Lege Artis Medicinae

[The Minister thanks]

KRASZNAI Éva

MARCH 31, 1993

Lege Artis Medicinae - 1993;3(03)

[The rapporteur for the in-depth parliamentary debate was Gyula Fekete (MDF) from the Committee on Budget, Tax and Finance. He said that his committee had discussed the motions to amend the revenue and expenditure of the Budget and its balance with particular attention. ]

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Lege Artis Medicinae

[Epidemiology of breast cancer]

JUHÁSZ Lajos

[In 1987 breast cancer occupied the 3rd place among female cancers in the world. In Hungary, 13.577 women died due to cancer in 1990, 15,4% from breast cancer. The author uses international, and Hungarian data (at the country and county level) and also the data from his own research results. Incidence of breast cancer has risen continuously and shows a wide range in different parts of the world from 14,1 %000/year to 121,2%8000/year. The 5 year crude survival rate is between 40–65% and is slowly improving. In addition to the well-known risk-factors, the author emphasizes the role of mastopathy because in his patient group of 843 cases 2,3%, but in the mastopathy group 4,1% developed cancer. Therefore, this alteration should be considered as a high risk factor. Among close female relatives of breast cancer patients breast and other cancer has occurred much more frequently, than in that of a control group. Prostate cancer occurs significantly more frequently among 1 st degree male relatives. Therefore it is necessary to study the risk factors with epidemiologic methods and to broaden screening, detection and therapy in order to reduce the incidence and mortality of breast cancer. ]

Lege Artis Medicinae

[Brest cancer screening, early diagnosis]

LENGYEL László

[There is no data in the medical literature concerning the late results of breast physical exam by paramedical personnel as a screening test. In a population screening for breast cancer in Debrecen, nearly 70 thousand women were observed from 1981 to 1985 and 298 new breast cancer patients were detected. 198 patients were from the screened population and 100 patients from the non screened population. All of the breast cancer patients were followed up, and the analysis was completed on 31st December 1991 with the help of statistical methods. The author analysed the overall survival, cumulative death rate and relative risk of dying according to age group. The difference of overall survival was 29% for the screened group. This result is nearly the same as that produced by mammographic screening.]

Lege Artis Medicinae

[Diagnostics of breast cancer]

PÉNTEK Zoltán

[The author interpretes and evaluates the diagnostic methods of breast cancer. Detailed description is given on physical examination, mammography, ultrasound examination, cytology, histology and miscellaneous methods, expressing their advantages and drawbacks. On clinical experience nowadays the combinative application of these by the same expert seems to be the most effective method, possibly in large breast clinic centres.]

Lege Artis Medicinae

[Breast cancer markers of prognostic significance]

TÓTH József, SÁPI Zoltán

[Prognosis prediction of breast cancers is difficult, particularly in early clinical stage (1) or in tumors with practically identical histological structure and degree of differentiation (invasive ductal NOS cancer) because node negative tumors of early developmental stage or with identical structure may demonstrate different clinical course. In such cases the steroid hormone receptor content, the prolife rating capacity of the tumor and the so called independent prognostic factors like the onco gene and supressor gene expression (c-myc, C-erbB–2, p53), the growth factor receptor content (EGFr) and the so called differentiation antigens accompanied by low metastatising capacity (MAM–6, nm23) may help the pathologist in diagnostics. Examinations of these markers are planned to be introduced in future diagnostics and contribute to the elaboration of effective treatment schedules.]

Lege Artis Medicinae

[The surgery of breast cancer]

SVASTICS Egon

[The incidence of breast cancer in Hungary is gradually increasing, not only in the elderly due to the increasing average age, but in younger women as well. In the operative stadia (St I-II), the best results can be achieved by a radical surgical intervention and an adjuvant radio-chemo-hormone therapy. The formerly routine radical mastectomies are being replaced by breast conserving procedures which remove the tumour and sacrife only the most necessary surrounding tissues to achieve the best local tumour control. The fundamental basis for this procedure was established by the clinical trials of B. Fisher and U. Veronesi. The practical basis is the circumstance, that owing to better propaganda, more frequent breast self examinations, and better mammographic and cytological facilities, more breast cancer will be recognized in an earlier stage.]

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[Paradigm shift in the drug therapy of HFrEF]

HEPP Tamás, VARJAS Norbert, BENCZÚR Béla

[The incidence and prevalence of heart failure (HF) is constantly increasing, its mor­bidity and mortality are still high, thus the disease burden is huge and its proper treatment is of paramount importance. Subs­tantial evidence on improving its prognosis remains available only by the treatment of chronic heart failure with reduced left ventricular function (HFrEF). There have been published a number of “milestone” studies in the last decades, the results of which fundamentally determined the HF therapy until recently. Baseline therapy for HFrEF has been placed on three pillars for a long time: angiotensin-converting-en­zyme inhibitors (ACEI), beta-blocker (BB), and mi­ne­ralocorticoid receptor antagonist (MRA) are included in different heart failure guide­lines with I/A level recommendation. The ground-breaking highly important PARADIGM-HF study was published in 2014, and examined an entirely new class of drugs, the sacubitril/valsartan, which belongs to the group of angiotensin receptor blocking/neprilysin inhibitors (ARNI) in HFrEF patients. Results of this study showed that sacubitril/valsartan significantly reduced the primary composite endpoint of CV mortality and HF hospitalization by 20% and reduced overall mortality by 16% compared to an active comparator enalapril, which has the broadest evidence in HFrEF therapy. The 2016 European Society of Cardiology (ESC) HF guidelines recommended the use of sacubitril/valsartan with an I/B evidence level as a replacement for an ACEI to further reducing the risk of HF hospitalization and death of out-patients with HFrEF who remained symptomatic despite optimal treatment with an ACEI, a BB and an MRA. Later, several smaller studies concerned sacubitril/valsartan with slightly different indications and in other patient groups. The PIONEER-HF study demonstrated that early initiation of sacubitril/valsartan therapy after the stabiliza­tion of acute HF is safe and effective in HFrEF patients, reduces more rapidly the NT-proBNP levels - which correlates with HF prognosis -, than the enalapril. The TRANSITION and TITRATION studies provided useful information on the initiation of sacubitril/valsartan therapy and the strategy of dose titration. The appearance of sacubitril/valsartan opened a new era in HFrEF therapy a few years ago, an era we are actually experiencing in Hungary. Thanks to SGLT-2 inhibitors, it is also possible that we are at the door of an even newer therapeutic era. This question is expected to be answered in the new ESC HF-guidelines to be published soon this year. ]

Lege Artis Medicinae

[About the same thing elsewhere, in a different tone]

ANDRÁS László

[It was a gesture of thanks and appreciation that a few days after the publication of the 1992/6 regulation on general practitioners, senior staff from the Ministry of Public Welfare and the OTF presented and discussed it with their colleagues at the LAM Club. Naturally, this was done only after the regulation had been published. They did not receive the same recognition and thanks when they made the same gesture to their colleagues sitting as Members of Parliament in the Committee on Social Affairs and Health. ]

Lege Artis Medicinae

[The future of chest X-ray screening in Hungary]

AJKAY Zoltán

[In 2001 4.095.134 chest screening examinations were carried out at 154 fixed and 50 mobile Xray screening stations in Hungary. Currently, screening for tuberculosis is mandatory by law, but a recently issued decree by the Health Minister states that the method is suitable for the screening of lung cancer as well. Unfortunately, the majority of the machines are old and since replacements are long overdue, the assessment with a high technical standard and quality is not always possible. These are the reasons why a plan must be outlined for the necessary improvement and for the renewal of the equipment pool, based on expert opinion. In the literature, there are ongoing spirited discussions on the efficacy of X-ray screening as well as on the possibilities of CT-scans for the identification of lung cancer. The size of the investment needed makes it necessary that costbenefit factors and the possibility of joining the National Health Prevention program should be considered.]

Lege Artis Medicinae

[Report]

[Interpellation of György Danis to Dr. László Surján, Minister of National Welfare, on "The working capacity of the health care system"]

Lege Artis Medicinae

[The debut of the minister]

NAGY András László