Biomedical subjects
D V Razis
Publications and source records attributed to D V Razis.
Medical confidentiality.
The Hippocratic definition of Confidentiality, i.e. the absolute and without any exceptions observation of secrecy by the physicians, expresses the Hippocratic philosophy in Medicine. Hippocratic Medicine is completely individualized--the physician's sole responsibility is the patient's well being. Confidentiality undoubtedly strengthens the trust in the patient-physician relationship and mutual trust is indispensable for both diagnostic work-up and therapeutic applications. Exceptions to confidentiality might be required in order to protect the society from infectious communicable disease, from dangerous patients and for the scientific progress. However, it is not easy at all to decide for exceptions to confidentiality. The profound changes of the human societies in the end of the 20th century, the fantastic progress in Medicine and Science and the completely different approach to the delivery of medical services in modern times, make necessary the re-evaluation of medical deontology and medical confidentiality.
Ethics and the universality of morality.
Ethics is one of the forces shaping the life of human societies and the ethical system contributes to the group's survival and to keep peace and order to satisfy social needs. The definitions of ethics, of what is good and what makes an action right or wrong, varies widely at different times and at different places. However, some basic moral elements are acceptable to most advanced societies. Furthermore, many modern scholastic writers defend the absolute universality of at least some ethical laws. The limitations of universality survives in war, in race discrimination, etc. In modern times, it might be appropriate to search for principles for the universality of morality in ecological considerations. Progress in ethics is lagging far behind and we must understand now, when the complete annihilation of human species is a real possibility, that ethics and philosophy are at least as important as science.
Randomized controlled trials in hematologic malignancies.
Explore the source record for details and available documents.
Modern Cassandras and our survival as a species--a new role for medicine?
Explore the source record for details and available documents.
How progress has been achieved in medicine.
Modern medicine is the result of a long historical development. It evolved from instinct and experience in prehistoric times to observation and reasoning in the Hippocratic period, to the formulation of a scientific system in Galen's period and experimentation in the 19th century. Philosophically, Aristotelian rationalism was challenged by Bacon's scientific empiricism, and C. Bernard's scientific determinism by today's indeterminism. Developments in medicine have always depended on the stage of the development of human societies, socioeconomically, scientifically, technologically and culturally.
Clinical trials in cancer research--philosophical and methodological considerations: discussion paper.
Explore the source record for details and available documents.
Modern trends in the management of hepatocellular carcinoma.
No treatment of proven validity in hepatocellular carcinoma (HCC) has yet been found, with the exception of surgery in a small subset of patients. Furthermore, there is a paucity of phase I and II trials and of phase III prospective randomized trials. Radiation therapy is not considered very effective, even as a palliative procedure, but there has been renewed interest in this modality, with several ongoing trials attempting to establish optimal doses, fractionation and effectiveness. Chemotherapy, single or combination, has not increased the survival of patients with HCC, although there have been unquestionable, even spectacular, responses to chemotherapy. Adriamycin seems the most effective agent with approximately 25% objective responses. The regional administration of drugs and/or interruption of arterial supply, in this malignancy with a pattern of local confinement, yields quite high response rates but no increase in survival. Several trials with combined therapeutic modalities are now in progress. Furthermore, there have been important advances in nuclear medicine, in the totally implantable pump, in the understanding of pharmacokinetics and in microspheres, monoclonal antibodies, etc. It is remarkable that there have been so few randomized trials in such a common malignancy. To obtain valuable results any future studies should randomize patients into "treatment" and "no treatment" groups and stratify patients according to prognostic factors. It seems, however, that the combination of local and systemic treatment is the most promising answer to this virulent and fatal disease.
Treatment of ovarian cancer with a combination of cis-platinum, adriamycin, cyclophosphamide and hexamethylmelamine.
During the last 2 1/2 years, 38 patients with ovarian cancer were treated with a combination of cisplatinum (CPDD), 50 mg/m2, adriamycin, 30 mg/m2, cyclophosphamide, 300 mg/m2, on day 1; and hexamethylmelamine (HMM), 6 mg/kg daily, for 14 days. Each course was repeated monthly. 2 patients had stage II, 14 stage III and 22 stage IV disease. 14 of the 38 patients were previously treated with chemotherapy, 1 with radiation, 6 with both chemotherapy and radiation, and 17 did not have any treatment before CPDD combination. 31 of the 38 cases (81.5%) demonstrated objective responses lasting for 2 months or more. These responses were partial in 19 and complete in 12 cases. Hematologic toxicity was moderate and with reversible anemia developing in 71% of patients. Gastrointestinal side effects from CPDD were universal. HMM gastrointestinal toxicity necessitated discontinuation of the drug in 5 patients. Severe nephrotoxicity was observed in 2 patients but was reversible. There were no drug-related deaths.
Hypercalcemia in breast cancer.
Hypercalcemia is a life threatening complication of generalized breast cancer. It developed in 28 out of 205 patients (13.5%) treated in the Department of Medicine of the Cancer Institute of Piraeus during the years 1974-1978. 32 hypercalcemic episodes appeared in these 28 patients and of these episodes, 15 were hormone induced and 16 spontaneous. The interval between hormone institution and appearance of hypercalcemia never exceeded one month. Hypercalcemia was moderate to severe in 81% of the spontaneous hypercalcemic episodes and only in 40% of those hormone induced. The clinical manifestations varied from no symptoms to a severe clinical picture. The most frequent biochemical abnormality was hyperuricemia; azotemia and hypokalemia were also frequent. Administration of phosphates is the most effective therapeutic agent in this complication. When the diagnosis was made promptly and correct treatment initiated without delay, no patient in our material died of hypercalcemia.
Randomized clinical trials in cancer chemotherapy.
Explore the source record for details and available documents.
Chemotherapy of ovarian cancer.
Chemotherapy using a modified Cooper's regimen was applied during the past few years on 41 cases of advanced cancer of the ovary. We believe this scheme has not been attempted elsewhere. Twenty-five cases (60%) responded positively to this regimen. Two patients with generalized ovarian cancer may be cured. The combination of palliative surgery and polychemotherapy in cancer of the ovary may prove to be one of the most effective multidisciplinary approaches to generalized cancer.
A new classification of generalized carcinoma of the breast based on response to therapy.
Classifications of generalized carcinoma of the breast were based up to now on factors of definitely proven prognostic significance. These classifications are very useful in defining prognosis, but they help only to a limited extent in selecting treatment. We are proposing a new classification of three groups for generalized carcinoma of the breast according to objective response to therapy: to (a) responders, (b) nonresponders, and (c) patients with static disease. It is pointed out that in some cases there is discrepancy between prognosis and response to therapy, as some patients with "poor prognosis" respond dramatically to treatment while others with "good prognosis" do not respond to any type of treatment and treatment is actually harmful. It is also pointed out that our classification has a dynamic meaning, as a patient can switch from one group to another. The proposed classification might be of more help in deciding the therapeutic management.
Diuretics in malignant effusions and edemas of generalized cancer.
Forty patients with generalized cancer complicated by water and electrolyte retention were treated with "medium" and "large" doses of furosemide and bumetanide with 35% and 40% objective positive response, respectively. A smaller percentage of patients benefited from these diuretics, mainly in the quality of their lives. Peaks" of diuresis lasting a few days were observed in positive diuretic response. It is therefore concluded that diuretics may be more effective in malignant conditions if administered in a "high-dose pulse" therapeutic schedule.
Chordoma of the cervical spine treated with vincristine sulfate.
Explore the source record for details and available documents.
Carcinoma of the cervix presenting with rectal symptomatology: report of three cases.
Explore the source record for details and available documents.
Prospective randomized study of aminoglutethimide (AG) versus medroxyprogesterone acetate (MPA) versus AG+MPA in generalized breast cancer.
Eighty-five postmenopausal women with metastatic breast cancer were randomized to receive aminoglutethimide (AG), medroxyprogesterone acetate (MPA), or AG+MPA. Patients with aggressive visceral disease were excluded. Response was observed in 36% of the patients in the AG treatment group, 31% in the MPA treatment group, and 47% in the combination treatment group. Statistical analysis showed that the percentage of responders was not different among the three treatment groups. Similarly, the duration of response did not differ. Toxicity of all three regimens was moderate, not necessitating discontinuation of treatment. In conclusion, AG, MPA and the combination of AG+MPA were found to be equally effective therapies for metastatic breast cancer in postmenopausal women with nonaggressive visceral disease. The lack of statistically significant superiority of the combination of AG+MPA suggests that sequential endocrine monotherapies may be more beneficial than combined hormonotherapies for this patient population.