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performed after the acute infection has subsided Persistence of CSF rhinorrhea usually requires surgical repair

his chapter concentrates on the ASPNET 35 incorporation of Language Integrated Query, generally referenced as LINQ A single chapter on this powerful new NET Framework 35 tool only scratches the surface of LINQ However, by looking at the basic functionality of LINQ and what it accomplishes in key examples, you will be able to see how SQL-type queries can be made using standard programming constructs This chapter first examines how to use new LINQ controls available in ASPNET 35 to create a powerful application for performing basic SQL commands using the LINQ framework Secondly, with a simple C# example, you can see how a normal programming command structure issues LINQ queries

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Think of LINQ as a kind of replacement for SQL, and what LINQ does will begin to be clearer All LINQ queries do the following:

The diagnosis of bacterial meningitis is not dif cult provided that one maintains a high index of suspicion Febrile patients with lethargy, headache, or confusion of sudden onset even those with low-grade fever should generally be subjected to lumbar puncture if no alternative explanation for the state is evident It is particularly important to recall the possibility of meningitis in drowsy, febrile, and septic patients in an intensive care unit when no obvious source of fever is apparent Overwhelming sepsis itself, or the multiorgan failure that it engenders, may cause an encephalopathy, but if there is a meningitis, it is imperative, in deciding on the choice of antibiotics, to identify it early The same can be said for the confused alcoholic patient Too often the symptoms are ascribed to alcohol intoxication or withdrawal, or to hepatic encephalopathy, until examination of the CSF reveals a meningitis Although this approach undoubtedly results in many negative spinal uid examinations, it is preferable to the consequence of overlooking a bacterial meningitis Viral meningitis (which is far more common than bacterial meningitis), subarachnoid hemorrhage, chemical meningitis (following lumbar puncture, spinal anesthesia, or myelography), and tuberculous, leptospiral, sarcoid, and fungal meningoencephalitis enter into the differential diagnosis as well, as discussed in later sections A number of nonbacterial meningitides must be considered in the differential diagnosis when the meningitis recurs repeatedly and all cultures are negative Included in this group are Epstein-Barr virus (EBV) infections; Behcet disease, which is characterized by recurrent oropharyngeal mucosal ulceration, uveitis, orchitis, and meningitis; so-called Mollaret meningitis, which consists of recurrent episodes of fever and headache in addition to signs of meningeal irritation (due in many cases to herpes simplex, as discussed in Chap 33); and the Vogt-Koyanagi-Harada syndrome, in which recurrent meningitis is associated with iridocyclitis and depigmentation of the hair and skin The CSF in these recurrent types may contain large numbers of lymphocytes or polymorphonuclear leukocytes but no bacteria, and the glucose content is not reduced (see discussion of chronic and recurrent meningitis on page 635) Carcinomatous and lymphomatous meningitis, discussed in Chap 31, rarely present in the fulminant manner of bacterial meningitis, but sometimes they do, and the CSF formulas can be similar Rarely, a fulminant case of cerebral angiitis or intravascular lymphoma will present with headache, fever, and confusion in conjunction with a meningeal in ammatory reaction The other intracranial suppurative diseases and their differentiation from bacterial meningitis are considered further on in this chapter.

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If you think that sounds a lot like what you do with SQL commands, you re absolutely right However, instead of writing SQL strings that are passed to ASPNET SQL controls or objects, you handle these queries in a way that looks just like standard programming in a wide variety of NET Framework 35 languages You write the queries in similar ways in such languages as C#, J#, Visual Basic, C++, and other NET-supported languages In other words, LINQ standardizes queries The key examples in this chapter show you how to make those three steps using LINQ