Francis James Browne is remembered as the foremost obstetrician of his day. He is widely recognised as the founder of modern antenatal care. His book, Antenatal and Postnatal Care, became the best of its kind and a bible to many generations of medical students and junior obstetricians. In this biography, Herbert Reiss presents a fascinating glimpse into the life of a great man in a deft and vivid portrait..

Perinatal medicine, which is concerned with the problems of the fetus and newborn, has rapidly developed in the last two decades as an important and challenging specialty. Rapid advances in the field, coupled with tech nological advances, now are making survival of infants with weights as low as 500 grams possible. Ventilator care for severe respiratory problems is on the verge of being replaced by surfactant replacement therapy; on the other hand, development of such technologies as extracorporeal mem brane oxygenation and jet ventilation has revolutionized the care of these sick infants. The advances taking place today in the field of perinatal medicine make periodic updates, like the one provided by this volume, a virtual necessity for clinicians and paramedical personnel alike. A distinguished group of specialists in various aspects of perinatal medicine has contributed to this book. Their wide-ranging experience and points of view should make this book a valuable reference for all physicians and allied health personnel involved in the care of the high-risk fetus and newborn. MANOHAR RATHI, M.D. Acknowledgements. I am grateful to the contributors for their cooperation in preparing the manuscripts, to my associates for their help and support, and to the publishers for their continued interest in this work. Above all, I thank Ms. Rose Aiello-Lech and Ms. MaryAnn Cichowski for their hard work in making this publication possible."

Endocrinologic investigations during pregnancy have focused in the last decades on placental hormones, the maternal endocrine system and maternal fetal interactions. Less is known about the fetus itself and the interaction of fetal hormonal response and physiological parameters. In this book physiologists, pediatricians and obstetricians active in experimental studies in both physiology and endocrinology combine both aspects of investigations. Historical remarks on the endocrine development of the fetus are followed by observations of the hormonal control of the cardiovascular system. Basic mechanisms of fetal endocrine control such as brain development, fetal growth, fetal behaviour, and thermoregulation are given particular consideration. Finally, carbohydrate metabolism and the mechanism of parturition are outlined.

When presented with the task of editing a volume on such a wide When presented with the task of editing a volume on such a wide and and diverse diverse topic topic as as Ovarian Ovarian Pathology, Pathology, it it is is difficult difficult to to know know how how to to limit limit the the range range of of subjects subjects to to be be covered covered when when there there are are so so many many taxonomical taxonomical entities, entities, both both neoplastic neoplastic and and reactive reactive that that could could be be included. included. However, However, I I have have chosen chosen to to cover cover concepts concepts that that are are not not usually usually dealt dealt with with in in depth depth in in Gynaecological Gynaecological Pathology Pathology textbooks. textbooks. From From the the clinicopathological clinicopathological viewpoint, viewpoint, a a wealth wealth of of new new data data has has been been updated updated and and critically critically reappraised. reappraised.

The account of "neonatal sterilization" is the story of the advocates of direct effect of steroids on the gonads and those who believed in the indirect influence, mediated through the hypothalamus and/or the pituitary gland. As often happens in biology, both convictions represent the same image seen from different perspectives. Prof DC Johnson (Kansas City, KS) reminisced the beginning of the story in a letter to me. I am paraphrasing parts of the letter with his permission. "As a starting point we could pick the life-long research of Emil Steinach ... " Steinach recognized the influence of testes on the develop ment of accessory sex organs in 1894, described virilization of females and feminization of males in 1913, and identified the controlling influence of the hypophysis on the gonads in 1928. He reviewed his work in a book Sex and Life, Forty Years of Biological and Medical Experience (E Steinach and L Loebe!; Faber and Faber, London, 1940). He got on the wrong road in later years and that is the reason everybody seems to have forgotten him. He presented his hypothesis that estrogen has a direct effect upon the testes, i. e. hormone antagonism, at the 1st International Congress on Sex Research in 1926.

The ultimate "consumer" of the data presented at conferences on the primary treatment of operable breast cancer is the patient, and when, as in this disease, the benefits of therapy are relatively mod est, the availability and interpretation of the data from trials be comes an issue of primary importance. The effects of present treat ment are in fact such that more patients relapse despite therapy than are estimated to benefit from it. It is, therefore, extremely dif ficult for the physician to recommend unequivocally one particular adjuvant treatment modality for the vast population of women with breast cancer. The interpretation of results from clinical research-oriented pro grams is constantly applied, however, in the treatment of breast cancer patients outside of clinical trials. From presented or publish ed data, many physicians extrapolate indications for the use of a given treatment regimen for their patients, perceiving it as the "best available therapy. " It is essential that the "best available therapy" be selected individually for each patient. However, considering the modest effect of treatment upon outcome, it is imperative that those who provide the data - those who are involved in both pa tient care and clinical research - make it known that the best cur rent treatment for the population of breast cancer patients is avail able within the framework of clinical trials. In this way not only present-day patients but also future ones will derive the greatest benefit.

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."

I am very happy and honoured to have so many famous contrib utors from around the world presenting their knowledge and experience in this book, including Dr. Rufer who, as early as 1967, attempted to improve the pressure-volume curve of a child dying from RDS using dried surfactant from dogs; Drs. Enhorn ing and Robertson who were the first to treat rabbit fetuses with surfactant replacement and impressively demonstrated that sur factant improved lung mechanics; and Dr. Fujiwara who at the end of the 1970's had already successfully treated the first babies with surfactant replacement and published this work al ready in 1980. Thus, the idea of surfactant replacement therapy is now more or less 20 years old and almost 10 years have passed since the first publication by Dr. Fujiwara of his impressive clinical results. Up to now (September, 1988) about 2,200 babies have been treated worldwide with tracheal instillation of surfactant, with most promising results. The type of surfactant used varies from pure natural extracts from bovine or pig lungs, to surfactant extracted from human amniotic fluid, to pure phospholipids. To date, however, there is still no surfactant commercially available (except in Japan), in spite of the fact that it is urgently awaited by neonatologists and intensive care doctors throughout the world. This volume is based on the contributions presented at the international congress on Surfactant Replacement Therapy which was held in Rotterdam, The Netherlands, in November 1987."

Breast Cancer, the second volume in the MD Anderson Solid Tumor Oncology series, this book provides the general surgeon, surgical oncologist, and medical oncologist with the state-of-the art multimodality care for breast cancer. Divided into five sections, the text brings the field's recognized esperts addressing the current status of breast imaging, breast pathology, the role of breast surgery including management of in situ and early stage carcinoma, prophylatic mastectomy, axillary node dissection, sentinel node and lymphatic mapping, and outpatient mastectomy, as well as coverage of special selected topics featuring breast cancer in pregnancy, inflammatory breast cancer and breast sarcoma. An important section on future research reviews on-going studies for the use of in situ laser ablation, cryosurgery, and translational research to bring the busy practitioner up-to-date on state-of-the art advances. This book is a must-have resource on the full specturm of current and prospective treatment options for this challenging disease.

Sexology as a discipline has had to fight for full-fledged recognition in the scientific community. Yet special knowledge of normal and disturbed sexual behavior is expected of medical professionals, psychologists and educators alike. Based on the papers given at the 8th World Congress for Sexology in 1987, this volume gives an up-to-date discussion of the most interesting and controversial topics, such as AIDS, in the field. Contributions have been grouped under the main headings: Family Planning, Sterility and Sexuality, Erectile Dysfunction, Sexuality in the Elderly and in Marriage, Transsexualism, Sexual Therapy, and Sexuality and Illness, and include items of historical interest as well as transcultural comparisons.

H.-J. Senn Adjuvant Chemotherapy (ACT) of breast cancer has now emerged as one of the controversial su):>jects in clinical and also experimental oncology. Driven by growing frustration about stagnating cure rates in breast cancer [1,4] and stimulated by elegant demonstration of highly curative effects of adjuvant systemic therapy in animal models [6, 11] and in several childhood neoplasias [15], researchers introduced ACT to the primary treatment of breast cancer with great hope some 15 years ago. After a first wave of isolated "historic" trials with generally limited but in one case remarkable success [5, 9], a second generation of ACT studies was initiated by NSABP investigators and oncology centers in Europe [2, 6, 13]. These trials were well conducted statistically and diagnostically, and all in the early 1970s included a surgical control arm. Early and intermediate beneficial effects on relapse-free survival (RFS) after 2-3 years median observation time then prompted a whole series of ACT studies in breast cancer. These "third-gener ation" studies usually regarded some positive influence of ACT as a given fact, dropping surgical control regimens and comparing different ACT regimens, hopefully in a prospective, randomized way 1984 Fig. 1. The mushrooming of adjuvant studies in breast cancer XII Introduction [reviews in 3, 14]. The "mushrooming" of ACT studies in breast cancer during the last 10 and especially 5 years is demonstrated in Fig. 1, and it gets really cumbersome even for the insider to keep on top of the multitude of sometimes conflicting data.

Few subjects in gynecology, let alone in medicine in general, have provoked such inter est or study as cervical cancer. Although the wealth of monographs and books publish ed on the subject would seem to obviate the need for more, the great advances made in the medical sciences and in gynecological experience and techniques in recent years call for, if not require, a new book on cervical cancer to bring together the latest ideas and trends in its methods of study, diagnosis, and treatment. Although precancerous lesions have become more common, the number of women developing invasive cervical carcinomas has not increased, owing in part to programs of patient education, in part to screening examinations sponsored by the government. The gynecologist is now able to detect with well-tried and proved techniques precan cerous states of the cervix, and to treat these effectively before they become invasive cancer. Accordingly, recent interests in cervical cancer have shifted from the classic descrip tion of invasive carcinoma to newer studies of cause, diagnosis, therapy, and terminol ogy of its precursors. As the reader will learn, epidemiological studies as guides for the future account for, and justifiably so, an important part of this book. New knowledge about changes in the morphology of cervical carcinoma confirms its dependency on hormonal stimulation. Furthermore, modem experiences serve to explain which therapy is best. Overlapping of concepts and opinions between some chapters could not be avoided."

The use of human in vitro fertilization in the management of infertility is the outgrowth of years of laboratory observations on in vitro sperm-egg interaction. "The editors of this work have themselves contributed significantly to basic knowledge of the mammalian fertilization process. The observations of Don Wolf on sperm penetration, the block to polyspermy and, most recently, sperm hyperactivation in the monkey and human, Gregory Kopf's elucidation of the mechanisms of sperm activation during penetration and the reciprocal dialogue between sperm and egg, and Barry Bavister's definition of culture conditions and requirements necessary for in vitro oocyte maturation, fertilization and development in model mammalian systems including nonhuman primates have contributed greatly to our understanding of the mammalian fertilization process. Wolf, Kopf and Gerrity have enjoyed substantial interaction with clinicians in Departments of Obstetrics and Gynecology and have been directly involved with successful IVF programs. Both Wolf and Kopf have served as research scientists in the Division of Reproductive Biology at the University of Pennsylvania, which, for more than 22 years, has fostered co-mingling of clinically oriented and basic science faculty. It is through such interaction, which clearly exists at many institutions including the University of Wisconsin, that the process of technology transfer is best served. Without an exquisitely coordinated laboratory, there can be no consistent success in human in vitro fertilization. Quality control is pivotal, but close collaboration between the laboratory and the clinic is also essential as information is shared and correlated.

The European School of Oncology came into existence to respond to a need for informa tion, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was. considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Univer sities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

The Third International Copenhagen Symposium on Detection of Breast Cancer afforded a further opportunity for scientists from all over the world to come together and present important papers con cerning breast cancer and early diagnostic procedures. The Sympo sium was an opportunity to learn from extensive screening proce dures carried out at outstanding centers in the United States, Sweden, the Netherlands, and England. Furthermore, the Sympo sium dealt with new modalities such as ultrasonography, magnifi cation techniques, and magnetic resonance; and very important contributions concerning self-examination, fine needle aspiration biopsy, and radiation risks were presented. A whole section was also dedicated to the highly important cooperation between radiologist, surgeon, and pathologist. It is our sincere hope that a study of the different aspects of breast cancer presented in this volume will encourage the reader to join in the struggle against this dreadful dis ease. December 1986 S. Brunner B. Langfeldt Contents B. Nielsen Image Quality in Mammography: Physical and Technical Limitations . 1 S. A. Feig, B. M. Galkin, and H. D. Muir Clinical Considerations in Selection of Dedicated Mammography Units . . . . . . . . . . . . . . . . . . . . 15 . . . E. A. Sickles The Role of Magnification Technique in Modern Mammography . . . . . . . . . . . . . . . . . . . . . . . . . . 19 B. M. Galkin, S. A. Feig, P. Frasca, H. D. Muir, and R. Z. Soriano Imaging Capabilities and Dose Considerations of Different Mammographic Units . . . . . . . . . . . . . . . . . . 25 . . . E. A. Sickles Computed Tomography Scanning, Transillumination, and Magnetic Resonance Imaging of the Breast . . . . . . . . . . . 31 A. G. Haus Recent Trends in Screen-Film Mammography: Technical Factors and Radiation Dose . . . . . . . . . ."

Sexual medicine is an interdisciplinary subject. Special knowledge of normal and disturbed sexuality is expected of general practitioners, gynecologists, dermato logists, urologists, specialists in internal medicine, neurologists, psychiatrists, and psychotherapists. Sexual dysfunctions may occur in connection with organic lesions or as psychosomatic phenomena. They are brought to the practicing physician's attention by the patient either directly or in the form of factitious symptoms. The disturbed sexual function generally causes suffering and so motivates the patient to consult a physician. Psychosomatic aspects are thus very much to the fore. In a significant number of cases, however the disturbances stem from a physical-functional handicap which not only affects the patient's general personality but also has a direct adverse effect on sexual function. The physical defect leads to disturbances of the body-image, and so can cause impairments in the sexual sphere both directly and indirectly. The diseases which result in sexual handicap and which can be treated by reconstructive surgery were examined and discussed at an international satellite symposium of experts on the occasion of the 8 th World Congress for Sexology in June 1987. The papers presented at this symposium have been collected and edited in this volume."

Progress in basic research has made it necessary to redetermine the possibility of classic endocrine therapy for the treatment of patients with breast cancer. Exemplary, close cooperation between biochemis try and animal and clinical research led to a truly interdisciplinary and international exchange of ideas and experience at a symposium held in autumn 1978 in Heidelberg. We owe our thanks to ICI-Pharma for the kind support of this sym posIUm. The participation of Charles Huggins in the meeting as honorary chairman signified to all participants the meaning of this joint endeavour. It was the same Charles Huggins who through experimental work laid the foundation stone for endocrine ther apy of prostate and breast cancer, and who applied his findings clinically. Thousands of patients owe to him relief from their suffering. He contributed greatly to the attempt to find and stabilize the endocrine therapy for breast cancer, for which we thank him sincerely. We hope that the following contributions will similarly serve the well-being of our patients."

an adequate oxygen supply is vital for the undisturbed development of the fetus and its functions. This book gives a synopsis of the ruling influence that oxygen has in multiple regulation sytems in the mother and especially in the fetus. The authors consider oxygen as a manipulated variable or as a corrective element during normal pregnancy, during delivery and during acute and chronic oxygen deficiency. Furthermore, they deal with the consequences that oxygen deficiency has on the fetus.

Sixty years ago, G. Fanconi published a paper entitled: "Familiiire infantile pemiziosaartige Aniimie (pemizioses Blutbild und Konstitu- tion)", in which he reported that this type of severe aplastic anemia represents a hereditary disease distinct from other pancytopenias of childhood (Fanconi 1927). Later this syndrome was named Fan- coni anemia (FA; van Leeuwen 1933). A more recent study of the genetics of FA confirmed that the syndrome is inherited in an au- tosomal recessive manner (Schroeder et al. 1976). Prenatal diagno- sis in FA families showed that about 25% of fetuses are affected (Auerbach et al. 1985, 1986). In 1964, Schroeder et al. discovered high frequencies of chro- mosomal aberrations in cultured peripheral blood lymphocytes from patients with FA. Schuler et al. (1969) reported that cells from FA patients are particularly sensitive to the chromosome-breaking activity or clastogenic effect of a polyfunctional alkylating agent. Since that time, studies of baseline and induced frequencies of chromosomal aberrations have been used for the identification of patients with FA. There is now a large body of data concerning the possible mechanism(s) underlying the hypersensitivity of FA cells to DNA cross-linking agents, the biochemical basis for which is still unknown. Complementation analysis, using cells from different FA pa- tients, has demonstrated genetic heterogeneity in the syndrome.

The term polycystic ovary syndrome (peOS) is meant to describe a clinical endocrinopathy characterized by menstrual irregularity and evidence of hyperandrogenism. While recognized since the 1800s, a clinical composite was not constructed until 1935 when Stein and Leventhal reported their findings of seven women with infertility, menstrual dysfunction, hirsutism, and enlarged ovaries. Notably, the ovaries contained numerous multiple cysts and the ovarian capsule was thickened. At the time, this preciseness of definition was sufficient to entitle the entity Stein-Leventhal syndrome. Subsequently, over the intervening years as investigators attempted to un ravel the pathophysiology and genesis of this disorder and the number of reported studies increased, there ensued a gradual and distinct terminologic conversion to polycystic ovary syndrome, which, whether intentional or not, connoted a less well-defined condition. Perhaps this is appropriately so, given the seemingly broadening spectrum of clinical presentations and the continuing debate over what constitutes peos. The expansive new knowledge about peos was discussed to a significant degree at an international symposium organized by Serono Symposia USA and held in Boston in the late spring of 1995. Ovarian physiology, including the fate of the follicular unit, was a central focus with several presentations on the genesis, growth, and death of ovarian cellular components. A discus sion of the regulation of ovarian cell function was also highlighted and comprised a major portion of the program."

During the past ten years numerous new findings have been documented in the field of gynecological pathology, especially in respect of neoplasms. These findings have been generated by the application of recently developed techniques of immunology and molecular biology. However, clinicopathologic examinations. are still an absolute requirement for the morphologic evaluation of neoplasms, including gynecological tumors. The International Society of Gynecological Pathologists (ISGYP) has contributed greatly to the progress within gynecological pathology. The ISGYP Nomenclature Committee has promoted the International Histological Classification of Gynecological Tumors under the auspices of the W orid Health Organization. A new edition of the classification of tumors and tumor-like conditions of trophoblastic disease, uterine corpus, cervix, vagina, and vulva is currently in press. A second volume covering the ovaries, fallopian tubes, broad ligament, and female peritoneum will be published later. Organization of scientific symposia and seminars has also been an important activity of the ISGYP. The present editor organized and chaired a symposium entitled "Recent Progress in Diagnostic Pathology of Gynecological Tumors" held in Sendai, Japan on 11 April 1986 in close cooperation with Prof. T. Okagaki, University of Minnesota Medical School, and under the joint auspices ofthe ISGYP and the Japanese Society of Pathology. The following topics were discussed at this symposium: - Immunocytochemistry of gestational trophoblastic disease (Dr. R.J."

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."

The anticipation of seeing and having to manage patients suffering from sensory disorders of the urinary tract brings dismay and foreboding to the urologist. This stems from his experience of the time that these patients take up, both at the stage of initial interview and subsequently during numerous consultations over periods of months and years. This and the largely unsatisfactory response to various forms of therapy in the past are reason enough for this bold attempt to define with objectivity the notoriously subjective disorders of interstitial cystitis, urethral syndrome and prostatodynia. In writing this book the principal aim of the authors has been to define these three entities concisely and to describe the investiga tional methods which are required to establish the diagnosis in each case. The importance of this cannot be overestimated since, when the label of one or other of these conditions is attached to a patient, further objective consideration of the case is-endangered. The casual attribution of these sensory diagnoses to inappropriate cases is already on record as having dulled clinical awareness and led to oversight of progressive disease and its sometimes avoidable conse quences."

In the last decade of the 15th century a new and deadly disease called Morbus Gallicus, or syphilis, appeared and spread rapidly throughout Europe. The effects of syphilis were so severe that it, and those suffering from it, where regarded with horror and despair. It is difficult for the modern reader to appreciate the fog of confusion which surrounded sexually transmitted diseases in earlier times. Those suffering with these diseases were often condemned as victims of their own "sinful lust of the flesh"; a judgement attitude which hindered most of the early attempts at control and treatment. Despite this general attitude, there were some doctors who persevered in their attempts to understand the causes and discover treatments for syphilis and other sexually transmitted diseases. The Scars of Venus is illustrated with pictures of people, places, instruments and documents. It presents the historical background and achievements of the early venereologists through to the current venereologists' fight against HIV. This book will be of interest to anyone concerned with venereal diseases: doctors, nurses, counsellors, laboratory workers, medical historians, and those working in the areas of public/world health and the spread of infectious diseases.

The subject of the Sixth Symposium on Clinical Oncology of the Royal College of Radiologists held in February 1984 was ovarian cancer. This publication presents the collected papers delivered at that meeting, but excludes much useful discussion which also took place. The annual clinical oncology symposia have been designed to re- view topics of current interest in cancer therapy from a multidis- ciplinary point if view. It was gratifying to the organisers and all who took part that the aims were so well met by both the contrib- utors and discussants. We believe that this can only be to the ad- vantage of future research and our present and future patients. Ovarian cancer is a common gynaecological cancer which freqently presents late. Its clinical management is bedevilled by the variable referral routes through which patients present for treatment. Thus, many are first seen by general abdominal sur- geons who may not be expert in their treatment, rather than gynaecologists or gynaecological oncologists. There are many in- teresting features about it which have been discussed by the var- ious speakers. Early spread within the abdomen is common, spread outside the abdomen less common. There is a variety of histopathological types, each with distinct aetiological, prognos- VI Preface tic and therapeutic assocations. In contrast to most cancers, sur- gical debulking of tumour is considered valuable even when there is no possibility of removing all tumour by the knife.