الفهرس 
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Abstract
Lt.) S UMMA RV AND CONCL S ION C’q
SUMMARY AND C 1 NCLUSI IN
Chronic venous insufficiency is a major health problem, ranging from unimportant varicosity to ulceration, it is a frequent cause of hospitalization and can lead to incapacity for work, it is estimated that 1-2% of the general population will suffer from a
venous ulcer at some period of their life.
It has long been recognized that not only hereditary, but also environmental factors are associated with the occurrence of venous disorders in a population, a standing occupation for many years is indicated as one of these risk factors.
The final stage of chronic venous insufficiency is ulceration, several theories have been suggested to explain the skin changes and ulcerations, however none of these can fully account for all the alterations which occur.
Adhesion molecules are considered to play an important role in inflammatory reactions and in the process of wound healing.
The aim of our study was to investigate the expression of intercellular adhesion molecule-I (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in venous leg ulcers.
Forty patients were included in the study (37 males and 3 females), complete history taking, physical dermatological
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examination, coloured Duplex and ascending venography were done for each patient.
Biopsies were taken from the surrounding liposclerotic skin of the venous ulcers, immunohistochemical staining using
immunoperoxidase technique for ICAM-1, VCAM-1 and H. & E. staining were done. Results were compared with 20 age, sex and
site of biopsy matched controls.
In this study males out numbered females, their age ranged (11-60 ys) with mean (40.03 ± 11.71), 77.5% of patients showed a history of chronic heavy smoking, 87.5% of patients had history of recurrence of venous leg ulceration.
By H. & E. staining, microscopic examination showed proliferation of papillary and reticular capillaries, dilatation and torsuosity, perivascular inflammatory mononuclear cell infiltrate, extravasation of RBCs and deposition of haemosiderin in the derm is.
ICAM-1 expression was significantly increased on the endothelium cells of capillaries directly below the venous ulcer and the basal keratinocytes in patients with CVI and ulceration as compared to controls.
Expression of VCAM-1 was significantly positive on the endothelium cells of capillaries and basal keratinocytes of venous ulcers as compared to controls.
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Expression of ICAM-1 and VCAM-1 on basal keratinocytes and ECs were significantly related to the duration of ulcer, but not as regards the recurrence of ulceration.
Increased expression of ICAM-1 and VCAM-1 on basal keratinocytes correlated to increased expression of ICAM-1 and VCAM-1 on ECs .
Expression of ICAM-1 on basal keratinocytes and ECs not correlated with expression of VCAM-1 on basal keratinocytes and ECs.
These data imply that the up-regulation of endothelial adhesion molecules (ICAM-1 & VCAM-l) and dermal infiltration of mononuclear cells in CVI-patients is limited to the region of the ulcer and is part of a secondary elimination of necrotic tissue
”injury and repair” process. These local chronic inflammatory reactions are certainly important factor in the persistence and recurrence of venous ulceration.