62_Patologie Dell'Ipofisi Anteriore Deficit Di Gh Optimized

\CRNJNIAF BFJJ‑A\NEAXA CKRFTANTF7 BFEAHAR BA I@

@ypnpatuatcrasm7 I@ bfhafkhy Hjcuban Iachnmnzza, Xtfeckn Hackecrcka

BFEAKAWANKF

Aj bfhat bfjj‑nrmnkf bfjjc hrfshatc (irnwt` `nrmnkf, I@) à jc enrmc ba

apnpatuatcrasmn pañ erfqufktf sac kfj dcmdakn h`f kfjj‑cbujtn, bnvf pfr apnpatuatcrasmn sa aktfkbf ukc hnkbazankf ba aksuehafktf sfhrfzankf ba ukn n pañ nrmnka sfhrfta bcjjc pnrzankf cktfranrf n pnstfranrf bfjj‑apnsa.  Knk fsastf ukc bfkazankf spfhahc ba bfhat ba I@ ukavfrscjmfktf hnkbavasc, mc cb niia puô fssfrf hnksabfrctn hnmf jc hnmdakczankf ba cjtfrczanka cuxnjniah`f, hjakah`f, danh`amah`f f mftcdnjah`f hcusctf bcjjc mckhcktf n aksuehafktf sfhrfzankf sfhrfzankf ba I@ bc pcrtf bfjjc cbfknapnsa, h`f fsatc ak ukc rabnttc saktfsa bfija nrmnka I@ bapfkbfkta f bfa ecttnra ba hrfshatc. J‑akhabfkzc mfbac bfj bfhat ba I@ kfa dcmdaka rashnktrctc

kfj knstrn \cfsf à ba 4-4.6/3<.<<< hnk ukc prfvcjfkzc trc 0.5-1.2/3<.<<<. 0.5-1.2/ 3<.<<<. J‑akhabfkzc mfbac kfjj‑cbujtn akvfhf, hcjhnjctc ak cmdatn furnpfn, à ba 3.5/3<<.<<<. FWAN\CRNIFKFXA F EAXAN\CRNJNIAC

Jc hrfshatc stcturcjf knk à barfttcmfktf prnmnssc bcj I@ dfksê bcjj‑AIE-A h`f ciashf c javfjjn bfjjf hcrtajciaka ba chhrfshamfktn f h`f vafkf prnbnttn prakhapcjmfktf bcj efictn prnpran snttn jn stamnjn bfj I@. Vkc bfhafkzc ba qufstn nrmnkf pnrtc quakba c uk bfhat sfhnkbcran ba AIE-A hnk hnksfiufktf rabuzankf bfjjc hrfshatc jnkiatubakcjf bfjjf nssc juki`f. J‑fzanpctnifkfsa bfj bfhat ba I@ puô fssfrf fstrfmcmfktf ftfrnifkfc (Rcdfjjc 3) f j‑akhabfkzc bfjjf hcusf vcrackn trc dcmdakn f cbujtn. Jf hcusf ba bfhat ba I@ pnssnkn bavabfrsa ak7 • Hnkifkatf Bc mutczanka ifkah`f7 Bfhat asnjctn sfkzc cjtfrczanka strutturcja apntcjcmn-apns apntcjcmn-apnscraf craf (I@T@-r, I@3). Bfhat mujtapjn hnk cknmcjaf apntcjcmn-apnscraf (\at-3, \rnp-3, @fsx-3, J`x-8). Bfhat sakinjn n mujtapjn cssnhactn c mcjenrmczanka bfj X.K.H. (baspjcsac sfttn-nttahc). §

§

• Chquasatf \frakctcja. Ak ftì pfbactrahc. Ak ftì cbujtc. Jc enrmc h`f sa nssfrvc pañ erfqufktfmfktf ak pfbactrac à qufjjc abanpctahc, cssfktf kfjj‑cbujtn kfjj‑cbuj tn kfj qucjf prfvcjinkn akvfhf jf enrmf sfhnkbcraf cb cbfknma apnscra sac sfhfrkfkta h`f knk sfhfrkfkta. Cj sfhnkbn pnstn hnmf erfqufkzc trnvacmn sac kfjj‑cbujtn sac kfj dcmdakn a tumnra bfj sastfmc kfrvnsn hfktrcjf, trc hua spahhc aj hrckanecrakianmc. Kfa dcmdaka cddacmn pna aj bfhat cssnhactn cjjf cknmcjaf strutturcja bfjjc cssf apntcjcmn-apnsa. Xa puô rashnktrcrf j‑apnpjcsac n cpjcsac bfjjc cbfknapnsa, j‑fhtnpac bfjjc kfurnapnsa, jc bashnkkfssankf bfj pfbukhnjn apnscran f jc prfsfkzc ba ukc sfjjc vuntc (‚fmpty sfjjc”) pcrzacjf n tntcjf. Sufstf cknmcjaf strutturcja pnssnkn prfsfktcrsa sakinjcrmfktf n cssnhacrsa trc ba jnrn f pnssnkn fssfrf hnksfiufkta c mutczanka ifkah`f n cssnhacrsa c mcjenrmczankaa fkhfecjah`f bfjjf strutturf nraiakckta bcjjc jakfc mfbackc. mcjenrmczank Jf enrmf ifkftah`f sfkzc cjtfrczanka ckctnmah`f, sfddfkf mnjtn rcrf,  pnssnkn fssfrf knk baciknstahctf f akijndctf kfjjf enrmf abanpctah`f. \nssnkn fssfrf snspfttctf ak hcsn ba enrmf ecmajacra cb fsnrban mnjtn  prfhnhf. Mfkn erfqufkta kfj dcmdakn raspfttn cjj‑cbujtn snkn ija apnpatuatcrasma pnst trcumc, sfddfkf, cb niia, pnh`a stuba jnkiatubakcja cddackn vcjutctn jf hnksfiufkzf c mfban f jukin tfrmakf bfa trcuma hrckaha bfj dcmdakn. Rcd. 3 - Fzanjniac bfj bfhat ba ba I@ pfr ftì f akhabfkzc akhabfkzc (Mnbahctc bc Oarstakf

Xtnh`njm, ft cj. Furnpfck Gnurkcj ne Fkbnhraknjniy (4<<5) 366 53-93) Ftì : 30 cc

Bfeahat abanpctahn Hrckanecrakianmc Kfnpjcsaf dfkaikf (Ifrmaknm (Ifrmaknmc, c, Cstrnhatnmc) Mcjenrmczanka Mcjenrmczan ka apntcjcmn-ap apntcjcmn-apneascraf neascraf \ctnjniaf kfnpjcstah`f Cjtrf7 Hnmpjahckzf pfrakctcja Kfurneadrnmctnsa Rrcuma Enrmf sakbrnmah`f

Ftì ; 30 cc A K H A B F K W C

Cbfknmc sfhfrkfktf n knk sfhfrkfktf Hrckanecrakianmc Kfnpjcsaf dfkaikf (Ifrmakn (Ifrmaknmc, mc, Cstrnhatnmc) Xakbrnmf ba X`ff`ck (Bnkkf) \ctnjniaf kfnpjcstah`f Cjtrf7 Hasta (Crchknabff, Fpabfrmnaba, Hnjjnabcja) Actrnifkf bc h`aruriac Cpnpjfssac Apneascrac Rrcuma

HCTCRRFTAXRAH@F HCTC RRFTAXRAH@F HJAKAH@F

\fr qucktn raiucrbc j‑cspfttn hjakahn bfj bfhat ba I@ pnssacmn bastakiufrf trf prakhapcja ecshf ba ftì7 • Kfj kfnkctn jc mckaefstczankf pañ hnmukf bfj bfhat ba I@ à jc hrasa apnijahfmahc, c hcusc bfjj‑feefttn apfrijahfmazzcktf apfrijahfmazzcktf bfjj‑nrmnkf f bfjjc erfqufktf cssnhaczankf cssnhacz ankf hnk aj bfhat ba CHR@. Vk fsnrban prfhnhf akectta akect ta à spfssn cssnhactn cjjc prfsfkzc ba mcjenrmczanka ckctnmah`f bfjj‑cssf apntcjcmn-apnsa apntcjcmn-apn sa ak hua sa rashnktrckn pañ erfqufktfmfktf bfhat mujtapja. Cb fsnrban prfhnhf snkn ckh`f a bfhat sfhnkbcra c mutczanka ifkah`f. Cjtrf hcrcttfrastah`f snkn jc prfsfkzc ba mahrnpfkf kfj mcsh`an f j‑attfrn  prnjukictn. •  Kfj pramn ckkn ba vatc jc saktfsa ba AIE-A knk bapfkbf bcj I@ mc ak mcssamc pcrtf bcjjn stctn kutrazankcjf, hnmf suhhfbf kfj eftn. Aj I@ knk à quakba aj prakhapcjf rfspnkscdajf bfjj‑chhrfshamfktn stcturn-pnkbfrcjf stcturn-pnkbfrcjf kfa dcmdaka cj ba snttn bfjj‑ckkn ba vatc. Suakba, njtrf cjjf pañ hnmuka hcusf ba shcrsn chhrfshamfktn, bfvf fssfrf bnsctn j‑AIE-A kfj snspfttn ba uk bfhat pramcran. Ak tcj sfksn puô fssfrf baramfktf aj pfsn cjjc kcshatc, ak qucktn kfa hcsa ba cjtfrczankf ifkahc bfjj‑AIE-3 sa rashnktrc uk dcssn  pfsn pfr j‑ftì ifstczankcjf. Xnkn stcta hnmukquf hnmukquf bfshratta bfhat hnkifkata ba I@ hnk rcjjfktcmfktn ba hrfshatc burcktf aj pramn ckkn ba vatc. • Kf  Kfjj dcm dcmdak dakn n cj ba snp snprc rc bfj bfjj‑c j‑ckkn kkn ba va vatc tc aj I@ à aj prakhapcjf rfspnkscdajf bfjj‑chhrfshamfktn stcturcjf, ba hnksfiufkzc aj bctn hjakahn mciianrmfktf suiifstavn pfr uk bfhat ba I@ à sahurcmfktf jc dcssc stcturc f jc rabnttc vfjnhatì ba hrfshatc. Aj dcmdakn hnk uk kckasmn apnscran puô prfsfktcrf ukc rabnttc mcssc mushnjcrf hnk uk cumfktn bfj tfssutn cbapnsn cbapns n snttnhutckfn, kn c pntfr rashnktrcrf ukc echafs pcrtahnjcrf, pceeutc, bfshrattc hnmf ‚c echhac ba dcmdnjc”, cspfttn h`f tfkbf c shnmpcrarf ak hnrsn ba tfrcpac.  Kfjj‑cbujtn sa nssfrvckn basturda mftcdnjaha, qucja cjtfrctc tnjjfrckzc ijuhabahc, cjtfrctn hctcdnjasmn prntfahn, apfrjapabfmac f cjtfrczanka kfjjc strutturc hnrpnrfc hcrcttfrazzctf bc cumfktn bfj ircssn vashfrcjf, rabuzankf bfjjc mcssc mcirc f rabnttc bfksatì nssfc. À stctn aknjtrf rashnktrctn kfjj‑cbujtn j‑cumfktn bfj rash`an ba pctnjniaf hcrbanvcshnjcra. BACIKNXA

 Kfj kfnkctn jc baciknsa baciknsa puô fssfrf pnstc bnsckbn aj I@ burcktf burcktf jc hrasa apnijahfmahc, sf a vcjnra snkn akefranra c qufjja knrmcja (: 4< mhi/J) jc baciknsa à sahurc. Xa bnvrì aknjtrf fsfiuarf ukc TM fkhfecjn.  Kfj dcmdakn pañ irckbf aj snspfttn ba uk bfhat bfvf fssfrf dcsctn, njtrf h`f sujjc ckcmkfsa f sujj‑fscmf ndafttavn, sujjc prfhasc vcjutczankf ba trf pcrcmftra enkbcmfktcja7

3. Jc stcturc bfj dcmdakn, sfmprf rfjctavcmfktf cj dfrscijan ecmajacrf. 4. Jc vfjnhatì ba hrfshatc ckkuc, nssfrvctc kfjj‑crhn tfmpnrcjf ba cj-

mfkn 5 mfsa. 8. Jc mcturczankf nssfc, trcmatf jc vcjutczankf bfjjc rcbanircc bfjjc

mckn f bfj pnjsn. Rcd. 4 - Xh`fmc baciknstahn ba ukc dcssc stcturc

Ckcmkfsa

Fscmf ndafttavn

• Easanjniahc7 pfsn cjjc kcshatc fb ftì ifstczankcjf, hnmpjahckzf pfrakctcja (cseassac kfnkctcjf, apnijahfmaf, pcrtn bastnhahn ak pcrtahnjcrf pfr prfsfktczankf pnbcjahc) • Ecmajacrf7 stcturc ifkatnra, pudfrtì ifkatnra, dcssc stcturc ecmajacrf (unmaka : 35< hm, bnkkf : 36< hm), pctnjniaf fkbnhrakf ak ecmaijac • \ctnjniahc Tfmntc7 pctnjniaf prfirfssf, h`fmantfrcpaf, aktfrvfkta h`aruriaha, rcbantfrcpac • \ctnjniahc \rnssamc 7 ftì f mnbcjatì ba aksnrifkzc bfjjn shcrsn chhrfshamfktn (crrfstn amprnvvasn>), aksnrifkzc ba pctnjniaf hnkhnmatckta • • • •

• Fscma fmctnh`amaha • • • Fscma strumfktcja

Masurczankf Masurczan kf stctur stcturcc ak rfjcza rfjczankf nkf cj tcrif tcriftt ifkftah ifkftahn n Ufjnha fjnhatì tì ba hrfsh hrfshatc atc nttfku nttfkutc tc ak cjmf cjmfkn kn 5 mfsa mfsa Ucju cjutcz tczank ankff stcb stcban an pud pudfrc frcjf jf Ucjutcz cjutczankf ankf ba bascrm bascrmnkaf nkaf sh`fjftr sh`fjftrah`f ah`f hnk rceer rceernktn nktn trc stctur stcturcc ak pnsazankf frfttc f ak pnsazankf sfbutc (apnhnkbrnpjcsac, chnkbrnpjcsac) ER2 f RX@ Cd Ckta Cktafkbnm fkbnmasan, asan, Ckta Cktatrcks trcksijutc ijutcmakc makcsa sa f AiC tntcj tntcjaa AIE-A Hcrantapn Hcra ntapn (sns (snspfttn pfttn ba X.R X.Rurkfr urkfr kfjjf efmm efmmakf) akf)

• Tx mc mckn kn f pn pnjs jsn n pfr pfr ftì ftì nssf nssfcc

3. Jc stcturc kfj bfhat ba I@ rasujtc spfssn akefranrf cjjf ‘ 4,6 BX, mc  pañ hcrctt hcrcttfrasta frastaha ha snkn uk hckcj hckcjff ba hrfsha hrfshatc tc kfttc kfttcmfkt mfktff cj ba snttn ba qufj qufjjn jn hnrraspnkbfktf cj hfktajf bfjjc stcturc dfrscijan f jc hnstcktf tfkbfkzc kfj tfmpn c pfrbfrf ba hfktajf. Jc stcturc dfrscijan sa nttafkf cttrcvfrsn jc mfbac cratmftahc bfjjf stcturf ak hm bfa buf ifkatnra, ciiaukifkbn ciiaukifkbn 38 hm cjjc mcbrf kfa mcsh`a f snttrcfkbn cj pcbrf 38 hm kfjjf efmmakf. Njtrf ca ifkatnra sa bfvf akbcicrf pfr pcrfkta hnk ukc stcturc akefranrf c 36< hm pfr jf bnkkf f 35< hm pfr ija unmaka, h`f rcpprfsfktckn raspfttavcmfktf aj hut nee pfr bfkarf ukc dcssc stcturc. 4. Jc vfjnhatì ba hrfshatc ckkuc pfr fssfrf hnksabfrctc pctnjniahc bfvf fssfrf akefranrf cj 8¼ hfktajf (-3.1 BX) f bfvf pnrtcrf c uk hcjn ba hfktajf kfjjc hurvc ba hrfshatc. Ruttcvac à bc tfkfr prfsfktf h`f ukc vfjnhatì ba hrfshatc hnstcktfmfktf cj ba snttn bfj 46¼ hfktajf pnrtfrì cb ukc pfrbatc

stcturcjf. \fr fssfrf cttfkbadajf jc vfjnhatì ba chhrfshamfktn bfvf fssfrf hcjhnjctc ak uk aktfrvcjjn ba tfmpn knk akefranrf ca 5 mfsa. Vk crrfstn hnmpjftn f amprnvvasn knk sa rashnktrc snjatcmfktf kfj bfhat abanpctahn ba I@ mfktrf à ba hnmukf nssfrvczankf kfa bfhat ba I@ bc hcusf nrickah`f. 8.  Jc mcturczankf sh`fjftrahc hcrcttfrastahcmfktf à ratcrbctc hnk ukc baeefrfkzc trc ftì nssfc fb ftì hrnknjniahc ak ifkfrf supfranrf c 4 ckka. Vk ratcrbn bfjjc mcturczankf nssfc sa puô rashnktrcrf ckh`f ak hcsn ba ratcrbn hnstatuzankcjf ba hrfshatc (pudfrtì tcrbc). Rcd. 8 - Baciknsa baeefrfkzacjf baeefrfkzacjf bfj bfhat ba I@  Baciknsa

Hcrcttfrastah`f Hjakah`f

I@ f AIE-A

Bfeahat ba I@ n bfeahat sfhnkbcran ba AIE-A

Xtcturc akefranrf cj 8¼ hfktajf f hnmukquf akefranrf cj dfrscijan stcturcjf ifkftahn, vfjnhatì ba hrfshatc akefranrf cj 46¼ hfktajf, prnirfssavc rabuzankf bfj hfktajf stcturcjf, ratcrbn ba ftì nssfc ; 4 ckka, prfvcjfkzc bfj tfssutn cbapnsn snttnhutckfn raspfttn cjjc mcssc mcirc.

4 Rfst Rfst ba stamnjn sta mnjn pfr aj I@ dcssa AIE-A dcssn / knrmcjf

Tatcrbn hnstatuzankcjf hnstatuzankc jf ba hrfshatc (pudfrtì tcrbc)

Ufjnhatì ba b a hrfshatc ≦ 46¼ hfktajf ak pcrtahnjcrf sf raefratc cjj‑ftì nssfc. Ckcmkfsa ecmajacrf pnsatavc pfr pudfrtì tcrbc. Tatcrbn ba ftì nssfc ; 4 ckka. Tatcrbn pudfrcjf.

Kn tfst AIE-A knrmcjf

Dcssc Xtcturc Ecmajacrf

Chhrfshamfktn sfmprf rfinjcrf f hnkhnrbcktf cj dfrscijan ifkftahn. Ckcmkfsa Ckcmkfsa ecmajacrf pnsatavc pfr Dcssc Xtcturc (unmaka : 35< hm, bnkkf : 36< hm). Ftì nssfc hnkhnrbcktf hnk qufjjc ckcirceahc.

Kn Rfst AIE-A knrmcjf

Bfeahat \ramcran ba AIE-A

\fsn f juki`fzzc cjjc kcshatc spfssn rabntta, ircvf f prnhnhf ratcrbn ba chhrfshamfktn pnst-kctcjf, ratcrbn ba mcturczankf nssfc.

I@ dcscjf fjfvctn AIE-A dcssn

 Knknstcktf jc hnrrfttc vcjutczankf bfa bcta cuxnjniaha f ckcmkfstaha jc baciknsa ba bfhat ba I@ sa dcsc ak irck pcrtf sua rasujtcta bfa tfst ba jcdnrctnran hnk tutta a jamata jficta cjjc hnrrfttc fsfhuzankf bfj bnsciian f mftnba utajazzcta. \ramc pfrô ba prfkbfrf ak hnksabfrczankf j‑fsfhuzankf j‑ fsfhuzankf ba uk tfst ba stamnjn  pfr aj I@ dasnikc sfmprf fshjubfrf cjtrf hcusf pañ hnmuka ba bfhat stcturcjf qucja j‑apntarnabasmn f jc hfjach`ac. Kfjjf efmmakf dasnikc sfmprf fshjubfrf jc X. ba Rurkfr akbapfkbfktfmfktf bcjjf hcrcttfrastah`f

efkntapah`f, h`f pnssnkn fssfrf mnjtn seumctf n bfj tuttn cssfkta kfjjf  dcmdakf hnk mnscahasma. mnscahasma. Jc vcjutczankf bfjj‑AIE-A bfjj‑AIE- A kfjjc baciknsa ba bfhat ba I@ `c ukc sfksadajatì ba harhc aj 96% fb ukc spfhahatì ba njtrf aj 1<%. Xf pna tcjf vcjutczankf sa cssnhac cjjc masurczankf bfjjc vfjnhatì ba hrfshatc sa rciiaukif cjjnrc ukc sfksadajatì fb ukc spfhahatì ba harhc aj 16%. À cmpacmfktf kntn nrmca h`f aj bnsciian bfj I@ dcscjf knk à cttfkba dajf kfjjc vcjutczankf ba uk fvfktucjf bfhat bfjj‑nrmnkf mc puô fssfrf utajf kfj snspfttn ba ukc rfsastfkzc pfraefrahc (X. ba Jcrnk) n ba uk bfhat  pramcran ba AIE-A, kfa qucja sa rashnkt rashnktrckn rckn vcjnra dcscja fjfvcta (; 6 mi/J). Aj I@ bfvf fssfrf bnsctn pramc (tfmpn <‑) f bnpn (tfmpa 8<‑- 5<‑- 1<‑34<‑) j‑akeusankf ba snstckzf hcpcha ba cumfktcrkf jc sfhrfzankf bc pcrtf bfjj‑cbfknapnsa. Fsastnkn baeefrfkta tapa ba tfst (Rcdfjjc 2), trc fssa aj tfst ba tnjjfrckzc cjj‑a pnijahf  pni jahfmac mac aksu aksujakn jakn-akb -akbnttc nttc (ARR) à hnks hnksabfr abfrctn ctn aj inj injbb stck stckbcrb bcrb,, mc mc pfr pfr a suna feeftta hnjjctfrcja, mciianra prnpran kfa sniiftta hnk bfhat ba I@ ak  pcrtahnj  pcrt ahnjcrf crf sf cssn cssnhact hactnn cj cj bfha bfhatt ba ba CHR@ CHR@,, rcpprf rcpprfsfk sfktc tc uk uk tfst tfst pntf pntfkzac kzacjjmfktf pfrahnjnsn. Cmpacmfktf uscta snkn a tfst ba stamnjn hnk h nk j‑Criakakc n jc Hjnkabakc, pañ sahura f echajmfktf prctahcdaja, mc ircvcta bc uk kumfrn mciianrf ba ecjsa pnsatava. Aj tfst ba stamnjn hnmdakctn hnk j‑Criakakc f aj ecttnrf ba rajcshan bfjj‑nrmnkf snmctntrnpn (ITE n I@T@) à hnksabfrctn uk tfst ba stamnjn pntfkzactn sfkzc pcrtahnjcra feeftta akbfsabfrcta f hcpchf ba akburrf ukc raspnstc mcssamcjf bfjjc i`ackbnjc apnscrac samajf c qufjjc nttfkutc trcmatf trcmatf j‑ARR. j‑ARR. \fr tcjf mntavn sa bfvf hnksabfrcrf uk hut nee bnppan raspfttn c qufjja utajazzcta kfa tfst ba stamnjn hnk Hjnkabakc f Criakakc. Rcd. 2 - Cjhuka tfst ba stamnjn pfr aj bnsciian bnsciian bfjj‑nrmnkf bfjjc hrfshatc hrfshatc RFXR

Mfhhckasmn

Hut Nee 

b‑czankf

Feeftta Akbfsabfrcta

Rfst ba tnjjfrckzc aksujakahc

Taspnstc cjj‑apnijahfmac akbnttc

3< ¶i/J

Apnijahfmac sfvfrc

Rfst ba stamnjn hnk Criakakc

Tabuzankf bfj tnkn snmctnstctakfriahn

3< ¶i/J

Kfhrnsa tfssutcjf suhhfssavc c strcvcsn, chabnsa mftcdnjahc

Rfst ba stamnjn hnk Hjnkabakc

Taspnstc cjj‑apntfksankf akbnttc

3< ¶i/J

Apntfksankf sfvfrc

Rfst ba stamnjn hnk ITE + Criakakc

Tabuzankf bfj tnkn snmctnstctakfriahn snmctnstctakfr iahn f stamnjczankf barfttc sujj‑cbfknapneasa

4< ¶i/J

Ufba tfst hnk Criakakc

Xa hnksabfrc knrmcjf ukc raspnstc c uk tfst ba stamnjn quckbn cjmfkn uk vcjnrf bfjjc hurvc supfrc aj hut nee stcdajatn. Xf aj tfst à knrmcjf sa  puô fshjubfr fshjubfrff aj bfhat ba I@, sf cj hnktrcr hnktrcran an aj tfst à pctnjniah pctnjniahnn sa bfvf feefttucrf uk sfhnkbn tfst ba hnkefrmc usckbn ukn stamnjn baeefrfktf bc qufjjn utajazzctn kfj tfst prfhfbfktf. Jc kfhfssatì ba feefttucrf uk sfhnkbn tfst bfravc bfjjc fjfvctc pfrhfktucjf ba ecjsa pnsatava (njtrf aj 4<%). Xf aj sfhnkbn tfst à knrmcjf cjjnrc sa puô fshjubfrf aj bfhat, mfktrf sf rasujtc kunvcmfktf pctnjniahn cjjnrc puô fssfrf ecttc baciknsa ba bfhat ba I@ f bavafkf nddjaictnrac j‑fsfhuzankf ba ukc TM fkhfecjn pfr fshjubfrf ukc kfnpjcsac n vcjutcrf jc mnrenjniac mnre njniac bfjj‑ukatì eukzankcjf apntcjcmn-apnsa. Xfhnkbn jc knstrc shunjc, à mnjtn ampnrtcktf ca ka ba ukc hnrrfttc fsfhuzankf bfj tfst ba stamnjn, jc vcjutczankf bfjjn stcban pudfrcjf bfj  pczafktf. Rutta a dcmdaka ckhnrc prfpudfra prfpudfra h`f snkn pfrô ak ftì pudfrcjf (mcsh`a ;3< ckka, efmmakf ; 1 ckka) bfvnkn fsfiuarf uk prftrcttcmfktn hnk nrmnka ckbrnifka n fstrnifka c sfhnkbc bfj sfssn. Kfa mcsh`a à kfhfsscrac ukc sakinjc snmmakastrczankf ba tfstnstfrnkf a.m. trf ianrka  pramc bfj tfst (X (X  46< mi , X, mfzzc cjc)? mfktrf kfjjf efmmakf à kfhfsscrac jc snmmakastrczankf ba ftakajfstrcbanjn kfa trf ianrka prfhfbfkta aj tfst (F hpr 6< ¶i, C, ½ hpr/baf). Sufstc stamnjczankf à kfhfsscrac pfr fvatcrf uk rasujtctn ecjscmfktf pctnjniahn, ak qucktn ak ftì pudfrf jc sfhrfzankf bfj I@ à akufkzctc pnsatavcmfktf ckh`f bcija nrmnka sfssucja. Dasnikc aknjtrf tfkfrf ak hnksabfrczankf h`f sniiftta knrmcja hnk fhhfssn pnkbfrcjf  pnssnkn cvfrf ukc rabnttc raspnstc bfj I@ ca tfst ba stamnjn. Ak tcja hcsa aj vcjnrf ba AIE-A (knrmcjf n fjfvctn kfija ndfsa sfkzc bfhat ba I@) scrì bfhasavn pfr nrafktcrf jc baciknsa. Jc TM bfjj‑fkhfecjn hnk m.b.h. pfr jn stuban pcrtahnjcrfiiactn bfjjc znkc apntcjcmn-apnscrac à akbaspfkscdajf pfr vcjutcrf j‑nraiakf bfj bfhat ba I@. Jc mciianr pcrtf bfa bfhat prfsfktc uk qucbrn hnmpjftcmfktf knrmcjf, hnkbazankf h`f spfssn sa cssnhac c uk bfhat abanpctahn ‚trcksatnran”, nvvfrn uk bfhat h`f knk scrì hnkefrmctn cjjc ravcjutczankf  pnst-tfrcpac. Cj hnktrcran jc prfsfkzc ba ukc fhtnpac bfjjc kfurnapnsa, hnmf ba ukc bashnkkfssankf bfj pfbukhnjn, à uk mcrofr spfhahn pfr uk bfhat pfrmckfktf. À stctn aknjtrf nssfrvctn h`f ukc cbfknapnsa hnk ukc cjtfzzc akefranrf cjjf ‘ 4 BX pfr j‑ftì à enrtfmfktf suiifstavc ba mutczankf bfj I@T@-T.

RTCRRCMFKRN

Jc tfrcpac knk bfvf fssfrf aktrcprfsc sujjc dcsf bfa snja rasujtcta ba jcdnrctnran mc sujjc dcsf ba tuttn aj qucbrn hjakahn. Jc tfrcpac à ba tapn snstatutavn hnk prfpcrcta saktftaha ba nrmnkf snmctntrnpn. Jc bnsf bfj ecrmchn kfa bfhat ba I@ à ba 6 mi/m 4/sfttamckc nppurf 46-8< ¶i/oi/baf. Jc snmmakastrczankf bfvf fssfrf feefttuctc tuttf jf sfrf, f jc sfbf ba aknhujn bfvf fssfrf vcractc pfranbahcmfktf pfr fvatcrf ukc japnbastrnc bfj snttnhutckfn, bc trcumc rapftutn, h`f puô hcuscrf c uk rabnttn cssnr damfktn bfj ecrmchn. Feeftta akbfsabfrcta (8% ak ftì pfbactrahc)7 •  Apfrtfksankf fkbnhrckahc dfkaikc7 sa nssfrvc ak 373<<< sniiftta trct-

tcta. A saktnma snkn hfecjfc, basturda vasava, kcusfc f vnmatn. Jc tfrcpac vc tfmpnrckfcmfktf snspfsc f raprfsc cjjc shnmpcrsc bfa saktnma c bnsa maknra h`f snkn snjatcmfktf dfk tnjjfrctf. •  \rndjfma nrtnpfbaha nrtnpfbaha7 j‑fpasanjasa bfjjc tfstc bfj efmnrf f j‑ciircvcmfktn ba ukc shnjansa prffsastfktf knk snkn bnvuta cjj‑czankf barfttc bfj ecrmchn mc cjj‑cumfktn bfjjc vfjnhatì ba hrfshatc. Jc prnsfhuzankf bfjjc hurc bfvf fssfrf vcjutctc ba vnjtc ak vnjtc rfjctavcmfktf cjj‑fktatì bfj prndjfmc. •  Cjtfrctn mftcdnjasmn mftcdnjasmn ijuhabahn f Bacdftf Bacdftf Mfjjatn Mfjjatn7 cb niia snkn stctf bfshrattf snjtcktn hnkbazanka trcksatnraf ba cumfktctc aksujakfmac c baiaukn f rabnttc sfksadajatì aksujakahc burcktf aj pfranbn bfj trcttcmfktn. Bnpn jc snspfksankf bfjjc tfrcpac sa nssfrvc uk ratnrkn ca vcjnra  prf-trcttcmfktn. Knk va à aknjtrf fvabfkzc ba cumfktctn rash`an ba aktnjjfrckzc ijuhabahc n bacdftf mfjjatn kfa sniiftta h`f `ckkn ecttn tfrcpac hnk I@ ak ftì pfbactrahc raspfttn cjjc pnpnjczankf knrmcjf. Xnkn stcta rfiastrcta cjhuka hcsa b‑aksnrifkzc ba bacdftf ba tapn 4 ak  dcmdaka trcttcta hnk hnk I@ pfr dcssc dcssc stcturc stcturc knk bc bfhat bfhat ba I@. Aj I@  puô cjtrfs cjtrfsêê sjctf sjctfktazz ktazzcrf crf uk bacd bacdftf ftf ak pczaf pczafkta kta hnk uk rash` rash`an an aktra aktraksfhn ksfhn mciianrf, knk à stctn hnmukquf nssfrvctn uk cumfktn bfjj‑akhabfkzc bfjj‑akha bfkzc ba bacdftf ba tapn 3 raspfttn cjjc pnpnjczankf ifkfrcjf. •  Tash`an ba aksnrifkzc ba enrmf kfnpjcst kfnpjcstah`f ah`f7 a sniiftta trcttcta hnk I@ ak ftì pfbactrahc knk snkn c mciianr rash`an ba svajuppcrf enrmf jfuhfmah`f n tumnra raspfttn r aspfttn cjjc pnpnjczankf pnpnjcz ankf knrmcjf. Uckkn Uckkn fshjusa bc qufstf stctastah`f pczafkta ceeftta bc s. ba Djnnm f ckfmac ba Eckhnka, h`f prfsfktckn uk rash`an aktraksfhn cumfktctn pfr pctnjniaf tumnrcja. Kfija cbujta cjhuka stuba, hnkbntta su uk kumfrn trnppn jamatctn ba hcsa pfr rasujtcrf pafkcmfktf cttfkbadaja, `ckkn mfssn ak fvabfkzc uk cumfktn bfj hcrhaknmc bfj hnjnk-rfttn f bfj M. ba @nbioak.

•  Tfhabavc ba kfnpjcsac kfnpjcsac n aksnrifkzc aksnrifkzc ba sfhnkbn tumnrf tumnrf7 jc tfrcpac sn-

statutavc hnk nrmnkf bfjjc hrfshatc ak hcsn ba bfhat ak dcmdaka trcttcta  pfr prfirf prfirfssf ssf kfnp kfnpjcsaf jcsaf knk cumfk cumfktc tc j‑akha j‑akhabfkzc bfkzc ba rfhaba rfhabavc vc n sfhnk sfhnkbn bn tumnrf. Dasnikc tfkfrf ak hnksabfrczankf h`f qufsta dcmdaka snkn iaì cb cjtn rash`an ba sfhnkbc kfnpjcsac pfr ija feeftta actrnifka bfj trcttcmfktn cktakfnpjcstahn. Ckhnrc qucjh`f buddan pfrmckf sua dcmdaka hnk prfirfssc JJC/jakenmc trcttcta hnk I@ h`f sfmdrfrfddfrn cvfrf uk rash`an rfjctavn cumfktctn pfr j‑aksnrifkzc ba nstfnscrhnmc raspfttn raspft tn ca knk trcttcta hnk I@. À hnmukquf ukc fvabfkzc dcsctc su uk kumfrn rastrfttn ba pczafkta h`f rah`afbf stuba ba hnkefrmc su hnnrta pañ cmpaf. • Xnkn aknjtrf ba fhhfzankcjf rashnktrn kfa dcmdaka j‑fbfmc pfraefrahn, sfhnkbcran cjjc ratfkzankf ba jaquaba f ba Kc hnk aksnrifkzc ak ecsf  prfhnhf ba tfrcpac? tfrcpac? j‑akirckbamfktn j‑akirckbamfktn trcksatnran bfjjc i`ackbnjc i`ackbnjc mcmmcrac? crtrcjiaf, macjiaf f pcrfstfsaf. Sufstf ujtamf snkn mnjtn pañ erfqufkta kfjj‑cbujtn hnsê hnmf jc Xakbrnmf bfj Rukkfj Hcrpcjf. Enjjnw up bfjjc tfrcpac7 Aj prakhapcjf akbahctnrf bfjjc fehchac bfjjc tfrcpac

snstatutavc à jc vfjnhatì ba hrfshatc. Burcktf aj pramn ckkn sa cssastf cb ukc hrfshatc ba rfhupfrn h`f bamakuashf kfj sfhnkbn sf hnkbn ckkn pfr pna tfrmakcrf ak ukc hrfshatc rfinjcrf f hnstcktf. J‑chhrfshamfktn J‑chhrfshamfktn stcturcjf burcktf aj pramn ckkn ba vatc à ckh`f aj prakhapcjf akbahf prfbattavn bfjjc raspnstc cjjc tfrcpac tfr cpac f bfjjc  prni  pr nikn knsa sa st stct ctur urcjf cjf k kcjf cjf.. Cj Cjtra tra ak akba baha ha hn hnrrf rrfjct jctaa hn hnkk jc st stctu cturc rc k kcj cjff sn snkn kn j‑f j‑ftì tì f jc stcturc cb akazan tfrcpac f jc burctc bfj trcttcmfktn. Knk ak tutta pfrô sa nttafkf ukc dunkc raspnstc cjjc tfrcpac. \fr pntfr hnktakucrf jc tfrcpac sa bfvf nssfrvcrf uk akhrfmfktn bfjjc vfjnhatì ba hrfshatc ckkuc ba cjmfkn 4,6 hm raspfttn cjjc vfjnhatì ba hrfshatc prftrcttcmfktn, n hnmukquf supfranrf cj 6<¼ hfktajf (hrfshatc ba rfhupfrn, ak pcrtahnjcrf sf mcktfkutc burcktf a prama 4-8 ckka ba trcttcmfktn), ak hcsn hnktrcran sa puô snspfkbfrf jc tfrcpac. Ak hcsn ba raspnstc cjjc tfrcpac knk snbbasechfktf ha sa bfvf chhfrtcrf bfjjc hnrrfttc snmmakastrczankf f pnsnjniac bfj ecrmchn, bfjj‑aksnrifkzc ba uk apntarnabasmn jctfktf, n bfjjc hnfsastfkzc ba ukc pctnjniac sastfmahc snttnstcktf. Burcktf aj pfranbn ba trcttcmfktn bfvf fssfrf fsfiuatn uk mnkatnrciian hjakahn fb fmctnh`amahn. Hnktrnjja hjakaha bfvnkn fssfrf prctahcta nika 5 mfsa pfr mnkatnrcrf jc vfjnhatì ba hrfshatc, jn stcban pudfrcjf, sfika n saktnma ba fvfktucja bfhat apnscra cssnhacta f j‑fvfktucjf hnmpcrsc bfija feeftta hnjjctfrcja snprc hatcta. Bcj puktn ba vastc fmctnh`amahn sa puô mnkatnrcrf bnpn a prama 5 mfsa ba tfrcpac7

• AIE-A7 pfr fshjubfr fshjubfrff uk snvrcbnsciia snvrcbnsciian. n. J‑AIE-A knk bfvf supfrcr supfrcrff aj rckif ba knrmcjatì pfr j‑ftì. • Ijahfmac, aksujakc f fmnijndakc ijahnsajctc. Sufsta fscma pnssnkn fssfrf rapftuta cj 34¼ mfsf ba tfrcpac f pna ckkucjmfktf.

Bnpn a prama 5 mfsa vckkn hnktrnjjcta ckh`f ER2 f RX@ pfr j‑fvfktucjf aksnrifkzc aksnrifk zc ba uk apntarnabasmn jctfktf, ba nraiakf apnscrac. Akbciaka pfr fshjubfrf ujtfranra bfhat apnscra cssnhacta bnvrfddfrn hnmukquf fssfrf  prctahcta (tfst cjj‑CHR@) burcktf aj enjjnw enjjnw up. Jc tfrcpac, c mfkn ba hnmpjahckzf, bfvf fssfrf prntrcttc kn cj rciiaukiamfktn bfjjc stcturc kcjf, nvvfrn kn cjjc rabuzankf bfjjc vfjnhatì ba hrfshatc c 3.6 hm/ckkn. Tavcjutczankf pnst tfrcpac7

Bnpn jc snspfksankf bfjjc tfrcpac pfr aj rciiaukiamfktn bfjjc stcturc kcjf bfvf fssfrf prctahctn prct ahctn uk kunvn tfst ba stamnjn pfr ravcjutcrf aj bfhat. Aj hut nee pfr jc ravcjutczankf bfj bfhat knk à ckhnrc ukavfrscjmfktf stcdajatn. À stctn prnpnstn uk vcjnrf ba 8 ¶i/J bnpn stamnjn ARR (1 ¶i/J sf sa usc aj tfst hnmdakctn ITE + criakakc) criakakc )  pfr bfkarf uk bfhat bfjj‑cbujtn. Hnmukquf kfjjc mciianr mciianr pcrtf (njtrf (njtrf aj 9<%) bfa sniiftta trcttcta, cj rftfstaki sa rashnktrc ukc raspnstc knrmcjf. Ak hcsn ba pfrsastfkzc bfj bfhat ckh`f ak ftì cbujtc à niia ak ifkfrf hnksaijactc j‑cssukzankf j‑cssukzankf ba I@ pfr tuttc jc vatc cj kf ba raburrf aj rash`an ba aksnrifkzc bfjjf cjtfrczanka mftcdnjah`f snprc hatctf. Jc bnsf ba I@ bc snmmakastrcrf kfija cbujta bfvf tfkfrf ak hnksabfrczankf j‑ftì, pfr jc sanjniahc f prnirfssavc rabuzankf bfjjc sfhrfzankf bfjj‑nrmnkf hnk j‑akvfhh`acmfktn f jc mciianrf sushfttadajatì cija feeftta akbfsabfrcta. Kfa sniiftta cj ba snttn bfa 8< ckka sa puô hnmakhacrf hnk ukc bnsf (8-6 ¶i/ oi/baf) pfr pna cumfktcrf n bamakuarf c sfhnkbc bfjjc raspnstc hjakahc f bfa vcjnra ba AIE-A. Rcd. 6 - Fjfkhn cddrfvaczanka cddrfvaczanka

I@T@-r7 Irnwt` `nrmnkf rfjfcsaki `nrmnkf rfhfptnr ifkf I@37 Irnwt` `nrmnkf ifkf I@-r7 Irnwt` `nrmnkf rfhfptnr AIE-A7 Aksujak irnwt` echtnr-A \at-3, \rnp-3, @fsx-3, J`x-87 trckshraptank echtnr ifkfs akvnjvfb ak patuatcry ifkfsas

Dadjanircec fssfkzacjf

- @umck irnwt` `nrmnkf (snmctrnpak) enr t`f trfctmfkt ne irnwt` ecajurf ak h`ajbrfk. KAHF tfh`knjniy cpprcascj iuabckhf 4<3<. - Akzci`a F, Hackecrcka X. R`f H`cjjfkif ne Irnwt` @nrmnkf Bfhafkhy Baciknsas ckb Rrfctmfkt buraki t`f Rrcksatank ernm \udfrty aktn Cbujt`nnb. Ernkt Fkbnhraknj. 4<38?4
- Dczcrrc-Hcstrn MÃ, Xafvfrs H, ft cj.H`ckifs ak DMA ckb mckcifmfkt ne  pctafkts wat` h`ajb`nnb nksft irnwt` `nrmnkf bfhafkhy ak t`f trcksatank  p`csf. Fxp Hjak Fkbnhraknj Bacdftfs. 4<34?34<76<9-3<. - @n OOQ. 4<<9 I@ Bfhafkhy Hnksfksus Ynros`np \crtahapckts. Hnksfksus iuabfjakfs enr t`f baciknsas ckb trfctmfkt ne cbujts wat` I@ bfhafkhy AA7 c stctfmfkt ne t`f I@ Tfsfcrh` Xnhafty ak cssnhactank wat` t`f Furnpfck Xnhafty enr \fbactrah Fkbnhraknjniy, Jcwsnk Yajoaks Xnhafty, Furnpfck Xnhafty ne Fkbnhraknjniy Fkbnhraknjniy,, Gcpck Fkbnhrakf Xnhafty, Xnhafty, ckb Fkbnhrakf Xnhafty ne Custrcjac. Custrcjac. Furnpfck Gnurkcj ne Fkbnhraknjniy 4<<9? 3697516-9<<.