a neurosonographer's critcal notes to Zamboni' s methodology

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

a neurosonographer's critcal notes to Zamboni' s methodology

Postby thisisalex » Fri May 21, 2010 5:22 am

Hello everyone,
A hungarian neuro-sonographer dr. Gyula Panczel has jus published a critical approach to Zamboni's Doppler methodology.

Dr. Panczel is a leader in the Hungarian Neuro Sonograpers Association http://www.neurosonologia.hu/vezetoszer ... x?tmi=1825

I have translated his opinion. (please note that i am not a professional translator!)


Here is what dr Panczel thinks about Zamboni's methodology:

All pieces of the Zamboni-theory is speculative.
Notes to the Doppler methodology:

there were 5 criteria defined by Zamboni:
1. reflux in the internal jugular and vertebral veins > 0,88s
It is normal to find reflux of 0,22 - 0,78 sec in the IJV in a healthy person. Increasing the reflux time with only 0,1 sec doesn't mean that the vein is stenosed. You can achieve this very small increase simply by pressing the transducer a little bit stronger against the skin. If we find a longer (1,23-6,15 sec) reflux time it is the symptom of valve problems, but Zamboni thinks this longer reflux time is not a valve problem, but occlusion of the vein, which leads to SM. (Zamboni rather thinks that valve problem causes transient global amnesia.)

2. reflux in the deep cerebral veins
Intracranial ultrasound imaging is a complex examination and requires a well trained person.
These veins are almost perpendicular to the ultrasound beam, thats why the cosinus of the angle is close to 0, and that's why we can not expect a significant amplitude. (velocity of flow is about 8-13 cm/s). There are two veins (Galen and Rosethal) joined here. that is why in the farthest part of the Rosenthal vein there is an outward flow, but in the nearest part of this vein there is an inward flow. These two opposite flows can be observed as reflux by an average observer.

3. high-resolution B-mode evidence of stenosis of the internal jugular. (cross sectional area < 0,3 cm2)
We never diagnose a stenosis by B-mode detection, especially not in a vein, because it is easily compressible (when its not thrombolyzed). It is a medical malpractice. The significant assymetry of the IJV is usual and is normal. In more than 60% of observed people the cross-sectional area of the dominant vein is double that of the other veins' area. In more than 20% of observed people this area is smaller than 0,4 cm2

4. flow in the internal jugular or vertebral veins that could not be detected with Doppler:
There is no color signal in the vein

5. reverted postural control of the main cerebral venous outflow pathways.
The IJV can be heavily dilated in an upright position, in Congestive heart failure for example. Zamboni could diagnose a vein occlusion in patients with congestive heart failure. (which is false)


Summary:
Three crieterias (Nr. 1, 2, and 5) are not the signs of vein occlusion for certain.

Zamboni needs only 2 criteria in order to define CCSVI, which could be:
- a healthy person (Nr.1 positive: with a little bit pressure aplpied with the transducer and Nr. 3 positive: IJV assimetry, normal flow)
- a patient with valve insufficiency (Nr. 1 and Nr. 3 positive)
- a patient with congestive heart failure (Nr1 and Nr5 positive)
- the doctor is not a well trained person.

the most obvious criteria for an occluded vein is the absence of Doppler spectrum, which is not included in the 5 criterias.

In school books the signs of vein occlusion are:
-no color signal
-no doppler spectrum
-above the occlusion dilated vein with fixed wall in B-mode

There are other interesting statements in Zamboni's papers. Above the vein occlusion the pressure is elevated, it would be logical for the wall to dilate, but Zamboni describes narrowing of the walls. The most beautiful thig is 100% sensitivity and specifity, but what can you expect from such a flexible 2/5 criteria system which was well adapted to Zamboni's expectations.

Occlusion of the IJV and the azygos vein is not without symptoms. But there were no clinical symptoms of IJV and azygoUs occlusion observed on MS patients.

None of the Ultrasound pictures published by Zamboni convinced me that a vein occlusion has been observed.

dr. Pánczél Gyula

source: http://www.sminfo.hu/beteg/docs/zamboni_kritika.pdf (in hungarian)



It would be very important to reply to this professional opinion, because in hungary we have just started to organize a CCSVI trial...

thank you very much
alex
Last edited by thisisalex on Sun May 23, 2010 8:17 am, edited 3 times in total.
User avatar
thisisalex
Family Elder
 
Posts: 218
Joined: Wed Dec 02, 2009 4:00 pm
Location: Hungary

Advertisement

Postby costumenastional » Fri May 21, 2010 5:33 am

This is interesting indeed.
May i suggest that you take this to Dr Sclafani's thread? As a vascular surgeon who is treating (and by that seeing) vein malformations he is the most capable to give you an educated answer.
Of course it will be interesting to see what he thinks of that article.

I am not an expert of course, but i have a strange feeling that this dude has never seen an MRV of an MS patient with CCSVI. Noone knows if CCSVI triggers MS but i dont think that Zamboni or whoever treats CCSVI sees stenoses only in his dreams which apparently this person implies.
User avatar
costumenastional
Family Elder
 
Posts: 740
Joined: Sat Jan 31, 2009 4:00 pm
Location: Greece

Postby frodo » Fri May 21, 2010 5:50 am

Well, at least it is a well founded critic. This is the first person that says something interesting against CCSVI. Previously all the statements were just "It is impossible".

Anyway, I find that he speaks about veins occlusion while Zamboni focuses in blood reflux. For sure the doppler will not be black when a reflux appears. Maybe what the author critizises is not exactly the Zamboni theory.
User avatar
frodo
Family Elder
 
Posts: 617
Joined: Wed Dec 02, 2009 4:00 pm

Postby costumenastional » Fri May 21, 2010 6:01 am

Image
Image

hope Johnson wont kick my ass for showing his/her pics...

according to this dude Johnson should let this condition untreated huh?
i guess this is normal...
like it s normal for a vein to have such a constriction and lead the flow to collateral veins.

Image
Image

In school books they say one more thing: when pictures talk, b.....t walk.
Last edited by costumenastional on Fri May 21, 2010 6:23 am, edited 2 times in total.
User avatar
costumenastional
Family Elder
 
Posts: 740
Joined: Sat Jan 31, 2009 4:00 pm
Location: Greece

Postby cheerleader » Fri May 21, 2010 6:03 am

It's an interesting read, I have no idea if he is right or wrong, since I'm not a doppler technician....but I do know that Zamboni and many others use TCD and doppler as a non-invasive indicator. It's their first step, and it's working for them. But more is made clear upon venography. And in Jeff's case...he had 95% occlusion of his left jugular, 80% of his right with a nothing special doppler. And that was really, really obvious to a vascular interventional radiologist.
there's gonna be lots of similar research coming out--
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5048
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Re: a neurosonographer's critcal notes to Zamboni' s methodo

Postby sbr487 » Fri May 21, 2010 6:10 am

thisisalex wrote:
Occlusion of the IJV and the azygos vein is not without symptoms. But there was no clinical symptoms of IJV and azygos occlusion observed on MS patients.

alex


Ok, so let us screw MS and just fix occlusion since it is not without symptoms.
What about MRV and Venogram? Is that flawed too?
User avatar
sbr487
Family Elder
 
Posts: 860
Joined: Tue Nov 24, 2009 4:00 pm
Location: India

Re: a neurosonographer's critcal notes to Zamboni' s methodo

Postby costumenastional » Fri May 21, 2010 6:21 am

sbr487 wrote:Ok, so let us screw MS and just fix occlusion since it is not without symptoms.


I think he suggests that vein occlusion symptoms have nothing to do with MS symptoms. But then again, everyone seems to have an opinion "opposing" ccsvi nowadays when noone is "in favor". I mean, all scientists who are into ccsvi research are doing exactly this:RESEARCHING and trying to help with minimal risks involved. But all these are well known to this online community. No need to take this further...

I live to see the day one of those "specialists" will give us another viable solution to treat our condition instead of trying to stop people from having their veins opened.
User avatar
costumenastional
Family Elder
 
Posts: 740
Joined: Sat Jan 31, 2009 4:00 pm
Location: Greece

Postby cheerleader » Fri May 21, 2010 6:35 am

nevermind
Last edited by cheerleader on Fri May 21, 2010 7:30 am, edited 1 time in total.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5048
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby costumenastional » Fri May 21, 2010 6:38 am

haha why this doesnt come as a surprise to me...

let them jumb Cheer...
User avatar
costumenastional
Family Elder
 
Posts: 740
Joined: Sat Jan 31, 2009 4:00 pm
Location: Greece

Postby cheerleader » Fri May 21, 2010 6:40 am

nevermind
Last edited by cheerleader on Fri May 21, 2010 7:30 am, edited 1 time in total.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5048
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby sbr487 » Fri May 21, 2010 6:47 am

Looks like he will be busy for next several months disproving CCSVI. Good. I think less casualties in his study :lol:
User avatar
sbr487
Family Elder
 
Posts: 860
Joined: Tue Nov 24, 2009 4:00 pm
Location: India

Postby cheerleader » Fri May 21, 2010 6:49 am

nevermind
Last edited by cheerleader on Fri May 21, 2010 7:31 am, edited 1 time in total.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5048
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby costumenastional » Fri May 21, 2010 7:03 am

Nooooo....this is not fair....
Poor fingo... Bad people are trying to give you a bad name here...
Is really skin cancer that bad? Whats wrong with cancer eating you alive to the bone??? It may be an awful way to dye but it WILL free you from MS.
Ungrateful people...

In the first years they are trialing it has already killed but they go on. I guess it s ok for us to be on it in our whole life. Living immunosuppressed. The new concept. Seems like the "living immunomodulated" one is old news since there are obviously NO benefits in the long term.

When are we going to understand that liberation is only one more bet we have to take? The only difference is that its not so risky as those killer drugs.

Noone knows for sure the benefits of CCSVI treatment. Short or long term. But for some reason EVERYBODY know the lethal risks of balloon angio.
User avatar
costumenastional
Family Elder
 
Posts: 740
Joined: Sat Jan 31, 2009 4:00 pm
Location: Greece

Postby sofia » Fri May 21, 2010 7:04 am

I am enjoying every minute of my reduced symptoms placebo period, may it last a very long time.
:-)
<div>I have lived with ms for 8 years. The last year has been hell, I've gone from shite to even worse every single month, until my liberation in May. </div>
User avatar
sofia
Family Elder
 
Posts: 162
Joined: Thu Mar 25, 2010 4:00 pm

shoot the message

Postby mohzi » Fri May 21, 2010 7:04 am

Not of offend anyone, but it would serve all of us better to shoot the message and not the messenger.
User avatar
mohzi
Family Member
 
Posts: 37
Joined: Sat Feb 28, 2009 4:00 pm

Next

Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service