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.

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."

This new SpringerBrief in Physiology explores the newest research findings on how exercise influences the fetus in utero and beyond. "Physiology of Prenatal Exercise and Fetal Development" reviews the current findings of how maternal exercise throughout gestation influences fetal development of key organ systems, and also encompasses the relationship between maternal activity level and fetal, birth, and neonatal effects. This information will help researchers and scientists better understand the physiological effects of exercise during pregnancy on offspring development."

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.

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."

The advent of assisted conception procedures such as in-vitro fertili sation (IVF) has provided the impetus for exploration of the factors that lead to the establishment of pregnancy. This collection of papers from leading research workers brings together current concepts of the processes which may be of importance in implantation. The complex signals from the embryo to the ovary, endometrium and myometrium are now being revealed through studies in both primates and other mammalian species. This book addresses the interrelationship of pituitary and ovarian hormones in controlling ovulation and the preparation of the intrauterine environment for implantation. Once fertilisation has occurred and trophoblast has formed, the next vital step is the production of materials which signal the presence of the pregnancy to the rest of the body. Trophoblastic proteins and other early-pregnancy factors are prime candidates for this role. Recent studies have emphasised the importance of the intrauterine environment in implantation. Specific secretory products of the endometrium have great potential in this process. The prostaglandins also play an essential part. Immunological adjustments are now considered a condition for the successful establishment of pregnancy. The possible use of immuno therapy in the treatment of recurrent abortion has highlighted interest in this area. The use of immunological techniques for contraception are in their infancy but offer much hope for the future.

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."

An excellent reference for the experienced breast surgeon is now available in Plastic and Reconstructive Breast Surgery, An Atlas. It assumes that the reader has a solid foundation in plastic surgery and is familiar with various operative methods. It describes the complete range of breast surgery: augmentation and reduction mammaplasty, anomalies, the treatment of primary breast cancer and breast reconstruction. The various flaps and grafts are described with emphasis placed on the presentation of specific details and complications. This is done with a series of illustrations and an accompanying text that is very easy to read. By looking up a similar case, the surgeon will find direct help for his own decision-making. Many less common types of cases are included to provide the broadest coverage possible. Coming from a single hospital, this atlas gives up-to-date information based on years of expertise. The authors present only the methods and techniques that have proved most successful at their hospital in the past two decades. A comprehensive bibliography directs you to further reading.

AIDS continually presents new questions for the obstetrician and gynecologist. The effect on pregnancy, the possibility of perinatal transmission, HIV positive tests, and risk to staff are just a few of the issues confronting clinicians and practitioners today. These and other questions were addressed by the 19th Study Group of the Royal College of Obstetricians and Gynaecologists, whose findings are reported here.

Reevaluation of tumor classification, differential diagnosis and differential therapy based on modern knowledge. Revision of all chapters to incorporate new facts based on recent discoveries.

The enormous expansion seen over the last decade in the mammo graphic detection of breast cancer lesions, especially the use of screen ing procedures for the early detection of clinically unsuspected tumors, has made it necessary to summarize the experience made by various centers in the world. The 2nd International Copenhagen Symposium on Detection of Breast Cancer afforded an opportunity of gathering scientists from all over the world to discuss the various problems of early breast cancer detection with special reference to screening procedures. This book forms a synthesis of the information presented by leading scientists from many of the world's mammo graphic centers, particularly those in Sweden and the USA. Hence, the reader will have the opportunity to study the outstanding work carried out by various institutes and centers of breast cancer screening. It is our sincere hope that a study of this volume will encourage other scientists to join in the work on screening procedures. S. Brunner B. Langfeldt P. E. Andersen Contents S. A. Feig: 1 Hypothetical Breast Cancer Risk from Mammography S. A. Feig: Benefits and Risks of Mammography 11 R. L. Egan and M. B. McSweeney: Multicentric Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . 28 M. B. McSweeney and R. L. Egan: Breast Cancer in the Younger Patient: A Preliminary Report 36 M. B. McSweeney and R. L. Egan: Bilateral Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . ' 41 N. Bjurstam: The Radiographic Appearance of Normal and Metastatic Axillary Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 M. Moskowitz, S. A. Feig, C. Cole-Beuglet, S. H."

R. B. GREENBLATT The original oral contraceptives contained more oestrogen in the form of ethinyloestradiol or mestranol and progestagen in the form of norethynodrel or norethisterone than was necessary f(x conception control. There has been a trend over the years to reduce dosages of both components in order to minimize side- eHects while ensuring eflcctiveness. However, as dosages were lowered, there has been an increase in spotting and break- through bleeding during the first few months of their adminis- tration. The sequential pill appeared more physiological in that it followed more closely physiological principles, but the need to employ large doses ofEE or EE3ME to inhibit O\'ulation and the higher pregnancy rate made the sequential regimen less attrac- ti\'e or useful. A triphasic formulation has become available that takes advantage of the synergism between ethinyloestradiol and the potent levonorgestrel so that low doses of the oestrogen and very low doses of the progestagen could be employed with great effectiveness. Such a preparation is relatively free from side- effects, partly because the basic pharmacological tenet of the minimal dose for the desired result and the division of'the cycle into three parts using 30 ,lIg ofEE for the first 6 days, then:) days of 40 ,lIg, followed by 30 ,fIg for 10 da ys, for a total of21 days, thus more or less mimicking the physiological rise and fall of 125 THE DEVELOP:'IE:-;T OF ,\ :-;E\\' TRIPH. \SIC OR.

Alfons Staudach has been a long-time member of the Anatomic Institute of Karl Franzens University in Graz, where he has devoted particular atten tion to the deeper understanding, appreciation and visualizion of gross ana tomic details. In this work the author has achieved correspondence between sonograms and anatomic sections with a consistency and persuasiveness unequaled in all the previous literature on diagnostic ultrasound. The various planes of section andtheir characteristic features, and indeed the entire format of the text, are designed to provide even the less experienced sonographer with a valuable basis for conducting his examinations. The more experienced reader will find essential information on topographic relations and organ development that is not available in any other work dealing with fetal ana to y. I am certain that my high estimation of this volume will prove justified, and that it will provice its readers with a useful and stimulating resource. Univ. -Prof. Dr. Walter Thiel (Chairman of the Anatomic Institute of the University of Graz) Foreword Anyone setting this book down after an initial perusal must wonder why such a reference was not available ten years ago. The meticulous and fas cinating juxtaposition of gross anatomic sections with sonograms, together with explanatory drawings and many practical guidelines, should enable even the novice accurately to identify details and interpret sonographic findings with precision."