course, also aware that many who use this volume One in every three slides examined by a general diagnostic pathologist in the United Kingdom, and will be well familiar with the classical, or 'textbook', in most other countries, comes from a gynaecological appearances of most of the more common conditions patient. Few pathologists can hope, therefore, to and have therefore often chosen an example which, escape a constant exposure to gynaecological path whilst being typical, is not necessarily classical. ology, and it is the aim of this atlas to lessen the We have deliberately chosen not to include any difficulties of this diagnostic burden by acting as an illustrations of gross specimens. This is partly because illustrated guide to the histological diagnosis of of ou r view that such illustrations are of I ittle real value female genital tract abnormalities. to any but the least experienced of pathologists, and Gynaecological pathology does, however, pose a partly because their inclusion would have narrowed number of specific problems: the range and scope of still further our selection of histological figures.

The modern obstetric anaesthetist must not only provide safe and effective pain-relief in labour and anaesthesia for Caesarean section, but also understand the wider role of the anaesthetist in the management of the pregnant woman. Originally published in 2002, Textbook of Obstetric Anaesthesia is a comprehensive, fully illustrated account of all aspects of modern obstetric anaesthesia. It provides useful, practical, evidence-based information on all aspects of labour ward management. Written by a multidisciplinary team of expert contributors, it features comprehensive chapters covering everything from departmental audit to cutting-edge practice for neonatal resuscitation and administration of mobile epidurals. It will be useful for both the trainee and practising obstetric anaesthetist.

Uterine fibroids are the commonest benign tumors of the uterus and pelvis, and are the single most common cause of surgery in women apart from childbirth. Originally published in 2003, this pioneering book compares and contrasts conventional surgical treatments with the rapid emergence of uterine artery embolization as an alternative and less invasive procedure, and is of major importance in relation to the treatment of the condition. A host of international experts from gynecology and interventional radiology have contributed chapters, including one by Dr Jacques Ravina, the pioneer of uterine artery embolization. Although the main focus is on embolization, the book does also give a very comprehensive account of the epidemiology, pathology, diagnosis and management of uterine fibroids, and of conventional treatments such as hysterectomy and myomectomy. This all-inclusive approach makes the book suitable for gynecologists, radiologists, and for all trainees and residents looking after patients with uterine fibroids.

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops and newsletters, successfully bring to the attention of physi cians within developing specialties what is occurring, but generally only in demonstration form without providing historical perspective, patho anatomical correlates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has developed during the past 15 years and over this period, neurosurgeons have ob tained special training in pediatric neurosurgery and then dedicated them selves primarily to its practice. Centers, Chairs, and educational pro grams have been established as groups of neurosurgeons in different countries throughout the world organized themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and followed by specialized courses, national and international journals, and ever-increasing clinical and investigative studies into all aspects of surgically treatable diseases of the child's ner vous system."

This book is designed primarily for anatomic pathologists to facilitate their task of accurately diagnosing embryos and fetuses. A detailed examination of the products of spontaneous and induced abortions is necessary for accurate genetic counseling and for establishing the risk for specific abnormalities or another spontaneous pregnancy loss in the future. The growing interest in the defects of early development reflects the profound change in general life-style. In the past, spontaneous abortions were considered a common, usually sporadic event in a patient's reproductive history. Only reassurance and encour agement were given to the patient and scant attention was paid to the detailed pathology of the abortus. Nowadays, however, as a result of reliable methods of contraception and of the availability of reliable prenatal diagnosis for chromosome abnormalities more frequent in advanced maternal age, significant numbers of parents plan to have pregnan cies later in their reproductive life. Consequently, in a case of spontaneous abortion, the question of "cause" and of "future risk" of recurrence of abortion or an abnormal infant is particularly important. In the era of more elaborate and accurate prenatal diagnostic tests, the pathologist examining products of conception has a primary responsibility to detect, in both spontaneous and induced abortions, any developmental abnormality that would indicate an increased risk of multifactorial, chromosomal, and single gene disorders in a subsequent child.

This volume summarizes the proceedings of the fifth biennial Cancer Teaching Symposium held on March 4 and 5, 1972 at the University of Chicago Pritzker School of Medicine. The program was prepared by Drs. MELVIN GRIEM, ELWOOD JENSEN, HAROLD SUTTON, JOHN ULTMANN, and ROBERT WISSLER. The purpose of the symposium was to present the current status of the challenging cancer problem, breast carcinoma, to the staff and students of this medical center and to students and in terested physicians from other institutions in the Chicago area. In a fashion similar to the other teaching symposia held in 1964, 1966, 1968, . and 1970, this symposium attracted over 450 physicians and scientists. In the course of one and one half days the audience had the opportunity to listen to 18 invited speakers and to the lively discussions. The formal presentations are recorded in these pages. This teaching symposium could not have been undertaken without the faithful assistance of the program committee, the cancer training grant education committee, the staff who recorded and transcribed the proceedings, and the editorial assistants. We wish to thank the following for their efforts: JULIE KANT, Administrative Secre tary for the Clinical Cancer Training Grant, as well as Dr. JAMES MARKS, MARGARET WOEHRLE, FRIEDA RANNEY, and ROSIE BARTLETT. This symposium received financial support from USPHS Clinical Cancer Train ing Grant 5T12 CA-08077-06 and from the Chicago Tumor Institute. MELVIN L. GRIEM, M. D. ROBERT W. WISSLER, Ph. D., M. D."

Reproduction is, it would appear, a very simple biological event: the result of an act of love. In actual fact, it has always been, and still continues to be, one of the most complex, yet at the same time, most fascinating, problems, with which Science has ever been engaged. Physiopathology of human reproduction has always made use of investigations of a morphological nature, perhaps on account of the need to "see inside" the reproductive apparatus or within the gonads themselves in order to better understand how they function. Observation of spermatozoa practically coincided with the discovery of the microscope, and histological study of the testis and ovary was, for a very long time, the only means available with which to closely follow the evolution of gametes destined to their meeting. Improvement of techniques resulting from the evolution of endocrinology of reproduction has only apparently put aside morphological techniques, whilst at the same time there has been a gradual development of ultrastructural techniques, on the one hand, and, on the other, macroscopic diagnostic systems through images.

Perinatal problems in thyroid gland physiology are common but complicated and present a diagnostic dilemma for the primary clinician. In December 1990, an international group of basic and clinical investigators gathered in Longboat Key, Florida to address these issues. The participants included internists, obstetricians, pedia tricians, neurologists, pathologists and basic scientists in cellular metabolism, endocrine physiology, and molecular biology. The presentations contained within this book bring together their most current and vital research related to the field of perinatal thyroidology. This book is based on the dynamic and fruitful exchange of the participants at the symposium. We are indebted to these individuals whose valuable insights and efforts are contained within this text. Barry B. Bercu Dorothy I. Shulman vii CONTENTS Session I Mechanism of Thyroid Hormone Action 1 Leslie J. DeGroot Thyroid System Ontogeny in the Sheep: A Model for Precocial Mammalian Species * . . * * 11 Delbert A. Fisher Pathologic Studies of Fetal Thyroid 27 Development * * * * * * * Douglas R. Shanklin Thyroid Hormone Control of Brain and Motor Development: Molecular, Neuroanatomical, 47 and Behavioral Studies * * * * * * * S. A. Stein, P. M. Adams, D. R. Shanklin, G. A. Mihailoff, and M. B. Palnitkar The Thyroidectomized Pregnant Rat: An Animal Model to Study Fetal Effects of Maternal Hypothyroidism 107 Susan P. Porterfield and Chester E.

Progesterone, the hormone "pro gestationem", plays a pivotal role in mammalian reproduction during almost all phases of the menstrual cyc1e and all stages of pregnancy. It is involved in the control of ovula- tion, prepares the endometrium for implantation, and, in later stages of pregnancy, is responsible for its maintenance by suppressing uterine contractility. The sudden withdrawal of progesterone action at the end of the nonfertile cycle leads to the constriction of spiral arteries and, in . turn, to menstruation in human beings and non human primates. The decrease in serum progesterone concentrations or its functional with- drawal in the myometrium and decidua are the most important events during parturition in various mammals. In the uterus, progesterone controls the growth and differentiation of endometrial and myometrial cells and regulates a variety of cell functions directly by either stimulating or inhibiting structural and functional proteins, but also indirectly by functionally opposing estra- diol action. In the nonpregnant uterus, there are different progesterone effects on uterine cell proliferation which vary among species. In the fertile cyc1e, progesterone regulates in synergism with estradiol the transport of the fertilized eggs and the c1eavage stage embryos through the oviduct and induces the secretory changes in the endometrium re- quired for implantation. During the period between ovulation and im- plantation, remarkable morphological and biochemical changes in the lumenal and glandular epithelial cells take pi ace under the influence of rising progesterone levels in the human and primate endometrium.

Liposuction began as a contouring procedure but has evolved into the treatment of obese patients, gynecomastia, ptosis, macromastia, and even patients who have complications from heart disease or diabetes. Other disorders such as axillary sweat hypersecretion, lipomas, and angiomas are also potential disorders that may be treated with liposuction.

Physicians performing liposuction must be adequately trained and experienced in the potential and actual complications before attempting to perform liposuction. Patient safety is the most important aspect of all surgeries, but especially of cosmetic surgery, which is an elective procedure.

New technology helps improve results but experience, care, and skill of the cosmetic surgeon is necessary to obtain optimal results that satisfy the patient.

The contributors to this book have spent time and effort presenting the cosmetic and plastic surgeon as much information as possible on the techniques and uses of liposuction for cosmetic and non-cosmetic surgery purposes.

Julio Morales describes the Puerto Rican nation as being comprised of those individuals who identify themselves as Puerto Ricans. This includes almost 6. 2 million people who live primarily, but not exclu sively, on the island of Puerto Rico, and in the northeastern United States. One gets to be a Puerto Rican by various means. You are Puerto Rican if you are born in Puerto Rico, although at the same time you are an American because you were born there. You are Puerto Rican if your parents are Puerto Rican, even if you have never visited the island, have never eaten arroz y habichuelas, and have never spoken a word in Spanish. You can be a second and third generation Puerto Rican of mixed marriage, be highly acculturated to American culture, but when asked, you say proudly, "I am a Puerto Rican. " You can meet some of us whose world is bicultural, a world where English and Spanish are easily interchanged, where traditional Thanksgiving turkey is followed by lechon asado at Christmas as the main treat, where salsa or bolero are enjoyed with the same passion as rock'n roll or the big band sound. It is a world where various cultures have merged and the historical forces of slavery and Spanish and American colonialism have left their indelible marks on the psyche."

Our knowledge of reproductive medicine has expanded rapidly since the birth of Louise Brown, the first baby to be conceived by in vitro fertilization, which was performed by Professors Patrick Steptoe and Bob Edwards in Oldham, Eng land, in 1978. Hardly a year goes by without the development of a new or a modification of an existing method of assisted reproduction. Within a relatively short period, in vitro fertilization has been introduced into the treatment of female infertility. Intracytoplasmic sperm injection has also created new opportunities for the treatment of male infertility. The first edition of this book was published in 1996. In the second edition most of the chapters have been updated and additional interest is focused on intracytoplasmic sperm injection (ICSI) in view of the risk of malformations in newborns. This manual addresses the techniques of assisted reproduction that are avail able today. Competent authors from various centers present, in a concise way, their tried-and-tested procedures, so that the latter can be readily implemented. Due to different legal regulations, the scope of assisted reproduction is much more limited in Germany than in many other countries. For example, whereas only three embryos may be created and transferred in Germany, such restric tions do not exist in several other European countries and the United States. Furthermore, heterologous fertilization, oocyte donation, and surrogate mother hood are banned in Germany."

This title includes a number of Open Access chapters. Nutrition is not only a basic need that all humans have to sustain life, but it is also critical to successful early development. This research compendium lends deeper insights into the links between nutrition and healthy brain function-and from the reverse perspective, between nutrition and neurocognitive disorders. This well-organized and accessible compendium offers a vital research context for policymakers, educators, medical providers, and families. It underlines our urgent responsibility to give children a strong start by improving prenatal and early childhood nutrition.

Amenorrhea: A Case-Based Clinical Guide is a comprehensive review of the current knowledge regarding normal female reproductive physiology. Replete with interesting case vignettes and providing diagnostic algorithms and therapeutic strategies for amenorrhea, Amenorrhea: A Case-Based Clinical Guide is divided into three sections. The first section is composed of two chapters that provide a thorough review of basic science and clinical knowledge about the organ systems responsible for normal physiology of the menstrual cycle. The second section includes discussion about menstrual cycle disruption as it relates to hypothalamic-pituitary dysfunction, surgical and natural menopause, genetic defects, premature ovarian failure/insufficiency and the effects of caloric excess and restriction. The third section offers an update on the physiological effects of prolonged amenorrhea induced surgically or by hypothalamic dysfunction and also includes an original chapter that focuses solely on the impact of race and ethnicity on the prevalence and diagnosis of amenorrhea. Amenorrhea: A Case-Based Clinical Guide brings together chapters from renowned experts who offer state-of-the-art, clinically useful information in a case-based, reader-friendly fashion. This title will be a welcome addition to the bookshelves of all clinicians who practice in women's health settings.

Despite its universality in human female aging, the menopause and its biology are not completely understood. New biologic mechanisms by which sex hormones may be detrimental or confer protection are continually being discovered. We are now starting to understand that the role of the estrogen receptor is not identical in all tissues. Important nongenomic effects for sex hormones have also been described. Hormone replacement therapy (HRT) has produced effects on health risks: some are reduced, some are increased, and the rest remain uncertain. HRT is being used by an increasing number of women to alleviate climacteric symptoms in the perimenopausal period and to prevent osteoporosis and cardiovascular disease later. Positive effects on Alzheimer's disease and dementia on the one hand, and an increase in venous thrombosis on the other, are currently being reported by several groups. Both the preventive benefits and the risk of breast cancer seem to be linked to long-term and current use. HRT requires further testing through specific clinical trials, currently underway in the United States, before confident recommendations may be made about the full range of benefits and risks.

Human reproduction is the most dynamic of processes. The events which lead to the birth of a normal healthy infant have their origin long before actual fertilization. Indeed, the whole process can be looked upon as a continuum. Human fertilization and early development, once sequestered in the protective environment of the fallopian tubes and uterus, have now been exposed in the laboratory. These events have, over time, been extensively observed and catalogued in animal models. The tools of modem morphology and molecular biology have reopened issues long since considered settled as facets of early reproduction are reexplored. This volume, consisting of the proceedings of a workshop on uterine and embryonic factors in early pregnancy, has been designed to enhance that effort. Attention is focused largely on early embryonal development with special attention to the interrelationship between the embryo and the uterus in early pregnancy. Each of the contributing scientists brings with him or her the perspective of one specific discipline or another. The common denominator is the application of emerging techniques in modem molecular biology to problems pertaining to embryonal-uterine interaction. The goal is to consider specific areas of concern in a multidisciplinary way and to reexplore the factors behind early development and implantation. Uterine complement, the function of uterine macrophages immunoregulatory loops in the peri-implantation period, colony stimulating factors and interferon-like factors are reviewed and their interrelationship explored. Uterine angiogenesis factors as well as embryonic growth factors are also considered.

Nearly one-half of an American woman's life is spent after the cessation of reproductive function. A woman of 40 years has an additional life expectancy of nearly 40 years; a woman of 75, over 11 years. This pattern of longevity is likely to continue, so that by the year 2000, it has been estimated, 30 percent of the female population will be postmenopausal. While it is difficult to separate the results of aging from those of estrogen deprivation, it is important that we try to do so, since the results of the latter are amenable to treatment. The medical infirmities resulting from estrogen deprivation take a high toll among postmenopausal women. Nearly 200,000 hip fractures occur annually in this group, resulting in 15,000 deaths and a high morbidity rate. Sleep disorders, compromised sexuality, psychomotor alterations of the climacterium, and urinary tract disorders all contribute to a lowered quality of life. Appropriate treatment of these disturbing postmenopausal conditions requires an understanding of the underlying bio chemical, endocrinologic, psychologic, and pathophysiologic al terations of estrogen deprivation. Toward this end, the reader will find herein chapters dealing with estrogen metabolism in the postmenopausal female, end-organ response to estrogen deprivation, and bone metabolism and osteoporosis. Next, the reader will find chapters dealing with specific or gans, organ systems, or conditions related to the quality of life; for example, sexuality, urinary tract problems, sleep disorders, the breast, sports and exercise, the climacteric, and the psycho biology of the menopause."

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 valuable resource for those concerned with experimental teratology and risk assessment and those requiring general information about the causes of birth defects. The treatment of these issues is sophisticated, succinct, and logical.'' --- American Scientist, from a review of a previous volume The current volume covers intergenerational factors in pregnancy outcome, the thresholds for developmental toxicants, and four other subjects.

This is the definitive reference on the medical, surgical, legal, and ethical aspects of establishing and maintaining an office-based egg donation program. The editor has assembled an international list of authors with known expertise in this rapidly expanding field. The clinical procedures are clearly depicted in the book's many line drawings and photographs.

Peritoneoscopy and culdoscopy were first introduced in the second edition of TeLinde's Operative Gynecology in 1953. TeLinde noted, "In many instances we find peritoneoscopy to be a useful procedure. Nevertheless it often left something to be desired." During the subsequent four decades, enormous progress has allowed the expansion of the application of laparoscopy and hysteroscopy throughout gynecol- ogy. Thus, it is appropriate and quite useful to have a text devoted solely to this rapidly advancing specialty. In its second edition, the text Practical Manual of Operative Laparoscopy and Hys- teroscopy is a complete and honest overview of the field providing the reader with a critical appraisal of the current literature on technique, development, and long- term follow-up. Refreshingly, the authors include not only the American experi- ence but also advances from Europe and Asia. Ricardo Azziz and Ana Alvarez Murphy have carefully organized the text into general concepts and laparoscopic and hysteroscopic operative techniques. The editors have selected authors of national and international stature to prepare chap- ters in their areas of expertise. The edited text carefully analyzes the advantages and disadvantages of each operative technique so as to allow readers insight as to the proper place for a particular endoscopic technique in their surgical practices.

Recent work in quantitative biology has shown theoretically why Fisher's Fundamental Theorem of Natural Selection does not preclude genetic influences on fertility, sexuality, and related processes. Genetic Influences on Human Fertility and Sexuality takes the next step, and presents a number of successful empirical searches for such genetic influence on a broad range of processes, such as puberty, marriage, sexual behavior, and twinning. Employing a broad range of methodological approaches, including molecular and behavioral genetics, this book weaves a new theoretical framework that shows how genes can help relate fertility planning to fertility outcome, and how puberty, sexuality, marriage, and reproduction can be conceptually linked through the genes that contribute to individual differences in the human process.

This book offers a progress report on efforts to meet the challenges faced by ovarian cancer patients and their doctors. It provides a current perspective on therapeutic developments as a partnership between laboratory-based and clinical-based researchers.

From a review of an earlier volume: 'Both the experimental and the human aspects of teratology are presented in this comprehensive text by a stellar group of internationally recognized scientists and clinicians....A valuable resource for those concerned with experimental teratology and risk assessment and those requiring general information about the causes of birth defects. The treatment of these issues is sophisticated, succinct, and logical.'-American Scientist