Antonín Dvořák used to be seen as an excellent writer of melodies, but a poor builder. But, the analysis of the Dies irae – Tuba mirum – Dies irae (DI 1 – TM – DI 2) movements of his Requiem (1890) reveals, in an impressive way, the author’s abilities of construction. Both choral movements (DI 1 and DI 2) were based by Dvořák on mere two three verse sections of the text. In DI 1, therefore, he repeated them twice, and gave them a different tectonic function each time – the first time in an ascending, gradating part of both movements, the second time at the peak and descent. The two movements, however, are not identical. The instrumental setting of the second is denser, there are more short counterparts and instrumental insertions (including the double quotation of the theme of the first movement in the bass instruments), and, especially: DI 2 at its peak brings several layers of confrontation of the text and motivic material of both movements. The composer also joined the whole set of three movements rhythmically. Every movement (DI x TM) uses its own basic rhythmical model, which also plays a key role at the juncture at the peak of DI 2: both rhythmical models sound simultaneously (together with other layers) with different speeds and instrumentation. Dvořák the constructivist? Certainly not in the primary sense of the word, but surely a composer who, at the peak of his composing career, was capable of impressive achievements in the field of construction and combination.
Although the fluid therapy plays a fundamental role in the
management of polytrauma patients (PP), a tool which could
determine it appropriately is still lacking. The aim of this study
was to evaluate the application of a bioimpedance spectroscopy
(BIS) for body fluids volume and distribution monitoring in these
patients. This prospective, observational study was performed on
25 severe PP and 25 healthy subjects. The body fluids
composition was repeatedly assessed using BIS between days 3
to 11 of intensive care unit stay while the impact of fluid intake
and balance was evaluated. Fluid intake correlated significantly
with fluid excess (FE) in edemas, and their values were
significantly higher in comparison with the control group. FE was
strongly associated with cumulative fluid balance (p<0.0001,
r=0.719). Furthermore, this parameter was associated with the
entire duration of mechanical ventilation (p=0.001, r=0.791)
independently of injury severity score. In conclusion, BIS
measured FE could be useful in PP who already achieved
negative fluid balance in prevention the risk of repeated
hypovolemia through inappropriate fluid restriction. What is
more, measured FE has a certain prognostic value. Further
studies are required to confirm BIS as a potential instrument for
the improvement of PP outcome.