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substantial in uence The most important of these are hypertension, heart disease, atrial brillation, diabetes mellitus, cigarette smoking, and hyperlipidemia Others, such as systemic diseases associated with a hypercoagulable state and the use of birth control pills, also contribute, but only in special circumstances Hypertension is the most readily recognized factor in the genesis of primary intracerebral hemorrhage It appears that the stroke-producing potential of hypertension is as much the product of heightened systolic pressure as of diastolic pressure (Fisher; Rabkin et al) The cooperative studies of the Veterans Administration (see Freis et al) and the report by Collins and associates (collating 14 randomized trials of antihypertensive drugs) have convincingly demonstrated that the long-term control of hypertension decreases the incidence of both atherothrombotic infarction and intracerebral hemorrhage And simple measures such as the use of hydrochlorthiazide for blood pressure control may be overall the most effective The presence of congestive heart failure and coronary atherosclerosis also greatly increases the probability of stroke As for embolic strokes, the most important risk factors are structural cardiac disease and arrhythmias, particularly atrial brillation, which increases the incidence of stroke about six-fold, and by eighteen-fold if there is also rheumatic valvular disease Bacterial and nonbacterial (marantic) endocarditis and right-to-left shunts between the cardiac chambers or in the lung also predispose to embolic stroke Diabetes hastens the atherosclerotic process in both large and small arteries; Weinberger and colleagues and Roehmholdt and coworkers have found diabetic patients to be twice as liable to stroke as agematched nondiabetic groups Also, Homer and Ingall and their colleagues have documented the importance of long-duration cigarette smoking in the development of carotid atherosclerosis The interactions between diabetes and hypertension on the one hand and intracerebral hemorrhage and atherothrombotic infarction on the other as well as the association of cardiac disease and cerebral embolism are considered further on in this chapter, in relation to.

each of these categories of cerebrovascular disease Subsidiary factors, such as low potassium intake and reduced serum levels of potassium, have been associated with an increased stroke rate in several studies, including one that we conducted, but the mechanism of this effect is obscure (Green et al); a detrimental effect on blood pressure is possible Numerous clinical trials have also shown a marked reduction in stroke incidence with the use of cholesterol-lowering drugs Public health measures designed to detect and reduce the aforementioned risk factors offer the most intelligent long-range approach to the prevention of cerebrovascular disease

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Windows 2000 and XP do not operate in real mode, so their boot process is quite different from that of Windows 9x Windows 2000 and XP provide more powerful troubleshooting and diagnostic boot modes then earlier operating systems The boot process for Windows NT 4, 2000, and XP are the same with few exceptions This boot process was introduced with Windows NT 35 and has changed little in process

In terms of functionality, Enterprise Manager has now grown to the point where you can do practically anything with this tool that you can do with any other management tool, even basic command-line utilities The screenshot shown in Figure 2-19 shows a simple list of the areas that you can view and modify for an Oracle database instance through Enterprise Manager In both of these figures, you can see another key facet of Enterprise Manager The user interface for Enterprise Manager is browser-based, and much of the information displayed also acts as a link to more detail on the area summarized by the information To show one more example, Figure 2-20 illustrates the type of detail you can get about a SQL query, which can be reached from many different pages that display information about SQL, from a historical listing to a list of the SQL statements that have used the most resources With this depth of functionality, Enterprise Manager has also greatly expanded the breadth of management coverage With Enterprise Manager, you can now manage software in the middle tier, applications and business

are frequently bilateral and occur in conjunction with cranial nerve palsies and other segmental brainstem and cerebellar signs; quadriparesis, hemiparesis, and/or unilateral or bilateral sensory impairment are typical, coupled with diplopia, dysarthria, and vertigo in various combinations

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