In memoriam

Our highly esteemed mentor, colleague, and great friend David Russell died on April 20, 2022, aged 74 years.

Born in Kells, a village near Ballymena in County Antrim, Northern Ireland, David was the youngest of three children. Showing great scholarly promise from an early age, he went on to study medicine and completed his medical degree at The Queen’s University of Belfast, Northern Ireland, in 1972. He held house officer and resident positions in medicine, general surgery, and neurology 1972-74 in Belfast, Southampton, and London 72-74.

Love brought David to Norway, working as a local GP in Nissedal 1975-76, to obtain a full Norwegian license. David then moved to The Department of Neurology, Rikshospitalet (later rebranded Oslo University Hospital), Oslo. There, he was a clinical consultant in neurology from 1985 until he retired in 2020.

David’s first scientific focus of interest was migraine and cluster headache: in 1985, he defended his Ph.D. thesis, “Studies of autonomous functions in the cluster headache syndrome”.  

At that time colleagues in the Neurosurgical department with Professor Helge Nornes had begun studies on transcranial Doppler ultrasound (TCD) methodologies for measuring cerebral flow velocities in neurovascular disorders and open-heart surgery. Thus, David employed TCD techniques to detect, monitor, and eventually prevent embolism to the brain during open-heart surgery. The studies revealed that brain emboli during heart surgery might be both gaseous bubbles and solid, insoluble particles. David became deeply involved in brain embolism as a cause of intraoperative stroke. He established himself as a world leader in the development and scientific implementation and clinical use of TCD techniques to detect, classify, and prevent intraoperative brain embolism. His pioneering efforts included monitoring ten younger colleagues and their Ph.D. theses.

For quality assurance, the consensus on criteria revealing the presence and the frequency of emboli became an area where David’s expertise played a major role. He participated substantially in automatic embolus detection and artifact rejection, necessary for clinical monitoring during carotid endarterectomy, carotid stenting and open-heart surgery. In the later years, his projects also involved studies on plaque inflammation in carotid and coronary artery atherosclerosis.

David was engaged in the societal aspects of his stroke research. In close collaboration with several Norwegian laypeople’s focus groups, he contributed to arranging meetings and conferences on stroke that were open for all who might be interested. David thus transferred to the lay community the results and implications of his research. He made Norwegian laypeople realize that cerebral stroke is emergency medicine and that a person with symptoms suggesting an acute stroke needs urgent hospitalization, high-tech investigation, and treatment.

In 1991 David was appointed full professor of neurology to the University of Oslo. He was then the youngest neurology professor in Norway.

David received several national and international awards. In 1996 David co-founded the European Society of Neurosonology and cerebral Haemodynamics (ESNCH).

In the field of medical publications, David’s contributions were vast and distinguished, acting as reviewer on stroke for the World Health Organization and for the British Medical Research Council. David also served as an Editorial Board Member in several international journals: Stroke – a journal of cerebral circulation; Cerebrovascular Diseases; The International Journal of Stroke; European Journal of Neurology; Acta Neurologica Scandinavia; Clinical Neurology and Neurosurgery; Journal of Clinical Ultrasound; Lipid forum; The Bulgarian Stroke Journal, and The Japanese Journal of Neurosonology.

He was a reviewer for several international journals: Stroke – a journal of cerebral circulation; The International Stroke Journal; Journal of Cerebral Blood Flow and Metabolism; Journal of Neurology, Neurosurgery and Psychiatry; European Neurology; Acta Neurologica Scandinavia; Cephalalgia and The Norwegian Medical Journal.

In 1976 David married Grete, and in 1979 they had a son, Kristoffer. Kristoffer went on to study medicine. He was David’s pride and joy and is now a recognized cardiologist at the Oslo University Hospital. Grete and David divorced in 1995. In 1998 David married Jeanette, whom he had known since they were teenagers.

David’s colleagues and associates enjoyed going with him to meetings. His charm and impulsivity were well known, he could sing karaoke, do the Riverdance, and quiz his friends expertly on 1960s British pop music. He was never boring because he was never bored.

We reach out to David’s entire family during their time of grief and we send them our deepest condolences. David is no longer among us, but his work, legacy, and his example will stay with us for a long time.

Prof. Karl-Fredrik Lindegaard and the ESNCH Executive Committee

May 2022

The ESNCH mourns the sudden death of Prof. Dr. Ekaterina Titianova, well respected neurologist, neurosonologist, colleague and friend of our society.“We are shocked to receive the sad news from our Bulgarian colleagues, that Ekaterina passed away suffering from COVID 19, just days after her husband. We have lost a respected colleague, friend and a member of our society”, remarked Prof. Malojcic, President of the ESNCH.

Prof. Dr. Titianova chaired the Clinic “Functional Diagnosis of the Nervous System” at the Military Medical Academy and she was also head of the Department of Neurology, Psychiatry, Physiotherapy and Rehabilitation, Preventive Medicine and Public Health at the Medical Faculty of Sofia University “St. Kliment Ohridski” where she greatly contributed to the development of medical science and practice, and the training of students and graduates.She was an academician of the Bulgarian Academy of Sciences and Arts and an academician of the Serbian Royal Academy.

Her scientific interests were focused on cerebrovascular diseases, neurosonology, motor gait control, autonomic disorders and neurorehabilitation.  She was an innovator in the study of gait through electronic analysis of steps and developed new directions in neurorehabilitation in Bulgaria.She was a recognized international expert in neurosonology, reviewer of scientific publications and invited lecturer at international meetings and conferences.

Her Bulgarian colleagues confirm, that Prof. Titianova was a principal investigator, national coordinator and participant in national and international studies in the field of stroke, multiple sclerosis, epilepsy and Parkinson’s disease. Her scientific output includes monographs, textbooks, manuals and over 250 publications at home and abroad, which are internationally cited. She was a co-author of national and international textbooks.

Prof. Titianova was awarded by the European Society of Neurosonology and Cerebral  Hemodynamics, the National Medical Award in the categories “World Recognition in Medical Science” and “Medicine and Education” for the establishment of a school of neurosonology.  She was awarded the Badge of Honor of the Ministry of Defense (2016), the “Peter Beron” medal of the Bulgarian Academy of Sciences and Arts (2017) and the Diploma of the Bulgarian Red Cross for Humanism (2018). She was the winner of the 2018 Pythagorean Grand Prize for overall contribution of the Ministry of Education and Science. She received awards from national and international scientific forums.But beyond all her academic and scientific achievements, Ekaterina will always be remembered by the ESNCH family because she was good-hearted, generous and full of passion, a true leader.

The Executive Committee
January 2022

Prof. Hiroshi Furuhata, Jikei University School of Medicine, Tokyo
Advisory Board Member of the Neurosonology Research Group of the World Federation of Neurology
Honorary Member of the Japan Academy of Neurosonology
Honorary Member of the European Society of Neurosonology and Cerebral Hemodynamics
President of the Japan Society of Embolus Detection and Treatment

The Executive Committee is deeply saddened to inform you of the passing of Prof. Hiroshi Furuhata. He died August 11, 2012, at the age of 67. His medical contributions continue to bring healing for generations – through the research that gave birth to lasting medical progress. We reach out to his entire family during their time of grief and we send them our deepest condolences.

The Executive Committee
August 2012

Merrill P. Spencer died on July 3, 2006 at the age of 84. As well known pioneer in the field of cerebrovascular ultrasound, he is credited with the introduction of a carotid ultrasound methodology into clinical medicine. He also made important contributions in the development of transcranial Doppler ultrasound and went on to describe a number of important observations regarding the role of embolic particles carried into the cerebral circulation, and their role in stroke.

Merrill completed his medical degree at Baylor University in Houston in 1945. Immediately after World War II he served as a Flight Surgeon in the Army Air Corps. Then he received a fellowship at Western Reserve Hospital in Cleveland, and later became an Associate Professor of Physiology & Pharmacology at Bowman Gray School of Medicine at Wake Forest University in Winston/Salem. There he performed research in the dynamics of blood flow in coronary arteries utilizing the electromagnetic flowmeter, which he had invented and patented. In 1963 he became Director of the Virginia Mason Research Center in Seattle, Washington where he established the leading Hyperbaric Laboratory in the Northwest United States. Merrill co-founded in Seattle the Institute of Applied Physiology & Medicine (IAPM), along with Dr. Jack Reid. Together they created first a Doppler ultrasound device to detect nitrogen bubbles to be applied in divers. This work is the basis for the algorithms used in today’s sport diving decompression tables and computers. Merrill and Jack developed the so called Dopscan, a device to record the Doppler signals first by listening the audiosignal, later supported by spectrum analysis. This was combined with a two dimensional (c-mode) image of the carotids taken from the Doppler signals during the scanning process. This resulted in an improved documentation which allowed physicians to read the exam offline after the recording by well trained technicians. Following this invention the IAPM offered many courses in Doppler sonography for technicians and physicians.

Today we still use as the most informative teaching material Spencer and Reid’s scheme illustrating the relation between Doppler frequencies recorded at the site of a carotid stenosis, the degree of narrowing and flow volume (Stroke 1979, 326 ff) Merrill opened the first vascular laboratory in Seattle at Providence Hospital. In 1987 he co-founded Pacific Vascular Inc., which expanded the laboratory business to 14 locations in Western Washington. The transcranial Doppler (TCD) was invented by Dr Rune Aaslid in 1981. He used the transtemporal approach. Merrill on the other hand tried to explore the intracranial arteries through the orbital window. In 1992 Dr. Spencer co-founded, with Scott Seidel, David Dobson, RVT, and Mark Moehring, PhD, a new company called Spencer Technologies, with a mission to improve upon Doppler technology to detect emboli in flowing blood. A special clinical application for the detection of microemboli is the detection of PFO, Merrill was very interested in this clinical field. This led to the Spencer grading system for the severity of the shunt through a PFO.

As a result of his world known research in hemodynamic physiology, neurovascular diagnosis and Doppler sonography in cardiology Merrill received many medical honors. He was a member of the Neurosonology Research Group of the World federation of Neurology from the beginning and did not miss one of the meetings. He organized 10 International Symposia on Cerebral Hemodynamics 1987-1996 as satellite to the yearly International Stroke Conference. From this series of meetings originated the European Society of Neurosonology and cerebral Hemodynamics (ESNCH). Merrill became honorary president of this society and was presented Mai this year at the meeting in Düsseldorf, Germany a lifetime award for his achievements in the field of Neurosonology.

Merrill was not only an exemplary and respected curious scientist but also a man with plenty of kindness and humor. He was taking part in countless international meetings all over the word especially in Europe and became a friend of many other researchers and clinicians. Despite his own extensive experience he was open for new ideas from others and ready to discuss papers in a helpful manner. He always talked about the future and exciting projects. He did continue his activities and research indefatigably up to the end of his life even after knowing that there was no more help against his final disease. All his achievements would not be possible without Joanne his beloved wife of 34 years. They always traveled together. It is also due to her warm-hearted personality that both were most welcome everywhere in the scientific community.

Our deep feelings go to Joanne and the children.

G.-Michael von Reutern and David W. Newell
Nidda Bad Salzhausen, Germany and Seattle, US, August 2006

On February 22nd, 2004, Professor Elietta Maria Zanette passed away in Genoa, her native city, after a long struggle against cancer. She was born on May 2nd, 1942. Professor Zanette was one of the most committed Italian pioneers in the use of ultrasounds in cerebrovascular disease, which was her main field of study until the very end of her life. She took her degree in medicine in Genoa in 1967, and completed her residency in neurology and psychiatry in 1970.

She collaborated with Prof. C. Fieschi for many years: first in Siena, then in Rome, from 1978 onwards, in the III Neurological Clinic of the University of Rome “La Sapienza”, where she developed her interest in ultrasounds in the late seventies; at that time, she also collaborated with Dr. L. Pourcelot, whose manual on the Doppler examination of peripheral vessels she translated from French into Italian. She was also interested in carotid echotomography, performing studies on the correlations between the echotomographic and pathological characterization of surgically-removed carotid plaques.

She was appointed associate professor of neurology in 1987, and was, from 1991, director of the Neurosonology Service of the Department of Neurosciences at the University of Rome “La Sapienza”. She was a keen believer in technological innovation, becoming, as a result, one of the first neurosonologists in Italy. She launched Transcranial Doppler (TCD) in Italy soon after it was first proposed by R. Aaslid in 1982, and went on to become one of the organizing committee members of the “Ist International Conference on Transcranial Doppler Sonography”.

From 1986 to 1993 she was a member of the executive committee of the Neurosonology Research Group of the World Federation of Neurology. She was also President of the Italian Society of Neurosonology from 1987 to 1989, consistently playing an active role in the promotion of ultrasounds in both Italy and the rest of the world. From the mid-eighties onwards, she focused her attention particularly on the study of TCD findings in the acute phase of ischemic stroke, which led to the publication of articles in international journals, to this day cited in many studies, in which emphasis was placed on the concept of an asymmetry of flow velocity between homologous arteries in the two hemispheres as a means of detecting an occlusive pathology in the middle cerebral artery.

She also studied and published papers on, among other topics, the dynamic evolution of TCD findings in the first week after stroke onset, and the correlations between CT scan and TCD findings in stroke. She was a member of the scientific committee of the European Society of Neurosonology and Cerebral Hemodynamics, whose memorable 4th Meeting was organized by her in Venice in April 1999. Every delegate who attended that event will undoubtedly remember her care, dedication and enthusiasm, which so greatly contributed to the success of the Congress at the Fondazione Cini on the island of S. Giorgio Maggiore. Professor Zanette created, in her Service of Neurosonology, a group of enthusiastic co-workers with whom she carried out studies on the cerebral hemodynamics of migraine and of degenerative and vascular dementias.

She collaborated for many years with the Faculty of Engineering in her search for analysis systems of the Doppler signal and methods for the computer filing of neurosonological images. She also worked on methodological improvements in the diagnosis of patent foramen ovale in cryptogenic stroke by means of TCD, which led to a Consensus Meeting being held on this topic during the afore-mentioned congress in Venice and, subsequently, to an article being published in 2000.

Elietta Zanette was not only a teacher for those who had the privilege of working with her, but she was, above all, the very heart of her group, acting as a strong stimulator of both personal and intellectual growth for all her students, and showing a quasi-maternal attention towards her co-workers. It is for this reason that she was both respected and loved by all who had the honour of working with her. She will be greatly missed. Thank you Prof!

Giovanni Mancini, Novella Bonaffini

On October 24th, 2003, the neurological world lost one of its most enthusiastic, innovative, and supportive citizens. Dr. William M. McKinney, best known for his pioneering work in the development and use of ultrasound for neurological disorders and stroke, succumbed to cancer following a prolonged, courageous, and inspiring battle.

Born in Roanoke, VA, Bill did undergraduate studies at Washington and Lee University, and received his degree in Chemistry from the University of North Carolina in 1951. He attended the University of Virginia’s School of Medicine, where he was awarded his M.D. degree in 1959. His internship and residency in Neurology were also at the University of Virginia, after which he was hired by Dr. James F. Toole, and joined the Department of Neurology at what was then the Bowman Gray School of Medicine in Winston-Salem, NC. Bill remained at this institution until he retired from active clinical practice in 1997, but he continued as a Professor Emeritus at what had then become Wake Forest University School of Medicine, the Bowman Gray Campus.

Although his father was a radiologist, Bill chose to approach the brain and nervous system from a clinical perspective, using non-roentgenographic methods; a decision that shaped his entire medical career. His first work in ultrasound was a medical school research fellowship in urolithiasis with the Department of Physiology. During residency training, his interest in ultrasound shifted to the emerging method of echoencephalography.

Upon arriving in Winston-Salem, his enthusiasm for this technology grew as he found a fertile academic environment and colleagues with whom he could practice what he called “cooperative creativity”. Some of his earliest accomplishments were to help establish the Center for Medical Ultrasound (1963), to organize an educational program for echoencephalography in 1964, and to set up the first neurosonology course in 1975.

Dr. McKinney’s most important research contributions involved the use of ultrasound to study the carotid arteries, which he first published about in 1971. He also participated in many advancements and innovations in ultrasound including 3-D mapping with continuous wave Doppler, B-mode imaging, duplex ultrasound, color flow imaging, volume flow rate measurements, transcranial Doppler, ultrasound contrast agents, and embolus detection.

Bill was the “father” of Neurosonology in the United States, and was credited with first defining the term “Neurosonology”, as the science of the application of ultrasonic energy to study the nervous system and its supporting structures, for diagnosis and treatment. He was always postulating new neurological applications of ultrasound for diagnosis and treatment.

Through it all, Bill remained focused on the question of how these techniques could help to improve patient care for the “little Aunt Hatties” of the world. Over the years, Dr. McKinney was recognized by his peers for his accomplishments, receiving the 1981 Caldwell Medal of the American Roentgen Ray Society, and being named as a Distinguished Member of the American Society of Neuroimaging (ASN). He was also awarded Fellowship status in the American College of Radiology, and the American Institute of Ultrasound in Medicine (AIUM). He served as President of the AIUM (1974-76), and the ASN (1990-92), and helped to found the Neurosonology Research Group of the World Federation of Neurology, as well as the North Carolina Stroke Association. He represented the American Academy of Neurology as an original member of the Board of Directors of the Intersocietal Commission for Accreditation of Vascular Laboratories, and was a staunch supporter of the International Cerebral Hemodynamics Society.

More than his creative research, awards, and positions, his enduring legacy in neurosonology will be his passion for education, as he preached the “gospel of ultrasound” all over the world. This is evidenced by the lives and accomplishments of the thousands of physicians, sonographers, medical students, residents, and fellows, who he taught and mentored. Bill did not care what specialty hat those in his courses wore, only that they were interested in learning and that they would use ultrasound to help their patients. Most leaders in neurosonology studied, did fellowships, lectured for, or collaborated with Bill McKinney at some time during their careers. The courses and programs he established have endured and grown, now with an international scope.

In later years, he led the development of a rocking chair to improve muscle function and overall well-being in the elderly. He also raised apples on his hilltop orchard in the nearby Brushy Mountains. Beyond Neurosonology, Bill was the prototype of a caring, compassionate physician, with a deep sense of duty and respect for every patient. He was a true southern gentleman, who treated each person as special. His infectious smile, sense of humor, enthusiasm, and his humility, endeared him to all. He truly had the “gift of gab”, he really loved people, and he never seemed to know a stranger. He was a mentor and role model for hundreds, as he also managed to keep his priorities straight, in spite of the demands of medicine, with God and family having first place in his life.

His advice and counsel was wise, down to earth, based on experience, and was highly valued. Bill was also a loving husband and father, and he is survived by his wife, Joan, three children, and five grandchildren. Our hearts go out to each of them over their loss. On a more personal note, Bill McKinney was the reason I came to Winston-Salem. During the time we shared here, Bill became my most valued colleague, mentor, and friend. For me, like many others, he was a surrogate “father” in medicine. I will forever recall how he greeted so many with a heartfelt, “You’re such a good man”, or his inevitable opening line to conversations of, “I want to discuss three things”. He will certainly be missed. However, he lives on through the lives and careers of those he touched, and the programs he created. He provides an example and an inspiration to urge us onward to find innovative new approaches, and new ways to extend our hands to teach others, while keeping our focus on how what we do can help our patients. It was a real blessing to have known Dr. William M. McKinney, who truly was “such a good man”.

Charles H. Tegeler, MD