Phlebosclerotic Colitis in a Healthy Young Female with Long-term Herbal Medicine Use / 대한소화기학회지

Phlebosclerotic colitis is a rare form of intestinal ischemia. It is caused by calcified peripheral mesenteric veins and a thickened colonic wall. These characteristic findings can be identified on CT and colonoscopy. A 37-year-old female with a history of long-term herbal medicine use presented with acute lower abdominal pain and vomiting of sudden onset. Colonoscopic findings showed dark-blue discolored edematous mucosa and multiple ulcers from the ascending colon to the sigmoid colon. Abdominal CT findings showed diffuse thickening of the colonic wall and calcifications of the peripheral mesenteric veins from the ascending colon to the sigmoid colon. Based on these findings, the patient was diagnosed with phlebosclerotic colitis. We report this rare case of phlebosclerotic colitis in a healthy young female patient with a history of long-term herbal medicine use and include a review of the relevant literature.

Congenital Long QT Syndrome Type 8 Characterized by Fetal Onset of Bradycardia and 2:1 Atrioventricular Block

An important, albeit rare, cause of fetal bradycardia is long QT syndrome (LQTS). Congenital LQTS is an ion channelopathy caused by mutations in genes encoding cardiac ion channel proteins. Fetal onset of LQTS imposes high risk of life-threatening tachyarrhythmias and sudden cardiac death. Here, we report the case of a female newborn with fetal onset of bradycardia and a 2:1 atrioventricular (AV) block. After birth, a 12-lead electrocardiogram (ECG) revealed bradycardia with QT prolongation of a corrected QT (QTc) interval of 680 ms and pseudo 2:1 AV block. Genetic testing identified a heterozygous Gly402Ser (c.1204G>A) mutation in CACNA1C, confirming the diagnosis of LQTS type 8 (LQT8). The patient received propranolol at a daily dose of 2 mg/kg. Mexiletine was subsequently administered owing to the sustained prolongation of the QT interval and pseudo 2:1 AV block. One week after mexiletine inception, the ECG still showed QT interval prolongation (QTc, 632 ms), but no AV block was observed. There were no life-threatening tachyarrhythmias in a follow-up period of 13 months.

Congenital Long QT Syndrome Type 8 Characterized by Fetal Onset of Bradycardia and 2:1 Atrioventricular Block

An important, albeit rare, cause of fetal bradycardia is long QT syndrome (LQTS). Congenital LQTS is an ion channelopathy caused by mutations in genes encoding cardiac ion channel proteins. Fetal onset of LQTS imposes high risk of life-threatening tachyarrhythmias and sudden cardiac death. Here, we report the case of a female newborn with fetal onset of bradycardia and a 2:1 atrioventricular (AV) block. After birth, a 12-lead electrocardiogram (ECG) revealed bradycardia with QT prolongation of a corrected QT (QTc) interval of 680 ms and pseudo 2:1 AV block. Genetic testing identified a heterozygous Gly402Ser (c.1204G>A) mutation in CACNA1C, confirming the diagnosis of LQTS type 8 (LQT8). The patient received propranolol at a daily dose of 2 mg/kg. Mexiletine was subsequently administered owing to the sustained prolongation of the QT interval and pseudo 2:1 AV block. One week after mexiletine inception, the ECG still showed QT interval prolongation (QTc, 632 ms), but no AV block was observed. There were no life-threatening tachyarrhythmias in a follow-up period of 13 months.

Association between Breastfeeding and Parental Socioeconomic Status: Analysis of the Korean National Health and Nutrition Examination Survey, 2013–2017

Purpose@#The importance of breastfeeding is well known. Socioeconomic status is one of the factors affecting breastfeeding. We investigated the association between breastfeeding and parental socioeconomic status to help design future breastfeeding promotion projects. @*Methods@#Data on demographic characteristics and socioeconomic status of parents of 1,220 children aged under 60months were extracted from the 2013–2017 Korea National Health and Nutrition Examination Survey. @*Results@#Some socioeconomic factors were associated with breastfeeding. Maternal factors such as education level (≥13 years: odds ratio [OR], 2.79; 95% confidence interval [CI], 1.21–6.42), middle high income level (OR, 2.30; 95% CI, 1.18–4.49), no smoking status (OR, 3.07; 95% CI, 1.28–7.36) and body mass index (BMI) (<25 kg/m2 : OR, 1.82; 95%CI, 1.12–2.95) were associated with breastfeeding (p<0.05). In addition, paternal factors such as age (30s: OR, 4.88; 95%CI, 1.82–13.04) and education level (≥13 years: OR, 7.94; 95% CI, 3.12–20.18) were associated with breastfeeding (p<0.05). After controlling for confounding factors, mother’s BMI, father’s age, and father’s educational level were found to be statistically significant predictors of breastfeeding. @*Conclusion@#This study demonstrated that some parental socioeconomic factors were associated with breastfeeding in Korea.

The Study of Relationship between Breastfeeding and Metabolic Syndrome and its Components in Premenopausal Parous Women: From the Korean National Health and Nutrition Examination Survey, 2010-2016

Purpose@#Here we aimed to examine the association of breastfeeding (BF) with the metabolic syndrome (Mets) and its components among premenopausal parous Korean women. @*Methods@#We conducted a cross-sectional study on 7,116 Korean women by using nationally representa tive data from the Korea National Health and Nutrition Examination Survey, between 2010 and 2016. Mul­tivariate logistic regression analysis was performed for examining the association of BF with Mets and its components. @*Results@#A total 7,116 women were selected for this study. Mets was present in 12.9% of the study parti cipants. The prevalence of Mets in the BF group (12.38%) was lower than that of the non-BF group (14.69 %) (p<0.05). The prevalence of hypertension and hypertriglyceridemia was significantly higher in the non-BF group compared to that of the BF group. For each of Mets components, the total cholestrol level and systolic blood pressure were significantly higher in the non-BF group, compared to those of the BF group (p<0.05). The BF group was associated with a decreased risk of Mets (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.68–0.99). and lower risks of hypo-high-density lipoprotein-cholesterolemia (OR, 0.78; 95% CI, 0.62–0.68), compared to those of the non-BF group. @*Conclusion@#BF is an important factor in reducing the risks of Mets. These results provide fundamental evidence for the establishment of policies for promoting BF.

Ascending Colon Variceal Bleeding in Cirrhotic Patient with Emergent Endoscopic Variceal Obturation with N-butyl-2-cyanoacrylate / 대한소화기학회지

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

Deep Vein Thrombosis Due to Compression of Huge Hepatic Cyst Successfully Treated by Inferior Vena Cava Filter and Cyst Drainage / 대한소화기학회지

An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.

Symptomatic Hypermagnesemia in Normal Kidney Function with a Colonic Cleansing Agent / 대한내과학회지

Most reported cases of hypermagnesemia are related to laxative abuse and impaired renal function, while hypermagnesemia is uncommon without iatrogenic magnesium administration and decreased renal function. Magnesium-containing bowel-cleansing agents are widely used before colonoscopy, usually without complications. However, we experienced a case of symptomatic hypermagnesemia with normal renal function after using a bowel-cleansing agent. A 74-year-old man with normal renal function complained of lethargy and motor weakness after taking a bowel-cleansing agent containing 14 grams of magnesium before a colonoscopy for hematochezia. His magnesium level was 12 mg/dL. Fluid stasis in the gut due to colonic obstruction might have caused the hypermagnesemia. He was treated successfully with a bowel enema and intravenous calcium. We should be cautious when prescribing drugs for colonoscopy if colonic obstruction is suspected.