ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

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ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby cheerleader » Thu Oct 20, 2011 7:54 am

http://registration.akm.ch/einsicht.php ... KEN_ID=900

As Dr. Zamboni has been saying for a few years....intraluminal malformations (like the truncular venous malformations found in Budd-Chiari) are inside the jugular veins of pwMS. And these have hemodynamic consequences.

Friday, October 21, 2011, 17:30 - 17:45
Anatomical and histological analysis of venous structures associated with chronic cerebro-spinal venous insufficiency

C. Diaconu, S. Staugaitis, J. McBride, C. Schwanger, A. Rae-Grant, R. Fox (Cleveland, US)
Background: Chronic cerebro-spinal venous insufficiency (CCSVI) is a new theory for MS pathogenesis. CCSVI includes alterations in cerebral venous outflow and is often assessed by ultrasound or magnetic resonance venography (MRV). No gross anatomical description of venous outflow in MS has been reported to date.
Methods: We harvested bilateral internal jugular (IJV), subclavian, brachiocephalic, and azygous (AZY) veins from 7 deceased MS patients and 6 non-MS controls. Veins were injected with silicone, dissected en bloc, incised longitudinally to expose the luminal surface, and fixed. All valves and structural abnormalities were characterized and photographed using a stereomicroscope. Vein wall stenosis was defined as a >= 50% reduction in cross-sectional area, defined from vein wall circumference and compared to a normal appearing region in the same vein.
Results: A variety of vein abnormalities were identified. The incidence of vein wall stenoses was similar in MS and controls: eight stenoses in 4 of 7 MS patients and five in 3 of 6 controls. Marked valvular and other intraluminal abnormalities with potential hemodynamic consequences were identified in 5 of 7 MS patients (7 abnormalities) and in 1 of 6 controls (1 abnormality). These abnormalities included circumferential membranous structures (1 MS and 1 control), longitudinally-oriented membranous structures (3 MS), single valve flap replacing IJV valve (2 MS), and enlarged and malpositioned valve leaflets (1 MS). In addition, minor anatomic variations without expected hemodynamic consequences were observed similarly in both MS and controls. These included valves with >2 leaflets, the presence of valves in the AZY, additional (duplicate) normal-appearing IJV valves, and small membranous septa.
Conclusion: Post mortem examination of the IJV and AZY veins of MS patients and non-MS controls demonstrated a variety of structural abnormalities and anatomic variations. Vein wall stenosis occurred at similar frequency in MS and non-MS controls. However, the frequency of intraluminal abnormalities with possible hemodynamic consequences was higher in MS patients compared to healthy controls, although the current sample size is limited. These results suggest that MRV (which predominantly evaluates vein wall stenoses) may be less effective than ultrasound in identifying venous abnormalities in CCSVI. In addition, examining only wall circumference in CCSVI ultrasound studies may miss some intraluminal abnormalities.
Claudiu Diaconu has nothing to disclose. Susan Staugaitis, MD,PhD, has nothing to disclose. Jennifer McBride, PhD, has nothing to disclose. Cynthia Schwanger has nothing to disclose. Alexander Rae-Grant, MD, presented a lecture for Teva Neuroscience and Biogen Idec with personal compensation. Robert Fox, MD, has received personal consulting or speaking fees from Biogen Idec, Genentech, Novartis, and Teva Neuroscience, and has served on clinical trial advisory committees for Biogen Idec. The current project is supported by the National MS Society (RC 1004-A-5).
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby frodo » Thu Oct 20, 2011 8:05 am

Thanks once more, cheer. Now let's wait for somebody saying that CCSVI does not exist.
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby Cece » Thu Oct 20, 2011 8:24 am

Marked valvular and other intraluminal abnormalities with potential hemodynamic consequences were identified in 5 of 7 MS patients (7 abnormalities) and in 1 of 6 controls (1 abnormality). These abnormalities included circumferential membranous structures (1 MS and 1 control), longitudinally-oriented membranous structures (3 MS), single valve flap replacing IJV valve (2 MS), and enlarged and malpositioned valve leaflets (1 MS). In addition, minor anatomic variations without expected hemodynamic consequences were observed similarly in both MS and controls. These included valves with >2 leaflets, the presence of valves in the AZY, additional (duplicate) normal-appearing IJV valves, and small membranous septa.

This is excellent. Since we are looking at visible structural abnormalities, it is hard to argue with autopsy results.

They found more of the longitudinally-oriented membranous structures (aka septums) than what we usually hear about here. Perhaps these are underdiagnosed in patients? Could they be missed on IVUS?

A single valve flap replacing IJV valve might be how you'd describe my left jugular issue, unless it were better described as an enlarged valve leaflet. Finding only three valve abnormalities total in seven MS patients (14 jugulars) is fewer than what the IRs are seeing in living patients.

But this is clear support of the association between CCSVI intraluminal abnormalities and MS. It also helps clarify why there might be so much difficulty finding CCSVI, if the imaging studies are failing to differentiate between venous wall stenoses, which were found equally in both the MS patients and controls, and the intraluminal abnormalities, which were overwhelmingly found in the MS patients.

frodo, we have never had an autopsy study saying that CCSVI does not exist in MS patients, and I do not think we will see one. This is flesh, it is either there or not there, and it is there.
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby cheerleader » Thu Oct 20, 2011 8:59 am

Absolutely right, Cece. The advantage of having IVUS to see the real hemodynamic flow in vivo is all that is missing....but these malformations exist. Very excited that Dr. Fox, and MS neurologist from the Cleveland Clinic, actually participated in this study and saw what Dr. Zamboni has been writing about all these years. Finally....
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby cheerleader » Fri Oct 21, 2011 3:13 pm

Here is Dr. Fox from ECTRIMS, doing a video interview for the MS Society, discussing his study....
this is big news, folks. A major neurologist from Cleveland Clinic finding venous malformations in autopsied jugular veins in pwMS, discussing the importance of correctly done ultrasound testing in CCSVI research. He has consulted with Dr. Zamboni and BNAC.

This may be the beginning of the tide turning....

http://www.youtube.com/watch?v=jSijkNDCotA


cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby Cece » Fri Oct 21, 2011 3:32 pm

I'm about to watch it. And I am sure that dehydration did not cause the luminal abnormalities found in this study!
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby PointsNorth » Fri Oct 21, 2011 3:51 pm

Hmmmm. One group sees 100%, the other 0%. In papers by Simka et.al. involving 000s of people we see a number north of 90%. And neurologists still think their opinion matters . . . . well I guess maybe to the MS Society.
Last edited by PointsNorth on Fri Oct 21, 2011 4:34 pm, edited 1 time in total.
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Hurry up and wait.
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby cheerleader » Fri Oct 21, 2011 4:04 pm

Cece wrote:I'm about to watch it. And I am sure that dehydration did not cause the luminal abnormalities found in this study!


very, very true, Cece :)
Dr. Fox is looking into hypovolemia and hydration---but that wouldn't cause a web, septum or inverted valve!
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby 1eye » Fri Oct 21, 2011 9:45 pm

If radiological evidence from Dr. Sclafani's clinic and others all over the place, and Dr. Haacke's MR has not swayed them what will? Where do they think these pictures all over the Internet are coming from? photo-shop?
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby MrSuccess » Fri Oct 21, 2011 11:20 pm

all of this is not possible if not for the foresight and courage of those that have donated their body to science. We cannot thank them enough . They are true hero's.


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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby CureOrBust » Sat Oct 22, 2011 4:05 am

I cant help but giggle at their loose use of the term "healthy controls", since they were DEAD! :lol:
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby Hooch » Sat Oct 22, 2011 6:24 am

Yes there is no way that all this is caused by hydration problems. I always drank a ton of water (yes I do have to get up to pee in the night) and both my jugulars were severely stenosed!
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby drsclafani » Sat Oct 22, 2011 9:27 am

Cece wrote:
Marked valvular and other intraluminal abnormalities with potential hemodynamic consequences were identified in 5 of 7 MS patients (7 abnormalities) and in 1 of 6 controls (1 abnormality). These abnormalities included circumferential membranous structures (1 MS and 1 control), longitudinally-oriented membranous structures (3 MS), single valve flap replacing IJV valve (2 MS), and enlarged and malpositioned valve leaflets (1 MS). In addition, minor anatomic variations without expected hemodynamic consequences were observed similarly in both MS and controls. These included valves with >2 leaflets, the presence of valves in the AZY, additional (duplicate) normal-appearing IJV valves, and small membranous septa.

This is excellent. Since we are looking at visible structural abnormalities, it is hard to argue with autopsy results.

They found more of the longitudinally-oriented membranous structures (aka septums) than what we usually hear about here. Perhaps these are underdiagnosed in patients? Could they be missed on IVUS?

Perhaps it is what we call elongated valves.
Perhaps some of the images interpreted as valves are septums. I think so.
perhaps with flow the septum is collapsed against the wall during venography and not visible.

A single valve flap replacing IJV valve might be how you'd describe my left jugular issue, unless it were better described as an enlarged valve leaflet. Finding only three valve abnormalities total in seven MS patients (14 jugulars) is fewer than what the IRs are seeing in living patients.


It is likely that autopsy is going to miss many of the malfunctioning valves because they fixed the tissue. Thus they are seeing only anatomical derangements, but not seeing mobility challenges. Many of the valvular problems seen with IVUS represent immobile valves. During a real time physiological analysis, one seems that the valve opens incompletely and the stenosis is present. I do not think that autopsy will detect these problems.

But this is clear support of the association between CCSVI intraluminal abnormalities and MS. It also helps clarify why there might be so much difficulty finding CCSVI, if the imaging studies are failing to differentiate between venous wall stenoses, which were found equally in both the MS patients and controls, and the intraluminal abnormalities, which were overwhelmingly found in the MS patients.


therefore emphasizing the importance of a real time intraluminal interrogation of the veins with IVUS.
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby drsclafani » Sat Oct 22, 2011 9:40 am

cheerleader wrote:Here is Dr. Fox from ECTRIMS, doing a video interview for the MS Society, discussing his study....
this is big news, folks. A major neurologist from Cleveland Clinic finding venous malformations in autopsied jugular veins in pwMS, discussing the importance of correctly done ultrasound testing in CCSVI research. He has consulted with Dr. Zamboni and BNAC.

This may be the beginning of the tide turning....

http://www.youtube.com/watch?v=jSijkNDCotA


cheer


I am waiting for some of the neurologists in the original Neurology rebuttal to zamboni to announce that they had discovered the concept of CCSVI.
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Re: ECTRIMS Cleveland Autopsy Study-jugular VMs in pwMS

Postby drsclafani » Sat Oct 22, 2011 9:46 am

PointsNorth wrote:Hmmmm. One group sees 100%, the other 0%. In papers by Simka et.al. involving 000s of people we see a number north of 90%. And neurologists still think their opinion matters . . . . well I guess maybe to the MS Society.


Yes, apparently the data is ignored in favor of the urban legend that zamboni found ccsvi in 100% of PwMS and that none of the healthy controls had CCSVI. Apparently his stating that having only one of the five criteria did not separate the MS cohort from the HC cohort and that the presence of two of the criteria is necessary for a diagnosis of CCSVI gets ignored.
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