Objectives. Transcriptomics of atrial fibrillation (AFib) in the setting of chronic primary mitral regurgitation (MR) remains to be characterized. We aimed to compare the gene expression profiles of patients with degenerative MR in AFib and sinus rhythm (SR) for a clearer picture of AFib pathophysiology. Methods. After transcriptomic analysis and bioinformatics ( n = 59 ), differentially expressed genes were defined using 1.5-fold change as the threshold. Additionally, independent datasets from GEO were included as meta-analyses. Results. QRT-PCR analysis confirmed that AFib persistence was associated with increased expression molecular changes underlying a transition to heart failure (NPPB, P = 0.002 ; ANGPTL2, P = 0.002 ; IGFBP2, P = 0.010 ), structural remodeling including changes in the extracellular matrix and cellular stress response (COLQ, P = 0.003 ; COMP, P = 0.028 ; DHRS9, P = 0.038 ; CHGB, P = 0.038 ), and cellular stress response (DNAJA4, P = 0.038 ). Furthermore, AFib persistence was associated with decreased expression of the targets of structural remodeling (BMP7, P = 0.021 ) and electrical remodeling (CACNB2, P = 0.035 ; MCOLN3, P = 0.035 ) in both left and right atrial samples. The transmission electron microscopic analysis confirmed ultrastructural atrial remodeling and autophagy in human AFib atrial samples. Conclusions. Atrial cardiomyocyte remodeling in persistent AFib is closely linked to alterations in gene expression profiles compared to SR in patients with primary MR. Study findings may lead to novel therapeutic targets. This trial is registered with ClinicalTrials.gov identifier: NCT00970034.

1396Vulva Yerleşimli Lenfanjiyoma Sirkumskriptum Ö ÖZ ZE ET T Lenfanjiyom, lenfatik endotelle çevrili, dilate lenf kanallarından oluşan hamartomatöz bir oluşum olup, gerçek bir neoplazi değil, malformasyon olarak kabul edilmektedir. En sık görülen tip lenfanjiyoma sirkumskriptumdur; lezyonlar genellikle doğumda ve çocuklukta, nadiren de erişkin dönemde ortaya çıkabilir. Lenfanjiyoma sirkumskriptum daha çok ekstremite proksimalleri, gövde, karın, aksilla ve oral mukozayı tutarken, penis, vulva ve skrotum daha nadir etkilenir. Vulvar lenfanjiyoma sirkumskriptum şişlik, kanama, ağrı, deride kuruluk, kaşıntı, ekzema ve enfeksiyona yol açarak hastada psikoseksüel ve kozmetik problemlere neden olabilir. Ayırıcı tanıda herpes zoster, molluskum kontagiosum, genital verrü, leiomiyom, sellüler anjiyofibrom, anjiyofibroblastom ve agresif anjiyofibrom düşünülmelidir. Bu makalede, nadir bir bölge olan vulvada yerleşim gösteren lenfanjiyoma sirkumskriptumlu bir olgu sunuldu.A An na ah ht ta ar r K Ke el li im me el le er r: : Deri hastalıkları, vasküler; deri abnormaliteleri A AB BS ST TR RA AC CT T Lymphangioma is a hamartomatous formation comprised of dilated lymph channels surrounded with lymphatic endothelium. It is considered a malformation, not a neoplasia. The most common type lymphangioma circumscriptum usually develops at birth and in childhood, but rarely in adulthood. While lymphangioma circumscriptum commonly involves proximal parts of the extremity, trunk, abdomen, axilla and oral mucosa, penis, vulva and scrotum are involved less frequently. It may cause psychosexual and cosmetic problems in the patients by leading to swelling, bleeding, pain, xeroderma, eczema and tendency to infection. Differential diagnosis includes herpes zoster, molluscum contagiosum, genital verruca, leiomyoma, cellular angiofibroma, angiofibroblastoma and agressive angiofibroma. Herein, a rare case of lymphangioma circumscriptum located on vulva was presented.K Ke ey y W Wo or rd ds s: : Skin diseases, vascular; skin abnormalities

Hastan›n tan›s› ile dermatologun tan›s› aras›ndaki iliflki uyumlu, uyumsuz ve bilmeyen olmak üzere üçe ayr›ld›. Üç grupta yafl, cinsiyet, e¤itim seviyesi, hastal›k süresi ve fliddetinin etkisi istatistiksel olarak karfl›laflt›r›l›rken; uyumlu ve uyumsuz grupta ayr›ca, tan›n›n kimin taraf›ndan kondu¤u (kendisi, doktor), kendisi koydu ise bilgi kayna¤› (arkadafl, aile büyükleri, medya, kendi fikri), doktor koydu ise doktorun uzmanl›k alan› (dermatolog ve di¤er doktorlar), daha önce tedavi görmesi ve tan›d›¤› bir kiflide bu hastal›ktan olmas›n›n etkisi araflt›r›ld›. Bulgular: Hastalar›n 829'unun (%56,1) uyumlu, 278'inin (%18,8) uyumsuz tan› koydu¤u, 372'sinin (%25,5) bilmedi¤i saptand›. Genç-lerde, kad›nlarda, e¤itim seviyesi yüksek olanlarda, hastal›k süresi uzun ve fliddeti fazla olanlarda, tan›s› daha önceden dermatolog taraf›ndan konulanlar ile, bilgi kayna¤› arkadafl çevresi olanlarda, ve tan›d›¤› bir kiflide benzer hastal›ktan olmas› durumunda tan› uyumu artmaktayd›. Tan› uyumu en fazla olan hastal›klar, akne vulgaris (%95,6), tinea unguium (%82,3) ve tinea pedis (%78,9) iken, en düflük olan hastal›klar numuler dermatit (%10,2), ürtiker (%11,9) ve liken planus (%25,9) idi. Sonuç: Çal›flmam›zda sonuç olarak Türkçe'de karfl›l›¤› olan veya orijinal ismi ile kullan›lan bir hastal›¤a sahip hastalarda dermatolog-hasta tan› uyumu yüksek olarak saptanm›flt›r. (Türkderm 2011; 45: 14-8) Anahtar Kelimeler: Dermatolog, hasta, tan›, uyum Summary Background and Design: According to the ICD-coding system, 862 diseases of the cutaneous and subcutaneous tissues. Only few diseases have a Turkish equivalent or a corresponding term in Turkish language. Our aim was to investigate the diagnostic agreement between dermatologist and patients and the factors affecting this agreement. Material and Method: The study involved 1479 cooperating patients aged 18 years or above who had applied to Dermatology Outpatient Clinic of Haydarpafla Numune Training and Research Hospital between September 2009 and April 2010 and had a disease with a Turkish name or original term. The patients were divided into three groups as their diagnoses were compatible or incompatible to the dermatologist's diagnosis or were unfamiliar. The groups were compared statistically for age, gender, education level, effects of disease duration and severity. The groups showing agreement and disagreement were additionally explored for: diagnosing person (patient or physician); when diagnosed by the patient, the information source (friends, parents, media, patient's own idea); when diagnosed by a physician, the specialization field (dermatology or other specialties); previous treatment and effect of disease presence in individuals in the patient's environment. Results: It was found that 829 (56.1%) patients' diagnoses were compatible, while 278 (18.8%) were incompatible to the dermatologist's diagnosis and 372 (25.5%) were unfamiliar. The agreement between diagnoses was higher in females, youngsters, and in patients with higher education levels, longer disease duration a...