This is the second compilation of papers given during the Related Communica- tions Sessions of the XIth International Federation of Fertility Societies World Congress held on June 26th-July 1st 1983 at the Royal Dublin Society, Dublin, Ireland. Except for Part I, where results of animal experimentations are gathered together, the volume is concerned solely with studies in the human. The role of infection and endometriosis in the aetiology and treatment of the tubo- uteroperitoneal factor in infertility are the concern of Parts II and III. Diagnostic and therapeutic aspects of tubal disease are covered in Parts IV and V and the book ends with Part VI, chapters on the uterus and vagina. Laparoscopy and microsurgical techniques have undoubtedly transformed the diagnostic and therapeutic outlook in this area of infertility. This book shows you how far such techniques have progressed and how much there is yet to do. Dublin, 1983 Robert F. Harrison lohnBonnar William Thompson xi List of Contributors 5. A. Z. BADAWY J. ABE Department of Obstetrics and Gynecology Department of Obstetrics and Gynecology Kyoto Prefectural University of Medicine Upstate Medical Center Kawarmachi-Hirokogi, Kamikyoku, Kyoto 750 E. Adams Street JAPAN 602 Syracuse, NY 13210 USA M. ALACHMAR "Marika Eliadi" Maternity Hospital 2 Helena Venizelos Square M. BERG Athens 115 21 Department of Clinical Sciences GREECE University of Tampere Teiskontie 35 W. ALBRICH SF-33520 Tampere Department of Obstetrics and Gynecology FINLAND University of Munich Marchioninistrasse D-8000 Munich 70 G.

Almost a quarter of a century has elapsed since Cellular Biology of the Uterus, the predecessor of the present volume, was planned. During that period, especially in the decade since the publication of the last edition of Biology of the Uterus, new information in the field has been so voluminous as to require major revisions of most of the chapters, the addition of several new chapters, and the collaboration of a second editor to facilitate the selection of appropriate experts as authors. As in prior editions, a balance has been struck between classical biology and modem biochemistry and biophysics. The inclusion of basic histological and embryo logical information provides a necessary, though often lacking, background for the protein chemist and molecular biologist and a bridge between the cell biologist and clinician. Thus, major practical problems in human reproduction, such as the genesis of endometrial carcinoma and the cause of the initiation of labor, may be approached on a firm scientific footing. The current edition deals primarily with the biology of the uterus itself (comparative and human) rather than placentation or pregnancy and thus is a synthesis of data derived from many techniques, both conventional and modem. As it is clearly beyond the competence of anyone scientist to prepare such a text on the basis of personal knowledge and experience, the aid of 22 distinguished scientists was enlisted."

Three International Congresses on the Menopause have been held during the last five years, evidence of the explosive increase in the scient ific study of this subject. The first, held in La Grande Motte, near Montpellier, France, inJune 1976, was designed to provide a consensus on menopause research (van Keep et al., 1976). The second, held in Jerusalem, was planned to assess the developing research (van Keep et al., 1979). The objective of the third congress, convened inJune 1981 in Ostend, Belgium, under the auspices of the International Menopause Society, was to explore areas of controversy in basic understanding and in the therapeutic advances relating to the climacteric. The workshop moderators were selected because of their acknow ledged leadership in menopause research, and each was invited to arrange a workshop on a specific area of interest or concern. The moderators, whilst being given a free hand as far as the selection of invited speakers was concerned, were asked to allow plenty of time for open discussion. In particular, they were encouraged to stimulate debate about controversial issues."

The need to improve maternal and child health care may be the most important global health need of the remaining years of the twentieth century. It is central to the World Health Organization's (WHO) goal of Health for All by the Year 2000. The vast majority of births occur in developing countries, where maternity care is often rudimentary. The rates of maternal and infant morbidity and death for these countries are extremely high but much of the morbidity and death is preventable, even with the limited resources available for health care in many parts of the world. The resources devoted to maternal and child care should be greatly expanded, but even the most hopeful projections will leave a wide gap between human needs and available services. WHO estimates that two billion deliveries in the remaining two decades of this century will not be attended by a trained person. At a minimum, it is probable that two million of these women will die in childbirth. There were approximately 130 million births in the world in 1980.

This book is a comprehensive and easy-to-read guide to obstetrics and gynecology in developing countries. Although significant progress has been made towards the reduction of maternal mortality and morbidity globally, they are still unacceptably high in developing countries. This can be directly or indirectly tied to poor quality maternal health care and lack of access to cost-effective, comprehensive healthcare. Health practitioners in developing countries also contend with trying to keep abreast of recent developments in obstetrics and gynecology while dealing with lack of time, resources, and access to relevant information. This textbook was thus created by experts in obstetrics and gynecology with extensive experience in African clinical settings and consultants in developed countries to teach proper and accurate diagnosis, treatment and management of gynecologic and obstetric health issues within the context of developing countries. This second edition has been fully updated throughout with an added 25+ chapters that cover topics such as reproductive health, gynecological cancers and research methods. The book is divided into six sections: Women's Reproductive Health; Obstetrics; Medical and Surgical Disorders in Pregnancy; General Gynecology; Gynecological Malignancies; Health Systems Organization, Research Methodology and Biostatistics. These section topics have been carefully covered by expert authors with the use of valid scientific data, policy instruments, and adapted to the cultural and social context of developing countries, with particular in depth coverage of conditions that have greater prevalence and incidence in developing countries. Each chapter also focuses on filling gaps in knowledge with a distinct pedagogical approach, starting with a set of learning objectives and ending with key takeaways for the chapter. This is an ideal guide for residents, medical students, practitioners of obstetrics and gynecology, midwives, general practitioners, and pediatricians, particularly those working in developing companies.

A. A. Haspe/s It is with pleasure that I welcome you, on behalf of Professor Rolland and myself, to Amsterdam for this International Symposium on 'Benefits and Risks of Hormonal Contraception'. As a means offamily planning the pill is about 25 years old - a timespan which has been characterized by an enormous increase in public interest and concern with family health and family-planning. Undoubtedly we have learned a lot over the last 25 years. As you see in Figure 1, in the seventies in Holland relatively more fertile women used the pill than in any other country in the world. In 1974 new combination pills were introduced containing less than 50 JAg of ethinyl estradiol. In 1981 50 % of Dutch pill users took a sub-50 (Figure 2). The same is true for the Scandi navian countries. In our own University Clinic 95 % of pill-users take a sub-50 pill; only 5 % use a 50 JAg pill on medical indication. This decrease in estrogen dosage, which is usually accompanied by a decrease of progestational component as well, has resulted in a decrease of thromboembolic disease. Factors that are still important to consider are diabetes mellitus, hypertension, adipositas and smoking. Good selection of patients together with the prescribing where possible of sub-50 pills may result in the numbers of compli cations and side-effects being close to those encountered in the control group.

Irvin M. Cushner, MD, MPH It is both remarkable and, at the same time, a sign of this era of rapid change that one can refer back to the "infancy" of a field which has existed for barely more than a decade. Yet, one now reads of the "maturing" of the family planning and abortion fields, both of which were incorporated into our society and integrated into our health care system within the past ten years. Indeed, in the very year that this book is being prepared, we note the tenth anniversaries of several significant events of 1970: 1) the enactment of Title X of the Public Health Service Act, establishing a Federal program in family planning; 2) the first issuance by a major health-related organization (the APHA) of a policy statement advocating repeal of all abortion laws; and 3) the enactment, by New York State, of an abortion law whose only restric tion was that it be performed by a licensed physician and the subse quent action, the first by any local health department (New York City), to assure both its implementation and its quality. They were, indeed, eventful days. These three events seemed to presage a then-unprecedented acceptance of fertility regulation as a right and as a needed service."

Since human prolactin was isolated and characterized 13 years ago, the study of the control of prolactin secretion has been intensive. Hyperprolactinaemia is the most commonly identifiable hypothal- amic pituitary disorder1,2. The dominant inhibitory nature of hypo- thalamic control of prolactin secretion may be the reason that hyperprolactinaemia is such a common condition. During the PClst decade two separate therapeutic approaches to the management of hyperprolactinaemia have been introduced: transsphenoidal selec- tive pituitary microsurgery and medical therapy to suppress prolactin secretion with orally active long-acting dopamine agonist drugs. Small prolactin-secreting tumours are treated extremely satisfactorily both with medical and with surgical therapy, both in terms of lower- ing serum prolactin levels to normal and in restoring gonadal func- tion. However, for the larger tumours, either where the tumour is invasive or the pretreatment serum prolactin level is greater than 1 250ngml- the results of surgery are poor in terms of restoring to normal circulating prolactin levels and gonadal functionJ-s. We now discuss the medical management of hyperprolactinaemia, potential problems during pregnancy and the management of large prolactin- secreting pituitary tumours.

Uncontrolled population growth, a significant problem for many countries, depresses real living standards in all developing areas. As a corollary, un controlled population growth also stresses the ability to deliver adequate reproductive health care on both national and individual levels. To focus on this and related problems an International Congress to examine many aspects of male and female Reproductive Health Center Care was held on 10-15 October 1982 in Maui, Hawaii, USA. This volume is a result of the proceedings from the 'Symposium on Male Fertility and its Regulation' which was a part of the Reproductive Health Care Congress. The organizers of this symposium recognized the need to focus male reproductive understanding on contraceptive development. The ultimate objective was and still is to produce a variety of safe and effective male contraceptives similar to that accomplished in the female. Speakers were invited to review the state of the art in several areas related to male contra ception, reproductive toxicity and reproductive biology. The abstracts of these sessions were published as a special issue of Archives of Andrology (Vol. 9, No.1, August, 1982). Subsequently, this volume was assembled from key papers presented at the Symposium. Additionally, invited man uscripts from leaders in specific areas were solicited to provide additional range to the topics covered."

Breast cancer is the most frequent cancer of women in the western hemisphere. This book presents a new imaging modality of the breast which improves the possibilities of mammography at a very high level: Cancers can be detected at a very early stage y MRM. The huge number ofbreast biopsies can be reduced dramatically. Even tiny breast cancers (e.g.3mm) can be detected. The prognosis for women with breast cancer will improve due to earlier detection.

For the Editors, the task of writing a Preface is most satisfying. It represents the completion of the book and a moment of reflection on whether the whole is more than the sum of all the parts. And also, one must reflect on how this book is likely to be utilized in this era of rapid communications. The Editors first met in May 2003 at a stimulating Italian symposium on endometrial cancer (organizers Drs. Luigi Frigerio, Roberto Grassi and Andrea Lissoni, with participation of the deans of Italian Gynecologic Oncology, Ugo Bianchi and Constantino Mangioni) that took place at Bergamo and Caravaggio. The impressive gains in biology and clinical trials were further discussed by the two editors and others that are co-authors in this venture on this side of the Atlantic at a 2004 Educational Session at the American Society of Clinical Oncology (ASCO). The pace of progress in various aspects of management of uterine cancer was no- worthy, not only was tumor biology fueling novel hypotheses such as questioning the mesenchymal origin of carcinosarcomas, but knowledge of molecular pathways was beginning to be applied as prognostic and as predictive factors portending benefit from systemic therapies. Surgical staging and sensitive imaging provided the underpinning for refining our treatment algorithms. Finally, a role for che- therapy had finally become established, principally through phase III studies c- paring chemotherapy to radiation in mostly locally advanced stages III and IV that had undergone resection.

Here is a practical, comprehensive text on fetal diagnosis, management and therapy which differs from competing texts in maternal-fetal medicine by focusing on the fetus rather than the pregnant woman. All new technologies in the field, from ulstrasound diagnosis to intrauterine treatment, are placed in perspective for the practicing physician.

Now in its third edition! Ovarian Carcinoma is an invaluable source of information because it gives a complete overview of all aspects: histologic classification, FIGO staging, tumor markers, symptoms, diagnosis, operative treatment, chemotherapy, radiation therapy, complications such as pregnancy and AIDS, biological response modifiers and the status of clinical trials. The new chapter on biologic response modification is especially noteworthy since it reports on new developments now being tested in clinical trials. All the other chapters have been expanded and updated, too. At the same time, the author has kept his clear, readable style that makes the book easy to understand. The contents are based on actual clinical experience and thus extremely practical.

THE JAN PALFIJN SYMPOSIA In 1979 the Department of Obstetrics and Gynaecology of the Jan Palfijn Hospital in Merksem, Antwerp, celebrated its 25th Anniver sary. To mark the occasion, the first symposium was organized, the theme chosen being hysteroscopy. Thanks to the cooperation of specialists from both within and outside Belgium the event attracted such a large attendance that it was decided to follow up this first venture with others. In the light of the experience gained from the first symposium, we established the Jan Palfijn Foundation for Gynaecological and Obstetrical Didactics, the reasons for this being budgetary and, in particular, organizational. This approach made it possible to attract the cooperation of enthusiastic fellow workers from outside the hospital on a permanent or ad hoc basis and hence to reach a much wider group of experts in all fields, both at home and abroad. In 1981 the second symposium was held at the Jan Palfijn Hospital, the topic being echography in obstetrics and gynaecology. Almost all of the Belgian universities were represented and papers were presented by confreres from practically all of the EEC countries. When the third symposium was held, in 1982, again on hysteroscopy, the speakers and audience could literally hardly be squeezed into the Jan Palfijn Hospital's facilities. The fourth symposium was accordingly organized in the modern, luxurious facilities of the new administration building of the Antwerp Provincial Authority."

This volume, focusing on the ureter and the diseases which involve it, is an updated second edition. Many journals and textbooks deal with the physiology, pathology, diagnosis, and therapy of derangements of the urinary tract. In most instances, however, the discussion properly centers on the disease process itself and its primary aspects, with only a tan gential description of effects on the ureter. The editor is therefore correct that the ureter itself should be considered a major organ. Though it has been regarded in the recent past as a simple muscular tube, reacting to stretching or filling by contraction, this simplistic view of ureteral phys iology is changing fast. With expanded knowledge of ureteral physiology, a pharmacology is developing which is becoming useful to the clinician in many ways. One of the most interesting aspects of the ureter is its role in inducing the permanent kidney, the metanephros. Relatively slight displacements in the origin of the ureteral bud result in ectopic ureteral orifices and a wide range of congenital anomalies. An ureteral bud which arises medial to the normal position at the genu of the mesonephric duct results in a lateral, and usually incompetent, ureterovesical junction after the duct is taken up to form a portion ofthe trigone. This appears certainly to be the developmental mechanism which results in primary reflux."

Because of increasing worldwide interest in the subject, a decision was made to coordinate the papers presented at the First European Symposium on Hysteroscopy, held in Antwerp, Belgium, in September 1982, into a text on hysteroscopy, including its indications, techniques, and complications. The Organising Committee called on Dr. Louis G. Keith of Northwestern University, Chicago, illinois USA, to edit all of the papers and to prepare them for publication as a multi-author textbook rather than as a haphazard collection of the proceedings of a meeting. Dr. Keith also supervised the many details of preparing the manuscript for publication, including the task of copy editing. The speakers at the Symposium were all eminent European hysteroscopists; the most up-to-date information was presented, assuring the current nature of the scientific data. By way of introduction (Part I), a historical survey of the development of hysteroscopy is presented. The material is then divided into several parts. Part II concerns the technical aspects of hysteroscopy. Part m includes the different clinical applications of hysteroscopy. Part IV concerns special applications of hysteroscopy, and the Conclusion (Part V) contains the remarks of two distinguished American guests. Dr. Alvin M. Siegler presented a special lecture on Jan Palfijn (Chapter 29), and Dr. Louis G. Keith was asked to discuss the relationship between art and medicine at a banquet at the Rubens Mansion in Antwerp (Chapter 30).

In recent years there has been an impressive surge of interest in the mecha nisms which control the onset and the maintenance of labour. Much of it stems from a constant awareness that gestational age at birth is still an important factor in neonatal mortality and morbidity. Advances in the sensitivity and specificity of immunoassay, the discovery of the prosta glandins, new skills in fetal surgery and chronic catheterisation in experi mental animals have greatly stimulated further research in this area. In the meantime clinicians became continuously more aware that, despite consider able advances in perinatal medicine, gestational age at birth remains the major determinant of neonatal mortality and morbidity. It led them to seek new and better ways of controlling uterine function whether by influencing cervical ripeness, by stimulating or by inhibiting myometrial contractility. This volume uniquely combines knowledge which has been gained from both experimental and clinical research on parturition. A brief outline of current evidence on the control of parturition in experimental animals may be fruitful in delineating problems and hypotheses for further study in human pregnancy. Much of our present day knowledge of human parturition has been gained by checking such data against experimental findings, careful measurements and clinical observations in human pregnancy. It is hoped that the interdisciplinary nature of this volume will enhance the understanding of human parturition and stimulate further research in this area. Thanks are due to Miss H. Wittenberg and Mrs M."

With the emergence of the biological sciences in the seventeenth and eighteenth centuries, some explanations of congenital malformations with a basis in scientific fact were formulated. It was not, however, until the thalidomide tragedy in 1961 that the necessity for further study of the effects of environmental factors on congenital malformations was recognized. By the early 1970s concentrated efforts had begun to be directed toward evaluating the effects on the unborn child of mood-altering drugs taken during pregnancy. Over the past decade, research and treatment programs have led to the recognition of a full range of psychoactive drugs that affect the developing fetus either somatically or behaviorally. Programs for the treatment of the pregnant drug addict have been developed which concentrate not only on the pharmacologic therapy of the woman but also on the social and psychologic characteristics that place her and her unborn child at risk. This book is an attempt to bring together clinicians and researchers who have been active in developing programs for the recognition and management of the chemically dependent pregnant woman and her newborn. The contributions of the multiple disciplines which the authors represent emphasize the need for a multifactorial approach to the problems of drug use and abuse during pregnancy. It is hoped that through this type of approach a better future for substance-exposed infants, innocent bystanders in the process of addiction, can be assured. Ira J. Chasnoff vii Contributing Authors I. J. CHASNOFF, MD W.

Clinical management algorithms for common and unusual obstetric problems have been developed to help guide practitioners to the best treatment options for patients. In this quick-reference guide, clear diagrams and concise notes show treatment options and evidence for over 80 high-risk obstetric complications, presented in two-page full color spreads to promote quick decision making in time-pressed situations. This new edition includes sections on obesity, late-preterm and early term delivery, and pregnancy termination. As a clinical manual, the book provides guidance to many common and less common obstetric situations in which either the mother or her fetus is at risk. An algorithm for each situation provides obstetric care providers with a step-by-step guide of necessary actions for any given clinical case. Written by internationally renowned experts, Clinical Obstetric Algorithms enables all obstetrics care providers to ensure delivery of a healthy mother and a healthy baby.

It seems only yesterday that the fetus in utero accurately parameters of uterine activity, and they and the uterine environment were almost complete taught a systematic approach to the clinician's understanding of uterine physiology. Their work ly shrouded in mystery. The gender of the child was spread extremely rapidly' beyond the boundaries principally a matter of sheer speculation. Its size of their native Uruguay. The last 30 years have was estimated by abdominal palpation with notori seen a quantum leap in our understanding of fetal ous lack of accuracy. The growth pattern of the and uterine physiology. Nearly all of the old ques fetus was not a subject for serious study inasmuch tions-diagnostic, therapeutic, and prognostic as antenatal care and observations were not being systematically made. A question of whether the have been at least partly answered. The body of fetus had a severe malformation was dealt with as a new knowledge is now housed largely within the matter of fear rather than a subject to be seriously subspecialty of Maternal and Fetal Medicine. evaluated. The condition of the fetus in utero at a The author of this book arrived on the scene given time and the question of whether the fetus just after the critical mid-century turning point. would tolerate labor had not seriously been He was fortunate to come under the influence of Professor Raoul Palmer in France, to work in brought forward."

The subject matter in this volume was derived from papers presented at the Pediatric Andrology session of the 1st Pan American Congress of Andrology held in Caracas, Venezuela in February 1979, as well as from selected additional manuscripts of interest in this field. Prior to this session, identification of a distinct discipline and specialty devoted to pediatric andrology had not occurred, nor had it been conceptualized. Pediatric andrology encompasses many different areas: disorders of sexual development, structural disease of the genital organs, normal and abnormal puberty, undescended testes, genital tumors, gonadal function and its relationship to growth, virilization, fertility and gender identity all represent areas of specific interest, to name but a few. Andrology itself is a unique field, bringing together clinicians and basic scientists with diverse back grounds. It should be noted that between one-half and three-quarters of the clinicians contributing to this issue conduct basic research as well. It has been this unique blend of basic research and clinical medicine which has done much to unravel many of these problems characteristic of this field."