DrSclafani answers some questions

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

Postby Cece » Tue Jul 13, 2010 10:52 pm

JOhnnybaby248 wrote:this would mean what dr. resulting in a negative delta (positive result). B mode abnormality noted ?

He's talked about delta before, does this help? (He's referring to Zamboni's five possible signs of CCSVI, of which two are needed.)
drsclafani wrote:Delta CSA measures the diameter of the same jugular vein when lying down and sitting up. Normally the vein is larger lying down. One of the five criteria is that the vein is larger sitting up than when lying down.
...
There are only five findings. So unless TCD and delta CSA are done, your chances of having two of the five signs (consistent with CCSVI) are maredly reduced
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Postby Sotiris » Wed Jul 14, 2010 4:56 am

JOhnnybaby248 wrote:what is venous thrombosis ?

Clotted blood in a vein.
what I dont understand is what veins both right ?

Reflux may be present even in the absence of a stenosis, e.g. due to malformed valves, septa etc.
What is the cross sectional area ?

Assuming the vein is a cylindrical tube CSA is π*r*r
Some people post that there veins are 70% 80% 90% closed how do you come up with that number

(Normal CSA, i.e above or below the stenosis – CSA where the narrowing is )/ Normal CSA
this would mean what dr. resulting in a negative delta (positive result). B mode abnormality noted ?

An IJV narrowing may cause reflux or a disturbance in the blood flow. B mode abnormality is suggestive of a problem in the vertebral plexus or in the azygos vein, i.e. the main drainage canal in the sitting position.
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Postby JOhnnybaby248 » Wed Jul 14, 2010 6:24 am

Sotiris wrote:
JOhnnybaby248 wrote:what is venous thrombosis ?

Clotted blood in a vein.
what I dont understand is what veins both right ?

Reflux may be present even in the absence of a stenosis, e.g. due to malformed valves, septa etc.
What is the cross sectional area ?

Assuming the vein is a cylindrical tube CSA is π*r*r
Some people post that there veins are 70% 80% 90% closed how do you come up with that number

(Normal CSA, i.e above or below the stenosis – CSA where the narrowing is )/ Normal CSA
this would mean what dr. resulting in a negative delta (positive result). B mode abnormality noted ?

An IJV narrowing may cause reflux or a disturbance in the blood flow. B mode abnormality is suggestive of a problem in the vertebral plexus or in the azygos vein, i.e. the main drainage canal in the sitting position.



So your saying there might also be a problem in my Azygos vein and I should have it checked as well
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Postby Sotiris » Wed Jul 14, 2010 8:13 am

JOhnnybaby248 wrote:So your saying there might also be a problem in my Azygos vein and I should have it checked as well
Actually, I wanted to write that negative ΔCSA is suggestive of a potential problem with vertebral plexus and/or azygos vein, but yes, acc. to the theory, there might be a problem with your azygos vein.
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Postby laura383 » Wed Jul 14, 2010 4:16 pm

Hi Dr Sclafani,
I was liberated last week. In the procedure ithe catheter went in on the right. Is there any way to check at this point if iliac or renal veins need dilating? I might just be paranoid about wanting to make sure every possible vein is opened! I just know that it made a big difference for Barb Farrell. I don't want to leave any stone unturned. Do I even need to be concerned about it?
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Postby Cece » Wed Jul 14, 2010 6:34 pm

drsclafani wrote: You as patients have an obligation to yourselves to seek out BEST practice. However that is not what is going on. You are seeking out AVAILABLE practice.

I once got lucky and picked a great one...who quickly became unavailable. Dang that irb.

It fits with the Go Expert vs Go Local vs Go Go Go dilemma. Go Go Go would be the Go Wherever's Available option. So how do we help a vulnerable population sort out where not to go? (No answer needed, unless you've got one.)

drsclafani wrote: i am not sure that a tidal wave is a healthy thing. I am deeply concerned when a patient is told that there catheter venogram shows a normal right IJV and an occlusion of the left IJV but I see an abnormal right IJV and a catheter venogram of the vertebral vein is called an occluded IJV. Some neurologists are smirking about this stuff

This plays right to our prejudices. Neurologists are smirking! I knew it. ;)

drsclafani wrote:You will be happy to hear that the first CCSVI Symposium, put together just a few weeks ago is getting a fair amount of interest, thanks in part to your efforts. Yesterday a CCSVI treating physician from Bulgaria reserved to come to the meeting in Brooklyn! Keep up the good work. You will accomplish much by encouraging doctors to be involved in the educational process.

If you find other ways for us to help, we are always here and always up to the task.
"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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Postby drsclafani » Wed Jul 14, 2010 8:40 pm

SCGirl wrote:Hello Dr.,
I sent you a PM, but wasnt sure if you would check that. I have had a venogram and angiogram (both catheter) and no stenosis was found. Should I have someone else looked at the films.. or should I have another test done?
I would love to hear from you.
Margarette


if you do not find abnormalities, you should get a second opinion. I think 62-90% incidence means the chances of disease are high.

Send me the images and i will look at them
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Postby drsclafani » Wed Jul 14, 2010 8:41 pm

L wrote:
drsclafani wrote:
L wrote:
drsclafani wrote:Thus occlusion of the inominate vein may make it impossible to treat any IJV obstructions on that side
Moreover, someone told me a story about how they had radiation to the chest that resulted in stenosis of the subclavian vein. that in turn appears to have resulted in MS. could you be a second patient?


I have had a couple of chest X Rays but no CT scan.

Is it possible to treat an occluded inominate vein?

Thanks Dr Sclafani.


sometimes there is a slit in the vein at the stenosis. if one can get a guidewire through that slit, it is often possible to venoplast or stent if necessary to reopen the vein. Always worth the shot


Thanks again. One final question (I promise.) If it does turn out to be the problem and venoplasty isn't an option would an operation be possible to fix the problem?

I think that I shall get in touch with my cardiologist.

Thanks again for taking the time for us, it is so very good of you.


possibly. but i would get a second opinion from someone.
too many misses

send me the images and i will look at it

it helps me stay in the game
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Postby drsclafani » Wed Jul 14, 2010 8:42 pm

SCGirl wrote:CeCe,
I hate to sound stupid, but I don't know what veins were checked! I just know they went in both sides of the groin and up through the neck and head. The IR who did it had read up on Zamboni's research; however, he did tell me that he had done the procedure on one other person and had found no stenosis on them as well.


therefore, you need a second opinion!
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Postby drsclafani » Wed Jul 14, 2010 8:52 pm

JOhnnybaby248 wrote:Dr. S

Well dr I got my results from the Doppler and was wondering if I post what it says can you please help me try to understand it. I know that I have CCSVI But dont understand in what way

Findings Right Jugular
The cerebral venous outflow appears patent with no evidence on venous thrombosis. Venous Insufficiency was evident with reflux in the internal Jugular vein at 0 and 90 degrees. The cross sectional areas of the internal jugular vein at 90 degrees is larger than the cross sectional area at 0 degrees resulting in a negative delta (positive result). B mode abnormality noted


Findings left Jugular
The cerebral venous outflow appears patent with no evidence on venous thrombosis. Venous Insufficiency was evident with reflux in the internal Jugular vein at 0 and 90 degrees. The cross sectional areas of the internal jugular vein at 90 degrees is larger than the cross sectional area at 0 degrees resulting in a negative delta (positive result). B mode abnormality noted

CONCLUSION
Venous reflux/insufficiency is noted in the internal jugular veins on the right and left at 0 and 90 degrees. positive values for cross sectional area of the internal jugular veins on the right and left B mode abnormalities noted bilaterally.
Criteria met for CCSVI:3/5

what is venous thrombosis ?


the vein is clotted and has no blood flow

what I dont understand is what veins both right ?

I do not understand this question. try again

What is the cross sectional area ?

the vein is seen end on and looks like something like a circle. a measurement is made of the area of the circle.

Some people post that there veins are 70% 80% 90% closed how do you come up with that number


you measure the diameter or the cross sectional area of the narrowed area and divide it by the diameter or cross sectional area of the normal vein


this would mean what dr. resulting in a negative delta (positive result).


normally subtracting the cross sectional area of the vein standing up from the cross sectional area of the vein lying down equals a positive number.
The zamboni criteria is present if the cross sectional area sitting up is greater than when lying down. That gives a negative delta

B mode abnormality noted ?


This means that something abnormal is seen on the views of the vein, like a stenosis, a valve, a septum, a web.

Any help would be appreciated Dr.

thanks a head of time


my pleasure. hope you understand
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My wife's condition

Postby MSwarrior » Thu Jul 15, 2010 12:51 am

Dear Dr. Sclafani,
I know you are not a neurologist, but I still have question. My wife was Liberated in Poland at the of June. Since than part of her symptoms got better. But now she is feeling dizzy in the morning and before noon. Is it normal, considering that we have very hot weather here right now, or may have happened that her LIJV restenosed?
Your answer will be highly appreciated.
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Postby SCGirl » Thu Jul 15, 2010 5:19 am

Hey Doc -
I am thrilled that you will look at my images from my procedure. How should I send them to you?
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Postby JOhnnybaby248 » Thu Jul 15, 2010 6:56 am

drsclafani wrote:
JOhnnybaby248 wrote:Dr. S

Well dr I got my results from the Doppler and was wondering if I post what it says can you please help me try to understand it. I know that I have CCSVI But dont understand in what way

Findings Right Jugular
The cerebral venous outflow appears patent with no evidence on venous thrombosis. Venous Insufficiency was evident with reflux in the internal Jugular vein at 0 and 90 degrees. The cross sectional areas of the internal jugular vein at 90 degrees is larger than the cross sectional area at 0 degrees resulting in a negative delta (positive result). B mode abnormality noted


Findings left Jugular
The cerebral venous outflow appears patent with no evidence on venous thrombosis. Venous Insufficiency was evident with reflux in the internal Jugular vein at 0 and 90 degrees. The cross sectional areas of the internal jugular vein at 90 degrees is larger than the cross sectional area at 0 degrees resulting in a negative delta (positive result). B mode abnormality noted

CONCLUSION
Venous reflux/insufficiency is noted in the internal jugular veins on the right and left at 0 and 90 degrees. positive values for cross sectional area of the internal jugular veins on the right and left B mode abnormalities noted bilaterally.
Criteria met for CCSVI:3/5

what is venous thrombosis ?


the vein is clotted and has no blood flow

what I dont understand is what veins both right ?

I do not understand this question. try again

What is the cross sectional area ?

the vein is seen end on and looks like something like a circle. a measurement is made of the area of the circle.

Some people post that there veins are 70% 80% 90% closed how do you come up with that number


you measure the diameter or the cross sectional area of the narrowed area and divide it by the diameter or cross sectional area of the normal vein


this would mean what dr. resulting in a negative delta (positive result).


normally subtracting the cross sectional area of the vein standing up from the cross sectional area of the vein lying down equals a positive number.
The zamboni criteria is present if the cross sectional area sitting up is greater than when lying down. That gives a negative delta

B mode abnormality noted ?


This means that something abnormal is seen on the views of the vein, like a stenosis, a valve, a septum, a web.

Any help would be appreciated Dr.

thanks a head of time


my pleasure. hope you understand



Hey thanks Dr S. I will see you Aug 7th for the fund raiser I plan on bringing a couple of your peers with me they are all interested in CCSVI so bring all your knowledge with you. Also Dr. S there is a Dr. I plan on asking to come. From what he says he is a close friend of yours and a close friend of Dr. Dake He ran into Dr. Dake in South Korea about 2 month's ago and they were talking about CCSVI.

Its pretty funny when I went to go see the Dr. (Professor) about CCSVI and as I was telling him about CCSVI and the Doctors in the states that were involved.
I told him there is a Dr. in Brooklyn,New York Dr. S
one in Arozina Dr. D
one in Pennsylvania Dr. Bonn
one in California Dr. Dake
He lightly patted my leg and Quietly said yes I know all of them they are all friends.
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One more question

Postby MSwarrior » Thu Jul 15, 2010 7:12 am

Dear Dr. Sclafani,
My wife has been liberated in Tychy, Poland. In her left IJV the stenosis was 7,5 inches long. They tried to liberate the stenosis, but the upper end of it is already in the skull area abve the left ear. Is there any way to fix this type of stenosis at the present time?
Best regards
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Postby L » Thu Jul 15, 2010 7:54 am

drsclafani wrote:possibly. but i would get a second opinion from someone.
too many misses

send me the images and i will look at it

it helps me stay in the game


Thanks Dr Sclafani. At the moment it's all my imagining the worst. MS has turned me into such a pessimist. All the best for the next IRB.
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