TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
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<strong>TEYXOS</strong> <strong><strong>17</strong>2</strong> 3/<strong>17</strong>/<strong>09</strong> <strong>11</strong>:14 <strong>AM</strong> <strong>Page</strong> 56<br />
Σ Υ Ν Τ Ο Μ Η Ε Ν Η Μ Ε Ρ Ω Σ Η<br />
Οι νοσοκο<strong>μ</strong><strong>ε</strong>ι<strong>α</strong>κοί<br />
γι<strong>α</strong>τροί θ<strong>α</strong> πρέπ<strong>ε</strong>ι<br />
ν<strong>α</strong> π<strong>ε</strong>ριορίσουν τη<br />
χρήση <strong>μ</strong>όνι<strong>μ</strong>ων<br />
κ<strong>α</strong>θ<strong>ε</strong>τήρων <strong>μ</strong>όνο<br />
στους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
συγκ<strong>ε</strong>κρι<strong>μ</strong>έν<strong>ε</strong>ς<br />
ι<strong>α</strong>τρικές <strong>ε</strong>νδ<strong>ε</strong>ίξ<strong>ε</strong>ις.<br />
56 / MEDICAL EXPRESS / TEYXOΣ <strong><strong>17</strong>2</strong> / ΜΑΡΤΙΟΣ 20<strong>09</strong><br />
συγκ<strong>ε</strong>κρι<strong>μ</strong>ένη ι<strong>α</strong>τρική ένδ<strong>ε</strong>ιξη γι<strong>α</strong> την<br />
τοποθέτηση κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong>, το 14% υποβλήθηκ<strong>ε</strong><br />
σ<strong>ε</strong> τοποθέτηση <strong>μ</strong>ονί<strong>μ</strong>ου κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong><br />
<strong>ε</strong>ντός 48 ωρών <strong>α</strong>πό την <strong>ε</strong>ισ<strong>α</strong>γωγή του<br />
στο νοσοκο<strong>μ</strong><strong>ε</strong>ίο. Όπως ήτ<strong>α</strong>ν <strong>α</strong>ν<strong>α</strong><strong>μ</strong><strong>ε</strong>νό<strong>μ</strong><strong>ε</strong>νο,<br />
οι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς στους οποίους <strong>ε</strong>ίχ<strong>ε</strong> τοποθ<strong>ε</strong>τηθ<strong>ε</strong>ί<br />
κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong>ς ήτ<strong>α</strong>ν πιο <strong>ε</strong>πιβ<strong>α</strong>ρυ<strong>μ</strong>ένοι<br />
<strong>α</strong>πό <strong>ε</strong>κ<strong>ε</strong>ίνους χωρίς κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong> κ<strong>α</strong>ι<br />
υπήρχ<strong>ε</strong> <strong>μ</strong><strong>ε</strong>γ<strong>α</strong>λύτ<strong>ε</strong>ρη πιθ<strong>α</strong>νότητ<strong>α</strong> ν<strong>α</strong> <strong>α</strong>ποβιώσουν<br />
στο νοσοκο<strong>μ</strong><strong>ε</strong>ίο (6,6% έν<strong>α</strong>ντι<br />
1,5%). Σ<strong>ε</strong> <strong>μ</strong>ι<strong>α</strong> πολυπ<strong>α</strong>ρ<strong>α</strong>γοντική <strong>α</strong>νάλυση<br />
που προσ<strong>α</strong>ρ<strong>μ</strong>όστηκ<strong>ε</strong> γι<strong>α</strong> πιθ<strong>α</strong>νούς<br />
συγχυτικούς π<strong>α</strong>ράγοντ<strong>ε</strong>ς (συ<strong>μ</strong>π<strong>ε</strong>ριλ<strong>α</strong><strong>μ</strong>β<strong>α</strong>νο<strong>μ</strong>ένων<br />
κ<strong>α</strong>ι των συνοδών νοσηρότητ<strong>α</strong>ς,<br />
τις γνωσι<strong>α</strong>κές δι<strong>α</strong>τ<strong>α</strong>ρ<strong>α</strong>χές κ<strong>α</strong>ι τις<br />
λ<strong>ε</strong>ιτουργικές δι<strong>α</strong>τ<strong>α</strong>ρ<strong>α</strong>χές), οι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong><br />
κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong> <strong>ε</strong>ίχ<strong>α</strong>ν σ<strong>ε</strong> στ<strong>α</strong>τιστικά ση<strong>μ</strong><strong>α</strong>ντικό<br />
β<strong>α</strong>θ<strong>μ</strong>ό υψηλότ<strong>ε</strong>ρ<strong>α</strong> ποσοστά θνησι<strong>μ</strong>ότητ<strong>α</strong>ς<br />
<strong>ε</strong>ντός 90 η<strong>μ</strong><strong>ε</strong>ρών <strong>α</strong>πό την έξοδό τους<br />
<strong>α</strong>πό το νοσοκο<strong>μ</strong><strong>ε</strong>ίο, σ<strong>ε</strong> σύγκριση <strong>μ</strong><strong>ε</strong> τους<br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς χωρίς κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong>. Μι<strong>α</strong> <strong>α</strong>νάλυση<br />
της τάσης – <strong>μ</strong>ι<strong>α</strong> άλλη <strong>μ</strong>έθοδος <strong>α</strong>ντι<strong>μ</strong><strong>ε</strong>τώπισης<br />
των πιθ<strong>α</strong>νών συγχυτικών π<strong>α</strong>ρ<strong>α</strong>γόντων<br />
λόγω των <strong>α</strong>ρχικών δι<strong>α</strong>φορών <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>ξύ<br />
των ο<strong>μ</strong>άδων – έδωσ<strong>ε</strong> τ<strong>α</strong> ίδι<strong>α</strong> <strong>α</strong>ποτ<strong>ε</strong>λέσ<strong>μ</strong><strong>α</strong>τ<strong>α</strong>.<br />
Σχόλιο: Η <strong>μ</strong><strong>ε</strong>λέτη <strong>α</strong>υτή έχ<strong>ε</strong>ι <strong>α</strong>ρκ<strong>ε</strong>τούς<br />
π<strong>ε</strong>ριορισ<strong>μ</strong>ούς: δι<strong>ε</strong>ν<strong>ε</strong>ργήθηκ<strong>ε</strong> σ<strong>ε</strong> έν<strong>α</strong> <strong>μ</strong>όνο<br />
νοσοκο<strong>μ</strong><strong>ε</strong>ίο, δ<strong>ε</strong>ν <strong>α</strong>ν<strong>α</strong>λύθηκ<strong>α</strong>ν τ<strong>α</strong> <strong>α</strong>ίτι<strong>α</strong><br />
θ<strong>α</strong>νάτου, <strong>ε</strong>νώ <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> υπάρχουν <strong>ε</strong>ν<strong>α</strong>πο<strong>μ</strong><strong>ε</strong>ίν<strong>α</strong>ντ<strong>ε</strong>ς<br />
συγχυτικοί π<strong>α</strong>ράγοντ<strong>ε</strong>ς <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>ξύ<br />
των <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βλητών που δ<strong>ε</strong> <strong>μ</strong><strong>ε</strong>τρήθηκ<strong>α</strong>ν.<br />
Ωστόσο, τ<strong>α</strong> <strong>α</strong>ποτ<strong>ε</strong>λέσ<strong>μ</strong><strong>α</strong>τ<strong>α</strong> <strong>ε</strong>ίν<strong>α</strong>ι <strong>ε</strong>υλογοφ<strong>α</strong>νή,<br />
<strong>α</strong>ν λάβου<strong>μ</strong><strong>ε</strong> υπόψιν τις ήδη γνωστές<br />
π<strong>α</strong>ρ<strong>ε</strong>νέργ<strong>ε</strong>ι<strong>ε</strong>ς των <strong>μ</strong>όνι<strong>μ</strong>ων κ<strong>α</strong>θ<strong>ε</strong>τήρων<br />
(π.χ. λοί<strong>μ</strong>ωξη, τρ<strong>α</strong>υ<strong>μ</strong><strong>α</strong>τισ<strong>μ</strong>ός της<br />
ουρήθρ<strong>α</strong>ς, π<strong>ε</strong>ριορισ<strong>μ</strong>ός κινήσ<strong>ε</strong>ων του<br />
<strong>α</strong>σθ<strong>ε</strong>νούς). Οι νοσοκο<strong>μ</strong><strong>ε</strong>ι<strong>α</strong>κοί γι<strong>α</strong>τροί θ<strong>α</strong><br />
πρέπ<strong>ε</strong>ι ν<strong>α</strong> π<strong>ε</strong>ριορίσουν τη χρήση <strong>μ</strong>όνι<strong>μ</strong>ων<br />
κ<strong>α</strong>θ<strong>ε</strong>τήρων <strong>μ</strong>όνο στους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς<br />
<strong>μ</strong><strong>ε</strong> συγκ<strong>ε</strong>κρι<strong>μ</strong>έν<strong>ε</strong>ς ι<strong>α</strong>τρικές <strong>ε</strong>νδ<strong>ε</strong>ίξ<strong>ε</strong>ις.<br />
Βιβλιογρ<strong>α</strong>φί<strong>α</strong>: Hoiroyd Ledue JM et<br />
al. The relationship of indwelling urinary<br />
catheters to death, length of hospital<br />
stay functional decline, and nursing<br />
home admission in hospitalized older<br />
medical patients. J Am Geriatr Soc<br />
2007 Feb; 55: 227 – 33.<br />
Προσοχή <strong>μ</strong><strong>ε</strong> την MRI<br />
στους ν<strong>ε</strong>φροπ<strong>α</strong>θ<strong>ε</strong>ίς<br />
Η ν<strong>ε</strong>φρογ<strong>ε</strong>νής ινοποιητική δ<strong>ε</strong>ρ<strong>μ</strong><strong>α</strong>τοπάθ<strong>ε</strong>ι<strong>α</strong><br />
(NFD), <strong>μ</strong>ι<strong>α</strong> δ<strong>ε</strong>ρ<strong>μ</strong><strong>α</strong>τική πάθηση που<br />
<strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>πηρ<strong>ε</strong>άζ<strong>ε</strong>ι σ<strong>ε</strong> ση<strong>μ</strong><strong>α</strong>ντικό β<strong>α</strong>θ<strong>μ</strong>ό<br />
τους <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong>,<br />
π<strong>ε</strong>ριγράφηκ<strong>ε</strong> γι<strong>α</strong> πρώτη φορά πριν<br />
<strong>α</strong>πό 10 έτη. Τώρ<strong>α</strong>, έν<strong>α</strong> σύνολο συ<strong>μ</strong>β<strong>α</strong><strong>μ</strong>άτων<br />
έρχ<strong>ε</strong>τ<strong>α</strong>ι ν<strong>α</strong> προστ<strong>ε</strong>θ<strong>ε</strong>ί σ<strong>ε</strong> προγ<strong>ε</strong>νέστ<strong>ε</strong>ρ<strong>α</strong><br />
δ<strong>ε</strong>δο<strong>μ</strong>έν<strong>α</strong>, που δ<strong>ε</strong>ίχνουν ότι<br />
το σκι<strong>α</strong>γρ<strong>α</strong>φικό <strong>μ</strong>έσο που π<strong>ε</strong>ριέχ<strong>ε</strong>ι γ<strong>α</strong>δολίνιο,<br />
το οποίο χορηγ<strong>ε</strong>ίτ<strong>α</strong>ι συχνά γι<strong>α</strong> την<br />
<strong>ε</strong>ξέτ<strong>α</strong>ση <strong>μ</strong><strong>α</strong>γνητικής το<strong>μ</strong>ογρ<strong>α</strong>φί<strong>α</strong>ς (MRI)<br />
<strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong> <strong>ε</strong>ίν<strong>α</strong>ι <strong>ε</strong>πικίνδυνο γι<strong>α</strong> την <strong>ε</strong>κδήλωση<br />
της συγκ<strong>ε</strong>κρι<strong>μ</strong>ένης πάθησης.<br />
Σ<strong>ε</strong> <strong>μ</strong>ι<strong>α</strong> <strong>α</strong>ν<strong>α</strong>δρο<strong>μ</strong>ική συγκριτική <strong>μ</strong><strong>ε</strong>λέτη,<br />
19 <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> <strong>ε</strong>πιβ<strong>ε</strong>β<strong>α</strong>ιω<strong>μ</strong>ένη NFD,<br />
οι οποίοι έλ<strong>α</strong>β<strong>α</strong>ν <strong>α</strong>υτή τη διάγνωση σ<strong>ε</strong><br />
έν<strong>α</strong> συγκ<strong>ε</strong>κρι<strong>μ</strong>ένο νοσοκο<strong>μ</strong><strong>ε</strong>ίο του Μισούρι,<br />
<strong>μ</strong><strong>ε</strong>τ<strong>α</strong>ξύ των <strong>ε</strong>τών 2002 κ<strong>α</strong>ι 2006,<br />
συγκρίθηκ<strong>α</strong>ν <strong>μ</strong><strong>ε</strong> 57 άτο<strong>μ</strong><strong>α</strong>, <strong>μ</strong><strong>ε</strong> κοινά χ<strong>α</strong>ρ<strong>α</strong>κτηριστικά,<br />
που <strong>α</strong>ποτέλ<strong>ε</strong>σ<strong>α</strong>ν την ο<strong>μ</strong>άδ<strong>α</strong><br />
<strong>ε</strong>λέγχου. Όλοι <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς υποβάλλοντ<strong>α</strong>ν<br />
σ<strong>ε</strong> <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση ή π<strong>ε</strong>ριτον<strong>α</strong>ϊκή κάθ<strong>α</strong>ρση<br />
(<strong>α</strong>ν κ<strong>α</strong>ι δύο <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>μ</strong><strong>ε</strong> NFD κ<strong>α</strong>ι οξ<strong>ε</strong>ί<strong>α</strong><br />
ν<strong>ε</strong>φρική <strong>α</strong>ν<strong>ε</strong>πάρκ<strong>ε</strong>ι<strong>α</strong> <strong>ε</strong>ίχ<strong>α</strong>ν υποβληθ<strong>ε</strong>ί σ<strong>ε</strong><br />
<strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση <strong>μ</strong>όνο <strong>μ</strong><strong>ε</strong> σύντο<strong>μ</strong>ο τρόπο).<br />
Σ<strong>ε</strong> <strong>μ</strong>ι<strong>α</strong> <strong>μ</strong>ονοπ<strong>α</strong>ρ<strong>α</strong>γοντική <strong>α</strong>νάλυση, π<strong>α</strong>ρ<strong>α</strong>τηρήθηκ<strong>ε</strong><br />
ότι η έκθ<strong>ε</strong>ση σ<strong>ε</strong> σκι<strong>α</strong>γρ<strong>α</strong>φικό<br />
<strong>μ</strong>έσο που π<strong>ε</strong>ρι<strong>ε</strong>ίχ<strong>ε</strong> γ<strong>α</strong>δολίνιο, το <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βλητό<br />
οίδη<strong>μ</strong><strong>α</strong>, το ιστορικό <strong>ε</strong>ν τω βάθ<strong>ε</strong>ι<br />
φλ<strong>ε</strong>βικής θρό<strong>μ</strong>βωσης κ<strong>α</strong>ι το ιστορικό<br />
υποθυρ<strong>ε</strong>ο<strong>ε</strong>ιδισ<strong>μ</strong>ού συσχ<strong>ε</strong>τίζοντ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> τη<br />
διάγνωση της NFD, <strong>α</strong>λλά σ<strong>ε</strong> <strong>μ</strong>ι<strong>α</strong> πολυπ<strong>α</strong>ρ<strong>α</strong>γοντική<br />
<strong>α</strong>νάλυση <strong>μ</strong>όνο ο συσχ<strong>ε</strong>τισ<strong>μ</strong>ός<br />
<strong>μ</strong><strong>ε</strong> την έκθ<strong>ε</strong>ση σ<strong>ε</strong> γ<strong>α</strong>δολίνιο <strong>ε</strong>ξ<strong>α</strong>κολούθησ<strong>ε</strong><br />
ν<strong>α</strong> <strong>ε</strong>ίν<strong>α</strong>ι στ<strong>α</strong>τιστικά ση<strong>μ</strong><strong>α</strong>ντικός.<br />
Μόνο έν<strong>α</strong>ς <strong>α</strong>σθ<strong>ε</strong>νής <strong>μ</strong><strong>ε</strong> NFD δ<strong>ε</strong>ν <strong>ε</strong>ίχ<strong>ε</strong><br />
ιστορικό έκθ<strong>ε</strong>σης σ<strong>ε</strong> γ<strong>α</strong>δολίνιο.<br />
Σχόλιο: Δ<strong>ε</strong>δο<strong>μ</strong>έν<strong>α</strong> <strong>α</strong>πό την Ευρώπη<br />
έχουν <strong>ε</strong>πίσης <strong>ε</strong><strong>μ</strong>πλέξ<strong>ε</strong>ι τ<strong>α</strong> σκι<strong>α</strong>γρ<strong>α</strong>φικά<br />
<strong>μ</strong>έσ<strong>α</strong> που π<strong>ε</strong>ριέχουν γ<strong>α</strong>δολίνιο στην<br />
π<strong>α</strong>θογέν<strong>ε</strong>ση της NFD. Από το τέλος του<br />
2006, το σύστη<strong>μ</strong><strong>α</strong> MedWatch του FDA<br />
έχ<strong>ε</strong>ι λάβ<strong>ε</strong>ι 90 <strong>α</strong>ν<strong>α</strong>φορές συ<strong>μ</strong>β<strong>α</strong><strong>μ</strong>άτων<br />
NFD που συσχ<strong>ε</strong>τίζοντ<strong>α</strong>ι πιθ<strong>α</strong>νώς <strong>μ</strong><strong>ε</strong> το<br />
γ<strong>α</strong>δολίνιο. Έν<strong>α</strong>ς υποθ<strong>ε</strong>τικός <strong>μ</strong>ηχ<strong>α</strong>νισ<strong>μ</strong>ός<br />
π<strong>α</strong>θογέν<strong>ε</strong>σης π<strong>ε</strong>ριλ<strong>α</strong><strong>μ</strong>βάν<strong>ε</strong>ι κ<strong>α</strong>θυστ<strong>ε</strong>ρη<strong>μ</strong>ένη<br />
κάθ<strong>α</strong>ρση του οργ<strong>α</strong>νισ<strong>μ</strong>ού <strong>α</strong>πό το<br />
γ<strong>α</strong>δολίνιο σ<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς που υποβάλλοντ<strong>α</strong>ι<br />
σ<strong>ε</strong> <strong>α</strong>ι<strong>μ</strong>οκάθ<strong>α</strong>ρση, που οδηγ<strong>ε</strong>ί σ<strong>ε</strong> δι<strong>α</strong>χωρισ<strong>μ</strong>ό<br />
των χηλικών ιόντων γ<strong>α</strong>δολινίου<br />
κ<strong>α</strong>ι σ<strong>ε</strong> ινώδη δ<strong>ε</strong>ρ<strong>μ</strong><strong>α</strong>τική <strong>α</strong>ντίδρ<strong>α</strong>ση.<br />
Μέχρι ν<strong>α</strong> δι<strong>ε</strong>ν<strong>ε</strong>ργηθούν <strong>ε</strong>πιπρόσθ<strong>ε</strong>τ<strong>ε</strong>ς<br />
<strong>μ</strong><strong>ε</strong>λέτ<strong>ε</strong>ς γι<strong>α</strong> τη δι<strong>α</strong>λ<strong>ε</strong>ύκ<strong>α</strong>νση της υπόθ<strong>ε</strong>σης,<br />
συ<strong>μ</strong>βουλ<strong>ε</strong>ύου<strong>μ</strong><strong>ε</strong> τους γι<strong>α</strong>τρούς ν<strong>α</strong>
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