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Localized argyria with pseudo-ochronosis: A report of two cases highlighting involvement of elastic fibers Pseudo-ochronosis in localized argyria was first reported in 2002,[1] when they described ochre-colored swollen homogenized collagen bundles seen on biopsy of localized argyria in the absence of the typical causes of ochronosis. Keywords: argyria; elastic fibers; localized argyria; pseudo-ochronosis EN argyria elastic fibers localized argyria pseudo-ochronosis 815 818 4 08/16/23 20230901 NES 230901 INTRODUCTION Argyria, either localized or generalized, is a rare dermatologic condition where the deposition of silver within skin or mucous membranes results in grayish-blue pigmentation that can be appreciated clinically. [Extracted from the article]

The absorption of silver presents as a grayish coloration in different locations as the skin and eye. Corneal argyrosis is characterized by micro-deposits in the stroma, Bowman or Descemt membranes. This metal could also affect other structures as the retina. We describe the case of a male jeweler with corneal argyrosis. Small whitish–grayish predescemetic depositis were observed by biomicroscopy, which were described as punctate and extra-cellular by in vivo confocal microscopy. Our patient presented a significative impairment of contrast sensitivity under scotopic conditions which could not be attributed to other condition. This test could be helpful in detecting retinal functional alteration before the structural anatomical alteration are visible.

Lentigo maligna (LM) can be difficult to diagnose and recurrence is not uncommon. In vivo reflectance confocal microscopy (RCM) improves diagnostic accuracy of LM. LM can be difficult to discern from coexistent metal‐induced cutaneous hyperpigmentation (MICH). We are the first to describe three cases of LM associated with gold, silver, and metal oxide (from tattoos) and the RCM findings, respectively. The images obtained via RCM were analyzed by two RCM experts, and histopathology reviewed by a dermatopathologist. MICH under RCM appeared as intensely hyperreflective dots (when found freely) or clusters of variable sizes (when engulfed by macrophages) limited to the dermis. Dermal dendritic cells and melanophages were also found in association but distinct from the confluence of dendritic cells at the dermoepidermal junction observed in LM. We showed longitudinal changes within the dermis in MICH, not previously reported, where these hyperreflective dots congregate into clusters. RCM was able to distinguish the features of LM from MICH, delineate treatment margins, and monitor for recurrence. [ABSTRACT FROM AUTHOR]

A unique specimen of argyria is preserved in the Morgagni Museum of Pathological Anatomy at the University of Padua (Italy). It is a stuffed head belonging to a man who decided to cure his syphilis by himself with the so-called infernal stone (silver nitrate) every day for years, thus developing argyria in the second half of the nineteenth century. Paleopathological and historical studies were performed on the specimen to confirm the diagnosis of argyria. Furthermore, a morphological investigation of the specimen was conducted with histological and ultrastructural investigations, including environmental scanning electron microscopy and electron dispersive x‐ray spectroscopy, recording high presence of silver in the dermis and epidermis and also other chemical elements correlated to the "infernal stone." A comparison with actual cases may also lead to a common feature: a potential dependence on the perceived benefits brought by silver compound that may sustain a further prolonged intake. [ABSTRACT FROM AUTHOR]

Introduction Psychotic disorders usually come with diagnosis difficulties, especially when the clinical presentation is recent or if there are organic factor associated. Regarding this, we propose the clinical case of a man 47 years old without psychiatric history, who is brought to the hospital after being run over by the subway. At his arrival, he verbalizes delirious thoughts of persecution and harm. Objectives The objective is to emphasize the importance of making an appropriate somatic study in psychosis cases, especially when we don’t know the time of setting or we can’t make a psychiatric interview in optimal conditions. Methods The study included a blood test including methemoglobine, cranial tomography, serologies and a heavy metals test. We reviewed the scientific literature in Pubmed and Web of Science about the possible association between the psychiatric and the dermatological symptoms. Results During his admission, the patient recognizes delusional thoughts of harm since he was young and he was so frightened because of this that he tried to commit suicide in the subway. Moreover, he also thinks that silver can heal any disease, so he has licked silver coins for years. The final diagnosis was schizophrenia, and argyria due to a chronic silver intoxication. Conclusions Heavy metals intoxications can be associated to acute psychotic disorders, so we must take them into account. As well, schizophrenia can cause bizarre believes which can lead to the intoxication. Disclosure No significant relationships.

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BackgroundLocalized cutaneous argyria is a rare skin condition caused by direct contact with silver or silver particles. It presents as asymptomatic gray or blue-gray macules that appear similar to blue nevi. Histologic features include brown-colored or black-colored silver granules in the basement membrane and dermis, most commonly surrounding eccrine glands, elastic fibers, and collagen fibrils. The condition is most frequently observed in individuals who are regularly exposed to small silver particles, such as silversmiths and welders. However, localized cutaneous argyria has also been associated with acupuncture needles, silver earrings, and topical medications containing silver nitrate. Although the condition is benign, patients who are concerned about the cosmetic features of localized cutaneous argyria may benefit from laser therapy.PurposeWe describe the clinical and pathologic findings of two women who developed localized cutaneous argyria. We also review the characteristics of other patients with localized cutaneous argyria and summarize the differential diagnosis and treatment options for this condition.Materials and methodsThe features of two women with localized cutaneous argyria are presented. Using PubMed, the following terms were searched and relevant citations assessed: acquired localized argyria, acupuncture, argyria, argyrosis, colloidal silver, cutaneous argyria, and localized cutaneous argyria. In addition, the literature on localized cutaneous argyria is reviewed.ResultsTwo women presented with small, asymptomatic blue-gray macules appearing at sites directly adjacent to ear piercings. A punch biopsy was performed on one woman. Microscopic examination revealed a yellowish-brown colored granular material found adjacent to elastic fibers. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of localized cutaneous argyria was established. The second woman did not undergo a biopsy. However, the clinical presentation was highly suggestive of localized cutaneous argyria. Both women were reassured of the benign nature of the condition and agreed to return for clinical follow-up if they observed any changes in the appearance of the lesions.

Exogenous pigmentation by silver nitrate is a rare disease whose clinical manifestations appear even years after the contact, making its diagnosis difficult on occasions. It is characterized by the presence of blue-gray macules or plaques on the skin or mucosa in the contact area, sometimes very similar to melanocytic lesions and melanoma, which constitute the main differential diagnosis. We report the case of a male patient from Medellín, Colombia, with a family history of melanoma and the presence of these lesions throughout his body. [ABSTRACT FROM AUTHOR]

Argyria is a rare disease in which chronic usage of products with a high silver content leads to deposition of silver granules in organs such as the skin, resulting in a permanent blue-gray discoloration. We present a 68-year-old woman with a 10-year history of chronic anemia of unknown etiology who was admitted for progressive generalized weakness, dyspnea, and a widespread slate-gray tint to her skin. She had previously consumed 1 tablespoon per day of colloidal silver orally for 7 years. Hematologic workup on admission showed the hemoglobin to be 2.4 g/dL with low ferritin and normal copper, zinc, and ceruloplasmin, indicating an iron-deficiency anemia. Differentiating the correct etiology of her anemia and skin discoloration was crucial since argyria can cause pseudocyanosis and microcytic anemia secondary to silver-induced copper deficiency. This case highlights the importance of asking and counseling patients about their nonprescription supplements. [ABSTRACT FROM AUTHOR]

Aim: Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are available: MUTARS® (Implantcast), Agluna® (Accentus Medical), PorAg® (Waldemar Link). The aim of this review is to provide an overview on efficacy and safety of silver-coated EPR both in primary and revision surgery, comparing infection rate according to the type of implant. Methods: Through an electronic systematic search, we reviewed the articles concerning silver-coated EPRs. Infection rate, silver-related complications, local and blood concentrations of the silver were evaluated. Meta-analyses were performed to compare results from each study included. Results: Nineteen studies were included. The overall infection rate in patients with silver-coated implants was 17.6% (133/755). Overall infection rate in primary silver-coated EPR was been 9.2% (44/445), compared to 11.2% (57/507) of non-silver-coated implants. The overall infection rate after revisions was 13.7% (25/183) in patients with silver-coated EPR and 29.2% (47/161) when uncoated EPR were used, revealing a strength statistically significative utility of silver coatings in preventing infections in this group (p: 0.019). Generally, the use of MUTARS® EPR had produced an almost constant decrease in the incidence of primary PJI but there are few data on the effectiveness in revisions. The results from the use of Agluna® in both primary and revisions implants are inconstant. Conversely, PorAg® had proven to be effective both in PJI prevention but, especially, when used in PJI revision settings. Local argyria was reported in 8 out of 357 patients (2.2%), while no systemic complications were described. Local and blood concentrations of silver were always reported very far to the threshold of toxicity, with the lowest concentration found using PorAg®. Conclusions: Silver-coated EPRs are safe and effective in reduction in PJI and re-infection rate, in particular when used in higher risk patients and after two-stage revisions to fight PJI. [ABSTRACT FROM AUTHOR]

Argyria is the chronic accumulation of silver in biological tissues such as skin, liver, kidneys, lungs, peripheral nerves, and brain. The presence of an actual pathophysiological and clinical correlate related to silver encephalic and peripheral nerve deposition is still much debated. In this paper, we reviewed and described case reports regarding argyria associated with neuropsychiatric symptoms in order to explain the underlying mechanism of the disease. We conducted a narrative review by searching for case reports that described subjects with chronic silver accumulation and who had associated neurological or psychiatric symptoms. Moreover, we report a case of a 50-year-old man admitted to our hospital with a diagnosis of major depression who presented with worsening psychiatric symptoms after abuse of silver-containing nasal spray. We found 15 cases of patients with argyria and neuropsychiatric manifestations such as epilepsy, neurodegenerative syndromes, multiple sclerosis, peripheral neuropathy, and psychiatric disorders. The knowledge of possible pathogenetic mechanisms and recognition of clinical features of argyria can help clinicians prevent brain deposition and its complications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and objectiveGeneralized argyria is a blue-gray hyperpigmentation of the skin resulting from ingestion or application of silver compounds, such as silver colloid. Case reports have noted improvement after Q-Switched Neodymium-Yttrium Aluminum Garnet laser (1,064 nm QS Nd:YAG) laser treatment to small surface areas. No reports have objectively monitored laser treatment of generalized argyria over large areas of skin, nor have long-term outcomes been evaluated.Study design/materials and methodsAn incremental treatment plan was developed for a subject suffering from argyria. A quantitative near infrared spectroscopic measurement technique was employed to non-invasively analyze tissue-pigment characteristics pre- and post-laser treatment. Post-treatment measurements were collected at weeks 1, 2, 3, and 4, and again at 1 year.ResultsImmediate apparent removal of pigment was observed with 1 Q-switched 1,064 nm Nd:YAG laser treatment (3-6 mm spot; 0.8-2 J/cm(2) ) per area. Entire face, neck, upper chest, and arms were treated over multiple sessions. Treatments were very painful and general anesthesia was utilized in order to treat large areas. Near-infrared spectroscopy was used to characterize and quantify the concentration of silver particles in the dermis based on the absorption features of the silver particles as well as the optical scattering effects they impart. We were able to estimate that there was, on average, 0.042 mg/ml concentration of silver prior to treatment and that these levels went below the minimum detectable limit of the instrument post-treatment. There was no recurrence of discoloration over the 1-year study period.ConclusionQS 1,064 nm laser treatment of argyria is a viable method to restore normal skin pigmentation with no evidence of recurrence over study period. Quantitative spectroscopic measurements: (1) confirmed dyspigmentation was due to silver, (2) validated our clinical assessment of no recurrence up to 1-year post-treatment, and (3) indicated no collateral tissue damage with treatments.

Background: Argyria results from silver accumulation in the skin. It is a stressful condition for patients due to skin discoloration. In the past, no effective treatments were available. However, it has been recently reported laser treatments showed promising results. Aim: To review and summarize all reported laser treatment options for argyria patients. Methods: We reviewed all laser treatment options for argyria in the database of the US National Library of Medicine PubMed. The search of the words "argyria and laser" was performed on the March 4, 2020. Results: We found 11 studies that reported laser treatment for argyria. All of the studies were case reports demonstrating treatment responses of laser devices such as 1064 nm Nd:Yag laser and 755 nm alexandrite laser. Despite various treatment parameters, 1064 nm Nd:Yag and alexandrite lasers showed good responses in argyria. However, severe pain during the laser procedure was the main concern. We summarized laser treatment options for argyria including their parameters, treatment response, and anesthesia for laser treatment in argyria. We also report a case of argyria, which successfully responded to low fluence 1064 nm Nd:Yag laser. Conclusion: Laser therapies resulted in almost complete clearing of pigment in argyria. Earlier reports showed that 1064 nm Nd:Yag laser successfully treated argyria but recent studies suggested 755 nm alexandrite was also a good treatment option for argyria. Additionally, our case achieved excellent results even in one session of low fluence Q‐switched Nd:Yag laser, though we need to ensure pain control during the laser treatment. [ABSTRACT FROM AUTHOR]

A case of severe mucogingival argyria secondary to leakage around and corrosion of silver cone root canal obturations and apical amalgam restorations is presented. Following removal of the silver points and re-treatment of the root canals, periradicular surgery was performed to remove the amalgam root-end restorations and reduce the amount of dispersed metallic particles in the subcutaneous tissues. Subsequent free gingival grafting created an esthetically pleasing and biologically acceptable result. [ABSTRACT FROM AUTHOR]

A 27-year-old female, a radiotherapy technician, was referred to our consultation with a localized gray pigmentation of the perinasal area. The condition had been asymptomatic for its entire duration of 2 years. A dermatological examination found a localized bluish-gray pigmentation in the perinasal area. Dermoscopy revealed an annular bluish-gray patch. Her occupation involved the manufacture and micromanipulation of machines, which required handling pure iron, nickel, copper, and silver with bare hands. She also reported a tic of flaring the nose. A skin biopsy was performed and histology revealed deposits of fine granules in the basal cell layer of eccrine sweat glands and along the elastic fibers of the superficial dermis, conforming with the diagnosis of argyria. The patient was given laser Q-switching treatment and showed a measurable improvement. This case studies a currently rare dermatological curiosity. Argyria is a disease caused by chronic absorption of silver-rich materials. This is the first description of argyria following the manipulation of radiopaque caches with a tic of flaring the nose. [ABSTRACT FROM AUTHOR]

Background: Argyria is a rare condition characterized by gray/blue dislocation of the skin caused by chronic exposure to silver salts.Case Report: We review the case of an 81-year-old man who presented to the emergency department after a motor vehicle accident, was incidentally found to have skin discoloration, and was ultimately diagnosed with argyria. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although most emergency physicians will not complete a toxicology fellowship, all emergency physicians are on the front line of toxicological presentations and should be able to recognize argyria and differentiate this condition from other causes of skin discoloration. [ABSTRACT FROM AUTHOR]

Abstract Silver is used in different applications that result in contact with skin and mucosal surfaces (e.g., jewelry, wound dressings, or eye drops). Intact skin poses an effective barrier against the absorption of silver. Mucosal surfaces are observed to be less effective barriers and compromised skin is often a poor barrier. Silver can deposit as particles in the human body causing a blue-gray discoloration known as argyria. Urine and feces are reported pathways of excretion. Acute human mortality has been observed following an abortion procedure involving the intrauterine administration of 7 g silver nitrate (64 mg silver/kg body weight). Localized argyria has been reported with exposure to silver ions, metallic surfaces, and nanocrystalline silver. Generalized argyria was observed with ionic and nanocrystalline silver in humans at cumulative doses in the range of 70–1500 mg silver/kg body weight. Silver is observed to have a low potential for skin irritation. Eye irritation and some cases of allergic contact dermatitis have been reported. Silver may cause genotoxicity, but additional data are required to assess its carcinogenic potential. Other reported toxicities include hepatic, renal, neurological, and hematological effects. Highlights • Silver is an ingredient in certain dermal and mucosal medical applications. • Silver can deposit in the body as particles causing a discoloration called argyria. • Silver seems to have a low potential for skin irritation. Eye irritation and allergic contact dermatitis have been reported. • Silver may cause genotoxicity, but additional data on its carcinogenic potential are required. [ABSTRACT FROM AUTHOR]

Background: Argyria is a rare irreversible cutaneous pigmentation disorder caused by prolonged exposure to silver. Herein, we report a case of generalized argyria that developed after chronic ingestion of soluble silver-nano particles and presented with muscle weakness. Case presentation: A 74-year-old woman visited our emergency room, complaining of fever and mental deterioration. She was diagnosed with acute pyelonephritis and recovered after antibiotic therapy. At presentation, diffuse slate gray-bluish pigmented patches were noticed on her face and nails. Two months prior to visiting our hospital, she was diagnosed with inflammatory myopathy and given steroid therapy at another hospital. We performed a nerve conduction study that revealed polyneuropathy. In skin biopsies from pigmented areas of the forehead and nose, the histopathologic results showed brown-black granules in basement membranes of sweat gland epithelia, which are diagnostic findings of argyria. We reviewed pathology slides obtained from the left thigh muscles and found markedly degenerated myofibers with disorganization of myofibrils without inflammatory reactions, consistent with unspecified myopathy, rather than inflammatory myopathy. The patient was diagnosed with generalized argyria with polyneuropathy and myopathy and transferred to a rehabilitation institution after being tapered off of steroids. Conclusions: Clinicians should be aware of clinical manifestations of argyria and consider it in differential diagnosis when they examine patients who present with skin pigmentation and muscle weakness. [ABSTRACT FROM AUTHOR]

The article discusses about the recurrence of argyria skin dyspigmentation post Q-switched laser treatment, and discusses treatment of slate gray pigmentation disorder; and use of ultraviolet induced reduction followed by sulfur to form black silver sulfide tarnish.

In this paper, Hermite interpolation by parametric spline surfaces on triangulations is considered. The splines interpolate points, the corresponding tangent planes and normal curvature forms at domain vertices and approximate tangent planes at midpoints of domain edges. Two variations of the scheme are studied: C 1 quintic and G 1 octic. The latter is of higher polynomial degree but can approximate surfaces of arbitrary topology. The construction of the approximant is local and fast. Some numerical examples of surface approximation are presented. [ABSTRACT FROM AUTHOR]

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Argyria is a rare disease caused by prolonged skin contact with silver. Localized cases have been described regarding the use of topical medications, and trauma with objects containing this metal such as acupuncture needles and jewelry. Clinically, a macule or a patch, round or oval, appears in the infected area, with a characteristic bluey-gray color. To our knowledge this is the first time that this clinical condition has been described through the use of dermoscopy.A argíria é uma doença rara, causada pelo contato prolongado da pele com prata. Foram descritos casos localizados relacionados ao uso de medicamentos tópicos e traumas com objetos que contem esse metal, como agulhas de acupuntura e jóias, por exemplo. Clinicamente, aparecem máculas ou manchas redondas ou ovais na área afetada, com uma característica cor azul-acinzentada. Até onde sabemos esta é a primeira vez que este quadro clínico foi descrito através da dermatoscopia.

A 70-year-old male rural worker was referred to our clinic with widespread grey pigmentation of the skin and nails. The condition had been asymptomatic for its entire duration (5 years). He reported past intranasal application of 10% Silver Vitellinate. A skin biopsy was performed and histology corroborated the clinical diagnosis of Argyria. This case represents a currently rare dermatological curiosity. Although silver colloids and salts have been withdrawn and/or banned by some drug surveillance agencies, they continue to be freely sold and unregulated as food supplements and as ingredients in alternative medicines, thereby risking the emergence of new cases of silver poisoning.Um homem de 70 anos, trabalhador rural, foi referenciado à nossa consulta por dermatose assintomática, com 5 anos de evolução, caracterizada pela pigmentação acinzentada generalizada da pele, mais evidente em áreas fotoexpostas, e das lâminas ungueais. Relatava no passado o uso prolongado de Vitelinato de Prata a 10%, por via nasal. Foi efetuado exame histológico de biopsia cutânea que corroborou o diagnóstico clínico de Argiria. O caso representa uma curiosidade dermatológica, atualmente rara. Apesar de abandonados e/ou proibidos por algumas instituições de farmacovigilância, a prata coloidal e sais de prata continuam a ser comercializados como suplementos alimentares, como parte de medicinas alternativas e sem regulação, podendo fazer ressurgir os casos associados à toxicidade pela prata.

Localized cutaneous argyria is a rare condition secondary to skin deposition of silver following exposure to substances containing this metal. The clinical appearance and dermoscopy findings require deep melanocytic lesions and particularly melanoma metastasis to be ruled out. Silver deposits are usually confirmed by scanning electron microscopy and/or energy-dispersive X-ray spectroscopy. Herein we describe the in vivo reflectance confocal microscopy ( RCM) features observed in one case of localized cutaneous argyria. These features include the presence of a hyperrefractile network in the papillary dermis and a periadnexal dotted bright pattern. In vivo RCM might be a useful tool for an early diagnosis of this uncommon entity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this report is to present a case of a patient, metal foundry worker, who had been exposed to industrial silver salts for over 20 years. It is well established that chronic exposure to silver compounds can cause accumulation of silver deposits in various tissues. This condition is referred to as argyrosis or argyria, whereas changes related to eye tissues are defined as ocular argyrosis. Methods: A complete eye examination, corneal confocal microscopy, kinetic and static visual field test, posterior segment optical coherent tomography, pattern visual evoked potentials (PVEP), flash visual evoked potentials, multifocal electroretinogram, pattern electroretinogram (PERG), full-field electroretinography (FERG) and electrooculogram were all performed. Results: Eye examination revealed decreased visual acuity, corneal deposits and drusenoid changes within the macula. Although electrophysiology tests did not show changes in the function of retinal pigment epithelium, they revealed abnormal function of photoreceptors in the central and peripheral retina. PERG abnormalities and delayed latency of P100 wave in PVEP confirmed impaired function of the inner layers of the retina in the macular region. Conclusions: Corneal confocal microscopy and electrophysiological tests may help confirm the diagnosis of ocular argyrosis. [ABSTRACT FROM AUTHOR]

Background: Silver is a transition metal, toxic when ingested in significant amounts, causing argyria (skin deposition) and argyrosis (eye deposition). It is excreted mainly via the gastrointestinal tract with only small amounts eliminated by the kidneys, and rarely have cases of nephrotoxicity due to silver been reported. Here we present the case of a woman who used colloidal silver as an alternative remedy for a T cell lymphoma, who subsequently developed argyria and a pauci-immune crescentic glomerulonephritis with evidence of extensive glomerular basement membrane silver deposition.Case Presentation: A 47 year old woman of Indo-Asian descent with a T-cell lymphoma who refused conventional chemotherapy for 18 months but self-medicated with a remedy containing colloidal silver, was admitted with acute dialysis-dependent kidney injury. A kidney biopsy demonstrated a pauci-immune crescentic glomerulonephritis with deposition of silver particles in the mesangium and along the glomerular basement membranes. The patient was treated with intravenous methylprednisolone and intravenous cyclophosphamide and recovered independent renal function.Conclusion: Chronological evolution of the the pauci-immune glomerulonephritis suggests that a cellular immune-mediated process was induced, potentially mediated by lymphomatous T cells directed at the glomerular basement membrane, following silver deposition. Immunosuppressive therapy improved the situation and allowed cessation of haemodialysis, supporting the hypothesis of an immune-mediated process. [ABSTRACT FROM AUTHOR]

A biopsy specimen from the nasal mucosa of a 37-year-old man disclosed a subepithelial accumulation of black granules mainly running parallel to the surface in the absence of any inflammatory infiltrate. Since the mucosal pigment was negative with Perls’ stain and resisted to melanin bleach, an exogenous pigmentation was suspected. The biopsy specimen had been taken because of a diffuse steel-blue pigmentation of the nasal mucosa, incidentally discovered during routine clinical examination. A diagnosis of occupational argyria of the nasal mucosa was finally made since the patient was a silver cleaner. Argyria is a rare cause of nasopharyngeal mucosal pigmentation; it is not a precancerous condition, but it can be mistaken for a melanosis or a melanocytic tumor both clinically and histopathologically. Clinicopathological correlation is mandatory, since the final diagnosis is based on a history of chronic silver exposure. [ABSTRACT FROM AUTHOR]

Argyria is a benign skin disease characterized by blue to slate-grey discoloration that is caused by deposition of silver granules in the skin and/or mucus membranes as a result of long-term ingestion of ionized silver solutions or exposure to airborne silver particles. The skin discoloration can be generalized or localized and is exacerbated by sunlight. The skin discoloration is usually permanent, and until recently, there has been no effective treatment for argyria. Over the past 6 years, a number of case reports and one case series have described cases of argyria that were successfully treated with a 1064 nm Q-switched ( QS) neodymium-doped yttrium aluminium garnet (Nd: YAG) laser; however, a review of these studies has never been reported in the dermatologic literature. To review the use of the 1064 nm QS Nd: YAG laser for the treatment of argyria. A search of the National Library of Medicine's PubMed Database and the SCOPUS Database was performed to find articles that detailed the treatment of argyria with 1064 nm QS Nd: YAG laser. Six articles were selected for inclusion in this review. Each article was reviewed and summarized in a table. A 1064 nm QS Nd: YAG laser offers a novel and effective treatment for argyria. A systematic review of the dermatologic literature revealed a limited number of case reports and case series using this treatment. However, the results gleaned by the authors from the literature review provide important information to the clinician. For patients with argyria, a single pass of the 1064 nm QS Nd: YAG laser offers immediate, effective and sustained pigment clearing without any long-term adverse effects. [ABSTRACT FROM AUTHOR]

The section of Pathology of the Morgagni Museum of Anatomy at the University of Padua (Italy) holds a unique specimen of argyria, an alteration consisting in a blue-greyish coloration of the skin caused by an excessive exposure to chemical compounds of the element silver. It is a stuffed head of a nineteenth century man who decided to refuse traditional medicine and cure himself with a caustic silver nitrate known as "infernal stone" every day for years. The prolonged intake of silver led him to develop a widespread and irreversible state of argyria. Recently, new paleopathological and historical studies were performed on the specimen to confirm his condition and the potential consequences of a continued ingestion of caustic silver. Histological and ultrastructural investigations were combined with morphological analysis, demonstrating a high presence of silver in the dermis and epidermis and highlighting other chemical elements, potentially related to the "infernal stone" composition. The rediscovery of this case allowed performing a comparison with present-day cases, potentially revealing a common feature: further prolonged intake may lead to a possible dependence on silver compounds due to the perceived benefits, although not real. [ABSTRACT FROM AUTHOR]

The plant Argyreia nervosa(AN) of family convolvulaceaeis a medicinal plant contains Saponins which is used in the treatment of hyperlipidaemia. The main objective of the study is to evaluate the antihyperlipidaemic activity of ethanolic extract of Argyreia nervosa(EEAN) against Atherogenic diet & Triton-x100 induced hyperlipidaemia in rats for controllinghyperlipedemia. In order to assess hypolipidaemic effect, Argyreia nervosa extract was tested against two models such as Atherogenic diet or high fat diet induced hyperlipidaemia and Triton x-100 induced hyperlipidaemia. After the completion of the treatment, they were evaluated for serum total cholesterolTC, triglycerides TGS, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) andatherogenic index (AI) were compared with the rats treated with Atorvastatin (10 mg/kg) of the body weightThe lipid profile status ofAtherogenic diet induced model was found to be better than Test 1 concentration 200mg/kg and the positive control and the values are TC155.3 ±0.97, TGS97.9 ±1.75, HDL 55.3 ± 1.89, LDL75.6 ±1.519, VLDL23.11 ± 1.888 which reveals that EEAN in a concentration of 400mg/kg was more effective in lipid control and the values are TC162.5 ± 0.91, TGS111.6 ± 0.93, HDL 50.8 ± 0.583, LDL85.1 ± 1.315, VLDL25.66 ± 0.78(p<0.0001). Supplementation of EEAN in a concentration of 400mg/kg in model 2 shows a further reduction in the level of TCI74.6 ± 0.94, TGS92.5 ± 0.9914, LDL111.6 ± 1.67, VLDL26 ± 0.579 and an increased level of HDL33.6 ± 0.846 when compare to positive control (Atorvastatin 10mg/kg)TC160 ± 1.29, TGS 84 ± 2.29, HDL 42 ± 1.02, LDL 97.16 ± 0.875 and VLDL 29.2 ± 1.85. From the result it was revealed that, Airgyreia nervosa has hypolipidaemic activity by reducing the LDL, VLDL, Cholesterol, Triglycerides and increases HDL levels in the blood. [ABSTRACT FROM AUTHOR]

Highlights: [•] We review the oral toxicity of ionic, nanoparticulate and colloidal silver. [•] Effects of silver formulations on different organ systems are described. [•] We report dose levels responsible for the effects. [•] We discuss whether effects of silver nanoparticles are mediated by released ions. [•] We report a Margin of Safety of at least 5 before a level of concern is reached. [Copyright &y& Elsevier]

The Neotropical genus Catharylla Zeller, 1863 (type species: Crambus tenellus Zeller, 1839) is redescribed. Catharylla contiguella Zeller, 1872, C. interrupta Zeller, 1866 and Myelois sericina Zeller, 1881, included by Munroe (1995) in Catharylla, are moved to Argyria Hübner. Catharylla paulella Schaus, 1922 and C. tenellus (Zeller, 1839) are redescribed. Six new species are described by Léger and Landry: C. bijuga, C. chelicerata, C. coronata, C. gigantea, C. mayrabonillae and C. serrabonita. The phylogenetic relationships were investigated using morphological as well as molecular data (COI, wingless, EF-1α genes). The median and subterminal transverse lines of the forewing as well as the short anterior and posterior apophyses of the female genitalia are characteristic of the genus. The monophyly of Catharylla was recovered in all phylogenetic analyses of the molecular and the combined datasets, with three morphological apomorphies highlighted. Phylogenetic analyses of the morphology of the two sexes recovered three separate species groups within Catharylla: the chelicerata, the mayrabonillae, and the tenellus species groups. The possible position of Micrelephas Schaus, 1922 as sister to Catharylla, based on both morphological and molecular data, and the status of tribe Argyriini are discussed. The biogeographical data indicate that the chelicerata species group is restricted to the Guyanas and the Amazonian regions whereas the tenellus group is restricted to the Atlantic Forest in the South-Eastern part of Brazil. The mayrabonillae group is widespread from Costa Rica to South Bolivia with an allopatric distribution of the two species. COI barcode sequences indicate relatively strong divergence within C. bijuga, C. mayrabonillae, C. serrabonita and C. tenellus. [ABSTRACT FROM AUTHOR]

Argyria is an uncommon grey-blue pigmentation of skin and mucous membranes caused by prolonged silver exposure. The impetus behind this review is our experience with cases of generalized argyria resulting from a uniquely Indian socio-cultural practice and belief that it is under reported. Our objective is to increase the awareness for this esoteric entity through a review of the pertinent literature and to highlight clinical and histological features using our four well worked-up cases as examples. [ABSTRACT FROM AUTHOR]

Introduction: Silver-coated grafts are designed to prevent vascular graft infections. Silver is a safe element but toxic effects have been reported. We describe two cases of possible localized argyria after silver graft implantation. Report: Two patients presented with perigraft groin collections after implantation of silver grafts. During reoperation, an ashen-grey necrotic substance was seen surrounding the grafts. The grafts were explanted and lower limb perfusion restored. Cultures were negative and both patients had uneventful recoveries. Discussion: Our cases are highly suggestive of a possible unique adverse effect: a combination of localized silver toxicity and neutrophilic mediated tissue destruction. [Copyright &y& Elsevier]

Some implantable medical devices contain silver. We aimed to assess at what amount implanted silver becomes toxic. Silver was elevated in bodily fluids and tissues surrounding silver-containing implants. Silver released from implants also distributes to blood and other tissues; there is evidence to suggest silver can pass the blood-brain-barrier. Silver can be deposited as nano-sized particles in various tissues. Such particles, in addition to silver, often contain other elements too, e.g., selenium and sulfur. Silver released from implants seems to stay in the body for long periods (years). Reported excretion pathways following implantation are urinary and fecal ones. Reported toxicological effects were virtually all local reactions surrounding the implants. Argyria is a blue-gray discoloration of the skin due to deposited silver granules. Localized argyria has been described after the implantation of acupuncture needles and silver-coated prostheses, although the presence of silver was tested only for and shown in the former. Other toxicological effects include local tissue reactivity and examples of neurotoxic and vascular effects. We did not include genotoxicity studies in the present publication as we recently evaluated silver to be genotoxic. Carcinogenicity studies were absent. We conclude that local toxicity of implanted silver can be foreseen in some situations.

This case report describes the clinical, autofluorescence, and optical coherent tomography findings in a patient with panocular argyrosis secondary to chronic intake of diluted silver nitrate salts in his water supply. An 86-year-old Caucasian male with a distinctive gray-bluish hue of the skin presented to our clinic, having developed a slow decrease in visual acuity in both eyes and nyctalopia for the past 2 years. Based on the patient's history of chronic intake of silver nitrate salts and a positive skin biopsy (performed by the dermatology department, data not shown), a diagnosis of panocular argyrosis was made. Fluorescein angiography showed choroidal blockage with a completely dark choroid. Fundus autofluorescence was within normal limits. Optical coherent tomography showed multiple excrescences of retinal pigment epithelium in both eyes. Although the drusen-like changes on fundus examination and retinal pigment epithelium changes may account for the diminished vision, the presence of concomitant nyctalopia suggests underlying damage of the photoreceptors. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 65-year old mother and a 26-year old daughter with argyria. The patients experienced diffuse graying of the skin after the ingestion of colloidal silver. The article discusses argyria, considering its treatment through the quality-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser.

Objective: To study the analgesic activity of ash of silver used in Indian system of medicine and to explore its safety. Materials and Methods: Albino mice of either sex (20-30 gm) were used to investigate the role of ash of silver against noxious stimuli: thermal (Eddy's hot plate and analgesiometer), mechanical (tail clip), and chemical (0.6% acetic acid induced writhing). An effort was made to find nature and site of action of ash of silver following naloxone pre-treatment. Maximum tolerated dose (MTD) and lethal dosage 50 (LD50) were also studied along with toxicological aspects of ash of silver. Results: Test drug (ash of silver) at a dose of 50 mg/kg p.o exhibited analgesic activity against thermal, mechanical, and chemical stimuli. Analgesic effects were compared with the standard drug, morphine, in thermal and mechanical noxious stimuli and to aspirin in chemical stimulus. Analgesic activity of the test drug was reduced following naloxone pre-treatment. MTD was found out to be greater than 1.5 g/kg p.o. LD50 was 2 g/kg p.o. Fraction of mice showed symptoms of argyria as explained by autopsy reports. Conclusion: Test drug exhibited moderate analgesic activity at 50 mg/kg p.o against all type of noxious stimuli, also suggesting a role of opioidergic system. The ash of silver was been found to be safe upto a dose of 1.5 g/kg p.o. in mice without any untoward toxicity. Further studies are required to explore the effect of ash of silver on pain mediators and excitatory neurotransmitters like glutamate, aspartate, or N-methyl-D-aspartic acid (NMDA). [ABSTRACT FROM AUTHOR]

We describe a 53-year-old man in good general health who presented with an 8-month history of progressive gray hyperpigmentation of the face. He denied using any prescription medications; however, he admitted to taking a herbal supplement. Clinically, the differential diagnosis included hemochromatosis, Wilson's disease and hyperpigmentation secondary to supplement use. Punch biopsies from the left forehead and preauricular region showed heavily sun-damaged skin with a minimal inflammatory infiltrate. Closer inspection, however, revealed minute scattered black/brown particles distributed in the basement membrane zone of eccrine and sebaceous glands. Similar particles were also present in hair follicles, blood vessels and arrector pili muscles. The particles did not stain with Gomori methenamine silver, Fontana-Masson or iron stains. Electron microscopy with energy-dispersive x-ray analysis showed numerous particles, less than 1 µm in greatest dimension, which showed peaks for silver and sulfur. This analytical result confirmed the impression of argyria. Further history revealed that the patient had indeed been taking a silver supplement for several months under the premise that it would boost his immune system. This case is unique in that the patient's hyperpigmentation developed in a short period of time as compared with other reports in the medical literature. Bowden LP, Royer MC, Hallman JR, Lewin-Smith M, Lupton GP. Rapid onset of argyria induced by a silver-containing dietary supplement. [ABSTRACT FROM AUTHOR]

The main objective of this article is the implementation of knowledge in organizations, taking place in the context of development projects. Some of the issues discussed are: What kind of learning conditions do the development projects have to offer? What are the causes and consequences of different levels of engagement from the staff in the projects? Why is often so difficult to transfer what is learned or implemented by the organization during the projects to the everyday activities of the organization after the finishing of projects? In the article a typology of development projects is presented and discussed as different ways of framing the organizational learning processes. The article is based on an empirical study of four organizational development projects (covering the organizations as a whole) run by four Danish upper secondary schools("gymnasium"). The study included questionnaires as well as interviews with the management and staff, plus a survey of selected written materials and documents. In the various ways in which different groupings among the staff and the management are relating to the project are described. A special focus is set on the different perspectives on the projects established by the staff and the management and how the perspectives have consequences on the actual learning outcomes of the different groups in the organization. Another issue is the weak links between what is experienced by the staff as 'ordinary problems' his objectives and goals of the development projects. The theoretical frame of analysis has references to the 'outside-in' perspective on organizational learning, presented by the neo-institutional theory (Scott 1995 DiMaggion& Powell 1983, Czarniawska & Sevon 2005, Røvik 2007) Nanoka and Takeuchis model of knowledge transformations in organizations (Nonaka & Takeuchi 1995) and of the forms of the knowledge), Argyris and Ellström's distinction between the learning modes of correction and development (Ellström 2001, Argyris 1992). [ABSTRACT FROM AUTHOR]

Nanosilver is one nanomaterial that is currently under a lot of scrutiny. Much of the discussion is based on the assumption that nanosilver is something new that has not been seen until recently and that the advances in nanotechnology opened completely new application areas for silver. However, we show in this analysis that nanosilver in the form of colloidal silver has been used for more than 100 years and has been registered as a biocidal material in the United States since 1954. Fifty-three percent of the E PA-registered biocidal silver products likely contain nanosilver. Most of these nanosilver applications are silver-impregnated water filters, algicides, and antimicrobial additives that do not claim to contain nanoparticles. Many human health standards for silver are based on an analysis of argyria occurrence (discoloration of the skin, a cosmetic condition) from the 1930s and include studies that considered nanosilver materials. The environmental standards on the other hand are based on ionic silver and may need to be reevaluated based on recent findings that most silver in the environment, regardless of the original silver form, is present in the form of small clusters or nanoparticles. The implications of this analysis for policy of nanosilver is that it would be a mistake for regulators to ignore the accumulated knowledge of our scientific and regulatory heritage in a bid to declare nanosilver materials as new chemicals, with unknown properties and automatically harmful simply on the basis of a change in nomenclature to the term "nano". [ABSTRACT FROM AUTHOR]