Document NG76BdGpjnNJp01wXrnMpavnV
SUSGECY' WUUAM 9. MILLBERG. M. D. MORRIS WASYUNKI. M. D.
GENERAL PRACTICE GLENN E. E1PPEST. M. D. RICHARD . M1LLBERG, M. D. -
4
as m T
IMTBtNAl MEDICINE
' >';
MOHAMMAD T. HOSSAIN, M. D.
CHARLES M. SUTTlS, M- D-
December ,13, 1973
*' '"-'-Robert W. Pringle, M. D. - Pittsburgh DiagnosticClinic . :/ Mellon Pavilion
: 4815 Liberty Avenue : - ` Pittsburgh, Pennsylvania 15Z24
ie Dear Doctor Pringle:
Enclosed Is a summary of the sixty employees of the North American
Rockwell Brake Division, Ashtabula, Ohio, who underwent pulmonary function
evaluation at the Ashtabula Clinic during the year of 1973. The rationale
for the study is presented, the methods of Investigation are discussed and
limited conclusions are made.
,
We feel very strongly that a cursory, evaluation would serve no
preventative purpose in the early detection of such a protean and insidious
disease as asbestos pneumoconiosis. For this reason we have recommended a
more complete evaluation.
-
A limiting factor In this initial study pertains to the comparison
of observed date with that of predicted normal values. Although worldwide
recognozed predicted values were utilized, the information obtained cannot
be compared with that of serial Individual determinations. The importance
of comparing an Individual with his own established values is paramount.
During the ensuing year this will be accomplished and the investigation will
be of far greater value to North American Rockwell Brake Division in that
changes, not expected by age increase, will be detected. This we hope will''
result in early detection of a possibly correctable disease. .
.
Since asbestosis is primarily an interstitial disease, we would highly reconwend the addition of diffusion studies to the present program. This parameter appears to be the earliest effected in asbestos exposure and would inhance th-e early detection of abnormality. With the addition of
i
ROCK 0006695
Robert VI. Pringle, M. D. Page 2 December 13, 1973
diffusion studies (single breath arid--if 'necessary, steady state carbon monoxide diffusion test) we feel that your surveillance program would be most complete and satisfy any critical Investigation.
If you so-agree, we would be most happy to discuss this with
you at any time.
`
Respectfully submitted,
WBM:bw Enclosures ' cc: Mr. Edward Gierok
William B. Millberg, M.D.,F.C.C.P. - >
'f \
i f '
!l`
ROCK 0006696
REPORT TO NORTH AMERICAN ROCKWELL BRAKE DIVISION, ASHTABULA, OHIO CONCERNING THE PULMONARY FUNCTION EVALUATION
. OF THOSE EMPLOYEES EXPOSED TU ASBESTOS
The purpose of this study was to detect any clinical, radiological, or physiological effects of asbestos exposure upon the work force of North American Rockwell Brake, Division, Ashtabula, Ohio. The basic parameters of this study comply with the recommendations of the National Institute for Occupational Safety and Health of the United States Department of Health, Education and Welfare for the occupational exposure to asbestos. Although the basic recommended criteria were followed, the present evaluation was expanded and investigated in far greater detail.
Each individual was evaluated from three diagnostic approaches which consisted of clinical evaluation, radiological examination and physio logical pulmonary function testing. To maintain consistency throughout the study and eliminate individual variations, only one technician was involved in the actual performance of the pulmonary function testing and interpretation of the physiological data was accomplished by one physician. All radiological examinations were taken by two technicians. To eliminate problems of radio logical film processing, films were automatically processed by a Kodak RP X-omat Processor. All films were interpreted by one physician. The quali fications of the physician interpreting the' radiological, physiological, and clinical data include Diplomat of the Board of Thoracic Surgery, Fellowship in the American College of Chest Physicians and membership in the American Thoracic Society.
ROCK 0006697
CLINICAL EVALUATION
Clinical evaluation consisted of a review of the individuals past
medical history, a systemic review, a review of industrial exposures, and
an appraisal of smoking habits. Emphasis was placed on cardiopulmonary
problems in the past or present respiratory symptoms. "The Questionnaire
on Respiratory Symptoms", approved by the British Medical Research Councils
Committee on research into chronic bronchitis and considered the world wide
standard was basically followed.
A physical examination was then conducted with special emphasis
placed on the cardio-respiratory symptoms. Two specific parameters were
thoroughly evaluated and consisted of evaluation of pulmonary basilar rales
and digital clubbing.
.
-radiological evaluation Radiological evaluation consisted of three separate 14 x 17 teleoroentgenograms. A PA teleoroentgenogram taken in maximal inspiration, a PA teleoroentgenogram taken in maximal expiration and a left lateral teleo roentgenogram taken in maximal inspiration were performed on each individual, High quality DuPont Cronex 4 film was used throughout and films were auto matically processed utilizing the Kodak RP X-omat Processor. The three views were selected since an early manifestation of asbestosis is limita tion of costal and diaphragmatic excursion. The three views also manifest far better correlation with pulmonary function testing.
ROCK 0006698
PHYSIOLOGICAL PULMONARY FUNCTION EVALUATION
Physiological pulmonary function evaluation consisted of determi nation of total lung capacity and the subdivisions. .Forced, timed, inspiratory and expiratory volumes were performed. Maximal voluntary ventilation and oxygen consumption were evaluated.
All studies were performed on a Godart Pulmonet, type 59004, to which was attached a Cardiopulmonary Instruments Corporation Flow-volume digitizer. Model 541 and a C.P.I. Norm Calculator, Model 550.
Total lung capacity was determined by the Godart spirometer gas analyzer. The spirometer is a water sealed spirometer with a capacity of nine liters. The brass spirometer bell is lightweight (0.1 mm. thickness) and balanced so that the subject breathes at an absolute zero pressure point. A constant flow of homogeneous gas mixture is provided within the circuit. A two speed recording Kymograph, operating at 60 and 1200 mm. per minute, provides a permanent record. Digital display of volume and flow is provided by the flow volume digitizer. .
The functional residual capacity was determined by the closed system helium determination technique utilizing a thermo conductivity gas analyzer for helium.
Forced inspiration and expiration volumes were determined both graphically and by digital display on the flow volume digitizer.
Maximal voluntary ventilation was determined both graphically and by digital display, using the flow volume flow volume digitizer and the spirometer.
ROCK 0006699
All paremeters of the physiological evaluation were repeated at
least three times and the best observed value was recorded. Each individual
was assumed free.of recent upper respiratory tract infection and if such
existed, the test was postponed. The timed spirographic tracing was evalu
ated and all observed data was compared with predicted values. The predicted
values used were those of the V. A. Cooperative study, the Oregon Thoracic
study, DuBois Body Surface chart and the normal values for pulmonary function
testing of Bates and Christie and the predicted maximal breathing capacity
of Baldwin et al.
Guidelines for the interpretation of the physiological data were
fundamentally expressed as follows:
--
Vital capacity
80 - 90% 60 - 80% 40 - 60% Less than 40%
Slight reduction Moderate reduction Marked reduction Very marked reduction
Increase In Residual Volume'
125 - 175% 175 - 250% Above 250%
Moderate increase Marked increase Very marked increase
Decrease In Residual Volume
60 - 80% of preducted 40 - 60% of predicted Below 40% of predicted
Moderate decrease Marked decrease Very marked decrease
Ratio of Residual Air To Total Lung Capacity
35 - 50 Above 50 Above 65
Moderate degree-of emphysema Severe degree of emphysema Very severe degree of emphysema
Maximal Voluntary Ventilation
80 .60 40 Less
95% 80% 60% than 40%
Slight decrease Moderate decrease Marked decrease
Very marked decrease
ROCK 0006700
Impairment. Of Pulmonary Mixing
2-2 1/2 minutes 2 1/2 - 3 minutes . 3-4 1/2 minutes 4 1/2 minutes or more
FEV/FEV FEV/FEV FEV/FEV
0.5 sec. 1 sec. 3 sec.
Slight decrease Moderate decrease Severe decrease Very severe decrease
NORMAL
50 - 55% 80 - 85% 97 - 100%
ROCK 0006701
DISCUSSION
Asbestos is*a generic term applied to the naturally occurring hydrated mineral silicates incombustible in air and separable into filaments. The particulate matter in asbestos dust is composed of broken fibers of crystalline magnesium silicate containing traces of iron, nickel,, calcium and aluminum. The workers of North American Rockwell Brake Division are exposed to chrysotile, a fibrous form of serpentine. The extent of this exposure is unknown to this examiner, but has been measured and is appar ently extremely low and effectively controlled.
Pulmonary asbestosis is an occupational disease which can effect any person working in a factory or industry dealing with asbestos or its products, or living in the vicinity of such an establishment. The develop ment of asbestos depends upon the degree of exposure and the duration of exposure. The asbestos fibers apparently cause mechanical irritation in the terminal and respiratory bronchioles initially surrounded by a gela tinous precipitated protein and resulting in both parenchymal and pleural fibrosis-. * Far advanced pulmonary asbestosis results in profound cardio respiratory, insufficiency, disability and failure. An increased incidence of bronchogenic and gastrointestinal carcinoma appears present. An in creased incidence of pleural mesothelioma is also noted. There appears to be*a synergistic effect between cigaret smoking and exposure to asbestos, with an increased incidence of neoplasis resulting.
ROCK 0006702
The most common symptom is dyspnea and clinical evaluation suggests pulmonary insufficiency with basilar pulmonary rales, distant breath sounds, and limitation of respiratory excursion with finger clubbing.
The roentgenographic appearance of asijfcstosi's is that of interstitial
fibrosis and pleural thickening. An early sign is limitation of costal and
diaphragmatic excursion. The pulmonary function derangement is that of restrictive disease with a decrease in vital capacity and residual volume.
The most sensitive index appears to be the diffusing capacity of the lung and this parameter is the earliest affected. Correlation between x-ray and pulmonary function studies is poor. The x-ray may be abnormal and the pul monary function study normal. The converse is also true.
A definite diagnosis of asbestosis cannot be established in any of the cases reviewed, as this would necessitate histological confirmation. The most prevalent finding was that of chronic bronchitis, which can be attributed to the general environment and the smoking habits of the employees. Since there appears to be a synergistic carcinogenic effect between asbestos
exposure and cigaret smoking, an effect should be extended to encourage the
workers to cease the practice of cigaret smoking. '
As' can be determined from1 the tables,- incidental disease was encoun tered, which included hypertension, hepatomegaly, inguinal hernia, pulmonary granuloma (proven), and cervical and prescalene lymphadenopathy. Findings
suggestive of pulmonary asbestosis were not encountered in any individual
studied.
ROCK 0006703
NEW RECOMMENDATIONS
After thorough review of this study, the following recommendations
are suggested to North American .Rockwell Brake Division in Ashtabula, Ohio.
1. An educational campaign be instituted to decrease the incidence of cigaret smoking.
2. Encourage the use of respirators in those exposed to asbestos.
3. Reevaluate each individual on a yearly basis. More meaningful information would be obtained by comparing the individual with his own baseline values than by comparision with predicted normal values. Early detection of abnormality would result and correction could be made.
'
4. Each parameter of the medical evaluation program is considered important if the goal of early detection of abnormality is
paramount. Detection of far advanced lung disease at an uncontrollable stage would serve no useful preventative purpose. Because of this, a comprehensive, rather than a cursory evaluation was utilized. . .
Clinical evaluation through correlation of the past medical history,
industrial exposure and physiological examination aid in the detection of not
only chronic lung disease, but other coexisting abnormalities. Radiological
evaluation correlated with the clinical picture increases the accuracy of
detection of early disease and the three separate roentgenographic studies
are considered paramount to this approach. Physiological pulmonary function
testing correlated with both the clinical and radiological pictures again
enhances the accuracy of early detection of abnormality. The parameters of
this physiological testing were selected as those being most affected by
early abnormality. In addition to the basic parameters now being evaluated,
It is.strongly recommended that pulmonary diffusion studies be included.
ROCK 0006704
This is be-ing recommended since abnormality in diffusion appears to be the earliest function to be affected by asbestos pneumoconiosis. Since chronic lung disease is such a prevalent abnormality throughput the United States with its end stage resulting in crippling disability, which for the most part is irreversible, detection and reversal of the early stage is a most significant preventative measure. It is felt that this recommended approach will satify the requirements and will offer an exceptional medical surveilance program to the employees of North American Rockwell Brake Division of Ashtabula, Ohio.
ROCK 0006705
NORTH AMERICAN ROCKWELL - PULMONARY FUNCTION 1973
X-RAY NO.
AGE
1. 7770
27
2. 7545
26
3. 7753
26
4. 3218
29
5. 7576
30
6. 7603
22
7. 7672
26
8. 8124
23
9. 7577
25
10. 7487
29
11. 7587
21
12. 7636
35
13. 7579
33
14. 928
30
15. 7447
39
16. 8508
30
17. 7568
29
18. 7616
39
19. 7504
30
20. 7635
44
21. 307
41
22. 7481 ' 50
23. 7168
29
24. 7743
33
25. 7970
42
26. 1764
57
27. 7617
35
28. 7050 27
29. 8290
25
30. 7560
30
SEX X-RAY NO.
M
' 31'.
7644
M 32. 7700
N 33. 7716
M 34. 7512
M 35. 7566
M 36. 7720
M 37. 7775
M 38. 5523
M 39. 7495
M 40. 7426
M 41. 7778
M 42. 7599
M 43. 7626
M 44. 7642
M 45. 7698
M .46. 7633
M 47. 7561
M 4B. 7779
M 49. 7996
M 50. 7554
M 51. 5371
M
52. 7513
M ,53. 7655
M
54.
7480
M 55. ' 7476
M'
56. 4411
M 57. 7556
M 58. 7622
M 59. 7503
M 60. 2127
AGE
29 35 49 49 52 42 32 31 20 49 43 38 42 20 28 45 ~2837 30 -38 43 33 32 55 33 41 27 42 54 32
SEX
M M M M M M M M M M M M M M M M M M H M M M M M M M M M M M
ROCK 0006706
TYPE OF WORK
. LENGTH OF EXPERIENCE
1. Machine operator - riveter
2. Machine operator
3. Assembly
4. Assembly
.
5. Machine operator
- ..
6. Riveter
"
7. Grinder
8. Grinder
.
9. Grinder
10. Machine operator
11. Riveter
12. Paint line
13. Machine operator
14.- Grinder *
15. Grinder
16. Riveter
17. Grinder
18. Riveter
19. ? 20. Assembly
21. Assembly 22. ?
'
'
23. - Grinder 24. Grinder
~ '
25. Machine operator
26. Assembly
27. Assembly 28. Riveter
29. Riveter
30. Paint line - grinder
31. Assembly
32. Riveter
33. Machine operator
34. ?
35. Riveter
36. Assembly
37. Riveter
38. Riveter
39. ?
40. .
?
41. Shift supertendent
42. Paint line
43. Machine operator
44. Machine operator
45. Grinder
.
3 years
20 months . 2 years
71/2 years
1 1/2 years 1 1/2 years
6 years
1 1/2 years
4 years ' ?
1 1/2 years
5 years
11 years 7 1/2 years 6 weeks 1 1/2 years
9 years 9 years
?
'
10 years 6 years
?-- 6 1/2 years 7 1/2 years 4 years 8 1/2 years 10 years 1 year 1 year 8 months 7 1/2 years 1 1/2 years
7 1/2 years 11 years
? 7 years
1 1/2 years 2 months 61/2 years
? ?
25 years 10 years 6 years 2 years 3 months
ROCK 0006707
TYPE OF WORK
LENGTH OF EXPERIENCE
46. Milling machine - grinder
47. Grinder
48. Machine operator - grinder
49. Riveter 50. Machine operator
.' ' *' '
....
51. Lift operator
52. ?
53. Grinder 54. ?
55. 7
56. Machine operator
57. Grinder 58. Foreman 59. 7
.
60. ?
.
25 years . 6 years
8 years
2 years 10 years 6 1/2 years
?
1 month ?
? 3 years 8 years 71/2 years
?
?
ROCK 0006708
RESPIRATOR
1. No 2. No 3. No 4. No 5. No 6. No 7. No
a. Yes
9. No 10. No
n. Yes
12. No 13. No 14. Yes IS. Yes 16. No 17. ? 18. No 19. No 20. No 21. Yes 22. No 23. No 24. No 25. No 26. No 27. No 28. No 29. No 30. No
CIGARETTE SMOKER
RESPIRATOR
No
Yes 1/day
Yes . 1/day 7 years
Yes 1/day 15 years
No '
. No
-
Yes 2/day 13 years .
No '
No
No
No Pipe
No Pipe
No
Yes 2/day 12 years
Yes 1 1/2 day 20 years
Yes 1 1/2-2/day 15 years ?
No Cigar .
No
Yes 1/day
No
Yes 2/day
Yes^ 1/2/day 10 years
Yes 1/day
15 years
Yes ' 1/day
30 years
Yes 1 1/2/day 40 years
No Cigar
Yes 1-2/day 7 years
Yes 1/day
10 years
Yes (quit 1 year ago)
31. No 32. No 33. No 34. ? 35. Yes 36. No 37. Yes 3B; No 39. No 40. ? 41. No 42. No 43. No 44. No 45. Yes 46. No 47. Yes 48. No 49. Yes 50. No 51. No 52. No 53. Yes 54. No 55. No 56. No 57. No 58. No 59. No 60. No
CIGARETTE SMOKER
No
Yes 1 1/2 day 20 years
Yes 1/day 25--30 years
Yes 1/day
Non smoker
Yes 1/day
22 years
Yes 1/day ?
Yes 1-1 1/2/day 7
No
No
. Yes 1/2/day
No
No (quit)
No
Yes 1/day
Yes 1 1/2/day 20 years
No
Yes 1-2/day
Yes 1/day
No
Yes 2/day
20 years
Yes 1-1 1/2/day ?
No (quit 3 years-ago) Yes 1/day
Cigar Yes 1 1/2/day
?
ROCK 0006709
PAST MEDICAL HISTORY
1. 2. 3. ' 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43.
44. 45.
Negative
Negative
Allergy
Negative
Pneumonia, age 16
Negative
Negative
Negative
Negative '
Negative
Negative ,
Pneumonia, age 27
Negative
Mild asthma
Negative
Negative
Pneumonia, child
Negative
Negative
Hiatal hernia, gall bladder
Pneumonia, age 33
Negative
Negative
Negative
`
Negative
Pleural effusion, 40 years ago
Pneumonia, age 12
Negative^
Negative
Negative
Negative
Negative
Pleurisy, age 29
Negative -
Negative
Negative
Negative
Spontaneous pneumothorax, age 27
Negative
Negative
Pneumonia, child
Negative
Negative
Allergic asthma
Carcinoma, testes
'
SYSTEMIC REVIEW
Negative
Negative
Negative
Negative
Negative
Negative
Productive cough
Negative
Negative
Negative
_
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
.
Negative
Chest pain
Chronic productive cough
Negative
Negative
.
Chronic cough
Negative
Negative
Negative
Mild cough
Negative
Negative
Negative
Negative
Negative
Minimal cough
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
Negative
ROCK 0006710
PAST MEDICAL HISTORY
46. Negative
47. Negative
48. Pneumonia, child
49. Negative
50. Negative
51. No chest disease
52. Negative
53. Negative
54. Negative
55. Negative
56. Negative
57. Negative
58. Negative
59. Negative
.
60. Negative
SYSTEMIC REVIEW
Negative Negative Negative Negative Negative Negative Negative Negative Cough, dyspnea Negative Negative Negative Negative Negative Negative
ROCK 0006711
PHYSICAL EXAMINATION
1. Normal
31. Normal
2. Normal
32. Chronic otitis media
3. Normal
33. Normal, chest scar
4. Normal
34. Normal
5. Normal
35. Left prescalene nodes
6. Normal
* 36. Normal
7. Normal
37. Normal
8. Inguinal hernia, right
38. Normal
9. Normal
39. Normal
*
10. Normal
40. Normal
11. Normal
41. Normal
12. Normal
42. Normal
13. Normal
43. Normal
14. Normal
44. Normal '
15. Normal
45. Absent right testes, old scar
16. Normal
46. Normal
17. Normal
47. Normal, left inguinal hernia
18. Normal
48. Normal, cough
19. Normal
49. Normal
20. Normal
50. Normal
21. Normal
51. 'Normal
22. Normal
52. Normal
--
23. Normal
-
53. Normal
24. Normal
54. Normal
25. Normal
55. Normal
26. Normal, with questionable liver and 56. Normal
increased blood pressure
57. Normal
27. Normal
58. Undescended left testes
28. Normal
59. Occasional extrasystoles
29. Normal, cough
' 60. Normal
30. Normal
ROCK 0006712
CHEST X-RAY
1. Normal
2. Residuals of remote disease,
no active disease.
.
3. Normal
..
4. Basilar fibrosis
5. Normal
6. Normal
7. Normal
8. Minimal bronchitis
9. Normal
10. Normal
11. Normal
12. Normal
13. Normal
14. Minimal bronchitis
15. Normal
'
16. Normal, bifed rib
17. Normal
18. Normal
19. Minimal pulmonary fibrosis
`
20. Normal
21. Chronic bronchitis, minimal
fibrosis-
22. Normal
.
23. Normal
24. Residuals of remote disease
25. Normal
26. Pulmonary fibrosis, minimal
27. Normal
28. Normal
29. Normal .
30. Normal '
31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53.54. 55. '56. 57. 58. 59. 60.
Normal
Minimal fibrosis
Pulmonary fibrosis
Normal
.
Questionable hilar mass, fibrosis
Minimal fibrosis
Normal
Normal .
Normal
Minimal fibrosis
.
Normal
.
Normal
Normal
Normal
Normal
Wide retrosternal air space
Normal
Normal
Normal
Normal
Normal
Normal
Chronic bronchitis
Solitary node (proven granuloma)
Normal
Normal
Normal
*
Normal
Widened retrosternal air space
Normal
ROCK 0006713
TOTAL LUNG CAPACITY
1. Normal
2. Normal
3. Normal
4. Normal
5. Normal
6. Normal
7. Normal
8. Normal
9. Normal
IQ. Normal
n. Slight decrease
12. Normal
13. Normal
14. Normal
15. Normal
16. Normal
17. Normal
18. Normal
19. Normal
20. Slight decrease
21. Normal
22. SIight decrease
23. Normal
24. Normal
25. Normal
26. . Slight decrease
27. Normal
28. Normal
29. Slight decrease
30. Normal
31. SIight decrease
32. Normal
33. Moderate decrease
34. Normal
35. Normal
36. Normal
37. Normal
38. Normal
39. Slight decrease
40. Slight decrease
41. Normal
42. Normal
43. Normal
44. Normal
45. Normal
PULMONARY FUNCTION
VITAL CAPACITY
RESIDUAL VOLUME
Normal
Normal
.
Normal
' Slight decrease '
Normal
Normal
'
Normal
Slight decrease
Slight decrease
Slight decrease
Moderate decrease
Normal
Slight decrease Normal
Normal
'
Normal
Normal
Normal
Normal
Moderate decrease
Normal
Slight decrease
Normal
Normal
Normal
Slight decrease
Normal
Normal
Slight decrease
Normal
Slight decrease
Normal
Moderate decrease
Normal
.Normal
Normal
'
Normal
Normal
Slight decrease
Moderate decrease
Normal
Normal
Normal
Normal
Normal
. Normal
Normal
. Moderate increase
Normal
`
Normal
Normal
Normal
Normal
Normal
Normal
Moderate decrease
Moderate increase
Normal
Normal
Slight increase
Slight decrease
Normal
Normal
Normal
Normal
Moderate Increase
Normal
Slight decrease
Slight increase
Normal
Normal
Slight decrease
Normal
Moderate decrease
Normal
Slight decrease Normal
Moderate decrease
Normal
Normal
Normal
' Normal
Slight decrease
Slight decrease
Normal
Slight decrease
Normal
Normal
Normal
Slight increase
ROCK 0006714
TOTAL LUNG CAPACITY
46. Normal 47. Normal 48. Normal 49. Normal 50. Normal 51. Normal 52. Normal 53. Normal 54. ' Normal 55. Normal 56. Normal 57. Normal 5B. Normal 59. Normal 60. Normal
'
PULMONARY FUNCTION
VITAL'CAPACITY
Normal
Normal
Normal
Normal
Slight decrease
Slight decrease
Normal
'
Normal
Normal
Normal
Normal
Normal
Normal
Moderate decrease
Normal
RESIDUAL VOLUME
Normal Slight increase Normal Normal Normal Moderate increase Normal Moderate increase Moderate increase Normal Slight increase Normal Slight decrease Slight increase Normal
ROCK 0006715
FORCED EXPIRATORY VOLUME
1. Normal
2. Normal
3. Norma 1
4. Slight decrease
5. Normal
6. Normal
7, Normal .
8. Slight decrease
9. Norma 1
10. Normal
11. Slight decrease
12. Normal
13. Slight decrease
14. Slight decrease
15. Normal .
16. Normal
17. Normal
18. Normal
19. Normal
20. Moderate decrease
21. Normal
22. Normal
23. Normal
24. Slight decrease
25. Normal
.
26. Slight decrease
27. Normal
28. Slight decrease
29. Slight decrease
30. Normal
'31. Normal *
32. Normal
33. Slight decrease
34. Normal
35. Normal
36. Normal
37. Normal
38. Normal
39. Normal .
40. Normal
MAXIMAL VOLUNTARY VENTILATION
Normal Normal Normal Slight decrease Norma) Normal Slight decrease Normal Normal Normal Normal Normal Slight decrease Slight decrease Slight decrease Normal Normal Slight decrease Normal Normal Normal Normal Normal Slight decrease Normal Slight decrease Slight decrease Normal Slight decrease Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
ROCK 0006716
FORCED EXPIRATORY VOLUME
MAXIMAL VOLUNTARY VENTILATION
41. Normal
42. Normal
.
43. Normal 44. Normal
.. - * '
45. Normal
46. Normal
'
47. Normal
48. Slight decrease
49. Normal
50. Normal
51. Slight decrease
'.
52. Normal
,
53. Normal
'
'
54. Normal
55. Normal
'
56. Normal
.
57. Normal
58. Normal
'
59. Normal
60. Normal
Normal
Slight decrease
Slight decrease
Moderate decrease
Moderate decrease
Normal
Normal
Slight decrease
Normal
Slight decrease
Slight decrease
Normal '
Slight decrease
Normal
~~
Slight decrease
Normal
Slight decrease
Normal
Normal
Slight decrease
ROCK 0006717
CONCLUSION OF STUDY
1. Normal
2. Normal
3. , Minimal degree of obstruction
Bronchial disease
-
4. Minimal chronic bronchitis
5. Normal
6. Normal
7. Normal
8. Normal. Inguinal hernia
9. Normal
10. Normal
11. Slight bronchitis
12. Minimal bronchitis
13. Normal
14. Minimal chronic bronchitis
15. Normal
16. Normal
17. Normal
18. Normal
19. Normal
20. Moderate restrictive disease
21. Normal. Slight increase of
respiratory volume
22. Minimal bronchitis
23. Normal
24. Minimal chronic bronchitis
25. Normal
26. Slight restrictive disease,
bronchitis
27. Normal
28. Normal
29. Chronic bronchitis
30. Normal
31. Normal
32. Normal
33. Slight restrictive disease,
old trauma
34. Normal
35. Abnormal physical and x-ray exam.
36. Normal
37. Normal
38. Normal
39. Chronic bronchitis
40. Minimal destructive disease .
41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53.
54. 55. 56. 57. 58. 59. 60.
Slight bronchitis
Normal
.
Minimal chronic bronchitis
Slight obstructive disease
Normal. History of cancer, testes
Normal
Normal
Chronic bronchitis.
Normal
Normal
Bronchitis
Normal
Chronic bronchitis. Questionable
early emphysema.
Early emphysema. Granuloma
Normal
Normal
Normal
Normal
Early emphysema
Normal
ROCK 0006718
NURTH AMERICAN ROCKWELL - PULMONARY FUNCTION 1973
X-RAY NO.
1. 7770 2. 7545 3. 7753 4. 3218 5. 7576 6. 7603 7. 7672 8. 8124 9. 7577 10. 7487 11. 7587 12. 7636 13. 7579 14. 928 15. 7447 16. 8508 17. 7568 18. 7616 19. 7504 20. 7635 21. 307 22. 7481 23. 7168 24. 7743 25. 7970 26. 1764 27. 7617 28. 7050 29. 8290 30. 7560
AGE SEX
27 31*.
26 32.
26 [4 G.
33.
29 30 M m.eA*JuL2*"35.
22 36.
26 M
37.
23 38.
25 M nv c-.-fajJv-' 39.
29 M . 40.
21 M-n.Q>A&u^=41.
35 M jujJJ-- 42.
33 M iQ-
43.
30 M
44.
39 45.
3Q
29 M47.
39 M Q-* iluA'Oi*-''" 48.
30 M ' 49.
44 - f*j Q_
50.
41 M 0..
51.
50 52.
29 M
.53.
33 54.
42
57 M
56.
35 '
57.
27 M UJ- t10f:C9imft<rwo 58.
25 59. 30 M^.moEcxJLi 60.
X-RAY NO. - AGE
SEX
7644
7700
7716
7512'
7566
7720
7775
5523
7495
7426
7778
7599
7626
7642
7698
7633
7561
7779
7996 `
7554
5371
7513
7655
7480
7476
4411 .
7556
7622
.7503
2127
29 35 49 49 ' 52 42 32 31 20 49 43 ' - 38 42 20 28 45 28 37 30 38 43 33 32 55 33 41 *
27 42 54 32
M a.
M rrvajLo^
M ijj.
M
JVJ ft. HC.Pja^
f*J O, RXc^
M M
' Z-
M rn . Rf-c^fi--
M
M > M OL. S-r-oTi-K
MB
M R*
M ^ ivyuJjA'
M C . *y%jLV4AyUrtxXJ
M Q.
M"
--C*J
*
M &. i^ 1''A'~ 0 n n
M 0- * xJUao-v
M ft. UJA^fcM
M
i i
I ROCK 0006719