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in uenzae meningitis, the gures were 105 and 6 percent, respectively Cranial nerve palsies other than deafness tend to disappear after a few weeks or months Deafness in these infections is due to suppurative cochlear destruction or less often to the ototoxic effects of aminoglycoside antibiotics Bacteria reach the cochlea mainly via the cochlear aqueduct, which connects the subarachnoid space to the scala tympani This occurs quite early in the course of infection, hearing loss being evident within a day of onset of the meningitis; in about half such cases, the deafness resolves Hydrocephalus is an infrequent complication that may become manifest months after treatment and then requires shunting if gait or mentation is affected It may be dif cult to determine on clinical grounds whether a residual state of imbalance is the result of hydrocephalus or of eighth nerve damage.

The acute complications of bacterial meningitis, the intermediate and late neurologic sequelae, and the pathologic basis of these effects are summarized in Table 32-1 Other aspects of current treatment have been well summarized by Lambert..

FIGURE 11-10

The power generatedis relatedto the magnitude of the current. Integration can be used to determine the averagecurrent over one cycle: , : I fr. i.",r. lpear sln(tr;/) - -!:= (- cos(2n) + cos(Q)) dt :0 T Ju

(20.2)

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Software engineering has been a major growth area in the computer industry in recent years. Software applications are needed to drive the Internet and communications networks, expand database systems, warehouse the growing amount of data, provide Web server support, and maximize office efficiency with groupware and project management software. There is a tremendous demand for software engineers to produce the sophisticated programs, languages, and operating systems required to fully utilize advanced computer capabilities. While these software engineers are basically analysts and programmers, the position of programmer is rarely heard of within the computer industry itself. Software engineers work in the following areas: development of new computer languages, operating systems, and applications packages; systems analysis and development; diagnostics and reliability testing; research; and simulation. The detailed work of systems analysts and programmers has already been discussed in previous chapters. Because software engineers work on the cutting edge of the new technology, they must have excellent skills. Most hold degrees in computer science or mathematics with strong analysis and programming backgrounds. However, other degree holders with substantial computer and programming experience are considered for software engineer positions, especially to work in the development of new systems. New operating systems and more complex application requirements will keep software designers very busy. Smaller yet ever more powerful computers will create much of this demand. The wider usage of networks establishes a high demand for more integration software. The technology in demand today is object-oriented design and programming. Expertise with popular languages such as Java, C++, C, and Cobol is required for professionals entering the software engineering field, as are specific skills in areas such as database development, networks, the Internet, enterprise applications, office and groupware, and systems software and support, depending on the area in which a software engineer chooses to work.

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The most impressive results have been obtained by the use of stereotactic techniques to make lesions that are centered in the ventrolateral nuclei of the thalamus or in the pallidum ansa lenticularis region Some frightfully deformed children, unable to sit or stand, have been restored to near normalcy for a time Approximately 70 percent of the patients in Cooper s series were moderately to markedly improved by unilateral or bilateral operations, and, based on a 20-year follow-up study, the improvement was usually sustained More recent studies have reported a somewhat less favorable but nonetheless clear-cut improvement (see Tasker et al; Andrew et al) The main risk of operation has been a corticospinal tract lesion, produced inadvertently by damaging the internal capsule Bilateral lesions have sometimes been disastrous, causing pseudobulbar palsy Newer techniques employing stimulators and implanted electrodes may give better results.

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