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Finally, to conclude with the external causes, beside the parasitic dyschromias whose etiology seems to October 23. 1920.] NEWS ITEMS. 641 he complex, it may seem logical to include those which are secoiidarj- to ibuprofen motrin the dermatoses, such as the bullae of pemphigus, herpes zoster, boils, papulone- crotic tuberculides, etc.. as well as syphilitic lesions. The macula of roseola, secondary ibuprofen mg papules, and ulcer- ating lesions are the starting points of pigmentary change in which either a melanodermia or a more or less atrophic leucodermia are observed. Still other causes of dyschromia have been in- \oked. both general and internal, whose mechanism has been diversely ibuprofen and motrin interpreted. Among them hyper- emia should first be mentioned : it unquestionably in- tervenes in pigmentations having a local or external cause, for example, the melanodermia advil ibuprofen occurring on varicose limbs. Lesions of the suprarenal capsules have for some time been recognized as a cause of the melanodermia of Addison's disease, but space forbids a discussion as to what extent renal insuffi- ciency or lesions of the pericapsular nervous plexus act as factors. If suprarenal insufficiency is incrim- inated, it should be pointed out that normally the suprarenals destroy pigment or a ibuprofen use pigmentogemous substance and that when diseased they cannot do so. Or if a sympathetic theory is maintained, it will be said that when irritated a hyperactivity of the cells secreting pigment occurs. The sympathetic and cerebrospinal sj'Stems undoubtedly play a part in many dyschromias, as in leprosy, vitiligo, and the so- called primary piginentation dose for ibuprofen dosage ibuprofen of syphilis. The latter does not belong exclusively to lues because it has been observed in tuberculosis and chlorosis. acetaminophen or ibuprofen On the other hand, in many ways it is similar to the chloasma of pregnancy and Addison's disease, and it may well be asked if the syphilitic dyschromia is not also conse- cjuent upon some disturbance of the pericapsular nerves dose of ibuprofen resulting from the Spirochasta pallida. Other dyschromias have been regarded as due to hematic changes such as malarial melanodermia and perhaps bronze diabetes. According to Diday the blood of syphilitics undergoes a peculiar ibuprofen acetaminophen change in its coloring matter which allows it to become de- posited in the tissues. If for any reason congestion arises, with a consequent increase of the blood in the skin, it will progressively infiltrate the integuments and finally the coloring matter will come acetaminophen with ibuprofen near enough to the surface to produce a perceptible change in hue. Petresco likens the mechanism of the pigmentary syphilide to that observed in paludism ; there is an exaggerated deposit of hemoglobin coming from the destroyed red blood corpuscles, hence melanin and its deposit motrin is ibuprofen in the tissues. Other observers have thought that the presence of bile pigments in the blood might be the origin of a good number of dys- chromias, and perhaps sjphilis, which does not spare the liver, produces pigments in this way. Finally certain disturbances of pigmentation have a advil and ibuprofen toxic origin, such as arsenical melanodermia and argyria. Although the etiology of dyschromia is poorly under- stood, this process can be divided into primary and secondary tj'pes. The first or spontaneous type is not preceded by an eruptive element. Secondary pigmentations are those succeeding an eruptive ele- ment, which was seated at the spot where the dys- chromia, melanodermia, or achromia, according 600 ibuprofen to the case, ultimately arises. In the first group can be placed the melanodermia of Addison's disease, lentigo and chloasma of pregnancy. In the second group of secondary dyschromias are the melanoder- mias or achromias following some local dermatosis, such as pemphigus, lichen planus and varicose ulcer. MUSIC WITH WORK. Transplanting rice in the Philippines costs about forty centavos a day, with two meals, cigarettes and betel nut, but when music is provided the out- dosage for ibuprofen put of work is increased thirty per cent. It is often a blind man who plays. He sits on the low ibuprofen and acetaminophen rice dyke and sings the old folk songs to his guitar, and frequently the workers join in the dosage of ibuprofen chorus. Some of the large stores in the States also tried the effect dose ibuprofen of music, with good results. \\"e have not heard much lately concerning music in hospitals and use of ibuprofen oper- ating rooms ; perhaps the patients were of the same opinion as the Socialist press, which says that all this welfare work is enlightened selfinterest. It proceeds without taking the trouble to find out whether such patronizing efforts are desired or appreciated.

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