The epididymis has great significance in the reproductive biology of the male and it is gaining recognition as an organ worthy of study in its own right - where the secretory and absorptive activities of one tissue (the epithelium) profoundly modify the function of another (the spermatozoon). Apart from cases of epididymal agenesis or physical blockage, however, it is not yet known to what extent mal functions of the epididymis contribute to "unexplained" male infer tility, but its importance as a target for antifertility agents in the male is now widely appreciated. This monograph evolved from two lectures on epididymal func tion given at the National Research Institute for Family Planning, Beijing and the Sichuan Provincial Family Planning Research Insti tute, Chengdu, China in 1983. In order to stress for this audience the central importance of the epididymis in fertilisation, and so highlight its potential for attack by antifertility agents, the talks attempted to put the epididymis in reproductive perspective by stressing the func tional development of the sperm cells during their sojourn in the epididymis, rather than merely listing the changes observed in them."

In 1909 a short contribution entitled "Geriatrics" was published in the New York Medical Journal. According to this article, old age represents a distinct period oflife in which the physiologic changes caused by aging are accompanied by an increasing number of pathologic changes. We now know that the organs of the body age neither at the same rate nor to the same extent and that physiologic alterations are indeed superimposed by pathologic changes; as a result of the latter phenomenon the origins and course of illnesses in the elderly can present unusual characteristics. The frequency of concurrent disorders in the elderly entails the danger of polypragmatic pharmacotherapy, i. e., the use of various drugs to combat various disorders while neglecting the possibly adverse combined effects of these drugs. To obviate this danger, special knowledge in the field of geriatrics, the medical branch of gerontology, is necessary. Geriatrics is constantly increasing in importance owing to the near doubling of life expectancy over the past 130 years and to the improved diagnostic and therapeutic techniques made available by medical pro gress. The rapid recent development of experimental gerontology has played an essential role in enabling us to understand the special features of geriatrics. This progress has, however, been accompanied by such a vast increase in the volume of literature on the subject that specialists in the field can scarcely maintain an overall perspective of new publications."

The World Congress of In Vitro Fertilization and Alternate Assisted Reproduction, held in Jerusalem, Israel, 2-7 April, 1989, was the sixth in the sequence of these Congresses, but was the first to emphasize the major importance and the place of assisted reproductive technologies in the treatment of infertility. The eternal City of Jerusalem witnessed the gathering of more than 1500 participants from allover the world who shared and exchanged knowledge and up-to-date experience in this ever-evolving field. The high quality scientific contributions to the Congress culminated in the publication of this Proceedings. It embraces all-important aspects in the field of in vitro fertilization and alternate assisted reproduction. Papers on controversies and diversities of methods to stimulate the ovaries, imaging techniques, basic research and state-of-the-art papers on ovarian physiology, the role of GnRH and its analog, clinical aspects of IVF treatment and cryopreservation, up-to-date techniques in assisted reproductive technologies that are quickly developing in conjunction with IVF, were included. When should IVF be preferable to surgery? What are the ex pected up-to-date world results and what are the psychological, moral, ethical and religious implications? These are all the concerns of the treating team and are addressed here. Male factor infertility remains a frustrating problem, but advances in the understanding of sperm-egg interaction, sperm evaluation and preparation are reported. Micromanipulation emerges as a possible alternative to bring some relief to this problem, but it also promises to be central in promoting the field of prenatal genetic analysis."

Volume 3 of this series is concerned with geriatric aspects of surgical specialties: gynecology, orthopedics, general surgery, otorhinolaryn gology, and ophthalmology. Closely associated with these specialties is anesthesiology. Dermatology has an intermediate position between surgical and nonsurgical fields. The peculiarities of physiological and pathological aging of otgans and the consequences for diagnosis and therapy - presented in the first two volumes - are of great significance, especially for surgical special ties. There are a large number of pre-, intra-, and postoperative problems in multimorbid geriatric patients, e. g., coronary insufficiency, brady arrhythmias, hypertonia, and hypotonia. While as recently as the tum of the century the age of 65 years was viewed as a contraindication for sur gery, today even older patients undergo operations on aortic aneurysms, bypass operations for coronary sclerosis, pulmonary resections, and abdominosacral resections of rectal carcinomas, for example. Pre requisite for successful surgery at an advanced age is good pre- and postoperative care of multimorbid patients. Physiological changes of the lungs with aging, the increased frequency in pneumonia and pulmonary just a few embolisms with age, and the decrease in receptors, to give examples, confront anesthetists with difficulties. The maxim "in old age a little less" is also applicable in this field. Only improved experimental gerontological research, possibly reaching even into anesthesia, will provide objective data for anesthesia in elderly patients. The skin is an organ that experiences characteristic qualitative and quantitative changes in old age."

Obstetric fistula is as old as mankind. While the incidence has diminished progressively with better health care in Western societies, the situation has changed little in many developing countries. Fistulae of pelvic organs, often monstrous defects, still are a major complication of child-birth causing misery to uncounted young women, and if they cannot find help in one of the very few hospitals with trained specialists, they became urological cripples losing everything: family, home and job. The magnitude of the problem is illustrated by some figures given by Reginald and Catherine Hamlin-about 700 fistula patients treated each year-a total of over 10,000 cases operated upon in their fistula hospital in Addis Ababa, Ethio pia. Most of these injuries could be prevented by better health care at the village level as some studies have shown conclusively. The incidence of fistula is an indicator of the standard of health and obstetrical care. The author of this book-Obstetric Fistula-is an internationally known Australian gynaecologist who for many years has been interested in all aspects of gynaecological urology, especially urinary stress inconti nence, other forms of involuntary loss of urine, and associated gynaeco logical conditions. He has devised a number of new operations to treat pelvic defects. Robert Zacharin's interest in obstetric fistula was a con sequence of his surgical activity in developing countries."

Since the pioneering work of Donald and his first Lancet paper in 1958, the use of ultrasound in obstetrics and gynaecology has evolved rap idly. The introduction of grey scale techniques enhanced our ability to identify different tissues on the basis of their texture. However, it was the introduction of the linear array real-time scanner in the mid seven ties that changed ultrasound from being an "eccentric art form" to a readily available and usable technique. This led to the first reports of the diagnosis of neural tube defects using ultrasound by Campbell, as well as the establishment of fetal biometry. In the midst of this activity the parallel development of the transvaginal probe by Kratochwill went almost unnoticed by most gynaecologists. Yet the application of this technique has since had a major impact on many areas of gyna ecological practice, and on infertility in particular. Since the demon stration of transvaginal follicle aspiration, the vaginal route has become standard for most invasive ultrasound guided gynaecological procedures. The relatively new technical advance of transvaginal colour Doppler may potentially have just as great an impact. The introduction and use of transvaginal colour flow imaging has facili tated the study of vascular changes within the pelvis.

In few areas of medicine is progress more spectacular than in the field of prenatal diagnosis. New clinical techniques such as chorion villus sampling, detailed ultrasound scanning and cordocentesis are being evaluated by obstetricians, and refinement of biochemical testing is widening the scope of maternal serum screening. In the laboratory, dramatic advances in molecular biology are occurring: families at risk of genetic disease can be investigated with gene probes, and preimplantation diagnosis of the embryo is now becom ing a reality. These technical advances have important ethical and practical implications, among which will be a further increase in public expectations of the standards required of antenatal services. Clini cians will need a high degree of skill to inform healthy women about the options for screening normal pregnancies, and to counsel high-risk women about the benefits and limitations of prenatal diagnosis. Obstetricians, scientists and health service managers will face the difficult task of deciding how prenatal diagnosis can be made available to women in a caring and cost-effective way. Recognising the rapid progress in this field, the Royal College of Obstetricians and Gynaecologists made prenatal diagnosis the subject of its 23rd Study Group. An international panel of leading researchers, whose expertise ranged from molecular biology to philosophy, was invited to participate in a three day workshop, with time for in-depth discussion as well as the presentation of papers.

In the past decade fetal heart rate monitoring has become a generally ac cepted method for fetal surveillance during pregnancy and labor. Although its importance has been doubted recently, I personally feel that this method has become an important obstetric tool. It has not only improved our knowledge about fetal behavior and fetal condition throughout gesta tion, but it has especially improved fetal surveillance during labor; the most dangerous period of human life has never been as safe as nowadays. The only people who can question the advantage of fetal heart rate moni toring are those who did not experience the period before fetal heart rate monitoring was generally introduced. The first paper on the history of fetal heart rate monitoring takes us back to the beginning of fetal surveillance and provides an introduction to the different aspects of fetal observation which are covered later in this volume. Common practices of fetal surveillance in different countries are discussed, and the paths that future developments will take are suggested. An outline of the physiological aspects of fetal heart rate regulation is fol lowed by discussion of the pathophysiology with which the obstetrician is very often confronted."

HRT and Osteoporosis is a response to the increasing awareness among both the medical profession and the general public that ovarian failure is an important cause of osteoporosis and that much of the bone loss after the menopause can be prevented by oestrogen treatment. There is now an urgent need on the part of women, their doctors and those responsible for public health policy for practical guidance on such questions as the safety and acceptability of long-term treatment with sex hormones, the economic costs and benefits of such treatment, and the role of specialists and GPs in promoting and monitoring hormone replacement therapy. All these issues and more are considered here. The book comprehensively reviews current knowledge of the subject and gives recommendations for clinical practice and future research.

It will be a long time before the quality of this profusely illustrated book is overtaken and the present spate of books on the subject of obstetric ultrasound may, as a result, suffer a numerical set-back - especially with translation into English which will "deliver the milk on everyone's doorstep". Two of the authors studied in our department in Glasgow and worked like If there are any rewards for teaching, then we humble Scots who demons. have had the privilege have had more than our share as a result of the pride with which we regard our pupils. In my own old age and looking back over the last thirty years, the innumer able difficulties, set-backs and disappointments have been more than compen sated for by those who have turned the subject from a laughable eccentricity (as I have at one time experienced) into a science of increasing exactitude. This transformation has come about, not by any efforts of mine, but by the enthusiasm and ingenuity of those who would probably have achieved as much on their own if given the encouragement which I ultimately received in Glasgow University life. Limbo must be the expected lot of most of us ordinary mortals but the work lives on. And so, in this reminiscent and philosophical mood I beg leave to quote a little poem which I wrote at an age when young men do that sort of thing.

The first edition of "Testosterone: Action, Deficiency, Substitu tion" was published in 1990. Since then our understanding of the hormone that turns males into men has tremendously increased. Therefore, the editors felt that a second extended edition of the book is warranted in order to summarize established and recent findings in the field and to present the reader with an up-to-date is reflected by the textbook. The increased mass of knowledge growth of the volume from 14 to 20 chapters. In the updated edition the biochemistry and metabolism of androgens have been complemented by extensive information on the molecular biology of the androgen receptor and its disorders. The key role of testosterone in spermatogenesis is now better de fined. We have a more complete understanding of the psychotro pic effects of testosterone and know so much about the different target organs and functions that individual chapters deal with testosterone and the prostate, lipids and the cardiovascular sys tem, hair, bones and muscles. The general chapter on pharmacol ogy and clinical uses of testosterone, in particular in male hypo gonadism, is extended by pharmacokinetic studies on testoster one preparations and individual substitution modalities using testosterone esters as well as implants and advanced trans dermal applications. The physiologic basis and possible clinical applica tions of testosterone in non-gonadal diseases, in male senes cence, in hormonal male contraception and in transsexuals are discussed. The last chapter describes the role of "investigative" steroid biochemistry applied to tracking anabolic steroid abuse."

Starting in 1986, the European School of Oncology has expanded its activities in postgraduate teaching, which consisted mainly of traditional disease-orientated courses, by promoting new educational initiatives. One of these is the cloister seminars, short meetings intended for highly qualified oncologists and dealing with specific, controversial aspects of clinical practice and research. Another is 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 developments and treatment in specific fields of oncology. This series of ESO Monographs was designed with the specific purpose of disseminating the results of the most interesting of the seminars and study groups, and providing concise and updated reviews of the subjects discussed. It was decided to keep the layout very simple in order to keep costs to a minimum and make the monographs available in the shortest possible time, thus overcoming a common problem in medical literature: that of the material being outdated even before publication. Umberto Veronesi Chairman, Scientific Committee European School of Oncology Table of Contents How to Read this Monograph F.CAvALLI ......... . 1 Experimental Strategies for Studying the Development of Breast Cancer with Special Reference to Steroid Hormones, Growth Factors and Oncogenes R.J.B. KING . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 5 . . .

Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.

The majority of scientists interested in fertilization and early developmental processes will undoubtably have encountered the works of Alberto Monroy at some time in their careers. Alberto's contribution to this field spans oogenesis to embryogenesis, where he used physiological, biochemical and morphological tools to answer a number of basic problems in cell biology. This multi-disciplinary approach, together with his remarkable intellectual flexibility and humour has had an enormous impact on this field and all those fortunate enough to have worked with him. The chapters in this book have been divided into four sections. The initial presentations revolve around late events of gameteogenesis, that lead to a physiologically mature gamete. Probably the most exciting area for research at the moment is the identification of the cytoplasmic mechanisms responsible for the meiotic arrest of oocytes and the factors responsible for initiating their maturation (Chapters 3 and 4). Less is known about the physiological changes in the male gamete in preparation for fertilization and this may be identified as a major area for future research. Although comparable data for the plant kingdom is presently restricted to studies on marine algae, new techniques for isolating angiosperm gametes (Chapters 1 and 17) promise rapid advances in this field. The second section looks at the events and molecules involved in gamete recognition, binding and fusion. One of the most controversial topics is when does sperm-egg fusion actually occur (Chapter 14).

ENTERING ON A CREATIVE AND ENTERPRISING PROJECT, DRS. DIZEREGA and Rodgers have taken an innovative look at the peritoneum. They have provided an interesting, informative, and stimulating text about an organ that is rarely considered independently-usually being thought of only as a part of other organs or organ systems. The peritoneum is an active membrane that serves as both a secretory organ and a structure that modulates diffusion and osmosis. Both of these important functions are described in great detail. The text is divided in classic fashion. The authors first examine the peritoneal anatomy from both macro and cellular viewpoints, during which exploration it becomes clear that what appears simply to be a lacy covering over abdominal organs actually is a complex structure. Fur thermore, during the discussion on its embryologic development the au thors make comprehensible the complexity confronting the student of the peritoneum. The authors then proceed to the practicalities associated with this im portant organ. To surgeons, for example, the key to the peritoneum is understanding the organ's repair mechanism, as it is adhesions formed on the peritoneal surfaces that interfere with the surgeon's hope of success."

Many of the studies discussed in this book were addition to discussions of a variety of hormonal, presented at the First Pan American Congress of biochemical, immunological, physical, and me Andrology, which was held in Caracas, Venezuela, chanical approaches. It is our hope that the efforts in March 1979. An international group of in of the contributors will help to intensify research vestigators have contributed reviews designed to and development of improved methods for safely be informative to medical, graduate, and post regulating male fertility. graduate students, as well as clinicians and in vestigators working in the area of male reproduc G. R. CUNNINGHAM tion. Current physiological concepts that may W. B. SCHILL provide insight for new initiatives are examined in E. S. E. HAFEZ TABLE OF CONTENTS Preface v Contributors IX Foreword by C. SCHIRREN XI 1. PHYSIOLOGY OF MALE REPRODUCTION 1. Hormonal regulation of testicular function 5 P. FRANCHIMONT 2. Inhibin: new gonadal hormone 15 P. FRANCHIMONT, A. DEMOULIN, J. VERSTRAELEN-PROYARD, M. T. HAZEE-HAGELSTEIN, and J. P. BOURGUIGNON 3. Morphological features of the epididymis: possible significance in male contraception 25 T. D. GLOVER 4. Regulatory physiology of male accessory organs 35 E. S. E. HAFEZ and G. R. CUNNINGHAM 5. Methods for evaluating contraceptive techniques 41 T. Z. HOMONNAI and F. G. PAZ II. HORMONAL CONTRACEPTION 6. Inhibition of male reproductive processes with an LH-RH agonist 55 A. CORBIN and F. J. BEX 7."

This volume contains the Proceedings of the Serono Symposium on Pre implantation Embryo Development, held in Newton, Massachusetts, in 1991. The idea for the symposium grew out of the 1989 Serono Symposium on Fertilization in Mammals* at which preimplantation development was the predominant suggestion for a follow-up topic. This was indeed a timely subject in view of the recent resurgence of interest in this funda mental phase of embryogenesis and its relevance to basic research and applied fertility studies in humans, food-producing animals, and endangered species. The symposium brought together speakers from a broad range of disciplines in order to focus on key regulatory mechanisms in embryo development, using a wide variety of animal models, and on representative topics in human preimplantation embryogenesis. The culmination of preimplantation development is a blastocyst con taining the first differentiated embryonic tissues and capable of initiating and sustaining pregnancy. The central objective of the symposium was to throw light on the regulation of cellular and molecular events underlying blastocyst formation. It was particularly appropriate that the date of the symposium marked the 20th anniversary of the publication of the classic volume Biology of the Blastocyst, the proceedings of an international workshop held in 1970. This book, which summarized most of the information then available on this topic in mammals, was edited by the pioneer in blastocyst research, Dr. Richard B1andau, who was the guest speaker at the symposium."

A Woman With Cancer Deborah came to University Hospital when she was 25. She was the mainstay of a young farming family. Her husband, Merle, was now farming his family land, working hard to keep financially solvent during these difficult f;lrming days. They had four children: Carolyn, 4 months; Michael, 17 months; John, 4 years; and Susie, 5 years. There was nothing special about this woman or her circumstances; she was like every woman who had ordinary daily chores and responsibilities, people in her life about whom she cared and who cared for her, worries, goals, dreams, and her life before her. Deborah's 4-week postpartum checkup and Pap smear were normal; however, six weeks later she had heavy, irregular bleeding. To Deborah this symptom picture did not seem to fit the pattern of her other preg nancies, and so she returned to her doctor. A large lesion was found on the posterior cervix and biopsies of the tissue revealed moderately dif ferentiated adenocarcinoma of the cervix. Referral to the University Hospital 60 miles away confirmed the diagnosis. Further tumor workup, which included a pelvic ultrasound, bladder cystoscopy, sigmoidoscopy, and chest x-ray, was normal, although the IVP was notable for nonvi sualization of the right ureter, thought to be secondary to an enlarged lymph node."

Third edition of the atlas discussing pathophysiology, epidemiology, diagnosis, prevention and treatment of postmenopausal osteoporosis, as well as the importance of bone quality and strength in fracture risk.

Fully illustrated with over 120 full colour images
Thoroughly revised and updated new edition
Written by a team of world-leading experts in bone health

Recent advances in molecular biology have provided new dimensions in the study of the reproductive system. There has been major progress in our understanding of the molecular mechanisms of hormone action in the past few' years. The symposium on "Molecular Basis of Reproductive Endocrinology" was organized to highlight new research findings on the regulation of the hypothalamic-pituitary-gonadal axis. The emphasis of the symposium was on physiological questions answered by the molecular biology approach. Studies on the functional relevance of gonadotropin releasing hormone and LH and FSH gene expression were presented, together with research on the molecular biology of ovarian and testicular steroidogenic enzymes and protein hormones. Also, several novel aspects of hormone gene expression in placental tissues were reviewed. The symposium was held July 25 to 26, 1991, immediately prior to the 24th Annual Meeting of the Society for the Study of Reproduction, on the campus of the University of British Columbia in Vancouver. Serono Symposia, USA generously financed and coordinated the meeting. We are indebted to Dr. Bruce K. Burnett and Dr. L. Lisa Kern for their professional assistance in the organization of the symposium. We would also like to thank Drs. Victor Gomel, Basil Ho Yuen, and John Challis, who served as session moderators. Most of all, we truly appreciate the efforts of all the invited speakers, poster presenters, and discussants in making this a memorable event as the largest one-day meeting of the Serono Symposia USA, series.

Although neonatal screening was begun only 20 years ago, and is consequently still in its early stages, it is already a classic example of efficient preventive pediatrics. At present, routine neonatal screening covering a satisfactory percentage of newborn babies is carried out in only a small part ofthe world. For some five diseases enough infants have been screened to give reasonably reliable information about the frequency of these diseases in various populations. Interesting differences are beginning to appear in popula tions of different ethnic and racial background. The medical importance of neonatal screening is especially obvious in metabolic diseases that are not too rare and for which effective treatment depends upon an early diagnosis, such as phenylketonuria, galactosemia, and - a more recent screening pro gram - hypothyroidism. About 1 of 4000 newborns is affected with hypothyroidism and can receive timely substitution with thyroid hormone. Of 34.5 million babies tested for phenylketonuria, 3000 cases have been diagnosed in time to prevent mental retardation by means of dietary therapy."

Over a mere 5 years, neonatal cranial sonography has evolved from an obscure and largely experimental imaging possibility to the modality of preference in the examination of the young brain. The almost immediate acceptance of the ultrasound examination of the neonatal brain was based on a number of coinci dent factors, the most important of which was the emergence of a burgeoning population of premature neonates who were, for the first time, surviving be yond infancy. These delicate patients were beginning to withstand the rigors of extrauterine life when not fully prepared for it; pulmonary, cardiac, and infec tious diseases no longer claimed most of them. With survival, a new specter reared its head: Would the eventual mental and neurologic status of these same children be worth the expense and time needed to bring them through their first months? This issue became increasingly pressing as evidence mounted through the 1970s that very premature neonates were at a high risk for intracranial hemor rhage and posthemorrhagic complications. An imaging modality that could evaluate the premature brain was sorely needed. The CT scanner with its proven ability to diagnose intracranial hemorrhage was of little value in this regard. So too were static gray-scale or waterpath ultrasound units. These modalities all had the same limitation, lack of portability. As neonatal intensive care units proliferated, so did the technology that would soon allow cribside neonatal neuroimaging, the real-time sector scanner."

Very thorough knowledge of breast pathology is a sine qua non for interpretation of breast films ... progress in X-ray diagnosis could only be made by careful comparison of the film with the actual specimen. H.INGLEBY Multiplication of the same e"oneous diagnosis does not make that diagnosis co"ect. J.G.AzZOPARDI Paradoxically enough, our specialty considers the radiologist who mis takes a skin fibroma or the calcifications in a sponge kidney for a kid ney stone to lack basic knowledge, while the radiologist who imme diately calls for the surgeon because of a few white spots on a mammogram is thought to be acting according to the rules of medical practice. Misunderstandings and confusion with regard to breast pathology as well as the comfortable philosophy that superfluous biopsies are the price we have to pay for the early detection of carcinomas have in many places led to a loss of confidence in mammography. Yet this is a meth od with which carcinomas can be detected earlier than with any other imaging technique.

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 multidiscipli nary 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 on cology."

Systemic Method Mark B. Mengel, M. D. , M. P. H. Learning Objectives 3 The Biomedical Model 6 A New Framework: The Systemic Patient-Centered Method 9 Physician Roles Patient Roles 22 Patient-Centered Clinical Decision-Making Data Base Responding to Patient Cues Constructing a Mutually Agreeable Plan The Systemic Patient-Centered Method: Other Concerns Changing Larger Systems Ethics of the Systemic Patient-Centered Method Efficacy of the Systemic Patient-Centered Method 32 Safety of the Systemic Patient-Centered Method Conclusion Cases for Discussion Recommended Readings XV 36 34 32 32 31 30 30 27 25 23 16 10 Patient-Centered The 1: Chapter !iiiii!i !ili !iil !i!i !iii !iii iiii !iiiii!i !iii !iil !iii!ii! !i!i!iiiiiii !i!i !i!i!iil ii!i !i!i !iii iiii!iiiiiii !ill !i!i!iii !iii !i!i !i!ilili!iii iiii !iil i!ii iili iii! i!ii ii!i i!ii iiii iiil iiiiiii! iiii iiiiii!iiiiiiiiiii!iiii!iiii iiii iiii ii!i iiiiii!i!i!iiiiiiiii !iii iiii iiiiiiiiii!i iiiiiiiiiiii iiiiiiii iiiiiiiiiiiiii!i iiii iiii iiiiiiii iiiiiiil iii!iiii iii! iiii iiii i!i! ilil iiii iiii iiii iiii iiii iiii iiii iiiiiiii iiii!iiiiiii iiii !iiiiiii iiii iiiiii!i iiii !iii !iiii!iii!i ii!i ii!i iiil iiii !i!i!iiiii!i!ill iiiiiiii! i!i iiii iili ii!i iiiiii!i iliiii!i iili iiiiiiiiiiililil iiii iiil ilil iliiiiiiiiiiiiii ilii ilii iiii iiii iiii iiii iiii iiiiiiii ilil i!il iiil iiii ii ii iiiiiiii iiiiiiii iiii !i !i!i !i!i !i!i !i!i !i!i !i!i !i!i !i!i !ill !i!i !i!iii!iii!i !i!i !i!i !!ii !iil !iii !iii !iii !i!i iiiiiiiiiiiiiiiiiiiiii!iii!i ililili! iii iiii iiii iiiil iii iiiil iiii iiii iiii xvi Part II.