Day 254 - 22 May 96 - Page 37
1 A. That is correct.
2
3 Q. And that affects the wall up and down which the blood is
4 running?
5 A. That is correct.
6
7 Q. Or actually running in only one direction, depending
8 whether it is an artery or a vein, and then that has the
9 facility for clots to stick?
10 A. That is correct.
11
12 Q. Rather than being rejected as they would be by a healthy
13 endothelia?
14 A. Indeed, yes, my Lord.
15
16 Q. So the unhealthy endothelium is the result of the atheroma
17 between the walls of the vessel?
18 A. Yes, that is correct.
19
20 Q. So unhealthy endothelia and atheroma is synonymous really?
21 A. Yes, indeed, but the changes in the endothelium is
22 secondary to the deposit of the fat within the wall of the
23 blood vessel.
24
25 Q. You say that that process is never found in the arteries
26 supplying the liver and is found in the lungs only when
27 pre-existing pulmonary hyper-tension exists?
28 A. That is correct, and lung metastases are common and
29 high blood pressure within the pulmonary circulation is not
30 common. Liver metastases are common and these are vessels
31 where you never ever see fat depositions within the walls
32 of the arteries.
33
34 MS. STEEL: Can I just say that the note I have got, and
35 obviously if it is going to get too detailed I am going to
36 have to wait until Professor Crawford comes back, but his
37 evidence was not that the tumours cells would stick to the
38 atheroma but that they might stick to any surface which was
39 partially damaged in some way.
40
41 MR. JUSTICE BELL: Yes. I may be wrong, but I thought that --
42 and I will be only too willing to accept that I have either
43 miss-remembered it, or failed to remember it -- it was all
44 part of events which resulted from atheromatosis?
45
46 MS. STEEL: No, I think it was just the same process, that was
47 all.
48
49 MR. JUSTICE BELL: Yes, but I would like to explain it in case I
50 have misunderstood. You have the unhealthy endothelium
51 which, just as it may enable blood clots to stick to the
52 vessel wall leading to a vascular accident -----.
53 A. It is the platelets actually.
54
55 Q. The platelets, right. So you might get a cancerous cell
56 sticking to the artery wall, and that might be part of the
57 cause of the progression of the cancer?
58 A. My understanding of the theory was that was suggested.
59
60 Q. What I understand you to say, for better or worse, is that
