Document 4aYKVdOeJnrnK7xKKyDG5pOzN

"W,? l;& :- % Jii :.^; .v<vta!*Htiiv*1 ri.sfcv ;*---*S,->4 K-J>/7">`- f /00 }, M v. I jf-nu-iu'o). 5 " Ortvi 'w :,%< Journal of Occupational Medicine Olficuil Dublic.ilion ol AM[ RICAN OCCUPATIONAI Ml UlCAL ASSOCIATION nn<] ol Af/CniCAN ACAOI MY Ol OCCUR/.!ioN-M Ml UiCiNt A RESPIRATORY SURVEY OF CEDAR MILL WORKERS Part I of this study discusses the prevalence of symptoms and pulmonary func tion abnormalities in a group of workers exposed to red cedar dust compared to control workers exposed to other wood dusts Pan II discusses the influence of work-related and host factors on these symptoms. Beginning on p. 323. TEN CASES OF ANGIOSARCOMA OF THE LIVER IN SHAWINIGAN, QUEBEC All ten of the cases of angiosarcoma of the liver which have been diagnosed in Shawinigan. Quebec since 1955 have occurred in men employed in a vinyl chloride polymerizing plant. This study attempts to shed more tight upon the causal relationship between vinyl chloride monomer and this angiosarcoma and to provide some understanding of the pathogenesis of the disease, p. 338. . V...... ; PLEUROPULMONARY DISEASE AMONG ASBESTOS WORKERS IN RELATION TO SMOKING AND TYPE OF EXPOSURE Chest roentgenograms of employees aged 40 and over in two asbestos manufacturing plants were read without knowledge of the plant or smoking habits. One plant used only chrysotile asbestos while the other used chrysotile along with amosite during a brief period See p. 341. INCIDENCE OF CARDIOVASCULAR DISEASES IN THE DUTCH VISCOSE RAYON INDUSTRY An investigation was made into the incidence of cardiovascular diseases in the Dutch viscose rayon industry. The first part of the article discusses a study into the distribution of cardiovascular cases among the various departments of a rayon plant. The second part deals with a case-control study in which the total number of patients per plant was matched with controls not suffering from car diovascular disease, p. 346. -! I ,, u "i V ! , t , 1 . l /.', ; * . t < May. 1978. Volume 20, No. 5 iM4 . '***;'' 7 ,t J f ' 1 Ten Cases of Angiosarcoma of the Liver in Shawinigan, Quebec Fernand Delorme, M.D., and Cilles Theriault, M.D. /\i !J Ten cases of angiosarcoma of the liver have been diagnosed in Shawinigan, Quebec since 19S5. All have occurred in men who worked in a vinylchloride polymerizing plant. Cigarettes and alcohol do not seem to be associated with this tumor. The amount of vinyl chloride to which these people were exposed, according to information obtained through questionnaires, ap pears elevated. Angiosarcoma of the liver is accompanied by a fibrosis of the liver which may precede its appearance. In de scribing the Canadian cases of angiosarcoma, this study at tempts to shed more light upon the causal relationship be tween vinyl chloride monomer and angiosarcoma of the liver and thus to provide some clues to understanding the patho genesis of this disease. In January 1974, three cases oi anginsarcorna ot the liver wore discovered among workers ot a thermal plant ` This finding appeari^ abnormal and tin* agent susper ted ni being responsible lor the disease was identified as vinyl c blonde monomer fVCMi Mm e then, many reports on tlx* occurrence of this rancor among vinyl chloride workers have appeared around the world'*'* and tlx* Unit ed States Occupational Satetv and Health Administration has enar U*d a new threshold limn value tor concentration of the rhemitai in the air of the working environment* Ten cases ol angiosarcoma oi the liver were dugmm*d among workers of a vinyl chloride polymerizing plant in Shawmigan Quebec This is llx* largest number ni rases ever to take pkn e in a single plant, The present study describes ok upational history, drinking and smoking habits and some histologiral teatures ot those Canadian cases. Data on some of these Canadian cast's jointly with cases ot angiosarcoma from the United States have al ready been described in another article by one of the authors.' Since more accurate and complete intormation was retrieved on dv Canadian cast's, it is being present'd separately in tlx* present art it le _____________ I mm th, fVjMrlmi'm <' P.ir holme Ontu* Hosou.iU-f (*!< in*! de L> \wf Shjwini)<.in Quotas Of Oflofm**' jn<l tta* rVpkiitmont ul Soi ul jod iSrveniis** M**d * mo iJVit Uhivofsiiv Quotas Or Ihvrwulri 338 Methods Case finding, -- A -.eau h III' < ,ise> of aog.osan .n.t nr lix* liver beginning as tar ii.uk .is PHI ,im! e*n riding ove* !,\u d<s,uf*s was < ar r nj < >u! ov si i uiinr/mg ii*es u' t*v** r*-ge n.i hospitals m tin* Sh.twtnigan Mr nets All rases ol primary tumiiK ot Itx* liver were oiler lui and !lx* histrrlogu al material 'slides hiop*o reports aul< ips\ rep. rts were review e<f lor tiie present i>ui .mgr* warr oma lo rontdm the d.agnos's r>i an gios.u t onia of tlx* liver tlx* rases vs ere submit led n i < i msulian Is h urn fix* United Males familiar with tills disease Occupational History* -- Hie questionnaires umiI to obtain a detail'd n t upalh nal iiistirv ol e.e ii ase r oiled rnhnrn.it ion r ore terning p.isi and presenl riwirjetir e niedit a! iiisiorv wiiokmg and dunking haints along with past or i upalionv and emplovefs in r hfotiologir al order Hie answers to most ot qu<*sponnaires were* giseri bv s>. ujses ni lix* men who diet} horn die disease In one in stant e however tlx* answers were given bv fix* sister and hro*l>er in I iw .inii m anollx*r bv tlx* wofker himself 1 wo former ro-wi 'kets )i tlx* men who died ot an angMwarr onia oi the liver i onnmiecj .rej completed tlx* intormation obtainrxj Through the families PUnt Description. -- rhe Shawimgun vmv I t hloode plant start* ed operating in 194 1 At that unit , it produt ed and polymerized vmvl rhloride monomer later m the N"Os a stopfxxj pnxJuc ing VCM and kept operating the polvmen/alion uni? Tix- workforce \ant'd from H)d to tin workers At the moment n emolovs 210 men I'rodur |mn of PVC has llut tualed with time Present produr tion is estimated at >0 million pcxjnds annualiv Ixpusure to VCM in tix* working atmosphere though not documented is believed to have b<s*n verv hgh m tix* past Slurp improvement bis taken place m ns em wars and it is estimat'd at less thin i ppm at tlx* moment Results Fable 1 shows the age at death tix* smoking habits and akohol consumption tor fix' ten cases ot angiosarcoma oi tlx* liver dugnosed in tix? Shawmigan region over the last two dexades All %^ f * .i-Wir.yiiSt&Si 27i 47 V TaW l. -- $4ir A|( Death. $mokin{ HabiU and Alcohol Cetvuiffiptton ct Ten Caw of Aftfwwcom* oY th* Uvof in a Canadian Community Cm* to. 1 2 3 4 6 7 a 9 to 7 s*. mete metr mite mile mile mile rrwlt m*t mate male A| *f Omyx 41 4] 42 48 bf> 51 5? 53 53 61 505 $mk*r liMtkir M**VXokar i lltAlfipfi ff No ot Ctc*rf<t*t p* Dtr - JO an ?* ?'j 70 75 N* o* Yoon SmoXod ?/ 71 -- 30 47 Yj 3( 35 35 43 AlCONol C*iiMmti** No htttn of oor ^or MTo^ 1 1 -- J l 71 p. t No ot Voom Oriofcmc 1 ?s 75 -- 43 s 71 70 10 _ were males, tlx* .tge -it death hinging irom *1! to f1 years with an average of SO S yejrv U is somewhat doubttul dvit smoking has mUt h to do with this type ot tumor Out of tlx* ten raves one m.m wav a ni>nsrn<ker live were nvxier.ite vmoke/v smoking an average ot 20 inmates or less per (lav, and tlx* remaining lout smoked one p,u k ol i ig.irelles per dav or more The tuni'ir appeared earlier in lhe moderate and nonsmokers -'x age 47 veurvi than in the Ixmvv smokers i\ S4 vearvi. The men who develops] an angios.iri nma ot the liver were very light drinkers Only two men out ot ten drank more than one hollle ot hevr |)ef d.iy Norn* ot the ten men drank wine nr lujifr regularly As with cigarette smoking drinking does not appear to tie associate! With an angiosarcoma ot the liver m vinyl i blonde workers f\ist diseases ot tlx* liver may also he ruled out av potentiating tlx* development ot angiosarc orna ot tiie liver vuue the media! history ol the ten cases showed no prevmuv liver diseases nor fx'paiu troubles Table 2 shows the length ot time the men were evp.ised hi vinyl (hloride either by working in dx* polvmen/ation umt nr hv being directly exposed tii vmvl (h(< >rtde It alv<shows tlx* mui|u (ions they performed and whether they worked overtime Th*v worked tor [>eru>ds ranging tmrn 1 1 to JO wars (Ii tlx* plan! with an average ot 21 sears and 4 months Daev t exposure to van! ihlinde in.aaiMX'f w is i h\ m uslv shortf r.tMgng tnrn ' ve.jrs t months V) .'* v**jr> w.'h an average *t lb ,ejr\ to months f t mu t'x- i< -n d-u op*, a o\ a t an be si*n th.il most * a dx* men worked eidx*t as wpefjhus rii.tinten.mi e worker-, *u h>lh Seven ni4*n w<*fed as nuihu i I.Mix*f> m {)<' i'kim vs hi< h si -fans !< i h i \ i* I vi s-n :1k- w , au at * p- *oug p- if#'#* f r, v -mv 1 i htonde Mu n i miri ' )ue wii'iui sati J < r U*i oust land M* v, enl i J< ivs n in*' i t hi * au t < n l.iv i*s n in v turn** ( )m * tlx*, iud h take hen i ml urn i u* < i. no It is d 'i , ut; *u g*-! a tae ide i nt !'e ,ini>*uut -it ,-rJ < blonde Ulilti'iilii 'f '. i w *Ui h ! hi'-i* pe< i;>le w e*e i*s*) \ed W m v 'Oowves siv out oi h"i usisi.t upon n,i*n['iifung but dv*e husbands worked > iv et tinx* V shnwn ,o I ible i tlx* tune elapsed betwes-n tx- t.rst ex posure 111 v m \ i * blonde mum unei and the diagnosis < a p** disease ranges Horn II vea* s to 28 vears w*:h an aveage ot years I his o/n ,;ts w tn pu-vious endings put an angosau oma ot trx* I iv er < in (j*v e(. v(i a: h a a minimum sposur** * a *. ut umk h n lli.it .utuai mamlest.if >- m d*x*s nut <*ttur tin at least ten vears* Resident e hisli*f.' revi-aiisj Plat all Wn'kers lived vsrtrxn a two mile rad ms * >t tlx* V( \Y plant sai. e j tx* b**ginn,ng ot dxar en>pli >v ment at ho', plant However no partu uUir pattern u\ tlv* residen tial hist or v i ould be ulcn! i,n*d hta. i ajd lead r - tmdiug iai\ iron- mental i.u t as i uninvin t* evefvo'ie f'asl oi i up.iti>evil rvsti.rv sb we<j that a" tlx-se wo:Via> spixp Com IX). 1 7 J 4 5 6 7 l 9 10 i Table 2. -- Occupational Hivtory ot Ten Cam ot Angourcoma ot the Liver m a Canadian Community. Tlmo Eipoud Wortod tn Wortod in tho Plan! Contact with VC Yoart Monthi Yta/i Monthi 11 11 14 2 U s 70 5 70 5 77 72 17 5 5 l 75 i 73 4 ?fr 6 75 6 75 g 5 5 70 76 to 10 14 9 71 4 16 10 QCCuMOon m Contact With VlAyl Olonda Reactor deaTw re*f**(/ Mif^f ^a*3n u**' Mjiftlp-uis,e 'wralV Iitt*' OaeiaTnf React* `'xemjn aj**' uoTi-v ij's* Reaflfe (tp*^e* 9*er lool*n* j^vt RparTor cteav martVesaf>*e ti.n*-.^*-* Rejn* c*ea.Te apeiar* cv *a*xj*ton aV yrii machine isix Rejrtof deane* maPion**** macS'se jvt fixnaca QtW'at* 0*W Mr*' m^*^vt^re ReaC1* Xxfv+ce ne^ai* t-* *ior- Journal ot Occupaiiooal Mcdicme/Vol 20 No 5/May 1978 Worked 0*#r1im* 'V 335 R&S 027148 Eli-.i-siiVU if ^ y, txpomr*. . OtllH fHHtf i%5 ' 1M3 f:,- - IW7 v 1V, tut iff- 1962 IMS : 7' 1967 StinriMtf Mortto -2 1 4 -8 1)44v 1966 f 3 .' .`.,>ijW 1Pv* B,<t.- efE; q ':-Xhf*te'*1"0- i- *`Vw?i4fe'*-i->s*.** i ' 1971 1946 *' '* 1972 .1961 1973 r 1946.'' 1974 !9SJ , . 1976 2` 7 8 2 jltve 4 41 ? 1 11 1 1 T* *1 TttM*r Ii ii 1 1 1< 111 1 >1 1 X II 1 f 0ibar iMtom Acc^oipMytoi I ! :? 5 0 :S 1 Is !. 6 1 1 1 * 5f ? %; l! 4(2 is Ii s& |3 U 4 1 2* 3 1 . 1111I 1 1 1*15 1 1I 11 * Not (OHufiorjt mfcml to prcut 1>11* 11 11*1111 1*1* * <111111 1 I 1 1A1 I 1 Iho greater part of tlieir active live*, working for the same em ployer. The longest period anyone worked outside the plant was four years. Once Ok* tumor IS diagnosed, the survival period is very short. In the present study, the longest survival period svas eight months, the average 4.1 months. It must be pointed out that angiosarcoma is not the only liver pathology found in vinyl chloride monomer workers......There are two types of benign lesions -- sclerosis and cellular transforma tion, Sclerosis manifests itself by a thickening of the capsule of the liver, a portal fibrosis with proliferation ot the bile dm ts and lym phocytic infiltrate, a sclerosis of the svall of the portal vein and centrolobular veins and a perisinusoidal fibrosis with sinusoid dila tation, Cellular transformation shows a sinusoidal cell proliferation svith atypic. dysplasic and rear tional liver cells. The tumor itselr is a malignant angiosarcoma type tumor appearing in tour detinue histological patterns: a cavernous pattern, a sinusoidal pattern, a nodulo-papillar pattern and a sarcomatous pattern. In our exper ience, the cavernous pattern is the most constant and Irequrnt one (Table 3). Discussion The present study is an epidemiological and a histological de scription oi the ten cases of angiosarcoma of the liver found in the region of Shawinigan, Quebec. Although tlie selection of cases was made from hospital records, it happened that all svere men who worked in the same factory -- a vinyl chloride polymeriza tion plant. This type of tumor being very rare, a causal relaiionship between the exposure to vinyl chloride and the development ot an angiosarcoma of the liver is established The present study reveals that tin* exposure necessary to develop the cancer must be relatively high. Cleaning reactors and operating production units were occupations earned out m an en vironment with a high concentration ot vinyl chloride monomer. Furthermore. It IS possible that in tin- 1940 s. the men svorked more than 40 hours a week. To this, one must add os-ertime work, another contributing factor. It will txe necessary to assess with as much accurany as possible the exposure of these people to vinyl ;' 340 c blonde monomer to discover a dose-response relationsh'p be tween tlie chemical and the disease 11 seems that benign non-tumoral read ions are tlie'rust re- sporwe o: its* liser to ttse cliemiral Eventually they give* way to malignant transionnations.'-' Obviously, more studic- will he* nci essarv to discover wliedier the* benign and malignant lc*sions art* two steps ot a unique ptsenoinenon or tsvo ditte-renl cfeeases. References 1 ( fii*t h 11 ,mH Mirist rfi M\ t's.i'j * mi i if lcf *f"i Mv* fn-in-i* t< lot< ** vi'nl illiquid iu\t 16 110 r. 1 1974 .* loo II ,uh1 H.irrv Os Ami*mm'< um.i *>t l*v lnt`1 n ,j v *rv'l * M`**i** \V. rlM-r / |*,t , , nil, MIH |ljf>d J9 1*171 I IiIia 1*. lir.niiiifij | Amjujs,(.111,1 >Ft fN* ! xdf :*.I! r.\ o.* vifi.l (hKjf*<iik d\| >c >xttrd f \ \ ' \ 229 11-14 Pi'4 *5 Krts 1 Mwv.r.'d Iu.mIIuft ,mH M jhf.ifH A Id f^t*d < (1 i'..r. o> n* l>'|viln|iid ht*/ u* < u\ fid- Hw t hi* *<* m. Id \n h \tjl h.r 111-111 I* (U-t` l'|7i 7 ('I'lllfl t. K OfstM-sC CofTt o ll *tnj M'lftl1 *K \\**dkh KdfVrft, 21 h I : fdh 197., I >d|),i?irivnf nf l,tr>tr Ot u;>.iftvMl s.t*df. .nil i|d,i!'h Atimm.stMlM*) o* viml thlixxld I* fit'iit Kt^-yit i J9 lo-i fh; I 1974 i1H9H hj/t U Wtkk l IVIormd f df ,tl f. f n.t al .ind m vfjhol.*; 4 id,i:uo*s f .tils',1',s* *ir 1 * .ni.t <n v ims l 'Aiukv.'** ( ih'd* "J7 *49 ll l'#"*) H l.!*./!*! M Ofltfin** } dt il Cl.cm jl .uni ,nnr;yv,'r^u UMtuo-s ot fii*lviiit ,un;niv.ift f)fii,i m \mvl t hlotiHd wufkts ( jiu ** `S? 1' Km 197o 9 Odlnmid f ,ind Wikk l An^itiN.trt Mint* Hu lvd < hd/ *<^* iw\fn*i7 .ujrU ft* dfi ( <Mil.ti t proh^r ,H"i Id < hld'uid (K* \ m\ Id Ot-7< pf>lirt fTViffrfmltT- UKjtid tk1'* ld-:`ils l ni.rfi \!t'fi t 104KJ4-M-U V-J71 10 Odl* rnd f ,inci M.jkk l' Ancni^irt mfif Hu 1* m* i 67 h < nj. ttt*fs ,|y.ini dft* dti tnfii.Hi p'il.-n^d .jus Id thhrfurd rid urnli* Dd'uPptHjo It^iFjiJd fid-- ld*xMX>7 Kd'.fM 'f.VH H Thorn,ts IB i:wi l`op;*r M ,irntKi^ s mv I t hlofKjd-^ilvv m\ I 246 26H-277 1**71 119 Mat, P,ith*lo^v ol ,ini;i<Mf<fKni cIiIotmK* \stifkdrs Ann fhi* At ,trj s. 1 12 Thom,is IH l'o{>;>dr H Sru /.Vij 1 I \U`ri 292 17-22, ,il Vmvh< hlontid-mdot <-d It.dr Hi%<mso IT Ofittfk f* Miitldf K df sll \lor;)*t(il(*v Of Its df tixtm.l^d urTl'jrm f>4v* vtm I t hi or ; in iut f > g\ v%< < kd* s A ofart im 11 <'.is4*s A'l*-* % t Ac 41i V / 24b .`H 281, I'Ci 14 Mt Oon.ilti KH Ptmvirv t.m 'ttomj 01 2"`f livdf Ao h lot \U*.j 99 2W>- II I'ojtfM'f h .jnp Trvim.lv IB AhdfalHjrtv of hv*f jnH vjjjty.n jrTv*>t; vvotkt*fs dwix.xi to vinvl ihltwi^* Ann W A* id S<" 246 172-194. 1975 Angiosarcoma of the liver m Shawinigan. Quebec/Delorme and Theriault -,J- wflJKj'rf*',' , R&S 027149