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Argyria: clinical implications of exposure to silver nitrate and silver oxide.

This article reports the clinical findings in a work force of 30 individuals who were exposed to silver nitrate and silver oxide. Six individuals had argyria and 20 had argyrosis (deposition of silver in the eye). Measurements of blood silver levels were included as part of the examination. The results of this examination generally support the benign nature of argyria, although the question of silver causing a decrement in kidney function and night vision is not settled. Periodic slit lamp examinations as well as monitoring of silver air concentrations are necessary to assure that engineering controls are actually limiting worker exposure to silver.

Adult

A modified method for the differential staining of spermatozoa using alcoholic acidic silver nitrate.

Differential silver staining patterns have been demonstrated in mammalian spermatozoa, using an aqueous silver nitrate reagent. In the present study, mouse, rabbit, and human spermatozoa were stained using a modification of the earlier method. In the modified method, an alcoholic acidic silver nitrate stain, with subsequent differentiation in alcoholic ammonia, was used. This method enhanced the intensity of staining of the head, mid-piece, and tail. In particular, marked differentiation of the acrosomal, subacrosomal, and postacrosomal regions was obtained, which facilitated determination of acrosomal integrity. Moreover, background interference was reduced, yielding better clarity of the stained smears. The staining was carried out in the cold. This modified technique offers an advantage in the assessment of sperm morphological anomalies and membrane and acrosomal integrity, and is a simple, reliable, and useful method for the evaluation of sperm function.

Acrosome

The early development of the human skeleton: a radiographic study of fetuses impregnated with silver nitrate.

The use of a silver nitrate impregnation technique and radiography for delineation of the bones of the developing skeleton is not widely known. Using this method, a study of skeleton development was undertaken over a three-year period and special attention was paid to 20 fetuses under the age of 16 weeks. The dates at which ossification in cartilage occurred and the sequence of bone development were noted. Although the technique may be used to delineate skeletal dysplasias in the stillborn, it is best suited to fetuses aged 9--20 weeks. It may become possible to show the earliest age at which bone dysplasias affect the skeleton though this is speculative at the moment.

Bone Development

Systemic argyria secondary to topical silver nitrate.

A case of generalized argyria secondary to topical silver nitrate use on the oral mucosa is described, and the nature and history of argyria reviewed. The patient has extreme pigmentation of her skin and abdominal viscera, as seen on physical examination, gastroduodenoscopy, and laparotomy. Her use of silver nitrate applicators was uncontrolled by her dentist and pharmacist, and the diagnosis of argyria was not made until 2 1/2 years of heavy usage had passed. Avoidance of similar cases requires the careful scrutiny of silver-containing medicinal usage by all health practitioners and pharmacists. Although the systemic distribution of silver in both elemental and ionic forms can be linked with no systemic toxicity, the resultant pigmentation can be devastating to the patient.

Argyria

Topical chemoprophylaxis with silver sulphadiazine and silver nitrate chlorhexidine creams: emergence of sulphonamide-resistant Gram-negative bacilli.

Controlled trials of 0.5% silver nitrate compresses (SN), 1% silver sulphadiazine cream (SSD), and a cream containing 0.5% silver nitrate and 0.2% chlorhexidine digluconate (SNC) showed that all were comparably effective in protecting burns from infection. SN compresses were much less active against miscellaneous Gram-negative bacilli than the other preparations, and the mean morning and evening temperatures and respiration rates in the patients treated with SN compresses were higher then those of patients treated with SSD. Pseudomonas aeruginosa and Proteus spp, though rare in all groups, were less often found in the patients treated with SN compresses. Sulphonamide-resistant Gram-negative bacilli became predominant during the trial of SSD cream on extensive burns and the prophylactic effectiveness of that preparation was thus reduced in the later stages of the trial.

Administration, Topical

Efficacy of ammoniacal silver nitrate in root canal therapy.

In order to find a simple and effective method for endodontic treatment of recalcitrant cases, the efficacy of ammoniacal silver nitrate was re-evaluated. The modified serial tube dilution method was conducted to determine the effective antimicrobial concentration of ammoniacal silver nitrate on selected test microorganisms and clinical isolates. The effective antimicrobial concentration for the most resistant microorganism, Streptococcus faecalis, was 5.0 X 10(-10) g/ml and the effectiveness persisted for several days. The diffusion ability of 4% ammoniacal silver nitrate into the dentinal tubules from root canal wall was also tested with freshly extracted teeth treated as in routine procedure for root canal therapy. The diffusibility was evident and the extent of infiltration was various, with more infiltration at cervical dentin than at apical one.

Ammonia

Anuria following silver nitrate irrigation for intractable bladder hemorrhage.

Intravesical silver nitrate has been used for intractable bladder hemorrhage. A case of anuria resulting from this technique is reported. The etiology of anuria in this patient was probably owing to obstruction from deposition of silver salts. The level of obstruction was the ureterovesical junction on 1 side and the collecting ducts at the renal papillae on the other side. Therapy consisted of vigorous endoscopic evacuation of deposited silver salts from the bladder and hemodialysis with good results.

Adult

Neutralization effect of some agents on the antimicrobial activity of ammoniacal silver nitrate.

The effect of some agents on the antimicrobial activity of ammoniacal silver nitrate, an endodontic medicament, was tested with Streptococcus faecalis by the serial tube dilution method. Its results indicated that sodium hypochlorite, hydrogen peroxide, and blood had a marked inhibitory effect. However, the presence of dentin, necrotic tissue, saliva, and hydrogen sulfide gas liberated from protein decomposition showed no or little effect on the antibacterial properties of the chemical. Since antiseptics or antibiotics generally may be decomposed by necrotic tissues, these findings suggested that the use of ammoniacal silver nitrate not only may resolve the problem of recalcitrant cases in endodontic treatment but also may simplify the disinfecting procedure for root canals.

Animals

Is alcoholic acidic silver nitrate reagent really specific for the histochemical localization of ascorbic acid.

The histochemical localization of ascorbic acid in plant tissues with the alcoholic acidic silver nitrate reagent is shown here to be not specific for ascorbic acid, since some of the polyphenolic substances, including flavonoids, which are known to be widely distributed in plant tissues, are also able to reduce the acidic alcoholic silver nitrate reagent at low temperature (0-4 degrees C) and at pH 2 to 2.5 in dark. This method may perhaps be used for animal tissues where flavonoid pigments do not occur in such large quantities as they do in plants. I therefore, come to the inevitable conclusion that the use of alcoholic acidic silver nitrate reagent in localizing ascorbic acid in plant tissues may be highly misleading.

Ascorbic Acid

Silver nitrate ophthalmic solution and chemical conjunctivities.

The current status of nursery routines of prophylaxis against ophthalmia neonatorum were surveyed by mail questionnaire to 100 leading maternity hospitals. More than 20% of the respondents were not using silver nitrate, mainly because of chemical conjunctivitis. The clinical significance and incidence of chemical conjunctivitis were studied in 1,000 newborns whose eyes were handled differently. Rinsing after instillation of silver nitrate does not reduce the conjunctival irritation. Although 90% of the infants had conjunctivitis in the first hours of life, the majority cleared within 24 hours. Chemical conjunctivitis did not increase secondary infection, neither did it mask bacterial infection. Silver nitrate is effective in vitro against Neisseria gonorrhoeae and Staphylococcus aureus in a concentration of 0.1% and against Escherichia coli in a concentration of 0.01%.

Conjunctivitis

A comparison between low background silver diammine and silver nitrate protein stains.

Several methods of silver staining of proteins after sodium dodecyl sulfate-electrophoresis in polyacrylamide gels were compared. The most rapid methods were found to be less sensitive than more time-consuming methods. Among the long methods, those using glutaraldehyde treatment of the gel and silver diammine complex as the silvering agent were found to be the most sensitive, at the expense of the use of a modified polyacrylamide matrix and higher silver concentrations.

Ammonia

Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.

From November, 1989, to October, 1991, 4544 neonates were born at our hospital. Neonatal ocular prophylaxis immediately after birth was used with 1% tetracycline ophthalmic ointment in 1156 neonates, 0.5% erythromycin ophthalmic ointment in 1163 neonates and 1% silver nitrate drops in 1082 neonates. No prophylaxis for neonatal conjunctivitis was given to 1143 neonates. A total of 302 infants (6.7%) developed conjunctivitis during the first 4 weeks of life. Between December, 1991, and January, 1992, 425 neonates were born at our hospital and all were given 0.5% erythromycin ophthalmic ointment twice in the first 24 hours after birth for ocular prophylaxis. Thirty-one (7.3%) infants developed conjunctivitis during the neonatal period. The incidence rates of neonatal chlamydial conjuctivitis in the tetracycline, erythromycin, silver nitrate, no prophylaxis and erythromycin twice groups were 1.3, 1.5, 1.7, 1.6 and 1.4%, respectively. We conclude that neonatal ocular prophylaxis with erythromycin (one or two doses) or tetracycline or silver nitrate does not significantly reduce the incidence of neonatal chlamydial conjunctivitis compared with that in those given no prophylaxis.

Conjunctivitis, Bacterial

Treatment of allergic and vasomotor rhinitis by the local application of different concentrations of silver nitrate.

In 1980, Bhargava et al. reported a new treatment of allergic and vasomotor rhinitis by the local application of 15 per cent silver nitrate. The results of further studies of the treatment by using different concentrations of silver nitrate ranging from 5 per cent to 25 per cent and normal saline as placebo are presented here; 15 per cent has been found to be the most effective concentration giving successful results in 75.7 per cent of cases. It is applied to the anterior portion of both inferior turbinates and the anterior part of the nasal septum once a week on five occasions. Best relief was obtained from the most annoying symptoms of sneezing and rhinorrhoea. Asthma was controlled in 50 per cent of such patients who had attacks of allergic rhinitis followed by asthma. For this widely prevalent disease, the treatment was found to be simple, easy and useful, with negligible side-effects.

Administration, Topical

Correspondence of silver nitrate staining patterns in decalcified bone withe the microradiographic image.

A procedure for differential staining of decalcified bone with silver nitrate showed major histological features which appeared to correspond closely to microradiographic images. The extent to which this is actually the case was investigated directly by preparing microradiographs of ground sections of baboon and dog radii and then decalcifying and staining the same sections. The many detailed similarities indicate that this staining procedure is a useful adjunct to microradiography. Thus, poorly mineralized osteons or layers of circumferential lamellae are darker stained by silver nitrate, and the variably mineralized layers of circumferential lamellae are closely duplicated by light and dark bands in the stained sections. These similarities imply that there is a relationship between the mineral density of bone and some condition of the organic matrix which is probably related to maturation changes in the collagen.

Age Factors

Combined methenamine-silver nitrate and hematoxylin & eosin stain for fungi in tissues.

Initial examination of hematoxylin & eosin-stained tissue from a human brain specimen did not reveal the fungi which were seen in subsequent tissue sections stained with methenamine-silver nitrate. Microabscesses seen in the hematoxylin & eosin-stained sections were not apparent in the methenamine--silver nitrate-stained tissue. Staining with methenamine--silver nitrate and counterstaining with hematoxylin & eosin proved excellent not only for detecting fungus cells, but also for revealing their relationship to the host cellular response in this case and in examples of experimental murine coccidioidomycosis and histoplasmosis.

Animals

Effect of silver nitrate application on the conjunctival flora of the newborn: and the occurrence of clostridial conjunctivitis.

Newborn conjunctival cultures were obtained from 35 babies prior to silver nitrate application and 48 hours later. On initial culture, 46 facultative bacteria and 27 anaerobes were recovered; 48 facultative and 18 anaerobes were recovered after 48 hours. Haemophilus vaginalis, Bacteroides species and anaerobic cocci decreased in numbers, whereas S. epidermidis, Micrococcus and Propionibacterium acnes increased during this time interval. Clostridial species were isolated from two cases who developed conjunctivitis, along with Peptostreptococcus in one of the cases. In vitro experiments demonstrated lack of killing of C. perfringens in silver nitrate concentrations of 0.1 percent, even after 24 hours exposure.

Bacteria

Silver nitrate irrigation to control bladder hemorrhage in children receiving cancer therapy.

Silver nitrate irrigations after cystoscopic evacuation of clots stopped intractable hemorrhage from the bladder in 8 of 9 children who had received cyclophosphamide and/or pelvic irradiation for various malignant diseases. This method of management produces fewer adverse side effects yet appears to be as effective as the more drastic measures of control, such as cystectomy or colocystoplasty.

Cautery

Salmonella typhimurium resistant to silver nitrate, chloramphenicol, and ampicillin.

A strain of Salmonella typhimurium appeared sequentially in three patients in a burn unit, and epidemiological study suggested the occurrence of person-to-person spread. This organism was responsible for both colonisation and invasive infection in these patients whose burn surfaces were receiving topical treatment with 0.5% silver nitrate (AgNO3) solution. The antibiotic and metal ionsusceptibility pattern of this strain of S. typhimurium was unique and disturbing: resistant to silver nitrate, mercuric chloride, ampicillin, chloramphenicol, tetracycline, streptomycin, and sulphonamides. This pattern of multiple resistances could be transferred by invitro mating experiments to sensitive recipient strains of Escherichia coli and S. typhimurium. Further transfer of these resistances could be consumated between different strains of E. coli. A survey of other salmonella strains isolated from patients in this hospital without thermal burns did not reveal this pattern of resistance. Also, strains of S. typhimurium, isolated elsewhere and showing simultaneous resistance to both ampicillin and chloramphenicol, were not resistant to AgNO3 in vitro. The very real danger of this strain of S. typhimurium in burn units stems from its resistance to the two most effective antibiotics (ampicillin and chloramphenicol) available for systemic therapy; and this threat may be compounded through the selection effected by the widespread topical use of AgNO3 solutions and sulphonamide preparations on burned surfaces.

Adult