This book grew out ofmy interest in what is often called "the immunological paradox ofpregnancy." How is it possible that the fetus-halfofwhosegenetic apparatuscomesfrom thefather and is foreign to the mother-can survive to term? This is a question that intrigues all immunologists. For me, it has been of interest ever since I heard a lecture on the subject in medical school, long before I thought ofbecoming a "professional immunologist." Indeed, the question ofthe immunological aspect of fetal survival (or demise) should be of interest to any biologist or physician. The question becomes broader ifone considers the immunologic relations between motherand fetus, because they represent a unique symbiotic union. Whatimmunologic problemsinthemothermayaffecttheoffspring, and isitpossiblethatfetal immunology willaffectthe mother? Finally, there is the question ofwhether immunology is important in recur- rent spontaneous abortion. Every authorowes the reader a general oversightofthe book in hand, indicating the terrain to be covered, and, by inference, the territory that will not be explored. 1. This is primarily a book for clinicians. I will only men- tion animal experiments and data in passing, and as they may illuminate a clinical problem or observation. 2. The interest here is the immunology ofmaterno--fetal re- lations, once a pregnancy has begun. Therefore, I will notcover immunological aspects ofsterility, nor touch on the immunological approaches to controlling fer- tility, i.e., "contraceptive vaccines." 3. This is a book mainly concerned with pathogenesis.

1. 1 The Cytokeratins as a Member of the Intermediate Filament Protein Family Intermediate filaments together with microtubules and actin microfilaments make up the filamentous cytoskeleton found in the cytoplasm of vertebrate cells. Recently, intermediate filament proteins have also been described in invertebrates, but their chemistry is not yet known (for review see Biessmann and Walter 1989). These filaments (about 10 nm in diameter) used to be categorized into five classes - cytokeratin, vimentin, desmin, glial fibrillary acidic protein (GFAP), and neurofilaments (NFs). The expression of these proteins follows differentiation-dependent rules: cytokeratins occur in epi- thelial cells, NF proteins are expressed in neurons, GFAP in astrocytes and some nonglial cells, desmin in smooth muscle cells and in striated myocytes, and vimentin in mesenchymal cells (for review see Lazarides 1980; Osborn and Weber 1983). Recent investigations including deoxyribonucleic acid (DNA) and protein sequencing and peptide mapping have redefined the intermediate filaments into five types or subfamilies (type I, acidic cytokeratins; type II, basic cytokeratins; type III, vimentin, desmin, peripherin, and GFAP; type IV, the three NF proteins; and type V, the nuclear lamins (for review see Nagle 1988). A new type VI intermediate filament protein, nestin, has been described in the developing nervous system (Lendahl et al. 1990), and is initially co- expressed with vimentin in neuroepithelial stem cells (Steinert and Liem 1990). The cytokeratins are the most complex subgroup of intermediate filament proteins.

This work attempts to sketch a coherent picture of the amniotic fluid com partment, its borders, and the interactions occurring between fetus and amniotic fluid, for it is this compartment which for 10 months provides the habitat in which the fetus and its functions develop. As a matter of course, our mor phological studies had to be limited to the situation prevailing at the full term of pregnancy. This portrayal purposely neglects the placenta, which is already the subject of an extraordinary profusion of literature. The other aspects of the embryonic sac have been overshadowed to date by the preeminent role 2 of the placenta, although they represent around 1200cm of contact surface in the maternal compartment. From our point of view, the fetal membranes not only act as a seal or simply a diffusion barrier, but actively participate in the exchange processes between compartments. The author also took pains to compile (albeit incompletely) the widely scattered findings reported in clinical journals in order to present them as a well-rounded summary of the mor phological picture and the functional happenings involved in fetal develop ment. The author's own studies of a specifically histomorphological nature provided the groundwork for this synopsis. A special branch of embryology, embryonal physiology, is treated only incidentally in today's embryology textbooks. This work offers several encounters with this field, which should help make it the focus of greater interest. 2 Definition of Terms Fig. 1.

As the older population in the United States is becoming more racially and ethnically diverse, it is important to understand the characteristics, the potential, and the needs of this population. In this new and fully revised edition of Aging and Diversity, Chandra Mehrotra and Lisa Wagner address key topics in diversity and aging, discussing how the aging experience is affected by not only race and ethnicity but also gender, religious affiliation, social class, rural-urban community location, and sexual orientation and gender identity. Taking this broad view of human diversity allows the authors to convey some of the rich complexities facing our aging population - complexities that provide both challenges to meet the needs of a diverse population of elders and opportunities to learn how to live in a pluralistic society. Mehrotra and Wagner present up-to-date knowledge and scholarship about aging and diversity in a way that engages readers in active learning, placing ongoing emphasis on developing readers' knowledge and skills, fostering higher order thinking, and encouraging exploration of personal values and attitudes.

1. 1 Historical Perspective In the nineteenth century, knowledge of the events leading to ovulation, fertilization, and implantation was very limited, so much so that Seiler (1832), in his book The Uterus and the Human Egg, wrote: ." . . in the left ovary the first signs of fertilization, namely a Graaf vesicle could be seen. The right ovary shows proof of a second successful copulation: a fresh scar from the ovulated egg and the beginning of a corpus luteum. " In fact all nineteenth century authors strictly divide the female cycle into two phases: the menstrual period and the intermenstruum (ct. Hitschmann and Adler 1908). The generally accepted histology of the endometrium in those days was that of the late proliferative phase. Deviations from this were considered to be pathological (Von Ebner 1902). As Gebhard (1899) expressly put it: "As a rule, it can be said that in the mature woman the endometrial glands run straight; an irregular course of the glands is to be regarded as pathological. " The same author describes the changes occurring during the secretory phase of the cycle as "endometritis glandularis" which he believed to arise from a local nutritional disturbance. The uterine stroma was believed to be lymphoid (Toldt 1877), and the uterine glands were compared to the crypts of Lieberkiihn (Von Ebner 1902).

In the USA, severe psychiatric illness after childbirth strikes one woman for every 1000 births, or about 3500 women each year. An unrecorded number of new mothers experience lesser degrees of postpartum illness, and two distinct forms of severe illness can be distinguished. One form, called postpartum psychosis, is an agitated, very changeable condition, often characterized by confusion, hallucinations, delusions and sometimes episodes of violent behaviour. The other condition, major postpartum depression, begins two or three weeks after childbirth, and is characterized by confusion, depression of mood, and often with exhaustion, headache and digestive upset. Mixtures of the two severe disorders occur frequently. This volume contains a number of essays which support the position that postpartum disorders are primarily organic and are mainly disorders of hormonal deficit. They develop as the endocrine system falls back from the hyperactivity of pregnancy toward or beyond the levels of the prior non-pregnant state. Tremendous therapeutic opportunities exist or are imminent for both the organic and the psychological components of postpartum mental illness.

Each of the 6 units of PROLOG addresses a major area in obstetrics and gynecology and consists of two parts - an assessment book and a critique book. Put your knowledge to the test and earn 25 CME credits for this volume! On completion, users of this unit should be able to: Screen with appropriate diagnostic tests for endocrinology and infertility conditions. Determine the appropriate medical management to address infertility. Understand the hypothalamic-pituitary-ovarian-uterine axis. Apply concepts of the hypothalamic-pituitary-ovarian-uterine axis when considering medical therapy. Understand the basics of assisted reproductive technology. Counsel women regarding treatment options for primary and secondary amenorrhea and infertility.

Endorphins and other endogenous opioids appear to be the connecting link between reproductive functions and stress adaption of the human organism. This book contains the con- tributions of an international group of biologists, bioche- mists, and endocrinologists on the opioidergic control me- chanisms in reproduction and stress physiology. Main topics covered are: endogeneous opioids and the pituitary-gonadal system; ovarian endorphinsecretion; pregnancy-associated changes of plasma endorphin; and opioid control of the hypo- thalamo-pituitary-adrenal axis. Although all chapters give an excellent review on various studies in basic opioid re- search, there are numerous clinical implications mentioned in this book.

During the past 20 years, endometrial carcinoma has continued to increase in frequency and it is quite possible that this carcinoma will become the major gynecologic malignancy in the future. For many years, endometrial carcinoma was considered less malignant than other gynecologic malignancies, simple hysterectomy and bil ateral salpingo-oophorectomy or surgery combined with radiation being effective in certain circumstances. It is unfortunate to note that the global 5-year survival rate for patients with advanced or recurrent endometrial carcinoma has improved only slightly. Therefore any complacency regarding this 'benign malignancy' should be reconsidered. There is a growing awareness of the nature of end ometrial carcinoma, with advances in our knowledge ranging from its etiology through its epidemiology to its clinical findings. This volume has been designed to fill a hiatus in the literature in China. To achieve this aim, we have attempted to review the world-wide advances on endometrial carcinoma and summarize systematically and comprehensively this common gynecologic malig nancy, including the clinical experiences gathered at the Cancer Institute (Hospital) of the Chinese Academy of Medical Sciences since 1958 as well as a brief description of the psychological problems in patients with gyneco logic cancers."

Doppler ultrasound is a hot topic at the present time. This is because studies of the uteroplacental and fetal circulation give fundamental information as to the physiology or pathology of placental function and the response of the fetal circulation to hypoxaemia. Dr. Arabin's clinical studies which are described in this book are an important contribution to knowledge in this field and will be of enormous interest not only to researches but also to clini cians interested in learning how this latest technology can be integrated into their clinical practice. London STUART CAMPBELL Foreword Although only three decades old, the field of perinatal medicine is marked by continuous new advances. Ultrasound diagnostic techniques comprise an important element of this new field. Dr. Arabin has taken the initiative to investigate the functional-diagnostic aspects of ultrasound. Among other things, she has further developed and refined the concept of "oxygen-con serving adaptation of fetal circulation" which originated in the Department of Obstetrics and Gynecology at the Neukolln Hospital Center in 1966. She thus has been able to show that the most reliable Doppler blood flow meas urement predictors of a high risk to the fetus are (1) a decrease in the flow volume of the descending thoracic aorta and the umbilical artery and (2) an increase in the flow volume of the common carotid arteries."

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin."

In the 1960s thousands of poor women of color on the (post)colonial French island of Reunion had their pregnancies forcefully terminated by white doctors; the doctors operated under the pretext of performing benign surgeries, for which they sought government compensation. When the scandal broke in 1970, the doctors claimed to have been encouraged to perform these abortions by French politicians who sought to curtail reproduction on the island, even though abortion was illegal in France. In The Wombs of Women-first published in French and appearing here in English for the first time-Francoise Verges traces the long history of colonial state intervention in black women's wombs during the slave trade and postslavery imperialism as well as in current birth control politics. She examines the women's liberation movement in France in the 1960s and 1970s, showing that by choosing to ignore the history of the racialization of women's wombs, French feminists inevitably ended up defending the rights of white women at the expense of women of color. Ultimately, Verges demonstrates how the forced abortions on Reunion were manifestations of the legacies of the racialized violence of slavery and colonialism.

The rapid development of reproductive technologies has questioned many essential concepts belonging to our symbolic universe, such as human reproduction, motherhood and fatherhood; the transmission of the biological and cultural inheritance of mankind and the constitution of the psychic subject. These concepts, however, are supported by ideologies and value systems which hide that they are but theoretical constructions; consequently, they are taken as describing the "natural" function of reproduction. In this sense, the technological development takes the form of an increasing medicalization of the human body, of the life, sexuality and desire of people, especially of women. All this requires that we think critically about the conditions of possibility of these technologies and their psychological and ethical implications. In this book the author provides a detailed and rigorous analysis which locates the reproductive technologies in the historical context of the progressive technification of the management of human life, and their relation to the social and medical discourses on femininity, maternity and infertility. From a psychoanalytic point of view, culture and its discontents, violence, domination, are related intimately to the problematic character of sexuality, which includes the uncertainties of our desires. Social, medical, anthropological and literary discourses try to define "maternal desire" in order to control it: the definitions which capture it in their nets are means to dominate desire as an object and to "construct" the desiring subject. But psychoanalysis (through the associations of the subjects in question) shows that we face here an impossible question: one thing is the enunciated "demand", what is said about one's own desire ("I want a child"), and a very different one is the unconscious desire which disturbs the conscious discourse and shows that there can be psychological obstacles that interfere with the accomplishment of conscious wishes, conflicts and contradictions emerging through the women's words. In this book, the circulation of representations between the individual imaginary and collective myths is the basis of a multidisciplinary complex and original point of view, which confronts a variety of discourses arising from psychoanalysis, medicine, journalism, ethnology, mythology and literature.

The Project on Reproductive Laws for the 1990s began in 1985 with the realization that reports of scientific developments and new technologies were stimulating debates and discussions among bioethicists and policymakers, and that women had little part in those discussions either as participants or as a group with interests to be considered. With the help of a planning grant from the Rutgers University Institute for Research on Women, the Women's Rights Litigation Clinic at Rutgers University Law School-Newark held a planning meeting that June attended by approximately 20 theorists and activists in the area of reproductive rights. Project purposes, methods, and general shape took form at the meeting. Two goals have characterized the Project's work since then: first, to generate discussion, debate, and, where possible, consensus among those committed to reproductive autonomy and gender equality as to how best to respond to the questions raised by re ported advances in reproductive and neonatal technology and new modes of reproduction; and second, to ensure that those shaping reproductive law and policy appreciate the ramifications of these developments for gender equality. In meeting this twofold agenda, the Project focused on six areas: time limits on abortion; prenatal screening; fetus as patient; reproductive hazards in the workplace; interference with reproductive choice; and alternative modes of reproduction. The Project identified individuals to take respon sibility for drafting model legislation and position papers in the six areas (for the drafters, see the Appendix)."

The Project on Reproductive Laws for the 1990s began in 1985 with the realization that reports of scientific developments and new technologies were stimulating debates and discussions among bioethicists and policymakers, and that women had little part in those discussions either as participants or as a group with interests to be considered. With the help of a planning grant from the Rutgers University Institute for Research on Women, the Women's Rights Litigation Clinic at Rutgers University Law School-Newark held a planning meeting that June attended by approximately 20 theorists and activists in the area of reproductive rights. Project purposes, methods, and general shape took form at the meeting. Two goals have characterized the Project's work since then: first, to generate discussion, debate, and, where possible, consensus among those committed to reproductive autonomy and gender equality as to how best to respond to the questions raised by re ported advances in reproductive and neonatal technology and new modes of reproduction; and second, to ensure that those shaping reproductive law and policy appreciate the ramifications of these developments for gender equality. In meeting this twofold agenda, the Project focused on six areas: time limits on abortion; prenatal screening; fetus as patient; reproductive hazards in the workplace; interference with reproductive choice; and alternative modes of reproduction. The Project identified individuals to take respon sibility for drafting model legislation and position papers in the six areas (for the drafters, see the Appendix)."

Why do women live longer than men? Does ownership of paired X chromosomes confer more prolonged survival on females, or is the gender difference in life-expectancy a cumulative consequence of differing life experiences for women and men? The areas of gender differences in aging, functional capacity, and the response to physical activity have often been the basis for speculation rather than informed judgment. Gender, Physical Activity, and Aging draws upon the sound knowledge base of leading investigators to provide objective, evidence-based evaluations of particular facets of the aging process. Focusing on gender differences, it examines the rate of aging, loss of functional capacity, disability, and the quality of life among the elderly and presents evidence of potential modification through physical activity and lifestyle.

How is growth controlled in normal cells? How are the growth control mechanisms perturbed in cancer cells? This book provides an up-to-date description of research aimed at resolving these questions. It is organized into four sections, each containing a series of short reviews written by experts in the field. The general headings are: growth factors, receptors, and related oncogenes: transduction of mitogenic signals and "ras" oncogenes; nuclear oncogenes and regulation of gene expression; and multiple steps involved in malignant transformation. The articles emphasize concepts rather than detailed facts and are intended not only for specialists in the field but also for interested readers, such as physicians and advanced students, who wish to stay abreast of developments in one of the most exciting fields in current biomedical research.

This book provides a state-of-the-art overview of key areas of subcellular aging research in human cells. The reader is introduced to the historical development and progress in biomedical aging research and learns, for example, about the role of microRNAs, circRNAs, mitochondria and extracellular vesicles in cellular senescence. The reader will also learn more about how gap junctions, the nuclear pore complex and the proteasome are affecting the ageing processes. In addition, novel therapeutic opportunities through modulation of cellular senescence are discussed. The book follows on from Parts I and II of Biochemistry and Cell Biology of Ageing (Volumes 90 and 91 of the Subcellular Biochemistry book series) by covering interesting and significant biomedical ageing topics not included in the earlier volumes. Comprehensive and cutting-edge, this book is a valuable resource for experienced researchers and early career scientist alike, who are interested in learning more about the fascinating and challenging question of why and how our cells age.

Most of the following chapters were presented as plenary lectures or symposium talks at the 1986 XXXth Congress of the International Union of Physiological Sciences in Vancouver, B.C. A distinguished international group of endocrinologists and physiologists have contributed up-to-date reviews of their particular fields. The early chapters are largely concerned with the brain and neuroendocrine mechanisms controlling the secretion of gonadotropin releasing hormone (GnRH) and its action on the anterior pitui- tary gland. Later chapters focus on the gonads themselves and the systemic and intrinsic hormones influencing the functional cytology of ovarian and testicular cells. Such comprehensive subjects as sex differentiation, puberty, placentation and parturition are also discussed authoritatively. According to Pfaff and Cohen and Arai et al., gonadal steroids, especially estrogen, exert multiple effects on certain hypothalamic and preoptic neurons, including growth, protein synthesis and electrical changes, which promote plasticity and facilitate synaptogenesis. The electrophysio- logy of the hypothalamic GnRH pulse generator in the rhesus monkey is reviewed more specifically by Knobil. In ovariectomized ewes, Clarke finds both positive and negative effects of estrogen on hypothalamic release of GnRH as well as on pituitary responsiveness to the peptide. Flerk6 et al.

Help your patients through the maze of infertility treatments

Infertility is suffered by around 1 in 7 couples and can be a source of confusion for both partners, providing high stress on relationships. 25% of cases are explained through male infertility, 50% through female infertility, whilst 25% are generally unexplained. The possible causes and solutions are many and complex.

Infertility, one of the first in the new Gynecology in Practice series, assists gynecologists and family practitioners to better care for their patients who have trouble conceiving. The authors provide a strong focus on effective diagnosis and management. Following a review of the factors that affect fertility, Infertility takes a practical approach to: Evaluation of fertilityManagement and treatmentComplicationsPre-implantation screeningFertility preservation

Gynecology in Practice

The Gynecology in Practice series provides clinical 'in the office' or 'at the bedside' guides to effective patient care for gynecologists. The tone is practical, not academic, with authors offering guidance on what might be done and what should be avoided. The books are informed by evidence-based practice and feature: Algorithms and guidelines where they are appropriate''Tips and Tricks' boxes - hints on improving outcomes'Caution' warning boxes - hints on avoiding complications'Science Revisited' - quick reminder of the basic science principlesSummaries of key evidence and suggestions for further reading

Brain Lateralization and Developmental Disorders provides a comprehensive review of key findings and speculations from previous research on atypical cerebral lateralization in the most common neurodevelopmental disorders: stuttering, dyslexia, autism and intellectual disability. Emphasis is placed on recent studies, as well as descriptions of the author's personal research which will provide a promising new direction for future research on these issues. In this text, Asenova presents four separate studies aiming to examine hemispheric asymmetries in neurodevelopmental disorders. These include the subtypes of developmental stuttering, the subtypes of developmental dyslexia, mild, non-syndromic intellectual disability with comorbid speech and language deficits and autism spectrum disorder with comorbid severe language impairment. The use of uniform research methods, including dichotic verbal perception tasks and lateral preference performance tests, has led to findings that suggest that this new approach could be a key factor in overcoming the ambiguity of findings from previous studies. By focusing on the discussion of key issues concerning the role of atypical laterality in the genesis of neurodevelopmental psychopathology in both past research and Asenova's own studies, Brain Lateralization and Developmental Disorders is a valuable reading for students and researchers in neurodevelopmental psychopathology, as well as in developmental neuropsychology and developmental neuroscience.

In 1953, at the grand age of 92, Ferdinand Hochstetter submitted his famous collection of photographs of human embryos entitled: "Uber die Entwicklung der Formverhaltnisse des menschlichen Antlitzes." Together with others papers, this contribution was published in 1955, a year after Hochstetter's death. In unbroken combativeness, Hochstetter discussed his results with regard to those of earlier embryologists and to those of his own lifetime. Thus, in an obituary, Elze (1956) reported about one of Hochstetter's letters from the year of his death (1954): "nur einige blodsinnige Behauptungen, die Fischel in seiner Ent- wicklung des Menschen verzapft hat, mochte ich vielleicht noch annageln," which may be translated as: "I would just like to pin down a few silly assertions that Fischel made in his Entwicklung des Menschen." In the first two paragraphs of his paper Hochstetter stated (in German, here translated freely): When I decided to write a detailed paper about the development of the morphology of the human face, too [in addition to a paper about morphology of the extremities in human embryos], I was especially moved by the fact that in none of the German manuals and textbooks on embryology known to me is there to be found a presentation of the development of the human face which could be considered - eveJ;l to a limited extent - rich in details, true, sufficiently illustrated, easy to understand by students as well as by scien-