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Gynecology Novaks

The 1st edition of Novak' s Textbook of Gynecology appeared in 1941, written by the distinguished Dr. Emil Novak of Johns Hopkins. The book became a successful and important international reference for the practice of gynecology. When I undertook the extensive expansion and reorganization for the 12th edition in 1995, it was a great honor to be invited to become the editor, and it is my privilege to continue in this role for the 14th edition, which bears the title Berek & Novak' s Gynecology.
The book retains the format of the prior two editions, enhanced by full color illustrations and photographic reproductions. As with the previous editions, the goal is to provide a comprehensive summary of the specialty of gynecology. All chapters have been thoroughly revised to provide timely information and references. Special attention has been paid to the illustrations and photographs to make them more accessible and informative. A new section on “Urogynecology and Pelvic Reconstructive Surgery,” with chapters devoted to urogynecology, prolapse and colorectal problems, has been added to address the new subspecialty and our expanded role as gynecologists in this essential area of care. The increasing use of nontraditional medicine in gynecology inspired the inclusion of a chapter on Complementary Medicine.
This textbook, originated by the faculty of the Johns Hopkins University School of Medicine, continues to reflect the contributions of that great institution. After the 5th edition and subsequent death of Dr. Novak in 1957, many physicians from Johns Hopkins, and subsequently some members of the Vanderbilt faculty, helped carry the torch—Dr. Edmund R. Novak through the 9th edition in 1979; Drs. Howard W. Jones, Jr. and Georgeanna Seegar Jones through the 10th edition in 1981; and Drs. Howard W. Jones, III, Lonnie S. Burnett, and Anne Colston Wentz through the 11th edition in 1988. These editors, assisted by many contributors from the faculty at Johns Hopkins, especially Drs. J. Donald Woodruff and Conrad G. Julian, helped define the specialty of gynecology during the latter half of the 20th century. These physicians shaped the practice of gynecology as we know it today—its surgical and medical therapies, reproductive endocrinology, assisted reproductive technologies, gynecologic oncology, urogynecology, and infectious diseases. As a graduate of Johns Hopkins University School of Medicine, I am proud to contribute to that rich tradition.
Berek & Novak' s Gynecology, 14th edition, is presented in eight sections. The first, “Principles of Practice,” includes the initial assessment of the gynecologic patient, the history and physical examination, and communication skills. This section addresses ethical principles of patient care, quality assessment and improvement, and the epidemiology of gynecologic conditions. The second section, “Basic Principles,” summarizes the scientific basis for the specialty—anatomy and embryology, molecular biology and genetics, and reproductive physiology. The third section, “Preventive and Primary Care,” emphasizes the importance of primary health care for women, which has evolved to address preventive care, screening, family planning, sexuality, and common psychiatric problems. The fourth section, “General Gynecology,” reviews benign diseases of the female reproductive tract, the evaluation of pelvic infections, pain, intraepithelial diseases, the management of early pregnancy loss and ectopic pregnancy, and the evaluation of benign breast disease. The fifth section, “Operative General Gynecology” covers perioperative care, and the operative management of benign gynecologic conditions using endoscopy and hysterectomy. The sixth section is new—“Urogynecology and Pelvic Reconstructive Surgery.” The seventh section, “Reproductive Endocrinology,” summarizes the major disorders affecting the growth, development, and function of women from puberty through menopause. The eighth section, “Gynecologic Oncology,” covers malignant diseases of the female reproductive tract and breast cancer.
I acknowledge the many individuals who contributed to this book. I am grateful to Rebecca Rinehart for her superb editorial assistance and to Tim Hengst, an outstanding medical illustrator, for the excellent illustrations, anatomic drawings and thematic designs. I appreciate the many people at Lippincott Williams & Wilkins who have helped me, especially Charley Mitchell, with whom I have worked for nearly two decades, and consider the best editor in medical book publishing. I extend my gratitude to Anne Sydor, Nicole Dernoski, Sonya Seigafuse, Nicole Walz, and Tracey Becker for their dedication and commitment during the editorial process to enthusiastically and skillfully produce the manuscript. I acknowledge the outstanding work of Barbara Stabb who so diligently and expertly worked closely with me to do the final page layout and formatting of this book that makes its first appearance in full color. I acknowledge the efforts of my mentors and colleagues—Dean Sherman Mellinkoff, Drs. J. Donald Woodruff, Kenneth J. Ryan, Isaac Schiff, J. George Moore, William J. Dignam, Gautam Chaudhuri, and Neville F. Hacker. Each of these physicians and scholars provided me with guidance and encouragement. My special thanks to Nicole Kidman, the chair of the advisory board for the UCLA Women' s Reproductive Cancer Program—whose support and friendship helped stimulate this project.
The publication of this book coincides with a major change in my medical career, which took me along the east coast from Brown to Johns Hopkins and then to Harvard, before providing a lengthy and rewarding sojourn at UCLA. After more than 26 years at UCLA, I moved to Stanford University School of Medicine to become the Professor and Chair of the Department of Obstetrics and Gynecology. I welcome the opportunity there to participate in teaching the specialty of gynecology, researching the related sciences, and delivering patient care while learning from my new colleagues.
I look forward to the continued positive impact of the specialty on women' s health throughout the world. It is my fervent hope that this work will benefit all women and reduce the numbers of those who are afflicted with diseases of the female reproductive tract. To that end, this book is offered as a resource to assist and encourage all who study the specialty of gynecology.

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Williams Obstetrics

In previous editions of Williams Obstetrics, we have emphasized that obstetrics, originally born as a technical specialty, began to accrue scientific-based underpinnings during the last half of the 20th century. And over the past three decades, evidence-based medicine became embraced and is now firmly inculcated into clinical obstetrics. Accordingly, we again acknowledge the many fruitful efforts of the National Institute of Child Health and Human Development (NICHD) to encourage and support basic science and clinical research in obstetrical specialties. In updating this text, we relied heavily on investigations performed by members of the Maternal-Fetal Medicine Units Network. We also applaud the efforts of the American Gynecological and Obstetrical Society, the Society for Maternal-Fetal Medicine, the Society for Gynecological Investigation, and the American Board of Obstetrics and Gynecology to support the scientific and fiscal health of young clinical investigators.

Evidence-based medicine can be a two-edged sword. How does the busy practitioner keep up with many innovations that seemingly appear daily into our clinical literature Who is the arbiter of their incorporation into clinical obstetrics Should observations that satisfy the mathematical definition of statistical significance, but that have limited clinical significance, be employed nationwide as the "standard of care" To us, the obvious answer is "no." And so we applaud our professional organizations such as the American College of Obstetricians and Gynecologists for their pragmatism and wisdom in recommendation of protocols for clinical management that inevitably do become the "standard." For our part, in this book we have attempted to perform a balanced review of the literature to present readers with pros and cons of different management methods so that they may select options that are best suited to their available resources. We have also tried to avoid dogmatism which unfortunately dominated the practice of obstetrics for several decades of the 20th century. At the same time, we are proud to be associated with academic teaching services that are disciplined examples of evidence-based obstetrics. Although none of these services is perfect in any sense of the definition, we draw heavily on our combined clinical observations when recommending management options. We do however emphasize that these recommendations do not necessarily represent a sole method of management.
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