Document k6JqRjXzVYJBDd94yYV5xdzwy

ei<4 <i aiv. WT mm E. I. ou Pont oe Nemours & Company W'umington. Delaware CMPUOYIC NCUATIONS DEPARTMENT cc: M.D. M. S. Riviello, M.D. Rr January 23, 1981 R. W. BAVRER V. R. SCHMALBACH A. B. PALMER REPAUNO REPAUNO WILMINGTON ASBESTOS RELATED GASTROINTESTINAL CANCER In a conversation with Paul Kotin, M.D., Medical Director of Johns-Manville on 1/21/81 about the relationship of gastric cancer and asbestos exposure, it is his opinion that certain quantitative chest findings must be present in order to make the identification. They are parenchymal disease (interstitial fibrosis) evident on the chest x-ray, and/or evidence of restrictive pulmonary pathology manifested by reduced forced vital capacity (FVC) in pulmonary function tests. When interstitial fibrosis and/or restrictive pulmonary pathology are present with or without pleural plaques or thickening, and when a positive history of asbestos exposure is obtained it is reasonable to assume that a gastrointestinal cancer could have the same cause. This is essentially a diagnosis of asbestosis. These criteria have been tested in litigation and compensation cases wLth denial of claims when chest x-ray findings are of lesser degrees or pulmonary function does not show a restrictive pattern. Pleural thickening or plaques without reduced FVC, or interstitial fibrosis would not be sufficient evidence to prove asbestos related gastrointestinal cancer. Marvin Kusehner, M.D., Dean of State University of New York at Stony Brook, New fork 11794 (Telephone (516) 444-2080), was recommended as an expert pathologist in asbestos related conditions in the North East United States. MEDICAL DIVISION DUP 0936375 JCB/kcb Asst. Medical Director TWSRS'S a WORkO OP TWINS W ARC COINS eOMSTMINO ABOUT DU 037554