This volume will explore the latest findings in research into the genetics of breast and reproductive cancers, covering the epidemiological aspects of these cancers, their etiology, the effect of environment on genes and cancer etiology, and how research in this area can lead to development of preventative measures and treatments.

It is clear today that several prostaglandins play an important role in the regulation of many of the physiological events of the reproductive organs in the human. Both naturally occurring prostaglandins and their analogues are used routinely in many countries to ripen the cervix and induce labour at term as well as to dilate the cervix and to terminate pregnancy. Prostaglandin biosynthesis inhibitors are widely used in the treatment of primary dysmenorrhoea. The editors have aimed at an accurate, thorough, yet easily under standable review of the status in 1986 of medical knowledge regarding both the physiological importance and the clinical use of prostaglan dins and their inhibitors in obstetrics and gynaecology. I believe this book will be of value for all clinicians concerned with reproductive health. The list of authors guarantees an authoritative and up-to-date review of this active field. SUNE BERGSTROM Karolinska Institutet, Stockholm, Sweden Table Examples of clinical use of natural prostaglandins and some prostaglandin analogues Indications Prostaglandin Route of administration Manufacturer Dilatation of the cervix prior 15-methyl-PGF * Intramuscular Upjohn, USA 2 to vacuum aspiration 16-phenoxy-PGE methyl sulphonylamide Intramuscular Schering AG, West Germany 2 16,16-dimethyl-PGE methyl ester 1 Vaginal ONO, Japan; May & Baker, UK Second trimester abortion Intra -amniotic Upjohn, USA; ONO, Japan PGF 20 Upjohn, USA PGE Vaginal 2 Upjohn, USA 15-methyl-PGF 2.

Mit den von anerkannten Sachkennern der Radiologie und der Frauenheilkunde erarbei- teten Beitragen fUr den Band XIII/2 des Handbuches der medizinischen Radiologie konnten erstmals in der Weltliteratur umfassende Zusammenstellungen des gesamten Wissensstof- fes auf dem Gebiet der gynakologischen Radiologie und der radiologisch-geburtshilflichen Diagnostik vorgelegt werden. Die Methodik und den Informationswert der Hysterosalpingographie hat FOCHEM abgehandeIt und gestiitzt auf die fundierten Ergebnisse eigener Arbeit, in klar gegliederten Kapiteln die morphologischen Rontgenbefunde des gesunden und kranken Uterus und der Tuben erlautert. Mit dem Beitrag tiber die gynakologische Rontgendiagnostik in der Padiatrie haben BENZ und WILLICH eine vollstandige Ubersicht der Ergebnisse ihres noch wenig bekannten Forschungsgebietes gegeben, das fUr viele Fachgebiete der Medizin groBe praktische Bedeutung erlangt hat. Die methodischen Grundlagen und den Informationswert der radiologischen Spezial- diagnostik in der Gynakologie haben GROTEMEYER und BREIT zusammengestellt. Einen grundlegenden Beitrag zur Anatomie und Topographie der Organe des weiblichen Bek- kens im Hinblick auf die Rontgen-Ganzkorper-Computer-Tomographie verdanken wir PLATZER, der das Fundament fUr die Bildanalyse dieser neuartigen diagnostischen Me- thode erarbeitet hat. Die spezielle Rontgendiagnostik der gynakologischen Tumoren mit Hilfe der Angio- graphie und Rontgen-Ganzkorper-Computer-Tomographie haben BREIT und ROHDE ab- gehandelt. In besonderen Kapiteln ist die oft vernachlassigte Rezidivdiagnostik bei Ge- schwiilsten von BREIT sowie LISSNER und SCHERER bearbeitet worden. Gestiitzt auf eigene Forschungs- und Entwicklungsarbeit geben die Autoren eine umfassende Ubersicht und berticksichtigen die wertvollen diagnostischen Informationen, die heute mit Hilfe der Rontgen-Ganzkorper-Computer-Tomographie fUr die klinische Arbeit zur VerfUgung stehen.

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

In this book we have expert urologists and gynaecologists on the two sides of the Atlantic working together with a common interest, the inadequate female urethra. What makes this volume so valuable is that it is not restricted to one speciality or one cult, but bravely (and systematically) presents established principles and practice. Not only is the current knowledge of the anatomy and function of the continence mech anisms defined by experts carefully selected by the two authorities in the field, but this infor mation is directly applied to clinical problems for the reader to use in the care of patients. Because the basics are presented first, and followed by the methods of diagnosis, the sec tions describing each form of treatment, whether medical or surgical, are set on rational bases. These are not cookbook directions. This background is especially valuable because the incontinent female usually has a complicated disorder, each case being different, so that the responsible gynaecologists or urologists must apply as much understanding as technique if their efforts are to achieve dryness. The clear descriptions and illustrations in this book, then, act as guides as much as directives. This second edition builds on the success of the first. All of us trying to help these unfortu nate women will do more for them from having this new edition at hand."

The practice of clinical reproductive medicine has practice in the era of managed care and coordinat gradually moved from its initial 1980-90 hospital ing ancillary offsite medical personnel. base to its present (circa 2001) office site of oper The objective of this text is to assist in this ongo ation. With this transition have been improvements ing endeavor by presenting in a clear, concise man in efficiency of practice often in response to ner many of the topics relevant to contemporary increased pressure to provide the most patient sat office-based infertility practice. The initial half of isfaction. An added challenge of office-based prac this text addresses topics which focus upon general tice has been taking on many of the responsibili concepts of infertility evaluation and practice. The ties of what had been traditionally the hospital's latter half is a practical approach to the execution domain. Some of these new responsibilities have of specific office-based infertility procedures. We included the ordering of operative supplies and hope this book will assist all medical personnel who equipment, the establishment of quality control dedicate their clinical effort in achieving what is programs, construction and maintenance of special most coveted by our patients, the birth of a healthy laboratory spaces, redesigning efficient methods of newborn. DAVID B. SEIFER, M. D. UMDNJ-Robert Wood Johnson Medical School ROBERT L. COLLINS, M. D. The Reproductive Center, Youngstown, Ohio October 2001 vii Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii . . . . . . . . . . . . . . . . . Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi . . . . . . . . . . . . . . . . . 1 Evaluation of the Female for Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bryan D."

The peri-menopause is emerging more and more as a subject for study by the doctor, the psychologist, the social worker, the gerontologist, the clinical chemist, the public health specialist, the sociologist, the psychiatrist and the experimental pathologist. The results of studies are gradually becoming known to the public, particularly to the prospective clients, ageing women. Women have begun to ask for treatment and they will most likely determine whether oestrogen replacement therapy comes into vogue. Psychosomatics in peri-menopause is an important sub ject, since the life-span of the woman has extended to nearly twice that of her fertile period. The life-expectancy for women in industralized countries is now some 70-75 years. This means that most can now expect to spend one third of their lives in the post-menopause. Consequently, there is now much more time than before in which to notice, experience and be bothered by peri menopausal changes. Moreover modern medicine has much more to oner than mere moral support to sufferers from ailments connected with progressing ovarian failure during peri-menopause. Although we cannot promise eternal youth - as Wilson does -there are more possibilities for treatment than 10 years ago."

Several papers dealing with the clinical relevance of steroid hormone receptors in breast cancer have already been published. However, no publication has overviewed studies currently being conducted in Europe, nor is there a register of the european centers performing receptor assays. It has been our purpose to fill these gaps. A large majority of authors who we contacted kindly agreed to con tribute to our book. Papers were grouped into six main parts according to their contents. The abundance of clinical data relevant to receptor assays led us to add critical summaries to help the reader to form his own opinions on the subject. We would like to thank Drs. R. J. B. King, G. Contesso, L. Santi, and E. Engelsman, who helped us in this regard. We hope that this book will enable the reader to become acquainted with the present state of European steroid hormone receptor studies devoted to breast cancer treatment. We also hope that it will promote cooperation between European oncologists involved in this field of research."

Pathobiology of Human Germ Cell Neoplasia is a state-of-the-art compendium on a very recent branch of tumor biology. It offers an awareness and understanding of germ cell tumors: from the earliest stages to their va- rious differentiations. Original data for this volume was supplied by experts in the fields of pathology, developmental biology, genetics, molecular biology and other related fields. This compilation of knowledge provides information necessary to persons working in clinical and preclinical areas.

Endometriosis is one of the most common diseases of women. This book provides a practical, clinical and thorough examination of both the medical and surgical treatment of this disease. A world renowned group of contributors address basic issues, management approaches and selected special topics, emphasizing the latest advanced operative techniques.
Topics include: - minimally invasive and advanced laparoscopic surgical technique in the treatment of endometriosis - treatment of endometriosis of the ovaries, cul-de-sac, gastrointestinal and urinary tracts, and extragenital sites - management of recurrent endometriosis - treatment of infertility and pelvic pain associated with endometriosis - guidelines for medical management and combined medical-surgical management.

Leading workers in the field of human reproduction provide both basic knowledge and useful practical information in this book about the most critical phase in the development of a new human being: the first twelve weeks of life. The period from fertilization and implantation to the end of the first trimester is still insufficiently understood and marks a new frontier. The knowledge necessary for applying our present diagnostic capabilities and for venturing into the problematic areas of fertilization technology and embryonic treatment is made easily available in this comprehensive textbook. The book is divided into two parts. The first presents basic information about physiology, anatomy, in vivo investigations, biochemistry and legal aspects. The second part focuses on pregnancy development, monitoring and the clinical diagnosis and management of disorders in the early stages of life. A full section is devoted to assisted conception and the newest possibilities in fertilizationtechnologies, whereby the ethical aspects are also discussed.

Cytologic diagnosis of cancer has its roots in clinical micro scopy as it was shaped during the first half of the 19th century. In reviewing some of the early writing on this subject, one is amazed at the accuracy of the descriptions and soundness of the observations. Cytology of the urine is no exception: in 1864 Sanders described fragments of cancerous tissue in the urine of a patient with bladder cancer (Edinburgh Med. J. 111, 273). This observation was confirmed by Dickinson in 1869 (Tr. Path. Soc. London, 20, 233). It is a source of special pride to me that in 1892 a New York pathologist, Frank Ferguson, advocated the examination of the urinary sediment as a best means of diagnosing bladder cancer, short of cystoscopy. Papanico laou freely acknowledged these contributions while estab lishing sound scientific bases for continuation and spread of this work. Papanicolaou's work in the area of the urinary tract has not fallen on dead ears. He documented to several urologists who were within his sphere of personal influence, mainly Dr. Victor Marshall, Professor of Urology at Cor nell University Medical School, that urinary tract cytology was a reliable tool in the diagnosis of urothelial carcinoma. Some of us who have attempted to spread the master's word had their share of success within institutions with which we were associated.

The International Life Sciences Institute (ILSI) was estab lished to stimulate and support scientific research and edu cational programs in nutrition, toxicology, and food safe ty; and to encourage cooperation in these programs among scientists from universities, industry, and government in order to facilitate the resolution of health and safety issues. The officers and trustees of ILSI believe that questions re garding health and safety are best resolved when govern ment and industry rely on scientific investigations, analy ses, and reviews by independent experts. This process is furthered by the examination and discussion of issues on an international basis. ILSI is pleased to sponsor this set of monographs on the pathology of laboratory animals. This project collectively brings together the most comprehensive information on non-neoplastic and neoplastic lesions that occur in com monly used laboratory animals. The international compo sition of the authors, editors, and editorial board who have contributed to these monographs strengthens our expecta tions that understanding and cooperation will be strength ened worldwide through this series."

Material for this book was gathered in the early 1980's in Manchester, where a higher incidence than usual of complications in the gastro-intestinal and urinary tract was observed. Part I describes the principles and methods of radiotherapy for pelvic tumours, pathological features and radiological analysis of bowel and urinary tract changes. Parts II and III are devoted to clinical assessment and management, where the need for a multi-diciplinary approach is emphasized.

Having received the invitation from Springer-Verlag to produce a volume on drug-induced birth defects for the Handbook of Experimental Pharmacology, we asked ourselves what new approach could we offer that would capture the state of the science and bring a new synthesis of the information on this topic to the world's literature. We chose a three-pronged approach, centered around those particular drugs for which we have a relatively well established basis for understanding how they exert their unwanted effects on the human embryo. We then supplemented this information with a series of reviews of critical biological processes involved in the established normal developmental patterns, with emphasis on what happens to the embryo when the processes are perturbed by experimental means. Knowing that the search for mechanisms in teratology has often been inhibited by the lack of understanding of how normal development proceeds, we also included chapters describing the amazing new discoveries related to the molecular control of normal morphogenesis for several organ systems in the hope that the experimental toxicologists and molecular biologists will begin to better appreciate each others questions and progress. Several times during the last two years of developing outlines, issuing invitations, reviewing chapters, and cajoling belated contributors, we have wondered whether we made the correct decision to undertake this effort.

Retinal haemorrhage occurring during birth is a common feature in the newborn. There is no basic funduscopic or morphologic difference between this perinatal type of haemorrhage and that in the adult. The difference is that perinatal haemorrhage resorbs rapidly, within a few days, and no functional defects of retinal vessels are known. The fIrst observation of perinatal haemorrhage took place nearly 100 years ago. Many observations have been published in short papers; what was still lacking was a systematic pathogenic classifIcation of the different types of haemorrhage, a compari son of the perinatal type of other types of retinal haemorrhage, a comparison to other perinatal ocular haemorrhages, a detailed histologic description and a multi-faceted correlation of haemorrhage to aetiologic factors. The author has based his comprehensive evaluation on the observation of more than 400 newborn infants, the reexamination of several cases with macular haemor rhage, the histologic work-up of serial sections and the review of extensive literature. It is a remarkable fact that a physiologic process, birth, is related to this type of vessel rupture, which is present during a short period of postnatal life. In its complex analysis of these facts and conditions this book is particularly valuable."

This book will explore the childbirth process through globally diverse perspectives in order to offer a broader context with which to think about birth. We will address multiple rituals and management models surrounding the labor and birth process from communities across the globe.

Labor and birth are biocultural events that are managed in countless ways. We are particularly interested in the notion of power. Who controls the pregnancy and the birth? Is it the hospital, the doctor, or the in-laws, and in which cultures does the mother have the control? These decisions, regarding place of birth, position, who receives the baby and even how the mother may or may not behave during the actual delivery, are all part of the different ways that birth is conducted.

One chapter of the book will be devoted to midwives and other birth attendants. There will also be chapters on the Evolution of Birth, on Women s Birth Narratives, and on Child Spacing and Breastfeeding.

This book will bring together global research conducted by professional anthropologists, midwives and doctors who work closely with the individuals from the cultures they are writing about, offering a unique perspective direct from the cultural group."

This RRCR-conference-volume marks "number six" in a 20-year evolution of international conferences on the adjuvant therapy of primary breast cancer. Starting in 1978, a handful of some 80 en thusiastic breast cancer surgeons and oncologists, met in a se cluded mountain resort near st. Gallen in Eastern Switzerland, to exchange their early data of some pioneer trials on adjuvant sys temic therapy of early breast cancer, and to correlate their future research efforts to overcome the frustrating prognostic stagna tion of this dominant neoplastic disease in Western females dur ing the past decades. Repeated every 3-4 years, these St. Gallen International Conferences on Adjuvant Therapy of Primary Breast Cancer have continuously grown in numbers of partici pants and in normative, therapeutic influence by being published in major oncology journals 1-3], the last (6th) conference hav ing taken place from February 25-28, 1998 with more than 1800 attendees from over 50 countries worldwide. What is the fascination of adjuvant therapy in primary (early) breast cancer, and what has changed, during the last 3 years since March 1995, to justify another international gathering of this size, and of the world's leading experts in the field? There is no question, that providing even more effective care and designing appropriate recommendations for the multitudes of patients with so-called early breast cancer or at high risk of developing the disease, remain highly important public health goals."

Advocating for Women with Postpartum Mental Illness takes the reader into the world of one of the most misunderstood mental illnesses. Affecting 1 to 2 out of 1,000 childbearing women a year in the United States, postpartum psychosis creates hallucinations and delusions, which, if untreated, can lead to infanticide and subsequently imprisonment or death for the mother. While other parts in the world, particularly the United Kingdom have more sympathetic laws, in the United States, women with postpartum psychosis are often stigmatized as "baby killers", and face the ultimate penalty. Through this book, authors Feingold and Lewis humanize the mother's experience to promote understanding and compassion. Beginning with an overview of the mental health and legal facets surrounding postpartum psychosis, the authors then provide vital resources and tools for mental health practitioners and legal professionals to enact change in their practices and communities. Complete with case studies and the authors' experiences in changing the law in their own state of Illinois, this book is a necessary resource for furthering dialogue and action around maternal mental illness.

The European School of Oncology came into existence to respond to a need for information, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Universities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

Pathology of Multiple Pregnancy collates case material from over 500 autopsies (including embryos) and 1200 placentas from twins, triplets, and higher multiples with selected literature on human multiple reproduction. It emphasizes important new concepts of pathophysiology and interpretation of less than ideal outcomes of multiple conception based on over 30 years experience in the field. Aspects of perinatal pathology unique to twins and higher multiples are emphasized, with practical suggestions for the service pathologist, including items of potential medico-legal significance. Controversial topics, such as the value of studies of concordance for diseases or malformations, and the significance of inter-twin anastomoses, are addressed and suggestions made for further investigation. A close working relationship between pathologists and clinical colleagues is encouraged by discussion of clinico-pathological correlations. And, the most recent discussions on mechanisms of twinning and genetic versus environmental influences on the development of twins are presented.

A. CORBIN Investigations on LHRH and its analogs have just completed their first decade. We have witnessed a veritable explosion of chemical, physiologic and pharmacologic data on this hypothalamic peptide and the approximately 1500 agonist and antagonist analogs that have been synthesized. In order to track this expanding field, I was asked to organize an international symposium on basic and clinical aspects of LHRH analogs as part of the Reproductive Health Care: CDS Symposium held in Maui, Hawaii, in October 1982. This meeting brought together a number of the leading investigators in the field. Much new state-of-the-art information was presented which I and my colleagues felt deserved a wider audience. Drs Vickery, Nestor, and Hafez consented to undertake this task. Upon review of the literature, it was apparent that there was no recent text which fully covered the breadth of developments in the field. Accordingly, the editors decided to use the symposium as a nucleus on which to build a singular, comprehensive state-of-the-art analysis of this rapidly growing discipline, and the application of such knowledge to reproductive medicine. As exemplified by the various areas of expertise provided by the individual contributors, it becomes obvious that the scope of the subject matter, while relating solely to a well-defined chemical class (LHRH analogs) and a circumscribed physiologic and pharmacologic entity (reproduction), has expanded enormously.

Traditions are dangerous; doubly so in science. Traditions are unchanging; science is about change. This was the 4th International Colloquium on Carbohydrate Metabolism in Pregnancy and the Newborn to be held in Aberdeen, and by now the form is set. How much its content has changed is a matter of nice judgement and not under the control of the organizers. It is not within their power to bring news of revolution, if there has been no revolution. Certainly many of the speakers had kent faces from previous Aberdeen meetings, but so they would be at any meeting on diabetes anywhere in the world. The written proceedings of scientific conferences have purposes other than to record changes: sometimes they need to state a consensus. The 3rd Colloquium came to an agreement about the importance of prepregnancy recognition and control of abnormalities of carbohydrate metabolism. The 4th set out to examine what results it had achieved. Much of this book is taken up with follow-up studies of the applications of similar regimes in different parts of the world. Since the first Aberdeen meeting in 1973, progress in the manage ment of diabetic pregnancy has been slow and steady, but the change in the city and the society where the meetings took place has been fast.

HOWARD C. TAYLOR, JR. Medicine, through its long history, has continually striven to enlarge its scope. Success in these endeavors has come in sudden bursts with long intervals of relative quiescence between. As a result of the spectacular discoveries in the basic sciences during the last decades, medicine is again in a period of revolutionary advance in many fields. One of these is the subject of this report, "The Intrauterine Patient." Until recently the fetus signalized his presence only by the mother's enlarging abdomen and by his own movements, perceived by the preg nant woman herself and evident to the examining midwife and physician. Later, the sounds of the fetal heart heard by auscultation and the varia tions in its rate became the single important means by which the welfare of the fetus might be roughly determined and threats to his survival per haps detected. Otherwise, the fetus remained isolated, his condition unknown and any therapy consequent on diagnosis, except for the induc tion or termination of labor, nonexistent."