Clofazimine-induced crystal-storing histiocytosis is a rare but well-recognized condition in the literature. Besides the common reddish discoloration of the skin, clofazimine produces gastrointestinal disturbances-sometimes severe abdominal pain, prompting exploratory laparotomy, because pathologic and radiologic findings can produce diagnostic difficulties if the pathologic changes caused by clofazimine are not recognized. The authors report such a case in a leprosy patient to emphasize the importance of history taking, the radiologic abnormalities of the small intestine, and the pathologic findings in small intestine and lymph node biopsies. Clofazimine crystals are red in the frozen section and exhibit bright-red birefringence. However, they are clear in routinely processed histologic sections because they dissolve in alcohol and organic solvents. They also appear as clear crystal spaces during electron microscopic study, but some osmiophilic bodies can be observed. Histiocytosis caused by clofazimine crystals produces infiltrative lesions in radiologic studies mimicking malignant lymphoma or other infiltrative disorders. Associated plasmacytosis in the histologic sections can simulate lymphoplasmacytic lymphoma or multiple myeloma with crystal-storing histiocytosis. With the knowledge of this rare condition caused by clofazimine, appropriate management to avoid an unnecessary laparotomy is possible.

While both WBIS and SBIS can be used to track relative ECF volume changes in HD patients, they are not accurate in quantifying changes in ECF volume. More studies are needed to evaluate the benefit of SBIS over WBIS in clinical practice.

Prednisolone metabolism is slower in solid-organ transplant recipients than in healthy subjects. The slower metabolism of prednisolone, particularly in liver recipients, may help explain the immunologic effectiveness of low-dose prednisone regimens in these patients.

Significant proteinuria as measured by quantitative collection techniques is often present in excellent cadaver kidney donors and is not detected by dipstick testing. It may be a marker of important terminal pathophysiologic events and deserves further study.

Data on cardiac arrhythmia and electrolyte changes during the dialysis cycle have been limited. Fifty-two hemodialysis (HD) patients underwent 48-h Holter monitoring during early-week and mid-week HD sessions. Pre-HD and post-HD blood samples were collected in both HD sessions. The 48-h Holter data were divided into five phases: (1) 4-h during the early-week HD (HD1), (2) 12-h post-HD1, (3) 16-h period between Phases 2 and 4 (used as the patient's baseline electrocardiography [ECG]), ( 4) 12-h pre-HD2 phase, and(5) 4-h during the mid-week HD (HD2). The patients' mean age was 68.54 ± 13.37 years. We found that the dialysate-to-serum[K] gradient and changes of S[K] were significantly higher in HD1 than in HD2, as well as changes of S [Mg]. There were no significant ECG changes during the 4-h HD1 and HD2 when compared with the baseline ECG. Phase 2 of Holter ECG was the most common phase that showed significant changes (increased QT interval dispersion (QTD), increased ventricular events, increased number of premature ventricular contractions, ST elevation and ST depression), which was contributed from the dialysate[K] 2 mmol/L subgroup, but not the dialysate[K] 3 mmol/L subgroup. In the subgroup of patients with a high ultrafiltration rate (UFR; mean UFR ≥10 mL/kg/h), there were significantly increased ventricular events and ST-segment changes in Phase 2. In conclusion, ECG changes were associated with the dialysis cycle, significantly in the 12-h after early-week HD sessions. These may be associated with low dialysate [K] or high dialysate-to-S[K] gradient, high ultrafiltration rate and duration of the interdialytic interval.

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Objective: The primary objectives were: 1) to study the impact of Qd (500 vs 800 ml/min) on the delivered dose by reused dialyzers, and 2) to determine dialysis efficiency of a dialyzer reused 15 times.Materials and Methods: A prospective randomized-controlled crossover study was conducted in 42 thrice-weekly hemodialysis (HD) patients (630 HD sessions in each Qd). Delivered doses at both Qds were assessed by single-pool Kt/V (spKt/V), equilibrated Kt/V (eKt/V) and online clearance monitoring Kt/V (Kt/VOCM), measured at mid-week HD session using a new dialyzer and then again at every mid-week HD session.Results: Although the spKt/V in HD sessions using new dialyzers at Qd of 500 ml/min was slightly lower than spKt/V at Qd of 800 ml/min (2.19±0.08 vs. 2.34±0.08, respectively, P=0.04), when accounting for urea rebound as assessed by eKt/V and Kt/VOCM, there was no significant difference. The average delivered doses in dialyzers reused 15 times, with the mean average of spKt/V, eKt/V and Kt/VOCM at Qd 500 ml/min, were not significantly inferior to the delivered doses at Qd 800 ml/min. Reusing a dialyzer 15 times did not decrease dialysis efficiency and delivered doses in all HD sessions reached spKt/V >1.4.Conclusion: Increasing Qd over 500 ml/min for modern dialyzers does not significantly increase delivered dose of dialysis. Dialyzer reuse does not affect dialysis efficiency and provides adequate dialysis therapy.

Objective: To compare LUS with other volume assessment methods, and to verify the prognostic value of LUS in Thai chronic HD patients. Materials and Methods: We conducted a prospective cohort study in 36 chronic HD patients. Volume status before the HD session was evaluated by physical examinations, bioimpedance analysis (BIA), and ultrasound lung comets (ULCs). Mortality and morbidities were recorded during a 1-year follow-up period. Results: The degree of lung fluid accumulation was assessed by summation of the number of ULCs, and was classified into 3 groups: mild-to-moderate (ULC<15–29), severe (ULC=30–59), and very severe (ULC>60) in 11.1%, 77.8%, and 11.1% of the patients, respectively. Either clinical edema or lung crackle had low sensitivity (20-32%) to detect extravascular lung water excess in patient with mild-to-moderate ULC and severe ULC. Overhydration assessed by BIA was found in 75% and 64.3% of patients with mild-to-moderate and severe ULC, respecively.  In patients with very severe ULC, the admission rate due to volume overload was significantly higher, there was also a trend of increased mortality, as well as intradialytic complications. Conclusion: Clinical assessment and BIA have limited value in determining extravascular fluid excess in the lung. Lung ultrasound is a useful tool to detect subclinical pulmonary congestion. The long-term outcome by using LUS-guided fluid management needs larger population studies.