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."

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.

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).

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."

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."

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."

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 New World primates are becoming widely used in scientific and medical work in fields from anthropology to zoology, behaviour to urology. They have unique attributes for studies in cancer, infectious diseases, genetics, virology and reproduction. However, it is only now that their reproductive physiology is being clarified in any depth and this book is a first synthesis of that knowledge. The nine authors involved in this project have presented an up to date account of the major New World species used in biological and medical science. In addition to their distribution and conservation in the wild, essential biological data from laboratory studies are presented on reproductive cycles, gestation length, seasonal breeding, puberty and other factors. The major applications of these species in research are explored. Whenever possible, research workers should steer away from using endangered species in their studies. The New World monkeys used in research in any numbers are still fairly common ~n the wild, yet their greatest advantages are ~n their smalle size and high fecundity. This makes possible the establishment of self sustaining captive breeding colonies at a fraction of the time and cost necessary for the more conventional Old World laboratory primates. Consequently the drain on wild stocks need not be extensive as only breeding nuclei should be necessary.

This volume contains a collection of papers based on presentations made at the Reproductive Health Care International Symposium held in Maui, Hawaii, USA, October 1982. The papers evaluate biologic interactions be tween intrauterine contraceptive devices and the host, examine the risks associated with the use of these devices and describe aspects of technical progress in the field. The contributing authors bring their knowledge and expertise from four corners of the world to the readers. The editors wish to express their appreciation to the authors for their valuable contributions, to Carolyn K. Osborn for helpful assistance in editing the manuscripts and to MTP Press for accurate preparation and fine presentation of the material. It is hoped that this volume will serve to expand knowledge and generate further interest among its readers in the dynamic and fascinating field of intrauterine contraception. April, 1984 H.M. Hasson, MD Chicago, Illinois, USA ix 1 Ultrastructure of the decidual response to a progesterone releasing IUD U.M. SPORNITZ. K.S. LUDWIG and M. MALL-HAEFELI INTRODUCTION The ever-increasing world-wide use of the IUD has prompted intensive research into the physiology of its contraceptive action. From these studies it has become clear that the alterations in morphology as well as in the physiological milieu produced by the IUD are manifold and differ greatly with the type of IUD used."

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.

Highlighting over 50 hot topics where controversy exist in management of patients with gynecologic malignancy, this book presents expertly argued opinions for and against, incorporating current evidence and clinical trials outcomes. A diverse range of topics are included that pertain to several disciplines in gynecologic oncology, including surgical management of disease, medical oncology, immunotherapy, radiation therapy, as well as screening, preventive and palliative care. This book will be relevant to a diverse audience of practitioners and trainees including gynecologists, gynecological oncologists, surgeons, medical oncologists, radiation oncologists, and general medics. It will be a useful guide for practicing clinicians managing their patients, as well as a concise textbook for trainees and students preparing for examinations and board certifications in gynecologic oncology. Readers will gain an insight into topical controversies, critically evaluating the different sides to enhance their own clinical practice.

This is the most comprehensive book to be written on the subject of fetal MRI. It provides a practical hands-on approach to the use of state-of-the-art MRI techniques and the optimization of sequences. Fetal pathological conditions and methods of prenatal MRI diagnosis are discussed by organ system, and the available literature is reviewed. Interpretation of findings and potential artifacts are thoroughly considered with the aid of numerous high-quality illustrations. In addition, the implications of fetal MRI are explored from the medico-legal and ethical points of view. This book will serve as a detailed resource for radiologists, obstetricians, neonatologists, geneticists, and any practitioner wanting to gain an in-depth understanding of fetal MRI technology and applications. In addition, it will provide a reference source for technologists, researchers, students, and those who are implementing a fetal MRI service in their own facility.

A panel of top experts in perinatal psychiatry reviews the many recent studies on the use of psychiatric medications in pregnancy and postpartum and assesses their impact on the diagnosis and treatment of pregnant/postpartum women. The authors focus on each of the major psychiatric illnesses, including depression, anxiety disorder, bipolar disorder, schizophrenia, substance abuse, eating disorders, and mental illness, as well as on the potential impact of these illnesses on infants and children. Interpreting conflicting and inconclusive clinical findings, they spell out the lesser-known risks of prenatal medication exposure and illuminate a variety of issues that must be taken into account in choosing such treatments as medications, psychotherapy, parental education, and social skills training.

Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. Providing a state-of-the-art analysis of the connection between insulin resistance and PCOS, this book comprehensively covers a range of topics. It provides an up-to-date and balanced overview of PCOS, with specific attention to the role of insulin resistance in its pathogenesis. It also examines diet and lifestyle factors in the aetiology and management of PCOS.

Half of all women will experience some form of debilitating pelvic disease or discomfort during their lifetime. These will include chronic urinary tract infections, various kinds of incontinence, pelvic floor prolapse, and interstitial cystitis. There has been a tendency to dismiss many symptoms of these disorders as an inevitable consequence of the aging process or, worse still, as indicators of underlying psychological disease. This concise new book suggests a new approach to urinary tract disorders is long overdue. It sympathetically explains what these diseases are and what women can do to get themselves properly diagnosed and treated.

Breast cancer is the leading cause of cancer-related deaths in women, and its prevalence has been steadily rising in recent decades. This book describes morphologic and kinetic signs that are important in the analysis of breast MR images before and after contrast administration and in various pulse sequences. It will help broaden the clinical application of MRM so that as many physicians as possible can make more accurate diagnoses.

Gestational Diabetes Mellitus is becoming an increasingly prevalent disease as obesity and other chronic diseases are on the rise. It requires careful and informed clinical management as the care received during pregnancy affects not only perinatal health but the risk of developing type 2 diabetes even decades into the future, in both the mother and the child.From epidemiology and pathophysiology to diagnosis and management, covering recent breakthroughs in research and up-to-date developments in clinical practice, Gestational Diabetes During and After Pregnancy offers the reader a comprehensive and current look at Gestational Diabetes. Anyone involved in the research, public health or clinical aspects of Gestational Diabetes will find this volume a valuable aid in consolidating all recent developments regarding this disease.

As controlled trials have demonstrated that in many European countries breast cancer mortality may be reduced by population-based mammographic screening of women over the age of 50, there is mounting pressure to introduce new service screening programmes. How should these programmes be planned and monitored ? Is it cost-effective ? We invited experts whowork with the principal screening programmes in Europe to answer these questions and to describe their experiences. Particualr attention has been given to planning, organisation and monitoring new screening programmes in order to achieve optimal results.

As our understanding of the human body broadens, so does the need for a comprehensive text that encompasses all aspects of human development. Essential Human Development is a great course companion that focuses on the human life cycle, ideal for the undergraduate student new to these fields, or for qualified practitioners looking for a reference guide. Featuring key information points and self-test assessments in each chapter, the book is organised in an accessible manner, beginning with fertilisation and embryology, then moving on to obstetric medicine, neonatal care and child health, with the final section exploring gynaecological medicine. Ensuring that information is placed in context to aid understanding, Essential Human Development is the perfect support for the modern medical school curriculum, as well as a vital reminder of the core information needed whilst on a women or child health clinical placement.

Minimally Invasive Gynecologic Surgery provides a complete, practical and timely review of the minimally invasive surgical techniques used to treat gynaecologic diseases and conditions. Recent advances in technology and instrumentation, particularly the use of robot-assisted surgery, mean that minimally invasive approaches have become increasingly established as alternatives to traditional open surgeries. This book describes the full range of minimally invasive procedures in current gynaecologic practice, with discussion of the indications and contraindications and a summary of available evidence. The book opens with a section describing instrumentation, electrosurgery, how to avoid and manage complications and single port surgery. Subsequent sections cover procedures for benign and malignant conditions and relevant robotically assisted surgeries. Highly structured chapters provide practical guidance to key steps of each procedure, alternative management options; contraindications and available evidence Stellar contributors from leading centers in the USA, Brazil, Chile, Canada, France, Italy and Belgium ensure coverage reflects global best practice

This book aims to provide updated facts and treatments for practicing gynecologists and postgraduate doctors to enhance their understanding of pathogenesis, pathology, symptoms and diagnostic imaging technology of adenomyosis, such as to select appropriate treatments, to improve the symptoms, fertility and the quality of life of women with adenomyosis. This book also particularly introduces the new treatment for adenomyosis using the non-invasive High Intensity Focused Ultrasound ablation treatment. Hopefully, it will provide a better understanding of its operation, effectiveness, and pregnancy outcome, to formulate a more successful treatment strategy for this disease.

A new addition to the "Gynecology in Practice" series, "Chronic Pelvic Pain" provides a practical guide to diagnosing and treating chronic pelvic pain in women. Emphasizing diagnosis, management and psychological aspects, the book assists gynecologists to better care for their patients suffering from this condition. As a part of the series, various feature boxes are highlighted throughout. "Tips and Tricks" give suggestions on how to improve outcomes through practical technique or patient questioning. In addition, "Caution" warning boxes supply helpful advice on how to avoid problems and "Science Revisited" boxes offer quick reminders of the basic science principles necessary for understanding the presented concepts.

Practitioners of obstetrics, maternal-fetal medicine and consultants in other branches of medicine who help provide excellent care to pregnant patients with hypertensive complications of pregnancy will welcome this compendium about HELLP Syndrome. Drawing upon the expertise of 37 contributors from 15 institutions and four countries, this book summarises the state of the science and practice for patients with HELLP syndrome. On a global basis, what we call HELLP syndrome accounts for hundreds to thousands of maternal deaths and is responsible for many more thousands of patients that suffer "near miss" mortality, which we more properly term "severe maternal morbidity". Our understanding of this pregnancy scourge -- the basic science or bench aspects -- is still relatively inadequate to fully comprehend the pathogenesis and the pathophysiology of this condition as it relates to its close relative, the syndromic disorder of preeclampsia. Although a corticosteroid-based management scheme has shown great promise in practice and has a strong physiologic basis, there remains a need for a high quality, large-scale (1000+ patients) constructed, prospective placebo-controlled clinical trial involving a heterogeneous patient population to fully and objectively evaluate this approach to practice. The need and the urgency are great given the risk of HELLP to mothers and babies.