Background: Previous reports described activation of the haemostatic mechanism in patients with abdominal aortic aneurysm (AAA). Both open and endovascular repair of AAA affect the haemostatic markers. Cystatin C is sensitive endogenous marker of renal function that is strongly associated with cardiovascular outcomes. Aim: To establish the medium-term effects of endovascular and open aneurysm repair on coagulation, fibrinolysis and renal function. Patients and Methods: Twenty-nine patients completed twelve months follow-up after EVAR, eleven patients were recruited after they had open aneurysm repair and eight age-matched control were recruited. Patients were tested for markers of coagulation, fibrinolysis and renal function pre-operatively and at 1, 6 and 12 months post-operatively. Results: Pre-operatively, PF1+2 levels were significantly higher in patients with AAA. PF1+2 levels post-EVAR and post-OAR were significantly lower than pre-operative values and similar to AMC. There was no significant difference in TAT, PAI, or t-PA between AMC, AAA preoperatively, and post-EVAR. Post-OAR, PAI activity was significantly higher than pre-operatively. 24 hours after procedure, a significant increase in Cystatin C and serum creatinine (sCr) and significant decrease in eGFR were seen. Cystatin C increased significantly at 1, 6 and 12 months. Conclusion: AAA is associated with increased thrombin generation without up-regulation of fibrinolysis. The pro-thrombotic, hypo-fibrinolytic diathesis returns toward normal in the medium term after EVAR and OAR. EVAR is associated with a significant increase in Cystatin C 24 hours after the procedure and is maintained for 12 months. sCr and eGFR show significant change at 24 hours.

Arteriovenous fistulae (AVF) are the preferred access for haemodialysis in endstage renal disease, but have a considerable failure rate. In this thesis we investigated factors which may affect patency and maturation of new AVF: (1) ethnicity, (2) native vein histology, (3) pre-operative vascular mapping with ultrasound, and (4) post-operative ultrasound of AVF. Ethnicity did not affect AVF outcomes in our large retrospective study, although diabetes was associated with AVF failure and more common among non-Caucasians. Native vein disease, specifically vein media fibrosis, was associated with immediate AVF failure in our small cohort study, possibly reflecting poor vein dilatation. In our randomised trial we showed that routine pre-operative ultrasound mapping of native vessels prior to AVF formation was effective at improving immediate and assisted primary AVF patency. Early post-operative assessment with ultrasound predicted subsequent AVF failure in our cohort study. In conclusion, we recommend routine pre-operative ultrasound vascular mapping to improve AVF outcomes. A randomised prospective trial should be considered to evaluate whether early post-operative ultrasound helps to improve AVF patency. The significance of native vein media fibrosis needs to be confirmed in a larger study.

This thesis investigates the management and prognosis of endometrial hyperplasia. The literature on conservative therapies for endometrial hyperplasia is systematically reviewed and a meta-analysis is performed to identify the most effective treatment. Further meta-analysis is performed for young women with severe endometrial hyperplasia or cancer to explore the effectiveness of fertility-sparing treatment. A national survey of Gynaecologists is performed to evaluate current and the need for further research. A large cohort study is included that defines the regression and relapse of endometrial hyperplasia with two popular conservative therapies, the Levonorgestrel-releasing intrauterine system (LNG-IUS) and oral progestogens. The LNG-IUS is found to induce regression more often with fewer events of relapse than oral progestogens. A prediction model based on clinical characteristics and biomarkers finds that morbid obesity is an independent predictor for relapse. This research has major implications for clinical practice and a national guideline in process is based on its findings.

Serum phosphate has recently emerged as a cardiovascular risk factor in several populations, including patients with chronic kidney disease. Much of the adverse cardiovascular risk profile seen in chronic kidney disease can be attributed to structural heart disease, which appears to be driven by an increase in arterial stiffness. There is strong evidence linking phosphate to vascular calcification, which in turn causes arterial stiffening. In the following studies, phosphate is shown to be an independent predictor of renal function decline in patients with stage 2–4 chronic kidney disease. In addition, phosphate is shown to be independently associated with left ventricular mass, a predictor of cardiovascular morbidity and mortality. In the final study, the cardiovascular effects of reducing phosphate exposure with sevelamer carbonate, an oral, non-calcium-based phosphate binder, are assessed in a randomised, double blind, placebo-controlled trial of 120 patients with stage 3 chronic kidney disease. Although no demonstrable effects were seen on arterial stiffness, left ventricular mass, or left ventricular function, adherence to study medication was low given the high pill burden. Testing of this hypothesis may therefore require introduction of a therapy that effectively lowers phosphate exposure through a more acceptable dosing regimen.

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Thesis (Ph. D.)--University of Illinois, 1930. / Vita. "Reprinted from the University of Illinois studies in language and literature, volume xv, number 3-4 [i.e. vol. xv, no. 4]." Appendix I contains 'Some unpublished letters of R.D. Blackmore', pp. 173-199. eContent provider-neutral record in process. Description based on print version record. Bibliography: p. [209]-216.

Inaug.-diss.--Greifswald. / Lebenslauf. At head of title: Romanische philologie. "Literatur": p. [120]-125.

General practice appears to provide an ideal setting for the study of a common condition such as hay-fever. The study which forms the main part of this thesis was carried out during the hay-fever season of 1983 in Glasgow. The observations, comments, ,and discussion are those of one general practitioner, the author, who has developed a keen interest in the subject over a number of years and are based both on day-to-day contact with patients who suffer from this condition and from scientific study of the subject and its literature. Details of the study are preceded by a historical review of hay-fever from "Rose Fever" to the discovery, in relatively recent years, of 1gE. The next section deals with basic mechanisms from botany through aerobiology, pollen characteristics and chemistry to allergen exposure, the Type I allergic reaction and the symptoms thus produced. Details relating to sources of grass pollen in the Greater Glasgow area are included and much of this information is based on data obtained at the West of Scotland Agricultural College, Auchencruive, Ayr. The thesis, which is the culmination of over four years interest in hay-fever in general practice, attempts to compare the symptom severity of eighty-two hay-fever sufferers with daily pollen counts during the hay-fever season of 1983 in Glasgow. Mean daily valu'7s for symptom severity were obtained from diary cards kept by the patients and are compared not only with the daily grass pollen count but with other elements of the total atmospheric pollen count and fungal spore counts. It has been suggested that grass pollen is indeed not the solely relevant antigen in causing hay-fever. Information was gathered about each patient's personal hay-fever symptom profile from a questionnaire incorporated into the diary cards. The study was carried out in a general practice setting and pollen counting was carried out on the roof of the Environmental Health Department, Glasgow District Council, 23, Montrose Street, Glasgow. A representative selection of photomicrographs are presented in relation to the different types of atmospheric pollen isolated from the air over Glasgow during the hayfever season of 1983. The thesis concludes by making recommendations regarding the management of hay-fever in general practice and regarding the design of clinical trials of new forms of therapy for hay-fever. It also raises questions regarding incomplete correlation between patients' symptoms and information available on atmospheric pollen. Suggestions are made for further work, including, in particular, continued efforts to relate specific grass varieties in West Scotland to patients' symptom severity. This thesis does not itself attempt to cover the wide areas of investigation and management of hay-fever in general practice but may inevitably have relevance in both of these areas. Considerable further study seems to be indicated in an attempt to improve our understanding of this common troublesome condition and thereby, hopefully, to help our patients by improved management and by more effective treatment.

Flavonoids are polyphenolic compounds whose main dietary source are fruits and vegetables. Epidemiological evidence has suggested that dietary flavonoids may protect against heart disease but biological effects have not hitherto been demonstrated directly in humans and there was no consistent evidence about the absorption of flavonoids. The studies performed for this thesis aimed to test antioxidant properties of flavonoids using an in vitro system, ex vivo tests on human tissue (lymphocytes) and in a dietary intervention. The main conclusions of this thesis are: 1. There is a potent antioxidant action of dietary flavonoids demonstrated by the comet assay, of potential importance in protection against cardiovascular disease and cancer. 2. The antioxidant capacities of most major dietary flavonoids are greater than vitamin C. 3. Results from the comet assay and TEAC show reasonable agreement in ranking. 4. Antioxidant activities of free flavonoids are more than the conjugated flavonoids. 5. There was a strong positive correlation between the number of hydroxyl groups of flavonoids and the antioxidant activity. 6. Dietary flavonoids are absorbed and the fasting plasma concentration can be increased 12 fold by a simple and palatable food supplement. 7. Supplementation with onions, tomato ketchup and tea led to protection of lymphocytes against free radical damage (H2O2), a biological effect of potential medical importance possibly attributable to the absorption of dietary flavonoids. 8. Dietary flavonoids intake (and specifically quercetin) can be estimated with reasonable accuracy from 24 hour urinary flavonoid excretion or fasting plasma concentration. 9. The range of dietary flavonoid consumption in ten NIDDM patients was estimated at 20-80 mg/day from their normal diets. On the basis of results in this thesis, dietary difference within this range would influence tissue antioxidant status.