Document 5DnbOj8pmNpo5dd5J3886oRL0

PRINGFIELD MEDICAL ASSOCIATE-.. INC. 2150 MAIN STREET SPRINGFIELD. MASSACHUSETTS'^ 104 TELEPHONE (413) 739-5676 Michael P. Coppola. M.D. CHEST DISEASES AND INTEENAL' MEDICINE Frederick a. Flatow. M.D. HEMATOLOGY. ONCOLOGY. AND INTERNAL MEDICINE Paul C. Hetzel M.D. ONCOLOGY. HEMATOLOGY AND INTERNAL MEDICINE Rorert P. Hoffman. M.D. INFECTIOUS DISEASES AND INTERNAL MEDICINE Thomas J. Keenan. M.D. CARDIOLOGY AND INTERNAL MEDICINE David H. Miller. M.D. RHEUMATOLOGY AND INTERNAL MEDICINE .David L. PlEET. M.D. GASTROENTEROLOGY AND INTERNAL MEDICINE Thomas F. Race. M.D. GASTROENTEROLOGY AND INTERNAL MEDICINE Michael H. Rosen. M.D. HEMATOLOGY. ONCOLOGY. AND INTERNAL MEDICINE Mary Ryczak. M.D. INFECTIOUS DISEASES AND INTERNAL MEDICINE Roy Stillerman. M.D. CHEST DISEASES AND INTERNAL MEDICINE May 3, 1988 Attorney James H. Tourtelotte Robinson, Donovan, Madden & Barry p.c 1500 Main Street - Suite 1400 Springfield, MA 01115 RE: John H. Warren Dear Attorney Tourtelotte: Mr. John H. Warren was first seen in consultation June 3, 1987 at the Baystate Medical center. The consultation was requested by Dr. Arthur McGuire following Mr. Warren's admission with neurologic symptoms. A CT scan of the brain had been done showing multiple metastatic lesions to the brain from an uncertain primary. Mr. warren reported repeated episodes of hemoptysis, and chest x*tay'also showed multiple metastatic lesions. There were episodes of gastrointestinal bleeding and hematuria suggesting abnormalities in the urinary and gastrointestinal systems. Mr. Warren also complained of pain in the right upper abdomen and lower chest, and scans showed an abnormality in the liver and first interpreted as a benign hemangioma. Mr. Warren gave a history of exposure to'the chemical vinyl chloride over a period of many years at his place of employment. Given the known association of vinyl chloride exposure and angiosarcoma of the liver, this lesion was suspected in Mr. Warren's case. Therefore a needle biopsy of the lesion in the liver was undertaken, but this was not diagnostic. Therefore on June 26, 1987, an open biopsy of the left lung and pleura was done revealing a malignancy diagnosed as angio sarcoma metastatic to lung and pleural. The known lesion of the liver was then considered to be the primary site. The hematuria and blood loss from the intestinal tract were assumed to be due to metastatic lesions to these organ systems. Mr, Warren was seen in consultation at the Dana-Parber cancer center in Boston. After review of the biopsy material and examination of Mr. Warren, the consultants concurred in the diagnosis of metastatic angio sarcoma and recommended chemotherapy. Chemotherapy was not successful UCC 085785 -PRINGFIELD MEDICAL ASSOCIATE-. INC. 2150 MAIN STREET SPRINGFIELD. MASSACHUSETT$`OII04 TELEPHONE (413) 739-5676 Michael P. Coppola. M.D. CHEST DISEASES AND INTERNAL MEDICINE Frederick a. Flatow. m.D. HEMATOLOGY. ONCOLOGY. AND INTERNAL MEDICINE Paul C. Hetzel. M.D. ONCOLOGY. HEMATOLOGY AND INTERNAL MEDICINE Robert P. Hoffman. M.D. INFECTIOUS DISEASES AND INTERNAL MEDICINE Thomas J. Keenan. M.D. CARDIOLOGY AND INTERNAL MEDICINE RE: John H. Warren David H. Miller. M.D. RHEUMATOLOGY AND INTERNAL MEDICINE David L Pleet. M.D. GASTROENTEROLOGY ASO INTERNAL MEDICINE Thomas F. Race. M.D. GASTROENTEROLOGY AND INTERNAL MEDICINE Michael H. Rosen. M.D. hematology, oncology, and internal medicine Mary Ryczar. M.D. INFECTIOUS DISEASES AND INTERNAL MEDICINE Roy Stillerman. M.D. CHEST DISEASES AND INTERNAL MEDICINE April 25, 1988 in controlling the metastatic lesions, and Mr. Warren continued to have hemoptysis and gastrointestinal blood loss with anemia. The brain metastases, which had responded previously to irradiation, recurredwith return of neurologic symptoms. Despite blood transfusions, intra venous fluids and nutritional-efforts, the disease progressed and Mr. Warren expired January 29, 1988. Angiosarcoma of the liver is quite a rate tumor, and it is my opinion that in Mr. Warren's case, there is a direct association between his angiosarcoma \ FAF/nbr UCC 085786