Lege Artis Medicinae

[Changes in the hormonal therapy of breast cancer patients]

MOSKOVITS Katalin

AUGUST 20, 2002

Lege Artis Medicinae - 2002;12(08)

[The hormonal therapy for breast cancer patients seems to be changing. At present the new, third generation aromatase inhibitors are the standard second line therapy for postmenopausal, receptor positive advanced breast cancer patients. Currently, tamoxifen (TAM) stands as the ”gold standard” first line therapy, with ist role changing, due to the aromatase inhibitors which seems to be more effective than TAM and have less side-effects. For these reasons, aromatase inhibitors may be useful in the adjuvant setting, but long-term side-effects are not yet known. In the next few years, sufficient experience will be gained with these drugs which might help us to change practice. Pure antioestrogens are also promising new drugs. Recently, the LHRH analogues were the preferred drug of choice in premenopausal women, in contrast to surgical or radiological ovarian ablation. All receptor positive breast cancer patients should receive hormonal therapy, regardless of age, menopausal status, node status, tumour size, but we should avoid hormonal therapy for the endocrine nonresponsive patients.]

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Lege Artis Medicinae

[Physicians’ attitudes and suppositions in 2001 in the Polyclinic of the Hospitaller Brothers in Budapest]

BALÁZS Péter

[INTRODUCTION - Following the total socioeconomic changes in Hungary in 1989, no scientific analysis has been made about physicians' religious attributes in the new circumstances. These attributes, after four decades of political anticlericalism may affect essentially the ideological and socio-economic patterns of medical professionalism. Hungary’s 2001 census favoured such an inquiry, since it went back to the traditional questions about religious affiliations. METHODS - The ”sensitive” questions ot the census were accepted without any obstacle in the whole population and backed up the present study together with the newly established religious atmosphere in the hospital of roman catholic Hospitaller Brothers of St. John of God, which was reopened on the 1st of July, 2000. The collection of data started in November 2000 ending in December 2001. All 98 full time employed physicians participated in the inquiry carried out by personal interviews guided by the same 51 questions. Following more than half a century span, the aim of the present study was to gain measurable information about the doctors’ unknown religious affiliation and its impact on clinical problems with ethical dimensions. RESULTS - All the doctors cooperated willingly in face-to-face interviews. There was a high proportion of religious affiliation (83 persons out of 98) without any sign of mysticism in the professional values. However, the pre-eminent role of psychological factors in the healing process was stressed, opposed to the simplified materialism of medicine. The same ideological pattern was represented while ranking other professions in the social hierarchy. No physicians experienced a conflict between their religious belief and professional activity in the dayto- day service. CONCLUSION - According to the extremely underpaid medical profession in Hungary, doctors of the new hospital do not believe that now they should tolerate their underpaid status as altruistic missionaries. However, they know exactly that balancing professionalism and business of medicine, is not a task for a single hospital but an urgent one of the whole society.]

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[Atypical forms of the gastroesophageal reflux disease]

KIS János Tibor, NEMESÁNSZKY Elemér

[There is growing interest in the gastroenterology literature towards gastroesophageal reflux disease (GERD) these days. The prevalence of the disease is much higher than estimated earlier and it frequently appears in atypical forms. Literature data suggests that 30-40% of the individuals suffer from gastroesophageal reflux disease. A broad spectrum of presentation of gastroesophageal reflux disease exists, e.g. noncardiac chest-pain, ear-nose-throat symptoms, pulmonary symptoms, dental erosions, chronic cough and hiccups. Atypical forms often cause diagnostic and treatment difficulties. Authors analyze the frequency, morbidity and the pathomechanism of the extraesophageal manifestations, based on self-experience. The main goal of the review is to help to establish the diagnosis of GERD, to recognize its atypical signs and to outline the diagnostic steps to be taken. Most up-to-date treatment strategies are also presented. By the demonstration of interesting cases, authors emphasize the diagnostic importance of intragastric pH-monitoring.]

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