This book is about a new surgical procedure, surgical hysteroscopy, for out-patients. It is both a diagnostic approach and a surgical procedure. As a simple and non-aggresive technique, it is a "patient-friendly" procedure with a little surgical trauma as it avoids hysterectomy or laparotomy procedures thus preserving the genital tract. It is the leading procedure in the treatment of uterine bleeding. It has also proved to be an essential investigation technique of in the assessment of infertility. This book is the result of surgical practice and teaching experience in the field of hysteroscopic procedures.

In his 35 years of teaching medical students and trainees Professor Gabor Kovacs, International Medical Director of Monash IVF, has devised a system of lectures which cover the entire core curriculum in Obstetrics and Gynaecology. The principle behind these lectures is to help the student understand various aspects of the specialty, rather than simply learning the key topics, and encourages ongoing problem solving as well as a more logical approach. Each of the lectures have been based around highly informative diagrams and tables, and each syndrome follows a set template making each topic very understandable and easy to assimilate. This will be an invaluable text for medical students, nursing and midwifery students, trainees in obstetrics and gynaecology as well as sexual and reproductive health, general and nurse practitioners.

This book aims to provide an up-to-date review of the literature in each of the major areas relating to the management of older gynecological cancer patients, and makes recommendations for best practice and future research. The authors come from a broad geographic spread including the UK, mainland Europe and North America to ensure a worldwide relevance.

This book covers in detail contemporary hypotheses and studies related to the immunology of implantation and provides a practical approach for the application of basic reproductive immunology research to pregnancy complications such as preeclampsia, pre-term labor and IUGR. Provides complete and up to date review of current knowledge of the role of the immune system during pregnancy and the interactions between the placenta and the maternal immune system.

To aid in unraveling the complexities of the causation of congenital malformations, various influences on their frequency are considered in this book. And of course the known and possible environmental bases of their occurrence are fully described. An introductory record of the history of perinatal mortality in the last three centuries gives foundation for the discussion of death in contemporary decades.

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.

Women with chronic medical problems are at higher risk for complications during pregnancy and, therefore, they are especially in need of appropriate preconception and contraception care. Furthermore, many women with chronic medical problems do not obtain adequate preconception and contraception care. Despite published guidelines by the Centers for Disease Control and Prevention, there is a substantial gap in medical practice regarding the use of contraception in women with co-existing medical problems. Contraception for the Medically Challenging Patient fills the gap that currently exists in the knowledge of correct contraceptive prescribing practice and shows that inappropriate contraindications can easily become a barrier to effective contraception use among women. Chapters highlight obsolete views about appropriate candidates for contraception and address the complex contraceptive needs of today's medically challenging patients with HIV/AIDS, uterine fibroids, or cardiac, neurologic or thyroid disease. The book gives attention to recommendations on the use of contraception in women with medical problems such as diabetes, obesity, epilepsy, and lupus, among others, and provides comprehensive information regarding the effects that certain drugs may have on contraceptive hormone levels. While national guidelines do exist for contraceptive eligibility, this book discusses in more detail the evidence behind the guideline recommendations and the nuances that clinicians confront in daily practice.

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."

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.

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.

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.

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."

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."

The world's population is growing at an unsustainable rate. From a baseline ?gure of one billion in 1800, global population is predicted to exceed nine billion by 2050 and 87. 8% of this growth will be localized in less developed countries. Such uneven population growth will yield a harvest of poverty, malnutrition, disease and en- ronmental degradation that will affect us all. Amongst the complex mixture of political, social, cultural and technological changes needed to address this issue, the development of improved methods of fertility regulation will be critical. The inadequacy of current contraceptive technologies is indicated by recent data s- gesting that the contraceptive needs of over 120 million couples go unmet every year. As a direct consequence of this de?cit 38% of pregnancies are unplanned and more than 50% end in an abortion, generating a total of 46 million abortions per annum particularly among teenagers. If safe, effective contraceptives were ava- able to every couple experiencing an unmet family planning need, 1. 5 million lives would be saved each year (UNFPA 2003). Progress in contraceptive technology should not only generate more effective methods of regulating fertility, but should also provide a range of methods to meet the changing needs of the world's population. Contraceptive practice was revo- tionized in 1960 in the US and 1961 in Europe by the introduction of the oral contraceptive pill by Gregory Pincus, MC Chang and colleagues, based on fun- mental hormone research conducted in Germany.

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.

This book is intended as a reference manual that will provide the busy clinician with up-to-date information on the diagnosis and treatment of uncommon and rare gynecological cancers. While standard textbooks briefly cover these tumors, this is intended as a more comprehensive yet easy-to-use guide. After opening chapters on epidemiology, pathology, and diagnostic imaging, the full range of infrequently encountered gynecological cancers (ovarian, uterine, cervical, vaginal, and vulval) is presented and discussed with the aid of high-quality illustrations. In each case, detailed attention is paid to both differential diagnosis and current treatment options. The book has been written by an international panel of experts and is the first to gather all the uncommon and rare gynecological cancers together within one volume.

Bladder Pain Syndrome: A Guide for Clinicians provides a comprehensive update in the pathophysiology, epidemiology, terminology, evaluation and treatment of patients with pelvic pain perceived to be related to the urinary bladder. The volume covers the tremendous evolution during the last decade in our understanding of pain syndromes and their diagnosis and treatment. It is now clear that Bladder Pain Syndrome belongs to the family of pain syndromes, and therefore treatment has moved from the treatment of the bladder to the treatment of a pain syndrome with the special problems this presents when the pain syndrome involves urinary symptoms. Interstitial Cystitis was poorly defined and the interpretation and patient selection differed enormously around the world in many ways, making exchange of information unreliable and confusing. Bladder Pain Syndrome is clearly defined and the result is a much better patient selection. This volume provides state of the art background for making a correct evaluation and diagnosis of patients with pelvic pain and voiding problems resulting in a more focused treatment to the benefit of the patients. The volume also covers the close relationship between different pain syndromes including those outside the pelvis. Bladder Pain Syndrome: A Guide for Clinicians will be of great utility to urologists, gynecologists and all health professionals dealing with patients with pelvic pain.

This second edition of Intrapartum Care for the MRCOG and Beyond has been comprehensively updated to reflect current clinical practice and developments since the publication of the original edition. Six new chapters have been added on topics that have become increasingly important since the first edition of the book: improving intrapartum care; lower genital tract trauma; emergency obstetric hysterectomy; acute uterine inversion; disseminated intravascular coagulation; and acute tocolysis. The book outlines a concise and pragmatic approach to intrapartum care, with a focus on the fine clinical balance needed from midwives and obstetricians to provide the vigilant care necessary to prevent and manage the relatively rare adverse events during labour, yet support the wishes of the woman who wants minimal interference.

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.

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.

Type 1 diabetes is a serious and common disease, afflicting one per 200 of the population worldwide. It is widely believed to cause harmful physical maldevelopment--congenital malformations--and other consequences in the unborn children of women with the disease. This book considers the history of the disease in pregnant women and this belief that it causes anomalies since the time of the discovery of insulin in 1921, and presents a profound and critical appraisal of the subject of its supposed prenatal harmfulness.

This concise drug guide lists 500 substances, such as pharmaceutical drugs, lifestyle drugs, and environmental toxicants, which show documented untoward effects on the male sexual organs and their functions. All substances are listed in user-friendly alphabetical order with a uniform structure throughout the book. Each listing includes evidence-based information with up-to-date references and all studies mentioned are evaluated and categorized according to study and sample types. This unique compendium provides more detailed information on each drug than any other standard pharmacology title.

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.