drsclafani wrote:[None of these four tests listed above is particularly helpful in assessing the azygous vein which drains the spinal cord. Only catheter venography and IVUS illustrate problems with that vein at the current state of the art.
drsclafani wrote:Johnson wrote:
Beyond heating, a greater danger is the metal being pulled through your brain at high speed when they are scanning the occipital, so be sure to take out that barbell in your tongue or nasal septum! You don't want to "shoot" yourself in the head.
There are some cool videos of scuba tanks, fire extinguishers, hammers and such getting mixed up in MRI machines. Just Google it.
those cool videos don't show the terrible cost that occurs removing them. They have to vent off the coolants when they shut down the magnet and it costs quite a bit of money to start up the unit again.
IT IS VERY IMPORTANT TO REMOVE ALL METAL, KEYS, NECKLACES, ETC BEFORE GOING INTO THE MR SCANNER. SOME OF THE PATCHES USED FOR DRUG DELIVERY, LIKE THE NICOTINE PATCHES, CAN GET HEATED AND CAUSE INJURY TOO
Zeureka wrote:...would seem the IVUS in combination to venography could be really important to find potential pathologic valves.
Cece wrote:After the travel and expense that people are going to, if they are leaving with any lesions missed and untreated, it is really unfortunate...I don't blame the doctors, this is all too new.
on Doppler and ECU, one sees hemodynamic evidence of abnormal flow and anatomical abnormalities of the jugular vein
on MRvenography one sees evidence of collapse of veins, collaterals and some real stenoses
MRvenography is NOT the same as what most would call venography or, to be a purist, i would call catheter venography
catheter venography is the Gold Standard, but i would argue that all have their value as does
intravascular ultrasound (IVUS)
you all know I am going to try to prove that catheter venography plus IVUS should be the gold standard.
None of these four tests listed above is particularly helpful in assessing the azygous vein which drains the spinal cord. Only catheter venography and IVUS illustrate problems with that vein at the current state of the art.
Cece wrote:And just like that, not twelve hours after the good doctor was here, he has two poignant questions waiting for him once again, between this and jr5646's.
Cece wrote:Cece wrote:
Mark, I think Dr. S will be interested in what you said here, it fits with what he's proposed before (that an upper area that seems like a narrowing or stenosis may not need direct treatment, but treatment of an area lower down will open up the flow)!
Oh, me certainly neither! I am really so thankful that they give us this chance to already apply what they know - and in the manner they know best and are good at (and each doctor will obviously have a bit different deeper specialisation on a certain aspect) - and this at the max of the current status of their knowledge, experience and expertise! That's already great and it's positive to know that there may be even more good things to come with further research!Cece wrote:Zeureka wrote:...would seem the IVUS in combination to venography could be really important to find potential pathologic valves.
Sure sounds like it. He said awhile back that he hadn't used IVUS in enough patients to feel comfortable publishing yet...hopefully the delay will lift soon.
After the travel and expense that people are going to, if they are leaving with any lesions missed and untreated, it is really unfortunate...I don't blame the doctors, this is all too new.
Happy Memorial Day weekend, everyone!
Dr S, I see you found the emoticons ... your use of them is so funny!
edit: I typed my daughter's adjective of "cute" the first time instead of mine, sorry Dr. S.
jr5646 wrote:Dr. S., I hope I'm not the one in class "constantly" waving his hand/arm with a question.. lol
Anyway, can you take a look below?? Dying to see what you think..
Thanks again for helping us all..jr5646 wrote:Dr. Sclafani,
I just had an MRV done at Buffalo (BNAC-selfpay option) and wanted to see if you think this image shows treatable stenosis/narrowing? Is this something common you've seen? Is this area too high to be reached? Below is a direct quote from the report which I can't really make heads or tails of.. Also, I only presented with one of the five Zamboni criteria via doppler.. #2 - Reflux propagted upward to the Deep Cranial Veins (DCV's) and/or from the White Matter (WM) to the Subcortical Gray Matter (SCGM). Perhaps a bunch of clollateral veins too? Possible lower right IJV valve issue (sticky valve?) and Iron measures very high (higher than the avg. MS Pt.)
From the report: "MR VENOGRAM FINDINGS: The superior sagittal sinus with appears to drain predomininatly on the right. The transverse sinuses are relavetly symmetric in size. The sigmoid sinuses and jugular bulbs are relatively symmetric in size. At the base of the brain, the internal jugular veins are well visualized. At the level of the cranical/cervical junction junction on the right, the internal jugular on the right takes on a flattened morphology with respect to flow charactists. This segment is small in size being less than 10mm. Throughout the neck, the internal jugular veins have an ellipsoid morphology. The junction of the internal jugular veins with the subclavian veins is normal in apperance. There is slight asymmetry of the internal juglar veins with the right being larger than the left."
I'm not quite sure if or how this correlates, but my very first two presenting symptoms showed up on the left side. Left arm/hand numbness (still have it approx. 10 yrs later and left eye Optic Neuritis 2002 - complete, but temporary blindness that resolved in about 3 mths with steroids..
Anyway, the rest of the report comments on the arterial side.. all good
Thanks again for all your help.. I decided on investing the $4500 to hopefully get some answers and further research, but would really rather give it to someone who needs it more than I do instead..
Donnchadh wrote:Dr. Sclafani:
Assuming that stents are implanted in the internal jugular veins, and a long term anti-coagulation regime is followed, would it ever be possible for the patient to donate a pint of whole blood?
The reason I am asking is that donating whole blood has been the best method for me in dealing with the MS effects of iron deposition.
I am not talking about donating while taking Plavik etc., during the immediate (30 days or so) recovery time, but later when presumably the inner vessel cells have completely covered the stent matrix.
jfgonmen wrote:Dear Dr. Sclafani.
My wife has MS for 20 years ago. She is 37 right now. She has SP MS two years ago and she is rapidly decline and worsering.
She was made some test to see if she has CCSVI ( Eco-doppler, flebography and scan ). We was told that she had asimmetrical yugulars. The left yugular has 12 milimiter and the rigth has 5.5 milimiter.
The doctor was surprise because it happen along the both yugular since top or beggining in cranial hole till the end of the neck. Even with the yugular cranial holes happens the same, the right cranial hole has a size that is less than a half than left one size.
My questions are:
Has it something to do with CCSVI?
Would it have any influency in MS?
Could it be treated some way?
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