(From the book, with some modifications, “Semeiotica Biofisica. Microangiologia Clinica”, Stagnaro-Neri Marina e Stagnaro Sergio, in advanced preparation).
In medical field, wide and enchanting, originated from
Biophysical Semeiotics, far away from having reached the borders of its
domain, Clinical Microangiology plays a primary role, from both
theorical and practical view-point, due to its excellent results,
collected at the bed-side in original
and refined manners.
more than 45 years of biophysical semeiotic research and practical
performance of this method, we are more and more convinced that a
scientific theory must have multiple valencies of efficaciousness and
beauty for cleaming to reach the scientific thrue.
now, at the beginning of the first millennium, only a few appointed
physicians studied clinical micrangiology. However, by Biophysical
Semeiotics, it will surely become cultural heritage of every open-minded
doctor, which will be able to collect at the bed-side numerous, original
and reliable data, obtaining excellent results on diagnosis,
differential diagnosis, clinical research and, ultimately, therapeutic
represents the clinical study of deterministic chaos of vasomotility,
i.e., sphygmicity of small arteries and arterioles, according to
Hammersen, and, then, of vasomotion, sphygmicity of capillaries
and post-capillaries venules, in all biological systems.
new discipline of Medicine, in fact, is based exclusively on
“clinical” evaluation (using a stethoscope and assessing ureteral
reflexes; See Technical Page N° 5) of autonomous and autoctonus
movements of all structures of tissue-microvascular-units, among them
Arterio-Venous Anastomoses (AVA), functionally speaking, of every organ,
gland, and tissue.
basal physiological conditions, tissue-microvascular-unit motor activity
shows an high degree of deterministic chaos, i.e. highest fractal
dimension or dimensionality, which is its measure.
calculation of this parameter, essential in Clinical Microangiology, by
easy and practical way, can be performed with the aid of evaluation of
disappearing time of caecal and/or gastric aspecific reflex: by elegant
and refined way doctor quantifies in sec. “differential latency
time” of caecal and/or gastric aspecific reflex, wich parallels its
disappearance, as will be described in details later.
a biological system, due to diseases, different in origin, evolves
slowly to pathological condition, both functional and/or structural,
although function and structure must be considered as poles of the same
equation, as states Leuckard, characteristic
modifications of deterministic chaos happen in both local vasomotility
and vasomotion and, at macroscopic level,
in volume fluctuations of organ, gland, and tissue, where
disorder is localized, allowing to draw related diagrams, illustrated in
the site pages, dedicated to Biophysical Semeiotics, and, therefore, jet
known to reader.
physiological oscillations (trajectories), in fact, appear modifyed at
microscopic as well as macroscopic level, causing progressive lowering
of the fractal dimension or dimensionality, that from the
physiological value, i.e., 3,81, lowers to about 2,57, as in the case of
pancreas during Reaven’s syndrome, classic or “variant”, we
described previously, slowly evolving to diabetes mellitus.
this point, interestingly dividing physiological dimensionality and
fractal dimension of Reaven’s syndrome slowly evolving to DM, or
other disease, of course, the result oscillates around 1,618,
or golden mean.
our opinion, such magic numbers, which are really numerous in clinical
microangiological evaluation, underline clearly the value of the chaos
fact, according to many authors, biological, physiological and
pathological “structure” shows its chaotic nature (Rambihar V.S. A
chaos theory for health care The Medical Post. Vol. 36, April 25,
2000) and the study of single patient has to be performed not by
principles valid for the “group” of individuals, population in
general, according to the
standards of Evidence Based Medicine (EBM), but on EBM, based on the
Chaos (Rambihar V.S. A New Chaos Based Medicine Beyond 2000.,
Vashna, Toronto, 2000).
is nowadays clear that the best knowledge of an individual, under
physiological and pathological situations, is acquired by a method based
on the sensitivity to initial conditions, on interaction, complexity,
standards totally ignored by EBM, as we suggested previously (BMJ.com,
Rapid Response: “Complexity in both health care management and in
biological systems“, 28 Settembre 2001)
the first part of the site are referred data of our researches,
performed over the past decades by Biophysical Semeiotics, in a way as
easy as possible, aiming to a practical utilization at the bed-side,
hopefully demonstating that phenomena observed in a single individual
very often are not “identical” to those evaluated in the “group”
of comparable subjects, on the base of an evidence, which allows to
forsee in probabilistic and statistic manner exclusively by “great”
to demonstrate what above referred, it is necessary to say that in the
course of chronic disease, dimensionality of
tissue-microvascular-units fluctuations and, then, of those macroscopic
of related biological systems, are equal to 1, i.e. topological
the above brief remarks, results clearly the usefulness and originality
of Clinical Microangiology in bed-side diagnosis, prevention,
research and therapeutic monitoring.
activity, both physiological and pathological, of a biological system is
strictly related to its microcirculatory blood-flow
pattern. Therefore, it is possible to assess function and
structure of the former by evaluating function and structur of the
study represents the aim and ultimate purpose of Clinical
Microangiology, originated with the aid of Biophysical Semeiotics,
which is its method or operative tool.
and Newton founded infinitesimal calculus, which has substancially
shaped physical concepts and human thinking, based on the hypothesis
that the world, in every its manifestation, could be explanable as
endless dividable “continuum”, one of the concepts of “classic”
theory of the 19th century mechanics, according to which all causal
interactions were continuous. As usually happens, there was who,
vox clamantis in deserto, doubted all that (Giorello G.
Caos, Continuità ed approssimazioni. Sfera, XXXVI, 21, 20, 1993).
the 14th., December 1990 at Berlin Acàdemy of Sciences Max Planck
communicated a discovery, which would have changed the very
fundations of physics: quantum elementary of action.
“I tried to place quantum elementary of action in some way into the scheme of “classic” theory, i.e. in the scheme of matematic “continuum”. But this constant proved irreducible. Failed every efforts to overcome this obstacle, appeared clearly that quantum elementary of action played a fundamental role in atomic physics and this discovery was epock-making in the science” ( Max Planck. La conoscenza del mondo fisico, pag.28, Boringhieri, Torino, 1993).
quantum discovery resulted difficult to be accepted, because, as writes
Max Planck (ibidem), “a new scientific truth is not triumphant since
its opposers are persuaded and, then, see the light, but because they
actually die and a new generation is born, to which the concepts become
familiar”. As all nowdays know, Max Planck’s discovery was the begin
of quantistic mechanics era, i.e. a new vision of the world.
the history is repeating, as it results clearly from considering science
evolution, like the following interpretation, although it seems
apparently reductive and theorical.
Let’s start with the fundamental question: “In positive or negative, which is the role of the rigid and conservative science element in the Darwin’s evolution theory?” (Stagnaro S. Vecchio e nuovo nella scienza.Tempo Medico,315, 67, 15 Novembre 1989 ).
order to clarify this fundamental point, it seems very useful G.
Bateson’s theaching (Bateson G. Mente e Natura, Adelphi, Milano,1984).
In Darwin’s evolution, the first bond, to which a new form must submit
itself, is represented by internal conditions; its vitality is related
to embryo “somatic flexibility”. For instance, in the sexual
reproduction, the “new” meets the “old” and the comparison
forsters both conformity and conservatorism: extreme changes are
eliminated due to incompatibility. Then, the epigenesis (embriological
processes considered at every stages as regards their links with the
preceding stage) will impose new tests of conformity, and, overcome them,
results the phenotype, “new” and mature from the sex point of view.
If it sounds absurd that, in case the “new” is more vital and better
than the “old”, something in the later was wrong, it is extremly
necessary and important that the “new” would not be worse than the
“old”, which, after all, has overcome more proofs. Internal
selection, then, represents the “critical analysis” to which has to
undergo every new genetic component or combination.
second selective bond takes root in external adaptation (interaction
between phenotype and environment): environment and physiology all
togheter suggest somatic changes, which can be vital or not vital; is
the actual state of organism, genetically-dependent, which establishes
the vitality. In other words, genetic state disposes what has been
suggested as change, allowing some changes, but preventing others.
conclusion, the genome of individual organism comprehends the
potentiality of changing (informatically speaking, the bank), a
research of possible alternative pathways of adaptation and, then, of
possible changing, which, however, can not be treu.
this necessary introduction, it seems easier to understand the analogy
exsisting between the biological evolution and thinking processes; the
parallelism between biological evolution and mind, according to G.
Bateson (ibidem), is realized petitioning stocastic character of the
thought and, then of creative process. Exploratory processess – “
The science does not demonstrate, explores” – namely, to proceed for
trials and errors, as states Karl Popper (Popper K. Logica della
scoperta scientifica. G. Einaudi Editore, III ed., Torino, 1970.) are
able to reach novelty exclusively going on ways appeared by chance and
somehow selected to what likes to survival.
We share E. De Bono’s thought, according to which lateral thought permits to create revolutionary and epoch-making theories, while logic, vertical thought plays the role of constructive criticism and analysis, hopefully honest and strict (De Bono. Il pensiero laterale. Rizzoli, Milano. 1996).
ideas, first of all, must show “coherence”, by passing through a
filter, precise and critic, like durin whole epigenetic process, where
it is required the conformity in the developing individual. In the
process of though the
“exactness” is analogous to “internal coherence”: we use with
pleasure the later term instead of “exactness”, when submit our
theory to criticism.
this point, let’s consider the adaptation, i.e., the relation between
mind and external world, analogously to somatic changing. Even here, we
meet facilitations and restrictions, external as well as internal, on
the base of what has been learned previously. Internal preservation
is conservative and such conservatism appears in both embriology
and in preserving abstract form.
conservatorism takes rooth in the coherence and consistenty, analogous
of exactness in mental process. According to G. Bateson, here is to be
searched osolescence rooth,
considering that the fear to lose coherence, clearity, and wisdom hinder
the war against them.
is necessary, however, to consider another aspect of the obsolescence:
if a part of cultural system developed a little, clearly there is
another one, which has developed too rapidly. In the contrast between
the two components is the obsolescence.
the delay of one of the components is due to the internal component of
natural selection, then obviously we can surmise that the rapid
development takes the rooth in the external selection: imagination has
overcome the exactness, i.e., in the mind of men, old and conservatory
it seems that changing is akin to
nightmare and madness.
some fields, as Medicine, this fact is well-known. However, we have to
reflect more deeply: in a lot of changing processes we find something
like an abstract relation, which recurs as necessary component of a
large variety of changes, e.g., form/function, exactness/imagination,
structure/quantity. Some prefer one of the components: liberals,
epistemological truth states that oppositions poles are, in reality,
dialectic necessites of living world, like day and night. The
obsolescence does not be avoided solely, neither by accelerating
structure change, nor slackening functional changes. Hopeful could be
the antagonistic combination of the two mental habits, surely better of
both, separatedly considered.
is well known that they undergo to external determinisms: in directing
decision the primary role
is played by te relative power of competitors, but certainly not by the
force of the arguments.
the “exactness” alone represents
the death due to paralysis, as the imagination alone is madness.
Therefore, it seems preferable to accept functional change with all
respect to the structure, when the “new” presents trough the filter,
exact and critic, as cultural enrichment and true progress.