[Exposure to smoke and its effects on pulmonary diseases]. / Effekte von Rauchexposition auf Lungenerkrankungen.

For many diseases, tobacco smoke is the most important risk factor. To understand the different risks concerning both quality and severity of the possible diseases, the differentiation between mainstream smoke, sidestream smoke and environmental tobacco smoke (ETS) is indispensable, since the different types of smoke are associated with different diseases. Before anything else, tobacco smoke is the main risk factor for the development of lung cancer and with restrictions for laryngeal and pharyngeal carcinomas as well. Moreover, the inhalation of tobacco smoke is of great importance in the genesis of chronic obstructive lung diseases (COPD). During recent years it has generally been acknowledged that ETS, besides a general activity in cancerogenesis also, seems to induce other morbidities. Nevertheless, when looking at the risks of smoking it has to be mentioned that the difficulty of gaining reliable information concerning quality and quantity of the smoking and the exposure to ETS is significant. That is why in many cases the relation between the dose of tobacco smoke and its effect is hard to make out. Not to be denied is the fact that both active and passive smoking has a great impact on the respiratory tract, which should be considered carefully when it comes to children being exposed to ETS. The age of children when exposed to regular ETS for the first time plays a key role concerning their disposition to later developing a COPD or a bronchial asthma. This subject of ETS is especially of great interest in the work of company doctors because there are many people exposed to ETS for many hours every day in their work environment. This problem is most obvious in the gastronomic work sector.

[Pulmonary hypertension--clinical aspects, pathophysiology, diagnostic and therapy]. / Pulmonale Hypertonie--Klinik, Patho- physiologie, Diagnostik und Therapie.

Pulmonary hypertension (PH) is a disease which is characterised by an increase in the mean pulmonary arterial pressure (mPAP) in the lung circulation of over 25 mmHg in rest and over 30 mmHg in movement. Due to the chronic overload of the right ventricle, the heart is always affected by a PH and often develops a so-called cor pulmonale chronicum which can lead to right-heart failure. There are five groups in the clinical WHO Venice classification which are arranged according to pathogenetical, clinical and therapeutical criteria. In addition, an adjusted NYHA classification helps to grade the significance of the disease stages. Principally, one classifies a mostly isolated form of the pulmonary arterial hypertension (PAH) and other secondary forms of the PH which develop on the grounds of existing problems such as left-heart diseases, hypoxic lung diseases, pulmonary embolism and infections. The pathophysiological reasons for a PH are just as various as the different manifestations. Yet there are generally four main alterations in the walls of the pulmonary vessels. This includes vasoconstriction, rarefaction of vessels, vascular remodelling and the occlusion of vascular lumen by a thrombus with subsequent structural remodelling of the vascular and mounted extracellular matrix. The diagnostic procedure should be algorithm-oriented and includes anamnesis, physical examination, electrocardiogram (ECG), thoracic x-ray and echocardiography. To confirm the diagnosis and for a better measuring of the prognosis, an examination with a right-heart flow-directed balloon-tipped catheter is favourable. Because of the change in the pathophysiological concepts of the PH from a vasoconstrictive to a vasoproliterative genesis, additional pharmacological targets are developed for therapeutic treatment. Today the former regime of therapy with high-dosed calcium-channel blockers such as vasodilatators only finds application after pharmacological testing at so-called responders. The current scheme of therapy is focused on the synergic effects of different drugs, such as prostacyclines, endothelial-receptor blockers and phosphodiesterase-5 inhibitors. After the failure of pharmacological treatments, the endarteriectomy remains as the last therapy option, although it is accompanied by poor survival rates.

[MRSA--current aspects of resistance, pathology, epidemiology and therapy]. / MRSA--aktuelle Aspekte der Resistenzentwicklung, Pathomechanismen, Epidemiologie und Therapie.

The Methicillin-resistant Staphylococcus aureus (MRSA) is a Staphylococcus aureus (S. aureus) resistant against all kinds of beta-lactam antibiotics. Moreover, resistances against other antibiotics have gradually started to develop. In the last decades, MRSA started as a serious problem only in hospitals, but in recent years it also rose as an alarming community pathogen. In addition to the resistances against Penicillin which emerged in the 1940s. with the use of beta-lactamase proof antibiotics in the 1960s, the resistance of S. aureus against Methicillin started to develop. According to the kind of resistance, the genotype, the time of infection and the origin of the infection, MRSA infections are classified as hospital-associated (HA-MRSA) and community-associated (cMRSA). On the one hand, this differentiation results in distinct strategies of calculated therapy against each class of MRSA. On the other hand, it is important in order to identify relevant judicious aspects of transmission.