PSExec is run from the command line. It's long list of optional parameters allow a great deal of flexibility. Click the following image to see the parameters and a short description of their use.

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Essentially, PSExec runs an application within the security context of either the currently logged on user or as a user provided during program initialization. The application shows up on the administrator's system without any notification to the remote user.
I conducted a short test on my test network. Using a Vista Home Ultimate desktop system, I attempted to run CMD.exe on my Windows XP SP2 laptop. It worked as advertised. Enlarge the following image to view the command line and the results as they appeared on my desktop. Note the remote system name and command executed in the upper left corner. A PSExec parameter can be used to shut down interactive sessions like this, allowing scripts to run unattended.

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Again, not only is this a great tool for administrators. It's also a good way to check for system vulnerabilities. Especially since this and other PSTools are integrated into malware from time to time. According to a note on the PSExec page,
Note: some anti-virus scanners report that one or more of the tools are infected with a "remote admin" virus. None of the PsTools contain viruses, but they have been used by viruses, which is why they trigger virus notifications.