Traditions are dangerous; doubly so in science. Traditions are unchanging; science is about change. This was the 4th International Colloquium on Carbohydrate Metabolism in Pregnancy and the Newborn to be held in Aberdeen, and by now the form is set. How much its content has changed is a matter of nice judgement and not under the control of the organizers. It is not within their power to bring news of revolution, if there has been no revolution. Certainly many of the speakers had kent faces from previous Aberdeen meetings, but so they would be at any meeting on diabetes anywhere in the world. The written proceedings of scientific conferences have purposes other than to record changes: sometimes they need to state a consensus. The 3rd Colloquium came to an agreement about the importance of prepregnancy recognition and control of abnormalities of carbohydrate metabolism. The 4th set out to examine what results it had achieved. Much of this book is taken up with follow-up studies of the applications of similar regimes in different parts of the world. Since the first Aberdeen meeting in 1973, progress in the manage ment of diabetic pregnancy has been slow and steady, but the change in the city and the society where the meetings took place has been fast.

The European School of Oncology came into existence to respond to a need for information, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Universities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

Pathology of Multiple Pregnancy collates case material from over 500 autopsies (including embryos) and 1200 placentas from twins, triplets, and higher multiples with selected literature on human multiple reproduction. It emphasizes important new concepts of pathophysiology and interpretation of less than ideal outcomes of multiple conception based on over 30 years experience in the field. Aspects of perinatal pathology unique to twins and higher multiples are emphasized, with practical suggestions for the service pathologist, including items of potential medico-legal significance. Controversial topics, such as the value of studies of concordance for diseases or malformations, and the significance of inter-twin anastomoses, are addressed and suggestions made for further investigation. A close working relationship between pathologists and clinical colleagues is encouraged by discussion of clinico-pathological correlations. And, the most recent discussions on mechanisms of twinning and genetic versus environmental influences on the development of twins are presented.

HOWARD C. TAYLOR, JR. Medicine, through its long history, has continually striven to enlarge its scope. Success in these endeavors has come in sudden bursts with long intervals of relative quiescence between. As a result of the spectacular discoveries in the basic sciences during the last decades, medicine is again in a period of revolutionary advance in many fields. One of these is the subject of this report, "The Intrauterine Patient." Until recently the fetus signalized his presence only by the mother's enlarging abdomen and by his own movements, perceived by the preg nant woman herself and evident to the examining midwife and physician. Later, the sounds of the fetal heart heard by auscultation and the varia tions in its rate became the single important means by which the welfare of the fetus might be roughly determined and threats to his survival per haps detected. Otherwise, the fetus remained isolated, his condition unknown and any therapy consequent on diagnosis, except for the induc tion or termination of labor, nonexistent."

R. B. GREENBLATT The original oral contraceptives contained more oestrogen in the form of ethinyloestradiol or mestranol and progestagen in the form of norethynodrel or norethisterone than was necessary f(x conception control. There has been a trend over the years to reduce dosages of both components in order to minimize side- eHects while ensuring eflcctiveness. However, as dosages were lowered, there has been an increase in spotting and break- through bleeding during the first few months of their adminis- tration. The sequential pill appeared more physiological in that it followed more closely physiological principles, but the need to employ large doses ofEE or EE3ME to inhibit O\'ulation and the higher pregnancy rate made the sequential regimen less attrac- ti\'e or useful. A triphasic formulation has become available that takes advantage of the synergism between ethinyloestradiol and the potent levonorgestrel so that low doses of the oestrogen and very low doses of the progestagen could be employed with great effectiveness. Such a preparation is relatively free from side- effects, partly because the basic pharmacological tenet of the minimal dose for the desired result and the division of'the cycle into three parts using 30 ,lIg ofEE for the first 6 days, then:) days of 40 ,lIg, followed by 30 ,fIg for 10 da ys, for a total of21 days, thus more or less mimicking the physiological rise and fall of 125 THE DEVELOP:'IE:-;T OF ,\ :-;E\\' TRIPH. \SIC OR.

Reevaluation of tumor classification, differential diagnosis and differential therapy based on modern knowledge. Revision of all chapters to incorporate new facts based on recent discoveries.

Alfons Staudach has been a long-time member of the Anatomic Institute of Karl Franzens University in Graz, where he has devoted particular atten tion to the deeper understanding, appreciation and visualizion of gross ana tomic details. In this work the author has achieved correspondence between sonograms and anatomic sections with a consistency and persuasiveness unequaled in all the previous literature on diagnostic ultrasound. The various planes of section andtheir characteristic features, and indeed the entire format of the text, are designed to provide even the less experienced sonographer with a valuable basis for conducting his examinations. The more experienced reader will find essential information on topographic relations and organ development that is not available in any other work dealing with fetal ana to y. I am certain that my high estimation of this volume will prove justified, and that it will provice its readers with a useful and stimulating resource. Univ. -Prof. Dr. Walter Thiel (Chairman of the Anatomic Institute of the University of Graz) Foreword Anyone setting this book down after an initial perusal must wonder why such a reference was not available ten years ago. The meticulous and fas cinating juxtaposition of gross anatomic sections with sonograms, together with explanatory drawings and many practical guidelines, should enable even the novice accurately to identify details and interpret sonographic findings with precision."

The commonest cause of blindness in young and middle-aged people in the Western world is diabetes mellitus. Although the mechanism underlying diabetic retinopathy is still not understood, the technology to reduce its progress exists, provided treatment is given at the appropriate time. Doctors caring for patients with diabetes should be familiar with all aspects of diabetic retinopathy as well as the other ocular complications of diabetes. They also need a basic knowledge of the special techniques used in the diagnosis and treatment of diabetic eye disease (fundus fluorescein angiography, retinal photocoagulation, vitrectomy) and to understand how these procedures affect the diabetic patient in terms of limitation of activities and time off work. To ensure the most efficient use of ophthalmic services a clear plan of referral to ophthalmologists is required. These are the concepts on which this guide is based, compiled by an ophthalmologist involved in the treatment of diabetic eye disease and a physician with a special interest in diabetes. In addition to doctors involved in the management of diabetic patients, this guide may be of value to ophthalmic opticians, medical students and nurses as a self-instruction manual. ' 7 1 Examination of the Eye Testing visual acuity Using the ophthalmoscope The normal fundus The abnormal fundus Recording the findings 9 TESTING VISUAL ACUITY Method Test one eye at a time. Test distant visual acuity. Correct the refractive error if the visual acuity is worse than 6/6.

Obstetricians and pediatricians in daily practice will find here the answersand explanations they need concerning the major problem of perinatal asphyxia. Leading experts in pediatrics, obstetrics and neurophysiology havecome together to produce a single sourcebook covering all aspects of thesubject. Biochemical mechanisms and clinical aspects of perinatal asphyxia, fetal and neonatal assessment, and perinatal management are thoroughly discussed. Neurodevelopmental outcome is another important issue addressed. In light of newer technologies, the prognosis of infants suffering from asphyxia is examined. Many figures and typicalcases are provided, making the book easy to use and providing quick access to solutions. The reader can easily identify a problem in the fetus and its subsequent development. With such knowledge, the improved managementof perinatal asphyxia is made possible.

Controlled and predictable interference with hormonal feed- back mechanisms has become a major direction of preclinical and clinical research. There is a steadily increasing number of hormonal pep tides detected and characterized that are re- sponsible for endo-, para-, and autocrine cellular actions. Naturally, these peptides have been studied with regard to their cell growth stimulatory action and, in parallel, the re- spective antagonists are being investigated in terms of their antiproliferative (antineoplastic) function. Among the numerous pep tides of interest in this respect, somatostatin (somatotropin release inhibitory factor) and bombesin antagonizing factors have been the topic of inten- sive research during recent years. No presentation of the role of pep tides in oncology would be complete without a compre- hensive treatise of their physiological, preclinical and clinical functions in the context of their antineoplastic mechanism of action. Somatostatin and its various short- and long-acting analogs have the unique feature of suppressing and inhibiting a wide range of cellular processes including cell proliferation. Recep- tors for these peptides, which belong in a wider sense to the family of neuropeptides or neurotransmitters, are widely dis- tributed, a feature which is not in keeping with the general view of a growth hormone regulatory system. Thus, these substances are found in the gut in a variety of endocrine and exocrine glands including breast, pancreas, and prostate, and in the nervous system.

The regulation of cell death in various reproductive tissues, as in other ma jor organ systems of the body, has become a focal point of research activity in many laboratories over the past few years. As such, the need for a "for mal" meeting to highlight recent work in this field, as well as to integrate knowledge from other sources (such as investigators working on cell death in cancer and immune function) in the broad context of identifying con served pathways that coordinate life-and-death decisions in diverse cell types, became apparent. Therefore, the goals of the Scientific Committee of the International Symposium on Cell Death in Reproductive Physiology, spon sored by Serono Symposia USA, were already predetermined by this need. Simply stated, we sought to bring together for the first time a select cohort of reproductive biologists and cell death researchers, many but not all cho sen based on their pioneering efforts in elucidating the fundamental aspects of apoptosis in reproductive and nonreproductive tissues, as a means to re view the current status of the field, foster new ideas, and promote scientific collaborations. In the ensuing chapters of this book, summaries of work dis cussed at the meeting are presented to emphasize both the diversity and the similarities in the occurrence and regulation of apoptosis in tissues of the male and female reproductive systems.

Reproductive Immunology is a compilation of research articles presented during the VII International Congress of Reproductive Immunology which was held in New Delhi, India on 27-30 October 1998. The articles pertain to the following six major themes: Molecular and Immunological Aspects of Sperm-Egg Interaction Embryonic-Endometrial Cross-Talk Immunobiology of Pregnancy Autoantibodies and Infertility Immunocontraception Mucosal Immunology and Reproductive Tract Infections . The first section deals with our current understanding of various steps involved in fertilization. The functional significance of sperm surface mannosidase and glutathione S-transferases to bind zona pellucida is described. The role of zona pellucida glycoproteins in the binding of sperm, induction of acrosome reactions and avoidance of polyspermy is discussed. In the second section, the role of various cytokines, growth factors and immunomodulatory agents in implantation of embryos is described. In the field of reproductive immunology, one of the major issues is to explore the successful gestation of the histoincompatible fetus in the uterus of an immunologically competent mother. The Proceedings presents the issues of paternal antigens at the feto-maternal interface and shows that Th2-type of immunity is involved in normal successful conception. The role of membrane-bound and soluble HLA-G in protecting the fetus from the lytic activities of maternal uterine and peripheral blood natural killer (NK) cells is also presented. Nature's experiments suggest that antibodies against sperm-specific antigens are responsible for infertility in some women. The possibility that an immunogenetic background contributes to production of sperm-immobilizing antibodies in infertile women is discussed in the section on autoantibodies and infertility. The Proceedings presents the issue of Th1-type cytokines in inducing recurrent spontaneous abortions of unexplained etiology. The roles of β2-glycoprotein 1 (β2-GP1)-dependent anticardiolipin antibody, lupus anticoagulant, antiphospholipids, anti-thyroid antibody and anti-nuclear antibody in miscarriages are also described. The rising global human population, particularly in the developing countries, has driven the need for new and safer methods of contraception. Fertility regulation by vaccines is thus an interesting proposition. The section on contraceptive vaccines discusses the latest advances in this area and describes the current status of vaccines based on βhCG, sperm antigens, zona pellucida glycoproteins, and riboflavin carrier proteins. The issues of mucosal immunity and strategies for enhancing local genital immune responses to combat HIV infection is discussed. The role of inflammatory and related cytokines in chorioamnionitis is described. The contents of this Proceedings describes various facets of reproductive immunology which will help us to design strategies to combat genital infections and miscarriages caused by immunological etiology. Descriptions of the molecular basis of gamete recognition, implantation and survival of the allogenic fetus will help in designing strategies for overcoming infertility and also new contraceptive approaches. The Proceedings will be useful to researchers and clinicians involved in basic or applied research in the disciplines of reproductive biology, reproductive immunology, and obstetrics and gynecology.

Chronic Pelvic Pain: Evaluation and Management presents a clinically oriented, multi-disciplinary approach to the diagnosis, treatment, and management of chronic pelvic pain in women -- one of the most common problems encountered in the practice setting. The editors present this challenging and often vexing subject in a practical, user-friendly, highly illustrated text, including chapters on: physiology of pain; pain associated with endometriosis; pain associated with fibroids; surgical management; the role of office based surgery; the role of the psychiatrist in pain management; pelvic pain of urinary origin; pelvic pain of gastrointestinal origin. Designed to be incorporated into the every day practice, this book is a must for all clinicians in obstetrics-gynecology as well as for any physician involved in the health care of women.

These four volumes comprlslng "GnRH Analogues in Cancer and Human Reproduction" are a distillation of the presentations of the invited speakers at alandmark International Symposium bearing the same name, organized by one of us (B. L. ) and held in Geneva, Switzerland in February 1988. lhe Symposium was truly interdisciplinary spanning gonadal hormone dependent disease including various forms of cancer and ranging to control of fertility, both pro- and conception. The international flavor can be caught from the 480 participants and 259 contributors drawn from 14 countries. The Symposium, and therefore this book, would not have been possible without the backing of lhe International CommitLee for Research in Reproduction and the sponsorship of the International Society of Gynecologic Endocrinology, The Swiss Society of Fertility and Sterility, lhe University of Geneva School of Medicine, The Swiss Society of Endocrinology and The US ~oundation for Studies in Reproduction Inc. , and help from the World Health Organizatlon. B. H. Vickery B. Lunenfeld June 1989 x~i LIST OF CONTRIBUTORS TO THE SERIES A. Abbondante H. Bartermann First Institute of Obstetrics and Urologische Universitatsklinik Kiel Gynecology Arnold-Heller Strasse 7 University "La Sapienza" 0-2300 Kiel 1, FRG Rome,ltaly M. Bartholomew P. Abel Department of Medicine/Endoerinology Department of Urology MUton S. Hershey Medical Center Hammersmith Hospital Pennsylvania State University DuCaneRoad PO Box 850, Hershey, PA 17033, USA London W12 OHS, UK D. Beck Departments of Obstetrics and H.

The state of health care is reflected by perinatal and neonatal morbidity and mortality as well as by the frequencies of long-term neurologic and developmental disorders. Many factors, some without immediately rec ognizable significance to childbearing and many still unknown, undoubt edly contribute beneficially or adversely to the outcome of pregnancy. Knowledge concerning the impact of such factors on the fetus and sur viving infant is critical. Confounding analyses of pregnancy outcome, especially these past two or three decades, are the effects of newly un dertaken invasive or inactive therapeutic approaches coupled with the advent of high technology. Many innovations have been introduced with out serious efforts to evaluate their impact prospectively and objectively. The consequences of therapeutic misadventures characterized the past; it seems they have been replaced to a degree by some of the complications of applied technology. Examples abound: after overuse of oxygen was recognized to cause retrolental fibroplasia, its restriction led to an in crease in both neonatal death rates and neurologic damage in surviving infants. Administration of vitamin K to prevent neonatal hemorrhagic disease, particularly when given in what we now know as excessive dos age, occasionally resulted in kernicterus. Prophylactic sulfonamide use had a similar end result. More recent is the observation of bronchopul monary dysplasia as a complication of respirator therapy for hyaline membrane disease."

This book is based on the 20th Study Group of the Royal College of Obstetricians and Gynaecologists, which concerned the important topic of fetal growth. Basic scientific and both obstetric and paediatric aspects of the subject were addressed in contributions from many different disciplines. The deliberations covered the broad topics of normal fetal growth, fetal overgrowth and fetal undergrowth. Clinical implications of these entities, especially fetal undergrowth, played a large part in the proceedings as dictated by clinical concerns. Definitions, epidemiology, aetiology and screening were covered, as were technological developments, with special reference to blood flow and volume flow measurements, both fetal and placental. Other aspects of clinical fetal monitoring, including fetal activity measurements, and biophysical evaluation were rationalised and placed in context, and the important newly emerging areas of cordocentesis and therapy in IUGR addressed. Finally, neonatal management of the SGA baby, mortality and long-term morbidity were discussed.The formal papers presented by the members of the Study Group are given together with edited versions of the ensuing discussions and the Group's conclusions.

Almost all known tumors and tumor-like conditions of the fe- male lower genital tract are classified in this complete mo- nograph on the subject. Clinical features, treatment and prognosis ar included, making this book a practical refe- rence for the busy clinician.

ABOUT THE SUBJECT MATTER Adolescence is a time of significant change. The adolescent era spans the interval between childhood and adulthood. It is a time of physical, social, and even emotional upheaval. During this relatively brief period of time not only does physical growth accelerate but, of more significance in the biology of any species, the individual attains reproductive maturity. Within this time frame, the human being acquires the capacity to procreate and perpetuate our species. From a reproductive standpoint, throughout adeolescence the individual is being prepared for perhaps what might be considered the most important function an organism has during his/her brief sojourn on earth, namely to endow successor(s) with a minute quan tity of DNA to enable continuation of its form of life. The interlude be tween childhood and adulthood is not always socially or emotionally sim ple. The anatomic and physiologic modifications that come to pass during adolescence are not necessarily paralleled by a capacity to assume the societal responsibilities associated with reproductive maturity. Although the physiologic changes normally proceed in a predetermined fashion, adaptation to a changing role is a far more trying process. Accustomed to living in a child's world, the subject of adolescent change requires considerable time and understanding to facilitate exis tence in the adult world. The early stages of sexual awareness, for ex ample, are generally extremely confusing and, as evidenced by the in ordinately high frequency of teenage pregnancy and sexually transmitted diseases, can be extraordinarily dangerous."

Medical ethics is a difficult and controversial field and that part of it dealing with reproductive medicine is no exception. Our first conference on philosophical ethics in reproductive medicine (PERM 1) in 1988 discussed many of the controversies in this field. The acclaim it received encouraged us to organise PERM 2 but choosing a relevant and topical programme was a clairvoyant challenge in its own right. Since PERM 1 we have seen a number of developments, in the UK and internationally, that have thrown the problems that society must face into sharp relief. Drawing on the expertise of contributors from science, many medical specialities, philosophy, theology and economics, we have sought to address the issues raised by these new developments, as well as a number of long-standing issues that remain as contentious as ever, but of undiminished significance. On the scientific front, the long-predicted technique of embryo biopsy and diagnosis is now a reality. This has prompted the inclusion of some of the topics addressed by this second conference.

Sexual medicine is an interdisciplinary subject. Special knowledge of normal and disturbed sexuality is expected of general practitioners, gynecologists, dermato logists, urologists, specialists in internal medicine, neurologists, psychiatrists, and psychotherapists. Sexual dysfunctions may occur in connection with organic lesions or as psychosomatic phenomena. They are brought to the practicing physician's attention by the patient either directly or in the form of factitious symptoms. The disturbed sexual function generally causes suffering and so motivates the patient to consult a physician. Psychosomatic aspects are thus very much to the fore. In a significant number of cases, however the disturbances stem from a physical-functional handicap which not only affects the patient's general personality but also has a direct adverse effect on sexual function. The physical defect leads to disturbances of the body-image, and so can cause impairments in the sexual sphere both directly and indirectly. The diseases which result in sexual handicap and which can be treated by reconstructive surgery were examined and discussed at an international satellite symposium of experts on the occasion of the 8 th World Congress for Sexology in June 1987. The papers presented at this symposium have been collected and edited in this volume."

More often than not, progress in medicine occurs incrementally. The report of an 'important' new observation is typically greeted by a mixture of excitement and skepticism. Yet the true value of the discovery may not be known for several years until it is confirmed (or refuted) by independently conducted studies. In some cases, controversy may continue to shroud a topic due to the discordant results generated by different research groups. Since the last Gynecologic Oncology volume in the Cancer Treatment and Research series, a number of new areas have emerged that shed new light on the pathogenesis, diagnosis, and treatment of gynecologic malignancies. In this volume of the Cancer Treatment and Research series, I have attempted to integrate articles that highlight some of these newest developments with chapters that provide an overview of selected areas of controversy. This volume is not meant to be an abbreviated text of gynecologic oncology but rather a collection of selected works that can provide the reader with a better perspective on the areas of change within the field. The application of molecular biology to cervical cancer has allowed us to understand more completely the roles of human papilloma viruses and cellular oncogenes in the development of cancer of the uterine cervix.

Introduction to Mammalian Reproduction is a welcome contribution to the fields of gametogenesis, gamete transport, fertilization, and reproduction technologies. Key topics covered include:
*formation and maturation of male gametes;
*morphology and physiology of female gametes;
*how the sperm meets the egg;
*sperm-egg fusion, egg activation, and implantation of fertilized egg;
*assisted reproduction and environmental chemicals that have an effect on formation and function of male and female gametes. This book is for both researchers and students involved in reproductive biology.

Androgen Receptors is the most comprehensive and up to date volume on the topic, including discussions of the basic mechanisms of androgen-androgen receptor actions, their roles in the androgen-related diseases, and their potential clinical applications. Key topics covered include: -The discovery and cloning of the androgen receptor; -Androgen receptor coregulators; -Androgen related genes and their consensus DNA response elements; -Basic mechanism of action including functional analyses, cellular localization and phosphorylation studies; -Cross-talk to other signal transduction systems; -The recent connections of androgens to women's diseases, such as osteoporosis and ovarian cancer. This book is of interest to students, basic scientists, and clinicians as both a study guide and reference of research in the androgen field. It could also be used as an advanced level text in endocrinology, urology, OBGYN, or oncology.

The field of human artificial reproductive technology (ART) is continually advancing and has witnessed significant changes since the inception of Louise Brown in 1978. Though Louise Brown herself was conceived after the trans fer of a blastocyst, there remain significant confusion and debate regarding the stage at which the human embryo conceived in the laboratory should be replaced in the mother. Developments in culture media formulations, leading to the introduction of sequential media, have brought the role of the blasto cyst in human ART back into the spotlight. It was due to this resurgence of interest in the niche of extended culture in human infertility treatment that the symposium on "ART and the Human Blastocyst" was held. of this meeting within this volume bring to the forefront The proceedings the main issues raised with the transfer of embryos at the blastocyst stage. It is evident from the chapters that follow that ART needs to be perceived as a continuum of procedures, each one dependent on the preceding one, and all equally as important as each other. That is to say, the development of a com petent embryo is ultimately dependent on the quality of the gametes from which it was derived. With regard to the oocyte, this then places the emphasis on the physician to use a stimulation protocol that both produces quality oocytes and does not impair endometrial function. Maintenance of gamete and embryo quality is the laboratory's role.

I am very happy and honoured to have so many famous contrib utors from around the world presenting their knowledge and experience in this book, including Dr. Rufer who, as early as 1967, attempted to improve the pressure-volume curve of a child dying from RDS using dried surfactant from dogs; Drs. Enhorn ing and Robertson who were the first to treat rabbit fetuses with surfactant replacement and impressively demonstrated that sur factant improved lung mechanics; and Dr. Fujiwara who at the end of the 1970's had already successfully treated the first babies with surfactant replacement and published this work al ready in 1980. Thus, the idea of surfactant replacement therapy is now more or less 20 years old and almost 10 years have passed since the first publication by Dr. Fujiwara of his impressive clinical results. Up to now (September, 1988) about 2,200 babies have been treated worldwide with tracheal instillation of surfactant, with most promising results. The type of surfactant used varies from pure natural extracts from bovine or pig lungs, to surfactant extracted from human amniotic fluid, to pure phospholipids. To date, however, there is still no surfactant commercially available (except in Japan), in spite of the fact that it is urgently awaited by neonatologists and intensive care doctors throughout the world. This volume is based on the contributions presented at the international congress on Surfactant Replacement Therapy which was held in Rotterdam, The Netherlands, in November 1987."