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.

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.

This new edition of an acclaimed text reviews the evidence for best practice in obstetrics to present the reader with the right information, with appropriate use of proven interventions and avoidance of ineffectual or harmful ones. The information is presented in the right format by summarizing evidence succinctly and clearly in tables and algorithms. The aim is to inform the clinician, to reduce errors, and "to make it easy to do it right." The volume can be purchased separately or together with the companion volume on Maternal-Fetal Evidence Based Guidelines (set ISBN 9780367567033). The Series in Maternal-Fetal Medicine is published in conjunction with the Journal of Maternal-Fetal and Neonatal Medicine. From reviews of previous editions: Obstetric Evidence Based Guidelines is a text that will prove useful to residents and fellows as well as to practicing obstetric clinicians. Furthermore, it can be used as a source for the development of hospital policies for the management of these obstetric problems ... The major advantage of this text is that it provides guidelines for the management of commonly encountered obstetric issues in a single book. -JAMA This is a welcome addition to a physician's library. Its use of current studies and easy-to-read format allow for easy fact-checking and referencing. -Doody's Review Service

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."

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."

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.

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.

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.

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.

Hemorrhage and thrombosis are major hazards for pregnant women and their newborn infants. This book is concerned with the developmental mechanisms, the diagnosis and treatment, as well as the prevention of these hemorrhagic and thrombotic disorders. The topics discussed in this volume, (1) perinatal hemorrhage in mothers and their offspring; (2) coagulation disorders complicating pregnancy; (3) neonatal intracranial hemorrhage; and, (4) vitamin K deficiency in the neonate, will help bridge the gap between basic scientists and clinicians and between the pediatri- cian and the obstetrician. Hopefully, all those concerned with preventing these disorders will be stimulated by the information and questions raised in the fol- lowing presentations. Acknowledgements We wish to thank Professors Takeshi Abe (Vice President, Teikyo University), Nobuyoshi Shinagawa (Hirosaki University), Hiroaki Soma (Tokyo Medical College), Tamotsu Miyazaki and Keisuke Sakurada (Hokkaido University) for their helpful advice. SHIGENORI SUZUKI WILLIAM E. HATHAWAY JOHN BONNAR ANTON H. SUTOR SHIGENORI SUZUKI. * 1936 in Sapporo, Japan. M.D., Uni- 'versity of Hokkaido, 1963. Lecturer, Hokkaido Univer- sity, 1974. Alexander Humboldt-Foundation Scholarship, Free University of Berlin. University of Munich, 1974- 1976. Foriner President, Japanese Society of Obstetrical, Gynecological, and Neonatal Hematology. President of International Symposium on Perinatal Thrombosis and Hemostasis (1989 Sapporo). Professor, College of Medi- cal Technology affiliated with Hokkaido University since 1983. WILLIAM E. HATHAWAY. * 1929 in Oklahoma, USA.

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."

Designed for easy revision of the key points, key references, and key management stages, the two volumes in this set review the evidence for best practice, presenting the reader with the right information, in the right format, summarized in easy-to-use tables and algorithms. Each guideline is designed to "make it easy to do it right", with appropriate use of proven interventions. The quality of evidence available is graded so that a well-informed clinician can improve the health of mother and baby by providing quality care. *Offers an easy-to-assimilate guide to the key points in maternal-fetal and obstetric practice *Supplies an invaluable resource for those revising topics for professional or clinical requirements *Ensures providers of care can locate the best intervention quickly and confidently

''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.

The book that you hold in your hands is the second in a series. The two titles in the series are the following: Genetic Influences on Human Fertility and Sexuality: Theoretical and Empirical Contributions from the Biological and Behavior Sciences Edited by Joseph Lee Rodgers, David C. Rowe, & Warren B. Miller Published by Kluwer Academic Press, 2000 The Biodemography of Human Reproduction and Fertility Edited by Joseph Lee Rodgers & Hans-Peter Kohler Published by Kluwer Academic Press, 2002 The series has published chapters by researchers who study human fertility, from a particular perspective: Biodemography. We welcome your interest and participation in this developing subfield. Or, perhaps, biodemography may be better referred to as a "superfield. " Because biodemography so naturally crosses interdisciplinary boundaries, and because its application draws together researchers from disparate disciplines, it may well be more appropriate to consider that biodemography subsumes a number of other disciplines, rather than the other way around. In this preface, we will describe our own efforts and those of many others to promote and develop the study of human fertility, using methods, models, and theories from both biological and demographic domains. In December, 1997, 25 participants from three different countries gathered in Tucson, Arizona for a small conference with the title "Genetic Influences on Fertility-Related Processes. " That conference represented a fascinating blending of research from two apparently separate domains.

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.

approaches to the experimental problems that still face us in understanding this most fascinating of organs. Too many people contributed to the completion of this volume to allow acknowledg ment of all the individual efforts, but we particularly thank the reviewers whose input into the editorial process was invaluable and the authors of these chapters who revised their text, sometimes more than once, to bring it to the high standards set by the Editors. The Com mittee gratefully acknowledges the support ofVysis, Inc. , in the publication of a color figure in Chapter 19, by S. Weber-Hall and Trevor Dale. Finally, we wish to express our heartfelt appreciation to Margot Ip and Bonnie Asch, who worked long and hard to bring this volume to fruition. Margaret C. Neville for the Committee on Mammary Gland Biology Preface One of the most exciting and beneficial developments in research on mammary gland biology and breast cancer has been the influx of increased funding to support this work. This influx, which has been due primarily to the tireless efforts of breast cancer activists to gamer addi tional money from various federal and state sources, has led to a rapid expansion of research efforts by attracting numerous new investigators into the field. These new investigators include students, postdoctoral fellows, and scientists from other fields.

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.

"Fertility Preservation in Males: Emerging Technologies and Clinical Applications" contains a selection of the valuable chapters and protocols of Seli and Agarwal s previously published hardcover text "Fertility Preservation: Emerging Technologies and Clinical Applications." Newly available in this convenient and affordable softcover format, this practical reference guide provides an update on options for fertility preservation in men, while also discussing important related epidemiologic, ethical, medico-legal, psychological, and social aspects. Using a format that combines concise scientific background with practical methodological information and easy-to-grasp algorithms, the chapters all conform to a uniform structure, including step by step protocol of laboratory procedures, key issues in commentary and a list of references. The result is a unique resource for reproductive endocrinologists, urologists, embryologists, reproductive scientists, and oncologists."

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.

Pelvic Inflammatory Disease is an in-depth, thorough guide for the clinician on the most common complication of sexually transmitted pathogens. Edited and written by the preeminent experts in the field, this volume presents the etiology, treatment, and diagnosis of PID, as well as chapters on risk factors, epidemiology, and prevention. In addition, the myriad clinical complications and challenges are discussed in chapters on tuboovarian abscess, PID and HIV infection, sequelae of PID, PID in adolescence, and PID in pregnancy. This is a must-have resource for obstetrician-gynecologists, primary care physicians, and all clinicians who provide health care to women of all ages.

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