Lipids and Women's Health is an up-to-date critical review of pertinent scientific and clinical issues connected with lipid disorders in women. Topics discussed include the public health significance of cardiovascular disease in women, lipoprotein and lipid metabolism, effects of estrogens and progestins on lipid metabolism, metabolic changes of menopause, and the paradox of obesity, a curable disease that is rarely cured, as well as those conceptual advances in our understanding of diabetes mellitus that have clarified diagnosis and may have improved treatment. The relationship of diet and lipid intake to the development of breast and uterine cancer; dietary and drug treatment of lipid disorders; effects of exercise, smoking, and stress; and repercussions of lipid disorders on the family are explored. The volume should prove of use to gynecologists, internists, family practitioners, and pediatricians, as well as to all other professionals with a major concern for the health of female patients.

The purpose of this book is to describe the nature of the materno-fetal immunobiological relationship and to suggest the direction in which the management of reproduction and its failure in man is moving. The several authors, who have written about their special fields of interest, need to be read within a framework designed to blend their contributions into a whole. This preamble provides a part of that framework, by describing the early development of the embryo, that of the placenta and its membranes and their anatomical relationship with maternal tissues: in other words, the stage upon which this materno-fetal dialogue takes place. Professor Maureen Young's 'tour de force', encapsulating the whole of fetal physiology into a single chapter, completes the background information. After Maureen Young's summary of fetal physiology, Matteo Adinolfi describes the development of the immune system in the fetus, including new information that allows more accurate speculation concerning the gestational age at which fetal immune responses of various kinds may begin. Charles Loke examines the nature of antigens which are found in the placenta, concentrating on those which occur on syncytiotrophoblast and suggesting roles for them in fetal development. Arnold Klopper covers the wide range of proteins and hormones which have been studied during pregnancy and found to vary in a potentially significant way. He has been careful to distinguish between observation and hypothesis, as far as any immunomodulating action is concerned, and his analysis is a model of scientific scepticism.

Almost every practising doctor will admit to difficulty in knowing how best to investigate, treat and advise the pregnant patient with renal problems. These doubts and difficulties may be exacerbated if the patient seeks pre-pregnancy advice - would a possible pregnancy cause a deterioration in renal function, what are the risks of the pregnancy for mother and baby? As the general public become more informed on medical matters these questions are being asked more frequently and doctors must be prepared to offer advice which is based on detailed factual knowledge. This book examines some of these increasingly common clinical problems. Each chapter has been written by a recognized expert in the field and provides the type of specific information now expected by discerning patients. The advances in treatment of the last decade clearly indicate that a knowledge of pregnancy and renal disorders is essential for doctors in many branches of medical practice.

The traditional concept of a neuroendocrine mechanism for regulation of growth hormone (GH) secretion is based in large part on the work of Roger Guillemin. The work of Dr. Guillemin, who was awarded the 1977 Nobel Prize in Physiology and Medicine, supported the view that quantita tive change in GH secretion was the net result of pituitary stimulation and inhibition by the hypothalamic neurohormones, GH releasing hormone (GHRH), and somatostatin (somatotropin release inhibiting factor; SRIF), respectively. During the 1970s, another endocrine research pioneer, Dr. Cyril Bowers, discovered that structural modification of enkephalin re sulted in a family of peptides with GH releasing properties. These com pounds, simply called GH releasing peptide (GHRP), were originally thought to mimic GHRH. However, upon subsequent investigation they were found to supplement the activity of the natural hormone through a different mechanism. Nearly two decades after their discovery, the differ ences between GHRP and GHRH have been described by many different laboratories throughout the world. The complementary GH secretagogues have different binding sites, second messengers, and effects on gene expres sion. Based on these differences, it has been suggested that expansion of the original two hormone mechanisms for GH regulation to include a third molecule may be appropriate, even though the naturally occurring ana logue of GHRP has not yet been identified. Despite our lack of knowledge concerning the natural product mimicked by GHRP, clinical development of the new family of GH secretagogues for diagnostic and therapeutic purposes has begun in earnest."

A central concept in the evolutionary theory of senescence is the idea that ageing results from life-history trade-offs. In particular, the disposable soma theory suggests that longevity is determined through the setting of longevity assurance mechanisms so as to provide an optimal compromise between investments in somatic maintenance (including stress resistance) and in reproduction. Comparative studies among mammalian species confirm that cells from long-lived species appear to have a greater intrinsic capacity to withstand stresses than cells from short-lived species. Childbearing at older ages has become increasingly common in modern societies because of demographic changes, medical progress and personal choice. While the detrimental effects of late reproduction on infant mortality and genetic diseases have been well documented, little is known about the possible postponed detrimental effects of late parenting.

G. Piekarski appears not to have been brought home to at Forty years have passed since Trussent pub- least some clinicians. Of special importance in lished an important book in the English lan- this connection are T. vaginalis and Pentatri- guage on Trichomonas vaginalis Donne and uro- chomonas hominis (Davaine), the intestinal tri- genital trichomoniasis. During the intervening chomonads of many mammalian species, in- four decades, much information has been accu- cluding humans. Some practitioners still tell mulated on trichomonads parasitic in humans their patients about the possibility of an intesti- and on the diseases they cause. In light of this, nal origin of trichomonal infection of the uro- many parasitologists and clinicians believe that the time has come for a complete review, in genital tract. book form, of various aspects of these parasites Trichomonas vaginalis infection of new- and of the trichomonad parasitemias. This need borns, infants, and young children constitutes has been further reinforced by the finding that, an interesting, although not extensively pur- despite the use of effective anti trichomonal sued, area of investigation. For hitherto incom- drugs during the past years, the prevalence of pletely understood reasons, the period of preg- human urogenital trichomoniasis, the world's nancy appears to favor the increase of most common sexually transmitted disease, has symptomatic trichomoniasis; there is, there- been increasing significantly. As might have fore, little doubt that infants can be infected been expected, therefore, discussion of various during birth.

The frontispiece, Leonardo da Vinci's drawing of the embryo in the womb, was chosen as a starting point for this book. It was Leonardo who in his notebooks and drawings combined artistic composition and accurate recording of the anatomy of the human body. Leonardo studied human anatomy in order to execute artistic drawings. His aim was to clarify form and function of human organs including reproductive organs. He followed up his extensive research with graphic representa tion and thereby initiated record keeping as a basis of scientific investigation. His records, accurate three-dimensional drawings, allowed others to reproduce his find ings and to test for correctness. Results could be updated and refined. Only after these steps can abnormalities be ascertained and defined as pathology. Though Leonardo was both artist and scientist, it is assumed that his anatomic drawings were used to improve his art, and thus scientific endeavor was at the service of his art. Anatomy, the offspring of science and art, is an integration of the two and became an accepted branch of the natural sciences. Although art and science continued to interact throughout the Renaissance, art was often placed in the service of science. In the course of history that followed, art and science in creasingly followed separate ways."

Now in its 3rd edition, Lecture Notes: Obstetrics and Gynaecology has been extensively revised and updated to provide a concise and practical introduction to obstetrics and gynaecology for medical students and junior doctors. Starting with a section on basic science, the text is divided into six sections that explain female health needs and their management from the early years to old age. The self-assessment section is now a separate chapter, and includes Extended Matching Questions (EMQs), scenarios for practical history taking for the Objective Structured Clinical Examination (OSCE) and Multiple Choice Questions (MCQs). Part 1 looks at female reproductive anatomy and physiology. Part 2 covers the puberty and menstrual problems of young women, sub-fertility, pregnancy prevention, and sexual problems. Part 3 examines the reproductive years including pregnancy and childbirth. Part 4 covers the mature woman including menstrual problems of the older woman and pelvic pain. Part 5 discusses the older woman including the menopause, incontinence and malignancy including breast cancer. Part 6 demonstrates the importance of public health statistics on the provision of services in obstetrics and gynaecology. Now in two-colour throughout, with a new colour plate section, Lecture Notes: Obstetrics and Gynaecology covers the core material needed for O&G courses, written specifically for medical students, nursing students, junior doctors on the Foundation Programme and the first two years of specialist training, midwives, and GPs.

Reproductive tract infections and other gynaecological disorders among women represent an enormous global health burden. This significant book will help focus research on this important though neglected area. The primary aims of the book are to provide an overview of reproductive tract infections and other gynaecological disorders, to highlight the conceptual and methodological challenges associated with undertaking research on this subject, and to serve as a reference for future research in this area. The book focuses on developing country settings, and recognizes that gathering this sort of information requires a multidisciplinary and culturally sensitive approach. Findings from the research described in this book will undoubtedly assist physicians, social scientists, epidemiologists and public health practitioners in evaluating the magnitude of this problem within the community at large and in identifying potentially effective medical and behavioural interventions to address this problem.

You've read your textbook and your course notes. Now you need to apply your knowledge to real life clinical situations. The problem-solving approach of Core Clinical Cases guides you to think of the patient as a whole, rather than as a sequence of unconnected symptoms. With its emphasis on everyday practice strongly linked to underlying theory, the series integrates your knowledge with the realities of managing clinical problems, and provides a basis for developing sound analytical and confident decision-making skills. The core areas of undergraduate study are covered in a logical sequence of learning activities: the same questions are asked of each clinical case, followed by detailed explanatory answers. Related OSCE counselling cases, with related questions and answers, also feature in each section. Key concepts and important information are highlighted, and the reader-friendly layout reflects exactly the type of question you will encounter, making these volumes the perfect revision aid for all types of case-based examination. The Obstetrics and Gynaecology volume, fully revised and updated in this third edition, focuses on the following topics: * Early pregnancy problems * Pregnancy dating and fetal growth * Late pregnancy problems * Labour * Medical disorders of pregnancy * Puerperium * Abnormal uterine bleeding * Amenorrhoea and menopause * Incontinence and prolapse * Neoplasia * Discharge and pain* Infertility * Fertility control Volumes in the Core Clinical Cases series remain absolutely invaluable in the run up to clinical, written or OSCE examinations, and ideal course companions for all undergraduate medical students at various stages in their clinical training.

Manual of Pathology of the Human Placenta, Second Edition is a concise, practical manual of placental pathology. While references are made to the more encyclopedic Pathology of the Human Placenta, this Manual is designed as a user-friendly, easy-to-read bench manual that can be used in the grossing room as well as at the microscope. Features of the text include: - A section on the approach to the placental specimen, providing suggestions on what to do, as well as when and how to do it.- Discussion of detailed development and normal histology of all parts of the placenta for those wanting to learn about specific areas of the placenta.- Discussion of placental lesions, disease processes related to the placenta, neoplasms, and trophoblastic lesions. An overview of the legal implications of placental examination and future direction. "Suggestions for Examination and Report" includes key points in gross examination, sectioning, and diagnosis. Suggestions for comments in the surgical pathology report guide the reader in problematic situations or when the diagnosis or diagnostic implications are unclear.An abundance of tables summarize pertinent information and provide easy access to the differential diagnoses of various lesions. Manual of Pathology of the Human Placenta is a must-have reference for every pathologist, resident and pathology assistant

Sex Hormone Replacement Therapy addresses important issues in contemporary endocrinology. Its major emphasis is on the consequences of the menopause and on androgen deficiency in the absence of overt disease of the hypothalamus and/or pituitary in men. The use of hormone therapy for the primary prevention of cardiovascular disease in post-menopausal women has become an area of major debate, and the pros and cons are examined in detail. Secondary prevention also remains controversial and is addressed in this volume. An issue of particular concern is the treatment of estrogen deficiency symptoms in women with the diagnosis of breast cancer. Whether older men with some androgen deficiency symptoms and equivocally low plasma testosterone concentrations should be treated with androgens is also a matter of great debate, as is the efficacy and safety of plant estrogens in the treatment of menopause-related complaints. Sex Hormone Replacement Therapy will be of interest to students and non-specialists, as well as a wide range of medical practitioners including endocrinologists, gynecologists, rheumatologists and cardiologists.

This book is intended as a reference manual that will provide the busy clinician with up-to-date information on the diagnosis and treatment of uncommon and rare gynecological cancers. While standard textbooks briefly cover these tumors, this is intended as a more comprehensive yet easy-to-use guide. After opening chapters on epidemiology, pathology, and diagnostic imaging, the full range of infrequently encountered gynecological cancers (ovarian, uterine, cervical, vaginal, and vulval) is presented and discussed with the aid of high-quality illustrations. In each case, detailed attention is paid to both differential diagnosis and current treatment options. The book has been written by an international panel of experts and is the first to gather all the uncommon and rare gynecological cancers together within one volume.

Progress in biomedical science has called for an international discussion of the medical, ethical, and legal problems that confront physicians, medical researchers, infertile couples, pregnant women, and parents of premature or disabled infants. In addition, the unprecedented technological developments in obstetrical, perinatal, and neonatal medicine in recent years have indicated a need for an international forum for interdisciplinary dialogue regarding the definition of early human life, the neurological development of early human life, the value of early human life, the obligations for its protection and prolongation, and the limits to these obligations.

In this thorough and state-of-the-art book, top experts provide cutting edge techniques which greatly expand the depth and scope of classical invasive prenatal diagnosis. The book features a totally unique focus on novel non-invasive approaches for prenatal diagnosis. Following the Methods in Molecular Biology series format, the chapters feature step-by-step laboratory protocols, lists of the necessary materials, and tips on troubleshooting and avoiding known pitfalls.

Diagnosis and Management of Polycystic Ovary Syndrome is a comprehensive clinical reference work for primary care physicians, internists, general endocrinologists, obstetricians, gynecologists and students. PCOS is a common but frequently misdiagnosed disease. Many symptoms can be alleviated by early intervention and effective management.

Prominent endocrinologists are gathered to detail current research and treatment in this metabolic disorder, affecting a growing population. The chapters are comprehensive, providing cutting edge knowledge on pathogenesis, manifestations, diagnosis and treatment of PCOS. Each chapter will be concise concluding with cogent practice points.

The variety of medical issues presenting in PCOS patients result in late referrals or in- appropriate advice. This title will be a tool in a further understanding of the metabolic and genetic basis of PCOS, while providing management strategies.

In recent years, increasing attention and resources have been brought to bear on the relationship between the environment and congenital diseases. These diseases were previously thought to be mostly due to genetic causes. Even though the importance of genes as factors in causation is accepted, environmental factors seem to be implicated just as strongly. This book explores some further concepts that have arisen from more recent perceptions of environmental effects and their possible interactions with living systems. Amongst the topics discussed are:

-effects of prenatal exposure to toxic chemicals

-intra-uterine exposure to drugs

-effects of endocrine disrupters

-environmental risk and sex ratio in newborns

-surveillance of environmental impact

-research and policy

Discussion and presentation of old and novel ideas is targeted at developing a more holistic and united perception of the interaction between congenital diseases and the environment.

This book clearly elucidates many of the key issues found in the disparate literature on sex-based differences in health and illness. It provides primary care clinicians with a practical, up-to-date source of information that can lead to optimal, targeted care for women. Among the topics examined in this comprehensive volume are treating and preventing osteoporosis, diabetes, cervical cancer, eating disorders, and more.

Early Life Origins of Health and Disease is a new book which presents and discusses the many factors that may have impact on normal development. In a concise and readable manner, the authors consider both the proven and suggestive evidence that the high prevalence of hypertension, diabetes, obesity and, in some populations, kidney disease, may not be all due to genetics or adult environment alone. There is good evidence that stress and more subtle dietary deficiencies, as well as placental malfunction, may increase the risk that the offspring will develop these problems in later life. Finally, new and emerging evidence for other areas of human health and disease such a motor control and mental health is critically reviewed for the first time. The book is a 'must' for all scientists interested in researching these areas, as there is a critical evaluation of the methodology used and suggestions for the 'optimal' way in which to investigate these phenomena.

This is an easy-to-use handbook written for the clinician and other healthcare professionals who treat and counsel pregnant women and women of child-bearing age. The authors provide historical perspective and background to support recommendations which are provided in each chapter. Importantly for the practitioners, recommendations and guidelines have been summarized and provided in tables that are easy to locate and interpret. This book discusses relevant topics in the scientific community such as determining to what extent prenatal and perinatal environmental factors are linked to childhood and adult obesity and chronic diseases.

This volume includes the latest diagnostic criteria for PCOS and comprises the most up-to-date information about the genetic features and pathogenesis of PCOS. It critically reviews the methodological approaches and the evidence for various PCOS susceptibility genes. The book also discusses additional familial phenotypes of PCOS and their potential genetic basis. All four editors of this title are extremely prominent in the field of PCOS.

Sexual mutilation is a global problem that affects 15. 3 million children and young adults annually. In terms of gender, 13. 3 million boys and 2 million girls are involuntarily subjected to sexual mutilation every year. While it is tempting to quantify and compare the amount of tissue removed from either gender, no ethical justification can be made for removing any amount of flesh from the body of another person. The violation of human rights implicit in sexual mutilation is identical for any gender. The violation occurs with the first cut into another person 's body. Although mutilation is a strong term, it precisely and accurately describes a condi tion denoting "any disfigurement or injury by removal or destruction of any conspicuous or essential part of the body. " While such terms as "circumcision" and "genital cutting" are less threatening to our sensitivities, they ultimately do a disservice by masking the fact of what is actually being done to babies and children. Although the courageous example of the survivors of sexual mutilation indicates that humans can certainly live and even re produce without all of their external sexualorgans, this biological phenomenon does not, however, justify subjecting a person to sexual mutilation. The remarkable resilience of the human body is a testament to the importance nature places on reproduction rather than a vindication for surgical practices that compromise this function."

The concept of the early life developmental origins of health and disease (DOHaD) in adults has stimulated a new approach to understanding disease trajectories, with major public health implications. Indeed, the principle of the 'lifecourse of disease' now influences health policies internationally. Environmental influences during pregnancy and early life that affect lifelong health are well documented, but there is a new focus on the preconception period and the significance of paternal health on the fetus. This fully revised second edition highlights scientific and clinical advances in the field, exploring new understanding of mechanisms such as epigenetics and the increasingly recognised role of external influences, including pollution. The book is structured logically, covering environment, clinical outcomes, mechanisms of DOHaD, interventions throughout the lifespan and finally implications for public health and policy. Clinicians and scientists alike will improve their understanding of the developmental origins of health and disease with this essential text.

As recently detailed in an Institute of Medicine Report, pain represents one of the most costly and prevalent public health conditions in the United States, and the burden of pain is substantially greater for women than men. Women make up half of the world's population. Yet, the overall treatment of pain in women remains challenging to this day. The differences between men and women are anatomical, physiological and psychosocial in nature. Consequently, several unique features come to mind when discussing pain as experienced by women, such as pain related to pregnancy, pain related specifically to female organs, and chronic painful conditions which have a higher prevalence in the female population. The purpose of this book is to address the current understanding of mechanisms related to sex differences, and the clinical management of common acute and chronic painful conditions in women, using up-to-date evidence-based information. The painful conditions discussed include those that are specific to female anatomy and physiology and conditions that have a higher female prevalence. The book is divided into three sections. The first section covers basic science topics related to sex differences in pain. The epidemiology of painful conditions with female prevalence; sex differences in response to pain, and to analgesics; the role of sex hormones and genotype in pain perception and analgesia; sex differences in cerebral responses to pain revealed by brain imaging ; and the role of psychosocial factors, including psychological interventions will be discussed in this section. The second and third sections are clinically directed. The second section focuses on pain specific to female patients. Topics include the management of labor pain; the management of painful conditions during pregnancy; and the management of pain in the opioid tolerant pregnant patient. The latter includes discussion on the impact of pain management on the fetus in utero, and on the newborn who is breastfed. Chronic pain specific to females, including dysmenorrhea, chronic pelvic pain and vulvodynia will be discussed in this section. Cancer-related pain issues in women will be addressed in the chapter on persistent pain after breast cancer treatment and the chapter on interventional management of pelvic cancer pain. The third section covers painful conditions with high female prevalence. These include fibromyalgia, chronic fatigue syndrome and neuropathic pain in complex regional pain syndrome. Visceral pain with female prevalence such as irritable bowel syndrome, chronic pelvic pain of undetermined etiology will also be addressed in this section. This section also includes chapters on the presentation of cardiac pain in women; headaches including migraine; and temporomandibular joint disorders and orofacial pain. The book is intended for a wide readership, including physicians and allied healthcare professionals who encounter female patients with acute or chronic painful conditions. In addition, residents and medical students in training as well as graduate students in health sciences will benefit greatly from this book as they continue to learn about and manage difficult and complex issues related to pain in female patients.

Gonadotropin-releasing hormone (GnRH) cells are the key regulators of reproductive function in all vertebrate organisms. The GnRH molecule is synthesized in a small number of neurons in rostral hypothalamic regions of the brain. In mammals, these neurons release the GnRH decapeptide into the portal capillary system leading to the anterior pituitary gland. There, GnRH causes the release of the gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn act upon the gonads to stimulate their maturation, and to cause synthesis of sex steroid hormones, estrogen, progesterone and testosterone. Although each of the levels of the hypothalamic-pituitary-gonadal axis is critical for reproductive function, GnRH neurons play the primary role in the control of reproductive maturation and adult reproductive function, and may even play a role in reproductive senescence.

Since its discovery in 1970, there has been intense interest in GnRH-producing neurons, with more than 8000 papers and chapters in the last decade alone. Despite this activity of research in basic and clinical science, there has never been a book written specifically on GnRH neurons. GnRH: The Master Molecule of Reproduction aims to bring together the large and diverse literature of both laboratory and applied research that focuses on these unique cells.

This book will provide basic background into reproductive neuroendocrinology, as well as specifics regarding the role of GnRH neurons in the control of reproduction. Students studying endocrinology, reproduction, neuroendocrinology or molecular endocrinology will benefit from this book. In addition, this book will take a multi-species approach which will be useful both to basic researchers as well as clinicians. Whenever possible, species differences and similarities will be presented, and if possible, studies on humans, or the clinical relevance of basic research findings to humans will be discussed (such as the treatment of reproductive disorders such as abnormalities in pubertal development, or infertility).