NYC-WTC_000195068

NYC 9/11 Public Portal Document

ASBESTOS MEDITEXT ® - Medical Management Page 4 of 4

a. HRCT detected pleural and/or pulmonary involvement in a group of 72 asbestos- exposed workers who did not have clear evidence of lung disease on chest radiographs (Falaschi et al, 1995). 11. Gallium scanning and/or bronchoalveolar lavage have been recommended as adjuncts for the detection of active (even subclinical) pulmonary inflammation in asbestos-exposed workers (Barbers & Abraham, 1989; Delclos et al, 1989; Hayes et al, 1989). 12. A prospective study of 3893 shipyard workers found no strong association between different exposure parameters (eg, chest radiographs, spirometry, and questions about smoking habits, asbestos exposure, and respiratory symptoms) and risk of mesothelioma. Traditional health monitoring parameters appear to be of little value in assessing persons with a high risk of mesothelioma following asbestos exposure (Sanden & Jaruholm, 1991). B. RADIOGRAPHIC-OTHER 1. Chest x-ray is useful, but the diagnosis is often difficult to make from x-rays taken early in the disease process, especially as there do not appear to be any pathognomonic radiographic findings in asbestosis (Gefter & Conant, 1988). 2. Oblique postero-anterior chest x-ray views are sometimes useful (Gefter & Conant, 1988; Newhouse, 1983). 3. Localized fibrous thickenings 3 to 5 mm in size in the parietal pleura are the most common asbestos-related changes on chest radiographs (Talcott & Antman, 1988). 4. Only minor pleural changes are seen 10 to 20 years after initial exposure; calcification is apparent on chest radiographs after 20 years (Talcott & Antman, 1988). 5. In early cases, blunting of the costophrenic zones may be seen (Gefter & Conant, 1988; Lilis et al, 1988). Diffuse pleural thickening with concomitant blunted costophrenic angle is also the most frequent residual radiological abnormality after benign pleural effusion (Lilis et al, 1988). 6. The "shaggy" cardiac border described in advanced asbestosis is an uncommon finding (Talcott & Antman, 1988). 7. Pleural effusion occurs in 3 to 5 percent of asbestos workers as early as 3 years after the first exposure. Rule out primary or secondary pleural malignancies and other entities such as tuberculosis. A unilateral pleural effusion more than 20 years after asbestos exposure suggests malignant mesothelioma (Talcott & Antman, 1988). 8. In a general health survey, men 30 to 59 years old had a 2.7 percent incidence of pleural effusions in non-asbestos exposed individuals and a 5.7 percent incidence in asbestos exposed individuals. The authors estimated that 10 percent or more of cases of pleurisy (with effusion) could be associated with asbestos exposure (Malberg & Hillerdal, 1990). 9. Thickened lobar fissures, especially with extensive pleural abnormalities, suggest mesothelioma (Talcott & Antman, 1988). 10. A positive gallium scan indicates lung inflammation and predicts a decline in FVC and the development of progressive radiographic abnormality (Harber & Smitherman, 1991).

4.3 METHODS

A. OTHER 1. OSHA REQUIRED AIR MONITORING - The OSHA Asbestos Standards specify required air monitoring in worksites with asbestos exposure. Refer to the Micromedex, Inc REGSLINK(R) Information System for more information.

http;//www.tomescps.conn/DATA7TM/TM356-4.htm 1/4/2002

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NYC-WTC_000195087