Bilateral sudden sensorineural hearing loss and chronic venous cerebrospinal insufficiency : a case report

OBJECTIVES: We report a case of bilateral sudden sensorineural hearing loss (SSHL) in a patient suffering from chronic venous cerebrospinal insufficiency (CCSVI). METHODS: Audiometric testing confirmed bilateral sensorineural hearing loss with hypoexcitability to caloric stimulation on the left side and echo-colour Doppler examination showed abnormal cerebral venous deficiency. RESULTS: The patient's condition improved after 15 days following medical treatment. CONCLUSIONS: CCSVI may explain the anatomical background which provides a predisposing factor for SSHL although further studies are needed to verify whether this observation is casual or coincidental

Chronic cerebro-spinal insufficiency in multiple sclerosis and meniere disease: same background, different patterns?

Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by demyelinating lesions with acute phases and progressive loss of sensori-motor functions. M\ue8ni\ue9re disease (MD) is a disorder of the inner ear characterized by acute spells of vertigo and hearing loss and progressive loss of cochleo-vestibular function. Both the diseases have a multifactorial pathogenesis and quite the same chronic cerebro-spinal insufficiency (CCSVI) frequency. However, as far as Author\u2019s knowledge concerns, no patients affected with both diseases are described so far. The aim of this paper is to investigate whether MS and MD present different CCSVI patterns. Three groups of patients were enrolled: 60 definite MS - 27 definite unilateral MD (MEN) - 41 with other no-M\ue8ni\ue9re, audio-vestibular disorders (OVD). All subjects underwent magnetic resonance venography (MRV) and venous Duplex (ECD) and only patients that satisfied both MRV and ECD CCSVI diagnostic criteria were considered. J1 was normal in 57% of MS, 88% of MEN and 95% of OVD. Stenosis (ST) were detected, respectively, in 30% of MS and 2% in MEN and OVD. J2 was normal in 78% of MS, 64% of MEN and 95% of OVD. At this level alterations of the trunk (AT) were detected in 17% in MS and 26% in MEN; J3 was normal in 74% of MS, 64% of MEN and 86% of OVD. AT were found in 15% of MS, 26% of MEN and 8% of OVD. Hyperplasia of the Vertebral Veins was observed in 35% of MS, 40% of MEN and in 15% of OVD. Other compensatory collaterals were detected in 25% in MS and only in 5% in MEN and OVD. Our results indicate that the MS pattern is characterized by J1 stenosis, J2 trunk alterations, a prevalence of J1-J2 medial-distal alterations, compensatory collaterals besides vertebral venous system. MD pattern is characterized by trunk alteration in J3, a prevalence of J3-J2 medial-proximal alterations and vertebral veins hyperplasia without other detectable collaterals. Although the group of patients with venous alterations is very small, OVD patients show a CCSVI pattern that is more similar to MD than MS pattern. The difference between MS and MD patterns indicates that CCSVI is not a unique entity and it could be an explanation of the fact that subjects affected with both the diseases are not reported

Endovenous laser ablation of varicose veins : personal perspective and from IEWG

Endovascular treatments are today the most preferred solution receiving patient\u2019s satisfaction. Once found all comfort and security problem solutions and thanks to improved knowledge on the best power wavelengths to be used, the procedure may really be carried out as outpatient treatment with less risks and side effects or complications. Until now energies spent involve an uneasy standardization of the connection of the parameters for the variables thickness (mm) - power (W) - time (msec) - fluency (J/cm2). The last years showed examples of higher dosage, lower but longer exposure /T, but the new laser wavelength like diode 1470 nm and fiber tips designed to fire radially at 360 degrees instead of linearly remarkable effective results and less collateral effects were achieved comparing the results and the effects currently obtained by using higher power and shorter laser wavelengths

Venous extracranial duplex ultrasound and possible correlations between multiple sclerosis and CCSVI : an observational study after 560 exams

The article regards an observational study after having carried out 560 Duplex Ultrasound (DU) exams on multiple sclerosis affected patients. The aim of the study was to find out, after the so-called \u201cZamboni Theory\u201d, if there may be any correlations between chronic cerebrospinal venous insufficiency (CCSVI) and Multiple Sclerosis (MS). All the patients had a certain diagnosis for SM and all exams were carried out, with a group of control in non-MS patients, by the same operator using two similar but different brand Duplex devices following the same procedure. The aim was to find presence of possible malformations in the extracranial venous cerebral outflow, mainly concerning the internal jugular vein and vertebral plexus system. Outflow malformations due to significantly reduced vein diameter and/or valve flaps were seeked both in horizontal and upright position. The results were interesting considering the constant presence of venous outflow problems in a significant number of patients affected by SM disease. The diagnosis percentage happened to be very similar, and significant, using either DU devices

Venous abnormalities in Ménière Disease

A brief definition of the M\ue9ni\ue8re disease, with principal symptoms. Correlations between these symptoms and those usually present in CCSVI affected patients (mainly multiple sclerosis patients). Most evident and frequent results in M\ue9ni\ue8re disease compared with those with over 2000 CCSVI MS Duplex exams. Anatomic differences and localizations between the two groups of patients at Duplex exams. MRI imaging of MS patients and M\ue9ni\ue8re disease patients, with comparison and/or differences (anatomical, morphological). Conclusions that mainly highlight the characteristics of the venous abnormalities within M\ue9ni\ue8re disease. Disclosures: The authors have nothing to disclose

Dynamic foot-exerciser : a validation study and testing in disuse oedema patients

Aim. It is well-known that sitting one hour results in swelling and fluid tetention. However sitting for a long-day work or in elderly people with leg disuse, the venous and lymphatic stasis might be important for chronic venous [and lymphatic] disorders (CVD). Physical training programmes developed to prevent CVD are aimed at calf muscles strengthening. Methods. We studied a patented, dynamic foot-moover or calf muscle pump facilitating device (PPD: VenoGym by Engineer E. Tacconi), designed to encourage the user to do a certain physical and spontaneous activity without any particular effort. A first test showed that a short period of use (half an hour in the morning and half an hour in the afternoon) of PFD induces subjective benefits, confirmed by the sensation of "light legs". Validation was carried out in a griup of 22 healthy people (mean age 52 years, range 27-69) by Photoplethysmography (PPG) and in 4 subjects by Laser Doppler Imaging. Moreover we tested PFD on 12 aged disable people and in 12 patients without mobility problems, based on a special form for the QoL and swelling reduction, color-Duplex and laser-Doppler exams. Results. PPG analysis showed that the few minutes of exercises with PFD determined a vein emptying of both legs (45%+/-18 M+/-SD right leg and 47+/-18 M+/- SD left leg). Laser-Doppler imaging performed on both feet after 10 minutes of exercise showed a mean reduction of 19% of tissue perfusion. The study carried out on disabled patients, showed an improvement in blood flow and leg swelling reduction in both groups, the most effectiveness in the control group. Conclusion. PFD device has a proven vasoactive effect both on micro and macrocirculation; the results on disabled confirm the necessity of a valid physical activity

Endovenous laser treatment of saphenous and perforators reflux for leg ulcers in primary chronic venous insufficiency

Aim. Venous leg ulcers are usually related to incompetent perforating veins also in primary chronic venous insufficiency. The need for new surgical strategies and techniques to overcome the barriers to effective treatment of this problem is always actual. We present a recent and larger experience in two Centres of IEWG and long-term results from a retrospective analysis of controlled patients versus the same number of randomized ones for the standard treatment with stripping, assessing some aspects of techniques, healing and recurrence rates. Methods. Between Jan 2002 and Dec 2006, 560 consecutive patients with an active venous leg ulcers, previously medically treated (not showing any sign of improvement after 4 weeks), qualified for the study. 280 were randomized for endovenous laser treatment of saphenous vein and/or perforator veins (A); 280 were randomized to stripping and/or perforators interruption (B). Results. The prevalence of IPVs reflux was high (42%) and comparable in both settings A and B. In a three-years follow-up, 226/280 group A patients and 231/280 group B patients underwent valid controls. Healing time showed to be shorter in group A and, when compared to the types of reflux, came to be significantly shorter only in group A patients with a brief and isolated reflux and with associated long/brief when compared to the same types within group B. Healing time showed no significant differences in both groups with single long reflux. In the whole, recurring percentage was lower in group A. Conclusion. Based our data and positive personal experience with ELT, particularly in the subgroups with IPVs reflux, the elimination of this reflux with a minimal surgical trauma of laser is expected to result in ulcer healing of most leg ulcers with primary CVI, reducing 3-years ulcer recurrence; whereas the value of such treatment for the saphenous reflux only is not clear