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terectomy In the North American study, however, they did so, but to a lesser extent than the group with severe stenosis Further analysis of the North American trial by Gasecki and colleagues has indicated that the risk of cerebral infarction on the side of the symptomatic stenosis is increased if there is a contralateral carotid stenosis but that operated patients (on the side of symptomatic stenosis) still had fewer strokes than those treated with medication alone In those with bilateral carotid disease, the risk of stroke after 2 years was 69 percent, and if operated, 22 percent In the nal analysis, the relative bene ts of surgery or medical treatment (anticoagulation or aspirin) depend mainly on the true surgical risk ie, on the record of an individual surgeon If the surgeon, by an independent audit of his procedures, has an established operative complication rate of no more than 4 to 5 percent and preferably lower, then surgery can be recommended in symptomatic patients with carotid stenosis greater than 70 percent This bene t extends to elderly patients and, indeed, it has been shown on a statistical basis to be most evident in patients over age 75 (see the reanalysis of NASCET data by Alomamowitch and colleagues) Before operation or angioplasty, the existence of the lesion and its extent must be determined Arteriography, the procedure that yields the best images and most accurate measurements of the residual lumen, carries a very small risk of worsening the stroke or producing new focal signs (this notion has never been documented systematically) Severe stenosis is re ected in conventional angiography by the lling of the distal branches of the external carotid artery before the branches of the middle cerebral artery are opaci ed a reversal of the usual lling pattern, indicating low ow in the distal carotid circulation Increasingly the diagnosis of carotid stenosis is being made by noninvasive methods, but with both ultrasound and magnetic resonance arteriography, there is dif culty in quantifying severe stenosis and separating it from complete carotid artery occlusion Perfusion CT imaging may provide a more accurate alternative at low risk (the volume of dye required may still be prohibitive in patients with renal failure) If the patient is in good medical condition, has normal vessels on the contralateral side, and has normal cardiac function (no heart failure, uncontrolled angina, or recent infarction), these lesions can usually be dealt with safely by endarterectomy The procedure is not, however, innocuous It may be followed by a new hemiplegia or aphasia that becomes evident immediately or soon after endarterectomy, usually by the time the patient arrives in the recovery room In general, surgeons prefer to return the patient to the operating room and open the artery, as discussed earlier on An intimal ap at the distal end of the endarterectomy and varying amounts of fresh clot proximal to it are usually encountered; but after removal and repair of the vessel, the effects of the stroke, if one has occurred, are not usually improved An uncommon but rather striking hyperperfusion syndrome develops several days to a week after carotid endarterectomy The features are headache, focal de cits, seizures, brain edema, or cerebral hemorrhage; these are thought to re ect an abrupt loss of autoregulatory ability of the cerebral vasculature in the face of hypertension and increased perfusion on the side of the recently opened artery Unilateral severe headache is the commonest symptom and may be the only manifestation On occasion the cerebral edema is so massive as to lead to death (Breen et al) Treatment is by control of hypertension; it is unclear whether anticonvulsant medications are required if there has been a single seizure, but they seem valuable to us We mention here that an identical syndrome of focal cerebral de cits and brain edema, perhaps with the excep-.

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Also, new to the most current Frontend Support Package (FEP) is the capability to create calculated key figures (CKFs) directly from the frontend of the BEx Web Analyzer (once CKFs are created, if you save your report, they will be saved for that specific version of the report) This offers a significant enhancement for the business user on the Web One of the concerns I ve heard over the past several years is that the capability to create any sort of additional columns or calculations is assigned specifically to the BW IT group rather than to the business user Well, now business users can create any CKF they need on-the-fly and save it The BEx Query Designer functionality is unavailable to the end user in only a few areas the creation of variables, restricted key figures, and some cell editor functionality Therefore, the business user now has a variety of options available at their fingertips This Web-based frontend has easy-to-use drag-and-drop functionality that allows the user to navigate intuitively through queries The Web frontend holds a very important position in the architecture of the reporting strategy A Web-based strategy increases the ability to distribute the information from a report twofold; it not only gives the business user access to information via a thin frontend a Web screen and thus obviates the need to have access to the GUI version of the workbook or query, it also allows them to access other, third-party systems via the Web Figure 1-1 shows the positioning of the Web-based frontend in the BEx-specific reporting strategy of SAP The capability of a business user to save a query or query view directly is also available in the BI environment, but your company, depending on its policies regarding what a superuser versus a business user can do, might not allow this option In other words, if your company has a standing requirement not to save anything in production, then saving a.