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REF A REF partition is another form of partitioning that reduces overhead, as well as saving storage space Having parent and child tables in a foreign key relationship is a common implementation practice, especially since this architecture allows for partition-wise joins, described in the next section on parallel execution A REF partition on the child simply points back to the parent and instructs Oracle to use the same partition scheme as the parent, as shown in Figure 2-10 Any changes made in the partitioning scheme in the

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In addition to the well-known chronic sensory neuropathy associated with chronic renal failure that is discussed later in the chapter, there is a more rapid ( accelerated ) process that has not been widely appreciated as a cause of acute and subacute weakness Most patients in our series were diabetics with stable end-stage renal failure who had been treated by peritoneal dialysis for their long-standing kidney disease (Ropper, 1993) In contrast to the better characterized and less severe chronic uremic neuropathy (page 1149), generalized weakness and distal paresthesias progress in over one or more weeks until a bedbound state is reached In some ways the illness simulates GBS More aggressive dialysis or a change to hemodialysis has little immediate effect, although kidney transplantation is curative Electrophysiologic studies show some demyelinating features but usually not a conduction block There is raised CSF protein concentration (not unexpectedly, for there is usually an element of diabetic neuropathy) A few reported cases have been clinically almost indistinguishable from in ammatory demyelinating polyneuropathy, including, in some, a response to plasma exchange or gamma globulin As with the more

20 You want to upgrade a FAT32 disk to NTFS on a Windows XP Home system Which process should you use A B C D Run the Drive Convert utility prior to the upgrade Use the Windows 9x FDISK program to partition the drive to NTFS Use the Disk Management tools to convert the drive Use the CVT program to upgrade the drive

(See page 1031) Some of the neurotoxic effects of Corynebacterium diphtheriae and the mode of action of the exotoxin elaborated by the bacillus are described in Chap 43 Local action of the exotoxin may paralyze pharyngeal and laryngeal muscles (dysphagia, nasal voice) within 1 or 2 weeks after the onset of the infection and shortly thereafter may cause blurring of vision due to paralysis of accommodation, but these and other cranial nerve symptoms may be overlooked At this stage, the cranial neuropathy must be distinguished from that of GBS, botulism, and most of all, from myasthenia gravis A polyneuropathy, coming 5 to 8 weeks later, takes the form

of an acute or subacute limb weakness with paresthesias and distal loss of vibratory and position sense The weakness characteristically involves all extremities at the same time or may descend from arms to legs After a few days to a week or more, the patient may be unable to stand or walk and occasionally the paralysis is so extensive as to impair respiration The CSF protein is usually elevated (50 to 200 mg/dL) Diphtheritic deaths that occur after the pharyngeal infection has subsided are due to cardiomyopathy or, less often, to severe polyneuropathy with respiratory paralysis This type of polyneuropathy, now quite rare, should be suspected in the midst of an outbreak of diphtheritic infection, as occurred recently in Russia (Logina and Donaghy) The important pathologic change is one of segmental demyelination without in ammatory reaction of spinal roots, sensory ganglia, and adjacent spinal nerves Anterior horn cells, axons, peripheral nerves distally, and muscle bers remain normal (Fisher and Adams) Treatment Diphtheria antitoxin, given within 48 h of the onset of the infection reduces the incidence and severity of neuropathic complications Antitoxin is probably of little value once the polyneuropathy begins Thereafter, treatment is purely symptomatic, along the lines indicated for GBS The prognosis for full recovery is excellent once respiratory paralysis is circumvented

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