Armağan Günal

Gulhane Military Medical Academy, Engüri, Ankara, Turkey

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Publications (11)10.46 Total impact

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    ABSTRACT: Background/aims:The normal oral mucosa is usually tolerant to its special microenvironment. Epithelial integrity and a wellmanaged immune system are important in sustaining harmony. A close look at the role played by adaptive immunity during recurrent aphthous ulcerations may throw some light into the pathogenesis. Materials and Methods: In this report, we provide a concise review of oral epithelial barrier function and present data on the possible pathogenetic mechanism of aphthous ulceration using immunohistocemical signs of nuclear factor kappa beta pathway activation on fourteen cases of mucosal aphthous ulcerations. Results: We strongly support the hypothesis that oral aphthous ulcerations develop as a result of loss of epithelial barrier function and that nuclear factor kappa beta signaling pathway seems to be involved in this type of injury. Conclusion: Interventions that strengthen the mucosal barrier function or modulate inappropriate activation of nuclear factor kappa beta signaling pathway can be considered in the treatment of oral aphthous ulcerations.
    The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 12/2013; 24(5):508-14. · 0.48 Impact Factor
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    ABSTRACT: Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound, 2013;
    Journal of Clinical Ultrasound 05/2013; · 0.70 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the role of diffusion-weighted magnetic resonance imaging (DWMRI) in differentiating benign and malignant thyroid nodules using a 3 Tesla (T) MRI scanner. MATERIALS AND METHODS: Twenty-eight nodules in 25 patients and 14 healthy control cases were included in the study. DWMRI was acquired with 6 b values with a 3T MRI scanner. The apparent diffusion coefficient (ADC) values of the nodules were calculated from reconstructed ADC map images and were compared with the final histopathological diagnoses. RESULTS: The mean ADC value of the benign nodules was 1548 ± 353.4 (×10(-6) mm(2) /s), and the mean ADC of the malignant nodules was 814 ± 177.12 (×10(-6) mm(2) /s). The normal thyroid tissue had a mean ADC value of 1323.43 ± 210.35 × 10(-6) mm(2) /s (958-1689 × 10(-6) mm(2) /s) in the healthy control group. The ADC values were significantly different among the three groups (P = 0.001). An ADC value of 905 × 10(-6) mm(2) /s was determined to be the cutoff value for differentiating benign and malignant nodules, with 90% (55.5-98.3) sensitivity and 100% (81.3-100.0) specificity. CONCLUSION: This study suggests that the ADC values of nodules measured with a 3T MRI scanner could help in differentiating benign thyroid nodules from malignant nodules. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 11/2012; · 2.57 Impact Factor
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    ABSTRACT: It has been shown that BRAF(V600E) mutation in papillary thyroid carcinomas (PTC) is associated both with pathogenesis and poor prognosis. In this study, we aimed to investigate the relationship of the BRAF(V600E) mutation and the established prognostic factors in a cohort of Turkish patients with PTC. Forty-six cases of papillary thyroid carcinoma have been evaluated for the presence of BRAF(V600E) mutation. BRAF(V600E) has been examined by restriction fragment length polymorphism. BRAF(V600E) mutation status has been compared with well-known histopathological and clinical prognostic parameters such as invasion of thyroid capsule, extrathyroidal extension, and the presence of lymph node and/or distant metastasis. We have found that BRAF(V600E) mutation was present in the majority of our cases (40/46). Considering the stage of the disease, five of the negative cases were in stage 1 while the remaining one was in stage 2. Only one BRAF(V600E) negative case has shown extrathyroidal extension and lymph node metastasis. All four patients with distant metastasis had BRAF(V600E) mutation. Statistical analyses revealed that there are no significant relationship between the BRAF(V600E) mutation and the established prognostic factors. We found a relatively higher BRAF(V600E) mutation rate in classical type PTC than in other similar studies. We think that the limited number of our cases may either weaken or mask some potentially important relationship between BRAF(V600E) mutation and the established prognostic factors.
    Endocrine Pathology 07/2012; 23(3):135-40. · 1.60 Impact Factor
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    ABSTRACT: Fascin is an actin-bundling protein that is important in cell motility. Fascin expression has been shown to have a potential role in tumor progression for some epithelial tumors. However, there are only a few studies related to its expression in mesenchymal tumors. We investigated fascin expression in gastrointestinal stromal tumors. Thirty gastrointestinal stromal tumors, which were very low (n=6), low (n=2), moderate (n=4), and high (n=18) risk, constituted our series. Immunohistochemical expression of fascin was studied in all cases. Immunoreactivity was observed in only five cases, all of which were in the high-risk group. The remaining cases (25/30) showed no immunoreactivity, and the difference did not seem statistically important (p=0.261). Fascin expression was stronger in epithelioid cells than spindle-shaped cells (p=0.003). In addition, gastrointestinal stromal tumors in the small bowel showed higher fascin expression than those in the other localizations (p=0.043). It seems that anatomic localization and the tumor cell type of gastrointestinal stromal tumors show statistically significant differences with regard to fascin expression. Although our series is limited, we think that fascin should be considered as a marker that is worthy of further study for its potential usage as a prognostic indicator in gastrointestinal stromal tumors.
    The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 08/2011; 22(4):363-8. · 0.48 Impact Factor
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    ABSTRACT: Myoepithelial cells are an important component of salivary gland tumors and are partly responsible from the diverse histology of them. In this study, we focus on the myoepithelial cell differentiation by using cytological morphology in a various types of salivary gland tumors especially with regard to their contribution to the diagnosis. The relation of myoepithelial cells with stromal matrix and the associated epithelial cells were evaluated. Cytologic slides of one hundred and forty one benign and twenty malignant salivary gland tumors were examined for identification of morphologically different myoepithelial cells such as; spindle-stellate, polygonal-epitheloid, plasmacytoid, basal and clear types. The best examples of myoepithelial cells were detected in pleomorphic adenomas, in some monomorphic adenomas and in the adenoid cystic carcinoma cases. Most of the pleomorphic adenomas were composed more than one type of myoepithelial cells and epitheloid-spindle cell combination was frequent. Basal and clear cell types of myoepithelial cells closely resembled the epithelial cells and their identification was relatively difficult. Identification of myoepithelial cell types was easier when they were associated with stromal matrix material and stood as a secondary layer around tubule-forming epithelial cells. Myoepithelial cell components of various salivary gland tumors may be quite different and identification of myoepithelial cell types may pose difficulties. A confident cytologic identification of myoepithelial cells may be critical part of diagnosing salivary gland tumors.
    Diagnostic Cytopathology 10/2010; 40(3):220-7. · 1.49 Impact Factor
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    ABSTRACT: Juvenile hyaline fibromatosis (JHF) is a rare autosomal-recessive hereditary disease, characterized by gingival hypertrophy, flexion contractures of joints, bone lesions, hyaline deposition in the extracellular spaces of the dermis and soft tissues, stunted growth, and skin lesions such as multiple nodules, tumors and pink, pearly papules. No case of JHF with a mandibular bone involvement, exists in the literature. Bone involvement in JHF is an uncommon finding and distinct solitary lesions in the calvarial bones has been reported by some authors. A 21-year-old male patient was referred to Diyarbakir Military Hospital, Department of Dental Service. Clinical findings were consistent with a solid alveolar mass in the right mandibular premolar-molar region and displaced right mandibular molar teeth. Orthopantomographic examination showed impaction of all lower right molars in a mixed radioopaque/radiolucent area. Microscopically, increased nodular connective tissue was seen under the lobulated mucosal surfaces of the resected area. The case presented here had a localized fibrous proliferation that infiltrated bone trabeculae and caused displacement of teeth. Juvenile hyaline fibromatosis should be considered in the differential diagnosis with the other intraosseous radiolucent-patchy opaque lesions of jaw bones. Based on the clinical and histopathological findings, a diagnosis of JHF was made.
    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 09/2009; 108(5):e59-63. · 1.50 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate and compare the microvascular architectural complexity in oncocytomas and chromophobe renal cell carcinomas (ChRCCs) by fractal box-counting on CD34-labeled slides. The study group consisted of 23 cases (12 oncocytomas and 11 ChRCCs) diagnosed from resections. Capillaries were highlighted by CD34, and digital images from randomly selected, non-overlapping areas were taken. Fractal dimensions of microvasculature were measured according to the "box-counting" method with the aid of image analysis software. Mean fractal dimensions (MFDs) were calculated and compared. Hierarchical cluster analysis was also performed to determine whether natural grouping occurs among the cases. Cluster analysis revealed that the cases tended to aggregate in two partially overlapping groups in which oncocytomas (8/12) and ChRCCs (7/11) predominate, respectively. A slight but statistically important difference was also revealed by the Mann-Whitney U test. Fractal dimension, a variable for measuring the geometrical complexity of highly irregular objects, is used for research in pathology. Although the number of cases is limited in our series, the results indicate an obscure but quantitatively measurable difference, which cannot be assessed by the naked eye. Similar studies investigating larger series are needed before a final conclusion can be made.
    Pathology - Research and Practice 05/2009; 205(10):677-81. · 1.21 Impact Factor
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    ABSTRACT: Uncontrolled hemorrhage is the leading cause of fatality. The aim of this study was to evaluate the effect of zeolite mineral (QuikClot - Advanced Clotting Sponge [QC-ACS]) on blood loss and physiological variables in a swine extremity arterial injury model. Sixteen swine were used. Oblique groin incision was created and a 5 mm incision was made. The animals were allocated to: control group (n: 6): Pressure dressing was applied with manual pressure over gauze sponge; or QC group (n: 10): QC was directly applied over lacerated femoral artery. Mean arterial pressure, blood loss and physiological parameters were measured during the study period. Application of QC led to a slower drop in blood pressure. The control group had a significantly higher increase in lactate within 60 minutes. The mean prothrombin time in the control group was significantly increased at 60 minutes. The application of QC led to decreased total blood loss. The QC group had significantly higher hematocrit levels. QC application generated a significant heat production. There were mild edematous and vacuolar changes in nerve samples. According to the physiological parameters, we observed that zeolite tends to reduce blood loss, however could not stop bleeding completely. We believe that further clinical trials are needed to conclude that zeolite could be used in the routine practice.
    Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 02/2009; 15(1):7-11. · 0.34 Impact Factor
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    ABSTRACT: Prevention of secondary infection is currently the main goal of treatment for acute necrotizing pancreatitis. Colon was considered as the main origin of secondary infection. Our aim was to investigate whether prophylactic total colectomy would reduce the rate of bacterial translocation and infection of pancreatic necrosis. Forty-two Sprague–Dawley rats were used. Pancreatitis was created by ductal infusion of sodium taurocholate. Rats were divided into four groups: group-1, laparotomy + pancreatic ductal infusion of saline; group-2, laparotomy + pancreatic ductal infusion of sodium taurocholate; group-3, total colectomy + pancreatic ductal infusion of saline; and group-4, total colectomy + pancreatic ductal infusion of sodium taurocholate. Forty-eight hours later, tissue and blood samples were collected for microbiological and histopathological analysis. Total colectomy caused small bowel bacterial overgrowth with gram-negative and gram-positive microorganisms. Bacterial count of gram-negative rods in the small intestine and pancreatic tissue in rats with colectomy and acute pancreatitis were significantly higher than in rats with acute pancreatitis only (group-2 versus group-4; small bowel, p = <0.001; pancreas, p = 0.002). Significant correlation was found between proximal small bowel bacterial overgrowth and pancreatic infection (r = 0,836, p = 0.001). In acute pancreatitis, prophylactic total colectomy (which can mimic colonic cleansing and reduction of colonic flora) induces small bowel bacterial overgrowth, which is associated with increased bacterial translocation to the pancreas.
    Indian Journal of Surgery · 0.09 Impact Factor
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    ABSTRACT: Splenic hamartoma is an uncommon benign lesion and usually determined incidentally. A 44-year-old female patient admitted with abdominal pain. There was not any history of trauma. During the ultrasonographic examina-tion a cystic mass was seen in the upper pole of the spleen. Only anemia was detected biochemically, and all other laboratory findings were normal. The patient underent splenectomy. Grossly, a cystic mass including solid component was seen in the upper pole of the spleen. Histopathologically, cystic component did not have lining epithelium. Solid component included sinus like clefts, broad cordons and areas of prominent endothelial prolif-eration. The lesion was diagnosed as hamartoma. In this report, the clinical and histopathological features of a case of splenic hamartoma with promi-nent endothelial proliferation that may be easily confused with malignancy is presented. ÖZET Maligniteyi taklit eden belirgin endotelyal proliferasyon gösteren kistik splenik hamartoma: olgu sunumu Splenik hamartoma nadir görülen benign bir lezyondur ve genellikle rast-lantısal olarak saptanır. Kırk dört yaşında kadın hasta karın ağrısı şikayeti ile başvurdu. Travma öyküsü yoktu. Batın ultrasonografisi sırasında dalağın üst kutbunda kistik kitle görüldü. Biyokimyasal incelemede sadece anemi saptanmış olup, diğer tüm laboratuvar incelemeleri normaldi. Hastaya sple-nektomi yapıldı. Makroskobik olarak, dalağın üst kutbunda solid komponent de içeren kistik kitle görüldü. Histopatolojik olarak kistik komponentin döşe-yici epitelinin bulunmadığı görüldü. Solid komponent, sinüs benzeri yarıklar, geniş kordonlar ve belirgin endotelyal proliferasyon alanları içermekteydi. Lezyon hamartoma olarak rapor edildi. Bu makalede maligniteler ile karış-tırılabilecek, belirgin endotelyal proliferasyon içeren bir splenik hamartoma olgusunun klinik ve histopatolojik özellikleri sunulmuştur.