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BackgroundThe aim of the present prospective observational study was to assess the tolerability and antihyperglycemic efficacy of metformin extended-release (MXR) in the routine treatment of patients with type 2 diabetes mellitus (T2DM) from six Asian countries.MethodsData from 3556 patients treated with once-daily MXR for 12 weeks, or until discontinuation, were analyzed.ResultsTreatment with MXR was well tolerated, with 97.4% of patients completing 12 weeks of treatment. Only 3.3% of patients experienced one or more gastrointestinal (GI) side-effects and only 0.7% of patients discontinued for this reason (primary endpoint). The incidence of GI side-effects and related discontinuations appeared to be considerably lower during short-term MXR therapy than during previous treatment (mean 2.71 years’ duration), most commonly with immediate-release metformin. A 12-week course of MXR therapy also reduced HbA1c and fasting glucose levels from baseline.ConclusionsThe present study provides new insights into the incidence of GI side-effects with MXR in Asian patients with T2DM and on the tolerability of MXR in non-Caucasian populations. Specifically, these data indicate that once-daily MXR not only improves measures of glycemic control in Asian patients with T2DM, but also has a favorable GI tolerability profile that may help promote enhanced adherence to oral antidiabetic therapy.

Phosphatidylcholine (PPC) and sodium deoxycholate (DC) injections have been used cosmetically to reduce localized fat, but to date, few studies have addressed the histological effect of human fat tissue following injections of PPC and DC. We injected PPC and DC mixed with normal saline into the patient's abdominal area. Examinations of postinjection tissue revealed marked changes within the subcutaneous fat. We observed important microscopic evidence of substitution of fat by fibrosis, marked inflammatory infiltration with microabscess formation in the dermis, and septal and lobular panniculitis with thick fibrous septa. Fat necrosis with microcalcification and cyst formation were observed in the subcutaneous fat. Fibroid necrosis with extravasation was noted in the small vessels around fat necrosis. Therefore, careful use of PPC and DC is recommended when patients want to cosmetically reduce localized fat.

Eosinophilic gastroenteritis (EG), as originally described by Kaijser in 1937, is an uncommon inflammatory disease characterized by eosinophilic infiltration of the gastrointestinal tract without evidence of known causes of eosinophilia (1). There are rare presentations of mesenteric lymph node involvement and recurrent diarrhea in Korea, and there is no agreed specific therapy for EG. Herein, we present a rare case of EG.A 58-year-old woman presented with a history of recurrent diarrhea, abdominal pain, and weight loss (5 kg in 2 weeks). Her past medical history revealed irritable bowel syndrome (IBS). She was admitted because of intractable watery diarrhea. She was treated with IBS medication (antispasmotic agent and antianxiolytics) and antidiarrheal agents. However, her symptoms had worsened. She had no family history of allergic diseases. Her physical examination was unremarkable. Laboratory tests revealed a WBC count of 8680/mm 3 and an eosinophil count of 1970/mm 3 (22.7%). The serum IgE level was 254 kU/L (normal: 0-25 kU/L). Stool examination for parasites and the allergy test were negative, including the MAST test. Endoscopic examinations revealed chronic atrophic gastritis. Abdominal pelvic CT revealed reactive changes, including above and below 1 cm-sized multiple mesenteric lymph node enlargements in the entire abdominal cavity (Figure 1). Colonoscopy revealed endoscopic features of colitis, including mucosal edema, loss of vascularity, and focal hyperemic change in the IC valve area. Multiple colonic biopsies revealed active inflammatory reactions with remarkably increased eosinophils in the lamina propria, and occasionally, the muscularis mucosa, which were consistent with EG (Figure 2). Before the use of steroids, a tricyclic antidepressant and a selective serotonin reuptake inhibitor was added to her treatment. After this, her symptoms improved and diarrhea stopped. Thus, steroid therapy was not required in this case. We administered the regimen for 4 weeks, and the patient promptly responded; the serum IgE level decreased to 99.2 kU/L. Turk

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