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This subject has already been introduced in Chap 48, where it was pointed out that everyone at some time or other experiences muscle cramps Usually they occur during the night, after a day of unusually strenuous activity; less often they occur during the day, either during a period of relaxation or occasionally after a strong voluntary contraction or postural adjustment A random restless or stretching movement will induce a hard contraction of a single muscle (most frequently of the foot or leg) that cannot be voluntarily relaxed The muscle is visibly and palpably taut and painful, and the condition is readily distinguished from an illusory cramp, in which the sensation of cramp is experienced with little or no contraction of muscle The latter phenomenon may occur in normal persons as well as in those with certain peripheral nerve diseases Massage and vigorous stretch of the cramped muscle will cause the spasm to yield, though for a time the muscle remains excitable and subject to recurrent cramps Visible fasciculations may precede and follow the cramp, indicating an excessive excitability of the terminal branches of motor neurons supplying the muscle Sometimes the cramp is so strong that the muscle appears to have been injured; it remains sore to touch and painful upon use for a day or longer Cramps of precordial chest muscles or diaphragm may arouse fear of heart or lung disease In the EMG, the cramp is marked by bursts of high-frequency, high-voltage action potentials, and the precramp

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phase by runs of activity in motor units Why cramps should be painful is not known; probably the demands of the overactive muscle exceed metabolic supply, causing a relative ischemia and accumulation of metabolites Overwork of muscle with or without impairment of circulation is also painful Between cramps, the muscles are normal clinically and electromyographically Cramps are known to increase in frequency under certain conditions and with certain diseases They are frequent during pregnancy for reasons not fully understood Dehydration and sweating predispose to cramping and are a constant threat to athletes, who try to prevent them by ingesting electrolyte solutions Exertional cramps are frequent in motor system disease and hypothyroidism and less so in chronic polyneuropathies Patients undergoing hemodialysis are subject to cramps, which can be suppressed by intravenous hypertonic saline or hypertonic glucose Rapid rehydration after dehydration is another provocative factor Focal cramping occurs after partial nerve or root injury and with diseases involving anterior horn cells In one such condition, the calf muscle on one side is subject to severe recurrent cramps after decompression of the S1 root in lumbar disc disease; in extreme cases, the muscle hypertrophies The mechanism of muscle cramping is obscure In a number of cases with exercise-induced stiffness and muscle pain, sometimes progressing to cramp, below-normal levels of myoadenylate deaminase have been found The signi cance of this observation is uncertain This enzyme, which is present in high concentration in muscle, is thought to function primarily during aerobic exercise and facilitate the regeneration of adenosine triphosphate from adenosine diphosphate through the action of adenylate kinase Others assert that low levels of this enzyme are not speci c, occurring in such unrelated disorders as hypokalemic periodic paralysis and spinal muscular atrophy (see Layzer for details) Quinine sulfate 300 mg at bedtime and repeated in 4 h if necessary, or 300 mg tid for diurnal cramping is an effective medication; diphenhydramine hydrochloride (Benadryl) 50 mg or procainamide 05 to 10 g can be substituted if quinine is not tolerated Phenytoin, carbamazepine, propoxyphene, and sometimes clonazepam are even more useful in alleviating repeated daytime cramping.

As pointed out on page 1096, a reduction in ionizable calcium and magnesium is associated with involuntary cramplike spasms; in their mildest form they appear as distal carpopedal spasms, but they may involve any of the muscles except the extraocular ones Stimulation of a muscle through its nerve at certain frequencies (15 to

A 35-inch floppy drive reads data from removable floppy disks and provides a good method for transferring data from one machine to another Floppy disks contain a thin internal plastic disk, capable of holding magnetic charges The disk is coated with a thin layer of magnetic materials The disk is surrounded by a hard plastic protective casing, part of which can be retracted to reveal the storage medium inside (see Figure 1-5) The back of the disk has a coin-sized metal circle that is used by the drive to grasp the disk and spin it When a floppy disk is inserted in a computer s drive, the drive spins the internal disk and retracts the protective cover The drive s read/write head moves back and forth along the exposed area, reading data from and writing data to the disk

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The notifications forwarded by Ops Center to Enterprise Manager will be associated with the appropriate targets they originated from, depending on the mapping option that you select The connector tracks the alerts forwarded from Ops Center and automatically updates the information in Enterprise Manager The alerts will be cleared from Enterprise Manager based on the properties set for notification options in the Grid Control Console The Ops Center notification severities of low and medium are mapped to the Enterprise Manager alert severity of warning, whereas the Ops Center severity of high is mapped to the Enterprise Manager alert severity of critical From Ops Center, you can choose the alerts that should propagate to Enterprise Manager by configuring the monitoring parameters and the user notification profile

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