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where the disease is prevalent In many cases of POEMS there is lymphadenopathy attributable to the angiofollicular hyperplasia of Castleman disease Another characteristic feature of the osteosclerotic-related polyneuropathy is a greatly elevated CSF protein The presence of the disease can be suspected from the presence of an immunoglobulin spike in the blood, often polyclonal or biclonal rather than monoclonal, and possessing a lambda light chain component The diagnosis requires the demonstration of the osteosclerotic lesion by a radiographic survey of the long bones, pelvis, spine, and skull (a bone scan is often insensitive) and a bone marrow examination, which shows a moderate increase in the number of well-differentiated plasma cells In most of our patients there have been several discrete bone lesions concentrated in the ribs and spine; the skull and long bones may harbor such lesions as well, or the lesions may be in the form of a single nodule, often in the spinal column Treatment The neuropathy that complicates a solitary plasmacytoma may improve markedly following irradiation of the bone lesion Multiple lesions, including those in the POEMS syndrome, when treated with chemotherapy (melphalan and prednisone) or focused radiation, demonstrate some improvement or stabilization in the neuropathy Treatment with plasma exchange has yielded uncertain but somewhat positive results in our patients Waldenstrom Macroglobulinemia Macroglobulinemia was the term applied by Waldenstrom to a systemic condition occurring mainly in elderly persons and characterized by fatigue, weakness, and a bleeding diathesis Immunoelectrophoretic examination of the blood disclosed a marked and mostly monoclonal increase in the IgM plasma fraction About half of patients with Waldenstrom disease and polyneuropathy will have anti-MAG antibodies, similar to the proportion in patients with nonmalignant IgM paraproteins A signi cant proportion of patients with this hyperproteinemia have a hyperviscosity state manifest by diffuse slowing of retinal and cerebral circulation giving rise to episodic confusion, coma, impairment of vision, and sometimes strokes (Bing-Neel syndrome) The neuropathy, when present, evolves over months or longer and may be asymmetrical, particularly at the onset, but becomes symmetrical and distal The pattern in our patients has been of the latter type, very slowly progressive, and limited to the feet and legs with mild sensory ataxia and loss of knee and ankle jerks The CSF protein is usually elevated and the globulin fraction increased In a case recorded by Rowland and colleagues, the polyneuropathy was purely motor and simulated motor neuron disease; other cases of this type, albeit rare, have been brought to our attention in clinical exercises and medical writings Treatment is discussed below Cryoglobulinemia As mentioned previously in the section on vasculitic neuropathies, cryoglobulin, a serum protein that precipitates on cooling, is usually of the IgG or IgM type and most often polyclonal While cryoglobulinemia may occur without any apparent associated condition (essential cryoglobulinemia), it also accompanies a wide variety of disorders such as mulltiple myeloma, lymphoma, connective tissue disease, chronic infection, and, particularly, hepatitis C Peripheral neuropathy occurs in a small proportion both of the essential and symptomatic cases Occasionally the neuropathy evolves over a period of a few days and remits rapidly More often it takes the form of a distal symmetrical sensorimotor loss, which develops insidiously in association with the Raynaud phenomenon and purpuric eruptions of the skin Initially, the neuropathic symptoms consist only of pain and paresthesias that may be precipitated by exposure to cold (as often, there is no.

= trap(func,a,b,n,varargin{: I(1,1) }) ; = 0; iter while iter<maxit = iter+l; iter n = 2^iter; I (iter+1, 1) - trap(func,a,b,n,varargin{ : } ) ; for k = 2:iter+l j = 2+iter-k; I (j , k ) = (4 ^ (k - 1 ) * I (j + 1 , k - 1 ) - r (j , k - 1 ) | / ( 4 ^ (k - 1 ) - 1 ) ; end -T(2,iter) ea = abs( (I(1,iter+l) ) /I(1,iter+l) ) "100; if ea<-es, break; end end q = I(1,iter+l);

Isn t it risky to put the login name and password in the C# code Wouldn t it be fairly easy for a hacker to get those You bet! The C# portion of the login example is to illustrate how the FormsAuthentication class can be used to send the requested URL to the user after she has successfully logged in Besides being a fairly risky way of protecting a username and password, it s awkward to store username and password information in a coded format Imagine a site that has thousands of users So keep in mind that the login example is to show how the webconfig file can redirect a request to a login page and how the FormsAuthentication class sends the logged-in user to the requested URL

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is under increased pressure, as high as 500 mmH2O an important nding in differentiating spontaneous subarachnoid hemorrhage from a traumatic tap The proportion of WBCs to RBCs in the CSF is usually the same as in the circulating blood (approximately 1: 700), but in some patients a brisk CSF leukocytosis appears within 48 h, sometimes reaching more than 1000 cells per cubic millimeter The protein is slightly or moderately elevated and in some instances glucose is mildly reduced Carotid and vertebral angiography is the only certain means of demonstrating an aneurysm and does so in over 90 percent of patients in whom the correct diagnosis of spontaneous subarachnoid hemorrhage is made on clinical grounds MRI with modern scanners (Fig 34-24) detects most aneurysms of the basal vessels and of their rst branches but may not yet be of suf cient sensitivity to replace conventional angiography in cases where an aneurysm is strongly suspected but too small to be detected by MRA Even when MRA demonstrates the aneurysm, the surgeon usually requires the kind of anatomic de nition that can be obtained only by conventional angiography The most up-to-date CT technology scanning with contrast infusion has certainly begun to equal the detail provided by conventional angiography and has additional advantages of showing the lesion in relation to the adjacent brain and skull in multiple views (Fig 34-24) Associated Systemic Changes Acute subarachnoid hemorrhage is associated with several characteristic responses in the systemic circulation, water balance, and cardiac function The ECG changes include symmetrically large peaked T waves and other alterations suggesting subendocardial or myocardial ischemia Also there is a tendency to develop hyponatremia; this abnormality and its relationship to intravascular volume depletion plays a key role in treatment, as discussed further on Albuminuria and glycosuria may be present for a few days Rarely, diabetes insipidus occurs in the acute stages, but water retention or a natriuresis is more frequent There may be a leukocytosis of 15,000 to 18,000 cells per cubic millimeter, but the sedimentation rate is usually normal Course and Prognosis The outstanding characteristic of this condition, mentioned earlier, is the tendency for the hemorrhage to recur from the same site This threat colors all prognostications and.

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The process ID of the current script is permanently available within the $$ variable Since this value will be different for each execution, you cannot rely on this number to store persistent information On the other hand, the process ID can be used as part of a random identification number if combined with date, time, and even a random number If you want to get the process ID of the parent process, you need to use the getppid function:

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print "The parent of $$ is ",getppid,"\n";

In Chap 17, we employedthe Newton-Cotes equations characteristic theseformulas A of (with the exceptionof the specialcaseof unequallyspaced data)was that the integral estimate was basedon evenly spacedfunction valuesConsequently, location of thebase the points usedin theseequations was predetermined fixed or For example,as depictedin Fig 183a,the trapezoidal rule is basedon takingthearea underthe straightline connecting function valuesat the endsofthe integration the interval The formula that is usedto computethis areais = (h + f (u)