"Four Ways of Writing the City" : St. Petersburg-Leningrad as a Metaphor in the Poetry of Joseph Brodsky

The present study discusses the theme of St. Petersburg-Leningrad in Joseph Brodsky's verse works. The chosen approach to the evolving im-age of the city in Brodsky's poetry is through four metaphors: St. Petersburg as "the common place" of the Petersburg Text, St. Petersburg as "Paradise and/or Hell", St. Petersburg as "a Utopian City" and St. Petersburg as "a Void". This examination of the city-image focusses on the aspects of space and time as basic categories underlying the poet's poetic world view. The method used is close reading, with an emphasis on semantical interpretation. The material consists of eighteen poems dating from 1958 to 1994. Apart from investigating the spatio-temporal features, the study focusses on exposing and analysing the allusions in the scrutinised works to other texts from Russian and Western belles lettres. Terminology (introduced by Bakhtin and Yury Lotman, among others) concerning the poetics of space in literature is employed in the present study. Conceptions originating from the paradigm of possible worlds are also used in elucidating the position of fictional and actual chronotopes and heroes in Brodsky's poetry. Brodsky's image of his native city is imbued with intertextual linkings. Through reminiscences of the "Divine Comedy" and Russian modernists, the city is paralleled with Dante's "lost and accursed" Florence, as well as with the lost St. Petersburg of Mandel'shtam and Akhmatova. His city-image is related to the Petersburg myth in Russian literature through their common themes of death and separation as well as through the merging of actual realia with the fictional worlds of the Petersburg Text. In his later poems, when his view of the city is that of an exiled poet, the city begins to lose its actual world referents, turning into a mental realm which is no longer connected to any particular geographical location or historical time. It is placed outside time. The native city as the homeland in its entirety is replaced by another existence created in language.

Iodine Brachytherapy for Large Uveal Melanomas

Uveal melanoma is the most common primary intraocular malignancy in adults. Vision in the affected eye is threatened by both the tumor and side-effects from the treatments currently available. Poor prognosis for saving vision increases with tumor size and, consequently, enucleation has been the treatment of choice for large uveal melanomas in most centers. However, increasing evidence suggests that no survival benefit is gained (nor lost) by enucleation as compared to eye-conserving methods. The Helsinki University Eye Hospital has since 1990 offered episcleral iodine-125 plaque brachytherapy (IBT) for all patients unwilling to undergo enucleation for a large uveal melanoma. The primary aim of this study was to assess survival, local tumor recurrence and preservation of the eye and vision after IBT in a population-based series of 97 patients with uveal melanomas classified as large by the Collaborative Ocular Melanoma Study (COMS) criteria. Further aims included reporting the incidence of side-effects and assessing the role of intraocular dose distribution and clinical risk factors in their development. Finally, means to improve the current treatment were investigated by using computer models to compare existing plaques with collimating ones and by comparing the outcome of a subgroup of 54 IBT patients with very thick tumors with 33 patients with similarly-sized tumors managed with transscleral local resection (TSR) in Liverpool, United Kingdom. Kaplan-Meier estimates of all-cause and melanoma-specific survival at 5 years after IBT were 62% and 65%, respectively, and visually comparable with the survival experience of patients reported after enucleation by the COMS. Local recurrence developed in 6% of eyes and 84% of eyes were conserved at 5 years. Visual prognosis was guarded with 11% avoiding loss of 20/70 vision and 26% avoiding loss of 20/400 vision in the tumor eye at 2 years. Large tumor height and short distance from the posterior pole were independently associated with loss of vision. Using cumulative incidence analysis to account for competing risks, such as enucleation and metastatic death, the 5-year incidence of cataract after IBT was 79%, glaucoma 60%, optic neuropathy 46%, maculopathy 52%, persistent or recurring retinal detachment (RD) 25%, and vitreous hemorrhage 36%. In multivariate competing risks regression models, increasing tumor height was associated with cataract, iris neovascularization and RD. Maculopathy and optic neuropathy were associated with distance from the tumor to the respective structure. Median doses to the tumor apex, macula and optic disc were 81 Gy (range, 40-158), 79 Gy (range, 12-632), and 83 Gy (range, 10-377), respectively. Dose to the optic disc was independently associated with optic neuropathy, and both dose to the optic disc and dose to the macula predicted vision loss after IBT. Simulated treatment using collimating plaques resulted in clinically meaningful reduction in both optic disc (median reduction, 30 Gy) and macular (median reduction, 36 Gy) doses as compared to the actual treatment with standard plaques. In the subgroup of patients with uveal melanomas classified as large because of tumor height, cumulative incidence analysis revealed that while long-term preservation of 20/70 vision was rare after both IBT and TSR, preservation of 20/400 vision was better after TSR (32% vs. 5% at 5 years). In multivariate logistic regression models, TSR was independently associated with better preservation of 20/400 vision (OR 0.03 at 2 years, P=0.005) No cases of secondary glaucoma were observed after TSR and optic neuropathy was rare. However, local tumor recurrence was more common after TSR than it was after IBT (Cumulative incidence 41% vs. 7% at 5 years, respectively). In terms of survival, IBT seems to be a safe alternative to enucleation in managing large uveal melanomas. Local tumor control is no worse than with medium-sized tumors and the chances of avoiding secondary enucleation are good. Unfortunately, side-effects from radiotherapy are frequent, especially in thick tumors, and long-term prognosis of saving vision is consequently guarded. Some complications can be limited by using collimating plaques and by managing uveal melanomas that are large because of tumor height with TSR instead of IBT. However, the patient must be willing to accept a substantial risk of local tumor recurrence after TSR and it is best suited for cases in which the preservation of vision in the tumor eye is critical.