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which supplies the anterior two-thirds of the cord, is itself supplied by only a limited number of feeders Infarction usually results from interrupted flow in one or more of these feeders, eg, with aortic dissection, aortography, polyarteritis, or severe hypotension, or after surgical resection of the thoracic aorta The paired posterior spinal arteries, by contrast, are supplied by numerous arteries at different levels of the cord Spinal cord hypoperfusion may lead to a central cord syndrome with distal weakness of lower motor neuron type and loss of pain and temperature appreciation, with preserved posterior column function Since the anterior spinal artery receives numerous feeders in the cervical region, infarcts almost always occur caudally Clinical presentation is characterized by acute onset of flaccid, areflexive paraplegia that evolves after a few days or weeks into a spastic paraplegia with extensor plantar responses There is an accompanying dissociated sensory loss, with impairment of appreciation of pain and temperature but preservation of sensations of vibration and position Treatment is symptomatic

Novy J et al Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients Arch Neurol 2006 Aug;63(8):1113 20 [PMID: 16908737]

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Generalized or focal disturbance of cerebral function, or both Increased intracranial pressure in some patients Neuroradiologic evidence of space-occupying lesion

Half of all primary intracranial neoplasms (Table 24 5) are gliomas and the remainder meningiomas, pituitary adenomas, neurofibromas, and other tumors Certain tumors, especially neurofibromas, hemangioblastomas, and retinoblastomas, may have a familial basis, and congenital factors bear on the development of craniopharyngiomas Tumors may occur at any age, but certain gliomas show particular age predilections (Table 24 5)

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Epidural or subdural hemorrhage may lead to sudden severe back pain followed by an acute compressive myelopathy necessitating urgent spinal MRI or myelography and surgical evacuation It may occur in patients with bleeding disorders or those who are taking anticoagulant drugs, sometimes following trauma or lumbar puncture Epidural hemorrhage may also be related to a vascular malformation or tumor deposit

Needle transmission occurs from injection drug users who acquired the infection in malaria-endemic areas outside the United States

Here s how it works. Each substitution parameter is a number between braces, starting with 0 for the first parameter, 1 for the next, and so on. So, if you re using just one substitution parameter, it might look like this:

XML-RPC and SOAP One of the coolest (and simplest) things to do with AppleScript is to access network-based services using XML -RPC and SOAP XML -RPC (remote procedure call) permits machines to communicate over a network and share and exchange services using XML for message encoding and HTML as a transport SOAP (Simple Object Access Protocol) also exchanges information over a network, but it uses an object-based hierarchy and requires named parameters (see http:// wwww3org/TR/SOAP for more information) You should get used to the idea of writing and using services over a network Thinking this way expands the possibilities of your programs by tapping into a wealth of existing network-based services In addition, it enables you to build distributed applications using remote services and write services that others can access See the XMethods site (http://wwwxmethods.

This chronic pulmonary infection caused by Burkholderia pseudomallei occurs occasionally in debilitated drug users, but most cases are reported in Asia and Australia

A common and difficult clinical problem is management of the parenteral drug user who presents with fever In general, after obtaining appropriate cultures (blood, urine, and sputum if the chest radiograph is abnormal), empiric therapy is begun If the chest radiograph is suggestive of a communityacquired pneumonia (consolidation), therapy for outpatient pneumonia is begun with a third-generation cephalosporin, such as ceftriaxone, 1 2 g intravenously every 24 hours, plus azithromycin, 500 mg orally or intravenously every 24 hours, or doxycycline, 100 mg orally or intravenously twice daily If the chest radiograph is suggestive of septic emboli (nodular infiltrates), therapy for presumed endocarditis is initiated, usually with a combination of vancomycin 15 mg/kg/dose every 12 hours intravenously (due to the high prevalence of methicillin-resistant S aureus and the possibility of enterococcus) and gentamicin, 1 mg/kg/dose every 8 hours intravenously If the chest radiograph is normal and no focal site of infection can be found, endocarditis is presumed While awaiting the results of blood cultures, empiric treatment with vancomycin and gentamicin is started If blood cultures are positive for organisms that frequently cause endocarditis in drug users (see above), endocarditis is presumed to be present and treated accordingly If blood cultures are positive for an organism that is an unusual cause of endocarditis, evaluation for an occult source of infection should go forward In this setting, a transesophageal echocardiogram may be quite helpful since it is 90% sensitive in detecting vegetations and a negative study is strong evidence against endocarditis If blood cultures are negative and the patient responds to antibiotics, therapy should be continued for 7 14 days (oral therapy can be given once an initial response has occurred) In every patient, careful examination for an occult source of infection (eg, genitourinary, dental, sinus, gallbladder) should be done

Gordon RJ et al Bacterial infections in drug users N Engl J Med 2005 Nov 3;353(18):1945 54 [PMID: 16267325] Infections in injection drug users (entire issue) Infect Dis Clin North Am 2002 Sep;16(3)

System.Console.WriteLine("Age of student: {0}", myInt);

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