Infertility, as with many aspects of medicine, is at the mercy of rapid technological advance. Many of these developments initially seem attractive to both clinicians and patients, but need to be rigorously assessed if their real value is to be understood and clinical practice is to develop. In this book issues of importance to the management of infertile patients are discussed. The gaps in our knowledge which prevent a better understanding of the condition are identified, and recent developments, both clinical and scientific, are subjected to peer review and discussion. An important feature of the book is an acceptance that training in infertility practice is a real problem. This is perceived not only by the practising clinicians, both doctors and nurses, but particularly by the clinical scientists, including embryologists, who now provide such an essential part of the service. Similarly the provision of the clinical service has been examined in detail from a variety of standpoints, in an attempt to make sensible recommendations which balance real need with limited resource. The book is based on the papers presented and discussed at the 25th RCOG Study Group held in April 1992. The discussion after each paper was civilised but uncompromising and forms an important part of this publication. The rapid processing of the written and recorded material by the staff at the RCOG, and particularly Miss Sally Barber, has ensured that the book has been produced while the issues are live, the reviews contemporary and the discussion relevant.

This volume contains all the invited papers, symposium contributions and workshop reports of the 7th International Congress of Human Genetics, held in West Berlin from September 22 to 26, 1986. The organizers of this congress made sure to gain the cooperation of the leading scientists in the field from all over the world. These contributions therefore document the enormous progress made in human genetics research in recent years. The volume covers a wide range of topics, from analysis of the human genome to basic mechanisms, diagnosis and therapy of hereditary diseases, and to distribution of normal and pathological genes and DNA variation in human populations. Ethical issues raised by modern developments are discussed thoroughly. The volume is a must for all scientists and medical doctors working in human genetics research, its teaching and practical applications.

Important contributions about the treatment modalities of breast cancer are presented in this book. The risks and limitations of breast conserving therapy of mammary carcinoma are dealt with. Newest findings show that this form of therapy has the same outcome as conservative treatment modalities. The book also considers controversial issues such as the treatment of mastopathy, precancerous, and non-invasive lesions of the breast. New, but not yet approved, regimes for the prevention of mammary carcinoma and open questions concerning adequate operative treatment are discussed. Latest results presented here show that all modern palliative chemotherapy has a certain but limited effect on outcome and that early detection and preventive therapy (surgical and hormonal) will be of great importance for improved chances of survival of breast cancer.

Medicine is changing at a speed never witnessed before in history. With each passing year, medical technology achieves the capacity to provide cures and improve treatments that even a short time before were difficult to con ceptualize and impossible to provide. Reproductive technology personifies this concept perhaps better than any other field of medicine. The 1990s have seen an explosion in endoscopic and ambulatory procedures, the application of molecular biology to clinical conditions, and the refinement of assisted reproduction to allow third parties (donors and surrogates) into the process of family building. More than ever before, comprehensive medical care requires a team approach. However, the team comprises not only medical and scientific personnel, but also mental health professionals, lawyers, and ethicists. This integrated and multidisciplinary approach to medical care will become even more necessary as medical capabilities continue to develop faster than society can respond. This book reflects such an approach. It is based on a Harvard Postgraduate Course in June 1990 entitled Infertility in the 1990s: Technological Advances and Their Psychosocial Implications that was sponsored by the Faulkner Centre for Reproductive Medicine. The first half of the course was directed by Drs. M. Seibel, A. Kiessling, and C. Richards. The second half of the course was directed by Dr. M. Seibel, J. Bernstein, R. N. and S. Levin, LICSW."

This collection of papers on different aspects of gynaecological oncology is taken from the proceedings of the Second International Conference on Gynaecological Cancer held in Edinburgh in Sep tember 1983. An attempt has been made to include topical material of interest and importance to all gynaecologists, both with and without specific oncological experience, and it is confidently expected that radiotherapists and general surgeons will also find much of value within these pages. Much of the material has been updated prior to its transfer to the printers, and authors have tried where possible to provide workable rather than tiresomely comprehensive bibliographies. Our sincerest thanks are directed to our other colleagues on the Organising Committee, namely Professors J. Carmichael, W. Duncan and J. F. Smyth and Doctors 1. Duncan, J. R. B. Livingstone, R. H. Nalick, T. J. O'Brien and E. Petrilli for their invaluable assistance on both sides of the Atlantic with the organisation ofthe above conference, to Dr. R. H. Kerr-Wilson for his help with, and sometimes translation of, the original proofs, and to our constantly overworked and uncomplaining secretaries Joann Little and Mary Hall."

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."

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.

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.

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."

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.

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."

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

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

Conceptual advances in the biological sciences are marked by the applica tion of new techniques and experimental strategies. Nowhere has this ge neric principle been more apparent than in the study of testicular cells, as judged by the evolution of themes presented at the Testis Workshop over the past 23 years. Like its predecessors, the 1995 Testis Workshop was structured to offer fresh insights and approaches for understanding the mechanisms of spermatogenesis and steroidogenesis. The chapters pre sented in this book emphasize three aspects of testicular cell function: first, the molecular analysis of the cell cycle; second, examination of the cell cycle, including the function and identification of specific macromolecules that direct the proliferation and differentiation of germ cells; and third, the development of Leydig cells and the role of specific macromolecules in the formation of testicular steroids. Each chapter is based on a lecture presented at the XIIIth Testis Work shop held on March 30 to April 1, 1995, at the Radisson Plaza Hotel in Raleigh, North Carolina. The selection of topics reflects the recommenda tions of the workshop'S organizing committee. Sincere thanks are due to the speakers who agreed to lecture and prepare chapters."

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

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 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."

The importance of osteoporosis in the United Kingdom as a cause of death and disability is now well recognised. There are in excess of 200,000 osteoporotic-related fractures in the UK per annum asso ciated with an estimated cost of GBP942,000,000. Following hip fracture it is known that about 50% of patients are unable to live indepen dently and about 20% of such patients die within the first 6 months. These figures, compelling as they are, reflect poorly on current medical practices which manifestly have failed to identify patients with low bone density at risk of fracture. The hope is that the techni cal advances which have enabled bone mineral density, and other allied indices, to be measured with high precision and accuracy offers the chance of identifying patients at risk of fracture and guiding the clinician to make treatment decisions which may reduce the patients' risk of fracture. In the UK, services for identifying patients at risk of fracture are still in their infancy and are not uniformly available throughout the country. This situation is, however, likely to improve particularly fol lowing the publication of the Royal College of Physicians report "Osteoporosis -clinical guidelines for prevention and treatment" and the recognition in "Our Healthier Nation" that osteoporosis pre vention should be included as a target to achieve a reduction of 20% in accidents by 2010.

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.

Intrauterine Growth Restriction: Aetiology and Management will be the first book to focus exclusively on this extremely important and common complication of pregnancy. There have been many recent developments in our understanding of the aetiology and pathogenesis of the condition as well as in screening, monitoring and therapy. This book is unique in that it covers both the aetiology and pathogenesis as well as clinical management and also includes sections on definitions and potential future advances. Every aspect is covered by an international expert which will provide the reader with a valuable insight into this condition.

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."

Different genetic diagnostic and treatment options are used worldwide to improve routine IVF procedures for the benefit of patients. This handbook updates the new genetic diagnostic technologies that have been translated to the clinic, aiming to improve outcomes in the clinic and result in a healthy baby in the home. Chapters cover the use of genetic technologies in a personalized manner to unravel the possible genetic risks for the couple wishing to conceive, in terms of sperm, the embryo, the endometrium, miscarriage, and finally the fetus. This expanded new edition covers the range of the latest genetic diagnostic technologies being translated into practice internationally to improve routine IVF procedures for the benefit of patients. Bringing together international experts to discuss their work, this text gives a context for the developments in this very fast-moving area of research and offers a comprehensive and rounded appraisal of hot topics.

This book aims to highlight all the existing information available on first and mid-trimester imaging of palate in prenatal ultrasound and to develop a methodical approach in imaging the palate. As formation of the palate is completed by 11 weeks of gestation and as there are no evolving changes in palatine anatomy at the mid-trimester, diagnosis of palatine clefts can now completely be shifted to late first-trimester. First-trimester evaluation of palate is now gaining importance and a number of techniques have currently been proposed by different authors. This book covers the existing literature and recent 2D and 3D techniques in evaluating palate and helps in the early detection of palatine clefts in the first trimester. Orofacial clefting is one of the most common birth defects and the burden of it in developing countries is substantial. This book helps in improving the counseling options for the obstetrician and the couple early in gestation. It includes 2D and 3D images of various types of palatine clefts and the nuances in imaging the secondary palate extensively. 3D images of the palate also help the multi-disciplinary team especially the maxillofacial surgeons involved in managing orofacial clefts. It also includes videos for easy understanding. This book is a ready reckoner for the imaging specialists and students /trainees involved in prenatal diagnosis. It provides essential information in diagnosing orofacial cleft both to the novice and to the skilled professionals involved in the field of diagnostic fetal ultrasound.