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TOMO™ 48IANOYAPIO™ - MAPTIO™ 2004
hellenicstomatological reviewHELLENIC DENTAL ASSOCIATION
VOLUME 48, ISSUE 1, JANUARY - MARCH 2004
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ISSN 1011 - 4181
ISSN 1011 - 4181
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ISSN 1011 - 4181
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¶EPIEXOMENA
ñ ¢È·ÊÔÚ¤˜ ÛÙËÓ ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ˘ÁÚÔ‡ ηٿ ÙËÓ ·Ó¿ÌÂÈÍËÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ Ù‡Ô˘ Grossman ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË.E. M·˙›Ó˘, I. M·ÚÁ¤ÏÔ˜ Î·È £. §·ÌÚÈ·Ó›‰Ë˜.....................................9
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ñ AÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ÌÂϤÙË ÙÔ˘ ˘‰·Ù·ÓıÚ·ÎÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘ 19-9(CA 19-9) Û ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ.A. EÈ‚·ÙÈ·Ófi˜, ™. IÔÚ‰·Ó›‰Ë˜ Î·È ¢. AÓÙˆÓÈ¿‰Ë˜..............................19
ñ AÎÙÈÓÔÁÚ·ÊÈ΋ Î·È ÈÛÙÔÏÔÁÈ΋ ÌÂϤÙË ÙˆÓ ‰ÔÓÙÈÒÓ 13 ηÏÔ‹ıˆÓ ΢ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ˆÔıËÎÒÓ.K. I. TfiÛÈÔ˜, E. ¶··‰¿Î˘, K. BÏ·ÛÙfi˜ Î·È I. TfiÛÛÈÔ˜ .....................27
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EN¢IAºEPOY™A ¶EPI¶Tø™H
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stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 601
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TOMO™ 48, TEYXO™ 1IANOYAPIO™ - MAPTIO™ 2004
ISSN 1011 - 4181
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T· ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο Â›Ó·È ÙÔ Â›ÛË-ÌÔ ÂÈÛÙËÌÔÓÈÎfi ¤ÓÙ˘Ô Ù˘ EÏÏËÓÈ΋˜O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜ Ô˘ ÂΉ›‰ÂÙ·È·Ó¿ ÙÚ›ÌËÓÔ.
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ñ T· ÔÛÙÂÔÂÓۈ̷ÙÔ‡ÌÂÓ· ÂÌÊ˘Ù‡̷ٷ ÛÙËÓ ÙÚ›ÙË ËÏÈΛ·.H. K·Úη˙‹˜, ¢. K·Ï‡‚·˜ ..................................................................51
ñ TÔ Úfi‚ÏËÌ· Ù˘ Ô‰ÔÓÙÈ΋˜ ·Á·ψÛ˘ ÛÙÔ ÊÚ·ÁÌfi:¢È¿ÁÓˆÛË, ÂÈÏÔΤ˜ Î·È ·ÓÙÈÌÂÙÒÈÛË.H. M·ÚÈÓfiÔ˘ÏÔ˜, °. TÛÔÚÔ‚¿˜ Î·È H. K·ÙÛ·‚ÚÈ¿˜...........................63
ñ O ÚfiÏÔ˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÚfiÏË„Ë ÙÔÈ΋˜ ‹ Û˘ÛÙËÌ·ÙÈ-΋˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÊÏÂÁÌÔÓ‹˜ ηٿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂ-ÛË ÙˆÓ ÂÁÎÏ›ÛÙˆÓ ÙÚ›ÙˆÓ ÁÔÌÊ›ˆÓ.E. EÏ¢ıÂÚÈ¿‰Ë˜, X. ¶··‰‹Ì·˜ Î·È M. §Â‚¤ÓÙ˘.............................73
ñ AÈÌÔÚÚ·ÁÈ΋ ÔÌÊÔÏ˘Á҉˘ Î˘Ó¿Á¯Ë: M›· ·Û˘Ó‹ı˘ ÛÙÔÌ·ÙÈ΋ ÓfiÛÔ˜ Ì ‰È·ÁÓˆÛÙÈÎfi ÂӉȷʤÚÔÓ.¢. TÚÈ¿ÓÙÔ˜, ¶. K·Ó¿Î˘ ...................................................................79
ñ H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓ‹ ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋.E. EÏ¢ıÂÚÈ¿‰Ë˜, M. §Â‚¤ÓÙ˘, E. °È·ÓÓÔ˘Ï¿ÎË Î·È X. ¶··‰‹Ì·˜ ......85
ñ XÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·:·ÚÔ˘Û›·ÛË 8 ÂÚÈÙÒÛÂˆÓ Î·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË.X. MÔ˘ÙÛÈԇ΢, ™. ¢·Ï·Ì›Ú·˜ Î·È A. MÔ˘ÙÛÈԇ΢ ....................93
BIB§IO°PAºIKE™ ANA™KO¶H™EI™
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 602
HellenicStomatologicalReview
Hellenic Dental Association
VOLUME 48, ISSUE 1JANUARY - MARCH 2004
ISSN 1011 - 4181
PROPRIETOR:Hellenic Dental Association
EDITOR -IN- CHIEF:J. G. Tzoutzas
EDITORIAL BOARD:G. DouvitsasF. Zervou - ValviH. KarkazisE. KatsavriasG. MountourisL. PapagiannoulisD. TziafasV. Topitsoglou - Themeli
COPY EDITOR:Evelin Babai
PRODUCTION - PROMOTION:TypeProductV. & E. Babai Ltd32 Epikourou Str., Athens HellasPhone#: (3210) 32.14.904Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLICRELATIONS:M. MorfoniouPhone#: (3210) 33.02.343Fax: (3210) 38.34.385E-mail: [email protected]
Hellenic Stomatological Review is theofficial publication of the Hellenic DentalAssociation, published trimonthly.
Annual subscription 40 $ USD
PUBLISHER:Panos AlexiouPresident of the Hellenic Dental Association
HEADQUARTERS38 Themistokleous Str., Athens, 106 78Phone#: (3210) 38.13.380Fax#: (3210) 38.34.385E-mail: [email protected]
CONTENTS
ñ Differences in powder - liquid ratio among dentists duringpreparation of Grossman - type sealer.E. Mazinis, J. Margelos and T. Lambrianidis.........................................9
ñ Effect of acidic and neutral buffer solutions on the stability of a visible light-cured periodontal dressing material.S. Silvestros, V. Chronopoulos, D. Karathanasopoulou and G. Eliades ..13
ñ Immunohistochemical expression of carbohydrate antigen 19-9 (CA 19-9) in salivary gland tumours.A. Epivatianos, S. Iordanidis and D. Antoniades ................................19
ñ Radiographic and histologic study of ectopic teethfrom 13 benign ovarian cystic teratomas.K. I. Tosios, E. Papadakis, K. Vlastos and I. Tossios ...........................27
ñ Snacks consumed by nursery school pupils in the North Westof Corfu.F. Daskas ...........................................................................................33
ñ Incidence and trigger factors of herpes labialis (HL) in adults.C. Donta-Bakoyianni, O. Nicolatou-Galitis and V. S. Papanicolaou ...39
ñ Desmoid fibromatosis (Desmoid tumor) of the oral andparaoral soft tissues: Report of a case and literature review.S. Iordanidis, A. Epivatianos, T. Zaraboukas and A. Markopoulos .....45
ñ Oral implants in geriatric patients.H. Karkazis, D. Kalyvas ......................................................................51
ñ The problem of dental ankylosis: Its diagnosis, sequences and treatment.E. Marinopoulos, G. Tsorovas and E. Katsavrias ................................63
LITERATURE REVIEWS
CASE REPORT
EPIDEMIOLOGICAL STUDIES
RESEARCH PAPERS
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 603
HellenicStomatologicalReview
Hellenic Dental Association
VOLUME 48, ISSUE 1JANUARY - MARCH 2004
ISSN 1011 - 4181
PROPRIETOR:Hellenic Dental Association
EDITOR -IN- CHIEF:J. G. Tzoutzas
EDITORIAL BOARD:G. DouvitsasF. Zervou - ValviH. KarkazisE. KatsavriasG. MountourisL. PapagiannoulisD. TziafasV. Topitsoglou - Themeli
COPY EDITOR:Evelin Babai
PRODUCTION - PROMOTION:TypeProductV. & E. Babai Ltd32 Epikourou Str., Athens HellasPhone#: (3210) 32.14.904Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLICRELATIONS:M. MorfoniouPhone#: (3210) 33.02.343Fax: (3210) 38.34.385E-mail: [email protected]
Hellenic Stomatological Review is theofficial publication of the Hellenic DentalAssociation, published trimonthly.
Annual subscription 40 $ USD
PUBLISHER:Panos AlexiouPresident of the Hellenic Dental Association
HEADQUARTERS38 Themistokleous Str., Athens, 106 78Phone#: (3210) 38.13.380Fax#: (3210) 38.34.385E-mail: [email protected]
ñ The use of antibiotics in the prevention of postoperativeinfection in impacted third molar surgery.E. Eleftheriadis, C. Papadimas and M. Leventis .................................73
ñ Angina bullosa haemorrhagica: an uncommon oral disorderwith diagnostic interest.D. Triantos, P. Kanakis.......................................................................79
ñ Management of the oral and maxillofacial surgical patientwith diabetes mellitus.E. Eleftheriadis, M. Leventis, E. Giannoulaki and C. Papadimas ........85
ñ Chronic focal sclerosing osteomyelitis: report of 8 cases andreview of the literature.C. Boutsioukis, S. Dalampiras and A. Boutsioukis ..............................93
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 604
™YNTAKTIKH ™E§I¢A
¶PO™ NEOY™ OPIZONTE™
MÂÏÂÙÒÓÙ·˜ ‹ ÍÂÊ˘ÏÏ›˙ÔÓÙ·˜ Ù· ¤ÁÎÚÈÙ· ÂÚÈÔ‰Èο ÙÔ˘ O‰ÔÓÙÈ·ÙÚÈÎÔ‡¯ÒÚÔ˘, ÌÔÚ› ‡ÎÔÏ· Ó· Á›ÓÂÈ ·ÓÙÈÏËÙ‹ Ë ÚÔÛ¿ıÂÈ· ÛÔ‚·ÚÒÓ ÂÚ¢-ÓËÙÈÎÒÓ Î¤ÓÙÚˆÓ ·ÏÏ¿ Î·È ÚˆÙÔfiÚˆÓ Û˘ÁÁڷʤˆÓ, Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘ÓÙÔ Ì¤ÏÏÔÓ ÙˆÓ ÂÈÛÙËÌÒÓ YÁ›·˜ ̤ۈ Ù˘ °ÂÓÂÙÈ΋˜.
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K·ıËÌÂÚÈÓ¿ ÏËı·›ÓÔ˘Ó ÔÈ ÂÚÁ·Û›Â˜ Î·È ÔÈ ·Ó·ÊÔÚ¤˜ ÔÈ Û¯ÂÙÈΤ˜ Ì ÙËÓ ÂÚÌËÓ›· ̤ۈ Ù˘°ÂÓÂÙÈ΋˜, οÔÈˆÓ ¿ÁÓˆÛÙ˘ ‹ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔÏÔÁ›·˜ ÓÔÛËÌ¿ÙˆÓ Î·È ÔÏfiÎÏËÚ· Ù‡¯Ë ÎÏ·-ÛÈÎÒÓ Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ, ·ÊÈÂÚÒÓÔ˘Ó ÙȘ ÛÂÏ›‰Â˜ ÙÔ˘˜ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÔχÏÔ-ÎˆÓ °ÂÓÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·È ÛÙȘ ÚÔÂÎÙ¿ÛÂȘ ÙÔ˘˜.
¶ÏËÛÈ¿˙ÂÈ Ì¿ÏÏÔÓ Ë ÂÔ¯‹ fiÔ˘ ÙÔ ÚfiÁÚ·ÌÌ· ÛÔ˘‰ÒÓ ÙˆÓ O‰ÔÓÙÈ·ÙÚÈÎÒÓ ™¯ÔÏÒÓ ı·ÂÌÂÚȤ¯ÂÈ ÙË ‰È‰·Ûηϛ· Ù˘ °ÂÓÂÙÈ΋˜ Î·È ÙËÓ Ì¤Ûˆ ·˘Ù‹˜ ÂÚÌËÓ›· ÌÂÁ¿ÏÔ˘ ̤ÚÔ˘˜ Ù˘·ıÔÏÔÁ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÙˆÓ ÂÚÈÔ‰ÔÓÙÈÎÒÓ Î·È ›Ûˆ˜ Î·È ÙˆÓ ÛÎÏËÚÒÓ Ô‰Ô-ÓÙÈÎÒÓ ÈÛÙÒÓ.
H ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ·Ú¿ÏÏËÏ·, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ı· ÙÚÔÔÔÈËı› ÛÔ‚·Ú¿, ÂÊfi-ÛÔÓ ·Ó·Ï·ÛÙÈΤ˜ Ù¯ÓÈΤ˜ Ì °ÂÓÂÙÈÎfi ˘fiÛÙڈ̷ ı· Â›Ó·È ‰È·ı¤ÛÈ̘ ÛÙÔÓ ÂÓËÌÂڈ̤ÓÔÔ‰ÔÓÙ›·ÙÚÔ ÁÈ· Ó· ÙȘ ÂÊ·ÚÌfiÛÂÈ Û ÂÚÈÛÙ·ÙÈο Ù˘ ηıËÌÂÚÈÓ‹˜ ÎÏÈÓÈ΋˜ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ Â-ÚÈÙˆÛÈÔÏÔÁ›·˜.
H E·ÓÔÚıˆÙÈ΋ Ô‰ÔÓÙÈ·ÙÚÈ΋, Ë ¶ÂÚÈÔ‰ÔÓÙÔÏÔÁ›·, Ë OÚıÔ‰ÔÓÙÈ΋ Î·È ¿ÏϘ ÂÍÂȉÈ·ÛÂȘı· ÂËÚ·ÛıÔ‡Ó ÛÔ‚·Ú¿ ·fi ÙËÓ ÂÌÏÔ΋ Ù˘ °ÂÓÂÙÈ΋˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ·fi ÙË ÛÙÈÁ̋ηٿ ÙËÓ ÔÔ›· ÚÔ˚fiÓÙ· Ù˘ °ÂÓÂÙÈ΋˜ Ù¯ÓÔÏÔÁ›·˜ ı· Â›Ó·È ‰È·ı¤ÛÈÌ· ÛÙÔ Â˘Ú‡ Ô‰ÔÓÙÈ·ÙÚÈ-Îfi ÂÈÛÙËÌÔÓÈÎfi ‰˘Ó·ÌÈÎfi.
O O‰ÔÓÙÈ·ÙÚÈÎfi˜ ÎfiÛÌÔ˜ ÔÊ›ÏÂÈ Ó· ÚÔÂÙÔÈÌ¿˙ÂÙ·È ÁÈ· ÙËÓ ˘Ô‰Ô¯‹ Î·È ÛÙÔ Ì¤ÏÏÔÓ ÙËÓ·Ô‰Ô¯‹ ÙˆÓ ÚÔÙ¿ÛÂˆÓ Ù˘ °ÂÓÂÙÈ΋˜, ÁÈ· Ó· ÂÊ·ÚÌfiÛÂÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘ –ÛÙȘ ÂÚÈ-ÙÒÛÂȘ Ô˘ ÂӉ›ÎÓ˘ÓÙ·È ·fiÏ˘Ù·– Ù¯ÓÈΤ˜ ·ÔηٿÛÙ·Û˘ Ù·¯‡ÙÂÚ˜ Î·È ÏÈÁfiÙÂÚÔ ÂÚÁÒ-‰ÂȘ, Û ۇÁÎÚÈÛË Ì ÙȘ ÛËÌÂÚÈÓ¤˜.
I. °. TZOYTZA™¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 605
ŸÚÔ˜ ™‡ÓÙÌËÛË ™‡ÓÙÌËÛË ™‡ÓÙÌËÛË ™‡ÓÙÌËÛË‹ ۇ̂ÔÏÔ ŸÚÔ˜ ‹ ۇ̂ÔÏÔ ŸÚÔ˜ ‹ ۇ̂ÔÏÔ ŸÚÔ˜ ‹ ۇ̂ÔÏÔ
™Ù·ıÂÚ¤˜ ÌÔÓ¿‰Â˜ampere Aangström AÆbarm bcalorie calcandela cdcoulomb Ccounts per minute cpmcounts per second cpscurie Cidegree Celsius ÆCdisintegrationper minute dpmdisintegrationper second dpselectron Volt eVequivalent Eqfarad Fgauss Ggram ghenry Hhertz Hzhour hinch in
international unit IUjoule Jkelvin Kkilogram kgliter/litre I or Lmeter, metre mminute minmolar Mmole molnewton Nnormal (concentration) Nohm øosmol osmolpascal Papound lbpound per square inch psirevolutions per minute rpmsecond ssquare centimeter cm2
volt Vwatt Wweek wkyear yr
™Ù·ÙÈÛÙÈÎÔ› fiÚÔÈcorrelation coefficient r probability pdegrees of freedom df standard deviation SDmean x Standard errormean not significant NS of the mean SEnumber of Student’s test t testobservations n variance F
™˘Ó‰˘·ÛÌfi˜ ÚÔıÂÌ¿ÙˆÓtera- (1012) T centi- (10-2) cgiga- (109) G mili- (10-3) mmega- (106) M micro- (10-6) Ìmkilo- (103) k nano- (10-9) nhecto- (102) h pico- (10-12) pdeca- (10) da femto- (10-15) fdeci- (10-1) d atto- (10-18) a
SEM: Scanning Electron MicroscopyTEM: Transmission Electron MicroscopyESEM: Environmental Scanning Electron MicroscopyCSEM: Confocal Scanning Electron MicroscopyAFM: Atomic Force MicroscopySPM: Scanning Probe MicroscopyEELS: Electron Energy Loss SpectrometryEDS: Element Dispersive SpectroscopyEPMA: Electron Probe MicroanalysisXRF: X-ray Fluorescence analysisXRD: X-ray DiffractionFTIR: Fourrier Transformation Infrared Spectroscopy
™˘ÓÙÌ‹ÛÂȘ Î·È ™‡Ì‚ÔÏ· ™Ù·ıÂÚÒÓ MÔÓ¿‰ˆÓ, ™Ù·ÙÈÛÙÈÎÒÓ ŸÚˆÓ Î·È OÚÁ·ÓÔÏÔÁ›·˜
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 606
ANA£EøPHMENE™ O¢H°IE™ °IA TOY™ ™Y°°PAºEI™
T· ™TOMATO§O°IKA XPONIKA Â›Ó·È Ë Â›ÛËÌË ÂÈ-ÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔ-ÛÔÓ‰›·˜ Î·È ˆ˜ ÛÙfi¯Ô ¤¯Ô˘Ó ÙË Û˘Ó¯‹ ÂÈÛÙËÌÔÓÈ΋ÂÓË̤ڈÛË ÙÔ˘ ŒÏÏËÓ· O‰ÔÓÙÈ¿ÙÚÔ˘ Î·È ÙËÓ ÚÔÒıË-ÛË Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ EÈÛÙ‹Ì˘ ÛÙÔÓ EÏÏËÓÈÎfi ¯ÒÚÔ.°È· ÙËÓ Ú·ÁÌ¿ÙˆÛË ÙÔ˘ ÛÎÔÔ‡ ·˘ÙÔ‡ ‰ËÌÔÛȇÔÓÙ·È:
1. K‡ÚÈ· ı¤Ì·Ù·:ÕÚıÚ· Û ÌÔÚÊ‹ ·Ó·ÛÎfiËÛ˘, Ô˘ ·ÊÔÚÔ‡Ó Â›Î·È-
Ú· Î·È ·ÌÊÈÏÂÁfiÌÂÓ· ı¤Ì·Ù· Î·È Ô˘ ÁÚ¿ÊÔÓÙ·È Ì ÚÔ-ÙÚÔ‹ Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·fi Û˘Ó·‰¤ÏÊÔ˘˜ ÌÂÂȉÈΤ˜ Û ‚¿ıÔ˜ ÁÓÒÛÂȘ ÙÔ˘ ı¤Ì·ÙÔ˜.
2. EÈÛÙËÌÔÓÈο ¿ÚıÚ· Ô˘ ÛÙ¤ÏÓÔÓÙ·È ·fi Û˘Ó·‰¤Ï-ÊÔ˘˜:
T· ¿ÚıÚ· ·˘Ù¿ ÌÔÚ› Ó· ·Ó‹ÎÔ˘Ó Û ̛· ·fi ÙȘ ·-ڷοو ηÙËÁÔڛ˜: ·) AÓ·ÛÎÔ‹ÛÂȘ (̤¯ÚÈ 3 Û˘ÁÁÚ·-Ê›˜) ‚) EÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ (¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜,KÏÈÓÈΤ˜ ÌÂϤÙ˜, EÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜, EȉËÌÈÔÏÔ-ÁÈΤ˜ ÌÂϤÙ˜, KÏÈÓÈÎÔÛÙ·ÙÈÛÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÔ·ıÔ-ÏÔÁÈΤ˜ ÌÂϤÙ˜) Á) EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰)¶Ú·ÎÙÈο ı¤Ì·Ù·, Â) E·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ÂÈÛÙËÌÔÓÈ-ο ÙÂÎÌËÚȈ̤ӷ Î·È ÛÙ) £¤Ì·Ù· ¢ËÌfiÛÈ·˜ YÁ›·˜.
3. °Ú¿ÌÌ·Ù· ÚÔ˜ ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹:T· ÁÚ¿ÌÌ·Ù· Ô˘ ‰ËÌÔÛȇÔÓÙ·È ÌÂÙ¿ ·fi ¤ÁÎÚÈÛË
Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·ÊÔÚÔ‡Ó: ·) ÎÚ›ÛÂȘ ÁÈ· ‰Ë-ÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ· Î·È ‚) Û˘ÁÎÂÎÚÈ̤ӷ ÂÚˆÙ‹Ì·Ù· Û¯Â-ÙÈο Ì ÂÈÛÙËÌÔÓÈο ı¤Ì·Ù· Î·È Ô˘ ı· ‰›ÓÔÓÙ·È ··-ÓÙ‹ÛÂȘ ·fi ÙË ÛÙ‹ÏË Ù˘ ·ÏÏËÏÔÁÚ·Ê›·˜.
4. ™‡ÓÙÔ̘ ÚˆÙfiÙ˘Â˜ ‰ËÌÔÛȇÛÂȘ:£· ·ÊÔÚÔ‡Ó ÚˆÙfiÙ˘Â˜ ÂÚÁ·Û›Â˜ ‹ Â˘Ú‹Ì·Ù·, ‰Â
ı· ¤¯Ô˘Ó ¤ÎÙ·ÛË ÌÂÁ·Ï‡ÙÂÚË ·fi 2.000 ϤÍÂȘ Î·È ı·‰ËÌÔÛȇÔÓÙ·È ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi ·fi ·ÍÈÔÏfiÁËÛËÙ˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜.
5. ¶ÂÚÈÏ‹„ÂȘ ¿ÚıÚˆÓ:OÈ ÂÚÈÏ‹„ÂȘ ·˘Ù¤˜ ı· ·ÊÔÚÔ‡Ó ¿ÚıÚ· EÏÏ‹ÓˆÓ
Û˘Ó·‰¤ÏÊˆÓ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÚfiÛÊ·Ù· Û Â-ÚÈÔ‰Èο ÙÔ˘ Â͈ÙÂÚÈÎÔ‡.
ŒÎÙ·ÛË ¿ÚıÚˆÓ: OÈ ·Ó·ÛÎÔ‹ÛÂȘ ‰Â ı· Ú¤ÂÈ Ó·ÍÂÂÚÓÔ‡Ó ÙȘ 7.500 ϤÍÂȘ (25 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂ-Ï›‰Â˜) Î·È ÙȘ 100 ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÂÍ·›-ÚÂÛË ÂȉÈο ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‚·ÛÈΤ˜ ÂÈÛÙ‹-̘. OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È Ù· Ú·ÎÙÈο ı¤Ì·Ù·‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 3.000 ϤÍÂȘ (10 ÛÂÏ›-‰Â˜) Î·È ÙȘ 40 ·Ú·Ô̤˜. T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÂÓ-‰È·Ê¤ÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘ÓÙȘ 1.000 ϤÍÂȘ (4 ÛÂÏ›‰Â˜), ÂÓÒ Ù· ·ÁÁÂÏÌ·ÙÈο ı¤-Ì·Ù· ı· Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙȘ 5.000 ϤÍÂȘ (20ÛÂÏ›‰Â˜). ™ÙËÓ ¤ÎÙ·ÛË ÙˆÓ ·Ú·¿Óˆ ¿ÚıÚˆÓ Û˘ÌÂÚÈ-Ï·Ì‚¿ÓÂÙ·È Î·È Ë ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ı· Ú¤ÂÈ Ó· ›ӷÈ›ηÈÚË Î·È Ó· ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ÙÔ ‰È·Ú·ÁÌ·Ù¢fi-ÌÂÓÔ ı¤Ì·.
™‡ÓÙ·ÍË ÎÂÈ̤ӈÓ: T· ¿ÚıÚ· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ·‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· Â›Ó·È ÁÚ·Ì̤ӷ ÛÙË ÓÂÔÂÏÏËÓÈ΋‰ËÌÔÙÈ΋, Ì ÌÔÓÔÙÔÓÈÎfi Û‡ÛÙËÌ·. O ‰ÈÔÚıˆÙ‹˜ ÙÔ˘ Â-ÚÈÔ‰ÈÎÔ‡ ¤¯ÂÈ ÙÔ ‰ÈηÈÒÌ· Ó· ÙÚÔÔÔÈ‹ÛÂÈ ÁψÛÛÈο ÙÔΛÌÂÓÔ, ¯ˆÚ›˜ fï˜ Ó· ·ÏÏÔÈÒÛÂÈ ÙÔ ‡ÊÔ˜ ÙÔ˘ Û˘ÁÁÚ·-ʤ·.
OÈ ÂÚÁ·Û›Â˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈ-ÏÔ‡Ó Î·È Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ Û ‰ÈÏfi ‰È¿-ÛÙËÌ·, ۠ϢÎfi ¯·ÚÙ› Û˘ÓËıÈṲ̂ÓÔ˘ ÌÂÁ¤ıÔ˘˜ A4, ÌÂÂÚÈıÒÚÈÔ ·fi ÙȘ ‰‡Ô Ï¢ڤ˜.
™Â ȉȷ›ÙÂÚË ÛÂÏ›‰· ·Ú¯›˙Ô˘Ó ÔÈ ÂÍ‹˜ ÂÓfiÙËÙ˜: Ë ÛÂ-Ï›‰· Ù›ÙÏÔ˘, Ë ÂÚ›ÏË„Ë Î·È ÔÈ Ï¤ÍÂȘ ÎÏÂȉȿ, ÙÔ Î›ÌÂÓÔÙ˘ ÂÚÁ·Û›·˜, Ë ÂÚ›ÏË„Ë ÛÙËÓ ·ÁÁÏÈ΋ Î·È ÔÈ Ï¤ÍÂȘÎÏÂȉȿ ÛÙËÓ ·ÁÁÏÈ΋, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜, ÔÈÏÂ˙¿ÓÙ˜, ÔÈ ›Ó·Î˜ Î·È ÔÈ ÂÈÎfiÓ˜. ŸÏ˜ ÔÈ ÛÂÏ›‰Â˜·ÚÈıÌÔ‡ÓÙ·È Ì ÙËÓ ·ÓˆÙ¤Úˆ ÛÂÈÚ¿.
¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÍÈÔÔÈËıÔ‡Ó ÔÈ Â˘ÎÔϛ˜ Ù˘ Û‡Á-¯ÚÔÓ˘ Ù¯ÓÔÏÔÁ›·˜ Î·È ÚÔ˜ ·ÔÊ˘Á‹Ó ÙˆÓ ÛÊ·ÏÌ¿-ÙˆÓ Î·Ù¿ ÙËÓ ÏËÎÙÚÔÏfiÁËÛË ÎÚ›ÓÂÙ·È Û·Ó ··Ú·›ÙËÙËË ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜ ÂȘ ÙÚÈÏÔ‡Ó Û˘Óԉ¢fiÌÂÓË·fi ‰ÈÛΤÙÙ· 3.5’’ fiÔ˘ Ù· ΛÌÂÓ· ı· Ú¤ÂÈ Ó· ›ӷÈÏËÎÙÚÔÏÔÁË̤ӷ Û ÚfiÁÚ·ÌÌ· Word Û ¯·Ú·ÎÙ‹Ú˜12 ÛÙÈÁÌÒÓ.
™ÂÏ›‰· Ù›ÙÏÔ˘: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ÙÔÓ Ù›ÙÏÔ Ù˘ ÂÚÁ·-Û›·˜, ‚) ÙÔ fiÓÔÌ· Î·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ (ÙˆÓ) Û˘ÁÁڷʤ·(ˆÓ), Á) ÙÔ ›‰Ú˘Ì· ·’ fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·, ‰) ÙÔ·Ó Ë ÂÚÁ·Û›· ¤¯ÂÈ ·Ó·ÎÔÈÓˆı› Û οÔÈÔ Û˘Ó¤‰ÚÈÔ Î·ÈÔÈÔ, Â) ÙÔ fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁÚ·-ʤ· ÁÈ· ÙËÓ ·ÏÏËÏÔÁÚ·Ê›·, ÛÙ) ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ÂÚÁ·Û›·˜ (‚¿ÛÂÈ ÙÔ˘ 2 ‹ 4), ˙) ¶Èı·Ó‹ ËÁ‹ ¯ÚËÌ·ÙÔ‰fi-ÙËÛ˘ Ù˘ ¤Ú¢ӷ˜.
¶ÂÚ›ÏË„Ë Î·È Ï¤ÍÂȘ ÎÏÂȉȿ: H ÂÚ›ÏË„Ë ı· Ú¤ÂÈÓ· ¤¯ÂÈ ¤ÎÙ·ÛË Ì¤¯ÚÈ 200 ϤÍÂȘ. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·-ۛ˜, Ë ÂÚ›ÏË„Ë ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÛÎÔfiÂÚÁ·Û›·˜, ÙÔ ˘ÏÈÎfi, ÙË ÌÂıÔ‰ÔÏÔÁ›· Î·È Ù· Û˘ÌÂÚ¿-ÛÌ·Ù·. OÈ Ï¤ÍÂȘ - ÎÏÂȉȿ ı· ·Ú·Ù›ıÂÓÙ·È Ì ÙËÓ ÂÚ›-ÏË„Ë Î·È ı· Ú¤ÂÈ Ó· Â›Ó·È 3-10 ÌÂÌÔӈ̤ÓÔÈ fiÚÔÈ ‹ ÌÈ-ÎÚ¤˜ ÊÚ¿ÛÂȘ. OÈ Ï¤ÍÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÛÙÔÈ-¯Ô‡Ó ÛÙÔ˘˜ ‰ÈÂıÓ›˜ fiÚÔ˘˜ ÏÂÍÈÎÔÁÚ¿ÊËÛ˘ Ô˘ ·Ó·-ʤÚÔÓÙ·È ÛÙÔ Index Medicus Î·È Dental Index.
K›ÌÂÓÔ: T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ·Ó·ÛÎÔ‹ÛÂȘ ı·Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ì›· ·ÓÙÈÚÔÛˆÂ˘ÙÈ΋ ÂÈÛ·-ÁˆÁ‹ Î·È Î·ÙfiÈÓ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÙÂÎÌËÚȈ̤Ó˜ ‚È-‚ÏÈÔÁÚ·ÊÈο fiϘ ÔÈ ·fi„ÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ Û˘ÁÎÂ-ÎÚÈ̤ÓÔ ı¤Ì·. T¤ÏÔ˜, ı· Ú¤ÂÈ Ó· ·Ú·Ù›ıÂÙ·È ÌÈ· ÎÚÈ-ÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·fi„ÂˆÓ ·˘ÙÒÓ ·fi ÙÔ Û˘ÁÁڷʤ·Î·È Ó· ηٷϋÁÂÈ ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ Û˘ÌÂÚ¿ÛÌ·Ù·.
OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏÔ‡ÓÙ·È·fi Ù· ÎÂÊ¿Ï·È·: EÈÛ·ÁˆÁ‹, YÏÈο Î·È M¤ıÔ‰Ô˜, E˘Ú‹-Ì·Ù·-AÔÙÂϤÛÌ·Ù·, ™˘˙‹ÙËÛË Î·È ™˘ÌÂÚ¿ÛÌ·Ù·.
™Ù· ˘fiÏÔÈ· ›‰Ë ÙˆÓ ¿ÚıˆÓ ÙÔ Î›ÌÂÓÔ ‰È·ÌÔÚÊÒ-ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ¿ÚıÚÔ˘.
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜: OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·-Ú·Ô̤˜ ÛÙÔ Î›ÌÂÓÔ, fiˆ˜ Î·È ÛÙÔ˘˜ ›Ó·Î˜ Î·È ÛÙȘ
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 607
ÂÈÎfiÓ˜ Ì ÙȘ ÏÂ˙¿ÓÙ˜ ÙÔ˘˜, ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ì ·Ú·‚È-ÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. TÂÏ›˜ ‹ ÎfiÌ·Ù· ÛËÌÂÈ-ÒÓÔÓÙ·È ÌÂÙ¿ ÙËÓ ·Ú¤ÓıÂÛË Ô˘ ·Ú¤¯ÂÈ ÙË ‚È‚ÏÈÔÁÚ·-ÊÈ΋ ·Ú·ÔÌ‹. H ·Ú›ıÌËÛË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·-Ú·ÔÌÒÓ Á›ÓÂÙ·È Î·Ù’ ·‡ÍÔÓÙ· ·ÚÈıÌfi Î·È Ì ÙË ÛÂÈÚ¿Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ.
ŸÏ˜ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ô˘ ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÙÔ Î›ÌÂÓÔ Î·Ù·¯ˆÚÔ‡ÓÙ·È ÛÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi η-Ù¿ÏÔÁÔ Ô˘ ·Ú¯›˙ÂÈ Û ȉȷ›ÙÂÚË ÛÂÏ›‰· ÌÂÙ¿ ÙÔ Î›ÌÂÓÔ.¶ÚÈÓ ·fi οı ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ÛÙÔÓ Î·Ù¿ÏÔ-ÁÔ, ÚÔËÁÂ›Ù·È Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ Ô˘ ÛËÌÂÈÒıËÎÂÛÙÔ Î›ÌÂÓÔ Î·È ÛÙÔÓ ÔÔ›Ô ·ÓÙÈÛÙÔȯ› Ë ‚È‚ÏÈÔÁÚ·Ê›·.
™ÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔ ÚÔËÁÔ‡ÓÙ·È Ù· ÔÓfiÌ·-Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ (ÚÒÙ· ÙÔ ÂÒÓ˘ÌÔ Î·È ÌÂÙ¿ ÙÔfiÓÔÌ·, ·ÎÔÏÔ˘ı› ÎfiÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ ÙÔ˘ ÂfiÌÂÓÔ˘Û˘ÁÁڷʤ· Î.Ô.Î.), Ù›ıÂÙ·È ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ (:) Ô Ù›Ù-ÏÔ˜ ÙÔ˘ ¿ÚıÚÔ˘, ÙÂÏ›·, ÙÔ ÂÚÈÔ‰ÈÎfi ÛÂ Û˘ÓÙÔÌÔÁÚ·-Ê›·, ÙÔ ¤ÙÔ˜, ÙÔ ÚfiÛËÌÔ (;), Ô ÙfiÌÔ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡,Û ·Ú¤ÓıÂÛË ÙÔ Ù‡¯Ô˜, ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ Î·È ÔÈ ÛÂ-Ï›‰Â˜ ÙÔ˘ ¿ÚıÚÔ˘ (ÚÒÙË, ·‡Ï· Î·È ÙÂÏÂ˘Ù·›·). OÈ Û˘-ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÂÚÈÔ‰ÈÎÒÓ Ú¤ÂÈ Ó· ÁÚ¿ÊÔÓÙ·ÈÛ‡Ìʈӷ Ì ÙÔ Dental Index Î·È Index Medicus. °È· ÙÈ˜Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ ÂÏÏËÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ ˘¿Ú¯ÂÈ Û¯ÂÙÈÎfi˜Î·Ù¿ÏÔÁÔ˜ ÙÔ˘ IATPOTEK. ¶Ú¤ÂÈ Ó’ ·ÔʇÁÂÙ·È ÁÂÓÈ-ο Ë ¯ÚËÛÈÌÔÔ›ËÛË ÂÚÈÏ‹„ÂˆÓ (abstracts) ˆ˜ ‚È‚ÏÈÔ-ÁÚ·ÊÈ΋ ·Ú·ÔÌ‹, fiˆ˜ ›Û˘ «·‰ËÌÔÛ›Â˘Ù˜ ·-Ú·ÙËÚ‹ÛÂȘ» Î·È «ÚÔÛˆÈΤ˜ ÂÈÎÔÈӈӛ˜».
EÚÁ·Û›Â˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ·Ï-Ï¿ ‰Â ‰ËÌÔÛȇıËÎ·Ó ·ÎfiÌË, ÌÔÚÔ‡Ó Ó· ·Ó·ÊÂÚıÔ‡ÓÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ÛËÌÂÈÒÓÂÙ·ÈÛÙÔ ÂÚÈÔ‰ÈÎfi Î·È Ë ÊÚ¿ÛË «˘fi ‰ËÌÔÛ›Â˘ÛË» Û ·-Ú¤ÓıÂÛË.
E¿Ó Î·È ÂÊfiÛÔÓ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÌÂÚȤ¯ÔÓÙ·È ¿Ú-ıÚ· ·fi ÂÚÈÔ‰Èο Ì ϷÙÈÓÔÁÂÓ‹ ÁÏÒÛÛ· Ô˘ ¤¯ÂÈ ÙÔÈ-Τ˜ ȉȷÈÙÂÚfiÙËÙ˜ (°ÂÚÌ·ÓÈο, ™Î·Ó‰ÈÓ·˘Èο, °·ÏÏÈο),Ô ÙÔÓÈÛÌfi˜ ÙˆÓ Ï¤ÍÂˆÓ Â›Ó·È Â˘ı‡ÓË ÙˆÓ Û˘ÁÁڷʤˆÓ.
¶·Ú¿‰ÂÈÁÌ· ÙÔ˘ ÔÚıÔ‡ ÙÚfiÔ˘ ÁÚ·Ê‹˜ ÙˆÓ ‚È‚ÏÈÔ-ÁÚ·ÊÈÎÒÓ ‰›ÓÂÙ·È ·Ú·Î¿Ùˆ:
¶ÂÚÈÔ‰ÈÎfi: AӷʤÚÔÓÙ·È Ù· ÂÒÓ˘Ì· Î·È Ù· ·Ú¯ÈÎ¿ÙˆÓ ÔÓÔÌ¿ÙˆÓ fiÏˆÓ ÙˆÓ Û˘ÁÁڷʤˆÓ ̤¯ÚÈ ¤ÍË (fiÙ·ÓÂ›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ·ÎÔÏÔ˘ı› Ë ¤Ó‰ÂÈÍË «et al», ÛÙ· ÂÏ-ÏËÓÈο ¿ÚıÚ· ÁÚ¿ÊÔ˘Ì «Î·È Û˘Ó.»), Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·-Û›·˜, Ë Û˘ÓÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÙÔ ¤ÙÔ˜, Ô Ùfi-ÌÔ˜, Ë ÚÒÙË Î·È Ë ÙÂÏÂ˘Ù·›· ÛÂÏ›‰· Ù˘ ‰ËÌÔÛ›Â˘Û˘.¶.¯. Papagiannoulis L, Kakaboura A, Eliades G: Invivo Vs in Vitro anticariogenic behavior of glass-ionomer and resin composite restorative materials.Dent Mater 2002; 18 (8): 561-569.
BÈ‚Ï›· Î·È ¿ÏϘ ÌÔÓÔÁڷʛ˜: AӷʤÚÔÓÙ·È Ì ÙËÛÂÈÚ¿ Ù· ÂÒÓ˘Ì· Î·È ·Ú¯Èο ÙˆÓ Û˘ÁÁڷʤˆÓ, Ô Ù›ÙÏÔ˜ÙÔ˘ ‚È‚Ï›Ô˘, Ô ·ÚÈıÌfi˜ ¤Î‰ÔÛ˘, Ë fiÏË ¤Î‰ÔÛ˘. AÎÔ-ÏÔ˘ı› Ô ÂΉfiÙ˘, ÙÔ ¤ÙÔ˜ (¿Óˆ - οو ÙÂÏ›·) ÎÈ Ë ÛÂÏ›-‰·. ¶.¯. Ryge GM: Dental Corrosion. 2nd ed. NewYork. Harper and Row. 1985: 204.
AÓ Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ·ÔÙÂÏ› ÎÂÊ¿Ï·ÈÔÂÓfi˜ ‚È‚Ï›Ô˘ Ô˘ ¤¯ÂÈ ÁÚ·Ê› ·fi ¿ÏÏÔ Û˘ÁÁڷʤ·, Ë·Ó·ÊÔÚ¿ Á›ÓÂÙ·È ˆ˜ ÂÍ‹˜: Johnston AJ: CorrosionResistance of Amalgams. In: Goldman AK, Johns KO,eds. Restorative Materials, Baltimore: Williams andWilkins Co., 1984-87.
H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ˘ÂÓı˘Ì›˙ÂÈ ÛÙÔ˘˜ Û˘ÁÁÚ·-Ê›˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ fiÙÈ Î·Ïfi ›ӷÈ, ÛÙȘ ηٷÙÈı¤ÌÂÓ˜ÂÚÁ·Û›Â˜ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜·Ú·Ô̤˜, ÂÊfiÛÔÓ ‚¤‚·È· ˘Ê›ÛÙ·ÓÙ·È, ÔÈÔÙÈοEÏÏËÓÈο ¿ÚıÚ· Û¯ÂÙÈο Ì ÙÔ ı¤Ì·.
AÁÁÏÈ΋ ÂÚ›ÏË„Ë: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ, ÛÙËÓ AÁÁÏÈ΋ÁÏÒÛÛ·, Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È ÙÔÓ Ù›ÙÏÔ Ù˘ÂÚÁ·Û›·˜. ™ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ ı· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·È ÛÙÔȯ›· ÁÈ· fiÏ· Ù· ÎÂÊ¿Ï·È· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÎ·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı·Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë ÂÈÛ·ÁˆÁ‹ Ô ÛÎÔfi˜, Ù· ˘ÏÈÎ¿Î·È Ë Ì¤ıÔ‰Ô˜, Ù· ·ÔÙÂϤÛÌ·Ù· Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ηÈË Û˘˙‹ÙËÛË. H ¤ÎÙ·ÛË ÙˆÓ ÂÚÈÏ‹„ÂˆÓ ı· Ú¤ÂÈ Ó· ›-Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 1/4 ÙÔ˘ ÎÂÈ̤ÓÔ˘.
¶›Ó·Î˜: ¢·ÎÙ˘ÏÔÁÚ·ÊÔ‡ÓÙ·È Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË ÏÂ˙¿ÓÙ·. H ÏÂ˙¿ÓÙ· Ú¤ÂÈ Ó·Â›Ó·È Û‡ÓÙÔÌË Î·È Î·Ù·ÙÔÈÛÙÈ΋. AÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚È-ÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. OÈ ÂÂÍË-Á‹ÛÂȘ ÙˆÓ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ηıÒ˜ Î·È ¿ÏϘ ‰È¢ÎÚÈ-Ó‹ÛÂȘ, Á›ÓÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ›Ó·Î·.
EÈÎfiÓ˜: T· Û¯‹Ì·Ù·, Ù· ‰È·ÁÚ¿ÌÌ·Ù· Î·È ÔÈ ÊˆÙÔ-Áڷʛ˜ (ÂȘ ÙÚÈÏÔ‡Ó) Ú¤ÂÈ Ó· ÛÙ¤ÏÓÔÓÙ·È ÛÙÔ Úˆ-ÙfiÙ˘Ô Î·È Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜: ™ÙÔ ›Ûˆ ¿Óˆ‰ÂÍÈfi ̤ÚÔ˜ Ú¤ÂÈ Ó· ÁÚ¿ÊÔ˘Ó Ì ÌÔχ‚È ÙÔÓ ·ÚÈıÌfiÂÈÎfiÓ·˜. H οı ÛÂÈÚ¿ ʈÙÔÁÚ·ÊÈÒÓ Ú¤ÂÈ Ó· ÙÔÔıÂ-ÙÂ›Ù·È Û Í¯ˆÚÈÛÙfi Ê¿ÎÂÏÔ Î·È Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È Ù·ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ. OÈ ÏÂ˙¿ÓÙ˜ ÙˆÓ ÂÈÎfiÓˆÓÁÚ¿ÊÔÓÙ·È Ì ÙÔÓ ·‡ÍÔÓÙ· ·ÚÈıÌfi ÙÔ˘˜ ۠ͯˆÚÈÛÙfi¯·ÚÙ›. Y¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÎÙ‡ˆÛ˘ ¤Á¯ÚÒÌˆÓ ÂÈÎfi-ÓˆÓ ÌÂÙ¿ ·fi Û˘ÓÂÓÓfiËÛË Ì ÙÔ ¢È¢ı˘ÓÙ‹ ™‡ÓÙ·ÍË˜Î·È ÙËÓ ·ÔÛÙÔÏ‹ slides, ‹ ¤Á¯ÚÒÌˆÓ ÊˆÙÔÁÚ·ÊÈÒÓ.EÊfiÛÔÓ ÔÈ ÂÈÎfiÓ˜ ‹ Ù· ÈÛÙÔÁÚ¿ÌÌ·Ù· ηٷٛıÂÓÙ·È Î·ÈÌ ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹ (‰ÈÛΤٷ ‹ CD) Ú¤ÂÈ ÔˆÛ‰‹-ÔÙ ӷ Û˘Óԉ‡ÔÓÙ·È ·fi Ù· ·ÓÙ›ÁÚ·Ê¿ ÙÔ˘˜, ÂÎÙ˘ˆ-̤ӷ ÌÂ Û˘Ì‚·ÙÈÎfi ÙÚfiÔ, Û ηٿÏÏËÏ˘ ÔÈfiÙËÙ·˜¯·ÚÙ›.
OÈ ÂÈÎfiÓ˜ ı· Ú¤ÂÈ Ó· ¤¯Ô˘Ó Û·Úˆı› Ì ·Ó¿Ï˘ÛËÙÔ˘Ï¿¯ÈÛÙÔÓ 300 dpi Î·È Ó· ¤¯Ô˘Ó ÙË ÌÔÚÊ‹ ·Ú¯ÂȈÓJPG.
H ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ Á›ÓÂÙ·È ·fi ‰‡Ô ÎÚÈÙ¤˜ Ô˘¤¯Ô˘Ó ÂÈÏÂÁ› ·fi ÙËÓ EÈÙÚÔ‹ ™‡ÓÙ·Í˘. H ™˘ÓÙ·ÎÙÈ-΋ EÈÙÚÔ‹ ÙÔ˘ ¶ÂÚÈÔ‰ÈÎÔ‡ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó·ÚÔÙ›ÓÂÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ Ó· ·ÔÚÚ›ÙÂÈ Ù· ¿ÚıÚ· Ô˘‰ÂÓ Â›Ó·È ÁÚ·Ì̤ӷ Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜Û˘ÁÁÚ·Ê›˜.
OÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ÙËÓ ˘Ô¯Ú¤ˆÛË Ì›·˜ Ù˘ÔÁÚ·-ÊÈ΋˜ ‰ÈfiÚıˆÛ˘ ̤۷ Û 2 Ì‹Ó˜ ·fi ÙËÓ ·ÔÛÙÔÏ‹ÙÔ˘ ‰ÔÎÈÌ›Ô˘. MÂÙ¿ ÙËÓ ÛÙËÏÔı¤ÙËÛË ‰Â Á›ÓÔÓÙ·È ‰ÂÎÙ¤˜ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘.
T· ‰ËÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ·, ÂÈÎfiÓ˜ Î·È ‰È·ÁÚ¿ÌÌ·Ù··ÔÙÂÏÔ‡Ó È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. °È· ÙËÓ ·Ó·‰ËÌÔ-Û›Â˘Û‹ ÙÔ˘˜ Â›Ó·È ··Ú·›ÙËÙË Ë ¿‰ÂÈ· Ù˘ ™˘ÓÙ·ÎÙÈ΋˜EÈÙÚÔ‹˜ Î·È ÙÔ˘ Û˘ÁÁڷʤ·.
EÈÛ‹Ì·ÓÛË: °È· ÙËÓ ·Ú·Ï·‚‹ ÂÈÛÙËÌÔÓÈ΋˜ ÂÚÁ·-Û›·˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÂÙ·È ‰È·‚‚·›-ˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ Î·Ù·ÙÂı›Û ¿ÏÏÔ ÂÈÛÙËÌÔÓÈÎfi ¤ÓÙ˘Ô ÂÚÈÔ‰ÈÎÔ‡ Ù‡Ô˘.
stomatologika exof. 7-10-08 11:16 ™ÂÏ›‰· 608
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TÔ Ê‡Ú·Ì· Grossman ÚÔÙ¿ıËΠÙÔ 1936 Î·È ÌÂÙ¿ ·fi ÔÏϤ˜ ÙÚÔÔÔÈ‹ÛÂȘ η٤ÏËÍ ÙÔ1974 ÛÙËÓ ÌÔÚÊ‹ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ Û‹ÌÂÚ·. E›Ó·È Â˘Ú‡Ù·Ù· ‰È·‰Â‰Ô̤ÓÔ Û·Ó ÂÌÊÚ·ÎÙÈ-Îfi ˘ÏÈÎfi ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ ÏfiÁˆ Ù˘ ¢ÎÔÏ›·˜ ·Ó¿ÌÂÈ͢ Î·È ¯ÂÈÚÈÛÌÒÓ, Ù˘ Ï·ÛÙÈÎfiÙËÙ·˜Î·È ÙÔ˘ ÈηÓÔÔÈËÙÈÎÔ‡ ¯ÚfiÓÔ˘ ÂÚÁ·Û›·˜ Ô˘ ·Ú¤¯ÂÈ. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ fï˜ ÂÌÔÚÈΤ˜ Û˘-Û΢·Û›Â˜ ·Ó·Ê¤ÚÂÙ·È Î˘Ú›ˆ˜ Ô ÙÚfiÔ˜ ·Ó¿ÌÂÈ͢ Ù˘ ÛÎfiÓ˘ Ì ÙËÓ Â˘ÁÂÓfiÏË, ¯ˆÚ›˜ Ó· ‰›ÓÔ-ÓÙ·È Û˘ÁÎÂÎÚÈ̤Ó˜ Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙËÓ ·ÎÚÈ‚‹ ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ¢ÁÂÓfiÏ˘. H ·Ó¿ÌÂÈÍËÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Á›ÓÂÙ·È Ì ‚¿ÛË ÙȘ Ô‰ËÁ›Â˜ Ô˘ ‰fiıËÎ·Ó ·fi ÙÔÓ Grossman Ì ÙË ̄ Ú‹ÛË ‰Ô-ÎÈÌ·ÛÈÒÓ «ÛÙ‹Ï˘» Î·È «ÛÙ·ÁfiÓ·˜».™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙ› ·Ó ÙÔ ÎÚÈÙ‹ÚÈÔ Ù˘ ȉ·ÓÈ΋˜ Û‡ÛÙ·Û˘ (‰Ô-ÎÈÌ·Û›· Ù˘ «ÛÙ‹Ï˘» ‹ «ÛÙ·ÁfiÓ·˜») ÂÍ·ÛÊ·Ï›˙ÂÈ ÛÙ·ıÂÚ‹ ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ˘ÁÚÔ‡ ηٿ ÙËÓÎÏÈÓÈ΋ Ú¿ÍË.ZËÙ‹ıËΠ۠¤ÓÙ ÁÂÓÈÎÔ‡˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ Î·È Ù¤ÛÛÂÚȘ ÂÓ‰Ô‰ÔÓÙÈÛÙ¤˜ Ó· Ú·ÁÌ·ÙÔÔÈ‹ÛÔ˘Ó·Ó·Ì›ÍÂȘ Ê˘Ú¿Ì·ÙÔ˜ Grossman Ì ÙÔÓ ÙÚfiÔ Ô˘ ÙȘ ÂÊ·ÚÌfi˙Ô˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ڿÍË. °È· ÙÔ ÛÎÔfi ·˘Ùfi ÙÔ˘˜ ‰fiıËÎÂ Û˘ÁÎÂÎÚÈ̤ÓË ÔÛfiÙËÙ· ¢ÁÂÓfiÏ˘ Î·È ¿ÁÓˆÛÙË ÔÛfi-ÙËÙ· ÛÎfiÓ˘ ·fi ÙËÓ ÔÔ›· ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÌfiÓÔ ÙËÓ ÔÛfiÙËÙ· Ô˘ ¤ÎÚÈÓ·Ó. TÔ Ê‡Ú·Ì· Ô˘¯ÚËÛÈÌÔÔÈ‹ıËΠ‹Ù·Ó ÙÔ Roth's 811. H ·Ó¿ÌÂÈÍË Ì ÙËÓ Â˘ÁÂÓfiÏË ¤ÁÈÓ Û Á˘¿ÏÈÓË Ï¿Î· Ì ÌÂ-Ù·ÏÏÈ΋ Û¿ıË, ÛÙȘ ›‰È˜ Û˘Óı‹Î˜ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ™ÙË Û˘Ó¤¯ÂÈ· ÌÂÙÚ‹ıËÎÂ Ë ÔÛfiÙËÙ· ÛÎfiÓ˘ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛÂ Ô Î¿ı ԉÔÓÙ›·ÙÚÔ˜. H ÔÛfi-ÙËÙ· ÛÎfiÓ˘ Ô˘ ̄ ÚËÛÈÌÔÔÈ‹ıËΠ·fi οı ԉÔÓÙ›·ÙÚÔ Î˘Ì·›ÓÔÓÙ·Ó ÌÂٷ͇ 5,39 gr Î·È 6,34 grÎ·È ÁÈ· ÙËÓ ÔÌ¿‰· B ·fi 4,60 gr ˆ˜ 7,32 gr. OÈ Ì¤ÛÔÈ fiÚÔÈ ‹Ù·Ó ÌÂٷ͇ 5,38 - 6,15 gr ÁÈ· ÙËÓ Ô-Ì¿‰· A Î·È ÌÂٷ͇ 4,56-7,14 gr ÁÈ· ÙËÓ B. AÎÔÏÔ‡ıËÛ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ë ÔÔ›· ¤‰ÂÈÍ fiÙÈ: ·) ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ÛÙË ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ˘ÁÚÔ‡ ÌÂٷ͇ ÙˆÓ ÁÂÓÈÎÒÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ Î·È ÙˆÓ ÂÓ-‰Ô‰ÔÓÙÈÛÙÒÓ (p<0.001) Î·È ‚) ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ·Ó·ÏÔÁ›· ηٿÙȘ ·Ó·Ì›ÍÂȘ Ô˘ ¤ÁÈÓ·Ó Û ‰È·ÊÔÚÂÙÈ΋ Ë̤ڷ ·fi ÙÔÓ ›‰ÈÔ ÁÂÓÈÎfi Ô‰ÔÓÙ›·ÙÚÔ (p=0.6732) ‹ÂÓ‰Ô‰ÔÓÙÈÛÙ‹ (p=0.6802).Œ¯ÂÈ ‚ÚÂı› Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, fiÙÈ Ë ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ˘ÁÚÔ‡ ·›˙ÂÈ ÛË-Ì·ÓÙÈÎfi ÚfiÏÔ ÛÙȘ Ê˘ÛÈΤ˜ Î·È ‚ÈÔÏÔÁÈΤ˜ ȉÈfiÙËÙ˜ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜. EÔ̤ӈ˜, ÔÈ ‰È·ÊÔÚÂÙÈΤ˜·Ó·Ì›ÍÂȘ Â›Ó·È Èı·Ófi Ó· Ô‰ËÁÔ‡Ó ÛÂ Ê˘Ú¿Ì·Ù· Ì ‰È·ÊÔÚÂÙÈΤ˜ ȉÈfiÙËÙ˜ ·fi ÙȘ ÂÈı˘ÌËÙ¤˜Û fiÙÈ ·ÊÔÚ¿ ÙȘ Ê˘ÛÈÎÔ¯ËÌÈΤ˜ Î·È ÙȘ ‚ÈÔÏÔÁÈΤ˜ ÙÔ˘ ȉÈfiÙËÙ˜. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂÈÛË-Ì·›ÓÂÙ·È Ë ‰È·ÊÔÚ¿ Ô˘ ˘¿Ú¯ÂÈ ÌÂٷ͇ ÙˆÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ ÛÙËÓ Û‡ÛÙ·ÛË ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜Grossman Î·È ÙÔÓ›˙ÂÙ·È Ô ÂÌÂÈÚÈÛÌfi˜ Ô˘ ÂÈÎÚ·Ù› ÛÙËÓ ·Ó¿ÌÂÈÍË ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ÙfiÛÔ Û Â-›Â‰Ô ıˆÚËÙÈÎÒÓ Î·Ù¢ı‡ÓÛÂˆÓ fiÛÔ Î·È ÛÂ Â›Â‰Ô ÎÏÈÓÈ΋˜ Ú¿Í˘.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 9-12, 2004
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O Grossman ÚfiÙÂÈÓ ÙÔ 1936 ʇڷ̷ ÁÈ· ÙËÓ ¤ÌÊÚ·ÍËÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ Ì ‚¿ÛË ÙÔ ÔÍ›‰ÈÔ ÙÔ˘ „¢‰·ÚÁ‡-ÚÔ˘ Î·È ÙËÓ Â˘ÁÂÓfiÏË, ÙÔ ÔÔ›Ô ÌÂÙ¿ ·fi ÔÏϤ˜ ÙÚÔÔ-ÔÈ‹ÛÂȘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·fi ÙÔ 1974 Ì ÙË ÛËÌÂÚÈÓ‹ÙÔ˘ ÌÔÚÊ‹(1-4). H ¢Ú›· ‰È¿‰ÔÛË Î·È ̄ Ú‹ÛË ÙÔ˘ Ê˘Ú¿Ì·-ÙÔ˜ Grossman ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ Â˘ÎÔÏ›· ·Ó¿ÌÂÈ-Í‹˜ ÙÔ˘, ÙËÓ Ï·ÛÙÈÎfiÙËÙ¿ ÙÔ˘, ÙÔÓ Â·Ú΋ ̄ ÚfiÓÔ ÂÚÁ·-Û›·˜ Ô˘ ·Ú¤¯ÂÈ, ÙÔ fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚ¤˜ ÔÁÎÔÌÂÙÚÈ-
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§¤ÍÂȘ ÎÏÂȉȿ: º‡Ú·Ì· Grossman, ¤ÌÊÚ·ÍË ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ.
* O‰ÔÓÙ›·ÙÚÔ˜.** O‰ÔÓÙ›·ÙÚÔ˜.
*** O‰ÔÓÙ›·ÙÚÔ˜, AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ EÓ‰Ô‰ÔÓÙÔÏÔÁ›·˜AÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢.
EÚÁ·ÛÙ‹ÚÈÔ EÓ‰Ô‰ÔÓÙÔÏÔÁ›·˜ AÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘£ÂÛÛ·ÏÔӛ΢. ¢È¢ı˘ÓÙ‹˜: K·ıËÁËÙ‹˜ ¢ËÌ‹ÙÚÈÔ˜ T˙È·Ê¿˜
H ÂÚÁ·Û›· ·Ó·ÎÔÈÓÒıËΠÛÙÔ 22Ô ¶.O.™., Kˆ˜, 2002
9-12 SEL. - Mazinis** 3-10-08 12:55 ™ÂÏ›‰· 9
Τ˜ ÌÂÙ·‚ÔϤ˜ ηٿ ÙËÓ ‹ÍË ÙÔ˘ Î·È Ù¤ÏÔ˜ ÛÙÔ ¯·ÌËÏfiÙÔ˘ ÎfiÛÙÔ˜(4, 5). H ‹ÍË ÙÔ˘ ÔÊ›ÏÂÙ·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙԢ¢ÁÂÓÔÏÈÎÔ‡ „¢‰·ÚÁ‡ÚÔ˘, ÂÓfi˜ ·ÛÙ·ıÔ‡˜ Û˘ÌÏfi-ÎÔ˘, Ô˘ ‡ÎÔÏ· ˘‰ÚÔχÂÙ·È(6). ™ÙÔ ÂÌfiÚÈÔ Î˘ÎÏÔÊÔ-ÚÔ‡Ó ‰È¿ÊÔÚ· Û΢¿ÛÌ·Ù· Ù‡Ô˘ Grossman (fiˆ˜ ÙÔʇڷ̷ Roth Ô˘ ¤¯ÂÈ Â˘Ú›· ¯Ú‹ÛË) Ù· ÔÔ›· ·Ó·Ê¤-ÚÔ˘Ó ÙÔÓ ÙÚfiÔ ·Ó¿ÌÂÈ͢ Ù˘ ÛÎfiÓ˘ Ì ÙËÓ Â˘ÁÂÓfiÏ˯ˆÚ›˜ fï˜ Ó· ‰›ÓÔ˘Ó ÚÔηıÔÚÈṲ̂ÓË ·Ó·ÏÔÁ›· ÛÎfi-Ó˘ / ˘ÁÚÔ‡(7). E›Ó·È ÂÓ ÙÔ‡ÙÔȘ ÁÓˆÛÙfi ·fi ÔÈΛϘ ¤Ú¢Ó˜ fiÙÈ Ë ÌÂ-Ù·‚ÔÏ‹ ÛÙËÓ ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ̆ ÁÚÔ‡ ÌÔÚ› Ó· ÂËÚÂ-¿ÛÂÈ ÛËÌ·ÓÙÈο ÙȘ ‚ÈÔÏoÁÈΤ˜ Î·È Ê˘ÛÈÎÔ¯ËÌÈΤ˜ ȉÈfiÙË-Ù˜ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜. AÓ·Ì›ÍÂȘ Ì ‰È·ÊÔÚÂÙÈΤ˜ ·Ó·ÏÔ-Á›Â˜ ÛÎfiÓ˘ / ¢ÁÂÓfiÏ˘ Ô‰ËÁÔ‡Ó ÛÂ Ê˘Ú¿Ì·Ù· Ì ‰È·-ÊÔÚÂÙÈΤ˜ ÌÂٷ͇ ÙÔ˘˜ ȉÈfiÙËÙ˜ Û fiÙÈ ·ÊÔÚ¿ ÙȘ ÔÁÎÔ-ÌÂÙÚÈΤ˜ ÌÂÙ·‚ÔϤ˜ ηٿ ÙËÓ ‹ÍË, ÙËÓ ‰È·Ï˘ÙfiÙËÙ¿ÙÔ˘˜, ÙËÓ ÈηÓfiÙËÙ· ÚÔÛÎfiÏÏËÛ˘ ÛÙ· Ô‰ÔÓÙÈÓÈο ÙÔÈ-¯ÒÌ·Ù· ·ÏÏ¿ Î·È ÙËÓ ‚ÈÔÏÔÁÈ΋ ÙÔ˘˜ ‰Ú¿ÛË, ÛÙÔȯ›·Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ ÂÚÌËÙÈ΋ ¤ÌÊÚ·ÍË ÙˆÓ ÚÈ˙ÈÎÒÓ Ûˆ-Ï‹ÓˆÓ Î·È ÙË ÛÙ·ıÂÚfiÙËÙ· ÙˆÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘˜ ÛÙÔÓ ̄ Úfi-ÓÔ(7-13).™‡Ìʈӷ Ì ÙÔÓ Grossman, ÙÔ Ê‡Ú·Ì· ¤¯ÂÈ ÙËÓ È‰·ÓÈ΋ÎÏÈÓÈ΋ Û‡ÛÙ·ÛË fiÙ·Ó ÏËÚ› ÙȘ ÂÍ‹˜ Û˘Óı‹Î˜: ·) fiÙ·Ó··ÈÙÂ›Ù·È ¯ÚfiÓÔ˜ 10-15 ‰Â˘ÙÂÚÔÏ¤ÙˆÓ ÁÈ· Ó· Î˘Ï‹ÛÂÈ·fi ÙËÓ ¿ÎÚË Ù˘ Û¿ı˘ (‰ÔÎÈÌ·Û›· «ÛÙ·ÁfiÓ·˜») Î·È ‚)fiÙ·Ó Ë Û¿ıË ÙÔÔıÂÙËı› ÛÙË Ì¿˙· ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ηȷӷÛËΈı› ·Ú¿ÏÏËÏ· Ì ÙËÓ Ï¿Î·, Û¯ËÌ·Ù›˙ÂÙ·ÈÛÙ‹ÏË Ì‹ÎÔ˘˜ ÂÚ›Ô˘ 2.5 ÂÎ. Ë ÔÔ›· Â›Ó·È Û˘Ó¯‹˜ ηȉÂÓ ‰È·Û¿Ù·È (‰ÔÎÈÌ·Û›· «ÛÙ‹Ï˘»)(4). °ÂÓÈο, ‰ÂÓ ¤¯ÂÈ Â-Ú¢ÓËı› ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ ·˘Ù¤˜ ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÛÙ·ıÂÚ‹·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ˘ÁÚÔ‡ ηٿ ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË.™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ÂÚ¢ÓËı› ηٿ fiÛÔ,¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË ‰ÔÎÈÌ·Û›· «ÛÙ‹Ï˘» ‹ «ÛÙ·ÁfiÓ·˜»,Ô ÎÏÈÓÈÎfi˜ ÂÈÙ˘Á¯¿ÓÂÈ ÌÈ· ÛÙ·ıÂÚ‹ ‰ÔÛÔÏÔÁ›· ÛÎfiÓ˘ /˘ÁÚÔ‡.
Y§IKA KAI ME£O¢O™
EÓÓ¤· Ô‰ÔÓÙ›·ÙÚÔÈ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó Ê‡Ú·Ì·Grossman ÁÈ· ÙËÓ ¤ÌÊÚ·ÍË ÙˆÓ ÚÈ˙ÈÎÒÓ ÛˆÏ‹ÓˆÓ ¤Ï·-‚·Ó ̤ÚÔ˜ ÛÙËÓ ¤Ú¢ӷ ·˘Ù‹. ¶¤ÓÙ ÁÂÓÈÎÔ› Ô‰ÔÓÙ›·ÙÚÔÈ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· (A) Î·È Ù¤ÛÛÂÚȘ Ô‰ÔÓÙ›·ÙÚÔÈÔ˘ ·Û¯ÔÏÔ‡ÓÙ·È ÂȉÈο Ì ÙËÓ ÂÓ‰Ô‰ÔÓÙ›·, ÙËÓ ÔÌ¿‰·(B). ŸÏÔÈ ÔÈ Ô‰ÔÓÙ›·ÙÚÔÈ ·Ó¤ÊÂÚ·Ó fiÙÈ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙËÓ ‰ÔÎÈÌ·Û›· Ù˘ «ÛÙ‹Ï˘» Û·Ó ÎÚÈÙ‹ÚÈÔ Ù˘ Û‡ÛÙ·Û˘
ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜. °È· ÙË ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËΠʇڷ̷ Ù‡Ô˘Grossman (Roth's Sealer Grade 811, Roth International,Chicago, Il, USA) Î·È ¯ËÌÈο ηı·Ú‹ ¢ÁÂÓfiÏË (Oxyzinc,Septodont, France). ™Â οı ԉÔÓÙ›·ÙÚÔ ‰fiıËÎ·Ó Ù¤Û-ÛÂÚ· ·ÂÚÔÛÙÂÁ‹ ÊÈ·Ï›‰È· Ì ÚÔ˙˘ÁÈṲ̂ÓË ÔÛfiÙËÙ·ÛÎfiÓ˘ (ÂÚ›Ô˘ 10 ÁÚ·ÌÌ¿ÚÈ·). ZËÙ‹ıËΠ·fi οı Ô-‰ÔÓÙ›·ÙÚÔ Ó· ·Ú·Û΢¿ÛÂÈ ÙÔ Ê‡Ú·Ì· Grossman ÌÂÙÔÓ ›‰ÈÔ ÙÚfiÔ Ô˘ ÙÔ ¯ÚËÛÈÌÔÔÈ› ÛÙËÓ Î·ıËÌÂÚÈÓ‹ÎÏÈÓÈ΋ Ú¿ÍË. °È· ÙÔ ÛÎÔfi ·˘Ùfi, ÙÔÔıÂÙ‹ıËΠÛÙËÁ˘¿ÏÈÓË Ï¿Î· 1ml ¢ÁÂÓfiÏ˘ Ì·˙› Ì ÙÔ ÂÚȯfiÌÂÓÔηıÂÓfi˜ ÊÈ·Ïȉ›Ô˘. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙ·‰È·Î¿ Û fi-ÏË ÙËÓ ÔÛfiÙËÙ· Ù˘ ¢ÁÂÓfiÏ˘, Ë ÂÓۈ̿وÛË ÙfiÛ˘ÔÛfiÙËÙ·˜ ÛÎfiÓ˘ fiÛ˘ ıˆÚÔ‡ÛÂ Ô Ô‰ÔÓÙ›·ÙÚÔ˜ ˆ˜··Ú·›ÙËÙË. H ·Ó¿ÌÂÈÍË ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ¤ÁÈÓ ÛÙËÓ ›‰È·Á˘¿ÏÈÓË Ï¿Î· ¿¯Ô˘˜ 20 ¯ÈÏ. Ì ÙË ¯Ú‹ÛË Ù˘ ›‰È·˜ ÌÂ-Ù·ÏÏÈ΋˜ Û¿ı˘ ·Ó¿ÌÂÈ͢ #24. H ÔÛfiÙËÙ· Ù˘ ÛÎfiÓ˘ Ô˘ ÂÚ›ÛÛ„ ÌÂÙ¿ ÙËÓ ·Ó¿-ÌÂÈÍË ˙˘Á›ÛÙËΠ̠˙˘Áfi ·ÎÚȂ›·˜ (Presica 180A,Switzerland). °È· ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ÛÎfiÓ˘ Ô˘ ÂÓÛˆ-Ì·ÙÒıËΠ(MÂÓÛ), ·Ê·ÈÚ¤ıËÎÂ Ë ÂÚ›ÛÛÂÈ· (MÂÚ) ·fiÙËÓ ·Ú¯È΋ Ì¿˙· (M·Ú¯).¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ·fi οı ԉÔÓÙ›·ÙÚÔ ‰‡Ô ·Ó·Ì›-ÍÂȘ ÙËÓ ÚÒÙË Ë̤ڷ Î·È ‰‡Ô ÙËÓ ÂfiÌÂÓË. OÈ Û˘Óı‹Î˜ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ηٿ ÙËÓ ·Ó¿ÌÂÈÍË ‹Ù·Ó 24Æ C ± 2ÆC ıÂÚÌÔÎÚ·Û›· Î·È Ë Û¯ÂÙÈ΋ ˘ÁÚ·Û›· 50% ± 10%.
A¶OTE§E™MATA
H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙËÓ‰ÔÎÈÌ·Û›· ·Ó¿Ï˘Û˘ ‰È·Î‡Ì·ÓÛ˘ (one-way analysis ofvariance, ANOVA) Î·È ÙËÓ ‰ÔÎÈÌ·Û›· t ÁÈ· ηٿ ̇ ‡ÁË ·-Ú·ÙËÚ‹ÛÂȘ (paired t-test) ÁÈ· Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜0.05. OÈ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·Ó·ÏÔÁ›· ·Ó¿ÌÂÈ͢ ÌÂٷ͇ ÙˆÓÔÌ¿‰ˆÓ ÙˆÓ ÁÂÓÈÎÒÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ Î·È ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈ-ÛÙÒÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙË ‰ÔÎÈÌ·Û›· Tukey -Kramer ÁÈ· ÔÏϷϤ˜ Û˘ÁÎÚ›ÛÂȘ. H ÔÛfiÙËÙ· ÛÎfiÓ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·fi οı Ô-‰ÔÓÙ›·ÙÚÔ ·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔÓ ›Ó·Î· 1 ÁÈ· ÙËÓ ÔÌ¿‰·(A) Î·È ÛÙÔÓ ›Ó·Î· 2 ÁÈ· ÙËÓ ÔÌ¿‰· (B). OÈ ÙÈ̤˜ ÁÈ· ÙËÓÔÌ¿‰· A Î˘Ì¿ÓıËÎ·Ó ÌÂٷ͇ 5,39 - 6,34 gr Î·È ÁÈ· ÙËÓÔÌ¿‰· B ·fi 4,60 gr - 7,32 gr. OÈ Ì¤ÛÔÈ fiÚÔÈ ‹Ù·Ó ÌÂÙ·-͇ 5,38 - 6,15 gr (ÔÌ¿‰· A) Î·È ÌÂٷ͇ 4,56 - 7,14 gr (Ô-Ì¿‰· B).
10
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 9-12, 2004
¶INAKA™ 1¶ÔÛfiÙËÙ· ÛÎfiÓ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·fi ÁÂÓÈÎÔ‡˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ ÁÈ· ÙËÓ ·Ú·Û΢‹ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ (OÌ¿‰· A)
H̤ڷ 1 H̤ڷ 2M ÂÓÛ. M ÂÓÛ.
°ENIKOI ¢ÔÎ1 ¢ÔÎ2 ¢ÔÎ3 ¢ÔÎ4 MO (gr) S.D. 1 6,22 gr 5,92 gr 6,13 gr 6,34 gr 6,15 17.72 2 5,39 gr 5,41 gr 5,51 gr 5,22 gr 5,38 12.03 3 6,06 gr 5,82 gr 6,17 gr 6,09 gr 6,03 15.06 4 6,30 gr 5,97 gr 5,89 gr 6,12 gr 6,07 18.05 5 5,83 gr 6,11 gr 5,81 gr 6,00 gr 5,93 14.31
9-12 SEL. - Mazinis** 3-10-08 12:55 ™ÂÏ›‰· 10
Y¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ Ô‰ÔÓÙÈ¿ÙÚˆÓ, ÂÓ‰Ô-‰ÔÓÙÈÛÙÒÓ, ηıÒ˜ Î·È ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ÛÙ˯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ̆ ÁÚÔ‡ (p<0.001).¢ÂÓ ˘¿Ú¯ÂÈ fï˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·Ó·-ÏÔÁÈÒÓ ÛÙȘ ·Ó·Ì›ÍÂȘ Ô˘ ¤ÁÈÓ·Ó Û ‰È·ÊÔÚÂÙÈ΋ Ë̤-Ú· ·fi ÙÔÓ ›‰ÈÔ ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ, ÙfiÛÔ ÛÙËÓ ÔÌ¿‰· A(p=0.6732), fiÛÔ Î·È ÛÙËÓ B (p=0.6802). ™‡Ìʈӷ Ì ÙˉÔÎÈÌ·Û›· Tukey-Kramer ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ ‰È·ÊÔÚ¤˜ ·-ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÛÙËÓ ÔÌ¿‰· B, ÙˆÓ ÂÓ‰Ô‰ÔÓÙÈÛÙÒÓ (p<0.001).
™YZHTH™H
TÔ Ê‡Ú·Ì· Ù‡Ô˘ Grossman Â›Ó·È ·fi Ù· ÈÔ ÎÔÈÓ¿ Ê˘-Ú¿Ì·Ù· ÂÓ‰Ô‰ÔÓÙ›·˜ ÁÈ'·˘Ùfi Î·È ·ÔÙ¤ÏÂÛ ·ÓÙÈΛÌÂÓÔ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜. ™·Ó ÎÚÈÙ‹ÚÈÔ Î·Ù¿ÏÏËÏ˘ Û‡ÓıÂ-Û˘ ÚÔÙ›ÓÂÙ·È ·fi ÙÔÓ Î·Ù·Û΢·ÛÙ‹ ÛÙË Û˘Û΢·-Û›· ÙÔ˘ Roth's 811 Ë ‰ÔÎÈÌ·Û›· Ù˘ «ÛÙ‹Ï˘» ÂÓÒ ‰ÂÓ ‰›-ÓÂÙ·È Î·ÌÈ¿ Ô‰ËÁ›· ÁÈ· ÙËÓ ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ̆ ÁÚÔ‡ Ô˘Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈËı›.H ‰ÔÎÈÌ·Û›· Ù˘ «ÛÙ‹Ï˘» Ì·˙› Ì ·˘Ù‹ Ù˘ «ÛÙ·ÁfiÓ·˜»·ÔÙÂÏÔ‡Ó ‰‡Ô ‚·ÛÈο ÎÚÈÙ‹ÚÈ· ηٿÏÏËÏ˘ Û‡ÛÙ·ÛË˜Ô˘ ¤¯ÂÈ ÚÔÙ›ÓÂÈ Ô Grossman(4) Î·È ¿ÏÏ· ÎÏ·ÛÛÈο Û˘Á-ÁÚ¿ÌÌ·Ù· ÂÓ‰Ô‰ÔÓÙ›·˜(5). OÈ ÂÓÓ¤· Ô‰ÔÓÙ›·ÙÚÔÈ Ô˘ ‹-Ú·Ó Ì¤ÚÔ˜ ÛÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÂÊ·ÚÌfi˙Ô˘Ó ÙÔ ÎÚÈÙ‹ÚÈÔÙ˘ «ÛÙ‹Ï˘», ÙÔ ÔÔ›Ô Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈ-Ô‡ÌÂÓÔ. T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ¤-‰ÂÈÍ·Ó fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ‰ÔÎÈÌ·Û›·˜ ·˘Ù‹˜ ‰ÂÓ Û˘ÓÂ-¿ÁÂÙ·È ÛÙ·ıÂÚ‹ ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ˘ÁÚÔ‡ ÛÙ· Ê˘Ú¿-Ì·Ù· Ù‡Ô˘ Grossman. OÈ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÔÛfiÙËÙ· Ù˘ÛÎfiÓ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-Τ˜ ÙfiÛÔ ÌÂٷ͇ ÙˆÓ ÁÂÓÈÎÒÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ fiÛÔ Î·È ÙˆÓÂÓ‰Ô‰ÔÓÙÈÛÙÒÓ. TÔ ÎÚÈÙ‹ÚÈÔ ‰Â Ù˘ «ÛÙ‹Ï˘» Â›Ó·È Î·ı·-Ú¿ ÂÌÂÈÚÈÎfi Î·È ‰ÂÓ ÂÍ·ÛÊ·Ï›˙ÂÈ ÛÙ·ıÂÚ‹ ·Ó·ÏÔÁ›·, Â-Ô̤ӈ˜ Â›Ó·È ·Ó·Áη›Ô Ó· ηıÔÚ›˙Ô˘Ó ÔÈ Î·Ù·Û΢·-ÛÙ¤˜ ÙËÓ ··Ú·›ÙËÙË ·Ó·ÏÔÁ›·(7).¢È·ÊÔÚ¤˜ η٤ÁÚ·„·Ó Î·È ÔÈ Benatti Î·È Û˘Ó(11) ÌÂٷ͇‰¤Î· ÂÓ‰Ô‰ÔÓÙÈÛÙÒÓ Ô˘ ÚÔÛ¿ıËÛ·Ó Ó· ηıÔÚ›ÛÔ˘ÓÙËÓ «È‰·ÓÈ΋» ·Ó·ÏÔÁ›· ÛÎfiÓ˘ / ̆ ÁÚÔ‡ ÔÚÈÛÌ¤ÓˆÓ Â˘ÁÂ-ÓÔÏÔ‡¯ˆÓ ÂÓ‰Ô‰ÔÓÙÈÎÒÓ Ê˘Ú·Ì¿ÙˆÓ. Œ¯ÂÈ ‰È·ÈÛÙˆı›·fi ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ Ë ÛËÌ·ÓÙÈ΋ ›‰Ú·ÛË Ù˘ ·Ó·-ÏÔÁ›·˜ ÛÎfiÓ˘ / ˘ÁÚÔ‡ ÛÙȘ ȉÈfiÙËÙ˜ ÙÔ˘ ˘ÏÈÎÔ‡, fiˆ˜ÙË ‰È·Ï˘ÙfiÙËÙ·(12), Ù· ÚÔÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο(10), ÙËÓÔÁÎÔÌÂÙÚÈ΋ ÛÙ·ıÂÚfiÙËÙ· Î·È ÙË ÛÎÏËÚfiÙËÙ¿ ÙÔ˘(7, 11). OȉȷÊÔÚ¤˜ ÛÙË Û‡ÛÙ·ÛË Î·ıÔÚ›˙Ô˘Ó ÙËÓ ·ÓÙÈÌÈÎÚÔ‚È·Î‹Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜(7) fiˆ˜ ›Û˘ Î·È ÙËÓ È-ı·ÓfiÙËÙ· ΢ÙÙ·ÚÔÙÔÍÈ΋˜ ÙÔ˘ ‰Ú¿Û˘ ÏfiÁˆ Ù˘ ̆ ÔÏÂÈ-fiÌÂÓ˘ ¢ÁÂÓfiÏ˘ Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤ÚıÂÈ Û ·-
Ê‹ Ì ÙÔ˘˜ ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÔ‡˜ ÈÛÙÔ‡˜(13). H ÔÛfiÙËÙ· Ù˘ ÛÎfiÓ˘ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ οı ÎÏÈÓÈ-Îfi˜ ηٿ ÙȘ ·Ó·Ì›ÍÂȘ Ù˘ ›‰È·˜ ‹ Ù˘ ÂfiÌÂÓ˘ Ë̤-Ú·˜ ‰ÂÓ ·ÚÔ˘Û›·Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜.A˘Ùfi Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Î¿ı ԉÔÓÙ›·ÙÚÔ˜ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ, ·Ó Î·È ¯ÚËÛÈÌÔÔÈ› ÁÈ· ÙÔÓ ¤-ÏÂÁ¯Ô Ù˘ Û‡ÛÙ·Û˘ ÙË ‰ÔÎÈÌ·Û›· «ÛÙ‹Ï˘», ¤¯ÂÈ ÚÔ-ÛˆÈÎfi ÙÚfiÔ ·Ó¿ÌÈ͢ Î·È ÂÔ›ıËÛË ÁÈ· ÙËÓ Î·Ù¿ÏÏË-ÏË Û‡ÛÙ·ÛË ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙȘ Ô‰Ë-Á›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹ Î·È ÙË ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ÂÓ‰Ô‰Ô-ÓÙ›·˜. ¶Èı·Ó¿ ÂÂÈÛ¤Ú¯ÔÓÙ·È ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ô Ù‡Ô˜ÙÔÓ ‰ÔÓÙÈÒÓ (ÌÔÓfiÚÚÈ˙·-ÔχÚÚÈ˙·) ‹ ·Ó ı· Ú·ÁÌ·ÙÔ-ÔÈËıÔ‡Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ÂÌÊÚ¿ÍÂȘ ÙËÓ ›‰È· Ë̤-Ú· Ì ÙÔ ›‰ÈÔ Ê‡Ú·Ì·.
™YM¶EPA™MATA
™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂÈÛËÌ·›ÓÂÙ·È Ë ‰È·ÊÔÚ¿ Ô˘ ˘-¿Ú¯ÂÈ ÌÂٷ͇ ÙˆÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ ÛÙËÓ Û‡ÛÙ·ÛË ÙÔ˘ Ê˘-Ú¿Ì·ÙÔ˜ Grossman. TÔÓ›˙ÂÙ·È Ô ÂÌÂÈÚÈÛÌfi˜ Ô˘ ÂÈ-ÎÚ·Ù› ÛÙËÓ ·Ó¿ÌÂÈÍË ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ ÙfiÛÔ Û ›‰ÔıˆÚËÙÈÎÒÓ Î·Ù¢ı‡ÓÛÂˆÓ fiÛÔ Î·È ÛÂ Â›Â‰Ô ÎÏÈÓÈ΋˜Ú¿Í˘. T· Û˘ÌÂÚ¿ÛÌ·Ù· Â›Ó·È ÂÓ‰ÂÈÎÙÈο ÁÈ·Ù› Èı·Ó¿ı· ¯ÚÂÈ·˙fiÙ·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‰Â›ÁÌ· Ô‰ÔÓÙÈ¿ÙÚˆÓ Î·È Â-ÚÈÛÛfiÙÂÚ˜ ·Ó·Ì›ÍÂȘ ÁÈ· Ó· ÁÂÓÈ΢ıÔ‡Ó Ù· ·ÔÙÂϤ-ÛÌ·Ù·. ¶ÂÚ·ÈÙ¤Úˆ ÂÚÁ·Û›Â˜ ı· ‹Ù·Ó ··Ú·›ÙËÙ˜ ÁÈ·ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ‰È·ÊÔÚÒÓ ·ÏÏ¿ Î·È ÙË Û˘Û¯¤ÙÈÛËÙ˘ ·Ó·ÏÔÁ›·˜ ÛÎfiÓ˘ ˘ÁÚÔ‡ fi¯È ÌfiÓÔ Ì ÙȘ ‚ÈÔÏÔÁÈΤ˜Î·È Ê˘ÛÈΤ˜ ȉÈfiÙËÙ˜ ·ÏÏ¿ Î·È Ì ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙ˜.
SUMMARY
“Differences in powder-liquid ratio amongdentists during preparation of Grossman -
Type sealer”E. Mazinis, J. Margelos, T. Lambrianidis
hellenic stomatological review 48: 9-12, 2004
Grossman proposed in 1936 a zinc oxide - eugenol basedroot canal sealer, which by various modifications is usedwith its current form since 1974. The popularity ofGrossman's cement results from its plasticity, its slowsetting time combined with a good sealing potential, thesmall volumetric changes upon setting and finally from itslow cost. The basic reaction of the cement formation isacid - base type as eugenol, a weak organic acid, is
11
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 9-12, 2004
¶INAKA™ 2¶ÔÛfiÙËÙ· ÛÎfiÓ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·fi ÙÔ˘˜ ÂÓ‰Ô‰ÔÓÙÈÛÙ¤˜ ÁÈ· ÙËÓ ·Ú·Û΢‹ ÙÔ˘ Ê˘Ú¿Ì·ÙÔ˜ (OÌ¿‰· B).
H̤ڷ 1 H̤ڷ 2M ÂÓÛ. M ÂÓÛ.
EI¢IKOI ¢ÔÎ1 ¢ÔÎ2 ¢ÔÎ3 ¢ÔÎ4 MO (gr) S.D.6 7,15 gr 6,82 gr 7,27 gr 7,32 gr 7,14 22.497 4,52 gr 4,59 gr 4,60 gr 4,53 gr 4,56 4.08 8 5,34 gr 5,54 gr 5,76 gr 5,45 gr 5,52 17.829 6,31 gr 6,55 gr 6,25 gr 6,41 gr 6,38 13.11
9-12 SEL. - Mazinis** 3-10-08 12:55 ™ÂÏ›‰· 11
reacting with zinc oxide in order to form zinc eugenolate.Most Grossman's type sealers are marketed with mixinginstructions but with no strict mixing ratios. According toGrossman, the cement has its ideal clinical consistencywhen: a) after manipulation, the mass of cement gatheredonto the spatula requires 10-15 seconds to drop off('drop' test), and b) after touching the mass of cementwith its flat surface, the spatula is raised up at least 2.5 cmwithout breaking the cement ('string' test). Theseinstructions are rather empiric, as the amount of liquid andpowder required for obtaining the ideal physicalproperties of the cement is not determined accurately. Itis, however, accepted from various researches that thealteration of powder / liquid ratio may influence thephysical (volumetric changes, solubility, hardness,adhesion) and the biological properties of the cement. Aim of this study was to determine whether the mixingcriteria result, in clinical practice, in constant powder /liquid ratio among dentists.For this purpose, nine dentists were divided in twogroups: group A general practitioners and group Bspecialists in endodontics. A random volume of powder(Roth's sealer 811) was placed on a glass slab with 1 mlof chemically pure eugenol. All dentists were asked tospatulate the cement in the same way that they do in theirprivate practice by the use of a stainless elastic spatula#24, without any time limitation. The excess of the powderfrom each mixture was weighed and the total amount thatused in the cement was recorded. Every dentistperformed two mixtures in two consequal days. The volume of the powder used by group A, rangedbetween 5,39 - 6,34 gr and from 4,60 - 7,32 gr by groupB. The means for each dentist ranged between 5,38 -6,15 gr for group A and between 4,56 - 7,14 gr for groupB.One-way analysis of variance (ANOVA) revealed that: a)there is statistical significant difference of powder / liquidratio between all dentists (p<0.001), between generalpractitioners (p<0.001) and endodontists (p<0.001), andb) there is no significant difference of powder / liquid ratiofor each dentist (p=0.6732) or endodontist (p=0.6802) indifferent days. The conclusion of this paper is that every dentist use adifferent powder / liquid ratio for the Grossman sealer.This ratio is determined by various factors: whether the
tooth is multi-rooted or single-rooted, the obturation ofmore the one teeth in the same day and also, in generally,by the personal opinion of each dentist for the idealconsistency of the sealer.
Key words: Grossman’s sealer, root canal obturation.
BIB§IO°PAºIA
1. Grossman L.I.: Filling root canals with silver points. Dent.Cosmos 1936, 78:679-687.
2. Grossman LI.: An improved root canal cement. J. Am. Dent.Assoc. 1958, 56:381-385.
3. Grossman L.I.: Algunas observaciones sobre obturation deconductos radiculares. Rev. Asoc. Odont. Argent. 1962,50:61-66.
4. Grossman L.I.: Endodontic practice. 8th ed. Philadelphia:Lea & Febiger 1974:299-30.
5. Ngyen N.T.: Obturation of the root canal system. In: CohenS., Burns R.C., eds. Pathways of the pulp, 6th ed. St Louis.C.V. Mosby. 1994: 231-2.
6. Copeland H.I., Brauer G.M., Sweeney W.T., Forziati A.F.:Setting reaction of zinc oxide and eugenol. J. Res. Natl. Bur.Stds. 1955, 55:133-138.
7. Fuss Z., Charniaque O., Pilo R., Weiss E.: Effect of variousmixing ratios on antibacterial properties and hardness ofendodontic sealers. J. Endod. 2000, 9:519-522.
8. Savioli R.N.: Study of the influence of each chemicalcomponent in Grossman cement on its physical properties.Master's Thesis. Ribeirao Preto. University of Sao Paulo.1992:1-123.
9. Sousa-Neto M., Guimaraes L.F., Saquy P.C., Pecora J.D.:Effect of different grades of gum rosins and hydrogenatedresins on the solubility, disintegration, and dimensionalalterations of Grossman cement. J. Endod. 1999, 25:477-478.
10. Batchelor R.F., Wilson R.F.: Zinc oxide -eugenol cements: I.The effect of atmospheric conditions on rheologicalproperties. J. Dent. Res. 1969, 48:883-887.
11. Benatti O., Stolf W.L., Ruhnke L.A.: Verification of theconsistency, setting time and dimensional changes of rootcanal filling materials. Oral. Surg. 1978, 46:107-113.
12. Norman B.D., Swartz M.L., Phillips R.W.: Additional studieson the solubility of certain dental materials. J Dent Res 1959,38:1028-1037.
13. Hashieh I.A., Pommel L., Camps J.: Concentration ofeugenol apically released from zinc oxide eugenol -basedcements. J. Endod. 1999, 25:713-715.
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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 9-12, 2004
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:EÌÌ·ÓÔ˘‹Ï M·˙›Ó˘M. AÏÂÍ¿Ó‰ÚÔ˘ 27,591 00 B¤ÚÔÈ·AÚ. ÙËÏ. 23310 70490e: mail: [email protected]
9-12 SEL. - Mazinis** 3-10-08 12:55 ™ÂÏ›‰· 12
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
MÂϤÙË Ù˘ ÛÙ·ıÂÚfiÙËÙ·˜ ÂÓfi˜ ʈÙÔÔÏ˘ÌÂÚÈ˙Ô̤ÓÔ˘ÂÚÈÔ‰ÔÓÙÈÎÔ‡ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÂÈı¤Ì·ÙÔ˜ Û fiÍÈÓ·
Î·È Ô˘‰¤ÙÂÚ· Ú˘ıÌÈÛÙÈο ‰È·Ï‡Ì·Ù·
™. ™ÈÏ‚¤ÛÙÚÔ˜*, B. XÚÔÓfiÔ˘ÏÔ˜**, ¢. K·Ú·ı·Ó·ÛÔÔ‡ÏÔ˘***, °. HÏÈ¿‰Ë˜****
™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ÌÔÚÈ·ÎÒÓ ÌÂÙ·‚ÔÏÒÓ Ô˘ ˘Ê›ÛÙ·Ù·È ¤Ó· ʈÙÔ-ÔÏ˘ÌÂÚÈ˙fiÌÂÓÔ ÂÚÈÔ‰ÔÓÙÈÎfi ¯ÂÈÚÔ˘ÚÁÈÎfi ›ıÂÌ· (¶XE) ÌÂÙ¿ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ Û fiÍÈÓ· ηÈÔ˘‰¤ÙÂÚ· ‰È·Ï‡Ì·Ù·, ηıÒ˜ Î·È ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ pH Î·È Ù˘ ·ÁˆÁÈÌfiÙËÙ·ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÏfiÁˆ Ù˘ ·Ô‰fiÌËÛ˘ ÙÔ˘ ÂÈı¤Ì·ÙÔ˜. TÔ ¶XE Ô˘ ÌÂÏÂÙ‹ıËΠ‹Ù·Ó ÙÔBarricaid. ¶·Ú·Û΢¿ÛÙËÎ·Ó 12 ‰ÈÛÎÔÂȉ‹ ‰ÔΛÌÈ· ‰È·Ì¤ÙÚÔ˘ 8 mm Î·È ¿¯Ô˘˜ 1,5 mm Ù· Ô-Ô›· ʈÙÔÔÏ˘ÌÂÚ›ÛÙËÎ·Ó ÁÈ· 40 s ÌÂ Ï˘¯Ó›· ʈÙÔÔÏ˘ÌÂÚÈÛÌÔ‡ ÂÓÙ¿Ûˆ˜ ÂÎÔÌ‹˜ 560mW/cm2. T· ‰ÔΛÌÈ· Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ¤ÍÈ Î·È ÂÌ‚·Ù›ÛÙËÎ·Ó ·ÓÙ›ÛÙÔȯ· Û ¤-Ó· fiÍÈÓÔ (pH: 4,4) Î·È Û ¤Ó· Ô˘‰¤ÙÂÚÔ (pH: 6,8) Ú˘ıÌÈÛÙÈÎfi ‰È¿Ï˘Ì· ÁÈ· 7 Ë̤Ú˜ ÛÙÔ˘˜ 37 ±1ÆC. OÈ ÂÈÊ¿ÓÂȘ ÙˆÓ ‰ÔÎÈÌ›ˆÓ ÚÈÓ Î·È ÌÂÙ¿ Ù˘ ·Ú·ÌÔÓ‹ ÙÔ˘˜ ·Ó·Ï‡ıËÎ·Ó Ì ÌÈÎÚÔ¸¤Ú˘-ıÚË Ê·ÛÌ·ÙÔÛÎÔ›· ÔÏÏ·Ï‹˜ ÂÛˆÙÂÚÈ΋˜ ·Ó¿ÎÏ·Û˘ ÌÂÙ·Û¯ËÌ·ÙÈÛÌÔ‡ Fourier (micro-MIRFTIR). ¶·Ú¿ÏÏËÏ·, ÙÔ pH Î·È Ë ·ÁˆÁÈÌfiÙËÙ· ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙÚ‹ıËÎ·Ó Ì „ËÊÈ·Îfi pH-ÌÂÙÚÔÎ·È ·ÁˆÁÈÌfiÌÂÙÚÔ. H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙÔ pH Î·È ÙËÓ ·ÁˆÁÈÌfiÙËÙ· ¤ÁÈÓ ÌÂÙË Ì¤ıÔ‰Ô t-test (· = 0,05). T· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÌfiÓÔ ÛÙÔ fiÍÈÓÔ pH ·ÓȯÓ‡ÙËΠ̛ˆ-ÛË Ù˘ ·ÔÚÚfiÊËÛ˘ Î·È ÙˆÓ ·Ìȉ›ˆÓ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ˘ÏÈÎÔ‡. ¢È·ÈÛÙÒıËΠÌÈÎÚ‹ ·‡ÍËÛËÙÔ˘ pH Î·È Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ÙÔ˘ ̆ ÏÈÎÔ‡, ·ÏÏ¿ ÔÈ ‰È·ÊÔÚ¤˜Ì ÙËÓ ÔÌ¿‰· ·Ó·ÊÔÚ¿˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜. T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·Û›·˜ ‰Â›-¯ÓÔ˘Ó fiÙÈ ÙÔ ÊˆÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓÔ ¶XE Barricaid ÂÌÊ·Ó›˙ÂÈ ·ÍÈÔÛËÌ›ˆÙË ÛÙ·ıÂÚfiÙËÙ· Û ¯·-ÌËÏfi pH. H ÛÙ·ıÂÚfiÙËÙ· ·˘Ù‹ fï˜, ÙÔ˘ ÂÚÈÔÚ›˙ÂÈ ÙËÓ ıÂڷ¢ÙÈ΋ ‰Ú¿ÛË ÛÙÔ˘˜ ¯ÂÈÚÔ˘ÚÁË-̤ÓÔ˘˜ ÈÛÙÔ‡˜, ÏfiÁˆ Ù˘ ·‰˘Ó·Ì›·˜ ·‡ÍËÛ˘ ÙÔ˘ pH ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ¿Ï-ÏÔ˘˜ Ù‡Ô˘˜ ¶XE, Ô˘ ÛÙÂÚÂÔÔÈÔ‡ÓÙ·È Ì ÔÍÂÔ‚·ÛÈ΋ ·ÓÙ›‰Ú·ÛË.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 13-18, 2004
§¤ÍÂȘ ÎÏÂȉȿ: ¶ÂÚÈÔ‰ÔÓÙÈο ¯ÂÈÚÔ˘ÚÁÈο ÂÈı¤Ì·Ù·, ‰È·Ï˘Ùfi-ÙËÙ·, ˘¤Ú˘ıÚË Ê·ÛÌ·ÙÔÛÎÔ›·, pH, ·ÁˆÁÈÌfi-ÙËÙ·.
* ¶ÂÚÈÔ‰ÔÓÙÔÏfiÁÔ˜, E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ AΛÓËÙ˘ ¶ÚÔ-ÛıÂÙÈ΋˜
** ¶ÚÔÛıÂÙÔÏfiÁÔ˜, ™˘ÓÂÚÁ¿Ù˘ AΛÓËÙ˘ ¶ÚÔÛıÂÙÈ΋˜*** O‰ÔÓÙ›·ÙÚÔ˜**** AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ Î·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘
EÚÁ·ÛÙ‹ÚÈÔ BÈÔ¸ÏÈÎÒÓ, TÔ̤·˜ B·ÛÈÎÒÓ EÈÛÙËÌÒÓ Î·È BÈÔÏÔ-Á›·˜ ™ÙfiÌ·ÙÔ˜, O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ
EI™A°ø°H
T· ÂÚÈÔ‰ÔÓÙÈο ¯ÂÈÚÔ˘ÚÁÈο ÂÈı¤Ì·Ù· (¶XE) ··ÚÙ›-˙Ô˘Ó ÌÈ· ͯˆÚÈÛÙ‹ ηÙËÁÔÚ›· Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ‚ÈÔ¸ÏÈÎÒÓÌ ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο. ŸÌˆ˜, ÔÈ ÏËÚÔÊÔڛ˜ۯÂÙÈο Ì ÙȘ ȉÈfiÙËÙ˜ Î·È ÙËÓ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ˘ÏÈ-
ÎÒÓ ·˘ÙÒÓ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜ ηȉȿ۷ÚÙ˜1-3. AÓ Î·È Û‹ÌÂÚ· Ë ·Ó¿ÁÎË ÁÂÓÈÎÂ˘Ì¤ÓË ̄ Ú‹-ÛË ÙˆÓ ¶XE ¤¯ÂÈ ÙÂı› ˘fi ·ÌÊÈÛ‚‹ÙËÛË4, 5, ÂÍ·ÎÔÏÔ˘-ıÔ‡Ó Ó· ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘˜, fiˆ˜ÁÈ· ÙËÓ Î·ı‹ÏˆÛË ÂχıÂÚˆÓ Ô˘ÏÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·È·ÎÚÔÚÚÈ˙Èο ÌÂÙ·ÙÔÈ˙fiÌÂÓˆÓ ÎÚËÌÓÒÓ, ÙËÓ ÚÔÛÙ·Û›··ÔÎ·Ï˘Ì̤ÓÔ˘ ÔÛÙÔ‡ Î·È ·ÓÔÈÎÙÒÓ ÙÚ·˘Ì¿ÙˆÓ, ÙÔÓ Â-ÚÈÔÚÈÛÌfi Ù˘ ·Ó¿Ù˘Í˘ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÈÛÙÔ‡ Î.Ï..6.OÈ ‚·ÛÈΤ˜ ··ÈÙ‹ÛÂȘ ·fi ¤Ó· ¶XE Â›Ó·È Ô Â·Ú΋˜¯ÚfiÓÔ˜ ÂÚÁ·Û›·˜, Ë Ï›· Î·È ÌË ÂÚÂıÈÛÙÈ΋ ÂÈÊ¿ÓÂÈ·ÙÔ˘ ÛÙÂÚÂÔÔÈË̤ÓÔ˘ ˘ÏÈÎÔ‡ Ô˘ ‚Ú›ÛÎÂÙ·È Û ·ʋÌ ÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ, Ë ‰È·Ù‹ÚËÛË Â·ÚÎÔ‡˜ ÂÏ·ÛÙÈÎfiÙË-Ù·˜ ÒÛÙ ӷ ·Óı›ÛÙ·Ù·È ÛÙȘ ÂÓ‰ÔÛÙÔÌ·ÙÈο ·ÛÎÔ‡ÌÂÓ˜ȤÛÂȘ ¯ˆÚ›˜ Ó· ıÚ·‡ÂÙ·È, Ë ÈηÓÔÔÈËÙÈ΋ ÚfiÛÊ˘ÛËÙÔ˘ ˘ÏÈÎÔ‡ ÛÙÔ˘˜ ÈÛÙÔ‡˜ Î·È Ë Î·Ù¿ÏÏËÏË ÛÙ·ıÂÚfiÙËÙ·‰È·ÛÙ¿ÛÂˆÓ ÒÛÙ ӷ ÌËÓ ·ÔÎÔÏÏ¿Ù·È ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ÌÈÎÚԂȷ΋ ‰È›ۉ˘ÛË ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÈÛÙÔ‡-˘ÏÈÎÔ‡7, 8.EÈÚÔÛı¤Ùˆ˜ ÙÔ ¶XE Ú¤ÂÈ Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ÌÈÎÚÔ-‚ȷ΋ ·Ô›ÎÈÛË Ù˘ ÂÈÊ¿ÓÂÈ¿˜ ÙÔ˘, Ó· ÌËÓ Â›Ó·È ·ÏÏÂÚ-ÁÈÔÁfiÓÔ Î·È Ó· ¤¯ÂÈ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ·Ô‰ÂÎÙ‹ Á‡ÛË9.
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13-18 ™E§. - Hliadis** 7-10-08 11:09 ™ÂÏ›‰· 13
Afi Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ '40 ̤¯ÚÈ Î·È Ù· Ù¤ÏË Ù˘‰ÂηÂÙ›·˜ ÙÔ˘ ’80 ·Ó·Ù‡¯ıËÎ·Ó ¤ÓÙ ‰È·ÊÔÚÂÙÈÎÔ› Ù‡-ÔÈ ¶XE Ì ‚¿ÛË ÙËÓ Û‡ÓıÂÛË Î·È ÙËÓ ·ÓÙ›‰Ú·ÛË ‹Í˘ÙÔ˘˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÁηٷϤÁÔÓÙ·È Ù· ÂÚÈÛÛfiÙÂÚ·ÂÌÔÚÈο ‰È·ı¤ÛÈÌ· Û΢¿ÛÌ·Ù·. OÈ Ù‡ÔÈ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÚÔ˚fiÓÙ·: ·) OÍÂȉ›Ô˘ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘-¢ÁÂÓfiÏ˘. TÔ ÙÂÏÈÎfiÚÔ˚fiÓ Â›Ó·È Ô Â˘ÁÂÓÔÏÈÎfi˜ „¢‰¿ÚÁ˘ÚÔ˜. H ·ÓÙ›‰Ú·ÛËÂ›Ó·È ·ÚÁ‹ ·Ú¿ ÙËÓ ·ÚÔ˘Û›· ÂÈÙ·¯˘ÓÙÒÓ fiˆ˜ ÔÍÂÈ-ÎÔ‡ „¢‰·ÚÁ‡ÚÔ˘ ‹ ÓÂÚÔ‡, ÂÓÒ ÙÔ Û¯ËÌ·ÙÈ˙fiÌÂÓÔ ÚÔ˚-fiÓ ÂÌÊ·Ó›˙ÂÈ ˘‰ÚÔÏ˘ÙÈ΋ ·ÛÙ¿ıÂÈ· Ì ·ÔÙ¤ÏÂÛÌ· ·Â-Ï¢ı¤ÚˆÛË Â˘ÁÂÓfiÏ˘ Î·È ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙËÓ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· ÙÔ˘ ÂÈı¤Ì·ÙÔ˜. AÓÙÈÚÔÛˆÂ˘ÙÈÎ¿Û˘ÛÙ‹Ì·Ù· ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ Â›Ó·È Ù· Nobetec,PPC- eugenol, Wondrpak, Cross Pack Î·È Septipak. ‚) OÍÂȉ›Ô˘ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘-ÏÈ·ÚÒÓ ÔͤˆÓ. TÔ ÙÂÏÈ-Îfi ÚÔ˚fiÓ Â›Ó·È Û‡ÌÏÔÎÔ ÏÈ·ÚÒÓ ÔͤˆÓ-„¢‰·ÚÁ‡-ÚÔ˘. T· Û΢¿ÛÌ·Ù· ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ‰ÂÓ ÂÚȤ¯Ô˘Ó ¢-ÁÂÓfiÏË. ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ·Ó‹ÎÔ˘Ó Ù· Coe-Pak,Perio-Pack, PPC-noneugenol, Peripac, Peripac Impro-ved Î·È PerioCare. Á) BÈԉȷÛÒÌÂÓ· ΢·ÓÔ·ÎÚ˘ÏÈο, Ù· ÔÔ›· ‹˙Ô˘Ó Ù·-¯‡Ù·Ù· ·ÚÔ˘Û›· ̆ ÁÚ·Û›·˜. T· ÙÂÏÂ˘Ù·›· ·ÚÔ˘ÛÈ¿˙Ô˘Óȉȷ›ÙÂÚ· ¯Ú‹ÛÈ̘ ȉÈfiÙËÙ˜ fiˆ˜ ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈοÙÔÓ ··ÈÙÔ‡ÌÂÓÔ ¯ÚfiÓÔ ÁÈ· Û˘ÚÚ·Ê‹, ÚÔηÏÔ‡Ó Ù·¯‡-Ù·ÙË ·ÈÌfiÛÙ·ÛË ÂÍ·ÈÙ›·˜ Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ÔÏ˘ÌÂÚÈ-ÛÌÔ‡ ÙÔ˘˜ ·ÚÔ˘Û›· ˘ÁÚ·Û›·˜, ÂÈÙ·¯‡ÓÔ˘Ó Ù· ·Ú¯ÈοÛÙ¿‰È· ÂԇψÛ˘ ÙˆÓ ÈÛÙÒÓ ‰ÚÒÓÙ·˜ ˆ˜ ÚÔÛٷ٢ÙÈ-Îfi ‰È¿ÊÚ·ÁÌ· Î·È Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ Â·ÎÚÈ‚‹ ÂÊ·ÚÌÔÁ‹ÎÚËÌÓÒÓ ‹ ÂχıÂÚˆÓ Ô˘ÏÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. AÓ Î·ÈÚÔ˚fiÓÙ· ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ̄ ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈ-ο ÛÙË ÌÈÎÚÔ¯ÂÈÚÔ˘ÚÁÈ΋, ÂÓÙÔ‡ÙÔȘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È Û‹ÌÂÚ· ÛÙË ̄ ÂÈÚÔ˘ÚÁÈ΋ ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ ÂÓÒ Û Ô-ÚÈṲ̂Ó˜ ¯ÒÚ˜ ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ë Î˘ÎÏÔÊÔÚ›· ΢·ÓÔ·-ÎÚ˘ÏÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ ÁÈ· Û˘ÁÎfiÏÏËÛË ÈÛÙÒÓ2, 3.™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 90 Ù¤ıËΠ۠΢ÎÏÔÊÔÚ›·¤Ó· Ó¤Ô Û··ÛÌ· ¶XE ‚·ÛÈ˙fiÌÂÓÔ ÛÙËÓ Ù¯ÓÔÏÔÁ›·Ô˘ ·Ó¤Ù˘ÍÂ Ë ÂÙ·ÈÚ›· Caulk/Dentsply ÛÙ· ʈÙÔÔÏ˘-ÌÂÚÈ˙fiÌÂÓ· ·ÔÙ˘ˆÙÈο ˘ÏÈο. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÊˆÙÔ-ÔÏ˘ÌÂÚÈ˙fiÌÂÓÔ ¶XE Barricaid (Caulk/Dentsply, Milford,DE, USA), Ô˘ ÂÚȤ¯ÂÈ ‰ÈÌÂı·ÎÚ˘ÏÈ΋ ÚËÙ›ÓË ÔÏ˘·Èı¤-Ú·-o˘ÚÂı¿Ó˘, ÂÓÈÛ¯˘ÙÈΤ˜ Ô˘Û›Â˜ ÔÍÂȉ›Ô˘ ÙÔ˘ ˘ÚÈÙ›-Ô˘ Î·Ï˘Ì̤Ó˜ Ì ÛÈÏ¿ÓÈÔ, ʈÙÔÂÓÂÚÁÔÔÈËÙ¤˜, ÂÈÙ·-¯˘ÓÙ¤˜, ÛÙ·ıÂÚÔÔÈËÙ¤˜ Î·È ¯ÚˆÛÙÈΤ˜. AÓ Î·È ‰ÈÌÂı·-ÎÚ˘ÏÈÎfi ·Ú¿ÁˆÁÔ, ÙÔ Û··ÛÌ· Barricaid ¤‰ÂÈÍ ηχ-ÙÂÚË ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· Û ηÏÏȤÚÁÂȘ ·ÓıÚÒÈÓˆÓÚˆÙÔÁÂÓÒÓ Ô˘ÏÈÎÒÓ ÈÓÔ‚Ï·ÛÙÒÓ, ·ÓıÚÒÈÓˆÓ Î˘ÙÙ¿-ÚˆÓ Ô˘ ÌÔÈ¿˙Ô˘Ó Ì ÔÛÙÂÔ‚Ï¿ÛÙ˜ Î·È ÈÓÔ‚Ï·ÛÙÒÓ Ô-ÓÙÈÎÒÓ ·fi ·ÓÙ›ÛÙÔÈ¯Ô ˘ÏÈÎfi Ì ·ÓÙ›‰Ú·ÛË ÔͤԘ-‚¿ÛÂ-ˆ˜10. E·ÚÎÒ˜ ÔÏ˘ÌÂÚÈṲ̂ÓÔ ˘ÏÈÎfi Barricaid ‰ÂÓ ÂÌ-Ê¿ÓÈÛ ÙÔÍÈÎfiÙËÙ· Û ηÏÏȤÚÁÂȘ ΢ÙÙ¿ÚˆÓ HeLa Î·È È-ÓÔ‚Ï¿ÛÙ˜11. ™Â ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· Ë Û˘ÁÎÚÈÙÈ΋ÈÛÙÔÏÔÁÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÓÙȉڿÛÂˆÓ ÙˆÓ ÈÛÙÒÓ ÌÂ-Ù¿ ÙËÓ Î¿Ï˘„‹ ÙÔ˘˜ Ì ÙÔ Barricaid Î·È ¤Ó· ¢ÁÂÓÔÏÔ‡¯Ô¶XE ‰ÂÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÊÏÂÁÌÔÓ҉˷fiÎÚÈÛË ÙˆÓ ÈÛÙÒÓ. H Ï‹Ú˘ ·ÔηٿÛÙ·ÛË Â‹ÏıÂÛ ‰È¿ÛÙËÌ· 2 ‚‰ÔÌ¿‰ˆÓ Î·È ÛÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜ ¶XEηıÒ˜ Î·È ÛÙËÓ ÔÌ¿‰· ·Ó·ÊÔÚ¿˜ Ì ›ıÂÌ· ‚ÈÔÛ˘Ì‚·-Ù‹˜ ËÎÙ‹˜ ηڂÔ͢ÏÈ΋˜ ÌÂı˘Ï΢ÙÙ·Ú›Ó˘12.
TÔ Û··ÛÌ· Barricaid ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚ· ‚ÂÏÙȈ̤-Ó˜ Ê˘ÛÈÎÔ¯ËÌÈΤ˜ Î·È Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜. §fiÁˆ Ù˘ ·-Ó¿Ù˘Í˘ ÙÚÈۉȿÛÙ·ÙÔ˘ ÔÏ˘ÌÂÚÔ‡˜ ‰ÈÎÙ‡Ô˘ ηٿ ÙËÓ‹ÍË ÙÔ˘ ÙÔ Barricaid ÂÌÊ·Ó›˙ÂÈ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚˉ˘Ûη̄›·, ÌÈÎÚfiÙÂÚË ‰È·Ï˘ÙfiÙËÙ· Î·È ÛÙ·ıÂÚ‹ ·ÔÚ-ÚfiÊËÛË ÓÂÚÔ‡ Û˘ÁÎÚÈÙÈο ÌÂ Ê˘Ú¿Ì·Ù· ÙÔ˘ Ù‡Ô˘ ÔÍÂÈ-‰›Ô˘ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘-ÏÈ·ÚÒÓ ÔͤˆÓ13. TÔ BarricaidÂÌÊ·Ó›˙ÂÈ ÌÈÎÚfiÙÂÚË Û˘ÁÎÔÏÏËÙÈ΋ ÈηÓfiÙËÙ· Ì ÙÔ˘˜ Ô-‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜ ·fi Ù· Û΢¿ÛÌ·Ù· ÔÍÂȉ›Ô˘ ÙÔ˘ „¢-‰·ÚÁ‡ÚÔ˘-¢ÁÂÓfiÏ˘ ‹ ÔÍÂȉ›Ô˘ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘-ÏÈ-·ÚÒÓ ÔͤˆÓ13. ŸÌˆ˜ Ë ÌÂÁ¿ÏË ·Î·Ì„›· ÙÔ˘ Î·È Ë ‰˘Ó·-ÙfiÙËÙ· ÌÈÎÚÔÌ˯·ÓÈ΋˜ Û˘ÁÎÚfiÙËÛ‹˜ ÙÔ˘ Ì ÙËÓ ·‰·Ì·-ÓÙ›ÓË Ì¤Ûˆ Ù˘ Ù¯ÓÈ΋˜ Ù˘ ·‰ÚÔÔ›ËÛ˘, fiˆ˜ ·ÎÚÈ-‚Ò˜ Ì ÙȘ ÂÌÊÚ·ÎÙÈΤ˜ ÚËÙ›Ó˜ ‹ Ù· ÔÚıÔ‰ÔÓÙÈο Û˘-ÁÎÔÏÏËÙÈο, ·˘Í¿ÓÂÈ Û ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfiÙËÓ Û˘ÁÎÔÏÏËÙÈ΋ ÙÔ˘ ÈηÓfiÙËÙ· Ì ÙÔ˘˜ Ô‰ÔÓÙÈÎÔ‡˜ È-ÛÙÔ‡˜, ȉÈfiÙËÙ· Ì ÌÂÁ¿ÏË ÎÏÈÓÈ΋ ÛËÌ·Û›· ÚÔÎÂÈ̤ÓÔ˘Ó· ηıËψıÔ‡Ó ÌÂÙÂÁ¯ÂÈÚËÙÈο ÎÚËÌÓÔ› ‹ ÌÔۯ‡̷ٷ14. H ¿ÌÂÛË Â·Ê‹ ÙˆÓ ¶XE Ì ÙÔ ÊÏÂÁÌ·›ÓÔÓ ¯ÂÈÚÔ˘ÚÁË-̤ÓÔ Â‰›Ô ¤ıÂÛ ·fi ÓˆÚ›˜ ÙÔ ÂÚÒÙËÌ· ÙÔ˘ ηٿ fiÛÔÙ· ˘ÏÈο ·˘Ù¿ ÂÌÊ·Ó›˙Ô˘Ó Â·Ú΋ ÛÙ·ıÂÚfiÙËÙ· ÛÙÔ‚ÈÔÏÔÁÈÎfi ÂÚÈ‚¿ÏÏÔÓ Ù˘ ÊÏÂÁÌÔÓ‹˜. ø˜ ÚÒÙË ·Ú¿-ÌÂÙÚÔ˜ ÁÈ· ‰ÈÂÚ‡ÓËÛË ıˆڋıËÎÂ Ë Â›‰Ú·ÛË ÙÔ˘ ¶XEÛÙÔ pH. H ÌÂϤÙË Ù˘ ›‰Ú·Û˘ ÙÔ˘ Barricaid Î·È Û΢-·ÛÌ¿ÙˆÓ ÙÔ˘ Ù‡Ô˘ ÔÍÂȉ›Ô˘ „¢‰·ÚÁ‡ÚÔ˘-ÏÈ·ÚÒÓ Ô-ͤˆÓ ÛÙÔ pH ‰È·Ï‡Ì·ÙÔ˜ 1% KCl (pH = 6,45) ¤‰ÂÈÍ fiÙÈÙ· Û΢¿ÛÌ·Ù· ÔÍÂȉ›Ô˘ ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘ ·˘Í¿ÓÔ˘ÓÛ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÙÔ pH ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ (·fi 6,45 ÛÂ9,89-10,29) ÂÓÒ ·ÓÙ›ıÂÙ· ÙÔ Barricaid ÙÔ ÌÂÈÒÓÂÈ (·fi6,45 Û 5,06) ÁÂÁÔÓfi˜ Ô˘ ıˆڋıËΠÌÂÈÔÓ¤ÎÙËÌ· ÙÔ˘ÊˆÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓÔ˘ Û΢¿ÛÌ·ÙÔ˜ ÏfiÁˆ Ù˘ ÎÏÈÓÈ΋˜ÛËÌ·Û›·˜ Ù˘ ‰È·Ù‹ÚËÛ˘ ˘„ËÏÒÓ ÙÈÌÒÓ pH Û ÂÚÈ-‚¿ÏÏÔÓ ÊÏÂÁÌÔÓ‹˜13, 14. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Û˘ÁÎÚÈÙÈ΋ ÌÂ-ϤÙË Ù˘ ›‰Ú·Û˘ ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜ Barricaid ÛÙÔ pHÎ·È ÙËÓ ·ÁˆÁÈÌfiÙËÙ· ‰‡Ô ‰È·Ï˘Ì¿ÙˆÓ, ÂÓfi˜ Ô˘‰¤ÙÂÚÔ˘Î·È ÂÓfi˜ fiÍÈÓÔ˘, ηıÒ˜ Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ›‰Ú·Û˘·˘ÙÒÓ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÛÙËÓ ÌÔÚȷ΋ Û‡ÓıÂÛË ÙˆÓ ÂÈ-Ê·ÓÂÈÒÓ ÙˆÓ ‰ÔÎÈÌ›ˆÓ ÙÔ˘ ˘ÏÈÎÔ‡.
Y§IKA KAI ME£O¢O™
¢ÈÛÎÔÂȉ›˜ ÌÂÙ·ÏÏÈΤ˜ Ì‹ÙÚ˜ ÂÛˆÙÂÚÈ΋˜ ‰È·Ì¤ÙÚÔ˘ 8mm Î·È ¿¯Ô˘˜ 1,5 mm ÙÔÔıÂÙ‹ıËÎ·Ó Û ·ÓÙÈÎÂÈÌÂÓÔ-ÊfiÚ˜ ϿΘ ÌÈÎÚÔÛÎÔ›Ô˘ Î·È ˘ÂÚÏËÚÒıËÎ·Ó Ì¿ÛÙ· ÌÔÓÔÌÂÚÔ‡˜ ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜ Barricaid. ™ÙË Û˘-Ó¤¯ÂÈ·, ÔÈ ÂχıÂÚ˜ ÂÈÊ¿ÓÂȘ ÙˆÓ ÌËÙÚÒÓ Î·Ï‡ÊıË-Î·Ó ÌÂ Î·Ï˘ÙÚ›‰Â˜ ÌÈÎÚÔÛÎÔ›Ô˘, ¤ÙÛÈ ÒÛÙ ӷ ·ÔÌ·-ÎÚ˘ÓıÔ‡Ó ÔÈ ÂÚ›ÛÛÂȘ. T· ‰Â›ÁÌ·Ù· ÔÏ˘ÌÂÚ›ÛÙËηÓÌ ÙËÓ Ï˘¯Ó›· Elipar Highlight (Espe GmbH, Seefeld,Germany) ÁÈ· 40 s ̆ fi Û˘Ó¯‹ ¤ÎıÂÛË Ì ·ÎÙÈÓÔ‚ÔÏ›· ¤-ÓÙ·Û˘ 560 mW/cm2 Û ̋ÎÔ˜ ·̷ÙÔ˜ 500-400 nm, fi-ˆ˜ ·˘Ù‹ ÌÂÙÚ‹ıËΠ̠ÂȉÈÎfi ʈÙfiÌÂÙÚÔ (Model 100,Demetron Corp., Danbury, CT, USA) ÛÙÔ Ú‡Á¯Ô˜ ÙÔ˘ Ô-ÙÈÎÔ‡ ·ÁˆÁÔ‡ Ù˘ Û˘Û΢‹˜ ʈÙÔÔÏ˘ÌÂÚÈÛÌÔ‡. K·-Ù¿ ÙÔÓ ÊˆÙÔÔÏ˘ÌÂÚÈÛÌfi ÙÔ Ú‡Á¯Ô˜ ÙÔ˘ ÔÙÈÎÔ‡ ·Áˆ-ÁÔ‡ ‹Ù·Ó Û ¿ÌÂÛË Â·Ê‹ Ì ÙËÓ Î·Ï˘ÙÚ›‰· ÒÛÙ ӷ ›-Ó·È ÛÙ·ıÂÚ‹ Ë ·fiÛÙ·ÛË ·ÎÙÈÓÔ‚fiÏËÛ˘ Î·È Ë ¤ÓÙ·ÛËÙ˘ ÚÔÛ›ÙÔ˘Û·˜ ·ÎÙÈÓÔ‚ÔÏ›·˜ ÛÙÔ ‰Â›ÁÌ·. MÂÙ¿ ÙÔÓ
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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 13-18, 2004
13-18 ™E§. - Hliadis** 7-10-08 11:09 ™ÂÏ›‰· 14
ʈÙÔÔÏ˘ÌÂÚÈÛÌfi Ù· ‰ÔΛÌÈ· ·Ê·ÈÚ¤ıËÎ·Ó ·fi ÙȘ Ì‹-ÙÚ˜ Î·È ÂϤÁ¯ıËÎ·Ó Û ÌÂÙ·ÏÏÔÁÚ·ÊÈÎfi ÌÈÎÚÔÛÎfiÈÔ(Eclipse ME 600, Nikon-Kogaku, Tokyo, Japan) ˆ˜ ÚÔ˜ÙËÓ ·ÚÔ˘Û›· ÂÈÊ·ÓÂÈ·ÎÒÓ ·ÙÂÏÂÈÒÓ (fiÚÔÈ, ÁÚ·ÌÌÒ-ÛÂȘ, ÚˆÁ̤˜, ·ÓÔÌÔÈÔÁ¤ÓÂÈ· ‰ÔÌ‹˜ Î.Ï..). ŸÛ· ‰ÔΛÌÈ··ÚÔ˘Û›·˙·Ó ·Ù¤ÏÂȘ ·ÓÙÈηٷÛÙ¿ıËηÓ. O Û˘ÓÔÏÈÎfi˜·ÚÈıÌfi˜ ÙˆÓ ‰ÔÎÈÌ›ˆÓ ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜ Barricaid Ô˘·Ú·Û΢¿ÛÙËÎ·Ó ‹Ù·Ó ‰Ò‰Âη. T· ‰ÔΛÌÈ· Ù·ÍÈÓÔÌ‹-ıËÎ·Ó Ù˘¯·›· Û ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ¤ÍÈ. TÚ›· ‰ÔΛÌÈ· ·fiοı ÔÌ¿‰· ÌÂÏÂÙ‹ıËÎ·Ó Ì ÌÈÎÚÔ¸¤Ú˘ıÚË Ê·ÛÌ·ÙÔ-ÛÎÔ›· ÔÏÏ·Ï‹˜ ÂÛˆÙÂÚÈ΋˜ ·Ó¿ÎÏ·Û˘ ÌÂÙ·Û¯ËÌ·-ÙÈÛÌÔ‡ Fourier (micro-MIR FTIR) Û ʷÛÌ·ÙfiÌÂÙÚÔ FTIR(Spectrum GX, Perkin-Elmer Corp., Norwalk, CT, USA) Â-ÊԉȷṲ̂ÓÔ Ì ΢„¤ÏË micro-MIR (Perkin-Elmer Corp.).H Ï‹„Ë ÙˆÓ Ê·ÛÌ¿ÙˆÓ ·fi Ù˘¯·›Â˜ ÂÈÊ¿ÓÂȘ ÙˆÓ ‰Ô-ÎÈÌ›ˆÓ ¤ÁÈÓ Ì ÙȘ ·ÎfiÏÔ˘ı˜ Û˘Óı‹Î˜: 4000-400 cm-1
Ê·ÛÌ·ÙÈÎfi ‡ÚÔ˜, 4 cm-1 ‰È·ÎÚÈÙÈÎfi fiÚÈÔ, 50 Û·ÚÒÛÂȘ,2,5 Ìm ‚¿ıÔ˜ ·Ó¿Ï˘Û˘ ÛÙ· 1000 cm-1, ÎÚ‡ÛÙ·ÏÏÔ˜KRS-5 ÁˆÓ›·˜ ·ÎÌ‹˜ 45Ô, 7 ÂÛˆÙÂÚÈÎÒÓ ·Ó·ÎÏ¿ÛˆÓ. ¶·Ú·Û΢¿ÛÙËÎ·Ó ‰‡Ô Ú˘ıÌÈÛÙÈο ˘‰·ÙÈο ‰È·Ï‡Ì·Ù·Ì pH 6,8 (0,01 M ʈÛÊÔÚÈÎfi Ô͇/0,14 M NaCl) Î·È pH4,4 (0,0218 M ÔÍÂÈÎfi Ô͇/0,1 M NaCl). H ·ÁˆÁÈÌfiÙËÙ·ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙÚ‹ıËΠ۠ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔ-ÓÙÔ˜ Ì ·ÁˆÁÈÌfiÌÂÙÚÔ (Gilson, Madrid, Spain). ™ÙË Û˘-Ó¤¯ÂÈ·, οı ‰ÔΛÌÈÔ ÂÌ‚·Ù›ÛÙËΠͯˆÚÈÛÙ¿ Û ‰È¿Ï˘-Ì· 10 ml ·fi οı ¤Ó· Ú˘ıÌÈÛÙÈÎfi ‰È¿Ï˘Ì·, fiÔ˘ ·Ú¤-ÌÂÈÓ ÁÈ· ‰È¿ÛÙËÌ· 7 ËÌÂÚÒÓ Û ıÂÚÌÔÎÚ·Û›· 37±1ÆC.AÎÔÏÔ‡ıˆ˜, Ù· ‰ÔΛÌÈ· ÍÂχıËÎ·Ó Ì ‰ÈÛ·ÂÛÙ·Á̤ÓÔÓÂÚfi, ÛÙÂÁÓÒıËÎ·Ó Ì ·ÂÚÔÛ‡ÚÚÈÁ· ÁÈ· 10 s Î·È ÌÂÏÂ-Ù‹ıËÎ·Ó Í·Ó¿ Ì micro-MIR FTIR. AÎÔÏÔ‡ıËÛ ͋ڷÓÛËÙˆÓ ‰ÔÎÈÌ›ˆÓ Û ÍËÚ·ÓÙ‹Ú· ÁÈ· 5 Ë̤Ú˜ Û ıÂÚÌÔÎÚ·-Û›· ‰ˆÌ·Ù›Ô˘ Î·È Î·Ù·ÁÚ·Ê‹ ÌÈ·˜ ‰Â‡ÙÂÚ˘ ÛÂÈÚ¿˜ Ê·-ÛÌ¿ÙˆÓ. TÔ pH Î·È Ë ·ÁˆÁÈÌfiÙËÙ· ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙ¿ÙËÓ ÂÌ‚¿ÙÈÛË ÙˆÓ ‰ÔÎÈÌ›ˆÓ ÌÂÙÚ‹ıËÎ·Ó Û ıÂÚÌÔÎÚ·-Û›· ‰ˆÌ·Ù›Ô˘ Ì ÙÔ ·ÁˆÁÈÌfiÌÂÙÚÔ Î·È Ì „ËÊÈ·Îfi pH-ÌÂÙÚÔ (P 903, Consort, Turnhout, Belgium). H ÛÙ·ÙÈÛÙÈ΋·Ó¿Ï˘ÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙËÓ ·ÁˆÁÈÌfiÙËÙ· Î·È ÛÙÔ pH¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô t-test ÌÂ Â›Â‰Ô ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·-ÓÙÈÎfiÙËÙ·˜ ÙÔ · = 0,05.
A¶OTE§E™MATA
™ÙËÓ EÈÎ. 1 Ê·›ÓÂÙ·È ÙÔ Ê¿ÛÌ· ·Ó·ÊÔÚ¿˜ ÂÓfi˜ ÔÏ˘ÌÂ-
ÚÈṲ̂ÓÔ˘ ‰ÔÎÈÌ›Ô˘ Barricaid. OÈ ÎÔÚ˘Ê¤˜ ·ÔÚÚfiÊËÛ˘·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙȘ ·ÎfiÏÔ˘ı˜ ¯ËÌÈΤ˜ ÔÌ¿‰Â˜: O-H str(3452 cm-1), N-H str (3352 cm-1), -CH2- str (2976-2928 cm-1),CH3- str (2897-2858 cm-1), CO2 atm (2363-2342 cm-1), -NCO str (2216 cm-1), C=O str (1718 cm-1), -NHCO- (·Ì›-‰È· I, 1648 cm-1), ·ÏÏËÏÔÂÈÎ·Ï˘ÙfiÌÂÓË Ì ÙËÓ C=C str(1636 cm-1), -N-H str (1610 cm-1), -NHCO (·Ì›‰È· II, 1537cm-1), -CH2- b (1454 cm-1), ˆ (-CH2-) b (1364 cm-1), C=Ostr (1296 cm-1), -NHCO- (·Ì›‰È· III, 1250 cm-1), C-O-C b(1063 cm-1), -C-H b (932 cm-1 Î·È 801 cm-1). ™ÙËÓ EÈÎ. 2 (·, ‚) ·Ú·Ù›ıÂÓÙ·È Ù· Ê¿ÛÌ·Ù· ÂÓfi˜ ‰ÔÎÈÌ›-Ô˘ Barricaid ÌÂÙ¿ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ ÁÈ· 7 Ë̤Ú˜ ÛÙÔ‰È¿Ï˘Ì· Ì pH: 6, 8 Î·È ÌÂÙ¿ ÙËÓ Û˘ÌÏËڈ̷ÙÈ΋ ·-Ú·ÌÔÓ‹ ÙÔ˘ Û ÍËÚ·ÓÙ‹Ú· ÁÈ· 5 Ë̤Ú˜. MÂٷ͇ ÙˆÓÊ·ÛÌ¿ÙˆÓ ‰È·ÎÚ›ÓÂÙ·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ·ÔÚÚfi-ÊËÛ˘ ÛÙȘ ÂÚÈÔ¯¤˜ 3600-3000 cm-1 Î·È 1647 cm-1 ÏfiÁˆÙˆÓ ·ÚÂÌ‚ÔÏÒÓ O-H str Î·È O-H b ·ÓÙ›ÛÙÔȯ· ÙÔ˘ ·-ÔÚÚÔÊË̤ÓÔ˘ ÓÂÚÔ‡ (EÈÎ. 2·), ÔÈ Ôԛ˜ ·ÔÌ·ÎÚ‡ÓÔ-ÓÙ·È ÌÂÙ¿ ÙËÓ Í‹Ú·ÓÛË (EÈÎ. 2‚). ¢ÂÓ ·Ú·ÙËÚ‹ıËηӉȷÊÔÚ¤˜ ÛÙȘ ÎÔÚ˘Ê¤˜ ·ÔÚÚfiÊËÛ˘ ÌÂٷ͇ ÙÔ˘ ÍË-Ú·Óı¤ÓÙÔ˜ ‰ÔÎÈÌ›Ô˘ Î·È ÙÔ˘ ‰ÔÎÈÌ›Ô˘ ·Ó·ÊÔÚ¿˜.
™ÙËÓ EÈÎ. 3 (·, ‚) ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ê¿ÛÌ·Ù· ‰ÔÎÈÌ›Ô˘Barricaid ÌÂÙ¿ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ Û ‰È¿Ï˘Ì· Ì pH: 4,4Î·È ÌÂÙ¿ ÙË Û˘ÌÏËڈ̷ÙÈ΋ ÙÔ˘ Í‹Ú·ÓÛË. ¶·Ú·ÙËÚ›-Ù·È Î·È ¿ÏÈ ·˘ÍË̤ÓË ·ÔÚÚfiÊËÛË ÛÙȘ ÂÚÈÔ¯¤˜ 3600-3000 cm-1 Î·È 1647 cm-1 ÏfiÁˆ ÙˆÓ ·ÚÂÌ‚ÔÏÒÓ ÙÔ˘ ·-ÔÚÚÔÊË̤ÓÔ˘ ÓÂÚÔ‡, ÔÈ Ôԛ˜ fï˜ ·Ê·ÈÚÔ‡ÓÙ·È ÌÂ-Ù¿ ÙËÓ Í‹Ú·ÓÛË. H ‰È·ÊÔÚÂÙÈ΋ ÎÏ›ÛË ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ Ù˘EÈÎ. 3· ÛÙËÓ ÂÚÈÔ¯‹ 3400-3000 cm-1 ·fi ÙËÓ ÂÚÈÔ¯‹3600- 3400 cm-1 ηıÒ˜ Î·È Ë ·Ì‚Ï›· ÎÔÚ˘Ê‹ ÛÙ· 2600-2500 cm-1 Â›Ó·È ̄ ·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰ÈÌÂÚÒÓ O-H str ÙˆÓfiÍÈÓˆÓ ÔÌ¿‰ˆÓ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙËÓ ‰È·ÌÔÚÈ·-΋ ·Ó¿Ù˘ÍË ‰ÂÛÌÒÓ ˘‰ÚÔÁfiÓÔ˘. AÓ Î·È ÌÂÙ¿ ÙËÓ Í‹-Ú·ÓÛË ÙÔ Ê¿ÛÌ· ·ӤگÂÙ·È ÛÙËÓ ·Ú¯È΋ ÙÔ˘ ηٿÛÙ·-ÛË, ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË Ù˘ ÎÔÚ˘Ê‹˜ ·ÔÚÚfiÊËÛ˘ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ·Ìȉ›ˆÓ I, fiÔ˘ Ë ·Ú¯È΋ Û‡ÓıÂÙË ÎÔ-Ú˘Ê‹ ·fi Ù· 1648 cm-1 ÂÍ·Ï›ÊÂÙ·È.
15
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 13-18, 2004
EÈÎ. 1: º¿ÛÌ· micro-MIR FTIR ÔÏ˘ÌÂÚÈṲ̂ÓÔ˘ ‰ÔÎÈÌ›Ô˘Barricaid (Ê¿ÛÌ· ·Ó·ÊÔÚ¿˜).
EÈÎ. 2: º¿ÛÌ·Ù· micro-MIR FTIR ‰ÔÎÈÌ›Ô˘ Barricaid ÌÂÙ¿ ÙËÓ ·-Ú·ÌÔÓ‹ ÙÔ˘ ÛÙÔ Ô˘‰¤ÙÂÚÔ ‰È¿Ï˘Ì· A) MÂÙ¿ ÙÔ ÛÙ¤Áӈ̷ Ì ·ÂÚÔÛ‡ÚÚÈÁ· B) MÂÙ¿ ÙËÓ ·Ú·ÌÔÓ‹ Û ÍËÚ·ÓÙ‹Ú·
13-18 ™E§. - Hliadis** 7-10-08 11:09 ™ÂÏ›‰· 15
™ÙÔÓ ¶›Ó·Î· 1 Û˘ÓÔ„›˙ÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ̤-ÙÚËÛ˘ ÙÔ˘ pH Î·È Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ,ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ÙˆÓ ‰ÔÎÈÌ›ˆÓ.
¶›Ó·Î·˜ 1. OÈ ÌÂÙ·‚ÔϤ˜ ÛÙÔ pH Î·È ÙËÓ ·ÁˆÁÈÌfiÙËÙ·ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ÙˆÓ ‰ÔÎÈ-Ì›ˆÓ (̤ÛË ÙÈÌ‹ ±ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË, n=6).
¢IA§YMA pH A°ø°IMOTHTA (mS /cm)·) ŸÍÈÓÔ
¶ÚÈÓ ÙËÓ ÂÌ‚¿ÙÈÛË 4,43 ± 0,06 52,92 ± 0,74MÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË 4,79 ± 0,04 53,69 ± 0,85
‚) O˘‰¤ÙÂÚÔ¶ÚÈÓ ÙËÓ ÂÌ‚¿ÙÈÛË 6,80 ± 0,08 47,6 ± 0,80MÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË 6,90 ± 0,04 48,4 ± 0,63
AÓ Î·È Û ·fiÏ˘Ù˜ ÙÈ̤˜ ·Ú·ÙËÚ‹ıËΠÂÏ·ÊÚ¿ ·‡ÍË-ÛË ÙÔ˘ pH Î·È Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙ¿ÙËÓ ÂÌ‚¿ÙÈÛË ÙˆÓ ‰ÔÎÈÌ›ˆÓ ÙÔ˘ Barricaid ‰ÂÓ ·Ú·ÙË-Ú‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ (p > 0,05).
™YZHTH™H
H ̤ÙÚËÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘ pH Î·È Ù˘ ·ÁˆÁÈÌfiÙË-Ù·˜ ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ÙÔ˘ ¶XE Û ‰È·Ï‡Ì·Ù· ËÏÂÎÚÔ-Ï˘ÙÒÓ ̄ ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔ˘˜ vonFraunhofer Î·È Argyropoulos13 ˆ˜ Ù·¯Â›Â˜ ̤ıÔ‰ÔÈ ÁÈ·ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȉڿÛÂˆÓ ÙˆÓ ·Â-Ï¢ıÂÚÔ‡ÌÂÓˆÓ ÈÔÓÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓηٿ ÙË Ê¿ÛË Ù˘ ‰È·Ï˘ÙÔÔ›ËÛ‹˜ ÙÔ˘˜. A‡ÍËÛË Ù˘ ·-ÁˆÁÈÌfiÙËÙ·˜ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ‰Ë-ÏÒÓÂÈ ·Ô‰fiÌËÛË ÙÔ˘ ˘ÏÈÎÔ‡, ÂÓÒ Ì›ˆÛË, ·ÔÚÚfiÊË-ÛË ÈfiÓÙˆÓ ·fi ÙÔ ‰È¿Ï˘Ì·. AÓ Î·È Ë Ì¤ıÔ‰Ô˜ ‰ÂÓ ÌÔÚ›ӷ ·Ú¿Û¯ÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ Ù‡Ô ÙˆÓ ÈfiÓÙˆÓ Ô˘·ÂÏ¢ıÂÚÒÓÔÓÙ·È ‹ ·ÔÚÚÔÊÒÓÙ·È, ‰›‰ÂÈ ÛËÌ·ÓÙÈΤ˜ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ˘ÏÈÎÔ‡ ›Ù ÁÈ·‰Â‰Ô̤ÓË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ›Ù ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙÔ ¯Úfi-ÓÔ, fiÙ·Ó ‰ÈÂÍ¿ÁÔÓÙ·È ÎÏÈÓÈΤ˜ ÌÂϤÙ˜. O Û˘Ó‰˘·ÛÌfi˜·˘Ù‹˜ Ù˘ ÌÂıfi‰Ô˘ Ì ÙËÓ Ì¤ÙÚËÛË ÙÔ˘ pH ÂÈÙÚ¤ÂÈÙËÓ ÂÈϤÔÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ηٿ fiÛÔ ·ÂÏ¢ıÂÚÒ-
ÓÔÓÙ·È ‹ ‰ÂÛ̇ÔÓÙ·È ·ÓÈfiÓÙ· ‹ ηÙÈfiÓÙ· ·fi ÙÔ ÚÔ˜ ¤-ÏÂÁ¯Ô ˘ÏÈÎfi. OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ì Â-ÈÙ˘¯›· ÁÈ· ÙËÓ ÌÂϤÙË Ù˘ ·Ô‰fiÌËÛ˘ ¶XE Ì ÔÍÂÔ‚·-ÛÈ΋ ·ÓÙ›‰Ú·ÛË ‹Í˘13. H ›‰È· ̤ıÔ‰Ô˜ ̄ ÚËÛÈÌÔÔÈ‹ıË-ÎÂ Î·È ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÔÏ˘ÌÂÚÔ‡˜ ¶XEBarricaid13. H ÂÊ·ÚÌÔÁ‹ fï˜ ·˘ÙÒÓ ÙˆÓ ÌÂıfi‰ˆÓ ÛÂÔÏ˘ÌÂÚ‹ ¯ÚÂÈ¿˙ÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹. AÓÙ›ıÂÙ· Ì ٷ ÔÍÂÔ‚·ÛÈο Û˘ÛÙ‹Ì·Ù·, fiÔ˘ ηٿ ÙË‰È¿Ï˘ÛË ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ÈfiÓÙ·, ÛÙÔ Û··ÛÌ·Barricaid ÙfiÛÔ Ë ÔÚÁ·ÓÈ΋ Ì‹ÙÚ·, fiÛÔ Î·È ÔÈ ÂÓÈÛ¯˘ÙÈΤ˜Ô˘Û›Â˜ SiO2 ÂÌÊ·Ó›˙Ô˘Ó ÂÍ·ÈÚÂÙÈο ¯·ÌËÏ‹ ‰È·Ï˘ÙfiÙË-Ù·. AÓ Î·È ·ÂÏ¢ıÂÚÒÓÔÓÙ·È Ô˘Û›Â˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ, ¤-Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ·fi ·˘Ù¤˜ ‰ÂÓ Ê¤ÚÂÈ ÈÔÓÙÈο ÊÔÚÙ›·(Ï.¯. ̆ ÔÏÂÈfiÌÂÓÔ ÌÔÓÔÌÂÚ¤˜, ‹ ÎfiÎÎÔÈ SiO2) Ì ·ÔÙ¤-ÏÂÛÌ· Ó· ÌËÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÓȯÓ¢ıÔ‡Ó ÌÂÙ·‚ÔϤ˜ÛÙËÓ ·ÁˆÁÈÌfiÙËÙ· ‹ ÛÙÔ pH. T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·-ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ÚÔËÁÔ‡ÌÂÓ· Â˘Ú‹Ì·-Ù· ÁÈ· ÙËÓ ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ÌÂÙ·‚ÔÏ‹˜ ÙÔ˘ pH Ô˘‰Â-Ù¤ÚˆÓ ‰È·Ï˘Ì¿ÙˆÓ ·fi ÙËÓ ÂÌ‚¿ÙÈÛË ‰ÔÎÈÌ›ˆÓBarricaid13. ¶¿ÓÙˆ˜ ÛÙȘ ÌÂÙÚ‹ÛÂȘ Û ¯·ÌËÏfi pH ‰È·È-ÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚÔ˘ ‚·ıÌÔ‡ ·‡ÍËÛË ÙÔ˘ pH, ·' fiÙÈÛÙÔ Ô˘‰¤ÙÂÚÔ ‰È¿Ï˘Ì·. ¶Èı·Ófiٷٷ Ë ÌÂÙ·‚ÔÏ‹ Ó· Ô-Ê›ÏÂÙ·È Û ÌÂÚÈ΋ fiÍÈÓË ˘‰ÚfiÏ˘ÛË ÙˆÓ ÎfiÎÎˆÓ SiO2
ÚÔ˜ ÛÈÏ·ÓfiϘ (Si-OH), ÔÈ Ôԛ˜ ¤¯Ô˘Ó Ù¿ÛË ·‡ÍËÛ˘ÙÔ˘ pH15. ŸÌˆ˜, ÙfiÛÔ ÙÔ ÌÈÎÚfi ̤ÁÂıÔ˜ ÙˆÓ ÎfiÎÎˆÓ Ô˘¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÂÓÈÛ¯˘ÙÈΤ˜ Ô˘Û›Â˜, fiÛÔ Î·È Ë ÌÈ-ÎÚ‹ Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÛÙÔ ‰È¿Ï˘Ì·, ÏfiÁˆ Ù˘ ÂÚÈÔÚÈ-Ṳ̂Ó˘ ‰È·Ï˘ÙfiÙËÙ·˜ ÙÔ˘ Barricaid, ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ ¤-ÎÙ·ÛË Ù˘ ÚÔÛ‚ÔÏ‹˜. H ·Ô˘Û›· ÌÂÙ·‚ÔÏÒÓ ÛÙÔ pH Î·È ÙËÓ ·ÁˆÁÈÌfiÙËÙ·, fi-ˆ˜ ÚԷӷʤÚıËÎÂ, ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ‰ÂÓ ·Ô‰ÔÌ›ٷÈÙÔ ˘ÏÈÎfi. H Ê·ÛÌ·ÙÔÛÎÔÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÂÈÊ·ÓÂÈÒÓÙˆÓ ‰ÔÎÈÌ›ˆÓ ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ÛÙ· ‰È·Ï‡Ì·Ù· Î·È ËÛ‡ÁÎÚÈÛ‹ ÙÔ˘˜ Ì ÙÔ ‰ÔΛÌÈÔ ·Ó·ÊÔÚ¿˜ ·ÔÎ¿Ï˘„ fiÙÈÛÙÔ fiÍÈÓÔ ‰È¿Ï˘Ì· ÙÔ Û··ÛÌ· Barricaid ˘Ê›ÛÙ·Ù·È Â-ÎÏÂÎÙÈ΋ ·Ô‰fiÌËÛË ÛÙÔ Ì‹ÎÔ˜ ·̷ÙÔ˜ ÙˆÓ ÎÔÚ˘ÊÒÓ·ÔÚÚfiÊËÛ˘ ÙˆÓ ·Ìȉ›ˆÓ. ¶Èı·Ófiٷٷ Ë ÚÔÛ‚ÔÏ‹ Û'·˘Ùfi ÙÔ ÛËÌÂ›Ô Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ÌË-¯·ÓÈÛÌÔ‡ ̆ ‰ÚÔÏ˘ÙÈ΋˜ ·fiÛ¯ÈÛ˘ AAL ÙˆÓ ÂÛÙ¤ÚˆÓ ÙˆÓ·Ìȉ›ˆÓ16. Afi ÙÔ ‚¿ıÔ˜ ·Ó¿Ï˘Û˘ Ù˘ Ê·ÛÌ·ÙÔÛÎÔ›·˜micro-MIR FTIR, ÙÔ ÔÔ›Ô ˘ÔÏÔÁ›ÛÙËΠ۠2,5 Ìm ÛÙ·1000 cm-1, ÚÔ·ÙÂÈ fiÙÈ Ë ÏËÚÔÊÔÚ›· ÚÔ¤Ú¯ÂÙ·È ·fiÙÔ Â͈ÙÂÚÈÎfi ÛÙÚÒÌ·. °È· Ó· ‰ÈÂÚ¢ÓËı› Â¿Ó Ë ÚÔÛ‚Ô-Ï‹ ‹Ù·Ó ÔÌÔÈfiÌÔÚÊË, ÔÚÈṲ̂ӷ ‰ÔΛÌÈ· ÏÂÈ¿ÓıËÎ·Ó Ì¯·ÚÙÈ¿ SiC ÌÂÁ¤ıÔ˘˜ ÎfiÎÎˆÓ 1200 ÒÛÙ ӷ ·Ê·ÈÚÂı› ÙÔÂ͈ÙÂÚÈÎfi ÛÙÚÒÌ· ¿¯Ô˘˜ 50 Ìm Î·È ·fi ÙȘ ÏÂÈ·Ṳ̂-Ó˜ ÂÈÊ¿ÓÂȘ ÂÏ‹ÊıËÛ·Ó ¿ÏÈ Ê¿ÛÌ·Ù· micro-MIR. T··ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ë ÎÔÚ˘Ê‹ ÙˆÓ ·Ìȉ›ˆÓ ·Ô-ηٷÛÙ¿ıËÎÂ, Ú¿ÁÌ· Ô˘ ‰ËÏÒÓÂÈ fiÙÈ ÙÔ Ê·ÈÓfiÌÂÓÔ Â›-Ó·È ÂÈÊ·ÓÂÈ·Îfi. H ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜ Barricaid Û ÂÚÈ‚¿Ï-ÏÔÓ ̄ ·ÌËÏÔ‡ pH Û ۇÁÎÚÈÛË Ì ¿ÏÏ· Û΢¿ÛÌ·Ù· ÌÔ-Ú› Ó· ıˆÚËı› ˆ˜ ÏÂÔÓ¤ÎÙËÌ·. ŸÌˆ˜ ‰ÂÓ ÚÔÛʤÚÂÈÙÔ ıÂڷ¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ˘„ËÏÔ‡ pH Ô˘ ÂÍ·-ÛÊ·Ï›˙Ô˘Ó ¿ÏÏ· ˘ÏÈο ηٿ ÙË ‰È·Ï˘ÙÔÔ›ËÛ‹ ÙÔ˘˜13.¶·Ú' fiÏ· ·˘Ù¿ Ë ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ ÔÏ˘ÌÂÚÔ‡˜ ‰ÈÎÙ‡Ô˘ÙÔ˘ Barricaid ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ̤ÙÚÔ ÁÈ·ÙËÓ ÂÏÂÁ¯fiÌÂÓË, ηٿ ÙÔ ‰˘Ó·ÙfiÓ, ·ÂÏ¢ı¤ÚˆÛË ·ÓÙÈ-ÛËÙÈÎÒÓ, ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ ·Ú·ÁfiÓÙˆÓ, ·Ó·ÏÁËÙÈÎÒÓ
16
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 13-18, 2004
EÈÎ. 3: EÈÎ. 3 º¿ÛÌ·Ù· micro-MIR FTIR ‰ÔÎÈÌ›Ô˘ Barricaid ÌÂÙ¿ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ ÛÙÔ fiÍÈÓÔ ‰È¿Ï˘Ì· A) MÂÙ¿ ÙÔ ÛÙ¤Áӈ̷ Ì ·ÂÚÔÛ‡ÚÈÁÁ· B) MÂÙ¿ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ Û ÍËÚ·ÓÙ‹Ú·
13-18 ™E§. - Hliadis** 7-10-08 11:09 ™ÂÏ›‰· 16
Î.Ï.. ¶ÂÈÚ·Ì·ÙÈ΋ ÂÓۈ̿وÛË. ¯ÏˆÚÂÍȉ›Ó˘ ÛÙÔBarricaid ¤‰ÂÈÍ ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· Û ÂÚÁ·-ÛÙËÚÈ·Îfi ›‰Ô, ¯ˆÚ›˜ fï˜ Ë Ì¤ıÔ‰Ô˜ Ó· Á›ÓÂÈ ÁÂÓÈ-ÎfiÙÂÚ· ·Ô‰ÂÎÙ‹ ‹ Ó· ˘ÈÔıÂÙËı› ·fi ÙÔÓ Î·Ù·Û΢·-ÛÙ‹17. H Û¯ÂÙÈ΋ ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ Barricaid Û Ԣ‰¤ÙÂÚÔ Î·È fi-ÍÈÓÔ pH, ‰ÂÓ ÂÍ·ÛÊ·Ï›˙ÂÈ ÙËÓ ·Ó¿ÏÔÁË Û˘ÌÂÚÈÊÔÚ¿ ÛÙÔÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ, fiÔ˘ Ë ·ÚÔ˘Û›· ÌÈÎÚÔ‚›ˆÓ, ÂÓ-˙‡ÌˆÓ Î.Ï.. ÌÔÚ› Ó· ÂÈÙ·¯‡ÓÂÈ ÙȘ ·ÓÙȉڿÛÂȘ ‚ÈÔ·-Ô‰fiÌËÛ˘ ÙÔ˘ ̆ ÏÈÎÔ‡, Ô‰ËÁÒÓÙ·˜ ÔÏϤ˜ ÊÔÚ¤˜ Û ÌË·Ó·ÌÂÓfiÌÂÓ· ÚÔ˚fiÓÙ· ·Ô‰fiÌËÛ˘. K·Ù¿ Û˘Ó¤ÂÈ· ËÛ˘ÛÙËÌ·ÙÈ΋ ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ÊˆÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓÔ˘ ¶XE Â›Ó·È ÙÔ Ï¤ÔÓ ·ÍÈfiÈÛÙÔÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ·Ô‰Ô¯‹ ‹ fi¯È ÙˆÓ ÏÂÔÓÂÎÙËÌ¿ÙˆÓÔ˘ ·Ú¤¯ÂÈ ÙÔ ˘ÏÈÎfi.
™YM¶EPA™MATA
T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Û˘ÓÔ„›˙Ô-ÓÙ·È ÛÙ· ·ÎfiÏÔ˘ı·:·) TÔ Ô˘‰¤ÙÂÚÔ pH ‰ÂÓ ÂËÚ¿˙ÂÈ ÙË ÌÔÚȷ΋ ‰ÔÌ‹ Ù˘ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ʈÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓÔ˘ ¶XE Barricaid.‚) TÔ fiÍÈÓÔ pH ÙÚÔÔÔÈ› ÙË ¯ËÌÈ΋ Û‡ÓıÂÛË Ù˘ ÂÈ-Ê¿ÓÂÈ·˜, ηٷÛÙÚ¤ÊÔÓÙ·˜ ÙȘ ÂÈÊ·ÓÂȷΤ˜ ÔÌ¿‰Â˜ ÙˆÓ·Ìȉ›ˆÓ. Á) TÔ pH ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ·ÚÔ˘Û›·Û ÌÈÎÚ‹ ·‡ÍËÛËηÙ' ·fiÏ˘ÙÔ ÙÈÌ‹ ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛË ÙÔ˘ ʈÙÔÔÏ˘ÌÂ-ÚÈ˙fiÌÂÓÔ ¶XE, ·ÏÏ¿ ÔÈ ‰È·ÊÔÚ¤˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈοÛËÌ·ÓÙÈΤ˜.‰) H ·ÁˆÁÈÌfiÙËÙ· ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÂÙ¿ ÙËÓ ÂÌ‚¿ÙÈÛËÙÔ˘ ˘ÏÈÎÔ‡ ·ÚÔ˘Û›·Û ÌÈÎÚ‹ ·‡ÍËÛË ÛÙȘ ̤Û˜ ÙÈ̤˜,¯ˆÚ›˜ fï˜ ÔÈ ‰È·ÊÔÚ¤˜ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.
SUMMARY
"Effect of acidic and neutral buffer solutions onthe stability of a visible light-cured periodontal
dressing material"S. Silvestros*, V. Chronopoulos**, D.Karathanasopoulou***, G. Eliades****
hellenic stomatological review 48: 13-18, 2004
The aim of the present study was to assess the chemicalchanges induced on the surface of a visible light-curedperiodontal dressing material after storage in acidic andneutral buffer solutions, and to monitor the changes in thepH and conductivity of the solutions. The product testedwas Barricaid. Twelve disk shaped specimens (8 mm indiameter and 1,5 mm in thickness) were prepared byirradiating the specimens for 40 s with a visible light-curedunit emitting 560 mW/cm2 light intensity. The specimenswere divided into two groups of six and were immersed inan acidic (pH: 4,4) and a neutral (pH: 6,8) buffer solutionrespectively for 7 d at 37±1Æ C. The specimen surfacesbefore and after exposure to the solutions were studied by
micro-MIR FTIR. Moreover, the changes in the pH andconductivity of the solutions were monitored before andafter immersion. The statistical analysis of the pH andconductivity measurements was performed by t-test (· =0,05). The results showed a reduction in the amideabsorption intensity after immersion in the acid solution.An increase in the solution pH and conductivity wasobserved after immersion, but the difference was notstatistically significant. The results of the present studyimply that Barricaid is a quite stable product under acidicpH. Nevertheless, This stability minimizes its therapeuticpotential, because has no capacity in increasing the pH ofthe incubating solution as the products set by an acid-base reaction.
Key words: Periodontal therapy, root planing, review.
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EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 13-18, 2004
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:°. HÏÈ¿‰Ë˜£Ë‚ÒÓ 2, °Ô˘‰›115 27 Aı‹Ó·TËÏ. 210 7461100-2e: mail: [email protected]
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EÚ¢ÓËÙÈ΋ ÂÚÁ·Û›·
AÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ÌÂϤÙË ÙÔ˘ ˘‰·Ù·ÓıÚ·ÎÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘19-9 (CA 19-9) Û ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ
A. EÈ‚·ÙÈ·Ófi˜*, ™. IÔÚ‰·Ó›‰Ë˜**, ¢. AÓÙˆÓÈ¿‰Ë˜***
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ÌÂϤÙË ÙÔ˘ ˘‰·Ù·ÓıÚ·ÎÈÎÔ‡ ·ÓÙÈÁfi-ÓÔ˘ 19-9 ( CA 19-9) Û ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ Î·È È‰È·›ÙÂÚ· ÙÔ˘ ÙÚfiÔ˘ ¤ÎÊÚ·-Û‹˜ ÙÔ˘ Û ۯ¤ÛË Ì ÙËÓ ÚfiÁÓˆÛË ÙÔ˘˜.XÚËÛÈÌÔÔÈ‹ıËÎ·Ó 69 ÌÏfiÎ ·Ú·Ê›Ó˘ Ù· ÔÔ›· ÂÚÈÏ¿Ì‚·Ó·Ó 21 ÂÚÈÙÒÛÂȘ ηÏÔ‹ıˆÓ ÓÂ-ÔÏ·ÛÌ¿ÙˆÓ, ·fi ÙȘ Ôԛ˜ 11 ÂÚÈÙÒÛÂȘ ÂÚÈ›¯·Ó Î·È ·Ú·Î›ÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤-Ó˜, 43 ÂÚÈÙÒÛÂȘ ηÎÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ·fi ÙȘ Ôԛ˜ 12 ÂÚÈÙÒÛÂȘ ÂÚÈ›¯·Ó Î·È ·-ڷΛÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜, Î·È 5 ÂÚÈÙÒÛÂȘ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÔÈ Ô-Ô›ÔÈ ·Ê·ÈÚ¤ıËÎ·Ó ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜. °È· ÙËÓ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ÌÂϤÙË ÙÔ˘ CA 19-9 ¯ÚËÛÈ-ÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›Ó˘-‚ÈÔÙ›Ó˘- ˘ÂÚÔÍÂȉ¿Û˘.TÔ ·ÓÙÈÁfiÓÔ ÂÓÙÔ›˙ÔÓÙ·Ó ÛÙ· ‚ÏÂÓÓÒ‰Ë Î‡ÙÙ·Ú· ÙˆÓ ·‰ÂÓÔ΢„ÂÏÒÓ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÛÈ·ÏÔ-ÁfiÓˆÓ ·‰¤ÓˆÓ Î·È ÛÙ· ·ÙÙ·Ú· ÙˆÓ fiÚˆÓ ÙÔ˘˜ ÂÌÊ·Ó›˙ÔÓÙ·˜ ‰È¿¯˘ÙË Î·È ÎÔÎÎÒ‰Ë ¤ÎÊÚ·ÛË,ÂÓÒ ÎÔÚ˘Ê·›· ¤ÎÊÚ·ÛË ÂÌÊ¿ÓÈ˙·Ó Ù· ·Ú·Î›ÌÂÓ· ·ÙÙ·Ú· ÙˆÓ ·˘ÏÒÓ Û ·ÚÎÂÙÔ‡˜ fiÚÔ˘˜. ™Â20 ÂÚÈÙÒÛÂȘ ıÂÙÈ΋˜ ̄ ÚÒÛ˘ ÙˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ, ıÂÙÈ΋ ̄ ÚÒÛË ÂÌÊ¿ÓÈ˙·Ó Î·È ÔÈ ·Ú·Î›ÌÂ-ÓÔÈ Ê˘ÛÈÔÏÔÁÈÎÔ› ÛÈ·ÏÔÁfiÓÔÈ ·‰¤Ó˜. O ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9 ÛÙ· ηÏÔ‹ıË Î·È Î·ÎÔ‹-ıË ÓÂÔÏ¿ÛÌ·Ù· ‰ÂÓ ‰È¤ÊÂÚ ·fi ·˘ÙfiÓ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜·‰¤Ó˜.T· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Ì·˜ ÂÈÙÚ¤Ô˘Ó Ó· ÚÔÙ›ÓÔ˘Ì fiÙÈ Ô ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ÙÔ˘ CA 19-9 ‰ÂÓ ı· ÌÔÚÔ‡Û ӷ ·ÔÙÂϤÛÂÈ ‰Â›ÎÙË ÚfiÁÓˆÛ˘ ÙˆÓ Î·ÎÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 19-25, 2004
§¤ÍÂȘ ÎÏÂȉȿ: K·ÚÎÈÓÈÎfi˜ ‰Â›ÎÙ˘, Y‰·Ù·ÓıÚ·ÎÈÎfi ·ÓÙÈÁfiÓÔ 19-9, NÂÔÏ¿ÛÌ·Ù· ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ, AÓÔÛÔ˚-ÛÙÔ¯ËÌ›·.
* AÓ·Ï. K·ıËÁËÙ‹˜.** AÓ·Ï. K·ıËÁËÙ‹˜.
*** K·ıËÁËÙ‹˜ Î·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÔÏÔ-Á›·˜.
O‰ÔÓÙÈ·ÙÚÈÎfi TÌ‹Ì· A.¶.£. £ÂÛÛ·ÏÔÓ›ÎË
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TÔ ˘‰·Ù·ÓıÚ·ÎÈÎfi ·ÓÙÈÁfiÓÔ 19-9 (CA 19-9) ·Ó·ÁÓˆÚ›-ÛıËΠ̠ÙËÓ ¯Ú‹ÛË ÌÔÓÔÎψÓÈÎÔ‡ ·ÓÙÈÛÒÌ·ÙÔ˜ Ô˘ÚÔ‹Ïı ·fi ÙËÓ ·ÓÔÛÔÔ›ËÛË ÔÓÙÈÎÒÓ Ì ̛· ÛÂÈڿηÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÂÓÙ¤ÚÔ˘1. O ·ÓÙÈÁÔÓÈÎfi˜ ηıÔÚÈ-ÛÙ‹˜ ÙÔ˘ Â›Ó·È ÁÏ˘ÎÔÛ˘ÏȈ̤ÓÔ ·Ú¿ÁˆÁÔ ÙÔ˘ ·ÓÙÈÁfi-ÓÔ˘ Lewis a Ù˘ ÔÌ¿‰·˜ ·›Ì·ÙÔ˜2, ÙÔ ÔÔ›Ô ÛÙÔ˘˜ ÈÛÙÔ‡˜
ÂÎÊÚ¿˙ÂÙ·È Ì ÙËÓ ÌÔÚÊ‹ ÌÔÓÔÛÈ·ÏÔÁ·ÁÁÏÈÔÛȉ›Ô˘, ÂÓÒÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜ Ì ÙËÓ ÌÔÚÊ‹ ÁÏ˘ÎÔÏÈȉ›ˆÓ3.™ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÈÛÙÔ‡˜ ÙÔ CA 19-9 ÂÓÙÔ›ÛıËÎÂÛÙÔ˘˜ ÌÂÚÔÎÚÈÓ›˜ Î·È ·ÔÎÚÈÓ›˜ ȉڈÙÔÔÈÔ‡˜ ·‰¤-Ó˜4, 5, ÛÙËÓ ÙÚ·¯Â›·,ÛÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜, Î·È ÛÙ· ‚ÚÔÁ¯Èfi-ÏÈ·6,7, ÛÙÔ ¿ÁÎÚ·˜8, 9 Î·È Û¿ÓÈ· ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔ-ÁfiÓÔ10. E›Û˘ ·ÓȯÓ‡ıËΠÛÙË ‚ϤÓÓ· ÙˆÓ ‚ÚfiÁ¯ˆÓ6,Ù˘ ¯ÔÏ‹˜11, Î·È ÙÔ˘ Û¿ÏÈÔ˘12.Afi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ CA 19-9 ÂÓÙÔ›ÛıËÎÂÛ ηÚÎÈÓÒÌ·Ù· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜8,13,14, ÙÔ˘ ÂÓÙ¤ÚÔ˘15,16,ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘17, ÙÔ˘ ÂÓ‰ÔÌËÙÚ›Ô˘18, ÙÔ˘ı˘ÚÂÔÂȉ‹ ·‰¤Ó·19, Î·È ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡20,ÂÓÒ ÚÔÙ¿ıËÎÂ Û·Ó Î·ÚÎÈÓÈÎfi˜ ‰Â›ÎÙ˘ ÛÙÔÓ ÔÚfi ·›Ì·-ÙÔ˜ ÁÈ· Ù· ηÚÎÈÓÒÌ·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘21-23, ÙÔ˘ ·ÁÎÚ¤·-ÙÔ˜24, 25, ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ Ë·ÙÔ¯ÔÏÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜26-28. ™Â ηÚÎÈÓÒÌ·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ù· ˘„ËÏ¿ ›‰¿ÙÔ˘ CA 19-9 ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜ ‚Ú¤ıËΠfiÙÈ ¤¯Ô˘Ó Û¯¤ÛËÌ η΋ ÚfiÁÓˆÛË29. EȉÈο ÛÙ· ηÚÎÈÓÒÌ·Ù· ÙÔ˘ Á·-ÛÙÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘30 Î·È ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜31 Ô ÙÚfiÔ˜¤ÎÊÚ·Û˘ ÙÔ˘ ÛÙÔ˘˜ ÓÂÔÏ·ÛÌ·ÙÈÎÔ‡˜ ÈÛÙÔ‡˜ ıˆڋ-
19
19-25 ÛÂÏ. - Epibatianos** 3-10-08 12:44 ™ÂÏ›‰· 19
ıËΠfiÙÈ ¤¯ÂÈ Û¯¿ÛË Ì ٷ ›‰¿ ÙÔ˘ ÛÙÔÓ ÔÚfi ·›Ì·-ÙÔ˜, ÂÓÒ ÛÙ· ηÚÎÈÓÒÌ·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘10 Ì ÙËÓ Úfi-ÁÓˆÛË ÙÔ˘˜. TÔ CA 19-9 ÌÂÏÂÙ‹ıËΠ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈο Û ÔÚÈṲ̂ӷηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ 20,32,33 Â-ÓÒ ÛÙ· ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Î·È ÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı›. ™ÙÔ ·‰ÂÓÔ΢-ÛÙÈÎfi Î·È ‚ÏÂÓÓÔÂȉÂÚÌÈÎfi ηÚΛӈ̷ ‚Ú¤ıËΠfiÙÈ ÔÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9 ‰ÂÓ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓÚfiÁÓˆÛ‹ ÙÔ˘˜33.™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ-΋ ÌÂϤÙË ÙÔ˘ CA 19-9 Û ηÏÔ‹ıË Î·È Î·ÎÔ‹ıË ÓÂÔÏ¿-ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ Î·È È‰È·›ÙÂÚ· ÙÔ˘ ÙÚfiÔ˘¤ÎÊÚ·Û‹˜ ÙÔ˘ Û ۯ¤ÛË Ì ÙËÓ ÚfiÁÓˆÛ‹ ÙÔ˘˜.
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Afi ÙÔ ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ·Ú¯Â›Ô ÙÔ˘ EÚÁ·ÛÙËÚ›Ô˘Ù˘ ™ÙÔÌ·ÙÔÏÔÁ›·˜ ÙÔ˘ O‰ÔÓÙÈ·ÙÚÈÎÔ‡ TÌ‹Ì·ÙÔ˜ ÙÔ˘A.¶.£ ̄ ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘ÓÔÏÈο 69 ÌÏfiÎ ·Ú·Ê›Ó˘ٷ ÔÔ›· ÂÚÈÏ¿Ì‚·Ó·Ó: 1) 21 ÂÚÈÙÒÛÂȘ ηÏÔ‹ıˆÓÓÂÔÏ·ÛÌ¿ÙˆÓ ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ·fi ÙȘ Ôԛ˜11 ÂÚÈÙÒÛÂȘ ÂÚÈ›¯·Ó Î·È ·Ú·Î›ÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔ-ÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜. 2) 43 ÂÚÈÙÒÛÂȘ ηÎÔ‹-ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ·fi ÙȘ Ô-ԛ˜ 12 ÂÚÈÙÒÛÂȘ ÂÚÈ›¯·Ó Î·È ·Ú·Î›ÌÂÓÔ˘˜ Ê˘-ÛÈÔÏÔÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜. 3) 5 Ê˘ÛÈÔÏÔÁÈÎÔ› ÌÈ-ÎÚÔ› ÛÈ·ÏÔÁfiÓÔÈ ·‰¤Ó˜ ÔÈ ÔÔ›ÔÈ ·Ê·ÈÚ¤ıËÎ·Ó ÁÈ· ‰È¿-ÊÔÚÔ˘˜ ÏfiÁÔ˘˜.Afi Ù· ÌÏfiÎ ·Ú·Ê›Ó˘ Ï‹ÊıËÎ·Ó ÙÔ̤˜ ¿¯Ô˘˜ 4ÌmÔÈ Ôԛ˜ ¯ÚÒÛıËÎ·Ó Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Î·È ËˆÛ›ÓË, Û Ô-ÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ Ì ÙËÓ ÈÛÙÔ¯ËÌÈ΋ ¯ÚÒÛË ÙԢ΢·ÓÔ‡ Ù˘ AÏÛÈ·Ó‹˜ pH 2.5-PAS ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ34, Î·È Ì ÙËÓ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ̤ıÔ‰ÔÙ˘ ÛÙÚÂÙ·‚ȉÈÓ˘-‚ÈÔÙ›Ó˘-˘ÂÚÔÍÂȉ¿Û˘35. T· ÓÂÔ-Ï¿ÛÌ·Ù· Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘¶.O.Y36. T· ‚ÏÂÓÓÔÂȉÂÚÌÈο ηÚÎÈÓÒÌ·Ù· Ù·ÍÈÓÔÌ‹-ıËÎ·Ó Û 3 ‚·ıÌÔ‡˜ ηÎÔ‹ıÂÈ·˜ Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹-ÚÈ· ÙˆÓ Seifert Î·È Û˘Ó37. H ‰È¿ÁÓˆÛË ÙˆÓ Î·ÏÔ‹ıˆÓ ηÈηÎÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ˘˜ ¶›Ó·-Θ 1 Î·È 2, ·ÓÙ›ÛÙÔȯ·.K·Ù¿ ÙËÓ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ̤ıÔ‰Ô Ù˘ ÛÙÚÂÙ·‚ȉ›Ó˘-‚ÈÔÙ›Ó˘-˘ÂÚÔÍÂȉ¿Û˘, ÔÈ ÙÔ̤˜ ˆ¿ÛıËÎ·Ó Ì ÙÔÚˆÙ‡ÔÓ ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ CA-19-9 ( Signet,Dedham, MA, USA ) Û ·Ú·›ˆÛË 1:40 › 18 ÒÚ˜ ÛÂ4ÆC, ÂÓÒ Ì ÙÔ ‰Â˘ÙÂÚ‡ÔÓ ·Óٛۈ̷ ( Signet ) Û ·Ú·›-ˆÛË 1:20 › 1/2ÒÚ· Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘. MÈÎÚÔ-ÙÔ̤˜ ·fi ·‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ¯ÚËÛÈÌÔÔÈ‹-ıËÎ·Ó ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ıÂÙÈ΋˜ ̄ ÚÒÛ˘, ÂÓÒ ÁÈ· ÙÔÓ ¤-ÏÂÁ¯Ô Ù˘ ·ÚÓËÙÈ΋˜ ¯ÚÒÛ˘ ÌÈÎÚÔÙÔ̤˜ ·fi fiÏ· Ù· ›-‰Ë ÙˆÓ ÈÛÙÒÓ Âˆ¿ÛıËÎ·Ó ÁÈ· ÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi Â›Ì˘ Î·È Û ڢıÌÈÛÙÈÎfi ‰È¿Ï˘Ì·ÊˆÛÊÔÚÈÎÔ‡ ¿Ï·ÙÔ˜ (PBS). °È· ÙËÓ ÙÂÏÈ΋ ·Ó›¯Ó¢ÛËÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰È¿Ï˘Ì· ‰È·ÌÈÓÔ‚ÂÓ˙È-‰›Ó˘ (DAB) Î·È ÛÙÔ Ù¤ÏÔ˜ ÔÈ ˘Ú‹Ó˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ¯ÚÒÛıËÎ·Ó Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Mayer.H ¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Ù·ÍÈÓÔÌ‹ıËΠˆ˜ ÂÍ‹˜: KÔÎ-Î҉˘, fiÙ·Ó ÌÈÎÚ¿ ηʤ ÎÔÎΛ· ‰È·ÎÚ›ÓÔÓÙ·Ó ÛÙÔ Î˘ÙÙ·-ÚfiÏ·ÛÌ· Ì ÌÂÁ¤ı˘ÓÛË 40X. ¢È¿¯˘ÙË, fiÙ·Ó ÌÈÎÚ¿ ηʤ
ÎÔÎΛ· ‰ÂÓ ‰È·ÎÚ›ÓÔÓÙ·Ó Ì ÙËÓ ÌÂÁ¤ı˘ÓÛË 40X ·ÏÏ¿ ̤-ÚÔ˜ ‹ fiÏÔ ÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÂÌÊ¿ÓÈ˙ ÔÌÔÈÔÁÂÓ‹ ¯ÚÒ-ÛË. KÔÚ˘Ê·›·, fiÙ·Ó Ë ¯ÚÒÛË ÂÓÙÔ›˙ÔÓÙ·Ó ÛÙÔ ÙÌ‹Ì·Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Ô˘ ÚfiÛÎÂÈÙ·È Û ·˘Ïfi.
A¶OTE§E™MATA
K·ÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Î·È Ê˘ÛÈÔÏÔÁÈÎÔ› ·‰¤Ó˜T· ·ÔÙÂϤÛÌ·Ù· ÛÙ· ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Î·È ÛÙÔ˘˜·Ú·Î›ÌÂÓÔ‡˜ ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜ Û˘ÓÔ„›˙Ô-ÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. O ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9
ÛÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÙˆÓ Î·ÏÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓÊ˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜ ‹Ù·Ó fiÌÔÈÔ˜ Ì ·˘ÙfiÓ Ô˘ ·Ú·-ÙËÚ‹ıËΠÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜ Ô˘ ·Ê·ÈÚ¤ıË-Î·Ó ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜. TÔ ·ÓÙÈÁfiÓÔ ÂÓÙÔ›˙ÔÓÙ·Ó΢ڛˆ˜ ÛÙ· ‚ÏÂÓÓÒ‰Ë Î‡ÙÙ·Ú· ÙˆÓ ·‰ÂÓÔ΢„ÂÏÒÓÙÔ˘˜, ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÛÙ· ·ÙÙ·Ú· ÙˆÓ ·˘ÏÒÓ ÙˆÓ ÂÌ‚fi-ÏÈÌˆÓ Î·È Ú·‚‰ˆÙÒÓ fiÚˆÓ Î·È Û˘¯Ó¿ ÛÙ· ·ÙÙ·Ú· ÙˆÓ·˘ÏÒÓ Î·È ÛÙ· ‚·ÛÈο ·ÙÙ·Ú· ÙˆÓ ÂÎÊÔÚËÙÈÎÒÓ fiÚˆÓ.™Ù· ‚ÏÂÓÓÒ‰Ë Î‡ÙÙ·Ú· Ë ¤ÎÊÚ·ÛË ‹Ù·Ó ÎÔÎÎ҉˘, ÂÓÒÛÙ· ·ÙÙ·Ú· ÙˆÓ fiÚˆÓ ÎÔÎÎ҉˘ Î·È ‰È¿¯˘ÙË. KÔÚ˘-Ê·›· ¤ÎÊÚ·ÛË ·Ú·ÙËÚ‹ıËΠ۠ÌÂÚÈÎÔ‡˜ ÂÌ‚fiÏÈÌÔ˘˜Î·È Ú·‚‰ˆÙÔ‡˜ fiÚÔ˘˜ Î·È Û˘¯Ó¿ ÛÙÔ˘˜ ÂÎÊÔÚËÙÈÎÔ‡˜fiÚÔ˘˜ ( EÈÎ. 1,2). O ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÛÙ· ηÏÔ‹ıË ÓÂÔ-
Ï¿ÛÌ·Ù· ‹Ù·Ó Ô ›‰ÈÔ˜ Ì ·˘ÙfiÓ Ô˘ ·Ú·ÙËÚ‹ıËÎÂÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ÙÔ˘ ÌÈ-ÎÚÔÔÚÈÎÔ‡ (canalicular adenoma) Î·È ‚·ÛÈÎÔ΢ÙÙ·ÚÈ-ÎÔ‡ ·‰ÂÓÒÌ·ÙÔ˜ ıÂÙÈ΋ ¯ÚÒÛË ÂÌÊ¿ÓÈ˙·Ó Î·È ÔÈ ·Ú·-ΛÌÂÓÔÈ Ê˘ÛÈÔÏÔÁÈÎÔ› ·‰¤Ó˜, ÂÓÒ ·fi fiϘ ÙȘ ÂÚÈ-ÙÒÛÂȘ ÙÔ˘ ÔχÌÔÚÊÔ˘ ·‰ÂÓÒÌ·ÙÔ˜ ·ÚÓËÙÈ΋ ¯ÚÒÛˢ‹Ú¯Â Û ̛· ÌfiÓÔ ÂÚ›ÙˆÛË ÛÙËÓ ÔÔ›· Î·È ÔÈ ·Ú·-ΛÌÂÓÔÈ Ê˘ÛÈÔÏÔÁÈÎÔ› ·‰¤Ó˜ ÂÌÊ¿ÓÈ˙·Ó ·ÚÓËÙÈ΋ ¯ÚÒ-ÛË. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, Û 11 ÂÚÈÙÒÛÂȘıÂÙÈ΋˜ ¯ÚÒÛ˘ ÙˆÓ Î·ÏÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ˘‹Ú¯ÂıÂÙÈ΋ ¯ÚÒÛË Î·È ÛÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜·‰¤Ó˜. ™Ù· ÓÂÔÏ¿ÛÌ·Ù· ·˘Ù¿ ·Ú·ÙËÚ‹ıËΠÎÔÚ˘-Ê·›· ¤ÎÊÚ·ÛË ÛÙ· ·ÙÙ·Ú· ÛˆÏËÓÔÂȉÒÓ, ·‰ÂÓÔÂȉÒÓ,
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 19-25, 2004
ŸÁÎÔ˜ AÚÈıÌfi˜ ıÂÙÈÎÒÓ AÚÈıÌ. ıÂÙÈÎÒÓ º˘ÛÈÔÏÔÁÈÎÔ›ÂÚÈÙÒÛÂˆÓ ÂÚÈÙÒÛÂˆÓ ·‰¤Ó˜ ¯ˆÚ›˜
·Ú·Î›ÌÂÓˆÓ ·Ú·Î›ÌÂÓËÊ˘ÛÈÔÏÔÁÈÎÒÓ ÓÂÔÏ·Û›·
·‰¤ÓˆÓ¶ÔχÌÔÚÊÔ 13/14 5/6 4/5·‰¤ÓˆÌ·B·ÛÈÎÔ΢Ù-Ù·ÚÈÎfi 2/3 2/3·‰¤ÓˆÌ·MÈÎÚÔÔÚÈÎfi 2/2 2/2·‰¤ÓˆÌ·(Canalicularadenoma)ŸÁÎÔ˜ ÙÔ˘ 2/2 -Warthin™‡ÓÔÏÔ 19/21 9/11
¶›Ó·Î·˜ 1. ¶·ÚÔ˘Û›· ÙÔ˘ CA 19-9 Û 21 ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ
19-25 ÛÂÏ. - Epibatianos** 3-10-08 12:44 ™ÂÏ›‰· 20
ÌÈÎÚÔ΢ÛÙÈÎÒÓ Î·È Î˘ÛÙiÎÒÓ Û¯ËÌ·ÙÈÛÌÒÓ. ™ÙÔ Ôχ-ÌÔÚÊÔ ·‰¤ÓˆÌ· ÎÔÎÎÒ‰Ë Î·È ‰È¿¯˘ÙË ¤ÎÊÚ·ÛË ÂÌÊ¿ÓÈ-
˙·Ó Ù· ·ÙÙ·Ú· Ô˘ ¤Ӊ˘·Ó ÙÔ˘˜ ·˘ÏÔ‡˜ ÛˆÏËÓÔÂÈ-‰ÒÓ Î·È ·‰ÂÓÔÂȉÒÓ Û¯ËÌ·ÙÈÛÌÒÓ. TËÓ ›‰È· ¤ÎÊÚ·ÛË ÂÌ-Ê¿ÓÈ˙·Ó Î·È ÂÏ¿¯ÈÛÙ· ·ÙÙ·Ú· ÌË ÚÔÛΛÌÂÓ· Û ·˘-ÏÔ‡˜ (EÈÎ. 3)T· ·ÙÙ·Ú· Ô˘ ¤Ӊ˘·Ó ·˘ÏÔ‡˜ ‹ ΢ÛÙÈÎÔ‡˜ ¯ÒÚÔ˘˜ÛÙÔÓ fiÁÎÔ ÙÔ˘ Warthin, ÛÙÔ ÌÈÎÚÔÔÚÈÎfi (canalicularadenoma) Î·È ‚·ÛÈÎÔ΢ÙÙ·ÚÈÎfi ·‰¤ÓˆÌ· ÂÌÊ¿ÓÈ˙·ÓÎÔÎÎÒ‰Ë Î·È ‰È¿¯˘ÙË ¤ÎÊÚ·ÛË (EÈÎ.4 ).TËÓ ›‰È· ¤ÎÊÚ·-ÛË ÂÌÊ¿ÓÈ˙·Ó ·ÚÎÂÙ¿ ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú· Ô˘ Û˘-ÁÎÚÔÙÔ‡Û·Ó ÓËÛ›‰Â˜ ‹ ‰¤Û̘ ÛÙÔ ‚·ÛÈÎÔ΢ÙÙ·ÚÈÎfi ·-‰¤ÓˆÌ·.
K·ÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Î·È Ê˘ÛÈÔÏÔÁÈÎÔ› ·‰¤Ó˜T· ·ÔÙÂϤÛÌ·Ù· ÛÙ· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Î·È ÛÙÔ˘˜·Ú·Î›ÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜ Û˘ÓÔ„›˙ÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 2. H ¤ÎÊÚ·ÛË ÙÔ˘ CA 19-9 ÛÙÔ˘˜ ·Ú·Î›-ÌÂÓÔ˘˜ ÙˆÓ Î·ÎÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·-‰¤Ó˜ ‹Ù·Ó ›‰È· Ì ·˘Ù‹ Ô˘ ÂÚÈÁÚ¿ÊıËΠÁÈ· ÙÔ˘˜ Ê˘-ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜ ÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÛÙ· ηÏÔ‹ıËÓÂÔÏ¿ÛÌ·Ù· ηıÒ˜ Î·È Ì ·˘ÙÔ‡˜ Ô˘ ·Ê·ÈÚ¤ıËηÓÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ÙÔ˘ ·‰ÂÓÔ΢-ÛÙÈÎÔ‡ ηÚÎÈÓÒÌ·ÙÔ˜ Î·È ÙÔ˘ ÔχÌÔÚÊÔ˘ ¯·ÌËÏÔ‡‚·ıÌÔ‡ ηÎÔ‹ıÂÈ·˜ ·‰ÂÓÔηÚÎÈÓÒÌ·ÙÔ˜, ÔÈ ·Ú·Î›ÌÂ-ÓÔÈ Ê˘ÛÈÔÏÔÁÈÎÔ› ·‰¤Ó˜ ÂÌÊ¿ÓÈ˙·Ó ıÂÙÈ΋ ¯ÚÒÛË ÁÈ· ÙÔCA 19-9 (5/5 Î·È 3/3 ·ÓÙ›ÛÙÔȯ·). ™Â Ì›· ·fi ÙȘ 4 ÂÚÈ-ÙÒÛÂȘ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·‰¤ÓˆÓ ·Ú·Î›ÌÂÓˆÓ Û ·‰ÂÓÔ-ηÚΛӈ̷ (NOS, non-otherwise specified adenocarci-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 19-25, 2004
EÈÎ. 33: K˘ÙÙ·ÚÔ‚ÚÈı‹˜ ÂÚÈÔ¯‹ ÔχÌÔÚÊÔ˘ ·‰ÂÓÒÌ·ÙÔ˜ Ë ÔÔ›·ÂÚȤ¯ÂÈ Û¯ËÌ·ÙÈÛÌÔ‡˜ fiÌÔÈÔ˘˜ Ì fiÚÔ˘˜. ¶·Ú·ÙËÚÂ›Ù·È ıÂÙÈ-΋ ̄ ÚÒÛË ÙÔ˘ ̆ ÏÈÎÔ‡ ÙˆÓ ·˘ÏÒÓ Î·È ÎÔÚ˘Ê·›· ¤ÎÊÚ·ÛË. KÔÎÎÒ-‰Ë˜ Î·È ‰È¿¯˘ÙË ¤ÎÊÚ·ÛË ÙÔ˘ CA 19-9 ÛÙ· ·ÙÙ·Ú· Ô˘ Úfi-ÛÎÂÈÓÙ·È ÛÙÔ˘˜ ·˘ÏÔ‡˜ Î·È Û ÌÂÚÈο Ì·ÎÚÈ¿ ·fi ÙÔ˘˜ ·˘ÏÔ‡˜(‚¤ÏË). (M¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›Ó˘ - ‚ÈÔÙ›Ó˘ - ˘ÂÚÔÍÂȉ¿ÛË˜Î·È Â›¯ÚˆÛË Ì Mayer ·ÈÌ·ÙÔÍ˘Ï›ÓË. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛË X132).
EÈÎ. 1-2 1: º˘ÛÈÔÏÔÁÈÎfi˜ ·‰¤Ó·˜ ÙÔ˘ ¿Óˆ ¯Â›ÏÔ˘˜. ¶·Ú·ÙËÚÂ›Ù·È ÎÔÎÎÒ-‰Ë˜ ¤ÎÊÚ·ÛË ÙÔ˘ CA 19-9 ÛÙ· ‚ÏÂÓÓÒ‰Ë Î‡ÙÙ·Ú· ÙˆÓ ·‰ÂÓÔ΢-„ÂÏÒÓ Î·È ‰È¿¯˘ÙË ÛÙ· ΢‚ÔÂȉ‹ ·ÙÙ·Ú· ÙÔ˘ ÂÌ‚fiÏÈÌÔ˘ fiÚÔ˘(‚¤ÏÔ˜). ™Ù· ΢‚ÔÂȉ‹ ·ÙÙ·Ú· ÙÔ˘ ·Ú·ÙËÚÂ›Ù·È Î·È ÎÔÚ˘Ê·›·¤ÎÊÚ·ÛË. (M¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›Ó˘ - ‚ÈÔÙ›Ó˘ - ̆ ÂÚÔÍÂȉ¿ÛË˜Î·È Â›¯ÚˆÛË Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Mayer. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛË X132).2: EÎÊÔÚËÙÈÎfi˜ fiÚÔ˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÚÂÈ·ÎÔ‡ ·‰¤Ó·. ¶·Ú·-ÙËÚÂ›Ù·È ÎÔÚ˘Ê·›· ¤ÎÊÚ·ÛË ÙÔ˘ CA 19-9 ÛÙ· ·ÙÙ·Ú· Ô˘ Úfi-ÛÎÂÈÓÙ·È ÛÙÔÓ ·˘Ïfi (ÌÂÁ¿ÏÔ ‚¤ÏÔ˜) Î·È ÎÔÎÎ҉˘ (ÌÈÎÚfi ‚¤ÏÔ˜)Î·È ‰È¿¯˘ÙË (ÎÂÊ·Ï‹ ‚¤ÏÔ˘˜) ÛÙ· ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔÙÔ‡Ó ÙÔÓfiÚÔ. (M¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›Ó˘ - ‚ÈÔÙ›Ó˘ - ˘ÂÚÔÍÂȉ¿Û˘ ηÈ›¯ÚˆÛË Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Mayer. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛË X132).
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EÈÎ. 44: MÈÎÚÔÔÚÈÎfi ·‰¤ÓˆÌ·. KÔÎÎ҉˘ Î·È ‰È¿¯˘ÙË ¤ÎÊÚ·ÛË ÙÔ˘CA 19-9 ÛÙ· ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔÙÔ‡Ó Û¯ËÌ·ÙÈÛÌÔ‡˜ fiÌÔÈÔ˘˜Ì fiÚÔ˘˜. (M¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›Ó˘ - ‚ÈÔÙ›Ó˘ - ˘ÂÚÔÍÂȉ¿-Û˘ Î·È Â›¯ÚˆÛË Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Mayer. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛËX132).
19-25 ÛÂÏ. - Epibatianos** 3-10-08 12:44 ™ÂÏ›‰· 21
noma) ‰ÂÓ ˘‹Ú¯Â ıÂÙÈ΋ ¯ÚÒÛË. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹·Ô˘Û›·˙Â Ë ̄ ÚÒÛË Î·È ÛÙÔÓ ·Ú·Î›ÌÂÓÔ ÓÂÔÏ·ÛÌ·ÙÈ-Îfi ÈÛÙfi. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2, Û 9 ÂÚÈÙÒÛÂȘıÂÙÈ΋˜ ¯ÚÒÛ˘ ÙˆÓ Î·ÎÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ˘‹Ú¯ÂÎ·È ıÂÙÈ΋ ¯ÚÒÛË ÛÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜.™ÙÔ ·‰ÂÓÔ΢ÛÙÈÎfi ηÚΛӈ̷ ıÂÙÈ΋ ¯ÚÒÛË ˘‹Ú¯Â Ûٷ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔÙÔ‡Û·Ó Û¯ËÌ·ÙÈÛÌÔ‡˜ fiÌÔÈÔ˘˜ ÌÂfiÚÔ˘˜ Î·È ÛˆÏ‹Ó˜. H ¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÛÙ· ·Ù-Ù·Ú· ·˘Ù¿ ‹Ù·Ó ÎÔÎÎ҉˘ Î·È ‰È¿¯˘ÙË. KÔÚ˘Ê·›· ¤Î-ÊÚ·ÛË ·Ú·ÙËÚ‹ıËΠÛÙ· ·ÙÙ·Ú· ÙˆÓ ‰ÔÌÒÓ ·˘ÙÒÓ·ÏÏ¿ fi¯È ÛÙ· ·ÙÙ·Ú· ÙˆÓ „¢‰Ô·ÛÙˆÓ. ™Ù· ·ÙÙ·Ú·Ô˘ Û˘ÁÎÚÔÙÔ‡Û·Ó ÙÔ ËıÌÔÂȉ¤˜ ÈÛÙÔÏÔÁÈÎfi ÚfiÙ˘ÔÎ·È Û ·˘Ù¿ Ô˘ Û¯ËÌ¿ÙÈ˙·Ó Û˘Ì·Á›˜ Ì¿˙˜ ÙÔ ·ÓÙÈÁfi-ÓÔ ·Ô˘Û›·˙ (EÈÎ. 5).™ÙÔ ·‰ÂÓÔηÚΛӈ̷ ( NOS) Ù· ·ÙÙ·Ú· Ô˘ ·ÔÙÂÏÔ‡-Û·Ó ÏÔ‚Ò‰ÂȘ Û¯ËÌ·ÙÈÛÌÔ‡˜ fiÌÔÈÔ˘˜ Ì fiÚÔ˘˜ ÂÌÊ¿-
ÓÈ˙·Ó ıÂÙÈ΋ ¯ÚÒÛË. E›Û˘ ıÂÙÈ΋ ¯ÚÒÛË ˘‹Ú¯Â Ûٷ·ÙÙ·Ú· Ô˘ Û¯ËÌ¿ÙÈ˙·Ó ‰¤Û̘ Î·È ÓËÛ›‰È·. H ¤ÎÊÚ·-ÛË ÙÔ˘ CA 19-9 ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ·‰ÂÓÔηÚÎÈÓÒÌ·ÙÔ˜ ‹-Ù·Ó ÎÔÎÎ҉˘ Î·È ‰È¿¯˘ÙË, ÂÓÒ ÎÔÚ˘Ê·›· ¤ÎÊÚ·ÛË ˘-‹Ú¯Â ÛÙÔ˘˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ Ô˘ ¤ÌÔÈ·˙·Ó Ì fiÚÔ˘˜.™ÙÔ ‚ÏÂÓÓÔÂȉÂÚÌÈÎfi ηÚΛӈ̷ ıÂÙÈ΋ ¯ÚÒÛË ˘‹Ú¯ÂÛ˘Ó‹ıˆ˜ ÛÙ· ÂӉȿÌÂÛ· Î·È ‚ÏÂÓÓÒ‰Ë Î‡ÙÙ·Ú·, ÂÓÒ ÌÂ-ÚÈΤ˜ ÊÔÚ¤˜ ıÂÙÈ΋ ¯ÚÒÛË ˘‹Ú¯Â Û ‰È·˘Á‹ Î·È ÂÈ-‰ÂÚÌÔÂȉ‹ ·ÙÙ·Ú·. H ¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ‹Ù·ÓÎÔÎÎ҉˘ Î·È ‰È¿¯˘ÙË. H ‚ϤÓÓ· Ô˘ ÂÓÙÔ›˙ÔÓÙ·ÓÛÙÔ˘˜ ΢ÛÙÈÎÔ‡˜ ¯ÒÚÔ˘˜ ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ ÂÌÊ¿ÓÈ˙Â›Û˘ ıÂÙÈ΋ ¯ÚÒÛË ( EÈÎ. 6).™ÙÔ ÔχÌÔÚÊÔ ·‰ÂÓÔηÚΛӈ̷ ¯·ÌËÏÔ‡ ‚·ıÌÔ‡ η-ÎÔ‹ıÂÈ·˜ ıÂÙÈ΋ ¯ÚÒÛË ·Ú·ÙËÚ‹ıËΠÛÙ· ·ÙÙ·Ú·Ô˘ Û˘ÁÎÚÔÙÔ‡Û·Ó ÛˆÏËÓÒ‰ÂȘ Û¯ËÌ·ÙÈÛÌÔ‡˜ Î·È Û¯Ë-Ì·ÙÈÛÌÔ‡˜ Ô˘ ¤ÌÔÈ·˙·Ó Ì ÙÔ ËıÌÔÂȉ¤˜ ÈÛÙÔÏÔÁÈÎfiÚfiÙ˘Ô ÏfiÁˆ Ù˘ ‰È¿Ù·Û˘ ÙˆÓ ·˘ÏÒÓ Ô˘ ÂÚÈ›¯·Ó.£ÂÙÈ΋ ¯ÚÒÛË ÂÌÊ¿ÓÈ˙·Ó Î·È Ù· ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔ-ÙÔ‡Û·Ó Û˘Ì·Á›˜ ÓËÛ›‰Â˜ Î·È ‰ÂÛÌ›‰Â˜. ™Ù· ·ÙÙ·Ú· fi-ÏˆÓ ·˘ÙÒÓ ÙˆÓ ÈÛÙÔÌÔÚÊÔÏÔÁÈÎÒÓ ÚfiÙ˘ˆÓ Ë ¤ÎÊÚ·-ÛË ÙÔ˘ CA 19-9 ‹Ù·Ó ‰È¿¯˘ÙË Î·È ÎÔÎÎ҉˘. KÔÚ˘Ê·›·¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ̆ ‹Ú¯Â ÛÙ· ·ÙÙ·Ú· ÌÈÎÚÒÓ fi-ÚˆÓ Î·È ÛˆÏËÓÔÂȉÒÓ Û¯ËÌ·ÙÈÛÌÒÓ. ™Â fiÏ· Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ˷ÚÔ˘Û›· ÙÔ˘ CA 19-9 ÛÂ Û˘ÛÙ·ÙÈο ‹ ·ÙÙ·Ú· ÙÔ˘ ̆ Ô-ÛÙÚÒÌ·Ùfi˜ ÙÔ˘˜.
™YZHTH™H
™Â ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Ë ·ÚÔ˘Û›· ÙÔ˘ CA 19-9 ÛÙÔ˘˜ È-ÛÙÔ‡˜ ‚Ú¤ıËΠfiÙÈ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ·-ÓÙÈÁfiÓˆÓ Lewis a Î·È b ÙˆÓ ÔÌ¿‰ˆÓ ·›Ì·ÙÔ˜ Û ηÚÎÈÓÒ-Ì·Ù· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È ÛÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÈÛÙfi ÙÔ˘9,Û ηÚÎÈÓÒÌ·Ù· ÙÔ˘ ÛÙÔÌ¿¯Ô˘17, Î·È ÛÙÔ ıËÏ҉˜ ηÚ-Λӈ̷ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜19. AÓÙ›ıÂÙ· ÛÙÔ ı˘Ï·ÎÈ҉˜ ·-‰¤ÓˆÌ· Î·È Î·ÚΛӈ̷ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜19 Î·È Û ÌÈÎÚfiÔÛÔÛÙfi (9%) ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ¿ÁÎÚ·˜ Î·È ÛÙ· ηÚ-ÎÈÓÒÌ·Ù¿ ÙÔ˘9 Ë ·ÚÔ˘Û›· ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙˆÓ ÔÌ¿‰ˆÓ·›Ì·ÙÔ˜ Î·È È‰È·›ÙÂÚ· ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Lewis a ‚Ú¤ıËΠfi-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ŸÁÎÔ˜ AÚÈıÌfi˜ ıÂÙÈÎÒÓ AÚÈıÌ. ıÂÙÈÎÒÓÂÚÈÙÒÛÂˆÓ ÂÚÈÙÒÛˆÓ
·Ú·Î›ÌÂÓˆÓÊ˘ÛÈÔÏÔÁÈÎÒÓ ·‰¤ÓˆÓ
A‰ÂÓÔ΢ÛÙÈÎfi ηÚΛӈ̷ 12/13 5/5
A‰ÂÓÔηÚΛӈ̷ ( NOS) 8/9 3/4
BÏÂÓÓÔÂȉÂÚÌÈÎfi X·Ì ‚·ı.ηÎ.4/4 -ηÚΛӈ̷ Y„. ‚·ı.ηÎ.5/5
¶ÔχÌÔÚÊÔ 4/5 3/3·‰ÂÓÔηÚΛӈ̷ ¯·ÌËÏÔ‡‚·ıÌÔ‡ ηÎÔ‹ıÂÈ·˜
K·ÚΛӈ̷ ÛÈ·ÏÈÎÒÓÓ 0/4 -fiÚˆÓ
A‰ÂÓÔ΢„ÂÏȉÈÎfi 0/3 -ηÚΛӈ̷
™‡ÓÔÏÔ 32/43 11/12
¶›Ó·Î·˜ 2. ¶·ÚÔ˘Û›· ÙÔ˘ CA 19-9 Û 43 ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ
EÈÎ. 55: A‰ÂÓÔ΢ÛÙÈÎfi ηÚΛӈ̷. ¶·Ú·ÙËÚÂ›Ù·È ÎÔÚ˘Ê·›· ¤ÎÊÚ·ÛËÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Û ۯËÌ·ÙÈÛÌÔ‡˜ fiÌÔÈÔ˘˜ Ì fiÚÔ˘˜ Î·È ÎÔÎÎÒ-‰Ë˜ Î·È ‰È¿¯˘ÙË ¤ÎÊÚ·ÛË ÛÙ· ·ÙÙ·Ú· Ô˘ ÙÔ˘˜ Û˘ÁÎÚÔÙÔ‡Ó(ÌÈÎÚ¿ ‚¤ÏË). T· ·ÙÙ·Ú· Ô˘ Û¯ËÌ·Ù›˙Ô˘Ó Û˘Ì·Á‹ ÓËÛ›‰È·(ÌÂÁ¿ÏÔ ‚¤ÏÔ˜) ‰ÂÓ ÂÎÊÚ¿˙Ô˘Ó CA 19-9. (M¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›-Ó˘ - ‚ÈÔÙ›Ó˘ - ˘ÂÚÔÍÂȉ¿Û˘ Î·È Â›¯ÚˆÛË Ì ·ÈÌ·ÙÔÍ˘Ï›ÓËMayer. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛË X33).
EÈÎ. 66: K˘ÛÙÈÎfi˜ Û¯ËÌ·ÙÈÛÌfi˜ ‚ÏÂÓÓÔÂȉÂÚÌÈÎÔ‡ ηÚÎÈÓÒÌ·ÙÔ˜ ¯·-ÌËÏÔ‡ ‚·ıÌÔ‡ ηÎÔ‹ıÂÈ·˜. T· ‚ÏÂÓÓÒ‰Ë Î·È ÂӉȿÌÂÛ· ·ÙÙ·Ú·ÂÌÊ·Ó›˙Ô˘Ó ıÂÙÈ΋ ¯ÚÒÛË Î·ıÒ˜ Î·È Ì¤ÚÔ˜ ÙÔ˘ ˘ÏÈÎÔ‡ ÛÙÔÓ Î˘-ÛÙÈÎfi ¯ÒÚÔ. (M¤ıÔ‰Ô˜ ÛÙÚÂÙ·‚ȉ›Ó˘ - ‚ÈÔÙ›Ó˘
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 19-25, 2004
19-25 ÛÂÏ. - Epibatianos** 3-10-08 12:44 ™ÂÏ›‰· 22
ÙÈ ‰ÂÓ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜. TÔCA 19-9 ‚Ú¤ıËΠÛÙËÓ ÛÈ·ÏÈ΋ ‚ϤÓÓ· ·ÙfiÌˆÓ Ô˘ ·Ó‹-Î·Ó ÛÙËÓ ÔÌ¿‰· Lewis a+b- ‹ Lewis a-b+ ·ÏÏ¿ fi¯È Û ¿-ÙÔÌ· Ô˘ ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· Lewis a-b-12. ŸÌˆ˜ ‰È·È-ÛÙÒıËΠfiÙÈ Ë Ê·ÈÓÔÙ˘È΋ ·ÚÔ˘Û›· ÙˆÓ ·ÓÙÈÁfiÓˆÓLewis a Î·È b Ú˘ıÌ›˙ÂÙ·È Ì ‰È·ÊÔÚÂÙÈÎfi ÙÚfiÔ ÛÙ· ·Ù-Ù·Ú· ÙˆÓ fiÚˆÓ ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ·fi fiÙÈ ÛÙÔÛ¿ÏÈÔ Î·È ÛÙ· ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ·38.AÓÂÍ¿ÚÙËÙ· ·fiÙËÓ Û¯¤ÛË ÙÔ˘ CA 19-9 Ì ٷ ·ÓÙÈÁfiÓ· Lewis a Î·È b, Û‡Ì-ʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù¿ Ì·˜, Ë ·ÚÔ˘Û›· ÙÔ˘ ÛÙËӂϤÓÓ· ÙÔ˘ Û¿ÏÈÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fiÙÔ˘˜ ÌÈÎÚÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜ ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë Û˘Ì-‚ÔÏ‹ ÙÔ˘˜ ÛÙËÓ Û˘ÓÔÏÈ΋ ÛÈ·ÏÈ΋ ‚ϤÓÓ· ·Ó¤Ú¯ÂÙ·È ÛÂÔÛÔÛÙfi 70%39. E›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·ÙÙ·Ú· ÙˆÓ ·‰ÂÓÔ-΢„ÂÏÒÓ Î·È Û Ôχ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi Ù· ·ÙÙ·Ú·ÙˆÓ fiÚˆÓ Ô˘ ÚfiÛÎÂÈÓÙ·È Û ·˘Ïfi Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓÛÈ·ÏÈ΋ ¤ÎÎÚÈÛË Î·È Û˘ÓÂÒ˜ Ë ·ÚÔ˘Û›· ÙÔ˘ CA 19-9 Û·˘Ù¿ ÌÔÚ› Ó· ıˆÚËı› ˆ˜ ÂÎÎÚÈÙÈÎfi Û˘ÛÙ·ÙÈÎfi.ŸÌˆ˜ Ë ·ÚÔ˘Û›· ÙÔ˘ CA 19-9 ÛÙ· ‚·ÛÈο ·ÙÙ·Ú· ÙˆÓfiÚˆÓ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÍËÁËı›. T· ·ÙÙ·Ú· ·˘Ù¿ ‰ÂÓ¤¯Ô˘Ó ÂÎÎÚÈÙÈ΋ ȉÈfiÙËÙ· Î·È Ô ÚfiÏÔ˜ ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ ¿-ÁÓˆÛÙÔ˜40.Ÿˆ˜ ÚԤ΢„ ·fi ÙËÓ ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ë ·ÚÔ˘-Û›· Î·È Ô ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9 ÛÙÔ˘˜ Ê˘ÛÈÔ-ÏÔÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜ Î·È ÛÙ· ηÏÔ‹ıË ÓÂÔÏ¿-ÛÌ·Ù¿ ÙÔ˘˜ ¤¯ÂÈ ÂÏ¿¯ÈÛÙ· ÌÂÏÂÙËı›. T· Â˘Ú‹Ì·Ù¿ Ì·˜ÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·‰¤Ó˜ ÂÓ Ì¤ÚÂÈ Û˘ÌʈÓÔ‡Ó ÌÂ Ù·Â˘Ú‹Ì·Ù· ÙÔ˘ Okamura Î·È Û˘Ó.33 H ‰È·ÊÔÚ¿ Ô˘ ˘¿Ú-¯ÂÈ ÂÈÓ·È fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ˘‹Ú¯Â ıÂÙÈ΋ ¤Î-ÊÚ·ÛË ÙÔ˘ CA 19-9 Î·È ÛÙ· ·ÙÙ·Ú· ÙˆÓ fiÚˆÓ. ™ÙÔ Ô-χÌÔÚÊÔ ·‰¤ÓˆÌ· Ù· Â˘Ú‹Ì·Ù¿ Ì·˜ Â›Ó·È fiÌÔÈ· Ì ·˘Ù¿Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÁÈ· ÙÔ ¯ÔÓ‰ÚÔÂȉ¤˜ Û˘ÚÈÁÁ›ˆÌ·5. TÔ¯ÔÓ‰ÚÔÂȉ¤˜ Û˘ÚÈÁÁ›ˆÌ· ‹ ÌÈÎÙfi˜ fiÁÎÔ˜ Â›Ó·È Î·ÏfiËı˜ÓÂfiÏ·ÛÌ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ Ù· ›‰È· ÈÛÙÔÏÔ-ÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ì ÙÔ ÔχÌÔÚÊÔ ·‰¤ÓˆÌ· ÙˆÓÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ41.ŸÛÔÓ ·ÊÔÚ¿ Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ·‰¤ÓˆÓ, ÔÈ Kuo Î·È Tsang42 ·Ó¤ÊÂÚ·Ó ÙËÓ ·ÚÔ˘Û›· ÙÔ˘CA 19-9 Û 11 ·fi 15 ÂÚÈÙÒÛÂȘ ÚÈÓÔÊ·Ú˘ÁÁÈÎÒÓ Î·Ú-ÎÈÓˆÌ¿ÙˆÓ ÙÔ˘ Ù‡Ô˘ ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÂÚÈÏ·Ì-‚¿ÓÔÓÙ·˜ 8 ‚ÏÂÓÓÔÂȉÂÚÌȉÈο ηÚÎÈÓÒÌ·Ù·, 4 ·‰ÂÓÔ-΢ÛÙÈο, 4 ·‰ÂÓÔηÚÎÈÓÒÌ·Ù· Î·È ¤Ó· ·‰È·ÊÔÚÔÔ›ËÙÔηÚΛӈ̷ ¯ˆÚ›˜ fï˜ Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ó Û ÔÈ· ·fi·˘Ù¿ ˘‹Ú¯Â ÙÔ CA 19-9. ™Â ÌÈ· ¿ÏÏË ÌÂϤÙË Î·ÚÎÈÓˆ-Ì¿ÙˆÓ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡20 Û˘ÌÂÚÈÏ‹ÊıË-Î·Ó Î·È ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÛÙ· Ô-Ô›· ÙÔ CA 19-9 ˘‹Ú¯Â Û ÌÂÚÈο ‚ÏÂÓÓÔÂȉÂÚÌÈοηÚÎÈÓÒÌ·Ù· ·ÏÏ¿ ·Ô˘Û›·˙ Û ÙÚ›˜ ÂÚÈÙÒÛÂȘ ·-‰ÂÓÔ΢ÛÙÈÎÔ‡ ηÚÎÈÓÒÌ·ÙÔ˜. H ‰È·ÊÔÚ¿ ÙˆÓ Â˘ÚËÌ¿-ÙˆÓ Ì·˜ Ì ÙËÓ ÌÂϤÙË ·˘Ù‹20 ˆ˜ ÚÔ˜ ÙÔ ·‰ÂÓÔ΢ÛÙÈÎfiηÚΛӈ̷ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Â›Ù ÛÙÔ ÌÈÎÚfi ·ÚÈıÌfiÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘˜ ›Ù ÛÙÔÓ ·ÓÙÈÁÔÓÈÎfi Ê·ÈÓfiÙ˘ÔÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘˜. T· Â˘Ú‹Ì·Ù¿ Ì·˜ ÛÙÔ ·‰ÂÓÔ΢ÛÙÈÎfi Î·È ‚ÏÂÓÓÔÂȉÂÚÌÈ-Îfi ηÚΛӈ̷ ÂÓ Ì¤ÚÂÈ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ Ô˘ ·Ó·Ê¤-ÚÔ˘Ó o Okamura Î·È Û˘Ó.33. OÈ ÔÌÔÈfiÙËÙ˜ ˆ˜ ÚÔ˜ ÙÔ ·-‰ÂÓÔ΢ÛÙÈÎfi ηÚΛӈ̷ ·ÊÔÚÔ‡Ó ÙËÓ ·Ô˘Û›· ÙÔ˘ ·ÓÙÈ-ÁfiÓÔ˘ ÛÙÔ ˘fiÛÙڈ̷ ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜, ÙËÓ ÎÔÚ˘-Ê·›· ¤ÎÊÚ·ÛË ÙÔ˘ ÛÙÔ ÛˆÏËÓ҉˜ ÈÛÙÔÌÔÚÊÔÏÔÁÈÎfi
ÚfiÙ˘Ô Î·È ÙËÓ ·Ô˘Û›· ÙÔ˘ ÛÙ· ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔ-ÙÔ‡Ó ÙÔ ËıÌÔÂȉ¤˜ Î·È Û˘Ì·Á¤˜ ÈÛÙÔÌÔÚÊÔÏÔÁÈÎfi Úfi-Ù˘Ô. AÓÙ›ıÂÙ· Ì ٷ Â˘Ú‹Ì·Ù¿ Ì·˜, Ô Okamura ηÈÛ˘Ó.33 ·Ó·Ê¤ÚÔ˘Ó ıÂÙÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ CA 19-9 ÛÙÔ ‚ÏÂÓ-ÓÔ¸·ÏÔÂȉ¤˜ ˘ÏÈÎfi ÙˆÓ „¢‰Ô·ÛÙÂˆÓ Î·È ·Ô˘Û›· ¤Î-ÊÚ·Û˘ ·fi Ù· ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔÙÔ‡Ó ÛˆÏËÓÔÂȉ›˜Û¯ËÌ·ÙÈÛÌÔ‡˜ Î·È Û¯ËÌ·ÙÈÛÌÔ‡˜ fiÌÔÈÔ˘˜ Ì fiÚÔ˘˜.ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ‚ÏÂÓÓÔÂȉÂÚÌÈÎfi ηÚΛӈ̷, Ù· ¢ڋ-Ì·Ù¿ Ì·˜ Û˘ÌʈÓÔ‡Ó Ì ÙËÓ ·Ô˘Û›· ¤ÎÊÚ·Û˘ ÙÔ˘ CA19-9 ÛÙÔ ˘fiÛÙڈ̷ ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Î·È ÙËÓ ¤ÎÊÚ·-Û‹ ÙÔ˘ ÛÙ· ‚ÏÂÓÓÒ‰Ë Î‡ÙÙ·Ú·. ¢È·Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ·ÚÔ˘Û›· ¤ÎÊÚ·Û˘ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÛÙ· ÂӉȿÌÂÛ·, ‰È-·˘Á‹ Î·È ÂȉÂÚÌÔÂȉ‹ ·ÙÙ·Ú· Ô˘ ·Ú·ÙËÚ‹ıËÎÂÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·. ŸÌˆ˜ ·Ú¿ ÙȘ ‰È·ÊÔÚ¤˜ ·˘-Ù¤˜, Ô ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9 ÛÙ· ‰‡Ô ·˘Ù¿ η-ÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ‹Ù·Ó fiÌÔÈÔ˜ Ì ·˘ÙfiÓ ÛÙÔ˘˜ Ê˘-ÛÈÔÏÔÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜ ÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û·ÂÚÁ·Û›· fiÛÔ Î·È ÛÙËÓ ÂÚÁ·Û›· ÙÔ˘ Okamura Î·È Û˘Ó33.O ÚfiÏÔ˜ ÙÔ˘ Ca 19-9 ÛÙ· ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ·‰¤ÓˆÓ Â›Ó·È ¿ÁÓˆÛÙÔ˜. ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ÂÚÁ·Û›·˜ Ì·˜ Ë ·ÚÔ˘Û›· ÙÔ˘ ÛÙ· ηÎÔ‹ıË Î·È Î·ÏÔ‹ıËÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÌÔÚ› Ó· ıˆ-ÚËı› Û·Ó ‰Â›ÎÙ˘ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÓÂÔÏ·ÛÌ·ÙÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ·ÙÙ·Ú· fiÌÔÈ· Ì ·˘Ù¿ ÙˆÓ ·‰ÂÓÔ΢-„ÂÏÒÓ Î·È ÙˆÓ fiÚˆÓ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÛÈ·ÏÔÁfiÓˆÓ ·-‰¤ÓˆÓ. ™‡Ìʈӷ Ì ÙÔ ÌÔÓÙ¤ÏÔ Ù˘ ÌÔÚÊÔÁÂÓÂÙÈ΋˜ ·-Ó¿Ù˘Í˘ ÙˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓÔ˘ ÚfiÙÂÈÓÂ Ô Dardick40, Ù· ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú· ›-Ó·È ‰˘Ó·ÙfiÓ Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È Û ·ÙÙ·Ú· Ê·ÈÓÔÙ˘-Èο fiÌÔÈ· Ì ·˘Ù¿ ÙˆÓ ·‰ÂÓÔ΢„ÂÏÒÓ Î·È ÙˆÓ fiÚˆÓÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ.™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ηȷ˘Ù‹˜ ÙÔ˘ Okamura Î·È Û˘Ó.33, Ô ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘CA 19-9 ÛÙ· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Â›Ó·È ›‰ÈÔ˜ Ì ·˘ÙfiÓÛÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤-Ó˜, ηıÒ˜ Î·È ÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤-Ó˜ ˘ÁÈÒÓ ·ÙfïÓ. AÓÙ›ıÂÙ· Ì ٷ Â˘Ú‹Ì·Ù· ·˘Ù¿, ¤¯ÂÈ·Ó·ÊÂÚı› fiÙÈ Ë ¤ÎÊÚ·ÛË ÙÔ˘ CA 19-9 Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ÛÙ· ηÚÎÈÓÈο ·ÙÙ·Ú· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ·fi ·˘Ù‹ ÙÔ˘·Ú·Î›ÌÂÓÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÁÎÚ·ÙÈÎÔ‡ ÈÛÙÔ‡13, ÂÓÒ·ÎfiÌ· fiÙÈ Û¿ÓÈ· ÂÎÊÚ¿˙ÂÙ·È ÛÙÔÓ ·Ú·Î›ÌÂÓÔ ÙˆÓ ·-‰ÂÓÔηÚÎÈÓˆÌ¿ÙˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ê˘ÛÈÔÏÔÁÈÎfi ‚ÏÂÓÓÔÁfi-ÓÔ10. M¿ÏÈÛÙ· ̆ ÔÛÙËÚ›¯ıËΠfiÙÈ Ë ·ÚÔ˘Û›· ÙÔ˘ CA 19-9 ÛÙÔ ˘fiÛÙڈ̷ ÙˆÓ Î·ÚÎÈÓˆÌ¿ÙˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜31
Î·È ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘30 ¤¯ÂÈ Û¯¤ÛË Ì ٷ ·˘ÍË-̤ӷ ›‰· ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜ ÙˆÓ ·-ÛıÂÓÒÓ. AÎfiÌ· ‰È·ÈÛÙÒıËΠfiÙÈ Ô ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ÙÔ˘ CA 19-9 ÛÙ· ηÚÎÈÓÒÌ·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ¤¯ÂÈ Û¯¤ÛËÌ ÙËÓ Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÛÙ¿ÛˆÓ, ÙËÓ ÂÈ‚›ˆÛË Î·ÈÁÂÓÈÎfiÙÂÚ· fiÙÈ ¤¯ÂÈ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›·19. H Û¯¤ÛËÙÔ˘ CA 19-9 Ì ÙËÓ ÚfiÁÓˆÛË Èı·ÓfiÓ ÔÊ›ÏÂÙ·È ÛÙÔ fi-ÙÈ Ù· ηÚÎÈÓÈο ·ÙÙ·Ú· Ô˘ ÂÎÊÚ¿˙Ô˘Ó CA 19-9 ÚÔ-ÛÎÔÏÏÒÓÙ·È ‰È· ̤ÛÔ˘ ÙÔ˘ Ï¢ÎÔ΢ÙÙ·ÚÈÎÔ‡ ÌÔÚ›Ô˘ÚÔÛÎfiÏÏËÛ˘-1 ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ( ELAM-1), Î·È ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙËÓ ·ÈÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›· ÚÔηÏÒ-ÓÙ·˜ ÌÂÙ·ÛÙ¿ÛÂȘ Î·È ·‡ÍËÛË ÙÔ˘ ÂȤ‰Ô˘ ÙÔ˘ CA 19-9ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ43,44. T· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Ì·˜ ÂÈÙÚ¤-Ô˘Ó Ó· ÚÔÙ›ÓÔ˘Ì fiÙÈ Ô ÙÚfiÔ˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-
23
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 19-25, 2004
19-25 ÛÂÏ. - Epibatianos** 3-10-08 12:44 ™ÂÏ›‰· 23
9 ÛÙ· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ‰ÂÓ ı· ÌÔÚÔ‡Û ӷ ·ÔÙÂϤÛÂÈ ‰Â›ÎÙË ÚfiÁÓˆÛ‹˜ÙÔ˘˜. H ÚfiÙ·ÛË ·˘Ù‹ ÌÔÚ› Ó· ˘ÔÛÙËÚȯı› Î·È ·fiÙ· Â˘Ú‹Ì·Ù· Ù˘ ÂÚÁ·Û›·˜ ÙÔ˘ Okamura Î·È Û˘Ó.33 ÛÙËÓÔÔ›· ‰È·ÈÛÙÒıËΠfiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û¯¤ÛË ÙÔ˘ ÙÚfiÔ˘¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9 ÛÙÔ ·‰ÂÓÔ΢ÛÙÈÎfi Î·È ‚ÏÂÓÓÔÂÈ-‰ÂÚÌÈÎfi ηÚΛӈ̷ Ì ÙËÓ ÚfiÁÓˆÛ‹ ÙÔ˘˜. °È· ÙËÓ ÂÈ-‚‚·›ˆÛË Ù˘ ÚfiÙ·Û˘ ·˘Ù‹˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚ·ÈÙ¤ÚˆÌÂϤÙ˜ ÙÔ˘ ÙÚfiÔ˘ ¤ÎÊÚ·Û˘ ÙÔ˘ CA 19-9 Û ۯ¤ÛË ÌÂÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ.
SUMMARY
"Immunohistochemicl expression ofcarbohydrate antigen 19-9 (CA 19-9) in salivary
gland tumours"A. Epivatianos S. Iordanidis, D. AAntoniades
hellenic stomatological review 48: 19-25, 2004
Carbohydrate antigen 19-9 ( CA 19-9) was obtained with amonoclonal antibody ( MAb) procured by immunizing amouse with a colon cancer line. The antigenic determi-nant is a sialylated derivate of the Lewis a blood groupantigen carried on glycolipids and mucin. The expressionof CA 19-9 has been studied immunohistochemically incarcinomas of pancreas, colorectum, gastric mucosa,endometrium, thyroid gland, and upper aerodigestivetract. The serum levels of CA 19-9 can be used todiagnosis and management of patients with colorectaland pancreatic carcinomas. The preoperative CA 19-9serum level has been found to correlate with a poorprognosis of pancreatic and colon cancer. The pattern ofexpression of CA 19-9 in gastric and pancreaticcarcinomas has been found to correlate with its serumlevels whereas in colorectal carcinomas with theprognosis.The aim of the present study was to investigateimmunohistochemically the pattern of expression of Ca19-9 in salivary gland neoplasms in an attempt todetermine its potential usefulness as prognostic marker.Twenty-one benign salivary gland tumours and 43malignant, fixed in 10% formalin and embedded inparaffin were retrospectively studied with hematoxylinand eosin stain and the streptavidin-biotin-peroxidasecomplex method using the MAb CA 19-9. Twenty-threeout of 64 cases of salivary gland tumours ( 11 benign and12 malignant)contained adjacent normal salivary glands.In addition 5 normal salivary glands which obtained fromreasons others than neoplasia were examined.Theantigen was expressed in mucous acinar and ductal cellsof normal salivary glands in a diffuse and granular pattern.Apical staining was observed occasionally in the luminalcells of intercalated and striated ducts and usually inexcretory ductal cells. In 20 out of 23 cases of salivaryneoplasms the tumour cells and adjacent normal salivaryglands expressed CA 19-9. The pattern of expression ofthe antigen in benign and malignant tumours was similarto that in normal salivary glands.
It is suggested that the pattern of expression of CA 19-9 inmalignant salivary gland tumours could not be used as aprognostic indicator
Key words: Tumour marker, carbohydrate antigen 19-9, salivarygland neoplasms, immunohistochemistry
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
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§¤ÍÂȘ ÎÏÂȉȿ: TÂڿو̷, ΢ÛÙÈÎfi, ÙÂڿو̷ ÒÚÈÌÔ, Ô‰ÔÓÙÔÁ¤-ÓÂÛË, ‰fiÓÙÈ, ¤ÎÙÔÔ, Ô‰ÔÓÙ›ÓË, Ô‰ÔÓÙÈÎÔ‡ ÔÏÊÔ‡ÂÓ·Û‚ÂÛÙ›ˆÛË, ‰ÔÓÙÈÔ‡ ·ÔÚÚfiÊËÛË.
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27-32 ÛÂÏ. - Tosios** 3-10-08 12:45 ™ÂÏ›‰· 27
‰‹˜, Ì ‰È¿ÌÂÙÚÔ ÌÈÎÚfiÙÂÚË ·fi 10 ÂÎ. H ΢ÛÙÈ΋ ÎÔÈÏfi-ÙËÙ· Â›Ó·È ÌÔÓfi¯ˆÚË ‹ Ôχ¯ˆÚË Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙÔ Â-ÛˆÙÂÚÈÎfi ÙÔ›¯ˆÌ· Ì›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÚÔ¤ÙÂÈ·, ÙË ‰ÂÚÌÔ-Âȉ‹ ·fiÊ˘ÛË, ‰ÂÚÌÔÂȉ¤˜ ¤Ì‚ÔÏÔ, ıËÏ‹ (mamilla), ‹ÚÔÂÍÔ¯‹ ÙÔ˘ Rokitansky. ™ÙË ı¤ÛË ·˘Ù‹ ˘¿Ú¯ÂÈ Î·Ù¿Î·ÓfiÓ· Ë ÌÂÁ·Ï‡ÙÂÚË ÈÛÙÈ΋ ÔÈÎÈÏ›·. H ÎÔÈÏfiÙËÙ· ÂÚȤ-¯ÂÈ ·¯‡ÚÚ¢ÛÙÔ ˘ÏÈÎfi, ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi ÙÚ›¯Â˜,ÛÌ‹ÁÌ· Î·È ÎÂÚ·Ù›ÓË.MÈÎÚÔÛÎÔÈο(1, 4), ·Ú·ÙËÚÔ‡ÓÙ·È ÒÚÈÌÔÈ ÈÛÙÔ› ÚÔÂÚ¯fi-ÌÂÓÔÈ ·fi Ù· ÂÌ‚Ú˘˚ο ‚Ï·ÛÙÈο ‰¤ÚÌ·Ù· Ô˘ Û˘ÌÌÂÙ¤-¯Ô˘Ó ÛÙÔ Û¯ËÌ·ÙÈÛÌfi Ù˘ ·ÛÙ˘, Û˘ÓËı¤ÛÙÂÚ· ÂȉÂÚ-Ì›‰·, ÚÔÛ·ÚÙ‹Ì·Ù·, ȉڈÙÔÔÈÔ› ·‰¤Ó˜ Î·È Ó¢ÚÈÎfi˜ È-ÛÙfi˜ ·fi ÙÔ ÂÍÒ‰ÂÚÌ·Ø Ì˘˚Îfi˜ ÈÛÙfi˜, ÔÛÙfi, ¯fiÓ‰ÚÔ˜ ηÈϛԘ ·fi ÙÔ ÌÂÛfi‰ÂÚÌ·Ø ·Ó·Ó¢ÛÙÈÎfi ÂÈı‹ÏÈÔ Î·È Á·-ÛÙÚÂÓÙÂÚÈÎfi ÂÈı‹ÏÈÔ ·fi ÙÔ ÂÓ‰Ò‰ÂÚÌ·. MÂÚÈΤ˜ ÊÔÚ¤˜ÔÈ ¤ÎÙÔÔÈ ÈÛÙÔ› Û¯ËÌ·Ù›˙Ô˘Ó ‰ÔÌ‹ Ô˘ ÌÔÈ¿˙ÂÈ Ì ÙÌ‹Ì·ÛÒÌ·ÙÔ˜ (homunuculus), ÔfiÙ ÙÔ ÙÂڿو̷ ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ˆ˜ «ÂÌ‚Ú˘fiÌÔÚÊÔ» (fetiform). ™¿ÓÈ· (1-2%) ÌÔ-Ú› Ó· ·Ó·Ù˘¯ı› ηÎfiËı˜ ÓÂfiÏ·ÛÌ·, ΢ڛˆ˜ ·Î·ÓıÔ-΢ÙÙ·ÚÈÎfi ηÚΛӈ̷(1). ™Â ÔÛÔÛÙfi 7,7%(4) ˆ˜ 31%(5) ÛÙ· ηÏÔ‹ıË Î˘ÛÙÈο ÙÂÚ·-ÙÒÌ·Ù· ÙˆÓ ˆÔıËÎÒÓ ·Ú·ÙËÚÔ‡ÓÙ·È Ô‰ÔÓÙÈο ÌÔÚÊÒ-Ì·Ù· ‹ ÒÚÈÌ· ‰fiÓÙÈ·, Ô ·ÚÈıÌfi˜ ÙˆÓ ÔÔ›ˆÓ Î˘Ì·›ÓÂÙ·È ·-fi ¤Ó· ˆ˜ ·ÚÎÂÙ¤˜ ÂηÙÔÓÙ¿‰Â˜(6). T· ‰fiÓÙÈ· «Ï¤Ô˘Ó»ÛÙËÓ ÎÔÈÏfiÙËÙ· ‹ Â›Ó·È ÂÓۈ̷و̤ӷ ÛÙÔ Î˘ÛÙÈÎfi ÙÔ›-¯ˆÌ·, Û˘ÓËı¤ÛÙÂÚ· ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÚÔÂÍÔ¯‹˜ ÙÔ˘Rokitansky(4, 5). ™¿ÓÈ·, Ù· ‰fiÓÙÈ· ‚Ú›ÛÎÔÓÙ·È Ì¤Û· Û Ô-ÛÙfi, ‰›ÓÔÓÙ·˜ ÙËÓ ÂÈÎfiÓ· ·ÙÂÏÔ‡˜ ÁÓ¿ıÔ˘(4).™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÎÙÈÓÔÁÚ·ÊÈÎ‹Î·È ÈÛÙÔÏÔÁÈ΋ ÌÂϤÙË ÙˆÓ ‰ÔÓÙÈÒÓ 13 ΢ÛÙÈÎÒÓ ÙÂÚ·Ùˆ-Ì¿ÙˆÓ ÙˆÓ ˆÔıËÎÒÓ, Î·È Ë Û˘Û¯¤ÙÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÌÂÙË Ê˘ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙÔÁ¤ÓÂÛË Î·È Ì ÙËÓ ÈÛÙÔÁ¤ÓÂÛËÙˆÓ Î·ÏÔ‹ıˆÓ ΢ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙˆÓ ˆÔıËÎÒÓ.
Y§IKA KAI ME£O¢O™TÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ ·ÔÙ¤ÏÂÛ·Ó 13 ÂÚÈÙÒÛÂȘ ΢-ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙˆÓ ˆÔıËÎÒÓ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì·-ÎÚÔÛÎÔÈο ÔÚ·Ù¤˜ Ô‰ÔÓÙÈΤ˜ ‰Ô̤˜ (EÈÎ. 1) ‹ ÂÚÈ›¯·Ó„ËÏ·ÊËÙÔ‡˜ ÛÎÏËÚÔ‡˜ ÈÛÙÔ‡˜ ÛÙÔ ÙÔ›¯ˆÌ¿ ÙÔ˘˜. OÈ Î‡-ÛÙÂȘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÈÛ¿ÚÈı̘ Á˘Ó·›Î˜ ËÏÈΛ·˜ 21ˆ˜ 37 ÂÙÒÓ, Ì ̤ÛË ËÏÈΛ· 29,15 ¤ÙË. MÂÙ¿ ·fi ÌÔÓÈÌÔ-
Ô›ËÛË Û ˘‰·ÙÈÎfi ‰È¿Ï˘Ì· ÊÔÚÌfiÏ˘ 10%, οı ·ÛÙËÙÔÔıÂÙ‹ıËΠ̠ÙË ÌÂÁ·Ï‡ÙÂÚË ÂÈÊ¿ÓÂÈ¿ Ù˘ Û ϷΛ-‰ÈÔ ÔÈÛıÔÊ·ÙÓȷ΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ (Kodak Extraspeedplus, Ù·¯‡ÙËÙ· E) ‹ ·ÎÙÈÓÔÁÚ·Ê›·˜ ‰‹Í˘ (Agfa DentatusM2) Î·È ·ÎÙÈÓÔ‚ÔÏ‹ıËÎ·Ó Ì Ì˯¿ÓËÌ· 65KV-7,5mA(Centex ORALIX AC) Û ÌÂÙ·‚ÏËÙ‹ ·fiÛÙ·ÛË. TÚÂȘ ÌÂ-Á¿Ï˜ ·ÛÙÂȘ ·ÎÙÈÓÔÁÚ·Ê‹ıËÎ·Ó ·fi ‰È·ÊÔÚÂÙÈΤ˜ ÂÈ-Ê¿ÓÂȘ. OÈ ·ÎÙÈÓÔÁڷʛ˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ÚÔ˜ ÙÔÓ·ÚÈıÌfi Î·È ÙË ÌÔÚÊ‹ ÙˆÓ ‰ÔÓÙÈÒÓ, ηıÒ˜ Î·È ̂ ˜ ÚÔ˜ ÙËÓ·ÚÔ˘Û›· ÔÛÙÔ‡ (Û˘Ì·ÁÔ‡˜ ‹ ÛÔÁÁÒ‰Ô˘˜), ÂÓ‰ÔÊ·Ù-ÓÈ·ÎÔ‡ ÔÛÙÈÎÔ‡ ÂÙ¿ÏÔ˘ (lamina dura) Î·È Ô‰ÔÓÙÈÎÒÓÛÂÚÌ¿ÙˆÓ. H ·ÍÈÔÏfiÁËÛË ¤ÁÈÓ ·fi ‰‡Ô ·fi ÙÔ˘˜ Û˘Á-ÁÚ·Ê›˜ ¯ˆÚÈÛÙ¿. OÈ ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ ‰ÂÓ ˘‹Ú-¯Â Û˘Ìʈӛ· ·ӷÍÈÔÏÔÁ‹ıËÎ·Ó ·fi ÎÔÈÓÔ‡.ŒÍÈ ‰fiÓÙÈ· ·fi ¤ÓÙ ·ÛÙÂȘ ·Ê·Ï·ÙÒıËÎ·Ó Û ‰È¿Ï˘Ì·EDTA 10% Î·È ÂÁÎÏ›ÛÙËÎ·Ó Û ·Ú·Ê›ÓË. TÔ̤˜ ¿¯Ô˘˜5Ìm ·Ú¿ÏÏËϘ ÚÔ˜ ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ· ÙˆÓ ‰ÔÓÙÈÒÓ ̄ ÚÒ-ÛıËÎ·Ó Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË-ˈۛÓË Î·È ÙÚ›¯ÚˆÌË ÙÔ˘ Mallory.
EYPHMATA-A¶OTE§E™MATAT· ·ÚÈ· ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ›-ӷη 1. ™ÙȘ ÂÈÎfiÓ˜ 2 ˆ˜ 5 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÓÙÈÚÔÛˆ-¢ÙÈΤ˜ ·ÎÙÈÓÔÁڷʛ˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂ-Ù‹ıËηÓ.
¶›Ó·Î·˜ I: K‡ÚÈ· ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· Û 13 ΢ÛÙÈ-ο ÙÂÚ·ÙÒÌ·Ù· ˆÔıËÎÒÓ.
·/· 1 2 3 4 5 6 7 8 9 10 11 12 13 Û‡ÓÔÏÔ·ÚÈıÌfi˜ ‰ÔÓÙÈÒÓ 3 15 9 11 3 4 2 3 5 3 2 60
ÙÔ̤·˜ 2 1 1 4΢Ófi‰ÔÓÙ·˜ 2 2 1 5ÚÔÁÔÌʛԘ 2 1 2 1 1 2 1 10
ÁÔÌʛԘ 1 6 1 1 9¿Ù˘Ô 1 6 2 2 1 4 2 1 19
Ô‰ÔÓÙÈÎfi Û¤ÚÌ· 1 1 4 4 1 1 1 13ÔÛÙÔ‡Ó
Û˘Ì·Á¤˜ * * * * * 5ÛÔÁÁ҉˜ * * * * * * 6lamina dura * * * * * * 6
28
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
EÈÎ. 1: ¶ÂÚ›ÙˆÛË 1. M·ÎÚÔÛÎÔÈ΋ ÂÈÎfiÓ·. ¢È·ÎÚ›ÓÂÙ·È ‰fiÓÙÈ ÌÂÌÔÚÊÔÏÔÁ›· ΢Ófi‰ÔÓÙ· (·È¯Ì‹ ‚¤ÏÔ˘˜).
EÈÎ. 2: ¶ÂÚ›ÙˆÛË 2. AÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ·.¢È·ÎÚ›ÓÔÓÙ·È 15 ‰fiÓÙÈ·: 2 ÚÔÁÔÌÊ›ÔÈ(5, 8), 6 ÁÔÌÊ›-ÔÈ(2, 3, 4, 6, 11, 13), 6 ¿Ù˘·(1, 9, 10, 12,
14, 15) Î·È 1 Ô‰ÔÓÙÈÎfi Û¤Ú-Ì·(7). TÔ ‰fiÓÙÈ 11 ·ÚÔ˘-ÛÈ¿˙ÂÈ Û·Ê‹ lamina duraÎ·È ÂÚÈÚÚÈ˙ÈÎfi ¯ÒÚÔ.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 27-32, 2004
27-32 ÛÂÏ. - Tosios** 3-10-08 12:45 ™ÂÏ›‰· 28
™Â 11 ·fi ÙÔ˘˜ 13 fiÁÎÔ˘˜ ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó 2 ̂ ˜ 16 ‰fiÓÙÈ·‹ ‰Ô̤˜ Ì ·‰Ú‹ Ô‰ÔÓÙÈ΋ ÌÔÚÊÔÏÔÁ›·. Afi Ù· Û˘ÓÔÏÈο60 ‰fiÓÙÈ·, 4 ¤ÌÔÈ·˙·Ó Ì ÙÔÌ›˜, 5 Ì ΢Ófi‰ÔÓÙ˜, 10 ÌÂÚÔÁÔÌÊ›Ô˘˜ Î·È 9 Ì ÁÔÌÊ›Ô˘˜. H ‰È¿ÎÚÈÛË ÌÂٷ͇ ÚÔ-ÁÔÌÊ›ˆÓ Î·È ÁÔÌÊ›ˆÓ ‚·Û›ÛÙËΠ΢ڛˆ˜ ÛÙË ÌÔÚÊÔÏÔÁ›·Ù˘ ̇Ï˘, ηıÒ˜ fiÏ·, ۯ‰fiÓ, Ù· ‰fiÓÙÈ· ›¯·Ó Ì›· Ú›˙·.¢ÂÓ ¤ÁÈÓ ‰È¿ÎÚÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ Û ÓÂÔÁÈÏ¿ Î·È ÌfiÓÈÌ·, ‹Û ‰fiÓÙÈ· ¿Óˆ Î·È Î¿Ùˆ ÁÓ¿ıÔ˘. ¢ÂηÂÓÓ¤· ‰fiÓÙÈ· ¯·Ú·-ÎÙËÚ›ÛÙËÎ·Ó ̂ ˜ «¿Ù˘·», ÂÂȉ‹ ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùfi Ó· Ù·ÍÈ-ÓÔÌËıÔ‡Ó ·ÎÙÈÓÔÁÚ·ÊÈο. ¶·Ú·ÙËÚ‹ıËηÓ, ›Û˘, 13 Ô-‰ÔÓÙÈο Û¤ÚÌ·Ù· Ì ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ·Ó¿Ù˘ÍË Ù˘ ̇-Ï˘ ‹ Ù˘ Ú›˙·˜. ™Â ‰‡Ô ÂÚÈÙÒÛÂȘ ÔÈ Ô‰ÔÓÙÈΤ˜ ‰Ô̤˜ ¤-ÌÔÈ·˙·Ó Ì ¿Ù˘· ‰fiÓÙÈ·, ‰›ÓÔÓÙ·Ó ÙËÓ ÂÈÎfiÓ· Û‡ÓıÂÙÔ˘(EÈÎ. 5) Î·È Û‡ÌÏÂÎÙÔ˘ Ô‰ÔÓÙÒÌ·ÙÔ˜, ·ÓÙ›ÛÙÔȯ·.™Â 5 ÂÚÈÙÒÛÂȘ ·Ó·ÁÓˆÚ›ÛÙËÎÂ Û˘Ì·Á¤˜ ÔÛÙfi Î·È ÛÂ6 ÛÔÁÁ҉˜. ™ÙȘ 2 ÂÚÈÙÒÛÂȘ ÔÈ ‰‡Ô Ù‡ÔÈ ÔÛÙÔ‡ Û˘-Ó˘‹Ú¯·Ó. ¢¤Î· ‰fiÓÙÈ· ·ÚÔ˘Û›·˙·Ó Û ¿ÏÏÔÙ ¿ÏÏË ¤-ÎÙ·ÛË lamina dura Á‡Úˆ ·fi ÙË Ú›˙· ÙÔ˘˜.T· ‰fiÓÙÈ· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÈÛÙÔÏÔÁÈο ¤ÌÔÈ·˙·Ó ÌÂ Ê˘-ÛÈÔÏÔÁÈο ‰fiÓÙÈ·. AÔÙÂÏÔ‡ÓÙ·Ó ·fi ÒÚÈÌË Ô‰ÔÓÙ›ÓË Î·ÈÂÌÊ¿ÓÈ˙·Ó ÔÏÊÈ΋ ÎÔÈÏfiÙËÙ·. H Ô‰ÔÓÙ›ÓË ·ÚÔ˘Û›·˙ Â-ÛÙȷο Â͈ÙÂÚÈ΋ ‹ Î·È ÂÛˆÙÂÚÈ΋ ·ÔÚÚfiÊËÛË (EÈÎ. 6)Î·È Û ‰‡Ô ‰fiÓÙÈ· ÂÌÊ¿ÓÈ˙ ÂÚÈÔ¯¤˜ Ô˘ ηٷϷ̂¿ÓÔ-ÓÙ·Ó ·fi ÈÓÒ‰Ë Û˘Ó‰ÂÙÈÎfi ÈÛÙfi. °È· ÙȘ ÂÚÈÔ¯¤˜ ·˘Ù¤˜‰ÂÓ ‹Ù·Ó ۷ʤ˜ ·Ó ÔÊ›ÏÔÓÙ·Ó Û Â͈ÙÂÚÈ΋ ‹ ÂÛˆÙÂÚÈ-΋ ·ÔÚÚfiÊËÛË. ™ÙȘ ı¤ÛÂȘ ·ÔÚÚfiÊËÛ˘ Î·È ·ÓÙ›ÛÙÔÈ-¯· ÚÔ˜ ÙȘ ÂÚÈÔ¯¤˜ Ô˘ ηٷϷ̂¿ÓÔÓÙ·Ó ·fi Û˘Ó‰Â-ÙÈÎfi ÈÛÙfi, ·Ú·ÙËÚ‹ıËΠ΢ÙÙ·ÚÔÊfiÚÔ˜ Ô‰ÔÓÙ›ÓË Ì Â-Ï¿¯ÈÛÙ· ‹ ηıfiÏÔ˘ Ô‰ÔÓÙÈÓÔÛˆÏËÓ¿ÚÈ· (ÙÚÈÙÔÁÂÓ‹˜ Ô-‰ÔÓÙ›ÓË) (EÈÎ. 7). O ÔÏÊfi˜, fiÔ˘ ›¯Â ‰È·ÙËÚËı›, ÂÌÊ¿-ÓÈ˙ ԉÔÓÙÈÓÔ‚Ï·ÛÙÈ΋ ÛÙÈ‚¿‰· (EÈÎ. 8) ηÈ, Û ̛· ÂÚ›-ÙˆÛË, ÂÛÙ›· ÔÛÙÂÔÂȉԇ˜ ‹ ÔÛÙÂ˚ÓÔÂȉԇ˜ ˘ÏÈÎÔ‡ Ì ÙËÌÔÚÊ‹ ÔÏÊfiÏÈıÔ˘. H Ú›˙· ÙˆÓ ‰ÔÓÙÈÒÓ Î·Ï˘ÙfiÙ·Ó Û˘-Ó‹ıˆ˜ ·fi ÔÛÙ½ÓË, Ë ÔÔ›· ·ÚÔ˘Û›·˙ ÂÛÙȷο ·ÔÚ-ÚfiÊËÛË. °‡Úˆ ·fi ÙË Ú›˙· ÙˆÓ ‰ÔÓÙÈÒÓ ˘‹Ú¯Â ÈÓÒ‰Ë˜Û˘Ó‰ÂÙÈÎfi˜ ηÈ, ÂÚÈÊÂÚÈο, ÏÂÙ¤˜ ‰ÔΛ‰Â˜ ÂÙ·ÏÈÒ-‰Ô˘˜ ÔÛÙÔ‡. ™Â Û¯¤ÛË Ì ٷ ‰fiÓÙÈ· ·Ú·ÙËÚ‹ıËηÓ, ›-Û˘, ¯fiÓ‰ÚÔ˜, ÛÌËÁÌ·ÙÔÁfiÓÔÈ Î·È È‰ÚˆÙÔÔÈÔ› ·‰¤Ó˜,Î·È ÙÚ›¯Â˜, ÂÓÒ ÙÔ ·Ú·Î›ÌÂÓÔ ÂÈı‹ÏÈÔ ‹Ù·Ó „¢‰ÔÔ-χÛÙÈ‚Ô ÎÚÔÛÛˆÙfi ΢ÏÈÓ‰ÚÈÎfi, ·Ó·Ó¢ÛÙÈÎÔ‡ Ù‡Ô˘. T·¤ÁÎÏÂÈÛÙ· ‰fiÓÙÈ· ÂÚÈ‚¿ÏÏÔÓÙ·Ó ·fi Ô‰ÔÓÙÔı˘Ï¿ÎÈÔ,Ô˘ ÂÂÓ‰˘fiÙ·Ó ·fi Ï·Î҉˜ ÂÈı‹ÏÈÔ.
29
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
EÈÎ. 3: ¶ÂÚ›Ùˆ-ÛË 3. AÎÙÈÓÔÁÚ·-ÊÈ΋ ÂÈÎfiÓ·.¢È·ÎÚ›ÓÔÓÙ·È 9‰fiÓÙÈ· Û ÛÔÁ-Á҉˜ ÔÛÙÔ‡Ó:2 ΢Ófi‰ÔÓÙ˜(3, 6),1 ÚÔÁÔÌʛԘ(8),2 ¿Ù˘· ‰fiÓÙÈ·(4,
9) Î·È 4 Ô‰ÔÓÙÈοۤÚÌ·Ù·(1, 2, 5, 7).O ΢Ófi‰ÔÓÙ·˜ 6·ÚÔ˘ÛÈ¿˙ÂÈ ·-ÎÙÈÓԉȷ‡Á·ÛËÛÙË Ì‡ÏË.
EÈÎ. 5: ¶ÂÚ›Ùˆ-ÛË 6. AÎÙÈÓÔÁÚ·-ÊÈ΋ ÂÈÎfiÓ·. ÕÙ˘-· Ô‰ÔÓÙÈο ÌÔÚ-ÊÒÌ·Ù·, Û˘Ì‚·-Ù¿ Ì ۇÓıÂÙÔ Ô-‰fiÓو̷.
EÈÎ. 4: ¶ÂÚ›ÙˆÛË 4: AÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ·. ¢È·ÎÚ›ÓÔÓÙ·È 11 ‰fi-ÓÙÈ·: 2 ÙÔÌ›˜(10, 11), 2 ÚÔÁÔÌÊ›ÔÈ(1, 9), 1 ÁÔÌʛԘ(3), 2 ¿Ù˘· ‰fi-ÓÙÈ·(2, 5) Î·È 4 Ô‰ÔÓÙÈο Û¤ÚÌ·Ù·(4, 6, 7, 8). ¶·Ú·ÙËÚ›ٷÈ, ›Û˘, ¤-Ó· Ô‰ÔÓÙÈÎfi Û¤ÚÌ· Û ÚÒ˚ÌÔ ÛÙ¿‰ÈÔ(6).
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 27-32, 2004
EÈÎ. 6: IÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ‰ÔÓÙÈÔ‡ Ì Â͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË Ù˘ڛ˙·˜ (·ÈÌ·ÙÔÍ˘Ï›ÓË & ˈۛÓË, ÌÂÁ¤ı˘ÓÛË x 100).
27-32 ÛÂÏ. - Tosios** 3-10-08 12:45 ™ÂÏ›‰· 29
™YZHTH™H
H ·ÚÔ˘Û›· ‰ÔÓÙÈÒÓ Û ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓ ˆÔıË-ÎÒÓ Â›Ó·È ÁÓˆÛÙ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi ÙÔ 1860(7), ÂÓÒ ÙÔ1900, Ï›Á· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë ÙˆÓ ·ÎÙÈÓÒÓ X, Ë·ÂÈÎfiÓÈÛË ‰ÔÓÙÈÒÓ Û ˘ÂÏÈÎÔ‡˜ fiÁÎÔ˘˜ ıˆڋıËΠˆ˜·ıÔÁÓˆÌÔÓÈÎfi ÛËÌÂ›Ô Ù˘ ÔÓÙfiÙËÙ·˜(7). ™ÙËÓ Ô‰ÔÓÙÈ·-ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ¤¯Ô˘Ó ÌÂÏÂÙËı› Ù· Ì·ÎÚÔÛÎÔÈο,ÌÈÎÚÔÛÎÔÈο Î·È ·ÎÙÈÓÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‰Ô-ÓÙÈÒÓ Û ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ(8-13) ‹, Û·ÓÈfiÙÂÚ·, ÛÂÛÂÈÚ¤˜ ΢ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙˆÓ ˆÔıËÎÒÓ(14, 15). K·Ù¿ÙÔ˘˜ Dick Î·È Honore(14) Ë ÌÂϤÙË ÙˆÓ ¤ÎÙÔˆÓ ‰ÔÓÙÈÒÓÛÙ· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓ ˆÔıËÎÒÓ ÌÔÚ› Ó· ‰ÒÛÂȯڋÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ Ô‰ÔÓÙÔÁ¤ÓÂÛË.M·ÎÚÔÛÎÔÈο Î·È ·ÎÙÈÓÔÁÚ·ÊÈο Ù· ‰fiÓÙÈ· ÙˆÓ Î˘ÛÙÈ-ÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙˆÓ ˆÔıËÎÒÓ ÌÔÈ¿˙Ô˘Ó ÌÂ Ê˘ÛÈÔÏÔÁÈ-ο ‰fiÓÙÈ· fiÏˆÓ ÙˆÓ Ù‡ˆÓ, ÓÂÔÁÈÏ¿ ‹ ÌfiÓÈÌ·(4, 6, 8, 14). ¶ÂÚÈ-ÁÚ¿ÊÔÓÙ·È, ›Û˘, ‰fiÓÙÈ· Ë ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ
Â›Ó·È Û·Ê‹˜, ÂÂȉ‹ Â›Ó·È ÌÈÎÚfiÙÂÚ· ·fi Ù· ·ÓÙ›ÛÙÔȯ·Ê˘ÛÈÔÏÔÁÈο, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÒÌ·ÏË ‰È¿Ù·ÍË ÙˆÓ Ê˘-Ì¿ÙˆÓ, ‹ ÂÌÊ·Ó›˙Ô˘Ó ‰˘ÛϷۛ˜, fiˆ˜ dens evaginatus‹ invaginatus(6, 8, 14, 15). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ù· ÂÚÈÛÛfiÙÂ-Ú· ‰fiÓÙÈ· ›¯·Ó ¿Ù˘Ë ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÌÔÚÊÔÏÔÁ›·, Î·È ·-ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÚÔÁÔÌÊ›ÔÈ Î·È ÁÔÌÊ›ÔÈ, Î·È ÔÈ Î˘Ófi‰Ô-ÓÙ˜ Î·È ÔÈ ÙÔÌ›˜. T· ‰fiÓÙÈ· Ì ÌÔÚÊÔÏÔÁ›· ÚÔÁÔÌÊ›ˆÓ‹ ÁÔÌÊ›ˆÓ ‹Ù·Ó Û˘¯ÓfiÙÂÚ· Î·È ÛÙËÓ ·Ó·Ï˘ÙÈ΋ Ì·ÎÚÔ-ÛÎÔÈ΋ ÌÂϤÙË ÙˆÓ Dick Î·È Honore(14), fiÔ˘ Ù· ÂÚÈÛÛfi-ÙÂÚ· ·fi Ù· 25 ‰fiÓÙÈ· ÔÎÙÒ Î˘ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÂÌ-Ê¿ÓÈ˙·Ó ÌÔÚÊÔÏÔÁ›· ÓÂÔÁÈÏÒÓ. ™Â Û˘Ìʈӛ· Ì ¿ÏϘÌÂϤÙ˜ ‰ÔÓÙÈÒÓ ·fi ÛÂÈÚ¤˜ ΢ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ˆÔ-ıËÎÒÓ(14, 15), ‰ÂÓ ÂȂ‚·ÈÒıËÎÂ Ë ·Ú·Ù‹ÚËÛË ÙÔ˘ Main(7)
ÁÈ· ÙËÓ ·ÚÔ˘Û›· ÂÓfi˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ, ΢Ófi‰ÔÓÙ· Û οı‚Ͽ‚Ë.MÈÎÚÔÛÎÔÈο, ÔÈ ÛÎÏËÚÔ› ÈÛÙÔ› ÛÙ· ¤ÎÙÔ· ‰fiÓÙÈ· ÙˆÓ΢ÛÙÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙˆÓ ˆÔıËÎÒÓ ÌÔÈ¿˙Ô˘Ó Ì ÙÔ˘˜ÈÛÙÔ‡˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ‰ÔÓÙÈÒÓ(9, 14, 15), Î·È Ë ÂÓ·Û‚Â-ÛÙ›ˆÛË Á›ÓÂÙ·È Ì ÙË ÌÔÚÊ‹ ·Ï¿ÙˆÓ ʈÛÊÔÚÈÎÔ‡ ·Û‚Â-ÛÙ›Ô˘(11). ™Â ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ÌÈÎÚ¤˜ ‰È·-ÊÔÚ¤˜, fiˆ˜ ¤ÏÏÂÈ„Ë ÙˆÓ ÁÚ·ÌÌÒÓ ÙÔ˘ Retzius Ù˘ ·‰·-Ì·ÓÙ›Ó˘ Î·È ÙˆÓ ÁÚ·ÌÌÒÓ ÙÔ˘ Owen Ù˘ Ô‰ÔÓÙ›Ó˘(7), ˘-ÔÏ·Û›· Ù˘ ·‰·Ì·ÓÙ›Ó˘(13, 15), ˘Ô- ‹ ˘ÂÚ-ÔÛÙÂ˚ÓˆÛË(7,
9), Î·È ·Î·ÓfiÓÈÛÙ˜ ÁÚ·Ì̤˜ ·Ó·ÛÙÚÔÊ‹˜ Ù˘ ÔÛÙ½Ó˘(13).OÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ ÔÊ›ÏÔÓÙ·È Èı·ÓÒ˜ Û ·Ú¿ÁÔÓÙÂ˜Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ù˘ ¤ÎÙÔ˘ Ô‰ÔÓÙÔ-Á¤ÓÂÛ˘ (.¯. ÙÔ ¯·ÌËÏfi pH Ù˘ ΢ÛÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ηÈÙËÓ ·Ô˘Û›· ÂÓÂÚÁÔÔÈÒÓ ÂȉڿÛÂˆÓ ·fi ÙÔ˘˜ Á‡Úˆ,ÂÙÂÚfiÎÏËÙÔ˘˜ ÈÛÙÔ‡˜), ÙËÓ ¤ÏÏÂÈ„Ë ¤ÎıÂÛ˘ ÙˆÓ ‰Ô-ÓÙÈÒÓ ÛÙÔ Û¿ÏÈÔ Î·È ÙË ÌÈÎÚԂȷ΋ ¯ÏˆÚ›‰· ÙÔ˘ ÛÙfiÌ·-ÙÔ˜, ηıÒ˜ Î·È ÛÙËÓ ·Ô˘Û›· Ì˯·ÓÔÏÂÈÙÔ˘ÚÁÈÎÒÓ ÂÈ‚·-Ú‡ÓÛˆÓ(7, 13, 15).E͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË Ù˘ Ú›˙·˜, ·ÚfiÌÔÈ· Ì ·˘Ù‹Ô˘ ·Ú·ÙËÚ‹ıËΠÈÛÙÔÏÔÁÈο ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÌÂ-ÏÂÙ‹Û·ÌÂ, ¤¯ÂÈ ÂÚÈÁÚ·Ê› ·fi ÙÔ˘˜ Main(7), Babbush ηÈAugust(8) Î·È Pullon Î·È Child(9), Î·È ·Ô‰›‰ÂÙ·È Û ·Ó·Ú-΋ ‰È¤ÁÂÚÛË ÙˆÓ ÔÛÙÂ˚ÓÔ‚Ï·ÛÙÒÓ ÏfiÁˆ ¤ÏÏÂȄ˘ Ì˯·-ÓÔÏÂÈÙÔ˘ÚÁÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ(7). ™¯ËÌ·ÙÈÛÌfi˜ ÙÚÈÙÔÁÂ-ÓÔ‡˜ Ô‰ÔÓÙ›Ó˘ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› Û ÚÔËÁÔ‡ÌÂÓ˜ÌÂϤÙ˜. ™‡Ìʈӷ Ì ÙȘ ÙÚ¤¯Ô˘Û˜ ·fi„ÂȘ, Ë ÙÚÈÙÔÁÂ-Ó‹˜ Ô‰ÔÓÙ›ÓË ·Ú¿ÁÂÙ·È ·fi ·‰È·ÊÔÚÔÔ›ËÙ· ·ÙÙ·Ú·Ô˘ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ÚÔ˜ Ô‰ÔÓÙÔ‚Ï¿ÛÙ˜, Û ·ÓÙ›ıÂ-ÛË Ì ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ Ô‰ÔÓÙ›ÓË, Ë ÔÔ›· Û˘ÓÙ›ıÂÙ·È ·fiÚÔ¸¿Ú¯ÔÓÙ˜ Ô‰ÔÓÙÈÓÔ‚Ï¿ÛÙ˜. K·È ÛÙȘ ‰‡Ô ÂÚÈÙÒ-ÛÂȘ, Ù· ·ÙÙ·Ú· ‰¤¯ÔÓÙ·È ‰ÈÂÁÂÚÙÈÎfi ÂÚ¤ıÈÛÌ·, Ô˘ ÛÙ·‰fiÓÙÈ· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·Ó ÂӉ¯Ô̤ӈ˜ Ë ·ÔÚÚfi-ÊËÛË Ù˘ Ô‰ÔÓÙ›Ó˘. OÈ Blackwell Î·È Û˘Ó.(6) Î·È Ô Zakin(8)
·Ó·Ê¤ÚÔ˘Ó ˆ˜ Û ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ÂÚÈÁÚ·-Ê› ÙÂÚˉÔÓÈṲ̂ӷ ¤ÎÙÔ· ‰fiÓÙÈ·.O ÔÏÊfi˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÈÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·Ó¿-ÏÔÁ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ‰ÔÓÙÈÒÓ, Ì ۿÓȘ ÂÚÈÙÒ-ÛÂȘ ÂÓ·Û‚ÂÛÙ›ˆÛ˘ Û ÔÛÙÂ˚ÓÔÂȉ¤˜ ˘ÏÈÎfi Î·È ÔÛÙÂÔÂÈ-‰‹ ÌÂÙ·Ï·Û›·(8, 14). ™ÙÔÓ ÔÏÊfi ÌÔÚÊÔÏÔÁÈο ÒÚÈÌˆÓ ‰Ô-ÓÙÈÒÓ ·Ô‰Â›¯ıËÎÂ Ë ·ÚÔ˘Û›· Ó¢ÚÈÎÒÓ ÈÓÒÓ, ÔÈ Ôԛ˜‰ÂÓ ˘‹Ú¯·Ó Û ‰fiÓÙÈ· Ì ·ÓÒÌ·ÏË ÌÔÚÊÔÏÔÁ›·(14).EÎÙfi˜ ·fi ÙËÓ ̆ „ËÏÔ‡ ‚·ıÌÔ‡ ÌÔÚÊԉȿϷÛË Î·È ÈÛÙÔ-‰È·ÊÔÚÔÔ›ËÛË, Ù· ‰fiÓÙÈ· ÛÙ· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓˆÔıËÎÒÓ ̄ ·Ú·ÎÙËÚ›˙ÔÓÙ·È Î·È ·fi ̆ „ËÏÔ‡ ‚·ıÌÔ‡ ÔÚÁ·-ÓÔÂȉ‹ ‰È·ÊÔÚÔÔ›ËÛË. ¶Ú¿ÁÌ·ÙÈ, Ôχ Û˘¯Ó¿ ·Ó·Ù‡Û-
30
EÚ¢ÓËÙÈ΋ EÚÁ·Û›·
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 27-32, 2004
EÈÎ. 8: IÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ‰ÔÓÙÈÔ‡. ¢È·ÎÚ›ÓÂÙ·È ÔÏÊfi˜ (¶), Ô‰Ô-ÓÙÈÓÔ‚Ï·ÛÙÈ΋ ÛÙÈ‚¿‰· (O™) Î·È Ô‰ÔÓÙ›ÓË (O¢) (·ÈÌ·ÙÔÍ˘Ï›ÓË &ˈۛÓË, ÌÂÁ¤ı˘ÓÛË x 100).
EÈÎ. 7: IÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ‰ÔÓÙÈÔ‡. ¢È·ÎÚ›ÓÂÙ·È ÙÚÈÙÔÁÂÓ‹˜ Ô‰Ô-ÓÙ›ÓË ‹ ÔÛÙÂÔ-Ô‰ÔÓÙ›ÓË, Ì ÔÛÙÈΤ˜ ÎÚ‡Ù˜ Î·È ÂÏ¿¯ÈÛÙ· Ô‰ÔÓÙÈ-ÓÔÛˆÏËÓ¿ÚÈ·, Û ·ʋ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙ›ÓË (·ÈÌ·ÙÔÍ˘Ï›ÓË& ˈۛÓË, ÌÂÁ¤ı˘ÓÛË x 200).
27-32 ÛÂÏ. - Tosios** 3-10-08 12:45 ™ÂÏ›‰· 30
ÛÔÓÙ·È Û ÔÛÙfi Û¯ËÌ·Ù›˙ÔÓÙ·˜ ‰Ô̤˜ Ô˘ ÌÔÈ¿˙Ô˘Ó ÌÂÂÚÈÔ‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜(6, 10, 14). H ÂÚÈÔ‰ÔÓÙÈ΋ ÌÂÌ‚Ú¿ÓË·ÔÙÂÏÂ›Ù·È ·fi ›Ó˜ ·Ú¿ÏÏËϘ ÚÔ˜ ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔ-Ó· Ù˘ Ú›˙·˜, fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È ÛÙ· ¤ÁÎÏÂÈÛÙ· ‰fiÓÙÈ·ÙˆÓ ÁÓ¿ıˆÓ(8, 9), ÂÓÒ ÂÚÈÔ‰ÔÓÙÈ΋ ÌÂÌ‚Ú¿ÓË ·ÚÔ˘ÛÈ¿-˙Ô˘Ó Î·È Ù· ¤ÁÎÏÂÈÛÙ· ¤ÎÙÔ· ‰fiÓÙÈ·(14). ŒÍÈ ·fi Ù· 54 ‰fi-ÓÙÈ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÚÔ˘Û›·˙·Ó ·ÎÙÈÓÔÁÚ·ÊÈο۷ʋ lamina dura, ‰›ÓÔÓÙ·˜ ÙËÓ ÂÓÙ‡ˆÛË Î·Ï¿ Û¯ËÌ·ÙÈ-Ṳ̂ÓÔ˘ ÂÚÈÚÚÈ˙ÈÎÔ‡ ¯ÒÚÔ˘. ™ÙȘ ÌÈÎÚÔÛÎÔÈΤ˜ ÙÔ̤˜,·Ú·ÙËÚ‹ıËÎ·Ó ‰ÂÛÌ›‰Â˜ ÈÓÒÓ ·Ú¿ÏÏËÏˆÓ ÚÔ˜ ÙÔÓ Â-ÈÌ‹ÎË ¿ÍÔÓ· Ù˘ Ú›˙·˜, ÂÚÈÊÂÚÈο ÙˆÓ ÔÔ›ˆÓ Û¯ËÌ·Ù›-˙ÔÓÙ·Ó ‰ÔΛ‰Â˜ ÒÚÈÌÔ˘ ÔÛÙÔ‡, fiˆ˜ ÛÙ· Ê·ÙÓ›·. ™¿ÓÈ·Ù· ‰fiÓÙÈ· ·Ó·Ù‡ÛÛÔÓÙ·È ·ÌÊÔÙÂÚfiÏ¢ڷ Î·È Û˘ÌÌÂ-ÙÚÈο ÚÔ˜ Ì›· ÎÂÓÙÚÈ΋ Û‡ÌÊ˘ÛË, ‰›ÓÔÓÙ·˜ ÙËÓ ÂÈÎfiÓ· ¿-Ù˘Ë˜ ÁÓ¿ıÔ˘(7, 8, 10). OÈ Audiat Î·È Û˘Ó.(13) ÂÚȤÁÚ·„·Ó ‰È¿-Ù·ÍË ÙˆÓ ÂÓÛˆÌ·ÙˆÌ¤ÓˆÓ Û ÔÛÙfi ‰ÔÓÙÈÒÓ Ì ÙÚfiÔÔ˘ ¤‰ÈÓ ÙËÓ ÂÓÙ‡ˆÛË ÙÌËÌ¿ÙˆÓ ÁÓ¿ıˆÓ Û ۇÁÎÏÂÈ-ÛË, Î·È ÔÈ Pullon Î·È Child(9) ‚Ú‹Î·Ó ÛÂÈÚ¿ ÌfiÓÈÌˆÓ ¿Óˆ ‰Ô-ÓÙÈÒÓ Û ‰ÔÌ‹ Ô˘ ¤ÌÔÈ·˙ Ì ÁÓ¿ıÔ. AӷʤÚÂÙ·È, ›-Û˘, ÂÌÊ¿ÓÈÛË ÁÓ¿ıˆÓ Ì ‰fiÓÙÈ· Û ۯ¤ÛË Ì ¤ÎÙÔËÁÏÒÛÛ·(8). AÏÏ¿ Î·È Ë ¯ÚÔÓÈ΋ ·ÏÏËÏÔ˘¯›· Ù˘ ¤ÎÙÔ˘ Ô‰ÔÓÙÔÁ¤-ÓÂÛ˘ Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·Ó¿ÏÔÁË Ì ·˘Ù‹ ÙˆÓ Ê˘ÛÈÔÏÔ-ÁÈÎÒÓ ‰ÔÓÙÈÒÓ. ™ÙË ÌÔÓ·‰È΋ ÂÚ›ÙˆÛË Î˘ÛÙÈÎÔ‡ ÙÂÚ·-ÙÒÌ·ÙÔ˜ ÙˆÓ ˆÔıËÎÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËΠ·ÎÙÈÓÔ-ÁÚ·ÊÈο › 13 ¯ÚfiÓÈ·, ÔÈ Wollin Î·È Ozonoff(16) ‰È·›ÛÙˆ-Û·Ó ÙËÓ ÚÔԉ¢ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ÌÔÚÊԉȿϷÛËÙÚÈÒÓ ‰ÔÓÙÈÒÓ. ™Ù· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· Ô˘ ÂÍÂÙ¿ÛÙË-Î·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÓÙÔ›ÛÙËÎ·Ó Ô‰ÔÓÙÈο Û¤Ú-Ì·Ù· Û ‰È¿ÊÔÚ· ÛÙ¿‰È· ·Ó¿Ù˘Í˘, fiˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚ-ı› Î·È ·fi ÙÔ˘˜ Pullon Î·È Child(9). Ÿˆ˜ Î·È Û ¿ÏϘ ÌÂϤÙ˜(9, 14), Ù· ¤ÎÙÔ· ‰fiÓÙÈ· ÛÙ· ΢-ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓ ˆÔıËÎÒÓ Ô˘ ÌÂÏÂÙ‹Û·Ì ‚Ú›-ÛÎÔÓÙ·Ó ÛÂ Ù˘¯·›Â˜ ı¤ÛÂȘ ̤۷ ÛÙȘ ‚Ï¿‚˜, ¯ˆÚ›˜ Ó·‰È·Ù¿ÛÛÔÓÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ÛÂÈÚ¿. TÔ Â‡ÚËÌ· ·˘Ùfi ˘-ÔÛÙËÚ›˙ÂÈ ÙÔ ÎψÓÈÎfi ÚfiÙ˘Ô (clone model) Ù˘ Ô‰Ô-ÓÙÔÁ¤ÓÂÛ˘(14), Û‡Ìʈӷ Ì ÙÔ ÔÔ›Ô ÙÔ Û¯‹Ì· ÙÔ˘ ‰ÔÓÙÈ-Ô‡ ÛÙ· ÂÙÂÚfi‰ÔÓÙ· (heterodont) ıËÏ·ÛÙÈο ηıÔÚ›˙ÂÙ·È·fi οı ‰fiÓÙÈ ·ÓÂÍ¿ÚÙËÙ·, ̤ۈ ÂÓfi˜ ÎÏÒÓÔ˘ Â͈ÌÂ-ÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÚÔÁÚ·ÌÌ·Ù›˙ÂÙ·È ·fi ÙÔÔ‰ÔÓÙÔÁÂÓ¤˜ ÂÈı‹ÏÈÔ(17). °È· ÙË Ê˘ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙÔÁ¤-ÓÂÛË ̆ ¿Ú¯Ô˘Ó ÛÙÔȯ›· Ô˘ ̆ ÔÛÙËÚ›˙Ô˘Ó Î·È ÙÔ ÚfiÙ˘-Ô ÙÔ˘ ‰›Ô˘ (field model), ηٿ ÙÔ ÔÔ›Ô ÙÔ Û¯‹Ì· οıÂÔÈÎÔÁ¤ÓÂÈ·˜ ‰ÔÓÙÈÒÓ Î·ıÔÚ›˙ÂÙ·È ·fi Ú·Ó‹ Û˘ÁÎÂÓÙÚÒ-ÛÂˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ÂÚÈÔ¯¤˜ ‹ «Â‰›·» ÙÔ˘ Â͈ÌÂÛÂÁ¯‡Ì·ÙÔ˜(17). ™‡Ìʈӷ Ì ÙȘ ÂÈÎÚ·ÙÔ‡Û˜ ·ıÔÁÂÓÂÙÈΤ˜ ıˆڛ˜,Ù· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓ ˆÔıËÎÒÓ ·ÔÙÂÏÔ‡Ó ÂÎÙÚˆ-ÙÈο ¤Ì‚Ú˘· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ·˘ÙÔÁÔÓÈÌÔÔ›ËÛË ‰‡ÔÁ·ÌÂÙÒÓ (·ÚıÂÓÔÁ¤ÓÂÛË) ‹ ·fi ‚Ï·ÛÙÔÌÂÚ¤˜ Ô˘ ·Ô-Û¿Ù·È ·fi ¤Ó· ÁÔÓÈÌÔÔÈË̤ÓÔ ˆ¿ÚÈÔ, ‹ ÚÔ·ÙÔ˘Ó ·-fi ÓÂÔÏ·ÛÌ·ÙÈ΋ ÂÍ·ÏÏ·Á‹ ÔÏ˘‰‡Ó·ÌˆÓ ΢ÙÙ¿ÚˆÓ(8, 9,
18, 19). H ̆ „ËÏÔ‡ ‚·ıÌÔ‡ ÌÔÚÊԉȿϷÛË Î·È ÈÛÙԉȷÊÔÚÔ-Ô›ËÛË ÙˆÓ ¤ÎÙÔˆÓ ‰ÔÓÙÈÒÓ ÛÙ· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù·ÙˆÓ ˆÔıËÎÒÓ ˘Ô‰ËÏÒÓÂÈ ÙËÓ ‡·ÚÍË ÛÙ· ÙÂÚ·ÙÒÌ·Ù·Ì˯·ÓÈÛÌÒÓ ›‰ÈˆÓ Ì ·˘ÙÔ‡˜ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙÔ Ê˘-ÛÈÔÏÔÁÈÎfi ¤Ì‚Ú˘Ô. H Ê˘ÛÈÔÏÔÁÈ΋ Ô‰ÔÓÙÔÁ¤ÓÂÛË ÚÔ¸-Ôı¤ÙÂÈ ÙËÓ ·ÚÔ˘Û›· ÂÈıËÏ›Ô˘ Ù˘ ·Ú¯¤ÁÔÓ˘ ÛÙÔÌ·ÙÈ-΋˜ ÎÔÈÏfiÙËÙ·˜ (·fi ÙÔ ÚÒÙÔ ‚Ú·Á¯È·Îfi ÙfiÍÔ) Î·È Â͈-
ÌÂÛÂÁ¯‡Ì·ÙÔ˜(17). ¶ÂÈÚ·Ì·ÙÈο, Ô Û˘Ó‰˘·ÛÌfi˜ ÂÈıËÏ›Ô˘·fi ¿ÏϘ ı¤ÛÂȘ, ·ÎfiÌ· Î·È ·fi ÙÔ ‰Â‡ÙÂÚÔ ‚Ú·Á¯È·ÎfiÙfiÍÔ, Ì Â͈ÌÂÛ¤Á¯˘Ì· ‰ÂÓ Ô‰ËÁ› ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ‰Ô-ÓÙÈÒÓ(17). H Ô‰ÔÓÙÔÁ¤ÓÂÛË ÂϤÁ¯ÂÙ·È ·˘ÛÙËÚ¿, ÙÔÈο ηȯÚÔÓÈο, ΢ڛˆ˜ ̤ۈ Ù˘ ¤ÎÊÚ·Û˘ ÌÂÙ·ÁÚ·ÊÈÎÒÓ Î·È·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙȘ ı¤ÛÂȘ ·Ó¿Ù˘Í˘ ÙˆÓ Ô‰Ô-ÓÙÔ‚Ï·ÛÙËÌ¿ÙˆÓ, fiˆ˜ ÙˆÓ ÌÔÚÊÔÁÂÓÂÙÈÎÒÓ ÚˆÙÂ˚-ÓÒÓ ÙÔ˘ ÔÛÙÔ‡ (Bone Morphogenetic Proteins BMP) BMP-2 Î·È BMP-4(17). EÈϤÔÓ Ì˯·ÓÈÛÌfi˜ ÂϤÁ¯Ô˘ Â›Ó·È Ë ¤Î-ÊÚ·ÛË ÛÙÔ ÂÈı‹ÏÈÔ ÙÔ˘ ÈÓÔ‚Ï·ÛÙÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ ·Ú¿-ÁÔÓÙ· 8 (Fibroblast Growth Factor - fgf8), Ô ÔÔ›Ô˜ οÓÂÈÙÔ Â͈ÌÂÛ¤Á¯˘Ì· ÈηÓfi Ó· ·ÓÙȉڿÛÂÈ ÛÙ· Ô‰ÔÓÙÔÁÂÓ‹ÂÚÂı›ÛÌ·Ù· ÙÔ˘ ÂÈıËÏ›Ô˘(17). H ·ÎÚÈ‚‹˜ ·Ó··Ú·ÁˆÁ‹ Ù˘ Ô‰ÔÓÙÈ΋˜ ÔÚÁ·ÓÔÁ¤ÓÂÛ˘ÛÙ· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· Â›Ó·È ÂÚÈÛÛfiÙÂÚË Û˘Ì‚·Ù‹ ̉˘ÛÏ·ÛÙÈ΋ Î·È fi¯È ÓÂÔÏ·ÛÌ·ÙÈ΋ ·Ú¯‹. ™ËÌÂÈÒÓÂٷȈ˜ ÔÈ ÌfiÓÔÈ Ô‰ÔÓÙÔÁÂÓ›˜ fiÁÎÔÈ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Û¯ËÌ·-Ù›˙ÔÓÙ·È ‰fiÓÙÈ· fiˆ˜ ÛÙ· ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓ ˆÔ-ıËÎÒÓ, Â›Ó·È Ù· Ô‰ÔÓÙÒÌ·Ù· Ù· ÔÔ›· ıˆÚÔ‡ÓÙ·È ·Ó·-Ù˘ÍȷΤ˜ ‚Ï¿‚˜, ‰ËÏ·‰‹ ÙÂÚ·ÙÒÌ·Ù·. H ·ÚÔ˘Û›· ÛÂ΢ÛÙÈο ÙÂÚ·ÙÒÌ·Ù· ÙˆÓ ˆÔıËÎÒÓ ‰ÔÌÒÓ Ì ÌÔÚÊÔÏÔ-Á›· Ô‰ÔÓÙˆÌ¿ÙˆÓ ÙˆÓ ÁÓ¿ıˆÓ, ·Ó¿ÏÔÁˆÓ ·˘ÙÒÓ Ô˘‰È·ÈÛÙÒıËÎ·Ó Û ‰‡Ô ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·ÚÔ˘-ÛÈ¿˙ÔÓÙ·È, ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤ-Ù˜.
SUMMARY
“Radiographic and histologic study of ectopicteeth from 13 benign ovarian cystic teratomas”
K.I. Tosios, E. Papadakis, K. Vlastos, I. Tossios
hellenic stomatological review 48: 27-32, 2004
Teratomas are tumors composed of tissues originatingfrom at least two embryonal layers. They are common in thegonads, in particular the ovaries, where they comprise 25%of the tumors and 30% of the benign tumors. Ovarianteratomas are usually asymptomatic cystic tumorscomposed of mature tissues and are commonly referred asbenign cystic teratomas or dermoid cyst. Many benigncystic teratomas (7.7% to 31%) present well formed teethor teeth-like structures composed of mature dental tissues,which are floating in the cystic cavity or are embedded inthe cystic wall, rarely in association with jaw-like bonestructures. The purpose of this study was to describe the radiographicand histologic features of ectopic teeth from 13 benignovarian cystic teratomas and to analyze the findings inrelation to normal odontogenesis and histogenesis of theovarian teratoma.The material of the study consisted of 13 ovarian cysticteratomas with macroscopically identifiable teeth-likestructures, from 13 women aged 21 to 37 years (averageage 29.15 years). Each case was radiographed and thefollowing parameters were evaluated independently fromtwo of the authors: teeth number, teeth form, presence ofbone and lamina dura, and presence of tooth germs. Sixteeth from five cysts were decalcified for microscopic study.
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Two to 16 teeth or teeth-like dental structures wererecognized in 11 of 13 tumors. From a total of 60 teeth, fivewere identified as incisors, seven as canines, 12 aspremolars and as 10 molars. Fifteen teeth had an atypicalmorphology. Thirteen tooth germs and, in two tumors,structures with an odontoma-like morphology were alsoseen. In ten teeth, a well-defined lamina dura was evidentaround the teeths toots. Unusual histologic findings included focal internal orexternal resorption with the formation of well-definedresorptive lacunae, osteodentin (cellular or tertiary dentin),focal pulpal calcifications consistent with pulp stones andperiodontal space composed of mature bone andconnective tissue fibers.The findings of the present study are compared with thoseof previous report and it is concluded that recapitulation ofnormal odontogenesis in benign ovarian cystic teratomas isconsistent with the clonal model of tooth morphogenesisand a dysplastic vice a neoplastic origin for thoseteratomas.
Key words: teratoma, cystic; teratoma, mature; odontogenesis;tooth eruption, ectopic; dentin; dental pulp calcifica-tion; tooth resorption
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¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:KˆÓ/ÓÔ˜ TfiÛÈÔ˜EÚÁ·ÛÙ‹ÚÈÔ ™ÙÔÌ·ÙÔÏÔÁ›·˜O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹£Ë‚ÒÓ 2, 115 27 Aı‹Ó·TËÏ.: 210 7461257e-mail: [email protected]
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EȉËÌÈÔÏÔÁÈΤ˜ MÂϤÙ˜
K·Ù·Ó¿ÏˆÛË ÎÔÏ·ÙÛÈÔ‡ ÛÙ· ÓËÈ·ÁˆÁ›· Ù˘ ÂÚÈÔ¯‹˜ÙÔ˘ K.Y. AÁ. Aı·Ó·Û›Ô˘ KÂÚ·ڷ˜
º. NÙ¿Ûη˜*
H ·ÚÔ‡Û· ÂÚÁ·Û›· ÂȯÂÈÚ› Ó· ηٷÁÚ¿„ÂÈ ÙÔ Â›‰Ô˜ ÙÔ˘ ÎÔÏ·ÙÛÈÔ‡ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó Ù· ·È-‰È¿ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ B.¢. K¤Ú΢ڷ˜. H ÂÚÁ·Û›· ÚÔ¤Ú¯ÂÙ·È ·fi ÛÙÔȯ›· Ô˘ ¤¯Ô˘Ó Û˘Ï-ϯı› ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Ô‰ÔÓÙÔÛÙÔÌ·ÙÔÏÔÁÈ΋˜ ÂͤٷÛ˘ ÙˆÓ ·È‰ÈÒÓ ÛÙ· ÓËÈ·ÁˆÁ›·Ù˘ ÂÚÈÔ¯‹˜ (1999-2000).¶‹Ú·Ó ̤ÚÔ˜ 232 Ì·ıËÙ¤˜ ·fi 13 ÓËÈ·ÁˆÁ›· Î·È ÙËÓ Î·Ù·ÁÚ·Ê‹ ¤Î·Ó·Ó ÔÈ ÓËÈ·ÁˆÁÔ› ÁÈ· ¤-Ó· Û˘Ó¯¤˜ ÂÓı‹ÌÂÚÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‰˘Ô ‰È·ÊÔÚÂÙÈÎÒÓ ÂÔ¯ÒÓ ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜.T· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘ ÓËÈ·ÁˆÁÂ›Ô ÙˆÓ ¢Ô˘Î¿‰ˆÓ ÂÓ·ÚÌÔÓ›˙ÔÓÙ·Ó ÂÚÈÛ-ÛfiÙÂÚÔ Ì ÙËÓ ˘Ô˘ÚÁÈ΋ ·fiÊ·ÛË ÂÓÒ Ù· ·È‰È¿ ÙÔ˘ ÓËÈ·ÁˆÁ›Ԣ ÙˆÓ N˘ÌÊÒÓ ÏÈÁfiÙÂÚÔ ÌÂÙ¿ÛË Î·Ù·Ó¿ÏˆÛ˘ ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡ 67,5% Î·È 5,5% ·ÓÙ›ÛÙÔȯ·. Afi ÙȘ ÌÂÚ›‰Â˜ ÙÔ˘ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ›¯·Ó ÙÔ Û¿ÓÙÔ˘ÈÙ˜ Ì „ˆÌ› Î·È Ù˘Ú› Î·È Ù· ÊÚÔ‡Ù·.Afi ÙȘ ÌÂÚ›‰Â˜ ÙÔ˘ ÌË ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ›¯·Ó ÙÔ ÎÚÔ˘·Û¿Ó Î·È Ô ¯˘-Ìfi˜ Ì ˙¿¯·ÚË. TÔ Ï¤ÔÓ ‰ËÌÔÊÈϤ˜ ÎÔÏ·ÙÛÈfi ‹Ù·Ó ÙÔ ÎÚÔ˘·Û¿Ó (19,69%) Î·È ÙÔ Û¿ÓÙÔ˘ÈÙ˜ Ì„ˆÌ› Î·È Ù˘Ú› (14,67%). TË ÌÈÎÚfiÙÂÚË ·Ó·ÏÔÁ›· ›¯·Ó ÙÔ ¿ÛÚÔ Á¿Ï· Î·È Ù· ·ÏÌ˘Ú¿ ÎÚ¿ÎÂÚ˜(0,62%).E›Ó·È Ê·ÓÂÚ‹ Ë ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÓfiÌÔ˘. A˘Ù‹ ÔÊ›ÏÂÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfiÛÙËÓ ÓÔÔÙÚÔ›· ÙˆÓ ›‰ÈˆÓ ÙˆÓ ÁÔÓÈÒÓ. AÓ¿ÁÎË Â›Ó·È ÏÔÈfiÓ Ó· ÂÓÙ·ı› Ë ÏËÚÔÊfiÚËÛË ÙÔ˘˜ Ò-ÛÙ ӷ ·ÏÏ¿ÍÂÈ Ë ÛÙ¿ÛË ÙÔ˘˜.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 33-38, 2004
§¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰ÈÎfi ÎÔÏ·ÙÛÈfi, ·È‰È¿, ÓËÈ·ÁˆÁ›·.
* EÈÌÂÏËÙ‹˜ A’ O‰ÔÓÙ›·ÙÚÔ˜ K.Y. AÁ. Aı·Ó·Û›Ô˘ KÂÚ·ڷ˜.
H ÂÚÁ·Û›· ·Ó·ÎÔÈÓÒıËΠÛÙÔ 1Ô ¶·ÌÂÏÔÔÓÓËÛÈ·Îfi O‰ÔÓÙÈ·-ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÙÔ 2000 Î·È Â›Ó·È ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË.
EI™A°ø°H
H ÙÂÚˉfiÓ· Â›Ó·È Ë Ï¤ÔÓ ‰È·‰Â‰Ô̤ÓË ÛÙÔÌ·ÙÈ΋ ÓfiÛÔ˜Ù˘ ÂÔ¯‹˜ Ì·˜ Î·È Ï‹ÙÙÂÈ È‰È·›ÙÂÚ· ÙËÓ ·È‰È΋ ËÏÈΛ·. HÂÌÊ¿ÓÈÛ‹ Ù˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÏÏËÏ›‰Ú·Û˘ ÔÏÏÒÓ·Ú·ÁfiÓÙˆÓ. ŒÓ·˜ ·fi ·˘ÙÔ‡˜ Â›Ó·È Î·È ÙÔ Â›‰Ô˜ ‰È·ÙÚÔ-Ê‹˜ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ·ÓıÚÒÔ˘. TÔ Â›‰Ô˜ Ù˘ ‰È·ÙÚÔÊ‹˜ÂÎÙfi˜ ·fi ÙË Â›‰Ú·ÛË Ô˘ ·ÛΛ ÛÙË ÁÂÓÈ΋ ̆ Á›· ÙÔ˘ ·-ÙfiÌÔ˘ Û¯ÂÙ›˙ÂÙ·È ÛÙÂÓ¿ Ì ÙËÓ ÛÙÔÌ·ÙÈ΋ ˘Á›·.Œ¯ÂÈ Á›ÓÂÈ Ê·ÓÂÚfi fiÙÈ Ë ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ˙·¯·-
ÚÔ‡¯ˆÓ ÚÔ˚fiÓÙˆÓ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ Î·È ·Ó·Ù˘ÛÛfi-ÌÂÓ˜ ¯ÒÚ˜ ›¯Â ˆ˜ Ê˘ÛÈÎfi ·ÎfiÏÔ˘ıÔ ÙËÓ ·‡ÍËÛËÙ˘ ÙÂÚˉÔÓÈ΋˜ ÚÔÛ‚ÔÏ‹˜(1, 2, 3).TÔ 1989 ¤ÂÈÙ· ·fi ÔÏϤ˜ ηٷÁÁÂϛ˜ ÁÔÓ¤ˆÓ Î·È ¿Ï-ÏˆÓ ÊÔÚ¤ˆÓ fiÙÈ ÛÙȘ Û¯ÔÏÈΤ˜ ηÓÙ›Ó˜ ΢ÎÏÔÊÔÚÔ‡Ó ·Ì-Ê›‚ÔÏ˘ ÔÈfiÙËÙ·˜ ÚÔ˚fiÓÙ·, Èηӿ ·ÎfiÌË Î·È Ó· ‚Ï¿-„Ô˘Ó ÙËÓ ˘Á›· ÙˆÓ Ì·ıËÙÒÓ, ıÂÛ›ÛÙËÎÂ Ô ÓfiÌÔ˜ Ô˘‰È¤ÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Î˘ÏÈΛˆÓ, ηıÒ˜ ›Û˘ ηıÔ-Ú›ÛıËÎ·Ó Î·È Ù· ÚÔ˚fiÓÙ· Ô˘ ÂÈÙÚ¤ÂÙ·È Ó· ‰È·Ù›ıÂÓÙ·ÈÚÔ˜ ÒÏËÛË ·fi Ù· ΢ÏÈΛ· ÛÙ· ·È‰È¿ Ì ÛÙfi¯Ô ÙËÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ ÙÔ˘ Ì·ıËÙ‹. O ÓfiÌÔ˜ fï˜ ‹ ηٷ-ÛÙÚ·ÙËÁÂ›Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ‹ ·Ú·Î¿ÌÙÂÙ·È ·fi ÙËÓÏÂÈÙÔ˘ÚÁ›· ηÓÙÈÓÒÓ Î·È ¿ÏÏˆÓ Î·Ù·ÛÙËÌ¿ÙˆÓ ÂÎÙfi˜Û¯ÔÏ›Ԣ. ¢˘ÛÙ˘¯Ò˜ Û˘Ó‹ÁÔÚÔÈ ·˘Ù‹˜ Ù˘ Ú·ÎÙÈ΋˜ Á›-ÓÔÓÙ·È ÔÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÏfiÁˆ Ù˘ ¿ÁÓÔÈ·˜ ÙÔ˘˜·Ê‹ÓÔ˘Ó Ó· ‰È·ÈˆÓ›˙ÂÙ·È ·˘Ù‹ Ë ··Ú¿‰ÂÎÙË Î·Ù¿ÛÙ·ÛË.Y‡ı˘ÓÔÈ ÁÈ· ÙËÓ ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓÈÒÓ Î·È ÙˆÓ·È‰ÈÒÓ ÙÔ˘˜ Â›Ó·È ÔÈ ‰¿ÛηÏÔÈ Î·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÔÈÏÂÈÙÔ˘ÚÁÔ› Ù˘ ‰ËÌfiÛÈ·˜ ̆ Á›·˜ Ì ÎÂÓÙÚÈÎfi ¿ÍÔÓ· ÙÔ˘˜Ô‰ÔÓÙ›·ÙÚÔ˘˜ ÙˆÓ K¤ÓÙÚˆÓ YÁ›·˜.
33
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EȉËÌÈÔÏÔÁÈΤ˜ MÂϤÙ˜
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 33-38, 2004
¶ÈÓ. 2: O ηٿÏÔÁÔ˜ Ì ٷ ›‰Ë ÎÔÏ·ÙÛÈÔ‡ Ô˘ Û˘ÌÏËÚÒıËΠ·fi ÙÔ˘˜ ÓËÈ·ÁˆÁÔ‡˜ ÁÈ· οı ¤Ó· ·È‰› Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó.
Y¶OYP°EIO Y°EIA™, ¶PONOIA™ NH¶IA°ø°EIO:& KOINøNIKøN A™ºA§I™EøN ONOMATE¶øNYMO MA£HTH:¶.°.N. KEPKYPA™ KENTPO Y°EIA™ A° A£ANA™IOY
A' ¢EI°MATO§HæIA B' ¢EI°MATO§HæIAKO§AT™IO 1Ë MEPA 2Ë MEPA 3Ë MEPA 4Ë MEPA 5Ë MEPA 1Ë MEPA 2Ë MEPA 3Ë MEPA 4Ë MEPA 5Ë MEPAA§MYPA KPAKEP°A§A A™¶PO°A§A ™OKO§ATOYXO°API¢AKIA°IAOYPTIKAPAME§E™KEIKKPOYA™AN§OYKOYMA¢E™MH§AM¶ANANE™M¶I™KOTA ME KPEMA¶A°øTA¶ATATAKIA™ANTOYIT™ ME æøMI KAI TYPI™OKO§ATE™™TAºI¢E™TO™TT™OYPEKITYPO¶ITAXYMO™ ME ZAXAPHXYMO™ XøPI™ ZAXAPHæøMI ME ME§IæøMI ™KETOKATI ¢IAºOPETIKO
H ·ÚÔ‡Û· ÂÚÁ·Û›· ÂȯÂÈÚ› Ó· ηٷÁÚ¿„ÂÈ ÙȘ ‰È·ÙÚÔ-ÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÙÔ Â›‰Ô˜ ÙÔ˘ ÎÔ-Ï·ÙÛÈÔ‡ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó Ù· ·È‰È¿ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓÙ˘ B.¢. K¤Ú΢ڷ˜. E›Û˘ ÂȯÂÈÚ› Ó· ÂÎÙÈÌ‹ÛÂÈ ÙÔ Î·-Ù¿ fiÛÔ ÔÈ ·ÓˆÙ¤Úˆ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÂÓ·ÚÌÔÓ›-˙ÔÓÙ·Ó Ì ÙÔÓ ÓfiÌÔ ÂÚ› Û¯ÔÏÈÎÒÓ Î˘ÏÈΛˆÓ.
Y§IKA - ME£O¢O™
H ÂÚÁ·Û›· ÚÔ¤Ú¯ÂÙ·È ·fi ÛÙÔȯ›· Ô˘ ¤¯Ô˘Ó Û˘ÏÏÂ-¯ı› ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Ô‰ÔÓÙÔÛÙÔÌ·ÙÔÏÔÁÈ΋˜ Âͤ-Ù·Û˘ ÙˆÓ ÓË›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ù˘ B.¢. K¤Ú΢ڷ˜.H ÂÚÈÔ¯‹ ·˘Ù‹, ÂÚÈÔ¯‹ ¢ı‡Ó˘ ÙÔ˘ K.Y. AÁÚÔ‡- AÁ.Aı·Ó·Û›Ô˘ ¤¯ÂÈ ÏËı˘ÛÌfi 20.000 ηÙÔ›ÎÔ˘˜. H ÂͤٷÛË·˘Ù‹ ¤ÁÈÓ ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 99-00 Î·È ‹Ú·Ó ̤ÚÔ˜ 232Ì·ıËÙ¤˜ 13 NËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ (¢Ô˘Î¿‰Â˜, K·-ÛÙÂÏÏ¿ÓÔÈ M¤Û˘, ¶ÂÚÔ˘Ï¿‰Â˜, K˘ÓÔÈ¿ÛÙ˜, §È·¿-‰Â˜, §¿ÎˆÓ˜, K·‚·‰¿‰Â˜, M·ÁÔ˘Ï¿‰Â˜, N‡Ìʘ BÂÏÔ-Ó¿‰Â˜, AÁÚfi˜, A˘ÏÈÒÙ˜, K·ÚÔ˘Û¿‰Â˜) Î·È ËÏÈΛ·˜ 4 ¤ˆ˜6 ÂÙÒÓ.¶ÚÈÓ ÙËÓ ÂͤٷÛË ‰È·ÓÂÌ‹ıËΠÛÙÔ˘˜ ÓËÈ·ÁˆÁÔ‡˜ η-Ù¿ÛÙ·ÛË Ì ٷ ›‰Ë ÎÔÏ·ÙÛÈÔ‡ Ô˘ Û˘Ó‹ıˆ˜ ÚÔÙÈÌÔ‡ÓÙ· ·È‰È¿, (¶ÈÓ. 2). ™ÙÔÓ Î·Ù¿ÏÔÁÔ ·˘Ùfi ÔÈ ÓËÈ·ÁˆÁÔ› ÛÂηıËÌÂÚÈÓ‹ ‚¿ÛË Â› ÂÓı‹ÌÂÚÔ, ηٿ ÙËÓ ̄ ÂÈÌÂÚÈÓ‹ Â-Ú›Ô‰Ô, ÛËÌ›ˆÓ·Ó ÙÔ ÎÔÏ·ÙÛÈfi Ô˘ οı ¤Ó· ·È‰› ͯˆ-ÚÈÛÙ¿ ¤ÊÂÚÓ ÛÙÔ Û¯ÔÏÂ›Ô (·' ‰ÂÈÁÌ·ÙÔÏË„›·). ™Â ÌÈ·‰Â‡ÙÂÚË Ê¿ÛË ·ÎÔÏÔ‡ıËÛÂ Ë ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ, ÂÓË-̤ڈۋ ÙÔ˘˜ Û ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ Î·È ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈ-ÂÈÓ‹˜ ηıÒ˜ ›Û˘ Î·È Û˘˙‹ÙËÛË Ì ÙÔ˘˜ ÓËÈ·ÁˆÁÔ‡˜Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ.K·Ù¿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ¿ÓÔÈ͢ ·ÎÔÏÔ˘ıÔ‡Û ÌÈ· Ó¤· η-
Ù·ÁÚ·Ê‹ ÙÔ˘ ÎÔÏ·ÙÛÈÔ‡ ÙˆÓ ·È‰ÈÒÓ, › ÂÓı‹ÌÂÚÔ Î·ÈÛ ηıËÌÂÚÈÓ‹ ‚¿ÛË ¿ÏÈ (‚' ‰ÂÈÁÌ·ÙÔÏË„›·).H ηٷÁÚ·Ê‹ ÙˆÓ ÂȉÒÓ Î·È ÙˆÓ ÔÛÔÙ‹ÙˆÓ ÙÔ˘ ηٷӷ-ÏÈÛÎfiÌÂÓÔ˘ ÎÔÏ·ÙÛÈÔ‡ ¤ÁÈÓ ·fi ÙÔ˘˜ ÓËÈ·ÁˆÁÔ‡˜ ηÈfi¯È ·fi ÙÔ˘˜ ÁÔÓ›˜ ·ÔʇÁÔÓÙ·˜ Ì ·˘Ùfi ÙÔÓ ÙÚfiÔÏ·Óı·Ṳ̂Ó˜ ÂÎÙÈÌ‹ÛÂȘ. EÈϤÔÓ Ô ̄ ÚfiÓÔ˜ ηٿ ÙÔÓ Ô-Ô›Ô ¤ÁÈÓÂ Ë ·ÚÔ‡Û· ¤Ú¢ӷ ‰ÂÓ ¤ÁÈÓ ÁÓˆÛÙfi˜ ÛÙÔ˘˜ÁÔÓ›˜ Î·È ÛÙ· ·È‰È¿ ÁÈ· Ó· ·ÔÊ¢¯ıÔ‡Ó Ï·ÛÌ·ÙÈΤ˜Î·Ù·Áڷʤ˜. H ¤Ú¢ӷ ¤ÁÈÓ Û ‰‡Ô ‰È·ÊÔÚÂÙÈΤ˜ ÂÔ-¯ÈΤ˜ ÂÚÈfi‰Ô˘˜ ÁÈ·Ù› ¤Ú ӷ ·ÔÙ˘ˆıÔ‡Ó ÔÈ ‰È·-ÊÔÚÂÙÈΤ˜ ÚÔÙÈÌ‹ÛÂȘ ÛÙÔ Â›‰Ô˜ Î·È ÙË ÔÛfiÙËÙ· ÙÔ˘·È‰ÈÎÔ‡ ÎÔÏ·ÙÛÈÔ‡ ·Ó¿ÏÔÁ· Ì ÙȘ ηÈÚÈΤ˜ Û˘Óı‹Î˜.T· ·ÔÙÂϤÛÌ·Ù· ÂÂÍÂÚÁ¿ÛıËÎ·Ó ÛÙ·ÙÈÛÙÈο Ì Ù˯ڋÛË ÙÔ˘ ÎÚÈÙËÚ›Ô˘ Students t-test Î·È ÁÈ· Â›Â‰Ô ÛË-Ì·ÓÙÈÎfiÙËÙ·˜ Ú<0,05.
A¶OTE§E™MATA
MÂÙ¿ ÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙȘ ‰ÂÈÁÌ·ÙÔ-ÏË„›Â˜ Ô˘ ¤ÁÈÓ·Ó, ·ÎÔÏÔ‡ıËÛÂ Ë Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ηٷ-Ó·ÏÈÛÎfiÌÂÓÔ˘ ÎÔÏ·ÙÛÈÔ‡. H ηٷÁÚ·Ê‹ ¤ÁÈÓ Û ۯ¤ÛËÌ ÙÔ Î·Ù¿ fiÛÔ ÙÔ Â›‰Ô˜ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÎÔÏ·ÙÛÈԇηٷÁÚ¿ÊÂÙ·È ‹ fi¯È ÛÙË Ï›ÛÙ· Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÔÈ Ô‰ËÁ›Â˜Ù˘ ˘Ô˘ÚÁÈ΋˜ ·fiÊ·Û˘ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Û¯ÔÏÈ-ÎÒÓ Î˘ÏÈΛˆÓ (¶›Ó·Î·˜ 1). ™‡Ìʈӷ Ì ÙËÓ ·ÓˆÙ¤Úˆ η-Ù·ÁÚ·Ê‹ Î·È Û ÂηÙÔÛÙÈ·›· ‚¿ÛË ÙÔ ÓËÈ·ÁˆÁÂ›Ô ÙˆÓ¢Ô˘Î¿‰ˆÓ ¤Ù˘¯Â ÙË Î·ÏÏ›ÙÂÚË Â›‰ÔÛË (67,6%) ÂÓÒ Ù··È‰È¿ ÙÔ˘ ÓËÈ·ÁˆÁ›Ԣ ÙˆÓ N˘ÌÊÒÓ ÙË ¯ÂÈÚfiÙÂÚË(5,5%). T· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ˘fiÏÔÈˆÓ ÓËÈ·ÁˆÁ›ˆÓ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ ›Ó·Î· 3. ™ÙÔÓ ›‰ÈÔ ›Ó·Î· ÂÎÙfi˜ Ù˘ Û˘-ÓÔÏÈ΋˜ ÂÎÙ›ÌËÛ˘ ̆ ¿Ú¯Ô˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·ÊÔ-
ÚÔ‡Ó ÛÙËÓ ·' Î·È ‚' ‰ÂÈÁÌ·ÙÔÏË„›·. H ÛÙ·ÙÈÛÙÈ΋ ‰ÈÂÚ‡-ÓËÛË ÙˆÓ ‰È·ÊÔÚÒÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô ‰ÂÈÁÌ·ÙÔÏË„ÈÒÓ ‰ÂÓ¤‰ÂÈÍ ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· (¶›Ó·Î·˜ 3).
OÈ ÌÂÚ›‰Â˜ ÙÔ˘ ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡, Û‡Ìʈӷ ÌÂÙËÓ ˘Ô˘ÚÁÈ΋ ·fiÊ·ÛË, Ô˘ ηٷÁÚ¿ÊËÎ·Ó Î·È ÛÙȘ‰‡Ô ‰ÂÈÁÌ·ÙÔÏË„›Â˜ ‹Ù·Ó Û˘ÓÔÏÈο 430 (44,1% ÙÔ˘ Û˘-ÓfiÏÔ˘). T· ϤÔÓ ÚÔÙÈÌÔ‡ÌÂÓ· ›‰Ë ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔ-Ï·ÙÛÈÔ‡ ‹Ù·Ó ÙÔ Û¿ÓÙÔ˘ÈÙ˜ Ì „ˆÌ› Î·È Ù˘Ú› (143 ÌÂÚ›-‰Â˜), Ù· ÊÚÔ‡Ù· (72 ÌÂÚ›‰Â˜), ÙÔ ÁÈ·Ô‡ÚÙÈ (54 ÌÂÚ›‰Â˜)Î·È ÙÔ ÙÔÛÙ (51 ÌÂÚ›‰Â˜). T· ÏÈÁfiÙÂÚ· ÚÔÙÈÌÔ‡ÌÂÓ· ‹-Ù·Ó ÙÔ ÛÙ·Êȉfi„ˆÌÔ (2 ÌÂÚ›‰Â˜), Ù· ÎÔ˘ÏÔ‡ÚÈ· (3 ÌÂÚ›-‰Â˜), ÙÔ ¿ÛÚÔ Á¿Ï· (6 ÌÂÚ›‰Â˜) Î·È ÙÔ ÛΤÙÔ „ˆÌ› (11ÌÂÚ›‰Â˜). EӉȿÌÂÛ· ¤¯Ô˘Ì ÙÔÓ ̄ ˘Ìfi ̄ ˆÚ›˜ ̇ ¿¯·ÚË (49ÌÂÚ›‰Â˜) Î·È Ë Ù˘ÚfiÈÙ· (39 ÌÂÚ›‰Â˜). (¶›Ó·Î·˜ 4).
OÈ ÌÂÚ›‰Â˜ ÙÔ˘ ÌË ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡, ‹Ù·Ó Û˘ÓÔ-ÏÈο 545 (55,9% ÙÔ˘ Û˘ÓfiÏÔ˘). T· ϤÔÓ ÚÔÙÈÌÔ‡ÌÂӷ›‰Ë ÌË ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡ ‹Ù·Ó ÙÔ ÎÚÔ˘·Û¿Ó(192 ÌÂÚ›‰Â˜), Ô ̄ ˘Ìfi˜ Ì ̇ ¿¯·ÚË (83 ÌÂÚ›‰Â˜), Ù· ·Ù·-Ù¿ÎÈ· (61 ÌÂÚ›‰Â˜) Î·È ÔÈ ÛÔÎÔÏ¿Ù˜ (42 ÌÂÚ›‰Â˜). T· ÏÈ-ÁfiÙÂÚÔ ÚÔÙÈÌÔ‡ÌÂÓ· ‹Ù·Ó Ù· ·ÏÌ˘Ú¿ ÎÚ¿ÎÂÚ (6 ÌÂÚ›-‰Â˜), ÔÈ ÏÔ˘ÎÔ˘Ì¿‰Â˜ (10 ÌÂÚ›‰Â˜), Ù· Á·Úȉ¿ÎÈ· (15 ÌÂ-Ú›‰Â˜) Î·È ÙÔ Î¤ÈÎ (22 ÌÂÚ›‰Â˜). EӉȿÌÂÛ· ¤¯Ô˘Ì ÙÔÙÛÔ˘Ú¤ÎÈ (38 ÌÂÚ›‰Â˜), Ù· ÌÈÛÎfiÙ· Îڤ̷˜ (39 ÌÂÚ›‰Â˜)Î·È ÙÔ „ˆÌ› Ì ̤ÏÈ (37 ÌÂÚ›‰Â˜). T· ·ÔÙÂϤÛÌ·Ù· Ê·›-ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5. ¶Ú¤ÂÈ Ó· ÏËÊı› ˘fi„ÈÓ fiÙÈ Î¿-ÔȘ ̤Ú˜ ÔÈ Î·Ù·Ó·ÏÈÛÎfiÌÂÓ˜ ÌÂÚ›‰Â˜ ‹Ù·Ó ÏÈÁfiÙÂ-Ú˜ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÏfiÁˆ ÙˆÓ ·Ô˘ÛÈÒÓ ÙˆÓ·È‰ÈÒÓ. OÈ ‰È·ÊÔÚ¤˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙȘ ‰‡Ô‰ÂÈÁÌ·ÙÔÏË„›Â˜ Û¯ÂÙÈο Ì ÙÔ ÂӉ‰ÂÈÁ̤ÓÔ ÎÔÏ·ÙÛÈfi ‹-Ù·Ó ÛÙ·ÙÈÛÙÈο ·Û·Ê›˜ (Ú>0,05), ÂÓÒ ·ÓÙ›ıÂÙ· Û¯ÂÙÈοÌ ÙÔ ÌË ÂӉ‰ÂÈÁ̤ÓÔ ÎÔÏ·ÙÛÈfi ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ϤÔÓÛËÌ·ÓÙÈΤ˜ (0,01>Ú>0,001).
35
EȉËÌÈÔÏÔÁÈΤ˜ MÂϤÙ˜
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 33-38, 2004
¶ÈÓ. 1: AfiÛ·ÛÌ· ·fi ÙËÓ ˘Ô˘ÚÁÈ΋ ·fiÊ·ÛË Ô˘ ‰È¤ÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Û¯ÔÏÈÎÒÓ Î˘ÏÈΛˆÓ.
M ÙȘ Ôԛ˜ ηıÔÚ›˙ÔÓÙ·È ÚËÙ¿ Ù· ·Ú·Î¿Ùˆ ›‰Ë, Ù· ÔÔ›· ÂÈÙÚ¤ÂÙ·È Ó· ˆÏÔ‡ÓÙ·È ·fi Ù· Û¯ÔÏÈο ΢ÏÈΛ·:1. ™¿ÓÙÔ˘ÈÙ˜ Î·È ÙÔÛÙ
·. ™¿ÓÙÔ˘ÈÙ˜ ÌÂ Ù˘Ú›‚. TÔÛÙ ÌÂ Ù˘Ú›. ¶ÚÔ·ÈÚÂÙÈ΋ Ë ÚÔÛı‹ÎË Ì·ÚÁ·Ú›Ó˘ Î·È ÂԯȷÎÒÓ Ï·¯·ÓÈÎÒÓ (.¯. ÓÙÔÌ¿Ù·, Ì·ÚÔ‡ÏÈ).
2. æˆÌ›.3. T˘ÚÈ¿.4. æˆÌ› ÔÏ˘ÙÂÏ›·˜ ÛÂ Û˘Û΢·Û›·.5. KÔ˘ÏÔ‡ÚÈ.6. ™Ù·Êȉfi„ˆÌÔ Û ·ÙÔÌÈ΋ Û˘Û΢·Û›·.7. ºÚ˘Á·ÓȤ˜ Û ·ÙÔÌÈΤ˜ Û˘Û΢·Û›Â˜.8. °¿Ï· Û ·ÙÔÌÈ΋ Û˘Û΢·Û›·.9. °È·Ô‡ÚÙÈ (¯ˆÚ›˜ ˙¿¯·ÚË ‹ ¿ÏϘ ÚÔÛÌ›ÍÂȘ).
10. ºÚÔ‡Ù· ÂÔ¯‹˜, Ï˘Ì¤Ó· Î·È Ù˘ÏÈÁ̤ӷ Û ÛÂÏÔÊ¿Ó.11. º˘ÛÈÎÔ› ¯˘ÌÔ› ÊÚÔ‡ÙˆÓ (¯ˆÚ›˜ ˙¿¯·ÚË).12. •ËÚÔ› ηÚÔ› (Û ·ÙÔÌÈ΋ Û˘Û΢·Û›·).13. T˘ÚfiÈÙ·-™·Ó·ÎfiÈÙ· Ôχ ηϋ˜ ÔÈfiÙËÙ·˜.14. TÛ¿È Î·È ÏÔÈ¿ ·Ê„‹Ì·Ù·.15. K·Ê¤˜ (ÌfiÓÔ ÁÈ· ÙÔ ÚÔÛˆÈÎfi).T· ÚÔ·Ó·ÊÂÚfiÌÂÓ· ÚÔ˚fiÓÙ· ıˆÚÔ‡ÓÙ·È Ù· ÈÔ ÂӉ‰ÂÈÁ̤ӷ ÁÈ· ÙË ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ ÙˆÓ Ì·ıËÙÒÓ. H ‡-·ÚÍË ¿ÏÏˆÓ ÚÔ˚fiÓÙˆÓ Ì¤Û· ÛÙÔ Î˘ÏÈÎÂ›Ô ·ÔÙÂÏ› Ô˘ÛÈ·ÛÙÈ΋ ·Ú¿‚·ÛË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÙÔ˘ ΢ÏÈΛԢ Î·È ÏfiÁÔ ÁȷηٷÁÁÂÏ›· Ù˘ Û¯ÂÙÈ΋˜ ۇ̂·Û˘
N. 2327/95 ¿ÚıÚ. 10 ·Ú. 8 (Ê. 156A' /31.7.95)
¶›Ó·Î·˜ 3.: AÔÙÂϤÛÌ·Ù· 1˘ Î·È 2 ˘ ‰ÂÈÁÌ·ÙÔÏË„›·˜ ηıҘ›Û˘ Î·È Ù˘ Û˘ÓÔÏÈ΋˜ ÂÎÙ›ÌËÛ˘ Ù˘ Ù¿Û˘ ηٷӿψÛ˘ÂӉ‰ÂÈÁ̤ÓÔ˘ ÎÔÏ·ÙÛÈÔ‡ ™Â ÂηÙÔÛÙÈ·›· ‚¿ÛË.
¢EI°MATO§HæIA* NH¶IA°ø°EIA ™YNO§O (%)
A' (%) B' (%)¢OYKA¢E™ 63,07 71,90 67,49KA™TE§§ANOI 61,88 59,38 60,63¶EPOY§A¢E™ 53,00 55,00 54,00KYNO¶IA™TE™ 53,50 51,50 52,50§IA¶A¢E™ 50,00 50,00 50,00§AKøNE™ 38,80 44,17 41,48MA°OY§A¢E™ 37,50 43,75 40,63KABA¢A¢E™ 35,83 42,92 39,38A°PO™ 29,39 36,00 32,69AY§IøTE™ 29,57 34,05 31,81BE§ONA¢E™ 32,14 24,29 28,21KAPOY™A¢E™ 20,00 20,00 20,00NYMºE™ 10,50 0,50 5,50°ÂÓÈÎfi˜ ̤ÛÔ˜ fiÚÔ˜ 40,80 45,18 42,99
* H ‰ÔÎÈÌ·Û›· t-test ÌÂٷ͇ ÙˆÓ ‰‡Ô ‰ÂÈÁÌ·ÙÔÏË„ÈÒÓ ‰ÂÓ ·Ó›-¯Ó¢Û ‰È·ÊÔÚ¤˜ Ô˘ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ (Ú>0,05)
¶ÈÓ. 4: K·Ù·ÁÚ·Ê‹ ÎÔÏ·ÙÛÈÔ‡ Ô˘ ÂӉ›ÎÓ˘Ù·È ·fi ÙËÓ ˘Ô˘Ú-ÁÈ΋ ·fiÊ·ÛË N. 2327/95 ¿ÚıÚ. 10 ·Ú. 8.
¢EI°MATO§HæIA* KO§AT™IOEN¢E¢EI°MENO A' B' ™YNO§O™ANTOYIT™ ME TYPI 95 48 143ºPOYTA 37 35 72°IAOYPTI 38 16 54TO™T 21 30 51XYMO™ XøPI™ ZAXAPH 33 16 49TYPO¶ITA 11 28 39æøMI ™KETO 4 7 11°A§A A™¶PO 4 2 6KOY§OYPIA 2 1 3™TAºI¢OæøMO 1 1 2™‡ÓÔÏÔ 246 184 430
* H ‰ÔÎÈÌ·Û›· t-test ÌÂٷ͇ ÙˆÓ ‰‡Ô ‰ÂÈÁÌ·ÙÔÏË„ÈÒÓ ‰ÂÓ ·Ó›-¯Ó¢Û ‰È·ÊÔÚ¤˜ Ô˘ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ (Ú>0,05)
ŸÏ˜ ÔÈ Î·Ù·ÁÂÁÚ·Ì̤Ó˜ ÌÂÚ›‰Â˜ ‹Ù·Ó 975. H ÔÛÔ-ÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ÂȉÒÓ ÙÔ˘ ÎÔÏ·ÙÛÈÔ‡, ÂӉ‰ÂÈÁ̤-ÓÔ˘ Î·È ÌË, ¤‰ˆÛ ٷ ·ÎfiÏÔ˘ı·:TÔ ‰ËÌÔÊÈϤÛÙÂÚÔ ÎÔÏ·ÙÛÈfi ‹Ù·Ó ÙÔ ÎÚÔ˘·Û¿Ó(19,69%). AÎÔÏÔ˘ıÔ‡Û·Ó ÙÔ Û¿ÓÙÔ˘ÈÙ˜ Ì „ˆÌ› Î·È Ù˘Ú›(14,67%), Ô ¯˘Ìfi˜ Ì ˙¿¯·ÚË (8,51%), Ù· ÊÚÔ‡Ù·(7,38%), Ù· ·Ù·Ù¿ÎÈ· (6,26%) Î·È ÙÔ ÁÈ·Ô‡ÚÙÈ (5,54%).Afi Ù· ÏÈÁfiÙÂÚÔ ‰ËÌÔÊÈÏ‹ ·Ó·Ê¤ÚÔÓÙ·È ÙÔ ÛÙ·Êȉfi„ˆ-ÌÔ (0,21%), Ù· ÎÔ˘ÏÔ‡ÚÈ· (0,31%), ·ÏÌ˘Ú¿ ÎÚ¿ÎÂÚ Î·ÈÁ¿Ï· ¿ÛÚÔ(0,62%). (¶›Ó·Î·˜ 6).
™YZHTH™H
H ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·ıÈÛÙ¿ Ê·ÓÂÚfi fiÙÈ ËÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË Û˘-ÁÎÂÎÚÈ̤ÓË ¤Ú¢ӷ ÛÈÙ›˙ÔÓÙ·È Ì ÌË ÂӉ‰ÂÈÁ̤ÓÔ ÎÔÏ·-ÙÛÈfi, Û¯ÂÙÈο Ì ÛÙËÓ ˘Ô˘ÚÁÈ΋ ·fiÊ·ÛË Ô˘ ÂΉfiıË-ΠÙÔ 1989. (¶›Ó·Î·˜ 3). ™ÙËÓ ›‰È· ÂÎÙ›ÌËÛË Î·Ù·Ï‹ÁÔ˘-Ì ÌÂÏÂÙÒÓÙ·˜ Ù· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ›Ó·Î· ‚ ‹ ÙÔ ‰È¿-ÁÚ·ÌÌ· Ù˘ ÂÈÎfiÓ·˜ 1. E›Ó·È ‡ÎÔÏÔ Ó· ‰È·ÎÚ›ÓÔ˘Ì ˆ˜·fi Ù· ¤ÓÙÂ, Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ÚÔÙ›ÌËÛË, ›‰Ë ÎÔÏ·-ÙÛÈÔ‡ ÌfiÓÔ ÙÔ ¤Ó· Â›Ó·È ÂӉ‰ÂÈÁ̤ÓÔ Û‡Ìʈӷ ¿ÓÙ·Ì ÙȘ ˘Ô˘ÚÁÈΤ˜ Ô‰ËÁ›Â˜.EȉÈÎfiÙÂÚ· ÛÙ· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ›Ó·Î· 3 Ê·›ÓÂÙ·È fiÙȷȉȿ ÓËÈ·ÁˆÁ›ˆÓ ·ÔÌ·ÎÚ˘ÛÌ¤ÓˆÓ ·fi ÙÔ K¤ÓÙÚÔYÁ›·˜ Ì·˜ fiˆ˜ ·˘Ù¿ ÙˆÓ ¢Ô˘Î¿‰ˆÓ, K·ÛÙÂÏ¿ÓˆÓ Î·ÈK˘ÓÔÈ·ÛÙÒÓ ¤‰ÂÈ¯Ó·Ó ÌÂÁ·Ï‡ÙÂÚË ÚÔı˘Ì›· ÛÙÔ Ó· ·-ÎÔÏÔ˘ı‹ÛÔ˘Ó ˘ÁÈÂÈÓfi ‰È·ÈÙÔÏfiÁÈÔ ·fi ·ÓÙ›ÛÙÔȯ· ÂÚÈÔ-¯ÒÓ ÏËÛȤÛÙÂÚˆÓ fiˆ˜ ·˘Ù¿ ÙÔ˘ AÁÚÔ‡, N˘ÌÊÒÓ Î·ÈK·ÚÔ˘Û¿‰ˆÓ. H ·Ú·¿Óˆ ‰È·›ÛÙˆÛË ¤Ú¯ÂÙ·È Û ¿ÌÂ-ÛË ·ÓÙ›ıÂÛË Ì ÙÔ ¤ÚÁÔ Ô˘ ¤¯ÂÈ Âȉ›ÍÂÈ ÙÔ Ô‰ÔÓÙÈ·-ÙÚÂ›Ô ÙÔ˘ K¤ÓÙÚÔ˘ YÁ›·˜ ÛÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ÏËı˘-ÛÌÔ‡ ÁÈ· ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ Î·È ÚfiÏ˄˘. ™ÙËÓ Û˘ÁÎÂ-ÎÚÈ̤ÓË ÂÚ›ÙˆÛË Ú¤ÂÈ Â›Ù ӷ ÂÓÙ·ÙÈÎÔÔÈËı› ÙÔÚfiÁÚ·ÌÌ· ÂÓË̤ڈÛ˘ Î·È Ì¿ÏÈÛÙ· ÛÙȘ ÂÚÈÔ¯¤˜ ÌÂÙ· ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· ›Ù ӷ ·Ó·˙ËÙËıÔ‡Ó ¿ÏÏÔÈÏfiÁÔÈ ÁÈ· Ó· ‰ÈηÈÔÏÔÁ‹ÛÔ˘Ó ·˘Ùfi ÙÔ Ê·ÈÓfiÌÂÓÔ. T· ÓË-È·ÁˆÁ›· Ô˘ ÂÚ¢ӋıËÎ·Ó ‰ÂÓ Â›¯·Ó ΢ÏÈΛÔ, ÔfiÙ ٷ·È‰È¿ ¤·ÈÚÓ·Ó ÙÔ ÎÔÏ·ÙÛÈfi ·fi ÙÔ Û›ÙÈ. Y‡ı˘ÓÔÈ ÏÔÈ-fiÓ ÁÈ· ÙËÓ ÔÈfiÙËÙ· ÙÔ˘ ‹Ù·Ó ÔÈ ÁÔÓ›˜, ÔÈ ÔÔ›ÔÈ fiˆ˜ÔÈ ÓËÈ·ÁˆÁÔ› ·Ó¤ÊÂÚ·Ó, ‹Ù·Ó ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘˜ ηϿÏËÚÔÊÔÚË̤ÓÔÈ Ì ÙÔ ÙÈ ¤Ú ӷ ÛÈÙ›˙ÔÓÙ·È Ù· ·È‰È¿ÙÔ˘˜ ÛÙÔ ÓËÈ·ÁˆÁ›Ô. Afi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÂÎ·È‰Â˘ÙÈ-ÎÒÓ ˘‹Ú¯·Ó ÂÚÈÙÒÛÂȘ ÓËÈ·ÁˆÁÒÓ Ô˘ ÂÚÈÔÚÈ˙fi-ÓÙÔ˘Û·Ó Û ¯·Ï·Ú¤˜ Û˘ÛÙ¿ÛÂȘ Î·È ·Ú·ÈÓ¤ÛÂȘ ÚÔ˜ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙÔ Â›‰Ô˜ ÙÔ˘ ÎÔÏ·ÙÛÈÔ‡ Ô˘ ¤Ú ӷ ‰›-ÓÔ˘Ó ÛÙ· ·È‰È¿ ÙÔ˘˜ Ì ·ÓÙ›ÛÙÔȯ· ¯·Ï·Ú¿ ·ÔÙÂϤ-ÛÌ·Ù· Î·È ÓËÈ·ÁˆÁÒÓ Ô˘ ÌÂ Û˘Ó¯›˜ Û˘ÓÂÓÙ‡ÍÂȘ ‹ÔÌÈϛ˜ ηٿÊÂÚ·Ó Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÛÙ¿ÛÂȘ ıÂÙÈΤ˜Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·. E›Û˘ ˘‹Ú¯·Ó ÓËÈ·ÁˆÁ›·(2 ÙÔÓ ·ÚÈıÌfi) Ô˘ ›¯·Ó ηıÈÂÚÒÛÂÈ Û˘ÁÎÂÎÚÈ̤ÓÔ Úfi-ÁÚ·ÌÌ· ‚¿ÛÂÈ ÙÔ˘ ÔÔ›Ô˘ ‹Ù·Ó ˘Ô¯Úˆ̤ÓÔÈ ÔÈ ÁÔÓ›˜Ó· ÚÔÂÙÔÈÌ¿˙Ô˘Ó ÙÔ ÎÔÏ·ÙÛÈfi ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.¶·ÚfiÌÔȘ Ì ÙË ‰È΋ Ì·˜ ¤Ú¢ӷ ¤¯Ô˘Ó Á›ÓÂÈ ÔÏϤ˜ ÛÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ:™ÙËÓ AÓÙ›ÁÎÔ˘· ¤ÁÈÓ ÂÓı‹ÌÂÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ‰È·ÈÙÔ-ÏÔÁ›Ô˘ 403 ·È‰ÈÒÓ. Afi Ù· ·ÔÙÂϤÛÌ·Ù· Û˘ÌÂÚ·›ÓÂ-Ù·È fiÙÈ ÔÈ Ì·ıËÙ¤˜ Û˘Ó‹ıÈ˙·Ó Ó· ηٷӷÏÒÓÔ˘Ó ˙·¯·-ÚÔ‡¯· ÔÙ¿ ÌÂٷ͇ ÙˆÓ ÁÂ˘Ì¿ÙˆÓ Ì ÌÂÁ·Ï‡ÙÂÚË ÚÔ-Ù›ÌËÛË ÙÔ ÙÛ¿È, ÙÔ˘˜ ¯˘ÌÔ‡˜ Î·È Ù· ˙·¯·ÚˆÙ¿(2). M·ÎÚÔ-¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ηٷӿψÛ˘ ˙¿¯·Ú˘ 429Ì·ıËÙÒÓ ·¤‰ÂÈÍ fiÙÈ 5 gr. ÂÈϤÔÓ Ù˘ ηıËÌÂÚÈÓ‹˜ÔÛfiÙËÙ·˜ ηٷӷÏÈÛÎfiÌÂÓ˘ ˙¿¯·Ú˘ Û˘Ó‰¤ÂÙ·È ÌÂ1% ·‡ÍËÛË Ù˘ Èı·ÓfiÙËÙ·˜ ÂÓÙÔÈÛÌÔ‡ ÙÂÚˉfiÓˆÓ(3, 4). ™ÙË ¢˘ÙÈ΋ IÛÏ·Ó‰›· Ë ·Ú·ÎÔÏÔ‡ıËÛË 50 ÓË›ˆÓ ›‰ÂηÂÓÙ¿ÌËÓÔ Ô‰‹ÁËÛ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Âȉ›-ÓˆÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Û˘Ó‰¤-ÂÙ·È Ì ÙËÓ ·˘Í·ÓfiÌÂÓË Î·Ù·Ó¿ÏˆÛË ÎÔÏ·ÙÛÈÔ‡ Ì ÌÂ-Á¿ÏË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ˙¿¯·ÚË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓÛ¯ÔÏÈÎÒÓ ÂÚÈfi‰ˆÓ(8).
EȉËÌÈÔÏÔÁÈΤ˜ MÂϤÙ˜
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 33-38, 2004
¶ÈÓ. 5: K·Ù·ÁÚ·Ê‹ ÎÔÏ·ÙÛÈÔ‡ Ô˘ ‰ÂÓ ÂӉ›ÎÓ˘Ù·È ·fi ÙËÓ ̆ -Ô˘ÚÁÈ΋ ·fiÊ·ÛË N. 2327/95 ¿ÚıÚ. 10 ·Ú. 8.
¢EI°MATO§HæIA* KO§AT™IO MHEN¢E¢EI°MENO A' B' ™YNO§O
KPOYA™AN 99 93 192XYMO™ ME ZAXAPH 71 12 83¶ATATAKIA 22 39 61™OKO§ATE™ 29 13 42T™OYPEKI 22 16 38M¶I™KOTA KPEMA™ 33 6 39æøMI ME ME§I 20 17 37KEIK 9 13 22°API¢AKIA 2 13 15§OYKOYMA¢E™ 1 9 10A§MYPA KPAKEP 4 2 6™‡ÓÔÏÔ 297 231 545
* H ‰ÔÎÈÌ·Û›· t-test ÌÂٷ͇ ÙˆÓ ‰‡Ô ‰ÂÈÁÌ·ÙÔÏË„ÈÒÓ ·Ó›¯Ó¢Û‰ȷÊÔÚ¤˜ Ô˘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ϤÔÓ ÛËÌ·ÓÙÈΤ˜(0,01>Ú>0,001)
¶ÈÓ. 6: K·Ù·ÁÚ·Ê‹ ÎÔÏ·ÙÛÈÔ‡ Ô˘ ηٷӷÏÒıËΠ۠·fiÏ˘-ÙË Î·È ÂηÙÔÛÙÈ·›· ÙÈÌ‹
KO§AT™IO ¶O™OTHTA (%)KPOYA™AN 192 19,69™ANTOYIT™ ME TYPI 143 14,66XYMO™ ME ZAXAPH 83 8,51ºPOYTA 72 7,38¶ATATAKIA 61 6,25°IAOYPTI 54 5,53TO™T 51 5,23XYMO™ XøPI™ ZAXAPH 49 5,02™OKO§ATE™ 42 4,30TYPO¶ITA 39 4,00M¶I™KOTA KPEMA™ 39 4,00T™OYPEKI 38 3,89æøMI ME ME§I 37 3,79KEIK 22 2,25°API¢AKIA 15 1,53æøMI ™KETO 11 1,12§OYKOYMA¢E™ 10 1,02°A§A A™¶PO 6 0,61A§MYPA KPAKEP 6 0,61KOY§OYPIA 3 0,30™TAºI¢OæøMO 2 0,20
™‡ÓÔÏÔ 975 100,00
36
™ÙÔ PÈ¿ÓÙ Ë ·Ó¿Ï˘ÛË ÙÔ˘ ÎÔÏ·ÙÛÈÔ‡ 68 ÓË›ˆÓ (4-6 ÂÙÒÓ)Ì ˘„ËÏfi ‰Â›ÎÙË DMFT ¤‰ÂÈÍ fiÙÈ ÙÔ 88.2% Î·È ÙÔ 75%ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Î·Ù·Ó¿ÏˆÓ ÎÔÏ·ÙÛÈfi Î·È ¯˘ÌÔ‡˜ ·-ÓÙ›ÛÙÔȯ· Ì ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ˙¿¯·ÚË(9).™Â ÌÈ· ¢Ú›· ËÏÈÎȷο ÔÌ¿‰· ·ÓıÚÒˆÓ ÛÙË T·Ó˙·Ó›· ËÂͤٷÛË Ù˘ Û¯¤Û˘ ÙÔ˘ ›‰Ô˘˜ Ù˘ ‰È·ÙÚÔÊ‹˜ Î·È Ù˘‡·Ú͢ Ô‰ÔÓÙÈÎÒÓ ÙÂÚˉfiÓˆÓ ¤‰ÂÈÍ fiÙÈ ·˘Ù‹ ‹Ù·Ó ÛË-Ì·ÓÙÈο ÛÙÂÓ‹. A˘Ùfi Á›ÓÂÙ·È È‰È·›ÙÂÚ· ÂÌÊ·Ó¤˜ ÛÙȘ ·-ÛÙÈΤ˜ ÂÚÈÔ¯¤˜(13).Œ¯ÂÈ Á›ÓÂÈ ÏÔÈfiÓ ÁÂÓÈο ·Ô‰ÂÎÙfi ·fi ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ÎÔÈÓfiÙËÙ· fiÙÈ Ë Û˘¯Ó‹ Î·È ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌfi ηٷӿψ-ÛË Ê·ÁËÙÒÓ ÏÔ‡ÛÈˆÓ Û ˙˘ÌÒÛÈÌÔ˘˜ ˘‰·Ù¿ÓıڷΘ ¤-¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙÂÚË-‰fiÓˆÓ(5). MÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÓÔ¯Ô-ÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË Ô‰ÔÓÙÈÎÒÓ ÙÂÚˉfiÓˆÓ ÛÙ·ÌÈÎÚ¿ ·È‰È¿ ÌÔÚԇ̠ӷ ·ÔÌÔÓÒÛÔ˘Ì ‰È·ÙÚÔÊÈΤ˜Û˘Ó‹ıÂȘ Î·È ÚÔÙÈÌ‹ÛÂȘ ÛÙ· ˙·¯·ÚˆÙ¿(10). H Û˘¯Ó‹Î·Ù·Ó¿ÏˆÛË ÎÔÏ·ÙÛÈÔ‡ Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ˙¿-¯·ÚË (ÙÛÔ˘Ú¤ÎÈ, ΤÈÎ, ·ÁˆÙÒÓ, ÚÔÊËÌ¿ÙˆÓ) Û˘Ó‰¤ÂÙ·ÈÌ ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÂÚˉfiÓˆÓ(11, 12). H invivo ηٷÁÚ·Ê‹ ÙˆÓ ‰È·Î˘Ì¿ÓÛÂˆÓ ÙÔ˘ ‰Â›ÎÙË pH ÌÂÙ¿·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ÎÔÏ·ÙÛÈÔ‡ ¤‰ÂÈÍ fiÙÈ Ë ÌÂÁ·Ï‡ÙÂ-ÚË ÙÒÛË Ù˘ ÙÈÌ‹˜ ÙÔ˘ ¤ÁÈÓ ηٿ ÙË ¯ÔÚ‹ÁËÛË ‰È·Ï‡-Ì·ÙÔ˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ 10% Û ̇ ¿¯·ÚË Î·È ÙË ÌÈÎÚfiÙÂÚËÌ ÙË Î·Ù·Ó¿ÏˆÛË Ù˘ÚÈÔ‡(6).TÔ ˘„ËÏfi Â›Â‰Ô Ù˘ ηٷӿψÛ˘ ˙¿¯·Ú˘ ‰ÂÈÎÓ‡ÂÈfiÙÈ Â›Ó·È ··Ú·›ÙËÙÔ Ô Û¯Â‰È·ÛÌfi˜ ÂÓfi˜ ‚ÂÏÙȈ̤ÓÔ˘ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô‰ÔÓÙÈ΋˜ ÚfiÏ˄˘ Ô˘ Ó· ÂÛÙÈ¿˙ÂÙ·ÈÛÙËÓ Î·Ù·ÓfiËÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ·Ó·-ÁηÈfiÙËÙ·˜ ÙÔ˘ ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ηٷӿψÛ˘ Ù˘ ˙¿-¯·Ú˘(1). ™¯ÂÙÈο Ì ÙȘ ÁÓÒÛÂȘ Ô˘ ¤¯Ô˘Ó ÔÈ ¤ÊË‚ÔÈ ÁÈ·ÙË ÙÂÚˉÔÁfiÓÔ ÈηÓfiÙËÙ· ÔÚÈÛÌ¤ÓˆÓ ÙÚÔÊÒÓ ÌÈ· ¤Ú¢-Ó· η٤ÏËÍ fiÙÈ ·˘Ù‹ ‹Ù·Ó ÁÂÓÈο ÂÚÈÔÚÈṲ̂ÓË Î·È fiÙÈ ËÂη›‰Â˘ÛË Î·È ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ڤÂÈ Ó· ÛÙԯ‡ÂÈ ÛÙËÓ Â·Ú΋ ÂÓË̤ڈÛË(7).°È· ÙË ‰È·ÌfiÚʈÛË Î·È ÂÊ·ÚÌÔÁ‹ Ù¤ÙÔÈˆÓ ÚÔÁÚ·ÌÌ¿-ÙˆÓ Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ˘Â‡ı˘ÓÔÈ Â›Ó·È ÔÈ Ô‰ÔÓÙ›·ÙÚÔÈ Î·ÈÔÈ ÂÎ·È‰Â˘ÙÈÎÔ›. OÈ Ô‰ÔÓÙ›·ÙÚÔÈ Ô˘ Û˘Ó‹ıˆ˜ ÛÙÂϯÒ-ÓÔ˘Ó Ù· K¤ÓÙÚ· YÁ›·˜ Ù˘ ÂÚÈÔ¯‹˜, Û·Ó ÊÔÚ›˜ Úˆ-ÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ Ô˘ ›ӷÈ, ÂÈ‚¿ÏÏÂÙ·È Ó· ÌÂÚÈ-ÌÓÔ‡Ó ÁÈ· ÙË ÛˆÛÙ‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÓfiÌˆÓ ÂÓËÌÂÚÒÓÔ-ÓÙ·˜ Î·È ÏËÚÔÊÔÚÒÓÙ·˜ ÙÔ˘˜ ¿ÌÂÛ· ÂӉȷÊÂÚfiÌÂÓÔ˘˜ÛÂ Û˘Ó¯‹ ‚¿ÛË. OÈ ÂÎ·È‰Â˘ÙÈÎÔ› Û˘ÓÂÈÎÔ˘ÚÒÓÙ·˜ ÛÙËÏËÚÔÊfiÚËÛË Î·È ·›˙ÔÓÙ·˜ ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ ÛÙÔ ¤-ÏÂÁ¯Ô Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ˘Ô˘ÚÁÈ΋˜ ·fiÊ·Û˘ ·Ô-ÙÂÏÔ‡Ó ÙÔÓ Û˘Ó‰ÂÙÈÎfi ÎÚ›ÎÔ ÌÂٷ͇ ÙÔ˘ Û¯ÔÏ›Ԣ Î·È ÙÔ˘Ô‰ÔÓÙÈ·ÙÚ›Ԣ(14).E›Ó·È ÁÂÁÔÓfi˜ ¿ÓÙˆ˜ fiÙÈ ‰ÂÓ ·ÚΛ ÌÈ· ˘Ô˘ÚÁÈ΋ ·fi-Ê·ÛË ÁÈ· Ó· ‰È·ÌÔÚʈı› ÌÈ· ıÂÙÈ΋ ÛÙ¿ÛË ÙˆÓ ·ÙfïÓÛ¯ÂÙÈο Ì ÙËÓ ˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È Û˘ÌÂÚÈÊÔÚ¿. ¶Ú¤-ÂÈ Â›Û˘ Ó· ·Ó·ÊÂÚı› fiÙÈ ˘¿Ú¯ÂÈ Ë Û˘Ó‹ıÂÈ· ÔÏÏ¿·È‰È¿ Ó· ÚÔÌËı‡ÔÓÙ·È ÙÔ ÎÔÏ·ÙÛÈfi ÙÔ˘˜ ·fi ηÓÙ›Ó˜‹ Ì·Á·˙È¿ ÂÁηÙÂÛÙË̤ӷ ·ÎfiÌË Î·È ¤Íˆ ·fi ÙÔ Û¯ÔÏ›Ô.E›Û˘ Ú¤ÂÈ Ó· ÂȈı› fiÙÈ ·ÎfiÌË Î·È ÔÈ ›‰ÈÔÈ ÔÈ ÁÔÓ›˜,fiÛÔÈ ·Ú·Û΢¿˙Ô˘Ó ·fi ÌfiÓÔÈ ÙÔ˘˜ ÙÔ ÎÔÏ·ÙÛÈfi وӷȉÈÒÓ ÙÔ˘˜, ·ÓÙÈÛÙÚ·Ù‡ÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi Ù· ·-Ó·ÌÊÈÛ‚‹ÙËÙ· ¢ÂÚÁÂÙ‹Ì·Ù· ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÓÔÌÔ-ıÂÙ‹Ì·ÙÔ˜. E›Ó·È ··Ú·›ÙËÙÔ ÏÔÈfiÓ Ó· ‰È·ÌÔÚʈı› ¤-Ó· ÚfiÁÚ·ÌÌ· ÂÓË̤ڈÛ˘ Î·È ÏËÚÔÊfiÚËÛ˘ ÙˆÓ Ô-
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Ï·ÙÛÈÔ‡ ‰ÂÓ Â›Ó·È Û‡ÌʈÓÔ Ì ·˘Ùfi Ô˘ ÔÚ›˙ÂÈ Ë ÓÔ-ÌÔıÂÙÈ΋ Ú‡ıÌÈÛË ÙÔ˘ ˘Ô˘ÚÁ›Ԣ ¶·È‰Â›·˜ ÁÈ· ÙËÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Û¯ÔÏÈÎÒÓ Î˘ÏÈΛˆÓ.
2. ™ÙËÓ ¤Ú¢ӷ ÙÔ ÓËÈ·ÁˆÁÂ›Ô Ô˘ ›¯Â ÂÓ·ÚÌÔÓÈÛı›ÂÚÈÛÛfiÙÂÚÔ Ì ÙËÓ ·ÓˆÙ¤Úˆ Ú‡ıÌÈÛË ‹Ù·Ó ·˘Ùfi ÙˆÓ¢Ô˘Î¿‰ˆÓ ÂÓÒ ·ÓÙ›ıÂÙ· ÛÙȘ N‡Ìʘ ̆ ‹Ú¯Â Ë ÂÏ¿¯È-ÛÙË Û˘ÌÌfiÚʈÛË Ì ÙÔ ÓfiÌÔ.
3. Afi ÙÔ ÂӉ‰ÂÈÁ̤ÓÔ ÎÔÏ·ÙÛÈfi ‰ËÌÔÊÈϤÛÙÂÚÔ ‹Ù·ÓÙÔ Û¿ÓÙÔ˘ÈÙ˜ ÌÂ Ù˘Ú› Î·È „ˆÌ› Î·È ·fi ÙÔ ÌË ÂӉ‰ÂÈÁ-̤ÓÔ ÙÔ ÎÚÔ˘·Û¿Ó. TÔ ÙÂÏÂ˘Ù·›Ô ÂÈϤÔÓ Â›¯Â Î·È ÙËÌÂÁ·Ï‡ÙÂÚË ÚÔÙ›ÌËÛË ·Ó¿ÌÂÛ· ÛÙȘ ÌÂÚ›‰Â˜ Ô˘ η-Ù·Ó·ÏÒıËÎ·Ó ÛÙÔ Û‡ÓÔÏÔ.
4. E›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÓÙ·ÙÈÎÔÔÈËı› ÙÔ ÚfiÁÚ·ÌÌ·ÂÓË̤ڈÛ˘ Î·È ÏËÚÔÊfiÚËÛ˘ ÙˆÓ ÁÔÓÈÒÓ Î·È ÙˆÓÂÎ·È‰Â˘ÙÈÎÒÓ Ì ÛÙfi¯Ô ÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ Û›ÙÈÛ˘ ÙÔ˘·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ô˘ ·Ô‰Â‰ÂÈÁ̤ӷ ı· Ô‰ËÁ‹-ÛÂÈ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÁÂÓÈ΋˜ ˘Á›·˜ ÙÔ˘.
SUMMARY
“Snacks consumed by nursery school pupils inthe North West of Corfu”
F. Daskas
hellenic stomatological review 48: 33-38, 2004
This project attempts at listing the nutritional habits and,particularly, the kind of snacks consumed by nurseryschool pupils in the North West of Corfu. The elementspresented in the project are based on the dentalexamination performed on these pupils within the year1999-2000.The total of participation numbers 232 children in 13nursery schools. Before the examination, teachers weresupplied with a list of the kids of the snacks pupils usuallyprefer. The were asked to take notes of the kind of snackspupils had. This had to be noted down daily (five days aweek) for two weeks period. The evaluation of the resultswas made considering the ministerial decision about theway buffets should operate. The best results were noticedin the nursery school of Doukades (67,5%) while the worstones were observed in Nymphes (5,5%). The portion ofproper snack were aparted more of sandwiches (breadand cheese) (143) and fruit (72) but less of raisin bun (2)and cookies (3). Inappropriate food portions were more ofcroissants and juice with sugar (83) but less of saltycrackers (6) and doughnuts (10).The percentage in order of preference for the portion ofsnacks are:
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EȉËÌÈÔÏÔÁÈΤ˜ MÂϤÙ˜
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 33-38, 2004
Sandwiches with bread and cheese (27%) , croissants(18%) juice with sugar (9%) and chips (7%). It is obviousthat croissants are top of the list (19,69%). Theineffectiveness of the law in question is obvious and it islargely so because of the parents way of thinking on thismatter. For that, it is essential that they becomeimmediately informed so that there can be a change intheir attitude.
Key words: Snacks, children, nursery.
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EȉËÌÈÔÏÔÁÈΤ˜ MÂϤÙ˜
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 33-38, 2004
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O Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ·ÔÙÂÏ› ÙËÓ Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÂÚËÙÈ΋˜ Ïԛ̈͢. OÈ‚Ï¿‚˜ ÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ· ¤¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÂΉËÏÒÛÂȘ Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ ÂÓÙÔÈ-Ṳ̂Ó˜ Ê˘Û·Ï›‰Â˜ ÛÙ· ¯Â›ÏË, ΢ڛˆ˜ ÛÙ· Ï¿ÁÈ· ÙÔ˘ οو ¯Â›ÏÔ˘˜ ÛÙÔ fiÚÈÔ ‰¤ÚÌ·ÙÔ˜ - ÂÚ˘ıÚÔ‡ÎÚ·Û¤‰Ô˘, ÌÂÙ¿ ·fi ·Ú¤Ì‚·ÛË ‰È·ÊfiÚˆÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. O Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜Û ÔÚÈṲ̂ӷ ¿ÙÔÌ· ˘ÔÙÚÔÈ¿˙ÂÈ 2-3 ÊÔÚ¤˜ ÙÔ ¯ÚfiÓÔ. ÕÏÏÔÙ fï˜ ÂÌÊ·Ó›˙ÂÙ·È Û ·Ú·È¿ ¯ÚÔÓÈ-ο ‰È·ÛÙ‹Ì·Ù· Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÍÂÂÚÓÔ‡Ó ÙÔ ¤Ó· ¤ÙÔ˜ ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ. H ‰È¿ÁÓˆÛË Ù‹˜‰Â˘ÙÂÚÔ·ıÔ‡˜ ÂÚËÙÈ΋˜ Ïԛ̈͢ Â›Ó·È Â‡ÎÔÏË Û˘Ó‹ıˆ˜ Î·È ÛÙËÚ›˙ÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi Î·È ÛÙËÓÎÏÈÓÈ΋ ÂͤٷÛË. EÂȉ‹ Ë ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ÙÔ˘ ÈÔ‡ Â›Ó·È ·Ô‰Â‰ÂÈÁ̤ÓË, ÂÈ‚¿ÏÏÂÙ·È Ë ÂÓË̤ڈÛËÙÔ˘ ÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ‚Ï¿‚˘ Î·È ÙËÓ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË Ù˘. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ·,Ù˘ ÁÓÒÛ˘ Û¯ÂÙÈο Ì ÙËÓ Ïԛ̈ÍË Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Úԉȷı¤ÙÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘ Û‰›ÁÌ· ÂÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. YÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ·ÔÙ¤ÏÂÛ·Ó 650 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· - ¤ÓÙ˘· ·ÛıÂÓÒÓ Ô˘ ÚÔÛÂÚ¯fiÙ·ÓÛÙËÓ ¢È·ÁÓˆÛÙÈ΋ KÏÈÓÈ΋ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ AıËÓÒÓ ÁÈ· ÂÚ›ı·Ï„Ë, Ù· ÔÔ›· Û˘ÌÏËÚÒ-ÓÔÓÙ·Ó ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜. Afi Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·˘Ù¿ Ù· 191 (29,4%) ··ÓÙ‹ıËÎ·Ó ·fi ¿-ÓÙÚ˜ Î·È Ù· 459 (70,6%) ··ÓÙ‹ıËÎ·Ó ·fi Á˘Ó·›Î˜ Ì ̤ÛË ÙÈÌ‹ ËÏÈΛ·˜ Ù· 43,7 ¯ÚfiÓÈ·. ø˜ ÚÔ˜ ÙËÓ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ‚Ï¿‚˘ ‰È·ÎfiÛÈÔÈ ¤ÓÙÂη ·ÛıÂÓ›˜ (32,5%) ·Ó¿ÊÂÚ·Ó ÂÈ-¯Â›ÏÈÔ ¤ÚËÙ·. ø˜ ÚÔ˜ ÙÔ Ê‡ÏÔ, ̄ ·Ú·ÎÙËÚÈÛÙÈ΋ ‹Ù·Ó Ë ̆ ÂÚÔ¯‹ ÙˆÓ Á˘Ó·ÈÎÒÓ Û ۯ¤ÛË Ì ÙÔ˘˜¿Ó‰Ú˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÛÙÔ ·ÚÂÏıfiÓ Âȯ›ÏÈÔ ¤ÚËÙ· (24,92% vs. 7,53%). ø˜ ÚÔ˜ ÙËÓ ËÏÈΛ·,‰È·ÊÔÚ¤˜ ÛËÌ·ÓÙÈΤ˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÌÂٷ͇ fiÛˆÓ Â›¯·Ó ÂÌÊ·Ó›ÛÂÈ ¤ÚËÙ· Î·È ÙˆÓ ̆ ÔÏÔ›ˆÓ, η-ıÒ˜ ›Û˘ Î·È ÌÂٷ͇ ÙˆÓ Á˘Ó·ÈÎÒÓ Ì ‹ ̄ ˆÚ›˜ Âȯ›ÏÈÔ ¤ÚËÙ· Î·È ÂÌÌËÓfi·˘ÛË. TÔ 58,4% ÁÓÒ-ÚÈ˙ fiÙÈ Â›Ó·È ÌÂÙ·‰ÔÙÈÎfi˜ ÂÓÒ ÙÔ 71,9% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ‹Ù·Ó ÂÓ‹ÌÂÚÔÈ ‹ ÁÓÒÚÈ˙·Ó fiÙÈ Ô ¤ÚËÙ·˜ÔÊ›ÏÂÙ·È Û Èfi. H ÛÙÂÓÔ¯ÒÚÈ· ‹ ¿ÏÏË „˘¯È΋ Î·È ÛˆÌ·ÙÈ΋ ηٷfiÓËÛË ·Ó·Ê¤ÚıËΠ̂ ˜ Ô Î‡ÚÈÔ˜ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¤ÚËÙ· (68,7%), ÂÓÒ Ë ÂÌÊ¿ÓÈÛË ÙÔ˘ ‰ÂÓ Û˘-Û¯ÂÙ›ÛÙËΠ̠οÔÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÂÔ¯‹ (71,1%). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ô Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ·ÔÙÂÏ› Û˘¯Ófi ‡ÚËÌ· ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi, ÁÈ'·˘ÙfiË ÂÓË̤ڈÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ̂ ˜ ÚÔ˜ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ÌÂÙ·‰ÔÙÈÎfiÙËÙ¿ ÙÔ˘ Â›Ó·È È‰È·›-ÙÂÚ· ÛËÌ·ÓÙÈÎfi ̤ÏËÌ· ΢ڛˆ˜ ÙÔ˘ Ô‰ÔÓÙÈ¿ÙÚÔ˘.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 39-43, 2004
§¤ÍÂȘ ÎÏÂȉȿ: Eȯ›ÏÈÔ˜ ¤ÚËÙ·˜, ÂÓ‹ÏÈΘ, ÂȉËÌÈÔÏÔÁ›·,ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜.
* E›ÎÔ˘ÚË K·ıËÁ‹ÙÚÈ· TÔ̤· ¶·ıÔÏÔÁ›·˜ Î·È XÂÈÚÔ˘ÚÁÈ΋˜ÙÔ˘ ™ÙfiÌ·ÙÔ˜, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂ. AıËÓÒÓ.
** AÓ·ÏËÚÒÙÚÈ· K·ıËÁ‹ÙÚÈ· TÔ̤· ¶·ıÔÏÔÁ›·˜ Î·È XÂÈÚÔ˘Ú-ÁÈ΋˜ ™ÙfiÌ·ÙÔ˜, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂ. AıËÓÒÓ.
*** I·ÙÚfi˜
M¤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜ ·ÚÔ˘ÛÈ¿ÛÙËΠÛÙËÓ 7Ë EÙ‹ÛÈ· ™˘Ó¿ÓÙËÛËÙÔ˘ International Herper Management Forum, M·‰Ú›ÙË IÛ·-Ó›·˜, 3-5 ¢ÂÎÂÌ‚Ú›Ô˘ 1999.
EI™A°ø°H
OÈ ÂÚËÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÔÊ›ÏÔÓÙ·È Î·Ù¿Î·ÓfiÓ· ÛÙÔÓ Èfi Ù‡Ô˘ 1 (HSV-1), Ô ÔÔ›Ô˜ ÚÔÛ‚¿ÏÏÂÈÙ· ·ÙÙ·Ú· Ù˘ ·Î·ÓıˆÙ‹˜ ÛÙÈ‚¿‰·˜ ÙÔ˘ ÂÈıËÏ›Ô˘ ÙÔ˘ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ·ÎÔÏÔ‡ıˆ˜ ÂÈÛ¤Ú¯ÂÙ·ÈÛÙȘ Ó¢ÚÈΤ˜ ›Ó˜ Ù˘ ÂÚÈÔ¯‹˜ ηٷϋÁÔÓÙ·˜ ÛÙ· ·È-ÛıËÙÈο Á¿ÁÁÏÈ·. H ÚÔÛ‚ÔÏ‹ Î·È Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ·-ηÓıˆÙÒÓ Î˘ÙÙ¿ÚˆÓ Ô‰ËÁ› ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ Ê˘Û·-Ï›‰ˆÓ ÔÈ Ôԛ˜ Ú‹ÁÓ˘ÓÙ·È Î·È Î·Ù·ÏÂ›Ô˘Ó ‰È·‚ÚÒÛÂÈ˜Î·È ÂÍÂÏÎÒÛÂȘ1, 2, 3.
39
39-43 ÛÂÏ. - Donta-Mpakogiani** 3-10-08 12:46 ™ÂÏ›‰· 39
H ÚˆÙÔ·ı‹˜ Ïԛ̈ÍË ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ·È‰È¿ ˘ÔÎÏÈ-ÓÈο ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜, ÂÓÒ ·ÓÙ›ıÂÙ· ÛÙÔ˘˜ ÂÓ‹ÏÈ-Θ Â›Ó·È Î·Ù¿ ηÓfiÓ· Û˘Ìو̷ÙÈ΋4. ¶ÂÚ›Ô˘ ÙÔ 90%ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Û ÂȉËÌÈÔ-ÏÔÁÈΤ˜ ÌÂϤÙ˜, ¤¯ÂÈ ·Ó·Ù‡ÍÂÈ ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ·-ÏÔ‡ ¤ÚËÙ· Ù‡Ô˘ I Î·È ÂÚ›Ô˘ ÙÔ 40% ·fi ·˘ÙÔ‡˜ ›-Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·Ó›ÛÂÈ ‰Â˘ÙÂÚÔ·ı‹ ¤ÚËÙ· ÛÙ· ¯Â›-ÏË (Âȯ›ÏÈÔ˜ ¤Ú˘) Î·È ÛÙËÓ ÂÚÈÛÙÔÌ·ÙÈ΋ ÂÚÈÔ¯‹Â›Ù ÂÓ‰ÔÛÙÔÌ·ÙÈο3, 4, 5.O Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ÂÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÎÏÈÓÈ-Τ˜ ÂΉËÏÒÛÂȘ Î·È ÔÈ ·ÛıÂÓ›˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ì ·ÎÚ›-‚ÂÈ· Ó· ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙÔ Úfi‚ÏËÌ¿ ÙÔ˘˜. ™Â Ì›· ¤Ú¢ӷfï˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌfiÓÔ 50% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌԇ̠ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ¤ÚËÙ·, ÁÓˆÚ›˙Ô˘Ó fiÙÈ Ë ÂÚËÙÈ΋‚Ï¿‚Ë ÛÙ· ¯Â›ÏË ÙÔ˘˜ ÔÊ›ÏÂÙ·È Û Èfi6, 7. OÈ ‚Ï¿‚˜ Ù˘ ̆ ÔÙÚÔÈ¿˙Ô˘Û·˜ ÂÚËÙÈ΋˜ Ïԛ̈͢ ·-fi ÙÔÓ Èfi Ù‡Ô˘ 1 ¤¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÂΉËÏÒÛÂÈ˜Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ̂ ˜ ÂÓÙÔÈṲ̂Ó˜ Ê˘Û·Ï›‰Â˜ ÛÙ· ̄ ›ÏË.AӷʤÚÔÓÙ·È ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ˆ˜ «ÊÔ˘ÛοϘ ˘ÚÂ-ÙÔ‡» ‹ «¤ÏÎË ÎÚ‡Ô˘», ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÂÌÊ·Ó›˙ÔÓÙ·È Û Ô-ÛÔÛÙ¿ 50%-75% ÙÔ˘ ÏËı˘ÛÌÔ‡, ÌÂÙ¿ ·fi ÙÔ Û˘ÓËıÈ-Ṳ̂ÓÔ ÎÚ˘ÔÏfiÁËÌ·3, 5. ¶·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘ÓÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¤ÚËÙ· Â›Ó·È Ô ˘ÚÂÙfi˜, Ë ÎfiˆÛË,ÙÔ ÙÚ·‡Ì·, Ë ÌfiÏ˘ÓÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜, Ë ËÏȷ΋ ·ÎÙÈÓÔ‚ÔÏ›·, Á·ÛÙÚÂÓÙÂÚÈΤ˜ ·Óˆ-̷ϛ˜, ¤ÌÌËÓÔ˜ Ú‡ÛË, Û˘ÁÎÈÓËÛȷΤ˜ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ-Τ˜ ÊÔÚÙ›ÛÂȘ7, 8. OÚÈṲ̂Ó˜ ÌÂϤÙ˜ Û˘Ó‰¤Ô˘Ó ÙËÓ ˘„Ë-Ï‹ Û˘¯ÓfiÙËÙ· ÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ· Ì ¯·ÌËÏÔ‡ ÎÔÈÓˆ-ÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘ ÏËı˘ÛÌÔ‡˜, ÂÓÒ ¿ÏϘ ÌÂ-ϤÙ˜ ‰ÂÓ Û˘Ó‰¤Ô˘Ó ·˘Ù¤˜ ÙȘ ‰‡Ô ηٷÛÙ¿ÛÂȘ9, 10, 11.™ÎÔfi˜ Ù˘ ÂȉËÌÈÔÏÔÁÈ΋˜ ·˘Ù‹˜ ÌÂϤÙ˘ Â›Ó·È Ó· ‰ÈÂ-Ú¢ӋÛÂÈ ÙËÓ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÂȯÂÈÏ›Ô˘ ¤ÚË-Ù· Î·È ÙË ÁÓÒÛË Û¯ÂÙÈο Ì ÙË Ïԛ̈ÍË, ηıÒ˜ ›Û˘ ηÈÙÔ˘˜ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘ÓÛÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘, Û ‰Â›ÁÌ· ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡.
Y§IKO KAI ME£O¢O™
TÔ ̆ ÏÈÎfi ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ·ÔÙ¤ÏÂÛ·Ó 650 ÂÚˆÙËÌ·-ÙÔÏfiÁÈ· Ù· ÔÔ›· ··ÓÙ‹ıËÎ·Ó ·fi ÈÛ¿ÚÈıÌÔ˘˜ ·ÛıÂ-Ó›˜ Ô˘ ÚÔÛ‹Ú¯ÔÓÙÔ ÛÙË ¢È·ÁÓˆÛÙÈ΋ KÏÈÓÈ΋ Ù˘O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ ÁÈ· ÂÚ›-ı·Ï„Ë. Afi Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·˘Ù¿, Ù· 191 (29,4%) ·-·ÓÙ‹ıËÎ·Ó ·fi ¿Ó‰Ú˜ Î·È Ù· 459 (70,6%) ··ÓÙ‹ıË-Î·Ó ·fi Á˘Ó·›Î˜. ŸÛÔ ·ÊÔÚ¿ ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ,·˘Ù‹ Î˘Ì·ÈÓfiÙ·Ó ·fi 17-87 ¤ÙË, Ì ̤ÛË ÙÈÌ‹ Ù· 43,7¯ÚfiÓÈ·.°È· οı ·ÛıÂÓ‹ ¯ˆÚÈÛÙ¿ Û˘ÌÏËÚˆÓfiÙ·Ó ÂȉÈÎfi ¤ÓÙ˘-Ô-ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ì ÙËÓ ‚Ô‹ıÂÈ· ÙˆÓ Û˘ÁÁڷʤˆÓÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó ÛÊ¿ÏÌ·Ù· ηٿ ÙËÓ Û˘-ÌÏ‹ÚˆÛË. OÈ ÂÚˆÙ‹ÛÂȘ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ·Ó·Ï˘-ÙÈο ·ÊÔÚÔ‡Û·Ó ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ·, ÙËÓÂԯȷ΋ ηٷÓÔÌ‹ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ˘ÔÙÚÔÒÓ ÙÔ˘,Ù· Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·, Ù· ·›ÙÈ· ÚfiÎÏËÛ‹˜ ÙÔ˘, ÙȘÁÓÒÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ Û¯ÂÙÈο Ì ÙËÓ ÚԤϢÛË Ù˘‚Ï¿‚˘ Î·È ÙËÓ ıÂڷ¢ÙÈ΋ Ù˘ ·ÓÙÈÌÂÙÒÈÛË.T· Â˘Ú‹Ì·Ù· ηٷÁÚ¿ÊËÎ·Ó Û ›Ó·Î˜ Î·È ·ÍÈÔÏÔÁ‹-ıËÎ·Ó ÛÙ·ÙÈÛÙÈο Û ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹ Ì ‰ÔÎÈ-Ì·Û›· x2 Î·È t-test.
A¶OTE§E™MATA
O Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ·Ó·Ê¤ÚıËΠ۠211 ÂÚÈÙÒÛÂȘ(ÔÛÔÛÙfi 32,5%) Î·È fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 ÔÈ Á˘-Ó·›Î˜ ›¯·Ó ÂÌÊ·Ó›ÛÂÈ ÛÙÔ ·ÚÂÏıfiÓ Û ̆ „ËÏfiÙÂÚÔ Ô-ÛÔÛÙfi Âȯ›ÏÈÔ ¤ÚËÙ· (24,92%) Û ۯ¤ÛË Ì ÙÔ ·ÓÙ›-ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ·Ó‰ÚÒÓ (7,53%).
H ÛÙ·ÙÈÛÙÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ¤‰ÂÈÍ fiÙÈ ˘-‹Ú¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Â-ÚˆÙËı¤ÓÙˆÓ Ì ‹ ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi Âȯ›ÏÈÔ˘ ¤ÚËÙ· ˆ˜ÚÔ˜ ÙÔ Ê‡ÏÔ (Pearson x2, ¤ÏÂÁ¯Ô˜ P=0.017).ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ, ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÌÂٷ͇ fiÛˆÓ Â›¯·Ó ÂÌ-Ê·Ó›ÛÂÈ ¤ÚËÙ· ÛÙÔ ·ÚÂÏıfiÓ Î·È ÙˆÓ ̆ ÔÏÔ›ˆÓ (t-test:P=0.732, ¶›Ó·Î·˜ 2).
™Â ÂÌÌËÓfi·˘ÛË ‚Ú›ÛÎÔÓÙ·Ó ÔÈ 291/459 Á˘Ó·›Î˜(63,39%). Afi ·˘Ù¤˜ ÔÈ 192 (41,83%) ‰ÂÓ Â›¯·Ó ÈÛÙÔÚÈÎfiÂȯ›ÏÈÔ˘ ¤ÚËÙ·, ÂÓÒ ÔÈ 99 (21,56%) ·Ó¤ÊÂÚ·Ó Âȯ›-ÏÈÔ ¤ÚËÙ· Î·È Ì¿ÏÈÛÙ· Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔ-Ú¿ ·fi ·˘Ù¤˜ Ô˘ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·Ó Û ÂÌÌËÓfi·˘ÛË Î·È·Ó¤ÊÂÚ·Ó ÈÛÙÔÚÈÎfi Âȯ›ÏÈÔ˘ ¤ÚËÙ· (Person x2,P=0,054 ¶›Ó·Î·˜ 3).
Afi Ù· 650 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ Û˘ÌÏËÚÒıËÎ·Ó ÛÙËÓ·ÚÔ‡Û· ÌÂϤÙË, 468 (71,9%) ·fi ÙÔ˘˜ ÂÚˆÙËı¤ÓÙ˜ ‹-Ù·Ó ÂÓËÌÂڈ̤ÓÔÈ fiÙÈ Ô Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ÔÊ›ÏÂÙ·È ÛÂÈfi, ÂÓÒ 380 (58,46%) ÁÓÒÚÈ˙·Ó fiÙÈ Â›Ó·È ÌÂÙ·‰ÔÙÈÎfi˜. ™Ù·-ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÂÓÙÔ›ÛÙËÎ·Ó ÌfiÓÔ ÛÙË ‰Â‡-
40
EȉËÌÈÔÏÔÁÈ΋ MÂϤÙË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 39-43, 2004
¶›Ó·Î·˜ 1: K·Ù·ÓÔÌ‹ ÙˆÓ 650 ·ÛıÂÓÒÓ ·Ó¿ÏÔÁ·Ì ÙÔ Ê‡ÏÔ Î·È Ùo ÈÛÙÔÚÈÎfi ‹ fi¯È Âȯ›ÏÈÔ˘ ¤ÚËÙ·.
AÛıÂÓ›˜ XˆÚ›˜ Âȯ›ÏÈÔ ¤ÚËÙ· M Âȯ›ÏÈÔ ¤ÚËÙ·N/% N/%
ÕÚÚÂÓ˜ 142/(21,8) 49(7,53)£‹ÏÂȘ 297/(45,6) 162(24,92)™‡ÓÔÏÔ 439/(67,5) 211(32,5)
x2, p=0,017
¶›Ó·Î·˜ 2: K·Ù·ÓÔÌ‹ ÙˆÓ 650 ·ÛıÂÓÒÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ ÈÛÙÔÚÈÎfi ‹ fi¯È Âȯ›ÏÈÔ˘ ¤ÚËÙ·.
Eȯ›ÏÈÔ˜ AÚÈıÌfi˜ M¤ÛË ™Ù·ıÂÚ‹¤ÚËÙ·˜ ·ÛıÂÓÒÓ ËÏÈΛ· ·fiÎÏÈÛË
N x SDAÚÓËÙÈ΋ ·¿ÓÙËÛË 439 43,5 15,8£ÂÙÈ΋ ·¿ÓÙËÛË 211 44,0 15,0™‡ÓÔÏÔ 650 43,7 15,5
t-test: p=0,732
¶›Ó·Î·˜ 3: K·Ù·ÓÔÌ‹ ÙˆÓ 459 Á˘Ó·ÈÎÒÓ Ì ‹ ¯ˆÚ›˜ Âȯ›ÏÈÔ ¤ÚËÙ· Û ۯ¤ÛË Ì ÙËÓ ÂÌÌËÓfi·˘ÛË.
AÚÈıÌfi˜ ·ÛıÂÓÒÓ XˆÚ›˜ Âȯ›ÏÈÔ ¤ÚËÙ· M Âȯ›ÏÈÔ ¤ÚËÙ·
EÌÌËÓfi·˘ÛË N/% N/%
NAI 192/(41,83) 99/(21,56)
OXI 105/(22,87) 63/(13,72)
™‡ÓÔÏÔ 297/- 162/-
x2, p=0,054
39-43 ÛÂÏ. - Donta-Mpakogiani** 3-10-08 12:46 ™ÂÏ›‰· 40
ÙÂÚË ÂÚ›ÙˆÛË, Ì fiÛÔ˘˜ ›¯·Ó ÛÙÔ ·ÚÂÏıfiÓ Âȯ›ÏÈÔ¤ÚËÙ· Ó· Â›Ó·È ‰ËÏ·‰‹ ÂÚÈÛÛfiÙÂÚÔ ÂÓËÌÂڈ̤ÓÔÈ fiÙÈÂ›Ó·È ÌÂÙ·‰ÔÙÈÎfi˜ (Pearson x2, ¤ÏÂÁ¯Ô˜ P=0.054). AÓÙ›ıÂ-Ù· ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ÙËÓ ÂÚÒÙËÛË Û¯ÂÙÈο Ì ÙÔ ·Ó ÔÊ›ÏÂÙ·È Û Èfi ‹ fi¯È(Pearson x2, ¤ÏÂÁ¯Ô˜ P=0.456, ¶›Ó·Î·˜ 4).
OÈ ·ÛıÂÓ›˜ Ô˘ ·¿ÓÙËÛ·Ó ÛÙ· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ù˘·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È Â›¯·Ó ÛÙÔ ·ÚÂÏıfiÓ Âȯ›ÏÈÔ ¤Ú-ËÙ· ÂÚˆÙ‹ıËÎ·Ó ÂÈϤÔÓ fiÙÂ Î·È ÔÈ¿ ÂÔ¯‹ ÙÔ˘ ¤-ÙÔ˘˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·Ó ÈÔ Û˘¯Ó¿ ÔÈ ÚÔÛ‚ÔϤ˜, ·Ó Ë ÂÌ-Ê¿ÓÈÛ‹ ÙÔ˘˜ Û˘Óԉ¢fiÙ·Ó ·fi fiÓÔ ‹ ο„ÈÌÔ, ηıÒ˜Î·È ·Ó ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î¿ÔÈ· ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ ‹·Ó ÙÔ˘˜ ÂÓÔ¯ÏÔ‡ÛÂ Ë ‚Ï¿‚Ë ·ÈÛıËÙÈο. OÈ 145 ·fi ÙÔ˘˜211 ·ÛıÂÓ›˜ Û˘Ó¤‰ÂÛ·Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Âȯ›ÏÈÔ˘¤ÚËÙ· Ì ÛÙÂÓÔ¯ÒÚÈ· (68,7%), ÂÓÒ ÔÈ 95 ·fi ÙÔ˘˜ 211(45,0%) ·ÛıÂÓ›˜ Û˘Ó¤‰ÂÛ·Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¤ÚËÙ·Ì ¿ÏÏË „˘¯È΋ ‹ ۈ̷ÙÈ΋ ηٷfiÓËÛË (EÈÎfiÓ˜ 1&2).H ÂÌÊ¿ÓÈÛË ÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ· ‰ÂÓ Û˘Û¯ÂÙÈ˙fiÙ·Ó ÌÂÌÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÂÔ¯‹ ‰ÈfiÙÈ ÔÈ 150 (71,1%) ·fi ÙÔ˘˜ Â-ÚˆÙËı¤ÓÙ˜ ·¿ÓÙËÛ·Ó fiÙÈ ÔÈ ÚÔÛ‚ÔϤ˜ ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·Ó ÔÔÈ·‰‹ÔÙ ÂÔ¯‹. (¶›Ó·Î·˜ 5).
E›Û˘, Û ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi, Ô Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜‚Ú¤ıËΠӷ Û˘Óԉ‡ÂÙ·È ·fi fiÓÔ ‹ ο„ÈÌÔ (154/211,73%) ÂÓÒ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ (141/211, 66,8%) ¯ÚË-ÛÈÌÔÔÈÔ‡Û ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹, ÛÙËÓ ÂÚ›ÙˆÛË ÂÌ-Ê¿ÓÈÛ˘ ÙÔ˘ ¤ÚËÙ·. EηÙfiÓ Û·Ú¿ÓÙ· ·fi ÙÔ˘˜ ‰È·Îfi-ÛÈÔ˘˜ ¤ÓÙÂη ·ÛıÂÓ›˜ (66,4%), ·Ó¤ÊÂÚ·Ó fiÙÈ ıˆÚÔ‡-Û·Ó ÙÔÓ ¤ÚËÙ· ÂÓÔ¯ÏËÙÈ΋ ‚Ï¿‚Ë. (¶›Ó·Î·˜ 5)
™YZHTH™H
OÚÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ÛÙËÓ AÁÁÏ›· ¤-¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÌÂٷ͇ 50% Î·È 100% ÙÔ˘ ÏËı˘ÛÌÔ‡ ¤-¯Ô˘Ó ÚÔÛ‚ÏËı› ·fi ÙÔÓ Èfi ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛ‹ ÙÔ˘˜.ŒÓ· ÌÈÎÚfi ÔÛÔÛÙfi (ÂÚ›Ô˘ 40%) ÂΉËÏÒÓÂÈ ÂÚËÙÈ΋‚Ï¿‚Ë ÌÂÙ¿ ·fi οÔÈ· ¯ÚfiÓÈ· ˆ˜ ·Ó·˙ˆ‡ÚˆÛË Ì ÙËÓÌÔÚÊ‹ ˘ÔÙÚÔ‹˜ Î·È Î˘Ú›ˆ˜ ˆ˜ Âȯ›ÏÈÔ ¤ÚËÙ·2. O Â-ȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ ‰Â˘ÙÂ-ÚÔ·ıÔ‡˜ ÂÚËÙÈ΋˜ Ïԛ̈͢ Î·È Û ·ÚÎÂÙ¿ ¿ÙÔÌ· ˘-ÔÙÚÔÈ¿˙ÂÈ 2-3 ÊÔÚ¤˜ ÙÔÓ ¯ÚfiÓÔ, ÂÓÒ Û ¿ÏÏ· ÔÈ ˘Ô-ÙÚÔ¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ·Ú·È¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·12.¢È¿ÊÔÚ˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Û ÔÛÔÛÙ¿ ·fi 10 ¤-ˆ˜ 21,3% Û ·ÛıÂÓ›˜ Ì Âȯ›ÏÈÔ ¤ÚËÙ· ›¯Â ÚÔËÁË-ı› ÚˆÙÔ·ı‹˜ ÂÚËÙÈ΋ Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·2, 13. ÕÏϘ ÌÂ-ϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó ÔÛÔÛÙfi ÂÌÊ¿ÓÈÛ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ·16,3% ÌÂٷ͇ ÙˆÓ ÊÔÈÙËÙÒÓ Î·È 30,7% ÌÂٷ͇ ÙÔ˘ ÚÔ-ÛˆÈÎÔ‡ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜14, 15. OÈ ‰È·Î˘Ì¿ÓÛÂȘ Û˘-
41
EȉËÌÈÔÏÔÁÈ΋ MÂϤÙË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 39-43, 2004
EÓË̤ڈÛË ·ÛıÂÓÒÓ AÚÈıÌfi˜ ·ÛıÂÓÒÓ %
¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜
K·Ù¿ ÙËÓ ¤ÌÌËÓÔ Ú‡ÛË 3 1,4
MÂÙ¿ ·fi ÛÙÂÓÔ¯ÒÚÈ· 145 68,7
K·Ù¿ ÙȘ ÂÍÂÙ¿ÛÂȘ 1 0,5
™ÙË ı¿Ï·ÛÛ· 4 1,9
ÕÏÏË ÛˆÌ·ÙÈ΋ ‹ „˘¯È΋ ηٷfiÓËÛË 95 45,0
¢È·ÊÔÚÂÙÈο-‰ÂÓ ·¿ÓÙËÛ·Ó 34 16,1
Eԯȷ΋ ηٷÓÔÌ‹
ÕÓÔÈÍË 11 5,2
K·ÏÔη›ÚÈ 13 6,2
ºıÈÓfiˆÚÔ 7 3,3
XÂÈÌÒÓ·˜ 39 18,5
OÔÈ·‰‹ÔÙ ÂÔ¯‹ 150 71,1
™˘Ìو̷ÙÔÏÔÁ›· (ÎÓËÛÌfi˜ ‹ fiÓÔ˜) 154 73,0
£Âڷ¢ÙÈ΋ ·ÁˆÁ‹ 141 66,8
AÈÛıËÙÈÎfi ‹ ÏÂÈÙÔ˘ÚÁÈÎfi Úfi‚ÏËÌ· 140 66,4
EÈÎ. 1: ¶ÔÏÏ·Ïfi˜ Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ Û ¿Ó‰Ú· 37 ÂÙÒÓ, ÌÂÙ¿ ·-fi Â̇ÚÂÙÔ ÎÚ˘ÔÏfiÁËÌ·.
EÈÎ. 2: Eȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ÛÙÔ Î¿Ùˆ ¯Â›ÏÔ˜ Ì ¤ÎÙ·ÛË ÛÙÔ‚ÏÂÓÓÔÁfiÓÔ Û ÎÔÚ›ÙÛÈ 15 ÂÙÒÓ ÌÂÙ¿ ·fi Ô‰ÔÓÙÈ·ÙÚÈ΋ Ú¿ÍË.
¶›Ó·Î·˜ 4: K·Ù·ÓÔÌ‹ ÙˆÓ 650 ·ÛıÂÓÒÓ ¯ˆÚ›˜ Âȯ›ÏÈÔ ¤ÚËÙ· ˆ˜ ÚÔ˜ ÙË ÁÓÒÛË ÙÔ˘˜ ·Ó Ô ¤ÚËÙ·˜
ÔÊ›ÏÂÙ·È Û Èfi Î·È ·Ó Â›Ó·È ÌÂÙ·‰ÔÙÈÎfi˜.
°ÓÒÛË ·ÛıÂÓÒÓ XˆÚ›˜ Âȯ›ÏÈÔ ¤ÚËÙ· M Âȯ›ÏÈÔ ¤ÚËÙ·N/% N/%
*OÊ›ÏÂÙ·È Û ÈfiNAI 320/(49,2) 148/(22,76)OXI 119/(18,30) 63/(9,69)
**E›Ó·È ÌÂÙ·‰ÔÙÈÎfi˜NAI 268/(41,23) 112/(17,23)OXI 171/(26,30) 99/(15,23)
*x2, p=0,456* *x2, p=0,054
¶›Ó·Î·˜ 5: K·Ù·ÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ Ì Âȯ›ÏÈÔ ¤ÚËÙ· ·Ó¿ÏÔÁ· Ì ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚Ï¿‚˘.
39-43 ÛÂÏ. - Donta-Mpakogiani** 3-10-08 12:46 ™ÂÏ›‰· 41
¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ‚Ï¿‚˘ Èı·ÓfiÓ ÔÊ›ÏÔÓÙ·È ÛÙ·‰È·ÊÔÚÂÙÈο ‰Â›ÁÌ·Ù· ÏËı˘ÛÌÔ‡ Ô˘ ÌÂÏÂÙÒÓÙ·È9, 16. H ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ˘ÔÙÚÔ‹˜ Û¯ÂÙ›˙ÂÙ·È Â›Ù ÌÂÙÒÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ¿Ì˘Ó·˜ ‹ ÔÊ›ÏÂÙ·È Û ÙÔÈ-ÎÔ‡˜ ÊÏÂÁÌÔÓÒ‰ÂȘ, ÙÚ·˘Ì·ÙÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔÓ Èfi. H ·Ó·˙ˆ‡ÚˆÛË ·˘Ù‹ ÙÔ˘ ¤ÚËÙ·Â͈ÛÙÔÌ·ÙÈο, ΢ڛˆ˜ ÛÙÔ ÂÚ˘ıÚfi ÎÚ¿ÛÂ‰Ô ÙÔ˘ ¯Â›-ÏÔ˘˜, Ì ÙË ÌÔÚÊ‹ Âȯ›ÏÈÔ˘ ¤ÚËÙ· Î·È fi¯È ÛÙÔ ‚ÏÂÓ-ÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·Ô‰›‰ÂÙ·È ÛÙËÓ ÂȉÈ΋ ‰Ú¿ÛË ÙÔ˘Û¿ÏÈÔ˘3, 10, 11. TÔ Û¿ÏÈÔ Ê·›ÓÂÙ·È ˆ˜ ‰Ú· ÛÙ· ·ÙÙ·Ú· ÙÔ˘ÂÈıËÏ›Ô˘ ηٿ Ù˘ ÏÔÈÌÔÁfiÓÔ˘ ‰Ú¿Û˘ ÙÔ˘ ÈÔ‡ ÙÔ˘ ¤Ú-ËÙ· Î·È ¤ÙÛÈ ÚÔÛٷهÂÈ ÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜·fi ÙȘ ˘ÔÙÚÔ¤˜ Ù˘ ‚Ï¿‚˘ ˆ˜ ¤Ó· ‚·ıÌfi. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· Ô Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ·Ó·Ê¤ÚıË-Π۠ÔÛÔÛÙfi 32,5% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ·ÛıÂÓÒÓ ÌÂÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ. OÈÔÚÌÔÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Èı·ÓfiÓ ·ÔÙÂÏÔ‡Ó ·ÈÙÈÔÏÔÁÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·˘Ù‹˜ Ù˘ ‰È·ÊÔÚ¿˜9, 12, 13.™ÙËÓ ÂÚÒÙËÛË ·Ó ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÔÈ ‚Ï¿‚˜ ÔÊ›ÏÔÓÙ·È ÛÂÈfi, ÔÈ ÂÚˆÙËı¤ÓÙ˜ ·ÛıÂÓ›˜ ·¿ÓÙËÛ·Ó ıÂÙÈο Û ÔÛÔ-ÛÙfi ÂÚ›Ô˘ 72% Î·È Û ÔÛÔÛÙfi ÂÚ›Ô˘ 59% ÁÓÒÚÈ-˙·Ó fiÙÈ Ë ‚Ï¿‚Ë Â›Ó·È ÌÂÙ·‰ÔÙÈ΋. ŒÚ¢ӷ Û AÁÁÏÈÎfiÏËı˘ÛÌfi ·Ó·Ê¤ÚÂÈ fiÙÈ ÙÔ 50% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ·ÛıÂ-ÓÒÓ ·¿ÓÙËÛ·Ó fiÙÈ ÁÓˆÚ›˙Ô˘Ó ÙËÓ ÈÔÁÂÓ‹ ÚԤϢÛËÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ·2. ¶Ú¿ÁÌ·ÙÈ Ë ‚Ï¿‚Ë ·˘Ù‹ Â›Ó·È Â˘-Ú¤ˆ˜ ÁÓˆÛÙ‹ Î·È ·Ó·ÁÓˆÚ›˙ÂÙ·È Â‡ÎÔÏ· ·fi ÙÔÓ ÁÂÓÈÎfiÏËı˘ÛÌfi, fï˜, Ë ÁÓÒÛË Ù˘ ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ ÙË˜Â›Ó·È ÂÏÏÈ‹˜ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ Ï·Ì‚¿ÓÔÓÙ·È Â·Ú-΋ ÚÔÊ˘Ï·ÎÙÈο ̤ÙÚ· ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÌÂÙ¿‰Ô-Û˘ Ù˘ Ïԛ̈͢17. I‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÁÈ· ÙËÓ ‰È·ÛÔ-Ú¿ Ù˘ Ïԛ̈͢ ı· Ú¤ÂÈ Ó· ‰›ÓÂÙ·È Û ÂȉÈΤ˜ ÔÌ¿‰Â˜·ÙfiÌˆÓ fiˆ˜ Û ÓÂÔÁÓ¿ Î·È Û ·ÛıÂÓ›˜ Ì ‚‚·ÚË̤ÓÔÈ·ÙÚÈÎfi ÈÛÙÔÚÈÎfi18, 19.ø˜ ÚÔ˜ ÙËÓ ÂÌÌËÓfi·˘ÛË Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Âȯ›ÏÈÔ˘¤ÚËÙ· ‰ÂÓ ‚Ú¤ıËΠӷ ̆ ¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË. M ÙÔ Â‡ÚË-Ì· Û˘ÌʈÓÔ‡Ó Î·È ¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜13.ø˜ ÚÔ˜ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ˘ÔÙÚÔÒÓ ··ÓÙ‹ıËΠfiÙÈÔÈΛÏÂÈ ·fi ÌÈ· ÊÔÚ¿ ÙÔ ¯ÚfiÓÔ ‹ Î·È Û·ÓÈfiÙÂÚ·, ̤¯ÚÈÌÈ· ÊÔÚ¿ ÙÔ Ì‹Ó· ÛÙËÓ ›‰È· Û˘Ó‹ıˆ˜ ı¤ÛË ÂÌÊ¿ÓÈÛ˘.™‡Ìʈӷ Ì ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ Û˘ÁÁÚ·Ê›˜, Ô Èfi˜ ÌÂ-Ù¿ ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË ÂÈÛ¤Ú¯ÂÙ·È Û ϷÓı¿ÓÔ˘Û·Î·Ù¿ÛÙ·ÛË ÛÙ· ·ÈÛıËÙÈο Á¿ÁÁÏÈ· ÙÔ˘ ÙÚȉ‡ÌÔ˘ Ù˘ Â-ÚÈÔ¯‹˜ Î·È ·ÚÁfiÙÂÚ· ÂÓÂÚÁÔÔÈÂ›Ù·È Î·È ÚÔηÏ› ˘Ô-ÙÚÔÈ¿˙Ô˘Û· ‚Ï¿‚Ë ÌÂÙ¿ ·fi ÔÈΛÏÔ˘˜ ÚԉȷıÂÛÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (ËÏÈ·Îfi ¤Áη˘Ì· ¯ÂÈϤˆÓ, ÙÚ·˘Ì·ÙÈ-ÛÌfi˜ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Î·Ù¿ ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ Ú¿ÍË, ¤Ì-ÌËÓ·, ηٷfiÓËÛË, ÚÔÛ‚ÔÏ‹ ·fi ÁÚ›Ë). EÓÙÔ›˙ÂÙ·ÈÛ˘Ó‹ıˆ˜ ÛÙÔ ÂÚ˘ıÚfi ÎÚ¿Û‰Ô, ÂÚÈÛÙÔÌ·ÙÈ΋ ÂÚÈÔ-¯‹ Î·È ÔÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÂÓ‰ÔÛÙÔÌ·ÙÈο, ÛÙÔÓ ·Î›ÓËÙÔÛ˘Ó‹ıˆ˜ ‚ÏÂÓÓÔÁfiÓÔ fiˆ˜ ˘ÂÚÒ· Î·È Ô‡Ï·9, 11, 13, 17, 18.AÓ Î·È Â›Ó·È Û·Ê‹˜ Ë ¿Ô„Ë fiÙÈ Ô Èfi˜ ·Ú·Ì¤ÓÂÈ ÛÙ· ·È-ÛıËÙÈο Á¿ÁÁÏÈ· Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË, Û‹ÌÂÚ· Â-ÈÎÚ·Ù› Ë ı¤ÛË fiÙÈ Ô Èfi˜ ηÙÔÈΛ Î·È ÛÙ· ԇϷ ‹ Û ¿Ï-ÏÔ˘˜ Â͈‰ÂÚÌÈÎÔ‡˜ ÈÛÙÔ‡˜13, 16, 17, 19, 20.ø˜ ÚÔ˜ ÙËÓ ÂÔ¯È΋ ηٷÓÔÌ‹, ‚Ú¤ıËΠfiÙÈ ÛÙÔ ÌÂÁ·-χÙÂÚÔ ÔÛÔÛÙfi ÔÈ ·ÛıÂÓ›˜ ·Ó¤ÊÂÚ·Ó fiÙÈ ÔÈ ̆ ÔÙÚÔ¤˜ÙÔ˘ Âȯ›ÏÈÔ˘ ¤ÚËÙ· ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÔÈ·‰‹ÔÙ Â-Ô¯‹. M ÙÔ Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓÔ‡Ó Î·È ¿ÏÏÔÈ Û˘Á-ÁÚ·Ê›˜ Û ÌÂϤÙ˜ ÙÔ˘˜, fiÔ˘ ̆ ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ‚Ï¿-
‚Ë ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ Û˘ÁÎÂÎÚÈ̤ÓË ÂÔ¯È΋ ηٷÓÔÌ‹20, 21.ø˜ ÚÔ˜ ÙËÓ Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ ‚Ï¿‚˘, Û ˘„ËÏ¿ÔÛÔÛÙ¿ ·Ó·Ê¤ÚıËÎ·Ó Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· fiˆ˜ÎÓËÛÌfi˜ ‹ Ó˘ÁÌ҉˘ fiÓÔ˜, Ù· ÔÔ›· Â›Ó·È Èı·ÓfiÓ Ó·ÂÌÊ·Ó›˙ÔÓÙ·È Î·È Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ‚Ï¿‚˘. (¶›Ó·-η˜ 5). E›Û˘ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Èı·ÓfiÓ Ó· ·Ó·-ÊÂÚı› ·›ÛıËÌ· ·Ú·ÈÛıËÛ›·˜ Ù˘ ÂÚÈÔ¯‹˜ Î·È Ó· ‰È·-ÁÓˆÛıÔ‡Ó ‰ÈÔÁΈ̤ӷ Î·È ÂÒ‰˘Ó· ·˘¯ÂÓÈο Î·È ˘Ô-ÁÓ¿ıÈ· ÏÂÌÊÔÁ¿ÁÏÈ·12, 13, 20, 21.ø˜ ÚÔ˜ ÙËÓ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ÔÈ ÂÚˆÙËı¤ÓÙ˜·Ó¤ÊÂÚ·Ó Û ˘„ËÏfi ÔÛÔÛÙfi (ÂÚ›Ô˘ 70%), fiÙÈ ¯ÚËÛÈ-ÌÔÔÈÔ‡Ó Î¿ÔÈ· ıÂڷ¢ÙÈο Û¯‹Ì·Ù·, fi¯È ¿ÓÙ· ‚¤-‚·È· Ù· ηٿÏÏËÏ·, (ÈÒ‰ÈÔ, Ô͢˙ÂÓ¤, ÔÈÓfiÓÂ˘Ì·, ·Î˘-ÎÏÔ‚›ÚË Î.·.), ‰ÈfiÙÈ ÙÔ˘˜ ··Û¯ÔÏ› Ë ‚Ï¿‚Ë Î˘Ú›ˆ˜ ˆ˜ÚÔ˜ ÙËÓ ·ÈÛıËÙÈ΋. MÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ô Âȯ›-ÏÈÔ˜ ¤ÚËÙ·˜ ‰ÂÓ ··ÈÙ› Û˘Ó‹ıˆ˜ ıÂڷ›· Î·È Ë ÂÔ‡-ψÛË ÙÔ˘ Û˘ÓÙÂÏÂ›Ù·È Û ‰È¿ÛÙËÌ· 10-15 ËÌÂÚÒÓ22. H ·-΢ÎÏÔ‚›ÚË (zovirax), Ë ÔÔ›· ·ÔÙÂÏ› Î·È ÙÔ ÂȉÈÎfi, ·-ÓÙÈÂÚËÙÈÎfi Ê¿ÚÌ·ÎÔ ÌÂÈÒÓÂÈ ÙË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ù˘‚Ï¿‚˘ Î·È Î·Ù·ÛÙ¤ÏÏÂÈ ÙȘ ˘ÔÙÚÔ¤˜23-26.T¤ÏÔ˜, ˆ˜ ÚÔ˜ ÙÔ ·ÈÛıËÙÈÎfi Úfi‚ÏËÌ· Ô˘ ÚÔηÏ› Ë‚Ï¿‚Ë, Û ˘„ËÏ¿ ÔÛÔÛÙ¿ ‰fiıËΠıÂÙÈ΋ ·¿ÓÙËÛË ÁÈ··˘Ùfi Î·È ÔÈ ·ÛıÂÓ›˜ ÂÈı˘ÌÔ‡Ó ÙËÓ ıÂڷ¢ÙÈ΋ Ù˘ ·-ÓÙÈÌÂÙÒÈÛË14, 19.™˘ÌÂÚ·ÛÌ·ÙÈο Ô Âȯ›ÏÈÔ˜ ¤ÚËÙ·˜ ·ÔÙÂÏ› Û˘¯Ófi‡ÚËÌ· ÛÙÔÓ EÏÏËÓÈÎfi ÏËı˘ÛÌfi. H ÂÓË̤ڈÛË ÙÔ˘ÏËı˘ÛÌÔ‡ ηÙfiÈÓ ÙÔ‡ÙÔ˘, ˆ˜ ÚÔ˜ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤-ÓÂÈ· Î·È ÙËÓ ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ÙÔ˘ ÈÔ‡, Â›Ó·È È‰È·›ÙÂÚ· ÛË-Ì·ÓÙÈ΋ ·fi ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ. E›Û˘ ÔÈ ·ÛıÂÓ›˜ ı· Ú¤-ÂÈ Ó· Û˘Ì‚Ô˘Ï‡ÔÓÙ·È ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ ÁÈ· ÙÔ ÂӉ¯fiÌÂ-ÓÔ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ˚΋˜ ·ÁˆÁ‹˜, ‰ÈfiÙÈ ¤ÙÛÈ ı· ÌÂȈı› ˉȷÛÔÚ¿ ÙÔ˘ ÈÔ‡, ·ÏÏ¿ Î·È Ô ÂÓÔÊı·ÏÌÈÛÌfi˜ ÙÔ˘ ÛÙ·¯¤ÚÈ· Î·È ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜.
SUMMARY
"Incidence and trigger factors of herpes labialis(HL) in adults"
C. Donta-Bakoyianni, O. Nikolatou-Galitis,V.S. Papanicolaou
hellenic stomatological review 48: 39-43, 2004
The aim of the present research was to determine Greekpeople's knowledge of HL in terms of causation,frequency of occurence and precipitating factors. The material of this study consisted of 650questionnaires-files of dental patients who were attendingthe Oral Diagnosis and Radiology Clinic of Dental Schoolof Athens University for treatment. These questionnaireswere completed in cooperation with the researchers(specialised authors) and patients. The 191questionnaires (29.4%) corresponded to males and the459 (70.6%) to females with the mean age of 43.7 yearsold.The frequency of the lesion occurrence showed that 211patients (32.5%) mentioned a positive history of HL.Specifically, the female to male ratio of patients with apositive HL history was 4:1. As for the age, statistical
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differences have not been established between the pa-tients who mentioned HL symptoms and those who hadnot mentioned the manifestation of the lesion. Also, therewas no statistical difference among the females withregular menstruation and those who had gone throughthe menopause. Finally, the 58.4% of the patients wereaware of the HL contamination, whereas the 71.9% of thepatients were informed that a virus was the aetiologicfactor of this lesion. Stress was referred as the main precipitating factor of HLmanifestation (68.7%) and its prevalence doesn't relate toa certain season (71.1%).In conclusion, HL is a frequent condition among Greekpopulation. Therefore, it is essential that patients areproperly informed by the dentist of the aetiopathogenesisand the contamination of the virus.
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39-43 ÛÂÏ. - Donta-Mpakogiani** 3-10-08 12:46 ™ÂÏ›‰· 43
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¢ÂÛÌÔÂȉ‹˜ Èӈ̿وÛË (‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜) Ù˘ ÛÙÔÌ·ÙÈ΋˜ÎÔÈÏfiÙËÙ·˜ Î·È ÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ:
¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘ Î·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË
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O fiÚÔ˜ Èӈ̿وÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ÔÌ¿‰· ˘ÂÚÏ·ÛÈÒÓ ·fi ÈÓÔ‚Ï¿ÛÙ˜ Î·È Ì˘Ô˚ÓÔ‚Ï¿ÛÙ˜ ÔÈ Ôԛ˜¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ̆ ÔÙÚÔÈ¿˙Ô˘Ó Î·È Ó· ‰ÈËıÔ‡Ó ÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜. O fiÚÔ˜ ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ÙÔÓ›ÛÂÈ ÙËÓ Û‡ÛÙ·ÛË ÙÔ˘˜ Ô˘ ÌÔÈ¿˙ÂÈ Ì ·˘Ù‹Ó ‰ÂÛÌ›‰·˜ ‹ Ù¤ÓÔÓÙ·. ¢È·ÎÚ›ÓÔÓÙ·ÈÛ ‰‡Ô ÌÂÁ¿Ï˜ ÔÌ¿‰Â˜, ÙȘ ÂÈÔÏ‹˜ Î·È ÙȘ ÂÓ Ùˆ ‚¿ıÂÈ. H ‰Â‡ÙÂÚË ÔÌ¿‰· ·Ó¿ÏÔÁ· ¿ÏÈ Ì ÙËÓ ÂÓÙfiÈ-ÛË ̆ ԉȷÈÚÂ›Ù·È ÛÙȘ ‰ÂÛÌÔÂȉ›˜ Èӈ̷ÙÒÛÂȘ ÂÎÙfi˜ Ù˘ ÎÔÈÏȷ΋˜ ̄ ÒÚ·˜ (Â͈ÎÔÈÏȷΤ˜), Ù˘ ÎÔÈÏȷ΋˜¯ÒÚ·˜, Î·È ÛÙȘ ÂÓ‰ÔÎÔÈÏȷΤ˜. O ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ ÛÙËÓ ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ÛÙÔ˘˜ ÂÚÈÛÙÔÌ·ÙÈ-ÎÔ‡˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ ‰ÂÓ Â›Ó·È Û˘¯Ófi˜. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì›· ÂÚ›ÙˆÛË ‰ÂÛÌÔÂÈ-‰Ô‡˜ fiÁÎÔ˘ Û Á˘Ó·›Î· ËÏÈΛ·˜ 32 ÂÙÒÓ Ì ÂÓÙfiÈÛË ÛÙÔÓ ˘Ô‚ÏÂÓÓÔÁfiÓÈÔ ¯ÈÙÒÓ· Ù˘ ·ÚÂÈ¿˜. O fiÁÎÔ˜‹Ù·Ó ·ÓÒ‰˘ÓÔ˜, ηϿ ÂÚÈÁÂÁÚ·Ì̤ÓÔ˜, ÌÂÁ¤ıÔ˘˜ 1X1cm Î·È ÂÌÊ·Ó›ÛıËΠÚÔÙÔ‡ 2 ¯ÚfiÓÈ·. H ÎÏÈÓÈ΋‰È¿ÁÓˆÛË ‹Ù·Ó ηÏfiËı˜ ÓÂfiÏ·ÛÌ· ÙÔ˘ ÌÂÛÂÁ¯‡Ì·ÙÔ˜ Î·È ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ. K·Ù¿ ÙËÓ ¯ÂÈÚÔ˘Ú-ÁÈ΋ ¤̂·ÛË ‰È·ÈÛÙÒıËΠ‰È‹ıËÛË ÙÔ˘ ‚˘Î·ÓËÙ‹ ̇ ·fi ÙÔÓ fiÁÎÔ, ÔfiÙ ڷÁÌ·ÙÔÔÈ‹ıËΠ¢Ú›·¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ì fiÚÈ· ˘ÁÈÒÓ ÈÛÙÒÓ. MÂÙ¿ ·fi 40 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ·ÛıÂÓÔ‡˜ ‰ÂÓ ÂÌ-Ê·Ó›ÛıËΠÌÂÙ¿ÛÙ·ÛË ‹ ̆ ÔÙÚÔ‹. H ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔÌÒÓ ̄ ÚˆÛÌ¤ÓˆÓ Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Î·È ËˆÛÈÓˉȤÁÓˆÛ ÙËÓ ‡·ÚÍË ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ÂÓ‹ÏÈη, ÂÓÒ Û ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈΤ˜ ¯ÚÒÛÂȘ Ù· ·ÙÙ·Ú· ÙÔ˘ fi-ÁÎÔ˘ ‹Ù·Ó ıÂÙÈο ÛÙËÓ ‚ÈÌÂÓÙ›ÓË, ·ÎÙ›ÓË Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ‰ÂÛÌ›ÓË. OÈ ˘Ú‹Ó˜ Ï›ÁˆÓ ΢ÙÙ¿ÚˆÓÛ ΢ÙÙ·ÚÔ‚ÚÈı›˜ ÂÚÈÔ¯¤˜ ÙÔ˘ fiÁÎÔ˘ ‹Ù·Ó ıÂÙÈÎÔ› ÛÙÔÓ ‰Â›ÎÙË Î˘ÙÙ·ÚÈÎÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Ki-67. T··ÓÔÛÔ˚ÛÙÔ¯ËÌÈο ·˘Ù¿ Â˘Ú‹Ì·Ù· ÂÓ›Û¯˘Û·Ó ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË. Afi ÙË ÌÂϤÙË Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔ-ÁÚ·Ê›·˜ ÚÔ·ÙÂÈ fiÙÈ : O ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì·Ï·-ÎÒÓ ÈÛÙÒÓ ÂÓÙÔ›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· (39.9 %) ÛÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ Á‡Úˆ ·fi ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ. O ̤ÛÔ˜fiÚÔ˜ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ̤¯ÚÈ ÙËÓ ‰È¿ÁÓˆÛË Â›Ó·È 3.4 Ì‹Ó˜ Î·È Ù˘ ÌÂ-Á·Ï‡ÙÂÚ˘ ‰È¿ÛÙ·Û‹˜ ÙÔ˘ 3.8cm.H ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·›ÓÂÙ·È ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ̤¯ÚÈ 70 ÂÙÒÓ,Ì ̤ÛÔ fiÚÔ 10.4 ¤ÙË. ™˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ Ì ÂÏ·ÊÚ¿ ÚÔÙ›ÌËÛËÛÙÔ ·Ó‰ÚÈÎfi ʇÏÔ (1.2:1). YÔÙÚÔÈ¿˙ÂÈ Û ÔÛÔÛÙfi 22%-23.8%.H ¢Ú›· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Â›Ó·ÈıÂڷ›· ÂÎÏÔÁ‹˜. H ÈÛÙÔÏÔÁÈ΋ ‰È·ÊÔÚԉȿÁÓˆÛË ÙÔ˘ ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙȉڷ-ÛÙÈ΋ ›ÓˆÛË, ÙËÓ Ô˙Ò‰Ë ÂÚÈÙÔÓÈ˚Ùȉ·, Î·È ÙÔ Î·Ï¿ ‰È·ÊÔÚÔÔÈË̤ÓÔ ÈÓÔÛ¿ÚΈ̷.H ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙÔ˘‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. TÚ·˘Ì·ÙÈÛÌÔ›, ÁÂÓÂÙÈÎÔ› Î·È ÔÚÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ ıˆڋıË-Î·Ó ˘Â‡ı˘ÓÔÈ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ÏÏÔ›ˆÛ˘.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 45-50, 2004
§¤ÍÂȘ ÎÏÂȉȿ: ¢ÂÛÌÔÂȉ‹˜ Èӈ̿وÛË, E͈ÎÔÈÏÈ·Îfi˜ ‰ÂÛÌÔÂÈ-‰‹˜ fiÁÎÔ˜, EÈıÂÙÈ΋ Èӈ̿وÛË.
* AÓ·Ï. K·ıËÁËÙ‹˜** AÓ·Ï. K·ıËÁËÙ‹˜
*** EÈÎ. K·ıËÁËÙ‹˜**** AÓ·Ï. K·ıËÁËÙ‹˜
O‰ÔÓÙÈ·ÙÚÈÎfi TÌ‹Ì· A.¶.£.
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O fiÚÔ˜ Èӈ̿وÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ÔÌ¿‰· ̆ ÂÚÏ·ÛÈÒÓ·fi ÈÓÔ‚Ï·ÛÙ˜ Î·È Ì˘Ô˚ÓÔ‚Ï¿ÛÙ˜ Ô˘ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó·‰ÈËıÔ‡Ó ÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ Î·È Ó· ˘ÔÙÚÔÈ¿-˙Ô˘Ó1. ¶ÂÚÈÁÚ¿ÊËÎ·Ó ÚÒÙË ÊÔÚ¿ ÙÔ 1832 ·fi ÙÔÓMcFarlane2 ÂÓÒ Ô fiÚÔ˜ ‰ÂÛÌÔÂȉ‹˜ Èӈ̿وÛË ‹ ‰ÂÛÌÔÂÈ-‰‹˜ fiÁÎÔ˜ , Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ì¤¯ÚÈ Û‹ÌÂÚ·, ‰fiıËÎÂÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1838 ·fi ÙÔÓ Muller3 ÙÔÓ›˙ÔÓÙ·˜ ÙËÓÛ‡ÛÙ·ÛË ÙÔ˘˜ Ô˘ ÌÔÈ¿˙ÂÈ Ì ‰¤ÛÌË ‹ Ù¤ÓÔÓÙ·. ™ÎÔfi˜Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË Ì›·˜ ÂÚ›ÙˆÛ˘‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ Î·È Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË.
45
45-50 sel. - Iordanidis** 3-10-08 12:48 ™ÂÏ›‰· 45
BIB§IO°PAºIKH ANA™KO¶H™H
OÈ ‰ÂÛÌÔÂȉ›˜ Èӈ̷ÙÒÛÂȘ (‰ÂÛÌÔÂȉ›˜ fiÁÎÔÈ) Û˘Ó·-ÓÙÒÓÙ·È Û fiϘ ÙȘ ËÏÈ˘, Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ·ÙËÓ 3Ë Î·È 4Ë ‰ÂηÂÙ›·1, 4-6. MÔÚ› Ó· ‰È·ÈÚÂıÔ‡Ó Û ‰‡ÔÌÂÁ¿Ï˜ ÔÌ¿‰Â˜: ™ÙȘ ÂÈÔÏ›˜ Î·È ÛÙȘ ÂÓ Ùˆ ‚¿ıÂÈ. H‰Â‡ÙÂÚË ÔÌ¿‰· ¿ÏÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ‰Â-ÛÌÔÂȉÒÓ Èӈ̷ÙÒÛÂˆÓ ¯ˆÚ›˙ÂÙ·È Û ÙÚ›˜ ˘ÔÔÌ¿‰Â˜:™ÙȘ ‰ÂÛÌÔÂȉ›˜ Èӈ̷ÙÒÛÂȘ ÂÎÙfi˜ Ù˘ ÎÔÈÏȷ΋˜ ̄ ÒÚ·˜(Â͈ÎÔÈÏȷΤ˜), ÛÙȘ ‰ÂÛÌÔÂȉ›˜ Èӈ̷ÙÒÛÂȘ Ù˘ ÎÔÈÏÈ·-΋˜ ¯ÒÚ·˜, Î·È ÛÙȘ ÂÓ‰ÔÎÔÈÏȷΤ˜ ‰ÂÛÌÔÂȉ›˜ Èӈ̷ÙÒ-ÛÂȘ1, 7. O Â͈ÎÔÈÏÈ·Îfi˜ ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ ÂÓÙÔ›˙ÂÙ·È Û˘-¯ÓfiÙÂÚ· ÛÙÔ˘˜ ÒÌÔ˘˜, ÛÙËÓ Ï¿ÙË Î·È ÛÙÔ˘˜ ÌËÚÔ‡˜1, 8.AÎfiÌ· ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Gardner Ô˘¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÂÓÙÂÚÈÎÒÓ ÔχԉˆÓ,ÔÛÙÂˆÌ¿ÙˆÓ Î·È ‰ÂÚÌ·ÙÈÎÒÓ Î‡ÛÙˆÓ9. ™ÙËÓ ÂÚÈÔ¯‹ Ù˘ÎÂÊ·Ï‹˜ Î·È ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ô ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ ÂÌÊ·Ó›-˙ÂÙ·È Û ÔÛÔÛÙfi 10%-30% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛˆÓ4, 7, 8, 10,
11. O ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ηÈÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ ‰ÂÓ Â›Ó·È Û˘¯Ófi˜12, 13.KÏÈÓÈο ÂÌÊ·Ó›˙ÂÙ·È Ì ÙËÓ ÌÔÚÊ‹ ¤ÓÙÔÓ· ÛÎÏËÚÔÂÏ·ÛÙÈ-΋˜ Ì¿˙·˜ Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ·ÓÒ‰˘ÓË ‹ ÂÒ‰˘ÓË.AÚÎÂÙ¤˜ ÊÔÚ¤˜ ÂÌÊ·Ó›˙ÂÈ ÂÚÈfi‰Ô˘˜ ·ÚÁ‹˜ Î·È ÁÚ‹ÁÔÚ˘·Ó¿Ù˘Í˘. H ‡·ÚÍË ÚfiÛıÂÙˆÓ ÎÏÈÓÈÎÒÓ Û˘Ìو̿وÓÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘. AÓ·-ʤÚıËΠ‰˘ÛÊ·Á›· Î·È ‰˘Û¯¤ÚÂÈ· ÔÌÈÏ›·˜ Ì ÂÓÙfiÈÛË ÙÔ˘‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ÛÙËÓ ÁÏÒÛÛ· Î·È ÙÚÈÁÌfi˜ Î·È ‰˘ÛÊ·-Á›· Ì ÂÓÙfiÈÛË ÛÙÔ˘˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ Á‡Úˆ ·fi ÙËÓ Î¿-Ùˆ ÁÓ¿ıÔ6, 8, 13, 14. O ̤ÛÔ˜ fiÚÔ˜ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘Ìو̿-ÙˆÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ‰ÂÛÌÔÂȉ‹ fiÁÎÔ˘ ̤¯ÚÈ ÙËÓ ‰È¿-ÁÓˆÛ‹ ÙÔ˘ Â›Ó·È 3.4 Ì‹Ó˜ Î·È Ô Ì¤ÛÔ˜ fiÚÔ˜ Ù˘ ÌÂÁ·Ï‡-ÙÂÚ˘ ‰È¿ÛÙ·Û‹˜ ÙÔ˘ 3.8 cm18. H ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î˘-Ì·›ÓÂÙ·È ·fi ÙËÓ ‚ÚÂÊÈ΋ ̤¯ÚÈ 70 ÂÙÒÓ, Ì ̤ÛÔ fiÚÔ 10.4¤ÙË. ™˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘˙ˆ‹˜ Ì ÂÏ·ÊÚ¿ ÚÔÙ›ÌËÛË ÛÙÔ ·Ó‰ÚÈÎfi ʇÏÔ (1.2 :1)12, 13.ø˜ ÚÔ˜ ÙËÓ ÂÓÙfiÈÛ‹ ÙÔ˘ Û˘¯ÓfiÙÂÚ· Û˘Ó·ÓÙ¿Ù·È ÛÙÔ˘˜Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ Á‡Úˆ ·fi ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ (39.9%)13. HÛ˘¯ÓfiÙËÙ· ÂÓÙfiÈÛ˘ ÙÔ˘ ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ÛÙȘ ‰È¿ÊÔ-Ú˜ ÂÚÈÔ¯¤˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙˆÓ ÂÚÈÛÙÔ-Ì·ÙÈÎÒÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Û˘ÓÔ„›˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1.
¶›Ó·Î·˜ 1. EÓÙfiÈÛË 99 ÂÚÈÙÒÛÂˆÓ ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ÛÙËÓÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ÛÙÔ˘˜ ÂÚÈÛÙÔÌ·ÙÈÎÔ‡˜ Ì·Ï·ÎÔ‡˜ È-ÛÙÔ‡˜13.
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46
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ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 45-50, 2004
45-50 sel. - Iordanidis** 3-10-08 12:48 ™ÂÏ›‰· 46
ÓÂÙ·È Û ÔÛÔÛÙfi 22%-23.8% ÙˆÓ ·ÛıÂÓÒÓ Î·È Û˘Ó‹ıˆ˜fiÙ·Ó Ë ·Ú¯È΋ ·Ê·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘ Â›Ó·È ·ÙÂÏ‹˜5, 6, 10. HÈı·ÓfiÙËÙ· ·Ú·ÌÔÓ‹˜ ‰ÈËıËÌ¤ÓˆÓ ÈÛÙÒÓ Î·Ù¿ ÙËÓ ¯ÂÈ-ÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Â͈ÎÔÈÏÈ·ÎÒÓ ‰ÂÛÌÔÂȉÒÓ fiÁΈÓÂ›Ó·È ÌÂÁ·Ï‡ÙÂÚË31. EȉÈο Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ‰Â-ÛÌÔÂȉÒÓ fiÁÎˆÓ Ì¤Û· Û fiÚÈ· ̆ ÁÈÒÓ ÈÛÙÒÓ ÛÙËÓ ÂÚÈÔ¯‹Ù˘ ÎÂÊ·Ï‹˜ Î·È ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏË Ïfi-Áˆ Ù˘ ·ÚÔ˘Û›·˜ ÔÏÏÒÓ ˙ˆÙÈÎÒÓ ·Ó·ÙÔÌÈÎÒÓ ÛÙÔȯ›-ˆÓ13. AÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ÚÔÛ‚ÔÏ‹˜ Ù˘ οو ÁÓ¿ıÔ˘¤¯Ô˘Ó ·Ó·ÊÂÚı›14, 32-35. OÈ Â˘ÌÂÁ¤ıÂȘ ‰ÂÛÌÔÂȉ›˜ fiÁÎÔÈÙ˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì·-Ï·ÎÒÓ ÈÛÙÒÓ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÂÓÙ‡ˆÌ· ÛÙËÓοو ÁÓ¿ıÔ11 ÂÓÒ ÔÛÙÈ΋ ηٷÛÙÚÔÊ‹ ÚÔηÏÂ›Ù·È fiÙ·ÓÙÔ ÔÛÙÔ‡Ó ‚ÚÂı› ÛÙËÓ ÔÚ›· ·Ó¿Ù˘Í˘ ÙÔ˘ fiÁÎÔ˘14. H ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÚÔÛʤÚÔ˘Ó Ô-χÙÈÌË ‰È·ÁÓˆÛÙÈ΋ ‚Ô‹ıÂÈ· ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Ô-Ú›ˆÓ ¢ÌÂÁ¤ıˆÓ ·ÏÏÔÈÒÛÂˆÓ Ô˘ ÚfiÛÎÂÈÓÙ·È Û ̇ ˆÙÈο·Ó·ÙÔÌÈο ÛÙÔȯ›·14, 29, 36.H ¢Ú›· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ·ÔÙÂÏ› ıÂڷ›· Â-ÎÏÔÁ‹˜. Y„ËϤ˜ ‰fiÛÂȘ ·ÎÙÈÓÔ‚ÔÏ›·˜ ›Ù Û ·ÓÂÁ¯Â›ÚË-ÙÔ˘˜ ‰ÂÛÌÔÂȉ›˜ fiÁÎÔ˘˜, ›Ù Û ˘ÔÙÚÔ¤˜, ›Ù ·Îfi-Ì· Î·È Û·Ó ‚ÔËıËÙÈ΋ ıÂڷ›· ¢ÌÂÁ¤ıˆÓ ‰ÂÛÌÔÂȉÒÓfiÁÎˆÓ ÚÔÛʤÚÂÈ Î·Ï¿ ·ÔÙÂϤÛÌ·Ù·4, 15, 37, 38. H ¯Ú‹Û˯ËÌÂÈÔıÂڷ¢ÙÈÎÒÓ ÚÔÙÔ‡ ÙËÓ ̄ ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛˉÂÛÌÔÂȉÒÓ fiÁÎˆÓ ÚÔηÏ› Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ÙÔ˘˜39, ÂÓÒ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Â˘Ú›· ¯ÂÈÚÔ˘ÚÁÈ΋ ·-Ê·›ÚÂÛË ÙÔ˘˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛËÂÚÈÙÒÛÂˆÓ Ì ˘ÔÙÚÔ‹40, 41.
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TÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2000, Á˘Ó·›Î· ËÏÈΛ·˜ 32 ÂÙÒÓ ÚÔ-Û‹Ïı ÛÙËÓ KÏÈÓÈ΋ Ù˘ ™ÙÔÌ·ÙÈ΋˜ Î·È °Ó·ıÔÚÔÛˆÈ-΋˜ XÂÈÚÔ˘ÚÁÈ΋˜ ÙÔ˘ A.¶.£ ÏfiÁˆ Ù˘ ‡·Ú͢ ÌÈÎÚ‹˜·ÓÒ‰˘Ó˘ ‰ÈfiÁΈÛ˘ ÛÙËÓ ·ÚÂÈ¿, Ë ÔÔ›· ¤ÁÈÓ ·ÓÙÈ-ÏËÙ‹ ÚÔ ‰ÈÂÙ›·˜ Î·È ÚÔԉ¢ÙÈο ÌÂÁ¿ÏˆÛ ÙÔ ÙÂÏ¢-Ù·›Ô ÂÍ¿ÌËÓÔ. H ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ÂÈÛÎfiËÛË ÛÙËÓ ·ÛıÂ-Ó‹ ‰ÂÓ ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· fiÁÎÔ˘ ÛÙÔÓ ‚ÏÂÓÓÔÁfi-ÓÔ Ù˘ ‰ÂÍÈ¿˜ ·ÚÂÈ¿˜. H ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ Î·È Â͈ÛÙÔÌ·-ÙÈ΋ fï˜ „ËÏ¿ÊËÛË ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· fiÁÎÔ˘Û·ÊÒ˜ ÂÚÈÁÂÁÚ·Ì̤ÓÔ˘, ÛÎÏËÚÔÂÏ·ÛÙÈÎÔ‡, ÌÂÁ¤ıÔ˘˜1X1 cm. Ô˘ ÂÓÙÔ›˙ÔÓÙ·Ó ÛÙÔÓ ˘Ô‚ÏÂÓÓÔÁfiÓÈÔ ¯ÈÙÒÓ··ÓÙ›ÛÙÔȯ· ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ. TÔ È·ÙÚÈÎfi Î·È Ô-‰ÔÓÙÈ·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂχıÂÚ·. HÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ‹Ù·Ó ηÏfiËı˜ ÓÂfiÏ·ÛÌ· ÙˆÓ Ì·Ï·-ÎÒÓ ÈÛÙÒÓ Î·È ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ. K·Ù¿ ÙËÓ ‰È¿Ú-ÎÂÈ· Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘, Ì ÙÔÈ΋ ·Ó·ÈÛıË-Û›·, ‰È·ÈÛÙÒıËΠ‰È‹ıËÛË ÙÔ˘ ‚˘Î·ÓËÙ‹ ̇ ·fi ÙÔÓ fi-ÁÎÔ, ÔfiÙ ڷÁÌ·ÙÔÔÈ‹ıËΠ¢Ú›· ¯ÂÈÚÔ˘ÚÁÈ΋ ·-Ê·›ÚÂÛË Ì fiÚÈ· ˘ÁÈÒÓ ÈÛÙÒÓ. AÎÔÏÔ‡ıËÛÂ Û˘ÚÚ·Ê‹ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È ÔÌ·Ï‹ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›·. MÂÙ¿·fi 40 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ·ÛıÂÓÔ‡˜ ‰ÂÓ ÂÌ-Ê·Ó›ÛÙËΠ˘ÔÙÚÔ‹ ‹ ÌÂÙ¿ÛÙ·ÛË. O ÈÛÙfi˜ ÌÔÓÈÌÔÔÈ‹-ıËΠ۠ÊÔÚÌfiÏË 10% Î·È ÌÂÙ¿ ÙËÓ ‰È·‰Èηۛ· ÚÔ˘Ù›Ó·˜ÛÎËÓÒıËΠ۠·Ú·Ê›ÓË ·' fiÔ˘ Ï‹ÊıËÎ·Ó ÙÔ̤˜ ¿-¯Ô˘˜ 4 Ì. OÈ ÙÔ̤˜ ¯ÚÒÛıËÎ·Ó Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Î·È Ëˆ-Û›ÓË Î·È Ì ÙȘ ·ÎfiÏÔ˘ı˜ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈΤ˜ ÌÂıfi‰Ô˘˜:1) ™ÙÚÂÙ·‚ȉ›ÓË-‚ÈÔÙ›ÓË-˘ÂÚÔÍÂȉ¿ÛË, ¯ÚËÛÈÌÔÔÈÒ-ÓÙ·˜ ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ‚ÈÌÂÓÙ›Ó˘,
Ù˘ ·ÎÙ›Ó˘ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Î·È Ù˘ Ì˘ÔÛ›ÓË˜Î·È ÔÏ˘ÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ S-100 ÚˆÙÂ˚-Ó˘ ( Signet ). 2) A‚ȉ›ÓË-‚ÈÔÙ›ÓË-˘ÂÚÔÍÂȉ¿ÛË, ¯ÚËÛÈ-ÌÔÔÈÒÓÙ·˜ ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÛÙÈÔ-΢ÙÙ·ÚÈÎÔ‡ ‰Â›ÎÙË CD-68 Î·È ÙÔ˘ ‰Â›ÎÙË Î˘ÙÙ·ÚÈÎÔ‡ ÔÏ-Ï·Ï·ÛÈ·ÛÌÔ‡ Ki-67.H ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ ¯ÚˆÛÌ¤ÓˆÓ ÙÔÌÒÓ Ì ·È-Ì·ÙÔÍ˘Ï›ÓË Î·È ËˆÛ›ÓË ¤‰ÂÈÍ fiÙÈ Ë ·ÏÏÔ›ˆÛË ·ÔÙÂÏ›-ÙÔ ·fi ÔÌÔÈfiÌÔÚÊ· ·ÙÚ·ÎÙÔÂȉ‹ ·ÙÙ·Ú· Ô˘ ‰È·¯ˆÚ›-˙ÔÓÙ·Ó ÌÂٷ͇ ÙÔ˘˜ ·fi ÎÔÏÏ·ÁfiÓÔ Î·È Û¯ËÌ¿ÙÈ˙·Ó ‰È·-ÏÂÎfiÌÂÓ˜ ‰ÂÛÌ›‰Â˜ (EÈÎ. 1). ™ÙȘ ¤ÓÙÔÓ· ΢ÙÙ·ÚÔ‚ÚÈ-
ı›˜ ÂÚÈÔ¯¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÂÏ¿¯ÈÛÙ˜ ÌÈÙÒÛÂȘ, ÂÓÒÛÙËÓ ÂÚÈʤÚÂÈ· Ù˘ ·ÏÏÔ›ˆÛ˘ Ú·‚‰ˆÙ¿ Ì˘Èο ·ÙÙ·-Ú· ÂÁÎψ‚ÈṲ̂ӷ ·fi ÙÔÓ ÓÂÔÏ·ÛÌ·ÙÈÎfi ÈÛÙfi ÂÌÊ¿ÓÈ-˙·Ó ÙËÓ ÂÈÎfiÓ· ÔÏ˘‡ÚËÓˆÓ ÁÈÁ·ÓÙÔ΢ÙÙ¿ÚˆÓ (EÈÎ. 2).T· fiÚÈ· Ù˘ ·ÏÏÔ›ˆÛ˘ ÂÓÙÔ›˙ÔÓÙ·Ó ÂÓÙfi˜ ˘ÁÂÈÒÓ È-ÛÙÒÓ. AÓÔÛÔ˚ÛÙÔ¯ËÌÈο, Ù· ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú· ‰ÂÓ¯ÚÒÛıËÎ·Ó ıÂÙÈο ÁÈ· ÙËÓ ÚˆÙÂ˚ÓË S-100Î·È ÙÔÓ ÈÛÙÈÔ-΢ÙÙ·ÚÈÎfi ‰Â›ÎÙË CD-68. AÓÙ›ıÂÙ· ‹Ù·Ó ıÂÙÈο ÛÙË ¯ÚÒ-ÛË ÁÈ· ÙË ‚ÈÌÂÓÙ›ÓË, ÙËÓ ·ÎÙ›ÓË Ï›ˆÓ Ì˘ÈÎÒÓ Î˘ÙÙ¿ÚˆÓ
47
EӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
EÈÎ. 1: IÓÔ‚Ï¿ÛÙ˜ Û ˘fiÛÙڈ̷ ÎÔÏÏ·ÁfiÓÔ˘ Û¯ËÌ·Ù›˙Ô˘Ó ‰Â-ÛÌ›‰Â˜ Ô˘ ‰È·Ï¤ÎÔÓÙ·È. AÈÌ·ÙÔÍ˘Ï›ÓË Î·È ËˆÛ›ÓË. AÚ¯È΋ ÌÂ-Á¤ı˘ÓÛË X 33.
EÈÎ. 2: M˘˚ο ·ÙÙ·Ú· ÂÁÎψ‚ÈÛÌ¤ÓˆÓ Ú·‚‰ˆÙÒÓ Ì˘˚ÎÒÓ ÈÓÒÓÂÌÊ·Ó›˙Ô˘Ó ÂÈÎfiÓ· ÔÏ˘‡ÚËÓˆÓ ÁÈÁ·ÓÙÔ΢ÙÙ¿ÚˆÓ (‚¤ÏË). AÈÌ·-ÙÔÍ˘Ï›ÓË Î·È ËˆÛ›ÓË. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛË X 33.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 45-50, 2004
45-50 sel. - Iordanidis** 3-10-08 12:48 ™ÂÏ›‰· 47
Î·È ÙËÓ ‰ÂÛÌ›ÓË (EÈÎ. 3), ÂÓÒ ÔÈ ˘Ú‹Ó˜ ÂÏ¿¯ÈÛÙˆÓ Î˘Ù-Ù¿ÚˆÓ ‹Ù·Ó ıÂÙÈÎÔ› ÛÙÔÓ ‰Â›ÎÙË Ki-67. M ‚¿ÛË fiÏ· Ù··Ú·¿Óˆ Â˘Ú‹Ì·Ù· Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ ‰ÂÛÌÔÂÈ-‰Ô‡˜ fiÁÎÔ˘.
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AÓ Î·È Ô ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜Î·È ÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Û˘Ó·ÓÙ¿Ù·È Û˘-¯ÓfiÙÂÚ· ηٿ ÙËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜12, 13 ÛÙËÓ ·-ÚÔ‡Û· ÂÚ›ÙˆÛË ÂÌÊ·Ó›ÛıËΠÛÙËÓ 4Ë ‰ÂηÂÙ›· Ù˘˙ˆ‹˜ Û˘ÌʈÓfiÓÙ·˜ Ì ÚÔËÁÔ‡ÌÂÓÔ˘˜ Û˘ÁÁÚ·Ê›˜1, 4-6
ÔÈ ÔÔ›ÔÈ ·Ó·Ê¤ÚÔ˘Ó ÔÙÈ ÔÈ ‰ÂÛÌÔÂȉ›˜ Èӈ̷ÙÒÛÂȘ ÂÌ-Ê·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ 3Ë Î·È 4Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ-‹˜. EÓÒ Ô Ì¤ÛÔ˜ fiÚÔ˜ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÛÙ·Û˘ ÙÔ˘‰ÂÛÌÔÂȉ‹ fiÁÎÔ˘ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙˆÓ Â-ÚÈÛÙÔÌ·ÙÈÎÒÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ Â›Ó·È 3.8cm18 Î·È ÂÌÊ·Ó›˙Â-Ù·È Û˘¯ÓfiÙÂÚ· Á‡Úˆ ·fi ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ13, ÛÙËÓ ÂÚ›-ÙˆÛ‹ Ì·˜ ÂÓÙÔ›˙ÔÓÙ·Ó ÛÙËÓ ·ÚÂÈ¿ Ô˘ ·ÔÙÂÏ› ÙËӉ‡ÙÂÚË Î·Ù¿ Û˘¯ÓfiÙËÙ· ÂÓÙfiÈÛË (19.9%)13 ÙÔ˘ Î·È ËÌÂÁ·Ï‡ÙÂÚË ‰È¿ÛÙ·Û‹ ÙÔ˘ ‹Ù·Ó 1cm. ™ÙËÓ ·ÚÔ‡Û· Â-Ú›ÙˆÛ‹ ÙÔ ÌÈÎÚfi ̤ÁÂıfi˜ ÙÔ˘, Ë ·›ÛıËÛË Î·Ù¿ ÙËÓ „Ë-Ï¿ÊËÛË ÂÓfi˜ ÂÚÈÁÂÁÚ·Ì̤ÓÔ˘ fiÁÎÔ˘ Î·È Ë Ì·ÎÚ¿ Â-Ú›Ô‰Ô˜ ·Ó¿Ù˘Í‹˜ ÙÔ˘ Ì·˜ Ô‰‹ÁËÛ ÛÙËÓ ÎÏÈÓÈ΋ ‰È¿-ÁÓˆÛË Î·ÏÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ ÙÔ˘ ÌÂÛÂÁ¯‡Ì·ÙÔ˜Î·È ÙˆÓ ÛÈ·ÏÔÁfiÓˆÓ ·‰¤ÓˆÓ.O ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ Ù˘ ÎÂÊ·Ï‹˜ Î·È ÙÔ˘ ÙÚ·¯‹ÏÔ˘ ÛÂÔÛÔÛÙfi 25%-70% ÙˆÓ ·ÛıÂÓÒÓ Î·È Û ‰È¿ÛÙËÌ· Ì ̤-ÛÔ fiÚÔ 18 Ì‹Ó˜ ˘ÔÙÚÔÈ¿˙ÂÈ9, 30.™ÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈ-Îfi, ÙÔ ̄ ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 40 ÌËÓÒÓ ̄ ˆÚ›˜ ̆ ÔÙÚÔ‹ ÌÔ-Ú› Ó· ·ÔÙÂÏ› ¢ÓÔ˚΋ ÂͤÏÈÍË ÁÈ· ÙËÓ ÌÂÏÏÔÓÙÈ΋ Ô-Ú›· Ù˘ ·ÛıÂÓÔ‡˜, fï˜ Ë Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙÔ˘fiÁÎÔ˘ ·Ú·Ì¤ÓÂÈ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·Ó·Ê¤ÚıËÎ·Ó ÂÚÈ-ÙÒÛÂȘ ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ·fi 12 ¯ÚfiÓÈ·30.IÛÙÔÏÔÁÈο Ô ‰ÂÛÌÔÂȉ‹˜ fiÁÎÔ˜ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›Ùˆ-ÛË ·ÔÙÂÏ›ÙÔ ·fi ÔÌÔÈfiÌÔÚÊ· ·ÙÚ·ÎÙÔÂȉ‹ ·ÙÙ·Ú·Ô˘ ‰È·¯ˆÚ›˙ÔÓÙ·Ó ÌÂٷ͇ ÙÔ˘˜ ·fi ÎÔÏÏ·ÁfiÓÔ Î·È Û¯Ë-Ì¿ÙÈ˙·Ó ‰È·ÏÂÎfiÌÂÓ˜ ‰ÂÛÌ›‰Â˜. ™Â ÂÚÈÔ¯¤˜ ÙÔ˘ fi-ÁÎÔ˘ Ì ¤ÓÙÔÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· ·Ú·ÙËÚ‹ıËÎ·Ó ÂÏ¿¯È-
ÛÙ˜ ÌÈÙÒÛÂȘ ÔÈ Ôԛ˜ ÂȂ‚·ÈÒıËÎ·Ó ·ÓÔÛÔ˚ÛÙÔ¯Ë-ÌÈο Ì ÙÔÓ ‰Â›ÎÙË Ki-67, ÂÓÒ ÛÙËÓ ÂÚÈʤÚÂÈ· Ù˘ ·Ï-ÏÔ›ˆÛ˘ ‚Ú¤ıËÎ·Ó Ú·‚‰ˆÙ¿ Ì˘˚ο ·ÙÙ·Ú· ÂÁÎψ‚È-Ṳ̂ӷ ·fi ÙÔÓ ÓÂÔÏ·ÛÌ·ÙÈÎfi ÈÛÙfi Ô˘ ÂÌÊ¿ÓÈ˙·Ó ÙËÓÂÈÎfiÓ· ÔÏ˘‡ÚËÓˆÓ ÁÈÁ·ÓÙÔ΢ÙÙ¿ÚˆÓ. T· Â˘Ú‹Ì·Ù··˘Ù¿ Û‡Ìʈӷ Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ4, 7, 8, 15, 17 ·-ÔÙ¤ÏÂÛ·Ó ÙËÓ ‚¿ÛË ÁÈ· ÙËÓ ‰È¿ÁÓˆÛË ÙÔ˘ ‰ÂÛÌÔÂȉ‹ fi-ÁÎÔ˘ Ë ÔÔ›· ÂÓÈÛ¯‡ıËΠ̠ÙËÓ ¤ÎÊÚ·ÛË ‚ÈÌÂÓÙ›Ó˘, ·-ÎÙ›Ó˘ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ‰ÂÛÌ›Ó˘ ·fi Ù· ÓÂÔ-Ï·ÛÌ·ÙÈο ·ÙÙ·Ú·. H ·ÚÔ˘Û›· ‚ÈÌÂÓÙ›Ó˘, ·ÎÙ›Ó˘Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ‰ÂÛÌ›Ó˘ Ûٷ·ÙÙ·Ú· ÙÔ˘ ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ ·Ó·Ê¤ÚıËΠ·fi ÙÔ˘˜Gabbiani Î·È Magno20. AÓÙ›ıÂÙ· Ô Roychoudbury ηÈÛ˘Ó.14 ‰ÂÓ ·Ó›¯ÓÂ˘Û·Ó ‚ÈÌÂÓÙ›ÓË Î·È ‰ÂÛÌ›ÓË Û ̛· ÂÚ›-ÙˆÛË ‰ÂÛÌÔÂȉԇ˜ fiÁÎÔ˘ Ù˘ ˘ÔÁÓ¿ıÈ·˜ ÂÚÈÔ¯‹˜.
SUMMARY
"Desmoid fibromatosis (Desmoid tumor) of theoral and paraoral soft tissues: Report of a case
and literature review"S. Iordanidis, A. Epivatianos, T. Zaraboukas, A.
Markopoulos
hellenic stomatological review 48: 45-50, 2004
The fibromatoses are a group of fibrous proliferations ofthe soft tisses with an infiltrative growth pattern and atendency to recur locally. They can be divided into twomajor groups : The superficial and the deep fibromatoses.The second group can be subdivided into extra-abdo-minal, abdominal, and intra-abdominal fibromatoses. Theterm desmoid tumor is used to emphasize the bandlike ortendonlike consistency of the deep fibromatoses. Extra-abdominal desmoid fibromatosis most often occurs in theshoulder, back, and the thigh. The head and neck regionaccounts for approximately 10% to 30% of all desmoidtumor cases. Desmoid fibromatosis of the oral andparaoral soft tissues is rare. The aim of the present studywas to report a case of desmoid tumor of the oral andparaoral soft tissue and to review literature .A 32-year-old woman was referred on February 2000because of a painless growth in the cheek over two yearsduration that has developed progressively during last sixmonths. Intraoral and extraoral palpation revealed a well-demarcated mass, slightly indurated, located in to thesubmucosa of the right cheek adjacent to the secondpremolar region and measuring 1X1 cm. The coveringoral mucosa was normal. A benign tumor of the soft tis-sues and of salivary glands was the tentative diagnosis.Under local anesthesia intraoral wide excisional biopsywith margins on healthy tissues was performed becauseof the infiltration of the buccinator muscle by the lesionthat was observed during the surgical procedure. A fortymonths period of follow-up showed no evidence ofrecurrence or metastasis.Sections were stained with hematoxylin and eosin andshowed the lesion to be composed of spindled-shaped
48
EӉȷʤÚÔ˘Û· ¶ÂÚ›ÙˆÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 45-50, 2004
EÈÎ. 3: ¢È‹ıËÛË Ú·‚‰ˆÙÒÓ Ì˘˚ÎÒÓ ÈÓÒÓ ·fi ·ÙÙ·Ú· ÙÔ˘ ‰ÂÛÌÔ-Âȉԇ˜ fiÁÎÔ˘ Ù· ÔÔ›· ÂÌÊ·Ó›˙Ô˘Ó ıÂÙÈ΋ ¯ÚÒÛË Û ·ÎÙ›ÓË Ï›-ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™ÙÚÂÙ·‚ȉ›ÓË-‚ÈÔÙ›ÓË-˘ÂÚÔÍÂȉ¿ÛË. E›-¯ÚˆÛË ÙˆÓ ˘Ú‹ÓˆÓ Ì ·ÈÌ·ÙÔÍ˘Ï›ÓË Mayer. AÚ¯È΋ ÌÂÁ¤ı˘ÓÛËX 132.
45-50 sel. - Iordanidis** 3-10-08 12:48 ™ÂÏ›‰· 48
cells of uniform appearance which were surrounded andseparated one another by collagen fibers and werearranged in interlacing bundles. Occasional mitoses wereobserved in more cellular areas. At the periphery of thegrowth , striated muscle cells entrapped by the tumorformed multinucleated giant cells. Immunohistochemicalstains showed the tumor cells to be negative for S-100protein and CD-68 and positive for vimentin, smoothmuscle actin (MSA) and desmin. A few tumor cells nucleiwere positive for Ki-67. Literature's data disclosed that the lesion is most oftenlocated in the soft tissues adjacent to the mandible(39,9%). The average duration of symptoms from onset todiagnosis is 3.4 months and the average tumor size is 3.8cm in diameter. Patient's age at initial presentation rangefrom birth to 70 years with an average age of 10.4 years.Most patients are in the first decade of life. There is aslight male predilection (male to female 1.2 : 1).Recurrence of the desmoid tumor is seen in 22% to 23.8%of the patients and appears most often when the initialresection is incomplete. The differential diagnosis ofdesmoid tumor includes reactive fibrosis, nodular fasciitisand well differentiated fibrosarcoma. The etiopathoge-nesis of fibromatoses is unknown but trauma, endocrineand genetic factors are implicated in their development .Wide local excision is the treatment of choice. High doseof radiation therapy for either inoperable or recurrentlesions or as surgical adjuvant for large primarly extra-abdominal lesions has been succefully used. Chemo-therapy alone has been effective in reducing tumor sizebefore surgery and in combination with wide localexcision in managing recurrent cases of the tumor.
Key words: Desmoid fibromatosis, Extra-ablominal desmoidtumor, Aggressive fibromatosis
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H ÛÙ·‰È·Î‹ ·‡ÍËÛË Ù˘ ·Ó·ÏÔÁ›·˜ ÙˆÓ ·ÙfiÌˆÓ Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜ ·ÔÙÂÏ› ¤Ó· ·fi Ù· ÛËÌ·ÓÙÈ-ÎfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ۯ‰fiÓ Û fiϘ ÙȘ ÔÈÎÔÓÔÌÈο ·ÓÂÙ˘Á̤Ó˜ ̄ ÒÚ˜. °È· ÙËÓ EÏÏ¿‰· ÙÔ Ô-ÛÔÛÙfi ·˘Ùfi ·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ Û 23% Ì ̛· Û˘Ó¯‹ Ù¿ÛË ·Ófi‰Ô˘. ¶·Ú¿ ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚ÈÔ-ÙÈÎÔ‡ ÂȤ‰Ô˘ Î·È ÙËÓ Î·Ï‡ÙÂÚË ÊÚÔÓÙ›‰· Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘Á›·˜ Ù· ¿ÙÔÌ· Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜Û˘Ó¯›˙Ô˘Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÚÔ‚Ï‹Ì·Ù· ÔÏÈ΋˜ ‹ ÌÂÚÈ΋˜ Óˆ‰fiÙËÙ·˜.¶ÚfiÛÊ·Ù· ÂÚ¢ÓËÙÈο Î·È ÎÏÈÓÈο ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÔÛÙÂÔÂÓۈ̿وÛË, Û‡Á¯ÚÔÓË Î·ÈÙÂÎÌËÚȈ̤ÓË Ì¤ıÔ‰Ô˜ ÛÙÔÌ·ÙÈ΋˜ ·ÔηٿÛÙ·Û˘, ÌÔÚ› Ì ·ÛÊ¿ÏÂÈ· Ó· ÂÊ·ÚÌÔÛı› ηÈÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜. H Û˘Ó‹ı˘ ·ıÔÏÔÁ›· Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜ fiˆ˜ Ë ÔÛÙÂÔfiÚˆÛË,Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ÎÏ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏÔ‡Ó ÛÔ‚·Ú‹·ÓÙ¤Ó‰ÂÈÍË, ÂÊfiÛÔÓ fï˜ ‚Ú›ÛÎÔÓÙ·È ˘fi ¤ÏÂÁ¯Ô.
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TȘ ÂÂÚ¯fiÌÂÓ˜ ‰ÂηÂٛ˜ Ù· ¿ÙÔÌ· Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜·Ó·Ì¤ÓÂÙ·È Ó· ·ÔÙÂϤÛÔ˘Ó ÌÈ· ÛËÌ·ÓÙÈ΋ ηÙËÁÔÚ›·ÛıÂÓÒÓ Ô˘ ı· ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Ì ÔÛÙÂÔ-ÂÓۈ̷ÙÔ‡ÌÂÓ· ÂÌÊ˘Ù‡̷ٷ. ¶ÚfiÛÊ·Ù· ‰ËÌÔÁÚ·ÊÈ-ο ‰Â‰Ô̤ӷ(1) ·ÔηχÙÔ˘Ó ÙË ÛÙ·‰È·Î‹ ·‡ÍËÛË Ù˘·Ó·ÏÔÁ›·˜ ÙˆÓ ·ÙfiÌˆÓ Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜ (>65 ÂÙÒÓ)ۯ‰fiÓ Û fiϘ ÙȘ ÔÈÎÔÓÔÌÈο ·ÓÂÙ˘Á̤Ó˜ ̄ ÒÚ˜. °È·ÙËÓ EÏÏ¿‰· ÙÔ ÔÛÔÛÙfi ·˘Ùfi ·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ Û 23%Ì ٿÛË Û˘Ó¯ԇ˜ ·Ófi‰Ô˘. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë fiÙÈ ¤Ó·ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ·fi Ù· ¿ÙÔÌ· ·˘Ù¿ Â›Ó·È ÔÏÈο ‹ ÌÂÚÈοӈ‰fi, Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜.™ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (.¯. >75 ÂÙÒÓ) Î·È È‰È·›ÙÂÚ·
ÛÙ· È‰Ú˘Ì·ÙÈ˙fiÌÂÓ· ¿ÙÔÌ·, Ù· ÔÛÔÛÙ¿ Óˆ‰fiÙËÙ·˜ ›-Ó·È ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚ·. Afi ‰È΋ Ì·˜ Û¯ÂÙÈ΋ ¤Ú¢ӷÛÙÔ ÁËÚÔÎÔÌÂ›Ô AıËÓÒÓ(2) ‚Ú¤ıËΠfiÙÈ ÙÔ 64% ÙˆÓ ÊÈÏÔ-ÍÂÓÔ˘Ì¤ÓˆÓ (̤ÛË ËÏÈΛ· 85,5 ¯ÚfiÓÈ·) ‹Ù·Ó ÂÓÙÂÏÒ˜ Óˆ-‰Ô›, ÂÓÒ ÔÈ ÂÓfi‰ÔÓÙ˜ ·ÚÔ˘Û›·˙·Ó ÛËÌ·ÓÙÈο ÚÔ‚Ï‹-Ì·Ù· Ì ٷ ÂÓ·ÔÌ›ӷÓÙ· ‰fiÓÙÈ· ÙÔ˘˜ (ÙÂÚˉfiÓ˜,ÊÏÂÁÌÔÓ¤˜ ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘, ·ÔÛÙ‹Ì·Ù·, ÎÏ). ™‡Ì-ʈӷ Ì ·Ï·ÈfiÙÂÚ· ÛÙÔȯ›·(3) Ù· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ÔÏÈ΋˜ Óˆ‰fiÙËÙ·˜ ÁÈ· ¿ÙÔÌ· ¿Óˆ ÙˆÓ 65 ÂÙÒÓ Û ¯ÒÚ˜Ù˘ E˘ÚÒ˘ ¤¯Ô˘Ó ˆ˜ ÂÍ‹˜: ¢·Ó›· 60%, IÚÏ·Ó‰›· 72%,OÏÏ·Ó‰›· 70%, ™Ô˘Ë‰›· 20%, ÚÒËÓ ‰˘ÙÈ΋ °ÂÚÌ·Ó›·58%, EÏ‚ÂÙ›· 25%, M¿ÏÙ· 50%. °È· ÙȘ H¶A ¤¯ÂÈ ˘ÔÏÔ-ÁÈÛı› fiÙÈ ÂÚ›Ô˘ fiÙÈ ÂÚ›Ô˘ 47 ÂηÙÔÌ̇ÚÈ· ¿ÙÔÌ·¯ÚËÛÈÌÔÔÈÔ‡Ó Î¿ÔÈÔ Ù‡Ô ÎÈÓËÙ‹˜ ÚÔÛıÂÙÈ΋˜ ÂÚÁ·-Û›·˜, ÂÓÒ ÂÍ ·˘ÙÒÓ ÔÈ ÔÏÈο Óˆ‰Ô› ·Ó¤Ú¯ÔÓÙ·È Û ÂÚ›-Ô˘ 20 ÂηÙÔÌ̇ÚÈ·. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ Û˘Ì‚·ÙÈ-Τ˜ ÌÂÚÈΤ˜ Î·È ÔÏÈΤ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜ Ì ÙȘ ·Ú·ÏÏ·-Á¤˜ ÙÔ˘˜ (¿ÌÂÛ˜, ¤ÓıÂÙ˜, ÔÌÔÈfiÙ˘Â˜, ·ÓÔÌÔÈfiÙ˘-˜, ηٷÁÚ·Ê‹ Ô˘‰¤ÙÂÚ˘ ˙ÒÓ˘) ÚÔÛʤÚÔ˘Ó Î·È ı·Û˘Ó¯›ÛÔ˘Ó Ó· ÚÔÛʤÚÔ˘Ó ÛÙÔ Ì¤ÏÏÔÓ ÛËÌ·ÓÙÈΤ˜ ˘-ËÚÂۛ˜ ÛÙ· ¿ÙÔÌ· ·˘Ù¿, Ë ÛÙ·‰È·Î‹ Î·È ÌË ·ÓÙÈÛÙÚÂ-Ù‹ ·ÒÏÂÈ· ÙÔ˘ ÔÛÙÔ‡ ÙˆÓ Ê·ÙÓÈ·ÎÒÓ ·ÎÚÔÏÔÊÈÒÓ, ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÙËÓ ÚÔ˚Ô‡Û· ·‡ÍËÛË Ù˘ ËÏÈΛ·˜, ηıÈ-ÛÙÔ‡Ó ÔÏϤ˜ ÊÔÚ¤˜ ÙËÓ ÂÈÙ˘¯‹ ̄ Ú‹ÛË ÙˆÓ ÎÈÓËÙÒÓ ·˘-ÙÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ ÚÔ‚ÏËÌ·ÙÈ΋(4). H ÂÌÊ¿ÓÈÛË Ù˘ÔÛÙÂÔÂÓۈ̿وÛ˘ ÚÔÛ¤ÊÂÚ ¿ÚÈÛÙ˜ Î·È ÚԂϤ„È-
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̘ ÂÓ·ÏÏ·ÎÙÈΤ˜ χÛÂȘ ÛÙȘ ÂÚÈÙÒÛÂȘ ÌÂÚÈ΋˜ ηÈÔÏÈ΋˜ Óˆ‰fiÙËÙ·˜, Ì ÔÈÎÈÏ›· ۯ‰ȿÛÂˆÓ ·Ó¿ÏÔÁ· ÌÂÙ· ·Ó·ÙÔÌÈο ‰Â‰Ô̤ӷ, ÙËÓ ËÏÈΛ· Î·È ÙË ÁÂÓÈÎfiÙÂÚË Î·-Ù¿ÛÙ·ÛË Ù˘ ˘Á›·˜ ÙˆÓ ·ÛıÂÓÒÓ. ¶ÔȘ fï˜ Â›Ó·È ÔÈÚ·ÁÌ·ÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÌÂıfi‰Ô˘ ÛÙ·¿ÙÔÌ· ÙÚ›Ù˘ ËÏÈΛ·˜; H ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ ˆ˜ ·ÓÂÍ¿Ú-ÙËÙÔ˜ ·Ú¿ÁˆÓ, Ù· ÙÔÈο ·Ó·ÙÔÌÈο Î·È Ê˘ÛÈÔÏÔÁÈο‰Â‰Ô̤ӷ ÙˆÓ ÁÓ¿ıˆÓ, Ë Û˘Ó‹ı˘ ÔÏÏ·Ï‹ ÁÂÓÈ΋ ·-ıÔÏÔÁ›· Î·È Ù· Û˘ÓÔ‰¿ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο ÚÔ‚Ï‹Ì·-Ù· Û˘ÓÈÛÙÔ‡Ó ‹ fi¯È ÊÚ·ÁÌfi ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂıfi-‰Ô˘; T¤ÏÔ˜ ÔÈÔ› Â›Ó·È ÔÈ Ï¤ÔÓ ÂӉ‰ÂÈÁ̤ÓÔÈ ÚÔÛıÂÙÈ-ÎÔ› ۯ‰ȷÛÌÔ› ÁÈ· ÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ ;
H H§IKIA
AÓ Î·È Ë ·ÔÌfiÓˆÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· «ËÏÈΛ·» ·fi ÙȘ ˘-fiÏÔȘ ·ÚÂÏÎfiÌÂÓ˜ ‚ÈÔÏÔÁÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ (‰È·Ù·-Ú·¯‹ Ì˯·ÓÈÛÌÒÓ ÂԇψÛ˘, ÂÚÈÔ¯‹ ÙÔÔı¤ÙËÛË˜ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ, ÁÂÓÈο ÓÔÛ‹Ì·Ù·, Â›Â‰Ô ÛÙÔÌ·ÙÈ-΋˜ ̆ Á›·˜ ÎÏ) Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË, Ù· ̤¯ÚÈ Û‹ÌÂ-Ú· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ΢ڛˆ˜ ·fi ÎÏÈÓÈÎÔÛÙ·ÙÈÛÙÈΤ˜ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô‡ÙÂ Ë ËÏÈΛ· per se, ·ÏÏ¿ Ô‡Ù ηÈË Û˘Ó‹ı˘ ·ıÔÏÔÁ›· Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜, ÂÊ fiÛÔÓ Â›Ó·È Â-ÏÂÁ¯fiÌÂÓË, ·ÔÙÂÏÔ‡Ó ÛÔ‚·Ú¤˜ ·ÓÙÂӉ›ÍÂȘ ÁÈ· ÙËÓ ÙÔ-Ôı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ. Afi ÙȘ Ï›Á˜ ̆ ¿Ú¯Ô˘Û˜ ‰ÈÂ-ıÓÒ˜ ÂÚÁ·Û›Â˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÁÎÚ›ÛÂȘ ÌÂٷ͇ Ë-ÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ ÚÔ·ÙÂÈ fiÙÈ Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ÁÈ· ÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ (60-90 ÂÙÒÓ)·Ó¤Ú¯ÔÓÙ·È ÛÙÔ ÂÓÙ˘ˆÛÈ·Îfi 94-97%, ÂÓÒ ÁÈ· ÙÔ˘˜ ÓÂÒ-ÙÂÚÔ˘˜ (28-69 ÂÙÒÓ) ÛÙÔ 88-99%(5-9). H ·Ô˘Û›· ˆÛÙfiÛÔÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÍ ·˘ÙÒÓ ·ÓÙÈÛÙÔȯ›·˜ ÌÂٷ͇ ‰Â›ÁÌ·-ÙÔ˜ Î·È ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ·ÚÈıÌfi, ÙÔ Ê‡-ÏÔ Î·È ÙÔ˘˜ ÚÔÛıÂÙÈÎÔ‡˜ ۯ‰ȷÛÌÔ‡˜ ·Ô‰˘Ó·ÌÒÓÂÈÛ οÔÈÔ ‚·ıÌfi ÙËÓ ·Í›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ™Â Ì›··ÚÙÈfiÙÂÚ· ۯ‰ȷṲ̂ÓË Î·È ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË ·˘ÙÔ‡ÙÔ˘ Ù‡Ô˘ ÔÈ Bryant & Zarb (1998) ·Ó·ÎÔ›ÓˆÛ·Ó Û˘ÁÎÂ-ÓÙÚˆÙÈο ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ 92% ÁÈ· Ù· 190 ÂÌÊ˘Ù‡̷-Ù· Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ (60-74 Â-ÙÒÓ), Î·È 86.7% ÁÈ· Ù· 184 ÂÌÊ˘Ù‡̷ٷ Ô˘ ÙÔÔıÂÙ‹-ıËÎ·Ó ÛÙË ÓÂÒÙÂÚË ËÏÈÎȷ΋ ÔÌ¿‰· (26-49 ÂÙÒÓ). EÈ-ϤÔÓ Ë Ì¤ÛË ÂÙ‹ÛÈ· ·ÒÏÂÈ· ÔÛÙÔ‡ Á‡Úˆ ·fi Ù· ÂÌÊ˘-Ù‡̷ٷ Î·È ÛÙȘ ‰‡Ô ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ‹Ù·Ó ÏÈÁfiÙÂÚÔ ·-fi 0.05 ¯ÈÏ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÊfiÚÙÈÛ˘. §·Ì‚¿ÓÔ-ÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ Ë ÌfiÓË ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ËÏÈ-ÎȷΤ˜ ÔÌ¿‰Â˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·Ó Ë ËÏÈΛ· Î·È ÂÓ‰Â-¯Ô̤ӈ˜ Ù· ·ÚÂÏÎfiÌÂÓ· Û˘Ó‹ıË ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜,ÔÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ Úˆ-ÙfiÎÔÏÏÔ Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘ ÌÔÚ› Ì ·ÛÊ¿ÏÂÈ· Ó·ÂÊ·ÚÌÔÛı› Î·È ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜. °ÓÒÌÔ-Ó·˜ ‚‚·›ˆ˜ Û’ ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ı· Ú¤ÂÈ Ó· ›ӷÈÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, Ë Î·Ù·ÓfiËÛË Î·È ıÂÙÈ΋ ÛÙ¿-ÛË ÙÔ˘ ËÏÈÎȈ̤ÓÔ˘ ·ÛıÂÓ‹ ÛÙËÓ ÚÔÙÂÈÓfiÌÂÓË ıÂڷ›·Î·È Ù¤ÏÔ˜ Ë ÂÈÏÔÁ‹ ·ÏÒÓ ÚÔÛıÂÙÈÎÒÓ Û¯Â‰È·ÛÌÒÓ.
TA O™TA TøN °NA£øN
¶ÔÛÔÙÈΤ˜ Î·È ÔÈÔÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ T· ÔÛÙ¿ ÙˆÓ ÁÓ¿ıˆÓ ˘Ê›ÛÙ·ÓÙ·È Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈ-Λ·˜ ÙfiÛÔ ÔÛÔÙÈΤ˜ fiÛÔ Î·È ÔÈÔÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ô˘ ¤-
¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ˆ˜ ·Ú¿ÁÔÓÙ˜ ÌÂȈ̤Ó˘ ÂÈÙ˘¯›·˜Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘(11). H ÌÂÁ¿ÏË Â›Û˘ ÌÔÚÊÔÏÔ-ÁÈ΋ ÌÂÙ·‚ÏËÙfiÙËÙ· ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ Î·È Û ÔÈΛϘ ÚÔ-Û¿ıÂȘ ÔÛÔÙÈ΋˜ Î·È ÔÈÔÙÈ΋˜ ηÙËÁÔÚÈÔÔ›ËÛË˜ÙˆÓ Óˆ‰ÒÓ ÁÓ¿ıˆÓ(12,13). ™ÙȘ ÔÈÔÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ηٷ-¯ˆÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÔÈ ÔÛÙÂÔÔÚˆÙÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ Ô˘ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ˘ÎÓfiÙËÙ·˜ Ù˘ÛÔÁÁÒ‰Ô˘˜ ÌÔ›Ú·˜ ÙˆÓ ÔÛÙÒÓ ÙˆÓ ÁÓ¿ıˆÓ(14). ÕÏÏÔÈ·Ú¿ÁÔÓÙ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ÙËÓ ËÏÈΛ· Ô˘ ÌÔÚÔ‡Ó fi-̈˜ ¤ÌÌÂÛ· Ó· ·ÏÏÔÈÒÛÔ˘Ó Ù· ÔÈÔÙÈο ̄ ·Ú·ÎÙËÚÈÛÙÈÎ¿ÙˆÓ ÔÛÙÒÓ ÙˆÓ ÁÓ¿ıˆÓ Â›Ó·È Ë ÌÂȈ̤ÓË ·ÁÁ›ˆÛË, Ë ·-Ó¿ÚÎÂÈ· ‚ÈÙ·ÌÈÓÒÓ C & D, ÔÈ ·Ó·È̛˜ Î·È Ë ̄ ÚfiÓÈ· ̄ Ú‹-ÛË ÛÙÂÚÔÂȉÒÓ(15). H ·ÚÈ· ÔÛÔÙÈ΋ ÌÂÙ·‚ÔÏ‹ Â›Ó·È Ë ·-ÔÚÚfiÊËÛË Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜. H ·ÔÚÚfiÊË-ÛË Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜ ÌÂÙ¿ ÙËÓ ·ÒÏÂÈ· ÙˆÓ ‰Ô-ÓÙÈÒÓ ·ÔÙÂÏ› Ì›· ÚÔԉ¢ÙÈ΋ Î·È ÌË ·ÓÙÈÛÙÚÂÙ‹ ÓÔ-ÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, Ô˘ÂΉËÏÒÓÂÙ·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ‡·ÚÍË ‹ fi¯È Ô‰ÔÓÙÔ-ÛÙÔȯÈÒÓ ÛÙÔ ÛÙfiÌ·(16, 17, 18). AÓ Î·È Â›Ó·È ‚¤‚·ÈÔ fiÙÈ Ë ·Ò-ÏÂÈ· ÙˆÓ ‰ÔÓÙÈÒÓ ˘ÚÔ‰ÔÙ› ÙÔ Ê·ÈÓfiÌÂÓÔ, Ë ÔÛÔÙÈÎ‹Û˘Ì‚ÔÏ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÙÔÈÎÒÓ Î·È ÁÂÓÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ ÛÙÔ Ú˘ıÌfi ·ÔÚÚfiÊËÛ˘ ‰ÂÓ ¤¯ÂÈ ·Ôχو˜ ÍÂη-ı·ÚÈÛÙ›. ™ÙÔ˘˜ ÙÔÈÎÔ‡˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ η-Ù·¯ˆÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ Ë Ì˯·ÓÈ΋ ÊfiÚÙÈÛË ·fi ÎÈÓËÙ¤˜ÚÔÛıÂÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÔÈ ·Ó·ÙÔÌÈΤ˜ ȉȷÈÙÂÚfiÙËÙÂ˜ÙˆÓ ÁÓ¿ıˆÓ ÂÓÒ ÛÙÔ˘˜ ÁÂÓÈÎÔ‡˜ Ë ‰È·ÙÚÔÊ‹ Î·È ‰È¿ÊÔ-Ú· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ÔÛÙÂÔfiÚˆÛË Ì ȉȷ›-ÙÂÚ˜ Ì¿ÏÈÛÙ· ÂÈÙÒÛÂȘ ÛÙȘ ÌÂÙÂÌËÓÔ·˘ÛȷΤ˜ Á˘-Ó·›Î˜. O Ú˘ıÌfi˜ Î·È ÙÔ ÔÛfi Ù˘ ÔÛÙÈ΋˜ ·ÔÚÚfiÊË-Û˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÙfiÛÔ ÌÂٷ͇ ÙˆÓ ·-ÙfiÌˆÓ fiÛÔ Î·È ÌÂٷ͇ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ ·ÏÏ¿ Î·È Â-ÚÈÔ¯ÒÓ ÙˆÓ ÁÓ¿ıˆÓ ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ. ¶ÚfiÎÂÈÙ·È Î·Ù¿ Û˘-Ó¤ÂÈ· ÁÈ· ÔÈÎÔ˘ÌÂÓÈÎfi Ê·ÈÓfiÌÂÓÔ Ì ÌÂÁ¿ÏË ‚ÈÔÏÔÁÈ΋ÌÂÙ·‚ÏËÙfiÙËÙ·. ™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜ Ô Ú˘ıÌfi˜ Î·È ÙÔ Ô-Ûfi Ù˘ ÔÛÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ Â›Ó·È È‰È·›ÙÂÚ· ¤ÓÙÔÓ·ÛÙÔÓ ÚÒÙÔ ̄ ÚfiÓÔ ÌÂÙ¿ ÙËÓ ÂÍ·ÁˆÁ‹ ÙˆÓ ‰ÔÓÙÈÒÓ (ÂÚ›-Ô˘ 2 ̄ ÈÏ) ÁÈ· Ó· ÂÈ‚Ú·‰˘ÓıÔ‡Ó ÛÙË Û˘Ó¤¯ÂÈ· ÛÙ·‰È·Î¿(ÂÚ›Ô˘ 0.5 -1 ¯ÈÏ/¯ÚfiÓÔ) ¯ˆÚ›˜ fï˜ ÔÙ¤ Ó· ÛÙ·Ì·-Ù‹ÛÔ˘Ó(16, 17, 18). H ÔÛÙÈ΋ ·ÔÚÚfiÊËÛË Â›Ó·È 4 ÊÔÚ¤˜ ÌÂ-Á·Ï‡ÙÂÚË ÛÙËÓ Î¿Ùˆ ÁÓ¿ıÔ ·fi fiÙÈ ÛÙËÓ ¿Óˆ, ÁÂÁÔÓfi˜Ô˘ ·Ô‰›‰ÂÙ·È ÛÙÔ ÏÈÁfiÙÂÚÔ Â˘ÓÔ˚Îfi Û¯‹Ì· Ù˘, ÛÙÔ ·-Ó·ÏÔÁÈο ÌÈÎÚfiÙÂÚÔ Ì¤ÁÂıfi˜ Ù˘ Î·È ÛÙËÓ ·Ô˘Û›· ·Ó·-ÙÔÌÈ΋˜ ÂÚÈÔ¯‹˜ Ô˘ Ó· ·ÓÙÈÚÚÔ› ÙȘ ÊÔÚÙ›ÛÂȘ ·fiÎÈÓËÙ¤˜ ÚÔÛı¤ÛÂȘ, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙËÓ ˘ÂÚÒ·ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ. ™ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ Ë ·ÔÚÚfiÊËÛË Â›Ó·ÈÂÚÈÛÛfiÙÂÚÔ ¤ÓÙÔÓË ÛÙȘ ÂÚÈÔ¯¤˜ ›Ûˆ ·fi Ù· ÁÂÓÂÈ·-ο ÙÚ‹Ì·Ù· ÂӉ¯Ô̤ӈ˜ ÁÈ·Ù› Ù· Ô›ÛıÈ· ‰fiÓÙÈ· ¯¿ÓÔ-ÓÙ·È ÁÚËÁÔÚfiÙÂÚ· ·fi Ù· ÚfiÛıÈ· Î·È ÁÈ·Ù› Ë ÚfiÛıÈ·ÂÚÈÔ¯‹ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÊÏÔÈÒ-‰Ô˘˜ ÔÛÙÔ‡ (Î·Ù·Ê˘ÙÈÎfi ‰›Ô ÔÏÏÒÓ Ì˘˚ÎÒÓ ÔÌ¿‰ˆÓ). K·Ù¿ ÁÂÓÈ΋ ÔÌÔÏÔÁ›· Ë ÚfiÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿-ıÔ˘ ·ÔÙÂÏ› ÙËÓ Ï¤ÔÓ Â˘ÓÔ˚΋ ·fi ·Ó·ÙÔÌÈ΋˜ ·fi„Â-ˆ˜ ÂÚÈÔ¯‹ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ÁÈ·˘Ùfi Â›Ó·È Î·È Ë ÚÒÙË Ì·˜ ÂÈÏÔÁ‹ ȉȷ›ÙÂÚ· ÛÙÔ˘˜ Óˆ-‰Ô‡˜ ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜. T¤ÏÔ˜ Ë ÛÙ·‰È·Î‹ ·Ò-ÏÂÈ· ÙÔ˘ ÔÛÙÔ‡ ÙˆÓ Ê·ÙÓÈ·ÎÒÓ ·ÎÚÔÏÔÊÈÒÓ Ô‰ËÁ› ·) Û·ÓÙ›ÛÙÔÈ¯Ë ÛÙ·‰È·Î‹ ·ÒÏÂÈ· Ù˘ ˙ÒÓ˘ ÙˆÓ ÎÂÚ·ÙÈÓÔ-ÔÈËÌ¤ÓˆÓ Ô‡ÏˆÓ, ‚) Û ˘„ËÏ‹ Î·Ù¿Ê˘ÛË ÙˆÓ ¯·ÏÈÓÒÓÎ·È Á) ÛÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÁÂÓÂÈ·ÎÒÓ ÙÚËÌ¿ÙˆÓ Â› Ù˘
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 52
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 51-61, 2004
ÎÔÚ˘Ê‹˜ Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜ Ì ·ÔÙ¤ÏÂÛÌ·ÙËÓ fiÏÔ Î·È ÌÂÁ·Ï‡ÙÂÚË ‰˘ÛÎÔÏ›· ·ÓÔ¯‹˜ Î·È ÂϤÁ¯Ô˘ÙˆÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ ÏfiÁˆ fiÓÔ˘ Î·È ÎÈÓËÙÈÎfiÙËÙ·˜. ¶·-Ú¿ÏÏËÏ·, ΢ڛˆ˜ › ·Ô˘Û›·˜ ÚÔÛıÂÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ,Ë ÁÏÒÛÛ· ÌÂÁÂı‡ÓÂÙ·È Î·È Î·Ù·Ï·Ì‚¿ÓÂÈ ÙÔ ‰ËÌÈÔ˘Ú-ÁÔ‡ÌÂÓÔ ¯ÒÚÔ ·fi ÙËÓ ·ÒÏÂÈ· ÙˆÓ ‰ÔÓÙÈÒÓ Î·È Ù˘ʷÙÓȷ΋˜ ·ÔʇÛˆ˜.
K§INIKE™ ME§ETE™
T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÚ¢ÓËÙÈΤ˜ ÚÔÛ¿ıÂȘ ÛÙԯ‡-Ô˘Ó, ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ Î·È ÛÙËÓ ·’ ¢ı›·˜ Û˘Û¯¤ÙÈÛËÙ˘ ÔÛfiÙËÙ·˜ Î·È ÔÈfiÙËÙ·˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ˘fi‚·ıÚÔ˘Ì ÙËÓ ÂÈÙ˘¯‹ ¤Î‚·ÛË Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘. ™Â Û¯Â-ÙÈ΋ ÂÚÁ·Û›·(19) ÂÍÂÙ¿ÛıËÎ·Ó 485 ÂÌÊ˘Ù‡̷ٷ Ô˘ ÙÔ-ÔıÂÙ‹ıËÎ·Ó Û 114 Óˆ‰¤˜ οو ÁÓ¿ıÔ˘˜, ÁÈ· ÌÈ· Â-Ú›Ô‰Ô 4-17 ÂÙÒÓ. TÔ Û˘ÓÔÏÈÎfi ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ ÁÈ· ÙËÓοو ÁÓ¿ıÔ Î·È fiϘ ÙȘ ̆ ÔÔÌ¿‰Â˜ Û‡Ìʈӷ Ì ٷ ÔÈ-ÔÙÈο ÎÚÈÙ‹ÚÈ· (Ù‡ÔÈ I-IV) ÙˆÓ Lekholm & Zarb(13) ‹Ù·Ó81%. AÓÙ›ıÂÙ· ÁÈ· ÙËÓ ¿Óˆ ÁÓ¿ıÔ (132 ÂÌÊ˘Ù‡̷ٷ ÛÂ25 ÁÓ¿ıÔ˘˜) Ù· ÔÛÔÛÙ¿ ‹Ù·Ó 88% ÁÈ· ÙȘ ÁÓ¿ıÔ˘˜ Ù‡-Ô˘ III (ÈηÓÔÔÈËÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÛÔÁÁ҉˜ ÔÛÙÔ‡Ó)Î·È ÌfiÏȘ 67% ÁÈ· ÙȘ ÁÓ¿ıÔ˘˜ Ù‡Ô˘ IV (¯·ÌËÏ‹˜ ˘-ÎÓfiÙËÙ·˜ ÛÔÁÁ҉˜ ÔÛÙÔ‡Ó Ì ÏÂÙfi ÊÏÔÈ҉˜ ¤Ù·-ÏÔ). ™ÙËÓ ›‰È· ÌÂϤÙË ÂÍ ›ÛÔ˘ ÂÌÊ·Ó‹˜ ‹Ù·Ó Î·È Ë Û˘Û¯¤-ÙÈÛË Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ˘fi‚·ıÚÔ˘, ȉ›ˆ˜ Ù˘¿Óˆ ÁÓ¿ıÔ˘, Ì ÙËÓ ÂÈÙ˘¯›· Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘.T· Û˘ÓÔÏÈο ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ ÁÈ· ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ Î·ÈfiϘ ÙȘ ˘ÔÔÌ¿‰Â˜ Û‡Ìʈӷ Ì ٷ ÔÛÔÙÈο ÎÚÈÙ‹ÚÈ·(ηÙËÁÔڛ˜ A-E) ÙˆÓ Lekholm & Zarb(13) ‹Ù·Ó 83%. AÓÙ›-ıÂÙ· ÁÈ· ÙËÓ ¿Óˆ ÁÓ¿ıÔ Ù· ÔÛÔÛÙ¿ ‹Ù·Ó 95% ÁÈ· ÙȘÁÓ¿ıÔ˘˜ Ù‡Ô˘ A Î·È B (ÈηÓÔÔÈËÙÈ΋ ÔÛfiÙËÙ· Ê·Ù-ÓÈ·ÎÔ‡ ÔÛÙÔ‡) Î·È ÌfiÏȘ 50% ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚÔ ·ÔÚ-ÚÔÊË̤Ó˜ ÁÓ¿ıÔ˘˜. ™Â ·Ó¿ÏÔÁË ÌÂϤÙË ÔÈ Jaffin &Berman(20) ‚Ú‹Î·Ó ÔÛÔÛÙfi ·ÔÙ˘¯›·˜ ÌfiÏȘ 3% ÁÈ· ÂÌ-Ê˘Ù‡̷ٷ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó Û ÔÛÙÔ‡Ó Ù‡Ô˘ I, II, IIIÎ·È 35% ÁÈ· ÂÌÊ˘Ù‡̷ٷ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó Û Ô-ÛÙÔ‡Ó Ù‡Ô˘ IV (ÏÂÙfi ¤Ù·ÏÔ Û˘Ì·ÁÔ‡˜ ÊÏÔÈÒ‰Ô˘˜ÌÔ›Ú·˜ Î·È ¯·ÌËÏ‹ ˘ÎÓfiÙËÙ· ÛÔÁÁÒ‰Ô˘˜ ÌÔ›Ú·˜). T··ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ÂȂ‚·ÈÒÓÔ˘Ó ÙȘ ‹‰Ë ÚÒÈ̘ ÎÏÈ-ÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ Ô˘ Û˘Ó¤‰Â·Ó ÙËÓ ÔÛfiÙËÙ· ηÈÔÈfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡, ÙËÓ ·Ú¯È΋ ÛÙ·ıÂÚfiÙËÙ· Î·È ÙÔ Èη-ÓÔÔÈËÙÈÎfi ̤ÁÂıÔ˜ ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Ì ÙËÓ ÂÈÙ˘¯‹¤Î‚·ÛË Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘.
°ENIKA NO™HMATA KAI O™TEOEN™øMATø™H
H ÙÚ›ÙË ËÏÈΛ· ‰˘ÛÙ˘¯Ò˜ Û˘Ì‚·‰›˙ÂÈ Ì ÙËÓ ·˘ÍË̤ÓËÓÔÛËÚfiÙËÙ·(21, 22). H ÔÛÙÂÔfiÚˆÛË, Ô ‰È·‚‹Ù˘, Ù· ηÚ-‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù·, Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, ηıÒ˜ ›-Û˘ Ë ÓÔËÙÈ΋ ¤ÎÙˆÛË Î·È Ë Î·Ù¿ıÏÈ„Ë Û˘ÌÂÚÈÏ·Ì‚¿-ÓÔÓÙ·È ÛÙȘ Û˘Ó‹ıÂȘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ÂÓ-‰¤¯ÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ¿ÌÂÛ· ‹ ¤ÌÌÂÛ· ÙËÓ ÔÛÙÂÔÂÓ-ۈ̿وÛË.
O™TEO¶OPø™H
H ÔÛÙÂÔfiÚˆÛË, ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ÙˆÓ ÔÛÙÒÓ Ì ÛÔ-‚·Ú‹ ›وÛË Û ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ Î·È ÛÂ
ËÏÈÎȈ̤ӷ ¿ÙÔÌ· Î·È ÙˆÓ ‰‡Ô ʇψÓ, Û˘ÁηٷϤÁÂÙ·ÈÛÙ· ÓÔÛ‹Ì·Ù· «ÊıÔÚ¿˜» Ì ·ÍÈÔÛËÌ›ˆÙË ÂȉËÌÈÔÏÔÁÈ-΋ ¤Í·ÚÛË. OÚ›˙ÂÙ·È ˆ˜ Û˘ÛÙËÌ·ÙÈ΋ ÛÎÂÏÂÙÈ΋ ÓfiÛÔ˜Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÔÛÙÈ΋ Ì¿˙· Î·È ‰È·Ù·-Ú·¯‹ Ù˘ ÌÈÎÚÔ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘ ÔÛÙ›ÙË ÈÛÙÔ‡, Ë ÔÔ›·Û˘Ó¿ÁÂÙ·È ·˘ÍË̤ÓË Â˘ıÚ·˘ÛÙfiÙËÙ· Î·È Ù¿ÛË ÁÈ· η-Ù¿ÁÌ·Ù·(23, 24). ™ÙÔ ÛÙÔÌ·ÙÔÁÓ·ıÈÎfi Û‡ÛÙËÌ· ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È ÈÛ¯˘Ú¤˜ ÂӉ›ÍÂȘ ·ÈÙÈÔÏÔÁÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂÙ·-͇ Ù˘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÔÛÙÂÔfiÚˆÛ˘, Ù˘ ÂÚÈÔ‰ÔÓÙ›ÙÈ-‰·˜ Î·È Ù˘ ·ÔÚÚfiÊËÛ˘ Ù˘ Óˆ‰‹˜ Ê·ÙÓȷ΋˜ ·ÎÚÔ-ÏÔÊ›·˜(25, 26). H ‰È¿¯˘ÙË ÂÓÙ‡ˆÛË fiÙÈ Ë ÔÛÙÂÔfiÚˆÛË ·-ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÔı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ÛÙË-Ú›˙ÂÙ·È ÛÙËÓ ¿Ô„Ë fiÙÈ ÙÔ ÓfiÛËÌ· Û¯ÂÙ›˙ÂÙ·È Ì ·‰˘Ó·-Ì›· Ï¿Û˘ ÔÛÙÔ‡ Î·È ‰È·Ù·Ú·Á̤ÓË ÂÔ˘ÏˆÙÈ΋ ÈηÓfi-ÙËÙ· Û ÂÚ›ÙˆÛË Î·Ù¿ÁÌ·ÙÔ˜, ‰È·‰Èηۛ˜ ··Ú·›ÙË-Ù˜ Î·È ÛÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË. M¿ÏÏÔÓ fï˜ ÚfiÎÂÈ-Ù·È ÁÈ· ·Ú¿Ù·ÛË ÂÓfi˜ ηٿ Ù· ¿ÏÏ· Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÌË-¯·ÓÈÛÌÔ‡ Ô˘ ÔÚÈṲ̂Ó˜ fï˜ ÊÔÚ¤˜ ÌÔÚ› Ó· ηٷ-Ï‹ÍÂÈ ÛÙË ÌË ·ÔηٿÛÙ·ÛË Ù˘ Û˘Ó¤¯ÂÈ·˜ ÛÙËÓ ÂÚÈÔ-¯‹ ÙÔ˘ ηٿÁÌ·ÙÔ˜(27). M ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ·fiÛÂÈÚ¿ ÌÂÏÂÙÒÓ, ΢ڛˆ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ·, ‰È·ÌÔÚÊÒıË-Πٷ ÙÂÏÂ˘Ù·›· ̄ ÚfiÓÈ· Ë ·ÓÙ›ÏË„Ë fiÙÈ Ì ÙËÓ ·‡ÍËÛË Ù˘ËÏÈΛ·˜ ÂÚÈÔÚ›˙ÂÙ·È Ë ÈηÓfiÙËÙ· ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ Ó··ÓÙ·ÔÎÚ›ÓÔÓÙ·È ıÂÙÈο Û ÊÔÚÙ›ÛÂȘ, Ì Èı·Ófi ·ÔÙ¤-ÏÂÛÌ· ÙËÓ ·‰˘Ó·Ì›· ÙÔ˘ ÛÔÁÁÒ‰Ô˘˜ ÔÛÙÔ‡ Ó· ‰È·ÙË-Ú‹ÛÂÈ Û ̷ÎÚÔ¯ÚfiÓÈ· ‚¿ÛË ÙË ÌÂÛfiÊ·ÛË Ì ÙÔ ÂÌʇ-ÙÂ˘Ì·(28). ™Â ¿ÏÏË ÂӉȷʤÚÔ˘Û· ÈÛÙÔÌÔÚÊÔÌÂÙÚÈ΋ ÌÂ-ϤÙË ÂÚ¢ӋıËÎÂ Ë ·’ ¢ı›·˜ ›‰Ú·ÛË Ù˘ ÔÛÙÂÔfi-ÚˆÛ˘ ÛÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË. H ÔÛÙÂÔfiÚˆÛË ÚÔ-ÎÏ‹ıËΠÂÈÚ·Ì·ÙÈο Ì ̂ ÔıËÎÂÎÙÔÌ‹ Î·È 28 Ë̤Ú˜ ÌÂ-Ù¿ ÙËÓ Â¤Ì‚·ÛË ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛËÙ˘ ˘ÎÓfiÙËÙ·˜ Ù˘ ÛÔÁÁÒ‰Ô˘˜ ÌÔ›Ú·˜ Á‡Úˆ ·fi Ù·ÂÌÊ˘Ù‡̷ٷ Û ۯ¤ÛË ¿ÓÙ· Ì ÙËÓ ˘ÁÈ‹ ÔÌ¿‰· ÂϤÁ-¯Ô˘. AÓÙ›ıÂÙ· ηÌÈ¿ ‰È·ÊÔÚ¿ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·Û˘Ì·Á‹ ÔÛÙÈο ¤Ù·Ï·(29). AÓ¿ÏÔÁ· ‹Ù·Ó Ù· ·ÔÙÂϤ-ÛÌ·Ù· ÙˆÓ Fujimoto et al(30) Î·È Nasu et al(31) Ô˘ ¤‰ÂÈÍ·ÓfiÙÈ Ë ÚfiÎÏËÛË ÔÛÙÂÔfiÚˆÛ˘ ÏfiÁˆ ·Ó¿ÚÎÂÈ·˜ ÛÙÂ-ÚÔÂȉÒÓ ‹ ·Û‚ÂÛÙ›Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘÛÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË.
K§INIKE™ ME§ETE™
™Â Ì›· ·fi ÙȘ ÚÒÙ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÙÔ˘ ›‰Ô˘˜ ·˘ÙÔ‡ÔÈ Dao Î·È Û˘Ó(32) ÂÚ‡ÓËÛ·Ó ÙËÓ Â›‰Ú·ÛË Ù˘ ÔÛÙÂÔfi-ÚˆÛ˘ ÛÙËÓ ¤Î‚·ÛË Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘. H ÌÂϤÙËÂÚÈÂÏ¿Ì‚·ÓÂ Û˘ÁÎÚ›ÛÂȘ ÌÂٷ͇ ·Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓÌÂÁ·Ï˘Ù¤ÚˆÓ ÙˆÓ 50 ÂÙÒÓ Î·È ÌÂٷ͇ 2 ÔÌ¿‰ˆÓ Á˘Ó·È-ÎÒÓ Ì ËÏÈ˘ ÌÂÁ·Ï‡ÙÂÚ˜ Î·È ÌÈÎÚfiÙÂÚ˜ ·ÓÙ›ÛÙÔȯ· ·-fi 50 ¯ÚfiÓÈ·. O ۯ‰ȷÛÌfi˜ ·˘Ùfi˜ ÛÙËÚ›¯ıËΠÛÙËÓ ÂÎ-‰Ô¯‹ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·Ó·ÌÂÓfiÌÂÓ˜ ·ÔÙ˘¯›Â˜ ı·Ú¤ÂÈ Ó· ÂÓÙÔ›˙ÔÓÙ·È ÛÙȘ Á˘Ó·›Î˜ ¿Óˆ ÙˆÓ 50 ÂÙÒÓÏfiÁˆ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ÔÛÙÂÔfiÚˆÛ˘. T··ÔÙÂϤÛÌ·Ù· ˆÛÙfiÛÔ, Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÂÈÙ˘¯›·˜ÙˆÓ Smith & Zarb(33), ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·ÔÙ˘¯›Â˜ ‰ÂÓ Û¯ÂÙ›-˙ÔÓÙ·È Ô‡Ù Ì ÙÔ Ê‡ÏÔ ·ÏÏ¿ Ô‡ÙÂ Î·È Ì ÙËÓ ËÏÈΛ·. ™ÙË‚¿ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·˘ÙÒÓ ÔÈ Û˘ÁÁÚ·Ê›˜ ηٷϋ-ÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÔÛÙÂÔfiÚˆÛË ‰ÂÓ ı· Ú¤ÂÈÓ· ·ÔÙÂÏ› ·Ó·ÛÙ·ÏÙÈÎfi ·Ú¿ÁÔÓÙ· ÛÙË ıÂڷ›· ÌÂÂÌÊ˘Ù‡̷ٷ. ™Â ϤÔÓ ÚfiÛÊ·ÙË ÂÚÁ·Û›· ÙÔ˘˜ ÔÈ von
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 53
Wowern & Gotfredsen(34) ‰È·›ÛÙˆÛ·Ó fiÙÈ Ë ÙÔÔı¤ÙËÛË 2ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È Î·Ù·Û΢‹ ¤ÓıÂÙ˘ Ô‰ÔÓÙÔÛÙÔÈ-¯›·˜ Û ӈ‰¤˜ οو ÁÓ¿ıÔ˘˜, ÚÔ¿ÁÂÈ Ì¤Ûˆ Ù˘ ÊfiÚÙÈ-Û˘ ÙËÓ Ï¿ÛË ÔÛÙÔ‡ Î·È ¤ÙÛÈ ÂÚÈÔÚ›˙ÂÈ ÙËÓ Ê˘ÛÈÔÏÔÁÈ-ο ·Ó·ÌÂÓfiÌÂÓË ÏfiÁˆ ËÏÈΛ·˜ ÙÒÛË ÙÔ˘ ÌÂÙ·ÏÏÈÎÔ‡ Â-ÚȯÔ̤ÓÔ˘ ÙˆÓ ÔÛÙÒÓ (BMC-Bone mineral content). T¤-ÏÔ˜ ÔÈ Friberg Î·È Û˘Ó(35) ÌÂÙ¿ ·fi Û¯ÂÙÈ΋ ÎÏÈÓÈ΋ ÌÂϤÙËη٤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÙÔÔı¤ÙËÛË ÂÌÊ˘Ù¢-Ì¿ÙˆÓ Û ·ÛıÂÓ›˜ Ì ‰È·ÁÓˆṲ̂ÓË ÔÛÙÂÔfiÚˆÛË (Û Ô-ÛÊ˘È΋ ÌÔ›Ú· Î·È ·˘¯¤Ó· ÌËÚÈ·›Ô˘) ÌÔÚ› Ó· Â›Ó·È ÂÈ-Ù˘¯‹˜ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. E›Ó·È ¿ÓÙˆ˜ ÁÂÁÔ-Ófi˜ fiÙÈ Ë ÔÛÙÂÔfiÚˆÛË Û ۯ¤ÛË Ì ٷ ÂÌÊ˘Ù‡̷ٷ ·-ÔÙÂÏ› ·ÎfiÌ· ·ÓÔÈÎÙfi ‰›Ô ¤Ú¢ӷ˜ Î·È ÛËÌ·ÓÙÈο ·-ÔÙÂϤÛÌ·Ù· ·Ó·Ì¤ÓÔÓÙ·È ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ.
K§INIKH KAI EP°A™THPIAKH ¢IEPEYNH™H TH™ ¶OIOTHTA™ TOY O™TOY
¶·Ú·‰ÔÛȷο Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÔÈfiÙËÙ·˜ Î·È ÔÛfiÙË-Ù·˜ ÙÔ˘ ÔÛÙÔ‡ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰Â¯ı› ÂÌÊ˘Ù‡̷ٷ Á›-ÓÂÙ·È Ì ÙËÓ ̆ ÔÎÂÈÌÂÓÈ΋ Ù·ÍÈÓfiÌËÛË ÙÔ˘ Û ̛· ·fi ÙȘηÙËÁÔڛ˜ fiˆ˜ ·˘Ù¤˜ ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔ˘˜Lekholm & Zarb(13). ¶ÂÚÈÛÛfiÙÂÚÔ ·ÓÙÈÎÂÈÌÂÓÈ΋ Ê·›ÓÂÙ·ÈË Ì¤ıÔ‰Ô˜ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ÔÈfiÙËÙ·˜ ÙÔ˘ ÔÛÙÔ‡ Ì ‚¿-ÛË ÙËÓ ·ÓÙ›ÛÙ·ÛË Ô˘ ÚÔ‚¿ÏÂÈ Î·Ù¿ ÙÔÓ ÙÚ˘·ÓÈÛÌfiÙÔ˘. ÕÏϘ ̤ıÔ‰ÔÈ Ô˘ ¤¯Ô˘Ó ηٿ ηÈÚÔ‡˜ ·Ó·ÊÂÚıÂ›Â›Ó·È Ë ÈÛÙÔÌÔÚÊÔÌÂÙÚÈ΋ ·Ó¿Ï˘ÛË ÔÛÙÈÎÒÓ ‚ÈÔ„ÈÒÓ, Ë„ËÊȷ΋ ·Ó¿Ï˘ÛË ÌÈÎÚÔÚ·‰ÈÔÁÚ·ÊÈÒÓ, Ë ÔÛÙÈ΋ ˘ÎÓÔ-ÌÂÙÚÈ›·, CT scan ÎÏ(35, 36). ™ÙËÓ Ú¿ÍË Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·-ÊÈ΋ ÂͤٷÛË ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ËÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ÔÈfiÙËÙ·˜ Î·È ÔÛfiÙËÙ·˜ ÙÔ˘ Ô-ÛÙÔ‡ ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘ (·ÓÙ›ÛÙ·ÛË Î·Ù¿ÙÔÓ ÙÚ˘·ÓÈÛÌfi, ÚÔ‹ ÎԯϛˆÛ˘ ÂÌÊ˘Ù‡̷ÙÔ˜) ·Ô-ÙÂÏÔ‡Ó ÙȘ ÌÂıfi‰Ô˘˜ ÚÔ˘Ù›Ó·˜.
™AKXAPø¢H™ ¢IABHTH™
¶ÚfiÎÂÈÙ·È ÁÈ· ÙË Û˘¯ÓfiÙÂÚË ¿ıËÛË ÙˆÓ ÂÓ‰ÔÎÚÈÓÒÓ ·-‰¤ÓˆÓ Ì ÔÈÎÔ˘ÌÂÓÈΤ˜ ‰È·ÛÙ¿ÛÂȘ Î·È ·‡ÍËÛË Ù˘ Û˘-¯ÓfiÙËÙ·˜ Ù˘ Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈÌÈ· ÛÂÈÚ¿ ·fi ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ Ì ÎÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfiÙË ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ÁÏ˘Îfi˙˘, ÙˆÓ Â-Ï¢ı¤ÚˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ÙˆÓ ˘‰·Ù·ÓıڿΈÓ. Oȉȷ‚ËÙÈÎÔ› ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜‰È·Ù·Ú·¯ÒÓ (ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·, Ì·ÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·,Ó¢ÚÔ¿ıÂÈ· ÎÏ) Ô˘ ¤Ú·Ó ÙˆÓ ¿ÏÏˆÓ ÂÈÙÒÛÂÒÓÙÔ˘˜ (·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·, ¤ÌÊÚ·ÁÌ· Ì˘Ô-ηډ›Ô˘, ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ·, ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·ÎÏ) ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙÔ˘˜ Ú˘ıÌÔ‡˜ ÂԇψÛ˘ Î·È ·˘Í¿-ÓÔ˘Ó ÙËÓ ÂȉÂÎÙÈÎfiÙËÙ· Û ÌÔχÓÛÂȘ(21, 37, 38). E›Û˘ Ô Â-ÈÔÏ·ÛÌfi˜ Ù˘ ÔÛÙÂÔÂÓ›·˜ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂ-Ó›˜ Ù›ÓÂÈ Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi fiÙÈ ÛÙÔ ÁÂÓÈÎfi ÏË-ı˘ÛÌfi(39). EȉÈÎfiÙÂÚ· Û ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˘˜ ·ÛıÂ-Ó›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ· ¤¯ÂÈ ·Ú·-ÙËÚËı› Ë Û ̷ÎÚÔ¯ÚfiÓÈ· ‚¿ÛË ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÙ·ÏÏÈ-ÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ÙˆÓ ÔÛÙÒÓ (Bone Mineral Consi-stency) Î·È ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ ·ÒÏÂÈ·˜. M·ÎÚÔÚfi-ıÂÛÌ· Ë ÔÛÙÈ΋ ·ÒÏÂÈ· Ê·›ÓÂÙ·È Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚËÛ ·ÛıÂÓ›˜ ÌÂ Ù‡Ô˘ 1 ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ ‰È·‚‹ÙË,
·fi fiÙÈ Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 2. ¶ÂÈÚ¿Ì·Ù· ÛÂ˙Ò· Ì ÌË ÂÏÂÁ¯fiÌÂÓÔ ‰È·‚‹ÙË Ù‡Ô˘ 1 ¤‰ÂÈÍ·Ó ÌÂȈ̤-ÓÔ ·ÚÈıÌfi ÔÛÙÂÔ‚Ï·ÛÙÒÓ, ÌÈÎÚfiÙÂÚË ÂÈÊ¿ÓÂÈ· ÔÛÙÂÔ-Âȉԇ˜, ÌÈÎÚfiÙÂÚ· ›‰· ÔÛÙÂÔηÏÛ›Ó˘ ÛÙÔ ·›Ì·, ¢-Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÂÏ·Ùو̤ÓÔ˘˜ Ú˘ıÌÔ‡˜ ÔÛÙÈ΋˜ ·-Ó¿Ï·Û˘. T¤ÏÔ˜ Ë ÙÔÔı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Û ‰È·-‚ËÙÈο ˙Ò· ¤‰ÂÈÍ ‰È·ÊÔÚÂÙÈ΋ ÔÛÙÈ΋ ·ÓÙ›‰Ú·ÛË Î·ÈÌÂȈ̤ÓË ¤ÎÙ·ÛË ÔÛÙÂÔÂÓۈ̿وÛ˘ Û ۯ¤ÛË Ì ÙËÓÔÌ¿‰· ÂϤÁ¯Ô˘(40).
K§INIKE™ ME§ETE™
™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÔÈ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ Ô-ÛÙÂÔÂÓۈ̿وÛË Û ·ÛıÂÓ›˜ Ì ÂÏÂÁ¯fiÌÂÓÔ ‰È·‚‹ÙËÂ›Ó·È ÂÏ¿¯ÈÛÙ˜. O Accursi(41) ÌÂϤÙËÛ ٷ ÔÛÔÛÙ¿ ÂÈ-Ù˘¯›·˜ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó Û 15 ‰È·‚Ë-ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È Ù· Û˘Ó¤ÎÚÈÓ Ì ٷ ÔÛÔÛÙ¿ Û Ô-Ì¿‰· ÂϤÁ¯Ô˘ Ô˘ ·ÚÔ˘Û›·˙ ϋÚË ·ÓÙÈÛÙÔȯ›· ηٿËÏÈΛ·, ʇÏÔ, ı¤ÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ, Ù‡Ô ÚÔÛıÂÙÈ΋˜ ·-ÔηٿÛÙ·Û˘, ηٿÛÙ·ÛË ·ÓÙ›ıÂÙÔ˘ ÊÚ·ÁÌÔ‡ ηȉȿÚÎÂÈ· Óˆ‰fiÙËÙ·˜. H ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó·fi 1-17 ¯ÚfiÓÈ·, Ù· ‰Â ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ¤‰ÂÈÍ·Ó ‰È·-ÊÔÚ¤˜ ÛÙȘ ·ÔÙ˘¯›Â˜ ÌÂٷ͇ ‰È·‚ËÙÈÎÒÓ Î·È ÌË ‰È·‚ËÙÈ-ÎÒÓ ·ÛıÂÓÒÓ. H ÌfiÓË ‰È·ÊÔÚ¿ ÂÓÙÔ›ÛÙËΠÛÙËÓ ·Ò-ÏÂÈ· ÔÛÙÔ‡ Á‡Úˆ ·fi Ù· ÂÌÊ˘Ù‡̷ٷ, Ô˘ ‚Ú¤ıËΠÂ-Ï·ÊÚ¿ ·˘ÍË̤ÓË ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ΢ڛˆ˜ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÊfiÚÙÈÛ˘. H ‰È·ÊÔÚ¿ ˆÛÙfiÛÔ ·˘Ù‹ Â-ÍÈÛÔÚÚÔ‹ıËΠÛÙË Û˘Ó¤¯ÂÈ·. ™Â ¿ÏÏË ÌÂϤÙË ÔÈ MorrisÎ·È Û˘Ó(42) ÂÚ‡ÓËÛ·Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ‰È·‚‹ÙË Ù‡Ô˘ 2ÛÙËÓ ÂÈÙ˘¯›· Ù˘ ÔÛÙÂÔÂÓۈ̿وÛË. ™‡Ìʈӷ Ì ٷ ·-ÔÙÂϤÛÌ·Ù· ÔÈ ·ÔÙ˘¯›Â˜ ‹Ù·Ó ÔÚȷο ÂÚÈÛÛfiÙÂÚ˜ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ ˘Ô‰Ë-ÏÒÓÔ˘Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÂÏÂÁ¯fiÌÂÓÔ ‰È·‚‹ÙË Î·È Î·Ï¿Â›Â‰· ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË-̤ÓÔ Î›Ó‰˘ÓÔ ·ÔÙ˘¯ÈÒÓ Î·È ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÔÎÏ›Ô-ÓÙ·È ·fi ıÂڷ›· Ì ÂÌÊ˘Ù‡̷ٷ(43).
¢IAXEIPI™H A™£ENøN
™‡ÓËı˜ Úfi‚ÏËÌ· ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ Â›Ó·È Ë È-ı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ ηٿ ÙË ‰È¿ÚÎÂÈ·Ù˘ ¤̂·Û˘, ÏfiÁˆ ·˘ÍËÌ¤ÓˆÓ ÂȤ‰ˆÓ ÈÓÛÔ˘Ï›Ó˘ ‹¿ÏÏˆÓ ·ÓÙȉȷ‚ËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ‹ ·Ó·ÚÎÔ‡˜ Ï‹„˘ÙÚÔÊ‹˜. AÓÙ›ıÂÙ· ˘ÂÚÁÏ˘Î·ÈÌÈ΋ ÎÚ›ÛË ÌÔÚ› Ó· ÔÊ›-ÏÂÙ·È ÛÙÔ ·Ú·ÙÂٷ̤ÓÔ stress Ô˘ ‰È·Ù·Ú¿ÛÛÂÈ ÙÔ ÌÂ-Ù·‚ÔÏÈÛÌfi Ù˘ ÈÓÛÔ˘Ï›Ó˘. O ÚÔÂÁ¯ÂÈÚÈÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ÙˆÓ ÂȤ‰ˆÓ ۷ί¿ÚÔ˘ ÛÙÔ ·›Ì·, Ë ÛˆÛÙ‹ ¯ÔÚ‹ÁËÛËÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ Î·È ÔÈ ÛˆÛÙ¤˜ ‰È·ÙÚÔ-ÊÈΤ˜ Ô‰ËÁ›Â˜ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ·ÔÙÂÏÔ‡Ó ÌÂ-ÚÈÎÔ‡˜ ·ÏÔ‡˜ ·ÏÏ¿ ‚·ÛÈÎÔ‡˜ ηÓfiÓ˜ ÚfiÏ˄˘ ÙˆÓ Â-ÈÏÔÎÒÓ(44, 45). H ¯ÔÚ‹ÁËÛË Â›Û˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â˘Ú¤ˆ˜Ê¿ÛÌ·ÙÔ˜ › ‰Âη‹ÌÂÚÔ, ·ÔÙÂÏ› Û˘Ó‹ıË Ú·ÎÙÈ΋ ÁÈ·ÙËÓ ·ÔÊ˘Á‹ ÌÂÙ·¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÂÈÏÔÎÒÓ(46).
KAP¢IA°°EIAKA NO™HMATA
H ΢ڛ·Ú¯Ë ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ı·Ó¿ÙÔ˘ ÁÈ· ÙÔ˘˜ Â-Ó‹ÏÈΘ Â›Ó·È Ë Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜, Ù˘ ÔÔ›·˜ ‚·ÛÈ-Τ˜ ÂΉËÏÒÛÂȘ ·ÔÙÂÏÔ‡Ó Ë ˘¤ÚÙ·ÛË, Ë ÛÙÂÊ·ÓÈ·›·
54
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 51-61, 2004
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 54
ÓfiÛÔ˜ Î·È Ù· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·(22). H ‰È·-Ù·Ú·¯‹ Ù˘ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ÏfiÁˆ Ù˘ ¯ÚfiÓÈ·˜ ηډȷÁ-ÁÂȷ΋˜ ÓfiÛÔ˘ (·ıËÚˆÛÎÏ‹ÚˆÛË), ÌÔÚ› Ó· ıˆÚËı›ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÂÌÏÂÎfiÌÂÓÔ˜ ÛÙËÓ ·ÔÙ˘¯›· Ù˘ ÔÛÙÂ-ÔÂÓۈ̿وÛ˘ ÏfiÁˆ ÂÚÈÔÚÈṲ̂Ó˘ ·ÚÔ¯‹˜ Ô͢Áfi-ÓÔ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜(47). ø˜ ÁÓˆÛÙfiÓ Ë ·ÚÔ˘Û›· ·ÚÎÔ‡˜ÔÛfiÙËÙ·˜ Ô͢ÁfiÓÔ˘ ·˘Í¿ÓÂÈ ÙËÓ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ È-ÓÔ‚Ï·ÛÙÒÓ, ÙË Û‡ÓıÂÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘, ÙË ‰ËÌÈÔ˘ÚÁ›·Ó¤ˆÓ ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Ì·-ÎÚÔÊ¿ÁˆÓ Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘ ÚÔÏ·Ì‚¿ÓÂÈ ÙË Ìfi-Ï˘ÓÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜(47, 48). ™Â ·Ó·‰ÚÔÌÈ΋ ÙÔ˘˜ ÌÂϤÙËÔÈ Khadivi Î·È Û˘Ó(49) Û˘Ó¤ÎÚÈÓ·Ó Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘ ÌÈ·˜ ÔÌ¿‰·˜ 39 ·ÛıÂÓÒÓ Ì‰ȷÁÓˆṲ̂ÓË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ, Ì ‰‡Ô ¿ÏϘ ÔÌ¿-‰Â˜ : (·) 98 ˘ÁÈÒÓ ·ÙfiÌˆÓ Î·È (‚) 109 ·ÛıÂÓÒÓ Ì ÓÔÛ‹-Ì·Ù· ÌË Û¯ÂÙÈ˙fiÌÂÓ· fï˜ Ì ÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË.T· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ·ÔÙ˘¯›Â˜ ·Ó¿ÌÂÛ· ÛÙȘ ÙÚ›˜ ÔÌ¿‰Â˜ Ô˘ ÌÂÏÂÙ‹ıË-ηÓ. ¶·Ú¿ ÙÔ ÌÈÎÚfi ̤ÁÂıÔ˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÔÈ Û˘ÁÁÚ·-Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Î·Ú‰È·ÁÁÂȷ΋ÓfiÛÔ˜ ‰ÂÓ Û˘ÓÈÛÙ¿ ·Ú¿ÁÔÓÙ· Ô˘ Ó· ·˘Í¿ÓÂÈ ÙȘ Èı·-ÓfiÙËÙ˜ ·ÔÙ˘¯›·˜ Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘.
¢IAXEIPI™H A™£ENøN
Afi ÏÂ˘Ú¿˜ ‰È·¯Â›ÚÈÛ˘, Û ¿ÙÔÌ· Ì ÂÏÂÁ¯fiÌÂÓË Î·Ú-‰È·ÁÁÂȷ΋ ÓfiÛÔ ··ÈÙÂ›Ù·È ÚfiÛÊ·ÙÔ˜ ηډÈÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜, ÚˆÙfiÎÔÏÏÔ ÂÏ¿ÙÙˆÛ˘ ÙÔ˘ ¿Á¯Ô˘˜ (¯Ú‹ÛË Ë-ÚÂÌÈÛÙÈÎÒÓ, ÂÈÙ˘¯‹˜ ‚·ıÈ¿ ÙÔÈ΋ ·Ó·ÈÛıËÛ›·, Û˘Ó¯‹˜¤ÏÂÁ¯Ô˜ Ù˘ ›ÂÛ˘ - monitoring), ‡·ÚÍË fiÏˆÓ ÙˆÓ Ì¤-ÛˆÓ ÚÒÙ˘ ·Ó¿Á΢ (ÓÈÙÚÒ‰Ë, Ô͢ÁfiÓÔ), ¯ËÌÂÈÔÚÔ-ʇϷÍË ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂÓ‰Ôηډ›Ùȉ·˜ fiÔ˘ ··ÈÙ›-Ù·È(44) Î·È Û ÂÚÈÙÒÛÂȘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ë ·Ó·ÌÔÓ‹ ÙÔ˘-Ï¿¯ÈÛÙÔÓ Â› ÂÍ¿ÌËÓÔ ‹ ‰ˆ‰ÂοÌËÓÔ ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘˘ÔÙÚÔ‹˜ Ë ·ÎfiÌ· Î·È Ì˘Ôηډȷ΋˜ ڋ͢(45, 50).
Y¶O£YPEOEI¢I™MO™
ø˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÂÚÈÁÚ¿ÊÂÙ·È Ë ÓÔÛÔÏÔÁÈ΋ η-Ù¿ÛÙ·ÛË Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·fi ÙËÓ ÂÏ·Ùو̤ÓË ·Ú·-ÁˆÁ‹ Î·È Î˘ÎÏÔÊÔÚ›· ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ. T· ÎÏÈÓÈοÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÛÙȘ ˘ÔÌÂÙ·‚ÔÏÈΤ˜ ηٷÛÙ¿-ÛÂȘ Ô˘ Û˘Ó‹ıˆ˜ ‰È·ÙÚ¤¯Ô˘Ó › Ì·ÎÚfiÓ, ÂÚÈÏ·Ì‚¿-ÓÔ˘Ó ·‰˘Ó·Ì›·, ο̷ÙÔ, ˘ÓËÏ›·, ‰˘Û·ÓÂÍ›· ÛÙÔ „‡¯Ô˜,‚Ú¿Á¯Ô˜ ʈӋ˜, Ï¤Ù˘ÓÛË ÙÚȯÒÓ, ‚Ú·‰˘ÛÊ˘ÁÌ›·, ‚Ú·-‰˘„˘¯ÈÛÌfi Î.·. H ˘ÔÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·‰¤ÓÔ˜ ÔÊ›ÏÂٷț٠۠¿ÌÂÛ· ·›ÙÈ· Ô˘ ‰ÚÔ‡Ó ÚˆÙÔÁÂÓÒ˜ ÛÙÔÓ ·‰¤Ó·(Ê¿Ú̷η, ·˘ÙÔ¿ÓÔÛ˜ ηٷÛÙ¿ÛÂȘ-Hashimoto, ¯ÂÈ-ÚÔ˘ÚÁÈ΋ ¤̂·ÛË), ›Ù Û ‰È·Ù·Ú·¯¤˜ Ù˘ ÏÂÈÙÔ˘Ú-Á›·˜ Ù˘ ˘ÔʇÛˆ˜ (.¯. ¯ÚˆÌfiÊÔ‚Ô ·‰¤ÓˆÌ·) Ô˘ Â-ȉÚÔ‡Ó ‰Â˘ÙÂÚÔÁÂÓÒ˜ ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÂÓ‰Ô-ÎÚÈÓÒÓ ·‰¤ÓˆÓ(21, 38). EÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ(51) ¤¯Ô˘Ó ‰Â›ÍÂÈfiÙÈ Ô ̆ Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÌÔÚ› Ó· ·Ó·ÛÙ›ÏÂÈ ÙËÓ ÔÌ·Ï‹ÂÔ˘ÏˆÙÈ΋ ÔÚ›· ÂÓfi˜ ηٿÁÌ·ÙÔ˜, οÙÈ Ô˘ ÂÌ̤ۈ˜·Ô‰ÂÈÎÓ‡ÂÈ ÙË ÛËÌ·Û›· ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓÛÙÔ˘˜ ÂÔ˘ÏˆÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÙÔ˘ ÔÛÙÔ‡. OAttard(52) ÌÂϤÙËÛ ÙËÓ ÂÈÙ˘¯›· Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘Û 27 ˘Ôı˘ÚÂÔÂȉÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ Ï¿Ì‚·Ó·Ó ıÂÚ·-›· ÔÚÌÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ Î·È Û‡Ìʈӷ Ì ٷ ·-
ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ‰ÂÓ ·ÚÔ˘Û›·Û·ÓÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰·ÂϤÁ¯Ô˘.
¢IAXEIPI™H A™£ENøN
™ÙÔ˘˜ ˘Ôı˘ÚÂÔÂȉÈÎÔ‡˜ ·ÛıÂÓ›˜ ȉȷ›ÙÂÚË ÚÔÛÔ¯‹··ÈÙÂ›Ù·È ÛÙËÓ Î·Ï‹ Ê·Ú̷΢ÙÈ΋ Ú‡ıÌÈÛË Ù˘ ÓfiÛÔ˘ÚÈÓ ÙËÓ Â¤Ì‚·ÛË, ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ̆ ÔÙ·ÛÈÎÒÓ ÎÚ›ÛÂ-ˆÓ(45).
™YN¢POMO SJOGREN
TÔ Û‡Ó‰ÚÔÌÔ Sjogren Â›Ó·È Ì›· ÁÂÓÈÎÂ˘Ì¤ÓË ‰È·Ù·Ú·¯‹ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Ì ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÚÔÛ‚ÔÏ‹.X·Ú·ÎÙËÚÈÛÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Ë ÍËÚfiÙËÙ·ÙˆÓ ÔÊı·ÏÌÒÓ, ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È Ù˘ ÚÈÓfi˜, Ù˘ ÙÚ·¯Â›-·˜, ÙˆÓ ‚ÚfiÁ¯ˆÓ, ÙÔ˘ ÎfiÏÔ˘, ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ηıÒ˜ Î·È˘ÔÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ ·‰¤ÓˆÓ Î·È ÙˆÓ ·ÚˆÙ›-‰ˆÓ(53). OÈ Isidor et al(54) ÌÂϤÙËÛ·Ó ÙËÓ ¤Î‚·ÛË Ù˘ ÔÛÙÂ-ÔÂÓۈ̿وÛ˘ Û 8 Á˘Ó·›Î˜ Ì ÛÙÔÌ·ÙÈΤ˜ ÂΉËÏÒ-ÛÂȘ Ù˘ ÓfiÛÔ˘ Î·È ‰˘Û·ÓÂÍ›· ÛÙȘ ˘¿Ú¯Ô˘Û˜ Û˘Ì‚·-ÙÈΤ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜. Afi Ù· 54 ÂÌÊ˘Ù‡̷ٷ Ô˘ ÙÔ-ÔıÂÙ‹ıËÎ·Ó Ù· 7 (12.96%) Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Û 4 ·-ÛıÂÓ›˜ ·¤Ù˘¯·Ó Ó· ÔÛÙÂÔÂÓۈ̷وıÔ‡Ó, ÂÓÒ 2 ÂÌÊ˘-Ù‡̷ٷ ·ˆÏ¤ÛıËÎ·Ó Î·Ù¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÊfiÚÙÈ-Û˘. H ̤ÛË ÂÙ‹ÛÈ· ·ÒÏÂÈ· ÔÛÙÔ‡ ‹Ù·Ó ÁÈ· ÙÔÓ ÚÒÙÔ¯ÚfiÓÔ 0.7¯ÈÏ. ÂÓÒ Ì›· ÂÈÚfiÛıÂÙË ·ÒÏÂÈ· 0.6 ¯ÈÏ. ·-Ú·ÙËÚ‹ıËΠٷ 4 ÂfiÌÂÓ· ¯ÚfiÓÈ·. AÍ›˙ÂÈ Â›Û˘ Ó· ÛË-ÌÂȈı› fiÙÈ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ÏËÓ ÂÓfi˜ ‰‹ÏˆÛ·Ó ÌÂÁ¿ÏË¿ÓÂÛË Î·È ·Ô‰Ô¯‹ Ù˘ ÚÔÛıÂÙÈ΋˜ ÙÔ˘˜ ·ÔηٿÛÙ·-Û˘.
NOHTIKH EK¶Tø™H
H ¯ÚfiÓÈ· ÓÔËÙÈ΋ ¤ÎÙˆÛË (¿ÓÔÈ·) ·ÔÙÂÏ› Ú·ÁÌ·ÙÈ΋̿ÛÙÈÁ· ÁÈ· ÙËÓ ÙÚ›ÙË ËÏÈΛ· Ì ÛËÌ·ÓÙÈΤ˜ ÎÔÈÓˆÓÈΤ˜Î·È ÔÈÎÔÓÔÌÈΤ˜ ÚÔÂÎÙ¿ÛÂȘ. OÈ Û˘¯ÓfiÙÂÚ· ·ÚÔ˘ÛÈ·-˙fiÌÂÓ˜ ·ÓÔ˚Τ˜ ÓfiÛÔÈ ÛÙËÓ ÙÚ›ÙË ËÏÈΛ· Â›Ó·È Ë ÓfiÛÔ˜ÙÔ˘ Alzheimer (50% ÙÔ˘ Û˘ÓfiÏÔ˘), Ë ÔÏ˘ÂÌÊÚ·ÎÙÈ΋ ¿-ÓÔÈ· (8-29%), Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ·Ú·¿Óˆ (10-25%)Î·Ë Ë ÓfiÛÔ˜ ÙÔ˘ Lewy (20%). ÕÓÔÈ· ̤ÙÚÈ·˜ ‹ ÌÂÁ¿Ï˘ÛÔ‚·ÚfiÙËÙ·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 3-9% ÙÔ˘ ÏËı˘ÛÌÔ‡ ¿ÓˆÙˆÓ 65 ÂÙÒÓ, ÂÓÒ Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ·˘Í¿ÓÔÓÙ·È ‰Ú·Ì·ÙÈ-ο Ì ÙËÓ ËÏÈΛ·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÂÎÊ˘ÏÈÛÙÈ΋ ÓfiÛÔ ÙÔ˘ Â-ÁÎÂÊ¿ÏÔ˘ Ô˘ Ô‰ËÁ› Û ÛÊ·ÈÚÈ΋ ¤ÎÙˆÛË ÙˆÓ ·ÓÒÙÂ-ÚˆÓ ÓÔËÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ (fiˆ˜ Ë ÌÓ‹ÌË, Ë ÈηÓfiÙËÙ·Ì¿ıËÛ˘, Ë ÎÚ›ÛË, Ë ÈηÓfiÙËÙ· Â›Ï˘Û˘ ÙˆÓ ÚÔ‚ÏËÌ¿-ÙˆÓ Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜ ÎÏ) Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·-Ô‰ÈÔÚÁ¿ÓˆÛË Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ Î·È ÙËÓ Ï‹ÚË Â-Í¿ÚÙËÛË ÙÔ˘ ·ÛıÂÓ‹(22, 55). AÛıÂÓ›˜ ‰È·ÁÓˆṲ̂ÓÔÈ ‹ ÛÙÔηÙÒÊÏÈ Ù˘ ÓfiÛÔ˘ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·ÈÌ ÂÌÊ˘Ù‡̷ٷ ÏfiÁˆ Ù˘ ÚÔԉ¢ÙÈ΋˜ ·‰˘Ó·Ì›·˜ Û˘-ÓÂÚÁ·Û›·˜ Î·È ‰È·Ù‹ÚËÛ˘ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜.™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·˘Ùfi Û˘Ì‚Â› ı· Ú¤ÂÈ Ó· ÂÈϤÁÔ-ÓÙ·È Â˘¤ÏÈÎÙ· Î·È ·Ó·ÛÙÚ¤„ÈÌ· Û¯¤‰È· ıÂڷ›·˜ (¯ Â-¤ÓıÂÙ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜) Î·È Ó· ¤¯ÂÈ ÂÍ·ÛÊ·ÏÈÛı› ËÛ˘ÓÂÚÁ·Û›· Ì ÙÔ˘˜ ÊÚÔÓÙÈÛÙ¤˜ (carers) Ô˘ ı· ·Ó·Ï¿-‚Ô˘Ó ÙËÓ ‰È·Ù‹ÚËÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜.
55
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 51-61, 2004
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 55
KATA£§IæH
H ηٿıÏÈ„Ë Â›Ó·È Ë Û˘¯ÓfiÙÂÚË „˘¯È·ÙÚÈ΋ ÓfiÛÔ˜. K¿ı¯ÚfiÓÔ ÂÚ›Ô˘ ÙÔ 8% ÙÔ˘ ÏËı˘ÛÌÔ‡ ¿Û¯ÂÈ ·fi ηٿ-ıÏÈ„Ë ÂÓÒ ÁÈ· ÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ÙÔ ÔÛÔÛÙfi ·Ó¤Ú¯ÂÙ·Èηٿ ̤ÛÔ fiÚÔ Û 15% (5-25%). °È· ÙËÓ EÏÏ¿‰· ·˘Ùfi ÌÂ-Ù·ÊÚ¿˙ÂÙ·È Û ÂÚ›Ô˘ 210.000 ËÏÈÎȈ̤ÓÔ˘˜ ηٷıÏÈ-ÙÈÎÔ‡˜. ¶Ï‹ÙÙÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÔÈ Á˘Ó·›Î˜, Ù· ÌÔÓ·-¯Èο ¿ÙÔÌ·, Ù· ¿ÙÔÌ· Ì ·Ó·Ëڛ˜, ·ÏÏ¿ Î·È ÔÈ ‰È·‚ÈÔ‡-ÓÙ˜ Û ȉڇ̷ٷ. ¶·Ú¿ ÙËÓ ÌÂÁ¿ÏË ÔÈÎÈÏ›· Û˘Ìو̿-ÙˆÓ, ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ Û˘Ó‹ıˆ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiıÏ›„Ë, ·ÂÏÈÛ›·, ÌÂÏ·Á¯ÔÏ›·, Û˘Ó¯¤˜ ·›ÛıËÌ· Îfiˆ-Û˘, Ì›ˆÛË ÂӉȷʤÚÔÓÙÔ˜, ·¸Ó›·, ‰È¿¯˘ÙÔ˘˜ fiÓÔ˘˜ÛÙÔ ÛÒÌ·, ·ÏÏ·Á¤˜ ÛÙÔ ‡ÓÔ Î·È ÛÙËÓ fiÚÂÍË. ¢˘ÛÙ˘¯Ò˜ÔÏÏÔ› Û˘Ó¿‰ÂÏÊÔÈ ÂÎÏ·Ì‚¿ÓÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ˆ˜ Ê˘ÛÈÎfi ·ÎfiÏÔ˘ıÔ Ù˘ ËÏÈΛ·˜ Î·È ÔÈ ·ÛıÂÓ›˜ ·-ڷ̤ÓÔ˘Ó Â› Ì·ÎÚfiÓ ·‰È¿ÁÓˆÛÙÔÈ. H ηٿıÏÈ„Ë ·ÓÙÈÌÂ-Ùˆ›˙ÂÙ·È Û‹ÌÂÚ· Ê·Ú̷΢ÙÈο Ì ȉȷ›ÙÂÚË ÂÈÙ˘¯›·.TÔ 80-90% ÙˆÓ Î·Ù·ıÏÈÙÈÎÒÓ ·ÛıÂÓÒÓ ·ÓÙ·ÔÎÚ›ÓÔ-ÓÙ·È ÛÙË ıÂڷ›·(21, 22). T· ÂÌÊ˘Ù‡̷ٷ Î·È ÁÂÓÈÎfiÙÂÚ·ÔÈ ÂÚ›ÏÔΘ ÚÔÛıÂÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ı· Ú¤ÂÈÓ· ̄ ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ì ÚÔÛÔ¯‹. OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› Û˘-Ó‹ıˆ˜ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÌÂÁ¿ÏË ‰˘ÛÎÔÏ›· ÛÙËÓ ÚÔÛ·Ú-ÌÔÁ‹ ÏfiÁˆ ·‰È·ÊÔÚ›·˜, ·¿ıÂÈ·˜ ‹/Î·È Ê·Ú̷΢ÙÈ΋˜ÍËÚÔÛÙÔÌ›·˜. ™˘¯Ó¿ ÔÈ ÚÔÛıÂÙÈΤ˜ Ì·˜ ÂÚÁ·Û›Â˜ Á›ÓÔ-ÓÙ·È ËÁ¤˜ ·Ú·fiÓˆÓ ¯ˆÚ›˜ ·ÓÙÈÎÂÈÌÂÓÈ΋ ‚¿ÛË. K·È Â-‰Ò Ô ÚfiÏÔ˜ ÙˆÓ ÊÚÔÓÙÈÛÙÒÓ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜.
A§§A NO™HMATA
™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· οÓÔ˘Ó Î·Ù¿ ηÈÚÔ‡˜ ÙËÓ ÂÌ-Ê¿ÓÈÛ‹ ÙÔ˘˜ Î·È ÎÏÈÓÈΤ˜ ·Ó·ÊÔÚ¤˜ ÂÚÈÛÙ·ÙÈÎÒÓ Ô˘ ·-ÊÔÚÔ‡Ó ÙËÓ ÙÔÔı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Û ·ÛıÂÓ›˜ ÌÂÂȉÈο ÓÔÛ‹Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó fï˜ Î·È ÌÈÎÚfiÙÂÚ˜ ËÏÈ-ÎȷΤ˜ ÔÌ¿‰Â˜. OÈ Brahim et al(56) ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ÂÈÙ˘¯‹¤Î‚·ÛË Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘ Û ·ÛıÂÓ‹ Ì ÙË Û¿-ÓÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ Erdheim-Chester Ô˘ ÚÔ-ÛÔÌÔÈ¿˙ÂÈ ¯ˆÚ›˜ fï˜ Ó· Ù·˘Ù›˙ÂÙ·È Ì ÙËÓ ÈÛÙÈÔ΢ÙÙ¿-ÚˆÛË X (Hand-Schuller-Christian). EÌÊ˘Ù‡̷ٷ ¤¯Ô˘Ó›Û˘ ̄ ÚËÛÈÌÔÔÈËı› Ì ÂÈÙ˘¯›· Û ·ÛıÂÓ›˜ Ì ÛÎÏË-ÚÔ‰ÂÚÌ›· fiÔ˘ Ë Î·Ù·Û΢‹, ÙÔÔı¤ÙËÛË Î·È ¯Ú‹ÛË Ô-ÏÈÎÒÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ Â›Ó·È ÚÔ‚ÏËÌ·ÙÈ΋ ÏfiÁˆ Ù˘ Â-ÚÈÔÚÈṲ̂Ó˘ ‰È¿ÓÔÈ͢ ÙÔ˘ ÛÙfiÌ·ÙÔ˜(57) ηıÒ˜ Î·È Û ·-ÛıÂÓ›˜ Ì Â͈‰ÂÚÌÈ΋ ‰˘ÛÏ·Û›· Î·È ÔÏÈÁÔ‰ÔÓÙ›· ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÂÂÌ‚¿ÛÂȘ ·‡ÍËÛ˘ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ Ô-ÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜(58).
ºAPMAKA-AKTINOBO§IA
º¿Ú̷ηH ›‰Ú·ÛË ÙˆÓ ‰È·ÊfiÚˆÓ Ê·Ú̷΢ÙÈÎÒÓ Û΢·ÛÌ¿-ÙˆÓ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Û˘ÛÙËÌ·ÙÈ-ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚ· ÌÂÏÂÙËı›. OÈ Stark Î·È Epker(59) ·Ó·Ê¤ÚÔ˘Ó ÌÈ· ÂÚ›ÙˆÛË ·ÛıÂ-ÓÔ‡˜ Ô˘ ¤¯·Û 5 ·fi Ù· 6 ÂÌÊ˘Ù‡̷ٷ, 6 ÌfiÓÔ Ì‹Ó˜ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂڷ›·˜ Ì ‰ÈÊÔÛʈÓÈο ÁÈ· ÙËÓ ·-ÓÙÈÌÂÙÒÈÛË ÔÛÙÂÔfiÚˆÛ˘. ÕÏÏË ÌÂϤÙË Û ̇ Ò· ¤‰ÂÈÍÂfiÙÈ Ë ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ıÂڷ›· (΢ÎÏÔÛÔÚ›ÓË, A/ÓÈ-ʉțÓË) ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙȘ ÂÔ˘ÏˆÙÈΤ˜ ‰ÈÂÚÁ·-
ۛ˜ Á‡Úˆ ·fi ÙÔ ÂÌʇÙÂ˘Ì·(60). °ÂÓÈο Ë Ï‹„Ë ·ÓÔÛÔ-ηٷÛÙ·ÏÙÈÎÒÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÚÔ-ηÏÔ‡Ó Î·Ù·ÛÙÚÔÊ‹ Î·È ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì¢„ËÏfi ÌÈÙˆÙÈÎfi ‰Â›ÎÙË fiˆ˜ Ù· ÂÈıËÏȷο ·ÙÙ·Ú· ÙÔ˘ÂÙÈÎÔ‡ ۈϋӷ, Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙÔ˘Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.H ›‰Ú·ÛË Ù˘ ÈÓÛÔ˘ÏÈÓÔıÂڷ›·˜ ÛÙËÓ ÔÛÙÂÔÂÓÛˆ-Ì¿ÙˆÛË ¤¯ÂÈ ÌÂÏÂÙËı› ΢ڛˆ˜ Û ˙Ò·(61). ™‡Ìʈӷ ÌÂÌÈ· Û¯ÂÙÈο ÚfiÛÊ·ÙË ¤Ú¢ӷ Ë ıÂڷ›· Ì ÈÓÛÔ˘Ï›ÓË‚ÂÏÙÈÒÓÂÈ ÙËÓ ÔÛÙÈ΋ ·Ó¿Ï·ÛË Á‡Úˆ ·fi ÙÔ ÂÌʇÙ¢-Ì·. ¶·Ú¿ Ù·‡Ù· Ë ÂÈÊ¿ÓÂÈ· ·ʋ˜ ÂÌÊ˘Ù‡̷ÙÔ˜ - Ô-ÛÙÔ‡ (¤ÎÙ·ÛË ÔÛÙÂÔÂÓۈ̿وÛ˘) ·Ú·Ì¤ÓÂÈ Û·ÊÒ˜ÌÈÎÚfiÙÂÚË Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘.H ·Ú·ÙÂٷ̤ÓË ̄ Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ·ÔÙÂÏ› È-ı·Ó‹ ·ÓÙ¤Ó‰ÂÈÍË Î˘Ú›ˆ˜ ÏfiÁˆ Ù˘ ‰È·Ù·Ú·¯‹˜ ÙˆÓ Â-Ô˘ÏˆÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·È Ù˘ ·˘ÍË̤Ó˘ Èı·ÓfiÙË-Ù·˜ ÊÏÂÁÌÔÓÒÓ. ™ÂÈÚ¿ ÓÔÛËÌ¿ÙˆÓ Ô˘ ··ÈÙÔ‡Ó ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÌÂÁ¿Ï˜ ‰fiÛÂȘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ(ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ·, Û‡Ó‰ÚÔÌÔ Sjogren, ÂÚ˘ıËÌ·-Ù҉˘ χÎÔ˜, ÔÏ˘Ì˘ÔÛ›ÙȘ, ¤ÌÊ˘Á·, Û‡Ó‰ÚÔÌÔBehcet ÎÏ) ·ÔÙÂÏÔ‡Ó Û¯ÂÙÈΤ˜ ·ÓÙÂӉ›ÍÂȘ ÁÈ· ÙËÓ ÙÔ-Ôı¤ÙËÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›-˙ÔÓÙ·È Ì ÚÔÛÔ¯‹.¶ÂÚÈÛÛfiÙÂÚÔ ‚¿ÚÔ˜ ÏfiÁˆ Ù˘ Ú·ÎÙÈ΋˜ Ù˘ ·Í›·˜, ¤¯ÂȉÔı› ÛÙËÓ ÚÔÏËÙÈ΋ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Î·È ÛÙȘ ÂÈ-ÙÒÛÂȘ Ù˘ ÛÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË. H ·Ó¿Ï˘ÛË ‰Â‰Ô-Ì¤ÓˆÓ ·fi 2.973 ÂÌÊ˘Ù‡̷ٷ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÛÂÛ˘ÁÎÂÎÚÈ̤ÓÔ Î¤ÓÙÚÔ ÙˆÓ H¶A, Ì ϋÚË Î·Ù·ÁÚ·Ê‹Ù˘ ¯ÔÚËÁËı›۷˜ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ (ÚÔ¯ÂÈÚÔ˘ÚÁÈ-΋ Ë/Î·È ÌÂÙ·¯ÂÈÚÔ˘ÚÁÈ΋ Î¿Ï˘„Ë, Ù‡Ô˜ Û΢¿ÛÌ·ÙÔ˜Î·È ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘) ¤‰ÂÈÍ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ·ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ Û ·ÛıÂÓ›˜ Ô˘ ›¯·Ó Ï¿‚ÂÈ ÚÔÏË-ÙÈ΋ ·ÓÙÈ‚›ˆÛË(62). ™Â ¿ÏÏË ÌÂϤÙË Ë ÚÔÏËÙÈ΋ ·ÓÙÈ-‚ÈÔÙÈ΋ ·ÁˆÁ‹ ‚Ú¤ıËΠӷ ‚ÂÏÙÈÒÓÂÈ Ù· ÔÛÔÛÙ¿ ÂÈÙ˘-¯›·˜ Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ÂÓÒ Ë ̄ ÔÚ‹ÁË-ÛË ÛÙÔÌ·ÙÔÏ˘Ì¿ÙˆÓ ¯ÏˆÚÂÍȉ›Ó˘ ›¯Â ·Ó¿ÏÔÁ· ıÂÙÈ-ο ·ÔÙÂϤÛÌ·Ù·(42). E›Ó·È ¿ÓÙˆ˜ ÁÂÁÔÓfi˜ fiÙÈ ¤Ú·ÓÙˆÓ Û·ÊÒÓ ÂӉ›ÍÂˆÓ Ù˘ (.¯. ΛӉ˘ÓÔ˜ ÌÈÎÚԂȷ΋˜ ÂÓ-‰Ôηډ›Ùȉ·˜),(63) Ë ÚÔÏËÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈ΋˜·ÁˆÁ‹˜ (¯ËÌÂÈÔÚÔʇϷÍË) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÛÙËÓ ÎÏÈÓÈ-΋ Ú¿ÍË ÂÚÈÛÛfiÙÂÚÔ ·fi ÂÌÂÈÚÈÛÌfi ·Ú¿ ·fi ÂÈÏÔ-Á¤˜ ÛÙËÚÈÁ̤Ó˜ Û ÂÈÛÙËÌÔÓÈΤ˜ ·Ô‰Â›ÍÂȘ (evidencebased dentistry).
AKTINOBO§H™H °NA£øN
H ·ÎÙÈÓÔıÂڷ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·-ÔÙÂÏÔ‡Ó ÙË Û˘Ó‹ıË ıÂڷ¢ÙÈ΋ ̤ıÔ‰Ô ÛÙȘ ÂÚÈÙÒ-ÛÂȘ ηÎÔ‹ıˆÓ fiÁÎˆÓ Ù˘ ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋˜ÂÚÈÔ¯‹˜. OÈ ÂÈÙÒÛÂȘ Ù˘ ·ÎÙÈÓÔıÂڷ›·˜ Ù·ÍÈÓÔ-ÌÔ‡ÓÙ·È Û ÚÒÈ̘ Ô˘ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙÔ˘˜ ‚ÏÂÓÓÔ-ÁfiÓÔ˘˜, ÙÔ ‰¤ÚÌ· Î·È ÙÔ˘˜ ÛÈ·ÏÔÁfiÓÔ˘˜ ·‰¤Ó˜ (ÍËÚÔ-ÛÙÔÌ›·, ‰ÂÚÌ·Ù›Ùȉ·, ‚ÏÂÓÓÔÁÔÓ›Ùȉ·) Î·È Û fi„È̘ Ô˘·ÊÔÚÔ‡Ó ÙÔ ÔÛÙÔ‡Ó (·ÒÏÂÈ· ÌÂÙ·ÏÏÈÎÒÓ ÛÙÔȯ›ˆÓ, ›-ÓˆÛË, ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÌÔχÓÛÂˆÓ Î·È ÙÂÏÈο ·Ó¿Á-ÁÂÈÔ˜ Ó¤ÎÚˆÛË)(64). §fiÁˆ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ·˘ÙÒÓ ‰È·Ù·-Ú¿ÛÛÂÙ·È ÙÔ ÈÛÔ˙‡ÁÈÔ Ï¿Û˘ ·ÔÚÚfiÊËÛ˘ ηıÒ˜ ηÈÔÈ Ì˯·ÓÈÛÌÔ› ÂԇψÛ˘ ÙÔ˘ ÔÛÙÔ‡. H ‰ÈÂıÓ‹˜ ÂÌÂÈ-Ú›· fiÛÔÓ ·ÊÔÚ¿ Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ ÙˆÓ ÔÛÙÂÔÂÓÛˆ-
56
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 51-61, 2004
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 56
Ì·ÙÔ‡ÌÂÓˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Û ·ÎÙÈÓÔ‚ÔÏË̤ÓÔ˘˜ ·-ÛıÂÓ›˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. T· ˘¿Ú¯ÔÓÙ· ÛÙÔȯ›· Û˘-ÓËÁÔÚÔ‡Ó ˘¤Ú ÌÂÈˆÌ¤ÓˆÓ ÔÛÔÛÙÒÓ ÂÈÙ˘¯›·˜ Û ۇ-ÁÎÚÈÛË ¿ÓÙ· Ì ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. H ÂÈÙ˘¯›· ¿ÓÙˆ˜Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘ Ê·›ÓÂÙ·È fiÙÈ Û˘Ó‰¤ÂÙ·È Ì ÙˉfiÛË Ù˘ ·ÎÙÈÓÔ‚ÔÏ›·˜ ηıÒ˜ η ÙËÓ ·Ó·ÙÔÌÈ΋ ÂÚÈÔ-¯‹. ¶Ï¤ÔÓ Â˘ÓÔ˚΋ Â›Ó·È Ë ÚfiÛıÈ· ÂÚÈÔ¯‹ Ù˘ οوÁÓ¿ıÔ˘ Î·È ÛÙȘ Â͈ÛÙÔÌ·ÙÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ÙÔ ÎÚÔÙ·ÊÈ-ÎfiÓ ÔÛÙÔ‡Ó(65). ™ÙȘ ÚÔÙÂÈÓfiÌÂÓ˜ ÌÂıfi‰Ô˘˜ ÁÈ· ÙË ‚ÂÏ-Ù›ˆÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤¯Ô˘Ó ηٿ ηÈÚÔ‡˜ ·Ó·ÊÂÚ-ı› Ë ÙÔÈ΋ Ë Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙȂȈÙÈÎÒÓ, ËÚÔÛ¿ıÂÈ· ‚ÂÏÙ›ˆÛ˘ Ù˘ ÔÈfiÙËÙ·˜ ÙÔ˘ ÔÛÙÔ‡ Ì ¯Ô-Ú‹ÁËÛË ·Û‚ÂÛÙ›Ô˘, ‚ÈÙ·Ì›Ó˘ D, ÔÈÛÙÚÔÁfiÓˆÓ / ÚÔÁÂ-ÛÙÂÚfiÓ˘ (΢ڛˆ˜ Û ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ ·ÎÙÈÓÔ‚ÔÏË-̤Ó˜ Á˘Ó·›Î˜), Ë ¯ÔÚ‹ÁËÛË ‚ÂÏÙȈÙÈÎÒÓ Ù˘ ΢ÎÏÔÊÔ-Ú›·˜ (΢ڛˆ˜ ·ÁÁÂÈԉȷÛÙ·ÏÙÈÎÒÓ) ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ÛÂÛ˘Ó‰˘·ÛÌfi Ì ¯Ú‹ÛË ˘ÂÚ‚·ÚÈÎÔ‡ Ô͢ÁfiÓÔ˘ (HBO), ÔÈ·Ú¿ÁÔÓÙ˜ ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Î·ıÒ˜Î·È ÔÈ ·Ó·‚ÔÏÈΤ˜ ÔÚÌfiÓ˜(64, 65). H ıÂڷ›· Ì ˘ÂÚ‚·-ÚÈÎfi Ô͢ÁfiÓÔ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ÙˆÓ ·ÎÙÈÓÔ-‚ÔÏËÌ¤ÓˆÓ ÈÛÙÒÓ ¯ÚÔÓÔÏÔÁÂ›Ù·È ·fi ÙÔ 1973 ÂÓÒ ÚÔ-ÛʤÚÔÓÙ·È Î·È Û¯ÂÙÈο ÚˆÙfiÎÔÏÏ· ÂÊ·ÚÌÔÁ‹˜(66, 67).
¶PøTOKO§§O ANTIMETø¶I™H™ TOY A™£ENH TH™TPITH™ H§IKIA™
¶¤Ú·Ó Ù˘ ‰ÈÂÚ‡ÓËÛ˘ ÙˆÓ ÌÂÌÔÓˆÌ¤ÓˆÓ Û˘ÛÙËÌ·ÙÈ-ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙˆÓ ÂÈÙÒÛÂÒÓ ÙÔ˘˜ ÛÙÔÓ ÔÛÙÈÎfiÌÂÙ·‚ÔÏÈÛÌfi, ÛÙÔ˘˜ ÂÔ˘ÏˆÙÈÎÔ‡˜ Î·È ·Ì˘ÓÙÈÎÔ‡˜ ÌË-¯·ÓÈÛÌÔ‡˜ Î·È Û˘ÓÂÒ˜ ÛÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË, Ë Î·-ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ ·ÛıÂ-ÓÒÓ Ì ÂÌÊ˘Ù‡̷ٷ ··ÈÙ› ÔÏÈÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È‰ÔÌË̤ÓÔ Û¯¤‰ÈÔ ıÂڷ›·˜. TÔ Û‡ÓıÂÙÔ È·ÙÚÈÎfi profile (ÔÏÏ·Ï‹ ·ıÔÏÔÁ›·, ¿Ù˘ËÛËÌÂÈÔÏÔÁ›·, ÔÏ˘Ê·Ú̷Λ·) ·ÏÏ¿ Î·È Ë ÁÂÓÈÎÂ˘Ì¤ÓË ¤Î-ÙˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ¿ÚÎÂÈ·˜ ÙˆÓ ·ÚÂÁ¯˘Ì·ÙÈÎÒÓÔÚÁ¿ÓˆÓ Î·È ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÔÌÔÈfiÛÙ·-Û˘ Û˘Óı¤ÙÔ˘Ó ÙËÓ È‰È·›ÙÂÚË ÂÈÎfiÓ· ÙÔ˘ ËÏÈÎȈ̤ÓÔ˘ ·-ÛıÂÓ‹, Ô˘ ··ÈÙ› ÂȉÈ΋ ηٿ ÂÚ›ÙˆÛË ·ÓÙÈÌÂÙÒÈÛË. X·Ú·ÎÙËÚÈÛÙÈο Â›Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· Û¯ÂÙÈ΋˜ ÌÂϤ-Ù˘ ÛÙËÓ ÔÔ›· ÂÍÂÙ¿ÛıËΠÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi 125 ËÏÈ-ÎÈˆÌ¤ÓˆÓ ·ÛıÂÓÒÓ Ì ̤ÛË ËÏÈΛ· 69 ¤ÙË, Ô˘ ÚÔÛ‹Ï-ı·Ó ÁÈ· ıÂڷ›· Ì ÂÌÊ˘Ù‡̷ٷ. K·Ù¿ ÙËÓ ÂÚ›Ô‰ÔÙ˘ ·’ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Ê¿Û˘ ÙÔ 67% ·ÚÔ˘Û›·˙Â Û˘ÛÙË-Ì·ÙÈο ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ÂÓÒ ÔÈ ·ÛıÂÓ›˜ ÂÏ¿Ì‚·Ó·Ó2 ÙÔ˘Ï¿¯ÈÛÙÔÓ Ê·Ú̷΢ÙÈο Û΢¿ÛÌ·Ù· ηٿ ̤ÛÔ fi-ÚÔ. ™Â Ì›· ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ ·fi 3-12 ¯ÚfiÓÈ··Ú·ÙËÚ‹ıËΠÂÈ‚¿Ú˘ÓÛË Ù˘ ˘Á›·˜ ÛÙÔ 23% ÙÔ˘‰Â›ÁÌ·ÙÔ˜ ¯ˆÚ›˜ ˆÛÙfiÛÔ Ë ÂÈ‚¿Ú˘ÓÛË ·˘Ù‹ Ó· ·ÎÔ-ÏÔ˘ıÂ›Ù·È ·fi ·Ó¿ÏÔÁË ·ÔÙ˘¯›· ÛÙ· ‹‰Ë ÂÓۈ̷و̤-Ó· ÂÌÊ˘Ù‡̷ٷ(68).H ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓ‹ ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘Ô-‚ÏËı› Û ÁÓ·ıÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ÂÚÈÏ·Ì‚¿-ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ, ÌÔÚ› ÂÌ̤ۈ˜ Ó· ·-ÍÈÔÏÔÁËı› Î·È Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ù˘ AmericanSociety of Anasthetiology (ASA). ™‡Ìʈӷ Ì ٷ ÎÚÈÙ‹-ÚÈ· ·˘Ù¿ ÔÈ ·ÛıÂÓ›˜ ηÙËÁÔÚÈÔÔÈÔ‡ÓÙ·È Û 5 ÔÌ¿‰Â˜(ASA I,V)(69, 70). H Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ̆ Ô„ËÊ›ˆÓÁÈ· ÂÌÊ˘Ù‡̷ٷ ·Ó‹ÎÔ˘Ó ÛÙȘ ηÙËÁÔڛ˜ I Î·È II. ¶Úfi-
ÎÂÈÙ·È ‰ËÏ·‰‹ ÁÈ· ¿ÙÔÌ· ¯ˆÚ›˜ ‹ Ì ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ÂÏÂÁ¯fiÌÂÓÔ Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ· Ô˘ ÂÏ¿¯ÈÛÙ· ‰È·Ù·-Ú¿ÛÛÂÈ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜ ηÈÙËÓ Ê˘ÛÈ΋ ÔÌÔÈÔÛÙ·Û›· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. OÈ ‚·ÛÈΤ˜ ·Ú¯¤˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓÂÚÈÏ·Ì‚¿ÓÔ˘Ó:·) ÙË Û˘ÛÙËÌ·ÙÈ΋ Ï‹„Ë È·ÙÚÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Î·È ÙË ‰ÈÂ-Ú‡ÓËÛË ÙˆÓ ˘·Ú¯fiÓÙˆÓ ÓÔÛËÌ¿ÙˆÓ‚) ·ÍÈÔÏfiÁËÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÁÈ· ÂӉ¯fiÌÂÓË ·ÚÂÌ-‚ÔÏ‹ ÙÔ˘˜ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È·Ù‹ÚËÛË Ù˘ ÔÛÙÂÔÂÓ-ۈ̿وÛ˘Á) ·ÍÈÔÏfiÁËÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Û ۯ¤ÛË Ì ÙËÓ ÂÈÎÈÓ-‰˘ÓfiÙËÙ· ÙˆÓ ··ÈÙÔ‡ÌÂÓˆÓ ÂÂÌ‚¿ÛÂˆÓ Î·È‰) ÂÓË̤ڈÛË, Û˘ÁηٿıÂÛË Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÍÈÔÏfi-ÁËÛË Ù˘ ÛÙ¿Û˘ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓ‹ ÛÙËÓ ÚÔÙÂÈÓfi-ÌÂÓË ıÂڷ›· (consent)
¶POTEINOMENOI ¶PO™£ETIKOI ™XE¢IA™MOI
E›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÌÂıfi‰ˆÓÚÔÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘ Ì ÔÏÈΤ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜Â͢ËÚÂÙ› ÈηÓÔÔÈËÙÈο ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ËÏÈÎȈ-̤ÓÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ Óˆ-‰fiÙËÙ·˜. øÛÙfiÛÔ Ë ̄ ÚÔÓÔÂÍ·ÚÙÒÌÂÓË Î·È ·Ó·fiÊ¢ÎÙËÌÂÙ·‚ÔÏ‹ ÙÔ˘ ‚ÈÔÏÔÁÈÎÔ‡ ̆ ÔÛÙÚÒÌ·ÙÔ˜ Ì ÚÔ¤¯Ô˘Û·ÙËÓ ÚÔԉ¢ÙÈ΋ ·ÙÚÔÊ›· ÙÔ˘ ÔÛÙÔ‡ Ù˘ Ê·ÙÓȷ΋˜ ·-ÎÚÔÏÔÊ›·˜ ÌÂÈÒÓÂÈ ÙËÓ ÈηÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ó· ¯ÚË-ÛÈÌÔÔÈÔ‡Ó ÂÍ›ÛÔ˘ ÈηÓÔÔÈËÙÈο ÙȘ Ô‰ÔÓÙÔÛÙÔȯ›Â˜ÙÔ˘˜ ÌÂÙ¿ ·fi Ï›Á· ̄ ÚfiÓÈ·. T· ÙÂÏÂ˘Ù·›· ̄ ÚfiÓÈ· Ë ‰˘Ó·-ÌÈ΋ ›ÛÔ‰Ô˜ Ù˘ ÔÛÙÂÔÂÓۈ̿وÛ˘ ÛÙÔ ¯ÒÚÔ Ù˘ Ô-‰ÔÓÙÈ·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘ ÚÔÛ¤ıÂÛ ÂÚ·ÈÙ¤Úˆ ‰˘Ó·Ùfi-ÙËÙ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Óˆ‰ÒÓ ·ÛıÂÓÒÓ. H ÔÏÈ-΋ Óˆ‰fiÙËÙ· ÌÔÚ› Ó· ·ÓÙÈÌÂÙˆÈÛı› Ì ÔÈΛÏÔ˘˜Û¯Â‰È·ÛÌÔ‡˜ Ô˘ ·ÊÔÚÔ‡Ó ÙfiÛÔ ÎÈÓËÙ¤˜ fiÛÔ Î·È ·Î›ÓË-Ù˜ ·ÔηٷÛÙ¿ÛÂȘ. ™ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÚÔÛıÂÙÈÎÒÓ Ï‡-ÛÂˆÓ ı· Ú¤ÂÈ Ó· Ú˘Ù·Ó‡ÂÈ Ë ·Ú¯‹ ÙÔ˘ ̤ÁÈÛÙÔ˘ Ô-ʤÏÔ˘˜ Ì ÙÔ ÌÈÎÚfiÙÂÚÔ ‰˘Ó·Ùfi ΛӉ˘ÓÔ ÁÈ· ÙÔÓ Û˘Ó‹-ıˆ˜ ÂÈ‚·ÚË̤ÓÔ ·ÛıÂÓ‹ Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜. H ¤ÓıÂ-ÙË Ô‰ÔÓÙÔÛÙÔȯ›· Ô˘ Û˘ÁÎÚ·ÙÂ›Ù·È ·fi ÂÌÊ˘Ù‡̷ٷ·ÔÙÂÏ› ÙË ÏÈÁfiÙÂÚÔ ÂÂÌ‚·ÙÈ΋, ÏÈÁfiÙÂÚÔ ‰··ÓËÚ‹Î·È ÏÈÁfiÙÂÚÔ ÂÚ›ÏÔÎË ıÂڷ¢ÙÈ΋ χÛË Ì ÙË ¯Ú‹ÛËÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ÁÈ’ ·˘Ùfi ·ÎÚÈ‚Ò˜ ÙÔ ÏfiÁÔ ·ÔÙÂÏ›ÙËÓ ÚÒÙË Ì·˜ ÂÈÏÔÁ‹.
KATø °NA£O™
H ¤ÓıÂÙË Ô‰ÔÓÙÔÛÙÔȯ›· › ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ¯ÚÔÓÈοÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙËÓ ˘‚ÚȉÈ΋ Á¤Ê˘Ú· Î·È ÛÙË ‰ÂηÂÙ›·ÙÔ˘ ’80 ÙÔ ‚·ÛÈÎfi ÚˆÙfiÎÔÏÏÔ, ÂÚÈÂÏ¿Ì‚·ÓÂ Û˘Ó‹ıˆ˜Ù¤ÛÛÂÚ· ÂÌÊ˘Ù‡̷ٷ Û˘Ó‰Â‰Â̤ӷ Ì ‰ÔÎfi. ™Ù· Ù¤ÏˈÛÙfiÛÔ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80 ÛÙË ‚¿ÛË ÓÂÒÙÂÚˆÓ ÂÈ-‰ËÌÈÔÏÔÁÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Ë ÛÙÚ·ÙËÁÈ΋ ·˘Ù‹ ¿ÏÏ·Í ηȉ‡Ô ÌfiÓÔ ÂÌÊ˘Ù‡̷ٷ (Û ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂȘ Î·È ¤Ó·ÂÌʇÙÂ˘Ì·) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÈÙ˘¯Ò˜ ÁÈ· ÙË Û˘-ÁÎÚ¿ÙËÛË Ì›·˜ ¤ÓıÂÙ˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜ EÈÎ. 1, 2(71).ŒÓ· ‚·ÛÈÎfi Úfi‚ÏËÌ· Ô˘ ÚÔ·ÙÂÈ ÏfiÁˆ Ù˘ ÌÂÁ¿-Ï˘ ÔÛÙÈ΋˜ ·ÙÚÔÊ›·˜ ÙˆÓ Ê·ÙÓÈ·ÎÒÓ ·ÔʇÛÂˆÓ Â›Ó·ÈÛÙ·‰È·Î‹ ·ÒÏÂÈ· Ù˘ ˙ÒÓ˘ ÙˆÓ ÎÂÚ·ÙÈÓÔÔÈË̤ӈÓԇψÓ. ¶·Ú¿ ÙËÓ ·Ú¯È΋ ·ÓËÛ˘¯›· Ë ¤ÏÏÂÈ„Ë ÎÂÚ·ÙÈÓÔ-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 51-61, 2004
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 57
ÔÈËÌ¤ÓˆÓ ÚÔÛÂÊ˘ÎfiÙˆÓ Ô‡ÏˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂË-Ú¿˙ÂÈ ÙËÓ ÔÛÙÂÔÂÓۈ̿وÛË, ÂÊfiÛÔÓ ÙËÚÔ‡ÓÙ·È ÔÈ ÂÓ-‰Â‰ÂÈÁ̤ÓÔÈ Î·ÓfiÓ˜ ÛÙÔÌ·ÙÈ΋˜ ̆ ÁÈÂÈÓ‹˜(72, 73). O ÙÚfiÔ˜ÊfiÚÙÈÛ˘, ÙÔ Â›‰Ô˜ Ù˘ Û˘ÁÎÚ¿ÙËÛ˘ (Û‡Ó‰ÂÛÌÔÈ, Ì·-ÁÓ‹Ù˜ ÎÏ) Î·È Ë ÛÎÔÈÌfiÙËÙ· Û‡Ó‰ÂÛ˘ ÙˆÓ ÂÌÊ˘Ù¢-Ì¿ÙˆÓ Ì ‰ÔÎfi ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎÔ‡˜ ÙÔÌ›˜ ÚÔ‚ÏË-Ì·ÙÈÛÌÔ‡, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ˘¿Ú¯Ô˘Ó ÍÂοı·Ú˜ ··-ÓÙ‹ÛÂȘ. E›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ·fi in vitroÂÚ¢ÓËÙÈο ÚˆÙfiÎÔÏÏ· ‰‡ÛÎÔÏ· ÌÂٷʤÚÔÓÙ·È ÛÙȘڷÁÌ·ÙÈΤ˜ Û˘Óı‹Î˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜(74) ÂÓÒ Ë ÌÂÁ¿ÏË‚ÈÔÏÔÁÈ΋ ÌÂÙ·‚ÏËÙfiÙËÙ· ·ÔÎÏ›ÂÈ ÁÂÓÈÎÂ˘Ì¤Ó· Û˘ÌÂ-Ú¿ÛÌ·Ù·(75, 76, 77). º·›ÓÂÙ·È ˆ˜ Ë ÂÈÏÔÁ‹ ÙÔ˘ ›‰Ô˘˜ ÙË˜Û˘ÁÎÚ¿ÙËÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙȘ ȉȷÈÙÂÚfiÙËÙé˜ Ù˘ ο-ı ÂÚ›ÙˆÛ˘ Î·È ÙËÓ ÚÔÛˆÈ΋ ÎÚ›ÛË ÙÔ˘ Ô‰ÔÓÙÈ¿-ÙÚÔ˘. TÔ ÛËÌ·ÓÙÈÎfiÙ·ÙÔ ¿ÓÙˆ˜ ÏÂÈÙÔ˘ÚÁÈÎfi fiÊÂÏÔ˜ ·-fi ÙËÓ ÙÔÔı¤ÙËÛË ‰‡Ô ÌfiÓÔ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ ÛÙËÓ Î¿ÙˆÁÓ¿ıÔ ÂÓÙÔ›˙ÂÙ·È ÛÙË ‰Ú·Ì·ÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ Û˘ÁÎÚ¿-ÙËÛ˘ Î·È ÛÙ·ıÂÚfiÙËÙ·˜ Ù˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜, ÛÙË ‰˘Ó·-ÙfiÙËÙ· ·Ó¿Ù˘Í˘ ÌÂÁ·Ï‡ÙÂÚˆÓ ‰˘Ó¿ÌÂˆÓ (Î·È Î·Ù¿Û˘Ó¤ÂÈ· ÌÂÁ·Ï‡ÙÂÚ˘ ‰Ú·ÛÙËÚÈÔÔ›ËÛ˘ ÙˆÓ Ì·ÛËÙË-Ú›ˆÓ Ì˘ÒÓ) ηٿ ÙË Ì¿ÛËÛË, ÛÙË Ì›ˆÛË Ù˘ ·Ó·ÛÊ¿-ÏÂÈ·˜ ÙÔ˘ ·ÛıÂÓ‹ Î·È ÛÙËÓ ÂÓ Á¤ÓÂÈ ‚ÂÏÙ›ˆÛË fiÏˆÓ ÙˆÓ·Ú·Ì¤ÙÚˆÓ Ù˘ Ì·ÛËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, fiˆ˜ ‰Â›Í·ÌÂÛ ÚfiÛÊ·ÙË ËÏÂÎÙÚÔÌ˘ÔÁÚ·ÊÈ΋ ÌÂϤÙË(78). T¤ÏÔ˜ Ù·
‰Â‰Ô̤ӷ ·˘Ù¿ ‚Ú›ÛÎÔÓÙ·È Û ϋÚË ·ÓÙÈÛÙÔȯ›· Ì ٷ·ÔÙÂϤÛÌ·Ù· Û¯ÂÙÈ΋˜ Û˘Ófi‰Ô˘ Ô˘ ¤ÁÈÓ ÚfiÛÊ·Ù·ÛÙÔ ·ÓÂÈÛÙ‹ÌÈÔ McGill ÙÔ˘ K·Ó·‰¿, ‚¿ÛÂÈ ÙˆÓ ÔÔ›ˆÓÔÈ Â¤ÓıÂÙ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜ › ‰‡Ô ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓÚ¤ÂÈ Ó· ·ÔÙÂÏÔ‡Ó ÙËÓ ÚÒÙË ÂÈÏÔÁ‹ Ì·˜ Û ӈ‰Ô‡˜·ÛıÂÓ›˜(79)
ANø °NA£O™
H ¤ÓıÂÙË Ô‰ÔÓÙÔÛÙÔȯ›· ·ÔÙÂÏ› Ì›· ¿ÚÈÛÙË ÂÓ·ÏÏ·-ÎÙÈ΋ χÛË Î·È ÁÈ· ÙËÓ ¿Óˆ ÁÓ¿ıÔ fiÔ˘ ÔÈ ·Ó·ÙÔÌÈΤ˜ È-‰È·ÈÙÂÚfiÙËÙ˜ Î·È Ë Û˘Ó‹ıˆ˜ ÌÂÈÔÓÂÎÙÈÎfiÙÂÚË ÔÛfiÙËÙ·Î·È ÔÈfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡ ηıÈÛÙÔ‡Ó ÙËÓ ·ÔηٿÛÙ·ÛËÌ ·Î›ÓËÙË ÚÔÛıÂÙÈ΋ ÂÚÁ·Û›· ·ÚÎÂÙ¿ ‰‡ÛÎÔÏË. §fiÁˆÙˆÓ ÂÚÈÔÚÈÛÌÒÓ ·˘ÙÒÓ ··ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù¤Û-ÛÂÚ· ÂÌÊ˘Ù‡̷ٷ 8 ̄ ÈÏ Î·È ¿Óˆ, ÌÂ Û˘ÌÌÂÙÚÈ΋ ηٿ ÙÔ‰˘Ó·ÙfiÓ Î·Ù·ÓÔÌ‹ ÛÙ· ‰‡Ô ËÌÈÌfiÚÈ· Î·È ··Ú·Èًو˜Û˘Ó‰Â‰Â̤ӷ Ì ‰ÔÎfi Ù‡Ô˘ dolder(80). °ÂÓÈο Ë Â¤ÓıÂ-ÙË Ô‰ÔÓÙÔÛÙÔȯ›· Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ Â›Ó·È Ì›· ‰˘ÛÎÔÏfiÙÂ-ÚË ·ÔηٿÛÙ·ÛË ‰Â‰Ô̤ÓÔ˘ fiÙÈ ··ÈÙ› ÚÔÛÂÎÙÈ΋‰ÈÂÚ‡ÓËÛË fiÏˆÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙȘ Ôԛ˜ ¿ÌÂÛ· ‹¤ÌÌÂÛ· ÂÌϤÎÂÙ·È fiˆ˜ Ë ·ÈÛıËÙÈ΋ ÙÔ˘ οو ÙÚÈÙËÌÔ-Ú›Ô˘ ÙÔ˘ ÚÔÛÒÔ˘ (ÛÙ‹ÚÈÍË ÙÔ˘ ¿Óˆ ¯Â›ÏÔ˘˜, ÙÔ Ì¤ÁÂ-ıÔ˜ Î·È Ë ı¤ÛË ÙˆÓ ÚfiÛıÈˆÓ ‰ÔÓÙÈÒÓ), Ë ÊÒÓËÛË ÎÏ.
™YM¶EPA™MATA
ñ T· ̤¯ÚÈ Û‹ÌÂÚ· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ΢ڛˆ˜ ·fiÎÏÈÓÈÎÔÛÙ·ÙÈÛÙÈΤ˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô‡ÙÂ Ë ËÏÈΛ·per se, ·ÏÏ¿ Ô‡ÙÂ Î·È Ë Û˘Ó‹ı˘ ·ıÔÏÔÁ›· Ù˘ ÙÚ›Ù˘ËÏÈΛ·˜, ÂÊ fiÛÔÓ Â›Ó·È ÂÏÂÁ¯fiÌÂÓË, ·ÔÙÂÏÔ‡Ó ÛÔ‚·-Ú¤˜ ·ÓÙÂӉ›ÍÂȘ ÁÈ· ÙË ¯Ú‹ÛË ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ.
ñ ™ÙËÓ ÂÚ›ÙˆÛË ÁÂÓÈ΋˜ ·ıÔÏÔÁ›·˜ (ηډȷÁÁÂȷοÓÔÛ‹Ì·Ù·, ÚfiÛÊ·ÙÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘, ‰È·‚‹-Ù˘ ÌË ÂÏÂÁ¯fiÌÂÓÔ˜, ÓÔÛ‹Ì·Ù· ı˘ÚÂÔÂȉԇ˜ ÎÏ) ÔÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜, Ë Û˘ÓÂÚÁ·Û›·Ì ȷÙÚÔ‡˜ ¿ÏÏˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È ÂӉ¯Ô̤ӈ˜ Ë Â-ÎÙ¤ÏÂÛË ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ Û ÓÔÛÔÎÔÌÂÈ·Îfi ÂÚÈ‚¿Ï-ÏÔÓ ·ÔÙÂÏÔ‡Ó Ï‡ÛË ÂÎÏÔÁ‹˜.
ñ Afi ÏÂ˘Ú¿˜ ۯ‰ȷÛÌÔ‡ ı· Ú¤ÂÈ Ó· ÂÈϤÁÔÓÙ·È ÔÈÛ˘ÓÙËÚËÙÈÎfiÙÂÚ˜ χÛÂȘ Ì ÌÈÎÚ¤˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Â-ÂÌ‚¿ÛÂȘ Î·È Â˘¤ÏÈÎÙ· ÚÔÛıÂÙÈο Û¯¤‰È· ·Ôηٿ-ÛÙ·Û˘ (¯ ¤ÓıÂÙ˜ Ô‰ÔÓÙÔÛÙÔȯ›Â˜) Ô˘ ηٿ ÙÂÎ-Ì‹ÚÈÔ Â›Ó·È Î·Ï‡ÙÂÚ· ·ÓÂÎÙ¿ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜.
ñ T¤ÏÔ˜ ÛÔ‚·Ú¿ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ̆ ’ fi„ÈÓ Î·È ËÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÙÚ›Ù˘ ËÏÈ-Λ·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ‰È·-‚ÈÔ‡Ó Ì ¯·ÌËϤ˜ Û˘ÓÙ¿ÍÂȘ Î·È ·Ó·ÚΤÛÙ·ÙË Ô‰Ô-ÓÙÈ·ÙÚÈ΋ Î¿Ï˘„Ë ·fi ÙÔ˘˜ ·ÛÊ·ÏÈÛÙÈÎÔ‡˜ ÙÔ˘˜ ÊÔ-Ú›˜. ¢˘ÛÙ˘¯Ò˜ ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ Î·Ì›·ÚÔÛ¿ıÂÈ· ¤ÛÙˆ Î·È ÌÂÚÈ΋˜ Î¿Ï˘„˘ ÙÔ˘ ÎfiÛÙÔ˘˜Ù˘ ıÂڷ›·˜ Ì ÂÌÊ˘Ù‡̷ٷ, ·ÎfiÌ· Î·È Û ÂȉÈΤ˜Î·ÙËÁÔڛ˜ ·ÛıÂÓÒÓ.
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 51-61, 2004
EÈÎ. 1: OÛÙÂÔÂÓۈ̷ÙÔ‡ÌÂÓ· ÂÌÊ˘Ù‡̷ٷ Ì ÎÂʷϤ˜ ÛÊ·ÈÚÈ-ÎÔ‡ Ù‡Ô˘ (Nobel Biocare) ÙÔÔıÂÙË̤ӷ ÛÙȘ ı¤ÛÂȘ 33, 43 ÁÈ·ÙË Û˘ÁÎÚ¿ÙËÛË Â¤ÓıÂÙ˘ Ô‰ÔÓÙÔÛÙÔȯ›·˜.
EÈÎ. 2: E¤ÓıÂÙË Ô‰ÔÓÙÔÛÙÔȯ›· οو ÁÓ¿ıÔ˘. ¢È·ÎÚ›ÓÔÓÙ·È ÔÈ Â-Ï·ÛÙÈÎÔ› Û˘ÁÎÚ·ÙËÙÈÎÔ› ‰·ÎÙ‡ÏÈÔÈ O-rings (Nobel Biocare).
51-61 ÛÂÏ. - Karkazis** 3-10-08 12:50 ™ÂÏ›‰· 58
SUMMARY
"Oral implants in geriatric patients"H. Karkazis, D. Kalyvas
hellenic stomatological review 48: 51-61, 2004
It is well documented that the increase in the number ofelderly people has been strong especially in theindustrialized regions. According to last demographicdata in Greece the percentage of those over 60 was 23%,while the growth was particularly strong among thoseaged 80 years and above. Although the border betweenphysiology and pathology becomes even broader withadvanced age, the higher morbidity rates, the differentpatterns of disease presentation and the requirements forsocial support call for some special medical and dentalskills. Despite however of this age-related tendency forsystemic illness, including osteoporosis, cardiovasculardisease and diabetes mellitus, recent studies supportearlier reports that the outcome of implant therapy iscomparable among older and younger individuals.Therefore age per se should not be used to excludepatients from implant therapy. Careful patient assessment,preoperative measures, and application of establishedsurgical and prosthodontic protocols will improve theprognosis. Finally among the various treatment modalitiessimple designs of implant retained overdentures seem tobe a favorable option for elderly patients. In view of thisentire special situation a trained team comprising at leastprosthodontist, oral surgeon, and physician shouldperform the implant treatment in aged population.
Key words: ageing, implants, overdentures.
BIB§IO°PAºIA
1. Eurostat. European social statistics. Demography. Office forofficial publications of european communities. Luxembourg,2000 edition. p 61
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* XÂÈÚÔ˘ÚÁÔ› O‰ÔÓÙ›·ÙÚÔÈ.** AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ OÚıÔ‰ÔÓÙÈ΋˜.
M¤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ·ÚÔ˘ÛÈ¿ÛıËΠÛÙÔ 9Ô ÂÈÛÙËÌÔÓÈÎfiÛ˘Ó¤‰ÚÈÔ ÊÔÈÙËÙÒÓ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·Ó. AıËÓÒÓ.
ÁfiÌʈÛË. EÍ ÔÚÈÛÌÔ‡ ÛÙȘ Û˘Ó·ÚıÚÒÛÂȘ Ë ÎÈÓËÙÈÎfiÙË-Ù· Ù˘ ¿ÚıÚˆÛ˘ Ï›ÂÈ ÙÂÏ›ˆ˜ ‹ Â›Ó·È Ôχ ÂÚÈÔÚÈ-Ṳ̂ÓË. ŸÌˆ˜ ÛÙȘ ÁÔÌÊÒÛÂȘ, Ï·Ì‚·ÓÔ̤ÓÔ˘ ̆ fi„Ë Î·ÈÙ˘ ȉÈÔÌÔÚÊ›·˜ Ù˘ ¿ÚıÚˆÛ˘, Ù· ‰fiÓÙÈ· ηٿ ÙȘ ‰È¿-ÊÔÚ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ÛÙÔÌ·ÙÔÁÓ·ıÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜fi¯È ÌfiÓÔ ‰ÂÓ Â›Ó·È ·Î›ÓËÙ· ·ÏÏ¿ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·ÛÙÚÔ‚ÈÏ›˙ÔÓÙ·È Á‡Úˆ ·fi ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ¿ ÙÔ˘˜. E›Ï¤ÔÓ ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ù· ‰fiÓÙÈ· ·ÎfiÌ· Î·È Û ηٿ-ÛÙ·ÛË ËÚÂÌ›·˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì›· Ù·Ï¿ÓÙˆÛË Ë Û˘¯Ófi-ÙËÙ· Ù˘ ÔÔ›·˜ Û˘Ì›ÙÂÈ Ì ÙÔÓ Î·Ú‰È·Îfi ·ÏÌfi. H η-Ù¿ÛÙ·ÛË ·˘Ù‹ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÛÙ‹-ÚÈÍË ÙˆÓ ‰ÔÓÙÈÒÓ, Ë ÔÔ›· ÛÙ‹ÚÈÍË Â›Ó·È ¤Ó· ÔχÏÔÎÔÊ·ÈÓfiÌÂÓÔ, Ô˘ Ï›ÁÔ Ôχ ÏÂÈÙÔ˘ÚÁÈο ÚÔÛÂÁÁ›˙ÂÈ ÙË
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EI™A°ø°H
T· ‰fiÓÙÈ· Û˘Ó‰¤ÔÓÙ·È Ì ٷ ·ÓÙ›ÛÙÔȯ· Ê·ÙÓ›· ÙÔ˘˜ ÌÂÌÈ· ÌÔÚÊ‹ Û˘Ó¿ÚıÚˆÛ˘, Ë ÔÔ›· ˆ˜ ÁÓˆÛÙfi ηÏ›ٷÈ
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 63
ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ·fiÛ‚ÂÛ˘ ÙˆÓ ÎÚ·‰·ÛÌÒÓ(·ÌÔÚÙÈÛ¤Ú) ÙˆÓ ·˘ÙÔÎÈÓ‹ÙˆÓ1, 2. ¢È·Ê·›ÓÂÙ·È fiÙÈ ÛÙȘÁÔÌÊÒÛÂȘ Ô Û˘Ó‰ÂÙÈÎfi˜ ÈÛÙfi˜ Ô˘ ·ÚÂÌ‚¿ÏÏÂÙ·È ÌÂ-ٷ͇ ÙˆÓ ÚÈ˙ÒÓ Î·È ÙˆÓ ·ÓÙÈÛÙÔ›¯ˆÓ Ê·ÙÓÈ·ÎÒÓ ·Ôʇ-ÛÂˆÓ ‰ÂÓ Â›Ó·È ·Ï¿ ¤Ó·˜ ‰È·¯ˆÚÈÛÙÈÎfi˜ ÈÛÙfi˜ fiˆ˜ÛÙȘ ˘fiÏÔȘ Û˘Ó·ÚıÚÒÛÂȘ ·ÏÏ¿ ¤¯ÂÈ ÔÏ˘ÏÔÎfiÙÂ-ÚË ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔÛÙÔÏ‹. E›Ó·È Ê·ÓÂÚfi fiÙÈ ‚·ÛÈ΋ ÚÔ-¸fiıÂÛË ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Ë ·ÎÂÚ·Èfi-ÙËÙ· ·˘ÙÔ‡ ÙÔ˘ ÈÛÙÔ‡. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ÔÛÙ½ÓˤگÂÙ·È Û ¿ÌÂÛË Â·Ê‹ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ê·ÙÓÈ·Îfi Ô-ÛÙÔ‡Ó, ¯ˆÚ›˜ ‰ËÏ·‰‹ ÙË ·ÚÂÌ‚ÔÏ‹ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ÚÔ·ÙÂÈ ·ıÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÁÓˆÛÙ‹ ˆ˜ ·Á·ψ-ÛË.H ηٿÛÙ·ÛË ·˘Ù‹, ÚÔ·ÙÂÈ ·fi οÔÈÔ˘ ‚·ıÌÔ‡ Û˘-Ó¤ÓˆÛ˘ Ù˘ ÔÛÙ½Ó˘ Ù˘ Ú›˙·˜ Ì ÙÔ Ê·ÙÓÈ·Îfi ÔÛÙfi,¯ˆÚ›˜ Ó· ¤¯ÂÈ È‰·›ÙÂÚË ÛËÌ·Û›· ÙÔ ÔÛÔÛÙfi Î·È Ë ¤ÎÙ·-Û‹ Ù˘. TÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi, ·Ú·ÙËÚÂ›Ù·È ·ÚÎÂÙ¿ Û˘¯Ó¿fi¯È ÌfiÓÔ ÛÙË ÓÂÔÁÈÏ‹ Ô‰ÔÓÙÔÊ˘˝·, ·ÏÏ¿ Î·È ÛÙËÓ ·ÓÙ›-ÛÙÔÈ¯Ë ÌfiÓÈÌË. øÛÙfiÛÔ ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë È-ı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙË ÌfiÓÈÌË Ô‰Ô-ÓÙÔÊ˘˝· Â›Ó·È ‰¤Î· ÊÔÚ¤˜ ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙË ÓÂ-ÔÁÈÏ‹3, 4.AÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ÔÛÔÛÙfi ÂÌÊ¿ÓÈÛ˘, Ë ·Á·ψÛË ¤-¯ÂÈ ÛÔ‚·Ú¤˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ Î·È ·ÈÛıËÙÈΤ˜ ÂÈÙÒÛÂÈ˜Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ÙfiÛÔ Ì ÙÔ Â›‰Ô˜ ÙÔ˘ ‰ÔÓÙÈÔ‡ fi-ÛÔ Î·È Ù˘ Ô‰ÔÓÙÔÊ˘˝·˜, ηıÒ˜ ›Û˘ Î·È Ì ÙËÓ ËÏÈΛ·.H ·ÓÙÈÌÂÙÒÈÛË Â›Û˘ Â›Ó·È ÔχÏÔÎË Î·È Û¯ÂÙ›˙ÂÙ·ÈÌ Ï›ÛÙÔ˘˜ fiÛÔ˘˜ ·Ú¿ÁÔÓÙ˜. øÛÙfiÛÔ Ë ·ÓÙ›ÛÙÔȯËEÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, ·Ô fiÛÔ ÂÌ›˜ ÁÓˆÚ›˙Ô˘ÌÂ, ›ӷÈÛ¯ÂÙÈο ÌÈÎÚ‹. H ¤ÏÏÂÈ„Ë ·˘Ù‹ Ì·˜ Ô‰‹ÁËÛ ÛÙË ·ÚÔ‡-Û· ·Ó·ÛÎfiËÛË Ô˘ ÛÎÔfi ¤¯ÂÈ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÙÔ ÙÈ Â›-Ó·È Û‹ÌÂÚ· ÁÓˆÛÙfi ÁÈ· ÙËÓ Ô‰ÔÓÙÈ΋ ·Á·ψÛË Û fiÙÈ ·-ÊÔÚ¿ ÙËÓ ·ÈÙÈÔÏÔÁ›·, ÙËÓ ÎÏÈÓÈ΋ Î·È ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ·,ÙË ‰È¿ÁÓˆÛË, ÙȘ ÂÈÙÒÛÂȘ, ÙËÓ ÚfiÁÓˆÛË Î·ıÒ˜ Î·È ÙËıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ì ·ÓÙ›ÛÙÔȯ· ÎÏÈÓÈο ·Ú·-‰Â›ÁÌ·Ù·.
I™TO§O°IKH EIKONA
H Ô‰ÔÓÙÈ΋ ·Á·ψÛË Ê·›ÓÂÙ·È ˆ˜ ÔÊ›ÏÂÙ·È Û ÊÏÂÁ-ÌÔÓ‹ ÙÔ˘ ÂÚÈÔ‰ÔÓÙÈÎÔ‡ ÈÛÙÔ‡, Ë ÔÔ›· ÙÂÏÈο, Ô‰ËÁ›ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÔÛÙÈ΋˜ Á¤Ê˘Ú·˜ ÌÂٷ͇ ÔÛÙ½Ó˘ Ù˘ڛ˙·˜ Î·È ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡. IÛÙÔÏÔ-ÁÈο ÂÌÊ·Ó›˙ÂÙ·È ¤ÓÙÔÓË ÔÛÙÂÔÎÏ·ÛÙÈ΋ Î·È ÔÛÙÂÔ‚Ï·-ÛÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙȘ ·ÁÎ˘ÏˆÌ¤Ó˜ ÂÚÈÔ¯¤˜, Ì ·-ÓÒÌ·ÏË ·ÔÚÚfiÊËÛË Î·È ÔÛÙ¤ˆÛË5. MÈÎÚÔÛÎÔÈο, ËÂÚÈÔ¯‹ ·˘Ù‹ ÌÂٷ͇ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ Î·È ÔÛÙ½Ó˘, ÂÌ-Ê·Ó›˙ÂÙ·È ˆ˜ ÌÈ· Û˘Ó¯‹˜ ‰ÔÌ‹. Ÿˆ˜ ηٷ‰ÂÈÎÓ‡ÂÙ·È·fi ÂÈÚ¿Ì·Ù· Ë ·ÔÚÚfiÊËÛË ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ ÓÂÔÁÈÏÒÓ‰ÔÓÙÈÒÓ ̄ ˆÚ›˜ ÌfiÓÈÌÔ ‰È¿‰Ô¯Ô ¤Ú¯ÂÙ·È Ì ηı˘ÛÙ¤ÚËÛË,ÂÓÒ ·ÓÙ›ıÂÙ· Ë ÊÏÂÁÌÔÓ‹ ‰Â›¯ÓÂÈ Ó· ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·-ÔÚÚfiÊËÛË6. E›Û˘ ·fi ¤Ú¢Ó˜, ·Ô‰ÂÈÎÓ‡ÂÙ·È ˆ˜‚·ÛÈÎfi Û˘ÛÙ·ÙÈÎfi Ù˘ ·ÔÚÚÔÊËÙÈ΋˜ ‰ÈÂÚÁ·Û›·˜ ›ӷÈË ÌÔ˘ÎÔÔÏ˘Û·Î¯·ÚȉÈ΋ ‰Ú¿ÛË ÂÓÙfi˜ Ù˘ ÂÚÈÔ‰ÔÓÙÈ-΋˜ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÓÂÔÁÈÏÒÓ ‰ÔÓÙÈÒÓ. H ‰Ú·ÛÙËÚÈfiÙËÙ··˘Ù‹ Ê·›ÓÂÙ·È ˆ˜ ·Ô˘ÛÈ¿˙ÂÈ ÛÙ· ÓÂÔÁÈÏ¿ ·ÁÎ˘ÏˆÌ¤Ó·‰fiÓÙÈ·, Ë ÂÚÈÔ‰ÔÓÙÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÂÍ·È-ÚÂÙÈο ÈÓ҉˘ Î·È ÂÚȤ¯ÂÈ ÌÈÎÚfi ·ÚÈıÌfi ΢ÙÙ¿ÚˆÓ7.
AITIO§O°IA
O ‚ÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ÚfiÎÏËÛ˘ Ù˘ ·Á·ψÛ˘‰ÂÓ Â›Ó·È ·fiÏ˘Ù· Û·Ê‹˜. K·Ù¿ ηÈÚÔ‡˜ ¤¯Ô˘Ó ÚÔÙ·ı›‰È¿ÊÔÚ˜ ·fi„ÂȘ ÔÈ Î˘ÚÈfiÙÂÚ˜ ·fi ÙȘ Ôԛ˜ Â›Ó·È ÔÈ·ÎfiÏÔ˘ı˜:I. H ‡·ÚÍË Û˘ÁÁÂÓÒ˜ οÔÈÔ˘ ÎÂÓÔ‡ ‹ χÛˆ˜ Ù˘ Û˘Ó¤-¯ÂÈ·˜ ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘, Ô˘ ÚÔηÏ› ÙË Û‡˙¢ÍË ÔÛÙ½Ó˘Ù˘ Ú›˙·˜ Î·È ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡8.M ÙË ÚÔÛ¤ÁÁÈÛË·˘Ù‹ ÂÓÙÔ‡ÙÔȘ, ‰ÂÓ ÂÍËÁÂ›Ù·È Â·ÚÎÒ˜ ˆ˜ Á›ÓÂÙ·È Ó·Û˘Ì‚·›ÓÂÈ Ë ·Á·ψÛË, Û ‰fiÓÙÈ· Ù· ÔÔ›· ¤¯Ô˘Ó ·Ó·-Ù›ÏÏÂÈ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. H ‡·ÚÍË ÂÓfi˜ Ù¤ÙÔÈÔ˘ÎÂÓÔ‡ Û˘ÁÁÂÓÒ˜, ı· Ô‰ËÁÔ‡Û ·ÁˆÁÈο ÛÙËÓ ·‡ÛËÙ˘ ‰È·‰Èηۛ·˜ ·Ó·ÙÔÏ‹˜ Ôχ ÈÔ ÚfiˆÚ·.II. H ÚfiˆÚË ·Ó·ÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ÌfiÓÈÌÔ˘ ÁÔÌÊ›Ô˘ Ô˘·ÛÎÒÓÙ·˜ ¤ÓÙÔÓ˜ Ì·ÛËÙÈΤ˜ ‰˘Ó¿ÌÂȘ ηıËÏÒÓÂÈ ÙÔ˘˜‰Â‡ÙÂÚÔ˘˜ ÓÂÔÁÈÏÔ‡˜ ÁÔÌÊ›Ô˘˜ ÂÓÙfi˜ ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ Ô-ÛÙÔ‡8. EÓÙÔ‡ÙÔȘ, Ë ·Á·ψÛË ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔ˘˜ÚÒÙÔ˘˜ ÓÂÔÁÈÏÔ‡˜ ÁÔÌÊ›Ô˘˜ ·ÚÎÂÙ¿ Û˘¯Ó¿,ÛÙÔȯ›ÔÔ˘ ÂÍ·ÛıÂÓ› ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ÂÍ‹ÁËÛË.III. H ̆ ¤ÚÌÂÙÚË Ì·ÛËÙÈ΋ ›ÂÛË ‹ ÙÚ·‡Ì· Â›Ó·È ‰˘Ó·ÙfiÓÓ· ÚÔηϤÛÂÈ Ì›· ÙÔÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘, Ë Â-ԇψÛË Ù˘ ÔÔ›·˜ ηٷϋÁÂÈ Û ÔÛÙ¤ˆÛË8. TÔ ÁÂÁÔ-Ófi˜ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ ·-Á·ψÛ˘ ÛÙÔ˘˜ ÓÂÔÁÈÏÔ‡˜ ÁÔÌÊ›Ô˘˜ Â›Ó·È ·˘ÍË̤ÓÔÛ˘ÓËÁÔÚ› ˘¤Ú Ù˘ ıˆڛ·˜ ·˘Ù‹˜. EÓÙÔ‡ÙÔȘ, ·ÓÂÍ‹-ÁËÙË ·Ú·Ì¤ÓÂÈ Ë ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ·Á·ψÛ˘ ÙˆÓÓÂÔÁÈÏÒÓ ÁÔÌÊ›ˆÓ Û ۯ¤ÛË Ì ÙÔ˘˜ ÌfiÓÈÌÔ˘˜. E›Û˘,¤Ó· ·ÎfiÌ· ·‰‡Ó·ÙÔ ÛËÌÂ›Ô ·ÔÙÂÏÔ‡Ó Ù· Â˘Ú‹Ì·Ù· ÂÈ-Ú·Ì·ÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ô˘ ÌÂϤÙËÛ·Ó ÙËÓ Èı·Ó‹ ÂÌÊ¿ÓÈ-ÛË ·Á·ψÛ˘ Ì ÂÊ·ÚÌÔÁ‹ ˘¤ÚÌÂÙÚˆÓ Ì·ÛËÙÈÎÒÓ‰˘Ó¿ÌˆÓ. ™ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜, Ù· ˘ÔΛÌÂÓ· Û ٤ÙÔÈ-Ô˘ ›‰Ô˘˜ ‰˘Ó¿ÌÂȘ ‰fiÓÙÈ·, ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ·Á·ψÛË9, 10.IV. H ‡·ÚÍË ÌÈ·˜ ÙÔÈ΋˜ ‰È·Ù·Ú·¯‹˜ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfiÛ οÔÈ· ÂÚÈÔ¯‹ ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘11, 12. Ÿˆ˜ Â›Ó·È ÁÓˆ-ÛÙfi Ë ‰È·‰Èηۛ· Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÚÈ˙ÒÓ ÂÓfi˜ ÓÂÔ-ÁÈÏÔ‡ ‰ÔÓÙÈÔ‡ ·ÎÔÏÔ˘ı› οÔȘ Ê¿ÛÂȘ. ™˘ÁÎÂÎÚÈ̤ӷ,ÙÔ ÂÚÈÔ‰fiÓÙÈÔ ÌÔÚ› Ó· ¯·Ú·ÎÙËÚÈÛÙ› Û·Ó ÂÓ· ÂÚÈfi-ÛÙÂÔ Ì ‰‡Ô Ï¢ڤ˜. Afi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ Ô-ÛÙÔ‡ Á›ÓÂÙ·È Û˘Ó¯‹˜ ÙÔÈ΋ ·ÔÚÚfiÊËÛË Î·È ÂÓ·fiıÂÛËÔÛÙÔ‡, ÂÓÒ ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ Ú›˙·˜ ÙÔ˘ ‰ÔÓÙÈÔ‡ Á›ÓÂÙ·ÈÛ˘Ó¯‹˜ ÂÓ·fiıÂÛË ÔÛÙ½Ó˘12. K·Ù¿ ·˘Ùfi ÙÔÓ ÙÚfiÔ ÙÔÂÚÈÔ‰fiÓÙÈÔ ·Ú·Ì¤ÓÂÈ ·Ó¤·ÊÔ,ÎÚ·ÙÒÓÙ·˜ ÙÔ ‰È·¯ˆÚÈ-ÛÌfi ÌÂٷ͇ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ Î·È ÔÛÙ½Ó˘, Î·È ÂÈÙÚ¤Ô-ÓÙ·˜ ÛÙȘ ›Ó˜ ÙÔ˘ Sharpey Ó· ·Ó·ÚÔÛ·ÚÌfi˙ÔÓÙ·È. TÔÂÚÈÔ‰fiÓÙÈÔ ·Ú·Ì¤ÓÂÈ Ì¤¯ÚÈ Ù˘ ·fiÙˆÛ˘ ÙÔ˘ ·ÓÙÈ-ÛÙÔ›¯Ô˘ ‰ÔÓÙÈÔ‡ Û ÛÙ·ıÂÚ‹ Û¯¤ÛË Ì ÙÔ˘˜ ‰‡Ô ÈÛÙÔ‡˜.¶·ÚfiÏ· ·˘Ù¿, ·Ó, Û‡Ìʈӷ Ì ÙË ¿Ô„Ë ·˘Ù‹, ÙÔ ÂÚÈÚ-Ú›˙ÈÔ ÙÔ˘ ÓÂÔÁÈÏÔ‡ ‰ÔÓÙÈÔ‡ ·ÔÚÚÔÊËı› ÓˆÚ›ÙÂÚ· ·fiÙËÓ Ú›˙· ·˘ÙÔ‡, ÙfiÙ ·Ó·fiÊ¢ÎÙ· ÙÔ ÂÚÈÔ‰fiÓÙÈÔ ı·ÛÙ·Ì·Ù‹ÛÂÈ Ó· ‰È·¯ˆÚ›˙ÂÈ ÙÔ ÔÛÙfi ·fi ÙË ÚÈ˙È΋ ÂÈÊ¿-ÓÂÈ·, Ì ·ÔÙ¤ÏÂÛÌ· Ë ÙÂÏÂ˘Ù·›· Ó· ¤ÚıÂÈ Û ·ʋ Ì ÙÔÊ·ÙÓÈ·Îfi ÔÛÙfi Î·È Ó· ¤ÏıÂÈ ·Á·ψÛË. AÓ Î·È ÂÈÎÚ·Ù¤-ÛÙÂÚË ·˘Ù‹ Ë ıˆڛ·, ‰ÂÓ ÂÍËÁ› ·ÚÎÒ˜ ÙËÓ ·˘ÍË̤ÓËÛ˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÓÂÔÁÈÏÒÓ ÁÔÌÊ›ˆÓ Û ۯ¤ÛËÌ ٷ ˘fiÏÔÈ· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ·.Ÿˆ˜ Â›Ó·È Ê·ÓÂÚfi Û·Ê‹˜ ·ÈÙÈÔÏÔÁÈ΋ ÂÈÎfiÓ· Ù˘ ·Á·-ψÛ˘ ‰ÂÓ ˘¿Ú¯ÂÈ. øÛÙfiÛÔ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂ-ÚÔÈ ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ÚÔ¸fiıÂÛË ·ÒÏÂÈ·˜ Ù˘ ÂÚÈÔ-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 64
‰ÔÓÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÁÈ· ÙËÓ ÚfiÎÏËÛË Ù˘ ·Á·ψÛ˘.A·Ú·›ÙËÙË Â›Ó·È Ë Û˘Ì‚ÔÏ‹ Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›-‰Ú·Û˘, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÈÛ‚ÔÏ‹ ÔÛÙÂÔÎÏ·ÛÙÒÓÎ·È ÔÛÙÂÔ‚Ï·ÛÙÒÓ. Afi ÙË ‰Ú¿ÛË ·˘ÙÒÓ ·Ú·ÙËÚ›ٷȤÓÙÔÓË ·ÔÚÚfiÊËÛË Î·È Â·ÎfiÏÔ˘ıË ·ÓÒÌ·ÏË ÔÛÙ¤ˆ-ÛË Ù˘ ÂÚÈÔ¯‹˜, Ô˘ ʤÚÂÈ Û ۇ˙¢ÍË ÙÔ Ê·ÙÓÈ·Îfi Ô-ÛÙfi Ì ÙËÓ ÔÛÙ½ÓË ÙÔÈο. H ‰È·‰Èηۛ· ·˘Ù‹ Â›Ó·È ÏÔÁÈ-Îfi Ó· Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙȘ ÂÚÈfi‰Ô˘˜ ÂΛӘ Ô˘ Á›ÓÂٷȤÓÙÔÓË ÂÓ·fiıÂÛË ÔÛÙÔ‡13. T· ·›ÙÈ· Ù˘ χÛ˘ Ù˘ Û˘-Ó¤¯ÂÈ·˜ ÙÔ˘ ÂÚÈÔ‰ÔÓÙ›Ô˘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Â›Ó·È Û˘Ó‹-ıˆ˜ Ì˯·ÓÈο, ıÂÚÌÈο ‹ ÌÂÙ·‚ÔÏÈο Î·È Û˘Ì‚·›ÓÔ˘Ó Â›-Ù ηٿ ÙË ‰È¿ÚÎÂÈ· ›Ù ÌÂÙ¿ ·fi ÙËÓ ·Ó·ÙÔÏ‹ ÙÔ˘ ‰Ô-ÓÙÈÔ‡ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. Œ¯Ô˘Ó ›Û˘ ·Ó·ÊÂÚ-ı› ÂÓ‰ÔÎÚÈÓÈÎÔ›, ÙÔÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÂÚÈ·ÎÚÔÚÚÈ˙ÈΤ˜ÏÔÈÌÒÍÂȘ, ÙÚ·‡Ì·Ù·, ÚÔËÁÔ‡ÌÂÓ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Â-ÂÌ‚¿ÛÂȘ ˆ˜ Èı·Ó¿ ·›ÙÈ· ÁÈ· ÙËÓ ÚfiÎÏËÛË Ù˘ ·Á·-ψÛ˘14. AÍ›˙ÂÈ Ó· ·Ó·ÊÂÚı› ÔÙÈ ÔÏϤ˜ ÊÔÚ¤˜ ÔÈ ÂÚÈÔ-¯¤˜ Ù˘ ·Á·ψÛ˘ ·ÔÚÚÔÊÒÓÙ·È ‰›ÓÔÓÙ·˜ ÛÙÈÁÌÈ·›·Â·ÓÂÓÂÚÁÔÔ›ËÛË Ù˘ ·Ó·ÙÔÏ‹˜ ÙÔ˘ ‰ÔÓÙÈÔ‡7. Œ¯ÂÈ‚ÚÂı› ˆ˜ Ë ÂÊ·ÚÌÔÁ‹ Ì·ÛËÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ Û˘Ì‚¿Ï-ÏÂÈ ıÂÙÈο ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ ÚfiÏ˄˘ Ù˘ ·-Á·ψÛ˘, οÙÈ Ô˘ ¤¯ÂÈ ·Ô‰Âȯı› ÂÈÚ·Ì·ÙÈο15.
™YXNOTHTA EMºANI™H™
H ·Á·ψÛË ··ÓÙ¿Ù·È ÈÔ Û˘¯Ó¿ ÛÙ· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ·.T· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Á·ψÛË ‰¤Î· ÊÔÚ¤˜ÂÚ›Ô˘ ÈÔ Û˘¯Ó¿ Û ۯ¤ÛË Ì ٷ ÌfiÓÈÌ·16. MÂϤÙ˜ ¤-‰ÂÈÍ·Ó ˆ˜ Ë Û˘¯ÓfiÙËÙ· Ù˘ ·Á·ψÛ˘ Û ¤Ó· ‹ ÂÚÈÛ-ÛfiÙÂÚ· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ· Ù· ÔÔ›· ‰ÂÓ ¤¯Ô˘Ó ·Ó·Ù›ÏÏÂÈÏ‹Úˆ˜ ÛÙÔ ÊÚ·ÁÌfi Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 1.5% Î·È 9.9% ·-Ó¿ÏÔÁ· Ì ÙÔÓ ÏËı˘ÛÌfi Î·È Ù· ÎÚÈÙ‹ÚÈ· ÂÚ‡Ó˘17.EÓÙÔ‡ÙÔȘ, ¤Ó· ÔÛÔÛÙfi Á‡Úˆ ÛÙÔ 6.9% Ê·›ÓÂÙ·È Ó· ·-ÓÙ·ÔÎÚ›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·3. AfiÙ· ÓÂÔÁÈÏ¿ ‰fiÓÙÈ· ÈÔ Û˘¯Ó‹ Â›Ó·È Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÓÂÔ-ÁÈÏÒÓ ÁÔÌÊ›ˆÓ Ù˘ οو ÁÓ¿ıÔ˘18. °ÂÓÈο, Ù· ‰fiÓÙÈ· Ù˘οو ÁÓ¿ıÔ˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ‰‡Ô ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ·fi Ù· ‰fiÓÙÈ· Ù˘ ¿Óˆ ÁÓ¿ıÔ˘19. EÓÙÔ‡ÙÔȘ, Ù· ‰fiÓÙÈ·Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÚÔηÏÔ‡Ó ÂÓÙÔÓfiÙÂÚ· Û˘ÁÎÏÂÈÛȷοÚÔ‚Ï‹Ì·Ù· fiÙ·Ó ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Á·ψÛË, Û ۯ¤ÛËÌ ·˘Ù¿ Ù˘ οو3, 20. Afi ÙËÓ ÌfiÓÈÌË Ô‰ÔÓÙÔÊ˘˝·, ÈÔÛ˘¯Ó¿ Ê·›ÓÂÙ·È Ó· ÚÔÛ‚¿ÏÏÂÙ·È Ô ÌfiÓÈÌÔ˜ ΢Ófi‰Ô-ÓÙ·˜4. º·›ÓÂÙ·È ˆ˜ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ·-Á·ψÛ˘ ÂÚÈÛÛfiÙÂÚˆÓ ÙÔ˘ ÂÓfi˜ ‰ÔÓÙÈÔ‡ ÛÙËÓ ›‰È·ÁÓ¿ıÔ6. ™˘¯ÓfiÙÂÚ· ‰Â›¯ÓÂÈ Ó· ÚÔÛ‚¿ÏÏÂÙ·È Ë Ï¢΋ Ê˘-Ï‹ Û ۇÁÎÚÈÛË Ì ÙË Ì·‡ÚË Î·È ÙËÓ Î›ÙÚÈÓË17, 19, 21. AÍ›˙ÂÈÓ· ÛËÌÂȈı› ˆ˜ ÔÈ ¿Óˆ ÓÂÔÁÈÏÔ› ÁÔÌÊ›ÔÈ ‰Â›¯ÓÔ˘Ó Ó· ·-Á΢ÏÒÓÔÓÙ·È ÚÈÓ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙˆÓÚÒÙˆÓ ÌfiÓÈÌˆÓ ÁÔÌÊ›ˆÓ, ¤Óˆ ÔÈ Î¿Ùˆ ÓÂÔÁÈÏÔ› Û ËÏÈ-Λ· 7-8 ¯ÚfiÓˆÓ22.
¶PO¢IA£E™IKOI ¶APA°ONTE™
AÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ Ô‰ÔÓÙÈ΋˜ ·Á·ψÛ˘ Ì ËÏÈ-Λ·, ʇÏÔ, ÙÂÚˉfiÓ·, Û˘ÛÙËÌ·ÙÈΤ˜ ÓfiÛÔ˘˜, ¤ÓÙ·ÛË ·-ÛÎÔ‡ÌÂÓˆÓ Û˘ÁÎÏÂÈÛÈ·ÎÒÓ ‰˘Ó¿ÌÂˆÓ Î·È Ô˘Ï›Ùȉ· ‰ÂÊ·›ÓÂÙ·È Ó· ̆ ¿Ú¯ÂÈ. º·›ÓÂÙ·È fï˜ ˆ˜ Û¯ÂÙ›˙ÂÙ·È Ì ·-Ó·Ù˘ÍȷΤ˜ ·ÓˆÌ·Ï›Â˜ Ù˘ ·‰·Ì·ÓÙ›Ó˘23, ηıÒ˜ Î·È Ì‰ȿÊÔÚ· Û‡Ó‰ÚÔÌ·, fiˆ˜ ·˘Ùfi Ù˘ Â͈‰ÂÚÌÈ΋˜ ‰˘-
ÛÏ·Û›·˜24. TÔ ÁÂÁÔÓfi˜ fiÙÈ ÂÌÊ·Ó›˙ÂÙ·È Û¯ÂÙÈο Û˘¯Ó¿Û ·È‰È¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ›¯·Ó ›Û˘ ÂÌÊ·Ó›ÛÂÈ·Á·ψÛË17, ‰ËÏÒÓÂÈ fiÙÈ Èı·Ófi Ó· ˘¿Ú¯ÂÈ ÎÏËÚÔÓÔÌÈ-΋ ÚԉȿıÂÛË25, 26. H ÚԉȿıÂÛË Ô˘ ÂÌÊ·Ó›˙ÂÈ Ë Ô‰Ô-ÓÙÈ΋ ·Á·ψÛË Ê·›ÓÂÙ·È, ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÓÂÔÁÈÏÔ›ÁÔÌÊ›ÔÈ ÚÔÛ‚¿ÏÏÔÓÙ·È Û˘¯ÓfiÙÂÚ· ·Ô Ù· ¿ÏÏ· ‰fiÓÙÈ·ÙÔ˘ ÊÚ·ÁÌÔ‡18, fiˆ˜ ›Û˘ Î·È ·Ô ÙÔ fiÙÈ ÙÔ Ê·ÈÓfiÌÂ-ÓÔ Ù˘ ·ÌÊoÙÂÚfiÏ¢Ú˘ ·Á·ψÛ˘, Û ÂÚÈÛÙ·ÙÈοÔÏÏ·Ï‹˜ ·Á·ψÛ˘, Â›Ó·È Ôχ ÈÔ Û˘¯Ófi ·Ô ÙË ÌÔ-ÓfiÏ¢ÚË ·Á·ψÛË3.
ENTO¶I™H
H ÂÚÈÔ¯‹ Ù˘ ·Á·ψÛ˘ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÓÙÔ›˙ÂÙ·ÈÛ ÔÔÈ·‰‹ÔÙ ÛËÌÂ›Ô Ù˘ Ú›˙·˜ ÙÔ˘ ‰ÔÓÙÈÔ‡, Û˘Ó‹ıˆ˜fï˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ ÛËÌÂ›Ô ·fiÛ¯ÈÛ˘ ÙˆÓ ÚÈ˙ÒÓ17.E›Û˘, ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Û ÓÂÔÁÈÏ¿ ‰fiÓÙÈ·, ÛÙ· Ô-Ô›· Ï›ÂÈ Û˘ÁÁÂÓÒ˜ Ô ÌfiÓÈÌÔ˜ ‰È¿‰Ô¯Ô˜, Ë ·Á·ψÛË,fiÙ·ÓÛ˘Ì‚·›ÓÂÈ, ¤¯ÂÈ Û˘Ó‹ıˆ˜ ·ÎÚÔÚÚÈ˙È΋ Î·È fi¯È ·˘¯Â-ÓÈ΋ ÂÓÙfiÈÛË17.
K§INIKH EIKONA
KÏÈÓÈο Ë ÂÈÎfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·ÁÎ˘ÏˆÌ¤Ó· ‰fi-ÓÙÈ·, Â›Ó·È ÂÈÎfiÓ· ÂÌ‚˘ıÈÛı¤ÓÙˆÓ ‰ÔÓÙÈÒÓ. H ÂÈÎfiÓ· ·˘Ù‹¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ‰È¿ÊÔÚÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ˘ÈÔı¤ÙËÛËÙÔ˘ fiÚÔ˘ ‚˘ıÈṲ̂ÓÔ (submerged) ‰fiÓÙÈ. ™˘Ó‹ıˆ˜ Ù· ·-ڷΛÌÂÓ· ‰fiÓÙÈ· ·ÔÎÏ›ÓÔ˘Ó ÚÔ˜ ÙÔ ·ÁÎ˘ÏˆÌ¤ÓÔ ‰fi-ÓÙÈ, ÂÓÒ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ˘ÂÚ¤ÎÊ˘ÛË ÙˆÓ ·ÓÙ·-ÁˆÓÈÛÙÒÓ. (EÈÎ. 1, 2).
§O°OI ¢IAKO¶H™ TH™ ºY™IO§O°IKH™ KINH™H™ ANA-TO§H™ ENO™ ¢ONTIOY
¶ÚÈÓ ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÔÈ Èı·ÓÔ› ÙÚfiÔÈ ‰È¿ÁÓˆÛ˘ Ù˘ԉÔÓÙÈ΋˜ ·Á·ψÛ˘, ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› ÙÔ Û‡-ÓÔÏÔ ÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ‰‡Ó·Ù·È Ó· ÚÔηϤÛÂÈ ·‡-
65
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
EÈÎfiÓ· 1: KÏÈÓÈ΋ (1· Î·È 1‚) Î·È ·ÎÙÈÓÔÁÚ·ÊÈ΋ (1Á) ÂÈÎfiÓ· Â-ÚÈÛÙ·ÙÈÎÔ‡ ¤ÁÎÏÂÈÛ˘ fiÏˆÓ ÙˆÓ ‰Â˘Ù¤ÚˆÓ ÓÂÔÁÈÏÒÓ ÁÔÌÊ›ˆÓ.
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 65
ÛË ‹ ‰È·ÎÔ‹ Ù˘ ΛÓËÛ˘ ÙÔ˘ ‰ÔÓÙÈÔ‡. º˘ÛÈÔÏÔÁÈο, Ù·‰fiÓÙÈ· ¤¯Ô˘Ó ¤Ó· Û˘Ó¯¤˜ ‰˘Ó·ÌÈÎfi ·Ó·ÙÔÏ‹˜. K¿ı‰ȷÎÔ‹ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·˘Ù‹˜ ΛÓËÛ˘ ·ÔÙÂÏ› ¤Ó·‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ· ÙfiÛÔ ̂ ˜ ÚÔ˜ ÙËÓ ‰È¿ÁÓˆÛË, fiÛÔÎ·È ÚÔ˜ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË27 Î·È ‰˘Ó·ÙfiÓ Ó· ÔÊ›ÏÂÙ·È ÛÂ3 ·Ú¿ÁÔÓÙ˜ :I. ⁄·ÚÍË ÂÌÔ‰›Ô˘ (.¯. Ô‰fiÓو̷,ÌÂÛfi‰ÔÓÙ·˜ ˘Â-Ú¿ÚÈıÌÔ ‰fiÓÙÈ, ¤ÏÏÂÈ„Ë ¯ÒÚÔ˘ Î.Ï..) ÛÙËÓ ÔÚ›· ·Ó·-ÙÔÏ‹˜ ÙÔ˘ ‰ÔÓÙÈÔ‡, ÌÂ Û˘Ó¤ÂÈ· ·˘Ùfi Ó· ·Ú·Ì¤ÓÂÈ ¤-ÁÏÂÈÛÙÔ Î·È Ó· ÌËÓ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙË-Ù·. EÓÙÔ‡ÙÔȘ, ÙÔ ‰˘Ó·ÌÈÎfi ·Ó·ÙÔÏ‹˜ ̆ ¿Ú¯ÂÈ Î·È ·Ó ·Ú-ı› Ô ÂÚÈÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ ‰fiÓÙÈ Û˘Ó¯›˙ÂÈ ÙËÓ·Ó·ÙÔÏ‹ ÙÔ˘.II. AÙ‡¯ËÌ· ‹ ÌfiÏ˘ÓÛË Ô˘ Ô‰ËÁ› Û ӤÎÚˆÛË ÙˆÓ Ô‰Ô-ÓÙÈÎÒÓ ÈÛÙÒÓ, ÌÂ Û˘Ó¤ÂÈ· Ó· ¯¿ÓÂÙ·È ÙÔ «‰˘Ó·ÌÈÎfi ·Ó·-ÙÔÏ‹˜»(Ôχ Û¿ÓÈÔ).III. AÁ·ψÛË, fiÙ·Ó Ë ·Ó·ÙÔÏ‹ ÂÌÔ‰›˙ÂÙ·È ÏfiÁˆ Ù˘ Û˘-Ó¤ÓˆÛ˘ ÌÂٷ͇ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ Î·È ÔÛÙ½Ó˘ Ù˘ Ú›-˙·˜.Œ¯Ô˘Ó ·Ó·ÊÂÚı› ›Û˘ ·Ô ÁÂÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ë ·-Ó¿ÚÎÂÈ· ÂÓ‰ÔÎÚÈÓÒÓ ·‰¤ÓˆÓ, ‰È¿ÊÔÚÔÈ ÓfiÛÔÈ ÙÔ˘ Û˘Ó-‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, ηıÒ˜ Î·È Ë ·ÎÙÈÓÔ‚ÔÏ›· ̂ ˜ ·›ÙÈ· ·‡Û˘Ù˘ ΛÓËÛ˘ ÙÔ˘ ‰ÔÓÙÈÔ‡. Afi ÙÔ˘˜ ÙÔÈÎÔ‡˜, ¤¯Ô˘Ó η-Ù· ηÈÚÔ‡˜ ·Ó·ÊÂÚı› ›Û˘, ÙÔ ÌÈÎÚfi ̤ÁÂıÔ˜ ÙÔ˘ Ô-‰ÔÓÙÈÎÔ‡ ÙfiÍÔ˘,Ë ·Ú·ÌÔÓ‹ ÙÔ˘ ÓÂÔÁÈÏÔ‡ ÂÚÈÛÛfiÙÂÚÔ¯ÚfiÓÔ ·fi ÙÔ Î·ÓÔÓÈÎfi, ‹ ÚfiˆÚË ·ÒÏÂÈ· ÙÔ˘ ÓÂÔÁÈ-ÏÔ‡ ‰ÔÓÙÈÔ‡, Ë Î·Î‹ ηÙ‡ı˘ÓÛË ·Ó·ÙÔÏ‹˜ ÙÔ˘ ‰ÔÓÙÈÔ‡,Ë ·ÚÔ˘Û›· Ê·ÙÓÈ·ÎÒÓ Û¯ÈÛÙÈÒÓ, Î·È Ë ÌË ·ÔÚÚfiÊËÛËÙ˘ Ú›˙·˜ ÙÔ˘ ÓÂÔÁÈÏÔ‡14. AÔ Ù· ·ÓˆÙ¤Úˆ, ‰È·Ê·›ÓÂÙ·È fiÙÈ ¤Ó· ‰fiÓÙÈ Ô˘ ̆ ÔÏ›Â-
Ù·È ÙÔ˘ Ì·ÛËÙÈÎÔ‡ ÂȤ‰Ô˘, οı ¿ÏÏÔ ·Ú¿ ÛËÌ·›ÓÂÈ fi-ÙÈ Â›Ó·È ·ÁÎ˘ÏˆÌ¤ÓÔ. K·Ù¿ Û˘Ó¤ÂÈ· Â›Ó·È ÂÈÙ·ÎÙÈÎfi Ó·‰È·Ï¢ηÓı› ÙÔ ·›ÙÈÔ Ù˘ ηٿÛÙ·Û˘. ¶¿ÓÙˆ˜ ·fi ÎÏÈÓÈ-ο Î·È ÈÛÙÔÏÔÁÈο ÙÂÎÌ‹ÚÈ·, ηٷ‰ÂÈÎÓ‡ÂÙ·È fiÙÈ ÌÂÁ¿ÏÔÔÛÔÛÙfi ÙˆÓ ÂÌ‚˘ıÈÛÌ¤ÓˆÓ ‰ÔÓÙÈÒÓ, Â›Ó·È ·ÁÎ˘ÏˆÌ¤Ó·28.
TPO¶OI ¢IA°Nø™H™
T· ÛÙÔȯ›· Ù· ÔÔ›· ı· Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁËıÔ‡Ó ÚÔÎÂÈ-̤ÓÔ˘ Ó· ÙÂı› Ë ÙÂÏÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi˜¤ÏÂÁ¯Ô˜, ÔÈ ‰ÔÎÈ̷ۛ˜ ÎÈÓËÙÈÎfiÙËÙ·˜ Î·È Â›ÎÚÔ˘Û˘ η-ıÒ˜ Î·È Ë Û˘ÓÔÏÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ‡ÔÙÔ˘ ‰ÔÓÙÈÔ‡. O ·ÎÙÈÓÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È Î˘Ú›ˆ˜ Ì ÔÈÛıÔ-Ê·ÙÓÈ·Îfi ·ÎÙÈÓÔÁÚ¿ÊËÌ· ‹ Ì ·ÎÙÈÓÔÁÚ·Ê›· ÌÂÙ¿ ÙÂ-Ú˘Á›Ô˘. EÓÙÔ‡ÙÔȘ, Ô ÙÚfiÔ˜ ·˘Ùfi˜ Ù˘ ‰È¿ÁÓˆÛ˘ ›ӷÈÛ˘¯Ó¿ ·Ó·Ú΋˜, ÂÍ·ÈÙ›·˜ ÙˆÓ ÌÂÈÔÓÂÎÙËÌ¿ÙˆÓ Ù˘‰ÈۉȿÛÙ·Ù˘ ·ÎÙÈÓÔÁÚ·ÊÈ΋˜ ·ÂÈÎfiÓËÛ˘ ÂÓfi˜ ÙÚÈÛ-‰È¿ÛÙ·ÙÔ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘29. Y¿Ú¯ÂÈ Û¯Â‰fiÓ ÔÌfiʈÓË ¿-Ô„Ë fiÙÈ Ë ·ÎÙÈÓÔÁÚ·Ê›· Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È¿-ÁÓˆÛË ÌfiÓÔ ÂÊfiÛÔÓ Ë ·ÁÎ˘ÏˆÙÈ΋ ‰ÈÂÚÁ·Û›· ·ÊÔÚ¿ ÌÂ-Á¿ÏÔ ÙÌ‹Ì· Ù˘ ÂÈÊ¿ÓÂÈ·˜ Ù˘ Ú›˙·˜ ÒÛÙ ӷ Á›ÓÂÙ·È·˘Ùfi ÂÌÊ·Ó¤˜ ÛÙËÓ ·ÎÙÈÓÔÁÚ·ÊÈ΋ Ͽη17. E›Û˘, ÙÔÊ·ÈÓfiÌÂÓÔ Ù˘ ·ÏÏËÏ›·˜ οÓÂÈ ‰˘Ó·Ù‹ ÙËÓ ÂÓÙfiÈÛËÙ˘ ·Á·ψÛ˘ ÌfiÓÔ fiÙ·Ó ·˘Ù‹ ·ÊÔÚ¿ ÙȘ fiÌÔÚ˜ ÂÈ-Ê¿ÓÂÈ·˜ ÙˆÓ ‰ÔÓÙÈÒÓ. ŒÙÛÈ, ÂÚÈÙÒÛÂȘ ·Á·ψÛË˜Ô˘ ·ÊÔÚÔ‡Ó ÁψÛÛÈΤ˜ ‹ ·ÚÂȷΤ˜ ÂÈÊ¿ÓÂȘ ‰Â ‰È·-ÁÈÁÓÒÛÎÔÓÙ·È ·ÎÙÈÓÔÁÚ·ÊÈο ‡ÎÔÏ·10. ™Â ÌÈÎÚfi ‰Â›ÁÌ·ÌÂϤÙ˘ ¤¯ÂÈ ‚ÚÂı› ˆ˜ ÂÓÒ Ë ·ÎÚ›‚ÂÈ· Ù˘ ·ÎÙÈÓÔÁÚ·-ÊÈ΋˜ ÌÂıfi‰Ô˘ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ·Á·ψÛ˘ ›-Ó·È ÎÔÓÙ¿ ÛÙÔ 70%, Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È ÎÔ-ÓÙ¿ ÛÙÔ 33%30. ™Â οı ÂÚ›ÙˆÛË, ¿ÓÙˆ˜, Ô ·ÎÙÈÓÔ-ÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ÌÔÚ› Î·È ‰ÂÓ Ú¤ÂÈ Ó· ¯ÚËÛÈ-ÌÔÔÈÂ›Ù·È Û·Ó ÙÔ ÌÔÓ·‰ÈÎfi Î·È Î·ıÔÚÈÛÙÈÎfi ÎÚÈÙ‹ÚÈԉȿÁÓˆÛ˘ ÁÈ· ÙËÓ ·Á·ψÛË, ·ÏÏ¿ Ó· ¯ÚËÛÈÌÔÔÈ›ٷÈÛ·Ó ÙÌ‹Ì· Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ‰È·‰Èηۛ·˜ Ô˘ ·ÚÔ˘-ÛÈ¿ÛÙËΠÈÔ ¿Óˆ.¢ÔÎÈÌ·Û›· ÎÈÓËÙÈÎfiÙËÙ·˜ Î·È Â›ÎÚÔ˘Û˘. ŸÏ˜ ÔÈ Úfi-ÛÊ·Ù˜ ÌÂϤÙ˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÔÈ ·-Ú·¿Óˆ ‰ÔÎÈ̷ۛ˜ Â›Ó·È Ôχ ·ÍÈfiÈÛÙ˜ (ÂÚÈÛÛfiÙÂÚÔÎ·È ·fi ÙÔÓ ·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô) Î·È ÌÔÚÔ‡Ó Ó· ·›-ÍÔ˘Ó Î·Ù·Ï˘ÙÈÎfi ÚfiÏÔ ÛÙË ‰È¿ÁÓˆÛË15, 31. °È· Ó· Û˘Ì‚·›-ÓÂÈ ·˘Ùfi fï˜ Ú¤ÂÈ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 20% Ù˘ ÂÈ-Ê¿ÓÂÈ·˜ Ù˘ Ú›˙·˜ ÙÔ˘ ˘fi ¤ÏÂÁ¯Ô ‰ÔÓÙÈÔ‡ Ó· ÌÂÙ¤¯ÂÈÛÙËÓ ·ÁÎ˘ÏˆÙÈ΋ ‰ÈÂÚÁ·Û›·5, 15. O ‹¯Ô˜ ηٿ ÙËÓ Â›-ÎÚÔ˘ÛË Â›Ó·È ·Ì‚χ˜ Î·È ˘fiΈÊÔ˜ Î·È ÙÔ ‰fiÓÙÈ ‰ÂÓ ·-ÚÔ˘ÛÈ¿˙ÂÈ Î·ÌÈ¿ ÎÈÓËÙÈÎfiÙËÙ·.H ÁÂÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ‡ÔÙÔ˘ ‰ÔÓÙÈÔ‡ ηıÒ˜ Î·È Ë ı¤ÛËÙÔ˘ ÛÙÔ Ô‰ÔÓÙÔÊ·ÙÓÈ·Îfi ÙfiÍÔ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙˉȷÁÓˆÛ‹ Ì·˜ ηıÔÚÈÛÙÈο. ™˘Ó‹ıˆ˜ ÙÔ ·ÁÎ˘ÏˆÌ¤ÓÔ‰fiÓÙÈ ˘ÔÏ›ÂÙ·È ÙÔ˘ Ì·ÛËÙÈÎÔ‡ ÂȤ‰Ô˘ Î·È ¤¯ÂÈ ¯¿-ÛÂÈ Ù· ÛËÌ›· ·ʋ˜ Ì ٷ ·Ú·Î›ÌÂÓ· Î·È ·ÓÙ·ÁˆÓÈ-ÛÙÈο ÙÔ˘ ‰fiÓÙÈ·17 (EÈÎ. 3). E›Û˘, Û οÔȘ ÂÚÈÙÒ-ÛÂȘ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ·Ú·ÌÔÓ‹ ÙÔ˘ ÓÂÔÁÈÏÔ‡ Â-ÚÈÛÛfiÙÂÚÔ ·fi ÙÔ Î·ÓÔÓÈÎfi ÛÙÔ ÙfiÍÔ, Ì ‹ ¯ˆÚ›˜ ‰È¿‰Ô-¯Ô ÌfiÓÈÌÔ ‰fiÓÙÈ17.™ÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ıÂڷ›· ÙÔ ÌÔÓ·‰ÈÎfi ۷ʤ˜ Î·È ·-fiÏ˘ÙÔ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ, Ô˘ ‰ÂÓ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ¤ÎÙ·ÛË Ù˘ ·Á·ψÛ˘, Â›Ó·È Û‡Ìʈӷ Ì ÔÏÏÔ‡˜ Û˘Á-ÁÚ·Ê›˜ Ë ·‰˘Ó·Ì›· ÙÔ˘ ‰ÔÓÙÈÔ‡ Ó· ÌÂÙ·ÎÈÓËı› οو ·-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
EÈÎfiÓ· 2: KÏÈÓÈ΋ (2·) Î·È ·ÎÙÈÓÔÁÚ·ÊÈ΋ (2‚) ÂÈÎfiÓ· ÂÚÈÛÙ·ÙÈ-ÎÔ‡ Ì ·Á·ψÛË fiÏˆÓ ÙˆÓ ‰Â˘Ù¤ÚˆÓ ÓÂÔÁÈÏÒÓ ÁÔÌÊ›ˆÓ ηÈÛ˘ÁÁÂÓÔ‡˜ ¤ÏÏÂȄ˘ ÙˆÓ ‰Â˘Ù¤ÚˆÓ οو ÌfiÓÈÌˆÓ ÚÔÁÔÌÊ›ˆÓ.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 66
fi ÙËÓ Â›‰Ú·ÛË ÔÚıÔ‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌˆÓ4. TÔ ‡ÔÙÔ‰fiÓÙÈ fi¯È ·Ï¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ·‰˘Ó·Ì›· Ó· ÌÂÙ·ÎÈÓËı› ·Ï-Ï¿ ·Ú·ÙËÚÂ›Ù·È ÂÌ‚‡ıÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ-ÛÙËÚÈÁÌ¿ÙˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ‰È¿ÁÓˆÛË Ù˘ ·Á·-ψÛ˘ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔ˘Ì ÔÙÈ ˘¿Ú¯Ô˘Ó Û¯ÂÙÈΤ˜‰˘ÛÎÔϛ˜. TfiÛÔ Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜, fiÛÔ Î·È ÔȉÔÎÈ̷ۛ˜ ÎÈÓËÙÈÎfiÙËÙ·˜ Î·È Â›ÎÚÔ˘Û˘ ‰ÂÓ ‰›ÓÔ˘Ó ¿-ÓÙ· ÍÂοı·Ú˜ ··ÓÙ‹ÛÂȘ ÌÂ Û˘Ó¤ÂÈ·, Ë ÔÚı‹ ‰È¿ÁÓˆ-ÛË Û˘Ó‹ıˆ˜ Ó· ‰È·Ê‡ÁÂÈ. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·‰˘Ó·Ì›·ÌÂٷΛÓËÛ˘ ÙÔ˘ ‰ÔÓÙÈÔ‡ οو ·fi ÙËÓ Â›‰Ú·ÛË ÔÚıÔ-‰ÔÓÙÈÎÒÓ ‰˘Ó¿ÌˆÓ5, 22, 30, ·Ó Î·È Â›Ó·È Ô ÈÔ ·ÍÈfiÈÛÙÔ˜ ηÈ¢·›ÛıËÙÔ˜ ÙÚfiÔ˜ ‰È¿ÁÓˆÛ˘, ʤÚÂÈ ÙÔ ÌÂÈÔÓ¤ÎÙËÌ·Ù˘ ÂÎÙÂٷ̤Ó˘ ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜ ÁÈ· ÙËÓ ÈÛÙÔÔ›Ë-ÛË Ù˘ ‰È¿ÁÓˆÛ˘, ηıÒ˜ Î·È ÙȘ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂÈ˜Ô˘ ÚÔ·ÙÔ˘Ó ·Ô ÙËÓ ÂÌ‚‡ıÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ ÛÙËÚÈÁ-Ì¿ÙˆÓ fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ.
E¶I¶Tø™EI™
OÈ ÂÈÙÒÛÂȘ Ù˘ ·Á·ψÛ˘ ÂÓfi˜ ‰ÔÓÙÈÔ‡ Ô˘ ÚÔ·-ÙÔ˘Ó, ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È ÌfiÓÔ ÛÙÔ ¿Û¯ÔÓ ‰fiÓÙÈ ·ÏÏ¿ Â-ÂÎÙ›ÓÔÓÙ·È Î·È ÂËÚ¿˙Ô˘Ó Û˘ÓÔÏÈο ÙÔ ÛÙÔÌ·ÙÔÁÓ·-ıÈÎfi Û‡ÛÙËÌ·32. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ:I. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi Ë ·‡ÍËÛË ÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ Á›-ÓÂÙ·È Ê˘ÛÈÔÏÔÁÈο Î·È Î·Ù¿ ÙȘ ÙÚÂȘ ‰È·ÛÙ¿ÛÂȘ ÙÔ˘ ̄ Ò-ÚÔ˘, ‰ËÏ·‰‹ ηٷ Ì‹ÎÔ˜, ηٿ Ï¿ÙÔ˜ Î·È Î·Ù¿ ‡„Ô˜.™ÙÔ ·ÁÎ˘ÏˆÌ¤ÓÔ ‰fiÓÙÈ ÙÔ Ê·ÙÓÈ·Îfi ÔÛÙfi ÛÙ·Ì·Ù¿ Ó· ·-Ó·Ù‡ÛÛÂÙ·È Î˘Ú›ˆ˜ ηٿ ÙËÓ Î·Ù·ÎfiÚ˘ÊË ‰È¿ÛÙ·Û‹ÙÔ˘, Ì ¿ÌÂÛË Û˘Ó¤ÂÈ· Ó· ˘ÔÏ›ÂÙ·È ÙÔ˘ Ì·ÛËÙÈÎÔ‡ÂȤ‰Ô˘. H ·fiÛÙ·ÛË ·˘Ù‹ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ Ë-ÏÈΛ· Ô˘ Û˘Ì‚·›ÓÂÈ Ë ·Á·ψÛË, ηıÒ˜ Î·È ·fi ÙÔ ¯Úfi-ÓÔ Ô˘ ÌÂÛÔÏ·‚› ̤¯ÚÈ ÙËÓ ·Ú·Ù‹ÚËÛË. EȉÈÎfiÙÂÚ·, fi-ÛÔ ÈÔ ÌÈÎÚ‹ Â›Ó·È Ë ËÏÈΛ· Ô˘ Û˘Ì‚·›ÓÂÈ Î·È fiÛÔ ÈÔ ÌÂ-Á¿ÏÔ Â›Ó·È ÙÔ ‰È¿ÛÙËÌ· Ô˘ ÌÂÛÔÏ·‚› ̤¯ÚÈ ÙËÓ ·Ú·-
Ù‹ÚËÛË ÙfiÛÔ ÈÔ ÌÂÁ¿ÏË Â›Ó·È Ë ·fiÛÙ·ÛË10. H ·fiÛÙ·-ÛË ·fi ÙÔ Ì·ÛËÙÈÎfi Â›Â‰Ô Û˘Óԉ‡ÂÙ·È ·fi ÙËÓ ·Ò-ÏÂÈ· ÛËÌ›ˆÓ ·ʋ˜ Ì ٷ ·Ú·Î›ÌÂÓ· ‰fiÓÙÈ· Ô˘ Ô-‰ËÁ› Û ÛÙÚÔʤ˜ Î·È ·ÔÎÏ›ÛÂȘ ·˘ÙÒÓ33. E›Û˘, Ë ·-fiÛÙ·ÛË ·˘Ù‹ ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜Î·È Ó· Ô‰ËÁ‹ÛÂÈ Û ˘ÂÚ¤ÎÊ˘Û‹ ÙÔ˘˜.II. Y¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜, ÂÊfiÛÔÓ ÙÔ ·ÁÎ˘ÏˆÌ¤ÓÔ ‰fiÓÙÈ Â›Ó·ÈÓÂÔÁÈÏfi, Ó· ÚÔÎÏËıÔ‡Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÛÙÔ ‰È¿-‰Ô¯Ô ÌfiÓÈÌÔ ‰fiÓÙÈ. T¤ÙÔÈÔ˘ ›‰Ô˘˜ ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ËÂÎÙfiÈÛË, Ë ‰È‡ڢÓÛË ÙÔ˘ ÂÓ‰ÔÊ·ÙÓÈ·ÎÔ‡ ÂÙ¿ÏÔ˘, Ë·ÒÏÂÈ· Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡ Î.·.6. £· Ú¤ÂÈ fï˜ Ó· ÂÈ-ÛËÌ·Óı› ˆ˜ ÂÓÒ Ë ·ÚÔ˘Û›· ÙˆÓ ÛËÌ›ˆÓ ·˘ÙÒÓ ÛÙ·‰È¿‰Ô¯· ÌfiÓÈÌ· ‰fiÓÙÈ· ¤¯ÂÈ ÂȂ‚·Èˆı›, ‰ÂÓ ¤¯ÂÈ ÙÂÎ-ÌËÚȈı› ·fiÏ˘Ù· Ô Ì˯·ÓÈÛÌfi˜ Ù˘ ÚfiÎÏËÛ˘ ÙÔ˘˜,·fi Ù· ·ÓÙ›ÛÙÔȯ· ·ÁÎ˘ÏˆÌ¤Ó· ÓÂÔÁÈÏ¿. ™ÎfiÈÌÔ Â›Ó·ÈÓ· ·Ó·ÊÂÚı› fiÙÈ ÂȉÈο ÁÈ· ÙÔ˘˜ ÓÂÔÁÈÏÔ‡˜ 1Ô˘˜ ÁÔÌÊ›-Ô˘˜ fiÙ·Ó Â›Ó·È ·ÁÎ˘ÏˆÌ¤ÓÔÈ, Û˘¯Ó¿ ÚÔηÏÔ‡Ó Î·ı˘-ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ Ù˘ Ú›˙·˜ ÙˆÓ ‰È·‰fi¯ˆÓ ÌfiÓÈ-̈Ó, οÙÈ Ô˘ ‰ÂÓ ·Ú·ÙËÚ›ٷÈ, Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-Îfi ‚·ıÌfi, ÛÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ 2Ô˘˜ ÓÂÔÁÈÏÔ‡˜ ÁÔÌÊ›-Ô˘˜18.III. Y¿Ú¯ÂÈ Ë Èı·ÓfiÙËÙ· ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ¤ÁÎÏÂÈÛ˘ ÙÔ˘·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡. TÔ‡ÙÔ Û˘Ì‚·›ÓÂÈ Û˘Ó‹ıˆ˜ ÛÙËÓοو ÁÓ¿ıÔ Î·È ·ÊÔÚ¿ ΢ڛˆ˜ ÙÔ˘˜ ‰Â‡ÙÂÚÔ˘˜ ÓÂÔÁÈ-ÏÔ‡˜ ÁÔÌÊ›Ô˘˜ (EÈÎ. 4). K·È ·˘Ùfi ÏfiÁˆ Ù˘ ¤ÓÙÔÓ˘ Ù¿-
Û˘ ÙˆÓ ÚÒÙˆÓ ÌfiÓÈÌˆÓ ÁÔÌÊ›ˆÓ Ù˘ οو ÁÈ· ÂÁÁ‡˜ÌÂٷΛÓËÛË. KÏÈÓÈο, ·Ú·ÙËÚÂ›Ù·È ·Ô˘Û›· ÙÔ˘ ÓÂÔÁÈ-ÏÔ‡ Î·È Ï‡ÛË Ù˘ Û˘Ó¤¯ÂÈ·˜ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Ô˘ ·-ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÌÔÚÊ‹ Û˘ÚÈÁÁ›Ô˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·-ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡. M ‚¿ÛË ÙËÓ ·fiÛÙ·ÛË Ù˘ ̇Ï˘ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡ ·fi ÙÔ Ì·ÛËÙÈÎfi Â›Â‰Ô Ë ¤-ÎÙ·ÛË Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ¤ÁÎÏÂÈÛ˘ ÌÔÚ› Ó· ‰È·ÎÚÈ-ı› ÛÂ:23
·) MÈÎÚ‹, fiÙ·Ó Ë Ì·ÛËÙÈ΋ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘‰ÔÓÙÈÔ‡ ·¤¯ÂÈ 1 ¯ÈÏ. ÂÚ›Ô˘ ·Ô ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ, ÛÂÛ¯¤ÛË Ì ÙÔ Ì·ÛËÙÈÎfi ›‰Ô.‚) M¤ÙÚÈ·, fiÙ·Ó Ë Ì·ÛËÙÈ΋ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘‰ÔÓÙÈÔ‡ ‚Ú›ÛÎÂÙ·È ÈÛÔ¸„Ò˜ Ì ٷ ÛËÌ›· ·ʋ˜ ÙÔ˘ Â-Ófi˜ ‹ Î·È ÙˆÓ ‰‡Ô ·Ú·Î›ÌÂÓˆÓ ‰ÔÓÙÈÒÓ.Á) MÂÁ¿ÏË, fiÙ·Ó Ë Ì·ÛËÙÈ΋ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ·ÁÎ˘ÏˆÌ¤-ÓÔ˘ ‰ÔÓÙÈÔ‡ ‚Ú›ÛÎÂÙ·È ¯·ÌËÏfiÙÂÚ· ·fi ÙËÓ fiÌÔÚË ÂÈ-Ê¿ÓÂÈ· ÙˆÓ Ô‡ÏˆÓ ÙÔ˘ ÂÓfi˜ ‹ Î·È ÙˆÓ ‰‡Ô ·Ú·Î›ÌÂÓˆÓ‰ÔÓÙÈÒÓ.
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
EÈÎfiÓ· 4: AÁ·ψÛË Î·È ‰Â˘ÙÂÚÔÁÂÓ‹˜ ¤ÁÎÏÂÈÛË ÙÔ˘ ‰Â‡ÙÂÚÔ˘ÓÂÔÁÈÏÔ‡ ÁÔÌÊ›Ô˘ (75). ¶·Ú·ÙËÚÂ›Ù·È ÂÌ‚‡ıÈÛË ÙÔ˘ ÓÂÔÁÈÏÔ‡ÁÔÌÊ›Ô˘ (75) Î·È ·fiÎÏÈÛË ÙÔ˘ ÌfiÓÈÌÔ˘ (36) ÚÔ˜ ÙÔ ·ÁÎ˘ÏˆÌ¤-ÓÔ ‰fiÓÙÈ.
EÈÎfiÓ· 3: KÏÈÓÈ΋ (3·) Î·È ·ÎÙÈÓÔÁÚ·ÊÈ΋ (3‚) ÂÈÎfiÓ· ÂÚÈÛÙ·ÙÈ-ÎÔ‡ Ì ·Á·ψÛË ÛÙÔÓ ¿Óˆ ·ÚÈÛÙÂÚ¿ ÚÒÙÔ ÌfiÓÈÌÔ ÁÔÌÊ›Ô (26).
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 67
£· Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ‚È‚ÏÈÔÁÚ·ÊÈο ·Ó·Ê¤ÚÔÓÙ·ÈÎ·È ¿ÏÏÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜¤ÁÎÏÂÈÛ˘, ÂÎÙfi˜ ·fi ÙËÓ ·Á·ψÛË, fiˆ˜ Â›Ó·È ÙÔ ÂÏ-ÏÂȤ˜ ‰˘Ó·ÌÈÎfi ·Ó·ÙÔÏ‹˜, Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈ-ÛÌÔ‡ Ù˘ ÂÚÈÔ‰ÔÓÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ÙÔ ÙÚ·‡Ì·, ÔÈ ÙÔÈ-Τ˜ ÊÏÂÁÌÔÓ¤˜, ÔÈ ÙÔÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·Ó¿Ù˘ÍËÙÔ˘ Ê·ÙÓÈ·ÎÔ‡ ÔÛÙÔ‡, ÔÈ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·ÏÏËÏ›‰Ú·-ÛË ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈ΋˜ ·ÔÚÚfiÊËÛ˘ Î·È ÂԇψÛË˜ÙˆÓ ÛÎÏËÚÒÓ ÈÛÙÒÓ fiˆ˜ Î·È ÎÏËÚÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜.EÔ̤ӈ˜, Ë ·ÚÔ˘Û›· ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ·Á·ψÛ˘ÛÙÔÓ Ô‰ÔÓÙÈÎfi ÊÚ·ÁÌfi ÂÓfi˜ ·ÛıÂÓ‹ ‰ÂÓ Ú¤ÂÈ Ó· Ï·Ì-‚¿ÓÂÙ·È ··Ú·›ÙËÙ· ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ Ô‰ÔÓÙÈ΋˜ ·-Á·ψÛ˘34. IV. A‰˘Ó·Ì›· Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ‰ÔÓÙÈÔ‡ Ïfi-Áˆ Ù˘ ·Á·ψÛ˘, Ô˘ ÛÙË Û˘Ó¤¯ÂÈ· ÂËÚ¿˙ÂÈ Î·È ÙËÓ·Ó¿Ù˘ÍË Ù˘ Ê·ÙÓȷ΋˜ ·fiÊ˘Û˘. ŒÙÛÈ, Â›Ó·È ‰˘Ó·ÙfiÓÓ· ‰ËÌÈÔ˘ÚÁËı› ·ÈÛıËÙÈÎfi Úfi‚ÏËÌ· ÛÙËÓ ÚÔÛıÂÙÈ΋·ÔηٿÛÙ·ÛË, ÂÊfiÛÔÓ ‰ÂÓ ¤¯ÂÈ ÚÔËÁËı› ıÂڷ›·ÛÙÔ ¿Û¯ÔÓ ‰fiÓÙÈ.V. ¢˘Ó·ÙfiÓ Ó· ÚÔÎÏËı› ÂÎÙÂٷ̤ÓÔ ÙÚ·‡Ì· ÛÙËÓ Â-ÚÈÔ¯‹ ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡ ·Ó ÂȯÂÈÚËı› Ë ÂÍ·-ÁˆÁ‹ ÙÔ˘ Û˘Ì‚·ÙÈο. H ·Á·ψÛË ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ¯ÂÈ-ÚÔ˘ÚÁÈ΋˜ ÂÍ·ÁˆÁ‹˜ ÒÛÙ ӷ ‰È·ÙËÚËı› fiÛÔ ÙÔ ‰˘Ó·-ÙfiÓ Ë ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ Ê·ÙÓÈ·ÎÒÓ ÂٿψÓ.VI. H ·Á·ψÛË ÂÓfi˜ ÓÂÔÁÈÏÔ‡ ‰ÔÓÙÈÔ‡ Â›Ó·È Èı·Ófi Ó·ÚÔηϤÛÂÈ, ÁÈ· ÚÔÊ·Ó›˜ ÏfiÁÔ˘˜, Ì›ˆÛË ÙÔ˘ ‰È·ı¤ÛÈ-ÌÔ˘ ¯ÒÚÔ˘ ÁÈ· ÙËÓ ·Ó·ÙÔÏ‹ ÙˆÓ ÌfiÓÈÌˆÓ ‰ÔÓÙÈÒÓ. K¿ÙÈÙ¤ÙÔÈÔ, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ¤ÁÎÏÂÈÛË ‹ ¤ÎÙÔË ·Ó·-ÙÔÏ‹ ÙˆÓ ‰È·‰fi¯ˆÓ ÌfiÓÈÌˆÓ ‰ÔÓÙÈÒÓ ·ÏÏ¿ Î·È Ó· Ô‰ËÁ‹-ÛÂÈ ÛÂ Û˘ÁÏÂÈÛȷο ÚÔ‚Ï‹Ì·Ù· ÌÂÙ¿ ÙËÓ ·Ó·ÙÔÏ‹ ÙÔ˘˜.VII. ¢˘Ó·ÙfiÓ Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ÛÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ·fiÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ·ÛıÂÓ‹, Ì ·ÚÂÌ‚ÔÏ‹ Ù˘ ÁÏÒÛÛ·˜,ÛÙÔ ÎÂÓfi Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÌÂٷ͇ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰Ô-ÓÙÔ‡ Î·È Ì·ÛËÙÈÎÔ‡ ÂȤ‰Ô˘, οÙÈ Ô˘ ÌÔÚ› Ó· Ô‰Ë-Á‹ÛÂÈ ·ÎfiÌ· Î·È Û ¯·ÛÌÔ‰ÔÓÙ›·21. VIII. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ô Ô‰ÔÓÙ›·ÙÚÔ˜ ‰ÂÓ ÂÈÙ‡¯ÂÈ Ó·‰È·ÁÓÒÛÂÈ ÙËÓ ·Á·ψÛË Û ¤Ó· ‰fiÓÙÈ Î·È ÂȯÂÈÚ‹ÛÂÈ Ó·ÙÔ ÌÂÙ·ÎÈÓ‹ÛÂÈ Ì ÔÚıÔ‰ÔÓÙÈο ̤۷ Â›Ó·È Ôχ Èı·ÓfiÓ· ÚÔηϤÛÂÈ ÂÌ‚‡ıÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ ÛÙËÚÈÁÌ¿ÙˆÓ, Ì¿ÌÂÛË Û˘Ó¤ÂÈ· ÙËÓ ‰ËÌÈÔ˘ÚÁ›· Ó¤ˆÓ, ÔÏ˘ÏÔÎfiÙÂÚˆÓÚÔ‚ÏËÌ¿ÙˆÓ, Ô˘ ηıÈÛÙÔ‡Ó ÙÔ ¤ÚÁÔ Ù˘ ·ÔηٿÛÙ·-Û˘ ‰˘Û¯ÂÚ¤ÛÙÂÚÔ (EÈÎ. 5 ).
EÓÙÔ‡ÙÔȘ, ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fi-ÙÈ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, Ë ·Á·ψÛË ‰ÂÓ Â›Ó·È ¿-ÓÙ· Û˘Ó˘Ê·Ṳ̂ÓË Ì ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ. °È· ·Ú¿-‰ÂÈÁÌ·, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ·ÁÎ˘ÏˆÌ¤Ó· ‰fiÓÙÈ· ‰ÂÓ ÌÂÙ·-ÎÈÓÔ‡ÓÙ·È Â‡ÎÔÏ· ¤¯Ô˘Ó ̄ ÚËÛÈÌÔÔÈËı› ·fi ‰È¿ÊÔÚÔ˘˜ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ ÔÚıÔ‰ÔÓÙÈ΋ ıÂڷ›· ˆ˜ ÛÙË-Ú›ÁÌ·Ù· Ì Ôχ ηϿ Ì¿ÏÈÛÙ· ·ÔÙÂϤÛÌ·Ù·. AÎfiÌ·Î·È ÂÚÈÙÒÛÂȘ Ù¯ÓËÙ‹˜ ÚfiÎÏËÛ˘ ·Á·ψÛ˘ Û ÓÂ-ÔÁÈÏ¿ ‰fiÓÙÈ· Ì ·ӷʇÙ¢ÛË ¤¯Ô˘Ó ·Ó·ÊÂÚı›, Ù· Ô-Ô›· ¯ÚËÛÈÌÔÔ›ËıËÎ·Ó ˆ˜ ÛÙËÚ›ÁÌ·Ù· ÁÈ· ÙËÓ ¿ÛÎËÛËÔÚıÔ‰ÈÎÒÓ ‰˘Ó¿ÌˆÓ. M ‰Â‰Ô̤ÓË ÙË ‚Ú·¯˘‚ÈfiÙËÙ·ÙˆÓ ÛÙËÚÈÁÌ¿ÙˆÓ ·˘ÙÒÓ Ù· ıÂڷ¢ÙÈο ·ÔÙÂϤÛÌ·Ù·‹Ù·Ó ÂÓÙ˘ˆÛȷο35, 36, 37, 38.
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H ÚfiÁÓˆÛË ÂÓfi˜ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡ Â›Ó·È ·ÌÊ›‚ÔÏËηıÒ˜ ÔÈ ıÂڷ¢ÙÈΤ˜ Ì·˜ ‰˘Ó·ÙfiÙËÙ˜ Â›Ó·È Û¯ÂÙÈοÂÚÈÔÚÈṲ̂Ó˜, ¯ˆÚ›˜ ·˘Ù¤˜ Ó· ¤¯Ô˘Ó ¿ÓÙ· ÂÈÙ˘¯‹ ·-ÔÙÂϤÛÌ·Ù·. E›Û˘, ÔÈ Û‡Á¯ÚÔÓ˜ ̤ıÔ‰ÔÈ ·Ôηٿ-ÛÙ·Û˘ ÌÔÚ› Ó· ··ÈÙÔ‡Ó ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÁÓÒÛÂȘ ηÈÂÌÂÈÚ›· Î·È Û›ÁÔ˘Ú· ‰ÂÓ ÌÔÚÔ‡Ó Ó· Ú·ÁÌ·ÙÔÔÈË-ıÔ‡Ó ¿ÓÙ· ‡ÎÔÏ· ·fi ÙÔ ÁÂÓÈÎfi Ô‰ÔÓÙ›·ÙÚÔ. MÂÁ¿ÏÔÚfiÏÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈÙÒÛÂˆÓ ÂÓfi˜ ·ÁÎ˘Ïˆ-̤ÓÔ˘ ‰ÔÓÙÈÔ‡ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ, Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË.
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°È· Ó· ‰È·ÌÔÚʈı› ÙÔ Î·Ù¿ÏÏËÏÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì·,ı· Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓÈÛı› Î·È Ó· ÏËÊı› ̆ fi„Ë ·Ó ÙÔ ̆ -fi ıÂڷ›· ‰fiÓÙÈ Â›Ó·È ÓÂÔÁÈÏfi ‹ ÌfiÓÈÌÔ, Ô ¯ÚfiÓÔ˜ Ô˘ÂÌÊ·Ó›ÛÙËÎÂ Ë ·Á·ψÛË ÛÙÔ ‰fiÓÙÈ, ÙÔ ¯ÚÔÓÈÎfi ÛËÌ›ÔÔ˘ ¤ÁÈÓÂ Ë ‰È¿ÁÓˆÛË, ηıÒ˜ Î·È Î˘Ú›ˆ˜ Ë ı¤ÛË ÙÔ˘ ‰Ô-ÓÙÈÔ‡39, 40 ÛÙÔ ÊÚ·ÁÌfi. H ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ‰È·ÊÔÚÂÙÈ΋Û ÓÂÔÁÈÏ¿ Î·È ÌfiÓÈÌ· ‰fiÓÙÈ· Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ı· ÂÚÈ-ÁÚ·Ê› ¯ˆÚÈÛÙ¿.
A) NÂÔÁÈÏ¿ ‰fiÓÙÈ·AÓ ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÈÏfi ‰fiÓÙÈ, ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÌÂÙÚÔÈ·ÔÙÂÏÔ‡Ó ÙÔ Ê‡ÏÔ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙÔ ÛÙ¿‰ÈÔ ·Ó¿-Ù˘Í˘ Ù˘ Ô‰ÔÓÙÔÊ˘˝·˜ Î·È Î·Ù¤ÎÙ·ÛË Ë ËÏÈΛ·. ™ÂÊ¿ÛË ÌÈÎÙ‹˜ Ô‰ÔÓÙÔÊ˘˝·˜ ÌÈ· ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·ÈË ÂÈÌ‹Î˘ÓÛË Ù˘ ̇Ï˘ ÙÔ˘ ·ÁÎ˘Ïˆı¤ÓÙÔ˜ ‰ÔÓÙÈÔ‡, ΢-Ú›ˆ˜ ÁÈ· Ó· ·ÔÊ¢¯ı› Ë ˘ÂÚ¤ÎÊ˘ÛË ÙˆÓ ·ÓÙ·ÁˆÓÈ-ÛÙÒÓ Î·ıÒ˜ Î·È Ë ÂÁÁ‡˜ ·fiÎÏÈÛË ÙˆÓ ·Ú·Î›ÌÂÓˆÓ‰ÔÓÙÈÒÓ. H ÂÈÌ‹Î˘ÓÛË ·˘Ù‹ ÌÔÚ› Ó· Á›ÓÂÈ Â‡ÎÔÏ· ÌÂÛ‡ÓıÂÙË ÚËÙ›ÓË. EÓ·ÏÏ·ÎÙÈ΋ χÛË ·ÔÙÂÏ› Ë ÙÔÔı¤-ÙËÛË ÛÙÂÊ¿Ó˘. øÛÙfiÛÔ ı· Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ Ë ·-ÔηٿÛÙ·ÛË ·˘Ù‹ ı· Ú¤ÂÈ Ó· Â›Ó·È ÚÔÛˆÚÈÓÔ‡ ¯·-Ú·ÎÙ‹Ú·, ·ÊÔ‡ ·Ó·fiÊ¢ÎÙ· ÌÂÙ¿ ·fi οÔÈÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· Ë ›‰È· ÎÏÈÓÈ΋ ÂÈÎfiÓ· ı· ·ӷÏËÊı›. O ¯Úfi-ÓÔ˜ ·Ú·ÌÔÓ‹˜ ÂÓfi˜ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ÓÂÔÁÈÏÔ‡ ‰ÔÓÙÈÔ‡ÛÙÔ ÛÙfiÌ· ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙË ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘.T· ‰fiÓÙÈ· ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ̤۷‰È·Ù‹ÚËÛ˘ ̄ ÒÚÔ˘ ηıÒ˜, fiˆ˜ ·Ó·Ê¤Ú·ÌÂ Î·È ÈÔ ¿-Óˆ, ˆ˜ ÂÓ›Û¯˘ÛË Ù˘ ÛÙ‹ÚÈ͢ ÛÙȘ ÂÚÈÙÒÛÂȘ ÔÚıÔ-‰ÔÓÙÈÎÒÓ ÌÂÙ·ÎÈÓ‹ÛˆÓ. ™ÙË ÂÚ›ÙˆÛË Ô˘ ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È ˆ˜ Ì˯·Ó‹Ì·Ù· ‰È·Ù‹ÚËÛ˘ ¯ÒÚÔ˘ ηÏfiÓ Â›-Ó·È Ó· ÂÏ·ÙÙˆı› Ë ÂÁÁ‡˜-¿ˆ ‰È¿ÌÂÙÚÔ˜ ¤ÙÛÈ ÒÛÙ ӷ
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
EÈÎfiÓ· 5: A‰˘Ó·Ì›· ÔÚıÔ‰ÔÓÙÈ΋˜ ÌÂٷΛÓËÛ˘, ÏfiÁˆ ·Á·ψ-Û˘, ÙÔ˘ ¿Óˆ ‰ÂÍÈÔ‡ ¤ÁÎÏÂÈÛÙÔ˘ ΢Ófi‰ÔÓÙ· (13) Î·È Ù·˘Ùfi¯ÚÔÓËÂÌ‚‡ıÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ ÛÙËÚÈÁÌ¿ÙˆÓ.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 68
‰È¢ÎÔÏ˘Óı› Ë ÔÌ·Ï‹ ‰È¢ı¤ÙËÛË Ù˘ Û‡ÁÎÏÂÈÛ˘.™Â ÂÚÈÙÒÛÂȘ Ô˘ Ë ·Ú·ÌÔÓ‹ ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ÓÂÔ-ÁÈÏÔ‡ ÎÚ›ÓÂÙ·È ˆ˜ ÌË Â͢ËÚÂÙÔ‡Û· ηӤӷ ÛÎÔfi ÂÈ-‚¿ÏÏÂÙ·È Ë ÂÍ·ÁˆÁ‹ ÙÔ˘˜. T˘¯fiÓ ·Ú·ÌÔÓ‹ ÙÔ˘˜ ı· ¤¯ÂȈ˜ Û˘Ó¤ÂÈ· ÙËÓ ÌË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Ù˘ Ê·ÙÓÈ·-΋˜ ·fiÊ˘Û˘, ΢ڛˆ˜ ηٿ ÙÔ Î·Ù·ÎfiÚ˘ÊÔ Â›Â‰Ô, Â-ͤÏÈÍË Ë ÔÔ›· ı· ¤¯ÂÈ ‰Ú·Ì·ÙÈΤ˜ ÂÈÙÒÛÂȘ Û ÔÔÈ·-‰‹ÔÙ ÌÂÏÏÔÓÙÈ΋ ·ÔηٿÛÙ·ÛË. H ‰È·‰Èηۛ· Ù˘ ÂÍ·ÁˆÁ‹˜ Û˘ÓÈÛÙ¿Ù·È fiÙ·Ó ÙÔ ÓÂÔÁÈÏfi‰fiÓÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ¿‰È· ·ÓÒÌ·Ï˘ ‹ ηıfiÏÔ˘ ·ÔÚ-ÚfiÊËÛ˘18 Î·È fiÙ·Ó ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ‰È¿‰Ô¯Ô ÌfiÓÈÌÔ Ê·›ÓÂ-Ù·È Ó· ÂËÚ¿˙ÂÙ·È ˆ˜ ÚÔ˜ ÙËÓ ÔÚ›· ·Ó·ÙÔÏ‹˜ ÙÔ˘22.ŒÓ‰ÂÈÍË ÂÍ·ÁˆÁ‹˜ ̆ ¿Ú¯ÂÈ Â›Û˘ fiÙ·Ó ÙÔ ·ÁÎ˘ÏˆÌ¤ÓÔÓÂÔÁÈÏfi ÚÔηÏ› Û˘ÁÎÏÂÈÛȷΤ˜ ·ÓˆÌ·Ï›Â˜ Ì ·fiÎÏÈ-ÛË ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ‰ÔÓÙÈÒÓ Î·È ·ÒÏÂÈ· ¯ÒÚÔ˘41. K·-Ù¿ ÙËÓ ‰È·‰Èηۛ· ÂÍ·ÁˆÁ‹˜ ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈÓ· ‰›ÓÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙˆÓ Ê·ÙÓÈ·-ÎÒÓ ÂÙ¿ÏˆÓ Ù· ÔÔ›· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰È·Ù‹ÚËÛË ÙÔ˘‡„Ô˘˜ Ù˘ Ê·ÙÓȷ΋˜ ·fiÊ˘Û˘. I‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÚ›ÙˆÛË ‰Â˘ÙÂ-ÚÔÁÂÓÔ‡˜ ¤ÁÎÏÂÈÛ˘ ÓÂÔÁÈÏÒÓ ÁÔÌÊ›ˆÓ Ì ‡·ÚÍË ‹ ·-Ô˘Û›· ÌfiÓÈÌÔ˘ ‰È·‰fi¯Ô˘, Ô˘ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚ÏËÌ·ÙÈ-ÛÌfi fiÛÔÓ ·ÊÔÚ¿ ÙÔ Û¯¤‰ÈÔ ıÂڷ›·˜29. ™Â ÂÚ›ÙˆÛË·Ô˘Û›·˜ ÌfiÓÈÌÔ˘ ‰È·‰fi¯Ô˘ ·ÍÈÔÏÔÁÂ›Ù·È Ë ÂÚÈÔ‰ÔÓÙÈ-΋ ηٿÛÙ·ÛË Î·È Ë ¤ÎÙ·ÛË ·ÔÚÚfiÊËÛ˘ Ù˘ Ú›˙·˜ ÙÔ˘·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡, fiˆ˜ Î·È Ë ËÏÈΛ· ÙÔ˘ ·ÛıÂÓ‹42.K·ÙfiÈÓ, ·ÔÊ·Û›˙ÂÙ·È ·Ó ÙÔ ÓÂÔÁÈÏfi ‰fiÓÙÈ ÌÔÚ› Ó··Ú·Ì›ÓÂÈ ÛÙÔ ÊÚ·ÁÌfi ‹ fi¯È.°È· ÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ fiÔ˘ ̆ ¿Ú¯ÂÈ ÌfiÓÈÌÔ ‰È¿‰Ô-¯Ô ‰fiÓÙÈ ¤Ó· ÎÏ·ÛÈÎfi Û˘Ì‚·ÙÈÎfi Û¯‹Ì·8 ÍÂÎÈÓ¿ Ì ÔÚıÔ-‰ÔÓÙÈ΋ ‰È¿ÓÔÈÍË ÙÔ˘ ¯ÒÚÔ˘ Î·È ·ÔηٿÛÙ·ÛË ÙˆÓ ·-ÔÎÏ›ÛÂˆÓ Î·È ÙˆÓ ÛËÌ›ˆÓ ·ʋ˜ ÌÂٷ͇ ÙˆÓ ·Ú·-ΛÌÂÓˆÓ ‰ÔÓÙÈÒÓ. AÎÔÏÔ˘ı› Ë ·Ê·›ÚÂÛË ÙÔ˘ ÓÂÔÁÈÏÔ‡ÁÔÌÊ›Ô˘ Î·È Ë ·ÔÎ¿Ï˘„Ë Ù˘ ̇Ï˘ ÙÔ˘ ‰È¿‰Ô¯Ô˘ ÌfiÓÈ-ÌÔ˘. K·ÙfiÈÓ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ì˯¿ÓËÌ· ‰È·Ù‹ÚËÛ˘¯ÒÚÔ˘ Î·È ·Ó·Ì¤ÓÂÙ·È Ë ·Ó·ÙÔÏ‹ ÙÔ˘ ÌfiÓÈÌÔ˘ ‰ÔÓÙÈÔ‡,Ô˘ ·Ó ‰ÂÓ Â¤ÏıÂÈ Ê˘ÛÈÔÏÔÁÈο (.¯ ÌË Â˘ÓÔ˚΋ ÊÔÚ¿ ·-Ó·ÙÔÏ‹˜) ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ÔÚıÔ‰ÔÓÙÈ΋ ¤ÏÍË.
B) MfiÓÈÌ· ‰fiÓÙÈ·AÓ ÚfiÎÂÈÙ·È ÁÈ· ÌfiÓÈÌÔ ‰fiÓÙÈ Ù· ÛÙÔȯ›· Ô˘ ı· Ú¤ÂÈÓ· ·ÍÈÔÏÔÁËıÔ‡Ó ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ Â›‰Ô˜ Î·È ÙË ı¤ÛËÙÔ˘ ‰ÔÓÙÈÔ‡ ηıÒ˜ Î·È Ë ‚·Ú‡ÙËÙ· Ù˘ ·Á·ψÛ˘. H ÌÂÔÔÈÔ‰‹ÔÙ ÙÚfiÔ ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ( ÂÈÌ‹-΢ÓÛË Ù˘ ̇Ï˘ Ì ÚËÙ›ÓË ‹ ÛÙÂÊ¿ÓË) ÙÔ˘ ‰ÔÓÙÈÔ‡ ÂÊfi-ÛÔ ·˘Ù‹ ÎÚ›ÓÂÙ·È ÂÊÈÎÙ‹ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ηÈÛ ·˘Ù¿ Ù· ‰fiÓÙÈ·.ÕÏÏÔ˜ ÙÚfiÔ˜ ·ÔηٿÛÙ·Û˘, ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ¯ÂÈ-ÚÔ˘ÚÁÈ΋ «¯·Ï¿ÚˆÛË» ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡ fiˆ˜¯·Ú·ÎÙËÚÈÛÙÈο ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ‚È‚ÏÈÔÁÚ·Ê›·. ™‡Ì-ʈӷ Ì ÙË Ì¤ıÔ‰Ô ·˘Ù‹, ÚÔηÏÂ›Ù·È Ì˯·ÓÈ΋ ıÚ·‡ÛËÙ˘ Û˘ÓÔÛÙˆ̤Ó˘ ÂÚÈÔ¯‹˜ ÌÂٷ͇ ÔÛÙ½Ó˘ Î·È Ê·Ù-ÓÈ·ÎÔ‡ ÔÛÙÔ‡. A˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ̛· ‰È·‰Èηۛ· fi-ˆ˜ ÌÈ· Ù˘È΋ ÂÍ·ÁˆÁ‹ ·ÏÏ¿ Ì ËÈfiÙÂÚ˜ Î·È ÚÔÛÂ-ÎÙÈÎfiÙÂÚ˜, ΢ڛˆ˜ ÂÚÈÛÙÚÔÊÈΤ˜ , ÎÈÓ‹ÛÂȘ ÒÛÙ ӷ ·-ÂÏ¢ıÂÚˆı› ÙÔ ‰fiÓÙÈ, ¯ˆÚ›˜ Ó· ÚÔÎÏËı› Ó¤ÎÚˆÛË·˘ÙÔ‡. H ‰È·‰È·Î·Û›· ·˘Ù‹ ·ӷϷ̂¿ÓÂÙ·È Î·Ù¿ Ù·-ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. B¤‚·È·,·fi ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹‰ÂÓ ÏÂ›Ô˘Ó ÔÈ ÂÈÏÔΤ˜ ÛËÌ·ÓÙÈÎfiÙÂÚË ÂÎ ÙˆÓ ÔÔ›ˆÓ
Â›Ó·È Ë Èı·Ó‹ Ó¤ÎÚˆÛË ÙÔ˘ ÔÏÊÔ‡ ·fi ‰È·Ù·Ú·¯‹ Ù˘·ÈÌ¿ÙˆÛ‹˜ ÙÔ˘, Ô˘ ÚÔ·ÙÂÈ ·fi ÙË ıÏ›„Ë ÙˆÓ ·ÁÁ›-ˆÓ Ô˘ ̆ Ê›ÛÙ·Ù·È ÙÔ ‰fiÓÙÈ5, 39. ¢ÂÓ Â›Ó·È Ï›Á˜ ÔÈ ÂÚÈÙÒ-ÛÂȘ Ô˘ ÙÔ ‰fiÓÙÈ ı· ¯ÚÂÈ·ÛÙ› ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· ‹·ÎfiÌ· ı· ηٷϋÍÂÈ Ó· ÂÍ·¯ı› ·Ó ÂÌÊ·ÓÈÛıÔ‡Ó Ê·ÈÓfi-ÌÂÓ· ·ÔÚÚfiÊËÛ˘ Ù˘ Ú›˙·˜43. T¤ÏÔ˜, Û˘¯Ó¿ ÙÔ ‰fiÓÙÈ Â-·Ó·Á΢ÏÒÓÂÙ·È ÛÙË Ó¤· ÙÔ˘ ı¤ÛË. O ·ÛıÂÓ‹˜ ı· Ú¤-ÂÈ ¿ÓÙ· Ó· Â›Ó·È ÂÓ‹ÌÂÚÔ˜ ÁÈ· ÙȘ Èı·Ó¤˜ ÂÈÏÔΤ˜Ô˘ ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó, ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ‰È·‰È-ηۛ·˜ ·˘Ù‹˜. ¶·Ï·ÈfiÙÂÚ· ›¯Â ¯ÚËÛÈÌÔÔÈËı› Ë Ï‹-Ú˘ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ¿ÚıÚˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ Ì ÂÎÁfiÌʈ-ÛË Î·È ¿ÌÂÛË ·Ó·Ê‡Ù¢ÛË Î·È ·ÎÈÓËÙÔÔ›ËÛË. T· ·ÔÙÂ-ϤÛÌ·Ù· Ù˘ ÌÂıfi‰Ô˘ ‹Ù·Ó ȉȷ›ÙÂÚ· ÊÙˆ¯¿, ‰ÈfiÙÈ Û˘-¯Ófiٷٷ ÚԤ΢Ù Â͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË Ù˘ Ú›˙·˜ÙÔ˘ ‰ÔÓÙÈÔ‡, ÂÓÒ ‹Ù·Ó ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ·Ó·Ù˘Á-̤ÓÔ˘ ÔÛÙÔ‡ ÛÙËÓ ÂÚÈÔ¯‹, ÒÛÙ ӷ ·Ô‰ÒÛÂÈ Ë Ì¤ıÔ-‰Ô˜ ·ÈÛıËÙÈο14. ¶ÈÔ Û‡Á¯ÚÔÓË Ì¤ıÔ‰Ô˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ·Á·ψÛË˜Â›Ó·È Ë ÙÌËÌ·ÙÈ΋ ÔÛÙÂÔÙÔÌ›·44. K·Ù¿ ÙË ̄ ÂÈÚÔ˘ÚÁÈ΋ ·˘-Ù‹ Ù¯ÓÈ΋, ÌÂÙ·ÎÈÓÂ›Ù·È ÙÔ ·ÁÎ˘ÏˆÌ¤ÓÔ ‰fiÓÙÈ Ì·˙› Ì fi-ÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ Ê·ÙÓÈ·Îfi ÔÛÙÔ‡ÓÔ˘ ÙÔ ÂÚÈ‚¿ÏÏÂÈ ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÈηÓÔÔÈËÙÈ΋˜·ÈÌ¿ÙˆÛ˘. B·ÛÈ΋ ÚÔ¸fiıÂÛË Ù˘ Ù¯ÓÈ΋˜ ·˘Ù‹˜ ›-Ó·È Ë ‡·ÚÍË ÙÔ˘ ·Ó·Áη›Ô˘ ̄ ÒÚÔ˘ ÁÈ· ÙËÓ ̆ Ô‰Ô¯‹ ÙÔ˘˘fi ÌÂٷΛÓËÛË ‰ÔÓÙÈÔ‡. E›Û˘ fiÙÈ ÂӉ›ÎÓ˘Ù·È ÌfiÓÔÁÈ· ÂÓ‹ÏÈη ¿ÙÔÌ· Û ¿ÙÔÌ· ‰ËÏ·‰‹ Ô˘ Ë ·‡ÍËÛË Î·Ù¿ÙÔ Î·Ù·ÎfiÚ˘ÊÔ Â›Â‰Ô ¤¯ÂÈ ÂÚ·Ùˆı›14. H ÙÂÏÂ˘Ù·›·ÚÔ¸fiıÂÛË Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ ÁÈ·Ù› ·Ó ‰ÂÓ ÏËÊı›ÛÔ‚·Ú¿ ˘fi„Ë ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÙÔ ‰fiÓÙÈ Ó· ·Ú¯›ÛÂÈ Ó·˘ÔÏ›ÂÙ·È ÙÔ˘ Ì·ÛËÙÈÎÔ‡ ÂȤ‰Ô˘ ÂÎ Ó¤Ô˘. ™ÙȘ ÂÚÈ-ÙÒÛÂȘ Ô˘ Ô ̄ ÒÚÔ˜ Â›Ó·È ·Ó·Ú΋˜ ı· Ú¤ÂÈ Ó· ¤¯ÂÈÚÔËÁËı› Ë Î·Ù¿ÏÏËÏË ÚÔÂÙÔÈÌ·Û›· Ì ÔÚıÔ‰ÔÓÙÈ΋ıÂڷ›·. K·Ù¿ ηÓfiÓ· Ë fiÏË ‰È·‰Èηۛ· ı· Ú¤ÂÈ Ó·Û˘Ó‰˘¿˙ÂÙ·È Ì ÔÚıÔ‰ÔÓÙÈ΋ ıÂڷ›· ÁÈ·Ù› ¤ÙÛÈ ÂÍ·-ÛÊ·Ï›˙ÂÙ·È ÈÔ Â‡ÎÔÏË ·ÎÈÓËÙÔÔ›ËÛË. H Ù¯ÓÈ΋ ·˘Ù‹,ÌÔÏÔÓfiÙÈ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰Â ıÂڷ‡ÂÈ ÙËÓ ·Á·-ψÛË, ·ÔÙÂÏ› ¤Ó·Ó Û¯ÂÙÈο ·Ïfi ÙÚfiÔ ÙÔÔı¤ÙËÛ˘ÙÔ˘ ·ÁÎ˘ÏˆÌ¤ÓÔ˘ ‰ÔÓÙÈÔ‡ ÛÙËÓ ÂÈı˘ÌËÙ‹ ÙÔ˘ ı¤ÛË. ø-ÛÙfiÛÔ ı· Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ·ÎfiÌ· Î·È Ì ÙËÓ Ù¯ÓÈ-΋ ·˘Ù‹ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·ÚÎÂÙ¤˜ ÂÈÏÔΤ˜ fiˆ˜ Ó¤-ÎÚˆÛË ÙÔ˘ ÔÏÊÔ‡, ÂÛÙȷ΋ ÔÛÙÂÔÓ¤ÎÚˆÛË Î·ıÒ˜ ηȷڷÌÔÓ‹ ÔÛÙÈÎÒÓ ıÚ·˘ÛÌ¿ÙˆÓ ·Ó¿ÌÂÛ· ÛÙ· ÔÛÙÂÔÙÔ-ÌË̤ӷ ÙÌ‹Ì·Ù·, ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ¤̂·Û˘44.™Â ÂÚÈÙÒÛÂȘ Ô˘ Ë Ì ÔÔÈÔ‰‹ÔÙ ÙÚfiÔ ÌÂٷΛÓË-ÛË ÎÚ›ÓÂÙ·È ·Ó¤ÊÈÎÙË ÂÈ‚¿ÏÏÂÙ·È Ë ÚÔÛÂÎÙÈ΋ ÂÍ·Áˆ-Á‹ ÙÔ˘ ‰ÔÓÙÈÔ‡ Î·È Ë ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË.
™YM¶EPA™MATA
H Ô‰ÔÓÙÈ΋ ·Á·ψÛË ·ÔÙÂÏ› ·‰È·ÌÊÈÛ‚‹ÙËÙ· ¤Ó·ÎÏÈÓÈÎfi Úfi‚ÏËÌ· Ô˘ ηÏ›ٷÈ, Û¯ÂÙÈο Û˘¯Ó¿, Ó· ·ÓÙÈ-ÌÂÙˆ›ÛÂÈ Ô Ô‰ÔÓÙ›·ÙÚÔ˜. ¶·Ú¿ ÙȘ Û¯ÂÙÈΤ˜ ¤Ú¢Ó˜, Ù··›ÙÈ· Ô˘ Ô‰ËÁÔ‡Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ù˘ ‰ÂÓ ¤¯Ô˘Ó Ï‹-Úˆ˜ ·ÔÛ·ÊËÓÈÛÙ›. H ‰È·ÁÓˆÛÙÈ΋ ÌÂıÔ‰ÔÏÔÁ›· Ô˘ ·-ÎÔÏÔ˘ıÂ›Ù·È ‰ÂÓ ÌÔÚ› Û˘Ó‹ıˆ˜ Ó· ‰ÒÛÂÈ Û·Ê‹ ·ÔÙÂ-ϤÛÌ·Ù·. ™ËÌ·ÓÙÈÎÔ› ·Ú¿ÌÂÙÚÔÈ ÁÈ· ÙËÓ Î·Ù¿ÚÙÈÛË ÙÔ˘Û¯Â‰›Ô˘ ıÂڷ›·˜ ·ÔÙÂÏÔ‡Ó Ë ÂÌÂÈÚ›· Î·È Ë ÁÓÒÛËÙÔ˘ ıÂÚ¿ÔÓÙ· fiˆ˜ Î·È Ë ÂÈı˘Ì›· ÙÔ˘ ·ÛıÂÓ‹. £·Ú¤ÂÈ Ù¤ÏÔ˜ Ó· ÂÈÛËÌ·Óı› Ë ÛËÌ·Û›· Ù˘ ¤ÁηÈÚ˘
69
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
63-71 ÛÂÏ. Marinopoulos** 3-10-08 12:51 ™ÂÏ›‰· 69
‰È¿ÁÓˆÛ˘ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ‰È¿ÊÔÚˆÓ ÂÈÙÒÛˆÓÔ˘ ÌÔÚÔ‡Ó Ó· ÚÔ·„Ô˘Ó ÛÙÔ ÛÙÔÌ·ÙÔÁÓ·ıÈÎfi Û‡-ÛÙËÌ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹.
SUMMARY
"The problem of dental ankylosis: Its diagnosis,sequences and treatment"
E. Marinopoulos, G. Tsorovas, E. Katsavrias
hellenic stomatological review 48: 63-71, 2004
Periodontium is a form of articulation in which the tooth isconstantly moving. However, if a fusion between thecementum and the alveolar bone occurs this normalmovement is inhibited and the tooth becomes ankylosed.The reasons causing this situation are not quite clear. Manytheories and possible mechanisms are proposed.Nowadays we believe that mechanic, thermic or metabolicdisturbances can provoke an inflammatory reaction whichcombined with an invasion of osteoblastic and osteoclasticcells can produce ankylosis. Ankylosis is more prevalent inthe primary dentition especially in the molar region. There isno apparent correlation with age, sex, caries, occlusalforces or gingivitis. It seems to be more prevalent at thefurcation area. The ankylosed tooth gives the clinicalimpression of submergence. Before establishing adiagnosis the dentist should differentiate ankylosis fromgeneral or regional situations which may obstruct or evenstop the tooths course towards the occlusal plane; such asimpaction or tooth necrosis. A radiographic assessment ofthe area as well as repercussion tests are helpfuldiagnostic means but a definite diagnosis can only bemade if the suspected teeth show a total lack of movementafter the application of orthodontic forces. Tooth ankylosiscan cause a variety of problems to the occlusion as well asthe anatomy and function of the orofacial system. The mostcommon ones include: cessation of the development ofthe alveolar bone area causing occlusal and estheticproblems, damage to the permanent successor, infra-occlusion, trauma if conventional extraction proceduresare operated, loss of arch length, open bite andsubmergence of the adjacent teeth during orthodontictreatment. The prognosis of ankylosis is rather poor and thetreatment plan depends on early diagnosis. In the primarydentition the teeth can be extracted or be prostheticallyrestored. In the permanent dentition however the possibletreatment options, include surgical intervention or luxationand immediate orthodontic traction.
Key words: Dental ankylosis, tooth submergence, infraocclu-sion, occlusal problems.
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71ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 63-71, 2004
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
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BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ AÓ·ÛÎÔ‹ÛÂȘ
O ÚfiÏÔ˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÚfiÏË„Ë ÙÔÈ΋˜ ‹ Û˘ÛÙËÌ·ÙÈ΋˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÊÏÂÁÌÔÓ‹˜ ηٿ
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E. EÏ¢ıÂÚÈ¿‰Ë˜*, X. ¶··‰‹Ì·˜**, M. §Â‚¤ÓÙ˘**
H ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ ÂÁÎÏ›ÛÙˆÓ ÙÚ›ÙˆÓ ÁÔÌÊ›ˆÓ ÁÈ· ÙËÓ ÚfiÏË„Ë ÌÂ-ÙÂÁ¯ÂÈÚËÙÈ΋˜ ÊÏÂÁÌÔÓ‹˜, Â›Ó·È Û¯ÂÙÈο ‰È·‰Â‰Ô̤ÓË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈ΋, ̄ ˆÚ›˜ fï˜ Ó·Â›Ó·È ¿ÓÙÔÙ ·ÈÙÈÔÏÔÁË̤ÓË. B¤‚·È·, Ë ÚÔÏËÙÈ΋ ¯ÔÚ‹ÁËÛË ÙÔ˘˜ Û ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜·ÛıÂÓ›˜ ‹ Û ·ÛıÂÓ›˜ Ì ÔÚıÔ‰ÈΤ˜ ÚÔÛı¤ÛÂȘ ÔÈ ÔÔ›ÔÈ ÂÌÊ·Ó›˙Ô˘Ó Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÌÈ-ÎÚԂȷ΋˜ ÂÓ‰Ôηډ›Ùȉ·˜ ‹ ÂÓ‰·ÚıÚÈ΋˜ Ïԛ̈͢, Â›Ó·È ÂÈÛÙËÌÔÓÈο ‰ÈηÈÔÏÔÁË̤ÓË Î·È ·-Ó·Áη›· ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·Ó¿Ù˘Í˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ‹ Î·È ÙÔÈÎÒÓ ÏÔÈÌÒ͈Ó. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÙÔÈ΋ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ïԛ̈ÍË Û ÎÏÈÓÈο ˘ÁÈ›˜ ·ÛıÂÓ›˜, ÔÈ ·fi„ÂȘ ‰È›ÛÙ·-ÓÙ·È. AӷʤÚÂÙ·È ·fi ÔÚÈṲ̂ÓÔ˘˜ Û˘ÁÁÚ·Ê›˜, fiÙÈ Ù· ·ÓÙÈ‚ÈÔÙÈο ÌÔÚÔ‡Ó Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙÔ ÂÓ-‰Â¯fiÌÂÓÔ ·Ó¿Ù˘Í‹˜ Ù˘, ÂÓÒ ¿ÏÏÔÈ ̆ ÔÛÙËÚ›˙Ô˘Ó ÙÔ ·ÓÙ›ıÂÙÔ. EÓ ÙÔ‡ÙÔȘ ·ÚÎÂÙÔ› Û˘ÓÈÛÙÔ‡Ó Ù˯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û ·Ú·ÙÂٷ̤Ó˜ ¯ÚÔÓÈο ÂÂÌ‚¿ÛÂȘ Î·È Û ÂΛӘ fiÔ˘ ··ÈÙ›ٷÈÂÎÙÂٷ̤ÓË ·Ê·›ÚÂÛË ÔÛÙÈ΋˜ Ì¿˙·˜. ¶¿ÓÙˆ˜, Ë ·ÏfiÁÈÛÙË ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰ËÌÈÔ˘ÚÁ›ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Î·È ÂÎÙfi˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Î·È ÙˆÓ ·ÏÏËÏÂȉڿÛÂˆÓ Ì ¿Ï-Ï· Ê¿Ú̷η Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó, Ë ÚÔηÏÔ‡ÌÂÓË ·Ó¿Ù˘ÍË ·ÓıÂÎÙÈÎÒÓ ÌÈÎÚÔ-‚È·ÎÒÓ ÛÙÂϯÒÓ ‰È·ÌÔÚÊÒÓÂÈ Ì›· ‰˘ÛÔ›ˆÓË ÚÔÔÙÈ΋ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒ͈Ó,Ô˘ ›Ûˆ˜ ÛËÌ¿ÓÂÈ ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÔ¯‹˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË ÙˆÓ Û‡Á¯ÚÔÓˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Î·ÈÙ¿ÛÂˆÓ Û¯ÂÙÈο Ì ÙË ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ ÂÁÎÏ›ÛÙˆÓ ÙÚ›ÙˆÓ ÁÔÌÊ›ˆÓÎ·È Ë ÌÔÚÊÔÔ›ËÛË ‚¿ÛÂÈ ·˘ÙÒÓ, ÔÚÈÛÌ¤ÓˆÓ Î·ÓfiÓˆÓ Î·È ÂӉ›ÍÂˆÓ ÁÈ· ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÛÙȘÂÚÈÙÒÛÂȘ ·˘Ù¤˜.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 73-78, 2004
§¤ÍÂȘ ÎÏÂȉȿ: AÓÙÈ‚ÈÔÙÈο, ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÂÁÎÏ›ÛÙˆÓÁÔÌÊ›ˆÓ.
* AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜** O‰ÔÓÙ›·ÙÚÔ˜, MS, ™˘ÓÂÚÁ¿Ù˘ Ù˘ KÏÈÓÈ΋˜
Afi ÙË ™ÙÔÌ·ÙÈ΋ Î·È °Ó·ıÔÚÔÛˆÈ΋ XÂÈÚÔ˘ÚÁÈ΋ KÏÈÓÈ΋ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ. ¢È¢ı˘ÓÙ‹˜: K·ı. AÁÁ. ¶. AÁÁÂÏfiÔ˘ÏÔ˜.EχıÂÚË ·Ó·ÎÔ›ÓˆÛË ÛÙÔ 22Ô ¶·ÓÂÏÏ‹ÓÈÔ O‰ÔÓÙÈ·ÙÚÈÎfi ™˘Ó¤-‰ÚÈÔ, Kˆ˜, OÎÙÒ‚ÚÈÔ˜ 2002.
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ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›-ÚÂÛË ÂÁÎÏ›ÛÙˆÓ ÛˆÊÚÔÓÈÛÙ‹ÚˆÓ, ·ÔÙ¤ÏÂÛ ¤Ó· ¤ÓÙÔ-Ó· ·ÌÊÈÏÂÁfiÌÂÓÔ ı¤Ì·. ¶¿ÓÙˆ˜ Ë Ì¤¯ÚÈ ÚfiÙÈÓÔ˜ ¯ÔÚ‹-ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û·Ó ÂÓ¤ÚÁÂÈ· ÚÔ˘Ù›Ó·˜ ÛÙȘ ÂÚÈÙÒ-ÛÂȘ ·˘Ù¤˜, ¤¯ÂÈ Â·ÓÂÎÙÈÌËı› ÚÈ˙Èο Î·È Á›ÓÂÙ·È Ï¤ÔÓÌ ‚¿ÛË Û˘ÁÎÂÎÚÈ̤Ó˜ ·Ú¯¤˜. AÓÙ›ıÂÙ·, ıˆÚÂ›Ù·È ÂÈ-‚‚ÏË̤ÓË Ë ·Ó¿ÁÎË ¯ËÌÂÈÔÚÔʇϷ͢ Û ¢·ı›˜ Ô-Ì¿‰Â˜ ·ÛıÂÓÒÓ Ì ÈÛÙÔÚÈÎfi ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜, ηÚ-‰È·ÁÁÂÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ ‹ ·ı‹ÛÂˆÓ Î·ıÒ˜ Î·È ÂΛӈÓÌ ÚfiÛÊ·ÙË ÚÔÛıÂÙÈ΋ ¿ÚıÚˆÛË, ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Û˘-ÛÙËÌ·ÙÈÎÒÓ ÏÔÈÌÒ͈Ó1.
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‰È·Î‹˜ ÂÓ‰Ôηډ›Ùȉ·˜, ·ÛıÂÓ›˜ Ì ÔÚıÔ‰ÈΤ˜ ÚÔ-Ûı¤ÛÂȘ Î·È Ù¤ÏÔ˜ ·ÛıÂÓ›˜ Ì ÂχıÂÚÔ È·ÙÚÈÎfi ÈÛÙÔÚÈ-Îfi Ô˘ ˘fiÎÂÈÓÙ·È Û ÂÂÌ‚¿ÛÂȘ Ì ÛÔ‚·Úfi ΛӉ˘ÓÔ Â-ÈÌfiÏ˘ÓÛ˘ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ (¶›Ó·Î·˜ I)Å.
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˘Ô‚ÏËıÔ‡Ó Û ÂÂÌ‚¿ÛÂȘ Ì ˘„ËÏfi ΛÓ-‰˘ÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ Ïԛ̈͢
™ÙËÓ ÚÒÙË Î·ÙËÁÔÚ›· ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› Â›Ó·È ÂÈÚÚÂ-›˜ Û Â͈ÁÂÓ›˜ Î·È ÂÓ‰ÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. AÓÔÛÔηÙÂ-ÛÙ·Ï̤ÓÔÈ ·ÛıÂÓ›˜ ·fi Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ (HIV-Ïԛ̈-ÍË, ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· Î.¿.) ‹ ·fi ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ (·-ÎÙÈÓÔıÂڷ›·, ·ÓÙÈηÚÎÈÓÈ΋ ¯ËÌÂÈÔıÂڷ›·, ÌÂÙ·Ìfi-Û¯Â˘ÛË ÔÚÁ¿ÓˆÓ) ηıÒ˜ Î·È ·ÛıÂÓ›˜ ¢·ı›˜ ÛÙȘ ÏÔÈ-ÌÒÍÂȘ, fiˆ˜ ¿ÙÔÌ· Ì ÌË ÂÏÂÁ¯fiÌÂÓÔ ‰È·‚‹ÙË, ÓÔÛ‹Ì·-Ù· ÎÔÏÏ·ÁfiÓÔ˘, ÓÂÊÚÈ΋ ‹ Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ·, ·ı‹-ÛÂȘ ‹ ÂÎÙÔÌ‹ ÛÏËÓfi˜, ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÚÔÊ˘-Ï·ÎÙÈ΋ ·ÓÙÈ‚›ˆÛË (¶›Ó·Î·˜ II)2, 3. OÈ Èı·ÓfiÙËÙ˜ ·Ó¿Ù˘-͢ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ Ïԛ̈͢ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜·˘Í¿ÓÔÓÙ·È fiÛÔ ÌÂÈÒÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿-ÚˆÓ ÛÙÔ ·›Ì·, Ì ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ·Ó¿-Ù˘ÍË ÛÔ‚·ÚÒÓ ı·Ó·ÙËÊfiÚˆÓ ÏÔÈÌÒÍÂˆÓ Ó· ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÂΛÓÔÈ Ì ›‰· ¯·ÌËÏfiÙÂÚ· ·fi 1000/mm3.
™ÙË ‰Â‡ÙÂÚË Î·ÙËÁÔÚ›· ·Ó‹ÎÔ˘Ó ·ÛıÂÓ›˜ ÌÂ Û˘ÁÎÂÎÚÈ-̤ӷ ηډÈÔÏÔÁÈο (Û˘ÁÁÂÓ›˜ ‚·Ï‚ȉԿıÂȘ, ÚfiÙˆ-ÛË ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜, ÚÔÛıÂÙÈΤ˜ ‚·Ï‚›‰Â˜, ÚÔË-ÁËı›۷ ÂÓ‰Ôηډ›Ùȉ·, ̆ ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·,ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·) Î·È ·ÁÁÂȷο (ÌÂÙ¿ıÂÛË ÌÂÁ¿-ÏˆÓ ·ÁÁ›ˆÓ, ÙÂÙÚ·ÏÔÁ›· Fallot, ¯ÂÈÚÔ˘ÚÁÈο shunts)ÚÔ‚Ï‹Ì·Ù· (¶›Ó·Î·˜ III). OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› fiÙ·Ó ˘Ô-
‚¿ÏÏÔÓÙ·È Û ԉÔÓÙÔÊ·ÙÓȷΤ˜ ÂÂÌ‚¿ÛÂȘ Ô˘ ÚÔη-ÏÔ‡Ó ‚·ÎÙËÚÈ·ÈÌ›· ¤¯Ô˘Ó ÙÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ‚·-ÎÙËÚȉȷ΋ ÂÓ‰Ôηډ›Ùȉ·4. H British Society ofAntimicrobial Chemotherapy (BSAC) ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ Â-Ê¿·Í ‰fiÛË 3g, ÂÓÒ Ë American Heart Association (AHA)2g ·ÌÔ͢ÎÈÏÏ›Ó˘ 1 ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·ÛË, Ì ÂÓ·ÏÏ·-ÎÙÈο Û¯‹Ì·Ù· ÁÈ· ÙȘ ‰È¿ÊÔÚ˜ ηÙËÁÔڛ˜ ·ÛıÂÓÒÓ (¶›-ӷη˜ IV Î·È ¶›Ó·Î·˜ V)5, 6. øÛÙfiÛÔ, Ë BSAC ÂÌ̤ÓÂÈ ÌÂÚfiÛÊ·ÙË ·Ó·ÎÔ›ÓˆÛË Ù˘ ÛÙËÓ Ô‰ËÁ›· ÙˆÓ 3g ·ÌÔ͢-ÎÈÏÏ›Ó˘ ıˆÚÒÓÙ·˜ fiÙÈ ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ ÙˆÓ 2g Ô˘ÚÔÙ›ÓÂÈ Ë AHA ÁÈ·Ù› ·Ú·Ì¤ÓÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ Û˘ÁÎÂ-ÓÙÚÒÛÂȘ ÛÙÔ ·›Ì· Î·È ÛÙÔ˘˜ ÈÛÙÔ‡˜ ·ÎfiÌË Î·È ÌÂÙ¿ ·fi10-12 ÒÚ˜. A˘Ù¤˜ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ı· ‹Ù·Ó ¯Ú‹ÛÈ̘·Ó ˘‹Ú¯·Ó ÂÈÚfiÛıÂÙÔÈ Î›Ó‰˘ÓÔÈ, fiˆ˜ Ë ‡·ÚÍË ·Ó-ıÂÎÙÈÎÔ‡ ÛÙÂϤ¯Ô˘˜ ·-·ÈÌÔÏ˘ÙÈÎÔ‡ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÛÙËÓ·ÌÔ͢ÎÈÏÏ›ÓË. ™ÙËÓ ÚfiÏË„Ë Ù˘ ÌÈÎÚԂȷ΋˜ ÂÓ‰ÔηÚ-‰›Ùȉ·˜ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ·›˙ÂÈ Ë Î·Ï‹ ̆ ÁÈÂÈÓ‹ ÙÔ˘ ÛÙfiÌ·-ÙÔ˜ Î·È Û˘ÛÙ‹ÓÂÙ·È Ë ¯Ú‹ÛË ÛÙÔÌ·ÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜0,12% ¯ÏˆÚÂÍȉ›Ó˘ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË4. H ÌÈÎÚԂȷ΋ÂÓ‰Ôηډ›Ùȉ·, ·Ú¿ ÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ Ù˘ ÂÈÎfiÓ· (·-Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜, ÔÚÁ·ÓÈÎfi ʇÛËÌ·, ÂÌ‚ÔÏÈο Ê·È-
74
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ AÓ·ÛÎÔ‹ÛÂȘ
A›ÙÈ·
MÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· MË Ú˘ıÌÈ˙fiÌÂÓÔ˜ ۷ί·Ú҉˘
‰È·‚‹Ù˘,
AÛıÂÓ›˜ ˘fi ÓÂÊÚÈ΋ οı·ÚÛË ‹ ÌÂ
ΛÚÚˆÛË ‹·ÙÔ˜ Î.·.
A˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· PÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ·,
™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜,
ÕÏÏ· ÓÔÛ‹Ì·Ù· ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘
NÂÔÏ·ÛÌ·ÙÈο ÓÔÛ‹Ì·Ù· §Â˘¯·ÈÌ›·, NfiÛÔ˜ ÙÔ˘ Hodgkin,
YÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· Î.·.
§ÔÈÌÒÍÂȘ ™˘ÛÙËÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ,
HIV-ÔÚÔıÂÙÈÎÔ› ·ÛıÂÓ›˜ Ì ÌÂȈ̤ӷ
Ï¢ÎÔ·ÙÙ·Ú·
º¿Ú̷η AÓÙÈηÚÎÈÓÈο ¯ËÌÂÈÔıÂڷ¢ÙÈο,
KÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (Û˘ÛÙËÌ·ÙÈ΋
¯ÔÚ‹ÁËÛË)
ÕÏÏ· AÎÙÈÓÔıÂڷ›· ÎÂÊ·Ï‹˜ -ÙÚ·¯‹ÏÔ˘,
AÛıÂÓ›˜ Ì ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙ· fiÚÁ·Ó·
‹ ÌÂ ÛÏËÓÂÎÙÔÌ‹,
¶·È‰›· οو ÙˆÓ 5 ÂÙÒÓ
¶›Ó·Î·˜ III: AÛıÂÓ›˜ Ì ηډȷΤ˜ ‚Ï¿‚˜ Î·È ·ı‹ÛÂȘ Ô˘ Û¯Â-Ù›˙ÔÓÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÌÈÎÚԂȷ΋˜ ÂÓ‰Ôηډ›Ùȉ·˜ ÛÙÔ˘˜ ÔÔ›-Ô˘˜ ··ÈÙÂ›Ù·È ÚÔÊ˘Ï·ÎÙÈ΋ ¯ËÌÂÈÔÚÔʇϷÍË.
A. AÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ñ ¶ÚÔÛıÂÙÈΤ˜ ηډȷΤ˜ ‚·Ï‚›‰Â˜ (‚ÈÔÚÔÛıÂÙÈΤ˜ Î·È ÔÌÔÈÔ-
ÌÔۯ‡̷ٷ).ñ ¶ÚÔËÁËı›۷ ÂÓ‰Ôηډ›Ùȉ· ·ÎfiÌË Î·È Û ·Ô˘Û›· ηډÈÔ¿-
ıÂÈ·˜.ñ ™‡ÓıÂÙ˜ ΢·ÓˆÙÈΤ˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ (ÌÂÛÔÎÔÈÏȷ΋
ÂÈÎÔÈÓˆÓ›·, ·ÓÙÈÌÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ÙÂÙÚ·ÏÔÁ›· FallotÎ.·.)
ñ ¶Ó¢ÌÔÓÈο shunts, ·ÁÁÂȷΤ˜ ÂÈÎÔÈӈӛ˜ ¯ÂÈÚÔ˘ÚÁÈο ‰ËÌÈ-Ô˘ÚÁËı›Û˜.
B. AÛıÂÓ›˜ ̤ÛÔ˘ ÎÈÓ‰‡ÓÔ˘ñ E›ÎÙËÙ˜ ‚·Ï‚ȉԿıÂȘ ÚÂ˘Ì·ÙÈ΋˜ ‹ ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜.ñ YÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·.ñ ¶ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜ Ì ·ÏÈÓ‰ÚfiÌËÛË (·Ó¿ÚÎÂÈ·) Ù˘
‚·Ï‚›‰·˜ ‹ Î·È ¿¯˘ÓÛË ÙˆÓ Áψ¯›ÓˆÓ.
°. AÛıÂÓ›˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (‰ÂÓ Â›Ó·È ··Ú·›ÙËÙË Ë ¯ËÌÂÈÔÚÔ-ʇϷÍË).
ñ MÂÌÔӈ̤ÓË ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·.ñ MÂÛÔÎÔÏÈ΋ ‹ ÌÂÛÔÎÔÈÏȷ΋ ‹ ·ÓÔÈÎÙfi˜ ‚ÔÙ¿ÏÂÈÔ˜ fiÚÔ˜ ÌÂÙ¿
·fi ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË Î·È ¿ÚÔ‰Ô ¿Óˆ ÙˆÓ ¤ÍÈ ÌËÓÒÓ.ñ ¶ÚÔËÁËı›۷ ÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë (bypass).ñ ¶ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜ ¯ˆÚ›˜ ·Ó¿ÚÎÂÈ· Ù˘ ‚·Ï‚›‰·˜.ñ AıÒ· ÏÂÈÙÔ˘ÚÁÈο ηډȷο Ê˘Û‹Ì·Ù·.ñ IÛÙÔÚÈÎfi ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ ‹ ÓfiÛÔ˘ Kawasaki ¯ˆÚ›˜ ‚·Ï‚È-
‰Ô¿ıÂÈ·.ñ TÔÔıÂÙË̤ÓÔÈ ‚ËÌ·ÙÔ‰fiÙ˜ (ÂÓ‰Ô·ÁÁÂÈ·ÎÔ› Î·È ÂÈοډÈÔÈ)
Î·È ÂÌÊ˘ÙÂ˘Ì¤ÓÔÈ ·ÈÓȉˆÙ¤˜.
¶INAKA™ II: AÓÔÛÔ·Ó·ÚΛ˜ ·ÛıÂÓ›˜.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 73-78, 2004
73-78 ™E§. - Eleftheriadis* 3-10-08 12:51 ™ÂÏ›‰· 74
ÓfiÌÂÓ·) Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ·ÓÙÈÌÂÙÒÈÛ‹˜ Ù˘ Ì ÙË ¯Ô-Ú‹ÁËÛË ÈÛ¯˘ÚÒÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Â›Ó·È ÌÈ· ·Ûı¤ÓÂÈ· Ì ˘-„ËÏfi ‰Â›ÎÙË ıÓËÛÈÌfiÙËÙ·˜ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ı· Ú¤-ÂÈ Û οı ÂÚ›ÙˆÛË Ó· Ï·Ì‚¿ÓÔÓÙ·È Ù· ··Ú·›ÙËÙ·ÚÔÏËÙÈο ̤ÙÚ· ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·Ó¿Ù˘Í‹˜ Ù˘7.™ÙËÓ ›‰È· ηÙËÁÔÚ›· ηٷٿÛÛÔÓÙ·È Î·È ÔÈ ·ÛıÂÓ›˜ ÌÂÔÚıÔ‰ÈΤ˜ ÚÔÛı¤ÛÂȘ ΢ڛˆ˜ ÁÈ· ÏfiÁÔ˘˜ ·Ó·ÊÔÚ¿˜,·ÚfiÏÔ fiÙÈ ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÂÌ‚¿ÛˆÓÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ÏÔÈÌÒÍÂˆÓ ÙˆÓ ÚÔÛıÂÙÈ-ÎÒÓ ·ÚıÚÒÛÂˆÓ ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı› ·fiÏ˘Ù·. HAmerican Dental Association (ADA) Î·È Ë AmericanAcademy of Oral Medicine (AAOM) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù·ÌÈÎÚfi‚È· Ô˘ ÚÔηÏÔ‡Ó ÏÔÈÌÒÍÂȘ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓÚÔÛıÂÙÈÎÒÓ ·ÚıÚÒÛÂˆÓ Â›Ó·È ‰È·ÊÔÚÂÙÈο ·fi ·˘Ù¿Ù˘ ÛÙÔÌ·ÙÈ΋˜ ¯ÏˆÚ›‰·˜ ‹ fiÙÈ ·˘Ù¿ ÂÌÂÚȤ¯ÔÓÙ·È ÛÂÔχ ÌÈÎÚfi ÔÛÔÛÙfi Î·È fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ÙÂÎÌËÚȈı› Â-ÚÈÙÒÛÂȘ ·ÚıÚÈ΋˜ Ïԛ̈͢ ÏfiÁˆ ·ÚÔ‰È΋˜ ÌÈÎÚÔ‚È-·ÈÌ›·˜ Ë ÔÔ›· Ó· ÚÔÎÏ‹ıËΠ·fi Ô‰ÔÓÙÔÊ·ÙÓȷ΋ Â-¤Ì‚·ÛË. Y¿Ú¯Ô˘Ó ¿ÓÙˆ˜ ·Ó·ÊÔÚ¤˜ Ô˘ ÂÌÊ·Ó›˙Ô˘ÓÔÛÔÛÙfi 0,04% ÌÂı‡ÛÙÂÚ˘ Ïԛ̈͢ ÙˆÓ ÚÔÛıÂÙÈÎÒÓ·ÚıÚÒÛÂˆÓ ÌÂÙ¿ ·fi ÂÂÌ‚·ÙÈ΋ ÛÙÔÌ·ÙÈ΋ ÂÓ¤ÚÁÂÈ·.º·›ÓÂÙ·È ¿ÓÙˆ˜ fiÙÈ Ë ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ ÎÈÓ‰‡ÓÔ˘ ›ӷÈÙ· ‰˘Ô ÚÒÙ· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·ÚıÚÔÏ·ÛÙÈ΋. B¤‚·È·ÁÈ· fiÛÔ˘˜ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÌÈ· ËÁ‹ ¯ÚfiÓÈ·˜ Ïԛ̈͢ÂÓ‰ÔÛÙÔÌ·ÙÈο, ηıÒ˜ Î·È Û ¤Ó· ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂ-ÓÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ̆ fiÎÂÈ-ÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÈÌ·ÙÔÁÂÓÔ‡˜ Ïԛ̈͢ Ù˘¿ÚıÚˆÛ˘ (¶›Ó·Î·˜ VI), Û˘ÓÈÛÙ¿Ù·È Ë ̄ ÔÚ‹ÁËÛË ̄ ËÌÂÈÔ-ÚÔʇϷ͢8-10.H ÙÚ›ÙË Î·ÙËÁÔÚ›· ·ÊÔÚ¿ ·ÛıÂÓ›˜ Ì ÂχıÂÚÔ È·ÙÚÈÎfi
ÈÛÙÔÚÈÎfi, ÔÈ ÔÔ›ÔÈ ÚfiÎÂÈÙ·È Ó· ̆ Ô‚ÏËıÔ‡Ó Û ¤̂·-ÛË ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ê·›ÚÂÛ˘ ÂÁÎÏ›ÛÙˆÓ ÛˆÊÚÔÓÈÛÙ‹-ÚˆÓ, Ì ̆ „ËÏfi ΛӉ˘ÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÊÏÂÁÌÔÓ‹˜. E¿ÓÚÔ¸¿Ú¯ÂÈ ÂÁηÙÂÛÙË̤ÓË ÙÔÈο ÊÏÂÁÌÔÓ‹ (ÔÍ›· Â-ÚÈÛÙÂÊ·Ó›Ùȉ·, ·fiÛÙËÌ·), Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈÌÔÏ˘Óı›ÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi ÙÚ·‡Ì· ÂÓ‰ÔÁÂÓÒ˜. ™ÙȘ ÂÚÈÙÒÛÂȘ·˘Ù¤˜ Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ı· Ú¤ÂÈ Ó· ıˆÚ›ٷÈıÂڷ¢ÙÈ΋ Î·È Ó· Á›ÓÂÙ·È Ì ÙȘ ·Ó¿ÏÔÁ˜ ‰ÔÛÔÏÔÁ›Â˜ÂÚÈÂÁ¯ÂÈÚËÙÈο Â¿Ó ·ÔÊ·ÛÈÛı› Ë Â¤Ì‚·ÛË ÂÓ ıÂÚ-ÌÒ. ™Â ·Û˘Ìو̷ÙÈΤ˜ ÂÚÈÙÒÛÂȘ ‚·ıÈ¿˜ fï˜ ¤-ÁÎÏÂÈÛ˘, fiÔ˘ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ı· ·Ê·ÈÚÂı› ÌÂÁ¿ÏËÔÛfiÙËÙ· ÔÛÙÔ‡ Î·È ¿Ú· ·ÂÈÏÂ›Ù·È Â͈ÁÂÓ‹˜ Ïԛ̈ÍË·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ÂӉ›ÎÓ˘Ù·È Ë ̄ ÔÚ‹ÁËÛË ̄ ËÌÂÈÔÚÔ-ʇϷ͢. ™ÙȘ ˘fiÏÔȘ ÂÚÈÙÒÛÂȘ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ËÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ô Î›Ó‰˘ÓÔ˜ Â-ÈÌfiÏ˘ÓÛ˘ ÙÔ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ ı· Ú¤ÂÈ
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BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ AÓ·ÛÎÔ‹ÛÂȘ
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 73-78, 2004
¶INAKA™ IV: ™˘ÛÙ¿ÛÂȘ Ù˘ American Heart Association ÁÈ· ÚÔʇϷÍË ·fi ÙËÌÈÎÚԂȷ΋ ÂÓ‰Ôηډ›Ùȉ· ·ÛıÂÓÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ԉÔÓÙÈ·ÙÚÈΤ˜ ÂÂÌ-‚¿ÛÂȘ ‹ ¯ÂÈÚÈÛÌÔ‡˜.
º¿ÚÌ·ÎÔ ¢ÔÛÔÏÔÁÈÎfi Û¯‹Ì·AÌÔ͢ÎÈÏÏ›ÓË 2g ·fi ÙÔ ÛÙfiÌ· (PO) 1 ÒÚ· ÚÈÓ ÙËÓ
¤̂·ÛË
AÛıÂÓ›˜ ·ÏÏÂÚÁÈÎÔ› ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË/ ·ÌÔ͢ÎÈÏÏ›ÓË
KÏÈÓ‰·Ì˘Î›ÓË 600mg PO 1 ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·ÛË‹KÂÊ·ÏÂÍ›ÓË ‹ ÎÂÊ·‰ÚÔÍ›ÏË 2g PO 1 ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·ÛË‹A˙ÈıÚÔÌ˘Î›ÓË ‹ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË 500mg PO 1 ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·ÛË
AÛıÂÓ›˜ ÌË ‰˘Ó¿ÌÂÓÔÈ Ó· Ï¿‚Ô˘Ó Ê¿Ú̷η ·fi ÙÔ ÛÙfiÌ·
AÌÈÎÈÏÏ›ÓË ‹ ·ÌÔ͢ÎÈÏÏ›ÓË 2g ÂÓ‰ÔÌ˘ÈÎÒ˜ (IM) ‹ ÂÓ‰ÔÊÏ‚›ˆ˜(IV) 30 ÏÂÙ¿ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË
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KÂÊ·˙ÔÏ›ÓË 1g IM ‹ IV 30 ÏÂÙ¿ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË
AÛıÂÓ›˜ ÌË ‰˘Ó¿ÌÂÓÔÈ Ó· Ï¿‚Ô˘Ó Ê¿Ú̷η ·fi ÙÔ ÛÙfiÌ·,·ÏÏÂÚÁÈÎÔ› ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË /·ÌÈÎÈÏÏ›ÓË
KÏÈÓ‰·Ì˘Î›ÓË 600mg IV 30 ÏÂÙ¿ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË
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KÂÊ·˙ÔÏ›ÓË 1g IM ‹ IV 30 ÏÂÙ¿ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË
¶·È‰È¿
AÌÔ͢ÎÈÏÏ›ÓË ‹ ·ÌÈÎÈÏÏ›ÓË 50mg/kg PO ‹ IM ‹ IVKÏÈÓ‰·Ì˘Î›ÓË 20mg/kg PO ‹ IVKÂÊ·ÏÂÍ›ÓË ‹ ÎÂÊ·‰ÚÔÍ›ÏË 50mg/kg POKÂÊ·˙ÔÏ›ÓË 25mg/kg IM ‹ IVA˙ÈıÚÔÌ˘Î›ÓË ‹ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË 15mg/kg PO
¶INAKA™ V: ™˘ÛÙ¿ÛÂȘ Ù˘ British Society of Antimicrobial Chemo-therapy ÁÈ· ÚÔʇϷÍË ·fi ÙË ÌÈÎÚԂȷ΋ ÂÓ‰Ôηډ›Ùȉ· ·ÛıÂÓÒÓÔ˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ԉÔÓÙÈ·ÙÚÈΤ˜ ÂÂÌ‚¿ÛÂȘ ‹ ¯ÂÈÚÈÛÌÔ‡˜.
ñ ™Â ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ·ÏÏÂÚÁ›· ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË Î·È‰ÂÓ ¤¯Ô˘Ó ¿ÚÂÈ ÂÓÈÎÈÏÏ›ÓË ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ÊÔÚ¤˜ ÂÓÙfi˜ÙÔ˘ Ì‹Ó·:
AÌÔ͢ÎÈÏÏ›ÓËEÓ‹ÏÈΘ: 3g ·fi ÙÔ ÛÙfiÌ· 1 ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·Û˶·È‰È¿ οو ÙˆÓ 10 ÂÙÒÓ: ÙÔ 1/2 Ù˘ ‰fiÛ˘ ÙˆÓ ÂÓËϛΈӶ·È‰È¿ οو ÙˆÓ 5 ÂÙÒÓ: ÙÔ 1/4 Ù˘ ‰fiÛ˘ ÙˆÓ ÂÓËϛΈÓñ ™Â ·ÛıÂÓ›˜ ·ÏÏÂÚÁÈÎÔ‡˜ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË:EÚ˘ıÚÔÌ˘Î›ÓË ÛÙ·ÙÈ΋EÓ‹ÏÈΘ: 1,5g ·fi ÙÔ ÛÙfiÌ· 1-2 ÒÚ˜ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË Î·È 0,5g 6ÒÚ˜ ÌÂÙ¿¶·È‰È¿ οو ÙˆÓ 10 ÂÙÒÓ: ÙÔ 1/2 Ù˘ ‰fiÛ˘ ÙˆÓ ÂÓËϛΈӶ·È‰È¿ οو ÙˆÓ 5 ÂÙÒÓ: ÙÔ 1/4 Ù˘ ‰fiÛ˘ ÙˆÓ ÂÓËϛΈӋKÏÈÓ‰·Ì˘Î›ÓËEÓ‹ÏÈΘ: 600mg ·fi ÙÔ ÛÙfiÌ· 1 ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·Û˶·È‰È¿ οو ÙˆÓ 10 ÂÙÒÓ: 6mg/kg ·fi ÙÔ ÛÙfiÌ· 1 ÒÚ· ÚÈÓ ÙËÓ Â-¤Ì‚·Û˶·È‰È¿ οو ÙˆÓ 5 ÂÙÒÓ: ÙÔ 1/4 Ù˘ ‰fiÛ˘ ÙˆÓ ÂÓËϛΈÓ
¶INAKA™ VI: AÛıÂÓ›˜ Ì ÔÏÈ΋ ·ÚıÚÔÏ·ÛÙÈ΋, ̆ „ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ··ÈÌ·ÙÔÁÂÓ‹ Ïԛ̈ÍË Ù˘ ¿ÚıÚˆÛ˘.
ñ AÓÔÛÔ·Ó·ÚΛ˜ Î·È ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔÈ ·ÛıÂÓ›˜ ·fi ‰È¿ÊÔ-Ú˜ ÓfiÛÔ˘˜ ‹ Ê¿Ú̷η ‹ ·ÎÙÈÓÔ‚ÔÏ›·
ñ ºÏÂÁÌÔÓÒ‰ÂȘ ·ÚıÚÔ¿ıÂȘ ·fi ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· ‹ Û˘-ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ
ñ ¢È·‚ËÙÈÎÔ› Ù‡Ô˘ 1 (ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔÈ)ñ T· ‰˘Ô ÚÒÙ· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·ÓÙÈηٿÛÙ·ÛË Ù˘ ¿ÚıÚˆÛ˘ñ ¶ÚÔËÁËı›Û˜ ÏÔÈÌÒÍÂȘ Ù˘ ¿ÚıÚˆÛ˘ Ì ÚfiÛıÂÛËñ YÔÛÈÙÈṲ̂ÓÔÈñ AÈÌÔÚÚÔÊÈÏÈÎÔ›
73-78 ™E§. - Eleftheriadis* 3-10-08 12:51 ™ÂÏ›‰· 75
Ó· ÂÚÈÔÚ›˙ÂÙ·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘È΋˜ (·ÛË„›·, ·-ÓÙÈÛË„›·) Î·È ·ÙÚ·˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Ù¯ÓÈ΋˜ (‹-È· ÌÂÙ·¯Â›ÚÈÛË ÙˆÓ Ì·Ï·ÎÒÓ Î·È ÛÎÏËÚÒÓ ÈÛÙÒÓ, ηϋ·ÈÌfiÛÙ·ÛË Î·È Û‡ÁÎÏÂÈÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ ¯ˆÚ›˜ Ù¿ÛË)ηıÒ˜ Î·È ·fi ÂÈÌÂÏ‹ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛËÙÔ˘ ·ÛıÂÓÔ‡˜11-14.
E¶I§O°H ANTIBIOTIKOY
™ÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· ˘¿Ú¯ÂÈ ÌÈ· ÌÂÈÎÙ‹ ÌÈÎÚԂȷ΋¯ÏˆÚ›‰· Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi Ï‹ıÔ˜ ·ÂÚfi‚ÈˆÓ Î·È ·-Ó·ÂÚfi‚ÈˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ. OÈ Û˘ÓËı¤ÛÙÂÚÔÈ ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ› Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÏÔÈÌÒÍÂȘ ÌÂÙ¿ ·fi Â-ÂÌ‚¿ÛÂȘ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Â›Ó·È ÔÈ ÛÙÚÂÙfi-ÎÔÎÎÔÈ, ÔÈ ·Ó·ÂÚfi‚ÈÔÈ Gram(+) ÎfiÎÎÔÈ Î·È Ù· ·Ó·ÂÚfi‚È·Gram(-) ‚·ÎÙËÚ›‰È·. EÂȉ‹ ÔÈ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÏÔÈÌÒ-ÍÂȘ ·fi ·Ó·ÂÚfi‚È· Â›Ó·È ·Û˘Ó‹ıÂȘ, Ë ÚÔʇϷÍË Ú¤-ÂÈ Ó· ηÙ¢ı‡ÓÂÙ·È Î˘Ú›ˆ˜ ¤Ó·ÓÙÈ ÙˆÓ ·ÂÚfi‚ÈˆÓ ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÒÓ. M ‚¿ÛË Ù· ·ÓˆÙ¤Úˆ ÚÔÙ›ÓÂÙ·È Ë ¯ÔÚ‹-ÁËÛË ÌÈ·˜ ‰fiÛ˘ 2g ‹ 3g ·ÌÔ͢ÎÈÏÏ›Ó˘ ·Ó¿ÏÔÁ· Ì ÙËÓÂÚ›ÙˆÛË, ÌÈ· ÒÚ· ÚÈÓ ÙËÓ Â¤Ì‚·ÛË. H ÂÓÈÎÈÏÏ›ÓË V,Ë ·ÌÈÎÈÏÏ›ÓË Î·È Ë ·ÌÔ͢ÎÈÏÏ›ÓË Â›Ó·È ÂÍ›ÛÔ˘ ·ÔÙÂÏÂ-ÛÌ·ÙÈΤ˜, ÚÔÙÈÌ¿Ù·È fï˜ Ë ·ÌÔ͢ÎÈÏÏ›ÓË ‰ÈfiÙÈ ·ÔÚ-ÚÔÊ¿Ù·È Î·Ï‡ÙÂÚ· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ ·Îfi-ÌË Î·È ÌÂÙ¿ ÙË Ï‹„Ë ÙÚÔÊ‹˜ Î·È ·Ú¤¯ÂÈ ˘„ËÏfiÙÂÚ· ηÈÛÙ·ıÂÚfiÙÂÚ· ›‰· ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜.™Â ÂÚ›ÙˆÛË ·ÛıÂÓÒÓ ·ÏÏÂÚÁÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË, Â-Ó·ÏÏ·ÎÙÈ΋ χÛË ·ÔÙÂÏÔ‡Ó ÔÈ Ì·ÎÚÔÏ›‰Â˜ Î·È È‰›ˆ˜ ËÎÏ·ÚÈıÚÔÌ˘Î›ÓË, Ë ÔÔ›· ¤¯ÂÈ ÂÎÙÔ›ÛÂÈ ÙËÓ ÂÚ˘ıÚÔÌ˘Î›-ÓË, ÁÈ·Ù› Ë ÙÂÏÂ˘Ù·›· ÂÌÊ·Ó›˙ÂÈ ÛÔ‚·Ú¤˜ Á·ÛÙÚÂÓÙÂÚÈΤ˜‰È·Ù·Ú·¯¤˜ ·ÏÏ¿ Î·È ·ÛÙ·ı‹ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋. ÕÏÏË Â-Ó·ÏÏ·ÎÙÈ΋ χÛË ·ÔÙÂÏÔ‡Ó ÔÈ ÎÂÊ·ÏÔÛÔÚ›Ó˜ 1˘ ηÈ2˘ ÁÂÓ¿˜, ·ÚΛ Ó· ÌËÓ ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ¿ÌÂÛ˘ ‹ Â-È‚Ú·‰˘ÓfiÌÂÓ˘ ÙÔÈ΋˜ ‹ Û˘ÛÙËÌ·ÙÈ΋˜ ·Ó·Ê˘Ï·ÎÙÈ-΋˜ ·ÓÙ›‰Ú·Û˘ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË. T¤ÏÔ˜ ȉȷ›ÙÂÚ· ÈηÓÔ-ÔÈËÙÈ΋ ÏfiÁˆ Ù˘ ηϋ˜ ‰È·ÓÔÌ‹˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ηÈÂÓ‰ÔÔÛÙÈο, ηٷ‰ÂÈÎÓ‡ÂÙ·È Î·È Ë ‰Ú¿ÛË Ù˘ ÓÂÒÙÂÚ˘ÏÈÓÎÔÛ·Ì›‰Ë˜, Ù˘ ÎÏÈÓÙ·Ì˘Î›Ó˘, Î·È ÁÈ' ·˘Ùfi ÁÈ· ÔÏ-ÏÔ‡˜ ıˆÚÂ›Ù·È Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜6, 14.™Â ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó Ï¿‚ÂÈ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 14 Ë̤Ú˜ ¤-ÛÙˆ Î·È Ì›· ‰fiÛË ÂÓÈÎÈÏÏ›Ó˘, ·ÌÔ͢ÎÈÏÏ›Ó˘ ‹ ¿ÏÏÔ˘ ·-ÓÙÈ‚ÈÔÙÈÎÔ‡ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ, ÂÊfiÛÔÓ ·˘Ùfi Â›Ó·È ‰˘Ó·-ÙfiÓ, Ó· Ú·ÁÌ·ÙÔÔÈËı› Ë Â¤Ì‚·ÛË 10 ¤ˆ˜ 14 Ë̤Ú˜ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡, ÔfiÙÂ Ë ÌÈÎÚԂȷ΋¯ÏˆÚ›‰· ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ӤگÂÙ·È ÛÙËÓ ·Ú¯È΋ Ê˘ÛÈÔ-ÏÔÁÈ΋ Ù˘ ηٿÛÙ·ÛË Î·È ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó Ù··Ú¯Èο Û¯‹Ì·Ù·. AÓ Â›Ó·È Â›ÁÔ˘Û· Ë Â¤Ì‚·ÛË, ÌÔ-Ú› Ó· ¯ÔÚËÁËı› ·ÓÙÈ‚ÈÔÙÈÎfi ¿ÏÏ˘ ηÙËÁÔÚ›·˜ ·fi ÙÔ‹‰Ë ¯ÔÚËÁËı¤Ó. ŸÛÔÓ ·ÊÔÚ¿ ·ÛıÂÓ›˜ Ì ˘ÔΛÌÂÓËηډȷ΋ ‚Ï¿‚Ë, ÔÈ ÔÔ›ÔÈ ‚Ú›ÛÎÔÓÙ·È Û ‰Â˘ÙÂÚÔÁÂÓ‹ÚÔʇϷÍË ¤Ó·ÓÙÈ ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Ì ÌËÓÈ·›·¯ÔÚ‹ÁËÛË ‚ÂÓ˙·ıÈÓÈ΋˜ ÂÓÈÎÈÏÏ›Ó˘ (Penadur), Ú¤ÂÈÓ· ÛËÌÂȈı› fiÙÈ ÙÔ Û¯‹Ì· ·˘Ùfi ‰ÂÓ Â·ÚΛ ÁÈ· ÙËÓÚÔʇϷ͋ ÙÔ˘˜ ·fi ÌÈÎÚԂȷ΋ ÂÓ‰Ôηډ›Ùȉ·. ŒÙÛÈ,fiÙ·Ó ÚfiÎÂÈÙ·È Ó· Ï¿‚Ô˘Ó ÚÔʇϷÍË ÂÓ fi„ÂÈ Î¿ÔÈ·˜Ô‰ÔÓÙÔÊ·ÙÓȷ΋˜ ¤̂·Û˘, ÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi ‰ÂÓ Ú¤ÂÈÓ· Â›Ó·È Ë ·ÌÔ͢ÎÈÏÏ›ÓË, ·ÏÏ¿ οÔÈÔ ¿ÏÏÔ ·fi Ù· ÂÓ·Ï-Ï·ÎÙÈο Û¯‹Ì·Ù·, ÂÂȉ‹, ÏfiÁˆ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¯Ô-Ú‹ÁËÛ˘ ÂÓÈÎÈÏÏ›Ó˘, ÔÈ ‚ÏÂÓÓÔÁfiÓȘ ÂÈÊ¿ÓÂȘ ÙÔ˘
ÛÙfiÌ·Ùfi˜ ÙÔ˘˜ Â›Ó·È Î·Ù¿ ηÓfiÓ· ·ÔÈÎÈṲ̂Ó˜ Ì ÛÙÚÂ-ÙfiÎÔÎÎÔ˘˜ Û¯ÂÙÈο ·ÓıÂÎÙÈÎÔ‡˜ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË Î·ÈÙËÓ ·ÌÔ͢ÎÈÏÏ›ÓË15, 16.
XPONO™ KAI ¢IAPKEIA XOPH°H™H™
EÚÁ·Û›Â˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· Î·È ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó·Ô‰Â›ÍÂÈ fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘ ÚÔη-ÏÂ›Ù·È Â›ÛÔ‰Ô˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· (·-ÚÔ‰È΋ ÌÈÎÚÔ‚È·ÈÌ›·) Ë ÔÔ›· ‰È·ÚΛ 15’-20’ ÂÚ›Ô˘.T· ·ÓÙÈ‚ÈÔÙÈο ı· Ú¤ÂÈ Û˘ÓÂÒ˜ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ¤ÙÛÈÒÛÙÂ Ë Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÛÙÔ ·›Ì· Î·È ÛÙÔ˘˜ÈÛÙÔ‡˜ Ó· Û˘Ì›ÙÂÈ Ì ÙË ¯ÚÔÓÈ΋ ·˘Ù‹ ÂÚ›Ô‰Ô ·ÏÏ¿Î·È Ó· ‰È·ÚΛ ÁÈ· οÔÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ·fi·˘Ù‹Ó. OÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ·˘Ù¤˜ Ú¤ÂÈ Ó· Â›Ó·È ÔχÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ÂÏ¿¯ÈÛÙ˜ ·Ó·ÛÙ·ÏÙÈΤ˜ ˘ÎÓfiÙË-Ù˜ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ù˘ÂÚÈÔ¯‹˜14, 16. ™˘Ó‹ıˆ˜ ¯ÔÚËÁÂ›Ù·È ÂÊ¿·Í ‰ÈÏ‹ ‹ ÙÚÈÏ‹ ‰fiÛË ·ÓÙÈ-ÌÈÎÚÔ‚È·ÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ·fi ÙÔ ÛÙfiÌ· ÌÈ· ÒÚ· ÚÈÓ ÙËÓ¤̂·ÛË. ™Â ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÂÌ‚¿-ÛÂȘ Ì ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›· ‹ Ô˘ ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔË ¯ÔÚ‹ÁËÛË ·fi ÙÔ ÛÙfiÌ· ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹, ÙÔ Ê¿ÚÌ·ÎÔ¯ÔÚËÁÂ›Ù·È ‰È· Ù˘ ÂÓ‰ÔÊϤ‚È·˜ ‹ ÂÓ‰ÔÌ˘˚΋˜ Ô‰Ô‡ 30ÏÂÙ¿ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË. ŒÓ·ÚÍË Ù˘ ̄ ÔÚ‹ÁËÛ˘ ÓˆÚ›-ÙÂÚ· Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ‰fiÛÂȘ ÌÔÚ› Ó· Ô‰ËÁ‹-ÛÔ˘Ó Û ·Ó¿Ù˘ÍË ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ. AÓÙÈÌÈÎÚÔ‚È·-΋ ¯ËÌÂÈÔÚÔʇϷÍË ÌÔÚ› ·ÔÙÂÏÂÛÌ·ÙÈο Ó· ‰Ôı›¤ˆ˜ Î·È 2 ÒÚ˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, ÂÓÒ ·ÓÙÈ‚ÈÔÙÈο Ô˘¯ÔÚËÁÔ‡ÓÙ·È 4 ÒÚ˜ ÌÂÙ¿ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÚÔÊ˘-Ï·ÎÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. E·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ‰fiÛÂȘ Û˘-ÛÙËÌ·ÙÈο οı 6 ‹ 8 ÒÚ˜ ‰ÈηÈÔÏÔÁÔ‡ÓÙ·È Û ÂÈ‚Ú·-‰˘ÓfiÌÂÓË ‹ ‰È·˘Ô‡ÌÂÓË ÂԇψÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ ‹Û ¤̂·ÛË Û ‹‰Ë ÊÏÂÁÌ·›ÓÔÓÙ˜ ÈÛÙÔ‡˜, ÔfiÙÂ Ë ¯Ô-Ú‹ÁËÛË ÛÙԯ‡ÂÈ ÛÙË ıÂڷ›· Ù˘ ‹‰Ë ÂÁηÙÂÛÙË̤-Ó˘ Ïԛ̈͢6, 14, 16.
¶APENEP°EIE™ - ¢IATAPAXH ºY™IO§O°IKH™X§øPI¢A™ KAI ANTOXH MIKPOOP°ANI™MøN
YÔÏÔÁ›˙ÂÙ·È fiÙÈ ÔÛÔÛÙfi 6-7% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï·Ì‚¿-ÓÔ˘Ó Û˘ÛÙËÌ·ÙÈο ·ÓÙÈ‚ÈÔÙÈο ı· ÂÌÊ·Ó›ÛÔ˘Ó Î¿ÔÈ· ·-ÚÂÓ¤ÚÁÂÈ·. OÈ Î›Ó‰˘ÓÔÈ ·fi ÙË ̄ ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓÂ›Ó·È Ë ·Ó¿Ù˘ÍË ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ, ‰Â˘ÙÂÚÔÁÂÓ›˜ÏÔÈÌÒÍÂȘ, ÙÔÍÈÎfiÙËÙ· Î·È ˘ÂÚ¢·ÈÛıËÛ›·. Afi ÙȘ ÈÔÛËÌ·ÓÙÈΤ˜ ·ÚÂÓ¤ÚÁÂȘ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ·ÓÙȉڿÛÂˆÓ˘ÂÚ¢·ÈÛıËÛ›·˜ ‹ ·ÎfiÌ· Î·È ·Ó·Ê˘Ï·ÎÙÈÎÔ‡ ÛÔÎ16, 17. T· ·ÓÙÈ‚ÈÔÙÈο Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfiÂÌÊ¿ÓÈÛ˘ ·ÓÙȉڿÛÂˆÓ ˘ÂÚ¢·ÈÛıËÛ›·˜ Â›Ó·È ÔÈ ÂÓÈ-ÎÈÏϛӘ (3-5%), Ì ‰Â‡ÙÂÚË ÔÌ¿‰· ÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜(1-5%). EÂȉ‹ ÙÔ 5-10% ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÚ¢·ÈÛıË-Û›· ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÂÌÊ·Ó›˙Ô˘Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ˘Â-Ú¢·ÈÛıËÛ›· Ì ÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜, ÔÈ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÓÚ¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ¿ÌÂÛ˘·ÓÙ›‰Ú·Û˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË (·Ó·Ê˘-Ï·ÎÙÈ΋ ·ÓÙ›‰Ú·ÛË), ÂÓÒ ÌÔÚÔ‡Ó Ó· ‰ÔıÔ‡Ó Ì ۯÂÙÈ΋·ÛÊ¿ÏÂÈ· › ‡·Ú͢ ÈÛÙÔÚÈÎÔ‡ ÂÈ‚Ú·‰˘ÓfiÌÂÓ˘ ̆ Â-Ú¢·ÈÛıËÛ›·˜. OÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ (Ó·˘Ù›·, ¤ÌÂÙÔ˜, Á·ÛÙÚÈ-
76
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ AÓ·ÛÎÔ‹ÛÂȘ
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 73-78, 2004
73-78 ™E§. - Eleftheriadis* 3-10-08 12:51 ™ÂÏ›‰· 76
Îfi˜ ÊfiÚÙÔ˜, ‰È¿ÚÚÔÈ·) ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÚÂ-Ó¤ÚÁÂÈ· ÛÙȘ Ì·ÎÚÔÏ›‰Â˜. øÛÙfiÛÔ ÔÈ ÓÂfiÙÂÚ˜ Ì·ÎÚÔÏ›-‰Â˜ (ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, ·˙ÈıÚÔÌ˘Î›ÓË) Â›Ó·È Î·Ï‡ÙÂÚ· ·ÓÂ-ÎÙ¤˜ Î·È ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó, ÏfiÁˆ ÙÔ˘ ÌÂÁ·Ï‡ÙÂ-ÚÔ˘ ¯ÚfiÓÔ˘ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, οı 12 ·ÓÙ› 6 ÒÚ˜.H ÛÔ‚·ÚfiÙÂÚË Î·È Û˘¯ÓfiÙÂÚË ·ÚÂÓ¤ÚÁÂÈ· Î·È ÙˆÓ ÏÈÓ-ÎÔÛ·ÌȉÒÓ Â›Ó·È ÔÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ (0,3-21%) Ì ÛÔ‚·ÚfiÙÂÚË ÙËÓ ÂÌÊ¿ÓÈÛË „¢‰ÔÌÂÌ‚Ú·ÓÒ-‰Ô˘˜ ÎÔÏ›Ùȉ·˜ (1,9-10%) Ë ÔÔ›· ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ó¿-Ù˘ÍË ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ Î·È ‰Â˘ÙÂÚÔÁÂÓÒÓ ÏÔÈÌÒÍÂ-ˆÓ, ÂÓÒ ÛÙȘ ÓÈÙÚÔ˚Ìȉ·˙fiϘ ÔÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·-Ú·¯¤˜ ·ÔÙÂÏÔ‡Ó Â›Û˘ ÙË Û˘¯ÓfiÙÂÚË ·ÚÂÓ¤ÚÁÂÈ·.™‹ÌÂÚ· ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë Û‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÙÔ˘Saccharomyces balarddi-17 ‹ ¿ÏÏˆÓ ÂÓ˙˘Ì·ÙÈÎÒÓ ‹ ‚È-Ù·ÌÈÓÔ‡¯ˆÓ Û΢·ÛÌ¿ÙˆÓ, ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙȘ ‰È·Ù·-Ú·¯¤˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ16, 18.
™YZHTH™H - ™YM¶EPA™MATA
O ÚfiÏÔ˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·Ù¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂ-ÛË ÂÁÎÏ›ÛÙˆÓ ÙÚ›ÙˆÓ ÁÔÌÊ›ˆÓ, ıˆÚÂ›Ù·È ıÂÙÈÎfi˜ Î·È ·-Ó·ÓÙÈηٿÛÙ·ÙÔ˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ·Ó¿Ù˘Í˘ Û˘-ÛÙËÌ·ÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Û ÂȉÈΤ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ (·-ÓÔÛÔ·Ó·ÚΛ˜, Ì ÈÛÙÔÚÈÎfi ·ÁÁÂÈÔ-ηډÈÔ¿ıÂÈ·˜ ‹Ì ÚÔÛıÂÙÈΤ˜ ·ÚıÚÒÛÂȘ). AÓÙ›ıÂÙ· Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ-‚ÈÔÙÈÎÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÙÔÈ΋˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜Ïԛ̈͢ ·ÔÙÂÏ› ¤ÓÙÔÓ· ·ÌÊÈÏÂÁfiÌÂÓÔ ı¤Ì·. ™ÙË ‚È-‚ÏÈÔÁÚ·Ê›· ‰È·ÈÛÙÒÓÔÓÙ·È ·ÓÙÈÊ·ÙÈΤ˜ ·fi„ÂȘ, Ô˘ Ô-Ê›ÏÔÓÙ·È ÛÙËÓ ˘ÔÎÂÈÌÂÓÈÎfiÙËÙ· ÙˆÓ ÎÚÈÙËÚ›ˆÓ ·ÍÈÔÏfi-ÁËÛ˘ Î·È Ì¤ÙÚËÛ˘ ÙˆÓ ÂÌÊ·ÓÈ˙ÔÌ¤ÓˆÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ-ÎÒÓ ÛËÌ›ˆÓ Î·È Û˘ÌÙˆÌ¿ÙˆÓ ÙÔÈο fiˆ˜ Ô fiÓÔ˜, ÙÔÔ›‰ËÌ·, Ô ÙÚÈÛÌfi˜ Î·È ÁÂÓÈο Ë ÔÌ·Ï‹ ÂԇψÛË ·ÏÏ¿Î·È ÛÙË ‰È·ÊÔÚÂÙÈ΋ ÌÂıÔ‰ÔÏÔÁ›· ÙˆÓ ÂÚ¢ÓËÙÒÓ, Ô˘‰ÂÓ ÌÔÚ› Ó· ‰ÒÛÂÈ Û˘ÁÎÚ›ÛÈÌ· ·ÔÙÂϤÛÌ·Ù·17, 18. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙȘ ‚·ÛÈΤ˜ ·Ú¯¤˜ ÛÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ıÂڷ›·, fiÙÈ ÙÔ fiÊÂÏÔ˜ ·fi ÙË ¯Ú‹ÛË Ù˘ Ú¤ÂÈ Ó· ›-Ó·È ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙËÓ Èı·ÓfiÙËÙ· ·Ó¿Ù˘-͢ ·ÓÂÈı‡ÌËÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Î·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·-ÓÙÈ‚ÈÔÙÈÎÒÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÊ˘Ï·ÎÙÈο Û ¯ÂÈÚÔ˘Ú-ÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ Ì ̆ „ËÏfi ÂӉ¯fiÌÂÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜Ïԛ̈͢, ‰ÂÓ ‰ÈηÈÔÏÔÁÂ›Ù·È Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓÛ·Ó Ú·ÎÙÈ΋ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ̆ Ô‚¿ÏÏÔÓÙ·ÈÛ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÂÁÎÏ›ÛÙˆÓ ÛˆÊÚÔÓÈÛÙ‹ÚˆÓ.øÛÙfiÛÔ, fiÙ·Ó Ë ÂÁ¯ÂÈÚËÙÈ΋ ‰È·‰Èηۛ· ÂÚÈÏ·Ì‚¿ÓÂÈ Â-ÎÙÂٷ̤ÓË ·Ê·›ÚÂÛË ÔÛÙÔ‡, ·Ú·ÙÂٷ̤ÓË ¯ÚÔÓÈ΋‰È¿ÚÎÂÈ· Î·È ¿Ú· ·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÛÙÔ ÌÈÎÚÔ‚È·ÎfiÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfiÎ·È ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÍ›·˜ ‹ ¯ÚfiÓÈ·˜ ÙÔÈ΋˜ ÊÏÂÁÌÔÓ‹˜Î·ıÒ˜ Î·È Û ·ÛıÂÓ›˜ Ì ‚‚·ÚË̤ÓÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfifiˆ˜ ·Ó·Ê¤ÚıËΠ·ÓˆÙ¤Úˆ, ÎÚ›ÓÂÙ·È ÂȂ‚ÏË̤ÓË. H ¯ÔÚ‹ÁËÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÈÓ ÙËÓ Â¤Ì‚·ÛËÛ‡Ìʈӷ Ì ÙȘ ÂΉÔı›Û˜ Ô‰ËÁ›Â˜ (¶›Ó·Î·˜ IV Î·È V).¶¿ÓÙˆ˜ Ô ¤ÏÂÁ¯Ô˜ Ù˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÙÔÈ΋˜ Ïԛ̈-͢ ‰ÂÓ Ú¤ÂÈ Ó· ‚·Û›˙ÂÙ·È ÛÙË ¯ËÌÂÈÔÚÔʇϷÍË, ·Ï-Ï¿ ÛÙËÓ Ù‹ÚËÛË ÙˆÓ Î·ÓfiÓˆÓ ·ÓÙÈÛË„›·˜, ·ÛË„›·˜ ηÈÙËÓ Î·Ï‹ ÂÁ¯ÂÈÚËÙÈ΋ Ù¯ÓÈ΋. T¤ÏÔ˜ ı· Ú¤ÂÈ Ó· ·Ú·-ÎÔÏÔ˘ıԇ̠ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ηٿ ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ÔÚ›· ÂԇψÛ˘ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, ÁÈ· Ù˘¯fiÓ ÂÌÊ¿ÓÈÛË·ÓÂÈı‡ÌËÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ·ÚÂÓÂÚÁÂÈÒÓ, fiÙ·Ó ·˘-
Ù¿ ¯ÔÚËÁÔ‡ÓÙ·È, Î·È ÁÈ· Ù˘¯fiÓ Ïԛ̈ÍË ‹ ‰È·‡ËÛË ÙÔ˘ÙÚ·‡Ì·ÙÔ˜ ·ÎfiÌË Î·È ÌÂÙ¿ ÙËÓ 7Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ̤ڷ,ÔfiÙ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ı· ··ÈÙËı› ıÂڷ¢-ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. H ηٿ¯ÚËÛË ÛÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ Ê·ÚÌ¿-ÎˆÓ ·ÔÙÂÏ› ÛÙȘ ̤Ú˜ Ì·˜ ¤Ó· ÛÔ‚·Úfi Úfi‚ÏËÌ·, ÙÔÔÔ›Ô ıˆÚÂ›Ù·È ıÂڷ¢ÙÈÎfi «·Ú¿‰ÔÍÔ». ¶·Ú¿ ‰ËÏ·-‰‹ ÙËÓ ‡·ÚÍË ÏËıÒÚ·˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓÎ·È ÙË Û‡ÓıÂÛË Î·È Î˘ÎÏÔÊÔÚ›· ÔÏÔ¤Ó· Î·È Óˆ٤ڈÓ, ÔÈÛ˘ÛÙËÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÂϤÁ¯ÔÓٷȉ‡ÛÎÔÏ· Î·È Ì¿ÏÈÛÙ· Ó· ·ÔÙÂÏÔ‡Ó ÙËÓ 4Ë Û ÛÂÈÚ¿ Û˘-¯ÓfiÙËÙ·˜ ·ıÔÏÔÁÈ΋ ·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂÙ¿ ÙȘ ηډÈÔ¿-ıÂȘ, Ù· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· Î·È ÙÔÓ Î·ÚΛ-ÓÔ. K‡ÚÈ· ·ÈÙ›· ÁÈ· ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ıˆÚÂ›Ù·È Ë ·Ó¿-Ù˘ÍË ÌÈÎÚÔ‚È·ÎÒÓ ·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ ·fi ÙËÓ ·ÏfiÁÈ-ÛÙË ¯Ú‹ÛË- ηٿ¯ÚËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ.ŒÙÛÈ, ȉȷ›ÙÂÚ· ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ê·›-ÚÂÛ˘ ÂÁÎÏ›ÛÙˆÓ ‰ÔÓÙÈÒÓ, ÔÈ ÂӉ›ÍÂȘ ÁÈ· ÚÔÊ˘Ï·ÎÙÈ-΋ ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ı· Ú¤ÂÈ Ó· Ù›ıÂ-ÓÙ·È Ì ÂÚ›ÛÎÂ„Ë Î·È ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÂÚÈÙÒÛÂȘ.°È' ·˘Ùfi ··ÈÙÂ›Ù·È Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÔÈ ·ÛıÂÓ›˜ Ì ÌÂ-Á¿ÏÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ Û˘ÛÙËÌ·ÙÈ΋˜ ‹ ÙÔÈ΋˜ ÌÂÙÂÁ-¯ÂÈÚËÙÈ΋˜ Ïԛ̈͢, Ó· ÂÈϤÁÂÙ·È Î·È Ó· ÂÊ·ÚÌfi˙ÂÙ·ÈË Ï¤ÔÓ ‹È· ÂÁ¯ÂÈÚËÙÈ΋ Ù¯ÓÈ΋ Î·È Ó· ¯ÔÚËÁÂ›Ù·È Ë ·-ÓÙÈ‚ÈÔÙÈ΋ ıÂڷ›· Û ηٿÏÏËÏÔ ÚÔÂÁ¯ÂÈÚËÙÈÎfi ¯Úfi-ÓÔ, ¤ÙÛÈ ÒÛÙ ӷ ÂÍ·ÛÊ·ÏÈÛı› Ë ÂÈı˘ÌËÙ‹ Û˘ÁΤÓÙÚˆ-ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜.
SUMMARY
"The use of antibiotics in the prevention ofpostoperative infection in impacted third molar
surgery"E. Eleftheriadis, C. Papadimas, M. Leventis
hellenic stomatological review 48: 73-78, 2004
It is almost common practice in third molar surgery to useantibiotics. In medically compromised patients (e.g.immunocompromised or patients at risk of infectiveendocarditis), antibiotic prophylaxis is a well establishedroutine therapy with the most recent guidelinesrecommending the use of 2g amoxycillin 1 hr preope-ratively.In medically healthy patients, the routine use of antibiotictherapy is controversial. The indiscriminate use ofantibiotics without appropriate indications can result inadverse outcomes such as the development of resistanceand hypersensitivity. However many surgeons prescribeantibiotics for time consuming operations and extensivebone removal. The purpose of this article is to review the literatureregarding the appropriateness of the use of antibiotics inthird molar surgery and to conclude some basic rules onthe subject.
Key words: Antibiotics, third molar surgery.
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ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 73-78, 2004
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14. ¶·ÙÚÈΛԢ A: AÓÙÈÌÈÎÚԂȷ΋ ¯ËÌÂÈÔÚÔʇϷÍË ÛÙË ¯ÂÈÚÔ˘Ú-ÁÈ΋ ÙÔ˘ ÛÙfiÌ·ÙÔ˜. ™ÙÔÌ·ÙÔÏÔÁ›· 1998;55:77-86.
15. AÓÂ˘Ï·‚‹˜ E: KÏÈÓÈ΋ §ÔÈ̈ÍÈÔÏÔÁ›·. I·ÙÚ. EΉ. ¶. X. ¶·-Û¯·Ï›‰Ë˜. Aı‹Ó·. 1997.
16. EÏ¢ıÂÚÈ¿‰Ë˜ E: AÓÙÈÌÈÎÚԂȷο Ê¿Ú̷η ÛÙË ̄ ÂÈÚÔ˘ÚÁÈ΋ÙÔ˘ ÛÙfiÌ·ÙÔ˜. ™ËÌÂÈÒÛÂȘ ÛÙ· MÂÙ·Ù˘¯È·Î¿ M·ı‹Ì·Ù·Ù˘ ¶·ıÔ‚ÈÔÏÔÁ›·˜ ™ÙfiÌ·ÙÔ˜. Aı‹Ó·. 2002.
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BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ AÓ·ÛÎÔ‹ÛÂȘ
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 73-78, 2004
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:E˘ÛÙ¿ıÈÔ˜ EÏ¢ıÂÚÈ¿‰Ë˜AÈوϛ·˜ 54,AÁ›· ¶·Ú·Û΢‹ 153 41TËÏ.: 210 6398888
73-78 ™E§. - Eleftheriadis* 3-10-08 12:51 ™ÂÏ›‰· 78
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
AÈÌÔÚÚ·ÁÈ΋ ÔÌÊÔÏ˘Á҉˘ Î˘Ó¿Á¯Ë: MÈ· ·Û˘Ó‹ı˘ÛÙÔÌ·ÙÈ΋ ÓfiÛÔ˜ Ì ‰È·ÁÓˆÛÙÈÎfi ÂӉȷʤÚÔÓ
¢. TÚÈ¿ÓÙÔ˜*, ¶. K·Ó¿Î˘**
H ÔÓÔÌ·Û›· ·ÈÌÔÚÚ·ÁÈ΋ ÔÌÊÔÏ˘Á҉˘ Î˘Ó¿Á¯Ë ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÌÈ· ·Û˘-Ó‹ıË, ηÏÔ‹ıË, ÛÙÔÌ·ÙÈ΋ ‚Ï¿‚Ë, ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜, Ô˘ ÂΉËÏÒÓÂÙ·È Ì ̆ ÔÙÚÔÈ¿˙Ô˘Û˜·ÈÌÔÚÚ·ÁÈΤ˜ ÔÌÊfiÏ˘Á˜. OÈ ·ÛıÂÓ›˜ Â›Ó·È ˘ÁÈ›˜, ¯ˆÚ›˜ ¿ÏÏÔ ˘ÔΛÌÂÓÔ ·˘ÙÔ¿ÓÔÛÔ ÓfiÛË-Ì· ‹ ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË. OÈ ‚Ï¿‚˜ ·Ó·Ù‡ÛÛÔÓÙ·È Í·ÊÓÈο, Û˘Ó‹ıˆ˜ ηٿ ÙËÓ ‰È¿ÚÎÂÈ· ÙÔ˘Ê·ÁËÙÔ‡ ‹ ÌÂÙ¿ ·fi ÙÚ·˘Ì·ÙÔÁfiÓÔ˘˜ ̄ ÂÈÚÈÛÌÔ‡˜ ηٿ ÙËÓ ÂÈÙ¤ÏÂÛË Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ÂÚÁ·ÛÈÒÓ.OÈ ÔÌÊfiÏ˘Á˜ ·˘Í¿ÓÔÓÙ·È Û ̤ÁÂıÔ˜ ̤۷ Û ϛÁ· ÏÂÙ¿ Î·È ‰È·ÚÚËÁÓ‡ÔÓÙ·È ÂÓÙfi˜ ˆÚÒÓ, ·-Ê‹ÓÔÓÙ·˜ ÂÍÂÏΈ̤ÓË ÂÈÊ¿ÓÂÈ· Ô˘ ÂÔ˘ÏÒÓÂÙ·È ¯ˆÚ›˜ Ô˘ÏÔÔ›ËÛË. H ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂÈÎfiÓ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÌË-ÂȉÈ΋ ¤ÏΈÛË ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÂÈı‹ÏÈÔ ˘ÂÚΛÌÂÓÔÙÔ˘ ÁÂÈÙÔÓÈÎÔ‡ ÌË-ÂÏΈ̤ÓÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘, ˘Ô-ÂÈıËÏȷ΋ ÔÌÊfiÏ˘Á· ÁÂÌ¿ÙË ·fi ÂÚ˘ıÚÔ-·ÙÙ·Ú· Î·È ÈÓ҉˜. H ÛËÌ·Û›· Ù˘ ÓfiÛÔ˘ ¤ÁÎÂÈÙ·È ÛÙËÓ ÎÏÈÓÈ΋ ÔÌÔÈfiÙËÙ· Ù˘ Ì ¿ÏϘ ÈÔ ÛÔ‚·Ú¤˜ ηٷÛÙ¿ÛÂȘÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·fi ÙȘ Ôԛ˜ Î·È Ú¤ÂÈ Ó· ‰È·ÊÔÚÔ-‰È·ÁÓˆÛı› (΢ڛˆ˜ ·fi ÙÔ ÂÌÊÈÁÔÂȉ¤˜‹ ÙËÓ ıÚÔÌ‚ÔÂÓ›·). §fiÁˆ ÙÔ˘ ÂÊ‹ÌÂÚÔ˘ ÙˆÓ ‚Ï·‚ÒÓ ·ÏÏ¿ Î·È ÁÈ·Ù› ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ ÔÈ ÔÌÊfiÏ˘Á˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÌÂÁ¿Ï˜ ηٿ ÙËÓ ·ÚÔ˘Û›·ÛË ÙÔ˘˜ ÁÈ· Ó· ÂÈÙÂϤ-ÛÔ˘Ì ‚ÈÔ„›·, Ë ‰È¿ÁÓˆÛË ı· ‚·ÛÈÛı› ÛÙÔ ÈÛÙÔÚÈÎfi ÙÚ·‡Ì·ÙÔ˜, ÛÙËÓ ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Î·È ÛÙËÓ¤ÏÏÂÈ„Ë ¿ÏÏˆÓ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ Î·È Û˘Ìو̿وÓ. ¢ÂÓ ̆ ¿Ú¯ÂÈ ÙÚfiÔ˜ ÚfiÏ˄˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘. A·ÈÙÂ›Ù·È Î·ıËÛ‡¯·ÛË ÙÔ˘ ·ÛıÂÓ‹, ÂÓË-̤ڈÛË ÁÈ· ÙËÓ Î·ÏÔ‹ıË Ê‡ÛË Ù˘ Î·È ·ÔÊ˘Á‹ ÙÚ·‡Ì·ÙÔ˜ Û fiÛÔ˘˜ ¤¯Ô˘Ó ÚԉȿıÂÛË. EӉ›-ÎÓ˘Ù·È Ë ¯Ú‹ÛË ÙÔÈÎÒÓ ·Ó·ÏÁËÙÈÎÒÓ/·ÓÙÈÛËÙÈÎÒÓ ÁÈ· Û˘Ìو̷ÙÈ΋ ·Ó·ÎÔ‡ÊÈÛË.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 79-83, 2004
§¤ÍÂȘ ÎÏÂȉȿ: AÈÌÔÚÚ·ÁÈ΋ ÔÌÊÔÏ˘Á҉˘ Î˘Ó¿Á¯Ë, ·ÈÌÔÚÚ·-ÁÈΤ˜ ÔÌÊfiÏ˘Á˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÔÌÊÔÏ˘ÁÒ‰ËÓÔÛ‹Ì·Ù·, ÂÏÎÒÛÂȘ ÛÙfiÌ·ÙÔ˜.
* ™ÙÔÌ·ÙÔÏfiÁÔ˜, ¢È‰¿ÎÙˆÚ (MSc., Ph. D) ¶·Ó. §ÔÓ‰›ÓÔ˘** EÈÌ. A, °Ó·ıÔ¯ÂÈÚÔ˘ÚÁÈÎfi I·ÙÚ›Ô, KÔÚÁȷϤÓÂÈÔ - MÂÓ¿-
ÎÂÈÔ EE™
AÓ·ÎÔÈÓÒıËΠÛÙÔ 21Ô ¶.O.™., £ÂÛÛ·ÏÔÓ›ÎË, 2001
EI™A°ø°H
MÈ· ȉȷ›ÙÂÚË Î·ÙËÁÔÚ›· ÓÔÛËÌ¿ÙˆÓ Ô˘ ÚÔÛ‚¿ÏÏÂÈÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Â›Ó·È Ù· ÔÌÊÔÏ˘ÁÒ‰ËÓÔÛ‹Ì·Ù· Ì ÎÔÈÓfi ÙÔ˘˜ ̄ ·Ú·ÎÙËÚÈÛÙÈÎfi ÙËÓ ÛÙÔȯÂÈ҉˂Ͽ‚Ë Ô˘ ηÏÂ›Ù·È ÔÌÊfiÏ˘Á·. ø˜ ÔÌÊfiÏ˘Á· ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ÙÔ ÂÚÈÁÂÁÚ·Ì̤ÓÔ ¤·ÚÌ· ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ
‹ ÛÙÔ ‰¤ÚÌ· Ô˘ ÂÚȤ¯ÂÈ ‰È·˘Á¤˜ ˘ÁÚfi Ì ‰È¿ÌÂÙÚÔ ·-fi 5 ¯ÈÏ.-10 ÂηÙ., ‰È·ÎÚ›ÓÂÙ·È ‰Â ·fi ÙËÓ Ê˘Û·Ï›‰· Ì‚¿ÛË ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÁÂıÔ˜ Ù˘(1). EÓÙÔ›˙ÂÙ·È Ì¤Û·ÛÙÔ ÂÈı‹ÏÈÔ (ÂÓ‰Ô-ÂÈıËÏȷ΋) ‹ ̤۷ ÛÙÔ ¯fiÚÈÔ (˘Ô-ÂÈıËÏȷ΋) Î·È ˘fiÎÂÈÙ·È ÛÙ· ‰È¿ÊÔÚ· Ì˯·ÓÈο ÂÚÂı›-ÛÌ·Ù· ηٿ ÙËÓ Ì¿ÛËÛË ‹ ÙËÓ ÔÌÈÏ›· Ì ·ÔÙ¤ÏÂÛÌ· Ó·Û¿˙ÂÈ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ Û¯ËÌ·ÙÈÛÌfi Ù˘, ÙÔ ˘ÁÚfi Ô˘ÂÚȤ¯ÂÈ Ó· ʇÁÂÈ Î·È Â›ÙÂ Ë ÔÌÊfiÏ˘Á· ·ÔÌ·ÎÚ‡ÓÂÙ·ÈÔfiÙ ̤ÓÂÈ ÌÈ· ÂÚ˘ıÚ‹ ÂÈÊ¿ÓÂÈ· ‹ ·Ú·Ì¤ÓÂÈ ¿ÓˆÛÙÔÓ ˘ı̤ӷ Ù˘ ‚Ï¿‚˘, ÙÔÓ ÔÔ›Ô Ûο˙ÂÈ ÔÏÈÎÒ˜ ‹ÌÂÚÈÎÒ˜(1). ™ÙËÓ ·Ú·¿Óˆ ηÙËÁÔÚ›· ·Ó‹ÎÂÈ Î·È Ë ·ÈÌÔÚÚ·ÁÈ΋ ÔÌ-ÊÔÏ˘Á҉˘ Î˘Ó¿Á¯Ë («angina bullosa haemorrhagica»),ÌÈ· ȉȷ›ÙÂÚË ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· Ô˘ ÂÚÈÁÚ¿ÊËΠÁÈ·ÚÒÙË ÊÔÚ¿ ÙÔ 1967 ·fi ÙÔÓ Badham(2). OÚ›˙ÂÙ·È ˆ˜ ˘-ÔÙÚÔÈ¿˙Ô˘Û˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÔÌÊfiÏ˘Á˜, ·ÔÎÏÂÈÛÙÈ-ο ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Ô˘ ‰ÂÓ ÌÔÚ› Ó· ·-Ô‰ÔıÔ‡Ó Û ¿ÏÏÔ ÔÌÊÔÏ˘Á҉˜ ÓfiÛËÌ· ‹ ·ÈÌ·ÙÔÏÔÁÈ-΋ ‰È·Ù·Ú·¯‹ ‹ ¿ÏÏË ÁÓˆÛÙ‹ ·ÈÙ›·(2). ÕÏϘ ÔÓÔÌ·Û›Â˜Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Â›Ó·È «ÛÙÔÌ·ÙÈΤ˜ ·ÈÌÔÚÚ·ÁÈ-
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Τ˜ ÔÌÊfiÏ˘Á˜» (oral blood blisters) ‹ «ÂÓÙÔÈṲ̂ÓËÛÙÔÌ·ÙÈ΋ ÔÚʇڷ» (localized oral purpura)(3) ‹ «·ÈÌÔÚ-Ú·ÁÈ΋ ÛÙÔÌ·ÙÔ-ÔÌÊfiÏ˘Á·» (stomatopompholyx he-morrhagica)(4). ¶·ÚfiÏÔ Ô˘ ÔÈ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ÛÙËÓ ‰ÈÂıÓ‹ ‚È-‚ÏÈÔÁÚ·Ê›· (΢ڛˆ˜ Ô‰ÔÓÙÈ·ÙÚÈ΋) ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 50,Ë ÓfiÛÔ˜ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ·ÎfiÌ· Î·È Û ۇÁ¯ÚÔÓ· Û˘Á-ÁÚ¿ÌÌ·Ù· ¶·ıÔÏÔÁ›·˜ ÙÔ˘ ™ÙfiÌ·ÙÔ˜ ‹ ¢ÂÚÌ·ÙÔÏÔÁ›·˜,Û˘Ó‹ıˆ˜ ·Ú·Ï›ÂÙ·È ·fi ÙËÓ ‰È·ÊÔÚÔ-‰È¿ÁÓˆÛË ÙˆÓÔÌÊÔÏ˘Áˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ¤ÙÛÈ Ë ¤Ï-ÏÂÈ„Ë ˘Ô„›·˜ Ù˘ ÓfiÛÔ˘ ·fi ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ÙËÓ Î·ıÈ-ÛÙ¿ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ·‰È¿ÁÓˆÛÙË. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë Ú·ÁÌ·ÙÈ΋ Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ ÛÙÔÓÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Î·È ÔBadham(2) ıˆÚ› fiÙÈ Â›Ó·È Ôχ ÈÔ Û˘¯Ó‹ ·fi fiÙÈ Ë ‚È-‚ÏÈÔÁÚ·Ê›· ˘Ô‰ËÏÒÓÂÈ. M¿ÏÈÛÙ· ·Ú·ı¤ÙÂÈ ÚÔËÁÔ‡-ÌÂÓÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ô˘ Èı·Ó¿ ·Ó·Ê¤ÚÔÓÙ·Ó ÛÙËÓ ›‰È·ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·. ŒÙÛÈ, Ô Heryng (1890) ÂÚȤÁÚ·-„ «ÂÈÊ·ÓÂÈ·Îfi ¤ÏÎÔ˜ Ì ˆÔÂȉ¤˜ ÂÚ›ÁÚ·ÌÌ· Ô˘ È¿-ıËΠ۠10-12 ̤Ú˜ ¯ˆÚ›˜ Ó· ·Ê‹ÛÂÈ Ô˘Ï‹», ÙÔ ÔÔ›ÔÎ·È ÔÓfiÌ·Û «Î·ÏÔ‹ıË ÂÏΈÙÈ΋ Î˘Ó¿Á¯Ë» («anginaulcerosa benigna»), ÂÓÒ, ¤ÓÙ ·ÎfiÌË ÂÚÈÙÒÛÂȘ Ù˘ ›-‰È·˜ ηٿÛÙ·Û˘ ÂÚÈÂÁÚ¿ÊËÛ·Ó ·fi ÙÔÓ Brown-Kelly(1990)(2).™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ÂÚÈÁÚ¿„ÂÈ ÌÂ Û˘ÓÙÔÌ›·Ù· ÎÏÈÓÈÎÔ-·ıÔÏÔÁÈο Ù˘ ̄ ·Ú·ÎÙËÚÈÛÙÈο Î·È Ó· ÙËÓ ÂÈ-Û·Á¿ÁÂÈ ÛÙËÓ ÂÏÏËÓÈ΋ Ô‰ÔÓÙÈ·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.
K§INIKA XAPAKTHPI™TIKA
H ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Â›Ó·È ·fiÙÔÌË Î·È ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ÌÔÓ‹Ú˘ ‰ÈfiÁΈÛË Ì ÙÔÓ Û¯ËÌ·ÙÈÛÌfi Ê˘Û·Ï›‰·˜ Ô˘ÂÍÂÏ›ÛÛÂÙ·È Û ÔÌÊfiÏ˘Á· Î·È Ô˘ Ì ÙËÓ ÛÂÈÚ¿ Ù˘ ·˘Í¿ÓÂÙ·È Ì¤Û· Û ϛÁ· ÏÂÙ¿ Û˘Ó‹ıˆ˜ Û ̤ÁÂıÔ˜ 3-4ÂÎ.(5). OÈ ·Ó¤·Ê˜ ÔÌÊfiÏ˘Á˜ ÂÌÊ·Ó›˙ÔÓÙ·È ¤ÓÙÔÓ· Â-Ú˘ıÚ¤˜ (ÁÂÌ¿Ù˜ ·›Ì·) Ì ÂÚÈ‚¿ÏÏÔ˘Û· Âί˘ÌˆÙÈ΋ ¿-ψ. H ÎÏ·ÛÈ΋ ÂÓÙfiÈÛË Â›Ó·È ÙÔ fiÚÈÔ ÛÎÏËÚ‹˜-Ì·Ïı·-΋˜ ̆ ÂÚÒ·˜ Î·È ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi Ô͇ ·›ÛıË-Ì· «ÎÂÓÙÚ›ÛÌ·ÙÔ˜ ‹ η„›Ì·ÙÔ˜» Ô˘ ÌÂÚÈÎÔ› ÙÔ ÂÚÈÁÚ¿-ÊÔ˘Ó ̂ ˜ «·›ÛıËÌ· „·ÚÔÎfiηÏÔ˘ ‹ Á˘·ÏÈÔ‡ ÛÙÔÓ Ï·ÈÌfi»(ÁÈ· ·˘Ùfi Î·È Ô fiÚÔ˜ Î˘Ó¿Á¯Ë)(5). E¿Ó ÔÈ ‰È·ÛÙ¿ÛÂȘ Á›-ÓÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ Î·È ÔÈ ‚Ï¿‚˜ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔÓ Ê¿-Ú˘ÁÁ· ‹ ÛÙËÓ ÂÈÁψÙÙ›‰· ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·›ÛıË-Ì· ·ÛÊ˘Í›·˜, ̤¯ÚÈ Î·È ·fiÊÚ·ÍË Ù˘ ·ÂÚÔÊfiÚÔ˘ Ô-‰Ô‡(6), Ô ·ÛıÂÓ‹˜ Ó· ·ÓÈÎÔ‚ÏËı› Î·È Ó· Ô‰ËÁËı› ÛÙËÓ·Ó·˙‹ÙËÛË Â›ÁÔ˘Û·˜ ÓÔÛÔÎÔÌÂȷ΋˜ ÊÚÔÓÙ›‰·˜(7). ¶¿ÓÙˆ˜, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ‚Ï¿‚˜ ‰ÂÓ ¤¯Ô˘Ó ÂÂÈÛԉȷ-΋ ηٿÏËÍË, Â›Ó·È ÌÂÌÔӈ̤Ó˜ Î·È Ú‹ÁÓ˘ÓÙ·È ÂÓÙfi˜ 24-48 ˆÚÒÓ, ·ÂÏ¢ıÂÚÒÓÔÓÙ·˜ ÙÔ ÊÚ¤ÛÎÔ ·›Ì· ̤۷ ÛÙÔÛÙfiÌ·, ηٷÏ›ÔÓÙ·˜ ÂÍÂÏΈ̤ÓË ÂÈÊ¿ÓÂÈ· (EÈÎ.1),·Ú·‰fi͈˜ ·ÓÒ‰˘ÓË, Ô˘ ÂÔ˘ÏÒÓÂÙ·È Û 2-10 Ë̤Ú˜¯ˆÚ›˜ Ô˘ÏÔÔ›ËÛË(5). H ÂÈıËÏÈÔÔ›ËÛË ÚÔ¯ˆÚ› ·fiÙ· fiÚÈ· ‹ ·fi ÔÏ˘¿ÚÈıÌ· ÌÈÎÚ¿ ÓËÛ›‰È· ÂÓÙfi˜ ÙˆÓ Â˘-Ú‡ÙÂÚˆÓ ÂÍÂÏÎÒÛˆÓ. I‰È·›ÙÂÚÔ ÎÏÈÓÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È fiÙÈ ‰ÂÓ ÚÔÛ‚¿Ï-ÏÂÙ·È Ô ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ˜ ‚ÏÂÓÓÔÁfiÓÔ˜ (ԇϷ, ÛÎÏËÚ‹˘ÂÚÒ·, Ú¿¯Ë ÁÏÒÛÛ·˜)(8). ™ÙËÓ ÚÒÙË ÂÚÈÁÚ·Ê‹ ÙÔ˘Badham(2), ÂÎÙfi˜ ·fi ÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÔÈ‚Ï¿‚˜ ·ÊÔÚÔ‡Û·Ó Ù· ·Ú›ÛıÌÈ·, ÙËÓ ÎÔÚ˘Ê‹ Ù˘ ÂÈ-
ÁψÙÙ›‰·˜, ÙÔ Ê·Ú˘ÁÁÈÎfi ÙÔ›¯ˆÌ· Î·È ÙÔÓ ÔÈÛÔÊ¿ÁÔ. K·-Ù¿ ÙÔ˘˜ Hopkins Î·È Walker(5), fiÙ·Ó ÔÈ ‚Ï¿‚˜ ÂÓÙÔ›˙Ô-ÓÙ·È Û ¿ÏÏ· ÛËÌ›· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÂÎÙfi˜ Ù˘ Ì·Ïı·-΋˜ ̆ ÂÚÒ·˜ (.¯ ̄ ›ÏË, ·ÚÂÈ¿, Ï¿ÁÈ· ̄ ›ÏË ÁÏÒÛÛ·˜,¤‰·ÊÔ˜ ÛÙfiÌ·ÙÔ˜) ÔÈ Ê˘Û·Ï›‰Â˜/ÔÌÊfiÏ˘Á˜ ¤¯Ô˘Ó ÙËÓÙ¿ÛË Ó· Â›Ó·È ÌÈÎÚfiÙÂÚ˜, ÂÚÈÛÛfiÙÂÚ˜ Î·È Ó· ˘ÔÙÚÔ-È¿˙Ô˘Ó ÈÔ Û˘¯Ó¿.
¶ÚÔÛ‚¿ÏÏÔÓÙ·È ÂÓ‹ÏÈΘ οı ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ (‰ÂÓ ¤-¯ÂÈ ÂÚÈÁÚ·ÊËı› Û ·È‰È¿) Ì ÌÈ· ÂÏ·ÊÚ¿ ÚÔÙ›ÌËÛËÛ Á˘Ó·›Î˜ ̤Û˘ Î·È ÙÚ›Ù˘ ËÏÈΛ·˜(9). H Û˘¯ÓfiÙËÙ·ÚÔÛ‚ÔÏ‹˜, Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÂÂÈÛÔ‰›ˆÓ Î·È Ë ‰È¿ÚÎÂÈ·ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÔÈΛÏÏÂÈ ÛËÌ·ÓÙÈο ÌÂٷ͇ ·ÛıÂÓÒÓ. MÂ-ÚÈÎÔ› ·Ó·Ê¤ÚÔ˘Ó ÌÂÌÔӈ̤ӷ ÂÂÈÛfi‰È·, ¿ÏÏÔÈ ‰›ÓÔ˘Ó È-ÛÙÔÚÈÎfi Ù·ÎÙÈÎÒÓ ÌËÓÈ·›ˆÓ ÚÔÛ‚ÔÏÒÓ(7), ÂÓÒ ÙÔ ÈÛÙÔÚÈ-Îfi ÌÔÚ› Ó· Â›Ó·È ·Ú·ÙÂٷ̤ÓÔ Î·È Û ÌÈ· ÂÚ›ÙˆÛˉȋÚÎËÛ ·ÎfiÌ· Î·È ÁÈ· 24 ̄ ÚfiÓÈ·(5). T· ÎÏÈÓÈο ̄ ·Ú·ÎÙË-ÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.
I™TO§O°IKH EIKONA
H ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂÈÎfiÓ· ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ·ÔÛ·ÊËÓÈ-Ûı›, Èı·ÓÒ˜ ÏfiÁˆ Ù˘ ‰˘ÛÎÔÏ›·˜ Ó· ÂÍ·ÛÊ·ÏÈÛı› ̆ ÏÈ-
80
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 79-83, 2004
EÈÎ. 1: H ÔÌÊfiÏ˘Á· Û¿˙ÂÈ ÁÚ‹ÁÔÚ· ηٷÏ›ÔÓÙ·˜ ÂÍÂÏΈ̤-ÓË ·ÈÌÔÚÚ·ÁÈ΋ ÂÈÊ¿ÓÂÈ·.1·: AÓ··Ú·ÁˆÁ‹ ·fi Wray D, Gipson J.: Pictures in OralMedicine, page 6, 1997 by permission of the publisher ChurchillLivingstone. ©
1‚: AÓ··Ú·ÁˆÁ‹ ·fi Scully C, Cawson RA: Colour guide inOral Medicine, page 52, 1993 by permission of the publisherChurchill Livingstone. ©
79-83 sel. - Triantos** 3-10-08 12:52 ™ÂÏ›‰· 80
Îfi ‚ÈÔ„›·˜ ·fi ÙȘ ÂÊ‹ÌÂÚ˜ ‚Ï¿‚˜(10). E›Ó·È Ì¿ÏÈÛÙ·‰˘Ó·ÙfiÓ, Ë ›ÂÛË ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ·fi ÙËÓ ·Ó·ÚÚfiÊË-ÛË Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ‚ÈÔ„›·˜ Ó· ÚÔηϤÛÂÈ ÂÈ-ÚfiÛıÂÙ˜ ‚Ï¿‚˜(11). H ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂÈÎfiÓ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÌË-ÂȉÈ΋ ¤ÏΈ-ÛË ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÂÈı‹ÏÈÔ ̆ ÂÚΛÌÂÓÔ ÙÔ˘ ÁÂÈÙÔÓÈÎÔ‡ÌË-ÂÏΈ̤ÓÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘, ˘Ô-ÂÈıËÏȷ΋ ÔÌÊfiÏ˘-Á· ÁÂÌ¿ÙË ·fi ÂÚ˘ıÚÔ·ÙÙ·Ú· Î·È ÈÓ҉˜ (EÈÎ. 2),(5). H
ÊÏÂÁÌÔÓ҉˘ ‰È‹ıËÛË, fiÙ·Ó Â›Ó·È ·ÚÔ‡Û·, ·ÔÙÂÏ›-Ù·È ·fi ÏÂÌÊÔ·ÙÙ·Ú·, ÂÓÒ Û˘Ó‹ıˆ˜, Ô˘‰ÂÙÂÚfiÊÈÏ· ηÈˈÛÈÓfiÊÈÏ· Ô˘ ·Ó¢ڛÛÎÔÓÙ·È Û ¿ÏϘ ÔÌÊÔÏ˘ÁÒ-‰ÂȘ ηٷÛÙ¿ÛÂȘ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È(12).
¶A£O°ENEIA-EK§YTIKOI ¶APA°ONTE™
H ·ÈÙÈÔÏÔÁ›· Â›Ó·È ¿ÁÓˆÛÙË Î·È Ì¿ÏÏÔÓ ÔÏ˘-·Ú·ÁÔÓÙÈ-΋. OÈ Hopkins and Walker(5) ıˆÚÔ‡Ó fiÙÈ Ì˯·ÓÈ΋ ·‰˘-Ó·Ì›· Ù˘ ¯ÔÚÈÔ-ÂÈıËÏȷ΋˜ ÚfiÛÊ˘Û˘ ηıÈÛÙ¿ ¢¿-ψÙÔ ÙÔÓ ÌË-ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ ‚ÏÂÓÓÔÁfiÓÔ Î¿ÙÈ Ô˘ Â-ÈÙÚ¤ÂÈ Û ‹ÈÔ ÙÚ·‡Ì· Ó· ÚÔηϤÛÂÈ ·fiÛ¯ÈÛË Ù˘·Ú·¿Óˆ Û‡Ó‰ÂÛ˘, ÙÚȯÔÂȉÈ΋ ·ÈÌÔÚÚ·Á›· Ì ÙÂÏÈ΋ηٿÏËÍË ÙËÓ ‰ËÌÈÔ˘ÚÁ›· ·ÈÌÔÚÚ·ÁÈ΋˜ ÔÌÊfiÏ˘Á·˜. ŒÙÛÈ, ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜, ÔÈ ÔÌÊfiÏ˘Á˜ÂÌÊ·Ó›ÛıËÎ·Ó Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Ì¿ÛËÛ˘ ÛÎÏËÚÒÓ‹ η˘ÙÂÚÒÓ ÙÚÔÊÒÓ/ÚÔÊËÌ¿ÙˆÓ (ηʤ˜, Á¿Ï·, ·ÏÎÔfiÏ,ÙfiÛÙ, ÛÔÎÔÏ¿Ù· ÎÏ), ηٿ ÙËÓ ‰È¿ÚÎÂÈ· Ô‰ÔÓÙÈ·ÙÚÈ΋˜ıÂڷ›·˜ (Ï‹„˘ ·ÔÙ˘ˆÌ¿ÙˆÓ, ·ÔÙÚ‡ÁˆÛ˘, ÚÈ˙È-
΋˜ ·fiÍÂÛ˘, ÙÔÈ΋˜ ·Ó·ÈÛıËÛ›·˜ ÎÏ)(5, 7, 12, 13, 14), ·ÏÏ¿·ÎfiÌ· Î·È ÌÂÙ¿ ·fi ÈÛ¯˘Úfi ÊÙ¿ÚÓÈÛÌ·(5). ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ, ηӤӷ˜ ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ›Ûˆ˜ ÏfiÁˆ Ù˘ ·‰˘Ó·Ì›·˜ ÙˆÓ ·ÛıÂ-ÓÒÓ Ó· οÓÔ˘Ó ÙËÓ Û˘Û¯¤ÙÈÛË Ì οÔÈÔ ÙÚ·˘Ì·ÙÈÎfi Â-Ú¤ıÈÛÌ·(7). ™Â οı ÂÚ›ÙˆÛË, ÔÈ ·ÙÔÌÈΤ˜ ‰È·Î˘Ì¿Ó-ÛÂȘ Ô˘ ηıÈÛÙÔ‡Ó Î¿ÔÈÔ ¿ÙÔÌÔ Â˘¿ÏˆÙÔ ÛÙËÓ ÂÌÊ¿-ÓÈÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÍËÁËıÔ‡Ó ·Ú¿ ÌfiÓÔÌÂÙ¿ ·fi ÏÂÙÔÌÂÚ›˜ ÌÂϤÙ˜ Ù˘ ˘ÂÚ‰ÔÌ‹˜ ÙÔ˘‚ÏÂÓÓÔÁfiÓÔ˘(10). EӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È Ë Û˘Û¯¤ÙÈÛË ÂÌÊ¿ÓÈÛË˜ÙˆÓ ‚Ï·‚ÒÓ Ì ÙËÓ ̄ Ú‹ÛË ÂÈÛÓÂfiÌÂÓˆÓ ÛÙÂÚÔÂȉÒÓ ÁÈ·ÙËÓ ıÂڷ›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹ ¯ÚfiÓÈ·˜ ·ÔÊÚ·ÎÙÈ΋˜ÓfiÛÔ˘(11, 15). H ̄ Ú‹ÛË ÙÔ˘˜, fiÙ·Ó ·˘Ù‹ Á›ÓÂÙ·È ÁÈ· ·Ú·ÙÂ-ٷ̤ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (>5 ¯ÚfiÓÈ·) Âȉڿ ÛÙËÓ ·-Ú·ÁˆÁ‹ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ‹ Ù˘ ÂÏ·ÛÙ›Ó˘, ηٷϋÁÔ-ÓÙ·˜ Û ·ÙÚÔÊ›· Î·È ·‰˘Ó·Ì›· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘, Ì ÌË-¯·ÓÈÛÌfi ·ÚfiÌÔÈÔ Ì ÙËÓ Ï¤Ù˘ÓÛË Ù˘ ÂȉÂÚÌ›‰·˜Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ‰¤ÚÌ· ÌÂÙ¿ ·fi ÙËÓ ·ÏfiÁÈÛÙ˯ڋÛË ÛÙÂÚÔÂȉÒÓ ·ÏÔÈÊÒÓ. ™Â ·˘Ùfi Û˘ÓÙÂÏ› Î·È ÙÔ fiÙÈÙÔ 80% ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÛÙÂÚÔÂȉÒÓ ·Ú·Ì¤ÓÂÈ ÛÙËÓÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ·ÔÌ·ÎÚ‡ÓÂÙ·È ÈÔ ·ÚÁ¿ ·fiÙËÓ ˘ÂÚÒ·(16).
¢IAºOPIKH ¢IA°Nø™H-¢IA°Nø™H
H ÓfiÛÔ˜ Ú¤ÂÈ ‚·ÛÈο Ó· ‰È·ÎÚÈı› ·fi ¿ÏϘ ÔÌÊÔ-Ï˘ÁÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ ÛÙfiÌ· η-ıÒ˜ Î·È ·fi Ù˘¯fiÓ ‡·ÚÍË ·ÈÌÔÚÚ·ÁÈ΋˜ ‰È¿ıÂÛ˘(17).§fiÁˆ ÙÔ˘ ÂÊ‹ÌÂÚÔ˘ ÙˆÓ ‚Ï·‚ÒÓ ·ÏÏ¿ Î·È ÁÈ·Ù› ÛÙËÓÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÈ ÔÌÊfiÏ˘Á˜ Â›Ó·È Â-Í·ÈÚÂÙÈο ÌÂÁ¿Ï˜ ηٿ ÙËÓ ·ÚÔ˘Û›·ÛË ÙÔ˘˜ ÁÈ· Ó· Â-ÈÙÂϤÛÔ˘Ì ‚ÈÔ„›·, Ë ‰È¿ÁÓˆÛË ı· ‚·ÛÈÛı› ÛÙÔ ÈÛÙÔÚÈ-Îfi ÙÚ·‡Ì·ÙÔ˜, ÛÙËÓ ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Î·È ÛÙËÓ ¤ÏÏÂÈ„Ë¿ÏÏˆÓ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ Î·È Û˘Ìو̿وÓ. H ·Ô˘Û›··ÔÊÏÔȈÙÈ΋˜ Ô˘Ï›Ùȉ·˜ (Ô ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ˜ ‚ÏÂÓÓÔ-ÁfiÓÔ˜ ÙˆÓ Ô‡ÏˆÓ ‰ÂÓ ÚÔÛ‚¿ÏÏÂÙ·È), ‰ÂÚÌ·ÙÈÎÒÓ/Ô-Êı·ÏÌÈÎÒÓ/ÚÈÓÈÎÒÓ ‚Ï·‚ÒÓ, ÙÔ ·ÚÓËÙÈÎfi ÛËÌ›ÔNikolsky ÎÏ, ‚ÔËıÔ‡Ó ÛÙËÓ ‰È·ÊÔÚԉȿÁÓˆÛË ·fi Ù·˘fiÏÔÈ· ÔÌÊÔÏ˘ÁÒ‰Ë ÓÔÛ‹Ì·Ù· (¶›Ó·Î· 2), ·fi Ù·
ÔÔ›·, ·˘Ùfi Ô˘ Ì ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ÌÔÚ› Ó·ÂÌÊ·ÓÈÛı› ˆ˜ ·Ó¤·ÊË ˘ÔÂÈıËÏȷ΋ ·ÈÌÔÚÚ·ÁÈ΋ÔÌÊfiÏ˘Á· Â›Ó·È ÙÔ ÛÙÔÌ·ÙÈÎfi ÂÌÊÈÁÔÂȉ¤˜(18, 19, 20). °È· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÎÙ›ÌËÛ˘, ÂÊfiÛÔÓ ˘-¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÁÈ· ‚ÈÔ„›·, Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔÓ ¿-ÌÂÛÔ Î·È ¤ÌÌÂÛÔ ·ÓÔÛÔÊıÔÚÈÛÌfi ıˆÚÔ‡ÓÙ·È Â·Ú΋.
81
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 79-83, 2004
¶›Ó·Î·˜ 1: KÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘
→ AfiÙÔÌË ¤Ó·ÚÍË.→ ¶ÔÌÊfiÏ˘Á· Ô˘ ·˘Í¿ÓÂÙ·È ÁÚ‹ÁÔÚ· Û ̤ÁÂıÔ˜ 3-4 ÂÎ.→ MÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi Ô͇ ·›ÛıËÌ· «ÎÂÓÙÚ›ÛÌ·ÙÔ˜ ‹ η-
„›Ì·ÙÔ˜».→ P‹ÁÓ˘Ù·È ÂÓÙfi˜ ˆÚÒÓ, ηٷÏ›ÔÓÙ·˜ ÂÍÂÏΈ̤ÓË ·ÓÒ‰˘ÓË Â-
ÈÊ¿ÓÂÈ·.→ EԇψÛË Û 2-10 Ë̤Ú˜ ¯ˆÚ›˜ Ô˘ÏÔÔ›ËÛË.→ ™˘Ó‹ıˆ˜ ÛÙÔ fiÚÈÔ ÛÎÏËÚ‹˜-Ì·Ïı·Î‹˜ ˘ÂÚÒ·˜.→ ¢ÂÓ ÚÔÛ‚¿ÏÏÂÙ·È Ô ÎÂÚ·ÙÈÓÔÔÈË̤ÓÔ˜ ‚ÏÂÓÓÔÁfiÓÔ˜.→ ¶ÚÔÛ‚¿ÏÏÔÓÙ·È ÂÓ‹ÏÈΘ οı ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘.→ OÈ ÚÔÛ‚ÔϤ˜ ÌÔÚ› Ó· ‰È·ÚΤÛÔ˘Ó ÔÏÏ¿ ¯ÚfiÓÈ·.
¶›Ó·Î·˜ 2: ¶ÔÌÊÔÏ˘ÁÒ‰Ë ÓÔÛ‹Ì·Ù· ·fi Ù· ÔÔ›· Ú¤ÂÈ Ó· ‰È·-ÊÔÚԉȷÁÓˆÛı› Ë ÓfiÛÔ˜.
♦ ™ÙÔÌ·ÙÈÎfi ¶ÂÌÊÈÁÔÂȉ¤˜.♦ ¶¤ÌÊÈÁ·.♦ ¶ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜.♦ ¶ÔÌÊÔÏ˘Á҉˜ ÌÔÚÊ‹ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó·.♦ ¶ÔÌÊÔÏ˘Á҉˘ ÌÔÚÊ‹ Û˘ÛÙËÌ·ÙÈÎÔ‡ χÎÔ˘.♦ °Ú·ÌÌÈ΋ IgA NfiÛÔ˜.♦ EÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›Ùȉ·.♦ E›ÎÙËÙË ÔÌÊÔÏ˘Á҉˘ ÂȉÂÚÌfiÏ˘ÛË.♦ AÌ˘ÏÔ›‰ˆÛË.
EÈÎ. 2: IÛÙÔÏÔÁÈο, ̄ ·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ̆ Ô-ÂÈıËÏȷ΋ ÔÌÊfiÏ˘Á· ÁÂÌ¿ÙË Â-Ú˘ıÚÔ·ÙÙ·Ú· (www.cal.eastman.ucl.ac.uk/ulcerspath/diseases/anginabullosa.htm.
79-83 sel. - Triantos** 3-10-08 12:52 ™ÂÏ›‰· 81
™ÙËÓ ·ÈÌÔÚÚ·ÁÈ΋ ÔÌÊÔÏ˘ÁÒ‰Ë Î˘Ó¿Á¯Ë ‰ÂÓ ·Ó¢ڛ-ÛÎÔÓÙ·È ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ›Ù ηıËψ̤ӷ ÛÙÔ˘˜ È-ÛÙÔ‡˜ ›Ù ΢ÎÏÔÊÔÚÔ‡ÓÙ·(17), Î·È ¤ÙÛÈ ÙÂÎÌËÚÈÒÓÂÙ·È fiÙÈË ·ÒÏÂÈ· ÚfiÛÊ˘Û˘ ÙÔ˘ ÂÈıËÏ›Ô˘ ÛÙÔÓ Û˘Ó‰ÂÙÈÎfi È-ÛÙfi ‰ÂÓ ÚÔηÏÂ›Ù·È ·fi ·˘ÙÔ¿ÓÔÛË Î·Ù·ÛÙÚÔÊ‹ fiˆ˜
ÛÙȘ ¿ÏϘ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ ÙÔ˘ ÛÙfiÌ·ÙÔ˜.AÓÙ›ıÂÙ· ÛÙÔ ÂÌÊÈÁÔÂȉ¤˜, ¤¯ÔÌ ÁÚ·ÌÌÈΤ˜ ÂÓ·Ôı¤-ÛÂȘ ·˘ÙÔ-·ÓÙÈÛˆÌ¿ÙˆÓ IgG ÛÙËÓ ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË Ì ‹¯ˆÚ›˜ Û˘Ó‰˘·ÛÌfi Ì C3(20) .™ÙËÓ ÂÚËÙÔÂȉ‹ ‰ÂÚÌ·Ù›Ùȉ·, ÁÚ·ÌÌÈ΋ IgA ÓfiÛÔ Î·ÈÛÙÔ ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜ Û˘Ó‹ıˆ˜ ÔÈ ‰ÂÚÌ·ÙÈ-Τ˜ ‚Ï¿‚˜ ÚÔËÁÔ‡ÓÙ·È ÙˆÓ ÛÙÔÌ·ÙÈÎÒÓ, ÂÓÒ Ë ÔÌÊÔ-Ï˘Á҉˘ ÌÔÚÊ‹ ÙÔ˘ ÔÌ·ÏÔ‡ ÏÂȯ‹Ó· Î·È ÙÔ˘ Û˘ÛÙËÌ·ÙÈ-ÎÔ‡ χÎÔ˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓȘ Î·È ¿ÓÙ· ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ¿ÏÏ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù·(18, 19). ™ÙËÓ ·Ì˘ÏÔ›‰ˆ-ÛË, ÔÈ ÛÙÔÌ·ÙÈΤ˜ ‚Ï¿‚˜ Â›Ó·È Û¿ÓȘ, ÔÈ ·ÛıÂÓ›˜ Û˘-Ó‹ıˆ˜ ¤¯Ô˘Ó ¿ÏÏ· ÎÏÈÓÈο ÛËÌ›· fiˆ˜ Ì·ÎÚÔÁψÛÛ›·‹ ÂÙ¤¯ÂȘ Î·È Âί˘ÌÒÛÂȘ ÛÙÔ ‰¤ÚÌ·, ÂÓÒ Û ·ÌÊ›‚Ô-Ϙ ÂÚÈÙÒÛÂȘ, Ë ¯ÚÒÛË ÙˆÓ ÈÛÙÒÓ Ì ıÂÈÔ‚Ï·‚›ÓË Î·ÈÂÚ˘ıÚfi ÙÔ˘ Congo ı· ÂȂ‚·ÈÒÛÂÈ ÙËÓ ‰È¿ÁÓˆÛË(21). E›Û˘, ÔÌÊfiÏ˘Á˜ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ ÛÙfiÌ· ηȿÏÏÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ ˘ÔÎÈÓÔ‡ÌÂÓ˜ ·fi ÙÚ·‡Ì· ·Ô-ÙÂÏÔ‡Ó ̄ ·Ú·ÎÙËÚÈÛÙÈÎfi ÁÓÒÚÈÛÌ· Ù˘ ›ÎÙËÙ˘ ÔÌÊÔ-Ï˘ÁÒ‰Ô˘˜ ÂȉÂÚÌfiÏ˘Û˘, ·ÏÏ¿ Ô ‰È·ÊÔÚÂÙÈÎfi˜ ˘Ô-ΛÌÂÓÔ˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ (·ÓÙÈÛÒÌ·Ù· ¤Ó·-ÓÙÈ ÎÔÏÏ·ÁfiÓÔ˘), Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ Ô‡ÏˆÓ, ÔÈ Û˘Ó˘¿Ú-¯Ô˘Û˜ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ Î·È Ù· ıÂÙÈο Â˘Ú‹Ì·Ù· ·fiÙÔÓ ·ÓÔÛÔÊıÔÚÈÛÌfi ÙËÓ ‰È·ÊÔÚÔÔÈ› Û·Ó ÓÔÛÔÏÔÁÈ΋ÔÓÙfiÙËÙ·(18, 19). T¤ÏÔ˜, ÙÔ ÈÛÙÔÚÈÎfi Î·È Ë ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛËı· ‰È·ÎÚ›ÓÂÈ ÙËÓ ÓfiÛÔ ·fi ‚Ï¿‚˜ ÙÚ·˘Ì·ÙÈ΋˜ ·ÈÙÈÔÏÔ-Á›·˜ ÔÊÂÈÏfiÌÂÓ˜ Û ÛÙÔÌ·ÙÔ-ÁÂÓÓËÙÈΤ˜ ÛÂÍÔ˘·ÏÈΤ˜Ú·ÎÙÈΤ˜(5). ™Â ·ÛıÂÓ›˜ Ì ·ÙÔÌÈÎfi ‹ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÌÔÚ-Ú·ÁÈ΋˜ ‰È¿ıÂÛ˘ ‹ Û ·ÛıÂÓ›˜ Ì ‡ÔÙ· ÎÏÈÓÈο ÛË-Ì›· fiˆ˜ ÌÂÏ·ÓȤ˜ ÛÙÔ ‰¤ÚÌ·/‚ÏÂÓÓÔÁfiÓÔ ‹ ·˘ÙfiÌ·-Ù˜ ·ÈÌÔÚÚ·Á›Â˜/Ô˘ÏÔÚÚ·Á›Â˜, ÁÈ· Ó· ÂȂ‚·Èˆı› ˉȿÁÓˆÛË Ú¤ÂÈ Ó· ‰ÈÂÚ¢ÓËı› Ë ÔÌ·Ï‹ ·ÈÌÔÛÙ·ÙÈ΋ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÛıÂÓÒÓ ÒÛÙ ӷ ·ÔÎÏÂÈÛÙÔ‡Ó ˘ÔΛ-ÌÂÓ˜ ‰È·Ù·Ú·¯¤˜ (ıÚÔÌ‚ÔÂÓ›·, ÓfiÛÔ˜ Von Wille-brand's)(17). A·ÈÙÂ›Ù·È Ï‹Ú˘ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜,ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ·ÚÈıÌÔ‡ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ, ¤ÏÂÁ¯Ô˜ ·ÈÌfiÛÙ·Û˘ Î·È ‰ÔÎÈ̷ۛ˜ ÙˆÓ·Ú·ÁfiÓÙˆÓ ‹Í˘(17), ÂÓÒ Ú¤ÂÈ Î·È Ó· ÂÏÂÁ¯ı› ÙÔ ÂÓ-‰Â¯fiÌÂÓÔ Ï‹„˘ ·ÓÙÈËÎÙÈÎÒÓ ‹ Ë ·ÚÔ˘Û›· Ë·ÙÈ΋˜ÓfiÛÔ˘(22).
ANTIMETø¶I™H
¢ÂÓ ˘¿Ú¯ÂÈ ÙÚfiÔ˜ ÚfiÏ˄˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘.°ÂÓÈο, Ë ÓfiÛÔ˜ È¿Ù·È ·˘ÙfiÌ·Ù·, ÌÔÚ› fï˜ Ó· ˘Ô-ÙÚÔÈ¿˙ÂÈ Û˘Ó¤¯ÂÈ· ÁÈ· 20-25 ̄ ÚfiÓÈ·. A·ÈÙÂ›Ù·È Î·ıËÛ‡-¯·ÛË ÙÔ˘ ·ÛıÂÓ‹, ÂÓË̤ڈÛË ÁÈ· ÙËÓ Î·ÏÔ‹ıË Ê‡ÛËÙ˘ Î·È ·ÔÊ˘Á‹ ÙÚ·‡Ì·ÙÔ˜ Û fiÛÔ˘˜ ¤¯Ô˘Ó ÚԉȿıÂ-ÛË(7). ™Â ·ÛıÂÓ›˜ Ì ÙÔÈ΋ ̄ Ú‹ÛË ÂÈÛÓÂfiÌÂÓˆÓ ÛÙÂÚÔ-ÂȉÒÓ, ·Ï¿ ÚÔÊ˘Ï·ÎÙÈο ̤ÙÚ· fiˆ˜ Í¤Ï˘Ì· Ì ÓÂ-Úfi ÌÂÙ¿ ÙËÓ ¯Ú‹ÛË ÁÈ· Ó· ·ÔÌ·ÎÚ˘Óı› Ë ÂÚ›ÛÛÂÈ·ÙÔ˘˜ Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙËÓ Û˘¯ÓfiÙËÙ· ÙˆÓ ‚Ï·‚ÒÓ ÛÙ·Â˘¿ÏˆÙ· ¿ÙÔÌ·(15). ™Â ÌÂÁ¿Ï˜ ·Ó¤·Ê˜ ̆ ÂÚÒȘ ÔÌ-ÊfiÏ˘Á˜ Ú¤ÂÈ Ó· ·Ê·ÈÚÂ›Ù·È Ë ÔÚÔÊ‹ ÙÔ˘˜ Ì ӢÛÙ¤ÚÈ,ÌÈ· ·ÓÒ‰˘ÓË ‰È·‰Èηۛ· Ô˘ ·Ó·¯·ÈÙ›˙ÂÈ ÙËÓ ÂÚ·È٤ڈ¤ÎÙ·ÛË ÙÔ˘˜ Î·È ·Ó·ÎÔ˘Ê›˙ÂÈ ÙÔÓ ·ÛıÂÓ‹(5). EÈÚfi-ÛıÂÙ·, ÛÙÔÌ·ÙÔχÛÂȘ Ì ÁÏ˘ÎÔÓÈ΋ ¯ÏˆÚÂÍȉ›ÓË Â›Ó·È¯Ú‹ÛÈ̘ ÁÈ· ÚÔʇϷÍË ·fi ‰Â˘ÙÂÚÔÁÂÓ‹ ‚·ÎÙËÚȉȷ-΋ Ïԛ̈ÍË ˘Â‡ı˘ÓË ÁÈ· ÙÔ ·›ÛıËÌ· ‰˘ÛÊÔÚ›·˜ Ô˘Û˘Óԉ‡ÂÈ Î·ÌÈ¿ ÊÔÚ¿ ÙȘ ‚Ï¿‚˜, ÂÓÒ ÁÈ· Ù˘¯fiÓ fiÓÔÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ÛÙÔÌ·ÙÔ-χ̷ٷ fiˆ˜ Ë ˘‰ÚԯψÚÈ΋ ‚ÂÓ˙˘‰·Ì›ÓË(7).
SUMMARY
"Angina bullosa haemorrhagica: an uncommonoral disorder with diagnostic interest"
D. Triantos, P. Kanakis
hellenic stomatological review 48: 79-83, 2004
The term angina bullosa haemorrhagica is used todescribe an uncommon, benign, oral lesion, of unknownetiology, which is manifested as recurrent blood-filledvesicles and bullae, not attributable to blood dyscrasias,vesiculo-bullous disorders, systemic diseases or otherknown causes. The lesions develop suddenly, usuallyduring meals or dental procedures and spontaneouslyburst resulting in ragged, often painless, superficialerosions that heal without scarring. The histopathologicpicture includes non-specific ulceration and sub-epithelial bulla, full of erythrocytes and fibrin. The etiologyis a multi-factorial phenomenon; trauma seems to be themajor provoking factor. This clinical entity should be distinguished from othermore serious oral disorders with similar presentingfeatures-mainly from oral pemphigoid and oral thro-mbocytopenia. The transient nature of the lesions usuallyobstacles the performance of a biopsy, thus, thediagnosis would be based in the history of trauma, theclinical picture and the absence of other clinical signsand symptoms. It is not feasible to prevent the recurrenceof the lesions. However, the patient should be informedabout the benign nature of the disease and be reassured.For symptomatic relief, the use of local analgesics andantiseptics is recommended.
Key words: Angina bullosa haemorrhagica, oral blood blisters,bullous diseases, oral ulcers.
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 79-83, 2004
¶›Ó·Î·˜ 3: H ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ı· ÛÙËÚȯı›
➢ IÛÙÔÚÈÎfi ÙÚ·‡Ì·ÙÔ˜
➢ EÓÙÔÈṲ̂Ó˜ ‚Ï¿‚˜ ÛÙÔ ÛÙfiÌ·
➢ AÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜
➢ ¢È·ÁÓˆÛÙÈ΋ ‚ÈÔ„›· (·ÊÔ‡ ·ÔÎÏÂÈÛÙ› ·ÈÌ·ÙÔÏ. ‰È·Ù·Ú·¯‹)
➢ ÕÌÂÛÔ˜ Î·È ¤ÌÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜
79-83 sel. - Triantos** 3-10-08 12:52 ™ÂÏ›‰· 82
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 79-83, 2004
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:¢Ú. ¢ËÌ‹ÙÚ˘ TÚÈ¿ÓÙÔ˜K·ÚÙ¿ÏË 6, 115 28 ¶Ï. M·‚›ÏË, Aı‹Ó·e-mail: [email protected]
79-83 sel. - Triantos** 3-10-08 12:52 ™ÂÏ›‰· 83
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
H ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓ‹ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋
E. EÏ¢ıÂÚÈ¿‰Ë˜*, M. §Â‚¤ÓÙ˘**, E. °È·ÓÓÔ˘Ï¿ÎË***, X. ¶··‰‹Ì·˜**
O ۷ί·Ú҉˘ ‰È·‚‹Ù˘ ·ÔÙÂÏ› ¯ÚfiÓÈÔ ÓfiÛËÌ· ÙÔ˘ ÔÔ›Ô˘ Ë Û˘¯ÓfiÙËÙ· ÔÈΛÏÏÂÈ ·fi ¯ÒÚ·Û ¯ÒÚ·, Î˘Ì·ÈÓfiÌÂÓË ·fi 3% ¤ˆ˜ 10%. YÔÏÔÁ›˙ÂÙ·È fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ‰È·ÁÓˆÛÌ¤ÓˆÓ ‰È·‚Ë-ÙÈÎÒÓ ·Ó¤Ú¯ÂÙ·È ÛÙ· 100 ÂηÙÔÌ̇ÚÈ· ·ÁÎÔÛÌ›ˆ˜ Î·È ·Ó·Ì¤ÓÂÙ·È Ó· ˘ÂÚ‰ÈÏ·ÛÈ·Ûı› ηٿÙËÓ ÂfiÌÂÓË 20ÂÙ›·, ÂÓÒ ıˆÚÂ›Ù·È fiÙÈ ÔÏÏÔ› ·ÎfiÌË ¿Û¯Ô˘Ó ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ¯ˆÚ›˜ Ó· ÙÔÁÓˆÚ›˙Ô˘Ó.¶ÔÏÏÔ› ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ Ú˘ıÌ›˙Ô˘Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÙÔ ÓfiÛËÌ·, ¿ÏÏÔÈ ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·È ÂÏÏÈÒ˜ Ú˘ıÌÈṲ̂ÓÔÈ, ÂÓÒ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ, ηٿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘ ÁÈ· οÔÈ·¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ ¯ÒÚ·, ·ÁÓÔ› Ï‹Úˆ˜ ÙÔ Úfi‚ÏËÌ·. H ·Ó·˙‹ÙËÛË, ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ÚÈÓ ·fi οı ¯ÂÈÚÔ˘ÚÁÈ΋¤̂·ÛË ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÙfiÛÔ ÁÈ· ÙÔÓ ·ÛıÂÓ‹, fiÛÔ Î·È ÁÈ· ÙÔ ¯ÂÈÚÔ˘ÚÁfi. H ÛËÌ·Û›· ÙÔ˘ÚÔ‚Ï‹Ì·ÙÔ˜ ¤ÁÎÂÈÙ·È ÛÙȘ ÂÈÏÔΤ˜ Ô˘ ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÂÈ Ô ‰È·‚ËÙÈÎfi˜ ·ÛıÂÓ‹˜, ÔÍ›˜ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘ (΢ڛˆ˜ ˘ÔÁÏ˘Î·ÈÌ›· ·ÏÏ¿ Î·È ˘ÂÚÁÏ˘Î·ÈÌ›·) ‹ ÌÂÙ·ÁÂÓ¤-ÛÙÂÚ˜, ÔÊÂÈÏfiÌÂÓ˜ ÛÙËÓ ̆ „ËÏ‹ ÓÔÛËÚfiÙËÙ· ÙÔ˘ ‰È·‚ËÙÈÎÔ‡ ÏËı˘ÛÌÔ‡. H ‚Ú·‰Â›· ÂÔ˘ÏˆÙÈ-΋ ÈηÓfiÙËÙ·, Ë ÂÏ·Ùو̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙȘ ÏÔÈÌÒÍÂȘ ·ÏÏ¿ Î·È Ù· ηډȷÁÁÂȷο, ÓÂÊÚÈο ηȿÏÏ· Û˘ÛÙËÌ·ÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ ··Û¯ÔÏÔ‡Ó ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ηıÒ˜Î·È Ë Ï‹„Ë ·fi ·˘ÙÔ‡˜ Û˘¯Ó¿ ÔÏÏÒÓ Ê·Ú̿ΈÓ, ··ÈÙÔ‡Ó ÚÔÛÂÎÙÈ΋ ÂÎÙ›ÌËÛË Î·È ÛˆÛÙ‹ ·-ÓÙÈÌÂÙÒÈÛË, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÔÏÔÎÏËÚˆı› ·ÔÙÂÏÂÛÌ·ÙÈο ÌÈ· ·Ó·Áη›· ‰ÈÂÁ¯ÂÈÚËÙÈ΋ Î·È ÌÂ-ÙÂÁ¯ÂÈÚËÙÈ΋ ‰È·‰Èηۛ·.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 85-91, 2004
§¤ÍÂȘ ÎÏÂȉȿ: ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ-΋ ¯ÂÈÚÔ˘ÚÁÈ΋
* AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜** O‰ÔÓÙ›·ÙÚÔ˜, MS, ™˘ÓÂÚÁ¿Ù˘ Ù˘ KÏÈÓÈ΋˜
*** ¢È¢ı‡ÓÙÚÈ· ¶·ıÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ °.¶.N.¶. «ÕÁÈÔ˜ AÓ‰Ú¤-·˜», Y‡ı˘ÓÔ˜ E͈ÙÂÚÈÎÔ‡ ¢È·‚ËÙÔÏÔÁÈÎÔ‡ I·ÙÚ›Ԣ
Afi ÙË ™ÙÔÌ·ÙÈ΋ Î·È °Ó·ıÔÚÔÛˆÈ΋ XÂÈÚÔ˘ÚÁÈÈ΋ KÏÈÓÈ΋ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ. ¢È¢ı˘ÓÙ‹˜: K·ı. AÁÁ. ¶. AÁÁÂÏfiÔ˘-ÏÔ˜.
EχıÂÚË AÓ·ÎÔ›ÓˆÛË ÛÙÔ 22Ô ¶.O.™., Kˆ˜, OÎÙÒ‚ÚÈÔ˜ 2002.
EI™A°ø°H
O ۷ί·Ú҉˘ ‰È·‚‹Ù˘ ·ÔÙÂÏ› ¤Ó· ÔÏ˘·Ú·ÁÔÓÙÈ-Îfi Û‡Ó‰ÚÔÌÔ, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ·fi ‰È·-Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÙˆÓÏÈÒÓ Î·È ¤¯ÂÈ Û·Ó Î‡ÚÈ· ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÙËÓ ·‡ÍËÛË
ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÔÚÔ‡ ÙÔ˘ ·›Ì·ÙÔ˜ ÙˆÓ·ÛıÂÓÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÙË ÓfiÛÔ. A›ÙÈÔ Ù˘ ·Ú·ÙË-ÚÔ‡ÌÂÓ˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ Â›Ó·È Ë ÔÛÔÙÈ΋ ‹ ÔÈÔÙÈ΋‰È·Ù·Ú·¯‹ Ù˘ ÈÓÛÔ˘Ï›Ó˘ ‹ Ë ‚Ï¿‚Ë ÙˆÓ ˘Ô‰Ô¯¤ˆÓÛ‡Ó‰ÂÛ˘ ·˘Ù‹˜ ÛÙ· fiÚÁ·Ó· ‰Ú¿ÛÂÒ˜ Ù˘. H ·ÈÙÈÔÏÔÁ›·ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¿ÁÓˆÛÙË Î·È Èı·ÓÔÏÔÁÂ›Ù·È ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘, Ë Â›‰Ú·ÛË ÔÈÎ›ÏˆÓ Â͈ÁÂÓÒÓ ·-Ú·ÁfiÓÙˆÓ Û ÁÂÓÂÙÈÎÒ˜ ÚÔηıÔÚÈṲ̂ÓÔ ˘fiÛÙڈ̷.MfiÓÔ ÛÙȘ H.¶.A. ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 6% ÂÚ›Ô˘ ÙÔ˘ÏËı˘ÛÌÔ‡ ¿Û¯ÂÈ ·fi οÔÈ· ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, ÛÙ· ¿-ÙÔÌ· ¿Óˆ ÙˆÓ 65 ÂÙÒÓ ÙÔ ÔÛÔÛÙfi ·˘Ùfi Êı¿ÓÂÈ ÛÙÔ18,4%, ÂÓÒ ·ÔÙÂÏ› ÙËÓ Ù¤Ù·ÚÙË ·ÈÙ›· ıÓËÛÈÌfiÙËÙ·˜,΢ڛˆ˜ ÏfiÁˆ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ (Ì·ÎÚÔ-·ÁÁÂÈÔ¿ıÂÈ·) Î·È ÙÔ ÚÒÙÔ ·›ÙÈÔ Ù‡ÊψÛ˘ Î·È ÓÂÊÚÈ-΋˜ ·Ó¿ÚÎÂÈ·˜ (ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·) ÁÈ· ÙȘ ËÏÈ˘ 20-70 ÂÙÒÓ1-3.
ø˜ ·¿ÓÙËÛË ÛÙË Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ· ÂÌ-Ê¿ÓÈÛ˘ Ù˘ ¯ÚfiÓÈ·˜ ·˘Ù‹˜ ÌÂÙ·‚ÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜, Ô¯ÂÈÚÔ˘ÚÁfi˜ Ú¤ÂÈ Ó· Â›Ó·È Û ı¤ÛË fi¯È ÌfiÓÔ Ó· ·ÓÙÈÌÂ-Ùˆ›ÛÂÈ ·ÔÙÂÏÂÛÌ·ÙÈο Î·È ˘Â‡ı˘Ó· οı ‰È·‚ËÙÈÎfi
85
85-91 sel. - Elejyueriadis* 3-10-08 12:55 ™ÂÏ›‰· 85
·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ·Ó¿ÁÎË ̄ ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘, ·ÏÏ¿ÔÏϤ˜ ÊÔÚ¤˜ Î·È Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛËÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÁÓÔÔ‡Ó ÙËÓ ¿ıËÛ‹ ÙÔ˘˜. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË ÙˆÓÛ˘Á¯ÚfiÓˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ÚÔ‚ÏËÌ·ÙÈÛÌÒÓ Á‡Úˆ ·fiÙËÓ ÂÚÈÂÁ¯ÂÈÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, Ô˘ ÚfiÎÂÈÙ·È Ó· ˘Ô‚ÏËı› Û¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ÂÚÈÔ¯‹.
¶A£OºY™IO§O°IA
KÂÓÙÚÈÎfi ÚfiÏÔ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë ÈÓÛÔ˘Ï›ÓË, Ë Ô-Ô›· Â›Ó·È ÔÚÌfiÓË ÂÙȉÈ΋˜ ʇÛˆ˜ Ì ¤ÓÙÔÓ· ·Ó·‚Ô-ÏÈ΋ ‰Ú¿ÛË, Ô˘ Û˘ÓÙ›ıÂÙ·È, ·ÔıË·ÂÙ·È Î·È ÂÎÎÚ›ÓÂ-Ù·È ·fi Ù· ‚-·ÙÙ·Ú· ÙˆÓ ÓËÛȉ›ˆÓ ÙÔ˘ Langerhans ÛÙÔ¿ÁÎÚ·˜. M¤Ûˆ Ù˘ ˘Ï·›·˜ ·ÚÙËÚ›·˜ ÌÂٷʤÚÂÙ·ÈÛÙÔ ‹·Ú fiÔ˘ Û ÔÛÔÛÙfi 60% ÂÍÔ˘‰ÂÙÂÚÒÓÂÙ·È ·fiË·ÙÈο ¤Ó˙˘Ì·. H ¤ÎÎÚÈÛË Ù˘ ÔÚÌfiÓ˘ Ú˘ıÌ›˙ÂÙ·È, η-Ù¿ ·ÚÈÔ ÏfiÁÔ, ·fi ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ÁÏ˘Îfi˙˘ ÛÙÔ·›Ì· Î·È Ë ÛÔ˘‰·ÈfiÙËÙ¿ Ù˘ ηٷ‰ÂÈÎÓ‡ÂÙ·È ·fi ÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ ¤ÏÏÂÈ„‹ Ù˘ ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi ÁÈ· ÌÂÁ¿ÏÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Â›Ó·È ·Û˘Ì‚›‚·ÛÙË Ì ÙË ˙ˆ‹. H ÈÓ-ÛÔ˘Ï›ÓË ‰Ú· ̤ۈ ˘Ô‰Ô¯¤ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘Ù-Ù¿ÚˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜, ÚÔ¿ÁÔ˘Û· ÙȘ ÌÂÙ·‚ÔÏÈΤ˜ ‰ÈÂÚ-Á·Û›Â˜ ·˘ÙÒÓ, ÛÙȘ Ôԛ˜ ˆ˜ ·ÚÈÔ ÚÔ˚fiÓ ¯ÚËÛÈÌÔÔÈ-Â›Ù·È Ë ÁÏ˘Îfi˙Ë. H ‰Ú¿ÛË Ù˘ ÁÂÓÈο ÛÙÔ˘˜ ÈÛÙÔ‡˜ Û˘ÓÔ-„›˙ÂÙ·È Û ÂÈÙ¿¯˘ÓÛË Ù˘ Û‡ÓıÂÛ˘ ·ÔÙ·ÌÈ¢ÙÈÎÒÓÔ˘ÛÈÒÓ (Û‡ÓıÂÛË ÁÏ˘ÎÔÁfiÓÔ˘ ÛÙÔ˘˜ Ì˘˜ Î·È ÙÔ ‹·Ú,ÚˆÙÂ˚ÓÔÛ‡ÓıÂÛË, ÌÂÙ·ÙÚÔ‹ ˘‰·Ù·ÓıÚ¿ÎˆÓ Û ϛËÎ·È ÂÓ·fiıÂÛË ·˘ÙÒÓ ÛÙÔ ÏÈÒ‰Ë ÈÛÙfi Ì ÙË ÌÔÚÊ‹ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ) Î·È Û ÂÈÙ¿¯˘ÓÛË ÙÔ˘ ηٷ‚ÔÏÈÛÌÔ‡ Ù˘ÁÏ˘Îfi˙˘ ÛÙËÓ ÂÚÈʤÚÂÈ· ÙÔ˘ ÛÒÌ·ÙÔ˜ (Ì˘˜ Î·È ÏÈÒ-‰Ë˜ ÈÛÙfi˜) Ì ÛÎÔfi ÙËÓ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜ (Ê. Ù. ÁÏ˘-Îfi˙˘ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜ 80-110 mg%)4, 5.M›ˆÛË Ù˘ ÔÛfiÙËÙ·˜ Ù˘ ·Ú·ÁfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ‹‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÔÚ›Ô˘ ·˘Ù‹˜ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Û‡Ó‰Â-Û‹˜ Ù˘, Û˘Ó¿ÁÂÙ·È ·Ó·Ú΋ ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ÁÏ˘Îfi˙˘ ·fi ÙÔ˘˜ ÈÛÙÔ‡˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛˢÂÚÁÏ˘Î·ÈÌ›·˜ Î·È ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÎÏ·ÛÈ΋˜ Û˘-Ìو̷ÙÔÏÔÁ›·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (ÔÏ˘Ô˘Ú›·˜, ÔÏ˘‰È-„›·˜, ÔÏ˘Ê·Á›·˜)4, 6.
TA•INOMH™H - AITIO§O°IA
™‡Ìʈӷ Ì ÙËÓ ·Ï·ÈfiÙÂÚË Ù·ÍÈÓfiÌËÛË (NationalDiabetes Data Group 1979) ÔÈ ‰‡Ô ·ÚȘ ηÙËÁÔڛ˜ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ‚¿ÛÂÈ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂ-ˆÓ, ‹Ù·Ó Ô «Ù‡Ô˜ I ‹ Ó·ÓÈÎfi˜ ‹ ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓԘ۷ί·Ú҉˘ ‰È·‚‹Ù˘ (type I ‹ juvenile ‹ insulin-dependent diabetes mellitus ‹ IDDM)» Î·È Ô «Ù‡Ô˜ II ‹ Â-ÓËÏ›ÎˆÓ ‹ ÌË ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘ ‰È·-‚‹Ù˘ (type II ‹ adult-onset ‹ noninsulin-dependentdiabetes mellitus ‹ NIDDM)»7. H ÚfiÔ‰Ô˜ fï˜ ÛÙÔÓ ÙÔ-̤· Ù˘ ıÂڷ¢ÙÈ΋˜ ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Ë ·-Ó·Î¿Ï˘„Ë ¿ÏÏˆÓ Ù‡ˆÓ Ù˘ ÓfiÛÔ˘ ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ·-ıÔÊ˘ÛÈÔÏÔÁÈÎfi ̆ fi‚·ıÚÔ, ηıfiÚÈÛ·Ó Ì›· Ó¤· Û‡Á¯ÚÔÓËηٿٷÍË (American Diabetes Association 1997)8, Ë Ô-
Ô›· ·Ó·ÁÓˆÚ›˙ÂÈ Ù¤ÛÛÂÚȘ Ù‡Ô˘˜ Ù˘ ÓfiÛÔ˘ ·Ó¿ÏÔÁ·Ì ÙÔ ·›ÙÈÔ ÂΉ‹ÏˆÛ‹˜ Ù˘: ·. T‡Ô˜ 1. X·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ηٷÛÙÚÔÊ‹ ÙˆÓ ‚-΢Ù-
Ù¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Ì ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈ-ÛÌÔ‡˜ ‹ ȉÈÔ·ıÒ˜. O ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 1··ÓÙ¿Ù·È ÛÙÔ 10% ÂÚ›Ô˘ ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂ-ÓÒÓ.
‚. T‡Ô˜ 2. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏÔ ÙÔ Ê¿ÛÌ· ‰˘Ó·ÙÒÓ Û˘Ó-‰˘·ÛÌÒÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ·fi ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓ-ÛÔ˘Ï›ÓË Ì ۯÂÙÈ΋ ¤ÏÏÂÈ„‹ Ù˘, ̤¯ÚÈ ÙË ‰È·Ù·Ú·¯‹Ù˘ ÂÎÎÚ›Ûˆ˜ ÈÓÛÔ˘Ï›Ó˘ Ì ÌÈÎÚfiÙÂÚË ÈÓÛÔ˘ÏÈÓÔ·-ÓÙ›ÛÙ·ÛË. O Ù‡Ô˜ 2 ·ÔÙÂÏ› ÙË Û˘ÓËı¤ÛÙÂÚË ÌÔÚʋ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ·ÔÙÂÏÔ‡Û· ÙÔ 75-85% ÙÔ˘ Û˘-ÓfiÏÔ˘ ÙˆÓ ‰È·‚ËÙÈÎÒÓ.
Á. ÕÏÏÔÈ ÂȉÈÎÔ› Ù‡ÔÈ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË. AÔÙÂÏÔ‡ÓÙËÓ ÔÌ·‰ÔÔ›ËÛË ÔÈÎ›ÏˆÓ ÌÔÚÊÒÓ Û·Î¯·ÚÒ‰Ë ‰È·-‚‹ÙË Ì ۷ʋ Î·È Í¯ˆÚÈÛÙ‹ ·ÈÙÈÔÏÔÁ›·. AÊÔÚÔ‡Ó۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ô˘ ÔÊ›ÏÂÙ·È Û ÁÂÓÂÙÈΤ˜ ‰È·-Ù·Ú·¯¤˜ ÙÔ˘ ÌÔÚ›Ô˘ Ù˘ ÈÓÛÔ˘Ï›Ó˘ ‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ (¯ÚˆÌ·ÙÔÛˆÌÈΤ˜,ÂÓ‰ÔÎÚÈÓÔ¿ıÂȘ, ·ı‹ÛÂȘ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, ÁÂÓÂÙÈ-ο Û‡Ó‰ÚÔÌ· Î.¿.).
‰. ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù˘ ·ËÛ˘. O Ù‡Ô˜ ÙÔ˘ ‰È·-‚‹ÙË Î‡ËÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Á˘Ó·›Î˜ Ô˘ ·Ó·Ù‡Û-ÛÔ˘Ó Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1 ηٿ ÙË ‰È¿ÚÎÂÈ·Ù˘ ·ËÛ˘.
¢IA°Nø™TIKE™ ME£O¢OI
°È· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ¤¯Ô˘Ó ¯ÚËÛÈ-ÌÔÔÈËı› ÔÈΛϘ ̤ıÔ‰ÔÈ Î·È ¤¯Ô˘Ó ıÂÛÈÛÙ› ηٿηÈÚÔ‡˜ ‰È¿ÊÔÚ· ÎÚÈÙ‹ÚÈ·. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÁÏ˘-Îfi˙˘ ÙÔ˘ ·›Ì·ÙÔ˜ (ÓËÛÙ›·˜ ‹ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋˜) ·ÔÙÂ-Ï› ÙËÓ Î‡ÚÈ· ̤ıÔ‰Ô ‰È¿ÁÓˆÛ˘ ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹-ÙË. T· Ó¤· fï˜ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·, ¤¯Ô˘Ó ϤÔÓ ·-ÏÔÔÈËı›7, 9-11. ™˘ÁÎÂÎÚÈ̤ӷ, Û‡Ìʈӷ Ì ٷ Ó¤· ÎÚÈ-Ù‹ÚÈ· Ù˘ ADA, Ô˘ ıÂÛ›ÛÙËÎ·Ó ÙÔ 1997, Ë ‰È¿ÁÓˆÛË‚·Û›˙ÂÙ·È ÛÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È Û˘ÁÎÂÎÚÈ̤ӷ:1. ™ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÎÏ·ÛÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰È·‚‹ÙË,
‰ËÏ. Ù˘ ÔÏ˘Ô˘Ú›·˜, ÔÏ˘‰È„›·˜ ‹ Ù˘ ·ÓÂÍ‹ÁËÙ˘·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ Î·È ÂÈϤÔÓ ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË Ù˘-¯·›· ·Ó‡ÚÂÛË ÌÈ·˜ ÙÈÌ‹˜ ÁÏ˘Îfi˙˘ Ï¿ÛÌ·ÙÔ˜ (·ÓÂ-Í¿ÚÙËÙ· ·fi ÙËÓ ÒÚ· ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ Á‡̷ÙÔ˜)ÌÂÁ·Ï‡ÙÂÚ˘ ‹ ›Û˘ ÙˆÓ 200 mg%.
2. EÈϤÔÓ, Ë ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Ù›ıÂÙ·È Â›Û˘ ÌÂÙËÓ ·Ó‡ÚÂÛË ÁÏ˘Îfi˙˘ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜ ≥ 126mg% (ÓËÛÙ›· ÙÔ˘Ï¿¯ÈÛÙˆÓ 8 ˆÚÒÓ).
3. EÓ·ÏÏ·ÎÙÈÎfi ÎÚÈÙ‹ÚÈÔ Â›Ó·È Ë ·Ó‡ÚÂÛË ÁÏ˘Îfi˙˘ϿÛÌ·ÙÔ˜ ≥ 200 mg% ÌÂÙ¿ ·fi ÙË Ï‹„Ë 75 g ÁÏ˘-Îfi˙˘ (۷ί·Ú·ÈÌÈ΋ η̇ÏË).
ÕÙÔÌ· ÙˆÓ ÔÔ›ˆÓ Ë ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ ·Ó¢ڛÛÎÂÙ·È ˘-„ËÏ‹, fi¯È fï˜ Û ÙÈ̤˜ Ô˘ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ··Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·, ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ¤¯ÔÓÙ· ‰È·Ù·-Ú·Á̤ÓË ‰ÔÎÈÌ·Û›· ·ÓÔ¯‹˜ ÁÏ˘Îfi˙˘ (Impaired GlucoseTolerance, IGT)12 Î·È fi¯È ˆ˜ ¿Û¯ÔÓÙ·.T¤ÏÔ˜, Ô ˘ÔÏÔÁÈÛÌfi˜ Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÙÚȯÔÂȉÈÎÔ‡·›Ì·ÙÔ˜ Î·È Ô Ù·ÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·˘Ù‹˜ ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÂȉÈΤ˜ Û˘Û΢¤˜, ·ÔÙÂ-Ï› ÙÔ ıÂ̤ÏÈÔ Ï›ıÔ ÛÙË Û‡Á¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ‰È·-
86
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 85-91, 2004
85-91 sel. - Elejyueriadis* 3-10-08 12:55 ™ÂÏ›‰· 86
‚‹ÙË. H ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÙÚȯÔÂȉÈÎÔ‡·›Ì·ÙÔ˜ ÂÈÙÚ¤ÂÈ ÙËÓ ÚfiÏË„Ë Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜,ηıÒ˜ Î·È Ù˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ ΢ڛˆ˜ Û ·ÛıÂÓ›˜ Ô˘ıÂڷ‡ÔÓÙ·È Ì ÈÓÛÔ˘Ï›ÓË Î·È Â›Ó·È ˘Ô¯ÚˆÙÈÎfi˜ Û‰ȷ‚ËÙÈΤ˜ ÂÁ·Ԣ˜, Û ·ÛıÂÓ›˜ ̆ fi ÂÓÙ·ÙÈ΋ ıÂڷ›·Ì ÈÓÛÔ˘Ï›ÓË Î·È Û ‰È·‚ËÙÈÎÔ‡˜ ÌÂ Û˘¯Ó¿ ˘ÔÁÏ˘Î·ÈÌÈ-ο ÂÂÈÛfi‰È· 10.
O•EIE™ E¶I¶§OKE™ TH™ NO™OY
H ·ÔÚ‡ıÌÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘ ÂΉËÏÒÓÂÙ·È Ì ÙȘ ‰‡Ô ·ÚȘÔÍ›˜ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘, ÙËÓ ̆ ÔÁÏ˘Î·ÈÌ›· Î·È ÙËÓ ̆ -ÂÚÁÏ˘Î·ÈÌ›·. H ‰È·‚ËÙÈ΋ ˘ÔÁÏ˘Î·ÈÌ›· ÂÌÊ·Ó›˙ÂÙ·È fi-Ù·Ó Ë ÙÈÌ‹ ÙÔ˘ ۷ί¿ÚÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜ ¤ÛÂÈ Î¿Ùˆ ·fi Ù·55 mg%. ™ÙËÓ Â›ÁÔ˘Û· ·˘Ù‹ ηٿÛÙ·ÛË Ù· ›‰·Ù˘ ÁÏ˘Îfi˙˘ ÛÙÔ ·›Ì· ÌÂÈÒÓÔÓÙ·È Ù·¯‡Ù·Ù·, Ì ·ÔÙ¤-ÏÂÛÌ· ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Ó· ÛÙÂÚÂ›Ù·È ·ÈÊÓÈ-‰›ˆ˜ ÙËÓ Î‡ÚÈ· ËÁ‹ ÂÓ¤ÚÁ›·˜ ÙÔ˘ Î·È Ì ÙÔÓ ÙÚfiÔ ·˘-Ùfi Ù· Û˘ÌÙÒÌ·Ù· Ó· ÂΉËÏÒÓÔÓÙ·È ¿ÌÂÛ·13, 14. H ˘Ô-ÁÏ˘Î·ÈÌ›· ÚÔηÏÂ›Ù·È Û ‰È·ÁÓˆṲ̂ÓÔ˘˜ Û˘Ó‹ıˆ˜ ‰È·-‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÌÂÙ¿ ·fi ¤ÓÙÔÓÔ stress ‹ ¿ÛÎËÛË ‹ ̆ -¤ÚÌÂÙÚË ̄ ÔÚ‹ÁËÛË ·ÓÙȉȷ‚ËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (ÈÓÛÔ˘Ï›-Ó˘ ‹ ¿ÏÏˆÓ ˘ÔÁÏ˘Î·ÈÌÈÎÒÓ, fiˆ˜ Â›Ó·È ÔÈ ÛÔ˘ÏÊÔÓ˘-ÏÔ˘Ú›Â˜). K·Ù¿ ÙËÓ Ù·¯Â›· ÂͤÏÈÍË Ù˘ ˘ÔÁÏ˘Î·ÈÌÈ΋˜ÎÚ›Û˘ Ô ·ÛıÂÓ‹˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÁÂÓÈ΋ ηÎÔ˘¯›·, ·ÓËÛ˘-¯›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ˘ÁÚfi ‰¤ÚÌ·, Ù·¯˘ÛÊ˘ÁÌ›·, ·›ÛıË-Ì· ›ӷ˜, ÎÂÊ·Ï·ÏÁ›· Î·È ›ÏÈÁÁÔ. E¿Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈ-Ûı› ¿ÌÂÛ·, Ë ÂÈÏÔ΋ ·˘Ù‹ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û Â-ÓÙÔÈṲ̂ÓÔ˘˜ ‹ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜, ·ÒÏÂÈ· Û˘-Ó›‰ËÛ˘ Î·È ÎÒÌ·. H Èı·ÓfiÙÂÚË ·ÈÙ›· ÂΉ‹ÏˆÛ˘ Ù˘ÔÍ›·˜ ·˘Ù‹˜ ÂÈÏÔ΋˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÂÈÚÔ˘ÚÁÈ΋˜Â¤Ì‚·Û˘ Â›Ó·È Ë ·Ì¤ÏÂÈ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Ó· Ï¿‚ÂÈ Ù· η-ıÔÚÈṲ̂ӷ Á‡̷ٿ ÙÔ˘ ÚÈÓ ·fi ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓËÛ˘Ó‰ڛ·, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ¤¯ÂÈ Ï¿‚ÂÈ ÙËÓ Î·ÓÔÓÈ΋ ‰fiÛËÙ˘ ˘ÔÁÏ˘Î·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÙÔ˘13, 15, 16.AÓÙ›ıÂÙ·, Ë ‰È·‚ËÙÈ΋ ˘ÂÚÁÏ˘Î·ÈÌ›· ÔÊ›ÏÂÙ·È Û Ôχ˘„ËϤ˜ ÙÈ̤˜ Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ·›Ì·ÙÔ˜, ηٿÛÙ·ÛË ËÔÔ›· Úԉȷı¤ÙÂÈ Û ·ÒÏÂÈ· ‡‰·ÙÔ˜ Î·È ËÏÂÎÙÚÔÏ˘-ÙÒÓ, ÔͤˆÛË Î·È ˘ÂÚÁÏ˘Î·ÈÌÈÎfi ÎÒÌ·. H ÔÍ›· ˘ÂÚ-ÁÏ˘Î·ÈÌÈ΋ ÎÚ›ÛË ÂÌÊ·Ó›˙ÂÙ·È Û ·ÚÚ‡ıÌÈÛÙÔ˘˜ ‰È·‚ËÙÈ-ÎÔ‡˜ ‹ Û ÌË ‰È·ÁÓˆṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜, ÂÁηı›ÛٷٷȂڷ‰¤ˆ˜ Û ‰È¿ÛÙËÌ· ËÌÂÚÒÓ ‹ ‚‰ÔÌ¿‰ˆÓ Î·È ÁÈ· ÙÔÏfiÁÔ ·˘Ùfi ıˆÚÂ›Ù·È ÏÈÁfiÙÂÚÔ ÂÈΛӉ˘ÓË ÂÈÏÔ΋ ·fiÙËÓ ÔÍ›· ̆ ÔÁÏ˘Î·ÈÌ›·. X·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ù· ÎÏ·ÛÈÎ¿Û˘ÌÙÒÌ·Ù· Ù˘ ÔÏ˘Ô˘Ú›·˜ Î·È ÔÏ˘‰È„›·˜, ˘fiÙ·ÛË,ηٷ‚ÔÏ‹ ‰˘Ó¿ÌˆÓ, Ó·˘Ù›·, ÍËÚÔÛÙÔÌ›· Î·È ÍËÚfiÙËÙ·ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ·fiÓÔÈ· ·ÎÂÙfiÓ˘ Î·È ·Ó·ÓÔ‹ Ù‡Ô˘Kussmaul, ‰ËÏ·‰‹ Ù·¯‡ÓÔÈ· ÔÊÂÈÏfiÌÂÓË ÛÙËÓ ÚÔÛ¿-ıÂÈ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙË ÌÂÙ·‚ÔÏÈ΋ Ô-ͤˆÛË14. H ÔÍ›· ̆ ÔÁÏ˘Î·ÈÌÈ΋ ÎÚ›ÛË ̄ Ú‹˙ÂÈ ¿ÌÂÛ˘ ·ÓÙÈÌÂÙÒÈ-Û˘ ÁÈ· ÙËÓ ÚfiÏË„Ë ÂÁηٿÛÙ·Û˘ ÌfiÓÈÌˆÓ ÂÁÎÂÊ·ÏÈ-ÎÒÓ ‚Ï·‚ÒÓ. XÔÚËÁÂ›Ù·È ˙¿¯·ÚË ‹ ۷ί·ÚÔ‡¯Ô˜ ¯˘Ìfi˜,ÂÓÒ Û ÂÚ›ÙˆÛË ·ÒÏÂÈ·˜ Û˘ÓÂȉ‹Ûˆ˜ ¯ÔÚËÁÂ›Ù·È 1mg ÁÏ˘ÎÔÁfiÓÔ ÂÓ‰Ô̸ÈÎÒ˜ ‹ ÂÓ·ÏÏ·ÎÙÈο 50-70 ml ˘-ÎÓÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ‰ÂÍÙÚfi˙˘ (20-50%) ÂÓ‰ÔÊÏ‚›ˆ˜. H ·ÓÙÈÌÂÙÒÈÛË ÁÂÓÈÎÒ˜ ÙÔ˘ ˘ÂÚÁÏ˘Î·ÈÌÈÎÔ‡ ÎÒÌ·ÙÔ˜Â›Ó·È ¤ÚÁÔ ÙÔ˘ ıÂÚ¿ÔÓÙ· ‰È·‚ËÙÔÏfiÁÔ˘ Ô˘ ı· ÂÍÂÙ¿-
ÛÂÈ Î·È ı· Ú˘ıÌ›ÛÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ·ÛıÂÓÔ‡˜. ™Â Ô-Í›˜ ‚¤‚·È· ÂÚÈÙÒÛÂȘ ˆ˜ ¿ÌÂÛË ·ÚÔ¯‹ ‚Ô‹ıÂÈ·˜ÌÔÚ› Ó· ¯ÔÚËÁËı› ·. 5-10 ÌÔÓ¿‰Â˜ ÈÓÛÔ˘Ï›Ó˘ Ù·¯Â›-·˜ ‰Ú¿Ûˆ˜ ÂÓ‰ÔÊÏ‚›ˆ˜ ‹ ÂÓ‰ÔÌ˘˚ÎÒ˜, ‚. Ê˘ÛÈÔÏÔÁÈ-Îfi˜ ÔÚfi˜ (ÈÛfiÙÔÓÔ ‰È¿Ï˘Ì· NaCl 0.9%) ÂÓ‰ÔÊÏ‚›ˆ˜ ηÈÁ. Ô͢ÁfiÓÔ. H ‰È¿ÎÚÈÛË ˆÛÙfiÛÔ ÙˆÓ ‰‡Ô ÂȉÒÓ ÙÔ˘ ‰È·‚ËÙÈÎÔ‡ ÎÒ-Ì·ÙÔ˜ Â›Ó·È ‰‡ÛÎÔÏË ·fi ÙÔÓ ÌË ÂȉÈÎfi. H ¯ÚËÛÈÌÔÔ›Ë-ÛË ÙˆÓ ÂȉÈÎÒÓ Û˘Û΢ÒÓ Ì¤ÙÚËÛ˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÙÚÈ-¯ÔÂȉÈÎÔ‡ ·›Ì·ÙÔ˜ ·Ó·ÌÊ›‚ÔÏ· ·Ú¤¯ÂÈ ÌÈ· ¿ÌÂÛË ·¿-ÓÙËÛË. ™Â ÂÚ›ÙˆÛË ·ÌÊÈ‚ÔÏ›·˜ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ô ·-ÛıÂÓ›˜ Ó· ·ÓÙÈÌÂÙˆÈÛı› ˆ˜ ˘ÔÁÏ˘Î·ÈÌÈÎfi˜, ÌÈ·˜ ηÈË ¯ÔÚ‹ÁËÛË ÁÏ˘Îfi˙˘ ı· ‚ÔËı‹ÛÂÈ Î·Ù·Ï˘ÙÈο ÛÙËÓ Â-ÈΛӉ˘ÓË Î·Ù¿ÛÙ·ÛË Ù˘ ˘ÔÁÏ˘Î·ÈÌÈ΋˜ ÎÚ›Û˘, ÂÓÒ‰ÂÓ ı· ÂËÚ¿ÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ‚Ú·‰¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂ-ÓË ˘ÂÚÁÏ˘Î·ÈÌ›·. K·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ Ô ·ÛıÂÓ‹˜ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıËı› ÂÍÂȉÈÎÂ˘Ì¤Ó· Û ‰È·‚Ë-ÙÔÏÔÁÈ΋ ÌÔÓ¿‰· ÁÈ· Û˘ÛÙËÌ·ÙÈ΋ Ú‡ıÌÈÛË ÙÔ˘ Û˘Ó‰Úfi-ÌÔ˘13, 14, 16.
XPONIE™ E¶I¶§OKE™ TH™ NO™OY
OÈ ¯ÚfiÓȘ ÂÈÏÔΤ˜ ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ·fiÚ-ÚÔÈ· Ù˘ ÌÈÎÚÔ- Î·È Ì·ÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·˜ Ô˘ ÚÔηÏÂ›Ë ÓfiÛÔ˜ ηٿ ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÔÚ›· Ù˘, ·ÊÔÚÔ‡Ó ‚·-ÛÈο ÏÂÈÙÔ˘ÚÁÈο fiÚÁ·Ó· Î·È Û˘ÛÙ‹Ì·Ù· ÙÔ˘ ÔÚÁ·ÓÈ-ÛÌÔ‡17-19. AÓ·Ï˘ÙÈÎfiÙÂÚ·, ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·ÂÌÊ·Ó›˙ÂÙ·È ·ıËÚÔÛÎÏ‹Ú˘ÓÛË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ηÈÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ· Ô˘ ÚÔÛ‚¿ÏÏÂÈ Ù· ·ÚÙËÚ›‰È· Î·È Ù·ÙÚȯÔÂȉ‹ ÙˆÓ ÈÛÙÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ·ÛıÂÓ›˜ Ó· ÂÌ-Ê·Ó›˙Ô˘Ó ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, Â-ÁÎÂÊ·ÏÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·È Á¿ÁÁÚ·ÈÓ·˜ ÙˆÓοو ¿ÎÚˆÓ. ™ÙÔ ÓÂÊÚÈÎfi Û‡ÛÙËÌ· ·Ú·ÙËÚÂ›Ù·È ‰È·Êfi-ÚÔ˘ ‚·ıÌÔ‡ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛË Ô˘ ηٷϋÁÂÈ Û¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ÂÓÒ Ë ‰È·‚ËÙÈ΋ ÔÊı·ÏÌÔ-¿ıÂÈ· ÂΉËÏÒÓÂÙ·È ˘fi ÙË ÌÔÚÊ‹ ‰È·‚ËÙÈ΋˜ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉԿıÂÈ·˜ Î·È ‰È·‚ËÙÈÎÔ‡ ηٷÚÚ¿ÎÙË. ¶·Ú¿Ï-ÏËÏ·, ÚÔηÏÂ›Ù·È ÛÔ‚·Ú‹ ·ÈÛıËÙÈ΋ Î·È ÎÈÓËÙÈ΋ Ó¢ÚÔ-¿ıÂÈ· Ô˘ ÂÌÊ·Ó›˙ÂÙ·È È‰È·›ÙÂÚ· ÛÙ· ÂÚÈÊÂÚÈο ÓÂ‡Ú·ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, ÂÓÒ Ë ‰È·‚ËÙÈ΋ ‰ÂÚÌ·ÙÔ¿ıÂÈ· ̄ ·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ÏÔÈÌÒÍÂȘ, ΢ڛˆ˜ Ì˘ÎËÙÈ¿ÛÂȘ Î·È ‰Ô-ıÈ‹Ó˜, ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ‰ÂÚÌ·Ù›Ùȉ˜ Ì ¤ÏÎË ÏfiÁˆÙ˘ ÈÛ¯·ÈÌ›·˜ ‹ Î·È Ù˘ Ó¢ÚÔ¿ıÂÈ·˜ 5, 13, 19, 20.
XEIPOYP°IKE™ E¶I¶§OKE™
I‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÁÂÓÈο Î·È Î·Ù’ Â-¤ÎÙ·ÛË ÁÈ· ÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋¤¯Ô˘Ó Ë ·˘ÍË̤ÓË Â˘¿ıÂÈ· ÛÙȘ ÏÔÈÌÒÍÂȘ Î·È Ë ÏËÌ-ÌÂÏ‹˜ ÂԇψÛË, Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÏfiÁˆ ÙˆÓ ¯ÚÔÓ›ˆÓ Â-ÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘ ÔÈ ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜, Î·È Ô˘ ·-ÔÙÂÏÔ‡Ó Î·Ù·ÛÙ¿ÛÂȘ Ô˘ ‰˘Ó·ÙfiÓ Ó· ÂÈϤÍÔ˘Ó ÙËÓÔÌ·Ï‹ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÙÔ˘˜ ÔÚ›·.
EԇψÛËH ‰˘ÛÌÂÓ‹˜ ›‰Ú·ÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ÛÙËÓ Â-ԇψÛË ÙˆÓ ÙÚ·˘Ì¿ÙˆÓ ¤¯ÂÈ ÌÂÏÂÙËı› ·fi ÙȘ ·Ú¯¤˜ÙÔ˘ ÂÈÎÔÛÙÔ‡ ·ÈÒÓ·, ÙfiÛÔ Û ÂÈÚ·Ì·ÙÈÎfi fiÛÔ Î·È Û ÎÏÈ-ÓÈÎfi ›‰Ô21. H ÂԇψÛË ÙˆÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÙÚ·˘Ì¿-
87
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 85-91, 2004
85-91 sel. - Elejyueriadis* 3-10-08 12:55 ™ÂÏ›‰· 87
ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ‰È·Ù·Ú·Á̤-ÓË Î·È ÌÔÚ› Ó· ·Ú·Ù›ÓÂÙ·È Â› Ì·ÎÚfiÙÂÚÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ˘ÁÈ›˜ ÁÂÓÈο ·ÛıÂÓ›˜5.Afi Ù· Ì·ÎÚÔ¯ÚfiÓÈ· ·ÔÙÂϤÛÌ·Ù· ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÂÂÌ-‚¿ÛÂˆÓ Û ‰È·‚ËÙÈÎÔ‡˜, Ê·›ÓÂÙ·È fiÙÈ Ë ÚÔ‚ÏËÌ·ÙÈ΋‰È·‰Èηۛ· ÂԇψÛ˘ ·Ú·ÙËÚÂ›Ù·È ÙfiÛÔ Û ·ÛıÂÓ›˜Ì ¤ÏÏÂÈ„Ë ÈÓÛÔ˘Ï›Ó˘ fiÛÔ Î·È Û ·ÛıÂÓ›˜ Ì ·ÓÙÔ¯‹ÛÙËÓ ÈÓÛÔ˘Ï›ÓË 22, ÂÓÒ ÁÂÓÈÎÒ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ‰È·Ù·Ú·¯‹Ù˘ ÂԇψÛ˘ Î·È ‰È¿Û·ÛË ÙˆÓ ÙÚ·˘Ì¿ÙˆÓ fiÙ·Ó ÔÈ ÙÈ-Ì‹ Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ·›Ì·ÙÔ˜ ÍÂÂÚÓ¿ Ù· 200 mg/dl 23, 24. YÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ÌË ‰È·ıÂÛÈÌfiÙËÙ· Ù˘ ÁÏ˘Îfi˙˘ ÁÈ··ÂÚfi‚ÈÔ Î·Ù·‚ÔÏÈÛÌfi ÚÔηÏ› ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÈÓÔ-‚Ï·ÛÙÒÓ Î·È Ô‰ËÁ› Û ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘. AÓ¿ÏÔÁ· Ì ÙÔ ‚·ıÌfi Ù˘ ̆ ÂÚÁÏ˘Î·È-Ì›·˜, ¤Ú¢Ó˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÏ¿ÙÙˆÛËÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÙˆÓ ÈÛÙÒÓ, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ÔÊ›ÏÂÙ·ÈÛ ÂÚÈÔÚÈṲ̂ÓË Û‡ÓıÂÛË ‹ Û ·˘ÍË̤ÓË ·Ô‰fiÌËÛË·˘ÙÔ‡. TÔ ÎÔÏÏ·ÁfiÓÔ ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË ÚˆÙ½ÓËÛÙ· ıËÏ·ÛÙÈο, Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ Â›Ó·È Â˘Ú‡Ù·ÙË Î·È ÛÙÔÈ-¯ÂÈÔıÂÙ› ÙÔ Î‡ÚÈÔ ÚˆÙÂ˚ÓÈÎfi Û˘ÛÙ·ÙÈÎfi ÙˆÓ Û˘Ó‰ÂÙÈ-ÎÒÓ ÈÛÙÒÓ. K·Ù¿ Û˘Ó¤ÂÈ·, Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈ-ÛÌÔ‡ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (Ì›ˆÛËÙ˘ Û‡Ó‰ÂÛ˘ ÂÙȉ›ˆÓ ‹ ÙÚÔÔÔÈ‹ÛÂȘ ÛÙÔ Û¯ËÌ·ÙÈ-ÛÌfi ÙÔ˘ ÌÔÚ›Ô˘ ÙÔ˘) ηıÈÛÙ¿ ÂÏ·Ùو̷ÙÈÎÔ‡˜ ÙÔ˘˜ Û˘Ó-‰ÂÙÈÎÔ‡˜ ÈÛÙÔ‡˜, ÁÂÁÔÓfi˜ Ô˘ ·ÓÙ·Ó·ÎÏ¿Ù·È ÛÙË ÊÙˆ¯‹ÂԇψÛË ÙˆÓ Ì·Ïı·ÎÒÓ ÌÔÚ›ˆÓ, ηıÒ˜ Î·È ÙË ÌÂÈÔÓÂ-ÎÙÈ΋ ·Ó¿Ï·ÛË ÙÔ˘ ÔÛÙ›ÙË Î·È ÙÔ˘ ¯fiÓ‰ÚÈÓÔ˘ ÈÛÙÔ‡ÛÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ ̄ ÂÈÚÔ˘ÚÁÈÎÒÓ ÔÛÙÈÎÒÓ ÙÚ·˘Ì¿-ÙˆÓ25.Œ¯ÂÈ ·Ô‰Âȯı› ÂÈÚ·Ì·ÙÈο fiÙÈ Ô Û·Î¯·Ú҉˘ ‰È·‚‹-Ù˘ ÂÈʤÚÂÈ ÛÔ‚·Ú¤˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÂÔ˘ÏˆÙÈ΋ ‰È·-‰Èηۛ· ÙˆÓ ÌÂÙÂÍ·ÎÙÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ. MÂϤÙ˜ Û ›-Ì˘Â˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËΠÛÙÚÂÙÔ˙ÔÙÔΛÓË ÁÈ·ÙËÓ ÂÈÚ·Ì·ÙÈ΋ ÚfiÎÏËÛË ‰È·‚‹ÙË, Ê·ÓÂÚÒÓÔ˘Ó Î·ı˘-ÛÙÂÚË̤ÓË Î·È ÚÔ‚ÏËÌ·ÙÈ΋ ÂԇψÛË Û ÌÂÙÂÍ·ÎÙÈοʷÙÓ›·21, 26. H ‰È·Ù·Ú·¯‹ ·˘Ù‹ Û¯ÂÙ›˙ÂÙ·È Ì ¤ÓÙÔÓË ÊÏÂÁ-ÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÛÙË ı¤ÛË ÙÔ˘ ÌÂÙÂÍ·ÎÙÈÎÔ‡ ÙÚ·‡Ì·-ÙÔ˜ Ì ˘ÎÓ‹, ¯ÚfiÓÈ· Î·È ÂÓÂÚÁ‹ ‰È‹ıËÛË ÙˆÓ ÈÛÙÒÓ ÌÂÔÏ˘ÌÔÚÊÔ‡ÚËÓ· Ï¢ÎÔ·ÙÙ·Ú·. ¶·Ú¿ÏÏËÏ·, ÛÙ·‰È·‚ËÙÈο ÂÈÚ·Ì·Ùfi˙ˆ· Ë ÂÈıËÏÈÔÔ›ËÛË ÙÔ˘ ÌÂÙÂÍ·-ÎÙÈÎÔ‡ Ê·ÙÓ›Ô˘ Â›Ó·È ÏËÌÌÂÏ‹˜ Î·È Û˘ÓÙÂÏÂ›Ù·È ‚Ú·‰‡-ÙÂÚ·, ÂÓÒ Ë ÔÛÙÂÔÎÏ·ÛÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ·ÚÔ˘ÛÈ¿˙Â-Ù·È ·Ú·ÙÂٷ̤ÓË Ì ÂÎÙÂٷ̤ÓË ÔÛÙÈ΋ ·ÔÚÚfiÊËÛËÛÙËÓ ÂÚÈʤÚÂÈ· ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜. K·Ù¿ ÙË Ê˘ÛÈÔÏÔÁÈ΋ÂԇψÛË ÙˆÓ ÌÂÙÂÍ·ÎÙÈÎÒÓ Ê·ÙÓ›ˆÓ ¤Ó· ˘ÎÓfi ‰›ÎÙ˘ÔÎÔÏÏ·ÁfiÓˆÓ ÈÓÒÓ ‰ËÌÈÔ˘ÚÁ› ϤÁÌ· ¿Óˆ ÛÙÔ ÔÔ›ÔÛ¯ËÌ·Ù›˙ÂÙ·È ÓÂfiÏ·ÛÙÔ ÛÔÁÁ҉˜ ÔÛÙÔ‡Ó. OÈ ̆ „ËϤ˜fï˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÁÏ˘Îfi˙˘ ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ· ÌÂÌË ÂÏÂÁ¯fiÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ê·›ÓÂÙ·È Ó· ·Ó·-ÛÙ¤ÏÏÔ˘Ó ÙÔ Û¯ËÌ·ÙÈÛÌfi ÈÓȉ›ˆÓ ÎÔÏÏ·ÁfiÓÔ˘ ·ÏÏ¿ ηÈÙË ‰È·Û‡Ó‰ÂÛË ·˘ÙÒÓ ÚÔ˜ ‰ËÌÈÔ˘ÚÁ›· ϤÁÌ·ÙÔ˜, ¤ÙÛÈÒÛÙ ӷ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ‰È·ÌfiÚʈÛË ÙÔ˘ ÌÔÚÊÔÁÂÓÂ-ÙÈÎÔ‡ ‰ÈÎÙ‡Ô˘ ÎÔÏÏ·ÁfiÓÔ˘, Ó· ηı˘ÛÙÂÚ› Ë ÔÛÙÈ΋ Â-ԇψÛË ÙÔ˘ Ê·ÙÓ›Ô˘ Î·È Ó· ÂÈϤÎÂÙ·È Ë ÌÂÙÂÍ·ÎÙÈ΋ÂԇψÛË.H ÂÍˆÎ˘ÙÙ·ÚÈ΋ ÁÏ˘ÎÔ˙˘Ï›ˆÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙÔ˘˜‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Â›Ó·È Â›Û˘ Èı·Ófi Ó· Û˘Ì‚¿ÏÂÈÛÙË ÌÂÈÔÓÂÎÙÈ΋ ÂԇψÛË. ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ‰Â›-¯ÓÔ˘Ó fiÙÈ Ë ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ÁÏ˘Îfi˙˘
ÙÔ˘ ·›Ì·ÙÔ˜ ÚÔ¿ÁÂÈ ÙË ÌË ÂÓ˙˘Ì·ÙÈ΋ ÂÍˆÎ˘ÙÙ·ÚÈ΋ÁÏ˘ÎÔ˙˘Ï›ˆÛË ÙÔ˘ ÓÂÔÛ¯ËÌ·ÙÈ˙fiÌÂÓÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÛÙ·ÂÁ¯ÂÈÚËÙÈο ÙÚ·‡Ì·Ù· Ì·Ïı·ÎÒÓ Î·È ÛÎÏËÚÒÓ ÈÛÙÒÓ. ToÁÂÁÔÓfi˜ ·˘Ùfi Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ·ÁˆÁ‹ Ù˘ ‰Ú·-ÛÙÈÎfiÙËÙ·˜ Ù˘ ÎÔÏÏ·ÁÂÓ¿Û˘ Ô˘ Ô‰ËÁ› Û ÛËÌ·ÓÙÈ΋Ì›ˆÛË Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÛÙË ı¤ÛË ÂÔ‡-ψÛ˘27, 28.¶·Ú¿ÏÏËÏ·, Ë ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙˆÓ ÈÛÙÒÓÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, Ê·›ÓÂÙ·È Ó· ‰È·‰Ú·Ì·Ù›˙ÂÈÛËÌ·ÓÙÈÎfi ›Û˘ ÚfiÏÔ ÛÙË ‰È·‰Èηۛ· Ù˘ ÂԇψÛ˘5.H ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ· ÚÔηÏ› Û¯ÂÙÈ΋ ̆ ÔÍ›· Î·È ÈÛ¯·È-Ì›· ÛÙÔ˘˜ ÙÚ·˘Ì·ÙÈṲ̂ÓÔ˘˜ ÈÛÙÔ‡˜, ÂÓÒ Ù· ·˘ÍË̤ӷ Â-›Â‰· ÁÏ˘Îfi˙˘ ÂÓÙfi˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Èı·Ófiٷٷ Â-ÌÔ‰›˙Ô˘Ó ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ Î·È ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ÙÔ˘Ô͢ÁfiÓÔ˘ ÛÙË ı¤ÛË ÂԇψÛ˘. ™‡Ìʈӷ Ì ÓÂÒÙÂÚ˜¤Ú¢Ó˜, Ë ·ÁÁÂÈԉȷÛÙÔÏ‹ ÛÙË ÌÈÎÚÔ΢ÎÏÔÊÔÚ›· ‰ÂÓÛ˘Ì‚·›ÓÂÈ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ˆ˜ ·¿ÓÙËÛËÛÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi Î·È ̂ ˜ ̤ÚÔ˜ Ù˘ ·ÓÔÚıˆÙÈ΋˜ ‰È·-‰Èηۛ·˜29. E›Û˘, Ë ‰˘Ó·ÙfiÙËÙ· ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂ-ÓÒÓ ÁÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÓÂfiÏ·ÛÙˆÓ ·ÁÁ›ˆÓ Ê·›ÓÂÙ·È Ó·Â›Ó·È ÂÏ·Ùو̤ÓË, ÏfiÁˆ Ù˘ ¿ÌÂÛ˘ ·Ó·ÛÙ·ÏÙÈ΋˜ ›-‰Ú·Û˘ Ô˘ ·ÛΛ Ë ˘ÂÚÁÏ˘Î·ÈÌ›· ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·-ÛÌfi Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ30. T¤ÏÔ˜, Ë ‰È·ÊÔÚÔÔÈË̤Ó˜ ÙÈ̤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢-ÎÔ΢ÙÙ¿ÚˆÓ Î·È ÛÙËÓ ÔÛfiÙËÙ· ΢ÙÙÔÎÈÓÒÓ fiˆ˜ Ë È-ÓÙÂÚÏ¢ΛÓË-6 ÛÙȘ ı¤ÛÂȘ ÂԇψÛ˘, ÚÔÛı¤ÙÔ˘ÓÛÙÔȯ›· ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ηı˘-ÛÙÂÚË̤Ó˘ ÂԇψÛ˘ ÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË. AÔ-ÙÂϤÛÌ·Ù· ÂÈÚ·Ì·ÙÈÎÒÓ ÂÚ¢ÓÒÓ ÂÌÊ·Ó›˙Ô˘Ó ¤ÓÙÔÓËÌ›ˆÛË ÙˆÓ ‰ÈËıÔ‡ÌÂÓˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÂÓÙfi˜ ÙˆÓÙÚ·˘Ì¿ÙˆÓ Î·È ÂÏ·Ùو̤Ó˜ ÙÈ̤˜ ÈÓÙÂÚÏ¢ΛÓ˘-6 ÛÙÔÌÂÙ·ÙÚ·˘Ì·ÙÈÎfi ÂÍ›‰ÚˆÌ·. OÈ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜, Ï·Ì-‚¿ÓÔ˘Ó ¯ÒÚ· ηٿ ÙË ÌÂٿوÛË Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ Â-Ô˘ÏˆÙÈ΋˜ ‰È·‰Èηۛ·˜ ·fi ÙËÓ ÚÒÈÌË ÛÙËÓ fi„ÈÌË Â-·ÓÔÚıˆÙÈ΋ Ê¿ÛË31.
§ÔÈÌÒÍÂȘH ÂÈÚÚ¤ÂÈ· ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÚÚ‡ıÌÈÛÙÔ Û·Î¯·Ú҉ˉȷ‚‹ÙË Û ‚·ÎÙËÚȷΤ˜ Î·È Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ, ‰Ë-ÌÈÔ˘ÚÁ› ÛÔ‚·Úfi ÚÔ‚ÏËÌ·ÙÈÛÌfi ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ˯ÂÈÚÔ˘ÚÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜.AÓ·Ï˘ÙÈÎfiÙÂÚ·, Ë ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ· Ô˘ ÂΉËÏÒÓÂÙ·ÈÌ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË, ˘·ÏÈÓÔÔ›ËÛË ÙˆÓ ÙÔȯˆÌ¿ÙˆÓÎ·È ¿¯˘ÓÛË Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÙÚȯÔÂȉÒÓ ·È-ÌÔÊfiÚˆÓ ·ÁÁ›ˆÓ, ‰Ú· ˆ˜ ÂÌfi‰ÈÔ ÛÙË ‰È¿¯˘ÛË ÙÔ˘ Ô-͢ÁfiÓÔ˘ ÚÔ˜ ÙÔ˘˜ ÈÛÙÔ‡˜, ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ÚÔ˚-fiÓÙˆÓ ÙÔ˘ ηٷ‚ÔÏÈÛÌÔ‡ Î·È ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË Ï¢ÎÔ-΢ÙÙ¿ÚˆÓ, ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ·-ÓÔÛÔÔÈËÙÈÎÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÊÏÂÁÌÔÓ‹˜. H ˘ÂÚ-ÁÏ˘Î·ÈÌ›· ¢ÓÔ› ÙËÓ ·Ó¿Ù˘ÍË ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, ÂÓÒÂ›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ë ·Ó‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÙÈÌÒÓ ÁÏ˘-Îfi˙˘ ÛÙÔÓ ÔÚÒ‰Ë Û›·ÏÔ Ô˘ ÂÎÎÚ›ÓÂÙ·È ·fi ÙȘ ·ÚˆÙ›-‰Â˜ ηıÒ˜ Î·È ÛÙÔ Ô˘ÏÈÎfi ˘ÁÚfi. ¶·Ú¿ÏÏËÏ·, Ô ¯ËÌÂÈÔ-Ù·ÎÙÈÛÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·-Ù·ÛÙ¤ÏÏÂÙ·È, ÂÓÒ ¿ÏϘ ‰È·Ù·Ú·¯¤˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿-ÚˆÓ, ÏfiÁˆ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÁÏ˘Îfi˙Ë˜Î·È ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ ·›Ì· ÙˆÓ ‰È·‚ËÙÈÎÒÓ, ·ÊÔÚÔ‡Ó ÙËÓÌÂÈÔÓÂÎÙÈ΋ ÚÔÛÎfiÏÏËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ÙËÓÊ·ÁÔ΢ÙÙ¿ÚˆÛË15, 17, 32. I‰È·›ÙÂÚ· ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔ-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 85-91, 2004
85-91 sel. - Elejyueriadis* 3-10-08 12:55 ™ÂÏ›‰· 88
ÛˆÈ΋ ¯ÒÚ·, Ë ÂÎ Ê˘ÛÈÎÔ‡ ÏËÌÌÂÏ‹˜ ·ÈÌ¿ÙˆÛË ÔÚÈ-ÛÌ¤ÓˆÓ ÂÚÈÔ¯ÒÓ (ÁˆÓ›· Î·È ÛÒÌ· Ù˘ οو ÁÓ¿ıÔ˘),ηıÒ˜ Î·È Ë ÌÈÎÚÔ‚ÈÔ‚Ú›ıÂÈ· Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙË-Ù·˜, Û˘ÓÙÂÏÔ‡Ó ÛÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÛÔ-‚·ÚÒÓ ÏÔÈÌÒ͈Ó, ›Ù ˆ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÂÈÏÔ΋, ›-Ù ˆ˜ ¤ÎÙ·ÛË ÚÔ¸¿Ú¯Ô˘Û·˜ Ô‰ÔÓÙÔÁÂÓÔ‡˜ ‹ ¿Ï-Ï˘ ÊÏÂÁÌÔÓ‹˜15. ¶·ÚfiÏÔ fiÙÈ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÔÍ›˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒ-ÍÂȘ ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋ ÂÚÈÔ¯‹ ·Ô‰Ú¿-ÌÔ˘Ó Û˘Ó‹ıˆ˜ ÁÚ‹ÁÔÚ· ÌÂÙ¿ ·fi ÙËÓ ÂӉ‰ÂÈÁ̤ÓË ·-ÓÙÈÌÂÙÒÈÛË (Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Û¯¿ÛË Î·È ·ÚÔ¯¤-Ù¢ÛË) ÛÙ· ˘ÁÈ‹ ηٿ Ù’ ¿ÏÏ· ¿ÙÔÌ·, ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜·ÛıÂÓ›˜ οı Ïԛ̈ÍË Ô‰ÔÓÙÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ ›ӷȉ˘Ó·Ùfi Ó· ÂΉËψı› Ì ÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ·, Ó· ›ӷÈÂÚÈÛÛfiÙÂÚÔ Â›ÌÔÓË, Î·È ÂÍ·ÏÔ‡ÌÂÓË ÛÙÔ˘˜ ÁÂÈÙÔÓÈ-ÎÔ‡˜ ·Ó·ÙÔÌÈÎÔ‡˜ ¯ÒÚÔ˘˜ Î·È ‰È·ÛÙ‹Ì·Ù· Ó· ÚÔηϤ-ÛÂÈ ÛÔ‚·Úfiٷ٘ ÂÈÏÔΤ˜ (§Ô˘‰Ô‚›ÎÂÈ· Î˘Ó¿Á¯Ë, ÙÚ·-¯ËÏÈο, ÌÂÛÔÓ¢ÌfiÓÈ· ‹ ÂÁÎÂÊ·ÏÈο ·ÔÛÙ‹Ì·Ù·), Ì¢„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÛÈÌfiÙËÙ·˜ 33, 34.OÈ ·ÛıÂÓ›˜ Ì ·ÚÚ‡ıÌÈÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Â›Ó·È Â-›Û˘ ¢·ı›˜ ÛÙËÓ ·Ó·Ù‡ÍË ÛÔ‚·ÚÒÓ Â˘Î·ÈÚÈ·ÎÒÓÌ˘ÎËÙÈ¿ÛˆÓ. EÎÙfi˜ Ù˘ Candida Albicans, ÛÙË ÛÙÔÌ·ÙÈ-΋ ÎÔÈÏfiÙËÙ· ÙˆÓ ‰È·‚ËÙÈÎÒÓ Û˘¯Ó¿ ‚Ú›ÛÎÔ˘Ó ÚfiÛÊÔ-ÚÔ ¤‰·ÊÔ˜ Ó· ·Ó·Ù˘¯ıÔ‡Ó Û·ÚÔÊ˘ÙÈÎÔ› ̇ÎËÙ˜ ˘-‡ı˘ÓÔÈ ÁÈ· ÙËÓ ÚfiÎÏËÛË ‰È·ÊfiÚˆÓ Ù‡ˆÓ Ì˘ÎËÙÈ¿ÛÂ-ˆÓ (·ÛÂÚÁ›ÏψÛË, ÌÔ˘ÎÔÚ̇ΈÛË Î.¿.). OÔÈ·‰‹ÔÙ¤̂·ÛË ÛÙ· Ï·›ÛÈ· Ù˘ ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋˜¯ÂÈÚÔ˘ÚÁÈ΋˜ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, Â›Ó·È ‰˘Ó·-ÙfiÓ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ‡ÏË ÂÈÛfi‰Ô˘ ÁÈ· ÙÔ˘˜ ̇ÎËÙ˜ ·˘-ÙÔ‡˜, ·fi ÙÔ ÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ ÂÓÙfi˜ Ù˘ ÁÓ·ıÔ-ÚÔÛˆÈ΋˜ ÂÚÈÔ¯‹˜. OÈ ‚Ï¿‚˜ ·˘Ù¤˜ Î·È Î˘Ú›ˆ˜ Ë ÚÈ-ÓÔÂÁÎÂÊ·ÏÈ΋ ÌÔ˘ÎÔÚ̇ΈÛË ÂÂÎÙ›ÓÔÓÙ·È Û˘Ó‹ıˆ˜Î·Ù¿ Û˘Ó¤¯ÂÈ· ÈÛÙÒÓ ‹ ‰È· Ù˘ ·ÈÌ·ÙÈ΋˜ Ô‰Ô‡ Î·È ÚÔ-Û‚¿ÏÔ˘Ó Ù· ÔÛÙ¿ ÙˆÓ ÁÓ¿ıˆÓ, ÙÔ˘˜ ÁÓ·ıÈ·›Ô˘˜ ÎfiÏ-Ô˘˜, ÙȘ ÚÈÓÈΤ˜ ÎÔÈÏfiÙËÙ˜, ÙÔ˘˜ ÔÊı·ÏÌÈÎÔ‡˜ ÎfiÁ-¯Ô˘˜ Î·È ÙË ‚¿ÛË ÙÔ˘ ÎÚ·Ó›Ô˘, ÚÔηÏÒÓÙ·˜ ÂÎÙÂٷ̤-Ó˜ ÓÂÎÚÒÛÂȘ ÙˆÓ ÔÛÙÒÓ Î·È ÙˆÓ Ì·Ïı·ÎÒÓ ÌÔÚ›ˆÓ. T¤-ÏÔ˜, ÂͿψÛË Ù˘ Ïԛ̈͢ ÂÓ‰ÔÎÚ·Óȷο Î·È ÛÙÔ ÛË-Ú·ÁÁÒ‰Ë ÎfiÏÔ ÂÁ΢ÌÔÓ› ÛÔ‚·ÚfiÙ·ÙÔ Î›Ó‰˘ÓÔ ÁÈ· ÙË˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜3, 32, 35, 36.
™YZHTH™H
H ÂÎÙ›ÌËÛË Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ‰È·‚ËÙÈÎÔ‡Ú¤ÂÈ Ó· ‚·Û›˙ÂÙ·È ÛÙË Ï‹„Ë ÂÓfi˜ ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔÚÈ-ÎÔ‡, ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÚÔ‡Û·˜ ηٿÛÙ·Û˘, ÛÙËÓÂÎÙ›ÌËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Î·È ÛÙȘ ·Ó·Áη›Â˜ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, ¿ÓÙÔÙ ÚÈÓ ÙËÓ ÔÔÈ·‰‹Ô-Ù ¯ÂÈÚÔ˘ÚÁÈ΋ Ú¿ÍË ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ΋¯ÒÚ·10. O ÂÓÙÔÈÛÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ÌË ‰È·ÁÓˆṲ̂ÓÔ ‰È·‚‹ÙËÂ›Ó·È Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ô ÎÏÈÓÈÎfi˜Ú¤ÂÈ Ó· Û˘ÏϤÁÂÈ ÏÂÙÔÌÂÚ¤˜ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Ì ·˘-ÍË̤ÓÔ ‰Â›ÎÙË ˘Ô„›·˜, ΢ڛˆ˜ Û ¿ÙÔÌ· Ì ÎÏËÚÔÓÔÌÈ-Îfi ÈÛÙÔÚÈÎfi Ù˘ ÓfiÛÔ˘, Û ·¯‡Û·Úη ¿ÙÔÌ· ¿Óˆ ÙˆÓ 40ÂÙÒÓ, ¿ÙÔÌ· Ì ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÙÔÓÂÊÚÈÎfi ‹ ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· Î·È Û Á˘Ó·›ÎÂ˜Ô˘ Á¤ÓÓËÛ·Ó ˘¤Ú‚·Ú· ‚Ú¤ÊË Ì ÌË Ê˘ÛÈÔÏÔÁÈÎfi ÙÔ-ÎÂÙfi37. AϤ˜ ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο ÌÂ Û˘ÌÙÒÌ·Ù· ÔÏ˘-
‰È„›·˜, ÔÏ˘Ô˘Ú›·˜ Î·È ÔÏ˘Ê·Á›·˜, ÚÔ‚ÏËÌ¿ÙˆÓ Â-ԇψÛ˘, ÌÔχÓÛÂˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÙË Ì¤ÙÚËÛË ÙÔ˘ ÛÙÈÁÌÈ·›Ô˘ ۷ί¿ÚÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜ Ì ÙË‚Ô‹ıÂÈ· ÊÔÚËÙÔ‡ ÁÏ˘ÎÔ̤ÙÚÔ˘, Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ôη-χ„Ô˘Ó Úfi‚ÏËÌ· ·‰È¿ÁÓˆÛÙÔ˘ ‰È·‚‹ÙË. K¿ı Â›ÁÔ˘Û· ¤̂·ÛË ÛÙË ÛÙÔÌ·ÙÔÁÓ·ıÔÚÔÛˆÈ-΋ ÂÚÈÔ¯‹, fiˆ˜ .¯. Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ‰È¿ÓÔÈÍË ÂÓfi˜ ·Ô-ÛÙ‹Ì·ÙÔ˜, ÌÔÚ› Î·È Ú¤ÂÈ Ó· Á›ÓÂÈ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ‡„Ô˜ ÙÔ˘ ۷ί¿ÚÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜, ¿ÓÙÔÙ fï˜ ˘fi ÙËÓÎ¿Ï˘„Ë ÈÛ¯˘Ú‹˜ ·ÓÙÈ‚›ˆÛ˘ (·ÌÔ͢ÎÈÏÏ›ÓË ÛÂ Û˘Ó‰˘·-ÛÌfi Ì ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇ ‹ ÓÈÙÚÔ˚Ì˘‰·˙fiÏË, ‹ ÂÓ·ÏÏ·ÎÙÈ-ο ÎÏÈÓÙ·Ì˘Î›ÓË). H ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË (Û¯¿ÛË) ÙˆÓ ·-ÔÛÙËÌ¿ÙˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜Â›Ó·È ÂȂ‚ÏË̤ÓË, ÁÈ·Ù› Ë ·Ó·‚ÔÏ‹ Ù˘ ¤̂·Û˘ Î·È Ë·Ú·ÌÔÓ‹ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÌÔÚ› Ó· ·ÔÚ˘ıÌ›ÛÂÈ ÂÚ·È-Ù¤Úˆ ÙÔ ÓfiÛËÌ·, ÂÓÒ ·Ú¿ÏÏËÏ· Ì ÙËÓ ÂÓ¤ÚÁÂÈ· ·˘Ù‹ÚÔÏ·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú‹ ¤ÎÙ·ÛË Ù˘ Ïԛ̈͢15, 37.AÓÙ›ıÂÙ·, ÛÙȘ ÂÚÈÙÒÛÂȘ ÔÈ Ôԛ˜ ‰ÂÓ ÎÚ›ÓÔÓÙ·È Â›-ÁÔ˘Û˜, fiˆ˜ Â›Ó·È ÔÈ ·Ï¤˜ ‹ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÍ·ÁˆÁ¤˜,Ë Â΢ڋÓÈÛË Î‡ÛÙˆÓ, ÔÈ ÂÂÌ‚¿ÛÂȘ ÚÔÚÔÛıÂÙÈ΋˜¯ÂÈÚÔ˘ÚÁÈ΋˜, Ë ·Ê·›ÚÂÛË ÔÁΈÙÈÎÒÓ ÂÍÂÚÁ·ÛÈÒÓ ÎÙÏ,Â›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÔÓÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ÛˆÛÙ‹ Ú‡ı-ÌÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. H ‡·ÚÍË Î·È Ë ‰È·Ù‹ÚË-ÛË Â˘ÁÏ˘Î·ÈÌ›·˜ ı· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙË ÁÚ‹ÁÔÚË Î·È ·Ó›-ÏÂÎÙË ÂԇψÛË ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜, ÂÓÒ ı·ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ Ïԛ̈-͢. OÈ ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ú˘ıÌ›˙ÂÙ·È ·ÔÙÂÏÂ-ÛÌ·ÙÈο ÙÔ ÓfiÛËÌ· Î·È Ë ÙÈÌ‹ ÙÔ˘ ۷ί¿ÚÔ˘ ÛÙÔ ·›Ì·‚Ú›ÛÎÂÙ·È ÛÂ Ê˘ÛÈÔÏÔÁÈο fiÚÈ·, Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙Ô-ÓÙ·È fiˆ˜ ÔÈ ˘ÁÈ›˜ ηٿ Ù’ ¿ÏÏ· ·ÛıÂÓ›˜ Î·È Ë ÚÔÊ˘-Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ıˆÚÂ›Ù·È ÂÚÈÙÙ‹. EÂȉ‹ οı ̄ ÂÈÚÔ˘ÚÁÈ΋ Ú¿ÍË ÚÔηÏ› ÙËÓ ·˘ÍË̤ÓË·Ú·ÁˆÁ‹ ÔÚÌÔÓÒÓ ÚÔÛ·ÚÌÔÁ‹˜ ÛÙÔ stress, fiˆ˜ ›-Ó·È ÔÈ Î·Ù¯ÔϷ̛Ә, Ë ÎÔÚÙÈ˙fiÏË, Ë ·˘ÍËÙÈ΋ ÔÚÌfiÓËÎ·È Ë ÁÏ˘Î·ÁfiÓË, Ô˘ ·˘Í¿ÓÔ˘Ó Ù· ›‰· Ù˘ ÁÏ˘Îfi-˙˘ ÛÙÔ ·›Ì· Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›-˙ÔÓÙ·È Ì ȉȷ›ÙÂÚË ÚÔÛÔ¯‹. H ηٿÏÏËÏË ·Á¯ÔÏ˘ÙÈ΋·ÁˆÁ‹, Ë Ì¤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ë ÛˆÛÙ‹Î·È Û ‚¿ıÔ˜ ·Ó·ÈÛıËÛ›· ı· ÌÂÈÒÛÔ˘Ó ÙÔ stress ÙÔ˘ ‰È·-‚ËÙÈÎÔ‡ ·ÛıÂÓ‹, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÚÔ-‚Ï‹Ì·Ù· ·fi ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· ‹ Ó· ·ÔÚ˘ı-Ì›ÛÂÈ ÙÔ ÓfiÛËÌ·. ¶·Ú¿ÏÏËÏ·, Ë ·˘ÛÙËÚ‹ Ù‹ÚËÛË ÙˆÓ ‚·ÛÈÎÒÓ ·Ú¯ÒÓ Ù˘¯ÂÈÚÔ˘ÚÁÈ΋˜, fiˆ˜ Ë Û¯ÔÏ·ÛÙÈ΋ ·ÛË„›· Î·È ·ÈÌfiÛÙ·-ÛË Î·È Î˘Ú›ˆ˜ Ô Û‚·ÛÌfi˜ ÙˆÓ Ì·Ïı·ÎÒÓ Î·È ÛÎÏËÚÒÓ È-ÛÙÒÓ Î·Ù¿ ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÂÁ¯ÂÈÚËÙÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜,ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹ ‰È¿ÚÎÂÈ· Ù˘ Â-¤Ì‚·Û˘, ı· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÙȘ Û˘Óı‹Î˜ ÁÈ· ÔÌ·Ï‹ÂԇψÛË, ÌÂÈÒÓÔÓÙ·˜ ÙÔÓ Î›Ó‰˘ÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÏÔ›-̈͢ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜10, 15, 37.°È· ÙËÓ ÚfiÏË„Ë ÔÍ›·˜ ˘ÔÁÏ˘Î·ÈÌÈ΋˜ ÎÚ›Û˘, ÔÔÈ·-‰‹ÔÙ ÁÓ·ıÔ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Û ηϿ Ú˘ıÌÈṲ̂-ÓÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ú¤ÂÈ Ó· ÚÔÁÚ·ÌÌ·Ù›˙ÂÙ·È ÌÂÙ¿ ·fiÁ‡̷ Î·È ·ÊÔ‡ Ô ·ÛıÂÓ‹˜ Ï¿‚ÂÈ ÙË Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹ ÙÔ˘, ÂÊfiÛÔÓ ‰ÂÓ Ú˘ıÌ›˙ÂÙ·È ÌfiÓÔ Ì ‰›·ÈÙ·. T¤ÏÔ˜, ËÂÍ·ÛÊ¿ÏÈÛË ÛˆÛÙ‹˜ ÂÓ˘‰¿ÙˆÛ˘ Î·È ıÚ¤„˘ ηٿ ÙËÓ¿ÌÂÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÂÚ›Ô‰Ô ı· ‰È·ÛÊ·Ï›ÛÔ˘Ó ÙËÓ Â‡-ıÚ·˘ÛÙË ÌÂÙ·‚ÔÏÈ΋ ÈÛÔÚÚÔ›· ÙÔ˘ ‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓ‹.
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 85-91, 2004
85-91 sel. - Elejyueriadis* 3-10-08 12:55 ™ÂÏ›‰· 89
SUMMARY
"Management of the oral and maxillofacialsurgical patient with diabetes mellitus"E. Eleftheriadis, M. Leventis, E. Giannoulaki,
C. Papadimas
hellenic stomatological review 48: 85-91, 2004
Diabetes mellitus is a complex syndrome of disorderedmetabolism and elevated blood glucose. Although theexact etiology of the disease is still unclear, hereditaryand environmental factors seem to play an important rolein all types of diabetes mellitus. The contemporary clinicians are frequently required totreat patients with type 1, type 2 or other form of diabetesmellitus. Most of these patients are well controlled, butothers may be poorly controlled when they seek surgicaltreatment. Diabetes mellitus is responsible for numeroussystematic complications, impedes wound healing andimpairs the immunological response to bacterial or fungalinfections. Therefore, the acute and chronic complica-tions of the disease, may increase the morbidity and mo-rtality in diabetics undergoing oral and maxillofacialsurgery, necessitating careful assessment and manage-ment of each diabetic patient. Acute surgical procedures in the oral and maxillofacialregion must be performed regardless of the plasmaglucose levels, strictly under antibiotic prophylaxis. On theother hand, routine surgical procedures should bepostponed until diabetes mellitus is efficiently managed.The preoperative management of the diabetic patient andthe establishment of a state of euglycemia, will ensure theuncomplicated healing of the surgical trauma. Well-control-led patients generally require no specific managementconsiderations and antibiotic prophylaxis is not necessary.The purpose of this study is to present the latest data onthe pathophysiology and clinical manifestations of thedisease, the diagnostic and treatment modalities and theoverall peri-operative management of the diabetic oraland maxillofacial surgical patient.
Key words: Diabetes mellitus, oral and maxillofacial surgery.
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K·Ù¿ ÙËÓ ¿Ô„Ë ÙˆÓ Û˘ÁÁڷʤˆÓ Ô fiÚÔ˜ «¯ÚfiÓÈ· ÂÓÙÔ-ÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·» ÂÚÈÁÚ¿ÊÂÈ Ì ÌÂ-Á·Ï‡ÙÂÚË ·ÎÚ›‚ÂÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹ Î·È ÁÈ' ·˘Ùfi ı·˘ÈÔıÂÙËı› ηıfiÏË ÙËÓ ¤ÎÙ·ÛË ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜. H·ÈÙÈÔÏfiÁËÛË ·˘Ù‹˜ Ù˘ ÂÈÏÔÁ‹˜ ı· ·ÎÔÏÔ˘ı‹ÛÂÈ ·Ú·-οو.™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ›ӷÈ, Ì ÙËÓ ·ÚÔ˘-Û›·ÛË 8 ÂÚÈÙÒÛÂˆÓ Ô˘ Û˘ÁÎÂÓÙÚÒıËÎ·Ó Ì¤Û· ·fiÙËÓ ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ÙˆÓ Û˘ÁÁڷʤˆÓ, Î·È ÙËÓ ·Ó·ÛÎfi-ËÛË Ù˘ ÚÔÛÈÙ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓÏËÚ¤ÛÙÂÚË Î·È Û·Ê¤ÛÙÂÚË ÂÓË̤ڈÛË ÙÔ˘ ÁÂÓÈÎÔ‡ Ô-‰ÔÓÙÈ¿ÙÚÔ˘ Á‡Úˆ ·fi ÙËÓ ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘-ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·, ÙËÓ ÎÏÈÓÈ΋ Î·È ·ÎÙÈÓÔÁÚ·ÊÈ΋ Ù˘ÂÈÎfiÓ·, ÙËÓ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ·ÚfiÌÔȘ ·ÏÏÔÈÒ-ÛÂȘ, ÙËÓ ıÂڷ›· Î·È ÙËÓ ÚfiÁÓˆÛ‹ Ù˘.
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K·Ù¿ ÙÔ ‰È¿ÛÙËÌ· 1988-2003 ÂÍÂÙ¿Û·Ì 7 ·ÛıÂÓ›˜ ÌÂÛÎÏËÚ˘ÓÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙËÓ ÂÚÈ·ÎÚÔÚÚÈ˙È΋ ÂÚÈÔ-¯‹ ÂÓfi˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi Ù· ‰fiÓÙÈ· ÙÔ˘ ÊÚ·ÁÌÔ‡ ÙÔ˘˜.Afi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, ¤Ó·˜ ÚÔÛ‹Ïı ÛÙÔ È·ÙÚ›ÔÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ ™ÙÔÌ·ÙÈ΋˜ & °Ó·ıÔÚÔÛˆÈ΋˜ XÂÈ-ÚÔ˘ÚÁÈ΋˜, ¤Ó·˜ ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ EÓ‰Ô‰Ô-ÓÙÔÏÔÁ›·˜, Ù¤ÛÛÂÚȘ ‹Ù·Ó ȉȈÙÈÎÔ› ·ÛıÂÓ›˜ Î·È ¤Ó·˜ Â-ÍÂÙ¿ÛÙËΠ۠ȷÙÚÂ›Ô MÔÓ‹˜ ÙÔ˘ AÁ›Ô˘ ŸÚÔ˘˜. O ¤Ó·˜·fi ÙÔ˘˜ ·Ú·¿Óˆ ·ÛıÂÓ›˜ ¤ÊÂÚ ‰‡Ô ÛÎÏËÚ˘ÓÙÈΤ˜·ÏÏÔÈÒÛÂȘ.EÍ ·˘ÙÒÓ, ÔÈ 2 ‹Ù·Ó ¿Ó‰Ú˜ Î·È ÔÈ 5 Á˘Ó·›Î˜. H ËÏÈΛ·ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 20-42 ¤ÙË, Ì ̤ÛË ËÏÈΛ·Ù· 31 ¤ÙË. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Û·Ó ‰fiÓÙÈ· Ù˘οو ÁÓ¿ıÔ˘. Afi Ù· 8 ‰fiÓÙÈ· Ì ÛÎÏËÚ˘ÓÙÈ΋ ‚Ï¿‚Ë, Ù·7 ‹Ù·Ó ÁÔÌÊ›ÔÈ, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ 5 ‹Ù·Ó ÚÒÙÔÈ ÁÔÌÊ›ÔÈ,ÂÓÒ ¤Ó· ‹Ù·Ó ÚÔÁfiÌÊÈÔ˜ (¶ÈÓ. 1).
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Û˘Ìو̷ÙÔÏÔÁ›·, 4 ‰fiÓÙÈ· ‹Ù·Ó ·Û˘-Ìو̷ÙÈο, fiÔ˘ Î·È Ë ·Ó·Î¿Ï˘„Ë ÙˆÓ ‚Ï·‚ÒÓ ¤ÁÈÓÂÌÂÙ¿ ·fi ·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ¿ÏÏË ·ÈÙ›·. Afi Ù·˘fiÏÔÈ· ‰fiÓÙÈ·, Ù· 3 ›¯·Ó ÈÛÙÔÚÈÎfi ‹ÈÔ˘ fiÓÔ˘ ΢-Ú›ˆ˜ ηٿ ÙËÓ Ì¿ÛËÛË Î·È 1 ·ÚÔ˘Û›·˙ ¤ÓÙÔÓ· Û˘-ÌÙÒÌ·Ù· (¤ÓÙÔÓÔ fiÓÔ Ô˘ ‰ÂÓ ˘Ô¯ˆÚÔ‡Û Ì ٷ Û˘-Ó‹ıË ·Ó·ÏÁËÙÈο, Ô›‰ËÌ· Ù˘ ÂÚÈÔ¯‹˜). ™Â η̛· ·fiÙȘ ÂÚÈÙÒÛÂȘ ‰ÂÓ ÂÓÙÔ›ÛÙËΠÂÌÊ·Ó‹˜ ‰ÈfiÁΈÛË ÙÔ˘ÔÛÙÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ·ÏÏÔÈÒÛˆÓ.OÈ ‰ÔÎÈ̷ۛ˜ ̇ ˆÙÈÎfiÙËÙ·˜ ÙÔ˘ ÔÏÊÔ‡ ·ÔÎ¿Ï˘„·Ó Ó¤-ÎÚˆÛË ÙÔ˘ ÔÏÊÔ‡ Û 2 ÂÚÈÙÒÛÂȘ, ¯ÚfiÓÈ· ÔÏÊÈ΋
94
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
¶›Ó·Î·˜ 1: H Û‡ÓıÂÛË ÙÔ˘ ̆ ÏÈÎÔ‡. ŒÓ·˜ ·ÛıÂÓ‹˜ ¤ÊÂÚ ‰‡Ô ÛÎÏË-Ú˘ÓÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ
ÕÓ‰Ú˜ °˘Ó·›Î˜ ™‡ÓÔÏÔHÏÈΛ·≤ 25 ¤ÙË - 2 226-35 ¤ÙË 1 2 3≥ 36 ¤ÙË 1 1 2™‡ÓÔÏÔ 2 5 7¢fiÓÙÈ·1ÔÈ ÁÔÌÊ›ÔÈ 1 4 52ÔÈ ÁÔÌÊ›ÔÈ 2 - 22ÔÈ ÚÔÁfiÌÊÈÔÈ - 1 1™‡ÓÔÏÔ 3 5 8
EÈÎ. 1: ¶ÂÚ›ÙˆÛË 1: A. O 46 ¤ÊÂÚ ·Ï·È¿ ¤ÌÊÚ·ÍË ·fi Û‡ÓıÂ-ÙË ÚËÙ›ÓË. B. H ÛÎÏËÚ˘ÓÙÈ΋ ·ÏÏÔ›ˆÛË ·Ó·Î·Ï‡ÊıËΠÛÂ Ù˘¯·›Ô·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. H ·ÛıÂÓ‹˜ ‰ÂÓ ‰¤¯ıËΠӷ ̆ Ô‚ÏËı› ÛÂÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·.
EÈÎ. 2: ¶ÂÚ›ÙˆÛË 2:™ÎÏËÚ˘ÓÙÈ΋ ·ÏÏÔ›-ˆÛË Á‡Úˆ ·fi ÙÔ ·-ÎÚÔÚÚ›˙ÈÔ Ù˘ ¿ˆÚ›˙·˜ ÙÔ˘ 36. TÂÚË-‰ÔÓÈÛÌfi˜ ˘fi Ù· fi-ÚÈ· Ù˘ ¤ÌÊڷ͢ ¿-ˆ ·˘¯ÂÓÈο.
EÈÎ. 3: ¶ÂÚ›ÙˆÛË 3:H ‰È·‡Á·ÛË ÛÙËÓ ÂÁ-Á‡˜ Ú›˙· ÙÔ˘ 46 ÂÚÈ-‚¿ÏÏÂÙ·È ·fi ÛÎÏË-Ú˘ÓÙÈ΋ ·ÏÏÔ›ˆÛË ÌÂÛ·Ê‹ fiÚÈ·. O ̄ ÒÚÔ˜ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ ‰È·-ÁÚ¿ÊÂÙ·È ÂÌÊ·ÓÒ˜.
EÈÎ. 4: ¶ÂÚ›ÙˆÛË 4:¢È¿¯˘ÙË ÛÎÏ‹Ú˘ÓÛËÙÔ˘ ÔÛÙÔ‡ ÂÚÈ‚¿Ï-ÏÂÈ ·ÎÚÔÚÚÈ˙Èο ηÈÙȘ ‰‡Ô Ú›˙˜ ÙÔ˘ 46.H ‡·ÚÍË ‚·ıÈ¿˜ ÙÂ-ÚˉfiÓ·˜ Î·È Ë ·ÙÂ-Ï‹˜ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂ-ڷ›· Û˘ÓËÁÔÚÔ‡ÓÁÈ· ÙËÓ ÊÏÂÁÌÔÓ‹ Ù˘ÂÚÈ·ÎÚÔÚÚÈ˙È΋˜ÂÚÈÔ¯‹˜.
EÈÎ. 5: ¶ÂÚ›ÙˆÛË 5:AÍÈÔÛËÌ›ˆÙË Â›Ó·È ËÛ˘Ó˘¿Ú¯Ô˘Û· Â͈-ÙÂÚÈ΋ ·ÔÚÚfiÊËÛËÛÙËÓ ¿ˆ Ú›˙· ÙÔ˘ 36(Ó¤ÎÚˆÛË ÙÔ˘ ÔÏ-ÊÔ‡), Ë ÔÔ›· Ê·›ÓÂ-Ù·È fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÌÂÙËÓ ÛÎÏËÚ˘ÓÙÈ΋ ·Ï-ÏÔ›ˆÛË Ô˘ ÙËÓ ÂÚÈ-‚¿ÏÏÂÈ. O 36 ˘Â‚Ï‹-ıË Û ÂÓ‰Ô‰ÔÓÙÈ΋ıÂڷ›·.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 94
ÊÏÂÁÌÔÓ‹ Û 2 ÂÚÈÙÒÛÂȘ, ÂÓÒ Û 4 ÂÚÈÙÒÛÂȘ ÚÔ-¸‹Ú¯·Ó ·Ï·È¤˜ ÂÓ‰Ô‰ÔÓÙÈΤ˜ ıÂڷ›˜ ¯ˆÚ›˜ Ó· ›-Ó·È ÁÓˆÛÙ‹ Ë ·ÎÚÈ‚‹˜ ·ÈÙ›· Ô˘ Ô‰‹ÁËÛ ÛÙËÓ Ù¤ÏÂÛ‹ÙÔ˘˜ (¶ÈÓ. 2). ¢È·ÁÓˆÛÙÈο Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· ·Ó·ÊÂÚı›·ÎfiÌË fiÙÈ ÌÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ¤Ó·‰fiÓÙÈ Ì ¤ÌÊÚ·ÍË Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ ¯ˆÚ›˜ Ô˘‰¤ÙÂÚÔÛÙÚÒÌ· (ÂÚ›ÙˆÛË 1) Î·È 7 ‰fiÓÙÈ· Ì ·Ï·È¤˜ ÂÌÊÚ¿-ÍÂȘ ·Ì·ÏÁ¿Ì·ÙÔ˜.H ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂͤٷÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¤ÁÈÓ Ì ÙËÏ‹„Ë ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÒÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ ‹/Î·È ÔÚıÔ·-ÓÙÔÌÔÁÚ·ÊËÌ¿ÙˆÓ. ŸÏ˜ ÔÈ ·ÎÙÈÓÔÁڷʛ˜ ·ÍÈÔÏÔÁ‹ıË-Î·Ó ÌÂÙ¿ ÙËÓ ÌÂÙ·ÙÚÔ‹ ÙÔ˘˜ Û „ËÊȷ΋ ÌÔÚÊ‹ (Ì ÙË‚Ô‹ıÂÈ· ÂÓfi˜ Û·ÚˆÙ‹ scanjet 5470c, Hewlett PackardCo, USA) Î·È ÙËÓ ÂÂÍÂÚÁ·Û›· ÙÔ˘˜ Ì ÙÔ ÚfiÁÚ·ÌÌ·Adobe Photoshop 7.0 (Adobe Corporation, USA) ÁÈ· ÙËÓÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ‰È·ÁÓˆÛÙÈ΋ ¢ÎÚ›ÓÂÈ·. AÓÙÈÚÔÛˆ-¢ÙÈΤ˜ ·ÎÙÈÓÔÁڷʛ˜ ·fi οı ÂÚ›ÙˆÛË ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È ÛÙȘ EÈÎfiÓ˜ 1B, 2-6, 8.K·Ù¿ ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ Ï¿‚·Ì ˘fi-„Ë Ù· ·Ú·Î¿Ùˆ ÛÙÔȯ›·:ñ ¢È¿ÌÂÙÚÔ˜ Ù˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ·ÏÏÔ›ˆÛ˘
̤ÁÈÛÙË ‰È¿ÌÂÙÚÔ˜ < 5 mm̤ÁÈÛÙË ‰È¿ÌÂÙÚÔ˜ > 5 mm
ñ OÌÔÈÔÁ¤ÓÂÈ· Ù˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ·ÏÏÔ›ˆÛ˘ ·ÏÏÔ›ˆÛË Ì ÔÌÔÈÔÁÂÓ‹ ÂÈÎfiÓ· (ÔÌÔÈfiÌÔÚÊË ˘ÎÓfiÙËÙ·)·ÏÏÔ›ˆÛË Ì ·ÓÔÌÔÈÔÁÂÓ‹ ÂÈÎfiÓ· (‡·ÚÍË ÂÚÈÔ¯ÒÓ Ì‰ȷÊÔÚÂÙÈ΋ ˘ÎÓfiÙËÙ· ‹ Ì ÂÌÊ·Ó‹ ÔÛÙÈ΋ ‰ÔΛ-‰ˆÛË)
ñ ŸÚÈ· Ù˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ·ÏÏÔ›ˆÛ˘۷ʋ Î·È Â˘‰È¿ÎÚÈÙ· fiÚÈ··Û·Ê‹ fiÚÈ·
95
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
¶›Ó·Î·˜ 2: ™˘ÓÔÙÈ΋ ·ÚÔ˘Û›·ÛË ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙȘ 8 ÂÚÈÙÒÛÂȘ. OÈ ÂÚÈÙÒÛÂȘ 6 Î·È 7 ·ÊÔÚÔ‡Û·Ó ÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹.
º‡ÏÔ HÏÈΛ· ¢fiÓÙÈ ™˘ÌÙÒÌ·Ù· K·Ù¿ÛÙ·ÛË ÔÏÊÔ‡ ÕÏÏ· ÛÙÔȯ›· ¢È¿ÁÓˆÛË AÓÙÈÌÂÙÒÈÛË1. £ 20 46 AÛ˘Ìو̷ÙÈÎfi XÚfiÓÈ· ÊÏÂÁÌÔÓ‹ ŒÌÊÚ·ÍË ¯ˆÚ›˜ XÚ. EÓÙ. ™ÎÏ. ¶·Ú·ÎÔÏÔ‡ıËÛË
Ô˘‰. ÛÙÚÒÌ· OÛÙÂÔÌ˘ÂÏ›Ùȉ·
2. £ 22 36 ◊ÈÔ˜ ¯ÚfiÓÈÔ˜ XÚfiÓÈ· ÊÏÂÁÌÔÓ‹ EÎÙÂٷ̤ÓË XÚ. EÓÙ. ™ÎÏ. EÓ‰Ô‰ÔÓÙÈ΋ÔÏÊÈÎfi˜ fiÓÔ˜ ÙÂÚˉfiÓ· OÛÙÂÔÌ˘ÂÏ›Ùȉ· ıÂڷ›·
3. £ 34 46 ◊ÈÔ˜ fiÓÔ˜ ¶ÚÔËÁÔ‡ÌÂÓË AÙÂÏ‹˜ XÚ. EÓÙ. ™ÎÏ. E·Ó¿ÏË„Ë Î·Ù¿ ÙËÓ Ì¿ÛËÛË ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· OÛÙÂÔÌ˘ÂÏ›Ùȉ· ÂÓ‰Ô‰ÔÓÙÈ΋˜
ıÂڷ›· ıÂڷ›·˜
4. £ 28 46 ◊ÈÔ˜ fiÓÔ˜ ¶ÚÔËÁÔ‡ÌÂÓË AÙÂÏ‹˜ XÚ. EÓÙ. ™ÎÏ E·Ó¿ÏË„Ëηٿ ÙËÓ Ì¿ÛËÛË ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·, OÛÙÂÔÌ˘ÂÏ›Ùȉ· ÂÓ‰Ô‰ÔÓÙÈ΋˜
ıÂڷ›· ÂÎÙÂٷ̤ÓË ıÂڷ›·˜ÙÂÚˉfiÓ·
5. A 33 36 AÛ˘Ìو̷ÙÈÎfi N¤ÎÚˆÛË E͈ÙÂÚÈ΋ XÚ. EÓÙ. ™ÎÏ. EÓ‰Ô‰ÔÓÙÈ΋ ·ÔÚÚfiÊËÛË OÛÙÂÔÌ˘ÂÏ›Ùȉ· ıÂڷ›·Ù˘ ¿ˆ Ú›˙·˜
6. A 42 37 AÛ˘Ìو̷ÙÈÎfi ¶ÚÔËÁÔ‡ÌÂÓË IηÓÔÔÈËÙÈ΋ XÚ. EÓÙ. ™ÎÏ. ¶·Ú·ÎÔÏÔ‡ıËÛËÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· OÛÙÂÌ˘ÂÏ›Ùȉ·
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7. A 42 47 ŒÓÙÔÓÔ˜ fiÓÔ˜, N¤ÎÚˆÛË EÎÙÂٷ̤ÓË OÍ›· EÍ·ÁˆÁ‹Â˘·ÈÛıËÛ›· ÛÙËÓ ÙÂÚˉfiÓ· ÂÚÈ·ÎÚÔÚ-
›ÎÚÔ˘ÛË ÚÈ˙›Ùȉ·XÚ. EÓÙ. ™ÎÏ.
OÛÙÂÔÌ˘ÂÏ›Ùȉ·
8. £ 41 45 AÛ˘Ìو̷ÙÈÎfi ¶ÚÔËÁÔ‡ÌÂÓË IηÓÔÔÈËÙÈ΋ XÚ. EÓÙ. ™ÎÏ. ¶·Ú·ÎÔÏÔ‡ıËÛËÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· OÛÙÂÔÌ˘ÂÏ›Ùȉ·
ıÂڷ›·
EÈÎ. 6: ¶ÂÚ›ÙˆÛË 6 Î·È 7: OÈ ·ÏÏÔÈÒÛÂȘ ·Ú·ÙËÚÔ‡ÓÙ·È Û¯Â‰fiÓÛ˘ÌÌÂÙÚÈο ÛÙËÓ ÂÁÁ‡˜ ÂÚÈÔ¯‹ ÙˆÓ 37, 47.
EÈÎ. 8: ¶ÂÚ›ÙˆÛË 8: H ÛÎÏËÚ˘ÓÙÈ΋ ·ÏÏÔ›ˆÛË ‚Ú¤ıËΠÛÂ Ù˘-¯·›Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Î·È Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ·-ÎÚÔÚÚ›˙ÈÔ ÙÔ˘ 45. E›Ó·È Èı·Ófi Ó· ÚfiÎÂÈÙ·È ÁÈ· ¯ÚfiÓÈ· ÂÓÙÔÈ-Ṳ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·, Ë ÔÔ›· ÚÔÎÏ‹ıËΠ·fiÔÏÊÈ΋ ‚Ï¿‚Ë ÙÔ˘ 45.
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 95
ñ ™˘Ó‡·ÚÍË ‰È·˘Á·ÛÙÈ΋˜ ·ÏÏÔ›ˆÛ˘ñ X·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÂÚÈÚÚÈ˙ÈÎÔ‡ ¯ÒÚÔ˘ ÛÙËÓ ÂÚÈ·-
ÎÚÔÚÚÈ˙È΋ ÂÚÈÔ¯‹Ê˘ÛÈÔÏÔÁÈÎfi˜ ÂÚÈÚÚÈ˙ÈÎfi˜ ¯ÒÚÔ˜ (‡ÚÔ˜ ≤ 0,5 mm)‰ÈÂ˘Ú˘Ì¤ÓÔ˜ ÂÚÈÚÚÈ˙ÈÎfi˜ ¯ÒÚÔ˜ (‡ÚÔ˜ >0,5 mm)
ñ ¶ÔÈfiÙËÙ· ÚÔ¸¿Ú¯Ô˘Û·˜ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ÈηÓÔÔÈËÙÈ΋ (·Ô˘Û›· ÂÌÊ·ÓÒÓ ÎÂÓÒÓ ÙÔ˘ ÂÌÊÚ·ÎÙÈ-ÎÔ‡ ̆ ÏÈÎÔ‡, ·ÎÚÔÚÚÈ˙ÈÎfi ¤Ú·˜ Ù˘ ıÂڷ›·˜ Û ·fi-ÛÙ·ÛË 0-3 mm ·fi ÙÔ ·ÎÙÈÓÔÁÚ·ÊÈÎfi ·ÎÚÔÚÚ›˙ÈÔ)ÌË ÈηÓÔÔÈËÙÈ΋ (fiϘ ÔÈ ˘fiÏÔȘ ÂÚÈÙÒÛÂȘ)
ñ ⁄·ÚÍË Â͈ÙÂÚÈ΋˜ ·ÔÚÚfiÊËÛ˘ Ù˘ Ú›˙·˜ / ÙˆÓ ÚÈ-˙ÒÓ ÙÔ˘ ‰ÔÓÙÈÔ‡
T· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂͤٷÛË ·ÚÔ˘-ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.H ‰È¿ÁÓˆÛË Ô˘ Ù¤ıËÎÂ Î·È ÛÙȘ 8 ÂÚÈÙÒÛÂȘ Ô˘ ·-ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‹Ù·Ó ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ Ô-ÛÙÂÔÌ˘ÂÏ›Ùȉ·. ™Â Ì›· ÂÚ›ÙˆÛË, ÛÙËÓ ÔÔ›· ÙÔ Û¯ÂÙÈ-˙fiÌÂÓÔ ‰fiÓÙÈ Â›¯Â Ó¤ÎÚˆÛË ÙÔ˘ ÔÏÊÔ‡, ·Ú·ÙËÚ‹ıËÎÂÂ͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË ÛÙÔ ·ÎÚÔÚÚÈ˙ÈÎfi ÙÚÈÙËÌfiÚÈÔÌ›·˜ ÂÎ ÙˆÓ ÚÈ˙ÒÓ (EÈÎ. 5).£Âڷ¢ÙÈο ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ¤ÁÈÓ·Ó Û 4 ÂÚÈ-ÙÒÛÂȘ ÂÓ‰Ô‰ÔÓÙÈΤ˜ ıÂڷ›˜, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ 2 ‹-Ù·Ó Â·Ó·Ï‹„ÂȘ ÏfiÁˆ ·ÙÂÏÔ‡˜ ·Ï·ÈfiÙÂÚ˘ ÂÓ‰Ô‰Ô-ÓÙÈ΋˜ ıÂڷ›·˜. ™Â Ì›· ÂÚ›ÙˆÛË (ÂÚ›ÙˆÛË 1) fiÔ˘‰È·ÈÛÙÒıËΠ¯ÚfiÓÈ· ÔÏÊÈ΋ ÊÏÂÁÌÔÓ‹, ‰ÂÓ ÚÔ¯ˆÚ‹-Û·Ì Û ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·, ‰ÈfiÙÈ Ë ·ÛıÂÓ‹˜, ·ÊÔ‡ÂÓËÌÂÚÒıËΠÁÈ· ÙÔ ı¤Ì·, ÚÔÙ›ÌËÛ ӷ οÓÂÈ ÙËÓ ıÂÚ·-›· Û ÌÂÏÏÔÓÙÈÎfi ¯ÚfiÓÔ. H ·ÛıÂÓ‹˜ Ù¤ıËΠ۠ÂÙ‹ÛÈÔÎÏÈÓÈÎfi Î·È ·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. ™Â 2 ÂÚÈÙÒÛÂȘ fi-Ô˘ ÔÈ ÛÎÏËÚ˘ÓÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ‰fiÓÙÈ·Ô˘ ¤ÊÂÚ·Ó ·Ï·È¿ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· (ÂÚÈÙÒÛÂȘ6, 8), ‰ÂÓ ÚÔ¯ˆÚ‹Û·Ì Û ·ӿÏË„Ë Ù˘ ıÂڷ›·˜Î·ıfiÙÈ ‰ÂÓ ˘‹Ú¯Â η̛· Û˘Ìو̷ÙÔÏÔÁ›·, ÔÈ ÂÓ‰Ô‰Ô-ÓÙÈΤ˜ ıÂڷ›˜ ‹Ù·Ó ÈηÓÔÔÈËÙÈΤ˜ Î·È ‰ÂÓ ˘‹Ú¯·Ó·ÎÙÈÓÔÁÚ·ÊÈΤ˜ ÂӉ›ÍÂȘ ÂÓÂÚÁÔ‡ ÂÚÈ·ÎÚÔÚÚÈ˙›Ùȉ·˜.
OÈ ·ÛıÂÓ›˜ Ù¤ıËÎ·Ó Û ÂÙ‹ÛÈÔ ÎÏÈÓÈÎfi Î·È ·ÎÙÈÓÔÁÚ·ÊÈ-Îfi ¤ÏÂÁ¯Ô. T¤ÏÔ˜, Û ̛· ÂÚ›ÙˆÛË (ÂÚ›ÙˆÛË 7) ÚÔ-‚‹Î·Ì ÛÙËÓ ÂÍ·ÁˆÁ‹ ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡ (47) ‰ÈfiÙÈÂÌÊ¿ÓÈ˙ ÔÍ›· Û˘Ìو̷ÙÔÏÔÁ›· Î·È Ô ·ÛıÂÓ‹˜ ‰ÂÓ ‰Â-¯fiÙ·Ó ÙËÓ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· (EÈÎ. 6, 7). T· ΢ÚÈfiÙÂÚ· ÛÙÔȯ›· ·fi ÙȘ 8 ÂÚÈÙÒÛÂȘ ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È Û˘ÓÔÙÈο ÛÙÔÓ ¶›Ó·Î· 2. O ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÛÙ·ÙÈ-ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Î·È ÙËÓ ÂÍ·ÁˆÁ‹ ·-ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, ·Ú¿ ÌfiÓÔ ÙËÓ ÂÈÛ‹Ì·ÓÛËÂӉ›ÍˆÓ.
™YZHTH™H
¶·ıÔÁ¤ÓÂÈ· - KÏÈÓÈ΋ ÂÈÎfiÓ·MÂٷ͇ ÙˆÓ 8 ÂÚÈÙÒÛÂÒÓ ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏË-Ú˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜, Û·Ê‹˜ ÔÏÊÈ΋ ·ÈÙÈÔÏÔÁ›·ÙÂÎÌËÚÈÒıËΠÁÈ· ÙȘ 6 ÂÚÈÙÒÛÂȘ, ÂÓÒ ÁÈ· ÙȘ ˘fiÏÔÈ-˜ ‰‡Ô (ÂÚÈÙÒÛÂȘ 6 Î·È 8) ˘¿Ú¯Ô˘Ó Û·Ê›˜ ÂӉ›-ÍÂȘ. TÔ Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜3, 5-7,
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
EÈÎ. 7: ¶ÂÚ›ÙˆÛË 7: O 47 ÂÌÊ¿ÓÈÛÂ Û˘Ìو̷ÙÔÏÔÁ›· ÔÍ›·˜ÂÚÈ·ÎÚÔÚÚÈ˙›Ùȉ·˜ Î·È ¤ÁÈÓ ÂÍ·ÁˆÁ‹ ÙÔ˘ ‰ÔÓÙÈÔ‡ ‰ÈfiÙÈ Ô ·ÛıÂ-Ó‹˜ ·ÚÓ‹ıËΠӷ ˘Ô‚ÏËı› Û ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·.
¶›Ó·Î·˜ 3: AÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ·fi ÙȘ 8 ÂÚÈÙÒÛÂȘ.
AÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· °ÔÌÊ›ÔÈ ¶ÚÔÁfiÌÊÈÔÈ ™‡ÓÔÏÔ ÕÓ‰Ú˜ °˘Ó·›Î˜ ™‡ÓÔÏԢȿÌÂÙÚÔ˜ Ù˘ ÛÎÏËÚ˘ÓÙÈ΋˜·ÏÏÔ›ˆÛ˘<5 mm 2 1 3 1 2 3>5 mm 5 - 5 1 3 4
OÌÔÈÔÁ¤ÓÂÈ·OÌÔÈÔÁÂÓ‹˜ ÛÎÏËÚ˘ÓÙÈ΋·ÏÏÔ›ˆÛË 1 - 1 - 1 1AÓÔÌÔÈÔÁÂÓ‹˜ ÛÎÏËÚ˘ÓÙÈ΋·ÏÏÔ›ˆÛË 6 1 7 2 4 6
ŸÚÈ· Ù˘ ÛÎÏËÚ˘ÓÙÈ΋˜·ÏÏÔ›ˆÛ˘۷ʋ 5 1 6 2 3 5Û·Ê‹ 2 - 2 - 2 2
⁄·ÚÍË ‰È·‡Á·Û˘ 3 - 3 - 3 3
¶ÂÚÈÚÚ›˙ÈÔÊ˘ÛÈÔÏÔÁÈÎfi 3 - 3 1 1 2‰ÈÂ˘Ú˘Ì¤ÓÔ 4 1 5 1 4 5
¶ÔÈfiÙËÙ· ·Ï·È¿˜ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ÈηÓÔÔÈËÙÈ΋ 2 - 2 - 2 2ÌË ÈηÓÔÔÈËÙÈ΋ 1 1 2 1 1 2
E͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË 1 - 1 1 - 1
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 96
11, 18, 21, ÔÈ ÔÔ›ÔÈ ̆ ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ̆ ¿Ú¯ÂÈ ¿ÓÙ· οÔÈÔ ̆ -·›ÙÈÔ ‰fiÓÙÈ, ÙÔ ÔÔ›Ô ÂÌÊ·Ó›˙ÂÈ ¯ÚfiÓÈ· ÔÏÊÈ΋ ÊÏÂÁÌÔ-Ó‹ (ÂӉ¯Ô̤ӈ˜ ˘ÔÎÏÈÓÈ΋) ‹ ·ÎfiÌ· Î·È Ó¤ÎÚˆÛË ÙÔ˘ÔÏÊÔ‡, Û ÈÔ ÚÔ¯ˆÚË̤ÓÔ ÛÙ¿‰ÈÔ. H ¯ÚfiÓÈ· ÊÏÂÁÌÔ-Ó‹ ÌÔÚ› Ó· ÚÔ¤Ú¯ÂÙ·È ·fi ÌÈÎÚÔ‚È·Îfi ÂÚÂıÈÛÌfi (ÙÂ-ÚˉfiÓ·), ‹ ·ÎfiÌ· Î·È ·fi ̄ ËÌÈÎfi ‹ ıÂÚÌÈÎfi ÂÚÂıÈÛÌfi ÙÔ˘ÔÏÊÔ‡ (.¯. Ì›· ·Ï·È¿ ¤ÌÊÚ·ÍË ̄ ˆÚ›˜ Ô˘‰¤ÙÂÚ· ÛÙÚÒ-Ì·Ù·, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË 1) Î·È Û¯Â‰fiÓ Û›ÁÔ˘Ú· ı· Ô-‰ËÁ‹ÛÂÈ ÌÂÙ¿ ·fi οÔÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Û ӤÎÚˆÛËÙÔ˘ ÔÏÊÔ‡8. E›Û˘, ÔÈ Caliskan Î·È Û˘Ó.20 ·Ó·Ê¤ÚÔ˘ÓÂÚ›ÙˆÛË ‰ÔÓÙÈÔ‡ Ì ¯ÚfiÓÈ· ˘ÂÚÏ·ÛÙÈ΋ ÔÏÊ›Ùȉ·Î·È ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÙÂÎÌËÚȈ̤Ó˜ ÂÚÈÙÒÛÂȘ Ô˘ Ó· ·Ô-‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÔÛÙÂÔ˘ÎÓˆÙÈ΋˜ ÂÍÂÚÁ·Û›·˜Û ‰fiÓÙÈ· Ì ‹‰Ë ÓÂÎڈ̤ÓÔ ÔÏÊfi18. AӷʤÚÂÙ·È fï˜ÛÙËÓ ‚È‚ÏÈÔÁÚ·Ê›· ÂÚ›ÙˆÛË ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ ¯ˆÚ›˜ Ó· ·Ó¢ڛÛÎÂÙ·ÈÚÔÊ·Ó‹˜ ÔÏÊÈÎfi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜14. ™Â Ù¤-ÙÔȘ ÂÚÈÙÒÛÂȘ Û˘ÓÈÛÙ¿Ù·È Ë ÏÂÙÔÌÂÚ‹˜ ·Ó·„ËÏ¿-ÊËÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ·ÎÙÈÓÔÁÚ·ÊÈ-ÎÒÓ Â˘ÚËÌ¿ÙˆÓ14.™ÙËÓ ÂÚÈ·ÎÚÔÚÚÈ˙È΋ ÂÚÈÔ¯‹ ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡ ·-Ó·Ù‡ÛÛÂÙ·È ÌÈ· ÂȉÈ΋ ÈÛÔÚÚÔ›· ÌÂٷ͇ ÙÔ˘ ÌÈÎÚÔ‚È·-ÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È Ù˘ ¿Ì˘Ó·˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ηٿÙËÓ ÔÔ›· ÂÈÎÚ·Ù› Ë ÔÛÙÂÔ‚Ï·ÛÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ÔÛÙÂÔÎÏ·ÛÙÈ΋˜, ¯ˆÚ›˜ Ó· ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› Ë ·ÎÚÈ-‚‹˜ ·ÈÙ›·8, 11. H ·ıÔÁ¤ÓÂÈ· ·˘Ù‹˜ Ù˘ ηٿÛÙ·Û˘ ÔÌÔÈ-¿˙ÂÈ Ì ·˘Ù‹ ÙÔ˘ ÂÚÈ·ÎÚÔÚÚÈ˙ÈÎÔ‡ ÎÔÎÎÈÒÌ·ÙÔ˜, fï˜ÙÔ ÎÔÎΛˆÌ· ·Ó·Ù‡ÛÛÂÙ·È Û ÈÛÙÈÎfi ˘fiÛÙڈ̷ ¯·ÌË-ÏfiÙÂÚ˘ ·Ì˘ÓÙÈ΋˜ ÈηÓfiÙËÙ·˜ Î·È ÂÓ·ÓÙ›ÔÓ ÈÛ¯˘ÚfiÙÂ-ÚˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ·Ú·ÁfiÓÙˆÓ2. YÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÂÍ·-ÙÔÌÈÎÂ˘Ì¤ÓÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ÙÔÈ΋ ÈÛÙÈ΋ ·ÓÙ›-ÛÙ·ÛË, Ù· ›‰Ë Î·È Ë ÏÔÈÌÔÁfiÓÔ˜ ‰‡Ó·ÌË ÙˆÓ ÌÈÎÚÔÔÚ-Á·ÓÈÛÌÒÓ, ÂËÚ¿˙Ô˘Ó ÙËÓ ÂͤÏÈÍË Ì›·˜ ÔÛÙÈ΋˜ ·ÏÏÔ›ˆ-Û˘ ÚÔ˜ ÔÛÙÂÔÛÎÏ‹Ú˘ÓÛË ‹ ÔÛÙÂfiÏ˘ÛË, ‰ÈfiÙÈ ÛÙÔÓ ›‰ÈÔ·ÛıÂÓ‹ ·Ú·ÙËÚÔ‡ÓÙ·È ÙfiÛÔ ÔÛÙÂÔÛÎÏËÚ˘ÓÙÈΤ˜ fiÛÔÎ·È ÔÛÙÂÔÏ˘ÙÈΤ˜ ‚Ï¿‚˜18, οÙÈ Ô˘ ·Ú·ÙËÚ‹Û·Ì ηÈÂÌ›˜ Û 3 ÂÚÈÙÒÛÂȘ.MÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘ÌÂ, 4 ‹Ù·ÓÂÓÙÂÏÒ˜ ·Û˘Ìو̷ÙÈΤ˜, fiÔ˘ Î·È Ë ·ÏÏÔ›ˆÛË ·Ó·Î·-χÊıËΠ۠·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ¿ÏÏË ·ÈÙ›·, ÂÓÒ 3ÂÌÊ¿ÓÈ˙·Ó ‹ÈÔ fiÓÔ Î·È Û ̛· ÂÚ›ÙˆÛË ÂÌÊ·Ó›ÛÙËΤÓÙÔÓÔ˜ fiÓÔ˜. TÔ Â‡ÚËÌ· ·˘Ùfi (·ÚÔ˘Û›· Û˘Ìو̿-ÙˆÓ ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛˆÓ) ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË ÌÂÔÚÈṲ̂ÓÔ˘˜ Û˘ÁÁÚ·Ê›˜2, 7, 8, 16, Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ›ӷÈÛ˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈ΋, ÁÈ' ·˘Ùfi Î·È ÛÙȘ ÂÚÈÛÛfiÙÂ-Ú˜ ÂÚÈÙÒÛÂȘ ·Ó·Î·Ï‡ÙÂÙ·È Ù˘¯·›· Û ·ÎÙÈÓÔÁÚ·ÊÈ-Îfi ¤ÏÂÁ¯Ô ÁÈ· ¿ÏÏÔ ÏfiÁÔ.
AÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ·AÓ·ÊÔÚÈο Ì ÙËÓ ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Ù˘ ¯ÚfiÓÈ·˜ Â-ÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜, ‰È·ÈÛÙÒ-Û·Ì fiÙÈ ÔÈ ·ÏÏÔÈÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È ÈÔ Û˘¯Ó¿ Ì fiÚÈ·Û·Ê‹ Î·È Â˘‰È¿ÎÚÈÙ· Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Ì ·Û·Ê‹ fiÚÈ·.TÔ Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜5,6,11,16
Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙËÓ ·ÏÏÔ›ˆÛË ˆ˜ ÌÈ· ηÏÒ˜ ÂÚÈÁÂ-ÁÚ·Ì̤ÓË ·ÎÙÈÓÔÛÎÈÂÚ‹ Ì¿˙· ÛÎÏËÚ˘ÓÙÈÎÔ‡ ÔÛÙÔ‡ Ô˘ÂÎÙ›ÓÂÙ·È Á‡Úˆ ·fi ÙÔ ·ÎÚÔÚÚ›˙ÈÔ ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈ-
Ô‡. O Topazian21 ıˆÚ› fiÙÈ Ù· fiÚÈ· Ù˘ ‚Ï¿‚˘ ÚÔ˜ ÙÔÁÂÈÙÔÓÈÎfi Ê˘ÛÈÔÏÔÁÈÎfi ÔÛÙfi ÌÔÚ› Ó· Â›Ó·È ÔÌ·Ï¿ ηÈ¢‰È¿ÎÚÈÙ· ‹ ·Û·Ê‹ Î·È Ó· Ê·›ÓÂÙ·È fiÙÈ ‰ÈÂÈÛ‰‡Ô˘Ó ̤۷ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÔÛÙfi. ™Â 7 ·fi ÙȘ 8 ÂÚÈÙÒÛÂȘ Ì·˜ Ë ‚Ï¿‚Ë Û¯ÂÙÈ˙fiÙ·Ó Û·ÊҘ̠ÙÔ ·ÎÚÔÚÚ›˙ÈÔ/·ÎÚÔÚÚ›˙È· ÂÓfi˜ ‰ÔÓÙÈÔ‡. MfiÓÔ ÛÙËÓ Â-Ú›ÙˆÛË 1 Ë ·ÏÏÔ›ˆÛË ¤‰ÂȯÓ ӷ Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙÔ ·-ڷΛÌÂÓÔ ‰fiÓÙÈ. ™Â η̛· ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ì·˜ ‰ÂÓ ·-Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÔÛÙÈÎfi ÊÏÔÈfi Ù˘ οو ÁÓ¿-ıÔ˘. T· ·Ú·¿Óˆ Û˘ÌʈÓÔ‡Ó Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ ¢·-Ϸ̛ڷ & °È·ÓÓÔ‡ÏË-TfiÏÈÔ˘12. ¢‡Ô ·fi ÙȘ ·Ó·ÊÂÚfiÌÂ-Ó˜ ÂÚÈÙÒÛÂȘ (ÂÚÈÙÒÛÂȘ 6 Î·È 7) ÂÓÙÔ›ÛÙËÎ·Ó ÛÙÔÓ›‰ÈÔ ·ÛıÂÓ‹. H ·ÚÔ˘Û›· ÂÚÈÛÛÔÙ¤ÚˆÓ Ù˘ Ì›·˜ ·ÏÏÔÈÒ-ÛÂˆÓ ÛÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹ ·Ó·Ê¤ÚÂÙ·È Î·È ·fi ÙÔ˘˜ Marmary& Kutiner14 Î·È Eliasson η Û˘Ó.18. ¶·ÚfiÏ· ·˘Ù¿, ÔÈ ·ÏÏÔÈÒ-ÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÌÂÌÔӈ̤Ó˜14,18.H ̤ÁÈÛÙË ‰È¿ÌÂÙÚÔ˜ ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ‚Ú¤ıËΠÌÂÁ·Ï‡-ÙÂÚË ·fi 5mm Û 5 ·fi ÙȘ 8 ÂÚÈÙÒÛÂȘ (Î˘Ì·ÈÓfiÙ·Ó·fi 2-15 mm). TÔ Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ÂΛӷ ÙˆÓMarmary & Kutiner14 Î·È Eliasson Î·È Û˘Ó.18. H ÂÈÎfiÓ· ÙÔ˘ÂÛˆÙÂÚÈÎÔ‡ ÙˆÓ ‚Ï·‚ÒÓ ‚Ú¤ıËΠӷ ÔÈΛÏÂÈ Û ÛÎÏËÚfi-ÙËÙ·, ÂÌÊ·ÓÈ˙fiÌÂÓË ÈÔ Û˘¯Ó¿ Û·Ó ÂÚÈÔ¯‹ ¤ÓÙÔÓ˘ ·-ÓÔÌÔÈÔÁÂÓÔ‡˜ ÔÛÙÈ΋˜ ‰ÔΛ‰ˆÛ˘ Î·È Û·ÓÈfiÙÂÚ· Û·ÓÔÌÔÈfiÌÔÚÊË ÔÛÙÈ΋ ‡ÎÓˆÛË, fiˆ˜ ·Ó·Ê¤ÚÔ˘Ó Î·È ÔÈDouglass & Trowbridge2. O ¯ÒÚÔ˜ ÙÔ˘ ÂÚÈÚÚÈ˙›Ô˘ ‚Ú¤ıËΠ۠5 ÂÚÈÙÒÛÂȘ ‰È-Â˘Ú˘Ì¤ÓÔ˜, ·ÏÏ¿ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ‰È·ÎÚ›ÓÔÓÙ·ÓÙ· fiÚÈ¿ ·˘ÙÔ‡ Î·È Ù˘ ‚Ï¿‚˘. T· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘Ì-ʈÓÔ‡Ó Ì ÙȘ ·fi„ÂȘ ¿ÏÏˆÓ Û˘ÁÁڷʤˆÓ14,16,18. EÈ-ϤÔÓ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î¿ÔȘ ÊÔÚ¤˜ ·Ú·ÙËÚÂ›Ù·È Î·È·ÒÏÂÈ· Ù˘ lamina dura ·ÎÚÔÚÚÈ˙Èο18, Ú¿ÁÌ· Ô˘ ‰ÂӉȷÈÛÙÒÛ·Ì Ì ‚‚·ÈfiÙËÙ· Û η̛· ·fi ÙȘ ÂÚÈÙÒ-ÛÂȘ Ì·˜.™Â 3 ·fi ÙȘ 8 ÂÚÈÙÒÛÂȘ ‰È·ÈÛÙÒıËÎÂ Ë Û˘Ó‡·ÚÍË·ÎÙÈÓԉȷÂÚ·Ù‹˜ (‰È·˘Á·ÛÙÈ΋˜) ·ÏÏÔ›ˆÛ˘, Ë ÔÔ›·ÂÚÈ‚·ÏÏfiÙ·Ó ·fi ÙËÓ ÛÎÏËÚ˘ÓÙÈ΋ ·ÏÏÔ›ˆÛË. TÔ ̄ ·Ú·-ÎÙËÚÈÛÙÈÎfi ·˘Ùfi ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙËÓ ‚È‚ÏÈÔÁÚ·Ê›· ·fi·ÚÎÂÙÔ‡˜ Û˘ÁÁÚ·Ê›˜1,2,8,18. H ·ÎÙÈÓԉȷÂÚ·Ù‹ fï˜ ·Ï-ÏÔ›ˆÛË ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·fi ÙË Ì¿˙· ÙÔ˘ ˘ÎÓˆÙÈÎÔ‡ Ô-ÛÙÔ‡ (EÈÎ.3, 4), ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ Î·Ù¿Ù·ÍË Ù˘ ·ÏÏÔ›ˆ-Û˘ ˆ˜ ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ-‰·14. OÈ Marmary & Kutiner14 ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ô Û˘Ó‰˘·-ÛÌfi˜ ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›-Ùȉ·˜ Î·È ‰È·˘Á·ÛÙÈ΋˜ ·ÏÏÔ›ˆÛ˘ Â›Ó·È ÈÔ Û˘¯Ófi˜ ·fiÙËÓ ·ÌÈÁ‹ ÂÈÎfiÓ· Ù˘ ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ-΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜.™Â Ì›· ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ì·˜ (EÈÎ. 5) ‰È·ÈÛÙÒÛ·Ì Â-͈ÙÂÚÈ΋ ·ÔÚÚfiÊËÛË ÙÔ˘ ·ÎÚÔÚÚÈ˙ÈÎÔ‡ ÙÚÈÙËÌÔÚ›Ô˘Ù˘ ¿ˆ Ú›˙·˜ ÙÔ˘ 36, ‡ÚËÌ· Ô˘ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙËÓ‚È‚ÏÈÔÁÚ·Ê›·2,12. OÈ Eliasson Î·È Û˘Ó.18 ·Ó·Ê¤ÚÔ˘Ó ·ÚÔ˘-Û›· Â͈ÙÂÚÈ΋˜ ·ÔÚÚfiÊËÛ˘ Û ‰fiÓÙÈ· Ì ¯ÚfiÓÈ· ÂÓÙÔ-ÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· Û ÔÛÔÛÙfi 12%.O EÏ¢ıÂÚÈ¿‰Ë˜17, ÂÍ¿ÏÏÔ˘, ·Ó·Ê¤ÚÂÈ fiÙÈ Ë ÂÈÎfiÓ· Ù˘¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓÂÍ·ÁˆÁ‹ ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡, ÔfiÙ ·Ó·Ê¤ÚÂÙ·È ˆ˜ ˘-ÔÏÂÈÌÌ·ÙÈ΋ ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔ-Ì˘ÂÏ›Ùȉ·.
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 97
IÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ·¢ÂÓ ˘¿Ú¯Ô˘Ó ÛÙËÓ ‰È¿ıÂÛ‹ Ì·˜ ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù··fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È, ηıfiÙÈ fiÏ¿ Ù·‰fiÓÙÈ· ÏËÓ ÂÓfi˜ ‰È·ÙËÚ‹ıËÎ·Ó ÛÙÔÓ ÊÚ·ÁÌfi ÙˆÓ ·ÛıÂ-ÓÒÓ ¯ˆÚ›˜ ·Ó¿ÁÎË ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔۤϷÛË Ù˘ Â-ÚÈ·ÎÚÔÚÚÈ˙È΋˜ ÂÚÈÔ¯‹˜ ̤¯ÚÈ Û‹ÌÂÚ·. TÔ ÌÔÓ·‰ÈÎfi‰fiÓÙÈ Ô˘ ÂÍ‹¯ıÂÈ, ÂÚÈ‹Ïı ÛÙËÓ ‰È¿ıÂÛ‹ Ì·˜ ·ÚÎÂÙ¤˜Ì¤Ú˜ ÌÂÙ¿ ·fi ÙËÓ ÂÍ·ÁˆÁ‹ ÙÔ˘ Î·È Î¿ı ÈÛÙÔÏÔÁÈÎfiÛÙÔÈ¯Â›Ô Â›¯Â ‹‰Ë ·ÏÏÔȈı› ·Ó·ÓfiÚıˆÙ·.H ÔÓÔÌ·Û›· Ù˘ ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ Ô-ÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ Ê·ÓÂÚÒÓÂÈ ÙËÓ ÊÏÂÁÌÔÓÒ‰Ë Ê‡ÛË Ù˘.B¤‚·È·, ηӤӷ ·fi Ù· ÎÏ·ÛÈο ÛËÌ›· Ù˘ ÊÏÂÁÌÔÓ‹˜‰ÂÓ ÌÔÚ› Ó· ·Ó·ÁÓˆÚÈÛÙ› Ì ‚‚·ÈfiÙËÙ·. IÛÙÔÏÔÁÈο, ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ‚Ï¿‚˘ ·Ú·ÙËÚÔ‡ÓÙ·È˘ÎÓ¤˜ ·Î·ÓfiÓÈÛÙ˜ ÔÛÙÈΤ˜ ‰ÔΛ‰Â˜ Ô˘ Û¯ËÌ·Ù›˙Ô˘ÓÛ˘Ì·Á¤˜ ÔÛÙfi Ì ÂÏ¿¯ÈÛÙ˜ ÔÛÙÈΤ˜ ÎÔÈÏfiÙËÙ˜, ÔÏ-Ϥ˜ ÂÎ ÙˆÓ ÔÔ›ˆÓ ¯ˆÚ›˜ ÔÛÙÂÔ·ÙÙ·Ú·4 Î·È ÂÏ¿ÙÙˆÛËÙˆÓ Ì˘ÂÏÔ΢„ÂÏÒÓ3, 5-7,11, 12. ™Â οÔȘ ÂÚÈÙÒÛÂȘ ·-Ú·ÙËÚÔ‡ÓÙ·È Î·È ÂÚÈÔ¯¤˜ Ì ÂÓÙÂÏÒ˜ Û˘Ì·Á¤˜ ÔÛÙfi16.M˘ÂÏfi˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ó¢ÚÂı› ÂÓÙfi˜ ÙˆÓ Ì˘ÂÏÔ΢-„ÂÏÒÓ Î·È Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÈÓÒ‰Ë ÂÎʇÏÈÛË Î·È ‰È‹-ıËÛË ·fi ·ÙÙ·Ú· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔ-Ó‹˜, fiˆ˜ ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ï·ÛÌ·ÙÔ·ÙÙ·Ú·2-8, 11, 12, 21.ºÏÂÁÌÔÓ҉˘ ‰È‹ıËÛË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ̆ ¿Ú¯ÂÈ Î·È ÛÙÈ˜Ì˘ÂÏÔ΢„¤Ï˜ ¤ÚÈÍ Ù˘ ‚Ï¿‚˘2, 5-8, 11, 12. B¤‚·È·, ̆ ¿Ú¯ÂÈÎ·È Ë ÂÚ›ÙˆÛË Ô Ì˘ÂÏfi˜ Ó· ÂÌÊ·Ó›˙ÂÈ ÂÏ¿¯ÈÛÙ· ‹ ηÈηıfiÏÔ˘ ÛÙÔȯ›· ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰È‹ıËÛ˘22 ‹Ó· Ï›ÂÈ ÂÓÙÂÏÒ˜21. ™Â οÔȘ ÂÚÈÔ¯¤˜ ·Ó¢ڛÛÎÔÓÙ·ÈÎ·È ÂÓÂÚÁÔ› ÔÛÙÂÔ‚Ï¿ÛÙ˜11, 12, ‡ÚËÌ· Ô˘ Û˘Ì‚·‰›˙ÂÈ ÌÂÙËÓ ˘fiıÂÛË ‰ËÌÈÔ˘ÚÁ›·˜ Ù˘ ‚Ï¿‚˘ ÏfiÁˆ ˘ÂÚ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ Î·È fi¯È ÏfiÁˆ ˘ÂÚ‚ÔÏÈ-΋˜ ÂÓ·Û‚ÂÛÙ›ˆÛ˘ ÙÔ˘ ÔÛÙÔ‡3. OÈ ÔÛÙÂÔÛÎÏËÚ˘ÓÙÈΤ˜‚Ï¿‚˜ ÛÙÂÚÔ‡ÓÙ·È ·ÁÁ›ˆÓ12.ŒÙÛÈ, ÂÊfiÛÔÓ Ë ÊÏÂÁÌÔÓ҉˘ ʇÛË Ù˘ ‚Ï¿‚˘ ›ӷÈۯ‰fiÓ Î·ıÔÏÈο ·Ô‰ÂÎÙ‹, Â›Ó·È ··Ú·›ÙËÙÔ Ó· ‰ÈÂÚ¢-ÓËı› ÔÈ· ·fi ÙȘ ÔÓÔ̷ۛ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›-Ó·È ÔÚıfiÙÂÚË. O fiÚÔ˜ ÂÚÈÔ‰ÔÓÙ›Ùȉ· ‹ ÂÚÈÚÚÈ˙›Ùȉ·‰ÂÓ ÌÔÚ› Ó· ÂÚÈÁÚ¿„ÂÈ ÙËÓ ‚Ï¿‚Ë, ÂÊfiÛÔÓ ·˘Ù‹ ÂÂ-ÎÙ›ÓÂÙ·È Î·È ÛÙÔ ÔÛÙfi ÙˆÓ ÁÓ¿ıˆÓ, ¤Ú· ·fi ÙË ÂÚÈÔ-¯‹ Ù˘ ¿ÌÂÛ˘ ÁÂÈÙÔÓ›·˜ Ì ÙÔ ÂÚÈÚÚ›˙ÈÔ. AÓ·ÊÔÚÈο ÌÂÙÔ˘˜ fiÚÔ˘˜ ÔÛÙÈ΋ ‡ÎÓˆÛË8 Î·È ÂÚÈ·ÎÚÔÚÚÈ˙È΋ Ô-ÛÙÂo‡ÎÓˆÛË16, Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÂÚÈÛÛfiÙÂÚÔÂÚÈÁÚ¿ÊÔ˘Ó ÙËÓ ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Ù˘ ηٿÛÙ·-Û˘ Î·È fi¯È ÙËÓ Ú·ÁÌ·ÙÈ΋ ·ıÔÏÔÁ›· Ù˘, ÁÈ'·˘Ùfi ηÈıˆÚԇ̠fiÙÈ ‰ÂÓ Â›Ó·È Â·ÚΛ˜. K·Ù¿ Û˘Ó¤ÂÈ·, Ë ÂÈ-ÏÔÁ‹ Ú¤ÂÈ Ó· Á›ÓÂÈ ÌÂٷ͇ ÙˆÓ fiÚˆÓ ÔÛÙ½Ùȉ· Î·È Ô-ÛÙÂÔÌ˘ÂÏ›Ùȉ·.K·Ù¿ ÙÔÓ Topazian21, Ô fiÚÔ˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ·Ó·Ê¤ÚÂÙ·ÈÛÙËÓ ÊÏÂÁÌÔÓ‹ ÙÔ˘ Ì˘ÂÏÒ‰Ô˘˜ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÔÛÙÔ‡. B¤-‚·È·, ÂÂȉ‹ ÛÙ· ÔÛÙ¿ ÙˆÓ ÁÓ¿ıˆÓ Ë ÊÏÂÁÌÔÓ‹ οı ÙÌ‹-Ì·ÙÔ˜ (ÊÏÔÈfi˜ - Ì˘ÂÏfi˜ - ÂÚÈfiÛÙÂÔ) Û˘¯Ó¿ ÂËÚ¿˙ÂÈ Î·ÈÙ· ˘fiÏÔÈ· ÂÍ·ÈÙ›·˜ Ù˘ ·Ó·ÙÔÌÈ΋˜ ηٷÛ΢‹˜ ÙˆÓ Ô-ÛÙÒÓ ·˘ÙÒÓ, Û˘Ó‹ıˆ˜ ·Ó·ÊÂÚfiÌ·ÛÙ Ì ÙÔÓ ›‰ÈÔ fiÚÔ ÁÈ·ÙËÓ ÊÏÂÁÌÔÓ‹ Ô˘ ÍÂÎÈÓ¿ ·fi ÙÔÓ Ì˘ÂÏfi Î·È Ù· Û˘ÛÙ‹Ì·-Ù· ÙÔ˘ Havers Î·È ÂÓÙÔ›˙ÂÙ·È ÙfiÛÔ ÛÙÔÓ Ì˘ÂÏfi fiÛÔ Î·ÈÛÙÔ ÊÏÔÈ҉˜ ÔÛÙfi ‹ ·ÎfiÌ· Î·È ÛÙÔ ÂÚÈfiÛÙÂÔ1, 13, 21.ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ fiÚÔ ÔÛÙ½Ùȉ· ·˘Ùfi˜ ·Ó·Ê¤ÚÂÙ·È Î˘-Ú›ˆ˜ Û ÂȉÈΤ˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ .¯. osteitis defor-mans ‹ ÓfiÛÔ˜ ÙÔ˘ Paget, osteitis fibrosa cystica Ô˘ ·-
Ú·ÙËÚÂ›Ù·È ÛÙÔÓ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌfi Î.·.. H ¶.O.Y.ÛÙËÓ Î·Ù¿Ù·ÍË ÙˆÓ ·ı‹ÛˆÓ9 ‰È·¯ˆÚ›˙ÂÈ Û·ÊÒ˜ ÙËÓ Ô-ÛÙ½Ùȉ· (K10.20) ·fi ÙËÓ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ÙˆÓ ÁÓ¿ıˆÓ(K10.21).AÓ·ÙÔÌÈο, Á‡Úˆ ·fi ÙÔ ÛÎÏËÚfi ÂÓ‰ÔÊ·ÙÓÈ·Îfi ¤Ù·ÏÔ(lamina dura) ‚Ú›ÛÎÂÙ·È ÛÔÁÁ҉˘ ÔÛÙ›Ù˘ ÈÛÙfi˜ ÌÂÌ˘ÂÏÔ΢„¤Ï˜, Ô ÔÔ›Ô˜ ·ÔÙÂÏ› Û˘Ó¤¯ÂÈ· ÙÔ˘ ÛÔÁÁÒ-‰Ô˘˜ ÔÛÙÔ‡ ÙˆÓ ÁÓ¿ıˆÓ23. ŒÙÛÈ, ηٿ ÙËÓ ·Ó¿Ù˘ÍË ÌÈ·˜ÂÚÈ·ÎÚÔÚÚÈ˙È΋˜ ÊÏÂÁÌÔÓ‹˜ ÚÒÙ· ÂËÚ¿˙ÂÙ·È ÙÔÛÎÏËÚfi ÂÓ‰ÔÊ·ÙÓÈ·Îfi ¤Ù·ÏÔ (Û˘Ì·Á¤˜ ÔÛÙfi Ì ÂÏ¿¯È-ÛÙ· ΢ÙÙ·ÚÈο ÛÙÔȯ›·). ™Â ·˘Ù‹ ÙËÓ Ê¿ÛË Ë ÊÏÂÁÌÔÓ‹ÌÔÚ› Ó· ÂÚÈÁÚ·Ê› ˆ˜ ÔÛÙ½Ùȉ·. ™ÙË Û˘Ó¤¯ÂÈ· fï˜ÏfiÁˆ Ù˘ ÛÙÂÓ‹˜ ÁÂÈÙÓ›·Û˘ ÙÔ˘ ÛÎÏËÚÔ‡ ÂÓ‰ÔÊ·ÙÓÈ·-ÎÔ‡ ÂÙ¿ÏÔ˘ Ì ÙÔ ÛÔÁÁ҉˜ ÔÛÙfi, Ë ÊÏÂÁÌÔÓ‹ ÂÂ-ÎÙ›ÓÂÙ·È ÛÙȘ ÔÛÙÈΤ˜ ‰ÔΛ‰Â˜ ·˘ÙÔ‡ Î·È ÙȘ Ì˘ÂÏÔ΢„¤-Ϙ Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û·ÊÒ˜ Û·Ó ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·. ŸÏÔÈۯ‰fiÓ ÔÈ Û˘ÁÁÚ·Ê›˜ ıˆÚÔ‡Ó fiÙÈ Û ÂÚÈÙÒÛÂȘ ¯Úfi-ÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ Ô Ì˘Â-Ïfi˜, fiÔ˘ ÂÍ·ÎÔÏÔ˘ı› Ó· ‚Ú›ÛÎÂÙ·È, ÂÌÊ·Ó›˙ÂÈ ÈÓÒ‰Ë ÂÎ-ʇÏÈÛË2, 4, 11 Î·È ¯ÚfiÓÈ· ÊÏÂÁÌÔÓÒ‰Ë ‰È‹ıËÛË ¿ÏÏÔÙ ¿Ï-ÏÔ˘ ‚·ıÌÔ‡4-6, 11, 16, 21. ™ÙȘ Ì˘ÂÏÔ΢„¤Ï˜ ¤ÚÈÍ Ù˘ ·ÏÏÔ›-ˆÛ˘ ÂÍ¿ÏÏÔ˘ ·Ó¢ڛÛÎÂÙ·È Â›Û˘ ¯ÚfiÓÈ· ÊÏÂÁÌÔÓÒ-‰Ë˜ ‰È‹ıËÛË8. MfiÓÔ Ô Boyne22 ·Ó·Ê¤ÚÂÈ ˘ÎÓˆÙÈΤ˜ ·Ï-ÏÔÈÒÛÂȘ Ì ·Ô˘Û›· ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰È‹ıËÛ˘, ÔÈ Ôԛ˜fï˜ Ì ٷ ÛËÌÂÚÈÓ¿ ‰Â‰Ô̤ӷ ›Ûˆ˜ ÌÔÚÔ‡Ó Ó· ¯·Ú·-ÎÙËÚÈÛÙÔ‡Ó ÈÔ ÛˆÛÙ¿ ̂ ˜ ÂÓÔÛÙÒÛÂȘ, fiˆ˜ ı· ·Ó·ÊÂÚ-ı› ·Ú·Î¿Ùˆ.OÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ˘˜ fiÚÔ˘˜ Ô-ÛÙ½Ùȉ· Î·È ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ¯ˆÚ›˜ η̛· ‰È¿ÎÚÈÛË2, 5-7, 11,ÂÓÒ ¿ÏÏÔÈ ÚÔÙÈÌÔ‡Ó ÙÔÓ fiÚÔ ÔÛÙ½Ùȉ·8, 14-16, 18, 24 ‹ ÙÔÓ fi-ÚÔ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·4, 10, 13, 17, 21. K·Ù¿ ÙË ‰È΋ Ì·˜ ¿Ô„Ë, Ô·˘ÛÙËÚfi˜ ‰È·¯ˆÚÈÛÌfi˜ Ù˘ ÔÛÙ½Ùȉ·˜ ·fi ÙËÓ ÔÛÙÂÔ-Ì˘ÂÏ›Ùȉ· ÛÙ· ÔÛÙ¿ ÙˆÓ ÁÓ¿ıˆÓ Â›Ó·È ‰˘Ó·Ùfi˜ ÌfiÓÔ Ì È-ÛÙÔ·ıÔÏÔÁÈο ÎÚÈÙ‹ÚÈ· Î·È ÌÂıfi‰Ô˘˜. EÈϤÔÓ, Ôȉ‡Ô ÔÓÙfiÙËÙ˜ Û˘Ó˘¿Ú¯Ô˘Ó ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜Ù˘ ÂͤÏÈ͢ Ù˘ ·ÏÏÔ›ˆÛ˘ Ì ÎÔÈÓ‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ÕÚ·ÏÔÈfiÓ, ‰Â‰Ô̤Ó˘ Ù˘ ¢ڇÙÂÚ˘ ¤ÓÓÔÈ·˜ Ô˘ ÚÔÛ‰›-‰ÂÙ·È ÛÙÔÓ fiÚÔ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·13, 21 ·ÏÏ¿ Î·È Ù˘ ÙÂÎÌË-ÚȈ̤Ó˘ ·ÚÔ˘Û›·˜ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰È‹ıËÛ˘ÛÙȘ Ì˘ÂÏÔ΢„¤Ï˜ ÂÓÙfi˜ Î·È ¤ÚÈÍ Ù˘ ·ÏÏÔ›ˆÛ˘, ıˆ-Úԇ̠fiÙÈ Ë Î·Ù¿ÛÙ·ÛË ·˘Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È ÈÔ ÛˆÛÙ¿Ì ÙÔÓ fiÚÔ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·.
™Ù·ÙÈÛÙÈο ÛÙÔȯ›·O ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓÂÈÙÚ¤ÂÈ ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ηÈÙËÓ ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ.™ÙËÓ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ̄ ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓËÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ·Ó¢ڛÛÎÂÙ·È ÛÙÔ 2-8%ÙˆÓ ÂÓËϛΈÓ14, 18, 19.OÈ ÂÚÈÙÒÛÂȘ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ-Á·Û›· ·ÊÔÚÔ‡Ó 5 ÚÒÙÔ˘˜ ÁÔÌÊ›Ô˘˜, 2 ‰Â‡ÙÂÚÔ˘˜ ÁÔÌ-Ê›Ô˘˜ Î·È 1 ‰Â‡ÙÂÚÔ ÚÔÁfiÌÊÈÔ, fiÏ· ‰fiÓÙÈ· Ù˘ οوÁÓ¿ıÔ˘. H ÂÓÙfiÈÛË Ù˘ ·ÏÏÔ›ˆÛ˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓοو ÁÔÌÊ›ˆÓ Î·È ÚÔÁÔÌÊ›ˆÓ ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜2, 7, 8, 11-19. H ÚÔÛ‚ÔÏ‹ ÙˆÓ Ô‰fiÓÙˆÓÙ˘ οو ÁÓ¿ıÔ˘ ·ÈÙÈÔÏÔÁÂ›Ù·È ÂӉ¯Ô̤ӈ˜ ÏfiÁˆ Ù˘·Ó·ÙÔÌÈ΋˜ ηٷÛ΢‹˜ Î·È Ù˘ ÌÂÈÔÓÂÎÙÈ΋˜ ·ÈÌ¿Ùˆ-Û˘ ÙÔ˘ ÔÛÙÔ‡ Ù˘ οو ÁÓ¿ıÔ˘ Û ۯ¤ÛË Ì ÙËÓ ¿Óˆ14,
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 98
18. ¶·ÚfiÏ·˘Ù·, Ô EÏ¢ıÂÚÈ¿‰Ë˜17 ·Ó·Ê¤ÚÂÈ Î·È ÂÚ›Ùˆ-ÛË ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ-‰·˜ Û ÚÔÁfiÌÊÈÔ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘. EÚÌËÓ‡ÔÓÙ·˜ ÙËÓ·ÚÈıÌËÙÈ΋ ˘ÂÚÔ¯‹ ÙˆÓ ÚÒÙˆÓ ÁÔÌÊ›ˆÓ, Ê·›ÓÂÙ·È fiÙÈË Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÔÏÊÔ‡ ¤-Ó·˜ ÚÒÙÔ˜ ÁÔÌʛԘ Â›Ó·È ·˘ÍË̤ÓË ÏfiÁˆ Ù˘ ·Ó·ÙÔÏ‹˜ÙÔ˘ Û ÌÈÎÚ‹ ËÏÈΛ·14, ÂÓÒ Ë ÈÛ¯˘Ú‹ ¿Ì˘Ó· ÙˆÓ ·Ùfïӷ˘Ù‹˜ Ù˘ ËÏÈΛ·˜ Ô‰ËÁ› ÛÙË Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË Ù˘ ¯Úfi-ÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ Û·˘Ù¿ Ù· ‰fiÓÙÈ·.™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‰È·ÈÛÙÒıËΠοÔÈ· ‰È·ÊÔÚ¿ÛÙËÓ ÂÌÊ¿ÓÈÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (3 ÂÚÈÙÒÛÂȘÛ ¿Ó‰Ú˜ - 5 ÂÚÈÙÒÛÂȘ Û Á˘Ó·›Î˜). ™ÙËÓ ‚È‚ÏÈÔ-ÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë Î·Ù¿ÛÙ·ÛË ·˘Ù‹ ÂÌÊ·Ó›˙ÂÙ·ÈÛ˘¯ÓfiÙÂÚ· Û Á˘Ó·›Î˜14, 18, ÂӉ¯Ô̤ӈ˜ ÂÍ·ÈÙ›·˜ Ù˘·ÚÔ˘Û›·˜ ÁÂÓÓËÙÈÎÒÓ ÔÚÌÔÓÒÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ Ô-ÛÙÈ΋ ·‡ÍËÛË (ÔÈÛÙÚÔÁfiÓ·)14. ¶¿ÓÙˆ˜, ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜2
˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ.H ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ‹Ù·Ó 20-42 ¤ÙË Ì ̤ÛË ËÏÈΛ·Ù· 31 ¤ÙË. OÈ Eliasson Î·È Û˘Ó.18 ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Â› 34 ·-ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘Â-Ï›Ùȉ·, ÔÈ ËÏÈ˘ Î˘Ì·›ÓÔÓÙ·Ó ÌÂٷ͇ 17-66 ÂÙÒÓ. T· ·-Ú·¿Óˆ ̆ Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ·ÓȯÓ¢ı›Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·. ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ·Ó·Ê¤ÚÔ˘Ó·ÏÒ˜ fiÙÈ Â›Ó·È Û˘¯ÓfiÙÂÚË Û Ó·ڿ ¿ÙÔÌ·6, 13, 15, 17, 19 Ì ÙÔ·ÈÙÈÔÏÔÁÈÎfi Ù˘ ηٿ ÙÂÎÌ‹ÚÈÔ ÈÛ¯˘Ú‹˜ ¿Ì˘Ó·˜ ÙÔ˘ ÔÚ-Á·ÓÈÛÌÔ‡ Û ·˘Ù‹ ÙËÓ ËÏÈΛ·12, 13, 15, 16. ¶ÈÛÙ‡ԢÌ fiÙÈ Ë‚Ï¿‚Ë ·˘Ù‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯ÚÔÓÈfiÙËÙ· Î·È ÌÔÚ›ӷ ¤¯ÂÈ ¤Ó·ÚÍË Û ÓÂÒÙÂÚË ËÏÈΛ· ·ÏÏ¿ Ó· ·Ó·Î·Ï‡ÙÂ-Ù·È ÔÏÏ¿ ̄ ÚfiÓÈ· ·ÚÁfiÙÂÚ·. ¶·ÚfiÏ· ·˘Ù¿, ‰ÂÓ Ê·›ÓÂÙ·ÈÓ· ÂÌÊ·Ó›˙ÂÙ·È Û ¿ÙÔÌ· ·È‰È΋˜ ‹ ÚÒÈÌ˘ ÂÊË‚È΋˜ËÏÈΛ·˜, ‰ÈfiÙÈ ÔÈ ÁÔÌÊ›ÔÈ Î·È ÚÔÁfiÌÊÈÔÈ Ù˘ οو ÁÓ¿-ıÔ˘ ·Ó·Ù¤ÏÏÔ˘Ó ÌÂÙ¿ ÙÔ 6Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ Î·È ··ÈÙ›-Ù·È ÈηÓfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÒÛÙ ӷ ÙÂÚˉÔÓÈÛÙÔ‡Ó Î·ÈÓ· ÂÌÊ·Ó›ÛÔ˘Ó ÔÏÊÈ΋ ÊÏÂÁÌÔÓ‹. MfiÓÔ ÔÈ Caliskan ηÈÛ˘Ó.20 ·Ó·Ê¤ÚÔ˘Ó ÂÚ›ÙˆÛË ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ Û ÎÔÚ›ÙÛÈ 9 ÂÙÒÓ.
¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛËH ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ‰ÂÓÂ›Ó·È Ê˘ÛÈο Ë ÌfiÓË ÔÛÙÂÔÛÎÏËÚ˘ÓÙÈ΋ ηٿÛÙ·ÛË Ô˘ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ÔÛÙ¿ ÙˆÓ ÁÓ¿ıˆÓ. ŒÙÛÈ, Û οı ٤ÙÔÈ·ÂÚ›ÙˆÛË Ô Ô‰ÔÓÙ›·ÙÚÔ˜ ÔÊ›ÏÂÈ Ó· Ï¿‚ÂÈ ˘fi„Ë ÙÔ˘Î·È ¿ÏϘ ηٷÛÙ¿ÛÂȘ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ·ÚfiÌÔÈ·ÂÈÎfiÓ·, ÒÛÙ ӷ ηٷϋÍÂÈ Û ÔÚı‹ ‰È¿ÁÓˆÛË. H ÂÓfiÛÙˆÛË ‹ ȉÈÔ·ı‹˜ ÂÚÈ·ÎÚÔÚÚÈ˙È΋ ÔÛÙÂÔÛÎÏ‹-Ú˘ÓÛË (idiopathic periapical osteosclerosis) (EÈÎ. 9) ·Ô-ÙÂÏ› Ì›· ȉÈÔ·ı‹ ηٿÛÙ·ÛË Û·ÊÒ˜ ÌË ÔÏÊÈ΋˜ ·È-ÙÈÔÏÔÁ›·˜, Ë ÔÔ›· ÔÌÔÈ¿˙ÂÈ ·ÎÙÈÓÔÁÚ·ÊÈο Ì ÙËÓ ¯Úfi-ÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· Î·È ÂÌÊ·-Ó›˙ÂÙ·È Ì ÙË ÌÔÚÊ‹ ˘ÎÓ¿ ‰È·ÙÂÙ·ÁÌ¤ÓˆÓ ÔÛÙÈÎÒÓ ‰ÔΛ-‰ˆÓ (Û·ÊÒ˜ ˘ÎÓfiÙÂÚˆÓ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÔÛÙfi) ÌÂÛ·Ê‹ fiÚÈ·, ¯ˆÚ›˜ Ó· Û¯ÂÙ›˙ÂÙ·È Û˘Ó‹ıˆ˜ Ì ٷ ‰fiÓÙÈ· ‹ÙÔ ÂÚÈÔ‰fiÓÙÈÔ. IÛÙÔÏÔÁÈο, Û ·ÏÏÔÈÒÛÂȘ ·˘Ù‹˜ Ù˘ηÙËÁÔÚ›·˜ ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È ÊÏÂÁÌÔÓÒ‰Ë ÛÙÔȯ›·10.EÌÊ·Ó›˙ÂÙ·È, ηٿ ÙÔ˘˜ Marmary & Kutiner14, Û ÔÛÔ-ÛÙfi ÂÚ›Ô˘ 8,4% ÙˆÓ ÂÓËϛΈÓ, ‹ ηٿ ÙÔ˘˜ Geist &Katz25 Û ÔÛÔÛÙfi ÂÚ›Ô˘ 5%. ™Â Ù¤ÙÔȘ ÂÚÈÙÒÛÂȘ,
·ÊÔ‡ Û˘ÓÂÎÙÈÌËı› Ë ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ·, Ë ‰È¿ÁÓˆÛËÙ›ıÂÙ·È ÌÂÙ¿ ·fi ‰ÔÎÈÌ·Û›· ̇ ˆÙÈÎfiÙËÙ·˜ ÙˆÓ ·Ú·ÎÂÈ̤-ÓˆÓ ‰ÔÓÙÈÒÓ, Ô ÔÏÊfi˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ˙ˆÓÙ·Ófi˜2, 5, 6, 11,
16, 19, 21 ÂÎÙfi˜ Î·È ·Ó Û˘Ó˘¿Ú¯ÂÈ ¿ÏÏË ·ÈÙ›·, ÔfiÙ ‰ËÌÈ-Ô˘ÚÁÂ›Ù·È ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ·. K·Ì›· ıÂڷ¢ÙÈ΋·Ú¤Ì‚·ÛË ‰ÂÓ ··ÈÙ›ٷÈ2, 5, 6, 11, 16, 19, 21 ÏËÓ ›Ûˆ˜ Ù˘ ·-Ï‹˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Û ÂÚÈÙÒÛÂȘ ·ÌÊÈ‚ÔÏÈÒÓ.M›· ¿ÏÏË Î·Ù¿ÛÙ·ÛË Ë ÔÔ›· Ú¤ÂÈ, ›Û˘, Ó· Ï·Ì‚¿-ÓÂÙ·È ˘fi„Ë Â›Ó·È Ë ÂÚÈ·ÎÚÔÚÚÈ˙È΋ ÔÛÙÂ˚ÓÔ-ÔÛÙÈ΋ ‰˘-ÛÏ·Û›· (periapical cemento-osseous dysplasia) Û ÂÓ-‰È¿ÌÂÛÔ ‹ ÚÔ¯ˆÚË̤ÓÔ ÛÙ¿‰ÈÔ, Ë ÔÔ›· ÔÌÔÈ¿˙ÂÈ ·ÎÙÈ-ÓÔÁÚ·ÊÈο Ì ÙËÓ ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ Ô-ÛÙÂÔÌ˘ÂÏ›Ùȉ·26. EÌÊ·Ó›˙ÂÙ·È Û ÔÛÔÛÙfi 0,5% ÙˆÓ ÂÓË-ϛΈÓ14. H ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ¯·Ú·-ÎÙËÚÈÛÙÈ΋ ·ÎÙÈÓÔÁÚ·ÊÈ΋ Ù˘ ÂÈÎfiÓ· (·ÎÙÈÓÔÛÎÈÂÚ‹ ·Ï-ÏÔ›ˆÛË Ô˘ ÂÚÈ‚¿ÏÏÂÙ·È ÛÙ· fiÚÈ· ·fi ·ÎÙÈÓԉȷÂÚ·-Ù‹ ÁÚ·ÌÌ‹)14, 19 Î·È ÛÙËÓ ˙ˆÙÈÎfiÙËÙ· ÙÔ˘ ÔÏÊÔ‡ ÙˆÓ ·-ڷΛÌÂÓˆÓ ‰ÔÓÙÈÒÓ19, 26. O Waldron26 ·Ó·Ê¤ÚÂÈ fiÙÈ Ë Î·-Ù¿ÛÙ·ÛË ·˘Ù‹ Â›Ó·È Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈ΋. ¶·ÚÔ˘-ÛÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË ÂÚÈÔ¯‹ ÙˆÓ Î¿Ùˆ ÚÔÛı›ˆÓ ‰Ô-ÓÙÈÒÓ Û Á˘Ó·›Î˜ AÊÚÈηÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È Û˘Ó‹ıˆ˜ÂÓÙÔ›˙ÔÓÙ·È ÔÏϷϤ˜ ·ÏÏÔÈÒÛÂȘ19. EӉ›ÎÓ˘Ù·È ÌfiÓÔË ·Ï‹ ·Ú·ÎÔÏÔ‡ıËÛË ·˘ÙÒÓ ÙˆÓ ÂÚÈÙÒÛˆÓ26. ™Â ÂÚÈÙÒÛÂȘ ˘ÂÚÔÛÙÂ˝ÓˆÛ˘ (hypercementosis)(EÈÎ.10), Ë ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Ê·ÓÂÚÒÓÂÈ fiÙÈ ‰È·ÙË-ÚÂ›Ù·È Ë Ê˘ÛÈÔÏÔÁÈ΋ ‰È·‡Á·ÛË ÙÔ˘ ÂÚÈÚÚÈ˙ÈÎÔ‡ ¯ÒÚÔ˘Ô˘ ÂÚÈ‚¿ÏÂÈ Î·È ÙËÓ ·ÏÏÔ›ˆÛË, ·ÓÙ›ıÂÙ· ·fi fi,ÙÈ ÛÙËÓ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·. TÔ‡ÚËÌ· ·˘Ùfi ̆ Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ·ÓÒÌ·ÏË ÔÛÙ½ÓË Â›Ó·È ·-Ó·fiÛ·ÛÙÔ ÙÌ‹Ì· Ù˘ Ú›˙·˜ ÙÔ˘ ‰ÔÓÙÈÔ‡, ‰›ÓÔÓÙ·˜ ÙËÓ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÈÎfiÓ· «Ï‹ÎÙÚÔ˘ Ù˘Ì¿ÓÔ˘»16, 19. ¢ÂÓ ·-·ÈÙÂ›Ù·È Î¿ÔÈ· ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ÂÎÙfi˜ Î·È·Ó Û˘Ó˘¿Ú¯ÂÈ Ó¤ÎÚˆÛË ÙÔ˘ ÔÏÊÔ‡ ‹/Î·È ÂÚÈ·ÎÚÔÚÚÈ-˙È΋ ÊÏÂÁÌÔÓ‹. H ÂÚÈ·ÎÚÔÚÚÈ˙È΋ ÊÏÂÁÌÔÓ‹ ·Ó·Ê¤ÚÂ-Ù·È ˆ˜ Èı·Ó‹ ·ÈÙ›· ˘ÂÚÔÛÙÂ˝ÓˆÛ˘4, 16, 19.¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Â›Û˘ Ó· Á›ÓÂÈ Î·È ·fi ÙÔ Î·-ÏfiËı˜ ÔÛÙÂ˚ÓÔ‚Ï¿Ûو̷, ÙÔ ÔÔ›Ô ·Ó¢ڛÛÎÂÙ·È ÈÔ Û˘-
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BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
EÈÎ. 9: ¶ÂÚ›ÙˆÛË ÂÓfiÛÙˆÛ˘. H ·ÏÏÔ›ˆÛË ¤¯ÂÈ Û·Ê‹ fiÚÈ·. O 35·ÓÙ¤‰Ú·ÛÂ Ê˘ÛÈÔÏÔÁÈο ÛÙȘ ‰ÔÎÈ̷ۛ˜ ˙ˆÙÈÎfiÙËÙ·˜.
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 99
¯Ó¿ ÛÙËÓ Ô›ÛıÈ· ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘ Û Ó·ڿ ¿ÙÔ-Ì· (<20 ÂÙÒÓ) Î·È ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó· ÚÔηÏ› ‰ÈfiÁΈÛË ÙÔ˘ÔÛÙÔ‡ Ù˘ οو ÁÓ¿ıÔ˘. O ÔÏÊfi˜ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ‰Ô-ÓÙÈÒÓ ‰È·ÙËÚ› ÙËÓ ˙ˆÙÈÎfiÙËÙ¿ ÙÔ˘. AÎÙÈÓÔÁÚ·ÊÈο, Ô fi-ÁÎÔ˜ ÂÚÈ‚¿ÏÏÂÈ ÙË Ú›˙· ÙÔ˘ ‰ÔÓÙÈÔ‡, ÚÔηÏ› Û˘¯Ó¿ ÙËÓ·ÔÚÚfiÊËÛ‹ Ù˘ Î·È ÙÔ fiÚÈÔ ÌÂٷ͇ Ù˘ Ú›˙·˜ Î·È Ù˘ ·Ï-ÏÔ›ˆÛ˘ ‰ÂÓ ‰È·ÁÚ¿ÊÂÙ·È Ì ۷ʋÓÂÈ·5, 16, 19, 24.T¤ÏÔ˜, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔ˘ÌÂ Î·È ÔÚÈṲ̂Ó˜ ÈÔ Û¿ÓȘÌÔÚʤ˜ ÓÔÛËÌ¿ÙˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ÙË ÌÔÚÊ‹ÛÎÏËÚ˘ÓÙÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ ÙˆÓ ÁÓ¿ıˆÓ, fiˆ˜ ÁÂÓÈο ‹Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· (ÓfiÛÔ˜ ÙÔ˘ Paget, ÔÛÙÂÔ¤ÙÚˆ-ÛË Î.·.)4, 27 ‹ fiÁÎˆÓ fiˆ˜ Ë ÈÓ҉˘ ‰˘ÛÏ·Û›·, ÙÔ ÔÛÙÂÔ-ÔÈÔ‡ÌÂÓÔ ›ÓˆÌ· Î·È ¿ÏÏÔÈ Î·ÏÔ‹ıÂȘ fiÁÎÔÈ28 Î·È ·fi ÙÔ˘˜Î·ÎÔ‹ıÂȘ fiÁÎÔ˘˜ Ô ÔÛÙÂÔ‚Ï·ÛÙÈÎfi˜ Ù‡Ô˜ ÙÔ˘ ÔÛÙÂÔ-Û·ÚÎÒÌ·ÙÔ˜ Î·È ÔÈ ÔÛÙÂÔ‚Ï·ÛÙÈΤ˜ ÌÂÙ·ÛÙ·ÙÈΤ˜ ‚Ï¿‚Â˜ÙˆÓ ÁÓ¿ıˆÓ ηÚΛÓÔ˘ ÙÔ˘ ÚÔÛÙ¿ÙË, ÙÔ˘ Ì·ÛÙÔ‡ Î·È ÙÔ˘Ó‡ÌÔÓ·17. H ·ÎÚÈ‚‹˜ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ ÙˆÓ·Ú·¿Óˆ ÓÔÛËÌ¿ÙˆÓ ÍÂʇÁÂÈ ·fi Ù· fiÚÈ· ·˘Ù‹˜ Ù˘ ·-Ó·ÛÎfiËÛ˘. °ÂÓÈο, fï˜, Ë ÌË ·Ó‡ÚÂÛË ÚÔÊ·ÓÔ‡˜ÔÏÊÈÎÔ‡ ·ÈÙ›Ô˘ ÁÈ· Ì›· ÔÛÙÂÔÛÎÏËÚ˘ÓÙÈ΋ ·ÏÏÔ›ˆÛËÚ¤ÂÈ Ó· Ô‰ËÁ‹ÛÂÈ ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ Û ÈÔ ÚÔÛÂÎÙÈ΋ ·-ÍÈÔÏfiÁËÛË Ù˘ ÎÏÈÓÈ΋˜ Î·È ·ÎÙÈÓÔÁÚ·ÊÈ΋˜ ÂÈÎfiÓ·˜.
£Âڷ›·¶·ÚfiÏÔ Ô˘ Ë ¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔ-Ì˘ÂÏ›Ùȉ· ·ÔÙÂÏ› Û˘¯Ó¿ ÌÈ· ·Û˘Ìو̷ÙÈ΋ ηٿÛÙ·-ÛË, Ë ÔÏÊÈ΋ Ù˘ ·ÈÙÈÔÏÔÁ›· ÂÈ‚¿ÏÏÂÈ ÙËÓ ıÂڷ¢ÙÈ΋·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡ Û οı ÂÚ›ÙˆÛË.MÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂÒÓ Ì·˜, ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· ·-ÎÔÏÔ‡ıËÛ Û 2 ÂÚÈÙÒÛÂȘ fiÔ˘ ‰È·ÁÓÒÛÙËΠ¯ÚfiÓÈ·ÔÏÊÈ΋ ÊÏÂÁÌÔÓ‹ ‹ Ó¤ÎÚˆÛË ÙÔ˘ ÔÏÊÔ‡ Î·È Â·Ó¿ÏË-„Ë ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂڷ›·˜ Û 2 ÂÚÈÙÒÛÂȘ ·ÙÂÏÒÓÂÓ‰Ô‰ÔÓÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¯ÚfiÓÈ·˜ Â-ÚÈ·ÎÚÔÚÚÈ˙È΋˜ ÊÏÂÁÌÔÓ‹˜. H ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¯Úfi-ÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· Û˘Ó›ÛÙ·Ù·È ·fi ÔÏÏÔ‡˜ Û˘Á-ÁÚ·Ê›˜2, 5-8, 11-19, 27. AÎfiÌË, ÔÈ OÈÎÔÓfiÌÔ˘ & ™›ÛÎÔ˜16 ÚÔ-Ù›ÓÔ˘Ó Û ÂÚÈÙÒÛÂȘ ‰ÔÓÙÈÒÓ Ì ˙ˆÓÙ·Ófi ÔÏÊfi ηÈÛ˘ÓÙËÚËÙÈ΋ ıÂڷ›· (ÔÏÊÔÙÔÌ‹).™Â Ì›· ÂÚ›ÙˆÛË ¤ÁÈÓ ÂÍ·ÁˆÁ‹ ÙÔ˘ ‰ÔÓÙÈÔ‡ ÏfiÁˆ ÌËÛ˘ÓÂÚÁ·Û›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ·ÚÔ˘Û›·˜ ¤ÓÙÔÓˆÓ Û˘-Ìو̿وÓ. H ÂÍ·ÁˆÁ‹ ÙÔ˘ ˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡ ·Ó·Ê¤ÚÂ-Ù·È ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË Û ÂÚÈÙÒÛÂȘ Ô˘ Ë ÂÓ‰Ô‰Ô-ÓÙÈ΋ ıÂڷ›· ·ÓÙÂӉ›ÎÓ˘Ù·È (fiˆ˜ Û ·‰˘Ó·Ì›· ÚÔ-ÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘ ÙÔ˘ ‰ÔÓÙÈÔ‡ ÏfiÁˆ ÂÎÙÂٷ̤-
Ó˘ ηٷÛÙÚÔÊ‹˜) ‹ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹12, 17.™Â 3 ÂÚÈÙÒÛÂȘ ÔÈ ·ÛıÂÓ›˜ Ù¤ıËÎ·Ó Û ·Ú·ÎÔÏÔ‡ıË-ÛË. K·Ù¿ ÙËÓ ¿Ô„‹ Ì·˜, ‰ÂÓ ÂӉ›ÎÓ˘Ù·È Î¿ÔÈ· ·Ú¤Ì-‚·ÛË Û ÂÚÈÙÒÛÂȘ ¯ÚfiÓÈ·˜ ÂÓÙÔÈṲ̂Ó˘ ÛÎÏËÚ˘ÓÙÈ-΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ Ô˘ ·Ó¢ڛÛÎÔÓÙ·È Û ‰fiÓÙÈ· Ì È-ηÓÔÔÈËÙÈ΋ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· ηıfiÙÈ Ë ·ÏÏÔ›ˆÛËÌÔÚ› Ó· ‚Ú›ÛÎÂÙ·È Û ÛÙ¿‰ÈÔ ÂԇψÛ˘. AÎfiÌË, Ë ·-ÎÚÔÚÚÈ˙ÂÎÙÔÌ‹ Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ·ÏÏÔ›ˆ-Û˘ ÁÂÓÈο ‰ÂÓ ÂӉ›ÎÓ˘Ù·È12, 17, ‰ÈfiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÌË ·-ıÔÏÔÁÈÎfi (·ÓÙȉڷÛÙÈÎfi) ÈÛÙfi Ô ÔÔ›Ô˜ ÌÔÚ› Ó· ·-Ó¤ÏıÂÈ ÌÂÙ¿ ÙËÓ ¿ÚÛË ÙÔ˘ ·ÈÙ›Ô˘ ÛÙËÓ Ê˘ÛÈÔÏÔÁÈ΋ ÔÛÙÈ-΋ ‰ÔÌ‹ Ù˘ ÂÚÈÔ¯‹˜2, 5, 6, 14, 18. TÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ̤۷ ÛÙÔ ÔÔ›Ô Ë ·ÏÏÔ›ˆÛË ÂÔ˘-ÏÒÓÂÙ·È ÔÈΛÏÂÈ7, 8, 11, 18, ÂÓÒ Ë ·ÔηٿÛÙ·ÛË ÌÔÚ› Ó·ÌËÓ Â›Ó·È Ï‹Ú˘8, 18. OÈ Eliasson Î·È Û˘Ó.18 ·Ó·Ê¤ÚÔ˘Ó fiÙÈÂÚ›Ô˘ ÙÔ 85% ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ÂÏ·ÙÙÒÓÔÓÙ·È Û ̤ÁÂ-ıÔ˜ ‹ ÂÍ·Ê·Ó›˙ÔÓÙ·È Ì¤Û· Û ‰È¿ÛÙËÌ· 4-5 ÂÙÒÓ ÌÂÙ¿ ÙËÓÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· Î·È ÙÔ ÂÚÈÚÚ›˙ÈÔ Â·Ó¤Ú¯ÂÙ·ÈÛÙËÓ Ê˘ÛÈÔÏÔÁÈ΋ ‰ÔÌ‹ ÙÔ˘. E›Û˘, ̆ ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ¤-Ó· ÔÛÔÛÙfi ·ÏÏÔÈÒÛÂˆÓ ‰ÂÓ ı· ·ӤÏıÂÈ ÛÙËÓ Ê˘ÛÈÔ-ÏÔÁÈ΋ ÔÛÙÈ΋ ‰ÔÌ‹ ·ÎfiÌË Î·È ÌÂÙ¿ ·fi lege artis ÂÓ‰Ô-‰ÔÓÙÈ΋ ıÂڷ›·, ηıfiÙÈ Ë ÔÈfiÙËÙ· Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ıÂڷ›·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂԇψÛËÙ˘ ·ÏÏÔ›ˆÛ˘18. °È· ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ÂÎÊÚ¿˙ÂÙ·È Ë¿Ô„Ë ·fi ÔÚÈṲ̂ÓÔ˘˜ Û˘ÁÁÚ·Ê›˜ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Â-ÓÔÛÙÒÛÂȘ Ô˘ Ù˘¯·›· ·Ó·Ù‡ÛÛÔÓÙ·È ÎÔÓÙ¿ Û ‰fiÓÙÈ·Ì ÔÏÊÈ΋ ·ıÔÏÔÁ›·29. ¶¿ÓÙˆ˜, ·ÎfiÌ· Î·È ·Ó Ë ·ÏÏÔ›ˆ-ÛË ·Ú·Ì›ÓÂÈ ÌÂÙ¿ ÙËÓ ıÂڷ›·, ‰ÂÓ ÚÔ·ÙÂÈ Î·Ó¤Ó·Úfi‚ÏËÌ· Ô‡Ù ÂËÚ¿˙ÂÙ·È Ë ÚfiÁÓˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡7.MÔÓ·‰È΋ ÂÚ›ÙˆÛË ÛÙËÓ ÔÔ›· ÂӉ›ÎÓ˘Ù·È ¯ÂÈÚÔ˘ÚÁÈ-΋ ·Ê·›ÚÂÛË ÙÔ˘ ÛÎÏËÚ˘ÓÙÈÎÔ‡ ÔÛÙÔ‡ Â›Ó·È fiÙ·Ó ̆ ¿Ú¯ÂȤÓÙÔÓË ÂÈ̤ÓÔ˘Û· Û˘Ìو̷ÙÔÏÔÁ›·15, 17.
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3. H ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ÛÙËÚ›˙ÂÙ·È ÙfiÛÔ ÛÙ· ÎÏÈÓÈο fi-ÛÔ Î·È ÛÙ· ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·. H ‰È·ÊÔÚÈ΋‰È¿ÁÓˆÛË ·fi ηٷÛÙ¿ÛÂȘ Ì ·ÚfiÌÔÈ· ÂÈÎfiÓ· Á›ÓÂ-Ù·È Î˘Ú›ˆ˜ Ì ‰ÔÎÈ̷ۛ˜ ˙ˆÙÈÎfiÙËÙ·˜ ÙÔ˘ ÔÏÊÔ‡ÙÔ˘ Û¯ÂÙÈ˙fiÌÂÓÔ˘ ‰ÔÓÙÈÔ‡.
4. £Âڷ›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· ÙÔ˘˘·›ÙÈÔ˘ ‰ÔÓÙÈÔ‡. XÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ‚Ï¿‚˘‰ÂÓ ··ÈÙ›ٷÈ.
5. MÂÙ¿ ÙËÓ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›·, Û˘¯Ó¿ ÔÈ ·ÏÏÔÈÒÛÂȘÂÏ·ÙÙÒÓÔÓÙ·È Û ̤ÁÂıÔ˜ ‹ ÂÍ·Ê·Ó›˙ÔÓÙ·È, Û ¯ÚÔÓÈ-Îfi ‰È¿ÛÙËÌ· Ô˘ ÔÈΛÏÂÈ. H ·Ú·ÌÔÓ‹ ÙÔ˘˜, ̂ ÛÙfiÛÔ,‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÚfiÁÓˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡.
6. O fiÚÔ˜ «¯ÚfiÓÈ· ÂÓÙÔÈṲ̂ÓË ÛÎÏËÚ˘ÓÙÈ΋ ÔÛÙÂÔÌ˘Â-Ï›Ùȉ·» ÂÚÈÁÚ¿ÊÂÈ Ì ÌÂÁ·Ï‡ÙÂÚË ·ÎÚ›‚ÂÈ· ·fi ÙÔ˘˜˘fiÏÔÈÔ˘˜ ÚÔÙÂÈÓfiÌÂÓÔ˘˜ fiÚÔ˘˜ ÙËÓ Î·Ù¿ÛÙ·ÛË·˘Ù‹.
100
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
EÈÎ. 10: A. ™ÙÔ ·ÎÚÔÚÚÈ˙ÈÎfi ÙÚÈÙËÌfiÚÈÔ ÙˆÓ 44 Î·È 45 ·Ú·ÙËÚÂ›Ù·È˘ÂÚÔÛÙÂ˝ÓˆÛË. O ÔÏÊfi˜ ÙÔ˘ 45 Â›Ó·È ÓÂÎÚfi˜ ÂÓÒ Ô 44 ·ÓÙÈ‰Ú¿Ê˘ÛÈÔÏÔÁÈο ÛÙË ‰ÔÎÈÌ·Û›· ˙ˆÙÈÎfiÙËÙ·˜. B. AÎÙÈÓÔÁÚ·Ê›· Ù˘ ›-‰È·˜ ÂÚÈÔ¯‹˜ 4 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂڷ›· ÙÔ˘ 45.
93-101 ÛÂÏ. - Boutsioukis** 3-10-08 12:55 ™ÂÏ›‰· 100
SUMMARY
"Chronic focal sclerosing osteomyelitis: Reportof 8 cases and review of the literature"C. Boutsioukis, S. Dalambiras, A. Boutsioukis
hellenic stomatological review 48: 93-101 2004
Chronic focal sclerosing osteomyelitis is a relatively rareradiographic finding during the ordinary clinical practice.When it comes up, it often causes a diagnostic problem,especially to the less experienced dentist. In this paperwe present a series of cases with chronic focal sclerosingosteomyelitis and, on this basis, we try a review of theliterature concerning this topic. The pathogenesis, theclinical and radiographic findings, the differentialdiagnosis from similar lesions and the possible treatmentalternatives are also discussed. In conclusion, the pulpalinfection was the main cause of the disease in all of ourcases. Furthermore, the relatively young patients, with anaverage of 31 years old, support the idea of the strongimmune response of the bone in the area.
Key words: chronic focal sclerosing osteomyelitis, condensingosteitis.
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101ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 48: 93-101, 2004
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