Timing of secondary arteriovenous fistula creation avoids tunneled catheter placement.

The concept of secondary arteriovenous fistula, though not novel, is seldom practiced for lack of initiative or hesitancy in deciding the appropriate timing to abandon the existing access. We report a case illustrating the benefits of implementing the strategy in an elderly diabetic dialysis patient, successfully avoiding a tunneled cuffed catheter placement.

Gynecomastia attributable to human chorionic gonadotropin-secreting giant cell carcinoma of lung.

OBJECTIVE: To describe a patient with human chorionic gonadotropin (hCG)-secreting giant cell carcinoma of the lung manifesting as painful gynecomastia, which resolved after surgical treatment. METHODS: We present the clinical, radiologic, and clinical course of our patient, who presented with painful gynecomastia. RESULTS: A 51-year-old man presented with a lung mass and rapidly progressing bilateral painful gynecomastia. Hormonal evaluation revealed high levels of hCG beta subunit, estradiol, and total and free testosterone and suppressed levels of luteinizing hormone and follicle-stimulating hormone. The patient underwent resection of the right upper and middle lobes of the lung. After the surgical procedure, the levels of hCG and estradiol rapidly decreased, and the gynecomastia resolved completely within 3 months. Fluctuation in the levels of serum hCG paralleled the clinical course of the lung tumor. CONCLUSION: Although gynecomastia is a common disorder, hormonal work-up including hCG beta subunit should be done in an adult male patient presenting with rapidly progressing or recent onset of painful gynecomastia. Lung cancer should be considered in the differential diagnosis of gynecomastia attributable to ectopic production of hCG beta subunit.