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Neuralgia associated with a vesicular eruption due to the herpes zoster virus may affect cranial as well as peripheral nerves In the region of the cranial nerves, two syndromes are frequent: herpes zoster auricularis and herpes zoster ophthalmicus Both may be exceedingly painful in the acute phase of the infection In the former, herpes of the external auditory meatus and pinna and sometimes of the palate and occipital region with or without deafness, tinnitus, and vertigo is combined with facial paralysis This syndrome, since its original description by Ramsay Hunt, has been known as geniculate herpes, supported only by the postmortem study of Denny-Brown and RD Adams (see Chap 47) Pain and herpetic eruption due to herpes zoster infection of the gasserian ganglion and the peripheral and central pathways of the trigeminal nerve are practically always limited to the rst division (herpes zoster ophthalmicus) Ordinarily, the eruption will appear within 4 to 5 days after the onset of the pain; if it does not, some cause other than herpes zoster will almost invariably declare itself Nevertheless, a few cases have been reported in which the characteristic localization of pain to a dermatome, with serologic evidence of herpes zoster infection, was not accompanied by skin lesions The acute discomfort associated with the herpetic eruption usually subsides after several days or weeks, or it may linger for several months Treatment with acyclovir, along the lines indicated in Chap 33, will shorten the period of eruption and pain, but the drug does not prevent its persistence as a chronic pain It is mostly in the elderly that the pain becomes chronic and intractable Usually it is described as a constant burning, with superimposed waves of stabbing pain, and the skin in the territory of the preceding eruption is exquisitely sensitive to the slightest tactile stimuli, even though the threshold of pain and thermal perception is elevated Allodynia is frequent This unremitting postherpetic neuralgia of long duration represents one of the most dif cult pain problems with which the physician has to deal Some relief may be provided by application of capsaicin cream, use of a mechanical or electrical stimulator, or administration of phenytoin, gabapentin, or carbamazepine Antidepressants such as amitriptyline and uoxetine are helpful in some patients, and Bowsher has suggested, on the basis of a small placebo-controlled trial, that treatment with amitriptyline during the acute phase may prevent persistent pain The addition of a phenothiazine to an antidepressant (eg, amitriptyline 75 mg at bedtime and uphenazine 1 mg tid) has proved to be a useful measure, but the long-term use of phenothiazines carries with it all the well-known risks, including that of inducing a movement disorder Probably equivalent results are obtained by a combination of valproic acid and an antidepressant, as reported by Raftery King has reported that two (5-grain) aspirin tablets crushed and mixed with cold cream or chloroform (15 mL) and spread over the painful zone on the face or trunk relieved the pain for several hours in most patients with postzoster neuralgia Ketamine cream has been suggested as an alternative The authors have limited experience with these topical treatments Extensive trigeminal rhizotomy or other destructive procedures should be avoided, since these surgical measures are not universally successful and may superimpose a diffuse refractory dysesthetic component on the neuralgia (anesthesia dolorosa).

Many computer users tend to eat while they use the computer They also tend to drink, use erasers, shuffle papers, or pick lint off themselves while at the computer The poor keyboard is usually an unfortunate witness to all these activities, and its design allows it to hold more dust, crumbs, hair, and other gunk than any other device Keyboards, therefore, typically require a lot of cleaning, and because the debris can be hard to get at, you might need to use some creative cleaning techniques If the keyboard is sticky, you can clean it with water; it won t harm the keyboard as long as the water doesn t contain impurities and the keyboard is not plugged into the computer while it s still wet There are also a number of chemical cleaners available to clean keyboard tops and surfaces Frequently keyboards become cosmetically dirty much sooner than they become sticky

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This syndrome is much less common than trigeminal neuralgia but resembles the latter in many respects The pain is intense and paroxysmal; it originates in the throat, approximately in the tonsillar fossa, and is provoked most commonly by swallowing but also by talking, chewing, yawning, laughing, etc The pain may be localized in the ear or radiate from the throat to the ear, implicating the auricular branch of the vagus nerve For this reason, White and Sweet suggested the term vagoglossopharyngeal neuralgia This is the only craniofacial neuralgia that may be accompanied by bradycardia and even by syncope, presumably because of the triggering of cardioinhibitory re exes by afferent pain impulses There is no demonstrable sensory or motor de cit Rarely, carcinoma or epithelioma of the oropharyngeal-infracranial region or peritonsillar abscess may give rise to pain that is clinically indistinguishable from glossopharyngeal neuralgia For idiopathic glossopharyngeal neuralgia, a trial of carbamazepine, gabapentin, or baclofen may be useful If these are unsuccessful, the conventional surgical procedure has been to interrupt the glossopharyngeal nerve and upper rootlets of the vagus nerve near the medulla Recent observations suggest that a vascular decompression procedure similar to the one

RMAN provides the ability to administer and manage backups by keeping a record of the backup metadata in a repository When RMAN formulates restore procedures, it uses the repository to identify files needed for recovery You can also generate reports of backup activity using the information available in the repository Oracle Enterprise Manager (OEM) provides a GUI-based interface to the RMAN client by using a comprehensive set of wizard-driven screens The screens provide similar functionality as the RMAN client and allow you to create and schedule backup tasks, set up backup policies and procedures, formulate recovery steps based on the recovery objectives, and perform recovery The RMAN features that help to set the context for our discussion on backup and recovery practices on the Database Machine are discussed next RMAN Backup Formats RMAN backups can be created as image copies or backup sets An image copy is a bit-for-bit copy of a database file, whereas a backup set is an RMAN-specific format that consists of one or more database files known as backup pieces Backup sets are the default format used by RMAN and is the only format supported when storing backups to tape The advantage of backup sets over image copies is that they allow the use of RMAN compression features (discussed shortly) Image copy backups, on the other hand, are only possible for disk backups They utilize the same space as the database files since they are an exact copy Image copies have the advantage of being restored faster than backup sets, since the database blocks do not need to be re-created during the restore process, which is the case when restoring backup sets Although it is not possible to use RMAN compression features with image copies, you can use compression mechanisms provided by the storage systems, such as the built-in compression features of the Sun ZFS Storage appliance In this case, the compression performed by the storage will be totally transparent to RMAN RMAN Backup Types At a high level, RMAN backups can be one of two types full or incremental Full backups, as the name suggests, are the backups of the complete database, whereas incremental backups only store modified blocks since the last full or incremental backup Incremental backups can only be stored as backup sets and not image copies.

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