-6.

7. Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries inteam handball. A one year prospective study of sixteenmen’s senior teams of a superior nonprofessionallevel. Am J Sports Med 1998, 26 (5): 681-7.

8. Lindbland BE, Hoy K, Terkelsen CJ, Helleland HE, Terkel-son CJ. Handball injuries. An epidemiologic and so-cioeconomic study. Am J Sports Med 1992, 20: 441-444.

9. Hoeberigs JH, Van Galen WCC, Philipsen H. Pattern of in-jury in handball and comparison of injured versus no-ninjured handball players. Int J Sports Med 1986, 7:333-7.

10. Backx FJG, Beijer HJG, Bol E. Injuries in high risk per-sons and high risk sports. A longitudinal study of 1818school children. Am J Sports Med 1991, 19: 124-30.

11. Nielsen AB, Yde J. An epidemiological and traumatolo-gical study of injuries in handball. Int J Sports Med1988, 9: 341-4.

12. Yde J, Nielsen AB. Sports injuries in adolescent’s ball ga-mes: Soccer, handball and basketball. Br J Sports Med1990, 24: 51-4.

13. Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M,Froberg K. Injuries in young female players in Euro-pean team handball. Scand J Med Sci Sports 1997,7(6):342-7.

14. Jorgensen U. Epidemiology of injuries in typical Scan-dinavian team sports. Br J Sports Med 1984, 18: 59-63.

15. Tyrdal S, Bahr R. High prevalence of elbow problems a-mong goalkeepers in European team handball –“handball goalie’s elbow”. Scand J Med Sci Sports1996, 6(5):297-302.

AÏÏËÏÔÁÚ·Ê›·:EÌ. ¶··ÎÒÛÙ·˜HÏÈÔ˘fiψ˜ 15671 00 – •¿ÓıË

Corresponding author:E. PapakostasIlioupoleos 15671 00 – XanthiGreece

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 267

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 268 - 273

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∏ oÏ˘ÌoÚÊ›· ·oÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÁÓÒÚÈ-ÛÌ· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ÙˆÓ ˘oÁfiÓÈÌˆÓ Î·ÈÙˆÓ ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ1. ¢Â›ÁÌ·Ù· Û¤ÚÌ·Ùo˜ ÛÙ· o-o›· Ùo Û‡ÓoÏo ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ·Úo˘ÛÈ¿-˙ÂÈ Ì›· ÌfiÓo ÌoÚÊoÏoÁÈ΋ ·ÓˆÌ·Ï›· Â›Ó·È È‰È·›ÙÂ-Ú· Û¿ÓÈ·2.

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268

Ù›Ó˘ Ùo˘ ˘Ú‹Ó·, o˘ ÚoÎÏ‹ıËΠ̠¯ËÌÈÎfi ÙÚfi-o, ‡ÚËÌ· o˘ ÂÓÈÛ¯‡ÂÈ ÙËÓ ¿o„Ë Ù˘ ÌË Û˘ÌÌÂÙo-¯‹˜ Ùo˘ ·ÎÚoÛÒÌ·Ùo˜ ÛÙË ‰ÈÂÚÁ·Û›· ·˘Ù‹16-28.

∆· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂ-Ê·Ï›· ηٷٿÛÛoÓÙ·È Û ‰‡o Ù‡o˘˜: 1. ÛÙoÓ ÚÒ-Ùo Ù‡o (Ù‡o˜ π) Ë ÎÂÊ·Ï‹ Ùo˘ ÛÂÚÌ·Ùo˙ˆ·Ú›o˘Â›Ó·È ÛÙÚfiÁÁ˘ÏË, ÂÏÏ›ÂÈ Ï‹Úˆ˜ Ùo ·ÎÚoÛÒÌÈoÌ ٷ ¤Ó˙˘Ì¿ Ùo˘, ηıÒ˜ Î·È Ë ÌÂÙ·ÎÚoÛˆÌȷ΋ı¤ÛË. O Ù‡o˜ ·˘Ùfi˜ ·oÙÂÏ› Ùo ÎÏ·ÛÈÎfi ÚfiÙ˘oÙ˘ ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·˜ o˘ ÂÚÈÁÚ¿ÊËηfi Ùo˘˜ Shirren Î·È Holstein3,4. 2. ÛÙoÓ ‰Â‡ÙÂÚoÙ‡o (Ù‡o˜ ππ) Ë ÎÂÊ·Ï‹ Ùo˘ ÛÂÚÌ·Ùo˙ˆ·Ú›o˘ ›-Ó·È Â›Û˘ ÛÙÚoÁÁ˘Ï‹, ·ÏÏ¿ ˘¿Ú¯o˘Ó ˘oÏ›ÌÌ·-Ù· ·ÎÚoۈ̛o˘. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ù· ÛÂÚÌ·Ùo˙ˆ¿-ÚÈ· Ùo˘ Ù‡o˘ π ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÁoÓÈÌooÈ‹-Ûo˘Ó Ùo ˆ¿ÚÈo, ÂÎÙfi˜ Â¿Ó ÂÊ·ÚÌoÛı› Ë Ì¤ıo‰o˜Ù˘ ÂÓ‰o΢ÙÙ·ÚoÏ·ÛÌ·ÙÈ΋˜ ¤Á¯˘Û˘ ÛÂÚÌ·Ùo-˙ˆ·Ú›ˆÓ (ICSI), ÂÓÒ Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ùo˘ Ù‡-o˘ ππ Â›Ó·È ‰˘ÓËÙÈο ÁfiÓÈÌ·27,29.

ªoÏoÓfiÙÈ ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚoÓÙ·È ÛÙ·ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·, oÈÌÂϤÙ˜ ·˘Ù¤˜ ·ÊoÚo‡Ó: 1) ÌÂÌoӈ̤Ó˜ ÂÚÈÙÒ-ÛÂȘ ÛÙȘ oo›Â˜ Ùo Û‡ÓoÏo ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ·Úo˘Û›·˙ ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·, 2) ÙË ÌoÚ-ÊoÁ¤ÓÂÛË Ù˘ ÌoÚÊoÏoÁÈ΋˜ ·˘Ù‹˜ ·ÓˆÌ·Ï›·˜, 3)ÙoÓ ÙÚfio ÎÏËÚoÓoÌÈ΋˜ ÌÂÙ·‚›‚·Û‹˜ Ù˘, 4) Ùo˘˜Ù‡o˘˜ Ù˘, 5) ÙȘ ȉÈfiÙËÙ˜ Î·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·-Ï›·, Î·È 6) Ùo˘˜ ÙÚfio˘˜ ıÂڷ¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈ-Û˘ Ù˘ ÌoÚÊ‹˜ ·˘Ù‹˜ Ù˘ ÙÂÚ·ÙoÛÂÚÌ›·˜. ∆· ‰Â-‰o̤ӷ fï˜ Â›Ó·È ÂÏ¿¯ÈÛÙ· Û fi,ÙÈ ·ÊoÚ¿ ÙËÓ‡·ÚÍË ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘-ÏoÎÂÊ·Ï›· ÛÙ· ‰Â›ÁÌ·Ù· Û¤ÚÌ·Ùo˜ ˘oÁfiÓÈ̈ÓÎ·È ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ22.

∞Ó·˙ËÙ‹ıËÎ·Ó Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚo-ÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· Û ‰Â›ÁÌ·Ù· Û¤ÚÌ·Ùo˜ ˘oÁfi-ÓÈÌˆÓ Î·È ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ, Ì ÛÎofi ÙË ‰ÈÂÚ‡ÓË-ÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ‡·Ú͢ Ù˘ ÌoÚÊoÏoÁÈ΋˜ ·˘-Ù‹˜ ·ÓˆÌ·Ï›·˜, ÙËÓ ·Ó‡ÚÂÛË Ù˘ ÂηÙoÛÙÈ·›·˜ Ù˘·Ó·ÏoÁ›·˜ Î·È ÙËÓ ‡·ÚÍË, ÂӉ¯o̤ӈ˜, Û˘Û¯¤ÙÈ-Û‹˜ Ù˘ Ì ÙȘ ¿ÏϘ ·Ú·Ì¤ÙÚo˘˜ Ùo˘ Û¤ÚÌ·Ùo˜.

Y§IKO KAI ME£O¢OIªÂÏÂÙ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· Û¤ÚÌ·Ùo˜ ·fi 114 ˘oÁfiÓÈ-

Ìo˘˜ ¿Ó‰Ú˜, ËÏÈΛ·˜ 24-53 ÂÙÒÓ (̤ÛË ÙÈÌ‹ ± SD 33,3 ¤ÙË ±6,1) Î·È ·fi 60 ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜, ËÏÈΛ·˜ 24-44 ÂÙÒÓ (33,1 ¤Ù˱ 4,2). OÈ ˘oÁfiÓÈÌoÈ ¿Ó‰Ú˜ ‰ÂÓ ¤Ù˘¯·Ó ÂÁ΢ÌoÛ‡ÓË ÁÈ·‰È¿ÛÙËÌ· 46,3 ÌËÓÒÓ ± 41,6, ÂÓÒ oÈ Á˘Ó·›Î˜ ÙˆÓ ÁfiÓÈ̈ӷӉÚÒÓ ‚Ú›ÛÎoÓÙ·Ó ÛÙo ÚÒÙo ÙÚ›ÌËÓo Ù˘ ÂÁ΢ÌoÛ‡Ó˘. OÈ·Ú·¿Óˆ ¿Ó‰Ú˜ ‰ÂÓ Â›¯·Ó Ï¿‚ÂÈ Î·Ó¤Ó· Ê¿ÚÌ·Îo ηٿ ÙˉȿÚÎÂÈ· Ùo˘ ÂÍ·Ì‹Óo˘ o˘ ÚoËÁ‹ıËÎ Ù˘ ÌÂϤÙ˘. ™Â fiÏ·Ù· ¿ÙoÌ· ¤ÁÈÓ ÚoÛÂÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË, o˘ ¤‰ÂÈÍ ϋ-

ÚË ·Ó¿Ù˘ÍË ÙˆÓ ‰Â˘ÙÂÚoÁÂÓÒÓ ¯·Ú·ÎÙ‹ÚˆÓ Ùo˘ ʇÏo˘ ηÈfiÁÎo ‰ÂÍÈo‡ 16,9 cm3 ± 4,5 Î·È ·ÚÈÛÙÂÚo‡ fiÚ¯È 16,2 cm3 ±4,3 (̤ÛË ÙÈÌ‹ ±SD 16,4 cm3± 4,1) ÁÈ· Ùo˘˜ ˘oÁfiÓÈÌo˘˜ ηÈ21,4 cm3 ± 2,7 Î·È 21,0 cm3 ± 2,7 (21,2 cm3 ± 2,7) ÁÈ· Ùo˘˜ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜.

™Â οı ¿ÙoÌo ¤ÁÈÓ ¤ÏÂÁ¯o˜ Ùo˘ Û¤ÚÌ·Ùo˜ ‰‡o ÊoÚ¤˜Ì ÌÂÛo‰È¿ÛÙËÌ· ¤ÍÈ ¤ˆ˜ oÎÙÒ Â‚‰oÌ¿‰ˆÓ. OÈ ÙÈ̤˜ ÙˆÓ ·-ڷ̤ÙÚˆÓ Ùo˘ Û¤ÚÌ·Ùo˜ o˘ ¯ÚËÛÈÌooÈ‹ıËÎ·Ó ÛÙË ÌÂϤÙË·ÓÙÈÚoۈ‡o˘Ó ÙȘ ̤Û˜ ÙÈ̤˜ ÙˆÓ ‰‡o ‰ÂÈÁÌ¿ÙˆÓ Û¤Ú-Ì·Ùo˜. ∏ Û˘ÏÏoÁ‹ Ùo˘ Û¤ÚÌ·Ùo˜ Á›ÓoÓÙ·Ó Ì ·˘Ó·ÓÈÛÌfi ÛÂÁ˘¿ÏÈÓ· ·oÛÙÂÈڈ̤ӷ ‰o¯Â›·, ‡ÛÙÂÚ· ·fi ·o¯‹ 3-7 ËÌÂ-ÚÒÓ (4,4 Ë̤Ú˜ ± 1,2). ∞Ú¯Èο ÂϤÁ¯oÓÙ·Ó Ë Ú¢ÛÙoo›ËÛË,Ùo pH, Ë ÁÏoÈfiÙËÙ· Î·È o fiÁÎo˜ Ùo˘ Û¤ÚÌ·Ùo˜. ∏ ÂηÙoÛÙÈ-·›· ·Ó·ÏoÁ›· ÙˆÓ ÎÈÓËÙÒÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ÂϤÁ¯ıËΠÌÂÙËÓ ˘oÎÂÈÌÂÓÈ΋ ̤ıo‰o Û ıÂÚÌoÎÚ·Û›· ‰ˆÌ·Ù›o˘ (25° C).O ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ÚoÛ‰ÈoÚ›ÛıËΠ۠·Ó·-Ú·›ˆÙo ‰Â›ÁÌ· Û¤ÚÌ·Ùo˜ Ì ÙËÓ Ï¿Î· ̤ÙÚËÛ˘ Ùo˘ Ma-kler30,31. ∏ ÌoÚÊoÏoÁ›· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ÂÎÙÈÌ‹ıËÎÂÛ ÂȯڛÛÌ·Ù· Û¤ÚÌ·Ùo˜ o˘ ¯ÚˆÌ·Ù›ÛıËÎ·Ó Î·Ù¿ ¶··-ÓÈÎoÏ¿o˘32. ∞fi οı ›¯ÚÈÛÌ· Û¤ÚÌ·Ùo˜ ÂϤÁ¯ıËÎ·Ó 100ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Î·È Ë Î·Ù¿Ù·ÍË ÙˆÓ ÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·-ÏÈÒÓ ¤ÁÈÓ ۇÌʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Ùo˘ ¶·-ÁÎfiÛÌÈo˘ OÚÁ·ÓÈÛÌo‡ ÀÁ›·˜33. ∂ÈϤoÓ Î·Ù·ÁÚ¿ÊËηÓÎ·È Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· (∂ÈÎ. 1)o˘ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓoÓÙ·È ÛÙËÓ Î·Ù¿Ù·ÍË Ùo˘ ¶·ÁÎfiÛÌÈ-o˘ OÚÁ·ÓÈÛÌo‡ ÀÁ›·˜.

∏ ηٷÓoÌ‹ ÙˆÓ ÙÈÌÒÓ ÂÎÙÈÌ‹ıËΠ̠ÙoÓ ÚoÛ‰ÈoÚÈ-ÛÌfi Ùo˘ ‰Â›ÎÙË Kolmogorov–Smirnov. °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ·Ú·Ì¤ÙÚˆÓ Ùo˘ Û¤ÚÌ·Ùo˜ ÙˆÓ ˘oÁfiÓÈÌˆÓ Î·È ÙˆÓ ÁfiÓÈ-ÌˆÓ ·Ó‰ÚÒÓ, ÂÊfiÛoÓ Ë Î·Ù·ÓoÌ‹ ÙˆÓ ÙÈÌÒÓ ‹Ù·Ó oÌ·Ï‹, ¯ÚË-ÛÈÌooÈ‹ıËÎÂ Ë ‰oÎÈÌ·Û›· Student’s–t, ÂÓÒ ÂÊfiÛoÓ Ë Î·Ù·-ÓoÌ‹ ‰ÂÓ ‹Ù·Ó oÌ·Ï‹, ¯ÚËÛÈÌooÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ΋‰oÎÈÌ·Û›· Mann–Whitney. OÈ Û˘Û¯ÂÙ›ÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ ÙÈ-̤˜ ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ Ùo˘ Û¤ÚÌ·Ùo˜ ¤ÁÈÓ·Ó Ì ÙËÓÂÎÙ›ÌËÛË ÙˆÓ Û˘ÓÙÂÏÂÛÙÒÓ Û˘Û¯¤ÙÈÛ˘ Pearson. ÃÚËÛÈÌo-oÈ‹ıËΠÙo SPSS for Windows 95 (rel. 7,5, SPSS Inc, 1997).

∞¶O∆∂§∂™ª∞∆∞O ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ·Ó¿ ΢‚ÈÎfi Âη-ÙoÛÙfi, Ë ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›· ÙˆÓ ÎÈÓËÙÒÓ ÛÂÚ-Ì·Ùo˙ˆ·Ú›ˆÓ, Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· ÌÂ Ê˘ÛÈoÏoÁÈ΋

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 269

∂ÈÎ. 1. OÌ¿‰· ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘Ïo-ÎÂÊ·Ï›·. ªÂÁ¤ı˘ÓÛË x 1500.

Î·È ·ıoÏoÁÈ΋ ÌoÚÊoÏoÁ›· Î·È Ùo Û‡ÓoÏo ÙˆÓÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Û 100 ÛÂÚÌ·Ùo˙ˆ¿ÚÈ·ÛÙo˘˜ ˘oÁfiÓÈÌo˘˜ Î·È ÛÙo˘˜ ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜ (̤-ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚfi ÛÊ¿ÏÌ·, fiÚÈ· ÙˆÓ ÙÈÌÒÓ) ·Úo˘-ÛÈ¿˙oÓÙ·È ÛÙoÓ ›Ó·Î· 1. O ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo-˙ˆ·Ú›ˆÓ ·Ó¿ ΢‚ÈÎfi ÂηÙoÛÙfi, Ë ÂηÙoÛÙÈ·›· ·Ó·-ÏoÁ›· ÙˆÓ ÎÈÓËÙÒÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Î·È Ù· ÛÂÚ-Ì·Ùo˙ˆ¿ÚÈ· ÌÂ Ê˘ÛÈoÏoÁÈ΋ ÌoÚÊoÏoÁ›· ‹Ù·Ó ÛË-Ì·ÓÙÈο ¯·ÌËÏfiÙÂÚ· ÛÙo˘˜ ˘oÁfiÓÈÌo˘˜ ·fi fi,ÙÈÛÙo˘˜ ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜. ∞ÓÙ›ıÂÙ·, Ù· ÛÂÚÌ·Ùo˙ˆ¿-ÚÈ· Ì ·ıoÏoÁÈ΋ ÌoÚÊoÏoÁ›· Î·È Ùo Û‡ÓoÏo ÙˆÓÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Û 100 ÛÂÚÌ·Ùo˙ˆ¿ÚÈ·‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· (p < 0,001) ÛÙo˘˜ ˘o-ÁfiÓÈÌo˘˜ ·fi fi,ÙÈ ÛÙo˘˜ ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜.

∏ ̤ÛË ÙÈÌ‹ Ùo˘ ·ÚÈıÌo‡ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›-ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· ÛÙo˘˜ ˘oÁfiÓÈÌo˘˜¿Ó‰Ú˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË (p < 0,05) ·fiÂΛÓË ÙˆÓ ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ (¶›Ó. 1). ∆o ¤Ó· ÙÚ›ÙoÙˆÓ ˘oÁfiÓÈÌˆÓ (42 ÛÙo˘˜ 114, 36,8%) Î·È Ùo ¤Ó·Ù¤Ù·ÚÙo ÙˆÓ ÁfiÓÈÌˆÓ (15 ÛÙo˘˜ 60, 25%) ·Úo˘Û›·-˙·Ó ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·ÛÙ· ÂȯڛÛÌ·Ù· Û¤ÚÌ·Ùo˜. ∂ÈϤoÓ, 17 ·fi 114˘oÁfiÓÈÌo˘˜ ¿Ó‰Ú˜ (14,9%) ·Úo˘Û›·˙·Ó ÛÂÚÌ·-Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· Û ·ÚÈıÌfi˘„ËÏfiÙÂÚo ·fi Ùo ·ÓÒÙÂÚo Ê˘ÛÈoÏoÁÈÎfi fiÚÈo. ∞fiÙo˘˜ ¿Ó‰Ú˜ ·˘Ùo‡˜, ÛÙo˘˜ 11 (9,7%) Ùo oÛoÛÙfiÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·‹Ù·Ó 5-10%, ÛÙo˘˜ Ù¤ÛÛÂÚȘ (3,5%) 11-20%, ÛÙoÓ¤Ó·Ó (0,9%) 30% Î·È ÛÙoÓ ¤Ó·Ó (0,9%) ‹Ù·Ó 45%.

OÈ ·Ú¿ÌÂÙÚoÈ Ùo˘ Û¤ÚÌ·Ùo˜ Ì ÙȘ oo›Â˜‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Ùo˘ ·ÚÈıÌo‡ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ-·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· ‹Ù·Ó: 1. Ë Âη-ÙoÛÙÈ·›· ·Ó·ÏoÁ›· ÙˆÓ ·ıoÏoÁÈÎÒÓ ÛÂÚÌ·Ùo˙ˆ-·Ú›ˆÓ (p<0,01), 2. Ùo Û‡ÓoÏo ÙˆÓ ÌoÚÊoÏoÁÈÎÒӷӈ̷ÏÈÒÓ Û 100 ÛÂÚÌ·Ùo˙ˆ·Ú›· (p < 0,01), 3.

Ë ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì·ÈoÂȉ‹ ÎÂÊ·Ï‹ (p < 0,05), 4. Ë ÂηÙoÛÙÈ·›· ·Ó·-ÏoÁ›· ÙˆÓ ·Î¤Ê·ÏˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ (p <0,05), 5. o ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ۷-Ṳ̂Óo ·˘¯¤Ó· (p < 0,05), Î·È 6. o ‰Â›ÎÙ˘ ‰˘ÛÌoÚ-Ê›·˜ Ùo˘ Û¤ÚÌ·Ùo˜ (p < 0,01).

™À∑∏∆∏™∏O Û˘ÓoÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓÛ 100 ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· ‹Ù·Ó ÛËÌ·ÓÙÈο ̆ „ËÏfiÙÂÚo˜·fi ÙËÓ ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›-ˆÓ Ì ·ıoÏoÁÈ΋ ÌoÚÊoÏoÁ›· Î·È ÛÙo˘˜ ˘oÁfiÓÈ-Ìo˘˜ Î·È ÛÙo˘˜ ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜ (¶›Ó. 1). ŸÛo Ì¿ÏÈ-ÛÙ· ̆ „ËÏfiÙÂÚË ‹Ù·Ó Ë ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›· ÙˆÓ ·-ıoÏoÁÈÎÒÓ ÌoÚÊÒÓ ÙfiÛo ˘„ËÏfiÙÂÚ· ‚ÚÈÛÎfiÙ·Ó ÙoÛ‡ÓoÏo ÙˆÓ ÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Û 100 ÛÂÚ-Ì·Ùo˙ˆ¿ÚÈ·. ŒÙÛÈ, Ùo Û‡ÓoÏo ÙˆÓ ÌoÚÊoÏoÁÈÎÒӷӈ̷ÏÈÒÓ Û 100 ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· ÛÙo˘˜ ˘oÁfiÓÈ-Ìo˘˜ ¿Ó‰Ú˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚo ·fi ÂΛÓoÙˆÓ ˘oÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ (p < 0,001). ∂›Ó·È ÁÓˆÛÙfifiÙÈ ¤Ó· ·ıoÏoÁÈÎfi ÛÂÚÌ·Ùo˙ˆ¿ÚÈo ÌoÚ› Ó· ·-Úo˘ÛÈ¿˙ÂÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ÌoÚÊoÏoÁÈΤ˜ ·Óˆ-̷ϛ˜ (∂ÈÎ. 2). ∆o ÛÂÚÌ·Ùo˙ˆ¿ÚÈo ·˘Ùfi ηٷÁÚ¿-ÊÂÙ·È ·Ú¯Èο ˆ˜ ·ıoÏoÁÈÎfi, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ÂηÙoÛÙÈ·›·˜ ·Ó·ÏoÁ›·˜ Ê˘ÛÈoÏoÁÈÎÒÓ Î·È ·ıoÏo-ÁÈÎÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, οı ·ÓˆÌ·Ï›· Ùo˘ ηٷ-ÁÚ¿ÊÂÙ·È Í¯ˆÚÈÛÙ¿, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ùo˘ ·ÚÈıÌo‡Ùo˘ ›‰o˘˜ Ù˘ ÌoÚÊoÏoÁÈ΋˜ ·ÓˆÌ·Ï›·˜. ∏ Ù·ÎÙÈ΋·˘Ù‹ ÂÊ·ÚÌfi˙ÂÙ·È, ÁÈ·Ù› ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÁoÓÈÌfiÙËÙ· ¤¯ÂÈ Ë ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›· Ùo˘ ›‰o˘˜Ù˘ ÌoÚÊoÏoÁÈ΋˜ ·ÓˆÌ·Ï›·˜ Î·È fi¯È o ·ÚÈıÌfi˜ ÙˆÓ·ıoÏoÁÈÎÒÓ ÌoÚÊÒÓ34.

™ÂÚÌ·Ùo˙ˆ¿ÚÈ· ¯ˆÚ›˜ ·ÎÚoÛÒÌÈo (Ì ÌÈ-ÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·) ‚Ú¤ıËÎ·Ó ÛÙo 36,8% ÙˆÓ

270 ¢. ¶ANI¢H™ KAI ™YN.

¶›Ó·Î·˜ 1. ∆È̤˜ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ùo˘ Û¤ÚÌ·Ùo˜ (̤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚfi ÛÊ¿ÏÌ·, fiÚÈ· ÙÈÌÒÓ) ÛÙ· ¿ÙoÌ· o˘ ÌÂÏÂÙ‹ıËηÓ

¶·Ú¿ÌÂÙÚoÈ o˘ ÌÂÏÂÙ‹ıËÎ·Ó ÀoÁfiÓÈÌoÈ ¿Ó‰Ú˜ °fiÓÈÌoÈ ¿Ó‰Ú˜(n = 114) (n = 60)

1. ∞ÚÈıÌfi˜ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ 22,9 ± 1,9 77,4 ± 3,6(106/ml) (0,3 - 82,4) (31,9 - 148,3)

2. ∫ÈÓËÙ¿ ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· 31,2 ± 1,5 60,6 ± 1,2(%) (0 - 61,7) (39,8 - 78,4)

3. º˘ÛÈoÏoÁÈο ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· 15,5 ± 0,9 46,3 ± 0,9(%) (0 - 44) (34 - 64)

4. ¶·ıoÏoÁÈο ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· 84,5 ± 0,9 53,7 ± 0,9(%) (63 - 100) (36 - 66)

5. ™‡ÓoÏo ÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ 127,7 ± 2,2 70,9 ± 1,5(ÛÙ· 100 ÛÂÚÌ·Ùo˙ˆ¿ÚÈ·) (77 - 186) (49 - 93)

6. ™ÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì 2,3 ± 0,5 0,5 ± 0,1ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· (%) (0 - 45) (0 - 4)

‰ÂÈÁÌ¿ÙˆÓ Û¤ÚÌ·Ùo˜ ÙˆÓ ˘oÁfiÓÈÌˆÓ Î·È ÛÙo25% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Û¤ÚÌ·Ùo˜ ÙˆÓ ÁfiÓÈÌˆÓ ·Ó-‰ÚÒÓ, ·Ú·Ù‹ÚËÛË o˘ ‰Â›¯ÓÂÈ fiÙÈ Ë ÌoÚÊoÏoÁÈ΋·˘Ù‹ ·ÓˆÌ·Ï›· Â›Ó·È Û˘¯Ó‹ ÙfiÛo ÛÙo˘˜ ˘oÁfiÓÈ-Ìo˘˜ fiÛo Î·È ÛÙo˘˜ ÁfiÓÈÌo˘˜ ¿Ó‰Ú˜. ∏ ̤ÛË ÙÈÌ‹,fï˜, ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘Ïo-ÎÂÊ·Ï›· ÛÙo˘˜ ˘oÁfiÓÈÌo˘˜ ¿Ó‰Ú˜ (2,3% ± 5)‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË (p < 0,05) ·fi ÂΛÓËÙˆÓ ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ (0,5% ± 0,1) (¶ÈÓ. 1). ∂È-ϤoÓ, Ùo 14,9% ÙˆÓ ˘oÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ ·Úo˘Û›-·˙ ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· ¯ˆÚ›˜ ·ÎÚoÛÒÌÈo Û ·ÚÈıÌfi˘„ËÏfiÙÂÚo ·fi Ùo ·ÓÒÙÂÚo Ê˘ÛÈoÏoÁÈÎfi fiÚÈo ηÈÙo 5,3% Û ÙÈÌ‹ ˘„ËÏfiÙÂÚË ·fi Ùo 10% ÙˆÓ ÛÂÚ-Ì·Ùo˙ˆ·Ú›ˆÓ. ™Â oÚÈṲ̂Ó˜, ÏoÈfiÓ, ÂÚÈÙÒÛÂȘ˘oÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ Ë ˘oÁoÓÈÌfiÙËÙ¿ Ùo˘˜ ı· Ìo-Úo‡Û ӷ ·o‰oı› ÛÙo ·›ÙÈo o˘ o‰ËÁ› ÛÙËÓ ÂÌ-Ê¿ÓÈÛË Ù˘ ÌoÚÊoÏoÁÈ΋˜ ·˘Ù‹˜ ·ÓˆÌ·Ï›·˜.

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, ˘¿Ú¯o˘Ó ÂÚÈoÚÈṲ̂ӷ‰Â‰o̤ӷ Û fi,ÙÈ ·ÊoÚ¿ ÙËÓ ‡·ÚÍË ÛÂÚÌ·Ùo˙ˆ-·Ú›ˆÓ ¯ˆÚ›˜ ·ÎÚoÛÒÌÈo ÛÙ· ‰Â›ÁÌ·Ù· Û¤ÚÌ·Ùo˜ÙˆÓ ˘oÁfiÓÈÌˆÓ Î·È ÙˆÓ ÁfiÓÈÌˆÓ ·Ó‰ÚÒÓ22. ∏·o˘Û›· ‰Â‰oÌ¤ÓˆÓ oÊ›ÏÂÙ·È ÛÙo ÁÂÁoÓfi˜ fiÙÈ o¶·ÁÎfiÛÌÈo˜ OÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ ‰ÂÓ Û˘ÌÂÚȤϷ-‚ ٷ ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·-Ï›· ÛÙËÓ Î·Ù¿Ù·ÍË ÙˆÓ ÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ33.

O ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ¯ˆÚ›˜ ·ÎÚo-ÛÒÌÈo ·Úo˘Û›·˙ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË, ÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋ (p < 0,01), Î·È Ì ÙËÓ ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›·ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ·ıoÏoÁÈ΋ ÌoÚÊoÏoÁ›·Î·È Ì Ùo Û‡ÓoÏo ÙˆÓ ÌoÚÊoÏoÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙ·100 ÛÂÚÌ·Ùo˙ˆ¿ÚÈ·. ŸÛo, ÏoÈfiÓ, ÌÂÁ·Ï‡ÙÂÚo˜ ›-Ó·È o ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁ-Á˘ÏoÎÂÊ·Ï›· ÙfiÛo ˘„ËÏfiÙÂÚË Â›Ó·È Ë ÂηÙoÛÙÈ·›··Ó·ÏoÁ›· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ·ıoÏoÁÈ΋ÌoÚÊoÏoÁ›· Î·È ÙfiÛo ÂÚÈÛÛfiÙÂÚ˜ Â›Ó·È oÈ ÌoÚÊo-

ÏoÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ·Ó¿ ÛÂÚÌ·Ùo˙ˆ¿ÚÈo. ∏ ÙÂÏ¢-Ù·›· ·Ú·Ù‹ÚËÛË ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ÙË ÛËÌ·ÓÙÈ΋ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙoÓ ·ÚÈıÌfi ÙˆÓ ÛÂÚÌ·-Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· Î·È ÛÙoÓ ·ÚÈ-ıÌfi ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ۷Ṳ̂Óo ·˘¯¤Ó· (p< 0,05). º·›ÓÂÙ·È fiÙÈ Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ÌÈÎÚo-ÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· ·Úo˘ÛÈ¿˙o˘Ó oχ Û˘¯ÓfiÙÂÚ·ÌoÚÊoÏoÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ùo˘ ·˘¯¤Ó· ·fi fi,ÙÈ Ù·ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· ÌÂ Ê˘ÛÈoÏoÁÈ΋ ÎÂÊ·Ï‹. ∆¤Ïo˜, o·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘Ïo-ÎÂÊ·Ï›· ·Úo˘Û›·˙ ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË (p< 0,05) Î·È Ì ÙËÓ ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›· ÙˆÓ ·Î¤Ê·-ÏˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Î·È Ì ÙËÓ ÂηÙoÛÙÈ·›· ·Ó·-ÏoÁ›· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ·ÈoÂȉ‹ ÎÂÊ·Ï‹. ∏Û˘Û¯¤ÙÈÛË ·˘Ù‹ ÛÙËÚ›˙ÂÈ ÙËÓ ¿o„Ë fiÙÈ Ù· ÛÂÚÌ·Ùo-˙ˆ¿ÚÈ· Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·, Ù· ·Î¤Ê·Ï·ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Î·È Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ·ÈoÂÈ-‰‹ ÎÂÊ·Ï‹ Â›Ó·È ÂӉ¯o̤ӈ˜ Ùo ·oÙ¤ÏÂÛÌ· Ùo˘›‰Èo˘ ·ıoÏoÁÈÎo‡ ÌoÚÊoÁÂÓÂÙÈÎo‡ Ì˯·ÓÈÛÌo‡.

∏ ˘oÁoÓÈÌfiÙËÙ· ÙˆÓ ·Ó‰ÚÒÓ o˘ ·Úo˘ÛÈ¿-˙o˘Ó ÛÙo Û¤ÚÌ· Ùo˘˜ ˘„ËÏ‹ ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›·ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ ¯ˆÚ›˜ ·ÎÚoÛÒÌÈo oÊ›ÏÂÙ·È ÛÙoÁÂÁoÓfi˜ fiÙÈ Ù· ÛÂÚÌ·Ùo˙ˆ¿ÚÈ· ·˘Ù¿ ‰ÂÓ ÌoÚo‡ÓÓ· Û˘Ó‰Âıo‡Ó Ì ÙË ‰È·Ê·Ó‹ ˙ÒÓË Î·È Ó· ‰ÈÂÈÛ‰‡-Ûo˘Ó ÛÙo ˆ¿ÚÈo. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÚÒÙË ·ÓÙ›‰Ú·-ÛË ·Ó¿ÌÂÛ· ÛÙo ÛÂÚÌ·Ùo˙ˆ¿ÚÈo Î·È ÛÙo ˆ¿ÚÈo Á›-ÓÂÙ·È ÛÙË ‰È·Ê·Ó‹ ˙ÒÓË. ∏ ‰È·Ê·Ó‹˜ ˙ÒÓË Â›Ó·È ¤Ó·ÂÍˆÎ˘ÙÙ·ÚÈÎfi ÛÙÚÒÌ·, o˘ ·Ú¿ÁÂÙ·È ·fi Ùo ˆ¿ÚÈoÛÙ· ÚÒÙ· ÛÙ¿‰È· Ù˘ ·Ó¿Ù˘Í‹˜ Ùo˘ Î·È ÂÓÙo›˙ÂÙ·È·Ó¿ÌÂÛ· ÛÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË Î·È ÛÙo ÂÛˆÙÂÚÈ-Îfi ÛÙÚÒÌ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ˆoÊfiÚo˘ ‰›ÛÎo˘. ∆oÛÙÚÒÌ· ·˘Ùfi ‰ÂÓ ÂÚȤ¯ÂÈ Î‡ÙÙ·Ú·, ·›˙ÂÈ fï˜ ÛË-Ì·ÓÙÈÎfi ÚfiÏo ÛÙË ‰È·‰Èηۛ· Ù˘ ÁoÓÈÌoo›ËÛ˘.∞oÙÂÏÂ›Ù·È ·fi ÙÚÂȘ ‰È·ÊoÚÂÙÈΤ˜ ÁÏ˘ÎoÚˆÙ½-Ó˜, ·fi ÙȘ oo›Â˜ Ë ÁÏ˘ÎoÚˆÙ½ÓË 3 ¤¯ÂÈ ÌÂÏÂÙËı›ÂÚÈÛÛfiÙÂÚo. ∏ ÁÏ˘ÎoÚˆÙ½ÓË ·˘Ù‹ Û˘Ó›ÛÙ·Ù·È ·fiÌÈ· oÏ˘ÂÙȉÈ΋ ·Ï˘Û›‰·, ÛÙËÓ oo›· Û˘Ó‰¤oÓÙ·È·ÚÎÂÙ¿ oÏÈÁo۷ί·Ú›‰È·, Î·È ·oÙÂÏ› ÂȉÈÎfi, Áȷοı ˙ˆ˚Îfi ›‰o˜, ˘o‰o¯¤· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ.

·oÙÂÏ› ·ÎfiÌË ·Ú¿ÁoÓÙ· o˘ Úo¿ÁÂÈ ÙËÓ ·ÓÙ›-‰Ú·ÛË Ùo˘ ·ÎÚoÛÒÌ·Ùo˜. ∏ ÈηÓfiÙËÙ· Ù˘ ÁÏ˘Îo-ÚˆÙ½Ó˘ 3 Ó· ·oÙÂÏ› ̆ o‰o¯¤· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ-·Ú›ˆÓ ·o‰›‰ÂÙ·È ÛÙo oÏÈÁo۷ί·ÚȉÈÎfi Ù˘ ÎÏ¿-ÛÌ·, ÂÓÒ Ë ÈηÓfiÙËÙ¿ Ù˘ Ó· Úo¿ÁÂÈ ÙËÓ ·ÓÙ›‰Ú·ÛËÙo˘ ·ÎÚoÛÒÌ·Ùo˜ ÂÍ·ÚÙ¿Ù·È ·fi Ùo oÏ˘ÂÙȉÈÎfiÙ˘ ÙÌ‹Ì·. ∏ ·oÙ˘¯›· ÁoÓÈÌoo›ËÛ˘, ÏoÈfiÓ, ÙˆÓÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓ Ì ÌÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›· ı·ÌoÚo‡Û ӷ ·o‰oı› Î·È Û ·‰˘Ó·Ì›· Û‡Ó‰ÂÛ˘Ùo˘ ÛÂÚÌ·Ùo˙ˆ·Ú›o˘ Ì ÙË ‰È·Ê·Ó‹ ˙ÒÓË Î·È ÛÙËÓ·o˘Û›· ·ÎÚoÛÒÌ·Ùo˜35.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 271

∂ÈÎ. 2. ™ÂÚÌ·Ùo˙ˆ¿ÚÈ· Ì ·ÈoÂȉ‹ ÎÂÊ·Ï‹ Î·È Û·-Ṳ̂Óo ·˘¯¤Ó· (ÛËÌÂÈÒÓoÓÙ·È Ì ÙfiÍo). ªÂÁ¤ı˘ÓÛË x 1000.

ABSTRACTPanidis D, Kourtis A, Pidonia I, Rousso D,Mavromatidis G, Stergiopoulos K, Vavilis D.Round–headed human spermatozoa in semenspecimens of infertile and fertile men. Hell Iatr,2000, 66: 268 - 273.

Round–headed spermatozoa were evaluated insemen specimens from 114 infertile and 60 fertilemen. It was found that: 1) round-headed sperma-tozoa existed in semen specimens of 36.8% of in-fertile and 25% of fertile men, 2) the percentage ofround-headed spermatozoa were 2.3% ± 0.5 in in-fertile and 0.5% ± 0.1 in fertile men, and 3) the14.9% of infertile men presented round–headed sper-matozoa in higher percentage than the upper normallimit. It is concluded that in some cases of infertilemen with high percentage of round–headed sperma-tozoa, their infertility could be attributed to the causewhich produces that morphological abnormality.Moreover, morphological abnormalities in the neckare significantly more frequent in round-headed spe-rmatozoa than in spermatozoa with a normal head.

µπµ§πO°ƒ∞ºπ∞1. MacLeod J, Gold RA. An analysis of the motile activity in the

spermatozoa of 1,000 men and 1,000 men in infertilemarriages. Fertil Steril 1951, 2: 187-93.

2. Aughey E, Drr PS. An unusual abnormality of human sper-matozoa. J Reprod Fertil 1978, 53: 341-5.

3. Shirren CG, Holstein AF, Schirren C. Uber die morphoge-nese rundkopfiger spermatozoen des menschen. Andro-logie 1971, 3: 117-22.

4. Holstein AF, Shirren C, Shirren CG. Human spermatids andspermatozoa lacking acrosomes. J Reprod Fertil 1973,35: 489-93.

5. Pedersen H, Rebbe H. Fine structure of round-headed hu-man spermatozoa. J Reprod Fertil 1974, 37: 51-6.

6. Kullander S, Rausing A. On round-headed human spermato-zoa. Int J Fertil 1975, 20: 33-8.

7. Baccetti B, Renieri T, Rosati F, Selmi MG, Casanova S. Fur-ther observations on the morphogenesis of the roundheaded human spermatozoa. Andrologia 1977, 9: 255-60.

8. Castellani L, Chiara F, Cotelli F. Fine structure and cytoche-mistry of the morphogenesis of round headed humansperm. Arch Androl 1978, 1: 291-6.

9. Nistal M, Paniagua R. Morphogenesis of round-headed hu-man spermatozoa lacking acrosomes in a case of severeteratospermia. Andrologia 1978, 10: 49-53.

10. Nistal M, Herruso A, Sanchez-Corral F. Teratospermia ab-soluta de presentation familiar. Espermatozoides mi-crocefalos irregulares sin acrosoma. Andrologia 1978,10: 234-9.

11. Weissenberg R, Eshkol A, Rudak E, Lunenfeld B. Inability of

round acrosomeless human spermatozoa to penetratezona-free hamster ova. Arch Androl 1982, 11: 167-72.

12. ¶·Ó›‰Ë˜ ¢, ªÚfi˙o˜ °, ∞Ú‚·ÓÈÙ›‰o˘-µ·ÁȈӿ ª, ªo˘Û·-Ù¿Ù ∆, ¶··Ïo˘Î¿˜ ∞. ªÈÎÚoÛÙÚoÁÁ˘ÏoÎÂÊ·Ï›·: ªÈ·Û¿ÓÈ· ÌoÚÊoÏoÁÈ΋ ·ÓˆÌ·Ï›· ÙˆÓ ÛÂÚÌ·Ùo˙ˆ·Ú›ˆÓo˘ Û˘Óo‰Â‡ÂÙ·È Ì ÛÙÂÈÚfiÙËÙ·. MMG 1984, 12: 489-92.

13. Syms AJ, Johnson A, Lipshultz LI, Smith RG. Studies on hu-man spermatozoa with round head syndrome. Fertil Ste-ril 1984, 41: 175-80.

14. Tyler JP, Boadle RA, Stevens SM. Round-headed spermato-zoa: a case report. Pathology 1985, 17: 67-70.

15. Radwan J, Pawlicki J, Bastit P. Male sterility caused by alack of the acrosome in spermatozoa with a roundshaped head. Ginekol Pol 1994, 65: 537-40.

16. Anton-Lamprecht I. Round-headed spermatozoa. Derma-tologica 1976, 153: 99-101.

17. Wolff HH, Schill WB, Moritz P. Round-headed spermato-zoa: a rare andologic finding (“globe-headed spermato-zoa” “globozoospermia”). Hautarzt 1976, 27: 111-6.

18. Florke-Gerloff S, Topfer-Peterson E, Muller-Esterl W, SchillWB, Engel W. Acrosin and the acrosome in human sper-matogenesis. Hum Genet 1983, 65: 61-7.

19. Weissenberg R, Eshkol A, Rudak E, Lunenfeld B. Inability ofround acrosomeless human spermatozoa to penetratezona–free hamster ova. Arch Androl 1983, 11: 167-9.

20. Florke-Gerloff S, Topfer-Petersen E, Muller-Esterl W, Man-souri A, Schatz R, Schirren C, Schill W, Engel W. Bioche-mical and genetic investigation of round-headed sperma-tozoa in infertile men including two brothers and theirfather. Andrologia 1984, 16: 187-202.

21. Flork-Gerloff S, Krause W, Topfer-Retersen E, Tschesche IT,Muller-Ester W, Engel W. On the teratogenesis or round–headed spermatozoa investigations with antibodiesagainst acrosin, an intraacrosomally located acrosin–in-hibitor, and the outer acrosomal membrane. Andrologia1985, 17: 126-38.

22. Schirren C, Juratli A. Insreased percentage of round-head-ed spermatozoa in human ejaculate. Andrologia 1987,19: 497-503.

23. Lalonde L, Langlais J, Antaki P, Chapdelaine A, Roberts KD,Bleau G. Male infertility with round–headed acro-someless spematozoa. Fertil Steril 1988, 49: 316-21.

24. Blanchard Y, Lescoat D, Le Lannou D. Anomalous distri-bution of nuclear basic proteins in round-headed humanspermatozoa. Andrologia 1990, 22: 549-55.

25. Escalier D. Failure of differentiation on the nuclear-perinu-clear skeletal complex in the round-headed human sper-matozoa. Int J Dev Biol 1990, 34: 287-97.

26. Von Brnhardi R, de Ioannes AE, Blanco LP, Herrera E, Bu-stos-Obregon E, Vigil P. Round-headed spermatozoa: amodel to study the role of the acrosome in early eventsof gamete interaction. Andrologia 1990, 22: 12-20.

27. Singh G. Ultrastructural features of round-headed humanspermatozoa. Int J Fertil 1992, 37: 99-102.

28. Bourne H, Liu DY, Clarke GN, Baker HW. Normal fertiliza-tion and embryo development by intracytoplasmic sperminjection of round-headed acrosomeless sperm. FertilSteril 1995, 63: 1329-32.

272 ¢. ¶ANI¢H™ KAI ™YN.

29. Anton-Lamprecht I, Kotzur B, Schopf E. Round-headed hu-man spermatozoa. Fertil Steril 1976, 27: 658-93.

30. Makler A. The improved ten-micrometer chamber for rapidsperm count and motility evaluation. Fertil Steril 1980,33: 337-8.

31. Panidis DK, Asseo PP, Papaloucas AC. Semen parametersin 114 fertile men. Europ J Obstet Gynec Reprod Biol1984, 16: 411-20.

32. Panidis D, Brozos G, Margaritis B, Vlassis G, Makedos G,Papaloucas A. The contribution of sperm morphology tothe diagnostic approach of varicocele. Acta Endocrinol(Suppl.) 1984, 265: 20-1.

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AÏÏËÏoÁÚ·Ê›·:¢. ¶·Ó›‰Ë˜ªËÙÚofiψ˜ 11954622 – £ÂÛÛ·ÏoÓ›ÎË

Corresponding author:D. Panidis119, Mitropoleos Str.54622 - ThessalonikiGreece

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 273

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 274 - 278

MÂϤÙË ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ÂÓ‹ÏÈÎˆÓ Â›Ì˘ˆÓ,ÌÂÙ¿ ·fi ı˘ÌÂÎÙÔÌ‹ Û ‰È·ÊÔÚÂÙÈ΋ ÓÂÔÁÓÈ΋ ËÏÈΛ·

A. K·˝ÎË-AÛÙ¿Ú·, ¢. OÈÎÔÓfiÌÔ˘, °. °Î›Ì·˜

EÚÁ·ÛÙ‹ÚÈÔ ¶ÂÈÚ·Ì·ÙÈ΋˜ º˘ÛÈÔÏÔÁ›·˜, TÌ‹Ì· I·ÙÚÈ΋˜ A¶£

¶ÂÚ›ÏË„Ë. ªÂÏÂÙ‹ıËÎ·Ó ÔÈ ÂȉڿÛÂȘ ÙÔ˘ ı‡ÌÔ˘·‰¤Ó· ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ ÂÈıËÏ›Ô˘ÛÂ Â›Ì˘Â˜ Ê˘Ï‹˜ Wistar, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ı˘ÌÂÎÙÔ-ÌËı› Û ‰È·ÊÔÚÂÙÈΤ˜ Ë̤Ú˜ Ù˘ ÓÂÔÁÓÈ΋˜ ÙÔ˘˜ËÏÈΛ·˜ (2Ë Î·È 9Ë Ë̤ڷ). ø˜ ·Ú¿ÌÂÙÚÔÈ ¯ÚËÛÈÌÔ-ÔÈ‹ıËÎ·Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Ô ÏfiÁÔ˜ “‚¿-ÚÔ˜ fiگˆÓ/‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜” ÙˆÓ ÂÈ̇ˆÓ fiψÓÙˆÓ ÔÌ¿‰ˆÓ, ηıÒ˜ Î·È Ë ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙˆÓfiÚ¯ÂÒÓ ÙÔ˘˜, Û 200-250 Ë̤Ú˜ ·fi ÙË Á¤ÓÓËÛ‹ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ‰ÂÓ ˘‹Ú¯·ÓÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·-ÙÔ˜ Î·È ÙÔ ÏfiÁÔ “‚¿ÚÔ˜ fiگˆÓ/‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜”fiÏˆÓ ÙˆÓ ı˘ÌÂÎÙÔÌËı¤ÓÙˆÓ (∆x) ÂÈ̇ˆÓ, Û ۇ-ÁÎÚÈÛË Ì ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ „¢‰ÔÂÁ¯ÂÈÚÈṲ̂ÓÔ˘˜(D) Â›Ì˘Â˜. ∞ÓÙ›ıÂÙ·, ·Ú·ÙËÚ‹ıËÎ·Ó ÈÛÙÔÏÔÁÈΤ˜ÌÂÙ·‚ÔϤ˜ ÛÙÔ˘˜ fiÚ¯ÂȘ ÌfiÓÔ ÂÎÂ›ÓˆÓ ÙˆÓ ÂÈ̇ˆÓÔÈ ÔÔ›ÔÈ ı˘ÌÂÎÙÔÌ‹ıËÎ·Ó Û ËÏÈΛ· ‰‡Ô ËÌÂÚÒÓ,

ÌÂÙ¿ ·fi Û‡ÁÎÚÈÛË Ì ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ Ì¿ÚÙ˘-Ú˜. ™˘ÁÎÂÎÚÈ̤ӷ, ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ÂÍ‹˜: ÌÂÚÈ΋·Ô‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ËÔÔ›· ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó Î˘Ú›ˆ˜ ·fi ÂÏ¿ÙÙˆÛË, η-Ù¿ ÙfiÔ˘˜, ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÛÂÚÌ·ÙÔÁÔÓ›ˆÓ ηÈÙˆÓ ÛÂÚÌ·ÙÔ΢ÙÙ¿ÚˆÓ, Ì ·ÚÔ˘Û›· ÎÂÓÔÙÔȈ-‰ÒÓ ¯ÒÚˆÓ ÌÂٷ͇ ÙÔ˘˜. ∆· ÛÂÚÌ·ÙÔ·ÙÙ·Ú··ÚÔ˘Û›·˙·Ó ·˘ÍË̤ӷ ÎÂÓÔÙfiÈ· ÂÓÙfi˜ ÙÔ˘ ΢Ù-Ù·ÚÔÏ¿ÛÌ·Ùfi˜ ÙÔ˘˜, Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓÙÔ˘ Sertoli ‹Ù·Ó Û ÌÂÚÈο ÛÂÚÌ·ÙÈο ÛˆÏËÓ¿ÚÈ·ÂÏ·Ùو̤ÓÔ˜, ÂÓÒ Ë ÌÔÚÊÔÏÔÁ›· ÔÚÈÛÌ¤ÓˆÓ Î˘ÙÙ¿-ÚˆÓ ÙÔ˘ Sertoli ‰ÂÓ ‹Ù·Ó ÙÂÏ›ˆ˜ Ê˘ÛÈÔÏÔÁÈ΋. ∞fiÙ· ·ÔÙÂϤÛÌ·Ù· ÂÍ¿ÁÂÙ·È ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë‡·ÚÍË ÙÔ˘ ı‡ÌÔ˘ ·‰¤Ó· Â›Ó·È ··Ú·›ÙËÙË Î·Ù¿ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ ÙˆÓ ÂÈ̇ˆÓ, ÁÈ· ÙËÓ·Ó¿Ù˘ÍË ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ ÙÔ˘˜ ÂÈıËÏ›Ô˘. EÏÏËÓ I·ÙÚ 2000, 66: 274 - 278.

∏ ‡·ÚÍË ·ÏÏËÏÂȉڿÛÂˆÓ ÌÂٷ͇ ÙÔ˘ ·ÓÔÛÈ·-ÎÔ‡ Î·È ÙÔ˘ ÂÓ‰ÔÎÚÈÓÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¤¯ÂÈ ÚÔÙ·-ı› ·fi ÔÏÏÔ‡˜ ÂÈÛÙ‹ÌÔÓ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·,ÒÛÙÂ Ë ¿Ô„Ë ·˘Ù‹ Â›Ó·È Ï¤ÔÓ ·Ô‰ÂÎÙ‹.

¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜, ÌÂÙ¿ ·fi ÂÈÚ·Ì·ÙÈΤ˜ ÌÂ-ϤÙ˜, Û˘Ì¤Ú·Ó·Ó fiÙÈ Ô ı‡ÌÔ˜ ·‰¤Ó·˜ Â›Ó·È ··-Ú·›ÙËÙÔ˜ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·Ó··-Ú·ÁˆÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ˙ÒˆÓ. ∏ ÂÌÊ¿ÓÈÛË ·-ÙÚÔÊ›·˜ Û fiÚ¯ÂȘ ÙÚˆÎÙÈÎÒÓ Ù· ÔÔ›· ›¯·Ó ı˘ÌÂ-ÎÙÔÌËı› ηٿ ÙË ÓÂÔÁÓÈ΋ ÙÔ˘˜ ËÏÈΛ·, ‚‚·ÈÒÓÂÈÙËÓ ·Ú·¿Óˆ ÚfiÙ·ÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ1-3. ŸÌˆ˜˘¿Ú¯Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ·fi„ÂȘ Û¯ÂÙÈο Ì ÙËÓËÏÈΛ· Ô˘ ¤¯Ô˘Ó Ù· ˙Ò· ηٿ ÙË ı˘ÌÂÎÙÔÌ‹, ÚÔ-ÎÂÈ̤ÓÔ˘ Ó· ÂÌÊ·ÓÈÛıÔ‡Ó ÌÂÙ·‚ÔϤ˜ ÛÙÔ˘˜ fiÚ-¯ÂȘ1,2,4.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ıÂÏ‹Û·Ì ӷ ÂÍÂÙ¿ÛÔ˘-Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ı‡ÌÔ˘ ·‰¤Ó· ÛÙËÓ ·Ó¿Ù˘ÍËÙˆÓ fiÚ¯ÂˆÓ ÂÈ̇ˆÓ, ÔÈ ÔÔ›ÔÈ ı˘ÌÂÎÙÔÌ‹ıËηÓÛ ‰È·ÊÔÚÂÙÈÎfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ ÓÂÔÁÓÈ΋˜ÙÔ˘˜ ËÏÈΛ·˜.

À§π∫√ ∫∞π ª∂£√¢√π ÃÚËÛÈÌooÈ‹ıËÎ·Ó 21 ¿ÚÚÂÓ˜ Â›Ì˘Â˜, Ê˘Ï‹˜ Wistar, ·fiÙËÓ Î·ÏÏȤÚÁÂÈ· Ùo˘ ∂ÚÁ·ÛÙËÚ›o˘ Ì·˜. ∆· ˙Ò· ‰È·ÙËÚo‡-ÓÙ·Ó ÛÂ Û˘Óı‹Î˜ ÛÙ·ıÂÚ‹˜ ıÂÚÌoÎÚ·Û›·˜ 22ÆC ± 2ÆC ηÈÙo˘˜ ¯oÚËÁfiÙ·Ó ¿ÊıoÓË ÙÚoÊ‹ Î·È ÓÂÚfi. ™Ù· ΢oÊoÚo‡ÓÙ·˙Ò· Î·È ÙȘ ÌËÙ¤Ú˜ ‰ÈÓfiÙ·Ó ÂÈϤoÓ Á¿Ï· Î·È Ï·¯·ÓÈοÁÈ· ÙoÓ ÂÚÈoÚÈÛÌfi Ùo˘ ηÓÓÈ‚·ÏÈÛÌo‡ ÙˆÓ ÌËÙ¤ÚˆÓ Úo˜ Ù·ÓÂoÁÓ¿ Ùo˘˜5. ∏ Ë̤ڷ Ù˘ Á¤ÓÓËÛ˘ ÙˆÓ ÂÈ̇ˆÓ ıˆÚo‡-ÓÙ·Ó ˆ˜ Ë ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ Ùo˘˜.

∏ ı˘ÌÂÎÙoÌ‹ ÙˆÓ ÂÈ̇ˆÓ ÁÈÓfiÙ·Ó Î·Ù¿ ÙË ‰Â‡ÙÂÚË Î·È

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¤Ó·ÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ Ùo˘˜ (oÌ¿‰Â˜ Tx2 Î·È Tx9 ·ÓÙ›ÛÙoȯ·),Ì ·Ó·ÚÚfiÊËÛË Ùo˘ ·‰¤Ó·, ÌÂÙ¿ ·fi ·Ó·ÈÛıËÛ›· Ì ˘oıÂÚ-Ì›· ‰È¿ „‡Íˆ˜. °È· οı ̛· oÌ¿‰· ˘‹Ú¯Â ˆ˜ Ì¿ÚÙ˘Ú·˜·ÓÙ›ÛÙoÈ¯Ë oÌ¿‰· „¢‰oÂÁ¯ÂÈÚÈÛÌ¤ÓˆÓ ÂÈ̇ˆÓ (D2 Î·È D9·ÓÙ›ÛÙoȯ·) (EÈÎ. 1).

∆· ˙Ò· ı˘ÛÈ¿˙oÓÙ·Ó Û ËÏÈΛ· 200-250 ËÌÂÚÒÓ ·Êo‡ÚoËÁo˘Ì¤Óˆ˜ Ï·Ì‚·ÓfiÙ·Ó Ùo ‚¿Úo˜ Ùo˘ ÛÒÌ·Ùfi˜ Ùo˘˜. ∂›-Û˘ ·Ê·ÈÚo‡ÓÙ·Ó oÈ fiÚ¯ÂȘ Ùo˘˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÁÈÓfiÙ·ÓÂȂ‚·›ˆÛË Ù˘ Ï‹Úo˘˜ ı˘ÌÂÎÙoÌ‹˜ Ì ̷ÎÚoÛÎoÈÎfi¤ÏÂÁ¯o ÛÙoÓ ÌÂÛoÓ¢ÌfiÓÈo ¯ÒÚo. ™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ¯ÚË-ÛÈÌooÈ‹ıËÎ·Ó ÌfiÓo oÈ Â›Ì˘Â˜ ÛÙo˘˜ oo›o˘˜ Ë ı˘ÌÂÎÙoÌ‹‹Ù·Ó Ï‹Ú˘.

OÈ fiÚ¯ÂȘ ·Êo‡ ηı·Ú›˙oÓÙ·Ó, ˙˘Á›˙oÓÙ·Ó Î·È ÙooıÂ-Ùo‡ÓÙ·Ó Û ÊoÚÌfiÏË 10%. ∞ÚÁfiÙÂÚ· Îfi‚oÓÙ·Ó Û Ùo̤˜ ·-Ú·Ê›Ó˘, ‚¿ÊoÓÙ·Ó Ì ∂ˆÛ›ÓË-∞ÈÌ·ÙoÍ˘Ï›ÓË ‹ Mallory ηÈÌÂÏÂÙo‡ÓÙ·Ó ÈÛÙoÏoÁÈο.

ø˜ ·Ú¿ÌÂÙÚoÈ ¯ÚËÛÈÌooÈ‹ıËÎ·Ó Ùo ‚¿Úo˜ ÛÒÌ·Ùo˜ÙˆÓ ˙ÒˆÓ (¶›Ó. 1), Ùo ‚¿Úo˜ ÙˆÓ fiÚ¯ÂˆÓ Û ۯ¤ÛË Ì Ùo‚¿Úo˜ Ùo˘ ÛÒÌ·Ùfi˜ Ùo˘˜ (¶›Ó. 2), ηıÒ˜ Î·È Ë ÈÛÙoÏoÁÈ΋ÂͤٷÛË ÙˆÓ fiگˆÓ. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓÁÈÓfiÙ·Ó Ì Ùo Mann-Whitney test.

∞¶O∆∂§∂™ª∞∆∞£ÓËÛÈÌfiÙËÙ·: ∫·Ù¿ ÙË ‰ÈÂÍ·ÁˆÁ‹ ÙˆÓ ÂÈÚ·Ì¿ÙˆÓ˘‹ÚÍ ıÓËÛÈÌfiÙËÙ· ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ· ηٿ ÙË ‰ÈÂ-Í·ÁˆÁ‹ Ù˘ ı˘ÌÂÎÙoÌ‹˜ (ÙÚ·˘Ì·ÙÈÛÌfi˜ ÌÂÁ¿ÏˆÓ ·Á-Á›ˆÓ), ·ÏÏ¿ Î·È ·ÚÁfiÙÂÚ·, ÏfiÁˆ ÂÌÊ¿ÓÈÛ˘ ‰˘-ÛÙÚoÊ›·˜ (wasting disease) Î·È Î·ÓÓÈ‚·ÏÈÛÌo‡, ¤ÛÙˆÎ·È ÂÚÈoÚÈṲ̂Óo˘, ÙˆÓ ÌËÙ¤ÚˆÓ Úo˜ Ù· ·È‰È¿ Ùo˘˜.

µ¿Úo˜ ÛÒÌ·Ùo˜: ¢ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂ-Ù·‚oϤ˜ ÛÙo ‚¿Úo˜ Ùo˘ ÛÒÌ·Ùo˜ ÌÂٷ͇ ÙˆÓ ı˘ÌÂ-ÎÙoÌËı¤ÓÙˆÓ ˙ÒˆÓ fiÏˆÓ ÙˆÓ oÌ¿‰ˆÓ Î·È ÙˆÓ ·ÓÙ›-ÛÙoȯˆÓ Ì·ÚÙ‡ÚˆÓ.

ŸÚ¯ÂȘ: ¢ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊoÚ¤˜ÛÙ· Û¯ÂÙÈο ‚¿ÚË ÙˆÓ fiÚ¯ÂˆÓ ÙˆÓ ı˘ÌÂÎÙoÌËı¤-ÓÙˆÓ ˙ÒˆÓ Î·Ù¿ ÙË 2Ë Î·È 9Ë Ë̤ڷ Ù˘ ˙ˆ‹˜ Ùo˘˜,Û ۇÁÎÚÈÛË Ì Ùo˘˜ ·ÓÙ›ÛÙoȯo˘˜ Ì¿ÚÙ˘Ú˜.

πÛÙoÏoÁÈ΋ ÌÂϤÙË: ™Ù· ı˘ÌÂÎÙoÌËı¤ÓÙ· ˙Ò·Ù˘ oÌ¿‰·˜ Tx2, ·Ú·ÙËÚ‹ıËΠÌÂÚÈ΋ ·o‰ÈoÚÁ¿-ÓˆÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ (∂ÈÎ. 3), ÛÂÛ¯¤ÛË Ì Ùo˘˜ Ì¿ÚÙ˘Ú˜ (∂ÈÎ. 2), fio˘ Ê·›ÓoÓÙ·ÈÙ· Ê˘ÛÈoÏoÁÈο ÛÂÚÌ·ÙÈο ÛˆÏËÓ¿ÚÈ· (Ì ÙoÓ‚·ÛÈÎfi Ùo˘˜ ˘Ì¤Ó· ÂÚÈÊÂÚÈο Î·È Ùo ÛÂÚÌ·ÙÈÎfiÙo˘˜ ÂÈı‹ÏÈo ÂÛˆÙÂÚÈο). ∏ ·o‰ÈoÚÁ¿ÓˆÛË ·˘Ù‹¯·Ú·ÎÙËÚÈ˙fiÙ·Ó Î˘Ú›ˆ˜ ·fi ÙËÓ ‡·ÚÍË ÎÂÓoÙo-Ȉ‰ÒÓ ¯ÒÚˆÓ ÌÂٷ͇ Ùo˘ ÛÂÚÌ·ÙÈÎo‡ ÂÈıËÏ›o˘(∂ÈÎ. 4), ÙˆÓ ÛÂÚÌ·ÙoÁoÓ›ˆÓ Î·È ÙˆÓ ÛÂÚÌ·Ùo-΢ÙÙ¿ÚˆÓ (∂ÈÎ. 5), ηıÒ˜ Î·È ÙËÓ ‡·ÚÍË ÎÂÓo-Ùo›ˆÓ ÂÓÙfi˜ Ùo˘ ΢ÙÙ·ÚoÏ¿ÛÌ·Ùo˜ Ùo˘ ÁÂÓÂÙÈÎo‡ÂÈıËÏ›o˘. ŸÛoÓ ·ÊoÚ¿ Ù· ·ÙÙ·Ú· Sertoli, ÛÙ·ÂÚÈÛÛfiÙÂÚ· ÛÂÚÌ·ÙÈο ÛˆÏËÓ¿ÚÈ· ›¯·Ó Ê˘ÛÈo-ÏoÁÈ΋ ÂÌÊ¿ÓÈÛË (∂ÈÎ. 6) Î·È ÌfiÓo Û ÌÂÚÈο o·ÚÈıÌfi˜ Ùo˘˜ ·Úo˘ÛÈ·˙fiÙ·Ó ÂÏ·Ùو̤Óo˜.

™Ùo˘˜ fiÚ¯ÂȘ ÙˆÓ ÂÈ̇ˆÓ Ù˘ oÌ¿‰·˜ ∆x9 ‰ÂÓ·Ú·ÙËÚ‹ıËÎ·Ó ·ÍÈfiÏoÁ˜ ÌÂÙ·‚oϤ˜ Û ۯ¤ÛË ÌÂÙo˘˜ fiÚ¯ÂȘ ÙˆÓ ·ÓÙ›ÛÙoȯˆÓ Ì·ÚÙ‡ÚˆÓ (∂ÈÎ. 7).

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 275

EÈÎ. 1. ¢È¿ÁÚ·ÌÌ· ÂÈÚ·Ì·ÙÈ΋˜ ‰È·‰Èηۛ·˜

¶›Ó·Î·˜ 1. µ¿Úo˜ ÛÒÌ·Ùo˜ Û g (x ± SD)

O ª ∞ ¢ ∂ ™ ∂ ¶ π ª À ø ¡

∆x D

Tx2 Tx9 D2 D9

415,6 ± 21,840 446,5 ± 24,561 396,48 ± 47,64 407,73 ± 22,058

¶›Ó·Î·˜ 2. µ¿Úo˜ fiÚ¯ÂˆÓ / ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Û g (x ± SD)

O ª ∞ ¢ ∂ ™ ∂ ¶ π ª À ø ¡

∆x D

Tx2 Tx9 D2 D9

8,235 ± 0,27 7,58 ± 1,11 8,135 ± 0,529 7,22 ± 1,85

276 A. KA´KH-A™∆∞ƒ∞ ∫∞π ™À¡.

∂ÈÎ. 2. º˘ÛÈoÏoÁÈο ÛÂÚÌ·ÙÈο ÛˆÏËÓ¿ÚÈ·. ÃÚÒÛË∂ˆÛ›Ó˘-∞ÈÌ·ÙoÍ˘Ï›Ó˘ (x 100)

∂ÈÎ. 3. OÌ¿‰· Tx2 : ∞o‰ÈoÚÁ¿ÓˆÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓÛˆÏËÓ·Ú›ˆÓ. ÃÚÒÛË ∂ˆÛ›Ó˘-∞ÈÌ·ÙoÍ˘Ï›Ó˘ (x 400).

∂ÈÎ. 4. OÌ¿‰· Tx2: ∫ÂÓoÙoÈÒ‰ÂȘ ¯ÒÚoÈ ÛÙo ÛÂÚÌ·ÙÈ-Îfi ÂÈı‹ÏÈo. ÃÚÒÛË ªallory (x 400).

∂ÈÎ. 5. OÌ¿‰· Tx2: AÔ‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ ÛÂÚÌ·ÙÔÁÔ-Ó›ˆÓ Î·È ÙˆÓ ÛÂÚÌ·ÙÔ΢ÙÙ¿ÚˆÓ ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ Ûˆ-ÏËÓ·Ú›ˆÓ. XÚÒÛË EˆÛ›Ó˘-AÈÌ·ÙÔÍ˘Ï›Ó˘ (x 400).

∂ÈÎ. 6. OÌ¿‰· Tx2: º˘ÛÈoÏoÁÈ΋ ÂÌÊ¿ÓÈÛË Î·Ù¿ Ùo Ï›-ÛÙoÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ Sertoli. ÃÚÒÛË Mallory (x 400).

∂ÈÎ. 7. OÌ¿‰· Tx9: ™ÂÚÌ·ÙÈο ÛˆÏËÓ¿ÚÈ· ÙˆÓ ı˘ÌÂ-ÎÙoÌËı¤ÓÙˆÓ ˙ÒˆÓ. ÃÚÒÛË Mallory (x 400).

™À∑∏∆∏™∏∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, oÏÏo› ÂÚ¢ÓËÙ¤˜ ÌÂÏÂÙo‡ÓÙËÓ Â›‰Ú·ÛË Ùo˘ ı‡Ìo˘ ·‰¤Ó· ÛÙËÓ ÂͤÏÈÍË Ùo˘¿ÚÚÂÓo˜ ·Ó··Ú·ÁˆÁÈÎo‡ Û˘ÛÙ‹Ì·Ùo˜, ‰ÈfiÙÈ ‰ÂÓ¤¯ÂÈ ÌÂÏÂÙËı› ÙfiÛo ÂÎÙÂٷ̤ӷ, fiÛo ÌÂÏÂÙ‹ıËΠËÛ¯¤ÛË ·˘Ùo‡ Ùo˘ ·‰¤Ó· Ì Ùo ı‹Ï˘ ·Ó··Ú·ÁˆÁÈ-Îfi Û‡ÛÙËÌ·. ∂›Û˘, ηٿ ‰È·ÛÙ‹Ì·Ù·, ˘‹ÚÍ·ÓÎ·È ‰È·ÊoÚÂÙÈΤ˜ ÂÈÛÙËÌoÓÈΤ˜ ·fi„ÂȘ Û¯ÂÙÈοÌ ÙoÓ ÙÚfio Ì ÙoÓ oo›o o ı‡Ìo˜ ·‰¤Ó·˜ ‰Ú· ÛÙo¿ÚÚÂÓ ·Ó··Ú·ÁˆÁÈÎfi Û‡ÛÙËÌ·.

ŒÙÛÈ, oÈ Hattori Î·È Brandon1 Î·È o DeshauxÎ·È Û˘Ó.6, oÈ oo›oÈ ÌÂϤÙËÛ·Ó ¿ÚÚÂÓ˜ ı˘ÌÂ-ÎÙoÌËı¤ÓÙ˜ Â›Ì˘Â˜, η٤ÏËÍ·Ó ÛÙo Û˘Ì¤Ú·ÛÌ·fiÙÈ, o ı‡Ìo˜ ·‰¤Ó·˜, o oo›o˜ ‰Ú· ÛÙo ·Ó··Ú·-ÁˆÁÈÎfi Û‡ÛÙËÌ· ‰È·Ì¤Ûo˘ Ù˘ ˘oʇÛˆ˜, ·ÛΛ‰Ú¿ÛË, ηٿ ÙË ÓÂoÁÓÈ΋ ËÏÈΛ·, ··Ú·›ÙËÙË ÁÈ·ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ fiگˆÓ.

ŸÌˆ˜, o Rebar Î·È Û˘Ó.7 ·Ú·Ù‹ÚËÛ·Ó, fiÙÈÁÂÓÂÙÈο ·ı˘ÌÈÎo› ̇˜ ›¯·Ó Ê˘ÛÈoÏoÁÈ΋ ÛÂÚ-Ì·ÙoÁ¤ÓÂÛË Î·È ·Ó··Ú·ÁˆÁÈ΋ ÈηÓfiÙËÙ·, ·Ú¿ÙËÓ ÂÏ·Ùو̤ÓË ÛÙ¿ıÌË ÙˆÓ ÁoÓ·‰oÙÚoÈÓÒÓ Î·ÈÙ˘ ÙÂÛÙoÛÙÂÚfiÓ˘ o˘ ÂÌÊ¿ÓÈÛ·Ó ÛÙo ·›Ì· Ùo˘˜.

∆¤Ïo˜, Ì ı˘ÌÂÎÙoÌËı¤ÓÙ˜ Â›Ì˘Â˜ ·Û¯oÏ‹ıË-ÎÂ Î·È o Bloom Î·È Û˘Ó.,8 Û‡Ìʈӷ Ì ÙË ÌÂϤÙË ÙˆÓoo›ˆÓ, Â›Ì˘Â˜ o˘ ı˘ÌÂÎÙoÌ‹ıËÎ·Ó Û ËÏÈΛ·‰‡o ËÌÂÚÒÓ, ÂÌÊ¿ÓÈÛ·Ó ·‡ÍËÛË Ùo˘ Û¯ÂÙÈÎo‡ ‚¿-Úo˘˜ ÙˆÓ fiÚ¯ÂÒÓ Ùo˘˜ Û ۯ¤ÛË Ì Ùo˘˜ Ì¿ÚÙ˘Ú˜.

∞fi Ù· ·oÙÂϤÛÌ·Ù· Ù˘ ‰È΋˜ Ì·˜ ÌÂϤÙ˘,Û¯ÂÙÈο Ì ÙËÓ ·Ó¿Ù˘ÍË Ùo˘ ÛÂÚÌ·ÙÈÎo‡ ÂÈıË-Ï›o˘ ÂÈ̇ˆÓ oÈ oo›oÈ ı˘ÌÂÎÙoÌ‹ıËÎ·Ó Û ‰È·-ÊoÚÂÙÈ΋ ÓÂoÁÓÈ΋ ËÏÈΛ·, Â›Ó·È Ê·ÓÂÚfi fiÙÈ Û η-Ì›· ÂÚ›ÙˆÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÌÂÙ·‚oÏ‹, ÙfiÛoÛÙo ‚¿Úo˜ Ùo˘ ÛÒÌ·Ùo˜ fiÛo Î·È ÛÙo Û¯ÂÙÈÎfi ‚¿Úo˜ÙˆÓ fiÚ¯ÂÒÓ Ùo˘˜, Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙoȯ· ‚¿ÚËÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∏ ‰È·ÊoÚ¿ ÌÂٷ͇ ÙˆÓ ‰ÈÎÒÓ Ì·˜·oÙÂÏÂÛÌ¿ÙˆÓ Î·È Ùo˘ Bloom Î·È Û˘Ó.,8 Èı·ÓfiÓÓ· oÊ›ÏÂÙ·È ÛÙË ÌÈÎÚfiÙÂÚË ËÏÈΛ· o˘ ›¯·Ó oȉÈÎo› Ùo˘˜ Â›Ì˘Â˜ ηٿ ÙËÓ Ë̤ڷ Ù˘ ı˘Û›·˜ Ùo˘˜,·ÏÏ¿ Î·È ÛÙo ‰È·ÊoÚÂÙÈÎfi ›‰o˜ ˙ÒˆÓ (Long-Evans) o˘ ¯ÚËÛÈÌoo›ËÛ·Ó ÛÙË ÌÂϤÙË Ùo˘˜. ∆o›‰o˜ Ùo˘ ÂÈÚ·Ì·Ùo˙Òo˘ o˘ ¯ÚËÛÈÌooÈÂ›Ù·È ÛÂÌ›· ÌÂϤÙË, ·oÙÂÏ› ·Ú¿ÁoÓÙ· o oo›o˜, ηٿÙËÓ ¿o„Ë Ùo˘ Farookhi Î·È Û˘Ó.,9 Â›Ó·È ‰˘Ó·ÙfiÓÓ· ÌÂÙ·‚¿ÏÏÂÈ ÙË ‰Ú¿ÛË Ùo˘ ı‡Ìo˘ ·‰¤Ó· ÛÙo ¿Ú-ÚÂÓ ·Ó··Ú·ÁˆÁÈÎfi Û‡ÛÙËÌ·.

ŸÛoÓ ·ÊoÚ¿ ÙËÓ ÈÛÙoÏoÁÈ΋ ÂÈÎfiÓ· ÙˆÓ fiÚ¯Â-ˆÓ ÙˆÓ ÂÈ̇ˆÓ Ù˘ ÂÚÁ·Û›·˜ Ì·˜, Ê·›ÓÂÙ·È fiÙÈ Ë·Ê·›ÚÂÛË Ùo˘ ı‡Ìo˘ ·‰¤Ó· ·fi Ù· ˙Ò· Û ËÏÈΛ·‰‡o ËÌÂÚÒÓ (∆x2), ÚoοÏÂÛ ÂÌÊ·Ó›˜ ÈÛÙoÏoÁÈΤ˜ÌÂÙ·‚oϤ˜, ·Ó¿ÏoÁ˜ Ì ·˘Ù¤˜ o˘ ·Ó¤ÊÂÚ·Ó Î·È oÈHattori Î·È Brandon1, oÈ oo›oÈ ¤Î·Ó·Ó ı˘ÌÂÎÙoÌ‹

ÛÂ Â›Ì˘Â˜ ËÏÈΛ·˜ Ì›·˜ Ë̤ڷ˜. ŸÌˆ˜, o Bloom ηÈÛ˘Ó.8 ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó ·ÍÈoÛËÌ›ˆÙ˜ ÈÛÙoÏoÁÈΤ˜ÌÂÙ·‚oϤ˜, ·Ú¿ ÙËÓ ÂÏ·Ùو̤ÓË ÛÙ¿ıÌË Ù˘ ÙÂ-ÛÙoÛÙÂÚfiÓ˘ o˘ ÂÌÊ¿ÓÈÛ·Ó Ù· ÂÈÚ·Ì·Ùfi˙ˆ¿Ùo˘˜, Û ۯ¤ÛË Ì Ùo˘˜ ·ÓÙ›ÛÙoȯo˘˜ Ì¿ÚÙ˘Ú˜.ÿÛˆ˜ Î·È ¿ÏÈ ÙoÓ Î‡ÚÈo ÚfiÏo ÛÙË ‰È·ÊoÚ¿ ÙˆÓ·oÙÂÏÂÛÌ¿ÙˆÓ Ó· ¤·ÈÍÂ Ë ÌÈÎÚfiÙÂÚË ËÏÈΛ· ÙˆÓÂÈ̇ˆÓ Ùo˘˜ ηٿ ÙËÓ Ë̤ڷ Ù˘ ı˘Û›·˜ Ùo˘˜.

µ¤‚·È·, Ë ÈÛÙoÏoÁÈ΋ ÂÈÎfiÓ· ÙˆÓ fiÚ¯ÂˆÓ ÙˆÓÂÈ̇ˆÓ Ù˘ oÌ¿‰·˜ ∆x9, Ù˘ ÂÚÁ·Û›·˜ Ì·˜, ‰ÂÓ ÂÌ-Ê¿ÓÈÛ ÛËÌ·ÓÙÈΤ˜ ÈÛÙoÏoÁÈΤ˜ ÌÂÙ·‚oϤ˜, Û ۯ¤-ÛË Ì Ùo˘˜ Ì¿ÚÙ˘Ú˜. ∆· ·oÙÂϤÛÌ·Ù¿ Ì·˜ ·˘Ù¿Û˘ÌʈÓo‡Ó Ì ÙȘ ·Ó·ÊoÚ¤˜ ÙˆÓ Tagushi Î·È Nis-hizuka2, oÈ oo›oÈ Â›¯·Ó ı˘ÌÂÎÙoÌ›ÛÂÈ Ì˘˜ Û ËÏÈ-Λ· ÂÙ¿ ËÌÂÚÒÓ. ∞ÓÙ›ıÂÙ·, o Zeng Î·È Û˘Ó.,4 ·-Ú·Ù‹ÚËÛ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚oϤ˜ ÛÙ· ÁÂÓÓËÙÈο·ÙÙ·Ú· Ì˘ÒÓ, ·fi Ùo˘˜ oo›o˘˜ ·Ê·ÈÚ¤ıËΠoı‡Ìo˜ ·‰¤Ó·˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ oÎÙÒ Î·È ÙˆÓ ‰Âη-ÙÂÛÛ¿ÚˆÓ Â‚‰oÌ¿‰ˆÓ.

∏ ·o˘Û›· ÈÛÙoÏoÁÈÎÒÓ ÌÂÙ·‚oÏÒÓ Û fiÚ¯ÂȘÂÈ̇ˆÓ ·fi Ùo˘˜ oo›o˘˜ ·Ê·ÈÚ¤ıËΠo ı‡Ìo˜ ·-‰¤Ó·˜ ηٿ ÙËÓ ÚÒÙË Â‚‰oÌ¿‰· Ù˘ ˙ˆ‹˜ Ùo˘˜, È-ı·ÓfiÓ Ó· oÊ›ÏÂÙ·È, Û‡Ìʈӷ Ì ÙËÓ ¿o„Ë ÙˆÓTagushi Î·È Nishizuka2, ÛÙo fiÙÈ ÂÌÊ·Ó›˙oÓÙ·È ÂÓ ÙˆÌÂٷ͇ ·ÙÙ·Ú·-ηٷÛÙoÏ›˜ (T-Suppressors), Ù·oo›· ηٷÛÙ¤ÏÏo˘Ó Ùo Û¯ËÌ·ÙÈÛÌfi ·˘Ùo·ÓÙÈÛˆ-Ì¿ÙˆÓ Î·Ù¿ ·ÓÙÈÁfiÓˆÓ ÙˆÓ fiگˆÓ. ∫·Ù¿ ¿ÏÏo˘˜ÂÚ¢ÓËÙ¤˜, o ı‡Ìo˜ ·‰¤Ó·˜ Û˘ÓÙÂÏ› ÛÙË ‰È·ÌfiÚ-ʈÛË ÙˆÓ ÁoÓ¿‰ˆÓ ¤ÌÌÂÛ·, ‰È·Ì¤Ûo˘ Ùo˘ ˘oı·-Ï¿Ìo˘ Î·È Ù˘ ˘oʇÛˆ˜1,6. ¢ËÏ·‰‹ o ı‡Ìo˜, È-ı·ÓfiÓ Ó· ÂËÚ¿˙ÂÈ Ùo ÂÚÈÁÂÓÓËÙÈÎfi ÛÙÂÚoÂȉ¤˜ÂÚÈ‚¿ÏÏoÓ Ùo˘ ˙Òo˘10, Ùo oo›o Û˘ÌÌÂÙ¤¯ÂÈ ÛÙoÓÚoÁÚ·ÌÌ·ÙÈÛÌfi ÙˆÓ Ó¢ÚoÂÓ‰oÎÚÈÓÈÎÒÓ ÏÂÈÙo˘Ú-ÁÈÒÓ Ùo˘ ˘oı·Ï¿Ìo˘ Î·È Âo̤ӈ˜, ‰È·Ì¤Ûo˘·˘Ùo‡, Ó· ÂËÚ¿˙ÂÈ Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÁoÓ¿-‰ˆÓ. ∞Ó ‰Â¯ıo‡Ì ‰Â, fiÙÈ, o ˘oı¿Ï·Ìo˜ ‰È·ÊoÚo-oÈÂ›Ù·È Î·Ù¿ ÙËÓ ÚÒÙË Â‚‰oÌ¿‰· Ù˘ ˙ˆ‹˜ ÙˆÓÂÈ̇ˆÓ11,12, ·ÈÙÈoÏoÁo‡ÓÙ·È Î·È Ù· ·oÙÂϤÛÌ·Ù·Ù˘ ÌÂϤÙ˘ Ì·˜.

™˘ÌÂÚ·›ÓÂÙ·È, Âo̤ӈ˜, fiÙÈ Ë ·Úo˘Û›· Ùo˘ı‡Ìo˘ ·‰¤Ó· Â›Ó·È ··Ú·›ÙËÙË Û ̛· ÎÚ›ÛÈÌË Â-Ú›o‰o Ù˘ ˙ˆ‹˜ ÙˆÓ ÂÈ̇ˆÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Úo-ÎÂÈ̤Óo˘ Ó· ·Ó·Ù˘¯ı› Ê˘ÛÈoÏoÁÈο Ùo ÛÂÚÌ·ÙÈ-Îfi Ùo˘˜ ÂÈı‹ÏÈo.

ABSTRACTKaiki-Astara A, Ekonomou D, Guibas G. Thestudy of the adult rats’ spermatic epithelium,after thymectomy in different neonatal age.Hell Iatr 2000, 66: 274 - 278.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 277

The effects of the thymus gland on the growingof the spermatic epithelium were studied in maleWistar rats, which they were thymectomized in dif-ferent days of their neonatal life (2nd at 9th day).The body weight and the ratio “testes weight/bodyweight” for all groups of rats were determined andthe histology of the testes was studied in thyme-ctomized (Tx) and sham-thymectomized (D) rats at200-250 days of age. No significant differenves inthe body weight and in the ratio of “testes weight/body weight” were detected in all thymectomizedanimals versus sham-thymectomized ones. In con-trast, histological changes were determined only inthe thymectomized animals at the 2nd day of age,versus the sham-thymectomized at the same age. Inparticular it was shown the following atrophy of theseminiferous tubules, which characterized by de-creased number of spermatogonium in some pla-ces; vacuoles in spermatide’s plasma as well betwe-en the spermatogens. In addition, some abnormalSertoli cells and decrease of connetive tissue wereshown. These results suggest that the excistence ofthe thymus gland is necessary, during the first daysof the rat’s life, for the growing of their spermaticepithelium.

µπµ§πO°ƒ∞ºπ∞1. Hattori M, Brandon MR. Thymus and the endocrine

system: ovarian dysgenesis in neonatally thymectomi-zed rats. J. Endocrinol 1979, 83: 101-11.

2. Taguchi O, Nishizuka Y. Experimental autoimmuneorchitis after neonatal thymectomy in the mouse. ClinExp Immunol 1981, 46: 425-34.

3. Kaiki-Astara A, Guiba-Tziampiri O, Economou L. Effectsof thymectomy on the male rat reproductive system.Scientific Annals of the Faculty of Medicine, Thessa-loniki 1995, 22(2): 32-5.

4. Zeng J, Zhang Y, Pomer S, Ren D. The influence of thyme-ctomy on germ-cells of the testis in mice. J Tongji MedUni 1995, 15(2): 112-6.

5. ∫aiki-Astara A, Guiba-Tziampiri O, Kallaras K. Method ofattenuation of rats cannibalism towards their operatedneonates. Scientific Annals of the Faculty of Medicine,Thessaloniki 1996, 23(2): 37-9.

6. Deschaux P, Massengo B and Fontanges R. Endocrine in-teraction of the thymus extracts. Thymus 1979, 1: 95-108.

7. Rebar RW, Morandini IC, Petze JE and Erickson GF.Hormonal basis of reproductive defects in athymicmice: reduced gonadotropins and testosterone inmales. Biol Reprod 1982, 27: 1267-76.

8. Bloom DF, Bloch GJ and Gorski RA. Effects of thyme-ctomy on reproductive function and behavior. Phy-siology and Behavior 1992, 52: 291-8.

9. Farookhi R, Wesolowski E, Trasler JM, and Robaire B. Mo-dulation by Neonatal hymectomy of the reproductiveaxis in male and female rats during development. BiolReprod 1988, 38: 91-9.

10. Strich G, Petze JE, Silva de Sa MF, Rebar RW. The effectof thymus-derived peptides on hypothalamic LRF andpituitary gonadotropin content in prepubertal conge-nitally athymic nude mice and their normal hetero-zygous littermates. J Reprod Immunol 1985, 7: 351-9.

11. Gorski RA. Sexual differentiation of the brain: Possiblemechanisms and implications. Can J Physiol Pharma-col 1985, 63: 577-94.

12. Goy RW, McEwen BS. Sexual differentiation of thebrain. Cambridge, MA: The MIT Press: 1980.

AÏÏËÏÔÁÚ·Ê›·:A. K·˝ÎË-AÛÙ¿Ú·EÚÁ·ÛÙ‹ÚÈÔ ¶ÂÈÚ·Ì·ÙÈ΋˜ º˘ÛÈÔÏÔÁ›·˜TÌ‹Ì· I·ÙÚÈ΋˜, A¶£540 06 – £ÂÛÛ·ÏÔÓ›ÎË

Corresponding author:A. Kaiki-AstaraDepartment of Experimental PhysiologySchool of Medicine Aristotle University of Thessaloniki540 06 – ThessalonikiGreece

278 A. KA´KH-A™∆∞ƒ∞ ∫∞π ™À¡.

°È·Ù› OÚıԷȉÈ΋ Î·È fi¯È OÚıÔ‰È΋

Iˆ¿ÓÓ˘ ¢. ¶Ô˘ÚÓ¿Ú·˜

OÚıԷȉÈ΋ KÏÈÓÈ΋ A¶£, NÔÛÔÎÔÌÂ›Ô «°. ¶··ÓÈÎÔÏ¿Ô˘», £ÂÛÛ·ÏÔÓ›ÎË

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 279 - 280

E›Ó·È ÁÓˆÛÙfi fiÙÈ ÙË Ï¤ÍË “OÚıԷȉÈ΋” Û¯ËÌ¿ÙÈ-Û ÚÒÙÔ˜ Ô °¿ÏÏÔ˜ K·ıËÁËÙ‹˜ Î·È ¶Ú‡Ù·Ó˘ Ù˘I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙˆÓ ¶·ÚÈÛ›ˆÓ Nicolas Andry(1658-1742). TË ¯ÚËÛÈÌÔÔ›ËÛ ̿ÏÈÛÙ· ÛÙÔÓ Ù›ÙÏÔÙÔ˘ ‚È‚Ï›Ô˘ ÙÔ˘ Ô˘ ÂΉfiıËΠÙÔ 1741. ™ÙÔ ›‰ÈÔ ‚È-‚Ï›Ô ˘¿Ú¯ÂÈ Î·È ÙÔ ÛΛÙÛÔ ÙÔ˘ ÁÓˆÛÙÔ‡ ÛÙÚ‚ÏÔ‡‰¤Ó‰ÚÔ˘ Ì ÙÔ ˘ÔÛÙ‹ÚÈÁÌ·, ÙÔ ÔÔ›Ô ·ÔÙÂÏ› Û‹-ÌÂÚ· ÙÔ ·ÁÎfiÛÌÈÔ ¤Ì‚ÏËÌ· Ù˘ OÚıԷȉÈ΋˜ ÂÈ-‰ÈÎfiÙËÙ·˜. ¶ÚÈÓ ·fi ÙÔ 1741 Ë Ï¤ÍË ‰ÂÓ ‹Ù·Ó ÁÓˆ-ÛÙ‹ Î·È ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Û ηӤӷ ÏÂÍÈÎfi, ÂÏÏËÓÈ-Îfi ‹ ͤÓÔ. ¢ÂÓ Â›Ó·È ‰ËÏ·‰‹ ·Ú¯·›Ô˜ ÂÏÏËÓÈÎfi˜ È·-ÙÚÈÎfi˜ fiÚÔ˜ fiˆ˜ ÔÏÏÔ› ›Ûˆ˜ ÈÛÙ‡ԢÓ. °È· ÙË ‰Ë-ÌÈÔ˘ÚÁ›· Ù˘ Û‡ÓıÂÙ˘ ·˘Ù‹˜ ÔÓÔÌ·Û›·˜ Ô AndryÛÙËÚ›¯ıËΠ۠‰‡Ô ÂÏÏËÓÈΤ˜ ϤÍÂȘ, “ÔÚıfiÓ” ηȓ·È‰›ÔÓ”. H ‰È·Ù‡ˆÛË ÛÙÔ ‚È‚Ï›Ô ÙÔ˘ ¤¯ÂÈ ˆ˜ Â-Í‹˜: “Quant au titre en question, Orthopedie, je l’ aiforme de deux mots grecs, a savoir d’ Orthos, qui ve-ut dire Droit, et Paidion, que signifie Enfant”. Œ-ÎÙÔÙÂ Ô Ù›ÙÏÔ˜ ·˘Ùfi˜ ¤ÁÈÓ ·Ô‰ÂÎÙfi˜ ·fi fiϘ ÙȘ¯ÒÚ˜ ÙÔ˘ ÎfiÛÌÔ˘ Î·È ¤ÙÛÈ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ì¤¯ÚÈÛ‹ÌÂÚ·, ·Ó Î·È ¤ÁÈÓ·Ó Ï›Á˜ ·ÔÙ˘¯Ë̤Ó˜ ÚÔÛ¿-ıÂȘ Û¯ËÌ·ÙÈÛÌÔ‡ ¿ÏÏˆÓ fiÚˆÓ fiˆ˜ “ÔÚıÔۈ̷-ÙÈ΋” ·fi ÙÔ˘˜ Bricheteau Î·È D’ Ivernois (1824) ‹“ÔÚıÔÌÔÚÊ›·” ·fi ÙÔÓ Delpech (1829). ŸÏÔÈ ‰ËÏ·-‰‹ ¤¯Ô˘Ó ·Ô‰Â¯ı› ÙËÓ ÚԤϢÛË ÙÔ˘ fiÚÔ˘ ·fiÙȘ ‰‡Ô ÂÏÏËÓÈΤ˜ ϤÍÂȘ “ÔÚıfi˜” Î·È “·È‰›ÔÓ”. °È·Ó· ÙÈÌ‹ÛÔ˘Ó ‰Â ÙȘ ÂÏÏËÓÈΤ˜ Ú›˙˜ ÙÔ˘ Ë AÌÂÚÈηÓÈ-΋ OÚıԷȉÈ΋ EÙ·ÈÚ›· Î·È Ë AÌÂÚÈηÓÈ΋ Aη-‰ËÌ›· OÚıԷȉÈÎÒÓ XÂÈÚÔ˘ÚÁÒÓ, Ô˘ Â›Ó·È Î·È ÔÔÏ˘ÏËı¤ÛÙÂÚÔ˜ ÊÔÚ¤·˜ Ù˘ ÔÚıԷȉÈ΋˜ ÂÈ-ÛÙ‹Ì˘ ·ÁÎÔÛÌ›ˆ˜, ·Ú·ı¤ÙˆÓ ÙȘ ‰‡Ô ÂÏÏËÓÈΤ˜Ï¤ÍÂȘ Ì ÂÏÏËÓÈο ÛÙÔȯ›· ÁÚ·Ì̤Ó˜ Î·È ÔχÂÌÊ·ÓÒ˜ ÛÙÔ Û‹Ì· Î·È ÙÔ ÏÔÁfiÙ˘fi ÙÔ˘˜.

™ÙËÓ EÏÏ¿‰· Ë Ï¤ÍË ¿ÏÏ·Í ÙËÓ ÔÚıÔÁÚ·Ê›·Ù˘ Î·È ¿Ú¯ÈÛ ӷ ÁÚ¿ÊÂÙ·È Ì “” ‰ËÏ·‰‹ “ÔÚıÔ-‰È΋” ηٿ Ù· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ· ‹ ÙȘ ·Ú¯¤˜ÙÔ˘ 20Ô˘. º·›ÓÂÙ·È fiÙÈ ÔÚÈṲ̂ÓÔÈ ·fi ÙÔ˘˜ ¯ÂÈ-

ÚÔ˘ÚÁÔ‡˜ Ù˘ ÂÔ¯‹˜ ıÂÒÚËÛ·Ó fiÙÈ Ë ÚԤϢÛËÙÔ˘ fiÚÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ¿ÏÏË, Ó· ÚÔ¤Ú¯ÂÙ·È ‰Ë-Ï·‰‹ ·fi ÙȘ ϤÍÂȘ “ÔÚıfi˜” Î·È “¤‰Ë” (ÙÚÔ¯Ô¤-‰Ë) ‹ “‰¿ˆ” (·ÛÊ·Ï›˙ˆ, ÛÙ·ıÂÚÔÔÈÒ). ŒÙÛÈ ÙÔ‰¤¯ÙËΠÛÙÔ ‚È‚Ï›Ô ÙÔ˘ (¤Î‰ÔÛË 1932) Î·È Ô K·ıË-ÁËÙ‹˜ XÚ˘ÛÔÛ¿ı˘, ·Ú’ fiÏÔÓ fiÙÈ ‰ÂÓ Û˘ÌʈÓÔ‡-Û ηıfiÏÔ˘ Ì ÙÔÓ fiÚÔ Î·È ı· ÚÔÙÈÌÔ‡Û ÙË Ï¤ÍË“ÔÚıˆÙÈ΋”. ¶ÔÈfi˜ ‹ ÔÈÔ› ›¯·Ó ÙËÓ È‰¤· Ù˘ ·ÏÏ·-Á‹˜ Ù˘ ÂÙ˘ÌÔÏÔÁ›·˜ Ù˘ Ϥ͢ Â›Ó·È ¿ÁÓˆÛÙÔ, fiˆ˜¿ÁÓˆÛÙÔ Â›Ó·È ·Ó ÚÔËÁ‹ıËÎÂ Ë ÁÚ·Ê‹ Ì “” ηȷÎÔÏÔ‡ıËÛÂ, ÁÈ· Ó· ‰ÈηÈÔÏÔÁËı› Ë ÔÚıÔÁÚ·Ê›·, Ë·ÏÏ·Á‹ Ù˘ ÂÙ˘ÌÔÏÔÁ›·˜ ‹ ÙÔ ·ÓÙ›ıÂÙÔ. ¶Èı·ÓfiÙÂÚÔÂ›Ó·È fiÙÈ Û˘Ó¤‚Ë ÙÔ ÚÒÙÔ. ¶Ô˘ıÂÓ¿ ¿ÓÙˆ˜ ‰ÂÓ ·-ӷʤÚÂÙ·È fiÙÈ Ë ·ÏÏ·Á‹ ·˘Ù‹ ¤ÁÈÓ ·fi οÔÈÔ Û˘Ï-ÏÔÁÈÎfi È·ÙÚÈÎfi fiÚÁ·ÓÔ ‹ οÔÈ· ÂÈÛÙËÌÔÓÈ΋ ÔÌ¿-‰· ÁψÛÛÔÏfiÁˆÓ. O‡ÙÂ Î·È ˘‹ÚÍ ·ÓÙ›‰Ú·ÛË ‰ÈfiÙÈÙfiÙÂ Ë ÔÚıԷȉÈ΋ ‰ÂÓ ‹Ù·Ó ·ÎfiÌË Û˘ÁÎÚÔÙË̤Ó˯ÂÈÚÔ˘ÚÁÈ΋ ÂȉÈÎfiÙËÙ·, fiˆ˜ Û˘Ì‚·›ÓÂÈ Û‹ÌÂÚ·.

ÿÛˆ˜ ÔÈ ıÈ·ÛÒÙ˜ Ù˘ ·ÏÏ·Á‹˜ Ó· ÂËÚÚ¿ÛıË-Î·Ó ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·ÎfiÌË Î·È Ô ÂÌÓ¢ÛÙ‹˜ ηȉËÌÈÔ˘ÚÁfi˜ ÙÔ˘ ÔÓfiÌ·ÙÔ˜, Ô Nicolas Andry, ¤ÁÚ·„ÂÛÙÔ ‚È‚Ï›Ô ÙÔ˘ ÙË Ï¤ÍË Ì “e” ·ÓÙ› ÁÈ· “ae” (L’Orthopedie), ‹ ‹ıÂÏ·Ó Ó· ‰Â›ÍÔ˘Ó fiÙÈ Ë ÔÚıԷȉÈ΋ıÂڷ‡ÂÈ Î·È ÂÓ‹ÏÈΘ. AÏÏ¿ Î·È ·Ó ·ÎfiÌË ÛÙË Á·Ï-ÏÈ΋ ‹ ¿ÏϘ ÁÏÒÛÛ˜ Ë Ï¤ÍË ÁÚ¿ÊÂÙ·È Ì “e” Ô˘‰¤-ÔÙ ·ÌÊÈÛ‚ËÙ‹ıËÎÂ Ë ÚÔ¤ÏÂ˘Û‹ Ù˘, ·fi ÙȘ ‰‡ÔÂÏÏËÓÈΤ˜ ϤÍÂȘ “ÔÚıfi˜” Î·È “·È‰›ÔÓ” Î·È Î·Ó›˜‰ÂÓ ÂÓԯϋıËΠ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û‹ÌÂÚ· ÔÈ ÔÚıÔ-·È‰ÈÎÔ› ‰ÂÓ ·Û¯ÔÏÔ‡ÓÙ·È ÌfiÓÔÓ Ì ·È‰È¿.

K·È ÂÌ›˜ ·ÎfiÌË ÛÙÔÓ ÍÂÓfiÁψÛÛÔ Ù›ÙÏÔ Ù˘EÙ·ÈÚ›·˜ Ì·˜ (Hellenic Association of Orthopae-dic Surgery and Traumatology) ÙË Ï¤ÍË OrthopaedicÙË ÁÚ¿ÊÔ˘Ì Ì “ae” Î·È fi¯È Ì “e”, fiˆ˜ ı· ¤ÚÂ- ·Ó ·ÎÔÏÔ˘ıÔ‡Û·Ì ÙËÓ ÂÏÏËÓÈ΋ ¿Ô„Ë ÚÔÂ-χۈ˜ ÙÔ˘ fiÚÔ˘.

™˘Ì‚·›ÓÂÈ ‰ËÏ·‰‹ ÙÔ ÂÍ‹˜ ·Ú¿‰ÔÍÔ: ÂÓÒ Ë‰ÈÂıÓ‹˜ È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ· Ì·˜ ÂÙ›ÌËÛÂ Î·È ¿ÏÈ, ‰Ë-

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ÌÈÔ˘ÚÁÒÓÙ·˜ ·fi ÂÏÏËÓÈΤ˜ ϤÍÂȘ ÙÔ fiÓÔÌ· ÌÈ·˜È·ÙÚÈ΋˜ ÂȉÈÎfiÙËÙ·˜, Ô˘ ·Ó·Ù‡ÛÛÂÙ·È Î·È ÚÔÔ-‰Â‡ÂÈ ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ, ÂÌ›˜ ‰ÂÓ ÙÔ ‰Â¯fi-Ì·ÛÙÂ, ·ÏÏ¿ ‰È·ÊˆÓÔ‡ÌÂ Î·È Ï¤Ì ÛÙÔ˘˜ ͤÓÔ˘˜ fiÙÈ¤Î·Ó·Ó Ï¿ıÔ˜. ¶ÈÔ ÛˆÛÙfi ›Ûˆ˜ ı· ‹Ù·Ó Ó· ¯ÚËÛÈÌÔ-ÔÈ‹ÛÔ˘Ì ÌÈ· Ó¤· ϤÍË Ô˘ ÂÌ›˜ ‰ËÌÈÔ˘ÚÁ‹Û·ÌÂÎ·È fi¯È Ó· ·ÏÏÔÈÒÛÔ˘Ì ÙËÓ ÂÏÏËÓÈ΋ ϤÍË Ô˘ ¿Ï-ÏÔÈ ÂÛ¯ËÌ¿ÙËÛ·Ó. ◊ Ó· ›ÛÔ˘Ì fiÏÔ ÙÔÓ ˘fiÏÔÈÔÎfiÛÌÔ Ó· ·ÏÏ¿ÍÂÈ ÙË ÁÓÒÌË ÙÔ˘ ÁÈ· ÙËÓ ÚԤϢÛËÙ˘ Ϥ͢ Î·È Ó· Û˘ÌχÛÂÈ Ì·˙› Ì·˜. H ÙÂÏÂ˘Ù·›·fï˜ ÚÔÛ¿ıÂÈ· Ì¿ÏÏÔÓ ˆ˜ “‰ÔÓÎȯˆÙÈ΋” Ú¤ÂÈÓ· ıˆÚËı›. TÔ ̄ ÂÈÚfiÙÂÚÔ Â›Ó·È Ó· Û˘ÌʈÓԇ̠ÌÂÙÔ ‰ËÌÈÔ˘ÚÁfi Ù˘ Ϥ͢ ˆ˜ ÚÔ˜ ÙËÓ ÚÔ¤ÏÂ˘Û‹ Ù˘·ÏÏ¿ Ó· ÙË ÁÚ¿ÊÔ˘Ì Ì ϷÓı·Ṳ̂ÓË ÔıÚÔÁÚ·Ê›·.

TÔ ı¤Ì· ‰ÂÓ Â›Ó·È ÁψÛÛÔÏÔÁÈÎfi. K·È ÔÈ ‰‡ÔÔÚıÔÁÚ·ÊÈΤ˜ ·Ú·ÏÏ·Á¤˜ Ù˘ Ϥ͢ Â›Ó·È ÁψÛÛÔ-ÏÔÁÈÎÒ˜ ÔÚı¤˜. TÔ ı¤Ì· Â›Ó·È Î·ı·Ú¿ ÈÛÙÔÚÈÎfi. ◊ı· ‰Â¯Ùԇ̠ÙËÓ ÚԤϢÛË ÙÔ˘ fiÚÔ˘ Ô˘ ‰¤¯ÔÓÙ·ÈÎ·È fiÏÔÈ ÔÈ ¿ÏÏÔÈ ‹ ı· ¯ÚËÛÈÌÔÔÈԇ̠ÂÌ›˜ ÙË ‰È-΋ Ì·˜ ÂÙ˘ÌÔÏÔÁ›·. ◊ ‰ËÏ·‰‹ ı· ‰Â¯Ùԇ̠ÙËÓ ÙÈÌ‹Ô˘ Ì·˜ ¤Î·Ó·Ó ÔÈ Í¤ÓÔÈ ‹ ı· ÙËÓ ·ÚÓËıÔ‡ÌÂ. M‚¿ÛË ÙÔ ÛÎÂÙÈÎfi ·˘Ùfi ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ŒÏÏËÓ˜ÁψÛÛÔÏfiÁÔÈ ÙÔÔıÂÙÔ‡ÓÙ·È Ì ÙËÓ ÚÒÙË ¿Ô„Ë.™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ‰Â‡ÙÂÚ˘ ¿Ô„˘ Ì·›ÓÂÈ Î·ÈοÔÈÔ ı¤Ì· ·ÔÌÔÓÒÛˆ˜ Î·È ›Ûˆ˜ ȉÈÔÙÚÔ›·˜.ŸÔÈÔ˜ Û˘˙ËÙ‹ÛÂÈ ÙÔ ı¤Ì· ÌÂ Û˘Ó·‰¤ÏÊÔ˘˜ ÙˆÓ ¿Ï-ÏˆÓ ¯ˆÚÒÓ Î·È ·Ó·Ù‡ÍÂÈ ÙË Ì¤¯ÚÈ ÚÔ ÔÏ›ÁÔ˘ ÂÈ-ÎÚ·ÙÔ‡Û· ÛÙËÓ EÏÏ¿‰· ¿Ô„Ë, ı· ‚ÚÂı› Û ‰‡-ÛÎÔÏË ı¤ÛË.

¶Ú¤ÂÈ ·ÎfiÌË Ó· ÙÔÓ›Ûˆ fiÙÈ ˘¿Ú¯ÂÈ ÌÈ· Ù¿ÛËÙËÓ ÂÏÏËÓÈ΋ ·˘Ù‹ ϤÍË Ó· ÙËÓ Î·Ù·ÚÁ‹ÛÔ˘Ó Î·È Ó·ÙËÓ ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó Ì ÙȘ ϤÍÂȘ OÚıÔ¯ÂÈÚÔ˘ÚÁÈ-΋ fiˆ˜ N¢ÚÔ¯ÂÈÚÔ˘ÚÁÈ΋ (Orthosurgery fiˆ˜Neurosurgery) ‹ XÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ OÛÙÒÓ fiˆ˜ XÂÈ-ÚÔ˘ÚÁÈ΋ Ù˘ K·Ú‰È¿˜ (Bone Surgery fiˆ˜ HeartSurgery) Î.¿. K¿ÙÈ Ù¤ÙÔÈÔ ¿Ú¯ÈÛ ӷ Û˘˙ËÙÂ›Ù·È Î·ÈÓ· ÁÚ¿ÊÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔ-ÁÚ·Ê›·. K·È ı· ‹ıÂÏ· Ó· ͤڈ ˆ˜ Â›Ó·È ‰˘Ó·Ùfi Ó·˘ÔÛÙËÚ›ÍÔ˘Ì ÙÔÓ fiÚÔ fiÙ·Ó ‰ÂÓ Û˘ÌʈÓԇ̠ÌÂÙÔ˘˜ ¿ÏÏÔ˘˜ ÁÈ· ÙËÓ ÂÙ˘ÌÔÏÔÁ›· ÙÔ˘.

£ÂˆÚ‹Û·Ì ÏÔÈfiÓ ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË Ó·ÂÈÛÙÚ¤„Ô˘Ì ÛÙËÓ ·Ú¯È΋ ÚԤϢÛË Ù˘ Ϥ͢ ηÈÓ· ·Ú¯›ÛÔ˘Ì ӷ ÙË ÁÚ¿ÊÔ˘Ì Ì “·È” (OÚıԷȉÈ-΋). N· ¯ÚËÛÈÌÔÔÈԇ̠‰ËÏ·‰‹ ÙËÓ ÔÚıÔÁÚ·Ê›·Ô˘ ˘Ô‰ËÏÒÓÂÈ ÙËÓ ÚԤϢÛË Ù˘ Ϥ͢ Û‚fiÌÂ-ÓÔÈ Û˘Á¯ÚfiÓˆ˜ ÙÔ ‰ËÌÈÔ˘ÚÁfi Ù˘. A˘Ùfi ‹Ù·Ó Ï›ÁÔ‰‡ÛÎÔÏÔ ÛÙËÓ ·Ú¯‹ ·ÏÏ¿ Ê·›ÓÂÙ·È fiÙÈ ÙÔ Û˘ÓËı›˙Ô˘-Ì fiˆ˜ Û˘ÓËı›Û·ÌÂ Î·È ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÔÚıÔ-ÁÚ·Ê›·. ŒÚ ‰ËÏ·‰‹ Ó· ÂÈÛÙÚ¤„Ô˘Ì ÛÙËÓ Â-Ù˘ÌÔÏÔÁ›· Ô˘ ¤ÁÈÓ ·ÁÎÔÛÌ›ˆ˜ ·Ô‰ÂÎÙ‹. Ÿ¯ÈÌfiÓÔÓ ‰ÈfiÙÈ ̆ ¿Ú¯Ô˘Ó ÈÛÙÔÚÈÎÔ› Î·È ÏfiÁÔÈ ÂÈÎÔÈÓˆ-

Ó›·˜ ·ÏÏ¿ Î·È ‰ÈfiÙÈ Ë ÂÙ˘ÌÔÏÔÁ›· Ô˘ ¯ÚËÛÈÌÔÔÈ-Ô‡Û·Ì ‰ÂÓ ‹Ù·Ó ÈÔ ÂÚÈÂÎÙÈ΋ Î·È ‰ËψÙÈ΋ Ù˘ÂȉÈÎfiÙËÙ¿˜ Ì·˜ ·fi fi,ÙÈ Ë ·Ú¯È΋.

◊‰Ë ·fi ÙÔ 1984 Ô K·ıËÁËÙ‹˜ Î. ¶·Ó. ¶. ™˘-̈ӛ‰Ë˜ ÛÙÔÓ ÚfiÏÔÁÔ Ù˘ A′ ¤Î‰ÔÛ˘ ÙÔ˘ ‚È‚Ï›Ô˘ÙÔ˘ “OÚıÔ‰È΋” ·ÌÊÈÛ‚ËÙÔ‡Û “ÙËÓ ·ÏÏ·Á‹ ÛÙËÓEÏÏ¿‰· ÙÔ˘ ·Ú¯ÈÎÔ‡ fiÚÔ˘, Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÂÏ-ÏËÓÈΤ˜ ϤÍÂȘ Î·È ¤ÁÈÓ ·ÁÎfiÛÌÈ· ·Ô‰ÂÎÙfi˜ Û·ÓÙ›ıÂÛË Ì ÙÔ ‰Â‡ÙÂÚÔ Ô˘ ÂÚÈÔÚ›ÛÙËΠÛÙËÓ ÂÏ-ÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·”. °È’ ·˘Ùfi Î·È ÛÙË B′ ¤Î‰ÔÛËÙÔ˘ ‚È‚Ï›Ô˘ ÙÔ˘ ÙÔ 1996 ·ӋÏı ÛÙËÓ ·Ú¯È΋ ÂÙ˘-ÌÔÏÔÁ›· Î·È ÔÚıÔÁÚ·Ê›· Ù˘ Ϥ͢ ‰ËÏ·‰‹ “OÚıÔ-·È‰È΋”.

°È· fiÏÔ˘˜ ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜ Ë EÏÏËÓÈ΋EÙ·ÈÚ›· XÂÈÚÔ˘ÚÁÈ΋˜ OÚıԷȉÈ΋˜ Î·È TÚ·˘Ì·-ÙÔÏÔÁ›·˜ Ô˘ Â›Ó·È Î·È Ë Â›ÛËÌË EÈÛÙËÌÔÓÈ΋ Ì·˜EÙ·ÈÚ›·, Ì ·fiÊ·ÛË Ù˘ °ÂÓÈ΋˜ Ù˘ ™˘ÓÂχÛÂ-ˆ˜ ÙÔÓ OÎÙÒ‚ÚÈÔ ÙÔ˘ 1998 ÛÙË £ÂÛÛ·ÏÔÓ›ÎË ¿ÏÏ·-Í ÙËÓ ÔÚıÔÁÚ·Ê›· Ù˘ Ϥ͢ ·fi “OÚıÔ‰È΋” Û“OÚıԷȉÈ΋”.

™‹ÌÂÚ· fiÏ· Ù· ‚È‚Ï›· Î·È Ù· ÂÈÛÙËÌÔÓÈο ÔÚ-ıԷȉÈο ÂÚÈÔ‰Èο Ù˘ ¯ÒÚ·˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙËÓ·ÔηٷÛÙ·ı›۷ ϤÔÓ ÔÚıÔÁÚ·Ê›·. TÔ ›‰ÈÔ Î·-ÓÔ˘Ó Ë EÏÏËÓÈ΋ EÙ·ÈÚ›· XÂÈÚÔ˘ÚÁÈ΋˜ OÚıÔ·È-‰È΋˜ Î·È TÚ·˘Ì·ÙÔÏÔÁ›·˜, Ë OÚıԷȉÈ΋ EÙ·È-Ú›· M·Î‰ÔÓ›·˜-£Ú¿Î˘ Î·È fiϘ ÔÈ ÂÈ̤ÚÔ˘˜OÚıԷȉÈΤ˜ EÙ·ÈÚ›˜ ÛÙ· ›ÛËÌ· ¤ÁÁÚ·Ê· ηÈÙËÓ ·ÏÏËÏÔÁÚ·Ê›· ÙÔ˘˜.

ZËÙԇ̠ÏÔÈfiÓ Î·È ·fi ÙÔÓ ˘fiÏÔÈÔ È·ÙÚÈÎfiÎ·È ÁÂÓÈÎÒ˜ ÂÈÛÙËÌÔÓÈÎfi ÎfiÛÌÔ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈÙÔ ·Ú¿‰ÂÈÁÌ· Ù˘ ÔÚıԷȉÈ΋˜ ÎÔÈÓfiÙËÙ·˜.

Pournaras ID. Why Orthopaedics and not Or-thopedics. Hell Iatr, 2000, 66: 279 - 280.

Bπµ§π√°ƒ∞ºÿ∞HÏÈfiÔ˘ÏÔ˜ K™. OÈ ÚˆÙÔfiÚÔÈ Ù˘ OÚıÔ‰È΋˜, Aı‹Ó·

1991: 192..

Kirkup JR. Nicolas Andry and 250 years of Orthopaedy. JBone Joint Surg 1991, 73-B: 361-2.

Kirkup JR. Orthopaedy, Orthopaedics or “Orthosurgery”.British Orthopaedic News, London, Spring 199: 7.

™˘Ìˆӛ‰Ë˜ ¶. OÚıÔ‰È΋. ¶ÚfiÏÔÁÔ˜, £ÂÛÛ·ÏÔÓ›ÎË:University Studio Press, 1994.

™˘Ìˆӛ‰Ë˜ ¶. OÚıԷȉÈ΋. ¶ÚfiÏÔÁÔ˜, ¢Â‡ÙÂÚË ¤Î‰ÔÛË.£ÂÛÛ·ÏÔÓ›ÎË University Studio Press, 1994.

TÛÔÏ¿Î˘ X. ¶ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·.

XÚÈÛÙ›‰Ë˜ Aº. OÚıÔ‰È΋ ‹ OÚıԷȉÈ΋. AÏÏËÏÔÁÚ·Ê›·,1996.

XÚ˘ÛÔÛ¿ı˘ I. OÚıÔ‰È΋. Aı‹Ó· 1932: 5

280 I. ¶OYPNAPA™

§ÔÈÌ҉˘ ÂÓ‰Ôηډ›Ùȉ· Ì ·Û˘Ó‹ıË ÎÏÈÓÈ΋ ÂÈÎfiÓ·Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜

M. AÚ‚·ÓÈÙ¿ÎË, Soheil Zahir

Universite Libre de Bruxelles, Department of Internal Medicine, Hopital Civil de Tournai

Tournai, Belgium

¶ÂÚ›ÏË„Ë. H ÏÔÈÌ҉˘ ÂÓ‰Ôηډ›Ùȉ· Â›Ó·È ‰˘Ó·ÙfiÓÓ· ÂΉËψı› ÎÏÈÓÈο Ì Â͈ηډȷΤ˜ ÂΉËÏÒÛÂȘ. HÂÚ›ÙˆÛË ·ÊÔÚ¿ Á˘Ó·›Î· 76 ÂÙÒÓ Ô˘ ·ÚÔ˘Û›·-Û ÔÍ›· Û˘Á¯˘ÙÈ΋ ηٿÛÙ·ÛË, ˘ÚÂÙfi, ‰È·Ù·Ú·¯¤˜ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡, ÎÈÓËÙÈ΋ ·Ê·Û›·, ‰ÂÍÈ¿ ËÌÈÏË-Á›·, ıÂÙÈÎfi ÛËÌÂ›Ô Babinski Î·È ‰˘Ûη̄›· ·˘¯¤Ó·.™ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ˘‹Ú¯Â Û˘ÛÙÔÏÈÎfi ʇÛË-Ì· ÛÙËÓ ÌÈÙÚÔÂȉ‹ ‚·Ï‚›‰·. H ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·-ΤÓÙËÛË ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ ÂÁÎÂÊ·-ÏÔÓˆÙÈ·›Ô ˘ÁÚfi. H ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·-Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο Ï·›ÛÈ·.AÂÈÎÔÓÈÛÙÈ΋ ÂͤٷÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì TC99 ÂÍ·-ÌÂı˘ÏÈ΋ ÚÔ˘ÏÂÓ·Ì›ÓË ÔÍ›ÓË (SPECT) ¤‰ÂÈÍ ·ÓÈÛfi-ÙÈÌË ·ÈÌ¿ÙˆÛË, Û˘Ì‚·Ù‹ Ì ÂÁÎÂÊ·ÏÈ΋ ÂÌ‚ÔÏ‹. HÂͤٷÛË ˘ÂÚ‹¯ˆÓ ηډ›·˜ ¤‰ÂÈÍ ÎÈÓËÙ¤˜ ÂÌ‚Ï·-ÛÙ‹ÛÂȘ Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜. H ‰È¿ÁÓˆÛË Ù˘ÏÔÈÌÒ‰Ô˘˜ ÂÓ‰Ôηډ›Ùȉ·˜ ÙÂÎÌËÚÈÒıËΠ̠ηÏÏȤÚ-

ÁÂȘ ·›Ì·ÙÔ˜ Ô˘ ¤‰ÂÈÍ·Ó Streptococcus viridans, ¢-·›ÛıËÙÔ Û ÎÂÊÙÚÈ·ÍfiÓË Î·È ÁÂÓÙ·ÌÈΛÓË. H ·¿ÓÙË-ÛË ÛÙËÓ ·ÓÙÈÌÈÎÚԂȷ΋ ¯ËÌÂÈÔıÂڷ›· Ì ÎÂÊÙÚÈ·-ÍfiÓË Î·È ÁÂÓÙ·ÌÈΛÓË ˘‹ÚÍ ·ÔÙÂÏÂÛÌ·ÙÈ΋. Mȷ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ıÂڷ›· ·Ú·ÙËÚ‹ıΠϋÚ˘‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì ·ÔηٿÛÙ·ÛË Ù˘ ÎÈ-ÓËÙÈ΋˜ Ó¢ÚÔÏÔÁÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. H Èı·ÓfiÙËÙ·Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÂÓ‰Ôηډ›Ùȉ·˜ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿-ÓÂÙ·È ˘’ fi„Ë Û ·ÛıÂÓ›˜ Ì Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒ-ÛÂȘ, ˘ÚÂÙfi Î·È ‚·Ï‚ȉԿıÂÈ·. H ÎÏÈÓÈ΋ ˘Ô„›·Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÂÓ‰Ôηډ›Ùȉ·˜ Ì ¿ÌÂÛË ¯ÔÚ‹ÁËÛË·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ÌÂηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ Â›Ó·È Î·ıÔÚÈÛÙÈ΋ ÁÈ· ÙËÓ Â¤Ì-‚·ÛË ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ, fiˆ˜ ·Ô‰Â›¯ıËΠÛÙËÓÂÚ›ÙˆÛË ·˘Ù‹.EÏÏËÓ I·ÙÚ 2000, 66: 281 - 285.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 281 - 285

∏ ÏoÈÌ҉˘ ÂÓ‰oηډ›Ùȉ· ·oÙÂÏ› Ì›· ·fi ÙȘ ·È-ٛ˜ ÂÌ˘Ú¤Ùo˘ Û˘Ó‰ÚfiÌo˘, ȉȷ›ÙÂÚ· Û ·ÛıÂÓ›˜ ÌÂÈÛÙoÚÈÎfi ‚·Ï‚ȉo¿ıÂÈ·˜. ∆o ÎÏÈÓÈÎfi Ê¿ÛÌ· ›ӷÈ¢ڇ Î·È oÈ ÂΉËÏÒÛÂȘ Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›ÙÈ-‰·˜ ‰ÂÓ ÂÓÙo›˙oÓÙ·È ÌfiÓo ÛÙo ηډȷÁÁÂÈ·Îfi Û‡-ÛÙËÌ·. ¶·Ú¿ Ùo ÁÂÁoÓfi˜ fiÙÈ Ë Ïo›ÌˆÍË ·ÊoÚ¿ ÛÙoÂÓ‰oοډÈo Î·È ÙȘ ‚·Ï‚›‰Â˜ Ù˘ ηډȿ˜, oÈ Û˘ÛÙË-Ì·ÙÈΤ˜ Â͈ηډȷΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Û˘¯Ó¤˜ ‰Èfi-ÙÈ ÚoÛ‚¿ÏÏoÓÙ·È oÏÏ·Ï¿ fiÚÁ·Ó·1.

µ·ÎÙËÚÈ·ÈÌ›·, ÛËÙÈο ¤Ì‚oÏ· ÛÙo˘˜ ÓÂ-ÊÚo‡˜, ÂÁΤʷÏo, ÛÏ‹Ó· Î·È Î˘ÎÏoÊoÚo‡ÓÙ· ·-ÓoÛoÛ˘ÌϤÁÌ·Ù· Â›Ó·È oÈ Î‡ÚÈoÈ ·ıoÁÂÓÂÙÈÎo›·Ú¿ÁoÓÙ˜ ÛÙo˘˜ oo›o˘˜ oÊ›ÏoÓÙ·È oÈ Û˘ÛÙË-Ì·ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ. OÈ Ó¢ÚoÏoÁÈΤ˜ ÂÎ-

‰ËÏÒÛÂȘ Â›Ó·È Û¯ÂÙÈο ·Û˘Ó‹ıÂȘ ˆ˜ ·ÚÈ· ÎÏÈÓÈ-΋ ÂÈÎfiÓ· ÛÙË ÏoÈÌÒ‰Ë ÂÓ‰oηډ›Ùȉ·.

™Îofi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·Úo˘Û›·ÛËÌÈ·˜ ÂÚ›ÙˆÛ˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜ Û Ë-ÏÈÎȈ̤ÓË Á˘Ó·›Î· Ì ÚoÂÍ¿Ú¯o˘Û˜ ÙȘ Ó¢Úo-ÏoÁÈΤ˜ ÂΉËÏÒÛÂȘ. O ˘„ËÏfi˜ ‰Â›ÎÙ˘ ÎÏÈÓÈ΋˜˘o„›·˜ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›-Ùȉ·˜ ˘‹ÚÍ ηıoÚÈÛÙÈÎfi˜ ÁÈ· ÙËÓ Â˘Óo˚΋ ÂͤÏÈ-ÍË Ù˘ ÓfiÛo˘ Ì ÙËÓ ¿ÌÂÛË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒ-ÈÛË Ì ·ÓÙÈÌÈÎÚo‚ȷ΋ ¯ËÌÂÈoıÂڷ›·.

¶∂ƒπ°ƒ∞º∏ ∆∏™ ¶∂ƒπ¶∆ø™Eø™°˘Ó·›Î· ËÏÈΛ·˜ 76 ÂÙÒÓ ÚoÛ‹Ïı Û oÍ›· Û˘Á¯˘ÙÈ΋ η-Ù¿ÛÙ·ÛË. ¢ÂÓ ˘‹Ú¯Â ÈÛÙoÚÈÎfi Ï‹„˘ „˘¯fiÙÚoˆÓ Ê·ÚÌ¿-

281

ΈÓ, oÈÓoÓ‡̷Ùo˜, ۷ί·ÚÒ‰o˘˜ ‰È·‚‹Ùo˘ ‹ ·ÏÏ˘ Ó¢-ÚoÏoÁÈ΋˜ ÓfiÛo˘. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ë ıÂÚÌoÎÚ·Û›· ‹Ù·Ó37ÆC, ∞¶ 140/95 mmHg, ÛʇÍÂȘ 88/min Î·È ·Ó·Óo¤˜ 21/min. ∏ ·Ú¯È΋ Ó¢Úo„˘¯È·ÙÚÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ‰È·Ù·Ú·¯‹ÚoÛ·Ó·ÙoÏÈÛÌo‡ ÛÙoÓ Ùfio Î·È ¯ÚfiÓo, ¯ˆÚ›˜ ¿ÏϘ ÂΉËÏÒ-ÛÂȘ Ó¢ÚoÏoÁÈ΋˜ Û˘Ó‰ÚoÌ‹˜. ∏ ˘fiÏoÈË Ê˘ÛÈ΋ ÂͤٷÛˤ‰ÂÈÍ ÙËÓ ·Úo˘Û›· Û˘ÛÙoÏÈÎo‡ Ê˘Û‹Ì·Ùo˜ ÛÙËÓ ÂÛÙ›· ·-ÎÚo¿Ûˆ˜ Ù˘ ÌÈÙÚoÂȉo‡˜. ∆o ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· ‰ÂÓ Â›-¯Â ·ıoÏoÁÈο Â˘Ú‹Ì·Ù·, Ùo ‰¤ÚÌ· ‹Ù·Ó Ê˘ÛÈoÏoÁÈÎfi Î·È oÈÏÂÌÊ·‰¤Ó˜ ‰ÂÓ ‹Ù·Ó „ËÏ·ÊËÙo›. æËÏ¿ÊËÛË Ù˘ ÎoÈÏÈ¿˜ ¤-‰ÂÈÍÂ Ê˘ÛÈoÏoÁÈο Â˘Ú‹Ì·Ù·. ∂ͤٷÛË ÙˆÓ ·ÁÁ›ˆÓ Ùo˘ ÙÚ·-¯‹Ïo˘ fiˆ˜ Î·È ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÁÁ›ˆÓ ÙˆÓ ¿ÎÚˆÓ ‹Ù·ÓÊ˘ÛÈoÏoÁÈ΋.

∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ. O ·ÈÌ·ÙoÎÚ›Ù˘ ‹Ù·Ó 35%, Ë·ÈÌoÛÊ·ÈÚ›ÓË 12 g/dl, o ·ÚÈıÌfi˜ ÂÚ˘ıÚÒÓ ·ÈÌoÛÊ·ÈÚ›ˆÓ3.500.000/mm3, ·ÚÈıÌfi˜ Ï¢ÎÒÓ ·ÈÌoÛÊ·ÈÚ›ˆÓ 3.600/mm3

(Ù‡o˜ o˘‰ÂÙÂÚfiÊÈÏ· 59%, ÏÂÌÊo·ÙÙ·Ú· 36%, ˈÛÈÓfiÊÈÏ·3%, ÌoÓo·ÙÙ·Ú· 2%), ·ÈÌoÂÙ¿ÏÈ· 160.000/mm3, ۿί·ÚooÚo‡ 96 mg/dl, o˘Ú›· oÚo‡ 30 mg/dl, ÎÚ·ÙÈÓ›ÓË oÚo‡ 0,65mg/dl, SGOT 38 U/ml, Á-GT 28 U/ml, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË125 U/ml, Ó¿ÙÚÈo oÚo‡ 136 mEq/l, οÏÈo oÚo‡ 3,7 mEq/l, ¯Ïˆ-ÚÈo‡¯· oÚo‡ 101 mEq/l, ‰ÈÙÙ·ÓıÚ·ÎÈο oÚo‡ 29 mEq/l, C-·ÓÙȉÚÒÛ· ÚˆÙÂ˚ÓË 0,6 mg/dl.

TËÓ ÂfiÌÂÓË Ë̤ڷ ·Úo˘Û›·Û ˘ÚÂÙfi Ì ıÂÚÌoÎÚ·Û›·39ÆC Î·È Ó¢ÚoÏoÁÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ ÎÈÓËÙÈ΋ ·Ê·Û›·, ·‡-ÍËÛË ÙÂÓoÓÙ›ˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ, ‰ÂÍÈ¿ ËÌÈÏËÁ›·, ıÂÙÈÎfi ÛË-Ì›o Babinski ‰ÂÍÈ¿ Î·È ‰˘Ûη̄›· ·˘¯¤Ó·. ∏ ·ӿÏË„Ë Ù˘C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ ¤‰ÂÈÍ ·‡ÍËÛË (2,3 mg/dl).

∆o ËÏÂÎÙÚoηډÈoÁÚ¿ÊËÌ· ¤‰ÂÈÍ ÊÏ‚oÎoÌ‚ÈÎfi Ú˘ı-Ìfi ¯ˆÚ›˜ ¿ÏϘ ‰È·Ù·Ú·¯¤˜. ∏ ·ÍoÓÈ΋ ÙoÌoÁÚ·Ê›· ÂÁÎÂ-Ê¿Ïo˘ ‹Ù·Ó Ê˘ÛÈoÏoÁÈ΋. ŒÁÈÓ oÛÊ˘oÓˆÙÈ·›· ·Ú·Î¤ÓÙË-ÛË Î·È Ë ÂͤٷÛË Ùo˘ oÛÊ˘oÓˆÙÈ·›o˘ ˘ÁÚo‡ ¤‰ÂÈÍ ‰È·˘Á¤˜¯ÚÒÌ·, 3 ÏÂÌÊo·ÙÙ·Ú·/mm3, 6 ÂÚ˘ıÚ¿ ·ÈÌoÛÊ·›ÚÈ·/mm3,ۿί·Úo 60 mg/dl, χΈ̷ 40 mg/dl.

∏ ÌÈÎÚoÛÎoÈ΋ ÂͤٷÛË ÁÈ· ÌÈÎÚooÚÁ·ÓÈÛÌo‡˜ Î·È ËηÏÏȤÚÁÂÈ· Ùo˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚo‡ ‹Ù·Ó ·ÚÓËÙÈΤ˜.∆o ËÏÂÎÙÚoÂÁÎÂÊ·ÏoÁÚ¿ÊËÌ· ¤‰ÂÈÍ ‰È·Ù·Ú·¯‹ ÛÙo ·ÚÈÛÙÂ-Úfi ËÌÈÛÊ·›ÚÈo. ™ÈÓıËÚoÁÚ·ÊÈ΋ ÂͤٷÛË ÂÁÎÂÊ·ÏÈ΋˜ ·È-Ì¿ÙˆÛ˘ (SPECT) Ì Tc99-hexamethyl-propyleneamineoxine (HªPAO) ¤‰ÂÈÍ ‰È·Ù·Ú·¯¤˜ ·ÈÌ¿ÙˆÛ˘ Î·È ‚Ï¿‚Â˜Û˘Ì‚·Ù¤˜ Ì ¤ÌÊÚ·ÎÙ· (∂ÈÎ. 1). ∏ Ì·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›·ÂÁÎÂÊ¿Ïo˘ ‰ÂÓ ¤‰ÂÈÍ ·ÁÁÂȷΤ˜ ‚Ï¿‚˜ ‹ ·Ó¢ڇÛÌ·Ù·.∂Ï‹ÊıË Î·ÏÏȤÚÁÂÈ· ·›Ì·Ùo˜ Î·È ¿Ú¯ÈÛ ıÂڷ›· Ì ÎÂ-ÊÙÚÈ·ÍfiÓË, ·ÌÈÎÈÏÏ›ÓË Î·È aciclovir ÁÈ· Èı·Ó‹ Ïo›ÌˆÍË Ùo˘ÎÂÓÙÚÈÎo‡ Ó¢ÚÈÎo‡ Û˘ÛÙ‹Ì·Ùo˜.

∏ ηÏÏȤÚÁÂÈ· ·›Ì·Ùo˜ Û 24 ÒÚ˜ ‹Ù·Ó ıÂÙÈ΋ ÁÈ· Stre-ptococcus viridans. ÀÂÚ˯oÁÚ·Ê›· ηډ›·˜ ¤‰ÂÈÍ ·Ó¿Ú-ÎÂÈ· ÌÈÙÚoÂȉo‡˜ ÏfiÁˆ ÚfiÙˆÛ˘ Î·È Â΂ϷÛÙ‹ÛÂȘ Ù˘ ÌÈ-ÙÚoÂȉo‡˜ ‚·Ï‚›‰·˜ (∂ÈÎ. 2). ∏ ·ÓÙÈÌÈÎÚo‚ȷ΋ ¯ËÌÂÈoıÂÚ·-›· ÙÚoooÈ‹ıËΠ·Ó¿ÏoÁ· Ì ٷ ·oÙÂϤÛÌ·Ù· Ù˘ ¢·È-ÛıËÛ›·˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ·. ∆o ıÂڷ¢ÙÈÎfi Û¯‹Ì· ‹Ù·Ó ÎÂ-ÊÙÚÈ·ÍfiÓË 2 g ÂÓ‰oÊÏ‚›ˆ˜ ËÌÂÚËÛ›ˆ˜ Î·È ÁÂÓÙ·ÌÈΛÓË 1 mg/¯ÁÚ ‚¿Úo˜ x 3 ÊoÚ¤˜ ËÌÂÚËÛ›ˆ˜ ÁÈ· 2 ‚‰oÌ¿‰Â˜ Î·È Û˘Ó¤-¯ÂÈ· Ì ÎÂÊÙÚÈ·ÍfiÓË 2 g/Ë̤ڷ ÁÈ· ¿ÏϘ 2 ‚‰oÌ¿‰Â˜.

™Â ÌÈ· ‚‰oÌ¿‰· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ ·Ú·-ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Î·È Ï‹Ú˘ ·oηٿ-

282 M. Aƒµ∞¡π∆∞∫∏

∂ÈÎ. 1. ™ÈÓıËÚoÁÚ·ÊÈ΋ ÂͤٷÛË ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌ¿ÙˆÛ˘ (SPECT) Ì Tc99-hexamethyl-propyleneamine oxine(HMPAO), o˘ ‰Â›¯ÓÂÈ ‰È·Ù·Ú·¯¤˜ ·ÈÌ¿ÙˆÛ˘ Ùo˘ ÂÁÎÂÊ¿Ïo˘ Î·È ‚Ï¿‚˜ Û˘Ì‚·Ù¤˜ Ì oÏÏ·Ï¿ ÂÌÊÚ·ÎÙ¿.

ÛÙ·ÛË ÙˆÓ Ó¢ÚoÏoÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ∏ ÙÂÏÈ΋ ‰È¿ÁÓˆÛË‹Ù·Ó ÏoÈÌ҉˘ ÂÓ‰oηډ›Ùȉ· Ì ÛËÙÈο ¤Ì‚oÏ· ÛÙoÓ ÂÁΤ-Ê·Ïo, o˘ ÚoοÏÂÛ·Ó ÙËÓ Ó¢ÚoÏoÁÈ΋ Û˘Ó‰ÚoÌ‹.

™À∑∏∆∏™∏To ÎÏÈÓÈÎfi Ê¿ÛÌ· Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜Î·È Ë ·ÈÙÈoÏoÁ›· Ù˘ ÓfiÛo˘ ¤¯o˘Ó ÌÂÙ·‚ÏËı› Ù·ÙÂÏÂ˘Ù·›· ¤ÙË. ∏ ‚·Ï‚ȉo¿ıÂÈ· ÂÎÊ˘ÏÈÛÙÈ΋˜ ·È-ÙÈoÏoÁ›·˜ Î·È Ë ÚfiÙˆÛË Ù˘ ÌÈÙÚoÂȉo‡˜ Â›Ó·È oÈÛ˘¯ÓfiÙÂÚ˜ ηٷÛÙ¿ÛÂȘ o˘ Û¯ÂÙ›˙oÓÙ·È Ì ÙËÓÏoÈÌÒ‰Ë ÂÓ‰oηډ›Ùȉ· Î·È ¤¯o˘Ó ·ÓÙÈηٷÛÙ‹ÛÂÈÙoÓ ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi.

∂ÈϤoÓ, ¿ÏÏoÈ ·ÈÙÈoÏoÁÈÎo› ·Ú¿ÁoÓÙ˜¤¯o˘Ó ÚoÛÙÂı›2, fiˆ˜ ÂÓ‰oÊϤ‚È· ¯Ú‹ÛË Ê·Ú-̿ΈÓ, Ùooı¤ÙËÛË ‚·Ï‚›‰ˆÓ, Ùooı¤ÙËÛË Î·ıÂ-Ù‹ÚˆÓ ÛÙËÓ ÎÂÓÙÚÈ΋ ÊϤ‚·, Ùooı¤ÙËÛË ‚ËÌ·-Ùo‰oÙÒÓ Î·È ·ÚÙËÚÈoÊÏ‚ÈÎÒÓ ·Ó·ÛÙoÌÒÛÂˆÓ ÁÈ··ÈÌoοı·ÚÛË3. ∏ ̤ÛË ËÏÈΛ· ¤¯ÂÈ Â›Û˘ ·˘ÍËıÂ›Î·È Ë ÓfiÛo˜ Â›Ó·È Û˘¯ÓfiÙÂÚË Û‹ÌÂÚ· ÛÙ· ËÏÈÎȈ-̤ӷ ¿ÙoÌ·.

∆o ÎÏÈÓÈÎfi Ê¿ÛÌ· Ù˘ ÓfiÛo˘ ¤¯ÂÈ Â›Û˘ ÌÂ-Ù·‚ÏËı› Î·È Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛı› Ì ·Û˘-Ó‹ıÂȘ Â͈ηډȷΤ˜ ÂΉËÏÒÛÂȘ. ™ÙËÓ ÂÚ›Ùˆ-ÛË o˘ ÂÚÈÁÚ¿ÊÂÙ·È Ë Ó¢ÚoÏoÁÈ΋ Û˘Ó‰ÚoÌ‹ ·-fi Ùo ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ‹Ù·Ó Ë Î‡ÚÈ· ÎÏÈ-ÓÈ΋ ÂΉ‹ÏˆÛË. O ˘ÚÂÙfi˜ Î·È Ë ‡·ÚÍË Ùo˘ Û˘-ÛÙoÏÈÎo‡ Ê˘Û‹Ì·Ùo˜ ÛÙË ÌÈÙÚoÂȉ‹ ‹Ù·Ó Ù· ÛÙoÈ-¯Â›· ·fi Ùo ÈÛÙoÚÈÎfi o˘ o‰‹ÁËÛ·Ó ÛÙËÓ oÚı‹ ‰È¿-ÁÓˆÛË Ì ÙËÓ ¿ÌÂÛË ÂÊ·ÚÌoÁ‹ ·ÓÙÈÌÈÎÚo‚ȷ΋˜¯ËÌÂÈoıÂڷ›·˜.

∏ ‚ÈoÏoÁ›· Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜ ›-Ó·È ÂÓ‰o·ÁÁÂȷ΋ Ïo›ÌˆÍË o˘ ÚoÛ‚¿ÏÏÂÈ Ùo ÂÓ-‰oοډÈo ÙˆÓ ÎoÈÏoÙ‹ÙˆÓ Î·È Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ‚·Ï‚›‰ˆÓ. ∏ ÓfiÛo˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙoÓ Û¯Ë-Ì·ÙÈÛÌfi ÛËÙÈÎÒÓ ÊÏÂÁÌoÓˆ‰ÒÓ ÛÙoȯ›ˆÓ ÛÙȘ

‚·Ï‚›‰Â˜ Û ¤‰·Êo˜ ‚·Ï‚ȉo¿ıÂÈ·˜ (ÛÙ¤ÓˆÛË ‹·Ó¿ÚÎÂÈ·). OÈ Û˘¯ÓfiÙÂÚoÈ ÌÈÎÚooÚÁ·ÓÈÛÌÔ› ›-Ó·È o Staphylococcus aureus Î·È Streptococcus viri-dans3. BÚ·‰¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓoÈ ÌÈÎÚooÚÁ·ÓÈ-ÛÌo›, fiˆ˜ o Hemophilus, Actinobacillus, ∞ctino-mycetem comitans, Cardiobacterium hominis, Ei-kenella Î·È Kingella (HACEK) ¤¯o˘Ó ·Ó·ÁÓˆÚÈ-Ûı› ÚfiÛÊ·Ù· ˆ˜ ·ÈÙÈoÏoÁÈÎo› ·Ú¿ÁoÓÙ˜ ÛÙËÏoÈÌÒ‰Ë ÂÓ‰oηډ›Ùȉ·.

∏ ÏoÈÌ҉˘ ÂÓ‰oηډ›Ùȉ· ‰ÂÓ ÂÚÈoÚ›˙ÂÙ·ÈÌfiÓo ÛÙË Ïo›ÌˆÍË Ùo˘ ÂÓ‰oηډ›o˘, ·ÏÏ¿ ·oÙÂÏÂ›Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛo o˘ ÚoÛ‚¿ÏÏÂÈ oÏÏ·Ï¿ fiÚ-Á·Ó·. ∫·Ù¿ Û˘Ó¤ÂÈ·, Û ·ÛıÂÓ›˜ Ì ˘ÚÂÙfi ηȿÏϘ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ, ··ÈÙÂ›Ù·È ˘„Ë-Ïfi˜ ‰Â›ÎÙ˘ ÎÏÈÓÈ΋˜ ˘o„›·˜ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿-ÁÓˆÛË Î·È ¿ÌÂÛË ÂȉÈ΋ ·ÓÙÈÌÈÎÚo‚ȷ΋ ¯ËÌÂÈoıÂ-ڷ›·4,5.

∏ Û˘¯ÓfiÙËÙ· ÙˆÓ Ó¢ÚoÏoÁÈÎÒÓ ÂΉËÏÒÛˆÓÛÙË ÏoÈÌÒ‰Ë ÂÓ‰oηډ›Ùȉ· Î˘Ì·›ÓÂÙ·È ·fi 28-35%. ¶·Ú·ÙËÚo‡ÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙË ÏoÈÌÒ‰Ë ÂÓ-‰oηډ›Ùȉ· o˘ ÚoÛ‚¿ÏÏÂÈ ÙËÓ ·ÚÈÛÙÂÚ¿ ηÚ-‰›·. ™˘¯ÓfiÙÂÚË ÂÈÏo΋ Â›Ó·È Ë ÂÁÎÂÊ·ÏÈ΋ ÂÌ-‚oÏ‹ o˘ Êı¿ÓÂÈ Ù· 40%, fiˆ˜ ·Ó·Ê¤ÚıËΠۢÏÈÎfi ·˘Ùo„›·˜8.

∂Ó‰oÎÚ·Óȷο Ì˘ÎÔÙÈο ·Ó¢ڇÛÌ·Ù· ·Ú·-ÙËÚo‡ÓÙ·È Û 2% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ-‰oηډ›Ùȉ·˜ Î·È ÂÓÙo›˙oÓÙ·È Î˘Ú›ˆ˜ ÛÙË Ì¤ÛËÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›·. ∂›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚoηϤÛo˘ÓÛ˘Ì›ÂÛË Ì ·oÙ¤ÏÂÛÌ· ÙË ‚Ï¿‚Ë ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓÛ˘˙˘ÁÈÒÓ, Ú‹ÍË Î·È Ûo‚·Ú¤˜ ÂÈÏoΤ˜ fiˆ˜ ÂÁÎÂ-Ê·ÏÈ΋ Ë ˘·Ú·¯ÓoÂȉ‹˜ ·ÈÌoÚÚ·Á›·.

∏ ÂÁÎÂÊ·ÏÈ΋ ÂÌ‚oÏ‹ Û˘Ó‹ıˆ˜ ÚoËÁ›ٷÈÙ˘ ÂÌÊ¿ÓÈÛ˘ Ùo˘ ÂÁÎÂÊ·ÏÈÎo‡ Ì˘ÎÔÙÈÎo‡ ·Ó¢-Ú‡ÛÌ·Ùo˜. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ÂÌÊ¿ÓÈÛË ÂÁÎÂÊ·ÏÈ-΋˜ ÂÌ‚oÏ‹˜ Û˘ÓÈÛÙ¿ ¤Ó‰ÂÈÍË ÁÈ· ·ÚÙËÚȷ΋ ‹ Ì·-ÁÓËÙÈ΋ ·ÁÁÂÈoÁÚ·Ê›·9.

∞fiÛÙËÌ· ÂÁÎÂÊ¿Ïo˘ ‹ ÌËÓÈÁÁ›Ùȉ· Â›Ó·È ‰˘-Ó·ÙfiÓ Ó· ·oÙÂÏo‡Ó ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÏoÈ-ÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜. ∏ ·ıoÁ¤ÓÂÈ· ÙˆÓ Ó¢Úo-ÏoÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Â›Ó·È oÏ˘·Ú·ÁoÓÙÈ΋.™¯ÂÙ›˙oÓÙ·È Ì ·fiÊÚ·ÍË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙË-ÚÈÒÓ, ‰Â˘ÙÂÚo·ıÒ˜ ·fi ¤Ì‚oÏ· o˘ Úo¤Ú¯oÓÙ·È·fi ÂÓ‰oηډȷΤ˜ Â΂ϷÛÙ‹ÛÂȘ, Î·È ÚoηÏo‡ÓÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë ·fi ÈÛ¯·ÈÌ›· ‹ ·ÈÌoÚÚ·Á›·.ÕÏÏoÈ Ì˯·ÓÈÛÌo› Â›Ó·È Ïo›ÌˆÍË Ùo˘ ÎÂÓÙÚÈÎo‡Ó¢ÚÈÎo‡ Û˘ÛÙ‹Ì·Ùo˜, ‰Â˘ÙÂÚo·ıÒ˜ ·fi ÛËÙÈο¤Ì‚oÏ· ‹ ‚·ÎÙËÚÈ·ÈÌ›·.

∏ ·Úo˘Û›· ÂÌ‚fiÏˆÓ ÛÙ· ÌÈÎÚ¿ ·ÁÁ›· ›ӷȉ˘Ó·ÙfiÓ Ó· ÚoηϤÛÂÈ ÛËÙÈ΋ ‰È¿‚ÚˆÛË Ùo˘ ·Ú-ÙËÚÈ·Îo‡ ÙoȯÒÌ·Ùo˜ Î·È Û¯ËÌ·ÙÈÛÌfi Ì˘ÎÔÙÈÎo‡·Ó¢ڇÛÌ·Ùo˜. ∆¤Ïo˜, ·ÓoÛÈ·Îo› Ì˯·ÓÈÛÌo› ÊÏÂ-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 283

∂ÈÎ. 2. ÀÂÚ˯oÁÚ·Ê›· ηډȿ˜ o˘ ‰Â›¯ÓÂÈ ·Ó¿Ú-ÎÂÈ· Ù˘ ÌÈÙÚoÂȉo‡˜ ‚·Ï‚›‰·˜ ÏfiÁˆ ÚfiÙˆÛ˘ Ì ÎÈ-ÓËÙ¤˜ Â΂ϷÛÙ‹ÛÂȘ ÛÙȘ Áψ¯›Ó˜ Ù˘ ‚·Ï‚›‰·˜.

ÁÌoÓ‹˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Ì‚¿ÏÏo˘Ó ÛÙËÓ ·ÚÙË-Úȷ΋ ·fiÊÚ·ÍË Î·È ÛÙo Û¯ËÌ·ÙÈÛÌfi ·Ó¢ڢÛÌ¿-ÙˆÓ.

∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ Ó¢ÚoÏoÁÈÎÒÓ ÂΉËÏÒ-ÛÂˆÓ oÈΛÏÏÂÈ Î·È ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ Ù˘È΋. ∂›Ó·È‰˘Ó·ÙfiÓ Ó· ˘¿Ú¯o˘Ó ÂÛÙȷΤ˜ ‚Ï¿‚˜ fiˆ˜ Ë-ÌÈ¿ÚÂÛË ‹ ËÌÈÏËÁ›·, ·Ê·Û›· Î·È ËÌÈ·Óo„›·. ¶oÏ-Ï·Ï¿ ÂÁÎÂÊ·ÏÈο ¤Ì‚oÏ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Úoη-ϤÛo˘Ó ‰È·Ù·Ú·¯‹ Ùo˘ ÂȤ‰o˘ Û˘ÓÂȉ‹Ûˆ˜ ¯ˆÚ›˜ÂÛÙȷΤ˜ ‚Ï¿‚˜. ™ÙËÓ ÂÚ›ÙˆÛË o˘ ÂÚÈÁÚ¿Êo˘-ÌÂ, Ë ·Ú¯È΋ ÂΉ‹ÏˆÛË ‹Ù·Ó ‰È·Ù·Ú·¯‹ Û˘ÓÂȉ‹ÛÂ-ˆ˜ Î·È ÚoÛ·Ó·ÙoÏÈÛÌo‡, ÓoËÙÈ΋ ·Ê·Û›· Î·È ‰Â-ÍÈ¿ ËÌÈÏËÁ›· Ì ıÂÙÈÎfi ÛËÌ›o Babinski.

OÈ ·ÂÈÎoÓÈÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ, fiˆ˜ ·ÍoÓÈ΋ÙoÌoÁÚ·Ê›· Î·È Ì·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· Û˘Ì‚¿Ï-Ïo˘Ó ÛËÌ·ÓÙÈο ÛÙË ‰È·ÁÓˆÛÙÈ΋ ·ÍÈoÏfiÁËÛË Î·ÈÛÙË ‰È·ÊoÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ ÈÛ¯·ÈÌ›·˜ Î·È ·È-ÌoÚÚ·Á›·˜. ∏ Ì·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· Â›Ó·È Ï¤oÓ¢·›ÛıËÙË ÛÙË ‰È¿ÁÓˆÛË Û¯ËÌ·ÙÈÛÌo‡ ·oÛÙËÌ¿-ÙˆÓ Î·È ÂÌÊÚ¿ÎÙˆÓ. ∏ ·ÁÁÂÈoÁÚ·Ê›· ‹ Ì·ÁÓËÙÈ΋ÙoÌoÁÚ·Ê›· ¤¯ÂÈ ˘„ËÏ‹ ¢·ÈÛıËÛ›· ÛÙËÓ ·Ó›¯Ó¢-ÛË ÙˆÓ Ì˘ÎÔÙÈÎÒÓ ·Ó¢ڢÛÌ¿ÙˆÓ.

∆o ÛÈÓıËÚoÁÚ¿ÊËÌ· (SPECT) Ì ·ÂÈÎfiÓÈ-ÛË ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌ¿ÙˆÛ˘ Ì ∆c99-hexamethyl-propyleneamine oxine (HMPAO) Â›Ó·È È‰È·›ÙÂڷ¢·›ÛıËÙË ÂͤٷÛË ÛÙËÓ ·Ó›¯Ó¢ÛË ÂÁÎÂÊ·ÏÈ΋˜Û¯·ÈÌ›·˜ Î·È ÂÌÊÚ¿ÎÙˆÓ Î·È Ï¤oÓ ÂȉÈ΋ Û˘ÁÎÚÈ-ÙÈο Ì ÙËÓ ·ÍoÓÈ΋ ÙoÌoÁÚ·Ê›·10. A˘Ùfi ÂȂ‚·È-ÒıËÎÂ Î·È ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, fio˘ Ë ·ÍoÓÈÎ‹Î·È Ì·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· Áӈ̷Ù‡ıËÎ·Ó ˆ˜ Ê˘-ÛÈoÏoÁÈΤ˜ Î·È Ë ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌ›· Î·È Ù· ÂÌ-ÊÚ·ÎÙ¿ ÂȂ‚·ÈÒıËÎ·Ó Ì Ùo ÛÈÓıËÚoÁÚ¿ÊËÌ·SPECT.

H ˘ÂÚ˯oηډÈoÁÚ·Ê›· ¤¯ÂÈ È‰È·›ÙÂÚË ‰È·-ÁÓˆÛÙÈ΋ ·Í›· ÛÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜ Ì ÙËÓ ·ÂÈÎfiÓÈÛË ÙˆÓ‚Ï·‚ÒÓ ÙˆÓ ‚·Ï‚›‰ˆÓ Î·È ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ÙËÓÚfiÁÓˆÛË Î·È ÙË ıÂڷ›·11. ∏ ‰ÈoÈÛoÊ·ÁÈ΋ ˘Â-Ú˯oηډÈoÁÚ·Ê›· ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›··fi ÙË ‰È·ıˆÚ·ÎÈ΋ ˘ÂÚ˯oÁÚ·Ê›· ÛÙËÓ ·Ó›-¯Ó¢ÛË ÙˆÓ Â΂ϷÛÙ‹ÛÂˆÓ ÙˆÓ ‚·Ï‚›‰ˆÓ12. ∂È-ϤoÓ ·oÙÂÏ› ¯Ú‹ÛÈÌË ÂͤٷÛË ÁÈ· ÙËÓ ·ÍÈoÏfi-ÁËÛË ·ÛıÂÓÒÓ ÁÈ· ·ÓÙÈηٿÛÙ·ÛË ‚·Ï‚›‰ˆÓ.

OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·Ùo˜ ·oÙÂÏo‡Ó ÛËÌ·ÓÙÈ-΋ ‰È·ÁÓˆÛÙÈ΋ ÂͤٷÛË o˘ ÙÂÎÌËÚÈÒÓÂÈ ÙËÓ ‡-·ÚÍË Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜ Ì ÙËÓ ·o-ÌfiÓˆÛË Ùo˘ ÌÈÎÚooÚÁ·ÓÈÛÌo‡ o˘ ÚoηÏ› ÙËÏo›ÌˆÍË. ∫·ÏÏȤÚÁÂȘ ·›Ì·Ùo˜ Ú¤ÂÈ Ó· ÏË-Êıo‡Ó ÂÓÙfi˜ ÙˆÓ ÚÒÙˆÓ 24 ˆÚÒÓ, fiÙ·Ó ˘¿Ú¯ÂÈÎÏÈÓÈ΋ ˘o„›· ÁÈ· ÏoÈÌÒ‰Ë ÂÓ‰oηډ›Ùȉ·. ∏ Ù·-¯Â›· Ï‹„Ë ·ÈÌoηÏÏȤÚÁÂÈ·˜ Î·È Ë Û˘Ì‚oÏ‹ Ùo˘

ªÈÎÚo‚ÈoÏoÁÈÎo‡ ∂ÚÁ·ÛÙËÚ›o˘ ¤¯ÂÈ Î·ıoÚÈÛÙÈ΋ÛËÌ·Û›· ÁÈ· ÙËÓ ¿ÌÂÛË ‚·ÎÙËÚÈoÏoÁÈ΋ ÙÂÎÌËÚ›ˆ-ÛË Ù˘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜ Î·È ÙËÓ ÂÈÏÔÁ‹Ù˘ ·ÓÙÈÌÈÎÚo‚ȷ΋˜ ¯ËÌÂÈoıÂڷ›·˜, fiˆ˜ Û˘Ó¤-‚Ë ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜.

∏ oÚıoÏoÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÏoÈÌÒ‰o˘˜ÂÓ‰oηډ›Ùȉ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ 1) ÙËÓ ‚·ÎÙËÚȷ΋ÙÂÎÌËÚ›ˆÛË ÛÙȘ ηÏÏȤÚÁÂȘ ·›Ì·Ùo˜ Î·È ÙËÓ‰oÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜ ÛÙ· ·ÓÙÈ‚ÈoÙÈο, 2) ıÂÚ·-¢ÙÈο Û¯‹Ì·Ù· ÌÂ Û˘ÓÂÚÁÈÛÙÈ΋ ‚·ÎÙËÚÈoÎÙfiÓo‰Ú¿ÛË, 3) ÂÈÏoÁ‹ ·oÙÂÏÂÛÌ·ÙÈ΋˜ ‰oÛoÏoÁ›·˜Î·È ‰È¿ÚÎÂÈ·˜ ıÂڷ›·˜.

™Â ÂÚÈÙÒÛÂȘ ÏoÈÌÒ‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜o˘ oÊ›ÏÂÙ·È Û ÛÙÚÂÙfiÎoÎÎo, ÂӉ›ÎÓ˘Ù·È ÂÓÈ-ÎÈÏÏ›ÓË Î·È ÁÂÓÙ·ÌÈΛÓË5. ™Â ËÏÈÎȈ̤ӷ ¿ÙoÌ· ËÎÂÊÙÚÈ·ÍfiÓË Â›Ó·È ÂÏ΢ÛÙÈ΋ ÂÈÏoÁ‹, fiÙ·Ó ̆ ¿Ú¯ÂÈÂÈʇϷÍË Û¯ÂÙÈο Ì ÙËÓ ÙoÍÈÎfiÙËÙ· Ù˘ ÁÂÓÙ·ÌÈΛ-Ó˘. ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ ¯ÚËÛÈÌooÈ‹ıËΠÙo Û¯‹-Ì· ÎÂÊÙÚÈ·ÍfiÓ˘-ÁÂÓÙ·ÌÈΛÓ˘ ÁÈ· 2 ‚‰oÌ¿‰Â˜ ηÈÛ˘Ó¯›ÛıËΠÁÈ· ¿ÏϘ 2 ‚‰oÌ¿‰Â˜, (Û‡ÓoÏo 4‚‰oÌ¿‰Â˜) Ë ¯oÚ‹ÁËÛË Ù˘ ÎÂÊÙÚÈ·˙fiÓ˘.

∆· ıÂڷ¢ÙÈο ·oÙÂϤÛÌ·Ù· ·˘Ùo‡ Ùo˘Û¯‹Ì·Ùo˜ ‹Ù·Ó ȉȷ›ÙÂÚ· ÈηÓooÈËÙÈο ÛÙËÓ ÂÚ›-ÙˆÛ‹ Ì·˜, Ì ٷ¯Â›· ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ Ó¢-ÚoÏoÁÈ΋˜ Û˘Ó‰ÚoÌ‹˜ Û ÌÈ· ‚‰oÌ¿‰· Î·È Ï‹ÚË·oηٿÛÙ·ÛË ÙˆÓ Ó¢ÚoÏoÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

∆o oÚıfi ÎÏÈÓÈÎfi ÎÚÈÙ‹ÚÈo ÛÙË ‰È·ÁÓˆÛÙÈ΋ÚoÛ¤ÁÁÈÛË Î·È Ë ¿ÌÂÛË ıÂڷ›· ›¯Â ÂÓÙ˘ˆ-Ûȷο ·oÙÂϤÛÌ·Ù· ÛÙËÓ ÂÚ›ÙˆÛË o˘ ·Úo˘-ÛÈ¿˙ÂÙ·È. °È· ÙËÓ Â›Ù¢ÍË ·˘Ùo‡ Ùo˘ ÛÙfi¯o˘ ··È-ÙÂ›Ù·È oÚı‹ ÎÏÈÓÈ΋ ÚoÛ¤ÁÁÈÛË, Ù·¯Â›· ‰È¿ÁÓˆÛËÎ·È ¿ÌÂÛË ÂÊ·ÚÌoÁ‹ Ù˘ ηٿÏÏËÏ˘ ·ÓÙÈÌÈÎÚo-‚ȷ΋˜ ¯ËÌÂÈoıÂڷ›·˜.

∏ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÚˆÙÂ˚ÎÒÓ Î·È ·Û˘Ó‹ıˆÓÂ͈ηډȷÎÒÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ù˘ ÏoÈÌÒ-‰o˘˜ ÂÓ‰oηډ›Ùȉ·˜, fiˆ˜ Â›Ó·È oÈ Ó¢ÚoÏoÁÈΤ˜Î·È Ë ÎÏÈÓÈ΋ ˘o„›· ·oÙÂÏo‡Ó ··Ú·›ÙËÙ· ÛÙoÈ-¯Â›· ÛÙËÓ ÂÈÙ˘¯‹ ‰È¿ÁÓˆÛË Î·È ıÂڷ›·, fiˆ˜·o‰ÂÈÎÓ‡ÂÙ·È ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜.

ABSTRACTArvanitaki M. and Zahir S. Infectious endocar-ditis presenting with neurological manifestati-ons. Hell Iatr 2000, 66: 281 - 285.

Infectious endocarditis may present clinicallywith extracardiac manifestations. We describe a 76-year woman who presented with acute confusionalstate, fever, disorientation, motor aphasia, right he-miplegia, positive Babinski sign and neck rigidity. Asystolic heart murmur over the mitral valve was pre-

284 M. Aƒµ∞¡π∆∞∫∏

sent. Lumbar puncture showed no abnormalities ofthe celebrospinal fluid. CT scan and magnetic reso-nance imaging of the brain were normal. A Tc99-he-xamethyl-propyleneamine oxine (HMPAO) SPECTimaging study of the brain showed heterogeneousperfusion, consistent with celebral ischemia. Echo-cardiography showed mobile vegetations of the mi-tral valve. The diagnosis of infectious endocarditiswas confirmed by blood cultures which grew Stre-ptococcus viridans, sensitive to ceftriaxone and gen-tamicin. The response to antimicrobial chemotherapywith ceftriaxone and gentamicin proved effective.Within one week after treatment there was completeresolution of symptoms and motor and cognitiveneurological function was fully restored. Infectiousendocarditis should be considered in patients pre-senting with neurological manifestations, fever andvalvular disease. A clinical suspicion of the diagnosisconfirmed by blood cultures and imaging studieswith early administration of antibiotics may prove lifesaving, as shown in this case.

µµπ𵵧§ππOO°°ƒƒ∞∞ººππ∞∞1. Harris SP, Cobbs CG. Cardiac, cerebral and vascular

complications of infective endocarditis - Diagnosis andmanagement of infective endocarditis. Cardiol ClinNorth Am 199, 14: 437-49.

2. Steckelberg JM, Wilson WR. Risk factors for infectiousendocarditis. Infect Dis Clin North Amer 1993, 7: 9-19.

3. Roder BL, Wandall DA, Frimodt-Moller N, Espersen F,Skinhoj P, Rosdahl VT. Clinical features of staphy-lococcus aureus endocarditis - a 10-year experience inDenmark. Arch Intern Med 1999, 159: 462-9.

4. Kjerulf A, Trede M, Aldershvile J, Horby N. Bacterialendocarditis at a tertiary hospital - how do we improvediagnosis and delay of treatment? - A retrospectivestudy of 140 patients. Cardiology 1998, 82: 79-86.

5. Wilson WR, Karchmer AW, Dajani AS, Tanbert KA, BayerA, Kaye D. Antibiotic treatment of adults with infe-ctive endocarditis due to streptococci, staphylococciand HACEK microorganisms - JAMA 1995, 274:1706-13.

6. Roder BL, Wandall DA, Espersen F, Frimodt-Moller N,Skinjoj P, Rosdahl VT. Neurological manifestations instaphylococcous aureus endocarditis - a review of 260bacteremia cases in non-drug addicts. Amer J Med1997, 102: 379-86.

7. Arauz-Gongora AA, Souta-Meirino CA, Cotter-Lemus LE,Guzman-Rodriguez C, Mendez-Dominguez A. Theneurological complications of infectious endocarditis.Arch Inst Cardiol Mex 1998, 68: 328-32.

8. Selky AK, Roos KL. Neurological complications of infe-ctive endocarditis. Semin Neurol 1992, 12; 225-233.

9. Patel U, Chase N. Neuroradiology. In Danil WG, KronzonI, Mugge A, edrs. Cardiogenic Embolism – London:Williams and Wilkins, 1995.

10. Sanger J, Kramez EL. Nuclear medicine in the evaluationof cardiogenic embolism. In Cardiogenic Embolism,In Daniel WG, Kronzon I, Mugge A, eds. CardiogenicEmbolism. London: Williams and Wilkins, 1995.

11. Durack DT, Lukes AS, Bright DK. New criteria for dia-gnosis of infective endocarditis - utilization of specificechocardiographic findings. Amer J Med 1994, 96:200-9.

12. Daniel WG, Mugge A. Transesophageal echocardio-graphy. N Engl J Med 1995, 332: 1268-79.

AÏÏËÏoÁÚ·Ê›·ª·ÚÈ¿ÓÓ· ∞Ú‚·ÓÈÙ¿ÎË37 rue du LacBrussels 1000, Belgium

Correspondance AuthorMarianna Arvanitaki37 rue du LacBrussels 1000, Belgium

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 285

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 286 - 290

B·ÚÈ¿ Ú·‚‰ÔÌ˘fiÏ˘ÛË Î·È ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·ÔÊÂÈÏÔ̤ÓË Û Èfi Áڛ˘ A

M.§. ™ÈÒÓ1, A. X·Ù˙ËÙfiÏÈÔ˜2, M. AÚÌÂӿη1, E. TÔ‡Ï˘2, K. MÈÎÔ‡‰Ë2

1 °′ ¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋ A¶£, NÔÛÔÎÔÌÂ›Ô «°. ¶··ÓÈÎÔÏ¿Ô˘», EÍÔ¯‹ £ÂÛÛ·ÏÔӛ΢2 A′ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋ A¶£, NÔÛÔÎÔÌÂ›Ô AXE¶A, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë. H ÌË ÙÚ·˘Ì·ÙÈ΋ Ú·‚‰ÔÌ˘fiÏ˘ÛË Û˘¯Ó¿Û˘Óԉ‡ÂÙ·È ·fi ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. H Ú·-‚‰ÔÌ˘fiÏ˘ÛË ·fi ÏÔÈÌÒ‰Ë ·›ÙÈ· (ÌÈÎÚfi‚È·, ÈÔ›, ·-Ú¿ÛÈÙ·) Â›Ó·È Û¯ÂÙÈο ·Û˘Ó‹ıÈÛÙË Î·È ÂÚÈÛÛfiÙÂÚ˜·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÔÊÂÈÏfi-Ù·Ó Û ÈÔ‡˜, Û˘Ó‹ıˆ˜ Û ÈÔ‡˜ Áڛ˘. ÕÓ‰Ú·˜, ËÏÈ-Λ·˜ 29 ÂÙÒÓ, ÂÌÊ¿ÓÈÛ ‰‡Ô Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ ÂÈ-Û·ÁˆÁ‹ ÙÔ˘ ˘„ËÏfi ˘ÚÂÙfi, ÎÂÊ·Ï·ÏÁ›·, ¤ÓÙÔÓ˜ÁÂÓÈÎÂ˘Ì¤Ó˜ Ì˘·ÏÁ›Â˜ Î·È ÛÔ‚·Ú‹ Ì˘˚΋ ·‰˘Ó·Ì›·Ì ·‰˘Ó·Ì›· ‚¿‰ÈÛ˘ Î·È ÛÙ‹ÚÈ͢. ™ÙËÓ ÎÏÈÓÈ΋ Âͤ-Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó ‰‡ÛÓÔÈ·, Ô͈ÙÈ΋ ·Ó·-ÓÔ‹, Ôȉ‹Ì·Ù· ·Ó¿ Û¿Úη, ¤ÓÙÔÓ· Ì˘˚ο ¿ÏÁË Î·Èۯ‰fiÓ Ï‹Ú˘ Ì˘˚΋ ·‰˘Ó·Ì›·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜

¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· ‚·ÚÈ¿˜ Ú·‚‰Ô-Ì˘fiÏ˘Û˘ (CPK = 732.000 U/I) Î·È ÔÍ›·˜ ÓÂÊÚÈ΋˜·Ó¿ÚÎÂÈ·˜, ÂÓÒ Ô ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·¤‰ÂÈÍÂÙËÓ ‡·ÚÍË ÂÓÂÚÁÔ‡ Ïԛ̈͢ ·fi Èfi Áڛ˘ A. MÂ-Ù¿ ·fi Û˘ÓÙËÚËÙÈ΋ ıÂڷ›·, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÂ͈ÓÂÊÚÈ΋ οı·ÚÛË, Ô ¿ÚÚˆÛÙÔ˜ ÂÌÊ¿ÓÈÛ ϋÚˇÊÂÛË Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Î·È Â·Ó·ÊÔÚ¿ Ù˘ ÓÂ-ÊÚÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜. OÈ ÈÔ›, ÂȉÈο Ù˘ Áڛ˘,Ú¤ÂÈ Ó· ıˆÚÔ‡ÓÙ·È ‰˘ÓËÙÈο ·›ÙÈ· Ú·‚‰ÔÌ˘fiÏ˘-Û˘ Î·È ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, ÂȉÈο Û Â-ÚÈfi‰Ô˘˜ ÂȉËÌ›·˜.EÏÏËÓ I·ÙÚ 2000, 66: 286 - 290.

H Ú·‚‰ÔÌ˘fiÏ˘ÛË Â›Ó·È ¤Ó· ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ, Ô˘¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡ÍËÛË Ù˘ ÎÚ·ÙÈÓÔʈÛÊÔ-ÎÈÓ¿Û˘ (CPK) ÛÙÔ Ï¿ÛÌ· Î·È ·fi Ì˘ÔÛÊ·ÈÚÈ-ÓÔ˘Ú›·, Ë ÔÔ›· Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÔÍ›· ÓÂ-ÊÚÈ΋ ·Ó¿ÚÎÂÈ·.

T· ·›ÙÈ· Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Â›Ó·È ÔÏÏ¿(¶›Ó. 1). MÂٷ͇ ·˘ÙÒÓ ÙˆÓ ·ÈÙ›ˆÓ, ÔÈ ÏÔÈÌÒÍÂȘ·ÔÙÂÏÔ‡Ó ¤Ó· Û¯ÂÙÈο Û¿ÓÈÔ ·›ÙÈÔ Ú·‚‰ÔÌ˘fiÏ˘-Û˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ÏÔÈÌÒ‰Ë ·›ÙÈ· ¢ı‡ÓÔÓÙ·ÈÁÈ· ÙÔ 5% ÂÚ›Ô˘ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ú·‚‰ÔÌ˘Ôχ-ÛˆÓ1. H Ú·‚‰ÔÌ˘fiÏ˘ÛË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·Ó-Ûı› ÌÂÙ¿ ·fi ÏÔÈÌÒÍÂȘ ÔÊÂÈÏfiÌÂÓ˜ Û ÌÈÎÚfi-‚È·, Û ÈÔ‡˜ ‹ Î·È Û ·Ú¿ÛÈÙ·.

H ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ˆ˜ ÂÈÏÔ΋Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘, Â›Ó·È ÌÈ· ·ÚÎÂÙ¿ Û˘¯Ó‹, ·ÏÏ¿fi¯È ··Ú·›ÙËÙË, ÂÈÏÔ΋. H Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈ-Û‹˜ Ù˘ Î˘Ì·›ÓÂÙ·È Û Ôχ ¢ڤ· fiÚÈ·, ·ÎfiÌË Î·ÈÛ ÂÚÈÙÒÛÂȘ ÏÔÈÌÒ‰Ô˘˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Ì ·›-ÙÈÔ ÙÔÓ ›‰ÈÔ ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ·.

™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÈ· ÂÚ›-ÙˆÛË È‰È·›ÙÂÚ· ‚·ÚÈ¿˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘, fiˆ˜ Ê·›-ÓÂÙ·È ·fi Ù· ›‰· Ù˘ CPK ÛÙÔ Ï¿ÛÌ· (732.000U/I), ÌÂ Û˘ÓÔ‰fi ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ÔÊÂÈ-ÏfiÌÂÓË Û Èfi Áڛ˘ A.

¶EPI°PAºH ∆∏™ ¶∂ƒÿ¶∆ø™Eø™ÕÓ‰Ú·˜, ËÏÈΛ·˜ 29 ÂÙÒÓ, ÚÔÛÎÔÌ›ÛÙËΠ·Ú·ÔÓÔ‡ÌÂÓÔ˜ÁÈ· ˘„ËÏfi ˘ÚÂÙfi (39-40ÆC), ÁÈ· ¤ÓÙÔÓ˜ ÁÂÓÈÎÂ˘Ì¤Ó˜ Ì˘-·ÏÁ›Â˜ Î·È ÌÂÁ¿ÏË Ì˘˚΋ ·‰˘Ó·Ì›·, ÂÍ·ÈÙ›·˜ Ù˘ ÔÔ›·˜ ÂÌ-Ê¿ÓÈ˙ ·‰˘Ó·Ì›· ‚¿‰ÈÛ˘ Î·È ÛÙ‹ÚÈ͢. T· Û˘ÌÙÒÌ·Ù· ·˘-Ù¿ ¿Ú¯ÈÛ·Ó 2-3 Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Î·È ‹Ù·ÓÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓ·.

§fiÁˆ ÙˆÓ ¯·Ú·ÎÙ‹ÚˆÓ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ÂÈÛ‹¯ıËÛ N¢ÚÔÏÔÁÈ΋ KÏÈÓÈ΋ Ì Èı·Ó‹ ‰È¿ÁÓˆÛË “AÓÈÔ‡Û· Ô-Ï˘ÚÚÈ˙ÔÓ¢ڛÙȉ·”. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ 24ÒÚÔ˘ Ù˘ÓÔÛËÏ›·˜ ÙÔ˘, Ô ·ÛıÂÓ‹˜ ÂÌÊ¿ÓÈÛ ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡-ÌÂÓË ‰‡ÛÓÔÈ· Î·È ÔÏÈÁÔ˘Ú›·, ÂÓÒ Ù· Ô‡Ú· ÙÔ˘ ¤ÁÈÓ·Ó ÛÎÔ‡-Ú· ηÛÙ·ÓÔÎfiÎÎÈÓ·. ™˘Á¯ÚfiÓˆ˜ ‰È·ÈÛÙÒıËΠ·‡ÍËÛË ÙˆÓÂȤ‰ˆÓ Ù˘ Ô˘Ú›·˜, Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È ÙÔ˘ Î·Ï›Ô˘ ÛÙÔÓÔÚfi Î·È Ô ·ÛıÂÓ‹˜ ‰È·ÎÔÌ›ÛıËΠ۠¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋.

286

H ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·ÚÚÒÛÙÔ˘ ¤‰ÂÈÍ ÙËÓ ‡·ÚÍË Ù·-¯‡ÓÔÈ·˜, ÔÚıfiÓÔÈ·˜ Î·È ÔȉËÌ¿ÙˆÓ “·Ó¿ Û¿Úη”. H Âͤٷ-ÛË ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÔÎ¿Ï˘„ ÙËÓ ¤ÎÏ˘ÛË ¤ÓÙÔ-ÓÔ˘ Ì˘˚ÎÔ‡ ¿ÏÁÔ˘˜, ·ÎfiÌË Î·È Ì ÙËÓ ÂÏ·ÊÚ¿ ›ÂÛË ÙˆÓ Ì˘ÒÓ,ȉȷ›ÙÂÚ· Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘, ÙˆÓ ÁÏÔ˘ÙÒÓ Î·È ÙˆÓ ÌËÚÒÓ. E›-Û˘ ‰È·ÈÛÙÒıËΠۯ‰fiÓ Ï‹Ú˘ ·‰˘Ó·Ì›· ÂÎÙ¤ÏÂÛ˘ ÂÓÂÚ-ÁËÙÈÎÒÓ ÎÈÓ‹ÛÂˆÓ ÙˆÓ ¿ÎÚˆÓ Î·È ¤ÁÂÚÛ˘ ·fi ÙËÓ ÎÏ›ÓË. ¢ÂÓÂÓÙÔ›ÛÙËÎ·Ó ÛÙÔÓ ·ÛıÂÓ‹ ·Ú·ÈÛıËۛ˜ ‹ ÂÏ¿ÙÙˆÛË Ù˘ ·È-ÛıËÙÈÎfiÙËÙ·˜.

H ıÂÚÌÔÎÚ·Û›· ÙÔ˘ ·ÚÚÒÛÙÔ˘ ‹Ù·Ó 37,8ÆC, Ë ·ÚÙËÚÈ·-΋ ›ÂÛË ‹Ù·Ó ·˘ÍË̤ÓË (165/120 mmHg), oÈ ÛʇÍÂȘ 115/minÎ·È ÔÈ ·Ó·ÓÔ¤˜ ÙÔ˘ 36/min.

K·Ù¿ ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ÂÓÙÔ›ÛÙËÎ·Ó ÏÂÙÔ›˘ÁÚÔ› ÚfiÁ¯ÔÈ, ‰È¿Û·ÚÙÔÈ Î·È ÛÙ· ‰‡Ô ËÌÈıˆÚ¿ÎÈ·, ÂÓÒ Ù· Ô‡-Ú· ÙÔ˘ ·ÛıÂÓ‹ ηٿ ÙÔ ÚÒÙÔ 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ÛÙËÓ·ıÔÏÔÁÈ‹ ÎÏÈÓÈ΋ ‹Ù·Ó 80 ml Î·È Â›¯·Ó ‚·ı‡ ηÛÙ·ÓÔÎfiÎÎÈ-ÓÔ ¯ÚÒÌ·. TÔ pH ÙÔ˘ ·›Ì·ÙÔ˜ ‹Ù·Ó 7,36 Ë PO2 68 mmHg, Ù·‰ÈÙÙ·ÓıÚ·ÎÈο 15 mmol/l Î·È ÙÔ ¤ÏÏÂÈÌÌ· ‚¿Û˘ -8 mmol/l. T·

˘fiÏÔÈ· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙˆÓ ‰‡Ô ÚÒÙˆÓ ËÌÂÚÒÓÙ˘ ÓÔÛËÏ›·˜ ÙÔ˘ ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2.

H ÂÓÙ˘ˆÛȷ΋ ·‡ÍËÛË Ù˘ CPK, ·ÏÏ¿ Î·È ÙˆÓ ¿ÏψÓÌ˘˚ÎÒÓ ÂÓ˙‡ÌˆÓ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ¤ıÂÛ·ÓÙË Èı·Ó‹ ‰È¿ÁÓˆÛË “ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ·fi Ú·‚‰Ô-Ì˘fiÏ˘ÛË”.

H ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÂÓ‹ ‹Ù·Ó ¿ÌÂÛË ÌÂÙË ¯ÔÚ‹ÁËÛË mannitol 50 ml/4h, NaHCO3 200 mEq/6h, ÁÏ˘-ÎÔÓÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ ÁÈ· ÙËÓ Î·Ú‰ÈÔÚÔÛÙ·Û›· ·fi ÙËÓ ˘ÂÚ-ηÏÈ·ÈÌ›· Î·È ÊÔ˘ÚÔÛÂÌ›‰Ë˜ 200 mg IV bolus. H ηٿÛÙ·ÛËÙÔ˘ ·ÚÚÒÛÙÔ˘ ‰Â ‚ÂÏÙÈÒıËΠÙȘ ÂfiÌÂÓ˜ ÒÚ˜ Î·È ÁÈ’ ·˘Ùfi¿Ú¯ÈÛ ıÂڷ›· Ì Ù¯ÓËÙfi ÓÂÊÚfi. ™Â fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ÓÔÛËÏ›·˜ ÙÔ˘ ¤Î·ÓÂ Û˘ÓÔÏÈο 8 Û˘Ó‰ڛ˜ Ù¯ÓËÙÔ‡ ÓÂÊÚÔ‡.

H ÎÏÈÓÈ΋ ÔÚ›· ÙÔ˘ ·ÛıÂÓ‹ ‹Ù·Ó ·Ú·ÙÂٷ̤ÓË Î·È‰‡ÛÎÔÏË. H ÔÏÈÁÔ-·ÓÔ˘ÚÈ΋ Ê¿ÛË Ù˘ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·ÓÂ-¿ÚÎÂÈ·˜ ‰È·ÙËÚ‹ıËΠÁÈ· 2 ‚‰ÔÌ¿‰Â˜, ÂÓÒ Ë ˘¤ÚÙ·ÛË ÁÈ·Ù¤ÛÛÂÚȘ. H ‰ÈÔ˘ÚËÙÈ΋ Ê¿ÛË ¿Ú¯ÈÛ ÌÂÙ¿ ÙȘ ‰‡Ô ‚‰ÔÌ¿‰Â˜,ÂÓÒ Ë ÔÏ˘Ô˘ÚÈ΋ ‰È·ÙËÚ‹ıËΠÁÈ· ¿ÏϘ ‰‡Ô ‚‰ÔÌ¿‰Â˜.

™ÙÔÓ ·ÛıÂÓ‹ ‰ÈÂÓÂÚÁ‹ıËΠ‚ÈÔ„›· Ì˘fi˜ ÙËÓ ÙÚ›ÙË Ë̤ڷÙ˘ ÓÔÛËÏ›·˜ ÙÔ˘. TÔ fiÚÈÛÌ· Ù˘ ÈÛÙÔÏÔÁÈ΋˜ ÂͤٷÛ˘‹Ù·Ó: M˘Ô·ıËÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ. H Ì·ÁÓËÙÈ-΋ ÙÔÌÔÁÚ·Ê›· ÙˆÓ Ì˘ÒÓ Ù˘ ˘ÂÏÈ΋˜ ˙ÒÓ˘ Î·È ÙˆÓ ÌËÚÒÓ¤‰ÂÈÍ ÙËÓ ·ÚÔ˘Û›· ‰È¿¯˘ÙÔ˘ ÈÛ¯˘ÚÔ‡ Û‹Ì·ÙÔ˜ Û fiÏË ÙËÓ¤ÎÙ·ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÁÏÔ˘ÙÈ·›Ô˘ Ì˘fi˜.

H ÔÚ›· ÙˆÓ Ì˘˚ÎÒÓ ÂÓ˙‡ÌˆÓ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔ-ÛËÏ›·˜ ÙÔ˘ ·ÚÚÒÛÙÔ˘ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 3.

O ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÙÔ˘ ‹ ÙˆÓ ·ÈÙ›ˆÓ Ù˘ Ú·-‚‰ÔÌ˘fiÏ˘Û˘ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· fiÏ· Ù· ÁÓˆÛÙ¿ ·›ÙÈ·, ÂÎÙfi˜·fi ÌÈ· ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈۈ̿وӤӷÓÙÈ ÙÔ˘ ÈÔ‡ Áڛ˘ A ·fi <1:8 Û >1:128, ·fi‰ÂÈÍË Úfi-ÛÊ·Ù˘ ÂÓÂÚÁÔ‡ Ïԛ̈͢ ·fi Èfi Áڛ˘A.

O ·ÛıÂÓ‹˜ ÌÂÙ¿ ·fi ¤Ó· Ì‹Ó· ÓÔÛËÏ›·˜, ›¯Â ۯ‰fiÓÏ‹ÚË ·ÔηٿÛÙ·ÛË ÙfiÛÔ Ù˘ ÓÂÊÚÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜, fiÛÔÎ·È ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙÔ˘˜ ̇˜ Î·È Ù· Ì˘˚ο ¤Ó˙˘Ì· ηȷԯÒÚËÛ ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ¢‡Ô Ì‹Ó˜ ÌÂÙ¿, ÛÙÔÓ Â·Ó¤-ÏÂÁ¯Ô Ô˘ ¤ÁÈÓÂ, ‰ÂÓ ‰È·ÈÛÙÒıËΠοÙÈ ÙÔ ·ıÔÏÔÁÈÎfi.

™À∑◊∆∏™∏OÈ ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜, ˆ˜ ·›ÙÈÔ Ú·‚‰ÔÌ˘fiÏ˘-Û˘, ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘1970, ÔfiÙÂ Î·È ·Ó·Ê¤ÚıËÎÂ Ë ÚÒÙË ÂÚ›ÙˆÛËÚ·‚‰ÔÌ˘fiÏ˘Û˘ ÔÊÂÈÏfiÌÂÓ˘ Û Èfi Áڛ˘ A2(Hong-Kong)2. To 1996 oÈ Singh Î·È Sheld3 η٤-ÁÚ·„·Ó fiϘ ÙȘ ÁÓˆÛÙ¤˜ ÂÚÈÙÒÛÂȘ Ú·‚‰ÔÌ˘fi-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 287

¶›Ó·Î·˜ 1. AÈÙÈÔÏÔÁ›· Ú·‚‰ÔÌ˘fiÏ˘Û˘

A. TÚ·˘Ì·ÙÈο ·›ÙÈ·1. ™‡Ó‰ÚÔÌÔ Î·Ù·¯ÒÛˆ˜ (Û˘ÓıÏ›„ˆ˜) (Crush syn-

drome)2. MÂÙ¿ ·fi Ôχ ¤ÓÙÔÓË ÛˆÌ·ÙÈ΋ ÚÔÛ¿ıÂÈ·3. IÛ¯·ÈÌ›· - MÂÙ¿ ·fi ·ӷÁÁ›ˆÛË

B. MË ÙÚ·˘Ì·ÙÈο ·›ÙÈ·1. M˘Ô¿ıÂÈ·

NfiÛÔ˜ ÙÔ˘ McArdleNfiÛÔ˜ ÙÔ˘ TaruiAÏÎÔÔÏÈ΋ Ì˘Ô¿ıÂÈ·™¿ÓÈ·: ¢ÂÚÌ·ÙÔÌ˘ÔÛ›Ùȉ· Î·È ÔÏ˘Ì˘ÔÛ›Ùȉ·

2. ¶·Ú·ÙÂٷ̤ÓÔ ÎÒÌ·YÂÚ‚ÔÏÈ΋ Ï‹„Ë ·ÏÎÔfiÏ˘§‹„Ë ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ Ó·ÚΈÙÈÎÒÓ, ËÚÂÌÈÛÙÈÎÒÓ,ËÚˆ›Ó˘YÂÚˆÛ̈ÙÈÎfi ÎÒÌ·

3. §ÔÈÌ҉˘ Ú·‚‰ÔÌ˘fiÏ˘ÛË4. ¢ËÏËÙËÚ›·ÛË Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη5. B·ÚȤ˜ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜

YÔηÏÈ·ÈÌ›·YÔʈÛÊ·Ù·ÈÌ›·

6. I‰ÈÔ·ı‹˜ ·Ú·Í˘ÛÌÈ΋ Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›·7. ¢È·‚ËÙÈ΋ ÎÂÙÔͤˆÛË, ÂÁη‡Ì·Ù·, ηÎÔ‹ı˘ ˘¤Ú-

Ù·ÛË, ‰ËÏËÙËÚ›·ÛË Ì ıÂÈÈÎfi ¯·ÏÎfi, Ì ¯ÏˆÚÈÔ‡¯Ô˘‰Ú¿ÚÁ˘ÚÔ, Ì ʈÛÊÔÚÈÎfi „¢‰¿ÚÁ˘ÚÔ

¶›Ó·Î·˜ 2. T· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÛıÂÓ‹ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘

AÈÌ·ÙÔÏÔÁÈ΋/BÈÔ¯ËÌÈ΋ ·Ú¿ÌÂÙÚÔ˜ TÈÌ‹ BÈÔ¯ËÌÈ΋ ·Ú¿ÌÂÙÚÔ˜ TÈÌ‹

AÈÌÔÛÊ·ÈÚ›ÓË gr/dl 13,7 K¿ÏÈÔ ÔÚÔ‡ mEq/l 7.50AÈÌ·ÙÔÎÚ›Ù˘ % 43,4 N¿ÙÚÈÔ ÔÚÔ‡ mEq/l 128§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·/ί 16.900 AÛ‚¤ÛÙÈÔ ÔÚÔ‡ mEq/l 4,15AÈÌÔÂÙ¿ÏÈ·/ί 164.000 ºˆÛÊfiÚÔ˜ ÔÚÔ‡ mg/dl 16,64TKE 15 ¯ÈÏ. M˘ÔÛÊ·ÈÚ›ÓË ÔÚÔ‡ ng/ml 399°Ï˘Îfi˙Ë mg/dl 91 SGOT u/l 3.150O˘Ú›· mg/ 168 LDH u/l 58.340KÚ·ÙÈÓ›ÓË mg/dl 6,33 CPK 732.000O˘ÚÈÎfi Ô͇ mg/dl 14,77 M˘ÔÛÊ·ÈÚ›ÓË Ô‡ÚˆÓ ++++

Ï˘Û˘, Ô˘ ÔÊÂÈÏfiÙ·Ó Û ÏÔÈÌÒ‰Ë ·›ÙÈ· (¶›Ó. 4 ηÈ5). Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙÔÓ ›Ó·Î· 4, ÌÂٷ͇ وӉȷÊfiÚˆÓ ÈÒÓ, ÔÈ ÈÔ› Ù˘ Áڛ˘ A Î·È B ÂÓÔ¯ÔÔÈ-Ô‡ÓÙ·È ÁÈ· ÙÔ 42,54% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ú·-‚‰ÔÌ˘fiÏ˘Û˘ ·fi ÈÔ‡˜. MÂÙ¿ ·fi ÙÔ 1996 ·Ó·-ʤÚıËÎ·Ó ¿ÏϘ 5 ÂÚÈÙÒÛÂȘ Ú·‚‰ÔÌ˘fiÏ˘Û˘4-7,ÔÊÂÈÏfiÌÂÓ˜ Û Èfi Áڛ˘.

Afi ÙË ÌÂϤÙË ÙÔ˘ ›Ó·Î· ÚÔ·ÙÂÈ Â›Û˘fiÙÈ fiϘ ÔÈ ÂÚÈÙÒÛÂȘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ·fi ÁڛˉÂÓ Û˘Óԉ‡ÔÓÙ·È ·fi ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·.Ÿˆ˜ Ê·›ÓÂÙ·È, Ë ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÂÌ-Ê·Ó›˙ÂÙ·È ÛÂ Û˘¯ÓfiÙËÙ· 44% ÙˆÓ ÂÚÈÙÒÛˆÓÚ·‚‰ÔÌ˘fiÏ˘Û˘ Ô˘ ÔÊ›ÏÔÓÙ·È Û ÈÔ‡˜ Áڛ˘. HÂÌÊ¿ÓÈÛË ‹ ÌË ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Ê·›-ÓÂÙ·È fiÙÈ ÂÍ·ÚٿٷÈ, ÂÎÙfi˜ ·fi ÙËÓ ¤ÓÙ·ÛË Ù˘ Ú·-‚‰ÔÌ˘fiÏ˘Û˘ Î·È ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ ›-Ó·È Ë ˘ÂÚÔ˘Úȯ·ÈÌ›·, Ë ·Ê˘‰¿ÙˆÛË Î·È Ë Ôͤˆ-ÛË8. ÕÌÂÛË Û¯¤ÛË ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ·fi ÁÚ›Ë AÎ·È ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ‰ÂÓ ¤¯ÂÈ Ê·Ó›, ·Ú¿ ÙÔÁÂÁÔÓfi˜ fiÙÈ ·ÚÎÂÙÔ› ÈÔ› ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ·ÙËÓ ÚfiÎÏËÛË ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. X·Ú·ÎÙËÚÈ-ÛÙÈο ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ù˘ ÔÍ›·˜ ÓÂÊÚÈ-΋˜ ·Ó¿ÚÎÂÈ·˜ ·fi Ú·‚‰ÔÌ˘fiÏ˘ÛË ıˆÚÔ‡ÓÙ·ÈË ‰˘Û·ÚÌÔÓ›· ÌÂٷ͇ ÙˆÓ ÂȤ‰ˆÓ Ù˘ Ô˘Ú›·˜ ÙÔ˘·›Ì·ÙÔ˜ Î·È ÙˆÓ ¿ÏÏˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ,

fiˆ˜ Ù˘ ÎÚ·ÙÈÓ›Ó˘, ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Î·È ÙÔ˘·ÓfiÚÁ·ÓÔ˘ ʈÛÊfiÚÔ˘ ÙÔ˘ ÔÚÔ‡.

™ÙÔÓ ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠ‹Ù·Ó ÂÓÙ˘-ˆÛȷ΋ Ë ¤ÓÙ·ÛË Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘, fiˆ˜ ·˘Ù‹Ê¿ÓËΠ·fi ÙȘ ÙÈ̤˜ ÙˆÓ ÂȤ‰ˆÓ Ù˘ CPK ÛÙÔÓÔÚfi Î·È ·fi ÙË Û¯Â‰fiÓ Ï‹ÚË ·‰˘Ó·Ì›· Ó· ¯ÚËÛÈ-ÌÔÔÈ‹ÛÂÈ ÙÔ˘˜ ̇˜ ÙÔ˘. EÓÙ˘ˆÛȷ΋ ‹Ù·Ó ›-Û˘ Ë ¤ÓÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, fiˆ˜ ›-Û˘ Î·È Ë ‰È¿ÚÎÂÈ¿ Ù˘. H ‚ÈÔ„›· Ì˘fi˜ ÂȂ‚·›ˆ-Û ÙË ‰È¿ÁÓˆÛË Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘, fiˆ˜ ›ÛË˜Î·È Ù· Â˘Ú‹Ì·Ù· Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜.

H ‰È¿ÁÓˆÛË Ù˘ Áڛ˘ ‚·Û›ÛÙËΠÛÙ· ÎÏÈÓÈο¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ Â̇ÚÂÙ˘ Ïԛ̈͢, ÛÙ· ÂÈ-‰ËÌÈÔÏÔÁÈο ÛÙÔȯ›· ÂΛӢ Ù˘ ÂÚÈfi‰Ô˘ (˘‹Ú-¯·Ó ·˘ÍË̤ӷ ÎÚÔ‡ÛÌ·Ù· Áڛ˘, ˘fi ÌÔÚÊ‹ ÌÈ-ÎÚÔÂȉËÌ›·˜, ÛÙËÓ fiÏË) Î·È ÂȂ‚·ÈÒıËΠÌÂÙËÓ ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈۈ̿-ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ A.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ì˯·ÓÈÛÌfi ηٷÛÙÚÔÊ‹˜ÙˆÓ Ì˘ÒÓ ÛÙȘ ÂÚÈÙÒÛÂȘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ·fiÈÔ‡˜, ·˘Ùfi˜ ‰ÂÓ Â›Ó·È Û·ÊÒ˜ ÁÓˆÛÙfi˜. ¶Èı·ÓÔÏÔ-ÁÔ‡ÓÙ·È 1) H ¿ÌÂÛË ÚÔÛ‚ÔÏ‹ ÙˆÓ Ì˘ÒÓ ·fi ÙÔ˘˜ÈÔ‡˜ Î·È 2) H ¤ÌÌÂÛË, ‰È·Ì¤ÛÔ˘ ÙÔÍÈÓÒÓ, ÚÔÛ‚Ô-Ï‹ ÙÔ˘˜. Y¤Ú Ù˘ ¿ÌÂÛ˘ ÚÔÛ‚ÔÏ‹˜ Â›Ó·È ÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ Û ‚ÈÔ„›Â˜ Ì˘ÒÓ ·Û¯fiÓÙˆÓ ·fi echovi-

288 M. ™IøN KAI ™YN.

¶›Ó·Î·˜ 3. OÈ ‰È·Î˘Ì¿ÓÛÂȘ ÙˆÓ Ì˘˚ÎÒÓ ÂÓ˙‡ÌˆÓ

M˘˚Îfi ¤Ó˙˘ÌÔ 1Ë Ë̤ڷ 5Ë Ë̤ڷ 12Ë Ë̤ڷ 18Ë Ë̤ڷ 30Ë Ë̤ڷÓÔÛËÏ›·˜ ÓÔÛËÏ›·˜ ÓÔÛËÏ›·˜ ÓÔÛËÏ›·˜ ÓÔÛËÏ›·˜

M˘ÔÛÊ·ÈÚ›ÓË ÔÚÔ‡ ng/ml 399 1.292 1.177 85M˘ÔÛÊ·ÈÚ›ÓË Ô‡ÚˆÓ ++++ ++ ++ + –SGOT u/l 3.150 586 472 50 31LDH u.l 58.340 39.430 1.629 1.322 310CPK 732.000 225.000 1.629 1.322 310

¶›Ó·Î·˜ 4. Io› Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· Ú·‚‰ÔÌ˘fiÏ˘ÛË

IÔ› AÛıÂÓ›˜ HÏÈΛ· E›Â‰· ™˘¯ÓfiÙËÙ· £ÓËÙfiÙËÙ·Ó (¤ÙË) CPK O.N.A. % %

IÔ› Áڛ˘ A 25 3-76 230-303.200 44 12IÔ› HIV 8 18-29 2.359-398.000 0 0IÔ› Coxcackie 8 1-67 8.500-600.900 50 25Ifi˜ Ebstein-Barr 5 6-23 4.500-482.000 20 0Io› ECHO 4 17-30 19.600-890.000 25 0MCV 2 21-27 4.800-74.850 50 0A‰ÂÓÔ˚Ô› 2 21-27 57.800-133.000 0 0Ifi˜ ·ÏÔ‡ ¤ÚËÙ· 1 30 126.600 100 0IÔ› ·Ú·˚ÓÊÏÔ˘¤ÓÙÛ· 1 38 66.000 0 0Ifi˜ ¤ÚËÙ·-·ÓÂÌ¢ÏÔÁÈ¿˜ 3 15-22 84.000-1.977.600 33 8

™‡ÓÔÏÔ 59 34 8

Singh Î·È Sheld3 (ÙÚÔÔÔÈË̤ÓÔ˜)

rus 6 Î·È Ú·‚‰ÔÌ˘fiÏ˘ÛË, ÂÓÙÔ›ÛÙËÎ·Ó ÈÔ› ηÈDNA ÈÒÓ Ì¤Û· ÛÙÔ˘˜ ̇˜9, ÂÓÒ Ô Èfi˜ Ù˘ Áڛ˘ A·ÔÌÔÓÒıËΠ·fi ÙÔ˘˜ ̇˜ ·Û¯fiÓÙˆÓ ·fi Ì˘Ô-ÛÊ·ÈÚÈÓ·ÈÌ›·10.

™ÙÔÓ ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ, ÂÎÙfi˜ ·fiÙË Ú·‚‰ÔÌ˘fiÏ˘ÛË Î·È ÙËÓ ˘ÂÚÔ˘Úȯ·ÈÌ›·, ·Ô˘-Û›·˙·Ó ÔÈ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ·Ó¿Ù˘ÍË ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Û ÂÚÈ-ÙÒÛÂȘ Ú·‚‰ÔÌ˘fiÏ˘Û˘.

H Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Ì˘ÒÓ Û fiϘ ÙȘ ÏÔÈÌÒÍÂȘ·fi ÈÔ‡˜ Î·È È‰È·›ÙÂÚ· ÛÙȘ ÏÔÈÌÒÍÂȘ ·fi ÈÔ‡˜Áڛ˘, Â›Ó·È Î·Ï¿ ÁÓˆÛÙ‹ Î·È ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈ-ο Ì ¤ÓÙÔÓ˜ Ì˘·ÏÁ›Â˜ Î·È ÌÂÁ¿ÏË Ì˘˚΋ ·‰˘Ó·-Ì›·, ÂȉÈο ÛÙËÓ ÔÍ›· Ê¿ÛË. H Ú·‚‰ÔÌ˘fiÏ˘ÛË ›-Ûˆ˜ Â›Ó·È ÌÈ· ·ÎÚ·›· ¤ÎÊÚ·ÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ·˘-Ù‹˜. ™Â ÂÚÈfi‰Ô˘˜ ÂȉËÌ›·˜ Áڛ˘, fiÙ·Ó ÔÈ ·ÛıÂ-Ó›˜ ÂÌÊ·Ó›˙Ô˘Ó Ôχ ¤ÓÙÔÓ˜ Ì˘·ÏÁ›Â˜ Î·È Ì˘˚΋·‰˘Ó·Ì›·, ÙfiÙ ÙÔ ÂӉ¯fiÌÂÓÔ Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú¿ ˘fi„Ë.

ABSTRACT

Sion ML, Hatzitolios A, Armenaka M, Toulis E,Mikoudi K. Severe rhabdomyolysis and acute re-nal failure associated with influenza A infection.Hell Iatr 2000, 66: 286 - 290.

Nontraumatic rhabdomyolysis is frequently asso-ciated with acute renal failure. Infections are a rarecause of rhabdomyolysis and virus, usually influenzavirus, causes most cases. A 29-year-old man presen-ted with a two-day history of high fever, headache,intense generalized muscle aches and severe weak-ness with inability to walk. Physical examination reve-aled respiratory distress, tachypnea, hypertension,

generalized oedema and almost total muscle weak-ness. The laboratory evaluation demonstrated rhabdo-myolysis with CPK 732.000 U/l and acute renal failure.Serologic studies confirmed acute infection with influ-enza A. The patient was started on supportive treat-ment and hemodialysis and had clinical improvementand normalization of laboratory data. One month afteradmission, the patient was discharged with normalrenal function. It is important to consider viruses,particularly influenza, as causes of rhabdomyolysisand acute renal failure, particlarly during periods of in-fluenza breaks.

Bπµ§π√°ƒ∞ºÿ∞1. Gabow PA, Kaeny WO, Kelleher SP. The spectrum of rhab-

domyolysis. Medicine (Baltimore) 1982, 61: 141-52.

2. Simon NM, Rovner RN, Berlin BS. Acute myoglobinuriaassociated with type A2 (Hong-Kong) influenza.JAMA 1970, 212: 1704-5.

3. Singh U, Scheld WM. Infectious etiologies of rhabdomyo-lysis: Three cases reports and review. Clin Infect Dis1996, 22: 642-9.

4. Dell KM, Schulman SL. Rhabdomyolysis and acute renalfailure in a child with influenza A infection. PediatrNeprol 1997, 11: 363-5.

5. Goebel J, Harter HR, Boineau FG, el-Dahr SS. Acute renalfailure from rhabdomyolysis following influenza A in achild. Clin Pediatr (Phila) 1997, 36: 479-81.

6. Watanade T, Oda Y. Rhabdomyolysis and acute renal fai-lure in acute necrotizing encephalopathy with influen-za A. Pediatr Nephrol 1998, 12: 85 (letter).

7. Annerstedt M, Herlitz H, Molne J, et al. Rhabdomyolysisand acute renal failure associated with influenza virustype A. Scand J Urol Nephrol 1999, 33: 260-4.

8. Dubrow A, Flemmenbaum W. Acute renal failure associa-ted with myoglobinuria and hemoglobinuria. In: Bren-ner BM, Lazarus JM, eds. Acute renal failure. New

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 289

¶›Ó·Î·˜ 5. MÈÎÚfi‚È· Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· Ú·‚‰ÔÌ˘fiÏ˘ÛË

MÈÎÚfi‚È· AÛıÂÓ›˜ HÏÈΛ· E›Â‰· ™˘¯ÓfiÙËÙ· £ÓËÙfiÙËÙ·Ó (¤ÙË) CPK O.N.A. % %

Legionella sp 14 26-61 1.850->400.000 79 29Francisella tularensis 9 31-71 1.049-474.000 33 33Str. Pneumoniae 8 36-81 244-105.700 50 25Salmonella sp 6 32-84 1.870-24.360 67 0Staph. aureus 5 15-70 14.46-83.000 40 40Str. Group B 2 <1 4.110-22.000 50 100Str. Pyogens 2 27-67 33.000-151.000 50 50Listeria monocytogenes 2 38-51 5.000-149.500 50 0Vibrio sp 2 28-51 9.260-? ? 100¢È¿ÊÔÚ· 10 18-56 70 70

™‡ÓÔÏÔ 60 57 38

Singh Î·È Sheld3 (ÙÚÔÔÔÈË̤ÓÔ˜)

York: Churchil Livingstone, 1988: 279-89.

9. Poels PJ, Ewals JA, Joosten EM, et al. Rhabdomyolysis as-sociated with simultaneous Epstein-Barr virus infecti-on and isolation of echovirus 6 from muscles dual in-fection. J Neurol Neurosurg Psychiatry 1989, 52: 412(letter).

10. Gamboa ET, Eastwood AB, Hays AP, et al. Isolation ofinfluenza virus from muscle in myoglobinuric polymy-ositis. Neurology 1979, 29: 1323-8.

AÏÏËÏÔÁÚ·Ê›·:M. ™ÈÒÓ°′ ¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋°.¶.N. “°. ¶··ÓÈÎÔÏ¿Ô˘”570 10 – EÍÔ¯‹ – £ÂÛÛ·ÏÔÓ›ÎË

Corresponding author:M. SionGen. Hospital “G. Papanikolaou”570 10 – Exochi – ThessalonikiGreece

290 M. ™IøN KAI ™YN.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 291 - 294

ƒ·‰‚ÔÌ˘fiÏ˘ÛË Û ·ÛıÂÓ‹ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi salmonella enteritidis

K. ∞ÔÛÙÔÏ›‰Ô˘, M. ª·ÏÙ·Ù˙‹, B. πˆ·ÓÓ›‰Ô˘, I. °Ô˘ÁÔ‡Û˘,

I. °ÂˆÚÁÈ¿‰Ë˜

¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋, NÔÛÔÎÔÌÂ›Ô «ª·Ì¿ÙÛÂÈÔ», ∫Ô˙¿ÓË

∏ Ú·‚‰oÌ˘fiÏ˘ÛË ÂÚÈÁÚ¿ÊËΠ·Ú¯Èο ÛÙË ‚È-‚ÏÈoÁÚ·Ê›· ˆ˜ ÎÏÈÓÈÎfi Û‡Ó‰ÚoÌo ÌÂÙ¿ ·fi ÂÎÙÂÙ·-̤Ó˜ Ì˘˚Τ˜ ηÎÒÛÂȘ1. OÚ›˙ÂÙ·È ˆ˜ “Ì·˙È΋ η-Ù·ÛÙÚoÊ‹ Ì˘˚ÎÒÓ ÈÓÒÓ Î·È ·ÂÏ¢ı¤ÚˆÛË Èı·ÓÒ˜ÙoÍÈÎÒÓ Î˘ÙÙ·ÚÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙË Û˘ÛÙËÌ·ÙÈ΋΢ÎÏoÊoÚ›·”. ∫ÏÈÓÈο ·ÎfiÏo˘ı¿ Ù˘ ·oÙÂÏo‡Ó ˢo‚oÏ·ÈÌ›· (“ÂÁÎψ‚ÈÛÌfi˜” ‡‰·Ùo˜ ̤۷ ÛÙ· η-ÙÂÛÙÚ·Ì̤ӷ Ì˘˚ο ·ÙÙ·Ú·), Ë ˘ÂÚηÏÈ·ÈÌ›·(·ÂÏ¢ı¤ÚˆÛË Ùo˘ ÂÓ‰o΢ÙÙ¿ÚÈo˘ ηϛo˘ ÛÙË Û˘-ÛÙËÌ·ÙÈ΋ ΢ÎÏoÊoÚ›·), Ë oÍ›· ÓÂÊÚÈ΋ ·Ó¿Ú-ÎÂÈ· (ÓÂÊÚoÙoÍÈ΋ ‰Ú¿ÛË ÙˆÓ ÙoÍÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ,o˘ ·ÂÏ¢ıÂÚÒÓoÓÙ·È ·fi Ù· ηÙÂÛÙÚ·Ì̤ӷ Ì˘˚-ο ·ÙÙ·Ú·) Î·È Ë ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË.

∆· ·›ÙÈ· Ù˘ Ú·‚‰oÌ˘fiÏ˘Û˘ Ê·›ÓoÓÙ·È ÛÙoӛӷη 12. ∏ ıÓËÛÈÌfiÙËÙ· ·fi ÙË Ú·‚‰oÌ˘fiÏ˘ÛË·Ó¤Ú¯ÂÙ·È Û 5% Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÈÙÈoÏoÁ›·Ù˘, ÂÓÒ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË ·oÙÂÏ› ÙË ‚¿ÛË ÁÈ·ÙËÓ Î·Ï‹ ÚfiÁÓˆÛ‹ Ù˘. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ófi-Ûo˘ Â›Ó·È ÌË ÂȉÈ΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÓÙ·ÙÈ΋ÂÓ˘‰¿ÙˆÛË, ÙË ¯oÚ‹ÁËÛË ÎÚ˘ÛÙ·ÏÏoÂȉÒÓ ‰È·Ï˘-Ì¿ÙˆÓ, ÙËÓ ·ÏηÏoo›ËÛË ÙˆÓ o‡ÚˆÓ (p∏ 7) ηÈÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÈηÓooÈËÙÈ΋˜ ‰Èo‡ÚËÛ˘. ∂ȉÈ-ο ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ Ú·‚‰oÌ˘fiÏ˘Û˘, o˘ ÂÈ-

ϤÎo˘Ó ÏoÈÌÒÍÂȘ ÂÈ‚¿ÏÏÂÙ·È ·Ú¿ÏÏËÏË Ê·Ú-̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïo›ÌˆÍ˘ ÂÊ’fiÛoÓ ·˘-Ùfi Â›Ó·È ‰˘Ó·Ùfi.

¶ÂÚÈÁÚ¿ÊÂÙ·È ÌÈ· ÂÚ›ÙˆÛË Ú·‚‰oÌ˘fiÏ˘-Û˘ Û ·ÛıÂÓ‹ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Salmonellaenteritidis Î·È Á›ÓÂÙ·È Û˘˙‹ÙËÛË Ù˘ ‰È·ÁÓˆÛÙÈ΋˜Î·È ıÂڷ¢ÙÈ΋˜ ÛÙÚ·ÙËÁÈ΋˜ Ù˘ ¿ıËÛ˘.

¶∂ƒπ°ƒ∞º◊ ∆∏™ ¶∂ƒÿ¶∆ø™Eø™¡Â·Úfi˜ ¿Ó‰Ú·˜, 20 ÂÙÒÓ, ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ¶·ıoÏoÁÈ΋ ∫ÏÈÓÈ΋ ÌÂÂ̇ÚÂÙË Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi 12ÒÚo˘. O ·ÛıÂÓ‹˜ ·Ó¿ÊÂÚ¢„ËÏfi ˘ÚÂÙfi (39,5ÆC), ‰È·ÚÚo˚Τ˜ ÎÂÓÒÛÂȘ (6-8 Û˘ÓoÏÈο) ηȤӷ ÂÂÈÛfi‰Èo Â̤Ùo˘. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ùo˘ ·Úo˘Û›·˙ fi„Ë¿Û¯oÓÙo˜ Î·È Ì¤ÙÚÈo˘ ‚·ıÌo‡ ·Ê˘‰¿ÙˆÛË. ∆o ·Ó·ÌÓËÛÙÈÎfiÈÛÙoÚÈÎfi Ùo˘ ·ÛıÂÓo‡˜ ‹Ù·Ó ÂχıÂÚo Î·È ‰ÂÓ ·Ó¿ÊÂÚ ϋ„ˇoÙ˘ ÙÚoÊ‹˜ ‹ ÓÂÚo‡. ∏ ıÂÚÌoÎÚ·Û›· Ùo˘ ‹Ù·Ó 40ÆC, Ë ·Ú-ÙËÚȷ΋ ›ÂÛË 95/60 mmHg Î·È oÈ ÛʇÍÂȘ 110/min. ∞fi ÙËÓ ÎÏÈ-ÓÈ΋ ÂͤٷÛË Ë ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ‹Ù·Ó Ê˘ÛÈoÏoÁÈ΋, ÂÓÒË ÎoÈÏÈ¿ ‹Ù·Ó ̷Ϸ΋ ÛÙËÓ „ËÏ¿ÊËÛË, Ì ¤ÓÙoÓË ÂÓÙÂÚÈ΋ ÎÈÓË-ÙÈÎfiÙËÙ·.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯o˜ ¤‰ÂÈÍÂ: Ht: 45%, §Â˘Î¿:10000/ul (oÏ˘ÌoÚÊo‡ÚËÓ· 88%), ∞ÈÌoÂÙ¿ÏÈ·: 165000/ul,∆∫∂:6mm, O˘Ú›·: 40mg%, ∫Ú·ÙÈÓ›ÓË: 1,1mg%, ÁÏ˘Îfi˙Ë:84mg%, ∫+: 4,1mEq/l, ¡·+:147mEq/l, SGOT: 139u/L SGPT:22u/L, ALP:75, Á-GT:31, LDH:860u/l, CPK:2800u/l, ¯oÏÂÚ˘-

¶ÂÚ›ÏË„Ë. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÈ· ÂÚ›ÙˆÛË Á·ÛÙÚÂ-ÓÙÂÚ›Ùȉ·˜ Û Ó·Úfi ¿ÓÙÚ· ·ÛıÂÓ‹. ∆Ë ‰Â‡ÙÂÚË Ë̤-Ú· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ÂÌÊ¿ÓÈÛ ڷ‚‰ÔÌ˘fiÏ˘ÛË ÌÂÙ·¯Â›· ·‡ÍËÛË ÙˆÓ ÙÈÌÒÓ Ù˘ CPK. ∏ ηÏÏȤÚÁÂÈ·ÙˆÓ ÎÔÚ¿ÓˆÓ Î·Ù¤‰ÂÈÍ ÙË Salmonella enteritidis,ˆ˜ ·›ÙÈÔ Ù˘ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜. ∏ ·ÓÙÈÌÂÙÒÈÛËÂÚÈÏ¿Ì‚·Ó ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ, ·ÌÈ-ÎÈÏÏ›ÓË Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎfi Ó¿ÙÚÈÔ. ∏ ηٿÛÙ·Û‹ ÙÔ˘‚ÂÏÙÈÒıËΠ·fi ÙËÓ ÙÚ›ÙË Ë̤ڷ Î·È ÔÈ ÙÈ̤˜ Ù˘

CPK ¤ÛÙÚ„·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο ›‰· ÌÂÙ¿ÔÎÙÒ Ë̤Ú˜. ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ÌÔÚ› Ó· ·ÔÙÂϤ-ÛÂÈ ÌÈ· Û¿ÓÈ· ÂÈÏÔ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ·fisalmonella enteritidis, Ô˘ ··ÈÙ› ÁÚ‹ÁÔÚË ‰È¿ÁÓˆ-ÛË Î·È ·ÓÙÈÌÂÙÒÈÛË, Ì ÛÎÔfi ÙËÓ ·ÔÊ˘Á‹ Â-Ú·ÈÙ¤Úˆ ÂÈÏÔÎÒÓ, fiˆ˜ Â›Ó·È Ë ÔÍ›· ÓÂÊÚÈ΋·Ó¿ÚÎÂÈ·. EÏÏËÓ I·ÙÚ 2000, 66: 291 - 294.

291

292 K. A¶O™TO§I¢OY ∫∞π ™À¡.

ıÚ›ÓË: 1,7mg%, Ca++: 9,3mg%, P+++: 3,3mg%, ¯ÚfiÓo˜ Úo-ıÚoÌ‚›Ó˘: 12/12sec, CRP: +++, mono-test: ·ÚÓËÙÈÎfi, Vidal:T(H) ·ÚÓËÙÈÎfi – ∆(0) 1/80+. OÈ ·ÎÙÈÓoÁڷʛ˜ ıÒڷη ηÈÎoÈÏ›·˜, fiˆ˜ Î·È Ùo ∏∫° ‰ÂÓ ·Úo˘Û›·˙·Ó ·ıoÏoÁÈο ¢-Ú‹Ì·Ù·. ∞ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÂÓ‰oÊϤ‚È· ¯oÚ‹ÁËÛË ˘ÁÚÒÓÎ·È ËÏÂÎÙÚoÏ˘ÙÒÓ Î·È ·ÓÙÈ˘ÚÂÙÈο, ÂÓÒ ÂÏ‹ÊıËÛ·Ó Î·ÏÏȤÚ-ÁÂȘ ÎoÚ¿ÓˆÓ.

∆Ë ‰Â‡ÙÂÚË Ë̤ڷ ÓoÛËÏ›·˜ Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË Ùo˘·ÛıÂÓo‡˜ ‚ÂÏÙÈÒıËÎÂ, ‰ÂÓ ·Ó¿ÊÂÚÂ Ì˘˚ο ¿ÏÁË Î·È Ù· ‰È·Ú-Úo˚ο ÂÂÈÛfi‰È· ÌÂÈÒıËηÓ, o ˘ÚÂÙfi˜ fï˜ ¤ÌÂÓÂ. O Ó¤o˜ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯o˜ ¤‰ÂÈÍ ÌÂÙÚ›ˆ˜ ˘„ËϤ˜ ÙÈ̤˜ ÙÚ·ÓÛ·-ÌÈÓ·ÛÒÓ, LDH Î·È oχ „ËÏ‹ CPK. (¶›Ó. 2). O ¤ÏÂÁ¯o˜ ÁÈ·Ë·Ù›Ùȉ˜ ∞,µ Î·È C, fiˆ˜ Î·È ÁÈ· HIV Ïo›ÌˆÍË ‹Ù·Ó ·ÚÓË-ÙÈÎfi˜. ∆o stick ÙˆÓ o‡ÚˆÓ ‹Ù·Ó ıÂÙÈÎfi ÁÈ· ·ÈÌoÛÊ·ÈÚ›ÓË, ¯ˆ-Ú›˜ Ó· ‰È·ÈÛÙÒÓÂÙ·È ·Úo˘Û›· ÂÚ˘ıÚÒÓ ÛÙË ÌÈÎÚoÛÎoÈ΋ÂͤٷÛË, Â˘Ú‹Ì·Ù· o˘ Û˘ÓËÁoÚo‡Ó ÁÈ· ·Úo˘Û›· Ì˘oÛÊ·È-ÚÈÓo˘Ú›·˜, ÈÛÙooÈÒÓÙ·˜ Ì·˙› Ì ÙËÓ ˘„ËÏ‹ CPK, Ú·‚‰oÌ˘fi-Ï˘ÛË. ∞˘Í‹ıËÎ·Ó Ù· ¯oÚËÁo‡ÌÂÓ· ˘ÁÚ¿ Î·È ÚoÛÙ¤ıËΠÛÙËÓ·ÁˆÁ‹ ·ÌÈÎÈÏÏ›ÓË (8gr ËÌÂÚËÛ›ˆ˜) Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎfi Ó¿ÙÚÈoÛ ÂÓ‰oÊϤ‚È· ¯oÚ‹ÁËÛË ÁÈ· ·ÏηÏoo›ËÛË ÙˆÓ o‡ÚˆÓ.

¶›Ó·Î·˜ 2. ∂ͤÏÈÍË ÙˆÓ ÂÓ˙˘ÌÈÎÒÓ ‰ÂÈÎÙÒÓ

¢Â›ÎÙ˘ (u/l)1Ë Ë̤ڷ 3Ë Ë̤ڷ 4Ë Ë̤ڷ 8Ë Ë̤ڷ

SGOT 139 320 209 80SGPT 22 94 87 39CPK 2800 13790 7970 412LDH 860 1612 763 320

∆ËÓ ÙÚ›ÙË Ë̤ڷ Ù˘ ÓoÛËÏ›·˜ o ·ÛıÂÓ‹˜ ‰ÂÓ ·Úo˘-Û›·Û ‰È·ÚÚo˚Τ˜ ÎÂÓÒÛÂȘ, o ˘ÚÂÙfi˜ ˘Ê¤ıËÎÂ, ÂÓÒ Ù· ›-‰· Ù˘ CPK ÛÙoÓ oÚfi ÂÍ·ÎoÏo˘ıo‡Û·Ó Ó· ·Ó¤Ú¯oÓÙ·È(¶›Ó. 2). ∏ ÓÂÊÚÈ΋ ÏÂÈÙo˘ÚÁ›· ·Ú¿ÌÂÓÂ Ê˘ÛÈoÏoÁÈ΋ ηÈÙo p∏ ÙˆÓ o‡ÚˆÓ ‹Ù·Ó ·ÏηÏÈÎfi. ™ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙˆÓÎoÚ¿ÓˆÓ ·oÌoÓÒıËΠSalmonella enteritidis. ∆ËÓ Ù¤Ù·ÚÙËË̤ڷ Ù˘ ÓoÛËÏ›·˜, o ·ÛıÂÓ‹˜ ‹Ù·Ó Û oχ ηϋ ÁÂÓÈ΋ηٿÛÙ·ÛË, ‹Ù·Ó ·‡ÚÂÙo˜ Î·È Ù· o‡Ú· Ùo˘ ‹Ù·Ó Ê˘ÛÈoÏoÁÈ-΋˜ ¯ÚoÈ¿˜. ∆· ›‰· Ù˘ CPK Ùo˘ oÚo‡ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ·.∏ ıÂڷ¢ÙÈ΋ ·˘Ù‹ ·ÁˆÁ‹ ·Ú·Ù¿ıËΠÁÈ· 7 Ë̤Ú˜. O ¿Ú-ÚˆÛÙo˜ ÂÍ‹Ïı ÙËÓ 8Ë Ë̤ڷ, ·Êo‡ Ù· ›‰· Ù˘ CPK ÏË-Û›·Û·Ó ÛÙË Ê˘ÛÈoÏoÁÈ΋ ÙÈÌ‹, Ì ÙË Û‡ÛÙ·ÛË Ó· Û˘Ó¯›ÛÂÈ ÙËÊ·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ì ·ÌoÍÈÎÈÏÏ›ÓË (1500mg ËÌÂÚËÛ›ˆ˜)ÁÈ· Ì›· ‚‰oÌ¿‰· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ӿÏË„Ë Ù˘ ηÏÏȤÚ-ÁÂÈ·˜ ÙˆÓ ÎoÚ¿ÓˆÓ.

™À∑◊∆∏™∏∏ Ú·‚‰oÌ˘fiÏ˘ÛË ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ̆ oÎÏÈÓÈÎ¿Î·È ··ÈÙÂ›Ù·È ·˘ÍË̤ÓË Â·ÁÚ‡ÓËÛË ÁÈ· ÙËÓ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘. ∆o Ì˘˚Îfi ¿ÏÁo˜ ·oÙÂÏ› Ùo·Ú¯ÈÎfi Û‡Ìو̷ ÛÙo 50% ÙˆÓ ·ÛıÂÓÒÓ2. ™Â ÌÈ-ÎÚfiÙÂÚo oÛoÛÙfi ·Úo˘ÛÈ¿˙ÂÙ·È ÛÎoÙÂÈÓfi˜ ÎfiÎÎÈ-Óo˜ ¯ÚˆÌ·ÙÈÛÌfi˜ ÙˆÓ o‡ÚˆÓ. ∞fi Ùo ÈÛÙoÚÈÎfi ÙˆÓ·ÛıÂÓÒÓ ‰È·ÈÛÙÒÓÂÙ·È Ùo˘Ï¿¯ÈÛÙoÓ ¤Ó·˜ Úo-‰È·ıÂÛÈÎfi˜ ·Ú¿ÁoÓÙ·˜ ÛÙo 97% ·˘ÙÒÓ, ÂÓÒ oÏ-Ï·Ïo› Úo‰È·ıÂÛÈÎo› ·Ú¿ÁoÓÙ˜ ‰È·ÈÛÙÒÓoÓÙ·ÈÛÙo 59% ÙˆÓ ·ÛıÂÓÒÓ2. ™Ùo˘˜ Úo‰È·ıÂÛÈÎo‡˜ ·-Ú¿ÁoÓÙ˜ ÂÚÈÏ·Ì‚¿ÓoÓÙ·È: o ·ÏÎooÏÈÛÌfi˜ (67%),

¶›Ó·Î·˜ 1. A›ÙÈ· Ú·‚‰ÔÌ˘fiÏ˘Û˘

TÚ·˘Ì·ÙÈο MË ÙÚ·˘Ì·ÙÈ΋ TÔÍÈο ¶ÂÚÈ‚·ÏÏÔÓÙÈο MÂÙ·‚ÔÏÈο ºÏÂÁÌÔÓÒ‰Ë AÓÔÛÔÏÔÁÈο KÏËÚÔÓÔÌÈοηٷÛÙÚÔÊ‹

Ì˘˚ÎÒÓ΢ÙÙ¿ÚˆÓ

M˘˚΋ οΈÛË ¤ÓÙÔÓË AÏÎÔfiÏ YÂÚıÂÚÌ›· YÔ- Î·È IÔ› ¶ÔÏ˘Ì˘ÔÛ›Ùȉ· EÓ˙˘ÌÈΤ˜ÛˆÌ·ÙÈ΋ ˘ÂÚÓ·ÙÚÈ·ÈÌ›· (Áڛ˘ ‰È·Ù·Ú·¯¤˜¿ÛÎËÛË HIV, Coxsackie, ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡

(.¯. Ì·Ú·ıˆÓÔ- Ebstein-Barr, ˘‰·Ù·ÓıڿΈӉÚfiÌÔÈ) CMV, Î·È ÏÈȉ›ˆÓ

A‰ÂÓÔÔÈÔ› EÚËÙÔ˚Ô›)

HÏÂÎÙÚÔÏËÍ›· Status º¿Ú̷η YÔıÂÚÌ›· ¢È·‚ËÙÈ΋ B·ÎÙ‹ÚÈ· ¢ÂÚÌ·ÙÔÌ˘ÔÛ›Ùȉ· M˘Ô¿ıÂȘepilepticus (·ÛÈÚ›ÓË, ÎÂÓÔͤˆÛË Î·È (ÎfiÎÎÔÈ, E. coli,Î·È status Ó¢ÚÔÏËÙÈο, ÌË ÎÂÙˆÓÈÎfi Û·ÏÌÔÓ¤ÏÏ·,

asthmaticus ·Ó·ÈÛıËÙÈο, ˘ÂÚÔÛ̈ÙÈÎfi ‚ÚԢΤÏÏ·,‚·Ú‚ÈÙÔ˘ÚÈο, ‰È·‚ËÙÈÎfi ÏÂÙfiÛÂÈÚ·,

·ÌÊÔÙÂÚÈΛÓË B, ÎÒÌ· ÌÔÚÚ¤ÏÈ·,ÛÙÂÚÔÂȉ‹) ÎψÛÙËÚ›‰È·)

ŒÁη˘Ì· OÍ›· „‡¯ˆÛË N·ÚΈÙÈΤ˜ YÔʈÛÊ·Ù·ÈÌ›· M‡ÎËÙ˜ I‰ÈÔ·ı‹˜ ¢Ú·ÓÔ΢Ù-Ô˘Û›Â˜ (οÓÙÈÓ·, ·ÚÔ͢ÛÌÈ΋ Ù·ÚÈ΋ ·Ó·ÈÌ›·

·Û¤ÚÁÈÏÔ˜) Ú·‚‰ÔÌ˘fiÏ˘ÛË

™Ô‚·Ú‹ K·Ê½ÓË YÔ- Î·È ‰˘ÛÙÔÓ›· ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜

AÚÙ. ıÚfiÌ‚ˆÛË ¢ËÏËÙ‹ÚÈÔ YÔηÏÈ·ÈÌ›·‹ ÂÌ‚ÔÏ‹ ÊȉÈÒÓ

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 293

Ë ÚfiÛÊ·ÙË Û˘Ì›ÂÛË Ì·Ï·ÎÒÓ ÈÛÙÒÓ (39%), Ë ÂÈ-ÏË„›· (24%), Ùo ÙÚ·‡Ì· (17%), oÈ Ó·ÚΈÙÈΤ˜ o˘-ۛ˜ (15%), oÈ ÌÂÙ·‚oÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ (8%), ˢoıÂÚÌ›· (4%), Ë ÁÚÈ҉˘ Û˘Ó‰ÚoÌ‹ (3%), ËÛ‹„Ë (2%) Î·È Ë Á¿ÁÁÚ·ÈÓ· (1%)3-8.

∏ Ê˘ÛÈ΋ ÂͤٷÛË ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Û˘Óo‰Â‡-ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ÂȉÈο Â˘Ú‹Ì·Ù·. ∂ÛÙÈ·Îfi ‹‰È¿¯˘Ùo Ì˘˚Îfi ¿ÏÁo˜ Â›Ó·È Û¿ÓÈo Î·È ÌfiÓo 5%ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ¿ÓÈÛ·Ó Ì˘˚Îfi o›‰ËÌ·2.

∂ÚÁ·ÛÙËÚȷο Ë ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ CPK ÛÙo Ï¿ÛÌ·. ∏ ¢·È-ÛıËÛ›· Ù˘ ÂͤٷÛ˘ Â›Ó·È 100%, ·ÏÏ¿ Ë ÂȉÈÎfiÙË-Ù¿ Ù˘ ¯·ÌËÏ‹. ¶·ı‹ÛÂȘ, fiˆ˜ Â›Ó·È Ùo ¤ÌÊÚ·ÁÌ·Ùo˘ Ì˘oηډ›o˘, ÌoÚ› Ó· Û˘Óo‰Â‡oÓÙ·È ·fi ·˘-ÍË̤ӷ ›‰· CPK. ∏ ·‡ÍËÛË Ù˘ CPK Û ·ÛıÂ-Ó›˜ Ì ڷ‚‰oÌ˘fiÏ˘ÛË Î˘Ì·›ÓÂÙ·È Î·È Â›Ó·È ‰˘Ó·-ÙfiÓ Ó· ÊÙ¿ÛÂÈ Ì¤¯ÚÈ oÏϤ˜ ¯ÈÏÈ¿‰Â˜ u/l. ∏ ̤ÁÈÛÙËÙÈÌ‹ Ù˘ ·Ú·ÙËÚÂ›Ù·È Ùo ÚÒÙo 24ˆÚo Î·È ·Îo-Ïo˘ı› ÙˆÙÈ΋ oÚ›· - ÂÚ›o˘ 40% ·Ó¿ 24ˆÚo.∞˘ÍË̤Ó˜ ÙÈ̤˜ o˘ ÂÈ̤Óo˘Ó, Â›Ó·È ÂÓ‰ÂÈÎÙÈΤ˜ÂÓÂÚÁo‡ Ì˘˚΋˜ ‚Ï¿‚˘9.

∆o stick o‡ÚˆÓ ı· Â›Ó·È ıÂÙÈÎfi ÁÈ· ·›Ì· ›·Úo˘Û›·˜ ·ÈÌoÛÊ·ÈÚ›Ó˘ ‹ Ì˘oÛÊ·ÈÚ›Ó˘. ∆o ıÂ-ÙÈÎfi stick ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·o˘Û›· ÂÚ˘ıÚÒÓ·ÈÌoÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚoÛÎoÈ΋ ÂͤٷÛË Â›Ó·È ÂÓ-‰ÂÈÎÙÈο Ì˘oÛÊ·ÈÚÈÓo˘Ú›·˜. ∏ ÁÂÓÈ΋ ÂͤٷÛË ÙˆÓo‡ÚˆÓ Â›Ó·È ıÂÙÈ΋ ÌfiÓo ÛÙo 50% ÙˆÓ ·ÛıÂÓÒÓÎ·È Âo̤ӈ˜ Ù· Ê˘ÛÈoÏoÁÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ·o-ÎÏ›o˘Ó ÙËÓ ¿ıËÛË.

∞˘ÍË̤Ó˜ ÙÈ̤˜ ·Ï‰oÏ¿Û˘, LDH Î·È SGOTÌoÚ› Ó· ·Ú·ÙËÚËıo‡Ó ·ÏÏ¿ ·oÙÂÏo‡Ó ÌË ÂÈ-‰ÈÎo‡˜ ‰Â›ÎÙ˜. ÀÂÚηÏÈ·ÈÌ›· ·Ú·ÙËÚÂ›Ù·È ÛÙȘÚÒÙ˜ ÒÚ˜ ÌÂÙ¿ οΈÛË Û 10-40% ÙˆÓ ·ÛıÂ-ÓÒÓ Î·È ÌoÚ› Ó· ·ÂÈÏ‹ÛÂÈ ÙË ˙ˆ‹. °È· Ùo ÏfiÁo·˘Ùfi ··ÈÙÂ›Ù·È ÛÙÂÓ‹ ·Ú·ÎoÏo‡ıËÛË ÙˆÓ ÙÈÌÒÓηϛo˘ ÛÙo Ï¿ÛÌ· Î·È Èı·Ó¤˜ ÂΉËÏÒÛÂȘ ˘ÂÚ-ηÏÈ·ÈÌ›·˜ ·fi Ùo ËÏÂÎÙÚoηډÈoÁÚ¿ÊËÌ·. ÀÂÚ-ʈÛÊ·Ù·ÈÌ›·, ˘·Û‚ÂÛÙÈ·ÈÌ›· Î·È ˘ÂÚo˘Úȯ·È-Ì›· ÌoÚ› ›Û˘ Ó· ·Ú·ÙËÚËıo‡Ó, ·ÏÏ¿ ‰ÂÓ··ÈÙo‡Ó ȉȷ›ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË10. ∏ ·Ú·ÎoÏo‡-ıËÛË Ùo˘ ËÎÙÈÎo‡ Ì˯·ÓÈÛÌo‡ (·ÈÌoÂÙ¿ÏÈ·, ¯Úfi-Óo˜ ÚoıÚoÌ‚›Ó˘ Î·È ¯ÚfiÓo˜ ÌÂÚÈ΋˜ ıÚoÌ‚oÏ·-ÛÙ›Ó˘) Â›Ó·È ··Ú·›ÙËÙË, ηıÒ˜ Ë ·ÂÏ¢ı¤ÚˆÛËÙ˘ ıÚoÌ‚oÏ·ÛÙ›Ó˘ ·fi Ù· Ì˘˚ο ·ÙÙ·Ú· Ìo-Ú› Ó· ÚoηϤÛÂÈ ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË11.

OÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÂΉËÏÒÓÂÙ·È ÛÙo30-40% ÙˆÓ ·ÛıÂÓÒÓ Î·È ·oÙÂÏ› ÙË Ûo‚·ÚfiÙÂÚËÂÈÏo΋12. O ÚoÙÂÈÓfiÌÂÓo˜ Ì˯·ÓÈÛÌfi˜ ÂÚÈ-Ï·Ì‚¿ÓÂÈ ÙËÓ Î·ı›˙ËÛË ÎÚ˘ÛÙ¿ÏÏˆÓ Ì˘oÛÊ·ÈÚ›ÓË˜Î·È o˘ÚÈÎo‡ oͤo˜ ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ·, o˘Ì¤Ûˆ Ì˯·ÓÈ΋˜-·oÊÚ·ÎÙÈ΋˜, ·ÏÏ¿ Î·È ÓÂÊÚo-ÙoÍÈ΋˜ ‰Ú¿Û˘ o‰ËÁ› ÛÙË Ì›ˆÛË Ù˘ ÛÂÈÚ·Ì·-ÙÈ΋˜ ‰È‹ıËÛ˘ (pH o‡ÚˆÓ ÌÈÎÚfiÙÂÚo Ùo˘ 5,9 ¢-

Óo› ÙoÓ ·Ú·¿Óˆ Ì˯·ÓÈÛÌfi)13. OÈ ÙÈ̤˜ Ù˘ o˘-Ú›·˜ Î·È Ù˘ ÎÚ·ÙÈÓ›Ó˘ Ú¤ÂÈ Ó· ·Ú·ÎoÏo˘-ıo‡ÓÙ·È ÛÙÂÓ¿. O ÏfiÁo˜ o˘Ú›·˜/ÎÚ·ÙÈÓ›ÓË ÌoÚ›ӷ ÌÂȈı› ÏfiÁˆ Ù˘ ÌÂÙ·ÙÚo‹˜ Ù˘ ÎÚ·ٛÓ˘,o˘ ÂÏ¢ıÂÚÒÓÂÙ·È ·fi Ù· Ì˘˚ο ·ÙÙ·Ú· Û ÎÚÂ-·ÙÈÓ›ÓË. ¶ÚoÁÓˆÛÙÈÎo› ·Ú¿ÁoÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿-ÓÈÛË ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ·oÙÂÏo‡Ó ÙÈ̤˜ CPK> 6,000 U/L, ·Ê˘‰¿ÙˆÛË (Ht >50%, Ó¿ÙÚÈo > 150meq/L), Û‹„Ë, ˘ÂÚηÏÈ·ÈÌ›· ‹ ˘ÂÚʈÛÊ·Ù·È-Ì›·, ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ùo˘ ·ÛıÂÓo‡˜ Î·È Ë ·Úo˘-Û›· ˘oÚˆÙÂ˚Ó·ÈÌ›·˜3.

∏ ·ÓÙÈÌÂÙÒÈÛË ÛÙËÚ›˙ÂÙ·È ÛÙË ¯oÚ‹ÁËÛËÈÛfiÙoÓˆÓ ÎÚ˘ÛÙ·ÏÏoÂȉÒÓ ‰È·Ï˘Ì¿ÙˆÓ. ∏ ¯oÚ‹ÁËÛˢÁÚÒÓ ·˘Í¿ÓÂÈ ÙË ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË Î·È ÙËÓ ·-Úo¯‹ o͢ÁfiÓo˘ ÛÙ· ·ÙÙ·Ú· Î·È ·Ú·ÈÒÓÂÈ ÙË Ì˘o-ÛÊ·ÈÚ›ÓË Î·È ¿ÏϘ ÓÂÊÚoÙoÍÈΤ˜ o˘Û›Â˜, o˘ ÂÏ¢-ıÂÚÒÓoÓÙ·È ·fi Ù· Ì˘˚ο ·ÙÙ·Ú·. ∏ ·Ú¯È΋ ¯oÚ‹-ÁËÛË ˘ÁÚÒÓ Ú¤ÂÈ Ó· Â›Ó·È 500ml/ÒÚ· Î·È ÛÙË Û˘Ó¤-¯ÂÈ· Ú˘ıÌ›˙ÂÙ·È ¤ÙÛÈ ÒÛÙ ӷ ‰È·ÙËÚÂ›Ù·È ˆÚÈ·›·‰Èo‡ÚËÛË 200-300ml. ∏ ·Ú·ÎoÏo‡ıËÛË ÙˆÓ ˙ˆÙÈÎÒÓÛËÌ›ˆÓ Â›Ó·È ··Ú·›ÙËÙË Î·È Û˘¯Ó¿ ··ÈÙÂ›Ù·È Ë Î·-Ù¿ÏÏËÏË ˘oÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹. ∏ ·ÏηÏoo›ËÛË ÙˆÓo‡ÚˆÓ (pH >7) ÚoÙ›ÓÂÙ·È ·fi Ùo˘˜ ÂÚÈÛÛfiÙÂÚo˘˜Û˘ÁÁÚ·Ê›˜ Î·È Á›ÓÂÙ·È Ì ÙË ¯oÚ‹ÁËÛË Ê˘ÛÈoÏoÁÈ-Îo‡ oÚo‡ Ì ÚoÛı‹ÎË ‰ÈÙÙ·ÓıÚ·ÎÈÎo‡ Ó·ÙÚ›o˘, ÂÓÒ·Ú¿ÏÏËÏ· ··ÈÙÂ›Ù·È ÚoÛÂÎÙÈ΋ ·Ú·ÎoÏo‡ıËÛËÙo˘ ·Û‚ÂÛÙ›o˘ Ùo˘ oÚo‡, ÏfiÁˆ Ùo˘ ÎÈÓ‰‡Óo˘ Ù˘ ˘·-Û‚ÂÛÙÈ·ÈÌ›·˜ ·fi ÙËÓ ·ÏοψÛË. ªÂÙ¿ ÙËÓ ÈηÓo-oÈËÙÈ΋ ¯oÚ‹ÁËÛË ˘ÁÚÒÓ ÌoÚ› Ó· ¯oÚËÁËı› Ì·Ó-ÓÈÙfiÏË ‹ Êo˘ÚoÛÂÌ›‰Ë, ¤ÙÛÈ ÒÛÙ ӷ ·˘ÍËı› Ë ·o-‚oÏ‹ ÙˆÓ o‡ÚˆÓ12. ∂ȉÈ΋ ·ÓÙÈÌÂÙÒÈÛË ··ÈÙ› Ë ÂÌ-Ê¿ÓÈÛË ÂÈÏoÎÒÓ, fiˆ˜ Â›Ó·È Ë ˘ÂÚηÏÈ·ÈÌ›·, ˉȿ¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË Î·È Ùo Û‡Ó‰ÚoÌo ÎÏÂÈÛÙo‡‰È·ÌÂÚ›ÛÌ·Ùo˜. ∞ÈÌo‰È‡Ï˘ÛË ÌoÚ› Ó· ··ÈÙËı› Û›ÌoÓË ˘ÂÚηÏÈ·ÈÌ›·, Û ‰È·Ù·Ú·¯¤˜ Ù˘ oÍÂo‚·ÛÈ-΋˜ ÈÛoÚÚo›·˜, Û Ó¢ÌoÓÈÎfi o›‰ËÌ· Î·È Û ‚·ÚÈ¿oÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∏ ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒ-ÈÛË ÛÙËÚ›˙ÂÙ·È ÛÙ· ÂÈ̤Úo˘˜ ·›ÙÈ· Ù˘ Ú·‚‰oÌ˘fi-Ï˘Û˘ o˘ ··ÈÙo‡Ó Î·È ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈ-ÛË9.

∏ ÂÌÊ¿ÓÈÛË Ú·‚‰oÌ˘fiÏ˘Û˘, ˆ˜ Û˘Ó¤ÂÈ· Á·-ÛÙÚÂÓÙÂÚ›Ùȉ·˜ ·fi Û·ÏÌoÓ¤ÏÏ· Â›Ó·È ÌÈ· Û¿ÓÈ·ÂÈÏo΋ Ù˘ ÓfiÛo˘ Ì ϛÁ· ÂÚÈÛÙ·ÙÈο ‰ËÌoÛÈ-Â˘Ì¤Ó· ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈoÁÚ·Ê›·13-16. OÈ Èı·Óo›·ıoÁÂÓÂÙÈÎo› Ì˯·ÓÈÛÌo› Ì Ùo˘˜ oo›o˘˜ ÏoÈÌo-ÁfiÓoÈ ·Ú¿ÁoÓÙ˜ fiˆ˜ Ë Salmonella ÚoηÏo‡ÓÚ·‚‰oÌ˘fiÏ˘ÛË, Â›Ó·È Ë ¿ÌÂÛË ÚoÛ‚oÏ‹ ÙˆÓ Ì˘˚-ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË Û·ÏÌoÓ¤ÏÏ·, fiˆ˜ Î·È ËÂÏ¿ÙÙˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ oÍÂȉˆÙÈÎÒÓÎ·È ÁÏ˘ÎoÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ÛÎÂ-ÏÂÙÈÎÒÓ Ì˘ÒÓ, Î·È Ë ÂÓÂÚÁoo›ËÛË Ï˘ÛoÛˆÌÈ·ÎÒÓÂÓ˙‡ÌˆÓ7. ∞˘ÍË̤ÓË Â·ÁÚ‡ÓËÛË ··ÈÙÂ›Ù·È ÁÈ·

294 K. A¶O™TO§I¢OY ∫∞π ™À¡.

ÙËÓ ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ·Ú·-¿Óˆ ÂÈÏo΋˜. ∏ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË, fiˆ˜Úo·Ó·Ê¤ÚıËΠÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈ-Û˘ ÙˆÓ Ûo‚·ÚÒÓ ÂÈÏoÎÒÓ Î·È Î˘Ú›ˆ˜ Ù˘ ÓÂ-ÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜.

ABSTRACTApostolidou K, Baltatzi M, Ioannidou V, GougousisI, Georgiadis I. Salmonella enteritidis infection,associated with rhabdomyolysis. Hell Iatr 2000, 66:291 - 294.

We present a case report of a young male patientwho was hospitalized with acute febrile gastroenteritis.On the second hospital day he developed rhabdo-myolysis with rapidly rising levels of serum CPK. Sal-monella enteritidis was isolated in stool cultures. Hewas treated with high doses of intravenous fluids, am-picillin and sodium bicarbonate. The patient improvedafter the third day of treatment and CPK level returnedto normal eight days later. Rhabdomyolysis is a rarelyreported complication of gastroenteritis due to sal-monella enteritidis. It must be diagnosed early andtreated properly in order to avoid more serious com-plications such as acute renal failure.

µπµ§πO°ƒ∞ºπ∞1. Better OS. The crush syndrome revisited (1940-1990).

Nephron 1990, 55:97-103.2. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of

rhabdomyolysis. Medicine (Baltimore) 1982, 61:141-52.3. Ward MM. Factors predictive of acute renal failure in

rhabdomyolysis. Arch Intern Med 1988, 148:1553-7.4. Jolly BT, Talbot-Stern J. Rhabdomyolysis secondary to

keyboard overuse: occupational hazard of the com-puter age. Am J Emerg Med 1995, 13:644-6.

5. Putterman C, Levy L, Rubinger D. Transient exercise-in-duced water intoxication and rhabdomyolysis. Am JKidney Dis 1993, 21:206-9.

6. Sinert R, Kohl L, Rainone T, Scalea T. Exercise-inducedrhabdomyolysis. Ann Emerg Med 1994, 23:1301-6.

7. Singh U, Scheld WM. Infectious etiologies of rhabdo-myolysis: three case reports and review. Clin Infect Dis1996, 22:642-9.

8. Wrenn KD, Oschner I. Rhabdomyolysis induced by acaffeine overdose. Ann Emerg Med 1989, 18:94-7.

9. Brumback RA, Feeback DL, Leech RW. Rhabdomyolysisin childhood. A primer on normal muscle function andselected metabolic myopathies characterized bydisordered energy production. Pediatr Clin North Am1992, 39:821-58.

10. ∞ÏÂÍfio˘Ïo˜ ∂. OÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÌÂÙ¿ ·fiÚ·‚‰oÌ˘fiÏ˘ÛË. ™Ùo: ¶··‰ËÌËÙÚ›o˘ ª, Û˘ÓÙ¿ÎÙ˘.¡ÂÊÚoÏoÁ›·. £ÂÛÛ·ÏoÓ›ÎË: ∂ΉfiÛÂȘ ™ÈÒ΢, 1992:307-311.

11. Zager RA. Rhabdomyolysis and myohemoglobinuricacute renal failure [editorial]. Kidney Int 1996, 49:314-26.

12. Better OS, Stein JH. Early management of shock andprophylaxis of acute renal failure in traumatic rhabdo-myolysis. N Engl J Med 1990, 322:825-9.

13. Rheingold OJ, Greenwald RA, Hayes PJ, Tedesco FJ.Myoglobinuria and renal failure associated with ty-phoid fever. JAMA 1977, 238:341.

14. Abdulla AJ, Moorhead JF, Sweny P. Acute tubular ne-crosis due to rhabdomyolysis and pancreatitis as-sociated with Salmonella enteritidis food poisoning[letter]. Nephrol Dial Transplant 1993, 8:672-3.

15. Sion ML, Hatzitolios A, Toulis E, Kounanis A, ProkopidisD. Rhabdomyolysis and acute renal failure associatedwith Salmonella enteritidis bacteremia [letter]. Ne-phrol Dial Transplant 1998, 13:532.

16. Lagarde C, Peyronnet P, Denis F, Benzakour M, Leroux-Robert C. Salmonella bonariensis salmonellosis, rhab-domyolysis and acute renal failure. Nephron 1989,53:179-80.

AÏÏËÏÔÁÚ·Ê›·:K. ∞ÔÛÙÔÏ›‰Ô˘ ª. ºˆÙ›Ô˘ 250100 – ∫Ô˙¿ÓË

Corresponding author:K. Apostolidou2, M. Photiou Str.501 00 – Kozani,Greece

∞ÁÁÂÈÔÔ›‰ËÌ· ÁÏÒÛÛ·˜ ÔÊÂÈÏfiÌÂÓÔ Û ϋ„Ë·Ó·ÛÙÔϤˆÓ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘

∂. ºÔ˘ÓÙÔ˘Ï¿Î˘1, ¢. ∫˘ÚÌÈ˙¿Î˘1, Ã. ¶··‰¿Î˘2,

°. ¶ÂÚÔÁ·Ì‚Ú¿Î˘1, ∂. ∫·Ú·ÎÒÛÙ·˜1, π. ™ÎÔ˘Ï¿˜1, ∑. ∞Ì·Ó¿Î˘1

1 øƒ§ ∫ÏÈÓÈ΋, «µÂÓÈ˙¤ÏÂÈÔ – ¶·Ó¿ÓÂÈÔ» °ÂÓÈÎfi ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ2 øƒ§ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ

¶ÂÚ›ÏË„Ë. ∆o ›ÎÙËÙo ·ÁÁÂÈoo›‰ËÌ· Ùo oÊÂÈÏfiÌÂ-Óo Û ¯Ú‹ÛË ·Ó·ÛÙoϤˆÓ Ùo˘ ÌÂÙ·ÙÚÂÙÈÎo‡ ÂÓ˙‡-Ìo˘ (·-ª∂∞) Â›Ó·È ÌÈ· Û¿ÓÈ·, ·ÏÏ¿ ‰È·ÚÎÒ˜ ·˘Í·Ófi-ÌÂÓË ÛÂ Û˘¯ÓfiÙËÙ· ÂÈÏo΋, ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ‰È¿-‰oÛ˘ ÙˆÓ ·Ú·¿Óˆ Ê·ÚÌ¿ÎˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛË Ù˘ ˘¤ÚÙ·Û˘ Î·È Ù˘ Û˘ÌÊoÚËÙÈ΋˜ ηډȷ-΋˜ ·Ó¿ÚÎÂÈ·˜. ÕÏÏoÈ Ù‡oÈ ·ÁÁÂÈooȉ‹Ì·Ùo˜,fiˆ˜ Ùo ÎÏËÚoÓoÌÈÎfi Ùo oo›o oÊ›ÏÂÙ·È ÛÙËÓ ·ÓÂ-¿ÚÎÂÈ· ‹ ‰˘ÛÏÂÈÙo˘ÚÁ›· Ùo˘ ·Ó·ÛÙoϤ· Ù˘ C1ÂÛÙÂÚ¿Û˘ Î·È Ùo ·ÏÏÂÚÁÈÎfi, ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈ-

Ï·Ì‚¿ÓoÓÙ·È ÛÙË ‰È·ÊoÚÈ΋ ‰È¿ÁÓˆÛË. ∆o ·ÁÁÂÈoo›-‰ËÌ· Â›Ó·È ÌÈ· ‰˘ÓËÙÈο ÂÈΛӉ˘ÓË ÁÈ· ÙË ˙ˆ‹ ηٿ-ÛÙ·ÛË, fiÙ·Ó ÂÓÙo›˙ÂÙ·È ÛÙËÓ ·ÓÒÙÂÚË ·Ó·Ó¢-ÛÙÈ΋ o‰fi. ∆o˘˜ ÙÂÏÂ˘Ù·›o˘˜ ¤ÍÈ Ì‹Ó˜ ·ÓÙÈÌÂÙˆ›-Û·Ì ÂÈÙ˘¯Ò˜ ‰‡Ô ·ÛıÂÓ›˜ Ì ·ÓÂÈÏËÌ̤ӷ ÂÂÈ-Ûfi‰È· ·ÁÁÂÈooȉ‹Ì·Ùo˜ ÁÏÒÛÛ·˜. ªÂ ÙËÓ Â˘Î·ÈÚ›··˘Ù‹, Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË ÙˆÓ Úo‚ÏËÌ¿ÙˆÓ ÛÙˉȿÁÓˆÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·˘Ù‹˜ Ù˘ ÂÈΛÓ-‰˘Ó˘ ¿ıËÛ˘. EÏÏËÓ I·ÙÚ 2000, 66: 295 - 298.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 295 - 298

∂π™∞°ø°∏∆o ·ÁÁÂÈoo›‰ËÌ· Â›Ó·È ÌÈ· ηٿÛÙ·ÛË ‰˘ÓËÙÈοÂÈΛӉ˘ÓË ÁÈ· ÙË ˙ˆ‹, Ë oo›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ÙËÓ ‡·ÚÍË ÂÓfi˜ ηϿ ÂÚÈÁÂÁÚ·Ì̤Óo˘ oȉ‹-Ì·Ùo˜ Ì ÛÎÏËÚ‹ Û‡ÛÙ·ÛË, Û˘¯Ó¿ ‰Â, Û˘Óo‰Â‡ÂÙ·È·fi ÂÚ˘ıÚfiÙËÙ· Î·È ÌoÚ› Ó· ÂÓÙo›˙ÂÙ·È Û ̛·‹ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈo¯¤˜ Ù˘ ÎÂÊ·Ï‹˜ Î·È Ùo˘ ÙÚ·-¯‹Ïo˘ (ÚfiÛˆo, ¯Â›ÏË, ÁÏÒÛÛ·, Ï¿Ú˘ÁÁ·˜). ∏ÚÒÙË ÂÚ›ÙˆÛË ÂÚÈÁڷʤÓÙo˜ ·ÁÁÂÈooȉ‹Ì·-Ùo˜ ·o‰›‰ÂÙ·È ÛÙoÓ Quinke (1882).

∆o ÎÏËÚoÓoÌÈÎfi ·ÁÁÂÈoo›‰ËÌ· Â›Ó·È ÌÈ· ηϿÙÂÎÌËÚȈ̤ÓË ÓoÛoÏoÁÈ΋ oÓÙfiÙËÙ·, o˘ oÊ›ÏÂ-Ù·È ÛÙË Ì›ˆÛË Ù˘ ÏÂÈÙo˘ÚÁÈÎfiÙËÙ·˜ ‹ Ù˘ ·Ú·-ÁˆÁ‹˜ Ùo˘ ·Ó·ÛÙoϤ· Ù˘ C1 ÂÛÙÂÚ¿Û˘1. ∆o ›-ÎÙËÙo ·ÁÁÂÈoo›‰ËÌ· ÌoÚ› Ó· oÊ›ÏÂÙ·È Û ̛·ÏÂÈ¿‰· ·ÈÙ›ˆÓ ·fi Ù· oo›·, Ë ¯Ú‹ÛË Ê·Ú̿ΈÓo˘ ·Ó·ÛÙ¤ÏÏo˘Ó Ùo ÌÂÙ·ÙÚÂÙÈÎfi ¤Ó˙˘Ìo Ù˘ ·Á-ÁÂÈoÙÂÓÛ›Ó˘ π Û ππ ıˆÚÂ›Ù·È Ùo Û˘¯ÓfiÙÂÚo (35%Ùo˘ ›ÎÙËÙo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ oÊ›ÏÂÙ·È ÛÙ· ·-Ú·¿Óˆ Ê¿Ú̷η)2.

∞fi Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ Ùo˘ 1980 fiÏo ηÈ

ÂÚÈÛÛfiÙÂÚo oÈ ·Ó·ÛÙoÏ›˜ Ùo˘ ÌÂÙ·ÙÚÂÙÈÎo‡ ÂÓ-˙‡Ìo˘ (·-ª∂∞) ¯ÚËÛÈÌooÈo‡ÓÙ·È ÛÙË ıÂڷ›·Ù˘ ˘¤ÚÙ·Û˘ Î·È Ù˘ Û˘ÌÊoÚËÙÈ΋˜ ηډȷ΋˜·Ó¿ÚÎÂÈ·˜3. ∞˘Ùfi ·oÙ¤ÏÂÛ ·ÈÙ›· ·‡ÍËÛ˘ ÙË˜Û˘¯ÓfiÙËÙ·˜ Ùo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ Î·È ·Ó·Ì¤ÓÂÙ·ÈfiÙÈ ÛÙo ̤ÏÏoÓ ·Ó¿ÏoÁ· ÂÚÈÛÙ·ÙÈο ı· ·˘ÍËıo‡Ó·ÎfiÌ· ÂÚÈÛÛfiÙÂÚo, ‰Â‰o̤Óo˘ fiÙÈ Ù· Ê¿Ú̷η·˘Ù¿, ÁÂÓÈο ¤¯o˘Ó ¯·ÌËÏfi oÛoÛÙfi ·ÓÂÈı‡ÌË-ÙˆÓ ÂÓÂÚÁÂÈÒÓ Î·È ÈηÓooÈËÙÈ΋ ‰Ú·ÛÙÈÎfiÙËÙ·4.∂›Û˘ Ë ·‡ÍËÛË Ùo˘ ̤Ûo˘ fiÚo˘ ˙ˆ‹˜ Î·È Ùo˘ o-ÛoÛÙo‡ ÙˆÓ ˘ÂÚËÏ›ÎˆÓ ÛÙȘ ‰˘ÙÈΤ˜ ÎoÈӈӛ˜ ηÈηٿ Û˘Ó¤ÂÈ· Î·È Ë ·‡ÍËÛË Ùo˘ ·ÚÈıÌo‡ ÙˆÓ˘ÂÚÙ·ÛÈÎÒÓ Î·ıÒ˜ Î·È ÙˆÓ ·ÙfiÌˆÓ o˘ ¿Û¯o˘Ó·fi Û˘ÌÊoÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ·, ıˆÚ›-Ù·È ¤Ó·˜ ·ÎfiÌË ÏfiÁo˜ Û˘¯ÓfiÙÂÚ˘ ¯Ú‹Û˘ ÙˆÓ ·-ª∂∞, ¿Ú· Î·È ·˘ÍË̤Ó˘ Û˘¯ÓfiÙËÙ·˜ ÂÚÈÛÙ·ÙÈ-ÎÒÓ ·ÁÁÂÈooȉ‹Ì·Ùo˜.

¶∂ƒπ°ƒ∞º∏ TøN ¶∂ƒπ¶∆ø™∂ø¡¶ÂÚ›ÙˆÛË 1: °˘Ó·›Î· 68 ÂÙÒÓ Î·È ‚¿Úo˘˜ 75 ÎÈÏÒÓ, ÚoÛ‹Ï-ı ÂÎÙ¿ÎÙˆ˜ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›·, ÏfiÁˆ ¤ÓÙoÓo˘ oȉ‹Ì·-

295

Ùo˜ ÁÏÒÛÛ·˜ Ë oo›· Úo¤‚·ÏÏ ÂÎÙfi˜ Ùo˘ ÛÙfiÌ·Ùo˜. ∞Ó·-Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ‰ÂÓ ·Ó·Ê¤ÚıËÎÂ. ∫·Ù¿ ÙËÓ øƒ§ Âͤٷ-ÛË ‰È·ÈÛÙÒıËΠÌÂÁ¿ÏË ·ÓÒ‰˘ÓË Î·È Û˘ÌÌÂÙÚÈ΋ ‰ÈfiÁΈÛËÙ˘ ÁÏÒÛÛ·˜. ∏ ÂÈÛÎfiËÛË Ùo˘ ˘oÊ¿Ú˘ÁÁ· Î·È Ùo˘ Ï¿Ú˘Á-Á· ‹Ù·Ó ·‰‡Ó·ÙË ÏfiÁˆ Ùo˘ Úo·Ó·ÊÂÚo̤Óo˘ oȉ‹Ì·Ùo˜. ∏·ÎÚfi·ÛË Ùo˘ ÙÚ·¯‹Ïo˘ ‹Ù·Ó ·ÚÓËÙÈ΋ ÁÈ· Û˘ÚÈÁÌfi Î·È Ë Ï¿-ÁÈ· ·ÎÙÈÓoÁÚ·Ê›· Ì·Ï·ÎÒÓ ÌoÚ›ˆÓ ÙÚ·¯‹Ïo˘ ‰ÂÓ ¤‰ÂȯÓÂÚfi‚ÏËÌ· ‚·ÙfiÙËÙ·˜ Ùo˘ ·ÓÒÙÂÚo˘ ·Ó·Ó¢ÛÙÈÎo‡.

∏ ·ÚÙËÚȷ΋ ›ÂÛË Ù˘ ·ÛıÂÓo‡˜ ‹Ù·Ó 140/80 mmHgÎ·È oÈ ÛʇÍÂȘ Ù˘ 78/min. ∏ ·ÛıÂÓ‹˜ ·Ì¤Ûˆ˜ ·ÓÙÈÌÂÙˆ›-ÛıËΠ̠¯oÚ‹ÁËÛË ˘o‰oÚ›ˆ˜ ·‰ÚÂÓ·Ï›Ó˘ 0,4 mg Î·È Â·-Ó¿ÏË„Ë Ù˘ ›‰È·˜ ‰fiÛ˘ ÌÂÙ¿ ·fi 20 ÏÂÙ¿. ∏ ·ÛıÂÓ‹˜ ·Ó¤-¯ıËΠÙË ¯oÚ‹ÁËÛË ·‰ÚÂÓ·Ï›Ó˘ ¯ˆÚ›˜ ȉȷ›ÙÂÚ· Úo‚Ï‹Ì·-Ù·. ∂›Û˘ ¯oÚËÁ‹ıËΠ‰ÂÍ·ÌÂı·˙fiÓË 16 mg ÂÓ‰oÊÏ‚›ˆ˜.

∞fi ÙË ÏÂÙoÌÂÚ‹ Ï‹„Ë Ùo˘ ÈÛÙoÚÈÎo‡, ‰È·ÈÛÙÒıËÎÂfiÙÈ Ë ·ÛıÂÓ‹˜ ·Úo˘Û›·Û 4 ÂÂÈÛfi‰È· oȉ‹Ì·Ùo˜ Ùo ÙÂÏ¢-Ù·›o ÂÍ¿ÌËÓo, ÂÏ·ÊÚfiÙÂÚ· Ùo˘ ·ÚfiÓÙo˜ (‰‡o ÛÙ· ¯Â›ÏË Î·È‰‡o ÛÙË ÁÏÒÛÛ·), Ù· oo›· ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÛÙo ∫¤ÓÙÚoÀÁ›·˜ Ù˘ ÂÚÈo¯‹˜ Ù˘. ∞fi ÂÙ·Ì‹Óo˘ Ë ·ÛıÂÓ‹˜ ›¯Â ·Ú-¯›ÛÂÈ Ó· Ï·Ì‚¿ÓÂÈ Î·ÙoÚ›ÏË 25 mg × 3 ÏfiÁˆ ·ÚÙËÚȷ΋˜˘¤ÚÙ·Û˘. ŒÓ· Ì‹Ó· ÌÂÙ¿ ÂÌÊ¿ÓÈÛ Ùo ÚÒÙo ÂÂÈÛfi‰Èo oÈ-‰‹Ì·Ùo˜. ¶ÚÈÓ ·fi ÙË Ï‹„Ë Î·ÙoÚ›Ï˘ Ë ·ÛıÂÓ‹˜ ‰ÂÓ ·Ó¤-ÊÂÚ ·Ó¿ÏoÁo Úfi‚ÏËÌ·. ∞fi Ùo ˘fiÏoÈo ÈÛÙoÚÈÎfi ‰ÂӷӷʤÚıËΠ·Ùo›·, o‡Ù ϋ„Ë ¿ÏÏˆÓ Ê·Ú̿ΈÓ, ÏËÓ ÌËÙ·ÎÙÈ΋˜ ¯Ú‹Û˘ ηÏÛÈÙoÓ›Ó˘ ÂÓ‰oÚÚÈÓÈο, ÏfiÁˆ oÛÙÂofi-ÚˆÛ˘ (Ùo ÙÂÏÂ˘Ù·›o ÂÍ¿ÌËÓo ‰ÂÓ ·Ó·Ê¤ÚıËΠ¯Ú‹ÛË ·˘Ù‹˜).

¢È·ÎfiËÎÂ Ë Ï‹„Ë Î·ÙoÚ›Ï˘. ∏ ¯oÚ‹ÁËÛË ÙˆÓ ÎoÚ-ÙÈÎoÛÙÂÚoÂȉÒÓ Û˘Ó¯›ÛÙËΠÁÈ· 6 Ë̤Ú˜, ·Ú¯Èο ÂÓ‰oÊϤ-‚È· Î·È ÌÂÙ¿ ·fi Ùo ÛÙfiÌ·, Ì ÛÙ·‰È·Î¿ ÌÂÈo‡ÌÂÓË ‰fiÛË. ªÂ-Ù¿ ·fi 4 ÒÚ˜ ·Ú·ÙËÚ‹ıËΠ‡ÊÂÛË Ùo˘ oȉ‹Ì·Ùo˜ Î·È ÌÂÙ¿·fi 36 ÒÚ˜ Ï‹Ú˘ ÂÍ¿ÏÂÈ„Ë ·˘Ùo‡. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÓoÛËÏ›·˜ Ù˘ ·ÛıÂÓo‡˜, Ë Ï‹„Ë ·Ó¿ ÙÚ›ˆÚo Ù˘ ·ÚÙËÚȷ΋˜›ÂÛ˘ ¤‰ÂÈÍ ‰È·Î˘Ì¿ÓÛÂȘ Û ·ÓÂÎÙ¿ ›‰· (Û˘ÛÙoÏÈ-΋<165mmHg Î·È ‰È·ÛÙoÏÈ΋<95mmHg), ¤ÙÛÈ ‰ÂÓ ¯ÚÂÈ¿-ÛÙËΠʷÚ̷΢ÙÈ΋ ·Ú¤Ì‚·ÛË ÂÓ‰oÓoÛoÎoÌÂȷο.

∏ ·ÛıÂÓ‹˜ ÌÂÙ¿ ·fi 6 Ë̤Ú˜ ÂÍ‹Ïı ·fi ÙËÓ ∫ÏÈÓÈ΋Ì ÁÚ·Ù¤˜ o‰ËÁ›Â˜ ÁÈ· ·oÊ˘Á‹ Ï‹„˘ ·Ó·ÏfiÁˆÓ Ê·ÚÌ¿-ÎˆÓ (·-ª∂∞). ∏ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ Ù˘ ·ÁˆÁ‹ ¿ÏÏ·Í ÛÂ Û˘-ÓÂÓÓfiËÛË Ì ÙoÓ Î·Ú‰ÈoÏfiÁo Ù˘ ÛÂ Û˘Ó‰˘·ÛÌfi ‚-blocker ̉Èo˘ÚËÙÈÎfi.

¶ÂÚ›ÙˆÛË 2Ë: ÕÓ‰Ú·˜ 76 ÂÙÒÓ Î·È ‚¿Úo˘˜ 84 ÎÈÏÒӉȷÎoÌ›ÛÙËΠÛÙËÓ øƒ§ ÎÏÈÓÈ΋ ·fi ¿ÏÏo ¡o̷گȷÎfi ¡o-ÛoÎoÌ›o ÂÍ·ÈÙ›·˜ ÂÓÙfiÓo˘ oȉ‹Ì·Ùo˜ ÁÏÒÛÛ·˜. ∞fi ÙËÓ ÎÏÈ-ÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÛo‚·Úo‡ ‚·ıÌo‡ o›‰ËÌ· ÁÏÒÛ-Û·˜ o˘ ÚoηÏo‡Û ÌÂÚÈ΋ ·fiÊÚ·ÍË Ùo˘ ·ÓÒÙÂÚo˘ ·Ó·-Ó¢ÛÙÈÎo‡ Ì ·oÙ¤ÏÂÛÌ· ‹È· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·.∞fi ÙËÓ ¤ÌÌÂÛË Ï·Ú˘ÁÁoÛÎfiËÛË o˘ ‹Ù·Ó ‰˘Û¯ÂÚ‹˜, ‰ÂӉȷÈÛÙÒıËΠ¤ÎÙ·ÛË Ùo˘ oȉ‹Ì·Ùo˜ ÛÙo Ï¿Ú˘ÁÁ·. O ·Û-ıÂÓ‹˜ ÂÌÊ¿ÓÈ˙ ÂÏ·ÊÚÈ¿ Ù·¯‡ÓoÈ· (17 ·Ó·Óo¤˜/min), ·Ú-ÙËÚȷ΋ ›ÂÛË 150/85 mmHg Î·È ÛʇÍÂȘ 85/min. ∆· ·¤ÚÈ·Ùo˘ ·›Ì·Ùo˜ ‹Ù·Ó ÛÂ Ê˘ÛÈoÏoÁÈο ›‰·.

O ·ÛıÂÓ‹˜ Ù¤ıËΠ۠·ÁˆÁ‹ Ì ÌÂı˘ÏÚ‰ÓÈ˙oÏfiÓË125 mg × 2 (Úˆ›–ÌÂÛË̤ÚÈ) Î·È Ùo˘ ¤ÁÈÓ ˘o‰fiÚÈ· ·‰ÚÂÓ·-Ï›ÓË 0,4 mg ÂÊ¿·Í. O ·ÛıÂÓ‹˜ ·Ó¤¯ÙËΠÙË ¯oÚ‹ÁËÛË ·˘Ù‹˜¯ˆÚ›˜ ȉȷ›ÙÂÚ· Úo‚Ï‹Ì·Ù·.

∞fi Ùo ÈÛÙoÚÈÎfi Ùo˘ ·ÛıÂÓ‹, ‰È·ÈÛÙÒıËΠfiÙÈ ·˘Ùfi ÙoÂÂÈÛfi‰Èo ‹Ù·Ó Ùo ÙÚ›Ùo Û ‰È¿ÛÙËÌ· 7 ÌËÓÒÓ Î·È Ùo o›‰ËÌ·ÂÓÙoÈ˙fiÙ·Ó ¿ÓÙoÙ ÛÙË ÁÏÒÛÛ·. ∆· ‰‡o ÚoËÁo‡ÌÂÓ· ÂÚÈ-ÛÙ·ÙÈο ›¯·Ó ·ÓÙÈÌÂÙˆÈÛı› Û ¿ÏÏ· ¡oÛoÎoÌ›· Î·È ‹Ù·ÓËÈfiÙÂÚ·. ∆o ÚÒÙo ÂÂÈÛfi‰Èo oȉ‹Ì·Ùo˜ ·Úo˘ÛÈ¿ÛıËΠ40

̤Ú˜ ÌÂÙ¿ ÙËÓ ·fi oÎÙ·Ì‹Óo˘ ¤Ó·ÚÍË Ï‹„˘ ÏÈÛÈÓoÚ›Ï˘20 mg × 1 ÏfiÁˆ ˘¤ÚÙ·Û˘. ∞fi Ùo ˘fiÏoÈo ÈÛÙoÚÈÎfi ‰ÂӷӷʤÚıËΠ·Ùo›·, o‡Ù ϋ„Ë ¿ÏÏˆÓ Ê·Ú̿ΈÓ.

¢È·ÎfiËÎÂ Ë ¯oÚ‹ÁËÛË ÏÈÛÈÓoÚ›Ï˘ Î·È Ë ·ÁˆÁ‹ Ì ٷÎoÚÙÈÎoÛÙÂÚoÂȉ‹ Û˘Ó¯›ÛıËΠÌÂ Û˘Ó¯Ҙ ÌÂÈo‡ÌÂÓË ‰fiÛË› 7 Ë̤Ú˜, ÂÓ‰oÊÏ‚›ˆ˜ ·Ú¯Èο Î·È ÌÂÙ¿ ·fi Ùo ÛÙfiÌ·.∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓoÛËÏ›·˜ ÁÈÓfiÙ·Ó Ù·ÎÙÈ΋ ·Ú·ÎoÏo‡-ıËÛË ÙˆÓ ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ Ùo˘ ·ÛıÂÓo‡˜, ¯ˆÚ›˜ Ó· ηٷÛÙ›··Ú·›ÙËÙË Ë ÂÓ‰oÓoÛoÎoÌÂȷ΋ ¯oÚ‹ÁËÛË ·ÓÙÈ˘ÂÚÙ·ÛÈ-ÎÒÓ. O ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙËÓ ¤ÌÙË Ì¤Ú· ÌÂÙ¿ ·fi Ï‹Úˢo¯ÒÚËÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì ÁÚ·Ù¤˜ o‰ËÁ›Â˜ ÁÈ· ·o-Ê˘Á‹ Ï‹„˘ ·-ª∂∞ Î·È Û‡ÛÙ·ÛË ÁÈ· ·Ú·ÎoÏo‡ıËÛË Ù˘·ÚÙËÚȷ΋˜ ȤÛˆ˜ Ùo˘ ·fi ÙoÓ ¶·ıoÏfiÁo Ùo˘.

™Â Î·Ó¤Ó·Ó ·fi Ùo˘˜ ‰‡o ·Ú·¿Óˆ ·ÛıÂÓ›˜ ‰ÂÓ Û˘-Ó¤ÙÚ¯ ÏfiÁo˜ ‰È·ÛˆÏ‹ÓˆÛ˘ ‹ ÙÚ·¯ÂÈoÙoÌ‹˜. OÈ ·ÛıÂÓ›˜Ù¤ıËÎ·Ó Û ٷÎÙÈ΋ ·Ú·ÎoÏo‡ıËÛË (·Ó¿ Ì‹Ó·) Î·È Â› ¤-ÓÙ ̋Ó˜ ‹Ù·Ó ÂχıÂÚoÈ ·Ó¿ÏoÁˆÓ Úo‚ÏËÌ¿ÙˆÓ.

™À∑∏∆∏™∏OÈ ·Ó·ÛÙoÏ›˜ Ùo˘ ÌÂÙ·ÙÚÂÙÈÎo‡ ÂÓ˙‡Ìo˘ (·-ª∂∞) Â›Ó·È Ê¿Ú̷η o˘ ¯ÚËÛÈÌooÈo‡ÓÙ·È Â˘-ڇٷٷ ÁÈ· ÙË ıÂڷ›· Ù˘ ˘¤ÚÙ·Û˘ Î·È ÙË˜Û˘ÌÊoÚËÙÈ΋˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜. OÈ Û˘¯Ófi-ÙÂÚ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ ·-ª∂∞ Â›Ó·È Ë˘fiÙ·ÛË (ȉ›ˆ˜ ÌÂÙ¿ ÙËÓ ÚÒÙË ‰fiÛË), Ë ÓÂÊÚÈ΋‰˘ÛÏÂÈÙo˘ÚÁ›·, Ë ˘ÂÚηÏÈ·ÈÌ›· Î·È o ÍËÚfi˜ ‚‹-¯·˜. ™·ÓÈfiÙÂÚ·, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛÙo‡Ó·ÁÁÂÈoo›‰ËÌ· (0,1%-0,2%), Ë·ÙoÙoÍÈÎfiÙËÙ·,‰ÂÚÌ·ÙÈο ÂÍ·Óı‹Ì·Ù·, ‰˘ÛÁÂ˘Û›· Î·È ·ÓˆÌ·Ï›Â˜Ùo˘ ÂÌ‚Ú‡o˘ › ¯oÚËÁ‹Ûˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÂÁ΢ÌoÛ‡Ó˘4.

¶ÂÚÈÁÚ¿ÊoÓÙ·È ·ÚÎÂÙ¿ ·›ÙÈ· ·ÁÁÂÈooȉ‹Ì·-Ùo˜. ∞˘Ù¿ Ù·ÍÈÓoÌo‡ÓÙ·È ÛÂ Û˘ÁÁÂÓ‹ Î·È Â›ÎÙËÙ·(¶›Ó. 1)5. ™ÙËÓ Î·ıË̤ڷ Ú¿ÍË Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›·Â›ÎÙËÙo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ Â›Ó·È Ë ¯Ú‹ÛË ÙˆÓ ·-ª∂∞. ∆o ·ÁÁÂÈoo›‰ËÌ· ÌÂÙ¿ ·fi ıÂڷ›· Ì ·-ª∂∞ Ê·›ÓÂÙ·È Ó· oÊ›ÏÂÙ·È ÂÚÈÛÛfiÙÂÚo Û ‚Èo-¯ËÌÈÎo‡˜ ·Ú¿ Û ·ÓoÛoÏoÁÈÎo‡˜ ·Ú¿ÁoÓÙ˜.

∆o ÌÂÙ·ÙÚÂÙÈÎfi ¤Ó˙˘Ìo ·Ú¿ÁÂÙ·È ÛÙo˘˜Ó‡ÌoÓ˜ Î·È Â›Ó·È ˘Â‡ı˘Óo ÁÈ· ÙË ÌÂÙ·ÙÚo‹ Ù˘·ÁÁÂÈoÙÂÓÛ›Ó˘ π Û ·ÁÁÂÈoÙÂÓÛ›ÓË ππ, ÂÓfi˜ ÈÛ¯˘Úo‡·ÁÁÂÈoÛ˘Û·ÛÙÈÎo‡ ·Ú¿ÁoÓÙ·. ∆o ÌÂÙ·ÙÚÂÙÈÎfi¤Ó˙˘Ìo Ùo oo›o Â›Ó·È ÁÓˆÛÙfi Î·È ˆ˜ ÎÈÓÈÓ¿ÛË ππ ›-Ó·È ˘Â‡ı˘Óo Î·È ÁÈ· Ùo ÌÂÙ·‚oÏÈÛÌfi Ù˘ ‚Ú·‰˘ÎÈ-Ó›Ó˘ (ÂÓfi˜ ÈÛ¯˘Úo‡ ·ÁÁÂÈo‰È·ÛÙ·ÏÙÈÎo‡ ·Ú¿Áo-ÓÙ·). ∏ ¯Ú‹ÛË ÙˆÓ ·-ª∂∞ o‰ËÁ› ÛÙËÓ ·‡ÍËÛË ÙˆÓÂȤ‰ˆÓ Ù˘ ‚Ú·‰˘ÎÈÓ›Ó˘ Î·È ÙËÓ ·Ú¿Ù·ÛË Ù˘‰Ú¿Û˘ ·˘Ù‹˜, ÂÓÒ ·Ú¿ÏÏËÏ· ÚoηÏ› Ì›ˆÛËÙˆÓ ÂȤ‰ˆÓ Ù˘ ·ÁÁÂÈoÙÂÓÛ›Ó˘ ππ Î·È Ù˘ ·Ï‰o-ÛÙÂÚfiÓ˘.

O Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ ÙˆÓ Ì˯·ÓÈÛÌÒÓ o‰ËÁ›Û ÙoÈ΋ ‹ ÁÂÓÈÎÂ˘Ì¤ÓË ·ÁÁÂÈo‰È·ÛÙoÏ‹ Ì ¤Ío‰oÂÓ‰o·ÁÁÂÈ·ÎÒÓ ˘ÁÚÒÓ ÛÙo˘˜ ˘o‰fiÚÈo˘˜ ÈÛÙo‡˜,

296 E. ºOYNTOY§AKH™ KAI ™YN.

ÁÂÁoÓfi˜ Ùo oo›o ÚoηÏ› Ùo ÈÛÙÈÎfi o›‰ËÌ· Î·È Ùo·ÁÁÂÈoo›‰ËÌ·6,7. ªÈÎÚoÛÎoÈο Ë ÂÚÈo¯‹ Ùo˘ ·Á-ÁÂÈooȉ‹Ì·Ùo˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È·ÛÙoÏ‹ ÙˆÓ·ÁÁ›ˆÓ ÙˆÓ ˘o‰fiÚÈˆÓ ÈÛÙÒÓ, ‰È¿¯˘Ùo o›‰ËÌ· ·˘-ÙÒÓ, ηıÒ˜ Î·È Ì¤ÙÚÈ· ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË ·fiÊÏÂÁÌoÓÒ‰Ë Î‡ÙÙ·Ú·.

∆o ÌÂÁ·Ï‡ÙÂÚo oÛoÛÙfi ÂÚÈÛÙ·ÙÈÎÒÓ ·ÁÁÂÈo-oȉ‹Ì·Ùo˜ ·ÊoÚ¿ ÙËÓ ÎÂÊ·Ï‹ Î·È ÙoÓ ÙÚ¿¯ËÏo8. ∏Û˘Ó‹ı˘ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ÛÎÏËÚo‡ÂÚÈÁÂÁÚ·Ì̤Óo˘ ÂÎÙÂٷ̤Óo˘ oȉ‹Ì·Ùo˜, Ùo oo›oÂÓÙo›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙo ÚfiÛˆo, Ù· ¯Â›ÏË Î·È ÙËÁÏÒÛÛ·. ™˘¯Ó¿ ·˘Ùfi Û˘Óo‰Â‡ÂÙ·È ·fi ÂÚ‡ıËÌ· ηÈÌoÚ› Ó· ÂÍÂÏȯı› ÛÂ Ï·Ú˘ÁÁÈÎfi o›‰ËÌ·, ·fiÊÚ·-ÍË Ù˘ ·ÓÒÙÂÚ˘ ·Ó·Ó¢ÛÙÈ΋˜ o‰o‡ Î·È ı¿Ó·Ùo.™·ÓÈfiÙÂÚ· Ùo ·ÁÁÂÈoo›‰ËÌ· ÂÓÙo›˙ÂÙ·È ÛÙ· ¯¤-ÚÈ·, Ù· fi‰È· Î·È Ù· ÎoÈÏȷο ÛÏ¿¯Ó· (ÌoÚ› Ùfi-Ù ӷ ÂΉËÏÒÓÂÙ·È Û·Ó ÎoÈÏÈ·Îfi ¿ÏÁo˜).

∆o ÛËÌ·ÓÙÈÎfiÙÂÚo ‚‹Ì· ÁÈ· ÙËÓ oÚı‹ ‰È¿ÁÓˆÛËÙo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ ·fi Ï‹„Ë ·-ª∂∞ Â›Ó·È Ë Ï‹„ËÏÂÙoÌÂÚo‡˜ ÈÛÙoÚÈÎo‡. ∂› ˘o„›·˜ Û˘ÁÁÂÓo‡˜ ‹·ÏÏÂÚÁÈÎo‡ ·ÁÁÂÈooȉ‹Ì·Ùo˜ Ë Ì¤ÙÚËÛË Ùo˘ ·Ó·-ÛÙoϤ· Ù˘ C1 ÂÛÙÂÚ¿Û˘, ÙˆÓ C4-C9 ÎÏ·ÛÌ¿ÙˆÓ Ùo˘Û˘ÌÏËÚÒÌ·Ùo˜, ηıÒ˜ Î·È Ë Ì¤ÙÚËÛË ÙˆÓ ÂȤ‰ˆÓÙ˘ oÏÈ΋˜ Î·È ÂȉÈÎÒÓ IgE Î·È oÈ ‰ÂÚÌ·ÙÈΤ˜ ‰oÎÈ-̷ۛ˜ ı· ‚oËı‹Ûo˘Ó ÛÙË ‰È·ÊoÚo‰È¿ÁÓˆÛË.

O ¯ÚfiÓo˜ ÂÌÊ·Ó›Ûˆ˜ Ùo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ Ùo˘oÊÂÈÏo̤Óo˘ Û ϋ„Ë ·-ª∂∞, ÌoÚ› Ó· ·¤¯ÂÈ·fi ÙËÓ ÚÒÙË Ï‹„Ë ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·fi Ï›Á˜ ÒÚ˜̤¯ÚÈ 2 ¤ÙË9. ∏ ‚·Ú‡ÙËÙ· Ùo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ ‰ÂÓÊ·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙË ¯oÚËÁËı›۷ ‰fiÛË.

£Âڷ¢ÙÈο, ·Ú¯Èο Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÍ·-

ÛÊ¿ÏÈÛË Ù˘ ‚·ÙfiÙËÙ·˜ Ù˘ ·ÓÒÙÂÚ˘ ·Ó·Ó¢ÛÙÈ-΋˜ o‰o‡. ∞˘Ùfi ·Ó¿ÏoÁ· Ì ÙË ‚·Ú‡ÙËÙ·, Ù· ‰È·ÙÈ-ı¤ÌÂÓ· ̤۷ Î·È ÙËÓ ˘¿Ú¯o˘Û· ÂÌÂÈÚ›·, ÌoÚ›ӷ Á›ÓÂÈ Ì ÙË Ê·ÚÌ·ÎoıÂڷ›·, ÙËÓ ·Ï‹ ‰È·Ûˆ-Ï‹ÓˆÛË, ÙË ‰È·ÛˆÏ‹ÓˆÛË Ì ÙË ‚o‹ıÂÈ· ‡ηÌ-Ùo˘ ‚ÚoÁ¯oÛÎo›o˘, ÙËÓ ÎÚÈÎoı˘ÚÂoÂȉoÙoÌ‹ ηÈÙËÓ ÙÚ·¯ÂÈoÙoÌ‹2. ™ÙË Û˘Ó¤¯ÂÈ· ¯oÚËÁo‡ÓÙ·È O2,˘o‰fiÚÈ· ·‰ÚÂÓ·Ï›ÓË (0,01 mg/Kg ‚¿Úo˘˜ ÛÒ-Ì·Ùo˜, ̤¯ÚÈ 0,5 mg ÛÙ· ¿ÙoÌ· ¿Óˆ ·fi 50 Kg,‰fiÛË o˘ ÌoÚ› Ó· ·ӷÏËÊı› ÌÂÙ¿ ÂÈÎoÛ¿ÏÂ-Ùo) Î·È ÂÓ‰oÊϤ‚È· ÎoÚÙÈÎoÛÙÂÚoÂȉ‹ Û ÌÂÁ¿Ï˜‰fiÛÂȘ (Û˘ÓËı¤ÛÙÂÚ· ‰›ÓÂÙ·È ‰ÂÍ·ÌÂı·˙fiÓË). OÚÈ-Ṳ̂ÓoÈ Û˘ÓÈÛÙo‡Ó Î·È ÂÈÛÓo¤˜ ÓÂÊÂÏooÈË̤Ó˘ڷÎÂÌÈ΋˜ ÂÈÓÂÊÚ›Ó˘.

¶Ú¤ÂÈ fï˜ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë fiÙÈ ·ÊÂ-Ófi˜, ÏfiÁˆ Ùo˘ Ì˯·ÓÈÛÌo‡ ÁÂÓ¤Ûˆ˜ Ùo˘ ›ÎÙËÙo˘·ÁÁÂÈooȉ‹Ì·Ùo˜ ·fi ·-ª∂∞ (‚Èo¯ËÌÈÎfi˜ Î·È fi¯È·ÓoÛoÏoÁÈÎfi˜), ‰ÂÓ Â›Ó·È ‚¤‚·ÈË Ë ıÂڷ¢ÙÈ΋‰Ú¿ÛË Ù˘ ·‰ÚÂÓ·Ï›Ó˘ Î·È ÙˆÓ ÎoÚÙÈÎoÛÙÂÚoÂÈ-‰ÒÓ Î·È ·ÊÂÙ¤Úo˘, oÈ ·ÛıÂÓ›˜ Ì ÙË ÓfiÛo ·˘Ù‹ Û˘-¯Ófiٷٷ Â›Ó·È ˘ÂÚÙ·ÛÈÎo› Î·È ‰˘ÓËÙÈο Ë ¯Ú‹ÛË·‰ÚÂÓ·Ï›Ó˘ Î·È ÎoÚÙÈÎoÛÙÂÚoÂȉÒÓ Â›Ó·È ÂÈΛÓ-‰˘ÓË. ø˜ ÂÎ Ùo‡Ùo˘, Û˘ÓÈÛÙ¿Ù·È Ë ÚoÛÂÎÙÈ΋ ·-Ú·ÎoÏo‡ıËÛË Ù˘ ·ÚÙËÚȷ΋˜ ȤÛˆ˜ ηı’ fiÏË ÙˉȿÚÎÂÈ· Ù˘ ıÂڷ›·˜.

∆¤Ïo˜ Ú¤ÂÈ Ó· ÙoÓÈÛı› fiÙÈ oÈ ·-ª∂∞ ¤¯o˘ÓÛ˘Ó‹ıˆ˜ ÌÂÁ¿Ïo ¯ÚfiÓo ËÌÈ˙ˆ‹˜. ŒÙÛÈ ı· Ú¤ÂÈ Ë¯Ú‹ÛË ÙˆÓ ÎoÚÙÈÎoÛÙÂÚoÂȉÒÓ Ó· Â›Ó·È ·Ú·ÙÂÙ·-̤ÓË ÁÈ· Ó· ÌËÓ ¤¯o˘Ì ˘oÙÚo‹ Ùo˘ ·ÁÁÂÈooȉ‹-Ì·Ùo˜.

™ÙËÓ Î·ıË̤ڷ Ú¿ÍË Â›Ó·È Û‡ÓËı˜ Ë oÚı‹ ‰È-

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 297

¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÁÁÂÈooȉ‹Ì·Ùo˜.

™˘ÁÁÂÓ‹ ·›ÙÈ· ·) ∞Ó¿ÚÎÂÈ· Ùo˘ ·Ó·ÛÙoϤ· Ù˘ C1 ÂÛÙÂÚ¿Û˘ (85%)‚) ¢˘ÛÏÂÈÙo˘ÚÁ›· Ùo˘ ·Ó·ÛÙoϤ· Ù˘ C1 ÂÛÙÂÚ¿Û˘ (15%)

∂›ÎÙËÙ· ·) ∞Ó¿ÚÎÂÈ· Ùo˘ ·Ó·ÛÙoϤ· Ù˘ C1 ÂÛÙÂÚ¿Û˘1. B-Cell ϤÌʈ̷2. ¡fiÛoÈ Û˘Ó‰ÂÙÈÎo‡ ÈÛÙo‡3. ∞Ó¿Ù˘ÍË ·˘Ùo·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ùo˘ ·Ó·ÛÙoϤ· Ù˘ C1 ÂÛÙÂÚ¿Û˘

‚) ∞ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ Ù‡o˘ π(¶·Ú¿ÛÈÙ·*, ÚoÛıÂÙÈο ÙÚoÊÒÓ*, Ê¿Ú̷η, ÙÛÈÌ‹Ì·Ù· ÂÓÙfïÓ, ÂÌ‚fiÏÈ··Â˘·ÈÛıËÙoo›ËÛ˘ Î.Ï..)

Á) ÃËÌÈÎo› ·o‰ÂÛÌÂ˘Ù¤˜ ÈÛÙ·Ì›Ó˘ (ÌoÚÊ›ÓË, Έ‰Â˝ÓË, Ȉ‰Èo‡¯· ÛÎÈ·ÁÚ·ÊÈο Î.Ï..)‰) º˘ÛÈο ·›ÙÈ·: ∞ÎÚ·›Â˜ ıÂÚÌoÎڷۛ˜, ËÏȷ΋ ·ÎÙÈÓo‚oÏ›·Â) ∞Ó·ÛÙoÏ›˜ Ùo˘ ÌÂÙ·ÙÚÂÙÈÎo‡ ÂÓ˙‡Ìo˘ Ù˘ ·ÁÁÂÈoÙÂÓÛ›Ó˘ (·-ª∂∞)ÛÙ) µÚÒÛË ‰È·ÊfiÚˆÓ ÙÚoÊÒÓ (·˘Á¿, oÛÙÚ·ÎoÂȉ‹, ÍËÚo› ηÚo›, ‰È¿ÊoÚ· ÊÚo‡Ù·)˙) ªÂÙ¿ ·fi ÈÒÛÂȘ (Ë·Ù›Ùȉ·, ÏoÈÌ҉˘ ÌoÓo˘Ú‹ÓˆÛË Î.·.)Ë) ¢È¿ÊoÚ· (Û¿ÓÈ·)

1. ™‡Ó‰ÚoÌo Û˘ÛÙËÌ·ÙÈ΋˜ ‰È·Ê˘Á‹˜ ÙÚȯoÂȉÒÓ (Systemic capillary leak syndrome)2. ªÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË

ı) π‰Èo·ı‹

* ∫·Ù¿ oÚÈṲ̂Óo˘˜ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÙÂÎÌËÚȈ̤ÓË Ë Û¯¤ÛË ·Ú·Û›ÙˆÓ Î·È ÚoÛıÂÙÈÎÒÓ ÙÚoÊ›ÌˆÓ Ì Ùo ›ÎÙËÙo ·ÁÁÂÈoo›‰ËÌ·

¿ÁÓˆÛË Ùo˘ ·ÁÁÂÈooȉ‹Ì·Ùo˜ ·fi ·-ª∂∞ Ó· Ù›ıÂ-Ù·È ÌÂÙ¿ ·fi ·ÚÎÂÙ¿ ÂÂÈÛfi‰È·. ∞›ÙÈ· ·˘Ùo‡ ›ӷÈfiÙÈ Ù· ÂÏ·ÊÚfiÙÂÚ· ·Ú¯Èο ÂÂÈÛfi‰È· ˘oÂÎÙÈÌÒ-ÓÙ·È, ÂÓÒ Ë ÂÓË̤ڈÛË ÙˆÓ ÁÈ·ÙÚÒÓ (ÁÂÓÈÎÒÓ, ηÚ-‰ÈoÏfiÁˆÓ, ·ıoÏfiÁˆÓ, øƒ§fiÁˆÓ Î.Ï..) ÁÈ· ·˘Ù‹ÙËÓ ÂÈÏo΋ ‰ÂÓ Â›Ó·È Ë ‰¤o˘Û·. ∞oÙ¤ÏÂÛÌ· ·˘-ÙÒÓ Â›Ó·È o ·ÛıÂÓ‹˜ Ó· ıÂڷ‡ÂÙ·È Û˘Ìو̷ÙÈο,ÂÓÒ Û˘Ó¯›˙ÂÈ Ó· Ï·Ì‚¿ÓÂÈ Ùo ˘Â‡ı˘Óo Ê¿ÚÌ·Îo(Û‡Ìʈӷ Ì ÚfiÛÊ·ÙË ÂÚÁ·Û›· ÛÙo 53% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ Ùo ˘Â‡ı˘Óo Ê¿ÚÌ·Îo Û˘Ó¯›˙ÂÙ·È)10 ηÈÓ· ÎÈÓ‰˘Ó‡ÂÈ Ó· ÂÌÊ·Ó›ÛÂÈ Ó¤o ‚·Ú‡ÙÂÚo ÂÂÈÛfi-‰Èo (‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚo) ·Ó¿ ¿Û· ÛÙÈÁÌ‹11.∞fi ÙËÓ ÒÚ· o˘ Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË ‹ ·ÎfiÌ· Î·È Ë˘o„›· Ù˘ ÓfiÛo˘, ı· Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È Ùo˘Â‡ı˘Óo Ê¿ÚÌ·Îo Î·È Ë ˘¤ÚÙ·ÛË ‹ Ë Û˘ÌÊoÚËÙÈ-΋ ηډȷ΋ ·Ó¿ÚÎÂÈ· Ó· ıÂڷ‡oÓÙ·È Ì ÂÓ·Ï-Ï·ÎÙÈÎfi ÙÚfio. ¶Ú¤ÂÈ ‚¤‚·È· Ó· ¤¯o˘Ì ˘fi„ËÌ·˜ fiÙÈ ·ÁÁÂÈoo›‰ËÌ· ÌoÚ› Ó· ÂÌÊ·ÓÈÛÙ› Î·È ·fiÙË ¯Ú‹ÛË ‰Èo˘ÚËÙÈÎÒÓ, ·ÓÙ·ÁˆÓÈÛÙÒÓ ·Û‚ÂÛÙ›o˘ ‹‚-·Ó·ÛÙoϤˆÓ12. ™ÙoÓ ·ÛıÂÓ‹ Ú¤ÂÈ Ó· ‰›‰oÓÙ·ÈÁÚ·Ù¤˜ o‰ËÁ›Â˜ ÁÈ· ÙËÓ ·oÊ˘Á‹ fiÏˆÓ ÙˆÓ Ê·ÚÌ¿-ÎˆÓ Ù˘ oÈÎoÁ¤ÓÂÈ·˜ ÙˆÓ ·-ª∂∞. ∆· ·Ú·¿Óˆ·oÎÙo‡Ó ȉȷ›ÙÂÚË ‚·Ú‡ÙËÙ· ‰ÈfiÙÈ ·Ó·Ì¤ÓÂÙ·È ÛÙo̤ÏÏoÓ Ë ¯Ú‹ÛË ÙˆÓ ·-ª∂∞ Ó· Û˘Ó¯›ÛÂÈ Ó· ·˘Í¿-ÓÂÙ·È Ì ÁoÚÁo‡˜ Ú˘ıÌo‡˜.

ABSTRACTFountoulakis E, Kyrmizakis D, Papadakis Ch, Pe-rogamvrakis G, Karakostas E, Skoulas J, Ama-nakis Z. Tongue angioedema after long-termuse of angiotensin-converting enzyme inhi-bitors. Hell Iatr 2000, 66: 295 - 298.

Angioedema secondary to angiotensin-conver-ting enzyme (ACE) inhibitors is rare, but it is a side–effect which is likely to be seen more frequently be-cause these drugs are efficacious and usually welltolerated in the treatment of mild forms of hyper-tension and congestive cardiac failure. Other types ofangioedema like hereditary type, which results fromdeficiency of C1 esterase inhibitor or allergic angio-edema must be included in the differential diagnosis.Angioedema may be life threatening due to the sud-den development of edema involving the mucosaland submucosal layers of the upper aerodigestivetract. We managed successfully two patients with se-

vere angioedema of tongue the last six months. Thetwo cases reported illustrate problems both in thediagnosis and management of this dangerous condi-tion.

µIB§IO°PAºIA1. Donaldson VH, Evans RR. A biochemical abnormality in

hereditary angioneurotic edema: absence of serum in-hibitor C1 esterase. Am J Med 1963, 35: 37-44.

2. Megerian CA, Arnold JE, Berger M. Angioedema: 5 Yearsexperience, with a review of the disorder's presenta-tion and treatment. Laryngoscope 1992, 102: 256-60.

3. Jett GK. Captopril-induced angioedema. Ann Emerg Med1984,13: 489-90.

4. Alderman CP. Adverse effects of the angiotensin-convertingenzyme inhibitors. Ann Pharmacother 1996, 30: 55-61.

5. Pracy JPM, McGlashan JA, Walsh RM, Gleason MJ. Angi-oedema secondary to angiotensin-converting inhibi-tors. J Laryngol Otol 1994, 108: 696-8.

6. Suarez M, Ho PW, Johnson, ES. Angioneurotic edema, ag-ranulocytosis and fatal septicemia, following captopriltherapy. Am J Med 1986, 81: 336-8.

7. Fuller RW, Warren JB, McCuster M. effect of enalapril onthe skin response to bradykinin in man. Br J Clin Phar-macol 1987, 23: 88-90.

8. Haddad A, Frenkiel S, Small P. angioedema of the headand neck. J Otolaryngol 1985, 14: 14-6.

9. Chin HL, Buchan DA. Severe angioedema after long-term use of an angiotensin converting enzyme inhibi-tor. Ann Int Med 1990, 112: 312-3.

10. Gabb GM, Ryan P, Wing LM, Hutchinson KA. Epidemi-ological study of angioedema and ACE inhibitors.Aust N Z J Med 1996, 26(6):777-82.

11. Orfan N, Patterson R, Dykewicz MS. Severe angioedemarelated to ACE inhibitors in patients with idiopathicangioedema. JAMA 1990, 264: 1287-9.

12. Hedner T, Samuelson O, Lindholm L, Andren L, WilhomB. Precipitation of angioedema by antihypertensivesdrugs. J Hypertension 1991, 9(suppl): S360-1.

∞ÏÏËÏoÁÚ·Ê›·:¢. ∫˘ÚÌÈ˙¿Î˘¶··Ó·ÛÙ·Û›o˘ 2571306 – ∏Ú¿ÎÏÂÈo

Corresponding author:D. Kyrmizakis25 Papanastasiou St.71306 – IraklioGreece

298 E. ºOYNTOY§AKH™ KAI ™YN.

¶ÂÏÏ¿ÁÚ·. ¶·ÚÔ˘Û›·ÛË ‰‡Ô ÂÚÈÙÒÛˆÓ

°. ™Î·Ú·Áο˜, A. K˘ÚÎÔ‡‰Ë˜, K. M¿˚Ó·˜, A. ™ÙÂÊ·Ó‹˜,

O. KÔ˘ÙÛÔÁÈ¿ÓÓ˘, N. ¶·¿˙ÔÁÏÔ˘

B′ ¶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋, NÔÛÔÎÔÌÂ›Ô «¶··ÁˆÚÁ›Ô˘» £ÂÛÛ·ÏÔÓ›Î˶·ıÔÏÔÁÈ΋ KÏÈÓÈ΋ °ÂÓÈÎfi NÔÛÔÎÔÌÂ›Ô KÔÌÔÙËÓ‹˜

¶ÂÚ›ÏË„Ë. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂȘ ÂÏÏ¿-ÁÚ·˜ ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜ Î·È Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ÙÔ˘˜ ÛËÌ·Û›·˜. ∏ ‰È¿ÁÓˆÛË Ù¤ıËΠ·fi ÙÔ ÈÛÙÔÚÈÎfiÎ·È ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·. OÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û·ÁˆÁ‹ Ì ‰ÈÛΛ· ÓÈÎÔÙÈÓÈÎÔ‡ ÔͤԘ Ì ·ÔÙ¤ÏÂÛÌ·ÙËÓ Ï‹ÚË ›·ÛË. ∆Ô ÂӉȷʤÚÔÓ ÙˆÓ ‰‡Ô ÂÚÈÙÒÛÂ-

ˆÓ ÂÏÏ¿ÁÚ·˜ ÂÛÙÈ¿˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ú¿ ÙËÓÛ·ÓÈfiÙËÙ·, ˘¿Ú¯Ô˘Ó ηÙËÁÔڛ˜ ·ÙfiÌˆÓ fiˆ˜ ÔÈ·ÏÎÔÔÏÈÎÔ› ·ÏÏ¿ Î·È ¿ÏÏ· ÌÔÓÔÌÂÚÒ˜ ÛÈÙÈ˙fiÌÂÓ·¿ÙÔÌ· Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·Ó›˙Ô˘Ó ÙËÓ ÎÏÈÓÈ΋ÂÈÎfiÓ· Ù˘ ÂÏÏ¿ÁÚ·˜.EÏÏËÓ I·ÙÚ 2000, 66: 299 - 301.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 299 - 301

∏ ÂÏÏ¿ÁÚ· oÊ›ÏÂÙ·È Û ΢ÙÙ·ÚÈ΋ ¤ÏÏÂÈ„Ë ÓÈ-·Û›Ó˘ (‚ÈÙ·Ì›Ó˘ µ3) ˆ˜ ·oÙ¤ÏÂÛÌ· ·Ó·ÚÎo‡˜ÚoÛÏ˄˘ Ì ÙȘ ÙÚoʤ˜ ÓÈ·Û›Ó˘ Î·È ÙÚ˘ÙoÊ¿-Ó˘. ™Â ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Û¿ÓÈ· ÂÌÊ·Ó›˙ÂÙ·È,΢ڛˆ˜ ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ì ·Ó·ÚΤ˜ ‰È·ÈÙo-ÏfiÁÈo fiˆ˜ Â›Ó·È oÈ ¯ÚfiÓÈoÈ ·ÏÎooÏÈÎo› Î·È ·ÛıÂ-Ó›˜ Ì ÓoÛ‹Ì·Ù· Ùo˘ Á·ÛÙÚÂÓÂÙÂÚÈÎo‡ Û˘ÛÙ‹Ì·Ùo˜Î·È Ì ‚·ÚÂȤ˜ „˘¯ÈΤ˜ ‰È·Ù·Ú·¯¤˜. ¶oχ Û¿ÓȘÂÚÈÙÒÛÂȘ ÂÏÏ¿ÁÚ·˜ ÂÌÊ·Ó›˙oÓÙ·È ÛÙo ηÚÎÈÓo-Âȉ¤˜ Û‡Ó‰ÚoÌo Î·È ÛÙo Û‡Ó‰ÚoÌo Hartnup. £ÂÚ·-›· Ì ÈÛoÓÈ·˙›‰Ë Ë oo›· ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙË ÓÈ·Û›-ÓË ¤¯oÓÙ·˜ ‚Èo¯ËÌÈ΋ oÌoÈfiÙËÙ·, fiˆ˜ ›Û˘ ıÂ-ڷ›· Ì 6-ÌÂÚηÙÔÔ˘Ú›ÓË Î·È 5-ÊıÔÚÈÔÔ˘Ú·-ΛÏË, ÌÔÚ› Ó· ÚoηϤÛÂÈ ÂÏÏ¿ÁÚ·1,2.

∏ ÓÈ·Û›ÓË Â›Ó·È ˘‰·Ùo‰È·Ï˘Ù‹ ‚ÈÙ·Ì›ÓË Î·È invivo ÌÂÙ·ÙÚ¤ÂÙ·È Û ÓÈ·ÛÈÌ›‰Ë ··Ú·›ÙËÙo Û˘-ÛÙ·ÙÈÎfi ÙˆÓ Û˘ÓÂÓ˙‡ÌˆÓ π(NAD) Î·È ππ(NADP)Ù· oo›· Â›Ó·È ‰fiÙ˜ ÚˆÙoÓ›ˆÓ ‹ ‰¤ÎÙ˜ ÈfiÓÙˆÓ˘‰ÚoÁfiÓo˘ Û ¤Ó· oχ ÌÂÁ¿Ïo Ê¿ÛÌ· ‚Èo¯ËÌÈ-ÎÒÓ ·ÓÙȉڿÛˆÓ. ∂ÌϤÎoÓÙ·È Û ÂÚÈÛÛfiÙÂÚ˜·fi 50 ‰È·ÊoÚÂÙÈΤ˜ ÌÂÙ·‚oÏÈΤ˜ ·ÓÙȉڿÛÂȘo˘ ·›˙o˘Ó ÚfiÏo ÎÏÂȉÈo‡ ÛÙËÓ ÁÏ˘ÎoÁoÓfiÏ˘ÛË,ÙoÓ ÌÂÙ·‚oÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ, ÛÙËÓ ··Ì›ÓˆÛË·ÌÈÓoͤˆÓ, ÛÙo Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ÂÚ˘ıÚo΢ÙÙ¿ÚˆÓÎ·È ÙˆÓ ÛÙÂÚoÂȉÒÓ Î·È Û oÍÂȉo·Ó·ÁˆÁÈΤ˜ ‰È·-‰Èηۛ˜ ÙˆÓ ÈÛÙÒÓ. ∏ ÓÈ·Û›ÓË ÚoηÏ› ÂÚÈÊÂÚÈ-΋ ·ÁÁÂÈo‰È·ÛÙoÏ‹, ·ÂÏ¢ı¤ÚˆÛË ÈÛÙ·Ì›Ó˘ ÛÂ

ÌÂÁ¿Ï˜ ‰Â ‰fiÛÂȘ ÌÂÈÒÓÂÈ ÙËÓ ¤ÎÎÚÈÛË Ùo˘ o˘ÚÈ-Îo‡ oͤo˜ Î·È ÂȉÂÈÓÒÓÂÈ ÙËÓ ·Óo¯‹ ÛÙË ÁÏ˘Îfi˙Ë.∏ ÙÚ˘ÙoÊ¿ÓË ·oÙÂÏ› ¤Ó· ··Ú·›ÙËÙo ·ÌÈÓo͇Ùo oo›o ÌÂÙ·ÙÚ¤ÂÙ·È Û ÓÈ·Û›ÓË. ∆o ÌÈÛfi Ù˘ o-ÛfiÙËÙ·˜ Ù˘ ÓÈ·Û›Ó˘ Ùo˘ ÛÒÌ·Ùo˜ Úo¤Ú¯ÂÙ·È ·fiÙȘ ÙÚoʤ˜ ÂÓÒ Ùo ˘fiÏoÈo ÌÈÛfi ·fi ÙË ÌÂÙ·ÙÚo-‹ Ù˘ ÙÚ˘ÙoÊ¿Ó˘ Û ÓÈ·Û›ÓË.

∏ Û·ÓÈfiÙËÙ· Ù˘ ÓfiÛo˘ ηıÒ˜ Î·È Ë ÂηÈ-‰Â˘ÙÈ΋ ÛËÌ·Û›· ·oÙ¤ÏÂÛ·Ó ÙoÓ ÛÎofi Ù˘ ‰ËÌo-Û›Â˘Û˘ ÙˆÓ ‰‡o ÂÚÈÙÒÛÂˆÓ ÂÏÏ¿ÁÚ·˜ o˘ ›-¯·Ì ÙËÓ Â˘Î·ÈÚ›· Ó· ÓoÛËχÛo˘ÌÂ Î·È Ó· ıÂÚ·-‡Ûo˘Ì ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜.

¶EPI°PAºH TøN ¶EPI¶Tø™EøN¶ÚfiÎÂÈÙ·È ÁÈ· ‰‡o ·ÛıÂÓ›˜ o˘ ÓoÛËχıËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋̷˜ ÙˆÓ oo›ˆÓ Ë ‰È¿ÁÓˆÛË Ù¤ıËΠ·fi Ùo ÈÛÙoÚÈÎfi Î·È ÙËÓÎÏÈÓÈ΋ ÂÈÎfiÓ·. OÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÁˆÁ‹ Ì ‰È-ÛΛ· ÓÈÎoÙÈÓÈÎo‡ oͤo˜ Ì ·oÙ¤ÏÂÛÌ· ÙËÓ Ï‹ÚË ›·ÛË.

1Ë ÂÚ›ÙˆÛË: ÚfiÎÂÈÙ·È ÁÈ· ¿Ó‰Ú· 68 ÂÙÒÓ Ìo˘Ûo˘Ï-Ì¿Óo ÛÙo ıÚ‹ÛÎÂ˘Ì· Ì ÈÛÙoÚÈÎfi ¯ÚfiÓÈo˘ ·ÏÎooÏÈÛÌo‡ ooo›o˜ ÂÌÊ¿ÓÈÛ 10 Ì‹Ó˜ ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ Ùo˘ ·ÏÏoÈ-ÒÛÂȘ Ùo˘ ‰¤ÚÌ·Ùo˜ oÈΛÏ˘ ÌoÚÊ‹˜ Î·È ÂͤÏÈ͢. ∏ Ê˘ÛÈ΋ÂͤٷÛË ¤‰ÂÈÍ ÍËÚfiÙËÙ· Î·È Ú‹ÍÂȘ Ùo˘ ‰¤ÚÌ·Ùo˜ Ì ÛÎoÙÂÈ-Ó¤Ú˘ıÚo ¯ÚoÈ¿, o›‰ËÌ·, ¤ÏÎË Ùo˘ ‰¤ÚÌ·Ùo˜ Î·Ï˘ÙfiÌÂÓ··fi ÂÊÂÏΛ‰Â˜ ÛÙ· ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· Î·È ÛÙo ÚfiÛˆo η-ıÒ˜ Î·È Â˘Ú‹Ì·Ù· ·fi ÙË ÁÏÒÛÛ· (‚ÏÂÓÓoÁfiÓo˜ ÂͤڢıÚo˜,ÂÒ‰˘Óo˜, ÍËÚfi˜ Î·È oȉËÌ·Ù҉˘) (EÈÎ. 1).

2Ë ÂÚ›ÙˆÛË: ¶ÚfiÎÂÈÙ·È ÁÈ· ¿Ó‰Ú· ËÏÈΛ·˜ 57 ÂÙÒÓ ÌÂÈÛÙoÚÈÎfi ¯ÚfiÓÈo˘ ·ÏÎooÏÈÛÌo‡ o oo›o˜ ÚoÛ‹Ïı Ì ÂÈÎfiÓ·

299

„‡¯ˆÛ˘ Î·È ·ÏÏoÈÒÛÂȘ Ùo˘ ‰¤ÚÌ·Ùo˜. OÈ ·ÏÏoÈÒÛÂȘ Ùo˘‰¤ÚÌ·Ùo˜ ÂÚÈÏ¿Ì‚·Ó·Ó ÂÚ‡ıËÌ·Ù҉˜, ÂÍ¿ÓıËÌ· Ì ·oϤ-ÈÛË, ʈÙo¢·ÈÛıËÛ›· ÛÙo ÚfiÛˆo, ÙoÓ ÙÚ¿¯ËÏo Î·È Ù· ¿Óˆ¿ÎÚ· Î·È Ì ÓÂÎÚÒÛÂȘ ÛÙ· οو ¿ÎÚ·.

™À∑◊∆∏™∏H ÂÏÏ¿ÁÚ· Â›Ó·È Ì›· ¯ÚfiÓÈ· ÓfiÛo˜ o˘ Ù˘Èο¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰ÂÚÌ·Ù›Ùȉ·, ¿ÓoÈ· Î·È ‰È¿Ú-ÚoÈ·. ∏ ‰ÂÚÌ·Ù›ÙȘ Â›Ó·È ·ÌÊoÙÂÚfiÏ¢ÚË, Û˘ÌÌÂ-ÙÚÈ΋ Î·È ·Úo˘ÛÈ¿˙ÂÙ·È Û ı¤ÛÂȘ o˘ ÂÎÙ›ıÂÓÙ·ÈÛÙoÓ ‹ÏÈo Î·È Â›Ó·È ·oÙ¤ÏÂÛÌ· ʈÙo¢·ÈÛıËÛ›·˜.OÈ ‰È·ÓoËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ÏÈÁfiÙÂÚo ‰È·ÎÚÈ-Ù¤˜. ¶ÚoËÁo‡ÓÙ·È ÎfiˆÛË, ·¸Ó›· Î·È ·¿ıÂÈ·Î·È ·ÎoÏo˘ıo‡Ó ÛÙË Û˘Ó¤¯ÂÈ· ÂÁÎÂÊ·Ïo¿ıÂÈ·o˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û‡Á¯˘ÛË, ·ÒÏÂÈ· Ù˘ÌÓ‹Ì˘ Î·È ÂÚÈÛÙ·Ûȷο ·ÏËı‹˜ „‡¯ˆÛË. E›Ó·È‰˘Ó·ÙfiÓ Ó· ˘¿Ú¯o˘Ó ·Ú·ÈÛıËۛ˜ Î·È oÏ˘Ó¢-Ú›ÙȘ ˆ˜ ·oÙ¤ÏÂÛÌ· Û˘Ó˘¿Ú¯o˘Û·˜ ¤ÏÏÂȄ˘ ηȿÏÏˆÓ ‚ÈÙ·ÌÈÓÒÓ. ∏ ‰È¿ÚÚoÈ· fiÙ·Ó Û˘Ì‚·›ÓÂÈ o-Ê›ÏÂÙ·È Û ‰È¿¯˘ÙË ÊÏÂÁÌoÓ‹ ÙˆÓ ‚ÏÂÓÓoÁfiÓˆÓÂÓÒ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤¯o˘ÌÂ Î·È ¿ÏϘ ‰È·Ù·Ú·-¯¤˜ ·fi Ùo˘˜ ‚ÏÂÓÓoÁfiÓo˘˜ fiˆ˜ ·¯ÏˆÚ˘‰Ú›·,ÁψÛÛ›Ùȉ·, ÛÙoÌ·Ù›Ùȉ· Î·È ÎoÏ›Ùȉ·.

∆Úoʤ˜ Ïo‡ÛȘ Û ÓÈ·Û›ÓË Â›Ó·È oÈ ÍËÚo›

ηÚo›, Ù· Á·Ï·ÎÙoÎoÌÈο Úo˚fiÓÙ·, Ùo ÎÚ¤·˜, Ù·o˘ÏÂÚÈο, Ù· „¿ÚÈ·, Ë ˙‡ÌË ,Ù· Ì·ÓÈÙ¿ÚÈ·, Ù· oÏÈ-ο ‰ËÌËÙÚȷο, Ù· ÂÌÏo˘ÙÈṲ̂ӷ Úo˚fiÓÙ· „ˆ-ÌÈo‡, Ù· ÍËÚ¿ Ê·ÛfiÏÈ· Î·È o ·Ú·Î¿˜. ¢È·ÈÙoÏfiÁÈ·ÊÙˆ¯¿ ‹ ÌoÓoÌÂÚ‹ o˘ ‰ÂÓ ÂÚȤ¯o˘Ó ηıfiÏo˘·fi ÙȘ ·Ó·ÊÂÚfiÌÂÓ˜ ÙÚoʤ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó·ÚoηϤÛo˘Ó ¤ÏÏÂÈ„Ë ÓÈ·Û›Ó˘ Î·È ÎÏÈÓÈ΋ ÂΉ‹-ψÛË ÂÏÏ¿ÁÚ·˜.

∆· Û˘Ó¤Ó˙˘Ì· π Î·È ππ Û˘ÌÌÂÙ¤¯o˘Ó Û ·ÓÙÈ-‰Ú¿ÛÂȘ oÍÂȉo·Ó·ÁˆÁ‹˜. ∏ ÙÚ˘ÙoÊ¿ÓË ÌÂÙ·ÙÚ¤-ÂÙ·È Û ÓÈ·Û›ÓË in vivo Ì ̛· ·Ó·ÏoÁ›· 60mg ÙÚ˘-ÙoÊ¿Ó˘ Úo˜ 1mg ÓÈ·Û›Ó˘. ∏ ÌÂÙ·‚oÏÈ΋ ·˘Ù‹o‰fi˜ Ù˘ ÌÂÙ·ÙÚo‹˜ ··ÈÙ› ıÂÈ·Ì›ÓË, ÚÈ‚oÊÏ·‚›-ÓË, ˘ÚȉoÍ›ÓË Î·È „¢‰¿ÚÁ˘Úo Î·È ÂÈÙÂÏ›ٷÈÛÙË ÂȉÂÚÌ›‰· Î·È ¿ÏÏo˘˜ ÈÛÙo‡˜. ∏ ¤ÏÏÂÈ„Ë ˘-Úȉo͛Ӣ (‚ÈÙ·Ì›Ó˘ µ6) Âo̤ӈ˜ ÌoÚ› Ó· Úo-ηϤÛÂÈ ¤ÏÏÂÈ„Ë ÓÈÎoÙÈÓÈÎo‡ oͤo˜3.

∏ ¤ÏÏÂÈ„Ë ÓÈ·Û›Ó˘ Â›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ÂÏÏ›„ÂȘ ‚ÈÙ·ÌÈÓÒÓ ÛÙo˘˜ ËÏÈÎȈ̤Óo˘˜ Î·È Û˘Ì-‚·›ÓÂÈ Î·È Û oÚÈṲ̂Ó˜ ηٷÛÙ¿ÛÂȘ fiˆ˜ o ·ÏÎo-oÏÈÛÌfi˜, Ë Ó¢ÚoÁÂÓ‹˜ ·ÓoÚÂÍ›·, ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿Î·È ·Ó¿ÌÂÛ· Û ʷӷÙÈÎo‡˜ Ù˘ ‰È·ÙÚoÊ‹˜ ÂȉÈοfiÙ·Ó ·˘Ùo› ·oʇÁo˘Ó ˙ˆ˚Τ˜ ÚˆÙÂ˚Ó˜ Î·È ÙÚÒ-Ó oχ Ï›Á· Ú¿ÛÈÓ· Ï·¯·ÓÈο fiˆ˜ ›Û˘ ηȈ˜ ÂÈÏo΋ Ù˘ ÓfiÛo˘ Ùo˘ Crohn.

∏ ÂÏÏ¿ÁÚ· Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈ Û ·ÁÚoÙÈΤ˜ÂÚÈo¯¤˜ ÌÂٷ͇ ÊÙˆ¯ÒÓ o˘ ÙÚÒÓ ÙÚoʤ˜ Ïo‡-ÛȘ Û ·Ï‡ÚÈ ·fi ηϷÌfiÎÈ Î·È ÊÙˆ¯¤˜ Û ˙ˆ˚-Τ˜ ÚˆÙÂ˚Ó˜, ÊÚo‡Ù· Î·È Ï·¯·ÓÈο.

∏ ¤ÏÏÂÈ„Ë ÙÚ˘ÙoÊ¿Ó˘ ›Û˘ o‰ËÁ› ÛÂÂÏÏ¿ÁÚ·. ŒÙÛÈ ÛÙË ÓfiÛo Hartnup Ë oo›· ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi Ì›· ‰È·Ù·Ú·¯‹ Ì ·˘Ùoۈ̷ÙÈÎfi ˘-oÏoÈfiÌÂÓo ¯·Ú·ÎÙ‹Ú·, Ë ÙÚ˘ÙoÊ¿ÓË ‰ÂÓ ·oÚ-ÚoÊ¿Ù·È ·fi ÙoÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ ÂÍ ·ÈÙ›·˜ÌÈ·˜ ‰È·Ù·Ú·¯‹˜ ÛÙË ÌÂÙ·ÊoÚ¿ ÌÈ·˜ oÌ¿‰·˜ Ìo-Óo¿ÌÈÓo–ÌÔÓÔηڂo͢ÏÈÎÒÓ oͤˆÓ4. ™Ùo ηÚÎÈ-ÓoÂȉ¤˜ Û‡Ó‰ÚoÌo Ë ÙÚ˘ÙoÊ¿ÓË ·Ú·Î¿ÌÙÂÙ·ÈÚo˜ Û¯ËÌ·ÙÈÛÌfi ÛÂÚoÙoÓ›Ó˘ ̤ۈ Ù˘ o‰o‡ Ù˘5-˘‰Úo͢˚Ó‰fiÏ˘. Œ¯ÂÈ Â›Û˘ ÂÚÈÁÚ·Ê› Û Ófi-Ûo Ùo˘ Crohn5-7.

∂Í¿ÓıËÌ· fiÌoÈo Ì Ù˘ ÂÏÏ¿ÁÚ·˜ ÌoÚ› Ó·ÚoηϤÛo˘Ó ‰È¿ÊoÚ· Ê¿Ú̷η fiˆ˜ Ë ÈÛoÓÈ·˙›-‰Ë8, Ë 6-ÌÂÚηÙoo˘Ú›ÓË, Ë 5-ÊÏo˘oڷΛÏË9, oÈÛo˘ÏÊoÓ·Ì›‰Â˜, Ù· ·ÓÙÈηٷıÏÈÙÈο Î·È Ù· ·ÓÙÈÂ-ÈÏËÙÈο Ê¿Ú̷η. π‰Ú˘Ì·ÙooÈË̤ÓoÈ ·ÛıÂÓ›˜o˘ ‰ÂÓ ÂÎÙ›ıÂÓÙ·È ÛÙo ËÏÈ·Îfi ʈ˜ ÌoÚ› Ó· ÌËÂΉËÏÒÛo˘Ó ÙËÓ ¤ÏÏÂÈ„Ë Ùo˘ ÓÈÎoÙÈÓÈÎo‡ oͤo˜ ÌÂÂ˘Ú‹Ì·Ù· ·fi Ùo ‰¤ÚÌ·. ∞ÓÂÍ‹ÁËÙ˜ fï˜ ‰È·Ù·-Ú·¯¤˜ ·fi ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ÏÂÈÙo˘ÚÁ›· ı· Ú¤ÂÈÓ· ÚÔηÏÔ‡Ó ˘Ô„›· ÁÈ· ¤ÏÏÂÈ„Ë ÓÈ·Û›Ó˘3.

O ·Ú·‚fiÛÈÙo˜ Î·È Ù· Úo˚fiÓÙ· Ùo˘ o˘ ıˆ-

300 °. ™KAPA°KA™ KAI ™YN.

EÈÎ. 1. AÏÏÔÈÒÛÂȘ ‰ÂÚÌ·ÙÈ΋˜ ÛÙËÓ ÂÏÏ¿ÁÚ·. (·) ÚÈÓ·fi ÙË ıÂڷ›·, (‚) ÌÂÙ¿ ÙË ıÂڷ›·.

Úo‡ÓÙ·È ÊÙˆ¯¿ Û ÓÈ·Û›ÓË Â›Ó·È Ïo‡ÛÈ· ۠ϢΛ-ÓË, ¤Ó· ·ÌÈÓo͇ Ùo oo›o ÂÓo¯ooÈÂ›Ù·È ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛË Ù˘ ÂÏÏ¿ÁÚ·˜ ·Êo‡ ıˆÚÂ›Ù·È fiÙÈ ÌÂÙ·‚¿Ï-ÏÂÈ ÙoÓ ÌÂÙ·‚oÏÈÛÌfi Ù˘ ÙÚ˘ÙoÊ¿Ó˘3,10. ∂ÌÊ¿ÓÈÛËÂÏÏ¿ÁÚ·˜ ·Ó·Ê¤ÚıËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ·Ì˘Ïo›-‰ˆÛË ‰Â˘ÙÂÚo·ı‹ Û oÏÏ·Ïo‡Ó Ì˘¤ÏˆÌ·11.

∫·ıÒ˜ ‰ÂÓ ˘¿Ú¯o˘Ó ‚Èo¯ËÌÈΤ˜ ‰oÎÈ̷ۛ˜o˘ ı· ı¤Ûo˘Ó ÙË ‰È¿ÁÓˆÛË, ·˘Ù‹ ‚·Û›˙ÂÙ·È ÛÙËÎÏÈÓÈ΋ ÂÈÎfiÓ· o˘ ı· ‰ËÌÈo˘ÚÁ‹ÛÂÈ ÙËÓ ˘o„›·ÁÈ· ÙËÓ ÓfiÛo Î·È ‚¤‚·È· ÛÙËÓ ·¿ÓÙËÛË ÌÂÙ¿ ·fiıÂڷ›· ˘oηٿÛÙ·Û˘12. ∏ ÓÈ·Û›ÓË ¯oÚËÁ›ٷÈÛ ÌÈÎÚ¤˜ ‰fiÛÂȘ (10 mg ËÌÂÚËÛ›ˆ˜) ÂÓÒ ÌÂÁ·Ï‡-ÙÂÚ˜ ‰fiÛÂȘ (40-200mg ËÌÂÚËÛ›ˆ˜) ‰˘Ó·ÙfiÓ Ó···ÈÙo‡ÓÙ·È ÛÙo ηÚÎÈÓoÂȉ¤˜ Û‡Ó‰ÚoÌo Î·È ÛÙËÓfiÛo Hartnup

OÈ ‰ÈÎo› Ì·˜ ·ÛıÂÓ›˜ Úo¤Ú¯oÓÙ·Ó ·fi ·ÁÚo-ÙÈÎfi ÏËı˘ÛÌfi, ‹Ù·Ó ·ÏÎooÏÈÎo›, ÊÙˆ¯¿ ‰È·ÈÙÒÌÂ-ÓoÈ Î·È Ì ϋÚË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛo˘ ·fi Ùo ‰¤Ú-Ì·, ÂÓÒ o ¤Ó·˜ ›¯Â Î·È „˘¯ÈΤ˜ ‰È·Ù·Ú·¯¤˜. ¢ÂÓ Â›-¯·Ó ÈÛÙoÚÈÎfi Ï‹„˘ Ê·ÚÌ¿ÎˆÓ o˘ ÂÓ¤¯oÓÙ·È ÛÙËÓÂÌÊ¿ÓÈÛË Ù˘ ÂÏÏ¿ÁÚ·˜.

™‹ÌÂÚ· ϤoÓ Ë ÂÏÏ¿ÁÚ· ıˆÚÂ›Ù·È Û¿ÓÈ·ÓfiÛo˜. ™ÙË ¢ÂÚÌ·ÙoÏoÁÈ΋ ÎÏÈÓÈ΋ Ùo˘ ∞.¶.£. ηٿÙËÓ ÙÚÈÂÙ›· 1974-1976 ÓoÛËχıËÎ·Ó 31 ·ÛıÂÓ›˜13.

∞fi ÙËÓ Âo¯‹ o˘ Ë ÓfiÛo˜ ÚˆÙo·Ó·ÁÓˆÚ›-ÛıËÎÂ, ÌfiÏȘ Ùo 1735, ËÌÂÚoÌËÓ›· o˘ o Dr JosephGoldberger ·Ó·Î¿Ï˘„ Ùo ·›ÙÈo Ù˘ ÂÏÏ¿ÁÚ·˜ ηÈÙËÓ ÌÂϤÙËÛÂ13, Ë ÂÏÏ¿ÁÚ· ¤ÂÛ ÛÙo ̇ıo Î·È ÙȘ‰oͷۛ˜ o˘ ‹ıÂÏ·Ó Ó· ÙËÓ Û˘Û¯ÂÙ›˙o˘Ó Ì Ùo˘˜‚Ú˘ÎfiϷΘ Î·È Ù· ‚·Ì›Ú˜15. ÷ڷÎÙËÚÈÛÙÈÎfi ‰ÂÂ›Ó·È fiÙÈ Ë Ï¤ÍË ‚·Ì›Ú ÚˆÙoÂÌÊ·Ó›ÛıËΠÛÙo ÏÂ-ÍÈÎfi Ù˘ OÍÊfiډ˘ Ùo 1734, ¤Ó· ¯ÚfiÓo ÌÂÙ¿ ·fiÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÂÏÏ¿ÁÚ·˜ ÛÙËÓ πÛ·Ó›·15. ™‹ÌÂ-Ú· Ë ÓfiÛo˜ ¤ÁÈÓ ۿÓÈ·.

ABSTRACTSkaragkas G, Kirkoudis A, Mainas K, Stefanis A,Koutsoyiannis O, Papazoglou N. Pellagra: report oftwo cases. Hell Iatr 2000, 66: 299 - 301.

We report two cases with clinical features ofpellagra. Their symptoms improved rapidly on ta-king oral nicotinic acid. The importance of thesecases is based on the fact that in spite of the lowincidence there are groups of people such as alco-holics or partially fed people prone to display pel-lagra.

µπµ§πO°ƒ∞ºÿ∞1. Findlay GH. Pellagra, Kwasiorkor and sun exposure. Br J

Dermatol 1965, 77: 666-7.

2. Stratigos JD, Katsambas AD. Pellagra: a still existingdisease. Br J Dermatol 1977, 96: 99-106.

3. Ryan AS, Goldsmith LA. Nutrition and the skin. Clinics inDermatology 1966, 14: 389-406.

4. Oakley WJ. Hartnup disease presenting in an adult. Cli-nical and Experimental Dermatology 1994, 19: 497-8.

5. Abu-Qurshin R, Naschirtz JE, Zuckermann E et al. Crohn’sdisease associated with pellagra and increased excre-tion of 5-hydroxyindolllllacetic acid. Am J Med Sci1997, 313: 111-3.

6. Zaki I, Millard L. Pellagra complicating Crohn’s disease.Postgrad Med J 1995, 71: 496-7.

7. Lifshtz AY, Stern F, Kaplan B et al. Pellagra complicatingCrohn’s disease. J Am Acad Dermatol 1992, 227: 620.

8. Ishi N, Nishihara Y. Pellagra encephalopathy among tu-berculous patients: its relation to isoniazide therapy. JNeurol, Neurosurg, Psych 1986, 48: 628-34.

9. Stevens HP, Ostlere LS, Bergent RH et al. Pellagra secon-dary to 5-fluoracil. Br J Dermatol 1993, 128: 578-80.

10. Bender DA. Effects of dietary excess of leucine on themetabolism of tryptophan in the rat: a mecha -nism forthe pellagrenic action of leucine. Brit J Nutr 1983, 50:25-32.

11. Itami A, Ando J, Kukita A, Naggai K. Pellagra associatedwith amyloidosis secondary to multiply myeloma. Br JDermatol 1997, 137: 829.

12. Wilson JD. Vitamin deficiency and excess. In:Harrison’sPrinciples of Internal Medicine. 11th edition 1988, 1:410-2.

13. ∫·ÓÈÙ¿Î˘ K. ¶ÂÏÏ¿ÁÚ·. ™Ùo: ¢ÂÚÌ·ÙoÏoÁ›·, ∞ÊÚo‰È-ÛÈoÏoÁ›·. £ÂÛÛ·ÏoÓ›ÎË 1975, 835-8.

14. Goldberger J, Wheeler GA. The experimental productionof pellagra in human subjects by means of diet.Washington: Goverment Printing Office HygienicLaboratory Bulletin, 1920.

15. Hampl JS, Hampl WS. Pellagra and the origin of mythevidence from European literature and folklore. J RSoc Med 1997, 90: 636-9.

∞ÏÏËÏoÁÚ·Ê›·:°. ™Î·Ú·Áο˜¡. ∆‡· 7546 46 - £ÂÛÛ·ÏoÓ›ÎË

Corresponding author:G. Skaragkas7 N.Typa Str.546 46 - ThessalonikiGreece

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 301

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2000, 66, 3-4: 302 - 305

∂ÈÏÂoÏË΢ıoÚˆÎÙÈ΋ ·Ó·ÛÙfïÛË: ÂËÚ¿˙ÂÈÙËÓ Î‡ËÛË Î·È ÙoÓ ÙoÎÂÙfi Î·È ÂËÚ¿˙ÂÙ·ÈË ÏÂÈÙo˘ÚÁ›· Ù˘ ·fi ÙËÓ Î‡ËÛË Î·È ÙoÓ ÙoÎÂÙfi;

µ. ¡¿ÙÛÈη˜1, Ã. ™¤ÌoÁÏo˘1, π. ∆˙·Ê¤Ù·˜2,µ. ¢·Ï·˝Ó·˜1

1 ∞′ ÃÂÈÚo˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ¡oÛoÎoÌ›o ∞Ã∂¶∞2 °′ ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎoÏoÁÈ΋ ∫ÏÈÓÈ΋ A¶£, ¡oÛoÎoÌ›o πoÎÚ¿ÙÂÈo, £ÂÛÛ·ÏoÓ›ÎË

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·ËÛË) Ì ‰È·ÎoÏÈÎfi ÙoÎÂÙfi. ∫‡ËÛË Î·È ÙoÎÂÙfi˜ÂËÚ¤·Û·Ó ÚoÛˆÚÈÓ¿ ÙËÓ ÂÈÏÂoÏË΢ıÈ΋ ÏÂÈÙo˘Ú-Á›· ÛÙo ÙÚ›ÙÔ ÙÚ›ÌËÓo Ù˘ ·ËÛ˘ Î·È 4 › Ì‹Ó˜ ÌÂ-Ù¿ ÙoÓ ÙoÎÂÙfi). ∏ O∫∂§¶∞ ¤ÊÂÚ ˘oÁoÓÈÌfiÙËÙ·Î·È ÛÙȘ ‰‡o ·ÛıÂÓ›˜ ·ÏÏ¿ ‰ÂÓ ÂËÚ¤·Û ÙËÓ Î‡ËÛËÎ·È ÙoÓ ÙoÎÂÙfi. ∞fi ÙËÓ ÌÈÎÚ‹ ·˘Ù‹ ÂÌÂÈÚ›· Î·È ÙËÓ·Ó·‰›ÊËÛË Ù˘ ÚoÛÈÙ‹˜ ‚È‚ÏÈoÁÚ·Ê›·˜ Û˘Ó¿ÁÂÙ·ÈfiÙÈ Ë O∫∂§¶∞ ÂÈʤÚÂÈ ˘oÁoÓÈÌfiÙËÙ· ÛÙȘ Á˘Ó·›-Θ ÂÓÒ Ë Î‡ËÛË Î·È o ÙoÎÂÙfi˜ Â›Ó·È ·ÛÊ·Ï›˜ Î·È ‰ÂÓÂËÚ¿˙o˘Ó ÛËÌ·ÓÙÈο Î·È ÌfiÓÈÌ· ÙËÓ ÂÈÏÂoÏË΢ıÈ΋ÏÂÈÙo˘ÚÁ›·.EÏÏËÓ I·ÙÚ 2000, 66: 302 - 305.

¶ÔÏϤ˜ Á˘Ó·›Î˜ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ Ô˘ ¤¯-Ô˘Ó ˘Ô‚ÏËı› Û ÔÏÈ΋ ÔÚıÔÎÔÏÂÎÙÔÌ‹ Ì ÂÈÏÂÔ-ÚˆÎÙÈ΋ ·Ó·ÛÙfïÛË (O∫∂§¶∞) ‰ÈÂÚˆÙÒÓÙ·È·Ó Â›Ó·È ÈηӤ˜ Ó· ·oÎÙ‹Ûo˘Ó ·È‰È¿ Ì ·ÛÊ¿-ÏÂÈ· ÁÈ· ÙȘ ›‰È˜ Î·È Ù· ·È‰È¿. ∞ÓËÛ˘¯o‡Ó ›Û˘oÈ Î˘oÊoÚo‡Û˜ —·ÏÏ¿ Î·È oÈ Ì·ÈÂ˘Ù‹Ú˜— Ì‹-ˆ˜ Ë Î‡ËÛË Î·È o ÙoÎÂÙfi˜ ÂËÚ¿ÛÔ˘Ó ‰˘ÛÌÂÓÒ˜ÌfiÓÈÌ· ÙËÓ ÂÈÏÂoÏË΢ıÈ΋ ÏÂÈÙo˘ÚÁ›·. ¶ÚoËÁo‡ÌÂ-Ó˜ ÌÂϤÙ˜ ¤¯o˘Ó ·o‰Â›ÍÂÈ fiÙÈ Ë ÂÏÎ҉˘ ÎoÏ›-Ùȉ· ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÁoÓÈÌfiÙËÙ·1-3, ÂÓÒ Ë Úˆ-ÎÙoÎoÏÂÎÙoÌ‹ Ì ÂÈÏÂoÛÙoÌ›· ÂÏ·ÙÙÒÓÂÈ ÙËÓ Áo-ÓÈÌfiÙËÙ·4. ∏ O∫∂§¶∞ ‰È·ÙËÚo‡Û· ÙË Ê˘ÛÈoÏo-ÁÈ΋ o‰fi ·Êfi‰Â˘Û˘, ¤¯ÂÈ Î·Ù·ÛÙ› ıÂڷ›· ÂÎ-ÏoÁ‹˜, Ï›·Ó ÂÏ΢ÛÙÈ΋ ÛÙo˘˜ Ó¤o˘˜ ȉ›ˆ˜ ·ÛıÂÓ›˜,·ÏÏ¿ Ë Â›‰Ú·Û‹ Ù˘ ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ ÏÂÈ-Ùo˘ÚÁ›· ȉ›ˆ˜ ÙˆÓ Á˘Ó·ÈÎÒÓ ‰ÂÓ Â›Ó·È ·ÎfiÌ· oχÁÓˆÛÙ‹5. ¶ÚfiÛÊ·Ù˜ ÂÚÁ·Û›Â˜5-9 ‚‚·ÈÒÓo˘Ó fiÙÈ Ë

·ËÛË Î·È o ÙoÎÂÙfi˜ ÂÚ·Ùo‡ÓÙ·È Ì ·ÛÊ¿ÏÂÈ· ÌÂ-Ù¿ ·fi ÂÈÏÂoÚˆÎÙÈ΋ ·Ó·ÛÙfïÛË, ·ÏÏ¿ Ë ÁoÓÈ-ÌfiÙËÙ· Ì¿ÏÏoÓ ‰È·Ù·Ú¿ÛÛÂÙ·È10,11, ·Ó Î·È ·o˘ÛÈ-¿˙o˘Ó ÛÙ·ıÂÚ¤˜ ÏËÚoÊoڛ˜ ÁÈ· ÙË ‰È·Ù·Ú·¯‹ ·˘-Ù‹5,11.

¶EPI°PAºH TøN ¶EPI¶Tø™EøN¶ÚÒÙË ·ÛıÂÓ‹˜. °˘Ó·›Î· 24 ¯ÚfiÓˆÓ, ȉȈÙÈ΋ ˘¿ÏÏËÏo˜,˘o‚Ï‹ıËΠ·Ú¯Èο (ÛÙÔ §ÔÓ‰›ÓÔ) ÂÂÈÁfiÓÙˆ˜ Û ˘ÊoÏÈ΋ÎoÏÂÎÙoÌ‹ Ù‡o˘ Hartmann ÏfiÁˆ ÙoÍÈÎo‡ ÌÂÁ·ÎfiÏo˘ Û¤‰·Êo˜ ÂÏÎÒ‰o˘˜ ·ÓÎoÏ›Ùȉ·˜ ‰È¿ÚÎÂÈ·˜ 4 ¯ÚfiÓˆÓ. MÂÙ¿¤Ó· ¯ÚfiÓÔ ˘o‚Ï‹ıËΠ(∞′ ÃÂÈÚo˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ¡o-ÛoÎoÌ›o ∞Ã∂¶∞) ÛÂ Û˘ÌÏËڈ̷ÙÈ΋ oÚıÂÎÙoÌ‹, oÚıo-ÚˆÎÙÈ΋ ‚ÏÂÓÓoÁoÓÂÎÙoÌ‹, ηٿÚÁËÛË Ù˘ ÂÈÏÂoÛÙoÌ›·˜Î·È ÂÈÏÂoÚˆÎÙÈ΋ ·Ó·ÛÙfïÛË Ì ·ÚÂÌ‚oÏ‹ ÈÛoÂÚÈÛÙ·Ï-ÙÈ΋˜ ‰ÈÂÏÈÎÈ΋˜ ÂÈÏÂoÏË·ıo˘ (H). ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÏÂÈ-Ùo˘ÚÁ›· Ù˘ ÂÈÏÂoÏË·ıo˘ ‹Ù·Ó ηϋ Ì 5-6 ÎÂÓÒÛÂȘ ¯ˆÚ›˜·ÎÚ¿ÙÂÈ·. ∆¤ÛÛÂÚ· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ O∫∂§¶∞ Û˘Ó¤Ï·‚ ÌÂ

302

Â͈ۈ̷ÙÈ΋ ÁoÓÈÌoo›ËÛË, ·Êo‡ Ë ‰ÈÂÓÂÚÁËı›۷ ˘ÛÙÂÚo-Û·ÏÈÁÁoÁÚ·Ê›· ¤‰ÂÈÍ ·fiÊÚ·ÍË ÙˆÓ Û¿ÏÈÁÁˆÓ.

∏ ·ËÛË ‹Ù·Ó ¿Ó¢ ÂÈÏoÎÒÓ Î·È ‰ÂÓ ÂËÚ¤·Û ÙËÓÏË΢ıÈ΋ ÏÂÈÙo˘ÚÁ›· ηٿ Ù· ‰‡Ô ÚÒÙ· ÙÚ›ÌËÓ·. ™Ùo ÙÚ›ÙoÙÚ›ÌËÓo ·˘Í‹ıËÎÂ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛÂˆÓ (¶›Ó. 1) Û 7-8 ËÌÂÚËÛ›ˆ˜ Î·È ÂÌÊ·Ó›ÛıËÎ·Ó ÛoÚ·‰Èο ÂÂÈÛfi‰È· ÌÈÎÚ‹˜Ó˘ÎÙÂÚÈÓ‹˜ ·ÎÚ¿ÙÂÈ·˜. ∆ËÓ 32Ë Â‚‰oÌ¿‰· ¤ÙÂÍ ÚfiˆÚ· ¿Ú-ÚÂÓ ÓÂoÁÓfi ÂÏÏÈo‚·Ú¤˜ (1300 g) o˘ ·ÓÙÈÌÂÙˆ›ÛıËΠÌÂÂÈÙ˘¯›· ÛÙË NÂoÁÓoÏoÁÈ΋ KÏÈÓÈ΋ Ùo˘ ∞¶£ (πoÎÚ¿ÙÂÈo¡oÛoÎoÌ›o £ÂÛÛ·Ïoӛ΢). ∆ÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi Ë·ÛıÂÓ‹˜ ·ӤÎÙËÛ ÙËÓ Úo΢ËÙÈ΋ Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛÂ-ˆÓ Î·È ÙËÓ ÂÁÎÚ¿ÙÂÈ· Î·È ÂÍ·ÎoÏo˘ı› Ó· Â›Ó·È Û ηϋ η-Ù¿ÛÙ·ÛË Â› 4 ¯ÚfiÓÈ·.

¢Â‡ÙÂÚË ·ÛıÂÓ‹˜. °˘Ó·›Î· 26 ¯ÚfiÓˆÓ, ȉȈÙÈ΋ ˘¿Ï-ÏËÏo˜, ˘o‚Ï‹ıËΠ·Ú¯Èο ÛÙo §oÓ‰›Óo ÂÂÈÁfiÓÙˆ˜ Û ˘Ê-oÏÈ΋ ÎoÏÂÎÙoÌ‹ Ù‡o˘ Hartmann ÏfiÁˆ ÙoÍÈÎo‡ ÌÂÁ·ÎfiÏo˘Û ¤‰·Êo˜ ÂÏÎÒ‰o˘˜ ·ÓÎoÏ›Ùȉ·˜. ŒÓ· ¯ÚfiÓo ·ÚÁfiÙÂÚ·˘o‚Ï‹ıËΠ(∞′ ÃÂÈÚo˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£) ÛÂ Û˘ÌÏËÚˆ-Ì·ÙÈ΋ oÚıÂÎÙoÌ‹, oÚıoÚˆÎÙÈ΋ ‚ÏÂÓÓoÁoÓÂÎÙoÌ‹, ηٿÚ-ÁËÛË Ù˘ ÂÈÏÂoÛÙoÌ›·˜ Î·È ÂÈÏÂoÚˆÎÙÈ΋ ·Ó·ÛÙfïÛË Ì·ÚÂÌ‚oÏ‹ ‰ÈÂÏÈÎÈ΋˜ ÈÛo·ÓÈÛoÂÚÈÛÙ·ÏÙÈ΋˜ ÂÈÏÂoÏË·ıo˘(J). ∏ ÏÂÈÙo˘ÚÁÈ΋ ¤Î‚·ÛË ‹Ù·Ó ηϋ, Ì 5-6 ÎÂÓÒÛÂȘ ÛÙo24ˆÚÔ Î·È ÌÈÎÚ‹ ÛoÚ·‰È΋ (1-2 ÂÂÈÛfi‰È· ÙËÓ Â‚‰oÌ¿‰·)Ó˘ÎÙÂÚÈÓ‹ ·ÎÚ¿ÙÂÈ·. §fiÁˆ ˘oÁoÓÈÌfiÙËÙ·˜ (˘ÛÙÂÚoÛ·ÏÈÁ-ÁoÁÚ·Ê›· Ì ÎÏÂÈÛÙ¤˜ Û¿ÏÈÁÁ˜) ˘o‚Ï‹ıËΠ۠ÂÈÙ˘¯‹Â͈ۈ̷ÙÈ΋ ÁoÓÈÌoo›ËÛË Ì ‰›‰˘ÌË Î‡ËÛË, Ë oo›· ‹Ù·Ó¿Ó¢ ÂÈÏoÎÒÓ ÂÎÙfi˜ ·fi ‰‡Ô ÂÂÈÛfi‰È· ‹È·˜ ÏË΢ı›Ùȉ·˜Î·Ù¿ Ùo ‰Â‡ÙÂÚo Î·È ÙÚ›Ùo ÙÚ›ÌËÓo o˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì¯oÚ‹ÁËÛË ·ÌÈÎÈÏÏ›Ó˘. ∫·Ù¿ Ùo ÙÚ›Ùo ÙÚ›ÌËÓo ‹Ïı ·‡ÍË-ÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È Ù˘ ·ÎÚ¿ÙÂÈ·˜ (¶›Ó. 1)o˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì Û΢¿ÛÌ·Ù· „‡ÏÏÈo˘. ∆ËÓ 34Ë Â‚-‰oÌ¿‰· ¤ÙÂÍ ‰È·ÎoÏÈο ÚfiˆÚ· ‰‡Ô ÓÂoÁÓ¿, Ùo ¤Ó· ÂÎ ÙˆÓoo›ˆÓ ‰ÂÓ Â¤˙ËÛ ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∆o¿ÏÏo, ÂÏÏÈo‚·Ú¤˜ (1200 gr), ·ÓÙÈÌÂÙˆ›ÛıËΠÂÈÙ˘¯Ò˜ ÛÙËNÂoÁÓoÏoÁÈ΋ KÏÈÓÈ΋ (πoÎÚ¿ÙÂÈo ¡oÛoÎoÌ›o £ÂÛÛ·Ïo-ӛ΢). ∆¤ÛÛÂÚȘ Ì‹Ó˜ ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi Ë ·ÛıÂÓ‹˜ ·ӤÎÙË-Û ÙËÓ Úo΢ËÙÈ΋ ÏÂÈÙo˘ÚÁ›· Ù˘ ÏË·ıo˘.

™À∑∏∆∏™∏∏ ÌÂϤÙË ÙˆÓ ·ÒÙÂÚˆÓ ·oÙÂÏÂÛÌ¿ÙˆÓ Ù˘O∫∂§¶∞ ¤¯ÂÈ ÂÈÎÂÓÙÚˆı› ΢ڛˆ˜ ÛÙË ÏÂÈÙo˘Ú-Á›· Ù˘ ÂÈÏÂoÏË·ıo˘ ÂÓÒ ¤¯ÂÈ Ì¿ÏÏoÓ ˘o‚·ı-ÌÈÛı› Ë Ûo˘‰·ÈfiÙËÙ· Ù˘ Á˘Ó·ÈÎoÏoÁÈ΋˜ ÁÂÓÈÎfi-ÙÂÚ· Î·È ·Ó··Ú·ÁˆÁ‹˜ ÂȉÈÎfiÙÂÚ· ÏÂÈÙo˘ÚÁ›·˜5,10.∏ ÏÂÈoÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ o˘ ˘o‚¿ÏÏoÓÙ·È ÛÂO∫∂§¶∞ ¢ڛÛÎÂÙ·È ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ·.OÈ ¿Ó‰Ú˜ ÂӉȷʤÚoÓÙ·È ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ù˘ Èη-ÓfiÙËÙ·˜ Î·È Ù˘ ÁoÓÈÌfiÙËÙ·˜, o˘ Ì¿ÏÏoÓ ‰ÂÓ ÂË-Ú¿˙oÓÙ·È ·fi ÙËÓ ÂÁ¯Â›ÚËÛË fiÙ·Ó ÂÎÙÂÏÂ›Ù·È Û ÂÈ-‰Èο ΤÓÙÚ· ·fi ¤ÌÂÈÚo˘˜ ¯ÂÈÚo˘ÚÁo‡˜5,11. OÈ Á˘-Ó·›Î˜ ·ÓËÛ˘¯o‡Ó ÁÈ· ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ùo˘˜ ÁoÓÈ-ÌfiÙËÙ·, ÙËÓ ·ÛÊ·Ï‹ ·ËÛË Î·È ÙoÓ ·ÛÊ·Ï‹ ÙoÎÂÙfi·ÏÏ¿ ›Û˘ Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË Ù˘ ·ËÛ˘ ηÈÙÔ˘ ÙoÎÂÙo‡ ÛÙËÓ ÂÈÏÂoÏË΢ıÈ΋ ÏÂÈÙo˘ÚÁ›·.

∏ ·Úo‡Û· ÂÚÁ·Û›· ·ÛÊ·ÏÒ˜ ‰ÂÓ ÌoÚ› Ó···ÓÙ‹ÛÂÈ ·fiÏ˘Ù· Û fiÏ· Ù· ·ÓˆÙ¤Úˆ ÂÚˆÙ‹Ì·Ù·,·Ú¤¯ÂÈ fï˜ ÙËÓ ·fi‰ÂÈÍË fiÙÈ Ë O∫∂§¶∞ ‰ÂÓÂȉڿ ÛÙËÓ Î‡ËÛË Î·È ÛÙoÓ ÙoÎÂÙfi. E›Û˘ ·Ú¤¯Âȉ‰Ô̤ӷ fiÙÈ Ë OKE§¶A ÂÈʤÚÂÈ ˘oÁoÓÈÌfiÙËÙ·.OÈ ÂÚÁ·Û›Â˜ ÁÈ· ÙË Á˘Ó·ÈΛ· ˘oÁoÓÈÌfiÙËÙ· ›ӷÈÌ¿ÏÏoÓ Ï›Á˜ Î·È ÂÏ¿¯ÈÛÙ· ‰È¢ÎÚÈÓÈÛÙÈΤ˜5,10,11,˘o‰ËÏÒÓo˘Ó fï˜ fiÙÈ Ë O∫∂§¶∞, fiˆ˜ Î·È oÈ·Ï·ÈfiÙÂÚ˜ ÂÚÁÒ‰ÂȘ ÂÁ¯ÂÈÚ‹ÛÂȘ ÛÙËÓ ˘ÂÏÈ΋ÂÚÈo¯‹, ÂÏ·ÙÙÒÓo˘Ó ÙË ÁoÓÈÌfiÙËÙ·11-13. ªÂÚÈÎo›Û˘ÁÁÚ·Ê›˜ ıˆÚo‡Ó ÙȘ ·Ó·ÙoÌÈΤ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ-Τ˜ ÌÂÙ·‚oϤ˜ ÛÙËÓ ÂÏ¿ÛÛoÓ· ‡ÂÏo ˆ˜ ·ÈÙ›· ÙȘ˘oÁoÓÈÌfiÙËÙ·˜5,10-13. ™Â ÌÈ· ÌÂϤÙË11 Ë ˘ÛÙÂÚoÛ·Ï-ÈÁÁoÁÚ·Ê›· ‹Ù·Ó Ê˘ÛÈoÏoÁÈ΋ ÌfiÓo Û 11 ·fi 21Á˘Ó·›Î˜11 Î·È Ë ˘oÁoÓÈÌfiÙËÙ· ·o‰fiıËΠ۠·o-ÎÏÂÈÛÌfi ÙˆÓ Û·Ï›ÁÁˆÓ ·fi Û˘ÌʇÛÂȘ o˘ ·Ó·-Ù‡ÛÛoÓÙ·È ÌÂÙÂÁ¯ÂÈÚËÙÈο ÛÙËÓ ÂÏ¿ÛÛoÓ· ‡ÂÏo.

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 303

¶›Ó·Î·˜ 1. §ÂÈÙo˘ÚÁ›· Ù˘ ÂÈÏÂoÏË΢ıoÚˆÎÙÈ΋˜ ·Ó·ÛÙfïÛ˘ ÚÈÓ, ηٿ Î·È ÌÂÙ¿ ÙËÓ Î‡ËÛË–ÙoÎÂÙfi, ÛÙȘ 2 Á˘Ó·›Î˜Ù˘ ÌÂϤÙ˘

¶·Ú¿ÌÂÙÚoÈ ∞ÛıÂÓ‹˜ 1Ë ∞ÛıÂÓ‹˜ 2Ë

¶ÚÈÓ ∫·Ù¿ ª¤¯ÚÈ 4 ªÂÙ¿ 6 ¶ÚÈÓ ∫·Ù¿ ª¤¯ÚÈ 4 ªÂÙ¿ 6(3Ô ÙÚ›ÌËÓo) Ì‹Ó˜ ÌÂÙ¿ Ì‹Ó˜ (3Ô ÙÚ›ÌËÓo) Ì‹Ó˜ ÌÂÙ¿ Ì‹Ó˜

∫ÂÓÒÛÂȘ 5,3±0,9 7,6±1,2 7,4±1,4 5,5±0,7 5,6±0,7 8,2±2,1 7,9±1,9 5,5±0,5Ë̤ڷ˜

∫ÂÓÒÛÂȘ 0,4±0,2 1,6±1,5 1,5±1,6 0,3±0,5 1,1±0,6 2,5±1,7 2,3±0,8 1,2±0,6Ó‡ÎÙ·˜

∞ÎÚ¿ÙÂÈ·Ë̤ڷ˜ 0 0 0 0 0,6±0,2 2,1±0,4 1,8±1,2 0,7±0,4(ÂÂÈÛfi‰È·)

∞ÎÚ¿ÙÂÈ·Ó‡ÎÙ·˜ 0,7±0,5 2,1±0,7 1,8±0,6 0,8±0,2 0,2±0,5 2,3±9,3 2,1±0,7 0,3±0,8(ÂÂÈÛfi‰È·)

™ÙËÓ ›‰È· ·ÈÙ›· Ú¤ÂÈ Ì¿ÏÏoÓ Ó· ·o‰oı› Ë ˘o-ÁoÓÈÌfiÙËÙ· ÙˆÓ ‰‡Ô Á˘Ó·ÈÎÒÓ Ù˘ ·Úo‡Û·˜ ÂÚÁ·-Û›·˜, oÈ oo›Â˜ ˘o‚Ï‹ıËÎ·Ó ‰‡o ÊoÚ¤˜ Û ÌÂÁ¿ÏËÂÁ¯Â›ÚËÛË Î·È ÛÙȘ oo›Â˜ Ë ˘ÛÙÂÚoÛ·ÏÈÁÁoÁÚ·-Ê›· ¤‰ÂÈÍ ·oÎÏÂÈÛÌfi ÙˆÓ Û·Ï›ÁÁˆÓ.

Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Ë Î‡ËÛË ÂÚ·ÙÒÓÂÙ·È ¯ˆ-Ú›˜ Úo‚Ï‹Ì·Ù· Î·È o ÙoÎÂÙfi˜ Â›Ó·È ·ÛÊ·Ï‹˜ 7,8,11,13.∞fi ÌÂϤÙË9 Ù˘ ›‰Ú·Û˘ Ù˘ O∫∂§¶∞ ÛÙËÓ Î‡Ë-ÛË Î·È ÛÙoÓ ÙoÎÂÙfi Û 20 Á˘Ó·›Î˜, oÈ 11 ›¯·Ó ‰È·-ÎoÏÈÎfi ÙoÎÂÙfi Ì ÂÈÛÈoÙoÌ‹ Î·È oÈ ˘fiÏoȘ 9 ÌÂηÈÛ·ÚÈ΋ ÙoÌ‹ ¯ˆÚ›˜ ÌËÙÚÈ΋ ıÓËÙfiÙËÙ· ‹ ÓoÛËÚfi-ÙËÙ· Î·È ÌfiÓo ¤Ó· ÓÂoÁÓfi η٤ÏËÍ ·fi ÓfiÛo ˘¿ÏÈ-Ó˘ ÌÂÌ‚Ú¿Ó˘. ∫·È oÈ ‰‡Ô ·ÛıÂÓ›˜ Ì·˜ ¤ÙÂÍ·Ó ÌÂÚfiˆÚo ‰È·ÎoÏÈÎfi ÙoÎÂÙfi.

ø˜ Úo˜ ÙËÓ Â›‰Ú·ÛË Ù˘ ·ËÛ˘ Î·È Ùo˘ Ùo-ÎÂÙo‡ › Ù˘ ÂÈÏÂoÏË΢ıÈ΋˜ ÏÂÈÙo˘ÚÁ›·˜ ¤¯ÂÈ ‰È·-ÈÛÙˆı›5-7,9 οoÈo˜ ‚·ıÌfi˜ Âȉ›ӈÛ˘ ·˘Ù‹˜Ì ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È Ûo-Ú·‰È΋ (1-2 ÊoÚ¤˜ ÙËÓ Â‚‰oÌ¿‰·) Ó˘ÎÙÂÚÈÓ‹ ΢ڛ-ˆ˜ ·ÎÚ¿ÙÂÈ·. ¶Ú¿ÁÌ·ÙÈ Î·È oÈ ‰‡o Á˘Ó·›Î˜ Ù˘·Úo‡Û·˜ ÌÂϤÙ˘ ÂÌÊ¿ÓÈÛ·Ó ·˘ÍË̤ÓË Û˘¯ÓfiÙË-Ù· ÎÂÓÒÛÂˆÓ Î·È ·ÎÚ¿ÙÂÈ· ÛÙo ÙÂÏÂ˘Ù·›o ÙÚ›ÌËÓoÙ˘ ·ËÛ˘ o˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì Û΢¿ÛÌ·Ù·„‡ÏÏÈo˘ Ì ÛÙfi¯Ô ÙËÓ ·Ô‚ÔÏ‹ ÏÈÁfiÙÂÚÔ ˘‰·ÚÒÓÎÔÚ¿ÓˆÓ. ∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛˆÓÚ¤ÂÈ Ì¿ÏÏoÓ Ó· ·o‰oı› Û ÂÏ¿ÙÙˆÛË Ù˘ ¯ˆ-ÚËÙÈÎfiÙËÙ·˜ Ù˘ ÂÈÏÂoÏË·ıo˘ ·fi ÙË ‰È·ÚÎÒ˜ ‰È-oÁÎo‡ÌÂÓË Ì‹ÙÚ· ̤۷ ÛÙËÓ ‡ÂÏo6.

∏ o‰fi˜ Ùo˘ ÙoÎÂÙo‡ ·oÙÂÏ› ‰›o ‰È·ÌÊÈ-Û‚‹ÙËÛ˘: ¶ÏÂoÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈoÓÂÎÙ‹Ì·Ù· ˘-¿Ú¯o˘Ó ÙfiÛÔ ÛÙÔ ‰È·ÎoÏÈÎfi ÙoÎÂÙfi fiÛÔ Î·È ÛÙËÓηÈÛ·ÚÈ΋ ÙoÌ‹. O ‰È·ÎoÏÈÎfi˜ ÙoÎÂÙfi˜ ÌoÚ› Ó·ÚoÍÂÓ‹ÛÂÈ ‚Ï¿‚˜ ÛÙo˘˜ ÛÊÈÁÎÙ‹Ú˜ Î·È ÛÙË Ï‹-΢ıo, ›Ûˆ˜ Î·È ÛÙo ·È‰oÈÈÎfi Ó‡Úo11, Ë ·Ó¿ÚÚˆÛËfï˜ Â›Ó·È Ù·¯‡ÙÂÚË ·fi ÂΛÓË Ù˘ ηÈÛ·ÚÈ΋˜ÙoÌ‹˜ Î·È ··ÏÏ·Á̤ÓË ·fi Ùo˘˜ ÎÈÓ‰‡Óo˘˜ Ù˘ÎoÈÏȷ΋˜ ÂÁ¯Â›ÚËÛ˘. ∏ ‰È·Ù‹ÚËÛË Ù˘ ÂÁÎÚ¿ÙÂÈ-·˜ ÌÂÙ¿ ·fi ‰È·ÎoÏÈÎfi ÙoÎÂÙfi ·o‰ÂÈÎÓ‡ÂÈ fiÙÈ Ëo‰fi˜ ·˘Ù‹ Â›Ó·È ÂÊÈÎÙ‹ Î·È ·ÛÊ·Ï‹˜, fiˆ˜ ÛÙȘ‰‡Ô ÂÚÈÙÒÛÂȘ Ì·˜. ∏ ηÈÛ·ÚÈ΋ ÙoÌ‹ ‰ÂÓ Â›Ó·È¿ÓÙoÙ ·Ó·Áη›· Î·È Ú¤ÂÈ Ó· ‰È·Ê˘Ï¿ÛÛÂÙ·ÈÁÈ· ÂÚÈÙÒÛÂȘ Ì oÚȷ΋ ÛÊÈÁÎÙËÚȷ΋ ÏÂÈÙo˘Ú-Á›· Î·È ÁÈ· ÙȘ Á˘Ó·›Î˜ Ì ·ÛıÂÓ¤˜ ÂÚÈÓÂ˚Îfi ÛÒ-Ì·. ¶Ú¤ÂÈ fï˜ Ó· ÙoÓÈÛı›, fiˆ˜ ˘oÛÙËÚ›˙o˘ÓoÏÏo›5,6, fiÙÈ Ë ÂÈÏoÁ‹ ·oÙÂÏ› ¢ı‡ÓË Î˘Ú›ˆ˜Ùo˘ Ì·ÈÂ˘Ù‹Ú· ÁÈ· ηı·Ú¿ Ì·È¢ÙÈÎo‡˜ ÏfiÁo˘˜ Î·È‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ù˘ ÂÈÙfiÎo˘.

™˘ÌÂÚ·ÛÌ·ÙÈο Ë O∫∂§¶∞ Ê·›ÓÂÙ·È fiÙÈÂËÚ¿˙ÂÈ ÙË ÁoÓÈÌfiÙËÙ· ÙˆÓ Á˘Ó·ÈÎÒÓ, Â›Ó·È fï˜Û˘Ì‚·Ù‹ Ì ·ÛÊ·Ï‹ ·ËÛË Î·È ÙoÎÂÙfi, o Ù‡o˜ Ùo˘oo›o˘ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙË ÏË΢ıÈ΋ ÏÂÈÙo˘ÚÁ›·. ∫‡Ë-

ÛË Î·È ÙoÎÂÙfi˜ ‰ÂÓ ÂËÚ¿˙o˘Ó ÛËÌ·ÓÙÈο ÙËÓ ÂÈÏÂ-oÏ‹Î˘ıo–ÚˆÎÙÈ΋ ÏÂÈÙo˘ÚÁ›·, ÂÎÙfi˜ ·fi ÙËÓ ·˘ÍË-̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È ÙË ÛoÚ·‰È΋·ÎÚ¿ÙÂÈ· ηٿ Ùo ÙÂÏÂ˘Ù·›o ÙÚ›ÌËÓo Ù˘ ·ËÛ˘, o˘·Ú¤Ú¯oÓÙ·È ÌÂÙ¿ ·fi 3-4 Ì‹Ó˜ ·fi ÙoÓ ÙoÎÂÙfi.

ABSTRACTNatsikas B, Semoglou Ch, Jafetas J, Dalainas B.Ilealpouch–anal anastomosis: The effect of pre-gnancy and delivery on the pouch and the effectof the pouch on pregnancy and delivery. HellIatr 2000, 66: 302 - 305.

Women with ulcerative colitis and familial po-lyposis have nearly normal fertility with ability toconceive and deliver healthy babies. After total re-ctocolectomy, rectoanal mucosectomy and ileal-pouch-anal anastomosis, a procedure with multiplemanipulations in the pelvis, questions arise withregard to effect of pregnancy and delivery on thepouch and effect of the pouch on pregnancy anddelivery. In this work our small experience with twoyoung women, who had urdergone this procedureand became postoperatively pregnant, is presented.Both women conceived after extracorporeal fertili-zation because of postoperative infertility, whichmight be attributed to the postoperative adhesionsin the pelvis. There were in both premature vaginaldeliveries with 3 babies (one pregnancy of twins).All babies were born alive but one of the twins diedbecause of respiratory insufficiency. Both womenhad a minimal and transient deterioration of the ilealpouch–anal function, especially during the thirdtrimester of pregnancy, which resolved 3-4 monthsafter delivery, and may be due to the pelvic locationof the ileal pouch where this is more susceptible topressure exerted on it from the pregnant utetus.This small experience does not resolve all the que-stions, but suggest that ileal pouch-anal anasto-mosis is compatible with normal childbearing anddoes not significantly and permanently interferewith the ilealpouch-anal function.

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AÏÏËÏoÁÚ·Ê›·:µ. ¡¿ÙÛÈη˜∞Ï. ªÈ¯·ËÏ›‰Ë 1µ546 40 – £ÂÛÛ·ÏoÓ›ÎË

Corresponding author:V. Natsikas1B Al. Mihailidi Str.546 40 – ThessalonikiGreece

∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 66, 3-4 305