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.

"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.

Counter-figures : An Essay on Antimetaphoric Resistance: Paul Celan's Poetry and Poetics at the Limits of Figurality

Titled "An Essay on Antimetaphoric Resistance", the dissertation investigates what is here being called "Counter-figures": a term which has in this context a certain variety of applications. Any other-than-image or other-than-figure, anything that cannot be exhausted by figuration (and that is, more or less, anything at all, except perhaps the reproducible images and figures themselves) can be considered "counter-figurative" with regard to the formation of images and figures, ideas and schemas, "any graven image, or any likeness of any thing". Singularity and radical alterity, as well as temporality and its peculiar mode of uniqueness are key issues here, and an ethical dimension is implied by, or intertwined with, the aesthetic. In terms borrowed from Paul Celan's "Meridian" speech, poetry may "allow the most idiosyncratic quality of the Other, its time, to participate in the dialogue". This connection between singularity, alterity and temporality is one of the reasons why Celan so strongly objects to the application of the traditional concept of metaphor to poetry. As Celan says, "carrying over [��bertragen]" by metaphor may imply an unwillingness to "bear with [mittragen]" and to "endure [ertragen]" the poem. The thesis is divided into two main parts. The first consists of five distinct prolegomena which all address the mentioned variety of applications of the term "counter-figures", and especially the rejection or critique of either metaphor (by Aristotle, for instance) or the concept of metaphor (defined by Aristotle, and sometimes deemed "anti-poetic" by both theorists and poets). Even if we restrict ourselves to the traditional rhetorico-poetical terms, we may see how, for instance, metonymy can be a counter-figure for metaphor, allegory for symbol, and irony for any single trope or for any piece of discourse at all. The limits of figurality may indeed be located at these points of intersection between different types of tropes or figures, and even between figures or tropes and the "non-figurative trope" or "pseudo-figure" called catachresis. The second part, following on from the open-ended prolegomena, concentrates on Paul Celan's poetry and poetics. According to Celan, true poetry is "essentially anti-metaphoric". I argue that inasmuch as we are willing to pay attention to the "will" of the poetic images themselves (the tropes and metaphors in a poem) to be "carried ad absurdum", as Celan invites us to do, we may find alternative ways of reading poetry and approaching its "secret of the encounter", precisely when the traditional rhetorical instruments, and especially the notion of metaphor, become inapplicable or suspicious ��� and even where they still seem to impose themselves.

War and Revolution in St. Petersburg : Modernist Links in the Poetry of Edith S��dergran and Anna Andreevna Akhmatova

Important modernists in their own countries, Anna Akhmatova and Edith S��dergran are compared in this dissertation as poets whose poetry reflects the climactic events of the early twentieth century in Finland and Russia. A comparatist, biographical and historical approach is used to uncover the circumstances surrounding these events. First the poets��� early works are reviewed and their contemporaries are mentioned to provide a poetic context. Then a brief review of Finnish and Russian history situates them historically. Next, the rich literary diversity of St. Petersburg���s Silver Age is presented and the work of the poets is viewed in context before their poetry is compared, as the First World War, October Revolution and subsequent Finnish Civil War impact their writing. While biography is not the primary focus, it becomes important as inevitably the writers��� lives are changed by cataclysmic events and the textual analysis of the poems in Swedish, Russian and English shows the impact of war on their poetry. These two poets have not been compared before in a critical review in English and this work contributes to needed work in English. They share certain common modernist traits: attention to the word, an intimate, unconventional voice, and a concern with audience. In addition, they both reject formal traditions while they adopt new forms and use modern, outside influences such as art, architecture and philosophy as subject matter and a lens through which to focus their poetry. While it may seem that Anna Akhmatova was the most socially aware poet, because of the censorship she endured under Stalin, my research has revealed that actually Edith S��dergran showed the most social consciousness. Thus, a contrast of the poets��� themes reveals these differences in their approaches. Both poets articulated a vibrant response to war and revolution becoming modernists in the process. In their final works created in the years before their deaths, they reveal the solace they found in nature as well as final mentions of the violent events of their youth. Keywords: St. Petersburg, Modernism, Symbolism, Acmeism, Silver Age, Finland-Swedish literature

Stone Weathering in the Monastic Building Complex on Mountain of St Aaron in Petra, Jordan.

Since 1997 the Finnish Jabal Haroun Project (FJHP) has studied the ruins of the monastery and pilgrimage complex (Gr. oikos) of Aaron located on a plateau of the Mountain of Prophet Aaron, Jabal an-Nabi Har��n, ca. 5 km to the south-west of the UNESCO World Heritage site of Petra in Jordan. The state of conservation and the damaging processes affecting the stone structures of the site are studied in this M.A. thesis. The chapel was chosen as an example, as it represents the phasing and building materials of the entire site. The aim of this work is to act as a preliminary study with regards to the planning of long-term conservation at the site. The research is empirical in nature. The condition of the stones in the chapel walls was mapped using the Illustrated Glossary on Stone Deterioration, by the ICOMOS International Scientific Committee for Stone. This glossary combines several standards and systems of damage mapping used in the field. Climatic conditions (temperature and RH %) were monitored for one year (9/2005-8/2006) using a HOBO Microstation datalogger. The measurements were compared with contemporary measurements from the nearest weather station in Wadi Musa. Salts in the stones were studied by taking samples from the stone surfaces by scraping and with the ���Paper Pulp���-method; with a poultice of wet cellulose fiber (Arbocel BC1000) and analyzing what main types of salts were to be found in the samples. The climatic conditions on the mountain were expected to be rapidly changing and to differ clearly from conditions in the neighboring areas. The rapid changes were confirmed, but the values did not differ as much as expected from those nearby: the 12 months monitored had average temperatures and were somewhat drier than average. Earlier research in the area has shown that the geological properties of the stone material influence its deterioration. The damage mapping showed clearly, that salts are also a major reason for stone weathering. The salt samples contained several salt combinations, whose behavior in the extremely unstable climatic conditions is difficult to predict. Detailed mapping and regular monitoring of especially the structures, that are going remain exposed, is recommended in this work.

Three Sides of a Wall : Obstacles and Border States in Paul Auster's Novels

Tutkielmani k��sittelee yhdysvaltalaisen kirjailijan Paul Austerin (s. 1947) romaanituotannossa esiintyvi�� esteit�� ja rajatiloja. Erityisesti olen kiinnostunut siit��, miten Auster liitt���� n��m�� "marginaalitilat" amerikkalaiseen vapauden ja laajentumisen ideologiaan sek�� kieleen ja kirjoittamiseen. Austerin romaaneissa esteiden ja rajatilojen k��sittely voidaan jakaa kolmeen vaiheeseen. Ensimm��isess�� vaiheessa henkil��t ovat vahvojen esteiden rajoittamia tai rakentavat niit�� itse. Rajoittuneisuus ei kuitenkaan aina tunnu h��iritsev��n heit�� - itse asiassa monet p����henkil��ist�� tuntevat itsens�� onnellisiksi tai v��hint����nkin tyytyv��isiksi joutuessaan esteen takia pys��hdytt��m����n vapaan liikkeens��. Toisessa vaiheessa henkil��t pyrkiv��t ylitt��m����n tai rikkomaan esteen p����st��kseen toiselle puolelle. Kuten amerikkalaiset esi-is��ns�� aikoinaan, he etsiv��t rajatonta, laajaa ja tyhj���� tilaa - "suurta tuntematonta" valloitettavakseen. T��llaisen tilan kohdatessaan he joutuvat kuitenkin usein ep��varmuuden valtaan. Kolmas vaihe on tutkielmani kannalta t��rkein: v��litila, josta k��yt��n ty��ss��ni nimityst�� "in-betweenity". T��h��n vaiheeseen p����st����n kulkemalla ensin kahden muun vaiheen kautta. Juuri tietoisuus n��ist�� kahdesta muusta vaiheesta synnytt���� t��m��n kolmannen tilan, er����nlaisen rajatilan, jossa tajutaan sek�� esteiden ett�� esteett��myyden t��rkeys. T��m�� v��litila on Austerille tyypillinen tila, joka kertoo paitsi amerikkalaisen unelman paradoksaalisuudesta my��s (kaunokirjallisen) kielenk��yt��n prosessista. Monet Austerin kirjojen muurin rakentajista tai purkajista voidaan n��hd�� kirjailijahahmoina, joiden omituinen suhde esteisiin ja rajoihin kumpuaa juuri siit�� rajatilasta, jonka asukkaita he kielentaiteilijoina v��ist��m��tt�� ovat. T��llaisen tilan/tilattomuuden kuvaaminen tekee Austerista oman postmodernin aikamme t��rke��n kirjailijan - kirjailijan, joka sen sijaan, ett�� pyrkisi eroon paradokseista, sijoittaa hahmonsa niiden sis����n. Rajoihin ja esteisiin liittyv�� problematiikka ei kuitenkaan ole pelk��st����n nykyajan ongelma vaan kysymys, joka ihmisen toisaalta rajoja kaipaavan toisaalta rajattomuutta kaipaavan luonteen vuoksi s��ilyy aina ajankohtaisena. Avainsanat: Paul Auster, este, muuri, raja, Yhdysvallat

Mies, talli ja moottoripy��r�� : Etnografinen tutkimus Misfit MC:st�� ja bikerkulttuurin eetoksesta

Tutkimuksen punaisena lankana kulkee kysymys siit��, millainen on bikerkulttuurin eetos? Miten se on syntynyt, miten sit�� yll��pidet����n ja miten Misfit MC:n j��senet sit�� tulkitsevat ja toteuttavat omassa el��m��ss����n? Tarkastelen eetosta kahdenlaisen aineiston valossa. i) Kentt��ty��ll�� (vuosina 1995-1998 ja 2000-2001) ker��tyn aineiston valossa tarkastelen yht�� p����kaupunkiseudulla toimivaa HD-moottoripy��r��kerhoa, vuonna 1989 toimintansa aloittanutta Misfit MC:t��. J��senet kutsuvat kerhoaan useimmiten talliksi, joskus pajaksi, kerhoksi tai klubiksi. Puhuessaan tallista, miehet voivat viitata kerhorakennukseen ("tuut s�� tallille?") mutta my��s ryhm����n ("meid��n talli") ja sen olemassaoloon ajallisesti ja paikallisesti. Aloittaessani kentt��ty��n vuonna 1995 Misfit MC:n kuului kymmenen 25-30-vuotiasta miest��. ii) Kentt��ty��ll�� ker��tyn aineiston lis��ksi k��yt��n materiaalia, joka koostuu Harley-Davidson-moottoripy��r��n ymp��rille rakentuneen bikerkulttuurin historiasta ja kulttuurituotteista, kuten kertomuksista, elokuvista, musiikista, kuvataiteesta ja moottoripy��r��lehdist��. Aineiston avulla valotan bikerkulttuurin eetoksen synty��, alkuvaiheita, levi��mist�� ja keskeisi�� elementtej��. L��hdeaineiston monimuotoisuus ja runsaus palautuu kentt��ty��h��ni jolloin vakuutuin siit��, ett�� tutkimusmatka bikerkulttuurin historiaan, perinteisiin ja median v��litt��miin (mieli)kuviin on v��ltt��m��t��nt��, sill�� menneisyys ja Harrikkaan ajan kuluessa varastoituneet merkitykset vaikuttavat ja ovat vahvasti l��sn�� Misfit MC:n toiminnassa ja talliin kuuluvien miesten el��m��ntyyliss��. Tutkimus etenee seuraavanlaisesti. Luku I on Johdanto. Luvussa II Etnografia k��sittelen etnografisen tiedon luonnetta niin tutkimusasenteena kuin kentt��ty��n valossa. Pohdin kentt��ty��t�� ja sen suhdetta etnografian kirjoittamiseen eli miten kentt��ty��ll�� ker��tty aineisto muuntuu etnografiseksi monografiaksi. K��sittelen my��s kentt��ty��ni reunaehtoja, kuten tytt��yst��vyyden ja sukupuolen merkityst��, ja tarkastelen tutussa kulttuurissa tehdyn kentt��ty��n ominaispiirteit��. Reunaehtojen kuvailu toimii my��s johdatuksena bikerkulttuuriin sellaisena kuin se ilmenee Misfit MC:n talliel��m��ss�� ja k��yt��nteiss��. Lopuksi pohdin "tihe��n kuvauksen" mahdollisuuksia ja vaateita aineistoni puitteissa. Luvussa III Bikerkulttuurin eetosta kartoittamassa, kuvailen Harley-Davidson-moottoripy��r��n ymp��rille rakentuneen el��m��ntavan synty��, levitt��ytymist�� ja keskeisi�� elementtej��. Tarkastelen media- ja populaarikulttuurisia tekstej�� (elokuvien kertomat tarinat, musiikkikappaleiden sanoitukset ja HD- ja bikerlehtien artikkelit) ja kuvia (elokuvien audiovisuaaliset aspektit, kuvataide ja HD- ja bikerlehtien kuvitus), jotka ovat vaikuttaneet bikerkulttuurin eetokseen. Luvun keskeisi�� - aineistosta nousevia ja miessukupuoleen vahvasti sidoksissa olevia - k��sitteit�� ovat biker, outlaw ja chopper, jotka ovat bikerkulttuurissa s��ilyneet alkuper��isess�� muodossa maantieteellisest�� tai kielialueesta riippumatta. Luvussa IV Misfit MC ja bikerkulttuurin eetos temaattinen painopiste siirtyy Suomeen ja Misfit MC:hen. Aluksi k��yn l��pi suomalaisen bikerkulttuurin muotoutumista ja ominaispiirteit��. Alkukappaleiden j��lkeen keskityn Misfit MC:n j��senten el��m��ntyylin s��vyihin ja heid��n k��sityksiins�� bikerkulttuurin eetoksesta. Analyysin kiintopisteit�� ovat Misfit MC:n j��senten n��kemys bikeriydest�� ja tallitoiminnasta, miesten el��m��ntyylin moraaliset ja esteettiset s��vyt, tallirakennus miesyhteis��llisyytt�� ja bikerkulttuurin eetosta luovana ja yll��pit��v��n�� sosiaalisena tilana ja Misfit MC miesten yhteis��n��. Luvussa V Eetoksen ytimess��: mies ja Harley-Davidson keskityn bikerkulttuurin ytimeen: miehen ja Harley-Davidson-moottoripy��r��n v��liseen suhteeseen. Luvun alussa esittelen ruotsalaisen yhteiskuntatieteilij�� Lars Lagergrenin moottoripy��r����n soveltamaa ty��kalu - leikkikalu - toteemi - v��litt��j�� -typologiaa ja tarkastelen moottoripy��r��n olemusta sukupuolittavana ja sukupuolittuvana artefaktina. Johdanto-osion j��lkeen siirryn kuvailemaan Misfit MC:n j��senten suhdetta Harley-Davidson-moottoripy��r����n. L��hestyn miesten ja moottoripy��rien suhdetta kahden toiminnan - moottoripy��r��n kunnostamisen ja rakentamisen sek�� moottoripy��r��ll�� ajamisen - kautta. Avainsanat: aineellinen kulttuuri, arvot, biker, bikerkulttuuri, chopper, eetos, el��m��ntapa, etnografia, Harley-Davidson-moottoripy��r��, Harley-Davidson-moottoripy��r��kerho, kentt��ty��, maskuliinisuus, mieskulttuuri, mieskuva, moottoripy��r��ily, osakulttuurit, outlaw, populaarikulttuuri, sukupuoliroolit, yhteis��t

Trust and Safe Choices: Coping with health-related risks in food consumption in St. Petersburg

This dissertation considers the problem of trust in the context of food consumption. The research perspectives refer to institutional conditions for consumer trust, personal practices of food consumption, and strategies consumers employ for controlling the safety of their food. The main concern of the study is to investigate consumer trust as an adequate response to food risks, i.e. a strategy helping the consumer to make safe choices in an uncertain food situation. "Risky" perspective serves as a frame of reference for understanding and explaining trust relations. The original aim of the study was to reveal the meanings applied to the concepts of trust, safety and risks in the perspective of market choices, the assessments of food risks and the ways of handling them. Supplementary research tasks presumed descriptions of institutional conditions for consumer trust, including descriptions of the food market, and the presentation of food consumption patterns in St. Petersburg. The main empirical material is based on qualitative interviews with consumers and interviews and group discussions with professional experts (market actors, representatives of inspection bodies and consumer organizations). Secondary material is used for describing institutional conditions for consumer trust and the market situation. The results suggest that the idea of consumer trust is associated with the reputation of suppliers, stable quality and taste of their products, and reliable food information. Being a subjectively constructed state connected to the act of acceptance, consumer trust results in positive buying decisions and stable preferences in the food market. The consumers' strategies that aim at safe food choices refer to repetitive interactions with reliable market actors that free them from constant consideration in the marketplace. Trust in food is highly mediated by trust in institutions involved in the food system. The analysis reveals a clear pattern of disbelief in the efficiency of institutional food control. The study analyses this as a reflection of "total distrust" that appears to be a dominant mood in many contexts of modern Russia. However, the interviewees emphasize the state's decisive role in suppressing risks in the food market. Also, the findings are discussed with reference to the consumers' possibilities of personal control over food risks. Three main responses to a risky food situation are identified: the reflexive approach, the traditional approach, and the fatalistic approach.

The determinants of sexually transmitted infections among reproductive age women in St. Petersburg, Estonia and Finland

OBJECTIVES: Sexually transmitted infections' (STIs) rate vary in St. Petersburg, Estonia and Finland; the aim was to compare the determinants of self-reported sexually transmitted infections in these areas. METHODS: Data from four population-based questionnaire surveys were used (Finland in 1992 and 1999; St. Petersburg in 2003; Estonia in 2004). With the exception of the 1992 Finnish survey (interview) all were postal surveys, with 1,070 respondents in Finland (78 and 52% response rates), 1,147 (68%) in St. Petersburg, and 5,190 (54%) in Estonia. RESULTS: Risky sexual behaviours were equally common in the three areas and the determinants were the same. Women with an STIs history more often had had their first sexual intercourse when aged under 18, had not used condom during first intercourse, had a high number of lifetime or previous year sexual partners. However, marital status and education were not similar determinants. Cohabiting and well-educated women in Finland were more likely to have STIs while in other areas the associations found were not statistically significant. CONCLUSIONS: Risky behaviour predicts STIs, but does not explain the varying rates of STIs between areas.