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Incident to cardiac arrest and bypass surgery there is risk of both generalized and focal hypoxia-ischemia of the brain Improved operative techniques have lessened the incidence of these complications, but they are still distressingly frequent Fortunately, most of these cerebral disorders are transient Atherosclerotic plaques may be dislodged during cross-clamping of the proximal aorta and are an important source of cerebral emboli In the last decade the incidence of stroke related to cardiac surgery has dropped to between 2 and 3 percent in large series numbering thousands of patients (Libman et al, Algren and Aren) Advanced age, congestive heart failure, and more complex surgeries have been listed as risk factors for stroke in various reports In a retrospective study by Dashe and colleagues, 22 percent had strokes, and the risk was greatly increased (greater than 70 percent) on the side of a carotid stenosis Curiously, almost one- fth of postoperative strokes have been of lacunar type In one prospective study of 2108 patients who underwent coronary operations in several institutions, 3 percent had strokes or TIAs and the same number had a deterioration of cognitive function; mostly the adverse effects occurred in older patients and were transient (Roach et al) Mohr and coworkers examined 100 consecutive cases pre- and postoperatively and observed two types of complications one occurring immediately after the operation and the other after an interval of days or weeks The immediate neurologic disorder consisted of a delay in awakening from the anesthesia; subsequently there was slowness in thinking, disorientation, agitation, combativeness, visual hallucinations, and poor registration and recall of what was happening These symptoms, in the form of a confusional state sometimes verging on delirium or acute psychosis, usually cleared within 5 to 7 days, although some patients were not entirely normal mentally some weeks later As the confusion cleared, about half of the patients were found to have small visual eld defects, dyscalculia, oculomanual ataxia, alexia, or defects of perception suggestive of lesions in the parieto-occipital regions The immediate effects were attributed to hypotension and various types of embolism (atherosclerotic, air, silicon, fat, platelets) The delayed effects were more clearly embolic and were especially frequent in patients having prosthetic valve replacements However, they also occurred subsequent to arterial homografts In addition to overt and covert strokes, a degree of cognitive decline and depression is to be expected in a proportion of patients undergoing coronary artery bypass grafting The frequency of these changes is reported to be between 40 and 70 percent (see page 363) It is our impression that many of these neurologic complications, both small strokes and cognitive abnormalities, pass unnoticed in many cardiac surgical units This was emphasized in the study by McKhann and colleagues, who extensively tested several neuropsychologic areas and found that only 12 percent of patients escaped some type of early cognitive problem However, several other studies, such as the one by Mulges and colleagues, have sug gested that only a small proportion (13 percent in their series) have permanent effects 5 years after operation Others have reported.

Some summary cost gures are given at the bottom of Figure 41 These show a total cost of the option of $248 or $248 per share, which is the $233 in premium plus commissions set at $1495 by default This commission level may be a high or low gure for your trading costs On larger quantities the effect of commission is spread across the total purchase premium, but remember to add the commissions and fees to the bottom line If you are buying 10 options, then the cost will be 1495 per share We now know that our breakeven is at $2248 per share, meaning that Home Depot stock must rise to $2248 by expiration in order for us to break even Any price above $2248 would be pro t on the position Prior to expiration, the option will gain value if the market rallies thereby creating an opportunity to sell the option for a pro t Note that the option we ve purchased in Figure 41 has a delta of 606 meaning that for each $1 of stock price movement, this option should gain 606 cents of that $1, with the delta increasing as the option goes further into the money Let s look at how this option position gains value as the market moves We have now purchased the at-the-money call option, and the delta on this option is strong at 606, so, assuming volatility remains constant, if Home Depot stock rises $1 tomorrow, we have a projected gain of $606 and a projected delta increase or gamma of 823 on the same increase in price We will lose the time value for the day (theta) of $156 and come out with a net gain of approximately $59 on the $1 underlying price move In Figure 42 you can see the projected pro t or loss on the option as the underlying price increases.

In addition to the eclamptic state, there is an increased incidence of cerebrovascular events during pregnancy and the postpartum period The risk of both cerebral infarction and intracerebral hemorrhage appears to be mainly in the 6-week period after delivery rather than during the pregnancy itself (Kittner et al) Fisher has reviewed the literature and has himself analyzed 12 postpartum, 9 puerperal, and 14 contraceptive cases, as well as 9 patients receiving estrogen therapy; arterial thrombosis was demonstrated in half of the group Most of the focal vascular lesions during pregnancy were due to arterial occlusion in the second and third trimesters and in the rst week after delivery Venous occlusion tended to occur 1 to 4 weeks postpartum In Rochester, New York, the incidence rate of stroke during pregnancy was 62 per 100,000, but it doubled with each advance in age from 25 to 29, 30 to 39, and 40 to 49 years Included in most series are cases of cardiac disease, particularly valve-related embolism It is perhaps surprising that subarachnoid hemorrhage is not more frequent during the Valsalva activity of childbirth Carotid artery dissection may also be encountered late in pregnancy or soon after delivery The occurrence of paradoxical embolus is always a consideration in pregnancy because of a tendency to form clots in the pelvic and leg veins, coupled with increased right heart pressures

In these syndromes, impairment of sensation, weakness, muscular atrophy, and loss of tendon re exes progress over a period of many months or years Within this large category, two groups are distinguished In the rst and less chronic of the two groups the neuropathy develops over a period of months or a year or two Comprising this group are mainly acquired processes such as certain metabolic and immune-mediated polyneuropathies Paraneoplastic neuropathies may also fall into this category though they are more often subacute in onset, being almost fully developed in a matter of months or less Leprous neuritis is the one infectious member of this group and also the one exception to the rule that all chronic neuropathies are more or less symmetrical in pattern The polyneuropathies that make up the second group are far more chronic than

This option allows you to create a nice Web query with the use of the Chart Web item rather than the Analysis Web item As its name states, this BI pattern has only the Chart Web item