Clinical environmental medicine.

Introduction: Clinical environmental medicine deals with environmental effects on human health in individual patients. Patients seek medical advice for problems of many different kinds that may be due to environmental exposures; such exposures must be considered carefully along with other potential causes. An environmental medical assessment should include thorough medical history-taking and physical examination, the formulation of a differential diagnosis, and (whenever indicated) human biomonitoring, site inspections, and ambient monitoring.

[Anxiety: an aspect of the interaction of doctor and patients on the waiting-list and after lung-transplantation].

Anxiety occurs frequently in patients who are on the waiting-list for a lung-transplantation or have already been transplanted. In this context anxiety is a theme of every interaction of doctor and patient but often remains unrecognized because it hides behind bodily symptoms and mechanisms of defense. Anxiety affects patients' behavior and compliance and may afflict - especially if not recognized - doctors' decisions and thus patients' health and survival.

[Isolated late pulmonary metastasis of adenoid cystic carcinoma of the parotid gland].

Eight years after removal of an adenoid cystic carcinoma (ACC = cylindroma) of the parotid gland, a female patient of 41 years of age developed isolated multiple lung metastases. She died three years later in the course of a respiratory insufficiency. Basing on this typical case record, the very rare ACC is presented, which has a tendency to pulmonary metastasising.

[Diagnosis of lung function in patients with ankylosing spondylitis].

In a group of 55 men of 18 to 58 years of age who were suffering from ankylosing spondylitis, changes in lung function were analysed by measuring the static parameters and by differentiating between the thoracic and abdominal parts in breathing at rest and under stress, using CO2 rebreathing. In accordance with the reduction in vital capacity, the thoracic share is restricted already at rest. At rest, there is compensation via the abdominal compartment, in contrast to the stress in CO2 rebreathing in which the abdominal part does not compensate.