These two volumes are unique in that they take into consideration the enormous progress made in the field over the last few years. Expert knowledge is given by Professor Runnebaum, whose department was appointed WHO Collaboration Center for Research in Human Reproduction. These extensively illustrated books provide detailed information on the function and detection of new hormones and growth factors, on therapy with female sexual hormones, on environmental factors, and on the diagnostic and surgical techniques employed in reproductive medicine. This English edition of a standard German reference has been expanded to include an appendix containing a comprehensive list of pharmaceutical agents used in hormone therapy, including international and trade names and compositions.

Novel Approaches into the Origins of Neurodevelopmental Disorders: The Fetal Physiology Foundation Over the past two decades, autism, a neurodevelopmental disorder that is defined by behavior and was once believed to be rare, became recognized in increasing numbers of children and recently received distinction as an "epidemic" [1]. While numbers of affected children have steadily increased, our knowledge is still ins- ficient to explain autism's diverse causes and broad range of presentations. Despite remarkable progress in research, available medical diagnostic testing applies only to a small minority of affected children. Thus, scientifically based explanations with which physicians can diagnose and treat the majority of children with autism and advise their parents are quite limited. Our society and scientific community were unprepared for the rise in autism, which explains our present inability to understand most of its causes. Researchers in neurodevelopmental disorders have long been aware of other disorders that, despite extensive efforts, have not yielded clear genetic or environmental origins, and autism has become symbolic of the need for new approaches to research into these complex conditions. Although autism has captured our attention in recent years, the prevalence of other neurodevelopmental disorders such as attention de- cit hyperactivity disorder (ADHD) and bipolar disorder, among others, also has been increasing [2-4].

This acclaimed text continues to focus on the essential techniques for effective surgical management of patients with ovarian cancer and related peritoneal surface malignancies. With a wealth of accompanying illustrations and operative videos; this fourth edition reflects the evolution - and controversies - in the use of minimally invasive and robotic surgery and the introduction of HIPEC treatment options.

A synopsis of the use of lasers in gynecology is presented in this book; it is supported by more than 10 years of experience and backed up by studies inthe fields of experimental surgery, technical medicine and clinical gynecology. The authors show how laser-assisted preparation hasbroadened the spectrum of operative possibilities in gynecology. Major points of attention are experimental surgery and basic research, details of application with respect to specific indications, and future potential. Furthermore, the clear definition of the possibilities and limitations of laser technology puts an end to the highly stylized view of a patent wonder divorced from general operative standards. Thereis no doubt that users of laser technology stand on the threshold of a promising development and yet, despite the present elegant applications, thefirst steps to maturity are only now being taken.

The study of prenatal development provides many clues for understanding the physiology as well as the pathogeny of malformations and many diseases. I became interested in the analysis of human development as a young medical student more than 30 years ago, and I have stayed in this field all my life. In my studies, I always tried to compare the events of different disciplines such as genetics, anatomy, bio chemistry and physiology. I learned that the development of a structure is, under normal circumstances, strictly determined and that the development of structures always precedes their proper function. There are no changes in function without changes in structure. The life of every cell is genetically preprogrammed and the program may be modified by complicated interactions with environment. Recent progress in our knowledge is basicly related to technology. However, using all the tools of today's technology, we are still unable to understand the basic normal development. After almost thirty years of work, I am trying to present a subjective review of the development of the human endocrine glands. I am presenting an image emerging from my experience. I personally studied several hundred human embryos using mostly anatomical, histochemical and some biochemical techniques. I found much additional information in the literature."

The mechanisms that initiate labour (i. e., the conversion of the quies cent uterus to an active and reactive organ at term) are poorly under stood. Of considerable importance are the factors that control preterm labour and preterm birth, with their devastating effects on society. This problem is the leading obstetrical issue. Preterm labour affects ap proximately 10% of all pregnant women (even higher numbers are re- Abb. I. The participants of the workshop VI Preface ported for less developed countries or where prenatal healthcare is a low priority) and it is the leading cause of morbidity and mortality of babies. Current practices to arrest preterm labour, once initiated, are in effective. In addition, procedures to stimulate labour and dilate the cer vix at term may not be used effectively. On October 19th - 21 st, 1992, a Schering Foundation Workshop took place in Berlin to discuss the "Basic Mechanisms Controlling Term and Preterm Labour." Leading scientists from Europe and North America were assembled to consider the fundamental systems which regulate the uterus and cervix during pregnancy. The topics in the sym posium ranged from key cellular events governing uterine contractility and cervical dilatation during labour to clinical advances and applica tions. This book contains the proceedings of the workshop. We were pleased to have been part of the workshop and to have been responsible for its organization."

Many women have to spend one third of their lives in a postmenopausal state and they should have a good quality of life during this period. Althoug HRT is well accepted as the logical treatment of climacteric problems, the prevalence rate is very low in some countries. The reasons for not accepting HRT are manifold and complex. The objective of this book is to describe the essential advances in basic and clinical research that forms the basis of current HRT and to give an overview of the efficacy and safety of HRT.

The introduction of colposcopy and exfoliative cytology as a means of examining the cervix uteri has opened up the possibility of studying the preceding and early stages of invasive carcinoma of the cervix and has also brought to light a number of conditions which are possibly only indirectly related, if related at all, to cervical neo with histological evaluation it is possible to plasia. Using these methods combined gain some insight into the natural history of cervical carcinoma. The importance of this is not confined to the cervix for, in this respect, the cervical lesions may prove a paradigm for those of the bladder, stomach and elsewhere. At present the broad outline of the natural history of these cervical lesions is emerging but the temporal and spatial relationships of the various phases is unclear, largely because of the number of possibilities envisaged which involves more vari ables than can be controlled in anyone investigation. In this monograph we have endeavoured to indicate the limitations of the various approaches and to stress the need for controlling the accuracy of assessment whether it be histological, cytological or colposcopic."

Professor Egon Diczfalusy, a pioneer in gynaecological endocrinology and in particular female contraception, celebrated his 80th birthday with a scientific symposium. The participants were scientists from all over the world who had been scholars and close collaborators at different points in time. The interdisciplinary meeting consisted of lectures on the epidemiological impacts of ageing, its challenge for the pharmaceutical industry, philosophical aspects of the future of mankind, and the history and future of contraception. Three round table discussions addressed the hormonal control of reproduction and ageing, new approaches and future perspectives of contraception for women and men, and hormone replacement in the elderly.

The events of September 11,2001 in the United States will always be r~membered with horror and sadness but also admiration for those who risked, and often lost, their lives attempting to save others. When the Fifth International Germ Cell Tumour Conference began, the US air space was closed and our American friends were unable to join us. We were faced with a programme that now had many gaps. What happened next was an illustration of the sense of community that prevails at the Germ Cell Tumour Conferences. Some of those who could not be there in person, such as Richard Foster and Craig Nichols, sent their slides by email, and we were indebted to those, such as Michael Jewett, Ben Mead and Malcolm Mason, who stepped into the breach to present them. Others gave impromptu, and often thought provoking, talks. The discussion periods were lively and it will come as no surprise to those who regularly attend the meeting that Tim Oliver won the prize for "Most Questions Asked", managing even to ask questions following his own presentations. The quality of the talks was outstanding. There was closer integration of the adult and paediatric sessions than in previous meetings. As a result, the differences and similarities between adult male, female and paediatric germ cell tumours became more apparent. This cross-fertilization of ideas from different groups will no doubt lead to further advances. As a result of all these efforts, the conference was a great success.

Sixteen British specialists pool their extensive knowledge of spontaneous abortion in one source. Their discussion is directly applicable to clinical situations and helps identify areas of debate and alternative methods.

This book is a collection of preclinical and clinical reports on the appli cation of gene therapy to human disease. The focus of these studies is on cancer and cardiovascular disease. There are two fundamental technologies for delivering therapeutic genes to diseased ceHs: either viral vectors, as discussed by Dr. Bal main, or non-viral vector systems, as discussed by Dr. Felgner. The strengths and limitations of each of these delivery systems are charac terized. The use of a therapeutic gene to treat a disease has taken two general approaches. The first is to introduce anormal (i. e., wild type) gene into the patient that will restore normal gene function. Dr. Weiss man has characterized the tumor suppressor gene (pS3), and has shown that it can restore normal ceH function in cancer cells. The second ap proach is to treat the disease with antisense molecules. Abnormal gene expression can be down-regulated and selectively inhibited by anti sense molecules, which can reverse the pathologie process in cancer cells. Dr. Gewirtz has demonstrated this with anti sense genes on leuke mia, while Dr. Scanlon has applied this principle using ribozymes in human carcinomas. During this symposium, Dr. Engler described clinical studies of gene therapy using growth factors to stimulate new blood vessels in patients with cardiovascular disease. Several gene therapy strategies were used for cancer: overcoming drug resistance by Dr. Bertino, a pro-drug strategy with ganciclovir by Dr."

Congenital cytomegalovirus (CMV) infection is the most common intrauterine transmitted viral infection, with a tremendous impact on fetuses and newborns. In this book the history of this disease, its pathophysiological background, epidemiology and symptoms, as well as diagnostic and therapeutic strategies, will be discussed. Since economic aspects are gaining more and more importance in health politics, one chapter is dedicated to this issue in the context of congenital CMV infection. The content is based on the latest scientific findings and written in an understandable manner, allowing persons not working in the field of congenital CMV to also profit from it. Thus, this book is of interest for medical doctors, nurses, midwives, economists, but also for men and women who want to inform themselves about this topic.

The optimal function of the placenta and thus fetal well being largely depends upon the integrity of both the fetal and maternal circulations of the placenta. Intense basic research concerned with placental vascularization and blood flow has been performed for the past 30 years, beginning with the classical morphological descriptions of the placental vessels by Boe (1953) and Arts (1961), as well as with the radioangiographic studies of maternal placental circulation in the human by Borell (1958) and in the rhesus monkey by Ramsey (1962). The scientific framework presented by these investigators has been filled and completed by numerous investigators, leading to more morphological details, functional considerations, and pathological understanding. For an extended period of time, this research has been of primarily academic interest by increasing our insights into one important system of the placenta, yet having nearly no practical importance. Recently, this situation has changed dramatically: in vitro studies of the isolated, dually perfused human placenta and in vivo studies of placental circulation for diagnostic purposes have raised an enormous interest in basic research data. New methods like Doppler Ultrasound and NMR became available. These technics have enabled the obstetrician to study fetal and placental hemodynamics in vivo. Meanwhile, such methods are becoming incorporated into the daily obstetrical routine, to some degree without an adequate background knowledge of placental vascularization and blood flow, since such experience is currently available to only a small group of experts.

Operative Gynecologic Endoscopy, Second Edition is completely revised and expanded with 17 new chapters that provide, step-by-step, the latest operative techniques for both laparoscopic AND hysteroscopic procedures. New and updated chapters include: - laparoscopic assisted vaginal hysterectomy - vaginal prolapse and bladder suspension - ectopic pregnancy - tubal reconstructive surgery - assisted reproductive technologies - lymphadenectomy and urologic procedures - operative hysteroscopy. In addition, this volume includes comprehensive chapters on instrumentation, photo documentation, anesthesia, operating room personnel, credentialing, and legal issues. More than 350 superb illustrations - with many in full color - complement and clarify the operative techniques. For every surgeon and resident performing gynecologic procedures, this is the definitive, most up-to-date text on gynecologic endoscopy.

Molecular biology emerged from advances in biochemistry during the 1940s and 1950s, when the structure of the nucleic acids and proteins were elucidated. Beginning in the 1970s, with nucleic acid enzymology and the discovery of the restriction enzymes, the tools of molecular biology became widely available and applied in cell biology to study how genes are regulated. This new knowledge impacted endocrinology and reproductive biology since it was largely known that the secretion of the internal glands affected the phenotypes, and expression of genes. Modern reproductive biology encompasses every level of biological study from genomics to ecology, encompassing cell biology, biochemistry, endocrinology and general physiology. All of these disciplines require a basic knowledge, both as a tool and as an essential aid to a fundamental understanding of the principles of life in health and disease. Overall, molecular biology is central to scientific studies in all living matter, impacting disciplines such as medicine, related health sciences, veterinary, agriculture and environmental sciences. In this book, the basic biochemistry of nucleic acids and proteins are reviewed. Methodologies used to study signaling and gene regulation in the endocrine/reproductive system are also discussed. Topics include mechanisms of hormone action and several endocrine disorders affecting the reproductive system. Professionals in the medical, veterinary and animal sciences fields will find exciting and stimulating material enhancing the breadth and quality of their research.

The body of any animal can be viewed as a society or ecosystem whose individual members are cells, reproducing by cell division and organized into collaborative assemblies or tissues. In this ecosystem, the cells are born, live and die under various forms of selection pressure such as territorial limitation, population size, source of nutrients provided, infectious agents, etc. The body is a highly organized society of cells whose main task is the maintenance of homeostasis of the whole organism. The failure of control mechanisms which make the cell the unit of society, marking the beginning of its asocial behaviour, is most frequently a malignant alteration. This process is not abrupt, nor is it based on a single event. It is, rather, a long-term process characterized mainly by mutation, competition and natural selection operating within the population of cells. The basic mechanisms controlling the cell sociability represent the first defence line against the altered cells, while the second line of defence is supposed to be made up of the immune system cells.Speaking in Darwinian terms, within the ecosystem of an organism, cells of the immune system operate as predators of the altered and mutated cells or cells infected by the intracellular parasites. The biological phenomena whose mechanisms are, at present, explored and largely understood, certainly had their own evolution. Searching for the origin and details of the evolution of advanced solutions as well as selection pressures that might justify their emergence and existence, we often fail to see that many such phenomena are, in fact, co-evolutionary by-products of evolutionary innovations. In other words, the evolutionary emergence of advanced solutions is sometimes, if not always, accompanied by certain by-products and by the co-evolution of compensatory mechanisms acting as a counterbalance to these. An example of the evolution of advanced solutions is the evolution of adoptive immunity, and co-evolution of auto-immunity and alloimmunity. Alongside the diversification of the mechanisms of adoptive immunity, auto-immunity and alloimmunity gain attributes of the evolutionary by-products and become sources of selection pressure.To that effect, alloimmunity could be a source of very strong selection pressure in mammals, simply because it is directly connected with the reproductive efficacy. At the same time, new forms of selection pressure that are connected with adoptive immunity gave rise to new mechanisms controlling killer machinery of the immune system. Finally, the last in a line of by-products in the processes of evolutionary modelling and re-modelling of vertebrate immune systems can be regarded as the failure of anti-tumor immunity. There is now much evidence that tumors can be immunogenic. Tumor cells very often express antigens in a form recognizable by the host immune system, but most frequently without consequences on tumor progression. This has been shown in many experimental models and different experimental conditions. Immediate mechanisms for the escape of tumors from the immune response are very similar to mechanisms for the escape of the fetoplacental unit (as allograft) from the maternal immune response. The similarity between these two mechanisms is so significant that any randomness must be banished.Mechanisms of anti-tumor immunity in mammals are probably substantially different from mechanisms of anti-tumor immunity in other classes of vertebrates. Moreover, the type of most frequent tumors in non-mammalian vertebrates is also significantly different. Finally, the incidence of malignant tumors in non-mammalian vertebrates is significantly lower than the incidence of malignant tumors in mammals. These facts indicate that the mammalian immune system during the anti-tumor immune response is tricked by the similarity between tumor cells and trophoblast or other placental cells. From this aspect, anti-tumor immunity failure in mammals can be defined as an immunoreproductive phenomenon, which is developed under the evolutionary pressure of auto-immunity and alloimmunity/reproductive effectiveness. It may be a specific evolutionary approach in the rendering of anti-tumor immunity failure in mammals, and a new possibility for anti-tumor immunotherapy.

For out of olde hokes, in good feyth, Cometh all this newe science that men lere. Geoffrey Chaucer The Parliament of Fowls During the past two decades knowledge of the human menstrual cycle and of normal and abnormal reproduc- tive function has increased at a dramatic rate. As rec- ognized in this volume, this explosion of knowledge is due in large measure to the development of radio- immunoassays for the measurement of the minute quantities of reproductive hormones found in the cir- culation. Yet the foundations for the many recent developments were laid well in advance. The concepts and hypotheses tested were often suggested even be- fore the hormones involved were identified and iso- lated. A consideration of the historic aspects of re- search in this field places recent research in the appropriate perspective. Moreover, as presented by Drs. vii viii FOREWORD Gruhn and Kazer, the history of progress in this field makes fascinating reading. A review of the history of reproductive endocri- nology should be required reading for all students of the subject and reproductive endocrinologists in train- ing. Dr. Griff T. Ross, a noted reproductive endocri- nologist, often instructed his students that every hy- pothesis he tested could be found in some form in the publications of previous scientists. The answers to present and future questions are often hidden in the lessons of the past.

Almost every aspect of energy and nutrient metabolism is altered by hormonal and other physiological changes during pregnancy and lactation. While it is evident that hormonal adjustments affect nutrient requirements, these are rarely considered when nutrient recommen dations are made for pregnant or lactating women, and often neglected during evaluation of nutritional status. In addition, changes in nutrient metabolism during the stages of pregnancy and oflactation are usually considered separately, while in reality events during pregnancy can have a major influence on nutritional status and nutrient requirements during lactation. The purpose of this volume is to describe changes in the metabolism of important nutrients during pregnancy and lactation, including the physiological basis for these changes and their implications for nutrient requirements and assessment. Authors have considered such issues as inter-relationships between endocrine changes and nutrient metabolism at the tissue, cellular and molecular level; alterations in nutrient binding proteins; the efficiency of nutrient absorp tion and retention; and the impact on maternal as well as fetal nutritional status. Another unique aspect of this book is the focus on pregnancy and lactation as a continuum."

Ovulation: Evolving Scientific and Clinical Concepts presents the proceedings of the International Symposium on Ovulation: Evolving Scientic and Clinical Concepts held in Salt Lake City, Utah. Internationally recognized experts provide new insights in the most recent developments in the area of mammalian ovulation, incorporating basic scientific and clinical concepts in the process. Topics include an overview of 37 years of research on ovulation, the follicle, the gonadotropin surge, the intraovarian steroid microenvironment, putative periovulatory intraovarian regulators and messengers, and clinical frontiers. More than 80 illustrations round out the text. The book is essential for all reproductive endocrinologists and Ob-Gyns.

Since 2005 a dozen states and more than 15 specialties have reported a physician shortage or anticipate one in the next few years. This anticipated shortage and a worsening of physician distribution are compounded by a projected increased demand for women's healthcare services.

Women's healthcare is particularly vulnerable, because the obstetrician-gynecologist workforce is aging and is among the least satisfied medical specialists. Furthermore, fellowship training in women's healthcare in internal medicine and in maternal child health in family and community medicine involves only a small portion of general internists and family physicians.

In response to this challenge, the Association of American Medical Colleges called for an expansion of medical schools and graduate medical education enrollments. As we cope with significant and rapid changes in organizations and reimbursement, academic departments of obstetrics and gynecology, family and community medicine, and internal medicine have opportunities to create a unified women's health curriculum for undergraduate students, share preventive health and well-woman expertise in training programs, provide improved continuity of care, instill concepts of lifelong learning to our graduates, and better develop our research programs.

This volume's chapters focus on strategic planning on behalf of academic faculty who will train the anticipated additional load of students, residents, and fellows in women's healthcare.
-changing demographics of faculty
-expanding roles of clinician educators
-physician investigators and their future
-the hidden value of part-time faculty
-faculty salaries
-required skillsets of academic leaders
-the meaning of tenure and faculty satisfaction and retention.

Recommendations presented here from authors with distinguished leadership skills indicate a consensus, but not unanimity. In furthering these goals, we summarize in the final chapter our collective expertise and offer ways to implement recommendations to better prepare for tomorrow's needs in academic women's healthcare.

Reproductive tract infections (RTis) have become a silent epidemic that is devastating women's lives. Each year, thousands of women die needlessly from the consequences of these infections, including cervical cancer, ectopic pregnancy, acute and chronic infections of the uterus and the fallopian tubes, and puerperal infections. For many women, this happens because they receive medical attention too late, if at all. The terrible irony of this tragedy is that early diagnosis of and treatment for many RTis do not require high-technology health care. For the hundreds of millions of women with chronic RTis acquired from their sexual partners, life can become a living hell. Infection is a major cause of infertility, and it leads to scorn and rejection in many countries. These women may experience constant pain, have festering lesions of the genital tract, be at enhanced risk of second ary diseases, and endure social ostracism. The problems associated with RT s have grown even greater in the past decade with the emergence of human immunodeficiency virus (HIV) and AIDS. Preexisting sexually transmitted disease, particularly when associated with genital tract ulcers, raises women's vulnerability to the transmission of HIV 3-5 fold."

Male Reproductive Function gives an up-to-date review on the physiology and disease processes associated with the male reproductive system. The first few chapters describe the regulation of the functions of the testis and the integration of its components: germ cells, Sertoli cells and Leydig cells. This is followed by a description of puberty and aging, and the disorders or dysfunction that may be associated with these physiological processes. Discussions on the current methods for the diagnosis and treatment of male hypogonadism, male infertility and male sexual dysfunction follow, with detailed descriptions of types of androgen replacement and the benefits and risks of such treatment. The book concludes with the development of male contraception and the possible influence of the environment on the male reproductive system. Male Reproductive Function represents a conglomeration of the efforts of experts in andrology from all over the world, both in basic cellular/molecular biology as well as in clinical science and practice. This book is suitable for endocrinologists, urologists, general internists, gynecologists and other students in the field of male reproduction.