DrSclafani answers some questions

[drsclafani]

If rapid flow in the azygous looks identical to flow in the azygous when nutcracker syndrome is present, and nutcracker syndrome may cause chronic fatigue, could my rapid flow in my azygous be causing fatigue?

Is it the rapid flow OR the question of what is causing it that raises our concern?

In my azygous, the flow was rapid but not refluxing. In CCSVI with azygous obstruction and nutcracker syndrome, there would be reflux. But in pediatric chronic fatigue in nutcracker syndrome despite no azygous obstruction, what is causing that chronic fatigue?

Cure, your question gets to the debate of whether to treat the stenosis or treat the flow!

maybe the child's normal azygous just cant handle that augmented flow

[Donnchadh]

Dr. Sclafani:

Has anyone been able to treat stenois in the sigmoid sinus yet?

Donnchadh

I already answered this on the IJ trauma thread but here it is again:

stenoses of the dural sinus has been treated by stenting. this has been published. Images in top row are before stenting. arrows in two leftside images point to the stenosis. The article was speaking about the treatment of the stenosis but the use of IVUS for to monitor the treatment of these stenoses.
DrS

Isn't the sigmoid sinus different from the dural sinus? The IR's told me that they were unable to enter the stenosis at the sigmoid sinus, so couldn't treat it. I would be very leery of having stents implanted in an area that isn't externally accessible if something went wrong.

Donnchadh

[drsclafani]

Haven't listened to the Conference yet and appreciate you notes Cece.

Interesting how collateral's are a problem in some cases, they may need to be targeted to close. If clotting etc is a problem in dilating veins with valve problems, maybe a cross over treatment could happen. The problem becomes the cure, so to say!
N

i have thought of that but we really have to be cautious. Those collaterals reduce the flow that would reflux into the primary circuits such as the other IJV, the deep cerebral veins, the vertebral veins and the azygous vein.

[drsclafani]

Dr. S - i see the posts on Facebook. great looking website.

any update on moving to Manhattan?

damn, no.
But Doug
brooklyn is nice too

[Cece]

But in pediatric chronic fatigue in nutcracker syndrome despite no azygous obstruction, what is causing that chronic fatigue?

maybe the child's normal azygous just cant handle that augmented flow

pediatric, everything is smaller.... ok, that makes sense.

It's a good analogue to an adult azygous that is blocked, making it more like a child's azygous in its inability to handle the augmented flow from the renal vein.

[drsclafani]

Can you effectively treat a kanootin valve at this juncture in your procedures? Mine is hurtin like a mutha.
yours truly

you got me, greek. Let me google that one and get back to you.

[drsclafani]

Can you effectively treat a kanootin valve at this juncture in your procedures? Mine is hurtin like a mutha.
yours truly

ok greek.

of course I can understand your strong interest in the kanootin valve, given that your mother is involved in this question. While I could find no familiy relationships between the kanootin valve and kalamazoo, i still thought it was important for the group to find an answer. I was unimpressed with wikipedia. the closest link i could find was to this:



it is quite clear that you were looking for something else, as i see no evidence of any valves in use here.

so i continued my search....since so many participants in TIMS are from north of the Border, perhaps you meant canuck, instead of kanootin. i know its a reach but one never can assume that the greek from the d can spell correctly, unless, of course it is the word "mortadella"
nonetheless, i found that
The Random House Dictionary notes that: "The term Canuck is first recorded about 1835 as an Americanism, originally referring specifically to a French Canadian. This was probably the original meaning, though in Canada and other countries, "Canuck" refers to a Canadian." [4] In fact, the 1835 source cited refers to a foreign-speaker: “Jonathan distinguishes a Dutch or a French Canadian, by the term Kanuk.[5]"

that makes a bit more sense. At least "kanuk" begins with a "k"

So I asked my friendly neurologist friends and they referred me to answerbag which provided an answer to my query about Kanootin valves:

" If it is not grounded properly you could blow your Kanootin valves and Caniflin pins and that will cause your Hypadermatroids or Thermotrackles to shut down and then you will be in some serious trouble." for more information go to http://www.answerbag.com/q_view/2611900#ixzz1eT3E6LDW

at least now i can explain my ignorance. For i am a humble plumber, not an electrician

I hope that helps

DrS

[Robnl]

Hi Doc,

The stenosis in the renal vein(s), do you see it very often or is it 'one in a million'?

Rgds,

Robert

[DougL]

Dr. S - i see the posts on Facebook. great looking website.

any update on moving to Manhattan?

damn, no.
But Doug
brooklyn is nice too

yes Brooklyn was very nice.

from Sex in the City

Carrie Bradshaw: New York Magazine says Brooklyn is the new Manhattan.
Miranda Hobbes: Yes, but whoever wrote that lives in Brooklyn.

[pelopidas]

For those who watched Dr. Sclafani on the expo, or those who didn't, were any of these topics of interest?

1 - If a patient has a physiological stenosis due to muscle compression of the jugular, rather than placing a stent inside the vein, Dr. Sclafani suggested a pharmacological solution to the muscle. I am imagining botox but it is the only muscle paralyzer that I know. Would paralyzing the muscle be what is needed, or would it be a muscle relaxant?

in this case, would you suggest botox injections on the sternocleidomastoid muscle alone, or more muscles are involved?

[THEGREEKFROMTHED]

Can you effectively treat a kanootin valve at this juncture in your procedures? Mine is hurtin like a mutha.
yours truly

ok greek.

of course I can understand your strong interest in the kanootin valve, given that your mother is involved in this question. While I could find no familiy relationships between the kanootin valve and kalamazoo, i still thought it was important for the group to find an answer. I was unimpressed with wikipedia. the closest link i could find was to this:



it is quite clear that you were looking for something else, as i see no evidence of any valves in use here.

so i continued my search....since so many participants in TIMS are from north of the Border, perhaps you meant canuck, instead of kanootin. i know its a reach but one never can assume that the greek from the d can spell correctly, unless, of course it is the word "mortadella"
nonetheless, i found that
The Random House Dictionary notes that: "The term Canuck is first recorded about 1835 as an Americanism, originally referring specifically to a French Canadian. This was probably the original meaning, though in Canada and other countries, "Canuck" refers to a Canadian." [4] In fact, the 1835 source cited refers to a foreign-speaker: “Jonathan distinguishes a Dutch or a French Canadian, by the term Kanuk.[5]"

that makes a bit more sense. At least "kanuk" begins with a "k"

So I asked my friendly neurologist friends and they referred me to answerbag which provided an answer to my query about Kanootin valves:

" If it is not grounded properly you could blow your Kanootin valves and Caniflin pins and that will cause your Hypadermatroids or Thermotrackles to shut down and then you will be in some serious trouble." for more information go to http://www.answerbag.com/q_view/2611900#ixzz1eT3E6LDW

at least now i can explain my ignorance. For i am a humble plumber, not an electrician

I hope that helps

DrS

Wow. I must admit I am impressed by your tenacity, stick-tuit-iveness and wherewithall. Unfortunately your explanation is more tailored toward those north of me, but nonetheless quite extensive and impressive. However erroneous and irrelevant it may be, I went on to further explore the valve in "plumber" terms as you so eloquently and diligently explain.

Apparently there is a derivative of the kanootin you may be more aware of: perhaps your highly regarded "ivus" will detect it!

the kanooter valve :
In the fire service, this a small, hard to find,nearly invisible piece found on the tactical, usually near the hose stretcher.
You better find that kanooter valve by lunch


just sayin...

Have a great Thanksgiving

love ya Mortadella

p.s. Gotta love those neuros they are so helpful and embody such knowledge.

[Cece]

Haven't listened to the Conference yet and appreciate you notes Cece.

The bulk of his presentation covered first the history of his career and then his involvement with CCSVI, from Michelle's letter through the IRB woes through the tragic death of the Canadian patient in Costa Rica, and Dr. Sclafani's subsequent decision to leave the hospital to join American Access Care. I didn't have any questions on that, having been along for the ride!

[MrSuccess]

... you may find your kanootin valve works much better after several " adult beverages "

Nothing worse than a dry kanootin valve ........


Mr. Success

[drsclafani]

For those who watched Dr. Sclafani on the expo, or those who didn't, were any of these topics of interest?

1 - If a patient has a physiological stenosis due to muscle compression of the jugular, rather than placing a stent inside the vein, Dr. Sclafani suggested a pharmacological solution to the muscle. I am imagining botox but it is the only muscle paralyzer that I know. Would paralyzing the muscle be what is needed, or would it be a muscle relaxant?

in this case, would you suggest botox injections on the sternocleidomastoid muscle alone, or more muscles are involved?

This was a thought. Let's not all go out and get botox of the neck strap muscles until some discussions and evaluations are done..

This will require a lot of discussion and proof. Kind of challenging when it costs so much to perform venography to check it.

[mo_en]

If i am not mistaken, vein abnormalities that lead to CCSVI are mostly congenital. However CCSVI seems to be an evolving, not a static condition. That means there is a transition between a non-problematic to a problematic CNS drainage at some point in a patients life. Is that point at birth, or rather puberty?