Effective August 18, 2017, the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation (“Division”) adopted new rules related to patient counseling that will affect your practice of pharmacy. In mandating patient counseling on all new prescriptions, patients receive greater protection against potential problems associated with medications. A direct pharmacist-patient encounter also provides the pharmacist one final opportunity to ensure the patient is receiving the appropriate medication. Signage notifying patients of their right to counseling encourages participation in meaningful dialogue.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) has a dismal survival rate without prompt surgical management. A variety of surgical regimens have achieved survival of 70% or greater; however, the postoperative course is frequently complicated by fistula, would infection, empyema, and sepsis. We report an unusual postoperative chest wound infection of clostridial myonecrosis, which presumably originated from the patient's gastric microflora. He was treated with immediate surgical debridement of all involved tissue, prolonged ventilation, total parenteral nutrition, and frequent dressing changes. The remaining defect was closed with a skin graft. Anaerobic wound infections of the chest wall and their management are discussed.

Ninety-nine patients with Stage I or II lung carcinoma that was other than the small cell type and who survived for more than 30 days after a “curative” resection were followed for five years or until death if it occurred prior to the five-year anniversary. Recurrent disease developed in 44 patients. Clinical data and data from postmortem examination were reviewed in these 44 patients in an attempt to classify each recurrence as either initially local or distant metastatic disease. The site of the first documented recurrence was local in 18 patients and distant metastases in 26. When the patients with recurrence were separated into TNM categories, it was apparent that in those patients without lymph node metastases demonstrated in the resected specimen (N0), the initial recurrence tended to be a distant metastases, whereas in those with such involvement (N1), the initial occurrence was more often local. In light of these data, selection of appropriate initial adjuvant therapeutic modalities may be different for each type of patient.

YAO, SEE TAO M.D.; VANECKO, ROBERT M. M.D.; CORLEY, RICHARD D. D.D.S., M.D.; STUTEVILLE, ORION H. D.D.S., M.D., F.A.C.S.; SHOEMAKER, WILLIAM C. M.D., F.A.C.S. Author Information

The concept has been reaffirmed that bacteria migrate from the skin to the interior of an abdominal wound via drains. It has been shown that obvious infection developed in nine out of ten splenectomized dogs in which drains were placed before closure, but not in dogs with no drains. Fifty patients were subjected to abdominal procedures followed by insertion of abdominal drains. Bacterial growths from cultures of the interior portion of their drains, upon removal, revealed that in 17 out of 50 of these patients, there were definite skin contaminants on the interior part of their drains. These findings strongly suggest that bacteria do migrate via the drain into the interior. The authors seriously question the routine placement of prophylactic abdominal drains, in view of the increased virulence reported even among commensal microorganisms which migrate down these drains.

PIFARRÉ, R.; RAGHUNATH, T. K.; VANECKO, R. M.; CHUA, F. S.; BALIS, J. U.; NEVILLE, W. E. Author Information

he operative approach to an acutely injured subclavian vesselprotected by clavicle, sternum, the costal cartilages, and ribs T -is by no means an easy one in the presence of active bleeding.We wish to describe a new emergency approach to these vessels which provides rapid exposure for control of bleeding and excellent visualization for arterial and venous reconstruction.During a three-year period at the Cook County Hospital in Chicago, 25 cases of acute subclavian vessel injury were managed without operative mortality.In this series, 12 gunshot wounds and 13 stab wounds resulted in 14 arterial injuries and 13 venous injuries.One of the patients who had sustained combined arterial and venous injuries presented with an arteriovenous fistula.In 1 patient it was necessary to ligate the injured subclavian artery.In all the remaining patients, the subclavian arteries and veins were repaired by lateral sutures, end-to-end anastomosis, or, in 1 patient, by a vein patch.Preparation of the patient included sterile draping of the entire anterior chest wall as well as the cervical regions.Recently, we have included sterile draping of the femoral regions for access to the saphenous vein and to the femoral artery and vein for possible cardiopulmonary bypass.Initial exploration was carried out through a supraclavicular incision with subperiosteal removal of a middle segment of the clavicle.This limited approach provided adequate exposure in 15 patients.Early in our experience, when additional exposure was necessary it was obtained in 1 case by median sternotomy, in 3 cases by separate anterior thoracotomy through the third or fourth intercostal space, and in 2 cases by splitting the upper sternum and extending the original incision downward and laterally into the third interspace for development of a chest wall flap [4, 131.In the 4 later cases, ample additional exposure was achieved rapidly by removal of the medial clavicular remnant and sectioning of the first two costal cartilages.

TECHNICAL advances have developed rapidly in many clinical areas, but diagnosis and management of the acute abdomen largely remain within the domain of clinical observations and experience. Successful treatment of the patient with acute abdomen depends upon early diagnosis, accurate judgment, and decisive action. The present report briefly describes the salient features of 21 patients with unusual and rare cases of acute abdomen, all of which were operated on and photographed by us. Fifteen percent of emergency abdominal operations were performed for uncommon or rare conditions.1These unusual conditions should be differentiated from the common etiologies of acute abdomen as noted in the following tabulation. Common Causes 1. Acute appendicitis 2. Perforated peptic ulcer 3. Incarcerated hernia 4. Adhesive small bowel obstruction 5. Acute pancreatitis 6. Acute cholecystitis 7. Large bowel obstruction due to carcinoma of the colon 8. Diverticulitis Unusual Causes 1. Diseases simulating acute appendicitis (a) Torsion