DrSclafani answers some questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby Zeureka » Tue Jun 29, 2010 2:37 pm

Dr Sclafani, have you maybe discussed the issue of occasional "transient headaches" that seem to appear in some (maybe few? I do not know) patients after angioplasty with other researchers? Not very common or is it? Reasons CCSVI-related?
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Postby Cece » Tue Jun 29, 2010 3:46 pm

fogdweller, that is rich indeed, that quote!
Last edited by Cece on Tue Jun 29, 2010 4:53 pm, edited 1 time in total.
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Postby SofiaK » Tue Jun 29, 2010 4:33 pm

Dear Dr. Sclafani:
I'm writing to ask if you know the names of any recommended Drs or maybe investigational radiologists who would remove an obstructing valve in the jugular vein.

Right now, I'm near the Buffalo area. It's hard for me, but I'll travel if I must.

I just don't have a clue of who can help.

Thank you,
Sofia
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Dr.

Postby bmk1234 » Tue Jun 29, 2010 4:48 pm

SofiaK wrote:Dear Dr. Sclafani:
I'm writing to ask if you know the names of any recommended Drs or maybe investigational radiologists who would remove an obstructing valve in the jugular vein.

Right now, I'm near the Buffalo area. It's hard for me, but I'll travel if I must.

I just don't have a clue of who can help.

Thank you,
Sofia


Sofia, it is my understanding you are signed up for treatment in Albany, NY?
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Postby JohnJoseph » Tue Jun 29, 2010 5:20 pm

Dr Sclafani - my first post and question here, after reading through (nearly) the whole thread - it's simply UNIQUE.
The azygos has recently been a topic again. As you've pointed out, the proper viewing angle is the key for informative images necessary to find abnormalities.
Here my question: But what are the typical pathologies at azygos ?
- Are several valves in the upper azygos arch (and further upstream) normal and their number is just an individual's factor - means only the proper flow / proper valves functioning matters?
- Or do multiple valves as such already represent a pathology with a consequently resulting flow problem and therefore an indication for a treatment (except for the last valve at SVC confluens I guess)?
For illustration I attach one venogram image on which I assume to see at least 2 valves in the azygos arch zone - your judgement here ? (and how bad is the picture?)

Image

Thank You, I truly appreciate
John
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Postby Cece » Tue Jun 29, 2010 5:24 pm

Welcome to the thread, JohnJoseph!
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Postby SofiaK » Tue Jun 29, 2010 5:53 pm

No one so far will treat my obstruting valve bmk.

That's why I'm asking.
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Postby Cece » Tue Jun 29, 2010 6:19 pm

google scholar results for Sclafani, Salvatore J. A.

http://scholar.google.com/scholar?hl=en&q=Sclafani%2C+Salvatore+J.+A.&as_sdt=100000000&as_ylo=&as_vis=0

Imagine if the IRB would let him churn out papers for us the way he does for the splenically injured, neck penetrated, pelvically gunshot...the list goes on and on.

Edited to add: this article, by a S J Sclafani among others, suggests that venous stenosis can occur either at typical locations of anatomic narrowing or at sites of previous trauma. So trauma can bring on a venous stenosis, at least according to drsclafani circa 1988? http://radiology.rsna.org/content/168/2/371.abstract But this sort of stenosis is not what you are seeing in CCSVI cases, not even for one of the couple malformations found in each patient? By trauma, could this mean car accident or are we talking gunshot wounds? Apologies if this is too forward....
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Re: Up Hill Battle

Postby drsclafani » Tue Jun 29, 2010 11:08 pm

Squeakycat wrote:It seems as though the US and Canadian MS Societies funding for CCSVI studies is aimed at putting a nail in the CCSVI coffin, once and for all.

Dr. Paul Hebert, a critical care physician and editor-in-chief of the Canadian Medical Association Journal.

Though treatment advocates believe it is relatively risk-free, Hebert says manipulating fragile veins can be dangerous.

"We normally only dilate arteries. Dilating veins is highly experimental and the structures are so weak that people will die," he warns. "At some point it will happen because putting in vascular catheters is dangerous at the best of times."

Dr. Aaron Miller, head of the MS clinic at New York's Mount Sinai Hospital and chief scientific adviser to the U.S. National MS Society.

Miller explains the procedures are mainly being done by interventional radiologists. They know about imaging vessels, but they may not know a lot about multiple sclerosis.

"So if they alone are going to provide the data, the data is of questionable validity. It would be comparable to my trying to produce credible information on some other subspecialty area that I don't have any expertise in."




We are climbing Mount Everest!

And the question for Dr. S, is: With this kind of opposition, is it really possible to make any progress?




SO LETS EXAMINE SOME OF THE STATEMENTS ABOVE:

dr herbert says

Though treatment advocates believe it is relatively risk-free, Hebert says manipulating fragile veins can be dangerous.

"We normally only dilate arteries. Dilating veins is highly experimental and the structures are so weak that people will die," he warns. "At some point it will happen because putting in vascular catheters is dangerous at the best of times."


VEINS HAVE BEEN DILATED SINCE 1980. THE STATEMENT JUST GOES AGAINST COMMON SENSE AND PRACTICE...

but Dr Miller says it best if you ask me



Dr. Aaron Miller, head of the MS clinic at New York's Mount Sinai Hospital and chief scientific adviser to the U.S. National MS Society.

Miller explains the procedures are mainly being done by interventional radiologists. They know about imaging vessels

"So if they alone are going to provide the data, the data is of questionable validity. It would be comparable to my trying to produce credible information on some other subspecialty area that I don't have any expertise in."


DR MILLER AREN'T YOU NOW TRYING TO PRODUCE OPINION ON SOME OTHER SUBSPECIALTY AREA THAT YOU DONT HAVE ANY EXPERTISE IN?


radiologists were told that angioplasty could not work for arteries...NOW STANDARD OF CARE

IRs were told that they could not drain empyema of the chest...STANDARD OF CARE

IRs were told they could not drain large abdominal abscesses because you needed to put in a surgical drain.....STANDARD OF CARE

IRs were told fibroids required hysterectomy....Today i treated two women who did not want their uterus removed.....STANDARD OF CARE

IRs were told that injured spleens needed to be cut out. Now IR controls the hemorrhage and patients keep their organ and heal without surgery....STANDARD OF CARE


i believe that we WILL collect the evidence and we will show an outcome and you will decide whether the data is sufficient for you to undergo this procedure.
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Postby drsclafani » Tue Jun 29, 2010 11:11 pm

fogdweller wrote:And my question to Dr. S is this. How common is angioplasty on veins? I have several different impressions from reading the posts on this and other threads.



the most common utilization of venous angioplasty is in the treatment of cancers that obstruct veins and in the treatment of dialysis fistulas

all the time

also consider that the pressure is very low in the vein. if the vein were to tear in the neck, light pressure would usually be sufficient to control the bleeding

exsanguination is not one of thepotential complications i mention to m y patients while obtaining informed consent
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Postby drsclafani » Tue Jun 29, 2010 11:14 pm

Zeureka wrote:Dr Sclafani, have you maybe discussed the issue of occasional "transient headaches" that seem to appear in some (maybe few? I do not know) patients after angioplasty with other researchers? Not very common or is it? Reasons CCSVI-related?


i can think of a few potential explanations

1. balloon dilatation hurts and pain is referred
2. the guidewire has entered the dural sinus through the jugular foramen. this can cause pain
3. contrast media can give you a headache
4. stress of the procedure

i am sure there are others
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Postby drsclafani » Tue Jun 29, 2010 11:20 pm

JohnJoseph wrote:Dr Sclafani - my first post and question here, after reading through (nearly) the whole thread - it's simply UNIQUE.
The azygos has recently been a topic again. As you've pointed out, the proper viewing angle is the key for informative images necessary to find abnormalities.
Here my question: But what are the typical pathologies at azygos ?
- Are several valves in the upper azygos arch (and further upstream) normal and their number is just an individual's factor - means only the proper flow / proper valves functioning matters?
- Or do multiple valves as such already represent a pathology with a consequently resulting flow problem and therefore an indication for a treatment (except for the last valve at SVC confluens I guess)?
For illustration I attach one venogram image on which I assume to see at least 2 valves in the azygos arch zone - your judgement here ? (and how bad is the picture?)

Image

Thank You, I truly appreciate
John



john
the abnormalities in the azygous are similar to those in the jugular. The most common abnormalities are the malformations of the trunk of the vein, not the distal part of the vein (although any part can be effected.)

twists, membranse covering the orifice, stenoses sescondary to hypoplastia, all occur. stiff unopening valves...all of these and more can occur
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Postby PCakes » Tue Jun 29, 2010 11:32 pm

posted by 'estrelinha' (sp) June 16 in the tracking sticky thread...

STENOSIS PROCEDURE HISTORY

Date/location of testing/procedure: June 14, 2010 Paris
Type of venographic study: (MRV, Doppler) both

Diagnosis: Nothing wrong with jugular veins, just a little difference between right and left flows (not pathological). The azygos vein has not been investigated because, according to the physician, the azygos can not suffer from stenosis if the jugulars are normal.



?????
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Postby Cece » Tue Jun 29, 2010 11:38 pm

PCakes wrote:The azygos vein has not been investigated because, according to the physician, the azygos can not suffer from stenosis if the jugulars are normal.

8O
Last edited by Cece on Wed Jun 30, 2010 9:34 pm, edited 1 time in total.
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Postby drsclafani » Tue Jun 29, 2010 11:45 pm

rom: HappyPoet
To: drsclafani
Posted: Wed Jun 30, 2010 8:06 am
Subject: 200,000
A few words from our good doc, perhaps?


it is quite interesting that 200,00 hit milestone passed with barely a peep.

i think the thread has been well received by most, although i was pillaried for my ego on another thread.



so lets look at some of the undeliverables to you

1. a test still has not been read
2. we are discussing an atlas
3. I did not get an IRB proposal accepted

but I did some good (even on the sideline; and that was satisfying) , i believe, by relating some of the nuances of Galleoti's and Zamboni's venographic technique to show may thurner and the lumbar veins

i have received several emails this week showing that the patients were able to advance the technique with the newbie liberators and much to my surprise several docs told me of picking up MT syndrome quite incidentally.
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