Pulmonary arteriovenous malformations

Abstract

Pulmonary arteriovenous malformations rarely present in childhood. Two cases are presented in this report. Both the cases presented clinically with cyanosis and clubbing without a cardiac murmur. The second case had cerebral abscess in addition. Both the cases underwent a contrast-enhanced echocardiography which suggested the presence of pulmonary arteriovenous malformations. The first case also underwent 99mTc radionuclide scan and pulmonary angiography. The cases are being reported for their characteristic clinical features and for emphasizing the role of non-invasive modalities like contrast-enhanced echocardiography and radionuclide scan in reaching the diagnosis.

Clinical Profile and Outcome of Pediatric Tetanus at a Tertiary Care Center

“…Similar to this study, Tullu et al too did not find any significant difference in mortality related to mode of infection in the study conducted in 2000; however, in the 2005 study, mortality was significantly higher among postinjury tetanus cases. 3 7 Both prolonged spasms and shorter incubation period were not found to be associated with higher mortality. Similar findings were observed by Angurana et al 9 Singh and Seth found both these factors to significantly increase mortality.…”

“…9 Tullu et al treated all tetanus patients with 2,000 IU HTIG intramuscularly and intravenous crystalline penicillin. 7 Sedation was decided depending on modified Patel and Joag severity score: mild—diazepam 20 mg/kg/d, moderate—diazepam 40 mg/kg/d and chlorpromazine 0.5 mg/kg/dose qid, and severe—diazepam 60 mg/kg/d, chlorpromazine 0.5 mg/kg/dose qid, and phenobarbitone 5 mg/kg/d. 7 Pancuronium was used for patients with refractory spasms not controlled with the above drugs.…”

“…Most of these complications are similar to those witnessed in similar studies, and are either due to the disease itself (e.g., autonomic dysfunction) or an outcome of prolonged ventilation and recumbence. 3 4 7 9 Autonomic instability is a known complication of tetanus and may be characterized by fluctuations in heart rate, blood pressure, or both. 4 8 Though this study did not find autonomic instability to be a significant predictor of mortality, 50% of patients with autonomic instability expired.…”

“…Angurana et al, Singh and Seth, and Tullu et al (2000 and 2005) found autonomic instability to be a significant predictor of mortality in tetanus patients. 3 5 7 9 Several complications can be witnessed during the course of illness in tetanus patients. Among these, an important one is rhabdomyolysis which occurs due to muscle spasms.…”

“…One of these is the modified Patel and Joag scoring system, which takes into account the frequency of spasms, vital parameters, and the extent of rigidity, based on which tetanus is classified as mild, moderate, and severe. 7 The management of tetanus involves eradicating the organism with penicillin G or metronidazole, neutralizing the toxin by tetanus immunoglobulin, and supportive measures such as mechanical ventilation, sedation, and muscle relaxation/paralysis. 1 8 Though tetanus is a treatable illness, it is associated with significant complications in the form of autonomic disturbances, rhabdomyolysis with acute kidney injury (AKI), complications of prolonged hospitalization and mechanical ventilation (nosocomial pneumonia, subglottic stenosis), gastrointestinal bleeding, sepsis, and disseminated intravascular coagulation (DIC).…”