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Background & Objectives: MS is not only a demyelinating disease of central nervous system, but it also affects cortical and deep gray matter (GM). Furthermore, it causes axonal damage in the brain and spinal cord through inflammation and axonal degeneration. It is mostly seen between the ages of 20 and 40 and prevalence of the disease is higher among females than males. In the present study, we measured different parameters in the brains of patients with multiple sclerosis (MS) and healthy controls in both genders to determine the amount of brain atrophy quantitatively in MS patients., Methods: We used T2-weighted MRI scans of 40 MS patients (25 females + 15 males) with clinically definite relapsing-remitting multiple sclerosis that was determined according to Poser criteria in multiple parts of the brain, and we compared these data with those of sex-matched healthy controls in the same numbers., Results: Wideness of the lateral and third ventricles and the volumes of cerebral sulci in MS patients were significantly increased compared to both male and female controls. Brain width, corpus callosum area and the total brain/cerebellum + brain stem volumes of MS patients were decreased considerably., Interpretation & Conclusions: The present measurements indicated that MS caused parenchymal destruction in the cortex, axonal degeneration and myelin loss in the white matter of the brain. Consequently, the current observations correlate well with worsening disability in MS patients., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Acute kidney injury (AKI) is a common complication in the early period of lung transplantation (LTx). We aimed to describe the incidence and perioperative risk factors associated with AKI following LTx., Methods: Clinical data of 30 patients who underwent LTx were retrospectively reviewed. Primary outcomes were development of AKI and patient mortality within 30 postoperative days. Postoperative AKI is determined based on creatinine criteria from Acute Kidney Injury Network (AKIN) classification. Secondary outcomes included the association between AKI and demographic and clinical parameters of patients and treatment modalities in the pre- and postoperative periods., Results: Of the 30 LTx recipients included, AKI occurred in 16 patients (53.4%) within the first 30 days. Length of intensive care unit (P = .06) and hospital stay (P = .008) and mechanical ventilation duration (P = .03) were significantly higher in patients with AKI compared with patients without AKI. Factors independently associated with AKI were intraoperative hypotension (odds ratio [OR] 0.500; 95% confidence interval [CI], 1.145 to 26.412, P = .02), longer duration of mechanical ventilation (OR 1.204; 95% CI 0.870 to 1.665, P = .03), and systemic infection (OR 8.067; 95% CI 1.538 to 42.318, P = .014) in the postoperative period. Short-term mortality was similar in patients with and patients without AKI., Conclusion: By the AKIN definition, AKI occurred in half of the patients following LTx. Several variables including intraoperative hypotension, longer duration of mechanical ventilation, and systemic infection in the postoperative period independently predict AKI in LTx recipients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Right heart catheterization (RHC) remains the gold standard to diagnosis of pulmonary hypertension among lung transplantation candidates. Doppler echocardiography (DE) may be as accurate as RHC, without risks of an invasive test. The aim of the study was to assess the feasibility of DE for the measurement of pulmonary artery pressure in lung transplantation candidates and the correlation between pulmonary artery pressures estimated by DE versus measured by RHC., Methods: A total of 103 lung transplantation candidates undergoing DE who were scheduled to undergo RHC within 72 hours were analyzed. The performance characteristics of DE were compared with RHC, and correlation analysis was performed to determine the correlation of pulmonary pressures obtained by DE versus measured by RHC., Results: The prevalence of pulmonary hypertension was 57% in lung transplantation candidates. Of the 103 candidates, evaluation of pulmonary artery systolic pressure (PASP) by DE was possible in 92 (89%). Median PASP by RHC was 45 (12-145) mm Hg and by DE 45 (20-144) mm Hg. There was a positive correlation between PASP estimated by DE and measured by RHC (r = 0.585, P < .0001). Sensitivity, specificity, and positive and negative predictive values of PASP estimation for diagnosis of pulmonary hypertension were 85%, 67%, 87%, and 61%, respectively., Conclusions: There is a strong positive correlation between PASP estimated by DE compared with measured by RHC with an acceptable sensitivity and specificity in detecting pulmonary hypertension. Echocardiography can be recommended for measuring pulmonary pressures in lung transplantation candidates., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Osteoporosis is a well-recognized complication in lung transplantation because of steroid use and immobilization. The aim of the study was to assess the prevalence of osteoporosis and risk factors associated with osteoporosis in lung transplantation candidates., Methods: The bone mineral density of 174 patients with various end-stage lung diseases was assessed at the pretransplantation period. Osteoporosis risk factors were analyzed with the consideration to principal diagnosis, demographic, and clinical parameters of lung disease, lung function tests and mobility test (6-minute walking test). A multivariate analysis was conducted to determine various demographic and clinical risk factors associated with bone mass loss in the pretransplant period., Results: The prevalence of osteoporosis and osteopenia was 46% and 35%, respectively, in the study population. Osteoporotic patients have lower body mass index and lower 6-minute walking distance than patients without osteoporosis. In addition, they have higher pulmonary artery pressure and history of noninvasive mechanical ventilation than in patients without osteoporosis. There was a significant negative correlation between the 6-minute walking test, body mass index, and the presence of osteoporosis in the study population. Multivariate logistic regression analysis confirmed that 6-minute walking test (odds ratio, 0.996) and body mass index (odds ratio, 0.847) were significantly and negatively correlated with the presence of osteoporosis., Conclusions: A significant proportion of patients with end-stage lung diseases have osteopenia or osteoporosis pretransplantation. This is the first study to demonstrate that 6-minute walking distance and bone mineral density independently predict osteoporosis in lung transplant candidates., (Copyright © 2016 Elsevier Inc. All rights reserved.)

A 57-year-old woman with severe bilateral bronchiectasis was evaluated for lung transplant. She was 148 cm tall and weighed 46 kg. Her FEV(1) was 0.63 liters (32% of predicted). Her PAO(2) was 64.6 mm Hg, and her Pa(CO2) was 44 mm Hg. All of her cardiac functions were within normal ranges. Her mean pulmonary arterial pressure was 32 mm Hg. She had no infections and no other systemic diseases. She was psychologically well and eager to undergo the lung transplant. She underwent a bilateral brain dead donor lobar lung transplant. After the recipient pneumo-nectomies had been performed, bilateral lower lobes were implanted sequentially. She was given extracorporeal membrane support during the operation. Her postoperative course was uneventful. Chest drains were removed after 8 days. She went to the general ward on the fifth postoperative day, and was discharged on the 15th day. As of this writing, she has had no problems through the ninth month follow-up. To the best of our knowledge, she is the first case of successful bilateral brain dead donor lung transplant in our country.

The chitosan scaffold, which has both of anticancer and antivascularization effects, was developed for using in local therapy of brain tumours. This is why, poly-lactic-co-glycolic acid (50:50) nanoparticles (~200 nm) including an anticancer drug, 5-fluorouracil (5-FU), were prepared by emulsion-solvent evaporation method. Then, these nanoparticles and antivascularization agent, bevacizumab, were loaded into the scaffold during manufacturing by freeze-drying and embedding after freeze-drying, respectively. The idea behind this system is to destroy tumour tissue by releasing 5-FU and to prevent the proliferation of tumour cells by releasing bevacizumab. In addition, 3D scaffold can support healthy tissue formation in the tumourigenic region. In vitro effectiveness of this system was investigated on T98G human glioblastoma cell line and human umbilical vein endothelial cells. The results show that the chitosan scaffold containing 100 µg 5-FU and 100 µg bevacizumab has a potential to prevent the tumour formation in vitro conditions.

Autosomal-dominant polycystic kidney disease is an inherited disorder characterized by the development and growth of cysts in the kidneys. Urinary protein excretion is generally less than 1 g/day, and the association of the nephrotic syndrome with this condition is considered rare. A 39-year-old man with autosomal-dominant polycystic kidney disease and nephrotic-range proteiuria is described. During admission, he had general edema and a diagnosis of pulmonary tuberculosis. The patient had hyperlipidemia, hypoalbuminemia, and 11.8 g/day proteinuria. The gingiva and rectum biopsies were performed in order to evaluate the etiology of nephrotic syndrome, and revealed AA amyloidosis thought to be secondary to pulmonary tuberculosis. We maintained the antituberculous treatment and began colchicine at a dose of 2 g/day and candesartan 8 mg/day. To our knowledge, this is the first autosomal-dominant polycystic kidney disease case with nephrotic syndrome due to amyloidosis secondary to pulmonary tuberculosis.

Background: The aim of this study was to investigate the factors influencing the morbidity and mortality of the non-small cell lung cancer (NSCLC) cases where pneumonectomy was performed., Material & Methods: All 101 patients who had underwent a pneumonectomy for NSCLC between 1994-2001 in our hospital were included in the retrospective study. There were 97 males and 4 females with a mean age of 56+/-9.6. Factors affecting morbidity and mortality were analysed by univariate and multivariate analysis., Results: The morbidity rate was 53% and the mortality rate was 9%. Morbidity was related to cardiopulmonary complications in 40% of the cases. The risk factors for cardiopulmonary morbidity with univariate analysis were age > 60 years (p = 0.004), FEV1 < 2 lt (p = 0.016), early bronchopleural fistula (p = 0.0001), tumour size > 4 cm (p = 0.033), vital capacity < 3.7 lt (p = 0.016), forced vital capacity < 3.5 lt (p = 0.033).. With multivariate analysis the risk factors cardiopulmonary morbidity were age (60 >) (p = 0.012) and tumour size > 4 cm (p = 0.043). The risk factors mortality with univariate analysis were right pneumonectomy (p = 0.025), respiratory morbidity (p = 0.0001), cardiac morbidity (p = 0.002), cell type (Epidermoid CA) (0.047), tumour size > 6 cm (p = 0.036), fluid infusion (p = 0.009), forced vital capacity < 78% (p = 0.039), forced expiratory volume in 1 second < 75% (p = 0.039), PO2 (p = 0.037), PCO2 > 42 mmHg (p = 0.023)., Conclusion: Among the pneumonectomies performed for NSCLC, the causes of postoperative morbidity were multifactorial, however, multivariate analysis did not show any significant factor affecting the mortality, related to this procedure.

We assessed the effect of intravenous high-dose methylprednisolone (IVMP) on cerebral reactivity in multiple sclerosis (MS) patients during exacerbations by means of functional transcranial Doppler imaging. Forty-eight clinically defined MS patients were evaluated with visual evoked potentials (VEP) and functional transcranial Doppler sonography (TCD) of both posterior cerebral arteries before and after 5 days of 1000 mg IVMP. After treatment, mean Expanded Disability Status Scale score, mean blood flow velocities and mean blood flow velocities at rest and at stimulation, significantly decreased (p < 0.0001, for each). The change in cerebral blood flow velocity ratio (CBFv) with visual stimulation after treatment increased slightly (p = 0.20). All TCD parameters were not significantly correlated with VEP changes. In conclusion, we observed significant changes in CBFv with a non-significant increase in vascular reactivity after treatment with IVMP in exacerbations of MS. Case-control studies are necessary to draw conclusions regarding the beneficial effects of IVMP treatment.

The nerves entering into the coracobrachialis muscle are the musculocutaneous nerve (MC) and the nerve (usually consists of several thin branches) branches to the coracobrachialis. These thin branches enter the coracobrachialis proximal to the MC. The thin branches and the MC are susceptible to injury during coracoid process transfer. The purpose of this study is (1) to reveal the number and origin of the thin branches and (2) especially to report the morphometric information about the two distances between the coracoid process and the points where the first thin branch and the MC enter the coracobrachialis. These distances were named as the "distance T1" and the "distance D," respectively. Forty-two cadaver upper extremities were used and the distance between the coracoid process and the medial epicondyle of the humerus as the "arm length" was measured. The "ratio T1" was calculated by dividing the distance T1 by the arm length. The "ratio D" was calculated by dividing the distance D by the arm length. The number of the thin branches varied between one and four. In the most common type, there were two thin branches (45%). All of the thin branches originated from the MC. The mean distance T1, distance D and arm length were found as 41.5, 62 and 304.5 mm, respectively. The mean ratio T1 and ratio D were determined as 0.13 (approximately 1/8) and 0.20 (=1/5), respectively. The findings about the number and origin of the thin branches may contribute to the anatomy of the nerve to the coracobrachialis. The shoulder surgeon may calculate the predicted distance T1 and distance D of any upper extremity, dividing its arm length by eight and five, respectively.

The most superior part of the superficial layer of the supinator muscle is named as the arcade of Frohse (AF). The deep branch of the radial nerve runs under this arch. The AF is reported to be the most common structure causing entrapment neuropathy of the deep branch of the radial nerve. The aim of our study was to reveal the anatomical properties and especially morphometric measurements of the AF in cadavers. This study was performed on 55 cadaver upper extremities. The AF was classified macroscopically as either tendinous or membranous. The width, length and thickness of the AF were measured as the dimensions of the AF. The "distance AF" between the lateral epicondyle of the humerus and the AF was measured. The "forearm length" between the lateral epicondyle of the humerus and the styloid process of the radius was measured. The distance AF was divided by the forearm length to find the "ratio AF". In 87% of the extremities the AF was tendinous, and in 13% it was membranous. The mean width, length and thickness of the AF were 10.13, 8.60 and 0.77 mm, respectively. The mean distance AF and forearm length were 46.23 and 233.17 mm, respectively. The mean ratio AF was 0.199 (approximately 1/5). These measurements of the dimensions of the AF may contribute to the anatomy of the AF. The surgeon may find the predicted distance AF of any upper extremity by dividing its forearm length by 5.

Hyperhomocysteinemia is as a risk factor for increased vascular disease in l-dopa-treated Parkinson disease (PD) patients. This effect of l-dopa is associated with the metabolism of l-dopa by methylation. This study aimed to assess the effect of pergolide on plasma homocysteine levels. Plasma homocysteine levels were compared between PD patients treated with pergolide as monotherapy, with l-dopa as monotherapy, or with an l-dopa and pergolide combination and compared with controls. Plasma homocysteine levels were significantly higher in the l-dopa monotherapy group, and there were no significant differences for the pergolide treatment groups. Pergolide can be beneficial for increased plasma homocysteine levels.

Background: Positron emission tomography (PET) scan is an imaging technique which relies on metabolic properties of the lesions. In this study, we evaluated the potential contribution of PET for thoracic malignancy in a consecutive series of patients presenting with multiple lesions or equivocal diagnosis., Methods: PET with 2-18 F fluorodeoxyglucose (FDG) was carried out in 41 patients. The diagnosis was primary intrathoracic malignancy in 22 (Group 1). On routine staging using CT scan we found 29 additional lesions and assessed these using PET scan. PET was performed to evaluate the number of metastatic lesions in the lung in 11 (Group 2), to characterise undiagnosed pathology in the chest in 4 (Group 3), to search clinically suspicious extrathoracic spread in 4 patients with known intrathoracic malignancy., Results: In Group 1, the sensitivity and specificity of PET was 81.2% and 92.3%. The accuracy of PET in the confirmation of metastatic disease to the chest was 73%. PET was falsely positive in a patient with chronic inflammatory disease in Group 3 and highly accurate to characterise unknown pathology in Group 4., Conclusions: Even though infection may cause false positive results, PET is a useful imaging technique for the evaluation of patients with thoracic tumours.