Answer #1:

Polychlorinated biphenyls - PCB's (Look this up)

Answer #2:

Refractory in this context means refractory to heat. Refractory bricks are made of silica. Thus manufacturing such bricks, cutting them, or knocking them out during furnace repair all potentially carry the risk of silicosis. In this case, he reports that he cut the bricks under water. He was not involved in furnace repair.

Answer #3:

One possibility is lack of a proper inspiration in the second film. This should have been repeated asking for a better inspiration if possible. Alternatively the disease process has resulted in volume loss (restriction) in both lungs with an increase in interstitial lung markings due to fibrosis.

Answer #4:

Spirometry: In 1997 his volumes were borderline normal, perhaps slightly reduced, but his ratio remained normal at 81%. By April 2002 his volumes were normal.

Diffusion: In 1997 his diffusion capacity was severely reduced. This is in keeping with fibrosing alveolitis in which the gas exchange part of the lung is damaged. By April 2002 there was considerable improvement in his diffusion capacity but it remained impaired.

Answer #5:

1. Get more detail on his exposures. Do not rely only on his or the management’s verbal reports if possible. Try to get documentation, e.g. on types and volumes of materials smelted and occupational hygiene surveys on air concentrations.
>
2. Review the literature to determine which metals have been documented as causes of fibrosing alveolitis. (Note that "documented" does not mean "proven"). Also, check whether the specific type of histology (from his lung biopsy) is known or believed to have environmental causes.

Answer #6:

No. The only metal for which a specific type of fibrosing alveolitis is well established is hard metal, specifically cobalt. See the reading by Nemery.

Answer #7:

No. The x-ray of siderosis shows diffuse rounded nodules, not irregular basal opacities. Also, the patient is sick, whereas siderosis by itself causes no symptoms.

Answer #8:

In the absence of reference (background) levels, one has to make the assumption that very little metal would be found in normal lungs and that these levels are therefore elevated. This confirms exposure and retention in the lung. This adds circumstantial plausibility to a causal relationship but does not prove it.

Answer #9:

Against: None of the metals to which he is exposed is specifically know to cause fibrosing alveolitis. The mechanism of such an effect in his case is therefore unknown.

For: His disease started some years after commencing exposure. Lung retention of copper and zinc was confirmed. There is some epidemiologic evidence of a "class" effect of metals in causing fibrosing alveolitis.

Answer #10:

The reasons for the claim having been rejected are unknown, as the Commissioner gives no reasons. The first step is to confirm that the condition is covered by the wording of the Third Schedule under COIDA. If you believe that the cause is more likely than not occupational, you can inform the claimant of his right to object to a decision of the Commissioner under Section 91 of the Act.

Answer #1:

Old tuberculosis, cancer of the lung, silicosis with progressive massive fibrosis (PMF). In PMF the typical bilateral diffuse rounded nodulation of silicosis in the upper lobes may be absent. In this case, the sausage shaped mass is more suggestive of PMF while the accompanying loss of volume and linear opacities is suggestive of old healed tuberculosis. The two conditions may of course co-exist.

Answer #2:

This is a test of ventilation, i.e. the volume of air that the lungs move in and out. These results show airflow obstruction. The FEV₁ and FEV₁/FVC ratio are reduced, while the FVC remains within normal limits. There is some reversibility in FEV₁ post-bronchodilator but this is less than 12 percent and therefore not "significant")

Answer #3:

Exactly what he did. It transpires that he sand blasted signs, i.e. directed fine sand under high pressure at glass and metal through a template screen. This was done in a booth, using an air supplied hood and a "surgical mask" type respiratory. However, this was reportedly not totally effective in keeping him from inhaling dust. He did this job on and off for 40 years, on occasions 8 hours/day for a whole week depending on demand.

Answer #4:

Sandblasting is a very high risk occupation for silicosis, because the dust becomes very fine and is disseminated under pressure. The pathogenesis of PMF is unknown, but high exposure to silica from a young age is a risk factor.

Answer #5:

Try to find if there is a legal successor company - in this case there isn’t. Try to find someone who worked at the company who would vouch for his employment in an affidavit. There is in fact a manager who is prepared to write a letter to this effect.

Answer #6:

The milk is irrelevant. As the combination of exposure history and chest x-ray are so highly suggestive of silicosis, one can only conclude that the precautions were insufficient.

Answer #7:

His FEV₁ is 56 percent of predicted and he is highly symptomatic. If impairment is the basis of the disablement, then clearly 20 percent is inadequate. This is important, as disablement less than 30 percent entitles him only to a single lump sum payment and not a monthly pension.

Answer #8:

For the claimant to complete an Objection Against a Decision of The Commissioner form, in terms of section 91 of the Act. The medical practitioner will need to assist if the objection involves medical evidence.

Answer #1:

Tuberculosis and cancer are the most likely.

Answer #2:

This brings malignant mesothelioma into the picture. A benign asbestos related effusion is also a possibility.

Answer #3:

The problem is to distinguish mesothelioma from adenocarcinoma of the lung which has grown into the pleura. There are two basic histological types of mesothelioma: epithelial and sarcomatoid, with a mixed type beeing common. Histochemical staining techniques may be needed to assist with the diagnosis. A pathologist familiar with these techniques is needed. Pleural biopsy as opposed to open lung biopsy may not yield sufficient malignant tissue to make the diagnosis.

Answer #4:

The calcified pleural thickening is independent of the mesothelioma and confirms "pre-existing" asbestos related disease. This is sometimes important if there is doubt about the exposure.

Answer #5:

Asbestos insulation was used to lag (insulate) boilers on locomotives. Any installation, repair or replacement of the asbestos, or work on the boiler, would expose repairmen and co-workers to asbestos dust. Pre-made asbestos insulation was used in the form of sheets ("blankets") for boilers and pipes, and string or rope for winding around joints and threads. Raw asbestos fibre was sometimes made into a paste ("pulp") on site for direct application.

Asbestos in hessian bags was also transported on the railways from the mines to the factories and harbours, with frequent spillage.

Answer #6:

He is covered by COIDA. The employer in this case is the railways (Spoornet). They need a First Medical Report of an Occupational Disease so that they can submit an Employer’s Report to the Compensation Commissioner. Once a claim number if received by the employer, the medical practitioner must supply full medical reports, histological reports and chest x-ray to the Commissioner (directly with the claim number on all reports, or via the employer.

Answer #7:

He is likely to be assessed with 100 percent disablement. This means payment of a monthly pension equivalent to three quarters of his last wage. (As he last worked in 1982 the last wage may be adjusted upwards). In case of his death, his wife would receive 40 percent of his pension for life.