Jorge A. Estrin

Factors influencing early survival after liver transplantation

The purpose of this study was to analyze data from all adult and pediatric liver transplants performed between January 1, 1983 and January 15, 1986 at the University of Minnesota Hospital and identify perioperative variables that predict patient survival and could aid in patient selection. Charts, intraoperative anesthesia records, blood bank records, flow sheets, outpatient records, and autopsy reports were examined in 45 pediatric and 15 adult patients who underwent primary orthotopic liver transplantation. Analysis of the data can be summarized as follows: (1) Pediatric patients whose coagulation parameters could not be corrected prior to operation and who consequently required preoperative exchange transfusion had poorer outcomes than those not requiring an exchange to correct coagulation parameters. (2) The rapid infusion technique for massive blood transfusion resulted in significantly decreased blood loss and intraoperative blood product replacement. (3) Twenty-four hour postoperative factor V levels were good predictors of survival. Patients with poor factor V levels required rigorous replacement of coagulation factors. (4) Pediatric patients with uncorrectable coagulopathies requiring immediate postoperative exchange transfusion had extremely high mortality.

Gardner’s syndrome and fibromatosis: Review of the problem and report of a case

SummaryGardner’s syndrome is inherited as an autosomal dominant trait. It is characterized by intestinal polyposis, bony exostoses, and multiple soft-tissue abnormalities. Life-threatening components of the trait are the malignant potential of the colonic polyposis and the malignant behavior of the histologically benign intraabdominal fibromatosis. Colectomy or proctocolectomy is indicated for colonic polyposis; a case illustrating the feasibility of wide resection for intra-abdominal fibromas is presented.

Automated data acquisition and analysis in muscle physiology research.

Research in muscle physiology has progressed in both the volume and complexity of data examined. Dependence on manual methods to analyze and condense this amount of information can present a narrow bottleneck to the efficient completion of a study, and can compromise the reliability of the results. We designed a general purpose computerized system for data acquisition in experiments in our cardiovascular physiology laboratory. In addition, we developed a software program specifically for the analysis of data from studies of isolated, isometrically contracting myocardium. This system has reduced the time for analysis of such data by approximately 50-fold over that of manual techniques, and has contributed significantly to our confidence in the measured results.

Anesthetic Management During Liver Transplantation

Liver allotransplantation confronts the anesthesiologist with complex and unique physiological problems, all of them resulting from end-stage liver failure and the peculiar stages of this operation. Contrary to a preliminary belief that the repercussions of the anesthetic intervention in the patients was the basic management problem, clinical experience has shown that the centerpiece of management lies on the ability of the anesthesia team to deal with excessive blood transfusions and its hemodynamic and metabolic correlates. A better understanding of and experience with these problems has led to significant changes in our perioperative anesthetic management.

Anesthetic Management During Cardiac Transplantation

The anesthetic care for patients undergoing cardiac transplantation was first described by Ozinsky in 1967.1 In subsequent years only three other reports2—4 have highlighted the experiences of the most active heart transplant centers. This chapter will discuss the concepts and techniques employed at the University of Minnesota since inauguration of our cardiac transplantation program in 1978.