Recovery of Symmetrical Peripheral Gangrene of Limbs in a Patient After Performing Hemoadsorption in Septic Shock.

We report a 42-year-old patient who had Hodgkin lymphoma and developed bilateral symmetrical peripheral gangrene (SPG) in the feet and hands, which occurred during septic shock after autologous hematopoietic stem-cell transplantation. SPG is a rare but severe complication of disseminated intravascular coagulation (DIC) and is frequently associated with sepsis. The pathophysiology of SPG includes DIC-mediated intravascular thrombosis and thrombotic occlusion of microcirculation, resulting in low blood flow. Sepsis-induced hypotension has been suspected as one of the other causes of SPG, and it is thought to be aggravated by vasopressor treatments given for hypotension. Our patient first experienced coldness, paleness, and cyanosis in his body's acral parts, and then SPG later developed in both his feet and hands. Septic shock management was performed with cytokine hemoadsorption, broad-spectrum antibiotics, and massive fluid replacement rapidly. The patient fully recovered without the need for amputation. Hemoadsorption is an extracorporeal cytokine-adsorption method for removing excess cytokines. Prompt management of septic shock and early monitoring of peripheral ischemia are essential to avoid SPG.

[The evaluation to relationship between serum vascular endothelial growth factor (VEGF) level, metastases and other tumor markers in patients with lung cancer]. / Akciger kanserli olgularda serum "vascular endothelial growth factor (VEGF)" düzeylerinin metastazlar ve diger tümör belirteçleri ile iliskisinin incelenmesi.

Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis. Increased expression of VEGF may be associated with advanced stage and poor prognosis in patients with lung cancer. We investigated the relationship between serum VEGF level and lung cancer stage. We also studied the correlation between serum VEGF level and some other tumor markers. Forty newly diagnosed lung cancer (31 non-small cell, 9 small cell) patients and 25 age-matched controls were enrolled in this study. Serum VEGF levels of lung cancer group (345.16 +/- 159.36 pg/mL) were significantly higher than that of the control group (230.36 +/- 47.87 pg/mL) (p< 0.001). The area under the ROC curve was 0.727 (p< 0.05) for serum VEGF threshold of 249.8 pg/mL predictive sensitivity and specificity, for lung cancer were respectively 70.0% and 76.0%. There were no significant relationship between serum VEGF level and age, gender, histologic type, lung cancer stage, distant metastases and site of metastases. In addition, there were no correlation between serum VEGF level and other tumor markers (NSE, CYFRA 21-1, CEA, CA125, LDH).