Elevated exhaled nitric oxide in anaphylaxis with respiratory symptoms.

BACKGROUND: Anaphylaxis is a serious type I allergic reaction that occurs suddenly and can result in death, but it is sometimes difficult to differentiate from other diseases, and physicians must rely on symptoms alone for its diagnosis. Meanwhile, fractional exhaled nitric oxide (FeNO) concentration, used in assessing airway inflammation in bronchial asthma, is known to be affected by atopic disposition. The possible role of FeNO measurements was evaluated in patients with anaphylaxis. METHODS: FeNO was measured in 52 adult patients (17-78 years old, median age 41.5 years) in whom anaphylaxis occurred. These measurements were made within 24 h after onset and after about one month when the patients were symptom-free. In some of these patients, FeNO was measured a third time, two months or more after onset. RESULTS: The FeNO level in the 52 patients was not significantly different in measurement made within 24 h of onset of anaphylaxis and after one month. However, excluding 9 patients who also had asthma history, the FeNO level in the remaining 43 patients decreased significantly from within 24 h of onset (36.7 ± 27.5 ppb) to one month later (28.8 ± 19.5 ppb). Of these 43 patients, this phenomenon was evident in a group that had respiratory symptoms (31 patients), but it was not seen in a group that did not have respiratory symptoms (12 patients). CONCLUSIONS: Elevation of FeNO was related to respiratory symptoms observed in anaphylactic patients without asthma. Although the mechanism of increased FeNO level is unclear, its usefulness for diagnosis of anaphylaxis must be examined in prospective studies.

[Clinical analysis of eight cases with pyothorax-associated lymphoma].

We retrospectively reviewed the medical records of eight patients (five males and three females, median age: 75.6) with pyothorax-associated lymphoma (PAL) from 1993 to 2007. All cases were histopathologically identified as diffuse large-B-cell lymphoma and had a history of artificial pneumothorax for the treatment of pulmonary tuberculosis. Chest and/or dorsal pain was the most common symptom followed by bloody sputum. Ten needle biopsies and five surgical biopsies were performed, and diagnostic rates were 30% and 60% respectively. More than two biopsies were needed in four out of eight patients. Nine months in median were necessary to confirm a diagnosis of PAL. We evaluated gallium scintigraphy in five and 18FDG-PET in two patients. High uptake was observed only at the tumor site, not in the pleural cavities of all examined patients. While all five male patients died of their tumors, the three female patients were all alive after intensive therapy. We conclude that gallium scintigraphy, and 18FDG-PET are useful for discriminating tumor from pyothorax. It is also necessary to further understand the uncertainty of biopsy results and the need for repeat examinations for early diagnosis of PAL.