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A possible relationship between passive smoking and coronary heart disease has been widely debated during the past decade. Convincing evidence links environmental (passive) tobacco smoke exposure to heart disease morbidity as well as mortality. In the United States, 37,000 coronary heart disease deaths per year are attributed to environmental tobacco smoke exposure, accounting for 70% of all deaths caused by environmental tobacco smoke. The analysis of 10 epidemiologic studies indicated a consistent dose-response effect related to exposure, but more proof is still needed. Evidence indicates that nonsmokers are more sensitive to smoke, including cardiovascular effects, and that sidestream smoke contains higher concentrations of gas constituents, including carbon monoxide. Pathophysiological and biochemical data after short- and long-term environmental tobacco smoke exposure show changes in endothelial and platelet function as well as exercise capacity similar to those in active smoking. Therefore, passive smoking is a relevant risk factor for heart disease morbidity and mortality.

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The relative merits of intraperitoneal (i.p.) and subcutaneous (s.c.) insulin delivery compared with intravenous (i.v.) delivery were investigated in seven diabetic patients using a combination of glucosecontrolled closed-loop (Biostator) and portable open-loop (Siemens minipump) insulin infusion systems. With appropriate algorithms for feedback-controlled insulin infusion, it could be shown that each of the three approaches was able to achieve satisfactory blood glucose levels. After glucose challenge, i.p. administration required almost twice as much insulin and twice as much time as i.v. to return to normal blood glucose (BG) levels. When the insulin dosage profile determined with Biostator feedback control is transformed to a simpler program consisting of basal rate and rectangularly shaped supplementary profiles for the open-loop system, good control was achieved during observation periods of about 1 wk with both s.c. and i.p. delivery. Subcutaneous infusion with the minipump was also carried out for a period of 70 days in one patient on an outpatient basis. In this long-term study s.c. infusion was not superior to twice-daily s.c. injections with frequent monitoring of BG and self-adjustment of insulin dosage by the patient. The optimal method of delivery appeared to be i.v., with i.p. and s.c. in second and third place. Intraperitoneal delivery seems to be a viable alternative that might help to solve some problems in the development of implantable devices. Further investigations should be carried out.