On the occasion of the symposium on Hypertension in Postmenopausal Women (Monte Carlo, January 19-22, 1994), international scientists and clinicians discussed the various aspects of high blood pressure in older women. This volume presents an overview of this important aspect of both cardiology and gynecology. Special emphasis is given to the different approaches to antihypertension treatment.

Here, the author clearly guides you through the necessary steps to controlling your gestational diabetes and reducing the risks for both you and your child.

The task of updating the classification was given to the Classification and Nomenclature Committee of the International Society of Gynecological Pathologists and its four subcommittees. This classification reflects the present state of knowledge and modifications are almost certain to be needed as experience accumulates. Since many of the tumours and tumour-like conditions in the classification occur in several sites in the female genital tract, cross-referencing from one site to another has been done in illustrating these lesions.

Why is it that women suffer far more than men from insomnia? What is the connection between the hormonal changes that a woman undergoes during her lifetime, and difficulty in falling asleep? What is the effect of cell phones on sleep? Should women engage in sports before going to sleep? What do women primarily dream about? In which country do people sleep the most? How do depression and anxiety affect sleep? And why is it inadvisable to resort to a "little pill" to provide unworried sleep? This clear and readable book, illustrated with short quotations of poetry and prose about sleep and dreams, provides a glimpse into the wonderful mechanism of sleep, explains how correct treatment of sleep disturbances results from understanding their causes, and shows the right path to a pleasant and satisfying night's sleep; it will be of great interest for all women and clinicians dealing with female patients. In particular, because of the connection between sleep and hormones, problems with sleep have repercussions for women's reproductive life cycle. This pioneering text will therefore be of particular interest to gynecologists working in Reproductive Medicine.

The main focus of this new edition remains the practical assessment and management of people presenting with psychiatric symptoms in late life. The core of the book describes the common presentations of depression, confusion, somatic preoccupation, hallucinations and delusions. Case vignettes are used to illustrate the approach to clinical problems. There is special emphasis on the complex interaction of social, psychological and medical factors and the need for close multi-disciplinary teamwork. The new edition has been revised to: update the clinical approach, update patient management under new policies, provide a precise diagnostic system and structure the book in keeping with today's practice.;This book should be of interest to postgraduate students in psychiatry or geriatrics; medical students; clinical psychologists; and nurses and other health professionals.

Biochemical monitoring of the fetus has been in the back of every perinatologist's mind. Technological advancements have been made in the last ten years but not to the expected level. A continued interest in the subject can only be maintained by symposiums of this nature where perinatologists from different countries can share their experience. Laserspectroscopy of the fetus is a valuable addition to this volume. The future of biochemical monitoring of the intrapartum fetus depends on the continued collection of scientific data and further technological advances. This successful symposium was held in October, 1990, in Albuquerque, New Mexico, USA. I would like to thank Hewlett Packard for their generous support without which this publication would not have been possible. My sincere thanks goes to my secretary, Nancy Whalen, who has done a tremendous job with the word processing, organization, and layout of the chapters. Molly S. Chatterjee, M. D. Associate Professor University of New Mexico Department of Obstetrics & Gynecology CLINICAL IMPORTANCE OF BIOCHEMICAL MONITORING OF THE FETUS DURING LABOR WITH DEMONSTRATION OF TYPICAL CASES E. SALING, J. BARTNICKI Institute of Perinatal Medicine, Free University of Berlin, Berlin, Germany The biochemical monitoring of the fetus during labor is historically the oldest part of prenatal medicine. The very first direct approach to the human fetus took place on June 21, 1960 when the first blood samples were taken from the fetal scalp in our labor room (3).

Fibroids are benign growths of the uterus. They are the most common tumours found in women (20-30% of women), usually in later reproductive years. This book covers evidence-based indications for treatment of uterine fibroids in gynecology, the management of fibroids in pregnancy, surgical treatments and outcomes, rare fibroid syndromes, and more.

This work attempts to sketch a coherent picture of the amniotic fluid com partment, its borders, and the interactions occurring between fetus and amniotic fluid, for it is this compartment which for 10 months provides the habitat in which the fetus and its functions develop. As a matter of course, our mor phological studies had to be limited to the situation prevailing at the full term of pregnancy. This portrayal purposely neglects the placenta, which is already the subject of an extraordinary profusion of literature. The other aspects of the embryonic sac have been overshadowed to date by the preeminent role 2 of the placenta, although they represent around 1200cm of contact surface in the maternal compartment. From our point of view, the fetal membranes not only act as a seal or simply a diffusion barrier, but actively participate in the exchange processes between compartments. The author also took pains to compile (albeit incompletely) the widely scattered findings reported in clinical journals in order to present them as a well-rounded summary of the mor phological picture and the functional happenings involved in fetal develop ment. The author's own studies of a specifically histomorphological nature provided the groundwork for this synopsis. A special branch of embryology, embryonal physiology, is treated only incidentally in today's embryology textbooks. This work offers several encounters with this field, which should help make it the focus of greater interest. 2 Definition of Terms Fig. 1.

This book was prepared to present an integrated review of selected topics in Human Embryology. It is designed specifically for students who completed stan dard courses in the various anatomical disciplines and who wish to review the developmental history of the major organ systems. This book will provide medical students with a highly suitable review for Step 1 of the United States Medical Licensing Exam (USMLE, Step 1). R. E. Coalson J. J. Tomasek Acknowledgments We wish to acknowledge the invaluable assistance provided by our colleagues at the University of Oklahoma Health Sciences Center during preparation of this review. In particular, we would like to thank Ms. Nancy Halliday for proofread ing, Mr. Shawn Schlinke for preparation of the illustrations, Mr. Melville Vaughan for assistance with mounting the illustrations, and Ms. Trenda Tanner for assis tance with the typing. Contents Preface to the Oklahoma Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii 1. Gametogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Female Reproductive Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Fertilization and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 4. Implantation and Formation of the Deciduae . . . . . . . . . . . . . . . . . . . . 15 5. Formation of the Placenta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 6. Fetal Membranes and Umbilical Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 7. Early Development of the Conceptus 26 8. Development of General Body Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 9. Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 10. Musculoskeletal System . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 11. Integumentary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 12. Oral Cavity and Development of the Branchial Apparatus . . . . . . . . 62 13. Differentiation of the Branchial Apparatus . . . . . . . . . . . . . . . . . . . . . . . 66 14. Face and Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 15. Digestive System and Mesenteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 16. Diaphragm and Body Cavities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 17. Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."

This text draws together the principal issues related to the identification of language difficulties in pre-school children. Factors closely associated with the development of language such as cognitive skills, play, behaviour and hearing are discussed. The basic principles underlying early identification, the role of the parent and the issue of early identification within the context of public health are also included.;To reflect the range of related professionals involved with language impaired children, there are chapters written by a health visitor, a psychiatric social worker and speech and language therapists specializing in hearing loss. This book should be a useful reference for all those professionals working with children in the health and education setting.;This book should be of interest to practising and student speech therapists, nurses, health visitors, paediatric nurses, nursery leaders, play group leaders, clinical medical officers, educational and clinical psychologists.

In the USA, severe psychiatric illness after childbirth strikes one woman for every 1000 births, or about 3500 women each year. An unrecorded number of new mothers experience lesser degrees of postpartum illness, and two distinct forms of severe illness can be distinguished. One form, called postpartum psychosis, is an agitated, very changeable condition, often characterized by confusion, hallucinations, delusions and sometimes episodes of violent behaviour. The other condition, major postpartum depression, begins two or three weeks after childbirth, and is characterized by confusion, depression of mood, and often with exhaustion, headache and digestive upset. Mixtures of the two severe disorders occur frequently. This volume contains a number of essays which support the position that postpartum disorders are primarily organic and are mainly disorders of hormonal deficit. They develop as the endocrine system falls back from the hyperactivity of pregnancy toward or beyond the levels of the prior non-pregnant state. Tremendous therapeutic opportunities exist or are imminent for both the organic and the psychological components of postpartum mental illness.

Gynecologists cannot fulfill the commitments of their profession without being psychosomatically oriented. Nevertheless, this field needs methodology and scientific thinking just as does any other subspeciality in clinical medicine. Although practiced by all gyne cologists, creative work is needed in order to develop the various aspects properly and to establish postgraduate training on a firm and sound basis. For this purpuse the European Symposia have been planned by several European Researchers on Psychosomatic Obstetrics and Gynecology in order to stimulate and integrate clinical scientific data and therapeutic skills in the bio-psycho-social field of obstetrics and gynecology. The first European Symposium in Leuven 1985 concentrated on the psychosomatic aspects of infertility and high risk pregnancies. This second European Symposium in Bad Sackingen centered around disturbed body perception, disturbances of the menstrual cycle, climacteric syndrome, and senium. These topics were elaborated in main lectures and workshops held by outstanding researchers in this rapidly expanding field. The second European Symposium on Psychosomatic Obstetrics and Gynecology was organized by the German Society of Psycho somatic Obstetrics and Gynecology, supported by the University Hospital Freiburg/Br., the University Hospital Basel, and the Women's District Hospital in Bad Sackingen."

Probleme bzw. Funktionsstorungen im Blasen- und Beckenbodenbereich sind weit verbreitet. Sie reichen von ungewolltem Urinverlust, Blasenentleerungsstorungen bis hin zu Schmerzen in kleinem Becken und Kreuz.

Die Integraltheorie, abweichend von traditionellen Lehrmeinungen, berucksichtigt gesamtheitlich alle beteiligten Strukturen des Beckenbodens und setzt sie in Beziehung zu deren Funktionen. Sie fusst auf dem Gedanken Rekonstruktion der Form und Struktur ermoglicht die Wiederherstellung der Funktion." Fur das Verstandnis der dahinterstehenden Theorie sind anatomische und physiologische Grundlagen aus spezieller integraltheoretischer Sicht bedeutungsvoll.

Die Autoren des Buches, Begrunder der Integraltheorie, fuhren in leicht verstandlicher Weise durch funktionelle Anatomie, Physiologie und Pathophysiologie. Physikalische Begriffe sowie die nuchterne Theorie werden vereinfacht und einleuchtend erklart. Kenntnisreich und detailliert erlautern sie die praktische Anwendung in Diagnostik und rekonstruktiver Beckenbodenchirurgie.

Mit uber 300 farbigen Abbildungen, die den Text hervorragend erganzen."

Endorphins and other endogenous opioids appear to be the connecting link between reproductive functions and stress adaption of the human organism. This book contains the con- tributions of an international group of biologists, bioche- mists, and endocrinologists on the opioidergic control me- chanisms in reproduction and stress physiology. Main topics covered are: endogeneous opioids and the pituitary-gonadal system; ovarian endorphinsecretion; pregnancy-associated changes of plasma endorphin; and opioid control of the hypo- thalamo-pituitary-adrenal axis. Although all chapters give an excellent review on various studies in basic opioid re- search, there are numerous clinical implications mentioned in this book.

During the past 20 years, endometrial carcinoma has continued to increase in frequency and it is quite possible that this carcinoma will become the major gynecologic malignancy in the future. For many years, endometrial carcinoma was considered less malignant than other gynecologic malignancies, simple hysterectomy and bil ateral salpingo-oophorectomy or surgery combined with radiation being effective in certain circumstances. It is unfortunate to note that the global 5-year survival rate for patients with advanced or recurrent endometrial carcinoma has improved only slightly. Therefore any complacency regarding this 'benign malignancy' should be reconsidered. There is a growing awareness of the nature of end ometrial carcinoma, with advances in our knowledge ranging from its etiology through its epidemiology to its clinical findings. This volume has been designed to fill a hiatus in the literature in China. To achieve this aim, we have attempted to review the world-wide advances on endometrial carcinoma and summarize systematically and comprehensively this common gynecologic malig nancy, including the clinical experiences gathered at the Cancer Institute (Hospital) of the Chinese Academy of Medical Sciences since 1958 as well as a brief description of the psychological problems in patients with gyneco logic cancers."

Doppler ultrasound is a hot topic at the present time. This is because studies of the uteroplacental and fetal circulation give fundamental information as to the physiology or pathology of placental function and the response of the fetal circulation to hypoxaemia. Dr. Arabin's clinical studies which are described in this book are an important contribution to knowledge in this field and will be of enormous interest not only to researches but also to clini cians interested in learning how this latest technology can be integrated into their clinical practice. London STUART CAMPBELL Foreword Although only three decades old, the field of perinatal medicine is marked by continuous new advances. Ultrasound diagnostic techniques comprise an important element of this new field. Dr. Arabin has taken the initiative to investigate the functional-diagnostic aspects of ultrasound. Among other things, she has further developed and refined the concept of "oxygen-con serving adaptation of fetal circulation" which originated in the Department of Obstetrics and Gynecology at the Neukolln Hospital Center in 1966. She thus has been able to show that the most reliable Doppler blood flow meas urement predictors of a high risk to the fetus are (1) a decrease in the flow volume of the descending thoracic aorta and the umbilical artery and (2) an increase in the flow volume of the common carotid arteries."

Female genital plastic surgery has become an increasingly sought-after option for women seeking improvement in genital appearance, relief from discomfort, and increased sexual pleasure. These surgeries are a combination of gynecologic, plastic, and cosmetic procedures. Every year sees a higher demand for physicians properly trained and able to perform them. This unique text from the acknowledged experts in the field covers; * the anatomy of the area * the specific surgical procedures and all their variations * patients' rationales for surgery * training guidelines and ethical issues * outcome statistics * sexual issues * patient selection * potential risks and complications. Examining the issues from individual patient's perspectives, it is written in an academic but easy-to-read style with understandable and unambiguous drawings and photographs. It contains a step-by-step surgical approach, how to best select the right surgical candidates, how to treat this select group of patients, the sexual issues involved, how to individualize techniques for each specific patient, how to deal with criticism from colleagues or journalists, psychosexual issues, and patient protection.

Ein Screening auf angeborene endokrine und metabole Stoerungen ermoeglicht die Fruherkennung von Krankheiten wie Hypothyreose, AGS (adrenogenitales Syndrom), Phenylketonurie, Galaktosamie, Biotinidasemangel, Cystische Fibrose oder Homocystinurie. Je nach Land und politischen Bestimmungen unterscheiden sich jedoch die routinemassig durchgefuhrten Untersuchungen. Dieses Handbuch beschreibt praxisbezogen die biochemischen Grundlagen, die Grundsatze der Labor- und Bestatigungsdiagnostik sowie Therapiemoeglichkeiten zu insgesamt zwoelf Krankheiten. Daruber hinaus werden praanalytische Fragen, wie Zeitpunkt und Art der Blutentnahme oder moegliche Stoerfaktoren, umfassend behandelt. Der allgemeine Teil geht auf ethische und psychosoziale Aspekte des Screenings ein. Ein Verzeichnis der Screeningzentren und jener Labors, die fur die Bestatigungsdiagnostik Dienste anbieten, sowie ein Adressenverzeichnis von Elterngruppen und Informationsquellen im Internet komplettieren dieses Buch.

Ihaltsverzeichnis.- I Allgemeiner Teil.- 1 Psychische Unterstutzung und Selbsthilfegruppen.- 1.1 Psychischer Unterstutzungsbedarf.- 1.1.1 Angst.- 1.1.2 Depressionen.- 1.1.3 Psychosoziale Betreuung.- 1.1.4 Sexualberatung.- 1.1.5 Beeinflussung des Tumorleidens durch Psychotherapie.- 1.1.6 Fatigue.- 1.1.7 Aufklarung.- 1.1.8 Aufgaben der Rehabilitationsklinik und des Rehateams.- 1.1.9 Aufgaben der Seelsorge.- 1.1.10 Angehoerige und Angehoerigenbetreuung.- 1.1.11 Vorsorgevollmacht - Patientenverfugung.- 1.1.12 Gesundheitstraining.- 1.1.13 Assessment, Verlaufsbeurteilung und Evaluation.- 1.2 Selbsthilfegruppen.- Literatur.- Internet.- 2 Soziale Hilfen.- 2.1 Hilfen von Beratungs- und Betreuungsinstitutionen.- 2.2 Hilfen und Beratungsangebote durch die gesetzlichen Krankenkassen.- 2.3 Anspruch auf Leistungen der Pflegeversicherungen.- 2.4 Beratungsstellen fur Krebsbetroffene.- 2.5 Nachteilsausgleiche, Vergunstigungen fur Schwerbehinderte.- 2.6 Eigenleistungen des Patienten, Zuzahlungen.- 2.7 Hartefallbestimmungen, Sonderfallregelungen, unzumutbare finanzielle Belastungen bzw. Wegfall von Zuzahlungen.- 2.8 Lebensversicherung.- 2.9 Voraussetzungen zur Durchfuhrung von Rehamassnahmen.- 2.10 Koordination und zeitlicher Ablauf der Rehabilitationsmassnahmen.- 2.11 Stationare Rehabilitationsmassnahmen, Anschlussheilbehandlungen und Kuren.- 2.12 Teilstationare Rehabilitationsmassnahmen/ambulante Rehabilitationsmassnahmen.- 2.13 Zugangswege zur Rehabilitation.- 2.14 Stationare und ambulante Hospiz- und Palliativdienste.- 2.15 Assessment.- 2.16 Qualitatssicherung.- 2.17 Wichtige Adressen.- Literatur.- 3 Berufliche Hilfen.- 3.1 Arbeit und Rehabilitation.- 3.2 Karzinogene Substanzen am Arbeitsplatz.- 3.3 Beurteilung der beruflichen Leistungsfahigkeit - Die sozialmedizinische Begutachtung.- 3.4 Berufliche Reintegrationshilfen.- 3.5 Mindestvoraussetzungen fur eine Rente.- 3.6 Altersteilzeit.- 3.7 Rente auf Zeit.- 3.8 Rentenberatung.- 3.9 Assessment und Evaluation.- 3.10 Wichtige Adressen.- Literatur.- II Spezieller Teil.- 4 Mammakarzinom.- 4.1 Nachsorge.- 4.1.1 Rezidivprophylaxe (adjuvante Hormon-, Chemo-, Strahlen- und Immuntherapien).- 4.1.2 Diagnostische Routinenachsorgeuntersuchungen mit dem Ziel einer Rezidivfruherkennung.- 4.1.3 Aufklarung der Patientin bei Feststellung einer Krankheitsprogression.- 4.1.4 Rezidivtherapien.- 4.2 Rehabilitative Massnahmen.- 4.2.1 Rehabilitationsmassnahmen zur Verminderung der koerperlichen Probleme ("Reha vor Invaliditat").- 4.2.2 Rehabilitationsmassnahmen zur Verminderung psychischer Probleme ("Reha vor Resignation und Depression").- 4.2.3 Rehabilitationsmassnahmen zur Verminderung sozialer Probleme ("Reha vor Pflege").- 4.2.4 Rehabilitationsmassnahmen zur Verminderung beruflicher Probleme ("Reha vor Rente").- 4.3 Palliative Massnahmen.- 4.3.1 Lokale/lokoregionare Probleme.- 4.3.2 Systemische palliative Therapien.- 4.4 Massnahmen zur Qualitatssicherung (Strukturqualitat, Prozessqualitat und Evaluation) palliativer unq rehabilitativer Massnahmen.- 4.4.1 Strukturqualitat.- 4.4.2 Prozessqualitat.- 4.4.3 Evaluation palliativer und rehabilitativer Massnahmen.- 4.5 Wichtige Adressen.- 4.5.1 Brustkrebsinitiativen - Hilfsorganisationen fur Brustkrebs.- 4.5.2 Adressen von Selbsthilfegruppen.- 4.5.3 Verschiedene hilfreiche Adressen.- 4.5.4 Internetadressen.- Literatur.- 5 Ovarialkarzinom.- 5.1 Nachsorge.- 5.1.1 Rezidivprophylaxe (adjuvante Radio-, Chemo- und Immuntherapien).- 5.1.2 Nachsorgeuntersuchungen.- 5.1.3 Aufklarung der Patientin bei Feststellung einer Krankheitsprogression.- 5.1.4 Rezidivtherapien.- 5.2 Rehabilitative Massnahmen im Rahmen der Nachbetreuung.- 5.2.1 Rehabilitationsmassnahmen zur Verminderung der koerperlichen Probleme ("Reha vor Invaliditat").- 5.2.2 Rehabilitationsmassnahmen zur Verminderung der psychischen Probleme ("Reha vor Resignation und Depression").- 5.2.3 Rehabilitationsmassnahmen zur Verminderung sozialer Probleme ("Reha vor Pflege").- 5.2.4 Reha

The number of diabetics in the elderly population is increasing rapidly, not merely because of the increasing size of the elderly population itself. In elderly people diabetes is often poorly diagnosed and occurs as a consequence of, or in addition to, some other condition. Although diabetes may manifest itself less dramatically in the elderly there is evidence to suggest that diabetes-related complications do arise more rapidly in this group. It is therefore extremely important that doctors and health professionals can spot the symptoms of diabetes at an early stage. This book provides a concise description of diabetes in the elderly as well as discussing related complications and should be useful to all health workers dealing with elderly people.;This book should be of interest to all health professionals working with elderly people.

Einfuhrung zur psychosomatischen Frauenheilkunde; Zur Arzt-Patient-Beziehung in der Frauenheilkunde; Aspekte der psychosomatischen Geburtshilfe; Symptome in der Schwangerschaft mit einer moeglichen Psychogenese; Psychosomatische Aspekte der Geburt; Psychosomatische Aspekte des Wochenbetts; Psychosomatische Gynakologie; Symptome und Krankheitsbilder in der Psychosomatischen Gynakologie; Psychosomatische Aspekte kritischer Zeitabschnitte; Askekte der angwandten psychsomatischen Frauenheilkunde; Entwicklungen und Zukunftstendenzen in der psychosomatischen Geburtshilfe und Gynakologie