Endometriosis provides a unique clinical and scientific challenge. It is being diagnosed with increasing frequency and yet we are unsure of the significance of this in many patients. Its appearance varies from a tiny focus of disease to a potently destructive phenomenon. Weare still unsure of the relative value of medical or surgical treatment. The pathogenesis and control of the cellular function of the disease proVide many scientific problems. The presence of a comparative normal epithelium, namely endometrium, provides a unique research opportunity. It is probable that only through basic science research will we be able to solve the clinical dilemmas that endometriosis presents. We felt that it was important to create a book that explored the important scientific and clinical problems. We therefore invited acknowledged experts from both Europe and the United States of America to review their fields. The purpose of these reviews is not only to provide a resource for clinicians and scientists but also to stimulate thought and new ideas for research and treatment. To fulfil that aim we have asked that the authors be more speculative than normal for a volume such as this. We thank them for responding to their task so well and hope that you will feel as stimulated by their efforts as we have been.

Interest in sexuality and reproductive function does not cease when people begin to age. Instead, a new set of questions arises. Women want to know if it is safe to have babies in their late thirties and early forties. They want to know more about hot flashes and other symptoms of menopause-which ones are dangerous and which are merely uncomfortable. They are eager to learn about the relative risks and benefits of estrogen replacement therapy. Men, too, are concerned about age-related changes in their sexual function. Experts in reproductive physiology, gerontology, and genetics met at the National Institutes of Health in June of 1984 to discuss these and other concerns about aging and the reproductive system. The conference on Aging, Reproduc tion, and the Climacteric was sponsored by the American Fertility Society, The National Institute on Aging, and the National Institute of Child Health and Human Development. This volume is based on the proceedings of that confer ence."

This volume contains papers presented at the Conference on the Demographic and Programmatic Consequences of Contraceptive In novations, which was sponsored by the Committee on Population and held at the National Academy of Sciences, October 6-7, 1988. The papers consider how new contraceptive methods currently being developed and changes in the use of already available contraceptives could affect contraceptive practice, levels and patterns of abortion use, and the health of women. In addition, several of the papers re view the probable consequences of introducing new technology into family planning programs in developing countries. The Committee on Population sponsored this conference in order to stimulate think ing and to provide a forum for scientists, family planning program managers, and donor agency personnel to exchange information and ideas about these important issues. The committee is publishing these papers to expand the discussion of consequences of contracep tive innovations and to give scientists, policy makers, and members of the public who could not attend the conference an opportunity to learn about new developments in fertility control and their likely consequences for individuals and the societies in which they live. NEED FOR NEW METHODS While a strong case can be made that the pill and the intrauterine device (IUD) have contributed to declines in the level of unintended pregnancies around the world, it is also clear that for many couples existing methods present problems.

The treatment of menopausal and postmenopausal symptoms is a focus of considerable debate, on account of both the medical and social factors involved. And perhaps the cause of the greatest current interest and concern is not so much the effectiveness of present-day treatment but its safety. Opinions on the subject vary; and to resolve the arguments we must turn to the results of scientific experiment, both the clinical and biological. It is only by comparing experimental results that it is possible to move forward, albeit slowly, towards a generally agreed consensus based upon objective scientific data. It is for this reason that we are particularly grateful to Ayerst Laboratories whose support and help have enabled us to turn our original proposal for an International Symposium into a reality. We are also grateful to the publishers for the efficiency with which they have organized the publication of the Proceedings. It is our hope and that of all the distinguished participants that all readers of this volume will be able to find something in it which will stimulate further thought and discussion - even though they may not necessarily agree with all the conclusions expressed - for the success of a Symposium turns not only on the subject under examination but also on the quality of debate and discussion it encourages.

About 21 years ago prenatal diagnosis became part of the physician's diagnostic armamentarium against genetic defects. My first monograph in 1973 (The Prenatal Diagnosis of Hereditary Disorders) critically assessed early progress and enunciated basic principles in the systematic approach to prenatal genetic diagnosis. Six years later and under the current title, a subsequent volume provided the first major reference source on this subject. The present second (effectively third) edition, which was urged in view of the excellent reception of the two earlier volumes, reflects the remarkable growth of this new discipline and points to significant and exciting future developments. Notwithstanding these advances, the use of the new tools and techniques for the benefit of at-risk parents has taken many more years than most anticipated. Key factors have been the lack of teaching of human genetics in medical schools in the preceding decades and the difficulty of educating practicing physicians in a new scientific disci pline. Even today the teaching of genetics in medical schools leaves much to be desired and this will further delay the introduction of newer genetic advances to the bedside."

The no-man's-land between reproductive physiology and immunology is becoming crowded. The last 10 years have seen a revolution in our under standing of many reproductive processes, brought about by the application of ever more sophisticated immunological methods. The increasing precision of these techniques has given us specific ways of assaying, enhancing or blocking hormonal mechanisms to yield more critical and interpretable information. In this volume eleven authors have presented the current status and future prospects of some immunological aspects of reproduction and fertility con trol. These include the relationships between mother and fetus, the diagnosis of pregnancy, the immunological complications seen in clinical management of human reproduction and some novel approaches for immunological control of fertility. We hope that in these chapters we have achieved an up-to-date account of a fast-moving field that calls on several disciplines. We intend the book to provide an adequate background and a current review for research workers and clinicians who wish both to understand the complex mechanisms involved and to develop improved scientific and clinical methods. We hope too that the student and newcomer will find this a useful reference book."

Discrimination of self from nonself is the major function of the immune system and understanding the mechanism(s) involved a main employer of immunologists. Hence, the age-old puzzle of why a fetus that contains a panel of major histocompatibility (MHC) antigens derived from its mother and its father is not rejected (spontaneously aborted) by lymphocytes from its mother who should theoretically recognize foreign MHC molecules from the father has remained of great interest. This dilemma has enticed immunologists and developmental biologists for many years. This volume was created to present the information currently on hand in this subject to the scientific public. The guest editor, Professor Lars Olding, has a long and distinguished history of contributions in this field, having been one of the main propo nents of the argument that lymphocytes from the fetus play an active role in this process by suppressing lymphocytes from the mother from proliferating and thereby acting as killer cells. His work has defined the phenomenon and identified suppressor molecules (factors) involved in the process. In a different but related chapter, Margareta Unander extends such observations to the clinical study of women with repeated "habitual" mIS carriages."

Surgical Diseases in Pregnancy explores the special problems confronted by the gynecologic surgeon treating pregnant patients. These problems include acute appendicitis, inflammatory bowel disease, breast cancer, carcinoma of the cervix, ovarian tumors, renal stones, and incompetent cervical os. Other topics discussed are induced abortion; septic abortion and septic thrombophlebitis; ectopic pregnancy; surgical disease of the endocrine glands during pregnancy; gastroduodenal, hepato-biliary and pancreatic emergencies during pregnancy; pregnancy in the kidney transplant recipient; and pregnancy and cardiac prosthetic valves.

The primary purposes of this volume are: 1. To provide mental health practitioners with a current overview of our knowledge about normal parental development during pregnancy and its relation to fetal development, with particular emphasis on the impact of acute and chronic stress on these developmental processes. 2. To provide an understanding of the general state of the field of pregnancy and childbirth care both in conventional health systems and in alternative options. 3. To provide an understanding of models of consultation and liaison that are adapt ed to the special conditions of pregnancy and childbirth care, as contrasted to the more traditional modes that characterize these activities in medical and surgical hospitals. If there prove to be secondary gains as a result of pursuing these goals, so much the better. The most desirable of these would be a heightening of awareness of the mental health needs of "pregnant families" and of the risks they incur in transition from non parenthood to parenthood, and a more effective level of primary and secondary prevention of childhood mental disorders. These latter goals are more global and perhaps even a bit grandiose. Their attainment could only be documented through a series of carefully designed research projects aimed at measuring long-range developmental outcome in children and families who have experienced appropriate and early intervention during the pregnancy period."

Dedication to Professor Dr. med. Dr. h. c. mult. Benno Runnebaum on his 65th Anniversary The name of Benno Runnebaum is closely tied to the status of gynaecological endocrinology and reproductive medicine. Therefore, we would like to dedicate this conference book entitled "Fertility Control" to him in recognition of his achieve- ments. Who is Benno Runnebaum? Benno Runnebaum was born on 22 July, 1933, in Ruschendorf, Germany. After taking his A-levels, he studied medicine in Munster, Bonn and Cologne. He graduated from Cologne University in 1961 and then prepared his doctoral thesis on the "Identificati- on and quantification of progesterone, 20a-dihydroprogesterone, 20~-dihydroproge- sterone and 17a-hydroxyprogesterone in the plasma of human placental blood". This Benno Runnebaum VI Preface publication was the first to describe the progestin cycle in the feto-placental unit. His thesis was supported by Professor Dr. med. Dr. h. c. Josef Zander. It was graded "sum- ma cum laude" and won him a scholarship from the National Institute of Health for training in steroid biochemistry at the Biochemical Institute in Salt Lake City (Profes- sor Samuels) in 1962 and 1963. After his return to Germany he worked at the Univer- sity Women's Hospital of Cologne. He received his further specialist training in 1964 at the Heidelberg Women's Hospital, under the chairmanship of his teacher, Professor Zander.

This book on fibroid uterus focuses on surgical challenges in minimal access surgery that a surgeon faces while treating this condition. This book explores the role of various imaging modalities in both diagnosis and planning of the treatment. Various surgical techniques, such as hysteroscopy, laparoscopy, and robotic are discussed which will help readers to understand the pros and cons of each one. Teaching practical tips from experts regarding these procedures, the book aims to help surgeons make clinical decisions while they choose surgical procedures for their patients in various clinical settings. The book highlights both the conservative (techniques of myomectomy) and hysterectomy by various methods for treating fibroids. Key Features How to use various imaging modalities for preoperative evaluation of fibroids Issues in preoperative counseling and consent before surgery for fibroids Overview of surgical treatment of fibroids Individual chapters on practical tips by experts for various surgical techniques used for both myomectomy and hysterectomy Discusses the controversy in morcellation and how to perform it safely Covers the problem of parasitic fibroids that have increased in recent times Discusses issues like breach in endometrial cavity during myomectomy, surgery for adenomyosis, uterine rupture and recurrence after myomectomy When to call it a day and convert from laparoscopy to laparotomy

It is clear today that several prostaglandins play an important role in the regulation of many of the physiological events of the reproductive organs in the human. Both naturally occurring prostaglandins and their analogues are used routinely in many countries to ripen the cervix and induce labour at term as well as to dilate the cervix and to terminate pregnancy. Prostaglandin biosynthesis inhibitors are widely used in the treatment of primary dysmenorrhoea. The editors have aimed at an accurate, thorough, yet easily under standable review of the status in 1986 of medical knowledge regarding both the physiological importance and the clinical use of prostaglan dins and their inhibitors in obstetrics and gynaecology. I believe this book will be of value for all clinicians concerned with reproductive health. The list of authors guarantees an authoritative and up-to-date review of this active field. SUNE BERGSTROM Karolinska Institutet, Stockholm, Sweden Table Examples of clinical use of natural prostaglandins and some prostaglandin analogues Indications Prostaglandin Route of administration Manufacturer Dilatation of the cervix prior 15-methyl-PGF * Intramuscular Upjohn, USA 2 to vacuum aspiration 16-phenoxy-PGE methyl sulphonylamide Intramuscular Schering AG, West Germany 2 16,16-dimethyl-PGE methyl ester 1 Vaginal ONO, Japan; May & Baker, UK Second trimester abortion Intra -amniotic Upjohn, USA; ONO, Japan PGF 20 Upjohn, USA PGE Vaginal 2 Upjohn, USA 15-methyl-PGF 2.

The peri-menopause is emerging more and more as a subject for study by the doctor, the psychologist, the social worker, the gerontologist, the clinical chemist, the public health specialist, the sociologist, the psychiatrist and the experimental pathologist. The results of studies are gradually becoming known to the public, particularly to the prospective clients, ageing women. Women have begun to ask for treatment and they will most likely determine whether oestrogen replacement therapy comes into vogue. Psychosomatics in peri-menopause is an important sub ject, since the life-span of the woman has extended to nearly twice that of her fertile period. The life-expectancy for women in industralized countries is now some 70-75 years. This means that most can now expect to spend one third of their lives in the post-menopause. Consequently, there is now much more time than before in which to notice, experience and be bothered by peri menopausal changes. Moreover modern medicine has much more to oner than mere moral support to sufferers from ailments connected with progressing ovarian failure during peri-menopause. Although we cannot promise eternal youth - as Wilson does -there are more possibilities for treatment than 10 years ago."

In this book we have expert urologists and gynaecologists on the two sides of the Atlantic working together with a common interest, the inadequate female urethra. What makes this volume so valuable is that it is not restricted to one speciality or one cult, but bravely (and systematically) presents established principles and practice. Not only is the current knowledge of the anatomy and function of the continence mech anisms defined by experts carefully selected by the two authorities in the field, but this infor mation is directly applied to clinical problems for the reader to use in the care of patients. Because the basics are presented first, and followed by the methods of diagnosis, the sec tions describing each form of treatment, whether medical or surgical, are set on rational bases. These are not cookbook directions. This background is especially valuable because the incontinent female usually has a complicated disorder, each case being different, so that the responsible gynaecologists or urologists must apply as much understanding as technique if their efforts are to achieve dryness. The clear descriptions and illustrations in this book, then, act as guides as much as directives. This second edition builds on the success of the first. All of us trying to help these unfortu nate women will do more for them from having this new edition at hand."

Several papers dealing with the clinical relevance of steroid hormone receptors in breast cancer have already been published. However, no publication has overviewed studies currently being conducted in Europe, nor is there a register of the european centers performing receptor assays. It has been our purpose to fill these gaps. A large majority of authors who we contacted kindly agreed to con tribute to our book. Papers were grouped into six main parts according to their contents. The abundance of clinical data relevant to receptor assays led us to add critical summaries to help the reader to form his own opinions on the subject. We would like to thank Drs. R. J. B. King, G. Contesso, L. Santi, and E. Engelsman, who helped us in this regard. We hope that this book will enable the reader to become acquainted with the present state of European steroid hormone receptor studies devoted to breast cancer treatment. We also hope that it will promote cooperation between European oncologists involved in this field of research."

Pathobiology of Human Germ Cell Neoplasia is a state-of-the-art compendium on a very recent branch of tumor biology. It offers an awareness and understanding of germ cell tumors: from the earliest stages to their va- rious differentiations. Original data for this volume was supplied by experts in the fields of pathology, developmental biology, genetics, molecular biology and other related fields. This compilation of knowledge provides information necessary to persons working in clinical and preclinical areas.

Endometriosis is one of the most common diseases of women. This book provides a practical, clinical and thorough examination of both the medical and surgical treatment of this disease. A world renowned group of contributors address basic issues, management approaches and selected special topics, emphasizing the latest advanced operative techniques.
Topics include: - minimally invasive and advanced laparoscopic surgical technique in the treatment of endometriosis - treatment of endometriosis of the ovaries, cul-de-sac, gastrointestinal and urinary tracts, and extragenital sites - management of recurrent endometriosis - treatment of infertility and pelvic pain associated with endometriosis - guidelines for medical management and combined medical-surgical management.

Cytologic diagnosis of cancer has its roots in clinical micro scopy as it was shaped during the first half of the 19th century. In reviewing some of the early writing on this subject, one is amazed at the accuracy of the descriptions and soundness of the observations. Cytology of the urine is no exception: in 1864 Sanders described fragments of cancerous tissue in the urine of a patient with bladder cancer (Edinburgh Med. J. 111, 273). This observation was confirmed by Dickinson in 1869 (Tr. Path. Soc. London, 20, 233). It is a source of special pride to me that in 1892 a New York pathologist, Frank Ferguson, advocated the examination of the urinary sediment as a best means of diagnosing bladder cancer, short of cystoscopy. Papanico laou freely acknowledged these contributions while estab lishing sound scientific bases for continuation and spread of this work. Papanicolaou's work in the area of the urinary tract has not fallen on dead ears. He documented to several urologists who were within his sphere of personal influence, mainly Dr. Victor Marshall, Professor of Urology at Cor nell University Medical School, that urinary tract cytology was a reliable tool in the diagnosis of urothelial carcinoma. Some of us who have attempted to spread the master's word had their share of success within institutions with which we were associated.

The advent of assisted conception procedures such as in-vitro fertili sation (IVF) has provided the impetus for exploration of the factors that lead to the establishment of pregnancy. This collection of papers from leading research workers brings together current concepts of the processes which may be of importance in implantation. The complex signals from the embryo to the ovary, endometrium and myometrium are now being revealed through studies in both primates and other mammalian species. This book addresses the interrelationship of pituitary and ovarian hormones in controlling ovulation and the preparation of the intrauterine environment for implantation. Once fertilisation has occurred and trophoblast has formed, the next vital step is the production of materials which signal the presence of the pregnancy to the rest of the body. Trophoblastic proteins and other early-pregnancy factors are prime candidates for this role. Recent studies have emphasised the importance of the intrauterine environment in implantation. Specific secretory products of the endometrium have great potential in this process. The prostaglandins also play an essential part. Immunological adjustments are now considered a condition for the successful establishment of pregnancy. The possible use of immuno therapy in the treatment of recurrent abortion has highlighted interest in this area. The use of immunological techniques for contraception are in their infancy but offer much hope for the future.

The International Life Sciences Institute (ILSI) was estab lished to stimulate and support scientific research and edu cational programs in nutrition, toxicology, and food safe ty; and to encourage cooperation in these programs among scientists from universities, industry, and government in order to facilitate the resolution of health and safety issues. The officers and trustees of ILSI believe that questions re garding health and safety are best resolved when govern ment and industry rely on scientific investigations, analy ses, and reviews by independent experts. This process is furthered by the examination and discussion of issues on an international basis. ILSI is pleased to sponsor this set of monographs on the pathology of laboratory animals. This project collectively brings together the most comprehensive information on non-neoplastic and neoplastic lesions that occur in com monly used laboratory animals. The international compo sition of the authors, editors, and editorial board who have contributed to these monographs strengthens our expecta tions that understanding and cooperation will be strength ened worldwide through this series."

Having received the invitation from Springer-Verlag to produce a volume on drug-induced birth defects for the Handbook of Experimental Pharmacology, we asked ourselves what new approach could we offer that would capture the state of the science and bring a new synthesis of the information on this topic to the world's literature. We chose a three-pronged approach, centered around those particular drugs for which we have a relatively well established basis for understanding how they exert their unwanted effects on the human embryo. We then supplemented this information with a series of reviews of critical biological processes involved in the established normal developmental patterns, with emphasis on what happens to the embryo when the processes are perturbed by experimental means. Knowing that the search for mechanisms in teratology has often been inhibited by the lack of understanding of how normal development proceeds, we also included chapters describing the amazing new discoveries related to the molecular control of normal morphogenesis for several organ systems in the hope that the experimental toxicologists and molecular biologists will begin to better appreciate each others questions and progress. Several times during the last two years of developing outlines, issuing invitations, reviewing chapters, and cajoling belated contributors, we have wondered whether we made the correct decision to undertake this effort.

Material for this book was gathered in the early 1980's in Manchester, where a higher incidence than usual of complications in the gastro-intestinal and urinary tract was observed. Part I describes the principles and methods of radiotherapy for pelvic tumours, pathological features and radiological analysis of bowel and urinary tract changes. Parts II and III are devoted to clinical assessment and management, where the need for a multi-diciplinary approach is emphasized.

Numerous reports demonstrate that the reproductive system could be affected by multiple potential toxicological agents. The volume includes different aspects of the development of new approaches to in vitro testing using sperm cells and systems involved on reproduction in mammals. Comparative analysis of in vivo and in vitro methods has been included to take steps towards the further development of and applications of new systems for germline toxicology.

The "ABC of Breast Diseases" provides comprehensive guidance to the assessment of symptoms, and how to manage all common breast conditions and provides guidelines on referral. It covers congenital problems, breast infection and mastalgia, before addressing the epidemiology, prevention, screening and diagnosis of breast cancer. It outlines the treatment and management options for breast cancer within different groups and includes new chapters on the genetics, prevention, management of high risk women and the psychological aspects of breast diseases.

Edited and written by internationally renowned experts in the field and highly illustrated in full colour, this fourth edition remains a practical guide for general practitioners, family physicians, practice nurses and breast care nurses as well as for surgeons and oncologists both in training and recently qualified as well as medical students.

An excellent reference for the experienced breast surgeon is now available in Plastic and Reconstructive Breast Surgery, An Atlas. It assumes that the reader has a solid foundation in plastic surgery and is familiar with various operative methods. It describes the complete range of breast surgery: augmentation and reduction mammaplasty, anomalies, the treatment of primary breast cancer and breast reconstruction. The various flaps and grafts are described with emphasis placed on the presentation of specific details and complications. This is done with a series of illustrations and an accompanying text that is very easy to read. By looking up a similar case, the surgeon will find direct help for his own decision-making. Many less common types of cases are included to provide the broadest coverage possible. Coming from a single hospital, this atlas gives up-to-date information based on years of expertise. The authors present only the methods and techniques that have proved most successful at their hospital in the past two decades. A comprehensive bibliography directs you to further reading.