DrSclafani answers some questions

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

Re: DrSclafani answers some questions

Postby NHE » Fri Sep 20, 2013 11:09 pm

dlynn wrote:Is stem cell therapy the only way to replace neurons, can the body naturally replace them in time?


Fred H. Gage of the Salk Institute has shown that exercise increases the production of stem cells in the hippocampus.

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Re: DrSclafani answers some questions

Postby NZer1 » Thu Sep 26, 2013 9:40 am

NZ researchers show reduced grey matter blood flow can reveal reduced function before permanent tissue loss is visible and may lead to improved tools for prognosis and clinical trials.
http://www.ncbi.nlm.nih.gov/pubmed/?ter ... +sclerosis
Abstract
BACKGROUND:
Grey matter (GM) pathology in multiple sclerosis (MS) is associated with progressive long-term disability. Detection of GM abnormalities in early MS may therefore be valuable in understanding and predicting the long-term course. However, structural MRI measures such as volume loss have shown only modest abnormalities in early relapsing-remitting MS (RRMS). We therefore investigated for evidence of abnormality in GM perfusion, consistent with metabolic dysfunction, in early RRMS.
METHODS:
25 RRMS patients with ≤5 years disease duration and 25 age-matched healthy controls underwent 3 Tesla MRI with a pseudo-continuous arterial spin labelling sequence to quantify GM perfusion and a volumetric T1-weighted sequence to measure GM volume. Neurological status was assessed in patients and neuropsychological evaluation undertaken in all subjects. Voxel-based analysis was used to compare regional GM perfusion and volume measures in patients and controls.
RESULTS:
There was reduced global GM perfusion in patients versus controls (50.6±5.8 mL/100 g/min vs 54.4±7.6 mL/100 g/min, p=0.04). Voxel-based analysis revealed extensive regions of decreased cortical and deep GM perfusion in MS subjects. Reduced perfusion was associated with impaired memory scores. There was no reduction in global or regional analysis of GM volume in patients versus controls.
CONCLUSIONS:
The decrease in GM perfusion in the absence of volume loss is consistent with neuronal metabolic dysfunction in early RRMS. Future studies in larger cohorts and longitudinal follow-up are needed to investigate the functional and prognostic significance of the early GM perfusion deficits observed.
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Re: DrSclafani answers some questions

Postby drsclafani » Thu Sep 26, 2013 10:05 am

NZer1 wrote:NZ researchers show reduced grey matter blood flow can reveal reduced function before permanent tissue loss is visible and may lead to improved tools for prognosis and clinical trials.
http://www.ncbi.nlm.nih.gov/pubmed/?ter ... +sclerosis
Abstract
BACKGROUND:
Grey matter (GM) pathology in multiple sclerosis (MS) is associated with progressive long-term disability. Detection of GM abnormalities in early MS may therefore be valuable in understanding and predicting the long-term course. However, structural MRI measures such as volume loss have shown only modest abnormalities in early relapsing-remitting MS (RRMS). We therefore investigated for evidence of abnormality in GM perfusion, consistent with metabolic dysfunction, in early RRMS.
METHODS:
25 RRMS patients with ≤5 years disease duration and 25 age-matched healthy controls underwent 3 Tesla MRI with a pseudo-continuous arterial spin labelling sequence to quantify GM perfusion and a volumetric T1-weighted sequence to measure GM volume. Neurological status was assessed in patients and neuropsychological evaluation undertaken in all subjects. Voxel-based analysis was used to compare regional GM perfusion and volume measures in patients and controls.
RESULTS:
There was reduced global GM perfusion in patients versus controls (50.6±5.8 mL/100 g/min vs 54.4±7.6 mL/100 g/min, p=0.04). Voxel-based analysis revealed extensive regions of decreased cortical and deep GM perfusion in MS subjects. Reduced perfusion was associated with impaired memory scores. There was no reduction in global or regional analysis of GM volume in patients versus controls.
CONCLUSIONS:
The decrease in GM perfusion in the absence of volume loss is consistent with neuronal metabolic dysfunction in early RRMS. Future studies in larger cohorts and longitudinal follow-up are needed to investigate the functional and prognostic significance of the early GM perfusion deficits observed.


I would argue that the decrease in GM perfusion in the absence of volume loss is consistent with diminished perfusion. What could be the cause of that in patients with MS? Could it be venous outflow obstructions?

Perhaps they could have concluded that impaired memory scores are seen in patients with MS who have decreased perfusion ?

Had they performed venography and IVUS in these patients they would have found that the majority of them would have had valvular stenosis (in my experience >99%). Then could they have concluded that memory dysfunction in early MS may be caused by decreased cerebral GM perfusion possibly caused by cerebral venous outflow obstructions .
Salvatore JA Sclafani MD
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Re: DrSclafani answers some questions

Postby MarkW » Fri Sep 27, 2013 8:32 am

Hello Dr S,
I wrote on another thread:
MarkW wrote:"Tethering CCSVI to MS created an either-or equation. Either CCSVI caused MS or it didn’t. Either CCSVI was found in people with MS exclusively or it wasn’t. Either CCSVI could cure MS or it couldn’t." wrote Anne Kingston.
CCSVI is not exclusive to MS. CCSVI does not cause MS. However treating pwMS with balloon venoplasty is logical. Measuring perfusion in DrS's 500 treated patients against healthy subjects and matched pwMS would give relevant data.

For me, this is now about correcting poor perfusion by using balloon venoplasty. Is anyone going to do/publish sufficient data in the current decade ?
Best wishes,
MarkW
(One of the 500)
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
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Re: DrSclafani answers some questions

Postby HappyPoet » Fri Oct 04, 2013 8:20 am

Hi DrS,

Can you please give us a report of your trip to Sherbrooke?
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Re: DrSclafani answers some questions

Postby drsclafani » Fri Oct 04, 2013 9:25 am

HappyPoet wrote:Hi DrS,

Can you please give us a report of your trip to Sherbrooke?


Sure. I will return to nyc on Monday and can give it some time then
Keep the blood flowing until then
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Re: DrSclafani answers some questions

Postby Cece » Wed Oct 09, 2013 5:52 am

HappyPoet wrote:Hi DrS,

Can you please give us a report of your trip to Sherbrooke?

I would like that too. :)
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Re: DrSclafani answers some questions

Postby Robnl » Wed Oct 09, 2013 6:40 am

drsclafani wrote:
cheerleader wrote:Hi Dr. Sclafani,
Not sure if you saw my earlier post, but I was wondering if this patient was also being checked for benign intracranial hypertension (pseudotumor cerebri). It's most prevalent in overweight or pre-menopausal women on birth control pills, but my slim and trim husband had it. It can create venous sinus stenosis and thrombosis of the dural/transverse sinus. In Jeff's case, it manifested as optic disc swelling, vision loss, headache and objective pulsatile tinnitus. All better since tranverse sinus stenting at Stanford hospital. Shunts can be helpful, so can medication. Sometimes, simply losing weight and stopping BCPs can help. Of course, if she's all better after jugular ballooning, that would be the best!
here's a great study on venous pulsatility and dural incompetence in IHH...has great MRV pics, too. Think you'll enjoy it :)
http://neurosurgery.med.wayne.edu/pdf/n ... y_2012.pdf
cheer


Thanks for the quote. I was surprised to consider that the stenosis could be caused by the intracranial hypertension. I had thought that the stenosis would be the cause of the intracranial hypertension.

In this case the patient experienced a defining severe and unrelenting headache leading to an MRI that showed "blood clot" in the brain for which she was given heparin and coumadin. That clearly suggests to me dural sinus thrombosis. She ceased birth control pills. Her symptom complaints were not visual signs but rather cognitive issues.

She is about two weeks past the jugular vein angioplasty procedure and states that she is 'clearer" inm thinking and her vision is sharper.

She is vacationing in France now and I will revisit her case when she returns.


Hi doc,

Any News for this case?

Rgds,

Robert
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Re: DrSclafani answers some questions

Postby Lety » Wed Oct 16, 2013 12:53 am

Lety wrote:
drsclafani wrote:
drsclafani wrote:Letty, at the current time, I think there is insufficient data to offer a solid recommendation regarding muscle entrapment. I have read a few case reports and anecodatal information. But i havent seen great outcomess In my experience many of these compressions are transient, meaning that they are not persistent 100% of the time.

Perhaps I have missed some reports. Does anyone have more information other than a few case reports and very small series "zamboni, Simka".



Lety wrote:Hello dr. Sclafani

Thank you for your answer, I don`t have case reports other than "zamboni, simka" http://www.ccsviitalia.org/7/post/2013/ ... bilia.html , but I know that dr. Pippo Cacciaguerra and dr. Pierfrancesco Veroux, Catania are study and treating this problem. Maybe you could contact these doctors and ask for concrete results ?
Your opinion is always important for me :smile:


drsclafani wrote:I have made contact with Dr Cacciaguerra. But august is a difficult month and dr cacciaguerra was on vacation. he sent me some slides but there wasnt anything substantive on it.

i look forward to analyzing and critiqueing this concept.



Lety wrote:Hi Dr. Sclafani

What do you think about this ? It is an important Award, were you in Boston at this congress ?

http://www.ccsvi-sm.org/?q=node%2F1867

best regards

Lety


Lety, i was not at this meeting. I read your link. Unfortunately there was no data on outcomes of this type of surgery. I am very interested and curious about this kind of phasic obstruction. If release of muscle compression (a phasic narrowing) results in durable clinical improvements, then I will have to review all my cases to determine who might be a candidate for this surgery 8O





Dear doc. Sclafani , yes it is very interesting

I sent you a PN



Dear dr. Sclafani

how are you ?

do you have any News :?:

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Re: DrSclafani answers some questions

Postby drsclafani » Thu Oct 17, 2013 6:39 am

drsclafani wrote:Letty, at the current time, I think there is insufficient data to offer a solid recommendation regarding muscle entrapment. I have read a few case reports and anecodatal information. But i havent seen great outcomess In my experience many of these compressions are transient, meaning that they are not persistent 100% of the time.

Perhaps I have missed some reports. Does anyone have more information other than a few case reports and very small series "zamboni, Simka".



lety wrote:Hello dr. Sclafani

Thank you for your answer, I don`t have case reports other than "zamboni, simka" http://www.ccsviitalia.org/7/post/2013/ ... bilia.html , but I know that dr. Pippo Cacciaguerra and dr. Pierfrancesco Veroux, Catania are study and treating this problem. Maybe you could contact these doctors and ask for concrete results ?
Your opinion is always important for me :smile:


drsclafani wrote:I have made contact with Dr Cacciaguerra. But august is a difficult month and dr cacciaguerra was on vacation. he sent me some slides but there wasnt anything substantive on it.

i look forward to analyzing and critiqueing this concept.



lety wrote:


Dear dr. Sclafani

how are you ?

do you have any News :?:

Lety

i received a copy of their unpublished paper on the subject of omohyoid. unfortunately it is in italia which I do not read. I sent it on to a vascular surgical colleague who does read italian and am awaiting his review of their paper

lets try in another week
Salvatore JA Sclafani MD
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Re: DrSclafani answers some questions

Postby Lety » Thu Oct 17, 2013 10:31 am

ok. thank you :smile:
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Re: DrSclafani answers some questions

Postby Robnl » Fri Oct 18, 2013 10:44 pm

Hi doc,

I'm missing your name at isnvd 2014??

Rgds,

Robert
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Re: DrSclafani answers some questions

Postby drsclafani » Sat Oct 19, 2013 4:32 am

Robnl wrote:Hi doc,

I'm missing your name at isnvd 2014??

Rgds,

Robert

I will be there, but i was not asked to speak this year. Time to hear new ideas

S
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Re: DrSclafani answers some questions

Postby Cece » Sat Oct 19, 2013 3:38 pm

Ohhhh the ISNVD schedule is out!
Looks like Dr. Ferral and Dr. Siddiqui will be the ones presenting on IVUS.
9:10 - 9:22 am: What additional information can intravascular ultrasound provide? - Adnan Siddiqui
Objectives:
•Define use of IVUS for detecting pathology of the extracranial venous system
•Describe qualitative and quantitative criteria for definition of intra-luminal and extra-luminal extracranial venous stenosis
•Discuss role of IVUS in detection of extracranial venous abnormalities in azygos or internal jugular veins
•Discuss ISNVD position statement, technical pitfalls for improving reliability of IVUS for screening of CCSVI
11:10 - 11:26 am: Procedural endpoints: how to best measure meaningful flow impairment, inter- and post-procedural therapy

A. IVUS driven intervention - Hector Ferral

B. Optimizing pure venographic therapy - Ken Mandato

Objectives:
•To describe details of IVUS driven intervention for CCSVI
•To describe details of venographic therapy optimization for CCSVI
•To review the role of IVUS and catheter venography for CCSVI treatment

http://www.isnvd.org/index.php?site=4th/program#content
Dr. Siddiqui mentions the quantitative criteria for definition of stenoses and that has always been a great benefit of IVUS since you get the actual CSA.
I would have been unhappy if no one was presenting on IVUS.
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Re: DrSclafani answers some questions

Postby Robnl » Sat Oct 19, 2013 10:22 pm

Yes, and i think that it is good that it is someone else, not dr. s..
Get what i mean?
(If it is a positive presentation....)
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