Hautamuistomerkki elämän ja kuoleman tulkitsijana : Heikki Häiväojan, Kain Tapperin ja Matti Peltokankaan tekemät hautamuistomerkit 1952-2002

Grave sculpture as interpreter of life and death. Grave sculptures done by Heikki Häiväoja, Kain Tapper and Matti Peltokangas 1952-2002. The thoughts of Philippe Ariès and Erwin Panofsky on western funeral art constitute the starting point of this study. These scholars speak about the 20th century as a period of decline regarding western funeral art. The reason for this situation lies, according to them, in the fact that death has been rejected and become a private affair in modern society. Especially Panofsky sees an important reason for the decay of funeral art also in the separation of death from religion. In this study, I approach the view of Ariès and Panofsky from the angle of Finnish funeral art. The subject of the study is grave sculptures of three Finnish sculptors: Heikki Häiväoja, Kain Tapper and Matti Peltokangas, from 1952 to 2002. (The analysis of the grave sculptures has been performed with the Iconology of Erwin Panofsky. The analysis has been deepened by the ideas of a graveyard as a semiotic text according to Werner Enninger and Christa Schwens. In order to confirm their argumentation, they analyse the graveyard text with the model of communicative functions of Roman Jakobson and verify that the graveyard is a cultural text according to Juri Lotman.) Results of the study In the grave sculptures of the sculptors, different worldviews appear alongside Christian thoughts indicating a new stage in the tradition of funeral art. In the grave sculptures characterised as Christian, the view of life after death is included. In these memorials the direction of life is prospective, pointing to the life beyond. Death is a border, beyond which one is unable to see. Nevertheless the border is open or marked by the cross. On this open border, death is absence of pain, glory and new unity. In memorials with different worldviews, the life beyond is a possibility which is not excluded. Memorials interpret life retrospectively; life is a precious memory which wakens grief and longing. Many memorials have metaphysical and mystic features. In spite of democratization the order and valuation of social classes appear in some memorials. The old order also materializes in the war memorials relating the same destiny of the deceased. Different burial places, nevertheless, do not indicate social inequality but are rather signs of diversity. The sculptors' abstract means of modern funeral art deepen the handling of the subject matter of death and reveal the mystery of it. Grave sculptures are a part of Finnish and sacral modern art, and there is an interaction between funeral art and modern art. Modern art acquires a new dimension, when grave sculptures become a part of its field. Grave sculptures offer an alternative to anonymous burying. The memorial is a sign of the end of life; it gives death significance and publicity and creates a relation to the past of the society. In this way, grave sculptures are a part of the chain of memory of the western funeral art, which extends throughout Antiquity until ancient Egypt. (In this study I have spoken of funeral art as a chain of memory using the thoughts of Danièle Hervieu-Léger.) There are no signs of decay in the grave sculptures, on the contrary the tradition of funeral art continues in them as a search for the meaning of life and death and as an intuitive interpretation of death. As such, grave sculptures are part of the Finnish discussion of death.

Ischemic Stroke in Young Adults

Stroke is the second leading cause of death and the leading cause of disability worldwide. Of all strokes, up to 80% to 85% are ischemic, and of these, less than 10% occur in young individuals. Stroke in young adults—most often defined as stroke occurring under the age of 45 or 50—can be particularly devastating due to long expected life-span ahead and marked socio-economic consequences. Current basic knowledge on ischemic stroke in this age group originates mostly from rather small and imprecise patient series. Regarding emergency treatment, systematic data on use of intravenous thrombolysis are absent. For this Thesis project, we collected detailed clinical and radiological data on all consecutive patients aged 15 to 49 with first-ever ischemic stroke between 1994 and 2007 treated at the Helsinki University Central Hospital. The aims of the study were to define demographic characteristics, risk factors, imaging features, etiology, and long-term mortality and its predictors in this patient population. We additionally sought to investigate, whether intravenous thrombolysis is safe and beneficial for the treatment of acute ischemic stroke in the young. Of our 1008 patients, most were males (ratio 1.7:1), who clearly outnumbered females after the age of 44, but females were preponderant among those aged <30. Occurrence increased exponentially. The most frequent risk factors were dyslipidemia (60%), smoking (44%), and hypertension (39%). Risk factors accumulated in males and along aging. Cardioembolism (20%) and cervicocerebral artery dissection (15%) were the most frequent etiologic subgroups, followed by small-vessel disease (14%), and large-artery atherosclerosis (8%). A total of 33% had undetermined etiology. Left hemisphere strokes were more common in general. Posterior circulation infarcts were more common among those aged <45. Multiple brain infarcts were present in 23% of our patients, 13% had silent infarcts, and 5% had leukoaraiosis. Of those with silent brain infarcts, majority (54%) had only a single lesion, and most of the silent strokes were located in basal ganglia (39%) and subcortical regions (21%). In a logistic regression analysis, type 1 diabetes mellitus in particular predicted the presence of both silent brain infarcts (odds ratio 5.78, 95% confidence interval 2.37-14.10) and leukoaraiosis (9.75; 3.39-28.04). We identified 48 young patients with hemispheric ischemic stroke treated with intravenous tissue plasminogen activator, alteplase. For comparisons, we searched 96 untreated control patients matched by age, gender, and admission stroke severity, as well as 96 alteplase-treated older controls aged 50 to 79 matched by gender and stroke severity. Alteplase-treated young patients recovered more often completely (27% versus 10%, P=0.010) or had only mild residual symptoms (40% versus 22%, P=0.025) compared to age-matched controls. None of the alteplase-treated young patients had symptomatic intracerebral hemorrhage or died within 3-month follow-up. Overall long-term mortality was low in our patient population. Cumulative mortality risks were 2.7% (95% confidence interval 1.5-3.9%) at 1 month, 4.7% (3.1-6.3%) at 1 year, and 10.7% (9.9-11.5%) at 5 years. Among the 30-day survivors who died during the 5-year follow-up, more than half died due to vascular causes. Malignancy, heart failure, heavy drinking, preceding infection, type 1 diabetes, increasing age, and large-artery atherosclerosis causing the index stroke independently predicted 5-year mortality when adjusted for age, gender, relevant risk factors, stroke severity, and etiologic subtype. In sum, young adults with ischemic stroke have distinct demographic patterns and they frequently harbor traditional vascular risk factors. Etiology in the young is extremely diverse, but in as many as one-third the exact cause remains unknown. Silent brain infarcts and leukoaraiosis are not uncommon brain imaging findings in these patients and should not be overlooked due to their potential prognostic relevance. Outcomes in young adults with hemispheric ischemic stroke can safely be improved with intravenous thrombolysis. Furthermore, despite their overall low risk of death after ischemic stroke, several easily recognizable factors—of which most are modifiable—predict higher mortality in the long term in young adults.