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Background/aim: Dyspnea is the subjective feeling of breathing discomfort, which is a significant problem for patients with heart and respiratory disease and also an important determinant of exercise tolerance, quality of life, and mortality in various diseases. Most of the scales are not enough to investigate the multidimensional effects of dyspnea; therefore, the Multidimensional Dyspnea Profile (MDP) was developed and validated in many languages. This study aimed to translate and culturally adapt the MDP into Turkish and investigate the psychometric properties of this adapted version in outpatients with respiratory disease., Materials and Methods: The MDP was translated and culturally adapted into Turkish following published guidelines. A total of 170 outpatients with respiratory disease were included to assess psychometric properties. The factorial structure was investigated using a principal component analysis. Two situations were used in this study evaluating dyspnea in activity-related and resting conditions. We formulated 17 hypotheses for each MDP domain (in total 68) to assess construct validity, and correlations were investigated between the MDP and measures of body mass index, pulmonary function test, other dyspnea assessments, anxiety, depression, and health-related quality of life. To investigate the test-retest reliability, the MDP was administered again after 1-h and 1 week, Results: Internal consistency of the MDP was excellent (Cronbach’s alpha coefficients ranged from 0.89 to 0.93). The exploratory factor analysis revealed 2 components explaining a 70% and 76% variance. Overall, 64 of the 68 predetermined hypotheses (94%) were confirmed to test construct validity. The MDP showed excellent test-retest reliability for a 1-hperiod (intraclass correlation coefficient values ranged from 0.98 to 0.99). However, test-retest reliability decreased moderate-to-high after 1 week (0.53–0.80)., Conclusion: The MDP was successfully translated and culturally adapted into Turkish and this version showed good psychometric properties including the factorial structure, internal consistency, test-retest reliability, and construct validity to assess multidimensional aspects of dyspnea., Competing Interests: All authors report no conflict of interest that may have influenced either the conduct or the presentation of the research., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: The aim of the study was to compare the different surgical approaches of two centers on outcomes of live donor laparoscopic nephrectomy., Material and Methods: The first 98 patients of each centre who underwent laparoscopic donor nephrectomy (LDN) or hand-assisted laparoscopic donor nephrectomy (HALDN) were included in the study. The following data were used for analyses: donor age, weight, height, body mass index (BMI), transfusion requirement, operative time, ischemia time and postoperative complications., Results: Median age, BMI, operation time and estimated blood loss (EBL) was 47.29 years, 27.91 kg/m 2 , 110.73 minutes, and 78.95 mL, respectively. Operation time was significantly shorter in the HALDN group (t=-3.554, p<0.01). EBL was not significantly different between the two groups. The difference in hospitalization time and warm ischemia times (WIT) was not significant between the two surgical technique groups (t=-1.554, t=1.258; p>0.05). No statistically significant difference was detected in the intraoperative and postoperative complication rates between two groups (p>0.05). The postoperative complication rate was 7.14% (n=7) and 6.12% (n=6) in the LDN and HALDN groups, respectively. There were two patients with conversion to open surgery in the HALDN group because of lumbar vein injury., Conclusion: The operative and postoperative outcomes for the two techniques were found to be similar. The HALDN technique preserves the benefits of minimally invasive surgery. In experienced urologic laparoscopy centres both techniques promise similar success rates.

Objective: Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH., Methods: Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer., Results: There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05)., Conclusion: Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

Background/aim: The aims of the present study were to assess the relationship between the distance walked during the 6-min walk test (6MWT) and exercise capacity as determined by cardiopulmonary exercise testing (CPET) in patients with pulmonary arterial hypertension (PAH) and to investigate the prognostic value of the 6MWT in comparison to clinical parameters of CPET and echocardiography findings., Materials and Methods: Thirty PAH patients participated in the study. Subject characteristics and New York Heart Association (NYHA) classifications were recorded. All subjects completed the 6MWT and CPET. Relationships among the variables were analyzed by the Pearson correlation test. Correlation coefficients between 6MWT distance and other variables were determined by linear regression analysis., Results: Distance walked in the 6MWT was significantly correlated with the following exercise parameters: peak oxygen consumption, work load, and metabolic equivalents. Additionally, cardiac index was correlated with peak oxygen consumption and metabolic equivalents. We also showed that cardiac index and age were two significant determinants for exercise performance, accounting for 35.4% of the variance in the 6MWT., Conclusion: The 6MWT provides information that may be a better index for the patient's NYHA functional class determination than maximal exercise testing.

Objectives: Nasal continuous positive airway pressure (nCPAP) treatment is the gold standard treatment for obstructive sleep apnea syndrome (OSAS). In this study, we aimed to show that the pulmonary functions, exercise limitation on the cardiopulmonary exercise test (CPET), and the health-related quality of life can be improved after a short treatment period by nCPAP., Materials and Methods: Our case group with severe obstructive sleep apnea (OSA) performed incremental CPET before and after 8 weeks of nCPAP treatment. All the subjects also underwent physical examination, body composition analysis, simple spirometric measurements, maximal inspiratory pressure (PImax)-maximal expiratory pressure (PEmax), and lung volume tests before and after nCPAP treatment., Results: Thirty-one patients (4 female, 27 male) completed the study. The mean age of the patients was 53.41 ± 1.46 years. Sixteen had at least one comorbidity. In addition, 17 of the subjects were ex-smokers. After nCPAP treatment for 8 weeks, higher PImax-PEmax (p< 0.05), peak oxygen uptake (p= 0.001), workpeak (p= 0.000), maximal heart rates (p= 0.000), and short form-36 scores (p< 0.05) were observed. nCPAP treatment helped control the blood pressure (p= 0.005). There was no significant change in body composition analysis, spirometric parameters, and lung volumes., Conclusion: In a short time period, nCPAP can improve exercise capacity, respiratory muscle strength, and the health-related quality of life scores and help control blood pressure., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: To evaluate the prognostic value of baseline neutrophil-to-lymphocyte ratio (NLR) in the prediction of long-term mortality in patients with pulmonary arterial hypertension (PAH)., Methods: This prospective study recorded NLR during initial diagnostic right-sided cardiac catheterization in adult patients with PAH. Demographic, clinical, laboratory and haemodynamic variables were compared by NLR tertile. Univariate and multivariate Cox regression analyses were used to determine whether NLR was independently associated with mortality., Results: Adults with PAH (n = 101) were followed-up for mean ± SD 36.8 ± 23.6 months. The number of deaths, New York Heart Association functional capacity (NYHA FC), levels of brain natriuretic peptide (BNP) or C-reactive protein (CRP) and presence of pericardial effusion increased as the NLR tertile increased, but haemoglobin and tricuspid plane annular systolic excursion (TAPSE) decreased. On univariate analysis, high NLR values were associated with mortality, but on multivariate analysis, NLR did not remain an independent predictor of mortality. Baseline NYHA FC, TAPSE, BNP level and pericardial effusion were independent predictors of mortality., Conclusions: NLR was correlated with important prognostic markers in PAH such as NYHA FC, BNP and TAPSE. This simple marker may be useful in the assessment of disease severity in patients with PAH., (© The Author(s) 2015.)

Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

Lithium remains to be the gold standard in the treatment of mood disorders. This study presents a case treated with lithium for an extended period with a good response. Following an increase in creatinine levels, further investigation of renal dysfunction revealed polycystic kidney disease. Lithium was used prior to the diagnosis of polycystic kidney disease, resulting in the unique opportunity to examine the effects of lithium on kidneys with polycystic kidney disease. Within this context, this study also discusses the pharmacokinetics of lithium, and its possible relation to cyst formation in polycystic kidney disease.

Introduction: The aim of this study is to assess the opinions of relatives about telling the lung cancer diagnosis to the patient and evaluate the implementation in our hospital., Materials and Methods: A survey questionnaire was designed, and applied on nurses and physicians working in oncology care units, 4th-6th grade medical students, and relatives of cancer and non-cancer patients., Results: Totally 347 (228 males, 119 females) participants (64 physicians, 100 nurses, 61 medical students, and 122 relatives of patients) with a mean age of 28 were enrolled in the study. 62.5% of doctors, 53.2% of nurses, 59.5% of medical students and 45.9% of relatives of lung cancer patients thought that the patient should be informed about his/her cancer diagnosis. 29.5% of the physicians told their patients about their diagnosis of cancer. Gender, age, abroad experience, academic career, speciality, and period of professional experience were not determined to have any impact on physician's opinion and clinical practices., Conclusion: It was determined that physicians care more about patients' right to be informed than other participating groups. Generally, although physicians agree that the diagnosis of cancer should be told to the patient, their routine clinical practices do not reflect this viewpoint.

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity in the world. Mortality rates vary between 15-54% in investigations. There is a limited number of studies evaluating factors associated with mortality and morbidity in our country. The aim of this study is to detect the mortality rate and to investigate the factors affecting mortality., Patients and Methods: 427 patients with COPD between July 2004-November 2005 were evaluated., Results: Mortality rate was found to be 17.3% at the end of four years. Deaths were most frequently due to pulmonary causes and secondly cardiac factors. Deaths due to lung cancer were 31%. Age, amount of smoking, COPD stage, FEV1 (L), FEV1% predicted, FVC (L), FVC% predicted, FEV1/FVC, PEF (L/sn), PEF% predicted, FEF25-75 (L) and FEF25-75% predicted values, presence of comorbid diseases, Modified Borg Scale and dyspnea severity according to MMRC, six minutes walking test and oxygen saturation following the test, BODE index, SF-36 quality of life questionnaire, physical function, physical role, emotional role and energy scores parameters and all parameters of SGRQ questionnaire were found to be significantly associated with mortality., Conclusion: COPD is a disease with high mortality and is one of the problems related with the public health. In the follow up of COPD, the usage of other measures like exercise capacity and quality of life besides spirometric measures should be encouraged. To make the patients and cases in the risky group conscious of their disease is important since the risk factors are preventable. This method may also contribute to the prevention of comorbid diseases.

Background: The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population., Methods: We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR., Results: Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically important higher Ca2+ levels in the AA990 allele carrying cases than AG990 positive ones (9.3 +/- 1.0 mg/dl vs. 8.8 +/- 0.9, p = 0.006). On the other hand, the expression of CaSR in parathyroid tissue was found inversely proportional with serum PTH level (r = -0.71)., Conclusion: Present data suggest that co-presence of CaSR gene AA990 and CC1011 alleles is a possible risk factor for bad prognosis in secondary hyperparathyroidism. Patients carrying this genotype have tendency to require operation early in their medical therapy period and need postoperative close follow up for possible recurrences.

In Turkey, there is inadequate data about the direct or indirect cost of community acquired pneumonia (CAP). This study aims to identify the clinical, laboratory, and radiological properties, direct hospital costs of CAP, and the factors that affect these costs. Grouping of the subjects and cost analysis were evaluated in accordance with Pneumonia Severity Index (PSI) and 'Turkish Thoracic Society (TTS) CAP Guideline'. 114 cases with an average age of 70.9 were analyzed retrospectively. Average hospital stay was 11.0 +/- 6.6 days. Three of the cases that appeared to be in group IIIb in accordance with TTS CAP Guideline, and that had a PSI score of 102.7 died. Average costs of medicine was 484.59 Euro, radiology costs were 65.38 Euro, laboratory costs were 329.38 Euro and the total cost was 1630.77 Euro. In group IIIb cases, costs of medicine and the total costs were higher than other groups. Radiological, laboratory and the total costs were not determined to be different among cases that did or did not conform to initial treatment guidelines (p> 0.05). There were no effect of gender and advanced age (>/= 65 years) on total cost (p> 0.05). Existence of a comorbid disease was detected to have increased the total cost (p= 0.003). Total costs according to PSI scoring were 1274.60 Euro in low-risk group, and 1929.49 Euro in high-risk group (p= 0.04). Hospital mortality due to CAP was 2.6%.

Totally 48 cases with diagnosed as community-acquired pneumonia who were treated in intensive care units of two different university hospital included to the study. The mean age of cases was 67.8, 29 were males and 19 females. Glasgow Coma Score (GCS), Acute Physiology Assesment and Chronic Health Evaluation II (APACHE II), Pneumonia Severity Index (PSI) and Sequential Organ Failure Assessment Score (SOFA) of 46 cases were determined. The most common comorbid disease was cerebrovascular disease. We determined that microbiological tests were made in 30 cases and pathogen agent was established in 7 cases of them. The mean lenght of stay in hospital and intensive care unit were 16.1 days and 8.8 days respectively. The mean GCS was 11.4, the mean PSI was 130.7 and 38 cases were in high risk classes. The mean APACHE II and SOFA scores were 20.7 and 4.4 respectively. We determined that hypotension and intubation increased the mortality risk. The mean blood urea nitrogen, %PNL and respiratory rate were higher in cases who were died. The mortality rate in group 3b and group 4 were respectively 41.2% and 44.0%. Totally 20 (41.7%) cases died.

Chronic obstructive pulmonary disease (COPD) is an important world health problem and estimated that the prevalance will increase. In early period this disease in symptomatic with cough, sputum and dyspnea. FEV(1)/FVC was greater than 70% in early period and it was accepted as stage 0 (at risk) COPD before the last The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. In last GOLD guideline this stage is excluded. In this study we aimed to find out the clinical differences between this cases and healty population. Prospectively spirometric measures, exercise capacity, dyspnea index, saturation of O2 (SpO2) and life quality are compared between two groups. We evaluated 58 at risk cases and 63 healty adults. There was no difference between two groups about age, sex and smoke cessations. In at risk group 77.6% cough, 53.4% sputum and 62.1% dyspnea were the symptoms. In currently smokers cough and sputum were dominant symptoms however dyspnea was dominant symptom in exsmokers. Absolute FEV1, FEF25-75 values, predicted FEV1/FVC, FEV1, FVC, PEF, FEF25-75% values are lower in at risk group (p<0.05). Mean six minutes walking distance were lower in at risk group but not statistically significant (p>0.05). Dyspnea index before walking were not different between two groups (p>0.05) however dyspnea index after walking and change were higher in at risk group (p>0.05). Resting SpO2, SpO2 after exercise and desaturation with exercise (DeltaSpO2) were lower in at risk group but not statistically significant. Physical and mental components of Short Form 36 (SF36) scores were similar in two groups (p>0.05). COPD at risk group is separated from healty population with chronic respiratory symptoms and inhalation of smoke or other irritans. In these cases spirometric measures are significantly worse although functional parametres are similar with healty population, so it is thought about being a subclinical disease. These cases must be educated about COPD, encouraged about giving up smoking and prevented occurring COPD.

Background/aim: Iron deficiency and lipid metabolism disorders are common health problems. We investigated the relationship between iron deficiency anemia and lipid metabolism in premenopausal women, in whom iron deficiency anemia is not uncommon., Methods: This prospective cohort study was carried out in 64 premenopausal women (median age of 40 years, ranging from 15 to 52) with iron deficiency anemia and 21 non-anemic control women (median age of 38 years, ranging from 28 to 50). Serum ferritin values less than 11 ng/mL and transferrin saturation below 15% were accepted as indicators of iron deficiency. All anemic patients were treated with oral iron replacement., Results: The mean levels of total and low density lipoprotein cholesterol of anemic women were lower than those of non-anemic control patients (173.6 +/- 39.3 vs 205.7 +/- 36.0, P = 0.001, 105.3 +/- 32.7 vs 135.6 +/- 31.3 mg/dL, P < 0.001, respectively). Despite increasing significantly after treatment of anemia (from 173.6 +/- 39.3 to 181.6 +/- 35.2, P = 0.018, from 105.3 +/- 32.7 to 111.3 +/- 29.4 mg/dL, P = 0.029, respectively), their levels were still lower than in the control subjects (181.6 +/- 35.2 vs 205.7 +/- 36.0 mg/dL, P = 0.008, 111.3 +/- 29.4 vs 135.6 +/- 31.3 mg/dL, P = 0.002, respectively). In anemic patients, statistically significant positive correlations were found between the pre-treatment total cholesterol levels and hemoglobin (r = 0.336, P = 0.007), hematocrit (r = 0.326, P = 0.009), serum iron (r = 0.404, P = 0.001), serum ferritin (r = 280, P = 0.026), and transferrin saturation (r = 0.314, P = 0.012). The only significant factor affecting pre-treatment total cholesterol levels was serum iron., Conclusions: We hypothesize that low iron states in premenopausal women may exert an additional protective effect against atherosclerotic heart disease via lipid metabolism.

Nosocomial infections are an important cause of preventable morbidity and mortality; they also result in significant socioeconomic cost. Nosocomial pneumonia (NCP) is defined as pneumonia, which occurs 48 hours after hospitalization or after discharge from the hospital. It is the second or third most frequent infection among all hospital acquired infections, and the mortality of NCP is higher than the other hospital acquired infections. Patients, diagnosed as NCP were retrospectively analyzed in order to detect microbiological agent and prognostic factors. We evaluated 173 patients, 67.0% of them were male and 33.0% female. Comorbid diseases were present in 94.2% and a medical procedure had been applied in 75.1% of cases. A single agent was isolated in 79.2% of the cases while a mixt infection was present in 13.3%. In 7.5% of the cases, cultures were negative. Endotracheal aspirates were the most common materials (38.9%) used for detected microorganism and sputum cultures were used in 16.8% of the cases. Most commonly encountered microorganism were Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus aureus respectively. NCP developed on approximately 18th day of hospitalization. Overall mortality rate was 45.2%. The effects of diabetes mellitus and chronic pulmonary diseases on mortality rate were analized by logistic regression analysis and it's evaluated that the mortality rates increase 3.7 times with diabetes mellitus and 2.4 times with chronic pulmonary diseases. There was no effect of mechanical ventilation history on mortality.

Between 2001-2002; in 62 cases, 33 (53%) male, 29 (47%) female, mean age 51.4 +/- 18.1 years) bronchoalveolar lavage (BAL) was performed for diagnosis of opportunistic pulmonary infection and specimens were evaluated for results of microbiological examinations. There was hematological malignancy in 18 (29%) and solid organ malignancy in 13 (21%) cases. Thirty-one (50%) cases were immunocompromised for reasons other than malignancy. By endoscopic evaluation endobronchial lesion was seen in 2 (3%) cases, indirect tumor signs were seen in 2 (3%) cases and signs of infection were seen in 11 (18%) cases. Forty-even (76%) cases were endoscopically normal. Acid-fast bacilli (AFB) direct examination was positive in 3 (5%) cases. In 4 (6%) cases mycobacterial culture was positive, Mycobacterium tuberculosis-polymerase chain reaction (PCR) was also positive in these four cases. Examination of gram-stained smears for bacteria was associated with infection in 14 (23%) cases. Bacteriologic cultures were positive for single potential pathogen in 10 (16%) cases, and for mixed pathogens in 7 (11%) cases for a total number of 17 (27%). Fungal cultures were positive in 3 (5%) cases all of which had hematological malignancy. As a result in 24 (39%) cases microbiological agent of infection is determined: in four mycobacteria, in 17 bacteria other than mycobacteria and in three fungi.

Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient.

Eosinophilic lung disease is characterised by eosinophilic infiltration of lung tissue besides peripherical blood and bronchoalveolar lavage (BAL) fluid eosinophilia. A 48 year-old male who attended our clinics with cough and sputum lasting for 2-3 months, has been evaluated for micronodular interstitial infiltration bilaterally in all lung areas. Eosinophilia was detected in hemogram but BAL fluid was not diagnostic. Transbronchial lung parenchymal biopsy was compliant with chronic eosinophilic pneumonia. No special cause has been found after evaluation and the case was accepted to be idiopathic. Because of unfamiliar clinical, radiological and pathological findings, we decided to present this case.

Childhood tuberculosis might have unusual clinical presentation. A seven-year-old female patient was admitted with fever and pleural effusion. Her pneumonia resolved following 21-day treatment period. An atelectatic appearance remained on the right middle zone in her chest X-ray. Tuberculin skin test showed 13 mm induration. Triple drug antituberculosis treatment was started. Since atelectasis persisted on her follow-up radiograph one month later, bronchoscopy was performed which revealed a hemorrhagic polypoid mass occluding the right upper lobe anterior segment orifice. Surgical removal was performed by right upper lobectomy. The pathological diagnosis was necrotizing granulomatous infection suggesting tuberculosis. The patient has been well on follow-up after completing a nine-month course of antituberculous treatment.

Objective: To analyze the spectrum of the lung parenchyma changes in ankylosing spondylitis (AS) with high resolution computed tomography (HRCT) and correlate the findings with disease duration., Material and Methods: Twenty patients (18 male, 2 female) with the diagnosis of AS according to New York criteria were included in the study. None of the patients had history of tuberculosis, prolonged inorganic dust exposure and hospitalization for pneumonia. Seven of the patients were smokers, three patients were ex-smokers, and 10 patients were nonsmokers. The patients were assigned to three groups depending on disease duration. Group 1: patients with disease duration or=6 years but or=11 years (N: 12 patients). HRCT and pulmonary function tests (PFT) were performed in all patients., Results: HRCT demonstrated pathology in 17 patients (85%). Two patients in group 1, 4 patients in group 2 and 11 patients in group 3 had pulmonary parenchyma changes. Emphysema (9/20), septal thickening (9/20) and pleural thickening (9/20) were the most common changes followed by nodule (8/20) and subpleural band formation (7/20). Three patients had apical fibrosis (AF). Septal and pleural thickening (both 4/10) were the most common changes when only nonsmokers were considered. Among nine patients with emphysema three were nonsmokers., Conclusion: There is a wide spectrum in pulmonary parenchyma changes in AS. These changes begin in early stages of the disease and increase with disease duration. Although smoking complicates the spectrum of changes in pulmonary parenchyma, they are predominately in the form of interstitial inflammation.