Pathologically confirmed diffuse alveolar haemorrhage in lymphangioleiomyomatosis.

A 40-year-old woman was referred to pulmonology after presenting with dyspnoea and self-limiting haemoptysis. Chest CT revealed diffuse ground glass opacities and small thin-walled cysts. Bronchoalveolar lavage cultures were negative and cytology revealed haemosiderin-laden macrophages. Transthoracic echocardiogram was normal. Connective tissue disease and vasculitis work-up were negative. Vascular endothelial growth factor-D level was indeterminate. Lung function was normal. She underwent video-assisted thoracoscopic lung biopsy. In addition to findings consistent with lymphangioleiomyomatosis, histopathological examination identified haemosiderosis without capillaritis, confirming a diagnosis of diffuse alveolar haemorrhage in the context of the associated clinical and radiographic features. Follow-up imaging after 5 months showed resolution of the diffuse ground glass opacities. Pharmacotherapy with sirolimus was not initiated due to absence of deterioration in pulmonary function. Diffuse alveolar haemorrhage in patients with lymphangioleiomyomatosis is a rare but important presentation. The few previously reported cases progressed to respiratory failure requiring mechanical ventilation.

Electrical impedance tomography in adult patients undergoing mechanical ventilation: A systematic review.

PURPOSE: The purpose of the study is to systematically review and summarize current literature concerning the validation and application of electrical impedance tomography (EIT) in mechanically ventilated adult patients. MATERIALS AND METHODS: An electronic search of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and the Web of Science was performed up to June 2014. Studies investigating the use of EIT in an adult human patient population treated with mechanical ventilation (MV) were included. Data extracted included study objectives, EIT details, interventions, MV protocol, validation and comparators, population characteristics, and key findings. RESULTS: Of the 67 included studies, 35 had the primary objective of validating EIT measures including regional ventilation distribution, lung volume, regional respiratory mechanics, and nonventilatory parameters. Thirty-two studies had the primary objective of applying EIT to monitor the response to therapeutic MV interventions including change in ventilation mode, patient repositioning, endotracheal suctioning, recruitment maneuvers, and change in positive end-expiratory pressure. CONCLUSIONS: In adult patients, EIT has been successfully validated for assessing ventilation distribution, measuring changes in lung volume, studying regional respiratory mechanics, and investigating nonventilatory parameters. Electrical impedance tomography has also been demonstrated to be useful in monitoring regional respiratory system changes during MV interventions, although existing literature lacks clinical outcome evidence.

Glutamate-mediated excitotoxicity in schizophrenia: a review.

Findings from neuroimaging studies in patients with schizophrenia suggest widespread structural changes although the mechanisms through which these changes occur are currently unknown. Glutamatergic activity appears to be increased in the early phases of schizophrenia and may contribute to these structural alterations through an excitotoxic effect. The primary aim of this review was to describe the possible role of glutamate-mediated excitotoxicity in explaining the presence of neuroanatomical changes within schizophrenia. A Medline(®) literature search was conducted, identifying English language studies on the topic of glutamate-mediated excitotoxicity in schizophrenia, using the terms "schizophreni" and "glutam" and (("MRS" or "MRI" or "magnetic resonance") or ("computed tomography" or "CT")). Studies concomitantly investigating glutamatergic activity and brain structure in patients with schizophrenia were included. Results are discussed in the context of findings from preclinical studies. Seven studies were identified that met the inclusion criteria. These studies provide inconclusive support for the role of glutamate-mediated excitotoxicity in the occurrence of structural changes within schizophrenia, with the caveat that there is a paucity of human studies investigating this topic. Preclinical data suggest that an excitotoxic effect may occur as a result of a paradoxical increase in glutamatergic activity following N-methyl-D-aspartate receptor hypofunction. Based on animal literature, glutamate-mediated excitotoxicity may account for certain structural changes present in schizophrenia, but additional human studies are required to substantiate these findings. Future studies should adopt a longitudinal design and employ magnetic resonance imaging techniques to investigate whether an association between glutamatergic activity and structural changes exists in patients with schizophrenia.