Argyria resulting from intranasal medication

331

ABSTRACTS

eczematoid d&thesis has a characteristic blood sugar a relative initial h-glycemia, an absence of the sugar increase following adrenalin, and a negative imposed tests.

tolerance hypoglycemic summative

curve

consisting in dip, a minimal effect with super-

Assuming a neurohormonal regulation of carbohydrate metabolism, there would seem to be a partial hypofunction of the hypophysis, adrenal, and pancreas, as well as poor glycogen formation in the liver. This disturbance of internal glandular secretion is established early in life and may even be congenital. The signs of allergy which often accompany exudative eczema usually make their appearance in later years and probably are not closely related to the disease.

Rhinology UNDER

THE

DIRECTION

and Ophthalmology

OF FRENCH

K. HANSEL,

M.D.,

ST. LOUIS

Cheilitis, Fixed Drug Eruption, and Gastrointestinal Allergy From Eosin Dye of Lipstick. Hecht, R., and Rappaport, B. Z.: J. A. M. A. 113: 2410, 1939. Hecht and Rappaport report a very interesting case of cheilitis with fixed drug eruption and gastrointestinal allergy from the eosin dye of lipstick. After x clinical investigation and patch testing, it was found that the symptoms were caused by the dye in a lipstick, tetrabromofluorescein. Upon avoidance of this preparation, the cheilitis and dermatitis of the face subsided. It is especially noteworthy that the gastrointestinal symptoms also subsided. It was finally concluded that the general use of lipsticks containing tetrabromofluorescein or similar dyes by American women may explain many obscure cutaneous eruptions, especially of the fixed type, and may explain some cases of gastrointestinal disturbances of the nature of spastic or mucous colitis.

Is the X-ray Examination of Transillumination? Waldapfel,

the

Maxillary

R.:

Sinus

Laryngoscope

Superior

50:

to

the

Simple

63, 1940.

Some difference of opinion has existed for some time as to the comparative value of transillumination and x-ray of the sinuses. It is generally agreed, however, that the x-ray is more exact and a more definite method of diagnosis. Waldapfel states that, in the simple transillumination, a difference in darkness of the maxillary sinus can be caused, not only by a disease of the ,sinus, but also by asymmetry of the two sinuses and varied thickness of the bone. These physiologic anomalies do not play a part in the x-ray examination and do not influence the results. He further points out that, apart from disease of the maxillary sinus itself, darkness in transillumination can be caused, not only by thickness of the bony walls and asymmetry of the maxillary sinus, but also by infiltration of the soft parts, even of the slightest degree. In such instances the transillumination may show more than the x-ray. Complete or massive cloudiness in transillumination with negative x-ray findings is to be regarded as significant of infiltration of the soft parts or subcutaneous edema or hematoma, even if no swelling or discoloration of the skin is evident.

Argyria 31: In often

Resulting 127,

From Intranasal

Medication.

Bryant,

B. L.:

Arch.

Otolaryng.

1940.

the local employed.

treatment of nasal allergy, Prolonged use of silver

preparations salts may

containing silver salts result in the production

are of

332

THE

JOURNAL

OF

ALLERGY

general argyria. Bryant reports the case of a patient who was treated daily for three months with a 10 per cent solution of mild protein silver in the form of Dowling packs for the relief of symptoms indicative of chronic ethmoiditis. IJpon examination, the entire nasopharynx looked as though it had been sprayed with soot, and the nose showed that every millimeter of the mucosa was almost The only other areas of pigmentation were the finger nai1.s and the conblack. ,junctiva of the lower lids. Several months after the discontinuation of the treatment with the silver protein, the nasal membranes had lightened considerably, indicating that absorption does take place directly from the site of application, despite the rather widespread opinion that the silver is absorbed only from the intestinal tract. Bryant suggests that reduction and absorption must occur at the site of application. Relation Allergy Arch.

of

Allergy in Cases Otolaryng.

and Tonsillectomy in of Routine Tonsillectomy. 31: 45, 1940.

Children. Hansel,

Incidence F. K.,

of and

Respiratory (‘hang, cf. 8.:

In the management of frequent colds, sinusitis, bronchitis, and recurrent Hansel and Chang emphasize consideration of allergy as a possible pneumonia, who were seen routincl! etiological factor. In an investigation of ZOO children for the consideration of removal of tonsils and adenoids, a definite diagnosis of Six of the patients had hay allergy was established in twenty-six, or 1:: per cent. fever. It was further stressed that these cases of respiratory allergy may 1~ overlooked unless an adequate history, physical examination, and cytologic atu(lies are carried out in each instance. Removal of the tonsils and adenoitls in allergic* children should not be performei( during a hay fever season, and the indications The tonsils :in(l for operation should be the same as in nonallergic children. adenoids should not be removed with the idea of alleviating allergic symptoms. Nasal Sinusitis and Asthma: Arch. Otolaryng. 30: 1051,

A Thesis. 1939.

Kackemann,

F.

Jl.,

and

Weille,

1’. L.:

Hxckemann and Weille discuss the relationship of disease of the paranasal sinuses and asthma. In a large series of cases in which operative procedures were performed upon the sinuses, they found t,hat, in general, the end results are often disappointing. Among the cases in which tissue from the antra was studied microscopically, pus pockets were found in the mucosa in about 10 per cent of the cases. No definite relationship was noted between the results of operative treatment and the degree of improvement of the asthma. They notell, for example, that in some instances asthma was relieved for months or years, but they state that the chances were almost, nine out of ten that sooncr or later %hr asthma would recur. Rackemann and Tobey emphasize the point that sinusitis is a part of the asthmatic syndrome, and not the cause of it. In al)out one-thirtl of the new patients with asthma which they observed, operatious had xlreatl) been done on the nose or on the nose and sinuses. -4bout one-half of the patients had lesions at the time of the examination. It was finally concluded tllilt, if tllr nature of the sinal lesion indicates operation for itself without regard to the astlmla, operative treatment will do good, but the good will be onlv partial and 0111~ temporary in most cases I ecause the sinxl lesion is a part of the picture and not :I cause of it.