Day 254 - 22 May 96 - Page 36


     
     1   MS. STEEL:  (To the witness): Would you agree that do you know
     2        anything about blood elements being made sticky, to use a
     3        not very technical term, by a diet high in saturated fat?
     4        You do not know anything about that?
     5        A.  No.  Well, I do, but I am not an expert in the field.
     6
     7   MR. JUSTICE BELL: As I understand it, the message I am rather
     8        getting from you is you do know something about these
     9        things but you feel rather inhibited as an expert in the
    10        witness box in purporting to give an expert view.  Is that
    11        a fair assessment?
    12        A.  That is correct, my Lord, yes.
    13
    14   MS. STEEL:  So are you really saying you cannot really comment
    15        on Professor Crawford's hypothesis as an expert?
    16        A.  No.  I think my understanding of Professor Crawford's
    17        statement was that he suggested that a similar process
    18        might exist to allow tumour cells to become lodged on the
    19        wall of the blood vessel and, therefore, be able to gain
    20        entry into the system and form a secondary deposit in the
    21        same way that we know that when you have fat deposits
    22        within the walls of blood vessels, it is more likely that
    23        platelets will be adherent there and form a thrombosis.
    24
    25        What I am saying is that we do not have evidence
    26        scientifically to support that concept.  I am saying no
    27        more than that.  Because the two sites in the body where
    28        you most commonly see secondaries, which is in the liver
    29        and in the lungs, they do obviously go to other places such
    30        as the bones and so on, but the commonest sites by far are
    31        the liver and lungs, and these are blood vessels where you
    32        never ever see atheroma or you get fat deposits within the
    33        walls of the blood vessels except in the lungs in patients
    34        who have high blood pressure within the pulmonary
    35        circulation which is not a very common event.  That would
    36        not explain why metastases were able to form in certain
    37        areas in the body which is the only point that I am making.
    38
    39   MR. JUSTICE BELL: Did you understand him where he referred to
    40        the "endothelium being damaged" to meaning that it became
    41        atheroma?
    42        A.  No, my Lord. What actually happens is that fat gets
    43        deposited in the middle of the wall of the blood vessels,
    44        and that then causes changes in the membrane which overlies
    45        that part of the wall, and it becomes irregular and you may
    46        get raw areas produced, and these, either because of the
    47        secretion of certain chemicals or because the very fact
    48        that they are raw, attract platelets to come to that point.
    49
    50   Q.   But the bit in the middle is the atheroma; is it not? 
    51        A.  Yes, it is. 
    52 
    53   Q.   So they become, you say, fat deposits, atheroma which gives
    54        the uneven surface on the lining.  The atheroma is in the
    55         ----
    56        A.  In the wall of the blood vessel.
    57
    58   Q.   It is not, as a lot of people think, on the facing wall on
    59        the inside of the blood vessel; it is between the two walls
    60        of the blood vessel?

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