Tamm T. I., Olejnik A. E., Reshetniak O. M.

PATHOMORPHOLOGY

Scentific article

Pathogenesis of venous ulcers of lower limbs serves a subject of active study for a many decades. Despite that in modern medical literature we can meet sufficient number of articles, devoted to morphology of chronic venous ulcers. Take place a fact of sizeable empiricism in choosing of settings of observation. Target of our research was studding of morphological features in structure of chronicle venous ulcers with using modern immunogystochemical methodic with using monoclonal antibodies to markers of proliferative activity ki 67, collagens I, III and IV types fibroblasts growth factor, vessel endothelial growth factor (VEGF), endothelial cell factor (CD34), epidermal growth factor, macromolecular cytokeratin (Cytokeratin HMW), also was define receptors to macrophages (CD68). According to received data, main link of pathogenesis is: disorder of microcirculation in case imperfect angiogenesis, appearance of “botryoidal” granular tissue with break down functional activity of endothelium; inflammatory infiltration and expressed tissue edema and also perverted synthesis of collagen, that apparent in disorder of ratio of fibrilar collagen I and III types and appearance in thickness of ulcer tissue seats of “net” collagen IV types in view of large deposits. This pathogenetic factors lead to prolong and perverting inflammatory processes, holding of reparation, appearance secondary necrotic changing that cause relapsing passing of venous ulcers, create “vicious circle” with persistent damage (necrosis) that lead to chronic inflammation, last one to incomplete regeneration (persistent granular tissue) which, in it turn, lead to progressive sclerosis and defective granulation and fibrous tissue are prone to secondary necrosis. «The vicious circle” of pathological relation closed, forming a new pathological self-sustaining system that extends from the body’s influence. In this way, based on received data, we can mace conclusion: 1. In a background of necrotic and inflammatory processes occurring in the venous ulcer tissues there is a significant disruption of fibrilar collagen types, and also changing of its ratio, to complete disappearing of III d type of collagen. 2. In ulcers tissue was observed atypical localization of collagen type IV, relating to the “net” types, in the form of compact deposits that don’t compared with basal membranes. 3. Disorders of microcirculation are largely associated with reduced of vascular endothelial function, which leads to disruption of vascular permeability and increase of a tissue edema. In this way, having an idea about the nature of the pathological processes that occurring in chronic venous ulcers, we can develop the concept of therapeutic interventions aimed at correcting disorders of blood circulation, reducing the phenomena of tissue edema and prevention development of destructive processes.

chronic venous ulcers, collagen, microcirculation disorders, granulation tissue

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«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 328-331 pages, index UDK 617.58:616.14 – 002.44 – 036.12 – 091:577.27:611.018