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ABSTRACT Successful leadership behavior of today's more culturally diverse workforce is one of the most important challenges organizations face. Technology has driven this demographically mixed workforce toward consensus to harness [...]

Transvaginal ultrasound can detect endometrial thickening, but may not be useful in screening women on hormone replacement therapy for serious disease. Hormone replacement can cause thickening of the uterine lining, particularly with high-dose estrogen. Researchers reviewed endometrial biopsies and ultrasound results from 577 examinations in 448 women taking hormone replacement or placebo. Ultrasound was poor at detecting cancer and precancerous changes in the endometrium. Ultrasound cannot differentiate serious disease from simple thickening.

THE SOCIETY OF JESUS IN IRELAND, SCOTLAND, AND ENGLAND, 1589-1597: BUILDING THE FAITH OF SAINT PETER UPON THE KING OF SPAIN'S MONARCHY. By Thomas M. McCoog, S.J. Burlington, VT: Ashgate, [...]

A six-year-old boy with sexual precocity, multiple skeletal deformities and light brown spots was diagnosed with McCune-Albright syndrome. Sexual precocity is the onset of sexual maturity before age nine and can be caused by a gonadotropin hormone dependent or independent mechanism. McCune-Albright syndrome is a form of gonadotropin-independent sexual precocity associated with multi-system defects. The boy had a 10-month history of facial acne, apocrine sweat, pubic hair growth, genital enlargement, mood swings and accelerated growth. He had suffered three fractures to his right leg following minor accidents at ages three, four and five. He had a testosterone level and genital size typical of mid-puberty and bone age typical of a nine-year-old. X-rays revealed polyostotic fibrous dysplasia, which is a bone disease. The boy's lack of gonadotropin pulsations indicated his sexual precocity was gonadotropin independent. McCune-Albright syndrome's association polyostotic fibrous dysplasia and cafe-au-lait spots explains his other defects.

A 14 1/2-year-old boy admitted for muscle weakness was examined again when at age 19 complaining of accelerated muscle weakness. The diagnosis of Emery-Dreifuss muscular dystrophy was based partially on a biopsy of the right quadriceps muscle. This disorder has symptoms of progressive muscle weakness, muscle contractures and progressive atrial conduction problems. The patient must be monitored for indications of pacemaker implantation. Corticosteroids help in the short term because of the inflammatory component of muscular dystrophy. The negative side effects of long-term use as well as disease evaluation problems indicate these drugs should not be considered for long-term use. The patient's mother was an obligate carrier of the disease. There have been two other cases reported with X-linked disease and typical clinical picture.

Women with sex-cord ovarian tumors may have higher levels of the hormone mullerian inhibiting substance (MIS) in their blood. Sex-cord ovarian tumors have cells similar to those found in sex cords, the fetal tissue that differentiates into ovaries before birth in females. The concentration of MIS in the blood of a patient with sex-cord ovarian tumors was 1,000 times the normal concentration in adults. The level of hormone decreased after the tumors were removed, and it increased each time the cancer re-occurred. Following the last surgery, the patient's MIS concentration was 10 times the normal adult level. A survey of 17 other patients with ovarian tumors found that the level of MIS was higher in those with sex-cord tumors. The concentration of MIS returned to normal when the women's tumors were removed. Sex-cord tumors appear to produce MIS, and their re-occurrence could be monitored by measuring blood levels of the hormone. Sex-cord tumors are rare; in one study, only 59 of 560,000 ovarian-biopsy samples reviewed were sex-cord tumors.

A case is described of a 75-year-old man, who was admitted to the hospital with impaired mental status, myoclonic jerks (quick muscle jerks caused by impaired neurologic function), and a tonic-clonic seizure (prolonged convulsion). The patient had a history of diabetes, hypertension (high blood pressure), and peripheral (in the extremities) nerve disease. A slow-growing tumor was detected in the membrane covering the brain. The patient was agitated, bewildered, and unable to give a coherent history or move his eyes to the right. Infection of the urinary tract was noted and treated with the antibiotic cefazolin. The patient's mental status shifted from sleepiness to alertness, and he was able to answer some questions. During his hospitalization, he experienced myoclonic jerks and a tonic-clonic seizure. Assessment of neurologic function indicated that he had severe dementia, or impaired intellectual function. The patient became progressively drowsy, reacted slowly, and answered questions only briefly. The diagnosis of his condition based on clinical findings was gliomatosis cerebri, a condition characterized by widespread formation of neuroglial tumors in the brain. Neuroglial tissue consists of the supporting cells and fibers within the brain. Gliomatosis cerebri may be associated with transient loss of consciousness, dizzy spells, mental deterioration, headache, and seizures. Based on anatomical or physical findings, the patient was diagnosed with cerebral amyloid angiopathy, a disease of elderly persons. Cerebral amyloid angiopathy may be characterized by bleeding within the brain due to weakness of the blood vessels walls, which results from the deposition of amyloid, a starch-like substance. The initial signs and symptoms may be acute dementia and seizures. The disease often develops after a head injury, but may be related to hypertension-induced blood vessel damage. In this case, cerebral amyloid angiopathy was associated with dementia, absence of bleeding, and disease within the white matter of the brain. (Consumer Summary produced by Reliance Medical Information, Inc.)