Study adds fuel to debate over MS and blocked veins

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Postby sbr487 » Sun Jun 20, 2010 11:01 pm

Malden wrote:
patientx wrote:...
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.


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.


I do hope your "research" will put an end to this controversy ...
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Postby L » Mon Jun 21, 2010 5:21 am

patientx wrote:
L wrote:
scorpion wrote:Exactly my point Lyon. Zamboni's "results" shoul be getting easier to replicate not harder. Now Zamboni is claiming that the recent results showing very little connection between CCSVI and MS are wrong because the researchers did not use HIS protocol . Red flags everywhere.


The Berlin study did not even attempt to use the same protocol though!


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.


OK, I stand corrected, I missed a few posts in the middle of the thread, I stand corrected.

Same recipe, same ingredients but one's no good.. What could be the explanation? Untrained chef?
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Postby jackiejay » Mon Jun 21, 2010 5:31 am

Dr. Sandy McDonald has trained with Dr. Zamboni and he is finding 90% positive results of CCSVI in MS patients....I believe that is similar to Zamboni's findings.
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Postby patientx » Mon Jun 21, 2010 8:50 am

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


I guess much depends on which one is no good.

Actually, I don't think the explanation is an untrained chef. Both studies were authored by established vascular experts.
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Postby MrSuccess » Mon Jun 21, 2010 9:52 am

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 ? :?: :idea:

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







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Postby cheerleader » Mon Jun 21, 2010 10:48 am

Dr. Lorne Brandes on the difference between the German doppler study and Dr. Zamboni's US technique--(he actually had sonographers read the papers instead of board postings) it's all about methodology--


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.


link to article
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby jimmylegs » Mon Jun 21, 2010 5:09 pm

now that's a good one cheer.
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Postby patientx » Mon Jun 21, 2010 5:10 pm

MrSuccess wrote: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 ? :?: :idea:

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


I don't know. Maybe the BNAC newsletter has some information:

http://www.bnac.net/wp-content/uploads/ ... ochure.pdf
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Postby rainer » Mon Jun 21, 2010 6:05 pm

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.


I do wonder if the results were positive would we see near as much detailed examination?

Maybe we would, but from different sources.
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