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Urinary incontinence is a humiliating disability and a common
problem in gynaecological clinics. In some centres specialised
facilities are avail able for its investigation and treatment but
in most hospitals the general gynaecologist has to manage this
difficult condition. For both generalist and subspecialist it is
timely to summarise advances in our knowledge of normal and
abnormal micturition. Since 1973 the Royal College of
Obstetrician's and Gynaecologists, through its Scientific Advisory
Committee, has convened Study Groups on important growth areas in
our specialty. The College invites an international panel of
leading researchers to participate in a workshop, allowing time for
in-depth discussion as well as the presentation of papers. It is
hoped that this will produce not only an up-to-date sum mary of
current knowledge but also a useful interaction between indi
viduals and between specialties. This book is the result of the
21st Study Group, which was held in October 1989. The participants
included urological and colorectal surgeons and a neurologist, as
well as scientists and gynaecologists. The meeting began with
sessions on basic science and advances in the investigation of the
lower urinary tract, then covered voiding diffi culties, genuine
stress incontinence and detrusor instability, before a final
session on the relationship between urinary incontinence and ali
mentary tract problems. The discussions formed an essential part of
the meeting, and it is hoped that the lightly edited versions
reproduced here will convey to the reader the stimulating
atmosphere of the Study Group.
HRT and Osteoporosis is a response to the increasing awareness
among both the medical profession and the general public that
ovarian failure is an important cause of osteoporosis and that much
of the bone loss after the menopause can be prevented by oestrogen
treatment. There is now an urgent need on the part of women, their
doctors and those responsible for public health policy for
practical guidance on such questions as the safety and
acceptability of long-term treatment with sex hormones, the
economic costs and benefits of such treatment, and the role of
specialists and GPs in promoting and monitoring hormone replacement
therapy. All these issues and more are considered here. The book
comprehensively reviews current knowledge of the subject and gives
recommendations for clinical practice and future research.
The introduction of prostaglandins into clinical practice has been
one of the most important advances in obstetrics and gynaecology in
recent years. During the last decade obstetricians have become
familiar with these drugs for inducing labour and for terminating
second-trimester pregnancy. Within the last year their use has been
extended, in association with antiprogestin, to first-trimester
termi nation. Although the effectiveness of prostaglandins in these
pharma cological roles is clear, their full potential has still to
be explored, and much remains to be learned about their physiology.
Prostaglandins playa central role in the initiation of labour.
Further clarification of this role could lead to improvements in
preventing or treating preterm labour, which still remains the most
important cause of perinatal mortality in this country.
Prostaglandins are also inti mately involved in the mechanism of
menstruation. More detailed understanding of this role should lead
to more effective treatments for menorrhagia and dysmenorrhoea.
These substances also playa part in the mechanism of implantation,
and further research in this area may lead to more effective
therapy for infertility.
Infertility, as with many aspects of medicine, is at the mercy of
rapid technological advance. Many of these developments initially
seem attractive to both clinicians and patients, but need to be
rigorously assessed if their real value is to be understood and
clinical practice is to develop. In this book issues of importance
to the management of infertile patients are discussed. The gaps in
our knowledge which prevent a better understanding of the condition
are identified, and recent developments, both clinical and
scientific, are subjected to peer review and discussion. An
important feature of the book is an acceptance that training in
infertility practice is a real problem. This is perceived not only
by the practising clinicians, both doctors and nurses, but
particularly by the clinical scientists, including embryologists,
who now provide such an essential part of the service. Similarly
the provision of the clinical service has been examined in detail
from a variety of standpoints, in an attempt to make sensible
recommendations which balance real need with limited resource. The
book is based on the papers presented and discussed at the 25th
RCOG Study Group held in April 1992. The discussion after each
paper was civilised but uncompromising and forms an important part
of this publication. The rapid processing of the written and
recorded material by the staff at the RCOG, and particularly Miss
Sally Barber, has ensured that the book has been produced while the
issues are live, the reviews contemporary and the discussion
relevant.
In few areas of medicine is progress more spectacular than in the
field of prenatal diagnosis. New clinical techniques such as
chorion villus sampling, detailed ultrasound scanning and
cordocentesis are being evaluated by obstetricians, and refinement
of biochemical testing is widening the scope of maternal serum
screening. In the laboratory, dramatic advances in molecular
biology are occurring: families at risk of genetic disease can be
investigated with gene probes, and preimplantation diagnosis of the
embryo is now becom ing a reality. These technical advances have
important ethical and practical implications, among which will be a
further increase in public expectations of the standards required
of antenatal services. Clini cians will need a high degree of skill
to inform healthy women about the options for screening normal
pregnancies, and to counsel high-risk women about the benefits and
limitations of prenatal diagnosis. Obstetricians, scientists and
health service managers will face the difficult task of deciding
how prenatal diagnosis can be made available to women in a caring
and cost-effective way. Recognising the rapid progress in this
field, the Royal College of Obstetricians and Gynaecologists made
prenatal diagnosis the subject of its 23rd Study Group. An
international panel of leading researchers, whose expertise ranged
from molecular biology to philosophy, was invited to participate in
a three day workshop, with time for in-depth discussion as well as
the presentation of papers.
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