Long QT Syndrome: a Korean Single Center Study

The long QT syndrome (LQTS) is a rare hereditary disorder in which affected individuals have a possibility of ventricular tachyarrhythmia and sudden cardiac death. We investigated 62 LQTS (QTc > or = 0.47 sec) and 19 family members whose genetic study revealed mutation of LQT gene. In the proband group, the modes of presentation were ECG abnormality (38.7%), aborted cardiac arrest (24.2%), and syncope or seizure (19.4%). Median age of initial symptom development was 10.5 yr. Genetic studies were performed in 61; and mutations were found in 40 cases (KCNQ1 in 19, KCNH2 in 10, SCN5A in 7, KCNJ2 in 3, and CACNA1C in 1). In the family group, the penetrance of LQT gene mutation was 57.9%. QTc was longer as patients had the history of syncope (P = 0.001), ventricular tachycardia (P = 0.017) and aborted arrest (P = 0.010). QTc longer than 0.508 sec could be a cut-off value for major cardiac events (sensitivity 0.806, specificity 0.600). Beta-blocker was frequently applied for treatment and had significant effects on reducing QTc (P = 0.007). Implantable cardioverter defibrillators were applied in 6 patients. Congenital LQTS is a potentially lethal disease. It shows various genetic mutations with low penetrance in Korean patients.

Analysis of genetic and non-genetic factors that affect the QTc interval in a Mongolian population: the GENDISCAN study

The QTc interval is a complex quantitative trait and a strong prognostic indicator of cardiovascular mortality in general, healthy people. The aim of this study was to identify non-genetic factors and quantitative trait loci that govern the QTc interval in an isolated Mongolian population. We used multiple regression analysis to determine the relationship between the QTc interval and non-genetic factors including height, blood pressure, and the plasma lipid level. Whole genome linkage analyses were performed to reveal quantitative trait loci for the QTc interval with 349 microsatellite markers from 1,080 Mongolian subjects. Among many factors previously known for association with the QTc interval, age, sex, heart rate, QRS duration of electrocardiogram and systolic blood pressure were also found to have influence on the QTc interval. A genetic effect for the QTc interval was identified based on familial correlation with a heritability value of 0.31. In a whole genome linkage analysis, we identified the four potential linkage regions 7q31-34, 5q21, 4q28, and 2q36.

Trans Fatty Acid Content in Commercial Processed Food in Jeon-Buk Area

This study was carried out to examine the proportion of fatty acids and contents of trans fatty acid in commercial processed foods in Jeon-Buk area. Contents of trans fatty acid in bakery products ranged from 0.2% to 1.0% per 100 g food. Especially garlic bread and pastry contained the highest amount. Popcorns contained trans fatty acid from 0.0% to 13.4%. Among them, instant popcorns for microwave contained the highest amount, while trans fatty acid was hardly detected in popcorns for theater. And trans fatty acid detected in popcorns was mostly in the form of 18 : 1 trans. The content of trans fatty acid in pizza was nearly 0.2%. Amounts of saturated fatty acid and unsaturated fatty acid were similar between each type of pizza and frozen pizza. Fritters such as fried chickens and vegetables contained trans fatty acid less than 0.2% per 100 g food.

Erratum

The authors regret an error in discussion, the authors wrote that "We also performed an additional linkage analysis using only the adult population (> or = 20 years old)(Table 7, Figure 2 and 3)." In this sentence, Table 7 should be changed to Table 6.

Clinical Features of Fulminant Hepatic Failure in a Tertiary Hospital with a Liver Transplant Center in Korea / 대한간학회지

BACKGROUND/AIMS: Striking geographic differences have been noted in the etiology of fulminant hepatic failure (FHF). The prognosis of patients with FHF who do not receive liver transplantation in a timely manner is quite dismal. This study intended to identify the etiology and outcome of FHF in Korean adults and to examine the role of urgent living-donor liver transplantation (LDLT) for treating this unique situation. METHODS: We identified all the adult FHF patients who were referred to our unit between 1999 and 2004. FHF was defined as severe acute hepatitis complicated by the rapid development of hepatic encephalopathy within 8 weeks of the initial symptoms in the patients without a previous history of liver disease. RESULTS: One hundred fourteen patients (47 males and 67 females) were identified. The mean age was 39.5+/-15.3 years. Drugs were the most common cause (28.1%) of FHF (herbal medications, 9.6%), and acute viral infection accounted for 23.7% (HBV accounted for 15.8%). Indeterminate etiologies were noted in 34%. The 90-day survival rate of the nontransplant group was only 15%. Fourteen patients received liver transplants (13 right-lobe LDLT, 1 cadaveric whole liver), and 12 of these (85.7%) survived and showed good graft function during 22 months of median follow-up. CONCLUSIONS: Although the causes of FHF in Korea were diverse, HBV infection and herbal medications were responsible for a significant proportion of the cases. Since urgent LDLT improved the overall survival rate of patients with FHF, this should be considered as an important treatment option for patients suffering with FHF.

The Long-term Follow-up Results after Steroid Treatment in Patients with Autoimmune Chronic Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: Autoimmune chronic pancreatitis (AIP) is a clinically attractive entity because of its dramatic response to steroid therapy. But the long-term results after steroid therapy have not been reported yet in Korea. The purpose of this study was to assess the long-term results and prognosis after steroid therapy in patients with AIP. METHODS: We retrospectively analyzed the clinical, radiologic, and laboratory features and evaluated clinical outcomes in 19 patients with AIP who have been treated with oral corticosteroid. All patients were initially treated with prednisolone (30-40 mg/d) for 1 or 2 months. After the confirmation of clinical improvement in radiologic imaging and laboratory findings, the daily dose of prednisolone was then gradually tapered by 5-10 mg per month to the maintenance dose (2.5-7.5 mg/d). RESULTS: All the patients showed normalization or marked improvement in symptoms, laboratory and imaging findings after steroid therapy. There were 4 cases (21%) of recurrence during the mean follow-up period of 27 months. All the patients with recurrence responded to oral steroid again. Among the 10 patients with diabetes mellitus, seven patients were able to stop or reduce the medication for diabetes after completion of steroid therapy. The biliary stents were additionally inserted in 10 patients who showed distal common bile duct stricture and obstructive jaundice. The accompanying autoimmune diseases were also improved with oral corticosteroid. CONCLUSIONS: Steroid therapy is very effective for AIP and is also effective in the cases of recurrence. A definitive protocol of steroid therapy for AIP should be established in the future.

A case of interstitial lung diseasec caused by Rituximab in non-Hodgkin lymphoma / 대한내과학회지

Rituximab targets CD20+ B cells and has been used increasingly for the treatment of B-cell Non-Hodgkin Lymphoma, alone or in combination with cytotoxic agents. Rituximab can kill CD20+cells by multiple mechanisms. Rituximab therapy has often been associated with an infusion-related symptom complex consisting of fever, chills, and rigors that is usually self-limited. These complications are transient without long-term effects. Several delayed pulmonary events involving interstitial reactions and bronchiolitis obliterans with organizing pneumonia have recently been described in conjunction with the use of Rituximab. In the lymphoma patient presented here there was no respiratory symptoms; however, respiratory difficulty developed after the third round of Rituximab plus CHOP chemotherapy. High resolution computed tomography (HRCT) and positive emission tomography (PET) were performed and revealed diffuse ground glass opacities. We report a patient with Non-Hodgkin Lymphoma in whom interstitial lung disease developed after Rituximab therapy.

A Case of Duodenal Ulcer Bleeding caused by Pancreatic Arteriovenous Malformation / 대한소화기내시경학회지

Arteriovenous malformation (AVM) of the pancreas is an extremely rare disease. It may be asymptomatic, but more than half of the patients present with gastrointestinal bleeding. The most common cause of the gastrointestinal bleeding is variceal bleeding due to the portal hypertension resulting from AVM. Bleeding from a duodenal ulcer and AVM to the pancreatic duct are rare findings. Surgical excision is the treatment of choice, but when portal hypertension has developed, this cannot be corrected even after surgical resection. We experienced a case of recurrent duodenal ulcer bleeding that was due to arteriovenous malformation in the head of the pancreas in a 45 year old man. He was successfully treated with pylorus preserving pancreaticoduodenectomy.

A Case of Diabetic Muscle Infarction Affecting Upper and Lower Limbs / 대한류마티스학회지

Spontaneous diabetic muscle infarction (DMI) is a rare condition that usually occurs in those with longstanding microvascular complications of diabetes. Typical presentation is abrupt onset of painful swelling in the lower limbs, uncommonly in the upper limbs. We report a 49 year-old woman with DMI affecting not only both thighs but also left arm. She had already advanced diabetic complications of retinopathy, nephropathy, and neuropathy. Magnetic resonance imaging (MRI) showed findings of hyper-intense T2 weighted signals and rim enhancement after intravenously administered gadolinium at the sites of infarction. Excisional biopsy specimens of the thigh muscle contained aseptic necrotic muscle mixed with areas of muscle fiber atrophy and fibrosis. The diagnosis of DMI was considered most likely, and she was treated with muscle rest, analgesics, and physical therapy. The swelling and pain of the involved limbs improved gradually without complications. Since ten months after discharge, her symptoms resolved almost completely, and never relapsed. Hence, we report a rare case of DMI involving left arm and both thighs with review of literature.

Clinical Presentation of Adverse Drug Reaction of Dalteparin in Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Heparin is crucial in the treatment of acute coronary syndrome. However, unfractionated heparin has pharmacokinetic, biophysical and biological limitations, but its low molecular weight has been used to overcome these limitations. The aim of this study was to find the optimal dose of dalteparin in Koreans. Instead, significant rises in the levels of aminotransferase were found in the liver during the study. SUBJECTS AND METHODS: A clinical investigation was conducted, at Seoul National University Hospital, between December 2000 and February 2001. The anti-Xa activity was checked just before the first, and 4 hours after, the second and ninth doses of dalteparin. Liver function tests were obtained on the first and follow-up day (day 6 or 7). RESULTS: Of the 17 patients who completed 10 doses of dalteparin, 13 showed significant rises in the levels of liver aminotransferase. In 5 cases, the levels of aminotransferase rose to 3 times, and in one case, to over 10 times the upper normal limit. All of the patients were asymptomatic, and the levels showed a decline one or two days later. The follow-up aminotransferase level was normalized in 8 out of 11 patients whose liver function tests were followed up. CONCLUSION: Previous studies have shown that 120 IU/kg of dalteparin was the optimal dose in Western countries. Whether this is the optimal dose for Koreans has not been proven, and there have been no studies to elucidate its adverse effects (e.g. hepatotoxicity) in Koreans. Therefore, large scale, randomized trials may be warranted to determine the pharmacodynamics and kinetics of dalteparin in Koreans.

Clinical Efficacy of Percutaneous Transluminal Coronary Angioplasty (PTCA) in Chronic Renal Failure / 대한신장학회잡지

BACKGROUND: Ischemic heart disease has become more important in regard to mortality in hemodialysis patients. Although PTCA has been used for the treatment of ischemic heart disease, its result has little been reported in chronic renal failure(CRF) patients not in maintenance dialysis. We examined the therapeutic outcome of PTCA in CRF group in comparison with that in control group with normal renal function. METHODS: In a retrospective case-control study, 15 patients with CRF(Scr >or=1.4 mg/dL) were compared with 29 sex, age and diabetes mellitus matched controls without renal disease who had been randomly selected from the PTCA registry of our institution. Restenosis was evaluated by follow-up angiography or recurrent angina. Twenty-two PTCAs were performed over 26 stenotic lesions in CRF group, and thirty-nine PTCAs undergone over 56 lesions in control group. RESULTS: CRF group consisted of 11 men and 4 women with a mean age of 59.2+/-9.2(mean+/-SD) years and a mean serum creatinine of 3.8+/-2.4 mg/ dL. Cause of renal failure was diabetes mellitus in 11 cases(73%). Angiographic lesion success was confirmed in 17(65%) out of the 26 stenotic sites and stents were inserted successfully in the other nine lesions. Restenosis was confirmed by angiography in 10 lesions(38.5%) over a mean of seven months and suspected by recurrent angina in 6 lesions(23.1%), so overall restenosis rate was 61.6% in CRF group. Risk of restenosis was little different compared with control group in single- and double vessel disease, but increased up to 89% in triple vessel disease in CRF in contrast with control group. Among CRF group patients with serum creatinine >or=2.5 mg/dL showed much increased restenosis rate(77%) compared with those with serum creatinine <2.5 mg/dL (46%). CONCLUSION: Restenosis rate significantly increased in CRF patients who have multivessel disease or advanced renal failure, so other reperfusion therapy should be considered for them.

Changes of Aortic Morphology after Aortic Dissection Evaluated by CT Angiography

BACKGROUND AND OBJECTIVES: In aortic dissection (AD), CT angiography (CTA) is useful both in initial diagnosis and long term follow-up. In this study, we used CTA to evaluate the morphologic changes of aorta after AD. SUBJECTS AND METHODS: We reviewed the initial and follow-up CTA images of 43 patients with AD. The diagnoses were double-lumen dissection (n=13), intramural hematoma (n=11), and residual dissection after surgery (n=19). The duration of CTA follow-up was 3.3+/-1.9 years (range 7 - 89 months). After reviewing the CTA images of the thoracic aorta level, and of the upper and lower abdominal aorta levels, we compared the areas of total lumen, true lumen and false lumen and the area ratio of true/total lumen. RESULTS: Changes in luminal areas were greatest in the thoracic aorta, where both the true lumen area and the ratio of true/total lumen area increased. Subgroup analysis revealed that although the total lumen area increased significantly in the classic AD group, no changes were noted in the ratio of true/total lumen area. Only the increase in false lumen area (from 5.8 cm 2 to 9.0 cm 2) was significant (p=0.036). In patients with intramural hematoma, a decrease in total lumen area and an increase in the ratio of true/total lumen area were noted. CONCLUSION: In classic AD, false lumen dilatation occurs with false lumen enlargement, whereas in intramural hematoma total aorta size decreases with any increase in the ratio of true/total lumen area.

Effects of Acute Hyperglycemia on Endothelium-Dependent Vasodilation in Patients with Diabetes Mellitus or Impaired Glucose Metabolism

BACKGROUND: Although impaired endothelial function is well known in patients with diabetes mellitus, the precise mechanism and the factors that contribute to this dysfunction remain to be clarified. We examined the effect of acute hyperglycemia on patients with impaired glucose metabolism in vivo by plethysmography. METHODS: Seven patients with diabetes mellitus or impaired glucose metabolism were studied. In each patient, endothelial function was examined in the fasting state and at two levels of hyperglycemia, which were achieved by the infusion of glucose, insulin, and somatostatin. Forearm blood flow was measured while acetylcholine was infused in increasing concentrations(7.5, 15, and 30 microgram/min) through the brachial artery. RESULTS: Glucose concentrations increased accordingly at each stage, from 135.3+/-18.4 mg/dl at stage 1(the fasting state), to 239.0+/-15.2 mg/dl at stage 2(the first level of hyperglycemia), and to 378.3+/-25.3 at stage 3 (the second level of hyperglycemia) [p<0.01]. Maximal acetylcholine-dependent vasodilation achieved by infusion of acetylcholine at 30 microgram/min was significantly aftenuated during stages 2 and 3 compared with stage 1(p<0.05 by AVOVA; forearm blood flow ratio was 2.87+/-0.18 and 2.56+/-0.14 versus 3.58+/-0.21, respectively). This was also evident during the infusion of 15 microgram/min and 7.5 microgram/min of acetylcholine. CONCLUSIONS: Endothelium-dependent vasodilation is significantly aftenuated by acute hyperglycemia in patients with diabetes mellitus or impaired glucose metabolism. Our findings suggest that elevated glucose may contribute to the endothelial dysfunction observed in patients with diabetes mellitus or impaired glucose metabolism.

Results of heart transplantation in Korea / 대한내과학회지

BACKGROUND: Heart transplantation is a definite treatment modality of the patients with end-stage heart failure. Heart transplantation has been performed in Korea since 1992, and currently it is an established procedure for the management of terminal heart failure. The purpose of this study is to clarify the Korean status of heart transplantation. METHODS: Six major heart transplantation centers' 137 cases during the period November 1992 through May 1999 are analyzed to evaluate the general demographics, underlying heart diseases, postoperative management, complications, and survival. RESULTS: The mean age of the patients is 37 years old, and the mean follow-up period is 25 months (1 day - 80 months, median 20 months). Most common underlying disease related to heart failure is cardiomyopathy (86%). Total 16% of patients underwent cellular rejection of ISHLT (International Society of Heart and Lung Transplantation) grade 3A or more within 1 year after transplantation. The most common type of clinical infection is bacterial (18%), and the most common organism is Herpes zoster virus (6.4%). Graft coronary artery disease examined by coronary angiography detected in 3.7% of recipients within 12 months after transplantation. One, 2, 3, and 5-year overall survival rates of recipients are 81% , 72%, 71%, and 62%, respectively. CONCLUSION: Distribution of underlying heart diseases and the frequency of graft coronary artery disease of Korean heart transplantation recipients were different from those of the western patients. Although the history of heart transplantation in Korea is relatively short, the early and long-term results are comparable with well-established centers.

Development of Registry System for the Construction of Coronary Intervention Database

BACKGROUND AND OBJECTIVES: The development of coronary intervention registry system is required for analysis of current status and more efficient management of patients with coronary artery disease in Korea. We developed database system and registry system in internet environment to confirm the possibility of nationwide system construction and of useful information providing on coronary intervention. MATERIALS AND METHOD: Database for coronary intervention and web-based registry system were developed and installed on internet server. Data elements consist of demographics, coronary risk factors, initial diagnosis, lesion characteristics, type of interventional procedures, and post-procedure outcomes. RESULTS: Total 734 patients were registed by 12 intervention centers from November 1998 to October 1999. Patients with angina pectoris and myocardial infarction were 78.5% and 21.5%, respectively and 14.6% of all patients had history of previous coronary intervention. Major coronary risk factors of the patients were smoking (38.6%), hypertension (33.8%), and diabetes (18.0%). Proportions of the patients with single-vessel disease, two-vessel disease, and triple-vessel disease were 64.7%, 26.2%, and 9.1%, respectively. Left main disease was detected in 2.0%. Balloon PTCA only was performed in 209 patients and 530 patients underwent coronary stent insertion. CONCLUSION: Multicenter data of coronary intervention were collected via internet-based system, and it was possible to construct intervention database. These web-based systems linked with database will provide status of Korean interventional procedures and be able to support multicenter study efficiently by expanding the participating hospitals and including more detailed database fields.

Effect of Converting Enzyme Inhibitor upon Myocardial Interstitial Tissue and Left Ventricular Remodeling after Nontransmural Myocardial Infarction in Rats

BACKGROUND: Left ventricular remodeling after myocardial infarction is closely related to the prognosis of the patients with infarction and can be modified by angiotensin converting enzyme inhibitor. In experimental transmural infarction rat model, captopril decreases the ventricular compliance and simultaneously decrease the ventricular volume, but its effects on the nontransmurally infarcted heart are not elucidated. METHODS: Female Sprague-Dawley rats underwent 45-minute left coronary artery occlusion followed by reperfusion to produce nontransmural myocardial infarction. At 5 days after infarction, rats were randomized into two groups : untreated(n=8) and captopril-treated(captopril 2g/liter drinking water)(n=8). After 21 days of treatment, the hearts were arrested at diastole and excised. Passive pressure-volume curve of the left ventricle was plotted, and the stiffness modulus and mean compliance were calculated in the range of 5 to 30mmHg of pressure. Infarct size was also measured to confirm each group has similar size of lesion. The extent of fibrosis(relative area of fibrosis to randomly-selected peri-infarcted zone) was quantified on Masson's trichrome-stained ventricular slices by automatic image analysis software. RESULTS: Compared with untreated group, captopril-treated rats showed significantly decreased ventricular weight-to-body weight ratio(2.60+/-0.18mg/g vs. 2.84+/-0.20, p<0.05), decreased ventricular stiffness modulus(7.24+/-0.61 vs. 8.28+/-0.57, p<0.005), increased mean compliance(9.71+/-0.75 1/mmHg vs. 7.55+/-0.67, p<0.0001), and decreased fibrosis extent(0.82+/-1.49% vs. 5.53+/-5.33, p<0.01). CONCLUSION: These findings suggest that captopril increases the compliance of nontransmurally-infarcted left ventricle at least partly by the suppression of fibrosis, in contrast with previous findings that captopril decresed the passive compliance of transmurally-infarcted ventricle.

Echocardiographic Characteristics of Normally Functioning CarboMedics and St.Jude Medical Mitral Valve

BACKGROUND: CarboMedics and St.Jude Medical bileaflet valves are in widespread use but few noninvasive studies about the two types of valves were performedd. The aim of this study was to assess the characterisics of the normally functioning CarboMedics and St.Jude Medical prosthesis in the mitral position. METHODS: Patients with normally functioning CarboMedics and St.Jude Medical valve in the mitral position were included. They underwent transthoracic and transesophageal echocardiography 7 to 14days after mitral valve replacement. With the use of color flow Doppler transesophageal echocardiography, we measured the length, width, and area of maximal physiologic regurgitation and by using 2-D transesophageal echocardiography, we measured the opening and closing angles of the bileaflet valves and we tried to elucidate whether spontaneous echo contrast is present in the left atrium. RESULTS: 31 pateints underwent mitral valve replacement with CarboMedics and 10 patients with St.Jude Medical. The length of maximal physiologic regurgitation ranged from 11mm to 44mm in carboMedics mitral valve and from 12mm to 36mm in St.Jude Medical mitral valve. The area ranged from 0.19cm2to 3.48cm2in CarboMedcs and from 0.58cm2to 4.49cm2in CarboMedics and The mean opening and closing angles are 83.2(+/-1.1)degrees, 22.3(+/-1.3)degrees in CarboMedics and 86.5(+/-1.2)degrees 26.2(+/-3.2)degrees in St.Jude Medical. Spontaneous echo contrast was positive in 66% of patients, of whom patioents with atrial fibrillation showed nuch higher revalence of SEC than patients with sinus rhythm. CONCLUSION: These finding valve will give us a reference valvue for the evaluation of prosthetic valve function in mitral position.

Change of Angiotensinogen mRNA in Rat Liver after Myocardial Infarction

BACKGROUND: Loss of myocardium due to acute myocardial infarction may cause acute heart failure and future left ventricular dysfunction. During heart failure, homeostatic mechanism will be activated and the renin-angiotensin system may play a role in congestive heart failure. Its primary components are angiotensinogen, renin, angiotensin converting enzyme, and angiotensin. According to the recent improvement of molecular biologic technique, it is possible to know the angiotensinogen nucleotidde sequence, amino acid sequence, and tertiary structure and to detect very small amount of material from tissue. The aim of the present study was to examine the change of expression of the liver angiotensinogen mRNA, a component of the circulation renin-angiotensin system in rats after myocardial infarction. METHODS: Female Sprague-Dawley rats(body weight 200-250g) were anesthetized and subjected either to left coronary artery occlusion or to sham operation. And the rats were sacrificed at 1 hours, 4 hours, 18 hours, 24 hours, 3 days, 7 days, 1 week, 2 weeks and 3 weeks. Northern blot analysis was performed. RESULTS: The liver angiotensinogen amRNA levels were elevated at 4 hours, 18 hours, 24 hours after myocardial infarction and reduced to control values at 3 days(max 5-fold). The liver angiotensinogen mRNA levels were lesser elevated at 4 hours, 18 hours, 24 hours after sham operation(max 1.8-fold). CONCLUSION: The renin-angiotensin system is one of the major regulators of blood pressure and fiuid and electrolyte homeostasis. It appears that the circulating renin-angiotensin system is activated acutely after myocardial infarction and is then turned off at cardiovascular compensation.

Risk Factors of the Atherosclerotic Peripheral Vascular Disease(PVD)

BACKGROUND: The main cause of atherosclerotic peripheral vascular disease is known to be atherosclerotic processing. In patients with atherosclerotic peripheral vascular disease, other atherosclerotic diseases are frequently combined, especially coronary artery disease. There were some suggestions that the risk factors of the atherosclerotic peripheral vascular disease be different from the those of the coronary artery disease. The aim of this study was to evaluate the independent risk factors for the atheroslerotic peripheral vascular disease(PVD) without influence of coronary artery disease(CAD). METHODS: The study population was male patients with atherosclerotic peripheral vascular disease(n=66) documented by peripheral angiogram form February 1991 to Octobor 1993, and during their abmission all patients with suspected atherosclerotic peripheral vascular diaease underwent both peripheral angiogram and coronary angiogram. Careful history taking and physical examination and lipid battery sampling after at least 14 hours of fasting were also performed. RESULTS: 60% of patients with peripheral vascular disease also had coronary artery disease. There was no significant difference in total cholesterol, HDL cholesterol, LDL cholestrerol, triglyceride between patients with peripheral vascular disease and age-matched control. The prevalence of hypertension was higher in patients with peripheral vascular disease but with no statistical significance. Smoking(p<0.0001) and diabetes(p<0.05) were strongly associated with peripheral vascular disease. When patients without coronary artery disease were compared to control from the viewpoint of risk factors again, the results were the same, that is, smoking and diabetes were also associated with periperal vascular diseaes. CONCLUSION: The prevalence of associated coronary artery disease was relatively high in patients with atherosclerotic peripheral vascular disease. And smoking and diabetes seem to be important risk factors of atherosclerotic peripheral vascular disease.

A Case of Dual Coronary Arteriovenous Fistulas Draining into the Coronary Sinus in a Patient with Acute Myocardial Infarction

In a 52-year-old man who presented with acute myocardial infarction, dual coronary arteriovenous fistulas from the right coronary artery and left circumflex artery both which drained into the coronary sinus were detected on coronary arteriography.This is the first case of dual coronary arteriovenous fistulas draining into the coronary sinus.