Volume 97, Issue 10

New and potent medications such as alpharadrenergic agonists, topically active carbonic anhydrase inhibitors, and prostaglandin analogs, are now available for use in the treatment of glaucoma. These ophthalmic medications have the potential to cause serious drug interactions and systemic side effects. The primary care physician should be able to recognize and to monitor any potential adverse effects and interact with the prescribing ophthalmologist for optimal patient care.

Fluconazole is an azole antifungal agent. Because it can be taken orally, it is perferred over amphotericin B for long-term treatment. Indications for fluconazole are increasing. Reports of hypersensitivity have been described. If adequate alternative therapy is not available, desensitization may be necessary. Desensitization with fluconazole has not been described. The patient described in this report required fluconazole and was successfully desensitized after manifesting a type 1 hypersensitivity reaction. The patient underwent desensitization during a IS-day period. The starting dose was less than 0.001 dose, with doubling each day. During desensitization, the patient experienced a slight transient rash that resolved with continued therapy. After desensitization, he has continued using fluconazole daily without adverse effects. This report indicates that desensitization to fluconazole can be accomplished safely in selected patients. A suggested desensitization protocol is provided.

Alcohol use disorders (AUD) can be destructive in the elderly because of drug interactions, higher blood alcohol levels per amount consumed, and limited functional reserve. However, physicians diagnose only about 30% of elderly with AUD. The objective of this study was to screen for AUD in rural elderly family medicine outpatients using the Alcohol Use Disorders Identification Test (AUDIT). A survey of all presenting patients aged 65 years or older who consented (N = 93) was done in four family practices in Southeast Ohio. Measurements included the CAGE and AUDIT questionnaires. On the AUDIT, 13 subjects (14.0%), [10 men, 3 women], screened positive for AUD, scoring 5 or more points, and seven subjects (7.5%) [six men, one woman] screened positive for AUD, scoring 8 or more points. On the CAGE, five men (5.4%) but no women screened positive (>2 affirmatives). The prevalence of AUD found in this survey (5.4% to 14.0%) is consistent with previous studies. Based on these findings, the AUDIT may be a useful screening instrument in the elderly population.

Ubiquitous in nature, members of the Coccidia and Microsporida are being reported with increasing frequency in the immunocompromised as well as the immunocompetent population. These protozoans are primarily waterborne, but foodborne disease has also been reported. These organisms are responsible for acute, as well as protracted, cases of watery diarrhea with various other related sequelae. The Coccidia includes three genera-Cryptoiporidium, Isospora, and Cyclospora. The latter two are of lesser importance in terms of morbidity and mortality. The Microsporida includes genera (Enterocytozoon, Encephalitozoon) only recently recognized as important agents of disease. Unlike the Coccidia, these organisms are more restricted to the immunocompromised population. Increased incidence and numbers of patients with prolonged diarrhea due to these forms indicate the need for increased clinical vigilance with regard to prevention, diagnosis, and treatment.

In July 1995, the American Osteopathic Association (AOA) Board of Trustees passed new regulations for the accreditation of osteopathic graduate medical education (GME) programs by establishing the Osteopathic Postdoctoral Training Institutions (OPTI) system, to be implemented over 4 years. The resulting changes include requirements for college cosponsorship of GME programs and the establishment of standards for the minimwn nwnber of residency programs, interns, and residents. The OPTIs will be subject to AOA inspections at least every 5 years. Proponents of the OPTI system claim it will strengthen the professi(;m by promoting educational collaboration, raising academic standards, and requiring appropriate resources to support osteopathic medical education. Opponents fear that it will be too resource intensive, create an additional layer of unnecessary bureaucracy, and have a negative impact on small colleges, hospitals, and states. Despite the controversy, a process for applying for OPTI status has been developed by the AOA, and a number of hospitals and colleges are already developing OPTIs. This article, the first in a two-part series, identifies issues and barriers to be considered in the formation of OPTIs and articulates principles underlying successful collaborations. In Part 2 these issues, principles, and.barriers will be reinforced by describing the process used to form a large OPTI-the Ohio University College of Osteopathic Medicine (OUCOM) Centers for Osteopathic Regional Education (CORE) System.

Hemoptysis secondary to an aortobronchial fistula is rare and uniformly fatal when left untreated. The authors describe a case of massive hemoptysis caused by an aortopulmonary fistula in an infected Dacron graft used successfully to repair a coarctation of the aorta.

A fusiform aneurysm involving the ascending aorta and aortic arch in an 8month-old infant was imaged with magnetic resonance. Histologic studies of the excised aneurysm indicated Takayasu's arteritis. Takayasu's arteritis has rarely been reported in infants, and involvement of the ascending aorta and aortic arch is an unusual finding in this age group.