Intrauterine Growth Restriction: Aetiology and Management will be the first book to focus exclusively on this extremely important and common complication of pregnancy. There have been many recent developments in our understanding of the aetiology and pathogenesis of the condition as well as in screening, monitoring and therapy. This book is unique in that it covers both the aetiology and pathogenesis as well as clinical management and also includes sections on definitions and potential future advances. Every aspect is covered by an international expert which will provide the reader with a valuable insight into this condition.

In the last few years rapid advances have been made in reproductive medicine, making it necessary for those involved to regularly update their knowledge. The purpose of this book is to describe the state of the art in this field, making it possible for the reader to gain an orientation among all the diagnostic and therapeutic potentials of modern reproductive medicine in order to advise patients fully. Chapters from the fields of gynecology, and reproductive medicine in a specific sense provide knowledge about these subjects. Authors of international standing have contributed chapters on their specialties. These chapters together form a book describing the state of the art in the diagnosis and therapy of sterility in gynecology and andrology.

It is a genuine honor and a privilege of distinction to provide the foreword for the proceedings that follow. This marvelous symposium reflects the unique qualities of its two principal sponsors. Whenever the Oregon Regional Primate Research Center is involved in matters of science, we see a consistent record of exceptional quality in both the work is unequaled and the people who do it. Likewise, Serono Symposia, USA in assuring a world-class speakers' forum, utterly without taint of commercial influence. The proceedings published herein are a remarkable testimony, not only to the contributors, but to Drs. Brenner, Wolf, Stouffer, and Burnett, who have shepherded its conception, presentation, and publication. Readers will notice immediately one of the universal strengths of this total composition; that is, the diversity of investigational interests among attendees. Presentations on the core topic of primate in vitro fertilization and embryo transfer were joined by specialist presentations in related areas, including human-assisted reproductive technologies, reproductive physiology of the great apes, sperm biology, implantation mechanisms, cryobiology, coculture systems for embryogenesis, micromanipulation technologies, and genetic diagnosis of heritable diseases in the pre embryo. Even though pro-fertility issues understandably dominated this forum, there was significant attention given to fertility-control research, especially the role of primates in this endeavor (more on this subject below)."

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and thera peutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-in duced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and comments. As clinically used, it now pertains to the inadvertent side effects and complications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmen tal, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders a major, although generally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condi tion. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

The concept of the foeto-placental unit as an integrated endocrine organ has been defined recently by many in vivo studies at the 17th- 20th week of gestation. A functioning foeto-placental unit is necessary for most of the increased oestrogen production of pregnancy and for the provision of glucocorticoids and aldosterone to the foetus. Neither the foetus nor the placenta alone have the necessary enzyme systems for the synthesis of these groups of steroids. However, when the foetus and placenta function as a unit, all of the enzyme systems are present for the synthesis of these steroids from circulating cholesterol. The placenta, but not the mid-gestation foetal adrenal, can synthesize physiologically significant amounts of pregnenolone from circulating cholesterol. Part of the pregnenolone is converted to progesterone in the placenta by the 3 -HSD system (absent in the foetus). The progesterone is transferred to the foetus where it is transformed by C-II, C-17, C-18 and C-21 hydroxylases (all absent in the placenta) to cortisol, corticosterone and aldosterone. Pregnenolone transferred from the placenta to the foetus undergoes 171X-hydroxylation, side chain splitting and sulfurylation (absent in the placenta) and is converted to DHAS. The DHAS may undergo 161X-hydroxylation (absent in the placenta) in the foetal liver and be transported to the placenta as 161X-OH-DHAS. There it is subjected to a neutral steroid sulfatase (absent in the foetus) and is converted to oestriol by action of the 3 -HSD system and the aromatizing enzyme system."

Bernard (Barney) Berelson had a major influence in the application of social science concepts and methods to population policy during the period from 1962 to 1980. This was the period when concern with population problems spread from a relatively small group of scholars and population activists to a much larger, diverse, international group of political and intellectual leaders and to the general public as well. There was an exponential growth in the number of scholars and service personnel in vari ous population and family specialities in this period. Barney came into the field with his appointment as Director of the Com munication Research Program of The Population Council in 1962. He had no previous training or experience in demography. Frank Notestein, Presi dent of The Population Council at the time, had the wisdom to appreciate the value and relevance of Barney's itTIpressive background in communica tion research and other social science areas, as well as his creative mind and leadership qualities. His influence on the Council's rapidly expanding program was so immediate and impressive that within a year, he was named Vice President. When Frank Notestein retired in 1968, Barney became President, a post he held for 6 very productive years."

The birth of a baby is the culmination of months of anticipation and plan ning. Most often, mother and infant are healthy and readily able to estab lish close contact-a bond. However, in some situations either mother or baby or both present complications. The more prompt and rational the treatment, the sooner the normal parent-infant relationship will commence. This book is devoted exclusively to the first days following birth. In its 15 chapters, postpartum and postnatal physiology and pathophy i: .;logy are reviewed by 18 specialists. Normal and abnormal development of mother and child is correlated with proven means of clinical management. Chapters 1 through 3 cover maternal postpartum developments and complications. Chapter 4 stresses the importance of a normal parent newborn relationship, a concept of increasing concern in modern society. The following ten chapters discuss neonatal physiology and pathophysi ology; the effects of obstetric anesthesia on infant behavior, pulmonary function measurements in the postnatal period and treatment of the sick newborn are discussed in detail. The final chapter reviews maternal and perinatal mortality; the data, based on extensive surveys in New York City, indicate that current management is effecting an overall decline in mortality."

Ovulation Induction gives an integrated view of basic ovarian physiology, pathophysiology, and the clinical management of ovulatory disorders. It provides core information upon which specialists can base clinical decisions. The most important feature is the inclusion of newer agents now available for ovulation induction. Newer clinical applications for older medications as well as various treatment combinations (including GnRH analogs) are thoroughly discussed. There is a frank discussion of risks, side effects, and the expense related to ovulation inducing agents. Many of the results in this book have never before been published in book form. Topics examined include the neuroendocrine regulation of the menstrual cycle, ovarian physiology and in vitro fertilization, the diagnosis of ovulation and the role of ultrasound in monitoring the follicular response, the use of clomiphene citrate for ovulation induction, and the role of bromocriptine and related compounds for ovulation induction in hyperprolactinemia.

Physical illness cannot be effectively treated other than in the context of the psychological factors with which it is associated. The body may have the disease, but it is the patient who is ill. Research psychologists from a number of different backgrounds have, in the past few decades, turned increasingly to the study of physical illness, and there is now an extensive literature on preventive behaviors, the role of stress in the etiology of illness, the patient's reactions to illness and its treatment, and the physician-patient relationship. At the same time practicing clinical psychologists have extended their concern beyond the treatment of speci fically psychiatric disorders, to include also the psychological care of people experiencing distress through illness or injury. Traditionally, these patients have tended to fall through the net, unless their distress is so great that it assumes the proportion of a psychiatric disorder that can then be treated in its own right. Because the physical disorder is the primary one, its existence has detracted from the salience of the very real emotional disturbance to which it can give rise. Moreover, emotional reactions in this setting, being the norm, seems to have been regarded as not meriting special attention and care. This situation is chang ing, and it is not just psychologists or psychiatrists who are responsible for the shift in attitudes. Within general medicine itself, there is now a renewed empha sis on the care of the whole patient and not just the disease."

Infectious diseases remain a major problem for physicians and other health professionals dealing with problems of the reproductive system. Accordingly, this two-volume comprehensive presentation of infectious diseases involving the male and female reproductive systems promises to be a major contribution in this field and to fill a much-needed vacuum. During the past three decades, the introduction of antimicrobial therapy has dramatically altered both the clinical presentation and the therapeutic approaches employed in dealing with the traditional infections of the repro ductive system. In addition, the changing demographics of infectious problems in the industrial countries and the developing world have been a source of concern. A good deal of important information on this topic is included in this series. In recent years, considerable attention has been given to the role of Myco plasma and Chlamydia in both male and female infertility and the problems related to genital herpes and human papilloma virus infections. Current clinical information is included on these infections as well as on newer aspects of diagnosis, such as the use of laparoscopy in the diagnosis and treatment of pelvic inflammatory disease. Also addressed is new information regarding the role of actinomycosis in pelvic infections; current problems such as toxic shock syndrome and acquired immune deficiency syndrome (AIDS) are reviewed as well. New concepts are included in these vohimes to complement the clinical information. The attachment of microbial organisms to sperm may help to explain access of these and other organisms to the upper female genital tract."

The course of history is never one of smooth progression. Periods of relative quietness are interrupted by periods of wars and revolution. This pattern resembles that of a river which, before flowing into the delta, has to pass countless rapids. The same holds for the development of the science of medicine. In obstetrics some of these 'revolutions' or 'rapids' consist of the introduction of conservative obstetrical treatment by Lucas Johann Boer at the beginning of the nineteenth century, the discovery of the cause of puerperal sepsis by Oliver Wendell Holmes and Semmelweiss between 1843 and 1847, the introduction of the principle of asepsis by Pasteur in 1874, the introduction of prenatal care at the end of the nine teenth and the beginning of the twentieth century (Mijnlieff, Treub, De Snoo), the improvement of surgical techniques, the possibility to treat shock by bloodtransfusion, and, finally, the acquisition of new means for the effective therapy of infection. All these developments have led to a sharp reduction of maternal and perinatal mortality. In this connection it must be pointed out that such a reduction could never have been accomplished without the favourable social changes as a result of which medical and prenatal care could be made universally available. In recent years there has been another revolutionary develop ment in obstetrics. Two factors have been responsible for this: the ap plication of basic sciences in obstetrics, and the dissolution of the isolation with respect to other clinical disciplines."

Contraception is the most comprehensive exploration of the newest technologies in the area of contraception. Edited by renowned authorities Dr. Donna Shoupe and Dr. Florence Haseltine, with chapters written by leaders in the field, this book comprises the most up-to-date, practical and clinical information available and presents a thorough examination of clinical efficacy, side effects, mechanisms of action, and benefits of all types of contraception, including: - chapters on the IUD, the new subdermal implant Norplant, injectables, the diaphragm, condoms, sponge, female sterilization, vasectomy, and more - discussions of cutting edge contraceptive technologies, including the new progestin oral contraceptive pills, contraceptive vaginal rings, and RU 486, - an important chapter on AIDS and contraception. This book will serve as an invaluable reference providing useful, instructive background information and pertinent clinical applications for the physician, resident, and researcher. At such an exciting time for contraceptive technology, no one in the field can afford to be without this text.

Neuroendocrine Perspectives, Volume 7, is part of an international book series designed to keep clinicians and researchers appraised of important trends and new data in basic and clinical neuroendocrinology. It focuses on four very rapidly evolving major topics: - the role of dopaminergic regulation of the intermediate pituitary lobe in elucidating intracellular signal transaction pathways and other regulatory mechanisms involved in transsynaptic regulation of peptide biosynthesis, post-translational processing, and hormone secretion; - the physiological and clinical implications of corticotropin releasing factor for such areas as diagnosing Cushing's syndrome, defining the hypothalamic and pituitary origins of secondary adrenal insufficiency, and distinguishing Cushing's syndrome from psychiatric states associated with hypercortisolism; - the large number of neurotrophic factors that affect CNS neurons and of neurite promoting factors that modulate neuronal performance, with emphasis on their mechanisms of action and their possible therapeutic applications to peripheral neuropathies and central diseases; - and the many factors that regulate changes in female reproductive cycles during middle age, with careful distinction between neuroendocrine and ovarian components and special attention to the possible cause-and-effect relationship within the cascade of events resulting in acyclicity and infertility.

As I read this unique volume on diabetes and pregnancy edited by Lois Jovanovic, I was struck by two themes that run throughout these collected chapters. First, this volume provides an excellent assessment of past problems, present management, and future challenges presented by dia betes in pregnancy. Orury's unique, longitudinal experience with diabetes iIi pregnancy provides the reader with an important overview, as does Coetzee's discussion of gestational diabetes. Current problems-deter mining the etiology and prevention of congenital malformations in infants of diabetic mothers (10M), assessment of antepartum fetal condition, management of pregnant patients with diabetic retinopathy, recognition of thyroid dysfunction in the pregnant diabetic woman, and understanding the multitude of metabolic sequelae observed in the 10M-are thoroughly reviewed. Finally, important considerations for future treatment and ther apy such as the adaptation of the fetal pancreas to the disordered intra uterine environment often seen in maternal diabetes, the use of fetal pan creatic tissue for transplantation, the application of exercise in the management of the pregnant woman with diabetes, and the long-term con sequences for the 10M provide an exciting glimpse into the future. The second important theme that emerges is the critical role the problem of diabetes in pregnancy has played in our understanding of maternal and fetal physiology. Clinical observations supported by basic research have emphasized the role of fetal fuels in teratogenesis.

SIDNEY CALLAHAN AND DANIEL CALLAHAN This book, like many other things to do with abortion, is a product of long controversy. Though carried out with cooperation, it was conceived in conflict. The conflict between the coeditors has per sisted for years-in fact, for at least half of their thirty-year marriage. One, Sidney, is prolife; the other, Daniel, is prochoice. Ever since the topic of abortion became of professional interest to us, in the 1960s, we have disagreed. At one time, while Daniel was writing a book on the subject, Abortion: Law, Choice and Morality (1970), we talked about the subject every day for the four years of the book's gestation. On many occasions during the 1970s, prolife articles writ ten by Sidney were passed out at Daniel's lectures in order to refute his pro choice views. Over the years, every argument, every statistic, every historical example cited in the literature has been discussed by the two of us. As Eliza Doolittle says about "words" in My Fair Lady, "There's nota one I haven't heard. " And yet we still disagree. How can it be, we ask ourselves, that intelligent people of goodwill who know all the same facts and all the same arguments still come down on different sides of the con troversy? As we well know, it is possible to agree about many things and have great love and respect for an opponent, and still differ."

Interest in mechanisms of embryo implantation is increasing, particularly with the realization that failure of implantation after in vitro fertilization and embryo transfer places significant limits on the success of treatment. In addition, there is a need to provide hypotheses, and ultimately mechanisms, for the high rates of embryonic loss in women in the population at large. Traditionally, implantation research has concentrated on genetics and endocrinology without providing many therapeutic benefits. A new era is now beginning with the application of modem cellular and molecular approaches to the investigation of the relationship between trophoblast and endometrium. At the same time, older data can be reevaluated in the light of current research into cell cell and cell-matrix interactions. The feeling that new avenues of research are open was apparent when an international group of scientists came together at a workshop on "The Cell Biology of Trophoblast Invasion In Vivo and In Vitro" held during the XXIV Annual Meeting of the Cell, Tissue and Organ Culture Study Group (C.T.O.C.) at Heidelberg in 1986. What was unusual about this Conference was the interdisciplinary dialogue between implantation researchers and tumor biologists, highlighting aspects common to invasion of trophoblast and tumor cells."

One of the first applications of lasers was for surgery on the retina of the eye. That, and the evident analogy to the old dreams of powerful heat rays, led many to predict that lasers would quickly be used for all kinds of cutting and welding, including surgical applications. It was soon apparent that laser sur gery could be performed in ways that caused little bleeding. Nevertheless, other surgical applications have been slower to arrive. One difficulty has been the enormous range of possibilities provided by the many different kinds of lasers. Infrared, visible, and ultraviolet light beams each interact very differently with human tissues. Light pulses of enor mously great peak powers became available from lasers, but their effects dif fered in surprising ways from those obtained with continuous beams. That provided both opportunities (i.e., treating or removing a very thin surface layer without affecting the underlying tissue) and problems with undesired side effects. Moreover, techniques were needed to deliver a precisely con trolled amount of energy just where it was desired. Lasers also had to be engineered and manufactured with the desired power levels and a high reliability."

This book is a compilation of edited papers which were presented at the XIth World Congress of Fertility and Sterility held in June 1983 in Dublin, Ireland. Although it has long been known that male factors are responsible in at least 30% of infertile couples only recently have concerted efforts been made on the part of urologists, gynaecologists and basic scientists to identify these factors more precisely. The nature of spermatogenesis is complex but application of various scientific methods have at last opened up new and promising approaches to our understanding of this subject. Clinical results however have been depressing; the majority of treatments lack realistic evaluation and are initiated in hope rather than with a sound scientific basis. We anticipate that this volume will in some small way correct these deficiencies. The papers have been grouped into related topics. The first section deals with the evaluation of the spermatozoa and includes a critical assessment of the recently introduced zona-free hamster egg test of sperm function. Further sections include the biochemistry of gonadal function and the immunology of male reproduction; most papers are concerned with studies in the human. The clinical sections cover medical and surgical approaches to treatment and the final section deals with various aspects of AID practice.

The VIIIth Annual International Spring Symposium on Health Sciences held at the George Washington University School of Medicine in Washington, D.C., attracted over three hun dred fifty scientists from twenty-five countries. The leading scientific experts in the field reported on recent biomedical advances in aging. They provided an up-to-date account of the molecular, genetic, nutritional, and immunological mechanisms associated with the aging process and approaches to intervention and treatment of the major disorders associated with the aging process, including Alzheimer's disease. A unique aspect of this meeting was a concurrent one-day hearing of the U.S. Senate Sub-Committee on Aging, organized by the Alliance for Aging Research. The theme for the hearing was "Advances in Aging Research." Seven scientists attending our aging sym posium were asked to testify. They were Drs. Carl Cotman (University of California-Irvine), Trudy Bush (Johns Hopkins University), Takashi Makinodan (University of California-Los Angeles), William Ershler (University of Wisconsin-Madison), Gino Doria (ENEA, Rome), Mr. Dan Perry (Director of the Alliance for Aging Research), and myself."

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 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.

These four volumes comprlslng "GnRH Analogues in Cancer and Human Reproduction" are a distillation of the presentations of the invited speakers at a landmark International Symposium bearing the same name, organized by one of us (B. L. ) and held in Geneva, SwitLerland in February 1988. The Symposium was truly interdisciplinary spanning gonadal hormone dependent disease including various forms of cancer and ranging to control of fertility, both pro- and conception. The international flavor can be caught from the 480 participants and 259 contributors drawn from 14 countries. The Symposium, and therefore this book, would not have been possible without the backing of The International Commitlee for Research in Reproduction and the sponsorship of the International Society of Gynecologic Endocrinology, The Swiss Society of fertility and Sterility, The University of Geneva School of Medicine, The Swiss Society of Endocrinology and The US foundation for Studies in Reproduction Inc. , and help from the World Health Organization. B. H. Vickery B. Lunenfeld June 1989 xiii LIST OF CONTRIBUTORS TO THE SERIES A. Abbondante H. Bartermann First Institute of Obstetrics and Urologische Universitatsklinik Kiel Gynecology Arnold-Heller Strasse 7 University "La Sapienza" D-2300 Kiel 1, FRG Rome, Italy M. Bartholomew P. Abel Department of Medicine/Endocrinology Department of Urology Milton S. Hershey Medical Center Hammersmith Hospital Pennsylvania State University DuCaneRoad PO Box 850, Hershey, PA 17033, USA London W12 OHS, UK D. Beck H.

This book was written to provide a clear and systematic sum mary of the principles of gynaecology in synoptic form. It is part of a three volume series, the first two volumes covering topics in undergraduate obstetricE and neonatal medicine respectively. Where appropriate, fundamentals of related anatomy and physiology are also covered. It is primarily directed at under graduate medical students and midwives, but material useful as reference to doctors revising for further qualifications has been included. Although much of the content is organized in the form of lists, this book differs from the usual 'list' book in that cover age is full and systematic. Thus the text has been organized into the following subheadings, where appropriate: Definitions, Aetiology, Pathophysiology, Clinical features, Differential Diag nosis, Investigations, Treatment, and Prognosis. To avoid rep etition, certain clinical areas including ectopic pregnancy and abortion which have been covered in the earlier volumes are not included. Certain useful diagnostic lists are also provided, and, in pre paring the book, previous examination papers of the Univer sities of Oxford, Cambridge and London, as well as of the Central Midwives Board, were consulted. Illustrations have been specially prepared in the form of explanatory line drawings that are simple, and easy to memorize and reproduce. Although drug dosages were checked with care before going to press, changes in medical practice make it advisable to verify regimes and doses with the latest prescribing information and the pharmacopoeia, before use."

The most complete presentation of basic and advanced laparoscopic techniques available, due to its integration of procedures from general surgery and other subspecialities. Enhanced by over 750 illustrations (113 of them in full colour) and written by no less than 132 international, interdisciplinary experts, this definitive reference covers all aspects of this still new and expanding technique. Four main sections deal with: basic laparoscopy; laparoscopy and thoracoscopy in general surgery; laparoscopy in surgical subspecialities (gynaecology, urology, angioscopy); plus the technological aspects of laparoscopy. Throughout this authoritative volume, the surgeon will find in-depth reviews of the literature and extensive clinical and scientific data on the rationale for using laparoscopic procedures.
Certain to become a standard in the field.

Infectious diseases remain a major problem for physicians and other health professionals dealing with problems of the reproductive system. Accordingly, this two-volume comprehensive presentation of infectious diseases involving the male and female reproductive systems promises to be a major contribution in this field and to fill a much-needed vacuum. During the past three decades, the introduction of antimicrobial therapy has dramatically altered both the clinical presentation and the therapeutic approaches employed in dealing with the traditional infections of the repro ductive system. In addition, the changing demographics of infectious problems in the industrial countries and the developing world have been a source of concern. A good deal of important information on this topic is included in this series. In recent years, considerable attention has been given to the role of Myco plasma and Chlamydia in both male and female infertility and the problems related to genital herpes and human papilloma virus infections. Current clinical information is included on these infections as well as on newer aspects of diagnosis, such as the use of laparoscopy in the diagnosis and treatment of pelvic inflammatory disease. Also addressed is new information regarding the role of actinomycosis in pelvic infections; current problems such as toxic shock syndrome and acquired immune deficiency syndrome (AIDS) are reviewed as well. New concepts are included in these volumes to complement the clinical information. The attachment of microbial organisms to sperm may help to explain access of these and other organisms to the upper female genital tract."