ABSTRACT
Chronic cerebrospinal venous insufficiency (CCSVI) may be associated with multiple sclerosis, and its treatment has been shown to potentially benefit patients with this condition. Color-assisted duplex imaging is used to assess the anatomical and physiological parameters of cerebrospinal venous function and to diagnose CCSVI. Standardized examination protocols as well as the diagnostic criteria used are important elements in ensuring reproducibility of results between centers. The objective of this article is to describe the technique our laboratory has used to assess patients for the presence of CCSVI using Doppler ultrasound.
Subject(s)
Cerebral Veins/diagnostic imaging , Cerebral Veins/surgery , Multiple Sclerosis/diagnostic imaging , Spinal Cord/blood supply , Spinal Cord/diagnostic imaging , Ultrasonography, Doppler/methods , Venous Insufficiency/diagnostic imaging , Chronic Disease , Humans , Multiple Sclerosis/complications , Venous Insufficiency/complicationsABSTRACT
BACKGROUND: Chronic cerebrospinal venous insufficiency (CCSVI) has recently been reported to be associated with multiple sclerosis (MS). However, its actual prevalence, possible association with specific MS phenotypes, and potential pathophysiological role are debated. METHOD: We analysed the clinical data of 710 MS patients attending six centres (five Italian and one Canadian). All were submitted to venous Doppler sonography and diagnosed as having or not having CCSVI according to the criteria of Zamboni et al. RESULTS: Overall, CCSVI was diagnosed in 86% of the patients, but the frequency varied greatly between the centres. Even greater differences were found when considering singly the five diagnostic criteria proposed by Zamboni et al. Despite these differences, significant associations with clinical data were found, the most striking being age at disease onset (about five years greater in CCSVI-positive patients) and clinical severity (mean EDSS score about one point higher in CCSVI-positive patients). Patients with progressive MS were more likely to have CCSVI than those with relapsing-remitting MS. CONCLUSION: The methods for diagnosing CCSVI need to be refined, as the between-centre differences, particularly in single criteria, were excessively high. Despite these discrepancies, the strong associations between CCSVI and MS phenotype suggest that the presence of CCSVI may favour a later development of MS in patients with a lower susceptibility to autoimmune diseases and may increase its severity.
Subject(s)
Brain/blood supply , Multiple Sclerosis/complications , Spinal Cord/blood supply , Venous Insufficiency/epidemiology , Adult , Brain/pathology , Humans , Middle Aged , Multiple Sclerosis/diagnostic imaging , Prevalence , Spinal Cord/diagnostic imaging , Ultrasonography, Doppler, Transcranial , Venous Insufficiency/complications , Venous Insufficiency/diagnostic imagingSubject(s)
Biomedical Research/organization & administration , Brain/blood supply , Cerebrovascular Disorders/therapy , Endovascular Procedures , Multiple Sclerosis/therapy , Radiography, Interventional , Spinal Cord/blood supply , Venous Insufficiency/therapy , Animals , Cerebrovascular Disorders/diagnosis , Chronic Disease , Cooperative Behavior , Humans , Interdisciplinary Communication , Magnetic Resonance Angiography , Multiple Sclerosis/diagnosis , Organizational Objectives , Phlebography , Treatment Outcome , Ultrasonography, Doppler, Transcranial , Venous Insufficiency/diagnosisABSTRACT
OBJECTIVE: Compare the performance of the OxyArm to that of nasal cannulae in the delivery of supplemental oxygen to patients with chronic obstructive pulmonary disease. METHODS: We tested various oxygen flows with 10 chronic obstructive pulmonary disease patients who were receiving prescribed supplemental oxygen. Blood oxygen saturation (measured via pulse oximetry [S(pO2)]), was measured with each device, and mean data were compared with paired, 2-sample tests. RESULTS: Mean S(pO2) was equivalent with OxyArm and nasal cannulae for 7 of the 10 subjects, over a range of oxygen flows (2-5 L/min). Mean S(pO2) was higher with the OxyArm with 2 subjects and lower with 1 subject (p < 0.01). CONCLUSION: The OxyArm maintained stable S(pO2) over the range of oxygen flows studied and at levels equivalent to those maintained by nasal cannulae in 9 of the 10 subjects. The OxyArm does not contact the face and may be ideal for patients on long-term home oxygen therapy.
