Document M4gbYYVx7RnO3JDMv0VaLoKy

TEXAS TUBERCULOSIS HOSPITAL "****** TYIMli 7.5701 A UNIT W THE TEXAS STATE DEPARTMENT of HEALTH January 27, 1967 Lee Grant, M. D. Medical Director Pittsburgh Plate Glass One Gatevzay Center Pittsburgh, Pennsylvania Dear Dr. Grant: My proposed protocol for the study of the workers exposed to asbestos has been temporarily held up at the State Health De partment in Austin. As soon as it has been returned I shall send you a copy for your suggestions and rpproval. Sincere:v GAH:vp George ' u**--** Clinics 'CSi <?*> o ,:'.J V-- t:!.. ` fii* .* - . c; o- c/; ' j 0: --' OO fr?-- ji <.; March 7, 1>6? o oo [I I George A. Hurst, M.D. Clinical Director fast Texas Tub'rculosi3 iloapital Hex 2003 Tyler, Texas 7b701 ' A13 ' O .V Dear Dr. Hurst: Please excuso my delay in answering your letter of ! j? . " *- c* January 2", IVof, containing your proposed protocol. I have -'x been trart-liny Tor the pant live woohs. ' As I indicated during r.y preliminary nee tin-; with you, the l-.3.?.?!.'?. has been interested in an environmental and o ;> a medical study in the asbostes procucti nanuTactxurir.- industry for sens uine. They have only recently agreed to include our Pittsburgh. Coming Plants at Tylor Toxas, and Port Allegany, Pennsyivaiia.,- in the-onviror.monfcal study. As you see frsn tha. copy of tie -write-up by Leiris J. Oralley which 1 hove enclosed-, they intend doir.j; redical studies, .bs yet, however, they do not havo the money for this study. Dr. Crallcy has indicated that ha will hr.cv in July whether they ./ill be able to do tha . o* nodical studies for our plants. For this reason I would lidco^q &to hold off until July on muring a final decision on your ^ nosed medical study. tv. *>4wv*s W VVV V * Vrii -* ib.*kV W . f ^ t on prat of their total study. If odioal stud;/, the*/ v.oula li'rn to ccnsi U' Urthnr. V V VUP'T^ LJS^ujirj ~~ r>m * f ' - * -V* ' ,; , *J V-V *. * Ti-* * frsrc:i y, ,4 / ^ u/'% 2 J.V11I. Ci'tVli'c-r. ::vit:il T; Irr Plant ;;ill ccrj~-:;;i' cn 'arch 0, l,'o7. and -ncrYtinuG for Ihrco t:> 1`cur diye. Ti'. n!c ,rcv lor yci.r nrcpco.nlj, and I vill kicp you advirod* wnlv Ins Enc. cc * mDi** iit J t Crallcy Mr. B. Stcut Loe 3. Crrirtt, M.D Medical IIrector jO CO iJ 2 * oo a : i </? < < PROTOCOL CLINICAL AND LABORATORY EVALUATION 0-' WORKERS EXPOSED TO ASBESTOS FIBERS BACKGROUND: Inhalation of dust containing asbestos fibers may cause a crippling form of pulmonary fibrosis which usually docs not appear until many years after initial exposure. (1) Amosite is mined in South Africa. These fibers, with a mean diameter of 0.5 micron, arc larger than Canadian asbestos fibers and tend t settle out more rapidly from the atmosphere. The diagnosis can be suspected when history of exposure is associated with O C/ one or more of the following: a) abnormal pulmonary function studies, specifically reduction in pulmonary diffusing capacity. (1,2) This is the hallmark of asbestosis and often precedes definite changes in the radiograph or discernible physical signs, b) radiographic changes consisting of fine diffuse mottling in both bases, c) phy sical signs such as crepitant rales, clubbing and labored breathing. The last 2 C r\ signs occur late in the disease. Although the relationship of asbestosis and tuber culosis has not been emphasized, this project will investigate any potential co existence of these 2 conditions. -r . J, ' A. METHODS OF PROCEDURE: Approximately 52 workers exposed to amosite fibers in a pipe :; insulation manufacturing firm* will be studied at the East Texas Tuberculosis Hospital,; ; Each employee will be administered a questionnaire on respiratory symptoms (Form I) by' one of the investigators. This questionnaire was used by Ferris and Anderson in a j*-- ,~ survey of chronic respiratory disease in a New Hampshire town. (3) It is similar ter ' questionnaires used extensively in Great Britain. (A,5) A brief physical will be dqiie . and findings recorded in the first part of Form It. _ s--j " ' The following laboratory tests will be done and recorded In the appropriate "' place on Form II. The forced vital capacity (FVC) aid the 0.5 second and 1 second forced expiratory volume (FEV) will be calculated from spirograms obtained with the Stead Wells Spirometer. The mean of 3 tracings will be utilized and volumes will be corrected to body temperature and pressure saturated (BTPS). Nomogram for pre dicting FVC and FEV will be taken from the Veterans Administration-Army Cooperative Study of Pulmonary Function by Kory, Callahan, Boren and Syner. (6) * The MBC will be performed utilizing the Stead Veils Spirometer. The mean of 3 tests which should check within 5 liters will be recorded. The prediction formula will be calculated according to the method of Motley. (7) The residual'volume will be determined by the helium closed circuit method utilizing the Collins helium residual volume apparatus and single breath carbon monsxide diffusing capacity unit with a 13.5 liter respirometer. This method has baaiO* described by Motley. (8) The single breath carbon monoxide diffusing capacity will be jk>fteJ &Ji5^abovg3S> mentioned apparatus by the method of Consolazio, Johnson and^^ciJ^.O^^V^ Arterial p02, pH and pC(>2, before and after ejeKiS^jejSft^bs^^i^Sftly in those cases which show low diffusing capacity. Radiomet3)^^0%^B^fliaj\^W3fth a Clarke electrode will be employed in the above named deteHB^pgfKjjp^sS^ Antero posterior and lateral radiographs of the ^est will be taken i 2 of the investigators independently. Comparison will be made with earli I employment films. ,ad by * Pittsburgh-Coming C rporation, Owentown, Texas t* *r.; r r> - oo BIBLIOGRAPHY (I) Williams, R., and Kugh-Jones, P.: The Significance of lung function changes in asbestosis, Thorax, 1960, 15, 109. (2) Thomson, M. L. and McGrath, M. W., Smither, W. J., Shepherd, J.M.: Some anomalies in the measurement of pulmonary diffusion in asbestosis and chronic bronchitis with emphysema, Clin. Sci., 1961, 21, 1. (3) Ferris, B. G., and Anderson, D. 0.: The prevalence of chronic respirato: disease in a New Hampshire Town, Amer. Rev. Resp. Dis., 1962, 86, 165. (4) Higgens, I. T. T.: Respiratory symptoms bronchitis and ventilatory capacity in a random sample of an agricultural population, Brit. Med. J., 1957, 2, 1193. (5) Fletcher, C. M., Elraes, P. C., Fairbaim, A. S., and Wood. 'C. II.: The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population, Brit. Med. J., 1959, 2, 257. (6) Kory, R. C., Callahan, R., Boren, H. G., Syner, J. C.: The veterans admini stration-army cooperative study of pulmonary function I. Clinical spirometry inv normal men, Amer. J. Med., 1961, 30, 243. (7) Motley, It. L.: Clinical pulmonary physiology II. Detection of early lung t function changes in industrial exposure. Indust. Med., 1953, 22, 267. ~ (8) Motley, H. L.: Comparison of a simple helium closed circuit method with the oxygen open circuit method for measuring residual air, Amer. Rev. Tuberc. ` ~ ' Dis., 1957, 76, 601. (9) Consolazio, 3. F., Johnson, R. E., Fecora, L. J.: Physiological mej of metabolic functions in man, 1963, 239. (McGraw Hill Book Company). O* rH.