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Presently available information on the causation and management of infertility disorders is sufficient for the formulation of some tentative proposals for the provision of preventive reproductive health care to females. This should be aimed at preventing the initiation of the infertility-associated disorder in the first place (primary prevention), at detecting and preventing overt manifestations of disease (secondary prevention) and/or halting or slowing disease progression, and at reducing long-term morbidity and preventing mortality (tertiary prevention). This review will suggest ways to implement such preventive strategies with respect to the care of women with endometriosis, polycystic ovary syndrome, tubal pathology, and hypoestrogenism. We will also discuss the prevention of iatrogenic problems encountered during infertility management such as multiple pregnancy, ovarian hyperstimulation syndrome, postoperative pelvic adhesions, and delayed referral for subspecialist care. These primary care issues should be considered by all physicians who care for females from infancy, through adolescence, to the reproductive and postreproductive age periods. We hope that dialogue and future developments will lead to further refinement of our present proposals.

Kunitz domain 1 (KD1) of tissue factor pathway inhibitor-2 in which P2′ residue Leu17 (bovine pancreatic trypsin inhibitor numbering) is mutated to Arg selectively inhibits the active site of plasmin with ∼5-fold improved affinity. Thrombin cleavage (24 h extended incubation at a 1:50 enzyme-to-substrate ratio) of the KD1 mutant (Leu17Arg) yielded a smaller molecule containing the intact Kunitz domain with no detectable change in the active-site inhibitory function. The N-terminal sequencing and MALDI-TOF/ESI data revealed that the starting molecule has a C-terminal valine (KD1L17R-VT), whereas the smaller molecule has a C-terminal lysine (KD1L17R-KT). Because KD1L17R-KT has C-terminal lysine, we examined whether it could serve as a decoy receptor for plasminogen/plasmin. Such a molecule might inhibit plasminogen activation as well as the active site of generated plasmin. In surface plasmon resonance experiments, tissue plasminogen activator (tPA) and Glu-plasminogen bound to KD1L17R-KT (Kd ∼ 0.2 to 0.3 μM) but not to KD1L17R-VT. Furthermore, KD1L17R-KT inhibited tPA-induced plasma clot fibrinolysis more efficiently than KD1L17R-VT. Additionally, compared to ε-aminocaproic acid KD1L17R-KT was more effective in reducing blood loss in a mouse liver-laceration injury model, where the fibrinolytic system is activated. In further experiments, the micro(μ)-plasmin–KD1L17R-KT complex inhibited urokinase-induced plasminogen activation on phorbol-12-myristate-13-acetate-stimulated U937 monocyte-like cells, whereas the μ-plasmin–KD1L17R-VT complex failed to inhibit this process. In conclusion, KD1L17R-KT inhibits the active site of plasmin as well as acts as a decoy receptor for the kringle domain(s) of plasminogen/plasmin; hence, it limits both plasmin generation and activity. With its dual function, KD1L17R-KT could serve as a preferred agent for controlling plasminogen activation in pathological processes.

The essay explores Smit’s thoughts on dialogue. In the first instance, the essay reflects on Smit’s conviction on the need for dialogue in all human endeavours. Secondly, it explores Smit’s (together with Leon Fouche) analysis of four dominant discussants on dialogue, namely Hans-Georg Gadamer, Jacques Derrida, Richard Rorty and Jurgen Habermas. What the essay sees as Smit’s own idea of dialogue in relation to the four discussants is stated in the concluding part of the essay.

Objective: This study was designed to determine whether simultaneous antegrade/retrograde cardioplegia improves myocardial perfusion in areas supplied by occluded vessels. Methods: Isolated pig hearts placed in a Langendorff preparation were divided into two groups. The left anterior descending coronary artery was occluded at its origin. In group 1 ( n = 7), simultaneous antegrade/retrograde cardioplegia was conducted with use of a single perfusion unit with tubing in a Y-shaped configuration at the end, joined to the aorta and the coronary sinus. In group 2 ( n = 8) simultaneous antegrade/retrograde cardioplegia was performed with two separate units, one for antegrade delivery of cardioplegic solution and the other for retrograde cardioplegic solution delivery. Myocardial perfusion in the region supplied by the left anterior descending artery and the region not supplied by this artery was assessed by magnetic resonance imaging, with use of a magnetic resonance contrast agent. The contrast agent was introduced into the common perfusion line in group 1 and into the aortic line only in group 2. Results: Magnetic resonance images showed that the myocardium in the region supported by the left anterior descending artery could not be perfused with antegrade cardioplegic solution because of occlusion of the artery. During simultaneous antegrade/retrograde cardioplegia, however, the myocardium in the left anterior descending region was perfused by approximately 40% to 50% (group 1) or 20% to 30% (group 2) of the degree of perfusion in the region not perfused by the left anterior descending artery (100%). Almost no cardioplegic solution was delivered to the heart through the coronary sinus route during simultaneous antegrade/retrograde cardioplegia in both groups of hearts. Myocardial perfusion in the region supported by the left anterior descending artery was heterogeneous during simultaneous antegrade/retrograde cardioplegia. Conclusions: Simultaneous antegrade/retrograde cardioplegia significantly improved myocardial perfusion in jeopardized areas of the myocardium. The jeopardized myocardium was mainly perfused by the solution drained from the adjacent normal tissue. Elevated pressure at the coronary sinus during simultaneous antegrade/retrograde cardioplegia is responsible for the redistribution of antegradely delivered cardioplegic solution. (J Thorac Cardiovasc Surg 1998;115:913-24)

A total of 37 percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm aspiration (TESA) procedures were performed under local anaesthesia (LA) on 34 men between June and November 1996. Local anaesthesia was achieved by injecting 10 ml of 1% lignocaine solution along the sides of the vas deferens near the external inguinal ring (spermatic cord block). Sperm retrieval was successful in 92% of the procedures. Of the 37 procedures, in 29 the patients felt either no pain or mild discomfort while in six they experienced moderate but tolerable pain. Analgesia was incomplete in two procedures and was supplemented with i.v. sedation. Vasovagal reflex in two procedures was reversed by i.v. atropine. In 24 procedures patients felt relaxed, whilst in 13 they felt anxious. In 32 procedures the patients expressed overall satisfaction. If the procedure was to be repeated, after 29 procedures the patients requested LA again, while after four procedures they preferred i.v. sedation and after four were undecided. LA is adequate for PESA and TESA in a large proportion of patients. Prior discussion of LA technique with the patient is necessary. Back-up facilities for i.v. sedation and atropine should be available.

Percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection (ICSI) were carried out in patients with congenital bilateral absence of the vas deferens (CBAVD) and men with failed reversal of vasectomy (FRV). PESA was successful in 55 out of 62 patients with CBAVD (89%) and in 57 out of 60 men with FRV (95%). The fertilization rates after ICSI (53 and 55%), cleavage rates (70 and 76%) and pregnancy rates (36 and 32%) did not differ significantly between the two respective groups (CBAVD and FRV). PESA and ICSI are effective both in patients with CBAVD and in those with FRV.

Objective: This study was done to determine whether retrograde delivery of cardioplegic solution provides uniform blood flow to the myocardium supplied by an occluded coronary artery and whether it maintains myocardial energy levels beyond the coronary occlusion. Methods: Isolated pig hearts were used. A hydraulic occluder was placed at the origin of the left anterior descending coronary artery. The perfusion pressure for retrograde delivery of cardioplegic solution was controlled at 40 to 50 mm Hg. Magnetic resonance imaging and localized 31P magnetic resonance spectroscopy were used to assess myocardial perfusion and energy metabolism, respectively. Results: Magnetic resonance perfusion images (n = 7) showed that the perfusion defect that occurred during antegrade delivery of cardioplegic solution (as a result of the occlusion of the left anterior descending coronary artery) resolved during retrograde delivery of cardioplegic solution. Retrograde perfusion delivered similar amounts of flow to the jeopardized myocardium as it did to other areas of the myocardium. However, the distribution of cardioplegic solution by the retrograde route was heterogeneous (cloudlike) across both ventricular walls. 31P magnetic resonance spectra showed that the ischemic changes induced by occlusion of the left anterior descending artery during antegrade perfusion were greatly alleviated by retrograde perfusion; however, it took longer for retrograde cardioplegia (n = 7, 17.08 minutes) to restore the levels of inorganic phosphate/phosphocreatine relative to the effect of releasing the left anterior descending artery occluder during antegrade delivery of cardioplegic solution (n = 7, 5.3 minutes). Conclusions: First, retrograde delivery of cardioplegic solution provides sufficient flow to the myocardium beyond a coronary occlusion to maintain near normal levels of energy metabolites, and second, the efficacy of the retrograde route of cardioplegic solution delivery (in terms of distribution of the solution and rate of myocardial energy recovery) is significantly lower than that of the antegrade route(J Thorac Cardiovasc Surg 1997;114:109-116)

Purpose: Our purpose was to determine if embryo cell stage at the time of intrauterine transfer correlates with pregnancy rate in patients treated with intracytoplasmic sperm injection (ICSI). Methods: We conducted a retrospective analysis of 455 embryo transfer cycles following ICSI and 304 conventional in vitro fertilization (IVF) and embryo transfer cycles in women aged 40 years or less. Abstracted information included grading of the embryo cell stage and quality at the time of transfer. Results: The overall ICSI pregnancy rate was 30.8%, while that of conventional IVF was 29.3%. However, the ICSI pregnancy rate fell to 9.3% for embryo transfers taking place at the two-cell stage but increased to 35.8% when at least one embryo had more than two cells, and this difference was statistically significant (P≤0.0001). The pregnancy rate following conventional IVF was 22.0% when only two-cell embryos were transferred and 32.0% when at least one of the embryos had more than two cells, but this difference in pregnancy rates was not significant (P>0.05). Conclusions: The stage of embryo development at transfer appears to exert a powerful influence on the successful establishment of pregnancy after ICSI.

The activities of five lysosomal hydrolases--namely beta-glucuronidase, beta-hexosaminidase, beta-galactosidase, alpha-galactosidase, and alpha-mannosidase--were measured in the plasma and urine of children (ages, 7 to 15 years) with sickle cell anemia (n = 11) and controls (n = 11) from Jos, Nigeria. The presence of SS hemoglobin was confirmed by electrophoresis of red cell hemolysates. Albuminuria was absent in all of the patients with sickle cell anemia. The creatinine-indexed urinary activity level (units of enzyme activity/milligrams creatinine) and the fractional enzyme excretion (FEE) value, which is defined as the ratio of enzyme clearance to creatinine clearance, were determined for each of the five lysosomal enzymes and compared between the two groups. The mean FEE values for beta-glucuronidase and alpha-galactosidase in the sickle cell patients were 10- and 3.5-fold lower, respectively, than the corresponding control values, and these differences were statistically significant (p.03) for both enzymes; however, beta-hexosaminidase, beta-galactosidase, and alpha-mannosidase levels in urine were not different between the two groups. When indexed to creatinine, a comparison of the urinary enzyme levels of control and sickle cell patients showed significant differences for beta-glucuronidase (p.01) and alpha-galactosidase (p.05) but not for the other three enzymes. Differences in level of plasma enzyme activity between control and sickle cell patients were not significant, except for alpha-galactosidase (p.05), which was increased slightly (25%) in the sickle cell group. These data indicate that there may be abnormalities in the metabolism of lysosomal enzymes in the kidneys of patients with sickle cell anemia.(ABSTRACT TRUNCATED AT 250 WORDS)

This essay argues and concludes that an interdependence of people and their cultures will better facilitate a move from multiculturality to interculturality in (South) Africa. The first part of the essay attempts a theological description of the concepts of multiculturality and interculturality. The second part discusses how interculturality can be distinguished from multiculturality. The last part proposes how the move from multiculturality to interculturality could be facilitated.

The management of a pregnant woman presenting with prolonged hypertonic uterine contractions (essential uterine hypertonus) and mildly elevated temperature at term is described. Histology of the placenta, cord and membranes, following delivery, revealed evidence of chorioamnionitis, funisitis and deciduitis. Our findings raise the possibility that essential uterine hypertonus may have an infective or inflammatory component to its etiology.

A 48 year old African American woman presented with bladder pressure leading to the diagnosis of broad ligament and multiple uterine leiomyomas. She was also found to have a lateral vaginal wall mass which was confirmed to be a leiomyoma. Unlike uterine leiomyomas, vaginal leiomyomas are uncommon and are most often found in Caucasian women. Cases of such co-existing tumors are rare and their etiologic relationship is uncertain.

Tissue factor pathway inhibitor-2 (TFPI-2) inhibits factor XIa, plasma kallikrein, and factor VIIa/tissue factor; accordingly, it has been proposed for use as an anticoagulant. Full-length TFPI-2 or its isolated first Kunitz domain (KD1) also inhibits plasmin; therefore, it has been proposed for use as an antifibrinolytic agent. However, the anticoagulant properties of TFPI-2 or KD1 would diminish its antifibrinolytic function. In this study, structure-based investigations and analysis of the serine protease profiles revealed that coagulation enzymes prefer a hydrophobic residue at the P2′ position in their substrates/inhibitors, whereas plasmin prefers a positively charged arginine residue at the corresponding position in its substrates/inhibitors. Based upon this observation, we changed the P2′ residue Leu-17 in KD1 to Arg (KD1-L17R) and compared its inhibitory properties with wild-type KD1 (KD1-WT). Both WT and KD1-L17R were expressed in Escherichia coli, folded, and purified to homogeneity. N-terminal sequences and mass spectra confirmed proper expression of KD1-WT and KD1-L17R. Compared with KD1-WT, the KD1-L17R did not inhibit factor XIa, plasma kallikrein, or factor VIIa/tissue factor. Furthermore, KD1-L17R inhibited plasmin with ∼6-fold increased affinity and effectively prevented plasma clot fibrinolysis induced by tissue plasminogen activator. Similarly, in a mouse liver laceration bleeding model, KD1-L17R was ∼8-fold more effective than KD1-WT in preventing blood loss. Importantly, in this bleeding model, KD1-L17R was equally or more effective than aprotinin or tranexamic acid, which have been used as antifibrinolytic agents to prevent blood loss during major surgery/trauma. Furthermore, as compared with aprotinin, renal toxicity was not observed with KD1-L17R.

Contemporary African theologians have taken a bold step to declare African Christianity a 'new religion' in its own right. Africans are called upon to be truly active agents and not "alien fraudsters" in their theology, Christian life, and welfare. Christian identity was racially determined and conditioned in apartheid South Africa. With more African countries having gained political independence from their colonial overlords, the issue of the relationship between Christianity and the state arose. Christians are identified and united together by the object of their worship, Jesus Christ. The identity of the religion-Christianity-is composed in the person and work of Jesus Christ. Since Africa is defining Christianity and Christianity is defining Africa, there is confusion as to what really identifies them. The interpretation and portrayal of Christ, who gives Christians their own distinctive identity, in African contexts, should not unavoidably lead to a confused Christian identity.Keywords: African Christianity; alien fraudsters; apartheid; Christian identity; Jesus Christ

The possible toxicological risks of Allium sativum aqueous extract upon consumption were assessed in mice and rats using acute and sub-chronic treatments. 36 male Swiss albino mice were used, and the various doses administered were 0, 2, 4, 8, 16 and 32 g/kg body weight. Mice were observed for behavioural changes and for mortality. For sub-chronic study, 50 Wistar albino rats were used, and the various doses administered were 0, 75, 300, 1200 and 4800 mg/kg body weight. After four weeks of administration of the extract to rats, the serum total protein and total protein titre of organs were determined by the biuret method, whereas changes in serum transaminases were determined by the kinetic method. Haematocrit values were also determined. Results obtained showed that mice administered the extract exhibited a reduced reaction to noise, an increased social interaction, a reduced reaction to pinch and losses in body weight. The exact value of lethal dose 50 (LD50) of the extract was not determined; however it is greater than 32 g/kg. Rats administered the extract also showed increased liver and spleen to body weight ratios, increases in serum total protein concentration and decreases in total protein titre of the liver and lungs. Also, increases in transaminase activities were observed in treated male and female rats, whereas marked decreases in haematocrit values were observed in the same animals. These data suggest that this extract may have a depressant effect on the central nervous system, a sedative effect, and may induce a decrease in plasma prostaglandin levels. Also, this extract, at high doses, may induce injury to liver, spleen and lungs, loss of appetite, and anaemic conditions. Keywords: Allium sativum, toxicity, liver, spleen, anaemiaRESUME Les risques toxicologiques pouvant être liés à la consommation de l'extrait aqueux d'Allium sativum ont été évalués chez les souris et les rats par les tests de toxicité aiguë et sub-chronique. 36 souris albinos mâles ont été utilisés et les doses administrées ont été de 0, 2, 4, 8, 16 et 32 g/kg de poids corporel. Les changements de comportement, et la mortalité, ont été évalués chez les souris après administration de l'extrait. Pour l'évaluation de la toxicité sub-chronique, 50 rats albinos ont été utilisés, et les doses administrées ont été de 0, 75, 300, 1200 et 4800 mg/kg de poids corporel. Après quatre semaines d'administration de l'extrait aux rats, la méthode de biuret a été utilisée pour déterminer les concentrations des protéines totales sériques et des protéines totales dans les organes. Les variations de concentration des transaminases sériques ont été évaluées par la méthode cinétique. Les valeurs d'hématocrite ont aussi été déterminées. Les résultats obtenus montrent une baisse de la réaction au bruit et une augmentation de l'interaction sociale, associée à une réduction de la réaction au pincement et des pertes de poids chez les souris. La valeur exacte de la dose létale 50 (DL50) de cet extrait n'a pas été déterminée; cependant elle est supérieure à 32 g/kg. Les rats ayant reçu l'extrait ont montré une augmentation des ratios foie et rate au poids corporel, une augmentation de la concentration en protéines sériques totales et une réduction de la concentration en protéines totales du foie et des poumons. Des augmentations ont été également observées dans les activités des transaminases sériques, tandis que les valeurs d'hématocrite ont été très faibles chez les rats mâles et femelles ayant reçu l'extrait. Ces résultats suggèrent que cet extrait aurait un effet dépressif sur le système nerveux central, un effet sédatif, et induirait une réduction de la concentration des prostaglandines. A des doses élevées, cet extrait de plante induirait des lésions dans le foie, la rate et les poumons, une perte d'appétit et l'anémie. Mots clés: Allium sativum, toxicité, foie, rate, anémie Cameroon Journal of Experimental Biology Vol. 1(1) 2005: 39-45

The possible toxicological risks of Allium sativum aqueous extract upon consumption were assessed in mice and rats using acute and sub-chronic treatments. 36 male Swiss albino mice were used, and the various doses administered were 0, 2, 4, 8, 16 and 32 g/kg body weight. Mice were observed for behavioural changes and for mortality. For sub-chronic study, 50 Wistar albino rats were used, and the various doses administered were 0, 75, 300, 1200 and 4800 mg/kg body weight. After four weeks of administration of the extract to rats, the serum total protein and total protein titre of organs were determined by the biuret method, whereas changes in serum transaminases were determined by the kinetic method. Haematocrit values were also determined. Results obtained showed that mice administered the extract exhibited a reduced reaction to noise, an increased social interaction, a reduced reaction to pinch and losses in body weight. The exact value of lethal dose 50 (LD50) of the extract was not determined; however it is greater than 32 g/kg. Rats administered the extract also showed increased liver and spleen to body weight ratios, increases in serum total protein concentration and decreases in total protein titre of the liver and lungs. Also, increases in transaminase activities were observed in treated male and female rats, whereas marked decreases in haematocrit values were observed in the same animals. These data suggest that this extract may have a depressant effect on the central nervous system, a sedative effect, and may induce a decrease in plasma prostaglandin levels. Also, this extract, at high doses, may induce injury to liver, spleen and lungs, loss of appetite, and anaemic conditions. Keywords : Allium sativum , toxicity, liver, spleen, anaemia RESUME Les risques toxicologiques pouvant etre lies a la consommation de l'extrait aqueux d'Allium sativum ont ete evalues chez les souris et les rats par les tests de toxicite aigue et sub-chronique. 36 souris albinos mâles ont ete utilises et les doses administrees ont ete de 0, 2, 4, 8, 16 et 32 g/kg de poids corporel. Les changements de comportement, et la mortalite, ont ete evalues chez les souris apres administration de l'extrait. Pour l'evaluation de la toxicite sub-chronique, 50 rats albinos ont ete utilises, et les doses administrees ont ete de 0, 75, 300, 1200 et 4800 mg/kg de poids corporel. Apres quatre semaines d'administration de l'extrait aux rats, la methode de biuret a ete utilisee pour determiner les concentrations des proteines totales seriques et des proteines totales dans les organes. Les variations de concentration des transaminases seriques ont ete evaluees par la methode cinetique. Les valeurs d'hematocrite ont aussi ete determinees. Les resultats obtenus montrent une baisse de la reaction au bruit et une augmentation de l'interaction sociale, associee a une reduction de la reaction au pincement et des pertes de poids chez les souris. La valeur exacte de la dose letale 50 (DL50) de cet extrait n'a pas ete determinee; cependant elle est superieure a 32 g/kg. Les rats ayant recu l'extrait ont montre une augmentation des ratios foie et rate au poids corporel, une augmentation de la concentration en proteines seriques totales et une reduction de la concentration en proteines totales du foie et des poumons. Des augmentations ont ete egalement observees dans les activites des transaminases seriques, tandis que les valeurs d'hematocrite ont ete tres faibles chez les rats mâles et femelles ayant recu l'extrait. Ces resultats suggerent que cet extrait aurait un effet depressif sur le systeme nerveux central, un effet sedatif, et induirait une reduction de la concentration des prostaglandines. A des doses elevees, cet extrait de plante induirait des lesions dans le foie, la rate et les poumons, une perte d'appetit et l'anemie. Mots cles : Allium sativum , toxicite, foie, rate, anemie Cameroon Journal of Experimental Biology Vol. 1(1) 2005: 39-45