ABSTRACT
Fenoldopam is a direct-acting vasodilator that acts at the postsynaptic dopamine 1 receptors in renal, coronary, cerebral, and splanchnic vasculature resulting in arterial dilation and a lowering of the mean arterial pressure (MAP). Preliminary evidence suggests its efficacy in the treatment of hypertensive urgencies and emergencies in adults. We present four children in whom fenoldopam was used to control MAP in various clinical scenarios, including hypertensive emergencies and urgencies, intraoperative reduction of MAP for controlled hypotension, and control of MAP during extracorporeal membrane oxygenation. The possible applications of fenoldopam and suggested dosing regimens in children are reviewed.
Subject(s)
Antihypertensive Agents/therapeutic use , Dopamine Agonists/therapeutic use , Fenoldopam/therapeutic use , Hypertension/drug therapy , Vasodilator Agents/therapeutic use , Age Factors , Antihypertensive Agents/pharmacology , Body Weight , Brain Neoplasms/surgery , Child , Dopamine Agonists/pharmacology , Emergencies , Female , Fenoldopam/pharmacology , Humans , Hypertension/etiology , Infant , Infusions, Intravenous , Intraoperative Complications/drug therapy , Intraoperative Complications/etiology , Male , Medulloblastoma/surgery , Near Drowning/complications , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Scoliosis/surgery , Vasodilator Agents/pharmacologySubject(s)
Learning , Teaching/methods , Curriculum , History, 20th Century , Minnesota , Schools, Medical/historyABSTRACT
Current perceptions of the association between William Osler and bacterial endocarditis are, for many of us, encompassed by the eponym, "Osler's nodes." Osler himself credited others with priority in description of those nodes, and the eponym is justified only because it signals the overlordship of the disease that the great clinician maintained for 3 decades (1885 through 1915). In the Gulstonian Lectures on malignant endocarditis, Osler provided, as Cushing said, "the first comprehensive account in English of the disease and did much to bring the subject to the attention of clinicians." In the present account, I have sought to assess the degree to which Osler's contributions to knowledge and understanding of bacterial endocarditis were extended or limited by forces of time and circumstance that, for the most part, extended beyond boundaries that any effort on his part could have altered.
Subject(s)
Endocarditis, Bacterial/history , Internal Medicine/history , Adult , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/etiology , History, 19th Century , History, 20th Century , Humans , London , Sepsis/complicationsABSTRACT
Papillary fibroelastomas are benign tumors of the heart and are most often incidental findings at cardiac surgery or autopsy. Rarely, symptoms or even sudden death can occur. We report two cases of cardiac papillary tumors diagnosed by two-dimensional echocardiography and successfully excised. One patient was asymptomatic and had a 1-by 1-cm papilloma of the mitral valve. The other patient had intermittent chest pains and diaphoresis associated with a 1.5- by 1-cm aortic valve papilloma.
