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Öğe The acute effects of pancreaticopyelostomy on the pancreas and kidney - A preliminary study(1993) Çoker A.; Menteş A.; Çoker I.A modified canine pancreaticopyelostomy model with an intact kidney was constructed. The effect of this procedure on the pancreas and kidney were examined in five dogs by monitoring the serum and urine levels of pH, bicarbonate, chloride, glucose, urea, creatinine and amylase in 24-h periods for up to 72 h. The contralateral kidney served as controls. The pancreas and kidney were removed and examined under light microscopy after the animals were sacrificed. Both of the organs had maintained their normal histological architecture. The serum and urine glucose levels were consistent with a normal response after the initial elevation immediately following the surgical trauma. The urine urea concentrations from both kidneys were similar, as were the creatinine excretion trends throughout the 72 h, except for a significant rise in the creatinine excretion on the pancreaticopyelostomy side at 24 h. The pH, bicarbonate, chloride, and amylase values revealed a normal and functioning exocrine pancreas. It is concluded from this preliminary study that pancreaticopyelostomy with an intact kidney does not have acute adverse effects, either on the pancreas or on the kidney. This procedure may be an alternative method for pancreatic exocrine drainage if similar results are obtained in chronic models. © 1993 Humana Press Inc.Öğe Effects of selected antibiotics on pancreatitis induced liver and pulmonary injury(2005) Önek T.; Erkan N.; Zeytunlu M.; Sagol Ö.; Çoker C.; Çoker A.OBJECTIVE: To investigate the protective effect of antibiotherapy in the early phase of acute pancreatitis on cellular injury induced in lungs and liver. BACKGROUND: Cellular viability and plasma nitric oxide (NO) levels were assessed to determine the efficacy of highly bactericidal imipenem and quinolones on liver and lung injury. METHODS: Imipenem, levofloxacin or saline were administered to rats with caerulein induced pancreatitis. Twenty-four hours later serum amylase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and NO levels, pancreatic interstitial inflammation, acinar cell necrosis, acinar cell vacuolisation, peripancreatic fat necrosis; spotty necrosis, focal inflammation of liver and inflammatory processes in the lungs were assessed. RESULTS: Enzyme levels in the antibiotherapy groups were lower than in the control group. Serum NO levels were higher only in the imipenem group. Levofloxacin decreased acinar cell vacuolisation in the pancreas; interstitial edema, neutrophilic infiltration and interstitial enlargement in the lungs. Antibiotherapy decreased spotty necrosis, apoptosis and focal inflammation in the liver. CONCLUSIONS: Although treatment with imipenem is associated with higher NO levels than levofloxacin, levofloxacin prevents organ injury more effectively than imipenem in acute pancreatitis. Our results indicate that antibiotherapy in the early period of necrotizing pancreatitis prevents cellular damage induced in pancreas, liver and lungs.Öğe Extra-gastrointestinal stromal tumor of the pancreas(2011) Erkan N.; Çoker A.; Postaci H.; Cengiz Yilmaz; Elif Selek; Erdem GokerBackground: Primary pancreatic gastrointestinal stromal tumors are very rare. Here in we present a malignat extragastrointestinal tumor of the pancreas that was managed multi-disciplinarily. Case presentation: A 64 -year -old male patient presented with a several month history of progressive fatique, nausea, loss of appetite and weight loss. Physical examination revealed a large, painless and smoooth epigastric mass. Laboratory data including tumour markers were within normal limits except a mild anemia. An abdominal CT scan revealed a predominantly cystic mass with solid component that had a 22x14 cm in size originating from body of the pancreas. The patient underwent laparotomy and distal pancreatectomy, splenectomy and wedge resection over gastric wall was made. Pathology revealed a malignant extragastrointestinal tumor of the pancreas. During follow-up period of two years, metastases located on 6-7th segment of liver was detected. Patient was treated as adjuvant by imatinib mesylate. Eventhuogh that adjuvant treatment, liver metastases showed progression. Five years after the first initial diagnosis, patient was reoperated for metastatectomy and bisegmentectomy, cholecystectomy and Roux en Y hepaticojejenostomy was made Postoperative period was uneventful and adjuvant imatinib mesylate treatment (400 mg bid) was continued. During follow-up period of 34 months following second surgery, multiple hepatic metasteses were detected and he was death due to multiple organ failure 8 years after initial diagnosis. Conclusion: Although rare in the pancreas, GIST should be considered in differential diagnosis of pancreatic masses and GIST patients with liver metastases require combined multimodal management from the outset.Öğe Gallstone ileus as an unexpected complication of cholelithiasis: Diagnostic difficulties and treatment [Kolelitiazisin beklenmedik komplikasyonu, safra taşi ileusu: Tani zorluklari ve tedavi](Turkish Association of Trauma and Emergency Surgery, 2010) Yakan S.; Engin O.; Tekeli T.; Çalik B.; Deneçli A.G.; Çoker A.; Harman M.BACKGROUND Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature. METHODS Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied. RESULTS There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine - required for decubital necrosis from the gallstone - was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities. CONCLUSION Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.Öğe Hydatid acute pancreatitis(2004) Zeytunlu M.; Çoker A.; Yüzer Y.; Ersöz G.; Aydin A.; Tekeşin O.; Özütemiz Ö.; Batur Y.Background/aims: Hydatid acute pancreatitis is a rare condition, mostly reported as case presentations. Methods: A series of eight patients with hydatid acute pancreatitis, referred between January 1990 and January 2003, are reported. All patients presented acute pancreatitis confirmed with clinical presentation, radiologic examination and laboratory findings. All patients had elevated levels of blood amylase value (more than 500 U/L). Five patients (62%) had high bilirubin levels (2.1 to 3.4 mg/dl) during the initial hospitalization. Computed tomography findings revealed acute pancreatitis in four patients; two had associated pseudocyst formation. Results: Endoscopic retrograde cholangiopancreatography was performed on all patients and revealed hydatid cystic material in the common bile duct secondary to cystobiliary rupture in all patients. All patients underwent endoscopic sphincterotomy that was performed after dilatation with extractor balloon, and hydatid material was removed in all. Six patients were operated on after the initial episode subsided. Drainage of the cyst, appropriate cavity management and T-tube drainage of the common bile duct was employed in all patients to control bile leakage after the operation. Scolices and hydatid membrane were detected during common bile duct exploration in all patients due to presentation of cystobiliary rupture. There was no mortality. Postoperative pulmonary infection and wound infection were encountered in one patient each. During two to 13 years' follow-up, one patient developed recurrent hydatid disease. Recurrent pancreatitis did not occur. Conclusions: Hydatid acute pancreatitis is a rare condition. However, it should be remembered in patients with abdominal pain, especially in endemic areas.Öğe Life-threatening abdominal injury during a soccer game: A rare clinical case [Futbol maçi{dotless}nda gelişen hayati{dotless} tehdit edici kari{dotless}n yaralanmasi{dotless}: Nadir bir klinik olgu](2011) Kara E.; Içöz G.; Ersin S.; Çoker A.Soccer (football) is a popular sport worldwide and can result in severe abdominal injuries. Nevertheless, the necessity of surgical intervention for abdominal organ injuries has been reported rarely. We report a case who was injured during a soccer game who underwent abdominal surgery. Distal subtotal pancreatectomy, splenectomy, cholecystectomy, and choledochotomy + T-tube drainage were performed. He was discharged on the postoperative seventh day without any complication.Öğe Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study(Elsevier B.V., 2019) Rystedt J.M.L.; Kleeff J.; Salvia R.; Besselink M.G.; Prasad R.; Lesurtel M.; Sturesson C.; Abu Hilal M.; Aljaiuossi A.; Antonucci A.; Ardito F.; Ausania F.; Bernon M.; Berrevoet F.; Björnsson B.; Bonsing B.A.; Boonstra E.A.; Bracke B.; Brusadin R.; Burda L.; Caraballo M.; Casellas-Robert M.; Çoker A.; Davide J.; De Gelder A.; De Rose A.M.; Djokic M.; Dudek K.; Ekmekçigil E.; Filauro M.; Fülöp A.; Gallagher T.; Gastaca M.; Gefen R.; Giuliante F.; Habibeh H.; Halle-Smith J.; Haraldsdottir K.H.; Hartman V.; Hauer A.; Hemmingsson O.; Hoskovec D.; Isaksson B.; Jonas E.; Khalaileh A.; Klug R.; Krige J.; Lignier D.; Lindemann J.; López-López V.; Lucidi V.; Mabrut J.-Y.; Månsson C.; Mieog S.; Mirza D.F.; Oldhafer K.J.; Omoshoro-Jones J.A.O.; Ortega-Torrecilla N.; Otto W.; Panaro F.; Pando E.; Paterna-López S.; Pekmezci S.; Pesce A.; Porte R.J.; Poves I.; Prieto Calvo M.; Primavesi F.; Puleo S.; Recordare A.; Rizell M.; Roberts K.; Robles-Campos R.; Sanchiz-Cardenas E.; Sandström P.; Saribeyoglu K.; Schauer M.; Schreuder M.; Siriwardena A.K.; Smith M.D.; Sousa Silva D.; Sparrelid E.; Stättner S.; Stavrou G.A.; Straka M.; Strömberg C.; Sutcliffe R.P.; Szijártó A.; Taflin H.; Trotovšek B.; van Gulik T.; Wallach N.; Zieniewicz K.; A European-African HepatoPancreatoBiliary Association (E-AHPBA)Research Collaborative Study management group; Other members of the European-African HepatoPancreatoBiliary Association Research CollaborativeBackground: Treatment of bile duct injuries (BDI)during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. Methods: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks)and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. Results: In total 913 patients from 48 centers were included in the analysis. In 401 patients (44%)the bile duct injury was diagnosed intraoperatively, and 126 patients (14%)suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009). Conclusion: After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable. © 2019 International Hepato-Pancreato-Biliary Association Inc.Öğe Simultaneous pancreas - kidney transplantation in patients with type 1 diabetes mellitus and end stage renal disease [Tip 1 diabetes mellitus ve son dönem böbrek yetmezligi bulunan hastalarda eşzamanli pankreas - böbrek transplantasyonu](2003) Çoker A.; Zeytunlu M.; Sözbiyen M.; Firat Ö.; Töz H.; Seziş M.; Ertilav M.; Ulukaya S.; Acar L.; Mir S.; Özkayin N.; Hoşçoşkun C.; Yüzer Y.; Kaplan H.Diabetes Mellitus is the most common cause of end stage renal failure. Dialysis and renal transplantation offer improvements in the quality of life and long term survival for these group of patients. In the last decade, simultaneous pancreas - kidney transplantation became a worldwide accepted treatment modality for the patients with renal failure related to type 1 Diabetes Mellitus. In this paper, the first four simultaneous pancreas - kidney transplantation cases of Ege University Organ Transplantation and Research Center were reported with a review of the medical literature.Öğe Solid and cystic papillary neoplasms of the pancreas: Report of four cases(2004) Zeytunlu M.; Firat Ö.; Nart D.; Çoker A.; Yüzer Y.; Tekeşin O.; Özütemiz Ö.; Killi R.Background/aims: In this report we present four cases with solid and cystic papillary neoplasms (SCPN) of the pancreas, and discuss the ]histopathological and immunohistochemical findings with a review of the literature. Methods: The four cases reported here consisted of three women (ages 20-48, mean: 32) and one man (age: 58). The clinical diagnoses were confirmed with ultrasound (US) and computerized tomography (CT). The surgical management of the tumors included enucleation (1 patient), distal pancreatectomy with splenectomy (1) and distal pancreatectomy (2). Results: The tumors were large (mean diameter of the resected tumor was 15 cm), had cystic degenerations between solid areas, and were distributed in the body and the tail of the pancreas. The cystic spaces contained hemorrhagic, necrotic and thrombotic material. The immunohistochemical studies revealed that the four tumors were all positive for ? 1 antitrypsin and neuron specific enolase, and were all negative for chromogranin. Vimentin and synaptophysin were positive in three different cases. The follow-up of the patients has been uneventful for 2, 1, 7 and 12 years, respectively. Conclusions: SCPN of the pancreas is an uncommon clinicopathologic entity with a relatively low grade malignant potential. The majority of the cases are young women. Fifty percent of the cases are asymptomatic, and the patients with symptoms generally suffer from an abdominal mass or abdominal pain. In spite of the characteristic macroscopic and microscopic aspects, the immunophenotypical view is nonspecific. Prognosis is excellent after complete surgical resection and recurrence is rarely seen. Metastatic spread is not expected and the tumor usually has a manner of local invasion. Acinar cell carcinoma, pancreatoblastoma and pancreatic endocrine tumor must be considered in the differential diagnosis.
