American journal of surgery
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The clinical records of patients identified by a prospective database as having undergone curative gastric resections for adenocarcinoma not involving the gastroesophageal junction were reviewed in order to examine transfusional practices and to determine if perioperative transfusion had an adverse effect on outcome. Between January 1985 and January 1992, 232 patients received such curative resections. The median follow-up for these patients was 19.0 months, whereas median survival for nonsurvivors was 12.3 months. ⋯ By univariate analysis, male sex (p = .004), total gastrectomy (p = .01), advanced stage of disease (p = .000006), high histologic grade of tumor (p = .03), and blood transfusion (p = .006) were predictors of poor outcome. By multivariate analysis using the proportional hazards model with stage, tumor grade, gender, extent of resection, and transfusion as covariates, blood transfusion was an independent predictor of poor outcome (p = .029, hazard 1.74). These results encourage prospective studies of transfusion on cancer recurrence and studies of alternatives to allogeneic blood transfusions in restoration of oxygen-carrying capacity during surgery in patients with gastric cancer.
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A review of 85 consecutive patients who acquired pneumonia in a surgical intensive care unit revealed several parameters associated with successful treatment. Fifty-five patients (65%) recovered after a single course of antimicrobial therapy. ⋯ Multiple antimicrobial resistance was uncommon in bacteria isolated on initial culture but occurred in two thirds of patients with treatment failures. Pneumonia due to Pseudomonas aeruginosa and Staphylococcus aureus were associated with the highest rate of treatment failure, which were 56% and 45%, respectively.