misregistrationCece wrote:That was nice, thank you.drsclafani wrote:you can join my residency program
CCSVIhusband, I think he is interested in generating discussion, so if you can weigh in, I would not hesitate to do so. Or are you familiar with this particular azygous?
Why do the middle two images have diagonal lines across them, while the first and last don't?
i am a follower of maimonides, who said, "he who saves a life, saves the whole world"CCSVIhusband wrote: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.
I know, I know!!! I know the answer (so do you want me to answer? - I defer to the expert in this case, you of course Dr. Sclafani) ... I don't want to devalue that education and expertise you've been so kind to bring to this forum by using incorrect terminology.
I just hope you work hard and put some collective brain power together with some of these great doctor colleagues of yours (perhaps your friend who treated it the first time) ... and find a good, permanent "fix" ...
It was a pleasure sir. A true honor.
Thank you Dehydration sounds like the answer to my first question.drsclafani wrote:so sorry you had stents placed. Do you know why there were put in? I wish you the best.CD wrote:Hi Dr Sclafani, two questions if you don't mind please. I'm late night thinking.
1. I had the CCSVI procedure Dec 11, 2010. Because of stents I am on Warfarin. My INR is 2.7 which is good I believe, but my RBC has increased from 3.4 barely normal, to the middle of the reference range lab chart, as of last week's testing. I go again tomorrow for my next weekly test.
no, I don't think that would be an explanation. Most plausible is simple dehydration resulting in concentration of your blood.I was always just one point above the normal reference range for years. Now I am higher, middle level. My question is does the Iron disposition, in the brain around lesions, now drain down to be part of the total RBC? Is this possible that iron may now be added to the total blood volume for a short time? Or does it exit via the kidneys?
this is not a term that we use as one of the findings of ccsvi. flap is often used to describe a piece of the wall of the blood vessel that gets unroofed. it can be flow limiting.especially if the flap is attached distally to flow, in which circumstances flow tends to push the flap down into the flow of blood. perhaps that is why a stent was used. I find that it is usually possible to press a flap back into the wall and avoid a stent2. In my left jugular, I had many thick webs, and a large tissue flap. What is a flap?
Are all the images taken from the same angle? If not, then perhaps the narrowing is hidden when seen from one angle. If they are from the same angle, then it is a dynamic obstruction? You mentioned twists and kinks as #3 up there. What could cause a kink to be dynamic?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.
J Vasc Surg. 1989 May;9(5):651-5.
Effect of twist on flow and patency of vein grafts.
Endean ED, DeJong S, Dobrin PB.
Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
Abstract
This article examines the effect of twist on flow through reversed vein segments in vitro and its effect on graft patency in vivo. Excised canine superficial femoral veins were perfused in vitro with normal saline solution or canine blood. Perfusion was carried out at five pressures and against three outflow resistances. Increasing increments of twist were applied to the outflow end of the vein. Flow was measured at each level of twist. With both saline solution and blood, flow was unaltered until twist reached 140 to 180 degrees. Flow then decreased sharply, stopping completely at 175 to 200 degrees of twist. In vivo experiments were then performed in 13 dogs. Reversed superficial femoral veins were used as end-to-end grafts to bypass the iliac arteries. Each graft was deliberately twisted 0, 45, 90, 135, or 200 degrees. All grafts were harvested 6 months after surgery. Eighteen of 20 grafts twisted 135 degrees or less remained patent. However, all five grafts twisted 200 degrees were thrombosed within 4 hours of surgery (p less than 0.05). These data suggest that in patients a slight amount of graft twist probably does not reduce flow;however, more than 135 degrees of twist will greatly reduce flow, leading to early graft thrombosis.
A sci-fi approach: Halfway the yellow arrow of the right-most picture, just beneath the bridge-like structure between the two ascending branches, lies a pseudo-valve with its leaflets reversed, that is allowing only a downward flow.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.
THEGREEKFROMTHED wrote: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.
I begin to feel that I say this a lot but dang those are excellent images.drsclafani wrote:
normbNormB wrote:This is in my mind a potential stupid observation or question.
When a vein is ballooned, why can it be not entertained to cook or slightly burn the vein surface at the location instead of using any kind of stents?
I know in this forum stents are discouraged but could'nt burn marks prevent restenosis by leaving solid surface indentation a bit like a cutting balloons would?
Just a random thought.
Regards,
Normb
I don't remember you going up to 25 atms before, not that you've mentioned.drsclafani wrote:Frankly i was befuddled by this schizoid vein. And i still don't know what exactly is the consequence of this , but suffice it to say that this patient had annular stenoses of both jugular veins that were treated by annuloplasty of 16 mm at 18-25 Atmospheres with pretty good flow after treatment.
But wouldn't that be exceedingly interesting, a patient with two incomplete duplications?hwebb wrote:I'm afraid to show my azygos venogram in case there's a hidden problem/duplicate there too!
about 15 minutes ago, i shared with dr zamboni. he stated that it is common for the vein to change configuration and diameter during the respiratory cycle.Cece wrote:I begin to feel that I say this a lot but dang those are excellent images.drsclafani wrote:
Have you consulted with any of the other doctors to see if they've seen something like this before?
How exciting.drsclafani wrote:about 15 minutes ago, i shared with dr zamboni.
But what could cause that?Not a general collapse as much as a focal narrowing.
Even last spring, he was saying you should publish on your IVUS findings. In your spare time, I suppose. How long until the AAC registry obtains IRB oversight so that you can publish?He said he had no experience with IVUS, but was impressed and was looking forward to using it when he gets one.
It's fascinating stuff. And you haven't seen anything like this in a jugular? Do you think it's specific to the azygous? Could it be related to the azygous webs at all, since those are not seen in the jugulars, or to whatever is different in the embrological formation of the azygous compared to the jugular.I will look more at the dynamics of vein distension and collapse in the azygos from now on.
