.net pdf 417

.net pdf 417

.net pdf 417

.net pdf 417

.net pdf 417

.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,
.net pdf 417,

occasion an organism is cultured If the patient is stuporous or comatose, there is a risk in performing a lumbar puncture, and one should proceed rst with other diagnostic procedures By CT scanning one can see the ear or sinus lesions or bone erosion The meninges around the empyema enhance and the collection of pus can be visualized more dependably with MRI Empyema that follows meningitis tends to localize on the undersurface of the temporal lobe and may require coronal views in order to be well visualized Several conditions must be distinguished clinically from subdural empyema a treated subacute bacterial meningitis, cerebral thrombophlebitis, brain abscess (see further on), herpes simplex encephalitis (page 638), acute necrotizing hemorrhagic leukoencephalitis (page 792), and septic embolism due to bacterial endocarditis (see further on in this chapter) Treatment Most subdural empyemas, by the time they are recognized clinically, require immediate drainage through multiple enlarged frontal burr holes or through a craniotomy in cases with an interhemispheric, subtemporal, or posterior fossa location The surgical procedure should be coupled with appropriate antibiotic therapy, which consists in most cases of the intravenous administration of 20 to 24 million units of penicillin per day plus a thirdgeneration cephalosporin and metronidazole Bacteriologic ndings or an unusual presumed source may dictate a change to different drugs, particularly to later-generation cephalosporins Without such massive antimicrobial therapy and surgery, most patients will die, usually within 7 to 14 days On the other hand, patients who are treated promptly may make a surprisingly good recovery, including full or partial resolution of their focal neurologic de cits As with certain small brain abscesses, small subdural collections of pus that are recognized by CT scanning or MRI before stupor and coma have supervened may respond to treatment with large doses of antibiotics alone The resolution (or lack thereof) of the empyema can be readily followed by repeated imaging of the brain (Leys et al).

This condition is almost invariably associated with osteomyelitis in a cranial bone and originates from an infection in the ear or paranasal sinuses or from a surgical procedure, particularly if the frontal sinus or mastoid had been opened or a foreign device inserted Rarely, the infection is metastatic or spreads outward from a dural sinus thrombophlebitis Pus and granulation tissue accumulate on the outer surface of the dura, separating it from the cranial bone The symptoms are those of a local in ammatory process: frontal or auricular pain, purulent discharge from sinuses or ear, and fever and local tenderness Sometimes the neck is slightly stiff Localizing neurologic signs are usually absent Rarely, a focal seizure may occur, or the fth and sixth cranial nerves may be involved with infections of the petrous part of the temporal bone The CSF is usually clear and under normal pressure but may contain a few lymphocytes and neutrophils (20 to 100 per milliliter) and a slightly increased amount of protein Treatment consists of antibiotics aimed at the appropriate pathogen(s) often Staph aureus Later, the diseased bone in the frontal sinus or the mastoid, from which the extradural infection had arisen, may have to be removed and the wound packed to ensure adequate drainage Results of treatment are usually good

Spinal Epidural and Subdural Abscesses These types of abscess possess unique clinical features and constitute important neurologic and neurosurgical emergencies They are discussed in Chap 44 with other diseases of the spinal column and spinal cord

.

Description of the Task (Initial Steps for Workbook Migration: System Setup) Open an Excel spreadsheet and go to the option toolbar and using the context menu go to Tools | Macros | Security Make sure that the security option is set to Low This will allow basic VBA to be migrated along with the workbook Still in the Security dialog box of the Excel spreadsheet, turn on the option Trusted Publishers by checking the box Trusted Access to Visual Basic Project Close the Security dialog box and proceed with the migration process If these two steps are not completed, the workbook migration will fail Description of the Task (Migration of the BEx Workbooks) Confirm that the workbook you are migrating exists by finding the description of the workbook to migrate Check if there are any nonconforming objects that is, VBA programs in the workbook Document this in the Migration Document As previously mentioned, if there is complex VBA in the workbook, it would be safe to create a copy of the workbook prior to migration so that a consistent backup is available Open the BEx workbook in the 70 version of the BEx Analyzer A message will appear confirming that this workbook will be converted to 70 upon opening Confirm that there are no messages generated with errors (see the bottom status bar line for messages access them by double-clicking them) If the migration is successful, execute the workbook and execute several navigational steps Also vary the values entered into the variable screens to confirm that the workbook is consistent and valid The testing process should be at least three different navigational processes Document the results in the Migration Document (for example, change the values of the variables, use the context menu of either the characteristics or key figures to navigate, drag and drop a characteristic into the report, execute Export to Excel and confirm the results) Close the workbook and exit the workbook itself Then reopen the workbook and execute with different parameters to validate the consistency of the format Document this process in the Migration Document Close the workbook to complete the migration.