1085

Sudomotor skin sympathetic activity recorded as electrodermal response on left (A) and right (B) hand palms in patient with migraine headache attack on right side,

support the suggestion of Friberg and colleagues that a low serotoninergic drive from perivascular nerves or reduced serotonin (5-HT) receptors on the smooth muscles of the arteries accounts for migraine. A supplementary argument comes from the subcutaneous Sumatriptan International Study Group’s report that sumatriptan (a selective agonist of 5-HT1-like receptors) is an effective and rapid-acting treatment for migraine attacks.4 Electrophysiology Laboratory and Diabetes Clinic,

University of Bucharest, Bucharest 2, Romania

CONSTANTIN IONESCU-TIRGOVISTI SIMION PRUNA

1. Iversen HK, Nielsen TH, Olsen J, Tfelt-Hansen P. Arterial responses during migraine headache. Lancet 1990; 336: 837-39. 2. Prunå S, Ionescu-Tirgoviste C. Dual-channel self-balancing electrodermal impedance reactometer for autonomic response studies. Med Biol Eng Comp 1987; 25: 613-19. 3. Ionescu-Tirgoviste C, Prunå S. Quantitative noninvasive electro-physiological evaluation of the activity of the cutaneous division of the sympathetic nervous system. Arch Int Physiol Biochem 1990; 98: 111-19. 4. The Subcutaneous Sumatriptan International Study Group. Treatment of migraine attacks with sumatriptan. N Engl J Med 1991; 325: 316-21.

autoimmune abnormalities were noted-anti-IgG IgM rheumatoid factor in patient 1 and antinuclear antibodies with anti-native DNA antibodies in patient 2. These findings are similar to those in Gong and Taskin’s patient in whom immune complex disease developed 25 years after the inhalation of ajax. Finally, in both women fibreoptic endoscopy and bronchoalveolar lavage were not diagnostic and lung biopsy with examination under polarised light was needed before extrinsic alveolitis due to inhalation of silica crystals was diagnosed. This diagnosis was confirmed by mineral analysis of the biopsy specimens and another interview. Both our patients also had recurrence of symptoms on reduction of steroid

therapy. Ajax, which contains ammonia (Colgate Palmolive), is a common household scouring powder containing 90% silica crystals. Both our patients admitted having repeatedly inhaled the powder because of its "nice smell", and acute silicosis developed. This is highly unusual since silicosis has seldom been described outside an occupational context-mainly quarrying, stone-cutting, and tunnel-digging.4 The difficulty of establishing the diagnosis, which requires a polarised light examination of lung biopsy specimens or mineral analysis of the bronchoalveolar lavage, as well as the reluctance of the patient to admit this type of intoxication, despite repeated questioning, may explain why the syndrome has gone undescribed. We suggest that acute silicosis due to inhalation of domestic products should be considered in a febrile patient with dyspnoea and a reticulonodular infiltrate.

Haematology Service, Centre Hospitalier Lyon Sud, 69310 Pierre-Bénite, France, and Hôpital Saint Joseph, Hôpital de la Croix Rousse, and Hôpital Edouard Herriot,

Lyon

CHARLES DUMONTET MICHEL VINCENT ERIC LAENNEC BRUNO GIRODET DANIÈLE VITREY DALITH MERAM LOUIS VAN STRAATEN

Silicosis due to inhalation of domestic

cleaning powder SIR,-We have reported acute silicosis in a young female patient who had repeatedly inhaled ’Ajax’ domestic cleaning powder.1 The observation of a second such case prompts us to suggest that this type of domestic intoxication, with the severe lung lesions it may induce, may be more common than suspected. Patient 1-A 20-year-old woman presented with acute dyspnoea, high fever (40°C), and bilateral end-inspiratory crackles. Chest radiography revealed a bilateral, predominantly basilar, reticulonodular infiltrate. Spirometric tests revealed a severe restrictive defect, a 50% reduction of the diffusing capacity (DLCO), and resting hypoxaemia. Symptoms regressed rapidly with steroid administration, but recurred when treatment was reduced. An increase in steroid dose was rapidly effective and the patient is symptom-free 18 months after interruption of therapy, with stable basilar infiltrates and a slight restrictive defect. Patient 2-A 17-year-old woman born in the Ivory Coast presented with left axillar pain, dyspnoea, and fever (39 °C). Chest radiography showed hilar adenopathies and a bilateral reticulonodular infiltrate. She had resting hyoxaemia. Severe microcytic hypochromic anaemia due to heterozygous sickle cell disease was noted. She improved transiently on steroids but when the treatment was being reduced she was readmitted with severe resting dyspnoea and received ventilation in intensive care. Four months after the onset of symptoms the patient is seriously ill and a therapeutic total lung lavage is being considered.2 Both these young women had no history of disease and denied addiction to tobacco, marijuana, or to inhaled or intravenous drugs. In both cases, although inhalation was repeated over a period of 2-3 years, symptoms (dyspnoea and fever) appeared for a few days (possibly because of superinfection). A reticulonodular infiltrate was a common feature, although only patient 2 had hilar adenopathies. Both patients shared common gasometric and spirometric abnormalities. An intense biological inflammatory syndrome, increased serum lactic acid dehydrogenase concentrations, and polyclonal hypergammaglobulinaemia were seen in both women. Circulating immune complexes as well as

C, Biron F, Vitrey D, et al. Acute silicosis due to inhalation of a domestic product. Am Rev Respir Dis 1991; 143: 880-82. 2. Mason GR, Abraham JL, Hoffman L, Cole S, Lippmann M, Wasserman K. Treatment of mixed-dust pneumoconiosis with whole lung lavage. Am Rev Respir Dis 1982; 126: 1102-07. 3. Gong H, Tashkin DP. Silicosis due to inhalation of abrasive scouring powder. Am J Med 1979; 67: 358-62. 4. Chapman EM. Acute silicosis. JAMA 1932; 98: 1439-46. 1. Dumontet

Reduced adrenal gland acetylcholinesterase activity in Alzheimer’s disease SIR,-Adrenal glands trom patients with a histological diagnosis of Alzheimer’s disease (AD) have been reported to show an abnormal ultrastructure, with numerous Lewy-body-like inclusions in medullary cells.! Adrenal chromaffin cells are rich in acetylcholinesterase (AChE),2 as are many of the neurons in the brain that show pathological abnormalities in this disease.3 Indeed, consistent findings in patients with AD are widespread reductions in AChE activity throughout the brain 4 We have therefore measured AChE activity in adrenal glands obtained at necropsy from 16 patients with a clinical diagnosis of AD confirmed by histological examination of brain material (mean age 80-5 [SE 13] yr; post-mortem delay 51-9 [5’7] h) and from 6 age-matched controls with no signs of dementia or any other neurological disease (mean age 82.6[4’8]; post-mortem delay 55-9 [9.0]). AChE activities were measured with a micro-version of the Ellman assay.s Total AChE activity per wet weight adrenal tissue was substantially lower (by 20%) in patients with AD than in controls (table). This reduction seemed to be due to a striking decrease in soluble AChE activity (by 51%) since membranebound AChE activities were in the control range. Protein contents in all fractions from AD patients did not differ significantly from those in controls; hence similar results were obtained when AChE activities were expressed per mg protein. Reductions in AChE activity are therefore not restricted to the brain in AD, adding support to Smith and Cuello’s3 theory that AD is associated with an abnormality of cells that contain AChE. It would be worth looking at other tissues of the peripheral nervous

Silicosis due to inhalation of domestic cleaning powder.

1085 Sudomotor skin sympathetic activity recorded as electrodermal response on left (A) and right (B) hand palms in patient with migraine headache at...
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