A Case of Urinothorax in Autosomal Dominant Polycystic Kidney Disease Hemodialyzed / 대한신장학회잡지

Urinothorax is rare cause of pleural effusion. Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. It has been reported in patients with trauma, malignancy, kidney biopsy and renal transplantation. Most cases are diagnosed retrospectively by promt resolution of symptoms after relief of urinary obstruction. But diagnosis can be made based on clinical suspicion, radiological findings and biochemical analysis of the effusion and most important finding is the pleural level of creatinine is higher than the serum level. We experienced right pleural effusion in autosomal dominant polycystic kidney disease hemodialyzed. The patient had right urinoma in the retroperitoneal space before pleural effusion developed. After 3month, he complained acute dyspnea. There was no effect in resolving effusion by lowering dry weight. We thought alternative diagnostic possibility, urinothorax and checked the pleural fluid to serum creatinine ratio. Finally concluded that pleural effusion was urinothorax secondary to remnant left polycystic kidney rupture and tried left nephrectomy. The patient showed reduction of pleural effusion. It is important to alert physician to this condition and to avoid the other invasive diagnostic study.

A Phase II Study with Vinorelbine and Carboplatin in Patients with Advanced Non-small Cell Lung Cancer / 대한암학회지

PURPOSE: To evaluate the efficacy and safety of vinorelbine and carboplatin in advanced non- small-cell lung cancer (NSCLC). MATERIALS AND METHODS: Between August 1998 and July 1999, 25 patients were enrolled. The median age was 68 (range, 46~77) years and male:female ratio was 23:2. Two patients had stage IIIa, 15 had stage IIIb and 8 had stage IV. Sixteen patients had ECOG performance status of 0 or 1 and 9 had 2 or 3. Sixteen patients had squamous cell carcinoma, 8 had adenocarcinoma and 1 had undifferentiated NSCLC. Treatment consists of intravenous carboplatin 400 mg/m2 on day 1 and vinorelbine 25 mg/m2 on days 1 and 8. The treatment was repeated every 28 days. RESULTS: Twenty-three of 25 patients were evaluable. Partial response were observed in 11 patients. The overall response rate was 48% (95% confidence interval: 27~69%) and the median response duration was 19 (range 7 ~44 ) weeks. The median survival of 25 patients was 52 (range 3~53 ) weeks. Toxicities were evaluated by WHO criteria. During a total of 108 cycles, granulocytopenia worse than WHO grade 3 occurred in 2%, thrombocytopenia in 4% and anemia in 10%, respectively. Treatment-related death occurred in 1 patient due to sepsis during cytopenic period. Non-hematologic toxicity was minor and easily controlled. CONCLUSION: A combination chemotherapy of intravenous vinorelbine and carboplatin has relatively high activity with acceptable toxicities in patients with advanced NSCLC.

A Case of Subclavian Vein Obstruction in a Patient with Hemodialysis / 대한신장학회잡지

Subclavian and internal jugular vein catheters are widely employed for temporary hemodialysis access. Placement of subclavian venous catheter has many complications such as pneumothorax and hemothorax, etc. Incidence of subclavian vein obstruction due to thrombosis is probably greater than is commonly appreciated. Subclavian vein obstruction may cause no specific complaints, but thrombosis in the presence of an arteriovenous fistula may produce severe symptoms such as massive edema and pain. This is report of one patient, who developed massive edema of upper extremity and in whom proximal subclavian vein occlusion developed after previous percutaneous dialysis catheter. Right internal jugular vein to axillary vein bypass with 8mm PTFE provided prompt and effective venous outflow, with complete resolution of venous engorgement of the affected limb and preservation of the dialysis fistula.

A Case of Pichia ohmeri Fungemia Related to the Central Venous Catheter / 감염

Pichia ohmeri is a very rare pathogen of human infection. To date, two cases of P. ohmeri infection were reported worldwide. We have experienced a case of catheter-related P. ohmeri fungemia. The patient had been admitted due to cerebrovascular accident in rehabilitation center since August 1998. He had been bedridden due to previous cerebrovascular accident and undergone several episodes of nosocomial infection. Multiple antimicrobial agents had been used with central venous catheter for parenteral nutrition. On February 1999, he had developed fever and dyspnea. Vancomycin and imipenem were administered empirically and central venous catheter was removed on the impression of central venous catheter related infection. Blood culture and catheter tip culture grew P. ohmeri. He developed septic shock and finally led to death before the administration of amphotericin B.