DrSclafani answers some questions

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

Postby NZer1 » Fri Oct 22, 2010 2:36 pm

Cece I think the Dr. has answered the question about the shape. The body forms this from the embryonic cord healing after disconnection from the mother ship.
Dr. S can we hear your views on the findings of Dr Chung please. It would appear to be important in our Jigsaw puzzle.
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Postby Cece » Fri Oct 22, 2010 3:25 pm

NZer1, it's much earlier than that, the end of the embryological stage is eight weeks into the pregnancy. I just wonder why the azygous would be prone to web malformations and the IJV other types, unless perhaps these spiderwebs can be found there too.

http://www.embryology.ch/anglais/pcardio/venen01.html

(Click on 'start' at the bottom and watch the veins differentiate.
#6, the superior cardinal vein in blue, is the one that becomes the IJV and subclavian and others.
#20 is the azygous, from the orange supracardinal vein)
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Postby NZer1 » Fri Oct 22, 2010 5:51 pm

Good find as always Cece.
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Postby drsclafani » Fri Oct 22, 2010 8:48 pm

Flashover81 wrote:Hi. Dr.S. I am the father of a 14 year old boy, who March of this yearl had a we were hoping ADEM episode. He made a full recovery with the 5 day's of steroids. He had around 10 lesions mostly in the periventricular area. Our Neuro wanted to do a MRI every 3 months for the next year. June we had a MRI and the lesions were getting smaller in size, he was happy. Oct 6th another MRI, this one showed a new lesion. He has no disabilities and is a normal athletic young boy. I know there isn't much info or testing for pediatrics, I was wondering if you or anybody else has heard if the trials in Buffalo for the pediatrics are looking promising? We have a Neuro appt. in 6 months, in the meantime we are doing the paleo diet and vitamins and see what happens. The Neuro we have is very open minded and looking at all the options.

Thanks Dr.S for all the hard work and dedication you have shown to all on this site.
Jimmy.


jimmy
i have no experience. I am not aware of any reports published as of yet
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Postby drsclafani » Fri Oct 22, 2010 8:56 pm

Cece wrote:
drsclafani wrote:What i was speaking about there , cece, is a different kind of web than that in the azygos. The azygos webs are like like spider webs forming small compartments. The semantics is pretty primitive so far

Is this sort of web found elsewhere in any other veins of the body? Why would this sort of web be found in the azygous and not the jugulars? (Or can these spiderweb tangles form there too?)

The theory behind the webs is in the development of the azygos from the cardinal system which occurs by deconstruction of the cardinal to reform as the azygos.
the theory behind most of the jugular lesions is somewhat different. truncular in location, possibly related to abnormal actin scaffolding leading to problems in vlaves....just conjecture, not important

{quote]I had assumed you wouldn't be trying the azygous ballooning diagnostic method, since you had IVUS. I don't suppose we know yet which is better.[/quote] The web lesion is a new focus, began after i was put in a straightjacket. I did not notice anything like this on IVUS but it was early and i wasnt prepared to look for it.[/quote
That was a good question, Donnchadh.

i agree

Would the 'gently' be because the ballooning could cause damage to the venous wall in a perfectly good azygous (assuming no webs found)? Or are these such small balloon sizes that there is little risk?

there is always risk, no matter how small. The veins are pretty small and i wound not want to damage a perfectly good one. But i tihink that compliant balloons are relatively safe with low pressures.

Flashover81, it might be possible to talk an IR into doing the doppler ultrasound on a minor, since that is noninvasive. It could not hurt to ask. Are there any ccsvi docs near you?


happy to help if you live near the defeated new york yankees :cry:
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Postby drsclafani » Fri Oct 22, 2010 9:24 pm

Cece wrote:NZer1, it's much earlier than that, the end of the embryological stage is eight weeks into the pregnancy. I just wonder why the azygous would be prone to web malformations and the IJV other types, unless perhaps these spiderwebs can be found there too.

http://www.embryology.ch/anglais/pcardio/venen01.html

(Click on 'start' at the bottom and watch the veins differentiate.
#6, the superior cardinal vein in blue, is the one that becomes the IJV and subclavian and others.
#20 is the azygous, from the orange supracardinal vein)


excellent cece
i will share with my trainees

no not you guys.
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Postby drsclafani » Fri Oct 22, 2010 9:33 pm

NZer1 wrote:Cece I think the Dr. has answered the question about the shape. The body forms this from the embryonic cord healing after disconnection from the mother ship.
Dr. S can we hear your views on the findings of Dr Chung please. It would appear to be important in our Jigsaw puzzle.


This is a different entity that that which causes ccsvi

the reflux chung is speaking about (i presume, because these are only abstracts) is incompetent valves that enable blood to back up from the heart and chest veins, up into the jugular veins. The reflux zamboni is speaking about is reversal venous flow from the brain and spine resulting from obstruction of the outflow veins themselves. Patients with ccsvi are unlikely to have the type of venous insufficiency talked about by Chung because the obstructions in the veins prevents the blood of the chest from going up by the same reason that blood cannot get down

Dr Doepp seems to have the same misunderstanding. Thus they both write about the valsalva manuever. The failure of the valsalva manuever to produce reflux leads them to the false conclusion that ccsvi does not exist.

If someone gets me the full article, i will review in more depth

s
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Postby malden » Sat Oct 23, 2010 1:34 am

drsclafani wrote:...Dr Doepp seems to have the same misunderstanding. Thus they both write about the valsalva manuever. The failure of the valsalva manuever to produce reflux leads them to the false conclusion that ccsvi does not exist.

If someone gets me the full article, i will review in more depth

s

No evidence for cerebro-cervical venous congestion in patients with multiple sclerosis
F. Doepp, F. Paul, J.M. Valdueza, K. Schmierer, S.J. Schreiber (Berlin, Bad Segeberg, DE; London, UK)

...
Methods: We performed extra- and transcranial Doppler ultrasound studies including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during valsalva manoever (VM) and 'CCSVI' criteria in 59 patients with MS (target: 80 patients) and 20 reference subjects.
...

IJV flow analysis during valsalva manoever was performed in addition . They also examined 'CCSVI' criteria:
Background: Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins. Recent studies suggested this topographic pattern may be caused by cerebral venous congestion, a condition termed 'chronic cerebro-spinal venous insufficiency' ('CCSVI'). In a recently published study we were unable to reproduce the reported findings of reflux in the deep cerebral veins and/or the internal jugular and vertebral veins (IJVs and VVs), stenosis of the IJVs, missing flow in IJVs and VVs, and inverse postural response of the cerebral venous drainage (Ann Neurol, in press).
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Postby Flashover81 » Sat Oct 23, 2010 7:44 am

Thank's Dr.S...... Sorry about the Yankees :cry: I live in Fla and have a Neuro in Tampa that just got back from a confernce in Sweeden, and is up to speed with CCSVI. I just thought somebody might have encouraging news about the pediatric study being done by Dr. Weistock-Guttman.

Once again sorry about the Yankees, I had the same feeling when the Rays got knocked out... Have a great weekend Dr.S.

Thanks CeCe, I know they are doing procedures at a few places here, but so little info and hesitation with pediatrics. I also am hesitant with my son till more info on pediatrics come out. I do think it's going in the right direction....
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Postby Cece » Sat Oct 23, 2010 12:50 pm

Flashover81 wrote:I just thought somebody might have encouraging news about the pediatric study being done by Dr. Weistock-Guttman.

If I hear any news or vague unsubstantiated rumors, I'll bring it back here. Or of course any published reports. ;)

From this http://www.bnac.net/?page_id=517 it is an imaging study only, using MRV and doppler, in pediatric patients with diagnosed MS. They mention limited funding, I wonder what role that is playing. Their results don't have to be perfect, if they're even as good as the Buffalo results last February (unpublished), that would provide more evidence of the association between MS and CCSVI. Dr. Weistock-Guttman is an expert on pediatrics MS.

There is also this pediatrics CCSVI study: http://tinyurl.com/29wd2t2
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Postby dunkempt » Sat Oct 23, 2010 1:06 pm

There is also this pediatrics CCSVI study: http://tinyurl.com/29wd2t2


Ah, yes, the one the head or our MS Clinic, Dr. Marrie, is involved in. Umm .... don't expect much!

-d
dx rrms august 2009 (dx CFS spring 1988) off avonex after 3 months
treated katowice 24-25 march 2010 - best thing that ever happened - check tracking thread
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Postby drsclafani » Sat Oct 23, 2010 5:42 pm

Malden wrote:
drsclafani wrote:...Dr Doepp seems to have the same misunderstanding. Thus they both write about the valsalva manuever. The failure of the valsalva manuever to produce reflux leads them to the false conclusion that ccsvi does not exist.

If someone gets me the full article, i will review in more depth

s

No evidence for cerebro-cervical venous congestion in patients with multiple sclerosis
F. Doepp, F. Paul, J.M. Valdueza, K. Schmierer, S.J. Schreiber (Berlin, Bad Segeberg, DE; London, UK)

...
Methods: We performed extra- and transcranial Doppler ultrasound studies including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during valsalva manoever (VM) and 'CCSVI' criteria in 59 patients with MS (target: 80 patients) and 20 reference subjects.
...

IJV flow analysis during valsalva manoever was performed in addition . They also examined 'CCSVI' criteria:
Background: Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins. Recent studies suggested this topographic pattern may be caused by cerebral venous congestion, a condition termed 'chronic cerebro-spinal venous insufficiency' ('CCSVI'). In a recently published study we were unable to reproduce the reported findings of reflux in the deep cerebral veins and/or the internal jugular and vertebral veins (IJVs and VVs), stenosis of the IJVs, missing flow in IJVs and VVs, and inverse postural response of the cerebral venous drainage (Ann Neurol, in press).

i have read, reviewed and commented on the doepp article. It has no merit for me.

i was speaking about the chung article
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Postby pklittle » Sat Oct 23, 2010 6:27 pm

Dr. Sclafani,
Since each Dr. treating CCSVI seems to have their own twist (no pun) on how to test, pick the balloon size, etc, what advice would you give a patient that has been treated with venoplasty but had no relief of symptoms? More specifically, would it be worthwhile to seek treatment elsewhere by someone who is also experienced but who's approach is a bit different?
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Postby David1949 » Sat Oct 23, 2010 8:05 pm

Dr. Sclafani
As I understand it, when we are standing most of the blood from the brain drains back to the heart through the azygous vein. But when we lie down in the supine position the jugulars kick in. So I've been wondering two things:
1) What mechanism regulates the flow through the jugulars? Is there something that serves as a shutoff valve to stop or throttle the flow when we are standing?
2) Is there a reason why the jugulars shut down when we stand? Could it be that too much blood flow from the brain might also be a problem, so the body reduces the flow in the jugulars?
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Postby fogdweller » Sun Oct 24, 2010 12:06 pm

David1949 wrote:Dr. Sclafani
As I understand it, when we are standing most of the blood from the brain drains back to the heart through the azygous vein. But when we lie down in the supine position the jugulars kick in. So I've been wondering two things:
1) What mechanism regulates the flow through the jugulars? Is there something that serves as a shutoff valve to stop or throttle the flow when we are standing?
2) Is there a reason why the jugulars shut down when we stand? Could it be that too much blood flow from the brain might also be a problem, so the body reduces the flow in the jugulars?


Apropois of this, if the stenosis treated are in the jugular, would it be a good idea to spend the first couple of days after treatment lying down alot so that there is plenty of blood flowing through the jugulars to prevent thromosis and prevent the walls of the jugular from healing shut against each other?
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