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.

The prevalence of hypertension is almost three times as high as that of diabetes mellitus type 2, with both conditions being major risk factors for stroke, ischemic heart disease, cardiac arrhythmias, and heart failure. The exact prevalence of hypertension related to hormonal derangements (endocrine hypertension) is not known but estimated to affect less than 15% of hypertensive patients. Recent scientific discoveries have increased the understanding of the pathophysiologic mechanisms of hypertension. In Endocrine Hypertension, a renowned panel of experts provides a comprehensive, state-of-the-art overview of this disorder, discussing when to assign an endocrine cause in one of many conditions that may present with hypertension. The first part of Endocrine Hypertension is dedicated to adrenal causes. The second part of the volume concerns potential nonadrenal causes of hypertension, such as growth hormone excess or deficiency, primary hyperparathyroidism, vitamin D deficiency, testosterone deficiency, insulin resistance, obesity-associated hypertension, and the role of central mineralocorticoid receptors and cardiovascular disease. An important contribution to the literature, Endocrine Hypertension is an indispensable reference not only for endocrinologists, diabetologists, and adrenal investigators, but also for translational scientists and clinicians from cardiology, internal medicine, pediatrics, family medicine, geriatrics, urology, and reproductive medicine / gynecology.

Gynaecological cancers are categorised as 'rare' diseases, although collectively they affect over 16,000 women each year in the UK alone. There is a lack of real understanding of these conditions compared with other malignancies, possibly owing to their relative rarity when viewed as individual diseases. The 60th RCOG Study Group brought together a range of experts to examine as many biological aspects of gynaecological cancers as possible, including both surgical and non-surgical therapies. This book presents the findings of the Study Group, with contents including: current understanding of the biology of gynaecological cancers translation of biology to the clinic state of the art in imaging and therapy current clinical trials advances in multimodal therapy individualised treatment."

In Vitro Fertilization, Embryo Transfer and Early Pregnancy is undoubtably the most exciting and onwardly progressing field in reproductive medicine today. It forms the major subject matter of this the second volume of the Proceedings and the first book of Related Communication papers given at the XI International Federation of Fertility Societies World Congress on Fertility and Sterility held in Dublin, Ireland from June 26th to July 1st 1983. The papers have been grouped into closely allied topics covering sequentially in three parts: Follicle and Ovum in the Human, Follicle and Ovum in the Animal Model, and Semen and Spermatozoa. Preceding a timely reminder on Ethical and Legal Aspects of IVF are some of the remarkable clinical results now been obtained throughout the world. The final section concerns various aspects of Pregnancy in Animals and Humans and is included in this volume because of its close relationship to the main subject matter. Related Communications sessions often produce the largest amounts of up-to-date information to be given on a particular subject during a Congress. IFFS Dublin '83 proved to be no exception. So although scientific and medical endeavour will ensure that knowledge and progress in the field will soom overtake many of the conclusions reached in these papers, nevertheless we hope you will agree in the merit of producing such a record of the state of the art at this time. Robert F. Harrison John Bonnar William Thompson Dublin 1983.

Proceedings of the 9th International Conference of the International Society for Research in Human Milk and Lactation (ISRHML), October 2-6, 1999, Bavaria, Germany. The quality of infant feeding is of major importance for child health development and well being, and breast feeding is the natural form of supplying food to the infant and is considered to be ideally adapted to the needs of both mother and child. This contributed volume therefore, brings together the research on the physiological foundations and on the biological effects of breast feeding, both short and long term. This book contains the work of scientists from over thirty countries, many of whom are leading researchers in their fields, and details papers presented by the invited speakers of the conference and short summaries of presentations of original research results.

Fetal and perinatal medicine is a rapidly expanding field, and noninvasive imaging by means of ultrasonography and MRI is playing a major role in refining diagnosis and therapy. Recent technological advances in these imaging modalities now allow unprecedented morphological depiction of the fetus and excellent insight into complex pathologic conditions, as well as yielding superior guidance for therapeutic fetal inter ventions. I am very pleased that Professor F. Avni , a leading international pediatric radiologist, was prepared to take on the challenging task of preparing and editing this comprehen sive and up-to-date overview of our knowledge in the area of fetal and perinatal imaging. He has been successful in engaging well-known experts with outstanding qualifications in fetal imaging to join him in this venture. I would like to congratulate Professor Avni and all contributing authors most sincerely for their excellent work. I am confident that this outstanding volume will meet with great interest not only from general as well as specialized pediatric radiologists but also from neonatologists and pediatricians. I trust it will enjoy the same success as many previous volumes in this series. ALBERT L. BAERT Leuven Preface Fetal and perinatal medicine would not have developed without the extensive use of obstetric ultrasound (US). In order to be efficient, the examination has to be performed very carefully and by sonologists fully conversant with the normal and abnormal development of the fetus.

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.

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.

Each year since 1961, the Rochester Trophoblast Conference has grown in the diversity of its approaches to trophoblast research. At the Ninth Conference, Professors Klopper, Villee and Winick molded the conference with their state of the art addresses on Endocrinology, Metabolism and Nutrition of the Trophoblast. The Conference was favored with a multitude of creative studies and with warm, sunny, autumn weather to discuss these results. In October of 1982, one hundred and five investigators from 12 countries and 21 states discussed 42 different presentations at the Holiday Inn in Rochester, New York. The Ninth Conference introduced workshops on Metabolism, Nutrition, Endocrinology and Trophoblastic Neoplasia. The chairmen of these workshops were: Metabolism -Villee and Miller; Nutrition - Winick and Maulik; Endocrinology - Klopper and Muechler; and Trophoblastic Neoplasia -Szulman and Helmkamp. These two-hour, intimate discussion groups were well-received by all who attended. As with the Eighth Conference, the University of Rochester will no longer produce a transcript of the Conference. Beginning with the Ninth Conference, Plenum Press in association with the University, will publish a peer-reviewed series entitled Trophoblast Research. An international editorial advisory board has been named to assure the direction of the series. The editorial board and the organizing committee will develop the future meetings of the Rochester Trophoblast Conference. Trophoblast Research will be published as single bound volumes with original contributions and editorial reports of presentations from the Conference.

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.

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."

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.

Pre-eclampsia is one of the leading causes of death and disability in mothers and babies. Over four million women worldwide will develop the disorder every year. This book, written by an international team of experts, focuses on both the scientific basis of pre-eclampsia and its management. The basic science section contains reviews of the most exciting research developments in pre-eclampsia. The clinical chapters provide a comprehensive review of the pertinent literature, highlighting data and ideas or developments in management. There is a section in each chapter (where relevant) that deals with practical management, giving clinicians a formulated treatment plan that they can implement directly. The book was originally published in 2007, and will have continuing relevance for all professionals interested in the reproductive sciences, and to obstetricians and physicians with an interest in pre-eclampsia.

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.

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.