Infectious diseases remain a major problem for physicians and other health professionals dealing with problems of the reproductive system. Accordingly, this two-volume comprehensive presentation of infectious diseases involving the male and female reproductive systems promises to be a major contribution in this field and to fill a much-needed vacuum. During the past three decades, the introduction of antimicrobial therapy has dramatically altered both the clinical presentation and the therapeutic approaches employed in dealing with the traditional infections of the repro ductive system. In addition, the changing demographics of infectious problems in the industrial countries and the developing world have been a source of concern. A good deal of important information on this topic is included in this series. In recent years, considerable attention has been given to the role of Myco plasma and Chlamydia in both male and female infertility and the problems related to genital herpes and human papilloma virus infections. Current clinical information is included on these infections as well as on newer aspects of diagnosis, such as the use of laparoscopy in the diagnosis and treatment of pelvic inflammatory disease. Also addressed is new information regarding the role of actinomycosis in pelvic infections; current problems such as toxic shock syndrome and acquired immune deficiency syndrome (AIDS) are reviewed as well. New concepts are included in these vohimes to complement the clinical information. The attachment of microbial organisms to sperm may help to explain access of these and other organisms to the upper female genital tract."

Originally published in 1982 Obstetrics and Gynaecology in Tudor and Stuart England traces the development of obstetrics and gynaecology over the past two centuries. Between the 16th and 18th century midwifery passed from a female mystery, employing traditional medicines and superstitions, to a scientifically-based clinical skill, with both gains and losses to the patient. The case-mortality was high enough to make the increasing involvement of male surgeons socially acceptable, despite sexual taboos. Thus, as scientific knowledge of anatomy and physiology developed and was applied in the form of new techniques, so the midwives, who had less opportunity and inclination to acquire the new knowledge and skills, lost esteem and by the mid-eighteenth century were increasingly relegated to the service of the poor. The book also examines ideas about sexuality, menstruation, conception, pregnancy and lactation and shows how the views of society about femaleness, marital relations and the management of pregnancy and childbearing were influenced by these notions.

Leading gender and science scholar Sarah S. Richardson charts the untold history of the idea that a woman's health and behavior during pregnancy can have long-term effects on her descendants' health and welfare. The idea that a woman may leave a biological trace on her gestating offspring has long been a commonplace folk intuition and a matter of scientific intrigue, but the form of that idea has changed dramatically over time. Beginning with the advent of modern genetics at the turn of the twentieth century, biomedical scientists dismissed any notion that a mother-except in cases of extreme deprivation or injury-could alter her offspring's traits. Consensus asserted that a child's fate was set by a combination of its genes and post-birth upbringing. Over the last fifty years, however, this consensus was dismantled, and today, research on the intrauterine environment and its effects on the fetus is emerging as a robust program of study in medicine, public health, psychology, evolutionary biology, and genomics. Collectively, these sciences argue that a woman's experiences, behaviors, and physiology can have life-altering effects on offspring development. Tracing a genealogy of ideas about heredity and maternal-fetal effects, this book offers a critical analysis of conceptual and ethical issues-in particular, the staggering implications for maternal well-being and reproductive autonomy-provoked by the striking rise of epigenetics and fetal origins science in postgenomic biology today.

As I read this unique volume on diabetes and pregnancy edited by Lois Jovanovic, I was struck by two themes that run throughout these collected chapters. First, this volume provides an excellent assessment of past problems, present management, and future challenges presented by dia betes in pregnancy. Orury's unique, longitudinal experience with diabetes iIi pregnancy provides the reader with an important overview, as does Coetzee's discussion of gestational diabetes. Current problems-deter mining the etiology and prevention of congenital malformations in infants of diabetic mothers (10M), assessment of antepartum fetal condition, management of pregnant patients with diabetic retinopathy, recognition of thyroid dysfunction in the pregnant diabetic woman, and understanding the multitude of metabolic sequelae observed in the 10M-are thoroughly reviewed. Finally, important considerations for future treatment and ther apy such as the adaptation of the fetal pancreas to the disordered intra uterine environment often seen in maternal diabetes, the use of fetal pan creatic tissue for transplantation, the application of exercise in the management of the pregnant woman with diabetes, and the long-term con sequences for the 10M provide an exciting glimpse into the future. The second important theme that emerges is the critical role the problem of diabetes in pregnancy has played in our understanding of maternal and fetal physiology. Clinical observations supported by basic research have emphasized the role of fetal fuels in teratogenesis.

The most complete presentation of basic and advanced laparoscopic techniques available, due to its integration of procedures from general surgery and other subspecialities. Enhanced by over 750 illustrations (113 of them in full colour) and written by no less than 132 international, interdisciplinary experts, this definitive reference covers all aspects of this still new and expanding technique. Four main sections deal with: basic laparoscopy; laparoscopy and thoracoscopy in general surgery; laparoscopy in surgical subspecialities (gynaecology, urology, angioscopy); plus the technological aspects of laparoscopy. Throughout this authoritative volume, the surgeon will find in-depth reviews of the literature and extensive clinical and scientific data on the rationale for using laparoscopic procedures.
Certain to become a standard in the field.

One of the first applications of lasers was for surgery on the retina of the eye. That, and the evident analogy to the old dreams of powerful heat rays, led many to predict that lasers would quickly be used for all kinds of cutting and welding, including surgical applications. It was soon apparent that laser sur gery could be performed in ways that caused little bleeding. Nevertheless, other surgical applications have been slower to arrive. One difficulty has been the enormous range of possibilities provided by the many different kinds of lasers. Infrared, visible, and ultraviolet light beams each interact very differently with human tissues. Light pulses of enor mously great peak powers became available from lasers, but their effects dif fered in surprising ways from those obtained with continuous beams. That provided both opportunities (i.e., treating or removing a very thin surface layer without affecting the underlying tissue) and problems with undesired side effects. Moreover, techniques were needed to deliver a precisely con trolled amount of energy just where it was desired. Lasers also had to be engineered and manufactured with the desired power levels and a high reliability."

This book was written to provide a clear and systematic sum mary of the principles of gynaecology in synoptic form. It is part of a three volume series, the first two volumes covering topics in undergraduate obstetricE and neonatal medicine respectively. Where appropriate, fundamentals of related anatomy and physiology are also covered. It is primarily directed at under graduate medical students and midwives, but material useful as reference to doctors revising for further qualifications has been included. Although much of the content is organized in the form of lists, this book differs from the usual 'list' book in that cover age is full and systematic. Thus the text has been organized into the following subheadings, where appropriate: Definitions, Aetiology, Pathophysiology, Clinical features, Differential Diag nosis, Investigations, Treatment, and Prognosis. To avoid rep etition, certain clinical areas including ectopic pregnancy and abortion which have been covered in the earlier volumes are not included. Certain useful diagnostic lists are also provided, and, in pre paring the book, previous examination papers of the Univer sities of Oxford, Cambridge and London, as well as of the Central Midwives Board, were consulted. Illustrations have been specially prepared in the form of explanatory line drawings that are simple, and easy to memorize and reproduce. Although drug dosages were checked with care before going to press, changes in medical practice make it advisable to verify regimes and doses with the latest prescribing information and the pharmacopoeia, before use."

This book is a compilation of edited papers which were presented at the XIth World Congress of Fertility and Sterility held in June 1983 in Dublin, Ireland. Although it has long been known that male factors are responsible in at least 30% of infertile couples only recently have concerted efforts been made on the part of urologists, gynaecologists and basic scientists to identify these factors more precisely. The nature of spermatogenesis is complex but application of various scientific methods have at last opened up new and promising approaches to our understanding of this subject. Clinical results however have been depressing; the majority of treatments lack realistic evaluation and are initiated in hope rather than with a sound scientific basis. We anticipate that this volume will in some small way correct these deficiencies. The papers have been grouped into related topics. The first section deals with the evaluation of the spermatozoa and includes a critical assessment of the recently introduced zona-free hamster egg test of sperm function. Further sections include the biochemistry of gonadal function and the immunology of male reproduction; most papers are concerned with studies in the human. The clinical sections cover medical and surgical approaches to treatment and the final section deals with various aspects of AID practice.

Interest in mechanisms of embryo implantation is increasing, particularly with the realization that failure of implantation after in vitro fertilization and embryo transfer places significant limits on the success of treatment. In addition, there is a need to provide hypotheses, and ultimately mechanisms, for the high rates of embryonic loss in women in the population at large. Traditionally, implantation research has concentrated on genetics and endocrinology without providing many therapeutic benefits. A new era is now beginning with the application of modem cellular and molecular approaches to the investigation of the relationship between trophoblast and endometrium. At the same time, older data can be reevaluated in the light of current research into cell cell and cell-matrix interactions. The feeling that new avenues of research are open was apparent when an international group of scientists came together at a workshop on "The Cell Biology of Trophoblast Invasion In Vivo and In Vitro" held during the XXIV Annual Meeting of the Cell, Tissue and Organ Culture Study Group (C.T.O.C.) at Heidelberg in 1986. What was unusual about this Conference was the interdisciplinary dialogue between implantation researchers and tumor biologists, highlighting aspects common to invasion of trophoblast and tumor cells."

In the middle of the 17th century, the great French philosopher Rene Descartes wrote (L'Homme, J. Le Gras, Paris, 1669) that a suitable stimulation of the brain results in two types of "movements": exterior movements, designed to seek desirable ends and to avoid undesirable or harmful ones and interior movements or "passions" which through the release of "animal spirits" regulate the heart, the liver, and other organs. When it appears appropriate to meet a threat with force, the passion of rage causes the release of strong spirits, whereas when avoidance appears to be the better choice, the passion of fear causes the brain to release weak spirits. We do not know what influence, if any, Descartes had on the thinking of Walter B. Cannon (Bodily Changes in Pain, Hunger, Fear and Rage, Appleton and Co. , New York, 1920), of Hans Selye (The Story of the Adaptation Syndrome, Acta, Inc. , Montreal, 1952), ofG. W. Harris or of R. Guillemin (Hypothalamic-Hypophysial Interrelationships. A Sym posium. c. c. Thomas, Springfield, 1956), but it is interesting to reflect upon the durable value of great ideas which constantly resurface even if modified by other ideas and by new techniques, as if propelled by a preordained intellectual imperative.

For many years now, our understanding of the somatotrophic and reproduc tive axes has evolved essentially independently, both fields of study reaching a highly advanced, although far from complete, level of under standing. Along the way, however, it became apparent that in some circumstances the reproductive and somatotrophic axes may be inter dependent. Inklings to this effect were at times feeble and at other times more convincing. Among those inklings are the clinical recognition by pediatric endocrinologists of the apparent association between isolated GH deficiency and delayed puberty, as well as of the apparent permissive, pUberty-promoting property of GH. Equally important is a body of experi mental studies establishing the ovary of multiple species as a site of GH reception and action. Arguing against an essential role for GH in the reproductive process is the observation that individuals who have GH resistance of the Laron variety are fertile arid that isolated GH deficiency does not constitute an absolute barrier to the attainment of sexual maturation and fertility. The intraovarian insulin-like growth factor (IGF) hypothesis proposes that IGFs may serve as amplifiers of gonadotropin action. Although the dependence of intraovarian IGFs on systemic GH action has never been unequivocally demonstrated, that leap of faith has often been made. The intraovarian IGF hypothesis serves as the rationale for the adjunctive use of GH in the induction of ovulation."

Lipids and Women's Health is an up-to-date critical review of pertinent scientific and clinical issues connected with lipid disorders in women. Topics discussed include the public health significance of cardiovascular disease in women, lipoprotein and lipid metabolism, effects of estrogens and progestins on lipid metabolism, metabolic changes of menopause, and the paradox of obesity, a curable disease that is rarely cured, as well as those conceptual advances in our understanding of diabetes mellitus that have clarified diagnosis and may have improved treatment. The relationship of diet and lipid intake to the development of breast and uterine cancer; dietary and drug treatment of lipid disorders; effects of exercise, smoking, and stress; and repercussions of lipid disorders on the family are explored. The volume should prove of use to gynecologists, internists, family practitioners, and pediatricians, as well as to all other professionals with a major concern for the health of female patients.

Almost every practising doctor will admit to difficulty in knowing how best to investigate, treat and advise the pregnant patient with renal problems. These doubts and difficulties may be exacerbated if the patient seeks pre-pregnancy advice - would a possible pregnancy cause a deterioration in renal function, what are the risks of the pregnancy for mother and baby? As the general public become more informed on medical matters these questions are being asked more frequently and doctors must be prepared to offer advice which is based on detailed factual knowledge. This book examines some of these increasingly common clinical problems. Each chapter has been written by a recognized expert in the field and provides the type of specific information now expected by discerning patients. The advances in treatment of the last decade clearly indicate that a knowledge of pregnancy and renal disorders is essential for doctors in many branches of medical practice.

During recent decades, it has been firmly documented that chlamydiae are com mon and important pathogens in humans and animals. In humans, chlamydiae are known to cause trachoma (which is still one of the major blinding diseases in the world) and are also one of the most common etiological agents of sexually transmitted diseases and the sequelae thereof, such as infertility. In the last few years, it has also become evident that chlamydiae, i.e., the so-called TWAR agents, are common respiratory tract pathogens. Chlamydiae are also important pathogens in birds and lower mammals, in whom they cause a variety of infectious conditions, a spectrum which has in creased every year. Some of these infections occur as zoonoses, e.g., psit tacosis/ornithosis and, as recently discovered, abortion. Know ledge of the molecular biology and immunobiology of chlamydiae has expanded rapidly during recent years. Insight into the pathophysiology of chla mydial infections has also increased, and new methods for the diagnosis of chlamydial infections have been introduced. The importance of establishing control and preventive programs for chla mydial infections has become obvious in order to combat the present chlamydial epidemic. We hope that this book can usefully serve those who want to increase their general knowledge of Chlamydia and that it can act as a handbook and reference source for those involved in chlamydial research as well as for those working with chlamydial infections in medical and veterinary clinical disciplines, includ ing clinical laboratories."

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 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.

The VIIIth Annual International Spring Symposium on Health Sciences held at the George Washington University School of Medicine in Washington, D.C., attracted over three hun dred fifty scientists from twenty-five countries. The leading scientific experts in the field reported on recent biomedical advances in aging. They provided an up-to-date account of the molecular, genetic, nutritional, and immunological mechanisms associated with the aging process and approaches to intervention and treatment of the major disorders associated with the aging process, including Alzheimer's disease. A unique aspect of this meeting was a concurrent one-day hearing of the U.S. Senate Sub-Committee on Aging, organized by the Alliance for Aging Research. The theme for the hearing was "Advances in Aging Research." Seven scientists attending our aging sym posium were asked to testify. They were Drs. Carl Cotman (University of California-Irvine), Trudy Bush (Johns Hopkins University), Takashi Makinodan (University of California-Los Angeles), William Ershler (University of Wisconsin-Madison), Gino Doria (ENEA, Rome), Mr. Dan Perry (Director of the Alliance for Aging Research), and myself."

The traditional concept of a neuroendocrine mechanism for regulation of growth hormone (GH) secretion is based in large part on the work of Roger Guillemin. The work of Dr. Guillemin, who was awarded the 1977 Nobel Prize in Physiology and Medicine, supported the view that quantita tive change in GH secretion was the net result of pituitary stimulation and inhibition by the hypothalamic neurohormones, GH releasing hormone (GHRH), and somatostatin (somatotropin release inhibiting factor; SRIF), respectively. During the 1970s, another endocrine research pioneer, Dr. Cyril Bowers, discovered that structural modification of enkephalin re sulted in a family of peptides with GH releasing properties. These com pounds, simply called GH releasing peptide (GHRP), were originally thought to mimic GHRH. However, upon subsequent investigation they were found to supplement the activity of the natural hormone through a different mechanism. Nearly two decades after their discovery, the differ ences between GHRP and GHRH have been described by many different laboratories throughout the world. The complementary GH secretagogues have different binding sites, second messengers, and effects on gene expres sion. Based on these differences, it has been suggested that expansion of the original two hormone mechanisms for GH regulation to include a third molecule may be appropriate, even though the naturally occurring ana logue of GHRP has not yet been identified. Despite our lack of knowledge concerning the natural product mimicked by GHRP, clinical development of the new family of GH secretagogues for diagnostic and therapeutic purposes has begun in earnest."

A central concept in the evolutionary theory of senescence is the idea that ageing results from life-history trade-offs. In particular, the disposable soma theory suggests that longevity is determined through the setting of longevity assurance mechanisms so as to provide an optimal compromise between investments in somatic maintenance (including stress resistance) and in reproduction. Comparative studies among mammalian species confirm that cells from long-lived species appear to have a greater intrinsic capacity to withstand stresses than cells from short-lived species. Childbearing at older ages has become increasingly common in modern societies because of demographic changes, medical progress and personal choice. While the detrimental effects of late reproduction on infant mortality and genetic diseases have been well documented, little is known about the possible postponed detrimental effects of late parenting.

The frontispiece, Leonardo da Vinci's drawing of the embryo in the womb, was chosen as a starting point for this book. It was Leonardo who in his notebooks and drawings combined artistic composition and accurate recording of the anatomy of the human body. Leonardo studied human anatomy in order to execute artistic drawings. His aim was to clarify form and function of human organs including reproductive organs. He followed up his extensive research with graphic representa tion and thereby initiated record keeping as a basis of scientific investigation. His records, accurate three-dimensional drawings, allowed others to reproduce his find ings and to test for correctness. Results could be updated and refined. Only after these steps can abnormalities be ascertained and defined as pathology. Though Leonardo was both artist and scientist, it is assumed that his anatomic drawings were used to improve his art, and thus scientific endeavor was at the service of his art. Anatomy, the offspring of science and art, is an integration of the two and became an accepted branch of the natural sciences. Although art and science continued to interact throughout the Renaissance, art was often placed in the service of science. In the course of history that followed, art and science in creasingly followed separate ways."

Ovarian carcinoma continues to be responsible for more deaths than all other gynecologic malignancies combined, due to a continued inability to achieve detection of early (rather than advanced) stage disease and the lack of effective tumor-specific therapeutics.

Ovarian carcinogenesis, invasion, and metastatic dissemination require a complex cascade of interrelated genetic, molecular, and biochemical events that regulate the neoplastic transition of normal ovarian surface epithelium.

This updated second edition includes exciting new advances in ovarian cancer detection and treatment and provides an analysis of current research into aspects of malignant transformation, growth control, and metastasis. A more detailed understanding of these processes may ultimately translate into the development of novel approaches for the detection and control of ovarian cancer.

This RRCR-conference-volume marks "number six" in a 20-year evolution of international conferences on the adjuvant therapy of primary breast cancer. Starting in 1978, a handful of some 80 en thusiastic breast cancer surgeons and oncologists, met in a se cluded mountain resort near st. Gallen in Eastern Switzerland, to exchange their early data of some pioneer trials on adjuvant sys temic therapy of early breast cancer, and to correlate their future research efforts to overcome the frustrating prognostic stagna tion of this dominant neoplastic disease in Western females dur ing the past decades. Repeated every 3-4 years, these St. Gallen International Conferences on Adjuvant Therapy of Primary Breast Cancer have continuously grown in numbers of partici pants and in normative, therapeutic influence by being published in major oncology journals 1-3], the last (6th) conference hav ing taken place from February 25-28, 1998 with more than 1800 attendees from over 50 countries worldwide. What is the fascination of adjuvant therapy in primary (early) breast cancer, and what has changed, during the last 3 years since March 1995, to justify another international gathering of this size, and of the world's leading experts in the field? There is no question, that providing even more effective care and designing appropriate recommendations for the multitudes of patients with so-called early breast cancer or at high risk of developing the disease, remain highly important public health goals."

Reproductive medicine is the most dynamic area within obstetrics and gynecology and, arguably, the most complicated. An explosion of scientific understanding and technological capabilities - particularly in contraception, infertility and menopause - has transformed the specialty into a high-profile subject that touches upon endocrinology, embryology, andrology, surgery, social science, and practical law and ethics. The Oxford American Handbook of Reproductive Medicine provides a practical overview of the reproductive system and a systematic approach to its disorders, covering diagnosis, assessment, and ongoing management with particular emphasis on common and important presentations. Concise, readable, and pocket-sized, this handbook is useful for medical students, primary care clinicians, and ob/gyn residents as a ready reference for daily practice.

The practice of clinical reproductive medicine has practice in the era of managed care and coordinat gradually moved from its initial 1980-90 hospital ing ancillary offsite medical personnel. base to its present (circa 2001) office site of oper The objective of this text is to assist in this ongo ation. With this transition have been improvements ing endeavor by presenting in a clear, concise man in efficiency of practice often in response to ner many of the topics relevant to contemporary increased pressure to provide the most patient sat office-based infertility practice. The initial half of isfaction. An added challenge of office-based prac this text addresses topics which focus upon general tice has been taking on many of the responsibili concepts of infertility evaluation and practice. The ties of what had been traditionally the hospital's latter half is a practical approach to the execution domain. Some of these new responsibilities have of specific office-based infertility procedures. We included the ordering of operative supplies and hope this book will assist all medical personnel who equipment, the establishment of quality control dedicate their clinical effort in achieving what is programs, construction and maintenance of special most coveted by our patients, the birth of a healthy laboratory spaces, redesigning efficient methods of newborn. DAVID B. SEIFER, M. D. UMDNJ-Robert Wood Johnson Medical School ROBERT L. COLLINS, M. D. The Reproductive Center, Youngstown, Ohio October 2001 vii Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii . . . . . . . . . . . . . . . . . Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi . . . . . . . . . . . . . . . . . 1 Evaluation of the Female for Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bryan D."

The recognition of normal and abnormal patterns in the breast by mammography is a skill that must be acquired through training and experience in the same way the radiologist learns to recognize the normal or abnormal skull, gastrointestinal tract, chest, spine, and other anatomy. To disseminate information on the breasts to radiologists on a large scale, the most effective method - person-to-person teaching - is obviously impractical. Even postgraduate courses in mammography can reach but a few fellow radiologists. Therefore we have felt for some time that a teaching Atlas of "1lalJlJJJography would serve a useful purpose, within the limita tions of the method, by bringing to the attention of radiologists and physicians in general the salient features of the X-ray appearance of the normal and the abnormal breast. In mammography as in no other area of roentgenologic study, technique is of crucial importance. Accurate diagnosis is abso lutely dependent upon demonstration of very fine detail, some times as delicate as a linear strand or two, or minute specks of calcium. To some extent the pictorial representation embraced by an atlas defeats the teaching objective, for much fine detail is often lost in reproducing radiographs. Every effort has been made to obtain the best possible reproductions of mammo grams in this Atlas) but some illustrations must of necessity remain unconvincing to the reader. Some of the details describ ed will be appreciated only when viewing a good quality original radiograph."