[Hyperglycemia and symmetrical proximal neuropathy in diabetes]

A 60-year-old woman, diagnosed as having a diabetic symmetrical proximal motor neuropathy, is presented. In March 1995, she was referred to us because of untreated diabetes mellitus since 1990. Insulin treatment during one month decreased her postprandial plasma glucose level from more than 400mg/dl to about 200mg/dl. Soon after the treatment, she noticed lower proximal limb weakness bilaterally. In several months, her weakness progressed as the fasting plasma glucose level was increased. Her muscle power gradually recovered when the plasma glucose level was normalized. We therefore suggest that metabolic changes related to hyperglycemia, rather than ischemic vascular changes, play an important role in the pathogenesis of a diabetic symmetrical proximal motor neuropathy.

[A case of pineal teratoma arising from hydrocephalus of unknown cause]

We report a case of "functional aqueductal stenosis" which reveals dilatation of the lateral and 3rd ventricles without stenosis at the aqueduct in MRI. This case shows a pineal teratoma which presents one year later with symptoms of hydrocephalus caused by "functional aqueductal stenosis". A seven-year-old boy was admitted to our department owing to headache and vomiting. CT and MRI showed hydrocephalus. The lateral and 3rd ventricles were dilated while the 4th ventricle was normal. Furthermore, tumoral obstruction of the aqueduct was not found. After a ventriculoperitoneal shunt, he recovered well without neurological deficits. One year later, symptoms of precocious puberty, that is the appearance of public hair and deepening of his voice, were found. A follow-up MRI demonstrated a pineal region tumor. Although human chorionic gonadotropin level in the serum and urine was transiently elevated, it normalized before surgery. The operation was performed by the occipital transtentorial approach and the tumor was totally removed. Histological examination proved this tumor to be a mature teratoma, showing three germ cell layers. About two weeks later, he was discharged without any neurological deficit. In this case, although hydrocephalus occurred, MRI didn't demonstrate aqueductal obstruction caused by the tumor. However, one year later, a pineal region tumor was confirmed by MRI. This suggests that hydrocephalus might have some association with the appearance of the pineal region tumor. Therefore, it is necessary to be aware of the possibility of the occurrence of tumors whenever we encounter "functional aqueductal obstruction", when MRI doesn't demonstrate aqueductal obstruction caused by a tumor.

Cerebral perfusion changes in traumatic diffuse brain injury; IMP SPECT studies

Diffuse brain injury (DBI) is characterized by axonal degeneration and neuronal damage which cause diffuse brain atrophy. We have investigated the time course of abnormalities in cerebral perfusion distribution in cases of DBI by using Iodine-123-IMP SPECT, and the relationship to the appearance of diffuse brain atrophy. SPECT scans were performed on eight patients with diffuse brain injury due to closed cranial trauma in acute and chronic stages. All patients showed abnormalities in cerebral perfusion with decreases in perfusion, even in non-depicted regions on MRI, and the affected areas varied throughout the period of observation. Diffuse brain atrophy appeared in all patients. In some patients, diffuse brain atrophy was observed at or just after the time when the maximum number of lesions on SPECT were seen. The abnormalities in cerebral perfusion in cases of DBI might therefore be related to axonal degeneration and neuronal damage which causes diffuse brain atrophy.

[A patient with epilepsy manifesting reversible memory dysfunction--a neuropsychological, electroencephalographical and radiological study]

A 49-year-old man was admitted to our hospital because of epileptic seizures and memory dysfunction. He had been experiencing seizures several times a day since the age of 43 years. Despite antiepileptic drug therapy (sodium valproate [VPA] and clonazepam [CZP], he suffered from frequent complex partial seizures originating in the temporal lobe, and he had a memory disturbance since age 47. When carbamazepine (CBZ) was substituted for VPA and CZP, the epileptic seizures stopped and the memory disturbance improved. Noninvasive regional cerebral blood flow (rCBF) measurements using 99mTc-HMPAO-SPECT imaging were performed twice. The initial measurements on admission showed overall decreased rCBP that was more prominent in the cerebral cortex than in the subcortical nuclei. A follow-up SPECT examination after clinical improvement revealed a marked overall increase in rCBF, especially in the cerebral cortex. The SPECT findings suggest that the memory disturbance in this patient may have been associated with the overall cerebral blood hypoperfusion. This overall hypoperfusion can be attributed to the frequent complex partial seizures and/or the adverse effect of VPA and CZP. SPECT can provide important information suggesting the pathogenesis of memory disturbance associated with epilepsy.

Two forms of hemitonic seizure in patients with infantile hemiplegia and epilepsy

Two forms of unilateral tonic (hemitonic) seizure were observed in two adult epileptic patients with infantile hemiplegia. Their ictal EEGs showed diffuse bilaterally synchronous spike bursts without focal features. In one case, a 31-year-old male, the VTR/EEG recording clearly demonstrated hemitonic seizure which simultaneously involved his paretic limbs and body and were associated with loss of consciousness and autonomic signs. In the other case, a 33-year-old male, partial seizures with secondary unilateral generalization were demonstrated by VTR/EEG recording. The reason why these cases do not exhibit motor seizure activity on the unaffected side despite diffuse bilateral EEG changes, a lower motor threshold in the paretic limbs and inhibitory effect in the brain-stem on undamaged side are postulated. These two cases suggest that hemitonic seizures include heterogeneous characteristics of partial and generalized epilepsy. In patients with diffuse brain damage, such as those with infantile hemiplegia, seizures appear to exhibit complicated patterns, with characteristics of partial and generalized seizures. There is a gradiation of expression of unilateral seizure, range from clearly partial seizures to those with mostly features of generalized seizures, except for an asymmetry of motor expression.

Interictal cerebral and cerebellar blood flow in temporal lobe epilepsy as measured by a noninvasive technique using Tc-99m HMPAO

The usefulness of noninvasive regional cerebral blood flow measurements using Tc-99m hexamethylpropylene amine oxime (HMPAO) was evaluated in 45 patients with interictal temporal lobe epilepsy. Seizure frequency did not show any influence on flow values or side-to-side asymmetry. Patients taking phenytoin had a significantly lower mean cerebral blood flow (mean 9.5%) and lower mean cerebellar blood flow (mean 12.9%) than those not taking it. Moreover, phenytoin reduced regional cerebral blood flow in the temporal regions more prominently on the contralateral side of the epileptic focus than on the ipsilateral side. Positive MRI findings of hippocampal sclerosis along with visually detected temporal hypoperfusion on SPECT showed a lower regional cerebral blood flow and greater flow asymmetry than other imaging findings in the temporal region. Results suggest that noninvasive cerebral blood flow measurements using Tc-99m HMPAO may give useful information about interictal cerebral blood flow around an epileptic focus and about the effects of antiepileptic drugs on brain function in temporal lobe epilepsy.

In situ localization of messenger ribonucleic acid for an oviduct-specific glycoprotein during various hormonal conditions in the golden hamster

The oviductal epithelium secretes specific glycoproteins that associate with the egg after ovulation. Several published reports including our preliminary studies have suggested that ovarian steroids regulate the secretion of oviduct-specific glycoproteins in several mammalian species. The objective of this study, using golden hamsters, was to analyze the hormonal effects on gene expression of these molecules more precisely during various hormonal conditions (estrous cycle, ontogeny, pregnancy, GnRH analogue treatment, and ovariectomy) by in situ hybridization. The message for the hamster oviduct-specific glycoprotein (HOGP) was detected by a digoxigenin-labeled single-strand specific DNA probe in paraffin sections. Data from these studies show the following. 1) In the oviduct, the signal was detected in both the perinuclear region and the basal region in the ampulla but was predominantly detected in the basal region in the isthmus. 2) The signal intensity was high in the ampulla compared with the isthmus. 3) During a normal estrous cycle, the message level was significantly altered between the estrous and diestrous stages in the ampulla but not in the isthmus. In addition, the signal did not disappear at any stage in either the isthmus or ampulla. 4) The HOGP message was first observed from around 14 days of age and then decreased in parallel with serum estradiol levels during aging. 5) The signal was also observed in the oviductal epithelium of pregnant animals at term and of postpartum animals. 6) When we treated the animals with TAP-144-SR (GnRH analogue) or performed an ovariectomy, which caused diminution of serum estradiol and progesterone levels, the message of HOGP was significantly decreased. Moreover, the message expression was greatly induced after estradiol administration to GnRH analogue-treated animals, whereas a high level of serum progesterone slightly inhibited HOGP message expression. These results suggest that elevation of the serum estradiol/ progesterone level affects the HOGP gene expression in the ampulla. However, a high serum estradiol level did not induce the gene expression rapidly, suggesting that an adequate serum hormonal level over a given period of time may be important for the HOGP gene expression.

Adrenal metastasis from hepatocellular carcinoma--report of a case

A 66-year-old man presented with an epigastric tumor demonstrated by both ultrasonography and computed tomography as hepatocellular carcinoma. He referred himself to a specialist at another hospital who performed transarterial embolization (TAE) of the hepatic artery. But the serum alpha fetoprotein (AFP) concentration gradually rose after the procedure. A right adrenal metastasis was discovered by computed tomography 9 months after his presentation, 8 months after first embolization. When TAE was performed for this metastasis, there was transverse palsy of the lower limb secondary to spinal artery embolization. He returned to our hospital where a right adrenectomy was performed 14 months after his first presentation. The operation was successful and he was discharged 6 weeks later. But he was readmitted in 8 months with an elevated serum AFP concentration and died within 2 weeks. The details of this case are presented, and the indications for resection of adrenal metastasis from hepatocellular carcinoma are discussed.

Apolipoprotein E genotypes and risk of diabetic nephropathy

Genetic susceptibility contributes to the development of diabetic nephropathy. In considering potentially important genetic factors, this study examined the association between genetic polymorphisms in apolipoprotein (apo) E and diabetic nephropathy in 146 patients with insulin-dependent diabetes mellitus (IDDM) of 15 to 21 years' duration. Using a case-control study design, patients with proteinuria (N = 41) (albumin excretion rate (AER) > or = 250 micrograms/min) and patients with microalbuminuria (N = 31) (AER 20 to 250 micrograms/min) were compared with patients who had normoalbuminuria (N = 74) (AER < 20 micrograms/min). Genetic polymorphisms at the apo E locus were identified by the method of denaturing gradient-gel electrophoresis. There was no significant difference in allele frequencies in the proteinuric, microalbuminuric, or normoalbuminuric groups (e2 7.3%, 9.7%, 9.5%; e3 78.1%, 72.6%, 68.2%; e4 14.6%, 17.7%, 22.3%; respectively). The distribution of the apo E genotypes among the three groups of patients was also similar. These results suggest that apo E genotypes are not associated with the development of early or advanced diabetic nephropathy in patients with IDDM.

Angiotensinogen polymorphism M235T, hypertension, and nephropathy in insulin-dependent diabetes

The allele 235T (a threonine in place of a methionine at position 235) of angiotensinogen has been found to be associated with a predisposition to essential hypertension. We investigated whether this allele also confers increased susceptibility to nephropathy in patients with insulin-dependent diabetes mellitus (IDDM). A group of 380 patients who had had IDDM for 15 to 20 years were genotyped at the angiotensinogen 235 locus. Included were 75 patients with normoalbuminuria (albumin excretion rate < 30 micrograms/min), two series of patients with microalbuminuria (n = 30 and n = 136), and two series with overt proteinuria (n = 41 and n = 98). Allele 235T frequency was higher among cases with microalbuminuria (0.41 in the two series combined) or overt proteinuria (0.40) than in the normoalbuminuria group (0.36). However, this difference was not statistically significant with this sample size (chi 2 = 1.2, P = NS with 2 df). Under a recessive model, allele 235T homozygotes had a 1.6-fold risk of developing nephropathy relative to carriers of other genotypes, but this value was not significantly different from 1(95% CI = 0.8 to 3.5). The strength of the association did not improve after stratification by degree of glycemic control. With respect to the hypertension in these IDDM patients, no association with allele 235T was found. Allele 235T frequencies in normotensive and hypertensive individuals were 0.363 and 0.353, respectively, among normoalbuminuric IDDM individuals (chi 2 = 0.01, P = NS) and 0.411 and 0.414 among microalbuminuric IDDM subjects (chi 2 = 0.0, P = NS). We conclude that the angiotensinogen polymorphism M235T might influence susceptibility to nephropathy in insulin-dependent diabetes, but its effect, if any, is rather small and independent of hypertension.

Brain death: MR and MR angiography

SUMMARY

Four patients in whom brain deaths was identified on the basis of neurologic and electroencephalographic findings were examined with MR imaging and MR angiography. MR images showed diffuse swelling of the cerebral gyri and cerebellar cortex, which prolongation of both the T1 and T2 signal (representing hypoxic ischemic brain injury), downward displacement of the diencephalon and the brain stem (central and tonsillar herniation), and loss of flow void in the intracranial portions of both internal carotid arteries. MR angiograms did not show the intracranial vessels above the level of the supraclinoid portion of the internal carotid arteries. MR angiography and MR imaging are noninvasive and reliable methods for use in determining brain death.

The influence of fatty liver on insulin clearance and insulin resistance in non-diabetic Japanese subjects

OBJECTIVE

To determine whether fatty liver impairs insulin clearance and contributes to insulin resistance in obese and lean healthy non-diabetic men and women.

DESIGN

Cross-sectional, descriptive.

SETTING

Medical outpatient clinic; university hospital.

SUBJECTS

Twenty-seven (14 men) non-diabetic obese (Body fat % = 31.5 +/- 9.3; mean +/- s.d.) and 19 (13 men) non-diabetic non-obese (body fat % = 19.0 +/- 6.8; P < 0.01 vs obese) healthy subjects aged 31-64 without liver disease.

MAJOR OUTCOME MEASURES

Liver density relative to the spleen on CT scan (LFS), glucose infusion rate (GIR) and metabolic insulin clearance rate (MIC) during euglycemic hyperinsulinemic clamp; anthropometric (waist-hip ratio: WHR) and CT-determined (visceral fat area: VFA) measures of fat distribution.

RESULTS

Fatty liver was inversely related to MIC (r = -0.39; P < 0.01) with a positive correlation with fasting p-insulin (r = 0.39; P < 0.01). There were no statistically significant correlations between BMI, body fat % or WHR and MIC. GIR was inversely related to body fat % (r = -0.49; P < 0.01), VFA (r = -0.56; P < 0.01) and WHR (r = -0.36; P < 0.01) in all subjects, with an inverse relationship to fatty liver in men (r = -0.43; P < 0.05).

CONCLUSION

Increased steatosis of the liver is associated with reduced insulin clearance, contributing to insulin resistance in non-diabetic Japanese men and women.

Molecular characterization of a hamster oviduct-specific glycoprotein

There is growing evidence that the oviduct is not a passive conduit for gamete and embryo transport but serves a function for the gametes and/or embryos. The oviductal epithelium secretes one or more specific glycoproteins that associate with the egg after ovulation. Several published reports including our preliminary studies have suggested that the egg-associating glycoprotein(s) from the oviduct exists in several mammalian species including golden hamster. However, little or almost no biochemical characterization of the hamster oviduct-specific glycoprotein (HOGP) has been reported. To analyze the molecular structure of the HOGP in detail, we have attempted molecular cloning of cDNA corresponding to HOGP. A cDNA library constructed from the hamster oviduct in the phage vector lambda ZAPII was screened with digoxigenin-labeled, baboon oviduct-specific glycoprotein cDNA as the probe. A single positive clone was isolated, and the nucleotide sequence of the isolated cDNA was determined. Rapid amplification of cDNA end was carried out to obtain a proximal 5' cDNA end of the clone. The cDNA clone consisted of 2387 bp, and the coding region contained 2013 bp translating to 671 amino acids. The amino acid sequence deduced from the cDNA sequence confirmed the chemically determined NH2-terminal sequence of a HOGP and suggested that the derived amino acid sequence contained a signal peptide region (21 amino acids) and 650 amino acids (70,890 daltons) of the mature form of the HOGP region. The amino acid sequence of HOGP appeared to have eight potential N-glycosylation sites. Northern blot analysis revealed that a single message of approximately 2.5 kb was present in oviductal RNA but not in the RNA of several other hamster tissues. The HOGP showed high amino acid sequence homology with baboon, bovine, and human oviduct-specific glycoprotein. These results demonstrate that an oviduct-specific glycoprotein homologue gene exists in various mammalian species including rodent.

Molecular cloning and characterization of a mouse oviduct-specific glycoprotein

In the present study, we have isolated the cDNA for the mouse oviduct-specific glycoprotein (MOGP) by screening the mouse oviduct cDNA library with the bovine oviduct-specific glycoprotein (BOGP)-cDNA probe and by the 5' rapid amplification of the cDNA end (5'RACE). The total length of cDNA was determined to be 2525 base pairs (bp) by sequence analysis. The coding region contained 2163 bp translating to 721 amino acids. Based on comparisons with the N-terminal amino acid sequences of purified-BOGP and of hamster oviduct-specific glycoprotein (oviductin), it was inferred that the derived amino acid sequence contained a signal peptide region of 21 amino acids and a mature MOGP (core protein) region of 700 amino acids (76,515 daltons). It was also inferred that the mature MOGP contained three potential N-linked glycosylation sites and 24 possible O-linked glycosylation sites, and had the unique seven-residue repeat sequence (21 repeats) within the predicted sequence in the C-terminal side. The amino acid sequence of a portion of MOGP was highly homologous to that of BOGP (71% identity), baboon oviduct-specific glycoprotein (61% identity), and human oviduct-specific glycoprotein (77% identity). Significant homologies were also observed with two mammalian secretory proteins that were reported as a mammalian member of a chitinase protein family. Northern blot hybridization with a DIG-labeled probe indicated that a single message of 2.8 kb was present in total RNA prepared from oviductal tissue. In situ hybridization using MOGP-cDNA showed that a MOGP message was only detected in the oviductal epithelial cells. These results strongly suggest that a significant degree of homology exists among oviduct-specific glycoproteins of various mammalian species.

Historical perspectives in epileptic psychosis in Japan

It was as long ago as 1908 when the first study of epileptic psychosis appeared from Japan. Major literatures since that time with regard to psychoses in patients with epilepsy in Japan are reviewed. The history of epileptic psychoses could be divided into five eras according to the main interests in that period: (i) dawn of the history of epileptic psychoses; (ii) the early era; (iii) the era of periodic psychoses; (iv) the middle era; and (v) the present era. The main topics in each era are described and re-evaluated herein.

Clinicopathological investigation of gyral high density on computerized tomography following severe head injury in children

The authors have treated five cases of severe head trauma in children in which abnormally high density along gyri, "gyral high density," was seen on plain computerized tomography (CT) scans in the subacute stage of the injury. The prognosis in all cases was poor, with either severe disability or a vegetative state as the outcome due to significant brain atrophy following gyral high density. This pathology was classified into three clinical stages: 1) acute stage, cerebral ischemia in which there is diffuse low density of the cerebrum on CT scans (most marked on the 3rd and 4th days); 2) subacute stage, hemorrhagic infarction showing gyral high density on plain CT scans (between 1 and 4 weeks); and 3) chronic stage, brain atrophy (beginning 4 weeks after the trauma). In their consecutive series of head-injured patients (516 children, 1459 adults), the authors did not find gyral high density on CT scan in adults. This is probably due to the fact that adults who suffer the severe head trauma associated with diffuse brain swelling or diffuse brain edema cannot survive, thus making this gyral high density unique to children.

[Partial status epilepticus developed 41 years after psychosurgery--an electroencephalographic and neuropathological study]

The authors report an 85-year-old man with schizophrenia, who had undergone bilateral frontal gyrectomy at the age of 44 and had a single series of convulsions 6 months after the psychosurgery. Forty-one years later, he had developed partial seizures with secondary generalized seizures, and died of partial status epilepticus. Ictal EEG showed generalized high-amplitude spikes or sharp waves spreading from the left frontal region. Interictal EEG showed slowing of background activity and high-amplitude paroxysmal discharges on the left frontal and central regions. Postmortem examination of the brain revealed tissue defects in the superior and middle frontal gyri caused by resection at the time of gyrectory and old cysts in the deep frontal white matter as late sequelae of the psychosurgery. There was fibrillary gliosis in the surrounding cerebral convolutions and the deep white matter. We considered that the glial scar in the frontal lobes, on the left side in particular, had developed the epileptogenic focus. The pathophysiological mechanism by which the intractable epileptic seizures appeared 41 years after psychosurgery is discussed.

[Relationship between insulin secretion and insulin resistance in nondiabetic subjects with myotonic dystrophy--a case control study]

Hyperinsulinemia in myotonic dystrophy (MyD) is generally considered as a result of insulin resistance. However, as a consequence of abnormality in systemic membrane fluidity in this disease, abnormal insulin clearance or intrinsic pancreatic beta-cell dysfunction could also contribute to the hyperinsulinemia. To clarify the cause of hyperinsulinemia in MyD, we examined the insulin resistance, insulin clearance and the capacity of insulin secretion in 6 patients with MyD. They received a euglycemic hyperinsulinemic (insulin 40 mU/m2/min) clamp study for the quantification of insulin resistance by the glucose infusion rate (GIR). We evaluated their capacity of insulin secretion by the ratio of increment of serum insulin level to that of plasma glucose level 30 minutes after a 75 g oral glucose load (insulinogenic index; I.I.) and the ratio of area under the curve of serum insulin levels to that of plasma glucose levels during a 75 g oral glucose load (AUCIRI/AUCPG). The I.I. (1.1 +/- 0.6 vs 0.4 +/- 0.3, p < 0.05) and the AUCIRI/AUCPG (0.5 +/- 0.2 vs 0.2 +/- 0.1, p < 0.01) in MyD were significantly greater than those of GIR, body mass index and sex matched 6 non-diabetic controls respectively. Insulin clearance, estimated by the level of insulin and C-peptide before and during a euglycemic clamp study did not differ between the two groups. These results indicate that the postload hyperinsulinemia observed in MyD is not solely resulted from insulin resistance. Other factors, such as intrinsic beta-cell disorder may be involved.

[Seven cases of pseudoseizure unnecessarily treated with AEDs]

An increasing number of pseudoseizures and/or behavioral abnormalities are being unnecessarily treated with anti-epileptic drugs (AEDs) for long periods, often producing adverse effects and even aggravating abnormal behaviors. Seven of the 77 new referrals (43 men, 34 women) to our epilepsy clinic within a single year (1992-1993) were misdiagnosed with epilepsy and had pseudoseizures or behavioral abnormalities alone. The initial episodes for which AEDs had been given were febrile convulsions during childhood in two patients, nonfebrile convulsions of uncertain nature in four patients, and learning difficulty with EEG abnormality in one patient. The reasons AED treatment had continued for so long are probably the persistence of behavioral problems and/or EEG abnormalities and failure to reevaluate the patients to determine whether they had true epileptic symptomatology. Based on the results of this study, we concluded that: 1. AED treatment should be initiated only after a suspicious episode had been demonstrated to be truly epileptic in nature. 2. The diagnosis of pseudoseizures should be made on the basis of careful investigation of clinical symptomatology and ictal pattern as described in "Proposed International Classification of Clinical and Electroencephalographic Epileptic Seizures, 1981". 3. In doubtful cases, frequent reevaluation of the nature of the episodes and the necessity of AEDs is needed to avoid adverse effects.

Brain SPECT imaging for laminar heterotopia

Brain perfusion SPECT was performed in an epileptic patient with a rare form of diffuse subcortical laminar heterotopia using 99mTc-HMPAO. MRI demonstrated generalized laminar heterotopia underlying the cortical mantle. Interictal SPECT imaging revealed identical or increased perfusion of the laminar heterotopia as compared with that of the overlying cortical mantle. Moreover, SPECT revealed low perfusion in the left temporal lobe that agreed with the seizure type of complex partial seizures and the EEG finding of frequent generalized spike-wave complexes with a slight left-sided dominance. Brain SPECT imaging may be useful for appropriate diagnosis of gray matter heterotopia and for detection of functionally focal abnormality associated with epilepsy.

Different change in lipoprotein(a) levels from lipid levels of other lipoproteins with improved glycemic control in patients with NIDDM

OBJECTIVE

To evaluate change both in lipoprotein(a) [Lp(a)] and lipid levels in other lipoproteins in non-insulin-dependent diabetes mellitus (NIDDM) after short-term improvement of glycemic control.

RESEARCH DESIGN AND METHODS

We compared Lp(a) levels in 210 NIDDM patients with those in 46 control subjects and evaluated the relationship between glycemic control and Lp(a) levels in diabetic patients. In addition, changes in Lp(a) levels and lipid levels were assessed after the improvement of glycemic control in 54 poorly controlled NIDDM patients.

RESULTS

In NIDDM, Lp(a) levels in all patients, 62 patients with HbA1c < 6.0%, and 75 patients with HbA1c between 6.0 and 8.0%, were significantly higher than those in control subjects (19.1 [1.7-106.6], 19.2 [6.0-106.6], and 20.3 [2.7-75.3] vs. 15.4 [2.0-61.7] mg/dl, median [range], P < 0.05). Lp(a) levels in 73 patients with HbA1c of > or = 8.0% (18.7 [1.7-58.8] mg/dl) were not significantly different from those in control subjects. After glycemic control, lipid levels in plasma and in other lipoproteins fell significantly, but Lp(a) did not change (from 18.3 [1.7-58.8] to 18.4 [6.6-95.3] mg/dl). Changes in lipid levels, including Lp(a), did not correlate with those in fasting plasma glucose or HbA1c.

CONCLUSIONS

These results suggest that elevated Lp(a) levels do not reflect poor glycemic control and that Lp(a) levels are independent of lipid levels in other lipoproteins after improved glycemic control in NIDDM.