One for the skeptics

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One for the skeptics

Postby scorpion » Tue Aug 10, 2010 6:28 pm

If you are not skeptical of CCSVI this article is probably not for you. I have chose to keep articles like this off the CCSVI forum in order to offend as small amount of people as possible.


http://skepticblog.org/2010/08/02/ccsvi ... plication/
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Postby rainer » Tue Aug 10, 2010 7:25 pm

if I could send you body armor via message, I would.
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Re: One for the skeptics

Postby NHE » Tue Aug 10, 2010 7:44 pm

Well, blogs are peer reviewed so I'm surprised this got past the reviewers...

Dr. Zamboni is an Italian neurosurgeon whose wife as MS.


First, it may make for good story telling, but it is a bit curious that a neurosurgeon set out to discover a treatment for MS and found a neurosurgical one – even though there was no prior suggestion that this would be the case.


I hope that Dr. Zamboni is enjoying his new career. :roll:

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Postby concerned » Tue Aug 10, 2010 7:48 pm

Doesn't he have something to do with the neurosurgery department at Ferrara or whatever it's called?

EDIT: I thought I read in one of the papers that Zamboni was affiliated with two university departments but I guess I didn't, or at least I can find anything that says that.
Last edited by concerned on Thu Aug 12, 2010 9:19 am, edited 1 time in total.
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Postby Algis » Tue Aug 10, 2010 8:46 pm

I would love to know if (and how many) neurologists have a wife with MS - That "must"exists no?
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Re: One for the skeptics

Postby NHE » Wed Aug 11, 2010 12:11 am

Algis wrote:I would love to know if (and how many) neurologists have a wife with MS - That "must"exists no?


I know of a neurologist who has MS. He promotes Tysabri for Biogen.

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Postby orion98665 » Wed Aug 11, 2010 12:30 am

OK, how can i even believe this article when it states Dr. Zamboni as a
neurosurgeon when he's really a vascular surgeon (lol).

http://en.wikipedia.org/wiki/Paolo_Zamboni

Quote:
Now we are in the midst of this pattern playing itself out yet again – with the Zamboni treatment for multiple sclerosis (MS). Dr. Zamboni is an Italian neurosurgeon whose wife as MS. He sought out to find a cure, and eventually discovered that patients with MS have a blockage in the venous draining of their brains, a condition he termed “chronic cerebrospinal venous insufficiency” (CCSVI). He further claims that MS can be treated, even cured, by opening up the veins that drain the brain with either angioplasty or stenting. Many MS patients have been interested in this potential new treatment, and many have even undergone treatment.
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Postby scorpion » Wed Aug 11, 2010 5:35 am

I noticed the error when I posted the article but I still thought he made some valid points.
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Postby fernando » Wed Aug 11, 2010 6:20 am

First, I think this post should be moved to the CCSVI forum.

Second, I would like to post what Dr. Scalfani said about the studies cited in the blog post referred in this thread:


TMrox wrote:
Dear Dr Sclafani,

Have you read the German and Swedish studies commented in the Wall Street Journal?

http://online.wsj.com/article/SB1000142 ... 10380.html

Did these studies use the doppler ultrasound with the right protocols?


It is regretful that Drs. Doepp and co-authors’ attempt to reproduce Professor Zamboni’s discovery of a link between multiple sclerosis and disturbance of the outflow veins of the brain and spine has been unsuccessful. It is particularly unfortunate that the authors’ misunderstanding of Dr. Zamboni’s publications about this subject have led to their conclusions that “No cerebrocervical venous congestion in patients with multiple sclerosis" exists

The authors mis-state several of the criteria for a positive ultrasound examination. They state that reflux must be present in both internal jugular veins or both vertebral veins. This is not accurate. Reflux in any one of these veins was considered a positive criteria by Zamboni.

It appears to me that Dr Doepp and colleagues have tried to elicit reflux by testing for incompetent valves in the lower jugular vein. Incompetent valves result in reversal of blood flow from the heart back up into the jugular veins. They used the Valsalva maneurer, a technique to increase pressure in the chest that reverses blood flow. However, Zamboni explicitly states that one should assess flow “never in (by) a forced condition such as the Valsalva manoeuvre.”

That the authors’ attempts were unsuccessful is not surprising. The ultrasound examination used by Zamboni is a simple one but the description of the technique has not been fully elaborated in his papers. Thus performance of the ultrasound by some investigators is often at variance and this may lead to differences of results. At my own institution, we were surprised that non-invasive testing by ultrasound did not correlate with the very obvious obstructive phenomena seen on catheter venography, which remains the Gold Standard of assessing veins. We also had difficulty identifying CCSVI on ultrasound, initially using the Valsalva maneuver during out testing. In fact we were able to find an obstruction in only one patient of twenty. It was only after being shown how to correctly perform this simple screening test by the Zamboni team during a visit to Ferrara, that we have become facile in detecting these abnormalities. It is clear that there is a learning curve to the use of this technique.

Nor does this paper refute the concept of CCSVI. Doppler ultrasound is only a screening test for CCSVI. When Doppler shows signs of CCSVI, the gold standard test of catheter venography is indicated to detect the sites of potential obstruction. Doppler is not the definitive test of CCSVI because it cannot assess the azygous vein, an important contributor to cerebrspinal venous outflow resistance. Catheter venographies routinely show evidence of outflow obstructions. Sluggish flow, reversal of flow, extensive collateral veins, strictures, duplications, reversed valves, thickened incompletely opening valves and misplaced valves are among the many abnormalities seen in MS patients that we never see in patients without MS.
The paper by Sundstrom and coauthors similarly rejected the CCSVI hypothesis by performing MR venograms and flow quantification in the neck. MR venography is suboptimal as a screening test because it underestimates and overestimates stenoses quite regularly. One can see from their illustrations two MRV images. It is noteworthy that neither image shows the portion of the jugular vein where lesions causing flow resistance are usually found: behind the clavicle as the vessel enters the chest. Both images show considerable collateral vasculature suggestive of CCSVI. Moreover the image on the right on page 258 purports to show a stenosis with an arrow. It is well known that most of the narrowings referred to by the white arrow are a common transient, non-stenotic narrowing caused by a true narrowing below the clavicle. Catheter venography shows abnormalities that cannot be detected by MRV.

I was struck by the rapidity of publication of both articles. Surprising! Both papers were accepted within six weeks. I have never had such rapid decision, editing and publication of any of my more than 120 publications.

This debate is going to be a challenging one. One side wants randomized prospective trials to prove efficacy. However while many proceduralists have noted sometimes impressive gains for patients, these proceduralists need to evaluate nuances of techniques before consensus can be built regarding the best approach to therapy. Only then can intelligent, carefully designed randomized prospective trials begin. Some who commonly perform randomized trials will try to reduce the work of those who will try to develop the best practices because they are not randomized. However, in my view this is a necessary initial step toward the final trials.


http://www.thisisms.com/ftopic-10680-3030.html
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Postby scorpion » Wed Aug 11, 2010 8:04 am

Ok Fernando if I accept Dr. Scalfani's explanation that the proper techniques were not used by the researchers than my next question is why not? Has Zamboni posted his specific technique for identifying CCSVI in any medical journals or online? I am asking becuaseI do not know. If the technique is so specific why did Zamboni not share it when he released the findings from his intial studies? If the moderators want to move this discussion to the CCSVI forum that is fine. I was just hoping to have a good discussion about this article and not be labeled as part of a big conspriacy.
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Postby fernando » Wed Aug 11, 2010 9:13 am

Scorpion

The information is there for you to see. Reread what Sclafani said.

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Postby scorpion » Wed Aug 11, 2010 10:05 am

That the authors’ attempts were unsuccessful is not surprising. The ultrasound examination used by Zamboni is a simple one but the description of the technique has not been fully elaborated in his papers. Thus performance of the ultrasound by some investigators is often at variance and this may lead to differences of results. At my own institution, we were surprised that non-invasive testing by ultrasound did not correlate with the very obvious obstructive phenomena seen on catheter venography, which remains the Gold Standard of assessing veins. We also had difficulty identifying CCSVI on ultrasound, initially using the Valsalva maneuver during out testing. In fact we were able to find an obstruction in only one patient of twenty. It was only after being shown how to correctly perform this simple screening test by the Zamboni team during a visit to Ferrara, that we have become facile in detecting these abnormalities. It is clear that there is a learning curve to the use of this technique.

Is that what you are referring to? I see where the article discusses catherator venography but I can not find anything specific relating to Zamboni's special ultrasound technique. I do not get why Zamboni has not elaborated on it in his papers? Maybe that is contributing to the medical communities skeptisicm of his claims?
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Postby sbr487 » Wed Aug 11, 2010 10:12 am

scorpion wrote:I do not get why Zamboni has not elaborated on it in his papers? Maybe that is contributing to the medical communities skeptisicm of his claims?


I really doubt that. If that was the case one can definitely articulate that and none of the papers or neuros have said that is the reason.

BTW, is medical communities = neuro community?
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 fernando » Wed Aug 11, 2010 10:37 am

Scorpion

"The authors mis-state several of the criteria for a positive ultrasound examination. They state that reflux must be present in both internal jugular veins or both vertebral veins. This is not accurate. Reflux in any one of these veins was considered a positive criteria by Zamboni.

It appears to me that Dr Doepp and colleagues have tried to elicit reflux by testing for incompetent valves in the lower jugular vein. Incompetent valves result in reversal of blood flow from the heart back up into the jugular veins. They used the Valsalva maneurer, a technique to increase pressure in the chest that reverses blood flow. However, Zamboni explicitly states that one should assess flow “never in (by) a forced condition such as the Valsalva manoeuvre.” "

It is not necessary to get into the protocol details. One has to wonder if these investigators read the Zamboni papers at all.

Regarding the "full protocol", Dr.Sclafani addressed this question somewhere in his thread.

Enough for now from me.

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Postby scorpion » Wed Aug 11, 2010 2:56 pm

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