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Step 4 in this process is the same as Step 2 of the second Small Web Template (IP_1IT_ CHART_1DP) covered in this chapter, in which you choose the Chart Item Settings By choosing Define New Chart Item and clicking the button to the right of the field, the Edit Web Item dialog box opens The following illustration displays some of the parameters that you can adjust for this component Again, leave everything at the default setting probably not ideal but definitely useable

Figure 34-29 Hypertensive encephalopathy in a 55-year-old woman with headache and a single seizure The characteristic changes of excess water in large regions of the white matter are seen on the CT scan (left panel) and in a T2-weighted MRI (right panel) The areas of signal change are associated with little mass effect and tend to be concentrated in the posterior regions of the brain Other small cortical and subcortical lesions are common in watershed areas There may be associated heterogeneous infarctions in the cerebral cortex, as shown in the following gure The same changes in the occipital white matter may occur in eclampsia and from other causes of posterior leukoencephalopathy (see also page 1040)

atation of cerebral and retinal arterioles in response to severe hypertension However, the observations of Byrom and of others indicate that overdistention of the arterioles (which have lost their adaptive capacity), rather than excessive constriction, may be responsible for the necrosis of the vessel wall (see reviews of Auer and of Chester et al) The brain edema is the result of active exocytosis of water rather than simply a passive leak from vessels subjected to high pressures A few eclamptic women will develop hemolysis, hepatic failure and thrombocytopenia hemolysis, elevated liver enzymes, low platelet count (HELLP syndrome) an illness that has similarities to disseminated intravascular coagulation (DIC) The interplay between eclampsia and HELLP in relation to cerebral lesions is complex and not fully understood (see further on) Treatment Lowering of the blood pressure with antihypertensive drugs may reverse the picture in a day or two In the past, when effective antihypertensive drugs were not available, the outcome was often fatal The BUN is only slightly elevated except in cases of renal failure, and the usual patient is not uremic The same can be accomplished by administering magnesium sulfate in the eclamptic woman Treatment consists of measures that promptly reduce arterial blood pressure, but antihypertensive drugs must be used cautiously; a safe target is a pressure of 150/100 mmHg One may use intravenous sodium nitroprusside, 05 to 08 mg/kg/min; a calcium channel blocker such as nifedipine, 10 to 20 mg sublingually; or intravenous beta-adrenergic blockers (labetalol, 20 to 40 mg intravenously followed by an infusion at 2 mg/min, or esmolol are favored) These must be followed by longer-acting antihypertensive agents such as ACE inhibitors or calcium channel blockers

Figure 34-30 MRI T2 signal changes in eclampsia Most of the vascular changes and edema are situated in the cortical watershed distributions between the middle and an anterior cerebral arteries These imaging ndings were transient, as was mild signal change in the occipital subcortical regions, the latter being typical of hypertensive encephalopathy, as in Fig 34-29

If there is already evidence of brain edema and increased intracranial pressure, dexamethasone, 4 to 6 mg every 6 h, is usually added, but its effect, and the use of hyperosmolar therapy, have not been studied systematically; our clinical impression is that they have little effect

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and cocaine, but there are few well-studied cases These are discussed below, under Arteritis Symptomatic of Underlying Systemic Disease and Sympathomimetic Drug Reactions In all cases, including those noted above, the treatment is cessation of the offending drugs; nitroglycerin, nitroprusside, or beta-adrenergic infusions have been tried with uncertain effect

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call in this scenario is trading for 550 In selling this call, we bring in roughly 6 percent of the total value of the spread and leave just over 2 percent gain potential for the market We have reduced the potential gain for the market over the course of the option s life to 8 percent, but we have added 6 percent to our risk protection So over the course of 140 days if the SPY is above 94, we will have an 8 percent gain and the ability to remove the option according to your objective or at expiration We can also allow the short option to offset the SPY with an 8 percent gain in 140 days Managing this position twice in the course of the year can add up to enhanced gains over the average annual return of the S&P The broad-based ETF is an excellent tool for managing systemic portfolio risk If we look at using a short market position in a broadbased index against an individual component or sector-based portfolio, we can accomplish a reduction in overall risk without limiting the strength of individual returns Narrow portfolios have higher risk because of the reduced diversity and theoretically higher returns By utilizing a risk strategy on a broad index versus your sector investment, you decrease the systemic risk to the portfolio along with leaving a larger portion of the upside open for pro tability on the sector-based indices The outright short call options or the risk reversal are the best positions to use to offset risk across the broad indices When you are outright selling a call, you are not able to set a oor, but you are bringing cash against the potential downside risk in the portfolio The risk reversal of buying a put and selling a call option allows you to place a oor on the broader market while the sector or individual investments remain intact You must use care when buying put options on broad indices With the average 10 percent return for the S&P 500, it is very easy to spend 10 percent of the index in put premium over the course of the year, which leaves you with.