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The diagnosis of chronic idiopathic polyneuropathy is one of exclusion Laboratory testing should include fasting blood glucose (FBS), hemoglobin A1C, oral glucose tolerance test (GTT), antinuclear antibody, antiRo and anti-La antibodies (SSA and SSB), erythrocyte sedimentation rate, rheumatoid factor, B12, serum and urine immunolelectrophoresis/immuno xation, and thyroid, liver, and renal function tests The most common abnormality, when one is found, in patients with sensory neuropathy is diabetes or impaired glucose tolerance (IGT) IGT (de ned as 2-hour glucose of >140 and <200 mg/dL) is seen in 17 61% and frank diabetes mellitus (de ned as 2-hour glucose of >200 mg/dL or FBS of >126 mg/dL) in 20 31% of patients with sensory neuropathy (Table 20 1)14,16,18 In patients with painful sensory symptoms (not just numbness), the likelihood of IGT or DM is even higher A population-based study of 2844 patients, aged 40 74 years, found undiagnosed DM in 27%, while 158% of those aged 40 74 years and 207% of those aged 60 74 years had IGT on GGT19 However, some authorities have not found increased risk of IGT in their patients with idiopathic neuropathy compared to age-matched controls20 Thus, although the risk of both previously undetected diabetes mellitus (DM) and IGT may be increased in patients with sensory neuropathy, this is still controversial

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onRelease event handler for the child_mc movie clip by typing the following code:

No of Patients 89 (total) 33 (painful sensory neuropathy) 48 (total) 24 (painful sensory neuropathy) 73 (total) 2884 (normal age-matched population)

Mean Age (Range) 64 yr (44 92 yr)

for every occurrence of the text kPrintReturn in your source code. You can base one #define on a previous #define:

Total with Abnormal Glucose Metabolism 43/89 (56%) 20/33 (60%) 24/48 (50%) 18/28 (65%) 41/73 (56%) 185% in patients aged 40 74 yr

child_mconRelease = function():Void { }

Impaired Glucose Tolerance 15/89 (25%) 7/33 (21%) 13/48 (27%) 10/28 (36%) 26/73 (36%) 158% in patients aged 40 74 yr 207% in patients 60 74 yr

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Interestingly, you could have reversed the order of these two #defines, and your code would still have compiled. As long as both entries are in the dictionary, their order of occurrence in the dictionary is not important. What is important is that #define appear in the source code before any source code that refers to it. If this seems confusing, don t sweat it. It won t be on the test.

Diabetes Mellitus 28/89 (31%) 13/33 (39%) 11/48 (23%) 8/28 (29%) 15/73 (20%) 27% in patients 40 74 yr

64 yr (41 82 yr)

You can create a #define macro that takes one or more arguments. Here s an example:

should match the code shown:

61 yr (44 91 yr)

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and a causal relationship has not as yet been rmly established21 About 5% of patients with chronic idiopathic sensory or sensorimotor polyneuropathy have a monoclonal protein detected in the serum or urine, but this is not much higher than the age-matched normal controls13,18, 22,23 Further, the relationship of these monoclonal proteins to the pathogenesis of most neuropathies is unclear There is a strong pathogenic relationship established in people with demyelinating sensorimotor polyneuropathies with IgM monoclonal proteins, most of whom have myelin-associated ganglioside antibodies (discussed in s 12 and 17) However, most individuals with chronic idiopathic sensory or sensorimotor polyneuropathy have axonal neuropathies histologically and electrophysiologically Amyloidosis is the other condition in which a pathogenic relationship between the neuropathy and the monoclonal protein is clear Thus, amyloid neuropathy needs to be excluded in patients with a monoclonal gammopathy before concluding that the neuropathy is idiopathic in nature (see 14) This may require a fat-pad, rectal, or nerve biopsy Although some studies have suggested that antisulfatide antibodies are common with painful small ber neuropathy,24 27 subsequent reports suggest that these antibodies have a very low sensitivity and poor speci city6,10,25,28 30 We never order them as we have found them to be of little use clinically, and a pathogenic relationship has never been demonstrated, That is, the presence of these antibodies does not imply that the patients have an immune-mediated neuropathy and that they may respond to treatment with immunotherapy We also feel that there is no role for screening various antiganglioside and other antinerve antibodies (eg, GM1 and Hu antibodies) in the workup of patients with chronic idiopathic sensory neuropathy7,31,32 CSF examination is usually normal and is also unwarranted In people with a large ber neuropathy, the sensory NCS reveal either absent or reduced amplitudes that are

#define kSquare( a ) ((a) * (a))

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