Document RpaBpp1Y0JbmwR3pRVyjYmEjX

MANUFACTURING CHEMISTS ASSOCIATION 1125 CONNECTICUT AVENUE, N.W. WASHINGTON, D. C. 20009 {202)483-8126 u? sr ^/AUy, U2LtO4tiJ- July 24, $35" J J A *rfn/V A , f /V, t*,/ An/ To the Designated Contacts of Companies JUl 8 W3 J. T. BARR supporting the Acroosteolysis Registry and. Consultation Center (The university of Michigan) Dear Sirs* Distributed herewith is the status report recently received from Dr. Dinman, the previous Di rector of the Acroosteolysis Registry and Consultation Center* At this time we have not been informed who will take over the duties of directing this project, as Dr. Dinman leaves for his new assignment as Corporate Medical Director ot. the Alumxnum Company of America. You will be informed on this point by a supplemental mailing as soon as we have this information. KDJiznb Gnclosure Kenneth D. Johnson, Ph.D. Assistant Technical Director Occupational Health RECEIVED AUG 1 -1973 A. k. McMillan AP0004253I REPORT OP ACROOSTEOLYSIS REGISTRY 1970-73 *7 The Institute of Environmental and Industrial Health The University of Michigan School of Public Health Ann Arbor, Michigan June 1973 Bertram 0. Dirunan, M.D. Director AP00042532 REPORT OF ACROOSTEOLYSIS REGISTRY 1970-73 I. Introduction A. Participation - Of tha 19 corporations that elected to participate in the original 1967-69 MCA Study of Acrooateolysls <AOL), all but four agreed to participate in the subsequent AOL Registry Program of The University of Michigan. Thus from the 32 plants engaged in PVC synthesis and/or compounding, 27 agreed to participate in the Registry activity. However, with the passage of tine and despite repeated communications, there was a progressive decrement in these numbers. By June 1973 among those 13 agreeing to perticlpete, only eight corporations (i.e.* 12 plants) provided the data requested. The reasons for this decrement are a reflection of plant closings, turnover in medical and administrative personnel which impaired communication, plus an Inevitable slackening of concern. The last steamed in fact from tha 1969 Report: for many corporations it appaarad that the AOL problem did not affect their operations. In addition, as the delineation of the AOL problem became more dear by virtue of the Report, previous concerns were somewhat abated. The net result was to Impair any ability of tha Registry to define the prevalence of the problem, or to clarify what direction the problem was talcing. Further, it made difficult any valid indication of whether changes In polycleaning-techniques was having any impact upon the-trend of AOL occurrence. B. Present Status and Limitations of Population Base - Of a total population of 5011 workers in the original 1967 study, only a total PVC population of 1332 could be for.-fn ** of 1970-71. If is of fnt-eT-ent to not* that fch-l* represented 501 of the population in 1967 at the reporting plants, i.e., plant popula tion among 1970-71 reporting plants was 50% of their 1967 enrollment. If the assumption is made that the plants providing no information also decreased their population by 50%, it might be estimated that presently there are approximately 1173 employees engaged in PVC operations among the non-reporting plants. ' Thus among the 19 corporations originally participating it might be estimated .that as of this date there are 2505 employees in PVC synthesis and compounding. So that one would not be tempted to consider the present population base as representing a valid 50% sample for the 1970-71 population at risk, the selection process whereby corporations elected to continue (y.s.) should make it clear that those participating represent a very biased population. This bias is also clearly apparent from review of Table I which indicates that participation was in some part conditioned by perceptions of management of the extent of the problem in their Individual corpora tions. For these reasons, any attempt to consider the presently available data as Dx Cat if 3 Dx Cat #4 Dx Cat #5 No. of Diagnoses 1967____________ 1970 % Lost 74 25 33 16 3 19 25 9 36 Table I.: Diagnoses Made in All Plants in 1967 vs Diagnoses From Plants Not Reporting in 1970-71. AP00042533 -2- reprepresft&etclv* Of S valid population base for epidemiologic analysis would be totally inappropriate. Accordingly, the best this report can do is is to present tabulations of present data plus other information which has been derived from the literature or experience of the Registry. ^ II. Present Status of AOL in the PTFC Industry A. Definition of AOL - By definition, active AOL was defined as Raynauds phenomenon associated with x-ray defects. Specifically the x-ray defects were considered significant If they demonstrated more then one marginal tuft defect, transverse defect(s) with or without distal phalanx resorption or fragmentation. There were 22 cases of active AOL discovered in the original 1967 survey in addition to three inactive cases. Inactive AOL was defined as the presence of the above x-ray changes or e "collar button" type or shortened distal phalange(s) In the absence of Raynauds phenomenon. Shortened* stubby diseal phalanges were considered as highly suspicious, especially among workers with e present or pest history of Raynauds phenomenon. B. Present Statue of AOL Among Reporting Plants in the United States - As of this report, the present status of AOL in die PVC industry as known to the Registry is as shown in Table IX, Corporation Code No. Reported 196*7 Reported 1972 2 17 23 A 3 No response 11 2 2 14 .5 Plant closed 18 ` 0 1 20 0 1 X* -- -- Total 25 28 Table IX: Cases Reported to Registry; as of 1972. *This corporation did not participate in 1967. Under new management, it has reported in 1972. If ve assume that the cases seen in 1967 in corporations 4 and 14 still exist, the total cases in the Registry at this time should number 33. Whether new cases have developed in those two organizations is not known at this time. AP00042534 C. Clinical Features of Hew Cases. 1* As of this report, the following tabulation describes the previous status of these newly discovered cases: Previous Reynauds only Previous nonspecific x-ray without Reynauds New AOL previously unknown 2 2 4 2. Discussion - Exaainetlon of the details of this data suggests the possibility that AOL may be manifestations of two etlologlcally different conditions* This possibility Is suggested because: 1) Two eases have gone on to show heeling bone changes characteristic of AOL without apparent history of Raynauds; 2) The incidence of Raynauds in plants polymerizing PVC which have not had cases of AOL since 1961 is 0.561 (l.e., two cases among 337 males) vs 0.2Z In compounding plants in 1967; 3) Recent discussions with Suciu (who originally reported in their Rumanian literature) (1) Indicates that he still sees Raynauds in PTC workers, yet has never succeeded In detecting x-ray changes of the hands. The* question might be raised whether the Reynauds and dermatoc manifest ations represent m response to one etlologlc agent in the PVC polymerisation process, and that the bone changes are due to a second agent. Given the .small numbers Involved above, this possibility is at best speculative, nevertheless, consideration of this question should not place an additional burden upon ongoing medical surveillance programs. 3. Atypical Forms of AOL - One polycleaner who has manifested Rayneuds in 1967 still had this condition in 1970-71 and in addition had by then developed a transverse defect of the ulnar styloid. A history of Injury or frecture could not be established in this man's previous data. Ve suggest that this represents, an atypicell form of Acroosteolyals. D. The Roentgenographic Course of AOL 1. Previous Concept and Proposed New Course of AOL - in the published reports derived from the 1967 survey (2), it was Indicated that the radiographic sequence of change was as indicated diagrsma&tlcally: Marginal Defect Stage 1 Plus Transverse Defect Stage 2 Distal Fragmentation Stage 3 Total Shortening, Resorption* Healing Stage 4 Stage 5 AP00042535 -4- However, we have found one cut of AOL which over a four-year period went from Steps 1 to 3 to 2. Whether he will ultimately go to 4 or 5 cannot be absolutely predicted. Kovever w would suspect oa the basis of previous end stages seen that he will go on to a minimal shortened terminal digit indicated in Step 5. (. Discussions with Dr. J. J. LePevre in Brussels revealed that he similarly had observed this new sequence of events. Thus it would appear that the trans verse defect, rather than being en early stage of AOL, actually represented a later atege in the process * 2 Proposed New Natural History of AOL - We would suggest that the bone manlfeatatlons of AOL go through the following steps: Former Stage Proposed Stage 1 Step #1 Marginal Defect 2 Step #2 Partial Decalcification Dlstel Tip Step #3 Total Decalcification with 3 Collapse of Distal Tip 4 Step' #4 Partial Recalicfication of Distal Tip with Transverse Discontinuity 5 Step #5 Recalcification of Distal Tip with Shortening AP00042536 -5 - If these ere Indeed the case, it would appear-that the process represents e decalcification of the osteoid matrix. To whet extent there is a decrease in the osteoid matrix Itself la not clear; that there an end decrease in the healed bone mass suggests that this is a process which also Involves the matrix. Thus the condition appears to be combination of osteomalacia-like (!.., decalcifica tion) and osteoporotic-like (i,e., decrease In osteoid matrix) change. Bone biopisy would further aid in delineation. III. Present Practicea Utilised Reactor Cleaning A. Reactor Cleaning Practicea, 1967 Of the 27 synthesis plants surveyed the practices utilised were: Method Ho. Z of Response Band cleaning only Hl-pressure water only Solvent only 18 2 2 67% 7.5% 7.5% Combined Hand and water jet Hand and solvent 3 11% 2 7.5%- B. Reactor Cleaning Frocaaaaa, 1972 Of the 10 synthesis plants responding. the reactor cleaning processes utilised were: Method Ho. % of Response Hand cleaning only Hi-pressure water jet only Solvent only Combinations 4 0 0 Ho. 50% 0 0 % of Response Hand and Hi-pressure water Hand and solvent All three methods 3 1 2 30% 10% 20% On the basis of reported man-months spent.In each process In 1970, the distribution of actual time spent In cleaning reactors by various methods are as follows; t Method Man-months % Total Hand cleaning Hl-pressure water jet Solvent 292 28 0 Combined Hand and water jet 859 Hand and solvent 36 Hand and water jet and solvent 122 Total 1337 22% 2% 0 64% 432 -- AP00042537 -6- C. Discussion It appaars that hind cleaning alone ie less frequently employed today than has been the case in the past. On the ether hand, solvent cleaning while still used, is not used to the exclusion of other methods among the companies reporting. The decrease from 1967 to 1970 in solvent ties may be more apparent than real; one company which used this method in 1967 did not report In 1970; the other corpora tion which 'used solvent cleaning in 1967 now usee water plus solvent. Further, what appears to be uncommon usage of solvent is probably more epperent than real. That Is, little actual working time is involved in transferring solvent from reservoir to reactor and out again. In the two pleats reporting in 1970-72 with new cases, hand cleaning and high water pressure jets ere used. Those corporations previously known to have casesof AOL sppser to have mada Increased use of high pressure water jet to augment band scrapping (except In one case). REFERENCES (1) Suciu, L., Drejman, I,, end Valeskai, H., Investigation of the Diseases Caused by Vinyl Chloride, Med, inters (Bucharest), 158967-78, 1963. (2) Dodson, V.N., Dlnman, B.D., Vhltehouse, Nasr, A.N.M., and Magnuson, H.J., Occupational Acroostsolysls XII. A. Clinical Study, Archives of Vmrl Health 22183-91. 1971. / AP00042538 .* '* ' ".X.'\` '" vV Mr.J.A. Marts -Mr. j.;f. Ode* . JVC Opwatimi Acrooateolrsls (AOL) Program October 10, 1972 Mr, A. K. McMillan \`T ~ Bacldaedlf the couplets package of infomatlon relative to or 'participation In tba AOL Pro*ran. Some of tha groundwork hat already'boon laid aa noted in aanos. . ^ ... V t . "I would auggset you coordinate the Initiation of thla program with V-Plowman, B. Julaaki and E, Jrineau, ton Beech '.should be able to give you same input also. <.4- ` : V need to start this immediately. If I can lend you assistance^ `lot ns know. Mrs. Pulaski should be able to *-.establish schedule, etc. on X-tays end Interpretetlon by :i>c."^ernes>.;*" : 7. . i AP00042539 AJ a*te C%e*mCCtl tSCAMSIA PtAMT INTEROFFICE MEMORANDUM ^Mr, R. E. Davis To: From: Re: R. W. Beech AOL Dots: Copies: January 28, 1972 E. M. Spurlock A. K. McMillan W, C. Wilde 1 have supplied Mr. Spurlock with all information concerning AOL of which 1 have a copy. This includes the MCA report which was subsequently published in the Archives of Environmental Health Volume 22, January, 1971. I believe the X-Ray program should start immediately and also the program should include a questional re similar to that used in the MCA study to indicate possible susceptabiUty to AOL. Mr. Spurlock wilL be supplied a list of employees and their current jobs. Also, we will establish record keeping procedures on each employee to determine length of time on each job and duties performed for each job. Especially records of reactor entry will be maintained. RWBsfls f- t^y v3*><Ajfe6 R. W. Beech tf V AP00042540 A- W' Chtmca/l Oat* January 5, 1972 3*"*:.- . * . Effective Immediately, the attached AOL PROGRAM shall be implemented for PVC operation* at the Escambia plant and the Calvert City plant* ThU program for monitoring AOL has been developed as a result of studies made by John Barr in consultation with Martin Spurlock, Ron Beech and Dick Harvey* TLCarey/d attachment Distribution: A* R. Adams J* T, Barr J. L, Cost R. B. Cross R. Fleming (2) G* J. Mantell A. K. McMillan ^ H. W. Smith W, Mayo Smith Ei M. Spurlock H L. Watson (all with attachments) r- -. ___ \*4 5 '^l (3201 AP00042541 A. T^&JuSZi- CAcmuxU* PVC OPERATIONS CALVERT CITY AND ESCAMBIA PLANTS AOL PROGRAM 1* X-ray the hands of present PVC production workers who have participated in reactor cleaning to establish a base line for present conditions. Those to be included are polymer building operators, pilot plant operators, laborers (utility men or trainees) and dryer operators, if they have been involved In reactor cleaning. Not Included are baggers, maintenance men, compound operators, or supervisors. Z. As a part of pre-employment physical examinations, include hand x-ray studies for all personnel to be assigned to PVC operations. This shall include personnel transferred from other operations who may be involved in reactor cleaning. 3. An annual x-ray examination shall, be performed on the specified employees and the records maintained on each plant with the work histories of the employees involved. ' * 4. Each plant shall have x-r'ay films read'by a competent radiologist. Background information on AOL shall be furnished him. Such w information would include MCA report and article by Dr. Diaman, If required, a consulting arrangement should be developed with the University of Michigan Institute of Environmental and Industrial Health or other competent specialist. 5. Review and update existing work procedures, protective equipment and instructions for reactor cleaning and establish formal procedures which contain requirements for operator compliance. Emphasise enforcement to supervisors. 6. Continue work on plant modifications such as solvent cleaning, that will reduce personnel exposure. 7. Continue participation in the MCA and Vinyl Chloride Safety Association studies to enable us to provide maximum protection for personnel. j 1 j I | iijj^ " I i AP00042542 / H. L. Watson ? L. Carey rvc - AOL Program Production D. Calvart City Calvert City I have John Barr's memo to W* M. Smith in Allentown (the subject of which is proposed AOL program continuance, dated October 1, 1971) . I would like to have John Barr make a trip to Pensacola in order to look at the requirements for this program at Pensacola and see if we can cone up with a uniform program for both locations. At least, I would like to have his recommendations* At the seme time, I think it might be of value if JOhn would take enough time to review the manufacturing procedures, techniques and/or procedures in sufficient detail to make a comparison and hopefully indicate some practices that might be utilized by the other plant. TLCarcy/d /cc: A.X.licliillan A. R. Adams P. C. - R. Fleming has corcnented on the need to X-ray new employees and says he believes that we neod to X-ray only those ',;ho would reasonably be expected to have cop.tir.uinc exposure. AP00042543 cdoi *fiu>duc& a*ut C/t&mtcaHs- *--4 .*. INTER-OFFICE MEMORANDUM t* Distribution Below From T* L. Carey Daw Janu&ry 5, 1972 pvc Operation. tcroostcolysis (AOL) Program (Location, Orgsnlzition, or Department) t . ,*# - N ' Valley Forge (. (Location, Organization, or Department) ''*' ' ** Effective immediately! the attached AOI PROGRAM shall be implemented for PVC operations at the Escambia plant and the Calvert City plant* This program for monitoring AOL has been developed as a result of studies made by John Barr in consultation with Martin Spurloek, Ron Beech and Dick Harvey* TLCarey/d attachment Distribution: A* R. Adams J* T, Barr J JL, Cost R* B. Cross R, Fleming (2) G. J* Mantoll A. K. McMillan H* W. Smith W* Mayo Smith E, M* Spurlock H* L,, Watson (all with attachments) - 2 - z;e 'A1, A?-*.,.V.'v (330J AP00042544 {. fXdtfiteft anJ (`/:CI%/It. tea/* PVC OPERATIONS CALVERT CITY AND ESCAMBIA PLANTS AOL PROGRAM 1. X-ray the hands of present PVC production workers who have participated in reactor cleaning to establish a base Line for present conditions. Those to bo included are polymer building operators, pilot plant operators, laborers (utility men or trainees) and dryer operators, if they have been involved in reactor cleaning. Not included are baggers, maintenance men, compound operators, or supervisors. 2. As a part of pre-employment physical examinations, include hand x-ray studies for &1) personnel to be assigned to PVC operations. This shall include personnel transferred from other operations who may be involved in reactor cleaning. 3. An annual x-ray examination shall be performed on the specified employees and the'records maintained on each plant with the work histories of the employees involved. * . Each plant shall have x-ray films read by a competent radiologist. Background information on AOL shall be furnished him. Such information would include MCA report and article by Dr. Dinman, If required, a consulting arrangement should be developed with the University of Michigan Institute of Environmental and Industrial . Health or other competent specialist. 5. Review and update existing work procedures, protective equipment and instructions for reactor cleaning and establish formal procedures which contain requirements for operator compliance. Emphasize enforcement to supervisors. 6. Continue work on plant modifications such as solvent cleaning, that will reduce personnel exposure. 7. Continue participation in the MCA and Vinyl Chloride Safety Association studies to enable us to provide maximum protection for personnel. j j j j I j ; j J i ; I i AP00042545 Mr. T. L. Carey February 23, 1971 A. SC. McMillan Occupation AOL from PVC Operations Ths Arehlvs* of environmental Hoalth Study Report of January. 1971. Indicates the AOL condition is clearly associated with band claanlng of PVC reactors. Of the 5. Oil employees examined there were 25 definite cases of AOL and all had been involved in hand cleaning reactors. The probability of develop ing AOL la one case la 52 for workers in reactor and one case in 140 workers for the total PVC study population. Work practices each as (1) ass cleaning methods used. (2) use of giovee. (31 reactor evacuation procedure have a strong influence on the occurrence of AOL. Method of entry of the agent causing AOL is also not established and the writers were in clined toward the respiratory method of entry rather than absorp tion through the skin. The report reconnmendSt 41) More extensive use of high pressure water and solvent cleaning (2) Good ventilation of reactors (3) Dse of giovee In reactor cleaning. Our reactor evacuation and cleaning procedures strongly favor good experience with regard to AOL. Use of eMmimt cleaning for all ceacjtprswill be accomplished this year. As additional precautions, we will see that gloves arc worn by reactor cleaners (this is now required but may not be rigorously followed) and that exploelmetere need to chock reactors are calibrated on pentane ns recommended la the study. 1 suggest that base Une X-rays of tho hands of PVC personnel be taken at the time that all reactors are converted to the chemical clean ing process. The medical questionalre (In study) should also be AP00042546 Mr. T. L. Carey 2 February 23, 1971 computed at this time. Xraye should be repeated on an annual basic uatU such time as we consider AOL not to be a problem in our operation. /ms attachment A. K. McMillan AP00042547 ( 4 7 ESCAMBIA CHEMICAL CORPORATION IMTIKOFNCt MEMORANDUM /X T: Mr. A. K. McMillan Dot*: February 25, 1971 From: R. W. Beech Copiat: Summation: Institution of Environmental and Industrial Health Report on Occupational Acroasteolysie This condition is clearly associated with hand cleaning of reactors. Workers engaged in other phases of PVC manu facturing do not appear to beat risk of developing AOL, Incidence of cases are low with only 25 definitive cases out of 5, Oil employees having 21, 510 man years experience in various phases of VCM and PVC manufacturing. Of the 25 definitive cases all had been involved in hand cleaning of reactors and 24 of 25 had symptoms of Reynauds* phenomenon! ae a concomitant disorder. Indeed the probability of AOL developing was one case per 32 workers for reactors cleaners vs. one case per 140 workers for the PVC study population. At this time work practices, rather than any one specific ingredient or combination in process, appear to determine whether this disease will occur. In those plants using high pressure water lances or chemical cleaning, there were possible cases in only one. Those plants with AOL provided gloves for reactor cleaners, but in consistent usage was observed and frequently airiag out of the reactor was short cut. * V- a , The etilggical agent (s) causing AOL is not teiown nor Is the^jjytthod of entry. In view of the systemic characteristics of the dise^srp^the writers were inclined toward the respiratory method of edtly rathe r than absorption through the skin. Cold, white fingers brought on by hand or body chilling or both. t\ AP00042548 Mr. A. K. McMillan -2- February 25, 1971 The writer* recommended: 1. More extensive employment of high pressure water and aolvent cleaning. 2. Adequate ventilation of the reactors prior to entry. This should be checked with a flammable vapor indicator with a scale of greater sensitivity than 1% of the lower explosive Limit of vinyl chloride. 3. An intimate review of the procedures and actual practice of those procedures for reactor hand.cleaning. They aleo concluded that with the present knowledge of AOL is such that catagoric statements as to preventive measures is not justified. With the use of solvent cleaning (currently scheduled for completion in June). I do not believe we should make any changes in our current procedure. Any X-ray work should be delayed until juet prior to advent of solvent cleaning. This wlU establish a base from which to judge future X-rays. R. W. Beech ... 'r ,iv AP00042549 Mr. T. L. Caxty February 23, 1971 A. X, McMillan Occupation AOL from PVC Operation* The Archlvta of environmental Health Study Report of January, 1971, Indicate* th* AOL condition la clearly aseoclated with hand cleaning of PVC reactor*. Of the 5, Oil employee* examined there were 25 definite cane* of AOL and all had been involved in hand cleaning reactor*. The probability of develop* lag AOL i* on* care la 32 for worker* in reactor cleaning and one C**e In 140 worker* for the total PVC study population. Work praeticoo ouch aa (1) uoo donning method! used, (2) nee of glove*, (3) reactor evacuation procedure have a strong Influence on the occurrence of AOL. Method of entry of tho ngont causing AOL I* also net eetnbliehed and the writer* war* In* dined toward tho respiratory method of entry rather than absorp* Hen through the skin. Th* report recommend*: " % (!U More extensive use of high pressure water and eolvent cleaning (2) Good ventilation of reactors (3) tJee of glove* In reactor cleaning Our reactor evacuation and denning procedure* strongly favor good experience with regard to AOL. Use of chemical cL**algg_for tU^iPMuswiU be accomplished this year. As addH^t^^fprecautions, we will eeo that gloves arc worn by reacted cleaner* (this Is new required but may not bo rigorously followed) and that exploslmeters used to check reactors are calibrated on pentane as recommended in the study. 2 suggest that base lias X-rays of tho hands of PVC personnel bo taken at tho time that all reactors are converted to the chemical clean* lag process. The medical questionaire (In study) should also bo AP00042550 Mr. T. L. CAr#y -2 Fbmry 23 1971 conpUtU t this Uxba. X*nyi should b# nptitid on u asboaI btila otttil net timo aa coaiUtr AOL not to bo a problem in our oporAtion. /me AttAckmont A* K. McMIUab AP00042551 TO FROM Please Handle Please Call ________ / SiT Please *ee me { * Q fnformedon -- Please rofurn I . ^.A*' x-f- tA rx. <* ' *tion ^ t c \ i'. t* t, t Z3 ^ +l xs^ i-J 7WW ------ ! r1 - / . A K23!?$ \xy J5 :?# |OCl 2>*Av3 `ftr *.. -.. \ -O / r\ OCT 2 51966 *W 4-^'xvAw.w ->j - ,-, rortiu . UX:.i Co tfca i- . 1 , i :;': :*%k P AP00042552 * , 0*to. Q Please Celt <U="7 Q Information -- Ploast return * *noN 1% * .. kv* i>, j.-xo .* ': "> -; res* Crrcv, CatbctCi pll, r<# ld- .& r- r j, J' .. / c* Li& <y fa. fc\ &oip ly Be ?. fO'O l.'IwO rc.-i Pi-5.5.-' [o t-.r; ',> i'Ii r.' . c^^c-rj KOC'iZ Cci /CT<L'\-/' tA (L'*j T.Aj-7>: s r'.*.,V" i .-o^r** j-'-r-* - " -scir ;;jj *H -' - * C *- ,V. . '*.' r* - j * ?* ;` '> of : `,, *: r" iT. AP00042553 ( To: rile ESCAMBIA CHEMIQAL CORPORATION ... INTEROFFICE ME( M. ORANDUM . i*.. ! * Data: OctC-iNAT 13* l%0t From; T7* Uc\yo :iith Re: T7->! r;:*3TC' T, F?.CSV Si * * '*** XL. ' - iRmtra* Corey* GrtVsefcC* Co|**! . iL-ttx-u, i-!v.: :Uo, Vctv>i>:i :' vin u<* twra fc/.lird to cttsr.d r.n I'CA Kfe3&i* -,i- ' $n Cleveland t>3 Oatober 0 Initiated Ivy B ?#. GcecLvicU* Tiio livViXo^ u*xO t?ou:ivi.d f->o loto '-* to. catbZo co to rxtorul. r* '" 2ho U^ta Ui*:i obtaifc'vdito-' v ctono C&iro.y* CirAdi::v\o i"sis:U -*;-;a ;>ivc;i cxd v&Zwtcac&s r*C;`t;.'.o;vj.jl u.xt .... .. C-Jk^ivl'.Cv>i ....... > :'.' . vi 1 ?. YVtfU* *V5"nJ t %*'i'* iV.W* IV,*A,\--..V.* V> t...%.**S*,-ii . to 'peir^r.i ?;*:> pzcr.?{^\ tra co ;`coe?.S .:- * Goo^:Uii*f#-:Lvvi^-:Ll^ <:;l ccnl tta iiu to il\o ( c&grctt .: . - ; '-4-':' - ; '' l tea {-rath :- *.:-V ' ` At*wvlCi*'i AP00042554 chcmal ernccs p. e. > PDTT.T.WM, .CMM.VW.MM ! RECEIVE Firestone Plastics Company OCT 1 9 1956 . MAAVIY f. PJAfSTPNf *OUNO(A MAYO SMITH POTT6TOWN, PENNSYLVANIA October 12, 1966 'Dr. W. Mayo Smith . Escambia Chemical Corp. Wilton, Connecticut "*r Dear Dr. Smiths Mr. L. B. Kuhn has given me your letter of October 7 con cerning the MCA Meeting held October 6 at Cleveland, Ohio. The following is a condensation pertaining to this meeting which was held under the auspices of the MCA Medical Advisory Committee. It was their 'intention to disseminate certain .in formation to the PVC manufacturing industry relating to a medical problem concerning reactor cleaning personnel. In dealing with this intelligence we were advised not to make it public, to the press or other periodicals, at this time* Mr. Nantz, President of B. F. Goodrich. Dr* Rex Wilson, Medical Director of Goodrich and to. William McCormick, ;Toxicologist of Goodrich were the chief sources of infor mation. * * *f * 1. Several years ago one Goodrich PVC (suspension type) plant reported a number of. cases of soreness in finger tips of their personnel. This was accompanied by skin blanching and slower recovery of temperature of the hand than normal. 2. X-Ray is the main diagnostic tool and this shoved-that the terminal finger bone was actually subjected to some' type of erosion. Slides were shown to demonstrate typical cases. Colored photoslides of hands were also shown and these indicated a blunting effect of the finger tips plus a modest color change. 3. Extent of disease: Goodrich reports cases in three of their five installations at a level of 1% of the total personnel. Concentration of the disease was in the reactor cleaning area, wherein 6# of the total personnel were found afflicted. 4. Early diagnosis was termed a type of finger SCLERODERMA sometimes accompanied with a RAYNAUD'S phenomenon. to > AP00042555 Dr,4 W. Mayo Smith Escambia Chemical Corp. Page 2 Octobor 12| 1966 { f* Cause: Not specifically known* It is believed that the disease is the result of contact vlth some chemical but proof that it is solely vinyl chloride monomer does not presently exist# Goodrich have X-Rayed their monomer plant personnel and have found no cases. . It is fair to say that contact vlth monomer on the finger tips is . roatest for the polymerization reactor cleaning personnel* oodrlch have also X-Rayed one complete synthetic rubber plant and found no evidence of the dis^a^e^ It was further mentioned that vinyl monomer intoxication vas not related to this disease* In short* reactor operators that might have been exposed to VC gas did not . snow effects of the disease* 6. Publications: Goodrich found no data published in this country regarding this problem. The following foreign articles vere found and translations are available from Goodrich: CORDIERy et al Cohiers de Kedicin du Travail, Jan* 1966 Suciu, et al Medicina Interna (Bucharest) 15$ 967-78 (August 1963) We were advised not to disclose any of the data given us because the total medical and legal complications just aren*t fully known. 7* Miscellaneous Goodrich information - a* Of the approximate 30 cases - three were not in a FVC area* The overwhelming evidence indicates there is no problem in other areas of processing of PVC resins* b* Length of service is npt `clearly relatable to the disease; some personnel have shown positive effects within three years and some have not shown effects after 1? years* c. All cases taken off the reactor cleaning job have shown improvement at different rates. d* New personnel are X-Rayed upon starting work and then every six months thereafter to noto changes* Mayo Smith Escambia Cberni cal ^orp. Page 3 .* x.V Ootober i2,' ' 4' f. Personnel relations: Goodrich personnel were aavisea^.u a- that there appeared to be a^bana problem and that ' xr'^V" the cause vas being sought* They had no problems with the bargaining unit and all cooperated in the a~<-s X-Ray task. - ^^ Generally X-Ray negatives were given to the' personal doctors of the individuals involved. In short, Goodrich have encountered no kickback and have con sidered these cases for compensation although there has been no claim paid to date. g. X-Ray - Since the task of reading X-Rays requires an expert - Roentgenologist, Goodrich stated they would be pleased to have their expert read any and all X-Rays free of charge. This is important since it is the only way to eliminate reading and interpre tation as a variable. Generally the majority Sid not know whether they did or did not have a problem. However, Carbide and Goodyear have done X-Ray work. Carbide indicated that they had uncovered four cases while none wore reported for Goodyear. Vfo were also advised that the various1 organizations1 medical staffs could make contact with Dr. Rex VJilson of Goodrich for the translations of the foreign articles previously mentioned^ I trust that this will help in your understanding as to what transpired at this meeting. However, if there is anything further we can do please advise. * Very truly yours, FIRESTOKE PLASTICS COKPAHT CJX/rc cc: Mr, L. B. Kuhn C.VJ. Kleinert Production and Technical Manager Chemicals . AP00042557 Hr. H. W* Ssith tf. A. Miller Cecy^atisnnt /.cro^ntrtlysifl February 2, 1971 w/o end.: H. Tlcain? D. lfcllan:: u.Sait:* T. L. Carry y .|U II. Spurioek / In reply to year lector of January 11, 1971 on the above subject, plca3C be advised that this subject t.*sa brcvrht to our atcoatinn in Lettoer, l6y bf tr* Mayo Soith efter a uccting of the MCA Medical Advisory Ccsnifctao. After some discussion, it was r'*reed that ve vould x-ray ecr e-.iayeee Curia- tt^ir annual s^ouic&L cuar.insttoa and accent the trior by Goodrich to read the X-reya ct r.o cost. During the period from J3*--try, 1957 trhrerch January, 19C3, 375 were tad* at tho bends c- ell r*VG Operators fi5 Sun ervieorc. t.- y cne operator ensued cry abncre-slitica. Vie :>r`V3 . _ .*e in w - ;-..2ryf l'ic-7 ci oaa o* ere tor tbouse `ccra destruction ox t *k j.*.U.4a*b lie ... A follouitn A-ruy uuil erda two aantnc later incti .it increase in tho t.oatructicn ox on3 iinnur wit:\ fceslin cl two wieners. As a result ol tanae M-rayo, vs irons-*rrsc ch 07tracer to the Atsscsta-.-. c tea ns i eras. r_n rcr.tns lr;t4T, :n u`..-'*.;ad etxoostcolyslo cs fvi'a ksniu 1? could r.:t ialluv-vo c.t y this case because the c-.craccr disccwefired. lilorts were ? sia to locate the operator through his cu-viie, hit mother rnd father. Chi Sheriff*ft Departefruc, Social ioourity bs.iers-ect, etc., without any results. Goodrich discontinued the reading of S-rsya frea ether ccrpsniss cht.i the hanutsc curin'; n.isnist3* Association Ljuas.e involved a study oa aa industrywide basis,, tnureicrc, we `-4.sc0nclr.ucd cur X*ray prograa. Besiaalag cn l!arcl> 1, 1937, all personnel engsr.ad In cljsr.in^ PVC reactors have been ra^uired to vear cotton gloves coated with pln^tieol. AP00042558 Uu Kr B* tf Smith 2 February 2, 1971 Viator blasting tvulp&ant barf-bees installed in reactor cleanin service for fipprc2isi.b7 twa years* AC the present ti-^, a chsmlc cleaning system la betno installed vhtch should cllclnsto the cleaning o reaccertr i*.y hand i:awt; except in extreme caeca involving a large build up ot` polymer* Translation copies o articles by Cordiar and Suciu on this subject are enclosed for your icrorwrtloa* 1-SrlKske Enclosure w. A. inner AP00042559 REACTOR ENTRY PERMIT Date Reactor No. Employee Entering Time J ' Attendant ___ NOTE: The attendant must stay on the third floor and Entering look into the reactor the entire time a man is Inside Operator Supervisor ______ _ Shift l. Valves tagged and blanks installed a. VC1 monomer line b. Demineralised water line c. Vacuum Line d. Overhead recovery, XA, and 2B line *' 2. Drop valve open and opening clear a. Remove hush flange b. Install blind between ell and block valve c. Back up valve closed and tagged h Blower hose in reactor and fan in operation 4t Hydraulic system a. Inlet valve closed and tagged b. Agitator stopped c. Outlet valve closed tight and bleed, open. a. Temperature controller on manual b. Maintain flow \*t cooling water c. Steam valve blocked 6. Ladder in reactor and secured outside manhole 7. Reactor checked for gas at manhole and dump valve. Air must be coming out the Dotcom* (by explosimeter) /OOUAMTBK ON ?2.M77}h l&L =- u4S% S. Proper tools supplied (drop light should not be put in reactor until reactor is gas free) 9. Harness on with rope attached by snap. Spare wristlets and rope available for attendant. 10. Harness rope secured outside manway. ii. Reactor ready for entry 12. Rupture disc checked and nossle open (by Supervisor) 13. Work Completed. Reactor ready for use. (cheeked by-Senior or Supervisor.) SPECIAL PRECAUTIONS: Reactor not to be entered if gas is present. If an unusual condition arises in the operation, the man must be called out of the reactor. This reactor entry permit is not a substitute for a hot work permit. Shift supervisor on relieving shift must check and co-sign all above items. CcpHon Cutsi^A w, ik are r AP00042560 V* I!. Smith H. W. Snith January 11, 1971 Occupational Acrcosteolycia (AOh) Aron FYC Operations coi R. Flemains D* Holland . If. Hiller e. m. JAN 29 1971 Tha cotter ot occupational ccroontcolyois is not ncv; various papers have been prosss&ed, &a veil os o number of clinical investigation reports circulated* Tho attached ctudy, cstrcetod frea the Jenuory 1971 edition of Archives of nnvironncntol health, has through it's cenplotonoss put Best of tho data in one placo* The report indicates that the Incidence of AOh la lov, hut I on con cerned vifch t3je possibility of our employees contracting this affliction* As the nodical outcome of AOL is not reversible, cad tho bono daaago could lead to pcrr..n5at ptrtinl or even permanent total disability, it 1c ty opinion that & feerral progvra should ho instituted to detcroino if Va hevo ppeplo in various estates of this fiiuordcr* This proven should cover oil capleycsa engaged In tho clcmicg of PVC roartoro, both in tho laboratory and production phatco* It ia vith rclv.otr.ucc, tfc&t X propose tho use of l'adio^rr.plyy ca tho netted of determination of tho preacaco 'of A0&* Tho reluctrace on cy part ia baaed on tfc-> feat that I-rny oposuxo io cutrslctivo, end roast bo held to a ninlua* Sut, as the clinical studios indicate * it is just about the only uolhod vhlch provideo a coed diegoonis# Xn cdditlcn to a medical progress, there ere carers! opinions expressed in tho report vhleh va nay vast to consider iu tho elesaies of reactor rcocols* Tho proposed grossest should include tho foll&rlsgt . Reactor clccnlr?? 1* 'All persona involved in tho cleaning of reactors chall - use adequate protectiva clothing* Cloves, overalls, . bootgi etc. cunt be impervious to PVC residua. This . . equipment cast ba thoroughly cleaned after each use* <i " ^ ~ ` . 8# Adequate breathing coshs (dual filter) shall be used* 3* Vatcr-Jot cloosins or colveat cleaning of tho reactors should ba Investigated* A* Proper ventilation of tho roactor shall be accomplished prior to entry* 5* The proper disposal cf reactor vasto chould ba outlined la order that environmental cedes arc hot violated. 2 AP00042561 - -2. Hodicd ftrc'ygt 1 AXL parsons lotrolvod la reactor oleonlns should boro a baao Use X-ray of the basis v vlth no-x-ray enoo a year* S. A eddied cuestlondro of the typo Illustrated on pesos C2 and (S3 of tko report should ho lnutl^atcd* 3 2be nodical perewmd inr/dved la tho Interpretation of tbs Quostlcnairo end X-rcyo otculd be Informed of AOL problems via a copy of thiu report* X vould appreciate your consents, ns vail co ccsacats froa those obeun on tho distribution of this ness, co that a foraalined procedure may bn presented to control AOL espasnro problems* EU3:ch Kcverd U* Cmith Industrial Safety engineer J,&LUA AP00042562  7n. Hies. It appears tlm * smoked fairly atvu. .tal grams of tobucw . Terences in CO level* hb study cannot l* of their charactering, t different cigarette ; diflerenees In InltnU 1 as factors such x 0 also of some impor- l 't \ t j l 1 * A(. Occupational Acroosteolysis * I. An Epidemiological Study Btrtrom D. Dinmon, MD; Warren A. Cook; Waiter M, Whitehoute, Jl/D; end Harold J. Magnueon, MD, Ann Arbor, Mich; end Theodort Ditdicck, MD, Phoenix, Arft %nccs u- Report of the Adebmry m Central of the PuMtr Lob 1103. Public H*llh race* of Smoking! A Put* or: 1967, puttketloci 1W2*. A !, Goldsmith JR: Carbon -cm myocardial Infarction. I0-S17,1009. nwnd EC, Onrflakal 1/ to atherosclerosis d the F.ng.d hied 273:775.771', Aa epldemtolegiesl study was performed cover prieUTy Information associated with details ing *,011 employees with 21,810 msrv-yeers ox- of manufacture, soxno disinterested group t perlones In various phases of vinyl ehloride (VC) was needed to evjduato operating processes, 1 end polyvinyl ehloride (PVC) manufacturing In as these might relate to the causation of 122 plants throughout the Untied States end Can AOL. Accordingly, the Manufacturing Che ada. The total number of deOnttive coses of mists* Association requested the Institute of ! | aeraestsolysis <A0L) was 2S; II other vlduaia ware tinker suspicion. This condition is Iinnddhustrial Health (Institute of Environmen dearly associated with the hand cleaning of poly- tal and Industrial Health asof Jan 1,1970) merizers. Workers engaged In cither phases of to conduct an epidemiological survey of the i VC or PVC manufacturing do net appear to be at PVC industry in tho United States and JIG, Richards ML, el al: arotlo smoking habits and n autopsiad awtles. Circuits risk of developing AOL The Importance of Rayeautfa phenomenon as t concomitant of AOL Is emphasised. Several statistical approaches lor Canada to meet thoir responsibility to the workers and the public. The institute was requested to determine 1 RW. Brass DJ, el at. tthcroselecoais and the im JVu< Eng J AM 273;M1-1. * AlhcrotcltroiU. Co* * r . k. jxtde and coransrv it*d nnoosoi, 1939. n MA, Jacob D: Tobacco: *njin* poctoris. Ann Intern naon AJ: Non.nlcotblxoH pectoris. Ann Intern iM sen AJ: The effect of lownjtlna poctoris, Ann Inter" It MF, Cedirsn JB. et id t alveolar and blood carlwn * during br*altitMlcIinj(. J l. 1058. nilh JR. Helwif HL et si: n monoxide exposur**. Arrh *. 1902. dr txifs for collection of jp li*>15-519,10C7. Analyeit of Variance. Nc x Inc, 1939. vfc Correlation Method*, l bliftfiing Co Inc. 1982. ` . j j : 5 ( ; j { ! ! j. } j . rapid medical survey are suggested. Aerooslsolysis appears to be a systemic rather then beat disease. Presently, neither the etiological agent nor Its portal of entry is known. w ITH THE emergence of a new clinical entity, occupational acroosteolysis (AOL),1 it becomo a manifest responsibility of the polyvinyl chloride (PVC) Industry to define more dearly tho character, extent, nnd posaibic causes of this disorder. Though intlividual corporations might survey their cmployccs, a statistically valid construction of the problem could not bo developed without collation of the health experience of all PVC producers. To maintain the privacy of pro- Submitted for publication Feb 9, 1970; accepted Match 24. From the Institute of Environmental and Indus* trial Health (Dr. Dinman), the Department o{ Environmental and Industrial Health, School of Pulitlc Health (Mr. Cook), the Department of lta> the extent of the problem among PVC workera. By establishing a specific job association with AOL, it was hoped io determine where the risk of incurring AOL arose within the PVC process. It was important to determine whether AOL was associated only wilh tho synthesis stage or If those handling the finished polymer also might be affected. The primacy of this consideration stems from the widespread use of tlx* polymer in the fabrication of a multitude of manufac tured goods that enter general commerce. While the number of workers engaged in tho chemical synthesis of PVC is relatively small, there arc thousands of small manufac turers engaged in the fabrication of products derived from this versatile plastic. Further, it was hoped that the epidemio logical and industrial hygiene3 investigation might define more precisely how variations in manufacturing processes might relate to variations in the prevalence of AOL among uintpson WA Jr Ranh sum i one- and tv-o-wsy etnaxi* I'C-tf*. ion?. dioiojry, School of Medicine (Dr. Whiteliwpc). and the School of Public Health <!>' Mn#tnwon>. UnL vemily of Michigan. Ana Arbor, and Ihe Depart* PVC producers. Medical and industrial hy giene studies might furnish some chics to ;. Willke TA: On an extreme ient ttinmetrika SOlITJhIW. of Statirtieal Tahlf*. j . I ment of II.kIIoIocv. Good Samaritan Hoxpiul. l*hoe- flix, Arix lDr. DiUboi-k). Itefirint re<iuc-tA to Institute of Environmental and Industrial Health, University of Mieltiean, Aim the precise etiological agent! s) as welt as suggest preventive measures that might be applied in the industry. 'Wcftey Publishing Co Ini'. Arbor 4B101 (Dr. Dmman). In addition, it was planned that a small, Arch Environ ffcalth-Vot 22, Jun 1071 rrr tt AP00042563 62 OCCUPATIONAL ACnOOSTZOLYSIS-MNMAN KT At HAMS Soc. See. -No. (B-137 RACE W K Other (14) " AGE______ SEX M F (16^I5T (17) DEPT. NO. aa-nr COMPANY SERVICE DATE Month Year- (20-21) (22-23) ARE YOU (RIGHT) (LEFT) HANDEDt (24) Do Net Write in This Box Corp. (132) Pint. 13=47 TO ANSWER THE FOLLOWING QUESTIONS, PUT A CIRCLE AROUND YOUR ANSWER. FOR EXAMPLE: MONDAY IS THE DAY AFTER - SUNDAY (YES) (NO) Have you noticed SUDDEN vhiteness, blanching, or paleness of the fingers of your RIGHT HAND LEFT HAND (YES) (YES) (NO) 29 (NO) Have you not iced a sudden redness or blueness of the fingers of your right hand LEFT HAND (YES) (YES) (NO) (NO) IF YOU HAVE NOTICED ANY OF THE ABOVE, are these changes brought on by cold (YES) (NO) (DON'T KNOW) 27 HAVE YOUR HANDS OR FINGERS BEEN BOTHERED WITH ANY OF THE FOLLOWING: Tingling or pins-and-needles RIGHT HAND feeling LEFT HAND * Warn feeling in hands or fingers RIGHT HAND LEFT HAND (YES) (YES) (YES) (YES) (NO) (NO) 23 (NO) (NO) 29 Cold feeling in'hands or fingers RIGHT HAND LEFT HAND (YES) (YES) (NO) (NO) 30 Numbness, fingers fall'asleep RIGHT HAND (YES) LEFT HAND (YES) (NO) (NO) 31 Stiffness, fullness, ortlghtness RIGHT HAND of fingers LEFT HAND Frequent tenderness,soreness, or RIGHT HAND pain at fingertips . LEFT HAND (YES) (YES) (YES) (YES) (NO) 32 (NO) (NO) (NO) 33 OC( Have you not Four hands, Thickenin Kliita, rai Whitish pi Shiny ski.-. Small, rai less than! (NOT inelu Have you beer. * Pits or sea Ridges or c Have you used at vork in the (DAILY)'( Have you ever crushed a fir. If yes, was Which fine* Arch Environ Health--Vot 22, Jun 1971 AP00042564 AU ;# in This Box TT^l -(3-4)- UND YOUR 3S) (0) S$) :S) (NO) (0) 25 fl (NO) 26 (HO) N'T KNOW) 27 3S) IS) (NO) 28 (NO) IS) IS) (NO) 28 (NO) ES) (NO) ES) (NO) ES) (NO) ES) (NO) ES) (NO) *rn ES) (NO) ES) ES) (NO) 33 (NO) OCCUPATIONAL ACltOOSTEOLYSIS--DINMAN ET AL C3 Have you noticed any of the following- changes of the skin of your hands* wrists, or arms; Thiokening of the skin (YES) (HO) 34 If yes, is it on (HANDS) (WRISTS) (ARMS) White, raised patches of skin ' (YES) (HO) 35 If yes, is it on (HANDS) (WRISTS) (ARMS) Whitish pintles (YES) (HO) 36 If yes, is it on (HANDS) (WRISTS) (ARMS) Shiny skin patches , (YES) (HO) 37 If yes, is it on (HANDS) (WRISTS) (ARMS) Snail, raised areas, or lumps less than 1/2 inch around (YES) (HO) (NOT including warts) If yes, is it on (HANDS) (WRISTS) (ARMS) 38 Have you been bothered by those fingernail troubles; a Pits or sears of the fingernails (YES) (NO) Ridges or cracking of the fingernails (YES) (NO) 39 40 Have you used hand-held power tools or air-driven tools at work in the past six years : (DAILY) (ONCE A WEEK) (LESS THAN ONCE A WEEK) (NEVER) 41 Have you ever broken, fractured, or crushed a finger? (YES) (NO) If yes, was It the (RIGHT) 42 or (LEFT) hand? Which finger vas injured (Thumb) (Index) (Kiddle) (Ring) (Little;1 (Thumb) (Index) (Kiddle) (Ring) (Little) 43 Arch Entnron //fali/i--Vol 2:', Jon 1071 AP00042565 C4 OCCUPATIOSAL ACHOOSTEOLYSIS--DINMAN ET AL selected sample of workers effected with AOL be studied in the clinical research unit of tho University of Michigan Medical Center.3 Previously, Rourch nnd co-workers' performed an extensive clinical evaluation of a group of such workers. Subsequent ex aminations here were designed to determine whether any new clinical features had de veloped since those prior studios. concerning film type, exposure factors, tech nique. nndj identification wore sent to each plant. The x-my film*, when forwarded to the iiMtitulc, ware coded and transmitted without fefonllfimtion to two radiologists for Indepen dent interpretation. The findings wars recorded on n specifically designed checklist which wiu then returned for statlxtical collation. Hand x-ray films that served as controls were drawn from 2.407 men over age 13; this represented Polyvinyl Chloride Manufacturing: A Brief Review the entire male pojwlntion of the town of Teeumseh. Mich. Work history questionnaires wore completed A more definitive description of the proc ess whereby PVC la synthesized, finished, and compounded is reported elsewhere in ' this issuo.1 A brief review of the operation is appropriate to the premises underlying the by each Individual employee or by th*`pt&6n- nel department at each plant or both. These forms recorded work assignments between ilea 1, 1961. through Doe SI, I960; each worker noted the first and last month of assignment for each specific assignment during that period. At epidemiological considerations. each plant, a team of investigator* converted Vinyl chloride (VC), together with water, local Job designations to standard job titles. peroxide catalysts, and other additives, are These arc lifted In the paper on the Industrial placed in a reactor where polymerization is hygiono aspects.* completed after ten to 16 hours. Unreocted VC is exhausted from the reaction vessel PJlotRun and the suspension or emulsion of the plas In order to determine tho reliability of tic transferred to equipment for dewatering survey techniques and recording methodo and drying. Following ventilation of the re- logical patterns, a pilot run was carried out . actor, one or two workers enter the vessel to at one large plant. Following this, minor remosc tho residua from its surfaces, using modification of procedures and forms was putty knives or chisel*. accomplished. Sixteen plants, In addition to synthesiz Epidemiological Design.--Acroosteolysis ing, also compound PVC while fivo plants- appeared to consist of characteristic x-ray are engaged only In compounding the resin. film abnormalities and Raynaud's phenome Methods non. Since the latter would be. expected to occur only infrequently in a population not Surrey Technique*--Nineteen corporations known to be engaged in the polymerizutioh of 1 VC wore uictiod. Tho workers who served as the study populations were employed in 32 plants In the United States and Canaria. All employees who worked at the time of the survey, or in the past. In any rapacity In ptents manufacturing VC, PVC, or in ccxniwunding 'such resin were survryod. In multiple-product plants, all workers having any possible expo* sure to tho PVC process were studied. This at risk of developing AOL, it could be used as a prime indicator of tho existence of AOL. Thus, wo hoped to establish an Initial distinction between two populations, ie, one having AOL and the other not having it Comparison of prevalence of defects with the Teeumseh control population of 2,407 men suggested that all defects occurred in the PVC population with a greater frequeney than in the control population (Table 1). population underwent medical survey, work However, the significance of this finding was history questionnaires, and hand x*ray filming. The self-completion medical questionnaire was designed to probe for signs of Raynaud's phenomenon or symptoms associated with pe ripheral vascular insufficiency. In addition, question* were potrd to disclose skin or tlorm.il appendage abnormalities, use of power tools, and hand-injury history. X-ray films of both hands ware requested clouded by an unavoidable bias which minimizfrd the value of the Teoumseh population as a control group, ie, identification marks which could not bo readily obliterated were present on these control films. Furthermore, as is apparent from previous discussions of the x-ray film abnormalities, linear radioluccnt defects could bo confused from tho cooperating plants: specific directions with old trauma, the absence of a tuft might j j j i ] j { 1 j i j | j Arch Environ Health--Vot 35. Jan 1971 OCCi follow nmiHilalion, ( wed plmlnugm tv consistent with a cck defect. Defects such msis of the shaft*, v, nf (lxs ttifls, nmi s> clubbing were each jbio to subjective ' error. Furthermore, theso defects coui from otlter bony di injury. Even mukip involvement could sistcnl with these <ri possibilities. Iiociu. problems did exist, leant divergencies film Interpretation found (Table 2). Because of the/e < poses of first appro the phalangeal tuft sidored as indteati roentgenologists im' to the presence of existence of niargii fragment (i) (cUfec (defect 3), transfer mentation (defect 4 distal portion of p considered as pot. bony defect of AO ,, radiologist and if -i defects could not b,* with any of these : lowed up subseque: there was a history involved finger cr j: x-ray film lesions tv .traumB, these indi from suspicion. Other x-ray film specific nature are with the later stage themselves considc ray film findings 1 phalanges (defect * (defect 8) or of tt soft-tissue clubbfhg looked with suspicir involving mulliplr whether they were . 2 to 5). In addition to 1 AP00042566 wure factor*, tcch- were sent to !n fnfwtwlcd to Ihatransmitted without' Inp-t* for Indcjren* "era recorded rhivktUt which wns raj collation. Hand rontroli were drown 1$; tli reprentoc! >n f tha town of ire* were completed e or by the person* kint or both. Thesa intents between J*n 1000; each worker ith of assiffnment for irlng that period. At Mtigators converted standard job titles. kt on the Industrial | j 1 , 7 i j ] in ! tho reliability of cconiine method0un was carried out lowing this, minor cr and forms was * jroosteolysis diaraclerlstic x-ray aynoud's phenomeuld bo expected to n a population not I* it could be used c existence of AOL. >lish an initial dis sipations, ie, one r not having it. nee of defects with opulntion of 2,407 defects occurred in i a greater frequenpulation (Table 1). i of this finding was to bins which minicumseh population Joutificalion marks ly obliternteil were IJms. arent from previous Him nbnormalitietf, i could be confused 'itcc of a tuft might . OCCUPATIONAL ACUOOSTEOLYS/S--tilNMAN AT AL 5 follow amputation, or short ened phalanges could be Table 1.--Prevalence of X-Ray FUm Daldctt h Control and PVC Populitions consistent with a congenital defect Defects such ns de Control. PVC Population, N m 2,407 N m 9,011 nari* of the shafts, widening of tlw tufts, nnd soft-tissuo Marginal doleet clulihlng were each suscepti . Detect No. Na. % No. % 1 44 149 321 6,41 ble to subjective reader error. Furthermore, each of these defects could arise from otlwr Ixmy discaso or injury. Even multiple finger Involvement could be con sistent with Utcse etiological possibilities. Because -these proldcms did exist, signif icant divergencies in x-ray film interpretations were fragment Trenaverae defect Trenaverae defect, with dlttif fragmentation Tout raaorpben t HiiUI puritan pbaJeni Sclereeia. with recaicificetloA Shortening WMtfHHf of tuft Widening al theft Seft-Oaiu* dubbin* taui 3 * 021 35 0.70 3 6 0.26 40 0.80 40 21 0.4* 6 3 0.08 0.18 i 1 T 0.004 IS 030 7 11 0.46 63 1.26 t 4 0.17 43 OJt a . 1 0.004 7 0.14 10 3 0.08 40 0.60 M 74 S.16 M4 11.67 found (Table 2). Because of these complexities, for the pur reported to occur in conjunction with AOL. poses of first appraisal, marginal defects of those x-ray film abnormalities unrelated to tho phalangeal tuft (delect 1) wero not con AOL were grouped as defect XI. sidered as Indicative of AOL unless both Combining the x-ray film findings and roentgenologists Independently concurred as Raynaud's, several diagnostic criteria were to the presence of this abnormality. The set up (Table 3). The diagnostic criteria for existence of marginal defects with residual category 0 consisted of essentially normal fragments) (defect 2), transverse defects workers while category 1 Included individu (defect 3), transverse defect with distal frag als having x-ray film abnormalities which by mentation (defect 4). and total resorption of history or radiographic evaluation or both distaV portion of pluilanx (defect 5) were were found to be consistent with old trauma, considered as possibly diagnostic of the disease other than AOL, congenital or famil bony defect of AOL If found by only one ial defects, etc. Tho history of persons in radiologist nnd if other causes for these diagnostic category 3 disclosed cold-induced defects could not be eliminated. Every man finger blanching unassociated with x-ray with any of these five abberntion* was fol film abnormalities, dearly meeting our crite lowed up subsequent to the field survey. If ria for AOL. Category 4 consisted of persons there was a history of trauma involving the without Raynaud's phenomenon and sugges involved finger or if the appearance of these tive, though not diagnostic, x-ray films for x-ray film lesions was dearly consistent with AOL. Category 5 Included those with classi trauma, these individuals were eliminated cal AOL x-ray film defects (2 to 5 and 1, 6, from suspicion. and 7 without and with concurrence, respec Other x-ray film defects of an even less tively) and Raynaud's phenomenon. Cate specific nature are known to be associated gory G had typical AOL bone abnormalities with the later stages of AOL but are not in (as diagnosed in category 5) but without themselves considered diagnostic. These x- Raynaud-positive replies to the medical ray film findings included sclerosis of the questionnaire. phalanges (defect 7), widening of the tuft (defect B> or of tho shaft (defect 9>, and soft-tissue dubbing (defect 10). Finally, we looked with suspicion upon any bony defects involving multiple fingers regardless of Computational and Statistical Analysis. --Medical and work questionnaires and xray film reports were checked for complete ness. They were then coded, verified, punched, and stored in an electronic com whether they wero AOL-spcctfic (is, defects puter. Quality control checking of the punch 2 to 5). cards, using a 25% sample, revealed an er In addition to those defects previously ror of 0.1% among these cards. Arch Environ Health--Vo! 22. Jan 1071 t j AP00<