Document 10vEdKjQ1jvoEwmaDqx891BJa

FILE NAME Brakes BRK DATE 1984 Nov DOC BRK088 DOCUMENT DESCRIPTION Medical Report with Autopsy ALBERT EHRLICH M.D. M.D. One Horizon Road Fort Lee New Jersey 07024 201 224-6126 DEC RECEIVED DEC 4 1984 Board Anatomic and Clinical Pathology College of American Pathology American Society of Clinical Pathologist November 27 1984 Gary Galiher & Associates Attorneys at Law Suite 88 Melim Building 333 Queen Street Honolulu Hawaii 96813 Re Dear Mr. Galiher On 11/10/84 1 reviewed the case of iii Ta: at the request of Mr Galiher after receiving medical reports on 11/9/84 Following are pertinent findings in the medical records SYMPTOMS He first noticed dyspnea on exertion in 1975 when diving Dyspnea and productive cough increased he was skin in 1980 when he could only climb one flight of stairs OCCUPATIONAL EXPOSURE TO ASBESTOS He was a general mechanic at Schoffield motor pool and ordinance for over 30 years where he worked on auto brakes and clutches He would remove old brake lining cut new lining to size drill holes in lining rivet the lining to the clutch and brake shoes and then would grind the asbestos on a sanding machine to correct size He used compressed air to blow out dirty brake assemblies He used asbestos cloths in welding He would sweep the work place daily thereby raising a cloud of dust PagPe age 2 SMOKING He smoked one half pack of cigarettes daily for 34 years..He stopped in 1975 XRays First report Feb. 15 1979 was Diffuse interstitial pulmonary disease of unknown etiology On 3/7/80 Dr. Sakuda reported his XRays to show Moderate diffuse interstitial infiltration witha nodular pattern and left diaphragramtic calcification These changes were compatible with previous asbestos exposure Dr. Childs reported on 1/20/81 pulmonary fibrosis is compatible with the the pattern of diffuse clinical diagnosis of asbestosis PULMONARY FUNCTION TESTS A screening pulmonary function test in June 1978 was abnormal On 1/23/81 he was reported to have moderate restrictive lung disease with deterioration of lung volume with increased restriction since 3/7/80 From March 7 1980 to 1/30/81 total lung capacity decreased from 3.9 liters to Vital capacity decreased from 2.8 to 2.47 liters " Findings were consistent with asbestosis PHYSICAL EXAMINATION January 3 1981. Dry interstitial rales were heard in both bases There was questionable early clubbing of fingers lung _} Biopsy from bronchoscopy on 1/6/82 revealed no evidence of malignancy ..page 3 DIAGNOSIS Dr. Massey - Markers of asbestos exposure and asbestosis present 5/21/80 - Dr. Morgan symptoms chest Deterioration in pulmonary function XRay and History are all related to tests clinical progression of asbestosis CLINICAL COURSE Dr. Schonfeld Major M.C. filed a report to U.S. Office on 12/8/78 reqesting full permanent disability Army personnel for Mr. C /, due to asbestosis effective 12/14/78 He was admitted to Kuakini Medical Center on 1/28/83 for hemoptysis and influenza His abnormal breath sounds increased with an increase of diffuse infiltrate on XRay An XRay on 1/24/83 was reported to show an acute component besides chronic interstitial disease which could represent infection His pulmonary arterial oxygen level was On 1/31/83 he had a respiratory code low On despite use of oxygen 2/9/83 he had a tracheostomyy tracheostomy and died later the same day DIAGNOSES AT TIME OF DEATH 1. Influenza 2. Asbestosis parenchymal & pleural 3 Cor Pulmonale Page Page 4 AUTOPSY FINDINGS LUNGS - MACROSCOPIC Diffuse nodules 0.5 cm in diameter were present under the thin visceral pleura of both lungs The lungs were firmer than usual The cut surface reveal numerous empty cystic bulbous spaces 1 cm in diameter most pronounced in the pleural aspects Subpleural empty cystic spaces measuring up to 2.5 cm are present in apices of both upper lobes LUNGS MICROSCOPIC - Sections of all lobes are examined microscopally and appear similar The visceral pleura is thin Many distal airways are moderately to markedly dilated and are lined focally by a stratified squamous epithelium Some of these lumin are filled with collections of neutro- philes necrotic cells and fibrin There is marked fibrous thickening not only of the alveolar septas but also of the alveolar ducts and respiratory bronchioles These thickening walls are characterized by fibroblasts wavy collgenous tissue smooth muscle tissue many small blood vessels moderate numbers of lymphocytes and plasma cells with lesser numbers of neutrophiles Also present are scattered histocytes containing both anthrocotic pigment and hemosiderin Definite asbestos or ferruginous bodies are not identified in the interstitium Scattered alveolar spaces contain collections of neutrophiles degenerating cells fibrin and hemosiderin macrophages Others connective alveolar proliferation alveolar proliferation within within . associated reveal connective tissue proliferation within the alveolar spaces associated with small blood vessels and chronic inflammatory cells SEEM .. Page 5 Examination of the lung tissue after digestion reveals the presence of two asbestos bodies A quantitive count is 2 bodies per 5 gm of lung tissue AUTOPSY DIAGNOSES . Acute and organizing bronchopneumonia bilateral patchy moderate 2 Chronic bronchiectasis and bronchitis diffuse moderate bilateral 3 Bronchial squamous metaplasia bronchi 4 multifocal moderate bilateral ' Medial hypertrophy pulmonary arteries moderate bilateral compatible with clinical pulmonary hypertension fifi fl Chronic Interstitial fibrosis diffuse severe bilateral fifi fl Asbestos bodies gm tissue EEE...P. age 6 On autopsy or about 4/18/84 I received 6 from Kuakina Medical Center paraffin blocks of FY They were labelled 18-7 LUL 18-8 LLL 18-9 LLL 18-10 RUL 18-11 RML and 18-12 RLL These blocks were from from the blocks Autopsy 18 Hemotoxylin Eosin The numbers 83 were missing and iron stain slides were made from each block On histological examination the H slides were similar There was extensive severe interstitial fibrosis moderate amount of anthracosis peribronchiolar fibrosis Numerous macrophages were in the alveolar spaces Many bronchi were dilated - some contained inflammatory cells- evidence of bronchiectasis and honeycomb disease Numerous chronic inflammatory cells were dispersed in the interstitium suggestive of viral pneumonia Thickened pleura with evidence of pleural plaque formation was found in the LUL Asbestos bodies were not found on any of the H & E and iron stained slides On Sep. 25 1984 I received 6 slides on Autopsy 83 two two of lymph nodes H & E , one LUL RLL iron stain and one large slide of lung digest There were also 22 ry Kodak 2 x 2 transparencies The findings of severe interstitial and peribronchial fibrosis with honeycomb disease plus early pleural plaque formation are consistent with and supportive for the pathological diagnoses of parenchymal and pleural asbestosis _ Other diagnoses were - 1. acute and chronic bronchopneumonia 2. chronic bronchiectasis 3. acute and chronic bronchitis Page Page 7 Interstitial or virai pneumonia can induce interstitial fibrosis However it does not produce honeycomb disease or pleura plaque formation as present in this case INABILITY TO DEMONSTRATE ASBESTOS BODIES As expected asbestos bodies were not found in the brake worker Chrysotile asbestos used almost exclusively in auto brakes 1 does not form asbestos bodies 2 Chrysotile fibers in the lung fragment into subunits and are leached of mineral constituents with the passage of time 3 Warnock 4 indicates because of preferential of chrysotile that persons who inhale only chrysotile might be found to have asbestos related fibrosis or cancer and a small concentration of fibers . In animals after 18 months inhalation of anthrophyllite and chrysotile only the chrysotile would disappear from the lung Chrysotile seldom forms asbestos bodies in man 5 An analogy can be made in the management of a clinical case of pulmonary tuberculosis in which the tubercle bacilli similar to our asbestos bodies cannot be demonstrated In this situation the patient may have a history of contact with people with tuberculosis clinical signs of the disease such as a productive cough fever hemoptosis fatigue night sweats weight loss and definite XRay findings of tuberculosis One thing is missing and that is the ability to find tubercle bacilli by culture or smear The overwhelming majority of physicians woud treat this patient + ... Page 9 References A.N. et al -Asbestos Exposure and repair ..Envir Res 12-110 During 1976 Brake Lining Lining Maintenance 2. Churg A.M. & Warnock Asbestos and Other Bodies J.Path 102 1981 ferruginous 3. Craighead J.E. Archives Path & Lab Med Report of Pneumoconiosis Comm..106 543-1982 4 Warnock M.L. et al -The Relation of Asbestos & Lung Cancer Path Annual 18 109 1983 5. Casey F.R. et al -Asbestos Related Diseases -Clin Chest Med 2 170-202 1981 Sincerely yours Albatr Albatr _ Albert Ehrlich M.D. M.D. . Pathologist . AE cc T. Hart 111 encl Prints and transparencies Statement