Klinefelter's syndrome occurs relatively frequently, being diagnosed for one in 600 male infants, yet it is probably very rare that it is recognized early enough to make effective treatment possible. Often the person afflicted does not go to a doctor until physical and emotional disturbances have developed on the ba sis of the syndrome. The appropriate therapy at the correct time can prevent many of these disturbances. In our andrology outpatient clinic we encountered Klinefelter's syndrome almost three decades ago in patients suffering from impotentia generandi. It was not until later that we dealt with it in our capacities as dematologists. It was observed at a rate too high to be coincidental among younger men suffer ing from ulcera crurum. On the other hand, we failed to see the condition during our work as con sultants in other specialities, especially internal medicine, although we re peatedly attempted to identify it. We should have encountered it at least occa sionally in our 10 years working in the Munich hospitals with their more than 4000 beds. It was this imbalance between the allegedly relative frequency of this condition and its rare detection which led us to plan a Klinefelter sympo sium. We soon determined, during a first search of the literature, that there was information in many more subject areas that we had expected or even guessed."

Mehr als 40.000 Behandlungsfehler werden Medizinern jedes Jahr vorgeworfen - Tendenz steigend. Die Auswirkungen koennen gravierend sein. Umso wichtiger sind detaillierte Kenntnisse uber das richtige Vorgehen nach einem Vorfall. Das Werk zeigt anhand von Fallbeispielen aus der Praxis, wie AErzte sich im Schadensfall richtig verhalten. Erlautert werden u. a. der Umgang mit Angehoerigen, die aussergerichtliche Einigung, die zivil-und strafrechtliche Auseinandersetzung vor den Gerichten sowie die Rolle von Versicherungen, AErztekammern und Krankenhausern.

In 1980 the Directorate-General of Labor, Ministry of Social Affairs and Employment, the Netherlands, requested the Coronel Laboratory for Occupational and Environmental Health, Faculty of Medicine, University of Amsterdam, to carry out "a critical study of literature on health risks to women from industrial and occupational exposure to chemical agents which are different from risks to male workers, or which have only been observed in female workers. " The principal investigator was Mrs. A. Stijkel, medical biologist; a part of the study was carried out by R. L. Zielhuis, physician. M. M. Verberk, physician, and Mrs. M. v. d. Poel-Bot, librarian, provided continuous assistance. The final report (in Dutch) covering the literature up to and including 1981, was submitted to the government in October 1982. A somewhat abridged and modified English text, updated to include 1982, was prepared. The Editorial Board and the publisher of the International Archives of Occupational and Environmental Health kindly made possible the publishing of this text in a special issue of the journal. The authors express their thanks to the Directorate-General of Labor, the Editorial Board and the publisher for making this publication possible. We sincerely hope that this report will be of assistance in making the industrial and occupational environment safer. Prof. Dr. R. L. Zie1huis Table of Contents Introduction 1 1 1. 1 Objective 1 Theoretical Possibilities for Extra Health Risks in Female 1. 2 Workers. 2 1. 2. 1 Differences Between Women and Men Apart from Reproduction .

Cut It Out examines the exponential increase in the United States of the most technological form of birth that exists: the cesarean section. While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland. How did this happen? Theresa Morris challenges most existing explanations of the unprecedented rise in c-section rates, which locate the cause of this trend in physicians practicing defensive medicine, women choosing c-sections for scheduling reasons, or women's poor health and older ages. Morris's explanation of the c-section epidemic is more complicated, taking into account the power and structure of legal, political, medical, and professional organizations; gendered ideas that devalue women; hospital organizational structures and protocols; and professional standards in the medical and insurance communities. She argues that there is a new culture within medicine that avoids risk or unpredictable outcomes and instead embraces planning and conservative choices, all in an effort to have perfect births. Based on 130 in-depth interviews with women who had just given birth, obstetricians, midwives, and labor and delivery nurses, as well as a careful examination of local and national level c-section rates, Cut It Out provides a comprehensive, riveting look at a little-known epidemic that greatly affects the lives, health, and families of each and every woman in America.

Why another dermatology text? In 1973, when Drs. Nasemann and Sauerbrey wrote the introduction to the first edition of Haut krankheiten und venerische Infektionen. they addressed this question. They promised their book would be concise and profusely illustrated to best teach the fundamentals of dermatology. The German text, now in its fourth edition, has been widely successful. In undertaking an American revised translation of their work, it was my hope to meet a need in the English-language literature similar to that met by the German text. I believe that both students and non dermatologic physicians will find this volume a useful introduction to the art and science of treating skin disorders. The practice of dermatology differs from country to country. This text is therefore not simply a translation, but an adaptation that incorporates much new material. In the pages that follow, I have built on the successful framework of the German text, incorporating its excellent photographs and other teaching aids. Discussion of therapy has been extensively revised to reflect current practice in the United States. Original chapters on male infertility and proctology (two dermatologic domains in Germany) are not included in this book. They have been replaced by wholly new chapters on cutaneous surgery and tropical dermatology. We are grateful to Ronald G. Wheeland, M.D., for contributing the surgical chapter.

The Sixth International Congress of Psychosomatic Obstetrics and Gynecology, which took place from 2 to 6 September 1980 in the congressional chambers of the former Reichstag building in Berlin, had as its theme "Women in a Changing Society." Partic ular emphasis was placed on the fact that in illness, as well as in good health, women must be considered in a comprehensive psychosocial context. Observations from medi cal, psychological, sociological, and anthropological perspectives on the healthy and sick woman through the various stages of her life presented a wide spectrum of scien tific research. Sessions covering such fundamental topics as the problems of the young mother, women in the postgenerative phase, and the early mother-child relationship were enriched by many recent scientific contributions. Further subjects, ranging from the dialogue in the gynecologist's consulting room through the emotional situation of the gynecologist, body language in female sexuality, and sexual disorders experienced by gynecological patients to psychosomatics and cancer, were pursued in small workshops. Of particular psychoendocrinological interest were the contributions on obesity and the premenstrual syndrome. The results of this workshop and another on unwanted pregnancy have ap peared recently in separate monographs."

Biochemical tests of fetal well-being ('placental function tests') have been part of routine obstetric practice for more than twenty years. This book provides an overview of the current status of these tests - the physiological basis for their use, and their advantages and limitations in clinical practice. Considerable attention is given to interpretation, a subject which in the past has led to much confusion both in the scientific literature and in the minds of clinicians. Recent advances are described in detail, in particular the discovery of a whole new generation of placental products some of which offer great promise in the prediction of conditions, such as placental abruption and premature labour, which cannot be identified by any other current parameters. Finally, a set of clear recommendations is put forward for the choice of test in most of the common complications of both early and late pregnancy. The emphasis throughout is on how the basic biology of fetoplacental products dictates their use and interpretation in pathological conditions.

Everyone involved in obstetric practice at the present time will be well aware oft he complexities of drug interactions in the mother and fetus, and newborn infant. Perhaps the most spectacular manifestations of these drug interactions are those that result in teratogenic effects, but the implications of drug therapy generally in pregnancy range far wider than the hazards of inducing fetal malformation. It must also be realised that there are hazards in withholding some therapeutic agents from pregnant women, and these hazards have to be weighed against the dangers of indiscriminate drug therapy. It is often very difficult to obtain relevant information about any given compound in relation to its use in pregnancy, and it is therefore appropriate to provide a handbook which brings together information about a wide variety of drugs in a form which allows ready access for the practising clinician. Rodney Ledward first discussed this project with me some years ago, and it seemed to me at the time that with his background as both a pharmaceutical chemist and an obstetrician that his talents were particularly well suited to this task. In conjunction with Professor Hawkins, he has produced a concise reference book for use in clinical practice, which I feel confident will prove to be invaluable to all those practising obstetrics at all levels of seniority. The book covers the use of drugs during pregnancy, but it also includes sections on the transfer of drugs into breast milk.

Die Ovarialtumoren gehoren heute mit zu den haufigsten Tumoren des weiblichen Genitale. Ihre morphologische Differentialdiagnostik und die sich darauf aufbauende gezielte Therapie ist aufgrund der Vielfalt dieser Tumoren ungleich viel komplizierter als in anderen Organen. Dement- sprechend liegt der Schwerpunkt dieses Buches auf dem Gebiet der Histo- pathologie. Spezialkenntnisse insbesondere tiber die selteneren Formen der Ovarialtumoren hangen von groBen Fallzahlen abo Hier ist der inter- nationale Erfahrungsaustausch von vorrangiger Bedeutung. Die derzeit weltweit anerkannte histogenetische Klassifikation der WHO erfahrt an- hand der Erfahrungen an drei deutschen Frauenkliniken kleine Erganzun- gen und Variationen. Einige Lander, Z. B. Israel verfUgen tiber groBe epi- demiologische Untersuchungen, deren Ergebnisse korrelierend aufgenom- men sind. Zur klinischen Diagnostik wurden in den letzten lahren mo- dernste Untersuchungsmt;thoden neu eingefUhrt; ihre Anwendung setzt jedoch individuell anzupassende kritische Indikationsstellungen voraus. AbschlieBend werden die sich sehr differenziert auf der histologischen Diagnostik aufbauenden modernen Moglichkeiten einer gezielten Thera- pie der Ovarialtumoren ausfUhrlich diskutiert. Hier steht die Chemothera- pie im Vordergrund. 1m Hinblick auf die Frage einer Hormonbehandlung kommt neuerdings auch dem Rezeptornachweis im Tumorgewebe Bedeu- tung zu. Diese Zusammenstellung spricht somit gleichermaBen Pathologen, Onkologen und Gynakologen an und will versuchen, gegenseitige Infor- mationslticken der Fachexperten auf dem Gesamtgebiet der Problematik der Ovarialtumoren in zumutbarer Klirze zu schlieJ3en. Daher nehmen ge- rade die selteneren und bisher weniger bekannten Tumoren in Bild und Text einen verhaltnismaBig breiten Raum ein auf Kosten der hinlanglich bekannten haufigeren Formen, bei denen Spezia1fragen der Differenti- diagnostik aufgrund neuester Erkenntnisse im Vordergrund stehen.

Advances in research, knowledge and clinical practice in all branches of medicine have been rapid over the past decades and the speed is accelerating. Thus, as we enter the 1980s the pressure on specialists is to concentrate on ever-narrowing fields of their science. For the research worker this is desirable, but the practising clinician Our patient is a whole can have no clearly defined dividing lines. individual and every aspect of her makeup, physical and psychological, must always be taken fully into account. This is of vital importance in obstetrics and gynaecology. These two closely inter woven disciplines are branches of medical science in which emergency situations are not uncommon. Thus every practitioner, doctor, mid wife and nurse needs understanding of these subjects. Although tech nology advances rapidly, many basic principles remain the same. The chapters that follow deal with these, and modern trends in clinical management are discussed. For some decades the author has been in clinical charge of a matern ity hospital some 12 miles south of Central London. The hospital is a training school for obstetricians and midwives, and the local popula tion is adequately supplied with a general practitioner service. These circumstances are of some relevance because many views expressed are based on personal experience while others are based on countless books, articles, congresses and discussion with colleagues. To every source of information I express my thanks."

In der Gynakologie und Geburtshilfe nehmen naturliche wie auch synthetische Prostaglandine zunehmend einen breiteren Raum ein. Auf- grund der rasch voran schreitenden Entwicklung ist die Anwendung dieser Substanzen nicht nur im deutschen Sprachraum uneinheitlich. Die noch verhaltnismassig junge Forschung ist im letzten Jahr- zehnt im Aufbruch in alle medizinischen Fachrichtungen. Zeugnis dieser sturmischen Entwicklung sind etwa 100 Originalpublikationen pro Monat, die sich mit der pharmakologischen Wirkung auf physio- logische und pathophysiologische Prozesse, mit der Neusynthese von Prostaglandinderivaten und mit neuen Anwendungs- und Applikations- moglichkeiten befassen. 8 Jahre nach den von Hickl und Brunnberg (Upjohn) veranstalteten Hamburger Prostaglandin-Gesprachen(l6./17. 11.1973) halten wir es fur angezeigt und notwendig, eine kritische Bilanz der klinischen Bedeutung der Prostaglandine im Sinne einer Bestandsaufnahme fur unser Fachgebiet im deutschsprachigen Raum zu ziehen. Gleichzeitig wollen wir die verschiedenen Arbeitsgruppen in den wissenschaftlichen Dialog fUhren, um vielleicht die Basis fur die weitere Grundlagen- und klinisch-wissenschaftliche Forschung zu verbreitern. Die vorliegende Monographie will in dieser Richtung ei- ne Zusammenfassung des Homburger Prostaglandin-Symposiums (22./23.5.1981) und eine Orientierungshilfe sein. Sie entstand aus den Referaten und Vortragen, die sich auf 4 Hauptthemen bezie- hen: I. Theoretische Grundlagen in der klinischen Anwendung von Prostaglandinen, 11. Prostaglandine zur Geburtseinleitung, III. Anwendung von Prostaglandinen in der Gynakologie und IV. Prostaglandine zur Abortinduktion.

During the past 3 years, little has been added to our funda mental knowledge of hormonal disorders in gynecology. Diagnostically, however, there has been an almost com plete departure from traditional chemical methods in favor of radioimmunoassay techniques. As a result, diagnostic capabilities which previously were restricted to large cen ters have now been extended to the office and small clinic. Accordingly, the chapters dealing with these techniques have been revised and updated. There is also new material on advances in the hormonal treatment of endometriosis and hyperprolactinemic states. Finally, the bibliography has been extensively revised to include a number of recently published books and survey articles of general interest. Paul J. Keller v Preface to the First German Edition Menstrual disorders and sterility are among the most com mon complaints noted by both the specialist and general practitioner. For many patients they are far more distress ful than is generally assumed. Recent years have brought our knowledge. While this has led to great advances in major improvements in the results of treatment, it has made it difficult for the nonspecialist to keep abreast of developments in the field of gynecologic endocrinology.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss "them": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by Women" (EIRTAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

In July 1978 a group met in Aberdeen to discuss the whole range of new proteins recently isolated from the human placenta. With the exception of Yuri Tatarinov all the main pioneers in the field were present, and this book arose from the discussions which took place. Each author was asked to bring a written man uscript corresponding to but not necessarily identical with their verbal presentation. Nobody was given a specified remit, for the reason that the subject is so new that it would be impossible to design the meeting or the book in advance. Each speaker was left free to put on display whatever he thought was interesting or important about the newly isolated proteins. Inevitably this has led to much overlap, since everybody tends to follow the same path at first. Nevertheless, we shall probably never achieve so much agreement again. Only Vernon Stevens was set a fixed title out side the immediate field of new placental proteins. This arose from the very exciting possibility that the new proteins could be used to induce an autoimmune state to products of conception and thus serve as the basis for a new method of contraception. There are few findings at present which bear specifically on this proposal, but the experience of Vernon Stevens with hCG could serve as a model of the problems that might be encountered with SP and PAPP-A."

Ductoscopy is a relatively recent, minimally invasive special procedure for the early detection of breast cancer. It enables the inspection of the milk ducts to the eighth ramification thus closing a gap between x-ray technology and invasive operations. The Greifswald Breast Center, headed by consultant Dr. Ralf Ohlinger, is currently testing ductoscopy as part of a Germany-wide multi-center study.

One of the major challenges in obstetrics and gynaecology is the need for a broad knowledge of medicine and surgery as well as the conditions specific to reproduction. The comprehensive nature of Differential Diagnosis in Obstetrics and Gynaecology achieves this goal. The book provides clinicians with invaluable assistance in the diagnostic process to differentiate quickly and correctly among various diseases. From minor to major symptoms, the differential diagnoses are explored and offered in a way that is easy to read and leads to practical management. Arranged alphabetically, and based upon presenting symptoms, the text takes readers through a step-by-step approach to that presentation, culminating in a description of the different diagnoses that it might represent. The layout of the book is engaging as the text is interspersed with excellent illustrations and useful boxes highlighting important points. Algorithms, references, and websites have been included where appropriate and a glossary of common terms and terminology used in obstetrics and gynaecology has been provided at the end.

In Memoriam xiii Preface xvii Chapter 1 Development, Mechanisms of Action and Evaluation of IUD Performance 2 Chapter 2 IUD Insertion 28 Chapter 3 Uterine Perforation 54 Chapter 4 Pelvic Inflammatory Disease 92 Chapter 5 Bleeding 138 Chapter 6 Cervical and Uterine Pathology 158 Chapter 7 Intrauterine Pregnancy 172 Chapter 8 Ectopic Pregnancy 194 Chapter 9 Return to Fertility after IUD Discontinuation 222 Chapter 10 IUD Complications in Perspective 232 Appendices 243 Index 253 Foreword Ever since Hippocrates observed that foreign bodies placed in the uterus would help to prevent pregnan cy, periodic interest in this information and its use has resulted in attempts to control unwanted fertil ity. Prior to the 1900s, this interest was somewhat episodic. Because of anxiety about infection, early attempts flourished only briefly and then were no more. In the twentieth century, however, as a result of renewed interest in intrauterine contraception, particularly in the developing countries, a number of individuals throughout the world began experiment ing with a variety of new intrauterine devices. Since then, a great number of these devices have been studied; a few have survived careful scrutiny, and IUDs now represent the second most commonly used form of medical contraception. It is estimated that approximately 15 million devices are in use at the present time, 3 to 4 million of them in the United States."

It has been our privilege to edit this volume which is complementary to the first book on Carbohydrate Metabolism in Pregnancy and the Newborn and which is based on work presented at the 2nd Aberdeen Colloquium bearing the same title held in April, 1978. The growth of knowledge of this subject in the 5-year period since the 1st Aber- deen Colloquium in 1973 is truly remarkable and fully justifies this second exposition of current ideas in this field at the present time. For example, the 1973 meeting failed to cover such recent to- pics as H. L. A. typing, glycosylated haemoglobin, control of glycae- mia in labour with the use of the artificial pancreas, fetal brea- thing and pregnancy specific B-glycoprotein and this volume provi- des such an opportunity. The scope of this book is broader and in- cludes data on placenta and fetal congenital anomaly related to ma- ternal diabetes and many aspects of birthweight while there is also a section on maternal weight and nutrition in pregnancy. In a wider prospective one of the stimuli for such work has been the impetus given by the regular meetings starting in 1969 of the Diabetic Preg- nancy Study Group of the European Association for the Study of Dia- betes. This has allowed much more effective integration of research on diabetic pregnancy. The work of the members of the Diabetic Preg- nency Study Group is widely represented in this publication.

Der vorliegende Supplementband enthalt Beitrage zum Thema "Aktuelle Probleme der padiatrischen Endokrinologie". Dabei handelt es sich urn erwei- terte Fassungen von Vortragen, die auf dem 1. Symposium des Ludwig-Boltz- mann-Institutes fur padiatrische Endokrinologie im September 1976 in Wien gehalten wurden. Die Reihenfolge der Veroffentlichung entspricht der Vor- tragsfolge auf dem Symposium. Der Bogen der abgehandelten Themen ist weit gespannt und spiegelt da- mit den groiSen Bereich wider, den die padiatrische Endokrinologie - ein relativ junges Spezialgebiet der Kinderheilkunde - he ute bereits umfaiSt. Durch die sturmischen Fortschritte der Biochemie und der Labormethoden wurden und werden einerseits standig neue Erkenntnisse gewonnen, anderer- seits aber auch standig neue Problemstellungen eroffnet. Durch die Beteiligung international bekarinter Experten am Vortragsprogramm, und damit am Inhalt des Supplements, wurde das Gesamtkonzept hinsichtlich seiner Qualitat wie auch seiner Aktualitat entscheidend bereichert. W. SWOBODA H. ZIMPRICH Inhaltsverzeichnis SAENGER, Po, LEVINE, L. So, WIEDEMANN, Eo, SCHWARTZ, Eo, KORTH-SCHUTZ, So, PAREIRA, Jo, HEINIG, Bo, NEW, Mol.

Ein ubersichtliches Kompendium mit dem notwendigen Wissen fur die Ausbildung und tagliche Praxis: Mutterschaftsvorsorge, Vorbereitungskurse, risikofreie Geburt, Stillberatung, Elternschule oder Hausbesuche am Wochenbett. Neben den Grundlagen der regelrechten Geburt erlautert es Risikominimierung, Geburtsatmosphare, Schmerzausschaltung, Gebarhaltung sowie die Geburt unter Wasser. (Angehende) Hebammen in Klinik und Praxis finden hier viele Anregungen. Eine Lehrhebamme, eine in freier Praxis tatige Hebamme, eine Hebammenlehrerin und der arztliche Leiter einer Hebammenschule geben ihr Wissen weiter, das sie uber viele Jahre erworben haben."

This book concisely presents the essential information in the field of gyneco logic endocrinology. Textual material is extensively supplemented by schemes, tables, and diagrams to elucidate etiologies, pathophysiologic mechanisms, and natural histories of the various clinical disorders in the field. The most timely and up-to-date laboratory procedures and physiologic manipulations for diagnosis are presented. Management rationales based on the definitive diagnostic studies and on knowledge of the natural histories are also presented. Special emphasis is placed on the roles of suprahypothalamic as well as extragonadal and peripheral factors in the pathogenesis of many of the disorders of the menstrual cycle. These include the influence of diseases, altered physiologic states, and drugs-areas which are largely neglected in other presentations of this field. The material presented is based on courses in gynecologic endocrinology presented at the Lorna Linda University School of Medicine and at other institutions over the past several years. Extensive use is made of authoritative reviews in this field, and only highly controversial material is authenticated by specific references. I am deeply grateful to Mrs. Lucille Innes of the Audiovisual Department at Lorna Linda University for the artwork. The loyal secretarial help of Alice Hickman, Carol Guzman, and Robbie Cleek is gratefully acknowledged. Habeeb Bacchus, Ph.D., M.D., F.A.C.P.