This Is MS Multiple Sclerosis Community: Knowledge & Support

I think I have crucial answer to this question. I just have to summarise and write it, it's on the way (brain fog is clearing now).
I already have a caption:

"Big mistakes in Professor's papers"

M.

When you say Berlin study, I assume you mean the study that Scorpion linked to start this thread. (I got tripped up before, because it seems there are a couple of German studies/papers that have been done.) If that is the case, they did try to replicate Zamboni's findings using the same methods/criteria. They used similar equipment, i.e. a 7.5 MHz probe for general imaging, and a 2.5 MHz probe for transcranial analysis.

The main point of contention seems to be that they had subjects use a Valsalva maneuver during the examination for reflux. But in the study, it seems they only did this to evaluate jugular valve incompetence, a test they added in addition to Zamboni's 5 tests.

The other discrepancy mentioned was they had subjects momentarily hold their breath at the top of each inhalation, i.e. episodes of apnea. But in the paper, "The value of cerebral Doppler venous haemodynamics in the assessment of multiple sclerosis" (Zamboni, et al), Zamboni's group did exactly the same thing.

So, the German researchers did use the same protocol in trying to replicate Zamboni's ultrasound findings. Why their results are so different (from the BNAC study, as well) is anyone's guess.

Same recipe, same ingredients but one's no good.. What could be the explanation? Untrained chef?

How do we account for this stark contrast? While the populations of MS patients and healthy subjects appear to be reasonably similar in all the studies, at least two major differences in methodology could account for the negative findings in the German/British study:

As opposed to the other studies, it only examined the jugular veins high up, near the angle of the jaw, where additional veins, called collaterals, often branch off the jugulars to maintain blood flow even if there is a blockage. Moreover, as the exam was limited to the top of the neck, it would not have picked up decreased blood flow due to severe jugular narrowing lower down, especially at the base of the neck, near the head of the collar bone, where vein anomalies often occur and there is little or no collateral circulation to maintain blood flow.

It assessed jugular vein narrowing in the “sagittal” plane (the ultrasound probe is placed parallel to the length of the vessel). The Zamboni technique uses the “transverse” plane ( the probe is placed at a 90 degree angle to the length of the vessel) to look for narrowing, webs, or abnormal valves that Dr. Zamboni believes are often missed in the sagittal plane examination.

Thus, as exemplified by all the examples cited, no matter what field of science and medicine we consider, even minor differences in how studies are conducted can, and often do, produce opposing results. This leads to confusion, debate and, all too often, strong disagreement over the “right answer” to crucial issues.

However, in the case of CCSVI, I believe that there is a simple solution to this dilemma: when looking for vein abnormalities, every study, whether involving ultrasound or MR scanning, should follow the technical methods developed by Dr. Zamboni; be blinded to prevent observer bias; and always include selective venography, where dye is injected into the vein and an X-ray taken. It is the gold standard for detecting anatomical vein abnormalities against which all other techniques must be compared.

PX - I have this nagging thought regarding healthy controls having stenosis .

And have not read anything to answer my question . Which is ........

Did the healthy controls that exhibited vein stenosis on MRI also have MRI tests for brain lesions ?

Would it not be prudent to do both tests in such an important research ?


I know you and Mark would be the ones to ask . You read everything .



Thanks in advance







Mr. Success

Thus, as exemplified by all the examples cited, no matter what field of science and medicine we consider, even minor differences in how studies are conducted can, and often do, produce opposing results. This leads to confusion, debate and, all too often, strong disagreement over the “right answer” to crucial issues.