Väkivalta ja kuolema roomalaisissa uskonnollisissa rituaaleissa

Pro gradu -tutkielmassani tutkin väkivallan ja kuoleman merkitystä roomalaisissa uskonnollisissa rituaaleissa. Lähestyn aihetta neljän eri esimerkin avulla. Väkivallan merkitystä pohdin Lupercalia- ja Matralia-juhlien rituaalien kautta, ja kuoleman merkitykseen paneudun Vestan neitsyiden sekä galli- ja kreikkalaispariskuntien elävältä hautaamisen pohjalta. Tutkimukseni perustana ovat pääasiassa latinankieliset antiikin kirjalliset lähteet, mutta tukeudun ajoittain myös kreikankieliseen lähdeaineistoon. Lähteitä ja nykytutkimuksen teorioita tarkastelemalla ja vertailemalla luon kuvan rituaaleista ja selvitän väkivallan ja kuoleman merkitystä niissä. Lupercaliassa väkivaltaa harjoittivat lupercus-papit, jotka löivät vuohennahkasuikaleilla muita yhteisön jäseniä juostessaan pitkin Rooman katuja. Piiskaniskujen tarkoitus oli alun perin toimia kuin rokotuksina ja suojata ihmisiä kuolleiden saastuttavalta vaikutukselta helmikuun Parentalian aikana. Myöhemmin juhlan merkitys muuttui ja iskut nähtiin hedelmällisyyttä tuottavana symbolisena penetraationa. Matraliassa roomalaiset matroonat ajoivat orjanaisen hakaten ulos Mater Matutan temppelistä. Rituaalin sisältämä väkivalta selittyy jumalatar Mater Matutan kautta. Matuta rinnastuu yhteisen indoeurooppalaisen perinnön kautta veda-uskonnon aamunkoiton jumalattareen, joka ajoi joka aamu pimeyden väkivaltaisesti pois. Tätä tekoa matroonat mahdollisesti jäljittelivät vuosittain Matralian aikana ja kannustivat Matutaa suoriutumaan tehtävästään päivien lyhetessä Neitsyytensä menettäneet Vestan papittaret haudattiin elävältä Rooman kaupungin laidalle lähelle muureja. Hautaamiset tapahtuivat usein poliittisina kriisiaikoina. Neitsyyden menettäminen, crimen incesti, tarjosi yhteisölle mahdollisuuden nimittää syntipukin, jonka hautaaminen sekä palautti rikoksen rikkoman tasapainon, että suojeli yhteisöä uhkaavalta kriisiltä. Samankaltaisina kriisaikoina haudattiin Forum boariumille galli- ja kreikkalaispareja. Tämän hautaamisen tarkoitus oli symbolisten vihollisten kautta saattaa Rooman maaperä jo valmiiksi vihollisten haltuun ja näin tehdä tyhjäksi vihollismiehityksen uhka. Tutkimukseni perustella näyttää siltä, että väkivaltaisia ja kuolemaan johtaneita rituaaleja yhdisti uhkaavan kriisin torjuminen. Lupercalian piiskaniskut suojasivat epäpuhtaudelta ja estivät lapsettomuuskriisin. Elävältä hautaamiset puolestaan torjuivat ulkoisia uhkia. Matralian väkivaltainen rituaali taas antoi aamunkoitolle voimia taistella pimeyttä vastaan ja näin vältettiin ikuisen yön uhka

Aivovaltimoaneurysman kasvua estävä lääkehoito - asetyylisalisyylihapostako ratkaisu ongelmaan?

Vuotamaton aivovaltimoaneurysma on varsin yleinen, joskin yleensä oireeton sairaus. Osa aneurysmista vuotaa, mikä aiheuttaa hengenvaarallisen kallonsisäisen verenvuodon. Kun pään kuvantamistutkimuksissa todetaan sattumalöydöksenä aneurysma, harkitaan siksi vuotoa ehkäisevää hoitoa. Vaihtoehtoina on kuitenkin toistaiseksi ollut vain merkittäviä riskejä sisältäviä kajoavia toimenpiteitä. Aivovaltimoaneurysman biologian perus- ja kliinisen tutkimuksen myötä on löytynyt mahdollisuuksia vaikuttaa vuotoriskiin lääkehoidolla. Ensimmäinen lääkehoito on Suomessakin tulossa kliinisiin kokeisiin.publishedVersionPeer reviewe

The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months

Purpose: To identify factors influencing short- and mid-term radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB).Methods: A total of 112 patients were treated for IAs with the WEB in at our institution between 2013 and 2020. Patients with 6- and/or 24-months follow-up data were included in the study. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification (RR). RR 1 and RR 2 were considered as adequate outcomes, while RR 3 inadequate.Results: Data were available for 91 patients (56 females, 62%) at 6 months and 62 of those patients (39 females, 58%) at 24 months. The adequate occlusion (RR 1/RR 2) rate was 89% (n = 81/91) at the 6-months follow-up and 91% (n = 56/62) at the 24-months follow-up. The treatment-related morbidity rate was 4% (n = 4/91), and mortality rate was 1% (n = 1/91). The predictor for inadequate occlusion at the 6-months follow-up was the lobular shape of an aneurysm (p = .01). The aneurysm's height (p = .02), maximal diameter (p = .001), width (p = .002), aspect ratio (p = .03), dome-to-neck ratio (p = .04), and lobular shape (p= .03) were predictive factors for inadequate occlusion at 24 months. All the thrombosed aneurysms (n = 3) showed unfavorable radiological outcomes and required re-treatment within 24 months. None of the patient-related factors were significant.Conclusions: The WEB provides favorable occlusion rates and low complications for both ruptured and unruptured wide-necked IAs. Unfavorable radiological outcomes after WEB treatment may be related to aneurysm morphology and size.</p

Alcohol use in the prehospital setting: a diagnostic challenge in patients treated by a physician staffed mobile intensive care unit

BACKGROUND: Alcohol use among emergency patients has been studied earlier, but the data regarding alcohol use especially among critically ill and injured patients treated in the prehospital setting is scarce. The aim of this study was to evaluate the incidence of alcohol use and the characteristics of cases attended by a physician staffed mobile intensive care unit (MICU). FINDINGS: During a 2 month period, exhaled air alcohol concentration-measured as a part of routine patient examination in all adolescent and adult patients treated by the MICU-was recorded. The MICU encountered 258 patients, of which 82 could be tested for alcohol use. Of the tested patients 43 % gave a positive breath test result. Proportion of male patients providing a positive result in the breath test did not differ significantly those of women. The primary reason for not to test the patient was a decreased level of consciousness in one-fifth of the initial 258 patients. CONCLUSIONS: A significant proportion (47 %) of the encountered patients could not be tested due to their critical condition. Alcohol use was observed in 43 % of those capable of providing a breath test sample. The rate of positive tests seemed to be higher than those reported from emergency departments. Novel diagnostic methods to detect alcohol consumption in non-cooperative patients are warranted

The outcomes of recurrent wide-necked intracranial aneurysms treated with the Woven EndoBridge (WEB): A retrospective bicenter study

Background: The Woven EndoBridge (WEB) is a device for the treatment of intracranial wide-necked bifurcation aneurysms. The safety and effectiveness of WEB for intracranial aneurysms have both been evaluated in previous trials. Our aim was to study the outcomes of recurrent intracranial aneurysms (IAs) treated with WEB.Methods: Clinical and radiological outcomes of patients with a wide-necked aneurysm recurrence, which was treated with WEB device, were assessed. Imaging follow-up was performed with digital subtraction angiography and/or magnetic resonance angiography. Aneurysm occlusion was determined using by the Raymond-Roy Occlusion Classification (RROC). RROC 1 and RROC 2 were considered as adequate radiological outcome.Results: Twenty-two patients with 23 recurrent IAs were treated with WEB. Of which, 17 of recurrent IAs (74%) previously treated by coiling, three (13%) by clipping and three (13%) by WEB. The most common location of the recurrent IA was the middle cerebral artery (n = 10, 43%). Endovascular treatment with WEB alone was suitable for 20 recurrent IAs (87%). Ancillary devices were also used: coils in two (9%), and a stent in one (4%). Radiological follow-up results available for all patients (range: 3-60 months; median 24 months). Adequate occlusion (RROC I and II) was achieved in 20 recurrent IAs (87%). A hemorrhagic complication occurred 2 weeks post treatment in one patient (5%).Conclusions: WEB could be an effective treatment with low rates of complications for challenging cases of recurrent wide-necked IAs.</p

Identification of potential organ donors after aneurysmal subarachnoid hemorrhage in a population-based neurointensive care in Eastern Finland

To analyze the organ donation action in population-based neurointensive care of acute aneurysmal subarachnoid hemorrhage (aSAH) and to seek factors that would improve the identification of potential organ donors (PODs) and increase the donor conversion rate (DCR) after aSAH. The Kuopio Intracranial Aneurysm Database, prospective since 1995, includes all aSAH patients admitted to the Kuopio University Hospital (KUH) from its defined Eastern Finnish catchment population. We analyzed 769 consecutive acute aSAH patients from 2005 to 2015, including their data from the Finnish Transplantation Unit and the national clinical registries. We analyzed PODs vs. actual donors among the 145 (19%) aSAH patients who died within 14 days of admission. Finland had implemented the national presumed consent (opt-out) within the study period in the end of 2010. We retrospectively identified 83 (57%) PODs while only 49 (34%) had become actual donors (total DCR 59%); the causes for non-donorship were 15/34 (44%) refusals of consent, 18/34 (53%) medical contraindications for donation, and 1/34 (3%) failure of recognition. In 2005-2010, there were 11 refusals by near relatives with DCR 52% (29/56) and only three in 2011-2015 with DCR 74% (20/27). Severe condition on admission (Hunt and Hess grade IV or V) independently associated with the eventual POD status. Nearly 20% of all aSAH patients acutely admitted to neurointensive care from a defined catchment population died within 14 days, almost half from cardiopulmonary causes at a median age of 69 years. Of all aSAH patients, 11% were considered as potential organ donors (PODs). Donor conversion rate (DCR) was increased from 52 to 74% after the national presumed consent (opt-out). Implicitly, DCR among aSAH patients could be increased by admitting them to the intensive care regardless of dismal prognosis for the survival, along a dedicated organ donation program for the catchment population.Peer reviewe

Finnish flow diverter study : 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.Peer reviewe

Finnish flow diverter study : 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.Peer reviewe