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Because the technologies that support the 3x and 70 WAD templates, respectively, are completely separate but support the same template in both 3x and 70 the WAD templates can be migrated multiple times The process of migrating BEx workbooks is outlined in Table 8-3 We haven t worked through a detailed analysis of the migration strategy for workbooks in this chapter, but this step-by-step process will give you some ideas and topics to discuss and review before you start the migration process with your BEx workbooks It is important to review the extent that complex programming was done in the BEx Workbook such as VBA and complex macros

Subdural empyema is an intracranial (rarely intraspinal) suppurative process between the inner surface of the dura and the outer surface of the arachnoid The term subdural abscess, among others, has been applied to this condition, but the proper name is empyema, indicating suppuration in a preformed space Contrary to prevailing

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opinion, subdural empyema is not a rarity (although it is only about one- fth as frequent as cerebral abscess) It is distinctly more common in males, a feature for which there is no explanation The infection usually originates in the frontal or ethmoid or, less often, the sphenoid sinuses and in the middle ear and mastoid cells As with bacterial meningitis, there have been in the last decade an increasing number of cases that follow surgery of the sinuses and other cranial structures In infants and children and infrequently in adults, there may be spread from a leptomeningitis Infection gains entry to the subdural space by direct extension through bone and dura or by spread from septic thrombosis of the venous sinuses, particularly the superior longitudinal sinus Rarely, the subdural infection is metastatic, from infected lungs; hardly ever is it secondary to bacteremia or septicemia Occasionally it extends from a brain abscess It is again of interest that cases of sinus origin predominate in adolescent and young adult men (Kaufman et al) In such cases, streptococci (nonhemolytic and viridans) are the most common organisms, followed by anaerobic streptococci (often Strep milleri) or Bacteroides Less often Staph aureus, E coli, Proteus, and Pseudomonas are causative In about half the cases unrelated to surgery, no organisms can be cultured or seen on Gram s stain The factors that lead to a subdural empyema rather than to a cerebral abscess are not fully understood Pathology A collection of subdural pus, in quantities ranging from a few milliliters to 100 to 200 mL, lies over the cerebral hemisphere Pus may spread into the interhemispheric ssure or be con ned there; occasionally it is found in the posterior fossa, covering the cerebellum The arachnoid, when cleared of exudate, is cloudy, and thrombosis of meningeal veins may be seen The underlying cerebral hemisphere is depressed, and in fatal cases there is often an ipsilateral temporal lobe herniation Microscopic examination discloses various degrees of organization of the exudate on the inner surface of the dura and in ltration of the underlying arachnoid with small numbers of neutrophilic leukocytes, lymphocytes, and mononuclear cells The thrombi in cerebral veins seem to begin on the sides of the veins nearest the subdural exudate The super cial layers of the cerebral cortex undergo ischemic necrosis, which probably accounts for the unilateral seizures and other signs of disordered cerebral function (Kubik and Adams) Symptomatology and Laboratory Findings Usually the history includes reference to chronic sinusitis or mastoiditis with a recent are-up causing local pain and increase in purulent nasal or aural discharge In sinus cases, the pain is over the brow or between the eyes; it is associated with tenderness on pressure over these parts and sometimes with orbital swelling General malaise, fever, and headache at rst localized, then severe and generalized and associated with vomiting are the rst indications of intracranial spread They are followed in a few days by drowsiness and increasing stupor, rapidly progressing to coma At about the same time, focal neurologic signs appear, the most important of which are unilateral motor seizures, hemiplegia, hemianesthesia, aphasia, and paralysis of lateral conjugate gaze Fever and leukocytosis are always present and the neck is stiff Cases that follow surgery may be more indolent The usual CSF ndings are an increased pressure, pleocytosis in the range of 50 to 1000 per cubic millimeter, a predominance of polymorphonuclear cells, elevated protein content (75 to 300 mg/ dL), and normal glucose values The uid is often sterile, but on.

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