Radical Intervention Research Articles

Остеорадионекроз лицевого черепа: современные доказательные данные (обзор литературы)

Despite recent advances in radiation therapy, osteoradionecrosis remains a common and severe complication of radiation therapy in patients with head and neck cancer. Modern methods of treatment are developed with regard to the disease severity and pathophysiology complexity, as well as theories of the osteoradionecrosis development. The following theories of osteoradionecrosis pathophysiology are currently considered: "radiation-induced osteomyelitis", "hypoxic, hypocellular, hypovascular" and "fibroatrophic". Prior to radiation therapy, the patient is provided with restorative dental treatment and radiation therapy planning. Treatments range from conservative «watch and wait» to more radical surgical interventions. Currently, there is no approved standard for the care of osteoradionecrosis patients, however, the activity in this direction is underway. Currently state-of-the-art treatment strategies are available with limited evidence. The review aims to assess the literature on osteoradionecrosis of the jaw with an emphasis on available treatment options.

PATIENT MANAGEMENT TACTICS AT DIFFERENT STAGES OF GASTROINTESTINAL STROMAL TUMORS (GIST).

The aim: To analyze the results of treatment even in limited groups of patients. Materials and methods: Clinical cases of GIST based on the materials of the surgical clinic of the Central Municipal Hospital in Uzhgorod (Transcarpathian region) were discussed. Clinical, ultrasound and CT monitoring was provided. CT dynamics were assessed according to RECIST 1.1. Conclusions: Only surgery resection is enough in case of the "small" tumor originated from the stomach. Otherwise, in case of locally-widespread GIST it is expedient to refrain from radical surgical intervention. High-grade GIST was verified by the IHC examination with mutation of the KIT gene in exon 11. Imatinib mesylate 400 mg PO daily was prescribed. More than 1-year follow-up result: firstly more than 50% reduction of the tumor size with subsequent stabilization of the disease. Minimally invasive processes allow surgical interventions and do not require aggressive adjuvant therapy. The presence of a giant GIST is a serious diagnostic and treatment challenge. Only management of the patient by a multidisciplinary team allows to resolve diagnostic and treatment contradictions, to create the prospect of achieving complete or partial remission and long-term survival.

Crafting literary Urdu: Mirza Hatim’s engagement with Vali Dakhani

AbstractThe emergence in eighteenth-century India of literary compositions that used the elite registers of what was, at the time, called ‘Rekhtah’, and later defined as Urdu, is poorly understood. Conventionally, after an initial infatuation in Delhi with the works of Vali Dakhani,1 a mid-century break is assumed, exemplified by the revision of Zuhur ud-Din Hatim’s Divan as Divanzadah in the 1750s. Scholars have viewed this as a radical intervention in the creation of Urdu, which excised old vernacular models and embraced further Persianization. This article re-examines the evidence, combining methodologies from literary and historical studies. It points to the continuities present in Hatim’s revision, including sustained engagement with Vali, even as Hatim attempted to appeal to new audiences, incorporating new trends alongside older literary models. Foregrounding literary networks and arenas of poetic practice shows the limited impact of the proscriptions and literary criticisms voiced by Hatim’s critics. In studying the contested space of literary aesthetics and linguistic shifts against self-fashioning within changing networks, this article demonstrates that the relationship between the Persianate and vernacular sphere continued to be generative, rather than oppositional or hierarchical.

Radical interventions for climate-impacted systems

Standard solutions to the threat of >1.5 °C global average warming are not ambitious enough to prevent large-scale irreversible loss. Meaningful climate action requires interventions that are preventative, effective and systemic—interventions that are radical rather than conventional. New forms of radical intervention are already emerging, but they risk being waylaid by rhetorical or misleading claims. Here, to encourage a more informed debate, we present a typology of radical intervention based on recent studies of resilience, transition and transformation. The typology, which is intended to be provocative, questions the extent that different interventions can disrupt the status quo to address the root drivers of climate change.

Ambient ms profiling of meningiomas: intraoperative oncometabolite-based monitoring

The primary method of initial treatment of meningiomas is radical neurosurgical intervention. Various methods of intraoperative diagnostics currently in development aim to improve resection efficiency; we focus on methods based on molecular profiling using ambient ionization mass spectrometry. Such methods have been proven effective on various tumors, but the specifics of the molecular structure and the mechanical properties of meningiomas raise the question of applicability of protocols developed for other conditions for this particular task. The study aimed to compare the potential clinical use of three methods of ambient ionization in meningioma sample analysis: spray from tissue, inline cartridge extraction, and touch spherical sampler probe spray. To this end, lipid and metabolic profiles of meningioma tissues removed in the course of planned neurosurgical intervention have been analyzed. It is shown that in clinical practice, the lipid components of the molecular profile are best analyzed using the inline cartridge extraction method, distinguished by its ease of implementation and highest informational value. Analysis of oncometabolites with low molecular mass is optimally performed with the touch spherical sampler probe spray method, which scores high in both sensitivity and mass-spectrometric complex productivity.

Surgical Aspects of Treatment of Hilar Cholangiocarcinoma

Introduction. Treatment of hilar cholangiocarcinoma remains one of the most complicated issues of surgical hepatology. As known, hilar cholangiocarcinoma is resistant to chemotherapy and radiation therapy, and only a surgical option is an effective way to improve patient survival.The aim of the study was to improve clinical outcomes of patients with cholangiocarcinoma by evaluating the efficiency of various options for resection and reconstructive and restorative stages of surgical treatment.Methods. The study involved clinical findings and outcomes of 68 patients with hilar cholangiocarcinoma. Biliary decompression was performed in 61 (89.7%) cases. Radical surgical interventions were performed in 35 (51.4%) cases, and palliative surgical interventions were performed in 33 (48.6%) cases.Results. Specific complications at the stage of biliary decompression were noted in 4 (6.5%) cases, inadequate drainage of the biliary tract occurred in 5 (8.2%) cases. The syndrome of "rapid decompression of the biliary tract" was recorded in 14 (23.0%) cases, cholangitis - in 12 (19.7%). Intraoperative complications were noted in 2 (15.3%) cases, postoperative - in 6 (17.1%) cases. Mortality rate was 8.5%. In the long-term period, stenosis of the biliodigistic anastomosis was recorded in 11.4% of cases, tumor recurrence occurred in 28.6% of cases. The five-year survival rate was 17.0%.Conclusion. Resection of the bile ducts combined with hemihepatectomy is an operation accompanied by high risks, especially at the height of jaundice and in the elderly patients. Performing a sparing hiatal resection of the liver and bile ducts provides an acceptable survival rate. The proposed method to form a biliodigistic anastomosis is effective in terms of preventing insolvency and stenosis of the anastomosis.

S2823 Endoscopic Bypass of Gastric Outlet Obstruction After Spontaneous Celiac Artery Dissection

Introduction: Spontaneous isolated celiac artery dissection (SICAD) is a unique pathology with unclear management guidelines. Complications include hematoma formation and rarely intestinal ischemia. Gastric outlet obstruction (GOO) may occur because of luminal narrowing from ischemic duodenitis or extrinsic compression from hematoma. EUS-guided gastroenterostomy (EUS-GE) is an accepted approach in the management of malignant obstruction however currently there is no guidance for benign obstruction. We describe a case of SICAD complicated by GOO requiring bypass with EUS-GE. Case Description/Methods: A 56 year-old man presented with a weeklong history of epigastric abdominal pain. A computed tomography angiography (CTA) of the abdomen demonstrated a 1.3cm dissection of the celiac artery with associated hemorrhage. He was managed with intravenous anti-hypertensive medications and discharged 2 days later. He returned in 1 week with intractable nausea and vomiting. Repeat CT abdomen demonstrated duodenitis, dilation of the stomach and proximal duodenum and resolving hemorrhage surrounding the celiac artery. Nasogastric decompression returned 1100ml bilious output. Esophagogastroduodenoscopy (EGD) demonstrated edematous mucosa within the proximal duodenum with luminal narrowing preventing passage of the scope. The decision was made to proceed with EGD-EUS. EUS demonstrated a dilated. Celiac artery with a areas of hemorrhage within the celiac axis and adjacent to the duodenum. After successful creation of an EUS-GE the patient was discharged on oral intake a day later. Surveillance imaging 2 months later demonstrated improvement of hemorrhage. (Figure) Discussion: Our case Illustrates a rare case of GOO as a result of a hematoma causing duodenal compression. Until the recently, the only option for management for benign GOO was radical surgical intervention. Endoscopic management with either ballon dilation or intraduodenal stents are poor choices due to risk of perforation and durable patency is not guaranteed. Current guidelines do not provide recommendations on EUS-GE for benign etiologies of GOO. Small retrospective studies have illustrated success however prospective and randomized trials are needed to demonstrate efficacy and safety in benign causes of GOO.Figure 1.: Panel A. EGD with duodenal narrowing. B. EUS demonstrating celiac artery dissection. C. Lumen-apposing metal stent (LAMS).

MODERN INDIVIDUAL-COMPREHENSIVE APPROACH IN THE TREATMENT OF HEMORHOIDS

Objective. The aim of the study was to analyze the effectiveness of modern treatments in 485 patients with chronic hemorrhoids stage II-III-IV over the past 3 years.
 Results. An individual-combined approach to the treatment of hemorrhoids has been introduced, as many patients can have nodules at different stages of the disease at the same time. Used a combination of methods with different ways to influence the pathogenesis of hemorrhoids. Thanks to the introduction of a set of systemic measures, good results were obtained, namely the healing time of postoperative wounds was reduced by 35-40% and the intensity of postoperative pain was reduced by 3-4 points on a 10-point analog visual scale.
 Conclusions. The use of an individual integrated approach to each patient in choosing the tactics of surgical treatment of hemorrhoids and the widespread introduction of modern techniques, has reduced the duration of the postoperative period, preserve radical intervention and reduce the likelihood of recurrence.

ACUTE AND CHRONIC CHOLANGITIS: PATHOPHYSIOLOGY, CLINIC, SURGICAL TACTICS

Summary. Aim of the study: Based on new knowledge about the course of acute and chronic cholangitis in patients with obstructive lesions of the bile ducts to improve the results of diagnosis and treatment, using improved algorithms and new minimally invasive technologies.
 Materials and methods. 200 patients with acute and chronic cholangitis were selected. There were 93 men — 107 men, the age of patients ranged from 25 to 79 years, the average age was (61,8 ± 2,4) years.
 Results and discussion. Reconstructive surgery for choledochal strictures should be performed if the patient’s condition allows as early as possible (preferably within 3–4 weeks after symptomatic minimally invasive biliary tree decompression) to prevent the development of irreversible cirrhotic changes in the liver parenchyma.
 Conclusions. Minimally invasive interventions are effective both in the treatment of cholangitis due to intraductal causes, where they are the ultimate treatment, and as a first-line method of preparation for major radical intervention in severe anatomical changes in the biliary system.

Fallacies of Democratic State-Building

Abstract This paper criticizes the epistemic foundations of democratic state-building, which are derived from a model of political transitions according to which liberal democratic institutions will transform a hitherto authoritarian and troubled country into a more prosperous and stable society and, therefore, foreign interventions to establish these institutions are realistic and worthy investments, provided they are properly planned based on knowledge of what has worked elsewhere. This expectation is based upon two epistemological premises. The first premise, linearity, is that social and institutional change exhibits identifiable input–output relations connecting socioeconomic conditions and outcomes. The second premise, ergodicity, is that these relations, inferred from past samples, provide reliable probabilistic projections about future outcomes, which can guide the focus of policy interventions. Drawing from the study of complex systems, the paper indicates why these two premises offer a flawed conception of political transitions and why radical and large-scale interventions, such as state-building, will tend to generate unintended consequences rather than the planned effect.

PUNISHING PERLEMOEN* POACHING – DEVELOPMENTS BOTH RECENT AND POSSIBLY FUTURE?

The problems related to curbing the poaching of abalone are legion. First, abalone is an easily accessible target. Sedentary in nature, occurring in shallow subtidal kelp beds rarely deeper than ten metres, growing slowly (taking 8-9 years to reach minimum legal size) and non-cryptic in behaviour, abalone presents little difficulty for exploitation (Houthoofd “Towards Some Solutions Relating to the Conservation of Abalone” 1997 4 SAJELP 301; and Hauck “Regulating Marine Resources in South Africa: The Case of the Abalone Fishery” 1999 Acta Juridica 211 212). Secondly, the authorities have struggled in the face of the systematic depletion of the abalone stocks. Conservation operations such as Operation Neptune, aimed at combating the poaching, have been largely unsuccessful (see Botha “See Weer Stropers se Speelplek” 23 December 2004 Die Burger 13). This state of affairs is not entirely surprising, given the limited resources on the part of the State, further hampered by bribery of conservation officials, as opposed to the enormous financial muscle of the poaching syndicates, associated with the Chinese Triads (see Hauck 1999 Acta Juridica 219ff). With the price of dried abalone currently at $1 000/kg, and the demand showing no sign of diminishing, the problem appears intractable, if not insoluble, without some radical intervention (Botha 23 December 2004 Die Burger 13). It has been argued that had South Africa previously listed the abalone species with the Convention on International Trade in Endangered Species (CITES), other countries would have assisted in monitoring the trade in abalone and enforcing the legality of shipments (Allen et al “A Review of Developments in Ocean and Coastal Law 2003” 2003 9 Ocean & Coastal Law Journal 139 161). As it is, the illegal poaching continues and the abalone population continues to decline at “an alarmingly rapid rate” (Allen et al 2003 9 Ocean & Coastal Law Journal 161). The way in which the crime has been dealt with in the courts has further complicated efforts to deal with poaching. Effective enforcement has been hampered on occasion by judicial perceptions that offences such as poaching are not serious (see Njobeni “Courts Score Low on Environmental Law” 7 September 2004 Business Day (http://www.bdfm.co.za/cgi-bin/pp/print.pl)). The aim of this note is to examine one aspect of judicialenforcement of this particular environmental offence, namely sentencing.

Everything Stays the Same while Everything Changes

Everything Stays the Same while Everything Changes

The erotic power of the dancer: labour of the erotic and the bodies of the sensory in the Arkestra of North India

This article analyses the erotic power of the dancer in relation to the performance of arkestra girls in the Indian states of Bihar and Uttar Pradesh. From the discursive lens of body, agency and identity, I move to the visceral presence of a dancer who foregrounds the labour of the erotic and the bodies of sensory in a live performance. I argue that the existing binary between dance and sex work not only conceals the labour question but also hides the power of the erotic. I see dance and sex as co-producing forces in the formation of the phenomenal body on stage. I call the ‘transformative’ force the erotic power of the dancer – the power of the erotic to transform the body and give it an exceptional ‘new’ dimension. The liveness of such performance rests on the sensory circulation of the body and its polyphonic vibes. Against the theories of affect that heavily rely on the individual body of a performer, I situate the erotic body as an exchange, as a commodity but also as having a potential for radical intervention.

Radicalising ‘Learning From Other Resisters’ in Decolonial Feminism

The rhetoric of decolonising feminism has been increasingly connected to reformism rather than a radical intervention. Problematising the idea of finality in the calls to decolonise, I suggest that decolonial feminism should be understood as an experiment, a risky, unfinished project rather than a fixed location, and I argue that it should be based on a more radicalised notion of what María Lugones calls ‘learning from other resisters’. I draw on my experience working with feminists across the vast and diverse Indonesian nusantara (archipelago) and reflect on Lugones’s concept of ‘other resisters’ in her essay ‘Toward a decolonial feminism’. Learning from feminists from places such as Nusa Tenggara and West Papua who challenge the singular imagination of the Global South, I advocate shifting the debate away from Euro-American academia as the locus of knowledge production by centring other resisters on the path towards decolonial feminism. I propose three aspects in learning from other resisters: actively engaging in the process of creating feminist linkages, acknowledging borders and friction within the Global South and interrogating the notion of resistance.

Current Assessment of the Use of Angioembolization in Radical and Palliative Surgical Treatment of Kidney Cancer (Literature review)

The incidence of new cases of renal cell carcinoma (NCC) in recent years has been steadily increasing both in the world and in Ukraine, and is about 403,000 and 4,900 per year, respectively. This phenomenon is largely due to the growing popularity of imaging methods (ultrasound, CT, MRI) and increased life expectancy (NCC is associated with old age). The important role of the kidneys in homeostasis maintaining, biological features of NCC (long latent course, susceptibility to recurrence, the likelihood of synchronous/metachronous contralateral kidney damage, high probability of metastases at the time of primary diagnosis), high risk of complications of surgical interventions stimulate organ-preserving ablation techniques. Trans-arterial embolization (TAE) is one of them. Its use is justified by the hypervascular nature of NCC. Presumably, blocking the blood supply to the tumor can reduce intraoperative blood loss, tumor volume, severity of pain, and hematuria. To date, a number of publications of retrospective/pilot studies and meta-analyzes have emerged that highlight the role of TAE in the treatment of NCC. A non-systematic analysis of previous publications was conducted, which highlight the effects of trans-arterial embolization in neoadjuvant and palliative regimens in patients with NCC. Search for relevant publications was conducted by keywords in electronic databases and bibliographies of selected articles for analysis. The results of retrospective and prospective studies of TAE before kidney resection or radical nephrectomy (RNE) do not provide clear evidence in its favor. A number of studies have shown that neoadjuvant TAE allows to: reduce blood loss, reduce the duration of surgery, minimize injury to surrounding tissues, conduct a more complete eradication of the tumor, expand the indications for surgery, increase the rates of 5 and 10 years of cancer-specific survival after radical intervention. Other studies, on the other hand, have found no ability for TAE to improve cancer-specific and overall survival after RNE. Also, according to pilot data, TAE does not improve the results of surgical treatment of patients with NCC and inferior vena cava thrombosis. It was found that TAE before venacavatrombectomy is associated with greater: duration of surgery, perioperative mortality, frequency of postoperative complications. Percutaneous ablation in NCC T1 is comparable in results to radical surgical treatment, but is associated with a fairly high risk of bleeding (3.5–14%). It is shown that TAE (ethanol in combination with lipiodol or microspheres) before radiofrequency ablation (RA) to reduce the risk of bleeding and local recurrence in patients with an average tumor diameter of 3.6 cm (max – 9 cm). The rationality of the combined use of TAE and cryoablation has not been conclusively proven. In patients with inoperable tumors or with contraindications to surgery, TAE can effectively control symptoms, achieve cytoreduction, and increase life expectancy. The effectiveness of TAE in the control of symptoms in palliative mode reaches 68-75%. In pilot studies, it was found that the latest modifications of TAE with the addition of chemotherapeutics or radioactive substances in NCC can cause more pronounced cytoreduction according to CT with contrast. Randomized placebo-controlled, sufficiently sampled studies are mandatory to establish the indications and effects of TAE in patients with NCC.

Actual aspects of surgical treatment of the mediagastric malignant tumors, complicated by bleeding and perforation

The aim of the work is to improve the results of surgical treatment of mediogastric malignant tumors complicated by bleeding, perforation and stenosis. During the period 2006–2020, the clinic treated 766 patients with malignant stomach tumors complicated by gastrointestinal bleeding and perforation. Malignant mediogastric tumors were diagnosed in 227 (29.6%) patients, in particular complicated by bleeding – in 212 (93.4%), perforation – in 9 (4.0%), perforation and bleeding – in 6 (2.6%) patients. In total, 106 (46.7%) among 227 patients were operated on, in particular, 13 (12.3%) patients underwent emergency surgery for tumor perforation, and in the group with newly detected cancer operative activity was 48.7% (56 out of 115). Radical operations were performed in 75 (70.8%) patients, palliative and symptomatic – in 31 (29.2%) patients. The total postoperative mortality was 6.6% (7 patients). After radical surgical interventions, 2 (1.9%) patients died, and after palliative and symptomatic operations – 5 (4.7%) (2 (40.0%) of them were operated on for tumor perforation, diffuse peritonitis). It was established that the mortality after emergency operations (22.2%) at the height of ongoing and recurrent bleeding is 4.0 times higher than after operations performed in the early delayed period (5.6%), which are performed after adequate preparation and comprehensive follow-up examination of patients. Therefore operations at the height of bleeding in patients with acutely bleeding malignant mediogastric tumors to be too dangerous, which is associated with high postoperative mortality. In the case of perforation of the tumor, it is advisable to perform palliative or symptomatic surgical interventions at the first stage in order to save the patient's life, followed by delayed (1.5–2 months) radical surgical intervention with lymphodissection D2. Keywords: malignant stomach’s tumors, endoscopic hemostasis, radical operations, palliative operations, symptomatic operations.

КЛИНИКО-МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА РАКА ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ ПО ДАННЫМ АУТОПСИЙ

Background. Over the past decades, the incidence of pancreatic cancer (PCa) has been on the rise. It is characterized by a long latent course, non-specificity of clinical symptoms, a tendency to early metastasis, and limited possibilities for biopsy. The survival rate of patients with pancreatic cancer within a year after its diagnosis is no more than 8%. Objective. To study the clinical and morphological features of pancreatic cancer and to assess the state of life-time diagnosis according to autopsy findings. Material and methods. A retrospective analysis of 58 autopsy protocols of patients died due to pancreatic cancer was carried out. The protocols of autopsies as well as micropreparations of the pancreas and other various organs taken during autopsy for histopathological examination were studied. Results. Among those who died due to pancreatic cancer there were 58.6% of men and 41.4% of women. The average age of males was 68.9 years, that of females - 67.0 years. The discrepancy between the pathoanatomical and clinical diagnoses was noted in 7.7% of cases. Chronic pancreatitis as a background disease occurred in 6.9% of cases of pancreatic cancer. A nodular form of cancer growth was detected in 87.9%, a diffuse-infiltrative one - in 12.1% of cases. In 81.0% of cases, the tumor was localized in one of the pancreatic sections, in 19.0% - in several ones. Cancer of the pancreatic head occurred in 72.4% of cases; in 5.2% of cases the tumor was localized only in the tail, in 3.4% - only in the body of the gland. The body and tail of the pancreas were involved in the tumor process in 10.3%, while the head and body in 5.2% of cases. In 3.5% of cases, the tumor completely infiltrated the pancreas. Conclusions. Radical surgical interventions were performed only in 20.7% of cases. They were performed in 28.6% of cases in patients with pancreatic head tumours. In case of tumour location in the distal parts of the pancreas, such interventions were impossible due to the presence of multiple metastases. In 7.7% of cases, the diagnosis of pancreatic cancer was established only at autopsy.

ВЛИЯНИЕ ПАНДЕМИИ COVID-19 НА ЛЕЧЕНИЕ ОСЛОЖНЕНИЙ ДИВЕРТИКУЛЯРНОЙ БОЛЕЗНИ

Abstract. Introduction. The COVID-19 pandemic affected not only the organization of the entire healthcare system, but also made adjustments to the diagnosis and treatment of a wide range of diseases, including diverticular disease. Aim. Analysis of the results of inpatient care for patients with acute diverticulitis during the COVID-2019 pandemic. Material and methods: From 2017 to January 2022, 244 patients with diverticular disease were treated in coloproctology clinic. During the pandemic period (March 2020 – December 2021) there were 15 patients with COVID-2019 associated pneumonia who developed complications of diverticular disease. Results and discussion. An increase of hospitalizations of patients with complicated forms of the disease was established, while patients with uncomplicated diverticular disease were hospitalized less frequently. There was also a decrease in the number of reconstructive surgeries in 2020. The most informative diagnostic tool that allows to verify complicated forms of diverticular disease and determines further treatment tactics, especially in the COVID -19 pandemic, is X-ray computed tomography with intravenous contrast, which was performed in 53.3% of patients. The number of urgent surgical interventions increased, including in patients with COVID - 2019. During the pandemic, minimally invasive interventions began to be performed more often, allowing the patient to be treated as gently as possible. Moreover, drainage of abscess under ultrasound guidance is currently becoming a popular procedure even with large abscesses (>3 cm). This technology should be considered as bridge operation before a radical intervention, which implementation should be carried out after the stabilization of the general condition of the patient. Diffuse peritonitis in COVID-positive patients continues to be considered as an indication for emergency laparotomy. At the same time, Hartmann-type operations should be performed, refusing the extended intestinal resection and primary anastomosis. Conclusion. The COVID - 19 pandemic has made adjustments to the organization of medical care for patients with diverticular disease. In this regard, it is advisable to conduct interdisciplinary multicenter research in order to study the influence of the pandemic on the course of the disease and take early measures to minimize the negative consequences of the pandemic

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases in an elderly population: outcomes from a single centre

The prevalence of elderly patients with resectable colorectal peritoneal metastases (CRPM) is increasing. This study aimed to compare short and long-term outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRPM in patients above and below 70 years of age. This was a retrospective, 10-year analysis of 90-day major morbidity and mortality, and long-term survival. Thirty-two (21.3%) of 150 consecutive patients who underwent CRS and HIPEC during the study period were aged 70 and older. PCI (P=0.04), perioperative chemotherapy use (P < 0.01) and organ resections (rectum P=0.04, diaphragm P=0.03) were less in the over 70 group. There was no significant differences in major morbidity (P=0.19) and mortality (P=0.32). There was also no difference in 5-year overall survival (OS) (≥70: 26% vs. <70: 39%; P=0.68) and disease-free survival (DFS) (≥70: 25% vs. <70: 14%; P=0.22). Age above 70 was not independently associated with worse OS (HR 1.55, P=0.20) and DFS (HR 1.07, P=0.81). The surgical management of CRPM appears safe and feasible in this elderly population. Appropriate selection of elderly patients for such radical intervention is reinforced by the comparable survival with those under 70.

Review: God at War: A Meditation on Religion and Warfare, by Mark Juergensmeyer

Those familiar with Mark Juergensmeyer’s work, particularly the successive editions of Terror in the Mind of God, will find him returning to themes and issues that have long preoccupied him. When Juergensmeyer considers religious violence, his attention focuses not on the actual mechanics of fighting but on the concept of war itself. He wants to figure out how the concept of war can come to dominate a particular view of the world and decisively shape the self-understanding, motivation, and actions of particular individuals and groups.In general, Juergensmeyer wants to unravel “why war needs religion and why religion needs war” (3). He ends up emphasizing how both war and religion offer totalizing worldviews that situate the perceived chaos and disorder of the world within an alternative reality that promises a triumphant establishment of order and endows both individuals and communities with meaning and purpose. Accordingly, religion can enhance a worldview focused on war by describing any battle in absolute terms, demonizing opponents, and providing moral justifications for acts of killing or giving up one’s own life, among other things. Juergensmeyer terms such religious legitimated violence “cosmic war,” which envisages “radical divine intervention in human history, an existential battle between religion and irreligion, good and evil, order and chaos” (76).Especially important, however, is Juergensmeyer’s caution that violent religious language only rarely inspires actual violent actions. For the most part religious violence remains in the realm of rhetoric and the imagination. Instances where rhetoric sparks actual physical violence are the exception rather than the rule. Juergensmeyer returns to that idea in the brief concluding chapter when he considers whether religion might prevent, restrict, or limit war. There he argues that keeping war on a symbolic level and contained within the realm of the cultural imagination might be a way of reducing its horrific impacts on human life. Appealing to Freud’s notion that symbolic violence can help to release violent impulses, Juergensmeyer mentions religion, literature, and even video games like Fortnite as ways of providing outlets for violent impulses without causing actual harm.Unlike some contemporary commentators, Juergensmeyer avoids making blanket assertions about whether religion is inherently violent, preferring instead to examine in detail the particular contours and dynamics of specific events. In fact, one of the signal strengths of both this book and the rest of Juergensmeyer’s work on religion and violence is the telling use of detail. Each chapter begins with a specific vignette based on Juergensmeyer’s own experience or his interviews with a wide array of individuals. Although he does not offer a sustained analysis of any of those brief examples, those bits of evidence help to ground his discussion as it moves nimbly through an impressive range of examples.This short book, based on lectures delivered in several venues, will be of interest to anyone interested in religious violence and should be accessible to intermediate and advanced students as well.