Document 26V0Vbv2Zd5Xvnyy2oqLN8eN

&7x.?' -\ , PB-246 691 RECOMMENDED STANDARD FOR OCCUPATIONAL EXPOSURE TO VINYL CHLORIDE National Institute for Occupational Safety and Health Rockville, Maryland 1975 L__J DISTRIBUTED BY: National Technical Information Service U. S. DEPARTMENT OF COMMERCE SPI-03115 Recommended Standard RECOMMENDED OCCUPATIONAL HEALTH STANDARD FOR THE MANUFACTURE OF SYNTHETIC POLYMER FROM VINYL CHLORIDE t. SCOPE AND APPLICATION This standard regulates the manufacture of synthetic polymer from vinyl chloride (chfo> roethene. Chemical Aostracts Registry No. 75014), in order to protect the health and safety of workers. Vinyl chloride also know as vinyl chloride monomer (VCM), chloroethvlenc and chloroethene, is a colorless sweet smelling gas at ordinary temperature and pressure and has a (toiling and melting point at one atmosphere of--13.8 C, and --153.71 C, respectively. Its chemical formula is CH CHCI and it has a molecular weight of 62.50. Although noncorrosive at normal atmospheric temperatures, in contact with water and at elevated temper atures it accelerates the corrosion of iron and steel. Of considerable concern is the fact that vinyl chloride is eas:ly ignited and has a lower and upper explosive limit of 3.6% and 26.4%, respectively. 2. DEFINITIONS For the purpose of this standard: a. "Assistant Secretary" means the Assistant Secretary for Occupational Safely and Health. U. S. Department of Labor or any person di rected by him. b. "Director" means the Director. National Institute for Occupational Safety and Health, or ar.y person directed by him or the Secretary of Health, Education, and Welfare to act for the Director. c. "Authorized employee" means an employee whose duties require him to be in the regu lated area and who has been specifically as signed by the employer. d. "Detectable levels" means the determina tion that airborne concentrations of vinyl chicride are ir excess of the limit ol scnsit.-.ity of the sampling and analytical metho-; rccommended by the Director. c. "Clean change ream" means a room where employees put on clean clothing; c.ean change room shall be contiguous to and ha/e an entry from a shower room, when the sho-wer room fa cilities are otherwise required in this standard. f. "Closed container" is any container which is used to prevent the physical contact of em ployees with material containing vinyl chloride monomer. g. "Closed system" means an operation in volving vinyl chloride where containment pre vents the release of vinyl chloride into regu lated areas, nonregulaled area* rr the external environment. h. "Contaminated" refers to detectable levels of vinyl chloride monomer. i. "Decontamination" means the inactivaticn of vinyl chloride to less than detectable levels or its safe disposaL j. "Disposal" means the safe removal of vinyl chloride from the work environment. k. "Emergency" means an unforeseen circum stance or set of circumstances, such as a rup tured transfer tine, resulting in the release of vinyl chioride sufficient to produce acute symptoms among workers exposed or having contact with the vinyl chloride. L "External environment" means any environ ment external to regulated and nonregulated areas. m. "Regulated area" means an area where entry tc and exit from a vinyl chloride work place is restricted and controlled. n. "Nonregufated area" means any area under the control of the employer where entry and exit is neither restricted nor controlled. o. "Protective clothing" means clothing de signed la protect an employee against contact with or exposure to vinyl chloride. p. "Waste resin" means any resin or other vinyl chloride reaction product whicn has been removed Iron vessels during clean-up opera tions. or which has been collected as a result of in-plant housekeeping operations. 3. REQUIREMENTS FOR REGULATED AREAS A regulated area shall be established where synthetic resins containing vinyl chloride are V______________________________ t SPI-03118 f ;"JJ>.TR rjw .'wi. ;'.?l'J.W'..Jfj-'*y T-J^ tWRM V--1.1 ' L, .'*l-`TP rw vn.u.'j i.ptj.^ jw^(ww,r Recommended Standard 1 * 32L206 t ! r* i for Occupational Exposure To -- Vinyl Chloride On January 22. 1974. representatives irom the B. r. however, that appropriate standards should not be Goodrich Chemical Company informed NIOSH that developed for other exposures to the basic chemical. the deaths of several employees of their Louisville. NIOSH is implementing further evaluation cf tne Kentucky, plant might have been related to occupa data, coupled with field observations, to determine tional exposures. An immediate industrial hygiene exposure potentials in pro- and post-polymerization walk-through survey of the facility was cundjcted by operations ... NIOSH and resulted in developing and transmitting to affected companies recommendations for precau Consultants from industry who worked with NIOSH tionary monitoring and control procedures for polym proposed that the recommended standard con'am erisation processes involving vinyl chloride. On Feb the concept of an allowable "working lever for vinyl ruary 1, 1974, NIOSH'COC conducted a briefing for chloride gas in the atmosphere.'which they identified otfiefTerferal agencies with health research responsi as a time weighted averace.ol_5Q.ppm. They recom bilities at which it was disclosed that four employees mended that where workers were exposed to concen of the plant in question had died of angiosarcoma of trations in excess of this level they snould wear air- the liver. Because of the extremely low incidence of supplied respirators. This concept of an allowable this disease, estimated to be on the nrder of 20 to 30 "working lever might seem lustifiab.'e in that Pro deaths per year in the United States, the history of- fessor Maltoni found no liver tumors at SO ppm. but four cases in a five-year period in -*te plant was con there is the possibility that tumors might have been sidered of great importance. It was concluded at the produced if a larger number of animals had been ex briefing that a new occupational cancer had been posed at that concentration. Based on theoretical discovered: angiosarcoma of the liver. It was further considerations, there is probably no liu-shild for concluded that this oisease was associated with the carcinogenesis although it is possible that wi'n very manufacture of polyvinyl chloride and that vinyl low concentrations, the latency period might be ex chloride was the prime etiological candidate in pro tended beyond the life expectancy. In view of these ducing tne disease. ' considerations and NIOSH's inability to describe a NIOSH, with tre assistance of expert consultants from both industry and organized labor, began de velopment of a recommended occupational health standard. These and other activities were discussed safe exposure level a; required in section 20!ai(3) of the Occupational Safety and Health Act. the concept of a threshold limit tor vinyl chloride gas i.n the atmosphere was rejected. r. in more detail at the OSHA Informal Fact-Finding Hearing on Possible Hazards of Vinyl Chloride Manu facture and Use on February 15. 1974. It was also during this Hearing that Professor Cesare Maltoni of Bolngna. Italy, presented the preliminary results of hi; research which showed induction of angiosarcoma of the liver and other organs, as weH as the produc tion of other cancers in rats exposed tn vinyl chloride. Consequently, the recommendations are such that where any employee is exposed to measurable con centrations of vinyl chloride, as determined by the recommended sampling and analytical method, he shall near an air supplied rf-rpirjrnx This recom mendation is based on some preliminary information that the standard chemical cartridge respirators are inefficient in protecting against vinyi chloride. NIOSH i; ir 'The results of these studies identify vinyl chloride as a carcinogen and further confirm its role in in ducing the cancers observed in the B. F. Goodrich workers . . . is implementing a. study to evaluate the degree of protection afforded by different types of respirators using vinyl chloride as the test gas. As information becomes available, it will be forwarded to OSHA as Although vinyl chloride must be considered os a car recommendations for alternative respirator usage. cinogenic agent, the immediate prob'em appeared to The employer is a'so required to develop a Control be concentrated in polymerization facilities. Conse P!ao_ta-r*duce-airborne..canc?nllllioas. of vmyi~cKfc quently, the attached NIOSH recommended standird ride to levels not detachable by the recommended onlr applies to such operations. This is not to say. method... * /..i-vr/irj /mm x Manh II. 1974. memorandum from Marchr ,ty. Key. Director. Sational Inttitute lor Occupational S.t/cty and Health to John II. Slender. Auittanl Secretary of Labor, tleeapatronal Safety and Health Adminirtratum Iruc.iinittinf the XIOSII recornmrnd.ttiont.I U ?. DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE Public Health Service Center for Disease Control National Institute for Occupational Saf.y and Health AMitiOnl C00*00 ovjMoDI# from; Oftict of TKtAiot Miiutiom iRiiitwli for OctwftotioA* blMy ino Him hU Off*# BvUCtof C*ocinn*ti, Onto *W9J mcioOO I mt um to idiM in ifnworinf your fMUfO. J SPI-03117 up m1 Recommended Standard i i i V vessel. Where operations such as cleanirg or at normal temperatures, waste materials, maintenance conducted inside an cpen vessel equipment, and other sources of the monomer could result in the liberation of vinyl chloride, in closed containers, shall not be placed in suitable procedures such as exhnust ventila areas Of excessive temperature or sunlight tion shall be- developed and implemented to since build-up of internal pressure may result insure that vinyl chloride is not ("leased into in rupture of the container, fire or explosion. the general work environment. 'ii) Waste resins or other materials con (ii) Exhaust air shall not be disoh.y ;edlo taminated with vinyl chloride shall be placed regulated areas._nonceguiated areas, or.:, c ex- in closed containers identified as required ternat.environment unless decontaminates. under paragraphs c(2)(i) c* (ii] of this standard. (iv) All piping to and from the vessel shall (iii) Appropriate procedures shall be de be blanked or otherwise isolated prior to entry. veloped and implemented for the decontam (v) Employees ..entering the reactor or ination and/or disposal of all such waste vessel shall be provided with and .required to material. wear and use a full-face, supplied air respira (iv) In clean-up of leaks or spills, mainte tor, of the continuous flow or pressure demand nance or repair operations on contaminated type in accordance with {1910.134. systems or equipment, or any operation in (vi) Employees entering the reactor or vessel where levels of vinyl chloride are mon itored and are found to not exceed amoient levels external to the vessel shall be provided with ">nd required to wear clean, full body pro volving work where direct contact with vinyl chloride monomer could result each autho rized empolyee involved in such operations 5hall.be provided with and requireo to wear clean, impervious garments, including gloves, tective clothing (coveralls or long-sleeved shirt and pants), gloves, footwear or foot coverings, and head covering. Where vessel levels are in excess ^f_ambient levels, employees shall in stead be provided with and required to wear boots and continuous air supplied hoods in accordance with {1910.134, be decontam inated before removing the protective garments and hood; and be required to shower upon re moving the protective garments and hood. impervious clothing to prevent skin contact of vir.yl chloride or other materials containing d. General Regulated Area Requirements vinyl chloride. 1. Employee identidcal'rcn. fviij After each exit from the reactor or A daily roster of employee_enfering regu vessel, employees shall beTequired to remove lated areas shall be established and main -.and leave'protective clothing and equipment at tained. The rosters or a summary of the roster a designated point in the regulated area, and shall be retained for a minimum period of 20 at the end of each work shift to place used years by the employer or successors thereto. clothing and equipment in impervious but The rosters and/or summaries shall he pro vented containers for Ihe purpose of decon- vided upon request to authorized represent tamination or disposal. The contents of such atives of the Assistant Secretary and the impervious containers shall be identified as r.- Director. In the event that the employer ceases quired under paragraph e(2)(i) of this standard. business without a successor, rosters shall be (viii) Employees engaged in reactor clean forwarded by registered mail to the Director. ing or other operations involving vessel entry 2. Emergencies. snail shower at the end of the work shift. In an emergency, immediate measures in- eluding but r.at limited to the requirements ol c. Maintenance and Decontamination Activities subdivisions (i). (ii). (iii). (iv). and (v) of this (i) Emphasis shall be placed upon imme- subparagnph. shall be implemented. -diate clean up of spills, periodic inspection, (i) The potentially exacted area shall be prompt repair of equipment and leaks, and .evacuated as soon as the existence of the proper handling, storage and disposal or de emergency has been determined. contamination uf materials to prevent airborne (ii) Hazardous conditions created by the contamination and accidental skin contact with emergency shall be elir mated and the poten vinyl chloride. Because vinyl chloride is a gas tially affected area shall be decontaminated SPI-03120 r**Tyrr. "r Recommended Standard "\ manufactured. These regulated areas shall in clude but are not limited to vinyl chloride loading or unloading operations, storag?, and transfer facilities.- synthetic resin polymeriza tion processes and operations; and resin han dling, compounding, packaging and storage areas. Access shall be restricted to authorized employees only. All such regulated areas shall be controlled in accordance with the following requirements. a. Routine Oparatiora (i) Initial concentration of vinyl chloride in all regulated areas shall be determined by per forming air measurements at strategic sam pling points under normal operating conditions. These initial sampling points must be . sleeted by a professional industrial hygienist and will serve as monitoring locations for future en vironmental measurements. The sampling pat tern shall be adequate to represent the en vironment of the controlled ar-a. '-(ii) Where detectable level* of vinyl chlo ride are measured, a Control 'hr to reduce such levels shall be developed, end imple mented. The Plan shall ecn.ist not only of establishing goats for reducing vfeyt chloride levels by designing and introducing engineer ing and process controls, but shall also identify plans for developing additional (healthful) work practices. Target dates shall be established for all goals and the Plan must be updated at least on an annual basis. Copies of the Contiol Plan shall be posted in all regulated areas and be provided to all authorized employees, v' (iii) There shall be periodic tests for proc ess or equipment leaks and for emission of vinyl chloride which may result from work practices. The frequency of these tests shall be such as to insure the integrity of equipment adherence to proper work practices, and to de termine achievement of the goals of the Con trol Plan. Tests shall be performed at each sampling point at least daily or more frequently if concentrations ol vinyl chloride are in excess of those established in the Plan. When such levels are exceeded, additional samples to identify sources of. contamination shT be taken. Results of all such tests shall be made available to authorized employees in such a manner as to evaluate achievement of goals contained In the Control Plan. (Iv) Until exposures to vinyl chloride are reduced below detectable levels, employees entering any regulated area shall be provided with and required to wear and use a lull-face, supplied air respirator, of the continuous flow or pressure demand type in accordance with {1910.134. (v) In operations involving loading or un- lqgdjng.vinyi chloride moncmer from tank cars, trucks, barges, or other conveyance equipment, each transfer line and each vapor-equalizing line shall be equipped with vent, connections permitting, at the completion of the transfer; pressure to be vented and the hose purged with an inert gasjn such manner to preclude any employee exposure! Specific and detailed transfer procedures shall be developed and provided to involved employees in written form. (vi) Employees shall be provided with and required to wear clean, f.ill-body protective clothing (smocks, coverall, or long-sleeved shirt and pants), and gloves prior to entering the regulated area. (vii) Prior to each exit from a regulated area, employees shall be required to remove and leave protective clothing and equipment at the point of exit and at the last exit of the day, to place used clothing and equipment in impervious containers at the point of exit for purposes of decontamination or disposal. The contents of such impervious containers shall be identified as required under paragraph e(2)(i) of this standard. b. Reactor and Vessel Entry (i) A reactor and vessel entry procedure shall oe developed and provided to involved employees in written form. Employees shall be familiarized with the procedure and shall be trained and rehearsed in the techniques pro vided for in the procedure. Emphasis shall not only be placed on concern fer potential expos ure to vinyl chloride but shall also include appropriate precautions for entry into.confined spaces. (ii) Techniques shall be developed and ap plied to minimize to the maximal practicable extent employee exposure ta_yinyl chloride when opening any dosed.vessel. Examples of effective me;hods are the application of k*-at or suction to the vessel prior to opening, or use of sufficient exhaust ventilation around the I* i 7 _____________________ _______________ / j SPI-03119 Recommended Standard Keep away from heat, spurns, and open (lame. Keep conlainer closed. Use with adequate ventilation. Avoid breathing vapor. Avoid contact with' skin. Keep cylinder out of sun and away from heat. Container should bo grounded when being emptied. Never drop cylinder. FIRST AID: If inhaled, remove to fresh air. If nut breathing give artificial respiration, pref erably mouth-to-mouth. If breathing is difficult, give oxygen. Call a physician. In case of: Fire -- Use water spray, dry chemical, or CO.. Spill or Leak -- For small spills evacuate area and permit to evaporate. For large spills or leaks, evacuate area. Dike or flush to ground and let evaporate. Do not flush to sewer because of explosion hazard. 3. Training and indoctrination. (i) Each employee, prior to being autho rized to enter a regulated area, shall receive a training and indoctrination program including, but not necessarily limited to: (a) The nature of the carcinogenic haz ards of vinyl chloride monomer, including local and systemic toxicity; (b) The specific nature of the operation involving vinyl chloride monomer which could result in exposure; ic) The purpose for and application of the medical surviellance program; (d) The purpose for and application of decontamination practices and purposes; (e) The purpose for and significance of emergency practices and procedures; (f) The employee's specific role under normal operating or emergency conditions.- (g) Specific information to aid the em ployee in recognition and evaluation of condi tions and situations which may resu't in the release of vinyl chloride monomer; (h) The purpose for and application of specific first aid procedures and practices; (i) A review of this standard at the employee's first training and indoctrination program and annually thereauer. (ii) Specific emergency procedures shall be prescribed, and posted, and employees shall be fanvli trized witn their terms, and rehearsed in their application. (iii) All materials relating to the program shall be provided upon request to authorized representatives of the Assistant Secretary and the Director. 1. Environmental Monitoring and Record keeping (i) Environmental concentrations of vinyl of methods for sampling and analysis recom mended by the Director or by methods of ah least equal sensitivity. (ii) Employees or their representatives shall be provided with the opportunity to observe chloride shalh~be determined through the use environmental monitoring activities and shall have access to the results. (iii) Complete and accurate records of all environmental measurements shall be main tained (or atjeast 20 years by the employer or successors thereto and shall be provided upon request to authorized representatives of the Assistant Secretary or the Director. g. Reports 1. Operations. Within 60 days the following information shall be reported in writing to the appropriate Occupational Safety and Health Administration (OSHA) Area Director. Any change in such in formation shall be similarly reported within 15 calendar days of such change. (i) A brief description and in-plant location of the area(s) regulated and the address of each regulated area. (ii) The number of employees in each reg ulated area, during normal operations, includ ing maintenance activity. (iii) A copy of the Control plan is developed under paragraph 3(a)(ii). 2. Err/ironrrental Measurements. On a .semi-annual basis the results of measurementTTaken at strategic sampling points, presented in such a manner as to identify achievement of goals established in the Con trol Plan, shall be reported in writing io the appropriate OSHA Area Director. 3. Incidents. tflciripnts wrrch result in the release of .vinyl chloride monomer into any area where employees may be potentially exposed shall be reported in accordance with this subparagraph. SPI-03122 \ Recommended Standard (i) A report of the occurrence of the in cident and the frets obtainable at that time including a report on any medical treatment of affected employees shall be made within 24 hours to the appropriate OSHA Area Director. (ii) A written report shall be filed with the appropriate OSHA Area Director within 15 cal endar days 'hereafter and shall include: (a) A specification of the amount of material released, the amount of time involved, and an explanation of the procedure used in determining this figure; (b) A description of the area involved, end the extent of known and possible employee exposure and area contamination; (c) Ajeport of any., medical treatment of affected employees, and any medical sur veillance program implemented; e.'id (d) An analysis of the circumstances^ the incident, and measures taken or to be taken, with specific completion datr., to avoid further similar releases. h. Medical Surveillance The following recommendations are di rected primarily at medical screening to detect liver disease and/or hepatic tumor. They should be considered in tne context o' routine health screening for any general employee health problems, including non-hepatic health con ditions potentially related to vinyl chloride monomer exposure. Routine health screening should include at_time_of initial employment the recording cf past medical history and the performance both of a general physical exam ination and certain basic laboratory procedure^ (e.g., complete blood count, urinalysis, chest x-ray); provisions should also be made fer rou tine periodic health followup!examinations. Employees covered by the fol'owing spe cific recommendations shall encompass all persons engaged in vinyl chloride monomer production and polymerization, including per sonnel peripherally involved such as in clerical and management assignments. The recom mendations shall be applied both as a pre employment requirement and as part of peri odic health followup. Screeping priority should be given to current employees.wilh prolonged and close potential, exposure to vinyl chloride monomer, whether in present or past work settings. (I) At time of initial employment, or upon institution of screening, a physical examination shall be performed with specific attention to detecting enlargement ofjiyer or spleen by abdominal palpation. (ii) At time of initial employment, or upon institution of screening and annually there after, a medical history check-list shall be com pleted by the employee. This list shall include questions concerning: (a) alcohol intake; (b) past history of hepatitis; (c) past exposure to potential hepatotoxic agents, including drugs and chemicals; (d) past history of blood transfusions; and (e) past history of hospitalizations. Completed medical check-list shall be re viewed by a physician and should be acted upon as medically indicated for each individual employee. (iii) At time of initial employment, or upon institution of screening. a_serum specimen ihj'! be obtained for screening*with respect to the following five bio-chemical determinations of liver function: (a) total bilirubin; (b| alkaline phosphatase: (c) serum glutamic oxafacetic trans aminase (SCOT); (d) serum glutamic pyruvic transam inase (SGPT); and fe) garrra glutamyl transpeptidase (GGTP). Additional tests that may optionally be con sidered for use in screening include lactic dehydrogenate (LDH). serum protein determin ations. serum protein electropf oresis. and platelet -ount. Laboratory an; iysis shall be performed In labora'ories accredited by the College ot American Pathologists or licensed in accordance with the provisions of the Clin ical Laboratories Improvement Act of 1967. (iv) If results or laboratory screening are normal, screening shall be repeated on an annual basis. If the person being screened has been employed directly in vinyl chloride monomer production or polymerization for 19 years or longer, screening shall be repeated every six.(6) months. (v) If one or more fiver function tests are abnormal, serum'lesting shall be repeated as soon as possible, preferably within two (2) to 7 Recommended Standard lour (4) weeks. if nc abnormalities are present upon zescreening, testing should be repeated in three. (31 months. (vi) if abnormalities persist on rescreenJng, the employee sh jfl be removed from con tact with vinyl chloride monomer operations and an individualized medical workup shall be instituted. Suggested as initial steps in medJcaljvorkup.are a complete physical examina tion and various special procedures such as hepatitis 8 antigen determination and liver scanning. ' ** liver function abnormalities .are deter mined to be unrelated to liver disease (e.g.. elevated alkaline phosphates in a young, phys ically active man or elevated bilirubin in Gilbert's syndrome) or to be transient (e.g., due to recent hepatitis or recent alcohol intake), the employee may be permitted to return to vinyl chloride-related employment, subject to individual medical evaluation. (vii) In view o( the preliminary results of animat toxicology studies, it is *ecommended that no woman who is pregnant or who expects to become pregnant should be employed di rectly In vinyl chloride monomer operations. RECOMMENDSO OSHA SAMPLING DATA SHEET 1. Substance; Vinyl Chloride Cas 2. Scape of Mrrfted; Vinyl chloride is * |as boiling at -134 degree C and having a vaeor pressure ol 2660 mm of mercury at ZS ccgrre C. The loner limit of detection lor the method is approximately t ppm. 3. Sampling Equipment: a) Personal sampling pump 61 250 cc glass gas collecting tubes antis teflon stopcocks 4. Sample Sim 250 CC & Sampling Procedure; Class Cas Collecting Tubes a) The gas collecting tube is connected at one end to the personal sampling pump. Both stopcocks are opened and air pulltd through at approx imately case liter per minute. b) A sampling period of 15 minutes would alien collection Of a lepresentatire sampling of the worker environment c) Stopcocks shall be closed tightly, closing the stopcock nearest the pump first & Analysis! The gas collecting lube sample is analyzed directly by gas chromatography. 7. Skipping Instructions; the gas collecting tube should be wiapoed with cushioning materiat placed in the . .oping case and shipped ia Air Mail to tlw OSHA laboratory, Sal; lake City. t I SPI-03124 U D346 ANNUAL MEETING ABSTRACTS atoay Investigation l\ Gray, and Jeanne W. Baer. The New York HospitalComell University Medical College and St. Luke's Hospital, New York, New York 10021. The most common cause of acute severe rectal hemor cases are repor s par of the world, and as far as is known this is the only case from Canada. Vinyl chloride is a new industrial carcinogen and the reactor cleaners in the polymerization plant are at the highest rhage is colonic diverticulosis. However, the precise site risk. The other toxic effects and the literature are briefly of bleeding, etiology, and pathogenesis have not reviewed. been previously identified. Arteriographic, microangio- graphic, and detailed histologic observations in 10 proved cases disclose strikingly consistent changes re lated to the characteristic angioarchitecture of colonic diverticula which we have established. This represents the largest reported series. The changes include: (1) asymmetric rupture of the vasa recta precisely at the dome or the antimesenteric margin of the diverticulum; (2) conspicuous eccentric intimal thickening of the vasa recta, often with medial thinning, at and near the bleed ing point; (3) general absence of diverticulitis. Compari son with colonic diverticula in 'nonbleeding cases indi cates that traumatic factors arising within the diverticu lar lumen induce asymmetric intimal proliferation and scarring of the associated vasa recta predisposing to rupture and massive bleeding. Skin in Systemic Lupus Erythematosus Richard O. Ores. Department of Dermatology, New York Medical College, New York, New York 10029. In four out of six patients with systemic lupus ery thematosus (SLE), but not in one with psoriasis and three healthy subjects, Feulgen-positive material was found in the outer part of the stratum corneum. Patients with SLE had positive DNA skin tests and in five of them LE cells were present in the reaction site. The dermal-epidermal junction showed direct staining with fluorescein labeled antihuman IgG and electron-dense deposits by electron microscopy. The intercellular mate rial was absent or diminished in stratum corneum which may enhance the penetration by short ultraviolet leading to photochemical alteration of DNA with resulting t P (i s r f> f. 1. 1. C f. antigenic photoproducts. Depending on the concentra 'World Health Organization International Histo tion of the antigen, three different immunologic re logical Classification of Tumors sponses may be elicited. With a sufficient concentration, F. K. Mostofi and James L. Hansen. Armed Forces the precursor cells would differentiate into the antibody Institute of Pathology, Washington, D. C. 20306. forming cells. A le-.-1-r concentration would result in i n The exhibit illustrates the most recent World Health production of memory cells only with a possible Ii Organization International Histological Classification of anamnestic response to subsequent contact with anti 1 vTumors. The four classifications to be demonstrated are genic determinants offered by viral infections or drugs I f.1 the bladder, ovary, skin, and thyroid. acting as haptens. A massive antigen dose would cau>e f `I an extremely good antibody production with no commit ! C! Cytologic Studies of Various Structures ted memory cells left to respond to subsequent antigenic 5 U; Gen Niwayama. Department of Pathology, Veterans exposure resulting in immune paralysis corresponding 1 d;i Administration Hospital and University of California, School of Medicine, San Diego, California. to spontaneous remissions and exacerbations of the disease. Clinically, discoid lupus erythematosus would af rc j t The exhibits will include: Cytology of pericardial meso- result when the antigenic determinants interact with 1 thelial cells, mediastinal germ cell tumor, spindle cells, T-cells. The humoral antibody production by B-cell> !o!i leiomyosarcoma, and de Toni-Debre-Fanconi syndrome: would result in SLE. Signs and symptoms characteristic j w I t!Clinical cytology of the liver and pancreas: Cytology ori for both forms of this disease would occur if boih ented autopsy. ISreactions take place simultaneously, or if humoral anti body response occurs after the cellular one the discoid Angiosarcoma of the Liver After Vinvl Chloride form would be transformed into the systemic one. Exposure: Report of a Case and Review of the i i, Literature. Philadelphia Chromosome Positive (Ph+) Acute Leu i B D. F. NQRiA S. Ritchie. M. D. Silver. Central Hnsni- tal, Toronto, M5A 2S5 Canada and Toronto General Hospital, Toronto M5G 1L7 Canada. An 8S-year-o!d man died of angiosarcoma of the liver--anextremely uncommon primary liver tumor. He had a brief 6-month history of diarrhea, ascites and edema, and died of hepatic failure At e r -y. the liver showed a diffuse honeycombed t.v which is characteristic: of these tumors. i\.pcal'y the oat- terns seen were sinusoidal, cavernous, papillary, and anaplastic types. In the areas of liver uninvolved by the tumor, ere was cirrhosis with ma ked perisinusoida! and porta! fibrosis. For 50 years the man had been a sales | 2kemia: Morphology, Clinical Features, and Sur vival of Nine Patients L. C. Peterson, C. D. Bloomfield, and R. D. Bki \ NING. University of Minnesota School of Mediant Minneapolis, Minnesota 55455. The Philadelphia chromosome was found in nine adultwhose initial blood and bone marrow morphology j. ju < in l tU indistinguishable from acute leukemia. These patient- | represent 33 per cent of adults presenting with acut, * s< lymphocytic leukemia (ALL) and 3 per cent present ir., \iith acute myeloid (AML) or acute mvelomomxu., i f i leukemia (AMML). Presenting morphology, cytochen-. . istry, clinical features, and survival in these nine patient., manager in an automobile tire manufacturing plant where vinyl chloride monomer is polymerized into poly vinyl chloride. The apparent rarity of angiosarcoma in vinyl chloride workers is noted by the fac* that only 26 were compared to 46 adults with Ph negative (I'h acute leukemia and 20 a-Jults with blast crisis following j typical history'of Ph+ chronic myeloid leukemia (CMI. Adults presenting with Ph+ acute leukemia dem.-r. j mi | fix I Co c be SPI-03125