Paolo Zamboni Explained

Paolo Zamboni
Birth Date:25 March 1957
Birth Place:Ferrara, Italy
Citizenship:Italy
Fields:Vascular Diseases
Workplaces:Ferrara, Italy
Awards:ISNVD Gold Medal

Paolo Zamboni (born 25 March 1957, Ferrara, Italy) is an Italian doctor and scientist. He is full Professor and Director of the School of Vascular Surgery at the University of Ferrara in Italy.

He is known for his description and proposed cure of the vascular disease chronic cerebrospinal venous insufficiency (CCSVI) strongly related with multiple sclerosis and other neurodegenerative diseases such as Ménière and Parkinson's, but the existence of this disease is very controversial, with significantly more detractors than supporters, and there is no good evidence that the surgery helps MS patients.

Biography

Graduated with honors in Medicine and Surgery in 1982, Zamboni specialized in General Surgery in 1987 and in Vascular Surgery 1992. In 1992 he obtained the fellowship at the Department of Vascular Surgery of the University of California in San Francisco. From 1993 to 2000 he was visiting professor at the Department of Surgery of the Uniformed Services University of the Health Sciences of Bethesda, Maryland and from 2008 to 2012 at the Jacobs Institute of Neurology in Buffalo, New York, and at the Neuroscience Department of Harvard University (2010) and Chicago University (2012).

Since 2004 he is director of the Vascular Disease Center of Ferrara University.[1] In 2008 he announced the discovery of a new venous pathology, called chronic cerebrospinal venous insufficiency (CCSVI) and postulates a controversial correlation between this pathology and multiple sclerosis[2] [3] [4]

During 2010-2011 he was the president of the International Society for Neurovascular Diseases (ISNVD).

Chronic Cerebrospinal Venous Insufficiency – CCSVI

See main article: Chronic cerebrospinal venous insufficiency controversy.

In 2008 Zamboni described Chronic cerebrospinal venous insufficiency (CCSVI or CCVI), the compromised flow of blood in the veins draining the central nervous system.[2] [5] He hypothesized that it might play a role in the cause or development of multiple sclerosis (MS)[6] [7] and devised a surgical procedure which the media nicknamed a liberation procedure or liberation therapy, involving venoplasty or stenting of certain veins.[8] Zamboni's ideas about CCSVI are very controversial, with significantly more detractors than supporters, and any treatments based on his ideas are considered experimental.[9] [10]

There is no scientific evidence that CCSVI is related to MS, and there is no good evidence that the surgery helps MS patients. Zamboni's first published research was neither blinded nor did it have a comparison group.[8] Zamboni also did not disclose his financial ties to Esaote, the manufacturer of the ultrasound specifically used in CCSVI diagnosis.[11] The "liberation procedure" has been criticized for possibly resulting in serious complications and deaths, while its purported benefits have not been proven.[8] [10] In 2012, the United States Food and Drug Administration states that it is not clear if CCSVI exists as a clinical entity and that these treatments may cause more harm.[12] In 2017 they emphasized that this use of balloon angioplasty is not an approved use.[13] In a 2017 study Zamboni et al. stated "Venous PTA cannot be recommended for patients with relapsing-remitting multiple sclerosis."[14] In 2018 a study in Neurology concluded "Our data do not support the continued use of venoplasty of extracranial jugular and/or azygous venous narrowing to improve patient-reported outcomes, chronic MS symptoms, or the disease course of MS."[15]

Research on CCSVI was fast-tracked, but researchers have been unable to find a connection between CCSVI and MS.[16] This has raised serious objections to the hypothesis of CCSVI originating multiple sclerosis.[17] Additional research investigating the CCSVI hypothesis is underway.[18] A 2013 study found that CCSVI is equally rare in people with and without MS, while narrowing of the cervical veins is equally common.[19] [20] [21]

Research on Chronic Venous Insufficiency - CVI

Zamboni has conducted research on lower extremity Chronic venous insufficiency, testing a minimally invasive and conservative treatment of the saphenous vein: the CHIVA method. On this topic he conducted several randomized clinical trials [22] [23] and published books.[24] [25]

The CHIVA and the stripping methods are equivalent regarding recurrence of varicose veins, but the CHIVA method may slightly reduce nerve injury and hematoma. The CHIVA method is also equivalent to either radio frequency ablation or endovenous laser therapy regarding recurrence and side effects.[26]

Cell therapies for the treatment of severe vascular ulcerations of the lower limbs are another Zamboni field of study. Randomized studies with autologous stem-cell derived from adipose tissue were conducted by his team.[27]

Research on physiology of cerebral venous drainage

The cerebral venous return was investigated by Professor Zamboni also in the Space, as PI of the study Drain Brain of the International Space Station, promoted by NASA, ESA and ASI. A novel post processing analysis of jugular vein ultrasound and strain gauge plethysmography allowed to monitor the astronaut cerebral venous drainage in microgravity condition.[28] [29] [30] Space trials involved the Italian astronaut Samantha Cristoforetti.

Zamboni also described other anomalies of cerebral venous return which generates neurological symptoms,[31] [32] as well as models in physiology of brain drainage [33] [34]

Diagnosis on painting

Initially started as a hobby, identify disease processes in paintings and canvas is lately one of the Professor Zamboni' research fields.Diagnosis ranges from the Raphael's Michelangelo, Rembrandt's Bathsheba at Her Bath and Caravaggio's Bacchus. In "The medical enigma of Rembrandt's Bathsheba", Zamboni solves the mystery of the controversial detail of the woman's left breast, furrowed by an irregular, slightly swollen mark of a color between bluish and brownish. The model for the Bathsheba, admired by millions of visitors to the Louvre, was suffering from thrombophlebitis of a superficial vein of the breast, a condition described by Mondor in 1939," states the professor. So not mastitis or carcinoma, as believed for centuries.According to Zamboni, the varicose veins on the legs and knees are evident in Michelangelo, in the role of Heraclitus, frescoed by Raphael in The School of Athens. The evident anemia, brown skin, and acanthosis nigricans of Young Sick Bacchus of Caravaggio exhibited at the Galleria Borghese in Rome, according to Zamboni suggest the diagnosis of Addison's disease, a condition described in the 1800s affecting the adrenal glands.[35] [36] [37] [38]

Works

Awards and recognition

Zamboni was appointed "Commander" of the Order of Merit of the Italian Republic in 2017.[39]

He is listed on topitalianscientists.org.[40]

External links

Notes and References

  1. Web site: Curriculum - Paolo Zamboni.
  2. Zamboni. P. Galeotti. R. Menegatti. E. Malagoni. A M. Tacconi. G. Dall'Ara. S. Bartolomei. I. Salvi. F. 2008-12-09. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry. en. 80. 4. 392–399. 10.1136/jnnp.2008.157164. 0022-3050. 2647682. 19060024.
  3. Book: Rosalind C. Kalb. Multiple sclerosis: the questions you have-- the answers you need. 2008. Demos Medical Pub. 978-1-932603-45-3. Rosalind C. Kalb. 4th. Demos Health Series. New York. 72. 162501964.
  4. Book: Phlebology, vein surgery and ultrasonography: diagnosis and management of venous disease. 2014. Springer. 978-3-319-01812-6. Eric Mowatt-Larssen. Cham. 208–210. 870563977. Sapan S. Desai. Anahita Dua. Cynthia E. K. Shortell.
  5. Al-Omari MH, Rousan LA . Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis . International Angiology . 29 . 2 . 115–20 . April 2010 . 20351667 .
  6. Khan O, Filippi M, Freedman MS, Barkhof F, Dore-Duffy P, Lassmann H, Trapp B, Bar-Or A, Zak I, Siegel MJ, Lisak R . 6 . Chronic cerebrospinal venous insufficiency and multiple sclerosis . Annals of Neurology . 67 . 3 . 286–90 . March 2010 . 20373339 . 10.1002/ana.22001 . A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). . 10.1.1.606.8269 . 16580847 .
  7. Lee AB, Laredo J, Neville R . Embryological background of truncular venous malformation in the extracranial venous pathways as the cause of chronic cerebro spinal venous insufficiency . International Angiology . 29 . 2 . 95–108 . April 2010 . 20351665 . A similar condition involving the head and neck venous system may cause chronic cerebro-spinal venous insufficiency (CCSVI) and may be involved in the development or exacerbation of multiple sclerosis. .
  8. Qiu J . Venous abnormalities and multiple sclerosis: another breakthrough claim? . The Lancet. Neurology . 9 . 5 . 464–5 . May 2010 . 20398855 . 10.1016/S1474-4422(10)70098-3 . 206159378 .
  9. Book: Ferral. Hector. Radcases Interventional Radiology. Lorenz. Jonathan M.. 2018-04-13. Thieme Medical Publishers. 978-1-62623-283-9. en.
  10. Experimental multiple sclerosis vascular shunting procedure halted at Stanford . Annals of Neurology . 67 . 1 . A13-5 . January 2010 . 20186848 . 10.1002/ana.21969 . 37071227 .
  11. Stone K . Medical device conflict of interest in the CCSVI debate . Annals of Neurology . 71 . 3 . A6-8 . March 2012 . 22451214 . 10.1002/ana.23560 . 205343879 . free .
  12. Web site: FDA Safety Communication: Chronic Cerebrospinal Venous Insufficiency Treatment in Multiple Sclerosis Patients. FDA. . May 2012 . 6 November 2013 .
  13. Web site: Safety Alerts for Human Medical Products - Balloon angioplasty devices to treat autonomic dysfunction: FDA Safety Communication - FDA concern over experimental procedures. www.fda.gov. 9 March 2017. en.
  14. Zamboni P, Tesio L, Galimberti S, Massacesi L, Salvi F, D'Alessandro R, Cenni P, Galeotti R, Papini D, D'Amico R, Simi S, Valsecchi MG, Filippini G . 6 . Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial . JAMA Neurology . 75 . 1 . 35–43 . January 2018 . 29150995 . 5833494 . 10.1001/jamaneurol.2017.3825 .
  15. Traboulsee AL, Machan L, Girard JM, Raymond J, Vosoughi R, Hardy BW, Emond F, Gariepy JL, Bone JN, Siskin G, Klass D, Isserow S, Illes J, Sadovnick AD, Li DK . 6 . Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial . Neurology . 91 . 18 . e1660–e1668 . October 2018 . 30266886 . 6207414 . 10.1212/WNL.0000000000006423 .
  16. Ghezzi A, Comi G, Federico A . Chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis . Neurological Sciences . 32 . 1 . 17–21 . February 2011 . 21161309 . 10.1007/s10072-010-0458-3 . 27687609 .
  17. Dorne H, Zaidat OO, Fiorella D, Hirsch J, Prestigiacomo C, Albuquerque F, Tarr RW . Chronic cerebrospinal venous insufficiency and the doubtful promise of an endovascular treatment for multiple sclerosis . Journal of NeuroInterventional Surgery . 2 . 4 . 309–11 . December 2010 . 21990639 . 10.1136/jnis.2010.003947 . free .
  18. Jagannath VA, Pucci E, Asokan GV, Robak EW . Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis . The Cochrane Database of Systematic Reviews . 5 . CD009903 . May 2019 . 7 . 31150100 . 6543952 . 10.1002/14651858.CD009903.pub3 .
  19. Traboulsee AL, Knox KB, Machan L, Zhao Y, Yee I, Rauscher A, Klass D, Szkup P, Otani R, Kopriva D, Lala S, Li DK, Sadovnick D . 6 . Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study . Lancet . 383 . 9912 . 138–45 . January 2014 . 24119384 . 10.1016/S0140-6736(13)61747-X . 25925875 .
  20. Paul F, Wattjes MP . Chronic cerebrospinal venous insufficiency in multiple sclerosis: the final curtain . Lancet . 383 . 9912 . 106–8 . January 2014 . 24119383 . 10.1016/S0140-6736(13)61912-1 . 205970625 . 29 October 2019 . 29 October 2019 . https://web.archive.org/web/20191029233146/https://zenodo.org/record/3423610 .
  21. Cocozza S, Canna A, Lanzillo R, Russo C, Postiglione E, Liuzzi R, Vastola M, Brunetti A, Salvatore M, Brescia Morra V, Palma G, Tedeschi E . 6 . Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study. . Br J Radiol . 89 . 1064 . August 2016 . 27282838 . 10.1259/bjr.20160321 . 5124897 .
  22. Zamboni. P.. Cisno. C.. Marchetti. F.. Mazza. P.. Fogato. L.. Carandina. S.. De Palma. M.. Liboni. A.. 2003. Minimally invasive surgical management of primary venous ulcers vs. compression treatment: a randomized clinical trial. European Journal of Vascular and Endovascular Surgery. en. 25. 4. 313–318. 10.1053/ejvs.2002.1871. 12651168. free.
  23. Carandina. S.. Mari. C.. De Palma. M.. Marcellino. M.G.. Cisno. C.. Legnaro. A.. Liboni. A.. Zamboni. P.. 2008. Varicose Vein Stripping vs Haemodynamic Correction (CHIVA): a Long Term Randomised Trial. European Journal of Vascular and Endovascular Surgery. en. 35. 2. 230–237. 10.1016/j.ejvs.2007.09.011. 17964822. free.
  24. Book: Principles of venous hemodynamics. 2009. Nova Science Publishers. Zamboni. Paolo. Franceschi. Claude. 978-1-60692-485-3. Hauppauge, NY. 265657952.
  25. Book: Saphenous vein-sparing strategies in chronic venous disease. Zamboni. Paolo. Mendoza. Erika. Gianesini. Sergio. 978-3-319-70638-2. Cham, Switzerland . Springer . 1038068108. 2018-05-29.
  26. Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ . September 30, 2021 . CHIVA method for the treatment of chronic venous insufficiency . Cochrane Database of Systematic Reviews . 2021 . 9 . CD009648 . en . 10.1002/14651858.CD009648.pub4 . 34590305. 8481765 . 238229135 .
  27. Zollino. Ilaria. Campioni. Diana. Sibilla. Maria Grazia. Tessari. Mirko. Malagoni. Anna Maria. Zamboni. Paolo. 2019. A phase II randomized clinical trial for the treatment of recalcitrant chronic leg ulcers using centrifuged adipose tissue containing progenitor cells. Cytotherapy. en. 21. 2. 200–211. 10.1016/j.jcyt.2018.10.012. 30583949. 58610844 .
  28. Web site: Space station investigation goes with the flow. phys.org. en-us. 2020-01-09.
  29. Zamboni. Paolo. Sisini. Francesco. Menegatti. Erica. Taibi. Angelo. Gadda. Giacomo. Tavoni. Valentina. Malagoni. Anna Maria. Tessari. Mirko. Gianesini. Sergio. Gambaccini. Mauro. March 2018. Ultrasound Monitoring of Jugular Venous Pulse during Space Missions: Proof of Concept. Ultrasound in Medicine & Biology. en. 44. 3. 726–733. 10.1016/j.ultrasmedbio.2017.11.001. 29276139.
  30. Taibi. A. Gadda. G. Gambaccini. M. Menegatti. E. Sisini. F. Zamboni. P. 2017-10-31. Investigation of cerebral venous outflow in microgravity. Physiological Measurement. 38. 11. 1939–1952. 10.1088/1361-6579/aa8980. 28857747. 1361-6579. 2017PhyM...38.1939T. 42665674.
  31. Zamboni. Paolo. Scerrati. Alba. Menegatti. Erica. Galeotti. Roberto. Lapparelli. Marcello. Traina. Luca. Tessari. Mirko. Ciorba. Andrea. De Bonis. Pasquale. Pelucchi. Stefano. December 2019. The eagle jugular syndrome. BMC Neurology. en. 19. 1. 333. 10.1186/s12883-019-1572-3. 1471-2377. 6925502. 31864313 . free .
  32. De Bonis. Pasquale. Menegatti. Erica. Cavallo. Michele Alessandro. Sisini. Francesco. Trapella. Giorgio. Scerrati. Alba. Zamboni. Paolo. July 2019. JEDI (jugular entrapment, dilated ventricles, intracranial hypertension) syndrome: a new clinical entity? A case report. Acta Neurochirurgica. en. 161. 7. 1367–1370. 10.1007/s00701-019-03908-2. 31025176. 131776842. 0001-6268.
  33. Zamboni. Paolo. Menegatti. Erica. Pomidori. Luca. Morovic. Sandra. Taibi. Angelo. Malagoni. Anna Maria. Cogo. Anna Luisa. Gambaccini. Mauro. 2012-03-01. Does thoracic pump influence the cerebral venous return?. Journal of Applied Physiology. en. 112. 5. 904–910. 10.1152/japplphysiol.00712.2011. 22174396. 25820701. 8750-7587.
  34. Gadda. G.. Taibi. A.. Sisini. F.. Gambaccini. M.. Zamboni. P.. Ursino. M.. 2015-02-01. A new hemodynamic model for the study of cerebral venous outflow. American Journal of Physiology. Heart and Circulatory Physiology. en. 308. 3. H217–H231. 10.1152/ajpheart.00469.2014. 25398980. 11392/2370597 . 9201170 . 0363-6135.
  35. The medical enigma of Rembrandt's Bathsheba . 2020 . 10.1111/jth.14801 . Zamboni . Paolo . Journal of Thrombosis and Haemostasis . 18 . 6 . 1268–1270 . 32346960 . free .
  36. Web site: Diagnosi su tela: le grandi malattie dipinte dei pittori del passato. 27 June 2020 .
  37. Corriere della Sera Corriere Salute, pp. 10 e 11 Giovedì 18 Giugno 2020
  38. Web site: Risolto l'enigma sul seno della Betsabea. 18 June 2020 .
  39. Web site: Commendatore Ordine al Merito della Repubblica Italiana.
  40. Web site: Top Italian Scientists. topitalianscientists.org. 2020-01-09.

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