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.

Julio Morales describes the Puerto Rican nation as being comprised of those individuals who identify themselves as Puerto Ricans. This includes almost 6. 2 million people who live primarily, but not exclu sively, on the island of Puerto Rico, and in the northeastern United States. One gets to be a Puerto Rican by various means. You are Puerto Rican if you are born in Puerto Rico, although at the same time you are an American because you were born there. You are Puerto Rican if your parents are Puerto Rican, even if you have never visited the island, have never eaten arroz y habichuelas, and have never spoken a word in Spanish. You can be a second and third generation Puerto Rican of mixed marriage, be highly acculturated to American culture, but when asked, you say proudly, "I am a Puerto Rican. " You can meet some of us whose world is bicultural, a world where English and Spanish are easily interchanged, where traditional Thanksgiving turkey is followed by lechon asado at Christmas as the main treat, where salsa or bolero are enjoyed with the same passion as rock'n roll or the big band sound. It is a world where various cultures have merged and the historical forces of slavery and Spanish and American colonialism have left their indelible marks on the psyche."

This book is based on presentations by some of the world's leading experts at the Sixth International Conference on Clinical Cancer Prevention, held in St. Gallen, Switzerland, during March 2010. The main themes are the latest advances in the prevention of breast and prostate cancer and the role of infection in the development of liver and gastric cancer. Special emphasis is given to perspectives on the chemoprevention of breast cancer, as the conference included an international consensus meeting on this subject. New research findings are presented and potentially more effective cancer prevention strategies are discussed, with careful consideration of controversies. The expertise of the contributors encompasses genetics and microbiology, epidemiology, and health economics, as well as clinical cancer prevention. This book will be of interest to all who wish to learn about the most recent progress in combating the development of cancer.

Pelvic Inflammatory Disease is an in-depth, thorough guide for the clinician on the most common complication of sexually transmitted pathogens. Edited and written by the preeminent experts in the field, this volume presents the etiology, treatment, and diagnosis of PID, as well as chapters on risk factors, epidemiology, and prevention. In addition, the myriad clinical complications and challenges are discussed in chapters on tuboovarian abscess, PID and HIV infection, sequelae of PID, PID in adolescence, and PID in pregnancy. This is a must-have resource for obstetrician-gynecologists, primary care physicians, and all clinicians who provide health care to women of all ages.

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."

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

Decision making in modem obstetrics and perinatology is con trolled by a variety of different factors, but there is little doubt that in industrialized countries one of the most powerful single factors is the concern and fear of causing permanent brain damage in the unborn and newborn. The dramatic increase in the rates of abdom inal deliveries in many parts of the world is certainly rooted to a substantial part in the bstetrician's concern not so much about possible perinatal death, but more so about permanent brain dam age in surviving children. This trend has been accelerated by the increasing number of litigations in connection with brain damage observed in many societies. This problem itself has many aspects, but it seems evident that litigation - justified or unjustified - is one modem expression of the human and social tragedy inflicted on individuals and families by the birth of a brain-damaged child. The medical, social, and human importance of the problem is in sharp contrast to the relative lack of scientific knowledge avail able. This became very clear when the National Institutes of Health published the excellent review in 1985 on "Prenatal and Perinatal Factors Associated with Brain Disorders" and its editor, J. M."

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

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.

This book aims to bring together clinical information on the biology, diagnosis, therapy and management of patients with inflammatory breast cancer. Authored by experts from the Instituto Nacional de Cancerologia in Mexico, this book will provide the reader with the state-of-the art treatment of this rare but pernicious disease.

March 23 and 24, 1983 saw the fIrst international symposium held under the auspices of the Wilhelm Vaillant Foundation for the Advancement of Pro- phylactic Medicine in the I. Frauenklinik der Ludwig Maximilians Univer- sitiit Miinchen. This symposium was concerned with Advances in Early Detection and Treatment of Breast Cancer and brought together patholo- gists, gynecologists,and radiologists from Denmark, England,France, Italy, Sweden, Switzerland, the German Democratic Republic, and the Federal Republic of Germany. The fIrst session dealt with problems concerned with the biology, patho- genesis, and histopathology of early carcinoma of the breast, with special reference to the clinical aspects. The second session was taken up with topi- cal developments in the early diagnosis of breast carcinoma and indicated the present limitations of early diagnosis. In the third session the latest results of the experiences by groups working on the treatment of early carci- noma of the breast in France, the United Kingdom, Italy, the United States of America, and the Federal Republic of Germany were discussed. The main emphasis lay on conservative treatment methods with complete or partial preservation of the breast. These vary quite widely. Some of the conclusions presented on the basis of long-term clinical studies must be regarded as signifIcant breakthroughs, and at the stage these have reached they must no longer be overlooked. The symposium has highlighted numerous unsolved problems and made it clear that conflicting opinions abound.

Honourable Chairman, distinguished speakers, ladies and gentlemen, May & Baker, Singapore is proud to play a part in organizing and hosting this symposium. I hope that it is not necessary for me to intro duce myself, as Singapore doctors have received my letter of invitation and overseas delegates have received my letter of welcome. It is my very pleasant duty to introduce our Director of Research, Dr J. A. McFadzean, who has come specially to grace this occasion. Dr McFadzean, Sir, may I invite you to say a few words to this gathering of distinguished participants. TanJoo Hock VUl Welcome It is my privilege on behalf of May & Baker to welcome you here today. We have representatives from nine countries - Singapore, Malaysia, Thailand, Hong Kong, Indonesia, Japan, Norway, Sweden and UK. It is appropriate that this Symposium on Cervagem be held in South-east Asia where so much excellent development work was done with this product. Cervagem has resulted from many years of collaborative research and development between May & Baker and the Ono Pharmaceutical Company of Japan. It has been a most happy collaboration from the time the active ingredient ONO-802 was synthesized by the Ono Company. You will hear today of the stage we have reached with the R&D work."

This volume will explore the latest findings in research into the genetics of breast and reproductive cancers, covering the epidemiological aspects of these cancers, their etiology, the effect of environment on genes and cancer etiology, and how research in this area can lead to development of preventative measures and treatments.

Der Umfang der Erkenntnisse uber das Mammakarzinom in Theorie, Klinik und Praxis ist in den vergangenen drei lahrzehnten so groB geworden, daB ein eigener Band zur Abhandlung dieses Themas erforderlich wurde. 1m Rahmen dieses Werkes ist es naheliegend, daB die radiologischen Disziplinen sowohl in der Diagnostik als auch in der Therapie besonders zu Wort kommen. Die Atiologie, die entsprechende Ethnologie, die Stochastik der Zellentartung, die Experimen- talmedizin, die Immunologie und die ausfUhrliche Chirurgie werden nicht abgehandelt, weil dadurch der Umfang des Buches wahrscheinlich mehr als verdoppelt werden wurde. Die Diagnose des Mammakarzinoms wurde zum einen durch die Mammographie und Thermographie erweitert und zum anderen durch die gezielte pditherapeutische Gewebsentnahme mit einer entscheidenden Histopathologie betrachtlich verbessert. Die fruhe Entdeckung eines Carcinoma in situ und die Differenzierung in ein lobulares, intraduktales oder infiltrierendes Karzinom bestimmen entscheidend das Schicksal der Frau. Die Frage nach der radikalen Mastektomie mit postoperativer Bestrahlung und der einfachen Mastektomie mit Bestrahlung konnen nur nach sorgfaltigen statistischen Unter- suchungen auf breiter Basis unter Berucksichtigung alterer und neuerer klinischer Erfah- rungen entschieden werden. Zur Vermeidung der oft sehr verstiimmelnden Operation sind die Kombinationsthera- pien, wie einfache Ablation des fortgeschrittenen Karzinoms oder Tumorektomie bei fruhen Karzinomen zusammen mit der Bestrahlung, in den Vordergrund getreten. Die Bedeutung der immer wieder diskutierten pdioperativen Bestrahlung und die Indikation dazu werden sorgfaltig besprochen. Eine ganz besondere Beachtung verdienen die jahrelangen sorgfaltigen Untersuchun- gen uber die alleinige Strahlentherapie mit Megavoltstrahlen, weil sie sowohl kosmetisch als auch statistisch ausgezeichnete Ergebnisse aufweisen konnen.

Mit den von anerkannten Sachkennern der Radiologie und der Frauenheilkunde erarbei- teten Beitragen fUr den Band XIII/2 des Handbuches der medizinischen Radiologie konnten erstmals in der Weltliteratur umfassende Zusammenstellungen des gesamten Wissensstof- fes auf dem Gebiet der gynakologischen Radiologie und der radiologisch-geburtshilflichen Diagnostik vorgelegt werden. Die Methodik und den Informationswert der Hysterosalpingographie hat FOCHEM abgehandeIt und gestiitzt auf die fundierten Ergebnisse eigener Arbeit, in klar gegliederten Kapiteln die morphologischen Rontgenbefunde des gesunden und kranken Uterus und der Tuben erlautert. Mit dem Beitrag tiber die gynakologische Rontgendiagnostik in der Padiatrie haben BENZ und WILLICH eine vollstandige Ubersicht der Ergebnisse ihres noch wenig bekannten Forschungsgebietes gegeben, das fUr viele Fachgebiete der Medizin groBe praktische Bedeutung erlangt hat. Die methodischen Grundlagen und den Informationswert der radiologischen Spezial- diagnostik in der Gynakologie haben GROTEMEYER und BREIT zusammengestellt. Einen grundlegenden Beitrag zur Anatomie und Topographie der Organe des weiblichen Bek- kens im Hinblick auf die Rontgen-Ganzkorper-Computer-Tomographie verdanken wir PLATZER, der das Fundament fUr die Bildanalyse dieser neuartigen diagnostischen Me- thode erarbeitet hat. Die spezielle Rontgendiagnostik der gynakologischen Tumoren mit Hilfe der Angio- graphie und Rontgen-Ganzkorper-Computer-Tomographie haben BREIT und ROHDE ab- gehandelt. In besonderen Kapiteln ist die oft vernachlassigte Rezidivdiagnostik bei Ge- schwiilsten von BREIT sowie LISSNER und SCHERER bearbeitet worden. Gestiitzt auf eigene Forschungs- und Entwicklungsarbeit geben die Autoren eine umfassende Ubersicht und berticksichtigen die wertvollen diagnostischen Informationen, die heute mit Hilfe der Rontgen-Ganzkorper-Computer-Tomographie fUr die klinische Arbeit zur VerfUgung stehen.

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

Despite a plethora of theories, premenstrual syndrome (PMS) has remained an enigma. There has persisted in the literature a constant conflict as to the existence of the syndrome, a question as to whether it is one syndrome or several, and a debate as to whether the origin is psychic, somatic, or both. Advances in endocrinology, specifically in radioligand assays, allowing for accurate hormone measurements, have precipitated a more scientific evaluation of PMS in recent years. Nonetheless, diffi culties have persisted in accumulating well-documented data because of the protean nature of the syndrome. Indeed, even at this time, the question of what requires measurement during the follicular phase of the cycle and the premenstrual phase remains unresolved, and is difficult to place in perspective. In view of the persisting conflict between the organic and the psychological schools of thought, we, the editors of this book, considered the Sixth International Congress of Psychosomatic Obstetrics and Gynecology to be an ideal venue for a workshop in which both parties could be encouraged to participate. Towards this end, the organizing committee of the Inter national Society of Psychosomatic Obstetrics and Gynecology (ISPOG) was approached, and their response was extremely encouraging. In this respect, we wish to record our thanks to the Scientific Committee oflSOPG for allowing this workshop to be organized under their auspices, but totally under our direction. We, in turn, stand responsible for the format and content of the workshop."

Extensive reviews have been published on the mor aspects, anatomy, ultrastructure, physiology, bio phology, anatomy, and physiology of the mam chemistry, endocrinology, pharmacology, and physiopathology of the mammalian ovary. The malian ovary. However, little attention has been given to the gaps between the physiological, endo contributors, who prepared their chapters metic ulously, are recognized experts in their respective crine and histochemical parameters of the ovary as disciplines and their writings reflect extensive per it relates to clinical aspects. There is a wealth of sonal experience and unpublished data of both publications concerning the biology of the ovary: basic and clinical sciences. Without the assistance of the purpose of this volume is to integrate this information with emphasis on modern concepts in good friends and permission to draw extensively microanatomy, physiology, methodology, clinical from investigations, this volume would not have complications, and therapeutic approaches. An been possible. attempt is made to place fundamental research in Thanks are due to G. F. Franchitto, F. Barberini, clear perspectives. P. Stoops. Lori Rust and J. Squiers for their editorial It is hoped that this volume will fulfil a long skills and for checking the references to the original standing need and serve as an important source for sources. Thanks are particularly due to 1. K. Smith investigators and clinicians concerned with the of Martinus Nijhoff Publishers BV for his excellent physiopathology of the ovaries for years to come. It cooperation during the production of the book."

When presented with the task of editing a volume on such a wide When presented with the task of editing a volume on such a wide and and diverse diverse topic topic as as Ovarian Ovarian Pathology, Pathology, it it is is difficult difficult to to know know how how to to limit limit the the range range of of subjects subjects to to be be covered covered when when there there are are so so many many taxonomical taxonomical entities, entities, both both neoplastic neoplastic and and reactive reactive that that could could be be included. included. However, However, I I have have chosen chosen to to cover cover concepts concepts that that are are not not usually usually dealt dealt with with in in depth depth in in Gynaecological Gynaecological Pathology Pathology textbooks. textbooks. From From the the clinicopathological clinicopathological viewpoint, viewpoint, a a wealth wealth of of new new data data has has been been updated updated and and critically critically reappraised. reappraised.

This volume contains the proceedings of the Symposium on Molecular and Cellular Aspects of Periimplantation Processes, held July 15 - 18, 1994, in Boston, Massachusetts. Despite considerable research, the molecular and cellular bases of embryo-uterine interactions are still poorly understood. The papers included in this volume address recent advances in several areas in the field of implantation, including uterine receptivity, hormonal regulation, cell-cell interaction, growth factors/cytokines, immunobiology, and trophoblast invasion.

For doctors and students who wish to learn ultrasonography concisely yet comprehensively. The authors present the subject both systematically and practically, and with the facility of quick reference in mind, making generous use of flow-charts, tables and teaching-points. All general aspects of diagnostic ultrasound are covered, concentrating on those disorders encountered in the daily routine of scanning, but also referring to rarer conditions which need to be considered in differential diagnosis.

Urinary incontinence is a humiliating disability and a common problem in gynaecological clinics. In some centres specialised facilities are avail able for its investigation and treatment but in most hospitals the general gynaecologist has to manage this difficult condition. For both generalist and subspecialist it is timely to summarise advances in our knowledge of normal and abnormal micturition. Since 1973 the Royal College of Obstetrician's and Gynaecologists, through its Scientific Advisory Committee, has convened Study Groups on important growth areas in our specialty. The College invites an international panel of leading researchers to participate in a workshop, allowing time for in-depth discussion as well as the presentation of papers. It is hoped that this will produce not only an up-to-date sum mary of current knowledge but also a useful interaction between indi viduals and between specialties. This book is the result of the 21st Study Group, which was held in October 1989. The participants included urological and colorectal surgeons and a neurologist, as well as scientists and gynaecologists. The meeting began with sessions on basic science and advances in the investigation of the lower urinary tract, then covered voiding diffi culties, genuine stress incontinence and detrusor instability, before a final session on the relationship between urinary incontinence and ali mentary tract problems. The discussions formed an essential part of the meeting, and it is hoped that the lightly edited versions reproduced here will convey to the reader the stimulating atmosphere of the Study Group.

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.