A strategy for reducing tuberculosis among Oglala Sioux Native Americans.

BACKGROUND: The Oglala Sioux people, who live on the second largest Native American reservation in the United States, the Pine Ridge Reservation in South Dakota, have a history of high rates of tuberculosis. METHODS: To determine a strategy for reducing tuberculosis in this population, Pine Ridge Reservation tuberculosis cases since 1968 were analyzed. Diabetic patients were identified through chart reviews and characterized for tuberculosis status. Age-specific tuberculosis rates and age-specific relative risks (RRs) were calculated and compared with those of South Dakota excluding Pine Ridge. RESULTS: Between 1968 and 1994, the RR for tuberculosis was 18.9 for a Pine Ridge Native American compared with rates for the rest of South Dakota. The age-specific RR was 65.7 for the Pine Ridge population 65 and older from 1985-1994. Tuberculin tests were positive in 70% of diabetic patients on the reservation. Diabetic patients comprise 23% of the population 45 and older at Pine Ridge. Fifty-five percent of all the tuberculosis disease in the 45 and older age group can be prevented by eliminating it in the diabetic population. CONCLUSIONS: A major stride toward reducing tuberculosis can be made by targeting high-risk groups such as diabetic patients, especially in a time of dwindling resources and personnel for tuberculosis control.

De novo dup (5p) in a patient with congenital hypoplasia of the adrenal gland.

We report on a black male child with congenital hypoplasia of the adrenal gland (CHA) with a de novo duplication of 5p [dir dup(5) (p13.3-->p15.1)], confirmed by fluorescence in situ hybridization (FISH). In addition to a characteristic clinical course, the patient has hyperpigmentation (melanoderma) since birth, normal external genitalia, marked elevation of ACTH, and absent response to an IV ACTH challenge. To the best of our knowledge, this is the first case of congenital hypoplasia of the adrenal gland associated with a chromosome abnormality. Reviews of dup (5p) and of our patient suggest that duplication of 5p13.3-pter has only minor phenotypic effect, while duplication of the relatively small critical segment p11-p13.2 apparently causes far more deleterious changes. The concurrence of CHA and dup(5p) in our patient may indicate the possible gene localization of an autosomal form of CHA to either at or near 5p13.3 or 5p15.1.

Limitations in the interpretation of intravenous carotid digital subtraction angiography.

To evaluate the limitations of intravenous carotid digital subtraction angiography (DSA) in the diagnosis of carotid disease, studies of 130 patients were reviewed. Factors that resulted in a nondiagnostic study included: (1) misregistration larynx artifact overlying the carotid bifurcation; (2) external carotid or vertebral artery overlying the internal carotid artery; and (3) poor arterial contrast density secondary to poor cardiac function. As a result of these limitations, the ideal of adequate demonstration of both carotid bifurcations in two opposite oblique projections or an oblique and anteroposterior projection was achieved in only 34 patients (26%). Of 126 carotid bifurcations that were seen adequately in two or more different projections, 19 (15%) showed an abnormality in one projection but appeared normal in another. These abnormalities would not have been detected had the vessel been visualized only in the spuriously normal-appearing projection. These and other limitations of intravenous DSA, such as contrast load and morbidity, are discussed.