Cece wrote:Nah, it was the other IR who was stumped. You were the one who saw the duplication in hwebb's image! Altogether impressive.drsclafani wrote:what is this? stump the professor day by asking about this stump of a vein?
ceceCece wrote:Here's a publication on a duplicated IJV found in a patient without MS. It shows a surgical image of it too.
http://tinyurl.com/2wwc8wl
My original post on this, which sadly got no responses:
http://www.thisisms.com/ftopic-14874-0- ... rasc-.html
It says this:So, since 1/800 people get MS and 1/250 is the reported incidence of a duplicated IJV, perhaps it can occur benignly?Duplication of the internal jugular vein is a rare anomaly found during the dissection of the neck. The reported incidence is 4/1000 of unilateral neck dissectionsOr is what we are seeing in CCSVI the rare low duplications? It would be just like us, to have the rare version.Duplication usually involves the upper third of the vein and extends down to a variable level.1 Very few cases have been reported about low duplication 3, 4. Duplication of the internal jugular vein is usually reported in association with phlebactasia, which is a soft non-pulsatile cervical swelling that increases in size during a valsalva maneuver
I am not familiar with phlebactasia. Perhaps this swelling would serve as an outflow obstruction as well.
I am still impressed, Dr. Sclafani, even if Helen's IJV does not turn out to be a duplication. If it'd been my vein and my doctor, he'd have used IVUS and we'd have known for sure right away. ;)
And I am convinced Helen has an excellent doctor also. He was able to identify the stenosis on the MRV and go back in a second time and fix it. With so many travelling patients, this is better care than nearly anyone gets; for many there would be no second procedure.
We might have to invent the instrumentspairOdime wrote:Dr. Sclafani,
Two potential techniques or methods (without stent or surgery) are intriguing.
(1) What technique or instrument might be used to create the opening in the common wall of the vessel? (2) How might the lumen be closed via endovascular procedure?
I know this is all very hypothetical.
Thanks in advance Dr. Sclafani.
helenhwebb wrote: Can you believe that my right side has worse symptoms these days than my left side (which is governed by a hypoplastic jugular...only 0.5cm in width now it's been stretched and the 0.2cm stenosis cleared).
H.
if you had improvements for four months, then you should go back and have another look. All the doctors are getting better at this day by day. The doctors in Tokuda work very hard to make good results. When you have long period of PPMS, the damage is great, the likelihood of miracles is low, but slowing the beast may be worth it to you.sara2407 wrote:Dear Doctor,
I wish you a successful 2011.
I have PPMS since 2003 with Edds 7.0.
25.08.2010. I have the liberation procedure in Sofia, Tokuda Hospital. I had a very small improvements, such as excess energy and I was stable so far.
Ten days ago I felt a tremendous fall, each day worse than the previous one. Galloping.
I called Tokuda hospital and they told me to come to control and if there was restenosis, repeat the procedure.
Does it make sense to go to the control and repeat the process of liberation?
This life makes no sense, but I am very afraid of the future.
drsclafani wrote:ok class....
Today we review an azygos vein. This vein, which drains the spinal cord via intercostal veins and lumbar veins, enters the superior vena cava at the top, the renal vein in the middle and the ascending lumbar veins at the bottom.
The findings of malformations are
1. valvular problems of fixation, stiffness and fusion
2. Webs & septations running through the ascending component of the vein
3. twists and kinks
Let's have a look at this:
1. on the left contrast media is injected at the tip of the catheter (red arrow). One notes that there is no dye flowing up toward the superior vena cava.
2. on the second image one sees that there is dye above the area of blockage (red arrows). This is flowing past the obstruction through a large feeding branch. (orange curved arrow)
3. On the third image the narrowed segment is quite obvious. For those readers who are not obvious and have real moral character, the red arrow points to the pointed narrowing.
4. Finally, the last image on the right SHOWS NO NARROWING. What could be the explanation?
Tomorrow we will continue this harrowing adventure.
This is Dr Whiplash, i am out to lunch.
That was nice, thank you.drsclafani wrote:you can join my residency program
