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to activated protein C has also been described (causing venous thrombosis almost exclusively) Antiphospholipid antibody is another cause of vascular occlusion that is not incited by damage to the vessel wall (see page 735) The metabolic disturbances in Fabry disease also favor clotting Persons with certain in ammatory bowel diseases (ulcerative colitis, Crohn disease) are prone to develop thrombotic strokes Whether in ammation elsewhere in the body also predisposes to cerebral vascular occlusions, as has been suggested, is an open question Curiously, the hypercoagulable state induced by certain adenocarcinomas, does not produce in situ arterial occlusion (although it may precipitate cerebral venous thrombosis) Nevertheless, it does cause platelet- brin aggregation on cardiac valves with subsequent cerebral embolism ( marantic endocarditis, as discussed further on) These factors should be sought when thrombotic disease in cerebral arteries or veins occurs in children or young adults with unexplained strokes, in families with strokes, in pregnant or parturient women, and in women who are migraineurs or taking birth control pills (see further on) According to Markus and Hambley, whose review of this subject is recommended, screening for lupus anticoagulant, anticardiolipin antibodies, de ciency of proteins C and S, and antithrombin III is probably justi ed only in these special circumstances These causes of vascular thrombosis are taken up in later sections Clinical Picture of Atherothrombotic Stroke In general, the evolution of clinical phenomena in relation to cerebral thrombosis is more variable than that of embolism and hemorrhage In more than half of our patients, the main part of the stroke (paralysis or other de cit) is preceded by minor signs or one or more transient attacks of focal neurologic dysfunction, or TIAs (Table 34-5) In a sense, these herald the oncoming vascular catastrophe A history of such prodromal episodes is of paramount importance in establishing the diagnosis of atherothrombotic stroke Only rarely and for unclear reasons are embolism and cerebral hemorrhage preceded by a transient neurologic disorder In carotid and middle cerebral artery disease, the transient attacks consist of monocular blindness or of hemiplegia, hemianesthesia, or disturbances of speech and language In the vertebrobasilar system, the prodromal spells most often take the form of Table 34-5 Development of the clinical picture in 125 cases of cerebral thrombosis (C M Fisher).

Multiple integralsare widely used in engineering and scienceFor example,a general equatiorlto compute the averageof a two-dimensional function can be written as lrecall E q ( t 1 1 ) l

This only sets and releases a lock for update You ll also need to include the necessary tests to ensure that the file is not already locked

Transient ischemic attacks progressing to a major or minor persistent neurologic de cit Stepwise development of a stroke, with or without transient ischemic attacks Stroke developing as a single event: Abrupt (hours), with or without uctuations Slow, gradual (a few days), with or without minor uctuations Transient ischemic attacks only Development of a limited stroke followed by transient ischemic attacks

l ' '( I i l t r , 1 ' ) t 1 x )

13:

14 7 17 11

(d-c)(b-a)

Although text and DBM databases have their place, as the quantity of information starts to grow, even the best organized DBM systems start to degrade in speed and become more difficult to manage and update Professional, and often commercial, databases have been part of the computing world almost from the start, and using them has a number of advantages over designing your own DBM system The advantages of a relational database management system (RDBMS) include I Faster access because an RDBMS is written in C, and often highly optimized in its routines and storage and indexing methods, it will be much faster than a typical DBM file for databases with large (>5,000) records I Easier management with a DBM or flat-file database, you have a lot of management overhead controlling what you delete, how it s deleted, and the general housekeeping of the files themselves An RDBMS does it for you I Easier access most, if not all, RDBMSs use SQL to create, modify, and access information, and this makes the entire process much easier as all you have to worry about is writing a suitable query; the RDBMS will do all the actual work There are a number of ways to access RDBMS systems from within Perl Some have their own interfaces and modules, while others have had a number of modules written specifically to access their contents However, a much better solution is to use either the DBI toolkit, which is available under Unix and Windows, or the Win32::ODBC toolkit under Windows Which you choose will largely depend on the database you are connecting to, your current platform, and how portable and compatible you want your scripts to be with different database systems

11 6 14 9

(r73 r)

The DBI toolkit, developed for the most part by Tim Bunce, is a suite of objects and methods that allow you to connect and execute queries to a database What actually happens is that the DBI module talks to a DBD (database driver) module, which is usually a C/C++ API to the actual database engine At all times, you actually communicate with the DBI module, so the underlying database becomes a relative non-issue This ability to separate the methods for executing queries and getting back information from the specifics of talking to the different databases has a number of advantages, and first and foremost is the ease of use and programming Because there are a fixed number of methods for accessing the database, you will always know how to send a query, check for errors during execution, and get any information back You don t have to worry about the specifics of the database you are using More importantly, though, you can develop a database-driven application that uses one database on your system, but that could be used with just about any database supported by the DBI kit Since the currently supported database list

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includes DB2, Informix, Ingres, JDBC, ODBC, Oracle, PostGreSQL, Sybase, Unify, Xbase, mSQL/mySQL, and even flat CSV files, you re not going to be short of a suitable database either for development or production purposes