Neither clinical signs, laboratory, radiological and endoscopic methods nor bacteriological and histopathological findings provide a gold standard by themselves in the diagnosis of abdominal TB. However, an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosis of this insidious disease which primarily necessitate a clinical awareness of this serious health problem.

In total, 151 newly diagnosed patients with smear-positive pulmonary tuberculosis were studied. The mean time from the onset of symptoms to the first visit to a physician was 46.4 days; the mean referral delay was 28.9 days; the mean delay in diagnosis was 2.4 days; and the mean delay in treatment initiation was 0.8 days. There was a delay in consulting a physician by 49% of patients. A low index of suspicion for tuberculosis on the part of the physician and healthcare system and laboratory delays were the most common reasons for delays in diagnosis.

Sağlık çalışanlarında tüberkülin cilt testi ile QuantiFERON-TB Gold-In Tube testinin karşılaştırılması Prospektif, kesitsel ve gözlemsel nitelikteki çalışmamızın amacı sağlık çalışanlarında latent tüberküloz infeksiyonu tanısında, tüberkülin cilt testi (TCT) ile QuantiFERON-TB Gold-In Tube (QTF-GIT) testini karşılaştırmaktır. Çalışma, aynı üçüncü basamak göğüs hastalıkları ve tüberküloz eğitim hastanesinde çalışan 78 gönüllü sağlık çalışanını içermektedir. Aktif tüberkülozu, immünyetmezliği ya da malnütrisyonu olanlar çalışmaya dahil edilmemiştir. TCT Mantoux metoduyla uygulandı. ESAT-6, CFP-10 ve TB7-7 antijenleri kanda interferon-gama (IFN-γ) araştırılması için kullanıldı (QTF-GIT). BCG skar sayısı ile TCT endürasyon çapı arasında istatistiksel olarak anlamlı ilişki saptandı (p< 0.01). QTF sonuçları ve önceki BCG aşılaması arasında anlamlı bir ilişki yoktu (p> 0.05). İki test arasında orta düzeyde uyum mevcuttu (κ: 0.346). QTF-GIT testinin duyarlılığı %56.14 (TCT ve QTF-GIT pozitif), özgüllüğü %90.48 (TCT ve QTF-GIT negatif), pozitif kestirim değeri %94.12, negatif kestirim değeri %43.18, doğruluk oranı da %65.38 olarak saptandı. QTF sonucuyla TCT endürasyon çapı arasında anlamlı düzeyde ilişki mevcuttu (p< 0.01). QTF-GIT testine göre çalışma popülasyonumuzdaki latent tüberküloz infeksiyon prevalansı %43, TCT'ye göre %73 idi ve BCG aşılanma oranı %87 idi. Sonuç olarak; TCT önceki BCG aşılanmasından etkilenmiş, buna karşın QTF-GIT etkilenmemiştir. Rutin BCG aşılama programı olan toplumlara latent tüberküloz infeksiyonu tanısında TCT'ye alternatif olarak QTF-GIT testini önerebiliriz.

No abstract

History of lung transplantation in the world can be traced back to the early years of the 20 th century when experimental vascular anastomotic techniques were developed by Carrel and Guthrie, followed by transplantation of thoracic organs on animal models by Demikhov and finally it was James Hardy who did the first lung transplantation attempt on human. But it was not until the discovery of cyclosporine and development of better surgical techniques that success could be achieved in that field by the Toronto Lung Transplant Group led by Joel Cooper. Up to the present day, over 51.000 lung transplants were performed in the world at different centers. Dr. James Hardy from Jackson Mississippi, USA was the first surgeon in the world to perform lung transplantation in man in 1963. The patient was a 58-year old man who had lung cancer involving the left main airway and obstructing distal airways resulting in lung collapse and recurrent pneumonia. While the patient was serving a life sentence in prison, Hardy outlined the potential complications and risks with him in detail and he agreed to proceed [1][2][3]. This was the time the countdown for a donor and prospect transplant started. Both medically and legally, such a patient would not be an appropriate candidate for lung transplantation at any transplant center at this time and day. No matter what opponents claim, this was a challenging and risky task both for Hardy and his patient with their own selfexplanatory reasons and motivation.The donor was taken to the operating room for retrieval while the recipient was prepared for transplantation in the adjacent operating room almost simultaneously. Both operations were remarkably uncomplicated and the recipient began breathing spontaneously. Indeed, the arterial oxygen saturation improved from 87% before to 98% immediately after the transplant. Chest X-rays and an angiogram confirmed that the transplanted lung was very well ventilated and perfused [2]. Surgeons had done their jobs perfectly well. The cornerstones of a successful lung transplantation today are good donor, good recipient and good surgery followed by meticulous early postoperative management. The donor and recipient selection in the very first lung transplantation of the world was maybe arbitrary due to aformentioned reasons and not so ideal, but the surgery had gone smooth owing to surgeons' interest and experience. The immunosuppressive regimen consisted of azathioprine, prednisone, and cobalt radiation to the mediastinum and thymus. Notably, cyclosporine and tacrolimus, which are the mainstays of immunosuppression in modern transplantation, had not yet been discovered [2,3]. Those were the times 'less was more' and against all odds, this was the first, but not the only or the final success in lung transplant history.Every single step, every attempt that we find worthy of mentioning today, be it from Hardy, Carrel, Guthrie, Demikhov are bricks in the gigantic wall of lung transplantation.