Sexology as a discipline has had to fight for full-fledged recognition in the scientific community. Yet special knowledge of normal and disturbed sexual behavior is expected of medical professionals, psychologists and educators alike. Based on the papers given at the 8th World Congress for Sexology in 1987, this volume gives an up-to-date discussion of the most interesting and controversial topics, such as AIDS, in the field. Contributions have been grouped under the main headings: Family Planning, Sterility and Sexuality, Erectile Dysfunction, Sexuality in the Elderly and in Marriage, Transsexualism, Sexual Therapy, and Sexuality and Illness, and include items of historical interest as well as transcultural comparisons.

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.

The Organon Symposia have actually become a tradition, keeping up with exciting developments in reproductive medicine. The purpose of this symposium on "Fertiliza tion of the Human Egg in Vitro" was to bring together the stilllimited number of elinical specialists in the field and to stimulate another group of basic research people to exchange their experiences and knowledge, hopefully promoting elose cooperation between the two groups. It was a kind of scientific "first" that all research teams so far successful in achieving the birth of a healthy baby, fertilized in vitro came together at a workshop conference without a large audience of spectators and reporters, but with a small number of highly critical colleagues from the fields of basic reproductive physiology and comparative developmental biology. This atmosphere allowed for the elose exchange of results, hypotheses, diagnostic and therapeutic procedures, criticism, and respect, and created very productive discussions, all of which furthered the aim of the method: To help more childless couples to have their own babies by the ultima ratio procedure of in vitro fertilization and embryo replacement. The book that has emerged from this symposium will help to disseminate the great amount of information and experience gathered among the scientifically and clinically interested colleagues of many other hospitals and universities who could not be invited to the meeting. At the same time, it will prove that there is much more work to be done in the basic and clinical sciences of human embryology and reproductive biology."

Breast Cancer, the second volume in the MD Anderson Solid Tumor Oncology series, this book provides the general surgeon, surgical oncologist, and medical oncologist with the state-of-the art multimodality care for breast cancer. Divided into five sections, the text brings the field's recognized esperts addressing the current status of breast imaging, breast pathology, the role of breast surgery including management of in situ and early stage carcinoma, prophylatic mastectomy, axillary node dissection, sentinel node and lymphatic mapping, and outpatient mastectomy, as well as coverage of special selected topics featuring breast cancer in pregnancy, inflammatory breast cancer and breast sarcoma. An important section on future research reviews on-going studies for the use of in situ laser ablation, cryosurgery, and translational research to bring the busy practitioner up-to-date on state-of-the art advances. This book is a must-have resource on the full specturm of current and prospective treatment options for this challenging disease.

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."

The authors of this book have a goal-to describe the management of infertility from the perspective of physiology and anatomy gone awry. To accomplish this goal, the chapters devoted to the causes of infertil ity begin with a description of the normal structure and function of the organ or system causing the infertility. We believe that under standing the normal will result in rational and effective diagnosis and treatment of infertility. Our intent is that this book be a useful re source for those who care for infertile couples. For an infertile couple, success is the delivery of a normal and healthy infant. Chapters that describe the causes and treatment of habitual abortion and the reproductive performance of previously infertile couples emphasize the hazards that exist between conception and birth. Our environment is one of these hazards, one that may also affect reproduction before conception. A chapter is devoted to a de scription of environmental agents that affect reproduction, the mech anisms of their effect, and methods to predict those present and future environmental agents which might also affect reproduction."

The many advances in breast cancer research, as well as the large quantity of published material, make it very difficult to gain insight into the global aspects of cancer management. To follow and understand all the new developments is becoming a major challenge. For this reason, the editors decided to bring together a group of top researchers in breast cancer to provide a comprehensive, yet readable conceptual review of the state of the art of breast cancer diagnosis and therapy. The proposal to focus the review on the quantitative assessment of the risk at diagnosis, the determination of which may permit selective therapies for individual patients, was met with enthusiastic approval, resulting in the present volume with contributions by the leading investigators in the field. While the volume relating to diagnosis, published re cently, focused on efforts leading to refinement at diagnosis of risk criteria sensitive enough to reliably distinguish the low- and high-risk categories, the second volume, by provid ing a review of the main problems and results of therapy given to high-risk patients, can be considered as a continua tion of the first book. A refined risk assessment at diagnosis and the application of the most suitable treatments to well selected individuals are the most important steps towards avoiding the present worrisome reality of overtreating the low risk and undertreating the high-risk patients. The first few chapters of the present volume offer an insight into the general management of early breast cancer.

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 introduction of prostaglandins into clinical practice has been one of the most important advances in obstetrics and gynaecology in recent years. During the last decade obstetricians have become familiar with these drugs for inducing labour and for terminating second-trimester pregnancy. Within the last year their use has been extended, in association with antiprogestin, to first-trimester termi nation. Although the effectiveness of prostaglandins in these pharma cological roles is clear, their full potential has still to be explored, and much remains to be learned about their physiology. Prostaglandins playa central role in the initiation of labour. Further clarification of this role could lead to improvements in preventing or treating preterm labour, which still remains the most important cause of perinatal mortality in this country. Prostaglandins are also inti mately involved in the mechanism of menstruation. More detailed understanding of this role should lead to more effective treatments for menorrhagia and dysmenorrhoea. These substances also playa part in the mechanism of implantation, and further research in this area may lead to more effective therapy for infertility.

Retinal haemorrhage occurring during birth is a common feature in the newborn. There is no basic funduscopic or morphologic difference between this perinatal type of haemorrhage and that in the adult. The difference is that perinatal haemorrhage resorbs rapidly, within a few days, and no functional defects of retinal vessels are known. The fIrst observation of perinatal haemorrhage took place nearly 100 years ago. Many observations have been published in short papers; what was still lacking was a systematic pathogenic classifIcation of the different types of haemorrhage, a compari son of the perinatal type of other types of retinal haemorrhage, a comparison to other perinatal ocular haemorrhages, a detailed histologic description and a multi-faceted correlation of haemorrhage to aetiologic factors. The author has based his comprehensive evaluation on the observation of more than 400 newborn infants, the reexamination of several cases with macular haemor rhage, the histologic work-up of serial sections and the review of extensive literature. It is a remarkable fact that a physiologic process, birth, is related to this type of vessel rupture, which is present during a short period of postnatal life. In its complex analysis of these facts and conditions this book is particularly valuable."

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."

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."

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.

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.

Changing approaches to diagnosis and clinical management of the uterus are comprehensively examined in this book. It gives a concise update of new concepts in physiology and pathology and their application in clinical practice. The book is designed especially for the gynecologist actively involved in patient care. Topics discussed include the pathophysiology of diethylstilbestrol (DES) changes, the immunology of the uterus, papillomaviruses and cervical neoplasia, endocervical carcinoma, mesenchymal tumors and diagnostic procedures such as colposcopy of the cervix, hysterosalpingography, and magnetic resonance imaging. The status of contemporary management is presented for hysteroscopy and hysteroscopic surgery, the congenital absence of the uterus and vagina, anovulatory dysfunctional uterine bleeding of the adolescent, uterine leiomyomata, genital prolapse, endometrial adenocarcinoma and childhood rhabdomyosarcoma of the vagina and uterus.

The incidence of endometrial cancer rose sharply in the United States in the early 1970s, paralleling changes in the use of postmenopausal estrogens by American women. A sizeable body of evidence supports the role of both excessive endogenous estrogen and exogenous estrogen in the etiology of endometrial cancer. There is growing evidence that inadequate progesterone has the opposite effect, in that progesterone supplementation of postmeno pausal estrogen therapy reduces the incidence of endometrial cancer. Despite this new awareness of the hormonal role that is played in carcino ma of the endometrium, the disease still plagues the oncologist. The general approach to carcinoma of the endometrium in the United States is that of primary surgical staging. This provides the maximum amount of information to best plan postoperative radiation therapy and/or chemotherapy for these patients. In general, patients who are considered candidates for surgical staging are those with advanced disease or high-risk stage I endometrial carcinoma. High-risk endometrial carcinoma is defined as those patients with moderately differentiated lesions with deep myometrial invasion, poor ly differentiated carcinoma of the endometrium, and the high-risk histolo gies such as papillary carcinoma and clear-cell carcinomas. The surgical staging has extended in most institutions to patients with occult stage II carcinoma of the endometrium, i. e."

Key questions involved in the treatment of disseminated breast cancer are discussed in this well-presented overview. It is the result of an initiative taken by the Swiss Group for Clinical Cancer Research to reveal the most recent developments in experimental and clinical research. The topics discussed include: the comparison of in vitro cultures of epithelial cells with breast cancer cells, the effect of steroids and their antagonists, the involvement of suppressor genes in tumour progression, the modulation of transforming growth factors by estrogen, and prognostic factors such as cERB-2 and EGF-R in breast cancer.

This book contains the proceedings of the Serono Symposia USA interna tional symposium on Genetic Models of Immune and Inflammatory Dis eases held on October 20 to 23, 1994, in Savannah, Georgia. The advent of methods for introducing genes into the germlines of mice, and for targeted disruption of particular genes by homologous recombination, has provided scientists in many disciplines with an extraordinarily powerful set of analyti cal tools. Some of the most informative applications of transgenic and gene knockout technology have been in studies of lymphocyte development and activation. The goal of this symposium was to bring together investigators using these genetic approaches for analyzing the immune system, with a view to defining common themes and novel directions. Transgenic mice have a wide variety of important applications in immu nology. Defined proteins can be expressed in selected tissues throughout development, thus acquiring the essential characteristic of "self" antigens. Such models have been used to study how immune responses to these artificially created "self" antigens are controlled. Antigen receptors of lym phocytes have been expressed as transgenes, and because lymphocytes are endowed with the unique property of allelic exclusion, such transgenic mice become essentially monospecific. Immunomodulatory agents have been expressed in defined tissues or throughout the body, providing tools for studying the functional consequences of dysregulated expression of biologi cal response modifiers."

an adequate oxygen supply is vital for the undisturbed development of the fetus and its functions. This book gives a synopsis of the ruling influence that oxygen has in multiple regulation sytems in the mother and especially in the fetus. The authors consider oxygen as a manipulated variable or as a corrective element during normal pregnancy, during delivery and during acute and chronic oxygen deficiency. Furthermore, they deal with the consequences that oxygen deficiency has on the fetus.

Advances in breast cancer research, achieved through the progress of knowledge and development of new therapies, have been translated into improved quality of care for breast cancer patients. Clinical investigations and clinical trials have made the largest contribution to the body of knowledge that finds its way to the patient. Never before during the past decades of management of breast cancer has there been such a fruitful intellectual cross-fertilization of ideas among individuals involved in the generation of hypotheses, basic research, development of drugs and treatments, conduct of clinical trials, and statistical evaluation - the results of all of which are now translated into progress in clinical care. Even issues such as the quality of life of breast cancer patients, once the domain for few, are now being openly addressed by trials and discussed in a much broader forum. The IVth International Conference on the Adjuvant Therapy of Primary Breast Cancer, also known as the st. Gallen Conference, was again attended by more than 800 scientists and clinicians interested in this broad spectrum of breast cancer research and the interactions between such diverse fields of interest and specialties as cancer pathology, molecular biology, and psychosocial oncology. This volume collects findings and conclusions presented at the conference.

Research on the hormonal control oflactation - the subject of this monograph - has long been the major interest of this laboratory. Studies were initiated in the mid 1930s by the late Professor S. 1. Folley, FRS, who directed the work with immense enthusiasm and devotion until his untimely death in 1970. This fruitful area of basic and applied research has, in recent years, attracted widespread attention; there have been many exciting events and developments with a dramatic increase in the number of publications. These events are diverse and include the identification, isolation and sequencing of human prolactin; the identification and isolation of placentallactogens in several ruminant species with recognition of their importance in mammary growth and differentiation; the introduction of highly sensitive bioassay, radioimmuno- and radioreceptor-assay techniques for mammotrophic hormones; the growing clinical appreciation of the immunological and nutritional importance of colostrum and milk to the newborn; the intensification of studies on normal mammogenesis to establish a sound basis for studies on mammary cancer; and the exploitation of the mammary gland, with its characteristic differentiation patterns and multiple synthetic abilities, as a valuable tissue for the investigation of basic mechanisms involved in the synthesis under hormonal control of enzymes and secretory proteins; and for the study of hormone - receptor interactions.

Sixty years ago, G. Fanconi published a paper entitled: "Familiiire infantile pemiziosaartige Aniimie (pemizioses Blutbild und Konstitu- tion)", in which he reported that this type of severe aplastic anemia represents a hereditary disease distinct from other pancytopenias of childhood (Fanconi 1927). Later this syndrome was named Fan- coni anemia (FA; van Leeuwen 1933). A more recent study of the genetics of FA confirmed that the syndrome is inherited in an au- tosomal recessive manner (Schroeder et al. 1976). Prenatal diagno- sis in FA families showed that about 25% of fetuses are affected (Auerbach et al. 1985, 1986). In 1964, Schroeder et al. discovered high frequencies of chro- mosomal aberrations in cultured peripheral blood lymphocytes from patients with FA. Schuler et al. (1969) reported that cells from FA patients are particularly sensitive to the chromosome-breaking activity or clastogenic effect of a polyfunctional alkylating agent. Since that time, studies of baseline and induced frequencies of chromosomal aberrations have been used for the identification of patients with FA. There is now a large body of data concerning the possible mechanism(s) underlying the hypersensitivity of FA cells to DNA cross-linking agents, the biochemical basis for which is still unknown. Complementation analysis, using cells from different FA pa- tients, has demonstrated genetic heterogeneity in the syndrome.