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Mehmet Keskek

Publications and source records attributed to Mehmet Keskek.

7 recordsLinked to original sources
PubMed2006

Re-evaluation of axillary skip metastases in the era of sentinel lymph node biopsy in breast cancer.

PURPOSE: To investigate whether skip axillary metastases are really skip metastases or a continuation of level I micrometastases in invasive breast cancer, and to determine whether there are any factors predisposing to skip metastases. METHODS: We reviewed 568 consecutive patients with breast cancer who underwent complete axillary lymph node dissections (ALND) between January 1998 and December 2004. For patients with skip axillary lymph node metastases, resectioning and immunohistochemical staining of the remaining part of paraffin blocks from level I lymph nodes were done to determine whether there were any micrometastases in this group of lymph nodes. RESULTS: Skip axillary metastases were found in 27 (10%) of 268 patients with axillary lymph node metastases. Re-evaluation of the level I lymph nodes, both with thin sectioning and immunohistochemical staining, in the patients with axillary skip metastases revealed no micrometastases. No significant correlation was found between the demographic and histopathological variables of the patients with skip metastases and those with regular axillary metastases. CONCLUSIONS: These results suggest that skip axillary metastases are actual skip metastases, not a continuation of undetected level I micrometastases. Moreover, none of the clinical and histopathological measures of primary tumors are predictors of the presence of skip metastases.

Adult↗
PubMed2006

Increased expression of cyclooxygenase-2 (COX-2) in radiation-induced small bowel injury in rats.

BACKGROUND: Radiation therapy is a widely used adjuvant therapy for various abdominal and pelvic cancers. On the other hand, it is not a benign treatment modality, as most radiation patients suffer from some kind of radiation enteritis. Currently available treatments are only palliative and no ideal compound has as yet been discovered. The aim of this study was to evaluate cyclooxygenase-2 (COX-2) expression, and to investigate the possible protective effect of the selective COX-2 inhibitor, Rofecoxib, in acute and late stages of radiation-induced intestinal injury in rats. MATERIALS AND METHODS: Forty-eight male Sprague-Dawley rats were randomly divided into eight groups. After abdominal irradiation of all of the animals except the six in the control group, the expression of the enzyme cyclooxygenase-2 (COX-2) was evaluated in different cell types present in the intestinal wall 2 h post exposure (study day 0) and again on study days 4, 14, and 60. The effects of Rofecoxib on histological damage, intestinal myeloperoxidase (MPO) activity, and malondialdehyde (MDA) levels were also measured. RESULTS: Expression of COX-2 in vascular endothelial cells was found to be significantly increased on post exposure days 4 and 14 (2.4 and 2.9 stained vessels/high power field [hpf] respectively compared to 1.3 vessels/hpf for controls) (P = 0.002). Expression of COX-2 in fibroblasts increased immediately after irradiation (29 cells/hpf 2 h after irradiation compared to 12 cells/hpf for non-irradiated control animals) and remained high during the entire study period (P < 0.001), whereas there was a peak COX-2 expression (54.9 cells/hpf) on day 14 that was similar to what was observed in endothelial cells. Irradiation of rats significantly increased intestinal epithelial damage, MPO activity, and MDA levels in comparison to the control group in a time-dependent fashion. Treatment with rofecoxib significantly decreased these elevations except on day 4 of the study. CONCLUSION: The current study suggests that the COX-2 pathway is involved in radiation induced intestinal injury and that targeting COX-2 may be useful in limiting radiation enteritis.

Acute Disease↗
PubMed2006

Value of preoperative serum CA 19-9 levels in predicting resectability for pancreatic cancer.

BACKGROUND: Pancreatic cancer carries a poor prognosis; at operation approximately 25% of patients will be found to have unresectable tumours even though CT has demonstrated that they are resectable. At our tertiary care centre, we wished to find out if there is an optimum cut-off value for the CA 19-9 level preoperatively that will indicate that the pancreatic cancer is unresectable despite radiologic imaging that suggests otherwise according to receiver operating characteristic (ROC) curve analysis. METHODS: Preoperative demographic data, clinical features and serum CA 19-9 levels were reviewed for 51 patients with pancreatic cancer who underwent laparotomy between 1998 and 2003. Preoperatively, resectability was determined from a complete history, physical examination and radiologic imaging. An ROC curve was constructed for the CA 19-9 levels. The sensitivity, specificity, positive and negative predictive values of CA 19-9 were calculated with several cut-off points. RESULTS: There were 18 (36%) resectable and 33 (64%) unresectable pancreatic cancers. The mean CA 19-9 level was 68.8 U/mL in the resectable group and 622 U/mL in unresectable group. When a CA 19-9 level of 256.4 U/mL was used as a cutoff point, the specificity and sensitivity was 92.3% and 82.4% respectively. CONCLUSION: Preoperative CA 19-9 levels may be a useful marker for determining preoperatively which patients have unresectable disease despite the demonstration on CT of resectable disease.

Adult↗
PubMed2005

Does technique alter quality of life after pilonidal sinus surgery?

BACKGROUND: Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patient discomfort. Controversy still exists about the best surgical technique for the treatment of the disease in terms of recurrence rate and patient discomfort. METHODS: From January 2000 to November 2003, 100 consecutive age- and sex-matched patients with chronic pilonidal sinus disease were randomized to receive surgical treatment in the forms of either excision and primary closure or rhomboid excision and Limberg flap. Time to return to work and to complete healing were recorded. To evaluate quality of life and patient comfort, all patients were asked to complete a questionnaire including short form 36, Visual Analogue Scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. RESULTS: Each group was composed of 50 patients. Mean follow-up was 19 months. There was a significant difference between the groups in terms of length of hospital stay (P=.005), time to complete healing (P<.001), time off work (P<.001), and wound infection rate (P=.03). Statistically significant differences were noted between the groups in items of general health perception (71.1+/-11.7 vs 78.2+/-14.1; P=.008), social functioning (87.3+/-32.8 vs 110.4+/-33.8; P=.001), and pain (54.5+/-14.0 vs 67.5+/-18.4; P<.001). Times to sitting on toilet and walking without pain showed significant differences between the groups (P=.006 and P<.001, respectively). The mean postoperative Visual Analogue Scale scores were 6.5+or= 1.7 and 7.4+/- 1.4, respectively (P<.001). CONCLUSIONS: Shorter hospital stay, earlier healing, shorter time off work, lower ratio of complications, lower pain perception, and improved general health perception are the main advantages of te Limberg flap technique in pilonidal sinus surgery. All together, these parameters add to patient comfort and satisfaction after surgical treatment.

Adolescent↗
PubMed2004

External metallic circle in hepaticojejunostomy.

BACKGROUND: Biliary-enteric anastomosis especially Roux-en Y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. In this study, we present the results of hepaticojejunostomy with external metallic circle. METHODS: Hepaticojejunostomy with external metallic circle were performed in eight male Sprague-Dawley rats. At the end of the third month, anastomoses were analysed for patency and stability of external circles. RESULTS: Relaparotomy revealed that all the anastomoses were patent and circles were in original places. CONCLUSION: To provide the patency of narrow hepaticojejunostomy anastomoses, external metallic circle can be a good alternative to use of internal stents in suitable cases.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Evaluation of P-POSSUM and O-POSSUM scores in patients with gastric cancer undergoing resection.

BACKGROUND/AIMS: The aim of this study was to evaluate the predictive accuracy of P-POSSUM and O-POSSUM models on patients undergoing elective gastric resection. METHODOLOGY: P-POSSUM and O-POSSUM predictor equations for mortality were applied retrospectively to 126 patients who had undergone elective gastrectomy for cancer. Observed mortality rates were compared with rates predicted by P-POSSUM and O-POSSUM using the Hosmer-Lemeshow goodness-of-fit test. Evaluation of the discriminative capability of both models was performed using receiver-operating characteristic (ROC) curve analysis. RESULTS: Overall fourteen deaths were observed. O-POSSUM predicted 15 deaths (chi2=14.61, p=0.13) and P-POSSUM predicted 20 deaths (chi2=25.41, p=0.002) using the Hosmer-Lemeshow test. ROC curves analysis revealed that O-POSSUM had better discriminatory power for mortality compared to P-POSSUM (area under curve=0.880, for O-POSSUM and area under curve=0.703 for P-POSSUM). CONCLUSIONS: These data suggest that O-POSSUM predicts mortality more accurately than P-POSSUM in patients undergoing elective gastrectomy for cancer.

Adult↗