Haemolytic Disease of the Foetus and Newborn (HDFN) and Foetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) are the most clinically relevant alloimmune disorders of pregnancy caused by maternal alloimmunisation to paternally derived foetal red blood cell (RhD) and platelet antigens (HPA-1a) respectively. Recombinant Fc-modified antibodies have been designed as inert potential biotherapeutics to compete with maternal alloantibodies and reduce foetal mortality. Fc-modified anti-D (Fog1G1 Δnab) and anti-HPA-1a (B2G1Δnab & B2G1Δnac) have been evaluated for their materno-foetal transport capacity using human placental models. For future in vivo efficacy, Fc-modified antibodies should transport at similar rates to wild-type antibodies (Fog1G1 and B2G1). The placental perfusion model showed that the Δnab mutation appeared to lower the transport capability of anti-D and anti-HPA-1a across the placenta. In a Human Umbilical Endothelial Vein Cell (HUVEC-c) cell culture model, transport of HPA-1a was favoured in a basal to apical direction and was statistically significant at hours 12 and 24 (p=0.002 & p=0.010 respectively). The relative order of transport was B2G1Δnac > B2G1 > B2G1Δnab implying the Δnac mutation enhances transport across the foetal endothelium. Since approximately 40% of RhD negative women give birth to RhD negative babies, these women currently receive anti-D prophylaxis unnecessarily. Foetal DNA was successfully extracted from maternal plasma and genotyped for foetal RhD status using Real-Time PCR. Foetal genotyping results revealed 96% and 98% concordance with cord blood serology for maternal blood samples taken at booking (~16 weeks) and at 28 weeks gestation respectively. Two-dimensional Difference in Gel Electrophoresis (2-D DiGE) was used to evaluate the normal placental proteome of syncytiotrophoblast membrane particles (STBMs) generated from placental perfusion. Eleven differentially expressed protein species were identified when comparing different STBM samples. Future work aims to compare the normal placental proteome with the proteome of placentas from complicated pregnancies (e.g. PE, IUGR, PTL and Trisomies 13, 18 and 21) to discover potential biomarkers for screening.

The impact of comorbidity on patient outcomes following an intervention has been largely ignored. No studies have been reported in the UK or Japan. The aim of this thesis was to assess the impact of comorbidity on the outcome of a common major surgical operation - total hip replacement. Comorbidity was measured using the Index of Co-Existent Disease developed in the USA, which reliability was assessed. Two retrospective cohorts, one in Japan and one in the UK were studied. Data were collected from patients' case notes extraction and by postal questionnaire to patients one year after surgery. After THR, patient's health status was improved in both countries and satisfaction for care was high. Significant differences in in-hospital complications were observed between Japan and the UK in terms of complication rate. type and severity, and their association with independent variables. Comorbidity was significantly associated with serious complications and with change in health status in the UK and with minor complications in Japan. A logistic regression model using the ICED and independent confounding factors suggested a significant relationship between comorbidity and complications. However, the model did not fit the data well. A multiple regression model for change in health status showed that much of the variance was explained by the preoperative health status but not by comorbidity. The low number of serious complications in Japan and the high complication rate in patients in the lowest comorbidity severity level in the UK made the predictive power weak. Finally, through the experience of this study, some recommendations for clinical practice and further research are discussed.

D.Cur. / Although tuberculosis is regarded as a curable disease, it still remains a health problem. The World Health Organization declared tuberculosis as a global emergency in 1993, and a global failure of health service providers to deal with the burden of tuberculosis in 1997. One of the factors that has a detrimental effect on the struggle against tuberculosis, is the fact that certain patients suffering from tuberculosis interrupt and/or stop taking their treatment before the scheduled period, thus, not adhering to their treatment. This non-compliance contributes to the increasing problem of chronic “halfcured and half-ill” patients with an increase of resistance against some of the first-linemedication. The problem with resistance is that second-line-medication must then be used. These medications are more toxic, the treatment is more expensive and takes longer, and, at the most, only half of the patients are cured. There are however other patients who comply with their treatment and complete it successfully. As a result of the above-mentioned problem the researcher has researched treatment compliance of tuberculosis within the context of the North West Province’s Southern District with the following objectives: ? to explore and describe the reasons why certain patients suffering from tuberculosis interrupt or prematurely stop their treatment; ? to explore and describe the reasons why certain patients suffering from tuberculosis comply with their treatment and complete it successfully; ? to develop and validate strategies in order to facilitate treatment compliance of the patient suffering from tuberculosis. Unstructured interviews were conducted with six patients who complied with their treatment, 11 patients who did not comply with their treatment (or defaulters), eight family members of non-compliant patients, and nine community health nurses. The following questions were asked in each respective group of participants: ? The treatment compliant patients and the defaulters were asked: “Tell me about your TB and treatment”. ? The family members were asked: “Tell me how his TB and treatment was for him”. ? The nurses were asked: “Why do you think some TB patients comply with their treatment and others are defaulters?” Interviews were recorded on tape and transcribed verbatim. Tesch’s (in Creswell, 1994:155) eight-step method of data-analysis was used in collaboration with an independent encoder to analyse the data. This research has proven that the treatment compliant patient is motivated and ready to comply with his treatment. Although the defaulter is also motivated he is not ready to comply with his treatment, because he does not accept tuberculosis as his problem nor the treatment thereof. This non-acceptance contributes to his misconceptions regarding tuberculosis and its treatment, and a negative attitude also develops towards the medicine, which becomes evident in the termination or adjustment of his treatment. The compliant patient on the other hand, within the same situation, when experiencing side effects, for example, still adheres to his treatment. Factors that contribute to the treatment compliance of the patient are: his motivation; his stage of behavioural change; the application of specific processes that will enable the patient to move from a nonready to a ready mode, where treatment compliance can be maintained; a patientcentred approach in the nurse-patient-relationship, where effective interpersonal skills are applied, where the patient is actively involved and where a member of his family is involved in the interaction process; and where cultural beliefs, stigmatisation and misconceptions with regard to tuberculosis and treatment are addressed. Strategies have been developed and validated that may enable the nurse to facilitate the patient’s treatment compliance. These strategies address the following aspects in order to promote the nurse’s knowledge and skills concerning: tuberculosis as problem and the treatment thereof; interpersonal skills within a patient-centred nursing approach; assessment of patient’s readiness to accept behavioural change within the patient’s cultural context; facilitation of the patient’s treatment compliance; facilitation of the community’s behavioural change in order to promote social support of the patient while cultural beliefs, stigmas and misconceptions are addressed.

MMed (Otorhinolargngology). Faculty of Health Sciences, University of the Witwatersrand / Introduction The bulk of the surgical literature about laryngeal cancer is concerned with cure rates or five-year survival rates. While this is important, the five year survival rate is only one measure of success of laryngeal cancer surgery. Whereas, postoperative morbidity and mortality are also very important. Pharyngocutaneous fistula (PCF) is the most frequent complication in the early post operative period after total laryngectomy. It creates a communication between the pharynx and the cervical skin or less frequently with the stoma of the tracheostomy. The pharyngeal contents, usually saliva, flow through the fistula emerging from the cutaneous orifice. This study aims to determine the incidence and the predisposing factors for the development of pharyngocutaneous fistula (PCF); and to review the management and outcome of such cases following total laryngectomy at Ear, Nose and Throat (ENT) department, Chris Hani Baragwanath Hospital. Patients and methods This is a retrospective study. The medical records of 30 patients who underwent total laryngectomy surgery for squamous cell carcinoma of the larynx with no local neck metastases between June 2000 and May 2008 were assessed. iii All patients had similar (standard) preoperative and post operative care. I studied a number of factors that could influence pharyngocutaneous fistula formation such as age, smoking habit, alcohol consumption, tumour stage, preoperative tracheostomy, preoperative hemoglobin and associated systemic diseases (gastroesophageal reflux, chronic obstructive pulmonary disease, systemic high blood pressure and diabetes mellitus) Results Pharyngocutaneous fistula appeared in 20% (6/30 patients). Spontaneous closure with local wound care was noted in 5 patients (83.3%), whereas a surgical closure was necessary in one patient . Conclusion The results of our study concluded that pharyngocutaneous fistula remains a troublesome complication of the early post-operative period after total laryngectomy. There are many conflicting reports in the literature concerning the pharyngoctaneuos fistula predisposing factors, but our study data (table 1 page 22) of age, smoking habit, alcohol consumption, tumor stage, preoperative tracheostomy, preoperative hemoglobin and associated systemic diseases( gastroesophageal reflux, chronic pulmonary obstructive disease, systemic high blood pressure and diabetes mellitus) did not show any significant value. Our experience confirmed that most pharyngocutaneous fistulas can be successfully treated conservatively.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2014 / Stroke is a significant contributor to disease worldwide and is the second highest cause of death in both men and women. Importantly, stroke is not only a common cause or mortality but also morbidity. This increased risk of suffering a stroke could lead to an increased number of individuals with functional limitations. The main objective in stroke rehabilitation is seen as aiding the patient to achieve their highest physical and psychological performance, with the ultimate goal of a stroke survivor being one of functional independence allowing them to return to their home and reintegrate into their community. The aim of this study is to describe the differences in functional abilities between patients with stroke who are HIV positive and those who are HIV negative admitted to Witrand rehabilitation unit in the North-West province of South Africa. This is a retrospective longitudinal study utilizing the review of subject records. All subject files dating back to 21 April 2005 to December 2010 were analysed. Functional ability of patients with stroke was scored using the Beta assessment tool.The Beta assessment tool is one of three platform level tools designed by the South African Database for Functional Medicine (SADFM).It is an evidence – based scoring system which can convert a patient’s functional abilities and behaviour into quantifiable data. Scores on admission and discharge were recorded to determine the presence of change in functional ability after having received rehabilitation. Demographic information and clinical characteristics of subjects were captured using a self-designed questionnaire. Data were analysed using both a two sample t-test and descriptive statistical tests. Over the period, 2005 – 2010, 173 stroke survivors were admitted to the Witrand rehabilitation unit.Data from 32 patient files was excluded for not meeting the inclusion criteria; leaving data from 141 files to form our study group (n). The study group included 53.2% male and 46.8% female stroke survivors, with the mean age for stroke at 54.4 years and52.4 years for males and females respectively. Ischaemic strokes were more prevalent than haemorrhagic strokes (74.5% and 25.5% respectively) with hypertension asthe most common (31.9%) stroke risk factor. The mean age of stroke onset for a HIV positive individual was 39.6 years and 54.9 years for an individual without HIV.This study found that HIV positive individuals required on average 7.5 days less to rehabilitate than an individual with HIV. This discrepancy could be a result of the notably younger HIV positive group. After receiving rehabilitation from a multidisciplinary team, the HIV positive group improved with an average of 40 points and the individuals without HIV by 38 points. When performing the various statistical tests there were in fact no significant differences between the two different clinical groups. Despite the statistically insignificant findings when comparing the HIV positive and HIV negative group, when taking a closer look at the study groups demographics and clinical characteristics this study yielded interesting results. It could be argued that a majority of the HIV positive group were generally younger than the HIV negative group and perhaps the advantage of age on recovery could result in this group in gaining, on average, a similar number of points on the beta scale with those individual without HIV.Prior to their commencement of rehabilitation it should be taken into account that neurological recovery requires a degree of brain reorganization and that with age comes a certain degree of neuronal loss. Neuroplasticity is the ability of the central nervous system to respond to internal and external stimuli by reorganizing its structure, function and connections. Normal ageing is associated with a decline in and reduced plasticity. These negative changes can be experienced as reductions in processing speed, working memory and peripheral nervous system functions; all of which can be associated with poorer rehabilitation outcomes. Neural plasticity is crucial for functional recovery and this occurs more effectively and efficiently in younger individuals.However, in general the age for stroke onset was younger than that of developed countries thus stroke should no longer be considered an ‘old-age’ disease in developing countries. Keywords: Stroke; Human Immunodeficiency Virus (HIV); Functional abilities

There is considerable evidence to show that obesity is associated with the development of heart failure independent of traditional risk factors. However, clarity is required on the process involved in the transition from obesity-associated left ventricular hypertrophy (LVH) to LV dysfunction. In the present thesis I evaluated the extent to which central obesity explains variations in LV diastolic function at a community level independent of LV mass (LVM), LV remodelling or haemodynamic factors; whether obesity-related increases in LVM exceeding that predicted by workload (inappropriate LVM [LVMinappr] or alternative haemodynamic factors explains variations in LV ejection fraction (EF) at a community level; whether regression of LVMinappr is more closely associated with improvements in EF than LVM or LVM index (LVMI); and whether obesity-associated insulin resistance may explain decreases in LV diastolic function and variations in LVMinappr. Data were obtained in either 626 or 478 participants whom were representative of a randomly selected community sample and in 168 mild to moderate hypertensives treated for 4 months. In 626 randomly selected participants over 16 years of age from a community sample with a high prevalence of excess adiposity (~24% overweight and ~43% obese) after adjustments for a number of confounders including age, sex, pulse rate, conventional diastolic (or systolic) blood pressure (BP), antihypertensive treatment, LVMI and the presence of diabetes mellitus or an HbA1c>6.1%; waist circumference (p=0.0012) was independently and inversely associated with a reduced early-ro-late transmitral velocity (E/A), with similar findings noted for e’/a’ in a subset of 212 participants with tissue Doppler measurements. Waist circumference-E/A relationships persisted even after adjustments for other adiposity indices including body mass index (BMI) (p<0.05-0.005). No independent relationships between adiposity indices and E/e’ were noted (n=212). In contrast to the effects on diastolic function, waist circumference was not correlated with EF (p=0.83). The independent relationship between waist circumference and E/A was second only to age and similar to BP in the magnitude of the independent effect on E/A. The inclusion of relative wall thickness rather than LVMI in the regression equation produced similar outcomes. The inclusion of carotid-femoral pulse wave velocity (PWV), or 24-hour BP as confounders, failed to modify the relationship between waist circumference and E/A. Thus, waist circumference is second only to age in the impact of the independent association with E/A in a community sample with a high prevalence of excess adiposity. This effect was not accounted for by left ventricular hypertrophy or remodelling, 24-hour BP or arterial stiffness. In 478 randomly selected participants from a community sample, waist circumference, but not BMI was independently associated with the homeostasis model assessment of insulin resistance (HOMA-IR). HOMA-IR was inversely correlated with E/A (p<0.0001) and in a multivariate model with adjustments for waist circumference, age, sex, conventional diastolic or systolic BP, diabetes mellitus or an HbA1c>6.1%, regular tobacco use, regular alcohol intake, pulse rate, treatment for hypertension and either LVMI or LV relative wall thickness in the model, the relationship betwreen HOMA-IR and E/A persisted (partial r=-0.13 to 0.14, p<0.005). With further adjustments for either 24-hour systolic or diastolic BP (partial r=-0.11, p<0.05, n=351) or for aortic PWV (partial r=-0.11, p<0.02, n=410), the independent relationship between HOMA-IR and E/A also remained. Therefore, the relationship between indices of an excess adiposity and abnormalities in LV diastolic function may be explained in-part by insulin resistance beyond haemodynamic factors. In 626 randomly selected adult participants from a community sample with a high prevalence of obesity, the strongest independent predictor of LVMinappr was BMI (p<0.0001). With adjustments for LV stress and other confounders there was a strong inverse relationship between LVMinappr and EF (partial r=-0.41, p<0.0001), whilst only modest inverse relations between LVM or LVMI and EF were noted (partial r=-0.07 to -0.09, p<0.05-0.09)(p<0.0001, comparison of partial r values). The independent relationship between LVMinappr and EF persisted with further adjustments for LVM or LVMI (partial r=-0.52, p<0.0001). LVMinappr and LV midwall fractional shortening were similarly inversely related (p<0.0001) and these relations were also stronger than and independent of LVM or LVMI. In conclusion, in a community sample with a high prevalence of obesity, inappropriate LVM is strongly and inversely related to variations in EF independent of and more closely than LVM or LVMI and BMI was the strongest independent determinant of inappropriate LVH. Therefore LVH is a compensatory response to workload, but when exceeding that predicted by workload, as may occur in obesity, is associated with LV systolic chamber decompensation. In 168 mild-to-moderate hypertensives treated for 4 months, although in patients with an LVMI>51g/m2.7 (n=112)(change in LVMI=-13.7±14.0 g/m2.7, p<0.0001), but not in patients with an LVMI≤51g/m2.7(n=56)(change in LVMI=1.3±9.3 g/m2.7) LVMI decreased with treatment; treatment failed to increase EF in either group (1.2±10.8% and 2.7±10.7% respectively). In contrast, in patients with inappropriate LVH (LVMinappr>150%, n=33) LVMinappr decreased (-32±27%, p<0.0001) and EF increased (5.0±10.3%, p<0.0001) after treatment, whilst in patients with a LVMinappr≤150% (n=135), neither LVMinappr (-0.5±23%), nor EF (0.9±10.3%) changed with therapy. With adjustments for circumferential LV wall stress and other confounders, whilst on-treatment decreases in LVM or LVMI were weakly related to an attenuated EF (partial r=0.17, p<0.05), on-treatment decreases in LVMinappr were strongly related to increases in EF even after further adjustments for LVM or LVMI (partial r=-0.63, confidence interval=-0.71 to -0.52, p<0.0001). In conclusion, decreases in LVMinappr are strongly related to on-treatment increases in EF beyond changes in LVM and LVMI. LVH can therefore be viewed as a compensatory change that preserves EF, but when in excess of that predicted by stroke work, as a pathophysiological process accounting for a reduced EF. In 478 participants of a randomly selected community sample with adjustments for waist circumference, age, sex, conventional systolic BP, diabetes mellitus or an HbA1c>6.1%, regular tobacco use, regular alcohol intake, pulse rate, and treatment for hypertension, an independent relationship between HOMA-IR and LVMinappr was noted (partial r=0.14, p<0.002). With further adjustments for either 24-hour systolic BP (partial r=0.11, p<0.05, n=351), aortic PWV (partial r=0.13, p<0.02, n=410), or circumferential LV wall stress (partial r=0.12, p<0.02, n=478) the independent relationship between HOMA-IR and LVMinappr also remained. Thus, the relationship between indices of an excess adiposity and LVM beyond haemodynamic factors may be explained in-part by insulin resistance. In conclusion, the results of the present thesis provide clarity on the process involved in the transition from obesity-associated LVH to LV dysfunction. In the present thesis I demonstrated that an index of central obesity explains a considerable proportion of the variation in LV diastolic function at a community level independent of LVM, LV remodelling and haemodynamic factors; that obesity-related increases in LVM exceeding that predicted by workload (LVMinappr) or alternative haemodynamic factors explains a marked proportion of variations in EF at a community level; that regression of LVMinappr is more closely associated with improvements in EF than LVM or LVM index (LVMI); and that obesity-associated insulin resistance may explain decreases in LV diastolic function and variations in LVMinappr and hence EF. Therefore, studies are warranted to evaluate the impact of interventions that improve insulin sensitivity on obesity-related decreases in LV diastolic function and increases in LVMinappr.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed (O&G) Johannesburg, October 2014 / Background Grand multiparous women, defined as women who have had five or more deliveries, have historically been considered to be at risk for maternal and fetal complications. Over the years, these complications have been attributed to physiological changes as a result of high parity, maternal age, age-related medical conditions and socioeconomic status. Recent research has indicated a strong relationship between access to health care, especially in the antenatal phase, and outcomes. This work aimed to describe maternal, obstetric and fetal complications occurring in GM women, to determine their attendance at antenatal clinic, to review their modes of delivery and to identify any demographic characteristics related to GMP. Methods This was a prospective, descriptive study undertaken at Chris Hani Baragwanath Academic Hospital, a tertiary and regional hospital situated in Soweto that serves approximately two million people within its jurisdiction. In excess of 23 000 deliveries take place there each year. The labour ward attends mostly to high-risk women and approximately 20 % low-risk walk-ins. Another 10 000 births are conducted at midwife obstetric units in Soweto. This study surveyed a sample of pregnant women presenting at Chris Hani Baragwanath and the referring midwife obstetric units who had had five or more viable deliveries, including the current birth, and was conducted over four months in 2011. Results A total of 122 women were included with 124 deliveries as there were two twin pregnancies. Detailed data were available for 98 of these women. The study group were largely of advanced maternal age and were generally healthy. The attendance rate at antenatal care was high (91.35%). Antepartum and postpartum complications were infrequent and there were no intensive care unit admissions or maternal deaths. The CS rate was high (32.79 %), with more emergency CSs performed than elective CSs. The majority of the emergency CSs performed was as a result of fetal distress. There were four stillbirths (3.23%), and 25 (20.16%) of infants weighed <2500g at birth. Conclusion This study showed good maternal and fetal outcomes in a group of GM women who have access to and who largely attended antenatal care facilities. The results, albeit from a small sample, do not support traditional views that GM women are at risk of poor outcomes due to advanced maternal age, physiological changes as a result of high parity or low socioeconomic status. GM women who are generally healthy and are afforded access to adequate health care facilities should have good pregnancy outcomes.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand , in partial fulfillment of the requirements for the degree of Master of Medicine, Johannesburg, 2013 / Postoperative nausea and vomiting (PONV) is a multifactorial, complex phenomenon that has been widely studied. Little work has been done in assessing the risk of PONV in South African population groups. The aim of the study was to compare the effect of racial background on the incidence of PONV in moderate to high-risk black versus non-black South African patients undergoing general anaesthesia. Methods A prospective, controlled observational study was carried out. After an initial power calculation, 82 patients in each group (164 in total) were required for the study. However, due to researcher availability, time constraints and a readjustment of the power calculation, 95 patients at moderate to high risk for PONV were enrolled onto the study over an extended study period of 20 months (initially the study period was planned to be 6 months). 89 patients fulfilling the inclusion criteria were divided according to race into two cohorts. Ondansetron and dexamethasone were used as PONV prophylaxis after induction of general anaesthesia. Propofol was used as the induction hypnotic with isoflurane to maintain anaesthesia. Nitrous oxide, ketamine and droperidol were avoided. Use of analgesics was unrestricted, but neuraxial and nerve plexus regional anaesthesia were avoided. If a non-depolarising neuromuscular blocking agent was used, a maximum of 2.5mg of neostigmine was given to reverse neuromuscular blockade. Nausea and vomiting were assessed by means of a visual analogue scale in the recovery room and ward. Time intervals to assess degree of PONV were 0 hours (defined by first assessment of a modified Aldrete recovery score of at least 9 out of 10 and Glasgow Coma Scale of at least 14/15), 15 minutes, 90 minutes, 180 minutes, and 24 hours. Reports of incidents of vomiting and complaints of nausea between interviews were obtained from patients through questioning. Results There were 59 black participants and 30 non-black participants. There were 17 males and 72 females. There were no differences in the black and non-black groups with regard to gender, past history of motion sickness, past history of post operative nausea and vomiting, ASA status, smoking and anaesthetic time (p>0.05). There was a significant difference in the distribution of surgical procedures in the black and non-black participants (Mann Whitney U test, p= 0.02), although this did not affect the final result. On univariate analysis there were significant correlations between black South African ethnicity and nausea at all time intervals and also vomiting. Using multivariate regression analysis, non-black South African ethnicity was identified as a risk factor for PONV. It was found that black South African patients were protected against postoperative nausea, with a RR of 0.41 (95% CI, 0.28-0.60). Conclusion In this study we found that black South African ethnicity reduced the risk of PONV as compared with non-black South African ethnicity. We found that non-black South Africans had a similar risk of PONV to that published in international literature and predicted by the Apfel score, whereas the risk of PONV in similar Apfel scored black South African patients was much lower.

M.Med.(Paediatrics), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Medium and large vessel vasculopathy in HIV-infected patients is an uncommon but important cause of mortality and morbidity in both adult and paediatric patients. The estimated frequency in children from the current literature is 1-2%. The overall HIV prevalence among children 18 years of age and younger in South Africa is currently 2.9%. This series reports on medium and large vessel vasculopathy in children with HIV. Six HIV infected children seen at three Johannesburg hospitals between 2000 -2006, are described, all presenting with complications arising from medium and/or large vessel involvement. Additional cases are reviewed from the literature. A description of the clinical presentation, radiological investigations, the possible aetiology, pathophysiology and management of these patients is presented. The case series and literature review compares HIV vasculopathy and Takayasu’s arteritis. Both entities can present with multiple aneurysms and a diagnosis of tuberculosis, thus a possible link in the pathogenesis is explored. Most patients with HIV vasculopathy present while severely immunosuppressed. However, some patients in the case series and literature review present despite adequate viral suppression, suggesting the possibility of an immune-reconstitution inflammatory syndrome in the pathogenesis of this vascular complication. Medical management and in selected cases, surgery, has been used in the management of patients with HIV vasculopathy. The outcomes thus far are good.

Copies of author's previously published articles enclosed. Bibliography: leaves 217-258. Examines recent literature which describes cases of metastatic involvement of laparoscopic port sites, not only in patients with advanced tumors but in patients with early stage carcinoma, and even in patients following laparoscopic procedures during which tumors were not disturbed. This thesis utilises an established small animal model to investigate the aetiology of port site metasrases and the efficacy of preventative strategies in reducing tumor implantation following laparoscopy.