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Maria Mejia Sanchez
Pediatrician & Neonatologist

Historical Perspective

The lymphatic vascular malformations were known since antiquity, and the mothers were blamed for the lesion, which was called maternal nevus. It was believed that a boy could remain marked in utero with representations of the emotions or objects of desire or repulsion of his mother. By the similarity of the lesions with certain food, they had a nomenclature based on descriptive terms that is maintained still nowadays: hemangioma in "strawberry" or "cherry", and stains in "port-wine", and plate "salmon", by citing some examples.

During the XIX century, Virchow and his disciple Dr. Werner proposed a histologic classification of the Vascular Anomaly of the Infancy. Virchow considered these lesions as tumors and called them with respect to the architecture of the channels that constitute them, simple, cavernous, and racemose angiomas. Werner proposed a histomorphologic classification similar to the lymphatic lesions that are still utilized today, simple, cavernous, and cystic lymphangiomas.

In 1908, a pathologist, Adami, observed that not all the vascular lesions behaved in the same way. He proposed that the term angioma should be utilized only for true vascular tumors with independent growth.

The distinction in the biological activity was emphasized in 1982 with Mulliken and Glowacki, who defined hemangiomas as true endothelial tumors that show a proliferative phase. The group of vascular lesions, which consisted of capillaries, veins, lymphatic or structurally abnormal arteries without capacity of growth nor of regression and with a normal cell sparing, was considered as vascular malformations.

In regard to the therapy, surgical resection has been recommended as the first therapy, but still in the most expert hands the percentage of complications is high from 12 to 33%, and the rate of recurrence is from 15 to 53%. Through the years, non-surgical strategies have been recommended, like radiation therapy, use of antibiotics such as the bleomycine, alcoholic solution of zein (Ethibloc), hot water, as well as many others. Nevertheless, by their poor results and the occurrence of secondary systematic-local lesions, they have been abandoned or little utilized.

In 1987, Dr. Shuhei Ogita published his results using OK-432 in children, reporting the total regression of the lymphangiomas in 8 of 9 treated cases. The revolutionary genius for the knowledge and therapy of the lymphangiomas was born. From then, the excellent results reported with this therapy around the world did change and continue changing from the selection of the surgical intervention as the first therapeutic choice. Increasingly, more children have been treated with this modality of therapy and more doctors have been interested not only in the substance of OK-432, but also in the study of the lymphatic vascular malformations.

The patients with lymphangiomas now have been identified in greater numbers in Mexico. We do not consider that the percentage of these patients has increased, but now the doctors have a sure and effective option for the aforementioned patients. Before this therapeutic alternative, the doctors deferred the attention for these patients and they avoided treating them, for which the majority of them did not receive any type of therapy, and a great percentage of them who received therapy presented neurological and/or vascular consequences, or scars that increased the unsightly aspect of the lesions.

The discovery of DR. OGITA has changed the quality of life of the patients with lymphangioma as well as that of their relatives. THE GENIUS OF DR. SHUHEI OGITA IN UTILIZING OK-432 (Picibanil) for the therapy of the lymphangioma is the most important advance that has been given in the chapter of lymphatic malformations, since the recognition of the same. And we consider that it is currently the GOLD STANDARD, for the patients with lymphangiomas.

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Humanitarian Aspect and the Relation with Mexico of Dr. OGITA

In 1993, Dr. Shuhei Ogita learned of the first case of a Mexican boy with lymphatic malformations named Carlos, who had to be transferred to Japan to receive his therapy. Almost at the same time another Mexican boy of the city of Merida, Yucatan, requested to Dr. Ogita for the application of OK-432, since at that moment the boy could not be transferred to Japan, nor could Dr. Ogita come to Mexico. In this regard, the negative response of doctors of the mentioned city to use OK-432 who ignored it motivated Dr. Ogita to carry out a course of training for Mexican doctors from 1994 to 1997.

In 1995, after returning from Japan, Dr. María Mejía initiated the institutional application of OK-432 in Torre Medica Hospital and Children's Hospital of Mexico, Mexico City, and the complete results of the first 12 Mexican children treated with OK-432 were presented in 1997 at the National Pediatric Congress in the National Medical Center, and in 1998 these results were published in the Pediatric Acta of Mexico. In 1999, Dr. Ogita came to Mexico City for the first time to visit Torre Medica Hospital and Children's Hospital of Mexico. There he gave an extraordinary lecture, which had a deep impact on the doctors and patients, not only by its content, but also due to his great humanism, ethics, kind heart, and his deep commitment toward the patients and their health. It was in that visit when he expressed his desire that the therapy could reach to ALL OF THE MEXICAN CHILDREN WHO HAVE LYMPHANGIOMA, AND WANT TO RECEIVE IT, and NO MATTER WHERE THEY LIVE AND IRRESPECTIVE OF THEIR ECONOMIC SITUACION.

In November 2002, Dr. Ogita returned to Mexico City to attend the First International Congress of Pediatric Otolaryngology, and visited again Torre Medica Hospital and Children's Hospital of Mexico, verifying the great quantity of patients that had benefited from his therapy, receiving affection and admiration by the relatives of the patients and the doctors. For those who had the great fortune to know and to receive the great teachings of the Venerable Dr. SHUHEI OGITA, not only in the field of lymphatic malformations, but in the humanitarian aspect, great human quality, dedication, and professionalism that Sensei Ogita exemplified, his death represents a great tragedy, and an irreplaceable loss. But it comforts us to continue the dissemination of his Great Work. His spirit and essence will live forever, in each smile of the children cured with OK-432.

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