AHMET ÇOKER | Ege University (original) (raw)

Papers by AHMET ÇOKER

PubMed, Jun 1, 2014

Introduction: Pancreas ductal adenocarcinoma (PDAC) is among tumors with unfavorable prognosis. T... more Introduction: Pancreas ductal adenocarcinoma (PDAC) is among tumors with unfavorable prognosis. The aim of this study was to determine potential prognostic factors in PDAC. Materials and methods: We retrospectively evaluated a total of 117 cases according to clinicopathological parameters and survivin and livin expression. We investigated the relationship between these parameters and their prognostic significance. Results: In univariate analysis, lymph node metastasis, surgical margin positivity, tumor size over 4 cm and survivin expression were associated with poorer survival but livin expression was not correlated with survival-time. In multivariate analysis, only lymph node metastasis was independent factor predicting a poorer outcome. Conclusions: In present study, the lymph node metastasis was the strongest predictor of survival. Our finding suggest that survivin could be a target for the treatment of advanced stage resectable PDAC. Our results need to be supported by studies on larger series with advanced techniques.

Turkish Journal of Surgery

Objective: Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We... more Objective: Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. Material and Methods: This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. Results: Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. Conclusion: The expert panel made recommendations for every topic.

Background and Aims: Superior mesenteric artery syndrome is an uncommon but well-recognized clini... more Background and Aims: Superior mesenteric artery syndrome is an uncommon but well-recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute complete or partial duodenal obstruction. The treatment of this arteriomesenteric compression includes conservative measures and surgical intervention. The purpose of the present study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. Materials and Methods: Between January 2000 and January 2006, the patients with superior mesenteric artery syndrome were retrospectively analyzed from the case records. Results: All four patients had a history of chronic abdominal pain, nausea, postprandial discomfort, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomog...

Giris ve amac: Kontrastli bilgisayarli tomografi (BT) akut pankreatitte nekrozu saptama amaciyla ... more Giris ve amac: Kontrastli bilgisayarli tomografi (BT) akut pankreatitte nekrozu saptama amaciyla kullanilan incelemeler arasinda hala "altin standart" olarak kabul edilmektedir. Literaturde, kontrast maddenin akut pankreatit uzerine etkisi konusunda celiskili bilgiler mevcuttur. Bazi yazarlar kontrast maddenin akut pankreatiti siddetlendirdigini iddia ederken bazi calismalarda da hicbir etkisi olmadigi soylenmektedir. Bu deneysel calismada kontrast maddelerin akut pankreatit seyrine doz bagimli etkisi incelenmistir. Gerec ve yontem: Bu amacla 42 Wistar sican (ortalama agirlik 250gr) 6 gruba bolunmustur. Sicanlar once 6-8 saat ac birakilmis, daha sonra da 100 mcgr serulein peritoneal olarak enjekte edilmistir. Bu enjeksiyondan 12 saat sonra IV olarak non-iyonik kontrast madde veya serum fizyolojik (SF) verilmistir. Grup 1 ve 3'teki sicanlara sadece SF verilirken, 2, 4, 5 ve 6. gruptaki sicanlar sirasiyla 2 ml/kg, 1 ml/kg, 1.5 ml/kg ve 2 ml/kg kontrast madde almistir. 12...

Biliyer kistadenomlar ve kistadenokarsinomlar karacigerin nadir kistik tumorlerindendir. Gerek ta... more Biliyer kistadenomlar ve kistadenokarsinomlar karacigerin nadir kistik tumorlerindendir. Gerek tani gerekse de tedavi surecinde ozellik gerektiren bu tumor tipi icin 15 yillik Ege Universitesi Tip Fakultesi Genel Cerrahi Anabilimdali'nin deneyimi degerlendirildi. 1989-2004 tarihleri arasinda tetkik ve tedavi edilen 11 olgu retrospektif olarak klinik ve histolojik parametreleri ve cerrahi tedavileri acisindan tekrar gozden gecirildi. 11 olgunun 9'u kadin, 2'si erkek iken yas ortalamalari 52 (33-70) olarak izlendi. Klinik on tani acisindan 11 olgunun 6'sinin (%54) kist hidatik olarak degerlendirildigi ve bu olgulardan 3'une daha onceden drenaj prosedurlerinin uygulanmis oldugu goruldu. Tum olgulara total eksizyon uygulandi. Tumor capi ortalamasi 8.3 cm olarak saptandi. Tani asamasinda preoperatif donemde, bu tumorlerin diger kistik karaciger tumorlerinden ayirici tanisini yapmak oldukca guctur. Ulkemiz icin ciddi saglik sorunu olusturan kist hidatik lezyonlari ile ...

Marmara Medical Journal, 2009

OZET Castleman Hastaligi hem malign hem de benign olma riski olan retroperitoneal yerlesimli olan... more OZET Castleman Hastaligi hem malign hem de benign olma riski olan retroperitoneal yerlesimli olan nadir bir patolojidir. Biz bu calismada retroperitoneal lenfatik zincirde malignitesi olan dort hastayi ve tedavi yaklasimlarini degerlendirecegiz. Bes yili askin bir suredir etiyolojisi bilinmeyen karin ici lenfadenopatisi ya da Castleman hastaligi tanili hastalar retrospektif olarak tarandi. Cerrahi tedavileri ve sonuclar degerlendirildi. Castleman hastaligi tanili, yas ortalamasi 54 olan uc erkek bir kadin hasta bulundu. Tum hastalarda retroperitoneal alanda yerlesimli izole bir kitle mevcuttu. Uc hastaya total eksizyon uygulanirken pankreas basi ile iliskili bir kitleye pankreatikoduodenektomi uygulandi. Bir tane mikst tip haricinde tum patolojik degerlendirmeler hiyalin vaskuler tip olarak rapor edildi. Tum hastalarin iyilesme periyodu sorunsuz gecti ve takip periyodunda nuks saptanmadi. Ozellikle retroperitoneal alan yerlesimli lenfatik zincirdeki bu nadir anomali retroperitoneal ...

Background and Aims: Little is known in our country about patients with autoimmune pancreatitis. ... more Background and Aims: Little is known in our country about patients with autoimmune pancreatitis. The aim of this study was to retrospectively evaluate our patients with autoimmune pancreatitis. Materials and Methods: Medical records of the patients who were histopathologically diagnosed as autoimmune pancreatitis between June 2001 and September 2007 were evaluated. Results: A total of 9 patients (6 male, 3 female; mean age: 30-71 years) were analyzed. Patients were admitted with jaundice (n=7), elevated liver enzymes (n=1), and abdominal pain (n=1). Radiological investigations revealed pancreatic mass suggesting pancreatic cancer in all patients. Eight patients underwent Whipple operation, one patient was diagnosed by intraoperative biopsy. Conclusions: Autoimmune pancreatitis has to be kept in mind in the differential diagnosis of pancreatic masses.

British Journal of Surgery, 2020

HPB, 2019

status (p=.025) and tumor grade (p=.017). Medium conditioned by pancreatic cancer cells (PCC-CM) ... more status (p=.025) and tumor grade (p=.017). Medium conditioned by pancreatic cancer cells (PCC-CM) led to a spindle-like morphology and increased proliferation in NIH 3T3 fibroblasts. Paracrine effects of NIH 3T3 fibroblasts promoted motility in all PCC. PCC-CM by poorly differentiated PCC led to a higher expression of vimentin in NIH 3T3 cells, whereas PCC-CM by well-differentiated PCC led to a down-regulation. NIH 3T3 fibroblast matrix decreased the proliferation of all PCC and led to up-regulation of ZEB1. Conclusion: CAF is a negative prognostic factor for PDAC. Physical growth limitation by stromal matrix leads to a ZEB1 upregulation, suggesting an interlink of stromal activation and epithelial-mesenchymal transition processes.

HPB, 2018

Introduction: The liver surgery for tumours that involve the IVC or the HV are a technical challe... more Introduction: The liver surgery for tumours that involve the IVC or the HV are a technical challenge and usually need to be operated upon under total vascular exclusion to prevent massive blood loss. Ante-situm liver resections, otherwise called "ex-situ in-vivo" resections is achieved through externalization of the liver outside of the abdominal cavity by clamping and sectioning of the efferent pedicles (suprahepatic veins) ("ex situ") without cutting the afferent vascular pedicle ("in vivo"), thus leaving the hepatic pedicle intact. Here we are presenting our experience of ex-situ hepatic resections. Materials and methods: This is a retrospective data of "Ex-situ in-vivo" Hypothermic Hepatic Resections done at Osmania General Hospital, Hyderabad in 8 years. In-situ cooling of the liver was done with cold HTK Solution. Ante situm hepatic resections were done for liver tumours involving the IVC/Hepatic veins. Results: Total 4 male patients with median age of 44.5 years (range 22 to 65 years). The average total vascular exclusion time was 120 minutes. The right extended hepatectomy with IVC resection in 1case, Central hepatectomy with middle hepatic vein tumour thrombectomy in 1case, Ante situm hepatic and IVC reconstruction for Chronic BCS in 1 case and left hepatectomy with IVC and RA tumour thrombectomy in 1case were done. Average blood lose was 1200ml.No operative mortality. The longest follow up was 2 years. Conclusion: Recent surgical innovations such as Ante situm or ex vivo resections under total vascular exclusion with in-situ hypothermia have improved the safety of complex hepatic resections that involve the IVC/HV.

International Journal of Research in Medical Sciences, 2017

Background: Peritonitis due to hollow viscous perforation is common cause of emergency surgery in... more Background: Peritonitis due to hollow viscous perforation is common cause of emergency surgery in India. Despite advances in surgical skills, antimicrobial agents and supportive care the morbidity and mortality of secondary peritonitis remains high. Prognosis and outcome of it depends on many factors which includes patient related factors, disease specific factors and management. Categorizing patients into different risk groups would help in management. Mannheim peritonitis index (MPI) is based on measuring simple clinical parameters in case of hollow viscous perforation. This study was conducted to know efficacy of MPI for predicting morbidity and mortality in hollow viscous perforation.Methods: 50 patients with peritonitis undergoing surgical treatment at Dr. D.Y. Patil medical college, Nerul were included in study. Demographic, clinical data, surgical treatment, outcome were documented and analysed.Results: The morbidity and mortality rate were higher in patients with MPI >29....

HPB, 2016

12000 ng/ml respectively. All BDTT were confirmed intraoperatively. The operative procedures incl... more 12000 ng/ml respectively. All BDTT were confirmed intraoperatively. The operative procedures included right hepatectomy with thrombectomy through choledochotomy and t tube drainage(n = 16), extended right hepatectomy combined with extrahepatic bile duct excision(n = 10), left hepatectomy(n = 9), extended left hepatectomy(n = 2) and left lateral segmentectomy(n = 2). Average blood loss and median operative time were 420 ml and 186 min respectively. The diameter of primary tumour ranged from 5 to 18 cm and the length of the thrombi ranged between 3 and 7.5cm. Postoperative morbidity was 28.2%(n = 11) which included bile leak in 4 patients. Two patients died of post hepatectomy failure (mortality 5.1%). The 1,3,5 year survival rates were 81.09%, 48%, 10.5% respectively with a median survival of 28.6 months. Conclusions: The mere presence of BDTT in HCC does not indicate an advanced or inoperable lesion. When technically feasible, formal hepatic resection is the preferred first-line treatment option in these patients.

World journal of gastrointestinal oncology, Jan 15, 2016

To evaluate the association between the interleukin 1β (IL-1β) polymorphisms and the pancreatic n... more To evaluate the association between the interleukin 1β (IL-1β) polymorphisms and the pancreatic neuroendocrine tumor (pNET) development. A case-control study was conducted analyzing IL-1β polymorphisms using germline DNA collected in a population-based case-control study of pancreatic cancer (51 pNET cases, 85 pancreatic ductal adenocarcinoma cases, 19 intraductal papillary mucinous neoplasm and 98 healthy controls). The distribution of genotypes for the -511 C/T polymorphism in the pNET patient groups showed significant difference compared to the control group. It is known that the carriers of the IL-1β -511T allele have increased concentrations of IL-1β. The -511 CT and TT high-expression genotypes were over-represented in pNET patients. The findings of this study suggested a possible role of IL-1β -511 C/T genotypes in the pathogenesis of pNETs since the presence of the IL-1β -511 CT and TT genotypes and the T allele was associated with an increased risk of pNET only.