According to David and Grasmann, the recognised comparative law scholars, there are basically three main criteria for differentiating between legal families and their subgroups: 1. meta-legal ...considerations; 2. legal sources; and 3. dogmatic legal structures. Concerning the last two criteria, which could also be designated as formal elements of a country’s legal identity, Slovenia has been deeply “immersed” in the civil law of a Central European type. Even after the decline of the Habsburg Empire, what remained to apply on the territory of nowadays Slovenia as part of the then Kingdom of Yugoslavia, was to an important extent Austrian law. Moreover, even the “decadent capitalist code” such as the Allgemeines bürgerliches Gesetzbuch (ABGB) more or less survived in spite of the communist “withering away of the state and law”, and can today still be applicable to some older cases. After one thousand years of Germanic dominance, the Slovenes turned to the East in trying to build their national identity, one hundred years ago when the Empire collapsed. Although that seemed to be a necessary move towards stronger national identity, it was their first step away from the rule of law. The second step away from that was the period of communism that endured almost half a century. Nevertheless, the formal part of the Central European legal identity somehow survived in Slovene law, with certain “injuries” of course, but it is mainly the meta-legal considerations, their sociological and psychological elements in particular, that nowadays make a difference between the situations of the rule of law in the Republic of Slovenia and, for example, in the Republic of Austria, both parts of the onetime joint Empire.
Although the legal context is a formalized framework, in judicial proceedings there is also room for multi-modal argumentation. To the traditional logical mode, multi-modal argumentation theory has ...added three additional modes (the so-called “alternate” modes: visceral, kisceral, and emotional). They complement the logical mode in unclear legal cases, those with vague and ambiguous premises (both legal and factual). What is discussed here is visual argumentation as part of the visceral mode. Visual arguments can be appropriate in legal argumentation as evidence used to determine the lower premise. However, “thick” visuals invite alternate arguments to be applied in legal argumentation. This “invitation” is not exactly the same as with “thick” verbal texts because what is at issue are different semiotic resources.
This paper discusses how an understanding of Jung's psychological types is important for the relevance of Gilbert's multi-modal argumentation theory. Moreover, it highlights how the types have been ...confirmed by contemporary neuroscience and cognitive psychology. Based on Gilbert's approach, I extend multi-modal argumentation to the area of legal argumentation. It seems that when we leave behind the traditional fortress of “logical” legal argumentation, we "discover" alternate modes (such as the intuitive, emotional, and sensory) that have always been present, concealed in the theoretically underestimated rhetorical skills of arguers.
Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in ...patients operated on for primary localized RPS.
We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs.
In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2%
. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity.
Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.
Background
Multi-visceral resection often is used in the treatment of retroperitoneal sarcoma (RPS). The morbidity after distal pancreatectomy for primary pancreatic cancer is well-documented, but ...the outcomes after distal pancreatectomy for primary RPS are not. This study aimed to evaluate morbidity and oncologic outcomes after distal pancreatectomy for primary RPS.
Methods
In this study, 26 sarcoma centers that are members of the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) retrospectively identified consecutive patients who underwent distal pancreatectomy for primary RPS from 2008 to 2017. The outcomes measured were 90-day severe complications (Clavien-Dindo ≥ 3), postoperative pancreatic fistula (POPF) rate, and oncologic outcomes.
Results
Between 2008 and 2017, 280 patients underwent distal pancreatectomy for primary RPS. The median tumor size was 25 cm, and the median number of organs resected, including the pancreas, was three. In 96% of the operations, R0/R1 resection was achieved. The 90-day severe complication rate was 40 %. The grades B and C POPF complication rates were respectively 19% and 5% and not associated with worse overall survival. Administration of preoperative radiation and factors to mitigate POPF did not have an impact on the risk for the development of a POPF. The RPS invaded the pancreas in 38% of the patients, and local recurrence was doubled for the patients who had a microscopic, positive pancreas margin (hazard ratio, 2.0;
p
= 0.042).
Conclusion
Distal pancreatectomy for primary RPS has acceptable morbidity and oncologic outcomes and is a reasonable approach to facilitate complete tumor resection.
Sarcoma patients should be treated in high volume referral sarcoma centers. Compartmental resection is proposed as the best treatment option in retroperitoneal sarcoma patients.
Institute of Oncology ...Ljubljana is the only referral sarcoma center in Slovenia. Having a population of 2.1 million poses a unique situation. We manage all sarcoma patients in the country and operate on patients with soft tissue tumors of extremities, trunk, and abdomen. Data for all consecutive patients surgically treated from January 1999 to December 2018 for primary localized retroperitoneal sarcoma was extracted from a prospective surgical database. Data about the incidence of sarcoma patients in Slovenia was extracted from the Cancer Registry of Republic of Slovenia. Clinicopathologic variables and the outcome were analyzed.
In total, 89 patients were included in the study. Median age was 62 years. Dedifferentiated liposarcoma was the most common histology (38.2%). Median tumor size was 21 cm. Compartmental resection was performed in 47.2% (42/89). Postoperative complication grade 3a or higher according to Clavien-Dindo classification had 30.3% (27/89) of patients. The 30-day and 90-day mortality rate was 2.2% and 5.6%. Median follow-up was 62.1 months. Corresponding 5-year overall survival was 67.2%, 5-year disease-specific survival was 72.6%, and 5-year local recurrence-free survival was 81.5%, respectively.
Results from our institution show that referral sarcoma centers may achieve very good results in management of retroperitoneal sarcoma patients, despite not meeting the criteria for high volume hospitals, as long as they have multidisciplinary team, appropriate facilities, and expertise.
Gilbert's kisceral argumentation is, roughly speaking, about arguing based on intuitions. In the forefront of such a (rhetorical) model are arguers and audiences, who resolve disagreements using ...kisceral arguments. Intuitions as reasons were more important in pre-modern law, when the law was not as explicit, precise, and determinate as today. Law influenced by religion or religious law was a typical example. In our much more secular modern era, intuitions are more or less subordinated to the (legal) logical mode of arguing. However, in tough legal cases, when logic "runs out," it is values that decide them. Not surprisingly, neuroscience and cognitive psychology have shown a strong connection between values and intuition.
Gilbert's kisceral argumentation is, roughly speaking, about arguing based on intuitions. In the forefront of such a (rhetorical) model are arguers and audiences, who resolve disagreements using ...kisceral arguments. Intuitions as reasons were more important in pre-modern law, when the law was not as explicit, precise, and determinate as today. Law influenced by religion or religious law was a typical example. In our much more secular modern era, intuitions are more or less subordinated to the (legal) logical mode of arguing. However, in tough legal cases, when logic "runs out," it is values that decide them. Not surprisingly, neuroscience and cognitive psychology have shown a strong connection between values and intuition.
Leiomyosarcoma is a rare malignant mesenchymal tumour. Some cases of leiomyosarcoma of the renal vein (LRV) have been reported in the literature, but no analysis of data and search for prognostic ...factors have been done so far. The aim of this review was to describe the LRV, to analyse overall survival (OS), local recurrence free survival (LRFS) and distant metastases free survival (DMFS) in LRV world case series and to identify significant predictors of OS, LRFS and DMFS.
Cases from the literature based on PubMed search and a case from our institution were included.
Sixty-seven patients with a mean age of 56.6 years were identified; 76.1% were women. Mean tumour size was 8.9 cm; in 68.7% located on the left side. Tumour thrombus extended into the inferior vena cava lumen in 13.4%. All patients but one underwent surgery (98.5%). After a median follow up of 24 months, the OS was 79.5%. LRFS was 83.5% after a median follow up of 21.5 months and DMFS was 76.1% after a median follow up of 22 months. Factors predictive of OS in univariate analysis were surgical margins, while factors predictive of LRFS were inferior vena cava luminal extension and grade. No factors predictive of DMFS were identified. In multivariate analysis none of the factors were predictive of OS, LRFS and DMFS.
Based on the literature review and presented case some conclusions can be made. LRV is usually located in the hilum of the kidney. It should be considered in differential diagnosis of renal and retroperitoneal masses, particularly in women over the age 40, on the left side and in the absence of haematuria. Core needle biopsy should be performed. Patients should be managed by sarcoma multidisciplinary team. LRV should be surgically removed, with negative margins.
Multi-modal argumentation is a relatively new approach in argumentation theory. In Gilbert's approach to multi-modality, it focusses not only on the logical mode of argumentation but also on the ...emotional, the kisceral, and the visceral: the so-called "alternate" modes. Due to the formal institutional constraints in law, the logical mode (in its dialectical variant) is a normative imperative due to the demands of the rule of law. However, especially in the so-called unclear cases, we can find traces of the alternate modes, either in their dialectical or rhetorical dimensions. If it already has been claimed that logic is only one part of legal "business," a multi-modal argumentation analysis of law, in a Gilbertarian style, is presented here for the first time.
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