Hi! all, I would like to gladly announce that our paper is
now published online. Unfortunately, special permission
(payment) is needed to access the journal to read the
entire paper. Please have a look at the abstract at this
site:
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1524-4725.2007.33315.x

Basically, we tried to workout the mechanism of action of
3 scerosants that are commonly used here; absolute
ethanol, 1% polidocanol & OK-432.

We use sclerosants to sclerose vascular malformations in
many patients, for many years now but we do not fully
understand the mechanism of action.

We summarize & recommended that absolute ethanol may be
used for treating deeper vascular malformations and for
both high flow & low flow lesions. They sclerose the
vessels by firstly, causing the formation of precipitants
around which a clot is formed. This clot is important to
block of the blood flow beyond it thus, achieving
sclerosis.

Polidocanol, do not form a clot but directly destroys the
endothelium. It is painless upon injection & is useful for
treating low flow, superficial lesions.

OK-432 is a preparation of killed & freeze dried bacterial
particles. In vivo they induce the expression of cell
adhesion molecules (eg. ICAM-1 etc.) This effect increases
permeabillity, of any cystic lesions which helps drains
cystic fluids & prevents their build-up (recurrence). With
the adherence of cell adhesion molecules and fibrosis
secondary to the chronic inflammation, the cyst closes
off. It should be used to treat cystic lesions as well as
macrocystic lymphatic malformation.

We are recruiting patients in PNG with vascular anomalies
to receive sclerotherapy. Please, if you come across any
such patients refer them to me or pass my email address to
them or refer them to Dr. Sam Endiken (ENT surgeon, Goroka
Base Hospital). I am planning to visit PNG again early
next year to attempt treatment of such patients. So far we
have seen 5 such patients in Goroka & 3 at PMGH. May be
there are many more out there not knowing that their
lesions can be treated.

I have seen a young melanesian girl of 16 years of age at
PMGH who received surgery for her venous malformation of
the right cheek area with horrible results. The surgery
was done in Melbourne, Australia. I wish it was left alone
in the first place.

Finally, take note that with the advance in technology,
surgery is becoming less and less invasive.

Thanks!

William



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