Electrification transforms city life. (1880) Research Paper

Electrification transforms city life. (1880) - Research Paper Example Electric powered street cars became developed, and electric trolleys in the 1880’s, made it possible for the rich and those in the middle class, to move smoothly in the newly constructed rail lines and trolleys. These trolleys allowed people to move smoothly from the business districts to their residential neighborhoods. This led to expanded and increased city limits and suburbs became developed. The developed suburbs allowed the wealthy families enjoy their privacy and ownership of their homes without sacrificing the excitement of the city.2 The introduction of the modern convenience and the vast technological marvels, such as indoor plumbing, telephone and the famous Brooklyn Bridge provided an appealing aura that attracted thousands of people to the city. Cities grew upwards and outwards. The tallest building in the US was the Trinity Church in New York before the invention of electricity. This got overtaken later by the New York World building, a 26 storey building. The growing size of the office buildings showed the healthy and vibrant growing economy. All businesses, steel mills and factories experienced an increase in their profits.3 The invention of electricity in turn saw the arrival of new technologies. These technologies enabled the constructions of buildings taller and bigger than before. The newly built sky scrapers needed elevators to transport people. In 1870’s, six storey buildings used steam powered elevators that became characterized by cables that got wound around a gigantic rotating drum. These elevators were not appropriate for taller buildings, because the drums would have to be abnormally large. During the 1880’s, with the invention of electricity, the invented electric elevator provided a more practical and suitable solution.1 The built tall buildings needed ventilation systems to cool them during the summer period and heat them during the winter. The ventilation systems adopted in the 1860’s, required steam powered

USA Contract Law Assignment Example | Topics and Well Written Essays - 2000 words

USA Contract Law - Assignment Example The contracting parties need to be of legal age and sound competence and they should agree mutually on the terms of the contract. The contract law is governed by the provisions of the UCC and the Restatement of Contracts. The UCC governs the sale of tangible and movable assets, property leases, and financial transactions. The common law principles of a contract are summarised, restated and published as the Restatement of Contracts by the American Law Institute. Legal professionals quote the provisions of the Restatement in their written opinions, though this does not have the force of law.[2] When a contract is made, both parties expect some benefit from it and the terms and conditions are consensual. Since unforeseen events in the future may create a loss for any one party, it is essential that both parties are very thorough about the meaning of the content to which they are putting their signature. The whole concept of contracts deal with the future and in many cases gives rise to problems; one or both parties may find that the events that they had anticipated had not gone their way. The problem may be due to a 'mistake.'When one or both parties, to the contract, erroneously believed that certain facts in the contract are true, then a 'mistake' is said to have occurred. In contract law, a mistake can be used to invalidate the agreement. There are two different types of mistakes, according to common law. A 'unilateral mistake' occurs when only one party is mistaken about the terms or contents of the contract. A 'mutual mistake' or a 'common mistake' occurs when both par ties, to the contract, are mistaken about the same term or condition in the contract. Since these mistakes can be used as 'excuses' to invalidate a contract, the provision of 'objective standard of agreement' becomes important in contract law.  

Electrification transforms city life. (1880) Research Paper

Electrification transforms city life. (1880) - Research Paper Example Electric powered street cars became developed, and electric trolleys in the 1880’s, made it possible for the rich and those in the middle class, to move smoothly in the newly constructed rail lines and trolleys. These trolleys allowed people to move smoothly from the business districts to their residential neighborhoods. This led to expanded and increased city limits and suburbs became developed. The developed suburbs allowed the wealthy families enjoy their privacy and ownership of their homes without sacrificing the excitement of the city.2 The introduction of the modern convenience and the vast technological marvels, such as indoor plumbing, telephone and the famous Brooklyn Bridge provided an appealing aura that attracted thousands of people to the city. Cities grew upwards and outwards. The tallest building in the US was the Trinity Church in New York before the invention of electricity. This got overtaken later by the New York World building, a 26 storey building. The growing size of the office buildings showed the healthy and vibrant growing economy. All businesses, steel mills and factories experienced an increase in their profits.3 The invention of electricity in turn saw the arrival of new technologies. These technologies enabled the constructions of buildings taller and bigger than before. The newly built sky scrapers needed elevators to transport people. In 1870’s, six storey buildings used steam powered elevators that became characterized by cables that got wound around a gigantic rotating drum. These elevators were not appropriate for taller buildings, because the drums would have to be abnormally large. During the 1880’s, with the invention of electricity, the invented electric elevator provided a more practical and suitable solution.1 The built tall buildings needed ventilation systems to cool them during the summer period and heat them during the winter. The ventilation systems adopted in the 1860’s, required steam powered

Global warming Research Paper Example | Topics and Well Written Essays - 1500 words - 1

Global warming - Research Paper Example As stated, the temperature of the earth’s surface has been slowly but surely rising over the span of a few centuries. This increase in temperature, though assumed to have always been taking place, was first called to attention in the early 1800s. The first Industrial Revolution brought with it coal, railroads, and the cutting down of forests for various projects, all of which prompted the speeding up of greenhouse gas emissions (Weart, 2008). The second Industrial Revolution saw a similar change, and scientists began recording the slightest of changes to the earth’s temperature. However, in the past decade, it has been noted that this increase in temperature has only quickened with time. This is thought to be due to the advancement in technology that has allowed us to create more finite-dependable utilities. Due to global warming, various locations throughout the world are seeing changes to their weather and temperatures that they have never experienced before. While so me places are experiencing unfamiliar, and often unbearable, heat, other places are finding themselves bundling up in attempts to withstand the unusual and unseasonal chill. The greatest change in surface temperature can be found in Alaska and Greenland, where the Inuit tribes are discovering for the first time what it means to have a warm day in a land predominantly made of ice. Similarly, the weather conditions throughout the world have changed, bringing rain to places that are otherwise barren and dryer weather to locations that are more used to rain or snow. The cause of global warming takes place on earth, but the effects primarily take place in the atmosphere. When greenhouse gases, mainly carbon dioxide emissions from deforestation, become trapped in the earth, the greenhouse effect comes as a result. These gases would normally be able to escape from the earth, but when they are unable to they remain close enough to the surface to cause dramatic changes in temperature. Carbon dioxide is the most harmful of these gases as it stays in the atmosphere for an increased amount of time, often exceeding many hundreds of years (Archer, 2007). Even a small buildup of carbon dioxide can cause a significant increase in temperature. The more emissions we allow to enter our atmosphere, the more carbon dioxide that remains. This buildup leads to increased temperatures, and thus global warming. Effects of Global Warming Though global warming is being experienced throughout the world, the most noticeable and drastic changes can be seen in locations where ice caps are great in quantity. As the earth’s temperature increasingly becomes warmer, these ice caps, such as those found in the Arctic, begin to melt. Contrary to popular belief, ice caps melt starting at the bottom, gradually losing size to their bases and slowly moving up as the ice caps become smaller. Approximately eleven percent of all landmass is glacial ice (Houghton, 2009), so the water levels are grea tly effected by the melting ice caps. The ramifications of these melting ice caps may not be immediately noticeable, but as they continue to melt, the sea levels continue to rise, which bring forth further problems. As the sea levels rise, the oceans expand. To make room for all of this excess water, the oceans have no choice but to spill over onto our landmasses, which can result in horrific flooding throughout the world. Any landmass that borders the oceans will be effected by

George and Lennie Essay Example for Free

George and Lennie Essay All the characters played in the novel Of Mice and Men are lonesome, living an empty life everyday consisting of mainly hard labor. The characters all live a very disheartening life, with the lack of happiness, love and affection in their lives. This can be seen also when George mentions that ranch workers are the loneliest people in the world and dont belong nowhere. Of the many characters in the novel, Curleys wife might be one of the most pathetic and reviled of the outsiders. Steinbeck introduces her to us as an outcast, where she is isolated from the community. Being a minor character in the novel, Steinbeck manages to illustrate her as a character that deeply influences the lives of the main characters George and Lennie. Throughout the whole novel, Curleys wifes name is never mentioned. This initiates the readers to feel the sense of belonging of Curleys wife to Curley and to emphasize as an pariah, being feared of, leaving her with nobody to talk to and her identity as a mystery. Apart from that, Curleys wife is portrayed as the only female in the ranch, and although she is married to Curley, the bosss son, giving her a high status at the ranch, they are psychologically separated, and are never witnessed together, leaving her desperate for camaraderie. Her desire of attention and escape from loneliness leads her to try to seek attention from other men working in the ranch by flirting. Her coquettish actions and inappropriate dressing leads other characters to think of her as a tart. The ranch workers are uneasy about this and avoid her in fear of being reprimanded by Curley which may cost them to lose their jobs innocently. She is first introduced by Steinbeck when she comes into the bunkhouse disrupting a conversation that Lennie and George are holding. The depiction is dramatic, Both men glanced up, for the rectangle of sunshine in the doorway was cut off. This suggests that she has obscured the light, and darkened the room with her presence. This gives a dark and threatening image. Steinbeck describes the image of her standing and peering through the door, heavily made-up with full rouged lips and her fingernails being applied with red nailpolish. The fact that she was looking in through the door standing there accentuates her as an outsider. She is also described wearing red mules and with bouquets of red ostrich feathers on them. The constant repetition of the word red used in the novel to describe Curleys wife portrays her as one who is dangerous because the color red is quite provocative and has connotations such as love, passion and danger. Her hair hung in little rolled clusters, like sausages implies the extensive amount of time she has, being alone with nothing better to do than to curl her hair. Her inappropriate body language proves how she dreadfully tries to seek attention and flirts openly with men as she positions herself against the door frame so that her body was thrown forward. She smiles archly and twitch(es) her body. This gives the reader the general impression that Curleys wife is an attractive young lady who seeks attention of men. Georges immediate comments such as Jesus, what a tramp, and So thats what Curley picks for a wife and reactions to Curleys wife, however, allows the reader to realize that she is a potential threat to George and Lennie. George fumes when he knows of Lennies admiration of her being one who is purty and fiercely tells him not to even take a look at that bitch and refers to her as poison and jail bait and to leave her alone. It is obvious that she longs for friends and for someone to talk to, however, males on the ranch dislike her because they see has as one who is a magnet to trouble.

Dilutional Hyponatremia During Intrauterine Adhesion

Dilutional Hyponatremia During Intrauterine Adhesion Severe dilutional hyponatremia in a patient during hysteroscopic of intrauterine  adhesion : A case report YE Yuzhu, LIN Lina Abstract Hysteroscopy is a minimally invasive procedure for the patients of intrauterin adhesion, but may result in potentially disastrous complication labeled transurethral resection of the prostate (TURP) syndrome. Excessive absorption of large scale of distension media under high inflow pressure by openings of venous channels in endometrium, the large volume of transfusion fluid that is beyond the modulation ability of body may produce the most dangerous situation of severe hyponatremia, hypervolemia and hypoosmolality. The consequence of hysteroscopy is mainly determined by the type of distension medium, irrigation pressure,condition of endometrium, preoperative catheterization, type of electrode system and duration of the surgery. A case of hysteroscopic resection of intrauterine adhesion in which severely symptomatic hyponatremia and hypervolemia happended with epidural anesthesia is presented. Key words: Hysteroscopy, hyponatremia, distension medium, infusion pressure, TURP (transurethral resection of the prostate ) syndrome. Introduction Hysteroscopy technique in the detection and treatment of intrauterine diseases plays an dominant role because of its unique feature of minimal invasion and remains the â€Å"gold standard† mean for the diagnosis of uterine disease, but may result in potentially disastrous complication known as TURP syndrome or hyponatremia and hypervolemia. A hysteroscopy precdure requires an intrauterin installation inserting into the uterine cavity accompanied by a suitable type of distention medium including dextrose 5% in water (D5W), 2.7% sorbitol, 0.54% mannitol and saline for the visualization of intrauterine situation. The most common fluid used clinically is D5W for its distinct features of low-viscosity, electrolyte-free, safety and lower cost. TURP syndrome appears when large scale of distension media (D5W) is overly absorbed including the following clinical signs: dyspnea, headache, nausea and vomiting, coma, and even can progress to cerebaral and pulmonary edema. Signs and syndrom es are nonspecific when the conditon is in its early stages and, as a result, it’s easy to be ignored. Vigilance and communication of the whole medical team is extremely required to avoid state of illness aggravating. Early management must be rendered as soon as possible for the critically ill patients by anesthetists. We report a case of a 36-year-old woman who developed TURP syndrome during hysteroscopic of intrauterine adhesion herein. 2. Case Report A 36-year-old, weight 62 kg , no medication or coexisting diseases, ASA physical status II , underwent hysteroscopy treatment because of her reiterative intrauterin adhesion during epidural anesthesia. Past surgical history revealed four times of previous hysteroscopies within the year, both of which were aimed to remedy for her secondary infertility but failed in acquiring satisfactory therapeutic efficacy. There were no positive fingds on the preoperative physical examination and normal values in laborarory results included blood routine test and plasmic electrolytes, and the concerntrations of sodium ion, potassium ion and blood glucose level were 139 mmol/L, 3.47 mmol/L and 4.0 mmol/L, respectively. A 12-lead electrocardiogram showed sinus rhythm. Upon arrival to surgical operating room, 500 ml lactated Ringers solution was dripped intravenously as maintenance fluid after standard monitors were placed. The heart rate was 76 beats per minute, respiratory rate was 18 breathes per minute and the oxygen saturation was 99%. Contiuous epidural anesthesia was performed successfully with 0.5% lidocaine and 0.375% ropivacaine 15ml totally within 15 minutes. Then the patient was placed in lithotomy position and no catheterization was offered because of the short operation period we had anticipated preoperatively although she expressed her micturition desire. The surgery initially proceeded unevenfully with very steady state of hemodynamics. 8,000 mL D5W as the irrigation fluid was delivered throught the hysteroscope by gravity pressure (60cm above the patient), and the irrigation pressure for uterine cavity distending was 150 mmHg. Monopolar electrode system was selected for endometrium resection, and controled the watts of electroresec tion and electrocoagulation within 40 60 watts and 60 80 watts, respectively. Simultaneous ultrasonographic monitoring was used to identify the sickness of uterus wall and uterine cavity size. A total of 1,000 mL of lactated Ringers solution was infused during the 70 minutes of surgery, with a total blood loss of 20 mL. Twenty minutes before the termination of surgery , the patient complainted of difficulty in breathing with simultaneous polypnea, shiver, and sensations of vertigo and nausea. Oxygen saturation dropped from 98% to 90% and recoverd soon after mask oxygen inhalation. Thereupon tramadol 50 mg was administered intravenously, and excellent effect obtained. Approximately 300 mL output of urine when the bladder was squeezed incautiously by ultrasound probe and the patient vomited once just the procedure completed. The patient appeared haziness of spirit-mind but responded appropriately to verbal stimulate. A dorsalis pedis artery blood sample was obtained from the patient , and electrolytes were reported using a blood-gas analyzing device. Results as follows: PH 7.31; Na+, 115 mmol/L; K+, 3.0mmol/L; ionized Ca2+, 0.93 mmol/L; Glucose, 27.8 mmol/L; HCO3—, 18.6 mmol/L. Based on the symptoms mentioned above, TURP syndrome was suspected. An indwelling urinary catheter was inserted immediately and 1,800 mL urine output was collected totlly at twice. A mixture of 50ml 10% saline and 100ml 0.9% saline was dripped to raise sodium concentration, meanwhile metoclopramide 10 mg was used for anti-nausea. But there were no diuretic and insulin used in case of aggravating of hypokalemia. Oxygen saturation maintained in 92% after oxygen mask was removed and with a progressive rise. Vital signs on permission to PACU were as follows: blood pressure, 126/79 mmHg; heart rate, 79 beats per minute; breathing rate, 20 breaths per minute; and oxygen saturation, 96%. The patient was transported to postanesthesia care unit (PACU) for continued treatments and review of blood gas analysis. On our arrival into PACU, arterial blood gas (ABG) analysis was performed when the venous transfusion of the hypertonic saline solution ended, revealing PH 7.36; Na+, 127 mmol/L; K+, 3.0mmol/L; ionized Ca2+, 1.0 mmol/L; glucose, 22.9 mmol/L; HCO3—, 21.5 mmol/L; BE, -3.6 mmol/L. The patient still had low sodium and potassium level from ABG, a mixture of 100ml 10% saline and 100ml 0.9% saline containing potassium chloride 0.5 g was supplemented in low-speed intravenously. Nurse anesthetist was asked to record vital signs every 15 minutes. 16:15~18:05, the patient got her vital signs stablized gradually and oxygen staturation could maintain over 95%. Review of her blood gas analysis showed: PH 7.36; Na+, 137 mmol/L; K+, 3.4mmol/L; ionized Ca2+, 1.0 mmol/L; glucose, 7.2 mmol/L; HCO3—, 23.2 mmol/L; BE, -3.6 mmol/L. The patient recieved 500 ml lactated Ringers solution totally in PACU, with a total urine output of 850 mL(data from PACU anesthetic chart), and sent back to the ordinary ward without any complaints and Alderete scores 10. 2. Discussion Hysteroscopy has gained widely used in diagnostic and therapeutic in gynecologic surgery for many special advantages, but is not devoid of risks especially when hysteroscopy is applied to resection of extensively endometrial lesion. Excessive absorption of irrigation fluid during hysteroscopic surgery from uterine cavity is the main cause of TURP syndrome or water intoxication, of which reported incidence is 0.2% [1]. The TURP syndrome mainly has clinical symptoms in cardiovascular system, respiratory system and nervous system including elevation of blood pressure, bradycardia, dyspnea, pulmonary edema, cerebral hemia and even death. The severity of consequence is associated with multiple factors, analysis of this case were as follows. The patient’s uterine cavity has low compliance and severe adhesion, so an intrauterine pressure (IUP) of 150 mmHg is required to obtain excellent visual conditions of bilateral tubal orifices. 8,000 mL D5W as the irrigation fluid is delivered i nto uterine for uterine distension in 70 minutes operation time. Based on clinical research, the absorptivity of distension media by body is within the range of 10 30 ml/min only when the irrigation pressure is less than 100 mmHg [2]. Therefore, we estimated 700 2,100 mL D5W is absorbed into circulatory system approximately, along with an infusion of 1,000 mL lactated Ringers solution. As a result, 1,700 3,100 mL is administered into blood intravenously at least, and even more. Hyperglycemia caused by excessive absorption of D5W produces hyperglycemic hyperosmolar status and then makes intracellular fluid transfers to outside the cell, which bings about exacerbating of hyponatremia status. The patient received high frequency hysteroscopy procedure in the short term leads to large-scale and severe damage of endometrium, allowing the distension fluid entering into blood circulation more easily, which contributes to hypervolemia in a more faster pace. As one of essential factors, ex cessive irrigation pressure plays a crucial role in distension fuild over absorption in the condition that endometrial venous sinus are widely open in hysteroscopic electric resection. In our case, we have to raise the pressure to 150 mmHg for a clear surgical vision of uterine cavity, therefore, rendering excellent chance for fluid entering into body. No catheterization was performed preoperatively, thus a large amount of fluid accumulates in bladder and circulation system. To sum up, in this case, fluid overload, hyperglycemic hyperosmolar status, high intrauterine pressure, disruption of endometrial vessles and lack of preoperative catheterization lead to a significant increasement of circulating volume and a sharply reduce of plasma colloid osmotic pressure. Extracellular free water in brain are transported from the outside to the inside of the cell, which results in cerebral edema and causes intracranial hypertension. A serious of neurological syndromes develop including dizzin ess, headache, nausea, vomiting, and haziness of spirit-mind. Likewise, as a consequence of irrigation fluid overload and dilution of the plasma protein concentration, pulmonary hydrostatic pressure elevated, leading to the accurrence of acute pulmonary edema and pulmonary interstitial edema. The ventilation/perfusion imbalance occurs, and then manifests in dyspnea, hypoxemia and a sustained downward trend of oxygen saturation, etc. Timely recognition and urgent corresponding treatment measures should be taken in the early course of water intoxication to prevent the condition deteriorated. In a general way, for every liter of hypotonic fluid absorbed, the serum sodium concentration will decrease by 10 mmol/L(10 mEq/L) [3]. The result of ABG analysis of the patient’s dorsalis pedis artery blood sample indicates severe hyponatremia (Na+ à ¯Ã‚ ¼Ã…’à ¨Ã‚ ¯Ã‚ ¥Ãƒ §Ã‚ »Ã‚ ¼Ãƒ ¥Ã‚ Ã‹â€ Ãƒ ¥Ã‚ ¾Ã‚  à ¥Ã‚ ¤Ã¢â‚¬Å¾Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¤Ã‚ ¸Ã‚ Ãƒ ¥Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ Ã‚ ¯Ãƒ ©Ã‚ -à §Ã¢â‚¬ ¢Ã¢â€ž ¢Ãƒ ¦Ã‚ °Ã‚ ¸Ãƒ ¤Ã‚ ¹Ã¢â‚¬ ¦Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ §Ã‚ ¥Ã… ¾Ãƒ §Ã‚ »Ã‚ Ãƒ §Ã‚ ³Ã‚ »Ãƒ §Ã‚ »Ã… ¸Ãƒ ¥Ã‚ ¹Ã‚ ¶Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §-†¡(à ©Ã†â€™Ã‚ ­Ãƒ ¦Ã‚ Ã†â€™Ãƒ ¯Ã‚ ¼Ã‚ ¶Ãƒ ¯Ã‚ ½Ã…’à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‹â€ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ¼Ã‚ ®Ãƒ ¯Ã‚ ¼Ã‚ ¦Ãƒ ¯Ã‚ ¼Ã… ½Ãƒ ¯Ã‚ ¼Ã‚ ¨Ãƒ ¯Ã‚ ½Ã¢â€ž ¢Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã… ½Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬  Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã…’à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¡Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢ €Å"à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã…’ à ¯Ã‚ ½Ã¢â‚¬  Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¾Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã… ½Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¡Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã… ½Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã… ½Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã… ½Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã…’à £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã… ½Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¡Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã… ½Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¾Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ½Ã¢â‚¬ °Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã…’à ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢ à ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ¼Ã… ¡Ãƒ ¯Ã‚ ½Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã†â€™Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å"à ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã¢â‚¬ Ãƒ ¯Ã‚ ¼Ã‚ »Ãƒ ¯Ã‚ ¼Ã‚ ªÃƒ ¯Ã‚ ¼Ã‚ ½Ãƒ ¯Ã‚ ¼Ã… ½Ãƒ ¯Ã‚ ¼Ã‚ ªÃƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ¼Ã‚ ²Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ½Ã‚ Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¾Ãƒ £Ã¢â€š ¬Ã¢â€š ¬Ãƒ ¯Ã‚ ¼Ã‚ ­Ãƒ ¯Ã‚ ½Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ½Ã¢â‚¬Å¾Ãƒ ¯Ã‚ ¼Ã…’à ¯Ã‚ ¼Ã¢â‚¬â„¢Ãƒ ¯Ã‚ ¼Ã‚ Ãƒ ¯Ã‚ ¼Ã‚ Ãƒ ¯Ã‚ ¼Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ¼Ã…’à ¯Ã‚ ¼Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ¼Ã‚ Ãƒ ¯Ã‚ ¼Ã‹â€ Ãƒ ¯Ã‚ ¼-à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¯Ã‚ ¼Ã… ¡Ãƒ ¯Ã‚ ¼Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ¼Ã¢â‚¬Å"à ¯Ã‚ ¼Ã¢â‚¬ Ãƒ ¯Ã‚ ¼Ã‚ Ãƒ ¯Ã‚ ¼Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ¼Ã¢â‚¬ Ãƒ ¯Ã‚ ¼-à ¯Ã‚ ¼Ã… ½(à ©Ã‚ «Ã‹Å"à ¥Ã‚ ®Ã‚ ¹Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ ¤Ã‚ ½Ã… ½Ãƒ ©Ã¢â‚¬â„¢Ã‚  Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §-†¡Ãƒ ¥Ã‚ Ã‹â€ Ãƒ §Ã‚ §Ã‚ °Ãƒ ¦Ã‚ °Ã ‚ ´Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã‚ ¯Ã¢â‚¬â„¢) (à ¦Ã‚ ­Ã‚ £Ãƒ ¥Ã‚ ¸Ã‚ ¸Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ¦Ã‚ µÃ¢â‚¬  Ãƒ ¦Ã‚ ¸-à ©Ã¢â€š ¬Ã‚ Ãƒ ¥Ã… ½Ã¢â‚¬ ¹ 280-320 mmol/L) (limiting correction to )à £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¦Ã‚ ºÃ‚ ¶Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ©Ã¢â‚¬â„¢Ã‚  Ãƒ §Ã‚ ¦Ã‚ »Ãƒ ¥Ã‚ ­Ã‚ Ãƒ ¦Ã‚ µÃ¢â‚¬Å"à ¥Ã‚ ºÃ‚ ¦Ãƒ ¤Ã‚ ¸Ã‚ Ãƒ ¥Ã‚ Ã‚ ¯Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ¡Ãƒ ©Ã‚ «Ã‹Å"à ¯Ã‚ ¼Ã…’à ¤Ã‚ ¸Ã¢â€š ¬Ãƒ ¨Ã‹â€ Ã‚ ¬Ãƒ ©Ã¢â€š ¬Ã¢â‚¬ °Ãƒ ¦Ã¢â‚¬ ¹Ã‚ ©3%à ¯Ã‚ ½Ã… ¾5%à §Ã… ¡Ã¢â‚¬Å¾Ãƒ ©Ã‚ «Ã‹Å"à ¦Ã‚ ¸-à ¦Ã‚ °Ã‚ ¯Ãƒ ¥Ã…’-à ©Ã¢â‚¬â„¢Ã‚  Ãƒ ¦Ã‚ ºÃ‚ ¶Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¥Ã‚ Ã…  Ãƒ ¦- ¶Ãƒ £Ã¢â€š ¬Ã‚ Ãƒ ©Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¥Ã‚ ºÃ‚ ¦Ãƒ ¨Ã‚ ¡Ã‚ ¥Ãƒ ¥Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ©Ã¢â€š ¬Ã¢â‚¬ °Ãƒ ¦Ã¢â‚¬ ¹Ã‚ ©Ãƒ ¥Ã‹â€ Ã‚ ©Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ ¥Ã¢â‚¬ °Ã¢â‚¬Å¡Ãƒ ¦- ¶Ãƒ ¥Ã‚ ºÃ¢â‚¬ Ãƒ ¦Ã‚ ³Ã‚ ¨Ãƒ ¦Ã¢â‚¬Å¾Ã‚ Ãƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ ©Ã¢â‚¬â„¢Ã‚ ¾Ãƒ §Ã‚ ¦Ã‚ »Ãƒ ¥Ã‚ ­Ã‚ Ãƒ ¦Ã‚ °Ã‚ ´Ãƒ ¥Ã‚ ¹Ã‚ ³Ãƒ ¯Ã‚ ¼Ã…’à ¤Ã‚ ½Ã… ½Ãƒ ©Ã¢â‚¬â„¢Ã‚ ¾Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §-†¡Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ ©Ã…“â‚ ¬Ãƒ ¦Ã¢â‚¬ ¦Ã… ½Ãƒ §Ã¢â‚¬ Ã‚ ¨Ãƒ ¥Ã‹â€ Ã‚ ©Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ ¨Ã‚ Ã‚ ¯Ãƒ ¯Ã‚ ¼Ã…’à ©Ã‹Å" ²Ãƒ ¦Ã‚ ­Ã‚ ¢Ãƒ ¤Ã‚ ½Ã… ½Ãƒ ©Ã¢â‚¬â„¢Ã‚ ¾Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §-†¡Ãƒ ¥Ã…  Ã‚  Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¯Ã‚ ¼Ã…’à ©Ã¢â€š ¬Ã‚  Ãƒ ¦Ã‹â€ Ã‚ Ãƒ ¦Ã¢â‚¬ ºÃ‚ ´Ãƒ ¥Ã‚ ¤Ã… ¡Ãƒ ¥Ã‚ ¹Ã‚ ¶Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §-†¡Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ ¾-à ¤Ã‚ ¸Ã‚ Ãƒ ¥Ã‚ Ã‚ ¿Ãƒ ¥Ã‚ ¤Ã‚ ±Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¥Ã‹â€ Ã‚ ©Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ ¥Ã¢â‚¬ °Ã¢â‚¬Å¡Ãƒ ¤Ã‚ ¸Ã¢â€š ¬Ãƒ ¨Ã‹â€ Ã‚ ¬Ãƒ ©Ã¢â€š ¬Ã¢â‚¬ °Ãƒ ¦Ã¢â‚¬ ¹Ã‚ ©Ãƒ ¦Ã‚ ¸-à ©Ã¢â€š ¬Ã‚ Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ ¥Ã‹â€ Ã‚ ©Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ ¥Ã¢â‚¬ °Ã¢â‚¬Å¡Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¨Ã‚ ¢Ã‚ ¢Ãƒ ¥Ã‹â€ Ã‚ ©Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ ¥Ã¢â‚¬ °Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ ¦Ã¢â‚¬Å¡20%à §Ã¢â‚¬ Ã‹Å"à ©Ã…“ ²Ãƒ ©Ã¢â‚¬  Ã¢â‚¬ ¡Ãƒ £Ã¢â€š ¬Ã‚ Ãƒ ©Ã¢â€š ¬Ã… ¸Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¨Ã¢â‚¬ ¹Ã‚ ¥Ãƒ ¦Ã¢â‚¬ ¢Ã‹â€ Ãƒ ¦Ã… ¾Ã…“à ¤Ã‚ ¸Ã‚ Ãƒ ¥Ã‚ ¥Ã‚ ½Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ Ã‚ ¯Ãƒ ©Ã¢â‚¬ ¡Ã¢â‚¬ ¡Ãƒ §Ã¢â‚¬ Ã‚ ¨Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¦Ã‚ »Ã‚ ¤Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ¡Ãƒ ¦Ã‹â€ -à ¨Ã¢â‚¬ ¦Ã‚ ¹Ãƒ ¨Ã¢â‚¬  Ã…“à ©Ã¢â€š ¬Ã‚ Ãƒ ¦Ã… ¾Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¦Ã¢â‚¬Å¡Ã‚ £Ãƒ ¨Ã¢â€š ¬Ã¢â‚¬ ¦Ãƒ ¦Ã…“ ¯Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¥Ã¢â‚¬ ¡Ã‚ ºÃƒ §Ã… ½Ã‚ °Ãƒ ¤Ã‚ ¸Ã¢â€š ¬Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ¡Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ ©Ã‚ «Ã‹Å"à ¨Ã‚ ¡Ã¢ ‚ ¬Ãƒ §Ã‚ ³-à ¨Ã‚ ¾Ã‚ ¾27.8 mmol/Là ¯Ã‚ ¼Ã…’à ¤Ã‚ ¸Ã‚ ´Ãƒ ¥Ã‚ ºÃ…  Ãƒ ¨Ã‚ ¯Ã¢â‚¬ ¢Ãƒ ©Ã‚ ªÃ…’à ¨Ã‚ ¯Ã‚ Ãƒ ¦Ã‹Å"Ã… ½Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ³-à ¤Ã‚ ¸Ã¢â€š ¬Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ¡Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ ¥Ã‚ Ã¢â‚¬ ¡Ãƒ ©Ã‚ «Ã‹Å"à ¯Ã‚ ¼Ã…“20 mmol/L,à ¤Ã‚ ¸Ã‚ Ãƒ ¤Ã‚ ¼Ã… ¡Ãƒ ¥Ã¢â‚¬ ¡Ã‚ ºÃƒ §Ã… ½Ã‚ °Ãƒ ¦Ã‹Å"Ã… ½Ãƒ ¦Ã‹Å" ¾Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ §-†¦Ãƒ §Ã¢â‚¬ Ã… ¸Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¦Ã¢â‚¬ Ã‚ ¹Ãƒ ¥Ã‚ Ã‹Å"à ¯Ã‚ ¼Ã…’à ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ³-à ¥Ã…“ ¨Ãƒ ¦Ã…“ ¯Ãƒ ¥Ã‚ Ã… ½4à ¥Ã‚ °Ã‚ Ãƒ ¦- ¶Ãƒ ¥Ã‚ Ã… ½Ãƒ ¤Ã‚ ¼Ã… ¡Ãƒ ¦Ã‚ Ã‚ ¢Ãƒ ¥Ã‚ ¤Ã‚ Ãƒ ¨Ã¢â‚¬ ¡Ã‚ ³Ãƒ ¦Ã‚ ­Ã‚ £Ãƒ ¥Ã‚ ¸Ã‚ ¸Ãƒ ¦Ã‚ °Ã‚ ´Ãƒ ¥Ã‚ ¹Ã‚ ³Ãƒ ¯Ã‚ ¼Ã…’à ¦Ã¢â‚¬ ¢Ã¢â‚¬ ¦Ãƒ ¦Ã…“ ¯Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¥Ã‚ ¯Ã‚ ¹Ãƒ ¤Ã‚ ºÃ… ½Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ³-à §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¦Ã‚ £Ã¢â€š ¬Ãƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ ¦Ã‹Å" ¯Ãƒ ¦Ã…“â‚ ¬Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¨Ã‚ ¦Ã‚ Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ©Ã‚ ¢Ã¢â‚¬Å¾Ãƒ ©Ã‹Å" ²Ãƒ ¦- ¹Ãƒ ¦Ã‚ ³Ã¢â‚¬ ¢Ãƒ ¯Ã‚ ¼Ã…’à ¤Ã‚ ¸Ã‚ ´Ãƒ ¥Ã‚ ºÃ…  Ãƒ ¤Ã‚ ¸Ã…  Ãƒ ¥Ã‚ Ã‚ ¯Ãƒ ¦Ã‚  Ã‚ ¹Ãƒ ¦Ã‚ Ã‚ ®Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ©Ã¢â‚¬â„¢Ã‚ ¾Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ³-à ¦Ã‚ µÃ¢â‚¬Å"à ¥Ã‚ ºÃ‚ ¦Ãƒ §Ã‚ »Ã‚ ¼Ãƒ ¥Ã‚ Ã‹â€ Ãƒ ¨Ã¢â€š ¬Ã†â€™Ãƒ ¨Ã¢â€ž ¢Ã¢â‚¬ËœÃƒ ¦Ã‹Å" ¯Ãƒ ¥Ã‚ Ã‚ ¦Ãƒ §Ã‚ »Ã¢â€ž ¢Ãƒ ¤Ã‚ ºÃ‹â€ Ãƒ ¨Ã†â€™Ã‚ °Ãƒ ¥Ã‚ ²Ã¢â‚¬ ºÃƒ §Ã‚ ´Ã‚  Ãƒ ¦Ã‚ ²Ã‚ »Ãƒ §Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ Ãƒ ¥Ã¢â‚¬  Ã¢â€ž ¢Ãƒ §Ã¢â‚¬ Ã‚ µÃƒ ¦Ã… ¾Ã‚ Ãƒ ©- ®Ãƒ ©Ã‚ ¢Ã‹Å" à ¯Ã‚ ¼Ã¢â‚¬ ° à ¨Ã‚ ¡Ã…’à ¥Ã‚ ®Ã‚ «Ãƒ ¨Ã¢â‚¬ ¦Ã¢â‚¬ Ãƒ ©Ã¢â‚¬ ¢Ã…“à §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ ¥Ã‚ ºÃ¢â‚¬ Ãƒ ¦Ã‚ ³Ã‚ ¨Ãƒ ¦Ã¢â‚¬Å¾Ã‚ Ãƒ ¯Ã‚ ¼Ã… ¡Ãƒ ¯Ã‚ ¼Ã‹â€ 1à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¨Ã¢â‚¬ ¹Ã‚ ¥Ãƒ ¦-  Ãƒ ¦Ã‚ ¤Ã… ½Ãƒ §Ã‚ ®Ã‚ ¡Ãƒ ¥Ã¢â‚¬  Ã¢â‚¬ ¦Ãƒ ©Ã‹Å" »Ãƒ ¦Ã‚ »Ã… ¾Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ §Ã‚ ¦Ã‚ Ãƒ ¥Ã‚ ¿Ã…’à §-†¡Ãƒ ¯Ã‚ ¼Ã…’à ©Ã‚ ¦-à ©Ã¢â€š ¬Ã¢â‚¬ °Ãƒ §Ã‚ ¡Ã‚ ¬Ãƒ ¨Ã¢â‚¬  Ã…“à ¥Ã‚ ¤-à ©Ã‹Å" » à ¦Ã‚ »Ã… ¾Ãƒ ¯Ã‚ ¼Ã…’à ¤Ã‚ ¼Ã‹Å"à §Ã¢â‚¬Å¡Ã‚ ¹Ãƒ ¥Ã…“ ¨Ãƒ ¤Ã‚ ºÃ… ½Ãƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ ¤Ã‚ ¿Ã‚ Ãƒ ¦Ã…’ Ãƒ ¦Ã‚ ¸Ã¢â‚¬ ¦Ãƒ ©Ã¢â‚¬  Ã¢â‚¬â„¢Ãƒ §Ã…  Ã‚ ¶Ãƒ ¦Ã¢â€š ¬Ã‚ Ãƒ ¯Ã‚ ¼Ã…’à ¦Ã‚ °Ã‚ ´Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã‚ ¯Ã¢â‚¬â„¢Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ §-†¡Ãƒ §Ã…  Ã‚ ¶Ãƒ ¨Ã†â€™Ã‚ ½Ãƒ ©Ã¢â€š ¬Ã… ¡Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ¡Ãƒ ¨Ã‚ ¯Ã‚ ¢Ãƒ ©- ®Ãƒ ¦- ©Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §Ã… ½Ã‚ °Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¤Ã‚ ½Ã¢â‚¬  Ãƒ ¥Ã…“ ¨ à ¥Ã¢â‚¬ ¦Ã‚ ¨Ãƒ ©Ã‚ ºÃ‚ »Ãƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã¢â‚¬ °Ã¢â€š ¬Ãƒ ¦Ã…“†°Ãƒ ¥Ã‚ Ã‹Å"à ¥Ã…’-à §Ã… ½Ã‚ °Ãƒ ¥Ã‚ Ã¢â‚¬ ¡Ãƒ ¤Ã‚ ¼Ã… ¡Ãƒ ¨Ã‚ ¢Ã‚ «Ãƒ §Ã¢â‚¬ ºÃ¢â‚¬ËœÃƒ ¦Ã…  Ã‚ ¤Ãƒ ¤Ã‚ »Ã‚ ªÃƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¦Ã‚ ­Ã‚ £Ãƒ ¥Ã‚ ¸Ã‚ ¸Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ ¾Ã‚ Ãƒ ¦Ã¢â‚¬ °Ã¢â€š ¬Ãƒ ¨Ã‚ ¦Ã¢â‚¬  Ãƒ §Ã¢â‚¬ º-à ¨Ã¢â€š ¬Ã…’à ¦-  Ãƒ ¦Ã‚ ³Ã¢â‚¬ ¢Ãƒ ¤Ã‚ ºÃ¢â‚¬  Ãƒ ¨Ã‚ §Ã‚ £Ãƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ º à ¥Ã¢â‚¬  Ã¢â‚¬ ¦Ãƒ §Ã… ½Ã‚ ¯Ãƒ ¥Ã‚ ¢Ã†â€™Ãƒ ¦Ã¢â‚¬ Ã‚ ¹Ãƒ ¥Ã‚ Ã‹Å"à £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ 2à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¥Ã¢â‚¬ °Ã‚ Ãƒ ¥Ã‚ Ã‚ ¯Ãƒ ¥Ã‚ Ã… ¡Ãƒ ©Ã‚ ¢Ã¢â‚¬Å¾Ãƒ ©Ã‹Å" ²Ãƒ ¦Ã¢â€š ¬Ã‚ §Ãƒ ¤Ã‚ ½Ã‚ ¿Ãƒ §Ã¢â‚¬ Ã‚ ¨Ãƒ ¦Ã¢â‚¬ Ã‚ ¶Ãƒ §Ã‚ ¼Ã‚ ©Ãƒ ¥Ã‚ ­Ã‚ Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¥Ã¢â‚¬  Ã¢â‚¬ ¦Ãƒ ¨Ã¢â‚¬  Ã…“à ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ®Ã‚ ¡Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¨Ã‚ Ã‚ ¯Ãƒ §Ã¢â‚¬ °Ã‚ ©Ãƒ ¥Ã¢â‚¬ ¡Ã‚ Ãƒ ¥Ã‚ °Ã¢â‚¬ËœÃƒ ¦Ã…“ ¯ à ¤Ã‚ ¸Ã‚ ­Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ®Ã‚ ¡Ãƒ ¥Ã‚ ¼Ã¢â€š ¬Ãƒ ¦Ã¢â‚¬ Ã‚ ¾Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¥Ã¢â‚¬ ¡Ã‚ ºÃƒ ¨Ã‚ ¡Ã¢â€š ¬[5],à ¥Ã‚ »Ã‚ ºÃƒ ¨Ã‚ ®Ã‚ ®Ãƒ ¦Ã…“ ¯Ãƒ ¥Ã¢â‚¬ °Ã‚ Ãƒ §Ã¢â‚¬ ¢Ã¢â€ž ¢Ãƒ §Ã‚ ½Ã‚ ®Ãƒ ¥Ã‚ ¯Ã‚ ¼Ãƒ ¥Ã‚ °Ã‚ ¿Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ §Ã¢â‚¬ Ã‚ µÃƒ ¥Ã‹â€ Ã¢â‚¬ ¡Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ¡Ãƒ §Ã‚ ¨Ã¢â‚¬ ¹Ãƒ ¥Ã‚ ºÃ¢â‚¬ Ãƒ ¦Ã… ½Ã‚ §Ãƒ ¥Ã‹â€ Ã‚ ¶Ãƒ ¨Ã¢â‚¬  Ã‚ ¨Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¥Ã… ½Ã¢â‚¬ ¹Ãƒ ¥Ã…  Ã¢â‚¬ ºÃƒ ¤Ã‚ ¸Ã‚ º 80~100mmHg6]à ¯Ã‚ ¼Ã…’à ¥Ã‚ °Ã‚ ½Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¦Ã… ½Ã‚ §Ãƒ ¥Ã‹â€ Ã‚ ¶Ãƒ ¨Ã¢â‚¬  Ã‚ ¨Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ©Ã¢â‚¬ ¡Ã‚ Ãƒ £Ã¢â€š ¬Ã‚ Ãƒ §Ã‚ ¼Ã‚ ©Ãƒ §Ã… ¸Ã‚ ­Ãƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¦- ¶Ãƒ ©- ´60minà ¤Ã‚ ¹Ã¢â‚¬ ¹Ãƒ ¥Ã¢â‚¬  Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ¼Ã‹â€ Ãƒ ¥Ã‚ ¼Ã¢â‚¬ ¢Ãƒ §Ã¢â‚¬ Ã‚ ¨anaethestic considertionà ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¯Ã‚ ¼Ã‹â€ Ãƒ ¦Ã… ½Ã‚ §Ãƒ ¥Ã‹â€ Ã‚ ¶Ãƒ ¥Ã…“ ¨90minà ¥Ã¢â‚¬  Ã¢â‚¬ ¦Ãƒ ¯Ã‚ ¼Ã… ¡Ãƒ ©Ã†â€™Ã‚ ­Ãƒ ¦Ã‚ Ã†â€™Ãƒ ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¯Ã‚ ¼Ã…’ à ©Ã‹Å" ²Ãƒ ¦Ã‚ ­Ã‚ ¢Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ ¤Ã‚ §Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¥Ã‚ ¿Ã‚ «Ãƒ ©Ã¢â€š ¬Ã… ¸Ãƒ ¨Ã‚ ¿Ã¢â‚¬ ºÃƒ ¥Ã¢â‚¬ ¦Ã‚ ¥Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã‚ ®Ã‚ ¡Ãƒ §Ã‚ ¨Ã¢â€š ¬Ãƒ ©Ã¢â‚¬ ¡Ã…  Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¦Ã‚ ¶Ã‚ ²Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ 3à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¥Ã‚ ¯Ã¢â‚¬  Ãƒ ¥Ã‹â€ Ã¢â‚¬ ¡Ãƒ ¨Ã‚ §Ã¢â‚¬Å¡Ãƒ ¥Ã‚ ¯Ã… ¸Ãƒ ¨Ã¢â‚¬  Ã‚ ¨Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¥Ã¢â‚¬ ¦Ã‚ ¥Ãƒ ¥Ã¢â‚¬ ¡Ã‚ ºÃƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¥Ã‚ ·Ã‚ ®Ãƒ ¯Ã‚ ¼Ã…’à §Ã¢â‚¬ Ã‚ µ à ¨Ã‚ §Ã‚ £Ãƒ ¨Ã‚ ´Ã‚ ¨Ãƒ ¨Ã¢â‚¬  Ã‚ ¨Ãƒ ¥Ã‚ ®Ã‚ ®Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¥Ã‚ ·Ã‚ ®Ãƒ ¯Ã‚ ¼Ã… ¾1.5Là ¦Ã‹â€ -à ©Ã‚ Ã… ¾Ãƒ §Ã¢â‚¬ Ã‚ µÃƒ ¨Ã‚ §Ã‚ £Ãƒ ¨Ã‚ ´Ã‚ ¨Ãƒ ¥Ã‚ ½Ã‚ ­Ãƒ ¥Ã‚ ®Ã‚ ®Ãƒ ¦Ã‚ ¶Ã‚ ²Ãƒ ¥Ã‚ ·Ã‚ ®Ãƒ ¯Ã‚ ¼Ã… ¾1.0Là ¯Ã‚ ¼Ã…’à ¥Ã‚ ºÃ¢â‚¬ Ãƒ ¦Ã… ¡Ã¢â‚¬Å¡Ãƒ ¥Ã‚ Ã…“à ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯(Issacson à ¦Ã…  Ã‚ ¥Ãƒ ©Ã‚ Ã¢â‚¬Å"à ¯Ã‚ ¼Ã…’à ¦Ã‚ ¯Ã‚ Ãƒ ¥Ã‚ Ã‚ ¸Ãƒ ¦Ã¢â‚¬ Ã‚ ¶ 1000 mlà ©Ã‚ Ã… ¾Ãƒ §Ã¢â‚¬ Ã‚ µÃƒ ¨Ã‚ §Ã‚ £Ãƒ ¨Ã‚ ´Ã‚ ¨Ãƒ ¨Ã¢â‚¬  Ã‚ ¨Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¤Ã‚ »Ã¢â‚¬ ¹Ãƒ ¨Ã‚ ´Ã‚ ¨Ãƒ ¯Ã‚ ¼Ã…’à ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ©Ã¢â‚¬â„¢Ã‚  Ãƒ §Ã‚ ºÃ‚ ¦Ãƒ ¤Ã‚ ¸Ã¢â‚¬ ¹Ãƒ ©Ã¢â€ž ¢Ã‚  10 mmol/Là ¯Ã‚ ¼Ã…’à ¥Ã‚ »Ã‚ ºÃƒ ¨Ã‚ ®Ã‚ ®Ãƒ ¥Ã‚ Ã‚ ¸Ãƒ ¦Ã¢â‚¬ Ã‚ ¶Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¨Ã‚ ¾Ã‚ ¾1000 à ¯Ã‚ ½Ã… ¾2000 ml à ¦- ¶Ãƒ ¥Ã‚ Ã‚ ³Ãƒ ¥Ã‚ ºÃ¢â‚¬ Ãƒ ¥Ã‚ Ã…“à ¦Ã‚ ­Ã‚ ¢Ãƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯:Issacson KBà ¯Ã‚ ¼Ã… ½ Complications of hysteroscopyà ¯Ã‚ ¼Ã‚ »Jà ¯Ã‚ ¼Ã‚ ½Ãƒ ¯Ã‚ ¼Ã… ½ Obstet Gynecol Clin North Amà ¯Ã‚ ¼Ã…’1999à ¯Ã‚ ¼Ã…’26(1):39à ¯Ã‚ ¼Ã‚ 51à ¯Ã‚ ¼Ã… ½ )à ¯Ã‚ ¼Ã…’à ¦Ã‚ £Ã¢â€š ¬Ãƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ¦Ã‚ ¸Ã¢â‚¬ ¦Ãƒ ©Ã¢â‚¬â„¢Ã‚   à §Ã‚ ¦Ã‚ »Ãƒ ¥Ã‚ ­Ã‚ Ãƒ ¦Ã‚ µÃ¢â‚¬Å"à ¥Ã‚ ºÃ‚ ¦Ãƒ ¯Ã‚ ¼Ã…’à ¦Ã‚ £Ã¢â€š ¬Ãƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ §Ã¢â‚¬ Ã… ¸Ãƒ ¥Ã¢â‚¬ËœÃ‚ ½Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ ¾Ã‚ Ãƒ £Ã¢â€š ¬Ã‚ Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ ¦Ã‚ °Ã‚ §Ãƒ ©Ã‚ ¥Ã‚ ±Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¥Ã‚ ºÃ‚ ¦Ãƒ ¥Ã¢â‚¬â„¢Ã…’à ¥Ã‚ °Ã‚ ¿Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ 4à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ©Ã… ¡Ã‚ Ãƒ ¦- ¶Ãƒ §Ã¢â‚¬ ºÃ¢â‚¬ËœÃƒ ¦Ã‚ µÃ¢â‚¬ ¹Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §Ã¢â‚¬ Ã‚ µÃƒ ¨Ã‚ §Ã‚ £Ãƒ ¨Ã‚ ´Ã‚ ¨Ãƒ §Ã… ¡Ã¢â‚¬Å¾ à ¥Ã‚ Ã‹Å"à ¥Ã…’-à ¯Ã‚ ¼Ã…’à ¥Ã‚ Ã… ¡Ãƒ ¥Ã‹â€ Ã‚ °Ãƒ ¦- ©Ãƒ ¦Ã…“Å ¸Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §Ã… ½Ã‚ °Ãƒ ¤Ã‚ ½Ã… ½Ãƒ ©Ã¢â‚¬â„¢Ã‚  Ãƒ ¨Ã‚ ¡Ã¢â€š ¬Ãƒ §-†¡Ãƒ ¯Ã‚ ¼Ã…’à ¦- ©Ãƒ ¥Ã‚ ¤Ã¢â‚¬Å¾Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¦- ©Ãƒ ¦Ã‚ ²Ã‚ »Ãƒ §Ãƒ ¯Ã‚ ¼Ã…’à ©Ã‹Å" ²Ãƒ ¦Ã‚ ­Ã‚ ¢Ãƒ §-†¦Ãƒ ¦Ã†â€™Ã¢â‚¬ ¦Ãƒ ¦Ã‚ Ã‚ ¶Ãƒ ¥Ã…’-à £Ã¢â€š ¬Ã¢â‚¬Å¡Ãƒ ¯Ã‚ ¼Ã‹â€ 5à ¯Ã‚ ¼Ã¢â‚¬ °Ãƒ ¦Ã…“ ¯Ãƒ ¥Ã‚ Ã… ½ à ¥Ã‚ ¿Ã¢â‚¬ ¦Ãƒ ©Ã‚ ¡Ã‚ »Ãƒ §Ã‚ §Ã‚ ¯Ãƒ ¦Ã… ¾Ã‚ Ãƒ ¨Ã‚ ·Ã… ¸Ãƒ ¨Ã‚ ¸Ã‚ ªÃƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¤Ã‚ ½Ã¢â‚¬Å"à ¥Ã‚ ¾Ã‚ Ãƒ ¥Ã‚ Ã‹Å"à ¥Ã…’-à £Ã¢â€š ¬Ã¢â‚¬Å¡ à ¦Ã‚ °Ã‚ ´Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã‚ ¯Ã¢â‚¬â„¢Ãƒ ¥Ã…“ ¨Ãƒ ¥Ã‚ ¤-à §Ã‚ §Ã¢â‚¬ËœÃƒ ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ °Ã‚ ¤Ãƒ ¥Ã¢â‚¬ ¦Ã‚ ¶Ãƒ ¨Ã¢â‚¬ ¦Ã¢â‚¬ Ãƒ ©Ã¢â‚¬ ¢Ã…“à ¦Ã¢â‚¬ °Ã¢â‚¬ ¹Ãƒ ¦Ã…“ ¯Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã…’†¦Ãƒ ¦Ã¢â‚¬ ¹Ã‚ ¬Ãƒ ¥Ã‚ ®Ã‚ «Ãƒ ¨Ã¢â‚¬ ¦Ã¢â‚¬ Ãƒ ©Ã¢â‚¬ ¢Ã…“à £Ã¢â€š ¬Ã‚ TURPà §Ã‚ ­Ã¢â‚¬ °Ãƒ ¯Ã‚ ¼Ã…’à ¨Ã¢â‚¬ ¹Ã‚ ¥Ãƒ ¤Ã‚ ¸Ã‚  à ¤Ã‚ ºÃ‹â€ Ãƒ ¤Ã‚ »Ã‚ ¥Ãƒ ©Ã‚ «Ã‹Å"à ¥Ã‚ ºÃ‚ ¦Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ ¨Ã‚ §Ã¢â‚¬  Ãƒ ¯Ã‚ ¼Ã…’à ¥Ã‚ °Ã¢â‚¬  Ãƒ ¥Ã‚ ¸Ã‚ ¦Ãƒ ¦Ã‚ Ã‚ ¥Ãƒ ¤Ã‚ ¸Ã‚ ¥Ãƒ ©Ã¢â‚¬ ¡Ã‚ Ãƒ §Ã… ¡Ã¢â‚¬Å¾Ãƒ ¥Ã‚ Ã… ½Ãƒ ¦Ã… ¾Ã…“à ¯Ã‚ ¼Ã…’à ¦Ã¢â‚¬ °Ã¢â€š ¬Ãƒ ¤Ã‚ »Ã‚ ¥Ãƒ ¥Ã…“ ¨Ãƒ ¤Ã‚ ¸Ã‚ ´Ãƒ ¥Ã‚ ºÃ…  Ãƒ ¤Ã‚ ¸Ã…  Ãƒ ¤Ã‚ ¸Ã¢â€š ¬Ãƒ ¦- ¦Ãƒ ¥Ã‚ Ã¢â‚¬ËœÃƒ §Ã… ½Ã‚ °Ãƒ ¦Ã‚ °Ã‚ ´Ãƒ ¤Ã‚ ¸Ã‚ ­Ãƒ ¦Ã‚ ¯Ã¢â‚¬â„¢Ãƒ ¥Ã‚ ¿Ã¢â‚¬ ¦Ãƒ ©Ã‚ ¡Ã‚ »Ãƒ ¥Ã‚ Ã…   à ¦- ¶Ãƒ ¥Ã‚ ¤Ã¢â‚¬Å¾Ãƒ §Ã‚ Ã¢â‚¬  Ãƒ ¯Ã‚ ¼Ã…’à ©Ã‹Å" ²Ãƒ ¦Ã‚ ­Ã‚ ¢Ãƒ ¦Ã‚ Ã‚ ¶Ãƒ ¥Ã…’-à ¨Ã¢â€š ¬Ã…’à ¥Ã‚ Ã‚ ±Ãƒ ¥Ã‚ Ã…  Ãƒ §-†¦Ãƒ ¤Ã‚ ºÃ‚ ºÃƒ §Ã¢â‚¬ Ã… ¸Ãƒ ¥Ã¢â‚¬ËœÃ‚ ½Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡ Reference [1] Jansen FW, Verdevoogd CB, Ulzen KV, et al. Complications of hysteroscopy: aprospective multicenter study [J], Obstet Gynecol, 2000, 96 (2): 266 270. [2] Rhymer JS, Bell TS, Perry KC, et al. Hyponatremia following transurethral resection of the postate [J].Br Jurol, 1985, 57(4): 450à ¯Ã‚ ¼Ã‚ 452. [3] Prost AM, Liberman RF, Harlow BL, Ginsburg ES. Complication of hysteroscopic surgery: predincting patients at risk. Obster Gynccol. 2000; 96:517-520 [4] Cooper JM Brady RM. Intraoperative and early post-operative complications of operative hysteroscopy. Obstetric and Gynecology Clinics of North America 2000; 27: 347-365 [5]Romer T. Benefit of GnRH analogene treatment for hysteroscopic surgery in patients with bleeding disorders [J].Gynecol.Obstet Invest,2003,50:112-120. [6]Murdoch JA. Tong JG. Anesthesia for hysteroscopy. Anesthesiol Clin North Am. 2001;19:125-140 [ J ].à ¤Ã‚ ¸Ã‚ ­Ãƒ ¥Ã¢â‚¬ ºÃ‚ ½Ãƒ ¥Ã‚ ¾Ã‚ ®Ãƒ ¥Ã‹â€ Ã¢â‚¬ ºÃƒ ¥Ã‚ ¤-à §Ã‚ §Ã¢â‚¬ËœÃƒ ¦Ã‚ Ã¢â‚¬Å¡Ãƒ ¥Ã‚ ¿-,2009,9(12):1097-109 à ¨Ã¢â‚¬Å¾Ã‚ ±Ãƒ ©Ã‚ «Ã¢â‚¬Å"à ©Ã… ¾Ã‹Å"à ¯Ã‚ ¼Ã… ¡Witz CA, Silverberg KM, Burns WN, Schenken RS, Olive DL. Complications associated with the absorption of hysteroscopic fluid media. Fertil Steril 1993;60:745-56.

Henrik Isbens A Dolls House Essay -- A Dolls House Essays

After she reveals the "dastardly deed" to her husband, he becomes understandably agitated; in his frustration he shares the outside world with her, the ignorance of the serious business world, and destroys her innocence and self-esteem. This disillusion marks the final destructive blow to her doll's house. Their ideal home including their marriage and parenting has been a fabrication for the sake of society. Nora's decision to leave this false life behind and discover for herself what is real is directly symbolic of woman's ultimate realization. Although she becomes aware of her supposed subordinateness, it is not because of this that she has the desire to take action. Nora is utterly confused, as suggested by Harold Clurman, "She is groping sadly in a maze of confused feeling toward a way of life and a destiny of which she is most uncertain (256)." The one thing she is aware of is her ignorance, and her desire to go out into the world is not to "prove herse lf" but to discover and educate herself. She must strive to find her individuality. That the perception of woman is inaccurate is also supported by the role of Torvald. Woman is believed to be subordinate to the domineering husband. Instead of being the strong supporter and protector of his family, Nora's husband is a mean and cowardly man. Worried about his reputation he cares little about his wife's feelings and fails to notice many of her needs. The popular impression of man is discarded in favor of a more realistic view, thus illustrating society's distorted views. Ibsen, through this controversial play, has an impact upon society's view of the subordinate position of women. By describing this role of woman, discussing its effects, and predicting a change in contemporary views, he stressed the importance of woman's realization of this believed inferiority. Woman should no longer be seen as the shadow of man, but a person in herself, with her own triumphs and tragedies. The exploration of Nora reveals that she is dependant upon her husband and displays no independent standing. Her progression of understanding suggests woman's future ability to comprehend their plight. Her state of shocked awareness at the end of the play is representative of the awakening of society to the changing view of the role of woman. "A Doll's House" magnificently illustrates the need f... ...le that Nora expects and the miracle that actually happens are entirely different. Nora dreams of the day that her husband will sympathize with her and cease to be the dominating figure with the "upper hand" in their relationship. She expects him to understand her struggles with the law and to be willing to take some of the blame himself. However, when he reacts to Krogstad's letter by exhibiting more dominance and control than ever before, Nora becomes more aware of her own individual needs as a woman in society. She understands that in order to be free, she must develop her own view of the world, by setting herself apart from the control and determinism that males have over her life. Therefore, Nora's decision to leave her husband and family is ironic because it proves to be the "miracle" she is waiting for, rather than the one she originally expected. Nora becomes a feminist heroine in the play by showing what women can achieve, but rarely attempt. The dete rminism that many men force on their women partners in society (in forms of control, dominance, and power) restricts the women's ability to strengthen as individuals, and gain their own self-determinism.