Document Rp6eg58zNJMb36JaB8pkLqknz

PLAINTIFF'S EXHIBIT DTJP-1551 GUIDELINE* TO* THE DIAGNOSIS AND CLASSIFICATION Of ASBESTCS-PELATED MEDICAL CASES IMI guideline supplements the Guidelines far tht Management of Chrome Occupational Illnesses (1) . This guideline covers those asbestos-rulatsd conditions listed below. Use of this classification should be restricted oo those caaas in which there ia evidence of prooahle eaoeacoa expos_r. Senior. Asymptomatic Abnormalitiest Pleural thickening and/or plagues and/or calcification with no evidence of parenchymal dnetse e Benign Symptomatic Illneaaeai Presumptive aabeatoaia Confirmed aabeatoaia Exudative pleural thickening Pleural effusion Malignant Illnossoat Me ao the Home of the pleura or peritoneum Carcinoma of the lung, larynx, or gastrointestinal tract (ttsaaeft, colon) A preaumptlve diagnosis of aabeetoele ia one in wnich there is good evidence of parenchymal dlaeesa due to asbestos exposure even though there <* no interstitlel fibrosis noeed on x-ray. Such a case would include pleurel x-ray changes, ayapcooa, abnormal spirometry and/or abnormal blood gases. Accepted medical < __ practise and MZOSH guidelines suggest that a confirmed diagnosis of esbeetosls should be made only with the presence of x-ray change, of interstitial fibrosis, symptoms (dyspnea, cough, see.), pnysicu. u-1 123 DUP 0903609 121597 DU 024985 -2- findings (rales, see.), impaired pulmonary function 'aonormal spirsnecry or blood gasasi , and a positive exposure nistrry '2, 3 A esmprenansi'-a mstcry cf proaauie exposure to isoesto* and other pulmonary irritants ihouid be ootained by the physician from the patient at the time of the examination. ,'This history will assist in the determination of causality as well a; a::.:.: i.t the diagnosis.) The history should include all possiale ?;-t occupational exposure and off-the^-ob asbestos-related exon, .re 11 A detailed evaluation of smoking habits should be made. A supplemental work history should be prepared oy site management listing ell periods end/or circumstances of possible aiUitsi exposure. If the employee wee not assigned to a 30s that involved handling asbestos-containing aatarials. an attempt should be made to determine whether the employae could nave incurred expoaure by working near an operation where asbestos dust was released. in determining when end whether causal exposure could have occurred, it should be borne in mind tnae eaoescos-relatad disorders can result not only from long-term me.aerate exposure but elec from short-term massive exposure. In all caews where the tentative diagnosis is e bemgn symptomatic illness or s malignant illnass a*d in othar cases if. the evaluation is inconclusive, the tentative diagnosis should bu uiauu*sd with the Mudical Division. Where appropriate, the site showiu u.e an approved medical specialist to carry out tne additional tustim, or (Valuation required to establish e diagnosis. DUP 0903610 121509 DU 024986 7ha tecpa of furthar castir? will noraally s daearsunad by tha ipacidli-at, bus should inciuda carcatn ainmus casts. A su^sscad rsfarral Ittctr indicating ths* cast* is accaenad. -fhara an asoastos-ralatad lung aonoraality of Du ?nt causality hat otan astahlishad, tha follow up should at a ainiaun inciuda a aasu-annual postarior-antarior and lataral chase x-ry, and puiaonsry function casts. If tha aaployaa rafutat, chit face mould ba doeuaantad in tha aaployaa't aadleal racord. Tfcoaa aaploytaa with confiraad asbastosis, axudativa plaural thickaning, plaural affusion or oalignant iilnattas should ba axcludad frsa casxs with poeantial for axposurt to asbascss. rhosa with banign asynpeoasatie abnormalicias naad not ba axeludad. Thosa with prasuaptiva asbastosis should ba handlad on an individual basis. XETEXENCtS 1. Madioil Division, Du Pont Eaployaa Halations Dapartaant, Guidalinaa for Physicians*. Section T. 2. ?ragar, , at si, 'Asbsttos-ftalatad Disaasa*, publishar Druna a Stratton, Haw verb, 197*. 3. HIOSH, *A Suida to tha Herk-Halatadnaas of Olsaasa*. Rav. Idician, January 1979. 4. National Cancar Inatituta, `Xabaatoat Aa(Information Xaatturea*, May 1971. " 0-3 DUP 0903611 121509 DU 024987 :<t; . an aaployaa of tha ou Pent . it r'trrsd for pulaonary avaluatirn. Chast x-ray findings n*vo saan mtarpratad as containing ior.o aonoraalitias. In your avaiuation, eha fallowing suniausia ara raquastad: A datailad hiitary at occupational and ncnoccupxtional exposures, including smoking history. a Examination at eha lungs. Review of racant cheat x-raya that tneluda right and laft oblique vim. a Coaplata vantilatory function easting without and with a broncnodilator. ^ a Maasuraaant of artanal blood gasas a: rase, and aftar axaseisa. a A statement of your avaluation of tha raspiratory impairment, if my. a The etiology of tha condition. Plaaaa sand your bill for this aarvica (examination, easting, and x-rays) and eha raport to me. If tha employee requests that a copy of your raport be aant to hi* or bar parsonai physleian, plaaaa as* chat this _ request ba auhaittad in writing to aa. A copy of your raport " will than ba aaat fra* our offlea. Plaaaa raturn our x-rays by csrtlfisd sail. Vary truly yours. U-4 DUP 0903612 121519 DU 024988