Dr. Zamboni's letter published in the Annals of Neurology

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

Postby patientx » Thu Nov 11, 2010 3:33 pm

Esme wrote:Normally, the drainage in sitting/upright position is taken care of mostly by the AV/VV and less by the IJV's. In suspine position the IJV's form the main road for draining blood from the brain. This is demonstrated in the HC and the patients (480 and 499 ml per minute, average).

In sitting/upright position most of the drainage is done by the AV/VV in the HC: only 123 ml blood per minute flows through the IJV's.
In the patient group 318 ml blood per minute flows through the IJV's.

So because of problems in the AV/VV the blood cannot follow its favourite path in upright position through the AV/VV and is forced to choose the IJV's.

(see fig. 11 http://csvi-ms.net/files/multiple%20sclerosis-USG.pdf)


I'm no expert, but I don't think the azygous vein is the outlet for the brain. In the Doepp, et al paper, the blood flow volume through the vertebral veins in the upright position was very similar for the patients and controls. This would seem to indicate that the blood flow through the VVs wasn't impeded for the MS subjects.
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Postby MrSuccess » Thu Nov 11, 2010 11:52 pm

well well well ...... our beloved Professor Zamboni has the nerve to enter the lions den ..... and face his critics .

....and the mathematicians are out in full force . :roll:

I expect Professor Zamboni 's spelling to be the next lame targeted attempt at disproving his Big Idea. :twisted:


What a brilliant and courageous man.



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Postby sbr487 » Fri Nov 12, 2010 1:58 am

MrSuccess wrote:well well well ...... our beloved Professor Zamboni has the nerve to enter the lions den ..... and face his critics .

....and the mathematicians are out in full force . :roll:

I expect Professor Zamboni 's spelling to be the next lame targeted attempt at disproving his Big Idea. :twisted:


What a brilliant and courageous man.



Mr. Success


Sometime back I was on blog that had CCSVI write up.
The writer of the blog, an young neurologist, was dismissing CCSVI.

After briefly discussing about CCSVI in negative tone his ending punch line was like ... "wait till I tell you the name of the person who has proposed this theory ...??? ... Zamboni ... ha ha ha ..."
A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it
- Max Planck
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Postby sou » Fri Nov 12, 2010 4:49 am

I wonder who's gonna remember the name of the neurologist after 10 years...
Shortest joke: "We may not be able to cure MS but we can manage its symptoms."
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Postby ThisIsMA » Fri Nov 12, 2010 11:49 pm

In reading the excerpt from Dr. Zamoni's letter that Cheerleader posted at the beginning of this thread, it seems to me that the following sentence is crucial:

The authors demonstrate a much larger change in blood flow volume in normal subjects compared to MS patients when the subjects go from a supine to an upright position.


(bolding of text added by me for emphasis)

I think what Dr Zamboni is saying is that there is much less change in blood flow volume between sitting and laying down in PWMS than in normal controls.

Its not that the blood flow volume neccesarily increased in the PWMS when they sat up compared with lying down, so much as that their blood flow volume doesn't lesson, which is what it should do.

I think this indicates the IJVs of the People with MS (PWMS) didn't collapse like they should when the PWMS sat up. That is one of the 5 criteria for CCSVI in the Zamboni doppler US protocol. So his contention that the study supports the existence of CCSVI makes sense to me.
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Postby Sotiris » Tue Nov 16, 2010 1:28 pm

The full paper of Doepp et al. can be found below:
http://onlinelibrary.wiley.com/doi/10.1 ... .22085/pdf
and the response of Prof. Zamboni can be found in http://www.msrc.co.uk/index.cfm?fuseact ... ageid=2479 (near the middle of the page for the time being)
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Postby MS_HOPE » Tue Nov 16, 2010 2:11 pm

Sotiris, thanks so much for posting those links to the papers - very helpful!
CCSVI:  Making Sense of MS
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Postby CuriousRobot » Tue Nov 16, 2010 2:17 pm

Sotiris wrote:The full paper of Doepp et al. can be found below:
http://onlinelibrary.wiley.com/doi/10.1 ... .22085/pdf
and the response of Prof. Zamboni can be found in http://www.msrc.co.uk/index.cfm?fuseact ... ageid=2479 (near the middle of the page for the time being)


Wow, surprising about that Russel Brand tidbit. He always seemed like bit of a twat. Guess you never should judge a book by it's cover (maybe you can with Katy Perry and the like, etc).
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Postby ms2009 » Wed Nov 24, 2010 10:04 pm

Letter - full text for Zamboni's response.

I read with interest the article titled “No Cerebrocervical Venous Congestion in Patients with Multiple Sclerosis” by Doepp and coworkers.1 Contrary to their conclusions, I believe that the authors' results are a further validation of venous flow irregularities in multiple sclerosis (MS) patients.

One of the major regulators of cerebral venous outflow is posture, due to the gravitational gradient between the cerebral parenchymal veins and the base of the neck (−30mmHg).2 The authors demonstrate a much larger change in blood flow volume in normal subjects compared to MS patients when the subjects go from a supine to an upright position. They find a change of 128ml/min and 56ml/min for the right and left sides, respectively, for MS patients. But they find a much larger change of 266ml/min and 105ml/min for their normal subjects. This result actually suggests the presence of chronic cerebrospinal venous insufficiency (CCSVI). Possible causes include intraluminal septum, membrane, and immobile valve affecting the hydrostatic pressure gradient in the upright position. The presence of such blockages in the extracranial and extravertebral cerebral veins has been proven also by using catheter venography, the unquestionable gold standard in medicine.3, 4

There was a trend toward significance (0.06) when comparing the mean global cerebral blood flow (CBF) in MS patients with that in controls. However, the level of significance is underestimated by the low control sample, 20 versus 56 patients. The reduction in CBF in MS, meaning in practical terms stasis, might become significant by simply increasing the control sample.

Both the above-reported results correspond with the reduction in CBF and in cerebral blood volume with increased mean transit time, assessed by means of magnetic resonance imaging (MRI) perfusion study.5

The authors failed to demonstrate CCSVI through the assessment of the criteria originally proposed by our group. However, it seems the latter were not precisely assessed. For instance, the authors exchange the parameter for defining stenosis we used in angiographic studies (>50% lumen reduction) with those used in Doppler ultrasonography. In addition, the frequent detection of intraluminal jugular septation is not described by the authors. The latter is the most common cause of flow blockage, and can only be diagnosed with high resolution ultrasonographic probes capable to explore the jugular in the supraclavicular fossa (Fig. 1) 3-4. Clearly, a complete understanding of the system is required before drawing conclusions about the lack of venous abnormalities, and this requires ultrasound, MRI, and catheter venography. This underscores the urgency of establishing an internationally accepted protocol. In the attempt to achieve this cultural osmosis, my group is available to travel to Berlin and rescan with German colleagues the entire series by the means of the proposed methodology.
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