This report supplies supportive data for the hypothesis that a high n-6/n-3 dietary fat ratio is a potent, negative variable in NIDDM. Further work is necessary to critically evaluate this hypothesis.

The Inadequate metabolic and hypertension control, especially in type 2 patients, needs to be addressed.

No abstract

LETTERS AND COMMENTS wk history of polyuria and polydipsia. Past medical history was positive for hypertension and negative for diabetes mellitus, neurologic, thyroid, or liver disease. Medications included a thiazide diuretic and alpha-methyldopa. Physical examination revealed an alert, oriented woman in no acute distress. Pulse was 72 beats/min and blood pressure was 136/ 88 mm Hg. The patient exhibited choreoathetotic movements of the right face, tongue, arm, and leg, and increased tone in the right upper and lower extremities. The serum glucose concentration was 584 mg/dl. Serum electrolytes, blood urea nitrogen, creatinine, calcium, phosphate, thyroid, and liver function tests were within normal limits. A CT scan of the brain revealed bilateral, 1-mm calcification of the caudate nuclei. The EEG was within normal limits. The choreoathetotic movements abated with return of the serum glucose to the 200-300-mg/dl range with insulin and hydration. The patient was discharged on haloperidol, intermediateacting insulin, and the same antihypertensive regimen.Haloperidol was subsequently discontinued due to excessive sedation.The patient did well for -1 yr without any abnormal movements and serum glucose concentrations between 150 and 275 mg/dl when she presented with a 2-wk history of polyuria and a 3-day history of involuntary movements of the left face, tongue, arm, and leg, but no abnormal movements of the right side. The remainder of the examination was unchanged. The serum glucose level was 622 mg/dl. Serum electrolytes, calcium, phosphate, thyroid, and parathyroid hormone levels were within normal limits. CT scan of the brain revealed increasing calcification of the posterior head of the caudate nuclei bilaterally. EEG was again within normal limits. The choreoathetotic movements abated after the serum glucose level was normalized with insulin. The patient was discharged on intermediate-acting insulin and has had no further abnormal movements with continued good control of hyperglycemia. DISCUSSIONAcquired paroxysmal choreoathetotic movement disorders arise from hypoparathyroidism, hyperthyroidism, and several neurologic diseases. 2 ' 3 A review of the etiologies of acquired paroxysmal choreoathetosis revealed that 60% of the cases are unilateral, 30% are bilateral, and the remaining 10% are alternately unilateral and bilateral. 2 Our case demonstrates that choreoathetotic movements associated with diabetes mellitus may be alternately unilateral during periods of hyperglycemia and be successfully managed by restoring normoglycemia with insulin. Insulin therapy and hydration have been shown to be effective therapies for other neurologic manifestations of hyperglycemia and hyperosmolarity, including focal seizures and transient ischemic attacks, 4 by reestablishing previous osmotic gradients.The choreoathetotic movements and basal ganglia calcification reported in this case are also seen in idiopathic hypoparathyroidism, a rare disorder in which neurons in the basal ganglia damaged by anoxia or vascular insuffici...

mmol/L) in 34%, high total cholesterol (.5.2 mmol/L) in 29% and high LDL-C (.4.1 mmol/L) in 20% of patients. 89% of dyslipidemic patients were on simvastatin on admission and of those 49% only achieved an LDL-C target less than 2.6 mmol/L. Conclusions: The present study shows a high prevalence of diabetes, hypertension, and dyslipidemia in the Omani population undergoing CABG. The most common pattern of dyslipidemia is low HDL-C. A small percentage of the study group had achieved therapeutic LDL-C targets, which put them at continuous risk of rapid atherosclerotic attrition of coronary bypass grafts.Synopsis: Three generations ago, most physicians learned very little about cholesterol, and many doubted the value of treating elevated values. Six decades of double-blind controlled trials have converted cholesterol into a daily conversation piece, and a standard of care requirement for cardiovascular disease. In a similar manner today, we are faced with a global increase in aging with significant impacts on a large number of associated risk factors and illnesses that threaten to eventually overburden an already stretched healthcare system. Nevertheless, aging per se has not been examined with an appropriately intense investigational effort. Life expectancy is lengthening in every developed nation. Three quarters of babies will live to their 75th birthday, and many will reach 80 plus years. Purpose: The object of this poster is to provide background information to better understand the roles of leptin and cholesterol ester transfer protein (CETP), along with suggestions for future studies and therapeutic approaches. Methods: Literature review and an examination of present prevailing beliefs. Results: Leptin is an adipokine, a biological mediator, which signals longer-term caloric intake and which facilitates synaptic plasticity in the hippocampus, promotes beta-amyloid clearance and improves memory in animal models of aging. In a prospective study of approximately 200 Framingham subjects (average age 87), after 7 years of leptin assay, greater leptin levels were associated with a lower risk of dementia and Alzheimer disease, as well as a greater total brain volume in asymptomatic adults. CETP regulates high-density lipoprotein metabolism. A genetic variant VV improved the odds of reaching 100 and reduced the risk of developing dementia. Compared with those elderly subjects lacking this gene variant, those with the gene were twice as likely to have good cognition. Subjects reaching 100 years of age were three times more likely to possess the VV gene variant of CETP compared with control patients.