Document jNNzw9rwqOdjbzBxm1dryjgk

R&S 106066 *.vTl--7W*- ' BIO-MEDICAL RESEARCH DOCUMENT DESCRIPTION FORM 63 Duplicate in all cards:--> 68 69 76 1 jOOQOtHq- year as-1961- File number [Right justify [Numeric only] 77 78 Sub-Index Code Author(s), as Last Name FS (No Punctuation) and coden for journal as JAMA preceeded by one blank space 1 20 21 , pa- /L M AM VILLA . A An a/a. /? A1 STL S#/. Al 40 41 60 61 62 AaAUC&R C- /H /MUAr/s/, _____________ Title of Report; end with space-hyphen-hyphen-space. Follow with Index Terms, separated from each other with comma-space. Avoid other punctuation; do not abbreviate. 61 62 21 11 23 24 Source (Journal, Vol., Number, Pages, Date) 12 AZ/AStryirg-r7r /A/rA. /Prr.^A //aJ7T _ Dv t/s// K. fc'Sr 61 62 31 32 Brief Summary 12 10 SUMMARY: 61 62 61 62 63 64 0000040 EPIDEMIOLOGICAL STUDY OF VINYL CHLORIDE EXPOSED WORKERS IN ITALY: I - METHODOLOGY P. A. BERTAZZI1, A. VILLA1, V. FOA\ B. SAIA2, L. FABBRI2, C. MAPP2, C. MARCER2, M.' MANNO1, M. MARCHI3, F. MARIANI3 and F. BOTTASSO1 Institute of Occupational Health, University of Milan, Milan, Italy1, Institute of Occupational Health, University of Padua, Padua, Italy1, Department of Statistics, Laboratory of Clinical Physiology, C.N.R., Pisa, Italy* and Institutefor Social Stcurity B. Rama%yini, Bologna, Italy* During the period 1975-1977 an investigation was made in Italy with the aim of identifying and controlling the effects of vinyl chloride monomer (VCM) in workers exposed to this compound in the production of VCM and PVC (polyvinyl chloride). The survey covered workers in 9 production plants in various places in Italy. Of the 5441 people for whom the exposure was confirmed, 4713 were examined and 64 had died, giving a total number traced of 4777, i.e., 86.2% of the total. The population examined included the workers who were exposed at the rime of the investigation, the workers exposed in the past who had been transferred to other departments, the workers exposed in the past and now retired. The investigation was organized jointly by the Chemical Workers Union, three University Institutes, and the Regional Health Services with the cooperation of hospitals and factory medical services. The same type of form for data collection was used in all the plants involved and the methods of performing various tests were standardized. The studies carried out included: a complete medical examination; recording of physiological, pathological and working anamnesis; chest X-ray and sputum cytology; X-ray of the hands; finger plethysmography - basic and after cold test; examination of the fundus oculi; complete blood counts and platelets; complete urine analysis with cytology in the case of microhaematuria; SGOT, SGPT, gamma GT, total bilirubin, alkaline phosphatase. For evaluation of VCM exposure, an individual index was constructed considering: homogeneous exposure group (ordinal scale), the dates of the exposure period, the length of exposure. On the basis of the values obtained, the population was divided into three categories of exposure (low, medium, high). On the basis of this investigation, a systematic prospective study of the exposed workers will be undertaken. /S2 f*. f M?r 1 497 Appendix 3 to the file : 4.4.1./78.1214. V* \ i n] :` lr' `S - ,CAi STITT 07 Y~~r. c~ ` " * -- r iC?ZZ23 U: TTJJLY t -1 * > ^"7 , 1 * - - J15.. ; Mc -*`C V. * :::r- 1*, -'-ip? c . , *^ p ' * ^-- vC. " * 1# v#-^ s. * t-- T--" -* ^oit.Z30 ?, of 0cc-jpi;i:r.3l -- -v * -" t TC'P' 1 -- c ^ v.* -~* qi j ^ ^ q^-*^ * ^ * <1^ _ ^ p * -: om.c^-SlXv O I* ^ CU-L 909Qi 37 # CO ^ StEtistios, 1; -c - .' C f C j ; r i c- ?is=. r~f,T : ? r ^ ' f ff Sccia2 Securitv, T* R&S 106069 Italy do cr.e cf the larpes".. producers of vCF and FT: me ir. lc~l vsr / >urhh place truer the Japar. eri the Federal ue~3r. o.c ss:.:;, m. - -ce are 7 T3'..; trccuc::::. prar.hs ar.d E pcl;-r erirat icr. rlnntr m.i "there cere ditior/3 -- -* W r^cT.tE (^ir. l): the- first pi =rt started operation:; ir. c,, *r- * -v***'- "*--<, 5,00C people have beer. employed ir. the various pi mis sir.ee the herhr_r.ir.-r c f product lor up to 1?75- ,, <I I t/ *1-1f * -- - -^ -*--v**~*,~ J-i -4-*^"--4 --**V* ( 2, 14, 19, 23, 25 ) rer.eved kXer.tior. vas Q-irecue: i:e cr_E.s: f^ ^ -, 4, 5, b 7,^9, 10, 17, 22, 2d, ), itbee .'eceriTi: -X _^ ^ >*.'. ^ i y ^ r- r ^ t- ^^ . tl w . <- ,5 --^ 'w- * -- * J mt ion vide r. >se . _ c.. .--. _ ,,s_lp. cor h c --s prrp_se. a. "ore cepsm_r, r ef sp T i * so ",.s_'soiscr amours T-re set up by the F.U.I.C.: ore epideriolorical or. health ccrditicr.: ar.d cruses of death, and the other or plant tachr.ol ory and safety. uvc vcr.-urr fzroups cczprrsec pzyeiczsrc, sua.zsticiars, crezhsts, er_-- r. o e r o ar.d also technicians =rd verbena frep the plants, irvo-lved, The air cf the s'err;- vrs r.ct to zrcducc cor.firr.atior of an already rrever. oathol c.~~ cut * * - >4_> * tc surrest neasures ievards ar. effective prevention ar.d surveillance or. the basis appraisal of the presort conditions both of the vorhers* hea ar.c or tee esar. ts. Eealth res surer alone in fact c rce c r _.se naa.lt a c; sse ve r.-'.ers unless t cep are csc?e:;-` s srr.ee he tearrres fccz-ed cr the source cf rial:, than is, st the plants. f. " w-.'iiiiCs I>urin die period lSly---911 en inTerdiradion van carried ord in I-trip vi.il tie ii cf icerdiil'ir.^ and cordrcllinr 'tie effects of vinyl cilcri.de romrer (9Clt) in orri era enrobed do ilia compound in die prodrcdior cf 7CP end F71 (polyvinyl chloride). Of die 5141 people for vim erpomre vm ccrdimed, 4713 vem ermired and 64 lad die-d, rivir_r a dotal ember -triced cf 1777, i.e., d,lv of die dedal. 'Tic- pepnlsdior enmined included vrriiers past vtrlad been Transferred dc odder depardrants,vcriiers erpmed in die ~ C * *, ~ ** *, t- #<-*o _^ ^ -1 <- - --J j ^ 4 4 fT*'*, > ^ 14- -4 *--t. ~ 'N ~1 -r--; r nd ^ a _ v *- /**** --4.^^ V w _ * - - _ - ^^ ~ 4 ^ ^ T /. -? ;l -- ^ -- _l w m_ *~-- * -- -- _ * *. *- ~ **d-- -- --r. % .. j: * 7i - Cz-Z j >p w5* * C--. 9 tP--* -- - id* * n. "'------. -r - - i ^ C _ * e e carried ord a co '-* ) cats ( and Dprdm cydolcry; 1-r *.* -- diu tends; O, >- fc cold desd); cc- ede blood co A d rladeled >. -<" ^--*= 9 j -L ~- -L+ pic S' .C e c IT 9 cor tree vara: as occli, c :, 1--1 function cT cc of V ei?o? t / ni<r z tx7-c a j* VI C- is J c--* * *- o v C-- i 0 ri cor R&S 106070 .i S'* 0 02tol,T3is Tar* otccr-red: a eicnificard E-ssociadicn bedveea idroxruency cd no d e mo ions fixpornra vs-3 oosirrz: da *n dodal pcp-oledicn Emd la the <?: ever 4>-ve=r3 aga gnom. */ 'bngcr pbcdopledbyEacm-aphy aidsr cold dtsd re.s tildarcd in 74? vromcm (17. ); die imm moles cf die aideradicn increase vidi enpesorre in all 3 and am nod nignificandly as sociaded vidb so oiling bedrid s. * ** _ ** o >4 v w ) w f a :b;scds (7 5>) vidb wonder 15- OCC pled sleds; dbs idraryj-enry r^ . --> * w t* * d " ^ "a 5 f"". * *2 ' 'I * *** A # W . . o _ -- C* ^ ^ w ^ w *. v J C. -T' - ,--* A ^ `i V M * -, C4. . w _- __ 3 jr . TMt is tel:*:: cf end sicchc! ccnsu-ptior.. r, ' A coriality study cf the exposed subjects started fi-or the conn one er.er.t of production in Italy. Hovever, due to the 1 sen of adequate records, only indicative data can he fumishod. As-orr the erpcGod "juidiors traced uuo had died a hirh perceutare cf tumours as cause of death vaa observed (iS.4:- of the total); of these tunour3, 3Cp vs re of the liver ana biliary 3ysts3j 3 of viich -aero auric sarcouaa cf the liver: ? vert diaaic = ad before and 2 -durinr the invert!ration. la thcas plants vhere the deceased subjects vers traced acre accurstelv an erceas of tunouru as cause of deatn eras ocservcc. 37 CO 14.0901. *; ,-ar 3#SJ f Yif ~~9 ? ifffr. ( ( R&S 106073 R&S 106075 c:.:.r="triced bp a value of this drier. Tic rtr.pe cf tie valuer oztE.ir.ed divided into three categories of ircreasinr: sere rid." viici, for the ea!:e of briefness, vill be defined S "iov", ni;ediur", end ^hiri". -exposure uss else classified usin/j onlp the duration calculated as the sun of the different periods of exposure. Also ir. this case the uorhers vere divided into three groups: "<^5 fears, 6-15 fears, >15 rears. Ir. 'Table 3 the *.Ttrn=r are distributed acccrdinr to tie caters--- and duration cf The cress--sectional rorbidit" investigation vae cased or. a series of CJ ioal, ir.st--urer.tal and laboratory tests invclvir-r the turret orrar.s ar.d systtrs affected bp the tonic action cf Tirfi chloride. ";r the lur_r; stu-tur c;r,olc -- and chest a-rap vere performed. For the hands: f.-rap cf both hards, pi c t c p I e i hy sz orrspry at rest ard before veri vita basic tracir.p fc a further traciru: after loved by/the "cold test" (irrersior. cf the hands ir running vater at 13-15" t for 1C nir.L-tes), Conplote urine and seditent analysis plus c.'^oloyical enanirstier ir. the case cf henaturie. Cc-plete blood and platelets cent. lap/ river: alhalir.e phospbatase^balirubir.ania, ram a Of, SOOT, SOFT; conplete aedical earn drat ion. About thirtp radical 'services, including hospitals, ur.iversitr institutes? local health services, plant z e die si services, par ti crated ir. car--~ir_g out these tests ar.i enaninaticr-s. `This rosed serious pro biers cf st=--iariicaticr. cf nechoes: each centre va: provided vith standard instructions for the or : i cl c picul en=r fust ior.s mi a double'r eadir.-p -..r$ cere; the riot; piechysroympt:.c tracing vas a 1 vas race up tne snrj R&S 106076  t.i.- cc-.-ccrrfrcrr i~c -.ravelled tr the ^~:cu: cer.rres vita their L .'.r-tr-rr.er.t: ~-c sane rethods -rere ac vised her the henatochezic: and aahem dory :ecnr.;c;"""" froz the Clir.icn del Lsvcro ir. V.i 1 an vent t: E:ze centres to train rhe staff of -he various laboratories sc as to c tain unifem. perforznr.ee: the ontological emir.zticr.s irere rear at the local hospitals and a checl; reading vas done at the Institute of Cr.colo.g ir. 1dorrs. Ir spite of these general instructions, for various ' In O C C :t T'-'T- :d_zOvj: no 1: -r - cer.rres; r spar; >.-as established only cr. the basis of an accurate redicsl ecarination. Ill the resrlte of the emanations perfened vers recorded cr. an ad hoc f:rr, punched and stored cr. napnetic tape. Pet all the vorherz included in the inveirVimticn ur.d;r~.*ent scheduled tests, one cf the rearers for viich vns that not all the ran err-; the part reported for examination. The variables c-n vhich in- forra.ion vas collected (are, snohirry^drirhirr habits, are vious illncc^sc, , vere controlled by stratification analysis. R&S 106077 JC' ccr.si ec e r.eraoc o; e. s oner. c eac: U` vi lecezber 1915 `ire :oiio>nra car a col:earec for eac vo e e cf e C5--- erpos' e S rg O r ; e ~ ts t. "ct C_ --^ <n ce e es so: fro: records, cue tc the h neve: e r itj. VvUuSs irpossible to urace all the subjects end obtain the exact nur.ber of deceased persons. A further inpadinent to cor.pl eu e end accurate analysis vas the lach of death rater specific for cause fund sen on a reyiorul "basis. The of-- K ficial data u=ec are these on death rates accord!nr sen and broad are fnoups and cateycries of causes on a nation-vide basis relative to the 73 (/> .periods lf0-c" and iv;-7C. The cate --ries of causes considered CT> O are "infectious and parasitic diseases" (l.C.T. codes C01-I31, Till 00 sion), "t'ncurr and 1 euhenias" (codes IdC-139)j "C.u.S. vascular lesicna and circulate"* diseases" (codes end "ether causes" (renaininy codes'- The are croups considered are Ip-1? ."ears, 5'--ch rears, op pears and over. To obtain the number cf corrected deaths for the caterories cf deaths, in the different ace groups in the various plants, the years or ris.: for each subject vers calculated considerdry: 1) the period of experience (for the years up to 1 -pr the mortality rates iron the l-pC-pl tables vers used, for the years up to 1?5 these cf the 1 JrT- 1 tables, and for the years up to 1975 those of the l?t-?r tables); c) the aye of the subject, i.e., the au^s croup into vhich fell a certain year at rib: experienced in a riven period. : c r those enh*'ecis include! in the investi-~aticn for v':;or. one or acre cf the above data vere not available, an artificial- value vas assiyned cn foe haeir cf the averaye value cf the come spend fair rroup. .. ,v r subjects exposed but ncf "traced, fenrs Ei rid: vere attributed - -T iV_e,,.*.- vere ell alive at the tire of the investigation This E-aari that the peer's at risb vere prcbabl" over--astiralec (arc cor.seruentlf also the "expected deaths") sir.ee it is verg lilcely that there v.eerre scz.e ceceasec subjects an err the minced. 1} 1 the data vere processed at the ho laboratory of Clinical rafale! leparizer.t cf B^cstatiat ics and Erl deride.--.'. Pisa. '-`he delloving are the rain results so far obtained R&S IO6O79 -- 9ra'bi~=74 gives the distribution of the cases of cdaacc or suspectad aero-- osteolysis cf at least one finger, according to age arc exposure category, j rar.d a-rap examination vas performed cm 43?9 venders. 11 together 27 cases .) cf c.-nfirv.ai acre--osteoivsis ar.d Id (3.3 ) suspected cases vara cbserved, "he frequency cf alterations increases rith statistical si end fi m ord `'vc duration-of -e-zoo sura-behave3 dr. id si : edig ` s i rr.i Heart in mp of -Lhe.-age strata.- >- V..J- -? photopl ethpsrcpra.hrc tracing vas done for 3d-7 wruerc: Ip" ^ ir.gs (3.9.-) vre abnormal: o'-7'7 c-c;ects had a tracing after cold test, to*note that -the trequnzcy of findinra other than *knorna2'1 are net associ ated vita act. E0 significant association vss observed bet veen frocuency of abnormal findings and snobinr bat its. l. -d - 4713 verb era unde event liver tests tut 114 ur.de event only scree of then. The follcvinc tmlyis rede is only to the 45?? irnb j e c 12 xbo under-cant at least rtuift 4 cf tbs scheduled tents, coverer, for each test the total is subject to variations. J- "illw ^ k 2 C --"'**''"*' -3 *2 ^ ^ " m- 2" 2 1 4 r"'"' O V3 C P "'"l 2."*"-- - " 4 n. _ (43.2?). 1110 (24.8;!) had one or tvo abnomal tests and S46 (l4t) bad \:W- ..- acre than tm abnormal tests ainuitareously, lbs frequency of subjects vith ./ v* ^213 2"22 j_ J.j.V'CIT ^ o ' 2_HC*f- S ^ 2 S HCCZ *2t~ * >" r* 3 f) tq --r *5; 3^3 C ^ C X--S2' v*1 * ^ R&S 106081 Vut "3.E3DclEticn-C'bserrec -vi*ih-ihs . -exposed. in^ rxv2 "za 2innr:*::on or .sacr a --cr\c: * -- >n> * accoroinr to deration of exposurd. The nost frequent alterations re re: hepstcreraly in 4^.2> of tbs subjects (un-2,2y--(potr^)--thn-lirer -uni aroc; err ^5_" yr enter than. 3 m) q el crated game GT (28.4`c); total bilirubin increased -- 13,3;:. Iransanirnssa vere derated a. CO ut 1C? of the subjects (SC-Cl u0.7y; 1C.3>); nlib t alterations //? P ) - T ' - a- Ili,ne poesuhstase vere 0: 1 served (7 . 6>). Trecuercy of hepator egnay, birr cans a GT? and 1J? increased si*7*.: ficantly in relation to duration of exposure:--enniusi:;-of-frequencies against -eeiegcri = 2 -of exposure revealed e greater prevalence of alterations :edim -and high categories* ouri vitbout-^statistical si;cnificar-ce. "* z c 1 1- 2:2*4 h * & si 4- -- ri iiC^. v -i -- -4 _i? . -** * ^ -- * %. _ S rests according to tie extent of t* ^ /C -4 4 /? of expotrure in each a stratus. There vac a positive tread ad.30 in the 3=-45 ard >45 are strataas veil as in tie total population. For the other liver tests no trend vas observed in relation to e roc euro in each 01 ore ?be influence of alcohol consumption on h epatou sraly pr ^ na GT (->;i-- ^ r . L -. * IM V ----'*----J *\ >) vu.3 Vcroo evaluated. Fj-on 'rsb-l-e--1-3- it can be seen that at the sans cermcticn of alcohol, hep aton eyaiy ir.creaaea vith duration cf exposure; the increase is particularly evident in the croup cf tea-- O't c.--^ SLTS^'S^'Q d-ZTLZl^ZOZTS a ~ "*b$ rgo w ^'--" ^.V = '--x cX^CfiUTC J2 d 3^.00 202- aeui to act aynercpcahly. Liver end nrrm end increases si1 sSw- ,J k> fc* fu.,1 -- u .- conauzpticn; hoverer, this vas not observed in the rroup of for -ore than 15 v^ars-'T! * r abncrunlitiea J'-u-a-blo-l-j) in fre-ruercy vith the increase in alcohol eomrraed. it the sane alcohol ccrauxuiicn, the frscuency of abncmalities increases "1th the rise in duration of exporare- in the heavy and avemye drinuers; this tre is ear nificant only in the heavy drirliers. t 7; The results of other expirations p erfera ec are not subject to co; uzent here. 7e vould only drsv attention to data already published relative to a plant under study. C-t of lp5 polyrerisaticn vorirers, 3C cases of r-ulroi fibrosis vere detected, (lo) t-'s R&S 106082 l 1-. c ZZ - w - Table 15 gives the resulte of the ncrtality stud" ir. the 6 plants vhere it could be perfoned. It can be observed that expected ncrtslity is, on * the vhole, definitely higher than observed mortality. This night be cue (as explained above); to; - an ever--estimation. of the expected values/ -- failure to sstabliah vh vers alive or dead; the ur.traced subjects/ -- the hreva "selection" effect vbereby voorx.-; ers en.ra.-red for emlcvrsnt a sign!iicar.tly different state of health vr a - fac-. = :t to the cere ml uorulaticr of the sane are and sex. vith a consequently lover mortality. M 3v exsririrr the data in the table it car. be observed that there is an excess of deaths due tc = tun cum and 1 eulieniss" art the plants in 3 r in din. It should be noted that the highest mortality both in the absolute and an ru.: :tier, to tumours vas observed at the Ferrara plant, vbich vas one of A- V - --X X* -- -L _ * -- c -*Sv S * 2-x. nearly production,and vh ere/al1 of the people vers slirht excess of heart and circulatory diseases as causes o x u.n! ii * -- x cL; also observed in the younger are groups at the Fg-rrsndina and .ltrr hX k S I - Table IS ccrrarsi the expected proportion against observed proportion of deaths fron tumours; the conparisor. has a United value but emus a'.tenti-" use c ifferent relative veirht of ncrtality, fron tumours, partly neut: izinm the effect of inadequate tracing of cases. -/bi R&S 106083 observed that, t'oours represent 4 .4!^ cf the causes arairst ar. erpectod cesr. proportion of 22.o. Of the 30 cases of tun ours, 7 (?3^) vere of the rospiratorp tract, 4 (135) of the G.I. tract, arc (2ox) cf the liver'and gall bladder. Of the 3 cases cf ar^iosarccns., 2 occurred in vorhers employed on polpr erica tier, ar.d 1 In a fabricator eagrrsd on ertr_sion operations (Ip ). Vascular lesions of the Cl'S ar.d circulatory diseases accounted for 3C.'r (2S.4 erpectc-d) of 3.-1 causes of death. Arc nr the renainirur causes cf death are to ha noted p cases o: "chronic liver disease1'' not better specified. Ar. arj sis in relation to erpesure (ca:' -pery ar.d/cr duration) vrs not possible sir.ee for r.arp deceased eubpeois erposrure data vere net available. R&S 106084 sggfeK# ms&si yJSCtTSSICK : : - - yy ; ' The `typo and frscuGncy of alterubious in VC5:/?7C production yorirers in Italy-are ainilar to those observed In studies carried out i so far in other countries. The frequency of oste-olytic al terstiors (0,6y) is r.idvay aeor.c the frequencies found in largo exposed populations, vhere 31 cases (l.C>) . .U ' vere obcervsd in 3,000 -raxdrsra . (?&) and ?p cases (0.4!*) -- 5011 exposed subjects exaxinsd (4); the frequency of suspected aero--osteolytic lesions vas higher: 3*3? nr-Banst the Ct3 p report ad i: (4). Lc gel ere den a-1 in a slrin lesions vers observed. R&S 106085 The peripheral circulation 3indies vith pbctopl eihysnogrEphy care alteration fpe-cuencies -chi ch it vao not possible to conpare vata a sue tael ,, *.c-^ i " -- -**-"^2 -**^ $* * csr'-5.ri ron oif ^r^crcc--ci 22 j ^ &r c<ii2 be rade vita the frequency cf Eayraud'a ayndrere found by Suciu (22) (cp- of 15 exposed subjects) and Lilia (12). In the latter study, Haynsud'a yr.drone van obgerrad in 5*6? of cases and abnormalities cf the Alien test in ?./;; the latter percent ays i3 slightly high tr than that observed in tbs tracinrz after "cold tost3, trhioh in our study vas 19?!* Th mbo cyiop ana a vas net seen vith the sane frequency as in ar.othc-r study cn a Ersller and sere selected group of people (l7, l), but it is uuch higne- than found by Lilia (l?). . An important fact is that the frequency of the three alterations (AOL, pari pa eml circul at icn, thronbocytcrania) vss found to be cl a arl v g i -- ificaril;delated to the exposure , except, in the ycur.ner aye groups for x\y-- T Co-- * <" thrc'xbccyioTeras, It she'd d be tome in nine that at the tine of the survey ( I?7=-7?) and that ^objects \rith potentially reversible alia rations nuch as those considered could have recovered in tbo neantire. The ireguency of ecological "abnormalities* of the uputun revoaled an association \"ith erp-osura in the total population and in ages >45* According to data obtained by haitonl ( p), the frornency of sgiauou* netaplnsy end typical adenonetcus hyparplasy (code 01) is similar in YCi'/PTC-erposcd vorhers and in other groupc of voricm in the plasties and pot re chemical industries, and is such higher than in the r etallurgical/erginesring in R&S 106086 dustries; the frc-guency of codes C4 to 0 alterations in TC1'./?7C--exposed subjects ms lever than that in ebreriur pigment 'nenktrs but higher than in other vorhera of the chemical and aet all urgical/cry!n5ering industries. Lastly, the iregesney of adenomatous hjperplasy (cede =,'}) am5 much higher ::Wr tear. v altcri found in a large group of archers. The fr&ruenoy of liver alterations observed is rather high? as has bean reported in previous c res sms soil oral studies on exposed populations (3, IS, 23, lc, 22); the frags ancy of alterations in ellial in s'phosphatase sras lever, hevever. The relationship betveen freousney of alterations and duration cf exposure is cults clear. Alcohol consumption, influences the results cut dce3 net explain the differences observed in grouca GT and hepatomegaly freg-encies. -he tve factory - alcohol and expo sure - appear to act synergic all 7., end particularly after rrclorged exposure a clear effect cue to exposure is a - * V-, * . ,;vTbe rojrtality ctudy, adaittadiy vith tho limitations already mentiorod, m reveals an exccs3 of tuaoura of every type as cause of death In the population under study precr 3el7 e~ those plants rare the deccaaed subjects could ba traced none accurately. Is a proportion, the number of tun ours ic clearly higher than expected (l?, 2l) end the sites cost fragrantly involved are the liver, lung and gastrointestinal tract, as as been found in ether studies (5, 19, ?0, 23). ;- R&S 106087 ^ T TT^ *'/*'?* J. V> . * ihe purvey is nos continuing in taro directions: ) Further search for deceased subjects in an stieupt to identify all o: i 1 ( p s <;j ry 5 F1 iat= brv t*--2 riulti-var4 *ts v^- _-vi-r^- " th" ~L' of discovering possible relationships not presently detectable, Nevertheless, the survey has already produced results as regards the situation in Italy by adequately dan castrating the present rish for people exposed to TCj'./'FVC in cur country and the fact that, although significant neasures to inprevs the environxental conditions in the plants have already -3 r- igitudinnl jnoniioring of the exposed vorhars must The results of this health survey and of the plant technology- and safety 'ey vnla re xare nv: an * re v.p-.trs concemao: -is vill be a further rusmntee that the serve" vill bring about further ir-- r cDSSaaX, J.':., rJZTZZ, C., IZPSYSZ, V.. J. * SSVXIX, , AcrooHieoly3e fit lesion: J5^ v * C---- ^ v O ^_30 :lrG5 ci: - n: cuvriers affectec au hetioyaaje d'autoclaves. CeA. >:#d. A (l5) 3-30 CSZZCH, J.L., JOHXSOir, K.IT. Annie sarcocE of live? in tbe carufaciurs cf pol; vinyl c'aloridc. J. Cccrap. V.ed., 26 (1974) 15c~251 -'v -- >- --j > * -V--!- --., -TJ. T iver dis6=.22 sscnr polyvinyl cnloride production vcrkers. Am. 5.T. Acad. Sol., ?d6 (1575) SS-94 s.sM ccca, p.a.. nxrrzHouss, tr.i:., yj-Girusoi*, e.j., iatczsc-i: j -71 < Cc cure i is real a cro oateclyai;;. 2. An epidoriel ordeal sr'-ucy. Area. sr.vi.ror, axm,, 7- 7- 6k'' a^ 7 --' )/ O; J * _ --- Iv^Af V * ^ * J Jlvj y L* 4 *J # - - 5--^ --*.; t: " --- - ------------ ^ -- ---- * -- ^ rroductid'. of polycalcrovinyl "ter and riararei of inprovexsrr, G15. i Sant., (2 957/ >H-d5 PCX, A.J., CCI1IZ2. ?.?. Pcrdaliiy experience of vorkerc erpc3 ed to vinyl fac rsnriacir.re of polyvinyl crl ori de in G^eat arid *. * b * Ind. 1'ed, V- (1577)1-10 --^ **-*Z*---T ~C J T^V * * y AXA-'.5, S.G.F. . A.cro--osteolysis occurring in a en erernyed : ! toVn. e pciyneriisticr of vinyl caloric:. Frit. ced. J., J3 (l?o7) 712-714 Hir3, c.v. Jr., ?A2Z, E,, C laSCI, J.L. Jr. Characteristics of cases of an sirccrs of ta: liver arenr vinyl caloric: vorkem. Ann. F.Y. Acad. Sci,, 7~ (2575) 931-25= R&S 106088 II ,1 - J ^ 1 ~ l-l---- aid acroosteolysis in voriers in the polyvinyl chloride producing Industry, 'Deut. y*d. cochschr., 07 (1972) 1922-1923 '.C. Zu, C.G., KOTCHLZS, J.Z. The correlation of clinical and eny1 rom en t al rezsurener.ts :'or voriiera orpo3d to vinyl chloride. Iner. industr. Eyg. Arc. J., il (1572) 19-30 11. LiDGZ, C,~Z., JTJZZ, S., STZIZ, G., VZDiiyJlT, G. Die ecc^nannte Yiuyl-chlorid- EmrLiait -- eine harufshecirrt e Systeuadd arose? Intern. Arch. irhsitnr ed,, so fV'-ST..Ti >/ -t-'.J o- - 12, LILTS, H. , AITjZZSOZ, 2., JTICECLSOK, 7.J., DIUV.,S., YISZZLJd, I.S., SELIEG7?, I,J . _ C^*ience o 1 cjLztz,sc acc vinyl chloride and polyvinyl chloride vorhers. Inn, Z.T. lead. Sci,, 2d (1975) 22-41 ~ 13. y_IE?:; L., CZZZCZ. J.L,, YZZUn, J.G., JOEL301, X.K. Liver dansre and anryir- aaroo-f= in vinyl chloride vorl.ccrs - a ay at an stic dstscticr. proyror. J. in, lied. Iss., 270.- (1974) 64--56 ` Id. SilTOM, C., 127242,"Z. C., cilice, P., CAnZZYil, D. Y.L;;I. chloride caroino- genesis: currant re rul 13 and perspectives. 1! e d. Lave no, o5_ (1974) 421-444 <"> Vt . Eli/TCEri, C. Liver anrlcssrcora in crarhers erpesed to vinyl chloride. Ked. La--ro, 3 (1574) 445-450 * V!~C ----------- > f* *5 Ei---LHI, I., 20SSI, I., 1'020, G., CZHYJ, G. Lung charges arcrx vinyl chloride and polyvinyl chloride verrerz. 1'ed. iavoro, 6_c (1978) 151-14 2 B 7. ZI25TIL1Z2, Z.J., LSXhiCTH, P.K., XULLZS, E.f JuEZ, S., LAJ7GZ, C.Z., ZOE377H, R&S 106089 E.G., YrLTyjj., G. Chrcnizch-tolieche Is hers chi den hei Irheitem en car r > o-- Preciicr. risen. red. Tschr., 5 (1973) 2311-2314 R&S 106090 f y liver mseaae &e evidenced by peri ton so a copy end padded liver biopsy cm o tin F i ; production vorrers. inn* IT.7. Acsd. Soi,, ?i< (1975) 95-134 i j !!? MCnSCP, H.H., rZTZ?*S, J.U., J0H5O7, M.P. Proportional mortality anor.r vinyl-chloride voters. Lancet, _ii (l974) 397-393 :?C. XlCHOLSC-n, J.7., PAXMOZL, .C., SH^bAl, H., S2LIT.CF?, I. J.' Mortality trpor arcs cf a cohort of vinyl chloride-polyvinyl chloride rorh ers. Ann. S.Y. le< c _ -- * ) e,--<r (1975) 225-730 Cd*, * C^ '-s*- y - A '- * j 1A5GITZZ, Z.Z., in drial enrircmsnt. A Arch. Znviron. Health, 0 22 * SUCj.o, 1., IZnJMiA, I., YALAe r ~ A T, 7. ntnde Ass nal -'.i i-s ones au chicmc c: vinyls. Mad. Lsvorc, S5 (1-7) 2=1-271 ;-; 23. YAeZdSHAs', I.E., GAP-td:, 7.E. Mortality 3tudy cf orur-Vv.- .1 in tha ranuiact^l cf vinyl chloride arid its polynera. J. Occur. Mod,, lo_ AI974) 50r~5l 24. 7X01A} ?.L. La nalattia da. clornro di virile. Med. Lavcro, 5 (1974) 1--99 2y. vrCLA, 1.1., HI GO1?? I, A., CAPUTO, A. Crcorrenic response of rat sLin, lunar and bones to vinyl eh!crude. Cancer Pes., (l97l) 513-527 TLL~--iV, G., LA~GZ, C.L., P032, S., S?2Ia, G., riCHXHE, D. Clinical cani- fesiatier and come of .vinyl chloride disease. Ann. A.7. Acad. Sci. , 2Lz (1975) 3-17 27. ViX^illvL, H.J., STHmAm., k\, VAOCPZH, J.F.., et al. Yeoplaetic rid anerr vnrhers srpcsec to vinyl chloride. Ann. K.7. AC2d. Sci., 21l_ (1976) 40-4-3 *- VILFOP, 3.H., MeCCHy.ICH, 7.E., 7ATUM, C.P., CPJ2CH, J'.L. CceupEtieml scr Osteolysis: report cf 31 cases. J. Acer. red. Ass., PCI (l?c7) 577--3331 m R&S 106091 ill ' -f LIS? OF ECJ-OGIilOUS GItO??S Monoc er prediction panel operator Konoctr operator Kononer atcrape and recovery operator Heactor operator and additive mate--up Bsactor clearer Folyn orient icr panel operator and assistant Seactor ciaebarre and ce vu e sirr operator Sryinr panel operator layer and ederating ocreen operator Lopping, shipping and varenouaa operator Security officer, ferszan, supervisor Conpoundinp operator Machine naintenmee FIectrical saintenance laboratory technician Si* R&S 106092 i ns nostribe of workers dlaminet EtPOSERE orac.corT'Inc. to exposure category ami deration - Exposure -at erory Duration cf Exposure (years) <5 6 - is >15 7) *. H0 1 i 1 i j^O * Mediur. Kith 4c-5 (2~.?7) (40.67) 1020 (52.37) (41.77) 467 f25-7) (2.07) 553 fOi.Ovl (51.1-7) 1170 (52.57) Scr\ 510 (22.57) (45.17) 69 (15.17) (6.37) 255 (4t.5'7) (10.57) 130 (25,27) (11.77) 1055 (23.47) 2445 (54.77) 1107 (25.97) TOTAL 1050 (42-C7) 2216 (45.27) 4 57 (9-Sa) 4643 (100-7) * Per 70 vorkers U713 - 4-43) irEorv.ition vas not sufficient to estimate tie eXTCSure R&S 106093 0? CZ27AIS OS SuSrSCTSI- ACL TO CATEGOHT, ET EACH R&S 106094 1^5 (Tzzt-s) j t \ j I </ 35 j |i 11 ! 36-15 EXpO Btr C at e 0 rJ L0V Eeditni Kish iJT. AOL s-osp. 71:* -** r------------ 1 (c.37 1 > V. 7 (2.27 316 1/^ 101 3-J-?. ^,. 2--'-.fid 2 (0,47 13 (3.c7 124 2 (0.27 14 (1.67 763 (i ? (c.?7 39 (3.?7 977 3 (0.97 4 (1.27 315 2 (0.4:7 18 (4.17 435 1 i^ 1 ; ">45 101 3=sp. : : ! ; ^ . 7-"i-fV)J-i 1 (C.'7 ' j 5 (2.0Jt) i 250 i 1 4 (0.47 iT, cS 11 101 s'-isp. So. Sr^ired 25 (2.57 090 4 (0.77 j 23 (4.17 550 13 (0.57 75 (3.37 2290 5 (1.57 17 (6.57 259 10 (i.c7 39 (3.67 1009 *0 fc 6 (0.41 25 (l.;t 1* IQ*/7 11 (c.=> 70 (3.37 1635 9 (c.E/; 45 (4.27 1059 27 ('-#' 140 (3.37 4289 (ice-7. 101 s^sp. >45: 7.; 6.5?. ?<0.C2 2 101 + 10L as?.'*>45: 7V#i 3 9.63,' P<0.01 101 * AOL fill Z Z Sx- ><7r4.?=, p<0.05 .'r^T-=c~ cz 5s--s^ectec 1C 1 incraijss pr~r .pressival" "slth -pe ("X. *1> n^4J ^;/ V. * For AC vorV.ers , 2 of vhon with A01 susp., exposure category vas nor cite~-.r.j astohmai ?hc: AGF S?HATu>: 2ets:-:cgea?eic teacutgs 2H2ETG TO EPCSU35 CAT3GOET, IK EACH r p 0 cj u r c Cat e g 0 r y (Tsars) j lo-r Medina High Total <*> 13.1* (35/267) 14.5* (90/620) 2?.Si! (68/2=8) 16.3* (193/1165) 3c - 45 j ! >^5 1 11 1 14.2* (55/333) 17. 9* (35/215) 15.5* (125/832) 25.9* ,(121/465) -22.7* (100/441) .32.5^ (90/277) 17.11* (?4/266l) j 23.0* (250/563) j All are 11 14.8(l2y/373) ______________ L 17.7* (340/1520) ?5.4* (?53/ici6) 19. i (727/5305) oc| i _ **> ao <35: 7, * " 10.25, p<0.01; 3^-45: 7 ` 3 H-Ol, ? <0.001; >45:7 , - 13.'; k2 " 1' ?<o.ooi. a:: 7 * - 35.5< ?<o.coi. 00 For 57 subjects ercposrre category no* detemir.se? (15 vith abnormal tracing). Fr^mercy of abnormal tracisprs Increases also 'jith. &-. B&S 106095 R&S 106096 JJISTilSSTKJK 0? TEPCXIOCTTOFZS'IA ACCOEDIEC TO EXPOSURE CAT200HT, H' jlAC srpirj): ! | | (Tears) i1 j < A? ii A ip o s" r c Cat ego r y Lo-/ y.odiv- aiga 3.S? (12/313) 5*7> (40/759) 6.3^ (20/318) Total 1 5*1? (72/1405) 35 - 45 | il >45 \ f*z (15/442) 3.c (22/?7o) 6.5* (5/95?) 12.2? (72/59?) 6.2? (37/452) 13.8^ (40/250) .2? (117/1652) 11.6? (134/1155) All ages 4.7? (49/103=) 7-5 ? {i77/i25c) 9.1* (97/10=9) 7.3?- (323/4455) 0 C <35: \c -- 2*07, ? a*s.} 25-45: . -v 2 A I " S.C3, ?<0,01; -745: A: - 4*52, ?<0.05;_ all ages:// ^ = 25*24, ?<0.001. ^ oo .3 subjects uc: included due to exporura . inform ation . (15 :''' throrio: Alieraiio:is are also associated uiti are. a .1 ;5dxA*... R&S 0CO 1 mi fa~ rz, * * V \>0 ?!>! l`K CTTOLOGT E2SHLTS CUSS dssceiptio:: FEEQUHNCT 01-02-03 04 05 05 07 09 10 TTorcBl" 1500 (58.7?o) Grads +4*+ scunrouE ret&plasia Typical adenomatous hyparplasia 764 (30.6) Initial dystyrisal acencrstoua hyperpl asis Initial acu^o'^s dysplasia . 212 ( 6.2*) As Op, ncrs represented 20 ( o.e*) Definite cystypical adenomatous hyperplasia Dei Laid e sr.r-nou; dy spl asia 35 ( 1.4*) Hyperplasia and 5crers dysplasia 7 ( 0.3?) Cells suspect of acerocarclmr a, epidemoid carcinoma, undifferentiated care in ora " *-- Cells indie at Its of epidemoid cancinora, adenocancirc-a, undifferentiated carcinora ?Q? T. 255S (ioo) a # (/} 0 0o> to IC\ V R&S 106098 nV' p:sr?T37?:oi; or asosu.l spotok cytoloct ktsttl-ts accokoikg to ex?osuk CATEGC2 IT me?. AGE Sr?_LTjT. Af* Cv.^-o : 1 3c - 45 ! ; >-= E i p o 0 '4 r e Cat e c r y Lev * 35-9/ (50/139; 1 | Eeiiuz: t 1 J 45.9/ (l47/3?0) Ei23 1 .5/ (79/185) 3o.5/ ! i (cO/ri?) i ! | 27.3/ i (30/110) 40-2/ f ' CO /,* op N 37.7/ (lOc/?62) 44. o> (121/275) 45.2< 0 (61/132) *_' _____ ! !j 34.1/ !l (1oC/4) 41.2^ (452/1097) 44.0* 00 (251/593) 7J = 9.13, ?< 0.01 a" 7\t * 1*02, ?< O.Of Toteta 42.7/ (276/545) / ^ > < (400/939) 37.5/ (197/524) 40,4/ (c>73/ 2155) + -e sultS does not increase vith ee, Vl 4- 400 nissir.r (cc--pa red to table 71 ere vor'-cers of Sardinian plants or vorV.er: or vhcnr e^nos-era data vrere not available. K ij r l K asnor^i. L 1 \ ^ 7 E S' L X X 'ORDIVC- *Ir V*> P'JR AT I ON xf-o DURATION OF EXPOSURE TEST 5 3 or 2 sbr.orr.i I 5 or >T.ort eboor/r.a i O~ 4/ "r- JA (4S 5/3966) 3 6. 07 (3 3 4/ 3 9o5) 6-15 15 24.5x (535/2355) 19.97 (435/2155) - 26.57 (l20/445) 21.69 -;(97/445) 1 0" c I ( 54 4 0.6;' 1ciw j (799/1966) c DfiOr .T. 11) 1 44.47 (970/2355) / C /.-/ >*:< (217/445) * 7Z = 13.49 P < 0.003 71 = n.50 P < 0.001 total 24.57 (3140/4595. 3 5.47 (46/4599) 4 3.27 (1956/4599) 30 fi8 C/J o 0o) (0 <0 i 'm- 00190/. S$y taii hr; 10 ]*iu:i}in-;Nt'v or aiinoiimai, i.ivkii tksts anii uvni miAiu.mwT aopoiuhng to mm/vnoN or Kxmsintr; hi vet* l',nl nrjtemenU Gamma GT Millrubin# . sgot sr.ivr ; ap llunit:ion of Kxpmntre <5 A 1.4% . (H06/1947) 6 - 15 48.2% (1048/216.9) 26.3% (512/1947) 28.6/ (620/2168) 12.7* (247/1945) 9-5% (182/1915) 9.8% (1R7/190R) 13.5% (29.1/2173) 12,?.?' (257/2100) 10,0?' (230.2110) 4.8/ (93/1944) 5.9% (128/2169) >15 .58.1/ (244/4 20) 37.1% wit (161/414) 14.7% (64/442) 8.2% (36/440) 9 3% ' (41/430) 7.8/ ,,!;" (34/435) Total. 46.2/ (2006/4 535) 28.4'/ (1203/4 540) 13.3/ (60 4/4 460) 10.7/ . (4 75/4454) 10..1/ (4 48/44 57) 5.6/ (2 55/4 548) ' Xl~ 44>H7> I^o.ooi I* , 'X l ~ 16.36, P<0.001 u "l! 7 ! =* 6.60, pc 0.02. L Subject: a ml fining from the total A 599 either did not have the Lc.'iL or the*Ir exposure woti not: determined i LIVER TEST RESULTS TEST K0RMA L E LEVATED T0 Gamma G ,T (unit U , 1 , / f ) 3262 71,6* (t 2S) 782 17.2* 331 7.3* ISO 3.9* 4555 (29-50) (51-100) (>100) B i I i rub i n (unit me/100 ml) SOOT ( U n i - l!. 1 . / 1 ) 3957 S6.75S (ti.O) 4005 89.3* (< 19) 523 11.5* . 84. l.S (1.1-1.5) (>1.5) 459 10.2^ 22 0.5% (20-50) (> 50) 4564 44S0 SGPT (unit U.1./I) 4026 89.7* (cl7) 42S 9.5* 34 0Xft (18--50) (>50) 44SS AP (unit L1. ! . / 1 ) 4315 94.4* (<4S) 1 239 5.2* 17 C.4% (49-SO) (>s o) 4571 Subjects missir,g from the tots I of 4599 <3 id not hav e the test. JJ 03 o> O R&S 106102 ^ ^4? k 1 1 X *Af 1. toV# * ur j_ii v k M>J* W w i*.-rr T * jLLvUFAJJ i.- 1 {y Stc-Ts ) D u r a i;ion 0 4 E x p 0 b n r e <5 6 - 15 >15 < 35 37-S5 (3SS/9SS) 39.0? (182/457) 66.7^(4/0 * Total i % 38.3>(557/1441) 35 - 45 42.7^ {269/630) 48.7? (545/1121) 48.0 (34/172) 4o.7?S (899/1923) >45 49.c (171/34? 54.8? (318/580) 64.5? 00 (156/247) 55.1'/ (645/1171) All Arcs 41.4? (605/1947) AS. 2? (1045/2165) 58.1^ 000 45,2? (2 44/4 20) (205-6/4535) 7/v Xto 'v 2 A ito 5X 4.?!, P <0.05 13.42, ? <0.001 = 16.35, . p <_0.0C1 e:.c;-' lr.cri=E2= significantly also -<ritA age. < DISTRIBUTION OF LIVER ENLARGEMENT ACCORDING TO DURATION Or EXPOSURE AND ALCOHOL CONSUMPTION - DURATION OF EXPOSURE ALCOHOL CONSUMPTION C5 Nor.-dr i nkers . 36.4% (36/9?) Aver6 c c dr inkers 40. (447/1116) Hard dr inkers 52.6-/ (282/536) 6-15 47. 5/ (55/115) .49.1% (041/1304) 55.7/ (322/575) >!5 TOT. 7S..6-/ ** '(22/28) 46.7?(113/242) 55.4/ (129/233) 45,9%(1217/2653) 63.6/ * . (89/140) 52.3-5 (693/1254) O *-x- = 13.85, p < 0.001 w v_v_ A- = 28.93/ p < 0.001 0 * y~ = 4.90/ p < 0,05 Subjects missing either did not declare alcohol consumption or did not have the test. f-' :; fc ; ' DISTRIBUTION or GAMMA gt elevated according to duration OF EXPOSURE AND ALCOHOL CONSUMPTION - ALCOHOL CONSUMPTION Non drinkers Averace dr inkers Hard drinkers DURATION OF EXPOSURE < 5 6-15 >15 S.2% CS/9S) 15.2/ (17/112) O---'-)` * *,-*r/r5 (25S/1149) 23.6/ (314/1331) 37 - S:^ (20S/550) 41.8/ (254/607) 12.9/ ` (4/31) . 27.1-/ (67/247 ) 57.8/ * (55/147) TOT. 12. C/ (29/241) 23.4/ (639/2727 41.9/ (547/1304' . Jc * -- *1 / < C.001 i'jcjecis .nissmg either did not dec 1 are cl coho I ccnsu,T.pL ion or did not heve the test, R&S 106104 v; TAI1LK NO. I 5 SOI-901- S*U OAu.sT.-srr.ou'H: mohtauty jn vom/fvc FxmsFii woukkhs in italy 1*1 ant P. Mnr^hern Hri ml vsi I'prnind ina Frrrnr.v Itnvc.iuia Itcvsi f*.no A/'a (yrs) < 50 50-6.S > 65 Tola L 5 50 50-6 5 > 65 Tola 1 ^ 50 50-65 > 65 To la l < 50 50-65 > 65 Total < 50 50-65 >65 To l a L 6 50 50-6.5 > 65 To tal Caun "s 0 il c 11 t h - Tumours Card i 0 vfi ruuil.ar d i soar.cn ON,8 vascular lesions 0 B SMH 0 V, .SMI l 6 2 - 8 4 - 4. 2 2 3 8 '1 12 2 - 2 - 1 1 0 Lm 7-4 3.5 0.4 11.3 ' 3.3 1.4 ~ .... 4-7 1.4 0.6 2.0 J.3 3.8 1.1 6.2 2.6 J.B 0,1 4.5 0.5 1.4 0.3 2.2 81.1 57.1 - 70.8 12] .2 - 85.1 142.9 100.0 230.h 210.5 90.0 193.5 76.9 - 44-4 - 71 .4 333-3 _ 90.9 3 a.o 37 - 5 3 4 .4 68.2 J 1.5 66.7 7 13 - 9 3.6 - 1.7 - 50.4 - - 5-3 - 2 1-5 133-3 - 0.8 - -- - *A1j 2.3 ' 8?.0 OL, 1 -4 M2.9 5 4.9 102.0 - 3-4 -- 7 9-7 72.2 1 2.8 35.7 2 2.3 87.0 -- 3 5*5- 54.5 - 0.5 - - 1.8 - - l .0 - - __3jl3_ __ - Ot her 0 F, SMU 1 2 - 3 5:i 5 2 2 2K - - 2 1" - - 1 - - - - 22.8 4.2 ' 0.8 27.8 10.1 1.7 - 11.8 4-3 0.8 -. 5-1 4.2 4.8 2.0 t 1 .0 7-9 2.2 0.2 10.3 1.7 1 -4 0.6 ... 3-7_.. 4 .4 47.6 10.8 49.5 42.4 250.0 - 39-2 47.6 - - 18.2 12.7 -- - 9.7 - - - , u -B ' All c.nusos 0 F, SMil 10 38.2 7 12 . 1 1 2.7 18 53.0 9 17.0 - 4-8 -- 9 21.8 4 7.2 2 2,2 261 571 37l 341 521 m 1 5r>| 90I - -. 6 .9,4 7 6.9 101 13 13-5 961 l 6.S-- 21 26.9 781 4 13-3 2 6.3 - 0.7 6- 2CI-3. - 2.7 1 4 .6 301 il 291 21 I 1 2 i-9 1 21] SL? TABLE So. lo TUMOURS AS PERCENTAGE OF ALL CAUSES OF DEATH R&S 106106 Plan- Location P. Marshera .Brindisi Ferrar.dar.a Ferrara Ravenna. R^si ^n Total T Expected 21.3 21.6 21.3 23.0 22.2 23-9 11.0 a Observed 44-4 44-4 33-3 57.1 J^ *j *o*' 100.0 . 4t * <T I j