The birth of a baby is the culmination of months of anticipation and plan ning. Most often, mother and infant are healthy and readily able to estab lish close contact-a bond. However, in some situations either mother or baby or both present complications. The more prompt and rational the treatment, the sooner the normal parent-infant relationship will commence. This book is devoted exclusively to the first days following birth. In its 15 chapters, postpartum and postnatal physiology and pathophy i: .;logy are reviewed by 18 specialists. Normal and abnormal development of mother and child is correlated with proven means of clinical management. Chapters 1 through 3 cover maternal postpartum developments and complications. Chapter 4 stresses the importance of a normal parent newborn relationship, a concept of increasing concern in modern society. The following ten chapters discuss neonatal physiology and pathophysi ology; the effects of obstetric anesthesia on infant behavior, pulmonary function measurements in the postnatal period and treatment of the sick newborn are discussed in detail. The final chapter reviews maternal and perinatal mortality; the data, based on extensive surveys in New York City, indicate that current management is effecting an overall decline in mortality."

The course of history is never one of smooth progression. Periods of relative quietness are interrupted by periods of wars and revolution. This pattern resembles that of a river which, before flowing into the delta, has to pass countless rapids. The same holds for the development of the science of medicine. In obstetrics some of these 'revolutions' or 'rapids' consist of the introduction of conservative obstetrical treatment by Lucas Johann Boer at the beginning of the nineteenth century, the discovery of the cause of puerperal sepsis by Oliver Wendell Holmes and Semmelweiss between 1843 and 1847, the introduction of the principle of asepsis by Pasteur in 1874, the introduction of prenatal care at the end of the nine teenth and the beginning of the twentieth century (Mijnlieff, Treub, De Snoo), the improvement of surgical techniques, the possibility to treat shock by bloodtransfusion, and, finally, the acquisition of new means for the effective therapy of infection. All these developments have led to a sharp reduction of maternal and perinatal mortality. In this connection it must be pointed out that such a reduction could never have been accomplished without the favourable social changes as a result of which medical and prenatal care could be made universally available. In recent years there has been another revolutionary develop ment in obstetrics. Two factors have been responsible for this: the ap plication of basic sciences in obstetrics, and the dissolution of the isolation with respect to other clinical disciplines."

Contraception is the most comprehensive exploration of the newest technologies in the area of contraception. Edited by renowned authorities Dr. Donna Shoupe and Dr. Florence Haseltine, with chapters written by leaders in the field, this book comprises the most up-to-date, practical and clinical information available and presents a thorough examination of clinical efficacy, side effects, mechanisms of action, and benefits of all types of contraception, including: - chapters on the IUD, the new subdermal implant Norplant, injectables, the diaphragm, condoms, sponge, female sterilization, vasectomy, and more - discussions of cutting edge contraceptive technologies, including the new progestin oral contraceptive pills, contraceptive vaginal rings, and RU 486, - an important chapter on AIDS and contraception. This book will serve as an invaluable reference providing useful, instructive background information and pertinent clinical applications for the physician, resident, and researcher. At such an exciting time for contraceptive technology, no one in the field can afford to be without this text.

Physical illness cannot be effectively treated other than in the context of the psychological factors with which it is associated. The body may have the disease, but it is the patient who is ill. Research psychologists from a number of different backgrounds have, in the past few decades, turned increasingly to the study of physical illness, and there is now an extensive literature on preventive behaviors, the role of stress in the etiology of illness, the patient's reactions to illness and its treatment, and the physician-patient relationship. At the same time practicing clinical psychologists have extended their concern beyond the treatment of speci fically psychiatric disorders, to include also the psychological care of people experiencing distress through illness or injury. Traditionally, these patients have tended to fall through the net, unless their distress is so great that it assumes the proportion of a psychiatric disorder that can then be treated in its own right. Because the physical disorder is the primary one, its existence has detracted from the salience of the very real emotional disturbance to which it can give rise. Moreover, emotional reactions in this setting, being the norm, seems to have been regarded as not meriting special attention and care. This situation is chang ing, and it is not just psychologists or psychiatrists who are responsible for the shift in attitudes. Within general medicine itself, there is now a renewed empha sis on the care of the whole patient and not just the disease."

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."

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.

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."

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.

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.

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."

These four volumes comprlslng "GnRH Analogues in Cancer and Human Reproduction" are a distillation of the presentations of the invited speakers at a landmark International Symposium bearing the same name, organized by one of us (B. L. ) and held in Geneva, SwitLerland in February 1988. The 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 The International Commitlee for Research in Reproduction and the sponsorship of the International Society of Gynecologic Endocrinology, The Swiss Society of fertility and Sterility, The University of Geneva School of Medicine, The Swiss Society of Endocrinology and The US foundation for Studies in Reproduction Inc. , and help from the World Health Organization. B. H. Vickery B. Lunenfeld June 1989 xiii 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" D-2300 Kiel 1, FRG Rome, Italy M. Bartholomew P. Abel Department of Medicine/Endocrinology Department of Urology Milton S. Hershey Medical Center Hammersmith Hospital Pennsylvania State University DuCaneRoad PO Box 850, Hershey, PA 17033, USA London W12 OHS, UK D. Beck H.

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 volumes 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."

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."

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."

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 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."

The book gives an overview of the clinical developments in the use of bisphosphonates in clinical oncology. The first part pre sents the composition, physiology, and pathophysiology of bone. Next is a section giving insight into mechanisms of bone resorp tion, bone formation, and bone remodeling, a field in which I was most influenced by O. L. M. Bijvoet and H. Fleisch. The sec ond part summarizes the pharmacological treatments for disor ders of bone remodeling. The clinical aspects of tumor-induced hypercalcemia and its management are described in detail, in cluding our first prospective randomized crossover study testing pamidronate versus mithramycin. The bisphosphonates were in troduced in clinical oncology by endocrinologists. The same was true for our institution in 1986, when P. Burckhardt proposed testing pamidronate in the above-mentioned trial in his institu tion (CHUV) and in our department. The impressive results ob tained in the hypercalcemia trial stimulated our interest, and we actively investigated the use of pamidronate to counteract osteo lytic bone destruction in cancer patients. These investigations are presented and discussed in the third part. They represent the interdisciplinary work involving many co-workers of the Depart ment of Internal Medicine C and other institutes of the Interdis ciplinary Oncology Center St. Gallen (IOSG), which I was privi leged to chair for 10 years. Initially, a pharmacokinetic study was performed in order to optimize and facilitate the administration of the drug to patients with malignant osteolytic bone disease."

G. Piekarski appears not to have been brought home to at Forty years have passed since Trussent pub- least some clinicians. Of special importance in lished an important book in the English lan- this connection are T. vaginalis and Pentatri- guage on Trichomonas vaginalis Donne and uro- chomonas hominis (Davaine), the intestinal tri- genital trichomoniasis. During the intervening chomonads of many mammalian species, in- four decades, much information has been accu- cluding humans. Some practitioners still tell mulated on trichomonads parasitic in humans their patients about the possibility of an intesti- and on the diseases they cause. In light of this, nal origin of trichomonal infection of the uro- many parasitologists and clinicians believe that the time has come for a complete review, in genital tract. book form, of various aspects of these parasites Trichomonas vaginalis infection of new- and of the trichomonad parasitemias. This need borns, infants, and young children constitutes has been further reinforced by the finding that, an interesting, although not extensively pur- despite the use of effective anti trichomonal sued, area of investigation. For hitherto incom- drugs during the past years, the prevalence of pletely understood reasons, the period of preg- human urogenital trichomoniasis, the world's nancy appears to favor the increase of most common sexually transmitted disease, has symptomatic trichomoniasis; there is, there- been increasing significantly. As might have fore, little doubt that infants can be infected been expected, therefore, discussion of various during birth.

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.

The purpose of this book is to describe the nature of the materno-fetal immunobiological relationship and to suggest the direction in which the management of reproduction and its failure in man is moving. The several authors, who have written about their special fields of interest, need to be read within a framework designed to blend their contributions into a whole. This preamble provides a part of that framework, by describing the early development of the embryo, that of the placenta and its membranes and their anatomical relationship with maternal tissues: in other words, the stage upon which this materno-fetal dialogue takes place. Professor Maureen Young's 'tour de force', encapsulating the whole of fetal physiology into a single chapter, completes the background information. After Maureen Young's summary of fetal physiology, Matteo Adinolfi describes the development of the immune system in the fetus, including new information that allows more accurate speculation concerning the gestational age at which fetal immune responses of various kinds may begin. Charles Loke examines the nature of antigens which are found in the placenta, concentrating on those which occur on syncytiotrophoblast and suggesting roles for them in fetal development. Arnold Klopper covers the wide range of proteins and hormones which have been studied during pregnancy and found to vary in a potentially significant way. He has been careful to distinguish between observation and hypothesis, as far as any immunomodulating action is concerned, and his analysis is a model of scientific scepticism.

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."