Pompholyx of the hands and feet

The term pompholyx, both because of historical priority and because it does not convey misleading implications about etiology, is the preferable designation for this condition. Irrespective of its localization, the primary lesion is the same: a deep-seated, sago-grain-like, pinpoint to pinhead size blister or pustule, embedded in the normal skin, primarily without inflammatory reaction, and appearing suddenly. Pompholyx, as microbiologic, histopathologic and immunologic investigations have proved, is an endoparasitic-hematogenous eruption, having a characteristic localization. It is caused by the circulating endoparasite,B. endoparasiticus Benedek, 1927. Due to an universal infection immunity it is not infectious and not transmissible. Other microorganisms, like hyphomycetes, yeastlike organisms, common bacteria, etc. play no causative role in any phase of the condition. Dermatophytes, molds as well as yeastlike organisms which may be found in the roof of the blisters and other scrapings of diseased tissues are incidental nosoparasites. Extensive statistical analysis is presented about the occurrence of pompholyx on the hands and feet in military personnel and in civilian patients. Pompholyx has only one etiologically directed therapy: the specific vaccine ofB. endoparasiticus. The vaccine is prepared from the S-type of the bacilli, cultured from the blood.     

Knuckle-walking and the evolution of hominoid hands

Knuckle-walking is a pattern of digitigrade locomotion unique to African apes among Primates. Only chimpanzees and gorillas are specially adapted for supporting weight on the dorsal aspects of middle phalanges of flexed hand digits II–V. When forced to the ground, most orangutans assume one of a variety of flexed hand postures, but they cannot knuckle-walk. Some orangutans place their hands in palmigrade postures which are impossible to African apes. The knuckle-walking hands and plantigrade feet of African apes are both morphologically and adaptively distinct from those of Pongo, their nearest relative among extant apes. These features are associated with a common adaptive shift to terrestrial locomotion and support placing chimpanzees and gorillas in the same genus Pan. It is further suggested than Pan comprises the subgenera (a) Pan, including P. troglodytes and pygmy chimpanzees, and (b) Gorilla, including mountain and lowland populations of P. gorilla. African apes probably diverged from ancestral pongids that were specially adapted for distributing their weight in terminal branches of the forest canopy. Early adjustments to terrestrial locomotion may have involved fist-walking which later evolved into knuckle-walking. Orangutans continued to adapt to feeding and locomotion in the forest canopy and their hands and feet became highly specialized for four-digit prehension. Although chimpanzees retained arboreal feeding and nesting habits, they moved from tree to tree by terrestrial routes and became less restricted in habitat. While adapting to a diet of ground plants gorillas increased in size to the point that arboreal nesting is less frequent among them than among chimpanzees and orangutans. Early hominids probably diverged from pongids that had not developed prospective adaptations to knuckle-walking, and therefore did not evolve through a knuckle-walking stage. Initial adjustments to terrestrial quadrupedal locomotion and resting stance probably included palmigrade hand posturing. Their thumbs may have been already well developed as an adaptation for grasping during arboreal climbing. A combination of selection pressures for efficient terrestrial locomotor support and for object manipulation further advanced early hominid hands toward modern human configuration.     

When the hands speak.

In the present review we will summarize evidence that the control of spoken language shares the same system involved in the control of arm gestures. Studies of primate premotor cortex discovered the existence of the so-called mirror system as well as of a system of double commands to hand and mouth. These systems may have evolved initially in the context of ingestion, and later formed a platform for combined manual and vocal communication. In humans, manual gestures are integrated with speech production, when they accompany speech. Lip kinematics and parameters of voice spectra during speech production are influenced by executing or observing transitive actions (i.e. guided by an object). Manual actions also play an important role in language acquisition in children, from the babbling stage onwards. Behavioural data reported here even show a reciprocal influence between words and symbolic gestures and studies employing neuroimaging and repetitive transcranial magnetic stimulation (rTMS) techniques suggest that the system governing both speech and gesture is located in Broca's area.     

Discoid eczema of the hands

In general it is probable that round or oval, rather defined groups of fine vesicles (or crusting that results from former vesicular eruption) recurring in the same location like a "fixed drug eruption" is a particular type of eruption deserving a distinct name. The morphological features and the clinical course of repeated recurrences, always in round or oval areas, seem to make the term "discoid eczema of the hands" an appropriate one for the disease.A feature that distinguishes discoid eczema of the hands from infectious dermatologic conditions which it most closely resembles clinically, is the response of the disease to dietary therapy. A simple elimination diet was used with good effect in 20 cases of the disease reported upon herein.     

Coronary stent healing, endothelialisation and the role of co-medication

Since the second half of 2006 percutaneous coronary revascularisation using drug-eluting stents (DES) has come under the scrutiny of the general cardiology community. The initial favourable reports and publications on the merits of DES suddenly changed due to more or less qualified new data on complications such as late stent thrombosis. It seems that the commotion about late stent thrombosis has been over-emphasised, considering the publications that followed from the randomised controlled trials published together in one issue of the New England Journal of Medicine earlier this year.1 The main message from these publications was that indeed late stent thrombosis occurred, but also in the bare metal stent (BMS) groups. However, the debate was further fuelled by data showing that in pathological specimens from autopsy studies more fibrinoid and less endothelialisation could be demonstrated in DES.     

The survival and transfer of microbial contamination via cloths, hands and utensils

Survival and transfer of bacteria from laminated surfaces and cleaning cloths were investigated under laboratory conditions. Drying produced substantial reductions in numbers of recoverable organisms and achieved satisfactory decontamination of clean laminate surfaces. On soiled surfaces and on clean and soiled cloths, Gram-positive and some Gram-negative species survived for up to 4 h, and in some cases up to 24 h. Where contaminated surfaces or cloths came into contact with the fingers, a stainless steel bowl, or a clean laminate surface, organisms were transferred in sufficient numbers to represent a potential hazard if in contact with food.