(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.

After 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.

Untill 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 monitoring

Clinical Microangiology 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.

 This 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.

Under 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.

The 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.

When 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.

These 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.

At 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, f, or golden mean.

In our opinion, such magic numbers, which are really numerous in clinical microangiological evaluation, underline clearly the value of the chaos in Medicine.

In 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).

It 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)

In 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” numbers.

Finally, 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 dimension.

From the above brief remarks, results clearly the usefulness and originality of Clinical Microangiology in bed-side diagnosis, prevention, research and therapeutic monitoring.

Functional 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  later.

Such study represents the aim and ultimate purpose of Clinical Microangiology, originated with the aid of Biophysical Semeiotics, which is its method or operative tool.


Old and news in the science.


Leibniz 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).

On 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).

The 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.

Notoriously 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 ).

In 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.

The 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.

In 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.

After 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).

New 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.

At 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.

The 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.

It 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.

If 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.

In 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, radicals, conservatories.

However, 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.

It 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.

Surely, 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.