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Novak's textbook of gynecology
Edited by LOUIS
M.
HELLMAN,
M.D.
and RALPH
M.
WYNN,
M.D.
Book review Novak’s Textbook of Gynecdogy. E. R. Novak,
and the ovary. The probable roles of FSH- and LH-releasing factors in the regulation of gonadotropic function are clarified. The addition of the excellent schematic summary on page 41 is of particular value in attempting to explain the neurohypothalamic-pituitary-ovarian relations. The illustrations accompanying the descriptions of abdominal and vaginal hysterectomies are clear and pertinent. The student may, however, incorrectly infer from the sequential description of combined vaginal hysterectomy and plastic repair that the former is necessarily related to the latter. For the woman with symptomatic vaginal relaxation who has compIete+d her family, the two are, of course, often logically combined. The chapter on embryology has been enlarged by the addition of excellent micrographs and illustrations; some appropriate compensatory deletions have been made. An excelient description of the development and differentiation of the ovary is accompanied by discussion of corticomedullary antagonism, which assumes a bipotential gonad. The authors have chosen to include a brief account of the classic experiments of Alfred Jost, who elucidated the effects of castration on the development of the fetal rabbit. Extension of this experimental model by others has led to stimulation of the effects of partial testicular deficiency. The background provided by thii lucid presentation is essential to understanding the subsequent discussions of congenital anomalies and hermaphroditism. The authors point out that endometrial hyperplasia in the menstrual age group is a benign, frequently transient process, but they emphasize that the same lesion in the menopausal and post-
G. S. Jones, and H. W. Jones. 136 1965, pages, 636 figures. Baltimore, The Williams & Wilkins Company. $10.75. (Paperback edition 1963.) In describing this book as an unrivaled source of gynecologic information for students, the publishers of Novak’s Textbook of Gynecology have expressed my opinion of the seventh edition of this standard text. In keeping with the authors’ aim to provide medical students with a thorough but concise text, this current volume was prepared in an attractive paperback version, priced to make it accessible to most undergraduates. Because of what will be its greater availability and its recognized merits as a textbook of basic gynecology, a review of the current reprinting seems justified. Whereas the discussion of such traditional topics as gynecologic anatomy, history-taking, and clinical features of menstruation have remained essentially unchanged, the sections on embryology, endocrinology, and cytopathology have been revised extensively. These portions of the current edition deserve specific comment, in light of the tendency in many medical schools to integrate the teaching of many aspects of reproductive biology within the framework of the clinical clerkship. The short span of time between the preparation of the sixth and seventh editions was marked by accelerated increase in knowledge of reproductive physiology. The chapter on physiology of menstruation thus appropriately includes a discussion of the critical role of the hypothalamus as an intermediary between the cerebral cortex
994
Volume 105 Number 6
menopausal patient may have malignant potential. They offer the suggestion that certain forms of hyperplasia in the aging woman may progress to ad.enocarcinoma. The authors believe that hyperplasia of the endometrium, sometimes the atypical variety, is often the result of excessive and prolonged administration of estrogens in the treatment of climacteric symptoms. They are convinced that recurrent atypical endometrial hyper,plasia in menopausal patients should not be treated conservatively, but that hysterectomy is justified prophylaxis to counter the increasing likelihood of endometrial carcinoma. Th’e authors’ classification of functioning tumors of the ovary has undergone significant reorientation. Previously, morphology was considered to provide the primary diagnostic criteria, but clinical endocrine effects are now thought to be the best indices. This workable approach to a complicated problem is based on the concept that hormone-producing tumors of the ovary arise essentially from mesenchymal tissue. The authors therefore suggest that these neoplasms be classified as “gonadal stromal tumors.” Some textbooks of gynecology carefully omit discus’sion of any subject related to obstetric problems. This book, on the other hand, includes a va’iuable chapter covering complications of pregnancy that inevitably merge into the daily practice of gynecology. An excellent discussion of choriocarcinoma and related trophoblastic diseases is included. In the few years since the last edition of this text, there have been significant advances in treatment and dramatic improvement in survival rates in this group of diseases, directly related to the outstanding success of chemotherapy. These results are well illustrated by the summarized account of the experience of Hertz and co-workers with the chemotherapeutic approach to metastatic trophoblastic disease. Between the years 1961 and 1965, utilizing methotrexate and actinomycin D, these workers reported a sustained remission rate of 74 per cent. The etiologic classification of amenorrhea used by th.e authors is the only satisfactory route to proper evaluation and management of this problem. The basic revisions in discussion of this topic reflect recent advances in human reproductive ,physiology and their clinical applications. One of the best examples of this progress is evidenced by further clarification of the biochemical disturbances in the “Stein-Leventhal syndrome.” In the previous edition, this syndrome was classified under lesions of peripheral
Books
955
located origin. Presently, it is more properly under lesions of central origin as an idiopathic hypothalamic dysfunction. This concept takes into account the syndrome’s variable clinical manifestations, disturbances of steroidogenesis, and perhaps more important, its reversibility. Variable factors including psychogenic stress may be responsible for the initial disturbance of the FSH/LH ratio, which ultimately leads to faulty ovarian steroidogenesis, with increased production of androgen or estrogen. The treatment of this disorder apparently depends on the readjustment of this ratio of gonadotropins, as evidenced by the at least temporary ovulatory response to drugs such as clomiphene. Since publication of the seventh edition, clomiphene has become commercially available and is now widely and successfully used as a means of ovulation-induction in properly selected cases of primary and secondary amenorrhea. The authors point out that HMG and HCG are desirable in the treatment of patients with low or absent endogenous gonadotropins and as secondary therapy m patients who fail to conceive after an appropriate trial of clomiphene. The authors’ discussion of the female climacteric seems quite rational in the present state of our knowledge. They advocate treatment of the symptoms of estrogen deficiency, if and when they are present, whether early or late. They also recommend long-term replacement for the young woman who is castrated, and they recognize the logic of prophylaxis in the menopausal woman with a strong familial history of cardiovascular disease and an abnormal serum cholesterol/phospholipid ratio. They do not view the climacteric as a disease in itself, however, and they therefore do not advocate the long-term administration of estrogen to the entire aging female population. Perhaps by the time of eighth edition, additional studies will have dispelled some of the uncertainty that surrounds this subject. The chapter devoted to cytopathology is excellent. This 48 page section could well serve as an introductory text in clinical cytology. The concept of the maturation index (M.I.) provides the basis for the excellent panoramic presentation of normal cytohormonal patterns from chiIdhood through the postmenopausal period. Against this backgound, the discussion proceeds to abnormal cytohormonal patterns. Of particular significance is the discussion of tumors of the ovary that do not necessarily produce hormones. Such neoplasms include solid and cystic adenomas and adenocarcinomas associated with a maturation
596 Books
November 15, 1969 Am. J. Oh. & Gyaec.
index that may be abnormal, thus providing the only clue to the detection of an asymptomatic lesion. Other highlights include a section dealing with the critical detection and diagnosis of neoplasms of the female genital tract. This chapter concludes with a well-illustrated section dealing with techniques for preparation of a proper specimen. Many photomicrographs and colorplates complement the descriptive material. A minor flaw is the wide separation between the legend and Plate XXXVI.
B&s
This book is probably as current as an! prepared as far back as 1965. While the search for an ideal textbook of gynecology for students and specialists continues, this seventh edition can unhesitatingly be recommended as one of the best standard sources of basic gynecology, endocrinology, and cytopathology. At $10.75 it is a bargain. Lewis A. Hamilton
received
Clinical
Pathology in Mental Retardation. R. D. Eastham and J. Jancar. 356 pages, illustrated. Baltimore, 1969, The Williams & Wilkins Company. $13.25.
Progress in Conception Conml, 1968. Edited by E. T. Tyler. 133 pages, illustrated. Philadelphia, 1969, J. B. Lippincott Company. $5.00.
Frigidity:
Dynamics and Treatment. F. Kant. 61 pages. Springfield, Illinois, 1969, Charles C Thomas Publishers. $5.00.
*Mw
Embryology. J. Langman. Second edition. 386 pages, illustrated. Baltimore, 1969, The Williams & Wilkins Company. $7.50.
Psychosomatic Aspects of Gynecobgical Disorders. A. 0. Ludwig, B. J. Murawski, and S. H. Sturgis. 119 pages, illustrated. Cambridge, Massachusetts, 1969, Harvard University Press. $5.00.
Midwifery
Illustrated. J. P. Maygrier (translated from the French with notes from A. Sidney Doane) . A facsimile of the Third Edition with additional matter and plates ( 1,834). 179 pages. Medical Heritage Press, 1969, Original third edition by Harper & Brothers, New York, 1834. $20.00.
Sex and the Unborn C&l& pages. New York, Press. $6.95. *Textbook
R. R. Limner. 229 1969, The Julian
of CoatraeeQtive Practice. J. Peel and M. Potts. 296 pages, illustrated. New York, 1969, Cambridge University Press (American Branch). $2.95.
M.
HELLMAN,
M.D.
and RALPH
M.
WYNN,
M.D.
Book review Novak’s Textbook of Gynecdogy. E. R. Novak,
and the ovary. The probable roles of FSH- and LH-releasing factors in the regulation of gonadotropic function are clarified. The addition of the excellent schematic summary on page 41 is of particular value in attempting to explain the neurohypothalamic-pituitary-ovarian relations. The illustrations accompanying the descriptions of abdominal and vaginal hysterectomies are clear and pertinent. The student may, however, incorrectly infer from the sequential description of combined vaginal hysterectomy and plastic repair that the former is necessarily related to the latter. For the woman with symptomatic vaginal relaxation who has compIete+d her family, the two are, of course, often logically combined. The chapter on embryology has been enlarged by the addition of excellent micrographs and illustrations; some appropriate compensatory deletions have been made. An excelient description of the development and differentiation of the ovary is accompanied by discussion of corticomedullary antagonism, which assumes a bipotential gonad. The authors have chosen to include a brief account of the classic experiments of Alfred Jost, who elucidated the effects of castration on the development of the fetal rabbit. Extension of this experimental model by others has led to stimulation of the effects of partial testicular deficiency. The background provided by thii lucid presentation is essential to understanding the subsequent discussions of congenital anomalies and hermaphroditism. The authors point out that endometrial hyperplasia in the menstrual age group is a benign, frequently transient process, but they emphasize that the same lesion in the menopausal and post-
G. S. Jones, and H. W. Jones. 136 1965, pages, 636 figures. Baltimore, The Williams & Wilkins Company. $10.75. (Paperback edition 1963.) In describing this book as an unrivaled source of gynecologic information for students, the publishers of Novak’s Textbook of Gynecology have expressed my opinion of the seventh edition of this standard text. In keeping with the authors’ aim to provide medical students with a thorough but concise text, this current volume was prepared in an attractive paperback version, priced to make it accessible to most undergraduates. Because of what will be its greater availability and its recognized merits as a textbook of basic gynecology, a review of the current reprinting seems justified. Whereas the discussion of such traditional topics as gynecologic anatomy, history-taking, and clinical features of menstruation have remained essentially unchanged, the sections on embryology, endocrinology, and cytopathology have been revised extensively. These portions of the current edition deserve specific comment, in light of the tendency in many medical schools to integrate the teaching of many aspects of reproductive biology within the framework of the clinical clerkship. The short span of time between the preparation of the sixth and seventh editions was marked by accelerated increase in knowledge of reproductive physiology. The chapter on physiology of menstruation thus appropriately includes a discussion of the critical role of the hypothalamus as an intermediary between the cerebral cortex
994
Volume 105 Number 6
menopausal patient may have malignant potential. They offer the suggestion that certain forms of hyperplasia in the aging woman may progress to ad.enocarcinoma. The authors believe that hyperplasia of the endometrium, sometimes the atypical variety, is often the result of excessive and prolonged administration of estrogens in the treatment of climacteric symptoms. They are convinced that recurrent atypical endometrial hyper,plasia in menopausal patients should not be treated conservatively, but that hysterectomy is justified prophylaxis to counter the increasing likelihood of endometrial carcinoma. Th’e authors’ classification of functioning tumors of the ovary has undergone significant reorientation. Previously, morphology was considered to provide the primary diagnostic criteria, but clinical endocrine effects are now thought to be the best indices. This workable approach to a complicated problem is based on the concept that hormone-producing tumors of the ovary arise essentially from mesenchymal tissue. The authors therefore suggest that these neoplasms be classified as “gonadal stromal tumors.” Some textbooks of gynecology carefully omit discus’sion of any subject related to obstetric problems. This book, on the other hand, includes a va’iuable chapter covering complications of pregnancy that inevitably merge into the daily practice of gynecology. An excellent discussion of choriocarcinoma and related trophoblastic diseases is included. In the few years since the last edition of this text, there have been significant advances in treatment and dramatic improvement in survival rates in this group of diseases, directly related to the outstanding success of chemotherapy. These results are well illustrated by the summarized account of the experience of Hertz and co-workers with the chemotherapeutic approach to metastatic trophoblastic disease. Between the years 1961 and 1965, utilizing methotrexate and actinomycin D, these workers reported a sustained remission rate of 74 per cent. The etiologic classification of amenorrhea used by th.e authors is the only satisfactory route to proper evaluation and management of this problem. The basic revisions in discussion of this topic reflect recent advances in human reproductive ,physiology and their clinical applications. One of the best examples of this progress is evidenced by further clarification of the biochemical disturbances in the “Stein-Leventhal syndrome.” In the previous edition, this syndrome was classified under lesions of peripheral
Books
955
located origin. Presently, it is more properly under lesions of central origin as an idiopathic hypothalamic dysfunction. This concept takes into account the syndrome’s variable clinical manifestations, disturbances of steroidogenesis, and perhaps more important, its reversibility. Variable factors including psychogenic stress may be responsible for the initial disturbance of the FSH/LH ratio, which ultimately leads to faulty ovarian steroidogenesis, with increased production of androgen or estrogen. The treatment of this disorder apparently depends on the readjustment of this ratio of gonadotropins, as evidenced by the at least temporary ovulatory response to drugs such as clomiphene. Since publication of the seventh edition, clomiphene has become commercially available and is now widely and successfully used as a means of ovulation-induction in properly selected cases of primary and secondary amenorrhea. The authors point out that HMG and HCG are desirable in the treatment of patients with low or absent endogenous gonadotropins and as secondary therapy m patients who fail to conceive after an appropriate trial of clomiphene. The authors’ discussion of the female climacteric seems quite rational in the present state of our knowledge. They advocate treatment of the symptoms of estrogen deficiency, if and when they are present, whether early or late. They also recommend long-term replacement for the young woman who is castrated, and they recognize the logic of prophylaxis in the menopausal woman with a strong familial history of cardiovascular disease and an abnormal serum cholesterol/phospholipid ratio. They do not view the climacteric as a disease in itself, however, and they therefore do not advocate the long-term administration of estrogen to the entire aging female population. Perhaps by the time of eighth edition, additional studies will have dispelled some of the uncertainty that surrounds this subject. The chapter devoted to cytopathology is excellent. This 48 page section could well serve as an introductory text in clinical cytology. The concept of the maturation index (M.I.) provides the basis for the excellent panoramic presentation of normal cytohormonal patterns from chiIdhood through the postmenopausal period. Against this backgound, the discussion proceeds to abnormal cytohormonal patterns. Of particular significance is the discussion of tumors of the ovary that do not necessarily produce hormones. Such neoplasms include solid and cystic adenomas and adenocarcinomas associated with a maturation
596 Books
November 15, 1969 Am. J. Oh. & Gyaec.
index that may be abnormal, thus providing the only clue to the detection of an asymptomatic lesion. Other highlights include a section dealing with the critical detection and diagnosis of neoplasms of the female genital tract. This chapter concludes with a well-illustrated section dealing with techniques for preparation of a proper specimen. Many photomicrographs and colorplates complement the descriptive material. A minor flaw is the wide separation between the legend and Plate XXXVI.
B&s
This book is probably as current as an! prepared as far back as 1965. While the search for an ideal textbook of gynecology for students and specialists continues, this seventh edition can unhesitatingly be recommended as one of the best standard sources of basic gynecology, endocrinology, and cytopathology. At $10.75 it is a bargain. Lewis A. Hamilton
received
Clinical
Pathology in Mental Retardation. R. D. Eastham and J. Jancar. 356 pages, illustrated. Baltimore, 1969, The Williams & Wilkins Company. $13.25.
Progress in Conception Conml, 1968. Edited by E. T. Tyler. 133 pages, illustrated. Philadelphia, 1969, J. B. Lippincott Company. $5.00.
Frigidity:
Dynamics and Treatment. F. Kant. 61 pages. Springfield, Illinois, 1969, Charles C Thomas Publishers. $5.00.
*Mw
Embryology. J. Langman. Second edition. 386 pages, illustrated. Baltimore, 1969, The Williams & Wilkins Company. $7.50.
Psychosomatic Aspects of Gynecobgical Disorders. A. 0. Ludwig, B. J. Murawski, and S. H. Sturgis. 119 pages, illustrated. Cambridge, Massachusetts, 1969, Harvard University Press. $5.00.
Midwifery
Illustrated. J. P. Maygrier (translated from the French with notes from A. Sidney Doane) . A facsimile of the Third Edition with additional matter and plates ( 1,834). 179 pages. Medical Heritage Press, 1969, Original third edition by Harper & Brothers, New York, 1834. $20.00.
Sex and the Unborn C&l& pages. New York, Press. $6.95. *Textbook
R. R. Limner. 229 1969, The Julian
of CoatraeeQtive Practice. J. Peel and M. Potts. 296 pages, illustrated. New York, 1969, Cambridge University Press (American Branch). $2.95.